Medical Bankruptcy – A Possible Solution

We are years away from a viable national healthcare system, pushed even father behind by the Trump administration’s constant erosion of the 2010 Affordable Care Act (the ACA aka Obamacare). Despite the fact that almost every effort Trump has made to grant exemptions to states from the ACA, gnawing away at the law’s clear mandate, has been reversed by the courts, there is no question that he has stalled the intended impact of greater access to healthcare and made the underlying costs skyrocket through his actions.

The late and great John McCain turned his GOP Senate vote against repeal of the ACA, putting nail in Trump’s plan to eliminate federally-supported healthcare for everyone. Clearly, Trump never intended to fulfill his campaign pledge to create a better and less expensive new healthcare plan to be made available to any Americans without coverage, free of an ability for carriers to reject preexisting conditions or impose a lifetime benefits cap. Everything he has attempted to do as her assaults the ACA has been to reduce coverage, create cheap (“skinny”) “plans” that do not cover preexisting conditions with major co-pays and staggering deductibles, while redefining the class of required coverage making insurance premiums skyrocket for those who need coverage the most. That Trump’s action has hurt his base more than almost anything segment seems to fall on their deaf ears.

While there is no legal and separate form of “medical” bankruptcy, in most of the developed world, bankruptcies due to unpaid medical bills are exceptionally rate, and most developed-world medically-related bankruptcies occur by reason of lost earning ability… not unpaid medical costs. Nevertheless, in the United States, unpaid medical bills are the number one cause of individual bankruptcy, even after the ACA was passed. Over 20 million Americans gained healthcare coverage under the ACA, but as that coverage gets more expensive due to Trump administration manipulation, we can expect those numbers of insureds to fall somewhat.

So if we know that Congress under Trump is years away from anything approaching national healthcare for all, or even expanding the ACA to cover more people while reducing costs in segments where they are completely out of control (like prescription drugs), what other paths might we consider? Maybe Congress can entertain a less-impactful approach, a crack in the door if you will. After all, in a gig economy, too many people work without access to any company benefits.

Perhaps by reforming our bankruptcy code, we can encourage medical vendors (hospitals, doctors, surgical facilities, pharmaceutical manufacturers, etc.) to act in a far more reasonable manner when it comes to healthcare costs. To settle their egregious “full freight” claims against uninsured patients. After all, when an individual without insurance is hospitalized and undergoes surgical procedures, they are usually charged at the highest, undiscounted rates at the relevant facility. Not remotely at the pre-negotiated and vastly discounted rates they have with the largest insurance carriers.

So let’s see what bankruptcy provisions might be modified to pave the way for an overall better healthcare system. First, the seven-year waiting period between bankruptcies might be reduced to five years where the majority of the debt sought to be discharged is for the unpaid medical costs.

Second, medical vendors should not be entitled to assert their delinquency claims based on the sums stated on the medical invoices. Rather, they should be required to reduce their claims to reflect the rates they charge their most favored insurance carriers for those billed services and prescription drugs. That would apply to pharmaceutical manufacturers and should embrace pharmaceutical rates charged in any comparable economy (notably Canada, Europe, Australia, New Zealand, Japan and Russia).

Third, the burden of proof of those rates should rest with the vendors seeking unpaid medical bills, and to the extent they supply false information, their underlying debt should be wiped out without further recourse (and they should be required to reimburse the cost of the petitioner’s finding the correct information).

Fourth, any hospital refusing to administer necessary care to anyone seeking emergency medical assistance should be held far more legally responsible for any resulting consequences (not just civil malpractice claims but adding rights to seek punitive damages), well beyond the massive fines and civil penalties that can be assessed for hospitals that violate this legal mandate. Generally, there are state and federal laws that prevent hospitals from turning away emergency room patients in need of immediate treatment. For example, as FindLaw.com tells us:

“At the federal level, we have the Emergency Medical Treatment and Active Labor Act, popularly known by its acronym, ‘EMTALA.’ EMTALA imposes the obligation to provide for examination and treatment for emergency medical conditions and women in labor. The first requirement is that of ‘medical screening.’ The law requires that, in the case of a hospital that has an emergency room department, if any individual presents themselves [sic] to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The obligation to examine and/or treat does not depend on whether the patient is eligible for Medicare or Medicaid benefits.”

But that doesn’t mean that the person treated gets away without be charged by that hospital if they are not otherwise covered by a government program (e.g., Medicare, Medicaid, etc.) or their own insurance. And sometimes those debts can get transferred to a close relative as well (parents, spouse, etc.).

In the end, we need slowly to envelop the healthcare industry with limits on what they can force people to pay, add increasing pressures to reduce the cost of prescription drugs (not remotely addressed in the ACA in order to win the support of the big pharmas when the law was passed) and target unnecessary expenses and unjustified rates wherever we can. Since individuals lack the bargaining power to reduce medical costs, we need to give them the same leverage that allows big insurance carriers to force price reductions from healthcare vendors. Doing nothing is no longer an option.

I’m Peter Dekom, and besides totally unnecessary tax cuts for the richest Americans, it is time to address the hard economic needs of the rest of us.

It’s Never Happened Before

Scientists have never seen the ice sheet immediately north of Greenland break up. Never in recorded history. Until 2018. Surprise, surprise. The Guardian U.K. (August 21^st) explains: “This phenomenon – which has never been recorded before – has occurred twice this year due to warm winds and a climate-change driven heatwave in the northern hemisphere.

“One meteorologist described the loss of ice as ‘scary.’ Others said it could force scientists to revise their theories about which part of the Arctic will withstand warming the longest… The sea off the north coast of Greenland is normally so frozen that it was referred to, until recently, as ‘the last ice area’ om the coast than at any time since satellite records began in the 1970s. because it was assumed that this would be the final northern holdout against the melting effects of a hotter planet.

“But abnormal temperature spikes in February and earlier this month have left it vulnerable to winds, which have pushed the ice further away from the coast than at any time since satellite records began in the 1970s… Ice to the north of Greenland is usually particularly compacted due to the Transpolar Drift Stream, one of two major weather patterns that push ice from Siberia across the Arctic to the coastline, where it packs.

“Walt Meier, a senior research scientist at the US National Snow and Ice Data Center, said: ‘The ice there has nowhere else to go so it piles up. On average, it’s over four metres thick and can be piled up into ridges 20 metres thick or more. This thick, compacted ice is generally not easily moved around… However, that was not the case this past winter (in February and March) and now. The ice is being pushed away from the coast by the winds.’…

“The latest readings by the Norwegian Ice Service show that Arctic ice cover in the Svalbard area this week is 40% below the average for this time of year since 1981. In the past month, at least 14 days in the past month have hit record lows in this region. Although thinner ice elsewhere in the Arctic means this is unlikely to be a record low year overall, they are in line with predictions that there will be no summer ice in the Arctic Ocean at some point between 2030 and 2050…

“As well as reducing ice cover, the ocean intrusion raises concerns of feedbacks, which could tip the Earth towards a hothouse state… Freakish Arctic temperatures have alarmed climate scientists since the beginning of the year. During the sunless winter, a heatwave raised concerns that the polar vortex may be eroding.”

As these new realities sink in, as flooding is slamming into the East Coast just as wildfires rage out of control in our West, as hurricanes continue to mount in intensity and coastal flooding and sea rise are the norm, as disease-carrying insects migrate with the rise in temperatures, the Trump administration remains committed to denying the existence of climate change. Instead, our government is proposing a new set of rules under our environmental laws to allow more greenhouse gasses into the atmosphere.

In addition to trying to freeze automotive mileage/emissions required, the Trump administration is also going one additional step to promote the use of the most polluting form of industrial carbon – coal – like never before. “The new power plan would relieve the electricity industry — the second-largest producer of potent greenhouse gases nationwide — from aggressive goals for reducing its carbon footprint. Heavily polluting coal plants that would have been forced into retirement under the Obama-era guidelines get a new lease on life under the Trump blueprint, which allows them to continue operating with modest modification.

“In some cases, states may be permitted to ignore federal guidelines for certain plants altogether and pursue their own strategy…

“Climate-conscious states like California are already mobilizing to fight, arguing the administration’s approach violates the Clean Air Act. The Supreme Court ruled in 2007 that the law requires the federal government to take steps to combat air pollutants that are warming the global climate.

“Administration talking points leaked to the media say the replacement of the Clean Power Plan is a signal ‘to the nation that the war on coal is over and a new era of energy dominance is underway.’ A spokesman for the Environmental Protection Agency, which oversees emission regulations, declined to comment on the draft plan.” Los Angeles Times, August 20^th. The sheer ignorance, the lack of shame, the rejection of overwhelming scientific support, the human suffering and the trillions and trillions of dollars of damage all over the earth that this callous disregard for reality represents are simply staggering.

I’m Peter Dekom, and I wonder how history books of the future will depict this dark period in our human experience… if there still are history books being written.

Ever Get That Sinking Feeling?

Miami and Miami Beach are getting used to rising tides and fierce rainstorms (not just hurricanes) that constantly flood coastal streets. Yes, the ocean is in fact rising. As ground water is pumped out for irrigation and human consumption, we are seeing an increase everywhere in sinkholes, many of which are big enough to swallow an entire car or even a house. We are also watching as very heavy buildings, not anchored in bedrock (which may be economically too deep to reach) slowly sinking down into the earth. Such is the case with the 58-story “Millennium Tower in San Francisco [which] is still sinking and leaning…the luxury building at 301 Mission Street… has sunk 17 inches and tilted 14 inches since it was completed in 2008.”  Business Insider, July 24^th. Nasty.

But when you combine all three of the above phenomena in, under and around a seaside city of 10 million residents – Jakarta (Indonesia’s capital city) – you just might get a megalopolis where the north side (aqua area in the BBC map to the right) has sunk a whopping 97 inches in ten years, and much of the city could easily slide entirely underwater by 2050. When Tokyo faced a similar problem many years ago, it immediately put severe limits on the pumping out of groundwater under the city. Jakarta is talking a similar game, but so far there is very little in the way of tangible efforts to implement the necessary water-removal restrictions. North Jakarta is sinking between half an inch to six inches a year!

The August 13^th BBC.com reports: “[Jakarta] sits on swampy land, the Java Sea lapping against it, and 13 rivers running through it. So it shouldn't be a surprise that flooding is frequent in Jakarta and, according to experts, it is getting worse. But it's not just about freak floods, this massive city is literally disappearing into the ground…

“In the district of Muara Baru, an entire office building lies abandoned. It once housed a fishing company but the first-floor veranda is the only functional part left… The submerged ground floor is full of stagnant floodwater. The land around it is higher so the water has nowhere to go. Buildings that are so deeply sunk are rarely abandoned like this, because most of the time the owners will try to fix, rebuild and find short-term remedies for the issue. But what they can't do is stop the soil sucking this part of the city down…

“North Jakarta has historically been a port city and even today it houses one of Indonesia's busiest sea ports, Tanjung Priok. Its strategic location where the Ciliwung river flows into the Java Sea was one of the reasons why Dutch colonists chose to make it their bustling hub in the 17th Century… Today 1.8 million people live in the municipality, a curious mixture of fading port businesses, poor coastal communities and a substantial population of wealthy Chinese Indonesians…

“But the impact on the small homes right by the sea is magnified. Residents who once had a sea view now see only a dull grey dyke, built and rebuilt in a valiant attempt to keep seawater out… ‘Every year the tide gets about 5cm higher [about 2 inches],’ Mahardi, a fisherman, said.

“None of this has deterred the property developers. More and more luxury apartments dot the North Jakarta skyline regardless of the risks. The head of the advisory council for Indonesia's Association of Housing Development, Eddy Ganefo, says he has urged the government to halt further development here [since the weight of these buildings just adds to the problem]. But, he says, ‘so long as we can sell apartments, development will continue.’…

“The rest of Jakarta is also sinking, albeit at a slower rate. In West Jakarta, the ground is sinking by as much as 15cm annually [6 inches], by 10cm [4 inches] annually in the east, 2cm [0.8 inches] in Central Jakarta and just 1cm in South Jakarta.

“Coastal cities across the world are affected because of rising sea levels caused by climate change. Increased sea levels occur because of thermal expansion - the water expanding because of extra heat - and the melting of polar ice. The speed at which Jakarta is sinking is alarming experts…

“It may seem surprising but there are few complaints from Jakartans because for residents here the subsidence is just one among a myriad of infrastructure challenges they have to deal with daily.

“And that is part of the story of why this is happening… The dramatic rate at which Jakarta is sinking is partly down to the excessive extraction of groundwater for use as drinking water, for bathing and other everyday purposes by city dwellers. Piped water isn't reliable or available in most areas so people have no choice but to resort to pumping water from the aquifers deep underground.

“But when groundwater is pumped out, the land above it sinks as if it is sitting on a deflating balloon - and this leads to land subsidence…The situation is exacerbated by lax regulation allowing just about anyone, from individual homeowners to massive shopping mall operators, to carry out their own groundwater extractions.

“‘Everyone has a right, from residents to industries, to use groundwater so long as this is regulated,’ says Heri Andreas. The problem is that they take more than what is allowed… People say they have no choice when the authorities are unable to meet their water needs and experts confirm that water management authorities can only meet 40% of Jakarta's demand for water…

“[Add a sea wall demand the locals, but] three Dutch non-profit groups released a report in 2017 which cast doubt on whether the sea wall and artificial islands could solve Jakarta's subsidence problem.

“Jan Jaap Brinkman, a hydrologist with the Dutch water research institute Deltares, argues it can only ever be an interim measure. He says it will only buy Jakarta an extra 20-30 years to stop the long-term subsidence.

“‘There is only one solution and everybody knows the solution,’ he says… That would be to halt all groundwater extraction and solely rely on other sources of water, such as rain or river water or piped water from man-made reservoirs. He says Jakarta must do this by 2050 to avoid major subsidence.” While it may be fascinating to watch, it is equally sad. Between global climate change and too many people sucking down too many resources, the earth is showing us her limits. For those unfortunate enough to be on the edge of the overlap of Malthusian population growth and global warming, the consequences become very personal… and even more severe.

I’m Peter Dekom, and frankly, scientific facts don’t really care whether you believe them or not; they just are and will do what the laws of physics programmed them to do.