The 12-year-+old boy and his little sister were waiting for the school bus in their New York suburban community one cool, clear morning. The boy felt dizzy and queasy. "I'm going home to puke," he told his sister.
He didn't get home. He collapsed on the doorstep. There was blood. His family rushed him to a teaching hospital not five minutes away. The senior neurosurgeon and his entire support team happened to be making rounds. They cleared out two operating rooms and spent the next 16 hours saving the boy 's life.
They hadn't had time for finesse. To vacate the massive cerebral hemorrhage as quickly as possible, they simply sawed out a piece of his skull. When he was out of danger they replaced the bone with a plate of surgical steel.
The entire episode was enormously costly, but the boy's father's employer provided good health insurance and major medical coverage. It cost the family only $8,000 out of pocket.
A triumph of private health insurance in this great country.
Twice over the ensuing years, the boy's body rejected the plate in his head, which had to be replaced with new space-age materials. The boy came to know the rejection symptoms well.
The replacement procedure is a relatively simple one. Private insurance paid all the costs.
The boy became a young man and got a job and got married. His employer provided HMO health coverage.
The rejection symptoms returned., The young man went to his HMO doctor. "I'm rejecting my plate," the young man said. "I need to see a neurosurgeon." Dollar signs spun in the doctor's eyeballs. He gave the young man a bar of soap and told him to wash his head. The young man asked to see another doctor. Against the rules.
The young man went home and called the neurosurgeon who had treated him when he was a boy, covered by his father's insurance. "How much to replace my plate if I'm a private patient?" he asked. The doctor told him. The price was far beyond his reach. "Tell your HMO doctor to call me," the neurosurgeon said. "We can work something out."
The HMO doctor didn't call the neurosurgeon. Two days later the young man collapsed at work. At the emergency room of the local hospital, the doctors recognized a neurological emergency they couldn't handle. The young man was rushed by helicopter to an urban medical center 100 miles away. The young man was near death
The senior neurosurgeon and his entire support team cleared out an operating room and worked 14 hours to save his life. Save him they did, but the entire episode was enormously costly.
The HMO munificently offered to cover one-third of the bill.