Wednesday, July 13, 2011

A predictable unintended consequence

Right now I have no love lost for the proposed carbon tax, and not for all the usually cited reasons. Nope, right now, I'm annoyed because it made me do math. I hate math.

Faced with the news that hospitals are not going to be compensated for the increase to their costs under a carbon tax, I had no choice but to gird my mathematic loins and join the fray, so as to put this into some kind of perspective. (Albeit with a quick call to good ol' Dad to translate some of the more technical terms. "Hey Dad, whats this thing..its an EM.DoubleYEW.Haich or something?") So if any of my more learned readers think I have gone astray with my calculations, please consider yourself volunteered. Do you have a calculator? I'll make the tea.

This is what I worked out. Hospitals are very expensive places energy wise. Operating theatres run around the clock, we have expensive kitchens, food bills, heating and cooling, expensive equipment, lots of fun drugs and kit made out of petroleum products and aluminium, linens, the list is endless. Oh, and we leave the lights on all the time. (Except when an enviro-bully has used the bathroom last and insists on turning the lights out when they leave, thus leaving the next user (i.e. Me) to stumble around in the dark groping blindly for where the switch should be if the facility wasn't designed for achondroplasic amputees, and hoping not to encounter bodily fluids / rapists / dead people. When I find you, you will pay.)

Hospital electricity bills alone run into the millions per annum, so just times that by anywhere between 10-20% to factor in a carbon tax, and it works out to be a lot of extra dosh the hospital administration is going to have to pull out of their backsides. Somehow I don't think they are going to voluntarily sacrifice large parts of their pay packets to compensate, and I sincerely hope they don't "find" the extra money in the junior doctor's salaries, either. Worse case scenario: we may have to treat less people, less well.

Let us look at one single, important facet of hospital medicine: The MRI scanner. They are really nifty, they have big-arse magnets and are super cooled with liquid helium*, reliably cost over a million dollars AUD to buy and we don't have enough of them to meet demand. The average wait time in the west of Sydney for a medicare funded, elective MRI is anywhere between 1-8 weeks. MRI is also funky because it doesn't deliver the radiation dose of CT.

They also use a fairly hefty wack of power to run. According to an analysis of the Magnetom Avanto MRI system from 2007, it looks a little something like this:

Just to make the things creates a massive carbon dioxide footprint. A fun MRI fact is that they are often shipped by air to prevent the helium that cools the superconducting magnet from evaporating in the absence of a power source (in which case it needs to be recooled at substantial cost and energy expenditure). If the length of time it took me to ship a box of my posessions from California to Sydney by surface mail is anything to go by, I dont think we can ship them by sea in a timely manner. (Even taking into account the length of time needed for customs to open my stuff and steal my CD's). As far as I know, neither marine or air transport will be compensated under this tax, anyway.

The running costs in terms of energy work out to over 600 tons of greenhouse gas emissions per year (at least according to the fine print on the back of my last electricity bill). Thats over AUD $14K a year extra just in terms of the price the government plans to put on carbon dioxide emissions, and not even including the other knock-on effects and existing predicted electricity price hikes. Just for one MRI machine!

So I have a question: What do we do to absorb the cost? Considering the existing waiting times for MRI scans, I'm not sure we can churn more people through. Are the medicare rebates for MRI scans going to be increased? At the moment, say a ball park figure for the rebate amount is around $400 (or you can peruse the list here, if you're feeling particularly masochistic). Thats not very much when you factor in the cost of the technicians needed to run a scan, the cost of purchasing and running the scanner and the cost of keeping a radiologist in luxury yachts and European cars. (I would tell you what a consultant interventional radiologist makes, but you might vomit.)

* For further information on the technological wonder that is the MRI machine, please ask someone more learned. Most of what I know about MRI can be summed up by the phrase "Big magnet = ferromagnetic metal bad" ** or watching the below clip. Warning: People upset by the gratuitous slaughter of melons should turn away now.

** UPDATE: That should probably be "Big Magnet + Ferromagnetic metal = Bad". I told you I was bad at math.

Take that, watermelon

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