"Then we have to wait to see what happens. ... Many will pay if they are trying to purchase a large item. Many patients have jobs with good benefits, but do not wish to have the insurance coverage, especially government employees."
Carroll Hospital Center said it sues based on debts over $500, credit rating, and work history. "A mortgage is an indicator for suit," the hospital wrote.
Calvert Memorial Hospital said it will seek a lien on a home or car if the debt is $500 or more. And Garrett County Memorial Hospital said it considered the ownership of two cell phones and a savings account as evidence a person could pay bills.
'Created to help people'
When state officials began regulating hospital rates in 1974, they saw the system as a model for the nation; a way to hold down soaring health care costs and prevent hospitals from "dumping" patients who were poor or lacked insurance. The system made it worth the hospitals' while to treat all comers.
"In order to take care of losses in the emergency room, they were raising costs in the hospital," Mandel said. "The hospitals, including Hopkins, were not created to lose money, but they weren't created to be moneymakers. They were created to help people."
Today, the system that Mandel helped create is run by the Health Services Cost Review Commission in Baltimore, whose seven volunteer members are appointed by the governor, mostly from within the health care industry. The current commission includes the chief executive of Holy Cross Hospital in Silver Spring, a medical director at University Specialty Hospital, a former trustee of the Greater Baltimore Medical Center, and a retired physician who is former president of the Health Insurance Association of America - an early supporter of rate regulation. The panel doesn't have a consumer representative.
Members proudly tick off the system's accomplishments, arguing that hospitals' costs in Maryland are now below the national average and that state regulation of rates has allowed hospitals for the most part to benefit financially. They say that uninsured people in Maryland pay far lower hospital rates than in other states. In other states that encourage hospitals to compete against each other over prices and services, they argue, a number of institutions have been forced out of business, causing catastrophe in the communities they served.
Yet it's difficult to tell whether the compensation formula for free and unpaid care is working as intended.
