Sunday, November 8, 2009

Beautiful Arteries

Is it just me, or does this strike you as sheer irony? Last Wednesday, when we arrived at the MCCG Heart Tower for the cath the doctor ordered, the person at the registration desk handed Daryl a pager-just like the ones you get at the restaurants where the problem likely started in the first place. Sort of drives home the prevention point, doesn't it? They need the pagers because the staff told me they do about 40-60 of these caths every day. That's a lot of folks to keep up with. The menu prices at the hospital are just a touch higher than your favorite chain restaurant, though.

I haven't actually seen the bill yet, but I do have the smelling salts ready. The MCCG billing folks called me a couple of days before the procedure to tell me that their facility fee for a basic heart cath was over 19K figuring their BCBS discounted rate. That did not include the doctor's fee, labs or anything else. In plain English, that meant that the 19K+ was a negotiated rate with BCBS. I suppose that means their 'list price', the amount someone with no insurance would be charged, is even higher. For me, I would be expected to pay my deductible plus 20% of that amount. You can do the math. We could either pay it all on the day of the procedure, or pay a portion and set up a 90 day-same-as-cash contract with the hospital. If we paid it all that day, then they would discount our co-pay (not the deductible) by 20%. Fine. I wasn't thrilled, but I wouldn't have to sell the house to pay the bill. But, I can think of plenty of points in my life where there just would not have been enough money to take care of this bill, in the long term or the short term. I would have had to cancel the procedure and live with uncertainty. As it is, I benefited from a state-of-the-art facility, a competent and caring staff and an excellent doctor. Most of all, I got to hear the doctor say that I have beautiful arteries and needed to look for other causes for the chest pain I was experiencing. That was great news for me, but the question remains: should ability to pay determine whether or not someone can get the medical care they need?

I've been trying to figure out how everyday, 9-5, working people, even those who HAVE insurance (like my kids) could afford the kind of excellent care I got last week. The short answer is, with even a 20% co-pay, they can't. And what happens?If the procedure is non-emergent, like mine, they don't get it done, and then, maybe walk around with a time bomb in their chest. Or, if they have a heart attack, maybe they become one of the many people who are forced to file bankruptcy because of medical bills that would no doubt make a 19K cath look like a Blue Light Special at K Mart. Those unpaid medical bills then get plowed right back into the cost of doing business and contribute to the overall cost to patients. Who pays for it? We all do.

That's why it was ridiculous to me yesterday as I listened to Republicans argue that people should be "free" to choose whether or not they have health insurance. Just like uninsured motorists, people without health insurance impact the rates we all pay. I favor making sure everyone can get coverage and then mandating that we all get covered. I have no problem at all with charging a fine to those who do not comply with that law. Why? Because there's nothing "free" about being uninsured.

And, by the way, the cholesterol medicine the doctor prescribed to help keep the pipes clean cost over $100 a month with insurance. That medicine may help me avoid health problems and more extensive, expensive procedures, but I know plenty of families for whom that monthly cost alone would be a non-starter. So, I am glad that Congress acted last night and took a clear step toward health insurance reform. It is past time.

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