Incoming!
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.
Charity
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."
Deep trouble
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.
My wife just got hired to start Monday after being out of work for 20 months; we've gone through savings, my part-time earnings and pulled all equity just to get here.
Bankruptcy is not an option for us right now as we don't owe anything but the mortgage; we paid off both cars and all the credit cards a year ago.
We may still end up having to sell the house just to lower our living expenses.
...and drives a 10 year old Ford and lives in one house?
One lady I met at a political gathering told a story about how a $75 doc bill+ointment was bankrupting her. She was serious. She was the last whiner of the group. She had poison ivy. After it was clear she would not in anyway accept responsibility for her own condition and bills I asked her, "do you want me to pay the bills?" She said, "yes I do." "You should pay them, because you have the money and a job." I told her no. What came out of her mouth shut the rest of the socialized medicine advocates down. The gathering dispersed in the state of shock.
I don't understand this. As I state in another post on this thread, my daughter had an endoscopy, and we have the bills. I am paying, of course, what I can afford, but at an accelerated level, not $10 a month. I am paying off the 20% charge, by paying hundreds of dollars a month toward the bills. They will be paid off shortly. This is a hardship, only because we are a typical American family with two children, and all of the costs and responsibilities involved.
If I take my car to the mechanic for repair, and owe the mechanic $1500, I would pay him, most certainly, for a car is a necessity. Why would I see this differently when it comes to my daughter's medical care? She is more important than transportation, after all.
Why is it that so many people ignore their bills, and do not feel obligated? Don't they realize that receiving the best medical care is a luxury that we cannot afford to lose? By paying our share of the costs, we are doing the right thing. However, we will pay for it in the future, with higher costs passed along to us. This is not fair.
But life is not fair.
Other people look at the matter in a different manner. They pay the mechanic because they recognize that he is a small businessman with a family to support, just like them. They also know that they'll end up in small claims court if they don't pay him. But they are aware that the hospital ignores millions of dollars owed it by illegal immigrants, indigents, and the elderly (and many of those elderly, BTW, are fairly prosperous but still don't pay the full fare because they have Medicare). These people wonder why they should pay when no one else seems to.
I'm not saying this is right. I'm saying that this is the rationale.
And let's be frank. While some of those who walk away from their debts have been restored to health and could well pay, others don't pay becuase the illness that brought them into the hospital is still with them and they can't work, or can just barely support themselves.
Incoming!
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