On Saturday morning, everyone slept in. It was the final weekend before school began anew, and the extra rest was welcomed. It was close to 9:15 AM and Lucy had yet to wander into my room to wake me with her favorite question, “Are you awake?” Cherie was out of town representing the family at her great aunt’s funeral so I had the bed to myself. I had expanded my territory comfortably without risking an elbow, a knee or an involuntarily rap across the head (at least I have been told that those are involuntarily).
Rested and relaxed, I headed downstairs for some coffee and some light Internet surfing. My first order of business was a quick review of personal emails. Most of these emails are hockey equipment sales announcements for “Today Only”, political panhandling based on yesterday’s perceived affront inside the Beltway, and various headlines questioning my manhood and my mortgage rate. I like to start my weekend mornings cleaning house, and my Outlook in box seemed as good a place to start as any.
As I pounded the delete key and sipped my inaugural coffee, one email caught my eye. It was from my mother-in-law who was in Pennsylvania with Cherie at the funeral. Her email must have been hacked, I thought. The message made no sense on this Saturday morning. The header read, Cherie:
we are in ER..severe pain in side of back, urgency and pain at urination, vomiting. Getting seen quickly in ER, IV fluid and pain med, then test urine and get pictures. This happened to be about 5 yrs ago..expect she will be fine..
I read and reread the email several times. I must not be as rested as I thought. If this were a legitimate email, someone would have called me by now. I am a sound sleeper, but we have dozens of phones in the house. Someone would have heard it. This has to be a mistake or a trick to get me to send money to a Nigerian prince who needs my help. This cannot be real. I was in denial and opted for a second cup of coffee to sharpen my thinking.
In my relaxed state, I could not understand the message, so I called Cherie’s cell phone. It was not an Internet scam. Cherie was in fact in the ER somewhere in the mountains of Pennsylvania slowly recovering from a rogue kidney stone. Her pain medication was clearly working, so our conversation was brief. She was going to be fine, and she was with her brother and her mother, arguably in better hands than if she had been at home for this emergency.
After the call, I must confess to having some uncomfortable thoughts about her entire experience, and I am somewhat ashamed. Like the raps across my head while I sleep, these too were involuntarily.
I wondered if the ER in Pennsylvania was considered in-network by our insurance company. I wondered what the co-pay was and what treatments would be considered covered expenses. I wondered whether the 2 hours of hospital care would mean a $50 ER co-pay or a $3,648 out-of-pocket cost. I didn’t want to think about it, but it crossed my mind, and I wish it hadn’t.
Why couldn’t she have shopped around central Pennsylvania for the best available pricing first? The marketplace of emergency care providers can only be cleansed of inefficiency and high costs when an educated consumer makes health care decisions based on price and value. Competition must be encouraged because without competition and a profit motive in health care, we all lose...or so I am told.
Alas, she went to the closest hospital, and that was her “choice”. My insurer may not like her decision and my insurer may fleece me because of her choice of hospitals, but she made not only the right decision, but the only possible decision available given her level of pain.
The health care marketplace is not the same as other consumer marketplaces. Our life doesn’t usually depend on what brand of vacuum we purchase or on what grocery store we frequent. Pain and fear tend to drive our health care purchases more than most other market purchases. We can’t afford to wait for a “20% off your next angioplasty” coupon to arrive in the mail before seeking treatment.
I hear cries that with Obamacare or any national health care program, freedom would be lost in this country. I am not so sure. Today, if I were to consider a job change, the first consideration would be the transition of my family health care coverage. My mobility is currently restricted because of today’s employer based health care system. I hear the cries that with Obamacare, we are all victims of a complex set of regulations that reduce health care choices. Today, I am a victim of a complex set of insurance company rules designed to reduce my discretionary dollars. The idea that today’s system provides me choice is silly when you consider the reasons we most often visit doctors or hospitals – unplanned emergencies. Closest provider wins.
Thankfully in America, we no longer have to worry about denial of coverage because of pre-existing conditions. Kids starting their careers or trying to be entrepreneurial job creators can remain on their parents’ health care plans until age 26. Lifetime maximum benefits are eliminated and emergency health consumers (free loaders) are being forced into the risk pool. It is not a perfect solution, but it’s a start.
Cherie’s emergency has passed, so to speak, and that’s the good news. In the back of my mind, however, I wonder if her choice of emergency rooms will cost me. It’s a worry I could do without.