Medical Debt: Sinking Into The Abyss

Summary

Uncared For: Medical Debt – Sinking Into The Abyss
Season 3, Episode Released August 6, 2025
Host: Sujin Pak | Produced by Lemonada Media and The Commonwealth Fund

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Introduction to the Medical Debt Crisis

In this poignant episode of Uncared For, host Sujin Pak delves deep into the pervasive issue of medical debt in the United States. Amidst a healthcare system fraught with challenges—from crushing medical bills and rural hospital closures to deep Medicaid cuts and insurance denials—medical debt emerges as a significant barrier preventing millions of Americans from accessing the care they desperately need.

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Personal Story: Fumiko Chino and the Cost of Cancer Care

The episode centers around the heartrending personal story of Fumiko Chino, an oncologist at Memorial Sloan Kettering Cancer Center, and her late husband Andrew. In their late 20s, Andrew was diagnosed with an aggressive form of pancreatic cancer, neuroendocrine carcinoma, which rapidly deteriorated his health. As Andrew's condition worsened, the financial strain became unbearable.

Elizabeth Craft (01:50): "It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further into the abyss."

Fumiko recounts her and Andrew's struggle with mounting medical bills, which led to them incurring thousands of dollars in debt despite having health insurance. The financial burden forced Fumiko to quit her job to care for Andrew full-time, exacerbating their financial instability.

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The Scope of Medical Debt in the U.S.

Noam Levy, Senior Correspondent at KFF Health News, provides alarming statistics that highlight the severity of the issue:

• At 05:44: "100 million people in the US have some form of healthcare debt. That's 41% of US adults."
• At 06:21: "Medical debt systematically is driving people into debt, like at an industrial scale."

Medical debt affects a broad spectrum of the population, including the young, the elderly, the insured, and the uninsured. The problem persists and may be exacerbating despite the Affordable Care Act's implementation, which reduced the number of uninsured Americans.

Noam Levy (08:52): "One of the most chilling things was the two thirds said they had to cut back on food, clothing, or other essentials as a result of a medical bill."

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Systemic Issues: Insurance and High Deductibles

The episode explores how changes in health insurance structures have contributed to the medical debt crisis. High deductibles and out-of-pocket costs have made healthcare increasingly unaffordable, even for those with insurance.

Noam Levy (11:19): "If you get a health plan through your employer, or you have to go out and buy it for yourself or your family, you probably have a deductible. ... you're going to end up in medical debt."

Levy emphasizes that individuals with chronic illnesses, such as diabetes and heart disease, are particularly vulnerable to accumulating medical debt due to the ongoing costs of their conditions.

Noam Levy (12:11): "We are, as a health care system, as a country, layering medical debt onto people who are already dealing with serious medical conditions."

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Impact of Medical Debt on Individuals and Families

Medical debt doesn't just strain finances; it has profound effects on individuals' physical and mental health. Fumiko Chino shares her experiences dealing with the financial aftermath of her husband's illness and passing.

Fumiko Chino (17:14): "The stress, that anxiety, it's like downward pressure that makes all symptom burdens worse."

The stress of medical debt can lead to deteriorating health outcomes, as individuals may delay or avoid necessary care to manage their financial burdens. Fumiko's story exemplifies how medical debt can overshadow personal tragedies, affecting every aspect of life.

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Policy Responses and Potential Solutions

The conversation shifts to potential policy measures aimed at mitigating the medical debt crisis. Despite efforts like the Biden administration's rule to ban medical debt on credit reports, judicial setbacks have hindered these initiatives.

Noam Levy (40:02): "We're only going to solve this medical debt problem if we change the way health insurance is structured."

Levy advocates for comprehensive reforms, including protecting patients financially by capping out-of-pocket expenses and regulating insurance and hospital pricing.

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Practical Advice for Managing Medical Debt

While long-term solutions are necessary, the episode offers practical steps individuals can take to manage and potentially reduce their medical debt:

1. Explore Financial Assistance Programs:
   Check if hospitals or providers offer sliding scale payments or financial aid.

   "Check if your hospital or provider has a financial assistance program."
   (Timestamp: 43:48)

2. Verify Medical Bills:
   Ensure that all charges are accurate and dispute any discrepancies.

   "Check your medical bills to make sure you're not being overcharged."
   (Timestamp: 43:48)

3. Understand Your Insurance:
   Familiarize yourself with your insurance plan's coverage, network, and out-of-pocket costs.

   "Become familiar with your health insurance plan, plan about what it pays for and what it doesn't."
   (Timestamp: 43:48)

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Fumiko Chino's Journey: Turning Tragedy into Purpose

After Andrew's untimely death, Fumiko Chino transformed her grief into a mission to reform the healthcare system. She pursued a career in medicine to address the systemic issues that contribute to medical debt.

Fumiko Chino (33:22): "I needed to go into medicine. ... try to just fix the system from inside."

Her tenure at MD Anderson Cancer Center in Houston, where Andrew was treated, highlights her dedication to improving patient care and reducing financial burdens on those battling cancer.

Fumiko Chino (35:20): "I work in the hospital where my husband was treated for cancer."

Fumiko's personal experience fuels her commitment to alleviating medical debt's impact on patients, striving to create a more compassionate and equitable healthcare environment.

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The Ripple Effects of Medical Debt

Noam Levy underscores the cascading consequences of medical debt, which extend beyond finances to erode trust in the healthcare system itself.

Noam Levy (38:51): "It's eroding people's trust in the medical system."

Medical debt can hinder individuals' ability to secure housing, employment, and further healthcare, perpetuating a vicious cycle of poverty and poor health.

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Conclusion: Collective Responsibility and Hope for Change

The episode concludes with a call to action, emphasizing that addressing medical debt requires collective effort and systemic reform. While individual strategies can provide temporary relief, meaningful change hinges on restructuring healthcare financing to prioritize patient well-being over profit.

Noam Levy (42:42): "There's nothing to be ashamed about with medical debt. You know, you didn't buy a gold ring, you shouldn't have bought, you got sick."

By sharing personal stories like Fumiko and Andrew's, Uncared For humanizes the statistics, fostering empathy and driving the imperative for a more just and accessible healthcare system.

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Key Takeaways

• Prevalence of Medical Debt: Approximately 41% of U.S. adults carry some form of healthcare-related debt, affecting both the insured and uninsured.

• Systemic Failures: High deductibles, inadequate insurance coverage, and rising healthcare costs are primary drivers of medical debt.

• Personal Impact: Medical debt significantly affects individuals' physical and mental health, leading to poor health outcomes and financial instability.

• Policy Solutions Needed: Comprehensive healthcare reform, including better insurance structures and price regulation, is essential to address the root causes of medical debt.

• Action Steps: Individuals should utilize available financial assistance programs, verify their medical bills, and thoroughly understand their insurance plans to mitigate the burden of medical debt.

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Uncared For powerfully illustrates that medical debt is not merely a financial issue but a profound public health crisis that demands urgent attention and collective action.

Transcript

[Gretchen Rubin]

This show is presented by the Commonwealth Fund, a nonprofit foundation whose mission is to promote a high performing, equitable health care system. The Commonwealth Fund supports research to improve healthcare policy and practice and has a long history of exploring what the US can learn from the best healthcare around the world to do better here at home, especially for people of color, people with low income, and those who are uninsured. To learn more, visit commonwealthfund.org work Are you looking for ways to make your everyday life happier, healthier, more productive, and more creative? I'm Gretchen Rubin, the number one bestselling author of the Happiness Project, bringing you fresh insights and practical solutions in the Happier with Gretchen Rubin podcast. My co host and happiness guinea pig is my sister, Elizabeth Craft.

[Elizabeth Craft]

That's me, Elizabeth Craft, a TV writer.

[Gretchen Rubin]

And producer in Hollywood. Join us as we explore ideas and.

[Elizabeth Craft]

Hacks about cultivating happiness and good habits.

[Gretchen Rubin]

Check out Happier with Gretchen Rubin from Lemonada Media Lemonade Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple podcasts for just 5.99. You'll get ad free episodes and exclusive bonus content from shows like this one, as well as Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show feed on Apple Podcasts and hit subscribe Make Life Suck Less with fewer ads with Lemonada Premium.

[Elizabeth Craft]

I met Andrew online. It was in the early 2000s. It's when meeting online was still a little maybe gauche. He was a computer science PhD and I was working as the art director of an entertainment company. And we met in our late 20s and started dating.

[Gretchen Rubin]

That's Fumiko Chino. She was living in Houston, Texas when she met Andrew, who'd eventually become her husband.

[Elizabeth Craft]

He's an odd duck, you know, really bad dancer, sort of a manic mind that had a lot of things juggling all at once and just a brilliant guy. Yeah, we were, God, dare I say it, a cool couple.

[Gretchen Rubin]

I think you could say that.

[Elizabeth Craft]

Yeah. We went to a lot of art events, a lot of music shows. We had a very active social life. We were out and about and it was just fun. We were, I always say, young and stupid, right? We were in love. And it all changed slowly. He started having problems eating, having some episodic nausea, vomiting. He started having a lot of abdominal pain. He had lost 35 pounds in about six months. And so that's when they did a CT scan his abdomen and they found that he had cancer kind of throughout his pancreas.

[Gretchen Rubin]

Andrew had a fast growing tumor that had spread throughout his body. He was diagnosed with neuroendocrine carcinoma, an aggressive cancer. Famico and Andrew knew the sickness would take a toll on their lives, but they had no idea about the financial burden the cancer would force on them. Andrew's sickness would lead to thousands of dollars of medical debt.

[Elizabeth Craft]

It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further into the abyss.

[Gretchen Rubin]

4 in 10 people in the US have medical debt. 4 in 10. It reaches all corners of the country. The young and old, the uninsured, and yes, the insured. To cope with the financial burden, Americans are making impossible sacrifices and decisions every what groceries to buy, where to live, what jobs to pursue, whether or not to drain their kids college savings. From La Nada media, this is uncared for. I'm your host Sujin Pak. Welcome to season three. And this season we're looking at the many ways people in the US are literally uncared for. In a country that seems more divided than ever, there's one thing almost everyone agrees on. We need health care that doesn't feel like a fight. So we're covering it all. From medical debt to insurance denials to rural hospital closures, there are so many ways our system is failing us. We're diving into the rage, the realness and the frustration we're all feeling in this moment. And we're not holding back. For a lot of us, medical debt isn't some abstract crisis. It's something we deal with every day. Avoiding bills, putting it on your credit card, or even crowdfunding. Whether you have a chronic illness, need an expensive treatment, or were laid off and got sick, debt is unfortunately our system's go to solution. We really wanted to get a sense of how big this problem actually is.

[Noam Levy]

100 million people in the US have some form of healthcare debt. That's 41% of US adults. And I mean, if you think about that, I mean, it's sort of mind boggling.

[Gretchen Rubin]

Noam Levy is a senior correspondent at KFF Health News. He's been covering healthcare for about 15 years and led the sweeping investigative series Diagnosis Debt.

[Noam Levy]

You know, medical debt is not just sort of some byproduct that, you know, is generated on the side along with you extra surgical waste and stuff. You throw out in the er. This is core to what the US Healthcare system does.

[Gretchen Rubin]

Yeah, this is the business.

[Noam Levy]

Yeah. It systematically is driving people into debt, like at an industrial scale. And if you ask people if they've ever had any health care debt in the last five years, that number jumps up to 57% of U.S. adults. And so that's a majority of American adults have been in debt in some form in the last five years.

[Gretchen Rubin]

The term medical debt can mean many things. Traditionally, it's been considered unpaid or past due bills from health care providers, like an unpaid hospital bill from an emergency room visit. Sometimes those bills are sent to collection agencies or debt collectors and may have ended up on your credit report. But Noem says medical debt encompasses a lot more than that.

[Noam Levy]

It's the bill that like, you get from the hospital and you put it on your credit card and then you don't pay your credit card off for, you know, six months or a year. So you're, you're in medical debt, even though that's maybe not measured traditionally as medical debt. Or, you know, maybe you go on a payment plan, you go to the hospital, you get a $5,000 bill, and the hospital says, can you pay this off over two years? Pay us, you know, $300 a month or something like that. And that might not get measured as medical debt either, but you're like, you're on an installment plan as if you're, you know, paying off an auto loan or maybe you've borrowed from friends or family, maybe it's your parents, maybe it's a sibling. And that's not recorded as medical debt technically. But like, think about the ways that that sort of changes people's family dynamics. You know, some of that debt is relatively small, a couple hundred dollars, but some of it is enormous. 5,000, $10,000. And we found that a lot of people say they're, they don't think they're ever going to pay it off. They're going to like, live with it forever.

[Gretchen Rubin]

Noam says medical debt is upending people's lives. Debt and lack of causes people to delay or avoid getting care, which makes them sicker. They're also making difficult sacrifices in so many other ways.

[Noam Levy]

Maybe they have to drain their savings, maybe they have to take on extra work. Maybe they have to change their living situation, like downsize or move in with friends or family. One of the most chilling things was the two thirds said they had to cut back on food, clothing, or other essentials as a result of a, of a medical bill.

[Elizabeth Craft]

Yeah.

[Noam Levy]

And, you know, you stop and think about that for a second. But, you know, we hear a lot of talk right now about social determinants of health, right? That how economically stable, how. How much stable housing you have, how well you eat is, is much more important to your health ultimately than kind of what the hospital or the medical system does to you. And yet here we have a healthcare system that's supposed to be taking care of people, that is making it literally more difficult for people to put food on the table.

[Elizabeth Craft]

Yeah, it's.

[Gretchen Rubin]

I mean, these are massive, massive. Like you said, industry size numbers. Who experiences medical debt? Right. Because I think the assumption is, if you haven't really thought about this, that it's people with major complicated health issues, maybe it's people without insurance. I want to know what the full picture is, and I want to know in the last 15 years if that's changed.

[Noam Levy]

So I think historically the idea of who was going into debt because of medical bills was like, this was someone who lacked health insurance, you know, who ends up in the ER with a car accident or they get diagnosed with cancer or something like that, and, you know, they end up in debt, and maybe they declare bankruptcy. And I want to be clear that that's still happening. And we know that medical debt is more prevalent among people with lower incomes, people who lack health insurance. But. But, you know, since the passage of the Affordable Care Act, Obamacare 15 years ago, the number of people without health insurance in this country has fallen significantly. I mean, it may. That may change, given what's happening right now in Washington. But we. We've seen some historic gains in healthcare coverage, but the medical debt problem hasn't gone away. And by some measures, it may even be getting worse. And now this is a problem of the insured.

[Gretchen Rubin]

There's a long standing assumption that if you have health insurance in the United States, health care becomes affordable, but that's simply not the case anymore. Insurance plans have changed dramatically in the past couple of decades. For instance, many plans have extremely high deductibles.

[Noam Levy]

If you get a health plan through your employer, or you have to go out and buy it for yourself or your family, you probably have a deductible. At this point. You have to pay 1000, 2000, maybe $5000 out of pocket before your health plan will kick in and start paying the bills. And for a lot of people, like a $5,000 deductible or even a $10,000 deductible for a family, I mean, that's devastating. And we know most people don't have a lot of savings that are readily accessible. So, you know, you don't need a Nobel Prize in economics to understand that if you owe two or three thousand dollars on your health plan and you only have five hundred dollars in the bank, you're going to end up in medical debt.

[Gretchen Rubin]

Noam says the best predictor of medical debt is whether or not you're sick, which may seem obvious, but. But when you really think about that, it's just so messed up.

[Noam Levy]

We looked at medical debt's prevalence at the county level around the country. Like which counties had the highest levels of medical debt? And what about that county best predicted whether or not there was going to be a lot of medical debt there? And it wasn't sort of how poor the county was. It wasn't whether or not there were a lot of people who lacked health insurance. It was whether or not there were a lot of people who had chronic illnesses like diabetes and heart disease. And so when you think about that, the kind of people who are going into debt are the kind of people who, like, if you have diabetes, you have prescriptions you got to fill, you got tests that you have to do, you got to see your doctor regularly, you're going to rack up medical bills. We are, as a health care system, as a country, layering medical debt onto people who are already dealing with serious medical conditions. And we know that this is not good for people's health. I mean, there is research that actually shows that people who have cancer who go into medical debt actually die more quickly than cancer patients who don't go into debt. It's crazy.

[Elizabeth Craft]

Yeah, yeah.

[Gretchen Rubin]

The stress will kill you, as some say before. Yeah, before the diagnosis. And if it doesn't kill, it often leaves a lot of people deeply changed. That's what happened to Fumiko Chino, who we heard at the top of the episode. The debt she and her husband experienced as 20 year olds changed the course of her life.

[Elizabeth Craft]

At a certain point, you're just trying to keep your husband alive. I quit my job. I was no longer opening up bills. I was just like, you go in a pile. I've got other things to deal with.

[Gretchen Rubin]

That's next after the break. Let's be real. Without the black press, who's covering how black Americans are really treated in the health care system? Mainstream media barely scratches the surface, but word in black goes deep because lives depend on it. They're reporting the truth about medical racism, black maternal mortality, breast cancer in black women, mental health stigma, all of it. Want to stay informed and empowered. Subscribe to their weekly health newsletter and get the stories that actually put black health first. Go to wordinblack.com that's wordinblack.com and sign up because being informed is how we protect each other. Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium. On Apple Podcasts, you'll get ad free episodes and exclusive bonus content from shows like Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, the Sarah Silverman Podcast, and so many more. It's a great way to support the.

[Elizabeth Craft]

Work we do and treat yourself to.

[Gretchen Rubin]

A smoother, uninterrupted listening experience. Just head to any Lemonada show feed on Apple Podcasts and hit subscribe Make Life Suck Less with Fewer ads with Lemonada Premium.

[Elizabeth Craft]

My name is Fumika Chino and I'm an oncologist at Memorial Sloan Kettering Cancer Center. Every day I use advanced technologies to treat and cure patients with cancer and I also do research on how to make healthcare more affordable.

[Gretchen Rubin]

In July 2024, Fumiko Chino testified before a Senate committee as Congress looked at what it could do to end the medical debt Cris I come today to.

[Elizabeth Craft]

Speak to you about the harms of medical debt as an expert in the field, but also as someone who has personal experience with the financial devastation on patients and families of a cancer diagnosis. On the day after his 27th birthday, my husband Andrew started having pain and throwing up. When he was finally diagnosed, we learned that he had fast growing tumor that had spread throughout his body like she.

[Gretchen Rubin]

Experienced with her husband's cancer diagnosis. She says that many patients are forced to literally choose between their money and their lives and she made that clear in her testimony.

[Elizabeth Craft]

There are more people who are worried about the financial costs of a cancer diagnosis than from dying of cancer and 40% of Americans have depleted their life savings within two years of a cancer diagnosis. Debt relief is needed now.

[Gretchen Rubin]

Today, Famika researches the effects of health care costs on a patient's quality of life and how to improve affordability. And her work as a radiation oncologist means she sees a lot of terminally ill patients deal with the stress of debt. How do you see this stress of medical debt show up in your patients?

[Elizabeth Craft]

That stress, that anxiety, it's like downward pressure that makes all symptom burdens worse. And this is not just my opinion. Research backs this up. People who have financial difficulties with their care have worse physical functioning, they have less social functioning, they have worse sleep, they have worse pain and some of it is because they can't afford their medications, right? They can't get the appropriate, like supportive care medications. And some of it is just that that additional burden, that mental burden, that extra weight that they're carrying is just one more thing, right? So many patients are worried about bankrupting their family beyond even their cancer diagnosis and potential death from cancer. Their larger worry is actually what is going to be carried forward for my kids, for my family, Are we going to lose our homes? Are we going to lose our car? People who were spending like their kids saved college tuition, right? Like in the hopes that they would actually be alive for their kids to go to college. And it's just horrifying to think about how common this is. All data points to the fact that this problem is only getting worse.

[Gretchen Rubin]

Even though more people have health insurance, the costs of high deductibles and co pays from medical care can still cause financial challenges. And keeping up with all the bills and understanding how your health insurance works can be extremely difficult.

[Elizabeth Craft]

It's infuriating for me as someone who's gone through this and understands the burden of paperwork, of having to stay on top of all these things all at once. In the midst of crisis, you can understand how some things could just be lost. It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just, just sinking further into the abyss.

[Gretchen Rubin]

That feeling of sinking into the abyss, it's a familiar feeling. For Fumiko, the spiral started when her husband Andrew was diagnosed with cancer. Do you remember what you were thinking or feeling when you found out that he was as sick as he was when he got the diagnosis?

[Elizabeth Craft]

I remember when they said cancer that it was like a Charlie Brown style interaction where you hear the word cancer and then everything else is just like.

[Gretchen Rubin]

A wah wah, wah wah.

[Elizabeth Craft]

I had stopped listening. They said cancer and I was out.

[Gretchen Rubin]

At the time, Fumika was an art director of an entertainment company and Andrew was a PhD student. They were in their late 20s. That stage of life where you're career building, figuring stuff out and supposed to be having fun. Instead, the couple was now dealing with Andrew's cancer, which seemed to be getting worse by the day. And Andrew's student health insurance had a lot of holes in its coverage, holes that would lead to Famico and Andrew picking up the tab for his prescriptions.

[Elizabeth Craft]

For example, he was on an anti nausea medication. We were paying $35 a pill and there were times when I would give him the medication and then like 20 minutes later he would throw it up and I would be able to see the pill and I would just be.

[Gretchen Rubin]

Like, that's $35, $35 for each anti nausea pill, $100 for a blood thinner shot. He needed twice a day. Andrew needed these medications and others to keep his pain somewhat managed and to treat infections, his blood clots.

[Elizabeth Craft]

So those were the immediate expenses. And so just trying to, you know, I cashed out my 401k, we borrowed money from family, that sort of thing. We would just get these just incredibly high bills and they just kept coming in the mail.

[Gretchen Rubin]

Earlier on in his cancer diagnosis, Andrew was responding to the cancer treatment, but at some point he stopped responding to it. Famico says he just started wearing out.

[Elizabeth Craft]

At a certain point you're just trying to keep your husband alive. He was having increasing nausea as the treatments kind of stopped working. He was in like the emergency room, he was in the hospital. He would get infections and just in the life sustaining function for me, I quit my job. I was no longer opening up bills. I was just like, you go in a pile. I've got other things to deal with. My husband's now on oxygen. He's just weaker. He had complications on complications. And then of course, maybe naively, we were still trying to have a wedding.

[Gretchen Rubin]

Famiko and Andrew were already engaged when they first learned of the cancer. Their original wedding date had been set for about a year out. As Andrew got sicker though, they moved that date up and got married in Fumiko's parents living room. It was Andrew and Fimico and her parents.

[Elizabeth Craft]

But I still wanted to gather our friends and families and have a formal wedding. And so we were still trying to do that. I think maybe intrinsically I knew how important it was to have this celebratory event, to have all of his friends and family and my friends and family together because it was so serious and critical. Yeah, I remember buying all of these Christmas lights on super sale for like 75% off from target because we were like, okay, the Christmas lights are going to be our decoration. When we were shopping for a suit for him because he had lost so much weight, he needed a new suit. He had lost 65 pounds on, you know, a guy who's over 6 foot. So he was just real thin. And I knew that I didn't want to put him in a black suit because that, that would be, I think too, I guess, scary. So he was in like this like linen suit that was like light colored. He Looked, you know, pretty good.

[Gretchen Rubin]

At this point, Famiko had quit her job and was caregiving for Andrew full time. He was vomiting all the time, losing weight, and she was working so hard to get calories in him. She knew the bills were piling up, but her focus was trying to keep him alive. So she set those huge medical bills aside. As those numbers and as that paperwork is building up, are you thinking about at some point we're going to have to deal with this? And I don't even know what that looks like.

[Elizabeth Craft]

Yeah, it was very much like a wave where you just, you know, like the first wave comes and you're like, okay, I can deal with this, I can stand steady. But then a larger wave comes and you're starting to lose your footing and then eventually you just get swept out to sea. Right. And we were both just ashamed of the fact that we couldn't pay his bills. And it was something that we were trying to hide from my friends and my family members. I think they understood that I was out of work and he, you know, was a graduate student. So, you know, money was tight. But even then, I don't think they quite maybe understood or I shared with them like, that these bills were coming in hot and hard and, you know, and just like really terrifying. Even like a hospitalization bill, like, you know, he was in the hospital for a week for pneumonia. It was tens of thousands of dollars.

[Gretchen Rubin]

I have to imagine then that every time you drive to the pharmacy or like you said, he's like, I have to go to the hospital, I'm not feeling well. I mean, at that point, you're already racking up the bill in your brain before you even get there. That level of stress, frankly, I don't even know what's more stressful that or dealing with a health crisis on a day to day basis.

[Elizabeth Craft]

It's not even just the pharmacy, it's the parking in the hospital. You know, we were paying $15 a day to just park for him to get infused with, you know, toxic chemicals that would hopefully kill more cancer than kill him. Right. So having to balance, you know, something stupid like the cost of parking with also, you know, rent and trying to make sure that we're getting his medications and figuring out, like, what's the balance here of what we can afford.

[Gretchen Rubin]

They also never told Andrew's providers and doctors that they couldn't pay the bills. They were afraid of Andrew getting cut off from care. Fumico says it was like a black cloud hanging over them at all times.

[Elizabeth Craft]

It's A very common sentiment for people who are facing large bills or unaffordable treatment is that they want to keep it from their providers because they are afraid of their providers cutting off the spigot and saying, well, you're done here. You're nothing but bad debt. You have not made any payments. And that was our main concern, is that at one point his cancer center was going to stop, that we would just stop being able to get care.

[Gretchen Rubin]

Andrew was not going to let that happen, though. Even with his serious illness, he managed to get a job, one with good health insurance.

[Elizabeth Craft]

Because my husband was a very brilliant person and because he did work his hardest to defend his thesis, in between being hospitalized for cancer, in between, I think his second and third line of chemotherapy, he interviewed for positions and secured a faculty position. And so we moved to the Ann Arbor area.

[Gretchen Rubin]

Leaving Texas meant disconnecting from their friends and support network. But Fumico says they literally had no other choice, so they moved to Michigan. His new faculty job came with much better health insurance.

[Elizabeth Craft]

We moved there. He was immediately hospitalized, like, basically the night we arrived.

[Gretchen Rubin]

Wow.

[Elizabeth Craft]

He never got to move into his office. He never got to actually work. He died March 4, 2007. He was 28. I was 29.

[Gretchen Rubin]

Famiko's life was turned upside down. She lost all purpose, and she had no good friends near her, no support.

[Elizabeth Craft]

It was just the trauma of him dying and then me being alone, and then in a place that I did not know anyone, had no support structure, and was really just all alone. Yeah.

[Gretchen Rubin]

I'm just thinking about all of the day to day, but also huge sacrifices. People make the impossible choices that people have to make to just live or to just die.

[Elizabeth Craft]

It's this false dichotomy. It's your money or your life. But he. He lost both. Yeah, Right. So no amount of money would have kept him alive. I know that. But even if you had asked me when he was in the icu, would you pay a million dollars to keep him alive for another five minutes?

[Gretchen Rubin]

Take it.

[Elizabeth Craft]

I would have done it.

[Gretchen Rubin]

Anybody would have. Anybody would have. So you're there alone. At what point did you realize you had to deal with this pile of paper?

[Elizabeth Craft]

By the time he died, we were actually already in collections. And I knew it was a problem when I started getting phone calls, because obviously Andrew's phone wasn't active, but mine was, and I was his next of kin. And so I started getting letters in the mail and phone calls. I even got a phone call from a debt collector when I was at my husband's funeral. And so that's when I kind of knew that this would be an issue.

[Gretchen Rubin]

Fimiko was being hounded by debt collectors while she was newly grieving her husband's death. She was 29 and a widow.

[Elizabeth Craft]

I was barely able to keep myself alive in this time period. My sister had to move in with me because I was really not getting out of bed or really eating. And so, again, immediate pressing concerns is just survival, right? And dealing with profound grief. At a certain point, I was, like, just ostrich ing it. I guess I was just kind of sticking my head in the ground and being like, you know what? One foot in front of the other. This is the only thing I can deal with right now, which is getting out of the house, seeing the sunlight, you know, doing something that's other than just grieving. That's, you know, sort of in that time period where I was like, okay, I need to do something with my life. I can't go back to what I was doing before. As an art director.

[Gretchen Rubin]

Fumiko wanted to reinvent herself and found a powerful message in Andrew's death date.

[Elizabeth Craft]

March 4th is the only date that's also a command.

[Gretchen Rubin]

March 4th to move forward with determination and purpose.

[Elizabeth Craft]

I don't know when I realized that that was. That was a message for me to reinvigorate my life, but at some point, it was like, kind of my banner call.

[Gretchen Rubin]

After the break, we'll hear how Fumiko is helping cancer patients back at the very same place Andrew was treated.

[Noam Levy]

Hello, I'm Joelle Brevel, medical mythbuster and host of the Dose, a health policy podcast from the Commonwealth Fund. Each season, I sit down with a leading health policy expert and medical professionals to have real conversations about the issues that keep them up at night. We talk about breakthroughs in their research and their new ideas to make our healthcare system work better for all Americans. This idea of equity needs to be.

[Elizabeth Craft]

Taken up by everyone.

[Noam Levy]

And wherever you are in your work.

[Elizabeth Craft]

Whatever sector that you're in, we need.

[Noam Levy]

To have conversations about what tomorrow looks like. I hope you'll check out the Dose and enjoy listening to our interviews. You can find us at thedose show or by searching upodcast app for the Dose from the Commonwealth Fund. Hi, everyone.

[Elizabeth Craft]

I'm David Duchovny. Join me on my podcast Fail Better, where we use failure as a lens to reflect on the past and analyze the current moment. I speak with makers and performers like Rob Lowe, Rosie o', Donnell, and Kenya Barris, as well as Thinkers like Kara Swisher and Nate Silver. To understand how both personal setbacks and.

[Gretchen Rubin]

Larger forces impact our world, listen to.

[Elizabeth Craft]

Fail Better wherever you get your podcasts.

[Gretchen Rubin]

To Famico. Her and Andrew's experience revealed the gaping holes in the US Healthcare machine, a system she says is seemingly designed to put profit over people. She wanted to use her valuable lived experience for good.

[Elizabeth Craft]

So that's when I sort of thought, okay, I need to go into medicine. Since I do have doctors in my family. They were like, you know, you should just go to medical school. And so that's when I started on that path to kind of think about how it would be like to actually try to join the other side, to try to just fix the system from inside.

[Gretchen Rubin]

Wow. I mean, you've lived eight lives, you know, but before you're 30, you know what I mean? It's just like it keeps unfolding. You said you wanted to fix the system from within. And you go to med school. How old are you when you enroll into med school? You know, give me the details.

[Elizabeth Craft]

I had the privilege of being able to start again. And then I had his life insurance money that actually kept me alive, paid my rent while I was trying to figure out how to, you know, dig myself out of this grief hole. His life insurance money also facilitated me going to medical school. It paid for medical school. And so I literally, you know, was trying to spin gold out of this straw, right? Of how do I reinvent myself with purpose, Right? How do I think about turning some of this grief into action?

[Gretchen Rubin]

Fumiko went to Duke University School of Medicine, and as we talked about earlier, she's now a radiation oncologist.

[Elizabeth Craft]

I'm part of curative treatment for breast cancer, but also part of palliative treatment, meaning trying to help with pain or bleeding for people who have metastatic disease.

[Gretchen Rubin]

About a year ago, Fumiko switched workplaces, from Memorial Sloan Kettering in New York City to the MD Anderson Cancer center in Houston, the very place Andrew had received his cancer treatment.

[Elizabeth Craft]

I work in the hospital where my husband was treated for cancer.

[Gretchen Rubin]

I suppose at first, getting there must have been bizarre, stepping through those doors.

[Elizabeth Craft]

There was a little bit of ptsd. Yeah.

[Gretchen Rubin]

Fumiko has memories of hearing bad news in the waiting room, waiting for lab draws, constantly looking for a place for Andrew to throw up. Those feelings sometimes bubble up when she's not expecting it.

[Elizabeth Craft]

I walked over from my office in my clinic to the hospital to visit a patient who was admitted, and I suddenly got, like, such deja vu, ptsd. I had to Sit down. Right. Because I had been in that hallway, but not in a good way, not as part of my. But as someone who was just terrified that they were gonna lose their husband. And I do still have those moments. But then I realized what a privilege it is for me to be able to be here, to be providing the superlative care that I know we can provide here, that we do every single day. And trying to, again, work within the system to say, what are the financial friction points for patients and how do we smooth them down? I'm never going to find the cure for cancer in my research, but what I can do is potentially find ways that more people can be cured of their cancer or for the ones who can't be cured, that they just have less suffering.

[Gretchen Rubin]

Yeah. Cure or not, that's life changing.

[Elizabeth Craft]

You know, even if I can help 1% of people, I feel like it's worth it.

[Gretchen Rubin]

It's completely worth it. Famiko ended up transforming her life after Andrew's death, all to make the process even just a little bit better for others. She's using her lived experience, her insider perspective, to make a difference. Still, while we have people like Fumiko working to change the system, our medical debt problem keeps growing. That's because it's not just the debt that we need to look at. It's the ripple effects of that debt. Here's Noam Levy from KFF Health News.

[Noam Levy]

Again, many of these stories of people that we've interviewed over the years, these are people who have been responsible in their lives, and through no fault of their own, they're ended up in this incredibly financially precarious position. So if you think about that, if you get a big medical bill, you can't pay it. It gets reported to the credit bureau, and there it is, sitting on your credit report score, dragging you down. And all of a sudden, because of this medical bill, you have a harder time renting an apartment or getting a mortgage, you have a harder time getting a car loan, or you have to pay more, you have a harder time getting a job. And if you can't get a job or you can't get a decent place to live, that's going to impact your health. And maybe you're going to sort of end up with even more medical bills. And it becomes this sort of vicious circle where again, something that started that originated in a system, the healthcare system that's supposed to be taking care of you and is supposed to making you better, has set in motion this sort of cascade of events of economic impact on your Life that's actually not only making you sicker, but it's sort of preventing you from advancing economically.

[Gretchen Rubin]

I mean, and when you speak of it in that way, and the domino effect it has on our health, on our finances, on our ability to climb up that financial ladder, that can't not have a cultural impact on us as a whole.

[Noam Levy]

It's eroding people's trust in the medical system. And I think that's really dangerous. And the healthcare system traditionally has sort of maintained a pretty high level of trust. You know, people still trust their doctors and their nurses, but when you start kind of talking to people about their experiences getting these bills, trying to deal with hospitals, or in the worst cases, getting sued by hospitals or other medical providers because they can't pay their bills, people start thinking differently about the health care system. And you know, I would argue, like, particularly in our unsettled times, the last thing we need is for another important sort of pillar of our society to be sort of torn asunder because people no longer have faith in it.

[Gretchen Rubin]

In January, the Biden administration finalized a rule that would have banned medical debt on credit reports, meaning lenders couldn't consider a person's medical debt when deciding whether or not to give them a loan. The rule set to go into effect in March. But in July, a federal judge reversed the rule, which means medical debt can remain on credit reports. Some states have implemented protection for people in medical debt. For instance, some already prohibit medical debt from being put on credit reports. Other states, as well as county and local level governments have pursued buying and forgiving medical debt. Like New Jersey. The state appropriated funds to cancel about a billion dollars in medical debt for its residents. But most of these protections aren't getting to the root of the issue.

[Noam Levy]

Now, ultimately we're only going to solve this medical debt problem if we change the way health insurance is structured. And that doesn't mean like Medicare for all, it just means some restrictions on what people have to pay out of pocket. We should start by talking about protecting patients financially. And from that will come a lot of other discussions about, well, okay, what do we have to do to make sure that the costs don't bubble up somewhere else? Do we need to cap how much insurance companies can charge? Do we need to cap how much hospitals can charge? And I would argue we should be having these discussions.

[Gretchen Rubin]

Obviously, these long term solutions, you know, they're not here. And in fact, in this current administration, arguably they're being rolled back. Are there, though smaller things people can do to avoid health care debt?

[Noam Levy]

Don't put big medical bills on your credit card because if you do, you are not protected the same way you are with a medical bill. And a lot of states have banned medical bills from being put on your credit score. But if you've put that bill on your credit card, then it's a credit card bill and you're in trouble.

[Gretchen Rubin]

Right.

[Noam Levy]

So try to avoid doing that. And, and you know, health insurance is a tough, tough landscape to navigate. It is really hard to choose the right health plan. But I, I would say if you have a choice and it's possible to avoid a big deductible, and if you can tolerate a little bit higher premium for more financial protections, that's good to do.

[Gretchen Rubin]

Is there anything else about the medical debt crisis from your point of view that you wish more people understood?

[Noam Levy]

You know, I think a lot of people are reluctant to talk publicly about their medical debt experiences because there's a lot of shame associated with it. Maybe they don't want people to think that they're looking for charity or looking for a handout. And as we've talked about throughout our conversation, it's everywhere. Like, you know, chances are you know somebody, if you don't have medical debt yourself, you probably know somebody who does. And I think removing the stigma a little bit so that we can talk about this more openly and kind of recognize the harm that it's doing, hopefully will get elected officials in this country and the healthcare system to sort of confront it a little bit more directly. And it's only by people stepping forward and sharing their stories and feeling okay about it. There's nothing to be ashamed about with medical debt. You know, you didn't buy a gold ring, you shouldn't have bought, you got sick. And hopefully people will feel they can speak up because, you know, we shouldn't tolerate this.

[Gretchen Rubin]

Noam is right. We collectively as a country shouldn't tolerate this. And though there is often a lot of of shame associated with medical debt, it doesn't have to be that way because we're all dealing with the consequences of it. Big changes like putting patient care over profits, improving health insurance coverage, and reigning in the high price of medical care would help ease our medical debt crisis. But in the meantime, here are a few things you can do on a personal level. If you're struggling with big medical bills. Check if your hospital or provider has a financial assistance program. Reach out to a patient, financial service officer or a social worker. If you qualify, you may be able to access free or sliding scale payment help with a plane ticket or gas if you have to travel or figure out payment plan options, you could be eligible even if you don't think you are. The website Dollar is a great resource for navigating a hospital's financial assistance program. That's DollarFor.org check your medical bills to make sure you're not being overcharged. It's always okay to ask providers what something is going to cost and to explain bills in plain language. And this isn't fun, but it is helpful to become familiar with your health insurance plan plan about what it pays for and what it doesn't, who's in network and who isn't, and then if and when you have the option to change plans to something that better fits your medical needs, there's more Uncared for with Lemonada Premium if you haven't subscribed to Lemonada Premium yet, now's the perfect time. Because guess what? You can listen completely ad free. Plus you'll unlock exclusive bonus content like tips from health experts and caregivers that you won't hear anywhere else. Subscribe now on Apple Podcasts or head to lemonadapremium.com to subscribe on any other app or listen ad free on Amazon Music with your prime membership. That's lemonadapremium.com Uncared for is a production of Lemonada Media. I'm your host Sujin Bay. Muna Danish is our Senior producer. Lisa Fu and Hannah Boomershein are our producers. Our mix is by Ivan Kuraev, Music is by Andrea. Kristen's daughter Jackie Danziger is our VP of Partnerships and Production Executive. Producers are Jessica Cordova Kramer and Stephanie Wittleswax. This season of Uncared for is presented by the Commonwealth Fund, a non profit foundation working toward a health care system where everyone, no matter who they are, where they live or how much money they make, can get the health care they need. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram at sujimpak and Lemonada menadamedia across all social platforms. Thanks so much for listening. See you next week. This show is presented by the Commonwealth Fund, a nonprofit foundation whose mission is to promote a high performing, equitable health care system. The Commonwealth Fund supports research to improve healthcare policy and practice and has a long history of exploring what the US can learn from the best healthcare around the world to do better here at home, especially for people of color and people with low income and those who are uninsured. To learn more, visit commonwealthfund.org it's easy to feel helpless these days. So take a break from the bad news and hear from people who are doing good things to address big problems.

[Elizabeth Craft]

We care about abortion access. We care about slowing down, reversing climate change. That's the approach we need to the these long term systemic problems.

[Gretchen Rubin]

We need the fixers feel empowered to take action. Listen to good things from Lamonada Media, available wherever you get your podcasts.