HULK SMASH (part 1 of 2)

Bitter Pill: Why Medical Bills Are Killing Us – TIME

It all started with a single bead of sweat, which gave way to nausea, and then there was the fiery, unrelenting diarrhea. I still remember fondly recalling a clear nasal passageway, but by now I was especially reminiscing with the utmost nostalgia about the days I had if only one well-functioning orifice, just one that didn’t have some blood-instilled, putrid liquid coming out of it, hunching me over a garbage can or toilet. Mind you this had taken place gradually. It was around the moment I woke up face-down on my kitchen floor in a pool of something I didn’t care much to identify, with a fever-induced Osama bin Laden telling me I didn’t look so hot, that I decided to reach over for the phone and call 9-1-1. I was promptly ushered to the nearest hospital and thus began:

THE DAY I TESTED THE MEDICAL CARE MARKET

I rose hours later in a hospital bed, in a room which featured little else than a potpourri on my bedside table, and a picture of a potpourri on the wall. An old TV was playing some kind of daytime TV show where they talk about problems only people who have the time to attend any such show to talk about their problems might possibly have. I was greeted by a semi-attractive, cheerful to the point of being condescending nurse, who stood at a healthy distance away from me, most likely due to the fact that I had not changed in a while, and by now my clothes probably reeked of vomit or fecal matter or both. The day’s event suddenly accelerated as she explained that, upon rummaging through my wallet in order to confirm my identity, they had stumbled upon my health insurance card, and, apologetically, informed me that, quite unfortunately, that particular insurance did not figure on the list of private health insurances that they accepted, and that I now owed the hospital $4300, that’s $932.87 for the ambulance ride that got me off my kitchen floor and to the hospital, $2099.13 for an inpatient stay, and $968 for a cocktail of blood tests, meds and a CT scan. My lavish lifestyle as a professional pancake flipper at IHOP unfortunately precluded me from eligibility for Medicaid, and my youthfulness did not comply with Medicare. As the news of this sizable bill started sinking in, my mind drifted to the unreasonably expensive nature of my irrepressible poker addiction as well as the college loans I had long since, stopped, thinking about actually. This certainly was not good news. The second-story jump of my timely hospital getaway certainly would seem like a rash decision in hindsight, but the anti-inflammatory meds I had just not paid for most likely cushioned the blow as even I was surprised at my renewed energy and subsequent Usain Bolt impression as I made my escape.

I must have blacked out again, because the next thing I knew I was at the wheel of my 2001 Chrysler Sebring rolling to St. Andrew’s Hospital on the other side of town. One may think after my daring/insane escape out of a second-floor window that I had lost all grasp on reality by this point, but I was well aware the clock was ticking. The amount of pus excreting from the sizable warts which had grown to adult size on my perineum was sending that message loud and clear. Something was really wrong with me. I just had to find affordable healthcare somewhere in this town before it was too late. I was most likely hemorrhaging somewhere in my brain by then because what usually is Robert F. Kennedy boulevard suddenly turned into Robert F. Kennedy boulevards, as 2 sister streets plainly materialized before my very eyes. I decided to pick the one in the middle and can only assume I made the correct choice as I finally arrived at a hospital for the second time today. It was not before I had already waited a couple hours in the “reception area” that a doctor informed me that the kind of ‘discount insurance’ I had (for which I paid a premium of $470 a month) would only reimburse about %50 of this hospital’s bills, that my health insurance, Argent, only applied full rate reimbursement in the states of Texas, Missouri and Washington, the combination of which was somewhat baffling. I informed the good doctor of my decision to thank him, but not thank him, and to shop for better prices elsewhere and his face contorted into an expression of horror in response.

‘But sir, your ears are bleeding…’ said the good doctor.

‘Then, I must be quick,’ said I, with an uncharacteristic determination in my voice, probably once again a result of the folly that was gaining on me.

The hospital was legally obligated to keep me from leaving in my current state and thus compelled to charge me obscene amounts of money in the process, and so it was that I was a fugitive of not one but two hospitals that day. I high-tailed it across state lines in direction of the wonderful state of Texas. My quest for the Holy Grail of affordable health care would continue in the Lone Star State, or it would end there.

to be continued in HULK SMASH (part 2 of 2)

HULK SMASH (part 2 of 2)

Bitter Pill: Why Medical Bills Are Killing Us – TIME

continued from HULK SMASH (part 1 of 2)

My Eldorado lay no further than an hour’s drive away, but my blood pressure was nonexistent and oxygen scarce by the time I made it to destination. Thankfully, what awaited me there was the American Dream still alive and true. There I was informed my insurance would pay back all of my bills. Good old red, white and blue, I thought. I spent a week in the hospital, as nurses poked and prodded me all day long and new doctors visited me daily to provide me with their opinion on the morning CT scan before ordering a slew of blood tests. The bills kept piling up, and granted I would indeed have had a rather stern disagreement to voice if Argent, my semi-dependable private health insurance hadn’t been paying for this, mostly due to the $13 per tylenol pill (500 for $10 on Amazon), $137.33 per day for heating my room which did not figure in the $3200 daily inpatient room rate, $600 per doctor who even glanced in the direction of my CT scan, a $35000 bill for a drug called CuReItAlL and a $13000 cost allocated to a category simply entitled ‘COMFORT’, which had such concessions as soap and hot water. The day of my hospital discharge finally arrived and I was informed that my bills had ballooned to a whopping $103,567.

‘I should really send someone at my health insurance some chocolates, or a wine bottle or something,’ I said with one of those awkward smiles I have when I am oddly proud of a bad joke that only I find amusing.

‘Right, but your insurance has an annual ceiling of $40,000,’ answered the receptionist.

My dimwitted smile kept on hanging comfortably on my face for a surprisingly lengthy few more seconds until the gravity of the situation suddenly seized me, and I became very, very serious. My hands began twitching, my muscles were bulging, my veins started protruding, my eyes swelled, green with rage. As my muscles expanded, so my body grew. My pants ripped apart, my shirt was reduced to little more than a thread. I had become the Incredible Hulk. I’m sure I don’t need to describe the look of shock, horror, disbelief that lay on the hospital staff’s overpaid faces, and I suppose it did not make things better when I grabbed one of the senior doctors by the feet and used him as a battering ram to destroy the overpriced hospital equipment, which I was being grossly over-billed for in order to justify their purchase. I then demanded in my highly-testosteroned voice to see the Chargemaster, the mythical being which determines all these hospital prices, that most have only heard of uttered in legends. I sure as hell had their attention now, most likely because their boss was still dangling between my thumb and index, and everyone complied swiftly. We all made our way to the president’s office, where he obediently pushed the big red button under his desk. A picture of Ronald Reagan on the wall slid to the side, revealing a safe. Inside, beside a 9mm handgun, $1 million in cash and a picture of his mother lied an old map that we dusted off to learn the location of the Chargemaster. This search would lead us down to the forgotten underground tunnels.

After dodging arrow trip-wire traps and poisonous spiders, our search brought us to the minotaur’s labyrinth, and after solving that and defeating the bi-pedal cow, we came to the ‘Janitor’s Closet’. The door creaked and whined to reveal a very large computer. The ground started shaking, truly a seismic wave. Parts of the ceiling rifted and fell to the ground. Finally, a voice rang, one so evil it shook us all to our very souls.

‘Who disturbs my slumber,’ demanded to know the unreasonable price setter known as the Chargemaster.

‘I am a patient here, and this is your staff, and we have questions,’ I responded.

‘Make it quick then, my time is money.’

‘Your profit-margin is obviously ridiculously high. What is the rationale and calculation behind these prices?’

‘I am not at liberty to discuss that’.

‘Well would you please explain how you calculate the cost for treating my radiation poisoning?’

‘Your soul + a 300% profit margin,’ said the Chargemaster, barely able to contain an evil giggle.

‘Well I think that’s total crap. I don’t want to pay $74 for a shower curtain. In fact there’s a lot on these bills that I don’t think I should be paying.’

‘Fine,’ said the sarcastic AI, ‘don’t pay, die of radiation poisoning, see if I care.’

And that was that really. Just then I realized what the ace in the hole really was for the Chargemaster. There was no negotiation to be had. I needed him exponentially more than he cared whether or not I paid the price. So then, I paid the price. I sold everything I could to pay my debts, which would only grow since I had to return to the hospital for further monthly consolations. My quest for affordable healthcare had indeed ended in Texas. As I left the hospital that day, a statue of the Virgin Mary loomed over the St. Gregory’s hospital parking lot. Underneath, a sign read ‘Give Us Your Sick And Your Poor’.

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A word of warning: Steven Brill’s article in a recent issue of TIME magazine may have you ripping your hair out from the seams. In it, Mr. Brill describes a situation that makes the bankers charged with gambling with your kids’ college loans seem like cute, fuzzy teddy bears. It depicts a country with a doom machine called ‘The Sequester’ on the way to stabilize the country’s deficit and risk further economic recession, while much of the overspending we as Americans do on a yearly basis is due to hospitals and pharmaceuticals (although more emphasis on hospitals here) seeking anywhere from 400% profit margins for wonder cancer drugs to 1000% margins for Imodium A-D, quite simply because they have a product that the free market cannot say ‘no’ to. If you’re wriggling in pain on the floor because of that poisonous snake bite, and I’ve got the antidote, it’s probably safe to assume that I’ll be the one setting the terms of our business deal, not you. We’re talking about families going home with bills amounting up to hundreds of thousands of dollars because their private health insurance had an annual payout limit, and they just weren’t ruthless enough to leave uncle Eddy, recently diagnosed with pancreatic cancer, on the sidewalk to rot and die. Around the country, hospital prices originate from the chargemaster (not a myth) with very few executives able to explain the calculation behind these final prices, but certainly very able to cash in on their multi-million dollar paychecks. The highest-paid aren’t even doctors. It is because electricity and gas are necessities that their prices are regulated. It is because we cannot let the free market dictate life and death that medical prices in other countries are regulated (albeit still with a comfortable profit margin). Obamacare does not fall short because it will boost premiums for those of us who could previously afford private healthcare, but because it does not act to regulate conflicts of interest between doctors and medical companies who provide the former with incentives to sell their drugs, their medical equipment, consequently having hospitals order more scans/blood tests and disseminate more drugs in order to maximize on their investments. Nor does it reign in price determination. The healthcare industry lobbyists in Washington have played their game so well, that we spend our time debating who should shoulder the price of medical care in this country instead of asking why anyone should be paying this much in the first place. To be clear, even hospitals think what they charge is ridiculous. This why many hospital bills actually constitute something of an “opening bid”, a point where both parties can begin negotiating. Has any doctor ever told you, after handing you a bill, ‘hey why don’t you get back to us and tell us what you think about this’? Most people don’t care to analyze hospital bills or even understand them, because their insurance companies will foot the bill. Others just assume they’re fucked. Executives, it would seem, are more often than not paid extravagant amounts of money based not on the hard work they put in but rather because they have based their entire business model, quite smartly I might add, on the fact that they well know they hold the antidotes. There will be no discounts with Obamacare. The medical companies in the US, are Too Big For Sales.

Note-worthy: “On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.”