How much does my life cost? A tale of US cancer care
The American healthcare system slaps a price tag on life, and I know how much mine costs. A doctor’s voice on the phone in November last year saying, “I’m sorry,” ended a life-long streak of health so rude it was a family joke. Diagnosis: breast cancer. I was 41.
The next nine months brought more mammograms, more biopsies, an MRI, a lumpectomy, six weeks of radiation, eight rounds of chemotherapy and God knows how many blood draws. Today my body appears free of disease. Survival allows me the luxury of reckoning the cost — philosophically, of course, but also in very real dollars and cents.
Medical issues are the leading cause of personal bankruptcy in the US. Fortunately, that does not apply to me. A decade ago I was uninsured for several years, but when the lightning bolt hit, I had a full-time job with solid health insurance. The Financial Times granted me paid medical leave, and I was treated by skilled, caring professionals at one of the teaching hospitals in Chicago’s Northwestern Medicine system. So far I have paid little out of pocket.
That doesn’t mean my life came cheap. Over the course of my treatment, insurer Cigna shelled out $175,725 in negotiated costs to the hospital. This is the “real” price of care, the money that changed hands. Northwestern billed my life at a more generous $416,328, which is less a nod to the value of my sparkling personality than a grim testament to the upside-down world of US healthcare pricing.
In the US system, healthcare is paid for by the government, private insurers, and individuals using their own cash. That results in different patients paying different prices for the same treatment, according to Ge Bai, a professor studying healthcare pricing at Johns Hopkins University.
Insurance companies argue that they wrestle hospitals and doctors to charge less. But elite health systems such as Northwestern have the clout to push back, because they know employers will not buy insurers’ plans if top hospitals are excluded. Nor is there any business incentive for reducing costs. “Lower [healthcare] spending does not help Cigna, because that reduces their revenue,” Bai explains. The US government has pushed for greater transparency in healthcare pricing, as providers charge wildly different amounts for the same procedure but hospitals and doctors refuse to say how much it costs them to provide services.
January 12 was a critical day for my goal of continued existence, and an expensive one. A surgeon cut out part of my breast and biopsied a lymph node. So what does a lumpectomy cost? I asked for help from Bill Kampine, co-founder of Healthcare Bluebook, a Tennessee company that analyses healthcare claims to determine what insurers are paying for procedures. The company shared 50 claims paid by private insurers from a representative US sample, ranging from $5,473 to $39,773. The average was $15,176.
Kampine looked over my bills, and after stripping out the pathology reports, which cannot easily be compared, concluded my procedure cost about $30,000, “the high end of what this should look like”. The bill included a $141 charge for a pregnancy test. Perhaps the drugstore down the street was closed.
This is where I need to point out that I am desperately grateful for the care I received, and that my surgeon earned Healthcare Bluebook’s top quality rating. And no one charged me $30,000, so why does any of this matter? Because employers and, increasingly, employees pay these costs through rising premiums.
“Every time I pay $30,000 for something that’s worth $10,000, that’s $20,000 I don’t have to hire another employee, to pay people higher salaries, or to use in other investment,” Kampine said. “The fact that nobody knows what anything costs . . . leads exactly to this sort of invisible overpricing.”
At $175,725, is my life overpriced? “How many books, to pay back the world for my still existing, would I have to write?” asks poet Anne Boyer in The Undying, a dissection of breast cancer and the healthcare system. “If I calculated the cost of each breath I took after this cancer, I should breathe out stock options.”
Another word for the price on a life is “ransom”. It turns out I could afford mine. In the US healthcare system, I am what success looks like: opaque, breathtakingly expensive and inaccessible to many.
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