This essay contains spoilers about Season 2, Episode 7 of “The Pitt.”
On Thursday on “The Pitt,” a patient divulged his most closely guarded secret. Five hours earlier, construction worker Orlando Diaz arrived at the emergency department after fainting on the job due to the life-threatening condition of diabetic ketoacidosis. Making too much money to qualify for Medicaid, yet not enough to afford private health insurance, he’s been rationing his insulin to make ends meet.
After regaining consciousness, Orlando refuses hospital admission because, unknown to his family, he already owes $100,000 in medical debt.
For more than 100 million Americans carrying health care debt, Orlando’s story isn’t high drama — it’s reality. Patients are often stranded between insurers, providers, pharmaceutical companies, and other corporate interests.
And yet, in the long history of medical TV shows, it’s not often viewers see their own frustrations with deductibles, co-pays, and out-of-network charges reflected on the screen. Art is finally catching up with the long-brewing medical debt crisis.
According to KFF, Americans owe at least $220 billion in medical debt. This staggering figure doesn’t account for the Gallup-estimated $74 billion that families borrowed for medical bills in 2024 alone. And neither of these shocking statistics includes those debts of necessity that wind up on credit cards with sky-high interest rates, often during the worst times of peoples’ lives.
We’re writing this piece as both storytellers and advocates. One of us is a trained emergency physician and executive producer of “The Pitt.” The other serves as the president and CEO of Undue Medical Debt, the only nonprofit that acquires and erases medical debt for those most burdened. Since 2014, Undue has relieved over $25 billion for more than 14 million families. We understand the implications of medical debt — how it is now the leading cause of bankruptcy, how beyond a financial burden it makes people three times more likely to struggle with anxiety and depression, and how even fear of debt prevents families from seeking the medical care they desperately need.
Like in Thursday night’s episode, recipients of medical debt relief have shared the weight of out-of-pocket expenses in their own words. Jennifer, a single mother of four in Missouri, shared written testimony with Undue after receiving a letter informing her that some of her medical debt was erased. “A few years ago, I faced a serious health issue that required immediate medical care. … Even though I had insurance, many services were either out of network or came with hidden fees.” She continues, “I had to make impossible choices — cutting back on essentials like food and utilities just to stay ahead of the bills. The stress was relentless. I often felt like I was failing my children, even though I was doing everything I could to keep our family together. The weight of that debt didn’t just affect our finances — it affected my health, my relationships, and my ability to move forward in life.”
Undue’s research with doctors and patients also reveals how medical debt undermines their therapeutic relationship. Treatment is discontinued, pills are split, medication is rationed, and outcomes are categorically worse when medical debt erodes access to care. Solutions to the tangled reality of the U.S. health care system are hard to come by and political agreement is lacking at the federal level. Lifting up stories of patients caught in this broken system can both lessen their feelings of isolation and hopefully spark discussions about the need for change.
As we write, the country is confronting rising medical costs, the closure of hospitals, and the increasing cost of comprehensive health insurance. We cannot shy away from this reality. Storytelling affirms the experiences of some viewers while teaching others about realities they might never know existed. Beloved TV characters can change public opinion and even meaningfully impact real-world policy.
“All in the Family” invited 1970s America to reflect on the brewing, intergenerational tensions of racism, sexism, and classism. “The Wire” is credited with humanizing inner-city life and challenging assumptions around policing, and “Will & Grace” is often cited as buoying a new wave of progress regarding LGBTQ issues. While not a silver bullet, television can illustrate such topics with humanity, empowering those affected communities to share their stories and sowing the seeds for change.
Jennifer from Missouri closes her testimony with: “Medical debt is something that no one chooses, yet it can leave families like mine in financial ruin. I hope that by speaking out, we can bring attention to the urgent need for changes in the health care system — more transparency, better insurance protections, and solutions that prioritize people over profits. Families deserve the chance to heal without the fear of losing everything.”
Back on “The Pitt,” patient Orlando Diaz insists on leaving the hospital against medical advice so he can report to his second job as a security guard, stating “every minute I stay is a meal, shoes, school supplies.” Resident physician Samira Mohan convinces him to stay until she can gather a large bag of medications and supplies to keep him safe. When she returns, Orlando is gone and attending physician Jack Abbot pays to have the package delivered to Orlando’s home.
While their compassion and generosity are admirable, their actions shouldn’t be necessary. In the future, we hope that Orlando’s story will be obsolete and that Undue can happily shut its doors. In the meantime, we must all work together to bring the issue of medical debt into the limelight.
Allison Sesso is president and CEO of the nonprofit organization Undue Medical Debt. Joe Sachs, M.D., is an emergency physician, writer, and executive producer of the HBO Max series “The Pitt.” This perspective is theirs alone and does not necessarily reflect that of any institutions or companies with which they are associated. Undue Medical Debt and “The Pitt”/HBO Max are not affiliated.
