Nearly 45 million Americans have no health insurance, according to a recent Census Bureau report. Fortunately, I'm not among them or I would have fainted when I recently received a bill showing that I owed my local hospital $40,000 for outpatient surgery.
But I wasn't worried. I'm among the privileged -- not because of my modest income -- for the simple reason that I have health insurance linked to my former job.
The hospital knows that these charges bear no relationship to the actual costs. It also has no expectation that I'll pay the $40,000, even though someone wasted considerable time generating a three-page, single-spaced bill.
The hospital doesn't expect me to pay $930 for the first 30 minutes I spent in the surgery room, or $465 for each extra 15 minutes that followed. (When did a surgical room turn into a parking lot?) Nor does it expect me to pay $10,000 for the two hours I was in the recovery room, clearing my lungs. And I'm certain it doesn't expect me to pay $10,000 for such exotic "medical supplies" as tubes, trays, needles and sutures. (The bill, by the way, doesn't even include the surgeons' fees.)
How can I be so sure about this? For decades, I've observed that my insurance company pays about 10% of whatever a hospital charges.
In short, my health insurer, which has a contract with this hospital, probably will pay about $4,000 for this procedure, and I will pay some nominal co-payment.
So who is expected to pay such an outrageous bill? Not the very poor, who would be covered by Medi-Cal. Nor the elderly, whose surgery would be paid by Medicare.
It is ordinary working people without health insurance -- between 1% and 4% of all hospital patients -- who would be required to pay the bill in full. They are the ones who would receive increasingly threatening letters from bill collectors and whose credit rating would be ruined.
Who are they? They are the two-income families that earn too much to receive government healthcare, but not enough to pay a $40,000 bill; the single mothers who work at Wal-Mart and can't pay for the corporation's unaffordable health premium; the young, whose jobs increasingly offer no health insurance at all; and the self-employed people who can't afford costly premiums for individual health plans.
In short, low-paid employees and many members of the middle class without health insurance can no longer afford medical care today.
Out of curiosity, I called the hospital and asked what it would do if I lacked health insurance. The nice lady in the business department told me I could receive a 20% discount if I paid the bill all at once. Or I could do what one man has done: commit to sending $50 a month for 30 years to pay off a bill for his wife, who died a decade ago.
This is a snapshot of our irrational and broken medical system. If you are very poor, elderly or have employer-based health coverage, you can have surgery and not dread the day the bill arrives. But if you have no health insurance, you would be expected to pay off a $40,000 debt that could devastate your family savings or destroy plans for your children's college education or your retirement.
In fact, as Anthony Wright, executive director of Health Access California, points out, these bloated "medical bills are the leading cause of personal and family bankruptcy."
Gov. Arnold Schwarzenegger has a chance to rectify this inequitable system. SB 379, a bill that provides consumer protection for uninsured patients, has passed the state Legislature and awaits action by him. It would prohibit hospitals from overcharging uninsured patients. Instead, they would have to permit uninsured people to pay the same amount that Medi-Cal, Medicare or workers' compensation would reimburse the hospital. Healthcare wouldn't be free, but it would be fair.
If the governor signs the bill into law, California would become the first state to offer protection to uninsured or self-employed people from having to pay outrageous and unaffordable hospital bills. He could create a model that other states might follow.
Americans believe in fairness. Schwarzenegger should not squander an opportunity to save countless Californians from the fear of falling ill -- a terror nicely summed up on a popular bumper sticker: "America's healthcare plan: Don't get sick."
Ruth Rosen is professor emeritus of history at UC Davis.