PNHP

Uninsured people may have a higher risk of death than once thought, study finds

Uninsured people may have a higher risk of death than once thought, study finds

A national report estimated that nearly 45,000 deaths in 2005 were associated with a lack of health insurance.

By Doug Trapp
AMNews
Posted Oct. 2, 2009

The uninsured might be about 40% more likely to die than the privately insured, according to a study published online Sept. 17 in the American Journal of Public Health. In contrast, a 1993 Institute of Medicine study concluded that those without health coverage were 25% more likely to die.

Nearly 45,000 people in 2005 might have died, in part, because they had no health insurance. That was the conclusion of “Health Insurance and Mortality in U.S. Adults,” authored by Cambridge Health Alliance researchers (www.ajph.org/cgi/content/abstract/AJPH.2008.157685v1/).

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health,” said lead author Andrew Wilper, MD, MPH, an internist who teaches at the University of Washington School of Medicine.

The authors used medical records from the Center for Disease Control and Prevention’s Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994. They narrowed the sample and excluded those who were younger than 17 or older than 64, who had government health insurance, and who didn’t complete all the physical exams and background information for the CDC’s study. Then the authors matched names to the National Death Index, a compilation of state death records, and extrapolated the mortality rate for 2005 using U.S. Census Bureau records.

Sixteen percent of the 9,000-person sample, or about 1,400 people, were uninsured, according to the study. The uninsured also were much more likely to be young, unemployed and/or a member of a minority group. They also were more likely to smoke, to forgo exercise, and to have lower levels of education and income than were the rest of the sample, after controlling for health status and demographic background.

The study was limited in that the authors could not verify the self-reported insurance status of participants, nor measure the effect of gaining or losing coverage after the interview. But the authors excluded people who did not provide complete medical information. Those people were more likely to be uninsured than the rest of the sample, the researchers said.

http://www.ama-assn.org/amednews/2009/09/28/gvse1002.htm

Locals gather at courthouse to discuss single-payer health care

By Sarah Bloom
Indiana Daily Student
Oct. 1, 2009

About 40 people gathered in the Monroe County Courthouse Wednesday evening for a meeting advocating a single-payer, universal health care system, which has garnered considerable support in Bloomington, but is not being seriously considered in the health care debate in Washington.

Hoosiers for a Commonsense Health Plan, a grassroots group that advocates for a single-payer system, organized the meeting to coincide with the Mad As Hell Doctors’ arrival in Washington, D.C.

The Mad as Hell Doctors, based in Oregon, made their case for a single-payer system at the Bloomington Farmer’s Market on Sept. 19. The traveling doctors are making their way to Capitol Hill in an attempt to meet with Congress and President Barack Obama.

Dr. Rob Stone, an emergency room physician at Bloomington Hospital and director of Hoosiers for a Commonsense Health Plan, opened the meeting by talking about a recent study from Harvard University published in the American Journal of Public Health.

The study found that 45,000 people die annually in America for lack of health insurance, a drastic leap from earlier estimates of 18,000.

Stone said the reform options Congress is considering, especially the new Senate bill,
would do little to remedy these numbers.

“The best version is projected by the Congressional Budget Office to cut the number of uninsured people to 17 million, which means only 17,000 needless, tragic, preventable deaths per year,” Stone said.

Speakers then addressed the crowd about the urgency of the issue and their frustration at insurance companies, special interest groups and representatives in Congress.

Jay Bainbridge spoke about his friend and colleague Libby Yarnell, former executive director of Mother Hubbard’s Cupboard, a Bloomington food pantry. Yarnell died in June at age 29 of a rare form of cancer.

Bainbridge said that because she did not have health insurance, Yarnell was unable to see a doctor for months after she began experiencing strange pains in her side.

She had to wait several more months to be able to pay for the numerous tests the doctor recommended.

“She may have died anyway, this may have been a cancer that was going to kill her no matter what,” Bainbridge said. “But I sure as hell would have liked to see her get a chance to get the tests done and start detecting what was ailing her when she was feeling sick.”

Other speakers shared similar stories about the dangers of being uninsured, and the necessity for universal health care.

Toby Strout, executive director of the Middle Way House, said employee health insurance costs are on their way to consuming 10 percent of Middle Way’s budget.

“We are shopping the market, and the market isn’t providing anything that makes sense,” Strout said. “If we don’t do this, the services that the Middle Way House provides aren’t going to be there anymore.”

Other speakers included Vic Kelson, president of the Monroe County Council, Sally Hegeman, president of the Bloomington-Monroe County League of Women Voters, and Nancy Woolery, health projects manager for the City of Bloomington, among others.

An audience member asked Stone if he was frustrated by the lack of attention Congress has paid to a single-payer model.

“It is a little frustrating, in fact it’s more than a little frustrating,” Stone said. “The original conception of the public option was going to be something that might, after five years, cover $100 million people. Now, even if there is a public option that comes through, it’s going to be, really, just a shadow. I don’t even know if you can use that term anymore to describe it.”

The Single-Payer Alternative

by Ashley Smith
Dissident Voice
Sept. 30, 2009

The politicians declared one plan for health care reform “off the table” from the beginning: a single-payer system that would cover all Americans and cut out private insurance. But as Dr. Andy Coates explains, it remains the only alternative that can solve the crisis of the health care non-system.

Coates is a member of Physicians for a National Health Program (PNHP), co-chair of Single Payer New York and a steward in the Public Employees Federation in New York.

Ashley Smith: The right wing has mounted a major offensive against Democrats proposals for health care reform, with all sorts of absurd allegations and distortions. What’s your assessment of the right-wing attacks?

Dr. Andy Coates: At one town hall I attended, a guy had a sign that said, incredibly, “Tsars are not for the USA, Tsars are for the USSR.” Nearby, there was quiet bragging that somebody had a gun in his car. So there is nuttiness, but also potential danger as the right wing mobilizes.

At that meeting, I thought that people for single-payer outnumbered the right wing. Those in favor of some kind of reform far outnumber those against, but the “get the government out of health care” group fought for the mike and fought for attention.

Earlier, I was heckled while speaking in favor of single-payer on a panel in Syracuse convened by a Congressman. The interesting thing to me–besides hearing people holler “socialism!” at the top of their lungs–was that the hecklers listened carefully to every word people said. And I noted their applause when I said that mandating the purchase of health insurance wouldn’t solve anything. At that meeting, a clear majority was for single-payer, but that’s not how the press reported it.

So I think that many people, swayed by Republican arguments, will actually think this through for themselves. For example, someone who’s 59 years old, avoiding the doctor, trying to make it a few more years to Medicare, worried that Medicare won’t be there–and rightly so, for the Republicans keep repeating that it’s “bankrupt,” and the President keeps saying that Medicare and Medicaid is breaking the country.

I believe we can win these people over to single-payer. We shouldn’t let the TV coverage of these meetings distort our view. Poll after poll, and our own experience, attests that the majority of people are on the side of real reform–of Medicare-for-all single-payer health care.

AS: Many people find the debate in Washington completely confusing and exasperating. What do you think is going on?

AC: It is confusing. Just think about it–the Republican Party recently came out foursquare in defense of Medicare, after decades of calling for its abolition. Of course, the Republicans want to protect Medicare Part D, a giveaway to the pharmaceutical industry, and they love Medicare Advantage, a privatization of Medicare that has proven lucrative for private insurance companies.

Meanwhile, we have the Pharmaceutical Research and Manufacturers Association of America, led by former Republican congressman Billy Tauzin. Tauzin was quoted in the Los Angeles Times saying that the White House promised not to negotiate with the pharmaceutical industry–promised to preserve Medicare Part D, and also not to allow the import of drugs from Canada or other countries where they would be cheaper than American prices. In exchange, PhRMA is going to spend $150 million advertising in favor of so-called “reform.”

So PhRMA and the White House and the Republicans all appear to be in alignment, defending Medicare Part D from reform. Perhaps Obama was accurate when he said recently that there was 80 percent agreement on the proposals. Yet we hear “government takeover!” as if someone were actually proposing such a thing.

AS: It seems like both the Republicans and the so-called “blue dogs” in the Democratic Party oppose the idea of government involvement in health care. What’s your view of their argument?

AC: We should set the record straight. The government is deeply involved in medical care. Taxpayers fund at least half of all health care spending in the U.S. The number of people covered by Medicare, Medicaid and military health plans is over 87 million. The idea of getting the government out of health care could be called a utopian fantasy.

Medicare has been an enormously successful program for 44 years. The Veterans Administration is a socialized system where the federal government owns the hospitals and clinics, pays the staff directly, and bargains with the pharmaceutical industry for low drug prices. The Veterans Administration delivers the best quality health care in the country–numerous studies attest to it.

AS: Why has the Obama administration made such a mess of its campaign for health care reform?

AC: No one disputes any longer that our system is in grave trouble. We’re spending twice as much as any other nation on health care, and yet we have a mediocre, dysfunctional system.

The Obama administration’s message has been, again and again: “If you like your insurance, you’ll get to keep it.” They needed to find an argument that would help them earn the support of the health insurance industry. So Democratic Party pollsters “discovered” that people love their health insurance. In the name of reform, ironically, they broadcast the idea that people fear change.

This is at odds with everyday experience and the 2008 election returns, on top of many polls that show popular support for single-payer. I think there is great enthusiasm and great expectation in favor of change–dramatic, fundamental change. And people find the hassles of health insurance ridiculous.

AS: What is the nature of the reform that the Democrats are proposing?

AC: The heart of the reform is a mandate that individuals purchase health insurance–to criminalize the uninsured.

In exchange for accepting some new regulation, the insurance industry will get the government to coerce people into buying their product. Because working people don’t make enough money to buy the product, tax money will be used to subsidize the private insurance premiums. The Los Angeles Times called this “a bonanza” for the health insurance industry.

AS: This is exactly what Massachusetts did. What has been the impact there?

AC: Yes, Massachusetts mandated that everyone buy health insurance. And this hasn’t made premiums affordable. To reduce premiums, policies have things like very high deductibles and large co-pays. In the case of a single person making just over $30,000 a year, if you add up the premiums and deductible, she or he will have to shell out over $5,000 before any insurance kicks in. This simply isn’t affordable.

Massachusetts subsidizes insurance premiums for everyone who makes less than 300 percent of the federal poverty line. This guarantees a constant flow of money into private health insurance companies, while it exacerbates the state’s budget deficit.

And to address the deficit, Massachusetts has cut safety net health care! They have taken hundreds of millions of dollars out of programs that would have helped poor and low-income patients–the very people most need the care and whom the reform should have most helped.

In addition, Massachusetts has a feature like what’s in the proposed federal reform–a brokerage house called the Commonwealth Health Insurance Connector. It’s supposed to help people get private health insurance. But it’s yet another layer of bureaucracy!

The Insurance Connector alone employs more people than the province of Ontario has working for its Medicare program. Medicare in Canada costs 1.3 percent of health spending. The Insurance Connector adds 4.5 percent in administrative cost to each policy it brokers. And the province of Ontario has twice as many people as the state of Massachusetts.

The Massachusetts model doesn’t work. It doesn’t lower costs, and it doesn’t cover everyone. It forces people to buy defective, unaffordable insurance. And when you lose your job in Massachusetts, you still lose your health insurance.

AS: Beyond the idea of mandates, the Democrats have also floated the so-called public option. What do you make this idea?

AC: Let’s look back to the early 1960s. When Medicare was gaining momentum and needed to be enacted by Congress, its opponents put forward a proposal intended to be friendly to the health insurance industry. The idea was that seniors should be able to purchase health insurance from private companies, but also have the choice of a public insurance option.

Medicare passed instead, thank goodness. It seems fair to ask whether today we should support a proposal that was objectionable over 45 years ago.

The idea of the public option was again put forward in 2007, in a briefing paper by Professor Jacob Hacker. He envisioned a very large public program, enrolling all of the uninsured and anyone else who voluntarily wanted to purchase health insurance from a public insurer. The public insurance company, in turn, would have the market share, the clout and the low overhead to compete against private health insurance companies.

Many good-hearted people have latched onto this proposal today because they think that the private health insurance industry is simply too powerful to conquer. These people aren’t against single-payer. They simply lack confidence that we can achieve a Medicare-for-all single-payer system in one step. They’re looking for an incremental route.

In PNHP, some of us like to say, “You can’t jump a chasm in two leaps.” In the insurance marketplace, the winning company keeps the healthy and wealthy customers and avoids or jettisons the sick and the poor.

Would a public option really be able to compete? Wouldn’t it simply end up with the sick patients, whose care is costly, and flounder? Wouldn’t it more likely lead to greater disparities, an official two-tiered system? Is there anyone who really believes that the heavily monopolized U.S. insurance market would even reform–let alone abolish–itself simply because people were given the choice of a public plan?

Even so, what seems surprising so far is that we haven’t seen much of a specific proposal for what this public option would look like. We hear the words “public option,” but the details about how it would be launched and funded, who would be enrolled, and how it would, in fact, impact the market remain murky. If you’re looking for an incremental route, some specific steps might be useful.

Because the Democratic leaders didn’t put forward a specific proposal, the public option really seems like little more than a bargaining chip. It’s a feint, not a punch.

The New York Times editorial the day after his September speech advised the president not to surrender the public option–yet. The advice was to try and trade away the public option for Republican votes. Meanwhile the public option, as a posture, has lured progressives and liberals to support a reform that is a huge giveaway of taxpayer money to insurance companies.

So the Democratic Party leadership now finds itself in a bit of a pickle. A significant part of the liberal community finds the public option utterly compelling. They see in the idea a morally defensible alternative to the insurance industry, whose profits are essentially blood money.

Will the Democratic leaders, even so, abandon the public option? We’ll see. In Rolling Stone, Matt Taibbi noted that when Nancy Pelosi was asked if progressives might bring down health care reform over the public option, she laughed out loud and said that there’s no way that progressives would vote against the President, no matter what.

AS: Even if we got the public option, would it deliver the health care reform that we need?

AC: In the best-case scenario, the public option will not cover everyone, improve quality, redress disparities or guarantee the choice of physicians. PNHP founders David Himmelstein and Steffie Woolhandler estimate that the maximum cost savings it would offer would be only 9 percent of what single-payer would offer. It would also add yet another insurance entity to the 1,300 different insurers we have now. And it won’t end the fundamental problem with health care–the profit motive. That’s what lies behind the health care crisis in America.

Let’s be honest–competitive insurance companies successfully shun sick and poor patients, and enroll healthy and wealthy patients instead. Any entity, including a public option, that enters that marketplace, even with the best intentions, has got to compete for the healthy and wealthy patients to survive.

How can a public option get the insurance market to reform itself? It would also require a colossal amount of regulation–active government coercion of the private industry.

Let’s talk about the political feasibility of getting the government to reform the insurance market in a way that all the companies would share the risks, the burden of the sick and poor, with account books open to the public, so everyone can know what resources are going to the care of patients, and see the fairness of the insurance market reform.

That proposal, in my estimation, would actually require much more political organization–a mightier political force–than we need to win single-payer and go ahead and expand and improve Medicare to include everyone. It makes more sense to simply ask the insurance industry, which has failed our country so terribly, to step aside.

AS: How would single-payer solve the health care crisis in the U.S., and how do you respond to those who say it’s unrealistic to challenge the health insurance industry?

AC: I think about the dimensions of health reform as a pentad, with five interrelated points. We need to reign in unaffordable costs, improve the quality of care, lessen disparities, guarantee access and protect the provider-patient relationship. Any proposal for comprehensive reform has got to get at all of these: costs, quality, disparities, access and choice.

When you see it that way, a single-payer program is the most basic foundation that would have the power to deliver comprehensive reform.

It would liberate tremendous resources, hundreds of billions of dollars annually, that are presently squandered in a vast administrative bureaucracy that exists to extract money from the system. This bureaucracy drives health care into a dysfunctional frenzy. Single-payer would not only eliminate that administrative waste but a myriad of perverse monetary incentives.

Under a single-payer system, everyone would have health care–not insurance, but health care. We would be able to build new hospitals and clinics to meet needs in medically underserved communities. This would not only guarantee access, but improve quality and lessen disparities. And this would be also an economic stimulus of gigantic proportions, a very important thing given the current economic crisis.

With everyone in and nobody out, single-payer would guarantee every patient the right to go to any doctor, nurse practitioner or any health care provider they chose. It would be based upon protecting, not eroding, the privacy of the provider and the patient.

As liberating as single-payer can be, without a true people’s movement, we can’t take on the entrenched power of the insurance industry. The insurance companies control hundreds of billions of dollars of health spending through a byzantine, bureaucratic apparatus that exists to extract resources, including profits, from the care of sick people. It has an enormous lobbying apparatus and contributes rivers of money to both Republicans and Democrats. It’s a very, very serious foe.

AS: How can the debate be shifted to put single-payer at the center?

AC: By sticking to the facts. The right likes to say that single-payer can’t happen because we need to have a uniquely American system.

But if we’re going to have an evidence-based debate about the best way to provide a uniquely American system of health care, it would be between the Medicare model, which is socialized health insurance, and the Veterans Administration, a socialized health system in which the federal government owns every hospital and clinic, pays the doctors and nurses directly, bargains with the pharmaceutical industry with bulk purchasing as its leverage, and monitors the quality of care, with excellent results.

The practicality of the single-payer proposal can’t be refuted. The idea is gaining momentum. If we mobilize, it will become unstoppable. If we’re creative and if we don’t back down, we will win this reform.

Remember, Medicare was implemented 45 years ago within one year. The government enrolled and guaranteed benefits for every single person over 65 in an era before personal computers, with typewriters and carbon paper. In the 1990s, the Taiwan government studied health reform and concluded that single-payer, modeled on our Medicare system, was the best way to go. They pushed it through within a few tumultuous months. And the health finance system in Taiwan has been successful and popular ever since.

AS: What should the strategy of single-payer advocates be in the health care debate this fall?

AC: Build the grassroots movement! Look at recent history. Our emerging movement has overcome all sorts of opposition.

Before he was elected, Obama organized living room discussions on health care. PNHP heard from across the country that hundreds of these meetings were actually in favor of single-payer. The Obama campaign’s report, over 100 pages, managed little more than a mention of single-payer. It was dismissive.

When the White House had a meeting on health care that didn’t invite any single-payer advocates, activist doctors threatened a picket line unless Oliver Fein, the president of PNHP, was invited. Within a day, the White House changed course and invited Oliver Fein and John Conyers, who had also been excluded.

Then, the White House held health forums throughout the country, in Michigan and Vermont, Iowa, North Carolina and California. Single-payer people came out in the hundreds to the meetings.

Max Baucus, the chairman of the Senate Finance Committee, declared single-payer off the table early in 2009. So when the Senate Finance Committee heard testimony, at two sessions, activists, including doctors and nurses, stood up to demand that single-payer be put on the table.

That civil disobedience galvanized our movement. Dr. Margaret Flowers was then invited to testify before the Senate Health, Energy, Labor and Pensions Committee. When the House committees took testimony, single-payer was on the table.

Meanwhile, members of Congress have now heard and heard and heard again from single-payer activists. This spring, Nancy Pelosi was quoted as saying, “It’s single-payer, single-payer, single-payer, everywhere we go.”

Because of this nascent mass movement, it looks like single-payer will now get to the floor of the House of Representatives this fall for the first time. New York Rep. Anthony Weiner managed to get Nancy Pelosi to allow a floor vote on HR 676, the single-payer bill.

In the Energy and Commerce Committee, Weiner and six other representatives proposed an amendment that would substitute the text of HR 3200 with the text of HR 676, the single-payer bill. The committee chair, Henry Waxman, interrupted Weiner to say that if he would withdraw the amendment from committee, the speaker would allow a floor debate and vote.

This shows that single-payer really is on the table. This should give our movement confidence.

AS: What do you think of the Rep. Dennis Kucinich’s proposed amendment that would allow states to pursue single-payer plans on their own? What should single-payer activists say about his state-by-state strategy?

AC: Dennis Kucinich has proposed an amendment to HR 3200, the main House health care reform bill, which would allow states to implement state-based single-payer programs. Because it came through committee–in fact, it passed the House health committee with Republican votes–it won’t have a floor vote. Three committee chairs and the House Speaker will decide whether the Kucinich amendment will be included in the final version of HR 3200.

The Kucinich amendment is an expression of the great energy to establish state-based single-payer health insurance programs in California, Vermont, Pennsylvania, New York and elsewhere. Many activists who argue for such a state-by-state strategy point to the precedent in Canada. There, Saskatchewan was the first province to enact a single-payer health care system, which then spread province by province in Canada.

Yet with 50 different states, it’s hard to imagine a similar process unfolding in the U.S. when we consider the wide disparities across states–say, Louisiana compared with Minnesota.

It’s also difficult to imagine how state-based single-payer reform would work practically. Say that we won state-based single-payer in New York state–how would it affect people from northern New Jersey, southern Connecticut and elsewhere, who use the excellent hospitals in Manhattan? If a small state like Vermont passed single-payer, how would the system defend itself against the onslaught of attacks that would inevitably come from the powerful insurance and pharmaceutical industries? The Kucinich amendment, in a way, highlights these challenges.

Even so, I’m completely in favor of fighting for state-based single-payer reform. It is a legitimate demand and great way to educate. However, we must not lose sight of our goal–national health insurance.

AS: Given that we are going to have some version of the Obama proposal likely passed what will that mean for the single-payer movement?

AC: Back in February, in his first appearance before Congress, the president said that health care reform cannot and will not wait another year. But even if a bill gets passed, the main elements–like the insurance mandate, any kind of public option if it survives and the insurance exchange–won’t begin until 2013. Meanwhile, we face a system where the experience of seeking care is often a hassle and humiliating, and is sometimes deadly.

This fall, health care activists should explain that we have workable reform within our grasp–single-payer health insurance. We should use the deliberations that go on in Washington and the points that come out of them to explain why and how single-payer would be better.

In reality, whatever happens in Washington will not change our lives much for the better. But the election of the president and the call for sweeping reform have raised the nation’s expectations sky-high that there will be meaningful change. Under those conditions, I’m enormously optimistic that we can build the kind of grassroots movement that we need to win single-payer national health insurance.

Ashley Smith is a writer and activist from Burlington, Vermont.

The lack of universal health care is a mass killer in this country

By Deb Richter
The Progressive Media Project
McClatchy-Tribune Newspapers
Oct. 1, 2009

Nearly 45,000 deaths in the United States each year are attributable to the lack of health insurance, according to a Harvard University study released in September.

That astonishing figure, which appears in the American Journal of Public Health, is a big uptick from the Institute of Medicine’s finding seven years ago that 18,000 people die each year because they lack insurance and thus have less access to care.

The Harvard Medical School researchers found that an uninsured person’s risk of death is 40 percent higher than his or her privately insured counterpart. Looked at another way, every 12 minutes a person dies unnecessarily because he or she doesn’t have health coverage.

As startling as this 45,000 figure is, I fear it underestimates the problem.

In my 20 years of practice as a family physician, I have encountered dozens of cases where the main contributing factor to a person’s death was the lack of health insurance for most of their lives.

I recall one family that lost three members this way.

George was 21 when he died of complications of juvenile diabetes that he’d had since the age of 2. Whenever George worked for a while, he lost his Medicaid. This meant he could no longer afford to test his blood sugars, they would get out of control, he would get sick, have to stop working, he would spend down, then qualify for Medicaid again. This went on for the three years I knew him.

His older sister Tina also had juvenile diabetes from the age of 6. Her situation was the same – working, losing insurance, getting sicker, not working, getting Medicaid etc. Tina was pregnant at the time of George’s death. Her poorly controlled diabetes made her a very high risk for complications in pregnancy. The baby was born three months prematurely and died in the intensive care unit one month later. Tina’s health worsened after that and within one year she died in post-op after heart bypass surgery. She was 25.

Then there’s Russell – also a diabetic, also on and off insurance. He died at age 37 of diabetic kidney failure. He was uninsured for years.

Another case – Vivian – had warning signs for cancer for years. She finally qualified for insurance but died two weeks into the workup of a pulmonary embolus (a complication of pelvic cancers).

I am only one clinician, and yet I have witnessed dozens of cases of people who died of preventable illnesses – preventable illnesses that could have been treated had these patients possessed uninterrupted, seamless coverage for needed treatments over their lives.

Take my experiences and multiply them 700,000 times for the number of physicians in this country and you arrive at a lot more than 45,000 deaths a year due to lack of insurance.

It is time that our nation join the rest of the industrialized world and guarantee seamless health care coverage to every man, woman and child in America.

In other words, it’s time to enact single-payer health care – Medicare for All.

ABOUT THE WRITER

Deb Richter practices family medicine in Montpelier, Vt., and is a past president of Physicians for a National Health Program (www.pnhp.org). The writer wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmproj@progressive.org; Web site: www.progressive.org. For information on PMP’s funding, please visit http://www.progressive.org/pmpabout.html#anchorsupport.

This article was prepared for The Progressive Media Project and is available to MCT subscribers. McClatchy-Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of McClatchy-Tribune or its editors.
ƂĀ© 2009, Deb Richter

Doctor: Care for all is right thing to do

Pediatrician says cost would be less than current levels

By Patricia C. McCarter
Huntsville Times
Thursday, October 01, 2009

Everybody in. Nobody out.

With these four words, Huntsville pediatrician Pippa Abston described what she believes is the best health care option for America. She also described it as ā€œMedicare for all,ā€ a concept that concerns citizens who donā€™t support the federal government getting bigger.

At a Wednesday night meeting at the University of Alabama in Huntsville, Abston told an audience of nearly 100 people that health care is a human right, and that providing insurance for everyone – regardless of whether they ā€œexercise and eat their vegetablesā€ – is the moral thing to do.

ā€œI have nothing against capitalism. ?Iā€™m not talking about across-the-board socialism,ā€ but health care and big profits donā€™t belong together, she said.

The meeting was organized by UAH College Democrats and North Alabama Health Care for All.

What Abston wants is a single-payer system, with that payer being the federal government. Under the plan she supports – as pitched in House Bill 676 by Democratic Congressman John Conyers of Michigan – private health insurance would go away.

From cradle to grave, the government would pay for citizensā€™ medical coverage, via a payroll tax of about 4.5 percent, ā€œwhich is considerably less than what people pay for health care premiums.ā€ It would cover doctor visits, hospital stays, preventive medicine, home health care and prescription drugs.

Abston said the cost would be substantially less than what is currently spent on health care because the government could negotiate better costs, and high salaries of insurance executives would go away. By everyone, rich and poor, having the same insurance, she said the wealthy and powerful will make certain it has excellent benefits.

The pediatrician said America is 50th in life expectancy among developed nations, a fact she said points to a lack of quality care for the elderly and the needy.

When asked if she thought she was being idealistic to back such a radical change in health care, Abston said she didnā€™t think she was supporting an impossible dream.

ā€œDuring the civil rights movement, who wouldā€™ve thought weā€™d have an African-American president in 2009?ā€ she said. ā€œThat wouldā€™ve been an idealistic thought, but here we are.

ā€œA lot of doctors have told me theyā€™re for (Medicare for all), but they donā€™t think it will happen. I think they gave up too soon. It makes sense.ā€

Estimating the number of uninsured Americans by Congressional District using Census Bureau data

Because of more intensive surveys of coverage than ever before, the Census Bureau’s survey data can now be used to calculate the numbers of uninsured in every congressional district. Thanks to Len Rodberg, Ph.D. from the New York chapter of PNHP for creating the following chart showing the number of uninsured people under age 65 by congressional district.

See table of Insurance and Uninsurance by Congressional District (Microsoft Excel)

Continued insurer discrimination assured

Discrimination by Insurers Likely Even With Reform, Experts Say

By David S. Hilzenrath
The Washington Post
October 4, 2009

If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.

Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.

And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania’s Wharton School.

At a more nuts-and-bolts level, AHIP has been trying to shape the legislation in ways that could help insurers attract the healthy and avoid the sick, though it has given other reasons for advancing those positions.

By itself, a ban on discrimination would not eliminate the economic pressure to discriminate.

“It would probably increase the incentive for cherry-picking,” Pauly said.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/03/AR2009100302483_2.html

Comment:

By Don McCanne, MD

No matter how tightly regulated, investor-owned private insurers will always find ways to avoid enrolling those with greater health care needs. To fulfill their business responsibilities they are mandated to control costs in any way possible. To remain competitive and survive, nonprofit insurers must follow their lead.

A public insurance program has a mission of assisting individuals in getting the care they need. It is especially important to include those who have greater needs.

What does this say about a stand-alone “public option” that competes with private plans on a level playing field by being fully funded by the beneficiaries? Adverse selection would drive the premiums sky high, and the program would fail.

Would we really want our government to engage in the same injustices of the marketplace in which the public administrators would devise schemes to exclude higher cost patients from the government program, just so they could keep the premiums competitive? Of course not. Almost everyone agrees that the government should serve as the safety net, and yet the proposed public option safety net is all holes and no mesh.

If the government were in charge of our health insurance, we would expect it to provide all of us with the coverage that we need. Yet when the private sector is in charge, we reward it richly for devising ways of preventing us from having the coverage that we need.

Maybe before we do anything else, we need to address our pervasive cognitive dissonance.

Pro-single-payer doctors seek place at Monday meeting with Obama

Pro-single-payer doctors seek place at Monday meeting with Obama

Physicians supporting ‘Improved Medicare for All’ decry exclusionary list of doctors invited to White House, seek full hearing for single-payer plan

Media advisory

For immediate release
Oct. 4, 2009

Contact:
Margaret Flowers, M.D., (410) 591-0892, mdpnhp@gmail.com
Paul Hochfeld, M.D., (541) 740-4065, phochfeld@msn.com
Mike Huntington, M.D., (541) 829-1182
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org
David Lerner or Karmen Ross, Riptide Communications, (212) 260-5000

WASHINGTON — Dr. Margaret Flowers and Dr. Paul Hochfeld, leading figures in the national movement for a single-payer health program, will lead a delegation of physicians to the White House Monday, Oct. 5, to seek a place at a meeting between President Obama and an estimated 50 doctors who have been invited to show their support for his health insurance reform measures.

Dr. Margaret Flowers, a Maryland pediatrician and congressional fellow for Physicians for a National Health Program, remarked, “The current health reform being written in Congress, particularly that being put together in the Senate Finance Committee (which is literally being written by a former vice president of WellPoint, a large insurer), will not be universal and will not control health costs. It will not stop medical bankruptcies and foreclosures due to medical debt. It will not end the suffering and preventable deaths. It will not produce a health care system that uses our health care dollars wisely.”

She continued: “We have a simple solution that will end the suffering and save lives: Expanded and improved Medicare for All. Most Americans and most physicians support such an approach, but this solution is being excluded. The White House is once again excluding those who advocate for real health reform.”

Dr. Paul Hochfeld, an Oregon emergency medicine physician, producer of the film “Health, Money and Fear” and a member of the group Mad as Hell Doctors who just completed at 26-city, cross-country tour advocating single payer, said: “We call on President Obama to be honest with the American people and tell them that nothing being seriously considered in Congress will fix the current health care crisis. We call on Congress and the president to delay the passage of health care reform legislation until public health authorities, health care providers, patient advocates, economists and health system administrators participate in a public dialogue to determine how we can get the most health for our precious health care dollars.”

Hochfeld continued: “The health insurance and pharmaceutical industry have demonstrated beyond a shadow of a doubt that they are only interested in corporate profits. They should be kept out of the room.”

What
Delegation of physicians who support single-payer national health insurance, often called an improved Medicare for All, will seek entry to a meeting between President Obama and a group of about 50 handpicked physicians supporting the president’s proposed reforms.

Who
Dr. Margaret Flowers, Maryland pediatrician and congressional fellow, Physicians for a National Health Program. Dr. Paul Hochfeld, Oregon emergency room physician and leader of Mad as Hell Doctors, a group of physicians who recently crisscrossed the country from Portland, Ore., to Washington. Other physicians, nurses and patients who support an improved and expanded Medicare for All.

Where
Initially outside the White House gates. If not admitted, outside the fence near the Rose Garden, venue of the president’s speech to the invited doctors. (The Rose Garden meeting is scheduled for 11:10 a.m. EDT.) Look or physicians in white coats, signs, and banner.

When
10 a.m. EDT, Monday, Oct. 5

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. For more information, visit www.pnhp.org or call (312) 782-6006.

Single-payer advocate joins doctors' meeting at White House

FOR IMMEDIATE RELEASE
Oct. 5, 2009

Contacts:
Paul Hochfeld, M.D.
Andrew Coates, M.D.
Margaret Flowers, M.D.
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org
David Lerner or Karmen Ross, Riptide Communications, (212) 260-5000

WASHINGTON – Dr. Paul Hochfeld, an emergency room physician and prominent advocate for a single-payer, Medicare-for-All health program, was unexpectedly admitted to a meeting of about 150 physicians with President Obama today.

Upon emerging from the gathering in the Rose Garden, which consisted mainly of a speech by the president to the assembly, he said: “Unfortunately, the current bills in Congress and the similar measures supported by the president will not fix the health care crisis – they will only perpetuate the miserable situation we presently have. These incremental reforms will leave the for-profit, private insurance industry in the driver’s seat. The insurance companies will continue to deny claims and raise premiums. Tens of millions will remain uninsured and underinsured. There will be no cost control.

“Today, instead of a health care system, we have a for-profit private-insurance-based sick-care non-system,” he said. “The president should use the current Medicare system and quickly improve and expand it to all people in our nation. In addition, only those who are knowledgeable in public health, health policy and health economics and who do not have ties to the health industry should write the health legislation. Those who themselves or whose families have directly suffered because of the deficiencies of the current non-system should also be involved in the drafting of the bill. The health insurance and pharmaceutical industries, on the other hand, have demonstrated beyond a shadow of a doubt that they are only interested in corporate profits. They should be kept out of the room.”

The Portland, Ore.-based physician was part of a delegation of about 15 pro-single-payer doctors organized by Physicians for a National Health Program (PNHP) who gathered outside White House gates this morning with the aim of participating in the meeting or otherwise explaining to those in attendance why the current bills advancing in Congress will not end the nation’s long health care nightmare. At the last minute, Hochfeld was admitted to the gathering.

Hochfeld said that many physicians whom he spoke with at the gathering share his opinion that the health care reform process has been corrupted by corporate money from the health industry, but feel some kind of action is needed.

However, Hochfeld said, “If we pretend to fix health care with a piecemeal reform that leaves things basically as they are, we will waste precious time. We won’t revisit health reform again for many years, and by then this inequitable and dysfunctional non-system will have inflicted pain, suffering and financial ruin on untold millions of additional victims – both those with insurance and those without.”

Hochfeld is no newcomer to single-payer advocacy, having been producer of the film “Health, Money and Fear” and having been a leader of just-completed Mad As Hell Doctors Tour, a 26-city, cross-country tour advocating “an expanded and improved Medicare for All.” In the course of the nationwide tour, which involved about a dozen physicians and other health professionals who traveled by car caravan from Portland, Ore., to Washington, D.C., the doctors succeeded in getting thousands of supporters to e-mail the White House requesting that the president meet with the group.

Hochfeld is by no means alone in these views. A survey published in the Annals of Internal Medicine last year showed 59 percent of all U.S. physicians support government legislation to enact national health insurance, an increase of 10 percentage points from five years before.

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. For more information, visit www.pnhp.org or call (312) 782-6006.

For more information about the Mad As Hell Doctors Tour, visit www.madashelldoctors.com

17 Held in Protest Outside Health Insurer’s Offices

By Colin Moynihan
New York Times
City Room Blog
September 29, 2009

Right-wing and antigovernment activists — a few of them wielding not only signs but even loaded firearms — have organized some of the angry protests surrounding the health care debate. But in Midtown Manhattan on Tuesday morning, a different sort of health care protest took place, led by left-leaning groups who accused insurers of greed and called for nationwide, single-payer health insurance.

The police said that 17 people were arrested after refusing to leave the lobby of an office building on Park Avenue where the insurance company Aetna has offices. They were charged with criminal trespass. In addition, the police said, three of those arrested were charged with obstructing governmental administration.

Organizers said it was the first step of a national campaign meant to publicize their views and challenge claims made by right-wing radio hosts and Republican officials.

“The myths about government death panels are pure hysteria,” an organizer, Mark Milano, said on Park Avenue. “The real death panels are people who are paid by insurance companies to deny health care to patients.”

About 50 people arrived at the building, at Park Avenue and 40th Street, at 10 a.m., participants said, and sent a representative to the Aetna offices upstairs to demand that the company agree to immediately approve “lifesaving” health care requests made by doctors. When that person was turned away, organizers said, 16 protesters entered the lobby of the building and sat on the floor.

Soon the police arrived and a senior officer used a bullhorn to inform those in the lobby that they were breaking the law and subject to arrest. By 10:45, officers could be seen removing the last of the demonstrators and ushering them into the back of police vans.

A spokeswoman for Aetna, Cynthia Michener, said that no protester visited the company’s office on Tuesday.

“Aetna has been actively engaged in health reform,” she wrote in an e-mail message. “When you put yourself out there like we have on this issue, you make yourself a target. But there is more agreement than disagreement on the need to get reform done. It is important we work together to make health care reform a reality this year.”

Ms. Michener added:

Broadly, Aetna ‘s goals are to get everyone covered, improve the quality of health outcomes and provide better value for each dollar spent on care. We’re committed to guaranteed coverage without regard to pre-existing conditions along with an individual requirement to get everyone in the system and subsidies for those who can’t afford it.

Outside, a crowd chanted “patients not profits” and said that large insurers routinely made decisions on what sorts of treatment to cover based more on cost than medical necessity.

“This is very much a dignified, nonviolent response to what some people call the howler movement that erupted in August,” said Katie Robbins, part of an advocacy group called Healthcare Now.

There has been a backlash from some quarters against Mr. Obama’s support for a public insurance plan that would compete with private insurers.

Ms. Robbins advocates on behalf of a bill before the House of Representatives that would, essentially, expand Medicare to cover all citizens. She said organizers from several groups across the country, with networks in 40 states, had been working together for about six weeks on a campaign they called Mobilization for Healthcare for All.

The groups have organized using a Web site and Twitter. So far, organizers said, 300 people have signed up to take part in additional protests using civil disobedience and aimed at insurance companies that are being planned for October, while legislators are expected to be working on health care issues.

“We’re going to be in Chicago next week and L.A. the week after that,” Ms. Robbins said. “We’re timing this around the legislative efforts of Congress.”

Video:

http://www.youtube.com/watch?v=gqP8bEyFRAo

http://cityroom.blogs.nytimes.com/2009/09/29/17-held-in-protest-outside-health-insurers-offices/

A Sit-in at Aetna:”Aetna Is the Real Death Panel”

by Private Health Insurance Must Go!
September 30, 2009

19 citizens and health care providers arrested, launching national mobilization for health care for all

29 September 2009, New York, NY — Citizens and health care providers today staged a sit-in at the offices of Aetna, one of the nation’s largest health insurance companies, in New York City (99 Park Ave @40th. The action is part of a national mobilization to end health insurance abuses such as the denial of coverage for lifesaving treatments, and win support for the only real public option — Medicare for all, a single payer plan. The action was part of a Mobilization for Health Care for All campaign that includes actions in Chicago, Los Angeles, and other cities across the country.

The 19 participants, wearing T-shirts with slogans that read “Medicare for All” and chanting “patients, not profits!” linked arms and sat down in the lobby of the Aetna building, prompting Aetna employees to step around them on their way into their offices, where insurance claim reviewers are busy looking for ways to deny people the lifesaving treatment that they need. A crowd of supporters picketing outside the building held signs that said “Aetna is the real death panel,” and “Single payer now.”

Participants in the action demanded that the insurance company immediately approve all doctor-recommended lifesaving treatments in their files, stating that they would not leave until Aetna approved care. Aetna, however, refused to meet with their representative.

“Insurance companies are denying care to people who need it right and left, but that’s not how it should work. Health care is a right, not a privilege,” said Constancia ‘Dinky’ Romily, 68, just before getting arrested. Romily is a retired nurse and a resident of East Village, New York. “I’m putting myself on the line and getting arrested to end insurance abuse and win health care for all,” she says.

The sit-in is part of the Patients Not Profit campaign of the Mobilization for Health Care for All. The mobilization was launched by the organizations Prosperity Agenda, Health Care NOW!, and the Center for the Working Poor. Today’s action has been organized by the Private Health Insurance Must Go! coalition, a local New York organization.

“People are dying because these corporations put profits before patients, and the health care bill currently on the floor of Congress fails to address the real cause of the health care crisis — the insurance companies,” says Katie Robbins, an organizer with Healthcare-Now! “The only solution to our health care crisis is the real public option, Medicare for All, a single payer plan.”

Laurie Wen, 38, a Manhattan resident, is one of the everyday Americans who are fed up with the state of health care in our country, and was arrested today to stand up for the hundreds of Americans who are denied lifesaving care every day, and to call for the only solution for health care for all, Medicare for all. A friend of hers, she says, was recently denied by Aetna for coverage for a bone marrow transfusion to treat cancer for three months, setting his care back for three months.

“We will continue to stage these sit-ins as Congress debates legislation that expands the insurance company stranglehold over our health, our lives, and our government,” says Wen. “We need a better system to end insurance abuse and win health care for all.”

The Private Health Insurance Must Go! Coalition (PHIMGC) is a growing and diverse New York City-based non-partisan organization focused on education, legislative advocacy and direct action in the fight for single-payer healthcare reform and HR 676.

Imagine getting sick, getting bills you can’t pay, then being sent to jail

Lawsuits, lost wages, even jail can result

By Janell Ross
The Tennessean
September 28, 2009

Kenneth Hoagland went to jail for what started as a cold.

Hoagland had refinanced his Nashville home to pay off the $25,000 tab for his weeklong diabetes-related stay at Southern Hills Medical Center.

The new mortgage left Hoagland out of medical debt but afraid to get sick again.

Unfortunately, he did. In 2004, Hoagland was in a health insurance waiting period on a new job when a cold turned into two days at Vanderbilt University Medical Center. This time, the bill was just over $1,200.

When a collection attorney working for Vanderbilt filed suit in 2005, Hoagland was afraid to take time off from work to show up in court. After a series of hearings, attempts to collect the debt and what Hoagland says were genuine efforts to pay it, an attorney working for Vanderbilt asked a judge to issue what’s known as a body attachment.

One Friday in late 2008, a sheriff’s deputy went to Hoagland’s home. Because he was at work, Hoagland was allowed to turn himself in the following Monday.

“They fingerprinted me, took my picture and asked some questions about my medical history,” he said. “When the guy who tested (my blood sugar) asked me why I was there and I told him … he said, ‘I didn’t know we did that in this country.’ I told him, ‘Until now, I didn’t either.’ ”

Hoagland, 36, is one of the hundreds of thousands of Americans — insured and uninsured — facing collection suits, wage garnishments and, more rarely, trips to jail because of medical debt.

On the other side are doctors and hospitals that say they try to work with debtors and provide millions in free care, but unpaid medical bills affect their ability to care for others.

Medical debt isn’t closely tracked by courts, but it’s one of the many types of debt collection suits that keep Davidson County’s General Sessions Courts so busy that the people at the center of those cases sometimes fill the courtroom’s audience seating and even the jury box.

But it’s the docket, the list of cases that will be heard in Courtroom 5D on any given day and the people with cases on it, that really tells the story. Some entries reveal the types of services rendered.

There are cases filed by Associates in Gastroenterology, the Anesthesia Medical Group and Nashville Bone and Joint PLLC. And then, there are the names of nearly all the area’s hospitals.

The suits represent attempts to collect on bills that in cases examined this summer ranged from $81 to $22,000. They are, in most cases, bills patients never expected to accumulate.

Judge Dan Eisenstein, one of the judges who hears these cases in Courtroom 5D, said debtors summoned to court often dispute just how much is owed to a landlord or whether a credit card debt is really theirs.

But debtors rarely dispute medical bills.

“There’s not a lot of dispute because people just have no choice,” he said. “They needed the care, and the law says they have to cover their bills.

“But it’s certainly tough to come into this courtroom and see people who have been sick or hurt and cannot pay their bills.”

Medical bankruptcy rises

A study published in the American Journal of Medicine this year found that medical debt is deeply damaging the finances of American families.

Based on a survey of 2007 filings, researchers estimate 62.1 percent of all bankruptcies that year were caused by medical debt and that 92 percent of these cases involved medical bills totaling more than $5,000, or 10 percent of the family’s total pretax income.

Other cases met the researchers’ criteria for “medical bankruptcy” because they had lost significant income from illness or mortgaged a home to pay medical debt.

Most medical debtors contacted by researchers were well-educated, owned homes and had middle-class occupations. Seventy-five percent of those surveyed had health insurance.

And, researchers found, the issue of medical debt has grown over time. Between 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6 percent.

Hoagland, who works in information technology, never filed bankruptcy or disputed his bill. Instead, he made payment arrangements with Vanderbilt and tried to keep them.

Sometimes he and his fiancée, Sonya Davis, had to choose between paying their mortgage or $200 a month on medical bills, Davis said. When that happened, they paid the mortgage. They figured the family had to have a place to live, and the house had belonged to Hoagland’s parents.

Then Vanderbilt filed suit. When Hoagland missed a hearing because of a work emergency, the court ruled in his absence that Vanderbilt was due the full amount. He missed two more court dates aimed at determining his assets.

A judge issued a body attachment — a document issued in civil cases that demands defendants explain why they didn’t appear in court. Sheriff’s deputies find the defendants and, in many cases, take them to jail, where they are allowed to post bond quickly.

It’s a rare action — out of 32,126 debt cases in General Sessions Court in 2008, for example, judges issued 98 body attachments.

Hoagland made bond and the $250 that he paid was applied to his debt. His wages were garnisheed for several months, and he thought he was paid up. Then a bill arrived several weeks ago for $70 — one he said he’ll pay without question.

People delay care

Davis said the experience changed their lives.

“The choice now is, do I stay sick? Because if I go run up this bill and can’t pay for it and then get arrested again, what then? What are you supposed to do?” she said.

Two months ago, they faced that question. Hoagland went to bed with a cold and woke up so listless that Davis knew immediately something was wrong.

His blood sugar was at 39. Hoagland’s blood sugar is supposed to stay between 80 and 120. He could barely speak.

“I called the ambulance,” Davis said. “And I hate to admit this, but as soon as they got here, I thought, ‘Oh God, I hope they aren’t going to have to take him.’ He was sick, but I know he was probably thinking, ‘We can’t afford another set of medical bills.’ ”

The ambulance crew wanted to take Hoagland to the hospital but agreed to let Davis make him some breakfast and see if his blood sugar levels would normalize. They wouldn’t leave until Hoagland drank some orange juice with a bit of sugar stirred in and his blood sugar surged.

As extreme as Hoagland’s attempt to avoid another hospital bill may sound, it’s not uncommon, said Shana Alex Lavarreda, the director of health insurance studies at the University of California, Los Angeles Center for Health Policy Research.

As a result of a study released by the center this year, Lavarreda began to hear troubling stories from people across the country who had delayed medical care because of existing medical debt.

“Delays in care could be something as serious as reattaching a portion of a finger or not or getting the respirator that you need,” she said.

The situation highlights the fact that many insurance policies carry a high deductible. This can turn out to be burdensome for families without significant savings if someone becomes ill, Lavarreda said.

Drama outside courtroom

What happens inside Courtroom 5D at General Sessions Court can pale in comparison to the high drama in the hallway outside.

There, hospital debt collectors pull defendants to the side for hushed conversations about what they can realistically pay. If they can figure something out, defendants don’t have to go back inside. The payment arrangement is entered into court records, and the person who owes the debt must pay it.

On Sept. 11, all the good hallway spots — with seating — were taken. So Centennial Medical Center’s attorney beckoned Stacy Grondin up to the long tables where prosecutors and defendants usually sit facing the judge during trials.

The conversation was about the $997.74 bill Grondin incurred in 2006 at Centennial when her heart rate spiked.

“I really thought I was having a heart attack,” she said.

Grondin, a grocery store manager, is insured. But she went to the hospital in an ambulance, and that required pre-approval from the insurance company.

So did her choice to seek care in an emergency room. She didn’t have approval for that either. So when it turned out the problem was anxiety or a condition doctors couldn’t precisely determine, her claim was denied.

Tom Norris, Centennial’s attorney, leaned in close.

“What kind of payment can you make?” he asked.

“I think maybe $50,” Grondin said.

Norris accepted but declined to comment about Grondin’s case or the collection process when approached by a reporter.

On that day, the bill was actually $1,246.96 — the original amount plus $161.75 in court costs and $87.47 in interest fees. The court costs are tacked on after collection efforts fail and a suit is filed. Interest accrues on medical debt at up to 10 percent after a court issues an order to pay.

But for Grondin, 35 and a single mother of three, that’s not even the sum total of her medical debt.

While Grondin discussed her bill with Norris, her 9-year-old daughter, Emily, sat in the courtroom’s gallery waiting for her mom to finish and take her to the doctor. Grondin feared Emily might have swine flu.

The little girl with the robin’s-egg blue eyes and a pair of silvery scars on her forehead heard every word of the payment discussion.

Emily barely survived a 2003 car accident with her father at the wheel. He’d been drinking. She wasn’t strapped in. A LifeFlight helicopter took her to Vanderbilt’s children’s hospital, where doctors saved her life.

Now Emily’s father is in prison because of that accident, and her mother is trying to pay $2,115.25 in medical debt charged to a credit card. That’s the 20 percent of Emily’s bill that insurance didn’t cover, plus court costs and interest.

“They sent papers to my job a couple of months ago saying they are going to garnish my wages, I think for her accident,” Grondin said. “But that hasn’t started yet.”

Grondin said she’s not sure how to feel. There’s the reality that services were rendered. But then there’s the fact that she is insured and still left with medical bills, collectors’ phone calls and soon, maybe, a wage garnishment.

“I know it’s our responsibility. It is ultimately my responsibility to pay,” she said. “But … when I first saw all the bills I was kind of mad because I am paying for this insurance which I barely use. Then, when it’s needed, it’s hardly there.”

Grondin’s medical debt story doesn’t end there. Her boyfriend, who has two children of his own, recently declared bankruptcy because he couldn’t have afforded child support and other bills if his wages were garnisheed to collect more than $7,000 in medical bills.

‘It’s good to have a plan’

Michael Wade Taylor, 57, was in Courtroom 5D just after 9 a.m. Aug. 28 when Judge Eisenstein called his name and case. Wedged between two men with debt cases of their own, Taylor stood and answered clearly, “Here.”

Southern Hills Medical Center’s attorney waved him into the hallway to work something out.

Today, Taylor is an unemployed construction worker. He had a job but no insurance in 2006, when doctors initially thought he’d had a stroke.

He spent several days in intensive care at Southern Hills, having a stent threaded from his groin to his heart to check for blockages. Later, he took a stress test on a treadmill.

The eventual diagnosis: “They told me I had the heart of a teenager and didn’t know what was wrong with me,” Taylor said. “They sent me home, and since that time I kept going down and going down.

“Then I find out that for those four days they charged me $33,000. Thirty-three thousand dollars for nothing.”

Hospital staff checked to see if he could qualify for TennCare — state-subsidized medical coverage — but his income was too high. Then they talked with him about financial aid and setting up a payment plan. Taylor said he didn’t qualify because he didn’t have a checking account.

The bills started coming, then the phone calls, then the loss of his job in 2008.

Turns out either he didn’t have the heart of a teenager or it aged very quickly, Taylor said. Two months ago, he had open-heart surgery for an arterial blockage. This time, because he was unemployed, TennCare paid the tab.

He and Southern Hills’ attorney reached an agreement that would let Taylor pay $20 a month until he covers $3,000 of the bill from three years ago.

“It’s good to have some kind of plan,” he said. “Really having that hanging over me was just something that took a situation from bad to worse.”

Hospitals provide free care

Deals like Taylor’s — taking a $33,000 bill down to $3,000 — aren’t uncommon, area hospital systems say. They give away millions in medical care each year.

Meanwhile, they say, unpaid medical debt keeps them from covering important capital costs — such as replacing buildings and equipment — or improving treatment and services.

Each has a policy of absorbing or forgiving some medical debt, but that benefits the poorest and most severely ill patients. Employees help some patients who qualify, such as Taylor, enroll in TennCare.

In fiscal year 2009, for example, Vanderbilt had $274.3 million in unpaid medical bills and absorbed about $197.9 million of that. It writes off debt for patients whose bills exceed their annual income or who earn less than 250 percent of the federal poverty rate — about $55,000 for a family of four.

Vanderbilt provides almost half of all the uncompensated care delivered in Davidson County, spokesman John Howser said.

TriStar Health System, which operates five health-care facilities in the Nashville area, offers similar help for low-income patients.

“The No. 1 reason for charity care denials is that they do not submit the application,” spokeswoman Teri Smith said.

The hospital system provided about $158 million in uncompensated care during calendar year 2008. This figure includes unpaid medical debt, bills that the hospital wrote off for its poorest patients and discounts offered to uninsured patients, Smith said.

Saint Thomas Health Services, which operates Saint Thomas and Baptist hospitals, is owed $90 million in unpaid medical debt for services provided over the past three years, spokeswoman Rebecca Climer said.

This figure does not include what the hospital system has forgiven or provided free to patients who cannot pay, Climer said. The system is a part of Ascension Health, the largest not-for-profit health-care system in the nation.

The hospital has a fiscal responsibility to attempt to collect unpaid debt from those who can pay, Climer said.
Additional Facts

MEDICAL WOES LEAD TO MORE BANKRUPTCIES

As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem.
By contrast, a 2001 study found that illness or medical bills contributed to about half of bankruptcies.
And in 2007, 62.1% of all bankruptcies were caused by medical debt.

SOURCE: American Journal of Medicine study

http://www.tennessean.com/article/20090928/NEWS01/909270377/