You are assuming $1000 is easy to pay off. This is simply not true for the working poor.

I'm not assuming anything, I'm wondering about their methodology (and since it's a self-reporting survey, how people were answering the questions).

Medical debt is a huge problem but to craft solutions we need to fully understand that problem. Should, for example, insurance companies collect "deductibles" ahead of time and refund those not used, similar to how you could use an HSA? Should healthcare providers and insurance companies be required to offer 0% financing for 12 months for certain amounts or certain customers?

The vast takeaway is usually "this survey supports what I think should be done" which often results in not much of anything being done, or getting something worse than what was before.

$1000 is $2 / day for les than 2 years (if you can do math unlike commenter below, that's including nearly 20% APR). I'm sorry but even the poor in america can come up with some way to make $14 in a week, if nothing else by picking up some cans.

I live in a city where a segment of impoverished people come up with ways to spend $20+ a day in fentanyl, and they don't seem to have much trouble coming up with that even while living in a tent.

You're taking one person's experience, who has mild medical expenses and applying their situation to loads of poor people as if their experience exemplifies the experiences of millions. Frankly, that's disgusting and while I don't wish you awful medical debt, it sounds like you could stand to be humbled by some.

Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.

>You're taking one person's experience, who has mild medical

"You" being the parent OPs who I responded to who introduced the nation of $1000, which happens to be above the median for my state and most states shown in the article? Remember I'm RESPONDING to the $1000 comment, not introducing the figure. But maybe they said something about the $1000 you agreed about, so you went with the disingenuous approach of only impugning someone commenting on it and in bad faith accusing THAT person of introducing the figure.

The MAJORITY in my state and most states have less than $1000 in medical debt. Millions. This isn't some edge case. $1000 "exemplifies" the median medical debt in most states, according to the article.

>sounds like you could stand to be humbled by some

Yeah a subtle suggestion I ought to experience medical problems. Keep it classy. "Frankly, that's disgusting."

>Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.

Yes I thought about it, and then decided my $2/day figure still holds as a possible approach for paying off median medical debt. Thanks for the thought exercise!

I'm really not sure how a median of $1000 is supposed to make your point any better.

I'm not sure how throwing around a $100k figure is supposed to make your point any better. If it's worth considering the 100k case of the minority it's worth considering the half of person's in these states for whom the debt is under $1k.

My intention was never to show that someone with $100k of medical debt could get out of it as easily as the majority with far less.

14 per week might be the difference between eating ok and not eating.

You can eat "ok" on $2 a day?

Yes if you are careful, but that isn't what I said. You are assuming that the base spent on food is 0 + 2 when that wasn't what I said.

>difference between eating ok and not eating.

>difference

> eating ok

> not eating

If you're not eating it follows you're eating $0 worth of food. So it is what you said, unless you're implying someone is spending money on food without eating any of it.

I'm interested in the meals you suggest that you think are "eating ok" while maintaining the nutrition to work, $2 all in per day (food cost + transport to buy the food + cost to cook the food + depreciation on any utinsils / cookware).

Also keep in mind many poor people live in a food desert so if you're counting on discount food you're gonna need a bus ticket or a hell of a long walk once in awhile.

As an aside, it's worth noting if your suggestion is true and one can truly eat ok on $2 a day, then the median medical debt holder who spends say $4 a day on food can easily pay off their loans in a few years following your cooking advice. You just came up with a way for them to produce $2 / day without any additional income.

There are multiple meals per day if one has to skip some of them to make ends meat then they are "not eating" those meals.

It's a bit more complicated than you are making it out to be, it would not hurt to remember you are talking about fellow human beings and not just numbers in a spreadsheet.

As for inexpensive ways to eat please see https://old.reddit.com/r/EatCheapAndHealthy/

Got it, the typical person can browse reddit, come up with an "ok" diet for $2 day, saving them $3+ a day vs what even the typical working class person spends on food. And simultaneously you believe it is achievable to save this $3+ per day eating following your reddit suggestion while somehow not being able to use $2 of those $3+ to pay your medical bills?

Do you find that being this uncharitable is an effective way to communicate with others?

You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.

>You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.

I don't know how poor you have been or are. And you don't know how poor I have been either. I'm not going to play oppression olympics with you. I have been homeless, sleeping in ditches and parks before, living off of minimum wage day labor. Even back then, if I needed $2 I simply worked an extra 15 minutes moving drywall at construction sites or whatever. Those who can't work may end up buying snacks with their foodstamp card and hawking them to high schoolers walking to school or something (as I see many homeless do near my house). There are very few people who aren't already covered by medicaid/medicare who are incapable of coming up with $2 / day somehow, and if they are they are the extreme case. Again even _drug addicts_ in my neighborhood, while high out of their minds, somehow manage to come up with $20/day for their fentanyl habit and that doesn't even cover the rest of their necessities.

And as an aside, I'm not buying the argument that being broke somehow makes you more of an expert on how to budget. The poor in this country are notoriously victims of sub-par education which sadly leaves many of them poorly situated to navigate managing their own economic future. If I want budgeting advice I'd much rather ask say a guy who started his own restaurant vs some random broke person on the street.

> I'm not going to play oppression olympics with you.

That wasn't my point. Honestly please take a look at your interaction with me and reflect on it, it isn't necessary to engage in such a hostile fashion. You have read a lot into what I have written that simply isn't there.

You have a pleasant rest of your day.

You have read a lot into what I have written that simply isn't there. It's not a good look to clam up and play the victim when called out on your presumptuous and contradictory statements, including your assuming the economic background of someone based on a short dialogue. Remember just one post ago you found it completely valid to retort about how I "haven't actually been poor like that" and how you have.

Please take a look at your interaction with me and reflect on it, and think to yourself about how you can be less presumptuous.

>You have a pleasant rest of your day.

Likewise!

Do you get your loans at 0% APR? Where do I sign?

Accounts Receivable at your local hospital.

People live in tents because 100% of their income goes to opiates.

They can’t make more money and save it, because their needs will always exceed their income short of massive windfalls

Yes, if you are living in a tent and are addicted to opiates, I doubt that "medical debt" would be anything that even registers on your radar. You'll get emergency medical care as needed at the nearest public ER, and since you don't have an address they probably won't even bother to try to send you a bill.

I’m in Canada and there is no medical debt but homeless addict encampments in many cities.

No need to wonder. You can read the poll and results methodology yourself.

The answer is two clicks from the article, both links above the fold on their respective page. If you’re being genuine in your curiosity, it would improve the discussion here if you shared what answer you find.

> The survey was designed to reach adults who currently have health care debt or have had health care debt in the last five years. In order to do this, the probability panel sample included an oversample of panel members with annual household incomes less than $30,000, individuals with current or past health care debt (n=641) were included in the sample. In addition, 52 adults with past or current health care debt were reached by calling back respondents that had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and reported an annual household income of less than $25,000.

> The combined online and telephone samples, excluding oversamples, were weighted to match the sample’s demographics to the U.S. population using data from the Census Bureau’s 2021 Current Population Survey (CPS). On the basis of this weighted sample, parameters for the debt and no-debt populations were extracted. Weighting parameters for each group included sex, age, education, race/ethnicity, region, education, and income, as well as patterns of civic engagement from the September 2017 Volunteering and Civic Life Supplement data from the CPS. The sample was also weighted to match population density parameters from the Census Planning Database 2020. The weights take into account differences in the probability of selection for each sample type. This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to be read as "63% percent of Americans".

The 100M in the title is extrapolated, and is likely correct, but people are not reading the percentages as they should be read.

The key takeaway from the study is that not all medical debt is reported as such, and poor people have difficulty paying bills, one type of which is medical bills.

> So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to

No, that's not how it works. You oversample a group you are interested in and then weight it.

To be honest, you don't know enough about statistics to evaluate this. You should either learn more or accept the conclusions of those who know more.

> ...to be read as "63% percent of Americans".

> The 100M in the title is extrapolated, and is likely correct,

What's the problem with their comment, exactly?

Even the study itself says "63% of respondents with debts".

Yes, it does. There's nothing wrong with that.

I also intentionally go in to debt for any of my expenses subject to deductible, because my hospital offers zero-interest payment plans. I then pay their payment plan with a credit card, get 2% back, and pay it off at the end of the month.

This also ties into that commonly statistic that 60+% of bankruptcies are caused by medical bills. The study is more complicated than that, and it's not the best summary:

https://www.politifact.com/factchecks/2009/jun/11/chris-dodd...

This is exactly the kind of thing I'm getting at - absolutely 100% of bankruptcies are caused by debt; perhaps 60% of them also have medical debt somewhere in there, but that may be a distraction (after all, once you're on the path to bankruptcy why bother trying to make medical payments, they're not going to repossess your lung but they very well may repossess your house).

The US has a major debt problem and the solution at some point is going to be curtailing just how much debt you can accumulate with just a signature.

A lot of people read that statistic as "medical debt is crippling" but there are also correlations with lot of other life circumstances going on in that figure too.

Most of the people who file something like chapter 7 have little to no income, don't have big bank accounts, luxury cars, second homes, etc. This often correlates with people who have medical issues and rack up big bills, and can't work a job. These people can file "no-asset" chapter 7 cases, in which case, they lose absolutely nothing. This is what happens in the majority of chapter 7 cases filed. So, for a lot of the people who do choose to file, this is because it is a good option, not because it is a life crippling choice forced upon them.

I'm very surprised they do not charge the credit card processing fee here. But I guess since you are actually paying they are making such high margin they don't even care.

Hospitals are incredibly forgiving if you will eventually pay. Collections will give them pennies on the dollar at best.

If you call them up, they'll usually just say "what can you pay?" and agree to just about anything you propose.

This is 100% the case, the billing side is completely and absolutely disconnected from the care side it's not even funny. As long as the inflows from customers and insurances companies roughly equal the outflows in expenses, they really don't care much how everything is billed.

Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.

At worst they'd put you as one of the 37% of people who haven't had to cut spending on food, clothing, or other basics.

Of course, 63% of the people with health care debt have (according to study).

So while your case is interesting from a technical point of view, it isn't really practically or morally interesting, and can only serve to detract from the important points of the study.

These studies are always self-reporting and taken at much more than they actually say. Checking the methodology is important and should be done more often, especially on surveys based on self-reporting and not on large amounts of data.

You are right. I tried to caveat my analysis with "(according to study)". My prior is not that the study is completely accurate, but that it is accurate enough to make the broader points described. I may be wrong, and you're right that everyone should be more cautious.

But I think there is a difference between cautioning neutrally (the comment I'm replying to now) versus obliquely cautioning in a way that casts doubt with negative consequences (the comment I replied to previously).

I wonder how they consider my family who receives bogus bills that are being mishandled by insurance or the hospital or both.

2/3 childbirths we missed one (tiny, in both cases) medical bill and it ended up in collections.

We were getting like 3-5 letters per provider per visit, and many visits resulted in bills from multiple providers.

"NOT A BILL" (so why the fuck are you sending it to me?) same thing again from insurance for some reason, incorrect bills we had to fight, insurance refusing to pay on things they should so that drags out for months and you're getting "FINAL BILL" in the meantime but the hospital billing people are telling you not to pay them until insurance is sorted out.

Many providers sending a bill exactly once and it goes to collections if you don't pay in 30 days, no calls or follow-ups (that's how both of ours ended up there—again, they were tiny, we'd have paid them instantly if we'd known about them).

Bills showing up two months after a visit and you've had 30 medical appointments in the last year so you can't remember WTF it was for. I think in one case we were still sorting crap out from the birth and prenatal care when the kid was 6 months old.

Hospital requiring full payment months in advance for the births. And getting it very wrong in one case (on the high side, of course—every billing error is in the hospital's favor, super weird how that works, bet it's just an accident and not them being actual no-bullshit criminals, though eyeroll) because they refused to use our version of what insurance would pay (which was correct) and basically just made up a number.

Total fucking mess. Horrible experience every time. Can't wait to get to deal with this horseshit when one of us is actually, seriously sick. I've added hospital billing departments to the list of medical-related folks I truly, sincerely wish the worst on, and I mean the worst—show me the headline, I'll open the champagne. They're either shockingly incompetent in ways that mess up people's lives, or they're malicious. Maybe both.

My wife and I have good insurance (like $200 out of pocket for surgery good) and I still hate going to the doctor because I know I'm going to get stuck with an involuntary side hustle as a medical billing clerk if I want the benefits we're entitled to to actually be honored. Our insurance paid maybe ~6k in charges one time, then 6 months later retroactively denied the claims and billed us for them. There's just no repose ever at any time, and you have to deal with a system that is always stacked against you.

No joke. If we'd been compensated at any kind of reasonable rate (not even our day-job rates) for time spent dealing with billing and insurance crap, it would've covered a good chunk of our (substantial) bills.

We've encountered similar situations (especially the "NOT A BILL" fuckery) and the "oh don't pay it when it arrives because insurance is always slow" shit - but luckily none of our three births have been that bad cost/handling wise, even though we used three different hospitals (same insurance).

The smaller hospitals in general have been better but it's so obviously a giant clusterfuck.

I can't even imagine how someone without partner support (who the hell wants to deal with hospital fuckery post-partum) does it.

> not them being actual no-bullshit criminals

Thou shalt never assume malice so sayeth lord Hanlon (brought to you by Carl's jr.)

I truly don't think everyone involved could be making so many mistakes in their own favor if it weren't the result of policies tuned to ensure that happens.

The policies are designed to find errors in the client's favor, that's manifestly clear.

Penalties need to be attached to misbilling; it needs to be made effectively illegal and allow others to help collect the penalties, then an industry of scummy lawyers will appear to help customers reduce their bills at the expense of the hospitals.

And they'd deserve it.

Yeah I was going to say, I would be 0% surprised if I had old outstanding medical bills somewhere just because of the general chaos of the process. I have plenty of cash to pay whatever I owe, it's just a low-visibility clusterfuck.

Yep. I'm dealing with a situation where speech therapy as rehab from a surgery is covered by by plan. But the hospital just submitted the claim with some general code. The insurance says they need the therapist to change the billing code. They won't allow us or the surgeon to submit anything to prove it should be covered. We have to wait for the inept therapist to change the code. All the while thousands in bills hang over our heads and we wonder if insurance will pay out.

And rarely, if ever, can you get the insurance company to admit what the secret billing code is before you have the procedure done. You have to hear it in whispered conversations from those in the know.