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.

The naked truth about health insurance

Supreme Court Building

Supreme Court Building

The Supreme Court of the United States of America just listened to three days of argument as to whether or not the recent Affordable Care Act (ACA) is Constitutional. Central to the twenty-six States’ argument is that the Federal government can not compel its citizen to purchase something they they do want to buy.

Like these opponents of the ACA, I have a big problem with the Federal government telling me what I should and should not be buying. But I have an even bigger problem with my fellow citizens who insist on sucking out only the benefits of citizenship without shouldering any of the responsibilities. In short, we should never be at a juncture where the government is forced to make us play nice with each other.

What affects you, affects me. The United States of America is our community and we should never cede control to a government because we can’t figure out how to take care of each other.

Solve that problem and you have a small government.

But I digress.

What we are calling health insurance is not really insurance. It is just a way to pay for health care. Mandating citizens buy health insurance is not at all like forcing them to buy car insurance. Not buying health insurance is an act of denial by some that their bodies will not get sick or injured.

If we want to stick with an automobile metaphor, it is more like being in denial about changing your car’s oil and expecting it to run simply because the oil is healthy today. Ignoring your health care by pretending you will always be healthy only acknowledges you are healthy today but ignores the fact that your body wears over time. Like oil, some bodies break down faster than others. Sometimes, the oil pan gets punctured even when the driver is careful.

In other words, illness and injury are a certitude with a human body. It’s just a matter of when. No business worth a damn capitalizes based on certain loss.

The current health insurance market is unsustainable and the industry knows it. What nobody is saying is that the health insurance companies were unsuccessful at selling insurance to young, healthy people, so they lobbied to get this group covered — and paid for — by their parents. That took care of that group while Medicare takes care of the older group they didn’t want to cover. Now, the only the group left are middle-aged people who are getting fired left and right by employers, thereby getting dropped from coverage.

Individual plans? These are gawd awful expensive for anyone over 45 so most just drop coverage and pray they don’t get cancer or a heart attack. If the ACA is struck down, in ten years there will be nobody left to buy health insurance.

Insurance companies know this.

The ACA gives them 20-30 years to transition their business model. Without it, they probably have fewer than ten years before they will all be frantically merging, trying to pool assets and mitigate losses. The argument against the individual mandate is being driven by the very wealthy, the very healthy and the already Medicare-serviced. Selfish pack of idiots.

You just need to be paying attention halfway with half a brain to figure this out. It just is not that hard. The morality of providing health care or the constitutionality of forcing us to pay for something does not even need to be part of the argument.

The business model is simply unsustainable.

Anthem Blue Cross Blue Shield of Ohio is calling me a liar. Again.

I’ve had three small, routine claims this year so far and that triggered the letter I posted here. More accurately, my daughter went to the doctor for a routine physical because that is the responsible thing to do.

I know that from an insurance company’s point of view, determining if they can shove off costs to another insurance company is the fiscally responsible thing to do and I understand subrogation. I used to buy insurance for groups of employees in a past life as an HR VP and I also understand insurance laws as a result of me selling medical devices in a past life. I get all that. Goodie for you, Anthem BCBS of Ohio, you are saving your shareholders money.

As a customer of your plan where you increased my premiums 21.8% last year and 18.2% the year before and consistently for the past seven years, let me tell you how I read your letter.

Dear Double-dipping pile of crap customer,

We think you are lying to us about what insurance plans you have and think you’re trying to stick us with the latest medical bill you generated. Since we have your nuts in our hand anyway, we’re going to make you jump through all these stupid hoops just because we can and you can’t do a damn thing about it because this is legal. And while we’re sending out this stupid letter, we’re going to hold up payments to your doctor until we get your response back. But it’s not likely we’ll pay any part of the claim anyway; we just like to watch you dance you miserable piece of crap.

Thanks for your money. And since you really don’t have much a choice in Ohio anyway, we really don’t care if we piss you off. You’ll come crawling back.

Have a really crappy day.

Faceless person blah, blah, blah.

Before anyone jumps in here and tells me that I should shop around and not buy from Anthem if that is the way they treat customers, buying individual health insurance in Ohio is like a torturer showing you the implements he is going to use on you and you picking out the one that will hurt the least and will kill you the fastest if used. Then hoping he’ll not ever use it. Anthem Blue Cross Blue Shield sucks, but the other choices suck worse.

And now insurance companies claim they have to raise premiums 20%+ to offset the costs of the Health Care Reforms passed earlier this year? What were the increases for last year?

And why again should we not be furious with health insurance companies? Is it the wholesale leeching or the blatant insults? Or is it a dread fear that our lawmakers who may be in power starting next year are entirely clueless about the state of health care insurance in HIS OWN STATE?? Please, somebody tell me as with my health insurance choices, I am literally dying to know.


How health insurance companies gave Obama’s health care reform it’s second wind

In November, the Democrats were on the ropes. The GOP had just elected themselves a golden child with Scott Brown and tilted the scales back below sixty votes in the Senate. They had won two gubernatorial elections in Virginia and New Jersey. The media was calling the Health Care Reform bill dead. Time between now and the next election cycle was getting shorter and the drums of defeat were beating loudly.

But then the bill got the biggest shot in the arm from the insurance companies. They increased their rates 39% in California, cut off cancer-survivors in Youngstown, Ohio, jacked up rates all over the country and even sent this poor puppy a letter that increased his health insurance costs by 21.8% over last year.

That was the second wind.

Had the health insurance companies instituted a premium freeze for 2010, not cut off existing customers regardless of circumstances and sent letters out with the message, “We’re all in this recession together, so we’re not going to increase your premiums,” they could have taken the wind right out of the sails of the Reformers. They would have convinced the average American they were not greedy, money-grubbig heartless bastards, but caring, warm folks who only had your health in their hearts.

They would have gained the entire GOP and most independents as free PR agents for their industry. “They get it, we can make a difference!” would have been the rally cry and the Obama Administration and progressive Democrats would have been left fighting an enemy that simply no longer existed. By August, the country and Congress would have been embroiled in a mid-term election with Democrats fighting to explain why they spent so much wasted time fighting the benevolent insurance companies. Most likely they would have lost a few seats and the balance of power would have tipped a bit. President Obama would have then had two years of accomplishing nothing and the insurance industry would have been healthy for the next several decades, free to plunder and pillage recklessly while Obama’s successor’s successor worked up enough public passion to start another health care reform movement.

But they didn’t. They rushed hard toward the profit line, cutting off aunt Sallie who had cancer and facing a home foreclosure. They dropped health insurance for residents in Flint, Michigan where unemployment is 27%. They continued to increase premiums an average of 22% across the country, claiming it was necessary because of rising health costs. They tightened their grip on the wallets of those lucky enough to remain employed and even tighter on the small businesses and entrepreneurs trying to weather the economic downturn and tight credit markets. And yet, they continue to post record profits.

Sometimes you have to retreat back a few steps to advance forward.

But they didn’t.

Bad business, bad public relations. On that account alone, the health insurance industry deserves to go the way of the horse buggy, passenger train and telegraph industries.

We are creating our own nanny state and them is us


The photo above in the Wall Street Journal caught my eye this morning and sent me into a tizzy. For the record, I am a bit upset at the direction the health care reform bill is taking. It favors the preservation of the insurance company system by forcing us to buy the same crap that got us into this mess and rewards job-holders (folks who choose security) over entrepreneurs. In short, it is re-establishing a job-based, status-quo economy instead of an entrepreneurial one where innovation and risk produces growth. I am very disappointed at the turn of events.

But the point that is sending me over the edge is the fifth “right” that says you have a right to stay on your parents’ health insurance policy until you are 27 26. I say it here now and when MSNBC starts saying it, you know you heard it here first.

The unintended consequence of this provision is insurance companies will not provide health insurance to anyone under twenty-six who have living parents. But an even worse consequence is the expansion of a parent-sponsored nanny state in our culture as a whole.

A quick conversation with my 24-year old son reveals that most of his friends with freshly-minted college degrees expect to be able to move back with their parents and live there rent-free and guilt-free indefinitely.

The FAFSA will not allow anyone under twenty-four to get financial aid without parents disclosing their financial resources. Despite almost no benefit to the parents, they are expected to pay a large chunk of an inflated tuition bill by leveraging the equity in their homes.

Almost all landlords in college towns will not rent/lease to a student without parents co-signing, even though the students are over eighteen and legally able to enter into a contract AND be sued in a court of law.

And now insurance companies and the Federal Government want to strap parents even more by obligating them to provide for health insurance for their kids until they are 27, nine years after they have legally become an adult.

What they should do is obligate kids to accepting and embracing their adulthood at eighteen. When parents have no legal right to their children, they should also have no corresponding legal responsibility. Either these kids are adults or they are not.

If they are, start treating them like adults. They should have a right to their own health insurance when they turn eighteen, not the obligation to be parasitic for the next nine years. And parents need to start expecting they act like the adults they are, regardless of how painful self-reliance is.

Insurance companies should fear people like Dr. Dave Ores more than any health care reform bill

Villager photo by Bonnie Rosenstock
Villager photo by Bonnie Rosenstock

While the politicians in Washington argue about how many uninsured people there really are, call each other liars and debate over eleventh-hour amendments, real people with real lives are not waiting around for some edict to determine their destiny. They get fed up, roll up their sleeves and get the job done themselves. And that is exactly with Dr. Dave Ores is doing.

Dr. Dave (as he in known locally) formalized his care for workers in the restaurant industry by founding the Restaurant Workers’ Health Care Cooperative. The healthcare cooperative is “an informal handshake” between the doctor and the participating restaurants. It is a not for profit health care delivery system that enables restaurant owners to provide health care to their employees, many of whom can not afford traditional insurance.

[What I’m doing] “should not be special, it should not be great. It should be the way things work,” Ores says in his CNN interview aired yesterday morning.

We agree. Health care should be not for-profit. When the profit is removed from health care, the measurement becomes “how well did we treat someone” verses “how much money did we make per patient.”

Dr. Dave is proving you don’t need to be rich or famous to change the world. You just need to care enough to get off your butt and do something for another human being, without expectation of reward. No big change ever happened without first being one small act, followed by another and another and another by someone who refused to give up.

Here is what CNN ran yesterday.

We found this photo published on the New York Daily News and had to include it. Apparently, Dr. Dave also founded the Eastminster Kennel Club Show, a spoof on the Westminster Dog Show. We knew there was another really cool reason we liked Dr. Dave! He is a dog person. (I wonder if he has a photo of Abe Lincoln in his office. That would complete the trifecta of a cool sit-com.)

Screen shot 2009-11-15 at 8.00.26 AM

Health care reform my puppy butt

Yesterday, Keith Olbermann had a one-hour special comment about health insurance and health care in America. He has recently had a first-hand experience with his father.

I don’t know how much it cost to produce one hour of Countdown nor do I know what the lost opportunity costs are from insurance ad revenue MSNBC will probably never get because of this and having Wendall Potter as a frequent guest, but I do know how much influence this hour will have on moving the health care debate.

Zip. Nadda. Nothing.

If Keith Olbermann’s celebrity and MSNBC’s money and reach can’t even blow a little breeze into the health care debate in this country, what chance do any of us have of being heard? Exactly.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Kill the beast! The public option in health care reform

The title of this post is taken from the lyrics of Disney’s Beauty and the Beast and explains what the right is doing with the so-called public option of health care reform. Love or hate him, Robert Reich explains the public option clearly, at least to us who laugh at the notion of “competition” with insurance plans. In Ohio, there really is none and opening up competition across state lines would do little to change that.

We don’t like what we don’t understand and in fact it scares us, and this monster is mysterious at least.
Bring your guns, bring your knives, save children and and your wives, so save our village and our lives!