The Sleeping Watchman

Making hospital rounds late one night, I happened to find the night watchman lying on a bench, his eyes closed. My first impulse was to wake him up and fire him for sleeping on the job. I spoke with the night-duty nurse, asking how long he had been lying there. She said about an hour; he had complained of a stomach ache earlier, and she had given him some aspirin. We woke him up, I talked with him and checked his abdomen. Two hours later he was in a hospital bed minus his severely inflamed appendix. I was glad I had not given in to my first impulse. I was doubly glad, many years later after I had moved on to other work, to hear from a reliable source that he was now the pastor of the town's church and had increased its membership ten-fold to about one thousand.

I reflected on that incident last night (January 11, 2015) after watching TV's Sixty Minutes presentation about  the ongoing conundrum of how to fix the Affordable Care Act. One interviewee said the good news is that ten million more people now have medical insurance. The bad news is that there's no way to pay for the increasing cost of medicine. I thought at first that the man merely had a knee-jerk Tea Party reaction to increased taxes, but no.

But he went on to enumerate what both parties in Congress have failed to do in the past six (or more) years. No price controls on pharmaceuticals, in order to placate the pharmaceutical lobbyists. No ceiling on lawsuit punitive damages except in Texas and a couple other states, where it has worked very well to keep down cost of medical malpractice insurance. That was to please the lawyers. Hospital overcharges, usually summed up in a few lines on your bill. All three of my own daughters are RN's with executive hospital experience, and they give me long lists of ways to cut hospital charges, from the price of a single pain pill, to the cost of "spare no expense, doctor!" in prolonging the life of an obviously terminal patient in the critical care unit. Read your hospital bill, and ask for an itemization. Question the necessity of multiple tests.


Is there any logical reason why a medicine manufactured in USA should be twice as expensive as it is across  the border in Canada (or anywhere else)? Is there any reason why the VA or any other government agency should be forbidden from seeking mass discounts on purchases of drugs or medical equipment?

Americans do not have "the best medical care in the world." By and large it's good care, but not the best. Congress often behaves like I almost did with my "sleeping watchman." More often they act like sleeping watchmen themselves, be they Republican or Democrat .

These topics and others are expanded in my 2008 book Access to Medical Care, available on line and on Kindle.
Your comments are welcomed.  Keith Dahlberg MD