The total cost of the rabies vaccines for Chelsi’s son was more than $4,000. Because their family is a … [+]
Last year my friend Chelsi took her family to Tennessee for a summer vacation. While her 8-year-old son was in the hot tub, he curiously scooped up what he thought was a frog floating in the water, but immediately dropped it in alarm when he realized it was a small, live bat. It all happened so quickly that her son wasn’t sure if the bat had bitten him or just pecked his hand as he flew away.
A week later, back home in Alabama, he developed fever, chills, body aches, headache, sore throat, nausea and vomiting – all symptoms that could indicate rabies. Knowing that rabies is one of the deadliest infectious diseases, his parents panicked. They took him to the emergency room, where he received the first round of rabies immunoglobulin and his first rabies vaccine, in accordance with Centers for Disease Control and Prevention recommendations. Because rabies is relatively rare in the United States, Americans do not routinely receive this vaccination. However, a full course of treatment also includes completing the vaccination schedule, which consists of three additional injections over the next few weeks.
After their visit to the ER, Chelsi called almost all the pediatricians in her area, but discovered that none had the rabies vaccine. This was not surprising, given the rarity of the disease today. She was told that only the health department would receive the vaccine if she chose not to return to the ER. Each additional vaccine at the health department would cost $400, bringing the total cost for this potential rabies case to more than $4,000, including the first emergency room visit. And because their family had high-deductible health insurance, most of this bill fell on their shoulders.
We’ll never know if it was rabies; the symptoms of early infection are so common that they are indistinguishable from the everyday viral infections that children get every few months. This situation precisely illustrates the difficulty of healthcare decision making; it could be an infection with a mortality rate of almost 100%, or it could be nothing. There was no time to be lost if it had been the former; the sooner you receive treatment, the greater your chance of survival.
Our healthcare system has been marketed to us as one in which patients can be considered “consumers” and can “shop” among the many options available. Chelsi’s experience is just one example where this analogy doesn’t work. The typical consumer is one who can carefully compare options for predictable purchases, whether curtains or a car. The Oxford Dictionary of Economics defines a consumer as “an individual who purchases goods and services for personal satisfaction, exercising free choice in a marketplace where preferences, tastes, and resources determine demand.”
Did Chelsi have a “free choice” when her son’s life was at stake? I guess she could have rolled the dice with her child’s life, but it’s hard to imagine any parent choosing not to save their child, no matter the cost. Furthermore, it may not even be legal for a parent to delay or deny her child this life-saving treatment. If a parent had taken this opportunity and their child developed increasingly worse symptoms, it would not only be too late for treatment, but could theoretically put a parent at risk of being charged with child neglect.
When considering whether patients can truly be consumers with free choice, it is essential to recognize that Americans are unique in the industrialized world when it comes to making healthcare decisions. These decisions are inherently agonizing in themselves, but are compounded by the uncertainty of what will and will not be covered by insurance.
In the end, the real horror wasn’t the bat; it is our healthcare system that forces us to decide whether we can afford to save our own lives. This chilling truth will persist well past Halloween and will continue to haunt Americans all year long until we change the system.