Which does not mean that collection firms would not buy that bad debt which has been written off at that same discount and then hound the people who owed that bad debt. There are a lot of people who get sick and are uninsured and have no choice but to incur debt levels that they have no chance to repay. Hounding them does not magically make the money to pay those bills appear in their accounts. If my choices were to let my wife or child die or sign the papers making me responsible for a couple of hundred thousand in debt that I have no idea how I would ever repay, I'd sign. heck, I *have* signed those papers after my son's car wreck. I was fortunate enough that our health insurance covered the vast majority of the almost half a million dollars having a kid with a traumatic brain injury in a coma costs, but at the time I had no clue how I'd cover the cost. I had absolutely no way to know what it would cost.. heck, his IV medications alone ran to over $200k. Do you seriously think that people are going to say "There's no way I can ever afford that, put him back in the ambulance and I'll take him home"?
Many are not so fortunate as we were.
Those bills were not paid, or only partially paid, but I bet that they were deducted off the hospital's taxes. Some of this is a result of this country having for profit health care, as well. There are many countries around the world who manage to care for the sick and the injured without bankrupting them.