I never realized how shitty the US was until I started reading these kinds of comments from people from other countries. We are so brainwashed into "needing a job with good benefits" that nobody dares even try doing something else. My wife and I were going to quit and start a farm, but everyone just kept saying, but what about benefits? Well, we could buy our own, but it's like 2k a month or more out of pocket. I'm pretty sure a lot of smart people are already avoiding college because they don't want crippling debt for their entire life. Probably a lot of geniuses out there who just can't afford college or are "too smart" to pay the absurd amounts of money. Most people think about the cost of the hospital more than if they will live or die. My grandma was in the hospital for 3 weeks before she passed away and it was a good million dollars. So to answer your original question, they can't. Even people who aren't poor can't afford to live.