A Tale of Four Patients — The Not-So Hidden Tax

With the Health Care Debate turning into grumbles from people who feel powerless to stop it, and Obamacare seeming to be here to stay for the foreseeable future, it’s time we discussed who’s really paying for all this “Free” health care.  It’s those of us with health insurance who are covering the expenses of those who can not.  It is a big part of why it is so expensive to go to get medical care, and why so many people end up bankrupt when they get ill.

There is a sweet couple we know who are college students.  He graduates in a couple months and she has a bit longer. In the meantime, their son is on CHIP – Children’s Health Insurance Program, and my friend, the wife, was on Medicaid while she was pregnant.

Our family has health insurance through my husband’s employer.  It is one the government considers to be a ” Cadillac Plan”, meaning that it is among the best available.  His company pays the premium for him, and we are responsible for the premium which covers the rest of us.

In the past year, both of our families had new baby girls, and both had to take our 5 year old boys to the Emergency Room. Both moms needed surgery post-delivery to fix issues not caused by the births, but certainly exacerbated by them.  The financial realities paint a stark difference between those of us on private insurance, and those who get their health care through the government.

Let’s start with the deliveries.  We both had baby girls in hospitals, epidurals, vaginal deliveries, and stayed a day and a half in the hospital:

Her Out of Pocket – $0

My out of Pocket –  $1617

• Hospital – $684
• Midwife – $215
• Obstetrician who discharged me (I saw her for 5 minutes) – $410
• The Epidural Man – $308

Our surgeries

Hers, done within 6 weeks of delivery so that it is covered as a part of this pregnancy –
Out of Pocket – $0

My surgery*, Out of Pocket- $1774+

• Surgeon Co-Pay – $ 741 (required up front)
• Anesthesiologist – $ 185
• Hospital – $ 848
• Other costs – Still coming in –

We both have very active 5 year old sons who ended up in the ER this past year (little boys can’t fly, they fall).  The biggest difference was that she went to the ER without a second thought. I stared at the gash on my son’s head and wondered how much it was going to cost, if we could afford it, if super glue could fix it (no kidding — I’ve super-glued wounds before), and checked my bank account in the car on the way to make sure we could cover the co-pay which the ER.

Her family’s Out of Pocket – $0

Our Out of Pocket – $678

• Emergency Room Co-Pay (up front) – $100
• Physician – $317
• Hospital – $261 (We didn’t stay.  He got 2 staples to close the wound and we were done)

 In the past year, our family has paid $4069** out of pocket for hospital care, plus $500 for the pre-natal care,  several hundred dollars in co-pays, and over $8000 in insurance premiums.  Her family has paid nothing, and gotten significantly better care.

Why the disparity?  It is a direct result of the low amount that the government pays to hospitals and physicians for services rendered.  The doctors with whom I’ve spoken about this have told me that what Uncle Sam pays doesn’t even cover all of their expenses, and the disparity between what Medicare pays and what things cost is passed along to people who do have insurance, people like my family.  It is the not-quite-hidden tax for healthcare, and it stretches back to long before Obama came to power. It has simply become more pronounced in the past four years.

While I do not begrudge them their medical care, there is something immoral about the way the government is paying for it.   If the government is going to legislate and provide free health care for those who couldn’t otherwise afford to pay for it (something I completely support), then it also needs to provide a way to pay fair market value for those services.  What we currently have could rightly be called a tax on those with health insurance as we are forced to cover the shortfall of those without. It is burdensome..and, yes, unfair.

*  I have not actually had the surgery I wrote about in this piece.  The costs I quoted are the estimates given to me by the insurance company and the doctor’s office.  They assume best case scenario, and that all medical personnel would be in-network.  If they are out of network, the costs skyrocket and there is no cap on them.  We have had to put it off.  It doesn’t matter how much I need it, we simply can’t afford it.

**  In the amount paid this year, I did not include the horrendous costs of our journey to a JRA diagnosis and everything which followed from that. That will be a post for another day.