Medical bill horror stories: M&M for the rest of us
Remember book reports? When I was a kid, I had one go-to topic for school assignments, and I honestly couldn’t tell you why: the Rwandan genocide. I must’ve been around ten the first time I read German writer Hanna Jensen’s Over a Thousand Hills I Walk With You, a fictionalized account of the war from a young girl’s point of view, as told to her adoptive mother — and based on the experiences of Jensen’s own adopted daughter, Jeanne. The book wasn’t assigned reading, and I don’t have a clue how I came across it, but from grades five through nine, I probably read it a dozen times. What was it about this book and its subject that I kept returning to? I’m sure it was beautifully written, but short of reading it again, what I remember is feeling drawn in to a world entirely different from mine, and horrified and confused at the cruelty on the page.
Maybe I gravitated to the book as a way of avoiding the more obvious genocide in my family, the one we didn’t talk about. Growing up, I vaguely knew that my grandparents had “escaped” the Holocaust. I also knew, without anyone having to tell me, that it wasn’t an appropriate topic at the dinner table. Rwanda however, like the Cold War and the periodic table of elements, was a topic removed enough from our lives that it could be an appropriate subject of conversation.
Though I didn’t realize it at the time, one possible word for my interest was “morbid.” The Oxford English Dictionary (remember gold standards?) defines morbid in two ways: The first: “ Causing disease; characteristic of, indicative of, or produced by disease; of the nature of disease; of or relating to disease.” The second: “Of a person, mental state, etc.: characterized by excessive gloom or apprehension, or (in later use) by an unhealthy preoccupation with disease, death, or other disturbing subject; given to unwholesome brooding.”* Both definitions relate to disease, the first directly, and the second more metaphorically. You can argue that a 10-year-old with an unhealthy preoccupation with any issue like genocide is certainly morbid, though I do take offense at the idea that brooding on death, disease, any any other most human of subjects is anything but wholesome. Isn’t mortality what makes us wholesomely human? But for conventional purposes, it’s true: my unusual interest was a morbid one.
These days, I don’t have many book reports to turn in, but I do have a new morbid interest: I can’t stop reading about medical bills.
You know the stories I’m talking about, and maybe you’ve read a few of them yourself. Sarah Kliff at Vox has an entire series on ER bills, where so far she and her team have covered: An $18,000 nap and bottle of formula; a $5,571 triage before leaving to avoid a pricey ER bill; $10,000 for rabies post-exposure prophylaxis; $937 for a tiny amount of ointment on a tiny toe; $12,000 for the inability to self-diagnose a “true” emergency; and $7,924 for out-of-network jaw surgery after making sure the ED is in-network after an assault.
Kaiser Health News wants you to send them your medical bill if it’s “exorbitant, baffling, infuriating or all of the above.” So far, in collaboration with the NPR Shots blog, they’ve told the stories of the $56,000 air ambulance ride; the $92,000 gender reassignment surgery that was supposed to cost $20,000; the $17,850 urine test; toenail fungus cream for $1,500; and most famously, the $109,000 heart attack.
While Vox, KHN and NPR are the current reigning champions of this new genre I’ll call the medical bill horror story, numerous other outlets like ProPublica, the New York Times and local newspapers are also publishing important exposés.
So what is it about these stories? What keeps me almost hungrily clicking the link to when I see a new story on my Twitter feed? These can’t possibly be warning stories, since the only imaginable warning is “stay away from American healthcare,” and I can’t endorse that. No, the message seems to be something more along the lines of “No one is immune.” It doesn’t matter how hard you try to stay in-network, or if you leave the ED before being seen; it doesn’t even matter if you’re the person who used to set the prices in the first place, you are not immune.
The medical bill horror story genre is a morbid one. The rush that we get from reading these stories comes from knowing that we dodged a bullet — it so easily could’ve been us. The epidemic of exorbitant medical bills is a disease on society, and reading about it is a morbid experience. These stories have become a public forum for our fascination with this disease, and in doing so, have taken on the role of a public morbidity and mortality conference (M&M).
Now, if you were part of the half of America watching Grey’s Anatomy back in 2006, you probably remember the clip below from the third season, and therefore know what M&M is:
In the clip, Chief of Surgery Dr. Webber reminds the blood-thirsty audience that “our purpose here is not to place blame. This is a forum to discuss mistakes in patient care and learn from them.” Although the content of this M&M is a tad implausible (remember that time Izzy cut Denny’s LVAD wire back when Grey’s Anatomy was a show that everyone watched?), its stated purpose is shockingly accurate.
The best part of my surgery rotation was undoubtedly the weekly M&M. Not because we brought candy and expected a show like the Seattle-Grace interns, but because it was a chance to sit back, listen to a story, and hear how surgeons thought. Yes, the chief resident presenting the cases might be asked some pointed questions about what happened, and some attendings might use the meeting as their personal grandstand, but it never felt malignant. In a similar way, the medical bill genre puts the morbidity of our health system on public display, for all to comment and account. A 2005 article in the AMA Journal of Ethics by Dr. Vincent Liu reviewed the historical role of the M&M conference, as well as its importance as an educational tool to prevent medical errors.* Medical bill narratives turn the spotlight not only on billing practices in individual institutions, but also on the shady business practices of American healthcare that have been allowed to flourish for too long.
And there’s good news — this public M&M is working. For many individuals who share their medical bill with an outlet like Vox or KHN, there’s the extremely satisfying but wholly unscalable happy ending where their exorbitant charges suddenly disappear when an investigative journalist calls the hospital. More importantly, these projects have spurred more sustainable legislative change, both at the state and federal levels.
Protection from surprise medical bills is a start, but there’s certainly a lot of work to be done before people trust the healthcare system not to inflict financial harm. Hopefully, the medical bill horror story genre won’t be around to feed our morbid inclinations much longer.
Medical bill horror stories: M&M for the rest of us
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