Shefali Luthra, Kaiser Health News
In a back-and-forth about “Medicare for All” and the price of well being care, Sen. Elizabeth Warren (D-Mass.) directed the dialogue again to medical debt and chapter — citing her personal work from Harvard Law School.
“Back when I was studying it, two out of three families that ended up in bankruptcy after a serious medical problem had health insurance,” Warren mentioned.
This is a brand new emphasis within the ongoing debate over well being care prices, and the talk over what function well being care performs in American funds. Instead of specializing in uninsurance, Warren stepped into whether or not the insurance coverage individuals at the moment have is adequate.
But a lot of the analysis round medical debt and chapter is controversial — particularly Warren’s personal work.
We determined to take a deeper look.
What The Research Says
Warren’s marketing campaign directed us to analysis printed in 2009 within the American Journal of Medicine. Co-authored by Warren, it appears to be like at a random pattern of two,314 chapter filers from 2007.
The paper examined what debtors reported as their reason for chapter. Warren is referring right here to individuals who both cited important direct medical debt, remortgaging a house to pay medical debt, or misplaced earnings attributable to sickness.
In that class, greater than two-thirds of households had medical insurance — actually, three-quarters did.
So from that straightforward standpoint, the quantity checks out.
The Controversy
But it isn’t essentially that straightforward. This particular paper has lengthy been the topic of controversy. In half, it’s as a result of it focuses on individuals who have declared chapter, relatively than wanting on the monetary influence of medical debt at massive.
Scholars are additionally fast to notice that, within the majority of so-called “medical bankruptcies” recognized within the paper, the difficulty wasn’t money owed incurred to repay well being care payments. Rather, the larger drawback was foregone earnings as a result of individuals couldn’t work.
That’s fueled a prolonged back-and-forth, particularly over whether or not this paper is definitely helpful in figuring out what function medical debt performs in fueling bankruptcies.
But its influence on this particular declare isn’t so clear. That’s as a result of Warren narrowed her assertion, and targeted on one thing much less disputable.
For one factor, the paper is obvious to find that two-thirds of households — actually, greater than that — skilled chapter after a medical drawback regardless of having medical insurance.
That discovering was “the headline of the study,” mentioned Paul Ginsburg, a well being economist and professor on the University of Southern California. (Ginsburg additionally famous the significance of foregone earnings in driving bankruptcies, relatively than medical payments.)
And Warren certified it additional throughout the debate, by limiting this statistic to what was discovered “back when [she] was studying it” — making it a much less sweeping declare.
What’s extra suspect is whether or not this discovering — even when correct — helps her subsequent level: that the price of well being care is what’s driving individuals’s monetary issues, and beneficiant single-payer plan would ameliorate this situation.
For occasion, “You cannot go from that result to a conclusion that we need Medicare for All,” Ginsburg mentioned.
Health insurance coverage is extra beneficiant at present than it was when Warren studied it, because of the Affordable Care Act. And insuring everybody — whilst generously as Medicare for All suggests — wouldn’t essentially deal with the difficulty of foregone earnings when individuals are sick, which the analysis suggests is a much bigger monetary concern.
Our Ruling
Warren’s declare comes from a paper that’s controversial, and whose strategies and interpretation have been referred to as into query. That mentioned, this statistic is pretty particular, and her wording within the declare exact. In itself, it’s a good reflection of what the paper says.
Where warning is extra vital: Warren says this discovering suggests the price of well being care is what’s inflicting Americans monetary hurt. That isn’t essentially borne out, and requires extra scrutiny.
This assertion is correct however would profit from extra info. We fee it Mostly True.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.