Its a little over six weeks since surgery and my bills have started to pour in. There are bills from Cleveland Clinic and then those from my local cardiologist. Then there are those that are for prescription medications. There are lab test bills, and other stuff that I'm sure is yet to come in.
The billing so far: $235,000 USD
Fortunately, nearly all of it has been settled via Medicare or my Medicare supplement insurance. The prescription medication has a co-pay provision and so some of the expense will be out of pocket. The billing amount does not mean that the providers will get that much from the government or the insurance companies, but its an indication of what the cost would be on a retail, walk-in basis for someone without coverage. I think the providers usually offer a discount to help those without insurance, but as you can see, the medical bills can be staggering and easily put people in very bad financial trouble. It may also mean that they don't get the medical service they need.
That brings us squarely into the current health care debate on Capital Hill. Having just experienced the system in close proximity, I think that the answer might be in a tiered approach towards health care. I was lucky to have coverage because of my being a senior and paying into Social Security for the decades I was working. Also, my employer provided extra benefits to cover the supplemental insurance. Others who did not pay into the system can still receive benefits, but there will be more out of pocket expenses. I do believe that everyone should have access to health care, but in a tiered manner.
For those who have never paid into any kind of plan, have no money, and have no assets, a government sponsored system should be in place for basic care. Similar to the government hospital system in Thailand, the cost to the patient is nominal. The doctors will be government employees, medical students (doctors and nurses), and or doctors on a mandatory community service assignment. Service will be first come, first served, and limited to resources available. All US doctors, in order to be re-certified, must complete a voluntary, two week mandatory assignment at one of these government hospitals each year. That would provide a pool of staff doctors, trainees, and seasoned experts to the system. This tier will have much lower service levels, likely long lines, and some may not get adequate long term care but after all, its going to be practically free. It should not encourage free loaders to take advantage of our medical system. By the way, big pharma must donate part of their products and/or money to the system as well.
The other tier should be those that have insurance coverage. Either through their employer or purchased on the open market, this system should be like it was before. A pool of people share the expenses and risk, just like auto insurance. The insurance should be open to all, across all state lines, and can have any level of coverage depending on how much the buyer wants to pay and the insurance company is willing to risk. The hospitals in this tier will be permitted to turn away patients that should be part of the previous tier (i.e. through their emergency rooms) or do not have the means to pay for the service.
Last but not least, the final tier where those who have no insurance and have the means to pay for any service can go to whomever they choose. They can pick and chooses their doctors and pay for the service out of their pockets.
To me, this stratification of health care is the only way we can get through this mess. We have a stratified economy and diverse medical needs. There is no way one single system, either the existing one, or its proposed replacement is going to address the issue. We need to model the system to reflect our diverse needs. The reality is that we are not a country of equals economically - there are rich and poor people. We are not a socialist country. We can not fix the problem of economical inequality through the health care system - that needs to be done separately.