Author’s Note: Names and pertinent details have been disguised and removed to conform to US privacy laws.
As part of my job as a chemist, I deal with both the biochemistry and physiology of how drugs and the body interact, and also the nuts and bolts of health care in 2011. Every treatment carries a risk and a cost. Interests have to be offset against each other, with lives in the balance.
“We’ve got a problem,” I told the moderately pretty woman as she came up to my counter. She was a new mom, slightly doughy, and a little confused and tired. She was blonde, but her eyes looked heavy, dark-circled, and her body hadn’t shed the weight from the new baby in the stroller in front of her. Chemists are taught to present problems as something “we” have, which isn’t true at all. “A couple of these are quite expensive,” I begin, and then show her the slip with her total bill on it.
“Oh, my God,” she says, eyes wide, voice edged with panic. The bill is $534.67.
$534.67 is either a very small or very large amount of money, depending on your point of view. Bill Gates may have that in his back pocket. For a healthy number of citizens around the world, that amount of money is as fantastic as a billion dollars - and just as difficult to obtain.
I outline what the different items cost, trying to sort out what is really necessary from what can wait for a time. I know, from previous experience, that something that "can wait" is a euphemism for “something I will never, ever pay for”.
“But I need it,” she says, her voice tight. She does. The antibiotic, fully 70% of the total, is probably the most important item there. We engage in a back and forth, and she takes one of the four items home with her. I don't know what will become of her. She needs an antibiotic to treat an infection - the infection may resolve on its own, or it may not. She may recover completely, or get much worse, hospitalized with bills mounting into the thousands. It is sensible to pay something now to avoid an enormous bill later: but if you don’t have the money now, you can’t make that choice.
These transactions - health decisions made for purely financial reasons - leave me nauseous, my stomach spasming, my mouth dry. In the abstract, health care decisions should be made by doctors and patients. In the real world, health care decisions come with a price tag, whether paid by a government, or an employer, or an insurance company. But in the United States, whether or not you get better depends on whether or not you have $534.67.
In my country, no expense is spared when a rifle, or a bomb, or a bullet is needed. Sensible people understand that individuals cannot build a school, or staff an army, by themselves - we need the collective will of a society to do big things, things that provide a common good. Yet when it comes to health and wellness, something the individual has limited control over and which is enormously expensive, in the United States we leave it up to the individual.
I have been a health care provider for nearly 20 years, and have made a decent living doing so. I tell people what things cost, negotiating treatments that will keep them alive and - hopefully - their wallets full. And I tell myself it's all I can do. But sometimes, I remember the new mom going home without her antibiotic, and I wonder.
published 23 July 2011