God's Won't
An Amish guy named Curtis Selby, 55, "doesn't believe in health insurance," writes Lucette Lagnado in The Wall Street Journal -- well, not when he's paying for it. How nice that he found his way to believing in other people kicking in when he got prostate cancer and treatment was projected to cost between $80,000 and $100,000. How come "god's will" becomes other people's generosity when it involves bringing out one's checkbook? The guy (who, Lagnado wrote, could afford health insurance, but chose not to have it because it doesn't agree with his religious beliefs) ended up sucking up "charity" funds that could have been used for somebody who "believes" in health insurance, but has fallen on hard times and doesn't have the money to pay for it:

...Mr. Selby threw a monkey wrench into the hospital's financial-aid apparatus by refusing to apply for Medicaid or Medicare, citing his religious principles. While his church doesn't forbid accepting Medicaid, Mr. Selby says that "individual convictions based on scriptures," guide him and others on health-care issues.

That was a big problem for UCSF. According to the hospital's policy, UCSF can write off some medical care as charity, but only if the person has been turned down for Medicaid or Medicare.

Mr. Selby and his wife went to meet UCSF's admissions director, Myriam Cabello. She decided to invoke a religious exception to the hospital's policy. She cited the fact that Mr. Selby couldn't apply to government health-care programs because of his beliefs, as a way to get around the rule. She also dipped into a private, philanthropic fund the hospital maintains to help cancer patients. The fund now stands at $213,000. Mr. Selby wasn't opposed to private charity.

The decision to decline health insurance is left to individuals, says Kenneth Landes, 72, a church elder. The Old German Baptist Brethren isn't a hierarchical organization. The estimated 6,000 to 7,000 members have local councils, and a standing committee of a dozen elders who meet once a year. Mr. Landes, who has served on the standing committee, says he has steered clear of commercial insurance out of a sense of community. "I felt that it is probably better that we would take care of ourselves and each other," he says.

In and around his community of Eldorado, Ohio, church members are assessed money each month for an "assurance" program to help pay medical bills of members who also haven't bought into health plans or HMOs. Some Brethren do purchase commercial insurance, Mr. Landes notes. He and others accept Medicare, he says, because they have paid into the system with their taxes. Others decline government health care.

Mr. Selby says UCSF delicately tried to determine what he could afford to pay for his cancer treatment. The figure $25,000 was suggested by a staffer at the cancer center, he says. He thought that was fair. He told them he would try to come up with that amount of cash.

At the same time, he was checking out other options. Months earlier, he had contacted Loma Linda University Medical Center in Loma Linda, Calif., which is well-known for its prostate-cancer treatment. The institution first quoted him an $80,000 treatment plan, he says.

After several phone discussions with officials at Loma Linda, the price came down dramatically, Mr. Selby says -- to between $36,000 and $38,000.

Cindy Schmidt, executive director of the patient-business office at Loma Linda said while they have a record of Mr. Selby's calls, they don't have records of any negotiations and can't comment. She added: "We make every effort to ensure that cash patients do not pay more than what an insurance company would pay."

Still, Mr. Selby was hoping that UCSF could work out a financial package for him. It did -- agreeing to do the treatment for one-fourth the cost of its initial estimate. Ms. Cabello approved the $25,000 price tag in late June 2003.

Mr. Selby's first radiation treatment began in July. At times, Mr. Selby would lug bins of sweet corn, tomatoes, and other fresh fruits and vegetables to the hospital -- and distribute them to therapists, the receptionist, office secretaries, and Dr. Roach, the physician recalls.

The UCSF hospital lost money treating Mr. Selby, says Ms. Cabello. Based on the hospital's list prices, his treatment cost $88,652. He came up with $25,000, and the philanthropic fund chipped in $34,000 -- for a total of $59,000. The rest will be written off as charity care.

And that makes me boil!