Medical Debt Is An Instrument of Suffering
By Luke Messac
I have seen patients with large, fungating masses, tumors that spread for months, growths that reek of dead flesh. These are the excruciating outrages that I had seen in century-old textbooks and in medical deserts in the world’s most impoverished places. But now I saw these masses in the United States of America, on the bodies of patients who considered themselves middle class. They festered because those afflicted by them feared the toll of medical debt on their families if they sought care.
We know that medical debt, and fear of debt, leads people to delay and forgo necessary medical care. For some, this isn’t even a choice, as health care facilities can refuse to treat patients with unpaid bills. Patients in debt are pursued with a punitive zeal that harkens back to Dickensian tales of immiseration. Hospitals sell debt to the highest bidder, to buyers who see patients as nothing more than figures on a spreadsheet. Hospitals and their collectors file lawsuits against their low-income patients, seize their bank accounts, garnish their wages, foreclose on their homes. They even seek the arrest of patients who do not appear for their court dates. Even after a patient dies, the grieving spouse is held responsible for their debts. These are the tools of a carceral apparatus, not a caring institution.
Our present is a tragedy, in part because these practices lead to missed opportunities for timely cures, for longer and more fulfilling lives. The dead brain tissue from delayed presentations for stroke and the infarcted heart muscle from forgone care for heart disease leads, inexorably, to needless suffering, to capabilities lost, to loving relationships cut short.
Our present is also a tragedy because medicine remains, in our collective imagination, so much more than a transaction. There is, in our secular world, still something of the sacred in these relationships between patient and doctor and nurse. When we are patients, we cannot help but be vulnerable. We offer up a part of ourselves to the care of others, in part because we are in such a state of need, but also because we hope the professionals caring for us see this care as an end in itself and not just as a means to remuneration. Those we turn to for care are, we hope, not mere moneychangers in the temple of healing.
Today, much of the ugly work of aggressive and punitive debt occurs without the active participation of those whose work it is to care. Debt collectors and hospital executives do not consult doctors before they take patients to court. But our ignorance can no longer be an excuse. Passive assent does not free us from responsibility. We must take sides, and if doctors are, as Virchow argued, the “natural attorneys of the poor,” we know what side that must be. Medical debt is a grotesque idea with even more grotesque real-world consequences. The only moral choice is to work to put an end to it.