Sick and injured battered by costs of hospitalization, long-term care, bad jobs

medbankruptcy-300x253Illness and accidents batter and beggar Americans worse than many of us realize. New studies show it’s not just the cost of medical services but also long-term care and loss of jobs staggering the lives and finances of too many.

Margot Sanger-Katz, writing in the data-driven New York Times column, “The Upshot,” reported that hospitalization can wreak havoc on Americans older than 50, with many suffering a significant loss in income from which they never recover. This is true, even if they have some financial protection through health insurance. That coverage may soften the blow of medical costs. It doesn’t help them if they can’t return to work, must spend long periods out of work, or must reduce their work hours so they are part-time or less, finds a new study, published in the American Economic Review.

As she wrote:

On average, people in their 50s who are admitted to the hospital will experience a 20 percent drop in income that persists for years. Over all, income losses dwarfed the direct costs of medical care. The pattern and impact are comparable to what happens to workers at a mill when it closes. The [researchers] were surprised by how often an illness or injury could upend the finances of Americans with health insurance.

Despite the significant rise in Americans who got covered under the Affordable Care Act, aka Obamacare, the researchers found that medical debt persists as an economic bane and continues as leading cause of bankruptcy (see the New York Times graphic above). Even with insurance, the numbers don’t add up for older patients, post-hospitalization, Sanger-Katz reported:

On average, uninsured people in the study owed the hospital $6,000, compared with only $300 for those with insurance. But the average decline in income for both groups was much larger — an average earnings hit of $11,000 by the third year. Much of that average — around 60 percent — came from people who never returned to work at all.

The Trump Administration and Republicans in Congress, meantime, keep attacking the ACA, Medicaid, and Medicare, insisting that government should stay out of health care, without explaining how Americans, if they don’t share the risks and rewards of staying healthy — such as through a social safety net and affordable health insurance — can deal with illness and accidents that lead to substantial medical costs and reductions in or loss of employment.

Sanger-Katz wrote that, “In general, the United States doesn’t provide much sick leave, disability or wage insurance to protect people” from work interruptions that can lead to sizable drops in household income. But she also observed, “To the authors [of the hospitalization study], the lesson of the paper is that standard health insurance isn’t enough — policymakers need to think about ways to better protect people against the income risks that accompany illness.”

Indeed, in my practice, I see not only the huge harms that patients suffer while seeking medical services, but also their  struggles to access and afford safe and quality medical care. Depending on their illness or injury, harmed patients may need it for long periods, some for the rest of their lives — and despite what ill-informed critics may contend, juries recognize the huge costs involved in many of their awards in lawsuits.

The crisis in long-term care, especially for dementia

Long-term care, meantime, grows by the day as a crushing burden for the chronically ill, the aged, and their friend and loved ones. This unmet and crisis-need is, of course, felt acutely in our rapidly graying nation among those with dementia — and especially by those who care for them. As NBC News reported:

Alzheimer’s disease just keeps getting worse in the U.S. The latest report on the most common cause of dementia shows that 5.7 million Americans have the disease and it’s costing us $277 billion a year. That doesn’t include the unpaid time and effort of the people, mostly women, who are caring for spouses, parents, siblings, and friends with dementia, the annual report from the Alzheimer’s Association shows. ‘In 2017, 16 million Americans provided an estimated 18.4 billion hours of unpaid care in the form of physical, emotional and financial support – a contribution to the nation valued at $232.1 billion,’ the Association says. ‘The difficulties associated with providing this level of care are estimated to have resulted in $11.4 billion in additional healthcare costs for Alzheimer’s and other dementia caregivers in 2017.’

It’s tragic that women shoulder the load in caring for those with dementia, with two-thirds of the caregivers for those with this disease being women, and a third of them daughters. They’re providing more than 20 hours a week on average in hard, unpaid labor to assist loved ones with dementia and Alzheimer’s — patients who, in later cognitive decline, may talk incessantly, wander, be difficult to control, and need basic assistance, including with bathing, dental care, feeding, and going to the bathroom.

Toxic workplaces

Although some employers may try to help caregivers and employees with chronic conditions cope with complicated and fraught lives, a Stanford Business School professor argues in a new book, “Dying for a Paycheck,” that U.S. working conditions themselves may be a cause of major harms to Americans’ health.

Jeffrey Pfeffer, starting in 2015, argued in a published paper, the Washington Post reported, that “more than 120,000 deaths a year and roughly 5 to 8 percent of annual health care costs may be attributable to how U.S. companies manage their workforces.” He contends too many U.S. companies foster tense, demanding, stressful workplaces where layoffs, job insecurity, toxic cultures, and long hours add to corporate and top executives’ profits but damage employees and their health, as well as adding to national health care costs.

He has estimated that negative work-related conditions can be blamed for $190 billion annually in “incremental health care costs,” and their 120,000 deaths per year would make the workplace “the fifth leading cause of death in the U.S. — higher than Alzheimer’s, higher than kidney disease,” he told the Washington Post.

Pfeffer says corporate leaders, politicians, and policy-makers need to use existing research and methods to build on what he’s found to figure how to make jobs safer and healthier. They should stop kidding themselves, too, that corporate wellness programs address major woes on the job, including work-life-family conflicts and balancing.

As we hurtle toward mid-term elections, American voters may need to weigh whether they’ve been well-served by partisans who have cut taxes for giant corporations and the wealthy elite, while slashing at health insurance and social safety net programs for everyone else — the middle class, young, old, poor, and the chronically and mentally ill. This fall might be an opportune moment to send an unmistakable message about where the country’s headed and under whose political leadership.

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