You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

Since the hospital takes a loss in those cases (and has to, since they have to treat everyone), everyone else's cost of care goes up to subsidize the loss.

> You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

As someone who's family has been in that situation before, not it is not. We had a $35,000 bill forgiven entirely because we couldn't afford it. The process was certainly stressful, distressing, and we shouldn't have a system where it happened in the first place. That doesn't change the fact that the end result was forgiveness.

If the patient is a destitute homeless person they literally cannot pay. The bill can get sent to collections, but it's not like they have an address to collect from, or a good credit score to ruin, so it's uncollectable.

You can typically try to work out a deal with the billing department which might be a payment plan, cash payment in exchange for a discount (easier to get if you have bad or no insurance), or a combination of both. But once they send it to collections, good luck.

You can negotiate with collections too. If they bought the debt for 5 cents on the dollar (typical) and you make it clear they can accept 50 cents on the dollar or call you for the next 7 years because you just don't care, they may accept.

You just don't pay. They send a bill, you ignore it.

That's about it.