Friday Rant: U.S. Medical Care Rationing & Personal Cost – A Tale From The Trenches

My wife and I have good employer-provided and sub-vented medical insurance coverage that will protect us from financial collapse should either or both of us ever need treatment for a catastrophic illness. It also comes with a high annual personal deductable, an essential component to affording coverage that also makes it possible for employers to offer and provide the benefit. We're fortunate to be in extremely good health as we enter our sixth decade on Planet Earth.

We're also interesting subjects in that we've contributed at least $600,000 in medical insurance premiums over the past 40 years, take no routine medications (except for vitamins, calcium and wine), and have mostly just paid deductible out-of-pocket fees for annual physicals until I recently decided to have hernia repair surgery during the August doldrums rather than take a vacation. My most recent prior and serious encounter with the health care system was having a tonsillectomy at age five.

I promise to keep this recent accounting brief with only administrative detail: Despite that I have been known to self suture DIY calamities, this particular procedure was clearly not a make or buy decision. I dutifully paid a few surgeons for the privilege of interviewing them, chose the one I believed most competent, and went through all the pre-op interviews and testing and felt very anxious on the eve of surgery as I awaited a check-in time call from the hospital. The first call I got was from the hospital business office asking me if I knew that I would be personally responsible for most of the impending cost of surgery due to my high deductible coverage. I said yes, of course, and that was that -- with no mention of what the cost might be. I shortly thereafter received a call instructing me to report at 7:30 the following morning.

Upon arriving at surgical intake, feeling dehydrated, nervous and resolved, I was informed by a desk clerk that I would need to make a minimum payment of $500 toward my insurance deductible. In the best public speaking tone I could muster, I stated that this was the first I'd heard of having to make this payment today. I went on to ask "If I do not make this payment today, will I be admitted for surgery." Answer: "Yes." I then said "If I do not make this payment now, will my care today be the same as if I had made the payment." Answer: "Yes." And finally, "May I make payment arrangements for my deductible expense following surgery." Answer: "Yes." One could have heard a pin drop in the crowded waiting area while a desk manager whispered that "These collection problems happen all the time because those who make the pre-op evening calls are supposed to discuss payment terms in advance but are generally too sheepish and embarrassed to do so."

I need to add at this point that I was at a premier Philadelphia Main Line medical facility and that my surgery went well with some recovery complications and I will be fully recovered far in advance of paying my deductible contribution of $500/month well into 2013. The myopic important point here is that I am well and able to fulfill my fiduciary responsibility. But in our society where the median family income, with two wage earners contributing, is $50K per year, necessary life-threatening conditions such as mine have become elective and untenable for the majority of U.S. citizens. Obfuscating presidential politicking from both parties aside, there are more than a few fundamental realities that we all must face and address.

From a New York Times article published this past week, consider the following:

- "Both campaigns claim they are out to protect future health care. Yet... Protecting federal health programs over the long term, as population ages and medical costs keep rising faster than economic growth, will require curbing the programs' spending.'

- "The federal government's spending on health care consumes 4.8 percent of the nation's economic production and is expected to eat up 9.2 percent in 25 years, according to estimates from the Congressional Budget Office... Decisions will have to be made about what services are not worth the cost."

- "The wealthiest 30 percent of the population accounts for nearly 89 percent of health care expenditures..."

- " Tens of millions of Americans -- those whose employers don't provide health insurance, who are too poor to pay for it themselves and yet too rich to use Medicaid -- get the least health care of all."

- "Does it make sense that older adults in their last years of life consume more than a quarter of Medicare's expenditures, costing more than six times as much as other beneficiaries."

- "Are there limits to what Medicare should spend on a therapy prolonging someone's life by a month or two?"

These are incredibly weighty issues that will never be addressed by our political parties and least of all by those running for office. Yet they comprise, along with many others, the cumulative essence of the U.S. health care debate. We must collectively as citizens force our representatives to pull their heads out of their political election and re-election malaise of sand and be willing to answer the hard questions without labeling solutions as spend thrift, socialist, anti-American or any of the other disabling rhetoric that prevents this nation from moving forward together as a world leader at all levels.

Our conjoined values of democracy and capitalism and our endless debate over the role of government vs. private philanthropy present a slippery slope from which we might continue to ignore the meaningful cost/benefit analysis and essential importance of a vital infrastructure of training, education, physical and -- if I may be so bold -- mental health, that are all pre-requisite to re-establishing the greatness of American society.

- William Busch

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First Voice

  1. Thomas Kase:


    We should all tag our wine purchases as ‘resveratrol supplements’ and deduct them as medical expenses. Just need an MD friend to back that with a prescription – perhaps as an anti-inflammatory chemopreventive. It would do wonders with our inflamed tax bills too.


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