I will NOT get into the grisly details of my new knee. For some reason many folks that is polite conversation. Oy. Ick. But this looks like an opportunity to pass along some insights into the US health care economy. The surgery is only a couple of hours and an overnight stay in the hospital, but a lot gets wrapped around that, and so do a lot of bills.

Today’s the day I went to the hospital to schedule the operation. They booked an hour to schedule the two-hour operation, which seemed odd. I suspected bureaucracy and insurance concerns. We scheduled over thirty appointments over the next five or six months, and that’s assuming everything works out well. OK. Gotta do, so am gonna do.

It’s really all my fault. I used my knee. No accident. No illness. No genetic abnormality. It was just decades of running, hiking, snowshoeing, skiing, dancing, karate – and yes, maybe a bone-head maneuver forty years ago. No one knows. I knew I was using my body, but I figured that was what it was there for. I’m not much of a spectator. I do rather than watch. I recall deciding that I’d rather have bad knees and a healthy heart than good news and an unhealthy heart. (See my books for examples.)

I have arthritis, but the doc said the cause was over-use. Guilty! So now my right knee is bone-on-bone, the cushioning layer is gone. I probably could’ve caught it earlier, but health care is expensive when you have nothing coming in.

We did try gel injections, so after today’s appointment I paid the bill. It was in the low $2,000s. Insurance covered more, I was told. When I got home I checked the paperwork. The gel injections cost over $11,000 without insurance or Medicare. Gulp. 

First, do no harm should include financial harm to me and the system.

I noticed a couple of things in the meeting today. There was no discussion of my condition. Good or not, how I felt was not an issue. There was also no discussion of the total cost or the cost to me. I’m on Medicare, but I’m frugal enough that I want to know what someone is going to get charged. There’s a money mill here, somewhere. I’m glad I’m not paying the majority, but I suspect I’m somehow going to be charged for it in a general sense.

The good news is that everyone I am working with seems competent. Thank you.

The system, however, is convoluted and contorted.

The surgery is two hours-ish and an overnight stay, just in case of…

There’s a pre-op meeting and a post-op meeting.

There’s an MRI so they know what shape the new part must be.

There’s another specialist or two, which I just nodded my head at.

There’s a couple of take home kits. 

And there are lots of physical therapy sessions.

I counted thirty appointments scheduled, and just an hour ago realized that the surgery was not on the list. Gotta call them about that.

I’m guessing each visit is far more than $1,000. We’re talking big bucks. Fortunately, I can afford it, I think.

But if it’s got to be done and I can do it I will get it done.

By the way, I also got some conflicting advice. One said I’d be walking up and down steps the first day. I was also advised to have someone take care of me for the first week. My house has four or five steps. Inside, it is all one level and I have a chair on rollers. I think I can do this.

I think I can do this, but despite the meetings, lessons, phone calls, and appointments, we’re talking about a human body, a thing that wasn’t built or maintained to spec. I know they plan for the middle of the bell curve, but I’m 95% in height and weight (or was), and various other health-related events have proved to me that I’m not wired like everyone else. (Dentists don’t believe me the first time, and learn after the Novocaine has to be applied again. The scream usually helps convince them.)

Blah. Blah. Blah. So the world is imperfect. That’s also why I go ahead despite the obvious inefficiencies and non-health-care related financial incentives to various organizations.

I am also doing this because I already sometimes need a cane. If it was going to get better on its own, which I hoped was the case for too long, then I’d let that do that. But one bone is digging into another bone, and that will just keep getting worse. Fixing it now will probably be cheaper than paying for accommodations for decades.

The side benefits will be the visual benefits. Folks will (hopefully) see me walking and dancing more and better. Those are easier motivations to talk about, but the less obvious benefits will be the more important.

I should have done this years ago, but years ago I couldn’t afford the financial price. Years ago, this possibly could have been fixed with simpler and cheaper measures. But we don’t get health care when we need it; we get it when we can afford it, even if it ends up costing far more.

Ironically, I tried one of the cheaper methods, but it didn’t work. Bone-on-bone is too tough. That was that >$11,000 bill, for the cheaper method. I’m the one who said yes. I asked for the price, but thought I heard ~$2000. Maybe after I get my knee fixed I’ll get my ears examined.