“Receivables Management Association” may not mean much to the average American. But this professional association — which changed its name from the more straightforward “Debt Buyers’ Association” in 2017, following media scrutiny of its practices — represents a burgeoning industry in the United States: medical debt collection.

As of March 2022, forty-three million Americans had medical debt on their credit reports. Much scholarship and reporting has shown how medical debt has ballooned in the United States over the past several decades, but the mechanisms by which debt is being pursued every day remain less visible.

In Your Money or Your Life: Debt Collection in American Medicine, emergency physician and historian Luke Messac traces medical debt collection from its beginnings to its current incarnation as a multibillion-dollar industry. Messac describes how medical debt has eroded trust in American health care and led countless patients into financial ruin. He draws from his experience as a doctor to argue that medical debt collection puts the foundational relationship between patient and provider, and the physical and financial health of patients across the United States, in grave danger.