Two Kinds of Debt: The Enforced and the Possible
By Zackary Berger
David Graeber, in his book Debt: The First 5,000 Years, argued that debt was moral and social, not just economic. This sort of obligation implies a reciprocal relationship, said Graeber. In everyday life, he pointed out, people do each other all sorts of favors without the expectation of monetary payment, or the record-keeping that would make it possible. I loan you a cup of sugar, and later you give me a ride to the train station. Monetary debt, policed by institutions of control (and, said Graeber, enforced by violence), is less bidirectional, or at least less encumbered by expectations of payback in anything but currency.
Medical debt, like debt in general, comes in various flavors. I am most familiar with two kinds of medical debt. I think, first, of organizations based on mutual aid and reciprocal acts of giving. So many exist all around us that we don’t take time to realize (I am speaking to myself as well). Groups collecting funds to help renters keep a roof over their heads. Organizations distributing masks and Covid tests. Those who collect and distribute medications which are overpriced and underdistributed. Volunteers who deliver one-on-one healthcare.
Of course, the second kind of medical debt is protected by thick walls of power and money. This kind of debt is enforced by law and politics, and depends on the mistaken notion that healthcare should, must, cost money – and, what’s more, that those with money should get better care, quicker care, more care than those without.
My patients are victimized by this second kind of medical debt. My institution, and others, sue them to squeeze every dime out of them. Their pay is garnished. Undocumented people without enough money to pay rent or buy food get bills from my employer in the thousands of dollars. This is done automatically; no one’s name is signed to these bills. It is what capitalist hospitals are expected to do.
What if, instead, we considered all of us bound in a reciprocal web of debt for our mutual health? This thought is already out there, it’s as old as the most ancient philosophical and religious texts, and has even been brought to fruition in a small scale, here or there; and even on a national scale, rarely.
During the roughest seas of the Covid-19 pandemic, in 2020 and 2021, there was a brief flash of moonlight on the waves which illuminated what was possible in this country. I am straining my eyes to see that flash again, but time and again I see it is just the blinking of my computer screen as I bill an encounter for the benefit of my employer.