So, I've got a friend who got her final bill in the mail the other day from the hospital. She had gone through kind of a big thing; having been in and out of the hospital for the better part of 5-6 months, and during that time there were a lot of specialized services administered. Anyway, my point is not to detail the hospital services, or to itemize her bill. Rather, my point is to address the bill as a whole, and determine exactly what type of alternate universe the medical community is currently inhabiting.
The total bill, for services performed in a roughly six-month time frame? $869,841.90. Not including a slew of other items that were billed separately, like anesthesia, radiology, and visits by specialists. The total amount, with all bills added together, was well over $900,000.00.
Have you fainted? Died, perhaps? I'll wait a few moments for you to compose yourself, because I nearly had a heart attack when I heard the news myself. NINE HUNDRED THOUSAND DOLLARS? Umm....WHAT?
That's more than the average American makes in a LIFETIME. And she just got a bill, sent to her house, for that amount. A bill for services rendered over a relatively short amount of time (just a few months). Does anyone else feel like we've totally lost touch with reality?
It's kind of like the California real estate market as compared to the real estate markets of 95% of the rest of the country (yeah yeah, NYC/Boston, I'm not counting you). People who live in California, and have for a long time, have just come to accept that buying a 1500 square foot, 2 bedroom 1.5 bath house is going to cost them somewhere between $500,000.00 and $1,000,000.00 depending on where in Cali they live. That's just the way it is, right? And yet the rest of us, living in the other 95% of the nation, see figures like that and think it must be a joke. I mean, I could literally pick my house up with a crane, put it on one of those big house-moving trucks, drive it all the way to SoCal, slap it down somewhere, and it would have quadrupled in value. Just like that! It's ludicrous. And when someone moves from California or NYC and goes house hunting, they feel like they've jumped up at least three tax brackets, because (gasp) they can easily afford an ENTIRE laundry room AND their own washer and dryer, not just the one they feed with quarters down the street.
It's like a little bubble - the Ridiculous Bubble. It somehow seems normal to spend $700K on a completely average, needs-some-work home if you live in San Francisco. It seems normal to cram your bed, dining room table, couch, dresser, and whatever else you can squeeze into your 500 sq ft studio if you live in NYC. Who needs all that space? And the rest of us, outside of the Ridiculous Bubble, are like "ummm....you don't actually have to do that, you know". Only difference is, at least you get the BENEFITS of living in the Ridiculous Bubble as it applies to real estate. If you're paying an arm and a leg to live in a tiny box, chances are, that tiny box is set right in the middle of some seriously awesome stuff. Maybe your box overlooks Central Park, and you can just run down the stairs and get groceries, great Chinese food, any magazine you can think of, and a hot dog at 4am. Maybe you live in the epicenter of business and finance. Maybe you live in the arts district in an amazing city. Maybe you live three feet from the beach, and can listen to crashing waves all night long, and enjoy 70 degree afternoons every single day of the year. My point is, I GET that for the most part, what you sacrifice by living in the Ridiculous Real Estate Bubble you more than make up for in culture and excitement and lifestyle.
So what are we getting in sacrificing our sanity and life-savings by living in the Ridiculous Health Care Bubble? Really, really rich doctors, and even richer pharmaceutical giants. And that's it! No really, THAT'S IT. I could try and write a moving, persuasive piece on how America's health care system needs a major overhaul, but I have neither the time nor the inclination to do so, when so many others are writing about it right this minute and doing a better job than I would be. I don't know everything that would have to change in order to make our health care not just AWFUL, and I'm not up for getting this whole thing torn apart because I didn't fact-check that one reference I made to whatever hospital statistic I used. I think it's pretty clear that our health care system is completely wack, and as further proof, I offer this as evidence:
The Three Types of Americans Able to Consistently Access Good Health Care:
1. Rich ones
2. Old ones (over 65, because Medicare kicks in)
3. Ones who work for mid to large-sized companies who are able to provide their employees with insurance
And that's it. All the rest of us are totally left behind, left to figure out what insurance we can afford (pretty much none of them), how high of a deductible we have to get (pretty freakin' high to have ANY hopes for a low monthly payment), and whether to get insurance at all or just cross our fingers and hope for the best. It's just absolutely ridiculous. I am self-employed, and so is my husband. To look at us from a health care perspective, you would think that I just said we are both UNEMPLOYED, and sit outside on the porch steps all day, drinking malt liquor out of a paper bag and listening to "Just A Friend" by Biz Markie on a giant boom box (and if you got that reference, my heart belongs to you 4Evah).
We're being punished for being small business owners! For being self-employed! For WORKING for the small businesses; businesses who can't afford health insurance plans for all their employees. I mean, is small business not what America is kind of ALL ABOUT? Isn't it like, I don't know...the LAND OF OPPORTUNITY? Or some such? And yet, if you do move here, and grasp your opportunity to make a living by doing what you're good at, you better hope you can A) get super rich doing it or B) get employed by a big company to do it because otherwise C) you're gonna have NO health insurance. And then you're gonna have to shop around for health insurance for individuals, and it's all going to be super expensive, and to get the monthly payments down, you're gonna have to have a $5000.00 deductible and so anytime you're not feeling well and you have to go to the doctor, you better be prepared to fork out another $300, just to have the doctor give you a well-exam and tell you you're okay. Because well-exams and strep throats and the occasional minor injury aren't enough to meet a $5000.00 deductible. And that means you're paying for your monthly premiums AND every ridiculously overpriced doctor's visit, because you're too scared that something REALLY bad might happen and then you'll need the insurance. And why would you be so scared, you ask? Because people get hospital bills in the mail for $900,000.00. That's why. So everyone is scared out of their mind that they'll get cancer, or in a terrible car wreck, or have pregnancy complications, and the hospital bills will bankrupt them in a heartbeat. So we all scrounge up our monthly premiums that pay for absolutely nothing but a catastrophic policy, and we try to avoid all the little doctor's appointments, because we know that we won't have met the deductible, and the doctor is going to order a minimum of three tests (because the more they order, the more they can bill!) and the total is going to be $700.00 just for stepping in there and breathing.
And the whole reason insurance is so freakishly expensive in the first place is because the insurance companies are playing a huge game of blackjack, knowing that although they can be smart and win most of the time (see: every single person who pays their insurance premium each month and never has anything go wrong), there will be plenty of times they are going to lose, and some of those times, they will lose HUGE (see: $900K hospital bills). So, you say, it seems like it's all easily traced back to these outrageous medical costs, right? And if it's so easily traced back there, then that seems like an easy enough solution - STOP BEING SO GREEDY AND CHARGING SO MUCH, MEDICAL PROFESSION. And yet, that clearly ISN'T the solution, because they keep charging more and more...and the doctor's houses get bigger and bigger...and the pharmaceutical companies will soon take over every commercial slot on television...and every American will be on at least five prescription drugs...and we'll STILL be the least healthy country in the world. Oh, you didn't know that? Well, we are. Of all the Tier One (First World) countries, we have the biggest, most advanced medical community, and yet we have the sickest populace. LOOKS LIKE IT'S WORKING GREAT, GUYS!
So, there's my rant. And if I ever DO get a medical bill in the mail for nine hundred thousand dollars, I am going to pull out the return envelope, go over to my Monopoly box, grab a handful of that pretty-colored, paper cash, and toss that in as payment. It's every bit as reasonable as them sending a bill like that and expecting compensation. Maybe I'll print this out and throw it in the envelope as well. Or maybe I'll make my letter a lot more succinct, something more brusque and to the point. I feel sure I could come up with something.
Despite my best attempts to avoid it, I'm going to the doctor tomorrow. Wish me luck that I don't come out crying, broke, or both. If there's a donate button at the top of this site tomorrow, you'll know why.
Your first mistake is assuming that somehow "America" and reality can be spoken of in the same sentence without laughter. We all know that's impossible and I'm sure if we put ten collective heads together, we could think of at least 1 trillion instances (not a bad idea for a group blog) of complete idiocy.
The American Dream is no longer "pulling yourself up by the bootstraps". We're long past those days, fully into the teeth of a corporatized society that enjoys the blessings that offers if, by chance, you're actually lucky enough to enjoy them.
I say that with ease because I am one of those assholes. I can't get my assistant, a mother of four who works her ass off a raise from $14 an hour, but it's no issue for me to fly to LA first-class, rent a convertible and stay at the Hilton.
The company spends the amount needed for her raise every time they send me to California.
So do I have an answer? Of course not, we are f'd beyond understanding.
A $900,000 hospital bill seems completely realistic in the society we now find ourselves in.
Posted by: regan | July 29, 2008 at 11:36 PM
Elise, Elise. I thought Cody was a doctor!?!
I have so many points to make I don't know where to start.
From the medical standpoint, what's charged and what's actually paid (per prior set caps) are two entirely different things. Your friend will not have to pay that bill and the insurance won't either.
Our medical services are high because the cost to run these businesses (and keep them out of the courtrooms) are high. I don't know any doctors rolling in like they used to. Most accept payments from insurance companies for pennies on the dollar. Many services are written off.
Health insurance is expensive for EVERYONE. The people who work for bigger corporations don't realize how much money they are actually making. Take out benefits companies are forced to pay and you'll see salaries go up substantially. Someone making 20K really is making 30K as an example. It just hurts more when you are forced to pay that monthly bill separately.
Drug companies deserve profits. They use huge capital for R&D, taking many risks. Our benefit is the cure. Theirs is the profit. Remove the profit, why take the risk?
It's not like you to be so cynical. Currently, the health care system is functioning in a quasi free market. Remove the capitalism, and you won't have incentive for people to take out huge loans to put themselves through decades of education to become doctors.
The more the government gets involved the more sub-standard the care. Where's the balance?
I hope your friend is doing well. Did she make a full recovery?
Posted by: Just My Type | July 30, 2008 at 12:00 AM
Wow, I think I get smarter every time I visit your blog, from you and your commenters alike. I have nothing to add, except that I have paid for health insurance out of pocket and that was RIDICULOUS. I'm really thankful to be covered by the company my husband works for. I'm also really glad I don't have to look at my sick child and worry about whether or not we can "afford" to see a doctor. I know many people are in that situation and it breaks my heart.
Posted by: beck | July 30, 2008 at 12:14 AM
It's not often that I get two completely opposing views in comments numbers one and two. I love it! I agree with you, Beck, I have great readers who contribute very intelligently to the discussion.
Just My Type, I've written you back via email (it would have been a whole new post in the comments section otherwise), but to sum up, I'll say the following:
Cody is a doctor (DC), my dad is an orthopedic surgeon, my brother-in-law is an ER doctor, and my uncle is a DO. This is not a post written to bash all doctors. Believe me, I understand the amount of school and training docs have to go through to get their degrees. Cody was in school for the same amount of time, and has the same amount of loans as his brother. I am not suggesting that doctors NOT get paid for their services. I am suggesting that they get paid less, sure. But more than that, I am suggesting that the entire profession has become corrupt and twisted into something it wasn't originally meant to be. It's NOT about the money, or it isn't supposed to be. Sure, capitalism is good, but the point you make about money/the potential for money being the main reason doctors would put themselves through school is not very ethical.
The drug companies are another thing altogether - the fact that in between commercials for Dawn dish soap and Chili's Bar and Grill we are enticed to "ask our doctor" about three different types of prescription medicine is absolutely unethical, not to mention ridiculous and completely greedy. Sure, there are research and development costs, and of course it's extremely important to fund finding cures for currently un-treatable diseases, but the way they are MAKING the money is so awful it's beyond words. To "sell" drugs to a population of untrained, non-medical "customers"? It's absolutely wrong. And the fact that the AVERAGE American is, currently, on at least four different prescription medications? AWFUL. These medicines all have side effects, and then another medication is prescribed to counter the side effects of the first, and so on! Very rarely do you find someone who actually, truly, has to be on every single one of their "necessary, prescription medications". More often, they are on these medications because the doctor is treating a set of symptoms by writing a script rather than looking at the cause of the problem. Want an example? Prescription meds for fibromyalgia are ridiculous, unnecessary, and useless. Fibromyalgia is nothing but an irritation of the sacs around the muscle - it's the muscles working way harder than they were designed for, because the person has had poor posture for so long/has been too sedentary/needs to build muscle tone. All that needs to happen for fibromyalgia to go away, completely, is for the person to A) learn proper posture B) exercise at least 30 minutes per day C) work on strengthening their body. And yet doctors prescribe medication for fibromyalgia HOURLY. There, I just saved you tons of wasted money for pointless, useless fibromyalgia medication. See how easy that was? No pill necessary! And exercise is free! Ooh, but wait...who's making money with that advice? Oh that's right, no one...better write that script after all.
Our bodies are amazing, and they do an incredible job of maintaining homeostasis. Sure, we get sick, and our bodies give us signs when things aren't going right. I wonder why people don't equate their daily processed food and sugar intake with their health problems, you know? Except I DON'T really wonder, because whatever "problem" they're having, whatever little warning signals their body is sending, we are brainwashed to believe that the cure is to go see the doctor and get a pill to "fix" it. "Fixing" just means covering it up, and the problem worsens, and then after a while, the little warning signs your body was sending you turn into major problems, and guess what - more meds, and then surgery, and then a lifetime of meds. This is NOT the way things are meant to be. This is NOT how things have to be. We are getting brainwashed to THINK this is normal, and it's just not!
As far as insurance, I am well aware that companies who pay for their employees insurance take a majority of the premiums out of the paycheck of the individual, and without the insurance, the individual's overall salary would be higher. However, you are leaving out the fact that since the company is able to afford such a better plan (split between lots and lots of employees), the premiums that come out of the individual's paycheck are relatively low, and their deductible is also low. So those people CAN afford to go to the doctor for a sore throat, and come out only $20 lighter, or whatever the co-pay was. Does that make sense to you? The companies can afford a much better plan, because the cost gets divided amongst all their employees. So yes, the employees are paying for their insurance, but they are able to afford a much better, more inclusive plan, because of all their fellow employees who are helping pay the premiums. The problem is that insurance costs are way too high; they are prohibitive for a self-employed person. And the reason insurance costs so much is because medical costs are out of control.
Anyway, that was long enough, but all to say I enjoy the dissenting views and the counterpoints. And as the fabulous Tim Gunn would say, carry on!
Posted by: elise | July 30, 2008 at 01:24 AM
I just emailed you back. I wasn't dissenting...just shedding some light in a very broad way. I really thought you were surprised by the bill. I don't disagree with anything you've added.
Say "no" to drugs. :)
Posted by: Just My Type | July 30, 2008 at 01:30 AM
Things have to change. Unbelievable.
Posted by: Deb on the Rocks | July 30, 2008 at 06:51 AM
Health care is expensive. No doubt about that. I, however, work for a small corporation (fewer than 10 employees) that provides me health insurance at no charge. I have a $200 family deductible. I pay a sizable percentage of my income to add family coverage to that plan, but it's well worth it, and actually less expensive than it would be for my husband, who works for a corporation with 50+ employees, to put himself and our son on a plan there.
My MS medication costs about $5,000 every three months. My portion of that? $80. I can't complain, and I won't complain. I consider myself darn lucky, and it's worth every penny I spend on it.
Not to say some sort of reform that makes it less expensive to me wouldn't be welcome...I'm just not sure it's realistic. I guess we'll see.
Posted by: 3carnations | July 30, 2008 at 08:58 AM
Elise, that was undeniably the best thing I have ever read here on blogspot. Your diagnosis of the health insurance situation in this country was top rate and spot on. I have never commented on blogspot but you made me laugh so loud with the monopoly money mention that I just had to write and tell you how much I enjoyed your rant. There is truly only one solution to this problem: Universal healthcare for all Americans! Take care, stay healthy and keep blogging. Mike
Posted by: Mike C | July 30, 2008 at 10:02 AM
Oh no. Your poor friend. It makes me feel awful to think of the health issues she has obviously just faced, only to be smacked with a bill of such astronomic proportions that there is absolutely no realistic prospect of paying it. Ever.
Canada's health care system is far from perfect, however, I do consider myself very lucky to live north of the U.S. border in respect of our health care policy. I hope things turn out ok for your friend.
Posted by: Jen | July 30, 2008 at 10:38 AM
I'm not really smart enough to comment on this, except to say, yes, I'm dead. $900,000?!?!?!
Posted by: "antoinette" | July 30, 2008 at 11:20 AM
What's yer man got to do with me?
Cuz I'm Smrt like that.
I wish I could write as intelligently as you do. Excellent post!
Posted by: Dory | July 30, 2008 at 11:25 AM
Well written and well thought out.
Don't even get me STARTED pharmaceutical companies. And the reps that are paid $150K a year (plus an expense account!) to court doctors and try to get more drugs on the market. Creating a NEED for drugs that might not even work.
Argh!
I learned yesterday that the US has the highest per capita health care costs. Why? Our overhead is 30%. France's? THREE PERCENT.
Oh, wow. We're so messed up.
Posted by: ashley.marie | July 30, 2008 at 01:35 PM
Wait a second. Can we get back to the part where you live in a house that can be lifted by a crane? That's cool. Please tell us more! :)
Posted by: Noelle | July 30, 2008 at 01:36 PM
Wow, that was so well written and pretty much sums up everything I feel about health insurance, too!
I work (for 1.5 more days) for a 8 employee nonprofit. We get full health coverage, paid by the employer. But it's not the greatest coverage--high copays, high hospital / surgery deductible, etc...
AS is also self-employed and went w/o insurance for 3 years. Fortunately, he gets subsidized coverage through the state of New York. Again, not GREAT. But it's something.
Posted by: Laurel | July 30, 2008 at 02:02 PM
Things need to change Elise.
Let's change them.
Mmmkay??
:)
Seriously though, 900K is RIDICULOUS.
Posted by: Julie | July 30, 2008 at 04:10 PM
My husband was in the hospital for a month and had two surgeries before we were married. He was in grad school and had insurance that he purchased through his school. The total bill was around $100,000. We had to pay about $22,000 of it. Yes it's crazy, but I think that a lot of what we are paying for is malpractice insurance for the surgeon and the hospital. And that sucks.
My advice to your friend is to ask for an itemized bill and try and negotiate the bill down.
Posted by: Andi | July 30, 2008 at 07:54 PM
I'm sorry, I read $869,841.90 and passed out. I'll go back and read the rest now.
Posted by: jamelah | July 31, 2008 at 09:44 AM
See? I passed out before I got to the $900,000 total. Good lord. Also, please don't get me started on health insurance or you will have a 1,000-word ranty comment. Great post, really.
Posted by: jamelah | July 31, 2008 at 10:12 AM
The healthcare system is disgusting. There must be a better way and we need to start thinking of it.
Sometimes universal healthcare sounds great, but is it. Countries who have that sometimes end up losing thier best doctors best they complain that they do not get paid enough. Other times, universal healthcare means high taxes for everyone. I was recently in Sweden, were they have free healthcare and all their citizens pay the same percentage on income tax no matter what.
We need help now!
Posted by: rita | July 31, 2008 at 11:03 AM
Not to mention that the universal healthcare, such as in canada, often creates things like an average wait time of 8 monthrs for an MRI or a biopsy. if i get cancer, i would rather not wait 8 months to find out...
Posted by: scott | July 31, 2008 at 05:29 PM
I could alllmost not agree more. Our healthcare system sucks completely and it makes me feel completey powerless to live in this country and fear the day that I might not have health insurance. My parents are both self-employed and have very modest incomes, and my dad used to shell out $1,000 a month for the most basic insurance my three brothers and himself. Still, when I had to go to the doctor and have an MRI in college, the insurance co refused to pay the bill (even though I had the referral and all the paperwork I needed) for months. I was in college, I didn't HAVE two thousand dollars for one lousy test, and every time I called, after being on hold for hours (literally), I'd get told something different. I usually hung up in tears. That is no way to run a health insurance company.
The one thing I disagree with is that it's doctors' faults. I think a lot of times doctors are also victims of the system, people think they're pocketing all the money that gets billed, when really they have to order three tests just to cover their own asses from malpractice suits because Americans are litigation-happy. I think the real villians are the pharma companies (and yes, drugs are great, but marketing drugs to people who may not need them just to make more money... not great) and the insurance companies. Insurance is such a great idea, in theory. We all give a little money each month to ensure that if something big comes up, we don't go bankrupt. But the problem is when for-profit companies are in charge of this, and their interest is to charge as much as possible and pay out as little as possible.
I really don't know what the solution is, but I think universal healthcare, with all its problems, is a great place to start. That's what a government is for, and I honestly don't think I should have to pay taxes if I'm not going to get anything in return.
I hope your friend's situation worked out OK.
Posted by: Operation Pink Herring | August 01, 2008 at 06:36 PM
PS - Baby, you... you got what I neeeed... but you say he's just a friend, you say he's just a friend.
PPS - I only have two brothers. I don't know why I typed three. I guess I should go get my head checked, luckily I pretty decent insurance because I work for a gargantuan soul-killing company.
Posted by: Operation Pink Herring | August 01, 2008 at 06:41 PM
Dennis and Dee follow their dreams and end up on welfare/crack.
Did you see my Jesus chain?!
P.S. I dig the rant.
Posted by: Robyn | August 04, 2008 at 05:15 PM