Tag Archives: healthcare

92nd Birthdays

My grandma turned 92 today. I think this means that, despite her somewhat poor health, she has lived longer than anyone in her family ever has.

My family celebrated today with a pretty average, low sodium, cooked-at-home lunch, followed by some cake. We bust out the Martinelli’s sparkling  cider for the occasion, which Grandma loves (but really, who doesn’t?). It was just her three surviving kids, her daughter-in-law, and awesome granddaughter (me, obviously — I’m the one who brought her cake). Simple times when Grandma can’t really get out of the house anymore.

It’s strange being around Grandma at this stage of her life. While I’m just starting to forge my own way into the world, she’s reached the end of her productive years. She’s not the most optimistic person in the world, and these days she latches on to the negative things that are happening to her (like… well, everything about aging). She’s frustrated with all the things she can’t do anymore. She obsesses over the missed opportunities from decades ago, and the people who prevented her from having them. Today, she didn’t even feel like smiling for the pictures, and she put up a big fight over taking her afternoon medications (though she does that every day).

So what does it mean to age well in the 21st century? Modern medicine has prolonged human life far beyond the average lifespan 92 years ago when Grandma was born. We can keep our loved ones alive, healthy, and relatively self-sufficient. With the chance for emergencies kept to a minimum, we can live comfortably beside them without as much worry and panic — but to what end?

My grandma can’t walk outside and enjoy the sunshine, her vegetable garden, or the birds flying by anymore. She can’t hear well enough to really listen to mealtime conversations, much less participate in them. She can’t cook for her children and grandchildren. Her eyes get tired when she reads. She’s bored of all the Chinese soap operas, kung-fu shows, and nature documentaries my dad dug up from the public library to have her watch. All she’s really doing now is waiting — dreading death and what might come next, but dreading each day in gradually equalling measure.

I suppose all we can do now is help her find pleasure in her simple days, as fleeting as it may be.

And boy did she enjoy that cake!

Medical Bills

The project for this afternoon, besides baking pizza from scratch for my grandmother while my parents are out at a cocktail party (???), is to take the stack of medical bills from my recent procedure and add up: 1) how much the entire process cost (insurance company negotiated price), 2) how much we paid out of pocket (not covered by insurance), and 3) how much we would have paid if I didn’t have healthcare insurance.

For those of you who, like me, are young, relatively healthy individuals whose parents took care of most insurance/billing things and have no idea what the differences are between those three sums, here’s how it works. When you go to the doctor (and you have healthcare insurance), they do their thing and send your insurance company a bill — or to use their terminology, a claim. The insurance company examines the claim, which includes charges for various services (i.e. physical exam, consultation, surgery, laboratory work – hematology, etc.). When you’re uninsured, these charges are the flat rates that you pay for these services. However, insurance companies use their leverage to negotiate lower prices for each service (noted on invoices as “Contractual Adjustment” or “Participating Provider Discount”). At this reduced rate, the insurance company covers a certain percentage, and you have to pay the rest.

This distinction between uninsured and insured cost is near and dear to me because as a non-student without a job, if it weren’t for Obamacare, I wouldn’t be covered under my mom’s company insurance. So here’s how much Obamacare saved my bank account*:

  1. Cost negotiated by insurance company: $23,691.43
  2. Amount paid out of pocket: $2,369.12
  3. Cost if uninsured: $98,632.80

That’s a difference of $74,941.37 between uninsured and insured cost, meaning my insurance company negotiated a 76% discount. Then, after that discount, my insurance company covered 90%, leaving me to pay only ten percent of the insured cost, or 2.4% of what I would have paid if I were uninsured.

I think there are two lessons to take from this. First, get health insurance. Even something as straightforward and relatively low-impact as the surgery I just had would have cleaned out my savings more than 10 times over, and even my parents would have trouble swallowing a bill for nearly $100K. Second, insurance companies have huge negotiating power over healthcare costs. I mean seriously, a Cantonese mother couldn’t manage to haggle a 76% discount.

I know there are a lot of things wrong with the way healthcare is structured in the United States. Service is inefficient, costs have skyrocketed out of control — something fundamentally is broken. But even as someone who has been through a procedure and seen everything from the patient side, as someone who has gone through all these bills and pondered each line item, and as someone who will be a healthcare provider in the future, I have no idea how to start fixing it. Do we point fingers at doctors who order too many tests? Do we blame insurance companies for working the system for profit? And even if we do find a place to start an overhaul of our current healthcare system, how do we know it won’t get bogged down in politics?

I don’t have any answers. I’ve started reading up on the healthcare reform debate, past and present, and maybe I’ll understand more in medical school, or when I start working. I’ll let you know if I find a solution, but in the meantime, get insurance and keep your fingers crossed hoping nothing bad will happen.

<edit> Here’s a graph:

Cost of Tiffany's Operation


* These numbers might be a little off; I think I’m missing one blood test invoice, receipts from prescriptions, and the charge for a follow-up with the surgeon.

Some tips for anyone who wants to try this:  Continue reading Medical Bills