The American healthcare system puts a price on life, and I know how much mine costs. A doctor’s voice on the phone in November of last year saying, “I’m sorry,” ended a lifelong health streak so rude it was a family joke. Diagnosis: breast cancer. I was 41
The next nine months brought more mammograms, more biopsies, an MRI, a lumpectomy, six weeks of radiation, eight rounds of chemotherapy, and God knows how many blood draws. Today my body seems disease free. Survival allows me the luxury of calculating the cost, philosophically of course, but also in very real dollars and cents.
Medical problems are the leading cause of personal bankruptcy in the United States. Fortunately, that doesn’t apply to me. A decade ago I was without insurance for several years, but when lightning struck, I had a full-time job with solid health insurance. I was placed on paid medical leave by the Financial Times and treated by caring and qualified professionals at one of Chicago’s Northwest Medicine system teaching hospitals. So far I have paid little out of pocket.
That doesn’t mean my life came cheap. Over the course of my treatment, Cigna insurer paid $175,725 to the hospital. This is the “real” price of attention, the money that it changed hands. Northwestern billed my life at a more than generous $416,328, which is less a nod to the value of my bright personality than a grim testimonial to the topsy-turvy world of US health care prices.
In the US system, the government, private insurers, and individuals pay for health care out of their own money. That results in different patients paying different prices for the same treatment, according to Ge Bai, a professor who studies health care pricing at Johns Hopkins University.
Insurance companies argue that they are fighting hospitals and doctors to charge less. But elite health systems like Northwestern have the clout to back off, knowing that employers won’t buy insurer plans if the best hospitals are left out. There is also no business incentive to cut costs. “Lower [healthcare] Spending doesn’t help Cigna, because it reduces their income,” Bai explains. The US government has pushed for more transparency in healthcare pricing as providers charge wildly different amounts for the same procedure, but hospitals and doctors refuse to say how much it costs them to provide the services .
January 12 was a critical day for my goal of continued existence, and an expensive one. A surgeon cut part of my breast and performed a lymph node biopsy. So how much does a lumpectomy cost? I asked Bill Kampine, co-founder of Healthcare Bluebook, a Tennessee company that analyzes health care claims to determine which insurers pay for procedures, for help. The company shared 50 claims paid by private insurers from a representative sample of the US, ranging from $5,473 to $39,773. The average was $15,176.
Kampine reviewed my bills and, after weeding out the pathology reports, which cannot be easily compared, concluded that my procedure cost about $30,000, “the high end of what it should be.” The bill included a charge of $141 for a pregnancy test. Maybe the street pharmacy was closed.
This is where I must state that I am desperately grateful for the care I received and that my surgeon earned the highest quality rating from the Healthcare Bluebook. and no one charged me $30,000, so why does any of this matter? Because employers and, increasingly, employees pay for these costs by raising premiums.
“Every time I pay $30,000 for something that’s worth $10,000, that’s $20,000 that I don’t have to hire another employee, pay people higher wages or use for other investments,” Kampine said. “The fact that no one knows what anything costs. . . leads to exactly this kind of invisible markup.”
At $175,725, is my life too expensive? “How many books, to pay the world for my still existing, would I have to write?” asks the poet Anne Boyer in the inmortal, a dissection of breast cancer and the healthcare system. “If I counted the cost of every breath I took after this cancer, I should exhale stock options.”
Another word for the price of a life is “ransom.” Turns out I could afford mine. In the US healthcare system, I am what success it seems: opaque, impressively expensive and inaccessible to many.