The National  Memo Logo

Smart. Sharp. Funny. Fearless.

Monday, December 09, 2019 {{ new Date().getDay() }}

Tag: health

In Senate, Manchin Says McConnell Is “Protecting Wall Street,” Not Workers

Reprinted with permission from Alternet

Sen. Joe Manchin (D-WV) called out Senate Majority Leader Mitch McConnell (R-KY) on Monday for being more concerned with propping up financiers than providing supplies to hospitals fighting the novel coronavirus.

“You can throw all the money at Wall Street you want to,” Manchin said after McConnell blamed Democrats for a stalled stimulus bill. “People are afraid to leave their homes. They’re afraid of the health care. I’ve got workers who don’t have masks. I’ve got health care workers who don’t have gowns.”

“And it looks like we’re worried more about the economy than we are the health care and the wellbeing of the people of America,” the West Virginia senator complained.

McConnell interrupted: “The American people are waiting for us to act today! We don’t have time for this! We don’t have time for it!”

“Let me ask you a question,” Manchin implored.

“Answer my question!” McConnell demanded. “In what way would the Democratic Party be disadvantaged?”

“Thirty hours [of debate] or 30 days, as long as you have the votes, 51 votes rule,” Manchin said. “So the final vote is going to be on passage, whether you have to negotiate or not with us.”

“Here’s the way it works!” McConnell exclaimed. “We have been fiddling around as the senator from Maine pointed out for 24 hours…”

At that point, Manchin reclaimed his time, silencing McConnell.

“We just have a little different opinion about this,” Manchin said. “You can’t throw enough money to fix this if you can’t fix the health care.”

“My health care workers need to be protected,” he added. “But it seems like we’re talking about everything else about the economy versus the health care. That doesn’t make any sense to me whatsoever.”

“It seems like we’re more concerned about the health care of Wall Street,” Manchin remarked. “That’s the problem that I’ve had on this.”

Watch the video below from

Which Foods Are Most Important To Buy Organic?

Most people know it’s a good idea to buy and eat organic foods whenever possible. Even those who aren’t particularly health-conscious are aware of this. However, it’s all-too-common for consumers to stare blankly at their kitchen’s subway tile backsplash, trying to make a shopping list filled with organic options that don’t empty their wallet. Healthy organic foods are almost always more expensive than nonorganic items — often dramatically more expensive. This can leave many people wondering if it’s even possible to be health-conscious and budget-conscious at the same time.

Fortunately, it’s absolutely possible, as long as you know which foods to buy organic and which you’re safe buying from the regular aisles.

Some foods aren’t much different, whether they’re organic or not. However, the foods on this list should always be purchased organic to avoid accidentally ingesting nasty chemicals. Knowing which foods are most important to buy organic will help you stretch your dollars as far as possible, helping you stay healthy and save money.

Coffee

Coffee is the third most sprayed crop in the world, just behind tobacco and cotton. And while neither cotton nor tobacco ever makes its way into our diets, 30% of the entire population drink coffee occasionally. For many people, two or even three cups of coffee is a part of their daily routine. So if you’re only going to buy one organic food regularly, you should make it this one.

Pesticides used on coffee plantations are supposed to be partially neutralized during the roasting process, but even worse than the effects they have on your body may be the effects they have on nature. These herbicides, pesticides, and fungicides can have negative long-term effects on farmers and the environment. If more people choose organic coffee, however, this won’t have to be a problem forever.

Dairy Products

The right dairy products are an essential part of a balanced diet. They are also important in having strong teeth and a healthy smile, which 99.7 percent of adults believe is socially important. Don’t settle for the cheapest butter, cheese, or jug of milk on the shelf, though. Nonorganic dairy products usually come from cows that received antibiotics, growth hormones, and a grain-only diet. What goes into the cow eventually makes its way into the milk and unhealthy animals can only produce poor-quality products.

And as if that wasn’t enough, animals in conventional industrial farms typically aren’t treated well and don’t enjoy lives that are healthy or pleasant. Not only does this ultimately mean poorer health for those who consume the animals or their milk, but it also means the animals themselves suffer needlessly while alive. Buying high-quality organic dairy products is a better option for you and our animal neighbors.

Grapes (and Wine, Too)

There are a lot of reasons to buy organic, but when it comes to grapes and products made with grapes, the reasons become even more convincing.

Many people enjoy a glass of wine now and then, especially at celebratory events like weddings and anniversaries. Even if you don’t drink wine, you probably eat grapes at least once in a while. Unfortunately, grapes have been found to contain multiple different types of pesticide residues. To make sure that your healthy treat or relaxing drink doesn’t carry any adverse effects with it, always buy organic grapes and wines and try to wash your grapes well before eating them.

Apples

As we all know, you should visit your doctor at least once per year and you should eat an apple a day so you don’t have to see them more often. One reason apples are so famous for being healthy is that they’re a good source of fiber, which helps keep your digestive tract in shape. But if your apples aren’t organic, you may want to reconsider: most apples contain residue from at least one pesticide.

Besides washing your apples before eating (which is something you should do with just about any fresh food you buy), try to find apples that are organic. This also applies to products like apple sauce and apple juice, which can be even worse than nonorganic apples because they’re so highly concentrated.

Tomatoes

If you love topping hamburgers with tomato slices or adding grape tomatoes to salads, you’ll want to make sure the tomatoes you’re buying are organic. The USDA Pesticide Program showed that tomatoes can carry 69 different pesticides. And since you always eat them with the skin left on, you’re even more likely to get those pesky chemicals in your system. When you’re looking for tomatoes for your next barbecue, go organic.

Peppers

Peppers are fascinating fruits. Not only do they possess an unusual flavor spectrum, from mildly sweet to intensely spicy, but they’re also known for a variety of health benefits. That’s because peppers contain a chemical known as capsaicin, which may help relieve nasal congestion and even fight off cancer.

Unfortunately, nonorganic peppers are likely to contain other chemicals that aren’t so helpful. Conventional grocery store peppers can carry up to 75 different pesticide residues, including recognized carcinogens and neurotoxins. No matter what kind of budget you’re on, when you buy peppers, they should always and only be organic.

Sadly, organic hot peppers aren’t as easy to find as other organic options, especially in smaller grocery stores. If you can’t find or can’t afford hot peppers, try using onions instead. They offer a similarly spicy flavor and they’ve been shown to be fairly clean, even when they’re not organic.

Leafy Greens

Dietary experts recommend that you eat five servings of vegetables every day and for many people, those servings come from tasty salads. From spinach to kale, leafy greens are worth splurging on to get organic. This is because the leaves offer a wider area for chemicals to stick. Considering that you can’t peel leafy greens and you need a lot of them to make a satisfying salad, the result is a concentration of pesticide residue on your plate. To avoid this problem altogether, go organic and be diligent when you’re rinsing or soaking greens as you prepare them.

And there you have it: these are some of the most important foods to buy organic. Even if you’re on a budget, to enjoy the best health possible, try to always buy these foods in the organic section.

Trump EPA Guts Chemical Plant Safety Regulation

Reprinted with pemrission from DCReport

Just before the holidays, Trump’s Environmental Protection Agency quietly threw out regulations protecting an estimated 177 million Americans who live and work near dangerous chemical plants. The EPA’s move came just 22 days after horrendous fire and multiple explosions 95 miles east of Houston threatened thousands.

The Chemical Disaster Rule, written under former President Barack Obama, covered about 12,500 industrial facilities nationwide using or storing highly hazardous chemicals. It included safeguards such as requiring an independent party to investigate spills and explosions and plant owners to keep safety information current.

‘People Will Die’

“People will die,” said Eric Whalen, a spokesman for Environmental Justice Health Alliance for Chemical Policy Reform.

For example, the explosion at Texas Petroleum Chemicals Group in Port Neches on Nov. 27, Thanksgiving eve, killed one person and forced out 50,000 people.

The plant manufactures butadiene, an extremely flammable, colorless gas used to make tires and plastics. Butadiene is a known human cancer-causing agent. It can cause blurred vision, nausea, unconsciousness and respiratory paralysis.

The EPA finalized the Chemical Disaster Rule just a day before Obama left office in 2017. The rule was supposed to prevent tragedies like the April 17, 2013, explosion near Waco, Texas, at the West Fertilizer Co. plant. That inferno killed 15 people, injured more than 250 and damaged or destroyed hundreds of homes.

No Inspections

The fertilizer plant stored 270 tons of ammonium nitrate,1,350 times the amount that would ordinarily trigger safety oversight by the U.S. Department of Homeland Security. There was no full plant inspection in almost three decades.

“The American people and American politicians, they have a short memory,” said West Mayor Tommy Muska. “They’re going to say everything is fine, and every few years something like this is going to happen again.”

At least one in three children attend school near a hazardous chemical facility. School in Port Neches was canceled after the explosions. People had to shelter in place because of the levels of butadiene.

Environmental Groups Sue

Thirteen environmental groups, including the Sierra Club and Air Alliance Houston, sued the EPA over gutting the Chemical Disaster Rule.

The EPA previously calculated that its protections before the rule failed to prevent more than 2,200 chemical fires, explosions, leaks and other incidents during a 10-year period, including about 150 a year that caused injuries.

Industrial groups including American Fuel & Petrochemical Manufacturers and the Chamber of Commerce worked to kill the rule.

Why A New York Times Columnist Says 2019 Was ‘Best Year Ever’

Reprinted with permission from Alternet

2019 will be remembered for developments in a long list of disturbing events and trends, including climate change, white nationalist terrorism in the United States, and far-right authoritarianism embodied by Brazil’s Jair Bolsonaro, Russia’s Vladimir Putin and Hungary’s Viktor Orbán.

Regardless, New York Times opinion writer Nicholas Kristof remains an optimist, asserting in his column that 2019 had a lot of positive trends and developments to go with the bad. He provocatively titled the op-ed, unironically, “This Has Been the Best Year Ever.”

Those who are “depressed by the state of the world,” Kristof asserts, should consider that “2019 was probably the year in which children were least likely to die, adults were least likely to be illiterate and people were least likely to suffer excruciating and disfiguring diseases.”

Moreover, Kristof adds, “Every single day in recent years, another 325,000 people got their first access to electricity. Each day, more than 200,000 got piped water for the first time. And some 650,000 went online for the first time, every single day.”

In 1950, Kristof notes, “27 percent of all children still died by age 15. Now, that figure has dropped to about 4 percent.”

Kristof goes on to cite some troubling events, writing, “But … but … but President Trump! But climate change! War in Yemen! Starvation in Venezuela! Risk of nuclear war with North Korea. All those are important concerns, and that’s why I write about them regularly. Yet I fear that the news media and the humanitarian world focus so relentlessly on the bad news that we leave the public believing that every trend is going in the wrong direction.”

Other positive trends, according to Kristof: more literacy around the world, and diseases that claimed countless victims in the past have been declining.

“Diseases like polio, leprosy, river blindness and elephantiasis are on the decline, and global efforts have turned the tide on AIDS,” Kristof explains. “A half century ago, a majority of the world’s people had always been illiterate; now, we are approaching 90 percent adult literacy.”

Being optimistic, Kristof stresses, doesn’t mean ignoring major problems like climate change, but too much emphasis on the negative can become self-defeating.

“I worry that deep pessimism about the state of the world is paralyzing rather than empowering,” Kristof warns. “Excessive pessimism can leave people feeling not just hopeless, but also, helpless.”

Healthcare Costs Impacting Children Nationwide

As healthcare costs continue to climb into the new decade, many families are feeling the strain more than ever. Unlike other insurances like life insurance, which 60 percent of Americans have, health insurance is essential for people of all ages to have access to. This necessity puts a huge weight on parents’ shoulders. While some protections are in place to support those in need of assistance, gaps in coverage and certain restrictions can leave middle-class families and their children in a precarious position. The new year will undoubtedly be a notable year for American politics. With this in mind, only time will tell what the future holds for the nation’s healthcare.

Healthcare Access Limited, Harming Children

With healthcare costs climbing rapidly for both the insured and uninsured, many parents are being forced to make incredibly difficult decisions when it comes to the care and protection of their children. In some cases, parents are unable to afford basic healthcare costs for their children, veering into a state of neglect. Neglect was the top reason why Kentucky children were removed from their homes between 2010 and 2015, making up 68.6 percent of removals. However, this is not always due to genuine malintent on the part of the parents. In some cases, costs have simply spiraled out of control, and they’re no longer able to support their children as well as themselves.

The result is a young population with worsening healthcare. Children in lower-income communities often lack resources such as mental healthcare support, routine exams, and more. However, this lack of resources isn’t exclusively due to an increasingly high cost; some areas simply lack the staff to support these services.

Staffing Shortages Despite High Costs

While costs remain high, the funds aren’t always directed where they need to be in order to provide more support for struggling communities. Many areas, particularly when it comes to psychiatry and psychology, are critically understaffed. Some studies show there are about 7.2 million open healthcare positions available in the world today because of staffing shortages. Shortages tend to be particularly high in low-income communities, as the positions often pay less than the average salary for the job. This pushes doctors and medical professionals to wealthier communities, rather than to communities that are most in need of additional medical services.

Long-Term Impacts On Population

Over time, the lack of medical resources in necessary areas could lead to long-lasting consequences. Being healthy doesn’t just consist of eating nutritious food and going on hikes, a mile of which can burn over 500 calories. To have the best chances of living a healthy life, you need easy access to professional healthcare. Children who grow up in communities that lack vital health resources will likely be less healthy than their peers. The cycle tends to perpetuate itself, as those who are less healthy may struggle with maintaining long-term jobs or higher-paying careers.

In theory, various government-supported programs exist to interrupt this cycle. However, these programs often are difficult to access and can have vital gaps in coverage. The Americans with Disability Act provides that reasonable accommodations must be provided to individuals who have a qualifying disability, absent a hardship caused to the employer. However, not every disability will qualify, and assistance may not be available to those who make just enough to not meet financial assistance requirements.

As 2020 quickly approaches, it’s uncertain what the future of the nation’s healthcare holds. The upcoming year will be an important one for American politics, and the debate over healthcare will continue up to and beyond the next presidential election. With so many of the nation’s most vulnerable population riding on the healthcare debate, hopefully a solution to the dilemma will be reached soon.

Veganuary, A Resolution We Can Skip

I never got the point of a vegan diet. I dislike its cultish mindset. And I regard New Year’s resolutions as prelude to failure. That gives Veganuary three strikes and an out as an obsession to commandeer my January.

The push to adopt a strictly vegan diet for the month of January speaks volumes about English-speaking peoples’ rocky relationship with food and affection for movements. Veganuary started in Britain.

A vegan diet is like a vegetarian one — no meat, fish or fowl — but it also bans animal byproducts, such as cheese, eggs and milk.

There’s always a new diet. There’s keto, a diet of very few carbs and very high fat, seen as a fast way to lose weight. There’s the paleo diet, based on what the earliest humans supposedly ate. It permits organic produce, naturally raised meats, wild-caught fish, eggs, nuts and seeds — but not dairy, processed foods and sugar. Oddly, both the keto and paleo diets forbid grains and legumes. (Rules are rules.)

Asked her opinion on the paleo diet, a nutritionist on Doctor Radio (a SiriusXM channel) responded that she had no idea what cavemen consumed. I know from a reliable source, however, that Fred Flintstone ate brontosaurus burgers.

I get vegetarian diets. I understand the reluctance to kill animals for food. I don’t share it, though I want the animals to have been treated as humanely as possible. After all, Rusty, my sweetheart mutt, wouldn’t hurt any creature except for rabbits, but he and I were given canine teeth for a reason.

Dietitians maintain that vegetarians who don’t load up on fatty vegetarian grub can be very healthy. And a lot of us should be eating fewer burgers and more cauliflower than we do.

But it’s harder to achieve good nutrition with veganism. In particular, vitamin B12 is found only in animal sources, so vegans are advised to take supplements, according to Harvard Women’s Health Watch. How natural are pills?

From an ethical standpoint, the vegan banning of eggs or milk makes no sense at all. The cow that provided milk for my coffee is doing just fine, and the chicken’s life was in no way shortened by the eggs that went into my omelet.

The vegan movement argues that industrialized dairy or chicken farms are bad for the environment. Thing is, crops such as soybeans, corn and grains are also industrially grown and produced with high use of chemical fertilizer, fungicides, pesticides and herbicides.

In a piece last year in the Guardian, Isabella Tree, who runs a “sustainable” livestock farm in England, makes the above point and others in questioning veganism. She endorses “traditional rotational systems, permanent pasture and conservation grazing” that actually “restore soils and biodiversity, and sequester carbon.”

Tree’s cattle graze on wildflowers and grasses. The pigs poke around for rhizomes and dive into ponds. All this animal action creates opportunities for other species of small mammals and birds. Animal dung, Tree explains, “feeds earthworms, bacteria, fungi and invertebrates such as dung beetles, which pull the manure down into the earth.”

Out of curiosity, I visited Veganuary’s UK-based website. It asked visitors to take the Veganuary pledge. I clicked “Take the Pledge.” Then it asked for my email address, which I also provided. But then — before letting me see the recipes and meal plans — it demanded more information including gender, age and telephone number. Could requests for money and sales pitches for products be far behind? I was out of there.

My diet for January will be restricted to meat, fish, fowl, vegetables, nuts, yogurt, cheese, milk, fruits, beans and grains, with the occasional cookie sprinkled with sugar. Hope I can stick to it.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators webpage at www.creators.com.

IMAGE: Via Flickr by Ella Olson. https://www.flickr.com/photos/ellaolsson/42019058960

Blackstone Equity Firm Pursued Poor Over Medical Bills

Reprinted with permission from ProPublica.

MEMPHIS, Tenn. — After nine visits to the emergency room at Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she’d never heard of, Southeastern Emergency Physicians.

Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn’t have.

In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.

The case against Brooks is one of more than 4,800 lawsuits Southeastern has filed against patients in Shelby County General Sessions Court since 2017. In the first six months of this year, Southeastern filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare, Baptist and Regional One combined.

Lawsuits against poor patients over unpaid medical debts have received widespread media attention over the past few years. In almost all cases, the plaintiff has been a hospital system, often a nonprofit.

What sets the practices of Southeastern, and its parent, TeamHealth, apart is that it is a physician staffing firm that contracts with the doctors who treat patients in four of Baptist’s emergency rooms around the region. Physicians historically have avoided suing patients en masse, instead choosing to send unpaid bills to collections or writing them off as bad debt.

TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.

“There is this tension between being a health care provider and doing what’s best for their care … and being a profit-maximizing firm that aggressively goes after patients,” said Brian Shearer, legal director for Justice Catalyst Law, a New York-based social justice nonprofit, though he added that he wasn’t aware of any lawsuits by providers like Southeastern.

TeamHealth initially defended the lawsuits in an interview with MLK50 and ProPublica, saying they reserved legal action only for patients who’d made no attempt to pay.

But late last week, faced with additional questions by the news organizations, the company reversed course, issuing a statement saying it would no longer sue patients and wouldn’t pursue the lawsuits it has already filed. “It’s difficult to ensure that only patients with a strong ability to pay are ultimately impacted, so we’ve decided to eliminate it,” a TeamHealth spokesman said.

TeamHealth also had policies in place that made it difficult for patients to access charity care, a form of financial assistance for low-income patients. Two former TeamHealth employees told MLK50 and ProPublica that they were instructed not to mention the term charity care when patients called with questions about their bills.

After the company was asked about this, TeamHealth president and chief executive officer Leif Murphy announced a new discount policy for patients without insurance.

“Effective December 1, 2019, we are implementing discount policies for our uninsured population to reduce the cost of care by as much 90 percent, and up to 100 percent when necessary. We will proactively include eligibility criteria in our invoices to help promote participation rather than force patients to seek assistance,” Murphy wrote in a letter to employees.

TeamHealth’s abandonment of its lawsuits, as well as the implementation of a new financial assistance policy, marks the second time in five months that a major health care entity in Memphis has overhauled its practices amid questions from MLK50 and ProPublica. In July, Methodist, a nonprofit faith-based hospital system, announced it would curtail its lawsuits over unpaid debt against poor patients. It has since zeroed out the balances owed by more than 5,100 patients and reduced bills for more than 2,200 others, according to a hospital spokesperson.

TeamHealth declined to talk about the suits involving patients interviewed for this story, even though the patients gave the company permission to do so.

Mark Rukavina, business development manager at Community Catalyst’s Center for Consumer Engagement in Health Innovation, a national advocacy organization, said nonprofit hospitals shouldn’t work with physicians groups that aggressively pursue patients for medical debts.

“They could say, ‘If you’re going to provide services in our hospital, you’re going to comply with our financial assistance policy,’” Rukavina said.

The lawsuit from Southeastern was just a small part of Brooks’ debt, but learning that TeamHealth won’t pursue her case was good news, she said. Plus, she now has TennCare, the state’s version of Medicaid, which she hopes will spare her from other large medical bills.

She and her husband still “go from paycheck to paycheck,” she said, and with $60,000 in student loans and thousands more in credit card debt, she thinks bankruptcy – or a winning lottery ticket – is the most likely path out.

“It definitely helps though, that you’re not having that [doctor’s bill] hanging over your head,” she said.

From A Closet To National Leader

TeamHealth’s roots in Tennessee stretch back 40 years, to when emergency medicine was recognized as a specialty.

In 1979, a small group of ER doctors in Knoxville, Tennessee, landed contracts to operate two emergency rooms, including at the University of Tennessee Medical Center in Knoxville, where administrators allowed them to use a closet as their office, according to a company video. It was a step up from their makeshift workspace at Mrs. Winner’s, a fast-food restaurant.

Southeastern’s initial strategy was to focus on hospitals within a two-hour drive of Knoxville, said co-founder Dr. Lynn Massingale in the video. But his ambition to be the nation’s biggest staffing firm led him to expand that radius to a two-hour plane ride, he said in an interview posted on TeamHealth’s website, and, gradually, across the country.

Hospitals “needed reliable, 24-7 physician coverage in their emergency departments, but no one was ultimately responsible for making sure the shifts were covered,” wrote co-founder Dr. Randal Dabbs in a 2018 column in an industry publication.

Southeastern would take on that responsibility. “Our goals have never included conquest, but instead, true collaboration and servant leadership,” Dabbs wrote.

In 1994, Southeastern merged with three other doctors groups to become TeamHealth. It had 200 ER physicians at 27 hospitals in four states, according to a Modern Healthcare article published that year.

TeamHealth now has more than 16,000 physicians and clinicians, according to the company’s website. It provides medical professionals to 3,300 medical facilities and physician groups in 47 states.

“They provided great care in our emergency room, and because they provided great care, they continued to grow,” said Baptist Memorial Health Care’s president and chief executive officer Jason Little, who in 2003 signed the TeamHealth contract for Baptist Collierville’s emergency department.

Private Equity’s Rise in Health Care

With $554 billion in assets under management, the Blackstone Group is one of the world’s largest private equity firms.

Increasingly, health care is an attractive target for private equity, thanks to an aging population and a rise in chronic disease. The growth is highest in specialties where the need for a long-standing doctor-patient relationship is low, such as emergency medicine, anesthesia and care provided to patients when they are hospitalized (a medical specialty known as hospitalists).

The 2017 acquisition was Blackstone’s second investment in TeamHealth, after buying it in 2005, taking it public in 2009 and then selling its interest four years later.

Proponents of private equity argue that its profit-driven mission helps keep afloat sectors that serve the public good. At least 150 public pension funds invest in private equity, including Blackstone, with higher annual returns than other types of investments, according to a recent report produced by an industry lobbying firm.

But critics such as Eileen Appelbaum, co-director of the nonprofit Center for Economic and Policy Research, a left-leaning think tank based in Washington, D.C., lament its growing influence in health care.

“Private equity firms buy small competitors to add on to an initial acquisition, building national powerhouses without any antitrust supervision,” Appelbaum testified at a congressional committee hearing last week about private equity. She cited TeamHealth and its competitor Envision Healthcare as prime examples of how this practice harms consumers. “They use surprise medical bills, or the threat of such bills, to get much higher payments than other doctors receive, driving up health care costs.”

A New York Times investigationin 2016 found that after private equity firms took over ambulance companies, some response times slowed and billing practices became more aggressive. Soon after, the companies went bankrupt — leaving gaps in emergency response across the northeast. Citing that report, Rep. Maxine Waters, D-Calif., the chairwoman of the House Financial Services Committee, raised concerns in the hearing last week about private equity firms managing public services including health care.

In 2017, the year Blackstone acquired TeamHealth, the disclosed value of private equity health care deals exceeded $42 billion — the highest level since 2007 — according to a market research report. The following year, the private equity firm KKR acquired Envision, which operates Emcare, another physician staffing firm, for $9.9 billion.

In public filings, Emcare reported that it operated in 45 states in 2017, while TeamHealth said it had a presence in 47 states that year.

TeamHealth estimated that the market for emergency medicine was $12 billion, according to its filing with the U.S. Securities and Exchange Commission. It claimed a 17 percent share of that market, which in 2016 accounted for 57 percent of its revenue.

Appelbaum, like other experts interviewed for this story, had not heard of instances in which private equity-backed doctors groups sued patients.

In separate interviews before TeamHealth said it would stop suing patients, officials at TeamHealth and Baptist said Blackstone’s acquisition had no effect on collection efforts.

“Yes, we were acquired by Blackstone in 2017,” said Joe Carman, TeamHealth’s chief administrative officer. “But we have not had any change in practice as it relates to pursuing patients and legal strategies in that time.”

Baptist’s Little agreed. “We’ve not seen any changes,” he said.

But the lawsuits show something began to change about the same time.

From Zero To Hundreds Of Lawsuits

In 2011, Southeastern did not appear as a plaintiff in any lawsuit filed in Shelby County General Session Court. In 2013, there were just over 100 suits filed by Southeastern, and the next year, more than 600.

Both Little and Carman speculated that increased volumes of patients treated at Baptist’s emergency departments were partially to blame.

However, such an explanation is not borne out by the data.

Between fiscal 2016 and 2018, the number of visits to three of the ERs staffed by Southeastern doctors — Baptist Memphis, the suburban Baptist Collierville and Baptist DeSoto in Southaven, Mississippi, just over the state line — grew by 12 percent , according to figures provided by Baptist. But the number of Southeastern lawsuits grew by 132 percent — from 798 to 1,855 — from calendar year 2016 to 2018, according to Shelby County General Sessions Court records.

One of the defendants is Laurie Kimbrough, 62, who went to Baptist Memphis in March 2017 complaining of flu symptoms.

When the bill arrived, she tried to make payment plans with Baptist but said the representative she talked to wouldn’t agree to a payment she could afford.

The bill went to collections and this March, Baptist sued her for nearly $1,300, not including court costs and attorney’s fees.

By that time, she’d lost her job and had started a small lawn care business. When the weather is good, she manages to make a few hundred dollars per week, if the lawn mower and blower don’t need repairs.

Family friends gave her money to pay off the Baptist bill, but three weeks after Baptist sued her, she was sued by Southeastern.

Even though she owed around $400, Kimbrough said she didn’t have it. When a longtime friend learned she’d have to pay interest on the relatively small bill, he gave her the money and refused to let her pay him back.

Health care expenses have an oversized impact in Tennessee, where 1 in 4 residents has a medical debt on their credit report, the 10th highest rate in the nation, according to a report this year by the Sycamore Institute, a nonpartisan think tank.

Memphis is the second-poorest large metropolitan area in the United States, so the impact is even more acute here. Inside the city limits, more than a quarter of residents live below the poverty line, according to the most recent census figures. More than 40 percent of workers in the city earn less than $15 an hour, according to one economic development report.

Kimbrough’s current insurance plan covers just three primary care doctor visits per year, which she’s already used. She doesn’t have the $60 copay to see a neurologist for her ongoing leg pain, much less any other diagnostic tests the doctor might order.

In February 2018, Kimbrough went to Baptist’s emergency room again with flu symptoms. The bill was over $1,300, but she was able to negotiate the hospital down from the $100 per month payment it initially demanded.

“I said I’ll come up with the $55 a month, even if it means I have to eat Vienna sausages 7 days a week,” Kimbrough said.

Court records show that on Nov. 4, Southeastern sued Kimbrough again. She has yet to be served with the lawsuit.

Charity Care Elusive by Design?

Baptist, which started in 1912 with a single 150-bed hospital, is a faith-based institution whose mission is “in keeping with the three-fold ministry of Christ — Healing, Preaching and Teaching.” It now has 22 hospitals, dotted mostly in rural communities in eastern Arkansas, West Tennessee and Mississippi.

“If it weren’t for Baptist and our mission,” Little said, “there wouldn’t be hospitals in a number of communities around the three-state region that we serve.”

At Baptist, insured patients receive a partial discount for bills over $5,000 for a single visit, regardless of income. Uninsured patients with a household income less than 200 percent of the federal poverty guidelines are eligible for a 100 percent discount on hospital charges. Even patients making 400 percent of the federal poverty guidelines — or just over $85,000 for a family of three — would be eligible for an 80 percent discount.

Baptist prefers that all doctors groups that operate in its facilities apply the hospital’s financial assistance policy to patients, but Little said he couldn’t discuss whether the hospital’s contract with TeamHealth requires it to do so. TeamHealth did not respond to a request from Baptist to provide the system permission to discuss the contract, Little said.

In an interview before TeamHealth changed its policy, Carman said the company’s internal policy is to match Baptist’s charity care discount if a patient submits written proof of the financial assistance Baptist provided.

However, TeamHealth’s billing statements haven’t mentioned charity care. And the firm is not on Baptist’s list of providers that participate in the hospital’s financial assistance program.

In interviews, two former TeamHealth call center agents said they were instructed not to mention charity care unless patients did so first.

Between 2017 and 2018, Sharon Lovingood was one of about 100 employees fielding patients’ calls from a single-story TeamHealth office in Knoxville. “We were the first person they talked to for any issues,” she said. When she worked in the U.S. Department of Education’s student loan division between 2012 and 2017, managers encouraged her and her colleagues to find solutions for those who called in.

But not at TeamHealth.

“A lot of times, a patient would call in and say, ‘Hey, can you give us a discount?’ But we had to say, ‘No, I can’t do that,’ because we weren’t allowed to say, ‘Well, did you apply for charity care at the hospital?’” Lovingood said. “They didn’t want us doing that.”

She asked her supervisors why and said she was told that the hospitals and billing groups TeamHealth had contracts with didn’t want call center workers bringing it up. Lovingood said she left the job in February 2018 because she could not stomach the restrictions that stopped her from helping people. “I was miserable working there.”

Sherry Breitung, who worked as a national patient service representative in Knoxville from 2014 to 2018, also said she asked for an explanation about the policy but didn’t get one. One thing was clear, though: “We weren’t allowed to mention charity care to the patients.”

Since all of their calls were monitored and reviewed by supervisors, Breitung and Lovingood, who don’t know each other, each said they devised their own work arounds — such as asking patients, “Did the hospital help you?” But the four minutes allotted per phone call wasn’t enough to help patients understand their options, they said.

Carman, on the other hand, said he thought call center agents were instructed to bring up charity care. “We are attempting always to try to understand their circumstance, and we’re trying to understand charity care.”

After additional questions, TeamHealth CEO Murphy said in his letter to employees that effective Dec. 1, the company would begin including eligibility criteria for charity care in patients’ invoices to make it easier to find.

After a reporter asked Kimbrough if the ER doctors had offered her charity care, she called TeamHealth to inquire.

“I said, ‘I need to talk to someone in your charity division,’” Kimbrough recalled, “and they said ‘What?’”

She said she was put on hold and then transferred to another call center agent, who asked her if she wanted to set up a payment plan.

“I said, ‘I want to know if I can’t pay, if you have a charity division,’” Kimbrough said.

The representative then told her that if she’d gotten a charity care discount from Baptist, she could send proof to TeamHealth and they’d consider her for the same discount.

But Kimbrough is uneasy with the idea of getting financial assistance. “I feel like if I pursue charity, there’s somebody who won’t get it who needs it worse than me.”

“Some way it’ll all work out,” Kimbrough said. “If it doesn’t, I’m lucky that if I lost everything I could go and live with my mom.”

Hospitals are abdicating their responsibility to protect patients from financial harm when they hide behind firms to which they’ve outsourced services, said Michele Johnson, executive director of the Tennessee Justice Center, which advocates for expanded health care access.

“Particularly with hospitals that have a mission that is aligned with treating low-income folks with fairness … it’s unfortunate that they’re not having people who intersect with their patients follow that same charitable mission,” Johnson said.

Health care is a necessary and often unavoidable expense, Johnson said. “These are not designer jeans. These are not video games. This is a whole different thing.”

Questions Remain For Hospital, Patients

TeamHealth declined to answer questions about its timeline for dropping existing lawsuits or whether its decision will apply to lawsuits that have already resulted in judgments, saying in a statement, “TeamHealth will not file additional cases naming patients as defendants and will not appear in any pending case.”

After MLK50-ProPublica’s investigation into Methodist Le Bonheur Healthcare’s debt collection practices, the nonprofit hospital dropped hundreds of lawsuits for unpaid medical bills and expanded its financial assistance policy to cover families making up to 250 percent of the federal poverty guideline, which will cover more than half of Memphis-area households. It has not filed any lawsuits since July 3.

It’s unclear whether TeamHealth’s change will shift the responsibility of unpaid bills from patients to Baptist.

In his letter to employees, TeamHealth’s CEO pointed the finger at insurance companies, noting that the share of insured patients with deductibles of more than $1,000 has risen sharply over the last five years. (In most cases, patients must pay deductibles out of pocket before their insurance coverage kicks in.)

The typical contract with a physician staffing firm calls for the hospital to guarantee enough business to at least break even, Little said.

“If they can’t do that on their own billing and collection, then they, generally speaking, look to the hospital for a subsidy to make them whole,” Little said.

He said he hasn’t spoken with TeamHealth since its statement was issued but doesn’t anticipate any changes. “We have a contract and it’s in place.”

Little was cautiously optimistic about the end of TeamHealth’s lawsuits for unpaid ER doctors’ bills. “It sounds like it’s going to be a benefit for patients, so I’m anxious to study it,” he said.

Through a spokesperson, Blackstone said it was not involved in “these specific practices at the company, which we understand are quite common in the broader industry. However, we fully agreed with and support TeamHealth’s determination to discontinue it.”

TeamHealth’s decision comes just in time for Loretta Baxter, who went to court Friday to keep Southeastern from garnishing her paycheck.

Baxter, 33, didn’t have insurance when she visited a Baptist ER in 2017 for stomach pain and couldn’t afford the $1,111 doctor’s bill.

In April, Southeastern sued her, and on Thursday, her employer told her that it had received a garnishment attempt that could take up to 25 percent of her paycheck.

That would leave her with $250 less to cover her rent, car note, insurance and expenses for her three children. She makes about $11 an hour as a caregiver at a social service organization for people with disabilities.

Baxter left court with paperwork to take to her employer that would postpone the garnishment until a Dec. 2 hearing. “I try not to let things stress me out because stress can kill,” Baxter said at court.

When a reporter asked TeamHealth how its decision would impact patients like Baxter, TeamHealth said that the outside collection agency “is sending a release to remove the garnishment and will be working with the court system to process it as soon as possible.”

Democrats: Get Real On Health Care

In listening to the Democratic presidential debates, we might conclude that “Medicare for All” is a legislative possibility. It is not, and any presidential candidate with a scintilla of self-respect must admit that fact. A recent Kaiser Family Foundation poll found that just 30 percent of Americans “strongly favor” a plan in which all of us get medical care from a single government plan, while 33 percent of us “strongly oppose” such a major change. Moving public opinion and persuading a deeply divided Congress to enact life-altering changes, the prospects of which understandably scare many congressional constituents, is tough, controversial, politically hazardous and even a career-threatening challenge. It will not be magically achieved — in fact, it is made less likely — by its advocates’ regularly asserting their moral superiority over those not on their side.

A quick review of post-World War II American health care reform efforts might be helpful. President Harry Truman advocated universal health insurance coverage, but opponents, led by the American Medical Association, branded it “socialized medicine.” President John Kennedy unsuccessfully backed legislation to provide health insurance to those over 65. President Lyndon Johnson’s landslide victory gave him the congressional muscle to pass both Medicare and Medicaid in 1965. The most ambitious efforts of Presidents Jimmy Carter and Bill Clinton to expand coverage to all Americans were defeated, and it was not until 2009 — some 60 years after Truman pushed it — that President Barack Obama, over all-out partisan resistance, was able to sign the Affordable Care Act passed by Democrats in the House and the Senate — a vote, let it be noted, that cost the Democrats their congressional majorities in the very next election. It would take a full nine years — when a new Republican president pledged to repeal the Obama-era health law — before a majority of Americans registered their approval of that controversial Democratic law.

Don’t pretend changing the law on health care is going to be easy or painless. Where is the 2020 reincarnation of Bill Bradley, the former New Jersey senator and Princeton All-American? History will show that he was the architect-engineer and father of the memorable 1986 Tax Reform Act that dramatically lowered American tax rates while abolishing most deductions and loopholes. Bradley had begun four years earlier, by relentless study, to seek out experts in order to master the tax code.

He wrote a well-received book on his Fair Tax idea. He spoke to hundreds of business, civic and university groups on the decidedly unsexy subject. He did interview after interview with editorial pages and reporters (I can attest) and radio stations. He proselytized Republicans as well as Democrats, and the tax plan he co-authored with then-Rep. Dick Gephardt of Missouri grabbed the attention of then-President Ronald Reagan, who announced a presidential task force to respond to Bradley’s tax reform. Bill Bradley persisted. Without fanfare, away from the spotlight and the cameras, he did the hard work of going to House members’ offices; answering questions one-on-one; and courting, with candid information, Congress’s two chief tax writers: Rep. Dan Rostenkowski, the tough Chicago Democrat, and Sen. Bob Packwood, an Oregon maverick Republican. Thus was born tax reform.

Where is the Bill Bradley of Medicare for All or Medicare for Some who is willing to do the tough, tiresome, painful, unapplauded work of reaching out, enlisting supporters, answering doubts and being the workhorse instead of the show horse? I haven’t seen him or her on the debate stage yet.

To find out more about Mark Shields and read his past columns, visit the Creators Syndicate webpage at www.creators.com.