The year has been a pretty medical year for me. In the spring, I had a medically-necessary eyelid lift. In July, I broke a finger. In the fall, I received radiation treatment for prostate cancer. I am just fine, and my treatment — all of it local — has been first-rate. My wallet is just fine, too. Thanks to Medicare and other insurance, my only real expense has been the cost of gas for my trips to Concord for care. I am acutely aware of how fortunate I am.
And I am also puzzled, but not about my body or the things that various medical professionals have done to it. Rather, my medical mystery is the one that appears on every single billing statement that arrives in my mailbox.
Let’s look at my broken finger. After an unfortunate dogwalking incident, I went to the emergency room with an index finger that was pointing about ninety degrees off course. I was treated at the ER, later had surgery to put in a couple of pins, and finished up with seven or eight sessions of occupational therapy.
According to the explanation of benefits forms from my insurance company, the sticker price for my finger treatments came to $22,953. Of that total, Medicare has paid $3,212. My federal retiree health insurance (for which I pay a monthly premium out of my pension) paid $837. And due to a billing error, I have paid $7.65 out of my own pocket. My medical providers have eaten the rest. What the what? That’s the medical mystery.
After I posted a preliminary draft of this column on Facebook, a college friend with experience in the hospital world helped clue me in, explaining that for any medical service, there are four possible prices: the cost for uninsured people, the cost billed to private insurance, the cost billed to Medicare, and the cost billed to Medicaid. Based on that, my explanation of benefits forms seem to indicate that Medicare paid its rate, my insurance paid the difference between the Medicare rate and its rate, and the medical providers said okay.
So, again, what the what? What if I had broken my finger without a pocket full of insurance cards? My ER visit alone had a sticker price of nearly $6,000. Would I have been on the hook for all of that? Yikes. For someone living paycheck to paycheck, an unexpected hospital bill like that could hurt way more than a broken finger.
Then there was my surgery. The sticker price for that was about $13,500, enough to purchase a used car. Without insurance, I’m sure I’d have opted for a non-surgical option, and given how weird my surgically repaired finger still looks, I imagine that a non-surgical option would have resulted in a really unsatisfactory outcome.
Thus, with the fate of an uninsured or underinsured broken-finger patient in mind, the big medical mystery is why this country continues to embrace our current system rather than a single-payer system with Medicare for all.
I suspect a perfect storm of factors that have made strange bedfellows of two seemingly opposed groups: insurance companies and individuals who, most likely, would benefit from wresting control of health care away from the insurance industry.
The interests of the insurance companies are obvious, especially during the Medicare open-enrollment period, when we are bombarded with millions of dollars worth of insurance-company advertising. Insurance companies wouldn’t spend that kind of coin if there weren’t money to be made, and money made by insurance companies (not to mention money spent on annoying television commercials and administrative costs) is money not spent on health care.
The other side of resistance to a single-payer system is a bit more difficult to figure out, but I think it may be a nagging fear that “my” tax money will be used to pay for “their” care. But doesn’t insurance work exactly the same way, with premiums paid by healthy people being spent on care for sick people?
As I first wrote this column in longhand, using my still-swollen finger, I employed that same digit to scratch my head. Are we really better off under a system that, for the most part, ties access to heath care to a person’s status as a employee with benefits rather than to their status as a citizen or as a human being, and do we really want our health care delivered through entities for which profit is the primary goal and that owe their primary allegiance to shareholders?
Don’t get me wrong. Insurance companies are not evil. They just are what they are, and do what they do. My only question is whether being in the middle of health care is something we really want insurance companies to be doing.