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POLICY/BLOGS: More slack crap from Medpundit exposes the big conservative morality lie

Late last month the NY Times had a pretty horrendous article about a family that was losing its house because it couldn’t pay for all the co-pays and co-insurance for its sick son’s care. I’ve just got round to catching up on my reading and I’m pretty shocked. You might think that someone who’d taken the Hippocratic oath might decide not to pile in on this, but you’d have mistaken the ever blackening stone that Syd at Medpundit seems to have in place of a heart these days.

She decides that the problem is that the family ran up credit card debt. And one of her readers jumps in to!

Sounds like the real problem here might be the credit cards.I get one or two notices of bankruptcy a year concerning my patients. They always list the debt that is to be forgiven along with the creditors, and it’s overwhelmingly credit card debt – the major cards and the local retailers that have their own credit cards. That’s probably true for the general population as well – which is why the Times couldn’t find a better example of people with health insurance going broke because of medical expenses alone. UPDATE: A reader does the math: The $5,000 a year quoted comes out to: $416.67 a month, $13.69 a day, 7% of the household’s income. One mistake people do make in managing their financial affairs is that they fail to readjust their living standards downward to account for unexpected regular expenses (e.g., sell the house and car and downgrade).Or are we so rich now that the idea is that not only should an illness not bankrupt but that you shouldn’t have to skip trips to the mall?

The only problem is that Syd and her reader failed to read the bloody article! Here’s what it said and it is quickly apparent that the expenses connected to the kid’s illness massively exceed their max-out of pocket and the $5000 number, almost certainly because many of these expenses are somehow excluded from their insurance coverage.

Then the bills started coming in. After a week in the hospital, the couple’s share came to $1,100 – not catastrophic, but more than their small savings. They enrolled in a 90-day payment plan with the hospital and struggled to make the monthly installments of nearly $400, hoping that they did not hit any other expenses.

But Zachery, who was eventually found to have an immune system disorder, kept getting sick, and the expense of his treatment – fees for tests, hospitalizations, medicine – kept mounting, eventually costing the family $12,000 to $20,000 a year.

So the cost is not the $5,000 a year. That’s just the co-pay on ONE of his drugs. The rest is between $12 and $20K a year, and the poor bloody father is out working 90 hours a week to make just 68K a year (which for those of you counting at home is under $30K for a regular working week). So somewhere between 17% and 30% of the family’s PRE-tax income was going to these costs. That’s way more than any young family is going to have to spare, unless perhaps they have a high-earning physician bringing home the bacon. So either the Times didn’t do any fact checking (and God knows they have a sorry legacy on checking them when it helps conservative loonies and their issues), or this family was financially destroyed by medical bills despite having some insurance coverage. And "some" is the appropriate word here:

As the family went from one doctor to the next, without a diagnosis of the root problem, the insurance company often questioned the expenses. Why did Zachery need four doctor visits or five rounds of antibiotics for an ailment that most children shook off in a couple of days? Mrs. Dorsett spent days on the phone, often in voice-mail loops, and often long-distance, pleading her case.

"Like when they refused to pay for antibiotics when he had pneumonia" last year, she said. "The antibiotics cost $373, and we didn’t have it. But we couldn’t just not give it to him. I knew the review board would come around eventually, but he needed the medicine right away. Finally the doctor gave us samples."

She managed the expenses, like many people, by constantly applying for new credit cards, rolling the debt from the old cards into the new ones, which usually came with low introductory interest rates. In a good year, they would have the rolling charges on their credit cards down to $5,000 or $6,000, but the charges always went up again.

And how does Syd’s reader really think they should do it?  Their solution: Stop going to the Mall! Of course Syd’s "reader" didn’t get to page two where it showed that they family buys its clothes at yard sales. And don’t bother bringing your plastic into Syd’s office for your co-pay. Syd apparently doesn’t know that you can use credit cards to pay medical bills, and that they charge outrageous interest rates, and that that is likely to be where the debt came from.

"Not only are the bills higher, but the way we pay for care has changed," said Elizabeth Warren, a professor at Harvard Law School and one of the study’s authors. "My mother always carried a bill with the doctor, but every dollar she paid went to principal. Today, the doctor takes a credit card, and a family might be paying that off at extraordinary interest rates. So people may recover physically from major medical injury, but may not recover financially."

So yup we have a nation of over spenders, but I don;t think this family fits the pattern. But the bullshit morality aimed at people with medical problems like this by our conservative brethren is just astounding. And I remind you that this does not go on to anything like this extent in other industrialized countries because they have come to the reasonable position that being sick should not be a financial death sentence.

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NeimonTom BakerLinMatthew HoltColin Recent comment authors
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Neimon
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Neimon

Once and for all: Not having a complete, perfect, counter-solution does NOT negate a criticism that someone’s ideas are factually and/or logically incorrect, nor that their point of view is colored by their ideology – something which happens far more on the right now than the left, since “left” has been redefined by the right to mean “gee, sometimes maybe we shouldn’t kick the guy who’s lying on the ground bleeding” while “conservative” has been redefined by the right to mean “DIE DIE DIE SCUM I WIN I WIN I WIN HAAHAHAH LOSER!” At least. It seems that way to… Read more »

theorajones
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theorajones

Erick Novak, the solution is, quite obviously, universal health insurance.
Duh.

Tom Baker
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Tom Baker

Interestingly, I facilitated a focus group in New York this past weekend. The participants represented managed care organizations from across the U.S. Many of their comments echoed Syd’s: to wit, well if they can’t afford the [insert name of expensive therapy or intervention here], maybe they should readjust their priorities. This is a fascinating response, because it assumes that anyone in a situation in which copayments, deductibles, and non-covered services collectively exceed their financial resources must have made the wrong choices. It is a nice bit of self-delusion. In fairness, the Medical Director at a Louisiana health plan noted that… Read more »

Lin
Guest

Matthew, I was profiled in a different story in the NYT in that series. This is tragic – tragic not only for the family, but for those who have answered here that cannot see thatr this is fraying the fabric of our society. People can’t move to better their lives, or to lake care of an ailing parent; people are afraid to leave jobs they hate, and can’t take entreprenurial chances for fear of losing everything. And some, like these, are left wth their lives ruined. Then they are berated and shamed by the healing profession, who are themselves being… Read more »

Matthew Holt
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Colin/Greg–My “attack” on Syd at Medpundit is simply to point out that she comes to conclusions on the basis of faulty logic — in this case, just not reading the article she was commenting on properly. And leaps from there to a moral attack on the choices made by the subject of the article, who is having a hard enough time as it is. On the rest of this blog is tons about my and various others theories about how we should solve the health care systems’s woes. I invite you to look around (in the “categories” under “policy”. I… Read more »

gadfly
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gadfly

//infallible argument that medicine is above the marketplace.// No right is natural: rights are developed by society, as a corollary to moral ideas and the public good. Health care needs to be conceptualized as a right in a society that values sparing human beings from the deliberate inflicting of pain and upholding optimal productive capabilities for the good of all society (keeping people contributing instead of draining resources). In terms of the medical profession, I think teaching is a better analogy than the military or the priesthood. Teachers are poorly paid. At the university level teachers are also expected to… Read more »

Colin
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Colin

//There are many who feel that people do have a right to healthcare. Those who deliver healthcare don’t necessarily have a right to be paid. I remember reading an article many years ago by a lawyer who suggested that being a doctor was a national resource, and that everyone in medicine should be paid a basic salary just like being in the military, and that no one should “get rich” from practicing medicine. Sort of like a priesthood of health with poverty vows, I gather.// There’s a great many people who believe healthcare should be a right. Many of them… Read more »

Greg P
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There are many who feel that people do have a right to healthcare. Those who deliver healthcare don’t necessarily have a right to be paid.
I remember reading an article many years ago by a lawyer who suggested that being a doctor was a national resource, and that everyone in medicine should be paid a basic salary just like being in the military, and that no one should “get rich” from practicing medicine. Sort of like a priesthood of health with poverty vows, I gather.

Colin
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Colin

I don’t understand why this post was even written. Even if Medpundit was wrong in her conclusions and this is the saddest story of all time it adds nothing to any sort of debate on the issue. Is this some sort of commentary on physician greed or an argument for universal healthcare? In either case this type of ’emotional’ appeal is the lowest demonimator. Pull your heart off your sleave and address the issue on a cerebral level. The government’s job isn’t to right every tragedy and neither is the physician’s; they’re running a business. There’s no right to health.… Read more »

gadfly
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gadfly

//get a much more compassionate response to your plight from your doctor than the hospital or the outpatient clinic.// The problem with this is doctors have made it so their patients can’t contact them and work out the situation. Patient calls go to receptionists or call centers that are directed to stonewall about billing matters. If you ask to speak to the doctor, or even a supervisor, the request is just denied. Of course doctors can claim to be all compassionate when they’ve arranged things so they never have to talk to people who might need compassion! And of course… Read more »

MedSleuth
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Thank you for your commentary and clarification. It is always easy to pass judgment on someone else’s situation when it isn’t your own. Jumping on a family and assuming their debt problem is due to too many trips to the mall is just plain ignorant. To assume a family with a sick child is living it up on their credit cards is just absurd.
I’m not sure there are many of us — no matter how well off — who wouldn’t be financially challenged by a major medical illness, even with the best insurance plan.

Greg P
Guest

So your solution is to attack Medpundit? Our system is one of “free choice” for health insurance — free choice for employers to buy what they see fit, and free choice for people to go bare because, “hey, I’m young and healthy.” Once we accept a patient, our free choice ends, even when it is woefully obvious that this family will go bankrupt or be quite unable to pay our bill. Doctors routinely find that our patients feel the obligation and pressure to pay the hospital but not the doctors. Patients leave bogus contact information, hang up when we call… Read more »

Eric Novack
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Eric Novack

Theora- still waiting for your solutions…

gadfly
Guest
gadfly

//But the bullshit morality aimed at people with medical problems like this by our conservative brethren is just astounding.// I’m going to steal you when your girlfriend isn’t looking, Matt. 😉 //people can work hard, play by the rules, do what we say they need to do to protect themselves from financial ruin if they get sick, and then get ruined by getting sick.// I was pretty conscientious about saving for retirement while I was working: I put the max in my IRA every year. Then I was forced to live off of it, so that money is all gone.… Read more »

theorajones
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theorajones

Reality check for your little doctor: the median American family makes around $45 k a year. If they have a catastrophic health plan that pays 90% of their costs after the deductible, they don’t know it, but they really don’t have health insurance. How the hell is a family making $45k a year going to pay 10% of a $100,000 medical bill (along with the deductible and their regular monthly payments)? Sure, they could pay it out of savings. But most families don’t have a big savings cushion. They dedicate a huge percentage of their income to fixed costs that… Read more »