Friday, November 21, 2014

What I've Been Thinking About This Week ....

from Jacqueline

I’m not usually one for fluff. I don’t watch every YouTube video I’m sent via email, and I am not generally one to send on jokes unless they’re really, really funny.  I don’t do the thought of the day either.  But while recovering from that fall from my horse, unable to drive, and in pain pretty much all the time, therefore unable to think straight to accomplish anything of note (though I checked copyedits on the next book and have been working through my research reading list in preparation for the novel I’ll begin writing on January 1st) – I have been watching all sorts of daft stuff.  Here’s a mere smidgeon of my viewing:

The 10 Funniest German Shepherd Videos
20 Best Jennifer Lawrence Movie Stills
The Sainsbury’s Christmas Ad (I forwarded that to everyone I know and posted it on Facebook – it was passed on some 30,000 more times from there).
Many sessions from Dressage Training Online
Dogs Who Can Say I Love You
The “We rise at daybreak” scene from The Trip – I love Steve Coogan

This is what my world has come to – though I give thanks every day because I know this pain and discomfort will pass. I know I was really lucky – I could be dead or paralyzed right now, and I know that millions of people are facing way more troubling illnesses than my silly broken clavicle.  But here are some things that came to my attention in the past week or so.

Seen in a British newspaper – article about the fact that the National Lottery is now 20 years old. Article comprised interviews with the 20 biggest winners – and believe me, we’re talking big ££££. Good for them.  However, placed just underneath this particular article was the story of a young girl, 7 years old, suffering from a rare brain tumor. Her medical team had fought hard for her, exhausting all treatment options, and the parents – clutching at any straw they could find – were trying to raise the £160,000 necessary to send their precious child to one of two hospitals in the world where she could undergo the type of proton beam therapy that might give her a chance at life.  The parents were selling their house and moving in with other family members, but that wasn’t going to make the whole amount needed, so they were fundraising any way they could.  Hmmm, I thought – the newspaper missed a chance to create a bit of synergy by passing the hat round those 20 lottery winners, decked out in their finery.  £10k each would do it - chump change – and what a great way to spend your money. 

Back to my own brush with the healthcare industry.  No error there – I meant to write “industry.”  About a week ago I started receiving the emergency room bills. I don’t know if you’ve received a hospital bill lately, but it seems hospitals are perhaps the only commercial enterprise that does not give you an itemized bill for services rendered (unlike, say, a building contractor).  You just get a big final “Pay this amount” after your insurance has kicked in the lowest they can possibly contribute, based upon your plan. And I ask you – why should healthcare be subject to “plans” or be a for-profit business hiding behind a non-profit smokescreen?  I’d read a New York Times article on this subject a few weeks ago – about a man who’d had surgery and upon asking for an itemized bill, realized that a doctor he had never met, had never heard of, was billing him for well over $100,000.  That’s a lot of dosh.  So he did some research and found out that this doctor was “observing.”  His presence was not required, nor was it requested, but he wanted to watch the procedure.  Then he billed for it.  Six figures. Nice work if you can get it.  So, when I received my statement, I thought I’d ask for the itemized bill.  Here are some interesting little points I picked up.

I was given one Vicodin pill – well, the generic (which I could not keep down once I'd arrived home, but that wasn’t the hospital’s fault): $20.  At a pharmacy, a 20-pill prescription is about $10, dependent upon your “plan.”

One pill to stop nausea – clearly didn’t work: $20

2 X-rays – over $900

Emergency Room and “procedure” - $1800.  Now, this is the kicker – the procedure amounted to the doctor asking me to grasp his hand so he could check whether I had any feeling, then he sent me to be x-rayed.  A nurse gave me the pills, and left.  After 15 minutes I had to shout to flag down another nurse to ask if someone had any ice for my shoulder (you would have thought that was a no-brainer).  The doctor – who was very nice indeed, I should add – popped his head in one more time to confirm that the clavicle was broken in two places, and I should come back if it started to poke through the skin. Another nurse gave me a sling ($80 – and it was a cheap one.  After I was home, my husband went out and bought a much better one at CVS for $12).  I queried the $1800 charge, and was told it was a standard charge for my level of emergency room admittance, and it paid for things like the ER nurses, and the nurse who admitted me, etc.  Now, I can live with paying extra to have a hospital nearby - as a member of the broader community in the county, I want to pay my way - but when I spent no more than (let’s be generous) 5 minutes with each of two nurses, and 10 minutes with the admitting nurse, I think $1800 is a bit much. Oh, I sat on the bed for about 45 minutes, so parking my rear on that bit of real estate clearly pushed up my bill.

Then yesterday I received the doctor’s bill (remember, I spent 10 minutes with him, plus he had a gander at my x-rays, which probably took a minute or two):  Over $1600, of which I pay about half and my “plan” pays the other half.

I consider myself fortunate, because I had money stashed away for this sort of eventuality – take part in potentially dangerous sports, and you’d be remiss not to.  Yet I cannot help but think that this is just one example of why healthcare in the USA is in such a terrible state.  Hospitals cost a huge amount of money to run, but here’s something interesting – an illuminating experience I had when I first came to America to live. I landed a job with a company contracted by a major hospital group in California, to inventory every item worth over $500 in every hospital and medical office across the group - about 30 facilities, some quite massive.  I worked in all sorts of medical environments, and often late at night, because hospitals are quieter at night.  But there were two incidents that seemed to echo down the years when I received my recent bills.

The first was the evening my team went into the executive suites after hours to get the contents of those offices inventoried while the “movers and shakers” were out.  You should have seen the size of those offices!  And you could not imagine the money spent on furniture, on artworks and expensive chairs – better than any ad agency I’ve ever worked with.  The legal department was so plush it made me angry.  The following day we went along to the marketing department (yep, the marketing department).  Lots of brand new Apple hardware everywhere, gorgeous desks and the de rigueur Aeron chairs.  When we thought we’d coded everything, I asked the manager if I could check a room that was locked.  He opened the door to reveal boxes and boxes – right to the ceiling – of brand new hardware.  I asked why the computers weren’t being used. “Oh, we had to spend our budget, so we ordered a load of kit and here it is.  We’ll never use it though.” 

That, dear reader, is your insurance $$$ at work.

And even though we have finally limped towards something akin to universal healthcare here in the USA – it's a start, but needs much, much more work – there are still people in this country struggling to pay medical bills and unable to fully insure themselves.  We may have “affordable” healthcare insurance, but doctors, hospitals and emergency room care are still far from affordable for the majority of people.  I’m lucky - I had the money saved.  But what if I hadn’t?  I’d be like that poor girl in Minnesota I read about this week – suffered a heart attack at work and (unconscious) was rushed to a hospital that wasn’t part of her “plan.”  She’s 26 and now filing for bankruptcy because she still owes $50,000 – and that’s after the hospital had “made allowances” and her insurer had paid a bit more than they normally would for an out-of-plan hospital.  

You’d better go to YouTube, find the 10 Funniest German Shepherd Videos – it’ll take your mind off it.

Wishing you a great weekend, and a wonderful Thanksgiving.  See you back here in a couple of weeks. 

PS:  It has occurred to me that we should all understand more about where our healthcare $$$ are going, and though the information is probably in the public domain, I'm not sure I know how to find it.  More information from hospitals  - perhaps online - showing running costs, and how money is spent, right down to the executive offices, would be handy.  That would enlighten me, and perhaps I would then see certain lines on my bill in a new light.  


  1. Medical bills are, according to a recent article I read, the number one reason for bankruptcy filings in the U.S. The system is so broken that "all the traffic can bear" seems to be the only rule.

    1. Richard - and what a sad, sad state of affairs that is. I did not add that a line on my bill offered a 25% discount if I paid within a certain time, so I did - but the people who need that discount most cannot pay within that short time, and end up paying significant interest charges for a payment plan. Something's not right there

  2. The burning question is: will you resume riding?

    1. from Jacqueline: Well, that is the burning question, Patty. Sadly, I will probably have to sell my beloved Oliver - the accident was not his fault, far from it, but he is a very, very strong horse and his breed has a very sensitive "bolting" response when danger is present, though they are also known to turn and face it down. I have to acknowledge that I cannot have another accident like that - so soon Oliver will be going on an extended vacation to a friend's ranch, while I work up to the next step with him. Wolke, my other horse, was a star on the day - my trainer was riding her - and she walked right through the swarming yellow jackets without batting an eyelid (mind you, she only had to deal with the stragglers, as most of them were in pursuit of Ollie!). I know I will ride again, but something smaller than a war horse might be in my future. I don't think my husband could stand another emergency room visit, and I don't think I could either. But I adore my horses and love being around horses - so what's a horsewoman to do?

  3. Sad indeed. I know how much you love Ollie.

  4. James O. Born11/23/2014 11:34 AM

    Good post. Sorry for the late comment. Just got back from the Miami Book Fair.


  5. from Jacqueline: Oh how great, The Miami Book Fair! Hope you had a really good time, Jim - and thanks for your comment. I really enjoyed your post on finding an agent - it always amazes me how many people think you have to "know someone" to get published - I am sure it works for some of those who mix in the higher echelons of power, but for the rest of us, it's down to the business of digging up information, crafting proposals and writing query letters!! Though the publishing landscape has changed in recent years, that's pretty much what it's still down to if you want an agent.