The year 2020 was an inspiring year to be a doctor. I saw colleagues tired, understaffed, fearing they might contract COVID-19 and nonetheless persevering to provide care to those most in need.

Alongside social justice leaders, doctors mobilized to collectively address enduring racial inequities in health care, with the American Medical Association proclaiming racism a threat to public health. Locally, doctors were in the streets, leading powerful marches through downtown Seattle against racialized police brutality.

We bore witness to doctors like Anthony Fauci espousing important public health messages, despite political pressure to do otherwise. My colleagues have made me proud to identify as a physician this year. But as we enter a new year, there is a glaring hole in doctors’ pursuit of medical justice — health economics. This year physicians and health care administrators must defend the economic well-being of our patients.

Even before COVID-19, nearly one in three Americans delayed medical care because of fears of medical costs. COVID-19 has only made this problem worse. As a family medicine doctor caring for patients in the hospital and in the clinic, I’m all too familiar with this conundrum. Last week, a patient, dreading medical debt, refused my recommendation to visit the emergency department when her usually high blood pressure was dangerously low, a serious signal that she needed medical attention. Another patient had the same cost-conscious rationale when explaining why he waited until the brink of intubation before going to the hospital, despite being short of breath with a known COVID-19 infection.

These anxieties are not unfounded. An estimated half million Americans file for bankruptcy each year because of medical bills, accounting for two-thirds of all bankruptcy filings. Even when not filing for bankruptcy, countless Americans face economic ruin when they return from visits to health care facilities with surprise medical bills charging thousands of dollars. The sinister “surprise medical bill” is so commonplace, it has inspired a national investigative news program — the National Public Radio / Kaiser Health “Bill of the Month.” Why do we allow this treachery?

Historically, it has been in large part because hospitals and doctors, who often benefit from the existing system, have fought against laws banning the practice. This may be why the American Medical Association lobbied Congress to alter language buried in the recently passed $900 billion relief package that would ban surprise medical bills.


While hospitals position themselves as beacons of community support, and doctors swear an oath to “do no harm,” these promises ring hollow when we continue advocating for health care practices that economically ruin those whom we serve. It isn’t enough that we are good at demonstrating acute compassion — comforting a sick child or protesting an immediate act of racial injustice — we need to improve our longitudinal empathy for the economic well-being of our patients. We need to put our money where our mouth is; failing to recognize our contribution to economic inequity threatens the integrity of our profession itself.

As doctors we must acknowledge the collective power we possess to change the economic structure of medicine. It is time we stop exclusively relying on the heroic philanthropy of folks like those at RIP Medical Debt, a brilliant nonprofit that has eradicated nearly $3 billion in medical debt via group debt purchasing. With medical debt continuing to balloon — it has risen another 7% since last year alone — philanthropy is insufficient. We need policy change. And this is one of the few areas with bipartisan support. If Republicans and Democrats were able to come together on the new legislation that bans out-of-network medical providers from charging beyond the in-network cost for services provided in emergency departments and some nonemergent settings, starting next year, then health care providers can and must play an active role, too. Our patients deserve honesty. We need to demand hospitals, clinics, insurance companies and administration provide cost transparency.

As we enter a new year, my dream for 2021 is for my profession to acknowledge the economic inequities that we help drive and to act justly for restitution. May 2021 be a year that not only limits the spread of COVID-19 but also limits the spread of medical debt.