Newsletter #90: Your Money Or Your Life w/ Luke Messac

This month, The Dig published Astra Taylor’s brilliant interview with Luke Messac, author and emergency physician who recently released Your Money or Your Life: Debt Collection in American Medicine. Nearly one out of three people in the United States — an estimated 100 million individuals — are in debt because they sought medical treatment. This debt isn’t just immiserating, undermining their financial well-being and freedom, but it also actively exacerbates poor and working-class people’s physical and psychological suffering — the very things they turned to care to resolve in the first place.

For listeners interested in taking this inquiry further, we asked Dr Messac to assemble a reading list on health care and capitalism and the organizing that is working to separate the two. These were his recommendations.

Victor Roy, Capitalizing a Cure: How Finance Controls the Price and Value of Medicines (2023)

Roy shows how a cure for hepatitis C made it from bench research into (some) patient’s bodies, focusing on the role of finance executives in setting the exorbitant price of this lifesaving drug. The price was not based on the costs of research and development or on any notion of a reasonable return on investment, but rather on how much public and private insurers could be made to bear. This political economy of drug pricing leaves millions of Americans unable to get their hands on medical breakthroughs that our tax dollars helped to bring about.

From the publisher: “Roy’s account moves between public and private labs, Wall Street and corporate board rooms, and public health meetings and health centers to trace the ways in which curative medicines became financial assets dominated by strategies of speculation and extraction at the expense of access and care. Provocative and sobering, this book illuminates the harmful impact of allowing financial markets to determine who heals and who suffers and points to the necessary work of building more equitable futures.”

Timothy Faust, Health Justice Now: Single Payer and What Comes Next (2019)

Faust, an irreverent polymath who has worked in the insurance industry, is an extremely knowledgeable and clear-eyed guide to the “big, dumb Rube Goldberg machine of American health care.” If you want to know how we get from here to single payer, he’s your guy.

From the publisher: “In Health Justice Now, Timothy Faust explains what single payer is, why we don’t yet have it, and how it can be won. He identifies the actors that have misled us for profit and political gain, dispels the myth that healthcare needs to be personally expensive, shows how we can smoothly transition to a new model, and reveals the slate of humane and progressive reforms that we can only achieve with single payer as the springboard.
“In this impassioned playbook, Faust inspires us to believe in a world where we could leave our job without losing healthcare for ourselves and our kids; where affordable housing is healthcare; and where social justice links arm-in-arm with health justice for us all.”

Astra Taylor, Remake the World: Essays, Reflections, Rebellions (2021)

In an incredible part of this book, Taylor recounts how a small group of artists and writers helped expose the dark underbelly of health care when they found out how to buy and cancel medical debt. She also discusses what this financialized and exploitative market shows about our society and reflects on how we can move from acts of solidarity and resistance to broader structural transformation.

From the publisher: “Over the last decade, author and activist Astra Taylor has helped shift the national conversation on topics including technology, inequality, indebtedness, and democracy. The essays collected here reveal the range and depth of her thinking, with Taylor tackling the rising popularity of socialism, the problem of automation, the politics of listening, the possibility of rights for the natural and non-human world, the future of the university, the temporal challenge of climate catastrophe, and more. Addressing some of the most pressing social problems of our day, Taylor invites us to imagine how things could be different while never losing sight of the strategic question of how change actually happens.”

. . . and we’d add that you should certainly check out Luke’s books: Your Money or Your Life: Debt Collection in American Medicine (2023)

From the publisher: “Your Money or Your Life reveals how medical debt collection became a multibillion-dollar industry and how everyday Americans are made to pay the price. Emergency physician and historian Luke Messac weaves patient stories into a history of law, finance, and medicine to show how debt and debt collection are destroying the foundational trust between doctors and patients at the heart of American healthcare. The fight to stop aggressive collection tactics has brought together people from all corners of the political spectrum. But if we want to better protect the sick from financial ruin, we have to understand how we got here.”

No More to Spend: Neglect and the Construction of Scarcity in Malawi’s History of Health Care (2020)

From the publisher: “No More to Spend challenges the inevitability of inadequate social services in twentieth-century Africa, focusing on the political history of Malawi. Using the stories of doctors, patients, and political leaders, Luke Messac demonstrates how both colonial and postcolonial administrations in this nation used claims of scarcity to justify the poor state of health care. During periods of burgeoning global discourse on welfare and social protection, forestalling improvements in health care required varied forms of rationalization and denial. Calls for better medical care compelled governments, like that of Malawi, to either increase public health spending or offer reasons for their inaction. Because medical care is still sparse in many regions in Africa, the recurring tactics for prolonged neglect have important implications for global health today.”