If you, a human being reading this post, are exposed to rabies by a bite or a scratch etc., you have a window of time in which you must act. If left untreated, rabies exposure in humans is considered 100% fatal. There have only been a small handful of reported cases in history where a human survived rabies after contracting the disease. According to the World Health Organization (WHO) 15,000,000 people each year get treated for rabies exposure. The disease is considered tropical in nature and most deaths associated with it occur in poverty stricken areas along the Equator. Annually, we can expect to see 49,000 deaths around the globe to humans every year.
From the United States Center For Disease Control:
"Human rabies cases in the United States are rare, with only 1 to 3 cases reported annually. Thirty-four cases of human rabies have been diagnosed in the United States since 2003, in which 10 cases were found to have contracted infection outside of the United States and its territories. The number of human deaths in the United States attributed to rabies has been steadily declining since the 1970’s due to animal control and vaccination programs, modern rabies biologics following exposure, and successful outreach campaigns. Rabies vaccination programs have eliminated domestic dogs as reservoirs of rabies in the United States, although we still see 80 – 100 dogs and >300 cats with rabies each year, usually infected by wildlife when these domesticated pets are not vaccinated against rabies. While the biggest rabies threat in the world (domestic dogs) has been controlled in the United States, interactions with other rabies reservoir species results in 30,000 – 60,000 Americans being vaccinated against rabies each year."
In other words, as long as you seek treatment after being exposed to rabies, you are likely to survive. But this is where my cautionary tale begins: Exposure to rabies and the resulting necessary treatment may cause you to go bankrupt even if you do survive. Lest you think I am spinning some fantastic yarn, this is almost certainly a greater danger to you than is the disease itself, and it happens because in the United States, insurance companies are in control of our medical system, and they can own you because of the nature of the state laws associated with disease prevention and the underhanded way our this system deals with potentially fatal disease.
A couple of years ago, my wife and I were exposed to rabies. The dogs got us up at 1 AM and were upset by something flopping on the floor. It was a bat and he was unable to fly from the floor. We have had bats from the woods surrounding our house for years. They do get inside from time to time, and we know how to deal with them from previous encounters. Unfortunately, in Elbert County, the health department is under staffed and so to turn the incident in to the county is time consuming, and once you realize you have been exposed, the survival clock is ticking. You must determine if the bat has rabies. We used known procedures to capture the bat, called the county and then, since Elbert County did not respond in a very timely manner, we transported the live bat to the state CDC lab for testing in the area where Lowry Air Force Base once stood. We could have waited for the county, but they were unsure of how long it would take. I called Tri-County Health (as we were directed to do) and explained our situation and they agreed our plan was a good one.
To find out if a bat has rabies, they must extract its brain. If dogs and other mammals are exposed to rabies, they must be quarantined. Bats get killed. We hate it, but in Colorado, if you let the Division of Health know you were asleep with a bat in the room, you are presumed to have been bitten and must by state law get treatment. You are now viewed as a potential health risk and the state will now be tracking what you do to remedy the situation. Our bat was rabid. We went in search of treatment.
The thing is, finding a medical facility which has the HRIG (Human Rabies Immune Globulin) vaccine available is extremely difficult. It has a short span of viability. We tried everywhere, to no avail. We were also told that even if we did find the HRIG outside of a hospital, no doctor would administer the shots. My wife and I were beginning to sense that something about this was just not right. Since this was our last resort, we went to a hospital and essentially turned ourselves into the emergency room staff. A doctor stuck his head in the room and from that point on we were in the capable hands of well-trained nurses. But the strangest thing was happening. Not a sole would answer a single question in regards to how much this would cost, what insurance would pay or even who would bill us. We asked each person who entered the room…and there were quite a few. They all just said that it was necessary and not to worry.
Yes, the shots are painful, but no longer given in the abdomen. The larger you are, the more shots you get because dosage is calculated by weight. I got six or more shots in the arms and legs. My wife got a few less than that of the vaccine. The one HRIG dose is very thick and to inject it is difficult. The nurse even had one syringe break in her hands from the pressure.
The remaining shots (vaccine) came in two sessions (3-4 days apart) at the Tri-County Department of Health in Douglas County. Those single shots were not nearly as painful and we had to pay out of pocket for the each visit It seemed expensive when they said $300 apiece times two sessions to Tri-County Health, but as everybody kept telling us, "You have no choice. Rabies is 100% fatal!" And of course we would agree. It was not long after those sessions we received the bill from the hospital.
The total cost for both of us, for the evening in the emergency room, for the HRIG shots and first round of vaccines, was $59,000. Think about your family for a moment. If you have three or four kids, the bill might be upwards of $200,000, and you would be responsible for it, because you would sign your family into the emergency room for care and no one would bother to prepare you for the financial nightmare that would be coming down the pike
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We were shocked, worried and simultaneously angry. All of the people we came into contact with in the emergency room, including the initial sign-in/registration desk, the nurses, the doctor, knew what we would be financially facing and were probably instructed that if they told us anything about the cost we would have been freaked us out of our minds…potentially bankrupting us. I went straight to work investigating how and why all of this was happening.
After reading everything I could on rabies, calling some insurance company watchdog groups, calling several doctor friends and lawyers, and then doing extensive reading on just how other countries around the globe deal with rabies, it became abundantly clear what was going on here: This is a scam and I am certain that it goes on with all types of different maladies, not just rabies. What tipped me off was learning that after calling the hospital and my insurance company, I discovered that there was a set price for rabies. The insurance company just looks on a price sheet and sees what price had been negotiated for rabies. They cut a check before I had even begun to complain. No outrage. No back and forth. No, they just cut a check to the hospital. It turns out that the healthcare providers and insurance companies sit down periodically and hammer out agreements on what they will pay for things and it is like a a huge game of monopoly. Insurance companies tend to look at things like rabies as bargaining chips.
Here is an oversimplified and made up negotiation but it is in essence how the industries dovetail to get our money:
Insurance company: “I will pay you somewhere in the range of $25,000 with no questions asked for rabies if you give me a 10% discount on Emergency Room trauma kits.”
Healthcare Provider: “Hmmm. I don't know. We use a lot of those kits and do pretty well on them.”
Insurance company: “Yes, but our actuary points out that Colorado has seen a 15% increase in HRIG treatments in emergency rooms for rabies exposure over the past few years. People do not argue the cost of treatment when they know that if they are exposed they will possibly die without treatment. In fact, our actuary says only 8 people in 100 ever even begin to challenge the costs associated with this type of incident. It is a very safe bet you will do better with ten vaccinations that will bring you $250K than we will do with the reduced price for trauma kits. What do you say?”
Healthcare Provider: “Make it a 8% discount on the trauma kits and $27k on the rabies and we have a deal.”
Insurance company: “Deal!”
My research, which I turned over to a gifted attorney, indicated that that most countries use ERIG (Equine Rabies Immune Globulin) when treating rabies and that it is shown to be just as effective as HRIG. No, the ERIG is not for horses alone, but it is made using equine based ingredients (E) as opposed to human based ingredients (H). The difference is amazing in terms of price. ERIG costs just a few dollars per dose. and at the time I did my research, the HRIG cost was $14/dose. Today, the average price for treating rabies runs about $40 according to the World Health Organization. Remember, 15,000,000 people around the world get treated for rabies. If everybody paid on an average of the $29,000 that we were charged, that would come to $435,000,000,000. People in third world countries struggle with $40 as the average income in the areas where rabies is most predominant make only $2 per day per family. Only here in the US can somebody get away with asking two retired school teachers for $59k for a set of injections who may or may not have been bitten by a rabid bat. And for many, many people, that would represent bankruptcy.
Those of you who are looking to attach your anger about Obamacare or the newly devised AHCA that has yet to be revised by the Senate can just forget it. This is why we need to get insurance companies out of our healthcare model. Think about this: INSURANCE COMPANIES DO NOT MAKE ANYONE WELL. THEY DO NOT GIVE INJECTIONS OR EVEN DISTRIBUTE BANDAIDS. THEY JUST DRIVE UP THE COST OF MEDICAL PROCEDURES AND THEN PAY LOBBYISTS TO SELL THEIR SCAMS TO POLITICIANS. I could have taken Gaye to Paris or Montreal, got our injections and vacationed for the price we were billed. Oh, sure they came down on the price some when we said we were going to fight them, but that is not the point. The point is that our system of healthcare is corrupt and immoral. The leading cause of bankruptcy in our country is health related. We are the only major country on the planet that plays this game and it has to stop.
I went to the town hall meeting for Congressman (4th District) Ken Buck in Parker on May 10th. We did not see eye to eye on much, but when I related our rabies story to him he dropped the false argument about our healthcare system costing more because it is the very best in the world. I contend that it can only be best if it serves people and our outcomes are the very best. They are not. When I told him that I was able to fight the system and get the price down to a manageable amount with the help of a good attorney and some decent research, he seemed pleased. That said, I told him it is immoral that everyone in the room is just a healthcare emergency away from losing everything, and he agreed. Did I make a dent in his opinion of the AHCA or the demolition of Obamacare by his political party? I sincerely doubt it…but one can hold out hope.
Dear people, stop injecting politics into the healthcare argument. It is either affordable for everyone or it is not. If you believe that it is okay to precociously charge unwitting patients ungodly amounts for a life or death vaccine that only costs a few dollars to make just so that a CEO for a healthcare group or an insurance company can buy another mansion in Aspen, then you-are-part-of-the-problem. Healthcare organizations and forward thinking countries around the have figured this out and I believe it is time to admit that we have been played like a fiddle. Whatever we end up with for healthcare in the United States, at least let it be known that we see how we are being devalued as human beings by wealthy corporate CEO's. And that, my friends, is not a batshit crazy thing to say.
What to do if exposed to a possibly rabid animal in Colorado.
