"Unless you're Bill Gates you're just one serious illness away from bankruptcy."

--Dr. David Himmelstein, Associate Professor of Medicine at Harvard and lead author of a 2005 study on the relationship between medical bills and banruptcy


You've probably heard it before: medical costs here in the U.S. are way out of control.

I mean, way, way out of control. If you don't have health insurance in this country, you are at risk of financial and physical ruin. And, based on census reports, over 40 million people in the U.S. don't have it.

Much of this is because insurance prices along with health care have been rising double-digit percentages each year. For instance, according to an ABC News report, in 2002 Kaiser Permanente (a major insurer) increased premiums for consumers in East Coast states by as much as 75%. My own health insurance company hiked their rates 36% in 2003, right in the middle of a deflated economy.

Furthermore, a 2004 survey revealed that U.S. hospitals routinely charge uninsured patients four times what they ultimately bill insurance companies for the same procedures. How they expect people who can't afford coverage in the first place to be able to pay a 400% markup is beyond me.

Even those with health insurance, particularly those in HMOs, are sometimes denied beneficial care because an insurance agent rather than their physician ultimately decides what care they should receive.

For instance, a 2003 study conducted by the Institute for Ethics at the American Medical Association asked 700 doctors how often they had withheld information about a "useful service to a patient because of health plan rules." 23% of the U.S. doctors surveyed said they sometimes did this, and 8% said they frequently failed to tell their patients about all treatment options because of the rules imposed by the patients' health plans. Those who served Medicaid patients were especially likely to not share information with patients.

The situation is slightly better than a few years ago when HMOs could regularly enforce "gag clauses" that barred doctors from even mentioning treatments that the HMOs weren't willing to pay for. Bad publicity convinced most health companies to drop such clauses, and most (but not all) U.S. states have subsequently banned such clauses.

According to Blue Cross Blue Shield of Hawaii, people in the U.S. spent $1.3 trillion on medical expenses in 2000; this was more than they spent on housing and food ... it's even more than the government spent on national defense. Many organizations expect U.S. health care costs to soar to $2.6 trillion by 2010. The Centers for Medicare and Medicaid Services estimates that American medical expenditures will equal almost 16% of the nation's Gross Domestic Product.

But broad statistics are a little abstract, aren't they? They get quite a bit more compelling when your friends and loved ones can't pay for insurance or health care.

Take Braunbeck, for instance. Like many professional writers, he doesn't make Rowling/King level paychecks. He's often lucky to make what he'd get at a minimum-wage job. The frustrating part is, that even though he's sold close to 200 stories and 10 books and is an excellent teacher, he has no college degree and thus he can't get a gig as a writing instructor at a college. The only other types of jobs he's had are as janitors and orderlies and such, and he really can't do manual labor any more due to back and joint problems.

I, with two college degrees, have only been able to find a very low-paying part-time job after a year and a half of searching. Braunbeck, with his ten years as a full-time fiction writer and high school diploma and bad back, has had of course no luck whatsoever in finding anything else.

So, health insurance for Braunbeck -- which would cost over $250 a month due to his age and history of health issues -- has been way out of reach.

Also like many writers, he has carpal tunnel. Last year, he had a bad flare-up that caused him excruciating pain ... couldn't move his hand, couldn't sleep. This happened around 9 p.m. after all the walk-in clinics closed. The only option you have for after-hours care in this city is to go to the emergency room.

So we went to the ER of a hospital with an inexpensive, charitable reputation, where we waited around for a couple of hours. A doctor came by, looked at his hand for about thirty seconds, wrote him a script for anti-inflammatories and painkillers, told him he needed surgery, and had a nurse bring him a wrist splint of the sort that can be purchased at a drug store for $15-$20

The bill? $500 for the 30-second ER doctor consultation, and $120 for the $20 wrist splint. I'm guessing the nurse didn't make $100 for the three minutes it took her to walk it down the hall. She'd handed it to him like it was a freebie; if he'd known the exorbitant charge, he'd have declined the brace, you can be sure.

Braunbeck's subsequent surgery took place at an outpatient center and took about half an hour from prep time to the nurses' assistant escorting him to the curb behind the clinic. It was classic drive-through surgery, the kind that's supposed to be ultra-economical. It would have cost him $5000, but the surgeon took pity on Braunbeck's lack of insurance and knocked his fee down to $2500. The anaesthesiologist didn't care and charged his full $800.

Flash forward to two weeks ago. Braunbeck broke his lower left canine tooth on a granola bar, and discovered it had gone bad. He didn't feel the rot setting in because a few weeks before that he'd had a severe back spasm and had to see his regular doctor ($70) to get a script for anti-inflammatories, muscle relaxants, and Vicodin.

So. Off to the dentist ($46) who referred him to an endodontist for a root canal for the rotted canine. The endo charged him $650 for the root canal (based on my research at dentistry sites, the going rate nationwide ranges from $400 to $750, depending on if a dentist or an oral surgeon does it) and temporary filling on the tooth, then told him he'd need to get his regular dentist to put a crown on it.

He called his dentist today to make an appointment, and found out they want $750 to put a crown on the tooth. Ack. He's calling around to see if any of the other dentists friends have referred us to can give him a better price, but I fear he's stuck, unless he can sign up to be a guinea pig at the OSU dental school.

That's going to make $1450 to fix One. Single. Tooth. That's more than what it cost me to get all four impacted wisdom teeth cut out of my jaw back in 1992.

How are we, with my $8/hour McJob and his 5-cents-a-word checks from publishers who regularly pay months after they've promised to, supposed to afford this?

And all this has been fairly minor stuff from a treatment standpoint. Heaven forbid one of us should really get hurt, or have something major go wrong.*

What good are all these amazing medical advances if regular people can't afford them?

I can completely see how the U.S. has turned into such a lawsuit-happy society. Imagine you have an accident or get sicker when treatment doesn't go as expected, and as a consequence you face enormous medical bills you have no way of paying. You can either go bankrupt ... or you can sue somebody (the guy who couldn't brake in time to keep from hitting you, the doctor who misjudged your infection) and at least have a hope of getting the money to pay your bills. You wouldn't have sued, otherwise, because you know people make mistakes ... but you need the money to pay for your treatment and keep the collection agencies from hounding you all day.

So you sue, and win, and after the lawyer's fees have enough to stay out of bankruptcy court. In the meantime, all the lawsuits from people like you drive malpractice insurance up and up, which drives medical costs up, up, up, thus spurring on more lawsuits and bankruptcies and on and on.

The winners? The law firms and the insurance companies, which get to play both sides of the field. The losers? Doctors and patients and everybody else.

Congress, of course, is composed of millionaires. Our President has lived a pampered, privileged existence from Day One. These folks have no concept of what it's like to have to watch a loved one suffer through pain because you can't afford a doctor; they're high on conservative ideology and flush with campaign donations from the insurance companies. They've apparently got no motivation whatsoever to try to improve the situation.

morven says Totally and utterly agreed. I especially agree with the point you make that I've made a bunch of times: the lack of affordable health care and any kind of social safety net in the U.S. is what makes the place such a sue-happy society. Why? Because the costs of any kind of medical problem can be immense. Even if you have health insurance. It constantly amazes me that people in the U.S. do not get just how much the lack of universal heathcare in the US actually costs, both in cold hard cash, and in terms of human suffering. Universal healthcare would be too expensive? Then explain why the current U.S. system costs more, as a percentage of GDP or anything else one cares to name, than the health care systems of any other nation on Earth.

TheBooBooKitty says I am 25 years old. I haven't seen a doctor or dentist in over 15 years. I probably won't ever get to see one. A nice side effect is that I also have to go to work when I am sick, since I can't afford to call off (haven't missed a day since 1998).

cbustapeck says I just graduated from college, so I am no longer covered by my parents' health insurance, and now I have to figure out what the heck I am going to do. I pay $90 a month for Adderall (or a few dollars less for the generic, which no pharmacies ever seem to have), and I have $120 visits to a shrink (who doesn't seem to do much) every four months. Most health insurance doesn't seem interested in covering anything else, either. And as an artist, with the work I do, I know I'm going to end up in the emergency room sooner or later. Either that, or I'll end up performing stitches on myself again. (not fun). Sigh.

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