Editor's note: I asked my colleague Rhiannon Meyers Collette to write this week's newsletter introduction on an important issue in health care that is impacting her family personally.
Two years ago, on his commute home from work, my dad was suddenly struck by what he described as the worst pain of his life. He veered to the side of the highway, tumbled from his truck, sprawled onto the grassy shoulder, and called 9-1-1. One ambulance ride, two separate emergency room visits, and one surgery later, he was free from the kidney stones that caused the acute pain, but the financial damage has continued.
Medical bills keep rolling in, even today, including two surprise bills — one for an out-of-network anesthesiologist and another for an out-of-network emergency room doctor, both of whom were conveniently working at an in-network hospital.
My dad’s single bout of kidney stones has resulted in $40,000 in medical bills. According to a new study this week in JAMA, nearly 18% of Americans are living with medical debt, with the highest burden borne by people living in Southern states like his home state of Texas (which coincidentally didn’t expand Medicaid) as well as in lower-income communities.
The total amount of medical debt has surged in recent years, growing from $81 billion held by collection agencies in 2016, to $140 billion last year. This number only represents debts sold to collection agencies. There are countless debts that patients like my dad still are paying off — every month he writes a check to the hospital for $400, the equivalent of a car payment — or are fighting in court.
The growing burden of medical debt is a symptom of excessive and rising health care prices in this country. As hospitals and health care providers have grown more consolidated in recent years, they’ve been able to squeeze out competition and extract high prices.
The out-of-network ER doctor who saw my dad for a total of five minutes sent him a bill for $2,000. When he called the billing department to ask for justification, he was told “ER doctors are expensive.”
“That’s not a justification,” he said.
These irrational prices charged for care leave Americans on the hook for higher premiums, higher deductibles, higher out-of-pocket costs and surging medical debt. To bring costs under control and staunch the financial damage experienced by households across the nation, market competition must be strengthened and prices should be regulated.
(Watch this 2-minute video explaining the impact of out-of-control health care prices.)
Biden Drug Order Falls Short
By Rhiannon Meyers Collette, Communications Manager
President Biden recently issued an executive order aimed at lowering drug prices by directing federal agencies to rein in anticompetitive market behaviors and work with states to import cheaper drugs from Canada.
What’s Happening: While the order signals the administration's support for reforming the pharmaceutical market and is certainly a move in the right direction, additional legislative steps are needed next to ensure more meaningful reform. In a new analysis, my colleague Erin Jones, drug pricing analyst, breaks down Biden's directives and why this order may fall short of its goal.
Why It Matters: Anticompetitive tactics by the pharmaceutical industry have come under growing scrutiny in recent years by policymakers and the general public, and there's strong support for reining them in. But simply encouraging stronger enforcement of pay-for-delay deals, for example, or acknowledging that the patent system is being exploited, aren't enough to lower drug prices on their own. For effective and meaningful change to occur, policymakers must address the fundamental flaws driving drug prices higher: patent abuses and anticompetitive behaviors, market distortions, high launch prices, and unjustified price increases.
Related: Read more about the evidence-based policy solutions that could address the problems undergirding America's unaffordable prescription drugs.
A Roadmap for Closing Rikers
By Evan Mintz, Communications Manager
Two years ago, New York City leaders vowed to shutter Rikers Island Jail by 2027. This week, the Center for Court Innovation released a new report documenting a roadmap to not only close the facility, but also reduce the city's overall jail population and support the communities of color that bear the brunt of an unnecessarily punitive policing and pretrial system.
Why It Matters: Rikers, the city’s most populated jail, has been plagued by years of crumbling infrastructure, horrid conditions, and violence. Located on a 400-acre island on the East River, the facility is far removed from the courts and nearly impossible to access for visitors and service providers. Detaining someone at the facility is shockingly expensive — it costs nearly a half-million dollars to hold one person for one year.
What's Next: The report recommends the city focus on reducing both crime and incarceration through “ending case delays, reducing bail, reforming parole, investing in mental health and treatment, and prioritizing proven alternative approaches.”
Thousands of people convicted of nonviolent offenses were released to home confinement last year to slow the spread of the coronavirus. This week came the disappointing news that the Biden administration will return them to federal prisons a month after the pandemic officially ends, unless Congress intervenes or President Biden issues mass commutations.
What’s Next: A bipartisan group of criminal justice advocates is asking the administration to grant clemency to these individuals, who have already begun the difficult process of reentering society, USA Today reports. "This is your opportunity to provide second chances to thousands of people who are already safely out of prison, reintegrating back to society, reconnecting with their loved ones, getting jobs and going back to school," the group writes.
Bottom Line: The news is especially frustrating after campaign pledges from Biden to drastically reduce the nation’s prison population. Instead, six months into his term, that number is growing. Grantee Holly Harris of the Justice Action Network calls the Biden administration’s actions on home confinement “one of the largest reincarceration events in American history, with no safety reason to back up his action.”
Larry Krasner, the district attorney of Philadelphia, about his plans to continue reforming the criminal justice system after an overwhelming victory in the recent Democratic primary. During his first term, Krasner demonstrated how district attorneys can rely on data and executive actions to shrink mass incarceration and mass supervision. Voters proved the critics wrong and rewarded his work with a huge win over a well-funded opponent. Now Krasner is planning to expand his ambitions not only within his own office, but also spread the gospel of reform prosecutors as a successful electoral model. "We have to run the data. We have to tell the individual stories. We have to communicate directly."
Nature Magazine does an excellent job explaining the history of gun research in this country and the events that have been catalysts for change.
Related: In a companion podcast episode, AV's Criminal Justice Director Asheley Van Ness talks about the restarting of gun violence research in the U.S. and why the need for more evidence is critical amid a rise in homicides across the country.
“Enough is enough”: Hospital CEOs are calling on Congress to support President Biden's proposal to fund $5 billion in hospital and community-based gun violence intervention programs, Axios reports.
“Aftershocks,” a new series from The Trace that examines the lasting impacts of surviving gun violence in Chicago — not just for victims and their families, but also witnesses, first responders, and nearby businesses. “What we found from reporting is that of the more than 30,000 people who have been shot in the past decade, five in six of them survived,” series author Lakeidra Chavis tells WTTW. “It really felt like this was something missing from the reporting that we really wanted to explore in Chicago.”
Related: NPR’s Cheryl Corley reports on Chicago’s new effort to target illegal gun trafficking in the wake of violence there, including the tragic shooting of a 1-month-old girl.
Oakland is making a big investment in violence prevention, doubling the number of violence interrupters, increasing support for victims' families, and adding staff for crime scene response, Governing reports.
The White House announces more than $1 billion in COVID-19 funding to at-risk communities, including correctional facilities and prisons, The Hill reports.
Black women are being hired in positions of power to kickstart reforms at police departments across the country, Vice reports.
This American Leader profile of AV grantee and “deficit hawk” Maya MacGuineas, who launched FixUS after years of congressional inaction on the rising national debt. She was an early advocate for pandemic relief spending.
Sen. Angus King of Maine and others take aim at charitable money sitting for years in tax-free donor-advised funds rather than being distributed to organizations in need. “The idea of getting a tax deduction today for money that may not be paid out for 50 years makes no sense,” he tells The Associated Press.
An AV-funded Brookings report on the performance of very short-term vocational programs that receive federal student loans finds that70% are for-profits that show low earning potential for graduates —averaging about $24,000 per year, or $12 per hour.
STAT offers details of a tentative opioid settlement for states, cities, and counties worth $26 billion. It includes funding for treatment and prevention and regulates the distribution of opioids.
One hundred years ago this month, researchers discovered insulin, a scientific breakthrough credited with extending the lives of countless diabetes patients. But today, as The Sun Chronicle writes, patients are still imperiled by the sharply rising costs of the miracle drug they depend on to stay alive. “The discovery and distribution of insulin has been a lifeline for myself and millions of diabetics like me, and people should not have to risk their lives rationing this medication because they can’t afford what pharmaceutical companies are charging for it.”
What We're Watching
The gripping documentary “17 Blocks,” an intimate portrait of a Washington, D.C., family navigating addiction, gun violence, and the criminal justice system that unfolds over decades. In 1999, filmmaker Davy Rothbart meets a magnetic and ebullient 9-year-old, Emmanuel Durant Jr., during a pickup basketball game. The filming begins there, and soon Durant and his family — mother Cheryl, brother "Smurf," and sister Denise — pick up a camera, too, documenting their everyday interactions at home 17 blocks from the U.S. Capitol and amassing more than 1,000 hours of footage. You will grieve with the family when a devastating act of violence alters their lives forever, and you will grow to know and love them as they try to move beyond the pain and embrace hope. The film is now streaming on Paramount+.
What We're Listening To
This week's episode of Tradeoffs podcast, which heads to Baltimore, Maryland, to speak with a violence prevention group trying to stem the tide of homicides. Hear from James “JT” Timpson, director of safety and community partnerships for Roca, a nonprofit that uses behavioral health techniques to help young men most impacted by violence. It recently expanded its work from Massachusetts to Baltimore, Timpson's hometown. He talks about the rise in shooting deaths there, the impacts of COVID-19, and the risks of the job.
I have to say, I am with the women of the Norwegian beach handball teamwho don’t want to play their sport in bikini bottoms “with a close fit and cut on an upward angle.” (Especially while the men can play in tank tops and shorts.) They’re changing the game and starting an important conversation.
Our Complex Care team isfunding research into how to improve the systems that deliver care to a population of more than 12 million people who are dually eligible for Medicare and Medicaid. Learn more here.
Stephanie DiCapua Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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