Need Another Reason For Universal Healthcare? How About Ending *Medical Debtor's Prison*?
It sucks to be poor in America. Especially when your misery is treated as a revenue stream. Some areas are even paying for local government by ramping up court fees and fines, essentially bringing back a form of Debtor's Prison. ProPublica reports on a fun new variation on that scheme: A sharp attorney for a medical debt collection agency in Coffeyville, Kansas, has built a good business by convincing a judge to help him put the screws to poor people.
The local magistrate judge, David Casement, summons people with unpaid medical bills again and again to court appearances so they can explain to the attorney, Michael Hassenplug, why they haven't paid bills to doctors, ambulance services, or the local hospital. Hassenplug requires they account for all their assets and prove they can't afford to pay, and then he decides whether to "set up a payment plan, to garnish wages or bank accounts, to put a lien on a property."
If people fail to show up, Judge Casement issues a contempt citation, and then if they miss that contempt hearing, he has them arrested. The $500 in bail he sets then goes to whichever medical outfit the person owes money to, and Hassenplug gets a nice fee -- as much as 33 percent -- from the money recovered for the creditor. Meanwhile, the debtors go deeper and deeper into debt.
Isn't that a lot better than socialism?
ProPublica's Lizzie Presser explains these sorts of arrangements really took off following the 2008 recession,
as collectors found judges willing to use their broad powers of contempt to wield the threat of arrest. Judges have issued warrants for people who owe money to landlords and payday lenders, who never paid off furniture, or day care fees, or federal student loans. Some debtors who have been arrested owed as little as $28.
And over half of the debt that's currently in collections in our great land is from medical care, debts that people seldom have a lot of choice about incurring. And yes, it gets worse:
The sickest patients are often the most indebted, and they're not exempt from arrest. In Indiana, a cancer patient was hauled away from home in her pajamas in front of her three children; too weak to climb the stairs to the women's area of the jail, she spent the night in a men's mental health unit where an inmate smeared feces on the wall. In Utah, a man who had ignored orders to appear over an unpaid ambulance bill told friends he would rather die than go to jail; the day he was arrested, he snuck poison into the cell and ended his life.
In some places, like Coffeyville, attorneys for medical providers have essentially converted the courts into a "government-sanctioned shakedown of the uninsured and underinsured," because it's a pretty good deal for the lawyers and for the doctors and hospitals and ambulance services. And the judges may feel like they're doing their part to keep lazy poor people from getting away with something.
Hassenplug really comes off looking like a local hero, if you live among vampires. He confronts Kenneth Maggard, a 28-year-old who's been diagnosed with several mental illnesses, and who owes over $2,000 "including interest and court fees" to an ambulance company that took him to the hospital when he tried to kill himself. Maggard's only income is from Social Security Disability, which is, happily, not subject to garnishment. But Hassenplug has Judge Casement summon Maggard to court again and again so his finances can be examined.
"Between you and me," he asked, "you're never going to pay this bill, are you?"
"No, never," Maggard said. "If I had the money, I'd pay it."
Hassenplug replied, "Well, this will end when one of us dies."
Hassenplug is proud of the work he does. Years ago, he realized there was an untapped market in Coffeyville, where the poverty rate is double the national average.
Hassenplug started collecting for doctors, dentists and veterinarians, but also banks and lumber yards and cities. He recognized that medical providers weren't being compensated for their services, and he was maddened by a "welfare mentality," as he called it, that allowed patients to dodge bills. "Their attitude a lot of times is, 'I'm a single mom and … I'm disabled and,' and the 'and' means 'the rules don't apply to me.' I think the rules apply to everybody," he told me.
He seems nice! Wonder if he's considered trying out to be a Fox News health expert?
Along the way, we meet Tres and Heather Biggs, who were driven into bankruptcy in 2012 by the $70,000 in debt that resulted from their son's treatment for leukemia, and then from Heather's treatment for a heart condition. They lost their home, but eventually Tres Biggs got a job on a ranch, with insurance, even. Was all well? Not entirely:
But it required Biggs to pay the first $5,000 before it covered medical expenses. When chest pain hit him as he worked cattle in the heat, and he began vomiting, the only nearby hospital was Coffeyville's. In 2017, the hospital sued again. It was the family's sixth lawsuit for medical debt.
Presser notes Tres Biggs has been arrested three times for medical debt: twice before the bankruptcy, and a third time in July 2019 after the new debts piled up.
Coffeyville Regional Medical Center is also part of the horror story. Like many rural hospitals, it's barely staying afloat -- in part because the Republicans running Kansas refused to accept Medicaid expansion -- which finally seems to be changing. Three other hospitals in neighboring towns have closed, and that means longer, costlier ambulance rides in emergencies. It's a nonprofit, but that doesn't mean it won't sue patients (in fact, nonprofit hospitals suing for collections is a whole 'nother ProPublica investigation). The hospital
accounts for the vast majority of medical debt lawsuits in the county — about 2,000 in the past five years. It also accounts for the majority of related warrants.
And while the hospital could direct collection agencies and their attorneys to ask judges not to issue warrants, nah, it decided that its finances are so precarious that if it can get any revenue, it will:
The Coffeyville hospital's attorney, Doug Bell, said that its only motivation is to continue to serve the area, and that Kansas' decision to not expand Medicaid under the Affordable Care Act has had a "dramatic effect on the economic liability of small rural hospitals."
Everyone needs to be paid, after all. You can't run a healthcare system on nothing, and we're definitely not socialists. So shit flows downhill, and some people end up drowning in it.
Judge Casement thinks his idea of charging $500 bail and then giving the money to the creditors instead of paying it back to the defendant is a pretty cool idea:
"Most people can come up with $500," he said. "It may not be their money, but they know someone who will pay." He made sure no one was arrested unless they'd been reached by personal service or certified mail.
Hassenplug explains it's a terrific system, since "A lot of times, that's the only time we get paid, is if they go to jail." But darn it, there's always some overeducated elitist expert saying a good scheme is somehow wrong:
Peter Holland, the former director of the Consumer Protection Clinic at the University of Maryland Law School, explained that this practice reveals that the jailing is not about contempt, but about collection. "Most judges will tell you, 'I'm working for the rule of law, and if you don't show up and you were summoned, there have to be consequences,'" he explained. "But the proof is in the pudding: If the judge is upholding the rule of law, he would give the bail money back to you when you appear in court. Instead, he is using his power to take money from you and hand it to the debt collector. It raises constitutional questions."
But so far, it doesn't appear to actually be illegal, so it's probably fine.
The essay ends with Hassenplug showing off a little. After claiming that he's definitely not making a fortune off any of this, and saying that some months his law office had trouble making expenses, he invites Presser to see one of the five buildings he owns in Coffeyville's largely vacant business district:
He walked me through the alleys under a cloudless sky, and when he arrived at one of his buildings, he tapped a code to his garage. The door lifted, and inside, five perfectly maintained motorcycles, Yamahas and Suzukis, were propped in a line. To their left, nine pristine, candy-colored cars were arranged – a Camaro SS with orange stripes, a Pontiac Trans Am, a vintage Silverado pickup with velvet seats. He toured me around the show cars, peering into their windows, and mused about what his hard work had gotten him.
Isn't the American healthcare system the BEST? That could never happen in Canada or France or Germany or Japan. Only in America! Or Bangladesh.
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Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.