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Big Medicine: The $147,000 Hospital Bill

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My mother was the Grand Inquisitor of hospital bills. She would question the inflated price of every pill dispensed, every package of unused gauze. She had excellent health insurance and rarely had to pay out of her own pocket for such things, but she understood how the padding built into the average sick bill jacked up health care costs for everyone.

I can imagine how she would have felt if she had been around to open the last hospital bill of her life, which I ripped open with great trepidation this morning. Her final illness had involved a tortuous two weeks in intensive care before her family, at her request, ordered a stop to all the extraordinary machinery that was keeping her alive. But even my best estimate of what all that ICU treatment would cost fell far short of the actual figure on the bill: $147,085.85.

We're not talking twelve-hour surgeries or heart transplants here. Almost half of the bill, $65,000 or so, was just for the room. Add another $17,000 for "respiratory services," twelve grand for drugs, another twelve grand for surgical supplies, and so on, and it starts to add up. There was even a $177 charge for visits by an occupational therapist, a peculiar service to provide a dying 86-year-old woman. But that's the cornucopia of health care provided to the well-insured in this country.

Her insurance paid Presbyterian/St. Luke's Medical Center $18,000 of the bill. Under its contract with her carrier, the hospital "adjusted" another $129,000 in charges, meaning that it simply wrote them off. The patient's part of this came down to a mere $27.65, which you can bet I paid in a hurry -- cheerfully and gratefully.

But it makes you wonder how anyone can negotiate the modern ICU without health insurance. What family could afford such a devastating final bill if the hospital wasn't obliged by contract to write off most of it? Would any hospital even attempt the kind of treatment my mother received if the patient didn't have the insurance to cover it?

Maybe as next year's election approaches, we'll see the politicians finally getting into the long-delayed debate over health care in this country. In the meantime, there's no question that the current system offers different care, at different prices, depending on the kind of insurance you've got. Or, as an attorney pointed out "High Trauma," in my recent article, "In our medical system, the amount of a bill depends on who it's billed to." -- Alan Prendergast

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