This "cashing in" isn't really anything new or different from what we expect elsewhere. If it costs money to get healthcare, and there's value in being able to

This "cashing in" isn't really anything new or different from what we expect elsewhere. If it costs money to get healthcare, and there's value in being able to delay paying for it, then it makes sense that there will be interest. It also makes sense that the amount of interest scales with the risk. If a hospital did all of their own bookkeeping and debt collection, I would expect it to converge to the same kinds of policies and costs that a separate debt collection agency has. The unfortunate result is that the people with less ability to pay (i.e., higher risk) end up paying more, as with anything else. That's the real problem. But as long as it costs money, and there's a time/risk value to money, I don't see it getting fixed.