Getting Sick and Going Broke – CVS, Credit Cards, and Crippling Medical Debt – The Health Care Blog

BY MIKE MAGEE

The Medical-Industrial Complex is swarming with grifters. This is to be expected when you build a purposefully complex system designed to advance profitability for small and large players alike. The $4T operation payrolling 1 in 5 American workers is, in large part, a hidden economy, one built by professional tricksters, designed by Fortune 100 firms with mountains of lobbyists, but reinforced as well by friendly doctors and hospitals engaged in petty and small scale swindling who justify their predatory actions as entrepreneurial, innovative, and purposeful means of necessary financial survival.

When lobbyists for high-priced stakeholders get called before Congress, as they did on March 29, 2022 before the House Committee on Oversight and Reform, they make it sound like Americans should embrace the privilege of being screwed over by MIC elite. But as former Kaiser Permanente CEO, George Halvorson, recently reminded, “People are getting bankrupted when they get care, even if they have insurance.”

It’s enough to draw a person back to the early 1950’s when Arthur Sackler helped launch the Medical-Industrial Complex. In fact, our modern day willingness to mask health care cruelty in high-minded language and miscarry  justice is extreme enough to draw one back to June 9, 1954, when Boston attorney, Joseph Welch, hired by the U.S. Army to defend it against accusations of Communist infiltration, said to Sen. Joe McCarthy, “Little did I dream that you could be so reckless and so cruel…You’ve done enough. Have you, sir, no sense of decency at long last?”

Halvorson and others seem to be reaching a similar boiling point, ready to utter to controllers and apologists of the MIC – “Have you not done enough?”

The most recent tipping point comes in the form of a June 16, 2022 KFF poll revealing that more than 100 million Americans, including 41% of all adults, carry significant medical debt, much of it out-of-sight, carried on personal credit cards. Hospitals and doctors have been tapping into the patients cards for payments, leaving patients tapped out, with high interest plastic debt. 1 in 8 now owe more than $10,000, which nearly 20% say they will never be able to pay off.

The problem is accelerating as health insurers have pushed skimpy plans with deductibles that can legally reach $8,700 a year per individual. As I documented with Tenet Health Care Systems and their Conifer Collection System in 2018, the debt business has bailed out poor hospital practices and medical group mismanagement more than once. Now four years later, 58% of collection agency listed debt is medical in nature. One in 10 of the desperate debtors owe money to family members, and collective medical debt now tops $195 billion as of 2019.

As if it couldn’t get worse, the debt (as one might expect) is not spread evenly. Southern states are over-represented due to poor insurance protection laws, lack of Medicaid expansion, and greater presence of chronic disease in their populations. Medical debt is 50% more common in Blacks, and 35% more common in Hispanics, than in whites. If you live in an unhealthy county (measured by high rates of chronic diseases), 1 in 4 have medical debt, compared to 1 in 10 in healthy counties.

Of course, if you are unhealthy in the U.S., you are also in the cross-hairs of direct-to-consumer drug advertising. The practice of pushing medications through TV ads is only allowed in one other nation in the world. 

More than 1 in 3 Americans will fill those prescriptions at CVS, where whistleblower, Alexandra Miller used to work. What is she blowing her whistle about? According to STAT’s uber-pharma investigative reporter, Ed Silverman, her lawsuit contends that “Starting in 2015, CVS allegedly coordinated an effort that relied not only on its SilverScript (Medicare Part D) subsidiary, but also its Caremark pharmacy benefit manager (PBM) and its chain of CVS retail pharmacies to prevent consumers from obtaining low-cost generics because the company profited from making only higher-priced brand-name medicines available to its customers….”

 The kickback scheme involved CVS Health’s Part D plan sponsor, SilverScript; its pharmacy benefit manager, CVS Caremark, and CVS Pharmacies with hidden rewards flowing back and forth as patients credit card debt skyrocketed. As America proceeds headlong into a recession, and the economy becomes bedridden, the ghost of Arthur Sackler is rising from its gilded crypt and whispering, “It is your own health care system that is making you sick and broke.”

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“



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