This Group Frees People From the Prison of Medical Debt, One at a Time

She had already had enough misfortune to last a lifetime. The 43-year-old registered nurse's problems had begun years earlier, when her back pain turned out to be a herniated disc. One surgery resulted in an infection, another surgery—after the disc re-herniated—led to meningitis and a long hospital stay, during which doctors removed a vertebrae. All these complications led to her losing her job, which meant losing her health insurance. The bills piled up until she was $700,000 in debt and couldn't afford rent; when the letter reached her about a year ago, she was staying with friends. So while the $5,000 didn't make much of a material difference to Cook's life, she was overwhelmed with gratitude, with the knowledge that these people cared.

"I felt very blessed, loved. I felt honored," she said from Kalamazoo, Michigan, where she now lives in a condo of her own thanks to disability income. "It wasn't so much the money as it was complete strangers helping me out of the kindness of their hearts, picking me without knowing me, without knowing I was struggling."

The group that forgave her debt was Grand Rapids Church, but another organization facilitated the process. RIP Medical Debt is a nonprofit that buys medical debt for a fraction of its price like debt collectors do, but rather than hounding people like Cook to pay up, it wipes the debt clear.

Like the countless GoFundMe campaigns created to pay for people's crippling medical costs, RIP Medical Debt is at once a symbol for the boundless generosity of strangers who want to help people in need, and the bottomless well of need created by the system that saddled Cook with $700,000 of bills she'll never be able to pay. It's a charity whose own founder says he hopes it will cease to exist 10 years from now.

The medical debt market is a particularly absurd outgrowth of the U.S. healthcare system. When people can't pay bills owed to their hospital or doctors—a common occurrence, even among people like Cook who have insurance—the debt is often sold to collections agencies at a discount, the idea being that not all of it will get paid back. Sometimes debt can be purchased for mere pennies on the dollar, as it's bought and sold several times. As documented in a 2016 segment from John Oliver's Last Week Tonight, collectors frequently use aggressive or harassing tactics to bully people into paying up. Occasionally they will try to get people to pay "zombie debt" that they have already paid off or that is no longer affecting their credit; particularly unscrupulous collectors will call about "phantom debt" that never existed in the first place.

Craig Antico and Jerry Ashton, the founders of RIP Medical Debt, were in the debt collection industry themselves in 2012, when an Occupy Wall Street project called Rolling Jubilee started buying people's debt in order to forgive it. "We thought it was the dumbest thing we've ever heard," Antico said. "Why would you forgive debt when you can collect it?" But the idea stayed with the two men, and they came to realize how important it could be. When Rolling Jubilee was winding down in 2013-14, they decided to step in.

"I said to Jerry, 'Actually, we can't let all these people that are getting help just go away,'" Antico said.

RIP has since expanded into a 501(c)3 nonprofit with a staff of two dozen and a board. It's received donations from fundraisers held by local television stations, charitable individuals, and churches around the country. Earlier this year, the NBA player Trae Young donated $10,000 to RIP and forgave over $1 million in debt for people in the Atlanta area. According to the group's website, it has forgiven nearly $1.4 billion in debt since 2014, which is still only a tiny sliver of the estimated $1 trillion medical debt owed by Americans. It can't target individuals for forgiveness—there is no way to apply to be one of its beneficiaries—but RIP does sometimes focus on certain classes of people, like military veterans.

Antico said that the process of forgiving debt is complicated. To buy debt you need to have relationships with the people selling it, and some collection agencies are worried that if they sell debt to someone who will forgive it, their hospital clients will be suspicious or confused, even though the transaction isn't costing the hospital anything. It also takes expertise to identify certain groups of debtors that RIP's donors want to target. RIP also has to safeguard the data that comes along with the purchased debt, and make sure it's getting a good value for its money. When John Oliver partnered with RIP to forgive $15 million in debt on his show in 2016, his show had already bought the debt for $60,000—and Antico said the English host got ripped off. "He overpaid probably by three times or more, but he didn't know that," said Antico. "If he would have enlisted us to help him at the start, he would've paid less than $20,000 for that $15 million portfolio."

Antico said that around 20 percent of RIP's forgiveness letters are returned and never reach their recipients, meaning they may be unaware some of their debt has been erased. A few people tell the nonprofit they never owed the money in the first place, or have since gone into bankruptcy (an indication that a portion of the debt sold on the market is illegitimate, a la zombie debt, Antico notes). Some, like Sara Cook, may not have all of their debt forgiven. But many recipients are profoundly grateful.

"We get calls, we get letters, we get emails," said Antico. "They're all pretty much awed, like, Why me? Like, You answered my prayers or Now I can get a mortgage."

But even as RIP has expanded, its scope remains more narrow than the aims of the Occupy project that inspired it. Andrew Ross, an NYU professor of social and cultural analysis who was part of the Rolling Jubilee Project and is a member of Debt Collective, an anti-debt group that emerged from Occupy, described Rolling Jubilee's effort as something other than charity. "We don't believe that people are at fault when they go into debt, so they don't have to be forgiven by anyone," said Ross, who wrote a book about debt called Creditocracy. "It was supposed to be a kind of social hack that would make a point, that would prove that collective action could bring that relief."

The goal that Ross and his fellow activists had was to move on from medical debt—the group also purchased millions of student debt—and draw attention to the way debt of all types shapes our society and our lives. They represent a radical edge of economic populist politics that has pushed slowly into the mainstream of the Democratic Party. In January, Elizabeth Warren announced that if she became president her administration would unilaterally forgive $640 billion in student loans, with or without Congress's approval. Bernie Sanders has said he wants to wipe out $81 billion in medical debt and make it easier to discharge medical debts in bankruptcies. As proposals like those make clear, if the federal government got into the forgiveness game, its efforts would dwarf what RIP Medical Debt has accomplished.

Antico admits that though the system is "messed up," his organization is not necessarily part of that more revolutionary agenda. "We're just trying to help people and resolve some things to get it off their head and stop hardship," he said.

RIP is similar in purpose to various debt-relief groups that cropped up in 18th and early 19th century England, when debtors were often sent to prison. As the historian Margot Finn has written, these groups made great efforts to make sure that the recipients of their charity were “of good character” and therefore deserved to have their debts forgiven and be freed from prison. Ross and others have written about debt as an omnipresent force in American life, a tool the financial industry uses to trap ordinary people in lifelong servitude. But it's also possible to look at debt as the result of bad individual choices—a moral failing, in other words.

Even if RIP wanted to, there's no way for the organization to target particularly "virtuous" debtors. But like those English philanthropists, Antico makes distinctions between various types of debt. Some people, he pointed out, get into debt because they've bought boats or expensive houses or cars. Others may have gone to expensive colleges. Payday loans or other types of debt incurred from severe needs may be more like medical debt—but in any case, he said, the board at RIP wants to restrict its focus to medical debt, which is uniquely unfair and cruel. (There's no way to hear a story like Cook's and conclude she's in debt because of poor choices.) RIP's medical-only mission also lines up with the priorities of many donors.

"Most people are doing this for virtuous reasons and want to see that their money is going to—not necessarily virtuous people but people that are being harmed," Antico said. "It's to right a wrong."

The piecemeal forgiveness of medical debt, no matter how well-intentioned, is, of course, insufficient. "I would love RIP not to be around in 10 years and I would like it to not have to do this," Antico said, stressing that this was his personal view and not RIP's. "It's not solving anything. It is stopping the hardship, and heck, it could grow to $1 billion and abolish $100 billion a year… But the problem is there's going to be much more than a hundred billion [in debts], and it's every year."

Antico said that he would support expunging medical debts when people go bankrupt (currently, medical debt is treated no differently than other types of debt). But government policies change slowly. In the meantime, RIP continues the incremental, never-to-be-finished work of striking down debt. In February, a group of churches in Kentucky, Ohio, Tennessee, and Indiana raised enough money to forgive $45 million in debt with RIP's help.

In Michigan, Cook keeps working on her own debt. The disability payments she now receives allow her to survive, but it's not enough; doctors' bills and payments on her condo cut into her checks. Still, she tries to pay down her medical debt when she can. "I do the best I can with what I have," she said. "I'm pretty sure it's probably never getting it paid off in my lifetime, but I'm working on it."

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