I need to say out loud that this is going to be mildly political, so you’ve been warned. Sorry. Trust me, it is relevant to the content domain of the channel, but it takes me a while to get there. So hold on to the end. I also want to say that I’m more than happy to have a deeper conversation around these topics. I have an opinion, I don’t have all the answers. But I also don’t think I need to have a solution in order to call out a problem.
Last night I went to the ER. While I was still sitting in the observation room, with a gown on, and hooked up to a bunch of machines. Someone came in and asked me for the $350 copay for the visit.
Mind you, they didn’t do anything besides check me out, and monitor my vitals for a bit, I’d already fixed the problem myself with a dose of Claritin. Apparently, I am allergic to Trilyte.
Normally, that would just be another messed up thing that I would keep to myself, but given recent events. I thought it might be useful to share some thoughts around it because – and this is important – I have lived outside the US two times in my life. Once, just for a few months. The other time, for several years. As someone who has experienced healthcare here in the US, and outside the US, I might have some helpful perspective on the different models.
Both of the other countries had an NHS, or single-payer / “socialized medicine” system, like most of the developed world. Both times, I had to use the medical system. Both times, I didn’t have to pay for it. I didn’t have to worry about anyone coming into the room, while still getting monitored, and asking for money.
That’s not to say that these systems are perfect. They absolutely are not. I didn’t live in Taiwan long enough to have more than one trip to the ER, so only one sample and beyond the fact that I needed urgent care, and I got urgent care, and didn’t have to worry about financial ruin – I don’t know much about how the system works more broadly there.
I did live in the UK long enough to have experience with a wide surface area of the healthcare system- both public and private. Again, very imperfect, but I never had to worry about whether going to the ER was going to generate a massive bill. Any of the times I went in. I didn’t have to worry about whether I could go to the doctor for routine care either. We had a local GP, I scheduled appointments, and for the most part it worked just as well as how the situation here works for me, because we can afford great insurance.
If you’ve been here long enough, you know that I am getting great use out of our medical insurance. Because of that, we pay for the best insurance we can get. It’s bonkers expensive, but unfortunately, it has proven to be worth it. Without it, I would have racked up hundreds of thousands of dollars in medical expenses over the last 3 years. I’m not complaining about my experience with the US healthcare system. I am fortunate that we can afford great medical care. I am fortunate that we can afford the thousands of dollars of out-of-pocket medical expenses incurred every year because I’m a middle-aged idiot.
My experience, and it feels smug to say it like this, is an example of the system working the way we like to think it always does. But it doesn’t work like that for way too many people in the US. As a society, the indifference we exhibit towards those who can’t afford great health insurance is terrible.
I believe that the level of indifference many of the for-profit entities in our system exhibit is a form of violence.
I think violence towards others is wrong. It’s wrong when a random person takes it upon themself to execute another person, regardless of how that person’s indifference and lack of empathy impacts others. It’s also wrong when a group of people cause the death and suffering of others so they can own a yacht. We can embrace a complicated world, and hold both of those ideas in our heads at the same time. Both are wrong. Neither should happen, ever.
So what does this have to do with bikes? Well, as I managed to prove a few months ago, a moment of inattention going 12 mph can have a big financial impact. Riding bikes is a great way to improve your healthspan, your mental health, and a whole bunch of other things, but it’s not without risk. The simple answer is you shouldn’t have to have great insurance to ride bikes. I don’t know what I would have done if we didn’t have great insurance when I broke my hip. I spent 4 days/3 nights in the hospital in September. I got Wolverine level hardware in my left hip now. It cost me ~$3,000 out of pocket. Much of my life, that would have been “oh shit what am I going to do” money.
I don’t know how many commas are the number my insurance paid out; I do know that it was significantly less than I would have paid if I didn’t have insurance. I didn’t run the numbers this time, I did when I broke my collarbone. The insurance paid out 40-45% of what the different providers charged them, and it was still a huge number.
We can do better.