Many Americans with excess debt have acquired that debt over a long period of time. While the great majority fully intend to repay their debts, they may find themselves unable to do so because of unanticipated changes in their financial circumstances caused by medical emergencies, job losses, failed businesses, disability, divorce or the death of a “bread-winning” spouse. Any of these circumstances, particularly combined with late payment or over-the-limit fees and high interest rates can result in insurmountable debt. In addition, credit is more readily available now than in the past, and that access has led many to financial problems. Health care has also become markedly more expensive over the years, and a single accident, illness or injury (or the need for long-term treatment for a chronic condition) can result in tens or hundreds of thousands of dollars in medical expenses.