Allegheny County Committee on Health and Human Services Public Hearing on Medical Debt and Universal Healthcare - September 18, 2023
Allegheny County Committee on Health and Human Services Public Hearing on Medical Debt and Universal Healthcare - September 18, 2023
The Committee on Health and Human Services held a public hearing to explore the crisis of medical debt and the need for universal, single-payer healthcare. Three expert presenters provided extensive data and personal narratives, followed by testimony from numerous residents and healthcare professionals. Council members expressed strong support and pledged to pursue further action, including exploring a county referendum and researching local medical debt impacts.
Public Comments & Testimony
- Dr. Judy Albert (co-founder, Western PA Coalition for Single Payer Health Care) detailed the scale of medical debt: 100 million Americans affected, premiums up 200% since 1999 while wages rose only 47%, and cancer patients 2.5 times more likely to declare bankruptcy. She argued that private insurance profits ($200 billion in overhead) should instead fund a public system like Medicare, which has only 2-3% overhead.
- Ed Gristar (former union rep, PA Staff Nurses) emphasized the need for a county referendum to pressure Congress, citing successful referendums in Wisconsin and Illinois that passed with large majorities. He urged the council to reduce obstacles for non-binding referendums and to research medical debt demographics in Allegheny County.
- Dr. Claire Cohen (child psychiatrist) shared personal and clinical experiences: she negotiated a $4,000 hospital bill down to $1,000 for her daughter; reported that U.S. infant mortality for Black women is 69.9 per 100,000 (ranking 85th globally); and noted that for-profit insurers earned $40.2 billion in profits in first half of 2023. She argued that health insurance companies increase profits by denying care and purging patients through high costs.
- Dr. Kate Neely (family doctor) told the story of a patient who died of colon cancer after avoiding a diagnostic colonoscopy due to fear of out-of-pocket costs, and described urgent care patients turning away because of outstanding balances.
- John Rice (resident) cited statistics: 18 million Google results for "medical debt horror stories"; U.S. spends twice as much on healthcare as peer nations but ranks last in access/quality; medical bills are the #1 cause of bankruptcy.
- David Hughes (resident) criticized privatization of Medicare (half now Medicare Advantage) and described his $8 bill for emergency care in Mexico vs. astronomical U.S. costs.
- Dr. Anthony Fiorilla (semi-retired physician) recounted a friend who died at 51 from a heart attack after avoiding care because he had no insurance and feared $30,000+ costs.
- Emily DeFari (resident): described women in labor without prenatal care due to insurance gaps; her mother's rehab delayed by Medicare Advantage plan; a relative's $2,000 surprise bill for reproductive care.
- Carl Redwood (activist): cited a Commonwealth Fund report noting medical debt affects people of color, women, and low-income families; called for linking short-term fixes to single-payer; noted 36% of UPMC employees have medical debt to UPMC (51% for those earning under $20/hr).
- Sandra Fox (Churchill Borough resident): paid $520.76 for an EpiPen due to a Medicare Part D deductible; argued for free care at point of service funded by progressive taxes.
- Teresa Chalich (registered nurse): concerned about the Medicaid "purge" in Pennsylvania (estimated 90,000–184,000 lost coverage); called for seamless Medicare for All to prevent debt.
- Sam Schmidt (resident): echoed the statistic that 51% of UPMC low-wage workers have medical debt; called for single-payer.
- Dr. Thomas Brockmeyer (retired orthopedic surgeon, multiple myeloma patient): his monthly Revlimid cost Medicare nearly $16,000, with his co-pays $5,800/month; argued only 2–3 of his 25 cousins could afford such care; endorsed improved Medicare for All.
- Lorraine Starsky (retired nurse): pointed out that the end of the public health emergency means free COVID tests are no longer available, burdening low-income families; cited Philadelphia's free test distribution as a model and urged Allegheny County to fund similar programs.
- Councilmember Barb Warwick (City of Pittsburgh): noted the city's $1 million ARPA-funded medical debt buyback through RIP Medical Debt; questioned why UPMC doesn't simply waive its own patients' debt; shared personal family medical costs ($3,000 ambulance bill, $900 ER visit for a dog bite that required no treatment).
Discussion Items
- Councilmember Hallam asked about negotiating medical debt; presenters confirmed it's possible but difficult for individuals.
- Councilmember Hallam pressed for legally binding, enforceable actions beyond resolutions, suggesting mandates like zero employee insurance contributions. Presenters emphasized that the ultimate solution is national single-payer, but local steps like publicizing medical debt data and supporting worker organizing could help.
- Council President Katina and Councilmember Palmasino expressed gratitude and acknowledged the severity of the issue, noting specific county programs (Aging services, higher life expectancy at home) and the need to amplify voices.
- Councilmember Macy shared his personal experience of being dropped from Medicaid after starting a new job and struggling with insurance, noting that mental health care is also a challenge. He emphasized that council members are not immune to these problems.
- Councilmember Klein (Chair) stated that the committee has a moral obligation to create a platform for these issues and pledged that the hearing will not be forgotten.
Key Outcomes
- No formal votes were taken. The committee committed to taking the testimonies to heart and exploring next steps.
- Presenters requested that the council: (1) reduce obstacles for a non-binding county referendum on a universal national health system; (2) research the impact of medical debt on Allegheny County residents (by municipality, race, age, sex); (3) encourage and support similar resolutions from other municipalities; (4) consider building a database of local elected officials backing Medicare for All, as suggested by the late Senator Jim Furlow.
- Council members indicated openness to these proposals and agreed to stay in contact with the presenters for further guidance.
- Chair Klein closed by thanking all participants and affirming that the council will not disappoint in following up.
Meeting Transcript
I'll go with her. How about that? This meeting of the Committee on Health and Human Services, this public hearing is now in order. I'd like to thank everyone who has signed on to join us this evening. We have a number of people who have already signed on to speak. And we have some we have three people who were presenting initially to kind of lay out before all of us what their considerations are, what they're paying attention to, and what they would like all of us to be attentive to as well. So just by way of a couple of uh opening remarks, um so this evening we gather to consider in real time the the challenges that we face in uh everywhere in this country in making health care accessible and affordable to all. And that is something that is uh truly problematic in our society uh unless you're not paying attention or unless you haven't been affected. And there are some people who have been insulated from you know the worst of it, that is for sure. Um it was none other than I'm gonna put a name out here that some of you might recall, it was none other than Walter Cronkite, the most trusted man in America, who many years ago said that American a number of years ago, he said this 40 years ago, that America's health care system is neither healthy, caring, nor a system. Um I also see this moment as an opportunity to recall someone who I have always had great regard and great respect for, and that is uh Paul Farmer, a physician, and uh first and foremost a teacher who founded the organization called Partners in Health. Uh Farmer reminded us that medicine should be viewed as social justice work in a world that is so sick and so riven by inequities. And he saw it, and he's and as he saw it, the delivery of high quality care is both medical and moral as well. So, as we gather here this evening, um, I mean, clearly as a governmental entity uh at the county level. There are obviously uh hurdles that we would face in terms of um legal authority and legislative output uh based upon what we talk about here this evening. So even though we might not have the legal authority uh to effectively act, we do feel that we have a moral obligation to create a platform to create a stage so that we can elevate the attention that this particular all-encompassing issue uh deserves and requires. So this evening we are going to hear from any number of people. We uh your fellow citizens are here to share their often anguished experiences with our health care system, and the hope is that we will heighten awareness and that we will mobilize a good deal more activity uh around this and the the issues that surround it as well. And um, by way of beginning this evening, we have our three presenters. We have uh Ed Gristar, who is the co-founder of the Western Pennsylvania Coalition for Single Payer Health Care, also a former union representative, um, Pennsylvania Staff Nurses and Allied Associates, and the past president of butt of the Butler County Labor Council. We have Dr. Judy Albert, physicians for in for National Health Care of Western Pennsylvania, and the Western PA Coalition for Single Payer Health Care, and Dr. Claire Cohen as well, uh a child psychologist, uh affiliated with physicians for a national health care program and the Western PA Coalition for Single Payer Health Care. So I would invite uh whoever among the three of you would like to open to uh get us started this evening. Okay. Well how is that I can tell it's on. Um well, first of all, I just want to thank um Allegheny County Council, uh, all of the representatives that are here who um voted to allow us to have this public hearing. Um it uh was a little bit of a a hard sell to get the idea going that maybe locally we can do something about these problems that affect people nationally. So I'm very grateful. Also, um Mr. Klein, uh I think your comments are spot on. Um Paul Farmer is also a hero of mine, and uh I think Walter Cronkite is also uh very correct. So I am going to start today talking about medical debt, why is our system broken and how can we fix it? We're here to talk about the crisis in health care in this country and bring it home to where we live actually in Allegheny County. We will talk about the massive amount of debt carried by many, why it is this way, and what is the solution. So first of all, we should talk a little bit about what's the impact of medical debt. What are the consequences? Well, it's a very widespread problem, and often it's hard to quantify. They avoid medical care to avoid more debt, they get sicker. They have GoFundMe pages to help out. It's absolutely ridiculous in the world's wealthiest country that this is happening. So some of the statistics, well, um everybody knows that the costs of premiums are rising. Americans may pay upwards of $4,000 a year for their insurance coverage, but get no coverage for mental health or dental care. The debt situation in the country is affecting a hundred million people, and it prevents families, especially black families, from building wealth, savings, and assets that are needed to access America's high-priced medical system. People suffer, they avoid medical care, and they get sicker. And finally, uh a cruel reality is that a cancer diagnosis is often financially devastating. Cancer patients are far more likely to declare bankruptcy than people without cancer. So first we need to understand exactly how insidious the invasion of profiteering has become into our health system. Top of the list, health insurance. Premiums for employer-sponsored health insurance have increased by 200%, 200% since 1999, while wages have increased only 47%.
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