April 30, 2008
If you don't have the cash, don't get the disease

This WSJ article is really scary.

Hospitals are adopting a policy to improve their finances: making medical care contingent on upfront payments. Typically, hospitals have billed people after they receive care. But now, pointing to their burgeoning bad-debt and charity-care costs, hospitals are asking patients for money before they get treated.

Hospitals say they have turned to the practice because of a spike in patients who don't pay their bills. Uncompensated care cost the hospital industry $31.2 billion in 2006, up 44% from $21.6 billion in 2000, according to the American Hospital Association.

The bad debt is driven by a larger number of Americans who are uninsured or who don't have enough insurance to cover medical costs if catastrophe strikes. Even among those with adequate insurance, deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals.

The story is built around the case of a Lake Jackson woman who contracted leukemia and has had to pay tens of thousands of dollars in cash up front to MD Anderson Hospital to receive care. Read it and ask yourself what might happen to you if you were in her position.

On a related note, since many long-term illnesses are really disabilities of some kind, you might care to know what the Presidential candidates' positions are on the subject. Michael Berube explains it all to you, in detail. Check it out.

Posted by Charles Kuffner on April 30, 2008 to National news

Google "hospitals overcharging the uninsured" or anything similar and you will conclude that the uninsured is generally billed about 2.5 times more than insured patients. And hospitals are complaining that they cannot collect this and therefore want cash up front. What a joke.

Posted by: Charles Hixon on April 30, 2008 6:24 PM

Sorry; I'm sorry for individuals when life deals them a sucky hand. But, I'm tired of the assumption that healthcare businesses have a moral obligation to drive themselves bankrupt.

In what other industry would a business be considered "evil" because they require payment in advance for a good or service, after experience had shown that customers frequently default on their debt for that good/service?

I left medical practice for several reasons, but one of them was that I was tired of how many people seem to feel that my time has no value. Not only was I supposed to be delighted to deliver free service, but I was supposed to be happy to do so at 3 AM for issues that could perfectly well have been addressed during my normal clinic hours.

Posted by: Tubin on May 4, 2008 6:32 PM

"Read it and ask yourself what might happen to you if you were in her position"

That's not the question to ask though. The question to ask is whether the economic model we have for healthcare is the right one. Right now, the model we have is that we pay healthcare providers for their products and services. Or, more often, we make a bet with an insurance company that we won't get sick and then ask them to pay out when we do (for which service our premiums are raised because we had the gall to get sick). So 'tubin' is right in that sense. Why do we expect healthcare providers to give us free stuff? Because we're ill? How ill do you have to be to get free stuff? Who draws that line? Who pays that bill, because there's no such thing as a free lunch, or free medical care?

With all due respect to Charles Hixon, Google's probably not the best way to acquire reliable data about hospitals overcharging. I bet if you substituted "insured" for "uninsured" you'd get just as many horror stories.

The model sucks, is the problem. Or, rather, the current model is working as one would expect, given that it's supposed to be driven by free-market forces. Better, given that many hospitals, including M.D. Anderson, provide treatment to a great many patients who cannot pay for the services they receive. But there's a bottom to that well and apparently some healthcare providers have reached it.

We should explore other options. I'm actually all for using my tax dollars to try and provide some minimal care for everyone. I know there will be fraud and abuse in that kind of system but there's fraud and abuse now.

So you can be scared if you want. The way they treated the woman from Clear Lake was actually pretty bad. But please don't be surprised when healthcare providers, who are money making entities in the current model, do exactly what you'd expect when faced with large numbers of non-paying customers and ask for payment up front.

Posted by: noodle on May 5, 2008 4:14 PM

I just don't think MD Anderson is evil.

I realize that this is anecdotal, but MD Anderson did treat and provide pain medication for a woman who was sometime housekeeper for my family. While we certainly paid her social security fees etc as her employer, she didn't have much if any health insurance and didn't have much funding. I'm certain the hospital lost money treating her and grateful they were able to do so, so she could die in as much comfort as possible.

Posted by: NicoleAllee on May 6, 2008 4:55 PM