The New Debtor's Prison
After my struggles with my health earlier this year resulted in a number of bills I've been having to pay in installments, this article on medical debt collection turning contempt of court judgments into an effective debtor's prison cut uncomfortably close. We at least do have some resources we can call upon, including family who can spot us some money when we're in a jam, but a lot of people don't have those resources, even for relatively small bills.
What I found really disturbing was the hectoring and humiliation that the poorest and most vulnerable had to endure, month after month, just to keep from being thrown in jail for contempt of court. It's not that they don't care about their bills -- most of them are painfully aware of those obligations weighing upon them -- but that they simply do not have the resources to pay. And when they were already collapsing under the load of medical debt, they were getting fees and court costs added to it.
Medical debt is especially problematic because it represents a fundamentally different sort of expenditure than most of the other things people get into debt trouble over. Except in the case of well visits and cosmetic procedures, the customer is not a rational consumer, but a desperate consumer with a clock ticking against them. In many cases, the person doesn't have a choice about undertaking it -- in an emergency, especially if they are badly injured or otherwise in no state to make a rational judgment about cost and risk, they may well be treated on the say-so of a concerned family member, or even a bystander. I've heard of persons with epilepsy or other conditions that can cause loss of consciousness or bodily control wearing a bracelet specifically directing that no ambulance be called, in hopes a well-meaning Good Samaritan doesn't inadvertently stick them with a bill beyond their power to pay.
I remember reading a blog post some years back about medical ethics and medical billing and making the comment that we developed all this cool technology for saving lives, but never stopped to consider about how it should be paid for. Especially when such technology moves from experimental (and thus often paid for by the research program) to ordinary, should the moral obligation to seek and obtain care leave the patient with a devastating financial burden, which can actually end up interfering with their ability to carry out their obligation of care for health?
What I found really disturbing was the hectoring and humiliation that the poorest and most vulnerable had to endure, month after month, just to keep from being thrown in jail for contempt of court. It's not that they don't care about their bills -- most of them are painfully aware of those obligations weighing upon them -- but that they simply do not have the resources to pay. And when they were already collapsing under the load of medical debt, they were getting fees and court costs added to it.
Medical debt is especially problematic because it represents a fundamentally different sort of expenditure than most of the other things people get into debt trouble over. Except in the case of well visits and cosmetic procedures, the customer is not a rational consumer, but a desperate consumer with a clock ticking against them. In many cases, the person doesn't have a choice about undertaking it -- in an emergency, especially if they are badly injured or otherwise in no state to make a rational judgment about cost and risk, they may well be treated on the say-so of a concerned family member, or even a bystander. I've heard of persons with epilepsy or other conditions that can cause loss of consciousness or bodily control wearing a bracelet specifically directing that no ambulance be called, in hopes a well-meaning Good Samaritan doesn't inadvertently stick them with a bill beyond their power to pay.
I remember reading a blog post some years back about medical ethics and medical billing and making the comment that we developed all this cool technology for saving lives, but never stopped to consider about how it should be paid for. Especially when such technology moves from experimental (and thus often paid for by the research program) to ordinary, should the moral obligation to seek and obtain care leave the patient with a devastating financial burden, which can actually end up interfering with their ability to carry out their obligation of care for health?