Need a Kidney? There's a Credit Card for That

By Tamara Draut, The American Prospect. Posted June 11, 2008.

As health-care costs continue to climb, the trend to more "cost sharing" continues, and the ranks of the uninsured keep swelling, more and more Americans are finding that paying for medical care means going into debt. The latest study by the Commonwealth Fund found that one out of five Americans have medical debt -- a population that includes many individuals with health insurance. In fact, nearly two-thirds of people who reported being in debt or having problems with medical bills had health insurance at the time the bill was incurred. Medical debt doesn't discriminate by race or class either, though like other economic forces, it disproportionately impacts lower-income individuals and individuals of color.

The rising cost of health care has created a move toward insurance plans that no longer actually insure patients from catastrophic or unexpected costs. As premiums have continued to rise, employers are increasingly offering their employees insurance that is cheaper in cost and quality. Higher deductibles, multiple deductibles for each family member, higher co-pays, along with exclusions for any number of treatments or drugs, have hollowed out the insurance from covering the health-care costs for which it was designed in the first place.

Of course, the uninsured remain at the highest risk of succumbing not only to illness by not getting preventive care, but to medical debt. Half of uninsured adults report medical debt or bill problems. The public often has the impression that the uninsured are immune to rising out-of-pocket costs since they can get free care at any public hospital, or qualify for charity care of some type. The reality is uninsured patients may actually be charged more for care they get at the doctor's office. Insured patients get negotiated discounted rates, while those without insurance are charged and often expected to pay the full sticker price. Many hospitals and providers are turning to financial service companies that ease their burden for collecting bills by providing patients with a new way to pay their health bills: with credit.

In 2005, the uncovered costs of health care, not including premiums, added up to $250 billion, according to the consulting firm McKinsey & Company. Increasingly, those out-of-pocket costs are being borne through debt -- as more providers outsource their receivables function to third-party collectors, or by teaming up with a financial services company that provides credit cards or a line of credit to patients when they receive care. Capital One, Citigroup, General Electric, and U.S. Bancorp have all entered the field to assist "self-pay" (read: uninsured or covered by high-deductive plans) patients in meeting their health-care costs. While some banks now offer medical-care credit cards, other products are less obvious to consumers. As a cover story in Businessweek detailed, hospitals or doctors' offices that once offered interest-free payment plans are now transferring their accounts to a third party, like CompleteCare, which pays the hospital upfront, then makes its money collecting the debt from the patient, often at considerable interest. Under these plans, patients who are past-due may be charged as much as 27 percent interest on their debt. Often these products are offered under the guise of "financial assistance" to patients, with fees and finance charges buried in fine print. Patients often think they are signing up for a payment plan with the doctor's office but are unwittingly agreeing to a credit card or credit line to pay for their visit.

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Tamara Draut is the author of Strapped: Why America's 20- and 30-Somethings Can't Get Ahead.

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