Here is a cautionary tale about health care.
The second week in January, on a Sunday, I woke up with a sore, swollen and red big toe. I got some Epsom salts, stirred them into to some moderately warm water and soaked that foot for about 30 minutes. It took away the soreness, but not the swelling and redness.
By Wednesday, my toe looked and felt like someone had smashed it with a hammer. So I went to my favorite urgent care store in Watertown — I’m not going to say which one — and the physician’s assistant who saw me refused treatment, telling me I had to go “to the ER.”
So off I went to Samaritan. And I have to say, as medical experiences go, it was a delight. In less than 45 minutes, a PA had examined the toe, declared it infected and abscessed due to a severely ingrown toenail, and had drained the abscess and bandaged the toe.
And made a call to my podiatrist, urging that office to get me in as soon as possible.
When I walked out, my toe was bandaged, drained and feeling right sprightly, as my grandmother used to say.
This week, when I got the bills from Samaritan and from North Country Emergency Medical Consultants, I had to sit down to absorb the numbers I was seeing.
Total costs for only the Samaritan treatment were $1,508.34.
I have, of course, company provided insurance, and the cost to me was a portion of the total. But to try to keep its insurance costs affordable, the company policy has had some creep, over the years, in the deductible amount each insured must pay before insurance kicks in, and after that the policy only covers a percentage of the total cost.
I will pay the $851.26 that is my share of these bills. But this brings home for me the health insurance and health care crisis that is enveloping this nation.
I wonder, for example, how draining an abscessed toe can cost four weeks of take-home pay for a person making around $35,000 a year. What part of this bill makes sense? What my congenial PA did was to take a sterilized needle and pop the abscess to let it drain. He also took a culture to determine the nature of the infection (it was streptococcus) and called a prescription into my drugstore. Total professional time: less than 30 minutes.
The larger issue here, of course, is not my infected toe. It is the cost of health care and its impact on everyday people. That hard-working young father of two, making $35,000 a year in Jefferson or Lewis or Oswego county, would likely have to set up a payment plan with both the hospital and the emergency room doctors’ group because he probably hasn’t been able to sock away $1,000 or $1,500 for such a mundane emergency.
And woe be unto the working underprivileged if they suffer a serious injury. What would a youngster’s compound fracture from a bicycle accident cost? Or the cost of removing a “hot” appendix, with hospital admittance?
We think about the incredible costs of long-term debilitating illnesses like heart disease or cancer, but we need to be worried about all health-care costs.
Viewed objectively, the Affordable Care Act didn’t live up to its eponymous goal of making health care affordable. By sharply reducing Medicaid reimbursement rates, it forced hospitals to make that loss up wherever they could. So costs for privately insured, underinsured and uninsured patients have taken a big hit.
But simply repealing the ACA is not the solution. And because the penalty for being sick or injured is so disproportionately spread across the income spectrum — the wealthier you are, the less it hurts, while the poor suffer all the more — any successful replacement for the ACA has to find a way to both reduce the cost of health care, and ensure that our working stiff doesn’t get screwed into the poor-house.
There is no simple solution to this problem, and it’s frightening. In an incident so infused with irony that it is a bit hard to believe, two weekends ago, rushing through a dark house, I jammed that same foot into my staircase. I’m 99 percent certain I broke my little toe, but I can’t confirm that because I don’t have a home X-ray machine.
Still smarting from my $850 ingrown toenail, pun intended, I didn’t go to the ER, or even to urgent care. I sat down and taped the broken toe to the one next to it, applied a cold wrap to reduce swelling and watched three or four old episodes of “The West Wing.”
I had the money for the abscess, but the $2,400 bill I anticipated for the break is money I can spend better elsewhere. And now, the foot just throbs a little, and the bright purple has faded to sort of a jaundiced yellow, and I should be fine for golf season — and have some money left to play.
Perry White is managing editor of the Watertown Daily Times. Reach him at pwhite@wdt.net.