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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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15 replies »

  1. 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 me. Feel free to come up with a fully-formed counter-plan.
    Meanwhile, assumptions that poor people are that way because they are lazy and/or stupid overspenders are exactly that – prejudiced assumptions – and vibrant, neonic signs of sloppy, lazy thinking.
    Sometimes life just grabs you and throws you. That’s when you’re supposed to be able to count on society to do what’s for the common good. Writing off human beings isn’t, because some day it’ll be you. Blaming them for bad luck is cruel and heartless.
    Acting in a cruel, heartless, oh-so-rational way is exactly the opposite of the common good. Get it?

  2. 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 for a U.S. household of median income, at best discretionary income represents 15% of their household income. That would mean that if that household devoted the full 15%, they would barely cover copays and deductibles, but little else. As a consequence, high copayments, percentage coinsurance, and rising OOP maximums serve increasingly as regressive taxes on the sick and less well off.
    Lost in all of this, of course, is that health care is not a strictly private good. Indeed, many services represent public goods, or at least merit goods. To blame a household of median income for making the “wrong choices” is a form of obfuscation. The impact of the current system on everything from labor mobility to infectious disease transmission is often negative. Blaming the sick for costs of healthcare utterly misses the point.

  3. 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 squeezed. The Docs just don’t get it. More and more, doctors are seeing patients as the enemy. Another rent in the public whole.
    Many of us are one pink slip, or one severe illness or accident away from exactly this family’s situation. I don’t know Medpundit, but I have a friend who worked all her life at several simultaneous careers. A little back trouble soon blossomed into 5 herniated lumbar discs and spinal fusion surgery. Four more inoperable herniations in her neck. In three years she has gone from being a productive member of society with money tucked away for retirement to being on Medicaid, SSDI, and on the waiting list for section 8 housing. And when her anti-spasmotic medication became hard to get, her Medicaid HMO PCP suggested that she go cold turkey off all her meds so she would have a clear breakdown and need hospitalization, so she could be returned to her benzodiazepams.
    She has been turned away from ERs because they see her as drug seeking. You would be too. Let Medpundit walk a week in her shoes.
    I don’t understand why the Times didn’t put me in touch with this family. I have a lot of resources – I know a lot about working the system. I know also about collections and hospital charges and what can and what can’t be billed. Where was Sociala Services in all this? Oh – that’s right. Hospitals have let many SW’s go because they really don’t make the hospital any money.
    Those commentators who don’t favor single payer – where exactly do you see the future is for families like this one? What is the future for them? What kind of product should they buy to prevent this catastrophe? the truth is that there is no way they could avoid it. There were no other choices for them. The moment disease struck, the arrow was launched.

  4. 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 was merely here objecting to Syd’s cavalier treatment of what is a very serious social problem that was visited on this family for no fault of their own.

  5. //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 write, speak at conferences, and advance their field – so their jobs suck up their entire lives. Brilliant people become universtity professors: they are lured into the field somehow. When teachers complain of poor pay and strike, outraged parents come out with pitchforks to defend education against teachers who are putting the crass demand for money first.
    I believe there needs to be a tax-supported public medical system just like we have a tax-supported education system. This would not prevent doctors from being entrepreneurial any more than teachers are prevented from marketing their books or patenting their discoveries. While some doctors might want to flee – there may not be a better deal waiting for them elsewhere. People stay in the education system because they get state benefits, relative tenure, and other incentives besides altruism and enjoyment of teaching.
    As for medicine supposedly winning the war for brilliant minds, I’ve never met a doctor who particularly stunned me with his or her outstanding intelligence. They mostly seem to be functionaries spending as little time and thought on their patients as possible. I’m all for lowering the cost of medical school and reforming working conditions in the medical field instead of letting these be excuses for granting doctors a far greater income than teachers, policemen, firemen, and bus drivers get.

  6. //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 because believing such is in their best interest. It doesn’t make the position defensible.
    We’ve all seen where vows of abstinence have gotten the priesthood.
    Not that altruism can’t be a large part of someone’s motive for choosing medicine especially since a good chunk of my classmates are capable of doing just about anything with their lives, including endeavours that would no doubt bring bigger bank rolls. I just haven’t heard nor can I imagine an infallible argument that medicine is above the marketplace.
    Maybe I misread the post entirely and I’ve taken the comments completely off subject…so I apologize.

  7. 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.

  8. 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. There’s no right to healthcare. Try to define that right for me. Does it include that MRI to check on that ligament? Do you define it as a right to the ‘best’ care available? I couldn’t pull ten of my future colleagues into a room together and get them to agree COMPLETELY on best care for anything from the flu to an aggressive cancer.
    There’s nothing inherent about a ‘right’ to affordable healthcare. I can define a right to speech and, beyond ever increasing mediums, it is the same today as it is tomorrow. I can’t define a right to healthcare with anything close to the same level of coherency and if you’re honest with yourself then neither can you.
    Don’t kid yourself, large profit margains attract the brightest into medical research, into putting in years of 100 hour weeks (forget the ACGME rules). The story is heart wrenching but let the market do its job.

  9. //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 people are going to look for any workaround for this system they can. Stonewalls are rude, demeaning, and cruel when the patient is in desperate straits. I don’t willingly volunteer for that experience if I can find another way. If doctors want to prove that “compassion” will keep people from falling through the cracks, then they have to either make themselves available or instruct their staff to talk to people about their financial situation. Who knows, it might turn out that you can direct the patient to services and get reimbursed by the government instead of left hanging by a bankruptcy.

  10. 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.

  11. 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 and fail to keep promises. We “write off” plenty of charges.
    But I do like to see most patients make a token effort — is $5 a month too much? (I realize that sometimes it is, thus the write offs) You will likely in general get a much more compassionate response to your plight from your doctor than the hospital or the outpatient clinic.
    And then we hear that the patient who doesn’t have the money to pay anything just bought a new pickup.

  12. //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. I can’t wait for my retirement years, should I actually get there, when people start lecturing me for not saving for my retirement. Actually, I may start preparing a flashcard deck of profanities now, to hold up at random whenever someone tries to label me as a lazy, imprudent leech on the system.

  13. 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 are VERY difficult (if not impossible) to downsize in response to a health crisis–the expensive house in the neighborhood that has the good schools, the car insurance, etc.
    So, even responsible families have very little cushion to deal with a health crisis. It’s not that they’re being irresponsible, it’s that the fundamentals it takes to live a middle class life have become increasingly expensive.
    So, when a health crisis strikes, even the financially responsible are unable to cope with it. Some of them turn to credit cards, hoping to weather the storm and pay it back when they get better. Others declare bankruptcy right away and get to keep their house.
    It’s completely crazy that 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. There’s no reason for it.

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