Today I had a week’s vacation in Colombia instead of having one mole removed
Well, not really. But I’m thinking about it.
I’m a (very) small business owner, so, like many very small business owners, affordable health insurance was something that was essentially unavailable to me until earlier this year when the Affordable Care Act was enacted. Naturally I jumped on the opportunity to get health insurance, and so after much research, thought, patience, and F5’ing of the healthcare.gov website, I was a proud owner of a shiny new health insurance plan. Great, right?
I sure thought so. One of the perks of the plan I chose was that I was allowed one free yearly physical. Since it had been many, many years since I’d had one, I thought I’d take advantage. After a quick trip to my new GP I left with a clean bill of health and a referral to a dermatologist to have a few of my moles checked. No biggie–I was willing to see a dermatologist and was happy to pay the $50 copay.
Once at the dermatologist’s office I got a professional and courteous checkup. The doctor picked out a particularly large mole on my back to be removed and biopsied. I though, “Sure, why not? I’m here, I’ve got insurance now, this is exactly what health insurance is meant to cover.” So he spent about 2 minutes (without exaggeration–I had barely turned on my stomach before he told me he was done) removing the mole, and I was on my way.
A week later they called to say that while the mole wasn’t dangerous, it was abnormal enough that they wanted me to come back and get a deeper excision. Fine, I thought, and we scheduled the procedure for a month later.
Meanwhile I got the bill from my insurance company for the dermatologist visit. It turns out the very nice and professional dermatologist wanted $700 for a checkup and the 2-minute removal and biopsy of a single mole.
In other words, a month’s rent.
Or seventy $10 meals out.
Or several month’s groceries.
Or two RCA 40-inch flat screen TVs.
Once I was finished pushing my eyes back in to their sockets, I called my insurance company to see if this was for real. And indeed it was–it turns out that even though I’m paying many hundreds of dollars a month for my insurance plan, and even though I’m a healthy, non-smoking twentysomething, my plan has a deductible of $2,000, and furthermore an out-of-pocket maximum of $5,000. That means that in any given year, I have to spend at least $5,000 plus the monthly cost of my insurance and copays before my insurance starts to completely cover the cost of my care.
Now, I knew this before I bought the plan. If I recall correctly, every reasonably-priced plan on healthcare.gov had a fairly high deductible, until you started getting into the airy realm of the gold and platinum plans that went at $500/month+ for one person. So the fact that I was to pay for some of my healthcare services wasn’t a surprise. What was a surprise was how much a visit cost.
Well I sucked it up and resolved to pay the bill. Once it was time for my deeper excision, I went in and before we started I asked what it would cost. It turns out that the deeper excision, plus a second biopsy, was ballparked at $1,200. That means that the dermatologist wanted a combined total of $1,900 to remove a single mole. Just let that number sink in for a minute.
What can you buy for $1,900? Four month’s rent in a shared apartment in Chicago. More than four month’s worth of groceries if you spend $100/week on them, which you could only do by shopping at Whole Foods every day. A 15-inch top-of-the-line Macbook. A used car. If you earn minimum wage ($8.25 in IL) and work 8 hours a day, 5 days a week, without a vacation for an entire year, $1,900 is 12% of your pre-tax earnings. More than a tenth of your earnings. That’s right, getting a mole removed would literally decimate your year’s wages.
Just a single non-cancerous mole.
I have some family living in Colombia and I try to visit now and then. Colombia has top-of-the-line doctors and hospitals, so I wanted to do the math to see if it would make financial sense to fly to Colombia, take a week’s vacation, have the mole removed there, and fly back.
On Hipmunk, the cost of a round-trip flight from Chicago O’Hare to Bogotá, bought just one week in advance, was $701.
On Hostelworld, the cost of a hostel averaged about $15 per night, for a total of $105 for a week.
Budget in $20 per day for food and drink, for $140.
The cost of the actual procedure in Bogotá is difficult to find online, but if past experience is a guide, I’d be surprised to see the same procedure for more than $300.
The ballpark cost, then? $1,246. It’s without exaggeration 34% cheaper to literally fly around the world, relax in a beautiful country for an entire week, and have the exact same routine procedure done than it is to go next door to my dermatologist in America. Even if we tripled my guess of the procedure’s cost in Bogotá, it’d still be cheaper to fly.
What a shame on our society that we’ve allowed this to become normal. We shrug it off with excuses like, “Well someone has to pay for the research,” (never mind that some studies show that pharma companies spend 19 times as much on promotion as they do on research) or, “That’s just how things are nowadays, nothing we can do.” I’ve had the fortune to have spent a lot of time traveling, and in all my travels I’ve never met a doctor who would dare charge as much as we do in America with a straight face. In France, they laughed at me when I asked how much the doctor visit cost. In Germany, it was just $30 to see the doctor without insurance, which is already less than just my insurance copay in America. My American doctor billed my insurance company $225 for walking in the door.
“Well, those countries pay for health care through taxes,” you say. And you’re right, they do! Those countries have realized that everyone benefits when the government has a hand in controlling prices of a life-or-death product, and that taxpayer money is better spent actually improving the lives the taxpayers rather than bombing brown people in strange and exotic countries or leaving third-world-warzone-level potholes unfixed.
And it doesn’t have to be this way. In Time’s great cover story, Bitter Pill, they come to the conclusion that the cost is high in part because… the cost is high. That is, they’re charging so much because they can, not because it actually costs $200 to have a simple skin biopsy done, or $500 to suture a centimeter-wide wound. The price is high in part because we accept it as so.
When I brought it up, my dermatologist commented that there are lots of people and equipment involved in something like a biopsy. That might be true—but how many people are involved in getting a plane from one part of the world to another? That industry managed to make a flight affordable even in an environment with crushing government regulation, unions, taxes, security law requirements, and external costs like the price of jet fuel. Meanwhile, a stitch costs the same as it did a hundred years ago and takes one person to apply—how can we justify a $500 price tag for a suture when for about the same price we can send a person around the world in a pinnacle of human engineering and technology?
It’s time for us to start asking the right questions: Not, “Why can’t we get everyone insured,” or “why is insurance so expensive,” but rather “why is health care itself so expensive?” After all, insurance only exists because health care is so expensive in America. Why do we accept that the removal of a centimeter of skin costs the same as a used car? Why do we think it’s OK that having a baby costs nearly $9,000? Why is it OK that an appendectomy can cost as much as $186,955? Why don’t we get up and shout No! This is outrageous and we’re not going to take it anymore! Why don’t we do anything about it? This is, in one of the most real and visceral ways possible, our very lives at stake!
Look at the rest of the world, America. It doesn’t have to be this way.
Me, I’m just going to fly to Colombia and have a mojito on the beach.