My Own Experiences with Health Care

September 12, 2013 Personal, Politics / Religion Comments (15) 390

In the three days since I posted my surprisingly popular Breaking Bad: Anywhere But America Edition comic strip, and since Michael Moore very kindly retweeted both the comic and my unscientific poll on socialized health care, my blog and Twitter have become venues for discussions of the American health care system and its alternatives.

And I have a confession to make: I’m not informed enough to really engage in this debate. I mean, I know the basics, and I’m suddenly motivated to get much deeper into the policy, but even though I’m a bit of a policy wonk, I know a lot less about health care policy than I do about, say, Constitutional law and related jurisprudence.

What I can do is share my own personal experiences with health care in the US—and [pullquote]if you are kind enough to share your own experiences, especially as they contrast with my own, we might really produce something illustrative and useful.[/pullquote] So here we go:

For starters, when I was 15 I fractured a vertebra in my lumbar spine. Never mind how; the story involves high school gym and a tall set of bleachers and a massive moment of personal stupidity. Luckily my dad had a job with good health insurance, and we were able to afford the ensuing hospitalization, the back brace I had to wear for a few months, and the physical therapy. Though looking back now, it may very well have put my family on the verge of bankruptcy, and my parents never told me—though I doubt it.

While that fracture healed and has impacted my life since age 15 almost not at all, my orthopedist did explain that due to the slight curve my spine healed into, there was a chance—somewhere between 5 percent and fifty percent, he helpfully volunteered—that I would lose the use of my legs at some point before I died.

Now here’s the important bit: He also advised me that, from that day on, I had to have health insurance every day of my life, because otherwise my broken spine would become a pre-existing condition, and health insurance companies would refuse to pay a penny toward any health issues that developed from it—including any future paralysis, physical therapy, wheelchairs, and so on. As long as I maintained coverage without any momentary lapse for the rest of my life, my back injury would always be covered.

I will point out here that the Affordable Care Act (AKA “Obamacare”) made it illegal for health insurance companies to refuse to cover pre-existing conditions. This is one of those few important ways in which the ACA really did improve American health care. Now, if for any reason my health insurance were to lapse for even a day, I wouldn’t have to worry for the rest of my life that my spine was a ticking financial time bomb—I can stick to worrying that it might someday take my legs away.

In 2006, when I was twenty-seven years old, I was hospitalized in Allentown, PA for acute appendicitis. I was once again lucky in that I noticed the problem early, and there were no complications from the surgery. I was hospitalized overnight, stayed an extra day for recovery, and went on my merry way.

For the next three years, my health insurance company and the hospital into which I’d been admitted argued over exactly how much my two-night stay should cost, and who was responsible to pay it. During that time, I would periodically receive invoices from the hospital for roughly $19,000. Sometimes I would get harassing phone calls from collectors, threatening legal action if I didn’t pay the bill. Just for perspective, my net worth at the time (accounting for student loans and payments on the car I needed to get back and forth to work) amounted to approximately negative $11 thousand.

When I would phone my health insurance company (which soon became my former insurance company thanks to a job change, though the billing issue continued) they would advise me that this was just part of the negotiation process, that they were going to pay the bill and I wasn’t liable, but they were negotiating for a lower price on certain services and in the meantime the hospital was harassing me, but I shouldn’t worry and I shouldn’t pay. This went on for three years, including a period of time when I changed my cell phone number, and the hospital collection agents instead harassed my parents at my old home number.

This past April, my girlfriend, Liz, was at the finish line of the Boston Marathon when two bombs exploded. She wasn’t close enough to be injured, but she was close enough to feel the blasts and, having just completed a marathon, to join a crowd of people screaming and sprinting for what they believed were their lives—the common belief at the finish line, as she has explained, was that the explosions were bombs, and that there were probably more of them.

Along with being a really excellent personal trainer and running coach (plug, plug) Liz is an actress and gets her health insurance from the Screen Actor’s Guild, but because she only barely qualifies for their most basic plan, her coverage does not include mental health care*. The Boston Athletic Association, which did a pretty top-notch job of dealing with a horrific and unexpected end to their annual celebration, did offer free mental health consultations to runners and spectators impacted by the bombings. After a week or two unable to sleep through the night, Liz phoned them. They told her she had all the symptoms of Post-Traumatic Stress Disorder, and that she should wait three months and call back if she was still having trouble.

In general, I should note that I have been very fortunate with both my health and my health insurance. I have been lucky to live most of my life as a privileged upper-middle class white male, which means I’m automatically better off than about 90 percent of Americans. I was covered under my parents’ plan throughout my childhood and through college, and I’ve had better-than-average plans through my employer for my adult life. I’ve been lucky not to have many serious health problems or illnesses. When I needed PT in the mid-2000s because of muscle problems stemming from my back injury, my insurance paid for it. When I needed rhinoplasty a few years back because of breathing problems, my insurance paid for it. And when I went through a period of major depression a year or so later and desperately needed a therapist, my insurance paid for that—well, mostly. I was on the hook for $35 a session, which I realize is still more than a lot of people could afford.

But as I said, I’m lucky. I lived most of that time in Pennsylvania, which has better regulations on insurance companies than a good bit of the country. I also got lucky to find several very good doctors, who helped me navigate the nebulous world of insurance billing, and often wrote prescriptions in a way that gave me the best chance at coverage. I could just have easily been victimized by crooked doctors who were interested in helping my insurance company make a profit, and maybe getting a nice year-end bonus or a free trip to the Caribbean.

So that’s a quick summary of my major experiences with health care in the United States. Now here’s what I’d ask you to do, if you’re willing:

If you’ve had health problems similar to my own, would you share what your own experiences were in dealing with doctors, hospitals, and insurance companies? Especially if you live in a different country, a different state, or a different economic situation than I’ve experienced myself. There are a lot of readers coming in from Europe right now, and I’d love to know what happens in Europe if you break your back, if you require emergency surgery, or if you’re suffering PTSD or similar mental illness.

I think if we can show some of the contrast of experiences, we might really be onto something. After all, we’re all human, and our bodies all work pretty much the same way in terms of illness and injury. What differs are the political and economic systems in which we find ourselves.

15 Responses to :
My Own Experiences with Health Care

  1. John Joseph says:

    I am 61 living in Australia since 1975. My government Medicare levy is about $1200 per year- taken out at tax time and my wife and I have private health insurance costing $4000 per year for a couple. We have a wonderful public health system. Major operation for testicular cancer – cost me nothing in 1996 as I was a public patient in a public hospital. Recently my wife had a mastectomy for breast cancer plus chemotherapy- she used her private health insurance- private hospital and private doctors- hospital cost $500 (excess we paid) and some other out of pocket expenses under $1000.

  2. Lin Hendler says:

    I was born with a complex heart defect, but I tried to never let it get me down. Despite having an open heart surgery in college and after law school, I did pass the bar and became a lawyer. I experienced healthcare systems both here and socialized care as a graduate student in the U.K.

    In the u.k., despite being a foreign student, I paid five pounds for any and each of my medications. I had my yearly heart exam at Royal Brompton. It was free and I was seen by the best cardiologists London had to offer. My cardiologists back at the teaching hospitals in the u.s. referred me to them and had the utmost confidence in them. I did not have to wait at all to see them.

    Here, in the United States, my first open heart surgery was referred to another expert in the field at UCLA medical center as I have a complex heart defect. I was 19 at the time and in college. After the surgery was completed, my family learned the referral to an out of state expert because my case was so complex was out of network. We talked to lawyers, but they did not think we had a winning case. My mother later declared bankruptcy.

    While my yearly heart care would have been free in the UK, I personally pay approximately $1000 an echocardiogram yearly. I also pay $250 for a weekly blood test. I feel like as a young professional with law school debt as well, these sorts of burdens are meant to keep the sick down in poverty.

    The final blow was when my insurance decided my cardiologist team was now out of network. In my state, only one group of cardiologists deal with complex heart defects. I would now have to pay them completely out of pocket with my echocardiogram alone costing $5,000. My in network provider faxed in a letter to my insurance company letting them know that they were not capable of providing me cardiology care. The insurance company still denied my exception. I am appealing, but today, I am still a complex heart defect patient without cardiac coverage. My options are basically to wait until an emergency which costs everyone extra in the long run, and hopefully won’t cost me my life.

    This doesn’t even cover what it takes to go through open heart surgery jobless in America just having graduated law school. I’ll spare you that story. Suffice to say we don’t offer much support for those in that circumstance. I know through experience — but I made it, fortunately.

    Thanks for reading.

    1. Daemoncan says:

      Just goes to show you that “the market” does not ensure competition or “reasonable” pricing. An echocardiogram at a private clinic here in Quebec costs $350. How any institution with it’s mission being health care can justify $5000 for a 1/2 hour non-invasive procedure is beyond me. Only explanation is CEO changes his yacht as often as he changes his underwear.

    2. Adolfoe says:

      In Costa Rica an echocardiogram at a private clinic cost about $100

  3. Hey Christopher. First to say, I loved your Breaking Bad cartoon. I often wondered with Walt’s drug money being used to pay for both his own and Hank’s treatment whether Vince Gilligan was making a point about the US private health insurance system.

    Twice this year I’ve had cause to marvel at how lucky we are in the UK to have the NHS. Early this year I fell in Austria on a skiing trip and had to pay around 500 euros for (very good) treatment over there. When I got back, I simply sent the NHS my receipt and they reimbursed me the entire amount, no questions asked.

    Then last month I

    1. Then last month I was referred by my doctor to a big central London hospital for persistent headaches. I was seen within two hours and although they thought haemorrhages or tumours were unlikely, I was still given the full range of scans and tests, costing thousands of pounds, just to be on the safe side. When it turned out I had viral meningitis (an unpleasant but non-life threatening condition) I was amazed that they still called me back in for check-ups with the viral diseases department and were so concerned about my recovery. Obviously there was never any question of me paying for any of this.

      My concern is now that our government is seeking to privatise our health service by the back door that this kind of care will be compromised. Even if the service here remains free at the point of use, will a private healthcare provider with their profit margins to consider really be that interested in the wellbeing of patients and spend money on expensive scans etc just to be on the safe side?

      1. I should also mention that my own father was diagnosed and died of lung cancer last year. Through work, he had access to private healthcare but elected to have his palliative care on the NHS as his insurance didn’t cover the full range of treatments he needed and private hospital lack the resources of public ones. I’d say the service was mixed – they did absolutely everything they could for him and the home care he received free on the NHS was excellent. But when he was admitted to hospital you could see about more why the service is criticised – bureaucracy was an issue when it came to seeing the right doctors and overcrowding in the hospital meant that his care was no more than average. But again, despite all the trauma and horror of his cancer, it was such a relief to know paying for treatment would never be an issue.

  4. James Young says:

    I am Canadian. I have never put my hand in my pocket to pay for healthcare in my life. The only cost associated with the birth of my children was buying a parking pass at the hospital. When my children get sick, I take them to a walk-in clinic. I give the clinic the kids’ health number, and a doctor treats them. When my doctor orders tests, he gives me a piece of paper that I give to the technicians and they do the tests. When I hurt myself playing sports, my doctor referred me to a specialist and the specialist didn’t charge me either. Weird, eh?

  5. I am a retired Canadian who has been fortunate to have good health. As a volunteer driver I regularly take many people who are not so lucky to a variety of medical appointments. Many have not worked in years but they are covered 100%. Even parking at clinics and hospitals is covered for volunteers through another branch of government.

  6. Stacy says:

    I have lived in both countries. The “free” healthcare is wonderful but the taxes and cost of living are so high in Canada, it makes it completely unaffordable. Healthcare costs Canadians a lot, they just don’t realize it. I find the healthcare system in the USA far superior. You don’t wait for tests and specialists etc, if you don’t have insurance, you can always negotiate and ask for the insurance rates. Most places will give it to you.

    1. Chris Chris says:

      Yeah, Stacy, I’ve got to say the “negotiating for the insurance rates” thing almost never works. I’ve heard of it happening, but I’ve had plenty of friends and colleagues who’ve tried that, and it’s a rarity. I think the insurance companies like to make that sound like a common and easy solution because it masks how bad the problem is.

      Further, even the insurance rates are SCORES higher than what single-payer insurers pay for the same treatments. I mean, multiples of 10, 100, even 1000 in cost.

      And while I won’t tell anyone that their own experiences are false, I’m always shocked to hear people suggest there’s no wait in the US for tests or specialists. I myself have waited months for a consult, as when I had to have nasal surgery–and even when I finally saw the specialist, my insurance company wanted me to spend several months on medications, all with nasty side-effects, before paying for a pretty basic surgery.

      That’s not to mention the wait times initiated not by availability, but by cost. Statistics I just saw this week said that 33% of Americans, and 55% of Americans without health insurance, say they have postponed necessary medical care because of cost. So this idea that Americans can all have what they want, when they want it is pretty far off-base as well.

  7. Just a clarification from Canada. We do not have socialized healthcare. We have a single-payer or if you prefer, socialized health iinsruance. Doctors are very much private, for profit practicioners and make healthy incomes.

  8. Rubbish. Its not “free” healthcare. We all pay via our tax dollars. As for being prohibitivly expensive, this is completely misleading. Even if it were true that taxes were significanly higher (which they are not), your private, for profit, inflated insurance premiums paid to private for profit corporations would MORE than make up for the difference in taxation rates…and NO pre-extisting consitions. Negotiating in the emergency room for a “good deal” while ill…what planet are you living on?

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