Report: Death By For-Profit Healthcare
- 1 Death by For-Profit Health Care
- 1.1 Executive Summary
- 1.2 Medical Debt: A Weapon of Class War
- 1.3 Eat The Young
- 1.4 Medical Debt and Bankruptcy - The Insurance Hoax
- 1.5 Disappearing Public Hospitals
- 1.6 The Debt Spiral
- 1.7 The Shame of Debt
- 1.8 Medical Debt and the Dystopian Nightmare of Credit Scoring
- 1.9 Who Profits from Medical Debt?
- 1.10 Won't Obama's Affordable Care Act Reduce Medical Debt?
- 1.11 Life or Debt?
- 1.12 Sources
Death by For-Profit Health Care
A Strike Debt Report
This Strike Debt report is part of an ongoing effort by a group of health care practitioners, lawyers, researchers, and activists to expose the disastrous impact of medical debt and for-profit health care on families and individuals in the United States. Private health care enriches a few-insurance companies, private equity firms, pharmaceutical companies, debt collectors, and global investors-at the expense of everyone else. Medical debt is a weapon of the class war because when patients cannot afford medical care, they are forced into debt, often with far ranging and catastrophic consequences. As the rate of uninsured has grown, local governments have looked to state subsidies for private health insurance as a band-aid solution. Massachusetts has implemented such a program, and the Obama Administration's Affordable Care Act has expanded this initiative on a national scale. Unfortunately, the ACA will not solve the problem because its primary goal is to expand the market-based system that has already proved to be a miserable failure. Insurance companies profit by denying coverage. As costs rise and benefits shrink, patients will continue to pay the price. We are in a major health care crisis, the consequences of which will be felt for decades to come. There is only one real solution: a grassroots social movement to demand universal health care, an end to the scourge of medical debt, and a national conversation on the meaning of health and wellness.
Medical Debt: A Weapon of Class War
The price of for-profit medical care is increasing at a relentless pace while quality is declining. Fifty million people have no insurance and 77 million have trouble paying medical bills (Rukavina). Despite these inequities, the US spends more on care than any other wealthy country in the world. The for-profit health care industry sucks up 18% of Gross Domestic Product, more than twice what countries that have publicly-financed health care spend. Despite the high cost, Americans are sicker and die earlier than people in other developed nations ("Shorter Lives").
People without insurance must privately finance health care. Less well understood, however, is that medical debt is not only a problem for those without coverage. One in five adults who are privately insured struggle to pay medical bills. Even more scandalous is the fact that Americans are paying more for weaker coverage ("Shorter Lives"). According to the Commonwealth Fund, the cost of insurance has outpaced wage increases for the last ten years. Employers are shifting these costs to employees and their families. Premiums increased 62% from 2003 to 2011 ("State Trends"). For at least ten million Americans, deductibles are so high that their insurance plans are little more than scams, providing a false sense of security in hard times (Young).
The cost of health care has also risen faster than inflation. As a result, over the last few years, families have had little choice but to accept lower wages to hold on to benefits that, in the case of a serious illness or accident, may not protect them from financial disaster. For many working people, the trade-off is simple: your money or your life. If you have a job and insurance, you may feel that you are protected. But that is false. No one is truly safe from a for-profit health care industry that preys on patients and families at the most vulnerable moments. Since insurance companies and for-profit providers also fund political campaigns, we can expect no help from politicians. The best hope we have is to ally with others in our circumstances to fight back and claim health care as a human right.
In 1996, while insured by United Healthcare, I had to undergo open heart surgery. Serious stuff-your circulation is diverted to a machine, your ribs opened up, your body cooled to about 70 degrees, your heart stopped and cut open, etc. My operation happened a day later than scheduled, because on the first attempt, after I was anesthetized, a tube used in the setup caused internal bleeding. The 2nd day I was anesthetized again and the operation was successful. Then the billing problem began. US Healthcare refused to pay for the 2nd anesthesia because by their rules, they only pay for 1 anesthesia for this operation. (This, despite the surgeon's report about the internal bleeding on the first attempt and the obvious fact that such a surgery could not conceivably happen without anesthesia!) For more than 6 months US Healthcare continued to refuse to pay, and Mt Sinai Hospital continued to bill me directly for more than $4000. And the "in network" surgeon billed me directly for the 1/2 of his fee that US Healthcare wouldn't pay (another $2500). I'm mighty bullheaded, and wrote plenty of letters. US Healthcare finally did pay up. But what if I didn't know I could fight it, as many people might not? - Anonymous, New York
== We're All at Risk ==
Almost everyone is affected by medical debt. The for-profit health care industry is designed to benefit a few at the expense of the rest. Debtors and non-debtors alike are forced to pay out-ofpocket for everything from basic care to life-saving operations. As patients, most of us understand instinctually that someone is making out like a bandit when we get sick. This becomes clear the minute you walk into a doctor's office or a hospital where you open your wallet to make an up-front payment, sometimes called a co-pay, before seeing a doctor. The costs can start piling up from there, even if you have insurance. If you have a serious illness or accident, it's unlikely that your insurance will cover all-or even most-of the care you need. What insurance doesn't pay, you're responsible for. Predictably, medical debt discriminates along familiar lines. According the Commonwealth Fund,
- Among the working-age population, 39 percent of women have medical bill problems, compared with just 25 percent of men. More than half of working-age African Americans (52%) report medical bill problems, in contrast with 34 percent of Hispanics and 28 percent of whites ("Seeing Red").
Although medical debt affects some more than others, it cuts across lines of class, race, and gender. In fact, rates of medical indebtedness are comparable for people with and without insurance ("Consequences"). Insurance companies make a profit by denying claims. In the words of Dr. David Himmelstein, of Physicians for a National Health Program,
- Private health insurance is akin to an umbrella that melts in the rain. It simply isn't there for you when you most need it.
How long are we willing to stand under our worthless umbrellas and pray that it doesn't rain? Many health plans don't cover all the treatments for a serious illness or accident. Others limit the total amount of benefits or require absurdly high deductibles, putting necessary care out of reach for people who believe they are protected ("Seeing Red"). According to the Access Project, a non-profit research and advocacy organization,
- Americans spent $300 billion on out-ofpocket costs in 2010; a figure over and above the cost of health insurance premiums (Rukavina).
People will say that we can't afford universal health care, that those of us who believe otherwise are living a foolish dream. But they are wrong. The dreamers have it right this time. We're not making an argument about affordability or appealing for the creation of what some call the Welfare State. We're saying that it is time to pay attention to the overwhelming evidence that for-profit health care is killing us. It's time to wake up from our national health care nightmare.
Eat The Young
Who is paying the price for our profit-based system? It may be obvious that low-income people pay a higher percentage of their income for health care. But the young are also at a high risk for incurring medical debt. This is because those ages 19-29 are more likely to lack health insurance than older Americans. Many low-wage employers that hire young adults do not provide coverage, and since the 2008 financial crisis, new college graduates have disproportionately high rates of unemployment and underemployment. Through a toxic combination of college loans, medical debt, and a recession caused by banks, many people's financial lives are ruined before they are even out of their 20s. Is this what we want for young people in America?
The evidence that publicly-funded care is far better than our current system is staggering. It turns out, when it comes to medical debt, it is better to be over 65 and sick than to be young and healthy (Garcia). Older people actually have the lowest rates of medical debt because they qualify for government-supported programs like Medicare. From the right and left of the political establishment, we hear no end of fearmongering about "socialism" and how awful it would be if health care became a public benefit, like it is in many countries around the world. But the truth is that Americans on Medicare and Medicaid are much less likely to lay awake at night fearing that the next medical procedure will force them into bankruptcy or foreclosure. It's time to rethink what obligations we owe to the young, what kind of promises we want to make to those who come after us, and how we intend to keep them.
Medical Debt and Bankruptcy - The Insurance Hoax
Bankruptcy is often presumed to be the result of profligate living by consumers who overspent on luxury items. Don't live beyond your means is common advice, as if personal responsibility is the only thing that matters in an economy that almost collapsed only 5 years ago. In fact, people are being forced into bankruptcy in America because they had the audacity to get sick without millions of dollars in the bank. Or, they believed their private health plan would protect them from the worst. By the time many realize that for-profit health care is a hoax, it's too late. The crisis is gaining steam. Just thirty years ago, debtors rarely filed for bankruptcy as a result of a medical problem. Today, an astonishing 62% of personal bankruptcies are linked to medical debt.
The link between medical debt and bankruptcy also shatters the myth of personal responsibility that makes many of us feel as if we are to blame if we can't afford basic needs. According to a report in the American Journal of Medicine, most people who declare bankruptcy as a result of medical debt had insurance at the time they incurred the debt (Himmelstein). Furthermore, the majority of medical debtors who declared bankruptcy attended college, owned their own home, and had middle-class jobs. They did everything "right," yet they were still financially devastated when a member of their family got sick or had an accident.
You might think that a sharp uptick in the number of medical debtors filing for bankruptcy would prompt the government to step in. After all, no one chooses to go into medical debt. Yet, our delusional Congress assumed people were abusing the bankruptcy law when their lives were turned upside down by an unexpected medical expense. In 2005, Congress enacted the Bankruptcy Abuse Prevention and Consumer Protection Act which made it even more difficult for people to file for bankruptcy. During this same period, the number of under-insured grew from 15.6 million people to 25.2 million (Himmelstein). To sum up the catastrophe: as a response to the rising cost of care and a growing number of Americans who cannot afford their medical bills, Congress responded by throwing up more barriers to bankruptcy. It's not that bankruptcy is a real solution, since it does not address the fundamental economic conditions that pushed individuals to bankruptcy in the first place. The point is that our elected representatives are out of touch and out of time. They have little to offer us but moralizing and useless reforms. The only reasonable response is collective action to create a health care program that reimagines the meaning of care and puts people before profits.
Disappearing Public Hospitals
If you have ever needed medical care but didn't have insurance, you most likely went to a public hospital or clinic. There are approximately 1,131 public hospitals in the US (Fraze). These institutions, which serve 75 percent more uninsured patients than their private counterparts, are a vital resource for low-income and uninsured patients. Yet, public hospitals are disappearing. Like public schools, they have been swept up in a wave of privatization: the public sector is being dismantled to create new profit streams for the super-rich, most of whom have never been to the local communities from which they are siphoning wealth. If your public hospital seems disorganized and dilapidated, it is easy to assume that it is being mismanaged at the local level. Hospitals have also been caught up in the same global economic changes that are at the root of the rising cost of care and ballooning rates of medical debt.
Hospital privatization is sweeping the country, and states like New York and Louisiana are leading the way. In early 2013, Governor Cuomo announced a budget that would mark the beginning of the end of publicly-funded hospitals in New York state. He is seeking to close Brooklyn's Long Island College Hospital and Interfaith Medical Center and replace them with private versions (Frost). The property where the hospital sits is also being eyed by developers as a location for a luxury condominium (Lutz). Shuttering lich is a significant step that has ramifications far beyond the fate of one institution. It would set a precedent for turning public hospitals over to the private sector, a move that Assemblywoman Joan Millman called "troubling" because private hospitals have a "fiduciary responsibility to their stockholders, not their patients." In an era when tens of millions of patients are drowning in medical debt and the number of uninsured is on the rise, public officials like Cuomo actual y believe the solution is to eliminate those few institutions that serve people in need to create a new market for the global investor class.
I had 30 minutes of outpatient surgery while I was uninsured. I fought the debt. I went as high as you can go in the hospital hierarchy. I sent a registered letter to the CFO, reminding him that the hospital's nonprofit status was based on offering a certain percentage of charity care. I never received an answer from him. Instead, he had a flunky send me a letter that said that I didn't deserve a discount at all. They refused to adjust my bill to my family's income level. - Anonymous, Indiana
There is no better example of a clueless official who seems to reside on a different planet from his constituents than Louisiana's Governor Bobby Jindal. In 2012, Jindal proposed funding cuts for the state's health care programs to plug a $165.5 million budget gap. The impact on public hospitals will be disastrous, forcing them to reduce the care they provide to Medicaid patients and to those without insurance. Louisiana State University alone plans to lay off 1,495 hospital employees and cut services at seven hospitals across the state. Some buildings will simply be abandoned and left to rot (Shuler). Jindal is also planning to restructure the state's health care system, turning several public hospitals over to the private sector. Private firms would receive public dollars to run hospitals whose first order of business is to earn returns for investors. Louisiana state Sen. Francis Thompson openly declared his opposition to a plan. "I'm afraid...we may get picked like a buzzard does a dead animal," he said (Millhollon).
Thompson's description is accurate. The public sector is a carcass being picked to the bone by private sector vultures. Privatization will deepen the debt crisis by forcing hospitals to focus on their credit rating, not patient care. As described below, credit ratings agencies are already among the most powerful corporations in the world. Under threat of a reduced rating, hospitals will be under even more pressure to aggressively pursue medical debtors. They will also offer less care to low-income patients because the bond ratings of hospitals can be negatively impacted if hospitals provide too much charitable care. Yes, too much charitable care is a thing that exists in the world of Wall Street finance. When hospitals are privately financed, bond rating agencies determine our future (Zieger).
Another world is possible. Under a humane health care system, we would begin to ask which measures of success really matter. We would start with the big questions: what does it mean to live a healthy life and how do we get there together? But under Wall Street's influence, hospitals are analyzed according to financial metrics, such as debt per bed and local market competition. The threat of lower bond ratings forces hospitals to hire Wall Street consultants, to cut back on purchases of medical equipment, to postpone the hiring of medical personnel, and to layoff staff. Indeed, in New York City, an investment banker named Stephen Berger has been recruited to drive the nails into the coffins of community hospitals in order to create more opportunities for Wall Street to make money (Benson). Debt starts a vicious cycle that keeps a hospital from focusing on patients. This is a kind of madness, a nightmare from which we must finally awaken.
The Debt Spiral
The madness extends beyond the walls of the hospital. Our cities and towns are being sucked dry by Wall Street and by global investors who demand a profit at any cost. In many cases, hospitals are responding to the crisis by aggressively trying to extract money from patients. It starts before patients even leave the hospital. In 2012, the Minnesota Attorney General began an investigation of Accretive Health, one the largest medical debt collection firms in the country. Documents reveal that debt collectors were allowed into hospitals where they were indistinguishable from regular hospital staff. According to the New York Times, such collectors routinely "demand [that patients] pay outstanding bills and may discourage them from seeking emergency care at all." This is a direct violation of a federal law requiring hospitals to provide care to anyone who needs it. In Minnesota, the mother of a child who needed surgery reported that collectors hounded her for payment before her son received care. She did not know the agents who approached her were debt collectors. "You really feel hoodwinked," she said. These collection tactics are becoming business-as-usual. A for-profit health care system means health care is a luxury enjoyed by those who can afford it. The rest of us must beg, borrow, and endure harassment to get the services we deserve.
The debt spiral doesn't stop with medical debt. Once the bills pile up, studies show that people borrow even more to make ends meet. As described in the Debt Resistors' Operations Manual, people who can't afford medical care turn to credit cards, the so-called "plastic safety net," to pay for daily necessities (Zandt). Thus, credit card debt, often assumed to be the result of overspending by impulsive shoppers, is actually inseparable from our for-profit health care system. Insurance companies and investors make a killing by withholding care, then credit card companies clean us out a second time by charging usurious interest rates and adding late fees to our accounts when we cannot pay. A report by the public policy group, Demos, "Borrowing to Stay Healthy," reports that
- Twenty-nine percent of low- and middle-income households with credit card debt reported that medical expenses contributed to their current level of credit card debt.
Reports like these illustrate the circular logic of the debt spiral. When people can't pay doctor bills, they often turn to other forms of credit, which compounds the problem. Because health insurance is tied to employment, a serious medical condition can limit a person's ability to work, earn income, and remain on a health plan. Get sick. Can't work. Lose health care. Go into debt. Take on more debt.
When medical debt leads to consumer debt, it can cause dire consequences. Health Affairs researchers Robert W. Seifert and Mark Rukavina explained that
- People with medical debt are often subject to legal judgments, wage garnishment, attachment of assets including bank accounts, or liens on their homes, which can lead to foreclosure.
It might be surprising that many medical debtors own their own homes. In fact, people with medical debt and those without have equal rates of home ownership. But there is one important difference: those with medical debt are more likely to use their homes as collateral for loans or take out a second mortgage to pay the bills. There is no better barometer of our time than the fact that owning a home pushes us deeper into the debt trap. The capitalist dream has led us down a dark path. The future has been gambled away. Millions have tapped into retirement funds to pay medical debt (Garcia). The debt spiral-from medical debt to consumer debt to foreclosure and a dwindling retirement account-shatters the myth of personal responsibility. Debt is a rigged system of overlapping and mutually reinforcing types. For many, there is no exit.
Sickness can destroy you in America. Both my partner and I had full-time jobs when I got sick. Though we had insurance, we did not have family leave. When you're on chemotherapy six days per week, there's no way you can keep your job. Then, two years later, my partner got sick. Even though we had health care, a bad situation became a crisis. When our savings ran out, there was no safety net for us. Who has an emergency fund to last nine months? What if you have to tap it twice? We began living on credit cards. I think people have a lot of assumptions about how people get into credit card debt. For us, it was how we survived during the most difficult time in our lives. The fact is that insurance doesn't cover everything, and you can't work if you're sick. Even people with health care are affected by medical costs. We'll be paying off our credit card debt into retirement. We can't save for our child's college or plan for the future. People who have insurance and a little money in the bank think nothing bad is going to happen to them. But what happened to us can happen to them too. It can happen to anyone. - Anonymous, New York
The Shame of Debt
To be in debt is a shameful thing. Most of us have been made to feel like our debts are our fault. This is true even though one in seven adults in the US is currently being pursued by a debt collector and more and more of us are in debt for basic necessities like housing, education, and health care. Medical debt is a source of shame that affects people's overall health.
It's quite simple, really. When people can't afford to see a doctor, they don't. Patients who can't afford to pay-or who have accrued medical debt-are less likely to seek out care because they are ashamed about their debt and don't want to end up owing more ("Consequences"). This ultimately leads to more health problems and increases the costs of care. A study in the Journal of General Internal Medicine showed that
- Over two thirds of those who either had a current medical debt or had been referred to a collection agency reported that it caused them to seek alternative sites of care or to delay or avoid seeking subsequent care when needed.
When Republicans in Congress invented a boogeyman called "death panels" during the 2008 presidential campaign, they weren't talking about the for-profit health care industry. But they should have been. One report showed that 45% of medical debtors put off necessary care to avoid debt (Garcia). Millions are not getting the care they need because they are too embarrassed to see a doctor. The US health care system is making people sick and keeping them that way because illness is profitable (Jacoby). Is that the kind of health care system we want? Is that the kind of world we want?
Medical Debt and the Dystopian Nightmare of Credit Scoring
If you're wondering why you have a low credit score or why you never seem to qualify for the lowest interest rates on home, car, or other loans, the problem may be medical debt. This is true even if you paid an overdue medical bill. The Federal Reserve has shown that more than half of all collection accounts that negatively impact credit reports are medical debt (Avery). This is a result of the fact that health care costs are on the rise and tens of millions are uninsured. But it is also because medical debt is treated differently from other kinds of debt. Private health insurance reimbursement is incredibly cumbersome. Different benefits are often covered by different companies and at different rates, leading to a lengthy, circuitous billing process that often leaves patients holding the bag.
If you have ever received a medical bill that you didn't understand or that you thought your insurance was supposed to cover, you have been caught up in this Kafka-esque system. If you have ever received a letter from a health care provider stamped with the notice "This Is Not A Bill," or if you have signed a form at a doctor's office promising to pay anything your insurance fails to cover, you have been an unwitting victim in the tangled web of medical billing, an industry that thrives on patient and health care provider confusion. According to Rukavina,
- One study found that nearly one-third of respondents let a medical bill go to a collection agency because they did not understand the bill or explanation of benefits statement. Another study estimated 14 million American adults said that a medical bill was sent to a collection agency because of a billing mistake.
Confusion is the grease that keeps the wheels of the medical collections industry turning. It's hard not to think that billing "mistakes" may not be mistakes at all but part of an intentional strategy to keep patients in the dark and in the red.
In addition to patient confusion, Rukavina has found that medical debt is more likely to end up in collection because hospitals routinely sell medical debt to debt collectors after 60-90 days of nonpayment, far less than the customary 180 days for other kinds of debt. Health care providers rarely report paid medical bills to the credit reporting agencies. So, even if you are billed in error, your health care provider may send your bill to a collection agency before you can dispute the charge (Bernard). Once in default, a medical debt stays on a credit report for up to 7 years, even if you pay the bill. Research by the Commonwealth Fund shows that, in 2010, 9.2 million people wound up in default on a medical bill because of a billing mistake ("Help").
These mistakes have serious consequences. According to evidence obtained by the Access Project, a single paid medical bill can lower a consumer credit score by as many as 80 points. That means you will pay a higher interest rate for almost anything else you want to buy on credit, including a home or a car. The fact that a relatively small medical bill can end up costing thousands in interest charges down the line demonstrates the obscene power of the credit rating agencies. Consumer protection attorney, Robert Nahoum, told Strike Debt:
I've never seen three companies with more power over the American consumer than the top three credit reporting agencies, Equifax, TransUnion, and Experian. There's very little consumers can do.
If patients are powerless, so are many health care providers. It's important to note that your doctor may be just as confused as you are. Strike Debt has talked to health care workers around the country, and they tell us that they are as frustrated as patients when it comes to medical billing. Why do insurance companies and ratings agencies have so much power over our lives? Why do we live in such perpetual confusion? These questions are important to ask when we think of what it means to be healthy and what kind of economy we need to sustain life.
We might also ask why our elected officials don't put a stop to predatory medical billing and curb the power of the ratings agencies. One attempt is being made to prohibit credit reporting agencies from listing medical debts on credit scores, the Medical Debt Relief Act. Yet, even this minor reform has little chance of passing because the CRAs and insurance companies are a powerful lobby in Washington. And even if the mdra were to make it through the Senate, it only applies to paid medical bills. As usual, Congress lacks the political will to challenge the power structure that puts people in debt and keeps them that way. Debt is a tool of capitalist exploitation, and we can't eliminate the debt without rethinking the larger economic system.
Indeed, the evidence actually indicates that if we don't act things will get worse for patients and debtors before they get better. There are reports that the powerful credit scoring company, fico, has begun developing a special ratings system to rank potential patients based on the likelihood they will pay their medical bills (Gipson). Like having a barcode tattooed on your forehead, we could be looking at a brave new world in which your credit rating determines not only whether you can obtain a credit card but whether you receive medical care when you get sick.
Who Profits from Medical Debt?
No one disputes that our health care system is for-profit. But whose profit? Patients are certainly losing the health care battle. "There's a tendency to attribute [the high cost of care] to minorities or those with severe health problems," Matthias Rumpf, of the Organization for Economic Co-operation and Development has explained. Actually, the evidence shows that
- Even Americans with health insurance and those who have the highest education and income levels fall behind their counterparts in other parts of the world (McHaney).
It is clear that insurance companies, global investors, and credit ratings agencies are reaping a massive windfall. Profiteers are descending on the health care industry from all corners of the Finance world. One of largest and most profitable health providers, HCA, runs 163 hospitals across the country. The company is also under investigation by the Justice department for defrauding Medicare by performing unnecessary heart surgeries on unwitting patients (Koleva).
At the root of the medical debt industry is our for-profit health care system. A few people are getting very rich from others' illness and injury. Medical debt buyers are the bottom feeders of the industry. But if you follow the money from patient care to medical billing and collections, you'll find that Hedge funds and other investors are included in the ones really cashing in. - Robert J. Nahoum, Esq. Consumer Protection Attorney
And, this year, HCA was ordered to pay a $162 million fine for failing to make agreed-upon repairs to run-down hospitals in Missouri as well as for reneging on a promise to provide charity care to low-income patients.
Who is profiting from this criminal activity? HCA, which was founded by former Senate majority leader Bill Frist's family, is primarily owned by Bain Capital, the private equity firm founded by Mitt Romney. Bain investors are not turned off in the least by how HCA treats patients. In fact, according to the New York Times,
- The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall (Creswell and Abelson).
In a private health care system, nothing-not fraud or patient abuse or crumbling buildings- interferes with the relentless drive for corporate profit. In fact, the same private equity firms that control many hospitals also have a stake in debt collections companies. This means that companies like Bain Capital that own the hospital networks that put us into debt also invest in many of the firms that try to collect that debt from us. Once the web is spun, there's no way the 1% can lose.
Most of us are focused on daily life: trying to earn enough to put food on the table and care for the people we love. We lay awake at night worrying about a sick child and pray our insurance policies will protect us if tragedy strikes. Wall Street knows that few people have the luxury of paying attention to what's really going on in their boardrooms. That is why it is more important than ever to change the conversation about medical debt and our for-profit health care system.
Won't Obama's Affordable Care Act Reduce Medical Debt?
The fact that many liberals greeted the passage of the Obama administration's health reform law with such delight is downright shocking when we consider its glaring inadequacies. In 2014, states will be required to create exchanges in which people can purchase private insurance. But, as pnhp physician Margaret Flowers has explained, the majority of these plans will not offer full coverage. And people who purchase insurance through an exchange will end up with plans that cover 70% or less of the cost of health care. Since even a short hospital stay can cost tens of thousands of dollars, the math is not on the side of people who don't already have huge bank accounts. Insurance companies profit by denying coverage. Now, thanks to aca, that strategy will be codified into law. Insurance companies will also gain access to a whole new market for their products while offering worthless umbrellas in return.
It gets worse. The federal subsidy that is supposed to help people purchase health insurance under the new law only applies to individuals, not families. So, depending on your income level, if you want to purchase coverage through an exchange, you'll be left with two options: pay market rate for private insurance or go without. The people who will benefit from an expansion of our market-based insurance system are not patients. Instead, the 1%, who already control the profit-driven health care system, will get a payout every time the rest of us see a doctor. Most appalling, however, is that more than 20 million people will not be covered under the new law (Babcock). It makes no sense to expand a failed market and demand that people participate in it, especially when we already have evidence that such reforms don't work. In Massachusetts, for example, health care reform did not stem the tide of bankruptcies linked to medical debt (Himmelstein, "Medical"). There is simply little evidence that the aca will do much beyond worsening an already grave labor crisis. Reports are emerging that employers, especially colleges and universities, are planning to cut employees' hours in order to avoid offering health benefits under the aca (Zorn). Considering what we know, the fact that many treated the passage of the aca as a Progressive victory, seems like magical thinking.
I practice medicine at a hospital in New Jersey. We care for a lot of patients who don't have health insurance. Many low-income people can't afford private insurance, but they make too much to qualify for Medicaid. Recently, I diagnosed a woman with Diabetes and cervical cancer. Originally from Africa, she has lived in the US for 15 years. But she never received regular medical care because she could not afford insurance. Now she is in real trouble. Another patient who does qualify for Medicaid has Diabetes. But he needs to see an eye doctor. I can't refer him because most specialists do not accept Medicaid. What are these patients supposed to do? Our for-profit health care system is literally killing people. The Obama administration's health care reform initiative, the Affordable Care Act, will help if it is implemented correctly, and if states don't cut corners. But it's not the ultimate solution. I'd like to see a system where people pay a percentage of their income to fund national health insurance for all. The people with more should pay a little more. In the most prosperous country in the world, no one should go to bed hungry and no one should die of an illness because they don't have health insurance. - Dr Akoma, Robert Wood Johnson Medical School
As Flowers noted, public relations and marketing expenses account for more than one third of the cost of care. Even the deficit-crazed political establishment seems to be suffering from willful blindness. According to the Washington Post, if we had the per-person health costs of France or Germany, two countries with publically-funded health care, "America's deficits would vanish" (Klein). It's time to follow the money and it's time to get real. According to research conducted by Physicians for a National Health Program, a single-payer system could save $400 billion per year. Yet politicians focused on deficit reduction would scoff at the suggestion that we publicly fund health care in America.
Life or Debt?
For-profit health care kills. In 2007, in Prince George's County Maryland, a twelve year old boy named Deamonte Driver died from a toothache. He had an infection, but his mother could not afford to take him to a dentist (Otto). Deamonte lost his life because he did not receive antibiotics that would have cost $80. This is the world we live in today. What kind of world do we want? Universal, single-payer medical care would be a short-term step in the right direction. But it's not the ultimate solution. State-financed care would give us, above all, a chance to take a step back from the relentless bills and the anxiety that comes from not knowing if we'll be able to afford to care for ourselves and our loved ones. It would give us a chance to ask if there are really only two choices: private or public, corporate or federal. It would give us, at long last, what we really need: the freedom to ask larger questions about the meaning of health and how we can work together to provide it to ourselves, to our families, and to those who come after us.
We have a difficult road ahead. But there is no doubt that the private insurance industry is wholly inadequate to the task. Our lives are in jeopardy because medical care in the US is a profit-making enterprise that enriches the few at the expense of the rest of us. Reform won't do in the long run. Politicians do not have the will to take the necessary steps. As Dr. Steffie Woolhandler, of pnhp, makes clear,
- It's not your fault if you're in debt and it's particularly not your fault if you're in debt because of a medical problem. This is unfair. No other developed nation forces people to go into debt because they get sick ("Time To End").
The situation we face is not our fault, but it's our job to take a stand together. The only real solution is a bottom-up, grassroots movement that puts people before profits. It will not be given to us by benefactors or by politicians who depend on Wall Street funding for re-election. It's up to us. The time is now. It's life or debt.
This Strike Debt report is dedicated to the memory of Deamonte Driver
Avery, R. et al, An Overview of Consumer Data and Credit Reporting, Federal Reserve Bulletin, Summer 2003
Babcock, Charles R. "Uninsured Americans Get Hit With Biggest Hospital Bills." Bloomberg News. 11 March 2013.
Benson, Barbara, "NY to Address Troubled Brooklyn Hospitals." Crain's. 28 June 2011.
Bernard, Tara Siegel, "Discrepancies on Medical Bills Can Leave a Credit Stain." New York Times. 4 May 2012.
"The Consequences of Medical Debt: Evidence from Three Communities." The Access Project, Feb. 2003.
Creswell, Julie and Reed Abelson. "A Giant Hospital Chain is Blazing a Profit Trail." New York Times. 14 Aug 2012.
Flowers, Margaret. "Saving on Health Care at the Cost of People's Health." Al Jazeera. 27 Feb 2013.
Fraze, Taressa, et al. Anne Elixhauser, Laurel Holmquist, and Jayne Johann. "Public Hospitals in the United States, 2008." Healthcare Cost and Utilization Project, September 2010.
Frost, Mary. "Gov. Cuomo's For-Profit Hospital Proposal Worries Hospital Workers and Local Reps." Brooklyn Daily Eagle. 4 Feb. 2013.
Garcia, José and Mark Rukavina. "Sick and in the Red: Medical Debt and its Economic Impact." Demos and the Access Project.
Gipson, Kevin. "Is Fair Isaac Back Pedaling on the Medical FICO score?" Bankruptcy Law Network.
"Help on the Horizon: How the Recession Has Left Millions Without Health Insurance and How Reform Will Bring Relief." The Commonwealth Fund. 16 March 2011.
Himmelstein, David U, and Deborah Thorne and Elizabeth Warren, and Steffie Woolhandler. "Medical Bankruptcy in the United States, 2007: Results of a National Study." The American Journal of Medicine. 2009.
Jacoby, Melissa. "Does Indebtedness Influence Health? A Preliminary Inquiry." The Journal of Law, Medicine, and Ethics, 30. (2002): 560-571.
Kane, Jason. "Health Costs: How the U.S. Compares With Other Countries." PBS online, 22 Oct. 2002.
Klein, Ezra. "Why an MRI Costs $1080 in America and $280 in France." Washington Post. 15 March 2013.
Koleva, Gergana. "Largest U.S. Hospital Chain Probed for Medically Unnecessary Heart Procedures." Forbes. 6 Aug 2012.
Lutz, Jaime. "Second Opinion: State Now Admits lich Real Estate was on the Table." The Brooklyn Paper. 14 March 2013.
McHaney, Sarah. "Americans Far Less Healthy, Die Younger than Global Peers, Study Says." PBS. 9 Jan. 2013.
Millhollon, Michelle. "Budgets of Public Hospitals Depend on Privatization Agreements." The Advocate. 25 Feb. 2013.
Otto, Mary. "For Want of a Dentist." The Washington Post. 28 Feb. 2007.
Rukavina, Mark. "Medical Debt and Credit." Suffolk University Credit Symposium, June 2012.
"Seeing Red: The Growing Burden of Medical Bills and Debt Faced by US Families." The Commonwealth Fund. Vol. 42. 20 Aug 2008.
Seifert, Robert W. and Mark Rukavina. "Bankruptcy is the Tip of a Medical Debt Iceberg." Health Affairs. 28 Feb. 2006.
"Shorter Lives, Poorer Health: Panel on Understanding Cross-National Health Differences Among High-income Countries." National Research Council and Institute of Medicine of the National Academy. 2013.
Shuler, Marsha. "lsu Plans to Lay Off 1,495 Hospital Employees." The Advocate. 6 Oct 2012.
"State Trends in Premiums and Deductibles, 20032011: Eroding Protection and Rising Costs Underscore Need for Action." The Commonwealth Fund, December 2012.
"Time To End Medical Debt, Medical Bankruptcy." Physicians for a National Health Program, March 16 2013.
Young, Jeffrey. "High Deductible Health Insurance Pinches Workers From Both Sides." Huffington Post, 20 Feb 2012.
Zandt, Deanna. "The Myth of Credit Card Abuse and Bankruptcy." AlterNet. 17 Oct 2005.
Zeldin, Cindy and Mark Rukavina. "Borrowing to Stay Healthy: How Credit Card Debt is Related to Medical Expenses." Demos, 2007.
Zieger, Anne. "Moody's Downgrades 18 Hospital Bond Ratings in Two Months." Fierce Health Finance. 17 Dec. 2008.
Zorn, Eric. "Teachers, Colleges, Getting an Early Lesson in Obamacare." Chicago Tribune. 6 March 2013.