Our Healthcare, Our Conscience

On one of the myeloma blogs I read, there was an entry titled, “The High Cost of Staying Alive.” The subject was a particular drug commonly prescribed for patients with multiple myeloma, thalidomide. In the article, the writer questioned its exorbitant monthly cost. He alleged that the drug’s manufacturer discriminated against myeloma patients due to their limited options. Evidently, the cost accelerated over 800% between 2000-2005. I don’t have enough information to judge whether the writer correctly exposed ethical shenanigans by the pharmaceutical company. I do know that my health insurance protected me from bankruptcy as well as cancer.

Winter sunrise

Winter sunrise

I used thalidomide for six months prior to my stem cell transplant. The list price was $4,800 for a 28-day supply. With my mail order prescription drug plan, I paid a nominal fee. It’s easy to scoff at enormous expenses when you’re using someone else’s money.

The extraordinary price of my healthcare only began with that drug therapy. Part of my consult with the Seattle Cancer Care Alliance about my transplant included a mandatory meeting with one of their financial representatives. Bluntly, the rep pegged the cost at $237,000. Patients must either have proof of coverage or pay up front. Without insurance, it’s time for a second mortgage.

I spent 3 1/2 months receiving care at the SCCA. I underwent numerous preparatory procedures. In addition to the transplant, I participated in a pre-transplant protocol requiring chemotherapy coupled with the harvest of my stem cells. During that period I contracted pneumonia requiring hospitalization for five days.

I scrutinized the hospital’s four pages of itemized billing. Just getting in the door costs $4,494.00 per day. Then each procedure and pharmaceutical added to the expense. For example, I paid as little as 0.87 cents for a daily multi-vitamin and as much as $965.34 for a shot of filgrastim, a stimulant to encourage stem cell proliferation. Other charges included a CT scan to view the pneumonia in my lungs billed at $1,287.00 and 29 doses of oxycodone for pain at $12.29 each. The total price of those five days: $41,916.25. You begin to see how that original quarter of a million dollar estimate plays out.

I’m not complaining or disputing the charges. My insurance covered nearly everything. My plan is a middle of the road Blue Cross/Blue Shield variety. It is one of several plans available to federal employees, including legislators. The plan works and, thanks to it, I am recovering from a complicated, lengthy treatment for blood cancer.

Whose head is in the sand?

Whose head is in the sand?

I’m not being smug about the fact that I have coverage. As medical consumers, we need to talk about the money. But, like discussions on mortality, there are social taboos about what life costs. Perhaps, because of this reticence, solutions to the phenomenal problem of healthcare evade us. Such passive head-in-the-sand behavior encourages sketchy ethics, arousing justifiable rage from the likes of the author I mentioned at the beginning of this update.

So, what about the huge cost of healthcare; is it worth it? Certainly the financial jeopardy can be as daunting as the disease, though that didn’t factor into my decisions. For me it was a bargain. Technically speaking, my insurance made me immune to the threat.

Still, my perspective matured as I watched other families make agonizing choices, weighing the value of their lives against the risk of financial ruin. What made me more deserving than anyone else? Would I have bought that prescription if I’d had to pay out of pocket? Would I have chanced bankrupting my family on a transplant with no guarantees? Seriously, at my age, I doubt it.

Our country is about to engage in a discourse on universal healthcare. Among the questions to be answered is whether we consider empathy for one another a shared responsibility or a product to buy and sell. Ideology, lobbying, and serial skeptics discouraged us from conducting this conversation in year’s past. But the reluctance to change shrinks along with the underlying security of our economy. Suddenly, it’s not easy to obtain that second mortgage. The juxtaposition of federal bailouts with newfound idealism may motivate us, at last, to find a cure for the high cost of staying alive.

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