EP443: Let Us Never Pay the First Bill in Honor of Marshall Allen

The first time I figuratively, not actually, met Marshall Allen was the day he did not meet Dave Chase for lunch. Dave was in Manhattan, and he was supposed to meet up with Marshall. But something happened, and Marshall was unable to make said lunch. So, I filled in for Marshall, who I had never met at that point.

I zipped uptown to have lunch with Dave instead. We simply could not have Dave Chase eating lunch alone in my home city, I guess; and I was extremely pleased to ensure that that did not happen. Anyway, of course I met Marshall after that—I mean, being his standby and all. This was, I’m gonna say, 10 years ago or more.

For a full transcript of this episode, click here.

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So, when I saw the beautiful words that Dave Chase had written about Marshall after his death in May of this year, 2024, of course I asked Dave if he wouldn’t mind coming on Relentless Health Value and saying a few words about Marshall and his legacy.

After Dave talks, I have teed up an earlier interview with Marshall that originally came out on Relentless Health Value after his book launch. I am sure that listeners of this show have heard Marshall speak many times, but I’d encourage you to listen all the same because this is Marshall talking to the healthcare industry. By that, I mean he’s talking to us listeners of the show; and it was a little cathartic (for me at least) to actually revisit.

If anyone is interested in supporting Marshall’s legacy, please subscribe to the content available at Allen Health Academy and consider purchasing access for employees. This is likely the best way to honor his legacy and amplify his work as a catalyst for change and to empower patients.

And from all of us at Aventria Health Group, our hearts go out to Marshall’s family.

Dave Chase: I was honored to be asked by Stacey to share a few memories on our friend Marshall Allen. In my role as founder of Health Rosetta, I had the privilege of working with Marshall quite a lot on different reporting stories that he did, and I was honored to be able to join his family and friends at the celebration of his life.

It was certainly a sad day for all of us on Sunday, May 19th, when we lost Marshall. Let me just share what I think about Marshall. He was a dedicated journalist and also a former member of the clergy. He had an unwavering commitment to investigative journalism that really left an indelible mark on the healthcare industry.

He was really a relentless voice for the little guy. He shed light on price gouging, sloppy billing, fraud, conflicts of interest, insurance denials, and unnecessary treatments that preyed on Americans in our most vulnerable moments of our lives when we’re in the healthcare system.

Marshall had a passion for justice and transparency, and it wasn’t just a professional pursuit. It was really a personal mission. Marshall’s work was driven by a deep-seated desire to help individuals and employers understand and navigate the convoluted healthcare system and really about empowering them to overcome its many injustices and win in the process.

His impact went beyond just great reporting and fascinating stories. He had a huge impact on healthcare legislation. One of Marshall’s most significant contributions was his yearlong investigation into the health insurance brokerage industry, which culminated in the publication of a pivotal article in ProPublica.

That investigation caught the eye of Senator Lamar Alexander, who was leading the Senate HELP Committee at that point in time, as well as on the Democratic side, Senator Patty Murray. They were seeking areas of bipartisan agreement, and the insights from Marshall’s work played a crucial role in drafting and eventual passage of the Consolidated Appropriations Act of 2021 (really a key part of that), regarded by many as the most consequential employee healthcare legislation since 1943.

He didn’t stop there. He wrote a book. Never Pay the First Bill is a tremendous resource for patients navigating the complexities of the healthcare system. It equips families and employers with the knowledge and strategies to fight back against unjust medical bills and practices and promoting a sense of empowerment and advocacy in the process. He also edited two healthcare books by Marty Makary, MD. This further cemented his legacy as a thought leader and communications leader in the healthcare industry.

After the success of his book, Marshall founded the Allen Health Academy. This is a platform dedicated to educating and empowering individuals to take control of their healthcare experiences. This really reflects Marshall’s enduring commitment to making healthcare more accessible and fair for everyone, especially the most vulnerable.

And anybody who knew Marshall knew that he was really on a moral mission rooted in his faith. It played a significant role in shaping his character and his work. In his New York Times piece entitled “The Biblical Guide to Reporting,” he shared how his five years of Christian ministry enriched his journalistic practice, fostering a sense of compassion, integrity, and dedication to truth.

He wrote his years in ministry made him a better journalist because he was a Christian, not in spite of it, is how he put it. It soured him to see people “getting beaten down by the system.” Marshall Allen’s legacy is one of courage, integrity, and relentless pursuit of justice. His work has not only illuminated the dark corners of the healthcare industry but has also inspired countless individuals to stand up for their rights and demand better, not to mention many journalists following in his footsteps.

As we mourn his loss, let’s celebrate the remarkable impact he had on the world and take solace in the lasting changes he brought about. Marshall will be deeply missed, but his contributions will continue to resonate for many years.

One of the people that Marshall was closest to as a friend and as an editor was Dr. Makary, and I’d like to wrap up with what Marty shared in a post announcing Marshall’s passing. “In his final hours, this is what I told him: Marshall, we watched you fight tirelessly for the voiceless and become a fierce advocate for the defenseless—a fight many will continue. At every step along the way, you reminded many of us what’s really important. … Thank you, my friend, for being a role model to so many. … We will miss you dearly.”

I’d encourage you to bring some part of Marshall into your day every day, and it’ll be a much better day and you’ll have a huge impact on our nation. And once again, thank you for the opportunity to share a few thoughts on Marshall. Thank you.

Stacey: Today, I’m interviewing the incomparable Marshall Allen. 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, has implications to healthcare leaders. 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. Because listeners of this show are healthcare 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 28-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)

Marshall’s book, by the way, is available wherever books are sold.

Also mentioned in this episode are Dave Chase; Marty Makary, MD, MPH; and Doug Aldeen.

Additional links mentioned in this episode: Healthcare Dive, Kaiser’s Bill of the Month 

You can learn more at Allen Health Academy and on Marshall’s site.

Marshall Allen spent more than 17 years investigating the healthcare system as a journalist. He is the founder of Allen Health Academy and the author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. His book and his health literacy videos, The Never Pay Pathway, are helping working Americans save hundreds and thousands of dollars—per healthcare encounter. Marshall is a two-time finalist for the Pulitzer Prize and winner of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting and dozens of other journalism awards. For more information, visit allenhealthacademy.com.

09:28 What’s the point of view that Marshall is coming from with his investigative reporting?

09:57 “How does this affect the people who are paying for it and the people who are undergoing the care?”

10:49 “There’s a lot of good people working within this very messed up system.”

11:03 Why are patients considered outsiders in the healthcare system?

11:45 “What’s happened in healthcare is that the stakeholders treat each other more as the customer.”

13:45 What is upcoding?

17:18 “These are schemes that have been created within the industry to increase revenue.”

17:46 “This system is not set up for the benefit of the patient.”

18:13 “On the financial side, the industry is actually oppressing the American people.”

19:14 “We have been expected to pay whatever aggregate sum is thrown at us.”

20:21 Why have patients been so passive toward this crooked healthcare system so far?

22:05 What’s the difference between making a profit and profiteering?

29:45 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?

30:45 “When you tell the truth about what’s going on … they become so ashamed … that they change their behavior.”

32:00 “The patient … is not their most important customer.”

32:50 “The sleeping giant is the employers.”