Neck Surgery

Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting. . . . In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindal, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6200. (Mr. Drier had to pay $3000 of that to meet his deductible [the amount his insurance requires him to pay out of pocket].) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill.

“I thought I understood the risks,” Mr. Drier, who lives in New York City, said later. “But this was just so wrong—I had no choice and no negotiating power.” (Rosenthal, 2014a)

The most basic element in any nation’s health care system is how it provides and pays for health care. As Peter’s story illustrates, however, the United States is the only more developed nation that does not guarantee affordable health care to its citizens. Nor, despite this chapter’s title, does it really have a health care system. In- stead, an agglomeration of public and private health care insurers (such as Medicaid and Aetna), health care providers (such as doctors and physical therapists), and health care settings (such as hospitals and nursing homes) function autonomously in myriad and often-competing ways.

In this chapter, we first look at the origins of the U.S. health insurance sys- tem. We then analyze two current crises in U.S. health care: rising costs and lack of access. Finally, we explore the nature and the impact of the health care reforms passed in 2010.