After a Soccer Injury: Reflections on Health Care, Cost and Communication

Last week, my family had a health care emergency, reminding me of how lucky I am to have good insurance.

My eleven-year-old son landed in the emergency room after a fall during a soccer game. His humerus broke, x-rays showed, and the surgeon told me he needed to realign the bone fragment under general anesthesia. He would then insert pins in his arm to hold the broken bone in the correct position while it healed.

By that evening, my son had been admitted to the hospital. He had a successful surgery the following day. A full medical team surrounded my son’s gurney as they wheeled him away, including two orthopedic surgeons (Ka-Ching), an anesthesiologist and two nurse anesthesiologists, among others (Ka-Ching, Ka-Ching, Ka-Ching). The surgery was a success, the orthopedic specialist told me afterward. My son then spent a good part of Thursday in a recovery area, attended by nurses who were kind and thoughtful.    

Last week, all I could think about was my son’s health. But with the crisis behind us, I found myself trying to fathom how I would have had the financial wherewithal to absorb the thousands or tens of thousands of dollars in medical bills that his care would have cost, instead of our $250 co-payment. The experience also prompted a few reflections on medical costs and coordination of care – issues more easily contemplated from a safe distance than from the emergency room. 

Medical Bankruptcy: In the run-up to the Affordable Care Act, much ink was spilled examining the burden of medical debt for Americans (which accounted for 62 percent of bankruptcies in 2007 according to an oft-cited but controversial 2009 study in the American Journal of Medicine). Looking ahead to gauge Americans’ experiences post-health reform, Harvard’s Alison Galbraith, MD, MPH, found it instructive to explore the experiences of families who earned too much to qualify for subsidies in the Massachusetts Commonwealth Health Insurance Connector Authority, the early model for Obamacare. She found “high levels of financial burden and higher-than-expected costs” among families with many children and those with incomes below 400 percent of the federal poverty level (in 2014, that’s $95,400 for a family of four, and the federal cutoff point for subsidy eligibility). Many Americans do not realize that even with health coverage, health crises can still carry stiff, unanticipated costs, especially for those on bronze plans. It’s an issue that’s ripe for good reporting. “Those with lower incomes, increased health care needs, and more children will be at particular risk after they obtain coverage through exchanges in 2014,” Galbraith wrote.

The Promise of Electronic Medical Records: Electronic Medical Records are supposed to help everyone to communicate with each other. In my son’s case, electronic medical records allowed for a proper diagnosis by a remote orthopedic specialist. An attentive x-ray technician also used the EMR system to correct an error by a pediatrician, who had jotted down incorrectly that it was his right arm that was injured. But EMRs also can serve as a communications short cut that leaves the patient out of the loop. After my son’s x-rays, we returned to the pediatrician’s office to be met by a nurse. She instructed us to leave right away and walk over to an orthopedics center more than a block away. I asked for a sling for my son, who was in pain. That would require a doctor’s order, she said ominously, implying a long wait. “They are waiting for you now in orthopedics.” As we trudged down a busy L.A. thoroughfare, crowded with foot traffic, my son winced in pain, clutching his arm. I had assumed he had a hairline fracture, but I was starting to wonder. When we arrived at the orthopedics building, a nurse hurried out of the clinic. “You have to go to the emergency room right away,” she said. “Was it serious?” I mouthed, hoping my son would not see. “Probably,” she replied. We still had no diagnosis. But this time, the nurse ushered us to a shuttle service, which whisked us to the emergency room. Still without information, I decided that my son must have a terrible, incurable disease. It was with some relief that I learned, many hours later, that he required surgery for a broken arm. I was even more relieved when the surgeon took out an old-fashioned ballpoint pen and scribbled his initials on my son’s left arm, signaling that it was the correct limb for the surgery.