I Have the Blues

On Monday of this week, a friend who scours the local Sunday paper sent me an article by email.  I read the title: "The Puzzling High Cost of Delivering a Baby."  For a few seconds I thought, well, okay, someone else has written on the same subject that I had submitted to the paper the preceding week!  Great, I'm not alone!  But when I touched the screen and started to read I saw that what she emailed me was the story that I had sent in.  It was in print already and I was excited to get a personal response so quickly. 

(Most recent post is here.)

Anyway, a few days later I went back to the York Hospital to look again at the old medical artifacts by the library where I had spotted the small bill for the delivery.  As I drove up I noticed the prominent “Valet Parking” sign.  It made me think that I was pulling up to a four-star hotel.  Maybe my room will have a view, maybe the food will be spectacular...No, that's just to make it easier for patients and families, I know.  There was no such welcoming sign 33 years ago when I arrived here from Baltimore.  

As I peered into the display case again I noticed a huge round ashtray.  They were once ubiquitous around the hospital, even seen in patients' rooms.   Maybe the “Valet Parking” sign, a somewhat jarring sign (to me) of our excesses will one day be relegated to the status of such an artifact. Perhaps in 2022?  Or maybe 2030? Or maybe even 2018!

I saw that the graduating nurses in the carefully-arranged black-and-white photo were all women.  The ratio of women to men in nursing was 12.7 to 1 in Pennsylvania in 2015 according to "Becker's Hospital Review."  The situation with regard to physicians years ago was, of course, the exact reverse.  In fact, I found only two women physicians in the official photo of the entire medical staff of 1983.  Now?  

Overall, the percentage of physicians who are male is 65% according to a Medscape report of 2016. But women represented 46% of U.S. graduating physicians in 2015.  So, in 1984 there were only two women doctors here, and almost no male nurses.  The change over three decades is striking.  It sometimes takes a long time to see the full story.  You need to stick around, and you need to pay attention.  Maybe the looking back causes us to wince when we see where we are now.  It takes time to get used to new ideas.  Sometimes we get stuck when “we like what we have.”  Sometimes it's better to change.  Sometimes it hurts to care about the world enough to try to improve it.  

My sister-in-law noted that our parents never talked about healthcare costs.  Why didn't they? The idea of health insurance started at the turn of the last century.  In Pennsylvania Blue Cross was a non-profit enterprise run by the Commonwealth.  In the 1930's membership in a Blue Cross plan was practically a civic duty.  Boy Scouts handed out enrollment procedures and preachers urged all members of their congregation to enroll.  

The Blue Cross and Blue Shield plans formed as not-for-profits to give communities access to medical care and protect against financial ruin. All members paid the same amount no matter how old or sick, and no one was turned away. The Blues became one of the trusted brands in America" (Sarah Varney, NPR Morning Edition, March 18, 2010).  In fact, the original Blue Cross of Pennsylvania Insurance started as a charitable mission.  It was affordable for nearly everyone. You went to the hospital and showed them your card, and all was well.  But when the commercial insurance industry took over and the profit motive took precedence over the welfare of the patient things changed.  

And that is how my parents could afford to have four children in the 1950s and not worry about becoming bankrupt and to even allow themselves the dream of sending us to college.  I can imagine my father smoking, with the cigarette dangling precariously from the corner of his mouth, waiting for the next mouth to feed and not being in the least concerned about the hospital bill, only that we were were healthy.  

Maybe the original Blues had the right idea.  Maybe some old things are worth looking at again (but not cigarettes). 

(Click here for the most recent story about one of our York, PA doctors.)

York Hospital and Dispensary Bill For Delivery in 1922

A week ago I was leaving the hospital by way of the old original entrance.  I was a visitor, not a patient.  I had several surgeries there for cancer, and since my daughter was adopted I had not had the experience of the delivery room and the faded crinkled 3" x 6" bill in the historical display case caught my eye.  I was not expecting to be stopped by a slip of paper since I had gone to the hospital on a mission and I was focused on that.

I was there as a collector of colored plastic disks.  My niece, an anesthesiologist in Los Angeles, wondered why the brightly colored caps from the injectibles used in the OR were discarded.  Could they serve another purpose? she thought.  So she created "TheArtOperation.com."  The caps from the vials of medication that were used to put people to "sleep" (actually into a light coma, she corrected me) and then brought back to awareness could do service as art objects.  They could be saved and given to children and even established artists to inspire them to create something of beauty (or whimsy).  But as I carried the bag of these reminders of surgery back to my car I reflected on the simple hospital bill and the stories I've heard about the high cost and the anxiety of carrying and delivering a baby, and I was disturbed.


The carefully-itemized typed and then the hand-annotated bill was for a total of $49.75! Yes, $49.75.  The bill was transparent.  
There were no cryptic billing codes (one for this, another for that, and one for who knows what), only English words and a few straightforward numbers. (The only expense not on the bill might be for the daily two-cent newspaper.)  As I said, I've listened to women's stories and I wondered what today's deliveries cost and how they are billed and how they are paid for, and how this affects the birth experience.

So I googled.  In the US the average total price charged now for pregnancy and newborn care is about $30,000 for a vaginal delivery and $50,000 for a C-section, with insurers paying out an average of $18,329 and $27,866, according to a recent report by Truven Health Analytics.

And the bill itself?  A long list of sometimes carefully-itemized charges including those for the use of the delivery room itself, the recovery room if there's been a C-section, the mother's room and board before and after delivery, the nursery, the anesthesia or epidural charge and the separate anesthesiologist's fee, the specialized neonatal nursing care, the physician's obstetrical bill, the pediatric fee, the lab, medication costs, the imaging and then the radiologist's fee, and the routine hearing screening, among others.  We have come to expect something like this.  

But that might not be all.  We might be shocked to see a charge of $39.35 for a quick "skin-to-skin" baby-to-mother contact after a C-section that was on an actual bill posted on the Internet by a confused but still grateful new father from Utah (as reported by Vox on 10/4/16). And there may be other mysterious charges.

But when you finally receive the bills the fun begins.  What does your insurance "allow" and what is the deductible? And is there now another deductible, one for the new family member?  And what does "copay" really mean?  And is anyone responsible for the full "price" as listed, and if not, what meaning does "price" have?  And will there be a denial of coverage because you didn't tell your insurance agent (if you can get them on the phone) that you were headed to the hospital ahead of schedule?  And what if the on-call doctor covering for your own doctor isn't in the network?  And then the bills come from different zip codes and from unrecognizable billing services.  Can you still find the "Queen of Hearts" in this Three-Card Monte?  What's a woman to do?

It is likely that as she is blindsided by this confusing financial and book-keeping burden her vitally-important oxytocin levels begin to wane and her potentially-damaging cortisol levels creep up.  Is this the right way, the just way, to usher in a new life?  Is this the way to honor new parents?  I believe we deserve something better.

HAPPY MOTHERS' DAY