The Progressive
February 2004
Gouging the Poor
By Barbara Ehrenreich
There’s been a lot of whining about health care recently: the shocking cost of insurance, the mounting reluctance of employers to share that cost, the challenge–should you be so lucky as to have insurance–of finding a doctor
your insurance company will deign to reimburse, and so forth. But let’s look
at the glass half full for a change. Despite the growing misfit between health care costs and personal incomes, it is not yet illegal to be sick.
Not quite yet, anyway, though the trend is clear…
… it’s not just the dodgier, second-rate hospitals that are relying on the police as collection agents. Yale-New Haven Hospital, for example, has obtained sixty-five arrest warrants for delinquent debtors in the last three years.
Of course, if you work for Yale-New Haven, it’s not your body that gets “attached.” On a recent visit to Yale hospital workers, I met Tawana Marks, a registrar at the hospital, who had the misfortune to also be admitted as a patient. Unsurprisingly, her hospital-supplied health insurance failed to cover her hospital-incurred bill, so Marks now has her paycheck garnished by her own employer–a condition of debt servitude reminiscent of early twentieth century company towns.
But for those of you who still imagine that illness and pain should elicit kindly responses from one’s fellow humans, I have one last half full observation: Our prisons do offer health care–grossly inadequate care to be sure–but at least it’s free, even for child molesters, ax murderers, and those miscreants who have the gall to be both sick and uninsured.
http://www.progressive.org/feb04/ehr0204.html
And…
The New York Times
February 20, 2004
Hospitals Can Provide Discounts to Uninsured and Needy Patients, Bush
Administration Says
By Robert Pear
The Bush administration encouraged hospitals on Thursday to give discounts
to uninsured patients and to financially needy Medicare beneficiaries. Such discounts are permissible under federal fraud and abuse laws, the government said, in a clarification requested by the hospital industry.
The new guidelines are a bit stricter for Medicare beneficiaries than for uninsured patients.
Consumer groups say the billing practices of some hospitals have been too aggressive. Medicare will pay hospitals for a share of their bad debt if they make “reasonable efforts” at collection, but the Bush administration said hospitals did not have to seize patients’ homes or other assets.
Comment: Routine discounting of fees for the uninsured and routine waiving of deductibles for the insured are usually prohibited by Medicare and by private insurance provider contracts. Third party payers rely on deductibles as disincentives, in order to reduce utilization of health services. Also, contracts are usually granted at rates below the usual fees charged. Routine discounts establish a lower usual fee than the list prices that then would be rarely collected. Thus Medicare and private insurance contracts have prohibited the routine waiving of list prices and deductibles.
The result was fully predictable. Aggressive collection practices have continued in order to demonstrate compliance with these requirements, whether it is for fear of reprisal or as an excuse to improve collection ratios. Personal bankruptcies because of medical bills have become commonplace. And non-payment of medical bills has even been criminalized by legal mechanisms such as “body attachment.”
It is a relief that the Bush administration does recognize the seriousness of the inability of many individuals to pay for essential medical care, even though they are hedging on the Medicare requirements. But rather than merely reducing penalties against providers for failing to aggressively pursue bill collection, wouldn’t it be better to find a way to provide everyone with comprehensive health insurance? Unfortunately, the current official position of the Bush administration is that it can’t be done.
We can show them how.