Really, really broken

My better half had to go to the ER on Tuesday. Before we get into the rest of it, let’s establish that she is absolutely fine. She gets terrible migraine headaches, which occasionally trigger nausea that can then trigger some minor cardiac rhythm issues. It’s a wicked positive feedback loop. So when that loop started Tuesday morning, we didn’t wait around to see what would happen. She went to the ER.

The health system in Singapore is divided into a “public” and a “private” system. Both are really good, but our insurance incentivizes us to use the public system (which are generally viewed as as-good-if-not-better-than the private network, anyway). So she went to the nearest public hospital, a ten-minute cab ride away from our condo. I mention this because you should understand that she went to the same hospital that most Singaporeans would use in similar situations.

Whenever this issue happened in the US, we have followed a similar process. Of course, the US doesn’t have “public” and “private” systems in the same way that Singapore does. But they do have ER’s. And we did have insurance. Excellent health insurance by US standards. Whatever the hospital would wind up charging, we would co-pay something between $20 to $80 when it was all said and done. I think the cost of delivering both of our children was less than $100 in total. Which is both wonderful, and relatively rare. Most people in the US do not have a level of insurance coverage that is anywhere near as robust as what we had.

Over here, I’ve been a bit less impressed with the level of care from our family’s health insurance. While we pay less up-front for our plan (we pay 0% of the cost of the plan to the school, in NY we paid 20% withheld from my paycheck), we have paid more at point-of-care. Not much more, but more (a doctor’s appointment might cost us S$100— about $70 US). I’ve had to fight with my insurer a bit more to get some items covered. Some things have been covered for colleagues, but not for me. As far as I can tell, we have still paid less for our health needs than we did in the US, but it hasn’t seemed that way (if that makes any sense at all).

All of this is the context in which we tested the ER services of Singapore this week. Our insurance has an S$700 annual in-patient deductible for the use of public hospitals. And I had no idea what this week’s visit was going to cost until it happened. Now I know. Here’s what it looks like:

Time from Admission through to back home: 4.5 hours.

Total pre-insurance cost for all aspects of care: S$146 (US $108).

As this is under our deductible, I assume we will pay all of this cost.

To compare this to the US, here’s what an ER visit from May 2015 for the same issue looked like:

Time from Admission until back home: 12 hours.

Total pre-insurance cost for all aspects of care: US$3485

Note: Given how US insurance works, this isn’t entirely accurate. This absolutely was the billed balance but billed balances are basically a negotiating tactic used by hospitals to get adequate payment for services rendered from insurers. So this initial cost was adjusted downwards, and our insurance company only paid US$1807.05 for the ER visit. We paid a US$40 co-pay, which was our total cost as the end-user.

Look at these numbers, and try to make a cogent argument that the US healthcare system is anything worth feeling good about. What can we call a system where a small percentage of people pay almost nothing to access adequate-but-not-world-leading healthcare, while most people have to deal with significant costs (and associated debts)?

I’ll suggest the best descriptor is “broken.” Totally, maybe irrevocably, broken. And the next time anyone suggests otherwise, I invite you to simply stop listening to them. Because they either don’t know what they are talking about, or they do, and they are lying to you. Neither of which is worth your time, attention, or effort.

What do you think about the state of US healthcare? Should we burn it to the ground and start again? Maybe you burn to let me know how I’ve gotten it wrong above? Leave me a comment or drop me a line if you want to have a conversation. I do not check social media.