Thread by @wendellpotter

In a bombshell piece this week, @sarahkliff & @sangerkatz revealed that Americans owe much more in medical debt than previously thought, as collection agencies held $140 billion in unpaid medical bills in 2020.

Here's the crazy part: the real total is WAY higher. Let me explain.

First, as the piece notes, the $140b doesn’t include anywhere close to all the medical bills Americans owe, just debts that have been sold to collection agencies. Not counted are bills patients put on credit cards & try to pay off. Many of those patients will never pay them off.

Another crucially important fact the @nytimes story does not mention is that much of Americans’ medical debt--maybe more than half of it--is owed not by the uninsured... but by people who have health insurance!

To meet Wall Street’s profit expectations, insurance companies, like the ones I used to work for, keep jacking up the amount Americans have to pay out of their own pockets before their coverage kicks in.

It is not at all uncommon for patients in this country to have to pay thousands of dollars in deductibles, copayments and coinsurance every year. That’s in addition to the premiums they have to pay to get the coverage in the first place.

I'll never get over stories like Sharon Kelly, a breast cancer survivor who stopped going to the doctor--even though she had insurance--for fear of adding to her debt. “It kind of paralyzes you,” she said, while paying ~$7K/yr in premiums alone in 2019. inquirer.com/health/consume…

Sharon learned from a routine mammogram that she had cancer when she was halfway through the calendar year. She had no choice but to pay her deductible over the remainder of the year. And then January came, and her deductible shot back up to $7K.

Her treatment continued -- and so, of course, did the bills. And because of those bills, Kelly decided not to undergo chemotherapy as her doctors advised. She also has put off going back to the doctor. She's far from alone. This country has a problem.

Fixing this disaster must become a priority of Congress & @joebiden. He is understandably protective of the ACA, but just getting more people enrolled in health plans & increasing premium subsidies is not helpful to the millions of middle-class Americans in high-deductible plans.

Zeke Emanuel, who helped write the ACA, told the @nytimes last year that not anticipating the growth and consequences of ever-rising out-of-pocket requirements was “a huge mistake.”

It is long past time for Congress & the Biden administration to fix that huge mistake.

For more on the huge amount of medical debt that Americans owe, read my latest on @SubstackInc!

wendellpotter.substack.com/p/nyt-medical-…