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  • Saturday, March 19, 2005


    Bankruptcy and Health Care, Part III

    It may seem that I'm beating the whole medical bankruptcy thing into the ground but it's important to counter the misinformation that only spendthrifts and irresponsible people file for bankruptcy. From one of my previous posts:
    That's a startling example of the "straw-man" school of argument. The study by the Harvard profs shows that in the two years before filing for bankruptcy, 19 percent of families went without food, 40 percent had their phone service shut off, 43 percent could not fill a doctor's prescription and 53 percent went without important medical care.
    One of the authors of the study mentioned answers a few questions here about how the methodology of the study. Here's a little bit from it:
    2) What did you say in the study?

    There were many ways to measure medical bankruptcy, from the family that was crushed by massive medical bills (medical debt) to the person whose bills were picked up by insurance but who was flatted by eight weeks with no income (job loss) to the family that paid off huge medical bills by putting a second mortgage on the house and who now can’t manage the mortgage and all their other bills (migrating debt). We said that reasonable people could make the count different ways, but that the data suggested that about 44.2%-54.5% of the families filing bankruptcy could fairly be classified as medical bankrupts. We extrapolated those numbers, which would mean about 750,000 households filing for bankruptcy, or about 1 million people (counting husbands and wives who file together). Once the children, the elderly dependent parents, and the non-filing spouses are counted, the total rises to about 2 million.

    These families were mostly middle class, with good educations and decent jobs. About three-quarters of them had health insurance at the onset of the illness or accident that eventually bankrupted them.

    3) Is it true that you included drug addiction and gambling in the definition of medical bankruptcy?

    Yes, we reported data on addition and gambling—but it made very little difference on the overall numbers. About 2.5% families described the costs of dealing with addiction and 1.2% reported uncontrolled gambling. Many of those families had other medical problems—children with serious illnesses, car accidents, a terminal illness in the family, etc. If all of these families were somehow disqualified from consideration as medical bankruptcies, then the top range of the estimate of medical bankruptcies would drop from 54.5% to 50.8%.

    4) Why include these people at all? Isn’t this their own fault?

    My physician coauthors felt strongly that a family driven to bankruptcy to pay for drug rehab treatments for a teen-aged son should be included in medical bankruptcies. They also thought that a family that lost everything when an out-of-control husband ran up hundreds of thousands of dollars in debts at casinos should be included. If a family described their reason for filing as addiction or uncontrolled gambling we reported it, but we also gave the exact percentages so that anyone who wanted to exclude these people could do so—and could see that it wouldn’t change the overall finding.

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