Medical Debt in California

The State of Health Insurance in California: Findings from the 2007 California Health Interview Survey: "The report . . . found that nearly one in 13 Californians had some kind of medical debt and that those with debt were twice as likely as those without debt to report delays in getting needed medical care."

The link is to a summary of an extensive report. The report expands on the medical debt issue to point out that two thirds of those with medical debt incurred it while insured, and that nearly 10% of those with medical debt, more than 200,000 people, had medical debt that exceeded $10,000.

The concept of medical debt, or medical bankruptcy (a large proportion of personal bankruptcies in the United States are caused by medical bills), is completely foreign to people in countries with universal coverage. Laying aside the moral imperatives here -- and conceding that there are principled moral and ethical positions on both sides of the question of universal, guaranteed health care -- the economic efficiency of broad based, prospective coverage is very compelling.

The reasons for this are several and fairly uncontroversial:

1. It is much more expensive to care for people after they are sick (or very sick) than to provide preventative care and/or care early in an illness.
2. People who don't have heath insurance coverage will consistently forgo preventative care and wait longer to seek care when they are sick.
3. We (mostly) do not deny emergency or life saving care to those who cannot pay. When people who are very sick come to emergency rooms, they get treated. Hospitals and doctors account for the losses they incur by treating these folks as costs of doing business and then raise their rates on those who can pay as a result. We already pay for health care to the uninsured, we just do it in an unbelievably inefficient and non-transparent manner.
4. A healthier population is more productive. How many billions of dollars are lost each year because people in the work force, or their families are sick? How much is lost as we force people into debt and bankruptcy due to illness or injury?

I don't want to seem cold hearted. I believe we should provide universal health care for every inhabitant of the United States. I think this is by far the most civilized and humane approach. I also acknowledge the imperative of personal responsibility, and have sympathy for those who feel that universal, government provided coverage undermines this. I just don't really think you have to solve that debate to conclude that a different, more inclusive and efficient approach to health care delivery and reimbursement is sorely needed, nor to conclude that the new approach must include universal coverage.