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.