When my best friend visited me from Israel in the summer of 2006, her daughter — the same age as my younger daughter, Sammi — was recovering from an ear infection. Like Sammi, my friend’s daughter had been through a lot of ear infections that year, and my friend had been traveling with a small bottle of ear infection medication just in case. When they left after a week at my house, I found the bottle had been left behind.

I panicked. I started emailing, sending messages through Yahoo Messenger, calling her temporary US cell phone. I couldn’t reach her for two days, and I imagined her in a panic, desperately searching for the bottle of medication. When I finally did get in touch with her, she was already home.

“Do you want me to ship it back to you?” I asked. “I don’t know how much express shipping to Israel is, but I know how miserable these infections can be. How is she?”

“Nah,” she said. “It’s just an antibiotic. I’ll get more if she gets another infection. You can throw it out.”

“Seriously!?” I answered. “But just the whole hassle of going and getting another prescription…do you know for sure it wouldn’t be cheaper to send it to you?”

“What? No, it’s no big deal,” she responded. “It’s just a quick visit down the street, and the meds are, like…ten shekel?”

I did the calculation to dollars — about two dollars.

“Right, but the visit to the doctor,” I pressed. “How much every time?”

“Nothing,” she answered. “Nothing, it’s free. Wait, how much does it cost you?”

In 2006, I had quit my job to stay home with Sammi, who was always sick. With my husband’s health insurance, I had determined that an ear infection for Sammi — and by her first birthday, she’d had ten of them — cost us between $45 and $105. My friend was horrified.

“How!?” she asked. “They charge so much for antibiotics?”

I broke it down for her. At the first sign of an ear infection for Sammi, I would call the doctor on call in the practice. Almost none of them trusted me that she really had an infection; all required us to come in for a visit. Just walking in the door of the office meant a $35 co-pay, assuming it was a weekday. On the weekends, during “emergency” hours, they added an additional $25 surcharge to the co-pay, making it an even $60 just to be seen. If the doctor could see an active infection, then the medication cost only $10 for an 8 day supply.

So, if it was a weekday and they saw an infection right away, the cost was:

$35 (visit)
+
$10 (meds)
__________
$45 total cost of ear infection

If it was the weekend and they saw an infection right away, then the cost was:

$35 (visit)
+
$25 (weekend surcharge)
+
$10 (meds)
______________________
$70 total cost of ear infection

However, there was more than one occasion that year when Sammi’s ear infection was obvious to me, but not to the doctor on call. Despite her red face, obvious discomfort, and runny nose, the doctor would declare that her ears looked a little red but not infected. Then they’d send us home, where her misery would escalate, bringing us back in two days later with an infection they could finally see. In that case, we paid for two visits. Depending on the timing, it could be:

$35 (first visit)
+
$35 (second visit)
+
$10 (meds)
______________________
$80 total cost of ear infection

or it could be

$35 (first visit)
+
$35 (second visit)
+
$25 (weekend surcharge)
+
$10 (meds)
______________________
$105 total cost of ear infection

“No wonder you thought I’d rather have you send the medicine,” my friend answered. “That system is fucked up.”

In the midst of our current pandemic, with health care surrounding COVID-19 subsidized, there’s no wonder that the pundits and social scientists are seeing a glimmer of hope for socialized medicine. If I was someone with minimal health insurance — or none — I’d think twice about going to the doctor a lot of the time. What if I have the flu, and not COVID-19? How much is it going to cost me to get treated for something the government doesn’t cover? 

One of my favorite podcasts — An Arm and a Leg — has been covering the costs associated with this pandemic, how people are finding a way to survive this financially. It’s pushing the dialogue in the right direction, which is great, but as much as I think it needs to keep talking about the costs of health care (and as much as I think you should listen to it – it’s a fantastic podcast in general), I wish more than anything that, after this crisis has passed, we can have a national conversation that looks at all these ways people are making health decisions based on money.

We don’t even realize how crazy we sound. There were times I held Sammi in my arms as she cried and thought, “is this cry worth $60, or should I try to wait until Monday when it will be a $35 cry?”

Is my daughter’s pain something I should quantify in dollars?

And here’s the thing: if the people who deliver the mail or shred the cheese at the grocery store or check people in at the dentist’s office decide that their sore throat isn’t worth losing a day of pay, then they’re making the same call. And our current system is allowing it. And now, that system is killing people — through this virus and through the poverty that the shutdown has created.

My friend was right. This system is a mess. I hope this shakes it down to the ground, to be rebuilt as something better.

This has been a Finish the Sentence Friday post hosted by Kristi of Finding Ninee, with the prompt of “Things the world will appreciate more because of the pandemic.”

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