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.

This is not a donut

Cosby Show

Cosby Show

Mitt Romney released his final 2011 taxes today and the media are all over it like there is some precious jewel they will uncover. For me, the fact that he has been arrogantly obstinate about not releasing more than two years tells me all I need to know about his character.

I was content with that until Chris Hayes from the UP w/ Chris Hayes Show tweeted something rather pointed this afternoon about Mitt’s tax returns that got me thinking.

I think it’s actually morally condemnable to take “extraordinary” measures to avoid taxes, even if legal. #hashout

I have absolutely no doubt whatsoever that everything on the Romney tax returns is entirely legal. Every deduction, every exemption and every income category complies with the letter of the law. And that is the crux of the issue Hayes was getting at.

Chris is young. He is not a grizzled, hardened small business person — yet — so we can forgive him his moralizing for a moment. But this got me thinking about how Mitt sees the tax code and why it is a peek into his character. For this point to stick, we need to climb into the Wayback Machine to the ’80s and watch a short clip of a Cosby Show episode. This is the one where Claire was invited to be on a panel for a Sunday morning show much like Hayes’ except the pastries were kept in the green room.

It’s a good thing we’ve evolved and let the pastries join us at the table. Let’s watch.

The scene that aligns with Mitt’s behavior and Hayes’ tweet is when Hector say, “This is not a donut!” as he bites hungrily into a chocolate-glazed long john. He is technically correct; a long john is not a donut. But it really IS a donut. You and I would call a long john a donut. So would Claire. And Cliff Huxtable knows damn well that a long john — and even a danish which he eventually bites into — is a donut.

This is what the “morally condemnable” bit is that I think Hayes is referring to. While Mitt’s tax avoidance may be perfectly legal, it is immoral to dance on the letter of the law as you force the spirit of the law to give up the ghost.

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Mitt the painter

While all the cable news shows are struggling with how to balance the odd appearance of Clint Eastwood and covering Mitt Romney’s speech, I went back and looked at the transcript and watched the video more times than one dog should be allowed. I nearly went deaf with all the dog whistles, but I soldiered on, trying to get to the essence of what he was saying.

The speech kinda rambled, trying to cover too many things too quickly, but one phrase popped out that lays bare the Romney thinking. It’s at about minute 33:50. So far, I think all the “analysts” have missed it. They may have been too busy focusing on the applause in the house instead of the words being said on stage.

President Obama promised to begin to slow the rise of the oceans and heal the planet. MY promise…is to help you and your family.

For months, we have been told the GOP was the party of big ideas, of bold and brave decisions. I think this one statement — buried right after the five-part jobs creation plan that appeared to be ripped out of a freshman economics textbook — crystalizes what a Romney presidency would really be like. It is the one thing in the speech that is consistent with his life and his campaign.

While President Obama works to solve the structural problems that creates the symptoms, a President Romney would focus on solving the symptoms. What does it help your family if they are in a nice house that is being swallowed up by the rising tides?

In short, we will paint over the water stains, flip this country and sell it to the highest bidder. Romney’s America is not a country that needs the foundation shored up and invested in, it is a 1 1/2 story bungalow with a crumbling foundation that just needs a new coat of paint.

This is the essence of what Romney did at Bain Capital. He found a fixer-upper, leveraged it to suck wealth out of it for a few owners at the top and discarded it or sold it off to the suckers who thought they were getting a good deal. That’s not a bad thing, that is what private equity is supposed to be good at. But I’m pretty sure it is not the skill set a president needs.

America needs infrastructure investment like health care, modern railways, education, roads, bridges, communications, modernized banking, environment and power. She also needs help with the intangible infrastructure like happiness, relief from chronic anxiety and a boost of confidence. And yes, she needs more hope and change.

America does not need more paint on her walls.

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.

Zoey is not impressed

Zoey is not impressed

Zoey is not impressed with your startup, the quality of this morning’s walk, the NBC Olympics coverage, Mitt Romney’s tax return explanation, Ann Romney’s whining about left wing attacks, Paul Ryan’s budget and the amount of frosting on the cupcake she had for dessert just a few minutes ago.

Take all that for whatever it is worth.

Zoey is not impressed

#zoeyisnotimpressed

What Ryan and Romney don’t understand about Medicare

Medicare Ryan Plan

Medicare Ryan Plan

Medicare is not about health insurance or health care. It is not about the money.

It is about security. It is about finally not having to worry about pre-existing conditions or getting kicked off a medical insurance plan. It is about not having to worry whether you are healthy enough to qualify for membership. It is about finally not having to pass some sort of test administered by a faceless, heartless insurance company review board.

It is about not having to lie and hide your real health issues to fool some hospital or doctor into treating you.

It is regaining your dignity as a human being.

It is about a release from the following things and more that you have suffered through the past 47+ years you have been working in a country that says it values you but only cares about how economically viable you are.

– The anxiety of being able to hang on to a job you hate but provides your health care.

– The anxiety that comes every October/November when the company you work for rolls out your benefits choices where your premiums and co-pays increase, your coverage shrinks and your doctor is no longer a choice on the plan.

– The anxiety every year when your individual plan you carry as a small business owner renewal date comes around and you hope that the letter is only a premium increase of 20-30% and not one that says they are dropping you because you went to the doctor last year for a bone scan or an MRI.

– The anxiety of hoping you will have insurance when the company merger is completed.

– The anxiety of not being able to take a day off to see the doctor for that cough that won’t go away because it could be cancer and if it is, you will need to use your company-provided insurance, get fired for some “performance issues” and then lose your insurance. The small comfort you feel because you will die knowing you did not cause extreme hardship on your family for not getting treated.

Paul Ryan and Mitt Romney will never feel any of that anxiety which makes it easy to tout courageous and bold decisions.

In the twilight hours of the day, the truth is your plan is neither bold nor courageous if your dog ain’t in the hunt.

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.