macro issues

I am a good kid. I am responsible, I follow the rules, I turn things in on time. If, statistically speaking, someone was going to have to be diagnosed with neuroendocrine cancer last year, I would be a good candidate because I am responsible and organized. You have to be responsible and organized to be a patient with a chronic condition and not make things worse for yourself later on. I take all my medicines as they’re prescribed. I do things the doctor tells me to do and not to do. Except, sometimes, wear sunscreen and a hat, because it’s a pain in the butt that one of my chemo drugs is photo sensitizing. And as a result, my oncologist makes fun of my weird tan lines every time I see him.

So when I get a bill from a collections agency, I freak out. I have an Excel spreadsheet that keeps track of the bills that come in and the ones i’m contesting with the insurance company and the ones I paid. I have an organized file full of the paper copies of my bills. My Excel speadsheet and this file say i’m all caught up. But this morning, I get two letters from a collections agency. They want $13.76 and $6.24 from me. OK, whatever, i’ll pay it. Even though i’m caught up according to all of my records. But WHY do they need to send bills for such a paltry amount to a collections agency when someone could have just called me, or sent me a bill, and I would have paid it? I mean, it’s $20. It probably cost more than $20 in administrative costs to get it to the collections agency.

I’m taking a health care policy class right now and we talk a lot about econ models of the health care market. And, like most econ models, the ones we talk about assume that the consumer (the patient–me) is fully informed. A fully informed consumer makes fully informed decisions and trade-offs about how they’re spending their money.

I am not fully informed. I am not even half informed. When I go to the doctor or get a scan, they never tell me how much I may get billed for later. I signed a form when I first got set up at all these clinics saying that I agreed to pay for whatever they’re going to charge me later; I was basically just writing a blank check. Would it be too much to ask that they tell me how much these things cost beforehand so I can decide whether or not I need them done? Yes. Because the problem is, no one knows how much these things cost. The costs are different for every patient depending on what insurance they have and what the agreement with that insurance company is.

I have written about the financial aspects of having cancer before. I tried not to get political. I am still trying not to get political. But I think something needs to be done. I don’t know what–but something. More transparency, maybe. It’s just plain bullshit that when you inexplicably encounter some major health problems, that so much of your time and energy and stress has to be spent sorting out the financial aspects of your care.

My dad says I spend too much time thinking and worrying about the “macro” issues of my care. The “big picture.” He is probably right. But i’m in grad school. It’s my job to learn about ways to fix all the macro issues in the world, like pollution, like traffic congestion, like obesity. This is a macro issue, too, but one it seems that not I, nor my doctors, nor the health system, not academia, nor the president can easily solve.