It is an honor to have with us today one of the premier investigative journalists in the United States, one could argue in the world. He was a finalist for a Pulitzer Prize in reporting, and he was the winner of the goldsmith award from Harvard’s Kennedy School for investigative reporting.
He his work for pro publica, which I have no doubt many of you have seen, it’s been picked up by NPR and amplified by that outlet has been devastating to the healthcare industry. He has turned over rocks, he has uncovered absurdities, and he has exposed the dysfunctions of our healthcare system.
So I’m here today to talk about some of the findings of the last year or two of research. And his new book. It is my pleasure to welcome Marshall Allen.
Thank you, it is an honor to be here with you today. I really appreciate the invitation from Nelson. And it’s great to be with you all. We’ve all been kind of cooped up with this pandemic. So I want to start us off with a little game. Okay, can we have a little audience participation game to kick us off? So here’s the question. I don’t know how many 10s of millions of COVID tests have been done in the last year. But how much do you think a typical COVID test actually cost? If you had to say, you all are a very sophisticated audience here. So I think you might actually know this. But what do you think? What do you think a COVID test would cost? Give me some numbers?
How much 110 bucks diagnostic 110 bucks.
$24, no charged, charged, let’s say charged. And then of course, we know that insurance companies were ordered by Congress to pay these things, right. With no no cost to the consumer. So when that kind of environment exists, it creates some interesting incentives, which is one thing I’ve been watching. So we have $100, we have $24 $300 $150. Okay, so so the silly thing is, is that we don’t actually know the answer to this, right? I mean, this is the crazy thing about American healthcare is that you there’s no actual price, the price is actually whatever they charge, and then people end up having to figure out whether they’re gonna pay it or not. So the actual answer is, you all are I actually quite quite close user in the blue shirt are the closest, although he did go over a little bit $100 for a diagnostic test, at least according according to a recent study that came out that looked at what was charged for COVID tests. Of course, the average is higher than that. That was the median. For the antibody tests, it was actually lower than that. But the problem is the average was higher, and the average goes higher, because there really isno limit on what could be charged. And so my job as an investigative reporter, I’m very interested in the incentives that drive the healthcare system, the incentives that drive the behavior. And especially for the last few years, I’ve been deeply, deeply focused on why working Americans are paying so much for health care, and getting such a bad deal. In return. We spend almost you all know this, these numbers, we spend twice as much as any other developed country pretty much, we get a lot less for our money and working Americans are paying much more. So I think I might have documented the most expensive payment for a COVID-19 antibody test. And ironically enough, it was this Dr. Zachary Sussman,
who was a pathologist who was actually running the antibody tests for a freestanding emergency room here in Austin, Texas. He thought they’d give him one on the house because he knew he worked there. He was running the tests, and he knew that the materials for the test only cost about $8. So assessment goes in, he’s expecting the bro deal. But they take his insurance information. He was covered by Golden Rule insurance, which is a united healthcare company, as I’m sure you all know.
He gets the EOB from his insurance company a few weeks after the test, the test turned out fine. And he sees that not only did they charge $10,984 for the test, but Golden Rule insurance paid it at 100%.
So what happened to the great insurance company discounts?
In many cases, I have found that the insurance company discounts are non existent. And I know a lot of you have probably found this too, that you can often get by better by asking the cash price or having a direct pay relationship then you can with the suppose that discounts through the networks that the insurance companies have set up for our employers. And in fact, how
I have a whole chapter in my book about how it’s often better to pay cash than it is to run things through your insurance plan, even if you have health care benefits.
So the price gouging is just a matter of fact, thing in our healthcare system. And in Sussman case, he was so concerned by this, he resigned immediately, he sent an email to the company said, I feel like you guys are committing fraud with this particular test, I can’t work for you anymore. He quit the job. He called me I wrote the story about it. And to me, that’s the highest one I’ve heard of that was actually paid at that amount. But it just goes to show that the insurance companies are not paying close attention. They’re auto adjudicating a lot of claims. They’re not analyzing them. They’re not the guardians of our health care dollars. And in many cases, their incentive is actually to pay higher and higher bills, because they’re just taking a cut off of what they pay. They’re a middleman that’s taking a cut.
So people often ask me how I got into covering healthcare. And I’m sure you all get this question, too. How did you get into what you’re doing? For me, it was rather accidental. But I had interest in investigative reporting. And when I went to the Las Vegas Sun newspaper in 2006, my editor invited me out to lunch. And you know, when your boss invites you out to lunch, there’s gonna be some kind of conversation, you just hope it’s a good one. Well, he said, Marshall, we’d like you to cover healthcare. And the first words out of my mouth, I said, I cannot imagine anything more boring than writing about healthcare. To me, it sounded absolutely miserable. You see, I had read so many stories about like, oh, there’s a new Da Vinci robot down at the hospital, and they’re doing operations with the robot or there’s always the disease of the week, you know, creating some panic about some, you know, well, now we did have a pandemic, but some disease that’s gonna sweep across the nation, which previously had been a bit of fear mongering, or there’s the studies where coffee is bad for you. Coffee is good for you. What is it this what is it this week, so I had read so many bad healthcare stories, I just didn’t understand it. And I’m really thankful to say I was wrong because
covering healthcare, as I do, from the point of view of the consumer, really puts me in a position where I’m covering something as an investigator that people care about most their health and their money, because healthcare is often dangerous, and healthcare is outrageously expensive. And so I’ve had a great privilege for covering healthcare for 15 years, I have talked to hundreds of patients who have been harmed. I’ve documented hundreds of stories of financial and physical harm to patients. I’ve dug into their records, I’ve read all their medical bills. I’ve talked to hundreds of experts about all of these cases, I have documented in depth in an authoritative and very fair way that our healthcare system is exploiting us for profit. And I know that this is something that you all are fighting against.
One of the last times I was here in Texas A few years ago, I came to Fort Worth to investigate this story. I think even though I’ve been doing this for 15 years, and nothing ceases to amaze me. I’m still amazed every day at just how bad it is. Because even when you know how bad it is, and you will know this because you all see this every day to even when you know how bad it is. You keep being stunned to realize is it really that bad? It’s so absurd.
This particular story was one of the most outrageous I’ve ever covered. David Williams was a personal trainer here in Fort Worth. Again, personal trainer, not a doctor, not a medical professional. This was a guy that supervised people when they would do sit ups push ups burpees
David Williams decided to create a little scam, it actually became quite a big scam, where he told his clients, they would come to these boot camps and in the Fort Worth area. A lot of them were Southwest Airlines Flight attendants. And he said, your insurance plan now covers your workouts. And of course these flight attendants that this is the greatest thing in the world. So they started inviting their friends and all David Williams did. He found a loophole in our healthcare payment system that is big enough that you could fit this convention center through it. So it’s almost an accurate to call it a loophole. It is a giant gaping hole in the way we pay for healthcare, called the National Provider Identifier. And you all may know an NPI number is something that a doctor has to apply to Medicare to receive. The Medicare designates you an NPI number. That’s a requirement on any health insurance claim that the NPI number of the clinician get added to the claim to legitimize the claim before it gets paid. Well, what people didn’t realize and what I did not realize until I did this story is that Medicare doesn’t verify that someone’s actually a doctor when they apply for an NPI number.
So, me or you or anyone in this room right now, we could get an Ei n number, go on the Medicare website, we could apply for an NPI and within minutes, we could have an NPI number it would be fraudulent
It would be criminal, it would be wrong.
But it’s that easy. So David Williams went and got himself an NPI number. And so it’s outrageous that Medicare doesn’t check before they give NPI numbers. But then, what do you think happened when he started filling in claim forms for United Healthcare, Cigna, Aetna,
they sailed right through, he got paid, this was the greatest gig in the world, he could run a boot camp. So I could run a boot camp for all of you in here right now. You give me your insurance information, of course.
I’d run you through some burpees. You know, we do some squat thrusts or whatever you want to do. And then I would submit you and they were all level five office visits that he was billing for $250 apiece, he billed more than $25 million to these three insurance companies over a span of more than four years, he got paid millions of dollars, the checks were just flowing in. He got other personal trainers in his in his group, he got them to do it. He built up a whole network in multiple states. This was not and I want to emphasize because when I called the United Healthcare about this, they of course said well, it was hard to catch him. It was hard to know. But this was not a criminal mastermind. Okay, this was not Lex Luthor, or whoever the greatest Bond villain is right. This was a guy who just lied and said he was a doctor filled in claim forms. And the great thing about this case was it ended up eventually he got caught. And by the way, the story is amazing. I really recommend you read the story. Because the other piece of this story that made it so rich, was that his ex wife caught him doing this. his ex wife saw him buying a new Harley Davidson buying this was a his house and a separate before it worth until a picture of it or an illustration of it. So all of a sudden, he’s reaping in all this money, she knows this guy doesn’t have any money. In fact, he had a previous criminal conviction for theft. This was not a good guy. So she got suspicious. She and her dad who he was also very motivated, you can imagine the former father in law sees his sees the son in law committing fraud. They called all the insurance companies and turned him in the insurance companies didn’t do anything about it. In fact, the insurance companies, the rich thing is it went to a federal trial. He’s now in prison.
But there’s testimony from all the investigators from United Healthcare, Aetna, Cigna, talking about how 96% of their claims are auto adjudicated. They don’t even look at them, they just pass them through. I’ve now talked to more than a dozen investigators who work for health insurance companies, they tell me it’s not that they can’t find the fraud. The fraud is everywhere. And if you look at the Medicaid plans and the Medicare plans, they have designated teams chasing from, but in the commercial plans, we trust that the health insurance companies are going to be the guardians of our dollars. They care about this, they protect this. Well, actually, they auto adjudicate everything they pass it through. And even when they caught him, so this went on for about four years after about year one, they caught him. They sent him letters, they said, Hey, we know that you’re not a doctor. So you need to repay us the money that we paid you. And if you don’t repay us, we’re going to recoup the payments from the future payments that we owe you.
Again, I’m like, how does this make any sense? It makes no sense other than if you start to realize that they don’t really care that much about protecting our healthcare dollars, they’re not really that motivated to keep healthcare costs low. And again, these are the giants in the industry, right? This isn’t some chump insurance company, United Healthcare is a what now a $270 billion company. So
maybe he should have but he was doing level five office visits. So he already was up coding it to go from burpees to a level five is is like, anyway, you’re right, though he should have upgraded it more. So eventually, he did get caught. But these stories as I document them, I see how the game really works, how the system is actually set up, and how if we continue to do things in the same way,
we are really not being wise at all. And this is this is what led me to write my book, I wrote my book because I get emails every day from patients and from consumers who are getting ripped off, who are who have bills that they can’t pay who are being cheated, who are who are experiencing upcoding. And they’re desperate. They don’t know what to do. I can’t cover all these things. So I decided to write a book. It’s called never paying the first bill and other ways to fight the healthcare system. And when where I document not just the problems because we all know the problems exist, but I’m really telling people what we need to do about this. I’m trying to equip and empower employees so that they can be on the front lines of watching their own family’s health care costs. And also when they save money, their health, their health plan saves a lot of money. So the
The book has nine chapters for employees as three chapters for employers because employers are also a big part of this solution. And so I’m trying to guide people into what they should do. Anyway, as I was working on the book, I love to read healthcare books. I don’t know if you guys know Dr. Marty mcherry. But I edited his last book, the price we pay. Marty is an amazing guy, a great friend, a great change agent. So I read a lot of these books. I helped Marty with his book. And I saw Don Bartlett and James Steele had written a book called critical condition. Now, I wouldn’t be surprised if you all never heard of barlett and Steele, but in the journalism world, these are like
Walter Cronkite level old school investigative business journalists. So I didn’t even know that they had written a book. But I heard as I was researching my book that they had written one I was like, I’ve got to get this book and see what they said, well, so I open up the book. And this is from the prologue, where they say that this is like page one, literally, the system is rigged in a way that would not be tolerated in the sale of any other consumer products, healthcare providers can and do charge one customer five times in some cases, even 10 times as much as another. I’m like, Berlin steel already wrote my book. What am I doing? These guys wrote this book, and now it’s like, Hey, wait a minute, when did this book get written? I flip it open. This book was written in 2004 17 years ago, barlett. And Steele wrote a book that’s highlighting the exact same problems that we’re here in this room and 21 talking about right now. This problem has been going on for decades. And a lot of times it feels like it’s a David and Goliath battle, you know, you all as edit advisors are out there trying to help these employers. I know some of them get it because I feature a lot of them in my book, The the book really focuses on the subtitle is how to fight the healthcare system. And when I’m really focused on the end win part, because what the myth is that we can’t do anything about this. And I know you all know this because you’re putting some innovative plans in place when you unbundle things and take it out of the world of the buka big United Healthcare package deal where everything’s a black box, you can’t see anything, you can provide better benefits for a lot less money. You can waive co pays, reduced deductibles. I’ve seen benefits advisors who have eliminated deductibles and provided on site primary care. I mean, it’s amazing when you cut these middlemen out just exactly what can be done. But still I know a lot of employers don’t get it. And so for you, you might feel like this is a David David and Goliath battle right? You’re up against a giant a lot of times in the David and Goliath story. We don’t emphasize a lot the the fierceness and the danger of the giant right. But the healthcare giant is a big giant United Healthcare as a giant company. They don’t really care about little old me or little Oh view. I know sometimes I feel like it’s a David Goliath battle to with me as an investigative reporter. But what I want to emphasize is, we have 180 million David’s we need to not think about this as us I am David or your David or one employer is David, fighting the system all by ourselves. My vision is there’s 180 million Americans that fall into this category where they’re either in an employer sponsored health plan, where they’re almost certainly paying more than they should be. Or they are uninsured. There’s probably 30 million uninsured still in the United States.
If I if we could empower and equip these, David’s to fight this battle, then really, we’re surrounding these healthcare giants, okay, we don’t need to be intimidated. We don’t need to be afraid. Because if we equip people to fight back,
I believe they are incredibly motivated to fight back. So this is why I’ve launched this is what I’m calling my new company, Alan health Academy. I don’t know do you like the name I like the AHA acronym is sort of what I was, what I was going for there. And I’m being serious. This is something that that I don’t know other journalists who have done this. But I’ve gotten so frustrated, hearing the same thing from the consumer perspective. And seeing that there’s nothing out there to help them that I wrote the book. Again, it’s called never pay the first bill and other ways to fight the healthcare system. And when it’s a how to guide, it’s got chapters on you know, I just call it like the never pay pathway. When you get a bill. You shouldn’t just send in the money for the bill. Get make sure you get an itemized bill, make sure it has medical billing codes, look up the CPT codes. It’s not rocket science. And it is possible for people to do this and then the route I tell people to go if they refuse to play fair with you sue them in small claims court.
I think small claims court is the most underutilized consumer empowerment tool that we have in the United States when it comes to health care. And so I’m looking to train consumers about how to use small claims court when they’re getting pushed.
In fact, I just had a friend of mine at my church, his dentist overcharged, he and his wife by about $400. For a procedure that that his wife had done, the dentist refused to run it through their insurance plan as they should have, instead just build their credit card and extra 400 bucks. So my buddy Josh, he tried to negotiate and tell the dentist you need to repay me my $400, the dentists just refused, he blew him off. And we’ve all seen that happen, right? When you’re calling the customer service number for the hospital, and they tell you to call the insurance company, you call the insurance company, they tell you to call the hospital, nobody will give the consumer a straight answer.
That’s because we’re playing in their playing field where they make the rules. When they get sued in small claims court as my buddy Josh did with his dentist. In New Jersey, the limits in small claims court are up to $15,000. So a little $400 claim that’s easy. In Texas, the Small Claims limits are $20,000. The limits are big enough to cover a lot of these bills.
So, of course, Josh files the case, a few days later, he gets a call from the dentist’s attorney, they want to settle the case, they want to pay him he got paid as money. Because it works. In fact, when I was a teenager, I sued my former employer in small claims court because he didn’t pay me after after shutting down the business. And I was amazed that the owner of the company that I sued had to show up in small claims court against me at age 16.
The judge listened to the case. And he told the owner right there on the spot to write me a check. And he wrote me a check. This is how this was my first experience to small claims court, I was like, wow, in the United States, sometimes the little guy can win. And so I have a whole chapter where I feature examples, I have sample letters demand letters that consumers can send to their doctor or their dentist or their hospital if they’re being abused or taken advantage of. Again, I’m not saying don’t pay your bills, we all know that we should pay our bills, there has to be a fair price. So I show people how to look up the code and how to look up a fair price. You can go now hospitals supposed to post their prices on their websites, as you know, many aren’t but many are. You can go to healthcare bluebook, you can go to fair health consumer.org, you can call and get the cash prices, you can call other facilities and see what they’re paying, it is possible to get an estimate you can get the Medicare prices so you can get an estimate of what you should be paying so so consumers can find out when they’re being price gouged. And then as
as I was talking to some different benefits advisors about the book, I had one of them say, you know what I really need for my employees and my clients, I need a video curriculum, could you take your stuff and turn it into some videos. And so we’re in the process now of building out 15 on demand videos, very short, three to five minutes each highlighting the tips and tactics, tricks, and the real how to on the ground stuff about how to think about healthcare as a consumer, how to be aware that the system is set up to exploit you. And what you can do about it, the real practical things that you can do to protect your family so that your family doesn’t get exploited by the healthcare system. And these are available now. For pre order. On my website, the website is Marshall Allen calm Nelson asked if we could give you guys a discount today. So the discount is 15%. For anybody here today, you’ll see there’s a there’s a code on there where you can accept the discount. And if you have any questions, just reach out to me Marshall at Marshall Allen comm is my email address. And I want to
educate and empower your clients and your employees who are in your health plans, so that they can be on the front lines of protecting their health care dollars. and by extension, protecting the health plans health care dollars. And I have been really pleased to see how effective it is when people do push back. It does not always work. You know, there’s no magic solution. And there’s no magic bullet like Oh, you do this and every time it works, but the point is right the the consumer has nothing to lose. And right now they don’t feel equipped and they don’t know how to do anything. I hear a lot of objections. And the objections always kind of crack me up to this.
Some people love to say, oh, employees, they’ll never understand how to fight back. This is too complicated for them. Well, I think that’s total hogwash. I think that we have not actually ever taken the time to really sit down and explain to employees just how messed up this system is, and just how predatory it is coming after their dollars. So I don’t think that that’s true. I mean, I know it’s true in a lot of cases, but it’s certainly not true in every case. I also hear people say, oh, employees are never going to go to the effort of fighting back. It’s too much trouble. It’s too complicated. It’s too hard to understand. And that’s true.
In fact, I know a lot of employees don’t have the personality where they would actually take on this fight. In fact, my wife, my wife is a total Peacemaker. So my wife is not going to
take on the healthcare system in the way I would. But I like to think of it this way, there’s 180 million Americans in this pool that’s getting exploited. If even 1% of them were to be equipped and were to fight back. That would make a revolutionary difference. If 1.8 million Americans started demanding an itemized medical bill, or started saying you don’t have a right to charge me whatever you want to. And I’m now suing you in small claims court. Think of how that revenue cycle Management Director in the hospital would respond. In fact, on LinkedIn, I’ve been getting some chippy responses from revenue cycle managers, and I love it every time, every time they come at me, I just absolutely love it. But some employees will fight back. And even my wife who’s a total Peacemaker, I have a chapter in the book on how to avoid unnecessary care, what are the key questions, you should ask your doctor to make sure you don’t undergo unnecessary care, which is a huge problem and a huge wasteful expenditure. When my wife will avoid unnecessary care, my wife will, she might not take the fight to them, but she’ll certainly find ways to navigate away from their predatory tactics. So I know there are always objections. I just think that sometimes these objections also come from people who are very satisfied with the status quo, maybe even making a lot of money on the status quo. They don’t want things to change. So I think I want to leave a little time for questions here. And I just have five minutes left. But I encourage you to reach out. This is this is a book in a product that is designed just for
you, your employers and the people in your health plans, especially because you all actually know already that something needs to be done that things need to change. And I have not found another health literacy product like it out on the market. So I think that there’s a big gap right now, where we are not properly equipping our employees to fight back. And so that’s really what I’m trying to do. So please just reach out to me if you have any questions. I’m not unfortunately not able to stay today. So I won’t be able to be with you today. But I’m easy to find on LinkedIn email on my website. And again, that that discount code if 15% is good for two weeks, so it’s not like you have to decide, oh, this very minute right now today. But if you could decide in the next two weeks, you can take advantage of that 15% off on the curriculum. And with the curriculum. It’s a bundle. It’s the book bundled with the video curriculum. I want to leave time for questions. Does anyone have any questions or anything that you would like to ask me about?
The book is out June 22. Great question. I got a question Marshall. Yeah. I through Marty’s book that you edited. In particular, I found that oftentimes doctors don’t understand the financial shit show that they’re unleashing on that patient. That’s correct things and have you we’ve found that effective sometimes when we get a thorny health system to call the doctor themselves and say, let me explain what your treatment did to this patient financially. And we’ve sometimes gotten them to pressure the hospital administrators to reduce the bill.
Have you seen that work more broadly than that?
Yes, and I think that’s a great idea, because it personalizes it, and I had I had my own, I write about this. In fact, if you sign up for my newsletter, on my website, I’ll send you the introduction of my book for free. I just got the introduction finalized. So I can send that out now. And in the introduction, I rant about my own health care battle, where I had to defend my parents. Unfortunately, my dad has dementia, and he was in an assisted living facility. And he suffered a medication error. And then they also billed for treatment that should not have been provided to my dad. So while I was in the process of writing a book about patients being exploited, I had to go through the process of applying some of these same tactics. And one of the things there I did is I called the nurse practitioner who did this examination without my mom’s consent, my mom has power of attorney. My mom was not even in the picture with all this, and they sent my mom a bill for
an exam that she had not even approved. In addition, the medication error was a whole nother thing. But I told that nurse practitioner, I said, I’m really sorry, but this is an unjustified exam. And this bill needs to be taken from my mom and I will file a complaint against you.
And your license, if this doesn’t get rectified, and she was very, she was very apologetic. But she did help put pressure on them to end up waiving that bill, which they did. And I think doctors and other medical providers, they have no idea how the payment system works. But they’re, they’re frustrated by it as we are, I really do think they’re victims of it too. And there are certainly some of them who are profiting from it and who are greedy and exploitative, too. But I don’t think that’s generally the case. In fact, in my in my book, I really don’t point the target at the clinicians. In fact, I think what’s happening is, there’s a halo effect that’s created around the nurses, the doctors, all the people who are healing us that’s being explored.
By the business side of the industry, the business side of the industry knows we love our doctor. They know we feel loyalty to our doctrine, you know, generally that the doctors are really trying to care for us. They take advantage of that trust. But our trust is misguided when we put it in the business side, right? The revenue cycle manager
does not have that same love. In fact, I just had a call yesterday with a woman who just had her baby die in the queue. And the hospital is threatening to send her to collections, because the baby started its own deductible when it was born. So they want $6,000 extracted from this family to pay for some bills. And you know, I think I think generally, I told this woman I think, I think honestly, the hospital can go after you for those bills. I said, the the insurance company has a deductible that’s applied to the infant. In fact, if any of you know differently, please tell me because I’m trying to help this woman. But unfortunately, this is a cruel system. It is a cruel system. This poor young mom had her newborn born premature, died after two days in the nick queue. And she thought her family deductible was covered. But no, she didn’t realize a new deductible started when that infant was born. And now they’re threatening to send her to collections.
That is so less egregious than anything that any one of us could tell you a story on how it doesn’t need to be for us to try to get some publicity.
Here’s the hard thing. There’s too many cases, like there are not enough reporters to cover every single egregious case. And this
Well, I mean, the $10,000 COVID test hit at a right time because everybody’s focused on COVID, right. But over the year, over the last year, the pandemic, the only thing any journalists could cover is COVID.
So I got, I got hit with all kinds of stories. I’ve been covering healthcare benefits for years. But the problem is the editors, the publications, they always want you to do something new. So if it’s just another story about this happening, or just another story about that happening, I encourage you to go to your local journalists, try and find a journalist who will do it. But these stories are hard and time consuming to do. A lot of journalists don’t want to take on the big power players, some local publications or TV outlets make a lot of money from the hospitals. They’re sometimes conflicted more than they would like to admit. So it’s very hard to get media coverage for these things. Yes.
Because you’re talking about the maximum out of pocket, which is actually even higher, it’s like 8400 for the Obamacare.
And I give the consumer at the day.
How is it possible that the average American did not go to Washington
to just progress to this healthcare system? How is it possible in your perspective?
Well, first of all, the average American has no idea what uneven what their deductible is, they can barely define the terms of a health plan, right? So they don’t actually think about it, I think, or even, they don’t want to take the time they sit in a benefits meeting. And here are the here’s what your plan is going to cover. They don’t they don’t really understand how it works. And they put a lot of trust in the healthcare system. I think there’s this this veneer of science, and everybody’s got an MD or a PhD or an MBA. And so consumers feel very intimidated. They don’t realize that if you pull behind the curtain, United Healthcare is just like, you know, paying the bills, no matter what they don’t realize just how unbelievably dysfunctional the system is.
Stop paying the bills.
Yeah. So that’s another big myth of rich benefits. Like I had I had a person tell me the other day, well, you know, people who have rich benefits are not going to be interested in your book and your curriculum. And I’m like, we need to get over this myth of rich benefits. Okay, I did a story about the New Jersey teacher health plan. They had no out of network limits for acupuncturist, chiropractors and physical therapists. So what do you think those three types of providers did? They started doing chairside massages in the teachers lounge to market their services. They started delivering orange juice and bagels to all the elementary schools in town. They donated wheelchairs, they donated checks. Why did they do that? They did that because they’re lowering the teachers into their facilities. And they are charging them out of network. There was one acupuncturist in New Jersey, who got paid by the teacher plan more than $1 million in one year for acupuncture. This is all legal. But it’s the way the plan was designed allowed this exploitation to happen. They estimated it was costing them 130
million dollars a year in excess spending just because of the out of network spending for these three types of acupuncture chiropractor and physical therapy. I wrote a story about it. But again, they had rich benefits. So the teachers unions didn’t want to let go of this, we have great benefits. We have great out of network benefits. Well, you are a fool. If you think that it’s great that your health plan will pay whatever the acupuncturist charges you, you don’t understand how it works, because at the end of the day, your wages are not going to be as high because all of your compensation is being sucked out of the compensation pool and given to the chiropractors and physical therapist and acupuncturist of New Jersey.
So thankfully, I wrote that story. And that story created enough political pressure that the the plan design Committee, which was really run by the unions, change the benefit design, and now they are I just talked to the woman who runs the plan the other day, I said, Hey, have you actually saved i can i can’t believe it. In my story. In fact, if you read the story, I said, How much do you think you’ve wasted in the last five years on this? She said we’ve probably wasted half a billion dollars.
I live in New Jersey, I’m paying property taxes like you would not believe that are funding the schools. Well, this money is all going being siphoned out. So she I said, Have you actually saved 130 mil. She’s like, yeah, we’re saving we I would say that’s right, we’re saving 130 million a year.
Griffin nama and what you said is the nebulous nature of this. The reason it’s hard to get reporters to do is because you can’t indict the whole health system. You want to indict Bernie Madoff, but who’s the Bernie Madoff in that space, and not a lot and say the outcome is happening in $1,000, the carrier’s found that if they jacking it up, it goes up, they make more money, and employers want to save money, so they think they’re saving money. And to Griffin’s point, you know, you don’t have anyone to blame in that situation. It’s a lot more sensational when you can point the finger at person and said they made the decision that resulted in this harm to these people. And that’s really hard to do. And yeah, this is it’s the normalization of deviance. And this deviant practice has become the status quo. And it’s something when people but here’s what I love. And David, I have his story in my book.
So I love talking to some of the employers who have figured it out and and learned a new way. And they’ve eliminated the deductibles and the CO payments, they’ve created direct primary care. They’re like converts. I love it, because they’re like evangelistic when they love to talk about what they’ve done. And so I have featured a lot of their stories in my book, just to show that, you know, if we keep doing things the same way, we’re suckers at a certain point, you have to say we’re suckers. barlett. And Steele wrote about this in 2004.
So some people are gonna get it, some people aren’t. And I think I’m just trying to get on board with the people who get it. Because there are a lot who do, yes,
made a great point that the halo effect. And one of the challenges that you’ll run into is that in many communities, the health care industry is the largest employer in the area. And so if we’re successful, we’re going to put people out of work. So how do you how do you respond to that argument? Or do you say,
figure that out? Oh, well, I mean, you’re talking to a journalist who’s had his complete industry disrupted over since the internet started, right. I’ve got survivor’s guilt, because I’m one of the few who has a full time job. So I think since when are they entitled to take twice as much money up to five times as much money from working Americans as they take from Medicare patients? To me it is discrimination against working Americans. That’s what we have going on here. They’re the the industry.
The industry is not entitled to just take as much as they want, because they’re the big healers. It does not work that way. fiduciary responsibility? Well, that’s a good question, too. It is. And you hear some rumblings of people talking about filing some of these fiduciary lawsuits. It’ll be very interesting to see if that happens. But it is a fiduciary responsibility. So the other thing I’m trying to do by educating the consumer and the employee is I want to start that brushfire at the ground level up. So I want because believe me, I’m a victim of this. You are all victims of this. It’s kind of weird that we’re all victims of the same thing. But I want but it’s hard. It’s very sensitive. I can speak from experience to go to your HR department and ask them if they could do things differently. They take that as criticism. But I think what needs to happen is I show people how to calculate how much extra you have spent on healthcare in the last 10 years. Go back 10 years in fact, barlett and Steele we wish we had 2004 prices. That would be a dream, but it was a crisis for them right then that they wrote a book about it. We wish it was at 2004 levels, but it has gotten so much worse.