When the courts do hospitals' dirty work
The story that drove me most insane in the last week was a USA Today piece about Hertz’s practice of filing police reports for cars that are not stolen, more information about which emerged in the proceedings of an ongoing lawsuit this week. Sometimes the cars are simply lost, or ‘missing’ in the system because someone extended a reservation by phone. This practice of filing police reports—which it does an average of 3,365 times per year, or about nine a day—has led to the 230 plaintiffs currently seeking justice in the lawsuit spending 2,742 collective days in jail. People interviewed by the paper have lost jobs or homes because of these false charges. This is not a healthcare story, but it does highlight an inescapable fact of American life that is horribly relevant to healthcare: The profitable partnership of massive corporations and the criminal justice system, holding hands to stamp on the faces of the poor.
The story reminded me immediately of two others. First, this New York Times story from 2018, which revealed how huge corporations like Walmart “employ aggressive legal tactics and take advantage of loosely written state laws” to demand money from people they accused of shoplifting, even if those accusations were false. Those retailers often “do not have to return the money they collect if the cases are ultimately dismissed or the people are cleared.” In one instance, a woman accused of stealing $25 worth of CDs alleged that “two police officers ‘threw’ her on a couch, handcuffed her and took her to jail.” The charges were later dropped, but not until after Walmart’s lawyers demanded money from her and threatened her with a lawsuit.
Second, in 2019, ProPublica wrote about the practice of jailing people who fail to appear in court for medical debt cases, which became especially profitable for one collection attorney in Kansas. The story provided harrowing examples, like the cancer patient who was “hauled away from home in her pajamas in front of her three children; too weak to climb the stairs to the women’s area of the jail, she spent the night in a men’s mental health unit where an inmate smeared feces on the wall.” Not long before that piece came out, a story from Kaiser Health News detailed the University of Virginia’s practice of taking patients to court for unpaid medical bills, for as little as $13.91. Together, these pieces tell a powerful tale about how hospitals can use the justice system to threaten and extract payment from patients—all possible because we make patients ultimately responsible for the individual costs of their healthcare. The charges the patients owe money for are, of course, completely arbitrary and wildly inflated, but they don’t have to justify the fees to sue the patient over them.
These are stories from three different sectors of the American economy—car rentals, retail, and healthcare—but they have an important aspect in common. In all of these stories, huge, profitable institutions are able to use the full might of the state, with all the consequences this has for their victims’ lives, to obtain mostly meaningless amounts of money—to them, that is. To the people whose lives they’re ruining, these sums can be life-changing, or life-ruining. The cops and the courts act on behalf of the corporation, no matter how egregiously wrong or aggressive they might be, to insure them against any little loss of profit.
I write about healthcare, not criminal justice or American history, so I don’t feel like I can adequately diagnose or explain how the American justice system got so eager to help corporations like this. I can’t explain why a judge in Virginia might have told a woman in her 70s, who arrived at hospital “bleeding and in pain” from uterine cancer, that her payment agreement with the hospital was not too vague to be enforced, because she always had “the ability to decline the surgery” that led to her $23,849 bill. I guess she could have gathered up her bloody clothes and tottered along to the next hospital, which would have had exactly the same clause “you owe us whatever we say you do” in its contract and might have charged her twice as much anyway (neither could have told her the cost beforehand, of course). I can’t explain how the debt collector in Coffeyville lives with himself. I can’t explain why Walmart goes to such lengths to pursue people for such stupidly small amounts of money, which must itself cost them a lot in legal fees.
I can’t explain any of it, but I do know that all over this country, there are frightening and arbitrary schemes put in place by corporations to ensnare regular people, extract their little bits of money, and toss them aside, into jail or financial ruin, or both. The criminal justice system opens its arms and welcomes the worst fucking snakes in America and happily lets them use it, with its gun-toting cops itching to humiliate people and its horrific, dangerous jails, to chop up the meager finances of the poor and turn them into snake food.
And I know that there are many, many hospitals that are no better in this way than Hertz or Walmart.
Thousands and thousands of lawsuits are filed by hospitals against their patients every year; some kept doing it during the pandemic, including New York’s Northwell Health. According to Axios, the Mayo Clinic Saint Mary’s Campus sought $4 million in 904 lawsuits against patients between January 2018 and July 2020; the Mayo Clinic’s total revenue just in 2019 was $13.82 billion. Those lawsuits over two and a half years represent 0.02 percent of the organization’s revenue in one of those years. 0.02 percent of a normal person’s yearly income is like what you might spend on lunch. Could they perhaps have foregone their lunch to not ruin 904 people’s lives?
Cops and judges arrested and jailed people who had not stolen a car to help out Hertz. They humiliated people who had not stolen stuff to help out Walmart. They jailed cancer patients for being unable to afford the made-up price a hospital charged them to stay alive, to help out the hospital. (I didn’t even mention the judges who sign off on landlords’ arrest warrants for unpaid rent.) The reverse of this—for ordinary people to use the legal system to obtain justice from large corporations—is absurdly difficult, thanks to neat things like arbitration clauses and ‘needing money to get a lawyer.’
The truth of American inequality is not just that some people have a lot of money and a lot more have very little, in some sad natural accident. The rich are rich because other people are poor. The wealthy elite extracts their riches from the poor through schemes like this, or underpaying workers, or pure wage theft. It’s a transfer, and the logic of capitalism and ever-increasing profits dictates that they must always use every possible avenue to expand this transfer. And sitting right there is the criminal justice system, already primed to oppress the powerless and vulnerable, with the legal authority to take people’s money. It’s a loaded gun, literally.
Maybe you expect this of Walmart. But hospitals? If a hospital is just as willing to engage in this behavior as Big Evil Corp., and the legal system is willing to enforce the complete fiction that hospital prices are real, we don’t really have a healthcare system—and we certainly don’t have justice, let alone a right to healthcare. We just have another type of greedy fuckers making money however they can, who just happen to sell healthcare instead of cars.
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