So, I was really thrilled with the Obamacare ruling. I was too cowardly to make a call ahead of time, plus predicting is quite clearly a “jinx” (just FYI) so anyone who was brave enough to write it down gets all credit from me whether they were right or wrong.
On that, we talk a lot about medical debt and bankruptcy, but the thing about bankruptcy is, if it’s a Chapter 7, medical debt is discharged. It goes away.
Medical debt is much, much bigger than that. Bankruptcy is really the last stop on the medical debt misery train for working class or middle class people. There are a lot of interim stops along the way that are not so great: reallocating family resources to paying down medical debt, wage garnishment, liens, and on and on.
With any luck, if this thing works right, maybe some of this will go away (pdf):
In 2007, more than two out of five working-age adults—41 percent—had trouble paying their health care bills, or were already paying off medical debt.The consequences of medical debt are serious. People who have medical debt worry about their health care bills and may therefore delay getting needed care—or go without it entirely. Medical debt also contributes to bankruptcy and housing insecurity, and it leaves consumers vulnerable to serious consequences when they are sued by health care providers or debt collectors—consequences such as wage garnishment, home foreclosure, and damaged credit.
Why Is Medical Debt Different from Other Kinds of Debt?
Medical Debt Strikes without Warning When People Are Most VulnerableUnlike credit card debt or other kinds of debt, medical debt is usually beyond a person’s control and impossible to plan for.
Illness and injury happen suddenly and unexpectedly. People don’t choose to get sick or to be injured, but when this happens, they find themselves with unplanned and involuntary health care expenses. These expenses can run into the thousands of dollars.
Making monthly payments toward health care bills can be a strain under the best of circumstances, and a long-term illness can make a difficult situation even worse.
If people with serious health problems have to miss work because of their health, they may earn less money and may have even greater difficulty paying off their bills.
I see medical debt that doesn’t reach crisis bankruptcy stage often, where I live, and I think it should be addressed when we talk about the costs of our decades-long avoidance of universal coverage.
We are paying for our current health care system. It isn’t free. When we analyze the costs and benefits of Obamacare, maybe we should take into account that a lot of uninsured and underinsured people are paying for the health care they receive, whether they can “afford it” or not, and they aren’t necessarily lining up voluntarily to pay these bills. In many cases, a court is issuing a judgment and then their wages are being garnished.
Understand, I don’t object to providers getting paid. They provide an essential service and they should absolutely get paid for the work that they do. What I object to is the idea that the uninsured or underinsured aren’t being compelled to pay for anything, so anything they pay for insurance under Obamacare is all downside and government seizure and an intolerable loss of liberty. They’re paying, plenty, in the wonderful “system” we have now, and having your wages garnished looks nothing at all like “freedom” to me.
shortstop
Sure, if they’re honest and ethical types. The ones who were wrong, wrong, wrong on the content of their predictions but are now desperately pretending they said something else? S-a-d b-u-f-f-o-o-n-s.
Anyway, OT, our friends on the wingnut side of reality are all abuzz about the possibility of President Romney and both Republican-majority houses using budget reconciliation to deal a death blow to the ACA “since the court ruled it’s a tax.” Please to discuss!
Kay
@shortstop:
Well, they’re (potential) jinx’ers, that much is true. I don’t know how we avoided that curse in their reckless predicting of… things :)
c u n d gulag
To speak nothing of the cost of good dental care.
I had some emergencies, including two bridges – one large and one small, and had to take out two loans from some dental credit outfits that charge outrageous percentages, to get them fixed, as well as take some money out of my 401K – and ended up in debt over the work done.
It took getting into a debt program to eliminate my debt – a little over half of it for the dental work.
And I HAD DENTAL coverage from work!
People don’t realize how insufficient corporate dental insurance really is until they need it. Like when they run into the yearly caps.
And many people have to take out loans at rediculous rates, if they don’t have some spare money lying around.
And who does?
Oh yeah – the “Job Creators.”
hitchhiker
Here’s what people can’t comprehend:
Me and trauma center financial counselor in conference room just of the neuro ICU, March 2001 . . .
FC: Well, I’ve reviewed your policy and it looks like your husband’s medevac, ICU, and surgery are all covered.
Me (just found out my 45 yr old husband is a quadriplegic) Uh huh.
FC: But the doctors are predicting he’ll need about six weeks of inpatient rehab, and less than 1 week of that is covered.
Me (dead silence)
FC: The cost is about $1,700 per day, so that comes out to about $70,000 . . . does your family have other resources? Because if not, there’s Medicaid . . .
Me: (Meaning to be ironic) Hopefully you’ll let us keep our house . . .
FC: (Dead serious) Oh, yes. You can keep your house. And one car. And you need to have less than $3,000 in other assets before you qualify.
———
And she wasn’t even talking about the need to make that house accessible, or the cost of a vehicle he could drive, or the fact that he wouldn’t be well enough to work for years, or the 2 years of outpatient physical therapy. People think that “catastrophic injury” coverage is going to protect them. Ha ha ha.
I spent Thursday in a state of extreme joy, just knowing that there’s going to be a day in America when no one has to be told they’re going bankrupt because they got hurt.
Davis X. Machina
.Cowed, compliant, and contingently employed. The more of us who live that way, the less likely we are to try anything….regrettable.
Just north of desperate, but well south of solvent. That’s the sweet spot.
dmsilev
@shortstop:
That should be read as “If we wingnuts control the government, we’re going to repeal the ACA no matter what ‘innovative’ procedural methods are necessary.”. Remember, procedural tools such as reconciliation are necessary and proper when used by Republicans, but a sign of horrific overreach and abuse of power when used by Democrats.
Chris
I don’t see how that makes you cowardly. As our beloved wingnuts just rediscovered, predictions on the outcome of SC votes are about as reliable as horoscopes. The Civil Rights Act could come to a vote tomorrow and I would be as sincerely concerned for that as I was for the ACA, and just as unable to predict the outcome.
Baud
@dmsilev:
I will always have fond memories of the “deem and pass” controversy. It’s a miracle the Republic survived. Good times.
Baud
@hitchhiker:
Why didn’t you go out into the free market to get a better deal?
Seriously, what a horrific experience. Sometimes, it’s hard for me to internalize how lucky I am.
SIA
I’ll read your post Kay, and the comments, as soon as I catch my breath. But OMFG we just opened our Kaiser “renewal” letter, and the monthly cost is going from 975.00 to 1200.00/month starting in Sept. I am so glad ACA was saved before I had to open that letter. In a couple years my spouse will be eligible for Medicare and the exchanges will be up and running. From now till then, 30,000.00 worth of premiums to keep the health care hounds at bay.
And I’m one of the lucky ones, with health care insurance, in a Kaiser-state (they are considered not-evil, aren’t they?) which we can more or less afford! But HC premiums almost as high as the mortgage. But the cost is just staggering, and the price jumps even more so.
What IS Medicare age? Is it 65?
I am having palpitations.
(Edited to correct hyperbolic arithmetic)
SIA
@hitchhiker:
I want to respond but don’t know what to say, except you are amazing and I respect you.
shortstop
@hitchhiker: I became extremely angry reading your comment. I am so sorry for what your family has been through. And I’m thinking of a friend who had very little in savings and had to turn over all his meager assets except his car in order to get Medicaid for his final illness, which incidentally could have been nipped in the bud by preventive care.
@Chris: I would not say it’s only the wingnuts who’ve discovered this. When four of nine–four of nine!–justices opine completely outside the constitution and precedent on a law that nearly every constitutional scholar in the U.S. agreed was solid, no one who’s not in self-serving denial can continue to pretend that we don’t have a corrupt and lawless high court on our hands.
Valdivia
@hitchhiker:
Like others here I am just boiling in rage for you at having to go through that. I am rarely left speechless and your story did just that.
MD Rackham
Why do articles like this “Medical Debt Fact Sheet” always understate the amounts involved?
The costs “can run into the thousands of dollars.” Oh, really?
A “mild” heart attack (I drove myself to the ER) ended up costing $195,000. Five days in the CICU plus 6 stents will do that. Fortunately, I had insurance, so my out-of-pocket was $6000 for the year (the plan max).
So I guess for me it was “thousands,” but for anyone without insurance it would “hundreds of thousands.”
Plus insurance would pay for only 1 week of cardiac rehab, when the doctors wanted 12 weeks. So much for “preventative care.”
hitchhiker
@shortstop
(puts hands over face)
I’m so sorry. People really don’t understand how brutally cruel our idiotic system has been.
If you were like us — two working parents, two half-grown kids, a habit of saving and avoiding debt — the punishment was extreme. No one was going to help us until we’d handed over everything.
For the first year he was out of the hospital, we were paying for private insurance out of our savings, and the monthly premium was higher than the mortgage on our house.
I quit my crappy-but-satisfying community college teaching gig (which didn’t come with benefits, fo course) and took a barista job at Starbucks because it was close to home, flexible, and offered full medical and dental for our family if I worked 20 hours per week.
So that was the insult to injury . . . I challenge the genius Republican pundits to go stand around in a green apron taking orders from a 20-yr-old shift supervisor and remember to smile at the customers.
You have to do it because it’s the only way to keep your family solvent, and I did, by God. Sometimes it was even fun, or would have been if things hadn’t been so desperate.
jl
Thanks for post. One quibble. I do have a problem with some of the providers getting paid, or at least getting paid as much as they do.
Insurance companies and providers get paid too much for too much useless adminstrative work. Large providers have gained significant market power in regional markets to extort even large insurers, and particularly uninsured and underinsured.
Some links to Uwe Reinhardt’s papers, who can explain it all better than anyone.
Reinhardt’s home page
http://www.princeton.edu/~reinhard/publications.html
Take a look at second paper on his homepage:
Divide et Impera: Protecting the Growth of Health Care Income (Costs)
Almost all of Reinhardt’s papers and presentations are intuitive and easy for a normal person to read. He does snark. He does jokes. He is not overly respectful of his own profession.
Edit: In fact, the title of that paper is snark. In US health care, “costs’ are really health care providers income.
Flying Squirrel Girl
I grew up poor without healthcare. The only reason my sister and I had anything even resembling health care was because my mom had a friend who was married to an obstetrician. When we were sick we would go to their house and he would diagnose us and give us sample meds since my mom couldn’t afford to get a prescription filled. My mom went 17 years without going to the doctor because she had no healthcare, and when she finally went was diagnosed with breast cancer. She was forced to seek treatment thru free clinics that offered the most basic treatment and little dignity. When she made it to 65 she finally had options, and could choose doctors and treatment regimens. She died one year after qualifying for Medicare, largely due to the lack of early detection and aggressive treatment, but also because being sick and not knowing what to do about it depressed the hell out of her. If taxes must go up so that no one has to experience a lifetime of fear and uncertainty regarding getting sick and receiving treatment, I am OK with that, and I believe a lot of Americans share similar stories and feel the same way.
jl
And here we go,
It’s The Prices, Stupid: Why The United States Is So Different From Other Countries
Anderson, Reinhardt, Hussey and Petrosian
http://content.healthaffairs.org/content/22/3/89.short
Reinhardt has said that the high costs of US health care are mostly transfer payments from the US citizens to owners of insurance companies and large providers with regional market power. Much of it would be better described as a public/private tax farming system.
I linked to the public front page. Think it’s open acces, but if not for most, you can read the abstract.
Raven
I called it 6-3 in favor that morning right here so I was wrong too.
kay
@MD Rackham:
Well, for me, 195k in debt means bankruptcy. I don’t think the paper is underestimating the costs. I think they’re talking about two kinds of medical debt.
People here end up getting garnished over 1k, 2k in debt.
That’s not enough to discharge in bankruptcy, because they only get 1 shot at bankruptcy every 8 years.
My point was huge debt can be discharged. Smaller debts can mean years of paying.
JPL
@hitchhiker: If you haven’t already please write the President and thank him. Share your story because it’s a powerful one. Call the local media. Even in the Atlanta a few media outlets have shared stories of health care nightmares. You are an amazing person.
Kay, I already mentioned on several posts how I didn’t think it would pass. I was convinced that Roberts would let it fail.
MikkiChan
Agree with jl–I have serious issues with how much bastards getting paid.
Had a colectomy late last year (17 days in hospital, 8 weeks in bed) after surviving a violent “flare-up” that had me in hospital 11 days, and home recovering for 4 weeks. Degenerative colon disease with a pissy pancreatic sidecar due to having no insurance for years. In northeast Louisiana so lousy to non-existent care for poor/uninsured.
As a state employee, I haven’t had a raise in 6 years. Bring home roughly $1100 a month. Have no assets; so they’ll be coming after my wages soon.
Glad ACA upheld, and I know it will eventually help family and friends w/o insurance. But until no one is making their fortune from others misery, SSDD.
ETA: Thanks for link jl. I’m sure I’ll be seething in a bit!
shortstop
@hitchhiker:
People don’t understand this is how Medicaid has worked. They think it’s a general safety net for people who lose insurance or don’t earn enough to buy insurance. They don’t get that you have had to give them pretty much every cent you have before they will give you coverage, and that building up any savings again will lose you that coverage. It’s consigning people to true pauperhood, in many cases forcing them to go on general assistance against their will, so they can get some healthcare. Brutal indeed.
RSA
@hitchhiker: My sympathies, hitchhiker.
I’ve been in a similar boat, though with not so drastic an outcome. When I looked at my 1040 tax form a couple of years ago and realized that the 7.5% medical deduction would apply again, and in fact that out-of-pocket medical expenses would account for 20% of my adjusted income even though my family has what people consider good insurance, I just had to shake my head and feel screwed over.
piratedan
@shortstop: my understanding is this…. if you already have health insurance, then there is no tax… correct? The tax deduction garnishment only applies if you haven’t secured any health insurance coverage for yourself.
pseudonymous in nc
I object to them getting paid so fucking much. It’s a small thing, given the Rmoneys and other megarich parasites, but there are a lot of doctors (and especially, a lot of hospital administrators) in the US who could do very well for themselves on not quite so much money.
@hitchhiker:
Two two-word phrases that do not belong together in the developed world.
pseudonymous in nc
@Flying Squirrel Girl:
I’m pretty sure most people have similar stories of a friend or family member with the power to write prescriptions without paying for an office visit, or shove samples across a desk instead of writing prescriptions, serves as health care.
There’s not really much research into under-the-table medicine in the US, for obvious reasons, but my gut feeling is that it’s a pretty substantial slice of health care delivery.
shortstop
@piratedan: Correct. I am unclear on why they think the BR process would apply here, but I have found that particular move confusing whenever it’s used or someone threatens to use it. Hope to hear more about this.
Gretchen
I know a young couple who had good health insurance. They had a complicated twin pregnancy requiring prenatal surgery in a desperate effort to save the twins. One didn’t make it, and the other spent weeks in the NICU. They ended up, despite their good insurance, with a quarter-million dollars in debt – the insurance company came up with all kinds of reasons for why this or that charge wasn’t their responsibility. These kids were, I think, 22 at the time. They’ve spent considerable tiime homeless since then, living with whatever friends would take them in. They haven’t declared bankruptcy – they say they can’t afford a lawyer. They’re now separated since the husband became suicidal. And remember, these kids had insurance, jobs, were married, and just wanted to have a baby. Their lives were blighted before they started.
And hitchhiker, I’m so sorry for your situation. I’m with the guy who said “trauma center financial counselor” are words that shouldn’t be used in the same sentence.
Omnes Omnibus
@hitchhiker: Along with everyone here, I am horrified by that idea that anyone would have to go through something like that on top of the actual medical situation.
Mike G
What I object to is the hell-bent foaming-mouth opposition and screeching about “Marxism” coming mostly from people who already get government-run healthcare through Medicare and/or the VA.
Tehanu
There are already 4 different horror stories — real stories — on this thread, barely 30 comments in. This is the richest, most powerful country not only in the world today but in history, and what are we spending our riches on? Killing and maiming as many people as we can in the rest of the world, and allowing our own people to be dragged down in misery and sickness before they die untimely. When I was young I felt proud to be an American. When I was a little older I felt proud that at least in America, we could protest and march to improve things for minorities and the poor. Now that I’m old I’m just ashamed that I was ever so naive and deeply, deeply sad for all of us and our children and grandchildren.
brantl
Does anybody realize that an uninsured person gets a bill that’s 2 times as big as an insured person? They do.