On Monday night in the Gold Room of the Allegheny County Courthouse, Downtown, County Council’s Health and Human Services Committee hosted a public hearing on the growing national and local problem of medical debt. Participants cited piles of statistics, such as how many American adults — 4 in 10 — are saddled with health care debt. Half are unable to pay an unexpected $500 medical bill. One third say that because they can’t afford it, they or family members have skipped medical or dental care.
But it was the human stories that most moved committee chairman Paul Klein, who represents District 11, and six other councilors who were present (two more joined by phone) and others among the two dozen attendees, including two County Council candidates — Carl Redwood and Sam Schmidt — and Pittsburgh City Councilor Barb Warwick.
Dr. Anthony Fiorillo, who is affiliated with Physicians for a National Health Program, told of a friend who lost his job and so lost health insurance for himself and his family. Knowing any diagnosis and treatment could cost tens of thousands of dollars, he put off treatment for worsening chest pains and wound up dropping dead standing at a sporting goods store checkout with his teenage son. He was 51. “I tell you this story to honor him.”
Another physician, Katherine Neely, told of a patient of hers who had a mail-in test clue that he might have colon cancer, but he was only covered if he had a full colonoscopy, which he decided to not pay for himself. He wound up dying. “That’s what medical debt does to citizens of Allegheny County.”
Now working for a private company that provides emergency care, Neely said she sees people seeking medical care who are blocked at the front desk by outstanding balances and copayments who turn around and walk out. “I have no idea if they’re able to get care somewhere else.”
Speakers repeated each other in citing this country as being the richest and spending more than others on health care, yet having some of the poorest outcomes, notably in maternal and infant mortality. That $4 trillion a year, proponents said, could more than pay for much better health care for everyone, from birth to grave.
“We are spending twice as much per capita as every other industrialized country, yet we trail in outcomes,” said Judith Albert, M.D., a retired obstetrician/gynecologist, co-founder of Physicians for a National Health Program of Western PA and steering committee member of the Western PA Coalition for Single Payer Healthcare.
Her fellow invited speaker Ed Grystar, chair of that coalition and a labor activist, said that what they are asking County Council to do is put a referendum on the ballot for citizens to vote for calling on their congressional leaders to push for national single-payer health care. That has happened recently in other states such as Wisconsin and Illinois.
“People are ready for fundamental change,” he said.
Among stats he cited: In the first six months of 2023, the seven big for-profit insurance companies made $40 billion in profits.
A referendum is different than council’s past resolutions, he said — “one tool to push the issue forward.” In addition, he urged the local leaders to do some research to know the numbers and demographics of county residents — insured, underinsured, uninsured — who have medical debt.
Councilor Liv Bennett of District 13 told everyone that it’s not just the indigent and the homeless, as she’s struggling with medical debt and with getting health care coverage at a new day job. “There is a face to these stories.”
Councilor at Large Bethany Hallam said, “I have lots of medical debt,” and she had questions for speakers who talked about negotiating medical bills down for those who couldn’t pay them.
Invited speaker Claire M. Cohen, M.D., a local child psychiatrist and coalition steering committee member who’s also part of PNHP of Western PA, had mentioned doing that for one of the bills for her adult children that she had to pay.
The hospital where this family member is employed sent her to the emergency room there and billed her for more than Cohen thought the procedure costs. So she negotiated the charge from $4,000 down to $2,000 down to $1,000.
Insurance reps tell her she’s “impassioned,” but she said, “I just get mad.”
Earlier Monday, she said, she spent an hour arguing for a patient who was being cut off from a medication that has kept him stable for five years — the kind of cutoffs she’s seeing more lately. “I just think it’s so wrong and so immoral.”
If the U.S. had a Medicare-for-all system, she said, there would be no need for medical debt relief. “People just get good care when it’s needed at a much lower price.”
Klein from the start acknowledged that the county has no legal authority when it comes to national health care, but at Hallam’s urging, Grystar and other speakers offered tangible acts that could help move the needle, such as urging local nonprofit but hugely valued health care providers to donate meds to county residents. Or COVID-19 tests and testing, as is happening in Philadelphia, to keep transmission and bigger problems in check.
On problem pointed out by Schmidt and others is how many health care workers themselves — 51% of the lowest-paid workers at local health care giant UPMC, she said — owe medical debt to their employers. Such workers shouldn’t have to choose between medical care or food, she said.
In his three-minute slot, Redwood said, “I think it is important that we become activist Allegheny County, activist Pittsburgh.”
Warwick noted City Council passage of her colleague Bobby’s Wilson’s bill to buy up $1 million dollars’ worth of city residents’ medical debt for pennies on the dollar and told her county counterparts, “Hopefully we can work together at tackling this problem.”
Klein closed by telling attendees, “We certainly will take this to heart.”
The meeting was livestreamed and a recording is posted online.
Bob, a feature writer and editor at the Pittsburgh Post-Gazette, is currently on strike and serving as interim editor of the Pittsburgh Union Progress. Contact him at firstname.lastname@example.org.