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The Price of My Health Emergency in Hawaii
Lawrence Boyd almost died and then lived in fear of the medical bills in a state with the nation's highest cost of living. He was in for a surprise.

About the Author

  • Lawrence Boyd
    Bill Boyd has a Ph.D in Economics and has been a faculty member in the University of Hawaii system since 1994. His enjoys scuba diving, hiking and distance swimming. He is still trying to learn how to paddleboard.

On February 10, 2015, I decided against going for a long swim. I stayed in my Waikiki apartment and moved from a chair to bed to the bath — restless, but not alarmed.

Then I almost died.

The story that inspired this one

I felt hot and cold at the same time, somehow disconnected from my body. I don’t recall what I ate. I don’t know if my wife and I watched a Sunday sunset. If I had died, that sunset might have had special significance.

That night, I developed the worst headache of my life. By 2 a.m. it got so bad that my wife, Michelle, and I thought about calling 911.

I don’t really remember the terrible pain. What I recall about it is more of metaphors than the actual sensations. It was like my brain was erupting from my skull. I felt like my eyes were being forced out of my head. Nausea overtook me.

But who dials 911 for a headache?

Lawrence Boyd after stroke

After nearly dying, Lawrence Boyd woke up in the hospital, uncertain about what had happened or how much it might cost.

Courtesy of Lawrence Boyd

After the pain became unbearable, I blurted out, “I think I’m dying.”

We did call 911. We requested “no siren” — we didn’t want to disturb the neighbors.

Quietly, the ambulance arrived. Then I threw up. Twice. In the ambulance, I asked for pain medication. The EMTs said no.

Hours later, at Kaiser Permanente’s Moanalua Medical Center in Red Hill, I woke up with my hands tied to a bed. I was in the intensive care unit. And I was still nauseous.

I had lost my ability to control my body.

I felt great joy at being alive, but a great fear of the looming costs. By that I mean medical bills, not the physical or psychological price.

Michelle told me I had suffered a stroke and undergone brain surgery. I had, fortunately, been brought to the hospital during a tiny window of time in which successful surgery was possible.

Constant nausea and occasional vomiting stayed with me for weeks. It was the physical discomfort caused by stroke that made me most miserable. I lost 25 pounds.

I now realize mental problems from my illness have caused me more suffering than the physical difficulties. Modern medicine is great at dealing with physical problems. There are meds for nausea and pain, and hospital staff usually give them to you when you ask, even if I was a bit shy about asking.

My neurosurgeon — it feels weird to type those words even now — told me that over the next year full recovery was possible.

He suggested I treat my survival “as a second chance.”

The Cost of Surviving

I felt great joy at being alive, but a great fear of the looming costs. By that I mean medical bills, not the physical or psychological price.

I began to obsess about finances. How much sick leave did I have? It may sound a little strange, but I had more than 2,000 hours, accrued over 20 years as a faculty member at the University of Hawaii.

My recovery began. Physical and occupational therapists helped me walk again. I became more self-sufficient. Questions arose. Should I go to a rehab hospital or go home? I was pleasantly surprised to discover that home healthcare included visits by the therapists, as well as a registered nurse.

Once home, I spent small amounts of money installing rails in my bathroom and mail-ordering supplies from CVS and Amazon. (An electric razor was a necessity for shaving because I didn’t trust myself with a blade.)

Such expenses rekindled my fear of big medical bills. So began my wife’s tortured trips to the mailbox. We opened every letter from the insurance company in fear. Helpfully, many letters began with the words: “This is not a bill.”

But the first bill eventually came, not from Kaiser, but from the ambulance service. It was for $1,075. It seems that the city had privatized this service. Michelle was crying when she handed it to me.

A second look revealed a form on the back for insurance information. The ambulance was covered.

Lawrence Boyd with walker

Recovery from a stroke, when possible, can be a lengthy process and it can bring unexpected costs.

Courtesy of Lawrence Boyd

The breadth of the insurance coverage was comforting, but at that time I couldn’t physically fill out forms. It was a small example of how our health care system doesn’t always take patients’ circumstances into account. But, all things considered, that complaint is small.


It was interesting how my family reacted to my illness, and the role of the insurance company. My diverse relatives — they include people who learn about world events from Fox News and others who are public school teachers — are scattered around the country. They and friends called me in Hawaii when they heard about my stroke.

In those conversations, we inevitably focused on our medical “war stories.” I described my care and coverage, which inspired some of them to share their own health sagas.

I never knew that medical bills had caused some of them to declare bankruptcy. In fact I didn’t know anyone in my family had ever declared bankruptcy. Others had spent years paying off healthcare debts.

As an economist, Hawaii’s astonishingly low rates of personal bankruptcy have mystified me. Hawaii is always in the bottom 10 states when it comes to bankruptcies per capita. We were 47th in 2014. Nationally the biggest reason for bankruptcy is medical debt. People have often explained this away by citing cultural reasons, but I now believe this has to do with the level and quality of health insurance here.

My family members’ problems stemmed from being under-insured rather than not having any coverage. I realized I have also been periodically under-insured.

Like the vast majority of people in Hawaii, I do have insurance. Since 1975, Hawaii has had employer-mandated insurance because of the Prepaid Health Care Act, known as PHCA. At least 90 percent of Hawaii’s population is covered by health insurance.

But until recently, I hadn’t really thought about the quality of that insurance.

By Hawaii standards, my insurance is average. (In fact, our condo association has the same plan for its employees.)

I was naïve. I thought good genes, exercise, diet and regular doctor’s visits meant I was invulnerable.

That said, there are some unusual things about my situation.

Fortunately, I am a union member in the University of Hawaii Professional Assembly. I have good benefits that include enough paid sick leave for my recovery.

I now understand why this should be a right for everyone, rather than a privilege for a few.

And taking advantage of that “second chance” is a whole lot easier when you aren’t dealing with a bankruptcy.

Invulnerable No More

Strokes often kill people, and survivors can lose their mental and physical capacities. After the stroke, it is possible to exist in a sort grey time, in a room that feels untethered from sunsets and sunrises. You can lose your grounding in reality.

But for me, there is an irony. I now seem to see things more clearly than I did before my stroke.

I was naïve. I thought good genes, exercise, diet and regular doctor’s visits meant I was invulnerable.

My stroke was probably caused by an irregular heartbeat. Since that happened occasionally, it went undetected despite regular medical checkups. (Some unlucky marathoners have developed this condition, too.)

Lawrence Boyd rehabbing

Boyd is working toward a full recovery within a year of the stroke.

Courtesy of Lawrence Boyd

So I now understand that much of our lives are governed by chance. That’s why insurance exists.

This has all been humbling for me. I can’t even say I had the foresight to purchase great insurance. My belief in my invulnerability meant that each year I chose the health plan with the lowest copay.

There’s no other way to say it: I got lucky about the timing of my misfortune.

One year, trying to minimize my copay, I mistakenly switched to a Kaiser plan that didn’t include major medical coverage at all. I only discovered this later when I got a letter in the mail from them. If the stroke had occurred during that year, my wife and I would be facing a bill for more than $200,000 now. Back then, it cost just a few dollars a month to upgrade my Kaiser insurance, which resulted in all the bills being covered.

I didn’t plan for a stroke that I never expected. I changed my policy because I dove, kayaked, and hiked a lot. I think I was worried about shark attacks or the bends. I never thought I might suffer the actual emergency I had.

I got lucky about the timing of my misfortune.

As an economist I’m familiar with Oscar Wilde’s description of us: “An economist is someone who knows the price of everything but the value of nothing.” My second chance means I now appropriately value my life and mental clarity.

And the value of universal health care, particularly in a place like Hawaii.

Then there are values I now embrace more fully; gratitude; compassion and love.

Do you have a story about the human impact of the cost of living in the islands, whether about you or someone you know? If so, click on the red pencil button share it through Connections or drop me a note at epape@civilbeat.com.

And join Civil Beat’s Facebook group on the cost of living in Hawaii to continue the conversation about this story, or to discuss broader practical and political solutions for the islands.