Ep 74 – Consumer Empowerment in the Fight for Value, with Marshall Allen

Every year, millions of Americans are overcharged and underserved while the health care industry makes record profits. We know something is wrong, but layers of complexity make it confusing and discouraging to do anything about it – it seems impossible for most.

Our guest this week is Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen reveals the industry’s pressure points and how companies and individuals have fought overbilling, price gouging, insurance denials, and more to get the care they deserve and protect against the system’s predatory practices.

The key message is that we, the consumer, can take back control of our health care. It is up to the American people to equip ourselves to fight back for the sake of our families–and everyone else. Consumers must lead the race to value.

Episode Bookmarks: 

01:40 An introduction to Marshall Allen and his work investigating the American healthcare system

03:35 The need for a grassroots consumer movement and employer-based disruption to reform a broken system

04:45 How Marshall’s work in investigative healthcare journalism was informed by his work in ministry

05:50 Marshall explains how the healthcare system’s business design violates the Golden Rule

08:15 “The business of medicine is conducted to maximize the profit for the industry, even at the financial harm of patients.”

08:30 Marshall’s new book: “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.”

10:00 The victimization of patients that occurs through flawed system design and the “normalized deviance” by those delivering care

11:30 The importance of reframing the health system to eliminate the exploitation of patients for profit

12:15 “Our healthcare system is allows for the exploitation of sickness for profit.”

13:00 Marshall discusses the lack of an ethical position to exploit consumers for non-discretionary choices

13:20 The escalating price of insulin as an example of how inelastic demand is exploited for profit

15:00 Marshall explains how employers and patients can demand better value by no longer tolerating profit maximization

16:30 Referencing the recent JAMA Study on Medical Debt showing that 1 in 5 Americans have medical debt in collections

17:00 Using Marshall’s new book as a step-by-step, tactical guerilla guide for patient and employer empowerment

19:30 The approval of non-effective drugs and pricing scams conducted by Big Pharma (e.g. the recent approval of Aduhelm)

20:20 Marshall explains how the specialty drug, Vimovo, is an egregious example of a Big Pharma profiteering scheme combining two common drugs with no additional therapeutic benefit (Marshall’s article on Vimovo)

24:00 Motivated to write book to help patients facing financial ruination by healthcare

25:00 185 million Americans in the employer-sponsored insurance market as an opportunity for grassroots reform

25:30 Marshall’s explains his family’s personal experience of financial exploitation by the healthcare system (the Introduction to his book)

28:30 The need for patients to gather evidence when disputing medical billing errors and upcoding

31:30 The effectiveness of small claims courts in empowering patients who are being financially exploited

34:00 Marshall provides guidance on how patients can avoid unnecessary care

37:00 Comparing the financial incentives between capitated models vs. fee-for-service

38:00 Always ask for the cash price as a patient! (you don’t always have to use insurance)

38:30 The massive price variation based on the site of service (e.g. MRIs in hospital vs. freestanding imaging center)

39:45 “You’re not getting more for your money when you pay extra for healthcare.”

42:00 Marshall explains his mission to help patients develop financial literacy by developing consumer empowerment curriculum

45:00 Massive surprise, out-of-network medical bills as an opportunity to fight the system and change the game

48:00 Marshall discusses how employers are “sleeping giants” and have the power to tip the scales in creating a new healthcare system

52:00 Reducing wasteful spending and fraud can reduce healthcare costs by at least 25% (upwards of $1T in savings per year)

53:00 Marshall explains how a phony doctor defrauded health plans by billing with fake NPI numbers

56:30 Marshall explains how an unethical health system in Las Vegas was exploiting foreign-training doctors (“Indentured Doctors”)

58:50 Marshall on the new Hospital Price Transparency rule and the increased exposure of unjustified price variation