NEWS AND VIEWS 

TODAY'S ARTICLES CONCERN THE EXTENT OF THE ECONOMIC AND SOCIAL BURDEN ON OUR SOCIETY CAUSED BY THE COMPOUNDING OF MEDICAL DEBT ON THOSE WHO, UNFORTUNATELY, ARE NOT BILLIONAIRES. 

SEPTEMBER 14 WAS THE DAY OF A RATHER SHOCKING EVENT AT A SANDERS RALLY. IT CAME JUST BEFORE THE NEW SANDERS PROPOSAL THIS LAST WEEKEND FOR RELIEF FROM MEDICAL DEBT. THIS MAN CAME PREPARED WITH HIS HOSPITAL BILL TO SHOW SANDERS. SEE BELOW.

‘I’m going to kill myself:’ A veteran tells Sanders he’s drowning in medical debt
September 14, 2019

John Weigel, a 58-year-old Navy veteran, was desperate to tell Sen. Bernie Sanders (I-Vt.) his story.

So on Friday afternoon, he folded his $139,000 hospital bill into his pants pocket and took the city bus to the Democratic presidential candidate’s town hall at the Carson City community center.

Sanders, who’d lost his voice earlier in the week, offered an abridged version of his typical Medicare-for-all speech, instead opening the floor to anyone who wanted to share stories about the U.S. health-care system.

Weigel had found a seat near the front. When Sanders turned to the audience, Weigel waved his medical bill in the air. A campaign aide took the paper from Weigel and slipped it to the senator, who eventually called on Weigel to speak.

The veteran stood shakily. He hadn’t eaten in hours and he was weak from his illness. Through slurred words, a symptom of his advanced-stage Huntington’s disease, Weigel told Sanders that he had somehow lost his veterans health coverage and was tens of thousands of dollars in medical debt.

“John, I’m looking at a bill that says account balance $139,000. What is that about?” Sanders asked.

“It’s because somehow after the fact they claim that my Tricare, I chose to end it, which I didn’t,” Weigel said. “They’re saying that I didn’t re-sign it or something.”

“So how are you going to pay off?” Sanders asked.

“I can’t, I can’t,” Weigel said. “I’m going to kill myself.”

“Hold it, John,” Sanders said firmly. “Stop it. You’re not going to kill yourself.”

That emotional moment was quickly shared across social media. Since the town hall, Sanders has tweeted several times about Weigel, holding him up as an example of a broken health-care system.

“Some in Washington say I am too angry about our broken health care system. I hear stories like this every day in America. My question is: why aren’t they angry about it?” Sanders wrote on Twitter Friday night.

Then Saturday he shared a video produced by his campaign of their exchange: “This is painful to hear. But there are millions of people like John facing an unimaginable burden due to the cost of medical care. This is why we fight for Medicare for All.”

Reached at his home Saturday afternoon, Weigel said he spoke to Sanders and his wife, Jane Sanders, after the event and they told him they would help, though they didn’t say how.

Later Saturday, the Sanders campaign said it had “already reached out to a Nevada senate office for case work help.”

Weigel, a Sanders supporter, said he appreciated that the candidate “didn’t blow me off” like so many others had in his life.

“Hearing his voice, that was really powerful. It was a wake-up call,” Weigel said. “I know he cares. He’s always cared about veterans.”

Weigel, who served overseas in the first Gulf War and in Somalia, signed up for Tricare health insurance when he retired from the military at the end of 2002, expecting to have coverage for life. Less than four years later he was diagnosed with Huntington’s disease, a degenerative brain disorder.

In December 2018 he’d been experiencing chest pains and went to the emergency room and needed stents. He later received a bill in the mail for $139,701 and another for the ambulance for $1,555. When he called Tricare he said he was told that his insurance had been canceled because he hadn’t re-enrolled. In years past his coverage renewed automatically, he said.

What Weigel didn’t share with Sanders is that he’s also had to pay for his anti-depressants and heart medications out of pocket, one month forgoing them because it was getting too expensive.

Weigel is back on his Tricare insurance as of June, but still doesn’t know how he was ever kicked off and is kept up nights worrying about those outstanding bills he can’t afford to pay.

“In the Navy we say we don’t leave our people behind and here it is and there’s nobody here for me,” Weigel said, his voice breaking.

Chelsea Janes contributed to this story from Carson City, Nevada.



BERNIE'S MEDICAL DEBT PLAN

Bernie Sanders’s plan to eliminate medical debt, explained
Bernie Sanders wants to eliminate $81 billion in medical debt and set up a public credit registry.
By Dylan Scott@dylanlscottdylan.scott@vox.com  Updated Sep 21, 2019, 10:30am EDT

BERNIE SANDERS SPEAKING   Ethan Miller/Getty Images

Americans go bankrupt every year because of unpaid medical bills.

Now Sen. Bernie Sanders (I-VT), one of the leading progressives in the 2020 presidential race, says he wants to eliminate all Americans’ medical debt. Sanders released a plan on Saturday to pay off $81 billion in existing medical debt, reform the 2005 bankruptcy reform bill, and set up a public credit registry.

“I am sick and tired of seeing over 500,000 Americans declare bankruptcy each year because they cannot pay off the outrageous cost of a medical emergency or a hospital stay,” Sanders said recently, while teasing the plan he has now formally laid out.

Under the Sanders plan, the federal government would negotiate and pay off unpaid medical obligations that have already been put out to debt collection agencies. He would also place restrictions on how aggressive health care providers and debt collectors could be in collecting payments from patients. Through a proposed public credit registry, which would replace credit reporting agencies like Equifax, Sanders would prohibit debts from medical care from counting against a person’s credit score.

It’s another big health care promise from Sanders, who campaigns on Medicare-for-all, a national health insurance program that would cover every American. He has also, because he regularly cites the 500,000 medical bankruptcies figure, reignited a longstanding debate about the actual scale of the medical bankruptcy problem. The Washington Post’s in-house fact-checkers dinged him for saying 500,000 people go bankrupt because of medical debt every year, stirring up an old scholarly fight that originated with a 2005 paper co-authored, in a fun twist, by Sanders’s now-rival Elizabeth Warren.

Academics have been debating since that 2005 paper’s publication how many people actually go bankrupt in the United States because of medical bills. It is a debate about causation and study design that frankly won’t matter to most people. It also risks losing sight of the underlying problem.

There is no denying that thousands of Americans go bankrupt entirely or partly because of medical debt. And even if they don’t go bankrupt, millions more people struggle with this type of debt on their personal ledgers, making it harder for them to borrow money and stay financially stable. Millions of Americans still lack health insurance, and they’re fully liable for their medical bills if they get sick or have an accident. But even health insurance does not always provide security against financial stress because poor health takes its toll in other ways, such as lost wages.

Bernie Sanders has put out a plan to eliminate $81 billion in medical debt

There is certainly some level of agreement that medical debt is a problem unusually endemic in the United States and our safety net should be better structured to address it.

“Health insurance still leaves Americans exposed to much more economic risk from poor health,” Amy Finkelstein, an economics professor at MIT who has studied medical debt, told me, especially compared to other countries with social insurance that better protect their citizens from the economic loss in the event of sickness or injury. “Even people with health insurance are not insured against the economic consequences of poor health.”

And this is part of what Sanders is targeting with his proposal. Here are the highlights:

  • The federal government would negotiate settlements for $81 billion in existing past-due medical debts and pay off the balance on behalf of patients

  • Restrictions would be placed on debt collectors: contacts with patients with past-due bills would be capped and there would be limits on the assets that could be seized and wages that could be garnished in collection

  • Various provisions of the “disastrous” (in Sanders’s words) 2005 bankruptcy bill (which Sanders notes was supported by then-Sen. Joe Biden) would be changed, making it easier for medical debts to be discharged and prohibiting evictions, utility interruptions, wage garnishments, and other practices that can inhibit day-to-day life for people facing debt collection

  • A public credit registry would be established to replace for-profit credit reporting agencies, providing a report on creditworthiness that would exclude medical debt from consideration

Sanders is making a bet that he is appealing to voters who understand the need to right a kind of moral wrong in the US economy.

“In the United States of America, your financial life and future should not be destroyed because you or a member of your family gets sick,” Sanders said. “That is unacceptable.”

There is a serious problem of medical debt in the United States

Medical debt is a serious problem in the United States. Here are the raw statistics:

  • The Consumer Financial Protection Bureau reported in 2014 that 43 million Americans had unpaid medical debts on their credit reports.

  • Americans accrued an estimated $88 billion in medical debt in 2018, according to a study by Gallup and the nonprofit group West Health.

  • Nearly half of Americans fear a major medical event could lead to their bankruptcy, Gallup found.
  • One in four people said that sometime in the past year they had skipped medical treatment because of concerns about cost.

Health care far outpaced other obligations in the number of Americans who’d had a debt pursued by collectors in 2014, according to the CFPB.

CFPB

Amy Finkelstein’s 2018 paper co-published with Carlos Dobkin, Raymond Kluender, and Matthew Notowidigdo in the American Economic Review found that people with health insurance who were unexpectedly hospitalized saw an 11-point drop in their likelihood of being employed and an average loss in labor earnings of $9,000, a 20 percent decline.

What must be said here is America is unusual in this degree of medically driven insolvency and economic loss. Not only is the United States the only developed economy with such a high number of uninsured people (still over 10 percent), but the government does not provide the same level of financial protection to people who get sick or hurt and lose income because they can’t work that other countries do.

The Finkelstein et al. paper used the notable example of Denmark, a socialist boogeyman for conservatives. They cited a Danish study showing that Danes who have nonfatal heart attacks and strokes lose about the same amount of income as Americans, but that 50 percent of their losses were then covered by government disability or sick leave programs.

The US doesn’t have such programs, and Americans only saw about 10 percent of their losses covered if they were not eligible for Social Security’s retirement benefits. The researchers also found that the drop in income for people in America is not offset by an increase in earnings by their spouse or partner.

In other words, medical bankruptcy is a problem uniquely pervasive in the United States. As T.R. Reid wrote in his tour of international health care systems from last decade:

I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally, the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry’s parking last week.

The academic debate about how many people actually go into medical bankruptcy, briefly explained

That doesn’t mean it’s easy to measure the exact size of the medical bankruptcy problem in a country and system as unwieldy as that of the United States. A seminal attempt came in 2005 by Elizabeth Warren and, among others, Dr. David Himmelstein, now a professor in the CUNY School of Public Health.

Himmelstein led an updated version of the survey and used a similar methodology as the studies in 2005 and 2009. The researchers sent questionnaires to people who had filed for bankruptcy, and two-thirds said they had medical debt or had lost income because of injury or illness. Take two-thirds of the 750,000 people who file for bankruptcy every year and you get 500,000, which is Sanders’s number. It’s this number that the Washington Post saw fit to give three out of four Pinocchios for lacking a strong enough empirical foundation.

Some economists have long been skeptical of the methodology and study design deployed by Himmelstein and Warren in their previous studies. Part of it is they don’t consider the survey model reliable; they also question what the proper context should be when most Americans who have medical debt don’t file bankruptcy in a given year. (Himmelstein, for his part, says some of his critics have gotten industry support and that there is a difference in philosophy between doctors and economists on trusting subject responses about issues like bankruptcy.)

Critics will actually cite Finkelstein’s 2018 paper in contrast to the previous iterations. Those researchers also sought to estimate how many people go bankrupt because of a medical crisis — specifically, a hospitalization. They found just 4 percent of bankruptcies could be traced back to an acute event that put somebody in the hospital.

That is obviously a much lower number than the 60-some percent Himmelstein found. The Post cited the Finkelstein paper in its fact-checking column that accused Sanders of “cherry picking.”

Himmelstein and co-author Steffie Woolhandler responded with their own questions about the Post’s evaluation, saying in summary:

Rather than checking facts, the Post has chosen one side in an ongoing and unsettled scholarly debate, and labeled those on the other side (and public figures who cite their research) “liars”.

The Week’s Ryan Cooper pointed to some other studies that found roughly 25 percent of bankruptcies could be blamed on medical debt. But this fact-check drama is at a standstill, with the Post standing by its rating. You can read more of the back-and-forth here. (Margot Sanger-Katz at the New York Times has also covered these issues and this research quite a bit.)

Whatever the exact number, Sanders thinks he has a plan to eliminate the problem for good.

IN THIS STORYSTREAM



FOR SANDERS MEDICAL DEBT PLAN, SEE CBS 9/23/19 ON "SURPRISE" MEDICAL BILLS: https://www.cbsnews.com/live/  

A RELATED PRINT STORY IS BELOW. "NEW CBS INVESTIGATION ON WHY PRICES ARE NOT TRANSPARENT." ALSO, ESTIMATE YOUR COSTS ON A PROCEDURE BY GOING TO CBS NEWS.COM'S HEALTH COSTS PROGRAM, PUT YOUR LOCATION IN AND GET THE COST. GO TO THE WEBSITE TO USE THE "MEDICAL PRICE ROULETTE" TOOL.

CBS NEWS    September 20, 2019, 10:10 AM
Medical Price Roulette: CBS News investigates the lack of transparency in America's health care system

Medical bills are a major frustration for many Americans who wonder what explains the prices and why they end up paying so much.

On Monday, CBS News will air the first of a three-part series called "Medical Price Roulette," which investigates the lack of transparency in health care pricing. The series is produced in partnership with ClearHealthCosts.  

"CBS This Morning" consumer investigative correspondent Anna Werner will dig into why costs charged by hospitals and other providers often vary dramatically, even within the same city. 

Click here to share your story and search prices


On Monday, we talk to one man who needed emergency back surgery to avoid being paralyzed — and then faced hundreds of thousands of dollars in bills. On Tuesday, a woman talks about the surprise medical bills she incurred after a tragic miscarriage. And on Wednesday, we meet a 27-year-old chronic care patient who faces dramatically changing costs for her infusions. 

"Most of our viewers, I think it would be fair to say, don't understand the bills that they get, don't understand why the price was so high," Werner said. She asked Dr. Aaron Carroll, a pediatrician and health services researcher, "Is there transparency in health care pricing?"

"Oh my God, no," Carroll replied. "I'm laughing only in the sense that you think patients are the only ones that think there's no transparency.  I mean, people working in the system don't often know what the price is. When my patients ask me what the price is, I don't have an answer for them … Nothing about the United States' health care system really makes sense." 


We'd like to know what you paid for medical procedures. Share your story and learn how you can search ClearHealthCosts' database of prices in our sample markets. You can also email us at healthcosts@cbsnews.com.

© 2019 CBS Interactive Inc. All Rights Reserved.



"SURPRISE" MEDICAL BILLS

Between the lines of Bernie Sanders' plan to eliminate medical debt
Caitlin Owens   SEPTEMBER 23, 2019  15 hours ago

Illustration: Sarah Grillo/Axios

Sen. Bernie Sanders released his 2020 plan to cancel $81 billion in existing medical debt, reform collections practices and change bankruptcy rules this weekend.

Why it matters: The proposal speaks directly to the issues of surprise medical bills and hospitals' lawsuits against patients — issues that have only recently entered the political lexicon.

The big picture: It also, of course, is a simple solution to the problem of unaffordable health care costs, a top issue for voters and one that has only become more prominent with the rise of deductibles and other forms of cost-sharing.

Yes, but: It's not hard at all to imagine how this will play with those who already think Sanders has made ludicrous financial proposals.

Between the lines: Sanders would have the federal government "negotiate and pay off past-due medical bills in collections that have been reported to credit agencies," per the plan.

But medical debt often doesn't get paid, so collectors will sell it for cheap. Craig Antico, founder of the nonprofit charity R.I.P. Medical Debt — which buys and absolves health care debt in bulk — told NYT that the market price for $81 billion in debt could be as low as $500 million.

How it works, via Axios' Orion Rummler:

Have the IRS review billing and collection practices of nonprofit hospitals.
Replace for-profit credit reporting agencies with a "secure public credit registry."
Stop requiring the disclosure of medical debt discharge on housing and loan applications.

What we're watching: Sanders' embrace of "Medicare for All" has transformed the Democratic party, pulling it much further left on health care. It's unclear if his stance on medical debt will play the same way, and how the rest of the 2020 field will respond.





ABOUT THOSE "CRACKS," THERE ARE AT LEAST 5 OR 6 ARTICLES ON THIS SUBJECT AND USING THE SAME WORDS. I HAVE CHOSEN THIS ONE BECAUSE "COMMUNITY ONCOLOGY" LOOKS TO ME TO BE A LIKELY ORIGIN.

THE CONDITION OF HOSPITALS POUNCING PARTICULARLY HARD ON THOSE WHO SHOULD BE GIVEN LESSER CHARGES BECAUSE THEY ARE RELATIVELY POOR IS NOT NEW. THERE WAS A STORY WITHIN THE LAST SEVERAL YEARS OF A GROUP OF HOSPITALS IN THE MIDWEST OWNED BY THE SAME CORPORATION -- CAN'T REMEMBER ANY DETAILS UNFORTUNATELY -- THAT WAS BEING SUED FOR THIS PRACTICE. IT SHOULD BE A CRIME, NOT MERELY A SIN, AS IT SEEMS TO BE. IT'S TOO COMMON, ACCORDING TO ARTICLE. LET'S GET BERNIE ON THE JOB, AND MAYBE SOME LAWS WILL BE WRITTEN TO MAKE THAT PRACTICE GROUNDS FOR REMOVING THEIR LICENSING TO PRACTICE AS DOCS AND AS HOSPITALS. A SIMPLE FINE WOULDN'T BE EFFECTIVE ENOUGH BECAUSE THEY HAVE TOO MUCH MONEY FOR THAT TO GET THEIR ATTENTION.

WHENEVER I HEAR ABOUT "FOR PROFIT HOSPITALS" AND "FOR PROFIT PRISONS," IT MAKES ME CRINGE -- AND THEN LEAP OUT IN ANGER. IF AMERICA IS ABOUT ANYTHING, IT SHOULD BE ABOUT PREVENTING THESE THINGS FROM HAPPENING, AND MAKING THE ABUSE OF THE POOR A FELONY, NOT WHITE COLLAR CRIME. THIS REFERENCE TO "CRACKS IN OUR SYSTEM" IS JUST ONE SENTENCE LONG, BUT THE WEBSITE IS APPARENTLY A SORT OF WATCHDOG, LIKE "COPBLOCK." IT IS PRODUCED BY "COMMUNITY ONCOLOGY ALLIANCE -- DEDICATED TO ADVOCATING FOR COMMUNITY ONCOLOGY PATIENTS AND PRACTICES."


Hospital Lawsuits Unearth “Cracks in our System”
September 4, 2019

Low-income patients often face steeper out-of-pocket costs — and that means they’re also more likely to be sued by hospitals when they can’t pay their bills.


Hospital lawsuits unearth "cracks in our system"
Caitlin Owens   Sep 4, 2019

Data: Peterson-Kaiser Health System Tracker; Chart: Axios Visuals

Low-income patients often face steeper out-of-pocket health care costs — and that means they're also more likely to be sued by hospitals when they can't pay their bills.

Driving the news: The New York Times yesterday reported on Carlsbad Medical Center's prolific use of lawsuits to collect its patients' medical debts, which often leads to wage garnishment or property liens.

  • The hospital is the only one in town and has filed nearly 3,000 lawsuits against patients since 2015, NYT found.

  • Its practices were first profiled in an upcoming book by Marty Makary, a doctor at Johns Hopkins, titled "The Price We Pay."

  • "The health insurance deductibles so often discussed in our health policy circles may seem inconsequential to wealthy people and to decision makers in the policy world, but they are crushing many Americans," Makary writes.

Not only are patients facing more out-of-pocket spending than ever before, but hospitals — including Carlsbad Medical Center — often greatly inflate their prices compared to Medicare rates.


  • "Hospitals want to get all the perks of their nonprofit status…but really rake patients through the coals with their billing practices," Yale's Zack Cooper told me.

The bottom line: "There's a space for folks who are vulnerable to get caught in the cracks of our system ... [such as] higher cost sharing and out-of-pocket costs, skimpier health insurance plans, and more aggressive collection practices by hospitals and providers," Cooper said.



The only health care prices that matter to consumers

Illustration: Aïda Amer/Axios

The most important detail to watch in the regulations for President Trump's executive order on price transparency for hospitals: will they require that insurers give consumers information on out of pocket costs in a timely and usable way?

Why it matters: That kind of timely information will be needed in the regulations — which have yet to be written — so consumers can shop based on the costs they will actually pay.

The big picture: One big reason general information on prices has only limited utility to consumers is that what they most want to know is not the price of an MRI, or a knee replacement of any other service at this hospital or that, but what they will have to pay for it themselves out of pocket under their insurance plan.

Some insurance companies have tools consumers can use to figure this out, but that information is not easily available to consumers today. As a recent Kaiser Family Foundation/Los Angeles Times survey shows:

  • 67% of the American people say it is somewhat or very difficult for them to figure out what a treatment or procedure will cost them.
  • 44% said they had difficulty determining what they would actually have to pay.
  • 40% had problems figuring out what was even covered.

Even with the right information, larger medical expenditures generally occur when people are in a medical crisis of some kind, in anything but shopping mode, and generally dependent on their physicians to direct them to hospitals, specialists or tests they need. This is why price transparency and shopping is helpful for some services but not a panacea. 

  • It’s not entirely clear whether low rates of price shopping today reflect the lack of price and quality information, or larger barriers to shopping in health care. Just 17 percent of people with typical deductibles shop today, and 21% with high deductible plans. More price transparency will drive these numbers up, but how much is unknown.

  • On the other hand, there is some evidence that people want to shop when they can: 47%, for example, asked for a generic drug to save money in the past year; and 36% checked with a provider or health plan on the cost of an office visit.

  • But just 23% used an online tool to compare provider costs. All told, 70% reported some shopping-like behavior in the survey.

It's important to add that the ability to shop based on price is not equally distributed throughout the population. If you are in a rural area, limited to a narrow network of providers, or dependent on emergency rooms or clinics, you may have very limited options to shop around.

The bottom line: Like putting price information in drug ads, the executive order may not have much impact in terms of actually lowering prices, but it will focus greater attention on high medical prices. That is likely the main reason for industry resistance, and potentially its greatest contribution.



UNDER THE HEADING OF "RELATED INFORMATION" IS ANOTHER PAINFUL SHOCK. SEE BELOW.

Hospitals earn greater profit from physician-administered meds than drugmakers, study finds
Alia Paavola - Thursday, September 19th, 2019 Print  | Email

Hospitals earn a greater profit from physician-administered drugs than pharmaceutical manufacturers themselves, according to a recent analysis by the Partnership for Health Analytic Research.

The analysis from the physician-led consultancy firm found that for every $100 spent on physician-administered drugs in the outpatient setting, the hospital retained $58, while the drugmaker retained $42. 

"This suggests that hospitals are earning more from administering medicines than the manufacturers who created the medicines and is consistent with recent research published by the Moran Company, which found that in the commercial market, hospitals retain 2.4 times their acquisition cost for a basket of 20 brand-name medicines," the researchers wrote. 

Additionally, the report compared how much of the gross profit of physician-administered drugs physician offices retained in comparison to hospital outpatient settings.

The study found that while physician offices and hospital clinics treat a similar number of patients in the commercial market, hospitals received a larger share of the gross profit. In particular, hospitals retained 91 percent of the gross profit margin, compared to physician offices, which retained just 9 percent. 

This discrepancy indicates that commercial payers reimburse hospital clinics at a higher rate, researchers said. In addition, the discrepancy may be explained by the fact that hospital clinics are eligible for discounts not offered to physician clinics, including the 340B program.

More articles on pharmacy:

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