The Patient, The Doctor and Bill Collector reveals the players behind today’s crushing wave of medical debt drowning more than 64 million Americans.

Authors Robert E. Goff and Jerry Ashton know the inside story on medical debt. Each offers more than 40 years of experience inside the healthcare and collections industries. They team up to deliver an almost surgical dissection of the good, bad and ugly practices of America’s healthcare system.

In simple and forceful language, they detail how present approaches are rigged to fatten the wallets of big pharmaceutical companies, insurance monopolies, hospitals and the medical debt collections industry impatiently awaiting its turn at the trough.

Want a Peek?  Chapter Excerpts

Chapter One – Debt is the Enemy of the Patient, Physician, Hospital and State

Being wise enough to seek medical treatment – but not being able to pay that bill – creates its own set of costs. (pg. 4)

Much to their detriment, Americans seldom invest the time needed to understand the nuances and limitations of their health insurance coverage.  When they or a family member become ill, care is often sought without fully realizing the financial consequences of from where and from whom it is sought. (pg. 9)

Chapter Two – Awakening to a Debt Hangover

Starkly put, if medical debt were to disappear overnight, so would a significant percentage of America’s collection agencies. Credit card statements would be slimmer for many people, as well.” (pg. 25).

Chapter Three – Conflict of Head and Heart

“There is little sympathy for physicians — and greatly diminished respect and stature — in the current political and economic environment. Fair or otherwise, in the near-relentless drumbeat of criticism of the medical system and structure in America, physicians are garnering their share.

While there remains a level of trust between individual physicians and their patients, the profession has been painted or spattered with the ills and evils of the healthcare system. To add to the insult, physicians are now lumped into the disdained ‘One Percenters.’” (pg. 33)

Chapter Four – Aggravating the Wound – It’s Not Just the Bill Collector

“Whether you read this book as a patient, doctor, or internal or external bill collector, you need to read it carefully to understand the interplay. Each of the roles, if fashioned to maximize the balance of mutual respect and a clear understanding of economic realities, can contribute to a better overall experience.

Bill collectors probably rank somewhere in social status below the insurance-company executive and somewhat above the beltway politician. Both of whom keep the bill collector employed, by the way. The physician is just the middleman who provides a constant flow of unfortunates.” (pg. 57)

Chapter Five – Obamacare and National Health Reform

“Health Reform, the Affordable Care Act, which created what is proudly or derisively called Obamacare, largely changed health insurance, dramatically providing access, while minimally, if at all, changing the structure of care delivery.

And in the process created some real devils in the detail.” (pg. 67)

Chapter Six – The Bill Collector and the Patient

“According to a report released by the Urban Institute, at least 35 percent of adult Americans have a debt in collections.

Caroline Ratcliffe, a senior fellow at the Urban Institute, related that collections debt ‘is pervasive and threads through nearly all communities,’ and added, ‘Delinquent debt can harm credit scores, which can tip employers’ hiring decisions, restrict access to mortgages, and even increase insurance costs.’” (pg. 91)

Chapter Seven – Obamacare and the Insurance Industry: Problem Solved?

Winston Churchill, a great observer of America, was quoted as saying; “You can count of America to do the right thing, after everything else has failed” Which leads to the question being debated; Is Obamacare a failure or is it the right thing? (pg. 101)

Chapter Eight – Sentenced to Debt!  Can We Re-Think This?

“The traditional way to escape medical debt has been through personal bankruptcy. It doesn’t “abolish” the debt, but does render it non-pursuable. The downside is that, much like a scar, the debt will show on the credit report when bankruptcy is filed.

According to a 2013 study by NerdWallet Health, unpaid medical bills will continue to be the #1 cause of bankruptcy filings — surpassing both credit card and mortgage debt. Adding to the harm, a credit score will take a hit for as long as 10 years.” (pg. 125)

Chapter Nine – Medical Debt: The End, the Beginning of the End, or More to Come?

When any discussion gets caught up in the fevered search to assign blame, facts become secondary, politics or self-survival becomes a priority, and any resulting solution is unsustainable.

One truth will remain.  The financial impact of accidents and illness on individuals and families is not going to magically disappear now that Health (Insurance) Reform has occurred.  (pg. 131)

Chapter Ten – Got Medical Debt?  Let’s Abolish It!

“If Obamacare can be considered a tsunami, in that its force surprisingly carried away almost everything opposing it, then the “Rolling Jubilee” (RJ) that was launched out of the Occupy Wall Street movement can be considered a 6.0 earthquake in the world of medical debt, medical debtors, and the collections industry.

Only a small percentage of Americans are aware of the phenomenon called the Rolling Jubilee or its role as a game-changer in a business that largely operates in the shadows. Much like its parent, Occupy, RJ seemingly came out of nowhere, even though the need for it was a long time brewing.” (pgs. 139-40)

Chapter Eleven – Tell Me If This Hurts

“To the extent that an individual is fortunate enough to have health insurance benefits, that cost is being paid generally by their employer. If their benefits are through Medicare or Medicaid, then it is paid largely by taxes. Since we as a society are not prepared to have people without insurance die on the streets, those costs are being built into the prices charged, or in subsidies to health care providers such as hospitals and clinics for the poor. Or, to the individual, if they still have a penny to their name.” (Goff – pg. 150)

It’s all of a piece. No one is sure which domino will fall first. But, because the system rewards greed and excess, we as a society are screwed. And, those dominoes will fall.  People are not taking it any more. They are stepping up in ways unimaginable to put their own lives and careers on the line to do that famous thing we call ‘make a difference.’” (Ashton – pg. 165)


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How RIP Medical Debt came to be

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As described elsewhere and more so in this book, RIP Medical Debt came into existence as inspired by the performance of the Occupy Wall Street movement’s “Rolling Jubilee.”  This gallant working group, supported by Occupy’s powerful Strike Debt! group, was tasked with raising donations to enable them to go to the debt industry to locate, buy and then abolish medical debt.

They did that with a passion, raising over $700,000 and using those funds to buy and eliminate over $31,000,000 in medical as well as payday loan and student debt.

When we learned that this campaign had ended and that Occupy was focusing their attentions elsewhere, Craig Antico and I chose to take up the baton.  Guided by the imminent NYC law firm of Cadwalader, Wickersham & Taft through the maze of launching a non-profit, RIP Medical Debt was incorporated on July 25, 2014.  We made our first successful debt buy and abolishment in May, 2015.

Most exciting of all, on May 26, 2016, RIP Medical Debt received notice from the IRS that our 501(c)(3) status as a not-for-profit had been approved.  Donors can deduct contributions they make under IRC Section 170.  “We determined you are a public charity.”

Most of our present energy, time and money is being invested in assuring that we have the infrastructure it will take to meet our stated mission: to buy and abolish $1,000,000,000 (yes, BILLION) in unpaid and unpayable medical debt.  A goal that cannot be met without your help, and the help of many other fellow Americans.