Blog PostOctober 28, 2014

American Health Care and a Family’s Eight Week Wait

“All they could say was I'm sorry. So now we need to come up with $9,795.00 and quick or Hunter may not be a hearing person anymore,” Kim explained. “I just don’t know what to do next.”

No family should be at the mercy of bureaucrats to determine if a child will be able to hear or not. Yet that is precisely what happened to 15 year old Hunter of Dayton, Ohio.

Hunter was born with significant hearing loss. In 2004, his parents opted for one of the best new treatments on the market – cochlear implants. The $65,000 equipment and surgery were expensive enough, but it was a rough year for the family with additional surgeries for carpal tunnel syndrome and a kidney stone. Even with employer-provided health insurance, the overwhelming medical costs sent the family into bankruptcy in 2005.

Then came breast cancer. Hunter’s mother, Kim, was diagnosed in 2009. The family managed to pay the out-of-pocket costs for treatment, double mastectomy and reconstructive surgeries, but related costly medical equipment and procedures very nearly put the family back into desperate financial straits for a second time.

This year, Kim needed breast revision surgery which ran $4,200, while her son needed to replace an outdated, faulty piece of hearing equipment with a new, $9,595 device just to keep his implant functional.

Insurance paid $600 of her surgery, leaving her with the rest of the tab. And her son’s equipment is not covered at all, as the insurance company does not pay for things they consider to be “hearing aids” even though what Hunter needed is technically durable medical equipment.

“All they could say was I’m sorry. So now we need to come up with $9,795.00 and quick or Hunter may not be a hearing person anymore,” Kim explained. “I just don’t know what to do next.”

One last resort had Hunter’s family appeal to the Bureau of Children with Medical Handicaps (BCMH), a state-run supplemental insurance program for children with certain medical conditions. While Hunter qualifies for the program, agents said it would take six to eight weeks to know if BCMH could cover the device.

“It’s just a waiting game at this point.” Kim said at the time, “And keeping our fingers crossed for the best.”

This is what our healthcare system – arguably the best in the world in terms of what is available – has come to. Government and insurance company bureaucrats make a family sweat out six to eight weeks to find out if these same bureaucrats will allow a boy to hear.

Kim’s medical drama perfectly illustrates why true healthcare reform needs to put control over health care dollars into the hands of people, not insurance companies or government.

Imagine if Kim’s family were required only to have a high-deductible, catastrophic insurance plan for major medical events along with a health savings account (HSA). Not only could Kim could pay for her follow up breast care or her son’s ear implants with HSA money, but she could shop around for doctors, hospitals and equipment. And those doctors, hospitals and equipment makers would be forced to respond to the pricing demands of Kim and her family, rather than insurance or government pencil pushers who they don’t know.

Lest this system sound preposterous, author and Game Show Network CEO David Goldhill tells us to consider Singapore. The nation has about the same life expectancy and per-capita gross domestic product, yet only four percent of their economy is spent on healthcare, compared with 18 percent in the United States. A Weekly Standard review of Goldhill’s book, “Catastrophic Care, How American Health Care Killed My Father – and How We Can Fix it,” suggests Singapore’s significantly lower health care spending is a by-product of treating patients like customers:

“Government doctors and facilities compete with private health care workers. Singaporeans are required to contribute to health savings accounts and purchase a catastrophic insurance plan. There is an insurance pool for the severely disabled and a fund to pay their bills. There are subsidies to providers based on their level of service… But the thrust of Singapore’s system is individual responsibility for a large portion of direct payment. And the results are positive. “Health care in Singapore is high quality, high-tech, and, by international standards, cheap,” writes Goldhill. “Genuinely cheap, not just misleadingly cheap at the point of service.”

Fortunately for Hunter, the state supplemental insurance program approved coverage of his hearing device. Unfortunately, nothing has changed for the next family facing bankruptcy or even a six to eight week wait.