A Spark Plug A Day...
A letter in The WSJ lays out yet another big old fail behind Obamacare:
I took my Mercury to the Ford dealer and was charged $90 for a "mid-level diagnostic check," in which the mechanic plugs in a computer to get readings from the engine. I asked my office's billing supervisor, "What do we get for an EKG?," for this seems similar to what the car dealer did. In both cases, wires are hooked up to get diagnostic information through a machine that is interpreted by someone. In my case it is a patient, an EKG machine and I, the doctor, do the interpreting. I was told that Medicare "allows" $12.90 for an EKG.ObamaCare does not address any of this. Is it any wonder that medical students who have, on average, $150,000 in debt to repay (plus interest) are not going into primary care?
Mark H. Gregory, M.D.
I'm not going to make any larger points about healthcare pro or con, but our doctor friend could have taken his car to the Autozone / Checker / O'Reilly where they would have performed that $90 check for absolutely nothing, and given him the diagnostic codes they read out and what the manufacturer said to do about them. He could also have taken the codes they read out to him over to the Internet and found out what they meant there. And if he wanted to read the codes out himself, it's only a $30 device.
He paid $90 for what the free market provides for free. Maybe he is not the person to tell us about what an EKG should cost.
jerry at November 10, 2010 12:32 AM
What he said. We just replaced our alternator belt an hour ago using free videos on you tube. And we are going to have our alternator checked at auto zone and possibly have them charge the battery.
JosephineMO7 at November 10, 2010 7:11 AM
I don't see any bell ringers for Autozone. They are not a charity. They make up the value of the service in the price of the parts. Or they make it up in the price you pay them to do the work for you. Either way, it is being paid for.
Maybe you could buy an EKG machine and give the printout to people for $20. I'm sure someone in India could "read the codes" and tell you what's wrong for another $20. Maybe he even went to medical school, but how would you know?
Maybe we ought not compare apples and oranges.
When I was younger, and poorer, I was forced to replace a water pump on my car, because I didn't have the money to pay someone to do it. It only took me a day and a half in a freezing garage. I saved probably $300 and I hurt for a week from being bent over for hours. At some point, it is worth it to pay the professionals and spend your time doing what you do well.
MarkD at November 10, 2010 7:18 AM
What MarkD said.
Amy Alkon at November 10, 2010 7:51 AM
The other thing is, as our local car radio show guy is fond of preaching, the diagnostic codes one gets at the garage don't necessarily tell you what's wrong with your car. A code indicating a fouled sensor doesn't always mean you should replace the sensor; you might have to spend some time finding out why the sensor was fouled in the first place, and fixing that. Learning how to work with diagnostic results to make effective repairs requires training, brains, and experience.
Old RPM Daddy at November 10, 2010 8:59 AM
And in my experience, anyway, the dealership will happily blow off the diagnostic fee once you tell them "Go ahead and fix the [fill in name of failed part]."
CGHill at November 10, 2010 9:09 AM
It's all about time. Sure, the doc could learn how to diagnose his own engine. If he's a typical primary-care physician, he's already working 12 hours days, and dealing with engine codes is the last thing he needs.
$13 bucks for an EKG is nuts: he's got to have the office, the machine, he's got to pay a nurse to hook it up and run it, and he's got to handle the diagnosis. At $100 he might just about break even.
bradley13 at November 10, 2010 10:26 AM
He paid $90 for what the free market provides for free. Maybe he is not the person to tell us about what an EKG should cost.
Ah, but then again, that free market isn't shackled with a dozen regulations, either. And exactly how long does the interpretation of an automobile's read out take, as opposed to interpreting an EKG?
Oh, and then there's the whole "what if the interpretation is incorrect" thing. At least when they get it wrong on your car, you can bring it back and tell 'em to fix it...
I R A Darth Aggie at November 10, 2010 10:27 AM
Jerry: Why do you assume that a "mid-level diagnostic check" is just reading OBD-II stored codes? Because that's what you get for free at Autozone.
I've never seen them do a live test, just read stored codes.
I've seen much more "significant" machines for live analysis at dealerships and shops, which presumably need a more significant charge for amortization.
(That said, I also find it easy to believe that a dealership would try and charge for OBD-II code reading. Because they tend to be money-grubbing bastards.
But I wouldn't simply assume it because some guy wrote a letter without specifying what sort of "diagnostic" was being offered.)
Sigivald at November 10, 2010 2:18 PM
Having just gone through this. Check engine light came on.
The local store would provide a free read of the stored error code. No live sensor reads. Code says sensor is bad. They don't have replacement and recommend contacting the dealer.
Dealer: diagnostics start at $130, they wouldn't go off the code I told them, but if that is correct the sensor was $300 and the labor would be $150.
local shop: diagnostics start at 95$. If I just wanted them to replace the valve (blindly, no testing) it was $300 + est $120 labor.
Internet: likely just dust built up on the senor (common problem), est. time to fix 5 minutes. Tried it and it worked! Took me about 15 minutes.
In my experience, most the shops just change parts till the computer no longer reports a problem. If you can find a good mechanic with knowledge they are golden - unfortunately they are rare.
So $13 appears to be too little (I don't know what is really involved), but $90 is a ridicules fee. If you want to pay it for convience, that is fine.
The Former Banker at November 10, 2010 2:49 PM
Amy Alkon
http://www.advicegoddess.com/archives/2010/11/10/a_spark_plug_a.html#comment-1780116">comment from The Former BankerIf only it were as simple with the body as having a "check carburetor" light come on.
Amy Alkon at November 10, 2010 2:51 PM
How much is Autozone paying for malpractice insurance?
What are the consequences if Autozone misreads the diagnostic tool output? What are the consequences if the doctor does?
Conan the Grammarian at November 10, 2010 4:30 PM
Amy Alkon
http://www.advicegoddess.com/archives/2010/11/10/a_spark_plug_a.html#comment-1780175">comment from Conan the GrammarianHah - great points. From the guy with one of the all-time-great blog names. I do miss Gog_Magog_Carpet_Reclaimers.
Amy Alkon at November 10, 2010 4:32 PM
It would be great if a "arteries clogged" light would come on and you could pass some Simple Green (or the like) through and be better.
The two seem rather incomparable.
If anything it is a study in power. In one, the mechanics have a lot of power because most people really need their car so if they don't have the knowledge and time to fix it, they pay a lot. In the other, the government has power so drives down how much is paid for a service.
Malpratice insurance is a big issue...one of my Father's friend quit his practice and went to work for a First Nation. Patients would have to sue the First Nation.
The Former Banker at November 10, 2010 6:19 PM
Malpratice insurance is a big issue...one of my Father's friend quit his practice and went to work for a First Nation. Patients would have to sue the First Nation.
The only references for First Nations I can find is a reference to some Canadian Health Care program for Inuits. How does that factor in the U.S. Health car debate?
Texas may have it close to right -- They reformed their tort laws and doctors have been coming to the state.
www.ibjonline.com/print_medical_malpractice_tort_reform.html
Jim P. at November 10, 2010 9:41 PM
You guys are walking all around the elephant.
An authority figure is telling you what the EKG is worth, regardless of your individual situation. That's just one reason the apple is not the orange in this argument! You don't get a choice - unless you pay.
Radwaste at November 11, 2010 2:45 AM
What Radwaste said. We don't really know the market value of an EKG when a third party arbitrarily sets the price. Could be $0.50 or $5000.00.
"If only it were as simple with the body as having a "check carburetor" light come on."
I believe this is the "check-tight-belt" warning sensor.
AllenS at November 11, 2010 10:22 AM
First Nation(s) is the current PC way of referring to various Native American (aka Indian) governing bodies in this area. I believe the use of the term came from Canada.
The point was that some one he treated to could not sue him for the work he was doing directly, they would have to sue the governing body, which is a pseudo sovereign body, in US court. At least that is how the theory worked, I don't know if it has been testing in practice.
The Former Banker at November 11, 2010 2:15 PM
"What are the consequences if Autozone misreads the diagnostic tool output? What are the consequences if the doctor does?"
Shhhh. You'll give some lawyer somewhere ideas.
Actually, I think Aggie hit on the essential point, with some reinforcement from Banker. Auto service is a pretty free market. I can choose to pay the dealer to hook up their fancy computer to my car, or I can go to Autozone and use their loss-leader free service (which they offer me in the hopes that I'll buy some parts from them), or I can buy a $100 device and do it myself. A lot depends on what I think the problem might be. In my experience, about half of the time when someone's "check engine" light is on, it's because they didn't put the gas cap back on right. If the problem is obvious -- the code is for the oxygen sensor, and I know it's got 50K miles on it -- I'll change it myself. If I get a bunch of "WTF?" codes, it's going to the dealer.
The point is, I get to choose what level of service I need, and the free market gives me options at different cost levels. With medical service, I have no options (and neither does the doctor). I can't buy an EKG machine for $100 even though it's basically just an oscilloscope and some signal conditioning circuitry, because EKG machine manufacturers have to jump through hundreds of thousands of pages of law and regulation and court precedents before they can build that machine. If I had an EKG machine, admittedly I could not diagnose everything, but I could probably learn enough to spot obvious problems. Of course, then I would need to be able to legally medicate myself, which is the other half of the problem.
I have a friend who has tachycardia. She has to take medicine for it, and her dose has to be constantly tweaked to keep her heart rate in the right range. If she had an inexpensive EKG machine and a bit of training to be able to read her condition with it, she could adjust her dose herself, and only have to go back to the doctor if the dose adjustment didn't work or if she saw something in the EKG she didn't understand. But since the free market in those things doesn't exist, she can't do that, and she has to rely on the more costly and labor-intensive method of twice-monthly doctor visits, for what is (for her) routine maintenance. Imagine if Band-Aids were only dispensed by prescription and you had to go to a doctor every time you cut your finger... that's pretty much what her life is like.
And regarding the "arteries clogged" light... it's not like computerized diagnosis of the human body is impossible. After all, that's what AED machines do -- and by definition they do it in life-or-death situations.
Cousin Dave at November 11, 2010 4:08 PM
While I can buy a glucometer (monitor my blood sugar) I have to jump through hoops if I want to get insulin without a prescription.
Why can't I be responsible for my own health without a doctor's prescription?
There was one many moons ago on E.R. where a midget came in knowing he had some sort of tachycardia that all he needed was a quick hit from a defibrillator. The ER staff was like "we need to test you". He eventually grabbed the defibrillator, shocked himself, and walked out fine.
I ran into the same thing when I was with my lady -- Having to jump through hoops when they over-medicated her when she was in the hospital. Getting her ostomy supplies we didn't have a "permanent" subscription.
Some of these things would be solved by getting insurance a deductible like your car insurance. If you have to pay 5% or $500 deductible -- you would have people consider whether running to the doctor for minor stuff.
If you had more drugs with no prescription and accurate dosing guides available -- you would have less need for full up doctors and could use physician assistants.
Jim P. at November 11, 2010 10:28 PM
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