Time for Obama, McCain to Tackle Threat to Patient care

Time for Obama, McCain to tackle threat to patient care

By Cory Franklin

August 8, 2008

A political issue that neither Barack Obama nor John McCain has addressed is an emerging development in health care, obvious in retrospect, but with tremendous implications for virtually every patient in America. It is the marriage of credit and medical histories, an inevitable partnership being consummated by at least one company already collecting information about how reliably patients pay their medical bills. Other companies are sure to follow what is essentially a means of creating a credit score related to a patient's health status with the clear goal of predicting his or her future ability to pay.

The next logical step would be to market that information to health-care providers. Patients are more responsible than ever for either part or all of their medical bills thanks to a flagging economy, rising health-care costs and the growing number of uninsured and underinsured.

With nearly 50 million Americans sans health insurance, hospitals are forced to assume unpaid bills estimated to be $40 billion annually. So a health-related credit score represents an invaluable service for health-care providers, allowing them to refine the clientele they want to attract and, of course, to identify patients unlikely to pay their bills.

The rationale behind this effort is that the credit profiles are in the best interest of patients. Hospitals and doctors will be able to provide patients with better payment strategies and allocate charity care more efficiently.

This sounds suspiciously like the Orwellian logic that characterizes modern corporate health care. The credit industry's misbehavior in the subprime mortgage debacle certainly leaves open the possibility that any benefits patients may realize could be dwarfed by major obstacles that could stand in the way of medical treatment. This includes fraud, medical identity theft and plain old credit reporting errors.

An even more ominous threat would be prescreening patients before medical treatment is provided. A patient's low health credit score could affect medical decisions or alternatively serve as a pretext for denying the patient care. Armed with a patient's health credit score, an emergency room triage nurse or medical administrator could do a quick medical screening before registering a patient and decide to refer the patient to another hospital because he is a bad financial risk. (By not registering a patient, a hospital might be able to skirt federal laws that make it illegal for hospitals to refuse patients emergency care.) There are built-in protections for patients, including the Health Insurance and Portability and Accountability Act, and several credit laws offer protection to consumers.

But this is such a new area that existing laws might not protect patients from having their credit scores used against them.

Such abuses can be prevented only by a significant ombudsman role by federal and state officials. Today more hospitals are becoming billion-dollar conglomerates. Providing them with more efficient instruments to collect payment from private individuals means the consumer must have more protection. Both major-party candidates for president should state their position on what, if anything, they are prepared to do to protect patients in the face of this threat from cooperation between the credit and health-care industries. Have you received a medical bill lately? The arcane health-care pricing and hospital billing system has become so egregious, it must seem it can't get any worse. But Shakespeare reminded us, "The worst is not, so long as we can say 'This is the worst.' " And as the credit industry courts the health-care field, things will probably get worse for all of us.

Cory Franklin, a physician, lives in Wilmette

Chicago Tribune