Skip to comments.Land where calling an ambulance is first step to bankruptcy
Posted on 11/05/2003 3:15:59 PM PST by Taff
The second in a three-part series on Bush's America looks at the inflated hospital bills facing the uninsured poor
Julian Borger Tuesday November 4, 2003 The Guardian
Rose Shaffer's heart attack taught her a lot of things that, as a nurse, she should have known. She learnt it pays to eat carefully and exercise regularly. And she learnt the hard way that if you cannot afford medical insurance in America, you better hope you don't get sick. A Chicago hospital saved Mrs Shaffer's life but she feels it is now trying to take it back. Since that frantic October night three years ago, the hospital owners, a Christian, non-profit foundation, have hounded her for crushing bills she could not afford, partly because as an uninsured patient she had been charged double.
The hospital sent debt collectors after her who called her all hours of the night, at home and work, until she gave in and was forced into bankruptcy. Now, at the age most people are thinking of retiring, she has to work long hours seven days a week at a nursing agency for the next three years to have any hope of holding on to her last asset, a suburban bungalow.
"When I was young I thought that, when you reach 60, if you don't have anything, then you're nothing. Well, I'm 63 and I don't have nothing, and I'm not going to get anything," Mrs Shaffer said, sitting at her kitchen table sifting through some of her latest bills.
"The whole system is messed up. In this country the rich get richer and the poor get poorer, and no matter how much you work, you're going to get poorer."
In the US today, there are nearly 44 million people in her position - without medical insurance in a country that does not guarantee basic healthcare - and the crisis is deepening. In the three years since George Bush took office, the ranks of the uninsured have risen by 10%, or four million people. The government will pay if you are destitute but not if you earn enough to keep above the poverty line - about $18,000 (£10,600) for a family of four. In theory, employers are supposed to provide health insurance but more opt not to, and buying cover individually is either very expensive or impossible if you have a "pre-existing condition".
Consequently, 15% of the population, most of them the working poor, live in the fear that an accident or sudden illness could plunge them into debt. The uninsured will typically put off going to see a doctor in the hope that their medical problems will pass. They tend to seek treatment only when their condition is critical.
Almost everyone in US politics, including all the candidates in the presidential campaign, agree the situation is unacceptable but differ widely on how to fix it. A succession of presidents, from Harry Truman more than half a century ago to Bill Clinton in 1993, have floated grand schemes for achieving universal healthcare coverage, but each time they have been defeated by resistance from the medical profession, employers and the tax-averse.
"I think the problem is the extent of income redistribution it would take to make it happen," said Karen Davis, the head of the Commonwealth Fund, an independent health and social policy foundation. "The greatest sentiment for change comes when the economy is bad, but that's also when resources are at their shortest."
There are public hospitals across America, but their size and number are tiny compared to the scale of the problem. Chicago has Cook County hospital which is overwhelmed in most departments by the sheer volume of needy patients. But it does have a world class emergency room and excellent trauma specialists.
Rose Shaffer, however, did not have the good fortune to suffer her heart attack near the Cook County ER. The ambulance did what it was supposed to - take her to the nearest trauma centre, at South Suburban hospital, part of a Lutheran-run chain called Advocate Health Care. Two days later, she was transferred to another Advocate hospital, Christ medical centre.
Christ's is the biggest hospital in its region, and its illuminated cross soars over Chicago's southern suburbs like a beacon - a vivid symbol of what President Bush calls faith-based charity. As a non-profit organisation Christ's is supposed to offer care to the needy, but there is no state requirement for just how much charity it should mete out. Mrs Shaffer said that when she was recovering from her heart attack, a hospital official told her she would be sent application forms for charity assistance. They never came. Instead, she received a bill for $18,000 - $6,000 for each day she spent at Christ's.
According to the Service Employees International Union (SEIU) which has investigated Advocate and other "charitable" hospitals in the Chicago area, Mrs Shaffer's bill would only have been $8,500 if she had been insured. Medical insurance firms typically negotiate heavily discounted rates for clients. The uninsured have no such leverage, and according to SEIU's hospital accountability project, end up paying on average 139% more than the insured. Joseph Geevarghese, the project director, said: "When these people go to hospital they lose their home." The hospitals often see the uninsured ("self-pay" in the jargon) as a profit opportunity. In the words of an industry consultant, Michael Zimmerman, "self-pay now stands alone as the financial category that will provide the biggest bank for the buck".
"It can and should be a cash cow for the hospitals, but it is not," Mr Zimmerman wrote in a newsletter for hospital administrators. He argues hospitals are not being tough enough when it comes to debt collection from patients.
Mrs Shaffer said there was no lack of enthusiasm in her hospital's pursuit of her money. "The collection people were real nasty," she complained. "They'd call on Sunday, they'd call at 9 o'clock at night. They'd call on the job. My voicemail was full. It was harassment."
Advocate says it is no more aggressive than any other hospital. In fact, according to Ed Domansky, a chain spokesman, the hospital is obliged by federal law to make "reasonable efforts" to collect debts, and to maintain a uniform price structure, which does not allow giving automatic discretionary discounts to the uninsured. The SEIU, he said, was picking on Advocate hospital because it was seeking to organise its workers, and he pointed out the chain had recently expanded its charity care, and made more effort to inform the uninsured about its availability.
"This is not just an issue in one hospital or one state," Mr Domansky said. "We believe the federal regulations on hospital billing make the plight of the uninsured worse, and we would welcome change."
It is not just the uninsured who can end up impoverished. Richard Roche thought he had insurance. His employer, a cab company, did not provide it, so he paid more than $400 a month for his own policy. When he had to have a growth removed from his windpipe, his insurer agreed to pay only a fraction of the cost. The hospital went after him rather than the insurer and the bills eventually forced the 61-year-old into bankruptcy. He had to sell his house and cashed in his life insurance. "They got me. Once you get sick - that's it. You're in deep trouble."
Ronald Pollack, the head of a Washington pressure group, Families USA, said: "This problem reaches deeper and deeper into middle class and working families. For most Americans it has gone from an issue of altruism for a discrete, disadvantaged population, to an issue of self-interest."
The crisis has become an issue in the presidential campaign. Remedies vary in cost and ambition, from schemes to expand Medicaid and Medicare (the government-funded schemes for the destitute and elderly) to cover the rest of the uninsured, financed by repealing the Bush administration's tax cuts, to the far more modest market-oriented proposals put forward by the White House itself, based on tax breaks for the self-insured.
History suggests that, whoever is elected, little will change. The hospital business and the $400bn insurance industry have too much to lose, as do corporate employers who would be asked to foot much of the bill.
Much like an uninsured patient, the US knows there is something wrong, but it is unable so far to face the cost of the cure.
Did you just sign up to post this predictable "parade the homeless and uninsured" leftist drivel that any breathing conservative could have found with no trouble on CBS, DU, Salon or the Denver Post during an election of an incumbent republican president?
Did you come here to offer opinion and solutions, or just annoy (read: troll)?
I couldn't agree more, although its not the only problem.
Washington chapter 7 bankruptcy laws protect $16,000 of your house's equity in a community state. 1/2 that amount if you're single.
You can do like most, pull all the equity out 8-12 months prior to filing.
"The hospital sent debt collectors after her who called her all hours of the night, at home and work, until she gave in and was forced into bankruptcy. "They'd call on Sunday, they'd call at 9 o'clock at night. They'd call on the job. My voicemail was full. It was harassment."
BS, the collection idiots are allowed one contact every 2 weeks by law in IL. Anything more is a crime and this "nurse" could sue for the entire amount if their's any truth to what she says at all.
Bush's America my butt. This is pure unadulterated socialist Eurocrap.
Hey, Taff, what's your opinion of the pure unadulterated solialist eurocrap you post here?
What's the frequency, Taff?
The insurance company is getting a volume discount. It sends all its customers--er, that is, patients--to some designated hospital(s). In exchange the hospital charges the insurance company slightly less. Perfectly normal capitalist business practice.
And I believe that insurance is an exempt asset.
I am a medical editor and I work for a company that does research for the US Public Health Service, among other government health-related entities. For the past seven years we have been creating the Medical Expenditure Panel Survey, which is an ongoing study of health care practices in the United States, what they cost, and who is paying how much for what. I analyze medical records all day long and study the outcomes of cases, both medical and economic. Participants in the study are chosen to demographically represent the US health-care consumer accurately.
Over and over, tens of thousands of times each year, we see the same stories repeated: the indigent Latino getting a $25000 cardiac catheterization at one of the nation's finest medical centers and not being billed for it; Medicaid pays the medical center $1200 and the cardiologists $300, and both hospital and doctors eat the difference. The elderly lady spending a month in the hospital, running up a $150K tab, and not being billed for it; the hospital accepts the Medicare payment because that's all it can get. The millions of poor children getting excellent care in major outpatient clinics and being asked only for a $5 copay when they get $2000 worth of lab work done.
And even the patients who don't have Medicare or Medicaid but just can't afford to pay often simply walk away from their bills. The hospitals are not at all aggressive about pursuing them, and a year later, when we're looking into their compensation, the hospitals' patient accounts departments just shrug and say, "We've written it off." I very rarely see evidence of patients working assiduously to pay off every dime over a period of months or years.
I no longer believe all the horror stories about people being denied care or being driven into bankruptcy. Most people confronted with overwhelming bills seem to Just Say No to the hospital. I would only urge them to pay their separate doctors' bills, because the truth is that most doctors, like our own Strongbow, are doing too much charity work as it is.
Maybe he has vision problems; here let me help...
What's your opinion, Taff?
It's about time you got a glimpse of cold reality. I take it that you have never had an uninsured experience with emeergency room billing.
Pure baloney. There are plenty of nurses making $80,000 to $100,000 a year because of the overtime. They get insurance from their employer. If nothing else, she could just file Chapter 7 and be done with it.
I can't believe any of this is true.
That and the fact that a bad medical result in the ER for one of these illegal invaders, generates millions for the shysters.