Essay Instructions: Here is a link to the video of the hearing I need to review on C-span
http://www.c-spanvideo.org/program/292354-1
Here is the instruction from the instructor on how to write the paper;
You still should imagine you work for a particular health or health care-related interest group.
You want to attract the attention of specific policymakers (legislators or regulatory bodies), or other health care leaders, that are key to changing some policy that will better your cause. Knowing that their time is valuable, and their attention spans are short, try to formulate a memo to catalyze action.
In this memo you are supplementing your recommendations with the relevant viewpoints expressed at a recent health policy session.
You will base this memo on a health policy session you either attend or watch that is related to your area of interest.
Students are to write a 3 page letter/statement (single-spaced) that is a summary of the session and that could be used to influence a legislator/regulatory body or health system leader on a specific issue that would be of particular interest for your group.
The letter should:
- Present a clear discussion of the scope of the issue/problem, and important developments that led up to the session.
- Offer a concise history of the issue, particularly those that are relevant to the session.
- Provide a summary of the session, highlighting the contrasting viewpoints.
- Inform the legislator/regulator/health care leader why the issue/legislation/regulation covered at the session is important to your particular interest group, individuals/groups like yours, or those impacted most.
- Clearly present the pros/cons of a policy swinging in a particular direction, which may have been fully covered at the session.
- Explain why a legislator/regulatory body/health care leader should respond in a specific manner. Specifically state why this issue should be important to them.
- Base your assumptions on facts and acknowledge those opinions that mirror your own, and incorporate statements from the session.
- The logic of your argument is of the utmost importance and will be highly scrutinized.
- Try and anticipate questions from the reader and avoid gaps in background, history, etc.
- Cite all references, when possible.
- Write clearly and succinctly, using proper structure and headings to best guide and inform the reader. The organization of your thoughts and designing your memo around specific sections - that target history, the session, viewpoints your specific recommendations, etc. - are key.
here is an example of a paper written by someone before
Senate Judiciary Committee Hearing: Bankruptcy and Medical Debt
Health Policy
HESY-621
Health Policy ??" Dr. Ormsby
November 3, 2009
Senate Judiciary Committee Hearing: Bankruptcy and Medical Debt
Medical Debt and Bankruptcy ??" Introduction & Background:
In 2009, comprehensive reform of the U.S. health care system is at the top of the nation’s domestic policy agenda. Both the Obama Administration and leaders of the key health committees in both chambers of Congress have made health reform their top priority. In this light, the Senate Judiciary Administrative Oversight and the Courts Subcommittee held a hearing on October 20, 2009, to deliberate on proposed legislation to address medical debt and bankruptcy.
The relationship between medical debt and bankruptcy has been a key concern for those seeking comprehensive health care reform. Indeed, a recent report from Harvard University (Himmelstein, Thorne, Warren, & Woolhandler, 2009) asserts that medical debt is a driving force in over 60% of annual U.S. bankruptcy filings. Senator Sheldon Whitehouse (D-RI), who chaired the hearing, talked about his proposed bill S.1624, the Medical Bankruptcy Fairness Act of 2009, which seeks to change current U.S. bankruptcy laws in order to reduce the number of people filing for bankruptcy because of medical debt (Medical Debt, 2009). Witnesses Elizabeth Edwards and John Pottow spoke in support of Senator Whitehouse’s bill, stressing the unique and debilitating impact of medical debt on American families. Witnesses Aparna Mathur and Diana Furchtgott-Roth presented in the opposition, emphasizing the various unintended consequences of such legislation, both for the bankruptcy system and the economy at-large.
Until S.1624, recent attempts at bankruptcy reform that address the nature of medical debt have been nonexistent. In 2005, Congress enacted the Bankruptcy Abuse Prevention & Consumer Protection Act (BAPCPA), which instituted an income screen and procedural barriers that made filing more difficult and expensive. BAPCPA’s new restrictions fell equally on medical and nonmedical bankruptcies, with no preference for medical debtors (Himmelstein et al., 2009). The favorable political climate for health care reform and the recent Harvard study appear to be the main impetus for this topic’s emergence in 2009.
Linkage Between Medical Debt and Bankruptcy:
Recent evidence suggests a strong relationship between medical debt and personal bankruptcy in the U.S. This August, Harvard researchers published the results of a national study of medical bankruptcy. The researchers surveyed a random national sample of bankruptcy filers in 2007, abstracted their court records and conducted interviews. Bankruptcies were designated as “medical” based on debtors’ stated reasons for filings, income loss to illness, and the magnitude of their medical debts. The study found that 62.1% of all bankruptcies have a medical cause. These “medical debtors” were characteristically well-educated and middle class; three quarters had health insurance. The Harvard study further revealed that the share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007 (Himmelstein et al., 2009).
Furthermore, as Seifert and Rukavina (2006) claim, medical debt affects approximately 29 million nonelderly adult Americans, with and without health insurance. According to their analysis, 58 million adults, which includes both the uninsured and underinsured populations, are at a high risk of incurring unaffordable medical bills. They state that medical debt is pervasive and damaging not only to personal finances but to health care access as well. Indeed, medical debt creates health care access barriers akin to those faced by the uninsured by altering the care-seeking behaviors of the underinsured. According to Seifert and Rukavina (2006), “People with medical debt ??" both uninsured and those with private insurance ??" are much less likely than those without debt to fill a prescription, see a specialist when needed, or visit a doctor or clinic for a medical problem, and they are more likely to skip a needed test, treatment, or follow-up.”
A 2008 study released by the Center for Studying Health System Change presents similar data, claiming that more than 57 million Americans experienced problems paying their medical bills in 2007 and 42.5 million of them had no insurance coverage (Cunningham, 2008). According to study author Peter Cunningham, “Increases in problems paying medical bills are affecting not only those who have always struggled with medical costs ??" low-income & uninsured ??" but also an increasing number of insured middle-income families.”
However, other sources claim that the link between medical expenses and personal bankruptcy is dubious. As Skinner (2009) states, according to a Department of Justice report, in 2005 medical spending was a contributing factor in only 17% of U.S. bankruptcies. Skinner declares that the findings of the recent Harvard study are due to a “generous” definition of what constitutes an episode of medical bankruptcy. He concludes that the majority of debt among bankrupt consumers in the U.S. is comprised of non-medical expenditures and is therefore unrelated to health insurance coverage (Skinner, 2009).
Senate Committee Hearing:
To reiterate, the U.S. is in the middle of a national debate regarding the appropriate breadth and scope of health care reform. In broad terms, President Obama, Democrats, liberals, and other special interests support greater government intervention into health care systems to expand health insurance access among other goals. Bankruptcy reform is desirable in order to help mitigate and reduce medical bankruptcies. In contrast, Republicans, conservatives, and other stakeholders, support certain, limited market reforms to increase competition within health care systems and control costs.
Testimony of Senator Sheldon Whitehouse (D-RI)
Senator Whitehouse begins with remarks concerning his perspective on bankruptcy and medical debt, declaring it time to fix the “bankruptcy system’s cruel effect on millions of American drowning in medical debt.” He states, “As health care costs continue to increase, so do the numbers of people who go bankrupt.” He refers to the 2009 Harvard study, stressing that medical debt is a driving force in over 60% of bankruptcy filings (Himmelstein et al., 2009). Whitehouse asserts that these medical debtors acted responsibly and thought they were adequately insured, but were bankrupted by co-pays, deductibles, premiums, coverage limits, and uncovered expenses. He concludes, “Families that think they are protected may be only 1 accident, 1 injury or 1 diagnosis away from bankruptcy.” According to his perspective, medical debtors are a unique group and deserve special status in the bankruptcy system.
Senator Whitehouse then introduces his plan for medical debtors, S.1624. As Whitehouse states, “Unfortunately, the bankruptcy code does not distinguish between debtors driven into bankruptcy by medical bills and those who become insolvent because of poor planning & overspending.” If enacted, S.1624 would waive procedural hurdles for bankruptcy filers with high medical debt and waive the means testing and credit-counseling requirements ??" all of which Whitehouse deems unnecessary, time-consuming, costly, and even humiliating for debtors forced to file due to medical misfortune. Additionally, the bill would make pre-petition attorneys fees non-dischargeable in bankruptcy, giving debtors the option of paying their attorney fees when they are on firmer financial ground after completing the bankruptcy. All told, bankruptcy proceedings via S.1624 would allegedly be more accessible, more viable, and less expensive for medical debtors.
Testimony of Elizabeth Edwards, Senior Fellow, Center for American Progress
Elizabeth Edwards states that in order to seek genuine comprehensive health care reform in the U.S., the issue of medical debt and bankruptcy must be considered. She declares that excessive medical debt is a critical concern because it is symptomatic of an out-of-control health care system driven by “skyrocketing costs”. She then highlights several causes of medical debt, particularly the elevated levels of uninsured and underinsured populations in the U.S. Edwards states that the poor and uninsured are especially susceptible to high medical debt and are therefore most vulnerable to medical bankruptcy. In order to finance their medical expenses, she explains how these underinsured and uninsured are borrowing heavily with credit cards, second home mortgages, retirement funds & personal savings, or even forgoing other essential purchases. Edwards supports S. 1624 because medical debtors are a distinct group and deserve unique treatment. As such, they should be given enhanced access to bankruptcy proceedings.
Testimony of John Pottow, Professor, University of Michigan Law School
John Pottow’s testimony was essentially an endorsement of the 2009 Harvard study on bankruptcy and medical debt. He commends the research design, methodology, and results, and in combination with other sources, concludes that there is an unmistakable linkage between bankruptcy & medical debt in the U.S.
Testimony of Senator Jeff Sessions (R-AL)
Ranking committee member Senator Jeff Sessions begins by pronouncing his opposition to the proposed legislation. He rebuffs notions that medical bankruptcy is an extensive problem in the U.S., citing that less than 1% of the population file for bankruptcy annually. Sessions takes particular exception with the bill’s proposal to eliminate the means test requirement. Used to determine bankruptcy proceeding status, the means test plays a key role in determining whether the individual can file for Chapter 7 bankruptcy, where they can have their dept wiped out, or Chapter 13 bankruptcy, where they may be required to pay back some portion of the debt. He claims that the existing means test is defensible, appropriate, and not a burden to debtors. It should therefore not be altered. S.1624 is unnecessary because those with high medical debt are already able to quality for chapter 7 bankruptcy proceedings via the means test. Additionally, Sessions explains how the means test already has a provision for special circumstances which includes high medical debt. All told, Sessions opposes S.1624 largely because he believes that there is already an appropriate process for medical debtors to file for bankruptcy ??" the means test.
Aparna Mathur, Research Fellow, American Enterprise Institute
Aparna Mathur explores the provisions of S.1624 that will help or hinder the efficient functioning of the bankruptcy system. She claims that certain provisions of the act will have the unintended consequence of opening up the bankruptcy system to abuse and fraud. Specifically, because the act gives medical debtors easier access to Chapter 7 proceedings it produces a strategic behavior whereby opportunistic debtors have an incentive to accumulate specifically medical debt. These “medical debtors” would be given easier access to bankruptcy proceedings where their debt could be wiped out. At the least, Mathur believes S.1624 would create a moral hazard toward accruing medical debt. Additionally, by removing the means testing requirement, high income debtors would be allowed to not only walk away from their medical debts but also other debts including credit card. The end result is that credit card companies and creditors will increasingly shoulder the financial loss from medical bankruptcies. According to Mathur, this will adversely affect the credit market at-large, causing interest rates to increase and credit to be rationed. Thus, the true costs of this reform will be passed onto consumers. Mathur opposes the bill because its unintended consequences will adversely affect creditors and credit markets, which will negatively impact the economy at-large.
Testimony of Diana Furchtgott-Roth, Senior Fellow, Hudson Institute
Diana Furchtgott-Roth immediately declares her opposition to the bill, stating the dubious link between medical debt and bankruptcy. She continues that concerns regarding medical debt and bankruptcy are being improperly and even disingenuously used as another indicator of the need for national health reform at-large. However, instead of addressing the merits of S.1624, she attacks the major health reform bills themselves. She states that both the Senate H.E.L.P. and Senate Finance Committee health reform bills would exacerbate medically-related bankruptcies in the U.S. As evidence, she claims that health care spending would rise as premiums increase substantially. She concludes remarks with generalized opposition points to both H.E.L.P. and Finance bills, stating that they will increase costs, lower wages, increase part-time work at the expense of full-time jobs, outsource jobs, and decrease funds for Medicare & Medicare. Instead of discussing bankruptcy & medical debt and addressing the virtues of S.1624, Furchtgott-Roth used the hearing as a forum to attack “liberal” health care reform proposals at-large.
Analysis and Recommendation:
Medical debt is a significant financial burden and a key contributor toward bankruptcy in the U.S. Although the severity of the problem is tied to the definition of an episode of “medical bankruptcy”, it is clear that medical expenditures are an important contributor toward declaring personal bankruptcy. As the Harvard study indicates, medical bills are a significant driver in over 60% of bankruptcies. Indeed, over 75% of these medical debtors had health insurance (Himmelstein et al., 2009). Even a less inclusive definition of medical bankruptcy still illustrates the widespread burden of medical debt, particularly within the uninsured and underinsured populations (Cunningham, 2008). The problem is therefore less about the linkage between medical debt and bankruptcy and more about formulating an appropriate policy solution.
Via S.1624, Whitehouse, Edwards, and Pottow advocate a solution that seeks to reduce medical bankruptcies and mitigate the effects of medical debt by providing medical debtors with easier access to more “favorable” bankruptcy proceedings. Their logic is that because medical debtors were largely acting financially responsible, they deserve enhanced status and should be allowed to sidestep the “burdens” of the current bankruptcy system, including the credit counseling and means test requirements.
To be sure, the prevalence of medical bankruptcies must be reduced and those individuals filing for bankruptcy due to medical debt are indeed unique. Even though these debtors may indeed deserve enhanced bankruptcy status as many acted “financially responsible”, S.1624 seems more of a quick fix rather than a lasting policy solution to underlying problems. Regardless of the differentiation of medical debtors and their treatment by the bankruptcy system thereafter, the real issue should be how these debtors came to have high medical debt in the first place. To be sure, it is unclear how Whitehouse’s bill will reduce the number of people filing for bankruptcy due to medical debt as intended. S.1624 seems to only scratch the problem’s surface by supporting medical debtors as they file for bankruptcy as opposed to reducing the factors that created the need to file. As far as the hearing demonstrates, S.1624 does little to address the root causes of medical debt, namely tremendous medical costs and the high prevalence of the uninsured and underinsured. As such, regardless of whether medical debtors deserve special status, if the goal were genuine health care reform, I do not support this bill. By supporting those believed to have acted “responsibly” in their accumulation of excessive medical debt, S.1624 seems more of a “plug” to an after-the-fact problem. Congress should instead seek to slash the need to file bankruptcies from the onset. Additionally, as Senator Sessions indicates, the current bankruptcy code already has special provisions for those filing because of medical debt. Perhaps these provisions deserve greater examination and recognition.
Rather than enhancing the status of medical debtors in the bankruptcy system, Congress should focus energies on finding solutions to fundamental, underlying problems. To reduce bankruptcy due to medical debt, the 47 million uninsured Americans must gain access to health insurance and the coverage of more than 11 million underinsured Americans must be expanded (Seifert & Rukavina, 2006).
References:
Cunningham, P.J. (2008). Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007 (Tracking Report No. 21). Retrieved from Center for Studying Health System Change website: http://www.hschange.org/CONTENT/1017/
Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009). Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine, 122(8), 741-746.
Medical Debt: Can Bankruptcy Reform Facilitate a Fresh Start?: Hearing before the Subcommittee on Administrative Oversight and the Courts of the Committee on the Judiciary, U.S. Senate, 111th Cong. (2009).
Seifert, R.W., Rukavina, M. (2006). Bankruptcy is the Tip of a Medical-Debt Iceberg. Health Affairs, 25, w89-w92. Retrieved from http://content.healthaffairs.org/cgi/content/full/25/2/w89
Skinner, B.J. (2009, August). The Medical Bankruptcy Myth. The American: the Journal of the American Enterprise Institute. Retrieved from http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth/article/print
