Wednesday, November 3, 2021

Medical Debt

I have not yet seen a pig fly, but I did recently see something I would have felt just as unlikely: a front-page story in the Rupert Murdoch-owned Wall Street Journal that could have been written by Bernie Sanders.

The headline read “$100,000 in debt: arbitrary hospital prices hit some hard.” It was the story of a hard-working South Dakota woman who died of cervical cancer after a long series of tests and treatments who was forced to use up all her retirement savings to pay down her medical debt. (Unmentioned was why this woman did not have the routine medical care that should prevent most women from dying of this disease that is easily cured when found early.) (may be paywall)

The article described the random and arbitrary nature of hospital pricing and how people with different health insurance plans might have dramatically different out-of-pocket costs for the same tests at the same hospital. It also emphasized how little control most people had over their medical costs. Many hospitals charge their highest prices to patients when a procedure is not covered by their insurance plan.

Standard right-wing dogma is that health care is “just another consumer choice,” whose pricing should be left to the marketplace. Omitted from this thinking are such factors as limited choice (the woman in the story lived in rural South Dakota with only one hospital anywhere close), the fact that very sick people are rarely in a position to negotiate prices and the incomprehensible pricing structure used by most hospitals.

Couple this story with research published this summer showing that U.S. debt collection agencies held $140 billion in unpaid medical bills last year and you have to ask why people are not out in the streets demanding change.

In part this is probably because medical costs hit the poor hardest: 35% of people living in households with an annual income below $24,000 reported skipping medical care because of cost versus 7% of all those with incomes under $180,000. The poor, with day-to-day worries about paying for food and utilities, are the least able to work for political change.

In the long run, we all pay. One in six patients with heart failure reported skipped or delayed medical care because of cost, and this was associated with higher overall spending because of increased hospitalizations.

The mark of a healthy society is how it cares for its most vulnerable citizens. By this measure, we are failing. When the dust settles in Washington, it is time to take up the cudgel again and fight for affordable care for all.

Prescription for Bankruptcy. Buy the book on Amazon


  1. The reality of who pays for healthcare is the elephant in the room of too many a politician and his/her adherents. As you noted, it is something that impacts the poor more than the average working person with insurance, at least, until it is their turn for expensive healthcare costs.

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