EP328: An Interview Specifically for Health Care Executives, With Marshall Allen, Author of the Best Seller Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

“Scientists Announce Successful Experiment to Bankrupt Mouse That Can’t Afford Cancer Drug.” That’s a recent headline from The Onion, which is, by the way, a funny satire newspaper, if you haven’t heard of it. You could swap out “Cancer Drug” in that headline with “a Trip to the ER”—or pretty much any aspect of health care in this country.

No matter what health care service you stick in there as the potential cause for a mouse’s bankruptcy, it’s a pretty LOL headline, right? But the reason why it became a headline is because obviously it’s based on a truth that resonates with your regular citizens in this country. Think about that. A critical mass of people around here believe that health care will bankrupt you. This is one of those sociological signals that has implications to health care leaders.

Here’s another signal with implications. In this health care podcast, I’m interviewing the incomparable Marshall Allen. That’s not the signal. His book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, a book with that title being on the New York Times best seller list, is the signal. Marshall’s book is an instruction manual for patients on how to fight back against unfair and/or egregiously inaccurate bills. 

This interview with Marshall Allen is different from others that you may be hearing. Marshall wrote a book to motivate patients, a critical mass of patients, to get empowered relative to their health care bills. Because listeners of this show are health care executives, I wanted this interview to be relevant to you. What does this book mean for you? Doug Aldeen told me one time, unless something has a direct impact on the CEO or leadership team at a health system or insurance company, they’re just bored. Let me sum up this interview in one sentence: This is not boring.

If you want to skip to the exact examples of “not boring,” you can skip ahead to about the 30-minute mark. We go through the ways that health systems can and probably will be hurt by the financial toxicity that they create. Here’s the three-ish ways that Marshall and I talk about:

1. Doctors who no longer trust their employers (ie, the health systems they work for) leave and then you have to recruit new doctors—#problematicandexpensiveonanumberoflevels, but I don’t need to tell you that.
2. Reputational damage. When the slogan on the door becomes a joke, that’s a problem.
3. Employers and taxpayers reading best-selling books like this one and Marty Makary’s (which also is or was just recently on the best seller list) and learning how to not be basically passive suckers anymore. 

You can find Marshall’s book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, anywhere that books are sold.

Marshall Allen investigates why we pay so much for health care in the United States and get so little in return. He is the author of the new book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. He is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the health care system. Marshall has investigated the health care industry for 15 years, including a decade at ProPublica. He has also spent a decade as an educator at the Craig Newmark Graduate School of Journalism at The City University of New York. His work has been honored with many journalism awards, including some of the top business reporting honors, the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting, and twice as a finalist for the Pulitzer Prize. Before he was in journalism, Marshall spent 5 years in full-time ministry, including 3 years in Nairobi, Kenya. He has a master’s degree in theology. 

03:35 What’s the point of view that Marshall is coming from with his investigative reporting?
04:06 “How does this affect the people who are paying for it and the people who are undergoing the care?”
04:58 “There’s a lot of good people working within this very messed up system.”
05:12 Why are patients considered outsiders in the health care system?
05:55 “What’s happened in health care is that the stakeholders treat each other more as the customer.”
07:54 What is upcoding?
11:27 “These are schemes that have been created within the industry to increase revenue.”
11:56 “This system is not set up for the benefit of the patient.”
12:22 “On the financial side, the industry is actually oppressing the American people.”
12:39 Can a critical mass of patients force health systems to become more accountable?
16:02 “We have been expected to pay whatever aggregate sum is thrown at us.”
17:09 Why have patients been so passive toward this crooked health care system so far?
18:04 “They’re violating the trust of the American people when they don’t treat us fairly.”
19:28 “It’s totally legal to do that, [but] is it ethical?”
20:11 What’s the difference between making a profit and profiteering?
21:43 “It’s hard to argue against your own paycheck.”
29:57 “The things that matter most to people are their health and their money.”
33:51 What are the first-order and second-order consequences of what’s happening in health care right now, and which of these consequences will actually drive change?
34:56 “When you tell the truth about what’s going on … they become so ashamed … that they change their behavior.”
36:10 “The patient … is not their most important customer.”
39:03 “The sleeping giant is the employers.”

You can find Marshall’s book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, anywhere that books are sold.