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Medical debt plays a role in a majority of Oregon bankruptcy filings (opb.org)
37 points by cratermoon 18 days ago | hide | past | favorite | 33 comments

I think those that want the US medical system to remain private are being extremely short sighted in not finding a way to fix this problem. They can either compromise today and keep a smaller amount of profits going forever, or they can extract maximum profits and increase the risk of a political change outlawing their entire company. It seems from the outside that they’re choosing the latter.

I feel a great frustration by those who argue against healthcare reform in the US, because most of the arguments against a socialized system resonate with me, but they also seem to be arguments against the current system.

I would be concerned about moral hazard leading to people not taking care of their own health. And yet, America has a disproportionately bad problem with weight and cardiovascular health. I get a discount for not smoking, sure, but I don't get a discount for going to the gym multiple times a week and adjusting my diet to keep my weight goals. I seem to be sharing a risk pool with a lot of very willingly unhealthy people.

I would be concerned about a DMV-like experience when trying to take care of my health care, except, that's what we have now. Bad incentives are created for providers, for insurers, and really it's all of them against me. And it's hardly a free market when there's still effectively a complete lack of transparency over pricing, and I can't very well shop around for where the ambulance should take me.

I'm very pro-immigration as long as we have some security / documentation process that people follow that we actually enforce, because I don't want a social healthcare system that just gets abused by people who have no intention of ever being a formal part of the system that funds it. Except we already have a drain on hospitals in many states where they have to provide life-saving care but will never get reimbursed for it. And that's exactly what Romney's major argument was in defense of his state's healthcare law, but Republicans ripped him to shreds over it.

I just don't understand what Republicans are arguing for here because the current system is not remotely giving any of the benefits of a free market and that doesn't seem to be changing any time soon. If the current system is privately-run healthcare, why is everyone so convinced that the vaccine is a government conspiracy? It seems to me we don't have either ideal, so we're stuck with a half-measure that isn't really working for anyone but insurers.

>>> but I don't get a discount for going to the gym multiple times a week and adjusting my diet to keep my weight goals. I seem to be sharing a risk pool with a lot of very willingly unhealthy people.

Government prevents that, the very people that push for government run healthcare, pushed to ensure all persons pay the same rates. The only discounts allowed by law are for Smoking. Your employer can not legally discount your health plan for anything other than smoking.

There are some loops holes for "health incentives" billed as bonus'

>>If the current system is privately-run healthcare,

Its not.

>> Its not.

No and that's really my point - we have this heavily regulated mix of public and private that I don't think anyone fully understands, makes it a nightmare for consumers, gives a heavy advantage to existing players, has massive amounts of overhead, etc. People who say things about wanting a free market don't seem to be pushing us in that direction, only pushing against reform.

I recently switched to an HDHP / HSA and I feel like it's much better. One of the problems is that insurance has stopped being about risk management because (almost) everyone has it and wants it to cover everything, so it's just a game of group negotiating on a group tab. I had the plan because my company negotiated it with the insurance company who had rates and networks negotiated and I was just supposed to go to the doctor and now pay whatever else was left but who knows what that was. But now my doctor's not even in-network. With an HSA, I can just pay her directly and forget the rest of it.

> It seems from the outside that they’re choosing the latter.

I agree, but I think the reason why is "it won't happen to me" syndrome. Sure, other companies or people might get regulated out of existence, but in the short term maximizing profits and hoping or expecting to see the boulder rolling downhill in time to get out of the way is seen as the better plan. Because if you're right, you get to keep a lot of money. And if you're wrong, well, you don't think you'll be wrong.

This seems to be the thinking of our entire economic system in the United States. Grab as much money as humanly possible, regardless of any future consequences, even if the very act of the grabbing increases the odds of a much worse outcome.

I think it's a bit of that, and the execs are aware that they'll always land on their feet, even if their company and workers won't. After all, if none of the bankers from 2008 went to jail, what does a Blue Cross VP have to fear?

None of the executives in the tobacco industry ever went to jail. I'm not even sure any of them ever felt any personal consequences, at least not of any lasting nature.

It's been pretty normal for a while for private industry to extract maximum profits for as long as possible while delaying change. See for example the tobacco industry.

The Tobacco industry knew that their industry was doomed. It's coldly rational, if a bit sociopathic, to decide to extract maximum value from your industry before what you perceive as an inevitable decline at the expense of your customers health. The oil industry is in a similar situation now, IMO.

The private health care industry is not in such a situation. There is no guarantee that socialized healthcare is the future for America. But the more and more they attempt to extract from consumers per year, the more likely they make it that socialized medicine will happen here.

> There is no guarantee that socialized healthcare is the future for America

The private health insurance industry in the US is doomed. Whether or not the outcome is "socialized medicine" or some other form of universal healthcare coverage is beside the point.

I don’t think current polling bears that out. If you look at any questions that imply or explicitly state that universal healthcare will eliminate their insurance, then those questions poll deeply underwater.

Furthermore, I don’t think anything political like this is pre-ordained.

It's not the polls or politics that matter, it's the economics.

I think people in the US that still believe the US medical System is private are delusional

I want a private health system, one with actual market economics not with the hand of government poking and prodding at every turn making things worse. Sadly the free market shipped sailed away decades ago.

What we have today is terrible system of heavy government regulation, poor subsidies, "insurance" that is not really insurance, combined with the US health system bearing most of the RnD costs for the world.

Those that are opposing complete government take over already lost they just do not know it yet and are just prolonging the pain. Personally I say let it happen, and watch as it collapses because a US Federal run health system will be atrocious, the US Federal government is incompetent and corrupt, but it seems many citizens want a health system run by corrupt incompetence. So lets to it. then we can get way back to a free market once the people learn the lesson the hard way.

I think the best systems in the world right now are hybrid. public options with private companies to fill in the gaps.

When you say free market do you mean with insurance? or without?

The problem with health care and free market is the incentive don't line up. Most of health care costs are accumulated at the end. so you can't really do loans. your left with some kind of upfront payment plan(aka insurance) and their incentive to maximize premium and minimize expenses(aka paying for your healthcare)

Then you run into the problem that you need private watchdogs to keep an eye on the insurance companies and rate them. Problem is the smaller they are the more easily corruptible they are.

>>When you say free market do you mean with insurance? or without?

Either I would like to so innovation in that space where today the government is stiffing that. For example there was a Doctor in Kansas I believe that attempted to open a Medical Coop where families would pay a monthly fee and then get access to the facility for their general medical needs.This was deemed to violate medical billing regulations so he was forced to shut it down. Then there is walmart, even a massive company like that could not navigate the regulatory burden to offer small clinics where a person could see an RN for minor medical conditions. They could not figure out how to comply with the regulations and make is profitable.

There is a reason ALOT of the medical services (Doctors offices, Networks, and Hospitals) are actually NON-profits. People believe that the "profit motive" is the reason for high costs, when in reality the delivery of medical services outside of Pharmaceuticals and devices, is already non-profit

As to insurance would also like to see a return of actual insurance. We we call "health insurance" is not really insurance. Insurance is about risk pooling to absorb known but unlikely events. Insurance that covers all medical expenses (i.e comprehensive coverage) is not insurance. My Auto Insurance does not cover oil changes, and my Home owners insurance does not cover replacing my HVAC system so why does my health insurance cover my annual checkup, and when I have a cold????

>>Most of health care costs are accumulated at the end.

That is not an example of the incentives not lining up, and we have a solution for that, a solution I would like see expanded but HSA are designed for that.

Terrible. Absolutely ridiculous that any person in 2021 anywhere on planet Earth should ever have their financial life ruined because of illness, let alone the U.S. of A.!

Terrible. Absolutely ridiculous that any person in 2021 thinks that they can do whatever they want to their body, regardless of the consequences, and other people should have to pay for it.

We already do pay for it. Most people don’t have any money to spend on medicine, which is why everyone’s insurance premium is so high. Or they are on state-provided care, which you pay for already as well.

You know people can get sick without wanting it, right? Tying up health care to your job make you less free, so ironic for world "most free" country.

Some people do everything "right" and still "win" the hard luck lottery.

The real question is health care a right?

If it is who pays? If it is the taxpayers, then they should have some say in the behavior of others right? No more overeating, no more smoking, no more risky sex, no more drugs, then the question is who will enforce this? It is a spiral of government intervention. It is a tough problem, now compound this problem with citizenship. Should noncitizens be covered? If the answer is yes then one must think of the global implications. If a country is exporting people without any restrictions we could easily bankrupt our taxpayers. If we treat them and charge back to the host country, and they refuse to pay, what then?

What percent of people going bankrupt have housing debt - either a mortgage or rent? What percent of people who declare bankruptcy have personal debt owed to people they know?

I understand that it's a 1 paragraph story but there's some nuance there that's being implied and some that people pass along that's not supported by that paragraph.

It seems unlikely for a mortgage owner to go bankrupt under today's circumstances. Right now, the housing market is up. This means that if anyone gets foreclosed upon, the house is worth more than the mortgage. So they aren't bankrupt at all. Sure, they lose their house and might be homeless, but no reason to declare bankruptcy yet.

In 2007, the housing market was down. That's where you'd get bankruptcies: because the house was worth less than the mortgage. So called "underwater mortgages". You get foreclosed upon, but still have to pay $100,000 after losing your house and becoming homeless.

So it all depends on the market price of homes.

Bankruptcy is a valid legal tool used all time by people ti get out from under crushing debt before it crushes them.

In many states your personal residence is protected and exempted from bankruptcy so it would not be wise to use your equity or get to the point of foreclosure in lieu of filing bankruptcy.

If you have large amounts of unsecured debt (i.e personal loans, credit cards, etc) then I would absolutely explore bankruptcy before becoming homeless or losing my home

Alternate summary of report: 91% of Oregon bankruptcy filings don't involve a large amount of medical debt.

Ah yes, this canard again.

Only 4% of US bankruptcies are because of medical bills (<https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0...>). A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause.

The biggest cause of bankruptcies is lack of income, which health insurance doesn't affect. In other words, people going bankrupt because health problems = lack of work = lack of income.

From the Post piece:

>So Carlos Dobkin, Amy Finkelstein, Raymond Kluender and Matthew J. Notowidigdo did what’s called an “event study.” Instead of looking at bankruptcies to see how many involved medical bills, they started with the illness, and asked how much more likely people were to declare bankruptcy after they got sick. That’s a much better way to tease out causation than asking whether someone who just went through a financially ruinous divorce also owed his or her dermatologist thousands of dollars.

In other words, it's not surprising that someone who declares bankruptcy owes medical bills among all the bills he is behind on. While "correlation is not causation" is used far too often by people who don't really understand its meaning, this is an example. Again, from the Post piece:

>That jibes with what we’ve seen in the bankruptcy data since Obamacare passed. If medical bills really were driving so many people into bankruptcy, then we would have expected filings to plummet after 2013, when millions of people gained health insurance coverage. Instead we see a smooth decline from the recession-era peak.

In any case (and contrary to what Reddit would have you believe), 91% of Americans have medical insurance (<https://www.census.gov/library/publications/2020/demo/p60-27...>), whether through their employers, or government programs like Medicare/Medicaid. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers.

Two thirds of Americans have private medical insurance. One third have public insurance of some type, including 20% from the aforementioned Medicaid.

Some large chunk of the 4-6% differential in the US versus other countries is illegal aliens who don't qualify for public insurance and are working cash jobs that don't provide private insurance. The only such national systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment.

Did you know the book "How to Lie With Statistics" was written not by a statistician but by a writer who was employed by the tobacco industry to downplay the research about the health effects of smoking? He had written a sequel "How to Lie with Smoking Statistics", but it was never published. https://kilthub.cmu.edu/articles/preprint/Huff_and_puff/1312...

People in America going bankrupt because they have unlimited risk against things that commonly happen to a lot of people? Let me quote Casablanca "I am shocked, shocked to find gambling (medical bankruptcy) going on in here".

Texas dosen't count your primary residence as attachable in a bankruptcy.

While in CA, you are only provided $250,000 in coverage.

Personally, I don't think anyone should be able to touch your first primary home for any reason.

(I thought all bankruptcy laws were federal. I just assumed they would all be the same in every state, but they don't appear to be? Everyone dumps on TX, but they do some thing right. I heard that if you are arrested for a DUI in Texas. A judge will take into account previous alcohol tolerance. So basically, if you are an alcoholic, and you pass a computer simulation provided by the state, you might be able to get out of that DUI. I think it logical, but I must have miss heard that?)

"if you are an alcoholic, and you pass a computer simulation provided by the state..."

What do they do, make you get exactly as drunk as when you were pulled over to take the test? Where does the alcohol come from, the mini-bar under the judges desk, between the gun rack and stack of bribe envelopes?

>>(I thought all bankruptcy laws were federal

There are some protections for primary residence in Chapter 7, but it is not complete protection. I believe it is around $25,000 in equity, Meaning if your home is worth $225,000 and you owe $200,000 then your home is safe

If however you have a $225,000 home, and only owe $80,000 on it under the Federal Exemption system you could be forced to sell to satisfy debtors

Many states, as you have discovered, have additional exemptions, one generally has to choose if they want to use State or Federal Exemptions at the time of filing.

That last bit does not sound right. DUI laws are set at the state level on the threat of the DOT withholding federal funds for state level road construction and maintenance. I'd be pretty surprised if the feds were okay with such a scheme.

(Nor, frankly, do I think that it's morally defensible. Laws are better when everyone can predict whether or not what they're doing is legal. A clear cut BAC limit is easier for everyone to comply with than some nebulous concept of "tolerance").

Texas is in the same bucket as Arkansas, DC, Florida, Iowa, Kansas, Oklahoma, and South Dakota as having an unlimited homestead exemption. Though, if you're convicted of securities fraud in Texas, you're limited to $125k. Dunno if that little caveat is still enforced.

California upped their homestead exemption to $600k this year.

There are still a bunch of states that have sub $100k exemptions on the books, with Tennessee and Virginia at $5k.


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