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“Health Care Gluttons” in Bankruptcy

posted by Angie Littwin

Yesterday New York Times blogger Judith Warner (registration required) asked a startling question:  What if the “health care glutton” is the new welfare queen?  This idea came at the end of a column addressing the recent efforts to scale back the Family and Medical Leave Act (FMLA), which provides workers with twelve weeks of unpaid leave to care for a personal illness, a new child, or a sick relative.  The statute’s critics want to tighten eligibility, allowing only workers with the most “serious” medical conditions to use the program.  Warner spends most of her column making the usual arguments that the FMLA cannot afford to be any more feeble than it already is.  The leave is unpaid, giving workers little incentive to take it unnecessarily, and the United States already has one of the weakest family leave systems in the world.  Our lack of paid maternity leave is on par with that of Liberia and Swaziland.

Warner derives the idea of the “health care glutton” from President Bush’s recent foray into the health-insurance debate, where he accused many American workers of having “overly expensive, gold-plated” health plans, and from the rhetoric of the National Coalition to Protect Family Leave (yes, that’s the group pushing to water down the law), which says that Americans are abusing the FMLA by taking leave for cosmetic surgery and “pink eye, ingrown toenails and colds.”  She conceives the “health care glutton” as the “villain du jour,” who “consumes doctor’s visits like so many donuts, sloughing off the burdens of his waste onto the hard-working and the health-care abstemious.”  She concludes by warning that if such rhetoric takes hold, the quality health insurance some American workers do have could go the way of welfare benefits.

If the image of the “health care glutton” takes hold, it could have a damaging effect on the consumer bankruptcy debate as well.  One of the central arguments for a generous consumer bankruptcy system is that vast majority of families who file for bankruptcy do so because of job loss, divorce, and/or medical problems.  But if the fact of having high medical bills becomes stigmatized in and of itself, where does that leave us?  Current bankruptcy critics argue that families who file are spendthrifts who acquire too many luxury goods.  I have nightmarish visions of future bankruptcy critics contending that these families are spendthrifts who acquire too much luxury health care.

The Department of Labor is accepting comments about the FMLA here until February 16.


But one of the unsolveable issues in health care from the get-go is tht health care is at least in part a discretionary consumer good. Recall the definition of a healthy patient: one whose case hasn't been worked up yet. We could all find ways to spend 100 percent of our income on health care if we wanted. I have no desire to demonize imaginary health care queens, but there are some core issues there that won't go away.

Thankfully, I cannot figure out how to spend 100% of my income on health (true health) care. (Are you criticizing those who elect annual check-ups when not ailing?) Taking unpaid leave, and incurring medical expenses that (virtually all) insurance will fund only if "reasonable and necessary" in the insurer's view, hardly smacks of gluttony in my view.

Without Chapter 11, anyone can get credit because they will have to repay regardless.

You most certainly have a class that abuses the health care system. FMLA has nothing to do with it. I love the thousands of cases I see every year of patients who have both commercial insurance and Medicaid as secondary "insurance." Far too many people in this country have no motivation to be reasonable in their use (abuse) of the health care system. It has nothing to do with illness.

I always find that the hassle of going to the doctor (not to mention the possible pain of getting a shot or blood drawn) to be a strong incentive to avoid using the health case system unless I must.

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