100 Million People in America Are Saddled With Health Care Debt

Yves here. Medical debt is an American disgrace. I know people who’ve had to declare bankruptcy and one now who is facing having to live in her car to pay for some cancer treatments…and even then probably not enough for her to recover. I’m sure readers have personal and one-degree-of-separation stories.

This is an important, well-researched and well-documented piece. I hope you will circulate it widely.

By Noam N. Levey, Kaiser Health News Senior Correspondent, who previously worked for the Los Angeles Times and San Jose Mercury News and has also been published in Health Affairs, JAMA, and The Milbank Quarterly. Originally published at Kaiser Health News

Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.

Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.

Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.

“I wanted to be a mom,” she said. “But we had to have the money.”

The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.

The picture is bleak.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.

A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”

The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.

Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.

The debt is also deepening racial disparities.

And it is preventing Americans from saving for retirement, investing in their children’s educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.

Perhaps most perversely, medical debt is blocking patients from care.

About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.

“It’s barbaric,” said Dr. Miriam Atkins, a Georgia oncologist who, like many physicians, said she’s had patients give up treatment for fear of debt.

Patient debt is piling up despite the landmark 2010 Affordable Care Act.

The law expanded insurance coverage to tens of millions of Americans. Yet it also ushered in years of robust profits for the medical industry, which has steadily raised prices over the past decade.

Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.

But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they’ve faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.

Now, a highly lucrative industry is capitalizing on patients’ inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to research firm IBISWorld.

Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.

“People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from,” said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. “It seems to be an epidemic.”

In Debt to Hospitals, Credit Cards, and Relatives

America’s debt crisis is driven by a simple reality: Half of U.S. adults don’t have the cash to cover an unexpected $500 health care bill, according to the KFF poll.

As a result, many simply don’t pay. The flood of unpaid bills has made medical debt the most common form of debt on consumer credit records.

As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That’s nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.

But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.

  • About 50 million adults ― roughly 1 in 5 ― are paying off bills for their own care or a family member’s through an installment plan with a hospital or other provider, the KFF poll found. Such debt arrangements don’t appear on credit reports unless a patient stops paying.
  • One in 10 owe money to a friend or family member who covered their medical or dental bills, another form of borrowing not customarily measured.
  • Still more debt ends up on credit cards, as patients charge their bills and run up balances, piling high interest rates on top of what they owe for care. About 1 in 6 adults are paying off a medical or dental bill they put on a card.

How much medical debt Americans have in total is hard to know because so much isn’t recorded. But an earlier KFF analysis of federal data estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece.

The credit card balances, which also aren’t recorded as medical debt, can be substantial, according to an analysis of credit card records by the JPMorgan Chase Institute. The financial research group found that the typical cardholder’s monthly balance jumped 34% after a major medical expense.

Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.

It’s unclear how much of the higher balances ended up as debt, as the institute’s data doesn’t distinguish between cardholders who pay off their balance every month from those who don’t. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees.

Debts Large and Small

For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.

Even small debts can take a toll.

Edy Adams, a 31-year-old medical student in Texas, was pursued by debt collectors for years for a medical exam she received after she was sexually assaulted.

Adams had recently graduated from college and was living in Chicago.

Police never found the perpetrator. But two years after the attack, Adams started getting calls from collectors saying she owed $130.68.

Illinois law prohibits billing victims for such tests. But no matter how many times Adams explained the error, the calls kept coming, each forcing her, she said, to relive the worst day of her life.

Sometimes when the collectors called, Adams would break down in tears on the phone. “I was frantic,” she recalled. “I was being haunted by this zombie bill. I couldn’t make it stop.”

Health care debt can also be catastrophic.

Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy’s colon had to be removed.

After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.

The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie’s surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple’s health plan.

When Foy couldn’t pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.

The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.

“They took everything we had,” Foy said. “Now we have nothing.”

About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.

Although most expect to repay their debt, 23% said it will take at least three years; 18% said they don’t expect to ever pay it off.

Medical Debt’s Wide Reach

Debt has long lurked in the shadows of American health care.

In the 19th century, male patients at New York’s Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a history of American hospitals by Charles Rosenberg.

The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn’t afford, historian Jonathan Engel said. “There was no notion of being in medical arrears.”

Today, debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare.

Nearly half of Americans in households making more than $90,000 a year have incurred health care debt in the past five years, the KFF poll found.

Women are more likely than men to be in debt. And parents more commonly have health care debt than people without children.

But the crisis has landed hardest on the poorest and uninsured.

Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread.

Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults 35% more likely than whites to owe money for care. (Hispanics can be of any race or combination of races.)

In some places, such as the nation’s capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.’s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.

In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. “It’s like having another arm tied behind their backs,” he said.

Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.

Cheyenne Dantona’s medical debt derailed her career before it began.

Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.

She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she’s been forced to move back in with her mother outside Minneapolis.

“She’s been trapped,” said Dantona’s sister, Desiree. “Her life is on pause.”

Barriers to Care

Desiree Dantona said the debt has also made her sister hesitant to seek care to ensure her cancer remains in remission.

Medical providers say this is one of the most pernicious effects of America’s debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.

The financial strain can slow patients’ recovery and even increase their chances of death, cancer researchers have found.

Yet the link between sickness and debt is a defining feature of American health care, according to the Urban Institute, which analyzed credit records and other demographic data on poverty, race, and health status.

U.S. counties with the highest share of residents with multiple chronic conditions, such as diabetes and heart disease, also tend to have the most medical debt. That makes illness a stronger predictor of medical debt than either poverty or insurance.

In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties.

The problem is so pervasive that even many physicians and business leaders concede debt has become a black mark on American health care.

“There is no reason in this country that people should have medical debt that destroys them,” said George Halvorson, former chief executive of Kaiser Permanente, the nation’s largest integrated medical system and health plan. KP has a relatively generous financial assistance policy but does sometimes sue patients. (The health system is not affiliated with KHN.)

Halvorson cited the growth of high-deductible health insurance as a key driver of the debt crisis. “People are getting bankrupted when they get care,” he said, “even if they have insurance.”

Washington’s Role

The Affordable Care Act bolstered financial protections for millions of Americans, not only increasing health coverage but also setting insurance standards that were supposed to limit how much patients must pay out of their own pockets.

By some measures, the law worked, research shows. In California, there was an 11% decline in the monthly use of payday loans after the state expanded coverage through the law.

But the law’s caps on out-of-pocket costs have proven too high for most Americans. Federal regulations allow out-of-pocket maximums on individual plans up to $8,700.

Additionally, the law did not stop the growth of high-deductible plans, which have become standard over the past decade. That has forced many Americans to pay thousands of dollars out of their own pockets before their coverage kicks in.

Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006, according to an annual employer survey by KFF. Family deductibles can top $10,000.

While health plans are requiring patients to pay more, hospitals, drugmakers, and other medical providers are raising prices.

From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, a report by the nonprofit Health Care Cost Institute found.

For many Americans, the combination of high prices and high out-of-pocket costs almost inevitably means debt. The KFF poll found that 6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.

Even Medicare coverage can leave patients on the hook for thousands of dollars in charges for drugs and treatment, studies show.

About a third of seniors have owed money for care, the poll found. And 37% of these said they or someone in their household have been forced to cut spending on food, clothing, or other essentials because of what they owe; 12% said they’ve taken on extra work.

The widespread burden of medical debt has sparked new interest from elected officials, regulators, and industry leaders.

In March, following warnings from the Consumer Financial Protection Bureau, the major credit reporting companies said they would remove medical debts under $500 and those that had been repaid from consumer credit reports.

In April, the Biden administration announced a new CFPB crackdown on debt collectors and an initiative by the Department of Health and Human Services to gather more information on how hospitals provide financial aid.

The actions were applauded by patient advocates. However, the changes likely won’t address the root causes of this national crisis.

“The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go into medical debt is they don’t have the money,” said Alan Cohen, a co-founder of insurer Centivo who has worked in health benefits for more than 30 years. “It’s not complicated.”

Buck, the father in Arizona who was denied care, has seen this firsthand while selling Medicare plans to seniors. “I’ve had old people crying on the phone with me,” he said. “It’s horrifying.”

Now 30, Buck faces his own struggles. He recovered from the intestinal infection, but after being forced to go to a hospital emergency room, he was hit with thousands of dollars in medical bills.

More piled on when Buck’s wife landed in an emergency room for ovarian cysts.

Today the Bucks, who have three children, estimate they owe more than $50,000, including medical bills they put on credit cards that they can’t pay off.

“We’ve all had to cut back on everything,” Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.

“It pains me when my kids ask to go somewhere, and I can’t,” Buck said. “I feel as if I’ve failed as a parent.”

The couple is preparing to file for bankruptcy.


“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

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    1. jackiebass63

      The only way that can happen is with major changes in our health care system. Presently it has become a for profit business. If we made our system a one payer publicly supported system, perhaps this could happen.Right now there are too many for profit interests draining our health care system of valuable resources. Too much money goes to things that don’t serve people that need care.

  1. Mark Gisleson

    This was triggering for me to read because it took me back to Clinton years when debt collectors hounded me over student loans that were mostly penalties and interest far in excess of the original loan.

    I truly think the only strategy that can work is to seize upon the Bible’s Jubilee concept. Every purported Christian in Congress should be pressed by their constituents to explain why modern usury-driven debt can never be discharged no matter what the Bible has to say about it.

    Marxists aren’t the only ones who can heighten the contradictions. It’s past time for Christians to start participating in the resistance to the oligarchy’s pagan religion of gewinn über alles.

  2. zagonostra

    Welcome to the U.S. empire where 100M people are shackled to Medical debt and where at a click of a computer mouse billions are sent overseas to lard the coffers of MIC(C).

    Glad to see focus back to what really impacts the majority of people and not on left/right, identity/cultural/entertainment issues, all carefully orchestrated to misdirect.

  3. Michigan Farmer

    This struck a chord of recognition with me:

    Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.

    Emphasis is on “pursue”.
    Recently, after having a stint placement performed, I received bills for office visits that I did not remember. I decided to let the bill ($75.00) go unpaid as it was essentially a trivial amount.

    I was punished by the various collection agencies who then decided to hound my every woke moment by stalking me; stalkers met me every moment that I left my home between 8am and 9pm. I can only guess how they knew where I was on a moment-by-moment basis as there are apps readily available on the dark web that can be surreptitiously placed on a person’s cell phone. Also, the same with GSP locators which can readily be slapped on the frame of an automobile. Stalking in itself is not illegal, the cell phone apps are, the GPS locator is in question.

    Let me assure all worthy readers of this that this is a factual account.

    1. JBird4049

      Sometimes debt collectors will go after the wrong people or try to collect on legally uncollectible or
      even already paid debt. The shadier debt collectors are not trying to collect on debts, they are only trying to extort money from anyone they can. You can send a debt verification letter. They have to show proof (documentation besides them saying so) that you do owe it, the correct amount, and that they are legally the ones who can collect, and not to contact you again unless they can do this. It does not stop everyone especially the outright crooks, but the honest ones will stop.

  4. Hannah

    In California people can just pretend to be undocumented:


    California leads all 50 U.S. states in the number of unauthorized immigrants – roughly 2.9 million in 2014, according to the U.S. Department of Homeland Security.

    The Affordable Care Act expanded Medi-Cal in California, and then in 2016 the state begin covering illegal immigrant children under the same program. Now undocumented residents 50 and up are covered by it. As more and more people went onto the Medi-Cal rolls, the number of doctors did not increase.

    Californians also should be appalled at the fact that the state recently killed a bill that would have allowed Californians over the age of 65 to also fold into the Medi-Cal program.

  5. Advait

    Just another reason to fight for
    * Federally funded Socialized Universal Basic Services (health care, education, insurance, public transportation, housing, water/electricity (with reasonable caps), internet, child care, defined benefits pension and perhaps others)
    * Federally funded Universal Job Guarantee ($25/hr or more and full benefits).
    Using wise MMT policies, all these programs can be easily paid for as long as the material and labor resources are available.
    Neoliberal predatory oligarchs would love to see Universal Basic Income which would be a supreme disaster for poor and working people.

    1. tegnost

      In the last century there was a saying’…who dies with the most toys wins”. It’s a bit different now…
      “who lives longest with the most uncollectible debt wins”
      Ol’ student loan Joe and his buddy ACA Barack are real pieces of work.

      1. JBird4049

        Talking to people online and it is our medical “system” that puzzles non Americans. Not the guns or corruption, but healthcare.

  6. johnherbiehancock

    Appropos of this topic… we’re in TX.

    Had a baby last year. My partner resigned from her job a month after the baby was born (she had crappy health insurance through her employer) and her FMLA time ended. Baby and her are now under my insurance.

    Hospital called our room the day after delivery and told us we owed ~$2500 for the visit. Said we could pay half then (done), and the rest later.

    Over the next month, we also got a bill for $800 for anesthesia. Okay. Started paying that, and sent another check for part of the remainder of the hospital bill.

    The next month we get a bill for a whopping $7,000 for the delivery. They claim her insurance is not covering it. A few hours on the phone results in some admissions this might be an issue, but no resolution despite showing proof of her employment dates and insurance coverage, and they never call back like they said they would. We get one more bill for the $7,000, but never pay anything. These bills stop coming.

    Remainder of the $2500 due gets sent to a collection agency without any notice.

    Then we start getting checks BACK totalling around $500 in refunds for payments made.

    Then today, nearly a year later, we get a bill for $2400 for a minor surgical procedure done the day after birth.

    Stupid. I hate this shithole country. Insane anything could possibly operate this way and be considered legit. All fraud, all the way to the top.

    1. anon y'mouse

      i get bills like this as well.

      just one visit with accompanying labs and bloodwork on a given day and i am getting nickel & dimed for the next 6months.

      all of the bills come coded, so all i know is that they are attributed to that one visit. i have no idea why they can’t bill for everything and send everything through the insurance at one go for one set of procedures. it seems to go back and forth between them and then somewhere along the way i get another bill. i think i’ve paid for “imaging” 3 or 4 times by now. i only had the one image done on that day.

      they are too confusing to sort out because of the separate codes, and i have called the hospital billing department to no avail. it begins to feel like someone or other is sending scam bills through just because i have some kind of insurance, although obviously not one which will pay everything.

      $85 dollars or $150 every month or so is beginning to make me wonder what the insurance IS actually covering. and i know what it does cover—the overinflated price that the hospital didn’t need to charge anyway. so i am likely still paying the -actual- cost of these things out of pocket. so what is the insurance for? to get money from the employer to play games with billing codes and send things back and forth through the mail. that seems to be it.

      this is the same insurance that wouldn’t let me have a procedure done under light anesthesia because they supposedly said to my doctor when the call for approval was made “if general anesthesia isn’t necessary, then the procedure isn’t urgent and thus not needed”. um, my doctor can’t figure out how to do this without hurting me and she doesn’t have the robotic scope that could do it for her. the procedure still hasn’t been done a year later. my doctor shrugs and says “well, you probably won’t die from it”.

  7. Oh

    Medical providers say this is one of the most pernicious effects of America’s debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.
    If they care so much why don’t provide free medical care to patients in order to allieviate the burden or even remove the yoke they have placed on the patients with their high medical charges?
    Contrary to what they project medical providers love the insurance boys because they have them to blame for their own rotten tactics.

    1. hunkerdown

      Medical providers might not be free agents. In fact, many of them are employees in the new world ruled by the ACA, and to provide free care would be to steal from one’s employer, and Western civilization has always valued property over life.

    2. Felix_47

      If they cared so much maybe American voters would have paid attention when Joe Biden said that if a Medicare for all bill crossed his desk he would veto it. American voters had a choice and they decided Sanders was not their choice. Obviously, voters in the South Carolina and Southern primaries did not see improving this medical situation as being important.
      Ideally we could adopt England’s NHS system and fund it better. They have had 80 years to work out the bugs. I doubt our voters really want that, assuming past voting reflects likely future voting. Vote Blue no matter who.

      1. Telee

        As we speak, Biden is presiding over the privatization of Medicare. Private equity groups will be awarded monies from Medicare based on the risk factors for each patient. These financial groups will be inserted between the patient and Medicare. They will administer the payments to patients. For their services they get to keep 40% of the Medicare dollars they were awarded plus money not spent on services denied. The administration of traditional Medicare now takes about 2% of the Medicare budget. Patients will be switched to the private plan without their consent or knowledge. At this time “trials” are being run and nearly 400,000 Medicare beneficiaries have been transferred. One of the private equity groups involved is run by Timothy Geithner. More information can be found from the The Physicians for a National Health Policy website.

  8. Hayek's Heelbiter

    I have four 50-year old American friends who would still be alive if they lived in the UK and one woman who would still own her own house.
    The neoliberals have embarked on a stealth campaign to destroy the NHS by privatization and are succeeding at least on the adminstribloat front.

    NHS bosses are earning up to £300,000 a year including bonuses – more than NINE TIMES the average pay of nurses.

    Other than fact it’s almost impossible to get an in-person appointment and people, including the elderly and informed, are forced to go through a labyrinthine process of trying to make appointments, change prescriptions, etc., online, A&E services remain top notch.

    1. Felix_47

      The destruction of the NHS is a work in progress and yet the voters seem to tolerate it. If US level funding was applied to an NHS style system or even half of US funding it would be a fine system. My relatives in the Oxford area are universally happy with the NHS and prefer it by far to what they have experienced in the US. And one of my friends was visiting England from the US and ended up having emergency surgery and quite an extensive problem. The costs were negligible. The care was excellent. The delays people complain about are for elective surgeries that would be done right away in the US with more marginal outcomes. Up to one third of patients with total knee replacements in the US are reported to be not satisfied with the outcome. This is usually because the surgery is done too early. The satisfaction level in England is quite a bit higher because they purposely delay these sorts of surgeries until the patient really hurts as opposed to showing arthritis on an X-Ray. So the waiting lists in England serve a purpose and are a feature, not a flaw.

  9. IM Doc

    I thought Obamacare was going to be affordable? Remember it was called the Affordable Healthcare Act?

    A plan put in place by the party of the working man, with a big smile on their face. “It is a big f#$%ing deal”.

    Actually Obamacare was the final nail in the coffin of my profession. It was the hand-over of all that generations of physicians had held dear. Handed over with gusto to Big Hospital, Big Insurance and Big Pharma.

    There are now more people in debt to these big industry companies than ever before. And they have no compassion, no mercy, no soul.

    Every single month, when I have new students, one of the first things we do is listen to an old song by Woody Guthrie — the best rendition of it is by Merle Haggard at this link –


    I reiterate the following words from that song to those students all the while they are looking at me as if I am from outer space ——

    Jesus Christ was a man who traveled through the land
    Hard working man and brave
    He said to the rich, “Give your goods to the poor.”
    So they laid Jesus Christ in his grave

    He went to the sick, he went to the poor,
    And he went to the hungry and the lame;
    Said that the poor would one day win this world,
    And so they laid Jesus Christ in his grave.

    Yes, if Jesus was to preach today like he preached in Galillee,
    They would lay Jesus Christ in his grave.

    American New Deal Liberalism at its finest – something that virtually no one remembers today in all our woke glory.

    I know I am the old man from the before times. I realize that. We live in such a much more advanced world today, don’t you know.

    For thirty years, I did everything I could to model this for my students and residents and colleagues. Just as it had been modeled to me by my grandfather. He gave everything he could to help those around him – and died not wealthy in financial terms, although not poor either. No, he died very wealthy indeed, as there were 6000 at his funeral praising him for all he did for them.

    I do my best to tell these kids it is far better to build your obituary than it is to build your resume. There is something transcendental about giving everything you have and expecting nothing in return. It strengthens you to give your time and energy to those who have nothing.

    My profession has sold its soul to Mammon. The consequences are just now being fully realized. My grandfather always told me about his youth. And how it was all fun and games until one day the money just vanished. “That will happen to your generation one day, son, and when it does you will know instantly who you can trust.” His words strengthen me every day as I see this going on all around me. I know it cannot last long.

    1. zagonostra

      If some of those saplings you’re teaching turn into oaks like you there may be some hope.

    2. Angie Neer

      Doc, you really got me with “better to build your obituary than your resume.” Thank you for that thought.

    3. anon y'mouse

      i could have sworn it was on this or an adjacent website that discussed what the people “in the room” were hearing around about the time ACA was passed.

      it went something like this: “we (insurance and other medical provision adjuncts & services investors) are going to be allowed to feed at the trough because the goal with this bill is to CRUSH the wages & power of the doctors. so fire up the investment funds around this space, because it’s going to be like the new MIC and there’s going to be almost no fallout. of course, we will find ‘innovations’ galore!”

      granted, i could be misremembering but who was it that said this? i could have sworn it was someone from Bain or similar.

    4. ChrisPacific

      ‘Sixteen Tons’ is another good Merle Haggard song (edit: oops, sorry, wrong Merle – Merle Travis). I find myself thinking about it more and more these days.

  10. Hepativore

    When I partially dislocated my left shoulder two years ago, the evaluation at the hospital, emergency room evaluation, and the sling ended up costing me around $3,000 out of pocket. As I am 38, not married, and do not have any dependents, I lost my eligibility for the Medical Assistance program through Minnesota when they drastically-lowered the income cap for the program for unmarried, childless adults in 2016.

    As I work in a deadend retail job at a pet store, nobody where I work are on the company health plans that are offered as even the Cigna bronze starts with a $6,000 deductible, premiums at $300 a month and a $60 copay. Nobody can afford this from what we are paid and I also have student loans to worry about as well. There would be little point to pay for a health plan that none of us can afford to use.

    I finally paid off my medical bill of $3K after two years, and luckily there was no permanent damage to my shoulder.

    The one thing I am grateful for in regards to Donald Trump is that he got rid of the individual mandate tax penalty for not being insured, which would still be cheaper than paying the premiums for junk insurance.

    1. Janie

      Your matter-of-fact story made the tears well up. It also reminds me to express appreciation at my local pet store, where they provide valuable advice. Wishing you well.

  11. Gusgus 2021

    I always wonder if the guys who run health care companys etc ,ever worry about going to hell…..I also wonder to if they make some deal with evil, since alot of them live to 95+

    1. Sue inSoCal

      (Thanks, IM Doc. I loved “The before times…”)

      Gus Gus, I worked for insurance companies. A long time ago in the Jurassic Era. Trust me, they have no conscience. Nor do the medical industrial complex billionaires, and in my day, they were pikers compared to today.

      The awful part is one can go broke on Medicare now with its privatization. The old government program, iirc, used 2% on administration. (Someone correct me if that’s wrong.) Not now. Additionally, there is no provision for any comprehensive management of patients with chronic conditions. I’ve fought with Medicare more than I have private insurers for certain necessities (in my case closed catheters, used for years) that were simply denied through Medicare. No appeal. Apparently, however, someone challenged that, but the goat rope eligibility scheme get these items, and some necessary treatments, are nearly or are impossible now.

      I have a 91 year old friend that, post stroke, had some immediate rehabilitation a few years ago, but if she’d like ongoing PT, which she should have, there is no home health to come to her. If you are chronically ill you’re on your own, except if you’re a money maker (ah! A new disease modifying drug! etc.) I estimate our out of pocket, deductibles for B plus a large D policy to cost over $7754/year. Medicare is not affordable imo and “help” programs for folks with lower income seem confusing and elusive, with the low income qualifications for extra help with costs plummeting to poverty level.

      Question: I thought the ACA took the 1 million cap off all private policies?

  12. Roxan

    I made it through 10 years of no health insurance, then as soon as I got Medicare, developed several major illnesses–as though they had been waiting. My bills have topped $125,000 several years in a row. And if you are poor enough for Medicaid or Medicare ‘extra help’, it’s hard to exist at such a rock bottom level.

    1. Hepativore

      I suppose that it does not help that Biden just raised the premiums of Medicare and Medicaid.

      As the increase is said to go into effect right before midterms, I am sure that this will go over really well with older voters. I would say that this would be political suicide, but all evidence suggests that the Democratic Party does not care if it loses, as long as the soft money train that keeps it afloat keeps chugging along.

      I am sure that right before he leaves office, he will try cutting Social Security. How is that for thanks to all of the older voters who helped put him into office?

    2. Sue inSoCal

      Roxan, I’m so sorry. I understand and I believe this is by design. By the time one is on Medicare, one generally has or develops health issues. My guess is we’re supposed to use our assets….while the push continues for Medicare Advantage for the medical complex to stay billionaires. (Note, I’m not saying doctors. I’m talking administration.)

  13. Anthony G Stegman

    In the US at least, the economy runs on debt. Forgiving the massive debts owed would cause immediate economic collapse, so a debt jubilee will never happen. Those who are burdened with debt will continue to struggle, and must find ways to muddle through. As Joe Biden said, nothing will fundamentally change.

  14. Dave in Austin

    Many hundreds of lines of article. 25 NC comments. Did anyone bother to look at the study?

    I am deeply tired of articles based on biased samples that claim to be objective. There is a word for this sort of behavior; its called lying. And just because the PR campaign is being run by a big non-profit like Kaiser doesn’t change the reality. A lie is still a lie.

    Why do I say it is a lie? The link says this about the study:

    “The Kaiser Family Foundation Diagnosis: Debt is a multimedia investigative journalism series by KHN and NPR that explores the scale, impact, and causes of health care debt in America. It represents a fusion of the investigative power of KHN and NPR, the public opinion survey expertise of the KFF polling team, and original data analysis.:

    The link lead to the study:

    “Diagnosis Debt:100 Million People in America Are Saddled With Health Care Debt, published June 16, 2022. “

    Burrow” down into the supposedly objective study under the methodology button and you get:

    “The survey was designed to reach adults who currently have health care debt or have had health care debt in the last five years. In order to do this, the probability panel sample included an oversample of panel members with annual household incomes less than $30,000, individuals with current or past health care debt (n=641) were included in the sample. In addition, 52 adults with past or current health care debt were reached by calling back respondents that had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and reported an annual household income of less than $25,000.”

    So, bottom line: if you sample households earning less than $30,00 and then select for people with a history of medical debt you find… people with medical debt.

    Lying with statistics is still telling a lie. And the Kaiser Foundation apparently feels free to lie if the lie gives good PR for one of its causes. These people are used car salesmen. They honestly think it is OK to lie in the service of a cause. It isn’t. It pollutes the public discourse and is the reason why people simply don’t believe anything that claims the mantle of “Statistic prove.”

    1. Yves Smith Post author

      You’ve just put your foot in your mouth and chewed by making clear you don’t understand what “oversampling” means. You are incorrectly acting as if “oversampling” = overweighing. It does not. It means they sampled that cohort more intensively to make sure their depiction of it was accurate but did NOT “overweigh” it in the final results. As Pew explains:

      Oversampling is the practice of selecting respondents so that some groups make up a larger share of the survey sample than they do in the population. Oversampling small groups can be difficult and costly, but it allows polls to shed light on groups that would otherwise be too small to report on.

      This might sound like it would make the survey unrepresentative, but pollsters correct this through weighting. With weighting, groups that were oversampled are brought back in line with their actual share of the population – removing the potential for bias.


      I don’t know what has happened to you. In the last month, you’ve had a run of comments that were factually false or analytically obviously misguided, like this one. I’ve already had to put you in moderation. In the future, I’m trashing comments like this rather than have to spend time correcting you.

      1. Dave in Austin

        You were absolutely right. I misinterpreted oversampling.

        But in my (weak) defense I passed the article by someone who follows this issue in the legislative context who’s not a statistics profesional. He thought the 100 million people number was nonsense and probably based on a question that asked “Have you ever had a medical bill you were not able to pay?”

        Huge numbers of medical bills are written off because there is no possibility that the person will ever be able to pay; they aren’t even worth sending dunning letters. He thought that the number of “The bill collecter is looking for assets to attach” was in the 5-10 million neighborhood, but that was a guess based on what his office (House side) is seeing from his district.

        This is a serious problem. but I accept his judgement that the 100 million number is way off even if my understanding of oversampling was wrong.

        I’m very bothered by the “…run of comments that were factually false or analytically obviously misguided” and I’d be happy to know which posts you’re talking about. But I see no reason to clog up comments on the subject. And we’re both busy. You know where to find me.

        1. jrkrideau

          He thought the 100 million people number was nonsense and probably based on a question that asked “Have you ever had a medical bill you were not able to pay?”

          It seems a bit unlikely since everything reportet here refers to debt.

          Maybe he should have verified this by reading the survey? It seems a bit unlikely

  15. Acacia

    Over the years, several USian friends have been hit with crazy $40,000 and $50,000 medical bills that they could not pay. One left the country (and members of his family tried to guilt trip him, saying “people like YOU are the reason we have to pay so much for health care”), another died with no family to take on the debt. When my mother passed away, I had to deal with various collection agencies, including a hospital that was overcharging her nearly $10K for an office visit, and threatening to go to a collection agency. They refused to even communicate with me unless I downloaded and installed some kind of crazy app to receiver their “secure” messages.

    I’ve had my share of rip-off healthcare experiences in the US, but it wasn’t until I spent some years living in the EU and then East Asia that the scales really fell from my eyes about the US system. Conditioned to the poor quality of care in the US, it was amazing to find that I could almost always get same-day appointments, care was good, and costs were a lot less.

    The final wake-up was during a routine visit to a dental clinic in France. The bill was going to be around $20, and when I mentioned to receptionist that I’d just cover it out-of-pocket, they asked about my insurance in the US. Yes, I replied, I had insurance via my US employer, but it wasn’t worth the hassle of trying to get this expense covered. This really triggered something, and within a few minutes literally the entire clinic staff was gathered, telling me in raised tones that on principle I should not have to pay, and they would issue however many documents/faxes/whatever necessary to get it covered by insurance.

    I tried to explain that the US healthcare system was a nightmare, there are all sorts of minimums, restrictions, and it wasn’t worth $20 to spend hours (again) arguing with my insurance company. The French finally relented, but they seemed utterly disgusted and dismayed about the outcome: that I was paying, not my insurance.

    Recently mentioned to a buddy that I had doubts about the US healthcare system. His response: “the healthcare system in the US is fine if you’re employed or can afford medi-gap insurance.” I figured there is no use in trying to argue over this. He’s never lived outside the country and has no experience with a functional national health care.

    To my mind, this may be a big factor in why nothing changes in the US: people simply haven’t experienced otherwise, so they are easily persuaded that what they’ve got is good.

  16. Lexx

    I suppose one could argue that slavery has never just gone away, it has always existed in one form or another. Debt is one of those forms. It’s what we humans do, exploit each other for personal gain. That message was always playing in the back of my mind somewhere, but about 20+ years ago I purchased a few stocks and started watching CNBC to gain some understanding of what I’d gotten into. It was around the dot-com bubble, high times on the stock market. What I got from that show was ‘debt bad’. Not from any one particular talking head, maybe all of them, and I began to feel a kind of panic and dread. Nothing I could really put my finger on, just ‘we have to pay off the house as quickly as possible’. And once we have it payed off to never get into debt again, and that’s what we did. We remain debt free.

    It’s amazing what you can do for yourself and your future when you free up that much money every month.

    To keep a people enslaved who see themselves as “free” is to play a very dangerous game (with 7.9 billion people). One way or another the rich and powerful seem determined to enslave everyone who can’t free themselves from debt, and deny them a future of their own design. And more and more the people are catching on. The revolution I’m waiting for, the one long overdue and that I probably won’t live long enough to see begin, is the one where enough of those who don’t want to spend their lives enslaved decide to break free.

    Those generations behind us are figuring it out, hell bent on paying off their homes, funding their futures (and that of their children), and retiring early to go do something else… like have time to think about something else apart from how scrape together the money for their next installment payment. Many see their futures as permanently precarious and refuse to opt in altogether. No marriage, no house, no kids, no tribe. They’re wanderers, adventurers of the ‘there and back again’ sort. They will not don the yoke, play the role assigned to them…

    … and how do you solve a problem like Maria? *

    How do you solve a problem like Maria?
    How do you catch a cloud and pin it down?
    How do you find a word that means Maria?
    A flibbertigibbet! A will-o’-the wisp! A clown!

    Many a thing you know you’d like to tell her
    Many a thing she ought to understand
    But how do you make her stay
    And listen to all you say
    How do you keep a wave upon the sand?

    ‘Gasp’, say the grandparents, ‘what about my grandchildren’?! Um, yeah. You might want to avoid giving your daughters a Mary Poppins doll for Christmas (OKC, 1964). For some future walking wombs that doll was a signpost on the way to freedom.

    *For some of us it was Julie Andrews, not Julie Newmar.

  17. Pat

    While Obama and Congress were passing their medical insurance rescue package, aka ACA or Obamacare, I called someone out who was buying the propaganda being spread by the West Wing brain trust. This person actually believed this massive turd was going to eliminate medical bankruptcy. Similar to the lack of reporting we have seen, you had to read outside the lines so to speak to discover that Romneycare had only slightly reduced medical bankruptcy in Massachusetts and that medical debt was still the cause of over fifty percent of bankruptcies there. But with regulatory controls being carved out like Swiss cheese ACA was going to eliminate soul crushing medical debt.

    There are so many reasons I despise Barack Obama, but the fact that his healthcare reform actually enabled if not encouraged the expansion of the predatory for profit investor class into all aspects of healthcare is tops.

  18. PrairieRose

    I am stunned by the statistic that the “average” deductible for a private employer insurance policy is $1,400. I work for a small law firm (less than 20 employees) and the deductible on the health care plan is $4,100 for an individual. I imagine a lot of small businesses are stuck with these high-deductible, crummy plans. Since most employed people work for small businesses, I have to take issue with this “average.” Not to mention that there are almost zero options for dental and vision care. Every single human being on the planet needs care for their teeth and eyes. I am facing a $4,000 bill for one root canal plus one crown. This cost has doubled in the last five years. U.S. “health care” is a very bad joke.

  19. Patrick Donnelly

    USA is run by gangsters.
    The rest of the world looks on as it eats the ‘citizens’ that rejected George.

    There are a plethora of scams being run out of NY. The UN is completely compromised.

    If you have alloweed your democracy to become a laughing stock, who is to blame?

    The sane wish to relocate elswhere….

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