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Illustration of a dog standing by a blue cross, with dollar signs floating around it. Zac Freeland/Vox

A sick pet, and an unthinkable choice

Are rising costs of care, and readily available credit, leading pet owners into vet debt?

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I was such a wreck that I can’t tell you what time I left my dog, Oscar, in the emergency room that first night. I know it was Memorial Day, because the first thought I had was that the banks were closed.

Two weeks earlier, Oscar stopped eating. There was a vague list of symptoms that pet owners fumble to describe before settling on “just not acting right.” I was waiting on a blood test, slipping him anti-nausea meds buried in peanut butter, and hand-feeding him kibble in the hope he’d eat something. He’d give my palm a disinterested sniff and turn away. So when I finally heard his steel dish clatter across the floor as he licked it clean of boiled chicken and plain rice, I was optimistic that he was on the mend. Then he collapsed on the floor. I carried him down to the car and then to the nearest 24-hour veterinary ER.

I was told Oscar had spleen cancer and hours to live, and, alternatively, that it could be a benign growth pressing on his intestines. For two days, I shuttled him between general vets and ERs for nightly monitoring, and at each step I was asked to pay in advance for services that had a coin-toss chance of keeping him alive even for a night. I ran up the following debts:

  • $1,378 for initial ER visit including radiology, 12-hour exam stay, fluids and scans
  • $1,349, ultrasound and biopsy
  • $182, back to the ER for another exam
  • $815, ER stay including overnight monitoring, IV drip, plasma, and blood filter
  • $137, general vet fee including histopathology
  • $1,455, general vet fee for hospitalization and transfusion

It was only later that I could catch my breath and tally it all up. The urgent demand for split-second, life-or-death decisions had consumed me. The only thing I knew was that I couldn’t live with myself if I didn’t give Oscar a fighting chance.

And I didn’t even have it that bad. Last December, I bought a year of pet insurance for about $350. Financial writers argue over whether this is a good investment. I say that if what you’re actually buying is a way to avoid calculating the value of your dog’s life, it’s a bargain.

If I didn’t have insurance, it’s safe to assume my bill easily would have been $3,000 more than what I wound up owing. But the plan I’d chosen only covered a portion of the costs and paid only in reimbursements after the fact.

Zac Freeland/Vox; Peter Rugg

So I charged all $5,316 of it to vet credit services, whose applications the veterinary techs conveniently had on hand or were trained to help me navigate on my phone. This was presented as a gift, an immediate way to untie the vet’s hands and let them get to work while Oscar’s chances worsened with every passing second.

In truth, it’s not so much a gift as an impossible choice. As treatment costs rise and in-house payment options quietly disappear, people are left vulnerable to catastrophic debts as the life of their pet hangs in the balance. The financial decisions made in these harrowing moments could haunt pet owners for years, regardless of whether their pet lives.

The waiting room solution

About Oscar: I adopted him as a puppy in 2009 in Kansas City, Missouri. His breed and birthday were impossible to know for sure as both he and his sister had been thrown from a moving car. The rescue people brought him to my house to see how we got along. He shivered, gazed deep into my eyes, and peed on my hardwood floor. Love.

The memory of it swirled 10 years later, as I took pictures of Oscar’s bills to send the insurance company and thought about the people crying in that emergency room. They wheeled dogs in on stretchers, or carried them hanging limp in their arms, and every single one watching their pet disappear into the back was asked what they knew about low-interest financing. They thumbed through credit card applications on their phones like it was a matter of life and death, which I now understand that it was. No payment, no treatment.

Leigh Kunkel, who is finishing her master’s in journalism at Northwestern, found herself facing a five-figure bill when her dog, Rutherford, was diagnosed with a brain tumor in 2017.

Leigh, who is also an acquaintance of mine, knew Rutherford needed help when the large-breed coonhound mix struggled to walk a straight line and keep his head up. But you can’t treat without a diagnosis, which meant brain scans, which meant $2,500 down before the technicians would warm up the machine.

Then the real bills started. Radiation therapy was projected to cost between $12,000 and $15,000, which, for perspective’s sake, is a quarter of the average American household’s annual earnings. It’s a sum weighty enough to give even relatively affluent Americans a lightbulb moment on how drastically their lives might be rerouted. Plans for a vacation, a house payment, a flight to see the relatives — all of that gone if you want to save a pet. Leigh worked two waitress jobs, and her boyfriend, Kyle, worked at a wine store.

“We tried to talk to the oncologist about a payment plan, and they said it all had to be up-front,” she says. The scans had maxed out their credit cards and drained their savings, so, still in the vet’s office, they signed up for CareCredit.

CareCredit provides people financing for medical and veterinary bills, offering a way to foot the bill for appointments, but especially emergency situations or surgeries, by advertising zero percent interest that retroactively ratchets up to the double digits if the loan isn’t paid back after a specific period. Along with Scratchpay, which offers to pick up vet bills of up to $10,000 with differing payment plans and interest rates, it’s now a common way to finance veterinary bills. In fact, they advertise in offices of partnering vets, the pamphlets for CareCredit and Scratchpay conveniently set up on the receptionists’ desks. In the end, I used both to pay for Oscar’s care.

Leigh was somewhat aware of the risks of getting credit on the fly. Not everyone is. According to a 2013 settlement that ended a New York state attorney general’s investigation into CareCredit’s lending practices, “Consumer complaints revealed that some consumers were led to believe that they were signing up for an in-house, no-interest payment plan directly with their provider. Others thought that they were applying for a line of credit with zero percent interest, while other consumers believed that the information they gave to their providers was being used to check their creditworthiness only, and was not an application for financing.”

The federal Consumer Financial Protection Bureau, which ordered the company to pay $34.1 million in restitution to customers that same year, determined some customers of CareCredit were apparently not aware that they were signing up for a high-interest credit card. CareCredit did not respond to requests for comment for this story.

“People often do not understand what the deferred interest means, and when they’re in a crisis, they’re not looking at the fine print,” says Chi Chi Wu, staff attorney at the National Consumer Law Center and author of its 2015 study, “Deceptive Bargain: The Hidden Time Bomb of Deferred Interest Credit Cards.”

Wu’s research found that many people incorrectly believe the interest on certain kinds of loans — at CareCredit, sometimes as much as 26.99 percent — is charged to whatever balance remains once the teaser rate expires. What they fail to understand is that the high-interest rate starts adding up that first day. (Scratchpay guarantees no deferred interest, but the interest rate you receive could vary widely from someone else’s, because it is “merit-based,” calculated by an individual’s “personal and financial profile.”)

“If you leave a single dollar on the balance, the second that introductory period lapses, the accrued interest crashes down,” Wu says.

Had Leigh had a balance when that period ended, that interest would have totaled more than $4,000.

She was lucky. She and her boyfriend took on as many extra shifts as they could and wrote to charities for financial aid. “We worked a lot those months. We paid it just under the wire,” she says. And two years later, Rutherford is alive and active.

And if Leigh were unwilling to take on a loan, or if her credit were bad, it’s entirely possible that Rutherford would not have gotten the same medical treatment. This month, a woman named Vivian Noell said she had little choice but to euthanize her injured 2-year-old pit bull when a Milford, Michigan, emergency clinic sought to set up a payment plan in advance. Noell worked part-time and didn’t have $3,000 for surgery and stabilization fees, and said she would not qualify for financing such as Scratchpay. Still, she told Home Life that she was willing to go “broke” for her dog and offered an alternate payment plan to the vet. She says the clinic turned her down.

The vet’s office has strongly denied her account, saying that it gave the dog stabilization treatment, that the prognosis was “grave and poor,” and that Noell could have gone into greater debt for a dog who might not have survived much longer.

Rising costs of care

There is at least one definitive difference between how care providers see your bipedal relatives and your family pet: There is no industry-standard term for the point when treating a person becomes so expensive that the family decides to stop fighting based purely on finances, and there are remarkably few cases in which the medical community will not treat an ill person. There is, however, a term for the financial event in which a pet owner’s bank account collapses, and it’s called the “stop-treatment point.” Vets surveyed by the trade publication DVM 360 calculated this as about $1,704 in 2012, almost twice the $961 pet owners were willing to spend in 2003.

How did we end up spending so much more on our dogs and cats in such a short time? Consider that in the worst economic years after the 2008 financial crisis, the pet industry thrived. The American Pet Products Association estimated consumers spent about $50 billion on their animals in 2010 alone and predicts they’ll pony up more than $70 billion this year. People might cut their grocery budgets before they deny their pets.

Spending on veterinary care has quietly been climbing, too. According to the products association, pet owners spent $17 billion on veterinary bills in 2017, a number that is expected to climb to just shy of $19 billion this year. Because pets are family, we want to give them a quality of care on par with what we believe people deserve. If there’s a machine that can detect a cluster of cancerous cells before they metastasize, and it saves your grandmother’s life, of course you want your furry best friend to have access to the same technology. Veterinarians are changing to capitalize on that demand the same as any other business would.

“Vets did use to offer [payment plans] more in-house, but overall the medical costs of treating humans and animals have both gone up. Vets have to keep up with those costs,” says Karen Leslie, executive director of the Pet Fund, a charity that helps pay for non-emergency medical services. “There was a time when access to an MRI test was limited unless you were near a university or a teaching hospital, and now they’re ubiquitous.”

In the past decade, what was once a field dominated by generalists has become increasingly specialized and expensive. We now have pet-specific ER doctors, cardiologists, oncologists, neurologists, dermatologists, and ophthalmologists. If your pet is bougie, you can order their prescription specs from Warby Barker. The trend shows no signs of slowing as long as specialists are at a premium. The American College of Veterinary Radiology had 70 job listings in August alone, 60 of which were for private practices.

Leslie asked that I not blame local vets for payment rules that are increasingly set by corporate ownership. (The Pet Fund’s corporate sponsors include Scratchpay. “We don’t tell anyone to use them,” she says.)

It’s true that fewer veterinarians’ offices are owned by vets. A 2018 census by the American Veterinary Association called market consolidation a trend, with only 9 percent of vets under the age of 40 reporting ownership of their practice in 2018, compared to 14.5 percent in 2008. Mars Inc. made headlines when it bought out more than 800 veterinary offices in 2017.

Known more for its candy, Mars has made pet holdings, including popular food brands Iams and Pedigree, a major part of its business. It is also one of Scratchpay’s biggest investors. When Scratchpay raised $6.4 million in series A funding last year, the charge was led by the Companion Fund, a pet-care investment group launched by none other than Mars Petcare. Mars did not offer comment despite multiple requests.

“Despairing” calls for help

Regardless of corporate ties, I doubt anyone who’s gotten a check from the Pet Fund will say it does anything short of God’s work. The requests at any animal charity are a slush pile of hopeless, Hail Mary pleas.

“I get flooded with calls and emails and requests to call vets and tell them we’ll help pay. I feel so helpless. The messages are despairing,” says Sarah Lauch, founder and president of the Live Like Roo Foundation. “These are people on food stamps. They just want out of that hole.”

Live Like Roo was started after Lauch took in a pit bull named Roosevelt from Chicago Animal Care and Control in April 2015. The previous owners had surrendered the 6-year-old dog for “issues urinating.” “Roo” was diagnosed with terminal bone cancer that same month. To raise money for a bucket list send-off, Lauch started the hashtag #LiveLikeRoo, and the national reaction inspired her to form a foundation.

Roo died in September 2015 after a summer of car rides, ice cream, photoshoots, and viral fame, and his namesake organization launched a few months later. Live Like Roo expects to award $500,000 in financial assistance this year, mostly to owners in low-income neighborhoods. If an applicant is turned down, they’re still sent a care package.

Like most pet charities, Live Like Roo started out helping with just a portion of expenses. Now they award fewer grants for larger amounts.

“It’s more effective. We were giving people $350 or $500, and it didn’t put a dent in what they owed,” Lauch says. “Now if we work with you and you have a $2,500 estimate, that’s what we give. Even people who have some money to throw around, most cannot afford to spend $2,000 right that second.”

Stories about food stamps and bad credit run the risk of making it seem as if this is only a problem for the poor, or people so financially irresponsible they should never have taken on the responsibility of a pet to begin with. That argument only works if you ignore the numbers. According to a May 2019 Federal Reserve report, 39 percent of US adults said they didn’t have the resources to cover a $400 emergency readily available.

And just like people delaying medical care until there’s no choice, high costs are also keeping animals owners from seeking preventive care. Of the 23 million pets living with families below the poverty line, almost 80 percent have never seen a vet, according to a 2014 post on a blog by Kitty Block, president of the Humane Society.

“They have a choice,” Lauch says. “The choice is, do I keep the dog and watch it suffer knowing I can’t do anything, or do I put it in the shelter to die?”

Peter’s Rugg’s dog on a sofa. Peter Rugg

A small comfort

I had far more options available than most do. My credit is solid, my income is steady, and my dog was insured. But Oscar James Rugg died two days after that first ER visit, with me petting his head. His insurance policy covered enough of the bills that my own balance is now just under the average stop-treatment point. A week after he died, his last vet sent a sympathy card: “Take comfort in knowing that you did everything you could have done for him.”

Working from home as a freelance journalist, I’m unmoored. I didn’t realize how much Oscar set the day’s rhythm: Up in the morning to do his business, breakfast, pause for walk around noon, another at 5 pm. I keep expecting him to boom onto the bed with me in the middle of the night, and now I hate sleeping uninterrupted till morning because there’s no 90-pound body to cannonball off the mattress at 3 am.

Friends have asked me what’s next. Oscar wasn’t the jealous type, and I’m sure I’ll get another dog someday. I’ve been advised to try fostering when I think I’m ready. My neighbor doesn’t think I will be, since he lost his own pooch years ago and still hasn’t gotten over it. “Never again,” he told me. “It hurts too much. I won’t put myself through it again.”

That seems cold. There are shelters full of dogs who need a home, and if I’m feeling tough, I’ll scroll through the urgent calls for homes and rescue groups on social media. I’d like to clear out some of that Scratchpay debt first. Someday.

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