Over half of Americans are stressed because of medical bills

Anxiety does not help other medical conditions, adding trouble on top of trouble.

Over half of Americans are stressed because of medical bills
Photo credit: Leonard Ortiz / Digital First Media / Orange County Register via Getty Images
  • More than 137 million people in the United States are struggling to pay their medical bills, according to new research.
  • A recent survey also suggests that employer-based insurance programs are not helping as much as believed.
  • The worst hit group is uninsured Americans, who struggle to keep up with mounting medical expenses.

Health care is at the top of the ticket in the rush toward the 2020 presidential election. Details between "Medicare for all" and public and private options will be on full display at a time when even so-called conventional wisdom is up for debate: the general consensus that employer-based health care options are best is not looking like a strong argument, as a recent survey shows.

The survey, a joint effort between the Kaiser Family Foundation and the Los Angeles Times, notes that over half (54 percent) of respondents claim that someone in their family suffers from chronic conditions, such as hypertension, diabetes, or asthma. A lifetime of medication and monitoring is ensured, putting serious strain on families. Job-based health plans have almost quadrupled in price over the last dozen years.

This isn't the only recent research to confirm struggles with America's health care system. A large-scale study by the American Cancer Society confirms an inconvenient fact: more than 137 million people in the United States are struggling to pay their medical bills.

The financial risk of cancer is well known: 42 percent of cancer patients lose their life savings within two years of treatment. This new research, conducted by four doctors in the Surveillance and Health Services Research Program at the ACA, looks at high out-of-pocket (OOP) spending for overall medical care—not just in the treatment of cancer—with a particular emphasis on employment-aged citizens, 18-64.

Why Medical Bills In The US Are So Expensive

Financial toxicity due to OOP costs have received much attention in recent years. One conceptual framework, proposed by Nandita Khera in 2014, features a four-level grading criteria for expressing financial problems:

  • Lifestyle modification (deferral of large purchases or reduced spending on vacation and leisure activities) because of medical expenditure; Use of charity grants/fundraising/copayment program mechanisms to meet costs of care
  • Temporary loss of employment resulting from medical treatment; Need to sell stocks/investments for medical expenditure; Use of savings accounts, disability income, or retirement funds for medical expenditure
  • Need to mortgage/refinance home to pay medical bills; Permanent loss of job as a result of medical treatment; Current debts household income; Inability to pay for necessities such as food or utilities
  • Need to sell home to pay for medical bills; Declaration of bankruptcy because of medical treatment; Need to stop treatment because of financial burden; Consideration of suicide because of financial burden of care

For this study, ACA researchers point to three domains of financial medical hardship—"material conditions that arise from increased OOP expenses and lower income (e.g., medical debt); psychological responses (e.g. distress, worry); coping behaviors (e.g. delaying or forgoing care because of cost)"—in their analysis. Looking beyond oncology, they used the 2015-2017 National Health Interview Survey (NHIS) to collect data.

Nearly 70 percent of respondents (ages 18-64) had private health insurance; nearly 50 percent of respondents over age 65 reported having Medicare and private insurance. The group having the most financial problems are in the 18-64 age range, with higher material, psychological, and behavioral financial hardship.

Members of National Nurses United union members wave "Medicare for All" signs during a rally in front of the Pharmaceutical Research and Manufacturers of America in Washington calling for "Medicare for All" on Monday, April 29, 2019. (Photo By Bill Clark/CQ Roll Call)

One-third of older Americans reported hardship in at least one of those three domains compared to 56 percent in the employment-aged group. Overall, women were hit hardest. Uninsured respondents reported problems in multiple domains (52.8 percent), followed by those with public insurance (26.5 percent) and finally, private coverage (23.2 percent). Over three-fourths of uninsured respondents are struggling in at least one domain.

As noted, over half of respondents experience hardship in one domain, while over a quarter report issues in two domains. Sadly, the authors write, this problem is only getting worse.

"With increasing prevalence of multiple chronic conditions; higher patient cost-sharing; and higher costs of healthcare; the risk of hardship will likely increase in the future. Thus, development and evaluation of the comparative effectiveness and cost-effectiveness of strategies to minimize medical financial hardship will be important."

Climate change and health care remain top issues in the upcoming election cycle. While candidates make their plea and pundits choose sides, the rest of the population is suffering. By the time November, 2020 rolls around, more citizens will be bankrupted (and more needlessly dead) due to the politics of health care.

That is the most tragic realization of all: we could have done something about this epidemic yet partisan paralysis has stopped us. There is nothing caring about such a system.

--

Stay in touch with Derek on Twitter and Facebook.

U.S. Navy controls inventions that claim to change "fabric of reality"

Inventions with revolutionary potential made by a mysterious aerospace engineer for the U.S. Navy come to light.

U.S. Navy ships

Credit: Getty Images
Surprising Science
  • U.S. Navy holds patents for enigmatic inventions by aerospace engineer Dr. Salvatore Pais.
  • Pais came up with technology that can "engineer" reality, devising an ultrafast craft, a fusion reactor, and more.
  • While mostly theoretical at this point, the inventions could transform energy, space, and military sectors.
Keep reading Show less

COVID and "gain of function" research: should we create monsters to prevent them?

Gain-of-function mutation research may help predict the next pandemic — or, critics argue, cause one.

Credit: Guillermo Legaria via Getty Images
Coronavirus

This article was originally published on our sister site, Freethink.

"I was intrigued," says Ron Fouchier, in his rich, Dutch-accented English, "in how little things could kill large animals and humans."

It's late evening in Rotterdam as darkness slowly drapes our Skype conversation.

This fascination led the silver-haired virologist to venture into controversial gain-of-function mutation research — work by scientists that adds abilities to pathogens, including experiments that focus on SARS and MERS, the coronavirus cousins of the COVID-19 agent.

If we are to avoid another influenza pandemic, we will need to understand the kinds of flu viruses that could cause it. Gain-of-function mutation research can help us with that, says Fouchier, by telling us what kind of mutations might allow a virus to jump across species or evolve into more virulent strains. It could help us prepare and, in doing so, save lives.

Many of his scientific peers, however, disagree; they say his experiments are not worth the risks they pose to society.

A virus and a firestorm

The Dutch virologist, based at Erasmus Medical Center in Rotterdam, caused a firestorm of controversy about a decade ago, when he and Yoshihiro Kawaoka at the University of Wisconsin-Madison announced that they had successfully mutated H5N1, a strain of bird flu, to pass through the air between ferrets, in two separate experiments. Ferrets are considered the best flu models because their respiratory systems react to the flu much like humans.

The mutations that gave the virus its ability to be airborne transmissible are gain-of-function (GOF) mutations. GOF research is when scientists purposefully cause mutations that give viruses new abilities in an attempt to better understand the pathogen. In Fouchier's experiments, they wanted to see if it could be made airborne transmissible so that they could catch potentially dangerous strains early and develop new treatments and vaccines ahead of time.

The problem is: their mutated H5N1 could also cause a pandemic if it ever left the lab. In Science magazine, Fouchier himself called it "probably one of the most dangerous viruses you can make."

Just three special traits

Recreated 1918 influenza virionsCredit: Cynthia Goldsmith / CDC / Dr. Terrence Tumpey / Public domain via Wikipedia

For H5N1, Fouchier identified five mutations that could cause three special traits needed to trigger an avian flu to become airborne in mammals. Those traits are (1) the ability to attach to cells of the throat and nose, (2) the ability to survive the colder temperatures found in those places, and (3) the ability to survive in adverse environments.

A minimum of three mutations may be all that's needed for a virus in the wild to make the leap through the air in mammals. If it does, it could spread. Fast.

Fouchier calculates the odds of this happening to be fairly low, for any given virus. Each mutation has the potential to cripple the virus on its own. They need to be perfectly aligned for the flu to jump. But these mutations can — and do — happen.

"In 2013, a new virus popped up in China," says Fouchier. "H7N9."

H7N9 is another kind of avian flu, like H5N1. The CDC considers it the most likely flu strain to cause a pandemic. In the human outbreaks that occurred between 2013 and 2015, it killed a staggering 39% of known cases; if H7N9 were to have all five of the gain-of-function mutations Fouchier had identified in his work with H5N1, it could make COVID-19 look like a kitten in comparison.

H7N9 had three of those mutations in 2013.

Gain-of-function mutation: creating our fears to (possibly) prevent them

Flu viruses are basically eight pieces of RNA wrapped up in a ball. To create the gain-of-function mutations, the research used a DNA template for each piece, called a plasmid. Making a single mutation in the plasmid is easy, Fouchier says, and it's commonly done in genetics labs.

If you insert all eight plasmids into a mammalian cell, they hijack the cell's machinery to create flu virus RNA.

"Now you can start to assemble a new virus particle in that cell," Fouchier says.

One infected cell is enough to grow many new virus particles — from one to a thousand to a million; viruses are replication machines. And because they mutate so readily during their replication, the new viruses have to be checked to make sure it only has the mutations the lab caused.

The virus then goes into the ferrets, passing through them to generate new viruses until, on the 10th generation, it infected ferrets through the air. By analyzing the virus's genes in each generation, they can figure out what exact five mutations lead to H5N1 bird flu being airborne between ferrets.

And, potentially, people.

"This work should never have been done"

The potential for the modified H5N1 strain to cause a human pandemic if it ever slipped out of containment has sparked sharp criticism and no shortage of controversy. Rutgers molecular biologist Richard Ebright summed up the far end of the opposition when he told Science that the research "should never have been done."

"When I first heard about the experiments that make highly pathogenic avian influenza transmissible," says Philip Dormitzer, vice president and chief scientific officer of viral vaccines at Pfizer, "I was interested in the science but concerned about the risks of both the viruses themselves and of the consequences of the reaction to the experiments."

In 2014, in response to researchers' fears and some lab incidents, the federal government imposed a moratorium on all GOF research, freezing the work.

Some scientists believe gain-of-function mutation experiments could be extremely valuable in understanding the potential risks we face from wild influenza strains, but only if they are done right. Dormitzer says that a careful and thoughtful examination of the issue could lead to processes that make gain-of-function mutation research with viruses safer.

But in the meantime, the moratorium stifled some research into influenzas — and coronaviruses.

The National Academy of Science whipped up some new guidelines, and in December of 2017, the call went out: GOF studies could apply to be funded again. A panel formed by Health and Human Services (HHS) would review applications and make the decision of which studies to fund.

As of right now, only Kawaoka and Fouchier's studies have been approved, getting the green light last winter. They are resuming where they left off.

Pandora's locks: how to contain gain-of-function flu

Here's the thing: the work is indeed potentially dangerous. But there are layers upon layers of safety measures at both Fouchier's and Kawaoka's labs.

"You really need to think about it like an onion," says Rebecca Moritz of the University of Wisconsin-Madison. Moritz is the select agent responsible for Kawaoka's lab. Her job is to ensure that all safety standards are met and that protocols are created and drilled; basically, she's there to prevent viruses from escaping. And this virus has some extra-special considerations.

The specific H5N1 strain Kawaoka's lab uses is on a list called the Federal Select Agent Program. Pathogens on this list need to meet special safety considerations. The GOF experiments have even more stringent guidelines because the research is deemed "dual-use research of concern."

There was debate over whether Fouchier and Kawaoka's work should even be published.

"Dual-use research of concern is legitimate research that could potentially be used for nefarious purposes," Moritz says. At one time, there was debate over whether Fouchier and Kawaoka's work should even be published.

While the insights they found would help scientists, they could also be used to create bioweapons. The papers had to pass through a review by the U.S. National Science Board for Biosecurity, but they were eventually published.

Intentional biowarfare and terrorism aside, the gain-of-function mutation flu must be contained even from accidents. At Wisconsin, that begins with the building itself. The labs are specially designed to be able to contain pathogens (BSL-3 agricultural, for you Inside Baseball types).

They are essentially an airtight cement bunker, negatively pressurized so that air will only flow into the lab in case of any breach — keeping the viruses pushed in. And all air in and out of the lap passes through multiple HEPA filters.

Inside the lab, researchers wear special protective equipment, including respirators. Anyone coming or going into the lab must go through an intricate dance involving stripping and putting on various articles of clothing and passing through showers and decontamination.

And the most dangerous parts of the experiment are performed inside primary containment. For example, a biocontainment cabinet, which acts like an extra high-security box, inside the already highly-secure lab (kind of like the radiation glove box Homer Simpson is working in during the opening credits).

"Many people behind the institution are working to make sure this research can be done safely and securely." — REBECCA MORITZ

The Federal Select Agent program can come and inspect you at any time with no warning, Moritz says. At the bare minimum, the whole thing gets shaken down every three years.

There are numerous potential dangers — a vial of virus gets dropped; a needle prick; a ferret bite — but Moritz is confident that the safety measures and guidelines will prevent any catastrophe.

"The institution and many people behind the institution are working to make sure this research can be done safely and securely," Moritz says.

No human harm has come of the work yet, but the potential for it is real.

"Nature will continue to do this"

They were dead on the beaches.

In the spring of 2014, another type of bird flu, H10N7, swept through the harbor seal population of northern Europe. Starting in Sweden, the virus moved south and west, across Denmark, Germany, and the Netherlands. It is estimated that 10% of the entire seal population was killed.

The virus's evolution could be tracked through time and space, Fouchier says, as it progressed down the coast. Natural selection pushed through gain-of-function mutations in the seals, similarly to how H5N1 evolved to better jump between ferrets in his lab — his lab which, at the time, was shuttered.

"We did our work in the lab," Fouchier says, with a high level of safety and security. "But the same thing was happening on the beach here in the Netherlands. And so you can tell me to stop doing this research, but nature will continue to do this day in, day out."

Critics argue that the knowledge gained from the experiments is either non-existent or not worth the risk; Fouchier argues that GOF experiments are the only way to learn crucial information on what makes a flu virus a pandemic candidate.

"If these three traits could be caused by hundreds of combinations of five mutations, then that increases the risk of these things happening in nature immensely," Fouchier says.

"With something as crucial as flu, we need to investigate everything that we can," Fouchier says, hoping to find "a new Achilles' heel of the flu that we can use to stop the impact of it."

The misguided history of female anatomy

From "mutilated males" to "wandering wombs," dodgy science affects how we view the female body still today.

Credit: Hà Nguyễn via Unsplash
Sex & Relationships
  • The history of medicine and biology often has been embarrassingly wrong when it comes to female anatomy and was surprisingly resistant to progress.
  • Aristotle and the ancient Greeks are much to blame for the mistaken notion of women as cold, passive, and little more than a "mutilated man."
  • Thanks to this dubious science, and the likes of Sigmund Freud, we live today with a legacy that judges women according to antiquated biology and psychology.
Keep reading Show less
Mind & Brain

Why do holidays feel like they're over before they even start?

People tend to reflexively assume that fun events – like vacations – will go by really quickly.

Quantcast