Luke Messac is an emergency physician and historian at Brigham and Women's Hospital and an instructor at Harvard Medical School. His research focuses on the history and political economy of health care. His work has been covered by The New York Times and published in The New England Journal of Medicine, and his first book, No More to Spend, was published by Oxford University Press in 2020.

The German word for debt is the same word for guilt. But you don't have to be German to be a guilty debtor in the United States, where the sin of being ill and poor is discharged by indentured labor and the harassment of the debt collector. Luke Messac takes us on a tour of the underbelly of America's hospitals and their horrific debt practices. If there's one country where you don't want to be both poor and ill, it's the United States.

• Acknowledgments Introduction Chapter 1: Before the Debt Machine Chapter 2: No Mercy Chapter 3: Trading in Misery Chapter 4: Shame Chapter 5: My Day in Court Chapter 6: An Incomplete Answer Chapter 7: From Here Conclusion

Luke Messac is an emergency physician and historian at Brigham and Women's Hospital and an instructor at Harvard Medical School. His research focuses on the history and political economy of health care. His work has been covered by The New York Times and published in The New England Journal of Medicine, and his first book, No More to Spend, was published by Oxford University Press in 2020.

The German word for debt is the same word for guilt. But you don't have to be German to be a guilty debtor in the United States, where the sin of being ill and poor is discharged by indentured labor and the harassment of the debt collector. Luke Messac takes us on a tour of the underbelly of America's hospitals and their horrific debt practices. If there's one country where you don't want to be both poor and ill, it's the United States.

• Acknowledgments Introduction Chapter 1: Before the Debt Machine Chapter 2: No Mercy Chapter 3: Trading in Misery Chapter 4: Shame Chapter 5: My Day in Court Chapter 6: An Incomplete Answer Chapter 7: From Here Conclusion