We Owe You Nothing is a series by The Debt Collective and Prism looking at four different kinds of major debt: student loan debt, medical debt, carceral debt, and renters’ debt. Our goal is to shift the narrative around debt and break the false idea that it is a personal, moral failure and that “easy” money management advice and a bootstrap mentality are the only solutions to financial freedom. The pieces will uncover debt traps, highlight collective organizing tactics, and celebrate the growing debt abolition movement. As The Debt Collective says, “Alone our debts are a burden, but together they make us powerful.” Read the complete series here.
“How do you experience debt? Viscerally, I mean. What sensations or images would you associate with it?” a friend asked me recently.
I was surprised by how quickly my response came: debt is a constricting snake, a boa or a python. It wraps itself around you, then squeezes. Attempts to fight or free yourself only lead the snake to tighten its grip. Moves that look like potential exit strategies—applying for an additional credit card, taking a payday loan, entering a repayment plan—are actually false escapes. Interest and fees compound, you fall behind on other bills, and eventually you find yourself in a position where you’re forced to make impossible decisions. This is what it means to be caught in a debt trap.
As the nation’s first debtors’ union, part of our work at The Debt Collective is to help people understand that these debt traps aren’t created by poor individual financial decisions. They’re the result of massive systemic failures that should make us all mad as hell. When we look at different types of household debt, it’s critical that we realize these debts don’t exist in a vacuum. They are the direct products of an economic system that refuses to recognize health care, housing, and education as public goods.
Take medical debt, for instance. It isn’t an anomaly. It’s one of the most concrete ways the failures of an extractive, profit-driven health care system appear in our lives.
There’s a growing national consensus that recognizes medical debt as a public health crisis, but it can be difficult to quantify just how enormous of a problem it has become. Estimates in recent years have placed the amount of U.S. medical debt in collections in the range of $88 billion to $140 billion. Although these numbers are huge, they dramatically understate the problem because they rely on data from major credit reporting agencies. In addition to excluding all the medical debt in collections that creditors haven’t formally reported, this credit agency data also excludes the enormous amounts of medical debt financed every year using credit cards, personal loans, predatory payday loans, and payment plans.
Last year, the Kaiser Family Foundation led an ambitious investigation that attempted to account for these different forms of medical debt that aren’t captured by credit agency data. Their findings revealed that more than 100 million Americans struggle with health care debt, which includes 41% of adults in the country. It should come as no surprise that this burden isn’t evenly distributed. Like other forms of household debt, medical debt is highly racialized, with Black and brown people and their communities by far the most intensely affected, even after controlling for other factors like education and assets. Around 56% of Black adults and 50% of Hispanic adults have unpaid debt from medical or dental bills, compared to 37% of white adults. About 80% of medical debt in collections belongs to households with zero or negative net worth.
This is obscene. These numbers don’t even address the way the fear of medical debt functions. Many of us can’t afford to see primary care providers for preventative treatment, and the looming threat of unmanageable health care costs means a growing number of people are forced to postpone care even when we sense there is a serious problem. We gamble and calculate with our bodies and lives on the line. Maybe the pain will disappear on its own. I can wait a little longer to get this checked out, just until I’ve found a job with better insurance. If we’re very lucky, the gamble pays off. But for many people, it doesn’t. Diseases advance, and early warning signs give way to full-blown health crises. A health care system structured around profit will always treat people as expendable, resulting in people losing their partners, parents, siblings, friends, and other loved ones.
So, what can be done? I think the answer to this question lies in the same numbers that make the problem feel so overwhelming. Something like medical debt that affects 100 million Americans has huge collective potential. There aren’t many experiences that unite 41% of adults in this country. If we act in unison, we could have enormous power. That’s what makes The Debt Collective’s project of organizing debtors to leverage our collective force so critical. As isolated individuals, debt squeezes us. It constricts and threatens to crush us. But together, as debtors united, we have power. Together, we can demand medical debt abolition, and we can fight for the health care system we deserve.
Once we’ve recognized this collective potential, we can begin to identify sites of struggle and places of possible debt resistance. The majority of Americans with past-due medical debt, for instance, owe the debt to hospitals. The predatory billing and collections practices of many large hospitals produce debtors on a mass scale; in this sense, hospitals are also a place where many of the injustices of our health care system converge and become explicit. The acuteness of the situation becomes especially clear when we consider nonprofit hospitals, which are required to provide financial assistance to low-income patients as a condition of the massive tax breaks they receive for being “charities.” But many of these hospitals fail to make patients who would qualify for financial assistance aware of this option, instead using debt collectors, lawsuits, wage garnishments, and home liens to go after them for debts they shouldn’t have owed in the first place.
Often, the pool of medical debtors include the same people who work at these hospitals—especially the service workers, who receive the lowest wages. Just last week, SEIU Healthcare Pennsylvania, the largest health care workers union in the state, filed a landmark complaint with the Department of Justice against the University of Pittsburgh Medical Center (UPMC), a massive health care system and regional economic behemoth. The complaint includes the union’s findings that 36% of UPMC workers surveyed in the last year are in debt to UPMC—their employer, provider, and insurer—for medical care. When controlling for focus on low-wage workers (defined as those who earn less than $20/hour), that number rises to 51%. These numbers align with what we’ve been hearing in conversations with people across Pittsburgh: they’re being squeezed by UPMC for medical debts they can’t afford.
Debt is a symptom of larger structural failures, an extractive tool of social control that helps uphold ruthless and unjust systems. When we fight medical debt, we aren’t just fighting for our own immediate relief. We’re fighting for a reparative, single-payer health care system that guarantees quality health care for all. We’re fighting for freedom from racking up impossibly expensive bills for care we need to stay alive. We’re fighting for the freedom to have a different relationship to our bodies, to care for our bodies, to care for one another. We’re fighting for the freedom to heal.
Medical debt is killing us, and our health care system is broken beyond repair. Join The Debt Collective in fighting back at bit.ly/abolishmeddebt.
As told to Maddy Clifford.