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Americans finally got a rule protecting their credit scores from unexpected medical debt. Now Trump is attacking the agency behind it

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In early January, the Consumer Financial Protection Bureau (CFPB) finalized a policy to eliminate medical debt from credit reports. This decision is particularly important for individuals burdened by unexpected health-care costs and represents a pivotal shift in how Americans manage and finance their medical expenses.

But the Trump administration aims to diminish the CFPB. While the bureau’s shortcomings are certainly up for debate, the policy to remove health-care bills from credit reporting must be kept in place to protect patients from predatory billing practices. In a truly fair system, a hospital bill would reflect the actual cost of care, with a reasonable margin, not an arbitrary, inflated price designed to exploit people at their most vulnerable moments.

One of the most egregious failures of the American health-care system is the way it handles emergency medical situations. When someone experiences a medical crisis, a heart attack, a stroke, or a severe injury, they don’t have the luxury of choosing which hospital will treat them. Instead, they are transported by ambulance to the nearest or most convenient hospital, often with no say in the matter. In any other industry, consumers choose their providers based on price, quality, and personal preference. But in health care, patients are stripped of that basic right the moment they need urgent care.

Price gouging

Going to an emergency room and being charged an arbitrary amount is strikingly similar to price gouging during a natural disaster. They both exploit people in situations where they have no real choice. When a hurricane, wildfire, or other disaster strikes, people often scramble to evacuate, needing essential supplies like gas, food, and lodging. Take the hoarded personal protective equipment (PPE) during the COVID-19 pandemic, for example. In one case, a company was found guilty of purchasing 250,000 KN95s—filtering facepiece respirators—from a foreign manufacturer and selling 100,000 of them to New Jersey grocers for a 400% markup. The National Library of Medicine found that factors like price gouging, demand shock, and disrupted supply chains contributed to “significantly elevated” PPE costs for national hospitals through the first wave of the pandemic. Examples like this illustrate why price-gouging is illegal in many states. The logic behind banning it is simple: When people are in crisis, they shouldn’t be exploited for basic needs.

Hospitals do essentially the same thing with emergency care. When someone experiences a life-threatening event, they don’t have time to compare prices or shop around for the best hospital. They are taken to the nearest facility, treated without being told the cost, and later hit with an outrageous bill that has no correlation to the actual cost of providing care.

The key similarity is coercion under duress. In both cases, people are not making free-market decisions; they are making life-or-death decisions with no ability to negotiate or walk away. Just as a gas station in a disaster zone is not operating in a fair market when it triples its prices, hospitals are not operating in a fair market when they bill patients thousands of dollars for care they never agreed to at a set price.

Health-care reform

If price gouging is unacceptable in the wake of a hurricane, why is it tolerated in health care, where the stakes are just as high? The reality is that hospitals are engaging in a legalized form of extortion, exploiting the lack of alternatives in emergencies to maximize profits at the expense of patients. It’s a broken system that prioritizes financial gain over fairness and transparency, and it needs serious reform.

Hospitals justify their arbitrary pricing by citing administrative complexity, uncompensated care, and the burden of uninsured patients. But these are just excuses for a system that lacks transparency and accountability. Unlike a free market, where businesses compete for customers by offering fair prices and quality services, emergency health care operates as a monopoly. The patient has no bargaining power, no knowledge of the price beforehand, and no way to opt out of the service.

Additionally, medical debt is a flawed indicator of creditworthiness. Unlike consumer debt—such as credit card balances or personal loans—medical debt is often incurred unexpectedly due to emergencies, illnesses, or accidents. According to data compiled by the Commonwealth Fund, 72% of medical debt stems from acute care situations like hospital stays or accident treatments—or in other words, unexpected emergencies. Individuals rarely choose to take on medical debt in the same way they might choose to finance a car or make purchases on credit. Yet, for years, unpaid medical bills have unfairly damaged credit scores, limiting access to mortgages, auto loans, and even employment opportunities.

Penalizing people for medical debt exacerbates the financial instability that the traditional health-care system already creates, functioning as a form of entrapment by forcing individuals into a cycle of financial hardship that benefits hospitals, insurance companies, and collections agencies while punishing patients. Many traditional insurance models leave individuals with unexpected out-of-pocket costs, high deductibles, and confusing billing practices, leading to debt accumulation. This debt, when reported to credit agencies, makes it even harder for individuals to recover financially.

The CFPB’s policy ensures that people are not punished for their health-related expenses, allowing them to focus on recovery rather than financial ruin. While the bureau’s future remains to be decided, this policy must be kept in place to reduce the long-term consequences of an already predatory system and allow people to rebuild their financial standing more fairly. Until this system changes, Americans will remain trapped in a cycle of medical debt, forced to pay whatever price hospitals decide after the fact. And that isn’t just unfair, it’s extortion.

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

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The billionaire pipeline: How a 2000s startup boom fueled Europe’s tech renaissance

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Picture the scene. It’s 2003 in Tallinn, Estonia. Taavet Hinrikus, a 20-year-old computer whiz, has just accepted an offer to become the first employee of a little-known video-call startup, Skype. Little did he know then, but it was the start of a multi-decade evolution that would make him one of Estonia’s first billionaires, spawn dozens of startups, and generate billions of dollars in venture funding across Europe. “The idea that you can start using this [video-chat technology] to have voice and video conversations was pretty crazy for a boy who was born in the Soviet Union. But it was also obvious to me that it was going to be an exciting journey,” Hinrikus tells Fortune.

Today, at age 43, Hinrikus can add cofounder of payment platform Wise and partner of founder-led venture capital fund Plural Platform to his résumé, having steered multiple companies through countless funding rounds. Hinrikus’s story—unique at the turn of the century—would make him a pioneer in a fascinating business trend: In Europe, a surprisingly high number of employees of unicorns like Skype would go on to launch still more unicorns.

Europe’s founder factories

It would be an understatement to say that Europe’s tech scene has undergone a revolution since Hinrikus started his first day at Skype.

“The idea that you can start using this [video-chat technology] to have voice and video conversations was pretty crazy for a boy who was born in the Soviet Union…”

Taavet Hinrikus

Some 1,650 European tech startups have been founded across Europe by former employees of 215 unicorns since 2008, according to data provided by venture capital group Accel and Dealroom.co. The pair provided Fortune with data on European spin-outs of startups in the region, having separately analyzed Europe and Israel starup activity over the21st century.

Certain countries have punched above their weight. Sweden, for example, is a standout performer, breeding the multibillion-dollar businesses Spotify and Klarna. Employees from that pair have founded a further 123 startups. King.com, the Swedish gaming group behind Candy Crush Saga, has seen 43 employees leave to create their own companies.

Skype employees would go on to launch 31 startups in total, including Hinrikus’s Wise and the ride-hailing group Bolt. To date, those startups have raised $3.5 billion in funding.

1,650

The number of European tech startups founded across Europe since 2008.

Most founders, around 55%, start their businesses in the same European city where they were first employed. This has helped spawn network effects across Europe that have turned unlikely cities, like Tallinn, into thriving tech hubs.

Repeat founders have also blossomed from the early-2000s scene. Spotify cofounder and CEO Daniel Ek, perhaps the most high-profile founder to emerge from Europe this century, recently announced a new funding round at a $1.7 billion valuation for his health-tech startup, Neko Health, making him a serial unicorn creator.

The question is, why did it take Europe so long to kick-start its entrepreneurial streak? And what changed to allow the continent’s founder factories to flourish?

Trailblazers

When Netherlander Harry Nelis—a partner at American fund Accel—who has operated out of Europe for the past 21 years, interviews a candidate for his company, he always asks the same question: “What’s the riskiest thing that you’ve ever done in your life?”

LISBON, PORTUGAL – NOVEMBER 06: Harry Nelis, Partner, Accel, delivers remarks on “Is Europe’s tech scene finally heating up?” on the second day of Web Summit in Altice Arena on November 06, 2018 in Lisbon, Portugal. Web Summit is an annual technology conference which brings together a variety of technology companies to discuss the future of industry. This year’s event runs from November 5- 8 and is expected to attract around 70,000 participants.. (Photo by Horacio Villalobos – Corbis/Corbis via Getty Images)

Nelis’s own answer? Getting married (he says he’s been happily married for 30 years now). But a close second might be Spotify. Nelis was part of the team that gave Spotify early financial backing, despite industry experts warning that a streaming music business would never work.

“The momentum was almost undeniable,” Nelis recalls when asked why he backed it anyway. “The product was so good and so easy to use, and the early consumer reaction so overwhelming, the company actually had a chance to make it.”

Think of any multibillion-dollar European tech company today, and it’s likely Accel was involved in its inception. After the group raised Series A funding for U.S. companies like Facebook, Nelis’s only real mandate in Europe was to find entrepreneurs with “big ideas.” That daunting brief is probably why he still asks job candidates about risk today. 

“The biggest mistake in venture is not losing money on an investment. It is missing the outlier,” Nelis tells Fortune from Accel’s London office. 

When he first came back to Europe after spending his early career in Silicon Valley, Nelis was struck by an obvious difference in attitude between Americans and Europeans, namely that it was unusual for the latter to pursue building a company instead of joining an established one.

“The biggest mistake in venture is not losing money on an investment. It is missing the outlier.”

Harry Nelis, partner at Accel

Europe has long been accused of lacking the work ethic often associated with Americans. Tom Blomfield, cofounder of British unicorns GoCardless and Monzo, last year accused the U.K. of suffering from a “know your place” attitude that suppressed entrepreneurship.

Matt Robinson, a fellow GoCardless cofounder and now a partner at Accel, disagrees with that assessment. However, like his colleague Nelis, Robinson did notice a difference in Europeans’ attitude toward entrepreneurship when he started GoCardless in 2011.

“Starting a company was not really an accepted thing to do. You know, when you sit over here and start a company, I think people assume you’re unemployed or unemployable,” he says. 

Some elements crucial to growing a startup, like access to seed funding, were nascent in the U.K. just 15 years ago, Robinson notes. 

Those who spoke to Fortune for this article, though, were aligned in their assessment that rather than an attitude overhaul, Europe just needed a few successful founders to show everyone else what was possible.

Ilkka Paananen, CEO and co-founder of Finnish mobile gaming unicorn Supercell, was one of those entrepreneurs working without a roadmap to follow.

“There were very few European tech entrepreneurs who I could call for advice, for the simple reason that we just did not have many tech startups at scale at that time,” Paananen recalled.

Nelis says Europe’s startup founders were role models who made success easier to envision for their successors. One of those would be Plural’s Hinrikus, who watched Skype become one of Europe’s first unicorns. 

“People know the drill better,” Nelis says, noting that new startups come to Accel today with plans to solve big problems in a way they often didn’t 20 years ago.

Plural’s Hinrikus says his crystallizing moment came when he realized Niklas Zennström, cofounder of Skype, didn’t possess any magical powers that made him more likely to be a successful founder: “He was an average person, just like me. If he can do it, then I can equally do it.”

Robinson says the major obstacles in building a startup became easier for him the second time around, namely, attracting the best talent and fundraising. 

Since Nelis returned to Europe in 2004, unicorns and decacorns have emerged from Europe’s VC pipeline, with a centacorn surely inevitable. Robinson spoke to one company that talked ambitiously about becoming the first-ever kilocorn, a $1 trillion private startup.

“I cannot imagine saying that or even thinking that back in 2011,” Robinson says.

Stick or twist?

Operating a thriving entrepreneurial startup environment brings the inherent and evidenced risk that employees will one day leave to start their own, sometimes competing, ventures.

Tara Ryan, Monzo’s VP of people experience, doesn’t see it as a tradeoff.

Monzo stands among Europe’s most prolific founder factories. The banking unicorn has spawned 23 startups since its creation. Oftentimes, when a new company is formed out of Monzo, it’s not just one person departing.

Map shows number of startup created by unicorns' ex-employees in europe
Map shows number of startup created by unicorns’ ex-employees in europe

“People start their own businesses, but often their founding team or their first handful of employees are also Monzonauts,” she says.

This has been something embraced, rather than suppressed. At Monzo, Ryan says, an internal company website celebrates former employees who went on to become founders. 

“People start their own businesses, but often their founding team or their first handful of employees are also Monzonauts.”

Tara Ryan, Monzo’s VP

“I don’t think it is healthy for employees or employers to try and retain people at all costs,” she says.

Accel’s Robinson goes one further. While at GoCardless, he would tell early interviewees his hope for them was that they would eventually leave and form their own startups.

The European dream

It’s worth a wager that Hinrikus, dressed in a hoodie and branded tee, and speaking from Plural’s London office, looks as invigorated as he did when he stumbled through Skype’s doors on his first day as an employee. 

Skype was acquired by eBay in 2005 for $2.6 billion, a now-familiar case of an exciting European startup being eaten up by a much larger U.S. tech behemoth. Its subsequent parent, Microsoft, no longer needs Skype now that Microsoft’s Teams video-chat function has been widely adopted. Similarly, DeepMind, the pioneering artificial intelligence research laboratory founded in London, is today a Google subsidiary.

Increasingly, though, European companies, driven by growing access to both capital and talent, are managing to stand on their own two feet.

Spotify, Accel’s risky early bet in Europe, had a market value of nearly $125 billion at the beginning of March. Its Scandinavian leadership team has maintained its grasp on the company’s operations as Spotify battles with Apple and Amazon. 

Other younger companies across Europe, like Monzo, now face the challenge of growing while maintaining what made them unique as startups. Alex Norström, Spotify’s copresident and chief business officer, has advice for startups on that journey.

“We’ve tried to maintain our entrepreneurial energy as we’ve scaled globally,” he says. “At Spotify, it’s always been about having big ambitions and delivering on them.”

Supercell’s Paananen, meanwhile, thinks Europe’s quirks make it easier for founders to stay true to their roots.

“Europe has a very unique, diverse culture, and a unique way of life that we all love — this is a great place to live and grow a family. This should help us both retain and attract the best talent,” said Paananen.

Hinrikus spoke of making the American Dream come true for his employees, only in Europe. 

“I think the scar tissue we have from owning our companies and building them makes us better partners for the next generation,” Hinrikus says. “There’s probably 100 early employees in various positions, even in customer support, who earned a million dollars from stock options.

“Now we’re showing time and time again that it’s not an American Dream,” he notes. “We have the same thing in Europe.” 

This article appears in the April/May 2025 issue of Fortune with the headline “The European dream.”

This story was originally featured on Fortune.com



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Job applications from federal workers surged 50% in February as staff targeted by DOGE flee

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DOGE’s plans for Social Security are a ‘backdoor’ way to cut payments, experts warn: ‘This is the most serious threat I’ve ever seen to it’

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  • Elon Musk’s government efficiency team, DOGE, is taking aim at Social Security, claiming fraud while pushing controversial changes that could make it harder for seniors to access benefits. Critics, including Mark Cuban, say the changes are part of a “backdoor” effort to cut payments and gut the agency.

Elon Musk’s Department for Government Efficiency has a new target in its quest to eliminate government waste: Social Security.

Musk and the DOGE team have accused the agency of being engaged in widespread fraud, most notably claiming that tens of millions of dead people are erroneously receiving payments.

To curb some of this claimed identity fraud, the agency is enforcing stronger identity proofing procedures: a proposal that would force millions to file Social Security claims in person.

The change has been criticized by some, including billionaire Mark Cuban, who called the move a “backdoor way to cut payments.”

Former SSA officials and experts have echoed Cuban’s comments and raised concerns about the impact DOGE’s initiatives could have on Social Security payments.

“SSA recently required nearly all agency employees, including frontline employees in all offices throughout the country, to work in the office five days a week. This change ensures maximum staffing is available to support the stronger in-person identity proofing requirement,” a Social Security spokesperson told Fortune in an emailed statement. “The agency will continue to monitor and, if necessary, make adjustments, to ensure it pays the right person the right amount at the right time while at the same time safeguarding the benefits and programs it administers.”

Backdoor benefits cut

Laura Haltzel, a former associate commissioner at the Social Security Administration who resigned in late February, told Fortune DOGE was using the pretense of fraud within the agency as a way to reduce the amount of benefits being paid out.

The agency announced on Tuesday that individuals who are unable to verify their identity through an online My Social Security account will need to visit their local Social Security office to do so in person. A leaked memo also hinted that Social Security phone support may end identity verification, which would also increase in-person visits.

In response to the new identity proofing measures, the Social Security Administration also plans to expedite the processing of direct deposit change requests—both online and in-person—to just one business day, a significant reduction from the previous 30-day hold.

Several people, including Cuban, have raised concerns about how this could affect senior citizens living off Social Security checks.

“How many seniors who live exclusively off of their SS checks can afford internet? How many seniors no longer have a SS office near them now that dozens have been closed? What are people without internet or the ability to travel, or don’t have an office near them supposed to do if they need to reconfirm their bank account,” the billionaire said in a post on X.

Haltzel said that the changes would make it more difficult for some Americans to access their benefits while doing little to target actual fraud. She said the changes amounted to a “de facto” Social Security cut, the Trump administration’s promise not to touch the popular benefit.

“It’s creating an environment where the very beneficiaries we’re trying to serve are simply not going to be able to access the benefits they’ve paid for,” she said.

“We have always tried to make it easier for claimants…more efficient for claimants. And the justification that’s being put forward for why they are pushing this is the idea that there’s a great deal of fraud taking place,” she said. “Well, the math there just doesn’t add up.”

According to the SSA’s inspector general, only 0.3% of claims are attributable to fraud. Social Security’s payment accuracy rate is over 99% and the agency has several safeguards in place against improper payments, according to the progressive think tank Center on Budget and Policy Priorities.

Tiffany Flick, a former chief of staff at the U.S. Social Security Administration, has also said DOGE’s takeover of SSA appeared to be “based on the general myth of supposed widespread fraud.”

In a court filing, Flick raised concerns about DOGE staffers’ ability to protect sensitive taxpayer data. She said she was “not confident” that DOGE employees had “the requisite knowledge and training to prevent sensitive information from being inadvertently transferred to bad actors,” as the team had “never been vetted by SSA or trained on SSA data, systems or programs.”

“In such a chaotic environment, the risk of data leaking into the wrong hands is significant,” she said in the filing.

On Thursday, a federal judge temporarily blocked DOGE from accessing sensitive data at the Social Security Administration, saying they had little justification for their search for fraud.

“The DOGE Team is essentially engaged in a fishing expedition at SSA, in search of a fraud epidemic, based on little more than suspicion,” the judge wrote.

Musk’s ‘dead people database’

One of the main arguments Musk and DOGE have used for the need for reform is the claim that dead people are being paid Social Security, something Musk has referred to as a “dead people database.”

“Maybe Twilight is real and there are a lot of vampires collecting Social Security,” Musk said in a post on X.

“Having tens of millions of people marked in Social Security as ‘ALIVE’ when they are definitely dead is a HUGE problem. Obviously. Some of these people would have been alive before America existed as a country. Think about that for a second,” he added in a separate post.

Trump later echoed the claims in a press briefing, claiming “millions and millions of people over 100 years old” were receiving Social Security benefits: “They’re obviously fraudulent or incompetent.”

The claims have been debunked by experts and news outlets, but Musk has continued to push the claim.

“What people don’t understand is that you can have an active Social Security number for a very long time because Social Security pays a worker’s earning record and can pay widow’s benefits or children’s benefits, so there can be many different benefits,” Nancy Altman, president of Social Security Works and chair of the Strengthen Social Security coalition, told Fortune.

Altman said she was concerned that DOGE was trying to convince people that there was widespread fraud to undermine confidence in the program and the government, while using it as an excuse to “hollow out” the agency.

“It could end up completely nonfunctional, and create a lot of waste and abuse,” she said.

The numbers thrown out by Musk and Trump appear to misrepresent Social Security data.

“They don’t understand the difference between an active claim and active benefits and historical claims and historical benefits,” Haltzel said, pointing out that people may still be in the system but not actually be receiving benefits. “It’s simply not worth the time and effort of our staff to go into the records to undo the previous history of somebody who has passed on they’re not receiving benefit payments today.”

Job cuts could put the already understaffed agency under strain

Officials have also raised concerns about the proposed staff cuts at the SSA.

Haltzel, who took early retirement in February, said the team had “instilled in everybody at SSA a definite fear that if they didn’t leave, their job might be lost to them.”

She accused the cost-cutting team of intentionally creating a culture of fear and unpredictability and operating with a clear disdain for government employees.

DOGE has been clear about its plans to slash government headcount, but experts say cuts could cause the already understaffed SSA to crumble under the pressure.

“You can reduce the direct costs by having fewer federal employees, and you can make it harder for people to claim benefits because the people who would have served them are gone,” Haltzel said. “The fewer people, the longer it’s going to take.

“They are absolutely creating administrative burdens where there need not be any, under the guise of saving, you know, waste, fraud, and abuse,” she added.

Altman warned the agency’s workloads had increased as staffing levels decreased. The SSA hit a 25-year low in agency employees in the 2024 fiscal year.

“You’ve got increasing birth and decreasing staff,” she said. “I’ve been working on this program for the last 50 years, and this is the most serious threat I’ve ever seen to it.”

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