On An Unrelated Note

By Big Tent Democrat, Section Media
Posted on Thu Apr 17, 2008 at 12:06:59 PM EST
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By Big Tent Democrat

On the Trina Bachtel story, I disagree with Paul Krugman's correction. I think Krugman is wrong when he writes:

The Columbus Dispatch reports that the debts in question had been written off as uncollectable long before her pregnancy, so that it does not appear that they were a barrier to care.

Declaring the debt uncollectable would not, in my experience have removed the debt as a barrier to receiving services or products as a result of the bad debt. The debt was not declared satisfied as a legal matter nor would its effect on someone' scredit history be removed. This is a bookkeeping matter for the clinic, not having any legal effect or positive effect on the credit history of Ms. Bachtel. Consider a car loan being declared uncollectable. Do you think the uncollectability would be a barrier to getting another car, or keeping the one you have (repo man)? I am afraid it would be an obstacle. As for Ms. Bachtel, the the AP report Krugman references makes this clear: "In some cases, Blevins said, Holzer clinics place 'credit restrictions' on patients . . ." unless it is an emergency. It seems clear that this is what happened to Trina Bachtel. I disagree with Krugman's correction here.

This is an Open Thread.

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On An Unrelated Note | 40 comments (40 topical)

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Seeing as it's an open thread (5.00 / 3) (#1)
by andgarden on Thu Apr 17, 2008 at 12:14:23 PM EST

Let me applaud dhonig for calling out the orange people on their hypocrisy.

I just read the post (5.00 / 2) (#8)
by ruffian on Thu Apr 17, 2008 at 12:31:43 PM EST

it is dead on target. Great job.

Comments were amusing as well, as much as I could stomach.


: I actually logged in (5.00 / 2) (#11)
by tamens on Thu Apr 17, 2008 at 12:44:23 PM EST

so I could recommend Dhonig's comments.

I may have to do the same, but gosh darnit (5.00 / 1) (#14)
by vicndabx on Thu Apr 17, 2008 at 12:57:49 PM EST

where's that damn logon of mine?


He's getting a lot of flak ... (5.00 / 1) (#18)
by cymro on Thu Apr 17, 2008 at 01:15:19 PM EST

... from people saying they are outraged at being labeled as hypocrites. he has definitely succeeded in raising the issue of the previous unfair coverage of Clinton, and the lack of objections by Obama supporters.

I almost never read KOS, but thanks for this link. Interesting, but exhausting, to read some of the reactions -- I'm really glad we don't have to deal with so much infantile nonsense here at TL.


: People got comments hidden (none / 0) (#23)
by Fabian on Thu Apr 17, 2008 at 01:24:31 PM EST

last night for pointing out the hypocrisy.
It's ridiculous over there and people really do not like it when you tell them that their outrage is long overdue.

I'm glad y'all went there. (none / 0) (#15)
by Fabian on Thu Apr 17, 2008 at 01:06:10 PM EST

I know BTD wonders why anyone still visits the orange. I do because there are still small pockets of moderation and rational thought that I support.

Thanks for giving dhonig your support!


Um (none / 0) (#26)
by Big Tent Democrat on Thu Apr 17, 2008 at 01:27:29 PM EST

that thread was an example of it?


: Not the thread. (none / 0) (#30)
by Fabian on Thu Apr 17, 2008 at 01:52:34 PM EST

That was the mindless beast lashing out.
But dhonig made them work for it - that was a well documented piece.

I agree that Krugman (5.00 / 2) (#3)
by waldenpond on Thu Apr 17, 2008 at 12:20:38 PM EST

has erred. My daughter kept refusing to seek care for a longstanding cough, even from the hospital where I worked. I didn't know she had outstanding bills and she wasn't aware of clinics that would take her without payment or how to sign up for medical benefits. She ended up in the ER (snap, crackle and pop) with emphasema. Intimidation from pushy care providers and shame are powerful disincentives to seeking care and cost all of us more in the long run.

Infantile id (5.00 / 3) (#12)
by ruffian on Thu Apr 17, 2008 at 12:46:55 PM EST

I stumbled onto this the other day, and re-read the article again today in light of the tantrums of this morning. Since the best test of a theory is how well it predicts the future, I think it has held up well.

From Paul Lukasiak at correntewire.com

It's the reaction of the infantile Id to the certain knowledge that it will be told "no." They want their Obama, not a Clinton or a McCain, and just like an infant that is being denied, they are going to make everyone's life a living hell unless and until they get what they want, or they run out of energy and finally fall asleep.

Link below for the whole article, and his series on sexism and misogyny in this campaign. He takes apart Sirota's "race chasm" very well. It is a little dense reading, so plan to spend some time with it

Speaking of unity, (5.00 / 2) (#16)
by vicndabx on Thu Apr 17, 2008 at 01:07:56 PM EST

why has that become the thing we are all supposed to be working towards? I remember the "Contract with America" days and the republicans didn't need to work w/us cuz they had a majority in Congress. Bill seeing the reality, moved toward the center. Shrewd move that could've boded real well for Dems in general if people would have had the time to see more of it (Gore). Anyway the question is, if we control the House and the Senate, and the bully pulpit of the presidency, why do we need to unite w/republicans? Why can't we just push our agenda out to people and make it happen just by keeping dems in line? Shouldn't that be the uniting argument for dems and not reaching across the aisle?

Interesting. (5.00 / 1) (#19)
by magisterludi on Thu Apr 17, 2008 at 01:20:25 PM EST

The GOP, if overly indulged, will water down any meaningful climate initiatives or health care proposals or re-instituting sound business regulations. That means no real change, just happy talk on how well they work together. And the world continues to burn.


unfortunately (none / 0) (#21)
by magisterludi on Thu Apr 17, 2008 at 01:22:39 PM EST

there are far too many dems like Ben Nelson and Rockefeller standing in the way, too.


: Toe the line (none / 0) (#25)
by vicndabx on Thu Apr 17, 2008 at 01:27:07 PM EST

I agree. Which is why I feel the prez/bully pulpit gives some of these scaredy cats the cover they need. It also gives us more opportunity to sway public opinion. The MSM may not cover what some senator or rep says, but they gotta cover the president. Especially if the plans are bold.

That was the Edwards argument (none / 0) (#31)
by ruffian on Thu Apr 17, 2008 at 02:02:38 PM EST

and to a lesser extent H. Clinton's (I think Bill was more of a compromiser).

It does not seem to get any traction these days. Trying to work with Republicans who will never work with us seems to be the holy grail.


: Tough (none / 0) (#34)
by vicndabx on Thu Apr 17, 2008 at 02:19:27 PM EST

We seem to have a problem being it, even when everything (votes in congress, public opinion, etc.) is telling us we should be.

Actually, I thought that was what (none / 0) (#33)
by ruffian on Thu Apr 17, 2008 at 02:18:35 PM EST

Kos was all about too - electing more and better Democrats, so we could push our agenda. Now he has embraced the post-partisan ideal, Obama.

I think Kos thinks he can have it both ways - Obama will usher in such a stunning Dem majority that the Republicans will have to fold up their opposition. I think he is soooooo wrong.


I think that's been a big argument (none / 0) (#37)
by sumac on Thu Apr 17, 2008 at 02:38:58 PM EST

for those who have not embraced Obama as to why they have not joined the unity train. Why are we offering compromise before we've even tried to push through a Democratic agenda and policies?

I understand bipartisanship as a diplomatic strategy, but inviting Republicans to the table before it's even been set pretty much ensures that we will not provide Democratic solutions to health car and the economy and the environment and our energy crisis...

The Republicans had their shot and we are currently "enjoying" where their policies have taken us. Why not strive for Democratic solutions and then use compromise as a backup plan?


Krugman may not know how collections work (none / 0) (#2)
by Prabhata on Thu Apr 17, 2008 at 12:14:46 PM EST

when a debt goes into collection, the debtor is out of luck to receive any sort of goods or service unless the debtor can pay for it.

Why is everyone so upset about the debate? (none / 0) (#5)
by halstoon on Thu Apr 17, 2008 at 12:26:12 PM EST

You all know I'm a big supporter of Obama, but I don't get why folks are so upset about the debate. I mean, in the past few weeks, Obama's remarks about bitter PA voters, Rev. Wright's comments, Rev. Wright's successor's comments, and the relationship with Ayers have all been beaten daily by the Right Wing drum machine. I was glad ABC gave him a national platform to answer the questions. If he's upset about having to answer them, then tough s*&t. The reason Kerry and Gore lost was b/c they acted like they didn't need to answer the stupidest questions possible. I'm glad ABC reminded Obama that he does have to.

And why get all heated up about ABC taking cues from Hannity when Clinton refused to let it go??!!?? Shouldn't we be criticizing her for insisting that the story be "looked at" further??

Sen. Clinton, imo, re-enforced the notion that she is a cut-throat, win-at-all-costs, damn the truth, politician last night. She could have appeared magnanimous and gracious, but instead she chose petty and biting.

Sen. Obama, imo, finally clearly won a debate. Hopefully he'll show well in PA (meaning lose by single digits) and continue on to the nomination despite the best efforts of Sen. Clinton, Sean Hannity, and George Stephonopolous, who I contend did Obama a favor and exposed his now-nemesis Sen. Clinton.

My main complaint actually comes (none / 0) (#20)
by inclusiveheart on Thu Apr 17, 2008 at 01:21:03 PM EST

from the perspective of a voter who cares about this democracy. The media is supposed to be the "fourth estate" acting as a quasi-representative of the people's interests. In a time when this country has severe problems, the media is doing anything but focusing on real issues that affect real people. I think the campaigns are to blame for this in terms of the day-to-day silliness they have generated in recent weeks, but ABC really had an opportunity to shine last night. They had the option to ask hard questions about real stuff - instead they devoted much of their time to the petty personality politics of this race - which is IMO a damn shame for "We the People".

Other than that, I'm not going to complain. These candidates are in for much worse in the general; and the failure of Democrats to defend all of our candidates from the media's idiocy in prior debates basically undermines any real credibility we might have had in complaining about last night just because it was Obama who got the brunt of their wrath. Too much whining about the media will just end up making the Dem candidates look like they are weak - victims - which never inspires the general public to pull a lever for a candidate in the voting booth.


: That's right. (none / 0) (#44)
by halstoon on Fri Apr 18, 2008 at 09:58:54 AM EST

By whining about the questions, you only look weak. And when the campaigns fan the flames of pettiness--with him using Tuzla and her using Wright--they really have only themselves to blame for the tenor of the debate.

Note on Springsteen Endorsement (none / 0) (#6)
by ruffian on Thu Apr 17, 2008 at 12:26:33 PM EST

I just looked at his tour schedule, and he is heading to North Carolina Apr. 27-28, before the primary May 6.

May explain the timing of his endorsement.

Not that it matters, just a bit of trivia.

He may have been sure but he is wrong (none / 0) (#7)
by Big Tent Democrat on Thu Apr 17, 2008 at 12:27:39 PM EST

He is wrong and these are the sorts (none / 0) (#17)
by inclusiveheart on Thu Apr 17, 2008 at 01:11:50 PM EST

of things also that aren't always committed to paper by the clinics and hospitals either. Sometimes staff are asked to make a call on patients with a bad debt history. It is surprising that Krugman wouldn't basically know/understand that side of the healthcare transaction under our current history. I have heard stories of patients with poor coverage being moved out of hospitals earlier than they should be and I have heard stories even of small rural hospitals holding on to patients with good coverage longer than it was responsible for them to do so - meaning that their condidtions should really have been treated at a larger more well staffed and equipped hospital - but the money from the patient was too good so they held on to them as long as they could for the much needed profit. It is actually scary any way you cut it to think that patient care decisions are so wed to the financial rewards or lack there of.


I wonder how they (none / 0) (#35)
by waldenpond on Thu Apr 17, 2008 at 02:29:16 PM EST

get away with that. At the hospital I worked at(California), I did the contractual allowances and per diagnosis, you get reimbursed fixed dollars per day for only a specific number of days. If you go over, you eat the cost. If Blue Cross says you get 2 days at $1500 per day for IP knee surgery, you get $3000 and not a dime more. There are very few exceptions under the insurance contracts.


: One of the stories I heard was from (5.00 / 1) (#42)
by inclusiveheart on Thu Apr 17, 2008 at 04:34:52 PM EST

a group of physicians who are in a particular specilized field during a summit on healthcare policy. They were talking about how they were getting patients much later (if at all) because the small rural hospitals would hang onto patients that they didn't necessarily have the full capacity and talent to attend to properly. A lot of this problem is driven by "hospital systems" which are reluctant to let go of a paying patient if it means that they go into a competing hospital system run by another HMO or health concern.
I know of one hospital system that is held by a healthcare company that has several really small hospitals and one so-so mid-sized facility. There is a teaching hospital in the area with all the bells and whistles, but that hospital is not in the same corporate system so if you go into the one smaller more limited hospital system they will never refer you to the teaching hospital even if your condition warrants the more expansive talent and resources.
In the old days, before all this, it was fairly standard practice that you would have been sent to the teaching hospital in that area if your condition warranted it because that was where the concentration of talent and resources was - the teaching hospital facility was established with state and federal money btw - and is now run by a private concern. So now because they are run by two competing concerns, if you go into one, you'll never get into the other unless you are able to walk yourself or can find a way to get someone to move you. Problem is that when you have an emergency in that rural region, you go to the lesser hospital system because it is the closest facility.
I have personal experience as well with this very problem because a lot of my family live in a small rural town that has what I've been calling a "dead end" hospital for a while now. It wasn't until those physicians explained the backstory to me that I understood why for instance my Grandmother who was experiencing severe heart trouble stayed in the rural hospital facility with no cardiologist on staff for more than three weeks before they finally moved her to the facility that did have a cardiology wing - which was very mediocre. By the time she got there, she was far too weak to undergo any of the advanced treatments that might actually have prolonged her life and she died. These physicians who relayed the stories to me told me that my story is much more common than anyone is currently acknowledging.

I agree w/BTD and also think that even (none / 0) (#9)
by vicndabx on Thu Apr 17, 2008 at 12:35:12 PM EST

if it was written off, it's not a stretch to imagine a person not going to a facility because they know they owe money. In addition, who's to say what someone from admitting (usually not far from the bookeeping folks) saw on some screen, i.e. "oh, it says here you still have a balance of....."

: Didn't the family say she had to come up with $100 (none / 0) (#22)
by jawbone on Thu Apr 17, 2008 at 01:24:06 PM EST

before they would see her again at the clinic she had had the debt with?
And the $100 was the barrier?

This is very unusual for me, but (none / 0) (#10)
by 1jpb on Thu Apr 17, 2008 at 12:42:02 PM EST

I'm a little impressed by Krugman. I'm pleasantly surprised to see him take a step toward correcting some of the errors* he's made. For the record, the Dispatch information was available before his mistaken piece was published And he still hasn't apologize for crediting a quote to the WaPo when it was not actually from the WaPo, it was a removed by two connections (Trina's aunt -> AP -> printed in WaPo) and this was not an acknowledgment of error on the part of the WaPo, as Krugman falsely implied.

*All kinds of predictions now proven wrong in his book "The Return of Depression Economics." And, his insistence on comparing US mandated health care plans to European plans that have very different underlying structures. His refusal to acknowledge and address the many problems associated with the MA plan which has much more in common with HRC's plan than do the European plans. His refusal to acknowledge that there is a Medicare/SS funding problem; that's why Gore was such a fan of the "lock box."

: For the record (5.00 / 2) (#13)
by Big Tent Democrat on Thu Apr 17, 2008 at 12:51:40 PM EST

You are mistaken still. Krugman's point is wrong in that he believes having a debt declared uncollectable has thee effect hwe thinks he it does. you are wrong because you STILL do not understand the story. Neither does the Dispatch which actually does not make Krugman's erroneous report.
In Dispatch World, the Holzer Clinic does not even exist.
You have been a fount of misinformation and misunderstanding on this story and still do not even understand the basics.

Not just debts, but lawsuits too, even small claim (none / 0) (#27)
by jerry on Thu Apr 17, 2008 at 01:35:20 PM EST

My understanding, and I am not a lawyer nor an economist nor a columnist, is that Hospitals and doctors can decide on care not just on debt, but also on "probable likelihood to sue".

In other words, if you have sued other doctors, or even used small claims court in non medical related manners, certain docs and hospitals can decide they won't treat you.

I honestly hope I am wrong and just reciting an urban legend.

Absolutely right (none / 0) (#28)
by BevD on Thu Apr 17, 2008 at 01:46:15 PM EST

I like Krugman and he is usually correct but in this case he made quite an error. First of all, I doubt that Holzer "wrote off the debt", I would think that they sold it to a collections agency and secondly, when you sit down in that little cubicle to give your information to the admitting clerk, they're pulling up records of every single transaction that you ever made with them. People have the mistaken idea that any hospital is obliged to treat any person presenting symptoms, and that is absolutely wrong. Most hospitals will require a deposit if you don't have insurance unless it is a life threatening emergency and even if it is a life threatening emergency the patient will still be billed for that service. If the patient doesn't pay the bill that will be reported on his credit history making it almost impossible to get any credit unless it is lent at an exhorbitant rate.

Even with life threatening illness that requires a transplant or experimental measures and the insurance company will not pay for it, the patient will not be treated if he cannot demonstrate that he can pay for the transplant/treatment. It's a business.

In my experience with uninsured friends (none / 0) (#32)
by sarcastic unnamed one on Thu Apr 17, 2008 at 02:18:20 PM EST

who've had life-threatening illnesses (appendicitis and ectopic (tubal) pregnancy) they both got the emergency care they needed and after the care they sat down with the hospital and worked out a payment plan.

iirc, the appendectomy guy's surgery cost around 7k and his payment plan was $10/month, no interest, and the ectopic girl's bill and payment plan was similar.


That's pretty much (none / 0) (#38)
by BevD on Thu Apr 17, 2008 at 02:39:51 PM EST

what I said, isn't it? The legal obligations of emergency care is that the hospital stabilize the patient and minimize complications. They are under no legal obligation to start therapy of any kind. Yes, the hospital will work out a payment plan in most cases, but nonetheless, the patient is still obligated to pay for the services rendered. If the patient fails to make payments in a timely fashion, the hospitals who regularly sell their bad debts to collections agencies will turn the account over to a collection agency. Both hospitals and collections agencies will report the debt to credit bureaus. Hospitals don't "write off the debts" per se, they sell their bad accounts receivables.


P.S... (none / 0) (#39)
by BevD on Thu Apr 17, 2008 at 02:41:53 PM EST

writing off bad debt does not in any way mean that the debt is "forgiven". That is a whole different ball game.


: All good. (none / 0) (#40)
by sarcastic unnamed one on Thu Apr 17, 2008 at 02:46:27 PM EST

I was just adding the info that hospitals will often work out payment plans for those w/o insurance, and that the plans can often be quite reasonable.

An unadmitted correction (none / 0) (#41)
by Lora on Thu Apr 17, 2008 at 04:31:29 PM EST

Krugman corrected himself here without admitting he did (from the above linked article)(emphasis mine):

Two points that are not affected by this correction:
1. Hillary Clinton repeated in good faith a story she had been told, although she should have vetted it.
2. Many people do in fact die from lack of insurance.

As I wrote here, Krugman stated before that Clinton was "accurately repeating the story as it was told to her." However that was not the case. Now he's saying she "repeated in good faith a story she had been told." That's more like it.

Obama demotes himself (none / 0) (#43)
by Emma on Thu Apr 17, 2008 at 04:35:29 PM EST

Thought this was funny.

Arlen Spector has sent letters to alll three presidential candidates, asking for their opinions on his "petition to take responsibility for initial consideration of three [judicial] nominees away from the judiciary committee." The stated purpose is to get judicial nominations moving by bypassing the committee.

Sen. Obama was the only candidate to respond, and his letter says, in part:

"As a former constitution law instructor," Obama wrote, "I fully appreciate the important work that our federal judges do and the need to fill judicial vacancies. However, I have great respect for the Senate's constitutional advice and consent role in the confirmation of these judges."

In related news, it looks like Helene White, from the MI Ct of Appeals, is going to the Sixth Circuit. She was one of Clinton's nominees who got stuck in committee limbo eight years ago. She's definitely going to be a welcome addition to that Court.