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Belly of the Beast #2: $5000 Deductible, ER Timing, Cost Implications and a Coda on Health Reform PDF Print E-mail
Written by John Weeks   

Belly of the Beast #2: $5000 Deductible, ER Timing, Cost Implications and a Coda on Health Reform

Summary: In which the author pays out on the crap shoot of a $5000 deductible, confesses stubbornness and possibly harmful delay of ER visit and hospital admission. Risk to patient, length of stay and cost of care may have been affected. The national debate over universal coverage is transformed from policy issue to voting the pocketbook ...

Image Readers of Part #1 of this hospitalization saga will have learned that your author had a plausible scenario in his mind for the gut ache that grew slowly September 15. Namely, an unconscionable consumption of peanuts and kettlecorn at a Seattle Mariners' baseball game on September 13.  My younger brother - one of but two of my five siblings who still has an appendix - had chowed down roughly the same amount at the game,
to which he'd invited me.

This sordid story line
was not the only
thing that kept me
from seriously
or diagnostics

for a good part of
September 15.

There was the business
side of the transaction.

We had that $5000


 He announced via the family email, when I was hospitalized, that if causality was established, he'd have to take full responsibility. In short, I thought I had a rare bout of constipation and bowel blockage.

But this sordid story line was not the only thing that kept me from seriously considering appendicitis or going in for treatment or diagnostics for a good part of September 15. There was the fact of past unpleasant, familial ER experience. And then there was the business side of the transaction. We had that $5000 deductible.

Regarding the Plight of the Over-Educated, Over Knowledgable ... and Yet Under-Insured

Our family is what policy folks call "under-insured." We have good coverage, a Lifewise/Blue Cross policy at $420/month, once the first $5000 per insured is paid out of pocket. We pay 30% after the $5000 deductible is met.

Insured, yes. Yet when asked if I am insured by a doctor or, in this case, an ER admitting aide, I hear this voice, sotto voce, but not right away. The reality of the $5000 deductible actually placed me, mentally, somewhere near the uninsured. And this was despite the fact that, unlike most un-insured and many under-insured, we are home owners, decently well-off, and with plenty of economic cushion around us.

In truth, I trypically try to avoid medical services of virtually any kind - other than the kinds of natural health care practices and services which we favor for our primary care. Those we just accept as home care costs or out-of-pocket.(*)

The question is, did our under-insured status influence my personal judgement about whether to seek outside care? Here is a time sequence and health status for the day, as best as I can reconstruct it.


My September 15 Timeline:

Would I, as a Fully Insured Person,
Behaved Differently?


 Relevant Events
 7:00 AM
Difficult night, woke feeling
not right, backed up

 8:30 AM
    Called off a planned tennis game
9:30 AM
Begged off work, cancelled a meeting
2:30 PM
Resting, sleeping, in-and-out of hot tub,
which brought relief but probably
masked the infection; use of some
natural meds related to presumed
peanut over-consumption
2:30 PM

Voice of reason: Spousal pressure
to get outside care begins in earnest
The author stubbornly refuses.
9:30 PM
More use of hot-tub to ease (and
mask) pain, TV, reading, resting
10:15 PM
Broke first fever, at 99+; esp.tender, lower
right quadrant, spouse says we're
going to the ER. Okay, honey, let's go.

10:45 PM
Emergency Care Begins

ER arrival, good quick care. Physical exam,
blood work, though not indicating major
infection, presents as appendicitis.

11:15 PM
Ambulance transport to another facility
where the surgery was to take place

2:15 AM

Surgery begins


Shadowed by the $5000 Deductible: Did it Increase the Cost of Care?

Avoidance of the financial hit certainly helped keep the all I needed is a good poop scenario alive. With a more level mind - and perhaps less native stubbornness - I might have said "yes" to getting outside care around the time when my spouse first began recommending it.

If I had not refused earlier care, here are possible outcomes:

  • surgery six to eight hours earlier
  • potentially, removal of the appendix prior to its rupture or "perforation" as is the currently preferred word
  • potentially, a "clean" appendix removal with but a 24-48 hour hospital stay
  • pontentially, less problem with fever and thus less need for diverse meds and the extended stay
  • potentially, two days less cost of hospital care.

I am stubborn, with what I am told is a relatively high pain threshold, and an inherited
Millions with no
employer coverage
have opted out,
or into "under-
insurance" or
similarly high-
deductible health
savings accounts.

How widespread
are such economically
-induced decisions?

disposition toward avoiding medical care which predates my 23-year involvement in the health care field. My avoidance desire has likely also grown with proximity to the field. Over-performance of procedures is epidemic in hospital medicine. I know the Wennberg and Eddy data. One can end up in a medical cascade. I typically like my body parts - though have not mourned the loss of the appendix and was pleased to have a chance to thank my surgeon.

In 20-20 hindsight, I believe I delayed care, partly because of the perceived cost of those first dollars.
Notably, we are, as a family, deeply insulated from the real horror of what $200 or $500 or $5000 mean to many other families. Millions of others have no employer coverage, have opted out, or into "under-insurance" or similarly high-deductible health savings accounts. They find themselves in parallel binds, weighing care decisions against an awful cost.
How widespread are such economically-induced consumer decisions? What is the impact on our health, and on the cost of our medical treatment?

Coda: As a part of my work I have read, recently, two long treatments of the national health care debate over universal coverage and the single payer option favored by the rest of the Western world, Japan, Costa Rica, and elsewhere. One article was that of economist-columnist Paul Krugman in the New York Review of Books and the second a series in the Fall 2006 issue of Yes! magazine.

I read these, originally, as a journalist and policy person who has friends and colleagues on all sides of the issue. The case for single payer always made sense, in an academic way: it's the way the national health outcomes indicators and cost numbers each add up. But now I can say fairly say that this recent experience has convinced me that on this issue, I'm henceforth aligning my personal interest with the evidence and I'm voting my pocketbook. We need a universal coverage plan; single payer is the best way to get there.

Happily for you readers who oppose this view, I don't expect that this issue will come to dominate the Integrator editorial line.

(*) While Washington State has the best coverage, nationally, for services of distinctly licensed complementary and alternative medicine (CAM) providers, there typically remain huge gaps in types of conditions and treatments which remain uncovered for CAM.

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