MEDICAL BANKRUPTCY, PERSONAL LUCK AND A NATIONAL SIN

By Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair at the Center for Practical Bioethics
Professor of Pastoral Theology—Ethics & Ministry Praxis, Central Baptist Theological Seminary
Clinical Professor, School of Medicine, University of Kansas Medical Center
Director, Hospital Ethics Consultation Service, The University of Kansas Health System

I was raised on a farm up in Minnesota by Fundamentalist Depression-era parents. Among the many rules taught by words and deeds was that you don’t buy what you can’t afford. And never accrue debt. Save enough to buy a car when it’s needed, and then only buy the car that costs the amount you have saved.

That policy worked well for my nuclear family because of white privilege and a whole lot of luck. Others in our family had not always been so lucky, however. My grandparents, on both sides, had bad luck during the 1930s. They had accrued debt that they couldn’t pay when times got hard. Family farms were lost. Everything gone to debt collectors, some of whom were luckier neighbors. So “Never buy what you can’t afford” became our mantra. Not cars or even farms. Never acrrue debt. 

What works for some and in regard to cars or farms doesn’t work as well when what one cannot afford is healthcare. I can live with a cheap set of wheels, or maybe none at all. But my Depression-era father could not live without expensive cancer and cardiology care when he needed it. And there were no cheaper options. In healthcare emergencies, there is no Ford instead of a Lexus. It’s all Lexus. Or Lamborghini. Thank God my Dad had Medicare. Thank God I have employer provided insurance. 

But not everyone is so lucky. That is the truth we all know and of which we’re reminded by a recent (September 1, 2020) West Health and Gallup report on bankruptcy due to medical costs. What researchers learned is summarized in the title: “50% in U.S. Fear Bankruptcy Due to Major Heath Event.” https://news.gallup.com/poll/317948/fear-bankruptcy-due-major-health-event.aspx  

While half of all adults reported that they are either “concerned” or “extremely concerned” that medical bills will bankrupt them, 64% of non-white adults are in that category, an increase from 52% reported in 2019.

 

There are no real surprises here. Why wouldn’t at least half of U.S. adults be concerned or extremely concerned about the specter of financial disaster if they get sick? On an inventory list of healthcare products and procedures for sale, there is virtually nothing the average person could afford to buy out of pocket. Yet when healthcare is really needed, we either buy or die. Or perhaps we don’t die but suffer instead, including the financial stress of accrued debt. For lack of good alternatives, many have bought what they couldn’t afford.

Of what am I reminded when reading this Gallup report? That Depression-era wisdom applicable to car-buying doesn’t work when it comes to healthcare—or only if one is very lucky. Surely in this nation we can and should depend on something other than luck. Shouldn’t we?

Actually, my people never used the word “luck”. We talked in terms of being “blessed”. We were blessed even if others were not when medical and then financial disasters struck. 

Really? I have come through my own faith journey to see things differently. Being blessed or not implies the intervention of a higher being, the actions of God. While remaining devout in my faith tradition, what I no longer believe is that God is the agent of inequity. When it comes to healthcare disparities and consequent financial disasters, I have stopped blaming God, even by implication. This mess is our fault. As a people, we have failed each other. It is a failing that many who believe as I do recognize as sin, both personally and socially. And individuals like my father and I who have thus far escaped the consequences of our national sin are indeed lucky while others are not. 

But even for those most fortunate and privileged, luck has a way of running out. If only as a matter of self-interest when it comes to healthcare costs, or possibly out of compassion as well, we all ought to be “concerned” or “extremely concerned.” Shouldn’t we?

[Portions of this essay were previously published Sept 14, 2020 in an article at GoodFaithMedia.org by Zach Dawes. https://goodfaithmedia.org/reaction-and-response-medical-bankruptcy-concerns-half-of-us/.]