I think medical bankruptcy is more a reflection of middle-class financial immaturity than it is an indictment of our health care system. OK Calm down for a minute. Hear me out.

According to the popular media, middle-class American families, most with private health insurance, are being forced into bankruptcy because of their medical bills. For instance, a CNN.com article called, Medical bills prompt more than 60 percent of U.S. bankruptcies. makes the following points: more than 60 percent of bankruptcies are linked to medical bills, and three-quarters of people with a medically-related bankruptcy had health insurance. There have been scores of stories like this in the past month based on the Himmelstein, Harvard University study. The story alarms us because most of us consider ourselves to be middle-class and most of us have health insurance. We thought we were protected from medical catastrophe. Many supporters of a single-payer government health plan say this story supports their case for government health insurance.

The following story is fictional, but conforms to the statistical facts of the Harvard study.

A year ago John and his wife, Ronnie, earned a combined $85,000 yearly. Living in high-priced Nassau County, NY, they barely considered themselves middle-class. They pretty much lived from paycheck to paycheck. Shortly after Ronnie was diagnosed with breast cancer, she had to quit her job. The family now has to make do on John's income of $60,000 per year. He didn't want to worry her, so he used their credit cards to pay bills. Now, John is running out of money and credit. He can't pay all his bills. He has to prioritize. At the top of the list go those bills with obvious consequences for nonpayment. Paying the mortgage is obviously a high priority. Don't pay and the bank will foreclose and take away the family home. He's seen it happen to a neighbor. Likewise, his car can be repossessed. The utilities can be turned off. The consequences of not paying his medical bills are not so obvious, so those bills go to the bottom of the list. He can rationalize not paying. He tells himself, "Doctors are rich. Why should I give them my last dollar? Besides, my insurance company has already paid most of the bill anyway. Can't they let me off the hook for the balance?" But John is surprised by how aggressive the doctors and hospitals are at collecting what he owes. His daughter's pediatrician has even filed in Small Claims Court to recover a lousy $210. Even so, John can't pay, so he goes into survival mode - paying the essentials and everything else will have to wait. Finally, the pressure from the constant phone calls and collection notices becomes overwhelming and John and Ronnie file for bankruptcy to get protection from their creditors and to try to save their home.

If John and Ronnie had been part of the sample group in the Harvard study, they would have been categorized as a "major" medical bankruptcy case. Major meaning that medical debt was the primary cause of the personal bankruptcy filing. John's total debt excluding his mortgage was just over $75,000 at the time of filing for bankruptcy. Yet, his medical debt was less than $10,000, (typical of the Harvard study), only 13% of his total debt. His health insurance covered over $80,000 in medical expenses and prescription drug claims for his wife and daughter in the year previous to his filing for bankruptcy.

The biggest cause of John and Ronnie's financial troubles was the loss of income from Ronnie's job because of her illness. There is state disability insurance. New York State made short-term disability payments of $170 per week for 26 weeks (total benefit of $4,420) and that helped, but not enough. While Ronnie has recovered from surgery and radiation treatments, it will be some time before she is ready to work again.

What if John and Ronnie had been covered by a single-payer government health insurance plan like Medicare? Would they have been better off? Yes, a little better. As Medicare patients, they would have had less out of pocket medical costs due to a smaller deductible than their private plan. But it would not have made a significant difference. It would not have saved them from medical bankruptcy. In fact, a large percentage of those listing medical debt as the reason for their bankruptcy are over 65. These people are already on a single-payer government health insurance plan called Medicare.

The message of the cautionary tale of John and Ronnie is not about health insurance but about personal responsibility. Nobody wants to hear it, but here it is. The government is not going to save us from financial ruin, even if it's caused by illness. It is our responsibility to spend less than we make and save for a rainy day. Sorry. No government bailout for us