Required Reading: "Lessons of a $618,616 Death"

Rather than discuss this at length, I'd like to use this Friday to just present Business Week's cover article titled "Lessons of a $618,616 Death" by Amanda Bennett. It's a personal story, and to me with its simplicity and candor stacks up with the best non-fiction short stories. The article's straightforward questioning of health care reminds me of the best of Atul Gawande. Its breakdown of the facts and figures of the charges, bills, and insurance coverage strikes me as the best anecdotal analysis I've seen of where our health care system currently stands.


  1. Terence used to tell a story, almost certainly apocryphal, about his Uncle Bob. Climbing aboard a landing craft before the invasion of Normandy, Bob's sergeant was said to have told the men that by the end of the day, 9 out of 10 of them would be dead. Said Bob: "Each one of us looked around and felt so sorry for those other nine poor sonsabitches."

  2. I've seen similar stories to this - I know of one cancer patient whose bills totaled to more than $300K, yet they only paid the $100 copay for their initial visit to the oncologist. I have no clue how much their insurance paid, but I can't imagine it being more than UHC's 80%.

    The thing I took away from this "article" (aside from a wonderfully told story/character sketch) is just how far away we are from any form of health care reform. Believing that Obama will be able to bring reform is akin to believing that I have 36 toes (note to the world: I don't have 36 toes). This is such a complex and robust beast that I can't imagine seeing/feeling any tangible benefits of reform for another 5+ years. We can only hope that he instills some intestinal fortitude to Congress (and the masses) to sit down and truly attack this mess.

    We also owe a great bit of gratitude and indebtedness to Ms. Bennett and others who open their lives to us to shine a brighter light on the current situation.

  3. I appreciated this article because it felt like the first time I read anything about health insurance that was not arguing a point one way or another. Her statement of facts and analysis of numbers was informative and refreshing.

    My new questions:
    1) How can hospitals afford to simply absorb costs like that? I'm guessing they can't, which is why we hear all the horror stories.
    2) How does one insurer negotiate a different rate with the hospital than another insurer. Does insurer A have more patients so they negotiate a lower per patient rate? How did this system come into place that even allows such a disparity between insurance payments. Has this been going on for many decades just a few dollars at a time?
    3) Based on this, I would think that there are at least some hospitals in favor of nationalized health care. They can probably charge their average rate for a procedure (or maybe slightly higher) knowing that the government will always pick up its share. I am very curious to see what parts of the medical industry are in favor or against nationalized health care. Are doctors and insurance companies against, while hospitals and medical equipment companies in favor?

  4. 2) Correct - insurance companies with larger patient lists can negotiate lower rates since a Hospital wants to be able to provide care to as many patients as possible. Conversely, insurers want to agree to terms/rates with as many hospitals as possible so as to advertise that they have the largest network, thereby giving them more leverage against the hospitals.

    Often times, rates an insurer imposes will differ across hospitals w/in its own network due to the leverage any given hospital may possess. It's a fun game of poker with both sides trying to get as much as they can without being called on any bluffs...