Non Profit Hospitals Sue Poorest Patients

RENEE MONTAGNE, HOST:
We've been reporting about nonprofit hospitals that dock the pay of some of their poorest patients. Now the chair of the Senate Judiciary Committee says hospitals could be breaking the law by suing those patients and seizing their wages. And he wants some answers. NPR's Chris Arnold reports.
CHRIS ARNOLD, BYLINE: NPR and ProPublica looked across six states, and in each we found nonprofit hospitals suing hundreds of their patients. One hospital in particular jumped out. It's called Heartland Regional Medical Center in St. Joseph, Missouri. Thousands of patients a year are getting their paychecks docked by the hospital and its debt collection arm.
KATHLEEN HERIE: They're greedy. I owe more in interest on those bills than I do the bill alone.
ARNOLD: That's Kathleen Herie. She and her husband Keith for years have had 10 and sometimes 25 percent of their paychecks seized by the hospital. Despite that they still owe more than $25,000 in medical bills, and the hospital's been charging them at 9 percent interest.
KEITH HERIE: It's like a never-never plan. You're never going to get rid of it, and you're never going to get ahead of it.
ARNOLD: And here's the thing, the Heries and other patients that we spoke to, based on their income, should have qualified for free medical care. That's based on the hospital's own charity care policy, but that didn't happen. We also documented that hundreds of patients with low-wage jobs at McDonald's, Walmart and elsewhere had their pay seized by Heartland Hospital.
SENATOR CHUCK GRASSLEY: Quite frankly, I'm astounded.
ARNOLD: That's Republican Senator Chuck Grassley who chairs the Senate Judiciary Committee. It turns out Grassley, for more than a decade, has been working to make nonprofit hospitals more accountable for the huge tax breaks that they get. They don't pay federal income tax or local property tax.
GRASSLEY: Government felt that nonprofit status was legitimate if you earned it by taking care of people that couldn't provide for their own health care.
ARNOLD: Grassley worked on voluntary standards but he also authored language in the Affordable Care Act requiring hospitals to do more to provide charitable care. So when the senator saw our story about Heartland Hospital, which by the way is changing its name to Mosaic Life Care, he decided to get involved.
GRASSLEY: Under the ACA, a hospital has a responsibility to make a determination - can a person or a family pay, or can they not? And it seems like Mosaic turned that on its head. The law requires that they take the initiative. And it seems to me, they have not taken the initiative, and they have not abided by the law.
ARNOLD: As a result of our stories, the hospital's board is reviewing its practices. Senator Grassley has now sent a letter to the hospital saying he wants to be briefed on the results of that review by January 30. Grassley wrote that the hospital, quote, "may not be meeting the requirements to be a nonprofit." And Grassley hopes his letter sends a wider message to other nonprofit hospitals that might be being too aggressive collecting bills from patients who can't afford to pay.
GRASSLEY: Well, I think some hospitals, you hit them over the head with a two-by-four, and they still don't get the message.
ARNOLD: Grassley says the health care law may need to be strengthened to force nonprofit hospitals to offer financial assistance to patients who can't afford their medical bills.
GRASSLEY: If they don't get the message now, we'll have to work towards getting the ideal language in the legislation.
ARNOLD: A Mosaic Life Care spokesperson says the hospital will quickly respond to the senator's request and that the hospital's goal is to, quote, "do the right thing." Chris Arnold, NPR News.
MONTAGNE: This series is part of a collaboration with ProPublica reporter Paul Kiel. And you're listening to MORNING EDITION from NPR News. I'm Renee Montagne.
DAVID GREENE, HOST:
And I'm David Greene.

Rejection Therapy

DAVID GREENE, HOST: We're introducing you this morning to Invisibilia. It's the name of a new NPR program that's all about the invisible forces that shape human behavior. This week's episode focuses on fear. And to give just a taste of one of Invisibilia's co-hosts, Alix Spiegel, brings us the story of a man with a debilitating fear of rejection.
ALIX SPIEGEL, BYLINE: The evolution of Jason Comley, freelance IT guy from Cambridge, Ontario, began one sad night several years ago.
JASON COMELY: That Friday evening in my, you know, one- bedroom apartment trying to be busy. But really, I knew that I was avoiding things.
SPIEGEL: See, nine months earlier, Jason's wife had left him.
COMELY: She, my ex-wife, had found someone that was taller than I was, had money more money than I had and was better-looking than I was. So yeah, yeah, it was...
SPIEGEL: And since then, Jason had really withdrawn from life. He didn't go out, avoided talking to people, especially to women. And that Friday, he realized that this approach was taking a toll.
COMELY: I had nowhere to go and no one to hang out with. And so I just broke down and started crying. It was just something that made me realize that I'm afraid. And then I just - I asked myself, afraid of what?
SPIEGEL: And sitting there, he says, it just suddenly hit him, why he was so afraid.
COMELY: It was rejection. I thought, I'm afraid of rejection. And so this is going to sound a little bit weird, but when I realized that it was rejection, I was kind of thinking about the Spetsnaz.
SPIEGEL: The who?
COMELY: Do you know about the...
SPIEGEL: No.
COMELY: ...The Spetsnaz?
SPIEGEL: No.
The Spetsnaz, apparently, are an elite Russian military unit with a really, really intense training regime.
COMELY: You know, I heard of one situation where they were locked in a room, a windowless room, with a very angry dog, and they'd only be armed with a spade. And only one person's going to get out, either the dog or the Spetsnaz.
SPIEGEL: And then a strange thought occurred to Jason - maybe he could somehow use the rigorous approach of the Spetsnaz against his fear.
COMELY: So I thought, you know, I'm going to try to apply their training methodology to this situation.
SPIEGEL: So if you're a freelance IT guy, living in a one- bedroom apartment in Cambridge, Ontario, what is the modern equivalent of being trapped in a windowless room with a rabid dog and nothing to protect you but a single, handheld spade?
COMELY: I had to get rejected at least once every single day by someone.
SPIEGEL: He started in the parking lot of his local grocery store, went up to a total stranger and asked for a ride across town.
COMELY: And he looked at me, like, and just said, I'm not going that way, buddy. Yeah, just like - and I was like, thank you.
SPIEGEL: It felt great.
COMELY: It was like got it. I got my rejection.
SPIEGEL: Because Jason, he had totally inverted the rules of life. He took rejection and made it something that he wanted so that he would feel good when he got it.
COMELY: It was sort of like walking on my hands or living underwater or something. It was just like a different reality. The rules of life had changed.
SPIEGEL: So he kept going - went to Wal-Mart, tried to give a flyer for his Mormon church to this woman he found in the aisles.
COMELY: And she looked me squarely in the eye and sort of spoke very slowly so that I would completely understand. And she just went, no.
(LAUGHTER)
SPIEGEL: Jason eventually came up with a name for this makeshift game he'd created. He called it rejection therapy. Then one day, Jason got another idea - he wrote down all of his real-life rejection attempts...
COMELY: Ask for a ride from a stranger, even if you don't need one.
SPIEGEL: ...Had them printed up...
COMELY: Before purchasing something, ask for a discount.
SPIEGEL: ...On a deck of cards.
COMELY: Ask a stranger for a breath mint.
SPIEGEL: And he began to sell those cards online, you know, to make his game more official. And slowly, rejection therapy, it became a kind of small, cult phenomenon with people playing all over the world.
MATT RAMIS: Hi, sir, do you have any chewing gum by any chance? No? OK.
SPIEGEL: Like this guy, a student in California named Matt Ramis.
RAMIS: Hi, excuse me, do you guys have chewing gum by any chance?
UNIDENTIFIED WOMAN: No, I don't, sorry.
RAMIS: All right. It's all right.
SPIEGEL: ...Or this guy, Joey Chandler from San Francisco.
JOEY CHANDLER: You want to come play golf with us tomorrow night?
UNIDENTIFIED MAN: When?
CHANDLER: Tomorrow night.
MAN: I would love to. I don't know if I can.
SPIEGEL: Jason's heard from a teacher in Colorado, a massage therapist in Budapest, a computer programmer in Japan and even a widowed Russian grandmother. She's using rejection therapy to pick up men.
COMELY: It's really cool. So there's an 80-year-old babushka playing rejection therapy.
SPIEGEL: So what has Jason learned from all of this? That your fears, most of them anyway, aren't grounded in reality in the way that you think that they are. They're just a story that you tell yourself, and you can choose to stop repeating it. You can choose to stop listening.
COMELY: Don't even bother trying to be cool. Just get out there and get rejected. And sometimes it's going to get dirty, but that's OK because you're going to feel great after. You're going to feel like, wow, I disobeyed my fear. You know, I disobeyed fear.
Say hello to three people at the grocery store. Offer to pay for someone's order. Introduce yourself to a stranger. Make yourself look radically different today. Knock on a neighbor's door, request something. Ask someone out on a date. Sit beside a stranger. Strike up a conversation. Smile at every person you walk past today.
GREENE: That story came to us from Alix Spiegel. She is co-host of Invisibilia. You can hear the program on many public radio stations this weekend. The podcast is available for download at npr.org and on iTunes.

How Dogs Understand Human Language

Article published by NPR on November 28, 2014

Transcript:
RENEE MONTAGNE, HOST:
Dogs are better known for their loyalty and warmth than their brains. But a new study suggests they may be smarter than we think. NPR's Michaeleen Doucleff talked with some scientists about the findings as well as a representative from the canine community.
MANGO: (Barking).
MICHAELEEN DOUCLEFF, BYLINE: That's Mango. She's a German Shepherd. She lives in San Francisco, and she's my dog. Mango loves to fetch and chase squirrels. And like many dogs, she recognizes about a dozen commands. Her favorite?
DOUCLEFF: Mango, do you want to go to the park?
MANGO: (Barking).
DOUCLEFF: No matter how I say this one command... (Speaking angrily) Mango, do you want to go to the park? (In a sing-song voice) Mango, do you want to go to the park? She perks up her ears, tilts her head and...
MANGO: (Barking).
DOUCLEFF: OK, scientists know that dogs pay attention to the emotion in our voices - how the pitch goes up and down, whether the tone is friendly or mean. But I swear, with this one command, Mango understands the words. And luckily, somebody's been looking into this. There's a study out this week in Current Biology that tries to figure out if dogs really recognize words. Or are they just responding to the emotions in our voices? For instance, would Mango respond if even Google said her favorite command?
(SOUNDBITE OF GOOGLE VOICE)
GOOGLE VOICE: Mango, do you want to go to the park?
DOUCLEFF: Vicky Ratcliffe is a graduate student in the psychology department at the University of Sussex in England. She worked on the news study, and she tells me about the experiment they set up.
VICKY RATCLIFFE: The way it works is we have two speakers which are placed either side of the dog, to their left and their right.
DOUCLEFF: Then, Ratcliffe played the command to come out both speakers at the same time. At first, the command sounded normal. It had meaningful words and emotional cues in it.
(SOUNDBITE OF ARCHIVED RECORDING)
RATCLIFFE: Come on, then.
DOUCLEFF: Then, Ratcliffe changed it up. She played a command with no emotion, but meaningful words.
(SOUNDBITE OF ARCHIVED RECORDING)
ELECTRONIC VOICE: Come on, then.
DOUCLEFF: Then a command with only emotion, no words.
(SOUNDBITE OF ELECTRONIC TONES)
DOUCLEFF: Then there was one that sounded like a robot.
(SOUNDBITE OF ROBOTIC TONES)
DOUCLEFF: For each command, Ratcliffe recorded which way the dogs turned their heads, toward the left speaker or toward the right speaker. Even though both speakers were playing the same sounds, a clear pattern emerged.
RATCLIFFE: So when the dogs heard meaningful verbal information, then most of them turned to their right.
DOUCLEFF: But when the dogs heard commands with just emotional cues, most dogs turned to the left. This suggests that dogs process emotional cues on one side of the brain and the meaning of words on the other side. This is similar to how we humans process speech. Attila Andics is a neurobiologist at the Hungarian Academy of Sciences and a top expert on dog brains. He says the results are strong and clear.
ATTILA ANDICS: In a way, this study tells me that dogs are able to differentiate between meaningful and meaningless sound sequences.
DOUCLEFF: That means when Mango hears, go to the park, it's not just the emotional cues that matter to her. She's paying attention to the words I use, too. Andics says a few previous studies have hinted at this, but this new study nailed it. So back to my home version of this experiment, how will Mango respond to Google saying her favorite command?
(SOUNDBITE OF GOOGLE VOICE)
GOOGLE VOICE: Mango, do you want to go to the park?
DOUCLEFF: She's just staring at me. Nothing's happening. She's not responding at all. About 10 percent of the dogs in the study didn't respond either. So maybe Mango's not as smart as I thought. Or maybe she just knows that that computer is never going to take her to the park.
MANGO: (Barking).
DOUCLEFF: Michaeleen Doucleff, NPR News.