The doctor-patient relationship may be viewed by both parties as one of sacred trust and mutual respect. But as a series from The News & Observer and The Charlotte Observer has shown, the hospital-patient relationship is considerably more complex. Setting a goal to make it more like that doctor-patient connection and less like a business-customer one is not unrealistic.
But theres a lot of finger-crossing going on right about now among those who are hoping for positive change for patients. Many of those patients come to hospital care without insurance or lacking adequate insurance, uninformed about their obligations and how the system works, and ultimately with no choice, because they or members of their families are sick and need help.
Those crossed fingers, of course, are about a coming U.S. Supreme Court decision that could support or kill federal health care reform.
If the high court scuttles reform, America and North Carolina are back where they started with a health care system in this country that leaves many without insurance because they dont get affordable coverage through a job and arent eligible for Medicare or Medicaid, and that denies coverage to others because they have pre-existing conditions which insurance companies decline to cover.
Big money game
And as this series showed, it is a system where hospitals, particularly the large ones, stack up cash and invest it in expansions and technology (no doubt benefiting many patients while driving up costs) and as well in seven-figure compensation for administrators.
It is a system, however, where patients face possible bankruptcy if they are without insurance and are left to battle aggressive hospital debt collectors, even though their debt is not the result of carelessness its because they got sick. And even though the hospitals have millions in the bank.
In North Carolina, its a system where those patients are pretty much thrown to the wolves. Some 13 states require that some medical care providers give free care to those who cant afford it. North Carolina doesnt. And 15 states set up billing and collection policies that apply to medical debt, recognizing it is different from ordinary consumer debt, for example. North Carolina doesnt. And seven states limit what hospitals can charge uninsured patients and how much patients have to pay out of pocket. North Carolina doesnt.
In the newspaper series final installment, seven proposals were reviewed that would force hospitals to do more on charity care and medical debt. In most cases, hospital spokesmen responded to the ideas by saying they might be under consideration but that changes were best left to the hospitals, and not to government regulation.
People in North Carolina need change now, not at the leisure of a self-interested industry.
What to do?
The ideas are:
• Once a person pays a medical debt, it should be removed from a credit report. There is no good reason not to do that.
• Require hospitals to post their charity care policies in places where patients can see and be informed about them. Hospitals say theyre doing this without legislative mandate. What theyre doing isnt good enough.
• Simplify the process whereby patients can apply for charity care (without requiring multiple years of tax returns, and other financial information that may be hard to collect). Hospitals say they need all the info to qualify someone for charity care. This is about medical care not buying a Camaro.
• Require hospitals to report charity care spending. Hospitals say theyre doing it, but compliance is voluntary.
• Stop hospitals from putting liens on the homes of patients who cant pay. Hospitals have a right to be paid; but they get tax breaks worth millions thanks to their nonprofit status. They can draw a line somewhere on how far theyll go and how much of a persons life theyll upend to collect their money from people whose only significant asset may be their house.
• Require hospitals to make prices more transparent, which might create pressure for them to hold prices down. The hospitals say this is evolving and they dont need government regulation.
Be it resolved: Hospitals do great things for people and for communities. But they are at the center of a health care industry that has become a behemoth, fueled by billions of dollars, and its burning the fuel at a low-mileage rate. For many patients, the breaking point approaches.