Budget "compromise," includes the war machine, a/k/a "Department of Defense," (per this online document at p.9 of 154pages), at $842 billion (base) allocation, with it not researched whether Ukraine spending is within that number, or ancillary, stashed elsewhere in spending. (Why the number has to be found on p.9, via a search = $ is a mystery in hiding the prize.)
In the context of the war budget, for FY 2024, there is a history and scale to things.
Having extricated adventures in Iraq and Afghanistan in recent years means the budget is going up? Curious. One might expect otherwise, if not knowing how Washington DC spends.
Bernie suggests the nation has wealth enough to socialize medical care delivery, to everyone, as needed, as a clear social good from which the people would benefit.
That lays the groundwork to examine Allina and its latest move against US.
Strib yesterday carried a NYTimes item which reports:
Allina Health System cuts off patients with medical debt
Although Allina's hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients.Many hospitals in the United States use aggressive tactics to collect medical debt. They flood local courts with collections lawsuits. They garnish patients' wages. They seize their tax refunds.
But a nonprofit health system in the Midwest is among those taking things a step further: withholding care from patients who have unpaid medical bills.
Allina Health System, which runs more than 100 hospitals and clinics in Minnesota and Wisconsin and brings in $4 billion a year in revenue, sometimes rejects patients who are deep in debt, according to internal documents and interviews with doctors, nurses and patients.
Although Allina's hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients, including children and those with chronic illnesses such as diabetes and depression. Patients aren't allowed back until they pay off their debt entirely.
Nonprofit hospitals such as Allina get enormous tax breaks in exchange for providing care for the poorest people in their communities. But a New York Times investigation last year found that over the past several decades, nonprofits have fallen short of their charitable missions, with few consequences.
Allina has an explicit policy for cutting off patients who owe money for services they received at the health system's 90 clinics. A 12-page document reviewed by the Times instructs Allina's staff on how to cancel appointments for patients with at least $4,500 of unpaid debt. The policy walks through how to lock their electronic health records so that staffers cannot schedule future appointments.
"These are the poorest patients who have the most severe medical problems," said Matt Hoffman, an Allina primary care doctor in Vadnais Heights. "These are the patients that need our care the most."
Allina Health said it has a robust financial assistance program that in an average year helps more than 12,000 of its 1.9 million patients with medical bills. The hospital system cuts off patients only if they have racked up at least $1,500 of unpaid debt three separate times. It contacts them by phone and with repeated letters that include information about applying for financial help, said Conny Bergerson, a hospital spokesperson.
"Allina Health's goal is, and will always be, to have zero patients go without services for financial reasons," Bergerson said. She said that cutting off services was "rare" but declined to provide information on how often it happens.
Allina suspended its policy of cutting off patients in March 2020, at the onset of the coronavirus pandemic, before reinstating it in April 2021.
An estimated 100 million Americans have medical debts. Their bills make up about half of all outstanding debt in the country.
It is part of wealth dictating that prols be kept in debt to make them docile and more manageable. That, as policy, in soundness can be debated, but we take it as how things currently are.
For now. Political reform comes with effort; and so far effort has proven inadequate.
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Allina, as other non-profits, does face scrutiny of Minnesota's Attorney General, as to ways and means and behavior; with it unclear as to how much authority and of what kind the AG has; but some may remember Mike Hatch as AG having had head bumping with Allina and how it resolved.
With that as context, Strib also publishes online yesterday, "Attorney general urges Minnesotans hurt by hospital debt collection to contact his office -- Keith Ellison responded to a New York Times story regarding Allina Health and its policy of cancelling appointments for patients with significant unpaid debts." By Jeremy Olson Star Tribune, June 1, 2023. More on that later.
For now it is noteworthy that Ellison, after having been reelected, is doing his job; and doing it in a most laudatory manner. His last opponent, Republican James Schultz, who in campaigning did his level best to exacerbate the urban/rural divide and to demonize, while Ellison takes steps toward helping vulnerable people, is playing around with his latest thing (subject of this recent Crabgrass post with this accounting showing there's money atop some things as a partial context). In terms of divisiveness, vs cohesiveness, Schultz seemed overly interested in campaigning about pyromania:
It is ABSOLUTELY NECESSARY to draw the Ellison-Schultz comparison, because had Schultz won we clearly would not be seeing an Attorney General in office soliciting those impacted by offensive healthcare debt collections practices to contact the office.
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Moving back to the Strib/NYTimes item, it seems clear from experiences, apart from dealing with the bean counters, that in general the practitioners on the top floors, the doctors, nurses and support people are good and well motivated people; once one can get past the ground floor gate-keeping policies of those running the circus gate, to get to the circus rides:
Allina is one of Minnesota's largest health systems, having largely grown through acquisitions. Since 2013, its annual profits have ranged from $30 million to $380 million. Last year was the first in the past decade when it lost money, largely owing to investment losses.
The financial success has paid dividends. Allina's president earned $3.5 million in 2021, the most recent year for which data is available. The health system recently built a $12 million conference center.
Yet Allina sometimes plays hardball with patients. Doctors have become accustomed to seeing messages in the electronic medical record notifying them that a patient "will no longer be eligible to receive care" because of "unpaid medical balances."
Dr. Rita Raverty, a primary care doctor who works at an Allina clinic, said the notifications were alarming because they meant she could not provide continuous care for some of her patients facing a number of health risks.
"Nobody wins when patients can't get preventive care," Raverty said. "It creates worse disease outcomes when you're not catching things early."
Doctors and patients described being unable to complete medical forms that children needed to enroll in day care or show proof of vaccination for school.
Serena Gragert, who worked as a scheduler at an Allina clinic in Minneapolis until 2021, said the computer system simply wouldn't let her book future appointments for some patients with outstanding balances.
Gragert and other Allina employees said some of the patients who were kicked out had incomes low enough to qualify for Medicaid, the federal-state insurance program for poor people. That also means those patients would be eligible for free care under Allina's own financial assistance policy — something many patients are unaware exists when they seek treatment.
Bergerson, the Allina spokesperson, did not dispute that but said the health system goes "to tremendous lengths to assist patients with their financial obligations for medical care."
It is an item that explores things further, and those having subscriptions to get past subscription walls at Strib and NYTimes should read it all at either source.
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The item about Ellison is short, this being the gist:
Minnesotans have had extra protection from hospital debt collection practices that are abusive, harassing or deceptive through an agreement reached in 2005. Ellison renewed that agreement in 2021.
"Denying patients needed care on the basis of medical debt harms every Minnesotan, whether or not they are Allina patients," Ellison said in a statement. "I encourage anyone ... affected by the practices raised in the article to contact my office so we can determine the scope of the problem and whether any laws or agreements have been broken."
The original agreement emerged over accusations of aggressive debt collection by Fairview Health, and then extended to include Allina, North Memorial and Park Nicollet. The Twin Cities health systems also agreed through the deal to offer uninsured patients the same discounted rates given to insured patients. The current version of the agreement covers all 128 nonprofit hospitals in Minnesota.
2006 was Hatch's last year as AG, choosing to run for Governor, while Lori Swanson then in the AG's office sought and won election as AG. That 2006 reform is an achievement of the DFL, and more specifically, Hatch and Swanson.
Policing non-profit activity is an AG power and duty, and Hatch did it well. Ellison is doing it well.
There is this:
The Independence Party took 5% of the vote and the split between Hatch and Pawlenty, who won, was far less than that IP margin where Dr. Maureen Reed, a HealthParthers executive, was IP VP candidate.
BOTTOM LINE: Medicare for All would eliminate the rapaciousness this latest Allina move demonstrates, as well as eliminating top non-practitioner administrators looting enormous salaries.
Not that the feeling of greed would be quelled. The opportunity for greed to hold sway is what would be quelled. That is the main reform MfA would establish.
____________UPDATE___________
Pioneer Press carried the story.