Remember Michael Flor, the longest-hospitalized COVID-19 patient who, when he unexpectedly did not die, was jokingly dubbed “the miracle child?” Now they can also call him the million-dollar baby.

Flor, 70, who came so close to death in the spring that a night-shift nurse held a phone to his ear while his wife and kids said their final goodbyes, is recovering nicely these days at his home in West Seattle. But he says his heart almost failed a second time when he got the bill from his health care odyssey the other day, according to a report published by The Seattle Times.

“I opened it and said ‘holy [bleep]!’ “ Flor says. The total tab for his bout with the coronavirus: $1.1 million. $1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.

The bill is technically an explanation of charges, and because Flor has insurance including Medicare, he won’t have to pay the vast majority of it. In fact because he had COVID-19, and not a different disease, he might not have to pay anything — a quirk of this situation I’ll get to in a minute.

But for now it’s got him and his family and friends marvelling at the extreme expense, and bizarre economics, of American health care.

Flor was in Swedish Medical Center in Issaquah with COVID-19 for 62 days, so he knew the bill would be a doozy. He was unconscious for much of his stay, but once near the beginning his wife Elisa Del Rosario remembers him waking up and saying: “You gotta get me out of here, we can’t afford this.”

Just the charge for his room in the intensive care unit was billed at $9,736 per day. Due to the contagious nature of the virus, the room was sealed and could only be entered by medical workers wearing plastic suits and headgear. For 42 days he was in this isolation chamber, for a total charged cost of $408,912.

He also was on a mechanical ventilator for 29 days, with the use of the machine billed at $2,835 per day, for a total of $82,215. About a quarter of the bill is drug costs.

The list of charges indirectly tells the story of Flor’s battle. For the two days when his heart, kidneys and lungs were all failing and he was nearest death, the bill runs for 20 pages and totals nearly $100,000 as doctors “were throwing everything at me they could think of,” Flor says.

In all, there are nearly 3,000 itemized charges, about 50 per day. Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies. The charges don’t include the two weeks of recuperating he did in a rehab facility.

Going through it all, Flor said he was surprised at his own reaction. Which was guilt.

“I feel guilty about surviving,” he says. “There’s a sense of ‘why me?’ Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

There also are special financial rules that apply only to COVID-19. Congress set aside more than $100 billion to help hospitals and insurance companies defray the costs of the pandemic, in part to encourage people to seek testing and treatment (including those with no insurance). As a result, Flor probably won’t have to pay even his Medicare Advantage policy’s out-of-pocket charges, which could have amounted to $6,000.

The insurance industry has estimated treatment costs just for COVID-19 could top $500 billion, however, so Congress is being asked to step up with more money.

The writer David Lat got a $320,000 bill for his COVID-19 treatment, and also ended up paying nothing. Yet he heard from dozens of cancer and leukaemia patients who have been hit with big bills or co-pays during this same time period.

It’s like we’re doing an experiment for what universal health coverage might be like, but confining it to only this one illness.

“Suffering from the novel coronavirus as opposed to cancer shouldn’t make a difference in terms of your financial burden,” Lat wrote, in Slate. “What you pay as a patient shouldn’t depend, in essence, on whether your disease has a good publicist.”

Flor said he’s hyper-aware that somebody is paying his million-dollar bill —  taxpayers, other insurance customers and so on. “Fears of socialism” have always stopped us from guaranteeing full health care for everyone, he said. But there’s also the gold-plated costs here, twice as expensive per capita as anywhere else in the world.

“It was a million bucks to save my life, and of course I’d say that’s money well-spent,” he says. “But I lso know I might be the only one saying that.”

https://www.youtube.com/watch?v=3XpMCGt6uvA