Well, not exactly, it's just that since some law in the 80s you can't be denied care in the ER. It seems like most hospitals have programs you can apply for to get help with your bills, and sometimes they'll wipe your debt. I don't know if you have to be uninsured, make under a certain amount or what. But even my mom had some bills wiped clean and she makes $40k per year. In my case I had to go for a few things and my bills were in the hundred, but under $1,000. They lost paperwork I submitted to get a discount or it forgiven since I only made like $15k a year at the time. I kept getting bills from different places for the same debts so I just never paid out of principle. To go to a regular office though you almost always pay up front for the visit which is a flat rate and then they bill you for lab things sometimes. I go to urgent care, health departments, and places that charge by income like Planned Parenthood and it's always $50ish, getting more expensive now, though. A lot of people have coverage through their job where there deductible isn't very high and they have copays. Mine offers one but it's over 10% of my income and the deductible is high so I can't afford it. It's far cheaper for me to pay out of pocket. I carry a high deductible plan in case of something catastrophic now. It really sucks, if you get a chronic illness you can't just not pay the bills like the ER thing. I just have to rely on charity programs and hope nothing terrible happens to me. I used to just not go to the doctor unless I was really sick, but fuck that, I'm not less entitled to healthcare than rich people.