By Eric Freedman

Director, Knight Center for Environmental Journalism

There’s nothing like almost dying to wake you up to the multiple realities of America’s health care system.

I nearly died in April from a still-unidentified collapse and its complications, including pneumonia, blackouts, heavy bleeding, liver damage and ICU delirium during seven weeks at Detroit’s Henry Ford Hospital, four of them on a ventilator.

I have no memory of my first five weeks there.

When it first happened, my children and grandchildren arrived from four states, although I don’t remember their visit or their encouraging words.

For me, the experience highlighted the fragility of life and our vulnerability to sometimes-inexplicable health crises, regardless of how well we’ve taken care of ourselves: eaten – mostly – right, exercised and had regular medical exams and tests.

Beyond that, however, came deeper insights about inequities in the American medical system, starting with access to and the high cost of care.

Medical expenses can push patients and their families without good health insurance, Medicare, Medicaid or VA benefits into a devastating choice between bankruptcy on one hand and foregoing lifesaving treatment on the other hand.

Talk about sticker shock. The retail price – the bottom line – for two days at Lansing’s Sparrow Hospital, where my arduous medical journey began in the emergency department: $87,748. The ambulance transfer while I was comatose and in critical condition from Sparrow to Henry Ford Hospital’s ICU: $13,520.

I haven’t seen the tally of the total cost of my lengthy stay at Henry Ford, with a plethora of payments for physicians, tests and medications, but I have no doubt it’s astronomical.

I’m fortunate to have insurance through my employer, Michigan State University, but a 2020 study from the National Health Insurance Survey found that high medical costs push one in 11 American adults to postpone their health care or go without recommended treatment.

The experience also made me more conscious of the even greater economic and access inequities between health care in the United States and most of the rest of the world.

In early July, President Joe Biden spoke at a White House press conference about policies to reduce health care costs. That included a crack-down on “junk fees” and “surprise medical bills” charged by health care providers, as well as high-interest medical credit cards.

As with me, Biden’s own life experiences provided insights to what works and what doesn’t work, even for middle-class families like the one he and his three siblings grew up in.

He recalled waking up one morning after hearing “a sort of restlessness going on” in his parents’ bedroom the night before. When he got up, he asked, “What’s wrong with dad?” Biden’s father had just learned his company would no longer pay for health insurance.

Biden continued. “Talk about being deprived of your dignity. Not being able to take care of your family if you don’t have health insurance is, I think, one of the most consequential things that can happen to a person.”

Another lesson I learned was the power of health insurance companies. Too often those companies rather than medical professionals are the deciders – what drugs to cover, what tests to authorize, what treatments to allow.

I have been fortunate, much more so than so many other Americans, to have available the specialists and therapists I needed – an ear, nose and throat specialist, a gastrointestinal specialist, a surgeon, a liver specialist, speech therapists, physical therapists and a caring personal physician who carefully monitors my case.

Even so, it sometimes took weeks to get appointments, but at least I could get to and from those appointments. Sadly, that’s not true for people who lack access to reliable transportation.

Sure, we have higher-quality medical facilities, medications and professional health care workers than are found in much of the world, but the financial disparities are mind-boggling. Hold onto your hat when you look at some of the numbers:

The global average for health care spending per person was $1,230 a year, according to the World Bank. Burundi was at the bottom, spending an average of only $16.42 per person, just below Madagascar at $17.95.

The West African nation of The Gambia—where I was scheduled to spend two weeks in April running journalism training workshops before I got sick—ranked 177^th in spending at only $18.55 per capita.

A final question: Why should it take near-death experiences like mine for us, as a society, to learn these lessons about equity and inequity, resources and lack of resources, and the functioning or nonfunctioning of health care services?