What can a small group of people do to fight a Goliath like the medical industry? Plenty, it turns out. In l996 the social action committee of the Genesee Conference of the Free Methodist Church decided to take on one of the greatest areas of injustice in health care: overcharging the uninsured.
The fact that approximately 45 million Americans lack health insurance is arguably an injustice in itself. Studies have shown that the uninsured do not receive the same medial care as the insured. Further, they often have to forgo needed medicines and tests and have to wait until their situation becomes critical before they receive care. Ours is the only industrialized country in the world without some type of universal health coverage, yet our average life expectancy is less than that of Canadians, Japanese, or Western Europeans.
But the lack of health insurance is only the beginning. If uninsured people go to a hospital for X-rays or lab tests, one might expect them to receive a discount, especially if they are poor. The reverse is actually true: the uninsured are routinely charged up to four times more than insurance companies pay. Many hospitals price gouge the uninsured, in essence pushing the working poor to the ground, rubbing their heads in the dirt, and even adding a few kicks!
Furthermore, those who try to purchase health insurance on their own have to pay much more than companies with group rates do. If the uninsured have a chronic condition like diabetes or heart disease, they might not even be able to buy insurance. Whether purchasing individual insurance or paying out of pocket for hospital and outpatient care, the working poor pay more because they have no employer-sponsored insurance.
These circumstances were unacceptable to Pastor David Phelps, some Genesee Conference representatives, and myself (a practicing physician and longtime member of the Free Methodist Church), because our denomination embraces justice at its very core. In fact, Free Methodism’s founder, B.T. Roberts, not only viewed owning a slave to be unjust but also charging rent for church pews. He also felt that it was unjust for railroads to charge local farmers more than Midwestern farmers to transport produce to New York City and formed the Farmers Alliance to put pressure on the politically powerful industry.
Now, our small group of modern-day Free Methodists decided to study the situation of overcharging the uninsured. The facts were not widely known, and there was no pending legislation to correct the problem. We surveyed all 46 hospitals in western New York, asking what the uninsured were charged for five common procedures, whether each hospital had a discount policy, and, if so, how a person would find out about it. Only ten hospitals responded, and the results were worse than we had imagined. The uninsured were usually charged three to four times more for a given service. Most hospitals had discount policies, but patients had to know whom to ask about them. Only two hospitals made the discount policy clearly known to the uninsured.
Next we met with the director of the Hospital Association of Western New York and asked for help in getting responses from the 30 nonresponsive hospitals. We were told that the association had seen the survey and had in fact recommended that hospitals not respond. We then talked about how hospitals with discount policies might make them known to the uninsured. At this point we were told to, “Go take care of religion and let us [the hospital association administrators] take care of medical care.”
Later the Genesee Conference passed a resolution calling on the hospitals and state to correct this injustice. Pastors and lay delegates were then asked to contact their representatives and any local hospital board members they might know. The official report, with supporting data, was sent to government officials. During the ensuing years I continued my efforts to publicize this issue and get it on various agendas. The Buffalo News did one front-page story in a Sunday edition, citing examples of patients who were price gouged and stating that hospitals would offer payment plans (on bills that were three times what an insurance company would pay) but usually not discounts. Our survey was then quoted, including, “The cost to Medicare for an abdominal ultrasound was $102. To the uninsured patient, it ranged from $180 to $406.”
I presented our report to the health department and various state assemblymen. All were sympathetic but said there was nothing they could do. There were laws governing how much hospitals could charge insurance companies, but nothing regulating charges to the uninsured.
Finally, after the issue was taken up by the New York Legal Aid Society and covered in the Wall Street Journal, a bill was introduced and passed in the New York Assembly. (There is no specific evidence as to what extent our efforts affected these developments.) Beginning in January 2007, hospitals in the state are penalized if they continue to make the uninsured pay more than insurance companies. Hospitals must publicize discount policies, and a collection agency must certify that the uninsured were clearly informed of all their rights to discounts before it can take a case to collections.
Although people in the government were open to listening to our church, many others were not. I went to the board of our small rural hospital, for example. I knew most of the board; they were volunteers and represented the community, including the poor and uninsured. Many professed Christian faith but were not willing to change anything. As they saw it, “This is the way things are in this state. Why should we be the only ones to change things?”
In the meantime, my own patients were being price gouged. I had one patient whose income was $18,000 a year. She had a CT scan, and the bill was $2,800. The hospital gave her a ten percent discount, bringing the bill down to $2,500, but would have accepted just $800 from an insurance company. They refused to reduce the bill further even though I was hospital chief of staff at the time.
I kept plugging away. As a rural delegate to the Medical Society of the State of New York, I brought forth resolutions annually in an effort to change this injustice. Each year my resolutions were defeated. The physicians were afraid of legislation regulating fees, and they also did not want to have the hospital association angry with them.
Why will good people (like hospital boards and physicians in the medical society) sit silently by while the poor are being price gouged? Why didn’t other churches— even though asked— join us in our protest?
Insurance price gouging is only one of many injustices the poor face today. Why do churches stand by while the poor go to jail because their court-appointed attorney first meets them at the time of the trial and knows nothing about them or their case? Why do poor people sit in jail for weeks or months rather than go home with a radio ankle bracelet to await trial (as the wealthier accused do)? What about those who spend a week or two in jail because they cannot pay a $100 fine?
People say, “What can we do? This is not our responsibility as Christians. We cannot fix everything.” Fortunately, B.T. Roberts did not stand silently by as he looked at injustice. Because of him and others like him, things did change. The Bible calls us not only to have personal righteousness but also to help develop a righteous, just community. Although God will ultimately judge injustice and establish total justice, he calls on his followers to work for righteousness and justice today. In Isaiah 58, he says that the kind of fasting he chooses is that which will loose the chains of injustice and set the oppressed free.
“Then your light will break forth like the dawn, and your healing will quickly appear…” Isaiah 58:8 (TNIV)
Although we cannot rid the world of injustice, we can attempt to establish justice within our sphere of influence. We live in a nation where we vote and give input to the legislators. We should speak out, not just on issues of personal morality but also on issues of economic morality and justice. Jesus identified with the poor and calls on the church to do the same.
In the biblical story, David had only five small stones, yet he defeated the giant, Goliath. Jesus asks each of us to use the small power and opportunities God has placed before us. Our political strength may not be great, but when we do what we can, God will help our efforts hit the mark.
Norm Wetterau, MD is a family physician at Tri-County Family Medicine in Nunda, New York who actively promotes justice through the church and medicine.
A version of this article first appeared in Light & Life magazine, a publication of the Free Methodist Church.