Arizona’s debt collection reform—a small step towards health justice

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    • #498985
      eridani
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      • Total Posts: 12,208

      https://www.bmj.com/content/379/bmj.o2822

      The Arizona initiative continues the US trend of voters passing progressive health reform policies for an individual state that their Republican controlled legislatures had resisted. In the November election, for example, South Dakota became the latest jurisdiction to use a popular vote to expand Medicaid coverage for people on low incomes—following states such as Idaho, Missouri, Nebraska, and Utah. Like Arizona’s proposition 209, these votes suggest a mismatch between US politicians and many of their constituents. …

      For Arizonans, proposition 209 does nothing to reduce the amount of medical debt they acquire, but it softens the consequences. The proposition’s most notable provision caps the interest rate on medical debts at 3% (or a percentage indexed to the yield on US Treasury bonds). Nonetheless, federal law allows national banks to export higher interest rates from the states where they are chartered. Consequently, if Arizonans put medical expenses on a credit card, or take on medical debt with another national lender, that debt will be unaffected by the 3% cap.

      Although proposition 209 is an important effort, these sorts of changes can’t substitute for the US implementing a simpler, more humane system of universal and robust health insurance coverage. One can imagine a world where consumer medical debt doesn’t exist—but Americans aren’t living in it.

      Comment by David Himmelstein & Steffie Woolhandler of PNHP: In the dozen years since the passage of the Affordable Care Act (ACA), policy wonks have applauded the shift to so-called “value based” payment. But this shift has had dire consequences: giant provider systems taking over local hospitals and physician practices, health insurer profits skyrocketing (mostly garnered from taxpayer-funded programs), and private equity marauders capturing a growing share of health care resources. Meanwhile, the number of Americans unable to afford care has surpassed pre-ACA levels.

      In response, politicians have done . . . virtually nothing. The best that can be said is that they stopped Medicaid programs from expelling enrollees during the height of the COVID-19 pandemic, and tinkered with ACA premiums and Medicare drug costs.

      When American voters have been asked whether that’s enough, they’ve answered, resoundingly, “NO” – in Red states as well as Blue. This year, Massachusetts voters in 20 districts were asked “Shall the Representative from this District be instructed to vote for legislation to create a single payer system of universal health care that provides all Massachusetts residents with comprehensive health care coverage including the freedom to choose doctors and other health care professionals, facilities, and services, and eliminates the role of insurance companies in health care by creating an insurance trust fund that is publicly administered?” Voter support was overwhelming: In Republican-dominated areas (yes, there are some in Massachusetts) as few as 55% voted to endorse that statement; in Democratic-dominated ones, as many as 87% did. Other communities across the US passed similar measures.

      Now, more than ever, Americans need and want fundamental health care reforms that will assure universal, first-dollar coverage, and drive the money grubbers from the temple of medicine.

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #499006
      djean111
      Participant
      • Total Posts: 9,081

      For Arizonans, proposition 209 does nothing to reduce the amount of medical debt they acquire, but it softens the consequences.

      The US is built on debt – medical debt, mortgage debt, student debt, credit card debt.  Designed to perpetuate debt.  And Biden is the boastful champion of ensuring student debt could not be discharged in bankruptcy, and, IMO, student loan forgiveness was always just campaign pandering.  As was the Public Option, for Biden and Obama.

      America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)

      "Sometimes when I try to understand a person's motives, I play a little game. I assume the worst. What's the worst reason they could possibly have for saying what they say and doing what they do? Then I ask myself, 'How well does that reason explain what they say and what they do?'" Baelish

      VFTBNMW is, IMO, literally "take the blue pill".

    • #499032
      Ohio Barbarian
      Moderator
      • Total Posts: 25,301

      I’ve seen this shit for thirty years. Neoliberal frauds never change.

      Never let your morals stop you from doing the right thing.--Isaac Asimov

      The United States is also a one-party state but, with typical American extravagance, they have two of them.--Julius Nyerere

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