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How did we get here? / September 18, 2019
A hardship story from Southside Virginia surfaced in the news a week ago, and this time it’s the world-at-large, not our small corner of it, that came off looking worse for the telling.

The source of all the consternation: A Washington Post report on the University of Virginia medical system and its outrageous debt collection efforts (“‘UVA has ruined us’: Health system sues thousands of patients, seizing paychecks and putting liens on homes,” from the Sept. 9 edition of The Post.) The reporters, Jay Hancock and Elizabeth Lucas, tracked down patients of UVA’s justly praised hospital-and-doctors network and found that while people had mostly good things to say about the medical care they received, “UVA Health System stands out for the scope of its collection efforts and how persistently it goes after payment, pursuing poor as well as middle-class patients for almost all they’re worth, according to court records, hospital documents and interviews with hospital officials and dozens of patients.”

Deep into the piece — which is long but hard to put down once you begin — The Post latched onto the woeful account of a Halifax County woman who went to Charlottesville for treatment of a balky back:

UVA sued Carolyn Davis, 55, of Halifax County, for $7,448 to pay for nerve injections to treat back pain that she hadn’t realized would be out of network.

Her husband is a cook at Hardee’s, taking home $500 to $600 a week, she said. UVA refused their application for financial assistance because his Hardee’s 401(k) balance of $6,000 makes them too well off, she said.

“We don’t have that kind of money,” Davis said. The hospital insisted on a monthly payment of $75. She was meeting it by charging it to her credit card at 22 percent interest.

Charges for Davis’s treatment were about twice as much as what a commercial insurer would have paid, according to an estimate by WellRithms.

The rest of the article reads roughly along the same lines, from the mind-blowing explanation of the intersectional lines between the UVA health system and state government policy (hospital officials justified their aggressive collection efforts by citing the terms of the Virginia Debt Collection Act of 1988), to the depiction of Charlottesville General District Court, where UVA collection actions so often end up. (“I probably see at least a couple a month,” said Marshall Slayton, a Charlottesville bankruptcy lawyer, holding up a new file. “This is the third case this week.”) The Post story is infuriating, illuminating, outrageous and bonkers all in one breath.

And you know what? As deplorable as UVA’s collection practices are, to judge from The Post’s fine reporting, the crummy payment policies of a single hospital system, even one bathed in as much outward glory as UVA Health System, doesn’t come close to earning a spot in the top five economic outrages of the American health care system. I was thinking about the items one could put on such a list. Without spending too much time on the matter, here’s what I came up with — five unfathomable ways, out of countless many, in which our health care system routinely fails ordinary people:

» Number 1 is easy, and in fact there’s a reference to it in the Post account involving Carolyn Davis of Halifax County: out-of-network patient billing. It’s not entirely clear from the article whether Mrs. Davis was ever informed of the financial consequences of venturing outside of her insurance policy network to receive treatment for her back pain, but nowadays it hardly matters — more than out-of-network billing, there’s now such a thing as “surprise out-of-network billing,” wherein patients check into in-network hospitals but receive care from doctors or labs that exist outside the network, and therefore can legally charge whatever they damn well please. According to Kaiser Health News (an invaluable source of information on America’s broken health care system), 1 in 6 insured hospital patients in the U.S. get billed for surprise out-of-network services. That’s Outrage #1.

» No. 2: How did a shortage of insulin become a thing? Insulin has been around for a century, yet it’s become increasingly, even prohibitively expensive to obtain. Americans being who we are — plucky and inventive folks — the response in certain areas of the country to this confounding situation is exactly as you’d expect: people with diabetes are crossing into Canada to purchase life-saving medications.

» No. 3 is an attempt to shorten this list, because already it’s gotten too long. So let’s just utter the name and move on: Pharma-Bro.

» No. 4: Again from the Post article, we get a primer on what happens to people without insurance: they pay through the nose for health care because of our Whack-A-Mole system of passing costs onto the next sucker. “Patients also have trouble,” explains The Post, “because like many U.S. hospitals, UVA bills people lacking coverage at rates far higher than what insurance companies pay on behalf of their members. Such bills often have little connection to the cost of care, experts say. Insurers obtain huge discounts off hospital sticker prices — 70 percent on average in UVA’s case, according to documents it files with Medicare.”

At some point in your life, you may be exposed — I know I have been — to the pain of having to pay for medical bills without the advance benefit of negotiated insurance company rates. But please, for those of you who have enjoyed the lifelong luxury of comprehensive health coverage, don’t succumb to the illusion that insurance companies are doing an especially good job of pushing down costs on your behalf. The industry catches enormous grief for its failings, most of which is deserved, but an underappreciated defect is the seeming inability to rein in the exorbitant costs of medical providers, especially conglomerate hospital chains. Not that this is any big secret, but America pays twice as much for medical care as most of the rest of the industrialized world, without receiving an appreciably better product for the vast sums of money we plow into the system. We don’t even like our own health care system all that much, judging from international surveys, our customary red, white and blue chest-thumping aside.

» The No. 5 top outrage? This one might not sound like an outrage at all. In fact, it’s something that can be held up as example of communities doing their noble best, helping their own citizens navigate life’s inevitable pitfalls and hazards. What am I referring to? Bake sales. GoFundMe pages. Charity drives. Anytime people come together to help a neighbor, friend or even a complete stranger cope with crushing medical bills. Again, this is incredibly praiseworthy action by large-hearted individuals, not to be misunderstood as anything else. But in the broader sense, the entire business is nuts. Medical bankruptcies can’t be staved off through cupcake sales. Sensible nations don’t pay for the health care of their citizens this way. Why do we?

Around the same time I read the article on the rapaciousness of the UVA Health System — which, to be clear, is not like some unheard-of phenomenon in this country — there was also a telling comment made during the most recent Democratic debate, on today’s very subject: “I’ve actually never met anybody who likes their health insurance company,” said Elizabeth Warren, the Massachusetts senator who is rising in the polls. “I’ve met people who like their doctors. I’ve met people who like their nurses. I’ve met people who like their pharmacists. I’ve met people who like their physical therapists. What they want is access to health care.” Warren’s words were exactly right, even if we, as citizens and health care consumers, aren’t ready to wrestle with the implications of the reality that she was describing.

Because I’m at the end of my proverbial rope and editorial page real estate, there will be no great discussion here of the exchange during last week’s Democratic debate between Warren and Bernie Sanders, the two candidates who are most vocal in their support of Medicare For All, and Joe Biden, who prefers a more cautious approach to health care that begins with shoring up the weaknesses of the Affordable Care Act, neé Obamacare. I could go on forever and a day on this subject, and you could certainly do better by spending a few minutes on the internet looking up better-researched work. Yet if you do so, one of the pieces you’re likely to see pop up in your search engine results is The Washington Post’s recent article on the UVA Health System and how it has spread financial ruin. It doesn’t require the vast storehouse of information that is the internet to look at this matter and ask a simple question — the simpler the better, in fact. Why do we put up with this nonsense? It truly is the mystery of our times.

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