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The best interpretation of this Dave Ramsey quote is that he believes debt has become such an entrenched part of American culture and society that most people can no longer conceive of major purchases or activities without taking on some form of debt.
By stating that Americans can’t envision things like owning a car without ongoing payments, owning a home without a mortgage, getting an education without student loans, or participating in the economy without a credit card, Ramsey is suggesting debt has become the default or expected means of obtaining or accessing these important things.
His quote implies debt has permeated cultural norms around consumption, assets, and participation in the financial system to such a degree that many find it hard to picture alternatives that don’t involve long-term debt obligations.