Monday, May 12, 2008

America's Pay-or-Die Health Care System By RALPH NADER

This is a tale of pay or die that recurs again and again all over our country and only in our country in the entire western world.

Advised by her physician to go to M.D. Anderson for urgent treatment of her leukemia, Mrs. Lisa Kelly was told she had to pay $105,000 up front before being admitted. The hospital declared her limited insurance unacceptable.

Sitting in the business office with seriously advanced cancer, she asked herself – "Are they going to send me home?" "Am I going to die?"

Time out from her torment for a moment. M.D. Anderson started this upfront payment demand in 2005 because of a spike in its bad debt load.

The Wall Street Journal explains – "The bad debt is driven by a larger number of Americans who are uninsured or who don't have enough insurance to cover costs if catastrophe strikes. Even among those with adequate insurance, deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals."

It isn't as if non-profit hospitals like M.D. Anderson are hurting. Look at this finding in an Ohio State University study: net income per bed at non-profit hospitals tripled to $146,273 in 2005 from $50,669 in 2000. And you also may have noticed the huge pay packages awarded hospital executives.

M.D. Anderson, exempt from taxation, recipient of funds from large government programs and research grants has cash, investments and endowment totaling $1.9 billion, with net income of $310 million last year, the Journal reports.

Back to the 52 year old, Lisa Kelly. She and her husband returned with a check for $45,000. After a blood test and biopsy, the hospital oncologist urged admittance quickly. Then the hospital demanded an additional $60,000-$45,000 just for the lab tests and $15,000 for part of the cost of the treatment.

To shorten the story, she received chemotherapy for over a year. Often her appointment was "blocked" until she made another payment.

In a particularly grotesque incident, she was hooked up to a chemotherapy pump, but the nurses were not allowed to change the chemo bag until Mr. Kelly made another payment.

She endured other indignities and overcharges. Reporter Martinez cites $360 for blood tests that insurers pay $20 or less for and up to $120 for saline pouches that cost less than $2 retail.

Imagine anything like Mrs. Kelly's predicament and pressures occurring in Canada, Belgium, Germany, Italy, France, Switzerland, Holland, England or any other western country. It would never happen.

These countries have universal single payer health insurance. No one dies because they cannot afford health care. In America, 18,000 Americans die each year because they cannot afford health care, according to the Institute of Medicine of the National Academy of Sciences. Many more get sick or become sicker.

None of these countries spend more than 11% of their GDP on healthcare. The U.S. spends over 16% of its GDP on health care and does not cover 47 million people and tens of millions are under covered

In the U.S. the drug companies charge their highest prices in the world, even though we, the taxpayers, subsidized them in large ways. In other countries like Mexico and Canada, they cannot get away with such drug price gouging, with a pay or die ultimatum.

In the U.S., computerized billing fraud and abuse cost over $200 billion last year, according to the GAO arm of Congress. In other counties, single payer prevents such looting.

In other countries, administrative expenses of their single payer system are about a third of what the Aetna's and other insurers rack up.

In other western countries, medical outcomes for children and adults and paid family leave are far superior to that of the U.S. The World Health Organization ranks the US health care system 37th in the world.

When apologists in Washington hear these statistics, they say "but we have the best medical research centers in the world, like M.D. Anderson."

Clearly much is wrong with the nature of pricing health care.

Like other hospitals, M.D. Anderson is caught in a macabre spider's web of cost allocations mixing treatment costs with research budgets, cash reserves, and just plain accounting gimmicks that burden patients.

When a friend showed the Journal's article to a Dutch visitor, the latter blurted in anger – "you are a nation of sheep." Not a very flattering description of "the land of the free, home of the brave."

Someday, soon maybe, Americans will finally band together and say "enough already," we're going for full Medicare for all- without loopholes for corporate profiteers and purveyors of waste and fraud.

Last month after being in remission, Lisa Kelly's leukemia has come back.

Ralph Nader is running for president as an independent.