Leader of the Pack

I got the final bill from the hospital for Shannon's 2 weeks in the ICU: $204,000, of which Medicare is paying $175,000. For the $29,000 discrepancy, they want $1,100 immediately. I've also gotten bills from several contractors that provided services like imaging and respiratory therapy for additional amounts. This total cost will come in somewhere between $205,000 and $210,000.

All that with little to no detail about what the charges are for.

If anyone doubts that our health care system is broken, those should be some sobering numbers. What's most shocking to me is that there is a two-tiered price system: one for people with insurance and a more expensive one for those that lack it. If my insurance company or Medicare is paying for something, providers discount the service. People without insurance pay more.

Health insurance is more expensive that some realize, but since I pay the bills at work, I know just how much it costs. I couldn't afford it if my employer didn't cover 75% of the cost. It's well over $600 a month just to cover me. I pay 1/4 of that.

For those without access to affordable health insurance, not only do the bills add up quickly, but they'll be charged more than I would in the same exact circumstances.

It spotlights the fundamental inequity in our health care system: because I'm lucky enough to have coverage, I'm charged less. I suppose I pay for it when premiums go up. But those increases don't mean a provider will be reimbursed on a higher level. That only mean the insurance company's profits will once again set records.

Any health care-delivery system that by its nature serves largely to provide profits to insurance companies won't be very good. That should be self-evident. Health care systems should exist to provide health care.

I have no doubt that individual practitioners never think about what something costs when they order it. I doubt that they even know or care. As it should be. They're treating a patient and doing what needs to be done to provide a standard of care that they find acceptable.

But the system, as it exists, drives costs up. People who can't afford health insurance certainly can't afford a $205,000 bill. Had Shannon not had Medicare, the entire bill would have be absorbed by other consumers, as opposed to the $29,000 that will be passed on because of Medicare's reimbursement rate. While that might still seem a high number, my private health insurance never reimburses at the rate medical providers would bill someone without insurance. Aetna would probably reimburse at a similar rate.

Therein lies the irony of our current system: the people who can afford it least are charged the most for health care, almost regardless of who is billing them. If my primary care physician normally charges $50 for an office visit, I give them $10 and Aetna sends them about $25. If I didn't have insurance, I'd have to pay $50 before I could see a doctor.

While my doctor makes less because I have insurance, the AMA has been a strong supporter of reform. They recognize that universal health care would, over time, lower its cost because most people would see a doctor if they could before they were so sick that they have to get emergency treatment . Very expensive emergency treatment that often leads to hospital admission. Then, the costs go higher, and the outcomes aren't as good as for people with insurance.

Health insurance encourages early care before illnesses begin to compound on themselves. It's one thing to go to a doctor who will charge $50 for 15 minutes and another when the visit will cost $10.

Universal care will ultimately lower health care costs because earlier medical intervention will forestall expensive emergency room visits and hospital stays by making earlier treatment available. It's much easier to treat someone with pneumonia during the first week they have it is than to treat someone in an ICU because their condition has deteriorated to the point that it's the last, best option.

Without reform, costs will continue to spiral out of control. It will eat up even more of the GDP that it does now. While some argue that universal care will bankrupt the country, I think the opposite is true. Not doing anything paints a far bleaker picture. Costs will continue to increase, and more employers will stop offering coverage. For the ones that continue offer it, employees' rising costs would force many out of the system.

The most powerful country in the world has about the worst health care system of all industrialized countries as far as access to quality care goes.. We lead the pack on many issues, but not this one.