End Medical Debt: Curing America’s $1 Trillion Unpayable Healthcare Debt, by Jerry Ashton, Robert Goff, Craig Antico (Hoku House, Kauai, Hawaii, 2018, 181 pages).
Book Review by Dennis Moore
Of all the forms of equality,
Injustice in health is the most
shocking and inhumane.
- Martin Luther King, Jr.
April 6, 2019 (San Diego) - The authors have written a timely and thought-provoking book about healthcare and debt, coming at a time when the Trump Administration is proposing doing away with the Affordable Care Act (ACA), or better known as Obamacare.
Jerry Ashton, Robert Goff and Craig Antico, founders of the national charity RIP Medical Debt, a 501 (c)(3) not-for-profit company based in New York, incorporated in 2014, locates, buys and forgives unpayable medical debt for those burdened by financial hardship. In a phone interview with one of the authors, Craig Antico, he stated to me: “People don’t realize the hardships that medical debt brings.”
RIP to date has abolished $500 million in medical debt for about 250,000 Americans. They support communities across the country in conducting local medical debt forgiveness campaigns. They have a special interest in forgiving the medical debts of veterans.
RIP buys large batches of medical billing accounts in “portfolios” for about a penny on the dollar, so donations to RIP deliver “a lot of bang for the buck.” A $100 donation can forgive $10,000 in debt.
The authors, with the assistance of editor Judah Freed, points out in End Medical Debt that in our urgent debates over U.S. healthcare costs and coverage, we have overlooked America’s devastating medical debt crisis. Medical debt continues to be one of the leading causes of bankruptcy in the United States.
They further point out that everyone knows someone who struggles to pay their medical bills. Millions of Americans confront $1 trillion in medical debt that produces hardships for individuals, families, communities, and our nation as a whole. I am sure that readers of this book can relate to this. As a matter of fact, the authors are donating all book royalties to forgiving medical debt.
In a novel approach by the authors of helping to address ending medical debt, the book features tips for your personal medical debt.
This triumvirate of experts, considering their business and healthcare background and experience, makes them eminently qualified to write this groundbreaking and informative book.
Jerry Ashton has 40 years of experience in the credit and collections industry. In 1995, to uplift how debtors are treated, he founded CFO Advisors, servicing a half billion in receivables for Fortune 500 companies. The Occupy Wall Street “Rolling Jubilee” inspired him and CFO partner Craig Antico to found RIP Medical Debt. Jerry serves as the Education and Outreach Director.
Robert Goff retired from 40 years in the healthcare industry to consult in care delivery, organization and financing. His past roles include hospital administration, regulator, managed care executive, and association executive. He developed one of New York state’s first HMOs. He later served as head of the University Physicians Network. Robert is RIP’s founding board member.
Craig Antico is a 30-year leader in credit, collections, debt buying, outsourcing, and data analytics. He has worked with IBM, Johnson & Johnson, collection agencies, medical distributors. He early joined eDebt, the exchange for distressed debt. He joined Jerry at CFO and as the founder of RIP Medical Debt. Craig serves as the Operations Director.
An example of what this book, End Medical Debt, is all about is described in an initiative by “Revolution Annapolis”, a church in Annapolis, Maryland. Revolution Annapolis partnered with the non-profit organization RIP Medical Debt to purchase and forgive $1,893,288.73 of medical debt from 14 counties in central and eastern Maryland. More than 900 families have been impacted by this act of no-strings-attached generosity, according to a news release from the church.
The money for the debt relief effort – an amount of more than $15,000 – was raised by Revolution Annapolis during the Christmas season last year and included donations from individuals throughout the United States. It was then donated to RIP Medical Debt, a non-profit organization that purchases medical debt from collections at a discounted price. By coordinating beforehand, Revolution Annapolis was able to focus their debt relief on their local community first, beginning by purchasing all of the available debt in Anne Arundel County. Then, as their fundraising efforts grew, they were able to increase the radius and impact of their project to a reach and scale they never anticipated.
Terms such as “Medicare for All” and the “Affordable Care Act (ACA)” are weighed and analyzed in this insightful book. The authors indicate that under “HR 676”, healthcare would be publicly financed, but privately operated, same as Medicare.
In further regard to the “Affordable Care Act (ACA)”, or “Obamacare”, the authors of End Medical Debt, makes a profound statement. I am not sure if it is to buttress their claims or add fuel to the debate about doing away with Obamacare. They state: “The ACA’s promises were more political than practical.”
They compare and analyze various healthcare providers throughout the country, such as Empire BlueCross BlueShield, UnitedHealthcare and Anthem (BlueCross BlueShield) as it relates to medical debt. They indicate that the products offered through a Health Insurance Exchange do not cover out-of-network care except in an emergency, which often means no coverage. The authors further indicate in their book that these “narrow” networks are claustrophobic.
The authors indicates that each insurance carrier uses proprietary data, proprietary algorithms, to decide which providers can be in its narrow network. This lacks transparency and disregards existing patient-physician relationships, and asks the question; is cost the only criteria – what about quality or efficiency? This makes me want to look at and closely consider my own healthcare provider; L.A. Care.
Further stated in their book; “The only insurer offering products on New Hampshire’s exchange, Anthem (BlueCross BlueShield) excluded ten of the state’s 26 hospitals. Hospitals are included or excluded based on unit price.”
A noteworthy and classic example of insurance coverage, or lack thereof, which can contribute to medical debt is pointed out in End Medical Debt.The authors state: “We seldom invest time to understand the limitations of our insurance coverage.”
For the purposes of this argument or case study, they state: “Aetna, the health insurance company, has taken an aggressive stance against enticing patients into financial traps. In New York, they filed a lawsuit against two doctors, in-network Dr. Ramin Rak and out-of-network Dr. Shuriz Hishmeh. Dr. Rak used Dr. Hishmeh as his co-surgeon on procedures. Dr. Rak got $183,294 in-network. Dr. Hishmeh got more than $1.1 million out-of-network. Crain’s New York Business reported the patient was liable for all costs for out-of-network surgery above Aetna’s allowable rates.” Is it any wonder that America has a $1 trillion unpayable healthcare debt with these types of shenanigans!!
The authors indicates in End Medical Debt that both of the proposed Medicare for All laws, one sponsored by Rep. Keith Ellison (D-MN), the other by Sen. Bernie Sanders (D-VT), would cut the current 12 percent rate of uninsured people to zero. Everyone would be enrolled into one plan without any deductibles or co-payments. No one could opt out.
Through random acts of charity, this book demonstrates what was always the solution to ending medical debt; “People helping people, voluntarily and without coercion.” Two New Yorkers erased $1.5 million in medical debt for hundreds of strangers. Over the summer months, the women raised $12,500 and sent it to the debt-forgiveness charity (RIP), which then purchased a portfolio of $1.5 million of medical debts on their behalf, for about half a penny on the dollar.
In my phone interview with Craig Antico, he indicates that there are 3 criteria under which they (RIP) selects someone for medical debt relief, one of which is that the candidate should be making less than 2 times the national poverty level.
The authors gives us an education on how we as a society got into this seemingly unpayable and un-curable medical debt, but fortunately in this book, they offer solutions and relief from it. This is an invaluable book that everyone should read.
Dennis Moore has been the Associate Editor of the East County Magazine in San Diego and he is the book review editor for SDWriteway, an online newsletter for writers in San Diego that has partnered with the East County Magazine. He is also an author of a book about Chicago politics. Mr. Moore can be contacted at firstname.lastname@example.org or you can follow him on Twitter at: @DennisMoore8.