If You Like Medical Bills, You’ll Love These

Activists in the blogosphere [1] are studying well over 500 amendments [2] to Sen. Max Baucus’ Senate Finance Committee health care reform bill, including three “public option [3]” amendments. All sides will hotly debate, soundly trash, and amend the hell out of the Baucus bill, H.R.3200 (on the House side) and any others that come out of the woodwork by October.

But those aren’t the only kind of bills Americans should be worrying about.

My sister died at 37 from a metastatic sarcoma (the same cancer that took Ted Kennedy, Jr.’s leg). I watched her die, went to her funeral, and then went back to her apartment to sift through stacks of medical bills.

In exhaustion and grief, we couldn’t tell which bills were paid, which were not, which were rejected, which were under review, and which were still in the pipeline and wouldn’t arrive for weeks or months. This doesn’t happen in most industrialized countries [4] and shouldn’t happen here. It's a disgrace, a disgrace that none of the bills pending in Congress will cure. A disgrace that health insurance conglomerates and their allies in Congress are fighting hard (and spending hard) to preserve, along with the profits the billing process helps generate.

Over 60 percent of personal bankruptcies [5] in the U.S. are from medical bills. Over three-quarters of those are in families who had health insurance, were probably satisfied [6] with it, and thought their coverage was adequate until a serious illness proved otherwise. But it's the burdensome billing process itself that the health care reform debate has not addressed.

At the America’s Future Now! conference in June, Dr. Salomeh Keyhani of Mt. Sinai Hospital detailed the number of weeks doctors, nurses and their staffs spend each year dealing with insurance paperwork and procedures. Insurers make it as difficult as possible for customers to collect. Bottom line: if patients and doctors get frustrated and go away, the insurer won’t have to pay. Keyhani described the labyrinthine claims process as “passive aggressive” by design.

Keyhani's name came up again last week in connection with a nationwide poll published in the New England Journal of Medicine. Keyhani helped conduct the survey funded by the Robert Wood Johnson Foundation of 5,000 physicians [7] representing a spectrum of specialties and regions, including American Medical Association members. The survey, Keyhani told NPR, found [8] that "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options." That included AMA members, whose organization opposes a public option.

Yet only a single-payer-style plan promises to eliminate the mountains of bureaucratic paperwork that make our patchwork system cost nearly twice what other advanced countries pay. But since a nationwide single-payer system is off the table, even if a strong public option gets to the president's desk, most Americans will be sifting through confusing stacks of insurance paperwork for years to come. Some reform.

The anti-reform forces had their Tea Party in Washington on September 12. They offered no alternatives and screamed loudly about not being heard, but not loudly enough to drown out a majority that decides to speak with one voice.

President Obama must know that he has only to say the word and a sea of pro-reform supporters will travel to Washington in support of real reform and a robust public option. If summoned, supporters should bring their collections of medical bills, rejection letters and appeal forms and wave them overhead.

Talk about “Don’t Tread On Me.” Medical insurance paperwork is universally recognized and universally loathed. It could serve as a potent symbol of everything wrong with America’s dysfunctional, for-profit health insurance system.

Reform supporters might, en masse, flood congressional fax machines with their medical bills. Or stage media events with fax machines set up in public spaces for patients to fax their medical bills to Congress -- just to put an exclamation point on demands for meaningful reform.

There's something viscerally satisfying about feeding documents into a fax machine and knowing they're spitting out onto the floor of your congresscritter’s office. It's the next best thing to being there.