The hall light flicked on at 2 AM. My dad was silhouetted in the doorway, arms out and leaning hard against the frame. “Sorry to wake you. You’ve gotta take me to the emergency room.”

That jolted the grogginess out of me. For the last couple of days, he had been complaining about kidney stones. They weren’t passing, and I knew he’d been in pain. My dad is whatever is the opposite of a hypochondriac, and had never taken a sick day in my memory. A fit man, he rarely sits still, does his own yard work and landscaping to relax, and has jogged or biked every morning that I’ve been alive. The last time he’d been to a hospital was nearly ten years ago, when he literally fell off the roof as he was cleaning it. He landed on pavement. So if he needed to go to the emergency room now, that was the threat level.

By then, he hadn’t peed in days, and that night the pain had gotten so bad that he couldn’t wait until morning, or even drive himself. The doctors told us later that when we got to the hospital neither of his kidneys were working. To this day, we don’t know what came first, the stones or the serious kidney infection that got my dad hospitalized, but one likely caused the other. The emergency room visit turned into a 13-day stay in the intensive care unit. At one point, completely unable to pee, he swelled up like a snowman before finally being put on dialysis. He jokes now that it’s the only time he’s weighed 200 pounds. The doctors told me that if he were only slightly less healthy, just an occasional cigarette or a marginally less active lifestyle, he wouldn’t have survived.

But surviving the ICU was just the first part. At a rate of nearly $10,000 a day, my father’s hospital bill came to just over $120,000. To make matters worse, he had cancelled his health insurance just a few months before he got sick—times were tight, he was looking for expenses to cut, and he’d never been hospitalized before. It seemed like a safe stop-gap, so he axed it. That’s how he wound up among the more than 1.5 million other people that same year: he declared bankruptcy.

This was in 2010, just two years after the Great Recession began and five years after the Bankruptcy Abuse Prevention and Consumer Protection Act made it harder for ordinary Americans to declare bankruptcy. 2010 was a five-year high point for people going bankrupt, with 1.5 million people filing. The numbers plummeted by nearly 50 percent in seven years, with only 760,000 people filing for bankruptcy by 2017. Fewer people declaring bankruptcy should be a sign that people have less debt. They wouldn’t need to declare bankruptcy if that were the case, right? But the opposite is true—consumer debt is actually at an historic high. So fewer filings likely has more to do with roadblocks and means testing than it does with people being generally better off.

The actual number of bankruptcies caused by medical debt every year is the subject of a surprisingly hot debate. Vermont senator Bernie Sanders cited a 2018 article in the American Journal of Public Health that found that medical costs factored into 530,000 bankruptcies a year. That accounts for a solid 66 percent of all bankruptcies annually. Washington Post fact-checker Salvador Rizzo gave Sanders’ citation three out of four Pinocchios, claiming, wrongly, that the study hadn’t been peer-reviewed. But the crux of Rizzo’s criticism is that the AJPH study cast too broad a net rather than just counting debt “caused by hospitalization,” which is the criteria of a New England Journal of Medicine study.