Lori Swanson: Health care and credit scores don't mix

Use of consumer payment histories could lead to an unfair rationing of medicine.

By LORI SWANSON

Last update: January 17, 2008 - 6:41 PM

A society is best measured by how it treats the less-fortunate. As your recent editorial points out ("Is health data plan akin to credit score," Jan. 14), credit scores currently determine the amount and availability of our loans, the amount we pay for homeowners' and automobile insurance, and in some cases whether our employment application is accepted. Now we read that Tenet Healthcare Corp., the third-largest hospital system in the United States, has joined forces with a venture-capital firm to establish a medical credit score to rank patients on their creditworthiness. Enough is enough.

When Congress enacted the emergency medical treatment laws in 1986, it mandated that every American has the right to receive emergency medical treatment and said that hospitals may not "dump" patients in the street. While some Americans may disagree on the attributes of universal health care, all Americans should abhor a rationing standard that permits different standards of treatment for different patients based on their medical credit scores.

Healthcare Analytics, the company that is spending $30 million to create the medical credit score, claims that such rationing won't occur because providers won't peak at the credit score until after treatment is rendered. The company claims that the only purpose for the medical credit score is to determine after the fact if the patient can pay the bill. With all due respect, the best way to determine if the patient can pay the bill is to send the patient an invoice.

Many Minnesotans already face a daunting time with a stalled economy, a mortgage fiasco, high inflation and high home heating bills. Credit scores, particularly a medical credit score, can affect every family. Just consider that:

•One-third of Americans have problems with medical debt, and two-thirds of them have health insurance, but with unaffordable deductibles and copays.

•More than 1 million Minnesotans spend 10 percent or more of their pretax income on health-care costs.

•The Consumer Federation of America surveyed 500,000 Americans and found that about one-third erroneously had credit scores 50 points less than they should have. (Will the provider tell the patient: "We could have saved your arm but there was a transposition error on your credit score?")

•Even the medical credit scores of the more-affluent could be affected if their HMOs or insurance companies deny or delay claims.

•Medical debt is the leading cause of personal bankruptcy.

Healthcare Analytics says that currently available credit scores are insufficient because providers usually don't report health-care debt to credit bureaus. It is true that many don't, and providers shouldn't change that practice now. Today's credit scores reflect a borrower's payment history with voluntary debt like credit cards, car loans and home mortgages. Health-care debt is fundamentally different. Patients do not go to the hospital because they want to -- they go because they have to. The health-care consumer seeking hospital treatment is a far different consumer than the one who goes to a big-box retailer to buy the latest plasma-screen TV.

I will be drafting legislation to prohibit the distribution of credit scores to medical providers until after the patient's treatment is completed. The legislation also will prohibit providers from reporting health-care debt to credit bureaus. We shouldn't send patients into a financial death spiral simply because they get sick. It is my hope that Minnesota will be one of the first states to stand up and say a resounding "no!" to this type of credit-based rationing of health care. In Minnesota, we can do better.

Lori Swanson is Minnesota's attorney general.

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