Top Doctors 2008: My Daughter’s $29,000 Appendectomy

The notion that for our health-care system to work properly, we all need to be savvier consumers seemed to me exactly right … and exactly wrong. Yes, half of what’s whacked with our system is its mind-numbing complexity and lack of transparency, which not only add billions in costs but make it impossible for anyone to behave like a rational consumer. How can you know whether a drug is overpriced when it’s so hard to find out the price in the first place?

And yet I certainly don’t feel confident that smarter health-care choices would necessarily mean lower premiums. Last year, for instance, even as it bemoaned the rising costs it was paying on behalf of its members, United Healthcare’s parent company made a profit of $4.1 billion.

Which leads to what may be the other fundamental flaw of our health-care system: the fact that we treat it as a capitalistic enterprise at all. Would it have made any difference if I had known the final cost of Sarah’s appendectomy ahead of time? I suspect I speak on behalf of most of the parents who pass through CHOP’s breathtaking, heartbreaking halls when I say: There is no amount of money I wouldn’t pay to see my kid get better. If you had told me on the night of Sarah’s surgery that I had to empty out my 401(k) to pay for it, I would have done it. Sell my house? Yup. Borrow thousands from friends and family? In a heartbeat. Buy a gun and knock over a liquor store?  If that’s what it took. Some things are more powerful than business, more powerful than money, more powerful, frankly, than right and wrong. And that may be precisely what makes our health-care crisis insolvable: We are trying to put a price on something that is, by its nature, priceless.





ONE RECENT FRIDAY afternoon, I sat down with Peter Mattei, the surgeon who took out Sarah’s appendix. Peter is a 43-year-old Harvard Med School grad whose jet-black hair and dark eyes make him look like a central casting version of Surgeon. I caught him on his lunch break, after a morning in which he’d done five surgeries.

He seemed embarrassed to admit he knew little about the billing and payment part of his profession. He explained, for example, that he’s a salaried employee of his surgical group, so whatever United Healthcare and I paid for Sarah’s surgery certainly hadn’t gone directly into his pocket.

We talked for a few minutes about his life as a pediatric surgeon — he does about 500 procedures a year, ranging from simple mole removal to treating kids with ­cancer — and then about the complexity of the system that brought us together one night last October. We agreed that there must be a better way to do this — though neither of us knew what that might be.

There was a time, long ago, when a surgeon like Peter Mattei would have operated on Sarah, then sent me a bill for what his services cost. I would have sent back a check, or worked out a way to pay what I could over time. It was a previous generation’s way of resolving the contradiction between what is, on the one hand, a business and, on the other, a basic human need. People seem capable of doing that; complex bureaucracies, not so much.

I’d brought with me my folder of the paperwork on Sarah’s case, and I started showing it to Peter. He noticed the itemized listing of charges — her real bill — and asked if he could take a look at it. He seemed fascinated by the list, finally zeroing in on some of the charges directly related to what had gone on in his operating room.

“Wow, an endostapler costs $550?” he said, referring to the device he’d used to close Sarah’s wounds, that had left such tiny little scars. Then the man who’d saved my kid, a guy I could never repay no matter how much I paid him, shook his head in disbelief. “That’s amazing.”


E-mail: tmcgrath@phillymag.com