Since millions of American patients face medical debt they didn't know they'd have - and many if not most of them purchased insurance to protect against that debt - it seems logical to me that patients should be fully informed up front of the financial risks they are taking on when they seek medical care. Doctors and others providers should publish and post in their offices their methods of debt collection and the numbers of patients they sue in an average practice year. They can put the disclosures of medical debt collection practices right next to the little signs that tell patients they must pay their co-pays prior to receiving medical care.

I shared the idea with my University of Chicago educated son, and he liked it. He said, "Even Vegas has to disclose the odds of winning." True enough. Even those who love the market economy like to know as much as possible about their financial entanglements before they enter them.

Disclosure. Disclosure. Disclosure. (Much like the old real estate advice - location, location, location.) Financial. Debt collection practices. Health condition outcomes.

So, along with the releases and privacy statements and risk assignment forms I must sign before I am accepted as a patient, providers should also publish their outcomes evidence as well. How am I to know if a given provider is just good buddies with the referring physicians or if they truly have a success record with the condition for which I require care?

I'd feel better about reform that promised those things than I do about a reform measure that simply forces me to purchase the defective financial product sold as private health insurance. Private health insurance is marketed to me to protect my health and wealth, and yet it may or may not do either. It's a crap shoot.

Did you know some medical providers in Pennsylvania go to what's known as "collectors' universities" to learn how to collect their medical debt from the families of deceased patients? They study two legal documents offered by the collection experts: the "Doctrine of Necessities" and "Collecting from the Deceased." Ouch. Imagine that after your loved one's for-profit private insurance company fails to pay all the bills when a child or spouse or parent dies. And Pennsylvania providers are no different than many others around the nation. Collecting medical debt is big, big business.

So regardless of what this Congress does or what this President celebrates in the Rose Garden framed by the billowing cherry blossoms, I'll still be slugging it out in the front offices of providers, at the admissions desks in hospitals and at the pharmacy counters to try to secure the care I need and pay for. Nothing has been done to improve my chances of getting what I bargained for as a patient. I am to accept on good faith what the providers secure as a legal guarantee from me.

I want a single standard of high quality care through progressive financing. I want to be able to choose the care that is high quality. I simply cannot do that unless and until my rights as a patient are protected. And we are a long way away from that day. Under an improved Medicare for all system, I would be saved from the terrible loop that is the medical collection system in this nation. I'd still want to know health outcomes data, but that would be far easier to obtain and track. Wow, imagine that.

Should gamblers playing slot machines really be given the legal right to know pay-out odds in a nation that thinks patients have no right to knowledge of results expected from their medical care providers? Surely, reputable providers could not object to that sort of patient or citizen empowerment.

But wait. A lawyer friend of mine from Colorado tells me that hospitals and many doctors could hardly be less cooperative in talking about this topic. Big surprise.

The day will come when patients will be the center of this debate. It has not come yet. This Congress and this administration have never put our interests first, so this effort was flawed from the start. Because the improvements I need to see as a patient are nowhere to be found in this mess, I understand why people lose interest in the fight. The disconnect between what we need and what we are getting from this round of health reform effort as patients and as citizens is a chasm too deep.

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Donna Smith, American SiCKO



About author Donna Smith is a community organizer for the Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign