Factually! with Adam Conover - Death to Medical Debt! with Allison Sesso

Episode Date: January 19, 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.  Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way I don't know what to think I don't know what to say Yeah, but that's alright Yeah, that's okay I don't know anything Hello and welcome to Factually. Adam Kahn over here.

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. That's right. 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. sense 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. I mean, human plus time equals you got to go to the hospital eventually. All right. You can get cancer. You can get hit by a bus. One of your organs could just up and fail with no notice. OK, you got no control over any of it and it'll happen to you at some point. And when it does, you need very, 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 or 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, well, the cost per person is quite low. Basically, on a mathematical level, when you've got a huge risk like that that could bankrupt you or throw you into debt, the best way to deal with it is to spread it among as many people as possible so 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 where 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. And that means when it comes time for that pool of money to pay out to you because something bad happened to you, well, 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. And the result of this is that one in five U.S. households now has medical debt. Now, the average debt is $2,500,

but many people carry much, much more. Now, 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 it 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. And 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 RIP 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, Executive Director of RIP Medical Debt. Please welcome Alison Sesso. Alison Sesso, thank you so much for being here. I appreciate the opportunity. So tell me about RIP Medical Debt, RIP Medical Debt. Tell me what it is that you do. debt, RIP medical debt. Tell me what it is that you do. 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 burdening them. And that's what we do. We're a nonprofit institution. So you take donations. I donate, you know, a hundred bucks to you. You use that money to purchase medical debt. Tell me, how does that work? Who are you purchasing it from? Yeah, so you give us a hundred dollars and we get rid of $10,000 of medical debt. So that's- Yep, that is for real.

We have a one to 100 ratio of return on investment. So it's a great thing to put your donated dollars towards. And 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 can 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.

And so we are able to take that model and turn it into a charitable response. So, yep. There's so much here I have questions about. I mean, this is amazing. But first of all, I think I don't often think about the fact, and maybe I haven't always realized that like debt is something that is bought and sold by other people. Like when I take out a loan from somebody for medical debt, for a mortgage, for my credit card. This is the United States of America. My debt, I owe somebody money, but then what?

They sell the fact that I own money to someone else and now I'm in debt to a different person. Correct, exactly. That is everything, you know, everything's a commodity in the United States of America. Sure, of course, of course. I mean, water is, so of course debt is too. Exactly, so yes.

So is it, so you're buying it at a very steep discount. You're buying it for pennies on the dollar. And why is it so cheap? Is it because this is debt that, you know, somebody was like a collection agency was trying to collect and they, and the person doesn't have the money. And so, you know, it's like, it's like sort of distressed debt or something? Yeah. So basically debt is, is it's about the debt buyer, like going to go to a hospital and a hospital or a physician group, whoever, you know, the medical debt starts with, um, and they buy the entire portfolio, right. On the bet that some portion of that portfolio they can collect on, right. That there'll be able to show, to put it on somebody's credit report and there'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 for that bet to ensure that it pays off, the entire portfolio's cost has got to be fairly low. And so that's why RIP Medical Debt is able of take advantage of that pricing and compete with the debt buyers and buy the, you know, buy the debt off the market and pay.

And just instead of collecting on it, you know, it's relieving people of that debt. Okay, I have a better metaphor for this. This is like when people buy a storage unit that's like full of crap, like on that show Storage Wars. Yes. And they buy the whole storage unit worth of shit for like $100 because they're like, well, it's probably just full of some hoarder's garbage. But maybe the Mona Lisa's in there. Exactly. 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 what? Forgive it. You just say now, now none of you owe us any money. Right? Exactly. Um, And I actually, I will tell you, I've been very careful to try to move our language along

to not say forgive, because I feel like I don't like the idea that it's this 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 words like that very intentionally. I like abolished.

Yeah, I do too. That feels good. We're abolishing that medical debt. And so whose debt is this, who are the folks who have this debt that you are abolishing? 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 all their debt. You abolish their debt. And then you send each of them a letter. Congratulations. The twenty thousand dollars that you owed because you had a heart attack or whatever. You no longer owe that money to anybody. Precisely. And so how we do it, though, it's it's it's source driven, if that makes sense. So like no one should ever call me and say, can you get rid of my debt? Because I can't. say, can you get rid of my debt? Because I can't. I go to the source. So 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? And can we look at it and analyze it? And the difference between us and a debt buyer is I'm more interested in the people that are on the poor and that can't pay it, right? 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, I'm, you know, that is wealthy and that the debt is relatively small. Like say you make a hundred thousand dollars and you have a thousand dollar debt. I'm not buying that debt. Like you're still responsible for that. Right. But if you are, you know, under 200% of poverty, or if the debt itself is 5% 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. And then I buy that entire portfolio, which could be a million dollars that I'm spending, but I'm, you know, buying millions of dollars of debt. And then exactly what you said, I send out letters to those but you're relieving many, many, many millions of dollars. Exactly. That's correct. And you're making sure that these are folks who the hospital and that's the credit, the credit bureau, that they 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. Exactly. And so tell me about what a difference this makes to people, because I sort of wonder, OK, if you're on the books of the hospital and they say this person owes us one hundred thousand dollars, this person makes 15 grand a year. They're unemployed. They're disabled. They they have, you know, all the you know, the many, many problems of life that might

mean they can't pay it back. Right. 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. That's right. They're not able to. But, you know, 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 take, you know, garnish your wages. They could, 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 credit report mark on your credit report so you don't have access to credit, right? 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 as sadly, it's the mental anguish it creates for people. I mean, people really, debt is a, is a real tool. And historically, you know, if there's racism that's like all embedded in it. Like it has been used to hold people back and to really constrain them. And so I think that that mental anguish and the cultural like feeling that it creates for individuals is significant. And really some of the debt that we relieve, the letters we receive back from people are like the amount of mental anguish that they clearly are being relieved from is significant. And then on top of that, there's actual, like people don't go to the hospital because they're worried about getting medical bills.

And so there's actual consequences of knowing you already have a debt that you don't go and get the care that you need. And so there's, there's lots of really layers to this. 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. And I imagine, are these folks who have already had the collection agency beating down their door about this when you buy the debt?

I mean, it actually depends because different hospitals take different actions, I've learned. Some of them, you know, are more aggressive than others. You know, some do have policies where they, in fact, I think it's, this is actually a nice thing. It's a growing trend that hospitals don't sue patients that they, a lot of them don't actually don't 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. Right, they don't necessarily like to advertise that because they want people to feel like they're on the hook, right? 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. I mean, you know, one in five households have medical debt. And this is before COVID. So it's a real systemic problem in the United States. Yeah. So let's talk about, let's move to that systemic problem. When we talk about medical debt as, I mean, one in five households, that is, that's a lot of people who have medical debt. How much debt are we talking and why does that debt, why do they accrue it? Yeah. So, so it's, 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, but not all medical bill, which is huge, 140 billion. I mean, 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, the, you know, 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 it's just sitting on hospitals books. Is that but if it's not on people's credit reports, is it is it harming those people or is that just a liability then for the hospital that like, oh, we've got all this debt that we can't It's a funny thing that you ask. I mean, I think it is still harming them. You know, I would argue that it is because, again, the hospitals haven't told the individuals we're not collecting on that debt for, you know, that we haven't put it on the credit report.

The hospitals aren't they may not be even reaching out to the individuals, but the individual got at least one bill and knows that that that's out there. So very much is impacting their decision to go to the hospital or not. And it may be impacting, you know, they're and 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. And it may even impact their decisions to buy a home because they think that they owe that bill. Like so the idea that just because it's not on a credit report, that it has no impact, I don't buy it. Yeah. And just tell me, if you could walk me through, like, if I'm someone who has the kind of debt that you relieve, how do I accrue that debt? Like if it just, what's a scenario that. Oh, there's so many. Okay. So it could, you know, first of all, the myth that

it's the uninsured only not, you know, that that's definitely a myth. You can absolutely have insurance. In fact, a growing number of people who have debt have insurance. Insurance is just shitty. Yeah. Yeah. And increasingly so. Yeah. I mean, my, my, uh, my very good friend and a writer from my show, Brian Frangie used to

do this incredible joke about how, what we say about health insurance, he's a standup comic. What we used to say about health, what we say about health insurance is like, oh, I broke my arm. Luckily my insurance covered it. Like, why do we say luckily? Because we all expect that you don't, we don't do any other business. You don't go to a sandwich shop. Oh, I gave the guy $10 and then luckily he go to a sandwich shop oh i gave the guy ten dollars and then luckily he made me a sandwich right please credit the very funny comic brian frangie for that joke i did not write that joke i'm i'm aping his delivery um but yeah that's the like exactly i mean i i've got i'm very lucky to have union health insurance it's very good

health insurance and there's i still have to be careful what will it won't pay. And I have friends who say, Oh, you know, the, the writer's good health insurance didn't cover this necessary procedure, et cetera. So it's a real, it's a real problem. Exactly. So, so increasingly people who have insurance end up with medical bills because, because it's full of loopholes because there's, there's a deduct, a large part of it is that there's huge deductibles that people have to pay increasingly i mean and if you have a five thousand dollar deductible and you're living paycheck to paycheck guess what you're not going to pay the deductible and you're going to end up in medical debt i mean a lot of the bills are not you know 140 000 bills that we relieve they're a thousand dollar bills they're 500 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 we're out of network, you know,

or, you know, it could be anything. I mean, they say that a lot of like, or you got a really, you know, bad lot handed to you. You end up with cancer and sometimes, you know, that ends up being very costly. And they, you know, they say that like a lot of people use and lose a lot of their assets that they've accumulated over their life because they got, you know, they say that like a lot of people use, use and lose a lot of their assets that they've accumulated over their life because they got, you know, cancer. Yeah.

And can you imagine like you get cancer and then you lose your financial standing too? I mean, God, can life be more of a bitch to you? Like, it's just not okay. Yeah. You're suddenly bankrupt or you have to, you have to sell your, your assets or your wages are garnished just because you got sick and suddenly and your insurance doesn't cover it. Right. It's like kicking you when you're super down. Yeah. Yeah. Well, and one question I have is when we talk about debt numbers, you know, a bill, the debt that you're relieving, the total debt. It's so hard to figure out what, whether or not those numbers are real, because I think we've all had the experience of getting a bill from, you know, I've had the experience of having a surgery, minor, 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. Okay. Everyone curious at home. This is like 10 years ago. I had a little, I had a little abdominal hernia and they put in a mesh. I was under anesthesia. Very normal. Very normal. It was outpatient and all that. Right. Yeah. And I remember going to the doc, the surgeon, and he's like, okay, if we do it in this place, it'll be good for your insurance. Like that way it's going to cost less. He like brought out some numbers and like circled some things like you want to do it here. I was like, all right, I guess let's do it there instead of the hospital at this outpatient place. I go 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, what do 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. So I don't owe you this money. And they were like, nah, like it was very, even though I had insurance and they told me it was covered.

It was like, it was on like, it was like on sand. I felt like, you know, it was all falling underneath me. And I've done a segment on Adam Ruins Everything about the charge master, about how hospital bills are essentially arbitrary. They just make the number the numbers up. Correct. That is accurate. OK, good. I'm glad. Because they're just a starting point for negotiations with the insurance company. That is exactly what they are.

And thank you for saying that, because I don't think people understand that and that they they absolutely keep saying like 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. Yeah. Yeah, exactly. Like the, you know, okay. We're, we're going to charge you a hundred thousand dollars for a roll of gauze. And you're like, I have to pay this. And, and they're not telling you, I'm going to go to CVS and get my own gauze and bring it in. You're a great guest. No, but yeah, because it's a starting point to say like the insurance company

goes, fuck you. We'll only pay you 50 or whatever. And OK, you got us. That was a starting point. But if you don't have insurance, you get charged that full amount. So, you know, 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? Well, so I would just say, first of all, I am infuriated that patients are in the position to be negotiators in the middle of when like they're again, they're being kicked, like when they're down, like you just said, they have a great story. You're going,

you're getting hernia. You're like, crap, like, you know, you're not, it's not a death sentence, but it's annoying. Who wants to go for surgery? And in the middle of that, you have to have this conversation about like, oh, like 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? Like you shouldn't have to worry about that. You should be focusing on your wellbeing. Um, but our system doesn't allow you to do that. And then once you were in the middle of recovering, they're also following up and giving you like a heart attack bill, right? That's like $50,000. And you're like, what the heck is this? And so you got to spend your time, you know, hobbling along with your hernia and your new mesh in your body and like make a phone call and get like 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 like underlying your own well-being, which is their goal. It's just, it doesn't make any sense. And so, you know, we're really just at at RIP medical debt, we're trying to think about all these different moving parts and how can we, 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 patient stories so that we get rid of, we point to the system, not the individual who owes the debt, and that we really say something more like 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. Yeah, because you're not going to solve medical debt by just buying it, you know, pennies on the dollar, leaving it for people. This is you're also doing this to make a political point and a policy point about here's how fucked up American health care is.

We'll 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 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 that you should support to support the show. And we'll be right back with Alison Sesso. We're back with Alison Sesso. So we were just saying that your organization, RIP Medical Debt, which buys medical debt for this,

for very cheap amounts, and then relieves massive amounts of debt from people. You're not going to solve the healthcare 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. Yeah, so I think that our organization does two things. One, in a very real way,

we help people who are at the end of this problem, right? And we actually, 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, you know, a new job in several years from now. And because we've figured out a more systemic way of dealing with this, you know, in the meantime,

I'm happy to be relieving the debt and, you know, leveraging this model. But what I think is 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, you know, who used to work, actually used to run revenue cycle for a major hospital system, more than one actually, has likened like this whole thing, like the patient is like the child in a bad divorce. And like, it's like the insurance company is the father, like trying to pay the bills and the hospital is like, you know, the

caregiver, the mom, and they are fighting it out. And in the middle of it, the patient or the child is kind of like, wait a minute, like, why is this problem falling in my lap? Like, I'm just trying to be taken care of here. You know, it's like such a good analogy. And, you know, and I think that increasingly our solutions are falling short. Like they're, you know, look, no surprises. That's good, right? It's progress. Transparency pricing, I don't, you know, I'm not thrilled about that. I mean, it doesn't really do much. Is that something that places, is that a new trend,

transparency pricing? Yeah. It's this idea that like, you know, the hospitals have to show what their prices are, but if their prices aren't based on anything that's really rational or you can point back to anything, then it based on anything that's really rational or, or, or you can point back to anything that it's, it's not really that helpful. And increasingly the patient is in a position to navigate this, like Mishigas, you know what I mean? It's like the patient is there trying to like figure out like, well, what does my insurance cover? And like, how much should I be paying? And if I go to this provider and if I negotiate or if I, you know, it's just it's madness. It's honestly it doesn't make a whole lot of sense.

And it undermines the overall well-being of people across the United States. And, you know, 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 it's colliding into this medical debt insanity. Yeah. When you let's let's talk a little bit more about that with the debt piece. Yeah. When you, let's, let's talk a little bit more about the, with the debt piece of it. When, if you were not purchasing the debt from people, I mean, are there situations where people are, you know, this is like sold to an aggressive collection agency that's like, after people and that kind of thing? Yes, absolutely. I, you know, collection, I will say, you know, collection agencies are not, you know, just inherently all evil or anything like

that. I think that that is a perspective. Do they go after people? Yes. So are some of them super aggressive? Yes. Um, but ultimately, um, they are a for-profit business. That's, you know, I mean, it's part of the, that's part of the United States. And I just, you know, feel like that's something we should pay attention to. But I do think that 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. Right. And they do focus appropriately, like people. I mean, it makes sense, right, that they're 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 be by them. And that's really a big a big problem. And, you know, the idea that even people say, like, well, you know, this person can afford to to pay this medical bill, like, OK, but what are they sacrificing? Like, is it OK that because your child needed some kind of special surgery or something like that, that you then that year can't take your kid to Disney? Like, I know that sounds like, oh, well that's, you know, middle-class issue, but like, that's, that kind of seems like a ridiculous expectation to me.

And if you're the person who is like, okay, so you're, you're below the poverty line that the collection agency considers. We're not going to collect below this. Okay, 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. Correct. Exactly. Absolutely. You know, there's people way further up the ladder who say, oh my God, this place called again, whatever. I'll just cut them a check. 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, on the overall sort of economic, you know, livelihood and health of our society to have this. Yeah, 100%. I mean, some of the stories we receive from people are

just like gut-wrenching. Like, you know, to think about, you know, I'm in the middle of, we had this one story of this woman who was a nurse and, you know, she needed help and she was getting bills from her own hospital. And, you know, we relieved like a thousand dollar bill from her and she was just so excited about it. And so like, it felt like such a relief for her. And, you know, that had that bill ended up in a collection agency's hand. I mean, she's a nurse. She probably made, you know, enough money where she would be on the list of people that they would have followed up with. And, you know, meanwhile, she's like, 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, you know? So it's stories like that, that are just, they, they, they sort of show and pinpoint the absurdity of the way we approach all of this. I mean, speaking of COVID, what effect has the pandemic had on the problem of medical debt and on your work? Yeah. So I don't, 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, right? So like, it's kind of like, we're not sure if it's like a wash, like how it impacted. We do know like, you know,

like most things, medical debt is worse for people of color in general. And I know that the pandemic was worse for people of color, especially on the I know that the pandemic was worse for people of color, especially on the economic side of things. So my guess is 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, right? And 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 a lot of people lost their jobs. And in this country, we time medical medical insurance to whether or not you have a job.

Right. And so and whether or not you have the right kind of job. Right. I was just going to say, like you said, you have union coverage. That's great. You know, that's a lot of people don't have that. And we got to fight to protect that coverage every single time we go to negotiate a contract because it's we all know we're so lucky to have it. And, you know, what's happening is it's probably impacting the rates of payment, too. Right. I mean, so because the insurance in order to protect that, that's your negotiating point. You're holding tight to that insurance and you're losing ground on the payment side. No, exactly right. And that is why people talk about, you know, why unions are for, we have good health coverage. Why would we support, you know, a single payer healthcare system? It's because if we didn't have to fight for that,

then we could go in a negotiating table and instead say, well, hey, give us on this next contract, we need to fund the health plan. We would say, no, just pay us more money. We wouldn't have to fight for this. And again, this is me being in a very fortunate position to be in a strong union, but I'm sorry. Well, I went off on a tangent.

Please return to your point. No, no, no, it's fine. No, but so 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. And so I think that that had real impacts on medical debt. If you got sick with COVID, I'm very interested to see in like a year or so from now, you know, because again, it takes time to really look at the medical debt numbers just for there to be some kind of study that really looks at people who got COVID versus, you know, who ended up in the hospital, whether or not, you know, they were fully covered. It probably depends on the hospital that they went to and what that kind of looks like. And also, frankly, you know, whether or not people that were vaccinated or unvaccinated, like there's so many dynamics to

this whole COVID story that interact with medical debt. I know 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. I mean, there were special laws put in place to deal with COVID that all of a sudden, you know, it was supposedly paid for. sudden, you know, it was supposedly paid for, but they were confusing and they put a lot of the, a lot of the control in the hands of the hospitals, as opposed to the individual, like this, the cares act that was, that was done under Trump allowed hospitals to bill, to bill the, the, the United States government, but they could decide to first bill the individual.

That's different than like letting, 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 the hospital's hands, which I don't think was probably the best move. Wow. Yeah. I mean, I've, I've been thinking a lot lately about how we're, we are not going to understand the impact of COVID-19 for, we're going to be feeling it for the next decade. Like changes, changes, changes have happened medically, politically, economically, that, that we're still, you know, the change is under the surface and it hasn't yet really bubbled up yet. We haven't yet appreciated it. But talking about medical debt, like you are, you're relieving medical debt, but your position is that we should abolish it altogether. That is something that that shouldn't exist. I mean, you were saying about collection agencies.

Hey, they're not all bad people. And I would maybe agree with that. But say there are people who are profiting off a system that should not exist, similar to like 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. So 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, you know? Right. And so that's my view. Maybe you share it. But so I think we're alike in feeling

we should not be funding healthcare this way. We should not be saddling people with so much debt. So how do you use the work that you're doing? You're doing direct aid, which is incredible. Yeah. 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? Yeah. So there's a couple of ways. So first of all, this is a little bit of a new direction for us. I mean, we're a fairly young organization. We only started in 2014. So I mean, and we've, and like I said, we've abolished $6 billion in that time. I know it's crazy. It's crazy. We've yeah. So that's a pretty big chunk of you said earlier how many billions

140 billion 140 billion total but you've abolished six yes that's not bad i'm not you're looking at me like hey don't hold me to that like i'm not trying to say we're the supermen or anything but but i am like i am impressed that's a huge number thank you i and it's look people donate to us and that i mean that's how we do it right we got we got a 50 million dollar gift from mackenzie scott which is uh formerly the bezos um i like i i really imagine every time she writes a check she's just going fuck you jeff there we go give that to rip because jeff's not donating that shit he's going to space but she's like i'll fucking spend your money motherfucker sorry go go on so that's wonderful yes she she was it was a huge help i mean it's not look the amount of debt

out there is a lot bigger and you know obviously but that's significant um and it makes it makes a big difference so yeah so what are we doing yes. 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, with a finger at the system. Right. We just hired an amazing director of public policy. She started at the beginning of this year. This is her second week she's here. And look, she's going to be looking at how RIP 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. And so what do we have to offer? We have the client, we have these, you know, these stories of these individuals. We also have data. I mean, we're working with these hospitals. We're getting a lot of medical debt. We can look at the data and say things like, you know, how large are the debts? Who do the debts belong to? You know, 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 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, like having this conversation, having my voice out there and talking about this issue, I think makes a big difference. So you're able to do. I really like that point where you are buying these huge tranches of debt and you're able to do research on that debt. and you're able to do research on that debt.

You're able 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 like, who is this harming and that sort of thing. The other thing that's actually really important is kind of like a middle between like 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, right? So like hospitals, most are nonprofit and they have a requirement to provide charity care in order to have that nonprofit status. And so when we look at their files, we find like holes in their system, if you will. Right. Like we're able to say, like, 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're not you don't have good enough outreach efforts or you have holes like, you know, 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. And so fix your charity care policies. And we've seen some success. Like we've given some of this feedback to hospitals and they've changed some of their policies in a way that hopefully reduces just at that hospital level, how many people end up with medical debt

because more people end up with medical debt because more people end up in the charity care bucket. And so I think there's a couple of ways that we're also, you know, moving the ball and trying to, as our mission states, end medical debt. Well, that's great, but it does put me in mind of what might be a tough question. I hope you don't mind. Is that we've been talking about how, you know, hospitals bear responsibility for this problem to some degree because they are the ones setting the prices. A lot of the prices are fake. A lot of the – not all the hospitals are good actors. Many, many hospitals in the U.S. 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, right? So do you have any concern that if you are working with hospitals, it's on your website, 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, right? You're taking the debt off of their books. So are you worried at all about, you know, that you are, you know, not contributing to the problem, but, you know, you're helping out the folks who are propping them up is the language. Is that a concern at all for you? Yeah. No, you know, we're definitely conscious of that. I mean, I certainly don't want to be used by a hospital, you know, to say like, oh, we're not, you know, we're going to clean up our image and,

you know, work with our medical debt. I'm definitely very conscious of that. Oh, it is. I mean, it's 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, right? Like, should somebody who, should I, you know, not get the debt that a hospital has and help that individual that's at the end of that because of this concern, like, I don't think that that's, you know, I think that's not a good trade-off. I also think that I'm not sure who's at fault here. As I said before, like, yes, hospitals are problematic, but so are insurance companies. Like, they both are problematic. And so, I think hospitals are, unfortunately, big bureaucracies. I don't think that they're like intentionally bad actors.

I think that they're also caught up in a bad system. I mean, increasingly we're talking to them and they struggle. I mean, a lot of them are trying to do good, 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 that are trying to, you know, move things forward.

But, you know, 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 like a bigger problem that's beyond the hospital's doors. And, you know, increasingly, the insurance companies aren't paying a lot of the bills. Increasingly, people are showing up to their doors that are underinsured. And so they've got to eat those costs. You know, I think that that it's it's more complicated than just being able to say, well, the hospitals are at fault. I don't I think that there's all different players that are at fault here. I think you're right. I also think, though, that in our conversation, and this is just my own personal hobby horse

that's a little bit off topic here, but I think that when we talk about the problems with the healthcare system in America and why everything's so expensive, we tend to point the finger at the healthcare providers a little bit too little. Everyone beats up the insurance companies all the time. And then, well, we should reform healthcare. Oh, the doctors and the hospitals are saying that's not great for them. Well, we need to remember that the doctors and the hospitals in many, many cases are profit seekers who are, you know, who the hospital shouldn't be the richest company in the entire county, right? If you look at the most highly paid public employee across, you know, most states, it's number one, football coaches at universities. And number two, it's the people who run like university hospital systems and things like that, because it is so, so lucrative. And guess what?

Maybe it, maybe it shouldn't be. And we. And we have a reticence to point our finger at the people providing the care because we want to be grateful to them and they're experts and they know their business. But at the same time, I think, you know, that's what was why in our episode, Adam Ruins the Hospital, we said the charge master problem

is it's not just the insurance companies we have to point at the hospitals too. So, but I think that's a really wonderful nuanced answer. And I, and I thank you for it. I'd love to know policy wise, if you could, you know, snap your fingers or say you go, you know, you go sit down with a bipartisan group of senators and they're listening to you. What, 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? Yeah, well, you're not going to hear me say, you know, it's Medicare for all. We're not in a position to really, like have all of the answers here and and because this is such a politically touchy issue i get it like it's it's complicated and and um uh it's just it's a difficult thing for us to wrap our hands around um because of the fact that we are in a for-profit system that uh is going to be a lot towind. 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 government more money. So you could expand Medicare so that there's more people that are covered. You could expand Medicaid. You definitely should ensure that we build off of the ACA to make sure that there's people have insurance that actually they can afford, meaning that they don't have deductibles that are going to they can't end up meeting. So I liken that to like, you know, subprime mortgage loans. Like there shouldn't be the ability to get an insurance, a health insurance policy that you can't afford at the end of the day. Like you didn't get regulation. There shouldn't be such a thing as an insurance policy, which has a deductible, which like, you know, based on your income, you can't afford it. Yeah. Like an insurance policy with a $50,000 deductible is like, why, why is this even being

sold? Right. To you. If you, we know when you buy it, what your income is, right. We know you're not going to 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 okay. But that's what I would suggest. I would suggest that that happens. I would suggest that, you know, 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 could be also, you know, there needs to be actually more regulation of what is allowed

in terms of collections. Like, you know, 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. You know, this is this is not something it's different than other other types of debts because you have a lot less control over it. You know, it's not like 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. Like, you know, maybe you're young and you

don't know and whatever, but you do, you do have a set, like when you're walking around the world and you get hit by something and you have to go to the hospital, it's like, you know, there's, you just, there's nothing you can do about it. Or all of a sudden you come, cancer shows up in your life. Like it is different. And I think that, that, that needs to be acknowledged. Look, I, I, I do want to say, I friends who have 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 own 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 like mandatory for surviving in today's economy. It's not a luxury. It's not for fun. It's like you got to have it. And so why are people impoverishing themselves in order to get it? 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. And yeah, anybody could be walked down the street, be hit by a bus. Anybody could have a random congenital condition. Anybody could get cancer. Exactly. And you could, by the way, your point earlier about a teenager or about to get into college, you don't understand finances is 100 percent true. The thing about medical debt is you could understand finances. You could, you know, be very eyes wide open and still not be able to avoid it. Yeah.

And it's just because the system is set up where these expectations on the patients are completely unreasonable and irrational. Yeah. Well, look, I understand why you as a nonprofit that's working very closely in this space are, you know, sort of, you know, not able to say, oh, we're going to go for Medicare for all because that's a very big picture proposal that is, you know, political football. Um, I myself, you know, lean toward, no, I'm serious. I bet, look, I've been, I've been on earth a little while now, right. We've been doing, we've been talking about single payer for a long time. Right. And we've been through a number of rounds of reform here. And, and, uh, you know, so I, I've started, you know, sometimes I'm an incremental, I'm like, I'm an incrementalist. Sometimes I'm a, we got to start from scratch. Right. Um, and I guess the, I guess the question I have is, um, you know, having when, you know, when the ACA was signed as like, all right, Hey, we got a great big package reforms here.

We're taking a great big step and it was super, super hard. And maybe this sort of way is to go, Hey, maybe we, maybe we get halfway there and we get halfway. 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 them 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 fixed the problem. And so, you know, a lot of the reforms you spoke about saying, hey, we have to make sure that the government is supporting this and that

type of assurance. That sounds like the smaller, like the smaller steps. Is there a bigger one that you, that, you know, you like hope to see somewhere in the future, even if it's not going to happen next year? Yeah, I mean, look, I like the idea even of a government option. Like I think that that's, you know, and I think that that's,

and again, this is not RIP endorsing any of these things yet. We haven't sort of figured out exactly what our public policy is. But I like that idea because I do, again, and I think government, there has to be, 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 like really, you know, providing people real coverage or subsidizing, you know, existing plans in a way

that ensures that people do not have to pay that much out of pocket. And these other little things, Frank, and to me, I think those are pretty big changes that would make a big difference. Yeah. You know, frankly, my answer about, you know, not Medicare for all is because I don't know how you unravel the system. The problem is that actually we are so in over our heads, I feel like, 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. You

know what I mean? I want to be realistic about what we can accomplish and stop the bleeding for these individuals. And so, you know, I even think, frankly, a government option is probably a really heavy lift in and of itself. So, you know, my answer really is, it's not just about what's like, you know, 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 things. You know, there's huge insurance industries like where would all those people work? Like, I get that those are those are questions that like have to be answered. And you don't you don't keep a policy in place because, you know, it employs people. I mean, then you would be like, well, then we just keep jailing people because, you know, there's people that work in prisons. Like, I get that 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, you know,

I mean, if I could, you know, turn back time as Cher would sing, you know, I would go back to the 1940s when Truman tried to get us to go in the right direction, where the rest of, you know, other countries in Europe and stuff were going in terms of getting our hands around how we support healthcare. And we didn't do that. And we, you know, I don't know if you know this, but we didn't do that because of this, like,

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 that people were convinced culturally that that was bad and not, you know, American. Yeah. So it started then. The for-profit medical industry around Truman's time. Yeah. They sent out, I think they like sent out like vinyl records,

like telling people it was socialism and, you know, ran commercials and things. And it was an intense like campaign against socialized medicine, which is the exact same thing that we'd hear today 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. Like I hear Bernie Sanders in the back of my head going like, you know what I think isn't realistic? It's paying trillions and trillions of dollars for blah, blah, blah, blah, blah. Right? And I'd say, yes, very, very good point. That is not realistic and that is very bad. And there is, you know, 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. And 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. You like here here in california we're about to get into that right because they're the the um a group of state legislators brought a new like proposal forward very early days about creating a new single-payer system uh i think it's called they're going to call it cal cares and it would be like a full single-payer system in the state of California. And there's an incredible amount of work to do because we've got, you know, this incredibly large medical system and you've got millions of doctors, you know, millions of health care providers.

You've got companies, you've got hospitals, and every single one of those companies are going to say, whoa, whoa, whoa, hold on a second. Hold on a second. Hold on a second. 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 get us if, you know, you should 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. And it's, and you know, it, it, know, 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 we'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. And, you know, 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, like we need to- Change is incremental. I mean, that's just real. I mean, and I have to say, by the way, good for Bernie Sanders. Thank God for him out there screaming about this issue. Like, that's what we need, right? Like you do need people saying this is insanity, which he does a very good job of and you do a good impression of him. But, you know, so I think that that we need voices like that saying like and throwing out big, bold ideas. And that's how you get the incremental change to actually happen, right? So it takes a lot of different strategies. And, you know, frankly, the politics matter a lot. And in this country right now, they are a freaking mess. And so getting them to do anything, even if everyone agreed, getting it done, because who's going to get credit for it, is nearly impossible.

Well, and people say politics, and 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 involved who's involved in the health care system and everybody who who's a stakeholder, like 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. And it's not just fucking AOC versus Mitch McConnell, right? Exactly.

It's a lot, it's a lot, lot bigger than that. There was some other, there was some other point I was going to make that, you know, like it's, well, and here's, here's the last thing I'll say, because I know this is not your, you know, like it's well, here's here's the last thing I'll say, because I know this is not your you know, you work for a nonprofit. You're like, oh, boy, I'm talking about politics. I don't want to get into this part. I'm OK with it. OK, good, good.

Yeah, you can hang. You can hang out. 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 like 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. And that's something that like people can really get behind. And it shows you a path. Hey, OK, Medicare for all. Well, you know what's 50 percent of the way there? Medicare for more. And so we can expand it as much as possible. And we've got a clear,

we've got a clear, you know, sort of 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 forward. Right. 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, right? So like, 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. that gets people to agree that we have to address this issue.

Yes. Okay, so let's bring it in for a landing here. How do people, you know, 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? Yeah, I mean, donations are what drives RIP Medical Debt. I mean, if you want to feel really good and make, you know, a $10 donation, you can get rid of $1,000 RIP medical debt. I mean, if you want to feel really good and make,

you know, a $10 donation, you can get rid of a thousand dollars worth of medical debt. I mean, this is, this is one of, I've talked about on the show before, you know, when, when I, I, I donate a certain percentage of my income every year and I look for those opportunities. They're like, where is the dollar going to go the furthest, right? There's, there's bed nets for malaria, like the Against Malaria malaria foundation there's give directly direct cash grants to people in need this is up there one dollar gets rid of wait sorry one dollar gets rid of ten thousand dollars it's one to a hundred yes yes that's right that's that is so massive if you if you think you donate a hundred dollars and someone is going to get a letter

saying ten thousand the ten,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 is such a cool thing you do. Yep. And the thing is, you can just give directly to us or you can also start a campaign. I mean, 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, you know, go on social media,

have a party, do whatever you need to do, get local corporations, et cetera, to give and to, you know, raise $50,000 to really get rid of $5 million ultimately of medical debt. So there's lots of different ways people can engage with RIP. So I would just, you know, check us out. The other thing is, you know, we are looking to buy debt. So if you are part of a hospital system or you are, you know, have access to a hospital system, reach out to us too, you know, because we both have to buy the debt and get donated dollars to do that. And we have to, you know, get the debt to be sold to us. So any hospital systems out there that are listening, give me a call.

If there's any chief financial officers of a hospital system who are still listening after I talked so much shit about you, like 20 minutes ago, please get in touch with Allison Sesso at RIP Medical Debt and work with them. No, that's a point well taken.

And for folks out there who are, I wanna make sure we don't forget about this. Folks out there who are struggling with medical debt, who have $5,000 in debt on their books 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? 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 Four. I'd 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 or there's like certain nonprofits will pick up debt for like specific diseases. You can check it on our website. We do have a page for people

to have other resources as well. Amazing. I mean, the work you do is so cool. I'm gonna go make another donation to you guys right after this conversation, because I'm inspired too. I hope folks- 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.

Sure. www.ripmedicaldebt.org. Wow. So obvious. I don't even know why I asked. It was just, you all could have guessed what it was. And follow us on Twitter too. Yeah.

Allison, thank you so much for being here. This has been an awesome conversation. Thank you, Adam. Well, thank you once again to Allison Sesso for coming on the show. Their URL once again is ripmedicaldebt.org.. Their URL once again is ripmedicaldebt.org. Check them out. That's ripmedicaldebt.org. And that is it for us this week on Factually.

I want to thank our producers, Sam Roudman and Chelsea Jacobson, our engineer, Ryan Connor, Andrew WK for our theme song, the fine folks at Falcon Northwest for building the incredible custom gaming PC that I record this very episode for you on. You can find me online at Adam Conover or adamconover.net. You can send me an email at factually at adamconover.net. If you want to, you know, tell me what you think about the show and thank you so much for listening.

We'll see you next time on factually. That was a hate gun podcast.