SOLILOQUY: If we all billed like doctors

Farm Forum

Years ago, if you needed medical help, you’d go to the doctor’s office. There, the doctor would examine you, and if you needed an X-ray, the doctor would take it. He’d interpret it, too, and sometimes he’d even put it up over a light to show you the trouble.

Now, medical care is broken into tiny parts, with experts for each part. Each separate part comes, of course, with its own bill. You’ll even get billed for venipuncture, being poked with a needle, and that is distinct from lab work, further broken down into individual tests.

No question medicine has advanced since the time of house calls and all-in-one doctor visits. Back then, 100 percent of people died, eventually; now only 40 percent do.

But the true genius of modern medicine is in the billing. Break each event into as many parts as possible, and bill for them all.

It occurred to me that other institutions could learn creative billing from the medical establishment. Imagine, for instance, if schools worked on the same model.

At the end of every school term, parents could receive a statement. Though the state pays the bill for public schools, parents could see each detail and a price attached. If school billing followed the medical example, though, bills would have to be sufficiently mysterious that parents were never totally certain what services were included. Statements would look something like this:

Sept. 6

MW (math worksheet) 2-882-d, $2.24 MW (math worksheet) 2-882-d evaluation, $3.86 Math instructional per. 1/ j, $17.88h Math learning enhancement fee, $.87 RW (reading worksheet) 2-221/43-d, $1.56 RW (reading worksheet) 2-221/43-d evaluation, $3.25 Reading instructional per. 2/d, $17.88h Reading learning enhancement fee, $.87 Recess monitor compliance fee, $1.45 Recess monitor development surcharge, $1.22 Recess safety supplement, $1.87 Swing occupational access fee, $1.45 Swing extended time surcharge, $.58 Monkey bar access fee, $1.45 Slide access fee, $1.45 Line-up diagnostic, $.88 Gym usage contribution, $.56 Gym maintenance surcharge, $1.76 Gym floor preservation fee, $3.21 SW (science worksheet) 2-624-f, $2.78

And so on.

The bill would continue to detail each worksheet, each instructional hour, each graded paper, multiplied by every day of the term.

But in true medical model format, supplement bills would arrive. Bills from the school counselor and nurse would arrive separately, just as bills from the lab and anesthesiologist do. Bills for each staple, paperclip and folder would be detailed in separate statements. Each pen borrowed from a teacher, noted and billed.

There would be bills for the occupied space at the lunch table, for cleaning services of the cafeteria staff, for trash can usage.

Parents would see science lab surcharges and locker combination retrieval fees.

Parking space for parents would be billed by the minute of expected use per term. Parent conference fees would be attached. Paperwork handling and completion services would be calculated and billed. Buses to sports events and field trips would be billed by seat per hour.

Bathroom maintenance and supplies would be detailed in separate charges. Landscaping, computer repair and window washing would be divided up and billed to each student every term, under mysterious names.

If anyone complained, you’d just point to the old, one-room school house and say how much things have improved since then.

Grocery stores could do the same, billing for shopping cart use, bagger development, produce inspection, expiration date safety checks, directional help.

Complaints? Well, it’s not the dull, old time counter-style market, is it?

Complicated, detailed billing must simply be the price of progress.

Donna Marmorstein writes and lives in Aberdeen. You can contact her at