Editorial: Rising medical debt puts patients, providers in untenable situation

The Virginian-Pilot and Daily Press Editorial Board, The Virginian-Pilot on Apr 21, 2026

Published in Op Eds

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Few of us needed convincing, but a new study on medical debt provides a harrowing look at just how badly broken our nation’s health care system is — through the prism of our experiences here in Virginia.

Researchers at George Washington and Stanford universities examined the state’s public court records and determined that Virginia hospitals filed 1.15 million lawsuits against patients over $1.4 billion in medical debt from 2010 to 2024. More than 800,000 suits led to judgments against the patients, with half of those resulting in garnishment of wages.

The study’s title refers to this lawsuit mill as “mechanized wealth extraction,” an apt description for the business of collecting medical debt. And a big business it is — researchers found that suits filed in Virginia district courts generated $87 million in attorney fees and about $46 million in court costs in those years. Twenty law firms accounted for half of all lawsuits.

As a general rule, of course, we should all pay our debts. But medical costs long ago outstripped the ability of many Americans — even insured ones — to afford the average hospital stay. Compound those costs with loss of income during illness and hospital-imposed interest rates as high as 18%, and the prognosis for many patients is unresolvable debt. About a half-million Americans file for bankruptcy because of overwhelming medical bills each year.

Critics of the medical community’s debt-collection practices say part of the problem is the failure of many hospitals and doctors to be fully transparent about costs.

“When you go to the grocery store, you don’t expect to pay 10 times more for a gallon of milk than what you knew was priced on the shelf,” Cynthia Fisher, founder of the nonprofit PatientRightsAdvocate.org and a co-author of the study, recently told WHRO. “But in health care, we do pay over 10 times more for an aspirin because we can’t see the prices.”

Under federal law, hospitals are required to post prices online, but few people in a medical crisis are likely to take time to search costs — and bills sent to patients after the fact can be mystifying or short on details. This makes checking the accuracy of charges difficult, Fisher said.

According to the study, Sentara Health filed the most lawsuits in the state (about 97,000), and other nonprofit hospitals and physician groups in Hampton Roads ranked high — Atlantic Anesthesia (seventh at 41,700), OrthoVirginia (ninth at 34,100) Eastern Medical Virginia (10th at 26,600), Chesapeake Regional Healthcare (14th at 22,800), and Emergency Physicians of Tidewater (17th at 14,900).

In 2020, bad publicity from a similar study by Johns Hopkins University prompted some hospitals in Virginia — including the University of Virginia’s health care system — to revise their policies on collecting debt. VCU Medical Center, which ranked at the top for lawsuits in that study, vowed to ease up on lawsuits and increase financial aid for patients.

UVA Health, No. 2 in that study, stopped filing lawsuits in 2019. “Our goal is to not need to use the collections process and instead work with our patients to provide financial assistance for those who qualify and offer fair payment options for all patients,” spokesperson Eric Swensen told WHRO.

That’s a commendable — and more humane — approach that medical providers throughout Hampton Roads and Virginia should follow. Yes, those providers have bills to pay, too, but their charges routinely exceed what the vulnerable recipients of their care can bear.

The onus doesn’t fall entirely on medical providers to behave like good corporate citizens, however. The job of fixing our health care system — shirked for decades — lies with leaders in the nation’s capital, who must finish the reform started 15 years ago with the Affordable Care Act. Those changes were flawed and not nearly enough to resolve our problems.

When the new members of Congress take their seats in January, this study should land loudly on their desks. Solutions won’t come easily, but they can be delayed no longer.

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