A massive national failure

Over the decades, the U.S. has built a Rube Goldberg contraption out of employer provided health insurance, Medicare, Medicaid, the Affordable Care Act, and some smaller bits and piece that has resulted in, officially, about 90% of Americans having insurance.

Great news! That means we can all afford the medical services we need and nobody has to go broke because they get sick or are injured in a car crash or shot by somebody exercising their Second Amendment rights! Err, no. Sadly it does not mean that. As a matter of fact, four out of ten insured adults surveyed in 2023 said they had skipped or delayed some type of care in the past year, and one in six said they had problems paying medical bills.[i] According to an investigation by KFF, more than 100 million Americans – 41% of adults – have debts for medical services. A quarter of those owe more than $5,000 and 1/5 of them never expect to pay it off.[ii]

The KFF investigation uncovered many depressing stories. A couple who were sued for $10,000 by a hospital where the husband’s leg was amputated; another who were left with $80,000 in debt after the premature birth of twins; innumerable people who have been denied services altogether because of outstanding debt. The New York Times reported recently on a large, not-for-profit hospital chain that had an explicit policy of refusing services to people with more than $4,500 in debt. The corporation’s CEO, according to the Times story, was paid $3.5 million in 2021.[iii] The main reasons for this have been mentioned here before, at least briefly: deductibles, copays/coinsurance, denial of services, coverage limits, and uncovered services. Medicaid generally has low to no deductibles or copays, but a given state may not cover specific services someone needs. We’ve already discussed the coverage gaps and limitations in Medicare. These are functions of what congress and the state legislatures have decided is best for us. But most people have private insurance – including people with Medicare Advantage plans – which requires more extensive consideration.

 

I'll discuss this next time.

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[i] Karen Pollitz , Kaye Pestaina , Alex Montero , Lunna Lopes , Isabelle Valdes , Ashley Kirzinger, and Mollyann Brodie. KFF Survey of Consumer Experiences with Health Insurance. June 15, 2023. Available at https://www.kff.org/private-insurance/poll-finding/kff-survey-of-consumer-experiences-with-health-insurance/ [Accessed June 15, 2023]

[ii] Noam N. Levy. One hundred million people in America are saddled with health care debt. KFF Health News. June 16, 2022. Available at https://kffhealthnews.org/news/article/diagnosis-debt-investigation-100-million-americans-hidden-medical-debt/. [Accessed June 15, 2023]

[iii] Sarah Kliff and Jessica Silver-Greenberg. This nonprofit health system cuts off patients with medical debt. The New York Times. June 1, 2023. Available at https://www.nytimes.com/2023/06/01/business/allina-health-hospital-debt.html [Accessed June 16, 2023.]