Friday, April 24, 2009

What to do with medical and credit card debt and mortgages: "Negotiate"? Or hire a Negotiator. (Ask Trump)

There is a lot of talk out there that patients should become aggressive in negotiating with their health care providers, to reduce bills. There are many possible tactics, including offering cash upfront for a lower bill.

An a new kind of business opportunity may be evolving: becoming a professional negotiator for medical bills. That could come out of the way debt collection companies operate. For medical bills, they often have separate staffs, which have to be trained in matters like HIPAA compliance. And collectors often have some discretion to reduce the balance due to settle, even though their employers may sometimes discourage it.

The news story was in the New York Times March 13, 2009, “Patient Money: Bargain Down the Medical Bills,” by Lesley Adlerman, link here.

Barbara Ehrenreich (Queen of the Left, maybe?) has written a lot about the abuse of the poor who became poor through medical debts. Her sharp-edged blog is here and on Oct. 8, 2008 she writes and entry called “The Communist Manifesto Hits 160”. Of course her literary rival Adam Shepard (who wrote a full-book answer to “Nickel and Dimed” called “Scratch Beginnings”) dealt with his own broken toe (from manual labor) with negotiation – a favorite word of Donald Trump, it turns out – even if his tactics came out of a gentler Stephen King. Ehrenreich’s classic piece is “Gouging the Poor” from The Progressive in Feb. 2004, here. Actually, Ehrenreich has an even louder entry (with shades of Johnathan Swift) on the Huffington Post, back in July 2008, “The Suicide Solution”, here. The piece focuses on foreclosures and credit card debt, but one of the comments (there are a lot) says, sarcastically, “Medical bills? Too bad. It's apparently your own fault for getting sick.”

It strikes me that, if we had single payer (Canadian style rather than British) and were used to it, universal health insurance wouldn’t be controversial, and it might even help out (even save!) our employers (most of all car companies) on an even keel with foreign competition that doesn’t have the same benefit structure. But there is no free lunch. We would face situations where we would delay or ration care if there weren’t enough blood family support. But hospitals and doctors and particularly debt collectors could stop acting mean. Gone would be the retort, “We’re bigger than you are.” Michael Moore (King of the Left), bring it on.

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