Episode 7 Outside The Medical Debt Box

According to CBS News Customers at Credit Karma carried an additional $2.2 billion in overdue medical debt from January 2020 through March 2021, reaching about $47 billion in total — the highest point in at least 16 months. Overdue medical bills are also impacting more people, Credit Karma also found that an additional 2.5 million people saw their medical debt enter collections since the pandemic started. 

In this episode, we talk about healthcare receivables and an out-of-the-box approach to some of the issues surrounding healthcare debt.   In 2014 two former debt collection executives, Craig Antico and Jerry Ashton founded a company called RIP Medical Debt.

Their website mentions they’ve helped over 2.5 million people abolish 4 billion dollars of medical debt and that number is growing every day.  With so much medical debt and increasing healthcare costs, we need out-of-the-box solutions. Craig shares insight into healthcare debt, why it makes sense to embrace additional options in how to handle the debt, and lessons learned in their journey.

Guest: Craig Antico

Craig Antico is the co-founder of  RIP Medical Debt, the national charity that has acquired and abolished over $5 billion in unpayable medical debt for over three million people since 2014. 

Craig understands the ins and outs of the debt collection industry because he was a financial industry leader in collections, debt buying, and outsourcing for 30-years! After completing his undergraduate degree at Florida Southern College in finance and economics, Craig went on to Pace University for his MBA in finance. His decades of experience include working for IBM, Johnson & Johnson, and several Fortune 100 companies.

Purchasing medical debts to then abolish them, the core of RIP’s work, didn’t cross Craig’s mind until a chance introduction facilitated by his long-time partner in the debt collection industry – and RIP co-founder – Jerry Ashton. Jerry had connected with a group of activists that wanted to cancel debts as a charitable good using donated funds. Realizing the depth and scope of medical debt’s burden on already struggling Americans, Craig and Jerry resolved to start a nonprofit to champion this cause.

After a hard road learning how to raise money, Craig and Jerry got their big break in 2016 when producers from the HBO series, Last Week Tonight with John Oliver, inquired about the show’s host purchasing and eliminating medical debt for an upcoming episode. Thanks to RIP’s guidance, John Oliver abolished $15 million in debt on a segment that has been watched by over fifteen million people.

Craig has appeared on NBC Nightly News with Lester Holt, PBS Newshour, and many other media outlets, including over 50 local TV stations throughout the country. The New York Times, The Guardian, Forbes, AARP, The Washington Post, and many others have published articles about Antico and RIP Medical Debt.  He is the author of the book “End Medical Debt,” now in its second edition. 

Resources:

    Website: https://ripmedicaldebt.org/

    Company LinkedIn:  https://www.linkedin.com/company/rip-medical-debt/

    Email:  cjantico@gmail.com

   LinkedIn: Personal: https://www.linkedin.com/in/antico/

Additional Resources:
RIP Medical Debt Story

2021 US Census Medical Debt in America Report

Transcript

Lex Patterson: 0:09

Of all the many segments of debt in America, medical or healthcare debt is one of the most difficult to collect. In fact, according to CBS News, customers at Credit Karma credit an additional 2.2 billion in overdue medical debt from January 2020 through March 2021, reaching about 47 billion in total 47 billion, the highest point and at least 16 months. In my research, it's evident that the impact of overdue medical bills is expanding, and the pandemic has exacerbated the problem. As 2.5 million more people saw their medical debt enter collections since the pandemic started. high deductible plans in increased self pay have changed the landscape of how many Americans pay for medical care. And health care costs have been a part of the national discussion for several administrations yet, it still continues to be a problem that begs a solution. In 2014, two former debt collection executives, Craig Amtico and Jerry Ashton founded a company called rip medical debt. Their website mentions they've helped over 2.5 million people abolish$4 billion of medical debt. And that number is growing every day. Our guest has been featured in the press and even on HBOs Last Week Tonight with John Oliver, in his journey to be an option for solving the healthcare debt problem in our country. But I wanted to talk to Craig about the untold stories about the problems he's trying to solve. It's acceptance in both healthcare and the debt collection industries. And the challenges that still lie ahead. Rip medical debt is an outside the box idea to build a discussion around one of our nation's growing problems. We begin this episode with Craig and Chico, as he recounts the days leading up to the John Oliver, one minute HBO debt buyer segment originating June 5 2016.

Craig Antico: 2:18

It was a seminal moment for us and we're actually building a statue for him because if it wasn't for John Oliver, we wouldn't be here today. John Oliver, of course, runs a show called Last Week Tonight with John Oliver. And it turns out, he's pretty zany. He'll actually oftentimes put on like such a such realistic situations to prove a point and make a joke. So I mean, he started a church one time to prove how easy it was to make a church. He called it Our Lady of Perpetual exemption. got donations. I mean, it was hysterical. I don't know stuff, the seed like, and people would send seeds. And that's that was his religion. This is really pretty funny. Yeah. John Oliver heard about this, this industry called the debt collection and debt buying industry. And he felt, hey, I'll do a show. And taboo, I'll start my own debt buying company. And I'll go out and buy debt. And to prove that you can, anybody can find that right. Now. He starts this company. But he also starts a nonprofit, because there was another nonprofit about two years earlier three years earlier, that had bought medical debt and abolished it. So what he was going to do is going to do the same exact thing. But that and he was going to abolish it on his show. Well, the lawyers got a little concerned about that. You know, they're thinking of HIPAA privacy. They're thinking of all the security issues. They're thinking of all these things that John Oliver doesn't think about. So what happens is, the lawyers put a kibosh on the show until they figure out what they can do. Well, they can't figure it out. It's now they started October, November, December, January, February, March they and they haven't figured out how to put the show on. So it turns out that one of our board members or one of our founding board members, and my co founder Jerry Ashton wrote a book. Funny Lady called the patient, the doctor and the bill collector. Oh, wow. It was an Obamacare Survival Guide. You know, that's what it was. So it happens that this this gentleman, Robert Koch, I handed this off this book at a lunch to his lawyer. Well, guess who gets the call from the HBO lawyers? Is this lawyer? Wow. Telling them, I've seen it. You can't do that. You can't do that. You can't do that. Like everything. They asked, Can you do that? Can you do that? No, you can't do that. So they're like, and they're stymied. And it just so happens, while she's been on this call that that week, she's stumbling through this book that Robert gave her. And she's thumbing through a chapter 10 says, got debt. Why don't you sell it to a debt buying company that abolishes the debt, which is rip medical debt. And she says, Oh, my goodness, I got the people you can call. She says to the HBO lawyers go Cragin, Tico and rip medical debt? Because this is what they do. They abolish medical debt, without an implication tax implication to the debtor. And the debt is wiped out completely. Oh, my goodness. So they said, we'll, we'll get in touch with him. And they call me on a Friday night. I'm at dinner with my wife just and they say we'd like to talk with you on Saturday on the phone. I said, Why should we do that? Why don't we just come down to the city and meet you on Monday? So you'll do that? Yeah, we'll do that. So we go down on Monday. And we're in the room with the head lawyer, the head research person, the head wine producer. And we start talking. And it turns out finally, that the nonprofit, they started the nonprofit, they use the lawyer that we use, oh, there we got my lawyer, talking to their lawyer say, Hey, you should get an RFP. And then we've got their lawyer using, you know, our lawyer for the 501 C three, I guess I think it was a 501 c 40 actually started, so it wouldn't have worked anyway, because he didn't realize that. But he didn't realize a lot of things. So what ended up happening? We ended up talking and within an hour, they were like, This is exactly what we need. Why don't we just we're going to go talk to our attorneys. And and we'll get back to you. I said, Well, why don't we just stay in the conference room until you talk to your attorneys. And you'll do that? Yeah, well. They ordered sushi for us. Well, the half hour later, they came back and we made a an arrangement. And within two and a half weeks, we had the show on the road. Now, the crazy part of it is I had no idea what the show was about. Now, I'm in the credited collection business. I ran collection agencies, I read debt buying companies, I own them. And now I'm in a show that completely eviscerates all parties involved. And I'm like, holy cow. Yeah. I'm just in disbelief. Now we're going to erect a statue for him. But at first, it seemed like our careers were over. Yeah, even friends of mine wouldn't talk to me. It took two years for them to realize that I wasn't threatening them. And that I didn't I wasn't part of it. I had a guy punched me. Oh, really? Holy cow. Yeah, it was really bad. But you know what, I'm a patient guy. And I knew how they were feeling because I would have felt the same way. So I just paired with it. I joined the it used to be the debt buyers Association of America. Now it's Receivables Management Association, but I wanted to be a member of them. Why should we let you in as a member?

Lex Patterson: 8:54

Really? Yeah. Oh, my goodness. Wow.

Craig Antico: 8:58

They let me in. And I mean, it's it's a tight group of people we, and we do care about the consumer, we care about the creditor. But it doesn't get portrayed that way in the media and the John Oliver show, I mean, he was using old stuff. He even had a person go into the RMI meeting and clandestinely tape, somebody talking at the pole. And he put that honest honesty. So they thought I had a wire.

Lex Patterson: 9:33

Oh my goodness. That is quite a story. That's amazing. It is. Yeah. So you you were you were a debt collector. You were in the business were you actually a collector ever did. Were you a collector when

Craig Antico: 9:45

I was a collector I wasn't that good at it. Okay, we're running them selling the service of Jerry my partner. He's one of the best collectors I've ever heard. Seen. You know, he He would tell the creditor to write it off, if he didn't think it was was owed. You know, he cared about both sides that came to a resolution. And that's, that's the way the collection industry works. Now, it doesn't work like, you know, a heart. I don't want to say hardest, but it doesn't work in a in a derogatory demeaning way. I mean, one of the things that that made me realize that this was a good thing to do. I'm talking about Rip medical debt, right? Because I did get called by a collector one time. And Jerry and I were in business together back in the early 2000s. And we owed, you know, one like the zoom. There used to be a WebEx of sorts. Well, right. Yeah. Money to to this company. So they were calling me on it. And the guy was so disrespectful, demeaning, abusive. I said to him, I said, you know, you're actually hurting. And I've never felt like this before in my life. I mean, do you know what you're saying? And how you're saying it? What I What? What are you doing? This is the worst thing I've ever been through. So, so people that do feel that way? They won't even answer the phone. So it's a detriment to the whole industry, if there is even one or two of those bad guys out of 1000? Because those are the ones that get put in the press, you know, where I felt so sick to my stomach, I had to tell the guy, I really can't talk to you anymore. If you're going to talk to me this way. This is just preposterous. So yeah, some people feel that that's how it how it happens nowadays. And it doesn't, lets you you can record your collectors. You know exactly. When somebody is being disrespectful, you get them out of your business as soon as possible. Yeah, so So I know that's wrong. But the good thing is, when you buy and abolish debt, you are buying debt that has very little or no chance of ever being collected. But a lot of times you don't know that. You can't read a book by its cover. So what are you supposed to do, you're supposed to keep trying. Maybe you look at credit reports every so often to see if they payment to some other creditors are now given, you know, granting credit to them, maybe they're able to pay now. But the medical debt is pretty tough on the medical debt puts people. I mean, it puts people insolvent, 15 million people go insolvent each year, because of medical debt. And that's not like a big screen TV, they bought urban Keishon. This is an illness. And now they're decimated. They're ill and they're financially decimated. That's a bad combination. So what rip his goal is to survive all the debt that say over two and a half, three years. And wipe it out. We do that by raising money from donors, we've raised almost $100 million. Thus far, we've wiped out $4 billion for just under 3 million people. And that's because the debt sellers that buyers are willing to sell to us because they know that we're first of all willing to pay market rate. We're not asking them to donate it. We're paying market rate for this debt. And why not stop collecting on people that can't pay? Or are in hardship by paying? So that's, that's where we are with our IT medical bat.

Lex Patterson: 13:42

Yeah, that's awesome story. I really appreciate you sharing that with us. But last time, we spoke, you mentioned some interesting statistics on the health care friend about the average recovery and crowds and how crowdfunding actually helps. Can you talk a little bit more about that?

Craig Antico: 14:01

Yeah, you know, rip is designed to almost be the crowdsourcing for medical where people don't have that resource. They don't have a network of people that are that can support that. Like a lot of these crowdfunding is done by friends or family of that person. It's not like that person says, I'm going to go put a crowdfunding up. They're embarrassed. They're there. It's a stigma to not be able to pay your bill. Since these people are proud people. They don't want to. Well, we do it. So we crowdfund and we raise the money and buy the debt for those that don't have the network. And they also don't have the friends and family that could lend them the money or give them the money to pay the debt or even to the services. For example, about $55 billion is lent or given to people to their friends or family for medical expenses. $55 billion Wow. Wow. And the other thing of all the crowdfunding money that gets raised in a year, over 36% of all crowdfunding dollars from GoFundMe, and all these places are for medical expenses and debt. So we know that people can't pay this, this money without hardship, they just, they just can't. And the interesting thing is, research shows that if people pay this is crazy, just two and a half percent of their gross income. So you make $50,000. And you're, and you're paying 1000 or 1200 $1,500 out of your pocket, you are in hardship. You go above 5%, you're in material hardship. So weird, where you can't even pay your bills can pay utility bills. One of our good partners, AARP, where we've done some innovation, I guess, models. They told me one of the biggest problems that people have to maintain and control their expenses is their utility. Well, when you go into hardship, you can't pay utilities. You get your water turned off, you get your electric and gas turned off. It's it's it's just debilitating, because you can't have a family without home, home or heated home or cool gone. So it's really sad.

Lex Patterson: 16:30

Yeah, yeah. And Craig, I guess, you know, as I was researching for this episode, I ran across recent census.gov article that I'll share on the show page for this episode at Kindred forest calm. The article said that 19% of US households can't afford to pay for medical care upfront, or care they received in the past year, the debt was disproportionately distributed across groups based on socioeconomic status, demographics, health status of the household members, including those with children under 18. The study said, There's no difference in the amount of medical debt being carried between those above or below the poverty level, both groups were about 19%. The ability to pay however, is another story. Lack of health care insurance is also key. The survey showed that 8.5% of households not fully insured. The debt burden was very, very high compared with only 2.9% of households that were fully insured. So I guess that really kind of lines up with and supports what you're seeing in your work, right?

Craig Antico: 17:39

Yeah, we do notice that we call it self pay, the self pay, or the people that don't have insurance. And the self pay can only pay this is a pretty stark difference to the people that have insurance. The people that don't have insurance can only pay about 10% of the amount that they're responsible for 10%. Whereas the people with insurance, and then therefore the balance after insurance, which is kind of like their self pay the balance after insurance, they can only pay about 50% of their responsibility. So that dovetails right into what you're talking about. But something that we're doing something about, we've worked with the Annie E Casey Foundation, and the southern partnership to reduce debt. And there's an inordinate amount of debt in the southern states, especially Mississippi and Louisiana. I mean, it's decimating whole communities, some communities, and this is interesting to you. The Urban Institute came out with a study that they keep, they keep refreshing it called debt in America. And it looks at medical debt and also financial debt. This financial debt is all reported on the on the credit report, medical debt is not all reported on the credit report. So when only seven to 10% of all medical debt gets reported. But 100% Of all the financial debt that's reported, is distorting it a little bit, but let's just say it was accurate. Let's just say that 10% is an accurate distribution across the country, let's just say some places like Minnesota, have only 5% of their people have medical debt in collections and on their credit report. you contrast that with the southern states, where 30 something percent of the population has medical debt in collection and on their credit report. So you can't even imagine how many people really do if only 10% is is actually being reported. What the heck are we talking about 60% of the people you know 5060 70% of the people. And, you know, we have an RFP. When we started RFP, Jerry and I, he said, it's not only about the poor, because they are being hit by this really bad. But it's about the middle class. And some of the people even above the middle class, where they're still spending over 5% of their income on medical expenses. So you're making $100,000 in middle class income, and you get a $5,000. Bill? Well, that's not easy to pay. I mean, yeah, what we find 50% of the people in this country can't even pay $400. That's a federal reserve study, or it's part of the ACS, certainly a Census Bureau thing with a reason. What do they do they survey these people. So if 50% 50% of the people can't pay$400, they'd have to borrow or use savings. It's crazy how they're going to pay a $5,000. Bill, because that goes for the people that are making good money, too. Right. So

Lex Patterson: 21:15

let's talk about that, you know, the research around healthcare, the impact that debt forgiveness has on wellness, and the economy really, and opening the door for foundation money for you guys to grow to a little bit there to talk about that a little bit.

Craig Antico: 21:31

Yeah, Jerry, and I realized early on that the first monies that we were going to get, and that's practically $50 million, was the first monies was really coming from people that just in a gut feel said, this is the right thing to do, that buying medical debt and abolishing it is the right thing to do. Every time I give, if I give $100, it's abolishing you put two zeros on it. So because it's 100 times, so 10,000 equals a million? Well, you know, it's unbelievable. 10 million equals a billion dollars of medical debt that. So we recognized early on, that there was only so much so much money that was going to come from the individuals, the you know, where it's like you and me, you know, and then the high net worth, people are gonna start to pay attention to it. And they did. But they still are very emotional and go from a gut feel. Well, it's the family offices, it's the big foundations. It's the highest of highest net worth people that want evidence, they want to know, does this really make a difference? Because I've had people say, Does this really make a difference? If the collection agency is not going to be collecting out of me more that you're wiping out a debt? It sounds like a waste of money? Well, when you think about it, these people might not be able to pay, but guess what, they're still going to get letters, they're still going to get called, they're not going to go to the hospital, because they know the high cost of the six, they're going to get into collection again. And they don't want to go through it again. So we're limiting that part. But we've raised for research, probably about a million and a half dollars to do research. Well, you also had three four major, major institutions, MIT, Harvard, university, Cago, UCLA, all these powerhouse. research institutions, said we want to do this research. And they raised over a million and a half dollars to do it. Now, what's happening is they just did a survey the researchers, and the results should be coming in probably in the next three to six months and three months, where it's going to say it's going to be front page, New York Times stuff. And this is this is huge, you know, finding because we don't really know what happens with debt. What happens to people when they're in debt? What happens if we abolish the debt? Yeah, when we find out, we already know the travesties of it. When we find out what it does, when we abolish it, the world is going to be a different place because there's so much debt that we can abolish, you know, we can wipe out debt and public and private partnerships, which haven't worked as well as we'd like. This is a prime example of how we could we could change the world and make this a better place without as much debt. I mean, believe me, when I first heard about Rip, not rip first heard about this idea of buying and abolishing debt. I said it was the dumbest thing I've ever heard. I mean, why in the world would you abolish debt when you can collect from the collection industry? I don't think About abolishing it, if I tell a client to abolish their debt, I'm like, does that mean I'm really bad at this? I can't collect any money? Are you telling me you should use a different collection agency that maybe can because you guys are horrible at this? So, in a way, it's kind of interesting. But so we've got two studies. One is an economic impact study, which shows what happens when that debt is abolished? Does it increase their credit worthiness? does it reduce the cost of credit of insurance? Because it's all based on your credit rating? That's one thing. And then the second thing is this wellness study? How is this affecting your mental health? What's happening in your life? Are you doing more than you used to do like, it's, it's looking into what changes you make because your debts abolished? And you know what, you can only do that when you've got 10s, and 10s, and 10s, and 10s of 1000s of people. And you see these changes, but you can only see him when you when you look at it in the big picture, right? He won't see it. If it's you and me, Hey, we got to get abolished. We owed 5000, we make 100,000. What did that really do? That you don't know until you put it all together, and you see more people are doing this or people don't want to get health care, you know, your wellness is improving. And that's what I believe in. preliminary evidence shows that that's what's happening. So it's really, it's really pretty cool. And it's going to open up foundations, because they want to make this work and foundation started. And they just believe it. But now once the evidence is out, there's no escaping it anymore. There's no escaping that we're in a credit takasi. And the debt that's being put onto people maybe need there needs to be more responsibility for the creditors. Yeah, like one, my father once said, I'm going to sue one of these creditors, because they're in that case, they were lending a guy or lady's business $100,000, and they had a net worth of 50,000. Like, it's like, it's just derelict. How many of these creditors are giving credit where we shouldn't be giving credit now then you say, Oh, we're not giving an equal opportunity for people? Well, they don't want the opportunity to be in debt, not be able to pay and never get out of it, and be in a debt, smile for the next 10 years and go bankrupt. Don't tell me that. People that want equality want that to happen? No, they don't. They want people to have responsible credit. And be responsible pay for? Well, we do too. I do. And here I am helping people get out of debt. But I believe strongly in people's responsibility in this too. So just want to make sure that people realize this is not some just some social thing. We care a lot about the people, but it's harming people. We don't want it to harm the people. And we can educate the people to be better users have credit. It's like, I have a choice, do I use cash, or they use my credit, cash or my credit? Well, balance those two. I mean, I even tell people, because I get 1000s and 1000s of emails and calls, asking for help. And I say to the people, and maybe the credit collection, people are not going to like this, this is what I tell them. People that comment, I say, you look at your income, let's say make $50,000 make sure that you do not spend more than two and a half percent of your income each month to pay for out of pocket medical expenses or get service. Now if you if you've saved a little, you can do a little more, she had more of a cushion, maybe go to 5%. But that's it. Because I've heard people, oh my god, I paid a collection agency said 20 bills, 20 creditors that she had to pay his medical, and she said, sometimes I pay too much and I can't eat for the last week. Oh, you can't do that. That's just wrong. And they will understand that I've got a pile of money here for this month. And I'm giving it out to all of you. And that's it. And what else are they gonna say? Responsible for being responsible? That's what I tell people to do. Yeah.

Lex Patterson: 29:40

And you know, Craig, I mean, from what I'm what I'm hearing and I've got over 30 years of experience in the business too. And, you know, nobody wants that. The collectors are working with these people trying to solve a problem. You know, they're problem solvers, their financial advisors in a way they're uniquely positioned in that role. You know, And the landscape, I believe in what you're saying exactly lines up with that the landscapes changing it is, you know, maybe the elephant in the room is as a collection agency, you know, you're at the end of the Rebs cycle, but you're expected to be tough and collect. So how do we bridge that gap? You know, what are your thoughts on that? I mean, are there opportunities that are Wait, you know,

Craig Antico: 30:24

what, this is what I'm thinking? And it's a it's an interesting idea. Why don't why don't we raise money as as nonprofits and actually become a resource for the collection agencies. But you don't usually think of, of a nonprofit being in relation to a collection agency. Even rip, I built our IP with a very strong board vote and an executive director, I've left our IP, I worked with them as a as a consultant to try to make sure the transition from the being there tapping there as smooth. So I'm talking here, as Craig Amtico. Sonia is co founder, but I'm not talking as part of our IP. Because I don't think our IP, they'd rather go directly to the creditor, the hospitals, the doctors, they'd rather not go through the debt buyers and the collection agencies. Now, collection agencies are interesting, they really can't sell the debt. They don't own the debt. They're collecting for their hospital doctor of a critical financial institution. But guess what? If I create a nonprofit, and I decide to pay off at all, that no one's gonna pay practically. And I combine a whole bunch of those accounts together, let's say 1000 accounts. It's pretty normal for a collection agency to go through there, you know, 1500 accounts, collect on you know, their 150 have another 200 in their in their house that they're getting promises on, maybe there's some propensity to pay. And then they've got this group, that they're going to, unfortunately get back to the creditor and say, I can't collect or you won't sue, I can't collect it. i I'll put it on the credit report. But is that really right? Yeah, I guess it's right. But is it fair? I don't know. We'll see. What if I came to that collection agency and said, Go to your creditor or your client? And tell them I'm going to pay you 1% Of all those accounts. Now from a netback perspective? What are they getting 5% After collection agency fees? That a net back? So what if I'm giving them 20% of the neck back? Want accounts that they would have not gotten any money? Are you telling me the creditors gonna say no. So that's something that I'm thinking about, I'm thinking about utilizing the collection agencies, they have the best relationships have anybody with these creditors. Now, they might not have the best relationship with the CFO, or the CEO. But they do in the revenue cycle. And guess what? The revenue cycle cares about their customers, they're being hammered to collect. If they weren't being hammered to collect, they probably would, would not push as hard on the collection agencies. The better thing would be if they didn't kill them on the rate. But give them a rate that enables them to not have to pound on the people to collect the money. I mean, I'm just talking about my own my own beliefs. And I've had clients when I came into a company. And let's say they were only allowing you to charge 13%. I said, if you really want a better collection, you have to give us more. More revenue, you have to give us a better percentage. And I got it up to 18% for like convinced them that it's not about how much the rate you pay me, it's what I give you back to Phil's important thing. Now, if we look at this in a whole picture, I'm giving 5% net back and I'm going to add another percent. So I'm increasing your net back by 20%. Why wouldn't they want? And maybe if they start being smart and saying, I'm going to give you a better rate, just because you're going to now that identify the people that really need to be put in this charitable class. Like they know all these people that are in the charitable class. So I don't know if I'm going off on a soapbox, but

Lex Patterson: 34:49

no, no, no, I think it's it's definitely an important very important part. And last time we were talking, Craig, you mentioned the potential bind that happens with the Community Hospital. between the regulators, the financial assistant program, the charity work, and how that can trickle down to the agency, and it puts the agency in this bind, right? Because they need to collect, they're paid to collect. But yet, there's this segment of accounts that is really not that collectible, you know, so what are you going to do? You're going to continue to hammer on people are you going to, you gotta show due diligence, right? There's a real bind there that potentially this, there's an opportunity here to maybe spin that turn it into a win for everybody,

Craig Antico: 35:32

I think it's great. Now there's a threat. There's a threat to the collection agency from a collection agency person, I know. I was territorial, kind of, in a way, you know, we're all kind of territorial, that's my client. I used to, I used to say, I could give my whole client list to the whole industry. And if they got those clients, then they weren't really my clients, like so. So like, I really could care less. But I know that there's a, you know, that's my business. So when a let's say that, what happens here, and this, this is an interesting part. And they'd have to trust, they'd have to trust me or my, my company, but I wouldn't go after their customer. So they're giving, they're letting me settle the debt. And that was at the hospital. Now, I'm not going to go after medical in this case, but let's just say I did. What if the hospital said, Well, why should I place these accounts for collection at all? Why should I just sell them to xyz medical collection, donor driven company? Well, I think there has to be some way that you, you pay those clips, bonuses for, like, some way that you keep them whole. Because these companies, these hospitals, for example, have to place accounts for collection, they have to make an effort to collect. But they would be very smart to say, just like the collection agencies know, they'll rank them by ABCDE. And say, you know, these, see, I'm not gonna send letters out, I'm not doing anything, they're on the shelf, as Michael burrows says, my, one of my great friends. But these hospitals know which accounts meet their criteria for charity care, whether it's two times the federal poverty level and below, or it's, is the debt equal to say, 1015 20% of their income? Those are the basic two things, they might have a some type of an asset test. We don't do an asset test that rip. But I'll tell you right now, 63%, of every account that we've ever bought from hospitals, or debt buyers, were two times the federal poverty level. Well, now, in this country, 33% of the people are two times the poverty level below. So there's an inordinate amount of people that are in collections that are less than two times the poverty level and below, it's twice as much as there are people in that category. So it's a, it's an, I think, if the I think the way that I used to run collection, is I was an advisor to my clients. I would tell them how not to place collections accounts, I would get them cleaned up so well, that they didn't need as much collection. They, they just streamline their business. And maybe that's why I was able to charge the most in the industry, because I wasn't just there for my own my own money, I was there to help them get better. Well, there's a way for collection aids to help their creditors get better. And the good thing is they can make money. Yeah, yeah, you just got to see. The one issue is if the creditors want to sell directly to me, as a debt buyer, nonprofit, that agents that the collection agency that referred me to them, they make less than they would if I had paid them for the accounts, and it was kind of settled with the creditor. Because I think they should get their full fee. They make 13% and I pay a million dollars for those accounts. They should get $130,000. So I would be kinder, the less crazy thing is if I do business directly with the hospital, I'm only going to give them you know, between 256 percent depending on how much work they do, and that's a lot less 60,000 is a lot less Stan?

Lex Patterson: 40:01

Yeah, yeah, but it goes back to the collectability of some of these accounts. And then it sounds like to me too, though, Craig, just listening to what you're saying that we've got studies coming out that might support a different, you know, a broader picture, let's call it that a broader picture of the psychology of debt and the health. I mean, you know, the doctors take the oath, do no harm, you know, but yet isn't going to come out that actually the burden of debt is really causing more harm than actually what you know. And so you can fight it. I think this is so timely, what you're saying because or you can try and get on the front end of that and say, let's, let's collectively try and solve a problem here. Let's, let's be on the front end of this. And yeah, but But you know, being part of that discussion is the whole answer to solving the problem, right?

Craig Antico: 40:53

Yeah, we need we need people from the hospitals from you know, and the CFO level and the CEO level, we need doctors, because doctors don't even have a connection to the feet. It's very interesting. They've been, they've been ripped away from the feet, in this business of healthcare. And they don't even know what's happening. I mean, they, they intuitively know that this is harming people. But I talked to a doctor from Yale University in New Haven, Connecticut. And he said, Craig, I had a person come in, they obviously didn't have a lot of money. Obviously, I don't know how obvious it is. But it didn't seem like they had the wherewithal. And I didn't want to give them the big cat scan, because the it wasn't as I could do other things that were practically as effective. And I didn't want to have them incur expenses that they couldn't afford to incur. But my, my group would not allow me to not do that. They may be due the whole battery of all these tests and all these gigantic things. And she was a self pay, she could she couldn't pay it. And now, what if she didn't get charity care? I'm of the belief that almost 50% of the people that qualify for charity care, don't get it. That's too bad. I believe there should be an opt out policy, meaning if you qualify, like I can do data, I have the best data in the world, I could add all the data that I need to have a very high percentage chance that I'm accurate to say that this person qualifies for charity care. Why not automatically give it to them? And if they're proud, they don't want to they didn't realize they had a million dollars in the bank account. And they say, I really don't need this help, because people don't actually listen, this one, AARP interviewed hundreds and hundreds of people that were over 50. And they asked them, if you qualify for charity care, are you going to take it? And 90% have said no. No, they should take it as it's there for them. Sure, you're gonna not be able to pay and they're going to get placed for collection. But the craziest thing was they wouldn't take it and what did they say? They said, Oh, someone needs it more than me. Okay, someone needs it more than me. Or they were proud. I don't ever take charity. You know, my father said to me, you can never go get unemployment. Because that's the worst thing you could ever do. Just never, ever, ever, ever, ever. And when I did get unemployment when I was out of work for a long time. He was embarrassed that I did. Yeah. It's probably an ethnic, cultural. racial, cultural. Yeah.

Lex Patterson: 44:03

Yeah. So yeah. Wow. Well, that again, I guess that leads us into, you know, what's the biggest challenge you're facing right now? With with the the whole picture with rip and Trent regional? Right. I mean, if you got some issues there.

Craig Antico: 44:21

Yeah. Well, it's interesting as we get to the foundation money, we're there knowing that we there's a there's a definite evidence that it shows when we're doing randomized control trials, these are like the gold standard for for research, right? When they see that they don't target it. They don't target their money. We just got a $50 million dollar donation. It wasn't targeted anywhere. And it was able to be used in any way that we want to use it because they trust that we're doing what we need to do. Now. When you get a church In the in a suburb, they want to help the people around the church, they want to help the people in the county. So early on, like churches abolished, you know, donated enough to about over a billion dollars of debt last year, wow, the most important, important groups that we have as our IP, now, we still have plenty of debt that we can buy, that would be in many of these counties. But if you think about it, there's 3000 counties, there's, I think, 15 16,000 cities. So people wanted to do cities, and they love zip codes. But when you only had like $4 billion of debt that you could buy, it was even hard to spread that $4 billion 3000 counties you did. So if you had more than two hospitals, I would say, if you had more than two churches that wanted to abolish debt in the same county, we might be able to do those. But what happens when the third one times and we don't have enough debt? Now, when you go directly to hospitals, this 1500 hospitals and maybe 3500, that we could buy debt from rip to buy debt from, and you sell you sell them, talk to them, build relationships with them. But you don't know where the sales coming from? might come from LA might come from Louisiana might come from Chicago, Pennsylvania. And guess what? You might not have a donor day. Like? So that's the challenge that our IP has is how do we get people churches to think more globally, globally in the United States? How we started to put together counties like Appalachian, for this Florida trippy County, Appalachian. And certainly people can support that. And we've had hundreds and hundreds of 1000s of dollars coated that Appalachian area, one of my visions was we were going to break up the country until about 11 regions. And I'm not talking like northeast southeast, like regions that were culturally

Lex Patterson: 47:22

in sync, based on your data, right?

Craig Antico: 47:24

Yeah, based on all this data, and some books that I've read, which talks about, you know, Yankee goes all the way from like New York all the way to Michigan, because they have the same ethic, then you have these people in Tidewater, like in Chesapeake, and you have the New Englanders and you have, you know, a family member, but a bunch of them. But it's really amazing. And they've got the same culture. And they so why not put put debtors or potential people to help into regions that tear about each other? Yeah. Yeah. So it's very interesting how we could do it. I didn't get to do it. So it's not going to get done. But but it's a I think it's got some good potential. But that is the problem is that we're going to get more regional debt. And it might not sync with regional giving. And that's what we're trying to do here is at Rip, is this to sink, giving with available debt? And that's going to be the biggest problem in the next two years. is aligning that. Yeah. Well, you know, one more thing, it's about. It's about building communities together. Like, it's about having the private, the public, the donor, the hospital, all together in this all the public service people. So our IP is starting to align itself to that model, where we're going to where it's going to be built on a community. I tried to do this. Five years ago, we started in 2014. And about 2017. We embarked on how to build it by community. But I needed like a Craig NCCCO in each community. You don't have you don't have me in every community, and it's kind of hard for it when you don't have enough money.

Lex Patterson: 49:24

Right. Wow. Well, I'll tell you, I mean, the future looks very bright in this area and a lot coming to so it's really cool. Seems like everything's really catching on and starting to really build even greater than what you've already done. So keep up the good work. Thank you for taking the time to share your vision, your thoughts, your ideas with us on this podcast, and I hope to see you maybe again on the podcast or maybe even in in person here. You've moved a little closer, so maybe that'll happen.

Craig Antico: 49:58

Yeah, that would be great. I really Enjoy that. I think we've got a whole a whole new line of thought and potential here. And I think it really needs to be developed. And I'd even like to talk with you about it. You've got such a such a keen understanding. We both come from the same industry. And I think that industry, the collection industry, the debt buying industry is so rich with people that care, and they haven't had a chance to show it. Yes. They haven't had the opportunity. I I actually didn't like the industry cuz I was always negatively put that. Yeah. I could go to like workshops to make myself feel better.

Lex Patterson: 50:44

Yeah. Well, I'd love to be a part of that discussion with you, Craig. And I know a lot of people in the industry would, too. It's the whole idea behind the podcast is trying to change that really bad negative image that's out there, you know, and there's so many good people and the ideas are there. We just have to come together and form that discussion. So yeah, I would, I would really welcome that. So

Craig Antico: 51:07

I'm so looking forward to it. And I love to hear from your people, the people that are listening. Yeah, some of their ideas. I mean, they're the ones that are this should be coming up with this just as much as me. Yeah, I mean, they have ideas they've been thinking about for years, but there's just never been the opportunity. But there is the opportunity. And it's not. We want to hear from these people think it'll be a whole new thing. I can't wait.

Lex Patterson: 51:34

Let's start revolution here, buddy. Yeah, it's been great talking to you. Thank you. Thank you for joining us on another episode of fair debt. Remember, you can access additional information about this and all episodes on our website. At kindred force, calm