Fed Up Yet?

Americans are understandably distracted by the current cultural battles that are, at their base, efforts to halt the steady erosion of White Christian male privilege. I spend a fair amount of time analyzing and discussing those battles, and ignoring a much more substantial disagreement about what a society/country owes its members/citizens.

It’s the question inherent in that old Amex commercial proclaiming “membership has its privileges.” 

As I’ve noted previously, in the United States, the “privileges” of citizenship do not include health care or financial security. Our approach to social welfare has been and remains punitive–and as a result, the “systems” we’ve built incentivize greed over good works.

A recent report from the New York Times focused on the reality of America’s approach to health care.

Many hospitals in the United States use aggressive tactics to collect medical debt. They flood local courts with collections lawsuits. They garnish patients’ wages. They seize their tax refunds.

But a wealthy nonprofit health system in the Midwest is among those taking things a step further: withholding care from patients who have unpaid medical bills.

Allina Health System, which runs more than 100 hospitals and clinics in Minnesota and Wisconsin and brings in $4 billion a year in revenue, sometimes rejects patients who are deep in debt, according to internal documents and interviews with doctors, nurses and patients.

Although Allina’s hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients, including children and those with chronic illnesses like diabetes and depression. Patients aren’t allowed back until they pay off their debt entirely.

Companies like Allina–theoretically “nonprofit”– get huge tax breaks for providing indigent care in their communities. An investigation by the Times  found that almost all  nonprofit hospitals have– for decades– fallen short of that charitable mission.

Allina cuts off patients who owe money for services received at any of its 90 clinics. Written policies instruct staff on how to cancel appointments for patients with at least $4,500 of unpaid debt– how to lock their electronic health records so that staff can’t schedule future appointments.

“These are the poorest patients who have the most severe medical problems,” said Matt Hoffman, an Allina primary care doctor in Vadnais Heights, Minn. “These are the patients that need our care the most.”

In 2020, less than half of 1 percent of Allina’s expenditures were for charity care, well below the pathetic national average of 2 percent for “nonprofit” hospitals, despite the fact that its annual profits since 2013 have ranged from $30 million to $380 million. In 2021, its president earned $3.5 million–and it recently built a $12 million conference center.

It’s estimated  that 100 million Americans have medical debts. Those debts make up approximately half of all the outstanding debt in the country, and are responsible for half of all personal bankruptcies.

Some 20 percent of hospitals nationwide have debt-collection policies that allow them to cancel care. The most expensive “health care system” in the world doesn’t seem very focused on health.

Then, of course, there’s what Jamelle Bouie calls a “twisted view” of the social safety net, most recently illustrated by the GOP’s insistence on work requirements for SNAP and Medicaid beneficiaries. 

As Bouie notes, there’s plenty of evidence that work requirements don’t lead to more employment–that their only effect has been a loss of benefits by poor Americans.

Work requirements don’t work, but Republicans still want them, so much so that they threatened to crash the global economy to get them. Why? The obvious answer is that work requirements are an effective way to cut programs without actually cutting them. With a little extra paperwork and another layer of bureaucracy, states can keep thousands of people who qualify from getting access to benefits.

To add insult to injury, It cost states tens of millions of dollars to implement work requirements. In Arkansas, for example, implementation cost close to $26 million; in  Iowa, the cost of administering the new rules was $17 million over three years — far more than the state would have spent on SNAP during that period.

We keep hearing that America is the richest country in the world. Not only could we afford to be less punitive to the people who most need a hand up, we could actually save money in the process. Tax dollars already pay some 70% of the country’s medical costs, and those dollars would probably cover 100% if CEOs weren’t overcompensated and we saved health insurer overhead.

I’ve previously argued that a Universal Basic Income would solve significant social problems– Whatever the pros and cons of a more expansive, less punitive view of “membership,” stories like these should remind us of the multiple deficits of what passes for current health and welfare policies in “rich” America.


  1. The profits and salaries to be made from the “nonprofit” world have grown exponentially over the years. This industry, once so honorable, has become the go to place for scoundrels and hypocrites. Aiding and abetting this transformation from the good guy’s home to the bad guy’s hideout has been the too easily bought lawmakers who twist the tax code to suit their master… money.
    There is no greater example of the decline of the United States than this.

  2. In the “Maddadam Trilogy”, Margaret Atwood describes a government that has been taken over by the “health care system” because they have figured out that the best way to transfer wealth is through that system. Mayhem ensues. A fun series and worth reading. Also horrifying because it is close to our reality.
    As long as profit is the leading motivation in health care this is what will happen.
    Greed, anger, and ignorance are the three poisons of the human condition. Currently it would seem that greed is in the ascendency.

  3. Sheila: “As I’ve noted previously, in the United States, the “privileges” of citizenship do not include health care or financial security. Our approach to social welfare has been and remains punitive–and as a result, the “systems” we’ve built incentivize greed over good works.”

    Theresa Bowers: “There is no greater example of the decline of the United States than this.”

    There were negative reactions to my comments yesterday regarding the term “deserving”; Sheila and I disagree on UBI as a possible solution but the quotes above point out the fact that the millions of “deserving” in this country are losing out to the greed of those who have no understanding, or simply do not care, about those in need and “deserving aid” due to circumstances beyond their ability to change. The new “work requirements” for countless SNAP and Medicaid beneficiaries will hit those most “deserving” of assistance, not only those living at poverty level but those who are elderly, physically or mentally disabled and unable to even seek help to continue receiving the “deserved” SNAP and Medicaid assistance. The current basic Medicare system denies public assistance to qualified Disabled for two years who have a source of income; such as my $159 monthly retirement when I qualified for $589 monthly Social Security. I managed by giving up some medications needed for my disability; others are forced to forego all medications to buy food and/or pay rent.

    This nation does NOT “deserve” Donald Trump or his cronies waiting for delayed court appearances but they, especially Trump, are fully “deserving” of their indictments and hopefully we will see more legal action against them. Trump is still qualified to be a presidential candidate but does he “deserve” that honor? I was Fed Up with Donald Trump decades before the Republicans latched onto his claimed wealth and his ability to lure racists and bigots who heard his calls to action for violence. We, as a nation, “deserve” to be rid of him before he can again be appointed to the presidency. He has been campaigning for reelection since January 20, 2017, the longest presidential campaign in history, another historical legacy which will probably not make it into future history books in any level of our education system. Trump qualifies for the former presidential “retirement” financial support and his secret service protection…but who believes he is “deserving” of more of our tax dollars?

    Theresa Bowers: “Aiding and abetting this transformation from the good guy’s home to the bad guy’s hideout has been the too easily bought lawmakers who twist the tax code to suit their master… money.”

  4. Concerning the health care facilities and debt collection, you can bet your bottom dollar that there is a religious element in there somewhere. In the Roman empire, with the advent of Christianity being adopted as the state religion, hence Church of Rome, The church became pseudo enforcement arm for the state. And, in the name of the state they would collect taxes, not tithes, but taxes. They taxed Christ!

    Is it any wonder, that this kind of chicanery has survived for several millennia? It was done under the Mosaic law also, and it continues today with a Christian bent.

    Back in the day, before American Independence, Georgia was basically a debtors prison. The crown would send copious amounts of released prisoners from debtor’s prison to the United States which actually was still part of, and under the crown’s control. Those banished British citizens would have to make an attempt towards paying back their debt from the new world. Any wonder why all of this is so screwed up today? Taxation without representation! And without a doubt the church of England was heavily involved!

    Food, clothing, shelter, education, health and well-being, freedom of choice, our basic human rights! And it’s also mirrored in our civil rights of this country, at least on paper. And, that paper isn’t even worth the roll that you have next to your commode.

    There still that bent of church control behind so many of governmental policies today. Because religion has wormed it’s way into secular government. And with Oklahoma board of education passing a law to allow the Catholic Church to run an educational facility completely funded by taxpayer public funds. It’s the first time this has ever been attempted. It’s not only against Oklahoma’s laws and Constitution but also the federal government.

    Any wonder why things keep moving backwards? Well because it is backwards! And, the Christian churches are completely non-Christian! Of course there are many other religions besides Christianity in this country, but those fanatical elements we have in fundamentalism, hold way way too much sway in governmental policy. All the way to the point of not having to follow basic constitutional tenets to carve out huge swaths of power and wealth for those true believers!

    Like I’ve mentioned before, Jesus Christ said the way to identify his followers, to love your neighbor, to love and support widows and children, to take care of the foreign resident, to love your enemy, to show compassion and empathy, to express faith, and not to judge your fellow man because it’s way beyond your authority. Judgment is supposed to be left to the superior authorities, in this country that’s secular. Well, it’s supposed to be secular.

    Until that religious meddling in secular government is brought under control and eliminated, you will never stop these sorts of issues. There has to be a time when resistance to this infiltration has to quit acting like a scaramouche!

    Remember, Christianity is not based on the church, it is based on scripture! It’s based on Christ! And, it flows freely from the old to the New testament.

  5. In America, if you work hard all your life and do everything right, but have the temerity to become seriously ill or injured, through no fault of your own, you will be punished! That’s been one of my mantras for years, and I’m beyond fed up and disgusted with our country’s health don’t-care system. Greed and power lust are the nation’s driving forces, and Todd’s favorite whipping boys, the oligarchs, are the drivers.

  6. It’s not really a health care system, is it? There’s not a single link to “care” and it’s not a “system” so much as an industry. Did you know that the debt owed by those seeking care is eventually sold to collection agencies for ten cents on the dollar? If you’re sitting around with a few million you don’t know what to do with, buy and forgive as much of the debt as you can. Meanwhile let’s work to change the health industry into a care system.

  7. Yes, what are described above in Sheila’s article are the “death panels” the Republicans ranted that the birth of Obamacare would bring.
    It took Indiana a very long time to accept the extra federal dollars offered during Obama’s reign and IUHealth also dragged its feet in support. Shame on them.

  8. How to do “UBI” right? First, drop “universal” – as many have noted, the well off shouldn’t get more money from the rest of us (they get enough from tax loopholes). How about a “win/win/win” approach? Maybe call it Povertyless US?

    There are good stats out on how much money it takes to be out of poverty/cover food and shelter, by zip code, even further segmented by married/working/number of kids/etc.. Give all folks under the number for their zip code enough money to make the difference. How to administer that? Use money from closing tax loopholes to fund it and hire/train people in poverty to run it.

  9. Even I am too disgusted to make a coherent comment that doesn’t include rage at the unbridled, un-regulated greed of these capitalistic wretches.

    I’m glad I’m old.

  10. Lester,

    You have it backwards. Instead of dropping people from UBI because they already get too much money from the government, how about closing the loopholes that give them too much. The appeal of UBI is everyone gets it so no one can complain that it is welfare. As soon as you make the wealthy unqualified to receive UBI is the moment you create the incentive for the rich to fight its implementation. Which is fairer, giving every American $1,000/mo or excluding the rich while giving them billions in tax subsidies

  11. Yes!
    It is almost not worth the energy to respond with sarcasm.
    This self-defined good “Christian” nation is now built of several
    systems that hurt the maximum number of people as often as
    possible, and health care is one of them.

  12. Peggy touched on this, but the US DOES NOT have a Health Care System. We have a Health Care Industry!

    It’s driven by corporate profits. Bigger is better. In Indiana we have some of the highest health care costs in the US because there is so little government regulation and new and improved hospitals are being built left and right. All the while, we’re trying to fix a broken system, we keep heaping on more and more Federal rules and regulations. But in a Red state they work hard to make if go the other way and I’ve already mentioned how that’s going for Indiana.

    I retired early and pay for my own health care insurance. The only reason I can do this because of the Affordable Care Act. But still, I went from a plan whose maximum out of pocket went from like $5000 a year to $10,000 a year and I pay almost twice what I used to pay when I was employed.

    I’m lucky I can afford it. I suspect for a good portion of the population, having a health care issue is financial death.

  13. I finally got comparable services at a health care provider that is for profit that was once always the quality almost approaching the old fashioned non-profit providers. Being old enough to remember non -profit hospitals and clinics. As well as remembering Dr..house calls. I can tell you it has taken for profit, extortion medicine to provide care at the same speed as the non-profits of yore. With two wing and a huge support staff two specialists were seeing huge numbers of patients per hour. One performing preliminary exams in one wing. The other performing follow up appointment surgical procedures at a rate of four to five per hour! Quality was “ adequate plus”. All preset scheduling was kept to the second! Cost as high and most patients obviously on Medicare. By contrast, five years ago , I had emergency room services for injuries in the ER of a County hospital in southern Indiana. One of the few still run by county government. The key difference was the “aim and purpose” of the efficiency. They left nothing to chance or speculation. Especially concerning a head injury. Speed was aimed at effective immediate care. Time was taken for thorough examination. Fast forward to a few weeks ago. My son had complications following surgery that were potentially life threatening. He went to two Indianapolis north side hospital ERs that had no Dr. on duty. Both which wanted paper work done first while he writhed in pain on the floor and did not treat him. But said they would make an appointment with specialist for him several days hence. It as only when he was driven to third north side for profit hospital that he was admitted and properly treated. For profit medicine is a crap shoot of life or death outcomes. It is inhumane and unconcionable.

  14. Jeffrey – never happen – “they” (the rich) own the politicians. Get real. Try polling folks on which they agree with: A. Give everyone no matter their income a handout or B. Give folks who can’t pay for basics a handout by taxing the rich.

  15. Hmm. White Christian Male privilege. I notice the word “wealthy” is missing. For some reason, this supposed “culture war” seems to be performative kayfabe designed to keep the PTB comfortable and solidly in place.

  16. The wildly uneven distribution of wealth AND opportunity in the U.S. today is at the root of so many of our most intractable problems. Any and all policies and programs that move us toward a better distribution of wealth and opportunity in our population should be considered. It is possible to curb greed without eliminating self interest. It is possible to encourage compassion without abandoning justice. The less the system is rigged in favor of a few, the greater the number of people who will make positive contributions to our society. I think that both universal health care and UBI are worthwhile goals but not at expense of the programs like social security, public education, Medicare, food stamps, etc. that are already in place. It has to start with rebalancing our tax policies to keep wealth flowing through the economy so it is less concentrated in the control of the few.

  17. Yesterday the US Supreme Court upheld the rights of pts. contracted with Medicaid to sue caregivers for malpractice. Just because a person is on public assistance doesn’t mean they don’t have rights. HHC needs to get it’s house in order. Where is all that money going?

  18. Besides being a “way to cut programs without actually cutting them”, this provides additional control over the workforce, especially those in low-paying service jobs.

    It’s also a method for separating the people into those who DESERVE the help, and those who don’t. I can’t help thinking about the prosperity doctrine. I’m sure it has a large influence on the people proposing and enacting these policies. This is the type of learned bias that infects too many people. It infuriates me.

  19. Jeffry, it won’t surprise anyone, but I agree with you completely. Sheila’s already gone over all these very logical reasons, but I’ll list a few: remove stigma, reduce cost of program by eliminating bureaucracy, remove fighting over the cutoff point and implementation. A complicated program will be harder to pass, as well.

    The argument against is just whether or not everyone DESERVES it. #$%@ that silly argument. 🙂

    Easy answer: raise taxes on rich, implement UBI. Done.

    Of course the rich will fight it, Lester, but they are a minority. While they will always have more power than they should, you guys seem to have made every effort in the last 60 years to increase their leverage by 1000%. The will of the vast majority of the people needs to start counting for something. And this starts with voting BLUE because–even as corrupt and corporate as many democrats are–they are your only chance.

  20. Indebtedness is a form of bondage similar to slavery. The accident of poor health luck often is the transportation of poor people into that bondage.

    It doesn’t have to be, we choose it.

  21. John H. – sadly, “the will of the vast majority of the people” is to get on with their lives. The US sadly and significantly lags the rest of the developed world in voting and the largest “party” is the unaffiliated. And the merry-go-round goes round and round…neatly powered by money

  22. I’m a 64 year old nurse working at a large urban “safety net” hospital in Indy that serves a lot of the poor and uninsured in our city and after 30 years of working in the health care-industrial complex I can tell you it TOTALLY sucks especially if one is poor and uninsured. And to make matter worse the federal govt under tRump cut BILLIONS of dollars in funding for our hospital and many others like it across the US! I hate this country and the despicable right wing aholes who love to prevent poor people from getting basic health care, I retire in 1 year and then we are moving to the mountains of Costa Rica…they have better health care coverage for ALL citizens and even as an expat our health insurance costs will be much less expensive there! (it helps the govt of Costa Rica does NOT spend an obscene amount of money on the military-industrial complex)

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