An effort specific to the US: A group wiped out $6.7 billion in medical debt, and it’s just getting started

Yuki Noguchi has a report at NPR that describes an effort that would not make any sense in other advanced nations, but is important in the US, the only advanced nation that doesn’t put a high priority on ensuring that its citizens are healthy. Noguchi writes:

Soon after giving birth to a daughter two months premature, Terri Logan received a bill from the hospital. She recoiled from the string of numbers separated by commas.

Logan, who was a high school math teacher in Georgia, shoved it aside and ignored subsequent bills. She was a single mom who knew she had no way to pay. “I avoided it like the plague,” she says, but avoidance didn’t keep the bills out of mind.

“The weight of all of that medical debt — oh man, it was tough,” Logan says. “Every day, I’m thinking about what I owe, how I’m going to get out of this … especially with the money coming in just not being enough.”

Then a few months ago — nearly 13 years after her daughter’s birth and many anxiety attacks later — Logan received some bright yellow envelopes in the mail. They were from a nonprofit group telling her it had bought and then forgiven all those past medical bills.

This time, it was a very different kind of surprise: “Wait, what? Who does that?”

RIP Medical Debt does. The nonprofit has boomed during the pandemic, freeing patients of medical debt, thousands of people at a time. Its novel approach involves buying bundles of delinquent hospital bills — debts incurred by low-income patients like Logan — and then simply erasing the obligation to repay them.

It’s a model developed by two former debt collectors, Craig Antico and Jerry Ashton, who built their careers chasing down patients who couldn’t afford their bills.

“They would have conversations with people on the phone, and they would understand and have better insights into the struggles people were challenged with,” says Allison Sesso, RIP’s CEO. Eventually, they realized they were in a unique position to help people and switched gears from debt collection to philanthropy.

What triggered the change of heart for Ashton was meeting activists from the Occupy Wall Street movement in 2011 who talked to him about how to help relieve Americans’ debt burden. “As a bill collector collecting millions of dollars in medical-associated bills in my career, now all of a sudden I’m reformed: I’m a predatory giver,” Ashton said in a video by Freethink, a new media journalism site.

After helping Occupy Wall Street activists buy debt for a few years, Antico and Ashton launched RIP Medical Debt in 2014. They started raising money from donors to buy up debt on secondary markets — where hospitals sell debt for pennies on the dollar to companies that profit when they collect on that debt.

RIP buys the debts just like any other collection company would — except instead of trying to profit, they send out notices to consumers saying that their debt has been cleared. To date, RIP has purchased $6.7 billion in unpaid debt and relieved 3.6 million people of debt. The group says retiring $100 in debt costs an average of $1.

RIP bestows its blessings randomly. Sesso says it just depends on which hospitals’ debts are available for purchase. “So nobody can come to us, . . .

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The Psychiatrist Who Warned Us That Donald Trump Would Unleash Violence Was Absolutely Right

Joshua Kendall writes in Mother Jones:

On the afternoon of February 1, 2016, as Iowa voters prepared for that evening’s caucuses, Bandy Lee sat by the bedside of her mother, who was terminally ill with cancer. An assistant professor of clinical psychiatry at Yale, Lee had been too preoccupied with her mother’s condition to pay attention to the nascent presidential race, so she was taken aback when she saw footage of a Donald Trump rally airing on the hospital room’s small TV. What shocked her was the way Trump interacted with the crowd. “He said something about how his supporters should knock the crap out of hecklers,” she recalls, “and that if they did, he would pay their legal bills.”

His belligerent behavior meant more to Lee than it might to a casual viewer. As part of her clinical work in prison settings, she had evaluated and treated hundreds of violent offenders, including leaders of prison gangs. A native New Yorker, she had assumed that Trump “was just a shady businessman,” Lee told me, but “I suddenly realized that he had a lot in common” with those patients. “Trump was engaging in the predatory manipulation of his vulnerable followers.” In some cases, gang leaders might “ask their members to engage in violence and then issue bogus promises of protection. Like Trump, these leaders also often project extreme self-confidence, and that appeals to their followers, who tend to feel a deep emotional need for protection, connection, and identity.”

Fast forward to November 9, 2016, the day after the election. Lee’s friends and colleagues were bombarding her with calls and emails. Would Trump’s victory herald an increase in hate crimes? “You are a violence expert,” one implored. “Can you do something?”

She decided to jump into the fray, organizing an academic conference that took place in New Haven the following April. Titled “Does Professional Responsibility Include a Duty to Warn?” the meeting featured a handful of prominent psychiatrists, including Robert Jay Lifton, author of The Nazi Doctors (1986), who addressed Trump’s mental state and the risks they believed it posed to the health and safety of Americans. Their consensus was, as Lifton put it, that psychiatric professionals had a compelling ethical duty to “bring our experience and knowledge to bear on what threatens us and what might renew us.” The event was initially sponsored by Yale’s schools of public health, medicine, and nursing, but Lee ended up running it independently to avoid the perception of “politicization.”

On the day of the conference, when only two dozen people filed into the 450-seat auditorium, the speakers—who also included clinical psychiatry professor Judith Herman from Harvard Medical School, and New York University psychiatrist James Gilligan, who also specializes in violent behavior—were “disappointed,” Lee says. “We assumed that our effort was a failure until we saw the press coverage, which included write-ups in news outlets in [many] different countries.” She proceeded to solicit papers on Trump’s potential for violence from a couple dozen other mental health experts and published the entire collection that fall. The Dangerous Case of Donald Trump was a surprise bestseller, hailed by the Washington Post as “the most daring book” of 2017.

Shortly after the book came out, leaders of the American Psychiatric Association began publicly attacking Lee, arguing she was acting irresponsibly. Her alleged offense was violating the 1973 Goldwater Rule, an APA guideline stating that “it is unethical for a psychiatrist to offer a professional opinion” of anyone without conducting a personal examination and getting proper approval.

The rule was the APA’s response to a 1966 lawsuit by Barry Goldwater, the late Arizona senator and presidential candidate. Goldwater had successfully sued Fact magazine, which, shortly before the 1964 general election, ran a piece in which dozens of leading psychiatrists offered crude armchair assessments of the state of Goldwater’s psyche. “His impulsive, impetuous behavior…reflects an emotionally immature, unstable personality,” wrote one doctor, who went on to cite Goldwater’s “inability to dissociate himself from vituperative, sick extremists.” (While the archconservative’s fiery campaign speeches were startling to many Americans at the time, they now seem relatively tame compared with Trump’s.)

This was the heyday of classical Freudianism, and most of the Fact magazine commentary was rooted in theoretical mumbo jumbo rather than empirical facts. One psychiatrist declared that the “core of [Goldwater’s] paranoid personality is…his anality and latent homosexuality.” The legacy of these off-the-cuff evaluations is a primary reason that today’s APA leaders were so eager to quash Lee’s Trump commentary.

“Anything a psychiatrist says without examining a patient is likely to be inaccurate, so it can harm the public figure,” says Paul Appelbaum, a Columbia University professor who has served as the APA’s president. Appelbaum is also concerned that diagnosing people from a distance casts the profession in a negative light: “These seemingly cavalier and politically motivated public statements can prevent people from getting the psychiatric care that they need.”

And yet Lee’s Cassandra-like warnings turned out to be remarkably prescient. On the morning of the insurrection, as former White House aide Cassidy Hutchinson revealed in sworn testimony to the January 6 committee, Trump had no compunction about unleashing armed loyalists on the Capitol, and was furious when told he could not accompany them. Two days later, as Bob Woodward and Robert Costa reported in their book, Peril, House Speaker Nancy Pelosi seemed to channel Lee when she told General Mark Milley, the chairman of the Joint Chiefs of Staff, “This unhinged president could not be more dangerous. And we must do everything we can to protect the American people from his unbalanced assault on our country.”

We also know from January 6 testimony that . . .

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Cayenne Pepper Sauce

What went into the hot sauce today

Rinse well a great number of red cayenne peppers and cut off and discard the stems. Then chop the peppers and put into a large bowl. Add to the bowl:

• 4″ fresh ginger root, sliced thinly
• 8 garlic cloves, sliced thinly
• 8 Medjool dates, chopped
• 1 Cosmic Crisp apple, sliced thinly (that’s the variety I have on hand)
• 1/2 large red onion, sliced thinly
• 1 medium Spanish onion sliced thinly

This recipe uses a carrot and a parsnip as fermentation food for the microbes, augmenting the peppers. I prefer fruit (apple, dates) and onion — which, like fruit, is fairly high in sugar — and I think ginger and garlic will go well in pepper sauce. (If you search the blog for my posts on such sauces, search both “pepper sauce” and “hot sauce” since I never settled on which to call it.)

I wore disposable gloves for the chopping — cayenne peppers. I chopped 4 or 5 peppers at a time with a chef’s knife. I used the garlic mandoline for the garlic, and the regular mandoline (at a 1mm setting) for the apple and Spanish onion.

I had planned to use 1 large red onion, but when I went to the store to buy it, they had no red onions at all. So I made do with the medium Spanish onion that I bought and the 1/2 red onion I had on hand.

I used my lesson learned in a previous batch: to make mixing easier, I did half the peppers, then the onions, garlic, dates, and apple, then the other half of the peppers.

Above left: the chopped ingredients before massaging and mixing: chopped peppers are the bottom layer and the top layer, the onion, garlic, ginger, apple, and dates in the middle.

Above right: after massaging and mixing, including mixing in the starter culture

UPDATE: I have since learned that mixing is fine, but massaging is not the way to do it. Just chop and mix; no massage. When making kraut, one does massage the cabbage to get it to release its liquid, but in fermenting other vegetables no massaging is done — and not massaging is not only for peppers but also (say) for cucumbers when making fermented pickles. I now want to make a new batch of pepper without massaging and with the red habanero peppers I saw recently. Live and learn. /update

Once all the ingredients were chopped and in a bowl, I added the vegetable starter culture to 1/2 cup water to rehydrate and let that sit.

The bowl of peppers etc. weighed 3325g. I subtracted the bowl’s weight (1135g) to get the weight of the vegetables: 2190g, or 4.8lbs.  I added an amount of sea salt equal to 2.5% of that weight — 55g — to the bowl of chopped vegetables. (I’m going a little saltier for this sauce (2.5%) than I usually do for fermented vegetables (2%).) — UPDATE: On reading more about the readiness of peppers to mold, I think the next time I make this (and I definitely will be making it again), I’ll use an amount of salt that weighs 4% of the weight of vegetables, maybe even 5%. ALSO: I belatedly realized that the spring water I added should also include an appropriate amount of salt, otherwise the added water will result in a dilution of the brine. See this post — important./update

I put on a fresh pair of disposable gloves and massaged the be-jesus out of the peppers etc., mixing and mashing well. [As noted in the update: don’t do the massaging. This step reflects my ignorance.] Once the vegetables were tender and some liquid was visible in the bottom of the bowl (though not much), I added the starter culture water and mixed and massaged some more to be sure the starter culture was well distributed throughout the batch.

About 3 1/2 liters, starting to ferment.

I’ll let the sauce ferment for 2 weeks. Then I’ll pour off and reserve the liquid and use my immersion blender to blend the peppers etc. in the jars. I’ll add back reserved liquid as needed to get a good pepper-sauce consistency. I might also add some vinegar or perhaps blended lemon pulp or lime pulp. Then I’ll fill 1-pint jars with the fermented sauce and cap and refrigerate the jars (to slow fermentation to a crawl). 

I discovered a while back that it’s best to use wide-mouth jars for homemade pepper sauce because it’s easier to spoon out as much as you want. Back then, though, I was making cooked pepper sauce. This fermented pepper sauce is a new direction for me. (Sriracha is fermented — but then pasteurized, which kills the probiotics. My sauce will retain the probiotic goodness.)

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Some useful articles on pepper/hot sauce

A post on making hot sauce offers good guidance to the variety you can find. See also  How to Ferment Chili Peppers and this Fermented Hot Sauce Recipe.

Also, my general post on fermentation. This is a good starting point for fermenting vegetables in general — for example, The Big Red One.

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The final product

The finished sauce (2 liters; full info at link)

After two weeks, I deemed the sauce finished, and I drained it (saving some of the liquid for future fermentation), blended it, and bottled it — details here. 

The sauce is fairly mild — some warmth, no real heat — and very flavorful. I like it, and I definitely will make another batch of pepper sauce when this runs out and I will include habanero peppers and/or Thai red chiles.

I was lucky to find cayenne peppers in the store since they seldom appear. Someone asked me whether a pepper sauce like this can be made from other peppers, and the answer is definitely “Yes.” In fact, since I doubt I’ll find cayenne peppers when I run out of the batch I made, I’ve given some thought to what I’ll use. Here’s my tentative list of ingredients:

• lots of jalapeños, at least a quart — these will be the main pepper
• good amount of Serrano peppers, say a pint — a supporting role
• a small number — 10-12 — Thai red chiles (for the heat, you know)
• either half a dozen dried chipotles or a can of chipotles in adobo
• 4 or 5 dried ancho chiles, with core and seeds discarded, cut into pieces

And then aromatics and food for the microbes:

• 4″ fresh ginger root, sliced thinly
• 8 garlic cloves, sliced thinly
• 8 Medjool dates, chopped
• 1 apple, sliced thinly
• 1 large red onion, sliced thinly

Or I might follow the suggestion of the recipe that gave me the idea and use a carrot and a parsnip.

Another Path to Intelligence

James Bridle writes in Nautilus:

It turns out there are many ways of “doing” intelligence, and this is evident even in the apes and monkeys who perch close to us on the evolutionary tree. This awareness takes on a whole new character when we think about those non-human intelligences which are very different to us. Because there are other highly evolved, intelligent, and boisterous creatures on this planet that are so distant and so different from us that researchers consider them to be the closest things to aliens we have ever encountered: cephalopods.

Cephalopods—the family of creatures which contains octopuses, squids, and cuttlefish—are one of nature’s most intriguing creations. They are all soft-­bodied, containing no skeleton, only a hardened beak. They are aquatic, although they can survive for some time in the air; some are even capable of short flight, propelled by the same jets of water that move them through the ocean. They do strange things with their limbs. And they are highly intelligent, easily the most intel­ligent of the invertebrates, by any measure.

Octopuses in particular seem to enjoy demonstrating their intelli­gence when we try to capture, detain, or study them. In zoos and aquariums they are notorious for their indefatigable and often suc­cessful attempts at escape. A New Zealand octopus named Inky made headlines around the world when he escaped from the National Aquarium in Napier by climbing through his tank’s overflow valve, scampering eight feet across the floor, and sliding down a narrow, 106-­foot drainpipe into the ocean. At another aquarium near Dun­edin, an octopus called Sid made so many escape attempts, including hiding in buckets, opening doors, and climbing stairs, that he was eventually released into the ocean. They’ve also been accused of flood­ing aquariums and stealing fish from other tanks: Such tales go back to some of the first octopuses kept in captivity in Britain in the 19th century and are still being repeated today.

Otto, an octopus living in the Sea­Star Aquarium in Coburg, Germany, first attracted media attention when he was caught juggling hermit crabs. Another time he smashed rocks against the side of his tank, and from time to time would completely rearrange the contents of his tank “to make it suit his own taste better,” according to the aquar­ium’s director. One time, the electricity in the aquarium kept shorting out, which threatened the lives of other animals as filtration pumps ground to a halt. On the third night of the blackouts, the staff started taking night shifts sleeping on the floor to discover the source of the trouble—and found that Otto was swinging himself to the top of his tank, and squirting water at a low­-hanging bulb that seemed to be annoying him. He’d figured out how to turn the lights off.

Octopuses are no less difficult in the lab. They don’t seem to like being experimented on and try to make things as difficult as possible for researchers. At a lab at the University of Otago in New Zealand, one octopus discovered the same trick as Otto: It would squirt water at light bulbs to turn them off. Eventually it became so frustrating to have to continually replace the bulbs that the culprit was released back into the wild. Another octopus at the same lab took a personal dislike to one of the researchers, who would receive half a gallon of water down the back of the neck whenever they came near its tank. At Dal­housie University in Canada, a cuttlefish took the same attitude to all new visitors to the lab but left the regular researchers alone. In 2010, two biologists at the Seattle Aquarium dressed in the same clothes and played good cop/bad cop with the octopuses: One fed them every day, while the other poked them with a bristly stick. After two weeks, the octopuses responded differently to each, advancing and retreating, and flashing different colors. Cephalopods can recognize human faces.

All these behaviors—as well as many more observed in the wild—suggest that octopuses learn, remember, know, think, consider, and act based on their intelligence. This changes everything we think we know about “higher order” animals, because cephalopods, unlike apes, are very, very different to us. That should be evident just from the extraor­dinary way their bodies are constituted—but the difference extends to their minds as well.

Octopus brains are not situated, like ours, in their heads; rather, they are decentralized, with brains that extend throughout their bodies and into their limbs. Each of their arms contains bundles of neurons that act as independent minds, allowing them to move about and react of their own accord, unfettered by central control. Octopuses are a con­federation of intelligent parts, which means their awareness, as well as their thinking, occurs in ways which are radically different to our own.

Perhaps one of the fullest expressions of this difference is to be found, not in the work of scientists, but in a novel. In his book . . .

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The Swedish philosophy of lagom: how “just enough” is all you need (a lesson often learned the hard way)

Jonny Thomson writes in Big Think:

The night is going well. Everyone is laughing, and there is a happy energy in the air. The conversation flows easily and you’re the merry, relaxed kind of drunk. Then Josh swaggers over with a tray of something. Then you see what it is. Oh no.

“Time to do shots!” he shouts. You’re not sure, and you see others aren’t too keen either. But you don’t want to be a spoilsport. A grimace and a cough later, and the night changes. You feel sick, the room is spinning, and within a few minutes, everyone is too drunk to talk.

There comes a point when a thing becomes too much. If you’re not the outgoing, drinking sort, you could replace the opening example with something else. It might be at the end of the meal when that final slice of pizza turns you from “comfortably full” to “ergh”; when the car karaoke goes from being huge fun to a throat aching chore; or when that Tarantino movie you’re liking so far still has another two hours to go. Anything in excess becomes miserable, even the good things in life.

The fact that humans have unquenchable thirst and insatiable appetites is not new wisdom. It’s found in early Vedic texts, in Ancient Greece, and in most of the world’s religions today (most starkly in Buddhism, Hinduism, and Jainism). But in the Swedish idea of lagom (lah-gomm), it has been given fresh life.

It’s an idea that might change how you see your life.

Just the right amount

Lagom translates as “just the right amount.” It means knowing when enough is enough, and trying to find balance and moderation rather than constantly grasping for more. Lagom is that feeling of contentment we all get when we have all that we need to make us comfortable. It’s neither a millionaire’s splurge in Vegas, nor a pauper’s cold winter night. It means having a roof over your head, food in your belly, friends at your back, and money — just enough money — in your pockets. If Goldilocks had a catchphrase, it would be “let’s lagom this bear house.”

There are two separate strands to lagom. The first is a kind of social awareness that recognizes that what we do affects other people. In this, we might see lagom more as a kind of “fair use” policy. If you take three cookies from the plate, two other people aren’t going to get one. If you hoard and grab everything you can, elbowing and cursing your way to the front of the line, then at best, that makes you a bit of an ass. At worst, it leaves others in ruin.

The second strand, however, is a mental shift that . . .

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The article has a link to a “fulfillment wheel.” Here is such a wheel. (See this post for explanation.)

Great shave with Solar Flare, Otoko Organics, and Ascension — but without Esbjerg aftershave gel (despite photo)

I continue to like Otoko Organics and its unique lather — in fact, I like it a lot, and Phoenix Artisan’s Solar Flare brush had an easy time working up the lather. The Ascension, also from Phoenix Artisan, is a really excellent little razor, which performed perfectly: 3 easy passes, a totally smooth result.

The fly in this morning’s ointment was the Esbjerg Sensitive Aftershave Gel — the pump produced nothing, and the container was curiously light. It was empty, and I was out of an aftershave I like a lot, which seems to be available at this point only from Esbjerg itself. (They offer quite a few, and their Paraplantox Aftershave Gel looks intriguing, though I very much liked the light, clean fragrance of the Sensitive version.) 

I grabbed a Doppelgänger Star Jelly aftershave balm and used that instead. Still a good shave, just not the one I expected.

The tea this morning is Murchie’s Earl Grey Cream: “a blend of fine Ceylon, Darjeeling, and Keemun teas, lightly scented with real oil of bergamot and sweet vanilla.”