Postcard from North America: Lucky escape

C&I Issue 2, 2015

This Postcard comes to you thanks to the skills of the exceptional neurosurgery team at Beth Israel Deaconess Medical Center in Boston, US. Just after completing the draft of my January 2015 issue Postcard, I had a brain haemorrhage. Remarkably, I’m already back in action, albeit with a rather fine scar and a titanium aneurysm clip lurking in my brain – plus three bonus titanium plates holding my skull back together. I have been very lucky.

I couldn’t have had better treatment from the Beth Israel medics. My eight-day inpatient experience of the US healthcare system was, however, something of an education. Never mind those four-hour A&E targets that are regularly missed in the UK, I was under the care of superb – and overworked – staff in our local ER for 12 hours then the Beth Israel ER for 16, with a 2am ambulance transfer between the two. Much of the second ER stay involved waiting, while feeling dreadful, first for a contrast head CT, and then for a bed in the ICU. Yes, bed shortages are rife over here, too. Post-surgery, I was ready for transfer to a regular ward after two nights, but again there wasn’t a bed, so I remained in the ICU for five nights.

Two nights in the neurology ward later I was desperate to escape – what should have been a comfortable and relatively peaceful one-bed room was instead a very cramped, uncomfortable and noisy two-bed one. Mercifully, my pleas were answered and I was let out for good behaviour to continue recuperating at home – where I have discovered just how exhausting brain surgery is!

And now, the eye-watering bills from a variety of providers are rolling in. Thanks to the transparency of the US system, they are eye-opening. $2500 for a 3.8-mile ambulance transfer, anyone? $1300 for an IV drip?

Fortunately I have great health insurance thanks to my husband’s employer, but this doesn’t mean it’s all free, as it would be on the NHS. We were already aware that every time you show up at any healthcare provider, on our insurance plan there’s a $25 ‘deductible’ charge. Further bills for out-of-pocket costs – our ‘share’ of those huge bills – materialise later. Even routine blood tests can set us back well over $100. The plan has a maximum annual charge on deductible and out-of-pocket payments, but we will still have to fork out about $1500 – and, of course, those limits reset in January 2015 so we’re now back to paying for follow-up appointments.

Careful study of those bills makes it clear just how important having good health insurance is. Had we been uninsured, we’d have been facing a six-figure bill ourselves. Ironically, the insurance company will be paying rather less, as they negotiate hefty discounts from providers. If you can’t afford health insurance and aren’t eligible for Medicaid, you get to pay the full whack. This is why you should never visit the US without travel insurance!

It’s also why the Affordable Care Act, aka Obamacare, is so important, even though it is nothing like an NHS-style single-payer system. Yes, some unscrupulous employers are using it as an excuse to cut their existing health plans and increase costs to employees, which is clearly wrong, and some who pay for non-employer-based insurance have seen premiums rise. But overall it means millions of people without employer coverage who previously could not afford health insurance now can, as can those rendered pretty much uninsurable by existing medical conditions.

Here in Massachusetts, the cheapest monthly plan I’m eligible for under the ACA is $240/month – though the higher patient payments mean my December surgical escapade would have cost me an additional $8500. Higher premiums give wider coverage and lower treatment charges. It’s still not cheap, but at least illness should now lead to fewer patient bankruptcies.

Sarah Houlton is a freelance writer based in Boston, US

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