Oh, Do We Owe

 

There are so many issues with healthcare coverage in the United States; there is a dramatic lack of uniformity state to state. In the developed world, the US is a definite outlier; as we all know, we are the only developed nation on earth without universal healthcare. Universal healthcare in Germany, for example, cover just about any medical condition; it even routinely covers dental work, vision care and hearing aids, elements excluded from all but the most expansive and expensive private insurance policies in the United States. The German program, administered by private insurance companies, charges a percentage of income for the care, not an atypical of such programs. Germany caps monthly contributions for prescriptions to €10/month and the minor other charges amount to almost nothing. Americans also pay double or more per capita on annual medical costs than the average spent on the rest of the developed world. 

And while the Affordable Care Act (AKA “Obamacare”) was passed in 2010, between Congress and the Supreme Court, its coverage is not well-funded and its additional costs remain burdens to many. One aspect of the ACA was the ability of states to expand their Medicaid programs to cover a larger swath of lower income participants. The costs to the states are relatively small, but almost all the red states, already vehemently opposed to government’s providing healthcare to everyone, failed to participate. 

What is Medicaid anyway? “Medicaid is a health insurance program offered in the United States. It is jointly funded by the federal government and each state. It is provided for individuals who qualify based on income, age, or health need. Those who receive Medicaid are usually children, adults with a disability, or a low-income older Americans.” Vittana.org. And obviously, it is the states that set the eligibility rules. Medicare is the medical coverage provided to the elderly as part of their return for a lifetime of payroll contributions.

The United States is home to so-called “medical bankruptcy,” which addresses not income loss from disability as much as it focuses on defaults in medical bills, generally resulting from lack of coverage, deductibles, exclusions and co-pays. Just having insurance does not mean a covered individual has no large medical bills. Even Medicare, with its “doughnut hole,” doesn’t cover the full cost of prescription drugs, and Social Security benefits get taxed in part to cover Medicare. You’d think that we would get these costs under control but instead of watching medical debt subside, the opposite is happening. It’s not just that Americans are unable to pay their medical bills, unsurprisingly a number that is significantly higher in red states that have not expanded Medicaid, but much of that debt is in the hands of collection agencies, which can be vicious in their pursuits, pushing many over the top into bankruptcy.

“New research published Tuesday [7/20] in JAMA finds that collection agencies held $140 billion in unpaid medical bills last year. An earlier study, examining debts in 2016, estimated that Americans held $81 billion in medical debt.

“This new paper took a more complete look at which patients have outstanding medical debts, including individuals who do not have credit cards or bank accounts. Using 10 percent of all credit reports from the credit rating agency TransUnion, the paper finds that about 18 percent of Americans hold medical debt that is in collections.

“The researchers found that, between 2009 and 2020, unpaid medical bills became the largest source of debt that Americans owe collections agencies. Overall debt, both from medical bills and other sources, declined during that period as the economy recovered from the Great Recession…

“The $140 billion in debt does not count all medical bills owed to health care providers, because it measures only debts that have been sold to collections agencies. The increasing number of lawsuits that hospitals file against patients to collect debt, which can lead to legal fees or wage garnishments, are not included in the figure. Nor are the medical bills that patients pay with credit cards or have on long-term payment plans. Some of the difference between the new estimate and the older, smaller one may reflect differences in how different credit rating agencies categorize debts… The new paper does not include data during the coronavirus pandemic, which is not yet available.” New York Times, July 20th.

Why? Uncapped and uncontrolled mark-ups, staggering profits and an attitude of pressing the market as far as it can be stretched. The Obama administration had to make major concessions to pharmaceutical companies and insurance carriers to end their massive lobbying efforts against the bill when it was presented to even a Democrat dominated Congress. It’s not as if healthcare lobbyists only have Republicans in their pockets (which they definitely do), but their dollars also fund a number Democrats desperate for campaign funding in a highly expensive and competitive field. There are so many well-funded and greedy players in healthcare solidly arrayed against a healthcare system that could make economic sense. 

Everybody knows the system does not work. But when 20 red state attorneys general, with the full cooperation of the Trump Department of Justice, attempt to throw the entire ACA out the window as unconstitutional, which would have cut millions and millions of Americans off from insurance coverage, you just know those monied interests are not going to allow “reasonable” to prevail without a bloody fight. Ever the populist, during his initial presidential campaign, Donald Trump promised a replacement for the ACA that would extend greater coverage to more people at a lower price. In the entire Trump term, there was never even a single attempt to articulate what that coverage would look like; the entire effort was focused on eliminating the paltry coverage that existed. Which the U.S. Supreme Court rejected anyway.

There’s just too much bribe money… er… unlimited Citizens United vs FEC campaign contributions funded by stakeholders in the healthcare industry primarily to generate profits. There are so many massive issues in the United States that can only be solved by concerted governmental action. Tax cuts for the rich creating massive federal deficits and cuts to state programs, depleting funding for so many necessary solutions to dire issues. Healthcare. Childcare. Unaffordable college tuition and resulting staggering student debt. Quality public education in general. Climate change. Infrastructure. Gun violence. Homelessness. Social safety nets. Pandemic recovery. But the players with the most money, unleashed to spend it to proselytize why hog-slopping richness is good for the country, are fighting back. You know it when a very sane and reasonable policy is labeled “creeping socialism.” We also should know that is a buzz phrase for fair taxation of the mega-rich to solve the most dire problems this nation has faced since WWII.

I’m Peter Dekom, and have we become so completely used to advertising manipulation that we make our most important decisions based on labels without looking at the substance?