Divorce & Burgeoning Healtcare Costs

Divorcing from Healthcare Costs

We know divorce negatively affects health.

Stress correlates with, or even underlies, many of the top health risks Americans face, from depression to heart disease. Divorce is always stressful, so it is no shocker it can carry significant risk for the health of a couple going through proceedings.

Conversely, we also know that divorce is sometimes a reaction to someone’s poor health — either to mitigate medical bills, or to escape from the demands of a partner with chronic illness. In some cases, that chronic illness may be a mental health condition, adding layers of confusion and hurt feelings when it leads to divorce.

Today, there is a growing general awareness of the costs, financial and personal, that come with healthcare and chronic disease. Is it possible that, on the tide of consumer-facing healthcare technology, rather than waiting for illness to get serious or expensive, couples will start separating preemptively?

 

Irreconcilable Ailments

Health is an important element of personality. Even kissing has been linked to a subconscious assessment of potential mates’ immune systems. An advantageous coupling likely to yield more robust offspring could be predicted in that first locking of lips.

Of course, that isn’t always on the forefront of young couples’ minds, especially when marriage is on the table. The individual quirks that added charm to a relationship may turn out to be the precursors of a serious fight. Even something as simple as restless leg syndrome, across the sands of time, could lead to sleeping in separate beds, separate rooms, and eventually separate households.

Other conditions may not be so innocuous. A gluten allergy or reliance on insulin may foster a sense of support and sharing challenges. When changes to employment, insurance, or even coincident risk factors and disease begin to present, that sense of being on the same team can come under threat.

So there is nothing particularly new about health and wellness being implicated in relationships; what about divorce based not just on current medical challenges, but anticipated ones?

 

In Sickness and In Debt

Declining health isn’t exactly a routine line item in prenuptial agreements; debts, however, are, and medical debt has become a challenge for roughly one out of every five Americans. It doesn’t matter whether they are insured or not. Even in the age of Obamacare, families routinely raid their child’s college fund or make premature withdrawals against retirement accounts in order to settle medical debts.

Legally speaking, medical bills and the associated debt are part of the marital estate — and therefore subject to division (and sharing) according to local property laws in the case of a divorce. But that applies to couples separating after a significant medical expense. Even then, a couple’s assets may be seized to settle bills as long as five years after a divorce, precisely because some couples choose separation over financial devastation.

As such, it can actually pay to call it quits earlier, especially in anticipation of long-term care expenses, or following an unexpected diagnosis. If the couple splits more than five years ahead of when significant bills are likely, the ill partner is likely to qualify for Medicaid earlier on, and limit the impact to savings accounts or other assets.

As EHRs become more mobile and health technology more integrated beyond the walls of the clinic, patients and couples will find themselves armed with more tools and information regarding their health and medical futures than ever before. That is already beginning to have an impact on behavior.

In fact, one side-effect of the Affordable Care Act was a gentle uptick in divorces, apparently due to provisions which made it easier for individuals to shop for their own insurance, rather than staying married in order to obtain spousal coverage under employer-sponsored plans. Fear of medical debt has historically kept couples together, lest the breadwinner take affordable insurance in the separation and leave a dependent without coverage. But with medical costs continuing their upward spiral, insurance can provide a limited buffer against debt and despair.

 

Longer-Lived, Lower-Paid, and Fully Digital

We likely aren’t yet prepared to measure the full impact of rising healthcare costs on American matrimony. But we can get a good look at how changing awareness, and changing technology, is already disrupting relationships for America’s older generations.

For now, the primary consumers of healthcare are baby boomers. As the longest-lived generation yet, they are managing more chronic conditions as a matter of routine, but also lived through the highest overall era of overall earning and relative wages in American history. They have the purchasing power, and in many cases the savings, to face aging differently than younger generations are likely to do.

Most importantly, they are healthcare’s transitional generation: baby boomer doctors and patients alike are aware of EHRs and other in-development tech, but the kinks aren’t quite worked out yet. We aren’t collectively realizing the savings of digital records or the patient-centered care powered by them, and boomers are polarized. A good chunk of patients and providers look nostalgically back at a time before EHRs; others, either optimistically or out of a sense of inevitability, are trying to cope with the new normal. Either way, their challenges are likely to be yet another legacy restricted in large part to their particular generation.

By contrast, millennials and Gen X-ers are more likely to enter old age in an era of preclinical disease. Thanks to modern medical tech and consumer-facing health devices like wearables, and even online symptom-checkers, young people today have more likelihood than ever before of predicting chronic disease or genetic risk factors well ahead of actual symptoms. As a result, these preclinical diagnoses stand a very real chance of becoming as important to courtship conversations as earning potential or thoughts on parenthood.

This, combined with the existent millennial tendency to postpone major life changes – like marriage – and it hardly seems a stretch to envision a future wherein weddings are called off and unions terminated on the basis of medical risk.

 

Keeping Love Alive

The effect of new health technology on consumers is already spreading, and has been for longer than providers and organizations have been grappling with Meaningful Use or confounded by EHR interfaces. Nevertheless, our preoccupation often is with how technology, and the expectations it carries, impacts the workflows and culture of the clinic, rather than how it has a trickle-down effect on the lifestyles and decision-making of patients outside the clinic. Providers are burning out and divorcing, in their own way, from hospitals, caregiving roles, and even medicine itself in response to this apparent assault on tradition and autonomy.

All this amounts to is another reminder of how important it is for us to get things right, today. That means getting things right with respect to patient care, empowering the frontline caregivers who often have the biggest bottom-line impact on both patient experience and systemic costs. We must also adjust our behavior, and the patient-facing conversations we have, with the technology shift in healthcare. The baseline demographics are changing in this country, and technology is having an effect on how people consider healthcare, as well as how healthcare choices influence other elements of people’s lives.

The reality is changing on just how compartmentalized healthcare is in the daily lives and risk calculus of future generations. The healthcare system is not just one system; it may be the system we need to focus on to make the biggest difference in the lives of the healthy and the ill alike.

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