Health Care and Debt

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This month’s Health Affairs has a couple of good pieces on health care costs and debt that are worth reading. The first article, by David Dranove and Michael Millenson, argues that only about 17 percent of all bankruptcies today are caused by unaffordable medical expenses, which is far lower than the 54.5 percent figure found by David Himmelstein and colleagues about a year ago.

So maybe crippling health care costs aren’t as crippling as once assumed, right? Hold on. Himmelstein and colleagues respond to the new study here, saying that Dranove and Millenson “misrepresented” their data. Among other things, Himmelstein and friends note that many people who appear before bankruptcy court give as their reason “credit card debt” or “mortgage,” even though that problem had been brought about by medical expenses. Yet Dranove and Millenson didn’t seem to count these people as those who go bankrupt because of medical bills, even though common sense would say otherwise.

It’s a fun debate, but either way, Robert Seifert and Mark Rukavina probably have the last word on the subject in this third piece, noting that regardless of who’s right, bankruptcy is really only the tip of the iceberg here. It’s still the case that one of six nonelderly adults—some 29 million Americans—are currently shouldering debt caused by medical bills, and another 56 million adults are at risk of incurring heavy debt, should they happen to get hurt or fall ill through no fault of their own. Regardless of how many people are being driven to actual bankruptcy by medical costs, a lot of people are finding themselves in pretty dire straits.

Additionally, the mere prospect of being saddled with medical debt prevents many people from seeking care—they don’t fill a prescription, or don’t see a specialist, or don’t visit a clinic for a medical problem. (Sometimes this is self-imposed, but sometimes not: some providers will refuse treat a patient with previous outstanding medical bills, so a person with too much medical debt may simply be denied care.) It’s another indication that merely reducing the number of uninsured Americans won’t solve the health care crisis in this country—many of those who are insured still face all sorts of problems associated with not being able to pay for necessary health care.


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