I have not had access to a computer since late last week, but I have been thinking about recent comments by Tim Murphy, a senior advisor to Governor Mitt Romney. Murphy has proposed that hospitals and other health care providers in Massachusetts be more aggressive in collecting deductibles and copayments from patients who do not pay. Murphy's comments have been criticized in a number of quarters, including Health Care For All, Blue Mass. Group, and Left in Lowell.
I have a somewhat different take from Murphy's critics. First, I think that Tim Murphy is one of the most thoughtful policymakers in the Romney administration. I don't know that he is advocating draconian collection measures, such as liens on cars and homes. Certainly, any sensible policymaker would see these steps as last resorts. I would think that Murphy would be looking toward hospitals and other health care providers to more actively take other types of collection measures, such as arranging payment plans with patients who have fallen behind on their payments of deductibles and copays. Currently, it can be difficult and costly for health care providers to engage with such patients even to get them "to the table." I know of health care providers who sometimes forego collection measures on even large bills because of the time and expense. One provider I know also said that in his experience it is usually people who can afford to pay that successfully avoid paying. Perhaps Murphy is thinking of ways in which the state government might enact changes that will facilitate stronger collections without putting people on the street.
Pursuing the strongest possible collection rates from patients without resorting unnecessarily to draconian measures is both a matter of equity and financial stability. To the extent that hospitals and other health care providers do not collect their debts, these costs are passed on to the rest of us. To the extent that this is not a matter of an inability to pay - in many cases, it is not - it is an unfair burden for the rest of us to carry the "deadbeats." Also, uncollected debts are contributing to the accelerating cost of health care. Bringing health care costs under control requires financially sensible measures, such as collecting outstanding bills.
I can point to another sector where financial stress forced organizations to improve collection rates - with some initial concerns similar to those expressed by my fellow bloggers and others. Before the passage of Proposition 2 1/2, cities and towns were not necessarily under pressure to collect the bulk of the property taxes owed to them. After the enactment of Proposition 2 1/2, cities and towns came under intense pressure to collect every dime owed to them. Tax collectors and treasurers increasingly used the legal means available to them to induce taxpayers to make them pay their back taxes. There were fears that many people, including the elderly, would be "thrown into the street." In response to such fears, collectors and treasurers generally worked out payment plans with taxpayers who could not afford large cash payments. The approach that many tax collectors and treasurers have taken on tax collections have enabled cities and towns to better weather the fiscal stresses of the past few years.
In conclusion, I would say that John McDonough of Health Care For All did raise good points in his letter to the Boston Globe. Collection measures do need to take ability to pay into account. Employers do need to be part of the solution on health care costs. In counterpoint to John, though, I would say that while it is true that health care is not a luxury, neither is housing. No one disputes that renters and homeowners need to pay rent, mortgages, and taxes - we should be able to arrive at a point in which the same is said about health care costs. Part of the process we now going through on health care is debating how we might make the system both fairer and more financially sensible.