At what personal point does the cost of healthcare outweigh the cost of life?
A warning up front... this is a rather depressing blog post on what many will find a disturbing topic. If you don't want to think about death vs. the cost of healthcare for whatever reason, don't read any further. I know a number of people for which this would be very painful to think about... so just stop here if there's any reason you don't want to go down that path.
Time magazine ran a story last week that I haven't been able to ignore and forget...
Bitter Pill: Why Medical Bills Are Killing Us
It certainly isn't a quick read (it's *really* long by internet standards), but it's something that every American who cares even one iota about the cost of heathcare should take the time to read and understand.
The focus is on how medical charges are determined and billed, and it's grotesque (in my opinion). It highlights the use of what's called a "chargemaster", or each hospital's list of what it charges for everything. From page 2 of the article...
Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.
I could probably riff on this for hours, on how the argument about the cost of healthcare has been deflected to focus on *who* pays for things, and not *why* nearly all aspects of the health care system are (in many cases) obscenely profitable for those who provide the services and equipment. Full disclosure... I do work for a healthcare insurance company, and that industry is not blameless in this mess either. But if hospitals are able to have markups of 200%, 300%, and more on common items like generic tablets of Tylenol (not to mention cancer drugs that run into the tens of thousands of dollars for a course of treatment or even a single dose), who ends up paying? Even for "non-profit" hospitals, the amount of profit that's made each year (which is then spent on things not always associated with cutting costs) is staggering. Our capitalistic system (basically, Wall Street) expects and rewards businesses that produce major profits and rapid earnings growth. Obviously, reining in costs and making things affordable goes contrary to that, and profit will rule all.
BUT... I'm getting completely off-topic for what I wanted to say here...
Page 6 of the article, under item 3: Catastrophic Illness - And The Bills To Match:
When medical care becomes a matter of life and death, the money demanded by the health care ecosystem reaches a wholly different order of magnitude, churning out reams of bills to people who can’t focus on them, let alone pay them. Soon after he was diagnosed with lung cancer in January 2011, a patient whom I will call Steven D. and his wife Alice knew that they were only buying time. The crushing question was, How much is time really worth? As Alice, who makes about $40,000 a year running a child-care center in her home, explained, “[Steven] kept saying he wanted every last minute he could get, no matter what. But I had to be thinking about the cost and how all this debt would leave me and my daughter.” By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452.
The question I'm left with is this... at what point is the cost of prolonging one's life too expensive? Is having to pay (or burden your survivors with) one million dollars in medical bills for an additional year of life an acceptable decision?
The general nature of people is to want to live as long as possible. With today's health care options, things that were certain death sentences a decade or two ago are now treatable conditions with a reasonable chance of survival. If there's a chance of a cure, many people will take it. The thought of who will pay for it (successful or otherwise) is secondary to the discussion. But in the example above, I personally believe the discussion of who has to deal with the bills is primary. They apparently knew that a cure was not possible, and that it was only a matter of time before he would die of the cancer. But to him, it was survival at all costs, and who cares about the financial carnage after you die?
I know it sounds crass, and some people would probably call it an immoral choice to have to make. But in my view (and again, this is *my* personal view, not one to be imposed on others as a rule), the cost of survival has to be weighed against the cost of living with the crushing debt that will be left behind. Someone will have to pay that, and it's likely to be the person or persons most ill-equipped to do so... your loved ones who have to continue living after you're gone.
I've actually thought about this even before I read this article... if I were diagnosed with a disease (let's call it cancer) that had a relatively low chance of survival, would I choose treatment or would I choose to let it run its natural course? My mom was diagnosed with cancer after ignoring some symptoms for a number of months. By the time the results came back, the chance of survival was very small. She chose to not fight it, and to let it play out... knowing that it was a matter of weeks at that point. It turned out to be six weeks. Realistically, she could have maybe prolonged life a few more months... but at what cost, both physically and financially? Everyone will die at some point... is another two months before saying good-bye worth the cost? For her, it wasn't. And if that decision were to ever face me, I think I'd probably go the same route.
I know that each situation is different... do you have young children? Do you have excellent insurance (but even then there will still be costs)? Are your kids grown and independent? It's always going to be painful to die and leave others behind, but do you add to that pain by leaving bills that will affect the lives of those left for years?
This isn't an easy question, and it is so wrong that we as a society are faced with these types of issues given the current state of healthcare in America. But I don't see the situation improving, and I think more and more people are going to be faced with the painful choice, which is...
How much is my life worth to those who will have to pay the bill when I'm gone?