When I ended the segment on HUD housing and the shelter system that includes health care access for the poor and working class I showed that Baltimore's system was indeed legally classified as criminal negligence as a lawyer told me as he said he would not represent my homeless friend. This is why I continually shout that almost all Clinton/Obama neo-liberal policies can be simply VOIDED as illegal and unconstitutional---BECAUSE IT IS. So, as we look at the effects of the Affordable Care Act on middle-affluent class we see the same process of blocking access only this time Wall Street is going to soak the US citizens still having money of all their disposable income just to keep ordinary access to care.
THE AFFLUENT MAY STILL ACCESS QUALITY HEALTH CARE IN THE SHORT-TERM---BUT THEY WILL BE BLED DRY OF MONEY TO GET IT.
All national players in ACA knew the goal was to end corporate health plans and reduce them to a minimum preventative care access and the worker's having those plans are mostly middle-class. The health plans for working class low-wage jobs have always been minimal. The window of salaries for this crunch on the middle-class spans from $40,000 to $200,000 a year. Obama and Clinton neo-liberals pretended to protect the lower end of middle-class with a subsidy that willl disappear in no time-----but buying Gold and Platinum health plans will go from manageable to fleecing as these plans on upper-middle class soar.
WHEN CLINTON NEO-LIBERALS SAY THEY ARE WORKING FOR THE MIDDLE-CLASS---THEY SEE THE US AS THE SAME AS THE WORLD'S MIDDLE-CLASS AND BELIEVE ME-----THERE IS A LOW PERCENTAGE OF WORLD CITIZENS CONSIDERED MIDDLE-CLASS----THE GAP GOES FROM RICH TO POOR PRETTY QUICKLY.
So, the ACA to Obama and Clinton ne0-liberals are geared to making what was everyone's access to quality health care now only accessible by families earning greater than $200,000 and that limit is growing fast.
Employees Are Paying More – Much More – for Health Care
By Beth Braverman
November 12, 2015
While wages have been stagnant over the past decade, the amount that workers pay for employer-sponsored health insurance has more than doubled.
Average employees at mid-size and large companies paid $2,490 toward their premiums and $2,208 in out-of-pocket costs (including copayments and deductibles) last year, for a total cost of about $4,700, according to a new report from Aon. The data in the report combines both individual and family plans.
In 2005, those employees’ total healthcare costs were just $2,001. That translates to a 134 percent increase in employee’s share of health care costs in 10 years.
Related: Workers Are Getting Slammed With Higher Health Care Costs
The rate of increase has declined in recent years. Last year the employee share of healthcare costs increased 3.2 percent, the lowest rate in 20 years. Aon projects that costs will increase 4.1 percent next year, which would mean workers would pay almost $4,900 for medical coverage and services.
“As prescription drug costs continue to grow at a double-digit pace and the economy picks up speed, it’s likely these premium rates will start to climb,” Mike Morrow, senior vice president of Aon Health, said in a statement.
In addition to the rising price of treatment, the increased worker expense reflects a trend of employers shifting their costs onto their employees. The amount of total health care costs covered by employers has decreased 1 percent per year over the past three years. Nearly half of employers plan to increase participants’ out-of-pocket costs in the near future and another 38 percent have already done so.
This shift has led to the rise of high-deductible health plans, with 16 percent of companies offering these as the only option for employees, and another 41 percent planning to make it the only option in the next three to five years.
There are two progressive posing stances Obama and Clinton neo-liberals gave in pushing the Affordable Care Act----that is would give most Americans health insurance-----saying nothing about that health insurance doing nothing for access to health care-----and reducing the amount of debt from health care costs the American people would attain. Well, placing a cap on health care debt at the same time the Federal funding subsidy for accessing health care AFTER THAT CAP----is disappearing shows that these health insurance plans will only be required to be responsible for so much payment before a patient simply will not be eligible for a routine medical procedure. Remember, Medicare Trust is being imploded this coming economic crash from collapsing bond market----global pols are taking all Federal funds out of health care....THAT IS WHAT THEY THINK.
As well, the Affordable Care Act deliberately makes the young buy health insurance even when most young adults never use health care----I was never sick or used health care until 40-50s for example. Global pols like to blame the senior cost of health care or the supposed insuring the poor as to why the mandate exists----but the only reason it exists is to boost profits for global health insurance corporations.
This week I will look at what deregulation and consolidation is doing to cost and quality health care for the middle-class and affluent-----as the mantra from Republicans and Clinton neo-liberals become----
GET RID OF MEDICAL BANKRUPTCY AND MEDICAL CLASS ACTION LAWSUITS BY THE PUBLIC BECAUSE THEY COST GLOBAL CORPORATIONS PROFIT.
'Just 30 years ago, debtors rarely filed for bankruptcy as a result of a medical problem. Today, an astonishing 62% of personal bankruptcies are linked to medical debt'.
'To sum up the catastrophe: as a response to the rising cost of care and a growing number of Americans who cannot afford their medical bills, Congress responded by throwing up more barriers to bankruptcy. It’s not that bankruptcy is a real solution, since it does not address the fundamental economic conditions that pushed individuals to bankruptcy in the first place'.
The US Constitution and Bankruptcy
by Douglas Jacobs, Esq.
July 6, 2007
Most of the rights granted to us by the US Constitution are found in the Bill of Rights: the first ten amendments to the document itself. The body (Articles) of this great document is mostly concerned with the operations of the government: the powers of Congress, the President, and the Supreme Court.
Article I, Section 8 lays out the general powers of Congress, and it specifically includes the power to create “uniform Laws on the subject of Bankruptcy throughout the United States.”
This means, according to most Constitutional scholars, that there should be the same bankruptcy law for everyone in the country.
So, we all have a Constitutional Right to file bankruptcy!
The interpretation and extent (or limitation) of that right keeps changing, but know that if you have to file for bankruptcy protection you are exercising one of those rights mandated by the great minds who formed this country.
The article below is great-----read towards the end for policy regarding medical bankruptcy and debt. This is critical because the goal of Clinton neo-liberals is to use these policies to keep American people from accessing health care they cannot afford to pay for outright. The medical code for centuries in Europe and the US has been the Hippocratic Oath------doctors and hospitals are obligated to take anyone in need of health care----and do no harm. This is what the Affordable CAre Act is doing with policy designed to keep Americans from even thinking of accessing care----from high deductibles and co-pays to caps to what insurance will pay followed by a supposed Federal subsidy that will disappear.
Remember, Obama and Clinton neo-liberals defunded that Federal agency that has existed throughout New Deal social democratic policy that served as a safety net for access for all-----whatever a citizen could not afford to pay in medical debt was paid the hospital by this Federal fund----this was a padding protecting the working class and poor that was largely defunded these several years....this is why the working class and poor are being diverted from emergency room and hospital admittance and being made to access a completely different lower-tiered set of medical clinics mostly preventative care only.
THIS IS A LONG ARTICLE BUT PLEASE GLANCE THROUGH----
March 26, 2013
Death By For-Profit Health Care
This report is part of an ongoing effort by a group of health care practitioners, lawyers, researchers, and activists to expose the disastrous impact of medical debt and for-profit health care on families and individuals in the United States. Private health care enriches a few—insurance companies, private equity firms, pharmaceutical companies, debt collectors, and global investors—at the expense of everyone else. Medical debt is a weapon of the class war because when patients cannot afford medical care, they are forced into debt, often with far-ranging and catastrophic consequences. As the rate of uninsured has grown, local governments have looked to state subsidies for private health insurance as a band-aid solution. Massachusetts has implemented such a program, and the Obama Administration’s Affordable Care Act has expanded this initiative on a national scale. Unfortunately, the ACA will not solve the problem because its primary goal is to expand the market-based system that has already proved to be a miserable failure. Insurance companies profit by denying coverage. As costs rise and benefits shrink, patients will continue to pay the price. We are in a major health care crisis, the consequences of which will be felt for decades to come. The only real solutions are: a grassroots social movement to demand universal health care, an end to the scourge of medical debt, and a national conversation on the meaning of health and wellness.
Medical Debt: A Weapon of Class War
The price of for-profit medical care is increasing at a relentless pace while quality is declining. Fifty million people have no insurance and 77 million have trouble paying medical bills (Rukavina). Despite these inequities, the US spends more on care than any other wealthy country in the world. The for-profit health care industry sucks up 18% of Gross Domestic Product, more than twice what countries that have publicly-financed health care spend. Despite the high cost, Americans are sicker and die earlier than people in other developed nations (“Shorter Lives”).
People without insurance must privately finance health care. Less well understood, however, is that medical debt is not only a problem for those without coverage. One in five adults who are privately insured struggles to pay medical bills. Even more scandalous is the fact that Americans are paying more for weaker coverage (“Shorter Lives”). According to the Commonwealth Fund, the cost of insurance has outpaced wage increases for the last ten years. Employers are shifting these costs to employees and their families. Premiums increased 62% from 2003 to 2011 (“State Trends”). For at least ten million Americans, deductibles are so high that their insurance plans are little more than scams, providing a false sense of security in hard times (Young).
The cost of health care has also risen faster than inflation. As a result, over the last few years, families have had little choice but to accept lower wages to hold on to benefits that, in the case of a serious illness or accident, may not protect them from financial disaster. For many working people, the trade-off is simple: your money or your life. If you have a job and insurance, you may feel that you are protected. But that is false. No one is truly safe from a for-profit health care industry that preys on patients and families at the most vulnerable moments. Since insurance companies and for-profit providers also fund political campaigns, we can expect no help from politicians. The best hope we have is to ally with others in our circumstances to fight back and claim health care as a human right.
We’re All at Risk
Almost everyone is affected by medical debt. The for-profit health care industry is designed to benefit a few at the expense of the rest. Debtors and non-debtors alike are forced to pay out-of- pocket for everything from basic care to life-saving operations. As patients, most of us understand instinctually that someone is making out like a bandit when we get sick. This becomes clear the minute you walk into a doctor’s office or a hospital where you open your wallet to make an up-front payment, sometimes called a co-pay, before seeing a doctor. The costs can start piling up from there, even if you have insurance. If you have a serious illness or accident, it’s unlikely that your insurance will cover all—or even most—of the care you need. What insurance doesn’t pay, you’re responsible for. Predictably, medical debt discriminates along familiar lines. According the Commonwealth Fund,
Among the working-age population, 39% of women have medical bill problems, compared with just 25% of men. More than half of working-age African Americans (52%) report medical bill problems, in contrast with 34% of Hispanics and 28% of whites (“Seeing Red”).
Although medical debt affects some more than others, it cuts across lines of class, race, and gender. In fact, rates of medical indebtedness are comparable for people with and without insurance (“Consequences”). Insurance companies make a profit by denying claims. In the words of Dr. David Himmelstein, of Physicians for a National Health Program,
Private health insurance is akin to an umbrella that melts in the rain. It simply isn’t there for you when you most need it
How long are we willing to stand under our worthless umbrellas and pray that it doesn’t rain? Many health plans don’t cover all the treatments for a serious illness or accident. Others limit the total amount of benefits or require absurdly high deductibles, putting necessary care out of reach for people who believe they are protected (“Seeing Red”). According to the Access Project, a non-profit research and advocacy organization,
Americans spent $300 billion on out-of-pocket costs in 2010; a figure over and above the cost of health insurance premiums (Rukavina).
People will say that we can’t afford universal health care, that those of us who believe otherwise are living a foolish dream. But they are wrong. The dreamers have it right this time. We’re not making an argument about affordability or appealing for the creation of what some call the “Welfare State.” We’re saying that it is time to pay attention to the overwhelming evidence that for-profit health care is killing us. It’s time to wake up from our national health care nightmare.
Eat The Young
Who is paying the price for our profit- based system? It may be obvious that low-income people pay a higher percentage of their income for health care. But the young are also at a high risk for incurring medical debt. This is because those from the ages of 19 to 29 are more likely to lack health insurance
than older Americans. Many low-wage employers that hire young adults do not provide coverage, and since the 2008 financial crisis, new college graduates have disproportionately high rates of unemployment and underemployment. Through a toxic combination of college loans, medical debt, and a recession caused by banks, many people’s financial lives are ruined before they are even out of their twenties. Is this what we want for young people in America? The evidence that publicly-funded care is far better than our current system is staggering.
It turns out, when it comes to medical debt, it is better to be over 65 and sick than to be young and healthy (Garcia). Older people actually have the lowest rates of medical debt because they qualify for government-supported programs like Medicare. From the right and left of the political establishment, we hear no end of fearmongering about “socialism” and how awful it would be if health care became a public benefit, like it is in many countries around the world. But the truth is that Americans on Medicare and Medicaid are much less likely to lay awake at night fearing that the next medical procedure will force them into bankruptcy or foreclosure. It’s time to rethink what obligations we owe to the young, what kind of promises we want to make to those who come after us, and how we intend to keep them.
Medical Debt and Bankruptcy:
The Insurance Hoax
Bankruptcy is often presumed to be the result of profligate living by consumers who overspent on luxury items. Don’t live beyond your means is common advice, as if personal responsibility is the only thing that matters in an economy that almost collapsed only 5 years ago. In fact, people are being forced into bankruptcy in America because they had the audacity to get sick without millions of dollars in the bank. Or, they believed their private health plan would protect them from the worst. By the time many realize that for-profit health care is a hoax, it’s too late. The crisis is gaining steam. Just 30 years ago, debtors rarely filed for bankruptcy as a result of a medical problem. Today, an astonishing 62% of personal bankruptcies are linked to medical debt.
The link between medical debt and bankruptcy also shatters the myth of personal responsibility that makes many of us feel as if we are to blame if we can’t afford basic needs. According to a report in the American Journal of Medicine, most people who declare bankruptcy as a result of medical debt had insurance at the time they incurred the debt (Himmelstein). Furthermore, the majority of medical debtors who declared bankruptcy attended college, owned their own home, and had middle-class jobs. They did everything “right,” yet they were still financially devastated when a member of their family got sick or had an accident.
You might think that a sharp uptick in the number of medical debtors filing for bankruptcy would prompt the government to step in. After all, no one chooses to go into medical debt. Yet, our delusional Congress assumed people were abusing the bankruptcy law when their lives were turned upside down by an unexpected medical expense. In 2005, Congress enacted the Bankruptcy Abuse Prevention and Consumer Protection Act which made it even more difficult for people to file for bankruptcy. During this same period, the number of under-insured grew from 15.6 million people to 25.2 million (Himmelstein).
To sum up the catastrophe: as a response to the rising cost of care and a growing number of Americans who cannot afford their medical bills, Congress responded by throwing up more barriers to bankruptcy. It’s not that bankruptcy is a real solution, since it does not address the fundamental economic conditions that pushed individuals to bankruptcy in the first place. The point is that our elected representatives are out of touch and out of time. They have little to offer us but moralizing and useless reforms. The only reasonable response is collective action to create a health care program that reimagines the meaning of care and puts people before profits.
Disappearing Public Hospitals
If you have ever needed medical care but didn’t have insurance, you most likely went to a public hospital or clinic. There are approximately 1,131 public hospitals in the US (Fraze). These institutions, which serve 75% more uninsured patients than their private counterparts, are a vital resource for low-income and uninsured patients. Yet, public hospitals are disappearing. Like public schools, they have been swept up in a wave of privatization: the public sector is being dismantled to create new profit streams for the superrich, most of whom have never been to the local communities from which they are siphoning wealth. If your public hospital seems disorganized and dilapidated, it is easy to assume that it is being mismanaged at the local level. Hospitals have also been caught up in the same global economic changes that are at the root of the rising cost of care and ballooning rates of medical debt.
Hospital privatization is sweeping the country, and states like New York and Louisiana are leading the way. In early 2013, Governor Cuomo announced a budget that would mark the beginning of the end of publicly-funded hospitals in New York state. He is seeking to close Brooklyn’s Long Island College Hospital and Interfaith Medical Center and replace them with private versions (Frost). The property where the hospital sits is also being eyed by developers as a location for a luxury condominium (Lutz). Shuttering LICH is a significant step that has ramifications far beyond the fate of one institution. It would set a precedent for turning public hospitals over to the private sector, a move that Assemblywoman Joan Millman called “troubling” because private hospitals have a “fiduciary responsibility to their stockholders, not their patients.” In an era when tens of millions of patients are drowning in medical debt and the number of uninsured is on the rise, officials like Cuomo actually believe the solution is to eliminate those few institutions that serve people in need to create a new market for the global investor class.
There is no better example of a clueless official who seems to reside on a different planet from his constituents than Louisiana’s Governor Bobby Jindal. In 2012, Jindal proposed funding cuts for the state’s health care programs to plug a $165.5 million budget gap. The impact on public hospitals will be disastrous, forcing them to reduce the care they provide to Medicaid patients and to those without insurance. Louisiana State University alone plans to lay off 1,495 hospital employees and cut services at seven hospitals across the state. Some buildings will simply be abandoned and left to rot (Shuler). Jindal is also planning to restructure the state’s health care system, turning several public hospitals over to the private sector. Private firms would receive public dollars to run hospitals whose first order of business is to earn returns for investors. Louisiana State Sen. Francis Thompson openly declared his opposition to the plan. “I’m afraid…we may get picked like a buzzard does a dead animal,” he said (Millhollon).
Thompson’s description is accurate. The public sector is a carcass being picked to the bone by private sector vultures. Privatization will deepen the debt crisis by forcing hospitals to focus on their credit rating, not patient care. As described below, credit rating agencies are already among the most powerful corporations in the world. Under threat of a reduced rating, hospitals will be under even more pressure to aggressively pursue medical debtors. They will also offer less care to low-income patients because the bond ratings of hospitals can be negatively impacted if hospitals provide too much charitable care. Yes, too much charitable care is a thing that exists in the world of Wall Street finance. When hospitals are privately financed, bond rating agencies determine our future (Zieger).
Another world is possible. Under a humane health care system, we would begin to ask which measures of success really matter. We would start with the big questions: what does it mean to live a healthy life and how do we get there together? But under Wall Street’s influence, hospitals are analyzed according to financial metrics, such as debt per bed and local market competition. The threat of lower bond ratings forces hospitals to hire Wall Street consultants, to cut back on purchases of medical equipment, to postpone the hiring of medical personnel, and to lay off staff. Indeed, in New York City, an investment banker named Stephen Berger has been recruited to drive the nails into the coffins of community hospitals in order to create more opportunities for Wall Street to make money (Benson). Debt starts a vicious cycle that keeps a hospital from focusing on patients. This is a kind of madness, a nightmare from which we must finally awaken.
The Debt Spiral
The madness extends beyond the walls of the hospital. Our cities and towns are being sucked dry by Wall Street and by global investors who demand a profit at any cost. In many cases, hospitals are responding to the crisis by aggressively trying to extract money from patients. It starts before patients even leave the hospital. In 2012, the Minnesota Attorney General began an investigation of Accretive Health, one the largest medical debt collection firms in the country. Documents reveal that debt collectors were allowed into hospitals where they were indistinguishable from regular hospital staff. According to the New York Times, such collectors routinely demand [that patients] pay outstanding bills and may discourage them from seeking emergency care at all.” This is a violation of a federal law requiring hospitals to provide care to anyone who needs it. In Minnesota, the mother of a child who needed surgery reported that collectors hounded her for payment before her son received care. She did not know the agents who approached her were debt collectors. “You really feel hoodwinked,” she said. These collection tactics are becoming business-as-usual. A for-profit health care system means health care is a luxury enjoyed by those who can afford it. The rest of us must beg, borrow, and endure harassment to get the services we deserve.
The debt spiral doesn’t stop with medical debt. Once the bills pile up, studies show that people borrow even more to make ends meet. As described
in the Debt Resistors’ Operations Manual, people who can’t afford medical care turn to credit cards, the so-called “plastic safety net,” to pay for daily necessities (Zandt). Thus, credit card debt, often assumed to be the result of overspending by impulsive shoppers, is actually inseparable from our for-profit health care system. Insurance companies and investors make a killing by withholding care, then credit card companies clean us out a second time by charging usurious interest rates and adding late fees to our accounts when we cannot pay. A report by the public policy group Demos, “Borrowing to Stay Healthy,” reports that
Twenty-nine percent of low- and middle-income households with credit card debt reported that medical expenses contributed to their current level of credit card debt.
Reports like these illustrate the circular logic of the debt spiral. When people can’t pay doctor bills, they often turn to other forms of credit, which compounds the problem. Because health insurance is tied to employment, a serious medical condition can limit a person’s ability to work, earn income, and remain on a health plan. Get sick. Can’t work. Lose health care. Go into debt. Take on more debt. When medical debt leads to consumer debt, it can cause dire consequences. Health Affairs researchers Robert W. Seifert and Mark Rukavina
People with medical debt are often subject to legal judgments, wage garnishment, attachment of assets including bank accounts, or liens on their homes, which can lead to foreclosure.
It might be surprising that many medical debtors own their own homes. In fact, people with medical debt and those without have equal rates of home ownership. But there is one important difference: those with medical debt are more likely to use their homes as collateral for loans or take out a second mortgage to pay the bills. There is no better barometer of our time than the fact that owning a home pushes us deeper into the debt trap. The capitalist dream has led us down a dark path. The future has been gambled away. Millions have tapped into retirement funds to pay medical debt (Garcia). The debt spiral—from medical debt to consumer debt to foreclosure and a dwindling retirement account—shatters the myth of personal responsibility. Debt is a rigged system of overlapping and mutually reinforcing types. For many, there is no exit.
The Shame of Debt
To be in debt is a shameful thing. Most of us have been made to feel like our debts are our fault, even though one in seven adults in the US is currently being pursued by a debt collector and more and more of us are in debt for basic necessities like housing, education, and health care. Medical debt is a source of shame that affects people’s overall health.
It’s quite simple, really. When people can’t afford to see a doctor, they don’t. Patients who can’t afford to pay—or who have accrued medical debt—are less likely to seek out care because they are ashamed about their debt and don’t want to end up owing more (“Consequences”). This ultimately leads to more health problems and increases the costs of care. A study in the Journal of General Internal Medicine showed that
Over two-thirds of those who either had a current medical debt or had been referred to a collection agency reported that it caused them to seek alternative sites of care or to delay or avoid seeking subsequent care when needed.
When Republicans in Congress invented a boogeyman called “death panels” during the 2008 presidential campaign, they weren’t talking about the for-profit health care industry. But they should have been. One report showed that 45% of medical debtors put off necessary care to avoid debt (Garcia). The US health care system is making people sick and keeping them that way because illness is profitable (Jacoby). Is that the kind of health care system we want? Is that the kind of world we want?
Medical Debt and the Dystopian Nightmare of Credit Scoring
If you’re wondering why you have a low credit score or why you never seem to qualify for the lowest interest rates on home, car, or other loans, the problem may be medical debt. This is true even if you paid an overdue medical bill. The Federal Reserve has shown that more than half of all collection accounts that negatively impact credit reports are medical debt (Avery). This is a result of the fact that health care costs are on the rise and tens of millions are uninsured. But it is also because medical debt is treated differently from other kinds of debt. Private health insurance reimbursement is incredibly cumbersome. Different benefits are often covered by different companies and at different rates, leading to a lengthy, circuitous billing process that often leaves patients holding the bag. If you have ever received a medical bill that you didn’t understand or that you thought your insurance was supposed to cover, you have been caught up in this Kafkaesque system. If you have ever received a letter from a health care provider stamped with the notice “This Is Not A Bill,” or if you have signed a form at a doctor’s office promising to pay anything your insurance fails to cover, you have been an unwitting victim in the tangled web of medical billing, an industry that thrives on patient and health care provider confusion. According to Rukavina,
One study found that nearly one-third of respondents let a medical bill go to a collection agency because they did not understand the bill or explanation of benefits statement. Another study estimated 14 million American adults said that a medical bill was sent to a collection agency because of a billing mistake.
Confusion is the grease that keeps the wheels of the medical collections industry turning. It’s hard not to think that billing “mistakes” may not be mistakes at all but part of an intentional strategy to keep patients in the dark and in the red. In addition to patient confusion, medical debt is more likely to end up in collection because hospitals routinely sell medical debt to debt collectors after 60-90 days of nonpayment, far less than the customary 180 days for other kinds of debt. Health care providers rarely report paid medical bills to the credit reporting agencies. So, even if you are billed in error, your health care provider may send your bill to a collection agency before you can dispute the charge (Bernard). Once in default, a medical debt stays on a credit report for up to 7 years, even if you pay the bill. Research by the Commonwealth Fund shows that, in 2010, 9.2 million people wound up in default on a medical bill because of a billing mistake (“Help”).
These mistakes have serious consequences. According to evidence obtained by the Access Project, a single paid medical bill can lower a consumer credit score by as many as 80 points. That means you will pay a higher interest rate for almost anything else you want to buy on credit, including a home or a car. The fact that a relatively small medical bill can end up costing thousands in interest charges down the line demonstrates the obscene power of the credit rating agencies. Consumer protection attorney Robert Nahoum told Strike Debt:
I’ve never seen three companies with more power over the American consumer than the top three credit reporting agencies, Equifax, TransUnion, and Experian. There’s very little consumers can do.
If patients are powerless, so are many health care providers. It’s important to note that your doctor may be just as confused as you are. Strike Debt has talked to health care workers around the country, and they tell us that they are as frustrated as patients when it comes to medical billing. Why do insurance companies and ratings agencies have so much power over our lives? Why do we live in such perpetual confusion? These questions are important to ask when we think of what it means to be healthy and what kind of economy we need to sustain life.
We might also ask why our elected officials don’t put a stop to predatory medical billing and curb the power of the ratings agencies. The Medical Debt Relief Act attempts to prohibit credit reporting agencies from listing medical debts on credit scores. Yet, even this minor reform has little chance of passing because the credit rating agencies and insurance companies are a powerful lobby in Washington. And even if the MDRA were to make it through the Senate, it only applies to paid medical bills. As usual, Congress lacks the political will to challenge the power structure that puts people in debt and keeps them that way. Debt is a tool of capitalist exploitation, and we can’t eliminate the debt without rethinking the larger economic system.
Indeed, the evidence actually indicates that if we don’t act things will get worse for patients and debtors before they get better. FICO has begun developing
a special ratings system to rank potential patients on how likely they are to pay their medical bills (Gipson). Like having a bar code tattooed on your forehead, we could be looking at a brave new world in which your credit rating determines not only whether you can obtain a credit card but whether you receive medical care when you get sick.
Who Profits from Medical Debt?
No one disputes that our health care system is for profit. But whose profit? Patients are certainly losing the health care battle. “There’s a tendency to attribute [the high cost of care] to minorities or those with severe health problems,” Matthias Rumpf of the Organization for Economic Co-operation and Development has explained. Actually, the evidence shows that
Even Americans with health insurance and those who have the highest education and income levels fall behind their counterparts in other parts of the world (McHaney).
It is clear that insurance companies, global investors, and credit ratings agencies are reaping a massive windfall. Profiteers are descending on the health care industry from all corners of the finance world. One of the largest and most profitable health care providers, HCA, runs 163 hospitals across the country. The company is also under investigation by the Justice Department for defrauding Medicare by performing unnecessary heart surgeries on unwitting patients (Koleva). And, this year, HCA was ordered to pay a $162 million fine for failing to make agreed-upon repairs to run-down hospitals in Missouri as well as for reneging on a promise to provide charity care to low-income patients.
Who is profiting from this criminal activity? HCA, which was founded by former Senate majority leader Bill Frist’s family, is primarily owned by Bain Capital, the private equity firm founded by Mitt Romney. Bain investors are not turned off in the least by how HCA treats patients. In fact, according to the New York Times,
The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall (Creswell and Abelson).
In a private health care system, nothing—not fraud or patient abuse or crumbling buildings—interferes with the relentless drive for corporate profit. In fact, the same private equity firms that control many hospitals also have a stake in debt collections companies. This means that companies like Bain Capital that own the hospital networks that put us into debt also invest in many of the firms that try to collect that debt from us. Once the web is spun, there’s no way the 1% can lose. Most of us are focused on daily life: trying to earn enough to put food on the table and care for the people we love. We lay awake at night worrying about a sick child and pray our insurance policies will protect us if tragedy strikes. Wall Street knows that few people have the luxury of paying attention to what’s really going on in their boardrooms. That is why it is more important than ever to change the conversation about medical debt and our for-profit health care system.
Won’t Obama’s Affordable Care Act Reduce Medical Debt?The fact that many liberals greeted the passage of the Obama administration’s health reform law with such delight is downright shocking when we consider its glaring inadequacies. In 2014, states will be required to create exchanges in which people can purchase private insurance. But, as PNHP physician Margaret Flowers has explained, the majority of these plans will not offer full coverage. And people who purchase insurance through an exchange will end up with plans that cover 70% or less of the cost of health care. Since even a short hospital stay can cost tens of thousands of dollars, the math is not on the side of people who don’t already have huge bank accounts. Insurance companies profit by denying coverage. Now, thanks to the Affordable Care Act, that strategy will be codified into law. Insurance companies will also gain access to a whole new market for their products while offering worthless umbrellas in return.
It gets worse. The federal subsidy that is supposed to help people purchase health insurance under the new law only applies to individuals, not families. So, depending on your income level, if you want to purchase coverage through an exchange, you’ll be left with two options: pay market rate for private insurance or go without. The people who will benefit from an expansion of our market-based insurance system are not patients. Instead, the 1%, who already control the profit-driven health care system, will get a payout every time the rest of us see a doctor. Most appalling, however, is that more than 20 million people will not be covered under the new law (Babcock).
It makes no sense to expand a failed market and demand that people participate in it, especially when we already have evidence that such reforms don’t work. In Massachusetts, for example, health care reform did not stem the tide of bankruptcies linked to medical debt (Himmelstein, “Medical”). There is simply little evidence that the ACA will do much beyond worsening an already grave labor crisis. Reports are emerging that employers, especially colleges and universities, are planning to cut employees’ hours in order to avoid offering health benefits under the ACA (Zorn).
Considering what we know, the fact that many treated the passage of the ACA as a progressive victory seems like magical thinking. As Flowers noted, public relations and marketing expenses account for more than one-third of the cost of care. Even the deficit-crazed political establishment seems to be suffering from willful blindness. According to the Washington Post, if we had the per-person health costs of France or Germany, two countries with publically-funded health care, “America’s deficits would vanish” (Klein). It’s time to follow the money and it’s time to get real. According to research conducted by Physicians for a National Health Program, a single-payer system could save $400 billion per year. Yet politicians focused on deficit reduction would scoff at the suggestion that we publicly fund health care in America.
Life or Debt?
For-profit health care kills. In 2007, in Prince George’s County, Maryland, a twelve-year-old boy named Deamonte Driver died from a toothache. He had an infection, but his mother could not afford to take him to a dentist (Otto). Deamonte lost his life because he did not receive antibiotics that would have cost $80. This is the world we live in today. What kind of world do we want? Universal, single-payer medical care would be a short-term step in the right direction. But it’s not the ultimate solution. State-financed care would give us, above all, a chance to take a step back from the relentless bills and the anxiety that comes from not knowing if we’ll be able to afford to care for ourselves and our loved ones. It would give us a chance to ask if there are really only two choices: private or public, corporate or federal. It would give us, at long last, what we really need: the freedom to ask larger questions about the meaning of health and how we can work together to provide it to ourselves, to our families, and to those who come after us. We have a difficult road ahead. But there is no doubt that the private insurance industry is wholly inadequate to the task. Our lives are in jeopardy because medical care in the US is a profit-making enterprise that enriches the few at the expense of the rest of us. Reform won’t do in the long run. Politicians do not have the will to take the necessary steps. As Dr. Steffie Woolhandler of PNHP makes clear,
It’s not your fault if you’re in debt and it’s particularly not your fault if you’re in debt because of a medical problem. This is unfair. No other developed nation forces people to go into debt because they get sick (“Time To End”).
The situation we face is not our fault, but it’s our job to take a stand together. The only real solution is a bottom-up, grassroots movement that puts people before profits. It will not be given to us by benefactors or by politicians who depend on Wall Street funding for reelection. It’s up to us. The time is now. It’s life or debt.
The Affordable Care Act builds in this advanced directives into its managed care and sees it as addressing cost of health care----now, remember, cost of health care in the US is health industry profiteering and corporate fraud----not patients accessing too much care. The costs a patient accumulates in an emergency crisis may look expensive on paper---but not be as costly as hospitals presume. Look at the considerations in this article of extraordinary care that may need to be written out in a Living Will to see---most are not costly. Families avoid to the end writing these wills because a person does not know what they want until they are in these crisis events. When a hospital requires as they do in Baltimore and Maryland that every patient has a Living Will----it is done strictly to make families consider cost and debt.
GLOBAL POLS ARE TRYING TO CHANGE A DOCTOR'S DIRECTIVE TO KEEP PEOPLE ALIVE----THAT BEING CONSIDERED DO NO HARM----TO THAT OF PATIENT CHOICE----CHOICE BEING SHADOWED BY HEALTH CARE COSTS.
People with chronic illness are particularly susceptible to wanting to 'give up' in the heat of a bad moment when working through these times often leads to years more of quality of life.
Living wills and advance directives for medical decisions
Living wills and advance directives describe your preferences for end-of-life care. These documents speak for you when you're not able to speak for yourself.
By Mayo Clinic Staff
Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.
By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.
Advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to prepare these documents.
Power of attorneyA medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for health care or a health care proxy.
The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill his or her role.
Depending on where you live, the person you choose to make decisions may be called one of the following:
- Health care agent
- Health care proxy
- Health care surrogate
- Health care representative
- Health care attorney-in-fact
- Patient advocate
- Meets your state's requirements for a health care agent
- Is not your doctor or a part of your medical care team
- Is willing and able to discuss medical care and end-of-life issues with you
- Can be trusted to make decisions that adhere to your wishes and values
- Can be trusted to be your advocate if there are disagreements about your care
A living will is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.
In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living. Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible?
Have discussions with your primary care doctor, your health care agent, family and friends about your personal wishes. Resources for organizing your own thoughts and having conversations with others about medical care and end-of-life care are available through the American Bar Association, the Conversation Project and the Center for Practical Bioethics.
You should address a number of possible end-of-life care decisions in your living will. Talk to your doctor if you have questions about any of these issues:
- Resuscitation restarts the heart when it has stopped beating. Determine if and when you would want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that delivers an electric shock to stimulate the heart.
- Mechanical ventilation takes over your breathing if you're unable to do so. Consider if, when and for how long you would want to be placed on a mechanical ventilator.
- Tube feeding supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.
- Dialysis removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.
- Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?
- Comfort care (palliative care) includes any number of interventions that may be used to keep you comfortable and manage pain, while abiding by your other treatment wishes. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe dryness, and avoiding invasive tests or treatments.
- Organ and tissue donations for transplantation can be specified in your living will. If your organs are removed for donation, you will be kept on life-sustaining treatment temporarily until the procedure is complete. To help your agent avoid any confusion, you may want to state in your living will that you understand the need for this temporary intervention.
- Donating your body for scientific study also can be specified. Contact a local medical school, university or donation program for information on how to register for a planned donation for research.
You don't need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. You can make your preferences known to your physician, who can write the orders and put them in your medical record.
If you have a living will, however, be sure to mention it it whether you have a DNR or DNI order on file.
I will look this week as well on the breakdown of oversight and accountability in medical research on medical devices and PHARMA that soared under Obama and Clinton neo-liberals as they super-sized funding to build corporate university patent mills tied to global health corporations. At the same time they are privatizing our system of universities that acted to hold power accountable by providing data that is public interest----they are subpriming all Federal laws designed to move new products and PHARMA through a vetting process before being released to the public. Now, global pols are making the American public the vetting process. In Baltimore if we are not seeing advertisements for tons of new PHARMA and devices---we are seeing these same medical products two years later in class action lawsuits for harming and killing people. THIS RARELY HAPPENED THROUGHOUT MODERN HISTORY IN THE US BECAUSE WELL-MANAGED CLINICAL TRIALS DETERMINED IF AND WHEN A PRODUCT WAS SAFE FOR THE PUBLIC.
Below you see just one of these cases-----each time I see the advertisement----I could go to the kitchen and make a cup of tea and come back and this ad would still be listing disclaimers as to how it can harm people. It also thanks THE CLINICAL TRIAL participants.....indicating a single clinical trial occurred and corporate data says it's OK to release.
THE US IS IN CRISIS OVER THE DANGEROUS EFFECTS OF THESE MEDICAL PRODUCTS ALL DUE TO DISMANTLING REGULATIONS AND OVERSIGHT.
Do you know that access to cancer treatment has been lost to most people and especially stage 4 cancer treatment---what do you want to bet the poorest will be allowed this option the first few years of this new brand name? You know---the clinical trial.
Generic Name: nivolumab (nye VOL ue mab)
Brand Names: Opdivo
What is Opdivo?
Opdivo (nivolumab) is a cancer medicine that works with your immune system to interfere with the growth and spread of cancer cells in the body.
Opdivo is used to treat a certain type of melanoma (skin cancer) that cannot be treated with surgery, or that has spread to other parts of the body. Nivolumab was approved by the US Food and Drug Administration (FDA) on an "accelerated" basis. In clinical studies, nivolumab produced complete or partial response. However, further studies are needed to determine if this medicine can lengthen survival time in people with melanoma.
Opdivo is also used to treat a certain type of non-small cell lung cancer. Nivolumab may increase the chance of a longer survival time in people with this type of lung cancer.
Opdivo is used only if your tumor has a specific genetic marker that your doctor will test for.
Opdivo is given alone or in combination with other cancer medicines. Nivolumab is sometimes given after other medicines have been tried without success.
Important informationOpdivo can cause side effects that may cause symptoms in many different parts of your body. Some side effects may need to be treated with other medicine, and your cancer treatments may be delayed. You will need frequent medical tests to help your doctor determine if it is safe for you to keep receiving Opdivo.
Slideshow: Clearing The Air: Signs, Symptoms and Treatment Options For Lung Cancer
Before taking this medicine
You should not use Opdivo if you are allergic to nivolumab.
To make sure Opdivo is safe for you, tell your doctor if you have:
- lung disease;
- liver disease;
- kidney disease;
- a thyroid disorder;
- an autoimmune disorder such as lupus, Crohn's disease, or ulcerative colitis; or
- if you have received an organ transplant.
It is not known whether nivolumab passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.
Obama and Clinton neo-liberals joined Republicans in making our Federal Medicare and Medicaid Trusts about accessing preventative care keeping people from accessing hospital care with higher costs and overnight stays. As a result we are seeing tons of advertisements for every kind of medical device that may help quality of life issues----back and knee braces to every kind of walker----marketing these as Medicare ------spending huge blocks of Medicare Trust on these items that often are replaced every few years. There is where Medicare is going as seniors are being denied vital care and PHARMA -----but the corporations selling those devices are earning billions from Medicare.
Medical Equipment Suppliers and MedicareGeneral information about U.S. medical equipment suppliers
According to industry analysts, the U.S. medical equipment and supplies manufacturing industry includes about 11,000 companies with combined annual revenue of about $85 billion. Major companies include Baxter International, Boston Scientific, Johnson & Johnson and Medtronic. The industry is concentrated: the 50 largest companies account for about 60 percent of revenue.
Medical equipment and supplies cover a vast range of tools and products for hospitals, health care facilities and homes. This includes monitoring systems, glucose meters, pumps, thermometers, syringes, blood processing devices, specialty bags, wound care, wheelchairs (electric, lightweight or standard), commodes, walkers, mobility ramps, bath benches, along with such medical supplies as catheters, adult diapers and latex gloves.
With an aging global population and rising life expectancy, demand for medical equipment and services is set to rise. According to the U.S. Central Intelligence Agency, in 2000, the number of people age 65 and older was 35 million. This figure is forecast to rise to 54 million by 2020 and to 86 million by 2050. That's a 146 percent increase in the elderly portion of the U.S. population from 2000 to 2050.
Medicare coverage for medical equipment and suppliesMedicare will cover certain types of medical equipment. In order to be covered by Medicare, medical equipment must be:
- Able to withstand repeated use.
- Primarily and customarily used to serve a medical purpose.
- Generally not useful for people without an illness or injury.
- Appropriate for use in the home.
- Likely to last for three years or more.
- Provided by specific suppliers that are approved by Medicare.
- Medically necessary for you.
Medicare also covers prosthetics, orthotics and certain supplies. Prosthetics are devices that can replace a missing body part, such as a hand or leg. Orthotics may include braces that help to support or correct the malfunction of a limb or torso.
What's not covered by Medicare?In most cases, Medicare does not cover medical supplies, like catheters, that are generally used and thrown away. However, Medicare will cover certain medical supplies, like lancets and test strips for diabetes. Some diabetes supplies are also covered under Medicare Part D. Furthermore, if you qualify for Medicare home health care, Medicare may cover certain disposable supplies, such as intravenous supplies, gauze or catheters.
Your costs for medical equipment and suppliesHow much you pay for medical equipment and supplies depends on whether you have Medicare Part B coverage and where you buy your equipment. In general, if you are enrolled in Medicare Part B, you will pay 20 percent of the approved Medicare amount after you have met your yearly deductible (if you do not have secondary insurance). You may owe little to nothing if you receive coverage through a Medicare Advantage plan. Review all the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through a Medicare-approved supplier that "accepts assignment," meaning they agree to accept no more than the Medicare-approved amount for a service.
How to choose your medical equipment supplierYou will save money if you order your items from a Medicare-approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your equipment from any store that sells it. However, if the supplier from which you order is not enrolled in Medicare, Medicare will not pay for the durable medical equipment.
There are two types of Medicare suppliers: participating suppliers and those who are enrolled, but have chosen not to participate. A Medicare-approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the approved rate. They may also ask you to pay the entire bill when you pick up your order. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait, as it may take a couple months to receive payment. If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own rules for equipment purchases.