Study: Half of U.S. Bankruptcies Due to Medical Bills

From Reuters today:

WASHINGTON (Reuters) - Half of all U.S. bankruptcies are caused by soaring medical bills and most people sent into debt by illness are middle-class workers with health insurance, researchers said on Wednesday.

Full story, worth reading: http://story.news.yahoo.com/news?tmpl=story&cid=594&e=2&u=/nm/20050202/hl_nm/health_bank ruptcy_dc

This is incredible data, and ought to be part of the policy debate.  This ought to be appreciated alongside the fact that many people, rather than exercise their entrepreneurial spirit, stay stuck in dead-end jobs just to hang onto their health insurance.  In short, it's becoming easier and easier to make the case that guaranteed health care is good economics, good for capitalism, and good for everyone's bottom lines.  There ought to be an intensified, concerted, sustained effort to press ("frame?") this point.

(Note also, for another day, this interesting item: "He said fewer than 1 percent of all bankruptcy filings were due to credit card debt. 'That truly is a myth,' Cauthen said in a telephone interview.")

•  Recommended

  I heard this on NPR today also.  Thanks for posting this.

  by Descrates on Wed Feb 02, 2005 at 10:13:21 AM PDT

•  needs to be seen as the scandal it is

  this is a huge story. it is one most people know is true & fear happening to them. the myth of "america has the best medical care in the world" needs to be placed in the light & shown to be the fraud it is.
  recommended.

  by rasbobbo on Wed Feb 02, 2005 at 10:18:21 AM PDT

  •  Best medical care

    It's amazing how our "best medical care in the world" has a higher infant mortality rate than Cuba.

    http://www.health-news.org/breaking/42/half-of-bankruptcy-due-to-medical-bills----us-study.html

    by political on Wed Feb 02, 2005 at 11:22:41 AM PDT

    •  38th best...

      I believe in 2000 we were #38, right behind Costa Rica.

      by k9disc on Wed Feb 02, 2005 at 12:06:51 PM PDT

  •  Translate: "Most Expensive Medical Care"

    What good is the "best" medical care if people can't afford it, even WITH insurance??????

    by CodeTalker on Wed Feb 02, 2005 at 12:18:12 PM PDT

•  We want corp. America on our side on this issue

  In short, it's becoming easier and easier to make the case that guaranteed health care is good economics, good for capitalism, and good for everyone's bottom lines.  There ought to be an intensified, concerted, sustained effort to press ("frame?") this point.

  Excellent comment.

  After observing the recent grocery strike here in San Diego, where one of the issues was the share of health insurance premiums to be borne by workers, I became convinced that the battle lines had been drawn in the wrong place.

  Business and labor are fighting over their share of the fast-growing cost of health insurance. That's the wrong battle. It doesn't make healthcare cheaper and more efficient, it doesn't increase the number of American's covered by health insurance, and it doesn't end the practice of parasitic companies gaining a competitive edge by shoving the burden of healthcare costs onto the public healthcare system.

  We need to figure out how to get corporations and Democrats on the same side of the issue. The economic efficiency framing may be one part of the approach.

  I'd love to hear more from people with some knowledge on the topic.
  

  by Ottnott on Wed Feb 02, 2005 at 10:22:23 AM PDT

  •  "shoving the burden"

    Can you say "Wal Mart?"

    by CodeTalker on Wed Feb 02, 2005 at 12:20:19 PM PDT

•  One of the many reasons people sue

  their doctors, insurance companies and corporations is because they don't have the money to pay their medical expenses!

  Now had Kerry been elected and he was able to create the catastrophic health care plan and malpractice reform.......ahhhh a girl can dream, can't she?

  Go whore this diary on Cheers & Jeers to get some mojo!

  Drink shade grown coffee!

  by mad ramblings of a sane woman on Wed Feb 02, 2005 at 10:22:39 AM PDT

•  One blocked artery away from bankruptcy

  We need to let people know that under the current health care system they really are just one blocked artery, just one slip on the ice, just one mid-speed car crash away from being financially ruined.

  You've got a "huge" million dollar lifetime cap on your benefits?  That's great.  One open heart surgery and therapy can wipe that out and then you're paying the $20K/day out of pocket for your hospital stay.  How much was that house worth, again?
  Right now, the system is rigged so you will be poor if you get sick enough before you die.

  And we all get sick eventually...

  by nightsweat on Wed Feb 02, 2005 at 10:29:57 AM PDT

  •  Huge All Right

    My sister was diagnosed with advanced cancer at age 31 (thankfully she survived). She blew through her $1 million coverage in two years thanks to a bone marrow transplant that saved her life.

    Now she is in the state "high risk" insurance pool, which charges outrageous rates for lesser coverage than she had before. The premiums place a real strain on her family's budget.

    Join the ownership society today: pledge that you'll never become seriously ill! Remember, if you do become ill, it's all your fault. Society has no responsibility towards sick people.

    by bramish on Wed Feb 02, 2005 at 11:07:03 AM PDT

    •  awsome signature line

      (that is all)

      by librarianbarbie on Wed Feb 02, 2005 at 11:29:26 AM PDT

  •  Remember what Edwards was saying during

    the primaries?

    "In the last 20 years, a sea change has happened in our country.  Working middle-class families have gone from being able to save for retirement or buy a house, to now teetering on the edge of bankruptcy. These aren't poor Americans; they're the working middle class.  And they are terrified that if something goes wrong: a lost job or a health care disaster, they're just one bad break away from falling off the cliff."

    and as Kerry's VP pick?

    "George Bush has a health care plan: Pray you don't get sick,'' Edwards said. "They have led us from the edge of greatness when Bill Clinton left office to the edge of a cliff."

    Drink shade grown coffee!

    by mad ramblings of a sane woman on Wed Feb 02, 2005 at 11:07:18 AM PDT

  •  asdf

    This is exactly how it works. In 2000 escalating medical problems forced me to quit my job(no disability insurance was offered by my company). Besides the growing medical costs, there was the monthly household expenses that also had to be dealt with.

      I couldn't get unemployment because you have to be able to work, foodstamps etc were also not available because I had a 401k. After burning thru that it looked as if my wife, my son, and myself would have to move in with my wifes family.

      Finally social security kicked in and after declaring bankruptcy we were able to keep the house.My wife works full time but a lot of the money goes to paying for medical insurance in addition to my having medicare. Health costs consist of 30 percent or our budget.

      In addition to having to worry about Bush screwing social security and medicare, filing bankruptcy raises your auto, home and other insurances because they think you will make false claims.

    by yosho on Wed Feb 02, 2005 at 02:33:26 PM PDT

•  Time to write our CEOs?

  I have wondered if perhaps the people we should be writing to about universal health care are the mangement of the companies we work for.  They can't be too happy about the huge cost of health care, which they are expected to help pay for, which companies in other countries don't have to pay for, making us less competitive.  I think a really good arguement could be made for this.  Why not get the CEOs and CFOs on our side for a change?

  by citygirl on Wed Feb 02, 2005 at 10:47:52 AM PDT

•  I Think it can be argued

  that our current health care financing system is the biggest handicap American businesses face in the global economy.  A business that provides health insurance for its employees is, in effect, paying a tax which its counterparts in the rest of the world do not. This is especially true of small businesses, which pay about twice as much for health coverage for their employees as large corporations do.  Add to that the fact that we pay more as a percentage of GDP to administer our byzantine system than many countries pay for their entire health systems, and its hard to see who benefits from the status quo except insurance companies, which seem to operate on a cost plus basis.

  by MadRuth on Wed Feb 02, 2005 at 10:47:56 AM PDT

  •  And more...

    They say that small business is the largest growth sector in our economy.  BUT, small employers cannot compete with large employers in hiring because small employers cannot provide the health insurance that large employers provide.  Large employers can make their employees fairly unhappy, but as long as they offer health insurance, most of the employees feel that they MUST stay, many for the sake of their families.  Imagine if you could work ANYWHERE, and not have to worry that you would lose your health insurance.  

    I predict that there would be an immediate and significant shuffle as employees used this opportunity to find jobs they liked better.  I think that corporations are aware of the effect that health insurance has on reducing turnover, and I think they are ambivalent about giving up the leverage over employees.

     

    by DFWmom on Wed Feb 02, 2005 at 12:00:29 PM PDT

•  I was going to write a diary on this

  after the SOTU.

  George Bush's health care policies have been ENTIRELY unresponsive to the real crises in health care, which revolve around cost increases and insufficient insurance coverage for the most part.  

  Bush has focused on "tort reform" (read: screw the lawyers), and on computerized medical records in a recent speech.  While both of these initiatives address ancillary issues, neither is particularly well crafted, and neither comes anywhere near addressing the real problems people are facing in trying to stay healthy in this country.

  Today's report on the huge number of bankruptcies caused by medical problems, including those among people with health insurance, points to the true magnitude of the crisis Bush is ignoring.

  And it points to the moral bankruptcy of a party which will rewrite bankruptcy laws to protect vastly profitable and dishonest credit card companies, and further victimize the people whose health problems lead them into this dire predicament.

  by Dallasdoc on Wed Feb 02, 2005 at 10:49:36 AM PDT

•  Hypocrisy of Bush's ownership society

  The hypocrisy lies in while imposing greater responsibility on health care consumers for bearing more of the cost for their health care, the Bush regime seeks to continue or even extend protections for drug companies, medical providers, and insurance companies.

  Well, of course, they are wealthy and powerful GOP sponsors, so they get government protection in the form of medical malpractice "reform", prohibition from drug price negotiation, and ludricious patent protections.

  Medical errors are the 8th leading cause of premature death in the U.S., so the medical profession needs Bush's regime to protect it from greedy trial lawyers representing injured patients.

  Some here argue for complete nationalization of health care in a single-payer (ala Canada) system. Maybe that is the right answer, but we don't even have a true free market or an even playing field in the "private" enterprise system of health care: we have an unholy alliance between a corporate plutocracy protected by a regime looking out for their profit.

  by baldandy on Wed Feb 02, 2005 at 10:49:55 AM PDT

•  Studies always have more credibility

  than anecdotes, but anyone who has volunteered in food banks, soup kitchens, or homeless stories has heard over and over again that medical bills caused the plight.

  by azindy on Wed Feb 02, 2005 at 10:51:48 AM PDT

•  10 years ago I got a kidney stone

  Not a big deal, right?  Just a little kidney stone. But it was too big to pass, and the treatment (lithotripsy, basically shaking the thing to bits using sound) is hard to schedule, because the machinery is so expensive that hospitals buy it on a time share basis.  I needed surgery to put in a stent to save my kidney, then follow up xrays and diagnostics and such.  I had medical coverage, but it included a 20% co-pay.  The bills came in - about $30,000 worth.  I couldn't believe how much it cost for an emergency room visit, an overnight hospital stay, and one lithotripsy session.  I was able to sell some stock to make my co-pay, but if I hadn't had insurance at all, or if I hadn't saved that stock "for a rainy day", I would have been financially ruined.  By a kidney stone.  

  by dianem on Wed Feb 02, 2005 at 10:58:15 AM PDT

  •  If you hadn't had insurance

    Your bills probably would have been close to twice that $30,000.  This is one of the cruel ironies of the current system.  Those with no insurance are billed at a much higher rate than those who have it. Insurance companies negotiate discounts with providers.  To make up the difference, providers charge the uninsured more.

    by MadRuth on Wed Feb 02, 2005 at 11:10:47 AM PDT

    •  Really?

      My experience has been the opposite, but then, the only significant procedure I've had in the last ten years was a pregnancy. My costs, as an uninsured who paid everything out of pocket, were less than half of what friends who had insurance were charged.

      Maybe I just had a doctor who was happy to be paid on time by someone paying it themselves, and discounted the prices. (I also got a substantial discount from the anesthesiologist by paying it myself within a certain period of time.)

      by think2004 on Wed Feb 02, 2005 at 11:53:13 AM PDT

      •  pregnancy may be exception

        When my wife was pregnant, I was a grad student and she was not insured.  We shopped around very extensively and we got a very good deal, 1/3 of the price of other places, from Harvard Medical School, with the proviso that students of medicine could be present at any procedure.

        It happened 24 years ago.  Now you would see larger bills after a single visit to emergency room than we paid for prenatal care, delivery and possible complications and two days in the hospital.  Back than the full price was ca. 2500.

        Perhaps in the case of elective procedure there exists a modicum of price competition.

        by Piotr on Wed Feb 02, 2005 at 12:06:56 PM PDT

      •  Mine is opposite, too

        My eye doctor knows I'm uninsured and gives me a lower price than insured patients on expensive diagnostic tests (e.g. $275 rather than $380).

        There are about 8 doctors in the practice, and it pays employees' health insurance. It's a burden for them, too.

        by cotterperson on Wed Feb 02, 2005 at 12:11:10 PM PDT

      •  You were indeed lucky

        I know that doctors are often willing to negotiate with the uninsured, but doctors are only a small part of the health care system.  Most people don't have a clue about who many of their providers are until they get a bill from them, so they don't have a chance to negotiate.  There are radiologists, anaesthetists, lab technicians and hospitals, to name a few.  All of these provide discounts to insurance companies and to some self-insured businesses.  The uninsured pay the retail price.  I know a person who had minor outpatient surgery this summer.  He had insurance.  The insurance discount on all of his providers' bills was at least 40 percent.

        by MadRuth on Wed Feb 02, 2005 at 12:14:26 PM PDT

    •  You are correct

      The health plan sent me statements for every bill itemizing 1) how much the hospital asked for 2) What they had negotiated in payment and 3) how much I had to pay.  The amount asked for was generally astronomical, but Blue Cross negotiated a lower amount and I only had to pay 20% of that amount.  In one case, the biller refused to negotiate and billed me directly, sending the account to a collection agency when I refused to pay more than Blue Cross told me I had to pay. I didn't total the amount that I would have had to pay if I hadn't had health insurance, but it wouldn't have mattered - I would have had to wipe out my entire savings and I still would have had to file bankrupcy.   I was lucky.  

      by dianem on Wed Feb 02, 2005 at 12:13:29 PM PDT

  •  health care accounts

    would be an answer.  With only minimal coverage and huge out-of-the-pocket component you would be in a better position to evaluate if you need these procedures or not.  Current system involves expensive moral hazard, because people making the decisions do not pay...

    Wait -- so you paid a lot after all?  So why did you decide to do it?  Just because the pain was about to blow eyes out of your head?  Sissy.

    More seriously, it is a total outrage, and terrible racket.  We may read that the chief reason for medical inflation is the explosive growth of technology that provides better medicine and treatment.  I think that there is nothing particularly new about lithotripsy, and yet the total cost exceeded the charges that would be made 10 years ago for open-heart surgery.  Hospitals can charge whatever they want -- how one can bargain?  For starters, there are no price lists, and if they were, billing involves a myriad of items, like mere entering the operating room (several thousand dollars).  For all I know, a hospital could offer the operation for free and charge 40k for the doctor saying the next morning "you look great".

    by Piotr on Wed Feb 02, 2005 at 11:59:33 AM PDT

    •  Yes

      When I first got the kidney stone, I was on vacation with my mother in florida (she was paying as a 30th birthday present for me).  I was in terrible pain, 3000 miles from home, and very frightened.  I wasn't asking about costs.  I just wanted the pain to stop.  I would have signed anything, done anything to make the pain stop.  They could have taken my house, my car, and my wages for the next 10 years if they had insisted that was what it took to stop the pain.  

      I think that the concept that an educated consumer will spend less on health care ignores the realities of medical treatment.  If I buy a VCR or a new washing machine, I research quality and effectivness on-line, find the best price I can get for the units I want, and then go out and get it at the lowest priced merchant.  For medical care, there is no time to comparison shop, and no place to do it.  Lithotripsy was the only option for me - the stone was too large to pass, and kidney surgery would have resulted in a partial loss of kidney function.  I actually had a chance to research the options, and talk to doctors.  The intial surgery was not portayed as an "option", it was presented as necessary to save my kidney from permanent damage.  I went to the only hospital we could find, and when I had the lithotripsy I went to where my insurance company told me to go (which was an hour's drive from my rural home - fortuneatly my mother was able to come take me).  

      This was an illuminating experience for a healthy 30 year old.  I hadn't really thought that I was subject to medical problems.  Doctor's were for giving me antibiotics for ear infections, not surgery.  

      by dianem on Wed Feb 02, 2005 at 12:29:11 PM PDT

      •  googling the costs

        2000. Medicare reimbursement rate 2100, ALS (American Lithotripsy Society) objects, 2 years later they calculated that 2300 is necessary.

        2004. for a dog you can get lithotripsy for ca. 1400.

        A publication advising tests about the nature of the kidney stone formation in a patients estimates lithotripsy costs as 7500 per session.

        A document of the State of Connecticut approves reimbursing a hospital for the cost of lithotripsy equipment, 430k.

        Summary: Lithotripsy should be a relatively inexpensive procedure, the cost of equiment alone should be under 1k.  Because it is a non-invasive procedure, operating room should be unnecessary.  It is unclear how honest accounting can rise the cost of short hospitalization involving lithotripsy above 20k, with test, local anesthesia, everything.  Yet dianem was presented with bills exceeding 100k.  Highway robbers were kinder and gentler.

        by Piotr on Wed Feb 02, 2005 at 01:25:40 PM PDT

        •  They did the procedure from a big van

          There was a huge travelling van that parked outside the hospital.  I don't recall exactly how much it cost - my entire "problem" cost over $30,000, but that include an emergency room visit and diagnostic procedures, surgery (under full anesthesia) to insert a stent to bypass the stone, a night's hospital stay, and the lithotripsy, which was done on an outpatient basis under sedation, not full anesthesia.

          I wasn't presented with bills exceeding $100,000.  The entire bill, based on what my insurance company and I paid, was around $30,000.  The originally billed amounts were higher, but the total didn't come out to over $100,000 (I don't have the bills anymore).  In some cases, the amount billed and what my insurance company paid differed significantly, but overall it wasn't quite that high.  

          Nonetheless, the expense was ridiculous for a fairly simple problem that could have been dealt with in one hospital visit if the hospital had it's own lithotripsy machine, but, as I said, the machine's are routinely used on a time-share basis, so I needed surgery to allow me to wait for the machine.  Doesn't make much sense, if you ask me.  It would have been cheaper overall if they had simply had a lithotripsy machine on hand and had charged me $10,000 on the spot. And I wouldn't have needed invasive surgery.  

          by dianem on Wed Feb 02, 2005 at 03:07:23 PM PDT

          •  my bad

            I multiplied 30 by 5.

            In any case, google search suggest that the equipment amortization is probably within 1k per session, 2k would cover the cost but the owner would not make much so ALS complains to Medicare,
            "normal" price is 7.5k with separate 2-3 for all test that may be needed.  The page discribing it was about the cost that you can avoid if you take preventive measures possible because of the test they recommend -- so the bias, unusually, was to estimate the cost on the high side.

            My experience: anytime you feel mild kidney pain, spend 2-3 days drinking 2-3 gallons of water per day.  2 gallons a day keep lipthotripter away.

            Only insurance companies have personel and sophistication that allows to haggle effectively, but unfortunately, they have two options -- pay less to doctors and hospital or collect more from us and our employers.  Moreover, this insane system generates overhead like crazy.  Prize gougers versus heartless beancounters like like Godzilla versus Fedora.

            by Piotr on Wed Feb 02, 2005 at 03:55:24 PM PDT

            •  Believe me...

              this was not "mild" pain.  This was a fully blocked ureter. The pain isn't from the stone passing, it is caused by fluids building up and causing swelling in the kidney.  It started like a gas pain, then gradually got worse and worse, until I was throwing up and was unable to even stand. I just curled up in a ball.  I've heard that this is the worst pain known to human beings, including childbirth, but it's hard to compare.  I can swear that it was mind-numbing. The nicest words I ever heard in the world were "This is morphine, it will stop the pain".  

              I've had a few smaller stondes, and had a bit of mild discomfort with them.  Nothing serious.  I drink a ton of water every day.  Preventative. I'm never going through that again.  

              by dianem on Wed Feb 02, 2005 at 04:47:27 PM PDT

•  Pelosi and Reid: SOTU Rebuttal

  Health care is the TRUE crisis in America. Not Social Security. I damn well hope that Pelosi and Reid use this awful, frightening and shameful news front and center in their rebuttal to the SOTU garbage.

  I have European friends who ask why do Americans accept this deplorable situation with our health care.

  Maybe, we will live long enough to tell our children or grandchildren that their was a time in America when people had to declare bankrupcy becuase of health bills.

  by nyceve on Wed Feb 02, 2005 at 11:04:34 AM PDT

•  Want to see your physician or hospital squirm ?

  Ask them where you can find out specific details on their ledger/history of outstanding and past trustee mediated bankruptcy/creditor actions they (or more likely, their accounts payable units/financial/legal departments) are parties to. (It is a matter of public record, but it is not what 'caring doctors groups and hospital corporations like to advertise)

  There was heartbreaking story on Pacifica radio a year back (i am looking for it) about this young women who came down with a sudden life-threatening illness requiring immediate surgery , soon after  loosing her health-insurance. She was personally  billed by the hospital for her care, at multiples of the rate that hospitals bill insurance companies for the same treatment codes (procedures).

  She fought the big hospital corporation's legal machinery for several years and ultimately won after publically exposing this perfectly legal practice [overcharging of uninsured patients then virtually  putting them on a conveyor belt directly to their "bankruptcy mill" department]  to be a systematic practice used by the "For Profit" medical industry. Big Hospital corp  quietly settled with her avoid the public revelation of the outrageous hospital practice that conflicted with their carefully crafted caring, angel of mercy PR image.

  In this context, it is worthwhile to remember that bushco repugs have been pushing to reform bankruptcy laws (thanks to intensive lobbying by hospitals and doctor PACs, not just CC companies), largely so that "dead beat" cancer survivors, and heart patients cannot escape from paying their inflated hospital bills.

  by shumard on Wed Feb 02, 2005 at 11:11:13 AM PDT

  •  The best way to create pressure for universal

    health care coverage from the medical community would be to prohibit price discrimination based upon health insurance coverage.

    by ohwilleke on Wed Feb 02, 2005 at 11:20:36 AM PDT

  •  Reform == Eliminate

    Yep, they want to reform bankruptcy just like they want to reform Social Security. Remember whenever a Republican wants to reform a government program, their unstated goal is to eliminate it.

    by DJ Adequate on Wed Feb 02, 2005 at 11:56:57 AM PDT

•  I can believe it

  I owe $1099 for my teeth, $740 for childbirth, $759 to my OB. $589 to the Pediatrician and close to $400 for misc. drug and lab fees.  This is all from April 2003 and I haven't made a dent in it.  I could only imagine what it would be like to pay for a majoy illness, especially if you're the breadwinner.  

  by fabooj on Wed Feb 02, 2005 at 11:29:50 AM PDT

•  The medical costs feedback loop

  If medical bills are causing so many bankruptcies, then what kind of impact are the bankruptcies having on medical costs?   The bankruptcies are a great indicator, but don't forget a lot of people who DON'T declare bankruptcy but are also unable to pay their medical bills.  

  So... People go bankrupt and/or don't pay their medical bills.  Medical service providers have to do something to cover the expense of providing medical services for which they are not paid.  They increase rates to cover the cost.  As the rates rise, more people are unable to pay their bills.  Rates rise, more people are unable to pay, rates rise...

  by DFWmom on Wed Feb 02, 2005 at 11:45:04 AM PDT

•  this is absolutley true

  I spent several years in the mortgage business and medical collections are absolutley the biggest cause of bankruptcy.  The funny thing is, we could usually get our lenders to overlook medical collections because:

  1. They are near-universal.  Everybody has them.  Lenders would have no business if they did not overlook them, and...

  2.  It was common knowledge that most of them are bogus.  Even if your insurance covers something, you can still get a collection for it, intentionally placed on the chance that you will just pay it to get it off your credit and never dispute the data.  

  Many providers get paid twice for one bill by doing this.  And it's not just the medical companies, cell phone companies frequently place collections when you terminate your service whether you even if you have fulfilled the terms of your service obligation, again because many peopl will pay it without asking any quesiotns.  Also fitness centers.

  As far as tort reform goes- the way to reduce malpractice lawsuits is to f*cking reduce malpractice, IMHO.  Malpractice happens.  It happens a lot.  

  by librarianbarbie on Wed Feb 02, 2005 at 11:46:25 AM PDT

  •  wow, bed splelling!

    absolutley= absolutely

    by librarianbarbie on Wed Feb 02, 2005 at 11:47:12 AM PDT

  •  criminal fraud?

    the practice of issuing bills for amounts you do not owe seems like fraud to me.  I did not write the law, though.  Moral turpitude in the most charitable interpretation, though.

    by Piotr on Wed Feb 02, 2005 at 12:11:11 PM PDT

    •  absolutely fraud

      And if you have the time to sue them, they will settle with you without much of a fight.  However, most of the people I worked with did not find out about these collections until they were trying to buy a house and then you are in a time crunch and it is quicker to just bite the bulet and write the check.  We all learned to watch our credit like hawks, and one of the guys who worked with me had what almost amounted to a cottage industry just suing bill collectors, and not even for clients, just from his own credit.  Because even if you pay a collection or win a lawsuit, you can still find it on your credit report again in a month or two, and then all you have to do is find the original payment receipt from the creditor and then sue you can sue them again.  Most of the time he got a flat settlement of a thousand bucks just to go away.

      by librarianbarbie on Wed Feb 02, 2005 at 12:38:07 PM PDT

•  Remove Bankruptcy Option

  It is so true that this happens. I have personal experience as the premature birth of my daughter, even with insurance, caused stunning bills. My family survived that, but barely.

  Sadly, the Republican response will simply be that it is too easy to file for bankruptcy. It's one of those issue that really easy to spin in their favor--tell stories of abuse, how defaulted loans hurt companies that pay your salaries, culture of personal responsibility...

  And all of a sudden, another safety net is gone. Ill, impoverished and in debt is how they would like to see us. A permanent underclass is their goal, and sadly they are close to making it happen.

  by DJ Adequate on Wed Feb 02, 2005 at 11:54:23 AM PDT

  •  Permanent underclass

    A permanent underclass is their goal, and sadly they are close to making it happen.

    Oh, how I agree! Keep us poor with medical costs, low wages, and high gasoline profits.

    Then we have to be slaves to their big off-shore theiving corporations!

    by cotterperson on Wed Feb 02, 2005 at 12:19:52 PM PDT

•  when i'm elected president

  i will have a dozen new teaching hospitals built. in it doctors, nurses & all manner of medical technicians will be trained. their education will be paid for in exchange for a 5 year contract to work in a public health setting. sort of like the service academies. this will be the beginnings of a national health service. there are a lot of problems that i see in the way we make doctors in the u.s. it is an industry that can be exploited to the benefit of everyone.

  by rasbobbo on Wed Feb 02, 2005 at 12:06:08 PM PDT

•  I was totally amazed

  when I moved to Texas from Ontario at how complicated the system is here.   Universal health care in Canada may have it's downside but my in-laws were never in danger of losing their house throughout my father in law's battle with cancer.  

  My neighbours would like to have another child but they don't have insurance and they don't have $20 000 in the bank.  I pay over $1000 a month for health insurance for a family of five and I'm still getting hit with extra costs for vaccines, x-rays etc.   It's a mess.  And it isn't the "evil lawyers" who are at fault.  

  by confusedintexas on Wed Feb 02, 2005 at 12:10:01 PM PDT

•  One problem I have with national helathcare...

  Sometime in the hopefully near future I will be practicing medicine. I would rather work for myself than the government. Nationalized healthcare would take away many of my freedoms.

  by Isopost on Wed Feb 02, 2005 at 12:14:50 PM PDT

  •  Can you expand on that?

    What do you think you wouldn't be able to do under a national or even state-run system that you would be able to do if you were independent?  

    by confusedintexas on Wed Feb 02, 2005 at 12:20:56 PM PDT

    •  A couple of things...

      I would assume that I would not be able to choose my patients, the state would give me a roster of people I had to treat. Also, I could not set my own fees (I plan on a cash only practice because I don't want to deal with insurance companies). I would also assume that there would be national standards that would limit my own choices on how to treat patients (standards aimed at cutting costs, etc)

      by Isopost on Wed Feb 02, 2005 at 12:24:40 PM PDT

      •  I don't think that it would work that way

        or, if those were the fears then perhaps in instituting the system the could be addressed.  

        I'm only familiar with the Canadian system and there is no assigning of patients in Canada.   Doctors are free to serve any patients they like and in fact many of them choose to work in walk in clinics because they can treat many more patients in far less time (if making money is their primary concern).  

        Because the whole system is under one insurance system it's far less complicated than dealing with multiple insurance companies and restrictions etc.  

        I'm not aware of any kind of standards to limit treatment options - my father in law was in for a stem cell transplant pdq after his cancer was diagnosed but that may not be the best example of how the system works.  

        It's not perfect - there's no question about it.  There have been times when I thought the US system was better.  But I do wonder if it's not possible to find the best of both systems (and maybe look at how the rest of the world does it as well) and find a system that really serves all involved.   I'm a bit of a dreamer, really.  

         

        by confusedintexas on Wed Feb 02, 2005 at 12:40:18 PM PDT

      •  like a teacher!

        The situation you describe fits the situation of a public school teacher pretty exactly.

        Now, what do we want to alter: let the teacher choose pupils, select his/her salary (or charge per homework?), abolish state standards on curriculum?

        by Piotr on Wed Feb 02, 2005 at 12:49:39 PM PDT

  •  Canadian doctors

    Seem to have the freedom to do whatever they like, and so do their patients.

    National health care results in a net increase in personal freedom, based on my observations after living in Canada since 1997. Canadians are free to do anything they want without fear of losing their health insurance - snowboard, ride a motorcycle, quit a crappy job to get a better one. This realization that a nation could actually have more freedom than the U.S. was at first hard to swallow.

    I never even tried rollerblades as an adult when I lived in the states - I didn't have health insurance, and what if I broke my wrist?

    Now I'm learning to ice skate - not that I'm careless because I have healthcare, but the spectre of financial ruin no longer hangs over my head.

    Funny how things work out.

    by Swampfoot on Wed Feb 02, 2005 at 12:36:53 PM PDT

    •  Thanks for your comment

      I am beginning to see how National healthcare could (possibly) be a very good thing for me and my future patients. I'm a pre-med, so I don't have a lot of time to study public policy for fun, but hopefully I can learn more...

      by Isopost on Wed Feb 02, 2005 at 01:03:54 PM PDT

      •  myths debunked

        Check out this American Medical Student Association site I found recently.
        http://www.amsa.org/hp/myths.cfm
        It has myths and facts about universal health care.
        And Canadians needed everyone covered so they could play hockey with abandon!

        by katdesign on Wed Feb 02, 2005 at 05:23:51 PM PDT

•  my mom facing bankruptcy in spite of insurance

  my mom is an amputee who has to go to her dialysis appointments by ambulance, on a gurney.

  when she first began dialysis we were led to believe that these transportation costs were covered by Medicare.

  But they are not.

  When she could still walk, I used to drive her back and forth to dialysis in her own car.  And when she was confined to a wheelchair, she could still pivot in and out of the car and stand with help and I would just put the wheelchair in the trunk.  Since the amputation, she has been unable to stand at all and needs a Hoyer lift to get in and out of a wheelchair.  So the ambulance rides began.  We both thought it would be temporary and soon she would get a prosthetic device and at least be able to pivot in and out of a wheelchair again.  But her wounds were slow to heal and she still does not have a prosthesis a year later.  She is so weak from a year in bed that it would take a lot of physical therapy for her to be strong enough to get around like she used to.

  The ambulance fee is about $500 (EACH WAY) for a ride to a hospital that I can see from my living room window.  For a ride to a hospital that I can walk to and have pushed her to in her wheelchair (back when she was still able to get in one).

  Medicare covers about $450 of this.  The remaining $50 (each way) is a co-pay that we are expected to come up with.

  She goes to dialysis three times a week (for a few months last year she was going four times a week).  That's $300 a week.  And she's needed the ambulance for the last 15 months:  that's about 60 weeks or $18,000.  And each week the cost continues and the bills keep coming.

  When we go to the doctor for the follow-up visits about her amputation, or to any other doctor for any other reason, the transportation cost is not covered AT ALL.  $1000 in transportation cost for each office visit.

  So we owe the ambulance company around $25,000 so far.  I honestly don't even know how much we owe now.  I have stopped opening the bills.  When they first started arriving I thought they were only statements showing how much Medicare had paid.  By the time I figured out they were bills and this was an amount we actually were expected to pay we already owed in the five figures.  If they cut off our service for nonpayment it will be a death sentence for her, or bankruptcy.  And if we declare bankruptcy, what other company will be willing to provide us with ambulance service?

  After being bailed out of some college-age financial irresponsibility, I became debt averse.  I have no credit cards (only debit cards) and no personal debt other than student loans.  Except for a car, I have never bought anything unless I had the money in the bank for it at the time.

  So this mounting debt is psychologically difficult for me.  I have many a sleepless night worrying about how we will pay for these ambulance bills.

  I'm in one of the low paid helping professions.  My employer can't afford to pay me for full time work.  I've thought of taking a second job but I need to be home to take care of her.  Plus I couldn't find a part time job that would pay me $300 take home a week.

  One of the roots of my Deaniac passion is that I am desperate for a President who will take this crisis in medical costs seriously.  There are no words to describe the utter stupidity of the Bush plan, persuading working people on Wal-Mart wages to trade guaranteed insurance coverage for a system of setting aside a few dollars each month in an account to help pay medical bills.  What a joke: promoted by people who have no idea what a visit to the emergency room costs, sold to people who have no idea that a brief hospital stay can cost more than they make in an entire year.

  Strom Thurmond, that racist child molester/rapist hypocrite, lived in a hospital for the last years of his life because he had health insurance that covered everything, just like all the other clueless Senators and Representatives in Congress.  He was able to just move into Walter Reed Hospital, one of the finest hospitals in the country, and have all his needs attended to with the highest possible level of care.

  Meanwhile my lovely mom, who has never had an unkind word for anyone even throughout all her medical ordeals, universally loved by everyone who has ever known her, who played by the rules and paid insurance premiums and worked very hard and paid into the system all her life, has to settle for me as primary caregiver (no medical training or nursing experience except what I have picked up by necessity).  The home health aide who helps with bathing can only come three times a week, and soon we will be cut off from that (and start paying for it ourselves).  We have already been cut off from physical therapy coverage, making it unlikely that she will ever get strong enough to get out of bed on her own or work with a prosthesis (and she was walking and active, going to church and the movies and out to brunch and other activities right before the vascular problem that led to the amputation).

  She really should have round the clock care, but only the wealthy can afford to do that at home, since very little home care is covered.  The only other alternative is to pay $335 a day out of pocket to put her in a skilled nursing facility (Medicare only covers the first 100 days of SNF coverage, after that you have to pay it all, including drug costs, unless you go on State Aid or Medicaid).  And some of those nursing homes, frankly, are places where you wouldn't feel comfortable boarding your dog (with food your dog wouldn't eat).

  And mom has insurance!  Blue Cross Blue Shield pays 75% of her prescription drug costs, which helps a lot.  Her health began declining in her early 60s and we kept assuming that if she could make it to 65 Medicare would cover everything.  Newsflash: it doesn't.  And we have to pay a quarterly premium for Medicare benefits that has just risen this year to $220 per quarter.  When my grandmother went on Medicare in the 60s, that was more than it cost for an entire year.

  I have no idea how many of these bills will be my responsibility when mom goes to the next life.  But worrying about this huge and ever increasing debt is a big part of a stressful situation that is affecting my health as well.  I'm not in very good shape myself, but I'm all she has, and I want to care for her with the comforts of home as long as my own health and our meager savings hold out.

  After that, God help us.

  by TrueBlueMajority on Wed Feb 02, 2005 at 12:23:22 PM PDT

  •  May God bless you and your mother.

    I am appalled but not surprised.  

    When my father was dying of a degenerative disease I participated in a "support group" type of listserve.  (I knew immediately what a "Hoyer lift" is, although we did not have to use one for my father.) Some of the stories shared there would break my heart. Others were tremendously inspiring. So many caregivers are out there, physically and emotionally exhausted and terribly isolated yet going on day after day for a decade or more. Our society pays lip service to family values but we don't value our caregivers.

    TrueBlueMajority, there may be someone on this list who has an idea of where you can get some help, or how you can avoid ambulance costs (I am at a loss), but we truly need to get our fellow citizens to open their eyes and see what the reality is.

    Half of all bankruptcies due to medical debts! Why isn't everyone appalled?

    by marylrgn on Wed Feb 02, 2005 at 01:03:10 PM PDT

•  I couldn't find that article in the online journal

  But Himmelstein has published some other very interesting papers recently.

  In December's Monthly Review, he published a paper comparing public hospitals to private hospitals in the USA and Canada.

  A few key quotes:
  

  Indeed, on a per capita basis, public funding for health care in the United States exceeds total health spending in nations with national health insurance.

  Market theorists argue that the profit motive optimizes care and minimizes costs. But a growing body of evidence indicates that this dogma has no clothes.

  The waste in lives is more shocking; 2047 unnecessary deaths annually caused by for-profit ownership of hospitals, and 2500 killed each year by for-profit ownership of kidney dialysis centers.

  Privatization results in a large net loss to society in terms of higher costs and lower quality, but some stand to gain. Privatization creates vast profit opportunities for powerful firms and investors. The Frist family, whose scion Bill leads Republicans in the U.S. Senate, amassed its vast fortune from Columbia/HCA's hospitals.

  But market fundamentalists continue to peddle privatization as a panacea for health care and America's other problems. They assure us that Aetna and Columbia/HCA will solve our health care woes, just as Edison will save our failing public schools, Enron will cut electricity rates in California, and Halliburton and Blackwater will rescue us in Iraq.

  Oh snap.

  by Primordial Ooze on Wed Feb 02, 2005 at 12:52:40 PM PDT

•  Republicans Don't Care About Health Coverage.

  Tort reform. Have you heard the Republicans whine about those evil lawyers who extort money from the health care system? That horrible John Edwards who made his fortune by bilking the insurance companies is the problem. The Republicans never mention John Edwards clients, because they don't represent his clients, they represent the insurance companies.

  Every Democrat running for president in 2004 supported some kind of plan to extend health insurance to all Americans. It's called justice. It's called compassion. Real compassion, not some made up Madison Avenue slogan, but the real thing.

  As the two America's that John Edwards discussed continue to bifurcate and the middle class disappears, the Republican party does nothing. Take it from someone who helped to keep the databases of the United States Bankruptcy Court up and running, the Bankruptcy Court is filled with former middle and upper middle class people.

  The reason is simple. They got sick and the Republican party does not care. If they cared, they would do something about it.

  If I lacked a conscience, I would've profited and bought stock in Senator Frist's company. The company, HCA, is the king of fraud.

  They are not your friend.

  A Liberal Primal Screen
  

  by erickh on Wed Feb 02, 2005 at 12:55:14 PM PDT

•  OK, found the article.

  It's Here

  The one point that Repubs will trot out is the old canard about lawsuits driving up costs.  I'll see what I can post as a rebuttal to this.  The evidence supports minimal effect of malpractice on premiums...

  by Primordial Ooze on Wed Feb 02, 2005 at 01:08:12 PM PDT

•  Pew Trusts Study

  In a report by Peter D. Jacobson entitled "Medical Liability and the Culture of Technology", we see a detailed analysis of how the race to adopt new technologies is, to some extent, driving adverse outcomes in medical treatment.  The conclusion is:

  "Malpractice crises have generated an enormous amount of commentary, empirical report and reform proposals. By focusing political attention on simplistic fixes, such as caps on damages, policymakers have lost sight of the broader factors responsible for the recurrent malpractice crises. As long as society demands technological innovation, liability exposure is an inevitable consequence for physicians, hospitals and other health care providers."

  There is a problem, but it aint the snake oil that the Republicans are selling.

  See Here for a summary.

  See Here for the full 117-page wonkfest.

  by Primordial Ooze on Wed Feb 02, 2005 at 01:28:42 PM PDT

•  For the next "This Week in Fascism"

       Bond Dad was first with the report that Medical Bills Cause Half of Bankruptcies followed closely by Joe W. Larson's report about Bankruptcy, an important protection for the middle class which both refer to the same Sun Times Article about how Bankruptcy protections have been whittled down while a large portion of the increase in Bankruptcy's can be attributed to rising health care costs and insurance companies limiting coverage's. When this country was founded Bankruptcy was set in place to prevent people who suffered from catastrophic losses from becoming wage slaves, but with the reductions in protection and the increased possibilities that people can face a crisis more and more people suffer.
       A.J. Snow provided the most discussed diary on this with his take on the Study: Half of U.S. Bankruptcies Due to Medical Bills. It's hard to understand how the least informative of the three diaries became the most discussed. But that's how thing work here sometimes.

  by Tomtech on Fri Feb 04, 2005 at 12:20:30 AM PDT