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We told you so...Even the Insured Often Can't Afford Their Medical Bills
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Leroy N. Soetoro
Jun 18, 2017, 10:10:13 PM6/18/17
to
https://www.theatlantic.com/business/archive/2017/06/medical-
bills/530679/?google_editors_picks=true
A chance trip to Long Island’s Adventureland amusement park just might
have saved Cassidy McCarthy’s life. After Cassidy—whose family calls her
Cassie—then 4, complained about pain and nausea following a ride on the
Ladybug rollercoaster, her dad, Daniel, a registered nurse, felt her
stomach and discovered a small bump. A CT scan ordered up at a local
hospital’s emergency room revealed a kidney tumor.
It was another seemingly chance decision by Daniel McCarthy to sign on as
a volunteer firefighter more than a decade ago that saved the family’s
finances in the wake of Cassidy’s diagnosis with cancer. As it turned out,
that activity allowed him to ask The Heather Pendergast Fund, a foundation
set up in 2009 to help out the families of Long Island’s volunteer
firefighters and EMS workers with their children’s medical expenses, to
pay many of Cassidy’s medical bills.
McCarthy says the charitable foundation was a financial lifeline. Cassidy
quickly racked up more than several thousand dollars in out-of-pocket
medical expenses—for the surgeon, the anesthesiologist, radiologists,
chemotherapy, you name it—since the family’s insurance policy had a $6,000
deductible. A few months later, Pendergast came through again when
McCarthy lost his job at a local nursing home and rehabilitative center
and the family suddenly had to find money for COBRA payments, which, at
$2,100 a month, were more than the monthly mortgage payment on their West
Babylon, Long Island, home.
“I don’t know how people who don’t have resources do this. I don’t. Many
people work three, four jobs, and can’t afford the time to volunteer in an
organization like the fire department that would be able to help them.
There are many people living out there that need help that can’t find it,”
McCarthy says.
The current debate over the future of the Affordable Care Act is obscuring
a more pedestrian reality. Just because a person is insured, it doesn’t
mean he or she can actually afford their doctor, hospital, pharmaceutical,
and other medical bills. The point of insurance is to protect patients’
finances from the costs of everything from hospitalizations to
prescription drugs, but out-of-pocket spending for people even with
employer-provided health insurance has increased by more than 50 percent
since 2010, according to human resources consultant Aon Hewitt. The Kaiser
Family Foundation reports that in 2016, half of all insurance policy-
holders faced a deductible, the amount people need to pay on their own
before their insurance kicks in, of at least $1,000. For people who buy
their insurance via one of the Affordable Care Act’s exchanges, that
figure will be higher still: Almost 90 percent have deductibles of $1,300
for an individual or $2,600 for a family.
Even a gold-plated insurance plan with a low deductible and generous
reimbursements often has its holes. Many people have separate—and often
hard-to-understand—in-network and out-of-network deductibles, or lack out-
of-network coverage altogether. Expensive pharmaceuticals are
increasingly likely to require a significantly higher co-pay or not be
covered at all. While many plans cap out-of-pocket spending, that cap can
often be quite high—in 2017, it’s $14,300 for a family plan purchased on
the ACA exchanges, for example. Depending on the plan, medical care
received from a provider not participating in a particular insurer’s
network might not count toward any deductible or cap at all.
At the same time, the most recent Report on the Economic Well-Being of
U.S. Households, an annual survey conducted by the Federal Reserve Board,
found that 44 percent of adult Americans claim they could not come up with
$400 in an emergency without turning to credit cards, family and friends,
or selling off possessions. When this reality combines with healthcare
bills, the consequences can be financially devastating. A 2015 poll by
the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of
Public Health discovered that 26 percent of those who took part in the
survey claimed medical bills caused severe damage to their household’s
bottom line. A poll conducted earlier this year by Amino, a healthcare-
transparency company, with Ipsos Public Affairs, found that 55 percent of
those they surveyed claimed they had at least once received a medical bill
they could not afford. No surprise, then, that the Consumer Financial
Protection Bureau reported earlier this year that medical debt was the
most common reason for someone to be contacted by a debt collector.
This spending is most pressing for households with the highest medical
bills, the 5 percent of Americans who make up 50 percent of the country’s
healthcare costs. Medicare, Medicaid, and private insurers will spend
$40,375 on average per patient for someone in this group. Their out-of-
pocket spending will be much less: on average, $2,582.90. This isn’t, in
the scale of things, a lot of money—but given Americans’ straightened
personal finances, it’s more than many can easily access.
This isn’t, it’s important to point out, a static group. A chronic illness
can land someone in this category but, given the increasing prevalence of
high-deductible plans, so can something as simple as a broken bone or an
emergency appendectomy. Although some people will be in this group year
after year, many will cycle in and out, and nearly everyone will be in it
for some brief period. The fact is that nearly any illness or injury can
lead to unexpected bills, and few are able to absorb those shocks without
difficulty. Yet, despite the commonness of such problems, there is little
in the way of a system for helping people out through these times.
“Do I pay the doctor bill because I’m getting collection notices? But I
gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the
rent.”
Some of these people will declare bankruptcy. How many is the subject of
controversy. A famous study—co-authored by Elizabeth Warren—found that
suffering from a medical misfortune was the most common reason for
ultimately leading someone to petition the courts for relief from their
financial obligations, but another study pointed to unnecessary spending
prior to the medical crisis.
As it turns out, determining what counts as a medical expense is
difficult. It’s not simply doctor bills. In addition to the not-covered
deductibles, there is transportation to and from medical appointments,
parking fees at many hospitals, and often childcare expenses while parents
are in treatment or at appointments. Time for cooking will be limited, so
take-out bills can pile up, too.
And families that experience an illness are often hit by a double
whammy—they lose income at the same time their financial needs grow, often
cutting back on work hours or leaving work altogether, either voluntarily
or not. McCarthy, for one, recently filed a lawsuit against his former
employer, Daleview Care Center in Farmingdale, Long Island, claiming he
was let go because of the amount of work he missed as result of his
daughter’s illness, a violation of several laws including the Family
Medical and Leave Act. In legal filings, Daleview denied McCarthy’s
allegations, but the company did not return requests for comment.
“The families get to the point where it’s, ‘What do I do? Do I pay the
doctor bill because I’m getting collection notices? But I gotta pay my
mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.’ That’s
where we come in,” Tom Pendergast of the Heather Pendergast Fund told me.
“They can pay their mortgage, their rent, their electric bills and not
have to worry about the medical part of it.”
For many, the idea of charity to help those in need out—which is, after
all, what saved the McCarthy family from financial disaster—holds much in
the way of appeal, speaking to both a sense of generosity and a can-do
spirit. It somehow seems, well, American, to think individual donations
can compensate for a broken, expensive system that views illness as a
moneymaking opportunity. So there is crowdfunding, small foundations like
the Pendergast Fund, hospital-charity programs for the needy, and disease-
specific resources. These efforts are patchy, and often inadequate, but
they’re what’s available. Their strengths and their failings reveal a lot
about the broader American healthcare system—something that is all too
easy to ignore till it is your life or the life of a loved one at stake.
***
CancerCare was founded in 1944 as a bereavement-support organization, but
quickly began helping people with the disease manage their financial
issues as well. “The first hospital bill we paid, in 1944, was to Memorial
Sloan Kettering for $13 and change,” said Patricia Goldsmith, the
organization’s chief executive officer. Today, finances are why between 60
and 70 percent of those who contact the organization reach out, and the
dilemmas are the same as those people who turn to The Heather Pendergast
Fund face. “For the most part, people call us because they are in some
kind of financial crisis,” says William Goeren, CancerCare’s director of
clinical programs. “The prices have increased ... so that really puts the
burden on the patient, who is weighing, ‘Do I pay for my mortgage or
should I pay for my diagnostic test?’ These are the calls we are getting.”
CancerCare attempts to head off these sorts of financial issues, while
still offering emotional support to people in need. They offer a
bereavement camp—located in Pennsylvania’s Poconos—and counseling groups
for cancer sufferers and their children alike. They also distribute more
than $4 million in transportation, home-care, and childcare assistance.
“If for some reason we got $500 million tomorrow to support co-pay
assistance, we could distribute that money likely within two months.”
But the heart of CancerCare’s aid is distributed through their disease-
specific prescription co-pay funds, which award anywhere between $4,000
and $15,000 per patient to income-eligible patients. (“Income eligible”
varies based on the fund, but is generally anywhere between 250 and 500
percent of the federal poverty line.) Last year, the organization
distributed slightly more than $14.2 million in total.
Such funds are not without controversy. The cost of treating cancer, a
disease that will be newly diagnosed in just under 1.7 million Americans
in 2017, is skyrocketing. According to research published in the Journal
of Oncology Practice, the average cost of a year of a cancer treatment
drug in 2000 was less than $10,000 in total. By 2005, that had more than
tripled to between $30,000 to $50,000 annually. In 2012, 12 out of the 13
drugs newly approved for cancer cost more than $100,000. Another study,
this one published in JAMA Oncology, found the price of one month of an
oral-cancer medication increased from $1,869 in 2000 to $11,325 in 2014.
As insurance companies, desperate to clamp down on their own expenses, cut
reimbursements for the more expensive drugs, and employers, hoping to cut
their own costs, push employees into high-deductible health-insurance
plans, more of this cost ends up being picked up by the patients.
A paper published by the journal Health Affairs in 2013 found cancer
patients are more than twice as likely as their peers without the disease
to declare bankruptcy. The consequences of this expense goes beyond the
patient’s checkbook: Last year researchers writing for the Journal of
Clinical Oncology found that cancer patients who declared bankruptcy were
significantly more likely to die than those who did not need to ask the
courts to discharge their debts. The reasons for the increased mortality
are unclear: It’s possible people with shaky finances are less likely to
receive adequate treatment, but it’s also possible stress is a
contributor.
Many believe the 2003 passage of Medicare Part D, which established
coverage for pharmaceutical costs, is partially responsible for the price
surge. The same legislation allowed for non-profit patient-advocacy groups
to establish co-pay funds that could be funded by the pharmaceutical
industry. (The CancerCare Co-Payment Foundation was established in 2007,
for example.) These co-pay funds are meant by the organizations offering
them to help people, but critics maintain the pharmaceutical-company
contributions to organizations like CancerCare and others like it should
be viewed less as charity and more as cover for the ever-increasing cost
of their medications, since these donations allow pharmaceutical companies
to stick insurance companies and government programs like Medicare with an
ever-greater bill, while helping the consumers cover their share of the
tab. “Co-pay programs are meant to mitigate criticism of high drug prices,
deflect legislation on drug pricing, get around payer restrictions and get
patients on expensive drugs they will stay on for a long time,” says
Adriane Fugh-Berman, an associate professor at Georgetown University
Medical Center and an expert on physician-industry relationships.
The amount of money is also not enough. The phrase “drop in a bucket”
barely does it justice. When CancerCare opened a $1.6 million fund for the
co-payment of multiple myeloma medications this past April, it was
exhausted within two days, Goldsmith told me. “I guarantee you tomorrow if
for some reason we got $500 million tomorrow to support co-pay assistance,
we could distribute that money likely within two months,” she said. But it
is, she points out, better than not distributing the money at all. “I can
tell you that that amount of money often makes the difference between
people being able to get their treatment and not get their treatment.”
This is hardly unique to CancerCare. Alan Balch, the chief executive
officer of the Patient Advocate Foundation, which provides both case-
management services and administers co-pay funds for a range of diseases
and distributed more than $50 million in assistance in the fiscal year
that ended in June of 2016, tells me that while some co-pay funds remain
open for a considerable period of time, others open and close quickly.
“There’s only so much money that is available at any one time and there’s
so much demand for it,” he says.
The evidence is clear when you visit the websites of the funds. The
Patient Advocate Foundation’s chronic pain fund? Its aid is limited to
$1,500 and you need to apply when it’s taking applications. “Effective
01/18/2017, we are unable to process applications that are pending or
accept new or renewal applications at this time. Should additional funding
for Chronic Pain Fund applicants become available in the future, it will
be necessary to re-apply if assistance is still needed.” The Patient
Advocate Foundation’s multiple-sclerosis and renal-cell-carcinoma funds
have been closed to new applicants since 2016. It helps to have a more
popular disease: Everyone I interviewed told me it was a lot easier to
find funds to assist sufferers of, say, breast cancer, than it was an
unusual malignant tumor. “The rarer the cancer, the less likely there will
be funding for that cancer,” said William Goeren of CancerCare.
For patients, this can seem like an elaborate, never-ending maze—and there
is no central clearinghouse for the information. The Leukemia & Lymphoma
Society’s Co-Pay Assistance Program will cover blood transfusions,
chemotherapy, and radiation therapy, among other things, but not
diagnostic procedures like surgery or lab work. United Way offerings vary
by locality. Still others, like the Pendergast Fund, are targeted to small
populations and can fly under the raadar. The hospital where Cassidy
McCarthy received her treatments, for example, did not inform the family
about the Heather Pendergast Fund, but the organization’s work is well
known in Long Island’s firefighting community. “The chief of the fire
department came to me and goes, ‘Well, there’s this Pendergast Fund so any
bills you have, just give them to me,’” McCarthy recalled.
And even when medical supplicants find programs, they are not guaranteed
aid even if they meet all the eligibility requirements. Amanda Collins,
36, is a Bartlesville, Oklahoma, resident who found herself financially
scrambling after first her husband and then herself suffered a succession
of medical crises. When the family finally obtained health insurance
through Sooner Care—that’s Medicaid in Oklahoma—they were also given a
list of local charities that could help out those in need. She says she
learned to call any organization, whether they were offering aid with
medical expenses or electric bills, mighty quick. “Then you call these
services, not just for medical help, but any help. They tell you, ‘Oh, you
have to hit us on this date,’ or ‘We get funding every month, but our
funding is gone by the fifth of the month.’”
But for many who do receive monetary aid in the face of a medically
induced financial crisis, it helps them, but it doesn’t make their money
woes go away. The American Kidney Fund, yet another patient-advocacy fund,
put me in touch with Lori Noyes, a 55-year-old nurse living in Upland,
California, with her two cocker spaniels, Kirby and Tucker. Noyes’
financial life all but collapsed when a donated kidney she received in
childhood failed in early 2014. Her out-of-pocket cost for prescription
co-pays was running about $200 a month. Every medical appointment resulted
in more bills. “Each little doctor would take a swipe at you,” she told
me. Credit-card bills mounted.
Noyes, too, found herself struggling to navigate the charities that could
potentially help. When she suffered vision loss following her kidney
transplant and could no longer drive, it wasn’t anyone at a medical office
who informed her of the Service Center for Independent Life, a Claremont,
California based organization that helps people with disabilities with
everything from transportation to employment assistance. A sympathetic
Uber driver told her about the program. Finally, a financial counselor at
the DaVita kidney-care location where she received dialysis suggested she
reach out to the American Kidney Fund, which offered Noyes help paying her
health-insurance bill and Medicare Part D premium. (All end-stage renal-
failure patients are eligible for Medicare.) “It gave me wiggle room,” she
says.
But that still left Noyes with a lot of bills. Even with the help of the
American Kidney Fund, Noyes claimed about $22,000 in medical expenses on
her taxes in 2014 and $19,000 in 2015, which included everything from
dressing supplies and over-the-counter medications to travel expenses to
and from the transplant center where she ultimately received a donated
kidney. There are few—if any—charitable organizations willing or able to
hand out this amount of assistance.
As for hospital-based charity, it can vary widely. Most studies find for-
profit hospitals provide less charity care than nonprofit medical centers.
But getting aid from a non-profit hospital isn’t exactly a gimme. A paper
published by the Brookings Institution in 2015 pointed out that the non-
profit hospitals with the most funds that could be devoted to charity
care—that is, covering or forgiving medical bills of those who cannot pay
full—are not located in the geographic areas where the need is greatest.
The higher the wealth in a particular region, the more money a hospital is
likely to have for indigent or needy patients. But those patients who need
financial assistance are likely to live in lower-income areas where there
is less in the way of resources. The paper uses two hospitals in
Connecticut’s Fairfield County to make the point. The facility located in
the high-income New York City suburb of Greenwich offers assistance to
people with higher incomes than one located in Norwalk, a less wealthy
town located a mere 15 miles away. But despite the lower ceiling, a much
higher percentage of the Norwalk hospital’s bad-debt cases turned out to
meet the eligibility guidelines for charity care.
Moreover, in the wake of the Affordable Care Act, a number of nonprofit
hospitals actually lowered the eligibility ceiling for charity assistance,
thinking that such a change would encourage more people to sign up for
health insurance. (For example, BJC Healthcare, headquartered in St.
Louis, now only offers aid to people with household incomes of 300 percent
of the federal poverty line, compared to 400 percent previously.) But
because of the increasingly high deductibles, even people who didn’t meet
the threshold for aid under the older, more generous standards are now
experiencing financial grief as a result of medical bills. In an effort to
cut down on uncollectable bills, a number of hospitals are now teaming up
with financial services firms like Commerce Bank to offer time-limited
interest free loans to patients something that, while helpful to some,
most certainly is not charity.
“Our health-care system is shit and it’s trending shittier.”
When I catch up with Savannah Dray—she calls me from her car, on the way
back to her Tallahassee apartment from a chemotherapy session—she begins
rattling off her debt. “I have all kinds of medical bills. I have
pathology bills. I have radiology bills. I have oral surgeon bills because
the disease eroded parts of my teeth and broke them off. Now I have a
regular dental as well as an oral surgeon bill. I have bills from my CT
scans, which I guess would fall under radiology. I have surgery bills.”
Dray, 22, was diagnosed earlier this year with stage-three colon cancer.
How much does she owe overall? She can’t tell me. The bills are coming in
by the day, and have been pretty much since the January day she doubled
over with pain, and went to a nearby emergency room. But it’s definitely
more than $10,000. She met her own $6,250 deductible, and then switched
over to her husband’s plan when she left work as an assistant manager for
a chain store. She now needs to meet that $6,250 deductible too.
A financial counselor at her oncologist’s office told Dray about
CancerCare, as well as programs available from the American Cancer Society
and Stupid Cancer, an advocacy and aid group for young adults fighting
malignancies. But Dray says she was initially so overwhelmed by her
illness and all the bills, she didn’t have the energy to reach out. For
Dray, crowdfunding was a more familiar process, so she went with that.
Only after she raised $4,712 toward a $30,000 goal on a page she set up at
GoFundMe did she send an application in to CancerCare for financial
assistance.
Little wonder, then, that an increasing number of patients turn to
crowdfunding even before they investigate more established charitable
giving programs. While turning to friends and family and holding
fundraisers for medical bills has almost certainly been with us as long as
people have paid for assistance when ill, turning to the Internet to plead
for help with medical expenses is less than ten years old. Yet it has
become all but ubiquitous, seemingly the first thing many people think to
do when confronted by a medical crisis or tragedy. Last year’s Orlando
nightclub shootings inspired numerous crowdsharing efforts for everything
from survivors medical bills to help for families paying funeral expenses.
The same thing happened this year, when two men were killed and another
injured by a man shouting anti-Muslim sentiments at a woman wearing a
hijab in Portland, Maine.
Recommending patients experiencing trouble with their bills give
crowdfunding a try has turned into all but a personal-finance trope. “Do
you need money for unexpected medical and long-term-care expenses, funeral
costs, or a local charitable endeavor? Maybe it’s time to turn to one of
the growing number of personal ‘crowdfunding’ sites and ask the public for
small donations,” chirped Kiplinger’s last fall. Newspaper articles about
successful campaigns are a staple of what remains of the local press and
heartwarming articles about the practice abound.
The truth is more than a bit darker. A few years ago, Ethan Austin, the
co-founder of Give Forward (which recently merged with YouCaring, another
crowdfunding site), one of the first sites to realize that crowdfunding
could be as useful for people facing medical bills as those seeking to
fund an independent film or fund a business venture, spoke to a group of
students at New York University’s Stern School of Business about his site.
He was blunt about one of the reasons he believed this segment of the
online fundraising world had taken off so dramatically. “Our health-care
system is shit and it’s trending shittier,” he told the group. Last year,
Nerdwallet broke down the numbers and discovered that just under 50
percent of the money raised by GoFundMe campaigns is somehow related to
healthcare. There’s likely a measure of nowhere-else-to-turn desperation
involved: A study published earlier this year by Lauren Berliner and Nora
Kenworthy, both on faculty at the University of Washington, found that
residents of states that didn’t take advantage of the Affordable Care Act
to offer more residents access to Medicaid were over-represented on
crowdfunding sites.
Yet for all the attention paid to crowdfunding, the limited evidence we
have shows that for most people, the hype is better than the actual
results. A 2015 analysis by Nerdwallet found only 11 percent of healthcare
fundraisers on Fundrazr, GiveForward, GoFundMe, Plumfund, and Red Basket
met the organizer’s financial target. Berliner and Kenworthy, who studied
a random selection of 200 campaigns on GoFundMe, they found a very similar
result. Nine in 10 were never funded in full.
According to Berliner and Kenworthy, most campaigns don’t go viral.
Instead, they stay among the ill person’s existing social networks. “There
seems to be some allure about what campaigns can do that exceeds what we
are seeing they can do,” says Berliner. “It’s probably unlikely that you
have some billionaires in your mix who are just looking to swoop in,” adds
Kenworthy.
In the healthcare community, some experts are increasingly down on the
concept. “We don’t recommend it routinely,” says Anne Bailey, a vice
president for patient support at DaVita, the chain of dialysis centers
where Noyes received treatment. In her view, crowdfunding works best for a
one-time emergency, not a medical issue that will potentially go on for
years. “That’s just not an acceptable solution for a long-term chronic
medical issue.” For the 5 percent of people with the largest medical
bills, crowdfunding is unlikely to come through, or least to come through
in a way that solves the financial problem in the long term.
Nonetheless, it’s also true that every little bit helps. If Dray’s
campaign hasn’t met her hoped-for expectations, it’s far from useless.
She’s already been able to use some of the money to pay for oral surgery,
not to mention to make a co-payment for a cardiologist. If not for the
GoFundMe and an account on Instagram where she sells her art, she tells
me, she’s not sure she could handle her medical bills, keep a roof over
her head, and food in the kitchen.
***
I spoke with numerous people for this piece who told me that at some
point, after all the fundraising, and asking for aid for organizations,
and cleaning out of retirement and savings accounts, they simply put all
their remaining bills on a credit card, and hoped for the best. They
simply couldn’t take the constant barrage of mail from numerous separate
medical providers and facilities.
For many, the financial turmoil caused by their illness already adds to
the emotional and physical turmoil they are already experiencing. “Many
people call us, and I am speaking anecdotally and they are angry. They say
I’ve been working my whole life, I’ve paid my taxes, I’ve been diligent,
but now I’m being slammed, I have to ask for charity ... There’s shame and
anger in that,” says Richard Dickens, CancerCare’s director of client
advocacy.
But there is more than simple embarrassment arguing against this system.
It’s the equivalent of taping a few bandages over a gaping wound and
hoping for the best. The cost of medical care is so high, and the personal
finances of many Americans so tight, it’s all but impossible for any
organization—or all of them—to keep up, and that’s whether or not the
charitable contributions they accept are part of the problem or the
solution. And this is now. Should Republicans succeed in their effort to
repeal the Affordable Care Act, an estimated 23 million people would lose
health-insurance coverage over the next decade. That would almost
certainly put even more pressure on the charitable resources available to
help those in need pay for medical care.
Yet illness exists in the here and now. People need the money, so we open
our wallets and we give what we can, feeling a little good about doing our
part. And it does help some: As CancerCare’s Patricia Goldsmith puts it,
“I can tell you that that amount of money often makes the difference
between people being able to get their treatment, and not get their
treatment.”
As for Cassidy McCarthy, she received what the family hopes was her last
dose of chemotherapy on May 22. Both she and a brother will be attending a
summer camp for children with cancer and their siblings that’s offered
free of charge. Daniel McCarthy has a new job, and no longer needs
assistance with his insurance premium. When a recent $45 blood-work lab
bill recently arrived, the family didn’t forward it to Pendergast. They
paid it themselves. “Some other people might need the money,” McCarthy
said. If the family is lucky, they’re heading toward the best approach to
avoiding big medical bills in the future: good health.
--
Donald J. Trump, 304 electoral votes to 227, defeated compulsive liar in
denial Hillary Rodham Clinton on December 19th, 2016. The clown car
parade of the democrat party has run out of gas.
Congratulations President Trump. Thank you for ending the disaster of the
Obama presidency.
Under Barack Obama's leadership, the United States of America became the
The World According To Garp.
ObamaCare is a total 100% failure and no lie that can be put forth by its
supporters can dispute that.
Obama jobs, the result of ObamaCare. 12-15 working hours a week at minimum
wage, no benefits and the primary revenue stream for ObamaCare. It can't
be funded with money people don't have, yet liberals lie about how great
it is.
Obama increased total debt from $10 trillion to $20 trillion in the eight
years he was in office, and sold out heterosexuals for Hollywood queer
liberal democrat donors.
bills/530679/?google_editors_picks=true
A chance trip to Long Island’s Adventureland amusement park just might
have saved Cassidy McCarthy’s life. After Cassidy—whose family calls her
Cassie—then 4, complained about pain and nausea following a ride on the
Ladybug rollercoaster, her dad, Daniel, a registered nurse, felt her
stomach and discovered a small bump. A CT scan ordered up at a local
hospital’s emergency room revealed a kidney tumor.
It was another seemingly chance decision by Daniel McCarthy to sign on as
a volunteer firefighter more than a decade ago that saved the family’s
finances in the wake of Cassidy’s diagnosis with cancer. As it turned out,
that activity allowed him to ask The Heather Pendergast Fund, a foundation
set up in 2009 to help out the families of Long Island’s volunteer
firefighters and EMS workers with their children’s medical expenses, to
pay many of Cassidy’s medical bills.
McCarthy says the charitable foundation was a financial lifeline. Cassidy
quickly racked up more than several thousand dollars in out-of-pocket
medical expenses—for the surgeon, the anesthesiologist, radiologists,
chemotherapy, you name it—since the family’s insurance policy had a $6,000
deductible. A few months later, Pendergast came through again when
McCarthy lost his job at a local nursing home and rehabilitative center
and the family suddenly had to find money for COBRA payments, which, at
$2,100 a month, were more than the monthly mortgage payment on their West
Babylon, Long Island, home.
“I don’t know how people who don’t have resources do this. I don’t. Many
people work three, four jobs, and can’t afford the time to volunteer in an
organization like the fire department that would be able to help them.
There are many people living out there that need help that can’t find it,”
McCarthy says.
The current debate over the future of the Affordable Care Act is obscuring
a more pedestrian reality. Just because a person is insured, it doesn’t
mean he or she can actually afford their doctor, hospital, pharmaceutical,
and other medical bills. The point of insurance is to protect patients’
finances from the costs of everything from hospitalizations to
prescription drugs, but out-of-pocket spending for people even with
employer-provided health insurance has increased by more than 50 percent
since 2010, according to human resources consultant Aon Hewitt. The Kaiser
Family Foundation reports that in 2016, half of all insurance policy-
holders faced a deductible, the amount people need to pay on their own
before their insurance kicks in, of at least $1,000. For people who buy
their insurance via one of the Affordable Care Act’s exchanges, that
figure will be higher still: Almost 90 percent have deductibles of $1,300
for an individual or $2,600 for a family.
Even a gold-plated insurance plan with a low deductible and generous
reimbursements often has its holes. Many people have separate—and often
hard-to-understand—in-network and out-of-network deductibles, or lack out-
of-network coverage altogether. Expensive pharmaceuticals are
increasingly likely to require a significantly higher co-pay or not be
covered at all. While many plans cap out-of-pocket spending, that cap can
often be quite high—in 2017, it’s $14,300 for a family plan purchased on
the ACA exchanges, for example. Depending on the plan, medical care
received from a provider not participating in a particular insurer’s
network might not count toward any deductible or cap at all.
At the same time, the most recent Report on the Economic Well-Being of
U.S. Households, an annual survey conducted by the Federal Reserve Board,
found that 44 percent of adult Americans claim they could not come up with
$400 in an emergency without turning to credit cards, family and friends,
or selling off possessions. When this reality combines with healthcare
bills, the consequences can be financially devastating. A 2015 poll by
the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of
Public Health discovered that 26 percent of those who took part in the
survey claimed medical bills caused severe damage to their household’s
bottom line. A poll conducted earlier this year by Amino, a healthcare-
transparency company, with Ipsos Public Affairs, found that 55 percent of
those they surveyed claimed they had at least once received a medical bill
they could not afford. No surprise, then, that the Consumer Financial
Protection Bureau reported earlier this year that medical debt was the
most common reason for someone to be contacted by a debt collector.
This spending is most pressing for households with the highest medical
bills, the 5 percent of Americans who make up 50 percent of the country’s
healthcare costs. Medicare, Medicaid, and private insurers will spend
$40,375 on average per patient for someone in this group. Their out-of-
pocket spending will be much less: on average, $2,582.90. This isn’t, in
the scale of things, a lot of money—but given Americans’ straightened
personal finances, it’s more than many can easily access.
This isn’t, it’s important to point out, a static group. A chronic illness
can land someone in this category but, given the increasing prevalence of
high-deductible plans, so can something as simple as a broken bone or an
emergency appendectomy. Although some people will be in this group year
after year, many will cycle in and out, and nearly everyone will be in it
for some brief period. The fact is that nearly any illness or injury can
lead to unexpected bills, and few are able to absorb those shocks without
difficulty. Yet, despite the commonness of such problems, there is little
in the way of a system for helping people out through these times.
“Do I pay the doctor bill because I’m getting collection notices? But I
gotta pay my mortgage, I gotta pay my electric bill, I’ve gotta pay the
rent.”
Some of these people will declare bankruptcy. How many is the subject of
controversy. A famous study—co-authored by Elizabeth Warren—found that
suffering from a medical misfortune was the most common reason for
ultimately leading someone to petition the courts for relief from their
financial obligations, but another study pointed to unnecessary spending
prior to the medical crisis.
As it turns out, determining what counts as a medical expense is
difficult. It’s not simply doctor bills. In addition to the not-covered
deductibles, there is transportation to and from medical appointments,
parking fees at many hospitals, and often childcare expenses while parents
are in treatment or at appointments. Time for cooking will be limited, so
take-out bills can pile up, too.
And families that experience an illness are often hit by a double
whammy—they lose income at the same time their financial needs grow, often
cutting back on work hours or leaving work altogether, either voluntarily
or not. McCarthy, for one, recently filed a lawsuit against his former
employer, Daleview Care Center in Farmingdale, Long Island, claiming he
was let go because of the amount of work he missed as result of his
daughter’s illness, a violation of several laws including the Family
Medical and Leave Act. In legal filings, Daleview denied McCarthy’s
allegations, but the company did not return requests for comment.
“The families get to the point where it’s, ‘What do I do? Do I pay the
doctor bill because I’m getting collection notices? But I gotta pay my
mortgage, I gotta pay my electric bill, I’ve gotta pay the rent.’ That’s
where we come in,” Tom Pendergast of the Heather Pendergast Fund told me.
“They can pay their mortgage, their rent, their electric bills and not
have to worry about the medical part of it.”
For many, the idea of charity to help those in need out—which is, after
all, what saved the McCarthy family from financial disaster—holds much in
the way of appeal, speaking to both a sense of generosity and a can-do
spirit. It somehow seems, well, American, to think individual donations
can compensate for a broken, expensive system that views illness as a
moneymaking opportunity. So there is crowdfunding, small foundations like
the Pendergast Fund, hospital-charity programs for the needy, and disease-
specific resources. These efforts are patchy, and often inadequate, but
they’re what’s available. Their strengths and their failings reveal a lot
about the broader American healthcare system—something that is all too
easy to ignore till it is your life or the life of a loved one at stake.
***
CancerCare was founded in 1944 as a bereavement-support organization, but
quickly began helping people with the disease manage their financial
issues as well. “The first hospital bill we paid, in 1944, was to Memorial
Sloan Kettering for $13 and change,” said Patricia Goldsmith, the
organization’s chief executive officer. Today, finances are why between 60
and 70 percent of those who contact the organization reach out, and the
dilemmas are the same as those people who turn to The Heather Pendergast
Fund face. “For the most part, people call us because they are in some
kind of financial crisis,” says William Goeren, CancerCare’s director of
clinical programs. “The prices have increased ... so that really puts the
burden on the patient, who is weighing, ‘Do I pay for my mortgage or
should I pay for my diagnostic test?’ These are the calls we are getting.”
CancerCare attempts to head off these sorts of financial issues, while
still offering emotional support to people in need. They offer a
bereavement camp—located in Pennsylvania’s Poconos—and counseling groups
for cancer sufferers and their children alike. They also distribute more
than $4 million in transportation, home-care, and childcare assistance.
“If for some reason we got $500 million tomorrow to support co-pay
assistance, we could distribute that money likely within two months.”
But the heart of CancerCare’s aid is distributed through their disease-
specific prescription co-pay funds, which award anywhere between $4,000
and $15,000 per patient to income-eligible patients. (“Income eligible”
varies based on the fund, but is generally anywhere between 250 and 500
percent of the federal poverty line.) Last year, the organization
distributed slightly more than $14.2 million in total.
Such funds are not without controversy. The cost of treating cancer, a
disease that will be newly diagnosed in just under 1.7 million Americans
in 2017, is skyrocketing. According to research published in the Journal
of Oncology Practice, the average cost of a year of a cancer treatment
drug in 2000 was less than $10,000 in total. By 2005, that had more than
tripled to between $30,000 to $50,000 annually. In 2012, 12 out of the 13
drugs newly approved for cancer cost more than $100,000. Another study,
this one published in JAMA Oncology, found the price of one month of an
oral-cancer medication increased from $1,869 in 2000 to $11,325 in 2014.
As insurance companies, desperate to clamp down on their own expenses, cut
reimbursements for the more expensive drugs, and employers, hoping to cut
their own costs, push employees into high-deductible health-insurance
plans, more of this cost ends up being picked up by the patients.
A paper published by the journal Health Affairs in 2013 found cancer
patients are more than twice as likely as their peers without the disease
to declare bankruptcy. The consequences of this expense goes beyond the
patient’s checkbook: Last year researchers writing for the Journal of
Clinical Oncology found that cancer patients who declared bankruptcy were
significantly more likely to die than those who did not need to ask the
courts to discharge their debts. The reasons for the increased mortality
are unclear: It’s possible people with shaky finances are less likely to
receive adequate treatment, but it’s also possible stress is a
contributor.
Many believe the 2003 passage of Medicare Part D, which established
coverage for pharmaceutical costs, is partially responsible for the price
surge. The same legislation allowed for non-profit patient-advocacy groups
to establish co-pay funds that could be funded by the pharmaceutical
industry. (The CancerCare Co-Payment Foundation was established in 2007,
for example.) These co-pay funds are meant by the organizations offering
them to help people, but critics maintain the pharmaceutical-company
contributions to organizations like CancerCare and others like it should
be viewed less as charity and more as cover for the ever-increasing cost
of their medications, since these donations allow pharmaceutical companies
to stick insurance companies and government programs like Medicare with an
ever-greater bill, while helping the consumers cover their share of the
tab. “Co-pay programs are meant to mitigate criticism of high drug prices,
deflect legislation on drug pricing, get around payer restrictions and get
patients on expensive drugs they will stay on for a long time,” says
Adriane Fugh-Berman, an associate professor at Georgetown University
Medical Center and an expert on physician-industry relationships.
The amount of money is also not enough. The phrase “drop in a bucket”
barely does it justice. When CancerCare opened a $1.6 million fund for the
co-payment of multiple myeloma medications this past April, it was
exhausted within two days, Goldsmith told me. “I guarantee you tomorrow if
for some reason we got $500 million tomorrow to support co-pay assistance,
we could distribute that money likely within two months,” she said. But it
is, she points out, better than not distributing the money at all. “I can
tell you that that amount of money often makes the difference between
people being able to get their treatment and not get their treatment.”
This is hardly unique to CancerCare. Alan Balch, the chief executive
officer of the Patient Advocate Foundation, which provides both case-
management services and administers co-pay funds for a range of diseases
and distributed more than $50 million in assistance in the fiscal year
that ended in June of 2016, tells me that while some co-pay funds remain
open for a considerable period of time, others open and close quickly.
“There’s only so much money that is available at any one time and there’s
so much demand for it,” he says.
The evidence is clear when you visit the websites of the funds. The
Patient Advocate Foundation’s chronic pain fund? Its aid is limited to
$1,500 and you need to apply when it’s taking applications. “Effective
01/18/2017, we are unable to process applications that are pending or
accept new or renewal applications at this time. Should additional funding
for Chronic Pain Fund applicants become available in the future, it will
be necessary to re-apply if assistance is still needed.” The Patient
Advocate Foundation’s multiple-sclerosis and renal-cell-carcinoma funds
have been closed to new applicants since 2016. It helps to have a more
popular disease: Everyone I interviewed told me it was a lot easier to
find funds to assist sufferers of, say, breast cancer, than it was an
unusual malignant tumor. “The rarer the cancer, the less likely there will
be funding for that cancer,” said William Goeren of CancerCare.
For patients, this can seem like an elaborate, never-ending maze—and there
is no central clearinghouse for the information. The Leukemia & Lymphoma
Society’s Co-Pay Assistance Program will cover blood transfusions,
chemotherapy, and radiation therapy, among other things, but not
diagnostic procedures like surgery or lab work. United Way offerings vary
by locality. Still others, like the Pendergast Fund, are targeted to small
populations and can fly under the raadar. The hospital where Cassidy
McCarthy received her treatments, for example, did not inform the family
about the Heather Pendergast Fund, but the organization’s work is well
known in Long Island’s firefighting community. “The chief of the fire
department came to me and goes, ‘Well, there’s this Pendergast Fund so any
bills you have, just give them to me,’” McCarthy recalled.
And even when medical supplicants find programs, they are not guaranteed
aid even if they meet all the eligibility requirements. Amanda Collins,
36, is a Bartlesville, Oklahoma, resident who found herself financially
scrambling after first her husband and then herself suffered a succession
of medical crises. When the family finally obtained health insurance
through Sooner Care—that’s Medicaid in Oklahoma—they were also given a
list of local charities that could help out those in need. She says she
learned to call any organization, whether they were offering aid with
medical expenses or electric bills, mighty quick. “Then you call these
services, not just for medical help, but any help. They tell you, ‘Oh, you
have to hit us on this date,’ or ‘We get funding every month, but our
funding is gone by the fifth of the month.’”
But for many who do receive monetary aid in the face of a medically
induced financial crisis, it helps them, but it doesn’t make their money
woes go away. The American Kidney Fund, yet another patient-advocacy fund,
put me in touch with Lori Noyes, a 55-year-old nurse living in Upland,
California, with her two cocker spaniels, Kirby and Tucker. Noyes’
financial life all but collapsed when a donated kidney she received in
childhood failed in early 2014. Her out-of-pocket cost for prescription
co-pays was running about $200 a month. Every medical appointment resulted
in more bills. “Each little doctor would take a swipe at you,” she told
me. Credit-card bills mounted.
Noyes, too, found herself struggling to navigate the charities that could
potentially help. When she suffered vision loss following her kidney
transplant and could no longer drive, it wasn’t anyone at a medical office
who informed her of the Service Center for Independent Life, a Claremont,
California based organization that helps people with disabilities with
everything from transportation to employment assistance. A sympathetic
Uber driver told her about the program. Finally, a financial counselor at
the DaVita kidney-care location where she received dialysis suggested she
reach out to the American Kidney Fund, which offered Noyes help paying her
health-insurance bill and Medicare Part D premium. (All end-stage renal-
failure patients are eligible for Medicare.) “It gave me wiggle room,” she
says.
But that still left Noyes with a lot of bills. Even with the help of the
American Kidney Fund, Noyes claimed about $22,000 in medical expenses on
her taxes in 2014 and $19,000 in 2015, which included everything from
dressing supplies and over-the-counter medications to travel expenses to
and from the transplant center where she ultimately received a donated
kidney. There are few—if any—charitable organizations willing or able to
hand out this amount of assistance.
As for hospital-based charity, it can vary widely. Most studies find for-
profit hospitals provide less charity care than nonprofit medical centers.
But getting aid from a non-profit hospital isn’t exactly a gimme. A paper
published by the Brookings Institution in 2015 pointed out that the non-
profit hospitals with the most funds that could be devoted to charity
care—that is, covering or forgiving medical bills of those who cannot pay
full—are not located in the geographic areas where the need is greatest.
The higher the wealth in a particular region, the more money a hospital is
likely to have for indigent or needy patients. But those patients who need
financial assistance are likely to live in lower-income areas where there
is less in the way of resources. The paper uses two hospitals in
Connecticut’s Fairfield County to make the point. The facility located in
the high-income New York City suburb of Greenwich offers assistance to
people with higher incomes than one located in Norwalk, a less wealthy
town located a mere 15 miles away. But despite the lower ceiling, a much
higher percentage of the Norwalk hospital’s bad-debt cases turned out to
meet the eligibility guidelines for charity care.
Moreover, in the wake of the Affordable Care Act, a number of nonprofit
hospitals actually lowered the eligibility ceiling for charity assistance,
thinking that such a change would encourage more people to sign up for
health insurance. (For example, BJC Healthcare, headquartered in St.
Louis, now only offers aid to people with household incomes of 300 percent
of the federal poverty line, compared to 400 percent previously.) But
because of the increasingly high deductibles, even people who didn’t meet
the threshold for aid under the older, more generous standards are now
experiencing financial grief as a result of medical bills. In an effort to
cut down on uncollectable bills, a number of hospitals are now teaming up
with financial services firms like Commerce Bank to offer time-limited
interest free loans to patients something that, while helpful to some,
most certainly is not charity.
“Our health-care system is shit and it’s trending shittier.”
When I catch up with Savannah Dray—she calls me from her car, on the way
back to her Tallahassee apartment from a chemotherapy session—she begins
rattling off her debt. “I have all kinds of medical bills. I have
pathology bills. I have radiology bills. I have oral surgeon bills because
the disease eroded parts of my teeth and broke them off. Now I have a
regular dental as well as an oral surgeon bill. I have bills from my CT
scans, which I guess would fall under radiology. I have surgery bills.”
Dray, 22, was diagnosed earlier this year with stage-three colon cancer.
How much does she owe overall? She can’t tell me. The bills are coming in
by the day, and have been pretty much since the January day she doubled
over with pain, and went to a nearby emergency room. But it’s definitely
more than $10,000. She met her own $6,250 deductible, and then switched
over to her husband’s plan when she left work as an assistant manager for
a chain store. She now needs to meet that $6,250 deductible too.
A financial counselor at her oncologist’s office told Dray about
CancerCare, as well as programs available from the American Cancer Society
and Stupid Cancer, an advocacy and aid group for young adults fighting
malignancies. But Dray says she was initially so overwhelmed by her
illness and all the bills, she didn’t have the energy to reach out. For
Dray, crowdfunding was a more familiar process, so she went with that.
Only after she raised $4,712 toward a $30,000 goal on a page she set up at
GoFundMe did she send an application in to CancerCare for financial
assistance.
Little wonder, then, that an increasing number of patients turn to
crowdfunding even before they investigate more established charitable
giving programs. While turning to friends and family and holding
fundraisers for medical bills has almost certainly been with us as long as
people have paid for assistance when ill, turning to the Internet to plead
for help with medical expenses is less than ten years old. Yet it has
become all but ubiquitous, seemingly the first thing many people think to
do when confronted by a medical crisis or tragedy. Last year’s Orlando
nightclub shootings inspired numerous crowdsharing efforts for everything
from survivors medical bills to help for families paying funeral expenses.
The same thing happened this year, when two men were killed and another
injured by a man shouting anti-Muslim sentiments at a woman wearing a
hijab in Portland, Maine.
Recommending patients experiencing trouble with their bills give
crowdfunding a try has turned into all but a personal-finance trope. “Do
you need money for unexpected medical and long-term-care expenses, funeral
costs, or a local charitable endeavor? Maybe it’s time to turn to one of
the growing number of personal ‘crowdfunding’ sites and ask the public for
small donations,” chirped Kiplinger’s last fall. Newspaper articles about
successful campaigns are a staple of what remains of the local press and
heartwarming articles about the practice abound.
The truth is more than a bit darker. A few years ago, Ethan Austin, the
co-founder of Give Forward (which recently merged with YouCaring, another
crowdfunding site), one of the first sites to realize that crowdfunding
could be as useful for people facing medical bills as those seeking to
fund an independent film or fund a business venture, spoke to a group of
students at New York University’s Stern School of Business about his site.
He was blunt about one of the reasons he believed this segment of the
online fundraising world had taken off so dramatically. “Our health-care
system is shit and it’s trending shittier,” he told the group. Last year,
Nerdwallet broke down the numbers and discovered that just under 50
percent of the money raised by GoFundMe campaigns is somehow related to
healthcare. There’s likely a measure of nowhere-else-to-turn desperation
involved: A study published earlier this year by Lauren Berliner and Nora
Kenworthy, both on faculty at the University of Washington, found that
residents of states that didn’t take advantage of the Affordable Care Act
to offer more residents access to Medicaid were over-represented on
crowdfunding sites.
Yet for all the attention paid to crowdfunding, the limited evidence we
have shows that for most people, the hype is better than the actual
results. A 2015 analysis by Nerdwallet found only 11 percent of healthcare
fundraisers on Fundrazr, GiveForward, GoFundMe, Plumfund, and Red Basket
met the organizer’s financial target. Berliner and Kenworthy, who studied
a random selection of 200 campaigns on GoFundMe, they found a very similar
result. Nine in 10 were never funded in full.
According to Berliner and Kenworthy, most campaigns don’t go viral.
Instead, they stay among the ill person’s existing social networks. “There
seems to be some allure about what campaigns can do that exceeds what we
are seeing they can do,” says Berliner. “It’s probably unlikely that you
have some billionaires in your mix who are just looking to swoop in,” adds
Kenworthy.
In the healthcare community, some experts are increasingly down on the
concept. “We don’t recommend it routinely,” says Anne Bailey, a vice
president for patient support at DaVita, the chain of dialysis centers
where Noyes received treatment. In her view, crowdfunding works best for a
one-time emergency, not a medical issue that will potentially go on for
years. “That’s just not an acceptable solution for a long-term chronic
medical issue.” For the 5 percent of people with the largest medical
bills, crowdfunding is unlikely to come through, or least to come through
in a way that solves the financial problem in the long term.
Nonetheless, it’s also true that every little bit helps. If Dray’s
campaign hasn’t met her hoped-for expectations, it’s far from useless.
She’s already been able to use some of the money to pay for oral surgery,
not to mention to make a co-payment for a cardiologist. If not for the
GoFundMe and an account on Instagram where she sells her art, she tells
me, she’s not sure she could handle her medical bills, keep a roof over
her head, and food in the kitchen.
***
I spoke with numerous people for this piece who told me that at some
point, after all the fundraising, and asking for aid for organizations,
and cleaning out of retirement and savings accounts, they simply put all
their remaining bills on a credit card, and hoped for the best. They
simply couldn’t take the constant barrage of mail from numerous separate
medical providers and facilities.
For many, the financial turmoil caused by their illness already adds to
the emotional and physical turmoil they are already experiencing. “Many
people call us, and I am speaking anecdotally and they are angry. They say
I’ve been working my whole life, I’ve paid my taxes, I’ve been diligent,
but now I’m being slammed, I have to ask for charity ... There’s shame and
anger in that,” says Richard Dickens, CancerCare’s director of client
advocacy.
But there is more than simple embarrassment arguing against this system.
It’s the equivalent of taping a few bandages over a gaping wound and
hoping for the best. The cost of medical care is so high, and the personal
finances of many Americans so tight, it’s all but impossible for any
organization—or all of them—to keep up, and that’s whether or not the
charitable contributions they accept are part of the problem or the
solution. And this is now. Should Republicans succeed in their effort to
repeal the Affordable Care Act, an estimated 23 million people would lose
health-insurance coverage over the next decade. That would almost
certainly put even more pressure on the charitable resources available to
help those in need pay for medical care.
Yet illness exists in the here and now. People need the money, so we open
our wallets and we give what we can, feeling a little good about doing our
part. And it does help some: As CancerCare’s Patricia Goldsmith puts it,
“I can tell you that that amount of money often makes the difference
between people being able to get their treatment, and not get their
treatment.”
As for Cassidy McCarthy, she received what the family hopes was her last
dose of chemotherapy on May 22. Both she and a brother will be attending a
summer camp for children with cancer and their siblings that’s offered
free of charge. Daniel McCarthy has a new job, and no longer needs
assistance with his insurance premium. When a recent $45 blood-work lab
bill recently arrived, the family didn’t forward it to Pendergast. They
paid it themselves. “Some other people might need the money,” McCarthy
said. If the family is lucky, they’re heading toward the best approach to
avoiding big medical bills in the future: good health.
--
Donald J. Trump, 304 electoral votes to 227, defeated compulsive liar in
denial Hillary Rodham Clinton on December 19th, 2016. The clown car
parade of the democrat party has run out of gas.
Congratulations President Trump. Thank you for ending the disaster of the
Obama presidency.
Under Barack Obama's leadership, the United States of America became the
The World According To Garp.
ObamaCare is a total 100% failure and no lie that can be put forth by its
supporters can dispute that.
Obama jobs, the result of ObamaCare. 12-15 working hours a week at minimum
wage, no benefits and the primary revenue stream for ObamaCare. It can't
be funded with money people don't have, yet liberals lie about how great
it is.
Obama increased total debt from $10 trillion to $20 trillion in the eight
years he was in office, and sold out heterosexuals for Hollywood queer
liberal democrat donors.
⊙＿⊙
Jun 19, 2017, 2:41:45 PM6/19/17
to
Fact Check Medical
Do Breatharians Survive Without Food or Water?
Claims about "breatharians" resurfaced in June 2017, but once again people purportedly living on light alone did not offer proof that they survive this way.
CLAIM
A Californian and Ecuadorian couple proved it is possible to live on nothing but air.
RATING
FALSE
ORIGIN
In mid-June 2017, tabloids and similar sources published articles about a couple that purports to survive by eating little to no food. Akahi Ricardo and Camila Castello, the articles said, call themselves “breatharians,” and say they survive on “the universe’s energy,” along with pieces of fruit and vegetable broth eaten 2-3 times per week.
This is not the first time that people have made this claim. A Wikipedia page for the practice perhaps best sums it up in noting that “[t]hough it is common knowledge that biological entities require sustenance to survive, breatharianism continues.” Notably, The Sun and many regurgitators of the piece repeated claims purportedly made by Ricardo and Castello without checking them against very basic science understood across humanity:
Camila and Akahi – who have a five-year-old son and two-year-old daughter together – have survived on little else besides a piece of fruit or vegetable broth just 3 times per week since 2008.
And Camila even practised a Breatharian PREGNANCY – not eating anything during the entire nine months that she carried her first child.
The married couple-of-nine-years claim that their “food-free lifestyle” has improved their health and emotional well-being as well as meaning they can spend money on travelling rather than the weekly shop … Camila explained: “I was completely open to changing my food-free lifestyle when I first became pregnant because my child came first. But I just never felt hungry so I ended up practicing a fully Breatharian pregnancy.
“I didn’t feel the need or desire to eat solid food during the entire nine months and so I only ate 5 times, all of which were in social situations.
Throughout the profile (which was republished across the web with no additional fact checking), the couple alternately claimed to eat occasionally and to describe themselves as “food free.” Whether the couple claimed to eat very little or nothing at all, no apparent verification of their claims was made before pushing the dangerous suggestion one could live without food or water out to large audiences.
Predictably, the practice has indeed proved fatal. Victims in Scotland, Australia, and Switzerland were among individuals who died in an attempt to survive without food or water. A 1999 Guardian article about the deaths quoted an expert on survival medicine:
Experts differ as to the absolute maximum length of time that human life can continue without water, but the broad consensus rests at somewhere between seven and 10 days – though severe dehydration and confusion (due to the build-up of sodium and potassium in the brain) would set in sooner. In the desert, of course, lack of water can kill in a matter of hours.
“It depends on the climate, and how much exercise you’re taking, but if you’re lying in bed you would probably be just about all right for a week,” says Dr Charles Clarke, who specialises in high-altitude survival medicine and has accompanied the climber Chris Bonington on expeditions to Mount Everest. “But towards the end of the first week, you’d become pretty gravely ill. Your blood would become thicker, your kidneys can’t cope; multiple organ failure follows, you get hypothermic and eventually you die.”
Moreover, the couple profiled by The Sun weren’t the first “breatharians” to admit to or be caught eating food while claiming not to eat or drink. Jasmuheen, an ex-business woman and founder of the movement has never proved she doesn’t eat, demonstrates signs of eating, and nutritional experts believe the claim may be a delusion shared among individuals who underestimate their “occasional” eating:
Jasmuheen freely admits to drinking orange juice regularly and occasionally nibbling chocolate biscuits for a “taste sensation”. In the past she has described her diet as including tea with honey and soya milk, chocolate, crisps, soup and the odd piece of fruit. Thoeretically, a diet consisting of those foods in small amounts could represent a calorific intake to which the body could adjust without significant weight loss.
Reporters visiting Jasmuheen’s Brisbane home have been bewildered to find her fridge well-stocked with vegetarian food which, she says, belongs to her partner Jeff Ferguson, a convicted fraudster. And a British journalist accompanying Jasmuheen to her check-in desk at Heathrow last December was astonished when the BA clerk asked her to confirm that she’d ordered an in-flight vegetarian meal. “No, no,” she replied. “Well, yes, OK, I did. But I won’t be eating it.”
Although claims of “breatharians” surviving and thriving pop up every few years, we were unable to find any evidence contradicting the body of science demonstrating humans require water and food to stay alive. It’s possible the couple profiled by The Sun in June 2017 both genuinely made and believed their own claims, but we found no proof the impossible assertion was actually true. When tested, purported breatharians such as Jasmuheen failed to last more than a few days without food and water.
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Sources
Filed Under:BreatharianBreatharianismDangerous Woo+1 More
Fact Checker:Kim LaCapria
Featured Image:Shutterstock
Published:Jun 16th, 2017
http://www.snopes.com/breatharians/
Do Breatharians Survive Without Food or Water?
Claims about "breatharians" resurfaced in June 2017, but once again people purportedly living on light alone did not offer proof that they survive this way.
CLAIM
A Californian and Ecuadorian couple proved it is possible to live on nothing but air.
RATING
FALSE
ORIGIN
In mid-June 2017, tabloids and similar sources published articles about a couple that purports to survive by eating little to no food. Akahi Ricardo and Camila Castello, the articles said, call themselves “breatharians,” and say they survive on “the universe’s energy,” along with pieces of fruit and vegetable broth eaten 2-3 times per week.
This is not the first time that people have made this claim. A Wikipedia page for the practice perhaps best sums it up in noting that “[t]hough it is common knowledge that biological entities require sustenance to survive, breatharianism continues.” Notably, The Sun and many regurgitators of the piece repeated claims purportedly made by Ricardo and Castello without checking them against very basic science understood across humanity:
Camila and Akahi – who have a five-year-old son and two-year-old daughter together – have survived on little else besides a piece of fruit or vegetable broth just 3 times per week since 2008.
And Camila even practised a Breatharian PREGNANCY – not eating anything during the entire nine months that she carried her first child.
The married couple-of-nine-years claim that their “food-free lifestyle” has improved their health and emotional well-being as well as meaning they can spend money on travelling rather than the weekly shop … Camila explained: “I was completely open to changing my food-free lifestyle when I first became pregnant because my child came first. But I just never felt hungry so I ended up practicing a fully Breatharian pregnancy.
“I didn’t feel the need or desire to eat solid food during the entire nine months and so I only ate 5 times, all of which were in social situations.
Throughout the profile (which was republished across the web with no additional fact checking), the couple alternately claimed to eat occasionally and to describe themselves as “food free.” Whether the couple claimed to eat very little or nothing at all, no apparent verification of their claims was made before pushing the dangerous suggestion one could live without food or water out to large audiences.
Predictably, the practice has indeed proved fatal. Victims in Scotland, Australia, and Switzerland were among individuals who died in an attempt to survive without food or water. A 1999 Guardian article about the deaths quoted an expert on survival medicine:
Experts differ as to the absolute maximum length of time that human life can continue without water, but the broad consensus rests at somewhere between seven and 10 days – though severe dehydration and confusion (due to the build-up of sodium and potassium in the brain) would set in sooner. In the desert, of course, lack of water can kill in a matter of hours.
“It depends on the climate, and how much exercise you’re taking, but if you’re lying in bed you would probably be just about all right for a week,” says Dr Charles Clarke, who specialises in high-altitude survival medicine and has accompanied the climber Chris Bonington on expeditions to Mount Everest. “But towards the end of the first week, you’d become pretty gravely ill. Your blood would become thicker, your kidneys can’t cope; multiple organ failure follows, you get hypothermic and eventually you die.”
Moreover, the couple profiled by The Sun weren’t the first “breatharians” to admit to or be caught eating food while claiming not to eat or drink. Jasmuheen, an ex-business woman and founder of the movement has never proved she doesn’t eat, demonstrates signs of eating, and nutritional experts believe the claim may be a delusion shared among individuals who underestimate their “occasional” eating:
Jasmuheen freely admits to drinking orange juice regularly and occasionally nibbling chocolate biscuits for a “taste sensation”. In the past she has described her diet as including tea with honey and soya milk, chocolate, crisps, soup and the odd piece of fruit. Thoeretically, a diet consisting of those foods in small amounts could represent a calorific intake to which the body could adjust without significant weight loss.
Reporters visiting Jasmuheen’s Brisbane home have been bewildered to find her fridge well-stocked with vegetarian food which, she says, belongs to her partner Jeff Ferguson, a convicted fraudster. And a British journalist accompanying Jasmuheen to her check-in desk at Heathrow last December was astonished when the BA clerk asked her to confirm that she’d ordered an in-flight vegetarian meal. “No, no,” she replied. “Well, yes, OK, I did. But I won’t be eating it.”
Although claims of “breatharians” surviving and thriving pop up every few years, we were unable to find any evidence contradicting the body of science demonstrating humans require water and food to stay alive. It’s possible the couple profiled by The Sun in June 2017 both genuinely made and believed their own claims, but we found no proof the impossible assertion was actually true. When tested, purported breatharians such as Jasmuheen failed to last more than a few days without food and water.
Feedback
Sources
Filed Under:BreatharianBreatharianismDangerous Woo+1 More
Fact Checker:Kim LaCapria
Featured Image:Shutterstock
Published:Jun 16th, 2017
http://www.snopes.com/breatharians/
⊙＿⊙
Jun 23, 2017, 1:42:56 PM6/23/17
to
A couple claimed they learned to live without food, and news outlets ate it up
By Oliver Darcy June 21, 2017: 5:47 PM ET
The sky is blue. The grass is green. Humans need food and water to survive. Well, unless you believe a story published in several major news outlets over the past week.
Akahi Ricardo and Camila Castillo, a so-called "breatharian" couple, were spotlighted in widely-shared news articles claiming that they are able to survive off "the universe's energy" and refrain from eating, save a piece of fruit or vegetable broth three times a week.
"Humans can easily be without food -- as long as they are connected to the energy that exists in all things and through breathing," Castillo was quoted as saying in one article.
"For three years, Akahi and I didn't eat anything at all and now we only eat occasionally like if we're in a social situation or if I simply want to taste a fruit," she said in another quote. "With my first child, I practiced a breatharian pregnancy. Hunger was a foreign sensation to me, so I fully lived on light and ate nothing."
The claims, which Ricardo told CNN on Tuesday the couple stands by, obviously defy all known science pertaining to the human body. Snopes, a website that fact checks internet rumors, snarked that it was "unable to find any evidence contradicting the body of science demonstrating humans require water and food to stay alive." Other people who have claimed to be breatharians in the past have been found to be eating. Jasmuheen, a woman credited as the founder of the breatharian practice, was once seen by reporters with a fully stocked fridge (she said the food belonged to her partner) and was caught ordering an in-flight meal (she said she wouldn't eat it), according to a profile in The Guardian.
In addition to the health concerns that should have made outlets pause before publishing their story, Ricardo and Castillo also stand to benefit financially from the publicity. The two sell a program that promises for "one payment" it will provide "all the tools you need to become food-free." (In a statement to The New York Post on Wednesday, the couple appeared to walk back some of their earlier statements, saying, "We do eat, just not with the same frequency or intensity as the average person.")
But none of that stopped this story from spreading quickly through the internet, with the couple's claims largely presented as unquestioned fact. Yahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro and a number of other outlets ran stories on the couple's supposed diet. The Independent's story was shared approximately 37,000 times. The Daily Mail's was shared about 24,000 times.
CNN traced the story's genesis to News Dog Media, a UK-based content creation company that packages and sells tabloid-style news stories to media outlets. Matt Growcoot, a representative for the company, told CNN that News Dog Media conducted "two long interviews over Skype" with Ricardo and Castillo, then sold stories to several news outlets. (Upon purchasing the story, the outlets can re-write and edit the article to match their own style, Growcoot said.) Growcoot, who declined to provide the amount the outlets purchased the story for, said his company found the couple through the breatharian school they run.
Asked if News Dog Media fact-checked the couple's claims in any way, Growcoot wrote in an email to CNN, "Short of flying to Ecuador and monitoring what they eat for a few weeks, I feel we did everything in our power to stand up the story. We're a small freelance outfit in the UK and clearly can't afford to fly to South America."
It's not clear which outlets News Dog Media sold its story to, but The Sun, Metro and The Daily Mail all credited photos to the company. The Sun and The Daily Mail are also listed as clients on News Dog Media's website.
Related: 5 Easy Ways To Save $1000
The Sun appeared to be the first major news organization to publish a story about the "breatharian" couple this month. From there it went viral and was aggregated by a number of media outlets. Yahoo7, an Australian outlet affiliated with Yahoo, published a less-than-skeptical story claiming the couple had "hardly eaten in the last NINE years."
"Food - it's a source of comfort for some, a way to socialise for others, but also a way to simply exist," wrote Yahoo7 reporter Allison Yee. "Not for 'Breatharian' couple Akahi Ricardo and Camila Castello who follow a 'food-free lifestyle' and believe they can sustain themselves using energy from the universe."
Yahoo News' Facebook page, which has 7.3 million followers, then shared the Yahoo7 story. Asked by CNN why the company would share an easily-debunked story with its large audience, a company spokesperson declined to comment. Shortly after CNN contacted the spokesperson, however, the Facebook post was deleted from the Yahoo News page. Yahoo's Style and Beauty page, which boasts 2.2 million followers, left a post on the couple up.
Representatives for the The Sun, The Independent, The New York Post, The Daily Mail, and Metro did not respond or declined requests for comment.
After it was contacted by CNN, however, The New York Post published a separate story refuting the couple's claims. Yahoo7 also published a similar story debunking the concept.
"'Breatharian' no-food diet claims are a bunch of hot air, experts say," declared the headline for the New York Post's story.
The New York Post's Monday story quoted Tanya Zuckerbrot, a registered dietitian, characterizing the claims made by Ricardo and Castello -- which the New York Post had amplified by republishing The Sun's story -- as "dangerous." (The New York Post still, however, left The Sun's story on its website.)
Zuckerbrot has a point. While this is far from the first fad to go viral on the Internet, refraining from eating food for long periods of time could obviously have dangerous consequences. On several occasions, The Guardian and others have reported, individuals attempting to follow the breatharian method and teach their bodies to live without food or water have died.
But the stories in the press have nonetheless generated interest in the idea. Ricardo told CNN that since his story "got to the mainstream" he has heard from thousands of people "who have [expressed] interest or are curious about it."
Ricardo said he wouldn't recommend attempting to starve the body of food without the proper "training" but insisted that with the "proper tools and awareness" the practice isn't harmful.
"We all know the air is light. We all know there is energy in nature," he told CNN. "So there's no way this can be dangerous."
Asked to respond to critics from the scientific and medical community who stress the practice is in fact dangerous and that it's not possible to survive without food and water, Ricardo said, "It's not possible when you don't have the state of mind. When your mind doesn't believe it's possible, it won't be possible."
The laws governing the human body, of course, may beg to differ.
June 21
NEW YORK
http://money.cnn.com/2017/06/21/media/breatharian-couple-news-outlets/index.html
By Oliver Darcy June 21, 2017: 5:47 PM ET
The sky is blue. The grass is green. Humans need food and water to survive. Well, unless you believe a story published in several major news outlets over the past week.
Akahi Ricardo and Camila Castillo, a so-called "breatharian" couple, were spotlighted in widely-shared news articles claiming that they are able to survive off "the universe's energy" and refrain from eating, save a piece of fruit or vegetable broth three times a week.
"Humans can easily be without food -- as long as they are connected to the energy that exists in all things and through breathing," Castillo was quoted as saying in one article.
"For three years, Akahi and I didn't eat anything at all and now we only eat occasionally like if we're in a social situation or if I simply want to taste a fruit," she said in another quote. "With my first child, I practiced a breatharian pregnancy. Hunger was a foreign sensation to me, so I fully lived on light and ate nothing."
The claims, which Ricardo told CNN on Tuesday the couple stands by, obviously defy all known science pertaining to the human body. Snopes, a website that fact checks internet rumors, snarked that it was "unable to find any evidence contradicting the body of science demonstrating humans require water and food to stay alive." Other people who have claimed to be breatharians in the past have been found to be eating. Jasmuheen, a woman credited as the founder of the breatharian practice, was once seen by reporters with a fully stocked fridge (she said the food belonged to her partner) and was caught ordering an in-flight meal (she said she wouldn't eat it), according to a profile in The Guardian.
In addition to the health concerns that should have made outlets pause before publishing their story, Ricardo and Castillo also stand to benefit financially from the publicity. The two sell a program that promises for "one payment" it will provide "all the tools you need to become food-free." (In a statement to The New York Post on Wednesday, the couple appeared to walk back some of their earlier statements, saying, "We do eat, just not with the same frequency or intensity as the average person.")
But none of that stopped this story from spreading quickly through the internet, with the couple's claims largely presented as unquestioned fact. Yahoo, The Sun, The New York Post, The Independent, The Daily Mail, Metro and a number of other outlets ran stories on the couple's supposed diet. The Independent's story was shared approximately 37,000 times. The Daily Mail's was shared about 24,000 times.
CNN traced the story's genesis to News Dog Media, a UK-based content creation company that packages and sells tabloid-style news stories to media outlets. Matt Growcoot, a representative for the company, told CNN that News Dog Media conducted "two long interviews over Skype" with Ricardo and Castillo, then sold stories to several news outlets. (Upon purchasing the story, the outlets can re-write and edit the article to match their own style, Growcoot said.) Growcoot, who declined to provide the amount the outlets purchased the story for, said his company found the couple through the breatharian school they run.
Asked if News Dog Media fact-checked the couple's claims in any way, Growcoot wrote in an email to CNN, "Short of flying to Ecuador and monitoring what they eat for a few weeks, I feel we did everything in our power to stand up the story. We're a small freelance outfit in the UK and clearly can't afford to fly to South America."
It's not clear which outlets News Dog Media sold its story to, but The Sun, Metro and The Daily Mail all credited photos to the company. The Sun and The Daily Mail are also listed as clients on News Dog Media's website.
Related: 5 Easy Ways To Save $1000
The Sun appeared to be the first major news organization to publish a story about the "breatharian" couple this month. From there it went viral and was aggregated by a number of media outlets. Yahoo7, an Australian outlet affiliated with Yahoo, published a less-than-skeptical story claiming the couple had "hardly eaten in the last NINE years."
"Food - it's a source of comfort for some, a way to socialise for others, but also a way to simply exist," wrote Yahoo7 reporter Allison Yee. "Not for 'Breatharian' couple Akahi Ricardo and Camila Castello who follow a 'food-free lifestyle' and believe they can sustain themselves using energy from the universe."
Yahoo News' Facebook page, which has 7.3 million followers, then shared the Yahoo7 story. Asked by CNN why the company would share an easily-debunked story with its large audience, a company spokesperson declined to comment. Shortly after CNN contacted the spokesperson, however, the Facebook post was deleted from the Yahoo News page. Yahoo's Style and Beauty page, which boasts 2.2 million followers, left a post on the couple up.
Representatives for the The Sun, The Independent, The New York Post, The Daily Mail, and Metro did not respond or declined requests for comment.
After it was contacted by CNN, however, The New York Post published a separate story refuting the couple's claims. Yahoo7 also published a similar story debunking the concept.
"'Breatharian' no-food diet claims are a bunch of hot air, experts say," declared the headline for the New York Post's story.
The New York Post's Monday story quoted Tanya Zuckerbrot, a registered dietitian, characterizing the claims made by Ricardo and Castello -- which the New York Post had amplified by republishing The Sun's story -- as "dangerous." (The New York Post still, however, left The Sun's story on its website.)
Zuckerbrot has a point. While this is far from the first fad to go viral on the Internet, refraining from eating food for long periods of time could obviously have dangerous consequences. On several occasions, The Guardian and others have reported, individuals attempting to follow the breatharian method and teach their bodies to live without food or water have died.
But the stories in the press have nonetheless generated interest in the idea. Ricardo told CNN that since his story "got to the mainstream" he has heard from thousands of people "who have [expressed] interest or are curious about it."
Ricardo said he wouldn't recommend attempting to starve the body of food without the proper "training" but insisted that with the "proper tools and awareness" the practice isn't harmful.
"We all know the air is light. We all know there is energy in nature," he told CNN. "So there's no way this can be dangerous."
Asked to respond to critics from the scientific and medical community who stress the practice is in fact dangerous and that it's not possible to survive without food and water, Ricardo said, "It's not possible when you don't have the state of mind. When your mind doesn't believe it's possible, it won't be possible."
The laws governing the human body, of course, may beg to differ.
June 21
NEW YORK
http://money.cnn.com/2017/06/21/media/breatharian-couple-news-outlets/index.html
XXX
Sep 3, 2018, 8:15:14 PM9/3/18
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How to Report Illegal Drug Activity
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DEA - Unlawful Pharmaceutical Drug Sales on the Internet: Reporting Form
https://apps.deadiversion.usdoj.gov/webforms/jsp/umpire/umpireForm.jsp
http://m.wikihow.com/Report-Illegal-Drug-Activity
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DEA - Unlawful Pharmaceutical Drug Sales on the Internet: Reporting Form
https://apps.deadiversion.usdoj.gov/webforms/jsp/umpire/umpireForm.jsp
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