But why? Debt is debt and affects someone’s ability to service other debts. This feels like a ban on speech about someone else’s credit worthiness.
They see a medical professional, the professional makes some recommendation, and then the patient accepts or rejects the recommendation. Neither the medical professional nor the patient know the costs the patient will eventually encounter.
The patient only finds out their costs some months later when they receive one or more bills negotiated between administrative groups and their health insurance provider. Any goods and services have already been rendered, and the patient is now on the hook for whatever the bills happen to see.
Maybe the more "fair" answer is to make medical costs transparent instead of treating medical debt different than other kinds, but the system is broken and needs critical attention either way. This is essentially a path of least resistence.
Medical practices bill an insanely high amount with zero upfront disclosure while demanding every bit of personal information (employers past and present, educational history, SSN, all possible insurers, etc) and are often caught billing people they failed to serve (left after waiting hours) or refused to serve.
The medical insurers aren't any better is the real kicker!
Many medical debts aren't paid off. I've disputed my fair share of them until the hospital agreed in writing to waive the charges. (Never went to collections, granted.)
The first step in each of those cases was refusing to pay.
> if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender?
Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer.
But if we did that, then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts.
They’d have to make up the difference elsewhere, and raise prices further.
This regulation seems well meaning but it’s just beating around the bush that our healthcare system is way too expensive and there’s no politically feasible solution.
Proper published pricing, for starters. If the price isn’t properly published and price wasn’t agreed upon ex ante, the bill should be dismissible. (It’s technically the law, but compliance is miserable.)
Medical debt is already heavily discounted given its abysmal collection rates. Papering over that by pretending something that trades at pennies is worth face value strikes me as a useless fiction to continue propagating.
> have to make up the difference elsewhere, and raise prices further
Medical debt trades at a nickel to a dime on the dollar [1]. This isn’t a meaningful difference.
[1] https://www.solosuit.com/posts/how-much-collection-agencies-...
I think most people here will probably agree with that (myself included!), but I suspect the disagreement is about whether that's a convincing argument against this policy given the political reality that reforming healthcare as a whole is not feasible at the moment and won't likely be any time soon. Trying to reform healthcare right now would require passing in the Senate (meaning either a supermajority voting for it or the majority party eliminating the filibuster), the House (which currently is not controlled by the same party as the Senate and the White House and unlikely to agree with them on any healthcare laws), signed by the president, upheld by the Supreme Court when it inevitably gets challenged, and then not repealed subsequently by a later presidential administration and Congress.
The part that people disagree with you on isn't whether this proposal is the best possible way to handle the issue of people unfairly having medical debt; it's whether doing nothing until the entire healthcare system gets overhauled would be letting the perfect be the enemy of the good.
Even though this is a serious issue that intimately, negatively affects nearly every American citizen at some point in their life, there is still not enough pressure on the government to enact a real change. Insurance companies simply have more political power than voters do.
This change will mean creditor companies have skin in the game, too, and so hopefully they will now lobby the government to fix the medical problem. It's not fair — it's not their fault that the insurance lobby is out of control — but fairness isn't working.
The way I see it, corporations are manmade tools, not human beings with innate desires and rights. Corporations cannot exist unless a society chooses to legally define incorporation, and societies only do this because corporations are very useful for advanced economies. Thus corporations ultimately exist in service to the society that creates them and grants them the means to participate in said society.
If some corporation get out of control, society should have the right to rope its other corporations into reigning the rogue corporation back in if necessary — because all corporations are ultimately tools that society creates, uses, and dissolves.
Isn't it helpful and important to know that a) how much debt the person is liable for and b) that they're willing to sign a contract allowing someone to charge them any amount to be decided at a later date?
The later seems important both to know that the person may continue to agree to writing blank checks in the future and that their willingness to do so says something about their financial awareness.
B) shouldn't be legal at all though, and that's the real problem. It is a fact that patients agree to owe whatever the hospital says they owe, and in my opinion that should be part of a credit history. Its also a fact, though, that hospitals charging this way is fraud and the system needs to be fundamentally fixed rather than band-aided by trying to just hide how much debt they are creating.
I'm guessing the argument here is that you can't expect someone to have the chance to make a nuanced decision or to turn down care because of the terms a hospital requires you to agree to. That's simply not true. Beyond the obvious, but unreasonable, fact that one doesn't actually have to get treated there if they don't like the terms, it's a contract and contracts have to be agreed to by both parties.
A patient doesn't have to sign intake papers as-is. It's a contract, scratch out what you don't agree to and add your own terms if necessary. Include "Under duress" with your signature and make sure the person at the desk is aware. You aren't trying to be difficult or fight with them, you simply don't agree to some of the contract and are making that legally clear while signing in.
No. You cannot make a nuanced decision when you're in an accident and are rushed (unconsciously) to an out-of-network hospital, or any kind of similar emergency situation. Negotiating a medical contract is not like signing a car lease.
Not sure why this is so difficult to understand? Have you actually been to a hospital, or in any form of even mild pain?
Hilarious to try to blame the US's broken medical system on the victim. If you've ever had any medical procedure done then you've done this thing that you consider so reprehensible. If you've ever been seriously injured you've done this (your consent to any price charged is presumed while you are unconscious, by law). If the hospital walks 5 specialists quickly through the room while you're out cold, congratulations, you legally consented to pay any price they charge.
Come on. It's a ludicrous system. Don't even try to blame the victims here.
If the latter, we totally agree. My view is that the system is fundamentally broken and continuing to just try to help patients deal with fraud after the fact isn't the right solution. In this case, allowing the fraud to continue and only hiding it from credit reports just makes it worse for us as consumers.
We need to stop band-aiding the problem and fix the medical system. They obviously shouldn't be allowed to decide to charge whatever they want after the work is done, and they shouldn't be able to game it by running multiple specialists through just to rack up fees.
There are actually ways around it today, but the hospital will hate you. When signing intake forms that have you agreeing to this payment model, cross out the terms you do to agree to and include "Under Duress" with your signature. Raise this with the hospital staff and make it clear what terms you disagree with, including that you must approve every individual treatment. They won't like you, or they may 100% respect you, but it is legal to do.
"A large portion of consumers with medical debts in collections show no other evidence of financial distress and are consumers who ordinarily pay their other financial obligations on time. 22 percent of consumers with collections tradelines (7 percent of all consumers with credit reports) have only medical collections tradelines. These consumers owe less, have more available credit which they could use to repay their debt, and are more reliable payers than consumers with non-medical collections tradelines or than consumers with both types of collections tradelines. Indeed, of the consumers with only medical collections tradelines, approximately 50 percent have otherwise 'clean' credit reports with no indication of serious past delinquencies" [1].
It thus seems up for debate whether these debts represent the financial health or creditworthiness of the consumer.
> feels like a ban on speech
It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech) [2].
[1] https://files.consumerfinance.gov/f/201412_cfpb_reports_cons...
[2] http://www.jtexconsumerlaw.com/V16N2/V16N2_FairCredit.pdf
You’re missing my point, I think (feel free to tell me otherwise). It doesn’t matter that they ordinarily pay their debts and are responsible financially before their medical debt. If they have medical debt that they’re obligated to pay off, then it affects their ability to pay other debts and is therefore something I would want to know as a lender.
> It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech)
I have not analyzed the SCOTUS precedent here. But I’m making a more generic claim that this violates free speech (a basic principle more fundamental than US law).
EDIT since I can’t reply deeper in the thread: this speech isn’t fraud so that feels like a false equivalence. It’s just informing others of the facts. That shouldn’t be limited, right?
I'm curious for data on how medical debt affects creditworthiness.
There are limits on collecting medical debt, for example, that might make someone with a massive on-paper medical debt a good credit concern. Medical billing is also notoriously error prone in a way e.g. credit card billing simply is not. That further reduces the information in each medical-debt line item.
> I’m making a more generic claim that this violates free speech (a basic principle more fundamental than US law)
Yes, so does prosecuting someone for fraud. We've been balancing rights for centuries, in law and philosophy, particularly when it comes to commercial speech.
1) Insurance is structured to be affordable to everyone by banning discrimination. Young, healthy people subsidize old, sick people. That's okay.
2) No one is banning free speech. People are banning specific types of decision-making based on free speech.
3) Speech here isn't free. See HIPAA. It's okay -- and even important -- to protect privacy. See also FERPA, RFPA, etc.
I don't feel bad having my interest rates a little bit higher right now, in return for not having them go up if I have a horrific medical expense later. I don't think that should be factored.
This is not a debt people choose.
Assuming there is a sufficient proportion of young, healthy people such that an acceptable proportion of the young, healthy people's productivity (income) is used to subsidize old, sick people.
Whether or not it is “acceptable” to the population is not an objective fact, although, there is always quite a bit of grumbling about increasing premiums, and the spending as a proportion of the nation’s productive output can only increased based on the population pyramid.
And I bet that applies to every developed country.
It's not like you have a choice to have life-saving care or not.
It's not obvious to me whether the proposal is a total ban on any medical related debt or if there's underlying legal details that attempt to condition the debt being excluded on some sort of test of whether the debt was unavoidable or not, but even if there's not, the question is whether excluding all medical debt is more fair than including; at least to me, it seems much more reasonable to punish medical debt at all than punish all of it.