I just returned from the annual conference of the National Health Care for the Homeless Council, where the link between medical bankruptcy and homelessness was made more clear than ever.

Which raises the question: Will the health reform we get end the “Only in America” phenomenon of medical bankruptcy? Just asking….

I am not usually the one to write about individual horror stories.  I will have my usual statistics and facts later in this diary. But one speaker’s story summed up so much of what is wrong Only in America.

Let me tell you the story of Joe Benson:

Mr. Joseph Benson (.pdf) is from Houston, Texas. When I met him for the first time last Wednesday he was wearing cowboy gear including the hat, which covered his long braided hair. He had a huge smile on his face and is a magnetic speaker; here is the story he told us: He was the first in his family to go to and complete college. After his BA, he went on and got professional chef’s training, and worked his way up in that industry, working in various restaurants and becoming a head chef. He saved money, moved back to Houston to help care of his parents and start his own family.  He built up a custom catering business, and was now the boss, employing 25 other people.

He had a wife and two children, and was putting money away for their college funds.  He had health insurance and auto insurance and his own home.

Surely this was the living embodiment of the “Only in America” all-American dream.

However, one night, on the way home from a catering job, he had an automobile accident, running head on into a commercial flatbed truck. The other truck was parked and loading scrap from a junk yard, and was jutting out into the road without it lights or blinkers on.

He survived but was in the hospital for almost a year.

Did I mention that when I met him, in addition to the cowboy outfit and smile, he was in a wheelchair with no legs, both amputated high above the knee?

The medical bills quickly blew past what his insurance would cover.  The owner and driver of the other truck did not have insurance, like 10-20% of vehicle owners despite the mandate to buy auto insurance, so Mr. Benson and his insurance company were unable to go after that source.

He lost his business.
His employees lost their jobs (and presumably their families suffered).
He and his family lost their house.
He and his family lost the kids college fund.
He lost his family.

When he was finally discharged from the hospital, it was to the street.

I’d probably would have just killed myself.
He survived but started drinking. A lot. And cocaine.
Note that in this instance it was the homelessness first, that then led to the drinking and drugs; not the other way around.

Eventually, he wound up in a shelter, and eventually he was able to put his professional chef skills to work in the “soup kitchen.”  From that he has worked his way back to sobriety, fulltime employment and housing.

Medical Bankruptcy:

Need I point out this is but an extreme (or not so extreme) example of the phenomenon of medical bankruptcy, despite having both a job and health insurance when he was injured.

Will our health care reform end the “Only in America” phenomenon of medical bankruptcy? In America:

  1. Illness and medical bills were linked to at least 62.1% of all personal bankruptcies in 2007. Based on the current bankruptcy filing rate, medical bankruptcies will total 866,000 and involve 2.346 million Americans this year – about one person every 15 seconds.
  2. Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of them had attended college and 66.4% had owned a home; 20% of families included a military veteran or active-duty soldier.
  3. 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the bankrupting illness; 60% had private insurance.
  4. 69% of debtor families had coverage at the time of their bankruptcy filing; 60% of families had continuous coverage.

Surprise, medical bankruptcy is also linked to losing your home, and to homelessness. Duh.

Homelessness in America:

Many factors put people and families at risk of homelessness. Systemic issues of unemployment, low wages, expensive housing, lack of health insurance and racial discrimination combine with common personal issues such as domestic violence, abuse of alcohol and other drugs, and serious mental and physical illnesses to create this persistent social problem.

But two trends are largely responsible for the rise in homelessness over the past 25 years: a growing shortage of affordable rental housing and a simultaneous increase in poverty. Homelessness in America is bigger and broader than many realize:

  1. Number of Homeless Persons in U.S. Annually: 3.5 million.
  2. Number of Homeless Persons in U.S. Nightly: 842,000.
  3. About 15 million of us experience homelessness at least once in our lifetime.
  4. 39% of the homeless are under the age 18: 1.35 million children per year and 200,000 on any given night.
  5. 23% of all homeless people were members of families with children
  6. 400,000 veterans are homeless per year, 200,000 on any given night.
  7. The role of mental illness and substance use is less than you may assume: Approximately 16% of the single adult homeless population suffers from some form of severe and persistent mental illness; 30% currently addicted to alcohol or drugs.  The cliché is that the closing of mental hospitals turned out many crazy people onto the streets. That is in fact a smaller and often over-emphasized part of the problem.
  8. The bigger part of the problem is stagnant income and less affordable housing.  The main cure for homelessness is affordable homes. 9 million low-income renter households nationwide pay more than half of their income for housing. In no community in the U.S. today can someone who gets a fulltime job at the minimum wage reasonably expect to find a modest rental unit he or she can afford.

And of course our current foreclosure crisis is also linked to increased homelessness.

The National Health Care for the Homeless Council endorses single payer and HR-676 for a reason. They are on the frontlines of how our health care “system” really works. Single payer — with automatic enrollment, everybody-in and nobody-out, and elimination of premiums, copayments and deductibles — assures that there is no more medical bankruptcy and that everybody regardless of circumstance really is covered. And single payer controls total costs to the country and for individuals.

Will the health reform we get in 2009 do that?
How do we get from here to there?