by Wally Duff
Marcia studied Brittany, who always wears her skirts short to display her legs. Tonight it was a tight white one. It was wrinkled, as was her royal blue silk top.
“I think I know what happened,” Marcia said. “You’ll have to tell me about it later.”
I saw Brittany glance around the table. When she saw Carter, she smiled widely and walked to our end of the table.
“If she calls me ‘Mrs. Thomas’ I’m gonna slug her,” I whispered to Linda, who sat next to me.
“As short as her skirt is, if she bends down too far, Janet might have to arrest her for indecent exposure,” Linda responded.
Brittany greeted Carter by shaking hands. At least she didn’t try to hug him.
“Hi, Tina,” Brittany said across the table.
“An unexpected surprise to see you here,” I said.
“Tony called at the last minute to invite me,” she said. “You probably remember how it is to be working on several great stories and have so little time to have fun, but since I knew Carter was going to be here I thought it would be okay.”
“It hasn’t been that long ago for me,” I said. “And I do remember having deadlines for stories, but I never took time off for fun. I worked too hard to beat the male reporters.”
“I’ll work extra hard tomorrow, even though,” she smiled at Tony, “I probably won’t get much sleep tonight. I’m sure you remember about those nights, even though it was a long time ago.”
I felt my face flush. She turned around and went to her seat. Linda leaned close to me. “Where’s your gun?”
“In the van. Maybe I can borrow Janet’s. I’m sure she’ll understand.”
The waiters served the salads. Marcia signaled for quiet by tapping her crystal wine glass with her knife.
“Greetings to the members of the Hanscom Park Irregulars and their mates.” David tugged at Marcia’s sleeve. She leaned down and he whispered in her ear.
She straightened up. “I mean the Hamlin Park Irregulars, but I’m not sure why that even matters. We have a lot to discuss about how hospitals make money. Dr. Wallace, would you please begin?”
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“Last week, Tina asked me to explain to you how hospitals make so much money,” Eddie began. “A recent study was done in which a person called more than one hundred hospitals in each state seeking prices for a hip replacement for a sixty-two-year-old grandmother who was uninsured but had the means to pay out of her own pocket. Only about half of the hospitals, including several top-ranked orthopedic centers, could provide any price estimate. Those who did gave quotes that varied from eleven thousand one hundred dollars to one hundred twenty-five thousand seven hundred and ninety-eight dollars.”
“That’s ridiculous,” Frankie said.
“Sadly, it isn’t,” Eddie said. “The lady was fictitious, created for a research project on health care costs, but the findings illustrate the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers. For example, I insert tubes into a little kid’s ear drums. My charge for the surgery is two hundred dollars. The kid is under anesthesia for five minutes. My hospital’s outpatient facility fee is five thousand dollars, but it could be twice that at another hospital in my same city.”
“How is that even possible?” Janet asked.
“Transparency is all the rage these days in government and business, but there’s been a minimal push for pricing transparency in health care, and there’s virtually no information available to the patient,” he said. “You can get the price to purchase a car, but health care? That’s not easy.”
“Are we missing something here?” David asked.
“They do it because they can,” Eddie continued. The hospitals blame the insurance companies. The insurance companies blame the hospitals, and the costs keep rising.”
“If one hospital can perform a hip replacement for eleven thousand dollars, then all hospitals should be able to do it for the same price,” Rick said.
“But Rick, when there’s one hundred percent variation in sticker price, there is no real price,” David said. “It’s obviously only about profit.”
“No kidding,” Molly’s husband Greg said. “This is like paying one hundred twenty thousand dollars for a twelve thousand dollar Honda.”
“I had a breast MRI not too long ago in Dr. Fertig’s office,” Janet said. “The bill came to twenty-eight hundred dollars for that test. The rest of the bill — including the ultrasound, lab, and consultation — totaled an additional seventeen hundred dollars. Did he overcharge me?”
“Let’s examine the real cost of the MRI,” Eddie said. “How many people were there to do the procedure?”
“One lady brought me in and put me in the machine,” she said. “Another guy ran the machine. The first lady came back and took me out about an hour later.”
“You never saw Dr. Fertig?”
“I don’t think I did, unless he was hiding in the back.”
“Two people. One hour. How much were you charged for their time?”
“Haven’t a clue.”
“And you’ll never know unless you requested an itemized bill, and even then, you won’t be able to figure it out. Assume the first woman makes eighteen dollars an hour. Pay her the full amount and give her boss a twenty percent profit. The total cost of her time, including the profit, would be twenty-one dollars and sixty cents. Do the same thing for each individual cost for the procedure. Electricity? Probably no more than ten dollars. The technician running the machine? Fifty dollars including the twenty percent profit.”
“What about the cost of the MRI machine?” Howard, Linda’s husband, asked. “It can run well over one million dollars. That’s why the test is expensive.”
“Howard, if they do twenty to thirty MRIs a week, the machine will be paid for in less than a year. And what if they bought that machine four years ago? They’ve already depreciated it out, allowing them to play with house money.”
“Seems to me like we’re getting screwed,” Joe, Cas’s husband, said.
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“I’m just getting started,” Eddie continued. “If you have a cardiac cath, they will charge three hundred dollars for anesthesia.”
“Is that the procedure where they stick a needle in one of your blood vessels?” Greg asked.
“In your femoral artery,” Cas said. “It’s in your groin.”
“Man, I’m paying whatever it costs for that anesthesia,” Greg said. “If they shove a needle down there, I don’t want to feel anything and I damn sure don’t want to move.”
“Guess what the anesthesia is?” Eddie asked.
“Two cc of Xylocaine, the same drug my dentist uses to work on my teeth,” Cas said. “And he never charges me for it.”
“And he won’t, since the total cost, including the syringe, is less than a dollar. The hospital charges over three hundred dollars for the same drug.”
“Tell them about Rocephin,” Cas said.
“Is that an antibiotic shot?” Greg asked. “I had one of those in the butt, and it hurt like crazy. Limped for a week.”
“It costs about sixty-five dollars wholesale, right?” Cas asked.
Eddie nodded. “That’s what they charge my office, but the hospitals get a deep discount due to their volume.”
“What do you charge for a shot in the office?” I asked.
“Seventy-eight to eighty-five dollars. Depends on the insurance company, but that same shot given in the ICU at my hospital costs four hundred and twenty dollars.”
“Expensive elevator ride from the pharmacy to the ICU,” Rick said.
“But is the owner of MidAmerica Hospital doing anything that other hospitals aren’t doing too?” Marcia asked.
“That’s why they’re all so profitable and why it’s hard to understand why her hospital is in financial trouble,” Eddie said.
“Forget the MidAmerica Hospital for a minute,” Alan said unexpectedly. His dark brown eyes n
ow looked black.
This should be interesting.
“A twenty percent profit is great in any business,” he continued. “Why not take the actual cost of each individual part of a procedure and tack on a twenty percent profit? Then add them together and you have a cost platform that will be significantly lower than it is presently. To solve the issue of skyrocketing medical costs, we need to standardize the costs and then control them from the inside out rather than the outside in.”
“If you have a total hip procedure done, it should cost the same if it’s performed in Omaha or Chicago,” Rick said.
“Almost the same,” Alan said. “There will always be regional differences due to the variations in cost of living, like rent in different parts of the country.”
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“I have a question,” Brittany Simon said.
Marcia made an effort to raise her eyebrows, but her Botox precluded that. “Who are you again, dear?”
“Brittany Simon. I’m one of Carter’s reporters.”
“And an extremely talented one, I might add,” Carter said.
I wanted to kick him, but he was across from me and he was right, so I didn’t. She was that good.
“As most of you know, I covered Dr. Fertig’s story,” Brittany said. “As Eddie just said, there are rumors that the finances of MidAmerica Hospital are shaky. Until he died, Fertig brought in most of the profits to the hospital.”
“He did,” Linda said. “It was about seventy-eight percent.”
“Do you think MidAmerica’s financial problems are because he died?” Brittany asked.
No one responded.
“And you guys also thought that there was something possibly illegal about his treatment,” she continued.
“That was our assumption because of his unbelievable breast cancer cure rates, but we never found out how he did it,” Cas said.
“After Fertig died, have the doctors Diane Warren hired been able to reproduce his results?” Brittany asked.
“We don’t know for sure,” Cas said.
Alan stood up and leaned forward with his palms outstretched on the table. His now-black eyes were glistening. “Nobody knows what causes cancer. Many cancer therapies are as poisonous to healthy cells as they are to cancer cells.”
His nose began dripping, and he pulled another piece of toilet paper from his roll and dabbed at his nostrils. “A treatment that is able to distinguish between healthy and cancerous cells would be less toxic and less difficult to endure for those with cancer.”
Putting the soiled tissue in his pocket, he pounded his fist on the table. “This is the answer to your question.”
He turned around and walked to the interior door to his house. Lori jumped up and punched in the code. She opened it for him and they left together.
“An interesting comment,” Marcia said. “This soup certainly is delicious.”
88
Dinner was over. Our group stood in the West Gallery sipping a succulent, cold Chateau d’Yquem. Most of the men were outside smoking cigars. Marcia was with them. David and Rick were with us. Brittany had departed with Tony without asking any more probing questions.
“What was Alan talking about?” Molly asked.
“I’m not sure,” I said. I nodded toward David and Rick. “Any ideas?”
“Alan is brilliant, or at least he used to be,” David said. “I think he has given us a clue.”
“A clue?” Linda said. “I think it’s the rambling of a man with dementia.”
“But what if he is trying to tell us something?” Molly asked. “He might have the answer on how to bring down Diane Warren.”
“Tell you what, Molly,” I said. “You seem to have connected with him. Why don’t you work on that, and the rest of us will attack Diane from a different angle.”
“When I met him in the receiving line, he seemed to like my boobs, so that might work,” Molly said. “I’ll see if he wants to have lunch with me.”
It was difficult to picture that encounter. I wasn’t sure Alan was any more ready for Molly than she was for him.
“Maybe I can show him the recordings Cas gave me from Zhukov’s office,” Molly suggested. “He might like those.”
“Molly, not now,” I said with a vigorous shake of my head. “I don’t think we should discuss this in Marcia and Alan’s home.”
“Oh, okay.”
“Tina, come on,” David said. “Let Molly and Cas tell us what they found. God knows we need a juicy tidbit after all that dreadfully dull medical talk.”
I looked at Cas and nodded. “Okay, but don’t say I didn’t warn you.”
“Zhukov had a couch in his office that folded out into a hide-a-bed, and he had a mirror on the ceiling above it,” Cas began. “Above the mirror he had a hidden camera where he recorded what he did.”
“How spicy!” Rick exclaimed. “I can’t believe you didn’t want her to tell us this. Please do keep talking, sweetie.”
“Tina and I found the recordings of all his encounters,” Cas said. “Since Molly’s the expert on this type of behavior, I gave them to her to analyze. I haven’t seen them.”
They waited. I considered helping wash the dishes.
“It was the usual,” Molly said.
“The usual what, for God’s sake, Molly?” David asked.
“Zhukov was having sex, right?” Linda asked.
“Was it kinky sex?” Rick asked.
“It kind of was. The women were actually guys dressed up like women.”
The group was silent.
“I obviously wasn’t expecting that,” I said.
“God, neither was I,” Cas said.
“I guess we should have watched those recordings with you,” I said. “We didn’t know what we were missing.”
“I can verify that Molly’s report of what she saw on the recordings is correct,” Janet said. “The lab guys tested the sheets you gave Tony from Zhukov’s office bed. The DNA was from two men.”
“Not a woman?” I asked.
“Nope.”
“I guess it’s possible that the killer I saw was a man dressed as a woman” I said.
“Sounds like Mr. Zhukov was a naughty boy,” David said. “I am surprised we never met him.”
“I don’t understand,” Linda said.
“Me either,” I said.
“Well, dears, we know a little something about men who dress like women,” Rick said.
There was more silence in the group.
“I think our group needs an education in this area, don’t you, Rick?” David asked.
“I totally agree,” Rick said. “How about we all meet up at The Max?”
“Isn’t that the place in Northalsted that bills itself as the best LGBTQ dance club in the Midwest?” Molly asked.
“Sweetie, you are so with it, I can’t believe what I’m hearing,” David said. “We all have to go.”
“Guys, we’re getting off the track,” I said. “Did you get any hits on the DNA from the two men, Janet?”
“We’re working on it, but slowly,” she said. “The Captain isn’t too thrilled having us use expensive tests for what now appears to be either a missing person or, according to the FBI, a flight from justice.”
“You and I know that isn’t true,” I said.
“The FBI never lies,” she said.
“You know what I think about the FBI,” I said.
“And I know what they think about you,” she said. “Watch your back. They think you know where Zhukov is.”
89
“Let’s go have some fun,” Marcia said, as she joined us. Her hair and clothes reeked from the stench of freshly smoked cigars and cigarettes.
“Fun?” I asked.
“I’ve waited all night for this,” she said. “We have to hurry before she leaves.”
“She?” Linda asked.
“Diane Warren. David, you and Rick stay here. If she sees you with Tina and the rest of the Irregulars, she’ll never tell Lesli
e Van Horn anything we can use.”
Our group moved into the library where Diane Warren stood with two men. She is slender and close to Molly’s height, which is six feet not including her heels.
Tonight, Diane’s heavily sprayed, blond hairdo was swept into a chignon. Professionally applied makeup covered her almost-translucent, wrinkle-free skin. The decrease in the size of her pot of gold hadn’t affected how she dressed. The last time we encountered her she was all Chanel. This time it was couture, but I wasn’t sure which designer.
