The reason I pursued PA school pertained to a loved one’s cancer diagnosis. During the trials and tribulations of the diagnosis and treatment, I learned a lot about our health care system. I witnessed the work of phenomenal PAs as they took care of my loved one, which inspired me to pursue my degree as a PA. During this time, I also promised myself that I would do my best as a clinician, one day, to educate my patients about the options they had when overseeing their own health care.
As my loved one was diagnosed, they realized that they did not have the appropriate coverage that would be needed to get them the care that they needed. This was because they did not understand that certain parts of Medicare only cover emergency medical treatment and that different parts of Medicare would be needed to cover the rest of the treatments needed. After being assessed by a multi-disciplinary team and requiring emergent surgery, my loved one realized that they needed Medicare Part B to cover the rest of the necessary surgeries and treatment. As a result, I spent long hours in the social security office and in the financial office working to obtain emergency access as my loved one underwent the surgery they needed.
After receiving the care they needed, we received the large sums of medical costs, which would be impossible to pay off without a payment plan through the hospital. Treating two forms of lung cancer entailed a pneumonectomy followed by chemotherapy and radiation. In Europe, this type of care came with costs acknowledged from the start, but in the United States, the only cost we knew pertained to how much it would be to get the tumor sequenced to determine the type of chemotherapy needed. This cost was $8,000 without including the doctor’s bills and appointment coverage for each treatment. With an additional diagnosis of COPD, inhalers were necessary, which would require an additional insurance plan to be purchased. As a result, an additional bill was tacked onto the monthly payments, but this time to cover Medicare part D for pharmaceutical coverage. Even with the insurance coverage, the inhaler costs were 430 dollars per month.
Living off a social security check and paying substantial prices for health care costs made me realize that there was a massive flaw in the health care system. In Europe and countries such as Australia, prices were more reasonable and publicly communicated, whereas in the U.S., one never knows what to expect after going to the doctor. With the constant fluctuations in prices per service, there is also a disconnect between the insurance companies, labs, and providers. As a result, some people opt not to go to the doctor to avoid any unexpected costs. Others may choose to have emergency health care coverage and hope that they don’t have any medical conditions arise that may require more coverage to be affordable.
I believe that platforms such as those created by Jeanne Pinder, which provide transparency, can help people seek medical care where it is most affordable. Rather than going to the $130 laboratory, thanks to Jeanne Pinder, patients may be able to undergo testing at a different lab, which can save them substantially in costs. As a future PA, I will always keep in mind the costs of tests and determine if they are essential to provide the best quality of care. There are many options when treating patients, and as Dr. Gawande states, “Sometimes the most expensive care is not the best care.”
My goal is to educate patients and have discussions with my patients regarding the process of obtaining the most affordable insurance coverage they need to provide them with the care that they need in this system.
Michelle Detka is a physician assistant student.
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