I’m beginning to formulate a theory about what it will take for people to understand the seriousness of the COVID-19 virus. For people who are not well-versed in science and who believe that personal freedom takes precedence over public health, I think one of two things have to happen to convince them to take this seriously:
- They must become desperately ill with the coronavirus (or know someone personally who was or who died from it), or
- They have to have been economically impacted by the coronavirus (not talking job loss here, but rather the financial burden of obtaining and paying for healthcare).
I hope you will indulge me by reading this post in its entirety, because you might really learn something new about American healthcare and insurance. In this post, I will illustrate, with a conservative example, how you could meet both of these criteria by having a cavalier attitude about the coronavirus.
Consider the following news story. In a short interview with young concertgoer Courtney Harris, of Tennessee, she defends her choice to not wear a mask to Chase Rice’s concert by saying she “feels[s] like everyone is gonna get it, whether you wear a mask or not.” That’s a big problem. Clearly Miss Harris is not acquainted with either of the criteria listed above. (Link to story and video below).
Many people who have been through battling this coronavirus have published blog articles, videos, and interviews telling others to take it seriously. Some people still aren’t listening, because they haven’t met the first criteria. It isn’t personal to them. I can guarantee you it’s personal to Broadway star Nick Cordero and his wife. At age 41 and in the ICU for over 90 days, if he survives it’s likely that his career is over. How will they pay the bills? It’s personal to Michael Flor, whose hospital bills total over $1.1 million.
Perhaps the unconvinced haven’t paid attention when choirs singing in close proximity, church congregations, or birthday parties result in a lot of sick family members, some of whom may not recover or have already died. Which relative or friend are you willing to bury right now?
But let’s say you remain unconvinced. You’re a 30-year-old who is in great health, works out 5 times a week, and is raising a family. You’re a bank teller, and your husband is a plumber.
You go about your business. You flaunt the recommendation (or mandate) to wear a mask in public, and also refuse to practice social distancing. Although your job has you working on tasks from home, you continue going out at leisure and often pick up fast food for the kids while you’re out.
One day, you start to feel a little “off”. You work through it and take some over-the-counter medicine. You feel a little worse, like you’re running a temperature now. Yep, it’s about 99.9. You take some Advil and go to bed. Your husband takes care of the kids, in between shifts, and hands them off to your parents when he leaves for work.
Late in the evening on the third day of this thing, you begin to have trouble breathing. You’ve never felt anything like it before. It’s like an elephant sitting on your chest. Your fever is now 103 F. You call your mother, who leaves the kids with your dad and takes you to the doctor. At the doctor’s office, they do a swab for COVID-19. As your oxygen saturation drops to 89 percent, your doctor sends you to the emergency room. While there, your condition deteriorates, and you are admitted to an ICU bed. A couple of days later, the test results prove positive for CoVid.
Complications ensue. You can’t eat anything, so your muscles begin to waste away rapidly. Your skin sags. You are gray. The doctors, trying to save your life, intubate you and place you into a medically-induced coma. Your family can’t come to see you, but now your mother is getting sick. She just finished treatment for breast cancer and isn’t as strong as she used to be. Your youngest one is starting to spike a temperature, too, but you’re not aware of any of this, because you’re in a coma.
A month later, you’ve survived and are being discharged from the hospital. You find that everything has changed.
Your little one managed to fight through the virus, but there were a couple of scary moments when her fever reached 104 F and she was treated in the emergency room. Your mother, however, was in an ICU bed down the hall from you for about a week. With her weakened constitution, she did not survive the virus. Her funeral was a private affair. The memorial service will be held after “things go back to normal”. You never got a chance to say goodbye.
You’ve lost that healthy body you worked so hard for and have little basic strength, and no energy. You lost a leg due to complications including blood clots, so you now have occupational and physical therapy appointments several times a week to help you adjust to your new body and life. You have to use several different medications for breathing, as well as some new drugs to control lingering blood pressure issues. Your husband gives you Heparin shots. Pain medication gets you through all those therapy sessions and through the long nights with phantom limb pain and spinal pain from the adjustment to your new way of moving.
There is no essential oil or exercise class that will work a miracle this time. You have to just motivate yourself to get out of bed every day and try to move forward. You become angry when people congratulate you on surviving, because for them it is over. For you, it’s still happening.
Well meaning friends come around to leave meals on the porch for your family, but their visits become rare after the second week. Your husband has had to bring in childcare for the kids. A visiting nurse comes once a week to help you, but you are dependent on the local medical transport to get you to and from all those appointments. Being shuttled about by strangers who are in no particular hurry is demeaning. You feel depressed but can’t afford yet another doctor, so you try to deal with it on your own.
Congratulations, you meet criteria 1 now. Prepare to meet criteria 2.
The bills begin to roll in from the hospital, the doctors, the radiologists, and the anesthesiologists. Soon, you are looking at $250,000 in medical bills on your desk. Like Mr. Flor, it’s got you , your family and friends “marveling at the extreme expense, and bizarre economics, of American health care.” Mr. Flor has insurance, including Medicare. Your father is going to be okay, because your mother had Medicare plus supplemental insurance. It’s the only silver lining he has found in the situation. He’ll be able to remain in his home and pay his monthly bills.
You on the other hand, although insured, have high out-of-pocket expenses with your plan. Your deductible is $10,000 per year for the family. That will be covered by just the expenses you’ve incurred for coronavirus. Your out-of-pocket maximum for the year is $15,000. That means your insurance will start paying its 80 percent of your medical costs once you hit $10,000, and you will be paying your 20 percent copay up until you have reached $15,000 out-of-pocket. Only then will insurance cover the rest.
But it’s a little more complicated than that. Let’s look at the math:
Total bills less the deductible equals net: $250,000 – $10,000 = $240,000
Net amount less the 20%: $240,000 – $48,400 = $191,600
Ah, but you’re saved by the $15,000 maximum out of pocket! Or are you?
Oops, seems like a couple of the providers that took care of you are not in-network with your plan. You didn’t really have a choice in the matter, but you are left with the results. Your plan only pays 50% of the allowable expenses for out-of-network providers. (That’s an important word, “allowable”, because it means your insurer may determine that a service is worth $3000, but the provider bills it at $5000. Your insurer may also determine that a service isn’t covered, in which case you are responsible for the entire amount. We’ll revisit this in a minute.) We’ll say that $50,000 of that original total was out-of-network. Under current law, if your insurance determines that it will pay only a certain amount for a given service to an out-of-network provider, that provider can bill you the balance. For example, if one of your bills was from an out-of-network respiratory therapist for $3,000 and your insurance only allows $2,000 for that service, insurance will pay $1,000, and the provider will bill you for the remaining $2,000. This is what’s known as balanced billing. Oh, and that $2,000? It doesn’t count toward your out-of-pocket maximum.
So now where are we?
Total in-network bills less the deductible: $200,000 – $10,000 = $190,000
Net amount less the 20%: $190,000 – $38,000 = $152,000
Your cost for in-network bills: $15,000
Total out-of-network bills, less payment by insurer at 50% of allowable, covered charges: $50,000 – $22,000 = $28,000
Your cost for out-of-network bills: $28,000
Your annual insurance premium cost (at $350 per month): $4,200
Total cost for your healthcare (so far) this year: $47,200
You are fortunate that your employer is continuing to pay their part of your insurance premiums until your FMLA allowance is used up (otherwise you’d be paying $1,100 a month in COBRA premiums and would likely have to let your healthcare coverage lapse). Short-term disability is paying you 2/3 of your normal income. (You’re one of the lucky ones, as many people have no disability coverage.)
Between your normal healthcare premiums and bills, your total cost of healthcare for the year, because of catching the coronavirus, is now $47,200. You are fortunate that the bulk of the cost will be either covered by insurance or negotiated away by them. But you’re going to have to pay this out of 2/3 of your normal paycheck plus your husband’s income. Oh, that now also needs to cover your childcare expense. You can no longer send the kids to your parents’ home, because your mom is gone and your dad is struggling with the aftermath of his loss.
If you’re lucky, you have savings to cover that huge financial burden, but the truth is that many Americans don’t. We’re much more likely to have debt than savings, and the FICO score encourages us to have debt to improve those oh-so-important ratios.
If, like most Americans, you have little to no savings, prepare for the worst. Some of your normal bills are going to fall behind because of your reduced paycheck and childcare expenses, which have to be paid one week in advance. You have a small emergency fund of $5,000, but it is quickly wiped out. You will get letters and phone calls from the healthcare providers and eventually from their collection agencies. You will be threatened with (or served with) lawsuits. Your once very healthy, organic diet has been replaced with quick meals that are far less nutritious, but which are cheaper. Your husband holds a yard sale to get rid of as many unnecessary items as possible. It is a success, bringing in $500. That goes for the kids’ school clothes, backpacks, shoes, and supplies for the fall. He sells your car, getting a mere $2,000 after the payoff.
Eventually, you find you must declare bankruptcy, which requires you to pay the lawyer $2,500 up front. (Because in this country, you have to have some cash on hand to even go bankrupt. Everyone gets to make money off the process.) The only thing you have of any value is your home, and your debt has continued to climb. You feel hopeless and defeated. You think terrible thoughts after how much your life insurance would give to your family, but your faith won’t allow you to indulge those thoughts any further.
For the next seven years after bankruptcy, you will have trouble getting any kind of credit, and you will feel deep shame every time you fill out a form that requires you to check a box for “Have you ever filed for bankruptcy?” Because you were a bank teller, you know that this will probably stop you from getting any job you applied for in your industry. You hope that it won’t cost you your current job, which you are unsure will be there after your FMLA runs out.
How do I know these things? Because in 1988, my ex-husband and I had to file bankruptcy after multiple emergencies and hospitalizations of our kids that year cost us everything, including our jobs and our apartment. We ended up living in his stepfather’s rental house (for free) for three long months until we could get back on our feet, and we considered ourselves lucky. The bankruptcy process and the next seven years were awful, but we had each other and we survived it.
Now you understand criteria 2.
Still think you don’t need that mask? Still feel like going out into a crowd at a concert? Really? I could try and paint the human picture for you of social responsibility, but that argument has already been dismissed with a wave of the hand by so many like you. Ms. Harris, I truly hope you don’t find yourself ill or struggling with a family member’s illness or death, but if your theory is correct and we all get this, God help our nation’s healthcare system. You are exhibiting the worst aspect of our freedom in this country — a failure to understand that we are all connected and that we owe each other respect. You fail to understand that by not taking control of your own behavior during an unprecedented pandemic, you are contributing to the spread of the virus and the length of time it is going to take before any of us can get back to school and work, before we can get back to normal.
Maybe next time I’ll write about what is happening to hospitals and clinics when patients can’t pay, because there is no program in place in our country to stop the collapse of the healthcare system. I’m not sure it will convince you, but it might be worth a read by our foreign friends who still can’t believe the nature of our healthcare system. Healthcare should be a human right. In America, it’s everyone for themselves. I hope you’re independent-minded enough to have a stockpile of cash and plenty of resources.