Life or Debt Situations with Angela Peoples and Dr. Luke Messac

00;00;00;02 – 00;00;17;18
Maurice BP-Weeks
Of all the types of debt I’ve been in, I’ve managed to avoid medical debt, knock on wood. I’ve only really had small patches of time without health insurance my entire life. Health insurance I had was often crappy. But even when I got into a terrible car accident years ago, a big percentage of my bills were just covered by insurance.

00;00;17;21 – 00;00;43;28
Maurice BP-Weeks
I know. I’m lucky. Medical debt is such a serious piece of the debt picture in this country. It’s consistently the top cause of bankruptcy, only occasionally falling second to job loss, although, as you can imagine, the two are related. In a country with such expensive health care and basically no medical safety net. It makes sense. But since it wasn’t in my personal experience, I decided to go on social media and post I posted.

00;00;44;00 – 00;01;01;08
Maurice BP-Weeks
Hey, if you’re black and you’ve dealt with over 25,000 and medical debt, please fill out this form and let me know. I posted this and then forgot about it for about an hour while I was in a meeting. When I came back and set up my desk again just one hour later, 200 people had filled out the form.

00;01;01;13 – 00;01;37;06
Maurice BP-Weeks
500 people had shared it. So I guess this problem is pretty huge. Welcome to episode five of Indebted, a podcast about debt and race in America. I’m your host. Maury Speaks, a lifelong economic and racial justice organizer. Each episode, we tackle a different aspect of debt, exploring how it works and why it spells bad news for black people and our entire economy.

00;01;37;08 – 00;01;56;07
Maurice BP-Weeks
In this episode, we’re talking about medical debt, the often unplanned and unavoidable debt that 85% Yes, 85% of all people with credit reports have. Let’s get into it.

00;01;56;09 – 00;02;18;16
Maurice BP-Weeks
Okay. So if you remember our first episode, I talked about medical bills that I got while really my son Charlie, got for his own birth. So we luckily didn’t have to pay that outrageous bill because we had health insurance. But that is not the case for many, many people, especially black people in this country. I took a look at a report from the Kaiser Family Foundation.

00;02;18;18 – 00;02;39;00
Maurice BP-Weeks
They’re not affiliated with the hospital system. Don’t worry. And the report featured a heat map of where medical debt is based throughout the country. We’ll link it in the show notes. The map shows light red for areas with less medical debt and dark red for areas with more debt. You immediately notice that one part of the country is mostly deep red.

00;02;39;02 – 00;03;06;15
Maurice BP-Weeks
The Southeast. So why is that significant? Well, even with the Great Migration, the term for the multi-million black person exodus from southeast to places with promises of less racism or better economic opportunity, nearly 60% of the U.S. black population currently lives in the South. If you ranked the states by black population percentage. Mississippi. Louisiana. Georgia. Alabama. South Carolina.

00;03;06;15 – 00;03;34;00
Maurice BP-Weeks
North Carolina. Virginia. Tennessee. Florida. Arkansas. They’re all in the Southeast and all in the top 15 of black percentage. Most of those states currently and really perennially also have Republican governors. So when Medicaid expanded, opening up the eligibility for the popular government subsidized health care program to low income folks, most of those states decided not to voluntarily enroll because of blah, blah, blah.

00;03;34;00 – 00;03;38;26
Maurice BP-Weeks
Obamacare. Don’t tread on me socialism. This is the Tea Party. Yada yada.

00;03;38;28 – 00;03;46;01
Sound on Tape
And he’s raising taxes like crazy in many freedom. We didn’t vote for this health care that he planned. mama, no.

00;03;46;01 – 00;04;09;07
Maurice BP-Weeks
Obama no more. So that means a majority of the black population’s access to health care is being legislated by wealthy white Republicans in the South. It’s a pretty targeted attack of black folks who are more likely to be eligible and also need programs like Medicaid. And it’s one without a quick political solution. Okay, so what am I very good friends.

00;04;09;07 – 00;04;23;17
Maurice BP-Weeks
Has a ton of medical debt and also happens to be an organizer and campaigner who thinks about debt and race a bunch just like me. And she lives in the South. So I thought she’d be the perfect person to go a little deeper on this issue. And she graciously agreed.

00;04;23;20 – 00;04;39;06
Angela Peoples
My name is Angela Peebles. I am a mother. I’m a black queer woman. I’m a cultural and narrative strategist. And I live in South Florida. And I’m in debt us.

00;04;39;08 – 00;05;10;02
Maurice BP-Weeks
It’s so great to talk to you. Angela Always. And thank you for chatting. I wanted to talk to someone who like, gets organizing, understands the issue of debt at organizing and campaigning level, but also like me is just in debt and specifically in medical debt. So I’m wondering if you could talk a little bit about what your medical debt story is at the moment.

00;05;10;04 – 00;05;35;16
Angela Peoples
Yeah, I mean, you know, my medical debt story is it isn’t just it isn’t about one procedure or one trip to the hospital or one, you know, doctor’s appointment or one illness, whatever that happened to me. It’s actually about just like the the shit that happens with life. My parents, especially my mom, is very big on like, you need health insurance.

00;05;35;16 – 00;05;55;20
Angela Peoples
You need health insurance, You need health insurance. And like, we had a large have health insurance and also have medical debt. Like, I don’t know if the you know, the two or not, then the math isn’t all the way math thing. They’re like, have you this sort of idea that you have health insurance so you don’t go into like catastrophic medical debt.

00;05;55;26 – 00;06;28;25
Angela Peoples
And yet here we all are. My medical debt looks like a couple of for a couple of things. One. It’s in between coverage. Right. And so whether that’s in between, jobs like that had coverage or for the last like 5 to 7 years, I’ve been in like a contractor basically or independently employed. And so sometimes I didn’t have insurance and that was fine because, excuse me, I was a healthy 20 something and it was just me and I didn’t have, you know, children or whatever.

00;06;28;27 – 00;06;51;29
Angela Peoples
So I was like, Yeah, sure, I’ll just tack on that if I have to go to the hospital too. If I have like a UTI or I have to get, you know, I have a sinus infection or whatever, and I just got to go to urgent care, I’ll just take care of it or, you know, it’s, it’s kind of like what I was just saying that you have coverage, but it’s not covering the it’s not covering the cost of the care.

00;06;52;02 – 00;07;32;25
Angela Peoples
And then there’s this other thing that happens where it’s just like the confusion of the medical industry or the health care system. Like it boggles my mind that you can like go to a hospital, get services and be like, well, what’s the cause? They’re like, Well, Bill, you later. Don’t worry about it. And then like, what’s later like worse and then later is like something that you get in the mail, a bill that you get in the mail that maybe comes to your old address, you know, because for, you know, a lot of people move frequently or so it goes to your old address or you you see you get it, but you don’t see

00;07;32;25 – 00;08;03;15
Angela Peoples
it. And then all of a sudden, like three months later, you get a call from some random law firm. Your X-ray that you got for your knee sprain is going into collections. Like to me, my medical debt story is about like the shit that happens because we’re living our lives the way that in this capitalist system, but also just in the way that I think that like happens in your when you’re growing, when you’re evolving, when you’re in your mid-career, when you’re just in different stages of your life.

00;08;03;17 – 00;08;29;02
Angela Peoples
And I don’t think that our systems that are more profit driven allow are aligned with or responsive to those shifts. You know. My most recent experience with medical debt is and I also have family that that that work in medicine and so like I know a little bit too much about how billing happens and why what they bill for or why and all of those things.

00;08;29;04 – 00;08;50;13
Angela Peoples
And so I know the questions to ask, you know, and so I took my baby who was like five or six months at the time. Everybody in our house was sick. She was sick and like not getting better. So I said, let’s just go to the E.R. to make sure that it’s not something that needs more attention. And of course, it wasn’t like, you know, babies get the flu or whatever.

00;08;50;15 – 00;09;05;02
Angela Peoples
But I went we went to the E.R. somebody came in to see us. And this is in between our insurance. We were on the exchange for a while, and then I was getting a job. And so but the insurance hadn’t kicked in. And so I was like, we’ll just pay out of pocket. I had already planned to do that.

00;09;05;04 – 00;09;23;13
Angela Peoples
And so they the billing person comes in and I’m like, okay, well, we’re going to, you know, just whatever it is, we’ll just pay out of pocket. It’s like, okay, well, it’s like $600 or something. And I was like, okay, cool. Let’s just take care of that. And then he’s like, Well, did you get any other like services, x rays, blood work?

00;09;23;13 – 00;09;44;09
Angela Peoples
And I was like, No, we literally just saw the doctor for like 5 minutes. And then and now we’re about to leave. We would like to leave now. And they’re like, okay, cool. And then I’m getting these calls first from like a medicaid person that’s like, Hey, do you have other insurance? If not, we can qualify for Medicaid to cover this 1200 dollar bill you had.

00;09;44;09 – 00;10;04;00
Angela Peoples
It’s a 1200 dollar bill. Where did that come from? we took your baby to the E.R., But I was like, well, we I paid for that out of pocket. And like, we didn’t do anything. Like, the doctor came, and then she didn’t talk to us, and then she left, like, is it 1200 dollars to see a doctor to walk into the E.R.?

00;10;04;00 – 00;10;29;03
Angela Peoples
To see a doctor? Like, that’s confusing to me. So my experience right now is that I’m actually literally going back and forth. And sometimes I just like, you don’t have the receipts, so call me back when you have the receipts. Like I know that you don’t have the I know you don’t have the information that proves that this is my debt or what is behind all of the things that make it so that I don’t actually have to pay this until you can prove that it’s real and that you own it.

00;10;29;05 – 00;10;57;07
Angela Peoples
I’m asking all of those questions and telling them, Call me back when you have that information. But it just is just so glaring to me that, like, it’s not even a scam. It’s like it’s something worse than whatever this scam is. Because if I’m not somebody that has this awareness, that has this information, that’s like, No, you can not I’m not liable for this one, especially if you can’t tell me what I’m being charged for.

00;10;57;09 – 00;11;22;15
Angela Peoples
And to I already have the receipt to say that I paid for what I what the cost like stop it. But it’s just really the thing that I often think about is like the emotional toll of it all. You know, like on top of the work that it takes to be on the phone to track your receipt is how the experience of going to the E.R. in the first place.

00;11;22;18 – 00;11;40;25
Angela Peoples
It’s not good. It’s not a it’s not a pleasant experience, especially down here in South Florida. It’s not a pleasant experience going to the E.R. And then on the back end of that, you have to like, be some like finance in debt, like expert get out of here. Right.

00;11;40;28 – 00;12;16;24
Maurice BP-Weeks
Yeah. You mentioned South Florida. And, you know, I, I just know that most of the black people in this country live in the South. And we talk about sort of the specific impacts of of debt practices on black folks all the time on this show. And I’m wondering how you see sort of the medical debt system acting differently for black folks, for black women, for black queer folks, for black trans folks, like.

00;12;16;26 – 00;12;39;20
Angela Peoples
Yeah, I think that the difference to me is twofold. One, there is an experience that I have where a lot of the people that work in the industry to collect debt or to collect like that are the people that you interact with in the medical field, particularly when it comes to the financing side of it are actually people of color.

00;12;39;20 – 00;13;09;05
Angela Peoples
They’re black women, at least in my experience. And so there’s something that’s a little bit like insidious about that, that sort of like it kind of adds to the the shame. It adds to the like sense of like individual responsibility when it’s like, actually this is not a we should not be having this conversation of, you know, black woman who is the account manager for whatever law firm that owns this debt, quote unquote owns this debt.

00;13;09;07 – 00;13;41;17
Angela Peoples
And me, the person who like is responsible for the debt, like it should not be this individual, but it really puts it on me and on this other person to like be having this conversation when the source of it doesn’t really have a whole lot to do with us, if that makes sense. And so to me, I think that there’s something that’s like particularly harmful and complicating of this conversation because you’re frustrated, you’re like, I don’t think I owe this or I shouldn’t or this or I do owe this.

00;13;41;17 – 00;14;12;00
Angela Peoples
And I, I had to go to the hospital. I mean, like, imagine the the experience that people have when they’re like, should I go to that? Should I deal with this cough that my baby has had for ten days? Should I go to the E.R. to make sure that they don’t have pneumonia? Or should I risk having to take on thousand, 2000, 5000, however many months dollars in debt and in crew that experience, that’s dehumanizing to me of saying you owe this.

00;14;12;00 – 00;14;39;14
Angela Peoples
Why aren’t you paying this? When are you going to pay this? How much are you going to put down on this? You know, and they use these tactics that are just so gross. Like, you know, you’re the one that decided to do this and like, you’re responsible or you need to like it just really using people that are in your community, from your community to have those conversations, I think is a particularly disgusting part of the debtors experience, particularly in the context of health care.

00;14;39;16 – 00;14;59;03
Angela Peoples
Like I did not. I actually had both of my children at home. One of the reasons why I wanted to have my second baby home is because even though I was willing to, even though I had to pay additional costs out of pocket with the midwife and the birth center and all of those things, at least I knew what it was going to what was going to be in it.

00;14;59;03 – 00;15;18;17
Angela Peoples
I knew how much it was going to cause. I knew what they were offering me and I knew what each of those items cost versus like going to the hospital. You kind of have no idea. They’re like, yeah, well, they’re these pants cost $39 and you need them because you’re bleeding. So sorry, like put on the third board.

00;15;18;20 – 00;15;51;21
Angela Peoples
So there’s the relational aspect of it. But then there’s, there’s also the shame that I just, I think that is I don’t know that enough research is being done and maybe your brilliant work is exploring. This varies, but there is something there’s a cost. There’s like there is definitely a financial time cost to the amount of time that I have to spend on the phone, you know, discovering which hospital, which doctor owns, what thing, and and then also the hospital bills this way.

00;15;51;21 – 00;16;06;06
Angela Peoples
But the doctors bill at the hospital bill this other way. So you got to talk to these other people while also because you thought you paid the hospital but you didn’t pay the doctors who work at the hospital. So you got to talk to the doctors that work at the hospital billing company like there is a cost to that.

00;16;06;09 – 00;16;28;08
Angela Peoples
There’s a time cost to it and there’s an emotional cost like it takes something out of my body because of how I’ve been socialized as a woman, as a black person, as a queer person, as a quote unquote leader, as someone who was raised to be respectful and respectable and respect the rule of law and all of that nonsense.

00;16;28;10 – 00;16;52;29
Angela Peoples
Like there is something visceral in me that like, I owe this thing, my God, they’re coming for me, you know? Yeah. Collection. Notice if you’ve never received a collect a letter in the mail that says collection or attempt to collect, like it creates a very visceral reaction in your body and.

00;16;52;29 – 00;16;54;24
Maurice BP-Weeks
Chills up the spine for sure. Yeah.

00;16;55;01 – 00;17;16;11
Angela Peoples
Every spine, your stomach drops. You’re like, And if you add on top of that again, in the context of medical debt and health care, that is that that causes stress in your body, that raises your blood pressure, increases your risk of stroke, increases your risk, it triggers if you have heart disease in your in your family can trigger those things.

00;17;16;14 – 00;17;37;26
Angela Peoples
So now we’re back and now we’re in a cycle. Right now we’re in a situation where not only am I in debt and now this debt is causing me stress, is causing me harm, and now I got to take my kids back to the doctors because of this stress that I’m getting from the medical, the bills, the debt, all of that.

00;17;37;26 – 00;17;43;01
Angela Peoples
I just think that there’s a there’s something just very, very sinister about it.

00;17;43;04 – 00;17;58;03
Maurice BP-Weeks
Okay. So you’re you’re like one of the organizers I respect the most in the world. And I think the most brilliant. So I’m going to ask you the impossible question of how we fix this. How do we fix this?

00;17;58;05 – 00;18;28;24
Angela Peoples
I think the way that we have to nationalize health care and I think that’s a pretty is a is a simplistic answer with very complicated like roots. You know, I was a part of one of many attempts to reform the student debt industry. And that was also a part of the major health care bill. I mean, the thing that I remember the most about that is that it was it it took a lot of work to get those bills passed into law.

00;18;28;27 – 00;19;03;01
Angela Peoples
And they’re really good ideas like that were at the root of those bills. But the thing that made those ideas not so great in terms of execution and implementation is the instinct to like sort of like water it down and make it more complicated in order to infuse profit into the process. Right. You know, like, well, we can’t just make there be one student debt company because what about all the other companies and their jobs in Pennsylvania and like, they matter so much?

00;19;03;01 – 00;19;33;27
Angela Peoples
Like, what about Senator blah, blah, blah? Is constituents, aren’t they going to need, you know I say that to say like, yes, we need to nationalize health care, but we also need to do it in a way that is like very strictly and specifically intended to cut the costs complete like in like very, very significant ways. Like if we’re trying to nationalize health care in a way that keeps people employed and keeps companies functioning, don’t do it.

00;19;33;27 – 00;20;19;19
Angela Peoples
Just forget it. Don’t do it at all. Just scrap the whole thing because it’s going to just make it more complicated. I think if we can make that make accessing care less complicated and make it and focus a lot more on the preventative care, then actually health care probably won’t cost as much. Like the thing I was saying earlier, like there’s literally and I this sounds like a joke, but it’s not there is a I’m, I’m being told that there’s one company to pay to walk into the hospital and then there’s another different separate company to pay to see a doctor that’s inside the hospital.

00;20;19;21 – 00;20;21;05
Maurice BP-Weeks
Right. Right.

00;20;21;07 – 00;20;25;11
Angela Peoples
Like yeah, I don’t know what, what how like.

00;20;25;12 – 00;20;29;00
Maurice BP-Weeks
Course no one understands that because that makes absolutely no.

00;20;29;00 – 00;21;11;14
Angela Peoples
Sense. Why So like, simplifying it for sure. And then I think that on the organizing side, and this is where I think this is less about like organizing people to take action and more about like organizing people to, like, unlearn white supremacy in like capitalism ideas is like we have to work on unlearning the shame and the like, individual responsibility for our own health care, like for that, for our care in the same way that like yes, I don’t I think that we need to like shift in how we think about who’s responsible for the children of this country and like our collective versus our individual responsibility on that.

00;21;11;17 – 00;21;21;00
Angela Peoples
I think the same thing is true for our health care, right? Like do we or do we not need people to work in this economy? Right. I sound like I think we do.

00;21;21;05 – 00;21;22;25
Maurice BP-Weeks
Yeah. Well.

00;21;22;28 – 00;21;53;01
Angela Peoples
If we need people that are healthy to work, wouldn’t it make sense that we make it easier for people to get or stay healthy? I’m just saying this is like one plus one is two guys like. So I think that there’s a bit of like cultural shifts that we need to make as a people, as a as a society to move away from like it’s me and my responsibility to take care of my health care and my family and actually, like we need all of us to have health care.

00;21;53;01 – 00;22;08;14
Angela Peoples
We need all of us to have our children that are well, we need our elderly to be well, because otherwise it creates all of these other consequences that are not good, that are expensive, that are inhumane. It’s very inhumane.

00;22;08;16 – 00;22;35;02
Maurice BP-Weeks
Yeah. Well, I so appreciate chatting with you, and I honestly could have had you on for any episode because this is really in your wheelhouse. Thank you so much for chatting with me as always, and thank you for just being a person that I always call for advice, whether it’s on organizing or how to put children to bed.

00;22;35;05 – 00;22;46;02
Angela Peoples
Thank you for having me. Thank you for all of the incredible work that you’re doing. Maurice, I really appreciate you and I admire you very, very much.

00;22;46;05 – 00;23;03;23
Sound on Tape
Hi. This is Kaden, the publisher of Convergence magazine. There are a lot of places that you can put your hard earned money in support of our movements. But if you’re enjoying this show, I hope you’ll consider subscribing to Convergence unpatriotic. We’re a small, independent operation and rely heavily on our readers and listeners like you to support our work.

00;23;03;25 – 00;23;21;24
Sound on Tape
You can join us at Patria Uncommon Convergence Mag Subscriptions. Ah, pay what you can, but at ten bucks a month you’ll get goodies as well as knowing you’re helping to build a better media system, one that supports people’s movements and fights fascism. And if you can’t afford it right now, don’t worry, all our shows will be free for you to enjoy.

00;23;21;26 – 00;23;31;12
Sound on Tape
You can also help by leaving us a positive review or sharing this episode with a comrade. Thank you so much for listening.

00;23;31;14 – 00;23;59;24
Maurice BP-Weeks
As we said earlier, there are so many black people with medical debt. So Angela’s is not alone. And I’ve heard stories from my sister, who’s a doctor, about how expensive necessary medical treatment can be for black folks. We’re not talking about voluntary cosmetic surgeries here. It’s just basic care. One of my sister’s coworkers is a historian. In addition to being a doctor and has a new book titled Your Money or Your Life Debt Collection and American Medicine coming out pretty soon.

00;23;59;27 – 00;24;05;15
Maurice BP-Weeks
So I decided to chat with him as well to get a little bit more of why we’re in this predicament.

00;24;05;18 – 00;24;15;06
Luke Messac
Yeah. Hey, my name’s Luke MESSICK. I’m an emergency physician and historian at Brigham and Women’s Hospital in Boston and Harvard Medical School.

00;24;15;09 – 00;24;27;08
Maurice BP-Weeks
Awesome. So great to have you on, Luke. I always get to talk to someone from Brigham and Harvard where my sister is, is a doctor as well. So very nice to meet you. Very nice to chat with you.

00;24;27;15 – 00;24;30;13
Luke Messac
Yeah, Really great to be here. Thanks so much. I really appreciate it.

00;24;30;16 – 00;24;36;20
Maurice BP-Weeks
So can you talk about, like your medical practice, like what you specialize in and what that looks like?

00;24;36;23 – 00;24;58;23
Luke Messac
Yeah, I’m an emergency physician, so I work in the E.R.. I work at a few different hospitals now. I finished my training a couple of years ago, but, you know, we we are the emergency specialists, so if you have something happen to you unexpectedly day or night, 24, seven, 365 days a year, we are your first point of contact when you come into come into the hospital.

00;24;58;25 – 00;25;27;29
Maurice BP-Weeks
And amazingly, also a historian, it’s focused on medical, medical debt. So I want to yeah, I want to start maybe on medical debt by asking. So we know that it’s a it’s a monster. It’s, you know, on so many people’s credit reports, like we know just from the discourse about medical debt, it’s just a major, major thing. But I’m wondering if from your perspective, you can give like a scale of how big this problem truly is.

00;25;28;01 – 00;25;53;24
Luke Messac
It’s massive. It’s more than I could have possibly imagined. And I think we’ve only started to get really a sense of the scope and scale of the problem in the last few years due to some great investigative journalists and academic work. But by most recent estimates, 100 million Americans hold medical debt in some form. And there’s many ways to determine, you know, what the scale of medical debt is.

00;25;53;24 – 00;26;13;22
Luke Messac
There was a paper that came out a couple of years ago, said it, saying it was about $80 billion based on some estimates. You know, some some include only medical debt in collections on credit reports. Some try to cast their net a bit broader there. But it’s it is a huge problem that affects a large number of Americans.

00;26;13;22 – 00;26;35;13
Luke Messac
And as you can imagine, it falls along steep gradients of class, race and gender. Medical debt is more commonly held by women than men. It’s more commonly held by black and Latino households than white households, and it’s much more commonly held by low income households. 79% of medical debt is held by households with zero or negative net worth.

00;26;35;13 – 00;26;39;12
Luke Messac
So it’s it’s an unequally burdened problem.

00;26;39;15 – 00;27;04;12
Maurice BP-Weeks
That is really, really wild. That’s a wild statistic. There. I want to zero in on some of those disparities. So, you know, throughout this series, we’ve talked about student debt. We’ve talked about payday lending, we’ve talked about credit scores throughout this podcast. And each one of those, it seems like, as you’re saying, black people end up with the short end of the stick.

00;27;04;14 – 00;27;10;29
Maurice BP-Weeks
So it sounds like that’s true here. I wonder if you could talk a little bit about why that’s true.

00;27;11;02 – 00;27;37;18
Luke Messac
Yeah. I mean, your your previous guests, of all stressed the importance of history, and that’s going to be key here. But just to give you a sense of the current scope of the problem, medical debt in collections afflicts about 28% of black households, 17% of white households. Hispanics are somewhere in the middle. That’s that’s the term used in the survey literature that I was looking at.

00;27;37;18 – 00;28;02;00
Luke Messac
But it’s Latinx households. It’s 22%. So it’s it is very unequally held. And yeah, I mean, history is going to be key here because a lot of medical debt actually falls geographically, too. You’ll notice that a great heatmap of it, which was published in JAMA last year, shows that the Southeast United States just has massive, massive amounts of medical debt.

00;28;02;00 – 00;28;22;24
Luke Messac
Some of the highest proportions of households with medical debt lie in the American South, in the states of the former Confederacy, which also happen to be the states that have had histories of disinvestment in health care and social protection. Some of the least generous Medicaid programs, the ones that are hardest to get into and that kick people off the quickest.

00;28;22;24 – 00;28;38;02
Luke Messac
And those states that have refused to expand Medicaid in line with the Affordable Care Act. So low income folks living in those areas who need access to care are just burdened with massive amounts of debt and then find themselves at the mercy of collectors thereafter.

00;28;38;04 – 00;28;47;29
Maurice BP-Weeks
Right. And for especially in the southeast, where the majority of the black population is, low income is just basically a substitute for black. Basically.

00;28;48;02 – 00;29;09;08
Luke Messac
Yeah. I mean, this is this is a problem that afflicts, you know, I shouldn’t say afflicts black people exclusively. Like this is a this is a national problem of tremendous scope. But yeah, you’re completely right that the the the disparities are are completely real. And they just they run so deep. It’s it’s sometimes hard to, you know, pin down any singular cause for them.

00;29;09;08 – 00;29;34;14
Luke Messac
But but there is a recent study that came out of Baltimore showing that, you know, black people were much less likely to have applied for charity care even when they were eligible for the The survey was suggested that maybe they weren’t even being told about it in disparate rates. So there’s you know, this is a really complex and meaningful problem, but it definitely affects black patients in ways that it doesn’t affect others.

00;29;34;16 – 00;29;57;17
Maurice BP-Weeks
And how do you see that playing out, like in your day to day like medical practice? Does that does that play out like you work in emergency rooms? Do you see folks who are coming in at some of their worst moments, I would imagine? Are they do you see folks who are making decisions about their care or their health based on cost and potential data?

00;29;57;23 – 00;30;01;09
Maurice BP-Weeks
And is that something that you all talk about or think about?

00;30;01;11 – 00;30;24;15
Luke Messac
My patients are the ones who taught me about this. I mean, I, I had always known that, you know, we have a horribly unequal health care system and one that, you know, praising the poor and minoritized in particular. But, you know, it was really when my patients started talking to me about why they couldn’t do what I was suggesting that they do, that that it really hit me.

00;30;24;15 – 00;30;46;28
Luke Messac
I mean, I had patients saying they you know, they came in with complications of diabetes, losing limbs, going to the ICU because they couldn’t afford their insulin. I had patients who told me that they really couldn’t stay overnight, even though that was the recommendation for their, you know, maybe heart attack that they were having because they just didn’t want to see that bill later on.

00;30;47;04 – 00;31;15;15
Luke Messac
Yeah, I saw patients. I remember one particular patient who came in with a tremendously painful forgetting mass that she’d seen grow on her body for the last six months and endured alone in pain because she knew that if she came in, she risked leaving her family with a tremendous burden. So by the time she came in, she all she wanted was morphine.

00;31;15;17 – 00;31;16;21
Maurice BP-Weeks
my Lord.

00;31;16;23 – 00;31;23;20
Luke Messac
So those are the folks who taught me that there was a problem going on and that, you know, I really needed to understand this a lot better.

00;31;23;23 – 00;31;48;09
Maurice BP-Weeks
Wow. That is really heavy. And I’m just imagining, you know, as as a as a doctor, you’re just seeing that all of these folks health outcomes are just so, so, so much worse because of this. You know, what is an entirely avoidable thing? I mean, like talk about preventative care. This is like beyond that, folks are just like declining treatment because of this.

00;31;48;12 – 00;32;07;15
Luke Messac
Yeah. And we’re really the last line of defense, you know, with folks coming into the ED or often coming in because the primary care system hasn’t hasn’t worked for them often because they couldn’t afford to get care to begin with. So, you know, we’re seeing kind of the ravages of the system, as you know, as they’re manifested in like late stage disease.

00;32;07;17 – 00;32;30;06
Luke Messac
Yeah. So, yeah, it’s it’s absolutely true that the cost of care and the fear of debt keeps people from coming in on time or in a timely fashion where we have the best chance of intervening on their illness. You know, there’s so many things in emergency medicine or in medicine in general where, you know, time is brain for stroke or time is hard for heart attack.

00;32;30;06 – 00;33;02;28
Luke Messac
So but we know that black patients tend to delay presenting for heart attack that they come in later. We know that patients who have deaths or who face even minimal charges at the point of care are much less likely to access preventative services, are much less likely to get diagnosed and treated for preventable conditions, and that those delays lead to differences in mortality, that they lead to worse, you know, worse outcomes for patients.

00;33;03;04 – 00;33;13;01
Luke Messac
So so yeah, this is this is a this is a medical problem. It’s not just a finance problem. It is a problem that is embodied in like really does damage to our bodies.

00;33;13;08 – 00;33;38;01
Maurice BP-Weeks
Right, right, right. Can we talk about some of the the bad actors are here? I mean, like the folks who are like making money off of off of this. I mean, you mentioned a lot of these bills are going to collections and that’s how they manifest themselves on folks credit reports. And I know collections agencies are making a buck there who are who are who are the bad guys like Trace this up the food chain here.

00;33;38;07 – 00;33;59;25
Luke Messac
Yeah, absolutely. So, okay, say you go into the hospital, you go, you go, you get care, you leave, you’re doing okay. And then somewhere between two and six months after your hospital stay, if you haven’t paid your bill, it might start going to collections. And then after six months, really like it’s really open season, a lot of things can happen to you if you still haven’t paid that bill.

00;33;59;25 – 00;34;29;09
Luke Messac
Maybe you don’t think you owe. It may be something you can’t afford, but at that point, the landscape of what’s called extraordinary collection actions opens up and you can have your debt sold to a third party. You could be taken to court, you could have your property like your bank account seized. You could have your home foreclosed on if you don’t show up for the hearings to decide how much of your property to take, you could be arrested.

00;34;29;11 – 00;34;47;19
Luke Messac
And all these things are happening to people around the country today. And a lot of the kind of affect or arms of that collection is being done by collection agencies. These are third parties that hospitals will hire to do the collection work for them, and some of them are small agencies, you know, kind of fly by night operations.

00;34;47;22 – 00;35;22;25
Luke Messac
But the ones that are making the lion’s share of the revenue are large, large operations. And I go into some of them in the book, but like to give you an example, one of the largest over the period that I covered kind of the 1980s to the present was called NCO Financial, which is a company started in a garage in Philadelphia, eventually right outside Philadelphia that was initially just devoted to going small scale operations, you know, collecting debts around the Philadelphia area, but grew into an operation with call centers around the world.

00;35;23;02 – 00;35;43;05
Luke Messac
And with 9000 collectors working for it, 2000 of whom were devoted to the collection of medical debt, that operation was eventually kind of broken up and sold. And the medical debt portion of it was sold to a gentleman named Tom Gorst, who I understand you’re from from Michigan. So this is this is owner.

00;35;43;05 – 00;35;43;28
Maurice BP-Weeks
I’m Gore as.

00;35;43;28 – 00;35;45;23
Luke Messac
Well. Owner of the Detroit Pistons.

00;35;46;01 – 00;35;51;13
Maurice BP-Weeks
We will talk about some cars at another point in this test as well. Yes.

00;35;51;17 – 00;36;12;02
Luke Messac
Yeah. So so, you know, this is this is getting to some of the wealthiest people in the world. Tom Gores is, by Forbes account, 424th on the list of the wealthiest people in the world, just behind like Johnny Dorsey and other folks like that. So so this is an operation that usually involves the work of poor people trying to collect from other poor people.

00;36;12;02 – 00;36;31;02
Luke Messac
I mean, collectors themselves, a recent survey found made less than the median wage, you know, that about ten years ago was $11 an hour, some of which comes in the form of, you know, incentives if they’re able to collect more. But these are not rich folks who are calling you on the phone, but they are working for some very wealthy people.

00;36;31;07 – 00;37;10;08
Maurice BP-Weeks
Right. So I want to be careful with this next question, because I don’t want to take any of the blame away from collections agencies which are like you’re saying, just really wealthy and horrible folks doing a horrible thing. And I’m just like imagining a hospital system knowingly sending some of these charges to collections agencies where, I mean, they know as well as I know that the collections process might end up with someone losing their home.

00;37;10;08 – 00;37;42;27
Maurice BP-Weeks
And they know as well as I know that losing your home is probably not great for your health. And I guess I’m just having trouble seeing how hospitals themselves, many of which have a great deal amount of money themselves, can really justify spending like contracting with companies like NCO Financial or sending to other collections agencies. And maybe I’m missing something about how, you know, how this makes sense for them in some way.

00;37;42;29 – 00;38;07;13
Luke Messac
Yeah, it’s a great question and it’s one that I struggled with for a long time. Most hospitals in the United States are are nonprofit institutions that, you know, don’t don’t pay taxes by virtue of the work that they do for the community benefit. And so I I’d always assumed that they would be some of the least likely institutions to hire debt collectors so that a great engage in these aggressive collection actions.

00;38;07;15 – 00;38;29;10
Luke Messac
But they’re not they’re some of the most likely I think part of it has to do with the fact that over time, over the course, really since the 19th century and progressively more and more in the later part of the 20th century, physicians and caring professionals really became more and more divorced from the work of collecting patients debts.

00;38;29;13 – 00;38;48;18
Luke Messac
I mean, in the 19th and the 19th century, you see physicians writing in medical journals complaining that they presented these bills to their patients. The patients say they can’t you know, the crop hasn’t come in this year. They’re another child got sick. They really can’t afford it. And it’s their job to make the decision about what to do with that.

00;38;48;18 – 00;39;11;07
Luke Messac
Are they going to forgive the debt? Are they going to accept something in kind? Are they going to sever the relationship? And it was it was a personal relationship that was very fraught. But but intensely personal over time that all got outsourced. And so now most of us, physicians, nurses, like a lot of us, work for these large corporations.

00;39;11;09 – 00;39;32;18
Luke Messac
And the idea of the independent professional coming to visit you at home is, you know, something you might see on old TV shows, but it’s not something that most of us have day to day. You know, it’s not our day to day reality. So that’s part I think that’s part of it that a lot. And then and then as a result, the collection work is done by professionals who really aren’t involved in clinical care.

00;39;32;18 – 00;39;55;28
Luke Messac
It’s no longer a personal relationship. And for them, you know, their priority is, is, you know, keeping the doors open and in some cases padding the bottom line to allow for expansion and other priorities. So, you know, if they can see another way to collect on patients who are notoriously difficult to collect from the self-pay, as they call them patients, patients who are uninsured or underinsured, then they’ll take it.

00;39;55;28 – 00;40;19;16
Luke Messac
And yeah, sales pitches from debt collectors can be pretty convincing for those folks. I mean, they’re out there promising them that they’re going to take this headache off their hands, essentially. I mean, people who work in collection offices, they’re used to working to try to collect from insurance companies. They are in this morass of paperwork and this bureaucratic battles with insurance to try to get their reimbursements.

00;40;19;18 – 00;40;38;18
Luke Messac
They don’t want to generally be calling individual patients and telling them to pay up. And so someone’s at knocking at the door saying, we can get you your money in some cases guaranteed if you sell it to us. And you don’t even have to do a thing, just sell it to us. Don’t even worry about it. Like that’s that’s a proposition that was too good for some folks to pass up.

00;40;38;20 – 00;41;03;23
Maurice BP-Weeks
That’s super helpful. Yeah. So what? So there’s actually been some recent news about, you know, medical collections, medical debt on credit reports. I know that in April of this year, the CFP got rid of collections that are $500 on credit reports, or at least that maybe they released a rule that they were that were going to do that.

00;41;03;23 – 00;41;22;06
Maurice BP-Weeks
I’m not sure it’s been completed for every person. And I’m wondering if this is do you see that as kind of a step in the right direction or is this just a distraction? And we’re not seeing the forest for the trees here and 500 bucks is probably a small percentage of medical debt amounts, I would assume.

00;41;22;09 – 00;41;55;01
Luke Messac
I think it is a good thing. It’s a it’s an undoubtedly a good thing. It is not nearly enough. But, you know, you got to give credit where credit is due. And the CFPB, man that thank God for that agency. I mean, they put out these great reports and one of them, they put out a few years ago basically proved that even if you believe in the credit system, the credit agencies and the work that they do, the the medical debts on those reports are not predictive of patient of people’s general credit worthiness, of their ability to pay back debts in general.

00;41;55;01 – 00;42;21;16
Luke Messac
These these aren’t I mean, you know, you’ve covered different forms of consumer debts and the the ways that they’re extremely unjust and problematic. But this one in particular is probably the most unpredictable. I mean, sure. How you know, even if you’re the most invested in an ethos of personal responsibility, you really can’t say that medical debt is a result of personal irresponsibility, that someone should be able to control every instance of it.

00;42;21;23 – 00;42;43;18
Luke Messac
Right? So so it makes sense that those debts wouldn’t necessarily correlate with someone’s ability to pay back other forms of debt. So so once the CFPB put out that report, then, you know, the credit agencies did, after facing some pressure, you know, announced together that they were going to take off some of those debts. And since then, there’s been a move by the Biden administration to remove even more of those debts from credit reports.

00;42;43;21 – 00;43;10;26
Luke Messac
And so it is it is a good thing. But I will say that there’s many other forms of aggressive collection actions that that still are taken against patients every day. I mean, they’re they’re they’re taken to court, They’re sued. They’re their bank accounts are seized, their homes are seized. And so, you know, until we really get at the whole panoply of consequences that people face for the crime of falling sick, then we’re really not doing enough.

00;43;11;03 – 00;43;49;08
Maurice BP-Weeks
Yeah, yeah, yeah. So, you know, just from I can even remember from readings in college that, you know, there’s a well-documented distrust of medical establishments from black people. And you can pretty much directly trace that back to slavery and other things that stem from slavery. And I’m it seems like to me, this disparate medical debt impact would have a continued adverse effect on on black folks, distrust of the medical establishment or or their willingness to seek care.

00;43;49;10 – 00;44;10;21
Maurice BP-Weeks
We kind of touched on that a little bit. And I’m just wondering if there’s Ken, is there something we can do in this arena that could help reestablish some some trust in medicine so that folks are, you know, more likely to go to doctors when they’re sick? Like it’s this is this an area that is making that disparity grow?

00;44;10;21 – 00;44;13;10
Maurice BP-Weeks
And if so, how do we repair it?

00;44;13;12 – 00;44;47;26
Luke Messac
Yes, it is absolutely making that disparity grow. It’s interesting that the health disparities literature, it’s great. It has had tremendous strides in the last few decades, but it largely focuses on the experience of minoritized patients within the hospital system or within the health care system. And it’s shown that, you know, they’re less likely to have their symptoms taken seriously, that they’re more likely to be restrained if they’re in distress, that they’re less likely to be admitted to specialist services for specialist problems.

00;44;47;29 – 00;45;11;03
Luke Messac
I mean, there’s a lot of great literature, but relatively little of it focuses on what’s now being called by a lot of oncologists who study this problem financial toxicity, the toxic effects of financial debt on patient outcomes. And I think we could do a lot more to study it and to study it, particularly in minoritized populations. That’s something I’m really interested in in carrying on in the future.

00;45;11;03 – 00;45;39;04
Luke Messac
I think there’s there’s the problem of, I think what one can call medical redlining, you know, like taking from the redlining literature that showed to show that that this really has kept patients, black patients in particular out of the hospital and from presenting to the hospital in a timely fashion for emergent problems. And what can we do to to alleviate this problem or to get rid of the problem?

00;45;39;07 – 00;46;07;05
Luke Messac
I mean, single payer health care is really the ultimate answer. It’s it’s yeah, eliminating charges at the point of care is the evidence based way to prevent people from from being denied that care. So that is that is really like our North Star. But in the meantime, there are plenty of things that can be done. I’ll point to one in particular that’s been taken up by a lot of advocates, which is presumptive eligibility.

00;46;07;05 – 00;46;24;14
Luke Messac
There’s interestingly enough software produced by credit raising agencies that is used not to determine someone’s eligibility for a loan, but to determine whether they are likely to qualify for financial assistance.

00;46;24;16 – 00;46;24;22
Maurice BP-Weeks
yeah.

00;46;24;28 – 00;46;46;12
Luke Messac
So Experian puts out one of these products and you know, all these all these credit rating agencies do the same. It’s it tells the hospital at the point of care, is this patient likely to have an income low enough such that we don’t have to send them a bill. We can just say that they qualify for our own particular income cutoff for financial assistance.

00;46;46;12 – 00;47;06;05
Luke Messac
And hospitals that have done this have found that it’s been tremendously helpful to them, that they’re not dealing with mountains of paperwork anymore. And it’s tremendously helpful to the patients because instead of getting bills for months, sometimes erroneously, they are told and given the assurance as they walk in the door that they will not be made to pay.

00;47;06;07 – 00;47;30;09
Maurice BP-Weeks
I really like this this term of financial toxicity. I mean, maybe like it’s the wrong word, but I think it’s I find it a useful term sort of identifying this thing that in medicine you can then, you know, use your normal rubric of here’s a here’s here’s here’s that thing. Let’s figure out how to solve that. And one of the ways to solve it is using this tool you’re talking about.

00;47;30;12 – 00;47;38;09
Maurice BP-Weeks
And obviously the long term cure is single payer, universal single payer health care for the country.

00;47;38;11 – 00;48;04;04
Luke Messac
Yeah. It’s also a way to help us understand our own responsibility and role in this problem. I think for a lot of us, you know, learning the medicine is is enough of a challenge and being able to, you know, go to work every day and trying circumstances, particularly over the last few years, has been a challenge. And so to add to physicians, plate or not, nurses plates, you know, you’re also responsible for, you know, burying your patients in mountains of debt and legal trouble.

00;48;04;06 – 00;48;23;17
Luke Messac
That can be a hard pill to swallow. And, you know, I, I think it’s important that we lay out ways that they can be part of the solution and not the problem and not, you know, lay at their feet. Another societal ill that they really have no desire to be a part of. So, you know, this is our this but this is our bailiwick.

00;48;23;17 – 00;48;39;13
Luke Messac
This is our problem. These are our institutions and our patients are counting on us to look after them and to do do right by them. And so we should be, you know, on the side of the of the patient. You know, we have to decide if we’re on the side of the predator or the prey. And in this case, I think we have to side with the patient.

00;48;39;15 – 00;49;00;24
Maurice BP-Weeks
Yeah, Yeah. I’m wondering if you could talk about what are what are some hopeful things that are happening in this arena. I mean, we’ve we’ve talked about the bad actors. We’ve talked about the bad impacts on individuals, like where are the areas that you’re seeing glimmers of hope that this this you know, hey, we can we can we can solve this issue.

00;49;00;27 – 00;49;30;04
Luke Messac
Yeah, there have been amazing strides. I mean, some of the stuff in the book I cover is about the work of labor unions in the early 2000s and the 20 tens pointing to this problem affecting their own union members, oftentimes low income workers within hospitals who are being sued by those hospitals for debts they cannot pay. You know, some of the most amazing stuff right now is being folks that are done by folks who really have nothing to do with medicine in their daily lives.

00;49;30;04 – 00;49;55;08
Luke Messac
I’m one of the guys who started this group called Dollar Four, which is a good group to know about. They help patients apply for hospital financial assistance. Every nonprofit hospital in the United States has to have a financial assistance policy that’s specifies at what level of income you get, free care and discounted care. And if you fall below those levels, you’re entitled to entitled to that level of free and discounted care.

00;49;55;08 – 00;50;17;23
Luke Messac
But this does applications can be tough to fill out, especially if you’re going through an illness. And so this group dollar for does that work for you for free and that was started by this guy, Jared Walker, who had an experience in his family of medical debt and really made it his mission, even as he was working as a bartender and a trampoline park operator to help to help folks.

00;50;17;23 – 00;50;25;21
Luke Messac
And it’s a it’s an organization that has really grown by leaps and bounds. Another one is the Debt Collective. I know he’s spoken with their members on your podcast.

00;50;25;25 – 00;50;30;03
Maurice BP-Weeks
I I’m a debt collective superfan, and I think a lot of our listeners are too. Yeah.

00;50;30;05 – 00;50;56;05
Luke Messac
They’ve done amazing work since Occupy to show what the debt buying industry looks like to relieve people of that medical debt. And then now really to push for a broader change by bringing debtors together in a union to show that, you know, this really isn’t a system that should be allowed to persist and that the ultimate, you know, answer for it is to eliminate medical debt and bring on a single payer health care system.

00;50;56;07 – 00;51;16;25
Maurice BP-Weeks
All right. So I’m wondering if you can tell us about your book, which I’m like, I’m so excited for this book, honestly. And I’m hoping that there is one of my favorite things to do is is tease my sister with random medical jargon to act like I know what I’m talking about. So I hope there’s some nuggets I can use in that to make my my sister troll game stronger.

00;51;16;27 – 00;51;21;15
Maurice BP-Weeks
But can you, can you talk about your your upcoming book, Your Money or Your life. I’m really excited for it.

00;51;21;16 – 00;51;48;28
Luke Messac
Yeah. Yeah. I you know, I used to be a history PhD student. I did a medical degree and a Ph.D. and so I was in school forever. But during that time I was really focused on the history of colonial medicine I was working on on Southern Africa and Malawi in particular. And in doing that work, I came across this problem called hospital detention, where in some countries patients who can’t pay for their care are literally detained in the hospital.

00;51;49;02 – 00;52;11;16
Luke Messac
So Margaret Atwood talks about this in a essay on debt, where she says that her own mother went through this in Canada before they passed their single payer health care system. So this is like this is a widespread problem that still exists today. And I you know, I thought it was horrific. I wanted to study it, but then I realized that my own hospital was doing something not dissimilar to this in suing patients and garnishing their wages.

00;52;11;18 – 00;52;33;08
Luke Messac
When I went to the courthouse, I looked it up and saw that my own hospital system where I was training, not where I work now, was going after patients in a really aggressive way. These were folks living on Social Security disability. These were recent immigrants. These were single mothers. And it was just it was just this film. It filled me with shame and also with curiosity as to how this could possibly happen and why it was so widespread.

00;52;33;08 – 00;53;11;14
Luke Messac
So I, you know, put on my historian hat and tried to dig into the archives and the records and all trade journals and hanging out with and talking with debt collectors to try to understand what this world was and where it came from. And so the book that came out of it, it’s called Your Money or Your Life Debt Collection in American Medicine, it comes out in early November, and I think it relates medicine and debt collection and tells the story of how, you know, debt collection became such a huge part of people’s experience of medicine in the United States in a way that I hope speaks to people who work in medicine or anyone

00;53;11;14 – 00;53;23;10
Luke Messac
who’s ever, you know, come into contact with it. It’s it’s a tale of some folks who are doing good, folks who are doing not so good. And really what we can do now to to change it.

00;53;23;12 – 00;53;45;01
Maurice BP-Weeks
That’s wonderful. We’ll have a link to purchase it and learn more about it in our our show notes for the podcast. Luke, it’s been so great to talk to you. This has been super illuminating. I’m just like, I’m so glad that there is a person who is working on this exact thing and it’s just so great to meet you and chat with you.

00;53;45;03 – 00;53;53;07
Luke Messac
Yeah, so great to meet you too. Really excited about the work you’re doing now and have done in the past and really looking forward to working in the future.

00;53;53;10 – 00;54;22;28
Maurice BP-Weeks
Thanks so much. Thanks. All right. So we’re in a time where things like Medicare for All or single payer health care aren’t really a pipe dream anymore. I mean, there are recent presidential candidates with platforms on these issues. I think it speaks to just how big of an issue this is in our country. And as usual in our system, the more oppressed, the heavier the financial impact.

00;54;22;28 – 00;54;41;23
Maurice BP-Weeks
It seems it’s way worse for black folks due to environmental factors like where we live and it’s way worse for black women. And it’s worse for black trans people and on and on and on. I can see a day where our health care is free. I mean, I live a few miles away from a country where it’s close to free.

00;54;41;26 – 00;55;03;26
Maurice BP-Weeks
But how do we right the ship on the impact medical debt has had on black people over the last many generations? Well, I think we need to demand that any solution includes reparations for the way black people have gone into debt for medical care. And that could mean anything from expanding health care services in black neighborhoods to sending more black students to medical school.

00;55;03;28 – 00;55;08;25
Maurice BP-Weeks
But that’s just one piece of the puzzle. Let’s keep having conversations about more.

00;55;08;28 – 00;55;22;16
Sound on Tape
We are spending twice as much per capita on health care as do the people of any other country. Maybe it has something to do with the fact that the health care industry last year made $100 billion in profits.

00;55;22;17 – 00;55;26;20
Unknown
Except in mathematics.

00;55;26;23 – 00;55;50;29
Maurice BP-Weeks
But my thanks again to Angela Peoples and Dr. Luke MESSICK for joining me. This episode, Indebted is produced and published by Convergence, a magazine for Radical Insights. You can help support this show and others like it by becoming a Patriot member of Convergence for as low as $2 per month at Patreon dot com slash convergence mag combine a direct link in the show notes.

00;55;51;02 – 00;56;05;18
Maurice BP-Weeks
This show is produced by Josh Ahlstrom. It’s written and hosted by me. Mori Speaks. Until next time, let’s keep fighting for the world we all deserve except take.