The High Cost of Health Care (Part 1)
As Congress goes into recession, the debate over healthcare hits home. But what's really happening on the reform front? Will it meet the needs of the American public? In a 5-hour special series over five days, we'll hear from doctors, hospital administrators, insurance companies, economists and average people about what's driving up healthcare costs, what it will take to make real changes, and what trade-offs people are willing to make to see meaningful reform through.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh and you're listening to These Days on KPBS. This month, the healthcare debate in America is expected to shift from the halls of congress to the living rooms of America. Congress is in recess, lawmakers remain deeply divided, and no healthcare reform proposal is ready for a vote. Partisans on both sides and every side of the debate about healthcare are planning big TV ad campaigns this month to try to sway or even scare the public. While Senators and members of congress are back in their home districts, they say they will spend their time listening to the people about what, if anything, should be done about the nation's healthcare system, and that is exactly what we are hoping to do this hour. Today begins a week-long series on These Days about healthcare reform. We'll hear from experts on healthcare costs, how other countries deliver healthcare; we'll examine the reform proposals being considered in Washington and we will be speaking with two of our own congressmen about their opposing views on healthcare reform. But today, we really want to hear from you. Our number is 1-888-895-5727. We're opening up the phones and asking you to weigh in on the question of what's right and what's wrong with healthcare in America. Can you afford to see a doctor? Can you afford to pay for your prescription drugs? Are you worried about losing your health insurance? Join this important conversation which really affects all of us. It’s the high cost of healthcare, and we do want to hear from you. That number, again, is 1-888-895-5727, 1-888-895-KPBS. Well, we have invited a few people to our studio to share their own stories about dealing with the healthcare system, and I’d like to introduce our first guest Norah Schwartz. She is a professor of medical anthropology and public health. She teaches at the Colegio de la Fontera Norte in Tijuana, and she is adjunct professor at SDSU and UCSD, but she’s not here to tell us about what she teaches. She’s here to tell us her own story, and, Norah, welcome to These Days.
NORAH SCHWARTZ (Professor of Medical Anthropology and Public Health; Cancer Survivor): Thank you so much.
CAVANAUGH: Now, Norah, you’re a breast cancer survivor…
CAVANAUGH: …and so you had at least one good outcome from the healthcare system.
SCHWARTZ: Oh, yes.
CAVANAUGH: When were you diagnosed with breast cancer?
SCHWARTZ: I was diagnosed in – on January 27, 2007.
CAVANAUGH: And what kind of health insurance did you have at the time?
SCHWARTZ: At the time, I had Health Net. I was under COBRA. I had excellent health insurance. The reason I was on COBRA is because I had been working at UCSF, left that job, decided to become independent, and so I was on COBRA for about three years.
CAVANAUGH: And so what happened to your insurance? How did it change?
SCHWARTZ: Well, in a nutshell, I lost it. Because I was on COBRA, in California you’re allowed eighteen months and then another eighteen months. So I had been on COBRA for one year, exactly one year, at the time. Over the next two years, as I was going through my diagnosis and my treatment, I was on COBRA but I started asking questions because I knew that I would have to switch to private insurance after that. In fact, I had planned on switching to private insurance right before I got my diagnosis. I called my insurance company and I asked them what’s going to happen. I have a diagnosis of cancer, I have to go through the treatment, what’s going to happen when I get off of COBRA? I’d like to switch over to private insurance. And they basically told me I could not. I would not be able to be insured for ten years after Stage II breast cancer diagnosis. So I stayed with COBRA for the two years going through my treatment but when it came time for follow-up care, I was left with nothing.
CAVANAUGH: So right now, you don’t have health insurance by any of your employers, is that right?
SCHWARTZ: That’s correct.
CAVANAUGH: But you do have limited private insurance.
CAVANAUGH: Tell us about that.
SCHWARTZ: Yes, I have a limited insurance. I pay about $300.00 a month and I’m allowed four doctors visits for – they’ll pay $75.00 for each visit, and three lab tests, they’ll pay $150.00 and that’s it. After diagnosis with cancer, after follow-up, that’s nothing. I need a lot more.
CAVANAUGH: Now, exactly, tell us again, what does it give you? What does this limited health insurance give you? Just a really – a few number of visits to the doctor?
SCHWARTZ: A few number of visits, four visits. They’ll pay $75.00. My doctors visits are about $225.00, $250.00, just to see my oncologist. And then the lab tests are about $500.00, so they’ll pay $150.00 for three lab tests. I’ve already had two of the lab tests. It does cover, God forbid if I’m in an accident, catastrophic healthcare, which is why I continue to pay for it. Now the Catch-22 here, however, is I’ve used most of my benefits already but if I don’t pay for this insurance, under the HIPAA rules, I will never be eligible for private health insurance again. I cannot say, well, I used all of my health benefits, now I want to take a break because I’m getting nothing from it and decide not to – not to pay for it. In two months, I won’t be able to get private insurance again ever under the HIPAA rules.
CAVANAUGH: So here in August, in the beginning of August, used – you have already used up the maximum amount of health insurance coverage that you have for at least your primary health concern.
CAVANAUGH: You’ve reached the limit.
SCHWARTZ: Pretty much, yeah.
CAVANAUGH: And yet you still have to keep paying your premiums every month or else you’ll never be able to get insurance again.
CAVANAUGH: Now, do you qualify for any kind of government sponsored insurance?
SCHWARTZ: Now, this is the other trick here, the Catch-22, is, no, I do not. I earn just above the maximum, 350% poverty level. I applied for County Medical Services, I was denied. I’m going back again. I think they made a mistake. They’re supposed to deduct the amount that I pay for insurance, and they didn’t, from my salary. So there’s a slight possibility but for now I do not qualify.
CAVANAUGH: I’m speaking with Norah Schwartz and she’s telling us her story about dealing with the healthcare system, and we are opening phones this morning and asking for you to call us. Tell us your personal stories about dealing with the healthcare system and also what you think might be done to change it. The number is 1-888-895-5727, and let me take a call from Paul in Vista. Good morning, Paul. Welcome to These Days.
PAUL (Caller, Vista): Hello.
PAUL: How are you?
CAVANAUGH: I’m doing fine. How can we help you? What is your story?
PAUL: Well, what I’ve noticed is that the insurance companies and the government have lost sight that medicine is about the patient, it’s not about the insurance company.
CAVANAUGH: What – How have you found that? I see on my little…
PAUL: Well, they…
CAVANAUGH: …crib sheet here that you’re a doctor, Paul, is that correct?
PAUL: …they don’t – Yeah, they don’t pay for the patient’s care. They figure out any way they possibly can to deny care. They use little tricks to delay payment, you know, as far as they can. And Medicare closed down for three or four months, and it made it very difficult to practice when Medicare decides, oh, we’re not paying you this month because we’re changing forms, or you forgot to put a dot in the column, and things like that. It – The insurance companies shouldn’t be practicing medicine. They ought to let the doctors practice the medicine and let the patients be patients and the insurance company have agreement with their clients, and let the clients decide how to pay the doctor.
CAVANAUGH: I wonder, the AMA has come out against any kind of government health insurance. Were you surprised by that, Paul?
CAVANAUGH: Tell me why.
PAUL: Well, I think there’s – I don’t think in this recession people have the funds to come up with the amount of money they’re going to need for health insurance.
CAVANAUGH: Well, I thank you for your phone call very much. Thank you for weighing in and talking with us. We’re taking your calls at 1-888-895-5727. Barbara is calling from Fairmount Park. Hi, Barbara.
BARBARA (Caller, Fairmount Park): Hi. I’ve been listening. I’m so afraid of getting co-opted again by big money. I’m old enough that I used to go to the doctor and pay the doctor for my care. And somewhere along the line this middle layer of management came in and they’re taking a lot of profits and then we have lobbyists. And we’ve got to figure out, as people, we’ve got to voice our need to get the profit motive out of healthcare because I really think that’s what’s doing it, what’s – where the money is all going instead of care. You know, why can’t we go back – And I know that’s re – you know, silly, but there’s got to be a way to go back to the way it used to be where I had money, I paid my doctor, my doctor gave me care, and get this middle management and the lobbyists out of our lives.
CAVANAUGH: Well, thank you for that call very much, Barbara. You know, tomorrow we are going to talk about the high cost of healthcare, why costs are so high, who’s making money from healthcare in America, the healthcare that so many of us don’t seem to be able to afford. That’s coming up tomorrow morning on These Days. And we’re continuing to take your calls. It’s open phones here on These Days this morning about healthcare, 1-888-895-5727. Norah, I wanted to ask you because we’ve heard from two people now who basically say, you know, the patient is the forgotten person in this healthcare system now. Do you feel that way?
SCHWARTZ: Well, I certainly feel that the patient is the forgotten person. I’m a little bit concerned. I was thinking about the last caller and wondering if I had to pay for my care out of pocket, oh, my goodness, where would that money come from?
SCHWARTZ: It’s expensive. And I’m not – and I’m not through yet, so I think this whole situation is very complicated. And we have a bill that’s 1,000 pages long and we really need to go through it and study it and figure out where the money is going to come from, who’s going to pay for it, why, etcetera. I think it’s a very, very complicated process. If I had to pay for a cold, it’s one thing. To pay for cancer, it’s a whole other situation.
CAVANAUGH: Do you see any of the bills – how much – how expensive are the treatments that you’ve been receiving?
SCHWARTZ: Oh, thousands upon thousands of dollars. I went through chemotherapy, radiation, five surgeries, and then I have the side effects from the chemotherapy and the radiation. So we’re talking a few hundred thousands – thousands of dollars at this point.
CAVANAUGH: And anything else you need this year is going to come out of your own pocket because you’ve exhausted your benefits.
SCHWARTZ: Oh, apparently, or I’m not going to get it. I mean, I just can’t afford – I can’t afford to see my doctors and I’m afraid to see my doctors because the – I don’t know what the tests are going to say. At this point, I don’t know if I have cancer again. I haven’t seen my oncologist yet. I don’t know about my bone health. I haven’t had a – I need a bone density scan, my thyroid health, I mean, all of these are side effects of the treatment. I don’t know how much that’s going to cost me.
CAVANAUGH: Let’s take another call. Magdalena is calling from Normal Heights. Good morning, Magdalena. Welcome to These Days.
MAGDALENA (Caller, Normal Heights): Yes, hi, good morning. I just wanted to make a brief comment about the last caller, about the finances. I do know of one resource that might help her. I don’t know the details but it’s an international organization called Cancer Care and I had a friend who had – was diagnosed with cancer and he got some funding from there to supplement what his insurance wouldn’t cover. And I just wanted to talk about my own personal experience. I, let’s see, I’m on Medicare and the dental coverage is pretty – just pretty nonexistent. So I sort of put off some things for my teeth and then paid for them out of pocket. Now, most recently, I had to see an oral surgeon and it wasn’t elective. I had about – some lumps in my jaw that had to be taken out and I got worked up. I thought I could manage the expenses, and it turned out that just my most recent thing cost $2,000.00 to have a biopsy of my mouth and a tooth extracted. And I guess I paid $250.00 for a pathology lab and I was lucky I somehow had the money in my savings because my insurance wouldn’t cover it. I understand there are a couple people in San Diego that take Medicare for oral surgery but I was worked up by this one doctor and then all of sudden I was – everything was escalating and I wanted to see the doctor but it just took everything I had. And I’m lucky I had the money but I think the whole dental picture in the United States is – doesn’t – isn’t – a lot of it isn’t brought to our attention. And our dental health is so important to our general health. You know, sometimes we lose sight of that.
CAVANAUGH: Magdalena, thank you so much…
CAVANAUGH: …for calling. I appreciate your sharing your story with us. We are taking your calls at 1-888-895-5727. And I want to ask you if you would, tell me what you think about – Norah, you’ve been through so much when it comes to dealing with health insurance and lack of health insurance and our healthcare system now. What kind of changes would you like to see made in America’s healthcare system?
SCHWARTZ: Oh, thank you for asking that. I – I have a list but if I can just respond to the last caller for a minute. I appreciate the reference to Cancer Care. I called Cancer Care, they did help. They gave me $500.00. I called every organization in the world dealing with cancer, including the Lance Armstrong Foundation and so on. They’re great organizations, they do not provide health insurance, and this is the issue that we have to deal with, is that we all need health coverage. So I have been reading everything I can about this – this issue. I have a list of things that I would like to see that many of the organizations that I’ve been working with would like to see also. The first thing I want to say is that without a public health plan, there is no healthcare reform. We need a public health plan. We have people out there that are trying to remove this. I have no one to go to. I’m denied health insurance, period. I need a public health plan. We want coverage to be universal. That means that everybody is covered. We want it to be affordable, that means based on your income. You pay what you can afford. Again, a choice of public or private. We’re not trying to remove – We’re not trying to take away anybody’s health insurance coverage. A choice of public/private. Comprehensive, that means that somebody like me doesn’t have to die because I lose my health insurance in the middle or because somebody decides that I don’t need to have a certain test. Equal access, equal to what congress has, equal to what the military has. And I just want to throw in there also that I founded an organization that we call health, I’m sorry, reformhealthcare.org. We met on – the day before President Obama’s inauguration. We’re meeting every three weeks now. We’re discussing this. We have to have universal coverage. It has to be affordable. And we invite everybody else to participate in our organization.
CAVANAUGH: Norah Schwartz, thank you so much for coming in, sharing your story, talking to us. We continue with open phones all this hour, talk – taking your calls, hearing your stories, hearing your opinions about America’s healthcare system. Our number is 1-888-895-5727. And just one healthcare statistic to leave you with: An estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick and were injured. We’ll be back taking your calls about healthcare on These Days.
CAVANAUGH: I’m Maureen Cavanaugh. We’re talking about healthcare on These Days. It’s the first day of our weeklong series on different aspects of the national healthcare debate. This morning, we’re opening up the phone lines to hear your stories and to hear what you’d like to see changed in America’s healthcare system. Our phone number is 1-888-895-5727. Our second guest in studio this morning is Karen McManus, whose 56-year-old brother died last year due to a heart condition. And I’m sorry for your loss, Karen, but thank you for coming in.
KAREN MCMANUS (Sibling of Cardiac Patient): Thank you so much for having me.
CAVANAUGH: Did your brother have health insurance?
MCMANUS: No, he did not. He had worked for an employer who did not provide healthcare. He had worked for this attorney for about 15 to 20 years, absolutely loved what he did but did not have healthcare.
CAVANAUGH: And he was taking medication…
CAVANAUGH: …for his heart condition.
CAVANAUGH: How was he able to do that?
MCMANUS: He was – he went down to Tijuana and he would get his healthcare and his prescriptions there. It was a struggle for him and I – I didn’t know until later that he was unable to afford his medication.
CAVANAUGH: Well, and – and that situation was exacerbated by the fact that your mother became ill and your brother began caring for her and he cut back on his hours at work.
MCMANUS: Yes, he did. Well, actually it was a – it was several – several things that occurred. Yes, my mother became ill in January of last year. She had fractured her foot. She was diabetic. And because he worked for an employer where they would pay him once they would complete a job, if you will, it was – it was basic commission, so he had to struggle with taking care of my mother and then also having to go to work to be able to get some type of source of income.
CAVANAUGH: So he cut back on his medication during that time.
MCMANUS: Yes, he did. Yes, he did.
CAVANAUGH: Now he died April 25, 2008, at the age of 56.
MCMANUS: Yes, he did.
CAVANAUGH: And he died in the hospital.
MCMANUS: Well, my mother was – We were informed my mother needed to have her leg amputated and it was very stressful for the both of us. And so he was trying to juggle his work around, you know, being at the hospital. They had postponed her surgery four days in a row and that final day, we were at the hospital waiting for them to take my mother to have her leg amputated and my brother had to go to the office to wrap up a few things and it was there that he had – died of a heart attack.
CAVANAUGH: Do you believe that if he had health insurance or access to be able to afford thecare and the prescriptions that he needed, that that would’ve been the outcome?
MCMANUS: Absolutely. My fath – my brother didn’t want to die. You know, it was just a – circumstances that he was so involved with the care of my mother and, as a matter of fact, about a week before my mother passed, he and I were talking and he had mentioned to me that he needed to pick up his prescriptions and, you know, I had urged him to do so. But it wasn’t until after he had passed and, you know, the dust had kind of settled a little that I was informed that he couldn’t afford it. And had he said that to me, that he needed money for the prescription, I would’ve given everything that I had to have – you know, to give the – the money to my brother to pay for the prescriptions. He’d be here today.
CAVANAUGH: I – We’re taking your calls about the healthcare system, health insurance in America, 1-888-895-5727. Let me – Let’s speak with Carolyn in Leucadia. Good morning, Carolyn, and welcome to These Days.
CAROLYN (Caller, Leucadia): Good morning. I get very angry when I hear politicians say that bureaucrats will be making healthcare decisions for us if we pass President Obama’s healthcare bill because it’s as though there aren’t bureaucrats making decisions now about our healthcare. And I’d like to relate a personal experience that I had that illustrates what happens when insurance companies make decisions. I was in graduate school at UCSD and was covered by graduate student health insurance and was doing dissertation research in France and I suddenly became very ill with necrotizing pancreatitis which was caused by a gallstone blocking the main bile duct. When I had recovered somewhat, the doctor was going to discharge me to a skilled nursing facility and the healthcare coverer, the insurance company, requested specific information about my condition. The doctors in France are bound by law to only disclose information to another medical professional so I called – my husband called the insurance company and they finally admitted that they had no doctor in their employ. So then the doctor wanted to release me to the skilled nursing facility and that was not covered by the healthcare insurance even though it would’ve been a lower cost for them. So I continued to remain in the hospital and was there for a total of four months rather than being provided good care but at a lower cost.
CAVANAUGH: So your point in this, Carolyn, is that we already have a bureaucracy in the health insurance companies.
CAROLYN: Exactly. It is a bureaucracy and it is a bureaucracy that is not educated in medical care and these, essentially, private bureaucrats in insurance companies are making the healthcare decisions for us and overriding what the doctors want to do and providing – in providing our best healthcare.
CAVANAUGH: Carolyn, thank you so much for your call. We are taking your calls at 1-888-895-5727. And now Gail is calling us from Alpine. Good morning, Gail. Welcome to These Days.
GAIL (Caller, Alpine): Oh, good morning. Thank you. I have a comment to make. I was talking to my son recently. He was telling me about a new program that they have in England where they have a 15 minute emergency room. So if you have something – like he had to go in for a gash on his hand that just needed a few stitches, you’re straight in and you’re straight out instead of having to wait in line between, you know, people having cardiac arrests or broken legs or whatever. That seemed to me a very sensible way to go.
CAVANAUGH: And you sound as if you know the English healthcare system quite well, Gail. Any other comparisons that you’d like to make?
GAIL: Well, I just think it makes a whole – it’s much, much more compassionate. Yes, you do have to wait if you’ve got a – if you’re waiting for surgery for your varicose veins, you may have to wait. If you’re in a car crash, then you’re dealt with. Nobody loses their home because of healthcare. And to be honest with you, animals get better care in England than they do here. They even have free services, free clinics, for people who can’t afford veterinary care for their animals. I think that’s fairly illuminating, don’t you?
CAVANAUGH: Yes, thank you very much for your call, Gail. I want everyone to know that as our healthcare series continues this week, we are going to be comparing the health systems of other countries with America’s healthcare system. That’s coming up on Wednesday on These Days. Karen, I wanted to ask you, did you – I mean, did you ever envision that you or your brother would be in a situation where you couldn’t afford the medication you needed in – for such a crucial, life-threatening illness?
MCMANUS: Absolutely not. We both have worked our entire life. My brother was a very hard worker. As I said earlier, he worked, you know, 50 to 60 hours a week. We never thought that we would have this type of tragic situation happen to us. We were under a lot of pressure with my mother’s illness and, you know, we were contributing to – to the community. I’m just – It was very, very tragic for my brother. He – like I said, he worked very hard. He had – he wanted to live. He had four children. And this was just very, very shocking to the entire family. And, as I’d mentioned earlier, my mother eventually passed. She was so heartbroken with my brother’s passing that she never recovered from it, so she passed this February. I, in essence, lost two of my – I lost my – my brother and my mother in ten months and it all started from – with this – this medical situation.
CAVANAUGH: Let me take another call. Eric is calling from Coronado. Good morning, Eric, and welcome to These Days.
ERIC (Caller, Coronado): Good morning. Thanks for taking my call. There – You know, listening to so many phone calls, it’s hard to try to stay on point. You know, you get so many other ideas. My fundamental con – comment was that we keep calling this a healthcare issue. I really think it’s an insurance issue. Everybody – The public is getting worked over by insurance companies from both directions. Doctors pay exorbitant amounts for malpractice insurance. They have to charge more money because they have to pay so much money to insurance companies. When you go to the doctor with your health insurance, your doctor bills you $75.00, then the health – your health insurance, another insurance company, only pays the doctor half of what he’s asking for. He also has to employ a staff of people to deal with the insurance companies, and he has to wait 90 days before he gets paid. You know, the – the for-profit motive for healthcare is important. It’s important to keep a for-profit motive there because, otherwise, what would drive research, etcetera. But this also has to be tempered by common sense, you know. This is – And I think it can be tempered by having a public option. The other thing I’ll just state quickly because I don’t want to take up too much time, your last guest said that she can’t get a public – cannot opt in for a public option because she makes too much money. She makes three and a half times the poverty level, which, I think, is $30,000.00.
ERIC: So she makes over $100,000.00 a year but – So I guess not to pick on a girl with cancer because that’s not exactly putting me in the best light but, you know, I think if it were my health, I think I would go to my employer and say, hey, pay me $20,000.00 less a year so I can get a public option.
CAVANAUGH: That – that you can -- $20,000.00 less a year so I can actually get on some sort of state insurance or government insurance, is that what you’re saying?
ERIC: Exactly. I mean, if it were the difference of ten or twenty thousand dollars, I would – I would, instead of greedily saying, okay, I make too much money to get a public option, let me go to a hundred different – or every – every aid, every assistance organization in the world and ask them for more money, why don’t you just go to your employer and opt for slightly less money and get free public healthcare?
CAVANAUGH: Thank you very much. Thank you very much, Eric. And Issac in Bay Park is now on the line. Good morning, Issac. Welcome to These Days.
ISSAC (Caller, Bay Park): Good morning. Great discussion, which is in contrast to what we’re getting in the mainstream media. My perception of the mainstream media, I’m thinking about CNN, the cable news shows, they’re basically amplifying the fear tactics that are spread by the insurance company and the very conservative politicians that are against the public option. It’s over and over again, and it’s very frustrating. And I’m not even talking about Fox News Channel. So I congratulate you on the level of your discussion but I also want to share my total dismay at the mainstream media that’s also starting to broadcast for-pay advertisements by the insurance groups, totally demonizing the public option. So that really is my comment, you know, just the role of the mainstream media in not really providing us with a real discussion, you know, with a two-sided discussion. And, you know, where’s Michael Moore, one of the main critics of our system? He’s totally absent. I was telling my wife, we need less Michael Jackson, which is 7/24, and more Michael Moore.
CAVANAUGH: Thank you, Issac, for your comment. And, Karen, I wanted to ask you, you’ve had these tragedies happen in your life so recently, you must have thought of what you would like to see changed in the – our healthcare system, the insurance system, whichever way you look at it.
MCMANUS: Actually, I’ve taken the first step towards that. After I lost my brother, I obviously was very devastated and I joined an organization. It’s San Diego Organizing Project, SDOP. We’re affiliated with PICO, it’s a national organization, and we’re going out there and we’re – we’re trying to bring to light the need to have healthcare. You know, my brother didn’t have healthcare because of his employer. I – and I question, that could be any of us. We can get laid off. I can be laid off tomorrow, and my circumstances could change. My brother made well above the minimum – or the maximum to receive, you know, healthcare or government-sponsored healthcare but he fell between the cracks. So that’s why I’m out there – I’m – I’m trying to do something about it. I do feel that our legislators do need to get – come together. I don’t know how they’re going to do it but we have to do something about this because those of you that are sitting out there feeling very comfortable that it’s not affecting you, I challenge you to go in to your families and ask your family members, who has healthcare? My brother never told me. He didn’t tell me he couldn’t afford it. I challenge you to ask your family members if something was to happen to you, could you afford your prescriptions? And I – I would say that many of you would be very, very surprised to see that with – even within your own family nucleus, that someone there may not have the healthcare. So it affects us all. It affects us all.
CAVANAUGH: Karen McManus, I want to thank you so much for coming in and sharing your story with us. Thank you.
MCMANUS: Thank you so much.
CAVANAUGH: And I want to let everyone know we are continuing to open the phones. We’re going to take a short break. And our number here is 1-888-895-5727. We will be taking your phone calls and your stories and your opinions on the healthcare system. I want to leave you with another health statistic before we take a break. The Commonwealth Health Insurance Fund reports that 68% of people with chronic illness but without health insurance report they either did not fill a prescription, skipped a medical test, did not visit a doctor or did not get needed specialist care because of the cost. And we will return in just a few moments.
CAVANAUGH: We are continuing to open the phones on These Days this morning, taking your stories about dealing with the healthcare system. These Days is beginning a weeklong series today on the debate over healthcare reform. Today is your day to give us a call and tell us what you think. The number is 1-888-895-5727. With me in studio is another guest, Alan Bennett, who recently had a surgical procedure to treat an enlarged prostate. But, Alan, your story really involves not getting the information you needed about how much the procedure cost. Now, how much did the surgery cost?
ALAN BENNETT (Surgical Patient): The surgery was on June second, and I do not know. So far, my insurance company has told me that they have been billed by UCSD Medical Center $42,058.00. This is for basically a laser roto-rooting of my prostate. I have absolutely no idea how they could possibly charge that much. I had spent about three months trying to make up my mind if I wanted to do this and I kept insisting that they had to tell me how much it cost. And I probably wrote two letters and talked to about four different people before I was finally told it would probably be in the neighborhood of $3,100.00.
CAVANAUGH: Thirty-one hundred as opposed to forty-two thousand, which…
CAVANAUGH: …you’re hearing now.
BENNETT: And when I went in the day of the operation, which – I mean, I’ve got medical coverage, ha-ha-ha-ha, in America, what does that mean? I was registered and had my appointment, but before I could actually see my doctor, I had to go and see an administrator called a financial counselor, and that is one of the most fantastic euphemisms of all times. She insisted that I had to pay, up front, $3,000.00 and I said, I’ve got insurance. And they says, yes, but you have to pay five -- $3,000.00. I says, the operation’s only going to cost $3,100.00. Says, you have to pay $3,000.00. How much is this operation going to cost? And she says, well, I don’t know. And I says, well, you’re sitting in front of your computer, look up the code. So she spent about five minutes trying to find out on her computer how much my operation was going to cost. She could not even find the code for a prostate operation. No reference material whatsoever. So I finally agreed to pay $500.00 so I could get the process rolling. I think she was very typical of just about everybody else I’d been talking to at the hospital. About three years ago, they replaced all their qualified administrative medical help at UCSD Medical Center and they’ve got a company that administers that for them now.
BENNETT: Those people have no medical knowledge and they’re very bad administrators.
CAVANAUGH: Well, Alan, let me – let me just make the point. This was right before you were supposed to go in for surgery.
BENNETT: Twenty minutes before my surgery.
CAVANAUGH: Now you had the surgery.
CAVANAUGH: You spent a long time thinking about whether you should have this done, trying to find out how much it’s going to cost, then you hear now that it may be costing someone $42,000.00. Do you have any idea how much is – this is going to cost you?
BENNETT: I really don’t – At this point, I still have no idea whatsoever. They – I haven’t even gotten a printout of what procedures were actually done. But the only thing I’ve got is the printout from my insurance company that they’ve been billed forty-two thousand some-odd dollars and there’s a little code there, a numbered code but it doesn’t even say what the operation was, just the day and this numeric code. That’s – that’s all I’ve got.
CAVANAUGH: Well, the irony of this situation is that you were treating your condition rather well with medications and it was just – this was sort of like – this is – the surgery would be better for you but nobody would tell you how much it was going to be.
BENNETT: Yes, and the price that I was quoted, I – it would have basically – that would have covered my cost of medications for about a year and a quarter, so I’d be money ahead. I’d be money ahead. I mean, not only would I urinate better and not have the pressure and the embarrassment, but I’d be off medication. That was a very significant factor in my decision to go forward.
CAVANAUGH: Do you have any idea when you might find out how much this is going to cost you? It could be thousands of dollars.
BENNETT: Hopefully, USD (sic) Medical personnel are listening to this broadcast and they’ll be calling me or their attorney will. But…
CAVANAUGH: Well, thank you. I want to go to the phone because we have another person who’s had a problem with a very, very expensive surgery. Mike is calling from Chula Vista. Good morning, Mike, and welcome to These Days.
MIKE (Caller, Chula Vista): Hi. After losing insurance, I had a blood clot in my leg that could’ve been treated with probably a ten-dollar generic prescription. I didn’t feel the pain anymore so I neglected to see a doctor and it – the clot traveled to my chest and turned into a hundred-plus thousand dollar problem. And right now I’m just having a nightmare dealing with all of the different billing people associated with the hospital. I had a change of address and I notified the hospital but for some reason they didn’t notify all of the people, the doctor groups and – and so forth. And I’m trying to pay my bill but I’m getting sent to collections, having billing issues.
CAVANAUGH: Now, Mike, you said you had no insurance?
CAVANAUGH: So now you have $100,000.00 bill that you have to pay off?
MIKE: Well, I’m negotiating that and – and they’re willing to work out a deal but it’s – it’s – just I – I can see clearly how if we have universal coverage, it’s not going to cost more. Ultimately, it will cost less.
CAVANAUGH: Well, thank you so much for your call, Mike. I really appreciate it. The number for our open phone line on healthcare is 1-888-895-5727. Justin is calling us from Spring Valley. Good morning, Justin. Welcome to These Days.
JUSTIN (Caller, Spring Valley): Hi. Thank you for taking my call. Actually, while I was on hold, I just had another idea. I used to work for an optometrist for about three or four years and I actually had to deal with some of the billing issues, insurance companies that we had to deal with as a private optometrist. It was really interesting to me that the pricing structure that had to go on for what we would bill somebody with no insurance versus somebody with insurance. And a lot of this had to do with a lot of the different insurance companies have different rates at which they would pay for procedures. So when you go in for your common eye exam, you may be, you know, as a private individual, you know, be charged, say, $130.00 for your eye exam. Well, you know, it’s $130.00 because the other insurance companies, we have to bill them at a higher rate so that we can get reimbursed at a much lower rate, you know, say, $40.00 or $50.00 reimbursement so that that can cover the doctor’s time. And so it’s sort of like the private cost of insurance is through the roof because there’s variability with the insurance companies that are out there and what they’re even willing to reimburse for.
CAVANAUGH: So you never really know how much it actually does cost to get these things done.
JUSTIN: Yeah. I mean, I think some of that cost is hidden to the – to the individuals and really it pushes the much higher costs onto the private individuals with no health insurance so that they can cover the people with not-so-good insurance or minimal insurance.
CAVANAUGH: Well, thank you for that, Justin. Thanks for calling in and letting us know from someone who dealt with that. Alan, you know, you – you have health insurance and you sort of made a joking reference to that fact, health insurance in America, but you have health insurance.
CAVANAUGH: And so, in theory, if you need these procedures done—people need certain procedures done—they should be able to be assured that they’re going to go in and their health insurance coverage is going to cover it. Now you don’t seem to have that assurance.
BENNETT: Well, again, it’s like your previous caller just said, the medical – the insurance companies—I don’t want to say they’re medical—these for-profit organizations will allow a certain amount per procedure. For example, my doctor will be reimbursed for $635.00 per operation, period. My doctor does not know how much he charges for a prostate laseroctomy (sic). He – And I believe him, when he tells me. He doesn’t know what I will be charged for his time. But if you walk onto a used car lot and said, I want that red Corvette, how much is it going to cost me? You know, that it’s – the sign in the front, it says eighty-eight thou – eighty-eight hundred dollars. And the salesman knows he’s going to get ten percent. I – I don’t under – I mean, I absolutely re – And I think the main thing is, the administration of the hospital is in the hands of a corporation whose motive is profit, period. And the hospital medical staff want to deliver care and they’re not allowed – I believe the model is, don’t let the hospital staff know how much the care costs to deliver. And that’s not – that’s absolutely not right because no one is making a rational decision if you don’t know how much it costs.
CAVANAUGH: Let’s take another phone call. Amy is calling from La Mesa. Good morning, Amy. Welcome to These Days.
AMY (Caller, La Mesa): Hi. Thanks for taking my call. I’m calling from the other end of the spectrum. I’m a provider. I’m a nurse practitioner and I’ve worked in both private practice and I actually – I work for the feds right now, I work at the V.A. But I’ve been doing this for almost 30 years. I feel very strongly that we do need a public option for people and it’s just very interesting from the inside to see how things work. When I worked in private practice, it was really hard to know what people were going to be charged. Folks would come in with all different types of insurance and I would want to order specific tests and they would want to know what this test is going to cost and I really wouldn’t have any idea. And – and it was just small things. I mean, you just want to order blood pressure medicine and you need a blood test so that you can do it safely and they don’t want the blood test because they’re not absolutely certain it’s going to be covered. So I found it a very frustrating experience. The other thing I’ve found is that fee-for-service is probably – I mean, it seems pretty clear to me that that drives up cost. I mean, if you’re going to have fee-for-service then you’re going to give service and you’re going to limit access. When I came to San Diego and I was looking for work, one of the places that was interested in hiring me was a private practice in La Jolla and they didn’t provide care to people over the age of around 52.
AMY: I mean, to me, that’s pretty obvious. I’ve done geriatrics for many years and those are very expensive people to take care of. So if you’re going to allow this type of structure, you’re always going to have folks who are going to capitalize on it by limiting care to those people that are easy to take care of and don’t cost very much and are not very time consuming. So – And I -- You know, I have two kids who live in Europe. One lives in Sweden, the other one lives in Norway. And they don’t – You know, they don’t even know what health insurance is. And my daughter-in-law had a baby and had a wonderful experience. The midwife comes to your house afterwards and make sure everything’s fine. They pay more in their taxes than we do but actually it’s surprisingly not as much as – I – I expected it to be much more than what they’re telling me they’re paying in their taxes and it’s really excellent care. So I am not afraid of a government option. I’m afraid, actually, in my experience, my bad experience as well in private practice, and I’m hoping that people won’t be frightened away by this discussion. I’ve noticed when patients of mine bring it up and they’re very afraid of it, which is funny because I work at the V.A., like what are you afraid of, I guess they must be watching the news and they’re getting all kinds of kooky ideas about what this is going to mean when, in fact, the horror story’s happening right now in their private insurance so I don’t really know what they’re worried about.
CAVANAUGH: Amy, thank you so much for giving us a very detailed and very good opinion about what’s going on from – from a nurse’s point of view. Thank you for calling in. Alan, I just wanted to ask you, in closing, you must, after all this, where were you in this healthcare debate? What would you like to see happen?
BENNETT: I’m – Your previous caller, I want that system. I want a V.A. system. It’s the highest-rated on 294-point criteria. They are the highest rated medical delivery system in the United States. And I think one of the reasons why they are so well respected and families love them is because they have a well system. Their – They have their patients for life, not cut off at 52, so they take care of people before they get sick and that really holds down medical care. I’d love to see single payer universal healthcare like our congress and Senators have.
CAVANAUGH: Thank you so much. I’ve been speaking with Alan Bennett. And my guests in-studio were Norah Schwartz and Karen McManus. I want to thank them all for coming in, sharing their stories with us today. And so many people who have called, thank you for sharing your stories about the healthcare system and what you think should be done in this healthcare debate, this national healthcare debate. I want to let you know that you can join us again tomorrow at 9:00. We will continue our special series “The High Cost of Healthcare.” Now, tomorrow, we’re going to be talking about why healthcare is more expensive in America than just about anywhere else in the world and what is driving those costs ever higher. If you would like to, you can continue this discussion online. We want to encourage you to post your comments at KPBS.org/TheseDays where you can find many other resources on this healthcare debate. And just to put the debate in perspective, we should remember that about 14,000 Americans lose their health insurance every day. So this month, the month that congress is in recess and not working on healthcare, more than 400,000 Americans can join the 45 million who have no healthcare coverage. Stay with us for the second hour of These Days here on KPBS.