It’s the price and cost problem, stupid. That’s a fictitious but new tattoo that voters might want politicians to take up as they consider the many major problems with the American health care system, especially as yet more medical billing outrages surface.
Marshall Allen, a reporter for ProPublica, the Pulitzer Prize-winning investigative site, posted about a doozy: It’s about almost $1 million in charges that a hospital group sought to saddle a new mom with, even as she wrestled with pregnancy complications and an ailing premature baby.
That mom also happened to be an emergency room nurse. And the chain that flubbed her medical bill was her own employer: Dignity hospitals. That’s a Christian medical enterprise that describes itself as the fifth largest health system in the nation and has as its motto, “Hello, human kindness.” As Allen reported, it’s worth noting this, too, about Dignity:
“In 2018, the organization reported $6.6 billion in net assets and paid its CEO $11.9 million in reportable compensation, according to tax filings. That same year more than two dozen Dignity executives earned more than $1 million in compensation, records show.”
But Dignity hung its ER nurse Lauren Bard out to dry after her difficult pregnancy, treated by specialists at the University of California, Irvine, hospital. Bard delivered her daughter Sadie at 26 weeks and weighing less than a pound and a half. The preemie was rushed into a neonatal intensive care unit, as mother Bard herself struggled with an infection and had to be hospitalized.
The young nurse also had enough presence of mind to call the administrator of her health plan, Anthem Blue Cross, to discuss her care and coverage. Anthem and UCI both assured her not to worry.
But later, Bard found that Dignity self-insures, meaning it covers the bulk of its employees’ health care costs. Her employer — no matter what Anthem and UCI had said — told Bard that she had missed a 31-day window after delivering Sadie to fill out forms to ensure the baby got covered by Bard’s policy. In repeated appeals, Dignity told its nurse that she was out of luck and would be responsible for her big medical bills, which soon mounted to almost $1 million. Representatives told her that she should have read her insurance information, given to her six years earlier when she signed up. As Allen found, Dignity also mistakenly told Bard that the company could not cut her a one-off break without possible consequences from the Internal Revenue Service.
Now, here’s where medical voodoo occurred: Bard, distraught over the possibility of paying medical bills for the rest of her life or her impending financial ruin, took to Facebook. She posted a picture of her largest bill, an invoice for more than $898,000. That photo was routed to ProPublica, which has, like several news organizations, sought to report on medical bill outrages.
Allen took up Bard’s dispute with Dignity. And, shazam, the health system suddenly found its compassion. It granted Bard an exemption and agreed to handle her whopping medical bills. But not before the nurse, already suffering post-partum depression, said she was traumatized beyond imagination.
Horror stories aplenty about medical debt
Her experiences, alas, are far from unique. In recent days, the independent, nonpartisan Kaiser Health News Service posted news articles on medical debtors, including one a grief-stricken mom, who, during a painful holiday, drank too many beers and sent too many concerning messages,. That got her sent for emergency hospitalization for mental health issues. After less than a week of extensive testing, sobering up, and some pointed chats with family and doctors, she has stopped drinking and is working on her issues. These now include how she will pay more than $20,000 in medical bills she racked up and which won’t be covered by a “skimpy,” association health insurance she took out.
Another KHN article described the financial plight of a graphic designer in suburban Los Angeles. He suffered from idiopathic pulmonary fibrosis, which the news story described as, “a progressive disease that scars lung tissue and makes it increasingly difficult to breathe.” He had gotten on the list for a lung transplant when he stopped breathing. He was transported to a nearby hospital by ground ambulance and was hospitalized briefly before he got super lucky — lungs became available to him for transplant.
To undergo the urgent procedure, doctors decided to fly him to a major academic medical center 27 miles away. As KHN reported, though, the patient later learned:
“[He] discovered the helicopter company, which was out of his [health insurance] network, had charged the insurance company $51,282 for the flight, and [he] was responsible for the portion his insurance didn’t cover: $11,524.79. By contrast, the charges from the day of his transplant surgery totaled $40,575 — including $31,605 for his surgeon — and were fully covered by Anthem [his insurer].”
Again, there’s a positive outcome to this story, after the air ambulance firm hounded the patient for payment. His insurer ended up contracting with the company, so others in its coverage won’t get hit in similar fashion. But, more important, publicity about this case, including a network broadcast, led the air ambulance firm to wipe away the bill.
Others aren’t so fortunate, KHN reported:
“The median cost of a helicopter air ambulance flight was $36,400 in 2017, an increase of more than 60% from the median price in 2012, according to a Government Accountability Office analysis. Two-thirds of the flights in 2017 were out-of-network, the report found. The air ambulance industry justifies these charges by pointing out that the bulk of its business — transporting patients covered by the public insurance programs Medicare and Medicaid — is severely underfunded by the government. The median cost to transport a Medicare patient by air ambulance is about $10,200, according to an industry study. However, air ambulance companies are reimbursed a median rate of $6,500 per flight. ‘The remaining 30% of patients with private health insurance end up paying over 70% of the costs,’ said [a spokesman for a national air ambulance service.”
The news service also revisited an earlier, excellent investigation into the harsh billing practices of the University of Virginia medical system. Although UVA has pledged to do better by its patients, and that it will wipe out or negotiate with more compassion the significant bills that exist, the enterprise hasn’t detailed its plans. Meantime, the dunning persists and those with recent and closed cases aren’t sure how or if UVA might do right for them, potentially saving them, for example, from losing property.
For those seeking a national perspective on crazy medical bills, medical debt, and hospitals dogging patients, especially the poor, over unpaid debt, the New York Times has weighed in with a detailed read on the issue.
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 an ordeal due to the skyrocketing cost, complexity, and uncertainty of medical treatments and prescription medications, too many of which turn out to be dangerous drugs.
Politicians and out-of-control health care costs
Although ProPublica, KHN, the New York Times, and the news site Vox deserve a salute from the bill-paying public for their watchdog work on medical providers, it is unacceptable that institutions respond only and mostly to public blaming-and-shaming. Why aren’t they listening to and helping their crucial customers — patients who also struggle with illness and injury as they try to cope with bankrupting medical bills.
Voters are fed up with the abusive aspects of health care, especially when it comes to outrageous expenses that not only are unjustified and inexplicable but can be waved away as if by magic when questioned in public fashion. Politicians, Democrats notably, seem to have heard the outcry. But they have allowed themselves to get caught up in policy tussles over the distant but desirable good of universal health coverage while downplaying what could be achieved by dealing with health care costs.
The New York Times reported that Pete Buttigieg, the Democratic hopeful and South Bend, Ind., mayor, has suggested a willingness to tackle health care costs with controls. Although other Democrats have talked about attacking Big Pharma’s sky-high prices, Buttigieg also is taking on hospitals — which have big money, lots of employees, and formidable political clout. Elizabeth Warren, the Massachusetts senator, also appears to be talking tougher about prices and costs in health care.
It would be good to see robust discussion of these ideas, rather than political reporters obsessing about magical words like “middle class tax hikes” to pay for a single-payer, Medicare for All plan. That option is worth discussion, even if, honestly, it may be more aspiration than reality.
The reality also persists that the Grand Old Party is determined to keep the federal government out of any role in health care, even if that inflicts punishing harm on the sick, injured, poor, working poor, middle class, children, and the elderly. Republicans — though they may fib that they aren’t doing what they are doing — have pushed a federal court case that could kill the Affordable Care Act. That could mean an end to patient protections against insurers’ caps on lifetime benefits and their discriminating against those with preexisting conditions (far too many of us). The Trump Administration, despite much boasting about its never-delivered ACA alternative and a fully realized health care plan, is scrambling behind the scenes to figure what it might do if the courts eliminate the ACA.
A November 2019 electoral message
Virginia voters made clear this will not do, turning the state from purple to deeply Democratic blue. With the legislature and state house firmly in Democratic hands, perhaps there will be common sense regulation of firearms and no efforts to slash at Medicaid.
In Kentucky, the gubernatorial race ended up in a razor-thin Democratic victory. Let’s see if that stands, because it would, among other things, halt the unpopular GOP-led efforts to slash at Medicaid in the Bluegrass state.
The voters’ message is ringing out, politicians: Do good things to help with runaway costs and improve the health care Americans get. We’ve got work to do before that critical 2020 vote.