DOUBLE BIND

Cartman and the Cost of Health Insurance

The ‘South Park’ character says appetizers are ‘what you eat before you eat to make you more hungry.’ Health insurance is a little like that. But you can’t live on appetizers.

03.09.17 8:05 PM ET

Hospital and provider bills are the inevitable epilogue of all health disasters. It’s like surviving a plane crash and being handed a bill by the captain and airlines for helping you survive. Like walking out of a burning building and having to pay the firemen and the water bill.

I got sick like so many others do. I got through the worst of the crisis like most would hope. But it was right then, as the adrenaline of crisis wore off, that the bills started trickling in. Bills and explanation of benefit forms became a regular feature of our mail amid all the other envelopes containing solicitations and get-well cards.

Welcome back to the world. Get well. Here’s a bill. Get well. Here’s a bill. Here’s a bill.

Health care isn’t free. But the alternative is death or prolonged sickness.

Doctors saved my life. I don’t fault them for charging money for providing care that they studied long and hard to provide. Or hospitals for providing equipment and staff and beds and linens. There’s no easy solution to the cost of healthcare—our country is embroiled in that debate right now.

When I got sick, I was lucky, because I had health insurance coverage.

I paid $500 a month to make sure I had coverage under such a disaster scenario. A stroke is pretty much a disaster scenario.

I was in the hospital for five days. I decided to go to the hospital because that is what one does when sick. I decided to go to the hospital, because I wasn’t thinking about the bills I’d receive. When the fire department sees a fire, they don’t think about whether the person has paid their water bills or taxes. They put the damn fire out. They don’t let the building burn down while they make sure the owner or the people inside the building have done their due diligence.

Health insurance is like eating appetizers—appetizers are, to quote Eric Cartman of South Park, “what you eat before you eat to make you more hungry”—you pay someone to make sure you don’t have to pay as much later.

But without coverage—there are no appetizers. And there is no guarantee of a main course, either. Your fate is starvation. Your house will burn. There are no firefighters.

Sometimes you pay, and health insurance doesn’t cover costs. Sometimes you cannot eat and do not eat because of poverty or lack of access. And because you cannot pay, you then pay some more.

The health insurance companies always make money.

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The health insurance companies are on a quest to cut down on fraudulent billing.

All for profit.

Our health is at the hands of profit machines.

But if you keep people healthier—costs decrease.

And yet we are dependent on health insurance to mitigate costs—or at the very least, to spread out cost so that we are not hit with disastrous debt. The bill for my five-day stay in the DCU stroke unit was $57,748.44. This bill did not include tests and laboratory work. It was just for the stay. After reimbursements and adjustments by health insurance, I paid $754.80 out of pocket. Health insurance saved my life, too.

Or did it?

They cherry pick who they insure.

The doctors cherry pick insurance.

In the end—the people who have the best care and the best coverage are the healthiest people.            

I’m no longer one of those people. I now have a pre-existing condition.

This is to say that if I’m ever in a burning building, I’ll get a volunteer fireman from the next town over.       

Also, the premiums for the company’s health insurance rose the year following my stroke. I happened to be the HR director for the small company at which I worked. So I asked our broker why. In oblique terms. he said it was because the pool became higher risk. In starker terms—it was because someone had gotten sick and so the insurance company was now recouping costs.

I remember holding an auction for a friend, who was not so lucky. She had Hodgkins’s Lymphoma. That was very unlucky. And she did not have health insurance coverage. Even unluckier. She had a graduate degree. She had just lost a job. She couldn’t afford to pay for COBRA. She had been a college instructor. She’d paid her taxes. She was in no violation of law.

About twenty artists and I offered up what we could to raise money for J’s medical bills. Some of us auctioned the opportunity for manuscript feedback. Others offered to name a character in an upcoming book for the winning bidder. There were signed books for auction, too. And personalized art pieces.

I forget what we, several handfuls of writers and artists, raised. I believe the total came out to less than $20,000.

It did not cover the full cost of her care. It did offset some. We all knew that our mission was not to cover all her costs—but to do the best we could. We knew the bills were too astronomical for a bunch of artists to auction and earn.

Part of recovery involves a type of depression. A mourning for the person we once were. The opportunities lost, before we see any opportunities gained. Bills play into that cycle, unfortunately—reminding us of what happened, and reminding us, if we are disabled, of our inability to earn the money to pay bills. It’s awful. When the bills are insurmountable due to lack of health coverage, recovery is even more complicated.

My friend was touched. She survived cancer. Part of her recovery was a mountain of debt, the cost for saving her life.

Christine Hyung-Oak Lee is a writer who lives in Berkeley, California. Born in New York City, Christine earned her undergraduate degree at UC Berkeley and her MFA at Mills College. Her short fiction and essays have appeared in The New York Times and on Buzzfeed and The Rumpus, among other publications. She has been awarded a Hedgebrook residency, and her writing has been nominated for a Pushcart Prize.  Her memoir, Tell Me Everything You Don’t Remember, will be published by Ecco on February 14, 2017.