Medical Debt Is Killing Our Patients

By Arvind Venkat, MD
Published September 16, 2023
As an emergency medicine resident in the early 2000s, I cared for a patient in her early 60s with back pain. Prior to the passage of the Affordable Care Act (ACA), approximately 16% of emergency department patients were uninsured. Often their issues were of low acuity, again because they had no other place to see a physician. I assumed that to be the case with this patient, that I would treat her presumably musculoskeletal back pain, and discharge her. However, while treating her, I noticed she struggled to walk and clutched her gown across her chest. It was the clutching that really struck me as unusual.
When I examined her chest, I saw something unexpected, right out of the medical history books. Her entire left breast was as hard as a rock, consumed by cancer that likely developed over months, if not years. She had severe hypercalcemia and was on the verge of going into cardiac arrest as a result.
After I stabilized her, I gently inquired why she had not sought care sooner. She explained that she did not have insurance, had previously sought care for other conditions, gone into debt, and feared that if she again sought care, her debt would only get worse. While I could alleviate her pain, it was too late for my patient to be cured of her illness, and she died shortly after hospital admission.
This story is all too common in the U.S.
Americans owed at least $195 billion in medical debt as of 2019, with medical debt disproportionately burdening people of color and adults with disabilities. Medical debt is the leading cause of bankruptcy in our country, and thousands use GoFundMe and other sites to raise funds to pay for their healthcare. But only 12% raise the funds necessary to pay for treatment, and it is incomprehensible that such pleas should be the norm. With healthcare spending predicted to increase by 5.2% by 2026, alleviating medical debt is a critical public health priority.
While the ACA expanded insurance access, the number of health insurance plans with high deductibles and co-payments continues to increase, which puts a strain on Americans’ finances should they need medical treatment.
Under the Emergency Medical Treatment and Labor Act, hospitals must treat patients that enter their emergency department, regardless of their ability to pay. This contributes to billions in uncompensated medical treatment per year, as approximately 25% of Americans struggle to pay their bills. This burden is commonly shifted through rising prices for the commercially insured, making medical debt a problem that affects all of us.