The doctors at BAMC explained to Gonzalez Jurado that he had fractured his heel bone and would need surgery. They inserted three pins in his heel, making a slanted “H” shape. Gonzalez Jurado called the doctors’ work amazing. After three days, he was out of the hospital and on his way to a full recovery. Soon, however, he would learn that treatment at a military health facility can come with a catch.

Before the surgery, Gonzalez Jurado, who is uninsured, had asked how much the procedure would cost, and he said the doctors told him they didn’t know. (BAMC told us, “Before any unplanned surgery, as in the case of trauma, it is exceptionally difficult to determine what charges may be incurred, as a variety of procedures may be necessary.”) About a month later, he received his bills from the hospital. They totaled more than $28,000. Gonzalez Jurado was taken aback. He hadn’t asked to go to BAMC, and he couldn’t afford to pay the hospital a giant lump sum. He negotiated a deal with the hospital to pay in increments. But even after years of on-time payments, he only sank deeper into a billing nightmare. His account was sent to a collections agency, and he said the federal government garnished his tax refund as a penalty for supposedly underpaying his bill.

Gonzalez Jurado had fallen into a dark, little-known crevice of the medical-debt world: The federal government, which tracks down debts for military hospitals, is one of the most unforgiving debt collectors around. Even as many policy makers are looking for ways to protect Americans from burdensome medical costs, the government itself can go after civilian patients in ways that are as punitive as they are unproductive. Military hospitals like BAMC are, in fact, required to aggressively pursue debts, even if the patients are uninsured or low-income. Treatment at a military hospital is the rare case in which a government service might take a needy American’s money, as opposed to providing it.

Gonzalez Jurado’s retreat lies down a dirt road about 15 miles from town. On the way is a street named Purgatory, an appropriate preview of Gonzalez Jurado’s vision of his property. “Out here,” he told us, “is paradise.” Beyond the cacti and bamboo thickets are a koi pond, sweeping views of the Central Texas hills, and few humans for miles.

At 66, Gonzalez Jurado is bald and thin, with sinewy limbs and a ramrod-straight back that belie his age. He moved to the U.S. from Guatemala in 1986, and for most of his life in America, he’s been self-employed and uninsured. Because of his age, he said, the cheapest Obamacare plan would be too expensive—about $700 a month—and he doesn’t qualify for Medicare.

Calmly, he brought out a ream of medical bills, which tell a winding story of error and miscommunication. When Gonzalez Jurado received his first bill from BAMC, he and the hospital agreed that he would pay $100 each month until the balance was settled. He sent in his $100 faithfully, according to his medical records. In 2014, BAMC asked for larger installments, and they compromised on $300. He began sending in that amount monthly. In 2017, Gonzalez Jurado received a letter from the hospital saying his balance had been “paid in full.” Knowing it hadn’t—he had only paid about $8,000 at that point—Gonzalez Jurado said he tried in vain to reach the hospital’s billing department. The hospital also began returning his $300 checks.