Monday, August 4, 2014

My Blog, My Soapbox -- Political Interlude #3

The way America allocates health care is, in a word, nuts.

If you think about it, there's really only one variable that ought to determine whether or not you get access to healthcare: are you sick? If you are, you should be able to see a doctor. If you're not, why would you want to? All the other variables we've managed to link to health care access -- do you have a job that provides health insurance? were you able to secure insurance individually? do you have enough cash on hand to cover the (unstated) expense? -- are sort of a nutty basis on which to determine who gets to see a doctor. 

A few months back I was on the bus home from work when the driver got in a dispute with two potential passengers. The one had blood pouring from a wound to his head, and the other was trying to figure out how to get him care without insurance. They did't want an ambulance called since they couldn't pay for that and they didn't want to walk a block to the urgent care clinic as they couldn't pay for that, so they wanted the bus to take them to the nearest ER. The bus driver, however, was not open to using his Metro coach as an ambulance. It was an incredibly strange argument to witness, and you'd think a civilized society could do better than to leave people bleeding on the street.

I thought a lot about the guy with the bleeding head when I was making my way to the urgent care center with abdominal pain. The one thing I didn't have to worry about -- at all -- was how I was going to pay for the treatment. I was sick, I needed care, so I got it. 
Except that's not really the operational equation. The actual equation was: I was sick, I had health insurance, so I got care. Nice for me, not so nice for all the people out there who might be as sick as me but don't have the health insurance that would let them obtain care. 

And the funny thing is, at least as far as my urgent care visit was concerned, I didn't actually need the insurance. The total bill for the seven hours in urgent care, including CT scan, IV and morphine, was just over $750. My share after insurance was $20. A great deal, and one I'll happily take, but the truth is that I could've -- and would've -- paid the $750 myself to make the pain go away. 

Now the hospital visit, of course, was a different story, and the bill for that raises all sorts of craziness in how we manage health care. The total bill for my six day stay in the hospital, which was basically just the facility costs (since Group Health employed my providers), was just under $43,000. But because I'm a Group Health subscriber and Group Health and Virginia Mason have an agreement, VM knocked about $13,000 off my bill. Of the remaining $30K, Group Health paid all but $300. 

So my share of a $43,000 bill was $300. Sweet! And my insurer's share of that bill was only $30K, and $13K got written off. But of course, if someone without insurance wound up in my situation, their responsibility would be the full $43K. How does this even make sense?

And, of course, while having health insurance has protected me from the financial ruin that would've come from this lovely experience with cancer absent insurance, it's had its costs as well. Most notably, my options for treatment are basically limited to those Group Health offers. Even if SCCA was interested in me as a patient and I wanted treatment there, it's not really on option for me under my current insurance plan.

Like I said. The way we allocate healthcare? Nuts. 

1 comment:

  1. Glad you are dealing with cancer so well, a lot of people just really loose motivation but you have managed to channel your energy through the blog. It inspires me and you give people hope through this. Glad you had insurance to cover your costs, I know how very expensive all this treatment can be. Keep your chin up!

    Derek @ U.S. HealthWorks Santa Ana (Tustin Ave)

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