"Cash Before Chemo" Two Arguments for Health Reform

This is the story of MD Anderson's treatment of Lisa Kelly, an underinsured cancer patient. The hospital asked for $105,000 cash up-front before it would admit her.

This story comes from the excellent newspaper site of the http://online.wsj.com/article_print/SB120934207044648511.html">Wall Street Journal.

MD Anderson is shredded--as it should be--in this article, which notes that the hospital

is a nonprofit institution exempt from taxes. In 2007, it recorded net income of $310 million, bringing its cash, investments and endowment to nearly $1.9 billion.

But this is a larger system issue than one hospital's cruddy behavior. Uncompensated care is a large problem for many hospitals. So are low provider reimbursement rates from Medicaid and other sources. Given these financial realities, it is hardly surprising that hospitals start doing icky things to ensure that they receive their desired payment. When otherwise benevolent hospitals start demanding cash up-front from very sick people, it's time for health reform.

But there are two complications.

First, there is the matter of Ms. Kelly's limited-benefit AARP Medical Advantage plan. She bought the policy three years after she quit her job as a school bus driver to help take care of her mother. The policy cost $185 per month, which is an immediate tipoff of something. Mrs. Kelly took an incredibly bad gamble using this as her sole insurance plan.

Second, there is the awkward fact that the Kellys are by no means poor. I hasten to add that poor people and the uninsured are heavy targets of heavy-handed hospital tactics. Books such as Jonathan Cohn's book Sick serve up revolting examples of non-profit hospitals roughing up poor people. My favorite involved a Catholic hospital system suing a 62-year-old low-income former nun.

The Kellys' case, however, is different. It not the usual story of a low-income person who couldn't afford coverage. According to the article, they have substantial real estate investments, interest income, and other assets.

If there is a middle ground on the fearsome individual mandate debate, cases like the Kellys might point the way. I hate to say this, but it seems clear that the Kellys went in with open eyes, and made a bad choice. It is sad but appropriate that they be held responsible for Anderson's low-six-figure bill. If we implement an individual mandate for people who can easily afford health coverage, people like Mrs. Kelly would be spared the opportunity to make irresponsible choices. The real issues arise with the more pointed political and administrative trade-offs involving low-income people.

Saying that the Kellys are responsible for their foolish bet does not for one moment excuse a major and prosperous cancer center that failed to treat a frightened and sick patient with basic decency. As one official put things:

Asking patients to pay after they've received treatment is "like asking someone to pay for the car after they've driven off the lot," says John Tietjen, vice president for patient financial services at M.D. Anderson.

We've come to that. This story really provides two arguments for health reform: First, we must address the reality that people make bad gambles that don't pay off. Second, we must change the mentality of a healthcare system in which a cancer hospital administrator describes his work through analogies to a car dealer.

There is one humorous side note to an otherwise unfunny story. Ms. Kelly's bill included an erroneous (later fixed) $314 charge for an, um, male incontinence clamp. Given the behavior of some people in this story, Ms. Kelly could be forgiven for wanting to put this clamp to proper use.

Comments

[BillCouzens]

IS THERE ANY QUESTION CANCER TREATMENT IS THE LEADING INDUSTRY IN THIS COUNTRY.
MD ANDERSON MUST BE PROUD-
CASH FIRST-PATIENTS SECOND!

BILL COUZENS, FOUNDER LESSCANCER.ORG

[Schaz]

This is one of the most frightening sentences I've read in ages: "...people like Mrs. Kelly would be spared the opportunity to make irresponsible choices."
Since "irresponsible" is subjective, the meat is: we must spare people from the opportunity to make choices..."someone" must decide for them. At best, that statement is condescending; at worst, it reeks of totalitarianism, no matter how well-intentioned any specific implementation of it might be.
Better that we suffer the consequences of our unwise choices than to have choice taken away from us.

[hopeless277]

The poor have always been sacrificed in favor of the rich. It's tradition among Republicans. If they could get away with it, I'm sure that Republicans would just burn them alive or probably, like their facist mentors, gas them. The good news is that Sen Chuck(I love me some Mukasey) Schumer will make sure it stays that way. After all, how do you expect the DemocRATS to pay for the genocide in Iraq and give the poor healthcare at the same time? They DO have their priorities. And DemocRAT priorities are the exact same as Republican priorities. Why else are we still murdering women and children in far away lands two years after getting a DemocRAT majority? This is no country to be ill in. Unless, that is, you have unlimited healthcare, postage, food, and transportation like the elite members of congress all have. It just really brings to light exactly what kind of country this is.

[TXfemmom]

If the Kelly's could have afforded insurance, and were eligible for it, as in not having pre-existing conditions which would have prevented them from obtaining it, then one can feel concern for her, but this points out why Obama's plan will not work.

If there is not a MANDATE for the insurance companies to take all comers, and one for ALL INDIVIDUALS to purchase it, then we shall see people who will take their chances, have accidents or become ill, and then they will demand to use the system which they just ignored. Mandates for the companies and individuals, especially those with the financial means to pay for it, are a necessary evil for cases such as this. M. D. Anderson is a State Hospital, meaning it is owned by the State of Texas, and at one time it had to take all Texas residents, whether they had insurance or not.

I firmly believe we must go to a single payer system, make all employers and individuals pay and join. If it is to remain private then the insurance companies must use the money from all the people and set up a system and pay for what works and is needed, and pay the right price for things, such as pharmaceuticals, and not one penny more than any other industrialized country. Those economies, and cutting out all these loopholes where too much is paid for things, and the system could cover all and spend far less than we spend.