For low-income patients in America, survival isn’t just about health: it's about affordability. The decision to fill a prescription or pay rent, to seek treatment or delay it until payday, transforms health into a negotiation with money. According to the Kaiser Family Foundation, about one-third of adults in the U.S report delaying or skipping medical care due to cost (KFF 2025). According to Elizabeth Rosenthal, high prices are an “American burden” as we have to accept being charged “twice as much for prescriptions as in any other country because lawmakers in nations like Germany and France don’t pay them enough to recoup their research costs” (Rosenthal, 15).
About 26 million Americans are uninsured, and this lack of coverage will likely lead to patients not undergoing recommended treatment options, which can lead to higher rates of hospitalization and mortality (Sara and Anvi). Patients are forced into prioritizing which parts of their health they can afford to save. The result is not only delayed care but also having to endure pain, illness, or complications that could have been avoided altogether.
Healthcare advocates argue that it's not simply a matter of individual hardship but of systemic design. In Elizabeth Rosenthal's book, she quotes Jaqui Bush, “I have worked in an ER for the past ten-plus years, and the administration was very frank that the ER was expected to generate revenue” (Rosenthal, 36). In a system where money determines access to care, being low-income is itself a kind of illness, one that distorts every decision about health and survival.
Solutions can exist, but they require looking at care beyond the clinic walls. We should recognize how housing, access to food, and wages directly influence medical outcomes. Similarly, community health programs like Oregon’s Coordinated Care Organizations that integrate social services, such as access to transportation, housing, and food subsidies, have been shown to improve treatment adherence and reduce emergency visits by more than 20 percent (Bachrach et al., 11).
Being able to live an ordinary life with secure housing, food, and work would allow people to make choices. Being low-income leaves patients exposed to both illness and the weight of financial insecurity. But by reframing healthcare to include economic support, society can help.
Low-income-oriented care offers more than financial relief; it can provide a way for patients to reclaim their story. By acknowledging the economic realities of survival, society can enable people to make choices that can benefit their health. Survival should not be a privilege afforded only to the wealthy, but a right that everyone should have.
Sources: https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/
https://www.acpjournals.org/doi/10.7326/M17-1403