We have:

• extremely expensive healthcare, business more important than public health
• health insurance tied to employment, less worker protections
• sprawl and car-dependent living, a sea of oversized trucks

So yeah... one medical issue can add massive debt, and avoiding care or bleeding out in a non-ambulance on the way to a hospital are possibilities. Or a teacher or nurse living in their car being hit by a drunk driver. Lots of other ways to get onto a downward spiral to some death of despair.