Long after a person recovers physically, illness and injury can have a significant financial impact on individuals and their families. In the past several years, the news media have given front-page attention to the money side of medical problems. Featured stories described how big hospital bills turn families' lives upside down, sometimes costing them their homes, their credit ratings, access to their bank accounts, and occasionally even their liberty.'These stories could have been an important catalyst for discussion of how the structure of the current health care finance system produces significant financial consequences for patients and their families. So far, however, the conversation mainly has taken a different and narrower path: these patients and their families suffered, the public has been told, because hospitals misbehaved. Lawmakers and advocates focused on allegations that hospitals overcharged the uninsured, improperly applied charity care policies, and engaged in inappropriate debt collection.'Proposed solutions focused, in turn, on suing hospitals and regulating hospital billing and collection with respect to the low-income uninsured.'We refer to this approach throughout this Article as the" hospital misbehavior model." The hospital misbehavior model has had some short-term utility. By examining the intersection of health care finance and debtor-creditor law and policy, however, it becomes clear that tinkering with the collection activities of hospitals will not substantially reduce medical-related financial distress or the entanglement between medical problems and the debtorcreditor system.

Using data on individual bankruptcy filers-a cross-section of middleclass households-we observe that the hospital misbehavior model inadequately accounts for the financial distress that can accompany medical problems. First, the hospital misbehavior model has focused on people with a chronic lack of insurance, but even the insured face significant medicalrelated indebtedness. 4 Second, hospital bills are only part of a larger picture of direct medical costs that also includes office visits, prescription drugs, and other expenses.'Third, medical bills readily are converted into consumer debt that is owed to third-party lenders; in those situations, hospitals will not be the direct creditor of the patient or family members. 6 Fourth, lost income often is a major component of medical-related financial distress, with hospital bills or other direct costs playing a much more limited role.'