• Why would a woman let her breast cancer grow for years without seeing a doctor, until her breast literally fell off? Dr. Otis Brawley, a distinguished oncologist and public policymaker, describes the constellation of racial, historical, cultural, and economic factors that sent a 53-year-old woman to Brawley’s Atlanta ER carrying her breast in a plastic bag. The answers say a lot about what’s wrong with our health care system and our society at large. [Atlanta Magazine]
• Maia Szalavitz builds on the New York Times’ scoop about debt collectors stalking the halls of hospitals shaking down patients with the hospital’s blessing. [TIME]
• Sara Kliff interviews the woman who runs the Massachusetts health insurance assistance line. Kate Bicego may not have a fancy title or a prestigious academic appointment, but she may know more than anyone else about how to implement Obamacare. [WaPo]

[Photo credit: Wander Mule, Creative Commons.]

“Embedded” debt collectors prowl the corridors of hospitals, shaking down patients, and even discouraging perceived deadbeats from seeking emergency care, Jessica Silver-Greenberg reports for the New York Times:

Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.

This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.

The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.

By law, hospitals must provide emergency care, even to the destitute. If a hospital “embeds” a debt collector to deter a patient from seeking care and that patient dies because she went untreated, are the hospital and the debt collector liable? 

Silver-Greenberg notes that the Accretive Health’s aggressive tactics are part of a larger trend of hospitals signing over core functions to debt collection agencies in an attempt to recoup more money. Critics worry that giving debt collectors this kind of access could compromise patient safety and privacy. Hospitals claim they have no choice because they are hemorrhaging billions of dollars a year in uncompensated care.

If you need an argument for universal health insurance, Silver-Greenberg has supplied one. 

[Photo credit: Which one is the debt collector? For illustration only. By Agência de Notícias do Acre, Creative Commons.]

Selena Ross digs deep to expose the sordid subculture of Montreal snow removal for Maisonneuve magazine. A handful of established snow removal companies divide the borough contracts between them. Bid-rigging is the norm and upstart competitors are kept in check by sabotage and even violence:

Over the course of a year-long investigation, Maisonneuve analyzed about 250 snow-removal contracts and interviewed more than a dozen private contractors, their employees and the municipal bureaucrats who administer their work. (All sources requested anonymity for their own safety; identifying details have also been omitted.) These sources described bid-rigging as a fact of life in the industry. More crucially, they said, Montrealers don’t understand how fiercely the system is maintained through violence and coercion. Those who obey are rewarded with extra, ill-gotten profits. Those who don’t play along are punished. A former employee of one of Montreal’s snowplow giants put it succinctly. “Snow removal,” he said, “is one of the biggest rackets there is.”

[Photo credit: Robbie1, Creative Commons.]

Friday’s labor breakfast panel asked: Is a multi-racial working class coalition still possible? Moderator Dorian Warren, a professor of political science at Columbia, framed the discussion in terms of America’s enduring racial divide; the Baby Boomers vs. the Milennials; the role of money in politics; and the electoral wildcard of the Occupy Movement.

Political scientist Ruy Teixeira explained that Obama won 80% of the non-white vote in 2008, but lost the white working class by 21 points. Journalist Thomas Edsall argued that the current Democratic coalition is strong enough to put the Democrats back into office, but that the Dems need to win more white working class votes in order to credibly claim to represent the average working person.

AFL-CIO official Julie Greene described the AFL-CIO’s strategy going into 2012: Building infrastructure to mobilize voters and protect the electorate from voter disenfranchisement. Minority voters are most likely to be disenfranchised by voter ID laws and other Republican-backed initiatives to make voting more difficult. Massive minority turnout helped put Obama over the top in 2008 and that surge did not go unnoticed by the other side, Greene said. Voter ID laws were introduced in all but three states. She estimated that 5 million people were disenfranchised across the 6 states that enacted voter ID laws.

The panel was sponsored by the Murphy Institute, CUNY, and the Sidney Hillman Foundation.

[Photo credit: Lindsay Beyerstein, all rights reserved.]