Daily Show host Jon Stewart was taking President Barack Obama's administration to task on Monday for not preparing its online rollout of the Affordable Care Act despite having three years to prepare itself, when he stopped to remind himself that Republicans aren't able to capitalize on that kind of mistake.
"Oh, right, I forgot -- they're f*cking nuts," Stewart said of GOP lawmakers. "The most egregious and blatant incompetence still pales in comparison to these guys."
Stewart also lampooned Republicans' insistence on tying the debate over raising the federal debt limit to their opposition to the new law, concocting a scenario in which they would refuse to send Bruce Willis to save the Earth in the movie Armageddon unless Democrats agreed to defund it, singling Rep. Joe Barton (R-TX) out for his statement that "in my household budget some bills that have to be paid and some bills that only paid partially."
"What a great strategy," Stewart said sarcastically. "That was my strategy -- in college, when I smoked a lot of pot and worked at Cinnabon."
Along the way, Stewart also pointed out the American public's particular impatience when it came to waiting for their chance to sign up for "Obamacare."
"Let's get one thing straight about this country: We will camp out all night to be the first people to buy a phone, or see a movie about shirtless werewolves," Stewart noted. "But you've got 10 minutes to get me this f*cking healthcare, you understand what I'm talking about?"
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.
Robin Wolfenden was practicing yoga on her balcony on a spring morning in Nashville when she heard the sirens -- the sound of first responders rushing to the scene of America's latest school shooting.
The next day she laid six stones -- a Jewish tradition -- for the victims at the entrance of the nearby Covenant School, where a 28-year-old former student broke in and stalked the halls, killing three staff and three young children.
"These kids are innocent children," Wolfenden told reporters, worried for her grandsons who are five and eight years old, only a few years younger than the students killed at the Covenant Presbyterian Church-affiliated elementary school on Monday.
Mass shootings are grimly frequent in the United States, and Nashville residents were in shock Tuesday after their city joined the nationwide roster of those that have experienced an armed assault on a school.
"It's just unimaginable to think that these beautiful kids are not going to come home again," Lisbeth Melgar, who brought her two children to see a growing memorial to the victims outside the school, told AFP as she gently tucked her daughter's hair behind her ear.
Melgar was among several parents who brought their young children among the stream of mourners visiting the memorial as the sun set on Tuesday, many of them in tears among the flowers, stuffed toys, and white crosses decorated with blue hearts.
Her daughter Alessandra, 11, said security had been tightened at her school Tuesday in the wake of the attack, with authorities only letting a few people at a time through the gate.
Her mother said there would be meetings this week with parents to discuss security, "because we do believe that we need to put more security in our schools."
"It definitely hits home for me today," said Stacie Wilford, a nurse at a local medical facility and mother to an eight-year-old at a nearby school.
"I live a mile and a half away so it's in your back door and it's so scary," she told AFP.
"You drop your kids off in the mornings and you don't think that you could get a call like this. It's just devastating. That just -- I can't even fathom."
Carolyn Lucas's children also attend a school just a 10-minute walk away from the scene of the shooting.
"I feel like our souls were shattered. It's unfathomable yet completely expected. You know, why wouldn't it happen to us?" she asked.
Despite the rate of gun violence in the country, Lucas said it's still easy to think it won't hit one's own community.
But, she said, "Of course it will. Gun violence sees no race or religion... it doesn't discriminate against anybody.
"We have to do better."
'Heartbreaking'
Kaylee Franzen, 22, who came with her 21-year-old friend Gabriella Massey to pay their respects, shares the same sentiment on gun violence.
"You hear about this happening all the time. And I don't think we've ever been somewhere where it's been so close and that in itself was really heartbreaking," said Franzen, a senior at the private Christian Belmont University in Nashville.
She said the shooting made the two women want to do something, even just by bringing flowers to the site of the makeshift memorial at the church property entrance, which was guarded by a police cruiser Tuesday.
"Even though this doesn't necessarily help anything, it sends a message that things need to change, and that thoughts and prayers alone aren't something that fixes or can aid the situation," she said.
That same message dominated a rally seeking more gun regulation that was held in Nashville on Tuesday. It had been planned before Monday's attack.
"It's horrifying to live in a world when we have to be afraid to educate our children," local mother Lisa Coffman told the rally.
To AFP she added: "You don't think it's going to happen in your city.
