Thursday, March 08, 2012

The Burden of Medical Bills

A recent study released by the CDC (and reported on Medscape and other sites) states the blunt fact that 20% of American households have difficulty paying their medical bills. And the National Center for Health Statistics states that 1 in 5 Americans has lived in a family that could not pay its medical bills in the last 12 months.

The questions asked in the survey by the CDC included whether the respondent had any problems paying medical bills in the last year, if they had medical bills that they were paying on a payment plan, or if they had bills that they simply could not pay.

Not surprisingly, children 17 and under were 5 times more likely to live in a family that could not pay its medical bills than an American over the age of 75. It is also clear from the report that it is the poor, "near poor" and working poor (and those earning within 100 or 200% of the poverty level) who have the most trouble paying for their medical expenses.

Once again, we receive another stark reminder that tens of millions of uninsured and underinsured Americans in our country are burdened by the costs of medical care. We have all heard stories of the elderly needing to choose between groceries and prescriptions, and we have also heard of countless Americans eschewing preventive care and primary care due to their lack of insurance and the financial means to pay out of pocket for such care.

What is the price that we pay for these uninsured Americans? And what is the price that we pay for those who cannot pay for the care that they do receive, some of it lifesaving and absolutely necessary? How many sick children fail to go to the doctor for their annual physical, or have never had a dental cleaning? How many elderly Americans skip a meal or otherwise suffer so that they can pay for an important prescription?

There are, of course, many costs to the continuing crisis of health care delivery in this country. There are economic costs, human costs, moral costs, and as yet uncalculated costs whose impact continues to grow exponentially.

Some argue that preventive medicine for all is simply too expensive, and that health care is a privilege in which only some Americans can partake. Others argue that there are just too many "lazy" Americans who need to get a job so that they can pay their fair share. The picture is obviously more complicated than these simplifications of a far-reaching socioeconomic phenomenon, and we have only to look at the foreclosure crisis and the banking industry to see that many Americans are saddled with debts and mortgages that they can ill afford. And as unemployment remains significantly elevated and millions are out of work, the ranks of the uninsured and underinsured will no doubt remain voluminous.

In an election year, there is much talk of repairing the economy and putting Americans back to work. But many of these newly created jobs will no doubt offer no healthcare coverage to speak of, and many Americans lucky enough to find a job will be no closer to accessing care---or paying for the care that they succeed in accessing.

Yes, it's an economic problem, but the moral and ethical issues at play are difficult to ignore. Our (relatively) mighty economy sends trillions of dollars overseas for war, economic aid to other countries (deserving of such aid or not), and other purposes, but we still cannot feed, clothe, house, and provide medical care for those among us who need such assistance. Other countries do it, but we simply seem to lack the ability---or moral stamina---to do so ourselves, even as we preach the gospel of the our way of life.

I am continually saddened by the ways in which we let our citizens down, and this is yet another stunning reminder of how far we truly have to go in order to fulfill the (as yet unfulfilled) promises of the American republic.

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