Your MasterCard or Your Life

By BOB HERBERT
The New York Times
January 22, 2007

Americans are increasingly living in a house of cards — credit cards.

A disturbing new report shows that with health care costs continuing their sharp rise, low- and middle-income patients are reaching for their credit cards with alarming frequency to cover treatment that they otherwise would be unable to afford.

This medical debt, to be paid off in many cases at sky-high interest rates, is being loaded onto consumer debt that is already at dangerously high levels. Many families have been crushed by the load, driven from their homes, forced into bankruptcy, and worse.

The report, released last week, was jointly compiled by Demos, a public policy group in New York, and the Access Project, which is affiliated with a health policy institute at Brandeis University and is trying to broaden the availability of health care in the U.S.

Imagine for a moment the seriously ill patient who needs to be hospitalized. In the cold new world of health care, the primary message to such patients is often “Show me the money!”

In many instances, of course, the patient does not have the money. What the report found is that even people with health insurance are being drained by health care costs to the point where the credit card seems the only option.

“As deductibles and co-payments increase,” the report said, “hospitals are finding more patients unable to pay their medical bills. Some hospital management analysts are expecting an increase in self-pay patients and are bracing for higher levels of bad debt.

“In recognition of the evolving payment landscape and the risk of hospital bad debt, health care providers are more aggressively seeking upfront collection of co-pays and deductibles. A component of this strategy is to encourage patients to use third-party lenders such as credit cards to pay for medical expenses they cannot afford, which families frequently do to meet high medical bills.”

It’s one thing to reach for your Visa or MasterCard to pay for a Barbie doll or flat-screen TV. It’s way different to pull out the plastic because you’ve just learned you have cancer or heart disease, and you don’t have any other way to pay for treatment that would prevent a premature trip to the great beyond.

A society is seriously out of whack when legalized loan sharks are encouraged to close in on those who are broke and desperately ill.

This medical indebtedness is hardly surprising. Health care costs continue to rise much faster than family income and inflation, and Americans (who have stopped saving altogether) were already mired in staggering amounts of personal debt. Some families have been putting their groceries on credit cards. Many have taken the financially disastrous step of using home equity loans to bring down credit card balances.

A serious illness for people already in shaky economic circumstances can be the final push into bankruptcy.

According to the report, called “Borrowing to Stay Healthy,” about 29 percent of low- and middle-income families with credit card debt reported using their credit cards to pay medical expenses — in most cases for major medical problems.

Over all, a full 20 percent of low- and middle-income families with credit card debt said they had used their cards to cover major medical expenses over the prior three years.

This indebtedness — subject to monthly late fees and penalties, and interest rates that can reach 30 percent — only adds to the trauma of serious illness.

It’s believed that 29 million Americans are burdened with medical debt of one form or another. Individuals who are already saddled with medical bills that they can’t pay are much more likely to avoid further medical treatment and to leave drug prescriptions unfilled. Such decisions often have life-threatening consequences.

There is an epidemic of personal bankruptcies in the U.S. and medical factors are believed to play a role in as many as half of them.

These are problems that cry out for reform — of the American health care system and the American way of debt, both of which seriously threaten the American way of life. At the very least, in the short term, we need to protect financially vulnerable patients from a credit card universe in which there are no legal limits on fees or interest, and where the abuse of customers is the norm.

Bob Herbert, New York Times, Medicine and Health, Credit and Money Cards, Credit, Health Insurance and Managed Care, news, commentary, op ed