Our health care system is broken.

One would think that it would be an easy fix. Every other industrialized nation has figured it out. The trick is that the solution is hard for us to swallow. We keep thinking that there must be an even better way.

David Roth

David Roth

It amazes me that in our country your trusted family doctor doesn’t have say over which treatments you get. Your insurance company does. And, when it comes to medical issues, your insurance often determines your future, both medically and financially.

About a month ago, I was in so much pain after leaving a meeting that I finally decided my only option was to go to the emergency room. I had been to my own doctor already. I don’t go to the hospital very often, so I just went to where I have always gone. Luckily, I thought, I checked to see whether the hospital accepted my insurance. Both the hospital website and my insurance website indicated my insurance is accepted there. For many people, though, it wouldn’t occur to them to check ahead of time. Unfortunately, I wasn’t as lucky as I assumed. After my visit, I learned that only certain departments accept my coverage.

After I got situated in an exam space, a nice administrative person came to do my intake. They took my insurance card and scanned it. This would have been an opportune time to indicate that the hospital emergency room was not an in-network provider for my insurance and that if I wanted to have my insurance pay the costs, I should drive two blocks to the other hospital.

While I waited to be taken for a CT scan, in my mind I started thinking about where I was at with my deductible to try to get a feel for what this would cost me. To make a long story short, the pain subsided and after a few tests and a few hours, I left with no more answers than when I got there. (Side note: The issue has since been diagnosed.)

I did everything I was supposed to, and no one told me differently, so imagine my surprise when I discovered the ER at that hospital is not an in-network provider. Even though I have met my deductible and max out of pocket, that few hours in the emergency room is going to set me back about $7,000.

I don’t know about you, but for me, that is a pretty large unexpected expense. What makes it worse is that I did everything right. I have a job. I have insurance. I work hard. I take care of my family. But because I turned one direction instead of another, I now owe a medical bill amounting to nearly 20% of my annual take-home pay.

This is why we need real health care reform. When individuals do everything they are supposed to and still end up buried in medical debt that indicates our system is flawed. It is time for legislators to start looking for solutions.

David Roth is the Legislative District 33 vice chair for the Bonneville County Democratic Central Committee.

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