Your Money or Your Life: Debt Collection in American Medicine

Despite American hospitals’ humanitarian pretensions, the institutions ruthlessly extract their pound of flesh from patients who can’t pay their bills, according to this searing debut. Emergency physician Messac recaps the shift from a 19th-century paradigm of providing free care to indigent patients to modern-day practices, in which hospitals, pressured by rising costs and stingier remuneration from Medicare and private insurers, recover debts owed by patients through a litany of avaricious practices. For example, hospitals, or the debt-collection agencies they sell debts to, subject patients to endless dunning letters and threatening phone calls; trash their credit ratings; garnishee their wages and seize their bank accounts; foreclose on their houses; and have them jailed for failing to appear in court. The overview of hospitals’ collection strategies outrages (in one case, a hospital arranged for a 68-year-old woman to discharge her debt by working in the facility’s laundry without pay), and the plenitude of patient stories drive home the ruinous consequences of America’s failure to rein in medical spending, as when Messac recounts treating a woman who had forgone medical attention and endured pain for six months after noticing a tumor for fear of saddling her family with exorbitant debt. The result is a hard-hitting exposé of one of the U.S. health care system’s cruelest derangements. (Nov.)