It's been 5 years now since Apple moved to ARM. I think that had a big enough impact on the market to start compiling ARM binaries. Those toolchains are much more common now and I think once Steam makes the plunge, you'll see a ton of games target it directly. As shitty as Apple's decisions are sometimes, you definitely see them force the markets to move like when they removed the headphone jack.
Just don't pay. Let it go to collections agencies. Medical debt is basically worthless and they don't even bother to harass you for it.