The Story of Lisa Kelly
America's Pay-or-Die Health Care System
By RALPH NADER
This is a tale of pay or die that recurs again and
again all over our country and only in our country in
the entire western world.
Advised by her physician to go to M.D. Anderson for
urgent treatment of her leukemia, Mrs. Lisa Kelly was
told she had to pay $105,000 up front before being
admitted. The hospital declared her limited insurance
unacceptable.
Sitting in the business office with seriously advanced
cancer, she asked herself – “Are they going to send me
home?” “Am I going to die?”
Time out from her torment for a moment. M.D. Anderson
started this upfront payment demand in 2005 because of
a spike in its bad debt load.
The Wall Street Journal explains – “The bad debt is
driven by a larger number of Americans who are
uninsured or who don’t have enough insurance to cover
costs if catastrophe strikes. Even among those with
adequate insurance, deductibles and co-payments are
growing so big that insured patients also have trouble
paying hospitals.”
It isn’t as if non-profit hospitals like M.D. Anderson
are hurting. Look at this finding in an Ohio State
University study: net income per bed at non-profit
hospitals tripled to $146,273 in 2005 from $50,669 in
2000. And you also may have noticed the huge pay
packages awarded hospital executives.
M.D. Anderson, exempt from taxation, recipient of
funds from large government programs and research
grants has cash, investments and endowment totaling
$1.9 billion, with net income of $310 million last
year, the Journal reports.
Back to the 52 year old, Lisa Kelly. She and her
husband returned with a check for $45,000. After a
blood test and biopsy, the hospital oncologist urged
admittance quickly. Then the hospital demanded an
additional $60,000-$45,000 just for the lab tests and
$15,000 for part of the cost of the treatment.
To shorten the story, she received chemotherapy for
over a year. Often her appointment was “blocked” until
she made another payment.
In a particularly grotesque incident, she was hooked
up to a chemotherapy pump, but the nurses were not
allowed to change the chemo bag until Mr. Kelly made
another payment.
She endured other indignities and overcharges.
Reporter Martinez cites $360 for blood tests that
insurers pay $20 or less for and up to $120 for saline
pouches that cost less than $2 retail.
Imagine anything like Mrs. Kelly’s predicament and
pressures occurring in Canada, Belgium, Germany,
Italy, France, Switzerland, Holland, England or any
other western country. It would never happen.
These countries have universal single payer health
insurance. No one dies because they cannot afford
health care. In America, 18,000 Americans die each
year because they cannot afford health care, according
to the Institute of Medicine of the National Academy
of Sciences. Many more get sick or become sicker.
None of these countries spend more than 11% of their
GDP on healthcare. The U.S. spends over 16% of its GDP
on health care and does not cover 47 million people
and tens of millions are under covered
In the U.S. the drug companies charge their highest
prices in the world, even though we, the taxpayers,
subsidized them in large ways. In other countries like
Mexico and Canada, they cannot get away with such drug
price gouging, with a pay or die ultimatum.
In the U.S., computerized billing fraud and abuse cost
over $200 billion last year, according to the GAO arm
of Congress. In other counties, single payer prevents
such looting.
In other countries, administrative expenses of their
single payer system are about a third of what the
Aetna’s and other insurers rack up.
In other western countries, medical outcomes for
children and adults and paid family leave are far
superior to that of the U.S. The World Health
Organization ranks the US health care system 37th in
the world.
When apologists in Washington hear these statistics,
they say “but we have the best medical research
centers in the world, like M.D. Anderson.”
Clearly much is wrong with the nature of pricing
health care.
Like other hospitals, M.D. Anderson is caught in a
macabre spider’s web of cost allocations mixing
treatment costs with research budgets, cash reserves,
and just plain accounting gimmicks that burden
patients.
When a friend showed the Journal’s article to a Dutch
visitor, the latter blurted in anger – “you are a
nation of sheep.” Not a very flattering description of
“the land of the free, home of the brave.”
Someday, soon maybe, Americans will finally band
together and say “enough already,” we’re going for
full Medicare for all- without loopholes for corporate
profiteers and purveyors of waste and fraud.
Last month after being in remission, Lisa Kelly’s
leukemia has come back.
America's Pay-or-Die Health Care System
By RALPH NADER
This is a tale of pay or die that recurs again and
again all over our country and only in our country in
the entire western world.
Advised by her physician to go to M.D. Anderson for
urgent treatment of her leukemia, Mrs. Lisa Kelly was
told she had to pay $105,000 up front before being
admitted. The hospital declared her limited insurance
unacceptable.
Sitting in the business office with seriously advanced
cancer, she asked herself – “Are they going to send me
home?” “Am I going to die?”
Time out from her torment for a moment. M.D. Anderson
started this upfront payment demand in 2005 because of
a spike in its bad debt load.
The Wall Street Journal explains – “The bad debt is
driven by a larger number of Americans who are
uninsured or who don’t have enough insurance to cover
costs if catastrophe strikes. Even among those with
adequate insurance, deductibles and co-payments are
growing so big that insured patients also have trouble
paying hospitals.”
It isn’t as if non-profit hospitals like M.D. Anderson
are hurting. Look at this finding in an Ohio State
University study: net income per bed at non-profit
hospitals tripled to $146,273 in 2005 from $50,669 in
2000. And you also may have noticed the huge pay
packages awarded hospital executives.
M.D. Anderson, exempt from taxation, recipient of
funds from large government programs and research
grants has cash, investments and endowment totaling
$1.9 billion, with net income of $310 million last
year, the Journal reports.
Back to the 52 year old, Lisa Kelly. She and her
husband returned with a check for $45,000. After a
blood test and biopsy, the hospital oncologist urged
admittance quickly. Then the hospital demanded an
additional $60,000-$45,
$15,000 for part of the cost of the treatment.
To shorten the story, she received chemotherapy for
over a year. Often her appointment was “blocked” until
she made another payment.
In a particularly grotesque incident, she was hooked
up to a chemotherapy pump, but the nurses were not
allowed to change the chemo bag until Mr. Kelly made
another payment.
She endured other indignities and overcharges.
Reporter Martinez cites $360 for blood tests that
insurers pay $20 or less for and up to $120 for saline
pouches that cost less than $2 retail.
Imagine anything like Mrs. Kelly’s predicament and
pressures occurring in Canada, Belgium, Germany,
Italy, France, Switzerland, Holland, England or any
other western country. It would never happen.
These countries have universal single payer health
insurance. No one dies because they cannot afford
health care. In America, 18,000 Americans die each
year because they cannot afford health care, according
to the Institute of Medicine of the National Academy
of Sciences. Many more get sick or become sicker.
None of these countries spend more than 11% of their
GDP on healthcare. The U.S. spends over 16% of its GDP
on health care and does not cover 47 million people
and tens of millions are under covered
In the U.S. the drug companies charge their highest
prices in the world, even though we, the taxpayers,
subsidized them in large ways. In other countries like
Mexico and Canada, they cannot get away with such drug
price gouging, with a pay or die ultimatum.
In the U.S., computerized billing fraud and abuse cost
over $200 billion last year, according to the GAO arm
of Congress. In other counties, single payer prevents
such looting.
In other countries, administrative expenses of their
single payer system are about a third of what the
Aetna’s and other insurers rack up.
In other western countries, medical outcomes for
children and adults and paid family leave are far
superior to that of the U.S. The World Health
Organization ranks the US health care system 37th in
the world.
When apologists in Washington hear these statistics,
they say “but we have the best medical research
centers in the world, like M.D. Anderson.”
Clearly much is wrong with the nature of pricing
health care.
Like other hospitals, M.D. Anderson is caught in a
macabre spider’s web of cost allocations mixing
treatment costs with research budgets, cash reserves,
and just plain accounting gimmicks that burden
patients.
When a friend showed the Journal’s article to a Dutch
visitor, the latter blurted in anger – “you are a
nation of sheep.” Not a very flattering description of
“the land of the free, home of the brave.”
Someday, soon maybe, Americans will finally band
together and say “enough already,” we’re going for
full Medicare for all- without loopholes for corporate
profiteers and purveyors of waste and fraud.
Last month after being in remission, Lisa Kelly’s
leukemia has come back.
"Of all forms of inequality, injustice in health care is the most shocking and most inhumane."
-- Martin Luther King, Jr.
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