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A new survey from Gallup shows that Americans borrowed a staggering $88 billion in 2018 to pay for health-care costs that were not covered by their insurance plans. Additionally, 45 percent of those polled were “concerned that a major health event will leave them bankrupt.”

These numbers line up with other telling facts about the health-care system in America, where two in three patients cannot pay off their entire hospital bill, and out-of-pocket spending for people with employer-provided health insurance has jumped 50 percent since 2010. Per capita, the U.S. spends more on health care than any other country, and yet almost 14 percent of Americans do not have insurance. In 2017, the life expectancy of Americans actually declined, a trend not seen since World War I and the Spanish flu. Despite the litany of embarrassing details, according to the Gallup survey, 48 percent of Americans believe that “the quality of care found in the U.S. is either the ‘best in the world’ or ‘among the best.’” American exceptionalism dies hard.

Among the most frequent health-care concerns expressed in the Gallup survey involved transparency in both price and quality of care. According to the poll, 47 percent of Americans don’t know what an emergency room visit will cost before they head to the hospital, and 41 percent report forgoing a trip to the ER in the last year due to the expense.

“Patients want to know more about their cost information, and we as a health-care system aren’t meeting that need,” wrote Anna Sinaiko, head of the Harvard T.H. Chan School of Public Health in Boston, in a 2018 study that found that only 21 percent of hospitals surveyed could provide any price information for a full hip-replacement surgery. “Transparency is important because it makes it harder for providers to charge higher prices without providing higher quality,” Sinaiko told Reuters that year.

The $88 billion borrowed in 2018 — in addition to the reported $1 trillion in health-care–related debt owed by Americans — helps explain why a strong majority of Americans want more than just a tweak to the current health-care system. According to a poll from October 28, 70 percent of Americans — and 52 percent of Republicans — would “support providing Medicare to every American.”