A long post about U.S. healthcare

**NOTE: this is a really long post. If you’d prefer to cut to the chase ($$$), scroll down to the section that starts with “THE UGLY”**.

Nick and I joined a recreational volleyball league, and I was having a lot of fun until I injured my left ring finger in the second game while trying to block a ball. I knew when it happened that I had done something bad (it hurt a LOT!), but figured it was just a sprain and kept playing through all 4 matches we had that night. When I got home, I was barely able to get my wedding ring off my finger was so swollen (normally my ring is very loose – I’ve actually been thinking of getting it resized).

I wrote it off as a sprain and went about my life as normal, until two days later when I looked down at it at work and…

This is when I started to worry...two days after it happened.
Seems like a normal colour.
After the doctor's visit, a friend used pretty tape to tape it up until I could get a splint.
A friend used pretty tape to tape it up until I could get an appointment.

I realized I should probably see a doctor, and here begins the tale of my first extended experience with American healthcare! (Other than routine dr.’s visits)

THE GOOD:

I recently joined a program called OneMedical (“The doctor’s office – reinvented”) and was happy to have the chance to try them out. They promise same-day appointments and online scheduling, which in my experience was 50% true – I could not get a same-day appointment, but I was able to make an appointment for the next day online, which was pretty neat. This is what the system looks like:

Appointment booking online with OneMedical.
Appointment booking online with OneMedical.

Upon arriving at the OneMedical office in Sunnyvale, about a 10 minute drive away from work, I was really pleasantly surprised to see a beautiful lobby area with comfy chairs and water and tea available for waiting patients. There was no one waiting, and the doctor came out 5 minutes early to call me into her shiny modern office.

I know I’m sounding like an ad for OneMedical, but it really was nice. My doctor’s offices waiting areas in Canada were never very nice – folding chairs, old carpets, crowded with people, and doctors usually late.

The doctor was very kind and concerned, and told me my finger was likely broken given the discolouration, but she’d have to refer me for some x-rays. I laughed and asked when I could play volleyball again, and she (nicely) chastised me and pointed out that fingers are kind of important (especially since it was on my dominant hand) and I didn’t want to damage it beyond repair. 

Now, the next part that was really nice…normally I would expect to get an X-ray referral form and then have to take it to the closest lab to me, which I would be left to find on my own, and they probably would be open at weird hours like 7am to 2pm, and I’d have to wait for the tech and then wait for the tech to send the X-ray over to my doctor…yadda yadda. Instead, the doctor printed the X-ray referral form, looked up the closest x-ray clinic to our current location, looked up whether they were open, and then PHONED them to find out how long the wait was!

So, off we went to the x-ray clinic. I had to wait for about fifteen-twenty minutes, and then they saw me for three quick x-rays. They asked me to wait around for about five minutes afterwards so that they could give me a digital copy of my x-ray! Another awesome feature of either U.S. healthcare or maybe just the Bay Area. Anyway, here’s a high-res picture of the inside of my hand:

Click to embiggen!
Click to embiggen!

The x-ray clinic said they’d send over a diagnosis to my doctor by the end of the day (it was around 3pm) and sent us on our way.

Later that night, around 7pm, my doctor emailed me(!) that she hadn’t received the report yet, but would call around the next morning to track it down. Sure enough, by 9am the next morning, she’d emailed me a copy of the report indicating that I had successfully fractured said finger (I win!…or, lose?)

Whatever that means...
Whatever that means…

She recommended I use a splint until I could see a hand surgeon.

Wait, hand surgeon?? WTF is this madness?? Yep, she referred me to a hand surgeon, again reminding me that fingers are important and you really need them to function well. Sigh. Okay, so next step, hand surgeon. The doctor emailed me a list of a few names, and I looked them up on Yelp (a review site for everything under the sun) and picked one based on the reviews. Yes, really. I called his office and booked an appointment for…the day after next.

(Some background for our American friends: it is impossible, in my own personal experience, to book an appointment with a specialist or surgeon with anything less than three months’ notice. Sometimes it is longer.)

As absolutely RIDICULOUS as I thought the whole thing was, it’s actually very good that I went to see the hand surgeon quickly, because he told me I should not actually be taping or splinting the finger at all and should be gently trying to move it and use it as much as possible in order for it to heal properly. He said he sees many people who wait weeks or months to come in, and they actually do end up needing surgery or therapy to correct the work of the splint, which had helpfully healed their finger in one position – perfectly straight. Who knew??

Final diagnosis from the hand surgeon: No surgery needed. Come back in 3 months if I still can’t put my wedding ring on. Hurray!

Net-net, through the whole process, everyone was so helpful and really communicative. I love that I got a copy of my x-rays and that Nick and I were able to look at them (and decide before we got the report that my finger actually wasn’t broken – ha ha, guess we aren’t x-ray techs after all!). I don’t know how much of my positive experience has to do with being in the Bay Area vs being in the U.S., but there you have it.

So, all of that is the GOOD. Now for the BAD:

  • I had to wait a long time at the hand surgeon’s – a good 45 minutes. They had squeezed me in between appointments and the doctor got an urgent phone call in the middle as well.
  • There aren’t many reviews on Yelp for surgeons/doctors and so I had to ask my boss (whose spouse is in medicine) for a recommendation.
  • Um…

And the UGLY:

Total cost for a broken finger: $558.82. But that’s just what I had to pay. As you might know, health providers actually inflate their bills with the expectation that they will be negotiated down. I am lucky enough to have a great health insurance plan, and here’s what the providers actually billed vs what I actually had to pay:

  • Doctor’s visit to OneMedical: $351 (I paid $338.70, a 4% discount)
  • X-rays: $200 (I paid $33.82, an 83% discount)
  • Hand surgeon consultation: $322 (I paid $186.30, a 42% discount)
  • Total billed: $873, Total paid: $558.82, a 36% discount overall.

Canadians might now be wondering a few things:

Why didn’t you have to pay the full bill amount? Because I have (very good) health insurance, the health providers first send the bill to Aetna, who’s my insurance provider. Because Aetna is so big, they have the power to negotiate lower rates with healthcare providers (kind of like a volume discount). If I didn’t have health insurance, I could probably also still negotiate a discount with the healthcare provider, but likely not as much as Aetna was able to negotiate for me.

Why did you have to pay so much even with health insurance? Because I have a high-deductible plan. What that means is that I have to pay the first $2,500 of healthcare costs every year. Since I broke my finger in January, I certainly hadn’t spent $2,500 yet, so I had to pay 100% of the rates that my insurance negotiated, out of my own pocket (actually my HSA).

What’s an HSA? Tax-free health savings account, sort of like an Ontario TFSA but you can spend it on healthcare expenses (and nothing else).

Your taxes must be so much lower in the U.S. since it’s private healthcare. Nope! While federal and California tax rates are lower than Canadian federal and Ontario provincial tax rates, Medicare & Social Security taxes are far higher than the max CPP and EI contributions. Net-net, my taxes, Medicare, and Social Security deductions are about the same as my taxes, EI, and CPP deductions would be in Ontario.

Special bonus answer: So, net net, the tax rate is about the same, I pay $2,000/year in health insurance premiums (and btw, my employer pays another LARGE chunk on top of that – their share is far more than mine), I have to pay the first $2,500 of health costs, and then 10% of the next $31,000, for a total healthcare cost outlay of about $7,600 per year.

TO SUM IT ALL UP:

So, for all the good, is the ugly worth it? As a Canadian through and through, from my hockey-puck heart to my maple-syrup soul, I have to say no. I am thrilled with the care I received and it is truly amazing to be able to book appointments online, see a specialist right away, and email back and forth with your doctor regarding a diagnosis. However, I know that I am receiving this care, because I am lucky enough to be able to afford it. I feel truly sad to know that there are many others out there in America who injure themselves much worse than I did, and must choose to treat the injury or keep a roof over their heads. I would absolutely wait 3-6 months to see a specialist, and have it be a pain in the butt to get ahold of my doctor, to know that not just the privileged few are able to receive care.

Further recommended reading: 

Bitter Pill: Why Medical Bills Are Killing Us
Time Magazine (February 20 2013)

The $2.7 Trillion Medical Bill
New York Times (June 1 2013)

Paying Til It Hurts: Cash On Delivery
New York Times (June 30 2013)

 

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