How to Survive the U.S. Healthcare System

I ventured into the heart of healthcare industry darkness and lived to tell the tale. What follows is my story.

ACT I

June 14, 2014

Marry someone much more talented than you, with significantly higher earning potential and access to high-quality health insurance.

September 4, 2020

Reach middle age.

January 1, 2022

Tell yourself: My family’s pretty dang healthy. We survived a global infectious disease pandemic FFS! We should try a high-deductible health plan (HDHP) and reduce our monthly health insurance premiums.

Sign up for HDHP, which includes a market-knows-all regressive tax scam for wealthy people called a Health Savings Account (HSA).

Like Silicon Valley Bank, you take a conservative approach to your HSA portfolio and buy a nice, safe bond ETF. This way, when the Federal Reserve finally wakes up, your bond ETF will lose fifteen percent of its principal value.

February 4, 2023

Reenact the opening set piece of RRR at the trampoline gym.

Unknowingly shred the meniscus in your right knee.

Limp around for a week and wait for the miraculous Wolverine-esque recovery that never arrives.

February 13, 2023

Hit the climbing gym. You just need to loosen up your muscles on the exercise bike, right? Exacerbate your injury, rendering yourself unable to walk.

Have your dejected wife drive you to a walk-in clinic/orthopedic surgery/sports medicine facility. Explain to the sports medicine doc how you injured your knee at the trampoline gym behaving like a complete maniac.

Get X-rays.

The sports medicine doc examines your knee and investigates your X-rays.

She has good and bad news.

The good news is you don’t have any broken bones, and your old man legs are in remarkably good condition. Since you’re still limping around like an undead, however, the bad news is one of your ligaments is unquestionably FUBAR.

The sports medicine doc says you need an MRI.

Provider bills: $884.00

Insurance covers: $315.23

Out-of-pocket cost: $568.77

ACT II

February 13, 2023

Your loving yet disappointed wife calls your insurance company and compiles a list of MRI facilities. Neither she, nor you, nor the people at the insurance company, nor any of the providers you call can figure out if your coverage will be in or out of network.

You contemplate the meaninglessness of existence while following the Kafkaesque set of directions provided by your sports medicine doc to schedule an MRI.

Call the closest hospital not affiliated with your sports medicine doc but hypothetically in your insurance network. The soonest available appointment is ten days from now.

“Am I supposed to limp around until then?” you ask, like a petulant child.

“Sorry,” the scheduling coordinator says.

You say you’ll call back.

Call the next provider. No answer.

Call the next provider. No answer.

Call a faraway hospital affiliated with your sports medicine doc and hypothetically in your insurance network. The soonest available appointment is eleven days from now. Jesus tits.

You say you’ll call back.

Call back the closest hospital not affiliated with your sports medicine doc but hypothetically in your insurance network. You ask if other facilities affiliated with this hospital but not affiliated with your sports medicine doc have earlier appointments. The soonest available appointment is in two days and it’s hypothetically in your insurance network.

Book it.

February 15, 2023

Limp fifteen minutes to the hospital’s MRI facility and check in. The care specialist asks for your MRI order. You hand her the after-visit summary from your sports medicine doc.

“That’s not an order,” she says.

“That’s all I have,” you say.

“That’s not an order,” she says.

“Well, that’s all I have,” you say.

For posterity she condescendingly reprimands you once more for not having the requisite paperwork, then asks for the name of your recommending provider. You tell her. She manually adds your sports medicine doc’s information to their database and says she’ll call and have them fax over the order.

“Fax?” you say.

“Just so you know, you’ve got a large balance projected,” she says.

“Am I in network?”

“Wait over there. If we don’t receive the order within thirty minutes you’ll have to reschedule.”

You wait thirty minutes and have to reschedule.

You limp home.

February 16, 2023

Call back the faraway hospital affiliated with your sports medicine doc andhypothetically in your insurance network. The soonest available appointment is thirteen days from now and your estimate is more expensive.

You wish you’d died honorably on the Eurasian steppe in the thirteenth century.

You confirm the appointment.

February 20, 2023

The closest hospital not affiliated with your sports medicine doc buthypothetically in your insurance network texts to say your MRI order is confirmed and you can reschedule your appointment.

Because you’re now clinically insane, you call back.

The estimate is cheaper and they can schedule you two days sooner than the faraway hospital affiliated with your sports medicine doc andhypothetically in your insurance network.

You confirm this appointment and cancel the other.

February 28, 2023

You limp back to the closest hospital not affiliated with your sports medicine doc — which previously sent you packing — and check in without incident.

You remove your clothes and put on an unfashionable hospital gown.

The medical technician excitedly confirms you’re a Virgo and deposits you inside the MRI machine. The hulking contraption makes an earsplitting sound — like a mashup of a jackhammer and a shot clock violation. You fall asleep inside because your children aren’t present.

Provider bills: $2,500.00

Insurance covers: $1,278.42

Out-of-pocket cost: $1,221.58

March 2, 2023

Your sports medicine doc reviews your MRI and says your meniscus died ingloriously at the trampoline gym while executing a tombstone pile-driver on your son.

“Complex, bucket-handle tear” is the official diagnosis. Because of the nature of the damage it won’t heal on its own. You’ll almost certainly need surgery. Your sport medicine doc’s not a surgeon, however, so you’ll need a new provider.

You’re not surprised, and you accept your fate, and you ask if she has any recommendations.

She enthusiastically refers two surgeons affiliated with her practice andhypothetically in your insurance network (though you should call to confirm).

“They’re the team doctors for the Chicago Bears,” she says. “They’re top-notch.”

You’re impressed, and oddly excited, and — well-acquainted with the Bears’ penchant for destroying the knees of its most gifted employees — certain you’ll be in good hands.

Provider bills: $278.00

Insurance covers: $35.31

Out-of-pocket cost: $242.69

March 7, 2023

Meet with legendary Bears surgeon. Surgeons do surgery so he recommends surgery as soon as possible.

He reviews the two possible outcomes and what to expect in the aftermath.

If your meniscus is reparable, you’ll wear a leg brace and “pirate around” for a month, then rehab for five more. You’ll need crutches, an ice machine, an in-home device that constantly moves your leg, and Job’s patience. You won’t ride a bike until Memorial Day and you won’t climb bouldering walls until Halloween — if ever.

If your meniscus is shot, he’ll excise the damaged tissue, you’ll walk the next day, and be back to normal within a month.

You wonder why he’d even bother with repair and he says you really need that meniscus to avoid downstream complications like early onset arthritis.

You tell him you’ve got little kids at home and the recovery timeline for a repair would be particularly disruptive.

“We’re gonna repair it if we can,” he says. You nod. Then he says you can be in surgery the following week, but you’ll need to get a physical first. Time is money, so they’ll schedule your appointment with the utmost haste.

You drive home wondering if you’ll be fortunate enough to die during surgery.

Provider bills: $505.00

Insurance covers: $183.85

Out-of-pocket cost: $321.15

March 9, 2023

You undergo a half-assed, box-checking, CYA-mandated physical. The doctor doesn’t even fondle your genitals or penetrate your orifices.

You feel ripped off.

Provider bills: $200.00

Insurance covers: $26.97

Out-of-pocket cost: $173.03

March 13, 2023

You get an email from the hospital not affiliated with your sports medicine doc but hypothetically in your insurance network saying you didn’t pay for your MRI.

You most certainly did pay $1,480.96 with your HSA debit card, so you call.

The customer service person confirms they received the payment but didn’t “process” it. She acknowledges you’ve been over-billed by $415.36 and issues a refund.

You’re happy for a fleeting moment, until you realize future services will blow through your deductible and you won’t end up “saving” any money.

You think of Chef. 

He just wanted some mangoes.

He just wanted to learn to cook.

March 15, 2023

The surgery center calls to confirm your arrival time at 7:15 a.m. the following morning. You have a Dostoyevsky-esque list of directions to follow, which includes not eating or drinking anything for eight hours before surgery.

Your estimated cost is $2,060.00.

A medical device/equipment company calls to arrange a delivery time for all the post-repair goodies you’ll need. You explain you’re not yet sure if they’re going to repair or remove your meniscus, but you’re fairly confident your meniscus is washed so you’re hedging your bets.

The sales rep is adamant you need all the equipment they sell, insisting your surgeon is “scary” and “very demanding” and you must have these items — in particular your leg brace — at your disposal immediately following surgery.

You ask about billing and reimbursement for all this equipment and the rep doesn’t know but she says, “Everything should be covered by insurance — except the ice machine rental.”

You clench your teeth and ask how much the ice machine rental will cost and she says $478.00 and you think: Surely humanity can do better than this.

You capitulate and say you’ll sort it out later. The rep wants to arrange delivery at your home but it’s too late in the day and the medical device/equipment company’s understaffed because nobody wants to work anymore. Thanks, Biden.

They’ll have to drop everything off at the surgery center tomorrow instead and somebody will have to be there to accept it.

You’re positive none of this makes sense, and you’ll be busy having surgery tomorrow, so your regretful wife will have to be there on your behalf.

You think of Major Major Major Major.

You agree to the terms.

Provider bills: Ungodly amount TBD

Insurance covers: Pitiful amount TBD

Out-of-pocket cost: You should reach your deductible soon right? TBD

ACT III

March 16, 2023

You take an Uber downtown to the independent, non-affiliated surgery center and pitch your Substack newsletter to the driver. He jots down the URL but never subscribes.

At the check-in counter you realize masks aren’t required in this medical facility despite its constant stream of bodies and open wounds. You remove yours. The pandemic is truly over.

The nurse checks you in and tells you the bill is $1,215.00. You say that’s lower than expected and make a joke about price transparency not being a strength of the healthcare system.

“Nobody knows how anything works,” she says.

A separate nurse takes you to a bathroom/changing room/locker room where you strip down to your underwear and put on a hairnet, gripper socks, and an open-backed hospital gown. You wonder: Will I die wearing this?

The nurse guides you to your waiting station and places you in a comfy chair with a warm blanket.

A separate nurse hooks you up to an IV (your first ever), another shaves all the hair off your knee, then the IV nurse spends fifteen minutes blowing through paperwork regarding the two possible outcomes — repair or removal. She reminds you you’ll be totally sedated during the procedure and discusses post-op pain management and medications.

The former organic chemist in you wants to know what’s in the sedation cocktail and the nurse says propofol and fentanyl. You think of Michael Jackson and she makes an unprompted Michael Jackson joke about “sleeping a little too well” and five minutes later “Billie Jean” plays on the hospital radio. You’re certain either a) you will die imminently or b) you reside in a simulation.

The nurse leaves you with paperwork to sign and absurdity to contemplate. You think: We’re at war with Eurasia, therefore we’ve always been at war with Eurasia.

The anesthesiologist swings by to say hello. She’s friendly and rushed — with mesmerizing grayish green eyes above her mask — and assures you she nudges people to the precipice of death multiple times per day and there’s nothing to worry about at all sign here.

You sign.

The nurse returns and is alarmed to see you actually reading the paperwork. You hurry up and sign and wonder if you’ll really need synthetic heroin for post-op pain management and ask if you can avoid prescription opioids altogether.

She advises you to take the drugs because the pain can be “severe.”

You think about the trenches at Verdun and the poor devils who had limbs amputated with hacksaws while being gagged with chloroform rags and figure you can tolerate some mild discomfort following an assembly line surgery with phenomenally accurate and precise tools. You tell her you’ll endeavor to suck it up.

The nurse pushes narcotics harder than Avon Barksdale, however, so you let it go and say you’ll fill the prescription.

She leaves and you sit with your thoughts for half an hour. You wonder if euthanasia wouldn’t be both more humane and cost effective.

You overhear the same nurse prepping the girl next to you for surgery. She’s in her early twenties and this is her second arthroscopic knee surgery.

You feel sad.

Your wife shows up with the head nurse, who laments some cock up with the medical supply drop off. He says he doesn’t know why the sales rep was so fixated on delivering the equipment here, considering they have an entire supply room and on-site reps. You laugh it off and he says your wife can stay a few minutes.

She looks concerned. She’s saddened she married you but also doesn’t want you to die because then she’d be saddled with your awful children. She kisses you goodbye and lugs the equipment home.

After another half hour an ethnically ambiguous surgeon materializes and says, “Hey what’s good my man?” and fist bumps you and you look at him quizzically and he says “Which leg are we operating on?” and you say “Right” and he says “Are you sure?” and you arch your brow and he says “Oh sorry I mixed you up with somebody else you look really familiar my bad!”

He moseys over two stalls and repeats the same shtick to a different patient with a thick Middle Eastern-ish accent.

Another half hour passes and you wonder if leaving people alone for this long without a smartphone should be classified as a war crime by The Hague.

The opioid-pushing nurse tells you it’s almost go time.

Another half hour passes and your surgeon shows up and asks “Which leg are we doing?" and you say "Right” and he says “Good answer.” He reminds you of the gametime decision aspect of the surgery and says if you have a brace on your leg when you wake up it’ll have been a repair.

He says it’s almost go time and departs. You overhear him and another surgeon chatting. You can’t quite make out the details of what they’re saying but based on their tone and a few errant words you’re certain they’re complaining about hospital management.

Another half hour passes and it’s finally, actually go time.

You limp into the surgery room and it’s very cold and suddenly it’s all a blur.

You lay down on the operating table and the head nurse adjusts your leg multiple times and the anesthesiologist fiddles with your IV and another surgeon straps down your opposite arm and you can’t help but laugh out loud at the ridiculousness of it all and the anesthesiologist says you’re in the “pit stop” phase of the process and the sedative will burn but happens fast and then you feel it burning and you say “That does burn” and she says “Sorry!” and you say “No problem” and she puts an oxygen mask over your mouth and tells you to take deep breaths and somebody says “Lights out” and— 

You wake in an unfamiliar room and look down and there’s no brace on your right knee. You’re relieved. The assistant surgeon confirms your meniscus was removed because the tissue had turned into imitation crab meat. He says the only thing you have to worry about now is having a knee replacement at sixty instead of sixty-five.

“Well, if I was born in eleven hundred A.D. I’d be dead already,” you say.

He laughs.

You dress yourself in a daze and hobble out of the surgery area.

Your wife is conflicted by your continued existence because your corpse is worth $500,000.00 but she stupidly loves you and wants your awful children to have a father — even one as ineffective as you.

The nurse wheels you down to the lobby and your wife drives you home to eat Grape Nuts.

An hour later the medical device/equipment company swings by to collect the equipment you told them you wouldn’t need. You’ll have to call customer service to get the $478.00 charge for the ice machine rental reversed.

Provider bills: $19,628.00

Insurance covers: $19,158.99

Out-of-pocket cost: $469.01 [deductible reached]

Final tally: You surpass your $3,000.00 in-network, out-of-pocket, individual deductible, but still get billed $3,586.24 in total.

You’ll never figure out why.

DENOUEMENT

March 17, 2023

You can walk and your leg can bear full weight and the miracle of modern medicine has restored you to almost proper function in less than a day.

You call the hapless medical device/equipment company and claw back your $478.00.

You don’t take the opioids because men were men once goddammit and you were born out of time and your life should’ve involved hacking and slashing and stabbing and bludgeoning other savages with melee weapons on gorgeous green grassy battlefields long before “The Enlightenment.”

You hug your awful kids and kiss your depressed wife and feel immense gratitude.

Your family fended off the financial terrorism of the U.S. healthcare industrial complex.

Your family navigated the byzantine processes and absorbed the exorbitant costs.

When you looked at your bills online you didn’t need to click the links that said “Can’t pay all at once?” or “Need a loan?” or “We offer financial assistance.”

Your job and your livelihood weren’t at stake.

You didn’t need healthy legs to stock shelves at the grocery store, or to operate heavy equipment on a construction site, or to load trucks in a distribution center, or to drive a delivery truck, or to stand all day in a classroom or kitchen.

You didn’t incur debilitating medical debt or lose your home.

You have zero co-morbidities and for forty-two years have been damn near indestructible.

You don’t take these things for granted.

Finally, you internalize the most important lesson of all: stay away from the goddamned trampoline gym.