I have a new entry in my daily planner: Rabies shot.
No, not for the dog. For me. And my wife.
I write this, not so much to talk about the process of dealing with a rabies scare, but because I think it illustrates, quite beautifully, one of the great failures of our medical care system.
I awoke one night recently, in bed, with the unpleasant sensation of an animal crawling on my face. I brushed it off, then sat up and turned on the light.
I was greeted by the sight of a bat flapping around the room.
I managed to capture and remove the bat from the room (good-hearted soul that I am), and then returned to bed with my wife, who managed to sleep through most of the event. I was reasonably certain I had not been bitten and, other than the initial contact, had not touched the bat in the process.
I awoke the next morning pondering what potential risk we had been exposed to. It was a busy day, so I didn’t dwell to heavily on it. But by that evening, I felt I needed to know more and hoped the Internet would provide some reassurance that all was well.
It didn’t. After a few minutes of searching for “bats” and “rabies”, I was thoroughly concerned. Most of what I came across indicated a significant risk of rabies from contact with bats. Some sources even went so far as to recommend PEP (Post Exposure Propholaxis) for anyone who even awoke in a room with a bat nearby.
The same research also revealed:
- Rabies was nearly always fatal once symptoms begin;
- It was a really, really awful way to die;
- Rabies treatment was painful and expensive.
Calls to our family physican were not helpful – they suggested the Emergency Room. And so, with fear mounting off we went.
The ER folks were friendly and efficient. They called the Centers for Disease Control and after an hour or so, came back with a verdict:
“The CDC recommends you get the rabies vaccine.”
They also noted that the treatment was expensive and painful. The decision was ours – we didn’t have to undergo treatment. But if we had been infected and we didn’t receive the treatment, we would die.
And there’s my point. Setting aside the painful nature of the treatment (which, by the way, isn’t nearly as bad as we were told), we were faced with a decision. How much was this risk worth?
My wife and I are self-employed. We have individual insurance policies for which we pay a total of $11,000 a year. These are high-deductible policies – we each pay $3,000 before receiving any coverage each year. We’re not poor, but $6,000 is a significant chunk of money for us. It’s money that, if spent for medical care, wouldn’t be going into our retirement account (we don’t have pensions). It wouldn’t be going towards anything fun or, for that matter, basic necessities like food or the mortgage.
So, we paused.
I didn’t think I had been bitten. As far as I or my wife knew, she had not contacted the bat at all. And we had no idea if the animal even had rabies, since I had set it free (dumb, dumb, dumb).
We had to decide whether to spend $6,000 (maybe more, since we’re never quite sure what our insurance will cover) to mitigate the possible risk of a fatal disease.
It’s tough to make an educated decision in this situation. No one could tell us what our risk was. 1%? 15%? 60%? We had the CDC’s recommendation, which we assumed erred on the side of safety. We’re reasonably well educated people, but we’re not medical professionals – and at any rate, even the medical professionals didn’t seem to have any good alternatives.
So we made the only sane decision – go with the treatment.
We have completed the process. After our initial visit, we went back to the ER four more times for a single shot each. We don’t have rabies.
But the bills have come in. The total cost for the treatment, for both of us, is approximately $23,000, of which we will pay our deductible portion of $6,000.
I acknowledge that our tale is pretty minor compared to many others. We will be able to pay our share, although the money we spent had been earmarked for a 20th anniversary trip. We won’t starve. Our vacation plans for the year (and maybe next year) will change (as in stay at home). We won’t be contributing much to the retirement fund this year.
We were lucky. But what would we have done if we didn’t have insurance, like so many other people? Or if we had higher deductibles (some policies go up to $15,000) ?I guess we’d choose – take a chance on a horrible disease, or acquiring a significant hunk of debt that we’d pay off over time – along with all of the other debt it our lives.
And this was only a single incident. Think of how many chances you have to enter the health care system, through no plan or blame of your own – slip and break a bone? You’ll suddenly start seeing bills for thousands of dollars. It doesn’t take much.
I hope those of you who are lucky enough to have good health insurance from your employers will be able to understand this dilemma. We desperately need a health care system in this country that covers everyone. A system that means an unexected trip to the emergency room won’t result in a lifetime of debt. Who reading this would have $23,000 to pay for such a sudden expense?
By the way – our insurance company isn’t happy about the situation, so they’re looking for someone else to blame – the owners of the home where we encountered the bat.