A recent act of kindness from Trinity Moravian Church in Winston-Salem, North Carolina, has gone viral for its creative method of tackling medical debt. It involves the church paying off $3.3 million in medical debt belonging to 3,355 local families – complete with a cathartic video of the oppressive debt being burned to ashes – by purchasing it for pennies on the dollar from debt collectors. Though heartwarming at first – and undoubtedly commendable – this event exposes the troubling state of the American health care system.
The actions of the Church are another iteration in a series of philanthropic movements attempting to lighten the burden of sickness in America, from thousands rallying together to crowdfund life-saving surgeries on GoFundMe to YouTubers covering the costs of cataract surgeries for 1000 people. However, when considering that in 2020, 8 million patients resorted to crowdfunding campaigns to cover their insurmountable hospital bills (a large proportion of whom suffer from the most debilitating conditions), it becomes clear that these faith-in-humanity-restoring moments are actually desperate attempts to jury-rig a sustainable economic health care model.
Beyond saving families from oppressive medical debt, these movements serve a second purpose: they highlight the need to shift the narrative surrounding the financing of medical expenses. Trinity Moravian Church and their partnering organization, RIP Medical Debt, go even further in showing us that the exorbitant medical fees bleeding millions of Americans dry are arbitrary.
Nevertheless, there are clear idiosyncrasies in the system that are notable points of action, with the lack of transparency in hospital billing being chief among them. In fact, an attempt to address this exploitation has already been made through legislation prohibiting unexpected charges from out-of-network providers and mandating that hospitals provide a clear and accurate estimate of all items and services for which the patient is being charged. However, despite this, surprise billing and cost inflation remain rampant, as it is more profitable for the business side of medicine to flout the law and bear the cost of fines than to abide by the law.
For better or worse, the American health landscape is a marketplace. Yet, such a system does not absolve institutions of their responsibilities towards patients or “consumers.” The precedent of autonomy as an enshrined and irrefutable tenet of patient care has already been set and enforced through practices such as obtaining informed consent before procedures, as well as protecting patient privacy through HIPAA. If we are going to accept that autonomy is a core right of the patient, we must do so comprehensively, including when it comes to the patient’s ability to make informed financial decisions about their own care. This is especially true in a health care marketplace, where variable pricing is central to the system’s existence to begin with.
Thus, it follows that the ramifications for violation of this autonomy follow established precedent as well. HIPAA violations are accompanied by severe penalties, including heavy fines and loss of accreditation. Such measures are not unwarranted in the case of opaque billing practices, especially when considering that normalizing the practice of health care corporations bypassing the law only paves the way for more exploitation.
Recent legislation in Colorado offers another solution, ensuring that health care entities not following the law will not be supported by the law. This bill prohibits hospitals or collection agencies from collecting on patient bills if they do not comply with federal transparency laws. Expanding this policy nationally is the next logical and potentially effective step in mitigating this problem.
The reality remains that many health care institutions are flagrantly ignoring their ethical and legal responsibilities, at the expense of the patient. While well-intentioned community movements have emerged as makeshift solutions, they ultimately highlight the fact that while Americans are justifiably trying to find ways to stay afloat, the actual problem is being overlooked. To truly respect the inherent right to autonomy and health, we must center these principles in practice and hold the health institutions and corporations that seek to disregard these rights accountable.
Sami Alahmadi and Fadi D. Masoud are medical students.
