Monday, September 19th, 2011
I woke up at 4:00 in the morning on August 24th feeling like I had been hit in the gut with a baseball bat. I assumed it was an evil bladder infection, so I chugged a pint of water. Within a few minutes I threw up the water. It definitely was not a bladder infection. I must have injured my back weed-whacking. I soaked in a very hot tub. The pain became worse. The baseball bat became a knife. I got dressed and found my car keys, but I couldn’t make myself drive. I was being stabbed to death. Today was my day to die. I called friends and by 6:30 I was in the emergency room of the hospital fifteen minutes from my house.
Within a half hour of my arrival, a doctor heard my classic symptoms and diagnosed the kidney stone, prescribed a dilaudid IV, and ordered a CT scan to confirm the diagnosis. Within an hour of arriving at the hospital, the pain was almost gone. Around 7:00 am the morning shift came in and the night shift went home. I was handed off to a new doctor and nurse. The CT scan took five minutes. Getting the radiology report, faxed in from an outsourced radiologist, took about 45 minutes. All in all, it seemed like a pretty efficient operation.
The report confirmed the 2mm diameter tube from my kidney to my bladder was being sliced up by a 4mm glass rock on its way home. In the next few hours, I had about four doses of dilaudid. They took a urine sample and found evidence of infection. The doctor explained to me what Flomax does to increase urine flow for men with prostate problems, and suggested I take the drug to dilate my tubes to make way for the stone. By 10:30 am, thanks to the help of another friend, I was on my way home with prescriptions for dilaudid for the pain, Cipro for the infection, and Flomax to make me feel like a man.
I expected to pay a few thousand dollars for the hospital visit. I knew just walking in the emergency room would be an automatic $1000. I was surprised the three prescriptions were only $45. But I was shocked to receive a bill for $4200 from the hospital, which doesn’t include the fee for the outsourced radiologist. I haven’t had health insurance since 1998 when my health insurance company stopped doing business in Massachusetts. Since then, health insurance has been much more expensive than paying for my healthcare myself. I am healthy. There is no history of heart disease, cancer, or diabetes in my family. I have been to see my family doctor less than a dozen times in ten years. My healthcare expenses for the past ten years have been less than $5000. I had no frame of reference for what a kidney stone could cost.
I made a couple phone calls to the hospital to better understand my bill. Ultimately, I decided it was worth $4500 to eliminate that pain. I received excellent care. But I am still trying to be an informed consumer. I don’t understand all the charges on the invoice, and I’m not going to be satisfied until I do. The person I spoke with assured me the rates I was charged are “usual and customary” for our region. In Massachusetts, hospital rates for each service are approved by a state commission. I received a 5% discount off the original amount of $4426.91 for being uninsured. And she added, “you are paying for healthcare for the poor.”
Of course, I am. But I was surprised by the way she said it. As though she was reminding me of an obligation. I am not poor. But I am not rich. I work for a living, and my income barely covers my expenses. I don’t have health insurance because I can’t afford it. The least expensive health insurance policy I can get here in Massachusetts is about a $500-a-month premium for a $5000 deductible. That’s $6000 a year — more than 10% of my income, more in one year than I have spent on healthcare in the past ten years. If I had one of these policies since 1999, I would have paid $72,000 to an insurance company, and I would still have to pay $4500 out-of-pocket for this kidney stone. That doesn’t seem fair or reasonable. This kind of health insurance is not good money management, it’s not cost-effective, it’s not affordable, and it feels abusive. But purchasing it is exactly what government health insurance mandates require me to do.
I believe poor people should have access to free healthcare, but I am hoping the Supreme Court strikes down as unconstitutional the health insurance mandates in Obama Care and Massachusetts. It can’t be legal for the government to force every citizen to purchase a commercial product. This is not the same as car insurance because, A.) you can choose not to have a car, B.) unlike with health insurance as your car ages the price of car insurance goes down, and C.) you can choose a low cost car to reduce the cost of your insurance.
The health insurance mandate sets a dangerous precedent by requiring citizens to make a life-long purchase from one business (insurance) to reduce the cost for some consumers (poor people) of another business (healthcare). Could the government require each of us to buy beef to keep a Big Mac more affordable, even if we are vegetarians? Could the government require each of us to buy a Chevy or a Ford to save Detroit, even if we don’t drive? Then how can the government require us to buy health insurance whether we need it or not, whether we intend to use it or not, whether it covers the kind of care we need or not?
I would rather pay my own personal medical expenses plus $1000 a year to my local hospital to cover the cost of healthcare for those who can’t afford it. If everyone else in my area did that, it would mean about $20 million a year to fund healthcare for the poor, more than enough to keep our hospital financially sound, and far less than we now pay for health insurance. We would see our healthcare dollars in action, we would be more conscious of how healthcare operates, we would have more options for controlling the costs, we would be creating jobs for ourselves, and we would very likely be a healthier community.
The health insurance mandate is another convoluted Wall Street scam that amounts to corporate welfare masquerading as social welfare. The United States of America should have a single-payer healthcare system. That’s the only real universal care. A single-payer system can be a sliding-scale, fee-based system where those who can afford to pay do so, and those who can’t afford to pay get their healthcare for free. I would still pay $4500 for my kidney stone, maybe more. But I wouldn’t pay $76,500 for my kidney stone as the law now requires.
I am a free-market capitalist. But Adam Smith’s free market forces don’t play in healthcare because healthcare is often a life-threatening emergency. There was no free market competition when I thought I was going to die. There was only one place to go — the hospital nearest me. The next nearest hospital is 45 minutes farther away, and others more than an hour away. I couldn’t shop around for the best place, the lowest price, or the most high-tech treatment. Emergency healthcare does not allow for comparison shopping.
Without place-based competition, the commercial healthcare system has no economic incentive to reduce costs. Reducing our costs reduces their income. If we had a community-based single-payer healthcare system, it would be in the community’s enlightened self-interest to control healthcare costs. Wellness programs — the kind that most people don’t have access to now because they don’t generate big corporate profits — would be an essential tool in serving the economic interests of communities. For example, regular check-ups, medication adjustments, nutrition and weight-loss guidance, stress management, and fitness programs could reduce heart disease, cancer, and diabetes, the plagues of our time.
The public debate between commercial healthcare and community healthcare is going to come up again. Lobbyists will again crank up the fear of socialized medicine, rationing healthcare, and death panels. This time, let’s do a better job of presenting a single-payer system as potentially lower cost, more accountable, and better quality. Let’s talk about community-based single-payer healthcare as a local jobs program at the heart of economic development and homeland security. Single-payer has the potential to build the health and wealth of our communities. The most efficient healthcare system is the one that keeps our healthcare dollars closest to home.
Commercial healthcare has become corrupt. Today, the main function of health insurance companies is to reduce the amount of care we receive while they reduce payments to service providers for the care they give. That’s not providing value for consumers, or doctors and hospitals. Health insurance companies are an unnecessary layer of bureaucracy, and an enormous, inefficient administrative burden. They prey on our families and our fears. It’s time for them to go. It’s time for Americans to embrace a community-based single-payer healthcare system.
Tags: Public Policy