Sunday, July 14, 2024

Up front: Healthy respect

Years of analyzing government reports and industry surveys have given our magazine some expertise on judging the quality of North Carolina’s hospitals, showcased this month starting on page 53. Congratulations to Duke University and Mission hospitals for topping this year’s list. It’s totally quantitative, and we don’t insert personal bias into the rankings.

But like a lot of aging people, I consider myself an industry expert. A few lucky folks have only positive encounters with hospitals, such as a joyous day or two spent celebrating a birth. More of us visit hospitals at difficult times, ranging from a few hours at the emergency room, a day or two before a loved one dies, or weeks or months of care and healing.

Five years ago this month, I drew an unlucky straw, suffering an abdominal aneurysm for unknown reasons, then spent six weeks in an Austin, Texas, hospital, followed by a couple of weeks in a rehab center. While heavily drugged for most of my stay, the experience provided more insight into health care than I ever hoped for, mostly incredibly positive. The nurses and orderlies who do 90% of the difficult work at hospitals are saints. Surgeon Dean Kocay, who dealt with my mess, saved my life. The compassion shown by family, friends and my faith community was integral to my recovery.

That’s the important, unquantifiable stuff that doesn’t get covered in hospital ratings. Most people come away from personal medical wars with great respect for caregivers, though problems develop in rare cases at all hospitals, whether ranked first or last.

I also learned about the business side of hospitals, including an unmistakable truth: If you are going to get really sick, make sure you work for a company with great insurance. My bills topped $1 million, though my then-employer paid less because of contracts that big companies can negotiate with insurers. My out-of-pocket cost was less than $10,000.

Unfortunately, many don’t have great insurance provided by well-heeled, compassionate companies. Had I been self-employed with no or mediocre insurance, I would have been hammered financially. Had I worked for a small business, the impact on insurance rates could have been catastrophic.

Hence, when I hear politicians promising to repeal the Affordable Care Act, I always ask: Could you point me to anyone who sleeps well at night without insurance coverage? No one has ever supplied a name.

I’ve also studied medical finance enough to know a society providing equitable health insurance for all can’t afford $1 million coverage to everyone who suffers an aneurysm. Health care spending now makes up nearly a fifth of U.S. gross domestic product, which isn’t sustainable. All parties involved — patients, employers, physicians, hospitals, insurers, pharmas, equipment makers and the government — must accept changes to slow health care’s price escalation. Reduced profit margins, wages and benefits seem inevitable.

In North Carolina, new leaders, already here or coming soon, are taking charge at critical institutions such as Carolinas HealthCare System, Wake Forest Baptist Medical Center, and Blue Cross and Blue Shield of North Carolina.

I came up big in the health care sweepstakes. I hope those folks — the true industry experts — take bold, decisive actions to heal the system so others might benefit as I did.

David Mildenberg
David Mildenberg
David Mildenberg is editor of Business North Carolina. Reach him at

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