Via Imgur
Meh, just tighten up the eating-out budget a little bit.
Hospital bills topping one million dollars are
on the rise,
and even a minor injury can leave you with a bill that looks like the
hospital replaced all of your internal organs with diamond-studded
plutonium. But beyond the initial punch to the wallet, the awfulness of
ridiculous medical bills extends to places you might not have thought.
Such as ...
#5. Even Insured People Are Going Bankrupt
The
majority of bankruptcies
in America are now caused by medical bills. Clearly, these bankruptees
were devil-may-care hooligans who chose not to protect themselves with
health insurance. Oh, wait: Most of them
did have insurance. Three-quarters of Americans whose medical bills contributed to their bankruptcies
were insured when their health problems began.
Their real problem was that these un-American slackers were dumb enough
to not be able to afford a low-deductible plan, or clumsy enough to
come down with something that their insurance didn't cover.
And when you look at the random bills that even insured people get
hit with, it's not hard to see how this can happen. I have a friend who
broke an ankle slipping on her frozen driveway during the seven-month
ice storm people in New York call a "winter." She was insured with an
80/20 plan,
but still received a bill for around $6,000. This month, I got a letter
from my own insurance company arguing that a single blood test I got
back in March wasn't "medically necessary" and warning me that I might
have to cough up the full price. How much was the full price of that
single blood test? Just 5,000 freakin' dollars. Luckily nothing came of
it, because otherwise I would have had to dip pretty deep into my weekly
writer's salary.
Allan Danahar/Photodisc/Getty Images
It's so embarrassing when you're at the local writer's club and can't afford to tip the valet.
These incredibly high and apparently random medical costs get even more ridiculous when you consider that ...
#4. Stupid Frivolous Shit Actually Costs Us Less
These bills are high, but hey, maybe doctor stuff just costs a lot.
Those long white coats and stethoscopes-around-the-neck don't pay for
themselves! Except that while fixing a broken ankle apparently costs as
much as a new car or two, the charge for laser eye surgery is usually
only
around $2,000 per eye. And this isn't a freak outlier: Nonessential procedures like
cosmetic rhinoplasty often cost a lot less than surgeries that people actually
need.
Why is essential medical care so much more expensive? Look at it like
this: Say you're a plastic surgeon who performs extra-nipple implants.
This procedure isn't considered medically necessary, and therefore is
not covered by most insurance companies, meaning that your patients must
pay you directly. If patients choose not to buy your extra nipples for
$5,000 per nipple, you'll have to lower the price to $4,000, or else
change your business model.
Siri Stafford/Digital Vision/Getty Images
"Nipple pills? Nipple serum? Aerosolized nipple spray?"
But when you add in the American system of mostly-employer-based
health insurance, things get weird. The patient doesn't pay the doctor
directly -- a lot of Americans don't even realize that this is an
option. Instead, hospitals and medical practices bill the patient's
insurance company. Because insurance companies are usually big and
powerful enough to have bargaining power, there's a good chance that
they will respond by farting on the bill and sending it back. Hospitals
know this, and so over the years they've started making up their own
extremely high prices and throwing them at insurance companies in the
hope that they will pay
something. These so-called "chargemaster" rates have grown so ludicrous over the years that
they now include things like $37 Tylenol pills and $137 IV bags.
Siri Stafford/Digital Vision/Getty Images
"For $137, that IV bag damn well better contain at least one nipple."
Once again, these chargemaster rates are mostly
completely made up
and have nothing to do with what these things actually cost. They're
simply part of the monetary dance-off that insurance companies and
hospitals are doing with one another. In most cases, the insurance
companies agree to pay a small amount of the stupidly high bill, the
hospital accepts this reduced amount, and everyone is happy. Except for
uninsured and underinsured people, that is, because they are also billed
at the chargemaster prices.
There are a bunch of other factors at work, of course, but this is a
big reason why a single petting-zoo mishap could end up costing you the
price of a small car. But most hospitals will still tell us that
everything is fine for Joe Injured American, because ...
#3. Everyone Is in on the Con but You
When asked how people could be expected to pay chargemaster rates, the vice president of the American Hospital Association
insisted
that $37-Tylenol-style prices are not so bad, because they are
"generally not what a consumer would pay." In other words, only suckers
pay sticker price. Big medical bills are just a silly game between
hospitals and insurers, and us consumers should just laugh it off for
the same reason we laugh off the neighbors' late-night throwing-knife
fights: It doesn't affect us, and it isn't our problem.
Let's pretend now that the American Hospital Association is telling
the absolute truth. Let's pretend that all patients have to do is call
and ask, and hospitals will slash the bill every time (and not just
sometimes, as is really the case). Let's pretend that cancer patients
have the time and money to dispute every single item on their $70,000
chemo bill while they are trying to concentrate on having the goddamn
cancer. Let's pretend that people are really only at risk of medical
bankruptcy if they break their leg 60 times in a row.
James Woodson/Digital Vision/Getty Images
"Dammit! Again!"
We'll assume all that, and it still doesn't matter, because
most people don't know that chargemaster rates are a joke.
Do a quick survey of posts about medical bills on social media, and you
won't find many stories of Americans receiving a letter, rolling up
their sleeves, and marching down to the hospital to dispute the fuck out
of some billing. Instead, most people receive bills and immediately
start wondering how they can pay the whole thing off, whether it's by
getting another job or asking for donations or by cooking meth or
whatever.
Tom Brakefield/Stockbyte/Getty Images
Personally, I'm running an illegal wombat-smuggling ring.
Why are so many people unwittingly allowing themselves to be ripped
off like this? Maybe it's because America is not a bargaining culture.
Guidebooks written for Americans traveling overseas are full of warnings
about not paying full price for traditional French penis statues or
whatever: French penis-mongers, the books will tell you, quote high
prices but expect to be haggled down. Maybe Americans need these
warnings because in this country bargaining is generally something that
happens only when you're dealing with professions seen as shady or
dishonest, like car dealerships. Yet at some point doctors and
hospitals, the people we trust with our family members' lives, have
migrated into this same shady "don't trust the quoted price" category.
And then we're surprised that some people don't realize this.
als,
patients' bills go up.
Jupiterimages/Stockbyte/Getty Images
"And here's where I drew a dick on a piece of paper. It's going to cost you $32,000."
Once a hospital chain becomes the dominant health provider in an
area, insurance companies are pretty much forced to keep that hospital
as a client, because otherwise they'll lose customers faster than if
they changed their name to "Death Panels of America, Inc." Who would
sign up with an insurance company that isn't accepted by any doctor in a
100-mile radius? Once insurers are trapped like this, hospital chains
are
free to start pushing up their prices even more.
A big problem here is that when Americans think about healthcare
costs, we're used to pointing at insurers like they're the sole bad
guys. After all, for most of us, "insurance company" means "those guys
who call you up in the ER after you've been bitten by a mountain lion
and question whether you really need all those stitches." Hospitals, on
the other hand, are the good guys: They sew us up, remove all those
mountain lion teeth, and save our lives. Unfortunately, these days a lot
of hospitals seem to be taking this innocent goodwill and using it to
turn into the antagonists in a James Cameron movie.
Medioimages/Photodisc/Photodisc/Getty Images
If you're ever depressed about the modern world, it sometimes helps to imagine yourself as the hero in a cool dystopian sci-fi.
And one of the worst things about these increasingly awful medical bills is ...
#1. They Destroy the Way You Think About Money
Although the average American cable news station spends approximately
50 billion hours a year discussing healthcare, one thing hardly anyone
talks about is the psychological effect of these stupidly huge bills. I
know all about this, because I'm a person with chronic health problems
who recently switched to private health insurance after many years
participating in the socialized healthcare system known as "the U.S.
military." I have the best insurance I can afford, and yet every trip to
the mailbox involves psyching myself up for this week's third surprise
bill, or maybe even another letter accusing me of getting a medically
unnecessary blood test, because apparently I'm some kind of blood-test
junkie who bursts into clinics and shakes down doctors to get my next
phlebotomist-administered hit.
Keith Brofsky/Digital Vision/Getty Images
The needle is the only way I can feel anything anymore.
Logically, at this point I should become super financially
responsible so I can pay these bills, right? But nope, it's a constant
effort not to react in the exact opposite way. I want to be a
responsible middle-class person with a mortgage and a sensible haircut
and well-organized kitchen utensils, I really do, but what's the point
in trying? At any moment in the near future, my insurance could decide
to dispute a random medication and send me a bill that wipes out all my
savings and more. So tell me why I shouldn't live in the moment and
spend $250 on a jewel-encrusted cockring.
Digital Vision./Photodisc/Getty Images
Sir Edgar Crowington deserves only the best.
Yes, many things can go wrong in life. Your house might burn down. A
dying bald eagle might fall on your parked car. The difference with
medical bills is that they're so potentially huge and arbitrary that
there is no preparing for them.
You can't just buy insurance and stop worrying: Insurance might cover
your bills, but it might not. You can't predict how bad your bills are
going to be if you get hurt in an accident, because
costs are pretty much random.
I have no idea why one of my generic medications costs me $150 after
insurance and the other costs me $15. It's not like the first one works
10 times better, or a panel determined that the second medicine is
needed only by people who are jerks. The extent of your money-beatdown
depends entirely on how your body decides to go wrong and how unlucky
you are.
We're living in a society where an ordinary misfortune like a broken
bone or a car accident can strike normal, responsible, insured Americans
out of nowhere, and it could cost us $200 or it could cost us $200,000.
There's
nothing any of us can do to prevent this looming
financial shark attack, except be incredibly rich. And we're all getting
older, and most of us aren't in perfect health, so why
not just
say "fuck it, YOLO" and spend all our income on monster trucks and
golden unicorn statues? Yet you'll hear people refer to this whole
shitty situation as some kind of opportunity to learn and practice
"personal responsibility." Guys, those words: I don't think they mean
what you think they mean.
C. Coville has a Twitter here and a Tumblr here.
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