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ROBERT SIEGEL, host:

A few weeks ago, when every other day we heard something new about health insurance and the cost of American health care, I found myself watching an episode of the Fox TV doctor show "House M.D." And all I could think was if they were actually billing this patient or his health insurance company, how much would all this treatment cost?

(Soundbite of music)

SIEGEL: If an ace diagnostician really were playing trial and error with the most puzzling cases and the most sophisticated therapies an American teaching hospital could offer, what would the tab be? And it turned out that Andrew Holtz, a writer in Portland, Oregon, was asking himself the same question. The difference was he actually set out to answer it.

Andrew Holtz is the author of "The Medical Science of House M.D." and the forthcoming book "House M.D. vs. Reality."

Andrew Holtz, Houseologist, thank you very much for joining us today.

Mr. ANDREW HOLTZ (Author, "The Medical Science of House M.D."): Glad to be here, Robert.

SIEGEL: And we asked you to think in particular about an episode of "House" that was called "Ignorance is Bliss." Perhaps you could run us through some of the medical issues that arose in the case of the patient, one James Sidas.

Mr. HOLTZ: Well, this patient showed up with some odd symptoms. They said he had ataxia, anemia, a mild cough. They started doing, as they always do in these episodes, a barrage of tests and then they started throwing out all sorts of bizarre potential diagnoses: the more bizarre, the better.

SIEGEL: Eventually, they're talking about something called TTP.

Mr. HOLTZ: That's right. Thrombotic thrombocytopenic purpura.

(Soundbite of TV show, "House")

Unidentified Man: (Unintelligible) suggests TTP.

Mr. HUGH LAURIE (Actor): (as Dr. Gregory House) Good.

SIEGEL: It's an important lesson of "House": anything that is believed to be true in the first half of the program can be dismissed as untrue.

Mr. HOLTZ: That's right, although sometimes in this show, they miss some obvious clues in order to prolong the drama and find out that it was something that any medical student should have figured out; and other times, it is something that's just so rare that it's only been mentioned at most a handful of times in the entire history of medicine.

SIEGEL: Turns out the patient is a drinker.

(Soundbite of TV show, "House")

Mr. PETER JACOBSON (Actor): (as Dr. Chris Taub) We found vodka stashed away in his place.

SIEGEL: And it is proposed that they do a liver biopsy.

(Soundbite of TV show, "House")

Mr. LAURIE: (as Dr. Gregory House) Taub and Thirteen can do the liver biopsy today.

SIEGEL: Go into a hospital, liver biopsy?

Mr. HOLTZ: Yeah. I found one estimate from one insurance company that estimated that a liver biopsy might cost somewhere between 8,000 and $11,000. So, not petty change.

One thing I found when I was looking at this, a lot of people said, well, we just don't know because it depends exactly which variety of the procedure we're doing, which institution we're doing it in, which insurer you have, whether the moon is in retrograde.

(Soundbite of laughter)

Mr. HOLTZ: You know, it just seems that, as with anything else in health care, trying to nail down what seems like a simple question turns into an episode in bizarro land.

SIEGEL: But the patient in this case collapses; he's sick. There's an MRI. Is there some obvious ballpark figure we could attach to what the MRI was?

Mr. HOLTZ: An MRI could be anything from maybe a couple of hundred dollars to a thousand dollars. And again, it often depends on the deals that insurance companies make with the hospital. It's all a matter of negotiation.

SIEGEL: And then there's a pretty serious procedure.

(Soundbite of TV show, "House")

Mr. JACOBSON: (as Dr. Chris Taub) So that means we have to give him a splenectomy?

Mr. LAURIE: (as Dr. Gregory House) Yes, it does.

Mr. HOLTZ: A splenectomy, I found one estimate in New Jersey, because that's where the show is set, found that a splenectomy often involves about eight days in the hospital and a charge of about $140,000.

SIEGEL: Wow. So that's the big one. And in this particular case, as you've noted to me, since the patient's spleen had broken up over the years, you could have called this multiple splenectomies.

Mr. HOLTZ: Yeah. At the end of the episode, they find out that, yes, they've taken out a spleen, the main spleen, but this patient had had an injury years before, broken a rib, which had punctured the spleen and little spleens had grown up, accessory spleens. And they found 16 of them. So I don't know if you get bulk rate discount when you have 16 splenectomies all in one day.

(Soundbite of laughter)

SIEGEL: But we're now well into six figures, and it sounds like a tab that's running up toward about a quarter of a million dollars or so from what you're describing.

Mr. HOLTZ: Yes. From this case, actually, ataxia - if they actually treated him for that - that was the lack of coordination scene at the beginning. There's -a typical charge of that would be around $40,000. You're talking 140, maybe a couple of hundred thousand for all these splenectomies. He had a stroke as they went through one thing after another, and that - I found one estimate - that might easily be, say, $60,000.

And then they found drug abuse. And so drug abuse treatment, say, he spent a handful of days in the hospital; that might be $50,000. So, yeah, a quarter of a million might be on the low side for this particular case.

SIEGEL: Was this particular episode, from your familiarity with "House," do you think this was an especially costly show that they had for the patient or pretty much run of the very high-priced mill?

Mr. HOLTZ: It seems somewhere in the middle. Maybe it might be a little bit on the high side because he did have a lot of surgical procedures. But he didn't have an organ transplant, which they do every now and then. Those can be easily a couple of hundred thousand dollars to begin with and then there's lifetime care after that.

So spending a few hundred thousand dollars on a complicated case is not at all unusual. I think people often really don't realize how quickly costs mount. Ten thousand dollars a day for fairly routine care is not unusual in hospitals.

SIEGEL: Andrew Holtz, thank you so much for talking with us and for bringing such rigorous scrutiny to one episode of "House M.D."

Mr. HOLTZ: Thank you, Robert. It was a pleasure.

SIEGEL: Andrew Holtz is the author of "The Medical Science of House M.D." and the soon-to-be published "House M.D. vs. Reality."

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MELISSA BLOCK, host:

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