Today Paul Blest joins us to write about medical debt. More from me down below.

A new study shows Americans have $140 billion in medical debt. Time to end it

by Paul Blest

It’s a crowded field, but there are few things unique to American life that are bleaker than the concept of medical debt. So it’s a good thing, then, that it turns out there’s much more of it than we previously knew.

Nearly one in five Americans, to the tune of $140 billion, had medical debt in collections between January 2009 and June 2020, according to a study published Tuesday in the Journal of the American Medical Association. This is an increase of more than 70 percent from a 2016 estimate of medical debt, which is “highest among individuals who lived in the South and in zip codes in the lowest income deciles and became more concentrated in lower-income communities in states that did not expand Medicaid,” according to the study’s authors—meaning that the people least able to handle the astronomical cost of medical care are saddled with this burden.

And those numbers likely don’t capture the full breadth of the crisis, as the New York Times pointed out:

The $140 billion in debt does not count all medical bills owed to health care providers, because it measures only debts that have been sold to collections agencies. The increasing number of lawsuits that hospitals file against patients to collect debt, which can lead to legal fees or wage garnishments, are not included in the figure. Nor are the medical bills that patients pay with credit cards or have on long-term payment plans. Some of the difference between the new estimate and the older, smaller one may reflect differences in how different credit rating agencies categorize debts.

The new paper does not include data during the coronavirus pandemic, which is not yet available.

Our friend Libby Watson has been sharing stories like this since she launched the newsletter Sick Note earlier this year. In one case, a person with Type 1 diabetes said he just straight-up doesn’t pay the co-pay for his bloodwork. “There’s so much about being a diabetic, I have so much medical debt right now and I just don’t pay it,” Drew, the patient, told her. “I don’t have an option.” And while medical debt itself doesn’t affect your credit score, it can if the bill ultimately goes to debt collectors. (As someone whose doctor told me that I need bloodwork and then had that request rejected by my insurance company after the fact, I do not blame him for skipping out on this bill.)

This is the logical endpoint of making healthcare a commodity. Requiring people to pay for medical care they need to stay alive forces them to put the cost on credit cards, payment plans, and their credit reports. It’s how bills pile up and consume people’s finances. It’s why people are driven to “steal” care—or more often just forgo care entirely because they can’t afford it. More than 530,000 people a year who file for bankruptcy cite medical issues as a contributor to the problem, a 2019 study found. (This was the source of one of the dumbest “fact checks” of the 2020 presidential campaign, by the way. )

That the $140 billion in debt has mostly been accrued by people whose only crime is being poor and living in a state run by Republicans still trying to kill Obamacare—which itself won’t solve the problem either—makes the situation even worse. Nearly 28 percent of Black households and 21 percent of Latino households held medical debt as of the 2018 Survey of Income and Program Participation, a substantially larger share than the 17 percent of white households who have medical debt. It’s a crisis exacerbated by class and race factors, which is one of the main reasons no one bothers to fix it.

But we should fix it—and we can. A national healthcare system or Medicare for All would end the crisis entirely, not to mention many more problems with healthcare in the U.S.), but the federal government could take a number of steps to get rid of the already-existing debt. One idea, as Sen. Bernie Sanders proposed during the presidential campaign, is to simply pay it off. (Some of the biggest agencies in debt collections, by the way, have faced massive fines in the past for scamming consumers. This is an industry that should not exist.)

Eliminating that medical debt could be part of a larger debt relief plan that includes forgiving the existing $1.7 trillion in student loan debt; unlike the bad-faith (and wrong) arguments about who’s helped by student loan debt, no one can make a halfway serious claim that rich people are the main beneficiaries of a plan to kill off medical debt. And given that Congress is currently weighing more than $4 trillion in investments across two different bills, $140 billion is a comparative drop in the bucket for something that would immediately improve the lives of millions of people.

One of the worst products of healthcare in the U.S. is that receiving it often compounds physical pain with financial anxiety, and this is one way to solve that without upsetting the underlying, severely broken system too much. If the worst thing that happens is that debt collection companies go bankrupt themselves, well, that’s just an added bonus.

Paul Blest is a staff writer at Discourse Blog who lives in Raleigh, North Carolina.

The sun rose on the east coast shrouded in the smoke of wildfires burning thousands of miles across the continent on the morning the richest man in the world took his first journey to space.

I don’t know if I say it too much or not enough but thank you so much to everyone who supports this newsletter either with a paid subscription or just by reading it. It means the world to me.

I touched on ol’ uncle daddy Jeff popping out to the space bodega for a pack of moon smokes briefly here the other day while resharing a piece I wrote about “Earthrise” the first color photo of this dumb planet taken from space back in 1968 that everyone lost their shit over at the time. The majesty of it all and so forth. The loneliness and the togetherness. The shared humanity. “The overview effect.”

I don’t have any hope that Jeff Bezos will have returned from his expensive PR stunt having learned anything or having had his perspective on the Earth or humanity or the value of the piss bottle lives he grinds into mud to afford such flights of fancy changed in any way I wrote and then almost immediately after that he landed and sat there in a chair in a cowboy hat and said:

“I also want to thank every Amazon employee and every Amazon customer because you guys paid for all of this.”

We sure did!

Look I enjoyed The Marvelous Mrs. Maisel as much as the next guy and Tony Shalhoub is a goddamned treasure but maybe the Prime subscription wasn’t worth it in the long run?

So then everyone there laughed when Bezos thanked us all but not in the way you and I might want to laugh. Then he said space was so beautiful we need to pollute it more and then he said when asked what it felt like while paraphrasing real American hero Jodie Foster “I’m not talented enough to describe this in words. Maybe we need to send a poet up — someone who would be better at describing it.”

Here’s a poem I just tossed off real quick:

Fuck you.
Pay your workers
and your taxes,
shit head.

Still got around $25k in outstanding loans from that MFA I never finished so sorry if my poem is bad.

They didn’t send a poet back in 1968 but they did employ one after that photograph was taken. (A poet with a job is more fanciful at this point than a big time divorced nerd flying to space.) Writing in the New York Times Archibald Macleish had this to say:

Men’s conception of themselves and of each other has always depended on their notion of the earth. When the earth was the World — all the world there was — and the stars were lights in Dante’s heaven, and the ground beneath men’s feet roofed Hell, they saw themselves as creatures at the center of the universe, the sole, particular concern of God -- and from that high place they ruled and killed and conquered as they pleased.

And when, centuries later, the earth was no longer the World but a small, wet spinning planet in the solar system of a minor star off at the edge of an inconsiderable galaxy in the immeasurable distances of space — when Dante’s heaven had disappeared and there was no Hell (at least no Hell beneath the feet) — men began to see themselves not as God-directed actors at the center of a noble drama, but as helpless victims of a senseless farce where all the rest were helpless victims also and millions could be killed in world-wide wars or in blasted cities or in concentration camps without a thought or reason but the reason — if we call it one — of force.

Now, in the last few hours, the notion may have changed again. For the first time in all of time men have seen it not as continents or oceans from the little distance of a hundred miles or two or three, but seen it from the depth of space; seen it whole and round and beautiful and small as even Dante — that “first imagination of Christendom” — had never dreamed of seeing it; as the Twentieth Century philosophers of absurdity and despair were incapable of guessing that it might be seen. And seeing it so, one question came to the minds of those who looked at it. "Is it inhabited?" they said to each other and laughed — and then they did not laugh. What came to their minds a hundred thousand miles and more into space — “halfway to the moon” they put it — what came to their minds was the life on that little, lonely, floating planet; that tiny raft in the enormous, empty night. “Is it inhabited?”

The medieval notion of the earth put man at the center of everything. The nuclear notion of the earth put him nowhere — beyond the range of reason even — lost in absurdity and war. This latest notion may have other consequences. Formed as it was in the minds of heroic voyagers who were also men, it may remake our image of mankind. No longer that preposterous figure at the center, no longer that degraded and degrading victim off at the margins of reality and blind with blood, man may at last become himself.

To see the earth as it truly is, small and blue and beautiful in that eternal silence where it floats, is to see ourselves as riders on the earth together, brothers on that bright loveliness in the eternal cold — brothers who know now they are truly brothers.

And then what happened next?

Zhengzhou, China saw eight months worth of rain dumped on the city in a single day this week and at least twelve people died in the floods there. Videos of commuters trapped on subways in water up to their necks illustrated the extent of the devastation. At the same time the parched United Arab Emirates are flying drones into clouds in an attempt to jumpstart them with electricity to produce rain.

There was an exchange below that tweet about the floods in Germany — (at least 155 people remain missing a week later) — that I thought nicely summarized where we are on this whole climate change thing.

“500 tons of fish dead,” one person wrote. “Manatees and other mammals dying at an increased rate...we are in a mass extinction right now and yes, humans are on that list. If we don't make our countries do their part and start reversing the damage, we are doomed.”

“What are you talking about?” some fucking guy replied. “There’s plenty of places on Earth that will still be perfectly livable with +4° warming. Yes, millions will perish, but humanity won't go extinct.”

Ah ok never mind then. Sounds basically fine.

In Georgia a five year old boy named Wyatt Gibson died from a stroke after getting ill with Covid. “In one video, Wyatt strums a toy guitar and wears cowboy boots, spinning around in the grass and singing, ‘I love you trees and birds and I love donkeys and I love dogs,’” NBC reported. Asked earlier this week about whether or not she felt any responsibility for keeping Georgians safe — Wyatt lived in her district — Marjorie Taylor Greene laughed in the reporter’s face. “You crack me up,” she said. “You know what? I think people’s responsibility is their own.” Covid “is not dangerous for non-obese people and those under 65,” she said.

Texas has seen around 9,000 deaths from Covid in the past six months. All but 43 of them were unvaccinated. Of the roughly 529 deaths in Alabama since April 1 only 20 were people who had been vaccinated. Overall cases are up 738% in Alabama over the past two weeks. Dr. Brytney Cobia a doctor in that state (which has the lowest percentage of vaccinated people in the country at around 34%) wrote an account of her experience treating the dying in a Facebook post that has gone viral.

“One of the last things they do before they're intubated is beg me for the vaccine,” she wrote.

“I hold their hand and tell them that I'm sorry, but it's too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn't know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn't get as sick. They thought it was ‘just the flu.’ But they were wrong. And they wish they could go back. But they can't. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.”

I’ve plugged this Hell World a couple times now but here you go again for good measure.

There are you will not be surprised to hear people arguing about vaccines in the comments under Dr. Cobia’s post.

It’s not a stretch to imagine that all of… ~this~ is all part of an insidious feedback loop. As Michelle Goldberg wrote in the Times recently “A cruel paradox of Covid is that the social distancing required to control it nurtured pathologies that are now prolonging it. Isolated, atomized people turned to movements that turned them against vaccines. Here, too, Arendt was prescient. She described people shaken loose from any definite place in the world as being at once deeply selfish and indifferent to their own well-being: “Self-centeredness, therefore, went hand in hand with a decisive weakening of the instinct for self-preservation.”

Commenting on the story our man Joe Keohane conjured another thinker to explain what might have happened to us all in the Trump/Covid era. “This piece on how politically destructive mass loneliness is reminds me of Camus’ line: ‘Tyrants conduct monologues, above a million solitudes.’ Dictators feed on loneliness, and even cultivate it, to build their bases.”

Perhaps relatedly a hospital in Jacksonville, Florida expected to break their record for Covid patients this week besting the previous high in January at the peak of the crisis. Resurrection School a Catholic school in Michigan is arguing in front of the courts that forcing students to wear a mask is an infringement on their religion. “Unfortunately, a mask shields our humanity,” the school said in its filing. “And because God created us in His image, we are masking that image.”

Let’s hope that the name of their school matches up with what they teach there for the sake of everyone involved.

Not so fast though “responsible blue states” because Massachusetts is on the precipice of sucking major shit too it seems. Cases rose 472% over the past two weeks here with an average of 268 new ones a day. Relatively speaking however the state (which is second in vaccinated percentage overall) is faring much better in terms of hospitalizations and deaths.

For Discontents this week I had Jesse Taub write about the people that are sometimes easy to forget when we’re doing our little life and death risk calculus vis a vis Covid risk. Raub who was diagnosed with MS not too long ago explained what the uncertainty of being immunocompromised in a pandemic world is like.

There’s no one definition for “immunocompromised.” There are many people who were born with a disability, or people who are going through cancer treatments, or people who just have weak immune systems. The one thing that ties us all together is the fact that we’re at an extremely high risk for serious illness, and that our well being is almost never talked about when cities, states, and the federal government are considering social guidelines for managing the pandemic.

So I won’t, and the rest of the immunocompromised won’t, be able to sit indoors maskless at a restaurant for, well, years potentially. That’s okay. I don’t have to go out to dinner. But I do have to go to the store. I do have to visit new places for work. I do have to just plain exist in a society that seems to ignore my needs. Which, I guess, is just my way of saying: Put on a damn mask when you go grocery shopping. I don’t want to find out for sure what will happen to me if enough people don’t.

After sixty years in the field reporter Jack Thomas wrote what may be his last piece ever in the Boston Globe Magazine this week. He’s dying not from Covid but just from cancer the regular old way we have to die.

“Atop the list of things I’ll miss are the smiles and hugs every morning from my beautiful wife, Geraldine, the greatest blessing of my life,” he wrote. “I hate the notion of an eternity without hearing laughter from my three children. And what about my 40 rose bushes? Who will nurture them?”

A cartoonist and paramedic named Phoebe Cohen drew a piece for The Nib this week explaining why she can’t afford to work the job she is trained for anymore.

“I literally could not afford to work as a paramedic,” she told Marketplace.

“So in the area I’m in — I’m in a pretty rural area — paramedics make about $17 an hour and the babysitters make $15 an hour. So, I was literally working to pay the babysitter and whatever $2 an hour net income I was making, of course, went to gas or to coffee or whatever. It was simply unsustainable for me. And I remember feeling the incredible injustice of it all, saying, ‘This can’t be right, there has to be some other alternative,’ and just realizing the more research I did — nope, nope, nope — because this daycare crisis has been allowed to persist because the people being affected by it are disproportionately women. And if women are the ones being disproportionately affected by it, it’s seen as not an important crisis.”

Elsewhere companies are responding to the perceived labor shortage in the sanitation, waste and recycling industry by looking toward increasing prison labor writes the Guardian.

In April, Russell Stover candy production facilities in Iola and Abilene, Kansas, began using prison labor through the Topeka correctional facility in response to staffing issues disrupting production lines.

About 150 prisoners work at the plant, making $14 an hour with no benefits or paid time off, while other workers start at higher wages with benefits and paid time off. Kansas also deducts 25% of prisoners’ pay for room and board, and another 5% goes toward a victim’s fund. The prisoners also must pay for gas for the nearly two-hour bus ride to and from the plant.

Brandilynn Parks, president of the Kansas Coalition for Sentence and Prison Reform, said these programs can be beneficial for prisoners, but often are a way for employers and the prison system to take advantage of a vulnerable population, while driving down wages and taking jobs from other workers in the community.

She noted many private companies that hire prison workers will not employ them after they are released and will not hire job applicants with criminal records. She added that these programs perpetuate mass incarceration.

Workers at a Frito-Lay plant also in Kansas are “entering their 12th day of striking today over poor working conditions, outrageous schedules, and poor treatment,” as our man Eoin Higgins reported. Now they apparently are experiencing a Covid outbreak in the plant. Vice has also reported on the horrific conditions there.

“Many of the 850 workers at the facility say they work 84 hours a week with no days off. Workers are nominally supposed to work eight-hour shifts, but because of shortages, workers are often forced to add on an extra four hours before or after their shifts. Workers call these extended shifts ‘suicides,’ because they say the schedule kills you over time. Some workers haven't had a single day off in five months, including Saturdays and Sundays.”

In D.C. this past weekend there was a shooting outside a Nationals game that sent the entire stadium into a panic. Afterwards an eight year old girl was interviewed about the experience.

“I didn’t know what was going on until I heard someone say, ‘Get down,’ so I just started to get down under the seats,” Faris Nunn said.

“It was my second shooting, so I was kinda prepared, because I always am expecting something to happen.”

Even worse than all that I also somehow fucked up my knee real bad this week and it sucks shit!!!! Can’t sleep type of agony. Getting old is so bad I do not recommend it. Better than the alternative Michelle said to me while I was whining yesterday and making me a heating pad and I said I suppose so. Fine.

Ok here’s Paul Blest of Discourse Blog writing on some other cool shit going on as part of our exchange program or whatever. Enjoy and please subscribe to Discourse Blog if you can they’re great.