Hospitals Doing Harm to Patients Paychecks


The Methodist Le Bonheur Healthcare system in Memphis, which includes Methodist University Hospital, has sued thousands of patients, including many of its own low-wage employees.
Andrea Morales for MLK50

New Orleans       With the passage of the Affordable Care Act, hospitals were on notice.  Costs were out of control and people were going to be looking.  Prices were going to be made public so some patients could compare.  Hospitals were going to be able to be ranked by health outcomes.  Accountability was coming!

This was especially true for nonprofits, thanks to a late amendment by Senator Charles Grassley, Republican from Iowa, their charitable contributions were going to be tracked to see if they aligned with their tax-exempt requirements.  The IRS was going to be doing the checking and the enforcement.  The penalty for not providing charitable care could be loss of the tax benefits, which would be a fatal diagnosis for most nonprofit hospitals. Reports indicate that the exemption is worth $9 billion.  They were given a number of years to get their act together, but the years since the passage of the Act meant that time has now come and gone.

What is the accounting now?  How is it working out?  We found that trying to parse the IRS 990s to determine the real level of charitable care was often whack-a-mole, where researchers with ACORN International and Labor Neighbor Research & Training Center were often trying to find the real charitable expenditures hidden in obfuscation.  Many nonprofit hospitals tried to claim the difference between their “sticker prices” for care and the Medicaid reimbursement rate as “charity.”

A recent report on Virginia hospitals in JAMA, the Journal of the American Medical Association, the doctors’ union and trade association, according to the Becker Hospital Review found that,

“…36 percent of hospitals in Virginia garnished patient wages to collect payment for medical bills in 2017. Most of the hospitals that garnished wages (71 percent) were nonprofit. Researchers note their findings “suggest hospitals with greater financial need (nonprofit, lower annual gross revenue) may be pursuing debt collection to the final stage of garnishment.” Those that garnished wages recorded average annual gross revenue of $806 million and garnished an average of $722,342 in wages, or $2,783 per patient.”

Virginia hospitals are not outliers.  The Wall Street Journal quickly reported that hospitals in Arizona followed the same playbook.  The hospital system connected to the University of Kentucky tried to use the Kentucky state revenue system to help collect their bills.  John Hopkins in Maryland was a big litigator.  All of this is after a raft of stories several years ago and reports by Pro Publica and others of nonprofits for whom debt collection was more central to their business plan than good patient care.

All of this is in the face of prohibitions in the Act that were supposed to curtail such practices, if not eliminate them entirely.  As the Journal reminded, the Act requires that,

“…hospitals must post and provide information on their financial-assistance policies and send notices that they are planning to sue. They also must limit the amount charged to the uninsured and wait four months before using stepped-up collection efforts such as filing a lawsuit.”

Ignoring the law, human decency, and the proscription that they “do no harm,” such practices define impunity.

If the IRS can’t do its enforcement job, then states, prosecutors, and the Justice Department need to step up, while the rest of us need to hit the streets before more patients are sentenced to poverty for the bad fortune of experiencing bad health.

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Google Sidewalk Project is Still Too Sketchy and Undemocratic

Sidewalk Labs

New Orleans    Maybe I should shut-up about the Sidewalk development project being proposed by Google in Toronto on 800-acres.  ACORN and some of our allies went after them from the day they won the bid to submit proposals on the issue of the lack of affordable housing in a city that is caught in an affordable housing crisis.  The more than 1000-page proposal they submitted this week actually makes concessions to our demands.  Of the 35,000 housing units now proposed, they claim that 40% would be affordable.  That’s a win, but is that enough to make us stomach the role of Google, the fakery of the consultative process up to this point, and, frankly, the neoliberal corporate control and privatization of public process, regulations, and responsibilities.

I’m not going to pretend that Google isn’t a tech wonder even as it has become a world power.  It’s not as creepy as Facebook, but it’s unaccountable with a business model that pimps out all of us who use their services.  I have a google address for some personal business.  I use Google Maps to navigate my way around the world.  ACORN has a YouTube channel.  When PalmPilot went under, I had to switch to Google calendar.  I’m not a hater.

ACORN Canada even uses Google to host their email system, despite the fact that Google is crystal clear that they never destroy anything.  The depth of their data mining operation is unlimited and unfathomable.  They want to make the Sidewalk project a data motherload for Google as well.  The company’s proposal claims that they will turn everything over to an independent data trust, sanctioned by the government, so that they, and others, can access the data.  Privacy experts are not so easily assuaged.  Neither am I.  Isn’t such citizen experience with public goods something that should remain purely the responsibility of government accountable to citizens, rather than accessible to a private business like Google or other private concerns?  If the city of Toronto or any other city announced that it was collecting data on its citizens and was then going to sell it, people there and anywhere else would be up in arms.

Google, as a private company, simply doesn’t get the fact that there are boundaries.  They are part of the “apologize later, never ask for permission” crowd.  Their proposal ignores existing Toronto zoning laws for example, and I couldn’t read any piece of this without feeling they were usurping the authority of government and the people.  That’s what neoliberalism is, the transfer of public rights and authority to private concerns.  If Google was hired to be a designer and developer, why would they believe that allows them to own the show and run it forever.  A developer, for good or evil, usually sells their “castles in the sky” and then gets their money and runs.  Google seems to think they should own this project forever.  Google needs to taught about limits.

The New York Times quotes Jim Balsille, who was the co-chairmen and co-chief executive of BlackBerry, once the ubiquitous smartphone of the business set, headquartered in Ontario in the Waterloo-Kitchener area, saying,

“I am keen to see the end of this faux consultation charade, an ugly 18-month, psychological public relations game….Google has deliberately weaponized ambiguity, subverted democratic process, obfuscated key elements of concern such as data governance and revealed information to the public only when smoked out by aggressive criticism or through a media leak.”

This just doesn’t seem like it’s going to end well.

ACORN Canada will continue to hold any and all feet to the fire on affordable housing, but perhaps all of us just need to thank Google for whatever good we see in the plan, ignore their attempt to buy support with their own investment masked as infrastructure spending, but recovered through selling data, and retake control of any development and hire contractors to provide whatever services public entities can’t provide.

Public entities have to be able to trust their partners, and Google is not a trustworthy partner at this point.  Google can bid like anyone else, but should not run or own anything.  Haven’t we learned that lesson from Silicon Valley by now?

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