Tuesday, August 16, 2022
Aug. 16, 2022

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In Our View: Medical debt a chronic disease of health care

The Columbian
Published:

A new study from Kaiser Health News and National Public Radio further highlights the shortcomings of American health care. Vast changes are needed to make the system viable for both consumers and providers and to do what that system professes to do — safeguard Americans’ health.

The study found that more than 100 million people in the United States – including 41 percent of adults – are facing large health care debt. Writes Kaiser Health News: “The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.”

As one California doctor says: “Debt is no longer just a bug in our system. It is one of the main products. We have a health care system almost perfectly designed to create debt.”

Most shocking is a heat map that accompanies the report, showing the level of medical and dental debt by county. In Washington, only Asotin County — which has 22,000 residents and borders both Oregon and Idaho — has more than 10 percent of residents facing health care debt.

States throughout the South report much more pervasive medical debt; across large swaths of those states, more than 40 percent of residents have accrued such debt. None of the 100 counties with the highest rate of debt can be found in the West.

That is not solely the result of healthier lifestyles. Unlike Washington and most states throughout the West, Southern states uniformly declined to accept a Medicaid expansion provided under the 2010 Affordable Care Act.

A study published last year in the peer-reviewed Journal of the American Medical Association found that new medical debt had declined 44 percent in states that immediately expanded Medicaid.

“This is a genuinely large effect,” one of the study’s authors told Vox.com. “The Medicaid expansion was well targeted at a population that was extremely vulnerable to medical bills and who did not (and do not in states that have not expanded) have access to affordable health insurance.”

The argument against Medicaid expansion is that people should be responsible for their own health care. If some people cannot afford care, those are the breaks of a competitive capitalist society.

That argument loses credibility, however, when a medical system grows inordinately expensive. When the financial futures of millions of families are threatened by medical debt, the system becomes untenable. As Kaiser Health News reports: “Now hospitals and other medical providers are pushing millions into credit cards and other loans. Patient debt also sustains a shadowy collections business fed by hospitals that sell debt to collection companies.”

Half of Americans do not have the cash to cover an unexpected $500 medical bill. In the long run, we all pay for that through increased insurance premiums, increased medical bills to cover the ones that go unpaid, and diminished health care that leads to additional costs down the road. According to various international studies, the United States pays by far the most for health care while achieving outcomes that rank anywhere from 18th to 30th among the world’s nations.

American health care is in dire straits, with a system that produces outstanding doctors, nurses and researchers but is beset by a shortage of those professionals. The fact that many patients are in dire straits only adds to the woes of that system.

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