An Economist Goes To The Hospital : Planet Money Economist Jared Bernstein recently survived a brain hemorrhage. The experience got him thinking about some of the economics in our healthcare system.
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An Economist Goes To The Hospital

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An Economist Goes To The Hospital

An Economist Goes To The Hospital

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STACEY VANEK SMITH, HOST:

Hey, Jared. Can you hear us?

JARED BERNSTEIN: I can.

VANEK SMITH: Jared.

CARDIFF GARCIA, HOST:

Welcome back, my friend.

VANEK SMITH: Woo.

BERNSTEIN: So nice to hear your voices.

VANEK SMITH: It's nice to hear your voice.

BERNSTEIN: Well, I'm not worm food. That's the headline.

GARCIA: And a happy headline it is.

VANEK SMITH: Yes, it is.

GARCIA: Jared Bernstein is an economist. We've had him on the show many, many times before. He works at the Center on Budget and Policy Priorities. And he was an economic adviser to President Obama.

VANEK SMITH: And recently, Jared had a pretty major health event, an event that plunged him right into the heart of the American health care system. Now, this was a system Jared had thought about a lot. He'd helped advise the White House on it, but he had never really been inside of it like this.

This is THE INDICATOR FROM PLANET MONEY. I'm Stacey Vanek Smith.

GARCIA: And I'm Cardiff Garcia. Today on the show, a conversation with Jared Bernstein. We talk to him about some of the insights he gained into the American health care system from his recent experience.

VANEK SMITH: And insights he gained into some other things, too.

(SOUNDBITE OF MUSIC)

VANEK SMITH: Jared, we're here to talk about health care. And this all started because you had your own experience with the health care system. Tell us a little bit about how that started.

BERNSTEIN: It started on a Saturday morning, March 23, actually just about two months ago, when I was sitting at my computer around 10:30 in the morning, just minding my own business, when all the sudden, I had a badass brain hemorrhage. I don't know how else to put it. And in the course of about 60 seconds, I went from feeling fine to having - just imagine the worst headache you've ever had and multiply it by a million. And I was on the floor. I was in terrible shape. Thankfully, my wife was home, and she rushed me to the emergency room.

I had what's called a subarachnoid hemorrhage, which is a brain bleed, basically.

VANEK SMITH: Yeah.

BERNSTEIN: And one-third of the people who fall victim to this die.

VANEK SMITH: Wow.

BERNSTEIN: Another third either don't get out of the hospital or come out with a pretty severe disability. And then there's the top third. I sound like I'm describing the income distribution. Then there's the top third, where, luckily, I was.

VANEK SMITH: So you got to the hospital, and...

BERNSTEIN: Right.

VANEK SMITH: ...What happened there?

BERNSTEIN: As an economist who thinks a lot about health care - it is 18 percent of our economy - I complain about a lot of aspects of our health care system, particularly access and inefficiencies.

The high end of our health care system can be, you know, really pretty amazing. And I think one example of that is very soon after I got into the emergency room, as far as I can tell - as you can imagine, things are all fuzzy - they had a tiny, little camera up in my brain, which they weaved through my groin and through my...

VANEK SMITH: Really?

BERNSTEIN: ...Some artery up into my brain, yeah. And they were looking for an aneurysm, meaning a burst vein or artery up there. And, you know, that became a very critical part of the diagnosis. So that's a kind of sort of high-end technology that, you know, saves people's lives if you have great coverage and live in a place where that sort of treatment is accessible.

VANEK SMITH: Was that something that, like, occurred to you while you were there?

BERNSTEIN: Any policy insights came later because...

VANEK SMITH: (Laughter).

BERNSTEIN: ...I was kind of focusing on trying to survive.

Well, I did have one that kind of just grew as I was there, and I thought it was kind of germane. This sort of goes back to when I was an economist for the Obama administration during the Great Recession. One thing I noticed every month is that while employment was really tanking - I mean, we were losing hundreds of thousands of jobs per month - there was one sector that just kept on ticking, and that was the health care sector.

Now, part of that is because health care is an inelastically demanded good, which means even in lousy times, if you have a brain hemorrhage, you know, you need help.

GARCIA: Jared, I have a question about health care costs because that is something that has been the subject of a lot of debate and consternation for, you know, policy wonks, but also just for normal folks who may have to pick up big health care costs.

You're insured. But I was wondering if at any point in time, especially when you realized, hey, I think I'm going to make it, you wondered, oh, my God, this is going to cost a small fortune. Now what?

BERNSTEIN: Absolutely. No question. And after I started - after my brain sort of came back online, those are precisely the kinds of things I was thinking about. For example, I'm engaged in a situation which is really classic. The insurer wants to charge me for a piece of equipment that a doctor prescribed on, like, Day 1 of my treatment.

VANEK SMITH: What was the machine? What did it do?

BERNSTEIN: It massaged veins and arteries and parts of my body to even out blood flow. This was for my calves...

VANEK SMITH: Oh.

BERNSTEIN: ...Part of my leg. And so I guess they were saying, hey, dude, the problem was, like, up north. What do you need something for down at your legs?

VANEK SMITH: How much would it have been if they didn't cover it?

BERNSTEIN: Three-thousand bucks.

VANEK SMITH: Wow.

BERNSTEIN: So real money.

VANEK SMITH: That is real money.

BERNSTEIN: Yeah. And the insurers were telling me, well, we don't think you really needed that. So that means that when I was in the midst of a hemorrhagic stroke that's fatal for a lot of people, I was supposed to get on the phone and ask the insurer if they would cover something the doctor told me I needed. That's what makes a lot of people really legitimately pissed off about our health care system.

I mean, the fact that I had great coverage meant that me or my family didn't have to worry about being bankrupted by this. I mean, yes, we're going to fight with the insurers over some significant bills, but at the end of the day, my family will face a tiny fraction of the overall cost of this. And there are still 9%, 10% of people in this country who have no health coverage. And there's a lot of people who have inadequate coverage.

And, in fact, one of the aspects of health care reform that has me increasingly nervous, given my experience, is the spread of these sort of fake plans - very high deductibles, plans that don't really cover the kinds of incidents that I had - so that you might think you have coverage, but something terrible happens to you, and it turns out, you know, you're going to be, essentially, bankrupted by it.

GARCIA: Jared, was there anything that really surprised you about your experience, given that - I'm assuming - this was your first sort of life-threatening incident?

BERNSTEIN: I'm going to say two things, and neither have anything to do with economics, I don't think. The first is that on Day 2, when I was just kind of coming back to some level of consciousness, I sort of squeezed one eye open, and standing next to me at my bedside in the intensive care unit were my three daughters.

Having them there, I felt like I was just levitating off the bed. I was so uplifted. And I just kind of somehow convinced myself in that five-minute discussion with them that I was going to be OK.

VANEK SMITH: Oh, that's really lovely. It's better than economics, and I think very highly of economics.

BERNSTEIN: (Laughter) Thank you.

And I think the second thing, which is also, again, you know, much more - probably more heart than head - there's this little section in "The Brothers Karamazov" by Dostoyevsky where he tells the story - and this actually happens to Dostoyevsky himself - of a prisoner who is going to be executed in a firing line. And he's in line, waiting for his turn to come, and somebody rides up on a horse and says, you're pardoned.

So then Dostoyevsky explores with this character in the book, well, then did you change your life so that you'd live completely different, valuing every second? And the guy basically says, yeah, I did for, like, a month or two, then I kind of fell back into my old self. So I've kind of avoided trying to say I'm going to now live every second to the fullest.

But that said, the notion of having a big, old fight about 25 basis points on the interest rate just seems really kind of not worth it. So I feel like I'm just not as incensed or excited by some of the small stuff that used to get under my skin and thinking a little bit more big-picture.

VANEK SMITH: Does it change the way that you see the health care sector? I feel like...

BERNSTEIN: Yeah.

VANEK SMITH: I feel like that's such a weird question...

BERNSTEIN: No, no.

VANEK SMITH: ...To follow such a beautiful insight with, but I am serious.

BERNSTEIN: It definitely changes the way I view the sector. So for example, I think the biggest challenge with health care reform is not that Americans overutilize health care. That's kind of a myth. It's that the price system is just so overinflated. Things that just cost a ton here cost much less in other places.

And so in the hospital, I was talking to a doctor who I thought was instrumental in saving my life. And I was thinking, this guy must make a tremendous salary, and, you know, he doesn't know that in the back of my head, I'm contemplating a health care reform that would probably end up...

VANEK SMITH: (Laughter).

BERNSTEIN: ...With a lower paycheck for him.

VANEK SMITH: Maybe don't mention that, you know?

BERNSTEIN: Yeah, I kept that to myself. But it was an interesting thought.

VANEK SMITH: Well, Jared, it is so nice to have you on the show.

BERNSTEIN: Thanks so much. I look forward to coming back and talking about 25 basis points on the Fed, durable goods and not hemorrhagic strokes. But, you know, it's all part of my life.

GARCIA: All right, Jared, thanks so much, man.

BERNSTEIN: OK, guys, thanks a lot.

VANEK SMITH: Thank you, Jared.

BERNSTEIN: Bye-bye.

(SOUNDBITE OF MUSIC)

VANEK SMITH: THE INDICATOR is a production of NPR.

(SOUNDBITE OF MUSIC)

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