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Forgive Us Our Debts

Churches are doing what politicians have been unable to do, rescuing Americans from crushing medical bills.

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Ms. Bruenig is an Opinion writer

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Credit…Bryan R. Smith/Agence France-Presse — Getty Images

Vanessa Matos couldn’t believe what she was reading. “I was like, OK, this is a scam,” she recalled of the letter she received in February. Her husband, she said, had the same reaction: “Yeah, this isn’t real.”

But it was. Ms. Matos’s medical debt — more than $900 owed because of complications from surgery at the Massachusetts hospital where she had worked as a nurse — had been forgiven by strangers at a church she had never been to.

Adam Mabry, the lead pastor of that congregation, Aletheia Church, a multiethnic, 1,400-member Boston-area Christian community, doesn’t know Ms. Matos, and she doesn’t know him; the two have never spoken. But he told me: “It doesn’t take a theologian to connect the dots. Jesus paid my debt at unbelievable cost to himself, so it probably makes sense for me to pay another person’s debt at some degree of cost to myself.”

Aletheia worked through RIP Medical Debt, a charitable organization founded in 2014 by two former debt collection executives, Craig Antico and Jerry Ashton. It uses donations to buy portfolios of medical debt at a fraction of their value — and then forgives it.

Debt is a particularly destructive consequence of an American health care system that treats medical care as a consumer good. A Kaiser Family Foundation survey in 2018 found that 67 percent of Americans worry about paying for unexpected medical bills. By way of comparison, only 43 percent expressed similar concern about paying monthly utility bills, and just 41 percent cited rent or mortgage payments.

In 2019, the foundation found that 26 percent of adults have either struggled to pay medical bills or live with someone who has. Unpaid medical bills become medical debt, which destroys credit ratings, attracts harassment from collections agencies and postpones or precludes important purchases, including additional care.

In just societies, these debts do not exist. But in our society, charity must stand in for justice so long as the latter is in short supply.

One of RIP Medical Debt’s early fund-raising partners was NBC Universal, which ran a segment about the company’s campaign on its Dallas station in February 2018. The story caught the attention of Covenant Church, an enormous network based in North Texas. That Easter, Covenant donated $100,000 to relieve local families’ medical debt. RIP Medical Debt said since then it has worked with 465 congregations and religious groups to relieve about $820 million in medical debt across the country.

Partners of RIP Medical Debt need not raise the actual amount of money they intend to relieve in debt, because the price of debt reflects what collectors could recover — far less than is owed. That means a buyer can eliminate the debt for much less money than the debtor could.

RIP Medical Debt estimates that just one dollar can purchase, and relieve, $100 in medical debt. So with a series of relatively moderate fund-raising efforts and donations from corporations, nonprofit and religious groups, and individuals, RIP Medical Debt said, it has been able to eliminate almost $2.7 billion in medical debt.

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Some religious congregations have donated money from cash reserves, and others from fund-raising drives. But all of them grasp what our legislators can’t: The cost of survival in this country is unconscionable, and we all share a moral obligation to do something about it.

And yet there is still something remarkable — almost miraculous — about this faith-driven debt relief. Although American Christianity is as malformed by the harsh tug of political poles as any other realm, forgiving medical debt has managed to ally very different Christians behind the same cause.

Mr. Mabry, for example, cheekily described his theological stance as “historically boring and orthodox,” even evangelical. Most people “would associate social concern with progressivism and maybe theological liberalism,” he said, but “the great majority of actual social programs are funded and executed by really frustratingly conservative, boring, historic, orthodox people, I think we would find.”

The Rev. Traci Blackmon is associate general minister of justice and local church ministries for the United Church of Christ, a fairly liberal denomination. “The U.C.C. has no rigid formulation of doctrine or attachment to creeds or structures,” the church’s website says. “Its overarching creed is love.”

A recent campaign led by the church abolished more than $26 million in medical debt throughout New England, and the church plans to expand efforts to include the entire country.

Ms. Blackmon, like her denomination, is committed to social justice, having organized protests in Ferguson, Mo., after the police killed Michael Brown, and led an interfaith worship service in Charlottesville, Va., to oppose the 2017 Unite the Right rally. She sees this work as a natural extension of the U.C.C.’s interest in justice. “We’re buying somewhere close to $100 worth of debt for a dollar,” she told me, “and when you think about how many people’s credit is being ruined, how much access is being denied people because they can’t pay that bill, and I can come and pay your $5,000 bill with $12 — that’s not just.”

Mr. Mabry said a similar thing in our conversation. But if Christians so different in creed can agree on the necessity of relieving medical debt, why can’t Democrats?

The trouble with medical debt is that it is a consequence of the way our health care system is structured, with individuals owing, even in the best case, some out-of-pocket costs for their care. Debt may be eliminated today, but more will begin accumulating tomorrow unless drastic changes are made.

Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said that while 45 percent of the uninsured have medical bills they can’t pay, one in five people in employer-sponsored coverage do, too.

In 2018, Kaiser asked people with high-deductible employer-sponsored insurance plans how they would pay if a medical procedure cost as much as their full deductible. Only 33 percent felt confident they could pay in full; the rest mentioned credit cards, payment plans, borrowing money — incurring medical debt, in other words.

It’s a reality many may soon face. Covid-19 can be an expensive illness to survive. Health System Tracker, a partnership between Kaiser and the Peterson Center on Healthcare, estimates that out-of-pocket costs for patients with private health insurance hospitalized for Covid-19 treatment can average about $1,300; those who require ventilator support or particularly long hospital stays can face even higher costs.

During his 2020 presidential bid, Senator Bernie Sanders proposed eliminating medical debt and then instituting a universal health care system that would prevent similar costs from building up again.

But President-elect Joe Biden’s record on helping Americans survive crushing debt is not promising. As a senator, he declined to vote for or he voted against measures that would have offered some protection to people suffering from medical debt. And he enthusiastically championed the 2005 bankruptcy bill that made it more difficult for families deep in debt to seek relief through the courts, touching off a feud with Senator Elizabeth Warren

So far, his health care plan consists of protecting the Affordable Care Act and expanding tax credits and insurance options — better than nothing, but far less than needed.

There is an apocryphal statement often attributed to Saint Augustine, who helped lay the foundations of modern Christian theology: “Charity is no substitute for justice withheld.” Augustine was a proponent of both justice and charity, each with its place in the order of things. It is unfortunate that in the United States — a country so rich, so suffuse with every possible luxury — so many people receive justice only in the form of charity, and only after they have lost so much.

Elizabeth Bruenig (@ebruenig) is an Opinion writer.

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