Bacon's Rebellion

Democracy Thrives in Sunlight

Virginia’s New Ruling Class: How Exploitation Works in the Real World

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by

James A. Bacon
in , ,

Graphic credit: Axios

Medical debt, which comprises 58% of all debt collections in the U.S., is the leading cause of bankruptcy in the United States. Between January 2018 and July 2020, hospitals filed tens of thousands of lawsuits and other court against against patients, according to AXIOS,  which drew upon Johns Hopkins University data. Until a public outcry compelled them to stop suing patients last year, the two most aggressive debt collectors in the country, by a wide margin, were the VCU Medical Center in Richmond (17,806 court actions) and the University of Virginia hospital in Charlottesville (7,197 court actions).

What do the VCU and UVa hospitals have in common? Several things. First, both enjoy nonprofit status. Second, both generate significant profits. Third, both are teaching hospitals affiliated with large research universities. Fourth, both universities are governed by self-perpetuating oligarchies accountable to no one, least of all to patients. Fifth, both are incentivized to suck every dime they can out of their customers to fund the thing that confers institutional prestige — medical research.

This is what social injustice looks like in the real world: Academic elites exploit the medical patients in their care to bolster profits and research funding. The fixation on racial injustice — obsessing over memorials named after slave holders and Civil War veterans, apologizing for sins that occurred a hundred years ago — is a dodge and a distraction.

— JAB 

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32 responses to “Virginia’s New Ruling Class: How Exploitation Works in the Real World”

  1. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    This simplistic rant is not worthy of you, Jim. On what basis do assert that these hospitals “exploit” their patients in order to bolster profits and fund research? For that matter, where is the evidence that these facilities are profitable? Where is the evidence that payments by patients are used to fund research?

    Do you think that patients who do not pay their medical bills should be absolved of paying them? That seems an unusual stance for Bacon’s Rebellion to be taking?

    1. LarrytheG Avatar
      LarrytheG

      I agree but it’s Katy bar the door with Bacon these days!

      One presumes that insurance, including Medicare and Medicaid set reimbursements for UVA and VCU similar to other hospitals.

      So, on that old apples-to-apples basis that Jim always talks about how does UVA and VCU compare to other hospitals, namely are they serving more lower income that can’t pay or if not, what do other hospitals do with their patients debt? Have they got more or less? , etc..

      OF course , in no other developed country do people go bankrupt over hospital bills. Why in this country?

      1. Matt Adams Avatar
        Matt Adams

        No, they just die waiting for surgery.

        https://www.fraserinstitute.org/article/while-politicians-dither-patients-die

      2. Nancy Naive Avatar
        Nancy Naive

        Monday already?

        https://www.cnn.com/2008/US/07/01/waiting.room.death/index.html

        1. Eric the half a troll Avatar
          Eric the half a troll

          Was a quick weekend, eh…??

    2. James A. Bacon Avatar
      James A. Bacon

      UVa and VCU are nonprofit hospitals. They are highly profitable. Look it up at the Virginia Health Information website. I’ve published the numbers before. Money is fungible. Patient revenues may not go directly to fund research projects, but the universities, as also demonstrated on his blog, do use their own funds to promote research. UVa has a Strategic Investment Fund (SIF), and VCU has a comparable fund, that consolidates low-yielding accounts and hands the money over to financial advisors to manage. Some of this money comes from hospital accounts. UVa pockets the return on investment and uses it for a variety of academic priorities, including research. VCU does the same thing. I can back up everything I said in this post, and, indeed, have detailed much of it on this blog.

      I agree that patients need to pay their bills. But, good god, Dick, VCU and UVa were the No. 1 and No. 2 most aggressive hospitals in the country with their court orders. They dwarfed everyone else. If they had been landlords instead of hospitals, every anti-poverty group in the entire state would have been all over them. Legislators would have fallen all over themselves to enact punitive legislation. You can’t possibly defend their collection techniques.

      The leadership of the VCU/UVa university/hospital systems is a parasitical class that exploits both patients and students bent upon lining its own pockets and bolstering the prestige of the institutions with which they are associated.

      1. James A. Bacon Avatar
        James A. Bacon

        VCU profits in 2019 fiscal year, according to vhi.org: $207.8 million.

        University of Virginia Medical Center profits: $96.7 million.

        Those are the flagship enterprises which are the linchpins of larger business ecosystems that include outpatient clinics, insurance companies, physicians practices and diagnostic centers.

        1. Dick Hall-Sizemore Avatar
          Dick Hall-Sizemore

          I concede these points.

      2. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        No, I certainly do not defend their collection techniques. I remember being somewhat appalled when I read about them a couple of years ago. https://www.washingtonpost.com/health/uva-has-ruined-us-health-system-sues-thousands-of-patients-seizing-paychecks-and-putting-liens-on-homes/2019/09/09/5eb23306-c807-11e9-be05-f76ac4ec618c_story.html

        I was just taken aback at your strong criticism of the efforts of the two facilities to collect debts.

        What is really telling is that the bills some of these people were saddled with were much higher than an insurance company would have been billed, as the article linked to makes clear. That is additional evidence that this country has a totally irrational system of health care.

        1. Matt Adams Avatar
          Matt Adams

          “That is additional evidence that this country has a totally irrational system of health care.”

          The system not so much, but the bureaucracies that run the systems. This isn’t about the practitioners, it’s about the upper management and insurance companies.

          1. Dick Hall-Sizemore Avatar
            Dick Hall-Sizemore

            The insurance companies are part of the system and upper management has to deal with them. Based on my experience, I have no problems with the practitioners, although right now I am irritated at the attempt of one of them to sell me something. Instead of a dispassionate explanation of my options, they gave me slick videos prepared by the company that makes the devices. But, that is upper management, not the individual doctor whom I was seeing.

      3. DJRippert Avatar
        DJRippert

        “If they had been landlords instead of hospitals, every anti-poverty group in the entire state would have been all over them.”

        No kidding. But they are liberal havens so they escape that kind of criticism.

    3. DJRippert Avatar
      DJRippert

      I think that two Virginia university medical systems being the two most aggressive collectors in the nation is noteworthy. Apparently they have backed down a bit but why were they going batcrap crazy chasing patients?

  2. Eric the half a troll Avatar
    Eric the half a troll

    I’ll count this as JAB’s vote for publicly funded healthcare!! That’s progress!!

    1. Matt Adams Avatar
      Matt Adams

      “I’ll count this as JAB’s vote for publicly funded healthcare!! That’s progress!!”

      Spoken by someone who has not been subjected to it.

      1. Eric the half a troll Avatar
        Eric the half a troll

        Like all those human beings in every other developed country in the world.

        1. Matt Adams Avatar
          Matt Adams

          That’s another lovely falsehood, did your boss tell you that one too?

          As illustrated by link to the Frazer Institute below, the primary outcome of a public based system results in death while waiting. You’d also have to know that the UK isn’t a sole public funded source, that if you want healthcare you’ve gotta pay a little extra for it.

          The issue at hand is not the medical world, it’s the Insurance companies and hospital administrators.

          1. Eric the half a troll Avatar
            Eric the half a troll

            You having problem with that internet thingie again, Sport?! Hit the juice too much this weekend?

          2. Matt Adams Avatar
            Matt Adams

            I’m sure that made a lot of sense in your obviously deteriorated mind, but it doesn’t to the rest of the world.

            So let’s try this again, this time you can make a comment that make sense.

  3. William O'Keefe Avatar
    William O’Keefe

    Jim, you must have gotten up on the wrong side of the bed today. Your screed makes a number of assumptions which Dick Hall Sizemore identifies. My question is what do you think that these two hospitals should do about those who don’t pay? Absolving them only incentivizes others to do the same. And, those who do pay bear the costs of those who don’t. Why should they have to?

    1. LarrytheG Avatar
      LarrytheG

      I don’t think people go to hospitals and run up bills for the hell of it, though. My impression of UVA is that they do not turn people away. I have heard so many stories of people with life-threatening disease going to UVA.

      All things equal and they never are – does UVA have higher patient debt than other hospitals? If so, why? Do other hospitals not collect debt and instead do what?

      As I said up-thread, this is not a problem in other developed countries. It is claimed they have longer wait times and people die waiting for care but if you look at life expectancy, we rank near last compared to those other countries and all them pay LESS for healthcare than we do.

      At any rate, I’d have to see MORE data because I’m willing to condemn UVA. My personal experience and knowledge of them is that they do a good job in central Va.

  4. Nancy Naive Avatar
    Nancy Naive

    Just tell your ambulance driver to take you elsewhere… oh, and go the scenic route.

    Could be worse…
    “A decade later, the law, otherwise known as Obamacare, appears to be accomplishing that goal, leading not only to millions more insured individuals but also to a sharp decline in bankruptcy risk among those with on-and-off coverage, new CU Boulder and University of Denver research suggests.

    “The big picture finding is that the ACA is doing what it is supposed to be doing, providing more people with health coverage and buffering them from crushing debt that can play out in financial ruin,” said co-author Tim Wadsworth, an associate professor of sociology at CU Boulder.”

    https://www.colorado.edu/today/2020/04/30/affordable-care-act-lived-promise-buffering-bankruptcy-risk-study-shows

    1. James A. Bacon Avatar
      James A. Bacon

      And that’s relevant how?

      1. Matt Adams Avatar
        Matt Adams

        It’s not relevant as per usual and also per usual he didn’t provide the entire opinion stated.

      2. Nancy Naive Avatar
        Nancy Naive

        Some editing needed for interlopers who can’t follow theaded conversations. Not you Wayne…

        AS YOU, BACON, SAID IN THE ARTICLE… “Medical debt, which comprises 58% of all debt collections in the U.S., is the leading cause of bankruptcy in the United States. Between January 2018 and July 2020, hospitals filed tens of thousands of lawsuits and other court against against patients, according to AXIOS, which drew upon Johns Hopkins University data.”

        IT COULD BE WORSE. Scratch that. Would be worse.

        How about this. What would happen if we eliminated completely medical debt and medical debt driven bankruptcies at the patient level? Gee, if only there were some way to do that? Perhaps we could find an insurer without a profit motive, someone who would be willing to be an honest broker, who could question provider costs, and would be a patient advocate. Who could that be?

        1. Matt Adams Avatar
          Matt Adams

          To bad your citation didn’t make that statement not did it prove it. For a so called “mathematician” you’re horrible at “proofs”

        2. WayneS Avatar
          WayneS

          “…someone who would be willing to be an honest broker…”

          Okay, then, based on that criterion you can’t be talking about the government. So, who might this magical insurer be?

          1. Nancy Naive Avatar
            Nancy Naive

            Actually, they could be if they were permitted to negotiate, specifically Part D.

            Medicare for all is not comparable to the UK system since the government wouldn’t own the providers, as they do in UK.

            In fact, we have provider networks in this country that are very successful businesses that are already single payer. There’s the Raytheon hospital network, the Grumann hospital network, the General Dynamics hospital network…

            Oh wait, no. They are single customer businesses. Well, they are profit capped and have for 70 been a value business. Perfect model for healthcare… “provide for the common defense and promote the general welfare…”

          2. Nancy Naive Avatar
            Nancy Naive

            I see your fingers moving, but just can’t see what you’ve typed…

          3. Matt Adams Avatar
            Matt Adams

            “Nancy Naive Nancy Naive • an hour ago
            I see your fingers moving, but just can’t see what you’ve typed…”

            Adding another lie your repertoire, if you block someone you, you can’t downvote them. Your additions of downvotes to my comments say others.

            I find it highly amusing that you three can’t take what you attempt to dish out.

  5. Baconator with extra cheese Avatar
    Baconator with extra cheese

    Those damn Republicans running UVA and VCU have no shame and put profits over people. Healthcare is a human right and these institutions are preying on those less fortunate. Things would be very different if those universities would allow some progressive voices.
    Hilarious how that argument is only one sided.

  6. Nancy Naive Avatar
    Nancy Naive

    https://wordsmith.org/words/images/mouse_potato_large.jpg

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