My guest today is Lynn Petrovich, a CPA and long-time advocate for universal health care. Welcome to OpEdNews, Lynn. You recently wrote an op ed piece about your own adventures in the health care system, “Hospital Accounting: It’s Complicated.” Up until a family member’s unscheduled visit to a local emergency room, you had assiduously avoided the health care system, although you do have health insurance. Why is that?
Joan, the for-profit health insurance industry has set up so many road blocks to payment for health services that it makes even those who have health insurance skittish about using the system.
About two decades ago, one Saturday afternoon,I came home from shopping and, noticing my husband’s car not in the driveway,walked through our front door to see a blood trail leading from the back room to the kitchen to the refrigerator to the freezer to the bathroom to the phone to the back door,down the steps and ending where his car would have been parked. It was apparent something terrible had happened. I was in a panic.
He had been working around the house and severely cut his hand using a hatchet. Despite the loss of blood and in severe pain, he was able to wrap his hand in ice and towels and drive himself to the emergency room…about a 10-minute ride.
The wound was deep enough to require extensive stitching from a surgeon, bandaging,and subsequent rehabilitation. He was lucky.
When the claim was processed by our insurance company, it was denied for the following reason:His injury was not considered an emergency.
The health insurance industry has finely tuned health “providing”into a set of definitions and procedures that are absolutely cumbersome, contradictory, and outright ridiculous. I’ve talked to many people who just give up and end up paying the bill out of pocket.
Over the next 15 years, when my daughter played sports throughout her school years,the insurance company’s madness intensified. The paperwork was enormous…and oftentimes hilarious. After one injury she incurred during a basketball game, the seven-page “Required Compensation Claim Damages” form received from the insurance company after her visit to the doctor asked, “What was the patient doing prior to be injured?” I responded, “Sitting on the bench waiting to go in the game.”Here’s another question: “What was the patient doing during the injury?” I responded, “Setting a screen so her teammate could drive to the basket.”
It often took three or four “appeals” to get the payment processed.
Five years ago, my husband had hernia surgery in a day-stay operation at our local hospital. The insurance company – Interstate Compensation Blue Cross and Blue Shield of New Jersey and Pennsylvania (which I nicknamed ICBS) refused to pay the hospital for the operating room. I fought them for four months. No payment. Finally it went to collection.
It would have been much easier for my husband not to have had the surgery. I mean he would have gotten some funny looks at the 7-11 and the movies what with his intestines hanging out and all…but it would have been much easier than going through all this nonsense with the insurance.
The operating room invoice ($900 for 1 and a half hours) after nine months finally was paid by insurance. But the damage was done. Our credit reflected an account in collection.
What a horror story. Now, I understand why you avoid the health insurance system like the plague! And I’ve heard that, in the majority of the bankruptcies caused by medical issues, most of those individuals had health insurance. Can that be true? If it is, we’re all truly one medical “incident” away from catastrophe.
Yes, if you think about it, the majority of American citizens are basically one incident away from becoming insolvent. We work The American Dream, buying a home, saving for our children’s colleges, building up equity in our homes, trying to save and plan for the future only to be faced with enormous medical bills should a loved one become sick, injured, or chronically ill. Many hospitals require tens of thousands of dollars up front prior to cancer treatments (and that’s if your insurance company hasn’t denied the treatment).
I prepare many tax returns for senior citizens. In fact I’d say the majority of my clients are over 65.I always ask them about medical bills which many new clients don’t seem to think is important. After I walk them through the process, that is, asking them:Did you have any dental work? How about doctor appointments? Lab work? Prescription drugs? Co Pays? Deductibles?Medicare B (which is shown on their SS statements and additional insurance (which many have through AARP)? Don’t forget you can deduct mileage for treatment to doctors and hospitals.
It is not unusual for these clients to have spent $10,000 to $15,000 on medical expenses/insurance during any given year – and don’t forget these are people who already have TWO separate health insurance policies.
You’re a CPA, so you see this health care mess in a different way than most people do – up close and personal, through the tax records of your clients. So, use your special perspective, Lynn, and tell us what your recommendations are for fixing this wholly unworkable system.
Well, that is an interesting question because I’m fortunate to see tax clients on a multitude of economic and social levels.
For the last decade, I’ve been involved with several tax clinics preparing tax returns pro bono, two of which are in an economically depressed City at the Jersey Shore. These clients are mostly the working poor, that is they’re employed full time but earning very little – places like WalMart, Burger King, Taco Bell,to name a few.
Medical expenses are always a topic of conversation; many of these clients are chronically ill, disabled, and, not surprisingly, many suffer from depression. Yet, they consider themselves lucky because they are managing their pain. They worry about those that cannot. I’ve never prepared a tax return for a WalMart/fast food restaurant employee who made more than $22,000 a year. Most do not pay into the health insurance system at these places because they can’t afford the premiums and then the co-pays and deductibles. So they end up either on Medicaid,which is a government health program for the poor, and also many are eligible for the Earned Income Tax Credit which is another federal program(NJ also has such a program) which gives refundable tax credits (money paid out over and above tax withholding).
So, instead of offering living wages and affordable health care, these corporate giants are able to (legally) push the responsibility of the health and welfare of their employees to the taxpayers which (of course) increases the profitability of the companies. It looks good for Wall Street…but not Main Street.So I ask: Isn’t that a form of corporate welfare?
Those taxpayers represent one slice of my clientele.I also prepare tax returns for teachers, professors, police officers, security brokers, engineers, corporate executives, retirees, etc. and they offer up additional insight into our health care system. Most of them have health insurance either through employment or as retiree benefits and yet the paperwork and out of pocket costs are enormous.I hear a lot of grumbling, especially from expectant and new mothers. Since these taxpayers are in the for-profit corporate health insurance industry pool, I often hear them complaining about “corporate greed”.
That’s when I have to explain the principals of our economic system: There is no such thing as corporate greed.A corporation’s sole purpose is to maximize profit and shareholder return. Period. They must cut costs to satisfy Wall Street and the investors in their stock who are ordinary citizens, money market fund managers, internet day traders, and beneficiaries of most pension plans. They must, by charter, deny benefits for health care and annually increase premiums if they adversely affect profit. The more important question is why have we allowed this for-profit corporate system to have control (literally) over our lives for something which should be considered a basic human right?
The only answer to this question is universal single payer health care which, aside from controlling costs and increasing employment,takes the “care” of our citizens out of corporate control and puts it into a system similar to our very successful, long-running, low administrative cost Medicare program.
In his best selling book, Eating Animals, Jonathan Safran Foer writes about his in-depth investigation into our corporate controlled animal factory farms which genetically alter, incarcerate, maim, torture, and slaughter as much as 90% of our meat in America. He points out:
“What the [food] industry figured out -and this was the real revolution – is that you don’t need healthy animals to make a profit. Sick animals are more profitable.”
Yes, sick animals (or humans) are more profitable. So the next time you boast of making a killing on that health care stock, you are absolutely correct.
Well, you lay things out pretty clearly here, Lynn. Anything you’d like to add before we wrap this up?
The only thing I’d add to what I’ve already said is this:In addition to the numerous medical expenses which citizens pay for health care as I outlined in my previous answers, I also see that my tax clients are forced to pay for something known as the “Donut Hole” which is an out of pocket cost most senior citizens inevitably get caught paying thanks to the George W. Bush Medicare D prescription drug program (which, by the way,took two years to implement so the taxpayers could “fund” the pharmaceutical industry billions of dollars to think about how they could “work” it….err, I mean…how it could work). The donut hole is the thousands of dollars per year each senior citizen is forced to pay out-of-pocket for prescription drugs – all because of a well defined math equation -calculated by the drug industry.
As one client said to me recently: “I think the government just doesn’t want to deal with old people any more.”
Sadly, it does appear that way. Thanks so much for talking with me and sharing your perspective on our health care system, Lynn. Good luck to you. And stay healthy!