By Dr. Sushama R. Chaphalkar, PhD. Mar 7 2024 Reviewed by Lily Ramsey, LLM
In a recent cross-sectional study published in JAMA Network Open, researchers from the United States of America (US) investigated, at the county level, the association between medical debt and population health outcomes in the US.
They found that medical debt is associated with worsened health status and increased premature deaths and mortality in the population.
Study: Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US . Image Credit: Pormezz/Shutterstock.com Background
Increasing economic burden and out-of-pocket costs for healthcare in the US have led to a concerning rise in medical debt, affecting 17.8% of individuals in 2020.
Certain vulnerable populations, including racial and ethnic minorities, females, younger individuals, and those with chronic diseases face a higher risk of incurring medical debt.
This debt is linked to adverse impacts on well-being, such as delayed healthcare, prescription nonadherence, and increased food and housing insecurity. Despite these individual-level associations, the county-level impact of medical debt on health outcomes remains poorly understood.
The present study aimed to address this gap by examining the relationships between medical debt and health status, mortality, and premature death at the county level in the US, using data from the Urban Institute Debt in America project. About the study
In the present study, debt data was obtained from a 2% nationally representative panel of deidentified records from a credit bureau. A total of 2,943 US counties were included, of which 39.2% were in metropolitan regions. The counties had a median 18.3% of residents above 65 years of age.
The median racial breakdown of residents was as follows: 0.4% American Indian/Alaska Native, 0.8% Asian/Pacific Islander, 3.0% Black, 4.3% Hispanic, and 84.5% White.
The excluded counties were predominantly non-metropolitan and had a smaller population size and a reduced socio-demographic diversity. Related StoriesDaily aspirin linked to higher mortality in older adults, study findsStudy suggests high levels of vitamin B3 breakdown products are linked to higher risk of mortality, heart attacks, and strokeCirculatory cholesterol levels are inversely linked to mortality of patients with sepsis and critical illness
The study investigated three health outcome sets from public data sources, including self-reported health status, premature death measured by years of potential life lost, and age-adjusted all-cause mortality rates and cause-specific mortality rates for leading causes such as cancers, heart disease, Alzheimer's, diabetes, and suicide, at the county level in the US.
Furthermore, the study considered county-level sociodemographic factors from the US Census data, including racial distribution, educational attainment, uninsured status, unemployment, and metropolitan status, as potential confounders.
The analysis considered two medical debt measures: the primary measure assessed the percentage of individuals with medical debt in collections, while the secondary measure focused on the median amount of medical debt (in 2018 US dollars).
Overall debt, including medical and other kinds of debt, were also included in the supplementary analyses.
Statistical analysis involved the use of descriptive analysis as well as bivariate and multivariable linear models, incorporating random state-level intercepts and weighted by county population size. Results and discussion
An average of 19.8% of the studied population had medical debt. Counties with fewer White and more Black residents, lower education levels, increased poverty, lack of insurance, and unemployment appeared to have higher medical debt rates.
It was found that a 1% increase in the population of medical debt-holders was associated with 18.3 more physically unhealthy days and 17.9 more mentally unhealthy days per 1,000 people in 30 days.
The percent-increase in medical debt-holders was also found to be associated with 1.12 years of life lost per 1,000 people and a rise of 7.51 per 100,000 person-years in age-adjusted all-cause mortality rate.
Consistent associations were found for major causes of death, including heart disease, cancer, chronic obstructive pulmonary disease, diabetes, and suicide.
Patterns were found to be similar for associations between the median amount of medical debt and the selected health outcomes. Supplemental analyses showed similar association patterns between medical debt and health outcomes.
This nationwide study reaffirms that medical debt remains a significant social determinant of public health.
However, the study is limited by the potential underrepresentation of medical debt in less populous counties, the inability to examine specific sources of medical debt, the exclusion of individuals not in the credit system, and the need for further research on the impact of coronavirus disease 2019 (COVID-19)-related policies on medical debt and population health.
Additionally, a broader focus on overall debt suggested that policies addressing various debts, like student loans, may impact population health. Conclusion
In conclusion, the study revealed associations between medical debt and adverse health outcomes, such as increased unhealthy days, premature deaths, and elevated mortality rates.
The results highlight the need for collaborative efforts among various stakeholders, including government entities, healthcare systems, hospitals, and employers, to mitigate medical debt with paid sick leave, clear financial assistance policies, and improved cost-related communication with patients.
Further, enhancing access to affordable healthcare through policies like expanding health insurance coverage may improve the overall health of the US population. Journal reference:
X. et al., (2024) Associations of Medical Debt with Health Status, Premature Death, and Mortality in the US. Han JAMA Network Open, 7(3):e2354766. doi: 10.1001/jamanetworkopen.2023.54766.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815530
Initial searches for Trump’s name within the Department of Justice search function returned nothing, while the presence of former president Bill Clinton, on the other hand, was everywhere.
It is PR strategy 101 – front-load the release of documents with the Democrat stuff and save any possible Trump content for a soft landing sometime between Christmas and New Year.
By that time, the public will have softened its focus on the story – it’s what the festive season does.
The presence of celebrity in the latest release might also feather Trump’s bed.
It’s clear that iconic superstars like Mick Jagger and Diana Ross were courted by Epstein as innocents, ignorant of his criminality. To see them in the files cements a narrative of a monster who lured the unsuspecting into his orbit.
We support Jagger and Ross as treasured icons, so we remind ourselves that simply being included in the files doesn’t equate to wrongdoing or knowledge of it. In turn, it shapes an empathy around the predicament that will extend to Trump and, perhaps, the benefit of any doubt.
Of course, not everyone will see it that way – the people who see a cynical exercise in delay and obfuscation, constituting a gross insult to the Epstein survivors at the heart of the story.
Image: Jeffrey Epstein and Michael Jackson. Pic: US DoJ
For all the talk (by the Trump administration) of a tight time scale and a willingness to act transparently, survivors and their supporters point out that Donald Trump could have published all the Epstein files long ago, never mind drip feed them with wide-ranging redactions.
Not to have done so is an affront to them and an attempt to evade accountability.
For all the talk about the release of the files, their significance is undermined by the lack of context. We are shown pictures and documents that reflect the life of a thoroughly unpleasant individual who inflicted suffering on an industrial scale. But with redactions, and without explanations, we are left having to join the dots in an effort to establish criminal behaviour and blame.
It is a level of uncertainty surrounding the Epstein files and a source of dissatisfaction to survivors, for whom justice further delayed is justice further denied.
The Delaware Supreme Court made its ruling in the fight over Tesla CEO Elon Musk’s $55 billion pay package from 2018, reversing the Court of Chancery’s decision and reinstating the pay package.
But the Court still penalized Musk $1 plus attorney’s fees due to the award’s unfairness.
The ruling is the latest and likely last step in the long story behind Musk’s excessive pay package, tied to company performance milestones, which was first approved by shareholders in 2018 and worth approximately $55 billion if all milestones were met. At current share prices, the award is worth more like $139 billion.
For a short recap, TSLA shareholders approved a compensation package in 2018 which would award Musk, and dilute all other shareholders by around 8%, if the company reached financial targets the company claimed were difficult to achieve.
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That package ended up being subject to a lawsuit, which alleged that Tesla misled investors when campaigning for the compensation package and that the board was too cozy with Musk himself, such that they did his bidding rather than acting in an independent manner.
The Delaware Court of Chancery, where Tesla used to be legally domiciled, found that argument persuasive, and ruled to rescind Musk’s entire pay package.
Delaware has long been known to be one of the most business friendly places for companies to host their legal domiciles. But after the ruling, Musk encouraged companies to leave the state, and moved his own companies out of it as well.
Tesla appealed that decision to bring it to the Delaware Supreme Court.
In the interim, the board gave Musk $26 billion in stock without asking shareholders first, draining the employee stock reserve and giving all of it to Musk. This award was meant to be a partial restoration of the 2018 award, but would be forfeited if the Supreme Court ruled in Musk’s favor.
Finally, TSLA shareholders once again voted for an even more ridiculous pay package last month, awarding Musk with stock worth a potential $1 trillion (and diluting all other shareholders by up to 12%) if all milestones of the award are met.
And one important note: each of these numbers are individually larger than any award ever given to any employee in the history of the world, by at least an order of magnitude, and are targeted towards a man who is currently doing his best to trash the company.
Now this week, we finally got the ruling from the Delaware Supreme Court, and it’s… an interesting one.
Court rules Musk gets his billions, but still has to pay a one dollar penalty (yes, really)
The Delaware Supreme Court ruled late Friday afternoon that the Court of Chancery was wrong in its decision to rescind all of Musk’s pay package, though it still accepted that some sort of penalty (“nominal damages”) is warranted.
It set that penalty in the amount of $1. In addition, the attorneys who sued Tesla (the plaintiffs) will be able to recoup attorneys fees (which will end up amounting in the hundreds of millions).
The court stated that while it may have accepted an argument that Musk should be entitled to part of the package – in recognition of how excessive the final package ended up being – the plaintiffs didn’t actually make that argument. The plaintiffs only offered complete rescission as a remedy, which the court decided was too “extreme.”
The court said that Musk deserves to be compensated for his time, and denied the plaintiffs’ argument that the significant appreciation of his own existing stock should be considered sufficient compensation. It called the decision “inequitable” (though it should be noted that despite this “lack of compensation,” Musk remained the richest man in the world prior to the court’s decision, largely due to the aforementioned stock).
And so, because plaintiffs didn’t make an offer for partial rescission of the pay package, and because the Court of Chancery didn’t itself craft a decision that partially rescinds the package (which it is allowed to do), the Supreme Court had to choose between giving Musk everything or nothing, and it chose to give him everything. Well, minus the attorney’s fees.
Electrek’s Take
I’m not a lawyer, but I did take time to read through the ruling before writing this, and to do my best to figure out the court’s reasoning here.
And, frankly, it seems like an odd decision to me from either perspective.
If Tesla was right all along, then it should be treated like it’s right – don’t hold back attorney’s fees or a $1 penalty saying that the plaintiffs just didn’t ask for the right remedy.
And if plaintiffs are right, then their win shouldn’t be dismissed simply because they didn’t ask for the exact right thing. If the court thinks they’re right but asked for too much, just give them part of what they asked for. If that’s not in the Supreme Court’s purview, then kick the decision back down and ask the Court of Chancery to reconsider and design a proper remedy.
What if Delaware is just spooked?
But maybe the decision isn’t just about what happened in this legal case, and more about Delaware trying to earn back its “pro-business” reputation which led over 2 million businesses to choose the state as their legal home.
That reputation has taken a hit in recent years as Musk has encouraged his ultra-wealthy pals to abandon the state. Despite that Delaware remains the state with the most established business law in the country, Musk moved to Texas hoping that he would be able to benefit from corruption there and push policies that would help him personally and harm shareholder rights – like a new law that bans shareholders from bringing actions like this court case unless they hold billions of dollars in Tesla stock.
Some other companies have also redomiciled, perhaps hoping to benefit from the same corruption Musk sought out.
This has spooked Delaware, and encouraged it to change its laws as a PR exercise to stop companies from leaving.
I wouldn’t be surprised if today’s ruling, beyond the legal rationale, was intended to have the same effect. What’s the big deal about spending $55 billion of Other People’s Money (namely, Tesla shareholders) if it helps Delaware regain its sheen of kowtowing to any corporation that comes its way?
Valuing one bad employee as worth more than all the rest
But past the legal aspects of this, the whole situation around the pay package stinks for just about everyone – employees, shareholders, and humanity as a whole.
There is certainly something “inequitable” about this award, but it’s not what the Supreme Court thinks it is.
Tesla is a company that is driven by its employees – some 120,000 of them. Most of those employees are bright people doing a good job at designing and building good products.
Most of them also don’t actively try to sabotage the company. But one does: Elon Musk.
Finally, his actions in the past years have harmed electric vehicles as a whole, and thus been bad for the environment, which is the most important issue facing humanity. Musk has even rhetorically got into climate change denial himself.
Any single one of these actions should be a fireable offense in any normal situation.
And the worst part is, everyone with a brain knew how bad these actions were going to be ahead of time, but this dummy only figured that out last week (anyone want to bet that he’ll actually follow through on that about face? anyone? hello?).
And yet, the pay packages approved for him, improperly marketed by a captured board and voted for by shareholders who were promised vast wealth despite that these packages have and will massively dilute their holdings, value this one bad employee at significantly more than all other Tesla employees combined. And that money is coming out of the pockets of shareholders.
Money taken from shareholders and given to Musk, denying their share in company success
The tens of billions of dollars that will now be channeled to Musk, which he has shown he will use to harm Tesla, come at the cost of value that would have otherwise been created for shareholders and employees who hold shares, by diluting everyone’s holdings in the company.
Tesla could instead have spent its money on stock buybacks or dividends, thus allowing shareholders to enjoy the company’s success (which is the entire point of a public company), but instead it chose to play financial games that channel money from shareholders to the person that is currently acting least in the company’s favor.
So here we have a situation where a man who is causing harm to the company, the mission, the shareholders, and indeed the entire planet, is being valued at more than all of his employees put together and has a court jumping through what it itself deems are “narrow” hoops to uphold an award that is larger than any other employee has received in the history of the world. And regardless of the legal reasoning involved, I just don’t think any of that that is a good idea for anyone.
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The owner of the fashion brand LK Bennett is this weekend racing to find a saviour amid concerns that it could be heading for collapse for the second time in six years.
Sky News has learnt that the clothing chain, which was founded by Linda Bennett in 1990, is working with advisers at Alvarez & Marsal (A&M) on an accelerated sale process.
Industry sources said on Saturday that A&M had begun sounding out potential buyers and investors in the last few days.
At one stage, LK Bennett was among the most recognisable brands on the high street, expanding to 200 branded outlets in the UK and overseas markets including China, Russia and the US.
In its home market it now trades from just nine standalone stores, with a further 13 listed as concessions on its website.
It was unclear whether a sale of the loss-making brand was likely or whether LK Bennett’s existing backers might be prepared to inject more funding into the business.
Contingency plans for an insolvency are frequently drawn up by advisers drafted in to run accelerated sale processes.
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The brand is owned by Byland UK, a company established in 2019 for the purpose of rescuing LK Bennett from a previous brush with insolvency.
Byland UK was formed by Rebecca Feng, who ran LK Bennett’s Chinese franchises.
At the time of that deal, Ms Feng said: “Under our plan, the business will continue to operate out of the UK, looking to maintain the long-standing and undoubted heritage of the brand.
“This will be achieved through a combination of working with quality British design, and the business’s existing supply chain.”
Accounts for LK Bennett Fashion for the period ended January 27, 2024 show the company made a post-tax loss of £3.5m on turnover of £42.1m.
The figures showed a steep loss in sales from £48.8m in 2023.
According to the accounts, LK Bennett paid a dividend of £229,000 “at the start of the year when performance was doing well”.
“Given the decline in revenue, the directors do not recommend the payment of any further dividends.”
Ms Bennett founded the eponymous chain by opening a store in Wimbledon, southwest London, in 1990, and promised to “bring a bit of Bond Street to the high street”.
Her eye for design earned her the nickname ‘queen of the kitten heel’ and saw her products worn by the Princess of Wales and Theresa May, the former prime minister.
In 2008, Ms Bennett sold the business for an estimated £100m to a consortium led by the private equity firm Phoenix Equity Partners.
She retained a stake, and then bought back the remaining equity in 2017.
The company’s administration in 2019 resulted in the closure of 15 stores.
It was unclear how many people are now employed by LK Bennett.
LK Bennett has been contacted for comment, while A&M declined to comment.