An answer may be that the chances of collection from the poor are so small that it would not be worth the administrative expense. But, under such an approach, what administrative expense would there be? Primarily, it would be keeping a record of the expenses that the medical consumer has incurred. But that’s something, of course, in billing the government, medical providers do already. The primary difference would be simply in the recognition that those charges to the government are also records of obligations that medical consumers, whatever their income, owe to the taxpayers. Why would we treat the poor any differently? If we do, we effectively say that they have no hope of paying—no hope of getting a better job, succeeding in business, getting an inheritance, or even winning a lottery. In short, we effectively say that the poor are somehow lesser beings than the rest of us. In short, we would be condescending.
Each ministry operates slightly differently, but the basic premise remains the same: Every month, members pay a certain amount (their “share”) into the ministry. When a need arises — say you break your leg, or get diagnosed with lung cancer, or have a baby — you submit your bills to the ministry’s office and you receive payments for the total amount you owe, usually in the form of checks or direct deposits from various members. Some ministries hold the funds in an online escrow account; others have members mail their checks directly to the other members. Shares out are published by the ministries each month, so you can see that your $405 is going to, say, Irene in Idaho who recently had a hip replacement.