HEALTH CARE/Joan Retsinas

Medical Debt is the Trifecta of Misery

The Center for Health Systems Change ( has tracked the numbers of people – 20% of American families in 2011, up from 15.1% in 2003 — who have trouble paying medical bills. Their average medical debt comes to $6,500; one-third of them owe more than $5,000.

The Presidential candidates who say we don’t need health reform legislation should meet these debtors. But since the debtors don’t contribute to candidates’ coffers or underwrite political action committees, they are easy to miss.

The sum of $6,500 is large or small, depending on your vantage. For the Kardashians, it might buy wedding favors or a few pairs of Ferragamo shoes. A 1982 Lafite-Rothschild bordeaux goes for $3,800; you could grab a bottle of that, plus some caviar.

It is not hard to amass these bills: a visit to a hospital emergency room with a broken ankle will come close, once you add the costs for the radiologist to read the x-rays, the orthopedist to set the ankle, the physical therapist to recommend exercises. A surgical procedure can reach six figures. Even with health insurance, a person can run up a few thousand dollars worth of co-pays, deductibles, and out-of-network charges. The fortunate among us can pay the bills.

Some of us set aside pre-tax money through our workplace’s “flexible savings accounts” just for these bills.

The less fortunate grapple with medical debt, often layered on top of housing debt (22% percent of Americans with mortgages owe more than their homes are worth) and consumer debt.

Hospitals do treat people without insurance, as does the sparse network of community health clinics, but those facilities generally send out bills. Patients may never pay all they owe, but the bills go out nonetheless. Thirty one percent of working-age Americans without insurance have trouble paying their medical bills. But insurance per se doesn’t guarantee a clean slate: 20.2% of insured Americans have trouble paying bills. Those nifty policies with exclusions, deductibles, limited networks and high premiums are partly the reason; incomes that haven’t kept pace with medical charges are another part. Medicare recipients also incur bills that they find onerous: 10.3% of people over age 65 reported trouble paying medical bills, up from 6.9% in 2003.

The debtors are likely to be sick: they need to visit the doctor, enter the hospital, take the medications. Often they wait too long, delaying preventive care, colonoscopies, and vaccinations. Often they forgo medications for hypertension, high cholesterol, asthma. The treatable problem turns into a crisis, sometimes an expensive one. Healthy people can avoid all those visits, all those bills. Medical debt isn’t a problem for them.

The debtors are likely to have low-to-middle incomes. Again, no surprise.. That is why they cannot easily pay the bills. Almost 30% of Americans with low and moderate incomes struggle with medical debt. Indeed, two-thirds of the debtors have been contacted by a collection agency; one-fourth have considered bankruptcy; 5% have filed for bankruptcy.

Climbing out of the financial abyss is hard. Some debtors predict it will take a year to erase the debt.

Some will borrow to pay bills — replacing one kind of debt for another. Others will ignore the debt.

Paying for food and shelter will take all their income.

In the last Presidential election candidates sought out “ordinary Joes” to showcase American values.

A startling percentage of this season’s ordinary Joes are sick, poor, and in debt.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, February 15, 2012

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