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But why? Debt is debt and affects someone’s ability to service other debts. This feels like a ban on speech about someone else’s credit worthiness.

swatcoder 2y ago
In the US, patients generally don't have adequate transparency to make decisions that impact how much medical debt they acrue. They see a medical professional, the professional makes some recommendation, and then the patient accepts or rejects the recommendation. Neither the medical professional nor the patient know the costs the patient will eventually encounter. The patient only finds out their costs some months later when they receive one or more bills negotiated between administrative groups and their health insurance provider. Any goods and services have already been rendered, and the patient is now on the hook for whatever the bills happen to see. Maybe the more "fair" answer is to make medical costs transparent instead of treating medical debt different than other kinds, but the system is broken and needs critical attention either way. This is essentially a path of least resistence.
- simfree 2y ago
  TL;DR: Our medical billing practices in the USA are fraud. Medical practices bill an insanely high amount with zero upfront disclosure while demanding every bit of personal information (employers past and present, educational history, SSN, all possible insurers, etc) and are often caught billing people they failed to serve (left after waiting hours) or refused to serve. The medical insurers aren't any better is the real kicker!
- blackeyeblitzar 2y ago
  I don’t disagree with any of that but that’s a different problem which should be directly addressed. If someone has debts they legally must pay off then it seems like regardless of how that debt came about, it would affect the risk associated with them, since they already owe someone else lots of money. For example if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender?
  - JumpCrisscross 2y ago
    > debts they legally must pay off then it seems like regardless of how that debt came about Many medical debts aren't paid off. I've disputed my fair share of them until the hospital agreed in writing to waive the charges. (Never went to collections, granted.) The first step in each of those cases was refusing to pay. > if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender? Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer.
    - tacticalturtle 2y ago
      > Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer. But if we did that, then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts. They’d have to make up the difference elsewhere, and raise prices further. This regulation seems well meaning but it’s just beating around the bush that our healthcare system is way too expensive and there’s no politically feasible solution.
      - blackeyeblitzar 2y ago
        What’s the politically infeasible but effective solution in your opinion? I’m having trouble coming up with something that doesn’t create an additional cost elsewhere.
        JumpCrisscross 2y ago
        > What’s the politically infeasible but effective solution Proper published pricing, for starters. If the price isn’t properly published and price wasn’t agreed upon ex ante, the bill should be dismissible. (It’s technically the law, but compliance is miserable.)
      - JumpCrisscross 2y ago
- _heimdall 2y ago
  The whole point of a credit report is to indicate the likelihood that an individual will pay back new debt that they're applying for. Isn't it helpful and important to know that a) how much debt the person is liable for and b) that they're willing to sign a contract allowing someone to charge them any amount to be decided at a later date? The later seems important both to know that the person may continue to agree to writing blank checks in the future and that their willingness to do so says something about their financial awareness.
  - yazzku 2y ago
    (b) does not apply here. Like the parent said, you don't know how much exactly a medical procedure is going to cost you until the price is negotiated with the insurance company, which can often take months. The medical office will, at best, give you an upper bound. When you're in pain, you don't really have choice.
    - _heimdall 2y ago
      B) applies here because medical intake forms include agreeing to the way prices are decided and agreeing to allow any treatments they deem necessary. It is basically a blank check. B) shouldn't be legal at all though, and that's the real problem. It is a fact that patients agree to owe whatever the hospital says they owe, and in my opinion that should be part of a credit history. Its also a fact, though, that hospitals charging this way is fraud and the system needs to be fundamentally fixed rather than band-aided by trying to just hide how much debt they are creating.
      - yazzku 2y ago
        By "does not apply" I meant that you can't use the same logic in a health situation. You're mostly just paraphrasing.
        _heimdall 2y ago
        Say more if you don't mind. What logic did I use that isn't right, and why can't it specifically for a health situation? I'm guessing the argument here is that you can't expect someone to have the chance to make a nuanced decision or to turn down care because of the terms a hospital requires you to agree to. That's simply not true. Beyond the obvious, but unreasonable, fact that one doesn't actually have to get treated there if they don't like the terms, it's a contract and contracts have to be agreed to by both parties. A patient doesn't have to sign intake papers as-is. It's a contract, scratch out what you don't agree to and add your own terms if necessary. Include "Under duress" with your signature and make sure the person at the desk is aware. You aren't trying to be difficult or fight with them, you simply don't agree to some of the contract and are making that legally clear while signing in.
JumpCrisscross 2y ago
> Debt is debt and affects someone’s ability to service other debts. "A large portion of consumers with medical debts in collections show no other evidence of financial distress and are consumers who ordinarily pay their other financial obligations on time. 22 percent of consumers with collections tradelines (7 percent of all consumers with credit reports) have only medical collections tradelines. These consumers owe less, have more available credit which they could use to repay their debt, and are more reliable payers than consumers with non-medical collections tradelines or than consumers with both types of collections tradelines. Indeed, of the consumers with only medical collections tradelines, approximately 50 percent have otherwise 'clean' credit reports with no indication of serious past delinquencies" [1]. It thus seems up for debate whether these debts represent the financial health or creditworthiness of the consumer. > feels like a ban on speech It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech) [2]. [1] https://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical-collections.pdf https://files.consumerfinance.gov/f/201412_cfpb_reports_cons... [2] http://www.jtexconsumerlaw.com/V16N2/V16N2_FairCredit.pdf http://www.jtexconsumerlaw.com/V16N2/V16N2_FairCredit.pdf
- blackeyeblitzar 2y ago
  > It thus seems up for debate whether these debts represent the financial health or creditworthiness of the consumer. You’re missing my point, I think (feel free to tell me otherwise). It doesn’t matter that they ordinarily pay their debts and are responsible financially before their medical debt. If they have medical debt that they’re obligated to pay off, then it affects their ability to pay other debts and is therefore something I would want to know as a lender. > It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech) I have not analyzed the SCOTUS precedent here. But I’m making a more generic claim that this violates free speech (a basic principle more fundamental than US law). EDIT since I can’t reply deeper in the thread: this speech isn’t fraud so that feels like a false equivalence. It’s just informing others of the facts. That shouldn’t be limited, right?
  - 2y ago
yks 2y ago
Medical debt in the US is unlike other debt. Amounts are declared post-factum and a patient doesn't have total control over the process in reality. The most important and visible choice is whether the provider/facility is in-network or out-of-network, but even that is not bulletproof cause no one discusses the exact billing codes with their providers and cross-checks with their insurance. As one example, sometimes pre-authorization is needed but not given and you're SOL. No Surprises Act took off some edge off this atrocity but the system remains unforgiving.
- deleted 2y ago
  [deleted]
- jrjarrett 2y ago
  Not to mention you have little choice in taking on that debt. If you need medical care, you need it. It's not like you have a choice to have life-saving care or not.
frognumber 2y ago
It doesn't matter. There are several issues: 1) Insurance is structured to be affordable to everyone by banning discrimination. Young, healthy people subsidize old, sick people. That's okay. 2) No one is banning free speech. People are banning specific types of decision-making based on free speech. 3) Speech here isn't free. See HIPAA. It's okay -- and even important -- to protect privacy. See also FERPA, RFPA, etc. I don't feel bad having my interest rates a little bit higher right now, in return for not having them go up if I have a horrific medical expense later. I don't think that should be factored. This is not a debt people choose.
- lotsofpulp 2y ago
  >Young, healthy people subsidize old, sick people. That's okay. Assuming there is a sufficient proportion of young, healthy people such that an acceptable proportion of the young, healthy people's productivity (income) is used to subsidize old, sick people.
  - amanaplanacanal 2y ago
    Are there any places in the first world where this isn’t true?
    - elashri 2y ago
      Japan, Italy and Germany are prominent example of this demographic problem. It is very obvious in japan that the country is struggling with increase cost of pension and Healthcare with the shrinking of workforce.
    - lotsofpulp 2y ago
      The US’s largest expense is healthcare for older and sicker people, between Medicare, Medicaid, and the portion of health insurance premiums that subsidized young and healthy to old and sick (due to Affordable Care Act mandating age rating factors capping premiums as a multiple of 21 year old premiums and getting rid of underwriting for any health issues other than using tobacco). Whether or not it is “acceptable” to the population is not an objective fact, although, there is always quite a bit of grumbling about increasing premiums, and the spending as a proportion of the nation’s productive output can only increased based on the population pyramid. And I bet that applies to every developed country.
eyelidlessness 2y ago
Exempting it from credit reporting would at least partially undermine the statement that “debt is debt”, and thereby at least partially exclude it from consideration in one’s ability to service other debts. It does these things by allowing people with medical debt to prioritize servicing those other debts, which they presumably agreed to take on, without fear of personal financial disaster for debts they generally had no choice in taking on.
saghm 2y ago
Because as a society, it's nice not to punish people as severely for requiring expensive medical care having a maxing out a bunch of credit cards. Sure, it would be better to reform health care so that care people actually need through no fault of their own doesn't put them into debt, but that's a lot harder to get done; reforming the way medical debt is treated is a much easier thing to do unilaterally. It's not obvious to me whether the proposal is a total ban on any medical related debt or if there's underlying legal details that attempt to condition the debt being excluded on some sort of test of whether the debt was unavoidable or not, but even if there's not, the question is whether excluding all medical debt is more fair than including; at least to me, it seems much more reasonable to punish medical debt at all than punish all of it.

swatcoder 2y ago

In the US, patients generally don't have adequate transparency to make decisions that impact how much medical debt they acrue. They see a medical professional, the professional makes some recommendation, and then the patient accepts or rejects the recommendation. Neither the medical professional nor the patient know the costs the patient will eventually encounter. The patient only finds out their costs some months later when they receive one or more bills negotiated between administrative groups and their health insurance provider. Any goods and services have already been rendered, and the patient is now on the hook for whatever the bills happen to see. Maybe the more "fair" answer is to make medical costs transparent instead of treating medical debt different than other kinds, but the system is broken and needs critical attention either way. This is essentially a path of least resistence.

simfree 2y ago
TL;DR: Our medical billing practices in the USA are fraud. Medical practices bill an insanely high amount with zero upfront disclosure while demanding every bit of personal information (employers past and present, educational history, SSN, all possible insurers, etc) and are often caught billing people they failed to serve (left after waiting hours) or refused to serve. The medical insurers aren't any better is the real kicker!
blackeyeblitzar 2y ago
I don’t disagree with any of that but that’s a different problem which should be directly addressed. If someone has debts they legally must pay off then it seems like regardless of how that debt came about, it would affect the risk associated with them, since they already owe someone else lots of money. For example if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender?
- JumpCrisscross 2y ago
  > debts they legally must pay off then it seems like regardless of how that debt came about Many medical debts aren't paid off. I've disputed my fair share of them until the hospital agreed in writing to waive the charges. (Never went to collections, granted.) The first step in each of those cases was refusing to pay. > if I were to offer them a loan and wasn’t aware that they’re saddled with medical debt, wouldn’t that leave me in a bad position as a lender? Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer.
  - tacticalturtle 2y ago
    > Yes, probably. This rule likely needs a sibling regulation reducing the capacity of collectors to collect on medical debt in ways that financially impair the consumer. But if we did that, then medical debt would become even less valuable to collectors, and hospitals will struggle to sell off unpaid accounts. They’d have to make up the difference elsewhere, and raise prices further. This regulation seems well meaning but it’s just beating around the bush that our healthcare system is way too expensive and there’s no politically feasible solution.
    - blackeyeblitzar 2y ago
      What’s the politically infeasible but effective solution in your opinion? I’m having trouble coming up with something that doesn’t create an additional cost elsewhere.
      - JumpCrisscross 2y ago
        > What’s the politically infeasible but effective solution Proper published pricing, for starters. If the price isn’t properly published and price wasn’t agreed upon ex ante, the bill should be dismissible. (It’s technically the law, but compliance is miserable.)
    - JumpCrisscross 2y ago
_heimdall 2y ago
The whole point of a credit report is to indicate the likelihood that an individual will pay back new debt that they're applying for. Isn't it helpful and important to know that a) how much debt the person is liable for and b) that they're willing to sign a contract allowing someone to charge them any amount to be decided at a later date? The later seems important both to know that the person may continue to agree to writing blank checks in the future and that their willingness to do so says something about their financial awareness.
- yazzku 2y ago
  (b) does not apply here. Like the parent said, you don't know how much exactly a medical procedure is going to cost you until the price is negotiated with the insurance company, which can often take months. The medical office will, at best, give you an upper bound. When you're in pain, you don't really have choice.
  - _heimdall 2y ago
    B) applies here because medical intake forms include agreeing to the way prices are decided and agreeing to allow any treatments they deem necessary. It is basically a blank check. B) shouldn't be legal at all though, and that's the real problem. It is a fact that patients agree to owe whatever the hospital says they owe, and in my opinion that should be part of a credit history. Its also a fact, though, that hospitals charging this way is fraud and the system needs to be fundamentally fixed rather than band-aided by trying to just hide how much debt they are creating.
    - yazzku 2y ago
      By "does not apply" I meant that you can't use the same logic in a health situation. You're mostly just paraphrasing.
      - _heimdall 2y ago
        Say more if you don't mind. What logic did I use that isn't right, and why can't it specifically for a health situation? I'm guessing the argument here is that you can't expect someone to have the chance to make a nuanced decision or to turn down care because of the terms a hospital requires you to agree to. That's simply not true. Beyond the obvious, but unreasonable, fact that one doesn't actually have to get treated there if they don't like the terms, it's a contract and contracts have to be agreed to by both parties. A patient doesn't have to sign intake papers as-is. It's a contract, scratch out what you don't agree to and add your own terms if necessary. Include "Under duress" with your signature and make sure the person at the desk is aware. You aren't trying to be difficult or fight with them, you simply don't agree to some of the contract and are making that legally clear while signing in.

JumpCrisscross 2y ago

> Debt is debt and affects someone’s ability to service other debts. "A large portion of consumers with medical debts in collections show no other evidence of financial distress and are consumers who ordinarily pay their other financial obligations on time. 22 percent of consumers with collections tradelines (7 percent of all consumers with credit reports) have only medical collections tradelines. These consumers owe less, have more available credit which they could use to repay their debt, and are more reliable payers than consumers with non-medical collections tradelines or than consumers with both types of collections tradelines. Indeed, of the consumers with only medical collections tradelines, approximately 50 percent have otherwise 'clean' credit reports with no indication of serious past delinquencies" [1]. It thus seems up for debate whether these debts represent the financial health or creditworthiness of the consumer. > feels like a ban on speech It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech) [2]. [1] https://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical-collections.pdf https://files.consumerfinance.gov/f/201412_cfpb_reports_cons... [2] http://www.jtexconsumerlaw.com/V16N2/V16N2_FairCredit.pdf http://www.jtexconsumerlaw.com/V16N2/V16N2_FairCredit.pdf

blackeyeblitzar 2y ago
> It thus seems up for debate whether these debts represent the financial health or creditworthiness of the consumer. You’re missing my point, I think (feel free to tell me otherwise). It doesn’t matter that they ordinarily pay their debts and are responsible financially before their medical debt. If they have medical debt that they’re obligated to pay off, then it affects their ability to pay other debts and is therefore something I would want to know as a lender. > It's commercial speech regarding a private concern and thereby subject to "intermediate scrutiny" (versus the strict scrutiny afforded to political speech) I have not analyzed the SCOTUS precedent here. But I’m making a more generic claim that this violates free speech (a basic principle more fundamental than US law). EDIT since I can’t reply deeper in the thread: this speech isn’t fraud so that feels like a false equivalence. It’s just informing others of the facts. That shouldn’t be limited, right?
- 2y ago

yks 2y ago

Medical debt in the US is unlike other debt. Amounts are declared post-factum and a patient doesn't have total control over the process in reality. The most important and visible choice is whether the provider/facility is in-network or out-of-network, but even that is not bulletproof cause no one discusses the exact billing codes with their providers and cross-checks with their insurance. As one example, sometimes pre-authorization is needed but not given and you're SOL. No Surprises Act took off some edge off this atrocity but the system remains unforgiving.

deleted 2y ago
[deleted]
jrjarrett 2y ago
Not to mention you have little choice in taking on that debt. If you need medical care, you need it. It's not like you have a choice to have life-saving care or not.

frognumber 2y ago

It doesn't matter. There are several issues: 1) Insurance is structured to be affordable to everyone by banning discrimination. Young, healthy people subsidize old, sick people. That's okay. 2) No one is banning free speech. People are banning specific types of decision-making based on free speech. 3) Speech here isn't free. See HIPAA. It's okay -- and even important -- to protect privacy. See also FERPA, RFPA, etc. I don't feel bad having my interest rates a little bit higher right now, in return for not having them go up if I have a horrific medical expense later. I don't think that should be factored. This is not a debt people choose.

lotsofpulp 2y ago
>Young, healthy people subsidize old, sick people. That's okay. Assuming there is a sufficient proportion of young, healthy people such that an acceptable proportion of the young, healthy people's productivity (income) is used to subsidize old, sick people.
- amanaplanacanal 2y ago
  Are there any places in the first world where this isn’t true?
  - elashri 2y ago
    Japan, Italy and Germany are prominent example of this demographic problem. It is very obvious in japan that the country is struggling with increase cost of pension and Healthcare with the shrinking of workforce.
  - lotsofpulp 2y ago
    The US’s largest expense is healthcare for older and sicker people, between Medicare, Medicaid, and the portion of health insurance premiums that subsidized young and healthy to old and sick (due to Affordable Care Act mandating age rating factors capping premiums as a multiple of 21 year old premiums and getting rid of underwriting for any health issues other than using tobacco). Whether or not it is “acceptable” to the population is not an objective fact, although, there is always quite a bit of grumbling about increasing premiums, and the spending as a proportion of the nation’s productive output can only increased based on the population pyramid. And I bet that applies to every developed country.

eyelidlessness 2y ago

Exempting it from credit reporting would at least partially undermine the statement that “debt is debt”, and thereby at least partially exclude it from consideration in one’s ability to service other debts. It does these things by allowing people with medical debt to prioritize servicing those other debts, which they presumably agreed to take on, without fear of personal financial disaster for debts they generally had no choice in taking on.

saghm 2y ago

Because as a society, it's nice not to punish people as severely for requiring expensive medical care having a maxing out a bunch of credit cards. Sure, it would be better to reform health care so that care people actually need through no fault of their own doesn't put them into debt, but that's a lot harder to get done; reforming the way medical debt is treated is a much easier thing to do unilaterally. It's not obvious to me whether the proposal is a total ban on any medical related debt or if there's underlying legal details that attempt to condition the debt being excluded on some sort of test of whether the debt was unavoidable or not, but even if there's not, the question is whether excluding all medical debt is more fair than including; at least to me, it seems much more reasonable to punish medical debt at all than punish all of it.