Emergency rooms, magical thinking, and the poor

Emergency Room

To hear Mitt Romney (and many others) tell it, Emergency Rooms are the physical embodiment of Mother Theresa, treating indigents like Jesus treated the lepers. The great seas of health care are suddenly parted for the poor and ill, and outstanding bills just miraculously become absorbed into the ether of write-off’s and tax exemptions.

This type of magical health care thinking isn’t limited to multi-millionaire politicians. Many in the public also believe ER’s effectively fill the wide gap between sickness and insurance. It’s a fallacy that has become so engrained that its standard line — get sick, get treated by an ER, get the tab picked up by someone else — goes nearly undisputed by those on both the right and the left.

That’s simply not the way it works.

Setting aside the fact that ER’s are not mandated to treat what their doctors may consider a non-emergency — a subject which merits its own, separate discussion — many uninsured ER patients find themselves saddled with bills they can’t hope to pay. These bills are not just from the hospital, but from outside physicians, diagnostic services, and laboratories, none of whom are mandated to treat the indigent or uninsured for free.

Depending upon the state and the hospital, uninsured patients may meet with a hospital social worker who will have them fill out forms for state aid or other programs. There is no guarantee of approval, and even when someone does qualify, benefits may not extend to other services rendered in the course of care.

On a trip across the US, I spoke to several people in dire straights due to medical debt. One of them was a homeless man in his 30s. John M. was a single laborer who was working a temp job when he was hit with over $8,000 in medical bills for non-work related wound that had led to a staph infection. In the hospital, he met with a social worker who helped him apply for aid. Later, he received notice that he didn’t qualify due to his income and status as a single person. The bills started pouring in, not just from the hospital, but from doctors whose names he didn’t recognize and labs that had processed his tests.

When bills like John’s go unpaid, hospitals and other businesses may “write them off,” but contrary to what many people may believe, this does not mean that they disappear. Collection agencies buy such debts for pennies on the dollar and then may vigorously pursue the patient-debtor, through judgments, wage garnishments, and bank account liens. To add to the confusion, medical debts can be bought and sold many times over, involving an almost incomprehensible string of collection agencies.

Like many people with medical debt, John attempted to work with the collection agencies on a payment plan, but there were too many of them, each demanding that their bill take precedence. Desperate for relief, John went to an agency that specializes in helping debtors reach payment agreements and was told he didn’t make enough to carry the minimum monthly payment that would be required. At that point, John considered filing for bankruptcy, but he couldn’t afford the attorney’s fees.

Four years after his illness, with his credit ruined and with several court judgments against him, John’s low wages were garnished and he could no longer afford his rent. He applied for a second job as a cashier at a home goods store and was told that they’d run his credit report as a matter of practice. It was the same at other places he applied. While he was never told why he wasn’t hired, he suspected that his low score had something to do with the lack of call-backs, particularly since he’d never had such a problem finding a minimum wage job before.

John scrambled for a cheaper place to live, but none of them were cheap enough to make up for the loss of wages, and all of them required better credit than his. He was told he’d need a cosigner or a larger deposit, neither of which he had. Feeling he had no choice, John quit his job and found work with another temp agency, hoping to outrun his garnishment and at least catch up on his rent. Within two months, the collection agencies had found his new place of employment and set the wheels in motion to collect their pay. John was eventually evicted. Jobless, he lived out of his 14 year-old truck for a while, but then his truck died and he couldn’t afford repairs. He sold it for scrap so that he could eat. He showed up at the county day labor office every weekday, hoping to make enough money to rent a motel room. Sometimes there was work, sometimes there wasn’t. Sometimes he slept in shelters, but many times he slept in the streets. When winter got to be too much, he scraped together enough to take a bus to a warmer climate. When I met him, he was among many of Florida’s homeless and his prospects for crawling out of the hole were dimmer than ever.

Of course, not all stories are as extreme as John’s, but the fact that some are is a stark reminder of how easily a life can be unraveled, particularly when medical debt can bring a host of life-altering consequences.

Some people do end up qualifying for State programs, and there are some hospitals which have developed their own foundations to assist in care, but there’s no national uniformity to the system. While an uninsured person at one hospital may qualify to have their ER charges reduced or paid for by another entity, another person, at another hospital, may not.

In any case, medical debt is on the rise and collection agencies are becoming increasingly aggressive in pursuing debtors.

The Commonwealth Fund, a private foundation that sponsors health care research, estimates that 22 million Americans were contacted by collection agencies for unpaid medical bills in 2005. That increased to 30 million Americans in 2010. – March 2012, USA Today

As the article in USA Today points out, credit may be wrecked even when medical debt is paid. Slow and late payments can stay on records for seven years, and as much as ten if there is a judgment involved. There is also a valid and growing concern that collection agencies are misusing the court system to have debtors thrown in jail, adding the element of warrants and jail time to people’s background checks which, like poor credit, may diminish their future employment and housing opportunities. Poverty by itself is a vicious cycle that is difficult to escape. Adding collections, garnishments, judgments, bad credit, and arrests to the list of obstacles can make it nearly impossible. In the bigger picture, it would seem to do more harm to our economy and social structure to keep people locked in the cycle of medical debt for years on end, rather than to offer them a real solution.

Despite receiving tax exemptions to care for the uninsured and poor, some hospitals have gone so far as to sue these patients for what they are owed. Others, as noted, turn their debts over to collection agencies. In the mix are the outside services which are not given the same exemptions, and which aren’t subject to the same guidelines.

The result of all of this is that both patients and the medical care industry are suffering, while collection agencies are growing richer. By 2007, the number of collection agents had doubled from the early 1990s, while industry revenue tripled to $15 billion (on $40 billion in collected debt).

So, no, emergency rooms are not the answer for America’s sick and uninsured. The illness that’s treated today should not result in years of financial consequences, which not only affects individuals, but society as a whole. To what end is a culture that binds people to medical debt in ways that may cost them their homes, jobs, and futures? To what end is a medical system that only increases the need for shelters, welfare, and other social services — while burdening the healthcare industry with millions of dollars in extra costs? An America that grows poverty is not as valuable as an America that grows potential. Anyone who would argue against that is as short-sighted as they are unreasonable.

Seventeen minutes that changed the world

Like many Americans, I stayed up late last night to listen to Governor Chris Christie deliver the keynote address at the Republican National Convention. I wanted to hear how Mitt Romney will transform the stagnant economy, how he will inspire us all to get up each morning and work; not because we have to, but because we are eager to build something our children and their children’s children can be proud of.

I was disappointed. What I heard was a tirade about how we need to quit whining, walk it off and get back into the coal mine. You haven’t yet lost all the fingers on your hands and your back is not yet broken.

When he finished speaking, I lifted my broken body from the coach, silently turned off the television and shuffled off to bed, feeling not only uninspired but a little more depressed. I prayed silently that I not wake up in the morning. Not in Chris Christie’s America.

But I did wake up. And on a whim — for the sake of comparison — I Googled Barack Obama’s 2004 keynote speech. I was reminded that life is lived in the moments, that seventeen minutes in a life can make a difference. Whether or not you voted — or will vote — for Barack Obama, would you not really want to live in an inspired America than a downtrodden and drepressing one?


On C_SPAN

I want to live there. I think many, many more do as well.

What the housing experts are missing that Warren Buffet sees

Watch the following video. See if you can spot the trend. I’ll give you a hint; it is almost at the very end, but you have to watch the whole thing to pick up on it.

Did you hear it? If not, watch the video again.

Warren Buffet is investing in COMMERCIAL INVESTMENT stuff, the banks that lend money to commercial leasing companies. But these commercial leasing companies aren’t leasing traditional commercial space. They are leasing to commercial property holders that are buying up the inventory of foreclosed properties, fixing them up like flips but instead of flipping for resale, they are flipping for longer-term leases to people who have kids and have grown used to the suburban lifestyle.

These commercial leasing companies are creating suburban slums in the first and second outer suburban rings to city centers.

Watch the video again. Did you catch it? Do you now understand why these pompous “experts” never quite see trends coming? I’ll give you more than a hint on that; I’ll give you the answer.

They are too enamored with the sound of their own voice to listen to what they’re saying.

This is why Congress has no interest in helping out those going through foreclosure. If they intervened, it would slow or stop the flow of inventories into the private residential leasing industry.

The real estate market is heating up and recovering; it’s just not flowing wealth into the middle class but rather, pushing more wealth into the upper classes and corporate coffers. Corporations have found a way to skim off the wealth that even a massive recession creates.

Give me another ten years and see if I’m right. I’ll bet you $10,000 I am.

A calculation almost every American man over fifty has made in his head

There is one calculation that almost every American man over fifty* has made in his head that he will almost never admit to. The ones who have made it more than once and many times a year are the ones who have families and responsibilities who now find themselves at the scary end of a medical diagnosis and/or the threat or reality of unemployment.

That calculation is:

Am I worth more dead than alive?

….

The columns and totals never really see a piece of paper, but they are nonetheless very real.

In the assets column:
That term life insurance that has five more years before it expires and has no value: $250,000.00; Cash in the bank: $50,000.00; That 401(k) I started too late; $30,000.00; Stocks and bonds I randomly bought; $35,000.00; House equity, assuming it can actually be sold in this economy: $100,000.00… and on through the value of furniture, cars and power tools in the garage.

In the liabilities column:
I just got fired, so my unemployment is only $481.00 a week but bills with mortgage and food is $2,100 a month, losing $200.00 a month… I’ll soon lose my health insurance and COBRA is a $900.00 set back per month making that $1,100.00 a month just standing still… if I am unemployed for more than six months, that will be about $10,000.00 gone from the bank account, making the past couple years of savings a waste of time… chances are, I will be unemployed for the rest of my life in this economy, so that will just stretch on, losing my family $20,000.00 a year with me being alive. I will lose my health coverage in less than a year and a half… That is a lot of cash, and that life insurance policy just inched its way to being one year less valuable with no employment in sight…

I just got diagnosed with a pretty serious health condition that will make it difficult for me to work. I will soon be out of a job as my employer will get tired of me calling in sick all the time… I will lose my health care coverage.. if I go into the hospital, that will cost about $8,000.00 a day, depleting my cash in about a week… the mortgage is due in a week… the last tuition bill is due in a couple months… and on and on down to how much dog food is left and how much that will cost to replenish…

If I die today, my family will be ok. If I die in a year or two, my family will be bankrupt, penniless and possibly homeless.

Sure, the kids will say that I am worth more to them alive than dead, regardless of how much money I have. Yeah, “I love you even if you are broke,” “you bring joy to others around you” and “life is not always about money” are things I expect to hear from friends and family.

But I know they are not true. Not really.

Our culture rewards those who are healthy and able to work and shuns those who have fallen on hard times. It guts the sick, dying and unemployed quickly in order to salvage what it can before the corpse begins to rot. It knows the time value of money.

Men know it too. We have made those calculations in our head at every turn throughout our lives. When we buy a house, we calculate how long we’ll have to be employed at this job to pay the mortgage in full. When we have kids, we calculate what we’ll have to earn and sock away to pay for the birthday parties, soccer practice, bicycles, cars and college tuition even as we watch them laugh and dance as if they haven’t a care in the world; even as we laugh and dance with them. We worry our backs and minds will give out before we are able to deliver them into adulthood and breath a sigh of relief when we no longer have to be concerned they won’t have enough to eat.

When we get to about fifty, we eventually make the ultimate calculation. We arrive at a break-even, whether anyone wants us to or not; whether we admit it or not.

The only thing we fear more than getting it wrong is losing the ability to execute if we ever needed to.

*With the exception of highly-paid politicians or the super-rich who never have to worry about health care. For clarification, this isn’t me. I’m fine and gainfully employed at my own company despite my best efforts at getting my boss to fire me 🙂 This is a persona of a 50+ year old man who had a “good job” for most of his life.

Grab your ankles

Yesterday, the Supreme Court of the United States of America ruled that it is legal for you to be strip-searched when arrested for any offense, however minor. Moreover, they did not limit the number of times you could be searched and apparently there is no need to even have just cause to conduct the search or searches.

Clearly, the justices have not read the Fourth Amendment to the US Constitution. For their benefit, I’ve included it below so they don’t have to page through a large law book.

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

You may have noticed that “persons” is the first thing listed that we should feel secure about.

A strip search is not conducted to keep the officer safe. It is intended as a humiliation tactic, to make you feel entirely powerless in the company of armed, clothed officers with badges. It is to search what rape is to sex. It is about power — complete, utter, dominating power — over another human being.

I’m not sure why what are supposed to be the best legal minds in the United States can’t see this glaringly obvious fact. I do wonder, though, if people now can be strip-searched, how can we strip-seach a corporation? Where is the anal cavity of a corporation?

The logic appears to be at odds. I’m beginning to think they are making this up as they go.

I can’t imagine what could possibly go wrong.

Drug testing our way to a Master Race

Drug testing

Drug testing

In October, Linn State Technical College in Linn, Mo., notified its 1,200 students that they will have to take a drug test to enroll there

Florida requires citizens applying for pubic assistance to submit to a drug test. Supporters of the policies note that public assistance is meant to be transitional and that drug tests are increasingly common requirements for getting jobs. So, the argument goes, people get drug-tested all the time so it must be ok.

Only it isn’t ok.

The question is not if it is ok that we test welfare recipients but that we are testing people at all for drug use. It is not an invasion of their privacy. It’s about assuming they are guilty of using and proving they are not. It assumes that people who test positive (whether or not they really are positive) are unemployable, bad credit risks, stupid or unworthy of basic human assistance

We don’t test for alcohol yet alcohol kills more people and contributes to more workplace accidents than marijuana does.

If we are wondering how to create a “Master Race,” this is how we do it. Only employ people with high FICO Scores, no prison record and a clean drug test. The rest with any human faults and frailties we can leave to the ravages of poverty.

But that is probably ok as we work toward privatizing prisons and then replace public sector employees with prisoners who make less than a $1.00/day. They are already being put to work as highway workers and firefighters.

Maybe we can replace teachers with prisoners one day as well.

You were carried

Sacajawea dollar

A popular legend about Sacagawea was that she carried a baby throughout her stint with Lewis and Clark as they mapped the Western regions of the United States. That baby grew up, thinking he had discovered America. In truth, he was carried the whole way.

I’m pretty sure this is a stretch, but the point is not lost.

Walmart did not get big because Sam Walton was a retailing genius. Walmart got big because the Interstate highway system enabled him to move massive amounts of freight cheaply within a just-in-time system. While Walmart pays road taxes, those taxes are minuscule compared to the investment the previous generations put into the road system. Sam Walton took advantage of the Interstate system in ways it was never intended.

Walmart was carried.

The 53percent here think they have achieved everything through their own hard work. They did not. They were able to serve in an Army because a previous generation created it. They were able to attend college because previous generations thought it important enough to create, foster and preserve education. They were able to save enough money to buy a house because a previous generation fought for fair wages and working conditions.

The 53percent are being carried.

One of the oddest things I’ve seen recently is Herman Cain talk about his successes as if they were commonplace in a country that does not divide itself by race. In truth, he was able to have those successes only by the sacrifices and courage of those who came before him.

Herman Cain was carried.

You were carried. We were all carried. And as we grow into adulthood, part of our obligation as a member of the human race is to carry the next generation.

Yes it is.