You know, I really should be reading a grant right now, but after seeing this article from yesterday’s Wall Street Journal, I am just too angry – and scared – to focus on anything else.
It begins thus:
When Lisa Kelly learned she had leukemia in late 2006, her doctor advised her to seek urgent care at M.D. Anderson Cancer Center in Houston. But the nonprofit hospital refused to accept Mrs. Kelly's limited insurance. It asked for $105,000 in cash before it would admit her.
Sitting in the hospital's business office, Mrs. Kelly says she told M.D. Anderson's representatives that she had some money to pay for treatment, but couldn't get all the cash they asked for that day. "Are they going to send me home?" she recalls thinking. "Am I going to die?"
Yes, apparently even nonprofit hospitals like the esteemed M.D. Anderson now have six-figure entrance fees. For insured patients.
Of course, Ms. Kelly committed the unpardonable sin of having "limited" (i.e., junk) insurance. Now, the kinder name for junk insurance is "catastrophic coverage" – something to protect you if you find yourself in a worst-case scenario, such as a cancer diagnosis. You might have a sky-high deductible and terrible prescription coverage, but at least you shouldn’t lose your life savings if disaster strikes, right? Right? Anyone?
When Mrs. Kelly called M.D. Anderson to make an appointment, the hospital told her it wouldn't accept her insurance, a type called limited-benefit...
Mrs. Kelly, 52, signed up for AARP's Medical Advantage plan, underwritten by UnitedHealth Group Inc., three years ago after she quit her job as a school-bus driver to help care for her mother. Her husband was retired after a career as a heavy-equipment operator. She says that at the time, she hardly ever went to the doctor. "I just thought I needed some kind of insurance policy because you never know what's going to happen," says Mrs. Kelly.
Okay, Republicans: can you, please, explain to me what this woman did to "deserve" her situation? (Because, as we all know, that must be the only explanation; only those who live irresponsibly could possibly find themselves in such a state.) Ms. Kelly was insured – self-insured, in fact. And why? Because she committed the unpardonable sin of quitting her job to care for an elderly mother. What appalling family values!
Well, clearly she must have been irresponsible in some other way. Perhaps she and her husband simply weren’t saving enough? Or, perhaps, they’re just lazy whiners who didn’t even make an effort to pay?
M.D. Anderson viewed Mrs. Kelly as uninsured and told her she could get an appointment only if she brought a certified check for $45,000. The Kellys live comfortably, but didn't have that kind of cash on hand. They own an apartment building and a rental house that generate about $11,000 a month before taxes and maintenance costs. They also earn interest income of about $35,000 a year from two retirement accounts funded by inheritances left by Mrs. Kelly's mother and Mr. Kelly's father...
The Kellys arrived at M.D. Anderson with a check for $45,000 on Dec. 6, 2006. After having blood drawn and a bone-marrow biopsy, the hospital oncologist wanted to admit Mrs. Kelly right away.
But the hospital demanded an additional $60,000 on the spot. It told her the $45,000 had paid for the lab tests, and it needed the additional cash as a down payment for her actual treatment.
Oh. Hmmm. Well, at least the noble hospital later lowered its demands to $30,000 – clearly, a reasonable amount – and then allowed her to be admitted via a temporary "override." Unfortunately, Mrs. Kelly’s troubles didn’t end there:
Chemotherapy would continue for more than a year, as would requests for upfront payments. At times, she arrived at the hospital and learned her appointment was "blocked." That meant she needed to go to the business office first and make a payment.
One day, Mrs. Kelly says, nurses wouldn't change the chemotherapy bag in her pump until her husband made a new payment. She says she sat for an hour hooked up to a pump that beeped that it was out of medicine, until he returned with proof of payment.
Once, Mrs. Kelly says she was on an exam table awaiting her doctor, when he walked in with a representative from the business office. After arguing about money, she says the representative suggested moving her to another facility...
Ron Walters, an M.D. Anderson physician who gets involved in financial decisions about patients, says...he is sorry if she was offended that the payment representative accompanied the doctor into the exam room, but it was an example of "a coordinated teamwork approach."
And there you have it: such crises are, indeed, the result of "teamwork" between insurance companies who won’t pay and hospitals determined to get their share any way they can. Now, I understand the costs associated with advanced medical care, and I understand that hospitals can’t continue to function if they just write off all the myriad charges that insurers deny. That said, hospitals are certainly culpable if they use funds intended for patient care to pay bonuses to executives, and they are culpable if they extort outlandish prices out of "uninsured" patients.
I’m sure you saw this coming a mile away, but that’s precisely what even nonprofit institutions, like M.D. Anderson, are doing:
An Ohio State University study found net income per bed nearly tripled at nonprofit hospitals to $146,273 in 2005 from $50,669 in 2000. According to the American Hospital Directory, 77% of nonprofit hospitals are in the black, compared with 61% of for-profit hospitals. Nonprofit hospitals are exempt from taxes and are supposed to channel the income they generate back into their operations. Many have used their growing surpluses to reward their executives with rich pay packages, build new wings and accumulate large cash reserves.
M.D. Anderson, which is part of the University of Texas, is a nonprofit institution exempt from taxes. In 2007, it recorded net income of $310 million, bringing its cash, investments and endowment to nearly $1.9 billion.
And here’s where those "growing surpluses" are coming from:
Mrs. Kelly had been billed more than $360 for blood tests that most insurers pay $20 or less for, and up to $120 for saline pouches that cost less than $2 at retail...
On one bill, Mrs. Kelly was charged $20 for a pair of latex gloves. On another itemized bill, Ms. Wallack found this: CTH SIL 2M 7FX 25CM CLAMP A4356, for $314. It turned out to be a penis clamp, used to control incontinence.
But, don’t be too mean to the poor hospitals. After all, they’re reasonable and willing to negotiate:
M.D. Anderson's prices are reasonable compared with other hospitals, [an executive] says...
This month, the hospital offered Mrs. Kelly a 10% discount on her balance, but only if she pays $130,640.08 by this Wednesday, April 30...
The hospital has urged Mrs. Kelly to sell assets. But she worries about losing her family's income and retirement savings. Mrs. Kelly says she wants to pay, but, suspicious of the charges she's seen, she says, "I want to pay what's fair."
So, what is fair? $45,000 for blood work and a bone marrow biopsy? $20 for a pair of latex gloves? $315 for a clerical error? Apparently, yes, if you are un- or under-insured. If you happen to be an insurance company, however, you shouldn’t have to pay nearly that price; after all, you then have CEOs’ billion-dollar salaries to pay.
This is the state of the "best health care in the world." Mrs. Kelly sat with an empty chemo bag until her husband showed up with a check, but, "like most Americans," she can "go see [her] doctor fairly regularly." She had to pay $105,000 before being treated for acute leukemia, but "people have access to health care in America. After all, you just go to an emergency room."
We must, absolutely must elect a leader who will be open to addressing this problem. I realize that neither Clinton nor Obama has proposed an ideal health care solution, but either one of them would, at least, begin to reform this horrid system. I believe that we could push either one toward a truly civilized approach to health care. McCain, on the other hand, would gladly exacerbate the problem.
I truly hope that Obama is our nominee, and I find Clinton’s recent behavior nearly inexcusable. Furthermore, there are moments when I almost agree with Jerome a Paris’s diary last week and think that our country is irredeemable. But articles like this one remind me that, even if the unthinkable and unlikely coup-by-superdelegate should come to pass, I absolutely must vote for Clinton in November – because another Republican administration will multiply the chances that the empty, beeping chemo pump will be attached to a person I love.
Oh, just one last thing:
Letting bad debt balloon unchecked would threaten hospitals' finances and their ability to provide care, says Richard Umbdenstock, president of the American Hospital Association. Hospitals would rather discuss costs with patients upfront, he says. "After, when it's an ugly surprise or becomes contentious, it doesn't work for anybody."