$12K For 25 Stitches: American Healthcare is Broken (Part 1)

Part One of several posts about how health care can be a heck of a lot better in this country.

It’s about the least surprising thing to say when talking about health and medicine in the western world: it’s totally fucked up. The system doesn’t serve people in the best way for their health, opting instead in many cases for pure survival. And that’s just the actual medical establishment, the place folks end up when something is going really wrong, whether it’s emergency trauma or the culmination of a chronic illness.

The pieces of health are not just what it takes to not “spend your last 10 years in a diaper and a wheelchair” (a genius post by Chris Kresser, who lured me into a lot of this research about 5 years ago by those very words). No, the pieces of health are far larger than just showing up at the doc’s office or the hospital when things are really wrong (or even just somewhat painful).

Emergency medicine in our society is extremely effective (and expensive), so if you are in a car crash, even if you don’t have money, you can and will get “fixed”. That means you’ll have bones pinned together, skin sewn up, fluids replaced, and (hopefully) infections prevented or addressed.

Original source: Broken Heart Source Image

Original source: Broken Heart Source Image

But even if you are faced with a relative trauma, the current state of the system can take down to slivers the savings of most average adults. Take, for example, something that happened just a few days ago at a massive health conference in Austin, TX called Paleo f(x). Darryl Edwards, one of the activity gurus, ended up with a mis-timed head butt and split open his eyelid. He didn’t think it would need intervention at first, but then he was convinced it wasn’t just a scratch by folks who kept noticing the bleeding gash.

Once he finally figured out that he really did need stitches, someone wanted him to get an ambulance. BUT. Because Darryl is from the UK, an ambulance would be about $4K right out of his pocket. Ok, so he should find someone to drive him to the ER. BUT. Emergency rooms have pretty long wait times. It was suggested, “go to urgent care”. Finally, word got around to the wife of a local dermatologist. He was taken right to their office and was taken care of, sewn right up to the tune of 25 stitches as a favor to a fellow health guru for no charge. The dermatologist told him that it would normally cost about $12K. TWELVE THOUSAND DOLLARS.

Even before the ambulance when it was looking like $4K out of his pocket, Darryl considered getting on a first class plane back to UK so that he could walk into a local doc and get things taken care of for free. The fact that someone without insurance considers a transatlantic flight in order to NOT spend about $16K on stitches is, a little, crazy.

In the next few blog posts I’ll go from panic-inducing examples like this to somewhat of a means to a solution. It involves the word OWNERSHIP. And we’ll get there.

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Why My Health Plan Was Killed by Obamacare

When I got the envelope in the mail from my private health insurance company, I didn’t think much of it. They send me various stuffed envelopes all the time, usually containing something I just need to file or toss out.

This one, however, was different, beginning with the ominous statement, “your policy will end on December 31, 2013.”

Celtic cancels me

Whoa.

So, I became one of those folks in the group represented by outraged reporters talking about how Obama said, “you can keep your policy if you like it.” and then went back on his exact words. I “liked” my policy, in that it was relatively cheap and gave me catastrophic coverage in the event that I have something happen that could otherwise bankrupt me. I’d be out my huge deductible ($6K) and then not a penny more.

But that sounds like it might never have actually happened: people with plans like mine have had a long history of getting dropped by their company the second it appeared your account might start requiring lots of payouts. Generally the (legal) reason cited is that you withheld information on your original insurance application. Say, your claim involves checking out and biopsy of moles on your skin – the company could say that you didn’t note that you have lots of moles. Or, you are getting treatment for back pain issues but never mentioned in your application that you’ve ever felt a bit of back pain in your life. That’s an undeclared pre-existing condition, and therefore eligible for policy exclusion.

And it gets worse – the internetz are full of these kinds of reports from consumers:

There was no law against this. So if that catastrophe happened, the insurance company could have (and might very likely have) paid out some hospital days or one inital ambulance ride, then called the whole rest of it a separate case (due to that pesky pre-existing or bad application stuff above) and dropped me like a hot potato. No recourse, only bankruptcy. Or a legal battle that you as the patient MIGHT win, but might not.

Then, there is my friend on the East Coast, paying for private insurance that costs far too much and hoping against hope that this whole Obamacare thing that is coming might actually benefit her and her partner. But she is very wary:

I’m afraid to be excited about this

– my friend (self-employed), regarding Obamacare’s having a) much lower costs & b) better coverage than their current plan.
She was rightfully paranoid for a long time, unable to process the very real possibility that her health care situation could, all of a sudden, get WAY better. She and her partner were paying nearly $750 a month for truly shitty coverage while needing periodic care and prescriptions.

A summary of our befores and afters:

  • ME, Before: $120 per month with almost certain droppage after a major event. ME, After: $190 per month with far better basic coverage and no chance to be dropped.
  • Her, before: $729 per month for “insurance” that did almost nothing she needed. Prescriptions were mostly out of pocket because the deductible was too high. Her, after: $341/mo with much lower deductible on prescription coverage. Her out of pocket per year goes from ~$8700 to ~$4100, and that’s just premiums. Nice deal.

And that’s how it works. It has to work that way. I am one of those gravy insureds: I am healthy. I’ll withdraw a few hundred bucks per year or less of my annual premiums in benefits. I am the person who helps to subsidize my friend on the East Coast. I am critical in the system as is everyone like me.

A special thank you to Julie today!