What does a brain tumor cost?

Posted in Uncategorized by Sean Holton on September 4, 2009

Medical Bills  “No one should die because they cannot afford health care, and no one should go broke because they get sick. We are only as strong as the weakest among us. If you agree, please post this as your status for the rest of the day.”

That was the message floating around all day on Facebook yesterday, urging supporters of health-care reform to post it as their status and pass the word to all their friends to do the same.

While I agree with the sentiment totally, I didn’t post it as my status because I’m in a very strange place right now as one of the health-care “haves.” I thought it would be hypocritical of me to rail against the current system after having directly benefitted so recently from the way it works. 

Instead, I thought I could make a better contribution to the health-care debate just by opening up my ledger and showing everyone flat-out what this damn brain tumor of mine has cost all of us — so far. I’ll still be running up more bills for chemo and radiation going forward. But the bills that have come in already will give you a pretty good feel for where things are headed. Basically, I have turned into a leach on society.

I’m starting to think the more appropriate federal plan for me might have been the “Cash For Clunkers” program. I absolutely love that program. Now if I could have just gone into a car dealership and received $4,500 cash for my old clunker of a brain to put toward the purchase of a brand-new, fuel-efficient Toyota Prius, society as a whole might be better off in the end. But for now I’m just stuck with this clunker. So the docs will just have to just patch it up, change the oil, maybe slap on a new muffler and send me on my way. And the rest of you will get to pay for it.

But that’s beside the point. Let’s move on to the cold, hard numbers.

First, just for fun, let’s have a look at the column on the left called “Initial Charge.”  Even though it really doesn’t mean much of anything in the end, I think people have a fascination with that column simply because of the mind-blowing numbers it contains. It’s almost like health-care porn. I actually drew some level of perverse enjoyment from telling people in the park where I walk my dogs twice a day that my 42 chemo pills cost $12,000. For just a few seconds, they looked at me in wide-eyed awe — like I’m some kind of Bill Gates figure, able to blow those kind of big bucks on a few lousy cancer pills while I also happen to be cruising the Mediterranean Sea on a yacht loaded with Brazilian hookers, or something like that. Wait until tomorrow, when I can tell the gang about the bill for my 5-day hospital stay being 92 grand. They’ll be asking me for stock tips.  But it’s a two-way street — my fellow dog walkers also get perverse enjoyment from this information exchange. They get to hear real-life, docudrama-style information totally unedited from me, the park’s new Cancer Guy. And the stupid-high numbers give everyone a great hook upon which to hang any kind of totally imaginary political or lifestyle point that they might want to make. I happen to live in the most volatile corridor of the most important swing state in the nation. So depending on whose dog needs to relieve itself at any given hour, that totally imaginary point might be: “Goddamn Obama is ruining the country” or “Stupid Republican Big Pharma Pigs Must Die” or “You should try Mangosteen juice and fish oil instead of listening to doctors” or “Jesus will protect you” or “I’ve always hated Blue Dogs” or “Hey, look at my new gun” or “From Time To Time, The Tree Of Liberty Must Be Watered With The Public Urination Of Complete Morons.”  It doesn’t matter. The silly-high numbers will back you up no matter what you have to say. That’s pretty much why the whole health-care debate with all the town halls has been ridiculous. There’s all this data out there, but no real knowledge or even any interest in acquiring it. We can all see Russia from our houses. We just don’t know what the hell Russia IS.

[Before leaving the lefthand column behind, I just want to point out that I do think I got a pretty good deal on the actual procedure that involved boring a hole into my anesthetized skull, navigating delicately around my healthy brain tissue and removing the evil Death Bird tumor from deep inside its nest. Just $10,260 for all of that? Can you even get a new Hyundai Sonata that cheap? Hell, I would have paid my neurosurgeon cash on the barrelhead just to come over to my house and do that. Next time, I’m going to have to check Craigslist for an even better deal.]

Now onto the center column — the “What Insurance Pays” area. This is where we get down to business. Essentially, these numbers represent what the insurance companies have negotiated with their in-network providers as to what they’ll actually pay for each type of service. And the providers all seem fine with that arrangement. As you can see, the actual payments are substantially less than what is initially billed — often as low as one-half or one-third. So who’s getting screwed here? The doctors? The insurance companies? Is everybody on the provider side deliberately high-balling everything with full knowledge that they’re going to be low-balled later? Or are the low-ballers the equivalent of mob leg breakers for a syndicate that sets its own prices for protection? What aspect of the entity that the rest of us refer to as “reality” are any of these prices based on? Are insanely high malpractice judgments mostly to blame? I have no idea. Besides, I’m tired. I have brain cancer. So I’ll let the town hall loons argue about that one, too.

The one person who certainly is not getting screwed is me, which brings us to the righthand “What I Owe” column. That number is dictated by a combination of the amount of the deductibles and the out-of-pocket maximums built into my health plan. Essentially, after I’ve paid a certain amount of the costs out of pocket — everything else is on the house. In this system, lots of folks are paying high health care premiums and may only get a couple of sniffles and scrapes each year but still might have to pay a couple thousand out of pocket for treating them before enjoying any benefits of insurance coverage. They may well wonder where all their premium cash is going. But if you have something like a brain tumor, like I do, you’re getting a great deal. Too bad part of the standard treatment regimen isn’t that, in addition to chemotherapy and radiation, you get to cover your walls with original works by Picasso. I bet Bill Gates gets that in his coverage.

There are other ways I could have been hosed: If any of my providers were not “in-network,” for instance, the insurance company legbreakers would just wash their hands of me and let me haggle over the high bills directly with the non-network providers. I would have been like Luca Brasi trying to go freelance and negotiate directly with the Sollozzo family in The Godfather. Didn’t he end up with an icepick in the back of his hand? Or was it piano wire around the neck? Or was it both? If my “in-network” list had been really restricted, I would easily have been bankrupted with these kinds of bills.

It’s all such a mess, I’m not sure how anyone will figure it out. All I know is that I had received a lot of this great care before anyone ever even asked me for the correct spelling of my name, let alone for my health-insurance information. Why was that? Was it just because I was a middle-aged white guy who had passed out at a whitebread gym? What if I’d been a young black guy with a damn gunshot wound in my head instead of a tumor? Would I have received such great benefit and such little doubt? I think I wrote earlier about how a representative from the hospital business office came into my room on the day after my surgery to ask if this was going to be covered by insurance or handled through “self pay.” That’s both comforting and scary. Comforting because it means I might have received the care I needed no matter what my insurance status was. Scary because, had I had no insurance or had crappy insurance, I’d now be hook for a much bigger chunk of all of these bills.

Now back to that Facebook status thing that I posted at the top. I think the points made there are a valid baseline for discussion on reforming our system. Getting good care shouldn’t hinge entirely on what job you happen to have or how rich you are. And given the fact that cancer is not exactly a rare disease in our society, it shouldn’t become an automatic death sentence based on your economic status.

That’s what I think. I’ve shown you my numbers. Now talk amungst yuhselves.


14 Responses

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  1. Lois Grebowski said, on September 4, 2009 at 8:46 am

    Wow, you’re really opening it up… Thank you! :-D)

    Healthcare reform is a lot like treating cancer. It’s a delicate dance. While there’s no single cure for cancer, there are a myriad of treatments available. The aim is to kill the offending cells and not person living with cancer.

    I’m not a pro, but I did work six years in the healthcare field (marketing) and stayed at a Holiday Inn once…LOL! This is my take:

    There isn’t a single fix. Healthcare reform is a mixture of little fixes… you just have to find the right formula…

    First off, insurance needs to be more portable and available. I would love the ability to buy my own insurance. This way we won’t have it tied to our jobs. I tried once, and we were denied coverage. By utilizing larger population pools, insurance providers can spread their risks. After all, insurance is gambling against risk.

    I’d like to see less bureaucracy. I’d be more interested to see the mounds of paper representing the claims you mentioned above (from the doc’s office to your final payment — all of it). Remember, you have to pay for all that paper/data and the many hands it goes through. Bureaucracies costs money. You’d be amazed how many “hands” touch a basic prescription claim — and that’s the easy stuff!

    I’ll bet that paper mountain is taller than you are. Seriously.

    Those are just a two ideas to start with…

  2. Barbara Hill Bissonnette said, on September 4, 2009 at 9:52 am

    In July, my husband went through not one, but two arterial bypass (lower extremities) surgeries, from which he is still recovering. He was hospitalized for 3 weeks, they ran test after test, scan after scan. He saw about 6 different specialists (for arteries, for heart, for endoscopy, for carotid arteries, and for a chest x-ray that was never explained.) He had the two surgeries a week apart. He stayed in emergency for 4 days, then was moved to a pavilion with private rooms (this hospital was built with rich people’s money.. historically, the rooms in this pavilion ALSO had adjoining rooms for valets and butlers!) I slept there on a number of nights, by 11:00 pm it just seemed easier. The doctors pretty much treated ME along with him. They never talked over me, they never talked over him. The nursing staff was wonderful, and so were the orderlies and preposes (those wonderful, mostly women, employees who accompany patients to various appointments around the hospital.)

    What did this cost us? Not one red cent! We showed up in emergency with our much-maligned socialist medicine card, presented it to the triage nurse, waited 10 minutes for his name to be called, and from then on, it was serious medical attention. We like to whine about our taxes too, but poll after poll indicates that the great majority of Canadians support single-payer healthcare, and if you’re going to be taxed to the hilt, at least we get services from our largesse!

    Everyone in this country is covered. You’ll hear horror stories about our system but don’t believe ’em! Yes, we have problems with access in rural areas, but I think that’s likely the same in all western countries. Doctors prefer to work in large urban areas, near universities which fund research and encourage “publish or perish.” Here in Montreal we have eight, count ’em, EIGHT university-affiliated health centres, with even a few suburban hospitals for those who prefer bedroom communities.

    I shudder to think where we’d be had we been presented with a bill at the end of his stay. Well, I know where we’d be. Debtor’s prison!

  3. April said, on September 4, 2009 at 11:07 am

    Excellent points. You know, for an Irish guy.

    Like you, I think there has to be a real discussion of how we provide care based on need and not income. But I also have a hard time railing against insurance companies.

    My most recent hospital run was at ORMC under Cigna. As you recall, they couldn’t stabilize me or get a handle on what was wrong. After five or so seemingly long days, when I finally got the upgrade from serious to fair condition, I figured I’d be out on the street that afternoon.

    Nope. I was there for 14 days, while they tried different treatments on suspected conditions. And the Cigna nurse came every day, to make sure I was comfortable and if I needed anything I wasn’t getting. Who does that? Surely no an evil insurance company.
    I’m glad to see you’re having the same experience.

  4. Michele said, on September 4, 2009 at 11:09 am

    My thoracic surgeon made $1800 for a 2 hour operation, 2 pre-surgery visits, 5 hospital visits and two post-surgery visits. I was embarrassed. How can this doctor, who sawed opened my chest and removed my cancerous thymus, receive so little compensation? He saved my life. How much is that worth? I had the idea to find out what his favorite charity was and make a donation in his name…still a good idea…I need to follow up on that one…hmmmm….
    P.S. The anesthesiologist made twice as much
    P.P.S. You have very good insurance…my adventure cost me $6k, on about $100k worth of bills.

  5. RebelliousRenee said, on September 4, 2009 at 1:40 pm

    I think I’m all talked out on the subject of healthcare reform. Craig posted something on it daily for 2 straight weeks over on TrailMix. People are still battling over it today even though Craig has moved on to Afghanistan.

    So here’s my short version. Healthcare reform. We need it. As much as we can get.
    And here’s to hoping Obama has a few balls. Don’t see much of them yet.

  6. fish said, on September 4, 2009 at 2:33 pm

    i, too, was fortunate to have great insurance and super-great (and hot!) young docs when i was diagnosed with breast cancer almost six years ago… i spend about $2,600 while Aetna spent more than $50K for two in-patient surgeries, three out-patient surgeries, four chemo treatments, et al…

    not everyone is so lucky. a younger woman friend asked to have a port (she would have 8 chemo infusions from the get go; a second opinion deemed the latter half “overkill” for me) but the HMO denied it. she ended up with an external line that needed to be flushed daily hanging off her arm because her veins were so screwed up. my insurance paid for a single shot of Neulasta blood-booster after each chemo @ $2,500 a pop (and i paid 10 percent, a bargain in my estimation). her HMO would only pay for the daily shots of an older (and less effective) blood booster, which meant she had to had to shoot up daily… we’re both fine these days (hell, she was out ice climbing a month after her chemo ended!)… but we also need to stay employed because we’d be denied coverage because of our preexisting conditions….

    again, not everyone is so lucky. here’s another Florida story i’ve been following, in which an insurance company denied coverage after a catastrophic illness, instead recommending the family go on Medicaid:

    to that i say, hey if Medicaid is good enough for Cigna, so is the public option.

  7. harborwoman said, on September 4, 2009 at 4:41 pm

    Thank God you have good coverage, Lard! I hope the day will come when all Americans will have access to quality, affordable health care for no better reason than that they need it.

  8. Ann Hellmuth said, on September 4, 2009 at 5:50 pm

    I feel that the British National Health Service is also maligned.

    OK, you may wait to get surgery for something like bunions, but you can always go private. However, if you are really ill you get excellent treatment and it is a great feeling to know your family won’t be bankrupted if you die or that you’ll spend the rest of your life paying the bills. Plus once retired you don’t have to pay a penny for your prescriptions.

    And on to Medicare. I was in the hospital in March for potassium and thyroid problems and never got a single bill. Never even got to see a bill. So here’s a toast to government-run programs.

  9. themusingbouche said, on September 4, 2009 at 6:08 pm

    Lovely post, Sean.

    People love to rally against health insurance companies, but there’s also the drug companies to talk about. Should your chemo pills cost $12,000 and under a national system would it be covered? What cutbacks would be made to ensure health care for all?

    The Boston Globe published this story a few months ago about the moral dilemas faced when national health and high-cost drugs intersect:

  10. Jeanne Klonr said, on September 4, 2009 at 10:07 pm

    I’m impressed by how far you have gone to show us the difference between the haves and the have nots. I’m not complaining because I too am covered by the system. I have a good HMO through medicare. I can’t tell you how much I would have to have paid for all the test, treatments, procedures and rx’s I have had in the last ten years of my Lupus. The first 30 were pretty cheap.

    California is a pretty progressive state except for the Terminator, we had programs for children and adults on a sliding scale, meaning the very poor paid nothing. But alas Swartzeneggar screwed that all up. now very few get any help. We do have one thing that I would like to see in any health reform bill, YOU CAN NOT BE DENIED INSURANCE because of a pre-existing condition.

    My daughter is living proof of that. She has a very rare condition, elhers-Danlos syndrome, which in her case causes all the ligaments and tendons in her body to become like stretched out rubber bands. Even though she has had a knee surgury, lost half of the thyroid, due to cysts (a part of the poblem) she has had 4 major back surgeries to straighten her spine. the first 2 I had her covered by my insurance cause she was 11 and 12 but when she was 25 she had to have 2 more. Luckily she had the same health ins. company that I had had for her. And she now has health insurance on herself as well as her children. I am so thankful that California has that in writing, can you imagine her trying to get health insurance if it was not for that law?

    The debate will go on, no one will ever be 100% happy with any program, but I do hope that something will start the ball rolling. By the way I like the way Obama is trying to fix this and not let it fall under the coverers as it did when Hillary was 1st lady.

  11. paul lester said, on September 4, 2009 at 11:58 pm

    Excellent, balanced post. But I can’t stop giggling over the following two words: “Brazilian hookers.”

  12. Emily Smith said, on September 5, 2009 at 6:26 pm

    Well said, Sean! My husband underwent catheter ablation on his heart last spring to control atrial fibrilation. The grand total was over $40,000 — a mere drop in the bucket compared to your expenses. Lucky us, we have good health insurance — our total out-of-pocket expense was $200 for the overnight hospital stay. Still, as you so eloquently point out, things could be vastly different if circumstances change. We, too, are grateful.

    By the way, I hope you are planning to turn these blogs into a book — I predict a bestseller!

  13. Scary said, on September 9, 2009 at 10:02 pm

    I don’t think the Eskimos set their elderly adrift on little icebergs anymore, although it probably seems like that for people who are sick and don’t have insurance.

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