The Debtor-Patient Revisited

Abstract

In this symposium contribution, Professor Jacoby posits that debates about medical debt need to be reframed to reflect the existence of multiple debtor-patient paradigms. Her analysis starts with a review of selected empirical studies of out-of-pocket medical expenses and medical debt in both the general and bankrupt population, which reveal a cleavage between a small segment with catastrophic expenses and a much larger and more diffuse group of people who struggle with more modest medical expenses. She next explores several arguments for how smaller medical expenses can contribute to larger financial problems, including coupling with indirect costs, failed coping mechanisms, and growing financial instability more generally. She briefly concludes that this more complicated picture of the intersection between medical problems and financial problems undercuts the foundation for well-meaning but ultimately mistaken efforts to regulate medical debt collection in particular ways, an issue she will take up more directly in future work.

JEL Classification: I11, I18, I31