Why is the US healthcare system so dysfunctional?
My first kidney stone
I love the US. Its people, diversity, attractions, and standard of living are amazing in many metro areas. But the US also has deep problems that many other countries have surmounted.
American friends who have lived overseas, particularly in Europe and Latin America, understand this dichotomy. Aside from social isolation, homelessness, and other cultural problems that may not find a short-term fix, one of the worst problems the US needs to "catch up" with, is Healthcare affordability.
The most excruciating pain I've ever felt
I had kidney stones right after I moved to Raleigh in 2015. No insurance, no car, no nothing at the time.
I literally had just woke up one morning, with excruciating pain. It felt like a spike piercing my abdomen. It wouldn't stop.
I called a friend who had a car who took me to the nearest hospital. Let's call it CountyMed Hospital in Raleigh.
The 30-minute drive to the hospital was pretty painful. I was crumpled up in a ball on the back seat of my friend’s car, almost fainting.
I've been told by female friends who have had both a baby and a stone, that the stone is worse. I wouldn't know.
Healthcare admission process
Upon arrival at the Emergency lobby, I had to register while enduring the pain and then was asked to wait to be called.
They had me endure hell for 45 minutes until I was admitted. My personal information was requested three times by different people and entered into the system repeatedly. This process lasted 30 horrible minutes more.
They had me sit through a CT scan, and 20 minutes later gave me an anti-inflammatory serum. I was told then that they had found an 11mm kidney stone. I was then taken to a room for 2 more hours and asked to relieve my bladder until I was better. I was let go three hours later.
The staff was friendly, the hospital is nice, and the whole infrastructure was ok. But the waiting process was terrible. I was scared my kidney would burst right then and there.
Medical Bills
CountyMed's Bill was ~$8.5K. Post-event consultation from urologist: $500 more. Before leaving, I was asked if I had insurance. As a transplant, I had none.
I was enrolled in a payment plan with their financial aid department since I wouldn't be able to cover those costs. Waiving fees was an option (only the hospital and CT scan fees, not the doctor's), but for that, I had to provide mountains of evidence.
The staff suggested I pay at least some nominal amount, so I could show goodwill. Otherwise, the system could send a collector after me. Thankfully, the process was approved after 5 months. A story for another time.
Getting treatment
After the above consultation, I was told I needed to get ultrasound lithotripsy done. I was told that for the CountyMed system in Raleigh, a lithotripsy van would need to be called in.
I would be admitted to the hospital, the van would park in their parking lot, I would be taken outside and into the van, get a 45min session done (with no assurance of kidney stone fragmentation), and then readmitted to the hospital for recovery. Optimistic estimates for that whole experience would amount to $35K according to Reddit and former patients, plus hospital expenses.
Alternative options
Being Ecuadorian, I decided to travel to Guayaquil. My family was able to get ahold of the city’s best urologist to handle my lithotripsy there, get all-inclusive treatment with brand new equipment, spend time with my family for a week, and fly back.
The experience was seamless. The doctor explained everything, made sure I was taken care of.
I was admitted to the hospital and moved to the lithotripsy area right away. The doctor handled the 2-hour lithotripsy himself with echography. I had a CT scan after surgery to double-check stone fragmentation, and I got my prescription and drugs for recovery that same day.
The whole thing was $5K, including travel.
Just today, an American woman lamented that she couldn’t afford a medical emergency in Tokyo. It turned out her bill turned out to be $33. This is not an isolated problem.
How can this be improved?
Quite frankly, I don't know. I'm not a healthcare management specialist. But what I can know is this:
Healthcare in the US is much more expensive than anywhere else, although it’s one of the countries with the highest healthcare expenditure per capita.
The standardization of healthcare quality worldwide is positive since it would allow for proper treatment elsewhere. Medical tourism, for example, is a booming industry in countries like Brazil, Thailand, Malaysia, and Mexico.
Moreover, EHR interoperability and telemedicine are also opening doors for global healthcare options. My hope is for this market to grow exponentially.
Personally, I'd like to see a shift in global healthcare competitiveness that forces US affordability, so future kidney stone patients won't have to travel thousands of miles to get affordable treatment.
