Wednesday, October 16, 2013

The True Cost of Pneumonia

If you follow me on Twitter or are friends with me on Facebook, you know that I've had pneumonia, bronchitis, and an ear infection in the last three weeks. Fortunately, I'm fully on the mend now and feeling about 95% like myself.

Now that I'm close to well, I've started to notice all the bills arriving from the plethora of doctors, nurse practitioners, x-ray technicians, radiologists, ENTs, and pharmacists who have treated me since September 25th.

Let's take a peek at my bills. These are all retail prices, but of course, BCBS has the established rates they will pay and the rest gets written off by the provider.

  • 4 Prescriptions . . . $235
  • 2 Walgreens Take Care Clinic Visits . . . $178
  • 2 Primary Care Physician Visits . . . $315
  • 1 Chest X-Ray at the Hospital (does not include Radiologist). . . $550
  • 1 Ear, Nose & Throat Doctor Visit . . . $190
TOTAL MEDICAL BILLS RELATED TO PNEUMONIA: $1,468 (excluding the Radiologist)

Fortunately for me, I have great health care insurance. Sure, I have a $2,500 annual deductible on top of my monthly premiums, but once I pay my deductible, I don't owe another penny unless I go outside of the vast BCBS network. Because I'd already fulfilled my deductible requirement, I owe exactly nothing on all of these bills. I don't even owe the difference between what BCBS paid and the actual bill.

I've got awesome medical insurance and I didn't give one ounce of thought about could I afford to go to the doctor. But if I didn't have insurance, I'd have thought long and hard about going to the doctor. Close to $1,500 would have been a very difficult pill to swallow.

And I know that for a fact because there were a number of years, in the not so distant past, when I did not have insurance. I worked for myself and could not afford it. Plus, I had a pre-existing condition that either made it nearly impossible to get or grotesquely expensive. I didn't go to the doctor for preventative care and only went to the doctor when I was sick in dire emergencies, which meant almost never. When I had no insurance, no health care provider gave me discounts. I paid full retail value.

Let's contrast this with the recent experience of my friend Sarah. Sarah lives in Toronto, Canada, where she is fully covered with the universal health care that Canada offers. I know what you're thinking. You think Sarah waits six months to get into the doctor and has to appear before multiple death panels to determine whether she deserves treatment or not. That could not be further from the truth.

When I had pneumonia recently, by coincidence, Sarah had it too. I swear I didn't give it to her. Sarah called her doctor and got in on the same day. In addition, she was allowed to bring her entire family with her so they could receive flu shots. The doctor examined her, diagnosed her, gave her family flu shots, and set Sarah up with prescriptions to make her healthy again.

The only cost Sarah paid for all of this medical care was $84 which was the co-pay for her prescriptions.


I pay more than $84 in health care premiums monthly in addition to the almost $200 per month I put into my Health Savings Account to cover my annual deductible. So annually, I spend close to $4,000 in out of pocket health care premiums and my deductible. This does not include my dental insurance or vision care.

Quality health care insurance changes lives. People are healthier because they receive preventative care.   Preventable diseases are prevented. Chronic diseases are treated at lower costs. They stop worrying about whether Sally's emergency appendectomy will bankrupt them. They have dignity.

It boggles my mind why we spend so much time and energy in the United States arguing about whether or not we should allow everyone to receive quality health care. Do we believe some people are less deserving than others? Who are we to decide that? And how do we decide where to draw that line about who is more deserving and who is less deserving?

Health care is not a luxury. It's not a "nice to have" or an "extra." It's also not an "entitlement" in the condescending, dignity stripping way we talk about entitlements in this country these days. Health care is a human right. Period.

The Affordable Health Care Act (aka Obamacare) isn't perfect. I'll admit that. It's also not the plan I wanted. I wanted Universal Health Care for everyone. For now, we've got the ACA and although it's not perfect, it allows millions and millions of people to get insurance and stop worrying about whether they'll go bankrupt from an unexpected medical procedure. I just wish people would give it a chance. And maybe, one day, the USA will join the rest of the developed world and provide Universal Health Care for everyone.


  1. I'm an asthmatic and don't have insurance, at the moment. Controlling my disease without access to quality meds is impossible. I look forward to the time when we'll have health care for all, but yes.. ACA is a damn fine first step.

  2. I'm sorry to hear that you don't currently have insurance. I know it's scary and causes an extreme amount of stress that just makes things worse. What's awful, in my opinion, is that I KNOW you work very hard. You are not "lazy" or a "deadbeat" or expecting a handout as so many would have us believe about the uninsured. You are employed and hard working. But until now, private insurance on the open market was impossible to get when you have a chronic condition without being part of an employer plan. I hope you'll be able to get care through the ACA.


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