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eridani

(51,907 posts)
Sat Nov 1, 2014, 04:00 AM Nov 2014

Why Americans Are Drowning in Medical Debt

Because for actual sick people, insurance is a totally useless product. Most of the bankrupted Americans had it, to no avail.

http://www.healthcare-now.org/why-americans-are-drowning-in-medical-debt

After his recent herniated-disk surgery, Peter Drier was ready for the $56,000 hospital charge, the $4,300 anesthesiologist bill, and the $133,000 fee for orthopedist. All were either in-network under his insurance or had been previously negotiated. But as Elisabeth Rosenthal recently explained in her great New York Times piece, he wasn’t quite prepared for a $117,000 bill from an “assistant surgeon”—an out-of-network doctor that the hospital tacked on at the last minute.

It’s practices like these that contribute to Americans’ widespread medical-debt woes. Roughly 40 percent of Americans owe collectors money for times they were sick. U.S. adults are likelier than those in other developed countries to struggle to pay their medical bills or to forgo care because of cost.

California patients paid more than $291,000 for the procedure, while those in Arkansas paid just $5,400.
Earlier this year, the financial-advice company NerdWallet found that medical bankruptcy is the number-one cause of personal bankruptcy in the U.S. With a new report out today, the company dug into how, exactly, medical treatment leaves so many Americans broke.



Americans pay three times more for medical debt than they do for bank and credit-card debt combined, the report found. Nearly a fifth of us will hear from medical-debt collectors this year, and they’ll gather $21 billion from us, collectively.

41 replies = new reply since forum marked as read
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Why Americans Are Drowning in Medical Debt (Original Post) eridani Nov 2014 OP
unfortunately heritage care has made actual health care nearly impossible Doctor_J Nov 2014 #1
The biggest failure of the ACA jamzrockz Nov 2014 #2
Yep. ACA does absolutely nothing concerning the cost/affordability of healthcare davidn3600 Nov 2014 #3
Except they now must, by law Doctor_J Nov 2014 #7
Only in the sense that you "must" buy a house. Recursion Nov 2014 #19
As candidate Obama said that trying to solve health care problems by mandating that people buy Bluenorthwest Nov 2014 #25
Well, not to quibble, but an outright owner with no mortgage interest to deduct Seeking Serenity Nov 2014 #33
Yes. I have a pretty good ACA plan, but the hospital facility fee for a minor 1 hr procedure Zorra Nov 2014 #37
Those out of network "assistant surgeons" are committing fraud IMO Crunchy Frog Nov 2014 #4
du rec. xchrom Nov 2014 #5
My wife has insurance UglyGreed Nov 2014 #6
K&R How bad is it? woo me with science Nov 2014 #8
ACA is going to help some people, but not the seriously sick eridani Nov 2014 #9
My experiences at hospitals in California, as truedelphi Nov 2014 #10
That kind of understaffing has probably killed more people than we'd like to know about eridani Nov 2014 #11
Which is why ACA plans all have out of pocket maximums Recursion Nov 2014 #12
$6K is a really major financial hit for most people n/t eridani Nov 2014 #13
It is but for the most middle income people it's not life changing scarystuffyo Nov 2014 #14
If you don't get subsidies for a silver plan, then the theory is you make enough Recursion Nov 2014 #15
The theory is bullshit, as befits a piece of legislation passed by millionaires n/t eridani Nov 2014 #16
Medicare costs $800 per month and has no out of pocket maximum Recursion Nov 2014 #17
HR 676 eliminates all deductibles and maxima eridani Nov 2014 #18
And I'd vote for it. Now, back to the point: Recursion Nov 2014 #20
Debt is never eliminated--it carries over to the next year n/t eridani Nov 2014 #21
so you're taking about debt from before ACA Recursion Nov 2014 #22
Now add in the next year's deductible because the episode of bad health straddled 2 years. Lars39 Nov 2014 #24
Yes, bronze plans waste money for people with chronic conditions Recursion Nov 2014 #30
It was explained in the article the OP linked to truedelphi Nov 2014 #38
So a doctor committed fraud. Not really the guy's problem Recursion Nov 2014 #39
Are you kidding me? truedelphi Nov 2014 #41
Most people pay 104.90 per month for Medicare, not $800. Bluenorthwest Nov 2014 #26
That's the full unsubsidized Part A and Part B premium Recursion Nov 2014 #28
My fiancee is on disability, which only pays about a little, and out of that, a little over 100... Humanist_Activist Nov 2014 #32
Those limits only really help those with acute medical problems, those with any type of chronic... Humanist_Activist Nov 2014 #23
Except for the fact that prior to ACA the patients with chronic problems had no insurance at all... lumberjack_jeff Nov 2014 #27
Which is why bronze plans are bad ideas for people with chronic conditions Recursion Nov 2014 #29
Except when they can't afford the premiums for those plans, and subsidies can't cover the loss... Humanist_Activist Nov 2014 #31
Give me an example Recursion Nov 2014 #34
The lack of subsidy makes it unaffordable, and i'm not being entirely fair... Humanist_Activist Nov 2014 #36
My PPO is going up $50 a month next yr. PasadenaTrudy Nov 2014 #35
My wife has a host of ailments... SomethingFishy Nov 2014 #40
 

Doctor_J

(36,392 posts)
1. unfortunately heritage care has made actual health care nearly impossible
Sat Nov 1, 2014, 06:37 AM
Nov 2014

It did two things to wreck any chance of reform: locked big insurance in to the system, with guaranteed profits of hundreds of billions of dollars per year, and got a lot of dinos/kool aid drinker/tiger beat to cheer for yet another republican policy. Sickening.

 

jamzrockz

(1,333 posts)
2. The biggest failure of the ACA
Sat Nov 1, 2014, 06:42 AM
Nov 2014

is the fact that they did not aggressively address cost of medicine in this country. At the present cost of healthcare, I don't think there is enough money in the US to take care of everybody who needed help. Is it no wonder people are still filing for medical related bankruptcies.

 

davidn3600

(6,342 posts)
3. Yep. ACA does absolutely nothing concerning the cost/affordability of healthcare
Sat Nov 1, 2014, 08:13 AM
Nov 2014

Many of these insurance plans that people have are useless. They can't use them because of massive deductibles. They might as well not even have insurance.

 

Doctor_J

(36,392 posts)
7. Except they now must, by law
Sat Nov 1, 2014, 01:36 PM
Nov 2014
They might as well not even have insurance.


They're now being forced to buy policies that are useless to them. I have to grudgingly tip my hat to the insurance and drug industries for pulling off the biggest robbery in history.

Recursion

(56,582 posts)
19. Only in the sense that you "must" buy a house.
Sun Nov 2, 2014, 08:11 AM
Nov 2014

You pay higher taxes of you don't have insurance, just like if you rent. I still don't see why people are fine with the one but not the other.

 

Bluenorthwest

(45,319 posts)
25. As candidate Obama said that trying to solve health care problems by mandating that people buy
Sun Nov 2, 2014, 10:54 AM
Nov 2014

insurance is like trying to end homelessness by mandating that everyone has to buy a house.

And by way of reality, you get a deduction not for owning a house, but for having a mortgage on a house. A renter and a deed holder have the same tax situation, housing wise. A mortgage holder gets a deduction on the interest, not on the property.

Seeking Serenity

(2,858 posts)
33. Well, not to quibble, but an outright owner with no mortgage interest to deduct
Sun Nov 2, 2014, 12:16 PM
Nov 2014

still does get to deduct his property tax, something renters don't get.

Zorra

(27,670 posts)
37. Yes. I have a pretty good ACA plan, but the hospital facility fee for a minor 1 hr procedure
Sun Nov 2, 2014, 01:53 PM
Nov 2014

(for a benign growth that is somewhat painful at times) turned out to be $8,000. My deductible is totally paid. I am responsible for 20% of the total cost, which would have been around $1600 out of pocket.

The surgeon's fee was separate, and was only a bit more than $750.00, and that would have only been $156 out of pocket, totally affordable for me.

Combined with testing and other expenses related to the procedure, my total out of pocket expenses would have been over $2000.

And I had to spend many hours just trying to find out how much it was all going to cost. Hospitals and other medical facilities don't like to let people find out how much services cost, because they don't want people comparison shopping and causing competition among facilities that would cause them to lose profit. And the hospital was really nasty to me because I was trying to find out these costs, and made it difficult for me to get an answer.

They don't tell people what everything is going to cost so they don't lose business, and then people go into sticker shock when they get their bill.

I had to cancel the surgery (because the hospital costs, the middleman, made the procedure way too expensive).

We need a system like Canada has, end of story. The privatized healthcare and healthcare insurance industry must die.

Crunchy Frog

(26,761 posts)
4. Those out of network "assistant surgeons" are committing fraud IMO
Sat Nov 1, 2014, 08:19 AM
Nov 2014

and should be prosecuted, or at least not reimbursed.

Maybe the system should be further reformed by banning the in network/out of network distinction.

UglyGreed

(7,661 posts)
6. My wife has insurance
Sat Nov 1, 2014, 08:37 AM
Nov 2014

through her work, but we are still in debt because of my many troubles. I try not to go to the doctor because I feel guilty adding more stress and financial problems.

woo me with science

(32,139 posts)
8. K&R How bad is it?
Sat Nov 1, 2014, 01:40 PM
Nov 2014
Medical Debt: A Curable Affliction Health Reform Won’t Fix
http://www.pnhp.org/news/2013/june/medical-debt-a-curable-affliction-health-reform-won%E2%80%99t-fix

The high frequency of medical bankruptcy was often cited by advocates of health reform during the debate over the ACA. Yet the debate largely ignored the fact that most medical debtors actually have coverage. In order to protect Americans from bankruptcy, coverage must be truly comprehensive, that is, it must cover virtually 100 percent of all needed medical care. Unfortunately, the insurance policies mandated under ACA are required to cover only 60 percent of expected health-care costs.



http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/

56 MILLION Americans under age 65 will have trouble paying medical bills.

Over 35 MILLION American adults (ages 19-64) will be contacted by collections agencies for unpaid medical bills.

Nearly 17 MILLION American adults (ages 19-64) will receive a lower credit rating on account of their high medical bills.

Over 15 MILLION American adults (ages 19-64) will use up all their savings to pay medical bills.

Over 11 MILLION American adults (ages 19-64) will take on credit card debt to pay off their hospital bills.

Nearly 10 MILLION American adults (ages 19-64) will be unable to pay for basic necessities like rent, food, and heat due to their medical bills.

Over 16 MILLION children live in households struggling with medical bills.

Despite having year-round insurance coverage, 10 MILLION insured Americans ages 19-64 will face bills they are unable to pay.

1.7 MILLION Americans live in households that will declare bankruptcy due to their inability to pay their medical bills.

Three states will account for over one-quarter of those living in medical-related bankruptcy: California (248,002), Illinois (113,524), and Florida (99,780).

To save costs, over 25 MILLION adults (ages 19-64) will not take their prescription drugs as indicated, including skipping doses, taking less medicine than prescribed or delaying a refill.



[font size=5]CORPORATE MONEY OUT OF OUR PARTY[/font size]


eridani

(51,907 posts)
9. ACA is going to help some people, but not the seriously sick
Sat Nov 1, 2014, 10:33 PM
Nov 2014

What people think they know about the insurance that they have is like what they think they know about whether their fire extinguishers are any good. The 85% who account for 15% of all health care costs are never going to know.

truedelphi

(32,324 posts)
10. My experiences at hospitals in California, as
Sun Nov 2, 2014, 12:51 AM
Nov 2014

A privately hired, home health aide taught me that most people don't criticize the hospital care they receive even if it is killing them.

A large percentage of the people who hired me were doctors or nurses. Believe me, they know when they are getting the wrong medicine combinations.

Or the wrong procedure suggested. (Assuming they are conscious, of course.)

But the average Joe Schmoe and his family, as long as the nurses' aides are freiendly and outgoing and cheerful, they just assume that the fate the family member may suffer is their fate. And not related to he fact that

One) before Hospitials in California became all-Corporatized, for-profit insitutions, circa 1994 or so, there were more nurses per floor. They had far more training than a nurses' aide.

Two) Although state laws came about and dictated that hospitals must now have X amount of nurses on a floor, hospitals hire nursing agencies to supply those workers, so they can keep the costs down. And believe me, a travelling nurse who doesn't know where the medicine cabinet for the floor is, or where the keys are to it, spends a lot of her time looking for things rather than daling with patients. And she won't be there tomorrow, so even if she does manage to get to know some patients, she will be at a different facility the next day!

Three) The vaguaries of health insurance. For instance, your policy may let you have a needed quad bypass for yr heart, but that same insurance may force you to pay for the anti infection anti biotics that are needed post op out of pocket. If you don't have that $ 6,000, you may die. But oh well, at least the heart surgeon got to have that $ 80,000 for the heart procedure. Gives new meaning to "The operation was a success, byut the patient didn't live to tell about it."

eridani

(51,907 posts)
11. That kind of understaffing has probably killed more people than we'd like to know about
Sun Nov 2, 2014, 02:21 AM
Nov 2014

Saw an artivle about it last wwek, but can't find it now.

Recursion

(56,582 posts)
12. Which is why ACA plans all have out of pocket maximums
Sun Nov 2, 2014, 02:24 AM
Nov 2014

Even with the bronze plan you can't end up owing more than $6k in a single year.

 

scarystuffyo

(733 posts)
14. It is but for the most middle income people it's not life changing
Sun Nov 2, 2014, 02:37 AM
Nov 2014

They can swing it

I think the biggest problem is finding doctors who accept many of the insurances .

When you find the closet one he's a hour drive away

Recursion

(56,582 posts)
15. If you don't get subsidies for a silver plan, then the theory is you make enough
Sun Nov 2, 2014, 06:54 AM
Nov 2014

that $6k won't drive you to bankruptcy.

It's possible the formula needs to be tweaked, but that's explicitly the logic behind it. Bronze plans are there to prevent bankruptcy by limiting single-year liability.

Recursion

(56,582 posts)
17. Medicare costs $800 per month and has no out of pocket maximum
Sun Nov 2, 2014, 07:46 AM
Nov 2014

And only coinsures for non-hospital treatments.

Are you really sure giving everybody that is better?

eridani

(51,907 posts)
18. HR 676 eliminates all deductibles and maxima
Sun Nov 2, 2014, 07:51 AM
Nov 2014

When I went on old unimproved Medicare, my health care expenses dropped 80%.

Recursion

(56,582 posts)
20. And I'd vote for it. Now, back to the point:
Sun Nov 2, 2014, 08:13 AM
Nov 2014

How did the patient in your OP get more than $6k in debt in a single year? You still haven't explained that.

Lars39

(26,146 posts)
24. Now add in the next year's deductible because the episode of bad health straddled 2 years.
Sun Nov 2, 2014, 10:48 AM
Nov 2014

What can easily be dismissed as just $6,000 has grown to $12,000 to $15,000, including previous medical debt. This is the reality a lot of people are facing.

Recursion

(56,582 posts)
30. Yes, bronze plans waste money for people with chronic conditions
Sun Nov 2, 2014, 11:51 AM
Nov 2014

Before 2010, the yearly limit your condition could cost you was infinity.

Now it's $6000 (or actually $6600 I think).

If you're regularly spending that year after year, a bronze plan is a bad idea for you. You'll save money with a silver or better plan.

truedelphi

(32,324 posts)
38. It was explained in the article the OP linked to
Sun Nov 2, 2014, 09:57 PM
Nov 2014

An operation was approved, by the Big Insurer that the patient had as their Insurer.

The doctor was approved. But the doctor had some assisting doctor come along to particpate and that assisting doctor was not part of the network, but had a price tag of over 100K as part of their charges for participating in the operation.

So the patient now has over 100K of debt to deal with.

Now many middle class people would not be bankrupt - they would simply have to empty out the retirement savings in order to cover that cost. (I was just reading about a week back that most people oover 55 have an average of 45K in retiremnet. Why? Well, this is a group of people who have lost out big time in terms of the housing crisis of 2006, and then the stock down turn and economic implosion of 2008. )

But the next time it happens to them, they will be bankrupt.





Recursion

(56,582 posts)
39. So a doctor committed fraud. Not really the guy's problem
Sun Nov 2, 2014, 10:01 PM
Nov 2014

Yes, criminals are irritating, but that charge won't actually make it through any legal challenge.

truedelphi

(32,324 posts)
41. Are you kidding me?
Mon Nov 3, 2014, 04:06 PM
Nov 2014

The Big Insurers have a gazillion laws on the books that allow them to operate as racketeers.

And sure, if the person who is afflicted like this is a lawyer or has a close family member who is a lawyer and the family member handle the case for them, fine.

But usually, you cannot in this day and age get anyone in the nation with the proper legal credentials to get you through court if your lawsuit involves going up against the Big guys (Banks, Big Insurance etc.)

Recursion

(56,582 posts)
28. That's the full unsubsidized Part A and Part B premium
Sun Nov 2, 2014, 11:43 AM
Nov 2014
http://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html

Most seniors (practically all for Part A) receive a subsidy from the Trust Fund they paid into, but younger hypothetical enrollees wouldn't.
 

Humanist_Activist

(7,670 posts)
32. My fiancee is on disability, which only pays about a little, and out of that, a little over 100...
Sun Nov 2, 2014, 12:13 PM
Nov 2014

dollars is paid to Medicare a month. Due to her disability, we are accumulating the bills, the only saving grace being that the hospitals/etc. can't really do much more than go to collections, and they can never touch her disability, so medicare pays 80%, we are supposed to pay 20%, and sometimes we make arrangements to try to pay off the bills, but when you are making 10 dollar a month payments, but getting hit with 100 dollar bill doctor visits at least 3 times a year, the point becomes kinda moot. So we ignore most of the bills, because we have to eat. :shrugs:

Technically she is covered by both Medicare and Medicaid, but, because the expansion never took place here, there's a spenddown of about 300 a month on Medicaid for her.

 

Humanist_Activist

(7,670 posts)
23. Those limits only really help those with acute medical problems, those with any type of chronic...
Sun Nov 2, 2014, 10:43 AM
Nov 2014

condition are fucked, because their debts from the previous year, even if only 6 grand, will carry to the next year, where they get hit with another 6 grand of debt. And so the cycle continues.

 

lumberjack_jeff

(33,224 posts)
27. Except for the fact that prior to ACA the patients with chronic problems had no insurance at all...
Sun Nov 2, 2014, 11:39 AM
Nov 2014

... this might be a valid point.

This entire thread is overstated. Yes, $6000 is a nontrivial amount of money to come up with for that open heart surgery. Yes, the ACA isn't perfect because of the overlapping profusion of medical plans drive up the odds that a given doctor won't be in your network.

But claims that it's worse than before, or that it does nothing for costs are hyperbolic nonsense.

Recursion

(56,582 posts)
29. Which is why bronze plans are bad ideas for people with chronic conditions
Sun Nov 2, 2014, 11:49 AM
Nov 2014

They're intended for young healthy single people in case they catch on fire or get hit by a bus. People with chronic health conditions will pretty much always save money with a silver or higher plan.

 

Humanist_Activist

(7,670 posts)
31. Except when they can't afford the premiums for those plans, and subsidies can't cover the loss...
Sun Nov 2, 2014, 12:06 PM
Nov 2014

or they are in one of those states that have yet to expand medicaid.

Recursion

(56,582 posts)
34. Give me an example
Sun Nov 2, 2014, 12:22 PM
Nov 2014

Give me an example of an income level where the subsidy makes silver unaffordable.

(I'll grant you people under the raised Medicaid limit in states that refused to expand Medicaid; that was clearly contrary to the intent of the law.)

EDIT: -aid, not -are, obviously...

 

Humanist_Activist

(7,670 posts)
36. The lack of subsidy makes it unaffordable, and i'm not being entirely fair...
Sun Nov 2, 2014, 12:40 PM
Nov 2014

Well, OK, technically I am, but we will use me as an example, my work offers a silver equivalent plan for me, so I'm required to use it, since the premium(for an individual) barely squeaks under the limit allowing me to go on the exchange, its affordable for me, barely, as far as premiums and regular doctor visits go, as long as you only go to a few. But at 12 bucks an hour, I cannot afford to pay a lot more if something happened to me, medical-wise.

I have a potentially acute condition that could theoretically get worse, a pinched nerve in my shoulder, but it requires surgery to fix, I work an office job, so don't need to lift things, so I just deal with the pain. At my pay, I simply can't afford the surgery, considering much of my pay already goes to help my fiancee's medical problems, and no, adding her to my plan would triple the premium, which is already 70 dollars a paycheck, 140 dollars a month.

Am I saying my plan is useless? No, its awesome for preventative care, standard checkups, vaccinations, etc.

I just hope I don't get sick.

PasadenaTrudy

(3,998 posts)
35. My PPO is going up $50 a month next yr.
Sun Nov 2, 2014, 12:23 PM
Nov 2014

Time to look for another plan! This one meets the ACA requirements and is basically a Platinum level plan. I turned 50 this year, so things are going to really get pricey now I guess. Time to downsize

SomethingFishy

(4,876 posts)
40. My wife has a host of ailments...
Sun Nov 2, 2014, 10:05 PM
Nov 2014

and we are racking up the bills. Damn shame too because we have no mortgage, we own our car, we have no credit cards and no credit card debt..

She's on Medicare/Medicade but it pays only 80%. Now 20% wouldn't be a lot if we lived somewhere where they didn't charge $80 for a box of Kleenex, but there you have it. She had chest pains awhile back, we rushed her to the emergency room, 4 hours later they figured out it was a bad gas attack. The bill, including all the tests and everything was over $20,000. The Doctor told me to make sure I went through the bill with a fine tooth comb because they were going to try to stick me. That's when I found the $80 box of Kleenex. It was listed on the bill as M.R.S. $80 Yeah.. M.R.S. Mucous Removal System, fucking tissues.

But hey, we have the greatest health care system in the galaxy!

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