What does a brain tumor cost?

  “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.