The Strain of Medical Bills

A recent New York Times article confirms what our own Health Security Index suggests, increasing numbers of Americans are struggling with the growing burden of unpaid medical bills. According to the Times:

Two studies released Wednesday morning provide further evidence of the toll health care is increasingly placing on working families, even for those who have health insurance. And as employees are paying more medical expenses out of their own pockets, they are having a harder time coming up with the money.

The studies, by the Kaiser Family Foundation and the Center for Studying Health System Change, were completed earlier this year before the financial markets reached their current state of crisis. But policy analysts say the findings underscore the mounting additional strain that medical care is placing on working Americans.

The studies, policy analysts say, underscore the need for the government to address the growing unaffordability of care, despite the distraction — and cost to taxpayers — of a proposed $700 billion bailout of the financial sector.

Although inflation in insurance premiums has moderated in recent years, the Kaiser survey found employees were continuing to spend more in medical costs, including their share of yearly insurance premiums. Employees are paying an average of $3,354 in premiums for family coverage, more than double the amount they paid in 1999. The total cost for family coverage now averages $12,680 a year, up 5 percent from 2007.

And as people are paying more, they are finding the higher expense less affordable. In the study by the nonpartisan Center for Studying Health System Change, based on its national survey of households, nearly one of every five families had problems paying medical bills last year. More than half of these families said they borrowed money to pay these expenses, and nearly 20 percent of those having difficulty said they contemplated declaring personal bankruptcy as a result of their medical bills.

The study estimates that 57 million Americans live in families struggling with medical bills, and 43 million of those have insurance coverage. "It’s hitting both the insured and the uninsured, and it’s hitting middle-class families," said Karen Davis, the president of the Commonwealth Fund, a nonprofit research organization that financed the study.

Because they are already in debt over their medical care, some families start forgoing treatments, even for serious or chronic conditions, Ms. Davis said. By deciding not to fill a prescription for high blood pressure medication or failing to go to the doctor for diabetes, they are at risk of incurring more serious and costly problems that can land them in the emergency room.

Indeed, how can we contemplate remedies to our nation's economic crisis without also addressing desperately needed reforms to our health care system?

To Care Even When We Cannot Cure

There's a flurry of articles today (see here and here for a couple of examples) about the benefits of palliative care. We've had palliative care teams at our hospitals for many years because we believe it is a method of treatment that respects the dignity of individuals suffering from chronic or life-threatening illnesses.

At its core, palliative care is about respecting the wishes of patients and families. Previously, the standard course of care for patients suffering from a terminal illness called for aggressive treatment up front, and then, when the resources of modern medicine had been exhausted, palliative care (also called comfort care) would begin.

Today, our caregivers work collaboratively with patients and families to give people suffering from serious illnesses a voice in their care and clear, ongoing communication with their physicians and other health care providers about what to expect.

Providers at our hospitals are guided by the following principles:

• Respect the wishes of the patient: There is no obligation for any patient to begin or continue life-sustaining treatment, if from the patient's perspective it is an excessive burden. An individual's decision to refrain from treatment will be respected even when such a decision may result in the person's death.
• Effective pain management: Health care must be a community of respect, love, and support for patients and their families as they face the reality of death. Pain management will be of the highest quality and is critical in allowing a person to die comfortably and with dignity.

The charge of medicine is to care even when it cannot cure. At CHW hospitals, physicians, nurses, pharmacists, chaplains, nutritionists, and many others work together to determine the appropriate use of drug and non-drug interventions for the relief of pain and symptom management.  Providing quality care to dying and seriously ill patients is an important issue for us and we are advocating for public policies and programs that will improve palliative care.

Finance Committee Hearings

We're pleased that the Senate Finance Committee continues to review and seek out expertise for health reform. They're September 9th hearings focused on improving quality. The main question, as summarized by Charles Grassley, was this: "How do we work to make sure that ALL providers give the right care at the right time?"

Testimony from William Roper, Chairman of the National Quality Forum, makes the case:

The overarching objective of health reform must be to ensure that every American, regardless of race, ethnicity, place of residence and SES, receives timely access to health care that is safe, effective, and affordable. Expanded access to care becomes almost irrelevant if in the end we're getting care that is poor quality.

We are very much in favor of publicly reporting quality measures as it helps consumers make informed decisions about where to receive health care services.

There's another hearing scheduled for September 16th, which will focus on the case for reforming the health care delivery system. We'll blog about those hearings shortly after the testimony is posted.

We Will Always Remember

As we pause to reflect and remember the tragedy of September 11, 2001 we bring you this photo mosaic of the new memorial at the Pentagon.

We also pause to remember the long-term health effects of this national tragedy, and call upon our nation's leaders once again to enact health reform that provides quality, compassionate health care services to all in need.

(Photo credit: Washington Post)

A Confusion of Medical Billing

Los Angeles Times columnist David Lazarus opines about the mixed up, confusing way that dollar values are assigned to medical services. His column highlights problems many people face when accessing the health care system, and the call for "a massive infusion of political courage to tackle genuine health care reform" is one we share.

But one statement in the column is worth clarifying: "[The system] spells doom for the 45 million Americans lacking health coverage, who have no choice but to pay the full amount of a hospital's cost-plus charges and thus can be wiped out financially by a major medical problem."

You do have a choice. As we blogged about here, you can negotiate with your provider (whether it's the doctor's office or the hospital) for a lower price. Almost all hospital providers have financial assistance programs in place that can help you access the care you need without placing what little you have at risk.

Make no mistake, the health care financing system is broken. We're working closely with local, state, and federal leaders to enact compassionate reform. Until then, call your provider to negotiate your bill, and join is in calling for major reform by contacting your representative and demanding that they give health care reform their full attention.

Senate Hearing Scheduled

The U.S. Senate Finance Committee has scheduled a hearing for September 9th on Improving Healthcare Quality: An Integral Step Toward Health Reform. Here's the line up of witnesses:

Peter V. Lee, J.D.
Executive Director, National Health Policy
Pacific Business Group on Health

Samuel Nussbaum, MD
Executive Vice President for Clinical Health Policy and Chief Medical Officer
WellPoint, Inc.

Gregory Schoen, MD
Regional Medical Director
Fairview Northland Health Services

Kevin B. Weiss, MD
President and CEO
American Board of Medical Specialties

William L. Roper, MD, MPH
Dean, School of Medicine, University of North Carolina and Vice Chancellor for Medical Affairs and CEO
UNC Health Care System

Being the Change

News out of New York over the weekend that a physician is taking it upon himself to help those living without health insurance. Dr. David Ores has started a health care cooperative for restaurant workers:

Here's how it works. The restaurants pay $1 for every seat in their restaurant. That money goes into a special fund, which then goes to pay for the health care. "Health care should be like water or food or housing," Dr. Dave said. "A basic human right, not a luxury.

...

With the potential to reach thousands desperately needing health care, Dr. Dave is lowering the barrier to that care. "To fix things earlier, to intervene early is 100 times less expensive than you wait for it to become a complicated case of pneumonia," Dr. Dave said.

We applaud Dr. Dave for his innovation and compassion for those in need. And we call upon our nation's leaders to learn from Dr. Dave's example - access to quality care is a basic human right. It should be available to all. We'll continue to advocate for compassionate reform while also opening more clinics and extending care to all in need.