25 January 2012

The double tragedy of Sarah Burke

While training on that halfpipe slope, Canadian freestyle skier Sarah Burke suffered a torn vertebral artery in her neck that caused bleeding in her brain, an injury that she would die from...
That's the first tragedy.  The Center for Public Integrity explains the second:
...her family will be laying her to rest in her native Canada — and pleading for money to help cover the estimated $550,000 they owe for the medical care she received at University of Utah Hospital over nine days.

The irony is that had the accident occurred in Canada... her care would have been covered because, unlike the U.S., Canada has a system of universal coverage...

It is clear the family needs help. Not only are they grieving, they are facing financial ruin, simply because Sarah Burke’s accident was in the United States of America. 
And, in case you are wondering about who pays for Gabrielle Giffords' rehab, that is discussed at ScienceBlogs' Pump Handle public health blog -
"Congresswoman Giffords was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act."...

The type of acute rehabilitation she receives - involving speech, occupational and physical rehab - costs about $8,000 a day, according to the Brain Injury Association of America. Post-acute rehabilitation can range in cost from $600 to $2,500 daily. The expenses leave the treatment options well out of reach for most patients whose insurers won't pay for the services. 
Photo: Doug Pensinger/Getty Images.


  1. ...this post isn't very clear -- if this had happened in Canada (i.e. foreign athlete injured and subsequently dies) -- the family of the deceased would face a hospital bill from the Canadian hospital. Only Canadian residents are covered by the Canadian system, and then only if they have applied for coverage... for most Canadians, that means paying health insurance premiums.

    Speaking as a Canadian who has lived in both countries: I prefer the American system -- at least I can choose my health care provider in the USA. The Canadian system is single provider, i.e. there is no choice. Plus it's a rationed system -- immigrants and people that relocate can wait years to find a family doctor that accepts a new patient.

    Finally -- the family doesn't need help -- money to pay the bills was raised through donations:


    1. Your perspective is clearly based on having good medical coverage and the resources to keep that coverage in force. You must have pretty good coverage to be able to choose whatever provider you want. Most bare-bones insurance limit you to a pool of approved providers. And depending on where you live and what insurance you carry you will find many U.S. providers have waiting lists. Particularly primary care and OB-gyn physicians. May you continue to be able to enjoy a perspective of privilege and complacent comfort.

    2. I've experienced both the Canadian and American health care systems firth hand by breaking an arm in each nation. As a Canadian, I was covered by the national system. In the USA I have (pretty great really) health insurance through my company. Honestly, the experience was fairly similar. I may have received slightly better treatment in Canada but only because I was at a shinny new hospital (my accident in America was out in the sticks). I got to have a great knock-down-drag-out fight with the insurance company after treatment, but it all worked out in the end.

      It is important to note that *both* systems are rationed. There is a finite amount of medical resources to go around. In Canada, health care is (intended) to be rationed based on need. This can really suck sometimes. In the USA is is rationed by the ability to pay.

      At the end of the day I can only say that I was very happy to have insurance in both cases.

    3. BJN -- privilege and complacency??? There's an assumption! I lived "insurance free" for my last 8 years in USA. I didn't break an arm -- but I hurt my ankle bad enough to need treatment for months... I found it for less than the cost of medical insurance. It was alternative medicine -- but I'm happy with that, and would entrust a broken arm to that modality too.

      This is not possible in Canada except maybe Vancouver & Toronto, because the national system operates a monopoly: given the choice between "free" treatment, and paid alternative medicine, most Canadians will choose free... doctors of alternative modalities are few and far between.

    4. Your comment about not being able to choose your doctor in Canada is specious and misleading. There is definitely a shortage of doctors in some areas - as in the U.S. - but that doesn't mean you're forced to see one doctor. If you don't like your doctor, you're free to choose another. They might get huffy about it, but the choice is still yours, providing there is a choice in your area. I live in a rural area of Nova Scotia, and as long as I'm willing to drive a moderate distance, I can see whichever doctor I chose, providing they are accepting new patients. This goes for GP's and specialists, BTW - as I recently found out myself due to a newly-diagnosed heart condition.

  2. As a professional athlete why didn't she have insurance to cover her? When I travel outside my home country I always make certain that I have health insurance coverage (came in handy in Italy once)... and my job doesn't really depend on my physical health being tip top.

    She clearly wasn't so poor that she couldn't afford health insurance.... she just choose to go without.

    Also... her parents are no on the hook for her medical costs. Only her estate is. They do not owe the 550k - she did.

    1. You seem to miss the entire point of the post.

    2. She would have been covered if she had been taking place in an event sanctioned by her professional organization, but this was an unsanctioned event and she was traveling/appearing courtesy of a sponsor - some power drink brand, I believe - who ungraciously decided not to pick up the tab.

    3. If I represented an insurance company, a freestyle snowboarder would be the LAST person I would insure.

    4. Why? They can charge outrageous premiums on the off chance that someone is going to seriously hurt themselves. What happened to Ms. Burke is a tragic accident, but just that - an accident. Such serious accidents don't really happen that often, and the insurance companies are laughing all the way to the bank on the usurious premiums they charge. Nice work if you can get it, I say!

  3. at least I can choose my health care provider in the USA.

    If you have the means to. A glaring difference between the two systems.

  4. I live in Canada and I can choose my health care provider. Not sure where this idea that you can't is coming from...

    1. You have a choice??? What province is that??? I have no choice -- I have to use the Medical Services Plan of British Columbia -- in an emergency, I have to use one of their hospitals -- and I have to wait until a doctor in their system is accepting new patients -- until then -- I can only use a walk in clinic which is also administered by MSPBC.

      Things I'd like my doctor to know about are nutrition and exercise -- but the Canadian medical system doesn't require doctors to understand these subjects.

    2. If US doctors knew about nutrition and exercise perhaps there wouldn't be an epidemic of obesity in this country.

      I had a hard time finding a doctor when my employer changed insurance plans and my doctor of many years was no longer an approved provider. I now have to go 30 miles to see a doctor; which is okay as long as I'm not sick, but I wouldn't want to have to travel that far on public transit if I were ill (I don't own a car).

    3. Don't blame doctors for people's choices... often times, obesity is a lifestyle choice. I can only speak of my own experience -- I'd pick health treatment options available in California over the ones where I live in Canada now any day. I lived insurance and car free in California for the last 8 years I was there.

    4. I wasn't blaming doctors, only trying to point out that doctors in the US probably know as little about nutrition and exercise as doctors in Canada.

      Your options in California (where I live) are only as good as your insurance, which is only as good as what your employer will provide, or you can afford to pay for out of your own pocket. And, to reiterate, when an employer changes insurance providers, because the cost of the previous insurance company has become too expensive, employees have to scramble to find physicians who will accept the new insurance and are taking new patients -- that wouldn't happen under a single-payer system.

      I think both countries can provide quality medical care; it's just that in Canada you are not likely to go without coverage, or be bankrupted because of a medical problem, an occurrence that happens all too often here in the US.

    5. PETER These comments are truly ridiculous, The US standards in health care are so far inferior to Canada, forget even trying to compare, your clearly a textbook example of American ignorance and ego i believe you are American even tho you say you lived in Canada, this isnt a pissing contest, ppl with the financial means get superior treatment while ppl who dont do not!! Everyone in Canada receives the same options!! Thank God im Canadian

  5. The actual expenses are approximately $200K, not $550 according to the "Salt Lake Tribune". A website set up to raise funds for her care says it has raised about $285K.

    I don't mean to minimize the financial peril that the U.S. medical system deals out to nearly everyone who has a medical crisis. A famous skier and a Congresswoman got far more help and attention than an average citizen or visitor.

  6. Two things - firstly, if you're visiting another country, particularly to do a dangerous sport, you really ought to buy appropriate insurance. When we travel in Europe we don't need to as our E111 form covers us, but when we're elsewhere we carry appropriate cover.
    Secondly - I wouldn't swap our NHS for the American system for anything. Sure, if you can afford it, it's probably very good, but if you can't, you're stuffed.

  7. The American system is built on outrageous list prices and deep discounts for the insurance companies. Cash patients have to pay the outrageous list price, which is inherently unfair to those struggling to break out of poverty and left in the gap between Medicaid (coverage for the poor), and making enough money to pay $1000 a month for a private or employer sponsored plan.

    America "could" have a great healthcare system if the government would limit insurance discounts to 50% of list price. In some cases today, cash patients pay 20 times more than insurance companies do...for the exact same procedure.

  8. I am Canadian. I live in a small Ontario town on the border of Michigan. I in a hospital in a Rehab unit with 38 patients. These patients are mostly strokes and joint. These patients get a least 1 hour each of Physio and Occupational therapy a day. They also get speech therapy if they need it, and have access to recreational therapy if they want it. All for free. The people I see everyday all desperately need these therapies, but I doubt if most of them would be able to afford it if they lived in the US. A lot of these people are retired and if they lived in the US may not be able to afford insurance. No workplace insurance for them.
    My hospital benefits offer me additional insurance. What this means is that I get my drugs free and if I travel outside the country I am covered. It also covers me for alternative therapies like massage and acupuncture etc. This is in addition to what my province gives me. As an Ontario citizen I am entitled to go to any Doctor in the province I want to I can go to any hospital, any walk in clinic, get lab work and X-rays done anywhere. If I need to see a specialist, I would have to have a referral from a family Doctor, but I could see anyone I wanted. These referrals could be for a specializing Doctor or Some kind of therapy. (We do have private therapy clinics in Canada, but you have to pay) I don't understand when people who are not Canadian say we can't choose our healthcare provider.
    On the Rehab unit we always have a few patients with dual citizenship, that always come back to Canada for health care, even though they are currently living in the US.
    Now all that being said, our healthcare is not free. I pay 40% income tax. I don't mind paying it because it means that the social services will be there for me when I am older and May need them. That 40% also pays for things like highways, education, public parks, police, fire services, and, My Wages! I do resent that it also pays for 2nd, 3rd and 4th generation welfare.
    When I talk to US citizens or when I watch TV, I am amazed at what a good job the American insurance industry has done to convince most of the population that free healthcare is bad. I wish that I could bring each American and show them our health care system, and that you don't have to suffer and hope you aren’t badly hurt when anything goes wrong. How many Americans have put off going to the Doctor when their child had something like an earache or banged their head only to have something go drastically wrong because they waited too long? Something that could have been fixed if it had been caught early enough. Wouldn’t be nice to know that you could go see a doctor anytime you need to and not have to worry about the cost? What I see is that the people that are low income think that the government will take care of them and they don't get involved. They see those ads on TV and think that they are true. The people that are medium to high paying jobs have health insurance, so they are not worried. But what if they lose those jobs, wouldn't it be nice if US citizens were all covered no mater what?
    The people that have insurance seem to be really proud of that. Maybe if everybody had insurance they wouldn't feel as special? Kind of like the Indian cast system.
    I recently read a study where 15 people were given an amount of money. One person got $15 the next $14 the next $13 etc all the way down to the last person only getting $1. These people were told that they had to give $1 to either the person with $1 more then them or the person with $1 less them them. Most people gave their money to the person with more money then them. When asked why they did this, they said that they didn't want to give it to the person with less then them because they wouldn't be as high on the money ladder. So I have to wonder if people don't want universal healthcare due to loss of status.

  9. People are so quick to blame the victim here.. Don't you guys see how outrageous it is, extremely rich politicians get nearly free healthcare.. But normal people have to go bankrupt.
    The richest country in the world. Yet the people are always afraid of stubbing a toe. breaking a bone. What's the point of being rich if you, your gov't and your neighbors don't have each other's back in a crisis?

  10. As an American, I have health insurance though my employer - NOW - and I only have a "choice" if I want to pay an impossible proportion of my income for coverage that will actually pay my doctor more than I give him in copays. Six years ago, I was a part-tie college student, aged out of my parent's coverage (the age has since been extended) and struggling to pay the rent, school bills, and everything else. I suffered a sub-arachnoid hemorrhage - not dissimilar to what killed Ms. Burke, but less dire. Still, the majority of sufferers are left dead or with significant deficit.

    I worked in technical theater. Per diem. No insurance, and no "choice" to do anything differently if I wanted to finish my degree. No "choice" in health insurance if I wanted to keep a roof over my head. The bill? $130,000.

    This "choice" that we Americans have is one that privileged people can make. The reality is that it's about as fictional as the mythic "choice" to find an employer that offers healthcare when you get out of school.

    ...Because... you know... I chose not to. Because the $12 an hour was just too good to pass up. Right.

  11. I am a US citizen and did not have health insurance for many, many years, simply because I couldn't afford it. It was a choice of groceries or health insurance. I'd spent a good portion of my childhood in Canada, so I understood the health care system there. I also had the good fortune of living in Europe for a couple of years while I was in college - the healthcare was also free there. With all the nonsense in the US about how social healthcare is somehow bad, I'm awfully tempted to just move to Canada.

  12. The family does not face financial ruin in the least. Her estate faces a lost of a half-million dollars or whatever amount could be negotiated. The family does not owe a single cent. I wonder how much scrutiny will be done regarding the funds raised

  13. @Bernard Black - Are you seriously suggesting the family are looking to profit from their famous daughters passing? Get a moral and human perspective in your life.

    I would point out that in Europe an E111 will not cover medical expenses incurred as a result of a skiing accident, helivac off the hill or repatriation, live or dead. It will cover drugs and hospital treatment but I would suggest anyone competing / engaging in snowsports ensures they are adequately / over covered.
    I have received excellent medical care in the US for a snowsports injury. It did require me to offer up a credit card for 600dollars for a 3 hour trip to the Emergency Room.
    My wife has received excellent expert medical care in France for a snowsports injury. She was fully insured for the trip and the cost was minimal.
    Individuals need to be cognisant of the system in which they will be cared for. Sarah Burke's case is a tragedy, and I would have expected her 'sponsors' to be more forthcoming.

  14. I'm very happy with Kaiser (California)and Medicare. I pay about $300 a month, with low co-pays for doctor visits and prescriptions. Tests, such as blood tests, X-rays, CAT scans, etc. are no additional cost. I sincerely hope that someday this country will join the rest of the industrialized nations and provide nationalized, single-payer care. The so-called "Obama Care" is a step in the right direction, but we still have a long way to go.

  15. Although I realise the posting was to illuminate the US health care situtation, Toronto newspapers reported that as of Jan 21 - some 24 hours after the request for donations from the family to cover Sarah's medical costs - will indeed cover the costs:

    The last 24 hours of generosity looks to have closed a $200,000 gap, said Burke’s publicist, Nicole Wool.
    It was originally believed the hospital bills would be $550,000.
    “We just received the numbers from the hospital today” said Wool.
    “Once charges are finalized, the University will work with Health Canada to determine what type of coverage may be available and what their contribution will be, as Sarah is a Canadian citizen.
    “Because of the donations in the last day, it is now clear that Sarah’s family will not have any financial burden related to her care.”
    Wool said any donations above and beyond will go towards establishing a foundation “to honour Sarah’s legacy and promote the ideals she valued and embodied.”
    The medical costs were incurred while Burke was undergoing surgery and treatment at the University of Utah Hospital in Salt Lake City.
    Burke died Thursday after being critically injured in a Jan. 10 crash during a training run at an event in Park City, Utah.
    (Proud to be Canadian ...)

  16. I am a dual citizen and have experienced both systems. A story: my grandfather came to my university graduation and had a heart attack while in Canada he was in intensive care for three days. While he was there all the doctors came to look at his porta-cat (IIRC a medical device that allows injections to be made without needle pokes) a comfort that was the first the doctors (this was 20 years ago) had ever seen. On his return to the U.S. his insurance company called him to inquire as to whether there should be an additional zero on the Canadian Hospitals bill - of $15,000.

    In short, my experience has been with major trauma's any difference in medical care is trivial. It is undoubted that attending an emergency room in Canada with a minor complaint (ie. on a weekend when your doctor cannot accommodate you or if you have no family doctor) can involve waiting a number of hours for treatment. However this is the price many Canadians are willing to pay for their system.

  17. @DrSnowboard I don't see what's wrong with @Bernard Black's assessment of the situation, at least if this post is to be believed. It's really unclear how the family would be on the hook for the medical treatment she received here. When was the last time your parents got a bill for your hospitalization (or anything else for that matter...)? Hospitals generally just go ahead and treat patients who are in critical condition and hope for the best, both for the patient and for the patient's ability to pay. I suppose the family could have come in and put their credit cards down and asked the hospital to go down a very high-cost, low-probability-of-success treatment plan that the hospital wouldn't have otherwise undertaken, but the fact that that ran up huge fees isn't our system's fault. That care would have just been denied if they were in Canada.

    None of this is to mitigate the terrible tragedy of what happened here, but a family getting nailed with bills for treatment that their daughter/sister/loved one received is very unlikely to be part of the story. So, yeah, at least the way this post makes it sound, it sounds like the family is raising money to cover costs they were never on the hook for. If there's money in Sarah Burke's estate to pay the hospital, then the $500k will only go to lessen the amount the family inherits from the estate.

    And it does seem pretty crazy to be a professional extreme athlete and not carry both health and life insurance.


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