Seven Days Inside America’s Healthcare System

I spent last Christmas in the hospital, my first stay since I was born. Although not an emergency, I needed my operation sooner than later. It was a humbling experience in one of the most complex, high tech sectors of modern life, much of which didn't exist when I was born.

I have a long relationship with heart disease. My father and his brother both died from it in their forties. Although older, their parents also both died from it.

Since I was young, I have been keenly aware of my bad genes. Wanting to live a long life, I never smoked, watched my diet, ran and developed other life habits to minimize my exposure to heart disease. 

It mostly worked. The kids are grown, we have grandkids, I'm safely retired and we’ve been walking five miles a day for years. 

Since my first physicals after college, I was encouraged to watch my diet, to run and to take medications to lower my cholesterol (even though my cholesterol numbers were good). 

In their zealous determination to keep me healthy, I once failed a treadmill test. They assumed that I had probably already had some heart attacks. But on further review, they cleared me to do anything I wanted. It was a false alarm.

But last year my luck ran out. I woke up a couple of times feeling short of breath. I wasn't sure what was a virus and what was more serious, but I reluctantly went into the clinic.

Once they heard my symptoms, they immediately sent me to the emergency room, offering me a ride in a wheelchair. (They let me walk.) For the first of several times, they told me to plan on spending the night—or a week.

But every time they sent me home. It's hardly an exaggeration to say that it took two general practitioners and four cardiologists a month to diagnose my problem. I had a bad heart valve and I would need it fixed.

And that means open heart bypass surgery, the "big one" as multiple people reminded me.

Open heart surgery for a valve problem is a non-trivial medical procedure. I had once read that if you ever saw open heart surgery performed, you'd wonder how anyone survives. 

Although it's safe and quite common, I knew enough to not want to hear what they were going to do to me. 

When writing up my health care directive years earlier, I repeatedly stated that in the end-of-life world, I was most afraid of pain. Dying isn't a fear of mine. 

So when they had me lying flat on a gurney and asked if I had any questions, I had one: What pain could I expect over the next several hours. 

I was told that I'd be unconscious before I left that room and I wouldn't feel anything. As for dying, I wouldn't know it if it happened. 

Open heart surgery for a valve replacement requires a team of at least seven people. It started with making a 7 to 8-inch incision down the center of my chest. They cut through my breastbone and spread my ribs apart to reach my heart. 

They connected me to a heart-lung bypass machine which takes over for my heart and lungs, both of which are stopped during the surgery. Finally they were able to repair my valve, which probably took about thirty minutes of the four hour surgery. 

Once my valve was repaired, they restored the flow of blood to my heart, got my lungs and heart working again and disconnected the bypass machine. Finally, they wired my ribs back together and closed me back up.

My first memory waking up was hearing my sons, a welcomed sound. I couldn't see yet but I could point and name which one was talking, which got them laughing. The nurse was right—I had felt nothing.

All went well sans a common complication that extended my stay a bit. Before they operated, I heard repeatedly that I will "do well." But after not eating for days, I didn't feel well. Early one morning, a nurse was making a routine visit.

Talking to her, I started to cry. I told her that I was confident that I would be well, but it sure didn't feel well then. I was on emotional overload. She was so kind. She gave me two hugs.

This was mostly my experience with the people that cared for me, whether the surgeon, the nurse who I talked with last before my surgery, or the one who gave me a hug when I needed one. They were very kind, very professional and most notably, very busy.

I was intrigued by the number of people who were involved in my recovery: nurses, doctors, pharmacist, maintenance and cafeteria people. They did their best to accommodate me for anything I asked for.

I was also high in a brand new glass medical facility overlooking Lake Superior. I had a private room with a gorgeous view. Sometimes I'd awake in the middle of the night and just look out over the quiet city and lake. It was stunning.

For years, I've been intrigued by the healthcare system. I realized long ago that healthcare is expensive, consuming about 20% of everything the U.S. spends today, nearly four times what it was when I was young.

My general observation from the outside has been that the system is exceptional in its output but is bloated and mismanaged.

I'm reminded of it when I receive two conflicting arrival times for the same appointment, when I provide the same information repeatedly or when I'm mailed indecipherable multi-page statements, often with "do not pay" stamped across them. 

Although I stand by many of my criticisms of our healthcare system, I admit that after my stay, I am quite amazed at it, and I have a new appreciation for why it is so expensive.

Having worked my life in IT operations, I quickly came to an understanding of where the money goes in healthcare. It's not in the $200 drugs, the overpaid specialist or our modern facilities.

Roughly, two-thirds of healthcare is labor, the people I saw all day long, plus many more.

And there's no AI or robotics that are going to straighten out my bed, which happened every several hours for days. No automated valve replacement. Ditto drugs, IVs or food.

After some days I realized I hadn't taken a shower. I put together a plan to get myself into the shower seat, turn on the water and wash myself up enough to feel better. This was the plan of a man who couldn't get out of bed without help. 

Good luck with that! I asked my nurse if I could take a shower. No problem, he said. "I'll be back in ten minutes." 

When he returned, his first words were that he would help me get undressed and onto the seat in the shower, but he would do all the work. My only job was to tell him what I wanted cleaned.

I'm still traumatized! I wondered what you have to pay a nice young person to give an old man a shower. But I soon realized that this is his career, and it was less work than washing his dog. 

Any pride I still had was gone! But I was clean and felt good. When he was done, he just asked if I needed anything else and then went on to his next task.

So what does open heart surgery, including seven days in the hospital, cost? This brings me to the most intriguing question of my stay, and that is what I call healthcare's imaginary money. 

The list price for my stay was $200,000, more than the median life savings of a retired person. Where did that price come from?

But my insurance said the price was $62,213. The surgeon billed me $17,110 but my insurance paid $2,112 as full payment. And for me? I paid the surgeon nothing and then $1,828 for everything else, a fraction of the total cost. 

The internet says that the average cost for my procedure in my area is between $80-200,000. How does a logical mind wrap themselves around figures like this? 

I now doubt that there is any silver-bullet for fixing healthcare and its costs. But here are a couple of thoughts. 

Start by getting the costs into real numbers that can be compared and challenged. What does something actually cost? Does anyone know?

Then build on the existing healthcare exchanges. They can seem burdensome but they live with real numbers and provide individual options. Nearly half of Medicare is already processed through their own exchange. Why not employers and Medicaid, too? 

And finally, let’s acknowledge that it’s the price for modern life, and that price is high: about 20% of everything you earn. We can argue all day about who pays for it, but in the end, collectively we all are.

While in the hospital, I listened carefully to every recommendation for a good recovery. They emphasized exercise and diet, and I intended to follow all that they said. 

I shared my plans with the staff, telling them that I loved them all but my goal was to never see them again.

Gold: Yesterday, Today and Tomorrow

Recently, in order to get through a sensitive metal detector, with some pain and effort I removed my wedding band. I hadn't had it off in years. 

I later had it resized and polished, and was quite surprised how nice it looked. It all reminded me of an old gold mine that I grew up near. Let me explain.

Rings have a long history, often used to signify power and status, and more recently, achievements and love. 

Not one to care much about marking myself with symbols, I tried to pass on a wedding ring. My wife convinced me otherwise.

Researching rings, I learned that I could have our rings made using gold that had just recently been mined and processed from the Ropes Gold Mine.

This is the old mine just a few miles from the house I grew up in in the Upper Peninsula of Michigan. The mine had recently reopened. 

I ordered two rings. We both have our rings. And each other. And three boys. And four grandchildren.

I recently saw an ad pushing the sale of gold. Yes, it's climbed a lot lately, up nearly 7 times in the past 20 years. 

Note, though, that in the same period the S&P 500 index is up five times (excluding dividends). In recent years, gold has not been a bad investment but history suggests it's not what it's said to be.

Back to our rings. When I was a kid, we occasionally brought our garbage to an open dump that was on the same gravel road as the old Ropes Gold Mine. There was a small sign recognizing this mine from the 19th century. It had been closed for decades.

The Upper Peninsula is known for its iron ore mining, which has been mined continuously since it was first discovered in 1844. Copper was once a big industry, too. But there were also over a dozen gold mines in the area.

The Ropes Gold Mine was the most notable of these gold mines. It was started by Julius Ropes, a chemist from Vermont who had searched for gold and silver on the west coast and in the south.

In 1862, at age 27, he came to the Upper Peninsula working for a local druggist. Mining had already been active in the area for years.

Mr. Ropes married a local girl, settled in my hometown, Ishpeming, Michigan, had four children and eventually opened a drugstore. He was very involved in the city, becoming postmaster and a school board member.

They lived in a house just a few blocks from the family home my great-grandfather bought about the same time, a home both my grandfather and dad grew up in.

Mr. Ropes continued his prospecting for gold and silver, and eventually discovered both in what became the Ropes Gold Mine organized by him in 1881. Mining began shortly afterwards.

It continued operations for fifteen years until it was closed due to financial difficulties. It produced $645,792 worth of gold, worth about $90 million today.

Note, though, that had this same amount of money been invested in the S&P 500, it would be worth tens of billions of dollars today. 

During this time, after accounting for inflation, gold went up about 4 times while the S&P 500 went up over 2000 times. Ok, enough of this. But I will carry this point out later to show just how bad of an investment gold is.

The Ropes Gold Mine remained closed for most of the 20th century. I remember as a kid walking through the mine ruins many times, looking through the history that sat overgrown with trees. Mounds of ore and equipment lay about, the former obscured by brush, the latter more rusted with each passing year.

Gravel roads eroded into trails, now as frequented by deer as man. But gold won't rust or be washed away, and beneath 100 years of shrubbery, it still coursed through the land's veins.

During these years the Ropes Gold Mine changed hands several times. As is usually the case, finances and investing were the drivers.

The big breakthrough came in the 1970s. Gold prices spiked, going up nearly 15 times while the S&P 500 about doubled (including dividends). Callahan Mining Corporation bought the mine and reopened it in 1983.

They ran it again for nearly ten years when it again closed primarily due to the rising cost of operating the mine while the price of gold fell. It’s during this second run of the Ropes Gold Mine that I bought our wedding rings.

Our marriage has been very good. But as an investment, the gold in our rings didn’t do so well. When I had my ring resized, I asked for an estimate on what it is worth. 

They said it was worth about $1100, three or four times what I paid for it nearly forty years ago. How does that compare with the S&P 500? Including dividends, that same money would be worth $18,000 today, more than ten times what the gold is worth.

Gold has a long history going back thousands of years. There's a reason it is considered a timeless item with an inherent value. But gold doesn't do much other than make nice jewelry. 

Although it's backed by more than crypto currency, it’s not by much. They both are mostly only worth what someone else will give you for it. It's the same with most commodities. But in this case, there's emotion and history, unlike natural gas or wheat.

That's quite different from money invested in companies. Almost all stocks are backed by companies with products and facilities, with many paying dividends. 

There's not a lot of emotion to Proctor & Gamble or Apple Computers or Ford Motor. Nothing to share at a wedding or to carry on your finger for decades.

But from a cold financial perspective, these companies make and sell things that people want, and as an investment they lap gold again and again.

By how much? According to Stocks for the Long Run by Jeremy Siegel, after accounting for dividends and inflation, the S&P 500 has averaged nearly 7% a year return since 1800, rising over 23 times in this period. 

During the same time, gold has averaged less than one percent a year, rising only 4 times after inflation.

Yes, gold occasionally goes up fast as it did in the 1970s and as it has again this century. But from 1980 to 2000, it hardly moved while stocks went up by multiples. And even in this century, gold hasn't done much more than keep up with stocks.

They claim gold is a hedge against inflation. Maybe and sometimes. It worked in the 1970s. But, no, it doesn't normally track with inflation any more than bonds or stocks.

Gold is wonderful. I like my ring. I like its history, both through ancient times and into the Ropes Gold Mine. I like what it symbolizes.

But an investment? No. If you own the actual gold, you have to store and secure it. If you buy it electronically, whether directly or through a fund, you're open to all the same issues that come with trusting others' commitments to you.

People rarely do well with gold. But in the long run, buying and holding stocks, whether individually or in low-cost funds, it is hard to lose. 

At the same time, love, history and sentiment can’t be measured purely in financial terms. I’m still glad that I have my wedding ring.