Land of Dreams and Shadows

The healthcare industry requires not just doctors and nurses, but an army of administrators. Of the $5 trillion spent on medical services each year, at least 40% has little to do with patients.

Source: The Far Side

Monday, March 03rd, 2025

Bill Bonner, writing from Johns Hopkins Hospital, Baltimore, Maryland

Narcotics won’t improve your world. But they can help you feel better about it. You nod off… even when they are cutting you open… and slide into your own dreamscape.

Here at Bonner Private Research we cast our net far and wide to bring you the widest possible view of what is going on. Dan on the high plains of Wyoming…Tom in some woebegone village in India…

And here we are in Johns Hopkins hospital, not exactly by choice but, whatever the motivation, it is a learning experience.

Here’s what to expect…

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You go into the hospital. You give your insurance info, your name and birthday. They put a plastic wristband on…and give you a badge. That allows you to go down the hall where the receptionist asks you for your name and date of birth. You are told to have a seat. “Someone will call for you.”

Someone does call for you. You enter a smallish area. She scans your armband with an electronic device.

“Your name?”

“You just called my name,” we answer.

“Yeah, I know your name. I want to make sure you know your name.”

“But I came when you called me.”

“Never mind. But I’ve got some questions for you.”

You are then required to sign several forms the gist of which is that you won’t light up a cigarette in the hospital, and that if anything bad happens to you while on hospital premises, it’s your own damned fault.

Along the road to the hospital, however, were several large billboards from law firms betting that it wouldn’t be your fault. “You deserve money. We collect $$millions$$ for our clients,” advertises one of them. Another: “Medical Malpractice? Know your rights. Get paid.”

But the questions are just beginning. Embarrassing questions — about bodily functions, medicines allergies, previous illnesses and accidents.

All of this information has already been provided, more than once. But they want to be sure.

When this interrogation is finished, we are told to return to the lobby, until “someone calls your name.”

Again, after a brief wait, we are greeted by a neat person in a hospital uniform and a mask. This time, we are taken to a small room, curtained off, with a bed and many complex instruments in it.

“What is your name?”

“William Bonner,” we answer.

“Your birth date?”

And then come the questions…health status…accidents, interventions…insurance carrier…etc. Have we had Covid shots? Do we get dizzy when we stand up too fast? Has any relative ever had cancer?

The most important question was, “Can I see your insurance card?” And for good reason. The system is staggeringly expensive. The average health insurance for a family of 4 is said to be over $20,000. The medical care expenditure per person is over $14,500.

The US now ranks 46th in life expectancy…and every one of those 45 countries where people live longer, spends less than we do. We’ve tried some of them — in France, Ireland, and Argentina. The general service seems similar…at half the cost; but the US is said to have a high-tech edge.

Our visit to Johns Hopkins gave us an occasion to see for ourselves. There are scores of people in hospital get-ups…and scores of people who ask your name and age. When they aren’t asking questions, or actually helping a patient, they are usually making small talk with their colleagues.

Thanks to the complexity of treatments, insurance programs and Medicare/Medicaid, the healthcare industry requires not just doctors and nurses…but an army of administrators. Of the $5 trillion spent on medical services each year, at least 40% has little to do with taking care of patients.

At Johns Hopkins, the doctors, nurses and skilled assistants were pleasant and competent. But efficiency does not appear to be a major concern. There’s little price competition to drive cost cutting. We never knew what anything cost. We never had to make a decision that involved trade-offs or prices. We saw plenty of ads for lawyers eager to sue…but none offering lower cost service.

And while there were no obvious efforts to cut costs, neither was much thought given to increasing revenues. We were never offered an ‘up-grade’ at a higher price. The food was free. No one solicited a charitable gift or offered a ‘frequent patient’ discount membership.

Nobody seemed to care. Including us. After all, the insurance company was paying. Why medical care is so inefficient and ineffective, we don’t know. But we can take a guess: the feds have gummed it up with regulations and subsidies. And if the new team — headed by RFK, Jr. — were serious about saving Americans $2 trillion, they’d begin by liberating the healthcare business. Whether that would result in lower prices and higher quality, we don’t know either. But it would be worth a try.

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Our adventure at Johns Hopkins continued…

We were getting pretty good at answering questions, asked by another nurse…an anesthesiologist…and the surgeons’ assistant.

“What are you here for?” asked at least two of them.

“What do you think we’re here for?” we replied.

“We just need to be sure that we have the right person and that he is capable of understanding what is happening to him.”

“What is today’s date?” asked one. “Where are you?”

Another handed us a piece of paper with a circle on it.

“Draw a clock that says 11:30.”

“AM or PM?” we asked.

Finally, we were laid out on the operating table…with a large robot, like a many-armed Hindu goddess, ready to go to work. The anesthesiologist administered his dose. Our eyes rolled backwards…we were getting drowsy, passing into the land of dreams and shadows.

Then, the most remarkable thing happened.

The top surgeon appeared. A tall man, dressed in a black cape with a black hood and a deep stentorian voice.

He was carrying a scythe. His eyes were like burning coals…his touch as cold as dry ice.

“What is your name,” he asked, sounding vaguely like Darth Vader.

“Jack Jones,” we lied.

“Oh… Must be some mistake. You’re not the one I’m looking for.”

Regards,

Bill Bonner