Medical bills are skyrocketing and New Yorkers are facing a health crisis. Life expectancy in the United States continues to plummet even as other wealthy nations recover from the pandemic. We receive an inadequate patchwork of care, yet we are burdened with medical debt.
As an attending physician in the outpatient pulmonary clinic of a city public hospital, I see every day how our healthcare system prioritizes profit over quality care. I recently saw a black woman who was suffering from asthma. My patient had been seen by a private doctor at a nearby hospital. She was referred to us because she had lost her insurance and she could no longer pay for private practice. Her referral hospital records showed that she had conducted two sleep studies but no baseline pulmonary function tests to verify her diagnosis and assess her progress.
Pulmonary function testing is simple, inexpensive, and, therefore, unprofitable. That would have been the appropriate assessment for my patient. However, by opting for expensive, profitable but not immediately indicated sleep studies, the private practitioner chose profit rather than proper patient assessment as the basis for his clinical decision-making. Baffling.
Medical debt is debilitating for many Americans. High costs of care, insurance and medications all contribute to unaffordable care, poor health outcomes and medical debt.
Last year, Governor Hochul signed two bills into law that bring some relief to New Yorkers. One protects patients from liens on their homes and wage garnishment. The other bans so-called preventive care facility fees and otherwise requires that patients be informed about such fees prior to treatment. While an improvement, this transparency doesn’t protect patients from these fees when they need urgent care, are stuck in restrictive insurance networks, or live in rural areas with few providers.
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Our government will have to do much more to contain the explosion in health care costs. More than half of US adults struggle to pay for care, a new Gallup poll shows a record 38% of Americans in 2022 have delayed or skipped treatments and medications because of costs, and 55% of Americans (many with insurance) has medical debts. Communities of color are disproportionately harmed. As costs and debts continue to mount, so do aggressive debt collection efforts.
New York hospitals have sued more than 52,000 patients for medical debts.
While by law all hospitals in New York City operate on a non-profit basis, many do not serve patients fairly and often fail to provide adequate financial aid. Hospitals also wrongfully receive millions of funds from the Indigent Care Pool (ICP), whether or not they provide care for the uninsured, underinsured and low-income patients those funds are meant to cover.
Action is required. Regulators must allocate ICP funds based on uncompensated care provided in order to adequately support our safety net hospitals. Lawmakers are expected to pass the Prevention Ounce bill before ending their session this week to immediately expand and modernize financial assistance. Lawmakers should ban all hospitals receiving ICPs or public funds from suing patients for medical debts.
Another bill, the New York Health Act, provides the ultimate solution, eliminating care gaps, surprise bills, and medical debt at source: universal, single-payer, fairly funded health care for all residents of New York and full-time workers, with no copays, deductibles or other out-of-pocket expenses. The New York Health Act surpasses all plans now offered by employers and unions, providing unprecedented and comprehensive care, including long-term care. It provides ongoing assistance to workers who change jobs or leave the workforce and provides coverage to retired city employees who live out of state. Establishes a medical expense trust fund that all New York residents pay at an affordable rate based on their income. Suppliers then invoice that fund and are reimbursed directly. No profit-seeking middlemen, no patient billing, no more medical debt.
Medical debt and high healthcare costs are taking a toll on the physical and financial health of our patients. Legislatures must now pass the New York Health Act, the Oounce of Prevention Act, and ICP reforms to help undo the damage to our unfair for-profit system. Ultimately, my patient’s previous doctor abused his trust in her and ultimately rejected her when he lost his insurance. The New York Health Act will end the narrow insurance networks that currently limit your choice of provider, allowing you to find doctors who will respect and prioritize your care, and foot the bill.
Lavietes is secretary of the New York City Metro Physicians Chapter for a National Health Program.
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