George Floyd, Ahmaud Arbery and Atrocity With No Justice

Dozens of Texas hospitals — many of them nonprofit — filed more than 1,000 medical debt lawsuits against their patients in the span of two years, often targeting low-income families, reveals a new report from Dr. Marty Makary, Professor of Surgery and Health Policy at Johns Hopkins University. It’s the kind of lawsuit that drove 53-year-old José Bravo to bankruptcy after he couldn’t afford to pay or fight a $200,000 medical bill on his $28,000 a year salary; he had his assets and savings seized. 

Why it matters: Aside from underscoring the unaffordability of our health care system and the excessive prices charged, there are other avenues hospitals can take that don’t leave patients financially devastated. Nonprofits have a duty to offer patients charity care or financial assistance. And the amount recovered by hospitals is a tiny fraction of hospitals’ overall revenue. 

Bottom line: Many Americans are losing their employment and health care amid the pandemic, and such predatory practices only add to their struggle. The report underscores the need for standardized billing, greater price transparency, and stronger patient protections against surprise billing and predatory practices. Says Cheryl Fish-Parcham of nonprofit Families USA: “The classic Hippocratic oath says ‘With regard to healing the sick, I will take care that they suffer no hurt or damage.’ Suing patients who can’t make ends meet and who aren’t able to defend themselves seems totally counter to this.” 

Maryland just passed the most comprehensive repeal of harmful juvenile fees and fines in the country — and it was intense lobbying by a group of Baltimore teenagers that helped get it over the finish line.

What They Did: House Bill 36 was in danger of languishing in committee when Arnold Ventures provided support to child advocacy groups CLIA Youth and Advocates for Children and Youth, which recruited and trained students like high school senior Dion Hill to lobby their legislators through personal stories, statehouse visits, and phone-banking. “In our classes, we talk about the criminalization of poverty,” Hill said. “I’ve never been in trouble with the criminal justice system myself, but I understand that we need to have a fair system. This bill was something we needed to pass to lift the burden of these fees and fines.” And pass it did, out of committee and through both houses of the General Assembly. Republican Gov. Larry Hogan allowed the law to go into effect without his signature. 

What else: Another Maryland bill allows more drivers to pay traffic tickets on installment plans, a small step toward helping people avoid driver’s license suspensions that can lead to a cycle of debt, poverty, and incarceration. 

Bottom line: Both bills are part of an effort to shift funding of the criminal justice system away from those who can least afford it. “Our view at Arnold Ventures is that the justice system is a public good,” says our Criminal Justice Manager Sebastian Johnson. “We should pay for critical justice system functions equally as a society because we all benefit from the provision of justice. It should be funded out of general revenue, not through this proliferation of user fees that affect the most vulnerable people in society, locking them into a cycle of poverty.”

Jim Greiner, founder of the Access to Justice Lab at Harvard Law School, got “bitten by the bug” of using quantitative methods to inform legal questions while he was a practicing lawyer. He recently co-authored an article in Science arguing for an evidence-based approach to the law and sat down with us to discuss why rigorous evaluation of the criminal justice system is surprisingly novel. “I thought that lots of lawyers would surely want to do RCTs to find out what worked in law, the same as we do in medicine...Instead, I encountered disdain, dismissiveness, and skepticism about why anyone would need quantitative techniques to find out what worked.” (Medicine wasn’t always considered a science. Law has a long way to go.) This interview covers everything: the ethical questions of RCTs on incarcerated people; choice and consent in the criminal justice system; and how to build consensus among the uninitiated. My favorite quote of this interview: “History is littered with consensus professional beliefs that RCTs have gone on to disprove.”

Read the Q&A >

By Stuart Buck, Arnold Ventures Vice President of Research

A research letter in JAMA — one of the top medical journals — claims that stay-at-home orders are associated with lower hospitalizations. The study is based on data from four states (CO, MN, OH, and VA). For each state, the authors figured out a simple exponential model that would fit the first two weeks or so of data, and then projected that exponential curve forwards in time. Here’s their graph for Ohio, for example: 

They then point out that actual hospitalizations after the stay-at-home orders “deviated from projected best-bit exponential growth rates.” This conclusion is nearly worthless. For one thing, the authors did not provide data from any comparison states that lacked a stay-at-home order. Worse, there is no reason to think that simple exponential curves are a good prediction of where COVID hospitalizations would have ended up.

Their model for Ohio, for example, predicts that the number of hospitalizations on a given day should be 18.8482 times e to the power of 0.2268 times the number of days since time zero. That model predicts that by May 14, 2020, the entire population of Ohio would be in the hospital, and that by May 29, 2020, there would be 292 million people in the hospital in Ohio. That prediction is obviously absurd. We simply can’t know the effect of a stay-at-home order by comparing it to a wildly unrealistic exponential model.