The Lottery of Birth

When my 76-year-old mother-in-law was told she needed a dual-chamber pacemaker, our family’s attention shifted to one thing: getting her safely through the surgery. Joey was especially anxious. Living thousands of miles away, he struggled with not being there for his mother. Thankfully, the surgery went well.

As relief replaced worry, I found myself thinking about something entirely different. Her surgery took place in the Philippines, and her family’s share of the cost, after government health insurance paid its portion, was about $5,000. That got me wondering: What would the same procedure cost elsewhere?

In the United States, hospital charges for pacemaker implantation can run from $30,000 to $80,000 or more, although insurers typically pay much less. What patients ultimately pay varies enormously depending on their insurance.

In the United Kingdom, the cost to the National Health Service might be roughly $3,000 to $6,300, but an NHS patient generally pays nothing directly. In Denmark, the cost might be $5,000 to $10,000, but medically necessary hospital treatment is publicly funded, so the patient generally doesn’t receive a bill.

These aren’t perfect comparisons. A hospital’s billed price, an insurer’s negotiated price and the cost to a government healthcare system are very different things.

Same heart. Same pacemaker. Very different financial experience.

Ultimately, the cost of healthcare has a lot to do with what I think of as the lottery of birth. Where we’re born often determines the healthcare system we inherit and how much of the financial burden of getting sick falls on us.

Imagine four 76-year-old women: one in Florida, one in London, one in Copenhagen and one in Manila. All four develop the same problem with the electrical system of their heart. All four need the same basic treatment.

None chose where she was born or the healthcare system she inherited. Yet those circumstances may determine whether her family worries about a hospital bill, waits for treatment, or simply focuses on her recovery.

It made me wonder how much of our financial well-being comes down to advantages we rarely stop to think about: our citizenship, healthcare system, education, legal protections and even the currency we’re paid in. All can profoundly influence our financial lives, and all were decided before we could even speak.

Perhaps this struck me because I’ve spent much of my life crossing borders. I was born in England, spent part of my childhood in Bangladesh and eventually made my home in the United States. Joey was born in the Philippines, where we’re now considering making our home for part of the year. Each country has shaped the opportunities and choices available to us.

I’ve been fortunate in ways that had little to do with any decision I made. I didn’t choose where I was born, the family I was born into or many of the opportunities that came my way. What I could choose was what to do with those opportunities. The older I get, the more I appreciate the difference between what we earn through our efforts and what we’re simply fortunate enough to receive.

My mother-in-law’s experience also challenged some of my assumptions. She received sophisticated cardiac treatment in the Philippines for a fraction of what an American hospital might charge, yet the experience wasn’t impersonal. The doctor overseeing her care messaged Joey directly to tell him how the surgery had gone and responded again when Joey later had concerns about her medications.

That personal attention meant a great deal to a son sitting thousands of miles away.
My mother-in-law didn’t choose the healthcare system she was born into any more than I chose mine. What mattered that day was that when her heart needed help, the technology and people were there to provide it.

For our family, the most important number wasn’t $5,000, $30,000 or $80,000. Those numbers became irrelevant once we heard her surgery had gone well.

In the end, what mattered wasn’t what her pacemaker cost, but what we hope it gives her: more time with the people she loves, and more time for us to love her.