We know that millions of insured Americans live with hundreds or thousands of dollars of medical debt. A Pro Publica story by Lizzie Presser (my daughter) uncovers how Americans with medical debt can end up arrested and sometimes jailed. It is a scathing indictment of our dysfunctional and cruel health care and legal systems.

Among the story’s horrifying takeaways: In Coffeyville, Kansas and in many other communities in states across the nation, judges give medical bill collectors the power to decide who is arrested — debtors who are too poor to pay their medical bills and too sick to make a court appearance. And, they may summon people to court multiple times a year, though it is against the law in Kansas to haul poor people with disabilities into court for nonpayment of medical debt more than once a year. In short, lacking legal advice, many people spend time and money they don’t have in their county courthouse.

To be clear, most states don’t allow contempt charges to be used for nonpayment of medical bills. Some say it is unconstitutional.

Presser is careful to explain that the non-profit hospital and city ambulance service, which are responsible for most of the medical debt collection actions in Coffeyville, operate at a loss. And, they are at risk of not surviving in poor communities because so many Americans can no longer afford to pay their share of their health care bills, even with insurance. Three local hospitals in the surrounding community Presser visited were shuttered not too long ago. If the only remaining hospital closed its doors, it could endanger even more lives.

Perhaps the only positive takeaway from the piece is that the die-hard Republican judge responsible for issuing dozens of bench warrants against people with medical debt who failed to appear for court hearings acknowledges the need for universal coverage. “What we have isn’t working,” he said. “As a lifelong Republican, I would probably be hung, but I think we need health care for everybody with some limits on what it’s going to cost us.”

It’s curious that the current debate around health care reform focuses so heavily on the need to allow people to keep their private insurance. Private insurance has never contained costs. What’s worse, it is leaving millions in medical debt. Democratic presidential candidates support a public option, unlike proponents of Medicare for All, leave people in medical debt and without predictable health care costs.