Weighing cost versus risk with no health insurance

I recently joined a group of runners in my area. We’re essentially strangers who get to know each other a little bit every Sunday as we jog through the city.

Tara Courtland

Communications Director Tara Courtland

A few weeks ago while we were running, one guy tripped and went down face-first onto the pavement. Over the next 15 minutes, it became clear that he had a broken nose, a torn-up hand and possibly a concussion. At the very least, he was too dazed to talk coherently or walk in a straight line.

It also became clear that at the age of 36, I was the Responsible Adult in the crowd. It wasn’t my age, as much as it was that I was the only one who didn’t think “let’s get him drunk!” was the proper medical treatment.

I promoted a fellow runner to Deputy Responsible Adult and we bundled the victim into the car to go to the emergency room.

And that’s when he uttered his first coherent words since he fell: “I don’t have health insurance.”

Those are five extremely terrifying words to hear when you’ve just assumed temporary responsibility for someone else’s well-being.

Fifteen years ago, most of my friends didn’t have health insurance. Who cares? You get hurt, you go to the emergency room, they treat you anyway, they send you a bill for $20,000 that you can’t pay and what happens next is so far off into the future (months and months!) that it’s akin to planning for what happens when the sun burns out.

This guy wasn’t 21 though. He was 30, had a master’s degree, was working a white collar job and was trying to be middle class. He was also new in town, didn’t have a roommate, didn’t have any friends, didn’t have any family and didn’t have anyone we could call.

Deputy Responsible Adult and I did a quick huddle and drew up the likely scenario:

We take him to the ER, they tape up his nose, bandage his hand, run a bunch of scans on his brain and observe him until they determine he is okay and send him home. He gets a bill for $10,000 if he’s lucky. He can’t pay it and either sends $200 a month to the hospital for the next four years, or declares bankruptcy, or he destroys his credit by ignoring it. At 21, he probably wouldn’t have cared. At 30, it was safe to assume that he did.

Or we take him home and hope he doesn’t die.

We ended up going with Option C – we took him to an urgent care center, where he’d probably only walk out with $200 in medical bills while someone with some medical training could at least look at him and decide whether he was $10,000 likely to die.

The urgent care doctor looked him over and told us that she couldn’t do much for him there and that we should take him to the ER for a CT scan to be sure he didn’t have a concussion. She even said that she wouldn’t charge us for the visit since she didn’t do anything; we could have them fix his nose and hand while we were in the hospital.

So we promised up and down that we would head straight to the hospital, then we walked him back out to the car. Slightly more coherent now, he said he didn’t want to go to the ER. The risk of the bills was, he thought, higher than the risk of death.

We concurred and we took him home, got his hand bandaged, ignored the nose in the hopes that it would heal on its own, put him to bed, and made him call every few hours all night to confirm he was still alive.

That was a few weeks ago and other than a slightly crooked nose, he’s fine. But I’m haunted by that moment of weighing death risk versus financial security for a near-stranger.

And more than that, I’m disheartened by the realization that with no health insurance, the proper medical treatment probably really was just “let’s get him drunk.”

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About Tara Courtland

Tara Courtland is the communications director at NEMT.
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