July 11, 2019

Beach Reads, Pods, and Healthcare Costs

An Arm and a Leg show - a podcast about the cost of healthcareIt’s summer at last. Time to read a good book, and catch up on some podcasts. Here’s one we like – it’s about the cost of healthcare. How much does healthcare cost in the U.S.? An Arm and a Leg, started in November by former WBEZ reporter Dan Weissmann, explores that. “Entertaining, empowering, and even useful” – rather than political – it’s about “the way that healthcare runs our lives.”

“The minute I started telling people I was thinking of doing this show,” Dan says in the first episode, “everyone had a story of their own.” They can be pretty riveting.

“I don’t know which was worse, the pain – or the fear of what is this going to cost me,” says a Chicago woodworker whose finger had an encounter with a table saw. And “the pain was so excruciating,” he clarifies, that “if I wanted to scream, I couldn’t even scream.” It worked out alright for this guy’s finger and his bank balance, but what happened was odd: The ER offered him a 60% discount.

Dan wanted to find out if this was “a normal thing” and talked to a hospital revenue director. Her hospital has brought in a firm called CarePayment – a “patient financial engagement company” – that offers 50% discounts to patients as a collection strategy. The hospital now takes in twice as much from patients as it used to, even after the half-off discount and the company’s cut. Asked how they can afford to give 50% off, a CarePayment official tells Dan “That’s in the range of what hospitals expect to get: 60% from carriers, 40% from Medicaid.” (Episode)

So why was the price so high in the first place is the sort of question a lot of people are asking. There has been a heightened interest in healthcare price transparency in recent years. President Trump’s executive order – released with little fanfare on June 24th – is aimed at (and titled) Improving Price and Quality Transparency in American Healthcare to Put Patients First. “Patients often lack both access to useful price and quality information and the incentives to find low-cost, high-quality care” it states.

Now, we’ve found little agreement with the Administration’s healthcare policies, but it’s hard to argue against consumers getting a bit more information. The weird thing is that in many cases, there seem to be no actual “prices” out there: As the CarePayment rep explained, Medicaid pays this, big insurers pay that, little ones pay something else. And of course, when your state does not have a mechanism in place to even question premiums, it’s not clear how much transparency will ultimately help to lower costs. This is why we think rate review is so important.

“The idea,” writes NPR in describing the executive order, “is that if people can shop around, market forces may drive down costs.” This idea has been out there for a while. “Health policy nerds like to talk about wanting these smart consumers to really call around” to get the best price, notes Dan in a recent episode. But for “most people facing a cancer diagnosis,” says Liz Salmi, a person living with brain cancer, “it’s suddenly like, alright you’re going into brain surgery tomorrow, and there’s no shopping around, there’s no time, it is an emergency.” Salmi (who, like many of Dan’s guests, is doing some interesting healthcare-related work in her own right), found prices for an MRI ranging literally from $9,800 to only $87. Kaiser Health News’ Elisabeth Rosenthal told Dan she’s seen MRI prices as high as $26,000. (Episode)

These are just two of the stories on An Arm and a Leg that shine a light into the black box we call healthcare costs. The show has told stories about costs of drugs and procedures, how even top economists are puzzled by health insurance choices, and how a bunch of Renaissance Faire performers uses homegrown strategies to make medical bills go away. Guests have included Sarah Kliff, Roman Mars of 99 Percent Invisible, economists, bloggers, financial advisers, and just everyday folks.

“As a reporter, I love these kinds of stories,” Dan says. “For one thing, they’re intimate and immediate. We’re talking about our bodies here, and our pocketbooks, at their most vulnerable. And every single one of them opens up questions about one of the biggest, most complicated, most frustrating and – for a lot of us – most terrifying issues in American life. … I am never going to run out of material for this show.” Now in its second season, An Arm and a Leg is partnering with this year with Kaiser Health News. Check it out, it’s totally worth a listen.

And here are a few other things you might like to take a look at or a listen to.

A June issue of the New Yorker had an article it billed as “when your healthcare plan is GoFundMe.” It is also all about stories, and how the most heart-rending ones win. “I would much prefer that people don’t have to use GoFundMe to pay for their medical care,” GoFundMe’s CEO Rob Solomon told the reporter, but also noted that the trend is spreading to other countries. GoFundMe has raised more than $5 billion dollars, a third of it for medical bills. “We’re going to be the world’s largest healthcare company that isn’t actually a healthcare company,” he said. “I think we are.” Another businessman interviewed, who had helped the Occupy movement’s Rolling Jubilee Fund extinguish more than $30 million worth of debt, went on to found a charity called RIP Medical Debt. It evaluates whether investors are “getting the most burdensome debt for the least amount of money.”

During the housing crisis, we learned that medical debt was the nation’s leading cause of foreclosures; and since then, health insurance deductibles have grown eight times as fast as wages. Social determinants, such as having a place to live, are a huge factor in a person’s health. So we would also recommend this remarkable four-part series on evictions from On The Media, called “The Scarlet E.” It’s quite eye-opening to hear how housing in poor neighborhoods is priced at or even above better housing in “better” areas, how the presence of children actually increases the likelihood of eviction, and how for many landlords, eviction is typically the first resort, not the last.

Feeling nostalgic? Why not travel back to the 1980s with Dallas Buyers Club? Matthew McConaughey creates a business that lets him distribute non-FDA-approved meds free to fellow patients with HIV/AIDS who pay a monthly membership fee. The many such clubs that sprang up around the country were among the forces that spurred the development of new treatments. Yep, it’s still available on Netflix.

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