Healthcare Thoughts From the Hospital Waiting Room

I started thinking about this post while I was sitting in the hospital waiting room while my husband Jesse had surgery. It’s much more difficult to write now because he died unexpectedly just before Christmas. The thoughts I had while I waited still loom large in my mind. So here we go.

Of all the things we had to worry about, paying for the surgery — and all the tests and consultations that led up to it — wasn’t one of them. Jesse was enrolled in a Medicare Advantage plan.

So most of the tests and consultations involved small copays, rather than the 20% generally required under traditional Medicare. The one exception barely broke the $100 level. And the hospital charges were tightly capped. If Jesse wasn’t well insured, these alone would have set us back more than $46,760.

Well, not us actually. (Hard to get over the plural pronoun.) I’m told Jesse’s medical debts will become the debts of his modest estate — what he hoped would make sure I was cared for when he no longer could. And it will, but wouldn’t have if he hadn’t had good health insurance coverage.

I read that Congressional Republicans (and perhaps some Democrats) want to allow people to go without health insurance again. The former are hoping that enough young, healthy (at the moment) people will opt out — and thus cause insurance purchased on an exchange to skyrocket.

The Affordable Care Act, as I’m sure you know, requires most people to have comprehensive health insurance, though they’re free to pay a penalty instead. Do we really want to enlarge the freedom to go bankrupt — or to die from conditions that could have been treated?

More to the point, House Republicans apparently favor a Medicare alternative that would shift costs to beneficiaries. I say “apparently” because Congressman Paul Ryan, who authored the House budget plans, partially revised his premium support, i.e., voucher, scheme when he was running for Vice President. Not so as to eliminate the cost shift, however.

The notion behind the vouchers, as I understand it, is that we wouldn’t go to the doctor so often, have as many tests, etc. if we had more “skin in the game,” i.e., had to pay a greater portion of the total costs of our care. At the very least, we’d shop around, as consumers do when they decide to buy, say, a car or a cell phone service contract.

This same “skin in the game” notion underlies Tennessee Governor Haslam’s proposal to require copays from the very low-income people who’d get subsidies for private health insurance, rather than coverage under Medicaid. Something of this sort is already in force in Michigan.

What might such cost-shifts have meant for us? Perhaps Jesse might not have gone to his primary care physician so soon. Then perhaps he’d have called around to price the recommended radiological tests. Then to find a surgeon.

How in the world could he, smart has he wasy, have made informed decisions about whom to engage for what — let alone whether to engage anyone at all? “Without a lot of help,” says Austin Frakt at The Incidental Economist, “one can learn a little, but not a lot about what might be good value.” And one surely can’t learn nearly enough to know whether what a doctor recommends is truly necessary.

As things played out, our Advantage plan professionals coordinated all Jesse’s care — from the first hint of trouble through the post-op exam. Appointments were scheduled for him. And every medical professional had instant access to his records because they were all electronically stored in a single system.

Here again, less stress for us.

The ACA, which Republicans will reportedly again vote to repeal, includes several provisions to promote more coordinated and integrated care. These include financial incentives for physicians and hospitals to serve Medicare beneficiaries through networks known as Accountable Care Organizations.

They are, in some ways, like the organization that managed Jesse’s care. And notwithstanding the outcome, I believe he couldn’t have gotten better.

Kevin Drum at Mother Jones bravely blogged on his cancer diagnosis — and subsequently his thankfulness for “immediate, skilled treatment,” largely covered by “great health insurance.”

“Why wouldn’t you want that for everyone?” he asked, noting, as many others have, that the U.S. is the richest country in the world.

No doubt health care here is too costly. But people who receive it aren’t to blame. Proposals that would deny them high-quality, affordable health care — whether indirectly, by driving up insurance costs, or by cost-shifting — are, to me, not only wrong-headed, but immoral.

I don’t suppose I’ve ever felt that as strongly as I do now.

18 Responses to Healthcare Thoughts From the Hospital Waiting Room

  1. Diane says:

    I am so sorry to hear of the death of your husband.

  2. Kathryn Baer says:

    Thank you, Diane. Hearing from friends at this time means a lot.

  3. I’m so sorry to hear of your loss. May your husband’s memory be for a blessing in your life.

  4. Kathryn Baer says:

    Thank you. My husband was the great blessing in my life while he lived, and I believe his memory will be.

  5. Nassim says:

    I am so deeply sorry, Kathryn. My thoughts are with you.

  6. Kathryn Baer says:

    Thank you, Nassim. Knowing there are people thinking of me is a comfort.

  7. Emily Uhar says:

    I’m so sorry for your loss, Kathryn.

  8. Kathryn Baer says:

    Thank you, Emily. It is a comfort to know that people care.

  9. Melissa Boteach says:

    I’m so sorry to hear about your husband Kathryn, my thoughts and prayers are with you.

  10. Kathryn Baer says:

    Thank you, Melissa. Thoughts and prayers from you and others who have responded gives comfort.

  11. Tracey L. McCorry says:

    I am glad you were able to expound on the experience Kathryn Peace

  12. Meredith Dodson says:

    Kathryn: I am so sorry to read about your husband’s death. You are in my thoughts (and, as always, I appreciate your perspective & powerful writing).

  13. Kathryn Baer says:

    Thank you, Meredith. I feel less alone at this time because of people like you.

  14. Lecia Imbery says:

    Kathryn, I’m so sorry to hear about your husband. You and your family are in my thoughts and prayers.

  15. Kathryn Baer says:

    Thank you, Lecia. It is a comfort to know that other people care.

  16. Kathryn, I am deeply sorry about your husband Jesse’s passing; please know I am thinking about you and wishing you comfort and peace. Your writing about the help that health coverage provided was immensely helpful, and an act of brave generosity.

  17. I’m just reading now about the loss of your husband. I’m so sorry that you’ve lost your partner. Since I’ve been doing the caregiving for both of my parents now for 6 years, I’m well acquainted with the challenges within the health care system.

    My Dad died at age 91 and my mom is now 90. Both of them have been covered by Medicare with a Tricare supplement and I am so grateful for their government subsidized insurance, despite the many challenges we faced to get good care.

    May your husband rest in peace and peace with be you also.

  18. Kathryn Baer says:

    Thank you, Diane, for your sympathies and for sharing your parents’ experience. The healthcare system may pose challenges, though my husband didn’t experience them. But imagine the alternative.

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