"Dang, Sundance, do you think you may have used too much powder on that ZOT?"
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.
"Dang, Sundance, do you think you may have used too much powder on that ZOT?"
It's more than a volume discount. There is not any difference in the cost of providing care to an insurance patient than a non-insured patient.
The only difference is marketing costs. And there's not that much difference their either. In fact most people decide who to go to based on word of mouth, rather than insurance companies. The only way insurance companies are able to direct patients to doctors is by limiting the patient's choice.
There is no way that difference is justified by volume. But it occurs in part because of the way insurance companies negotiate. And the difference is also exaggerated by the way we make up for indigent care.
Volume discounts don't normally drive the price below the incremental cost of providing care (without fixed costs). But the difference between fully loaded costs and incremental costs are larger because fully loaded must absorb the cost of indigent care.
She was 63. She was probably either retired or working part-time. And not every nurse works for a hospital that offers insurance.
In case you haven't noticed, there are a lot of small business who are being priced out of the health insurance market. Group insurance is twice as high as individual insurance. So it's cheaper just to pay your employees a little bit more and tell them to get their own insurance.
"BUSH; FOOD; POVERTY; TAKEYOURMEDS; TROLL; USA;" Long queue at drive-in soup kitchen
So far Taff has been a hit an run poster who appears to have an agenda other than comment and debate.
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.It's all Bush's fault !! ...
< /sarcasm >
I guess he had to post and run ?? ...
Unless it's changed in the last couple years, it's the other way around. Groups are given discounted premiums, because of the volume and lower admin. cost. Small business is priced out, because their group membership is low. THey have the option of pooling with other business though. Ultimately the insurance itself is expensive, for various reasons. There are also fed and state tax considerations for the business when calculating cost. Paying the employees a little more really isn't going to cover the cost of any insurance.
"She was 63...
She was a nurse in an area that pays very well. What did she do with all that cash she earned over the years? Retired, she has medicare. At any rate the story is completely bogus and well beyond any reasonable exaggeration.
I checked them 3 years ago and recently. Both times individual was less than half the price of group. Group must accept preexisting conditions. Individual insurance can still deny you unless you are completely healthy. That more than offsets any volume discount.
She was a nurse in an area that pays very well. What did she do with all that cash she earned over the years?
Nurses used to make squat. The rates have only shot up in the last couple of years. Medicare doesn't kick in until 65.
I don't think it's bogus at all. You do get charged double if you don't have insurance.
That depends on the state. The last time I looked over insurance premiums for IL and WI. Groups were always significantly cheaper. Individual, or family plans would only come close at best, but were always higher w/o exception. When preexisting conditions were allowed to be excluded from coverage, the situation was the same.
"Nurses used to make squat."
She worked in a high paying area. It's been that way for many decades. Unless she was a lifelong candy striper.
"Medicare doesn't kick in until 65.
Yes, she may be young enough to put her to 65. Still the story is completely bogus, as per my first 2 posts.
"Both times individual was less than half the price of group."
This doesn't even make sense. The admin costs alone to handle individual accts and the agents cut make it ridiculous. Any company would automatically buy individual plans, instead of group plans.
Not up here. The price is the same, unless the price is discounted, because the patient's in a PPO, or it's an HMO.
Duh! One group getting a discount of 50% is exactly the same think as another group paying double. It's just semantics.
Sure it is, but you have it the price the groups are being charged backwards. The group that consists of individual heath care plans pays more, than the group whose members are covered under the single group plan.
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