Friday, March 6, 2020

What if your loved one couldn’t pay their healthcare bills?

If you read my blog, you know I believe that the United States has the best doctors and nurses in the world; however, they work in a system that spends at least 40 percent more per capita on healthcare than all other countries. So, when an individual gets sick in our country, depending on his or her health insurance, it is very easy to end up with significant out-of-pocket expenses.

There are several groups of patients who are covered by programs that have little or no out-of-pocket expenses. This is often called “first dollar coverage.” Medicaid, a federal and state program, covers low-income patients and disabled patients and Kaiser Permanente offers a similar program. Veterans’ medical expenses are covered through the Veterans Administration (VA). The technical definition of “socialized medicine” is healthcare provided by the government. Like the National Health Service (NHS) in England, the doctors, nurses and other clinicians serving the VA are all federal government employees.

Medicare, the U.S. program that covers citizens over the age of 65 (and a few other groups, like those with end-stage renal disease), has out-of-pocket expenses, so Medicare beneficiaries can opt for Medicare Advantage (HMO) plans where they have limited out-of-pocket expenses but fewer choices of providers. Medicare does not employ doctors or nurses so, by the definition above, this is not socialized medicine. The only thing that Medicare does is pay the actual medical bills. By the way, by this definition, the Canadian system is not socialized medicine either, because the Canadian government does not provide care, it only covers medical costs. There is actually more socialized medicine presently in the U.S. through the VA than there is in Canada. Canada is one of the countries that pays about 40 percent less per capita on care than the U.S. and their average life-expectancy is longer than ours. There is no appreciable difference in healthcare quality between the U.S. and Canada.

The majority of working Americans have employer-based health insurance (like me and my 4,000 or so GBMC HealthCare System colleagues). These plans vary significantly from employer to employer. At GBMC, if you take our platinum plan and use GBMC medical staff members and GBMC facilities, you can run up large bills with no out-of-pocket expense. But, many employers have been dealing with the rising cost of healthcare by pushing more and more of the cost onto employees through deductibles and co-pays. We now have many Americans who have insurance through their employer but cannot afford care because they cannot afford the out-of-pocket expense. This is a real problem for many.

I know someone who is currently facing this dilemma. This person is a graduate of a prestigious college and a hard worker, with a good job and is making a reasonable wage. The person recently needed to have a medical procedure and the amount this person had to pay out-of-pocket was much more than the person could afford. I know that this story is not unique.

Middle class Americans are paying a greater percentage of their earnings than ever before for healthcare, according to this report, from The Commonwealth Fund, which says rising premiums have outstripped wage growth over the past decade. Medical debt is the most common cause of people filing for personal bankruptcy (65%). So, last week’s news about hospitals’ bill collection practices should not come as a shock. The number of people who can’t pay their bills is growing significantly and hospital margins are very slim, so they are trying to capture the reimbursement. We at GBMC make sure that we treat patient fairly by offering financial assistance for those patients in need and creating reasonable payment plans for those who have the ability to pay their medical bills.

The real question is: Do we believe that healthcare is a right or a privilege? If we believe that healthcare is a right, then we should learn from other countries where all people are covered, and the total cost is less to create a smarter insurance system. What do you think?

Thank You to Our Social Workers!
March is Professional Social Work Month and I would like to thank the devoted group of social workers who serve GBMC. Our social workers help inpatients and outpatients navigate the complexity of the medical care world and prepare them for discharge along with our care managers. Please thank our social workers for all that they do to move us closer to our vision.

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