I wrote up this afternoon some of my thoughts on my recent experience with the health-care system. Some background: I woke up Sunday morning with abdominal pain. I did my best to ignore it, figuring it likely to be indigestion or something caused by a bit of carousing the night before, but when the pain persisted Monday morning I knew that I might have a real problem on my hands.
It was an unfortunate bit of timing -- I finished graduate school in December, and I was to start my new career that very Monday. Unfortunately the company's policy was not to begin health insurance coverage until a month after a new employee's start date.
I had a devil of a time yesterday getting ahold of someone at the hospital with whom I could discuss my issues regarding payment and my lack of health insurance. Not long before discharge, however, I did speak with a representative who told me that I had three courses of action: San Diego County Medical Services (CMS), Medi-Cal, and the hospital's own indigency payment program.
Honestly, I don't think she really knew at all what she was talking about. I called CMS while still at the hospital -- she had given me a pamphlet describing the program's eligibility requirements and whatnot from which I got the phone number -- only to be told that medical expenses incurred at Thornton Medical Center, where I'd had my surgery performed, were in no cases eligible for coverage. This is because, I was told, CMS does not have a "contract" with the hospital. That to me is quite strange. CMS is meant to serve as a safety net for those without insurance who are stricken with the need for emergency care, like, say, an appendectomy. From their website:
A program that funds medical care for uninsured indigent adult county residents. While not a health insurance program, CMS funds services through a network of community health centers, private physicians and hospitals.
Emergency care by its very nature precludes investigating in advance which hospitals are eligible for a sort of coverage that I'd never had to investigate before... How was I supposed to know where I was supposed to go to be covered? I just don't understand it. Another question is why the hospital representative even had their pamphlets on hand if no such contract exists.
As for the Medi-Cal business, I dealt with one of their offices last year on an unrelated matter, and the layers of bureaucracy were almost impossible to navigate while I was taking classes full-time. I doubt that I'll be able to do it while working full-time, and the fact that I'm supposed to be starting a job soon (and also that I'm both white and well-educated) will probably result in my eligibility being denied there, too.
It's a strange thing, isn't it? I understand a bit better now why proponents of health care reform decry the entanglement of employment and health insurance. Why should the unemployed also be those most likely to be uninsured? Surely that's a social injustice. I was only unemployed (and thus uninsured) for a three month period -- in December I was both receiving paychecks and covered by employer subsidized insurance, and the same will be true from April onwards. The potential cost of my poor luck in these circumstances could be ruinous! If the hospital were to insist on charging full freight, almost anyone would feel pushed to declare bankruptcy. As it stands, my family can support my medical costs if necessary, either through an outright gift or a long-term, low-interest loan. But without such lenders of last resort? I don't know what I would do.
To add insult to injury, it's an open secret that the insured pay significantly more for health-care expenses than do large insurers. (For example see this article from the Wall Street Journal.) The same price will be quoted to all comers for any given service -- and my appendectomy will cost about $20,000, give or take $5,000, I think -- but HMOs and Medi-Care are in a much stronger negotiating position than any individual hospital and generally dictate terms. Had I been insured, the insurer would pay out $2,500 to $5,000, all told. That discrepancy, a tacit policy of price discrimination against the uninsured, who are more likely to be indigent or unemployed or both, is truly criminal.
Finally (and fortunately), I hopefuly will not have to pay out the full amount, either, which leaves one to wonder whether anyone truly pays the charges that are billed. Several years ago while still living in the Los Angeles area I made the mistake of experimenting with E. I learned to my dismay that in my brain E induces terrible anxiety attacks. In the midst of such an attack I ended up in the emergency room at Cedars-Sinai Hospital in Beverly Hills -- I was hooked up to an IV, pumped with fluids and Ativan (an anti-anxiety agent), and discharged in just a couple hours. The final bill? More than $3,000. In recognition, I think, of the facts that I've been talking about throughout this entry, most hospitals actually have programs to defray medical expenses for the indigent and the unemployed. After filling out a ream of paperwork, including paystubs showing that I was only earning $13/hr at the time, they waived my fees entirely. Of course, UCSD's program may not be so generous -- but here's to hoping!
Otherwise I may have to start soliciting you all for donations. ;)