Army of one 

For the first three months of this year, K.B. Forbes spent much of his time flying to Orlando from his office in East Los Angeles. His mission: to interview more than 60 low-income people, mostly Hispanics, who had the misfortune of being ill enough to require a hospital visit. Every one of Forbes' subjects had a hard-luck story to tell. Julio P. told Forbes that when his wife suffered from severe back pain at a car wash one day, she was rushed by ambulance to the hospital. Julio's wife was diagnosed with kidney stones and given an injection. The total cost for the visit stunned Julio: "When I received this bill for almost $5,000, I said this was only a kidney stone, not a diamond."

Nicolas S. received an $8,000 bill for a one-night hospital visit in which a stab wound was sewn up. Another man was charged $21,000 for a four-day stay required to alleviate high blood pressure. Another blood-pressure patient, Olga L., got a bill for $9,000 for a one-day visit. Evelyn O.'s mother, ill with pneumonia, was charged $15,000 for her two days in the hospital.

And so it went. The 36-year-old Forbes tape recorded his subjects, then flew back to Los Angeles to transcribe the contents. Last week, he released the information in a 44-page report titled "Infierno" in which Forbes presents testimony from former hospital patients living in Chicago, Denver, Oklahoma City and Orlando, who describe hospital overcharging and aggressive collection policies.

The target of the report is HCA Inc., the Nashville-based, publicly-traded corporation whose 200 hospitals comprise the largest for-profit hospital chain in the country. HCA owns two hospitals in the Orlando area: the Osceola Regional Medical Center in Kissimmee and Central Florida Regional Hospital in Sanford.

"Nationally, HCA is the worst abuser of price gouging," Forbes said in an interview last week.

The poorest of the poor typically have some sort of federally subsidized insurance -- such as Medicaid or Medicare -- to pay their medical bills. The middle-class and wealthy are typically covered by a private insurance policy. But in a strange twist of capitalistic logic, insurance companies are allowed to negotiate huge discounts for the patients they cover. The result: only the uninsured -- people too poor to afford medical coverage -- are stuck with outrageous medical bills.

Forbes, a former reporter for the San Gabriel (California) Daily Tribune, became aware of the practice two years ago when he tried to help an acquaintance understand why she racked up $23,000 from a minor auto accident. He formed a nonprofit named Consejo de Latinos Unidos -- Council of United Latinos -- which employs two part-time office workers.

Forbes, though, is not the most likely consumer advocate. According to a June Wall Street Journal article, he worked on the campaigns of Steve Forbes (no relation) and Pat Buchanan, and has received funding from J. Patrick Rooney, a retired Indianapolis insurance executive who promotes such conservative initiatives as school choice and medical savings accounts.

In two short years, Forbes has posted an impressive victory. He is credited with changing the policies of Tenet Healthcare Corp., the second largest for-profit hospital chain in the country. Meeting with Tenet's board of directors, Forbes showed them snapshots of trailers and small houses owned by patients of Tenet Healthcare. The hospital chain had placed liens on the property in an attempt to recover medical expenses. Shortly after the meeting, Tenet announced it would stop placing liens on people's homes and provide discounts to the uninsured comparable to the discounts provided to insurance companies.

Forbes was drawn to Orlando, he says, because of the large number of calls he received on Consejo de Latinos Unidos' toll-free hotline (800-474-7576). Most of the calls, he notes, complained about the exorbitant pricing and aggressive collection policy of Florida Hospital and Orlando Regional Hospital, Central Florida's two largest hospitals, which are both non-profit.

After interviewing many of the patients, however, he quickly learned that he could continue building his case against HCA. There are four key points in his report:

  • The uninsured should be charged the same rate as the insured.

  • The uninsured will be offered reasonable payment plans over a reasonable period of time.

    Litigation will be use only as a last resort -- after charity and governmental programs are exhausted and a payment plan put into effect.

  • Litigation will not be used against patients whose only asset is a family home.

    Forbes' fight with HCA doesn't mean he's forgotten about Florida Hospital, which is operated by the Seventh Day Adventist religious sect, and Orlando Regional, whose eight medical centers include the Arnold Palmer Hospital for Children and Women. "It appears that these two nonprofits, Orlando Regional and Florida Hospital, have learned the tricks of the trade from the for-profits," he says. "They are unrepentant in their efforts to steal the hard-earned assets of working middle Americans. They have demonstrated this repeatedly, over and over."

    He says Orlando Regional and Florida Hospital have heard his criticism and have reacted against it. "They are completely aware and defensive about it," he says. "It's the same bullshit you hear from all hospitals. They talk about the charity they provided, the $4 million in write-offs. But that's not what I'm talking about. What I'm talking about is the people who did not qualify for charity, who did not get a write-off."

    Rich Rasmussen of the Florida Hospital Association admits uninsured patients are a problem. "It is the single-most important health-care issue," he says. But he's less inclined to talk about reform than about an unwillingness to pay to be covered for medical care. "Most of the uninsured are employed," he says. "They made a choice not to insure themselves. Often when they need treatment, they wait to go to the emergency room, which is expensive. They're paying more on the back end and less on the front end."

    Insurance companies deserve a wholesaler's discount, he says, because they are, in essence, buying in bulk. They guarantee a hospital tens of thousands of sick people each year, which more than offsets a 50 percent price reduction. "The discount is made up in volume," he says. "You don't get that with onesies or twosies."

    Look for Forbes to return to Central Florida this fall. He expects to host a series of seminars educating people on hospital pricing and collection policies. He also in-tends to meet with the Florida Attorney General's Office, members of Central Florida's Congressional delegation as well as members of Gov. Jeb Bush's staff.

    Forbes says he's merely using the tactics HCA, Florida Hospital and Orlando Regional use on their uninsured patients. "They hit the roof when they found out we were coming to town," he says. "We want to run workshops to educate people how to fight this. We want to show patients how to find legal aid. If Orlando Regional and Florida Hospital want to play hardball with the uninsured, we will play hardball with them."


    More by William Dean Hinton


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