Obesity and Ozempic

Medicare for All

I have been fortunate to have medical insurance for my entire lifetime. For many years I was not a large consumer of healthcare. While in the Navy I had care for a large kidney stone that required removal as well as a malignancy requiring surgery. The only bills I received were for the food I consumed while I was hospitalized. For those who have never been in the military, a reminder: military medicine is socialized medicine and it was damned good in my experience. 

I needed spine surgery as a retiree. Medicare covered it along with my wife's Blue Cross/Blue Shield from her retirement as a government employee. I remember the explanation of benefits (EOB) for that procedure. The bills totaled almost $40K. That was not what was paid out by Medicare and the Blues, of course, but the providers accepted the payment. I did not have a bill. Earlier this year, as the COVID-19 pandemic was unfolding, I needed replacement of my aortic valve. I had a world-class team at a world-class hospital here in Los Angeles and I am eternally grateful to them for their swift response to my need. Now under stay-at-home orders, my new valve and I are doing well and I feel that a new lease on life has been issued.

The EOBs have arrived. My wife and I looked at them with great interest. When all the charges are totaled, the bills for my care approach $500K. Yes, $500K. And thinking about that you begin to see one of the horrid problems of American healthcare. I am among the most fortunate of Americans. Between Medicare, private insurance, and Tricare for Life (the health insurance provided for military retirees), my bill for this was... zero. I thought about this today because the problem of access to healthcare and the ability to pay for it is poor for many millions of my fellow Americans. Yes, the ACA (Obamacare) has been a godsend for many; the Republicans and Donald Trump are still trying to abolish it to replace with their "plan", except they have no plan. They only have the word "plan". 

Why is healthcare so expensive? One reason seems to be that the charges made by all in the healthcare arena bear little relationship with reality. In deciphering the EOB, as an example, the valve itself had a charge of $207K. It was inserted as a transcutaneous valve replacement (TAVR) which obviated the need to crack my chest and keep me in an ICU after the procedure. In fact, I went home the same day. I am sure that developing the valve was costly. It was reimbursed for less than this (I have not fished about in the complex coding that is used to determine each cost) but that $207K figure makes me feel like the bionic man.

Now, let's suppose I needed this procedure but had no insurance. The charges as explained would still apply. The hospital would contact me and ask how I would like to arrange payment. Let's further suppose I am a blue-collar worker who has a family and two children and makes just enough to pay the rent and food and the bottom level of Maslow's Hierarchy of Needs. I am now screwed. Bankruptcy? Charity? Lowered standard of living? This happens every single day in the United States. It is wrong. Each person is worthy of a life that is healthy and allows for their full productivity as a member of the American community. The sociological insight that the postman delivered today reinforces why our nation needs a real healthcare system. In the long run, Medicare for All seems the best bet. As noted, our military has a socialized medical care system. Why can't we have it for everybody? One of the profound questions that will remain when we emerge from the pandemic world we are in will be, how do we provide healthcare equity for all Americans? That should be at the top of the discussion as we pass out of the Age of COVID-19 and hopefully, out of the Age of Trump.