The high cost of being uninsured

<p>The pain was a black python that lived in my hip. Every two or three minutes it would snake down and squeeze relentlessly, crushing the life right out of the leg.</p><p>I had a ruptured, fragmented disc and was in no shape to ask how much it would cost to get me out of this horrible situation. I would do anything to kill that python.</p><p>So I did. I had neurosurgery -- and only then did I start to understand some of the financial realities of our health care system. The realization was enough to scare me almost as much as the python had.</p><p>Nationwide, some 45 million Americans have no health insurance. They don't have coverage through their jobs, don't have individual policies, are too young for Medicare and do not qualify for MediCal. These are the people who stand to lose the most when something goes wrong. And things do go wrong. Bodies do break.</p><p>I'd like to share three possible scenarios. The first is fact: It is my own.</p><p>I have a high-deductible preferred provider (PPO) policy with an HSA (health savings account). I received excellent care: My surgeon had me in the hospital operating room for about two hours and I was required to stay overnight to make sure there were no complications.</p><p>I didn't really think about what this was going to cost until I was home and slowly regaining the ability to walk. That's when I got an invoice from the hospital. The bill, for hospital care alone, was $38,892.62.</p><p>I calmed my impending panic attack when I saw that this invoice had been sent to my insurance plan and discounted by $37,351.62. They had agreed to pay the remaining $1,541. What had been an absurdly high charge had been discounted to a ridiculously low payment. Neither end of this equation made much sense.</p><p>So I called the hospital billing office and asked, "If I didn't have insurance, would I really have to pay almost $39,000?" I was told, "Yes, that is accurate, but there are programs if you qualify (MediCal). If you don't qualify, you could take advantage of our offer to discount it by 40 percent if it's paid within 30 days."</p><p>Wonderful! That meant I would have had to come up with more than $23,000 while I was still learning how to walk again.</p><p>As this reality sank in, I sat down, feeling rather ill at the thought that now I had a pre-existing condition, which would make future insurance changes much more difficult. As I checked to make sure my PPO premiums were paid up to date, I thought about so many others in slightly different situations.</p><p>For example, the uninsured person in Scenario No. 2: He does not work for a big company, and he doesn't own much either. He works for a living wage, rents a home in Sonoma County and is busy making ends meet while raising a family. He may qualify for MediCal and if so, the $39,000 will be negotiated and the state program will pay a discounted rate. No worries: Just fill out reams of paperwork, and the state will cover it out of a budget that is running out of money for health care. The type of care will be limited by what MediCal will cover, but the family will not go bankrupt.</p><p>Most frightening is Scenario No. 3: This hardworking person doesn't have a job at a big company either. His employer may not offer benefits, or he works for himself. He doesn't qualify for an individual health insurance plan or he may think he can't afford one with the high cost of living in Sonoma County. But he's managed to accumulate some hard-won assets.</p><p>This is the person who is home, stressed out from back surgery, unable to work, and finds himself faced with a huge debt. And the hospital is only part of what he will owe -- the anesthesiologist, the radiologist, the pharmacy and the surgeon have their own fees. And why is this individual charged full fees by the hospital when the large insurance companies are paying only 4 percent of those charges? Because that's the way the current system works.</p><p>As recently reported on "60 Minutes," it's a national issue. Federal law requires hospitals to charge every patient the same, regardless of insurance, but they can -- and do -- accept different payments from different patients.</p><p>Hospitals give huge discounts to insurance companies for the patients they cover, and government programs like Medicare and MediCal pay even less.</p><p>Only the uninsured are charged full price.</p><p>Linda Reid, a Santa Rosa insurance agent I spoke with, offers this advice: Buy coverage while you can still qualify, and keep it. She can find the most affordable plan for an individual, but continues to be frustrated by those who spend their money on new toys instead of health insurance. She understands this is due to a combination of fear and an inability to understand the way the system works. She wishes we had price controls on fees, coupled with mandatory health insurance.</p><p>Health care may be an ethical right, but it is certainly not an economic one. Hospitals charge whatever they will, and those of you without insurance will have to pay the full price.</p><p>The harsh reality is: Every single person who owns any assets at all needs to get health insurance for themselves and their families while they can. Yes, it is odious to pay a substantial amount of money each month for something you hope you never need, but it's a dangerous gamble to assume you will stay healthy and won't need hospital care.</p><p>One minute you are healthy and the next you are in debt for the cost of a new car, or more. Your assets will be sold, and you may be out of work while you heal. You are now uninsurable and face paying for all your health care needs out of pocket for years to come. That's too high a price to pay.</p><p>Longtime Sonoma County family physician Dr. Stacey Kerr, a graduate of UC Davis Medical School, is certified in her specialty by the American Board of Family Medicine. E-mail comments to drkerr@the-doctors-inn.com.</p>