Faith-based charity as the answer to crushing medical debt? Only in America.

Praise be: Churches nationwide are leaping in with their congregations’ blessing and financial support, putting up small sums to buy up and wipe out one of the huge shames of the American health care system: patients’ medical debt.

The faithful work with RIP Medical Debt, a nonprofit organization based in Rye, N.Y., that provides the know-how to many kinds of donors to help eliminate bills that can crush patients and their loved ones for a lifetime, the Kaiser Health News service reported. Roxie Hammill wrote how this all works in modern medicine:

When a person can’t pay a bill, that debt is often packaged with other people’s debt and sold to bill collectors for some fraction of the total amount of the bill. Those debts usually come from low-income people and are more difficult to collect. RIP Medical Debt buys debt portfolios on this secondary market for pennies on the dollar with money from its donors. But instead of collecting the debt, RIP forgives it. To be eligible for repayment from RIP, the debtor must be earning less than twice the federal poverty level (about $25,000 a year for an individual), have debts that are 5% or more of their annual income and have more debt than assets. Because hospitals and doctors are eager to get those hard-to-collect debts off their books, they sell them cheap.

That means that Good Samaritans  — some of whom say they have learned about medical debt by watching a segment on it by HBO satirist John Oliver, as shown in the video above — can put up relatively small sums but have a huge impact, as KHN found has occurred with at least 18 churches in Maryland, Virginia, Texas, Illinois, Kansas, and elsewhere:

  • Pathway Church in Wichita, Ks., gave $22,000 collected among its middle-class parishioners, and pledged it for Easter with RIP to wipe out “$2.2 million in debt not only for the Wichita area but all available debt for every Kansan facing imminent insolvency because of medical expenses they couldn’t afford to pay — 1,600 people in all.”
  • For its $15,000 donation to RIP, Revolution Annapolis, a nondenominational Maryland church with Sunday attendance of around 200 and without a permanent building, eliminated $1.9 million in debt for 900 families in March.
  • Fincastle Baptist Church, with 1,600 members in the Roanoke, Va., area used money it had budgeted for an annual “Freedom Fest” event to honor first responders, partnering with WSLS-TV in a telethon to raise more. That effort abolished over $2.7 million in medical debt targeted at veterans.
  • With $15,000 donated to RIP, Emmanuel Memorial Episcopal Church, a congregation of about 175 families in Champaign, Ill., targeted money owed by patients in Champaign County alone, the Rev. Christine Hopkins told KHN. But their gift zapped $4 million of debt for the entire diocese, which stretches across the southern half of the state.

A persistent nightmare

Let’s keep all these heartening Christian initiatives in perspective, though. Medical bills stagger far too many Americans, and charity — from traditional sources like churches or through online crowd funding drives — is insufficient to begin to address this nightmare, as KHN also reported:

Medical debt contributes to two-thirds of bankruptcies, according to the American Journal of Public Health. And a 2018 Kaiser Family Foundation/New York Times poll showed that of the 26% of people who reported problems paying medical bills, 59% reported a major life impact, such as taking an extra job, cutting other household spending, or using up savings.

The Los Angeles Times, in its continuing examination of the plight of Americans with chronic conditions, reported on how workers, even with employer-provided health insurance, find themselves sinking into medical debt and bankruptcy, hit by the “double whammy” of rising premiums and soaring deductibles (out of pocket costs they must pay before they can see any benefit from their coverage). The newspaper noted:

The financial strain [of growing medical bills, weak employer-provided insurance and high deductibles] is pushing millions of seriously ill Americans to ration their care, jeopardizing their health and even their lives. In 2016, for example, Americans taking multiple sclerosis medications every month paid on average $3,708 a year out of pocket for the drugs. Patients in high-deductible health plans paid even more, with average annual costs of nearly $8,000, according to a study by Callaghan. Fifteen years earlier, the out-of-pocket costs for those medications were $244 on average, adjusted for inflation. The average patient with lymphoma, a common blood cancer, pays nearly $3,700 in the 12 months following the diagnosis, according to an analysis of commercial insurance data by Milliman, a national healthcare consulting firm. Patients with acute leukemia pay more than $5,100.

U.S. News and World Report, in a recent news article, found anew that medical debt crushes cancer patients, quoting a study by the federal Centers for Disease Control and Prevention on 125,000 Americans, ages 18 t0 64:

Nearly 5,000 said they were cancer survivors, with half having been diagnosed within the past five years. Annual out-of-pocket costs were higher for cancer survivors than the general population — averaging about $1,000 for the former and $622 for the latter, the study found. Often, these medical bills were tough to pay. ‘Financial hardship was common; 25.3% of cancer survivors reported material hardship (e.g., problems paying medical bills), and 34.3% reported psychological hardship (e.g., worry about medical bills),’ the CDC team reported. Out-of-pocket spending tended to be higher for older cancer survivors and those who had more health issues. Not surprisingly, ‘survivors who were uninsured were most likely to report material financial hardship,’ researchers said, but even the insured often found themselves saddled with high out-of-pocket expenses.

Regulators really reining in bill collectors?

A separate KHN news article reported that federal financial watchdogs want to tweak the way collectors dog those with medical and other debts, with those carrying hefty medical bills a sizable group:

At least 43 million … Americans have overdue medical bills on their credit reports, a federal Consumer Financial Protection Bureau report on medical debt found in 2014. And 59% of people contacted by a debt collector say the exchange was over medical bills, the most common type of contact stemming from an overdue bill, according to the CFPB.

The agency, the news service said, has “proposed a rule to frame what debt collectors are allowed to do when pursuing many types of overdue bills, including medical debt.” As KHN reported:

Federal law already prohibits debt collectors from harassing consumers or contacting them before 8 a.m. or after 9 p.m., among other things. But the law, which was passed in 1977, didn’t anticipate emails and text messages. The CFPB’s proposal clarifies how debt collectors can use these communication tools. And it would allow consumers to opt out of being contacted this way. The rule also specifies that debt collectors can make no more than seven telephone calls weekly over a specific debt. But some consumer advocates panned the effort.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become a greater ordeal with the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which prove to be dangerous drugs.

Scrutiny of medical bills

The politically riven Congress, of course, is plodding along with a few surprising bipartisan pushes to try to address soaring prices of prescription drugs and medical services, notably in the categories of “surprise” and “balance” billing (the practice of medical providers receiving an insurance reimbursement, then seeking to recover yet more from patients in the uncovered costs).

Emergency room charges have become a big focus of patients’ fury with surprise bills, those involving higher costs patients incur when they receive treatment by doctors and others who are not included in the insurer-approved “narrow networks.” Maybe there’s no surprise here, but anew study found that:

“The average emergency room visit cost $1,389 in 2017, up 176% over the decade. That is the cost of entry for emergency care; it does not include extra charges such as blood tests, IVs, drugs or other treatments.” Researchers said that “hospital emergency rooms not only substantially increased prices for care from 2008 through 2017. The hospitals and doctors also billed for more complex care, which allows them to collect more lucrative fees from consumers, employers and private insurers.”

Fancy that. Patients and their families might be even more galled that yet another study found that, when it comes to expensive and new drugs, as a Bloomberg BusinessWeek headline described it, “Too many medicines simply don’t work.” As the story reported:

It’s possible that the medicine you’re taking isn’t helping—even if it’s been approved by the Food and Drug Administration. That’s the upshot of a pair of studies in the latest issue of JAMA Internal Medicine. Not good. As an invited commentary in the same issue says, ‘Charging vulnerable patients for drugs without evidence that they actually improve patients’ survival and quality of life is unconscionable.’

We’ve got so much to do with the quality, safety, and cost of medicine these days that it almost seems as if only divine intervention will help.

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