January 18, 2022
Our abusive, for-profit healthcare system has left Americans swimming in harmful medical debt. On this week’s episode, Adam meets someone who’s doing something about it: Allison Sesso, executive director of RIP Medical Debt, a non-profit which uses donations to buy and abolish medical debt for good. Check them out at ripmedicaldebt.org
140 — Death to Medical Debt! with Allison Sesso
Speaker 1 [00:00:00] Hello, and welcome to Factually. I’m Adam Conover. Thank you for joining me once again on the show. It’s a pleasure to have you here. Let’s talk about one of the weirdest things about America. I’m talking about how we pay for health care. On an almost mathematical level, it is stupid nonsense and we are doing it the wrong way. Let’s break it down. Health problems can afflict anyone at any time, and in fact, eventually will hit you. Human plus time equals you got to go to the hospital eventually. You can get cancer. You can get hit by a bus. One of your organs could just up and fail with no notice. You got no control over any of it, and it’ll happen to you at some point. When it does, you need very expensive treatments, all of a sudden, that you might not be able to pay for at that particular moment. So what do we do about this? Well, in many countries, everyone in the country pools their money together through a system called taxation, and then that pool of money pays out the medical costs for people when they get hit by the cancer-bus-organ failure whatever. Now the great thing about this system is that because everyone pays into it (including young, healthy people who might not need to use that pool of money that often), the cost per person is quite low. Basically, on a mathematical level, when you’ve got a huge risk like that which could bankrupt you or throw you into debt, the best way to deal with it is to spread it out among as many people as possible. That way, everyone just takes on a little tiny bit of risk. That way, no one’s life is ruined and everyone is taken care of at their worst moment. But in America, we do not use a system like that. Instead, we have a private insurance based system: we pay to enter one of many thousands of smaller pools of money. Now, because these pools of money are a lot smaller, they cost a lot more to enter into. That basic efficiency of spreading the risk out as much as you can just isn’t there. And before I forget, in this country, those pools of money are administered by for-profit companies that are trying to make a profit off of them. That means when it comes time for that pool of money to pay out to you because something bad happened to you, that company’s goal is to pay out as little to you as possible. So we have to pay a lot more for coverage that is actively working against us. And by the way, that’s the good scenario, because that means you have coverage. Nearly 30 million Americans don’t. They simply can’t afford to pay to enter one of these risk sharing schemes. So they are left bearing that entire catastrophic risk alone. The result of this is that one in five U.S. households now has medical debt. Now, the average debt is $2500, but many people carry much, much more. Having this much debt hanging over you isn’t just an immense psychological weight on your life. It doesn’t just mean that your possessions or your money could be confiscated. It also just drags people’s lives down in small ways. Carrying debt like this can require families to cut back on things like retirement savings or college savings or food, or can require them to pick up an extra job and spend less time with their kids. For many, it means that they’ll spend all of their savings just to pay for a life saving procedure that they needed. The ultimate effect of this bizarre for profit medical system is to ruin people’s lives just for being alive. Now, this system is so obviously terrible (once again, almost mathematically terrible) that there are plenty of people trying to change it here in the United States. I recently learned about one group that is taking a really fascinating approach towards alleviating medical debt and raising awareness about it. Their name is R.I.P. Medical Debt, and here’s what they do. They buy up unpaid medical debt at a very low cost, and then they abolish it. They relieve the people who had the debt from the burden. They literally purchase the debt and then say, ‘Poof, it’s gone. You don’t owe anybody this money anymore.’ It’s a fascinating approach, not just because it really does help out people, but because it sheds light on how fucked up this system ultimately is. So look, without further ado, let’s get to the interview. Here today to explain to us the incredible damage that our financialized medical system does to Americans every day and to give us a sense of what might be done about it, our guest today is Allison Sesso. Allison is the executive director of RIP Medical Debt. Please welcome Allison Sesso. Allison Sesso, thank you so much for being here.
Speaker 2 [00:04:57] I appreciate the opportunity.
Speaker 1 [00:04:59] So tell me about RIP Medical Debt. Tell me what it is that you do.
Speaker 2 [00:05:06] Yeah, we buy people’s medical debt and we relieve them of that debt and send them letters without them knowing that they are free and clear of the medical debt that has burdened them. That’s what we do. We’re a nonprofit institution.
Speaker 1 [00:05:20] So you take donations. I donate 100 bucks to you. You use that money to purchase medical debt. Tell me, how does that work? Who are you purchasing it from?
Speaker 2 [00:05:32] Yeah. So you gave us $100 and we get rid of $10,000 of medical debt.
Speaker 1 [00:05:37] For real?
Speaker 2 [00:05:38] Yep, that is for real. We have a one to 100 ratio of return on investment, so it’s a great thing to to put your donated dollars towards. That’s because of the debt market and the fact that a lot of people have medical debt. A lot of people can’t pay that medical debt. So if you were to sell that debt to the debt buyers, they could only make so much of a return on investment. And so in order to make that profitable, you have to make sure the price that you initially pay is very low. So the debt market prices medical debt fairly low. So we are able to take that model and turn it into a charitable response.
Speaker 1 [00:06:26] There’s so much here I have questions about. This is amazing. But first of all, I don’t often think about the fact (and maybe I haven’t always realized) that debt is something that is bought and sold by other people. When I take out a loan from somebody for medical debt, for a mortgage, for a credit card
Speaker 2 [00:06:43] This is the United States of America!
Speaker 1 [00:06:46] I owe somebody money. But then what? They sell the fact that I owe money to someone else and now I’m in debt to a different person.
Speaker 2 [00:06:52] Correct. Exactly. Yeah, everything’s a commodity in the United States of America.
Speaker 1 [00:06:58] Of course. Of course. I mean, water is. So of course debt is too.
Speaker 2 [00:07:02] Exactly, yes.
Speaker 1 [00:07:05] So you’re buying it at a very steep discount. You’re buying it for pennies on the dollar. Why is it so cheap? Is it because this is debt that somebody like a collection agency was trying to collect and the person doesn’t have the money? Is it sort of distressed debt or something?
Speaker 2 [00:07:24] So basically, it’s about the debt buyer going to a hospital or a physician group, whoever the medical debt starts with, and they buy the entire portfolio on the bet that some portion of that portfolio can be collected on. They’re betting that they’ll be able to put it on somebody’s credit report and they’ll be able to collect on it. Now, if you look at the entire portfolio, they’re only going to be able to collect on a small percentage of that. And so it’s that bet that they’re making. But in order to ensure that it pays off, the entire portfolio’s its cost has got to be fairly low. That’s why R.I.P. Medical Debt is able to take advantage of that pricing and compete with the debt buyers and buy the debt off the market and instead of collecting on it, it’s relieving people of that debt.
Speaker 1 [00:08:19] OK, I have a better metaphor for this. This is like when people buy a storage unit that’s full of crap, like on that show ‘Storage Wars.’ They buy the whole storage unit worth of shit for like a hundred dollars because they’re like, ‘Well, it’s probably just full of some hoarders garbage, but maybe the Mona Lisa is in there.’ And so they’re buying it. So these are people saying, ‘We’re getting all this crappy debt. These are just impoverished people who have no money and they owe hundreds of thousand dollars. But maybe there’s one dude in there who we can collect from.’ And so they buy it for pennies on the dollar. But you are looking at it saying, ‘Hold on a second. It’s so cheap we can just buy it. And then just forgive it.’ You just say, ‘Now none of you owe us any money.’
Speaker 2 [00:09:03] Right, exactly. I will tell you, I’ve been very careful to try to move our language along to not say ‘forgive’ because I don’t like the idea that somebody did something wrong when they’re in medical debt. So I’ve really tried this and it’s not easy, but I like to say ‘relieved’ or ‘canceled’ or ‘abolished’ or words like that.
Speaker 1 [00:09:26] I like ‘abolished,’ that feels good. We’re abolishing that medical debt. Whose debt is this? Who are the folks who have this debt? Oh, well, actually, let’s finish the process. So these people, you purchase all their debt, you abolish their debt, and then you send each of them a letter. ‘Congratulations, the $20,000 that you owed because you had a heart attack or whatever, you no longer owe that money to anybody.’
Speaker 2 [00:09:55] Precisely. How do we do it, though, it’s source driven if that makes sense. No one should ever call me and say, ‘Can you get rid of my debt?’ Because I can’t. I go to the source, I go to a hospital, I go to a physician group and I say, ‘Can we review your bad debt that you have sitting on your books? Can we look at it and analyze it?’ The difference between us and a debt buyer is that I’m more interested in the people that are on the poor end that can’t pay it. I’m not actually taking charitable dollars and buying the debt of people who do have the money to pay. If there’s somebody that happens to be in a portfolio that has a bunch of money and that is wealthy and that the debt is relatively small: say, you make $100,000 and you have a thousand dollar debt. I’m not buying that debt. You’re still responsible for that. But if you are under 200 percent of poverty or if the debt itself is five percent or more of your income, I will buy that debt. So I take the portfolio from the hospital. I analyze it using TransUnion data to see whose debts I can buy that qualify for our program for low income people. Then I buy that entire portfolio, which could be a million dollars that I’m spending. But I’m buying millions of dollars of debt. And then exactly what you said. I send out letters to those individuals and I let them know that we’ve gotten rid of their debt and they’re free and clear of it.
Speaker 1 [00:11:16] If you spend a million dollars, you said $100 relieves $10,000 worth of debt. So if you spend a million dollars (I’m bad at math) but you’re relieving many, many, many millions of dollars.
Speaker 2 [00:11:28] Exactly. That’s correct. Mm-Hmm.
Speaker 1 [00:11:30] And you’re making sure that these are folks about whom the hospital (and the credit bureau) say, ‘OK, these are all folks who are very low income and have no chance of being able to get out from under this debt.’ Those are the folks that you’re focusing on.
Speaker 2 [00:11:47] Exactly.
Speaker 1 [00:11:50] Tell me about what a difference this makes to people, because I sort of wonder, if you’re on the books of the hospital and they say, ‘This person knows this $100,000, this person makes $15K a year.’ They’re unemployed, they’re disabled. They have all the many, many problems of life that might mean they can’t pay it back. Well, if that person is so far in the hole, how does it affect that person’s life to have the debt relief because they’re not able to pay it back anyway?
Speaker 2 [00:12:14] That’s right. They’re not able to. But I will tell you, there’s a couple of things. First of all, hospitals can garnish your wages. So even if you’re making $15,000, they could decide that they want to garnish your wages. Let’s say you make $15,000, but you inherited a house from your family. They can put a lien on that house and they can take that house away from you. They could put a negative mark on your credit report so you don’t have access to credit. So there are very real consequences that the hospitals (and/or debt collection agencies who they sell the debt to) could take against you. The other thing is (and I think that this is often overlooked, sadly) the mental anguish it creates for people. Debt is a real tool and, historically, there’s racism that’s all embedded in it and it has been used to hold people back and to really constrain them. I think that mental anguish and the cultural feeling that it creates for individuals is significant. I mean, the letters we received back from people say to me that the amount of mental anguish that they clearly are being relief from is significant. Then on top of that, people don’t go to the hospital because they’re worried about getting medical bills. So there’s actual consequences of knowing you already have a debt: that you don’t go and get the care that you need. There’s lots of layers to this.
Speaker 1 [00:13:45] Right. ‘I can’t go to First Presbyterian (or whatever). I already owe them 50 grand. They’re already calling me every week. So now, I’ve got a chest pain and I can’t go there.’ I imagine, are these folks who have already had the collection agency beating down their door about this when you buy the debt?
Speaker 2 [00:14:02] It actually depends, because different hospitals take different actions. I’ve learned some of them are more aggressive than others. Some do have policies where they – In fact, I think this is actually a nice thing. It’s a growing trend that hospitals don’t sue patients and that a lot of them, increasingly, don’t put it on credit reports. Now, they don’t necessarily like to advertise that because they want people to feel like they’re on the hook. But there’s increasingly a lot of hospitals who don’t take aggressive actions. But then there are the outliers that do take aggressive actions and really do impact individuals lives. So it’s really an unfortunate situation and it’s a systemic thing. It’s not a one off. One in 5 households have medical debt and this is before COVID. So it’s a real systemic problem in the United States.
Speaker 1 [00:14:55] Yes, so let’s move that systemic problem. When we talk about medical debt as – I mean one in five households, that is a lot of people who have medical debt. How much debt are we talking and why do they accrue it?
Speaker 2 [00:15:11] Yeah. So it’s actually really hard to wrap your hands around how much debt it actually is. There was a report out that said that there’s at least $140 billion on credit reports, which is huge. One hundred and forty billion, that’s a lot of money and that’s been growing and it is worse in the south where a lot of the states haven’t taken up the expansion of the ACA; Obamacare. But I will say that there’s a lot of medical debt. It could be as high as a trillion dollars, the actual amount of medical debt, because there’s a lot of medical debt that isn’t on credit reports and is just sitting on hospital’s books.
Speaker 1 [00:15:57] But if it’s not on people’s credit reports, is it harming those people or is that just a liability then for the hospital? That ‘Oh, we’ve got all this debt that we can’t recoup?’
Speaker 2 [00:16:06] It’s a funny thing, that you ask. I think it is still harming them. I would argue that it is because again, the hospitals haven’t told the individuals, ‘We’re not collecting on that debt. We haven’t put it on the credit report.’ They may not be even reaching out to the individuals, but the individual got at least one bill and knows that’s out there. So it very much is impacting their decision to go to the hospital or not. It may be that they’re walking around in fear that one day they might get that bill, or one day they might get a lien on their home. It may even impact their decision to buy a home because they think that they owe that bill. The idea that just because it’s not on a credit report means that it has no impact, I don’t buy it.
Speaker 1 [00:16:47] Yeah. If you could walk me through this; if I’m someone who has the kind of debt that you relieve, how do I accrue that debt? What’s that scenario look like?
Speaker 2 [00:16:59] There’s so many. OK, so first of all, the myth that it’s the uninsured only, that’s definitely a myth. You can absolutely have insurance and debt. In fact, a growing number of people who have debt have insurance. Insurance is just shitty, and increasingly so.
Speaker 1 [00:17:22] Yeah, my very good friend (and a writer for my show), Brian Frange, used to do this incredible joke about health insurance. He’s a standup comic. What we say about health insurance is like, ‘Oh, I broke my arm. Luckily, my insurance covered it.’ Why do we say luckily? Because we all expect that they won’t. We don’t do it with any other business. You don’t go to a sandwich shop. ‘I gave the guy $10 and then luckily, he made me a sandwich.’ Please credit the very funny comic Brian Frange for that joke. I did not write that joke. I’m aping his delivery. I’m very lucky to have union health insurance. It’s very good health insurance and I still have to be careful about whether it will or it won’t pay. And I have friends who say, ‘Oh, the writer’s guild health insurance, didn’t cover this necessary procedure, et cetera.’ It’s a real problem.
Speaker 2 [00:18:15] Exactly. So increasingly, people who have insurance end up with medical bills because it’s full of loopholes. A large part of it is that there’s huge deductibles that people have to pay, increasingly. If you have a $5,000 deductible and you’re living paycheck to paycheck, guess what? You’re not going to pay the deductible. You’re going to end up in medical debt. A lot of the bills are not $140,000 bills that we relieve. They’re a thousand dollar bills, they’re five hundred dollar bills. That, by the way, in and of itself is a sad state of affairs. Because this is not just a health care financing problem, it’s an economic problem, right? People don’t have $500 to pay. That means that they are very close to living paycheck to paycheck and just can’t make it happen. So it’s people who don’t have insurance, it’s people who do have insurance. It’s people who have good insurance but were out of network, it could be anything. Or you got a really bad lot handed to you, you end up with cancer and sometimes that ends up being very costly. They say that a lot of people use and lose a lot of their assets that they’ve accumulated over their life because they got cancer. Can you imagine? You get cancer and then you lose your financial standing too? I mean, God, can life be more of a bitch to you? It’s just not OK.
Speaker 1 [00:19:40] Yeah, you’re suddenly bankrupt or you have to sell your assets or your wages are garnished just because you got sick and your insurance doesn’t cover it.
Speaker 2 [00:19:51] It’s like kicking you when you’re super down.
Speaker 1 [00:19:57] One question I have is, when we talk about debt numbers: a bill, the debt that you’re relieving, the total debt, it’s so hard to figure out whether or not those numbers are real. I think we’ve all had the experience of getting a bill from – I’ve had the experience of having a surgery, minor abdominal surgery, I was under. You want to know what it was? It was a hernia. I had a little hernia and they put a mesh in. OK, everyone curious at home? This is like ten years ago, I had a little abdominal hernia. They put it in a mesh. I was under anesthesia.
Speaker 2 [00:20:29] Very normal, very normal.
Speaker 1 [00:20:30] It was outpatient and all that. I remember going to the surgeon, and he’s like, ‘OK, if we do it in this place, it’ll be good for your insurance. That way, it’s going to cost less.’ He brought out some numbers and circles of things like, ‘You want to do it here?’ I was like, ‘All right, I guess let’s do it there instead of the hospital. So I go to this outpatient place and I get the surgery. I get home. Two weeks later, they send me a bill for like $50,000 or something, some crazy amount. And I called them and I was like, ‘You guys told me my insurance would cover it. What the fuck is this bill?’ And they say, ‘Oh, that’s not a real bill. That’s a bill that we are sending you to tell the insurance, blah blah blah.’ And I said, ‘So I don’t owe you this money?’ And they were like, ‘Urhmmmm, ummmm.’ Even though I had insurance and they told me I was covered. I felt like I was on sand. I felt like it was all falling underneath me. And I’ve done a segment on ‘Adam Ruins Everything’ about the chargemaster, about how hospital bills are essentially arbitrary. They just make the numbers up.
Speaker 2 [00:21:32] That’s correct, that is accurate.
Speaker 1 [00:21:32] OK, good. I’m glad. I’m glad it’s accurate because they’re just a starting point for negotiations with the insurance company.
Speaker 2 [00:21:37] That is exactly what they are. And thank you for saying that because I don’t think people understand that. They absolutely keep saying ‘Transparency, transparency.’ I’m like, ‘But if you get to see something that’s a bunch of bullshit, it’s not going to help you.’
Speaker 1 [00:21:50] Yeah, exactly. Like, ‘OK, we’re going to charge you $100,000 for a roll of gauze’ and you’re like, ‘I have to pay this?!’ And they’re not telling you –
Speaker 2 [00:22:00] It’s like, ‘Hang on, I’ll be right back. I’m going to CVS to get my own gauze and bring it in.’
Speaker 1 [00:22:05] You’re a great guest. But yeah, because it’s a starting point. The insurance company goes, ‘Fuck you, we’ll only pay you 50’ or whatever, and they go ‘OK, you got us. That was a starting point.’ But if you don’t have insurance, you get charged that full amount. You hear more and more the advice from people: when you get billed by your doctor or your hospital, the first thing you do is call them up and say, ‘I’m not paying this. Charge me less.’ Because we all know the numbers are fake. So how does that relate to your work?
Speaker 2 [00:22:37] Well, so I would just say, first of all, I’m infuriated that patients are in the position to be negotiators in the middle of when (again) they’re being kicked when they’re down. You just told a great story. You get a hernia, you’re like ‘Crap.’ It’s not a death sentence, but it’s annoying. Who wants to go in for surgery? And in the middle of that, you have to have this conversation about like, ‘Oh, which hospital am I going to go to? What’s it going to cost me? What is this going to mean for me financially at the end of the day?’ You shouldn’t have to worry about that. You should be focusing on your well-being. But our system doesn’t allow you to do that. Then once you were in the middle of recovering, they’re also following up and giving you a heart attack bill. That’s like $50,000. And you’re like, ‘What the heck is this?’ And so you gotta spend your time, hobbling along with your hernia and your new mesh in your body, and make a phone call and get your stress levels up. Which is totally the opposite of what you’re supposed to be doing when you’re getting medical care. So it’s undermining your own well-being, which is their goal. It doesn’t make any sense. At RIP Medical Debt, we’re trying to think about all these different moving parts and, in relieving this debt for individuals, how can we be pointing a finger at the system overall and how broken it is and really elevate these patients stories. We point to the system, not the individual who owes the debt. And that we really say something more holistically about the way we finance health care in the United States and how it’s so contrary to the overall goals that we have in terms of people’s well-being.
Speaker 1 [00:24:17] Yeah, because you’re not going to solve medical debt by just buying it for pennies on the dollar and relieving it for people. You’re also doing this to make a political point and a policy point about here’s how fucked up American health care is. Well tell you what. Let’s move to that part of the conversation after the break, because I think that’s going to be a whole thing. I don’t want to get into it and then have to read an ad for Casper mattresses or whatever the fuck. So let’s take a really quick break. We’ll hear the awesome ad for the great advertiser that you should support to support the show. And we’ll be right back with Allison Sesso. We’re back with Allison Sesso. We were just saying that your organization, RIP Medical Debt, which buys medical debt for very cheap amounts and then relieves massive amounts of debt from people is not going to solve the health care problem with this. You are trying to make a point. So tell me more about the point that you’re trying to make and what you think your work sheds light on?
Speaker 2 [00:25:25] Yeah. So I think that our organization does two things: one is that, in a very real way, we help people who are at the end of this problem. We’ve relieved $6 billion of medical debt, helping over 3 million people. So that’s very real. That’s great. I also think we shouldn’t exist. So I would love to be looking for a new job in several years from now because we’ve figured out a more systemic way of dealing with this. In the meantime, I’m happy to be relieving the debt and leveraging this model. But I think that we need to recognize that the expectation that our system increasingly has, that patients have to pay a fair amount of money out of pocket to get medical care, has got to be solved. This idea that individuals are responsible for a large portion of their bill (or could be) has got to be addressed. A colleague of mine who actually used to run revenue cycle for a major hospital system (more than one, actually) has likened this whole thing to the patient being the child in a bad divorce and the insurance company is the father trying to pay the bills. The hospital is the caregiver (or, like, the mom) and they are fighting it out and in the middle of it, the patient (or the child) is like, ‘Wait a minute. Why is this problem falling in my lap? I’m just trying to be taken care of here.’ It’s such a good analogy. I think that, increasingly, our solutions are falling short. They’re like, ‘No surprises that that’s good, right? It’s progress.’ Transparency pricing, I’m not thrilled about that. It doesn’t really do much.
Speaker 1 [00:27:14] Is that something that is a new trend? Transparency pricing?
Speaker 2 [00:27:17] Yeah. It’s this idea that hospitals have to show what their prices are. But their prices aren’t based on anything that’s really rational or that you can point back to anything, so it’s not really that helpful. And increasingly, the patient is in a position to navigate this mess. The patients, as they are trying to figure out, ‘Well, what does my insurance cover? How much should I be paying? If I go to this provider and if I negotiate or whatever.’ It’s madness. Honestly, it doesn’t make a whole lot of sense and it undermines the overall well-being of people across the United States. I really think that, for the role that we play, we would like to say something larger about the system and say that this has to be an issue that is front and center and not only recognized as a problem for people getting access to health care, but the fact that it’s ruining people financially. So it’s both economic and health care that is colliding into this medical debt insanity.
Speaker 1 [00:28:23] Yeah. Let’s talk a little bit more about the debt piece of it. If you were not purchasing the debt from people, are there situations where this is sold to an aggressive collection agency that’s coming after people and that kind of thing?
Speaker 2 [00:28:38] Yes, absolutely. I will say, collection agencies are not just inherently all evil or anything like that. I think that is a perspective people have. Do they go after people? Yes. Are some of them super aggressive? Yes. But ultimately, they are a for profit business. That’s part of the United States, and I feel like that’s something we should pay attention to. But yeah, I do think that the collection agencies tend not to go after the people that are lower income, which is a lot of the people that we’re trying to help. I mean, it makes sense that they’re more incentivized to go after people that have higher incomes. But it’s still a problem. And I honestly think that even people in the middle class can be taken down and beaten by them. And that’s really a big, big problem. Even people say like, ‘Well, this person can afford to pay this medical bill.’ Like, OK, but what are they sacrificing? Is it OK that because your child needed some kind of special surgery or something like that, that you then that you can’t take your kid to Disney? I know that sounds like, ‘Oh, well, that’s a middle class issue.’ But that kind of seems like a ridiculous expectation to me.
Speaker 1 [00:29:57] And if you’re the person who is below the poverty line that the collection agency considers the ‘We’re not going to collect below this’ line then OK, fine, but if you’re the person who’s one step above that line; you’re on the lowest rung of what they will go collect after, well, that’s going to drag you down below the line.
Speaker 2 [00:30:15] Exactly, exactly.
Speaker 1 [00:30:18] There’s people way further up the ladder who say, ‘Oh my God, this place called me again. Whatever, I’ll just cut ’em a check.’ But yeah, but there’s got to be a ton of people who aren’t in that situation, and it’s a huge drag on people’s lives and on the overall sort of economic livelihood and health of our society, to have this.
Speaker 2 [00:30:37] Yeah, 100 percent. I mean, some of the stories we received from people are just like gut wrenching. We had this one story of this woman who was a nurse. And she needed help and she was getting bills from her own hospital. We relieved like a thousand dollar bill from her, and she was just so excited about it. And it felt like such a relief for her. Had that bill ended up in a collection agency’s hand, I mean, she’s a nurse. She probably made enough money where she would be on the list of people that they would have followed up with. Meanwhile, she’s one of the COVID heroes. She’s out there helping in the middle of COVID. And this problem is falling in her lap and it’s her own industry. It’s stories like that which show and pinpoint the absurdity of the way we approach all of this.
Speaker 1 [00:31:33] Speaking of COVID, what effect has the pandemic had on the problem of medical debt and on your work?
Speaker 2 [00:31:39] Yeah. It’s hard to know how exactly it’s going to impact the final numbers of medical debt because it’s complicated. A lot of people didn’t go for care that they would have normally gone for because they were scared to go to the hospitals and the hospitals were overrun anyway. So we’re not sure if it’s like a wash, how it impacted. We do know, like most things, medical debt is worse for people of color in general. I know that the pandemic was worse for people of color, especially on the economic side of things. So my guess is that it exacerbated those racial dynamics in terms of medical debt. Again, I don’t have hard proof of that because it takes time for medical debt numbers, because there’s a collection cycle that’s at least a year long. So it takes some time for us to really wrap our hands around the numbers related to medical debt. But what did happen during the pandemic is that a lot of people lost their jobs and in this country, we tie medical insurance to whether or not you have a job, right? And so –
Speaker 1 [00:32:46] Whether or not you have have the right kind of job,
Speaker 2 [00:32:47] Right? Like you said, you have union coverage, that’s great. A lot of people don’t have that.
Speaker 1 [00:32:54] And we gotta fight to protect that coverage every single time we go to negotiate a contract because we all know we’re so lucky to have it.
Speaker 2 [00:33:01] What’s happening is, it’s probably impacting the rates of payment too. In order to protect that negotiating point, you’re holding tight to that insurance and you’re losing ground on the payment side.
Speaker 1 [00:33:14] No, exactly right. People talk about why unions have good health coverage. Why would we support single payer health care system? It’s because if we didn’t have to fight for that, then we could go in to the negotiating table and instead say, ‘Well, hey, on this next contract we need to fund the health plan.’ We would instead say, ‘No, just pay us more money.’ We wouldn’t have to fight for this. Again, this is me being in a very fortunate position; to be in a strong union. But I’m sorry I went off on a tangent. Please return to your point.
Speaker 2 [00:33:46] No, no, no. It’s fine. I think that in terms of what happened during COVID is that a lot of people lost their health insurance coverage because they got disconnected from their jobs, because there was a lot of job loss. I think that had real impacts on medical debt: if you got sick with COVID, I’m very interested to see in a year or so from now – Because again, it takes time to really look at the medical debt numbers for there to be some kind of study that really looks at people who got COVID versus who ended up in the hospital; whether or not they were fully covered, it probably depends on the hospital that they went to and what that data looks like. Also, frankly, whether or not these people that were vaccinated or unvaccinated. There’s so many dynamics to this whole COVID story that interact with medical debt; like whether or not people lost their jobs and their insurance and all of that. I think it’s going to be an interesting thing to tell. And frankly, I’m hopeful that this experience has us realize that we do need to do something about the way we finance health care. There were special laws put in place to deal with COVID: all of a sudden, it was supposedly paid for, but they were confusing and they put a lot of the control in the hands of the hospitals as opposed to the individual, like the CARES Act that was done under Trump. That allowed hospitals to bill the United States government, but they could decide to first bill the individual. That’s different than saying to the individual, ‘Don’t worry, we’re kind of providing insurance for you and you can decide what hospital you want to go to.’ It put a lot of control in hospital’s hands, which I don’t think was probably the best move.
Speaker 1 [00:35:38] Wow. I’ve been thinking a lot lately about how we are not going to understand the impact of COVID 19 for – We’re going to be feeling it for the next decade. Changes have happened medically, politically, economically that are under the surface and it hasn’t yet really bubbled up. We haven’t yet appreciated it. But talking about medical debt: you’re relieving medical debt, but your position is that we should abolish it altogether. It’s something that shouldn’t exist. You were saying about collection agencies, ‘Hey, they’re not all bad people.’ And I would maybe agree with that, but also say they are people who are profiting off a system that should not exist, similar to a landlord. It’s like, look, a landlord might not be a bad person, but do we think that private ownership of a need such as housing (that’s financialized, such that people see it as an investment) is a good way to provide things to people? Is that a great and ethical system? No, it is not. It’s not. It’s one that’s a little bit slimy and you get a little slime on you when you participate in it, even if you’re a nice little old lady. So that’s my view. Maybe you share it. So I think we’re alike in feeling that we should not be funding health care this way. We should not be saddling people with so much debt. So how do you use the work that you’re doing, (in doing direct aid, which is incredible and I love that) – We had the executive director of GiveDirectly on the show, which is a wonderful organization that gives money directly to people in need. So I’m a big fan of that sort of like, ‘Hey, let’s just help people out, give them a financial boon.’ But you are simultaneously trying to make that policy point and trying to change things. So how do you do that? How do you go about making that argument?
Speaker 2 [00:37:27] Yeah. So there’s a couple of ways. So first of all, this is a little bit of a new direction for us. We’re fairly young organization. We only started in 2014 and like I said, we’ve abolished $6 billion in that time. It’s crazy. It’s crazy. Yeah.
Speaker 1 [00:37:45] That’s a pretty big chunk of change. You said earlier, how many many billions of debt exist?
Speaker 2 [00:37:49] $140 billion total
Speaker 1 [00:37:50] $140 billion total, but you’ve abolished 6? That’s not bad.
Speaker 2 [00:37:57] That’s not bad.
Speaker 1 [00:37:57] You’re looking at me like, ‘Hey, don’t hold me to that. I’m not trying to say we’re the supermen or anything,’ but I am impressed. That’s a huge number.
Speaker 2 [00:38:06] Thank you. And look, people donate to us and that’s how we do it, right? We got a $50 million gift from Mackenzie Scott, which is formerly Bezos money which I like.
Speaker 1 [00:38:19] I really imagine every time she writes a check, she’s just going, ‘Fuck you, Jeff, there we go. Give that to RIP Medical.’ Because Jeff’s not donating that shit. He’s going to space, but she’s like, ‘I’ll fucking spend your money, motherfucker.’ Sorry. Please go on, that’s wonderful.
Speaker 2 [00:38:35] Yes, it was a huge help. The amount of debt out there is a lot bigger obviously, but that’s significant and it makes a big difference. So we are absolutely relieving the debt, in that process we are trying to lift up the stories of the individuals and make sure that their voices are heard. And in doing that, we’re hoping to address the stigma associated with medical debt and again, point the finger at the system. We just hired an amazing director of public policy. She started at the beginning of this year, this is her second week or something like that. She’s here and she’s going to be looking at how R.I.P can really be participating; in both the federal and local conversations around medical debt in a meaningful way. And again, to leverage what we have to offer. What do we have to offer? We have the client, we have these stories of these individuals. We also have data. We’re working with these hospitals. We’re getting a lot of medical debt. We can look at that data and say things like, ‘How large are the debts, who do the debts belong to? Can we draw out this racial divide a little bit more? Can we talk about who’s insured, who’s not insured?’ Are there trends that we can find through getting these large portfolios off of debt and analyzing them? We can really, I think, add something that’s meaningful to the conversation. So those are the ways that I think we’re going to be contributing to the larger issue and doing things like this: having this conversation, having my voice out there and talking about this issue, I think, makes a big difference.
Speaker 1 [00:40:15] I really like that point where you are buying these huge tranches of debt and you’re able to do research on that debt. You’re right to look at it and say, ‘Hey, this was just sitting on a hospital’s books.’ But now that we as a nonprofit, who is trying to make change around this issue, have it we can really analyze it and say, ‘Who is this harming?’ and that sort of thing.
Speaker 2 [00:40:36] The other thing that’s actually really important is a middle ground between the bigger picture: changing public policy and just helping the individual. When we work with hospitals, increasingly, we’re able to give them feedback on their own charity care policies. Most hospitals are nonprofit and they have a requirement to provide charity care; in order to have that nonprofit status. So when we look at their files, we find holes in their system, if you will. We’re able to say, ‘Here’s a bunch of people that probably should have gotten charity care that didn’t have enough money to pay and didn’t get access to your charity care policies. So either you don’t have good enough outreach efforts or you have holes. Maybe you need to raise the federal poverty level of who qualifies or there’s reasons why there’s certain people that aren’t qualifying. So fix your charity care policies.’ And we’ve seen some success. We’ve given some of this feedback to hospitals, and they’ve changed some of their policies in a way that (hopefully) reduces, at that hospital level, how many people end up with medical debt because more people end up in the charity care bucket. I think there’s a couple of ways that we are also moving the ball and trying to (as our mission states) end medical debt.
Speaker 1 [00:41:58] Well, that’s great. But it does put me in mind of what might be a tough question. I hope you don’t mind.
Speaker 2 [00:42:03] Yeah, no go ahead.
Speaker 1 [00:42:04] We’ve been talking about how hospitals bear responsibility for this problem to some degree, because they are the one setting the prices. A lot of the prices are fake. Not all the hospitals are good actors. Many hospitals in the US are nonprofit, but even the nonprofit hospitals are complicit in this practice. I’m sure there’s great hospitals out there. There’s also some very bad ones, and I think the average is not good. Do you have any concern that if you are working with hospitals – On your website, you have a you have a whole page that’s like, ‘Hey, if you’re a hospital, here’s how to learn about what we do,’ and you are paying the hospitals. You’re taking the debt off of their books. Are you worried at all that you are – not contributing to the problem, but – helping out the folks who are
Speaker 2 [00:42:53] Propping them up?
Speaker 1 [00:42:54] Propping them up, yes thank you. That’s the language. Is that a concern at all for you?
Speaker 2 [00:42:57] Yeah, no. We’re definitely conscious of that. I mean, I certainly don’t want to be used by a hospital to say, ‘Oh, we’re going to clean up our image and work with our medical debt.’ It’s a risk, it is something we’re conscious of. At the same time, I will tell you that I’m very conscious of the people at the end of this. Should I not get the debt that a hospital has and help that individual that’s at the end of that because of this concern? I think that’s not a good tradeoff. I also think that I’m not sure who’s at fault here, as I said before. Yes, hospitals are problematic, but so are insurance companies. They both are problematic. I think hospitals are, unfortunately, big bureaucracies. I don’t think that they’re intentionally bad actors. I think that they’re also caught up in a bad system. Increasingly, we’re talking to them and they struggle. A lot of them are trying to provide good charity care. I’m not saying all of them are. I definitely agree that there are bad apples. There is for everything in the world, but there’s a lot of hospitals are trying to move things forward. But increasingly, the economics of people in the United States who go for care are not in a good position. So more and more people come to the door that can’t pay. So that’s a bigger problem that’s beyond the hospital’s doors. And increasingly, the insurance companies aren’t paying a lot of the bills. Increasingly, people are showing up to their doors that are underinsured. So they’ve got to eat those costs. I think that it’s more complicated than just being able to say, ‘Well, the hospitals are at fault.’ I think there’s all different players that are at fault here.
Speaker 1 [00:44:44] I think you’re right. I also think, though, that in our conversation (and this is not this is just my own personal hobbyhorse, that’s a little bit off topic here) when we talk about the problems with the health care system in America and why everything’s so expensive, we tend to point the finger at the health care providers a little bit too little. Everyone beats up the insurance companies all the time. And then, ‘Well, we should reform health care.’ ‘Oh, the doctors in the hospitals are saying that’s not great for them.’ Well, we need to remember that the doctors in the hospitals (in many, many cases) are profit seekers who are part of this system. And guess what? Maybe the hospital shouldn’t be the richest company in the entire county. If you look at the most highly paid public employee across most states, it’s number one: football coaches at universities. Number two is the people who run university hospital systems and things like that because it is so, so lucrative. And guess what? Maybe it shouldn’t be. We have a reticence to point our finger at the people providing the care because we want to be grateful to them and their experts and they know their business. But at the same time that was why in our episode, ‘Adam Ruins the Hospital,’ we said the chargemaster problem is not just the insurance companies. We have to point at the hospitals, too. But I think that’s a really wonderful, nuanced answer, and I thank you for it. I’d love to know, policy wise, if you could snap your fingers – Or say you go sit down with a bipartisan group of senators and they’re listening to you. What reforms would you like to see that would A: start to solve this problem? What’s the low hanging fruit? And then B, what’s the high hanging fruit? What would really fix the problem, in your view?
Speaker 2 [00:46:36] You’re not going to hear me say, ‘It’s Medicare for all.’ We’re not in a position to really have all of the answers here. And because this is such a politically touchy issue, I get it. It’s complicated and this is a difficult thing for us to wrap our hands around, because of the fact that we are in a for profit system that is going to be a lot to unwind. So my answer to your question is really that government has got to take a more hands on role in making sure that people have insurance. That’s going to cost the government more money. So you could expand Medicare so that people that are covered. You could expand Medicaid. You definitely should ensure that we build off of the ACA to make sure that people have insurance that actually they can afford, meaning that they don’t have deductibles that they can’t end up meeting. I liken that to subprime mortgage loans. There shouldn’t be the ability to get a health insurance policy that you can’t afford at the end of the day. There needs to be some regulation.
Speaker 1 [00:47:59] There shouldn’t be such a thing as an insurance policy which has a deductible which
Speaker 2 [00:48:05] based on your income, you can’t afford it.
Speaker 1 [00:48:08] Yeah, like an insurance policy with a $50,000 deductible is like, ‘Why is this even being sold?’
Speaker 2 [00:48:14] Right. If we know, when you buy it, what your income is. We know you’re not going be able to meet it. So why are we allowing you to? Now that’s going to take government subsidy, in order for that to happen. Government’s going to have to put more money in and subsidize that health insurance. And that’s OK. But that’s what I would suggest. I would suggest that happens. I would suggest that, again, Medicare get potentially expanded to cover more people. So I think what I would say, is that it’s going to take more government support for people to have adequate coverage so that they don’t end up with bills. And there needs to be more regulation of what is allowed in terms of collections. There shouldn’t be the ability to garnish people’s wages. There shouldn’t be the ability to put liens on homes. I think that we should think about not letting people have medical bills on credit reports, ever. This is different than other types of debts because you have a lot less control over it. All other types of debts you kind of know – Even college debt, which I think is really problematic. You at least go in with your eyes open, right? Maybe you’re young and you don’t know and whatever but you do have a set, like – When you are walking around the world and you get hit by something and you have to go to the hospital, there’s nothing you can do about it. Or all of a sudden, cancer shows up in your life. It is different. And I think that needs to be acknowledged.
Speaker 1 [00:49:44] Look, I do want to say I have friends who are under mountains of student debt and have told me, ‘I signed up for this when I was like 17 years old and I did not know. I literally did not know how money worked, and no one explained it to me and now I owe hundreds of thousands of dollars that I can never pay back.’ But I agree with your general point, which is that student debt is bad enough, and we’re finally having a conversation about forgiving student debt because we know that education is mandatory for surviving in today’s economy. It’s not a luxury. It’s not for fun. You gotta have it. So why are people impoverishing themselves in order to get it? Medical debt is even further than that, which is that you just need it to live. You need medical care to live. Anybody could be walking on the street and be hit by a bus. Anybody could have a random congenital condition. Anybody could get cancer.
Speaker 2 [00:50:40] And by the way, to your point earlier about being a teenager that’s right about to get into college and not understanding finances is 100 percent true. The thing about medical debt is, you could understand finances. You could be very eyes wide open and still not be able to avoid it. And it’s just because the system is set up where these expectations on the patients are completely unreasonable and irrational.
Speaker 1 [00:51:09] Yeah. Well, look, I understand why you (as a nonprofit that’s working very closely in this space) are not able to say, ‘Oh, we’re going to go for Medicare for all,’ because that’s a very big picture proposal that is political football.
Speaker 2 [00:51:28] [laughter].
Speaker 1 [00:51:28] No, I’m serious. Look, I’ve been I’ve been on Earth a little while now. We’ve been talking about single payer for a long time, and we’ve been through a number of rounds of reform here. Sometimes, I’m an incrementalist. Sometimes I’m a ‘We got to start from scratch’ guy. I guess the question I have is: when the ACA was signed I was like, ‘All right, hey, we got a great big package of reforms here. We’re taking a great big step.’ And it was super, super hard. Maybe the way is to go, ‘Hey, maybe we get halfway there and we get to do the other half later.’ Except that you guys were founded in 2014, which was (I believe) four years after the ACA was passed and the ACA was the hugest lift of an entire administration right to get that done. Took him like a better part of a year to get it done. And a decade later, none of us are going, ‘Wow, everything sure is better.’ No one’s saying, ‘Wow, that really fix the problem.’ A lot of the reforms you spoke about: saying, ‘Hey, we have to make sure that the government is supporting this type of insurance etc,’ that sounds the smaller steps. Is there a bigger one that you hope to see somewhere in the future, even if it’s not going to happen next year?
Speaker 2 [00:52:51] Yeah, I mean, look, I like the idea even of a government option. Again, this is not RIP endorsing any of these things yet. We haven’t figured out exactly what our public policy stances are. But I like that idea because it comes down to people actually having enough. Not having the patient have to pay so much out-of-pocket. So whatever it takes for that. And to me, that is either a government option that would make sure that there’s an insurance plan that’s really providing people real coverage or subsidizing existing plans in a way that ensures that people do not have to pay that much out of pocket, and these other little things. I think those are pretty big changes that would make a big difference. Frankly, my answer about ‘not Medicare for all’ is because I don’t know how you unravel the system. The problem is that we are so in over our heads in the way the health care system is financed, that to unravel it would not be easy. During some of the presidential debates, there was a lot of conversation around this. Elizabeth Warren had some plans, for example, where she talked about how to unravel this. I think it would take quite a bit of time to undo the pieces. I don’t think it’s a bad goal to try to figure that out. But the politics are not even close to there on that, and I’m a pragmatist. I want to be realistic about what we can accomplish and stop the bleeding for these individuals. I even think, frankly, a government option is probably a really heavy lift in and of itself. So, my answer really is not just about what’s like a magic wand, but like, let’s be realistic about what our country is going to do and what it’s going to mean to make those changes. There’s huge insurance industries, where would all those people work? I get that those are questions that have to be answered. Or ‘You don’t keep a policy in place because it employs people.’ You would be like, Well, then you just keep jailing people because there’s people that work in prisons.’ I get that those are not the answers. But at the same time, I think they are considerations and have to be well thought out as we make moves towards progress. If I could turn back time, as Cher would sing, I would go back to the 1940’s when Truman tried to get us to go in the right direction; where the rest of the other countries in Europe and stuff were going, in terms of getting our hands around how we support health care and we didn’t do that. I don’t know if you know this, but we didn’t do that because of this really slick political campaign. It was one of the first of its kind, where people were convinced that doing what Truman was suggesting with this group, Baxter and Baxter, that we were going to end up with a socialized medicine and people were convinced, culturally, that was bad and not ‘American.’
Speaker 1 [00:55:58] Yeah, the for profit medical industry, around Truman’s time, sent out vinyl records (I think it was) telling people it was socialism and ran commercials and things. It was an intense campaign against socialized medicine, which is the exact same thing that we’d hear today and that we do hear today when people talk about expanding Medicare or things like that. Look, I think every point you raise is a good one. I hear Bernie Sanders in the back of my head going, ‘You know what I think isn’t realistic? It’s paying trillions and trillions of dollars.’ And I’d say, ‘Yes, very, very good point. That is not realistic and that is very bad.’ We should be clear and persuasive in our argument for what the better system should be. And then we need to be extremely clear about how exactly we’re going to get there. That will entail having a clear view of what currently exists and who all the stakeholders are and what forces are pushing back against you doing that. Here in California, we’re about to get into that. A group of state legislators brought a new proposal forward (very early days) about creating a new single payer system. I think they’re going to call it Cal CARES, and it would be a full single payer system in the state of California. And there’s an incredible amount of work to do because we’ve got this incredibly large medical system and you’ve got millions of doctors and millions of health care providers and companies and hospitals, and every single one of those companies is going to say, ‘Whoa, whoa, whoa. Whoa, hold on a sec. Hold on, hold on. What is my life going to look like the day after you pass this? It’s got to look like this. It’s got to look like that.’ They’re going to start calling their legislators. They’re going to start da da da da da, and you need to actually work it out and be able to say, ‘We’re at point A. We’re trying to get to point B, and here’s how we’re actually going to get there.’ The slogan is really important, but once we have the slogan, we have to go into the details and that’s going to be a long process, and it’s also going to be proving that it works. So when you say public option, or perhaps you’re talking about California doing it first, that’s a matter of showing, ‘OK, here’s the better policy that we want, and let’s try it out.’ It can coexist next to the other system for a little bit, and we can see that it’s working better and things are starting to move in that direction. You know?
Speaker 2 [00:58:36] Change is incremental. I mean, that’s just real. I have to say, by the way, good for Bernie Sanders. Thank God for him out there screaming about this issue. That’s what we need. You do need people saying, ‘This is insanity,’ which he does a very good job of and you do a good impression of him. I think that that we need voices like that sayings o and throwing out big, bold ideas. That’s how you get the incremental change to actually happen, right? So it takes a lot of different strategies. And frankly, the politics matter a lot. In this country, right now, they are a freaking mess. So getting them to do anything, even if everyone agreed, getting it done (because of who’s going to get credit for it) is nearly impossible.
Speaker 1 [00:59:21] People say politics, they think that it’s just Republicans and Democrats and progressive Democrats versus conservative Democrats. But when you’re talking about politics, you’re talking about everybody in the society, and that means getting everybody who’s involved in the health care system and everybody who’s a stakeholder. Thinking about who those people are, what they need and what they can do to fuck you as you’re trying to make change and how you’re going to beat them on a really specific granular level. It’s not just fucking AOC versus Mitch McConnell. It’s a lot, lot bigger than that. There was some other point I was going to make. Well, here’s the last thing I’ll say, because I know this is not your – You work for a nonprofit and you’re like, ‘Oh boy, I’m talking about politics. I don’t want to get into this part of it.
Speaker 2 [01:00:12] I’m OK with it.
Speaker 1 [01:00:14] OK, good. Good. Yeah, you can hang. You can hang, Allison. But no, I think actually the pitch of ‘Medicare for All’ was a really good example of just getting a little bit more thinking about how we’re going to do this. Because instead of just saying, ‘Hey, let’s abolish everything and do single payer instead.’ It’s ‘No, let’s expand the most popular, most successful part of our current system to as many people as possible.’ That’s something that people can really get behind. And it shows you a path. ‘Hey. OK, Medicare for All. Well, you know what’s 30 percent of the way there? Medicare for more.’ We can expand it as much as possible. We’ve got a clear bit of low hanging fruit we can go for. That continues to make the argument for the better system that we all know that we want to get to and we’re not going to stop pushing for.
Speaker 2 [01:01:02] And from where I sit, what I can do is I can keep giving examples and raising the flag about how the current system is not working. So we need to do something. I might not be able to say, ‘Well, I’m getting on the train for Medicare for all.’ But I can say, ‘Well, we got to do something’ and I can keep putting that out there into the cultural conversation that gets people to agree that we have to address this issue.
Speaker 1 [01:01:26] Yes. OK, so let’s bring it in for a landing here. From your position as someone who’s running a nonprofit on this, how can people get involved in this topic and how can people support the work that you guys do?
Speaker 2 [01:01:41] Donations are what drives R.I.P. medical debt. I mean, if you want to feel really good and make a $10 donation, you can get rid of a thousand dollars worth of medical debt.
Speaker 1 [01:01:51] I mean, I’ve talked about on the show before. I donate a certain percentage of my income every year and I look for those opportunities that are like, ‘Where is the dollar going to go the furthest?’ There’s bed nets for malaria; The Against Malaria Foundation. There’s GiveDirectly which gives direct cash grants to people in need. This is up there. One hundred dollars gets rid of $10,000. It’s one to a hundred.
Speaker 2 [01:02:17] Yes, yes, that’s right.
Speaker 1 [01:02:19] That is so massive. If you donate one hundred dollars and someone is going to get a letter saying, ‘The $10,000 that you owe has been abolished.’ The weight that’s going to be lifted off of them is like, that’s so massive. That it’s such a cool thing you do.
Speaker 2 [01:02:33] Yeah. And the thing is, you can just give directly to us or you can also start a campaign. We’re big fans of people saying, ‘I’m going to pledge $10,000,’ which starts you out at a million dollars of medical debt you’re relieving ‘but my goal is to raise $50,000’ and to go on social media, have a party, do whatever you need to do, get local corporations to give and raise $50,000 to really get rid of $5 million dollars, ultimately, of medical debt. So there’s lots of different ways people can engage with RIP. So I would just say, check us out. The other thing is, we are looking to buy debt. So if you are part of a hospital system or you have access to a hospital system, reach out to us too because we both have to buy the debt and get donated dollars to do that. We have to get the debt to be sold to us. So any hospital systems out there that are listening? Give me a call.
Speaker 1 [01:03:30] If there’s any chief financial officers of a hospital system who are still listening after I talked so much shit about you 20 minutes ago, please get in touch with Allison Sesso at RIP medical debt and work with that. No, that’s a point well taken. For folks out there who are (I want to make sure I don’t forget about this) struggling with medical debt, who have $5,000 in debt on their books that they that they can’t get rid of. They can’t email you and say, ‘Hey, please buy my debt’ because that’s not how you do it, but what can they do instead? Do you have any advice for people who are in that situation?
Speaker 2 [01:04:05] Yeah, absolutely. There’s a lot of nonprofits out there that are helping people. I definitely think people should look at the charity care policies of the hospital they might have received care from. There’s a group called ‘Dollar For’ that I would give a shout out to, that really helps individuals weed through that insanity of the system and really helps get the charity care that they need. So yeah, there’s a lot of different nonprofits. If it’s a specific disease, there are certain nonprofits will pick up debt for specific diseases. You can check it on our website. We do have a page for people to have other resources as well.
Speaker 1 [01:04:40] Amazing. I mean, the work you do is so cool. I’m going to go make another donation to you guys right after this conversation because I’m inspired to. I hope folks listening come check you out. Allison, thank you so much for being here. Just tell us your website URL real quick, before you go.
Speaker 2 [01:05:02] www.RIPmedicaldebt.org
Speaker 1 [01:05:03] Wow, so obvious, I don’t even know why I asked. You all could have guessed what it was.
Speaker 2 [01:05:09] And follow us on Twitter too.
Speaker 1 [01:05:13] Allison, thank you so much for being here. This has been an awesome conversation.
Speaker 2 [01:05:16] Thank you, Adam.
Speaker 1 [01:05:22] Well, thank you once again to Allison Sesso for coming on the show. Their URL, once again, is RIPmedicaldebt.org. Check ’em out. That’s RIPmedicaldebt.org. That is it for us this week on Factually. I want to thank our producer, Sam Roudman and Chelsea Jacobson. Our engineer, Ryan Connor. Andrew W.K. for our theme song. The fine folks at Falcon Northwest for building the incredible custom gaming PC that I am recording this very episode for you on. You can find me online @AdamConover or at adamconover.net. You can send me an email at firstname.lastname@example.org if you want to tell me what you think about the show. Thank you so much for listening. We’ll see you next time on Factually.
July 26, 2022
How can we best help animals, when it’s we humans who cause their suffering? Animal Crisis authors Alice Crary and Lori Gruen join Adam to explain how the same systems that hurt and kill animals also harm humans. They discuss the human rights abuses that happen in industrial slaughterhouses and how palm oil monocrops are devastating the world’s rainforests. They also share how we can have solidarity with animals in our daily lives. You can purchase their book at http://factuallypod.com/books
July 19, 2022
In times of turmoil, it can be useful to take a longer view of history. Like, a LOT longer. Paleontologist and author of “The Rise and Reign of the Mammals” Stephen Brusatte joins Adam to explain how mammals took over the Earth hundreds of millions of years ago, and why we survived and achieve sentience when dinosaurs died out. Stephen goes on to discuss why taking a deep look at our history can help prepare us for the crises of the near future. You can purchase Stephen’s book at http://factuallypod.com/books
July 13, 2022
Trans people have existed as long as, you know, people have. But the barriers to legal inclusion and equality are still higher than most people realize. “Sex is as Sex Does” author Paisley Currah joins Adam to discuss why institutions have been slow to give legal recognition to trans identities, why Republicans have shifted their attacks from bathroom policies to trans youth in sports, and why the struggle for trans equality is tied to feminism and women’s liberation. You can purchase Paisley’s book at http://factuallypod.com/books