Medical Debt
A Health Disparity, Determinant of Health, and a Public Health Emergency.
Medical debt is often framed as a personal financial failure or an unfortunate byproduct of illness. In reality, it is neither. Medical debt is a predictable outcome of structural inequities embedded within the U.S. healthcare delivery system—and it now constitutes a public health emergency.
Over 100 million people in the United States live with some form of medical debt. This burden is not evenly distributed. Medical debt disproportionately affects low-income households, communities of color, individuals with disabilities, older adults, rural residents, and those with chronic illness. It is both a symptom of health inequity and a driver of worsening health outcomes.
Medical Debt as a Determinant of Health.
Medical debt directly undermines health by shaping the conditions in which people live, work, and heal. Individuals burdened by medical debt are more likely to:
Delay or forgo needed medical care.
Skip medications or preventive services.
Experience housing instability and food insecurity.
Suffer from chronic stress, anxiety, and depression.
This creates a vicious cycle: illness generates debt, and debt worsens illness. From a public health perspective, medical debt functions as a toxic exposure, eroding individual and community well-being over the life course decreasing both health span and life span.
Disparities by Design, Not Accident.
Medical debt is not simply the result of being uninsured. Many people with employer-sponsored insurance still accrue catastrophic bills due to high deductibles, copays, out-of-network charges, and coverage gaps. These financial barriers are structurally embedded and disproportionately harm individuals, families and communities already marginalized by race, income, geography, and disability.
In this sense, medical debt represents a failure of health system design—one that prioritizes billing complexity and cost-shifting over proactive health strategies, continuity, and equity.
A Public Health Lens Is Essential.
If medical debt were treated as an infectious disease, it would warrant immediate public health intervention. It spreads through families and generations, damages mental and physical health, destabilizes communities, and increases long-term healthcare costs.
Addressing medical debt requires moving beyond charity-based relief toward systemic proaction, including:
Universal access to affordable, comprehensive care.
Strengthened integrated person-centered primary health care.
Integration of essential healthcare and public health services and financing.
Consumer protections against predatory billing practices.
Recognition of medical debt as a health equity metric.
From Moral Failure to Collective Responsibility.
Medical debt should not be a rite of passage for surviving illness. A socially-just and resilient healthcare delivery system does not punish people for seeking medical care—it protects them from harm.
Framing medical debt as a health disparity and a public health emergency reframes the conversation from blame to responsibility, from individual hardship to collective action. The question is no longer whether we can afford to address medical debt—but whether we can afford not to.
