21st Century Dynamic Duo: Bankruptcy and Health Care

Since my wife's family is mostly in the Indiana area, I tend to check out the news up there fairly frequently, especially with the recent levee failures and flooding. That is how I stumbled upon this letter to the editor by Fran Quigly, Director of Operations for the Indiana-Kenya Partnership, on IndyStar.com. The introductory paragraphs should be enough to get you started:

It is Friday morning at the federal courthouse in Downtown Indianapolis, and U.S. Bankruptcy Court Trustee Gregory Silver sits behind a low table in a room on the fourth floor calling out names of Hoosiers who have filed for discharge of their debts. In a somber scene with the air of a fiscal confessional booth, many petitioners come forward with slumped shoulders and slightly bowed heads, and then softly answer Silver's questions about the financial collapses that led them to this room.

A young woman from Southside Indianapolis has racked up enormous debt due to the costs of childbirth. A middle-aged couple from the Northwestside was sued for payment of their medical bills. Another woman had the misfortune of being attacked by a dog before health insurance from her new job kicked in. Even after turning a lawsuit settlement over to bill collectors for hospitals and doctors, she still owes them $35,000.

The rest of the letter is well worth reading, and if you have strong stomach the comments are interesting as well. I think the comment streams one finds on articles like this make for an interesting study, most particularly the anonymous comments. People tend to speak their minds pretty staunchly when they do have to worry about being connected to their opinions publicly.The results can often be both vile and illuminating.

On a subject that combines high profile and controversy in the fashion that health care currently does the comments come thick and fast, a maelstrom of invective and opinion that demonstrate just how impassioned our populace is becoming on the subject.

The letter goes on to suggest potential paths for improvement, and quotes a 2005 Harvard study that found fifty percent of bankruptcies in the U.S. stem from medical bills.

Fifty percent. Think about it.

SOURCE: "A day in bankruptcy court would make you sick" 06/30/08
photo courtesy of danesparza used under its Creative Commons license

Prevention and Coverage: A Malignancy Revealed

This morning, Forbes brings us confirmation that preventative care is a key issue in the ongoing debate about health care reform. The article examines the ominous topic of cancer in this context:

"Having financial barriers to health care, based on insurance status, is having a significant impact on our efforts to reduce the toll of cancer," said Elizabeth Ward, director of surveillance research in the department of epidemiology and surveillance research at the American Cancer Society.

"We could make considerable progress in reducing cancer mortality if we could ensure that financial barriers, such as lack of health insurance, did not prevent people from getting recommended cancer screening and access to health care when they have symptoms," Ward added.

Like any health issue, the sooner you are diagnosed, the better your chances. Being without coverage and having minimal financial resources makes the idea of spending money on screenings quite simply out of the question for many Americans. As with other chronic conditions, by the time a malignancy is causing enough physical discomfort for a trip to the emergency room, it is not only vastly more expensive but the chances for recovery are also drastically reduced.

"We know that the uninsured are 25 percent more likely to die than other Americans," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School, and co-founder of Physicians for a National Health Program. "This study tells us one reason why. Many uninsured cancer victims don't get the screening and primary care that would find their disease early, when a cure is still possible," she said.

While important, these findings are not exactly new news. Go back to the top of this post and take a look at the poster image again. That poster was printed in 1938 according to the Library of Congress. It would seem that the lack of preventative care in the United States is, in and of itself, a chronic problem.

SOURCE: "Timely Cancer Diagnosis Linked to Insurance Status" 02/18/08
Public domain photo courtesy of Library of Congress via pingnews.

Hurry Up and Wait: Emergency Care in The US

"I mean, people have access to health care in America. After all, you just go to an emergency room. "
- President George W. Bush Cleveland, OH July 7, 2007

This morning a Harvard study was released that is causing ripples across the media and Internet. Let us begin with the The Boston Globe's medical column:

Between 1997 and 2004, wait times went up an average of 4.1 percent per year for all patients, but for heart attack patients, the waits stretched 11.2 percent per year, researchers from Cambridge Health Alliance report in today’s issue of Health Affairs. Blacks, Hispanics, women, and patients in urban hospitals waited longer than other patients.

"The striking finding is that waits are increasing for all Americans, for people who are insured and for people who are uninsured," lead author Dr. Andrew Wilper, also a fellow in internal medicine at Harvard Medical School, said in an interview. “For patients with severe illnesses, it is troublesome.”

The Houston Chronicle converts those percentages into minutes and also provides this telling quote from Charles Begley, a professor at the University of Texas School of Public Health:

"Because the emergency room has become a source of primary care for a lot of people, it is distracting the emergency room from being able to provide the emergency trauma care that the community needs," Begley said.

For patients across the country identified as needing "emergent" care, wait times increased to 14 minutes in 2004, up from 10 minutes in 1997, study authors reported. And the subset of patients who were diagnosed as suffering from heart attacks saw a significant increase, from eight minutes in 1997 to 20 minutes in 2004.

A twenty minute wait time for a heart attack victim? Think about that for a moment. Think about how long a minute is when suffering chest pains.

The Washington Post also has a piece online today which tells us a bit more about how the data was compiled :

The researchers analyzed data on patient visits and wait times collected between 1997 and 2000, and from 2003 and 2004, by the National Hospital Ambulatory Medical Care Survey, a nationally representative database. Among other findings, they learned that wait times tended to be longer for African Americans and Hispanics, perhaps because those patients are often treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed the strains on emergency room care in the United States. Three reports issued in 2006 by the Institute of Medicine, a branch of the National Academies, concluded that the nation's emergency medical system is "overburdened, underfunded and highly fragmented."

It is well documented (in Health Care Reform Now! of course) that for chronic conditions such as asthma, a few hundred dollars a year are required to manage the condition, while a single emergency room visit could skyrocket to over $20,000. This cost factor combined with the wait times present a disturbing portrait of a broken system.


SOURCE: "Emergency room wait times getting longer" 01/15/08
SOURCE: "Wait times at the ER are ticking upward: Researchers say patient care is at risk as crowding causes many to just leave" 01/15/08
SOURCE: "Emergency Care Waits Found to Be on Rise" 01/15/08
photo courtesy of macoggins, used under this Creative Commons license