Rep. Allen West (R-FL), a tea party favorite, said Wednesday in a speech to the U.S. House of Representatives that his colleagues in the Democratic Party engage in "the most insidious form of slavery remaining in the world today."
"Our party firmly believes in the safety net," West said. "We reject the idea of the safety net becoming a hammock. For this reason, the Republican value of minimizing government dependence is particularly beneficial to the poorest among us. Conversely, the Democratic appetite for ever-increasing redistributionary handouts is in fact the most insidious form of slavery remaining in the world today, and it does not promote economic freedom."
The comment, though startling, is not unusual for West, who's collected a litany of critics with his often over-the-top rhetoric.
He's particularly fond of attacking Democrats with analogies to "slavery," and once called himself "the modern-day Harriet Tubman" for his efforts to lead black voters off the "21st-century plantation," which he thinks is run by "certain black leaders, who are nothing more than the overseers of that plantation."
His argument that food, medical and financial support for the poor is a kind of "slavery" is also a common Republican theme, but due to the obvious racial implications, it is rare that a white conservative raises the analogy in public.
That's a hard case for Republicans to make with polls saying three out of every four Americans want lawmakers in Washington to keep Social Security and Medicare just the way it is. It's an even harder case to make when West characterizes programs that effectively cut poverty in half in the U.S. as "the most insidious form of slavery remaining in the world today," especially considering that there are more humans in slavery in modern times than ever before.
The United Nations and other groups suggest the number of forced laborers and sex slaves around the world today could be as many as 27 million people -- all of whom might object to their plight being compared to the relative luxury of food, medical and financial aid.
Omar Buddakey emerges from a nondescript building in Los Angeles with a joint in his hand.
Five years after cannabis was legalized in California, black market transactions like this one -- where no one pays any taxes, and the product is not regulated -- remain commonplace.
"Legal shops are too expensive," the 27-year-old tells AFP, as he lights up his preroll.
Over the course of a year Buddakey estimates he saves the equivalent of a paycheck from his patient transport job by avoiding the state-sanctioned outlets.
"I'd rather pay less for the same thing. And I know it's the same thing, because it gives me the same feeling."
Buddakey's working-class neighborhood in east Los Angeles is teeming with stores like this one, many marked by a green cross.
Although they are illegal, they openly advertise online, and many have their own websites.
Inside one of them, a man who gives his name only as "Joe" welcomes a steady stream of customers who are offered a selection of buds and leaves.
Here, an ounce (30 grams) of weed sells for $100 -- $35 less than at a state-regulated store.
"Cops have raided this shop probably eight to 10 times," he tells AFP. "They take the weed, our cameras and all the cash.
"We just re-open the next hour or the next day."
'Nickelled and dimed'
A 2016 referendum legalized recreational use of cannabis in California, 20 years after it was permitted for medical use with a prescription.
The idea was to rid the streets of illegal sellers, to regulate the substance to ensure it was of sufficient quality, and to raise tax for state coffers -- goals shared by other jurisdictions, including Canada, Uruguay and Germany.
The first legal shops opened in 2018, and are now found in many cities throughout the state.
Few thoroughfares in Los Angeles are without one, from straightforward holes-in-the-wall to glitzy boutiques, where a cannabis sommelier -- or "budtender" -- can recommend the right blend, and expects a tip for their services.
But the rush of stores has not dented the size of the underground market, which has remained steady at around $8 billion a year, according to Tom Adams of Global Go Analytics.
The legal business is struggling. In 2022, sanctioned cannabis sales fell 8.2 percent to $5.3 billion.
"California is now paying for the two fatal errors it made when designing its program," says Adams. "They loaded it up with too many taxes, and too many regulations."
Indeed the rules around cannabis selling are complicated, and -- like many things in California -- are subject to separate, and sometimes overlapping, jurisdictions.
Each city or county has the final say in whether to allow the sale of recreational cannabis on its turf. As a result, less than 40 percent of them have given the green light.
The state's 40 million inhabitants can buy cannabis from 1,100 legal stores, but they are far from evenly spread, leaving a large base of customers who have no option but to buy from illegal vendors.
And in areas where trade is allowed, "we're just nickelled and dimed to death," says Nathan Holtz-Poole, of Green Goddess Collective in Venice Beach, which employs 18 people.
"Unfortunately, that is putting a real strain on the industry."
Excise and sales taxes imposed by both the California government and the city add 35 percent to the cost of weed bought legally, Holtz-Poole explains.
His lavishly decorated, herbalist-like dispensary offers everything from home-grown plants to ultra-potent cannabis concentrates, from gummies to drinks.
Despite chasing the premium sector of the market, he's not exactly coining it in, the 57-year old businessman says.
"We're barely surviving. We break even, at best."
Competition from illegal sellers eats into his bottom line, he says, estimating that he loses 30 percent of his customers to outlets who don't have to file tax returns.
It's common knowledge, Holtz-Poole says, that you can get products containing THC -- the psychoactive ingredient in marijuana that causes a high -- from some places that are only supposed to be selling CBD, a marijuana derivative that doesn't give users a buzz.
Despite his regular reports to police, "there is just no enforcement at all," he sighs. "We feel completely abandoned."
Police officers say they are climbing a mountain with one hand tied behind their backs.
"We're working our butts off," says Michael Boylls, who heads the Cannabis Support Unit in the Los Angeles Police Department's Gang and Narcotics Division.
His men carry out 300 to 400 searches a year and sometimes have illegal businesses shut down.
But sellers rarely face more than a fine and quickly return to business.
"The problem is there's no teeth in the law," he says.
Dr. Sara McLin thought she made the right choice by going to an in-network emergency room near her Florida home after her 4-year-old burned his hand on a stove last Memorial Day weekend.
Her family is insured through her husband’s employer, HCA Healthcare, a Nashville-based health system that operates more hospitals than any other system in the nation. So McLin knew that a nearby stand-alone emergency room, HCA Florida Lutz Emergency, would be in their plan’s provider network.
But McLin said a doctor there told her she couldn’t treat her son, Keeling, because he had second- and third-degree burns that needed a higher level of care. The doctor referred them to the burn center at HCA Florida Blake Hospital, about a 90-minute drive away.
McLin, who is a dentist, said the doctor told her the stand-alone ER would not charge for the visit because they did not provide treatment.
“I don’t remember exactly how she phrased it. But something along the lines of, ‘Well, we won’t even call this a visit, because we can’t do anything,’” McLin said.
At Blake Hospital, she said, a doctor diagnosed Keeling with a second-degree burn, drained the blisters, bandaged his hand, and sent them home with instructions on how to care for the wound.
“I didn’t think anything more of it,” McLin said.
Then the bills came.
The Patient: Keeling McLin, now 5, is covered by UnitedHealthcare through his father’s employer.
Medical Service: At the stand-alone emergency room, a physician assessed Keeling and sent him to another facility for treatment. “Keeling needs a burn center,” the doctor wrote in the record of his visit.
Service Provider: Envision Physician Services, which employed the emergency room physician at HCA Florida Lutz Emergency in Lutz, Florida, near Tampa, and HCA Florida Trinity Hospital, the main, for-profit hospital to which the stand-alone emergency room belonged.
Total Bill: For the emergency room visit, Envision Physician Services billed $829 to insurance and about $72 to the family. HCA Florida Trinity Hospital billed Keeling about $129, noting it had applied an “uninsured discount.” An itemization showed the original charge had been nearly $1,509 before adjustments and discounts.
What Gives: The stand-alone emergency room and ER doctor, who saw Keeling but referred him to another hospital, billed for his visit. But McLin soon learned she was unable to dispute some of the charges — because her young child’s name was on one of the bills, not hers.
Months after the ER visit, McLin received a bill addressed to the “parents of Keeling McLin” from Envision Physician Services, the provider staffing service that employed the ER doctor at Lutz. McLin recalled the doctor’s promise that they would not be billed. “I should have made them write something down to that effect,” she said.
She said she called her insurer, UnitedHealthcare, and a representative told her not to pay the bill.
She received an insurance statement that identified the bill from Envision’s doctor — an out-of-network provider working in an in-network emergency room — as a “surprise bill” for which the provider may charge only copays or other cost-sharing costs under federal law. McLin said she had not heard anything since then about the bill.
After being contacted by KHN, Aliese Polk, an Envision spokesperson, said in an email that Envision would waive the debt, apologizing to Keeling’s family “for the misunderstanding.”
She described the ER doctor’s evaluation, determination, and referral as a medical service. She said the bill was for cost sharing for the visit — not the difference between what the doctor charged and what insurance paid, as the law prohibits.
“We recognize the patient’s family may have understood at the time of treatment that there would be no charge for the visit, including the medical service provided by our physician,” Polk said. “Unfortunately, this courtesy adjustment was not captured when the claim was processed.”
Maria Gordon Shydlo, a UnitedHealthcare spokesperson, said the insurer believed the matter had been resolved and did not follow up on requests for an interview, even after McLin waived federal health privacy protections, which would allow the insurer to speak to the reporter about the case.
McLin also received a bill from HCA Florida Trinity Hospital for its stand-alone ER at Lutz and decided to dispute the charges.
But after calling the hospital to appeal, McLin said, the billing department would not discuss the debt with her because the statement was in her young son’s name.
“They had him as the guarantor,” McLin said. Unlike Envision, which billed Keeling’s parents and their insurance, McLin said the hospital listed the child as “unemployed, uninsured.”
The child’s ER record also included his date of birth and doctor’s notes referencing his age. McLin said she wrote to HCA in November asking to appeal the bill and that a billing representative told her over the phone that it would put the debt on hold and review the dispute.
“I never heard anything back and assumed we were good,” McLin said.
Then, in January, she received a letter from Medicredit, a collection agency and an HCA subsidiary, stating that Keeling owed $129 and that he had until mid-February to contest the debt. KHN was unable to make contact with Medicredit representatives, and HCA Healthcare did not respond to requests for comment from its subsidiary.
Once again, Sara McLin’s name was not on the debt collector’s letter, and she said Medicredit representatives refused to discuss the debt with her because it was in her son’s name. She said she called HCA, too. “They said, ‘We can’t help you. We don’t have the case anymore,’” she said.
Erin Fuse Brown, a law professor and director of the Center for Law, Health & Society at Georgia State University, said McLin did everything right and that it is unusual for a parent to be barred from discussing a debt related to their minor child.
“The fact that the hospital wouldn’t even talk to her strikes me as the part that is absurd. It’s absurd as a business matter. It’s absurd as a privacy matter,” Fuse Brown said, adding that federal health privacy laws allow a parent or legal guardian to access their dependent’s medical information.
Fuse Brown said the hospital should have been able to correct the error quickly with more information, such as a birth certificate or other document establishing that McLin was Keeling’s parent. At the very least, she said, it could have given McLin notice before sending the bill to collections.
“You get the feeling that it’s this large, automated process, that there’s no human to get through to, that there’s no human to talk to and override the mistake,” Fuse Brown said. “Maybe it’s routine, but she couldn’t even talk to someone to correct a correctable billing error, and then the system just steamrolls over the patient.”
The Resolution: When the collection agency’s deadline passed without resolution, McLin said she felt frustrated. “Nobody can explain to me who has to approve talking to me,” she said. “I don’t know who that person is or what the process is.”
After KHN contacted the health system, HCA Healthcare canceled the family’s debt. HCA representatives declined to be interviewed on the record despite also receiving a privacy waiver from McLin.
“We have attempted to contact Mrs. McLin to apologize to her for the inconvenience this has caused her and to let her know that there is a zero balance on the account,” Debra McKell, marketing director for HCA West Florida Division, said in an email on March 3. “We also will be sharing with her that we are reviewing our processes to ensure this does not happen again.”
McLin later received a letter from HCA stating that the account had been cleared. She also said she received a call from a customer service representative informing her that the debt had not been reported to any credit agencies.
She said she was pleased, but that patients should not have to struggle to correct a billing error before it is sent to a collection agency and potentially ruins their credit.
“It’s the principle of the thing that’s annoying me at this point,” she said.
The Takeaway: Though the notion of a debt collector pursuing a 4-year-old boy may seem farcical, it happens. When seeking medical care for a minor, it is important for the parent or guardian to ensure their name is listed as the responsible party.
Consumers who find themselves fighting a medical billing error need to “think like a lawyer,” Fuse Brown said, including documenting every interaction with the debt collector, getting any promises in writing, and recording phone calls. (State laws vary about how many parties on a call must give permission to record a conversation.)
Patients do not have to give up once a bill goes to collections, Fuse Brown said. “Once you hear from a debt collector, it’s not like the game is over and you lose,” she said. “Consumers do have rights.”
François de Brantes, a home health company executive and expert on how money flows through the health care system, said that hospital billing errors are not uncommon but that he had never heard of a situation like the one McLin experienced. He called it “puzzling” that HCA would issue a formal claim in a dependent child’s name.
De Brantes said those in a similar situation should also ensure that the collection agency removes any record of a debt against a minor to protect the child’s financial future.
“This stuff happens, where you have children who are improperly billed for stuff that they shouldn’t be billed, and they end up in collection,” he said. “Then the kid finds themselves with a collection record and they can’t get loans in the future, potentially student loans.”
Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Brazilian Viktor Ferreira was elated in May 2018 when he was accepted into the elite Johns Hopkins School of Advanced International Studies (SAIS) in Washington.
"Today we made the future... WE fucking did it!!!" he wrote a colleague.
But Ferreira was no normal student: according to a US indictment, he was a Russian spy under deep cover, an "illegal" whose real name was Sergey Cherkasov. The colleague he wrote to was his handler.
SAIS was his dream school: closely entwined with the US diplomatic, military and intelligence communities, it would place Cherkasov just a few steps from America's secrets.
"We won, bro. Now we are in the big-boys league," he told the handler.
The messages, along with a wealth of other information, came from memory drives seized from Cherkasov after he tried to take a job last year in the International Criminal Court in the Netherlands.
He is one of several Russians recently exposed living like the illegals depicted in the hit US television series "The Americans."
Two weeks ago Greek authorities revealed that a popular knitting shop owner and photographer known as Maria Tsalla was actually Russian spy "Irina S".
Last October Norway arrested a Brazilian academic, Jose Assis Giammaria, who worked at Tromso University on Norway's Arctic policy and other security-related issues.
He was in fact a Russian agent, the Norwegians said.
Also last year, a joint investigation by Bellingcat and European media unveiled the Russian GRU ties of an ostensibly Peruvian woman who had operated a popular luxury goods business in Italy, catering to NATO officials there.
'Vivid memories' of a fake life
After being deported from the Netherlands, Cherkasov was jailed in Brazil last year for identity fraud. Moscow has requested his extradition, claiming he is a wanted drug trafficker.
But documents on his devices appear to portray the life of a Russian illegal.
Detailed in the US indictment of Cherkasov last week, they include his "legend", the alternative autobiography agents must commit to heart to burrow into their new lives.
The four pages tell a convoluted story about relatives with differing nationalities who mostly all passed away -- explaining his own Germanic looks, his imperfect Portuguese and lack of a family network.
"I remember my aunt as a tiny woman with grey hair, kind eyes, and soft hands. She spoke Portuguese badly and taught me several Spanish words," his legend said.
"From my youth I have vivid memories of the President Costa e Silva bridge (in Brazil) ... But I disliked the stench of fish that hung in the port near our house. I think that is why I hate fish," it said.
Steps away from US secrets
Cherkasov, 38, arrived in Brazil with that story in 2010, according to the US indictment.
Like the illegals in "The Americans" he worked as a travel agent, until he gained admission to Trinity College Dublin where he studied political science from 2014-2018.
That set him up for graduate school in the United States.
SAIS would cost the GRU $120,000, but it offered a potentially brilliant payoff: many of Washington's policy elite attend the school, and it opens many doors.
For example, Cherkasov joined a class tour to Israel that brought him in contact with US and Israeli security officials.
And, as Russia's threat to invade Ukraine mounted in late 2021, SAIS experts were advising the US government -- which he duly reported to handlers.
'Mind-boggling' incompetence
His devices gave insight into how a modern illegal works, emailing and texting with handlers, rather than taking calls in a dark phone booth.
In one exchange, in fact, Cherkasov told a handler he preferred email.
"This SMS shit kills me," he wrote.
In February 2022, before departing for the Netherlands, he messaged a girlfriend saying that he still did not have approval from his handler to get married.
"You gotta push the issue as soon as you are in Europe," the woman told him.
His files show how he took advantage of a friendly Brazilian official to authorize a false document, that enabled him to obtain more genuine papers to legitimize his "legend."
"She is quite religious and believes that helping people in need is what will deliver her to paradise after death," he wrote.
But the drives also revealed his spycraft, including where he hid electronic equipment in a forest and how he communicated with handlers, giving clues as to who they were.
Former US intelligence official Chris Costa said keeping such sensitive information on memory sticks was "mind-boggling" incompetence.
"That is abysmal tradecraft," Costa, now executive director of the Spy Museum in Washington, told AFP.
Costa said the same trend was clear in the recent exposures of other illegals and hundreds of Russian spies working under official cover.
During the Cold War the KGB had "decades of refinement" of spy tradecraft under their belt, he said.
"This current crop of intelligence officers ... seem particularly sloppy," he said.
