Again, see my response to the other guy. NO WHERE in my original post did I say that we "have financial problems" I said that our credit is crappy "thanks to over $41,000 in medical bills". Which it IS! And there's NOTHING we can do about that!
I'd chime in to defend those responses because of the way you made it sound originally, I believe it was (unintentionally) misleading. Most people with "crappy credit" have tons of debt, it's a reasonable assumption. However, if I understand your clarification correctly, it doesn't sound like you should have "crappy credit". It sounds like you racked up some (unavoidable) debt from our lovely health care system, and worked your a$$ off to pay it off. Highly commendable actions (though it's certainly not my place to pass judgement, good OR bad) and a tough thing to do, but by itself it's not credit destructive.
Since you did get it all paid off (and in a timely manner), are you sure your credit is so "crappy"? I'm guessing you would know, so you probably had to do some "dealing" with the creditors, but that ought to be the exact right thing to do to protect your credit. Shoot, I would figure that the credit folks would be falling all over themselves to try to get you back on the credit wagon, seeing as how you've just proven yourself (the hard way!) to be a responsible creditee.
Anyway, I'd +1 to talking to Claude, hopefully there's a way to waive some of these credit requirements upfront and save you some money. I wouldn't necessarily avoid credit cards if I were you, since you they obviously aren't what caused or contributed to your problem, and could save you money in the long run (when used responsibly). I personally hate auto-pay setups, but I use them sometimes when they'll save me money (and cancel them as soon as I can once they do).
As for the Direct vs. Dish decision, I generally actually discount the weight of the upfront costs a lot if I plan to be with something for a long time. Dish has the better DVR and mostly better movies, while Direct has mostly better sports. If I were you I'd push for trying to waive some of the upfront credit-related costs and go with Dish. The owning vs. leasing equipment option really shouldn't be a huge decision point, with technology changing so fast, leasing can actually be a better option sometimes.