Living Can Ruin Your Life
I still have the scar, a small white sliver on the palm of my left hand. I had been slicing a piece of stale french bread with a serrated knife when the bread gave way and the blade sawed into my palm. I remember piercing pain, staring at the white layer of lipid under my exposed flesh, knowing I was well and truly fucked. I didn’t have health insurance but that didn’t matter because the wound wouldn’t stop bleeding. I went to the nearest emergency room named after the patron saint of charity.
The ER doctor derisively laughed at me for even coming in. The cut, he said, didn’t require stitches. Instead, he glued it back together with a small tube of medical grade adhesive. I pocketed the rest of the tube in order to look up its retail value — were I to have purchased it over the counter, I would have spent $20.
For this, he billed me $1,046. His fee was independent of the hospital’s own bill of $2,200, which brought the grand total to $3,246, an amount that kept increasing the longer I didn’t pay. I couldn’t pay. So I didn’t.
I wrote the hospital a hardship letter a week after my ER visit, throwing myself upon the patron saint of charity. I informed them I had brought in an income of $577 the month prior, and had made $5,200 in self employment income the year before that. For six months I attempted to follow up with the hospital’s “outreach benefits specialist,” inquiring as to the status of my charity application, to no avail. They did not reply but the bills kept coming. The bills, as most neglected bills do, went to collections. The unpaid debt was, as most unpaid debt is, sold, then sold again. Then sold again.
While I knew it would destroy my credit, waiting seven years until the statute of limitations ran out on the debt wasn’t really a choice so much as a necessity. Had I not, had I paid anything at all to one of the myriad debt collectors who incessantly called and mailed me for years afterward, I may have been well and truly fucked all over again. In only three states — North Carolina, Wisconsin, and Mississippi — does medical debt that persists beyond the statute of limitations actually go away. While debt collectors lose the right in most states to sue debtors after three years, collectors can, and do, continue harassing people for eons after they incurred their original debts. Give them something, anything, thinking it’ll make the phone calls and letters go away and they’ll in turn have the right to sue you, as they now have proof you’ve acknowledged the debt as legitimate. Like magic, a dead debt is given new life.
The hospital where I incurred my arrears almost a decade ago closed earlier this year after its owner filed for bankruptcy. Nevertheless I occasionally get letters from recovery firms that invariably have “mountain” or “pinnacle” in their names. I throw them in the trash.
(Side Note: The “nonprofit” company that owned said hospital declared bankruptcy even after being injected with $250m in capital from BlueMountain, a hedge fund. The company was allowed to be sold to BlueMountain (operating as “Integrity Healthcare”) after another potential purchaser balked at the California Attorney General’s insistence they continue to provide the same level of relief care the original owner, the Daughters of Charity, had, claiming to do so would have been “impossible.”)
I still have the scar, a small white sliver, below my belly button. It isn’t from an accident, but from the opposite; sterilization surgery I underwent because fertility would ruin me. I had no choice in where I’d get sterilized, nor did I really have a choice in whether or not I could be; as a 35-year-old woman who had never brought a child to full term, it was hard to convince the medical industrial complex I knew it was in my own (and really, America’s) best interest to never breed. This time, however, I had insurance — Medi-Cal, California’s public health program for poors.
(Another Side Note: I write a lot about being on public assistance because I am not ashamed of it. I am not proud, but I’m also not ashamed. The way I see it, if I had been born in a western country that actually supported artists, giving them grants to work, my existence would be supplemented by those funds — instead, my lamentable living is made semi-manageable by free food and healthcare. Were I a resident of Toronto, publishing just one article in my lifetime would qualify me for a $5k emerging writer grant. Were I German, I’d be able to tap into the $54b in assistance they specifically allocated to small businesses and freelancers in the creative sector earlier this year. Instead I was born in a myopic and selfish country that only supports those who don’t need the support, corporations who willfully ruin the world and don’t pay taxes. Who, I ask you, is the welfare queen?)
The procedure was done at the “region’s leading faith-based, nonprofit teaching hospital,” where I was given directions to hang a right at the statue of Jesus Christ surrounded by children in order to find the OR room (Church, meet state. Now kiss). The hospital bill for this procedure, which was performed with little to no compassion, ended up costing more than a 2020 Toyota Corolla. If you ever get the opportunity to look at an itemized bill charged to your insurance company, I highly recommend it; there you will see just how much the fix is in. While an OB-GYN can only bill the country’s largest private insurer $2,100 for all the visits necessary in order to bring a child to term (sans ultrasounds), this “nonprofit” hospital attempted to charge Medi-Cal over ten times that amount for one outpatient surgery that rendered me barren. My insurance company refused, instead choosing to pay out $2,850, the cost of a 2000 Corolla, and that was fine. Were I to pay out of pocket, it certainly would not have been fine. I, after all, have zero lobbyists on retainer.
As my outpatient surgery was considered “non-emergency and non-medically necessary care,” even if I qualified for financial assistance as an uninsured person I would have been expected to pay half the amount billed, even though half the amount billed would have been half my yearly income (this particular hospital, in their religious-based benevolence, still charges an uninsured person who makes 200% or less than the federal poverty level this rate).
The itemized list of the charges the hospital attempted to charge included $4,357 for use of the recovery room, a claim Medi-Cal denied. I woke up from my surgery cold, disoriented and in the dark, a puddle of unexplained blood beneath my crotch, unable to move my shoulders from the stiffness that was the byproduct of the breathing tube the doctors didn’t tell me they were going to insert. My last memory before going under was that of the anesthesiologist, who was late to the proceedings, brusquely grabbing my arm in order to inject me. I remember piercing pain. I woke up, alone, with the scar, but without the bill.
And now my best friend is in the hospital and my primary concern is not of her wellness but of the bottom line. It’s not that I’m not worried about her wellbeing — of course I am, I’m not a sociopath — but I know the right things to fear. She’s poor like me, thank Christ, and on Medi-Cal. Were she not, she’d be well and truly fucked. MRIs, emergency room fees, surgery fees — the out of pocket costs at this point, even with private insurance, would be astronomical. I know she does not have this money, in much the same way I know she’d be milked for it were she not on public assistance. There is little comfort to be taken in this landscape. But we are like hospitals in that we take what we can get.