The Healthcare Crisis A True Story

Posted on July 1, 2009 by Greenberg & Bederman

 

This is a true story that Greenberg & Bederman is sharing that happened to a colleague of ours to illustrate yet another reason our country is in a healthcare crisis.

Back in 2003, I got sick.

I know that isn’t the most earth-shattering of statements. Everybody gets sick, after all. But I got VERY sick.

At the time, I had just gotten out of college and was struggling to find a job. In order to pay the bills I began substitute teaching, which meant that every day I was sent into a different classroom full children, with the age ranging anywhere from 5 to 17. On occasion I would end up in a high school, but for the most part my duties would involve looking after grade school students.

Young children, as many of you who are parents may know, are quite susceptible to illness and infections. And considering that I was a bachelor in his twenties, I can tell you with great certainty that my immune system wasn’t exactly operating at its peak performance. So within three weeks of starting my substitute teaching duties, I got a sore throat.

 

The difference was that it didn’t go away. It got worse and worse, so much so to the point that after three days I was unable to swallow anything, or even talk. I brought myself into the emergency room and wrote down my symptoms to the admitting room nurse. After waiting for about an hour, they brought me in and gave me x-rays and further pokes and prods. Then another doctor came in and shoved a fiber optic camera up my nose and down the back of my throat, and then I was informed that I had a badly infected epiglottis.

For those of you who don’t remember your high school biology, the epiglottis is a piece of cartilage that forms part of the voice box. It remains inert while you are breathing and talking, but when you swallow food or water it expands to cover the trachea. This is what keeps food from going down your windpipe.

Mine was swollen in place, and the doctor told me that it was the medical equivalent of a garage door being rusted shut. They put me to bed, gave me extremely powerful intravenous antibiotics, and fed me jell-o, broth and tea, and I stayed there for three days.

What is important to note here is that at the time I did not have health insurance. It wasn’t a matter of irresponsibility on my part. I wanted health insurance, but I simply couldn’t afford it. Not on a substitute teachers pay.

The initial bill for my treatment was $10,000. The hospital allowed me to plead “financial hardship,” and lowered the bill to $7,000. The bills took me about two years to pay off.

What makes this story interesting is not necessarily my past illness, but rather what happened about a week ago. I was down in Richmond, Virginia visiting some friends, and I ran into a person I went to college with. We reminisced about old times for awhile, and then he mentioned that he had just gotten out of the hospital. When I asked him why he was in the hospital, he asked me if I knew what the epiglottis does.

It turns out that my friend had the exact same illness, received the exact same tests and treatment, stayed in the hospital for the exact same length of time, and was even fed the same jell-o, broth and tea diet. I knew that my friend had a good job that provided him with health insurance, so I asked him what his out of pocket costs would be, and he told me that it was going to cost him $7,000.

I asked him if he had bad insurance, and he told me that he had chosen the most expensive coverage that was available under his company health plan. The problem was that the insurance company didn’t agree with many of the tests and were refusing to pay for them. They also claimed that my friend was kept in the hospital a day longer than necessary and they were refusing to pay for that as well. His employers were filing appeals and were doing everything that they could, but my friend was not optimistic. He was weighing his two options, which were depleting his savings to pay the bills or getting a second job on the weekends.

To recap, my friend and I had the exact same illness and got the exact same treatment. I did not have insurance, and he did, yet the illness cost us the exact same amount of money.

It was an interesting time to have that particular conversation with my friend, considering that at the time of this writing, President Obama is attempting to move forward with health care reform. Opponents of his attempts are painting a very dire picture, claiming that any reform will end up ruining American health care by forming a huge, inefficient government run bureaucracy.

One of the many vitriolic right-wing radio hosts described efforts at reform as “…government telling us what doctors we can see, which treatment we can have, and what pills we can have.” That seems like nothing more than a description of the status quo.

Have you ever tried to see a doctor that was out of your network? If your treatment isn’t refused outright by the doctor, your insurance company will probably refuse to pay for it. Right now it isn’t the “government telling us what doctors we can see.” It’s the insurance companies.

Considering how my friend was treated by his insurance company, the idea of “government telling us what treatment we can have” doesn’t seem like much of an issue. Anyone reading this can have any treatment that they want, but the prospect of their insurance companies actually paying for that treatment is probably fifty/fifty at best. Actually, seventy/thirty is probably more accurate, considering that my friend had to pay $7,000 out of a $10,000 bill.

And as far as “government telling us what pills we can have,” I actually went into get a prescription filled about a year ago, and I expected the price to be about $10. It turns out that it was $210. When I asked my insurance company why, the answer was because the prescription that I needed wasn’t on the pre-approved list. I asked to see the pre-approved list, and basically that list contained medications that were all old enough to be sold in generic form. So under my insurance company plan, they will pay for any pill, so long as it isn’t the newest and best medications. In order to have that sort of coverage, it would have cost me an extra $75 a month.

Everyone is still taking a look at how this health care reform is going to play out. President Obama seems to be taking the tactic of “let them legislate,” which means that he is perfectly fine with Congress and the Senate batting around ideas until a suitable compromise is reached. While that is all well and good, you have to wonder what good health care reform would be if there was no insurance reform to go with it. Because right now, insurance isn’t “coverage” as much as it is a “coupon.” In the case of my friend, he thought he had insurance, but what he had was 30% off.

We currently live in a country where anyone who gets sick can go broke, regardless of whether they have insurance or not, and that seems much more frightening than getting government involved in health care.

Greenberg & Bederman is apersonal injury lawfirm located in downtown Silver Spring, Maryland, one half block form the Metro Station, one mile to the Washington DC line. Free consultation.
Tags: , , , , , , , ,