The Eisenthal Report has commented on my post on the governor’s chief health care advisor suggesting that hospitals be more aggressive in collecting on unpaid bills. I appreciate his input, and there’s a very useful discussion in the comments section of his post from Lynne and our own David.
Eisenthal’s main point is that bills need to be collected as a practical business matter for the hospitals, and as a matter of equity to those of us that do pay our bills; that just as rent and property taxes need to be paid, so then do medical bills.
That’s fine with me, and perfectly sensible, all things being equal. But as we know, all things aren’t equal. As David points out in the comments, one has some control over what rent one pays, and from then on it’s fairly predictable. Medical costs are wildly unpredictable — part of the unfairness of life. Lynne points out that uninsured people actually pay more on an individual basis than do insurance companies, and much more than the government. (I once had a doctor give me a "professional courtesy" discount when she realized I had a large deductible, and I would be paying for her care out of pocket.)
So, it behooves us (yes, we are behooven) to look at health care in its own unique and messed-up context. The real problem of health care is: Who’s paying for it? See, "health insurance" is really a misnomer: "Insurance" implies pooling of risk, where individuals get resources together, pay out for the unfortunate circumstances, and endeavor to encourage safe behavior. Well, we’ve got no true pooling of risk in our current system; health plans are more like memberships with benefits, like your local health club: you pay in, and you can show up. And with the rising cost and increasingly exclusionary rules of the club memberships, a lot of people simply can’t afford to buy in.
To make a long story short, the people that Tim Murphy wants to collect money from, are the people who are least likely to be able to afford it, for one or more of the following reasons:
- *They don’t have any insurance (and are therefore charged higher prices),
- **They have inadequate insurance (i.e. high deductibles and co-pays)
- They have just gone through an illness or injury which has very possibly compromised their earning ability: lost work hours, decreased productivity, etc.
I’m sure we can all think of other reasons. (Lynne has courageously told her personal story here. I am going to be collecting more personal stories and posting them here.)
Just as a practical matter of helping hospitals collect on their bills: Instead of going after the folks who are in the weakest position to pay, doesn’t it make more sense to strengthen the institutions that can pay?
I’ll have a lot more on this in the weeks and months to come. Bear with me — the wonkery can be pretty thick. But the human side is really very easy to understand, and that’s the side that RomneyCo seems to find the most elusive.
*To put this in perspective regarding our statehealth system: The adults in a family of four that makes$26,000 a year are too rich to qualify for MassHealth under ourcurrent system (cf. also here).
**The Governor’s Commonwealth Care proposal would charge families anaverage of $500/month for a stripped-down, high-deductible and – co-pay plan. Here’s the Greater Boston Interfaith Organization’s helpful proposal comparison of Romney’s and Travaglini’s plans with the Health Care Access and Affordability Act, which is being promoted by a wide variety of civic groups.
Interesting comparison at GBIO – wish I had more time to comment now, but I’m up to my eyeballs.I did want to say that $500 for a family under Romney’s proposal for stripped-down high-deductable insurance sounds like a rip-off – especially when I suspect “family” means with or without kids (another beef I have with most of the health care industry), such that those without children pay as much as those with.Why can’t the government come up with a better deal than private insurers? It makes no sense to me. At least at first glance, Romney’s plan is not much better than what’s out there on the private market. I know $500 a month is too much for my little family. That’s $6000 a year!!Thanks for keeping this discussion going. It’s an important one.
The current rate structure for the Blue Cross plans is 1.0 for 1 adult, 1.8 for two adults, 1.55 for 1 adult plus kids, and 2.36 for 2 adults plus kids. So this latter category is likely the Romney “family.” So two adults would be about $365, and a single parent would be about $320.The Romney plan is the private market. The state isn’t paying for any of it, just restructuring the current regulatory set-up to allow the (low benefit, low cost) combination.The recurring problem with the private market is that it is voluntary. So healthly people avoid buying insurance, and the average cost becomes the average cost of the sick people who subscribe.
I’ve done a trackback to a post on my blog from this morning on a report issued by the National Coalition for Health Care. If their recommendations were adopted, much of this current discussion could be pre-empted.I have one other comment on Charley’s post. I think that the among those who don’t pay their medical bills, the proportion of people who can truly afford to pay but choose not to is higher than people are conceding here. I think that it’s higher than the 10 percent cited in the study that John McDonough cited in his letter to The Boston Globe. It is these people that should be pursued, not those who are being pushed to the brink of – or into – bankruptcy.
David Eisenthal,Id everyone had insurance, we wouldn’t have to worry about pursuing those people, now would we?
PatrickA is quite right re healthy people not wanting to buy expensive, high-deductible policies like those that Romney will offer. This is what Charley means by “health insurance” being a misnomer because it isn’t true pooling of risk. The people who are likely to buy into a Romney-type plan are people who are sick or are likely to get sick. That will either drive up the cost of the plans to the point where poor people, again, can’t afford them, or it will bankrupt the insurers. It’s not sustainable. You NEED to have healthy people paying for health insurance in order for it to work.David E.: sure, people who buy health care and can pay for it but choose not to should be pursued. But I’d bet it’s hard to figure out who those people are (do you put a lien on a family’s second car, even if both parents have to drive to work?). Moreover, debt collection ain’t free – it means legal fees and substantial administrative overhead from the hospital. I’d frankly be quite surprised to learn that there are rich people out there stealing health care. Why? Because I would guess that most rich people have health insurance! Maybe I’m wrong, but I’m skeptical that this will make more than a marginal difference.
Here’s another little twist, at least from our hospital experience. Many of the people hospitals go after for unpaid bills are actually eligible for one of the Masshealth products, or Free Care, if anyone had screened them or helped them apply. But, it’s often easier for the hospital to just chase down payment from the patient, so that’s the path they take.
thai Insurance: “The Importance of Travel InsuranceBy: Karen Zastudil “thai insurance: “What Is Term Life Insurance?By: Tim Gorman “thai insurance: “How Do I Lower My Auto Insurance Premiums?By: Tim Gorman “
http://public.imi-paris.org/kennel/ banditeatquenched
I hope the event is sparkling and shines bright! I’m sorry I can’t be there. Best of luck!
Charley, you are starting to creep me out…Kidding.Where online can i get info on Health Care Access and Affordability Act. I recall an interfaith effort in late 90s for housing. It became very devisive.
Troll, thanks for indulging my literary flights of fancy… đŸ™‚ Seriously, it’s a good group of folks.You can go to Health Care for All’s summary and gorge on the policy if you like.Also, ‘BUR bobbled their mention on the radio this morning — first of all, they didn’t mention GBIO by name, and then said we were calling for universal health coverage by covering 80% of the uninsured. As you can see, this is a contradiction in terms. The bill in question is not a universal health care bill. I would guess that just about everyone in the coalition supporting the bill supports universal health care; but this bill is intended as a feasible next step.
Oh man, that’s what they were talking about this morning? I heard it on my way up to NH. Didn’t put two and two together (and since they didn’t mention the coalition by name, why would I?).You know, WBUR is really starting to go down hill…they used to be eminently listenable.
Hey Lynne,Do you know about Chris Lydon’s new show on WGBH? Eventually he’ll be broadcasting from Lowell. I bet he’d love to know about your blog.It’s called radioopensource.