Health Care Crisis

In December 2005, I was on a group biking tour of California wine country when I got going too fast on a steep downhill, couldn't quite make it around a sharp left turn, went off the road, and fell over. My last thought as I went down was, "oh, this won't be so bad, I've slowed down considerably." The next thing I remember is being loaded onto a stretcher. I have no memory of anything in between, but I'm told that after my friends revived me (I was out for about a minute), I tried to get back on the bike and had to be restrained. Thank heavens, I was wearing a helmet.

An ambulance took me to the hospital. I looked like something out of a horror movie (photos here), but in the end the only real damage was that I broke one small bone in my left hand, which the doctors taped up. My ribs were pretty sore, but the doctors couldn't quite tell whether any were broken. They thought not, but since there's no treatment for ribs anyway, they didn't bother to make certain. The hospital did a CAT scan, and the doctors said, oh, there might be some bleeding in your brain, we'd better keep you overnight. So I stayed overnight (in a semi-private room), and then the next morning, they did another scan and said, no, everything's fine, that first scan must have been a false positive, go home. They did another scan in there somewhere to check for broken bones. And they gave me some pain medication and cleaned me up generally. And that was it. No surgery or anything like that.

So. Three scans, pain medication, tape for the broken bone in my hand, and not quite 24 hours in the hospital. Go ahead and take your wildest guess how much that would cost.

Most people have guessed something like $3,000 or $5,000 or maybe $10,000 at the most. That was their wildest guess. The bolder guessers have picked $12,000 or $15,000. I think the highest guess was $20,000.

How about $45,000? In your wildest imagination, could you ever guess that that would be the bill? Well, it was. For some reason the bill reflected an "out of state adjustment" for my insurance plan of about -$11,000, which brought the total down to $34,000, but $45,000 is what the hospital thought the services should cost. And bear in mind, that was just the hospital. That's before the doctors and the ambulance.

$45,000! And there was nothing wrong with me! I broke one bone in my left hand! I didn't even need surgery! What if there had been something wrong? What if I'd really had some bleeding in my brain or something else that required surgery? Would the bill have been $245,000?

I am reminded of all this because I have just received the bill for the amount I actually have to pay. My insurance company, perhaps understandably, was a little skeptical about this bill and kicked it back and forth with the hosptial for over a year. It was somewhat unnerving to have a $34,000 bill hanging over me all that time, even though I knew I wouldn't have to pay all of it. Based on what I thought I knew about my insurance plan, I guessed that the insurer would disallow about half the bill (its usual practice) and then I would have to pay 20% of what remained, in other words about $3,400. For some reason that I didn't understand (but am certainly not complaining about), that's not how it worked. The insurer actually forked over a little over $31,000 ($31,112.81 to be exact), and my share came to a bit less than $2,000. I felt like I'd gotten off easy. Of course, with the doctor bills and the ambulance bill it all came to somewhat more -- my total was $3,169.40. My insurer kicked in a total of $32,526.69, making the grand total $35,631.99.

Man! If you've ever wondered whether there's a health care crisis in this country, let me tell you, there is. I understand now what people mean when they say that most people are just one accident or bad illness away from bankruptcy. Imagine if I didn't have insurance! The hospital would be coming after me for $45,000. Combined with the other charges, the total amount the medical system would be seeking from me would be $48,235.35.

For one broken bone! OK, they had to check whether there was anything worse, but still! If this is what one broken bone costs, what does a serious medical problem cost?

How do people without insurance manage? There are almost 50 million of them, you know. I presume most of them don't have the odd $50,000 that they can just throw at a medical bill. I guess they just pray to stay healthy.

I lead a highly privileged existence. I have a good job that provides good health benefits, and I could afford my share of the costs of this accident. But even I was unnerved by the stunning cost of just falling off your damn bike.

Fortunately, I'm just a law professor. It's not my job to fix the health care system, and no one could expect me to know how to do it. But boy, if it is your job, you'd better get cracking. There's a crisis.

My hand still hurts. Always wear your helmet.