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The Honolulu Advertiser
Posted on: Sunday, March 14, 2010

Health scare


By Jim Kelly

Hawaii news photo - The Honolulu Advertiser
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Hawaii news photo - The Honolulu Advertiser

Salim Hasham

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Last July 15, I suffered a seizure at work and crashed to the floor with what I can only assume was an impressive thud.

Ambulance, emergency room, hospital admission. Lots of tests. It all worked out, full recovery.

I'm fortunate because I received excellent care, and especially fortunate because I had insurance.

The experience enabled me to get a peek into the specifics of this whole health care crisis thing, which, I'm ashamed to say, I had almost completely tuned out months before because of the ear-splitting political noise.

I wasn't poor, I had insurance, I had a job. In a blissful world of $5 co-pays, I didn't have much skin in the health care showdown.

And that's the thing when you're talking billions and trillions. They're like light years and radioactive half-lifes, too huge and abstract for our puny brains to process.

So then along came a number I had no trouble processing: $32,915.44. It was the total charge for four days at Hawaii Medical Center last July.

I was astonished.

I thought I had a ballpark idea of what a hospital stay cost ... maybe 12 grand? Fifteen?

Since when does four days in a hospital cost $32,000?

The room alone was $2,500 a day. Four hours in the emergency room $3,476 (doctor not included she billed separately for her services). A brain MRI $3,700?

$32,000? As hospital stays go, this one wasn't even especially dramatic. No surgery, no E.R. drama, no exotic medications, no experimental treatments. I lay in bed until my fever waned and the experts concluded I didn't have any tumors, heart disease, brain swelling, epilepsy, hepatitis, swine flu or AIDS.

It's still a mystery, but as several specialists have pointed out to me, real life isn't like "House." People get sick all the time for reasons that science never discovers and once you've recovered, the doctors move on.

So they sent me home and the bills from doctors, labs and even the ambulance ($679.45) started showing up. Summerlin took care of most of it, including the monster bill from the hospital.

As the bills piled up on the kitchen table I suddenly understood how a hospital stay, even a brief one, could bankrupt a family without insurance.

"This is really the heart of the health care issue," said Salim Hasham, chief operations and restructuring officer of Hawaii Medical Center, which is itself restructuring itself through bankruptcy. A health care executive with 30 years of experience around the world, Hasham said he and his colleagues on the "delivery" end of the system are united in their belief that requiring everyone to have insurance is a non-negotiable piece of any health care system overhaul.

With an estimated 30 million Americans walking around without insurance, Hasham said we're all subsidizing the uninsured anyway with $32,000 hospital bills and double-digit increases in premiums.

"The only way to do this is to mandate coverage of everyone so that not one person goes into bankruptcy because of some catastrophic illness," he said. "It's the only way."

As for the hospitals, they are weighed down by the massive cost of the infrastructure and overhead, including the training and salaries of personnel, acquisition of complex equipment and maintenance of emergency rooms that must treat anyone who walks in the door. That's how a $5 box of swabs from Longs becomes a $35 item at a hospital.

And that's part of the reason the U.S. ends up spending 17 percent of its gross domestic product on health care, while European nations are spending around 10 percent and insuring everyone.

Even Hawai'i's celebrated Prepaid Health Care Act has some gaping holes. The law requires employers to provide the employee's insurance, but not their family's. Unrelenting financial pressure has led some companies to refuse to offer family coverage, and most people I know can't afford a $1,000-a-month premium to cover Mom and the kids.

And then there's the 20-hour cutoff. Work less than that on an average week and the boss doesn't have to cover you.

If you get laid off, COBRA is nice but it still costs a family big money, even with the federal government now chipping in.

How many people are just rolling the dice, praying they stay healthy?

I asked Hasham what would have happened if I hadn't been covered that day I was brought into the emergency room. What about that $32,000 bill?

"We'd work out a payment plan," he said. "At the end of the day our job is to take care of people, make sure they get well, that's purely our focus."

But he added, "At the same time we have to make sure we're financially viable." (Translation: collection agency.)

I don't know how financially viable I'd be with payments on a $32,000 hospital bill weighing me down for the next decade. Maybe I'd declare bankruptcy and leave HMC and the doctors and the labs and the ambulance holding the bag, figuring they could absorb the losses better than I could.

And that's kind of the problem with the whole health care deal, everyone expecting someone else to pay.

So I've bought into one argument in this debate, thanks to my $32,000 bill and my conversation with Salim Hasham.

Call it anti-American or pro-socialist or unconstitutional but everyone needs to have health insurance. You shouldn't get stuck paying my bill.