Your Money or Your Life : Debt Collection in American Medicine

Abstract

For the crime of falling sick without wealth, Americans face grave punishment. Patients are being sued and having their wages and bank accounts seized, their credit destroyed, their homes foreclosed. Patient debtors can even be thrown in jail. This book tells the story of how the collection of medical debt in the United States came to be so aggressive and the impact this is having on Americans’ lives. For centuries, doctors were often unable to collect—or declined to pursue—unpaid patient debts. But since the 1980s, such debts transformed from obligations negotiated by doctors, hospitals, and patients into assets bought and sold by people with no role in patient care. As government spending for the care of the poor slowed, and insurance companies pushed patients to pay higher out-of-pocket costs, hospitals faced growing debts. Hospital executives then turned to a rising industry of debt collectors, debt buyers, and collection attorneys. Entrepreneurs made fortunes in medical debt buying and collections, but the ruthlessness toward patients did not solve hospitals’ financial woes. The tactics did spark protests from patients, health care workers, and politicians from across the political spectrum. Although investigative reporting, congressional hearings, class action lawsuits, and new regulations have changed some debt collection practices, the industry has continued to find ways to demand patients pay up, no matter their means. This book exposes the criminalization of poverty and illness and reimagines how health care can be redesigned to fulfill its true purpose.