Saturday, March 06, 2010

The cost of dying

Hello world. Sorry I've been so quiet; balancing apartment-buying (eeek) and work is brain-and-time consuming. The real-estate adventure has yielded a ton of blog material, but I feel like I need to sit on a fair bit of it until the closing contracts are actually signed and stuff can't suddenly go awry -- which it has been on a fairly regular schedule. So I'm stockpiling material and planning lots of updates in a month ...

Meanwhile, I wanted to drop in a link to one of the best magazines pieces I've read in years: "Lessons of a $618,616 Death," this week's BusinessWeek cover story. (The cover itself is also breathtaking, with its fade-to-white line "The End of Life." The whole package is a wonderful reminder of the unique ways design and writing can fuse together in print.)

Health care is a topic I frequently come back to in this blog. I can't think of any financial decision more urgent -- what wouldn't you pay when you life is at stake? I also can't think of any financial system more utterly broken in this country. You think the housing market got irrational during the last decade years? It's nothing compared to health-care spending.

Amanda Bennett and her reporting colleague, Charles Babcock, do an astonishing job illustrating both the micro- and macro-economic issues of our current health system. The story's eye-grabbing headline number, $618,616, is what it cost for a seven-year fight against the kidney cancer that in 2007 killed Bennett's husband, Terence Bryan Foley -- "father of our two teenagers, a Chinese historian who earned his PhD in his sixties, a man who played more than 15 musical instruments and spoke six languages, a San Francisco cable car conductor and sports photographer, an expert on dairy cattle and swine nutrition, film noir, and Dixieland jazz."

It's a vast number -- not to corporations and Fortune 500 CEOs, but to those of us who budget carefully each month to pull together rent or mortgage checks. "I think had he known the costs, Terence would have objected to spending an amount equivalent to the cost of vaccine for nearly a quarter million children in developing countries," Bennett writes. "That's how he would have thought about it."

It's a number with almost no basis in tangible costs. The list price on one chest scan was $3,232. Medicare pays less than $300 for that scan. UnitedHealthcare pays almost $2,600. Empire BlueCross pays $775. What does it actually cost? "The documents revealed an economic system in which the sellers don't set the prices and the buyers don't know what they are," Bennett reports. "Prices bear little relation to demand or how well goods and services work."

Was one life worth this investment? Bennett does a deft job illustrating how fraught and unanswerable that question is. "Who did the paying? The health insurance system depends on healthy people bearing the cost for sick ones like Terence," she writes. "Should you have had a voice in Terence's final days? Would I make the same decision with my money for your loved ones? These are things I think about now but can't answer."

And yet. The intensive medical intervention -- at a six-figure expense -- bought Terence some statistically improbable extra time. I'll leave it to Bennett to describe what those extra months meant to her family -- stop reading this, go read her article.

I have my own version of the story, which almost certainly colors my health-care views. My mother was diagnosed with cancer when I was 14, and died of it when I was 16. I'm almost 32 now, which means I've lived nearly as many years without her as I had with her -- but there still isn't a day I don't feel how strongly how who she was affects who I am (hi, pitch-black sense of humor and perfectionistic streak! Also, the financial geekery. I like reading SEC filings. There's no way that's not genetically influenced by my bookkeeper mom -- it's downright unnatural.) And four years ago, I spent most of a week haunting the ER and waiting rooms at our local hospital. It was a medical problem with a lingering aftermath, and a fresh reminder -- not that I needed one -- of how essential good health is to having a life you enjoy living. And how financially fraught trying to safeguard it can be.

Fixing our health-care system is a bogglingly complex undertaking. There's a thousand ways changes can go wrong, and just as many ways for those with vested financial interests to hijack improvement efforts. But there's also a giant cost to leaving things as they are. And even for those like me, like Bennett -- with top-quality health insurance and the financial resources to navigate the labyrinth -- it's a badly broken system.

We can't afford to maintain the status quo.