An Arm and a Leg

I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD. And it meant a big homework assignment for me.Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course).I mean, what I actually learned was not a hundred percent cheerful.We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up. (They’re called “pharmacy benefit managers” — PBM for short.)Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down.Economist Geoffrey Joyce used to think they did OK at that, but he’s changed his mind.One thing that turned him around:They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’So, not all sunshine. But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun.See omnystudio.com/listener for privacy information.

This week, we look at three MRIs with four different price tags, and an enormous range. Liz Salmi and a view of her brain. (Photo: Kaiser Health News)The first two price tags come from listener Liz Salmi, who has been living with brain cancer for more than a decade.Liz gets MRI scans twice a year, to make sure the cancer isn’t growing. A couple years ago, Liz changed insurance, changed providers… and got serious sticker-shock when she saw the bill for a scan: $1,600 — AFTER insurance.So when she needed a follow-up scan, she shopped around — and found an option that set her back less than 90 bucks.Which is great news, and useful — as far as it goes: As Liz points out, not everybody has six months to shop around.But Liz’s experience isn’t even the craziest MRI-price-tag story we look at this week. Stick around for that.Coming in to bat cleanup — to help us understand why these prices are so crazy, and so variable — is journalistic super-star, friend of the show, and my new colleague:Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. She breaks it down in an authoritative, funny, clear-as-glass way.(Reminder: Kaiser Health News — our co-producers for this season — is not affiliated with the health care provider Kaiser Permanente. It’s a great story, and we’ve got it for you right here.)This is the first of three episodes where we look at where health care prices come from. So this week it’s MRIs.Next up: Prescription drugs. And then: Insulin. Yep, we are going there.See omnystudio.com/listener for privacy information.

Hospital bills are too high, and insurance doesn’t cover enough. Turns out, that’s a crisis for hospitals too: more and more of us aren’t paying those bills, because we can’t. So, they’re getting creative about collecting — and offering discounts. Which raises questions about why the bills are so high to begin with.Photo courtesy James CrannellWe start with Chicago woodworker James Crannell, who — and there’s no non-scary way to say this — stuck his finger in a table saw.Even more scary: He didn’t have insurance. “I don’t know which was worse. The pain in my hand, or the fear of: What is this going to cost me?”Spoiler alert: The emergency-room didn’t charge him full price.This episode kicks off a series where we start asking: How did prices get so high to begin with? See omnystudio.com/listener for privacy information.

Caitlin and Corey Gaffer got a surprise letter from their insurance company — saying they were being dumped for non-payment. Except, as far as they knew, they were paid up.As it turned out, they’d made a couple of small mistakes, which they were eager to fix. But their insurer was definitely not interested. Caitlin and Corey spent fruitless weeks on the phone.And then, Caitlin’s pregnancy — more than six months along — ran into complications.They scrambled for months to get covered, while racking up about $30,000 in hospital bills.There’s a happy ending. Two, in fact.First, their baby was born healthy (and insured) in January. She’s in the episode too, and she’s adorable.Maggie, Corey, and Caitlin Gaffer, with Luna the dog. (Photo by Lauren Cutshall.)Second: In March their old insurer offered an apology — and offered to reinstate them. (This was the day after a reporter called to ask the insurer for their side of the story.)… but the whole journey was harrowing, and opens up questions about what kinds of safeguards consumers have — or should have — against getting dropped.Welcome to Season Two!This story — like a lot of this season — came straight from my inbox. A few days after the show launched, I got an email with the subject line “Pregnant woman and her husband in Minnesota need help.”We’ve got new friends!We’ve got co-producers for Season Two, Kaiser Health News. Three things to know:First: Kaiser Health News is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor — which is a fun story I’ve written all about here.Second: They ARE a great non-profit newsroom covering health care in America, an editorially independent project of the Kaiser Family Foundation. (There’s that name again. And again, here’s the story.)Third: Their editor-in-chief is one of the people who inspired this show.YEP. The whole story is worth reading. I am so pleased and proud to be working with these folks.Catch you next time. Till then, how about…Following us on Twitter or Facebook?Becoming a Patron?Sharing a story?See omnystudio.com/listener for privacy information.

Hey there! We’ve been working hard on season 2. We hope you enjoy this preview — there’s so much good (and frightening) stuff ahead.See omnystudio.com/listener for privacy information.

Bari Tessler is a little famous as a “financial therapist,” but even she gets rattled by the price of health care.Her story is complicated. And very relatable.Bari chose to use a Christian "health share" instead of regular insurance. It's cheaper, but it comes with strings: Things the group doesn’t cover, limits on their obligations to you… and a religious vision that not everybody is comfortable with. Including Bari.She sees it, for now, as the least terrible of a bunch of terrible options — but she’s conflicted about it.Also: What my family is doing for health insurance next year.And: A taste from one of the most painfully-hilarious things to hit the Internet for a long time. Welcome to Our Modern Hospital, Where if You Want to Know a Price, You Can Go F*** Yourself, published by McSweeney’s.There’s a longer excerpt, and an interview with the author, Alex Baia — that’s on our Patreon. Thanks to Alex for permission to record excerpts, and to ttsreader for dramatizing the text for us!Find Us OnlineWebsite: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshowOur Team:Host: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Audio Wizardy: Adam Raymonda (adamraymonda.com)Music: David Winer (wearefancymountain.com)See omnystudio.com/listener for privacy information.

Emergency rooms often bill you a “cover charge” just for walking in the door, and it can be thousands of dollars.That’s in addition to the huge markup on everything that happens there: seven bucks for a band-aid. Twenty dollars for a couple of pills.Reporter Sarah Kliff has collected more than a thousand ER bills from her readers at Vox.She was an expert on health care before starting this project — she covered it for years at the Washington Post before moving to Vox — but even she found plenty of surprises.Find Us OnlineWebsite: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshowAbout UsHost: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Audio Wizardy: Adam Raymonda (adamraymonda.com)Music: David Winer (wearefancymountain.com)Image adapted from a drawing posted to flickr by Wellness Corporate Solutions.See omnystudio.com/listener for privacy information.

Turns out, insurance companies allow — even encourage — crazy price-gouging by hospitals. For example, the leg brace Blake needed was available for $150 on Amazon. But thanks to his insurance, he paid more than $500.Investigative reporter Jenny Gold’s work helps us understand how that kind of thing happens.She compares health care to shopping for a gallon of milk.“We can look at the cost of a gallon of milk at lots of different stores and decide which one is the best,” she says.At the store, there’s maybe there’s a couple different brands, with the prices on the shelf. We pick the one we want, pay on the way out.“Now with healthcare,” she says, “the analogy would be, you go to the store for a gallon of milk. You have no idea what it costs. You don’t know what it costs at that store compared to other stores. You walk into a random store, pick out a gallon of milk, go through check-out. You still don’t know what it costs. You give them your credit card information and then a few weeks later you get a bill telling you how much they charged you.”Super-crazy. Jenny’s reporting shows how insurance companies help to keep those prices hidden, and keep them high.Jenny Gold works for Kaiser Health News — which, we should explain, is not part of Kaiser Permanente health care. It’s part of an independent foundation that basically runs on an endowment set up by Mr. Kaiser, more than 50 years ago.RESOURCE ALERT: Jenny’s boss, former New York Times reporter Elisabeth Rosenthal, published an amazing book in 2017: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. I have been studying it like a bible and a playbook since I started working on this show. If you want to really get mad — and learn a ton about how health care got so crazy in the U.S. — this is the book to read.An audio version of Jenny’s story ran on the public-radio show Marketplace. Thanks to Kaiser Health News, and to Marketplace for the story and for the tape of Sarah Azad and Ken Weber.Photo, above: by Liza, via Flickr. CC 2.0 license.Thanks again to the great Mucca Pazza for the use of their tune War of Amusements at the close of this episode.Find Us OnlineWebsite: http://armandalegshow.comTwitter: See omnystudio.com/listener for privacy information.

The health-care system — especially the financial side — can feel like a Medieval torture device. So maybe it fits that workers from Renaissance fairs have come up with a work-around.In this episode I meet Robin Hood and a woman who has made more than $2 million in medical bills… disappear.Also, you’ve started sending us stories as voice memos. And they are awesome.Send more! [email protected] emails are nice too. You’ve sent some powerful stories that way. We are listening.Also, you’ve shared tips, including this CBS News story about insurance companies refusing to pay ER bills. Super-timely, since we’ve got a story about ER bills coming up in the next couple of weeks.You can find more information about the Rescu Foundation at the group’s website: rescufoundation.org(Photo from the Sherwood Forest Faire Facebook Page.)See omnystudio.com/listener for privacy information.

Because as smart economists recently proved) it is super-confusing, and most of us can’t do the math.But! We found glimmers of hope. So don’t be scared.We’d like to hear how you’re choosing your health insurance for next year— or are you going to do without? — and what you’ve learned from past mistakes. You can scroll down and just start typing, or hit us up at insurance [[at]] arm and a leg show [[dot]] [[com]]  EXTRA CREDIT: We’d love it if you send us a voice memo!Finally, we’ve got some resources here — guides from some smart, friendly folks — to help you get smarter and avoid some worst-case outcomes.The basics from a smart, kind civilian: Arm and a Leg listener Anna Jo Beck gave herself an education on the topic after her husband was diagnosed with cancer (he’s fine now) — and captured what she learned in a charming, self-published booklet. For Your Health: Making Sense of American Health Insurance starts with “What is it, and do I need it?” and goes on from there. BONUS: It’s peppered with what Anna describes as “moments of cute, heartwarming distraction to keep you from wanting to totally give up hope.”Another version of the basics, from a smart journalist: Vox.com health-care reporter Sarah Kliff published I’m a health-care reporter. Here’s how I shop for health insurance in 2015. It’s still a good primer.More advanced and detailed (also funny), from another smart journalist: Business Insider’s health editor Zachary Tracer chronicled his own decision-making — including actual math — in fall 2018: My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan.The basic premise all around: If you can afford to think about anything but the lowest-possible monthly premium, then a good thing to think about is: Financially speaking, what’s the worst-case scenario, if I get hit by a bus or something?  Which is not exactly a fun scenario to contemplate, but still. It’s why the very cheapest plans, in terms of what you pay every month, may not be a good deal.The Oh My Dollar podcast goes into good-humored detail in a recent Halloween episode, The $30 Spooky Health Plan You Probably Don’t Want. (No time to listen? No problem: They’ve done a great write-up.)This episode closes with War of Amusements by Mucca Pazza—a Chicago treasure since 2004. The group’s self-description — “the marching band that thinks it’s a rock’n’roll band” — doesn’t begiin to do it justice. You can download the track on a pay-what-you-want basis, or listen on Spotify.See omnystudio.com/listener for privacy information.

The answer involves a suburban housewife, a 1970s TV star, and a Las Vegas maker of popcorn and nacho cheese sauce. Also: Wall Street.Produced with our friends at 99 Percent Invisible.Many thanks to Abbey Meyers, Joshua Schein, and Nora Guthrie.Find Us OnlineWebsite: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshowAbout UsHost: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Social Media Magic: Multitude Productions (http://multitude.productions)See omnystudio.com/listener for privacy information.

Laura Derrick takes a drug that costs more than $500,000 a year.So when her family was going to lose their insurance, she made crazy sacrifices… and changed the course of history.Find Us OnlineWebsite: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshowAbout UsHost: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Audio Wizard: Adam Raymonda (adamraymonda.com)See omnystudio.com/listener for privacy information.

When I first started talking about doing a show about the cost of health care… everybody had a story. Including me.It’s like that famous speech by the writer David Foster Wallace called This is Water. It starts with a joke about two young fish swimming along. An older fish passes by and says, “Morning boys. How’s the water?”He goes, then one young fish turns to the other and says, “What the hell is water?”Sound familiar? The cost of health care is like water. We’re all surrounded by it. We don’t even see it anymore.That’s what this show is for: To help us see the water we’re in, and figure out together how to navigate it, and keep each other good company along the way. Maybe we’ll tell some jokes– dark ones– along the way. Welcome aboard.Find Us OnlineWebsite: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshowAbout UsHost: Dan Weissman www.danweissmann.comEditor: Whitney Henry-Lester thedarlingkiller.comConsulting Producer: Daisy Rosario @RunDMRSee omnystudio.com/listener for privacy information.

The spiraling cost of medical care shapes people’s lives: The jobs we’re afraid to leave because of insurance, the risk that a trip to the doc could end in bankruptcy. It’s not healthy.This is my story too, and that’s why I’m making this podcast. Here’s what I’ve got in mind.An Arm and a Leg will be entertaining, empowering— even useful. As a reporter, I’ll bring my skill at finding and telling revealing, surprising stories. But the project’s big focus— since I’m in this mess too—is connecting and problem-solving, together.You are not alone. We may be screwed, but we’re together. And if we want to get even a little bit less-screwed, we need each other. If nothing else, we can be good company to each other.We can have a good, dark laugh.We can offer each other empathy.We can sing hilarious punk-rock campfire-songs of rage at whoever turns out to be responsible.So I’ll be looking to you, over time, to offer up your own stories— by sending in voice memo recordings (and email, and FB posts). Also, punk-rock campfire songs.To start, I’ll be reporting out on stuff I’ve found out on my own— stories that help us get a little less scared and confused about the mess we’re in. Early episodes will:Pull back the curtain and show how the dark machinery works. A simple leg brace shows how insurance companies allow— even encourage— crazy price gouging.Check out inventive hacks: Renaissance-fair workers have cooked up a creative, home-brew safety net.Tell some wild stories. Like one woman’s epic quest for health insurance. To keep her family out of medical bankruptcy, she made crazy sacrifices— and tweaked history.Over time, you’ll tell me what needs finding out.We can’t count on single-payer or some other big fix getting enacted and coming to save our butts anytime soon. (We don’t even have to agree on single-payer.No matter what our politics, we’re all screwed right now.) But we need each other’s help and company RIGHT NOW, just muddling through the mess we’re in.You know what? I think it’s going to be fun.Meanwhile:Are you game to share your two cents about stuff we should do?Maybe you can support us with a donation to help get the show launched?Thanks! Talk with you soon.Till then… take care of yourself.See omnystudio.com/listener for privacy information.