Shouldering Health Care Reform

(MoneyWatch)  There's nothing like personal experience to bring an issue to light. Today I go in for surgery that will repair my separated shoulder. The hospital looks so serene from the outside, but anyone who has either undergone surgery or dealt with the morass of health care in this country knows that this is just an illusion.


As I pore over information from doctors and insurance companies, I'm experiencing the health care crisis first-hand. Here's the running tally so far:

• Emergency Room Visit=$100 (insurance co-pay)
• Consult with orthopedic surgeon=FREE (my friend)
• Consult with 1st shoulder specialist=$300
• Consult with 2nd shoulder specialist=$400
• Pre-op blood work=$20 co-pay
• Acupuncture (one session)=$125
• Approximate fees for out-patient surgery=$25,000
• Shoulder Immobilizer and cold therapy wrap=$250

The good news is that I'm one of the 180 million or so Americans who is lucky enough to have access to employer-provided health insurance. Actually, the coverage is through my spouse's employer, which was far cheaper and more robust than the coverage that I had when I owned my own small company.

Even with excellent coverage, my out-of-pocket for the whole enchilada will likely be close to $3,000. Part of the reason is that I chose a surgeon out of my network, but then again, he was the only one who did the surgery in a less invasive manner that I believe will give me the best outcome.

Since my bicycling accident two weeks ago, I've wondered how I would have fared in this process without health insurance. Here's what would have happened. I would have gone to the emergency room and been billed for the total cost. Then, after being informed by the young resident in the ER as well as the attending physician on call, that the injury did not require surgery (a misdiagnosis, by the way), I might have blown off the follow up with an orthopedic surgeon. After all, if a doctor says I don't need to go under the knife, why search for one that would tell me otherwise?

The shoulder would have healed, but I would have likely been riddled with chronic pain. I also may have been limited in my activities, which would be a pretty major bummer. In the end, my quality of life would have been so much worse off. This scenario doesn't even account for the constant anxiety that those without insurance endure.

It's clear that we need health care reform. Yes, it's going to cost money to cover those without insurance, but we also need to address the fact that the US spends almost 50% more per person on health care than the next most costly nation. According to estimates, if costs grow at current rates, health care will consume twenty cents of every dollar of GDP by 2050.

Because my summer activities will be limited, I'll have plenty of time to research this story and to follow the Congressional machinations. In the mean time, wish me luck!

Image by Flickr user joshmadison, cc 2.0