Medical Debt and Personal Bankruptcy: Time for Reform
Many individual Americans have in fact already tasted from the bitter cup of personal bankruptcy brought on by devastating brushes with the health care system as it exists now. The American Journal of Medicine released study findings this summer that uncovered the extent of medically related causes that lay behind personal bankruptcy filings in 2007. The AJM study authors implemented conservative controls on their work, ensuring a random sample of bankruptcy filers nationwide and followed up with in depth interviews with a significant cross section of participants. This study, a first ever of its kind due to its broad sampling and well defined parameters, revealed that nearly a whopping 62% of these filers indicated medically related expenses as major contributing factors to their debt disaster.
Steffie Woolhandler, M.D., one of the study’s authors, appeared in a CNN interview saying “If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that is the major finding in our study.” As a counterbalance Dr. Woolhandler’s bracing conclusions, the nonpartisan policy research foundation, the Center for Studying Health System Change, voiced mild skepticism of the study’s weighting of medical causes for bankruptcies. But they also offered little comfort with their statistic that 1 in 5 American families are “unduly strained” by medical bills.
In 1981, only 8% of families filing for bankruptcy claimed to have done so in the wake of a major medical crisis. (The accuracy of that figure is somewhat debatable since court records do not indicate the origin of debt that is handled by collection agencies, possibly obscuring debt generated by doctor or hospital bills.) In 2001, a major study concluded that over 46% of personal bankruptcies were medically related. The American Journal of Medicine study’s most recent conclusions of 61% used data from 2007, indicating an alarming trend and numbers which interestingly predate the fallout of our economy’s current recession.
The stigma that hangs over personal bankruptcy in our country is in part due to the public’s common misunderstanding of what the average filer looks like; many people have a mental image of a hapless slouch. The American Journal of Medicine’s study reveals this misapprehension for the untruth that it is. Most of the debtors surveyed were middle class, middle aged and college educated. 75% of the debtors had health insurance coverage at the onset of their financial and health problems. Typically this insurance left them with the commonplace gaps of high premiums, copayments, hefty deductibles and a range of uncovered medical services. It is important to note that policy rescission is a normative practice among medical insurance companies with 25% cancelling an individual’s policy immediately upon a disability diagnosis and another 25% of companies cancelling within one year of the diagnosis.
If “what is good for the middle class is good for America” is a useful measure of social and economic policy in this country, it is plain to see that viable and visionary health care reform is a mandate. With premiums, deductibles, institutional and procedural costs running on an unchecked course, the system will shortly be unsustainable. This year, 2009, the U.S. is predicted to spend an unprecedented 17.6% of its GDP on health care. What is not taken into account on top of this mind-boggling statistic is the hidden economic and societal costs of medically related personal and small business bankruptcies.
Responsible citizens owe it to themselves to review this American Journal of Medicine study in its entirety and to engage in further health care reform fact finding. A brief online search at amjmed.com (Vol.122, Issue 8, pp. 741 to 746) will get you started. Let your opinions be fully informed and get in touch with your elected representatives. This is an important national subject that requires vision and a patriotic, nonpartisan commitment to our future.
