Money

• Hemoglobin 9.1 (normal 14.0-17.3)
• Absolute neutrophil count 0.7 (normal 1.4-7.5)
• White blood cell count 1.0 (normal 4-10)
• Platelet count 200 (normal 150-450) — NORMAL

Ended up with a pretty good day yesterday (Weds.), despite everything. Surprised myself by starting off on a walk and going for a full hour, slowly of course, but at least moving. After that, a few minutes lifting light weights, 30 minutes of yoga. Then into bed with ice packs for my right hip and knee — now sore from stretches I'm doing for my hip — and a one-hour nap. Then I actually felt OK for a few hours.

Later, as if the HCL just had to show me who's boss around here, I had another horrible night, awake 3-5 AM. This morning the infernal headache blasted back in like a monster truck, an evil tom-tom pounding my head into hamburger. On top of that, my entire ribcage burned: pectorals trashed from lifting 8-lb. dumbbells maybe two dozen times. Sixteen f-ing pounds.

Went for more blood tests late in the morning. All the counts are up a bit, especially compared to Monday, when they'd dropped back as the transfusion effect wore off. The best news: platelets are finally NORMAL, well inside the range. White cells and neutrophils still super-low, very risky for infection. My hemoglobin level's still dismal, which is why I have these tremendous headaches, but today's 9.1 looks a lot better than last week's 7.9. I've got some hope of hitting 10 by this time next week. Once I get there, I should start to feel semi-normal. Here are new blood count charts.

Let's talk money.

Frankly, I haven't paid a lot of attention to the hospital's billing notices. That's because I work for a major university with outstanding health insurance plans, so my bills always say do not pay — insurance reimbursement pending. Yeah, I've forked out a few $15 copays, and not every single thing is covered, for example the emergency visit to my dentist on Tuesday. But in general I don't even have to think about how much this all costs. I don't even have to fill out forms. I just show my card and walk away.

But from the cursory glances I've given the billing statements, I'd guess this episode has already cost at least $20,000. Possibly $30,000. Every blood test is a few hundred bucks, even though it takes them less than two minutes to draw the blood and the results come back in under half an hour, the blood having been examined automatically by a machine. CT scans are $1500 a pop, and they did three of them. X-rays, the bone marrow biopsy, flow cytometry, doctor visits. In the US health care system this adds up to unbelievable sums.

This isn't to say that my insurance company is actually paying out that much money. No, it gets a steep discount, on the order of 60-70 percent. God help you if you don't have insurance: then you pay retail.

When we lived in South Africa in 2003-04, my aging father-in-law flew in from Miami for a visit. The night he arrived he collapsed in his room with a brain seizure. He then spent over a week as an in-patient at the best hospital in Durban. He traveled by ambulance, had every brain test known to medicine, saw neurologists multiple times, had a sleep test, numerous blood tests, meds up the wazoo, basically everything they could throw at him. You may think South Africa's the Third World, and a lot of it is, but the medical system there is second to none; this was high-tech medicine at its finest.

Total bill, including 8 nights in a private hospital bed? Less than $6,000. For the same thing in the USA, you'd be lucky to walk out for $30,000.

Editorial, since it's an election year: the US health insurance system is totally broken.

Insurance is supposed to be a collective bet. We all pool our money. When somebody gets sick or injured, they take what they need from the pot. Since we never know when this might happen to us, or how bad it could be, it always makes sense to pay in your share, even if you never end up using it. If you lose, you win. You can be the healthiest guy on the planet. Then you walk out of a Starbucks, get nailed by a drunk driver while crossing the street with your latte, and end up paraplegic with a half-million-dollar hospital bill. Ask me last summer and I'd have told you the insurance companies were making a bundle off me. Now....?

I'm all for free market solutions when they work, but in medicine, they don't. The problem is that you (or your employer) shop for the cheapest insurance, not the cheapest medical care. You do not in fact want the cheapest medical care. You want the best. So the real market competition is at the level of the insurance, not the medical care.

And how do insurance companies keep prices down? They try to be sure that their pool of customers is healthier than everybody else's. That means excluding people from coverage if they have pre-existing medical conditions — like my self-employed friend Todd, who's been told that no company in California will cover him as an individual after his COBRA extension runs out next year. That's just one way we've ended up with millions of uninsured Americans.

The big irony is that we end up pooling our money to pay for them anyway: through higher prices for medical services, through higher taxes, through all the secondary expenses of supporting sick people who can't work. It's stupid. Medical insurance ought to be a basic right, not a privilege of the wealthy. It ought to be single payer, with everybody contributing their share and everybody able to draw out whatever they need.

That's not just the only sane solution. It's also the least expensive one. For the best thinking on this, read Paul Krugman's columns in the New York Times. (Try this one for starters.)