I am sitting here with my leg in a brace, up on a footstool, looking at my medical bills and I can’t help thinking how this minor little incident could ruin someone without medical insurance. I also am looking at the billing, paid for by my health maintenance organization (Kaiser), and marvel at how inefficient this whole system is. My little scrap with emergency medical care woke me up to why we need a single payer system. But let’s start from the beginning.
As many of you know, I am a small vineyard owner and there are always things to do in the vineyard. Well about 5 weeks ago on a Monday, I went to play golf. My plan was that a major storm (first of the year) was coming in, and although the cover crop (grass and clover) was well established to prevent erosion in the steep areas of the vineyard, there were some bare spots and I wanted to rake in some grass seed and straw. So when I got home about 4 pm from my golf round with the storm moving in, I jumped on my ATV loaded with 50 pounds of grass and clover seed and went to work. I was spreading and raking in seed and straw, and working my way up a particular steep area, when I turned and started to walk back down to my ATV, I slipped on the steep slope, and then the fun began.
When I hit the ground in a particularly violent way, I heard a loud pop and then I was kind of focused on pain in my knee for the next minute or two until it subsided. I did not know it at the time, but this little slip resulted in a ruptured patellar tendon. For those of you who are not anatomy majors, the patella tendon connects your lower leg (tibia) to the patella which is in turn connected to the quadriceps muscle through the quadriceps tendon. In other words once it is ruptured (ruptured means either torn in two or completely torn off the bone), you have no way to extend your lower leg. But after the pain had subsided I decided to try it and found that to be a very stupid idea. So here I am sitting up now in my vineyard, my leg useless, it is starting to get dark, the rain is moving in, and I am immobile. Now I tell you all this because I want you to understand that there was no way for me to get myself out of my vineyard. So let the costs begin.
After a failed attempt to somehow get on my ATV after scooting down to it, I realized I had my cell phone, and for once in the vineyard I had reception so I called my wife who called 911. I cannot say enough kind words about the fire and rescue team that showed up to get me out of there and to the hospital. When they got there, they put me on a board, cut off my pant leg, pointed out that my knee cap (patella) was now up in my thigh, started an IV, and then pushed some morphine because as they said, I am going to need it when the shock wears off. Then six of them carried me down to the ambulance and delivered me to the nearest hospital about 6 miles away. $593.78 ka-ching! And since these guys were county workers, I am sure that cost was heavily subsidized already.
I was delivered to the local hospital emergency room (Marshal Hospital in Placerville) where my knee was evaluated, x-rays taken, saline solution started along with something to control the pain. They put my leg in a brace to stabilize it. I was there about 4 hours until my primary provider (Kaiser) could send an ambulance there to transfer me to their main hospital in Roseville, about 45 miles away. Cost for the emergency room care: $6,055.20, ka-ching! Note costs are still rolling in with the latest being the radiology clinic so I am not sure this is the final number.
I should mention that it is common to send one home in a brace and then have surgery a few days later when it can be scheduled. The nurse at Marshal said that this might be the case and went to get some crutches. But when Kaiser decided to accept me and perform the surgery that evening, she took the crutches back and said that is good thing because they would be billed at $600. I was looking to see where the DVD player must be installed on the crutches for that price. As an aside, both my crutches and cane were manufactured in China. Oh yeah, when these costs were billed, they were listed under OB/GYN. I called Kaiser to make sure this billing to them was correct and they seemed unconcerned. I wanted to confirm that my insurance wasn’t paying for somebody else’s baby, but I never did get a warm and fuzzy that they cared. The cost were definitely billed to me and I had an accident on that day so it must be right. Okay the ambulance showed up and they loaded me for the trip to Kaiser in Roseville, about 45 miles away. $1532 ka-ching! I am being billed $50 for this as a co-pay which I think is a steal.
So by the time I had arrived at Kaiser’s emergency room at 1130 pm that night, about 6 hours after the initial little slip in the vineyard, I had incurred costs of a little over $8,180.98. The rest of the real costs I will never see. This included my surgery early the next morning, the full time recovery nurse they assigned to me in recovery, the drugs prescribed for pain, the crutches they gave me, the new flexible brace when they removed the staples, the physical therapy, the cane they issued me (I actually had a $4 co-pay on this one), or the follow-up visits with the surgeon. Oh, I also had to pay a co-pay of $50 for my ambulatory surgery, and every time I show up for an office visit a co-pay of $15, and some similar fee for drugs, but the real costs are hidden from me and covered by Kaiser.
The final piece was a letter notification to call Kaiser’s Health Recovery office to see if someone is liable and they can recover their costs. I wonder what this costs in administration costs and lawyer’s fees. I was thinking they could sue the golf course since if I had done this earlier in the day, maybe I would have worn my work boots, and not have slipped. Golf is a terrible addiction and someone ought to be responsible.
So what are the lessons learned here to be pondered while one has his leg elevated? First, if you don’t have insurance, get somebody to drive you to the hospital. That is a sad lesson isn’t it? I can imagine how painful it would have been to get into the car assuming my wife could have carried me there. Second how much of all these costs were attributable to covering people that they have to treat in emergency rooms that don’t have insurance? Third, what is the cost of all that cost accounting and billing? Fourth, if we are not worrying about who is responsible, but getting good care, could not those costs pay for more people to be covered? Finally, what would have the impact of these costs been on a typical vineyard worker who doesn’t have insurance and also probably can’t work for 12 weeks? And that is assuming he could find someone to do the surgery for free.
I am very lucky. I had excellent care every step of the way, and the kind of work I do can be done from home. It was just a little speed bump in our very comfortable life. But this minor little scrape in the vineyard could have ruined a less fortunate family. Is this any way to run a railroad?