I used to work with a homeless shelter and the director told me the #1 cause of homelessness was sudden massive healthcare bills. This can even extend to caring family members who foot the bill, leaving them financially at the edge, just before suffering some shock of their own.

Hmm... seems like if someone in your household is diagnosed with some terrible (expensive to treat) illness, you should just operate under the assumption that you will be declaring bankruptcy after all is said and done. And therefore:

- Do NOT touch IRAs or any other asset that might be protected during bankruptcy (i.e., don't liquidate everything in a futile attempt to keep up with the medical bills).

- Pay as little as you can get away with on those medical bills during treatment. Then sort it all out in bankruptcy court.

> Pay as little as you can get away with on those medical bills during treatment. Then sort it all out in bankruptcy court.

That sounds like a good strategy anyway, since you can't ever be sure a procedure will fix a problem, even if it should, so future expenses are a fairly open question.

You don't have a lot of options if after your first medical solution you've paid everyone in full and are out of money but the problem isn't resolved, but frugal rationing of payments might mean you have quite a few tries before your funds are exhausted (even if you've left a trail of partially paid bills).

Unfortunately, I imagine the length of time involved means it's probably tricky to prevent past bills being reported as debt that might affect future actions.

Yea, this really depends on the illness but there is a lot of slack in the system.

It can take 2-3 months before you get a bill after medical treatment add another 60-90 days before it's very late and you have 6 months or so before your credit get's trashed assuming zero payment.

However, partial payments can push this out much further. Remember, companies don't want to sell you debt as they only get a fraction of it's total value so work with them. So, paying say 1% per month is often enough to avoid sending a very large bill to collections.

You may be right, but those strategies are disincentivized not only by things like your credit score (which, I mean, by the time you're facing ruin, who cares, but it's understandable that someone would be worried about it) but also by a culture that often has moralizing assumptions about personal debt.

Negative health shocks can also lead to wealth loss because they can impact the ability to work and can require help of various kinds--even outside of actual healthcare costs that may be covered by insurance to various degrees.

This is discussed in the Limitations section of their article: https://jamanetwork.com/journals/jama/fullarticle/2677445

> Third, despite adjusting for conditions that frequently precipitate wealth shocks, including marital disruption, unemployment, and a variety of health status and access to care indicators, residual confounding is likely.

They adjusted for it, but maybe not enough.

Unless they controlled for it, this seems like the obvious primary cause of the observed effect. Especially since this was mostly a pre-ACA period where many more people were uninsured. I don't see any indication that they did control for this, so I'm not updating my beliefs very much about the health effects of losing your wealth via non-medical expense mechanisms.

Sounds like a viscous, dangerous, terrible feedback loop.