Comments on: Medical Bankruptcy: Myth vs Fact http://www.kevinmd.com/blog/2006/12/medical-bankruptcy-myth-vs-fact.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70053 Anonymous Tue, 02 Jan 2007 22:01:00 +0000 http://clients.emmense.com/kevinmd/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70053 Himmelstein does appear to go too far, but so do Dranove and Millenson.<br/><br/>In particular, the inclusion of families in the "medical bankruptcy" total who simply reported significant medical expense but who did not cite medical expense as a reason for bankruptcy is clearly a stretch. But is also a stretch to discount such families entirely.<br/><br/>Indeed, it is also possible that there are cases where the cost of medical care is a contributing factor to bankruptcy even when not one penny was spent on medical care! For example, suppose you have someone who is clinicly depressed but who, because of cost issues, fails to receive proper diagnosis and treatment. They lose their job as as result of their depression and are forced into bankruptcy. They may not even be aware of their situation and hence aren't going to cite a medical cause. <br/><br/>Dranove and Millenson also make much of the distinction between causation and contribution. However, this ignores the fact that bankruptcy is often the end result of what engineers call a cascade failure: Many factors had to align to produce that result. In such situations it is pointless to try and determine the definitive causative factor.<br/><br/>But there's an even bigger problem in this study, which is that financial disasters don't always result in bankruptcy, for a variety of reasons: It may not make financial sense, people may be unaware of this option, or they may be afraid of the social stigmata that's still associated with it in some circles. So what we're looking at may be no indication of the degree of hardship medical costs actually impose.<br/><br/>The bottom line is that this study fails to answer the real questions people want answered: If my family<br/>suffers some sort of expensive medical crisis, statistically what will it do to our standard of living? And if there is significant risk here, what changes to the health care system would reduce that risk?<br/><br/>It would very interesting to see the results of a study constructed to answer these questions. However, the only approach I see would be to look at the outcomes for a random sample of families who have had such a crisis. Given medical privacy issues that may be hard for an independent research group to assess. Himmelstein does appear to go too far, but so do Dranove and Millenson.

In particular, the inclusion of families in the “medical bankruptcy” total who simply reported significant medical expense but who did not cite medical expense as a reason for bankruptcy is clearly a stretch. But is also a stretch to discount such families entirely.

Indeed, it is also possible that there are cases where the cost of medical care is a contributing factor to bankruptcy even when not one penny was spent on medical care! For example, suppose you have someone who is clinicly depressed but who, because of cost issues, fails to receive proper diagnosis and treatment. They lose their job as as result of their depression and are forced into bankruptcy. They may not even be aware of their situation and hence aren’t going to cite a medical cause.

Dranove and Millenson also make much of the distinction between causation and contribution. However, this ignores the fact that bankruptcy is often the end result of what engineers call a cascade failure: Many factors had to align to produce that result. In such situations it is pointless to try and determine the definitive causative factor.

But there’s an even bigger problem in this study, which is that financial disasters don’t always result in bankruptcy, for a variety of reasons: It may not make financial sense, people may be unaware of this option, or they may be afraid of the social stigmata that’s still associated with it in some circles. So what we’re looking at may be no indication of the degree of hardship medical costs actually impose.

The bottom line is that this study fails to answer the real questions people want answered: If my family
suffers some sort of expensive medical crisis, statistically what will it do to our standard of living? And if there is significant risk here, what changes to the health care system would reduce that risk?

It would very interesting to see the results of a study constructed to answer these questions. However, the only approach I see would be to look at the outcomes for a random sample of families who have had such a crisis. Given medical privacy issues that may be hard for an independent research group to assess.

]]> By: mohttp://www.kevinmd.com/blog/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70008 mo Sun, 31 Dec 2006 15:41:00 +0000 http://clients.emmense.com/kevinmd/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70008 interesting fact interesting fact

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70005 Anonymous Sun, 31 Dec 2006 14:05:00 +0000 http://clients.emmense.com/kevinmd/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-70005 When will we expose the lie that lawsuits are bankrupting doctors all over the country regularly? When will we expose the lie that lawsuits are bankrupting doctors all over the country regularly?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-69995 Anonymous Sun, 31 Dec 2006 00:33:00 +0000 http://clients.emmense.com/kevinmd/2006/12/medical-bankruptcy-myth-vs-fact.html#comment-69995 And while we are at it we can have universal home mortgage coverage, universal gambling coverage, universal disability, life, and accident insurance. Go ahead, chain smoke or stuff those fries in your face while riding that hog without a helmet. And let's fund it with taxpayer dollars.<br/><br/>Himmelstein's is a ludicrous argument. And while we are at it we can have universal home mortgage coverage, universal gambling coverage, universal disability, life, and accident insurance. Go ahead, chain smoke or stuff those fries in your face while riding that hog without a helmet. And let’s fund it with taxpayer dollars.

Himmelstein’s is a ludicrous argument.

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