Summary: U.S. medical debt structure has substantially evolved from amounts negotiated among care participants in the 1980s, to commoditized assets and aggressive collection today. With sky-high deductibles and other cost-sharing, debt magnitude is rapidly growing. Single payer would end this painful complication of our health insurance.
Debt Collection in American Medicine – A History, New England Journal of Medicine, October 26, 2023, by Luke Messac
A historical lens reveals that since the 1980s, medical debts have shifted from obligations negotiated by doctors, patients, and hospitals to assets bought and sold by people with no role in patient care. In part because of the proliferation of insurance plans with higher copayments and deductibles, hospitals have faced more delinquent payments. Hospital administrators have turned away from charity care and have opted instead for aggressive debt collection.
Comment:
By Don McCanne, M.D.
This report discusses the all-too familiar topic of medical debt in the United States. Sections in the report include: “Debt in the Doctor-Patient Relationship,” “The Rise of the Collection Industry,” and “The Criminalization of Debt.” The concluding section is “The Physician’s Responsibility.”
The message that should come across today is that The New England Journal of Medicine recognizes that this topic of medical debt is not only important enough to feature in their journal, but the closing sentence of the article demonstrates that PNHP can be a part of the solution! The closing statement (bold type added for emphasis): For their part, doctors who seek to be a part of the solution can join ongoing grassroots efforts, including organizations such as Physicians for a National Health Program and the Debt Collective, to make medical debt, and its destructive consequences, a thing of the past.
Now let’s mobilize to get the politicians on board.
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