Thursday, November 14, 2019

A Debtor's Prison

That is the state of medical care and the bills associated with the debt accumulated when an individual enters the medical industrial complex, emphasis on complex.

The story below is one of many about the problems individuals in America face daily when it comes to finding care, paying for care and the reality behind what it is like to become ill and need treatment be you insured or not.

The real issue in the election of 2020 is not the Ukraine nor Trump's crazy it is the issue surrounding medical care and insurance followed by taxes and the rising tide of inequality that has enabled this division in the tide that allows some access to care and to stability once that care is provided.  For the rich it is an easy fix for those not it is not.

I debated whether to sign up for medical insurance this year and with premiums topping 700 bucks a month for services I have never used other than a joke of a flu shot and some meds associated with my dental needs I decided I would be better off putting that money into an emergency fund that I could use in an emergency be it medical or otherwise.  And of course I get this whole concept of negotiation - or quid pro quo as the word of the week has taught us.  Yes you can negotiate medical care. 

To put it mildly we have a fucked up system of care.  The dental insurance industry is largely unregulated and covers very little and is a disaster when it comes to finding qualified capable individuals who can offer consistent appropriate care and treatment. Then we have vision care which runs the gamut from mall specialty sight providers to actual Doctors and licensed professionals who at least have some training and education to offer service. Add the absurd costs for frames and lenses it again puts basic care at the equivalent of a Jenga game where you are hoping  your pull will not crash the entire set up.

Add to the current state of affairs is now Google acquiring Ascension medical records giving them troves of personal data to mine like a coal miner in Kentucky back in the day and of course the move by Amazon and others to provide a quasi medical service from prescriptions to diagnosis all which again puts the consumer at risk to what kind of care and the legitimacy of the drugs being received. It is one thing to get a bogus pair of Air Jordan's another to get a drug that has the incorrect dosage or diagnosis.

Then we have the rise of the medical lawsuits for unpaid bills.  From low to high more and more hospitals are taking their patients to court and winning, garnishing wages, freezing accounts and placing liens on property to garner payment for the debt owed.

For the record I pay in Cashier's check when I pay medical bills so they don't have access to my account information, I have a post office box and no phone listed so that all bills and no calls come to my home while I finish my treatment at Vanderbilt.  I prepaid on my dental bill 5K when the estimate came and I was told it was a slush fund that is used to pay any and all debt in whatever department I used in the facility. No, no its not.  Even their own Doctors don't get medical billing.   I will not pay one more dime until they can provide a detailed accounting of the money, where it is, how it is being used and to where it is going.  They can in a well used phrase: Go fuck themselves.

This is the issue for 2020 MEDICARE FOR ALL.  However you want to express it, define it or understand it.  We need a Government run health care insurance provider whom you can opt in or not and for the rich they can still buy private insurance and all the accoutrements that it entitles them to have but basic care is a human right and frankly the access and availability of said care is non existent as it stands now.   No one should find themselves homeless to get needed care.  Yes sure you are an idiot and you do drugs and don't take care of yourself but ultimately let's find a way to get these people the help they need to ultimately care for themselves in a manner that is less reliant of other public services such as disability and welfare.  Imagine if that one case mentioned in the article was allowed to keep his job, to work and provide that his only debt was in basic needs he would be not a burden on society but on himself and those around him who could help him learn ways to live with less risk, have a healthy happy lifestyle that has the medications that he can use and need to survive without the risk of further decline - physically or financially.   Independence matters but right now we are all living in debtor's prisons just waiting for parole.


'I live on the street now': how the insured fall into medical bankruptcy

Having health insurance is often not enough to save Americans from massive debts when serious illness strikes

Michael Sainato
The Guardian
Thu 14 Nov 2019

It’s been over a dozen years since Susanne LeClair of West Palm Beach, Florida, was first diagnosed with cancer, she’s been fighting ever since. Now she, like many other Americans facing life-threatening illness, is bankrupt despite having health insurance.

Before her first cancer-related surgery, LeClair was told by the hospital they accepted her employer-based health insurance.

“I paid my $300 copay. After the surgery, I started receiving all these invoices and came to find out the only thing covered was my bed because the hospital was out of network,” said LeClair. “My bills were hundreds of thousands of dollars, so I had no choice but to file bankruptcy.”

LeClair is on the verge of having to file for bankruptcy a second time due to the mounting medical debt she has accrued for additional cancer-related surgeries, regular appointments, medications and supplies related to her recovery, despite having health insurance and paying as much as she can out of pocket for copays, deductibles and premiums to maintain insurance.

“My medical bills are at $52,000. I’ve done everything from credit cards to consolidation loans, I just keep simply paying one credit card with another interest-free one until I can pay the next one,” LeClair added. “It’s the side of cancer most people don’t understand or know about and it’s never-ending. It just keeps adding up and adding up and before you know it you’re back in debt that you can’t believe again.”

Bankruptcy can also make it difficult to find employment given that many employers will disqualify a candidate with a bankruptcy filing found from a background check.

According to a study published in February 2019, about 530,000 bankruptcies filed annually are because of debt accrued due to a medical illness. The study found that even the Obama administration’s landmark Affordable Care Act (known as Obamacare) has failed to change the proportion of bankruptcies caused by medical debts, with poor health insurance cited as one of the main culprits.

Republicans and Democrats are currently at loggerheads over Trump administration plans to further weaken Obamacare by making it easier for states to opt out of certain requirements and offer cheaper plans that could further exacerbate the situation. And health insurance has emerged as one of the signature issues of the 2020 election, and the fight for the Democratic presidential nomination with senators Bernie Sanders and Elizabeth Warren promising a total overhaul and Joe Biden and others pledging milder reforms. What all sides admit is that the current system is broken.

“Health insurance that we have today is a defective product,” said Dr David Himmelstein, distinguished professor of public health at City University of New York’s Hunter College and a lecturer in medicine at Harvard Medical School.

“A lot of people, a little over 60%, are filing bankruptcy at least in part because of medical bills. Most of them are insured. It’s clear that despite health insurance, there are many, many people incurring costs not being covered by their insurance,” said Himmelstein. “Medical debt is incredibly common, it’s the main cause of calls from collection agencies, and the vast majority of people with it have insurance,” said Himmelstein, lead author of the study Medical Bankruptcy: Still Common Despite the Affordable Care Act.

One out of every six Americans has an unpaid medical bill on their credit report, amounting to $81bn in debt nationwide, while about one in 12 Americans went without any medical insurance throughout 2018. Even as many Americans struggle to afford health insurance coverage in the first place, those that have it are not insulated from facing massive debt due to medical bills.

“I have insurance through my job but it has a high premium and high deductible. I have to pay $450 a month. When you think about living paycheck to paycheck, $450 is a lot of money. I’m barely making it. Some bills don’t get paid every month,” said Mary Cross of Detroit, Michigan, who has filed for bankruptcy twice since early 2013 when she was admitted to the hospital for pneumonia, required lung surgery and was diagnosed with sarcoidosis, an inflammatory disease.

“I’m currently struggling to stay afloat now due to having surgery this past January,” added Cross, 51. “I’ve been getting constant calls from the billing department at the hospital where I had surgery.”

In Savannah, Georgia, a 35-year-old man who requested to remain anonymous to avoid being associated with a bankruptcy, recently found himself homeless and jobless due to prolonged hospital stays and hundreds of thousands of dollars in medical debt.

A type 1 diabetic for years, he had to reduce his work hours for a cellular retail store when trouble regulating his blood sugar resulted in a toe amputation in April 2019.

“I had to cut my work hours so bills were harder to pay. But in July 2019 I was admitted to the hospital again and I was fired from my job because I was in the hospital. I lost my insurance. They amputated my leg, which means I still can’t work,” he said.

When he lost his job due to the prolonged hospital stay and leg amputation, his employer offered Cobra, a health insurance program for employees who lose their job or have a reduction in work hours, but he couldn’t afford it. He is currently working on trying to file bankruptcy to release the medical debt he’s accrued from amputations this year and he lost his house in October 2019 as a result.

“I have amassed over $400,000 in medical bills I need to pay, and still have at least six months before I get a disability hearing. So I owe over $400,000 in medical bills, have lost my house and I live on the street now, with no end in sight,” he said.

Just outside of Chicago, Illinois, Jessica Hillman filed for bankruptcy in 2016 due to medical debt accrued from battling a seizure disorder, despite having health insurance coverage for the majority of her treatment.

“I had thousands of dollars in various medical debt which made the majority of my claim. The last bill I got that really pushed me toward the bankruptcy was for a routine lab test that my insurance refused to approve because of a billing mistake. That bill was about a thousand dollars,” Hillman said. “I couldn’t work and had no way to pay these.”

At the time, Hillman was receiving several collection notices in the mail for past hospital stays and tests amounting to several thousand dollars, often having no knowledge of the bills that health insurance didn’t cover until receiving the collection notices.

“One of the biggest hurdles you face as a patient is just the sheer confusion of the process. You think you just show up and present your card, sometimes pay a copay, and that’s it. You don’t expect all these plan limitations and authorizations,” Hillman added. “What are you going to do if your authorization gets denied? You don’t really have a choice to not go get care. All these processes that are in the finest of fine print. And sometimes it feels like you are literally paying for nothing.”

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