Friday, July 8, 2011

On good health, and how much it costs

A few years ago I thought I was having a heart attack. I looked up the symptoms I was experiencing on several reliable websites, and they all told me I should go to the emergency room immediately. Tim Russert had just died and I was taking this pretty seriously. I went.

What happened next could serve as a parable illustrating what is wrong with our health care system. When I reported my symptoms, they snapped a plastic band on my left wrist and immediately asked me - if I had my insurance card. Fortunately, I did, and my bank debit card as well. A $50 copay properly disposed of, I was then asked to describe my symptoms in detail.

What I said apparently concerned the docs enough that they whisked me back for a CT scan. After waiting anxiously for a few hours and trying in vain to contact my family (my cell phone didn't work in the ER), I learned that the CT scan showed nothing wrong with my heart. Just to be sure, though, I was told to come back in a few days for a nuclear stress test. I also passed that with flying colors. The conclusion was that I have absolutely no cardiac problems whatsoever. The symptoms I was experiencing were diagnosed as acid reflux, and I was able to get them under control with a relatively inexpensive over-the-counter medication. By now they've completely disappeared.

Happy ending? Yes - except for the bill, which eventually came to about 30 times the amount of my initial copay. Those tests were expensive. And then there was the obligatory followup with my family physician.

The first thing he asked me was whether I had ever smoked. I was pretty sure he knew I hadn't, and since I already knew the results of the CT and the stress test, I couldn't imagine why he was asking. I soon found out. The CT, while finding nothing whatsoever wrong with my heart, had detected a small nodule in the upper lobe of my left lung. It was impossible to tell at this point, but there were two possibilities: It was either completely benign and nothing to worry about, or it was the beginning of lung cancer. As a result, the doctor wanted me to come back for repeat CT scans after three months and one year.

Needless to say, I was a bit anxious for the first three months. It was extremely gratifying when the CT scan results came back showing that the nodule was completely unchanged, meaning that it was not growing, meaning that it was not cancerous, meaning that it was nothing to worry about. I wasn't particularly surprised when the one-year CT scan showed the same thing and I was given the all-clear.

Did I mention that CT scans are not free? Since a full year had passed by the time of the third and final one, I had a new annual deductible to meet that was not affected by the costs of the previous two visits. The total net cost of finding out that I was completely healthy in every way that medical science could determine: over $2000. That's right; that initial impulsive visit to the ER morphed into a series of experiences that ultimately cost me two grand and three months of considerable (though unnecessary) anxiety. Of that, the cost of the Prilosec to fix the GERD was a truly insignificant portion.

What lesson have I learned from this? It's hard to say, but it's quite likely that if I ever think I am having a heart attack again, I will hesitate for much longer before going to the ER. As a result, if it turns out not to be a false alarm next time, I am likely, assuming I survive, to end up incurring considerably higher expenses than I would have with a more timely appearance. I have learned, essentially, that being safe rather than sorry is expensive, often unnecessary, and likely to leave you feeling a bit foolish. And, of course, I have insurance.

I'm a little nervous about writing up this experience and sending it out into the blogosphere, because I don't want others to follow my example. If you get chest pains, get them checked out immediately. In the meantime, though, you might want to think about the implications of having a health insurance system that makes preventive actions so expensive that it can often seem more prudent to skip them and hope for the best instead.

[NB: Last week, I spoke with a staffer at Congressman Flores's Washington office and restated my earlier complaints about the budget impasse. I told her that liberals in the district were getting the message that the Congressman wasn't interested in hearing from us. She assured me that was not the case, and gave me the name of another staff member to contact. I emailed him and received a return email promising to be in touch ASAP. It hasn't happened yet.]


  1. A few years ago I had a migraine that showed no signs of leaving after 3 days. I knew it was a migraine because there was an aura. So the health plan's same-day care told me to come in. I saw a resident and she got nervous because I have tubing in my brain (4th ventricle stent due to Chiari). So they sent me to the ER because they were worried it was blocked (despite the aura). ER also got too excited. So I ended up having to get a CT scan to show it wasn't blocked or dislodged. I told them it was a migraine. This all took a total of 7 hours and I can't imagine how much it cost. In the end they concluded it was a migraine.

  2. What the doctors are doing is covering their own rear ends against possible lawsuits and charging the costs of doing so to us, the consumers. I also imagine hospitals that have invested huge amounts of money in expensive equipment are anxious to use it, if for no other reason than to show that the investment was justified. I won't even get into the politics behind all this; current events should speak for themselves.