Consider this true story.
A baby is born and all seems well. The baby goes home however within two weeks is back in the hospital. That hospital stay lasts for an entire year and sadly the infant passes away. During that year the child receives highly specialized care in an attempt to save his life.
The insurer is billed $6,700,000 for the hospital stay (what someone without health insurance would pay), the actual payment because of pre-negotiated discounts and other arrangements is $1,600,000.
This case occurred within an employer self-insured plan and had a direct and measurable impact on plan costs for the year and on the premiums charged via payroll deduction for all plan participants. This case, while unusual, is not so rare as to not impact health insurance premiums on a regular basis. You simply cannot predict such claims.
I know nothing of the specific circumstances of the illness, I do know that if I were the parent, I would want every possible thing done to save my child (provided there was hope for a relatively normal life), but is that what society wants or can afford? It is these situations (and others somewhat less dramatic) that will have to be addressed as we go forward with real health care reform. It is this type of case that in other countries is assessed for the relative value of providing such care. It is under these circumstances that critics fear rationing will be enacted. This was an infant, but what if it were a 70-year-old or a 45-year-old, would our conclusions be the same?
So, does cost ever override care? Does society want to and it is able to write a blank check for all health care? And most important, what caused this care as extensive as it may be to cost nearly two million dollars?
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