NY Times: the Financial Reality of Being Really Sick

[zippy2020]

Worthwhile read. The NYT allows 5 free articles per month access.

1,495 Americans Describe the Financial Reality of Being Really Sick
“Do you pay the hospital bill or do you pay the utility bill?” Don’t count on your health insurance for serious illnesses, a new survey warns.
NY Times Oct. 17, 2018
https://www.nytimes.com/2018/10/17/...tion=click&module=RelatedLinks&pgtype=Article

(excerpt) The whole point of health insurance is protection from financial ruin in case of catastrophic, costly health problems. But a recent survey of 1,495 people facing such problems shows that it often fails in that basic function.

The survey, of some of the country’s most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and co-payments; treatments their insurance won’t cover; and financial challenges — like lost work — that health insurance alone can’t address.

The New York Times, the Commonwealth Fund and the Harvard T.H. Chan School of Public Health used the survey to examine the sliver of the American population who use the health care system the most. To be included in the results, a respondent had to have been hospitalized twice in the last two years, and to have seen at least three doctors. In some cases, when patients had died or were too ill to answer questions, relatives who had taken care of them participated in their place.

Their experiences may serve as an early warning system for problems that all of us may face: Because the estimated 40 million people in this population visit doctors, hospitals, nursing homes and pharmacies the most, they are the likeliest to see the weak points in the health care system.

One of these is financial insecurity. Among people with health insurance, more than 20 percent had trouble paying for basic necessities. More than a quarter had bills in collection, and 13 percent had borrowed money as a result of their illness.

 

[MRG]

Thanks for posting this, it hits very close to home. A friend of mine lost his DW to cancer after a long fight. She'd been in a cancer treatment facility for a lengthy time.

Her husband is a little outgoing and loves to help others. He noted how many families were choosing to not eat so they could pay for a loved ones treatments and medications. He's started a charity to help provide food and some assistance to help families in this situation.

Obviously the problem is bigger than he'll ever solve.

 

[Mdlerth]

Meh

I'm not at all sure what the point of the article is beyond routine doom-and-gloom. Let's see, 1500 cherry-picked hard cases have problems. That isn't news.

It isn't real science, either. The article closes with the claim "The results are nationally representative." Nonsense. They restricted their interview sample to people who had much higher than average illnesses. How can that be representative of the population?

Sorry, New York Times; a swing and a miss. Strike one.

 

[ceciledian]

I'm not at all sure what the point of the article is beyond routine doom-and-gloom. Let's see, 1500 cherry-picked hard cases have problems. That isn't news.

It isn't real science, either. The article closes with the claim "The results are nationally representative." Nonsense. They restricted their interview sample to people who had much higher than average illnesses. How can that be representative of the population?

Sorry, New York Times; a swing and a miss. Strike one.

Maybe you don’t know anymore with an expensive chronic illness. I do. I also know 2 men who died from hepatitis because they couldn’t afford to get medical care. And as the article states, even those with health insurance wind up with expensive deductibles and co-pays which could wipe out all the savings of a family at median or below income. It’s s national problem.

 

[TwoByFour]

I'm not at all sure what the point of the article is beyond routine doom-and-gloom. Let's see, 1500 cherry-picked hard cases have problems. That isn't news.

It isn't real science, either. The article closes with the claim "The results are nationally representative." Nonsense. They restricted their interview sample to people who had much higher than average illnesses. How can that be representative of the population?

Sorry, New York Times; a swing and a miss. Strike one.

I read the article when it came out and thought it was spot on. The point they are making is that this country needs to decide whether it is acceptable to allow people to go through what the 1500 people here did. Remember this 1500 is just the people who chose to write their story to the NYT so the number is obviously way higher. Basically, if you think this is not acceptable than the healthcare system we have needs to be fixed. If you think it is acceptable, well then not much more to be said.

 

[Mdlerth]

There are 2 types of people: those who understand statistics, and the others

Maybe you don’t know anymore with an expensive chronic illness. I do. I also know 2 men who died from hepatitis because they couldn’t afford to get medical care.

Why would it matter whether I know any of these unfortunate folks? It wouldn't change their suffering. Nor would it change my observation that the article is standard-issue heartstrings-pulling. There are people who are badly off; that is sad, but it is not news.

And as the article states, even those with health insurance wind up with expensive deductibles and co-pays which could wipe out all the savings of a family at median or below income.

Anything could happen. That it doesn't happen to the vast majority of the population means that it's a low-probability event.

It's a national problem.

No, that's exactly what it is NOT. Read the article again. It's a problem for a tiny sliver of the population.

 

[Walt34]

No, that's exactly what it is NOT. Read the article again. It's a problem for a tiny sliver of the population.

Apparently other sources disagree:

https://www.cnbc.com/id/100840148

Medical debt and personal bankruptcy | Physicians for a National Health Program

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.w74

I would have qualified to be included in that study. While I am fortunate to have excellent insurance and had very little OOP (mostly minor prescription copays) I am very much aware that not everyone does. Without that insurance we'd be either broke or close to it.

 

[googily]

It's also part of a rich-get-richer reality, in that if you work for a big-deal company that gives great benefits, you are much less likely to have skyrocketing out-of-pocket costs, even when you do run into a serious long-term illness. And you're also are probably more likely to be able to handle a large financial hit but don't have to because of the great benefits.

I have an out-of-pocket max of $4,500 a year on my health care. I don't doubt that {unnamed insurance company} would start fighting much harder against paying claims once I've hit that max, but with really good insurance, along with employer provided short- and long-term disability benefits, people in my general strata are far less likely to see these sorts of outcomes.

DH didn't last long enough to get the insurance company mad at him, but they paid every single claim he made, except for genomic testing of his tumor which we were 90% sure they weren't to pay anyway. And he had six months of short-term disability at full pay and then began long-term disability at 60% of pay. And the company also never made me go on any sort of leave, even though I was not exactly spending much time on work while he was sick.

I remain very much aware of the gold-plated-ness of my health care and other employer benefits, and how rare my experience is anywhere outside of big employers in big cities who want to attract top-quality employees.

Is this also part of the issue with health care still being tied to employer benefits? Would everyone's coverage improve if muckety mucks had to get the same sort of insurance on an open market instead of through their employer?

 

[joeea]

There's no doubt in my mind that a small percent of folks who are insured still have trouble paying the deductibles and copays. And a small percent of folks lose work time due to their own illnesses or illnesses of their family.

I feel lucky that I'm not underinsured. My cancer infusions alone have cost between $22k and $28k each, not to mention all the diagnostics leading up to my diagnosis. I've had 10 so far with 2 more planned. My ACA plan meant that I had to pay a $22 co-pay for each visit and little else.

And I fear for a future where the best parts of the ACA are taken away and we go back to the days where you could be refused insurance (or pay through the nose) due to pre-existing conditions.

I'll be keeping all that in mind as I vote next month.

 

[USGrant1962]

These are some weird statistics. As of last year, 4 in 10 Americans didn't have enough savings to pay for an unexpected $400 expense: https://www.federalreserve.gov/publ...-economic-well-being-us-households-201805.pdf

Four in 10 adults, if faced with an unexpected
expense of $400, would either not be able to cover
it or would cover it by selling something or borrowing
money. This is an improvement from half
of adults in 2013 being ill-prepared for such an
expense.

So only 3 in 10 of this group are having financial problems?

The headline might as well have been 1,495 Americans Describe the Financial Reality of a Broken Refrigerator.

 

[Mdlerth]

Last time I checked, I wasn't God

The point they are making is that this country needs to decide whether it is acceptable to allow people to go through what the 1500 people here did...

Basically, if you think this is not acceptable than the healthcare system we have needs to be fixed. If you think it is acceptable, well then not much more to be said.

The word acceptable shows up a lot, carrying with it the implication that I have the resources to correct it but simply choose not to because I'm morally deficient. No, I consider the prayer of St Francis, and accept a lot of things that I don't have the power to change.

If you have the solution to their problems, then by all means pursue it. Enroll in med school and find cures for their diseases. Get a job that pays millions and write them each a check. Go forth and do good. I look forward to reading the accounts of your success.

 

[pj.mask]

Europe and Canada seem to have a solution to their problem. We haven’t implemented it because it would increase taxes!

 

[gauss]

These are some weird statistics. As of last year, 4 in 10 Americans didn't have enough savings to pay for an unexpected $400 expense: https://www.federalreserve.gov/publ...-economic-well-being-us-households-201805.pdf

So only 3 in 10 of this group are having financial problems?

The headline might as well have been 1,495 Americans Describe the Financial Reality of a Broken Refrigerator.

+1

If you buy an ACA policy with an out-of-policy maximum that you cannot afford then obviously you will either need to finance the health care bills or file for personal bankruptcy.

Probably no more of a national problem than poverty or the every growing wealth inequity gap.

 

[MRG]

+1

If you buy an ACA policy with an out-of-policy maximum that you cannot afford then obviously you will either need to finance the health care bills or file for personal bankruptcy.

Probably no more of a national problem than poverty or the every growing wealth inequity gap.

+2

My ACA policy has a new trick with prior authorizations. Sure it's on the formulary but it requires prior authorization. So far I'm paying more for drugs on my formulary that the insurance won't cover because I "don't need them". That's why I'm paying thousands yearly for them!

 

[MichaelB]

+1

If you buy an ACA policy with an out-of-policy maximum that you cannot afford then obviously you will either need to finance the health care bills or file for personal bankruptcy.

Probably no more of a national problem than poverty or the every growing wealth inequity gap.

If US median household income is $61k and the average cost of employer group family insurance is $19.6k, I’d say this has the potential to affect half the population.

 

[Mdlerth]

The only fun kind of risk involves Irkutsk and Yakutsk

Apparently other sources disagree:

https://www.cnbc.com/id/100840148

Medical debt and personal bankruptcy | Physicians for a National Health Program

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.w74

You might want to reread your second source. It makes the point that stories of medical bankruptcies are grossly exaggerated. People with agendas take instances of genuine human suffering, extrapolate them to the entire population and use that as an axe drive their agendas. All too true.

I would have qualified to be included in that study. While I am fortunate to have excellent insurance and had very little OOP (mostly minor prescription copays) I am very much aware that not everyone does. Without that insurance we'd be either broke or close to it.

Again you make my point (at least, you make one of my points). You did not go broke. The high price of medical care notwithstanding, most of the population doesn't go bankrupt.

Might you have done so? Certainly. And you might have been struck by lightning, or eaten by sharks, or been gunned down by the mob when you were keeping the rest of us safe from them (I'm delighted you survived). We all are at risk of disasters of every kind all the time. The OP's cited article is only one of a million which could be written. But my point is that, while risk is always a possibility, and sometimes misfortune strikes hard, most people survive most risks. I apologize for not writing that more clearly.

One more comment to all the folks piling on (BTW, thank you for doing it in such a polite, well-mannered fashion. You rock!) over what an insensitive clod I must be. There is no such thing as zero risk. You can readily exchange some risks for others, but you can't eliminate them. So before jumping to conclusions about what Must Be Done To Fix This Catastrophe, consider the unintended consequences your proposed solution would generate. If you aren't painfully, brutally honest about them, then you haven't really thought through the issue.

 

[marko]

I don't think anyone would disagree that the US health system is a complete mess. It's expensive, it's broken, often ineffective and needs to change.

However:
#1: NYT

#2: It seems that there's always some sort of article with 'statistics' that get me all worked up until I realize that the information has been twisted to fit an agenda. Then I just feel used.

#3: It also seems, no matter what the subject that someone, somewhere, will find one single person who's life has been impacted by X and make it seem like it's going to happen to everyone. It might take a few weeks, but, by golly we'll find someone.

#4: There's always going to be someone out there like in #3. Life isn't fair. Sorry.

My brother ran up almost a $700,000 medical bill last year. His insurance paid for it. He didn't work for a Mega-corp with great benefits. Just a run of the mill job where he paid half his premiums for a pretty average BCBS. He didn't go broke trying to cover what wasn't covered. Probably cost him $20K.

#5: There's always someone out there for whom $20K is going to bankrupt them. Sorry.

Maybe I'm just having a bad day but I'm sick of this crap and sick of people trying to scare me or make me worry about the .00001%

We need to fix the system. Will we? I absolutely doubt it.

Time for "family cocktail hour".

 

[candrew]

It's a problem for a tiny sliver of the population.

Medical debt and personal bankruptcy | Physicians for a National Health Program

"When over half of Americans lack confidence that they can afford health insurance and almost 44 million are already having difficulties paying their medical bills, we have a problem."

Going out on a limb here, but I'm saying that 44 million exceeds the "tiny sliver" designation.

 

[NW-Bound]

... The survey, of some of the country’s most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and co-payments; treatments their insurance won’t cover; and financial challenges — like lost work — that health insurance alone can’t address...

Note the above emphasis that I added.

There are a lot of reasons and causes for people to become destitute, not just medical problems. It was suggested that Canada and Europe have solved this problem. I beg to differ, if we stand back and look beyond medical problems.

See quote below:

At least 200,000 Canadians experience homelessness in any given year.
At least 150,000 Canadians a year use a homeless shelter at some point.
At least 30,000 Canadians are homeless on any given night.
At least 50,000 Canadians are part of the "hidden homeless" on any given night — staying with friends or relatives on a temporary basis as they have nowhere else to go.
Those numbers come from the Canadian Homelessness Research Network (CHRN) and the Canadian Alliance to End Homelessness, the groups behind what they call the first extensive national report card on homelessness.

Source: https://www.cbc.ca/news/canada/30-000-canadians-are-homeless-every-night-1.1413016.

 

[marko]

There are a lot of reasons and causes for people to become destitute, not just medical problems.

That's why they now sell insurance for your water heater and refrigerator.

 

[candrew]

Note the above emphasis that I added.

There are a lot of reasons and causes for people to become destitute, not just medical problems. It was suggested that Canada and Europe have solved this problem. I beg to differ, if we stand back and look beyond medical problems.

Source: https://www.cbc.ca/news/canada/30-000-canadians-are-homeless-every-night-1.1413016.

The article does go on to state that a lack of affordable housing for low income Canadians largely contributes to their country's homelessness problem along with high rents and low vacancy rates.

I think it safe to say that in countries like Canada that have universal health care, medical debt is not a causative factor in homelessness. If it were, it is likely the number of homeless Canadians would be greater.

 

[gauss]

If US median household income is $61k and the average cost of employer group family insurance is $19.6k, I’d say this has the potential to affect half the population.

Under ACA, the employee contribution would be capped at less than 10% of income and thus the insurance premiums remains affordable.

If, on the other hand, we blowup the ACA, then we risk everything becoming unaffordable and nontransparent on an individual level again.

 

[NW-Bound]

...
I think it safe to say that in countries like Canada that have universal health care, medical debt is not a causative factor in homelessness. If it were, it is likely the number of homeless Canadians would be greater.

Well, compare the 100,000's of homeless people to the 1,495 people with medical problems cited in the article, perhaps the medical problem is not so bad. We should pay more attention to what affects more people.

 

[candrew]

perhaps the medical problem is not so bad.

Considering that 20 million or so Americans still are medically uninsured, millions more are underinsured, we spend almost 2X as much per capita as any other industrialized nation on healthcare and yet have outcomes that rank near the bottom of that same cohort - I'm suggesting, based on the data, that the medical problem in the U.S. is worse than "not so bad".

 

[MichaelB]

Under ACA, the employee contribution would be capped at less than 10% of income and thus the insurance premiums remains affordable.

If, on the other hand, we blowup the ACA, then we risk everything becoming unaffordable and nontransparent on an individual level again.

Yes. Healthcare insurance becomes affordable through subsidy, not health care cost containment.

To be fair, I suspect no matter what we do, the NYT (et al.) will find, and highlight, its shortcomings. No approach 'round the world is safe from that.