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Thursday, February 28, 2019

The scourge of medical billing

I know this stuff all too well. As I'm sure do many of you.

From NPR:
MARY LOUISE KELLY, HOST:
This is what having cancer in the U.S. these days entails - grueling treatment, yes, but also surprising medical expenses, insurance denials, depleted savings accounts, even bankruptcy. Anna Gorman reports from Texas on one family coping with the financial fallout of cancer.


ANNA GORMAN, BYLINE:

Carol Marley is 50 years old. She has pancreatic cancer. Every day counts. And every day brings a frustrating phone call with an insurer or medical provider.

CAROL MARLEY:

This is Carol Marley calling. I'm getting ready to be going out of town for a treatment for my cancer, so I really - I need some help. If you could please call me today, I would appreciate it.

GORMAN:

Even though pancreatic cancer is one of the deadliest cancers, Carol's doctors caught it earlier than most.

C MARLEY:

I have faith in God that my cancer is not going to kill me. I have a harder time believing that this is going to get straightened out and isn't going to harm us financially.

GORMAN:

Carol is a nurse near Austin, Texas. She was diagnosed in July, and the cancer hasn't spread beyond her pancreas. Her health and the finances weigh on her.

C MARLEY:

It's incredibly stressful. I mean, I don't sleep at night. I take anxiety medication, you know, more often than I want to...

Just what you need when you're fighting serious, life-threatening illness.

This is a particularly pernicious area exacerbated by chronic data opacity / siloing, and what I irascibly call health IT "interoperabble."

My own 2015 experience with prostate cancer consumed most of that year. My head-scratching hassles with the medical billing industry were mostly a recurrently eye-rolling annoyance. See my prior post "The U.S. healthcare 'system' in one word: 'shards'."

Ten months after losing my younger daughter to pancreatic cancer on April 27th 2017, I continue on her late behalf to foist off aggressive attempts to collect absurd amounts of money (though by now it is abating). Twenty years prior to her death, we lost her elder sister to (unrelated) cancer. Similar postmortem bureaucratic hassles ensued.

Both of my girls died beyond flat broke as a result of their illnesses. Not that any of that mattered to medical bill collectors. But, the money gumshoes all eventually came to learn that they were messin' with the Wrong Irishman.
Danielle is survived only by her son, my grandson Keenan. Notwithstanding that I am not legally on the hook from any of her residual debts, I try to shield him from most of this crap so he doesn't get gamed into assuming liabilities for which he is not responsible. The Wrong Irishman knows the ropes. I used to work in subprime risk management. I know all about delinquency, collections, and charge-offs.
Listen to the entire NPR episode. Read the transcript. I so wish this woman well.
"Every misspent dollar in our health care system is part of someone's paycheck" -- Brent James, MD, M.Stat
Yeah. An observation in passing:
“I don’t think in ideological terms. I never have,” Obama said, continuing on the health care theme. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”

Graeber, David. Bullshit Jobs: A Theory (p. 157). Simon & Schuster. Kindle Edition.
Stay tuned. Once again, political talk of "Medicare for All" and "Single Payer" (my 1994 Argument Analysis pdf) are in the air as the 2020 presidential race heats up. It will no doubt be as contentious as the "Obamacare" reform, if not more so.

apropos, see my post on the CATO Institute book "Overcharged" (a post which cites other relevant reads as well).

UPDATE: SPEAKING OF BOOKS

Reviewed at Science Magazine:

A science writer probes the one risk factor shared by a bevy of devastating diseases

Chronic disease states—including diabetes, most cancers, and cardiovascular and neurodegenerative syndromes—have become the leading drivers of morbidity and mortality. Medicine has set out to develop therapies for each condition separately, and yet they share a common denominator: aging. This has led to the revolutionary idea that interventions that slow aging will have the biggest impact on our collective health: not just extending life span but also delaying or preventing the onset of many diseases and improving functional parameters later in life.

But what causes aging, and how do we intervene? In Borrowed Time, Sue Armstrong describes proposed hallmarks of aging—which include accumulation of cellular damage, loss of stem cell function, cellular senescence, and others—and makes a cogent case for the role of each in driving age-associated dysfunction. Along the way, she describes the origins and development of the aging research field…
 Looks interesting. Only $9.99 Kindle price. In the wake of the stresses of the past couple of years here, I'm certainly feeling and seeing the effects of aging, at 73 now. 
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More to come...

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