 Americans with medical debt are three times more likely to forego care than those who have none. Patients in financial distress after a cancer diagnosis are less likely to follow treatment recommendations and have lower survival rates. While some commentators continue to insist on the risks of moral hazard and the virtues of copays and deductibles, we have decades of evidence, including a study published just this year in the prestigious Quarterly Journal of Economics, that the more Americans are made to pay out of pocket for medical care, the sooner they will die.