Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.


A gubmint shutdown and you

Joni Mitchell’s Big Yellow Taxi provides today’s lede…and for good reason. The handful of elected House members on the verge of shutting down the entire government claim no one will notice when the Feds are furloughed.


Here’s a very brief list…

  • Most inspections of hazardous waste sites and drinking water and chemical facilities would stop.

  • CMS will furlough non-essential workers, potentially delaying MSA processing

  • OSHA will shut down all but critical operations
  • FEMA has begun rationing its money, pausing about $1.5 billion in longer-term recovery projects to ensure it has enough cash on hand in the event of a major, deadly crisis

  • Workplace safety inspections would be reduced or, if the shutdown persists, potentially stop

  • New applications for Social Security will be delayed, affecting some claim settlement negotiations
  • In past shutdowns the E-Verify system (for employers to verify work status/eligibility) wasn’t operating, likely limiting new hiring
  • Major infrastructure projects would stop
  • The Community Health Center Fund (CHFC), which sends federal funding to health centers – could be halted, among others…patients would have to seek care elsewhere, further increasing the burden on hospitals.
  • Enrollment in clinical trials would be delayed or postponed
  • Grants for new clinical research would halt
  • Funding for Federal courts runs out October 13 (although some may be able to continue operating)
  • 10,000 kids would lose access to HeadStart  – and thousands of others would also lose daycare, impacting parents’ ability to work.

sources here, here, and here.

What does this mean for you?

After you’ve burned the place down, where will you live?


Yelling into the void

I attended a New England Journal of Medicine webinar on value-based care yesterday…net is I heard a lot about “patient centric” care, “patient experience” and quality but precious little about functionality and patient-specific or patient-desired “outcomes.”

Except for a few tangential mentions by the Optum Medical Director, what patients actually want was not addressed at all.

This is a big miss.

Like so many other failing industries, healthcare is completely missing the point – which is delivering what the consumer wants. “Patient experience” is mostly was the office clean, the nurse nice, the floor quiet.

We are ignoring this at our peril…we are not asking what patients actually want from healthcare; NOT the processes and functions noted by one of the panelists but how patients define “healthy”, what they want to be able to do, what functionality is important to them, how they want to live their lives.

Healthcare is provider and process centric;  the entire industry has failed to address what consumers and employers want from healthcare.

Here’s hoping that healthcare figures this out faster than Detroit did.

What does this mean for you?

Healthplans and healthcare providers that figure this out will kick butt.



Medical inflation in work comp…

Isn’t a problem. In most states. Today.

That is the headline takeaway from WCRI’s presentation last week…

First a few key factors.

  • Drug spend is a much lower percentage of total medical today than it was a decade ago. I’m quite confident total drug spend in WC today is 40% lower than it was 15 years ago.
    • That equals a reduction of about $2 billion.
  • Facility costs continue to be the main driver of what inflation there is. Inpatient (IP) and outpatient (OP) hospital inflation averaged 2.5% annually from 2012 to 2022;
  • Facilities account for 53% of total medical spend – 26% of which is OP; 9% is ASCs (Ambulatory Surgical Centers)

The details…

the best way to think about medical spend is per claim…this accounts for changes in claim volume (which is driven by injury rate and total employment).

Leaving out COVID’s impact (see end note for details) medical costs have barely budged for more than a decade…up a paltry 2 percent per year. 

However…Facility costs are a big problem for all payers…exacerbated by massive consolidation in health systems which allows them to charge “facility fees” for services rendered in physicians offices and clinics. (what a scam…)

Work comp specifically…

National averages don’t mean much if you operate in states like Florida or Wisconsin, where poor controls on workers comp medical billing enable providers to hoover dollars out of employers’ and taxpayers’ pocket.

Of note, drug costs would likely be several hundred million dollars lower if it weren’t for the profiteers enabling physician dispensing.

What does this mean for you?

All costs are local…which means all cost management approaches must be as well.

COVID…medical costs for claims during COVID were down 10% – decreases in utilization and price drove this with utilization the main driver. Not surprising…during COVID no one wanted to go to any healthcare facility for anything not essential.

This was totally predictable...


Scary stuff…COVID death details

A just-released study found striking differences in death rates from COVID based on political party affiliation.

The study reviewed “538,159 deaths in individuals aged 25 years and up in Florida and Ohio between March 2020 and December 2021…”

more from JAMA

“Between March 2020 and December 2021, excess death rates were 2.8 percentage points (15%) higher for Republican voters compared with Democratic voters…(Table)….political party affiliation became a substantial factor only after COVID-19 vaccines were available to all adults in the US.”

After April 1, 2021, when all adults were eligible for vaccines in Florida and Ohio, this gap widened…with excess deaths among Republican voters 43% higher than among Democratic voters.

(you can get a higher resolution view here)

What does this mean for you?

Take a step back and consider how it came to this. 



Fentanyl, immigration, and home health care

Illegal immigrants are NOT smuggling in fentanyl across the Southern border.

Americans are.

Yet half Americans  – and 6 out of ten Republicans – think it’s those damn immigrants.

I’ve been yelling about opioids of all types for almost two decades…and avoiding it for the last year or so because I’m burnt out on the topic. Yet here it is again, with demagoguing politicians and “news” outlets using the fentanyl crisis to scare the crap out of people by blaming brown folks for a crisis entirely of our own making.

News flash – WE Americans are consuming fentanyl…if we weren’t, there would be no crisis, no awful death toll, no broken families and destroyed communities.

And we Americans are the ones importing fentanyl.

From a Former Border Patrol sector chief:

Virtually none is smuggled by migrants themselves, says Victor Manjarrez, Jr., a former Border Patrol sector chief who’s now a professor at the University of Texas at El Paso.

“The probability that they’re going to carry some kind of illicit narcotic is probably close to zero,” Manjarrez said. “The vast majority of that fentanyl is going through a port of entry.” [emphasis added]

This is clearly a fact-free campaign to demonize immigrants, to scare us into voting for politicians that talk about building walls and banning immigration.

What does this have to do with healthcare?

I’m sooooo glad you asked.

As a nation – and individuals – we are getting older fast. Older = more need for healthcare = need for more healthcare workers.

Where are those workers going to come from? Are your kids signing up to be home health aides? Your neighbors’ kids?


There is a crisis  – but is sure as hell isn’t immigrants bringing in fentanyl.

No, the crisis is in healthcare staffing, so blocking immigration is worsening the crisis.

By far the most projected job openings is in direct healthcare workers in the decade ending in 2026 – 2 1/2 years from now – we’ll need 1.4 million direct health care workers – plus over 400,000 nurses.

States most affected by the healthcare worker crisis include Texas, Florida, Nebraska, Alabama, Wyoming and Maine.

Where are those workers going to come from – especially home health care workers? Today, almost four out of ten home heath aides are immigrants; that HAS to increase if we are going to have enough workers to care for us and our parents and grandparents.

Meanwhile Canada is attracting immigrants by giving health care workers a path to citizenship.

What does this mean for you?

If you want to change your own bed pan, vote to block immigration. 

PS…I dumped Twitter and moved to threads – follow me there at joe_paduda


We are all Hawaiians

The disaster in Maui is one of the most awful things I’ve ever seen. An entire town of 12,000 is gone, burned to the ground by a horrific firestorm.

At last 36 are dead, while countless others survived only because they jumped into the ocean to avoid being burned to death.

Here’s how we should think about this.

Of all the places in the US, no one ever thought Maui, a tourist paradise, would ever be in the news for a devastating wildfire. If it can happen in Maui, it can happen in Ohio, or New Jersey, or your home town.

Think it can’t?

So did residents of Lahaina.

What does this mean for you?

Prepare. Now. Not tomorrow, not next week, not as a 2024 goal.  Now.

Here’s a detailed discussion along with a list of what to do.

note – I am on Threads – joe_paduda


Just the facts, ma’am…

Another day, another record-breaking heat wave. And this one is really really bad.

Amazon workers are going on strike…construction crews on the Canadian border are knocking off early to avoid heat…Florida utility workers are postponing checks for gas leaks due to excessive heat risks

Yet some folks still don’t think we humans are the problem…they call up all kinds of specious arguments supported by “I read an article…” “They said…” “This one scientist”

I’ve put together a handy point:counterpoint addressing deniers’ arguments…feel free to plagiarize!

About global warming!

Denier: Scientists don’t agree that humans are driving global warming or, another equally wrong argument that “non-human events” (volcanoes??) are the driver.

Well…Net is even four years ago, almost every climate scientist agreed global warming is caused by humans.

Every credible scientific organization agrees.

More than 400 billion metric tons of carbon have been released into the atmosphere from the consumption of fossil fuels and cement production since 1751- half of which was emitted since the 1980s. 

There are no credible sources asserting non-human greenhouse gas production is a significant contributor to the 45% increase in carbon over the last 150 years. (If you have any, please post in comments below)

Denier: The climate changes all the time…those scientists don’t know why.
Well…research shows climate changes NOT associated with greenhouse gases were most likely generated by earth’s wobbling on its axis – and the sun was cooler long ago.
Denier: You can’t prove human-generated greenhouse gas increases are causing these big weather events.
Well…yes we can.  Attribution science is becoming ever better at predicting future events based on human-caused global warming’s effects.
Denier: Weather was worse (pick a time) and here’s a chart/graph/meme that proves it.
These are misleading misuses of data from credible fave is this – which is actually from the EPA…which deniers use to say “see…it was worse back in the thirties!!”
A graph showing the temperature of the year Description automatically generated
Well…a “heat wave index” is really misleading as it refers to a specific event – a “heat wave” and doesn’t address global warming.  Fortunately, the EPA has this. As you can see, things varied in the past – up until about 1980…then, the trend is only up.