> SOUTHERN INDIANA — Health care has dominated the national conversation ever since the Supreme Court’s ruling last week that upheld the Patient Protection and Affordable Care Act as constitutional.

Ironically, as all this was going on, my wife Diane was contending with extensive surgery and an overnight stay in the hospital. Let me assure everyone that the surgery wasn’t life-threatening and everything turned out fine, even though the operation lasted more than six hours. Currently, Diane is making a remarkable recovery, despite the fact that she has me as her chief caregiver.

All of this, however, has given us a fairly intense first-hand look at the health care system in our area. First of all, I was struck at how hospital care has changed over the years. Despite the extended time in surgery, Diane was released the very next evening. When I was a teenager I think I was in the hospital for three full days just to have an ingrown toenail treated.

Several years ago, when we lived in Orlando, a lot of people we knew used a local hospital that was renowned for its excellent food. The place even gave gift baskets with fruit and homemade banana nut bread when you were discharged. The wife of one of my co-workers stayed an extra day in the hospital after having a baby, just so she could have the lunch special.

Since those days, managed care, Diagnosis-Related Groups (DRGs) and other developments have drastically changed the way hospitals do business. DRGs refer to a system that originally classified all hospital stays into one of 467 groups.

Robert B. Fetter and John D. Thompson from Yale University developed this approach to replace the government’s traditional “cost-based” reimbursement system. Patients are assigned to a DRG based on diagnosis, procedures provided, age, sex, discharge status and the presence of complications. Hospitals are then paid a fixed amount based on this classification. DRGs have been used since 1982 to determine how much Medicare will pay hospitals for each stay. Since then, DRGs have been revised 27 times.

It’s sort of like how mechanics in garages charge for labor. Most of them today consult a labor guide like Chilton’s or Mitchell and then, for example, charge you for 2.3 hours of labor to replace a starter. They bill by the job, not by the hour.

Private health insurance companies and their managed-care surrogates use similar methods. They are generally able to get deeply discounted rates from hospitals and other medical providers by providing them with a high volume of referrals.

I have always thought it was ironic that people without health insurance are usually the ones charged the most, since they don’t have the massive leverage that large insurance companies have to get the best rates. I recently saw a consumer advocate on television encouraging people without insurance to try to negotiate cash discounts from hospitals to lower their costs. Many medical providers are willing to negotiate with individuals, as well as their large corporate customers.

Of course, sometimes even the big insurance companies and medical providers hit a financial stalemate, which can adversely impact patients. I experienced this when I was trying to get Diane’s post-op medications. I discovered that our insurance company no longer provided coverage at the large pharmacy chain where I went to buy the medicines. Evidently they were unable to come to terms.

If it were not for an incredibly helpful pharmacist and the fact that most of the medications were nonprescription, this could have been terribly inconvenient and expensive. I noticed another customer in a similar predicament who was not so fortunate and ended up paying an exorbitant price for the medications he needed.

A few months ago I heard one hospital medical director say things had changed so you are no longer expected to stay in the hospital until you get well. He said the hospital’s role is only to stabilize your condition sufficiently enough so that you can recover at home. I had never thought of it in this way before.

The other major change we noticed was how much medical technology has advanced. Despite the surgery lasting so long, there was no major incision, bleeding or need to dress a wound. There were only a few Band-Aids and bruises. The whole thing was done laparoscopically.

In addition to the familiar IV drip, after the surgery, they attached a morphine infusion pump, which allowed Diane to administer her own pain medication. These pumps have been around for a while, but it was the first time we saw one. Studies have shown that patients usually report more satisfaction with this method and end up using less pain medication than in traditional administration. I guess nothing is worse than waiting for someone to give you a pain pill when you’re in distress. Personally, I thought Diane was much too conservative in clicking the button. If it were me, it would have sounded like there was a cricket in the room.

There was a lot of wheeling of various devices in and out of Diane’s hospital room — like the multifunction machine that takes blood pressure, temperature and pulse. There was also a robotic looking thing on wheels that had a laptop computer that they used to access their electronic medical record to chart things. There was also an oxygen saturation monitor than made an annoying beeping sound. I half expected to see all these devices built into the hospital bed itself, like the ones in the Star Trek medical bay that constantly monitored vital signs.

They gave Diane a funny looking plastic device that looked like a cross between a party noise maker and some sort of game. I later discovered that it was called an Incentive Spirometer. It is often used with patients who have had surgery that could jeopardize lung functioning, such as procedures requiring extended periods of time under anesthesia. You’re supposed to breathe into the spirometer as deeply as possible while an indicator provides feedback on how well you are doing. It is just the perfect thing for competitive grandchildren.

All in all I’m grateful that we have such health care available today, although health insurance claims certainly could be simpler. Albert Einstein once said to his colleague Leo Mattersdorf, “The hardest thing in the world to understand is income taxes.”

Clearly he never tried to figure out how the deductibles from our insurance policy work.

— Terry L. Stawar, Ed.D., lives in Georgetown and is the CEO of LifeSpring the local community mental health center in Jeffersonville. He can be reached at tstawar@lifespr.com. Checkout his Welcome to Planet-Terry blog and podcast at www.planetterry.wordpress.com.