Health Care Crisis

Now that the last of the congressional health care bills has been unveiled, and the health care debate is in full swing, it seems like an opportune time to reprint this post from February 2007, in which I describe my own encounter with the American health care system:

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In December 2005, I was on a group biking tour of California wine country when I got going too fast on a steep downhill, couldn’t quite make it around a sharp left turn, went off the road, and fell over. My last thought as I went down was, “oh, this won’t be so bad, I’ve slowed down considerably.” The next thing I remember is being loaded onto a stretcher. I have no memory of anything in between, but I’m told that after my friends revived me (I was out for about a minute), I tried to get back on the bike and had to be restrained. Thank heavens, I was wearing a helmet.

An ambulance took me to the hospital. I looked like something out of a horror movie (photos here), but in the end the only real damage was that I broke one small bone in my left hand, which the doctors taped up. My ribs were pretty sore, but the doctors couldn’t quite tell whether any were broken. They thought not, but since there’s no treatment for ribs anyway, they didn’t bother to make certain. The hospital did a CAT scan, and the doctors said, oh, there might be some bleeding in your brain, we’d better keep you overnight. So I stayed overnight (in a semi-private room), and then the next morning, they did another scan and said, no, everything’s fine, that first scan must have been a false positive, go home. They did another scan in there somewhere to check for broken bones. And they gave me some pain medication and cleaned me up generally. And that was it. No surgery or anything like that.

So. Three scans, pain medication, tape for the broken bone in my hand, and not quite 24 hours in the hospital. Go ahead and take your wildest guess how much that would cost.

Most people have guessed something like $3,000 or $5,000 or maybe $10,000 at the most. That was their wildest guess. The bolder guessers have picked $12,000 or $15,000. I think the highest guess was $20,000.

How about $45,000? In your wildest imagination, could you ever guess that that would be the bill? Well, it was. For some reason the bill reflected an “out of state adjustment” for my insurance plan of about -$11,000, which brought the total down to $34,000, but $45,000 is what the hospital thought the services should cost. And bear in mind, that was just the hospital. That’s before the doctors and the ambulance.

$45,000! And there was nothing wrong with me! I broke one bone in my left hand! I didn’t even need surgery! What if there had been something wrong? What if I’d really had some bleeding in my brain or something else that required surgery? Would the bill have been $245,000?

I am reminded of all this because I have just received the bill for the amount I actually have to pay. My insurance company, perhaps understandably, was a little skeptical about this bill and kicked it back and forth with the hosptial for over a year. It was somewhat unnerving to have a $34,000 bill hanging over me all that time, even though I knew I wouldn’t have to pay all of it. Based on what I thought I knew about my insurance plan, I guessed that the insurer would disallow about half the bill (its usual practice) and then I would have to pay 20% of what remained, in other words about $3,400. For some reason that I didn’t understand (but am certainly not complaining about), that’s not how it worked. The insurer actually forked over a little over $31,000 ($31,112.81 to be exact), and my share came to a bit less than $2,000. I felt like I’d gotten off easy. Of course, with the doctor bills and the ambulance bill it all came to somewhat more — my total was $3,169.40. My insurer kicked in a total of $32,526.69, making the grand total $35,631.99.

Man! If you’ve ever wondered whether there’s a health care crisis in this country, let me tell you, there is. I understand now what people mean when they say that most people are just one accident or bad illness away from bankruptcy. Imagine if I didn’t have insurance! The hospital would be coming after me for $45,000. Combined with the other charges, the total amount the medical system would be seeking from me would be $48,235.35.

For one broken bone! OK, they had to check whether there was anything worse, but still! If this is what one broken bone costs, what does a serious medical problem cost?

How do people without insurance manage? There are almost 50 million of them, you know. I presume most of them don’t have the odd $50,000 that they can just throw at a medical bill. I guess they just pray to stay healthy.

I lead a highly privileged existence. I have a good job that provides good health benefits, and I could afford my share of the costs of this accident. But even I was unnerved by the stunning cost of just falling off your damn bike.

Fortunately, I’m just a law professor. It’s not my job to fix the health care system, and no one could expect me to know how to do it. But boy, if it is your job, you’d better get cracking. There’s a crisis.

My hand still hurts. Always wear your helmet.

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5 Responses

  1. DCLawyer says:

    Thanks for sharing – that’s an interesting and enlightening account.

    I’d note that if you had a high deductible, inexpensive plan (known in the vernacular as a catastrophic plan that pays nothing until you hit a few thousand but then kicks in), you’d probably be out the same amount out of pocket.

    Why don’t more people have low cost high deductible plans? it is because of state regulations that, in essence, mandate coverage levels and make it impossible? (I’m asking – it’s not a pointed question). I have the sense that its like a law that says we all need to have safety features on our cars comparable to a Mercedes, and then complaining we can’t buy a $15,000 car any more.

  2. Strange story – after all, you were in California which is blessed with a large “undocumented” immigrant population, a heavily unionized state and local government infrastructure (with genorous retiree benefits) and large swaths of progressive voters; all of which I am told lends itself to decreased costs, increased efficiencies and a more caring and nurturing society, unfettered by the crass demands of materialism.

    I’m going to just chalk it up as an aberation.

  3. TalkingHead says:

    My wife and I had a similar experience in Las Vegas, NV (MD conservatarian might note NV is a libertarian mecca). We were insured (by the U.S. government) for my wife’s pregnancy (twins). The twins were in the neo-natal intensive care unit for several days. My wife was fastidious about asking each provider whether he/she/it was on our plan. (She even asked the doctors preparing to perform the C-section.) We were in network, or so we thought, at a hospital covered by our plan. As it turns out, the NICU unit doctors and insurer had a dispute over renewal of their in network status. We were unlucky enough to fall in the crack in between their being in network. As it turns out, the NICU doctors belong to a nationwide practice and they were the ONLY game in town — the only doctors who provided these medically necessary and emergent services anywhere in NV. Thus, the insurer’s promise of in network neonatal coverage was really just illusory.

    Our share of the bills would have equaled over $35,000. I fought long and hard with the insurer and had to appeal over the course of more than a year. I finally “won” (and thereby only had to pay about $4,000), but I could easily see a non-attorney just simply rolling over. I understand from Professor Elizabeth Warren’s work that many people end up filing for bankruptcy due to medical bills. I see how that easily could happen. Lucky for us, we had a significant rainy day fund, but it could have easily been otherwise.

  4. I’m guessing it was the scans: Medical scanners are ferociously expensive capital purchases, and if they don’t have a high rate of utilization, the cost amortized per use can be insanely high.

    BTW, one the subject of high deductible policies, I’ve got one, and I’m rather disturbed that the currently proposed plans all seem intent on outlawing them.