Health Care in the US – A Post Mortem

I do have a few thoughts about the state of health care in the US as a sort of post mortem following my wife’s recent health crisis. I’ve been paying attention to the insurance statements and bills as they have arrived and the results have been eye-opening even for me.

The amount billed by the various providers and hospital totaled over $50,000. If we did not have insurance, a fact of life for over 40 million Americans, that’s how much we would owe. There was nothing optional about it. If my wife did not receive the care she received, she would have died. Even with all the medical care she received, there were some frightening moments. Sepsis can be fatal despite quick medical intervention.

That’s the fundamental reason “market forces” (the voodoo doll of many modern conservatives) don’t work in health care. There is no point where you can say, “I don’t want that,” and walk away. It doesn’t matter how much it costs. In an emergency, you won’t even fully understand everything that’s happening, nor will you have time to research it on your own. Instead, you listen to the medical providers, and make the best decisions you can. But there is no price that is too much to save the life of someone you love.

However, the problem does not stop with the uninsured in our country. Millions more are under-insured or poorly insured. They have policies that don’t negotiate procedure prices with providers and whose coverage is more limited. While someone with such a policy might not have had to pay $50k, they could have easily been on the hook for anything from $5,000 to $25,000. And after the insurance company paid the claim (if they paid it), someone with such a policy either would have been faced with exorbitant premium increases or had their policy canceled outright.

Fortunately, we have a good insurance policy with a large group. The negotiated, allowed amount from all the procedures and care in our case was less than $5,000. (That’s another problem with our current system, of course. If you have decent insurance, you won’t actually know the “secret” negotiated amount your insurer has negotiated with the provider until after the fact. It’s another ancillary reason the magical “market forces” don’t work.) Out of that amount, we paid $500 or so ourselves with the insurance company paying the other roughly $4,500.

While I’m glad my family has decent health insurance, fewer and fewer Americans do. (If the Republicans get their way with Medicare and repealing rather than improving elements of the Affordable Care Act, that number will spike tremendously. Hopefully my countrymen are not stupid, delusional, and self-destructive enough to take that path, but that’s not yet clear.) Since my two youngest children both also have celiac disease, I’m grateful for the extra time the ACA bought us by allowing them to remain on our coverage until they 26. By then, hopefully, the remaining provisions of the law will be fully in place and they will be able to obtain the coverage they need at an affordable price.

I’m not thrilled by the ACA. Given that Medicare operates at a 98% medical loss and has a great deal of negotiating strength (at least where Congress hasn’t stripped that power as they did in the prescription drug extension to Medicare), I would vastly prefer that we simply extend Medicare to all Americans. However, Republicans and Democrats have been fighting that battle fruitlessly for four decades. I agree that it was better for the Democrats to concede and pass the long-standing Republican health care reform plan than continue to do nothing. (The Republican response, of course, proved that if they had ever been serious about health care reform, they aren’t anymore. The Democrats passed the Republican plan and the Republicans threw a hissy fit and launched a massive propaganda campaign in response. It would almost be amusing if it weren’t so disgusting.) Hopefully we can continue to improve the ACA, which will, by reforming the overall health care sector, also save Medicare. We don’t have a Medicare problem. We have a health care problem.

I guess it remains to be seen if a majority of Americans grasp reality or if a majority of us are mired in delusion. That’s really what it comes down to.