Public Policy Becomes Personal

I haven't blogged since late May because, as many of you know, I suffered sudden, life-threatening diverticular bleeding in Moab, Utah, at the start of what was to be two-plus weeks of visits to and hikes in the national parks and monuments of southern Utah, Death Valley, Yosemite, and the Northern California/Oregon coast. I was lucky -- doubly lucky. First, it happened in town as we finished a nice, late dinner. Had it been 15 hours later, I would have been out on the back-country trails of Arches or Canyonlands, and who knows how quickly I might have gotten aid. As it was, we were 5 minutes from the Moab Hospital ER. Second lucky? They airlifted me out to Grand Junction, CO. Grand Junction?!? What the hell is there? Just St. Mary's Regional Medical Center, top ranked in the Dartmouth Health Atlas study of 2008, a simply superb center of caring, exacting professionals supported by terrific staff. We all should be so lucky as to fall into the hands of such people when in need.

What did they do? Medivac'd, stabilized, transfused (10 times!), tested and probed, found the leak, removed 3/4ths of my colon, put me back together, watched over me and finally allowed me to fly home. What did that cost, to restore me to health? $145,000. And I seem to be restored, save for the oddities of my new plumbing; I finally got back into the boats last Friday and felt great after 1hr, 40mins of sculling.

How does one rack up $145,000? (And the bills are still trickling in.)
ER Moab - $ 1,353
Medivac flight to Grand Junction - $18,801
ER Grand Junction - $3,870
Medical, Surgical, ICU Rooms and Board - $24,537
Pharmacy - $3,501
Supplies - $2,014
Lab and pathology - $4,030
Radiology - $19,513
Nuclear Medicine - $2,202
Surgical - $43,611
Blood Bank - $7,155
Attending physicians - $1,951
Gastroenterologists - $3,225
Radiologists - $1,006
Anesthesiologist - $4,485
Surgeons - $4,382

Through Ann's employer, we are among the 85% of Americans that are insured -- first tier, United Health Care; second tier, Medicare. But what if I had been only on Medicare? Would the hospital, the physicians and the specialists have lavished such care on me? And what if I were in that benighted, uninsured 15%? I don't know the answers; I'd like to think the Sisters of Charity would treat all equally -- the privately insured, those on medicare or medicaid, the uninsured. But would a for-profit hospital?

I'm fairly fit for an old fart. In part, again, because we are insured. We take full advantage of check-ups and preventative medicine; we don't let little ills grow into crises. What are the odds that my uninsured 76 year old doppelganger has taken such care of himself?

What is a fit 76 year-old worth? $145,000? $250,000? $750,000? Others in the ICU were two obese patients, 300-plus pounds , one a smoker to boot, and a very audibly ill 90 year old woman more fit for hospice it sounded like than hospital. Did those three receive the same batteries of tests, transfusions, probes? Or did I get special attention? (I overheard one staffer saying to another, "...oh, he's an executive of some sort.") Again, I don't know.

What should society ask of its health care givers? Is the Hippocratic Oath absolute or relative to physical condition, financial condition, age, odds or role in society? How do "they" -- the ER staff, physicians, specialists, administrators, those on the front line -- how do they make those calls?

In retrospect, I was three times lucky -- the right time, the right place and insured. But now those public policy abstractions of health care reform -- single payer, universal coverage, medicare cuts, advisory councils, all that stuff -- have suddenly become quite personal since that balmy spring evening in Moab.