by Sandor Stern

Dear Republican Friends,

Regarding Healthcare: A Tale Of Two Countries...

In my previous letter I outlined the facts that spurred my questioning of your stance on healthcare, I thought I might offer two stories that personalize the issue and portray a sharp contrast in style and substance.

In 2008, my niece, J, living in Los Angeles was diagnosed with an ovarian tumor that was possibly malignant. She required hospitalization and surgery. At the time she was an employee at a firm that did not offer health insurance. As a single mother of a 14 years-old athletic boy subjected to sports injuries, she had purchased private insurance at what was an affordable rate for her circumstances – $275/month. The plan offered her one doctor's visit per quarter and two visits for her son per quarter. Her co-pay for those 12 visits was 20% of the bill. Any visits beyond that would be paid out of her own pocket. Her annual cap on medical bills was $30,000. Her deductable for hospitalization was $5000.

My wife took her to the hospital where she was informed she would not be admitted without paying the $5000 deductable first. After a heated argument, the hospital allowed J in for a $1000 payment on my credit card. Surgery revealed a malignant tumor that had spread to the other ovary. Both ovaries were excised. The day following surgery while in intensive care she was informed that she must pay the remaining $4000 immediately. A panic call later and J's father paid the money. Fortunately she had family to help her out and fortunately, the tumor had not metastasized to other organs and she required no radiation or chemo. She was discharged after eight days. Her hospital bill totaled $85,780.11. With the PPO reduction and the $30,000 annual cap, the final payment she personally owed was $24,557.07. Her surgeon's bill was $3600 of which she paid $1200 out of pocket. Her oncologist, as an act of kindness, waved his fee. She could not afford to pay off the hospital bill and arranged for monthly payments. Her debt was sold off by the hospital to a collection agency. She has continued to pay $50.00 a month for the past 4 years. That has barely paid the monthly interest. She presently owes $22,000. She maintains her insurance policy, fearing to seek another insurer because of her pre-existing condition. Her monthly payments are now $325.

Her son is now 18 years-old and attending college. Because of the Affordable Care Act he is allowed to remain on her insurance policy – inadequate though it remains. And because of the Affordable Care Act the arbitrary annual cap on coverage has been eliminated.

My friend, D, is an American citizen who grew up in Canada. He was educated there and worked in the entertainment industry. In 2005 he arrived in Los Angeles to seek work in a playing field much larger than that in Canada. In 2007 he began having health issues that led to a diagnosis of a brain tumor. He had no health insurance. The cost of surgery and hospitalization would be more than $275,000 with an additional $200,000 if complications occurred. His neurosurgeon gave him a list of the four best surgeons in North America for his type of tumor. One of those surgeons was in Toronto. Since D had left Canada just under two years ago, his Ontario Hospital Insurance was still valid. He flew to Toronto and met with the Canadian neurosurgeon. A team of six medical specialists contributed their expertise to his diagnosis. Within six weeks he underwent successful surgery. The total out of pocket expense was a $100 co-pay that had been newly introduced by OHIP and which the hospital apologized for having to charge him.

A few months following his recovery he returned to Toronto for a follow-up MRI. He had not been feeling well but there was no indication that any of his symptoms were a result of his brain surgery. He visited an internist who recommended a cardiac stress test. Following that, D took a train to visit his mother in Cornwall, Ontario, 300 miles east of Toronto. While on the train he received a call from his internist informing him that his stress test was troubling and he should come to the office ASAP. D explained that he was on a train to visit his mother and would be back in Toronto in a few days. The internist told him that when the train reached his destination he should immediately take a cab to the ER of the nearest hospital. D balked. The doctor was adamant. He did as told. At the ER he was examined and diagnosed with a silent coronary. He was immediately sent by ambulance to a cardiac unit in Ottawa where he underwent angioplasty. He recovered from that bout. His total out of pocket expense for all that – ER treatment, ambulance ride, angioplasty and hospital stay was zero dollars.

He returned to Los Angeles in good health and good spirits. He went back to Toronto three months later for another MRI and six months after that for gamma radiation and an MRI. For the next two years he received an MRI in Toronto every six months. There have been zero medical costs to him.

Aside from the excellent treatment at no cost, D shared with me the most significant moment in his medical odyssey. When he first visited the neurosurgeon in Toronto, he was terrified. There had been much discussion in Los Angeles and in Toronto about the invasiveness of his tumor. It was wrapped around his brain stem. In removing the tumor, how much damage would be done to the healthy tissue? Would he lose his hearing? Would he be paralyzed? Would he lose some other essential function? He related those fears to the surgeon. The man's response: "I will remove as much of the tumor as possible without damaging healthy tissue even if it means not excising all the tumor tissue. It's a slow growing tumor and perhaps in five years I will need to operate again but maybe not. There is nothing compelling us to take it all in one bite." That was a reassurance D needed. "Think about it." he told me. "I was dealing with a healthcare system in which the cost factor no longer entered the equation. Can you imagine a surgeon in the USA having the freedom to work that way? He knows he has one shot at cutting out that tumor and getting every bit of it because the system here is controlled by private-for-profit insurance companies and a second surgery would not be covered. The annual cap on insurance outlay would take care of that possibility."

As I stated previously, the Affordable Care Act has since removed the arbitrary annual cap on coverage that existed in 2007.

During the election of 2008, I told these stories to a Republican friend. He made no comment about D's story, ignoring it completely. As for my niece, his response was: "She should have gotten better insurance." Really? I was indignant at his dismissive attitude but this year I heard a similar remark from your candidate, Mitt Romney. When urging an audience of college students to become entrepreneurs he said: "Start your own business. If you can't get the money borrow it from your parents."

Really?

Your inquisitive friend,

Sandy

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