America either has the best health care in the world or the worst of the developed nations. It is either a proud bastion of capitalism that our Kenyan president and his liberal elites are trying to destroy through socialism, or it is a greedy and broken den of thieves decimating the livelihoods of those Americans who are unfortunate enough to get sick. The Affordable Care Act (most often called by its quippy nickname, “Obamacare”) is being challenged in the Supreme Court. The court is expected give its ruling on the subject in the next few days, but there are many emotions involved in this touchy subject no matter the result.
I had a recent run-in with the health care system that left me on the fence, both challenging and reinforcing the various expectations I had about the status quo. One afternoon about a month ago, I noticed some mild but still unpleasant stomach cramps. I assumed I’d eaten something bad, or perhaps was just having a reaction to stress, so I ignored it and went about my day. But by midnight, I was in so much pain I couldn’t even stand up straight.
My roommate drove me to the emergency room, where they puzzled over the symptoms. The pain was all around my stomach, not in the usual lower right quadrant that would indicate appendicitis. I had no swelling, vomiting, or even fever. The emergency room nurse and doctor raised their eyebrows at me patronizingly when I described my pain. One even criticized my description of where the pain started (“the solar plexus isn’t a real thing,” he said with a scoff. Okay, maybe it’s not a medical term for a body part, but everyone knows what region you’re talking about when you say those words, doc.) I worried that they doubted me – thought I was some high-strung hypochondriac, or worse, a drug addict trying to scam the medical system out of pain pills. I was neither: I was simply in a great deal of mystery pain.
They ran a barrage of blood tests, and around four in the morning informed me that everything was normal except for a slightly elevated white blood cell count. I didn’t have any clear appendicitis symptoms, but they said they would do a CT scan just in case. By five in the morning, I was being wheeled into the radiology department, and by six they had an answer: I did, indeed, have appendicitis. The doctor rushed out of my room immediately upon giving me the diagnosis and saying I would need to have surgery. I heard her say something about signing me over to my doctor, but then I was left alone on my hospital bed in the ER with no one to tell me what that meant. When would the surgery be? What would it cost? Was it urgent – something that would be done immediately?
Alone on a hospital bed in a bustling emergency room, I felt completely powerless. I had very little information, and my emergency room nurse would disappear for nearly an hour at a time and didn’t even know my name (he kept calling me “Ms. Burgess”). For what felt like hours – but was about 45 minutes in reality – I laid there alone. This is exactly what I had expected from the American health care system. Horror stories.
The American health care system is often the most expensive, but access to care is restricted and the quality of care is actually not ranked first in the world. In fact, America recently came in last in a ranking of overall healthcare quality where it was ranked against five other developed nations: The Netherlands, the UK, Canada, Germany, New Zealand, and Australia. A simple Google search will bring up hundreds of health care horror stories: people not receiving the care they needed, or going into bankruptcy because of insurance companies retroactively canceling their policies. I felt quite uncomfortable and more than a little scared.
When a woman finally came into the room to take an inventory of the items I’d brought with me (and of course to charge me a $150 emergency room co-pay), she had no information about where I would be going next or when the surgery would be, or even who my new doctor was. Finally, around seven, a young surgical resident came to explain the situation to me. Dr. Neel Joshi would be doing the surgery. It would be laparoscopic, using three small incisions and a camera to work instead of making a large cut. It would be later that day – whenever there was a free operating room. If the appendix burst, that just meant I would have to stay in the hospital longer to take antibiotics, but a burst appendix was no longer something to fear. It happened. They could fix it.
They wheeled me out of the ER and up to a room, where I would be staying until I was recovered from the surgery (which turned out to be under 24 hours). This is where my experience changed suddenly and radically. The nurse assigned to my room, Darlene, greeted me immediately. She was so warm and friendly, and she answered all of my questions and chatted with me. She made me feel like I wasn’t in the hospital – like I wasn’t about to have emergency surgery.
When they finally got an open operating room and came to fetch me, my nerves returned full force. The only time I’d ever been under general anesthesia was for my wisdom teeth removal. Somehow, having a procedure that’s akin to teeth pulling is not as terrifying as one involving cutting into your abdomen. (For those of you not familiar with human anatomy, that’s where all the important organs are.)
I think I managed to disguise my fear until they hooked my up to the EKG. When the heart monitor connected and started beeping at an alarming rate, it was hard to hide how scared I was. I was all alone, 3,000 miles from my family, and about to be put under with powerful drugs while doctors I never met cut into my stomach to remove my malfunctioning appendix.
That was when the head surgeon, Dr. Joshi, stepped in. He started talking to me – asking me questions to distract me. We talked about running and he asked about races I’d competed in and how many miles I ran in a week. While I was not paying attention, my heart rate slowed back to a normal pace and I relaxed enough that in the moment when the anesthesia kicked in and I blacked out, I felt at peace. I trusted the doctors – not just because I’d heard that Dr. Joshi was one of the best surgeons, but also because they’d bothered to connect with me on a human level.
The remainder of my time in the hospital was equally pleasant. The nurse on the next shift, Alla, checked on me frequently to make sure my pain wasn’t bad. I had a whole hoard of friends come to visit, and they stayed long past the visitor’s hours without so much as a raised eyebrow from the staff. I didn’t feel like a number on a medical bracelet; I felt like a patient who was cared for. I didn’t worry that if complications arose it might slip past their attention. I felt safe.
I was discharged the next morning and returned home with pain pills and a positive outlook. My view of healthcare in America had been sufficiently buoyed. After all, I’d gotten amazing treatment and so far had only paid a $150 emergency room co-pay. Maybe it wasn’t as bad as I’d heard.
Then the bills came.
My jaw dropped as I unfolded the letter the hospital had sent to me and realized that the number at the top was not a mistake. For an appendectomy – one of the most routine surgeries in the world – and under 48 hours in the hospital, my total came to over $66,000 dollars. For the two to three minutes spent in the CT machine, they charged me over $13,000 dollars. My hospital room – which was nice, but certainly not luxurious – for one night cost me a little over $5,000. The hour I’d spent in the recovery room after my surgery came with a nearly $4,000 price tag. I’m still receiving mailings on a weekly basis. My insurance is covering most of it, but it’s still leaving hundreds for me to take care of.
But what if I hadn’t had insurance? I was laid off in February, and $66,000 is more than twice what I made in a year when I was employed. And appendicitis is not a preventable condition. I didn’t get it thanks to reckless behavior or unhealthy habits. I’m a healthy weight, I eat my fruits and vegetables, I exercise daily, I drink in moderation, and I have never smoked. But thanks to a simple surgery caused by a common and non-preventable condition, if I hadn’t had insurance, I would have had to file for bankruptcy at twenty four.
The Affordable Care Act is far from perfect, but I am immensely grateful for the provision that allows me to remain on my parents’ healthcare plan until my twenty-sixth birthday. If it weren’t for that provision, I would be spending the next couple of decades of my life trying to recover from the financial devastation that my appendicitis would have caused.
Some would say that this is a non-issue. I had health insurance through my former employer, and when I was laid off, I was eligible to continue on that same plan through the COBRA program. Sounds great, right? Here’s the problem with COBRA: it’s expensive. And I don’t mean it’s “cut-back-on-the-luxuries” expensive.
COBRA payments can be upwards of $1,000 per month. That equates to 60 or 70 percent of a monthly unemployment check. This means that someone who is on unemployment while between jobs has their income reduced by half or more, and then has an additional 60 to 70 percent taken away to pay for health insurance. This is not insurmountable if you’ve been working for decades and had a six-figure salary. However, if you’re a recent college graduate or someone working a minimum wage job, there is no way you have saved enough to cover a long stretch of unemployment. And in this economy, long is likely to be exactly what your unemployment is.
I would be lying if I said I knew how to fix the system. It’s clear that it’s not perfect, and whether it just needs a little reform or a complete overhaul is a matter for the experts. My suggestion would be to look at the countries that seem to be doing it right. The Netherlands were ranked first overall in healthcare among those six developed countries analyzed for various quality factors, access, affordability, and cost. Maybe we should take a look at what they’re doing and see if we can adapt it to suit our unique needs as a country.
But we can’t leave things as they are. I am one of the fortunate ones. I’m healthy overall, insured under my parents’ plan, and have no pre-existing conditions to disqualify me from health care. But there are many who are not so fortunate, and no one should have to declare bankruptcy because they got cancer. Whether you support socialized medicine or are against it, I hope we can at least agree on that.