Teaching Orwell’s 1984 always affords me with the opportunity to discuss politics and economics with my Honors 11 students. I don’t share my political beliefs, but I actively push them not only to share their own but to identify the assumptions underlying their opinions. This semester, one student I particularly like and respect talked about how welfare tends to be exploited by people who should just buckle down and work. Welfare, many of my middle-class suburban students think, compensates the poor for their flawed system of values and
consistently bad decision-making. Before we could explore the assumptions supporting that conclusion, one of his classmates, whose family had at one point used WIC, blasted him. Both of their families had suffered difficult, financially debilitating divorces.
When it comes to politics, I don’t go past encouraging students to investigate their assumptions. And in this case, the opportunity for dialogue was lost. But if we were to discuss this topic again (at this point it’s unlikely since we’re now reading Hamlet), I would bring up the fact that life is rigged against the poor, not just economically, but legally. Too often they don’t have a chance to make bad choices.
On the eastern edge of St. Joseph, Missouri, lies the small city’s only hospital, a landmark of brick and glass. Music from a player piano greets visitors at the main entrance, and inside, the bright hallways seem endless. Long known as Heartland Regional Medical Center, the nonprofit hospital and its system of clinics recently rebranded. Now they’re called Mosaic Life Care, because, their promotional materials say: “We offer much more than health care. We offer life care.”
Two miles away, at the rear of a low-slung building is a key piece of Mosaic—Heartland’s very own for-profit debt collection agency.When patients receive care at Heartland and don’t or can’t pay, their bills often end up here at Northwest Financial Services. And if those patients don’t meet Northwest’s demands, their debts can make another, final stop: the Buchanan County Courthouse.
From 2009 through 2013, Northwest filed more than 11,000 lawsuits. When it secured a judgment, as it typically did, Northwest was entitled to seize a hefty portion of a debtor’s paycheck. During those years, the company garnished the pay of about 6,000 people and seized at least $12 million—an average of about $2,000 each, according to a ProPublica analysis of state court data.
Many were uninsured Heartland patients who were eligible for financial aid that would have eliminated or drastically cut their bills. Instead, they were charged full price for their care, without the deep discounts negotiated by insurers, according to court records, interviews and data provided by Heartland. No other Missouri hospital sued more of its patients.
Blue collar workers, Walmart cashiers, nursing home aides, clerical staffers—these types of patients have long been the most vulnerable to unexpected debt. They can’t afford insurance, yet they’re not poor enough for Medicaid. Even after the 2010 Affordable Care Act, about 30 million Americans remain uninsured, in part because some states, like Missouri, have not expanded Medicaid to cover more of the poor.
Earlier this year, ProPublica and NPR reported that the wages of millions of U.S. workers are diverted to pay off a variety of consumer debts. Most states, like Missouri, allow creditors to take a quarter of after-tax wages—an amount that government surveys show is unaffordable for lower-income families.
Consumer advocates say the laws governing wage garnishment are outdated and overly punitive, regardless of the debt’s source. But the consequences are especially dire when garnishment is used to collect unavoidable health care bills—with interest and legal fees piled on.
Utterly terrible and a loophole in ACA that should be immediately corrected. If only we could amend it to close these loopholes and add a public option without re opening debate on ACA itself….
“Many were uninsured Heartland patients who were eligible for financial aid that would have eliminated or drastically cut their bills. Instead, they were charged full price for their care, ”
Why is THAT? If they were eligible, why the upcharge?
BTW, this happened here as well until MA health care reform, which was designed to bail out the free care pool, not provide universal coverage. Garnishment of wages for debt is legal.
It’s a stupid loophole that shows just how terribly run and inefficient private health care can be. In many cases these garnishment a were occurring for decades to pay off substantial bills-it’s not like the hospital needs or will really get much money off of these garnishment a. It’s not even freed-just gross negligence and incompetency that leads to suffering for many . In fact, the hospital likely stands to save money on legal fees and processes and by writing off these patients as part of the pro bono pool. I see no logic involved here. I am also not sure how to design a regulatory fix that solves for this specific issue or solves for the bigger problem it is a part of. Short of course, of a wider health reform.
Is there no one that can settle a debt for hardship? Even the IRS has provisions for offers-in-compromise.
Incidentally, I learned the other day that the Massachusetts Department of Revenue can now take a license to drive from an individual incurring back taxes so the errant taxpayer is handicapped in the effort to seek employment. Limiting the ability to pay. Is DOR a tax collection agency or the avenging angel of the State? Is it better to collect a portion of a debt or drive the debtor (and family) to homelessness?
Where’s the good judgement?
“When critics sit in judgment it is hard to tell where justice leaves off and vengeance begins.” –Chuck Jones
Because revenue, not heath, is what drives the American medical model. When we consider health care to be “part of the economy” and we salivate when the economy rises, we encourage doctors, administrators, and CEO’s to “rake in the money”, not cure the sick in our hospitals and clinics.
I was eligible for a discount at a popular clothing store when I bought a pair of chinos but missed the fact that a “20% Off” coupon was readily available in the flyer that was at the entrance. Is the store cashier obligated to tell me about the coupon? Nope. Is the store focused on outfitting me with clothing? Nope. The store, and the hospital are focused on profits.
From a past acquaintance of mine, a fellow blogger who tell the story of a hospital CEO taking in $4.4 million in salary while his “non profit” hospital has teenagers begging outside Stop & Shop to raise money for the hospital.
Sloan-Kettering asks for donations, pays CEO 4.4 million
I think it has an extra http in the front of its URL.
http://open.salon.com/blog/dr_evan_levine/2011/05/15/sloan-kettering_asks_for_donations_pays_ceo_44_million
to learn that much of what we all have or lack thereof is simply a matter of chance; what Albert Camus called “the benign indifference of the universe” (a favorite quote of mine).
The time and place of our birth, our family and our community are the largest predictors of our life’s outcome (rare exceptions noted) as is proven statistically in the USA by our lack of social mobility. Born poor? Die poor. Boor rich? Die rich.
Mitt Romney’s advice to kids saddled with college debt was to “borrow from your parents” or as he had it, sell off your stock portfolio with care.
Like famous libertarians such as Grover Norquist and John Stossel and our own Jay Severin, these children are born into a great deal of privilege and assume that anything they achieve from there is the result of their hard work, moral path, and some would think, God’s will.
The problem for these suburban students and conservatives in general is that admitting that life is unfair demands that they take down their achievement trophies and spend time helping others, and that’s not as much fun, or so they are told.
Our national ideology from the beginning has been that you should in fact be able to be born poor, but die rich. People seem to forget, however, that there are certain policy choices that have to be made in order for this to be possible.
The only problem is it’s working against the labor class, not for it. As Elizabeth Warren famously said, the middle class (AKA the self supporting labor class) is getting hammered by “certain policies”.
We need to make economic security a campaign issue. I was born into a middle class family. All I ever wanted was the same as my parents had. Sure, I bought a lottery ticket or two, but all I wanted was much the same: a comfortable life and a secure retirement. Those are no longer as certain for today’s middle class.
There’s plenty of social mobility where the middle class is concerned — with tens of millions of Americans thrust into the permanently unemployable or Working Poor during the past 40 years, and especially since the Great Recession.
Not too many people are rising into the Middle Class, Upper Middle Class or 1%, though. Those are facts well born out by numerous studies, now. All those in my parent’s generation had to do was go to college and they could rise in the ranks — and in my grandfather’s generation, all they had to do was get a job at the GE to live a healthy middle class lifestyle.
Now I have hardworking friends and family with college degrees working at the GAP or as teacher’s assistants and living with parents well into their 30s, and I have family retiring into poverty because our system has collectively decided that since our seniors are no longer ‘productive’ they don’t matter.
The corporate and Republican notion of Social Mobility is downward for all but the exceptionally rare few.
That’s the common response from Republicans and their ilk when one points to our shrinking middle class and collapsing numbers of laborers who are no longer able to support themselves and their families in a manner compatible with the majority of society. “It’s a global economy” is shorthand to say that corporate interests trump national interests when it suits the rentier class but not when it does not. It means that labor (and that’s most of us) must compete with the lowest common denominator on a global scale. It does not mean, however, that while all the developed nations have universal single payer health care, we should too nor does is mean that while CEO pay pales in comparison to CEO earnings across the globe, ours should as well.
In other words, “It’s a Global Economy” is pure bunk.
There IS a global economy – not a whole lot we can (or IMO should) do about that. We should call out the things you mention toward the end of your comment and also say that global economy means some semblance of global standards. I also think we should applaud, rather than resent, people in other countries getting jobs.
the United States should enact taxes to take away the cost advantages that businesses get by making products that pollute in China, causing cancer for children, which they could not do here.
Likewise, food imported from Mexico where children harvest it should have a tax on it.
Likewise, clothing made cheaply by companies that let roofs collapse on human beings in Bangladesh should have taxes on it.
Businesses who are unethical in practices like these should have their practices curtailed by a government enforcing a free, fair market.
Some things, like human safety, health, and dignity, are not for sale.
I was thinking of such things like environmental regulations and child labor laws.
If all we are interested in is protecting corporate profits, sure, let’s sign one trade agreement after another. But what about protecting American jobs, clean water, clean air? The wealthy business owner with his summer home on the Connecticut River in Old Lyme closes his factory up river because it’s too expensive to produce sneakers and not toss the waste into the river, a practice that pollutes the water and leads to a spike in birth defects, so he moves it to China where he can make cheap sneakers and not worry about birth defects or spoiling the value of his summer home on the river? He gets protected. His profits get protected but the American laborer and the Chinese citizens are unprotected.
…who missed my reference to global standards.
Gramps worked at the GE and went to college on the GI. My parents both had low paying but good benefits jobs in the government with decent unions and pensions. I am hoping to get into teaching while the wife to be pursues nursing. We are desperately hoping both occupations can bring me back to MA and away from the stagnant swamp of IL. But it’s so bloody hard. Everyone is co housing and working at wages far lower than what we expected with our “elite” educations.
The eye examiner at LensCrafters was shocked I was a U Chicago grad living with my fiancées parents-but it’s where we are. She was already contemplating an MA since she knew her BFA from SCAD was next to worthless. That’s where we are in America.
I’m reminded of that great West Wing episode where Josh and Toby talked to the dad taking his daughter to Notre Dame. “I don’t want a handout-just want it to be a little easier”. That’s all we gotta do. Warren gets this. Franken gets this. Brown (D-OH) gets this. Deval at his best got this. Baker got this rhetorically (even if policy wise he will make things worse). Time to take that agenda on for the national party. It’s way more important to our future than ISIS, Ebola, Korean hackers or the next big fear.
Caritas Christi and it had it’s own billing scam going.
All the hospitals in the system we required to use CC collection service, a service which kept 90% rather than the customary 50% of what they collected. This funnelled huge sums up to the parent organization and away from the eyes of regulators and allowed lavish spending and large salaries, some of which ended up in the Globe as a result of scandals. The hospitals meanwhile were deprived of funds that could have helped or otherwise improved services.
Another example of the “nonprofits are better than for-profits” myth- they all will cheat if given a chance.
As I’m sure you know, at the beginning of Act V of Hamlet, the gravediggers, having been tasking with digging a grave for Ophelia, argue about the dispensation given to suicides (in this case a christian burial) who are rich and how this dispensation would not happen if she had been poor. They come to the conclusion that the rich “have leave to hang or drown themselves” not available to the rest of us. So, maybe, the topic can come again…
St Judes hospital provides world class free care (the Shriners also) and never asks patients for a nickel. Why don’t the liberal progressives (you can ask Oprah and Buffet to help) endow hospitals where those who choose not to, or can’t pay can go for treatment. Start here in Mass and become an example for the rest of the country. It can become a holiday tradition to donate, Warren can donate time for fundraising speeches.
…at least for emergency and essential care, but it should be publicly rather than privately financed.
Every hospital runs like that in Britain at a lower cost thanks to publically funded national health insurance. Every Briton can walk into a hospital knowing they will not be burdened financially for the care they need, nor will they burden their family. That’s the only way to get every hospital to run like that, it shouldn’t be a privilege or a charity case but a right for all citizens. Or you really want that style of care for every American start voting for the party that has been advocating for it since 1946.
jconway, don’t be a hater, its an idea. I’m curious since I don’t know, how about illegal aliens, or aren’t there any in Merry Old England?
It seems to me if someone is sick or injured, you heal them without asking a whole lot of questions.
And that is the response I would expect from a true progressive. But the reality of the world is that someone pays for everything. If liberals are willing to draw their line in the sand and say all citizens should get free care (but not illegals) there is little difference between my contention that those who pay for it should get care, those who don’t will have to rely on charity. It’s just a matter of where you draw the line in the sand.
End corporate welfare and subsidies, close loopholes, rollback the Bush tax cuts, roll back the military budget to pre-9/11 levels since Osama is dead and we won the war, end the bank bailouts, repeal TARP, and then if we still have a deficit we can talk about cutting services for the poor and the “illegals”. Plenty of fictional “legal persons” can get their benefits cut and stop eating at the public trough before we start talking about actual people losing their benefits.
When I had to have hip surgery last year I naturally wanted to do it at New England Baptist Hospital and got some recommendations for surgeons from someone who works there. But none of them — none — took my health insurance for which I was paying about $675/month. I couldn’t believe it, especially since my Boston real estate tax dollars support NEBH and all its prime Mission Hill property.
How could this be so? All of the surgeons are in private practices, that’s how. To add injury to injury. the surgery, which I had done at another Boston teaching hospital, didn’t go well and I’ve just had knee surgery to repair what wasn’t broken before my hip surgery.
One thing that’s certainly broken is the health care industry. Oh how I wish we had nominated Don Berwick and had a governor who was not from the very industry. I hope he proves me wrong.