When Luke Messac began his emergency medicine residency at Rhode Island Hospital in 2018, he noticed a lot of his patients came to him concerned about costs. Some worried about his recommendations for them to stay in the hospital overnight. Others questioned his motives when he asked them to undergo a test, like an X-ray or MRI. A few came in way too late in the course of their illnesses out of fear of the cost. 

He’d heard about aggressive debt collection practices at hospitals around the country that put people at risk of profound financial and legal consequences. It made him wonder: Was his hospital doing that, too? After a quick trip to the country courthouse to examine the case files, what he found troubled him. 

“I was inundated with what I thought were pretty horrific cases,” said Messac, author of the 2023 book, Your Money or Your Life: A History of Medical Debt Collection in the United States. “Low-income single moms, people living on disability, recent immigrants, were facing thousands of dollars of bills and court fees and interest fees. And if they did not pay and if they did not settle their suits quickly, then they could have their wages garnished. They would be charged double-digit interest rates.”

In Berkeley Talks episode 219, Messac, now an attending physician at Brigham and Women’s Hospital and an instructor in emergency medicine at Harvard Medical School, discusses how the changing role of hospitals, and the passage of Medicare and Medicaid in the 1960s, transformed how medical debts are collected in the U.S.

This talk took place on Sept. 17, 2024, and was sponsored by the Berkeley Center for Social Medicine at the Institute for the Study of Societal Issues (ISSI) and cosponsored by Berkeley Public Health.  

Listen to the episode and read the transcript on UC Berkeley News (news.berkeley.edu/podcasts) or on YouTube @Berkeley News (youtube.com/@BerkeleyNews/podcasts).

Music by Blue Dot Sessions.

Photo by Ahmed for Unsplash+.

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