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What do Americans have in common with Afghan families?

Debt.

Unfortunately, though, in countries like Afghanistan, debt can force a whole family into “bonded labor.”  Can you imagine your 11-year old daughter leaving for work at 5 am and returning at 4 pm?

Cross posted at Voices on the Square.

I saw this article at yahoo the other day and it utterly appalled me.

Thousands of Afghan children lose their youth in brick kilns

Gulmena is 11 years old but she is no longer a child. Her face is lined, her hands are rough and her feet worn hard by the hours spent working in a brick kiln in the eastern province of Nangarhar.

Gulmena, her three younger brothers, and her father, Jan Agha, must make 1,500 bricks a day to earn a daily wage of 250 afghanis between them. Jan Agha says he has no choice but to bring his children to work as their family has no money. They left Pakistan when the floods destroyed their home earlier this year, but are now facing a debt of 40,000 rupees, or about 21,000 afghanis.

This family went into debt when the mother became ill.
Afghan family works to pay off crushing debt

When he turned 18, Khan went to work in Iran before returning to Peshawar, a Pakistani city across the border, where he wed in a marriage arranged by his family. He was working in a brick factory in Peshawar when his wife became ill. So he borrowed money from the factory to pay for treatments and feed his growing family.  

Unfortunately, this problem is not uncommon in Afghanistan.
Afghan brick-makers seek break from bonded labour

"Many Afghans here face this problem," said Qaiser Siddiqi, who works with SHARP (Society for Human Rights and Prisoners' Aid), a UNHCR-funded legal clinic for Afghans. "They borrow money from the brick kiln owners to build a house or for medical bills, which leads to bonded labour. They often have no official documents and are afraid to venture out, so they're caught in this vicious cycle of poverty and indentured labour."  

His Pakistani neighbour, Mohammed Ikram, said that "once it gets to 2,000 rupees, the debt goes on and on, it just grows. I'm now 20,000 rupees in debt and it's not going away. One of my relatives had to sell his kidney."

Afghan brick workers trapped by debt

Hundreds of thousands are working as bonded labourers in kilns in various parts of Pakistan, says the president of the All Afghanistan Federation of Trade Unions, Mir Ali.

A large part of the kiln workforce is made up of underage children working to service their parents' debts.

Himself a kiln worker, Mr Ali says: "My whole family, including two sons and three daughters, have been working for the past 14 years as bonded labourers in a bricks factory."

When I read the first article, I was shocked at how common it is for children in developing nations to end up working hard labor to help pay off their families’ debt.  I dug a little more into this issue and was surprised to realize that a reoccurring theme of these families was their inability to pay for medical care.  So I found a recent study that looked at debt and medical care for developing nations.

Consider this:

Many families around the world make sizable out-of-pocket payments for health care. We calculated the frequency of borrowing money or selling assets to buy health services in forty low- and middle-income countries and estimated how various factors are associated with these coping strategies. The data represented a combined population of 3.66 billion, or 58 percent of the world’s population. On average, 25.9 percent of households borrowed money or sold items to pay for health care. The risk was higher among the poorest households and in countries with less health insurance. Health systems in developing countries are failing to protect families from the financial risks of seeking health care.
Did you catch this in the summary above for the study on health care in developing countries?
Health systems in developing countries are failing to protect families from the financial risks of seeking health care.
Sound familiar?

I guess we Americans can be thankful that our children aren’t forced to work to pay off our medical debt. But the real problem is that Americans face issues similar to families in developing countries when we look at medical debt.

A recent report released by the NHIS Early Release (ER) Program (pdf) included these highlights on the debt burden Americans face from medical debt:

In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.

Chances of being in families having problems paying medical bills, paying medical bills over time, and having medical bills that could not be paid at all, decreased with age. Almost 24% of children aged 0–17 years were in families having problems paying medical bills compared with 21% of adults aged 18–64, 10% of adults aged 65–74, and 7% of adults aged 75 and over.

Among adults aged 65 and over, those who were poor and those who were near poor were more than three times as likely as those who were not poor to be in families that had problems paying medical bills in the past 12 months.

For more info, go to the cdc website

While this study shows that Americans are less likely to face medical debt as we get older, Medicare doesn’t keep all families out of medical debt.  
A report on out-of-pocket spending for medical care in the last five years of life, presented at the American Geriatrics Society annual meeting in early May, illustrates the financial disaster facing millions of retirees and their families, even as the Republicans and Democrats squabble in Washington over how to impose even greater burdens on working people.

In fact, out-of-pocket costs average nearly $39,000 over the last five years of life. For nearly 10 percent of the sample they approach $100,000, despite the fact that these people are covered by Medicare.

So, what is the goal of Health Care policy in the US?

Is the US policy objective to protect families from the financial risks of seeking health care?

Or something else?

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