Inefficiency
Categories: Health policy, Economic Systems
Tags: Excuse me. I do not know that.
Lawana Hughes didn't like the sound of her son's cough.
It wasn't going away, and the single mom thought a trip to Kaiser was in order, just to have 2-year-old Marcus checked out.
The routine doctor's office visit was anything but.
With a stethoscope to the toddler's chest, the doctor heard something more than a bad cough. Marcus' heart didn't sound right.
At a cardiologist's office a few weeks later, Hughes watched the specialist closely as he examined her son. And then she started getting scared.
"Why is he listening to him for so long?" Hughes remembers thinking. "It seemed like 30 minutes."
The next day, the doctor called.
"Your son has a hole in his heart," he told Hughes.
The diagnosis in August confirmed that Marcus had a hole in the upper left chamber of his heart. The right side was doing the heavy lifting to compensate.
As scary as the diagnosis was, the Alameda resident also worried about supporting her son and 15-year-old daughter during the required surgery and two-month recovery.
A FedEx sorter for 11 years, Hughes needed to take time off, and while her job would be secure, the absence would be unpaid.
"I had rent to pay," she said, and she had already used her vacation for the year and had essentially no savings.
"It was hard for me to just go ask someone, 'Hey, can you help me pay my rent?' "
But at Echo Housing in Hayward, Hughes found that help.
There Shelia Brunson, a direct services specialist, advised Hughes of her short-term options, including state disability assistance and other resources. But in the meantime, the Season of Sharing fund bridged the gap by paying her rent.
"It's a good story because she's a hardworking person, she's a single mom," Brunson said, adding that Hughes was overwhelmed by the help.
Brunson said Hughes went to Toys for Tots so she could provide Christmas gifts for her children, but ultimately left empty-handed.
"She said she felt there were people there who were way worse off than she is, so she didn't take anything," Brunson said.
On Nov. 16, just after his third birthday, Marcus was wheeled into a UCSF operating room for the nearly five-hour surgery.
The procedure involved rerouting veins and placing a Gore-Tex patch over the hole, Hughes said.
Now, a month later, Marcus is a typical, happy toddler, save the scar running from his belly to his collarbone.
Health benefits covered by her employer paid all but $500 of the $100,000 surgery, Hughes said, adding that she plans to return to work in January.
"Who prepares for this?" she said of the experience. "You never know what can happen until you're in that position."
About the fund
Donations to The Chronicle's Season of Sharing fund help thousands of people in the Bay Area throughout the year. Assistance is in the form of grants paid directly to the supplier, such as a landlord. Individuals cannot receive direct grants. For more information, visit www.seasonofsharing.org.
Which is a fine inspiring story and shows just how private charity can fill in the gaps in our somewhat tattered social safety net.
But the story also points just how far we are from a real free market economy.
First government interventions: Thanks to the Family and Medical Leave Act Ms. Hughes employer was forced to keep her job open and to pay for her medical benefits during an extended leave of absence. Disability insurance helped to support her during this leave. Both of these programs increase labor costs and lower stockholder value, not to mention restricting the freedom of businesses to act strategically. They also create opportunities for malingering and decrease incentives to work.
This seems not to have happened in Ms. Hughes case since she has held the same job for 11 years but it may be the start of a downward spiral.
Second Cadillac health insurance plans. It is clear that Ms Hughes has one of those since she is taking her child to the doctor for little things like persistent coughs when she might have postponed treatment and waited until her son's condition had become real emergency. Then she got $100,000 worth of surgery from a major medical center for only $500.
Any decent plan would have charged at least $75 for the initial visit and required her to pay at least $10,000 deductible before insurance kicked in.
No shopping around or comparing prices. No going on the web for information. Just listen to your doctor
Clearly shareholders and healthy people everywhere would benefit if folks like Ms. Hughes were forced to bear more of the costs that their ill health impose on society.
Comments