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The hospital sells medical debt at a fraction of the bill to recoup their actual costs, which are often times in the $100 range. The debt collector goes after you for years until you pay, they give up, or a small chance they take you to court, where you pay.
If you don’t pay, the debt collectors are only out a fraction of the debt anyway. Frightening one person into paying up pays for 10 people who don’t from the debt collector’s perspective.
Unfortunately, not paying them is accounted for by the system.
Other than one meal a week I go meatless. This won’t end global warming. This is what I can do.