The Big Story: Medical Debt Is Making Americans Angry. Doctors and Hospitals Ignore This at Their Peril. – KFF
“Many Americans say they simply no longer trust their medical providers,” says Noam N. Levey, one of the KFF Health News reporters reporting on the 100 million people in America driven into debt by medical bills.
“If nothing else, this should be a flashing red light: the simmering resentment of growing numbers of patients who feel victimized by this system… Some of my conversations have been heartbreaking. Some enraging. Many have revealed a deep and disturbing disillusionment with our health care system.”
From boiling points to tipping points
By David Jarrard
Anger is fear in disguise.
It’s an old saying, relevant now in our post-pandemic, hot summer communal life. It’s there, in the news, in Twitter threads, in town hall and school board meetings. It’s maybe in your ER, too, just inside behind the “No weapons allowed” sign taped to the doors.
It is from anger (and its cousins, fear and frustration) that people act because the status quo is untenable, and something must be done. The steps angry people take may not be the best thing or the wise thing, but it’s better than sitting still. Waiting. Feeling powerless. Enduring.
People are angry about healthcare.
You might think this is a relatively small group caught up in individual tragic situations but not, on the whole, consequential. People whose plights should be addressed individually. You’d be wrong. It’s more than that.
“Patients vote, which is why their economic pain is starting to translate into legislative proposals,” Axios told us this week, listing step after step that Congress, state lawmakers, the Biden administration and others are exploring to do something.
Site neutral payments, 340B, transparency regulation, rate caps, consolidation restrictions, “hidden” fees. The efforts to tackle the cost of care are all over the map, forcing providers into defensive battles on multiple fronts in multiple places. It’s the source of that dreaded voicemail you don’t want to get from the New York Times, saying “Explain yourself, please.”
No political party loses by appearing to tackle the high cost of healthcare. It’s a rare bipartisan safe space; it polls well, in a season when little else does. Sensing blood in the water, there’s even fighting inside the family:
- The New England Journal of Medicine asked earlier this month, “Do nonprofit hospitals deserve their tax exemption? Data suggest that many nonprofit hospitals don’t provide enough charity care or have a substantial enough Medicaid shortfall (compared to for-profit hospitals) to justify their favorable tax treatment.”
- The AHA quickly snapped back, “It’s sketchy math. This article should be understood for what it is: just another attempt by a deep-pocketed organization (Arnold Ventures) with a biased agenda to attack hospitals.”
All this sound and fury can seem like thunder from a distant horizon. It’s important – maybe there’s a storm front moving in, maybe it’s just more heat lightning – but it’s not immediate, not like staffing the ICU next week or driving next month’s patient volume.
The issue can feel too big, too sweeping and immune to the efforts of a single organization. Why fight the weather?
So, it’s easy to be defensive and dismissive, armoring your organization against the anger and its rippling actions instead of trying to affect them. Opening your umbrella, if you will. Again, from Kaiser:
“Hospitals and doctors blame the government for underpaying them and blame insurers for selling plans with unaffordable deductibles. Insurers blame providers for obscene prices. Everyone blames drug companies.
“The upshot is that each of these medical industries hunkers down and, pleading its own suffering, looks out for its own interests. They rarely talk seriously about what they could do to relieve the financial burdens they create…”
There it is. The inconvenient opportunity to talk seriously about what can be done to fix a broken system that – despite its mission to heal – causes pain and anger.
The need to develop a vision for the delivery of care that’s more than the defense of a particular model, or funding mechanism – a vision that charts a new path that embraces the entire community of care deliverers and payers and acknowledges the shortfalls of our system.
At great expense, our healthcare provider industry is missing the “so, therefore” that must follow the defense of our current, jury-rigged, duct-taped model of care delivery.
It’s not enough to cross arms and say, “Trust me.” Or point fingers. If we oppose the grab-bag of “solutions” being created out of frustration and anger, what’s our better path?
Without a clear, articulated vision, we’re pushing away from the table, leaving the conversation about the future of care to others. Instead, we should be the dinner hosts, the facilitators.
It’s a lot, but so is the momentum to do something with or without us.
What’s our “so therefore” on this Sunday morning?
- Zoom in. All politics is local. Know your story and tell it. It’s easy to demonize and mistrust people you don’t know. Those coffee meetings we talked about a couple of weeks ago? Do that.
- Zoom out. Find those opportunities for you and members of your leadership team and board to ally with other like-minded providers and join in the creation of a vision of what the delivery of healthcare should be. Those colloquiums are convening. Find them.
No, it’s not easy. And there’s plenty of pressure to stay the course, to defend the known.
There is no risk-free, change-free option for our industry. The status quo is unsustainable, for you and your patients. The anger – and consequential actions cascading from it – is real. We must join the conversation to shape it.