An Arm and a Leg

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Mom vs. Texas Nov 14, 2019

Show notes

Stephanie Wittels Wachs has a daughter born with hearing loss, which is how she found out insurance didn't cover hearing aids for kids. Those start at $6,000 and only last a few years. Stephanie teamed up with a few other moms to change Texas law... and won.

Stephanie is a terrific storyteller. She's the author of Everything Is Horrible and Wonderful, a memoir about grieving her brother, Harris Wittels, a writer for TV comedies like Parks and Recreation, who died of a heroin overdose.

... and she is the host of the new podcast Last Day, which uses her brother's story as a starting point for a deep and smart and very-human look at the opioid crisis. Highly recommend: https://www.lemonadamedia.com/show/last-day

P.S. This podcast, An Arm and a Leg, is a finalist for a very-strange, very-approriate award: Best True Crime show of 2019. Because not all crimes are against the law. Let 'em know: Go vote for us right now — voting closes November 18: https://awards.discoverpods.com/finalists/

Also: We'd love it if you support this show on Patreon: https://www.patreon.com/armandalegshow

Thanks!

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Hey there! Season 3 is coming November 14. Here’s a preview. Oct 31, 2019

Show notes

It’s going to be REALLY fun. Also, maybe useful. Catch you here soon!

Also, here’s a little video preview.

Bonus news: Did you know we're nominated for an award as a TRUE CRIME show?

Almost too perfect. Everything on this show is legal, and that's the true crime. Here's a link — please pass it around!

Wanna share it with folks? Be our guest! Here it is on Twitter, Facebook, Instagram, and Vimeo.

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A place where they do health care more cheaply and effectively. (And yes, it’s in the U.S.) Jul 31, 2019

Show notes

For our Season 2 finale, time for some inspiration.

For 30 years, James Gingerich has run a super-effective clinic in Indiana, delivering great results at low cost — to high-need, low-income patients.

James Gingerich stands in front of shelves holding books that Maple City Health Care Center distributes to families with young children.

He’s not a modest guy, and two of his brags stand out — as a study in contrasts.

One is a quote from a board member that makes him sound like a big dreamer:

“People think of us as a medical organization. We’re not. We are fundamentally a peace and justice organization that happens to be engaged in our community through medical care.”

The other is the way he stands at his desk and nerds out on stats that show his clinic beating the pants off the competition, on preventive-care measures like screenings for cervical cancer, vaccination rates for two-year-olds, etc..

“OK, next: diabetes control,” he says. “Are you getting the idea here?”

At the heart of it, he says, is listening to people’s stories. The rest he calls “housekeeping.”

It’s not a fix for our whole broken system — you can’t just copy-and-paste what’s happening here — but it’s definitely pretty inspiring.

There’s a bit more in this write-up I did for our pals at Kaiser Health News.

But first! How about taking our listener survey?

It just takes a few minutes, and you’ll be helping us out a TON: https://armandalegshow.com/survey/

Thank you! You’ll be helping us get Season 3 made.

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An actor walks into a doctor’s office… Jul 24, 2019

Show notes

Dr. Saul Weiner is a physician and researcher at Jesse Brown VA Medical Center and the University of Illinois at Chicago. (Photo: Roberta Dupuis-Devlin)

Researcher Saul Weiner has been sending fake patients — actors, wired for sound — into real doctors’ offices, to learn about what actually happens, especially: How well doctors really listen to their patients.

He’s tallied up what doctors miss (a lot), and how much it costs (ditto).

In today’s episode, we hear what actually happened in one of those “secret shopper” doctor visits — with the doctor and the actor who played his patient reading from the transcript of their visit, and then unpacking what went wrong.

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Whoa, this medical device is spying on me. In my sleep. So my insurer can deny me coverage. Jul 17, 2019

Show notes

That’s the rude awakening Eric Umansky got when he called the company that provided his CPAP machine — a device that helps him breathe at night.

He got mad. And he got even, in a way: Eric is an editor at the non-profit newsroom ProPublica, and he tipped a colleague —Marshall Allen, who covers health care there.

The two of them together, in this episode, are hilarious and enlightening.

The story Marshall wrote

opened up bigger issues about how insurance companies are collecting all kinds of data to use against us.

And it included at least one example of how the “little guy” can fight back sometimes, and win.

Extra fun: One of those examples features a 16 year-old Marshall Allen.

Marshall Allen, age 16, in his 1988 yearbook photo. (Photo courtesy Marshall Allen.)

Note: Eric curses a couple of times. We left it in.

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The surprising history behind insulin’s absurd price (and some hopeful signs in the wild) Jul 10, 2019

Show notes

The price of insulin is iconic — doubling, tripling, multiplying like crazy, for medicine Type 1 diabetics can’t live without.

To understand it, we went back almost 100 years and dug up a story of sweaty Canadian researchers — swatting away flies and doing business with probable dog-nappers, on the way to a Nobel Prize… and a deal with corporate pharma.

Charles Best and Frederick Banting on the roof of the University of Toronto medical building, petting a dog they probably picked up from some shady character on the street … and whom they would soon sacrifice in the name of science. (Photo courtesy University of Toronto.)

We also found hopeful signs out there today, including the folks at the Open Insulin Project in Oakland, California, who are working on their own recipe for insulin, which they hope to share as widely as possible.

Anthony Di Franco holds a 3-D printed model of an insulin molecule at Counter Culture Labs in Oakland. (Photo courtesy Anthony Di Franco.)

If it sounds crazy — well, we talked with a listener who has hacked together an artificial pancreas from outdated equipment, raw computer parts, and open-source software, all with the help of her fellow “rogue, cowboy hackers,” who are growing in number. So, you never know.

Terri Lyman of Arizona shows off the home-made rig that regulates her blood-sugar and insulin levels according to her specifications. (Photo courtesy Terri Flynn.)

Meanwhile, activists with T1 International — an advocacy group run by Type 1 diabetics — are lobbying Congress, like the woman who leads off our story.

Adeline Umubyeyi, a T1 International activist, models a t-shirt from the group’s Washington, DC chapter president. (Photo courtesy Adeline Umubyeyi.)

They’re also organizing “caravans to Canada” (as our colleagues at Kaiser Health News recently documented with PBS News Hour)

You will find a TON of details, links and resources in our newsletter. We’ve been told that even the sign-up process is pretty entertaining.

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Coming next week: The price of insulin Jul 03, 2019

Show notes

As we started working on season two of this podcast, there was one topic that seemed like we just had to look at: insulin.

… and I wondered: There are stories about insulin prices everywhere. Would we really have something to add? Something that wasn’t just more of the same? (Enraging, terrifying, depressing.)

Turns out: OH YES WE DO.

And some of it is… hopeful.

We are holding it back a week, so you can take a break for the holiday, come back fresh, and be ready for something epic. See you then.

(If you’re new here, welcome! All our episodes so far are on our home page, or wherever you get podcasts. You can sign up for our newsletter , share a story, or check us out on Facebook and Twitter @armandalegshow.)

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Why are drug prices so random? Meet Mr. PBM Jun 26, 2019

Show notes

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.

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How much for an MRI? Well, that depends… Jun 19, 2019

Show notes

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.

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To get paid, hospitals get creative Jun 12, 2019

Show notes

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 Crannell

We 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?

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