With Charity Toward None
On the day an ambulance rushed her to a Manhattan hospital emergency room shortly after her 48th birthday, she was jobless, uninsured and having a stroke.
Ms. Rubel’s medical problem was rare, a result of a benign tumor on her adrenal gland, but the financial consequences were not unusual. She depleted her savings to pay $17,000 for surgery to remove the tumor, and then watched, “emotionally paralyzed,” she said, as $88,000 in additional hospital bills poured in. Eventually the hospital sued her for the money.
Full article on the charity care system in The New York Times.
This was so depressing to read. The image of debt collectors hounding a family with a disabled adult son who want to make right on their payment is disgusting.
We can sit here and blame hospitals for being “overly aggressive” all we want, but in the end, they’re only playing by the rules of the game to the extent that they don’t prohibit the business’s own survival. I think it was the CEO of AIG who said, at the peak of the financial crisis, “as long as the government plays the music, we have to keep dancing.” Private actors will always do their best to circumvent and avoid government obstacles to survival – that’s as true of corporations as it is of individuals. In the end, I wasn’t at all surprised to read that among the states that implement these types of systems are California and New York. It seems that whereever there’s a force for nonsensical government intervention, these two states are in the vanguard.
Healthcare policy is easily the most confusing of all areas of lawmaking. I understand the fundamental concepts, but the implementation and efficacy of various proposed solutions is impossible to grasp. It’s one of the few policy areas that truly needs a silver bullet – of course, it will never get one.
Hospitals can’t have it both ways. If they receive a subsidy to help the indigent pay then they should apply that subsidy to helping the indigent pay. The lone silver lining is that it seems hospitals are finally starting to implement a new emphasis on loan advising instead of debt collectoin.
Is especially telling that state hospitals are the most aggressive collectors.
It is problematic to give hospitals a subsidy to treat indigent patients and then expecting them to decide which patients are truly indigent and which ones can afford to pay their bills. Disproportionate share hospital payments are not really sufficient for hospitals to treat all patients who enter their doors and then claim to be unable to pay bill. On the other hand, many patients lack health coverage and cannot afford to pay out of pocket. It seems reasonable for hospitals to attempt to collect from all patients treated and then use indigent care funds to offset the cost charity care provided to those who cannot pay.
The current, government-run, health system has corrupted even the Presbyterians!
The reporter missed an obvious question: These patients are obviously not capable of paying even a fraction of their bills. What is the point of hounding them?
Despite state laws that are supposed to favor patients who cannot pay their bills, there are other laws and policies that cause hospitals to go aggressively even after bad debts that will never be paid, or they’ll have trouble getting paid by Medicare. See Carol Seifert & Robert Seifert, “Unintended Consequences: How Federal Regulations and Hospital Policies Can Leave Patients in Debt,” Commonwealth Fund (2003).
There are other questions the reporter should have asked. For example, what is the real story of the disabled son who’s insurer “unexpectedly dropped” him in 2007? This is illegal in every state and demands clarification, because the disabled son could sue for significant damages.
Even within the constraints of the current system, without radical change, I think one good step would be for the state’s charitable care budget be paid to patients who need it, rather than hospitals directly.
So she didn’t die?
I’ll take owing money over being buried any day, and the free market system is what pays for medical advances that save lives, and ultimately it is what pays for the ability of hospitals to treat people who didn’t pay their bills.
I have not one iota of sympathy for someone who complains about being alive and in debt because our healthcare system costs money, whereas in another country (that controls costs through rationing the availability of higher end services) she would possibly be dead.
I would call a saved life a success, and I know I’m paying for it when I request an itemized copy of my hospital bill and see my insurance was billed $20 for a single 200mg ibuprofen.