An Arm and a Leg

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California plans to make its own insulin and sell it super-cheap. Really. Sep 29, 2022

Show notes

This year, the state of California put up $100 million to produce its own insulin, and sell it for cheap. How’s it going to work? (Is it going to work?)

The price of insulin could be the starkest example of our out-of-control health care system: More than 7 million Americans need it to survive, and some die because they can’t afford it— medicine that’s been around for 100 years, medicine its discoverers didn’t want to patent.

We look at how California’s plan came to be, and what might stand in the state’s way.

Further listening:

How insulin got so horribly expensive was one of the first stories we covered on this show. Here’s that story-- a version we ran in 2021, including updates on what citizen-scientists, hackers, and activists are up to: https://armandalegshow.com/episode/revisiting-insulin/
One of the biggest possible obstacles to California’s plan is the power of middleman companies called pharmacy benefit managers, or PBMs. We unpacked their role, their power, and the profits they make when drug prices are high, in this 2019 episode: https://armandalegshow.com/episode/why-are-drug-prices-so-random-meet-mr-pbm/
… and here’s a deep dive on the devious, clever games among PBMs, pharma companies, and insurance companies — games where we, people who need medicine, always lose. https://armandalegshow.com/episode/swimming-with-sharks/

Also, we mention our recent coverage of the legal and lobbying power of the pharmaceutical industry. That’s in our last episode, here: https://armandalegshow.com/episode/congress-fixed-a-piece-of-medicare/

Here’s a transcript of this episode.

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Congress fixed (a piece of) Medicare. It only took a few decades. Sep 08, 2022

Show notes

Lots of seniors have to pay thousands of dollars for drugs—even tens of thousands—or do without life-saving medicine. That’s finally going to change.

The new Inflation Reduction Act will set a $2,000 cap on out-of-pocket drug costs for seniors. (Yes, it’ll do a bunch of other stuff too.)

It took a long time. Folks like researcher Stacie Dusetzina spent years building evidence about how Medicare prescription drug policy was failing people with cancer and other conditions.

The pharmaceutical industry fought this change tooth and nail — for decades. Julie Rovner, Chief National Correspondent for Kaiser Health News, takes us on a journey back to the late 1980’s, when Congress learned the cost of messing with Big Pharma.

Transcript
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The Medical-bill "Negotiation Lab" Aug 18, 2022

Show notes

It’s often possible to negotiate medical bills. It sounds hard — and it can be — but what if we got it down to a science? Mapped out all the moves ahead of time? Jared Walker and his team at the nonprofit Dollar For are running a big experiment to see if they can do just that. And we got to visit the lab.

The folks at Dollar For caught our attention — and lots of other people’s—when they went super-viral on TikTok with a 60-second recipe for crushing medical debt by accessing charity care, financial assistance that most US hospitals are legally required to offer. That was early 2021.

Next, a group of whip-smart volunteers helped Dollar For develop a user-friendly system to help folks apply for that assistance. Dollar For also started holding open trainings on Zoom, teaching people the ins and outs of applying for charity care—and helping others to do so. They say their work to date has helped erase more than $18 million in medical debt.

But lots of people who can’t afford their medical bills don’t qualify for charity care. So Dollar For is trying something new: what they’re calling a “negotiation lab” for gaming out the best way to negotiate with hospitals and debt collectors.

We listen-in on one of Dollar For’s real-life negotiations with a debt collector and take notes.

Here’s a transcript of the episode.
Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG
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The Genetic Testing ‘Bait-and-Switch’ Jul 28, 2022

Show notes

Is it possible for a health care company to make enough people mad about their billing practices that it hurts their business? For one genetic testing company, maybe so.

An Arm and a Leg listener Jessica got a test that’s become routine in early pregnancy: non-invasive prenatal testing. It was supposed to be $99. But then — after she took the test — that turned into $250. And when she asked questions, she was told it could go up to $800 if she didn’t pay up quick. , Jessica looked up the testing company, and found out that lots of people experienced what she called “the genetic testing bait-and-switch.”

And she’s not the only one who noticed.

When some guys on Wall Street, plus New York Times reporter Sarah Kliff, started hearing about those bills, the company found itself in some hot water.

Here’s a transcript of the episode.

Bonus reading:

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One ER Doc’s Journey Through the Pandemic — and the Health Care System Jul 07, 2022

Show notes

Thomas Fisher is an emergency room doc in Chicago. His book, The Emergency, is an up-close chronicle of the COVID pandemic’s first year in his South Side ER.

It also zooms out to tell the story of his journey as a doctor: How his upbringing on the South Side fueled his desire to become a doctor. And how the realities and inequities of American health care limited his ability to help.

He details how the failures of the American health care system — and the racial inequities it perpetuates — leave health care workers with a profound sense of moral injury.

“Over time, when you have this conflict between what you can do and what you're supposed to do—what you wish you could do, what you're trained to do—that creates a moral conundrum….It also leads a lot of people to leave the profession ”

For a time, Fisher himself stepped away from practicing medicine. The journey took him to the executive suite but ultimately landed him back in the ER where he started.

On the street outside the hospital where Fisher works, he sits down with host Dan Weissmann to discuss the book and his search for meaning in the daily sprint of life in the ER.

Here’s a transcript of this episode.
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These docs are trying to kick private equity out of their ER Jun 16, 2022

Show notes

About a third of ER doctors now work for companies backed by private equity. A lot of those docs do not like the arrangement, which they say puts profits ahead of patients. Now, a group of ER docs are suing to kick one of those private-equity owned companies out of their hospital-- and all of California. They see it as the first step in a long, long fight.

The suit cites California’s ban on the “corporate practice of medicine” — which is supposed to outlaw situations where non-doctors tell doctors what to do, for profit.

Which raises a question: How did it get left to a group of doctors to get that law enforced?

We break it down, with help from:

Dr. Lisa Moreno, immediate past president of the American Academy of Emergency Medicine which filed the lawsuit.
Law professor Erin Fuse Brown, who has written about private equity’s growing role in medicine.
Legendary financial reporter Gretchen Morgenson, now at NBC News, who has been reporting on private equity’s role in medicine since 2020, and whose reporting tipped us off to this lawsuit.

And while you're here, why not:

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Credit Where It’s Due May 26, 2022

Show notes

Credit reporting bureaus announced in April that they would start taking most medical debt off of people’s credit reports. At first, we weren’t sure that would be such a huge deal. After all, the medical debt would still exist, people would still get harassed by debt collectors, or even sued over it.

But it turns out, there’s a bunch of reasons why these changes could be life-changing, and we want to give credit (the good kind) where it’s due.

The changes include:

Paid-off medical debt disappears from credit reports on July 1, 2022
Debts under $500 (even if you haven’t paid them) come off reports in March 2023
Medical bills under $500 that you received after March 1, 2022 should will never be counted on your credit report
No medical bills – of any size– will appear on your credit report until they’re at least a year old, starting July 1, 2022

Plus, some an end to some games debt collectors can play with your credit score.

Here’s a transcript of this episode.

Subscribe to our newsletter, First Aid Kit.

Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG

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Support the show: https://armandalegshow.com/support/

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“The Golden Age of Older Rectums” (for investors) May 05, 2022

Show notes

A new golden age is dawning, and it starts where the sun don’t shine.

A listener got a pricey quote for her colonoscopy, but the medical practice behind it seems like “the only game in town.” We scope it out and learn the surprising reason why: Investors have decided your butt is a goldmine.

Private equity investors have made their way into many areas of our lives. Now, they’re at the gastroenterologist’s —and lots of other medical specialists, too. We learned why these doctors are selling their practices to private equity, and what it could mean for your health care and your bills.

Correction notice: The original version of this story mis-identified the organization where Claire McAndrew worked when we spoke to her in 2019. Whoops. We've updated the audio file, so it's correct now.

Here's a transcript for this episode.

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Sick Note, pt. 2: Dang Apr 21, 2022

Show notes

Dan’s COVID has hung on there for a while, kept him SUPER tired. Yoinks. Back in a couple weeks!

Meanwhile, as always, we'd love for you to:

Get in touch to share a story or your thoughts.
Subscribe to First Aid Kit, our newsletter about how to survive the health-care system
Support us: Your donations are this show's biggest source of income.

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Sick Note: Dan has COVID. (He's fine, but ...) Apr 07, 2022

Show notes

Hey there — I got COVID a little before we were scheduled to tape this week's episode. Whoops!

I'm fine now, but kinda tired. Just to be on the safe side — some people stay tired for a while — let's give me two weeks before we come back with a full episode.

Meanwhile, I'll share this: I think one reason I got better quick was, I was able to get anti-viral meds. (Paxlovid, in my case.)

And I mention this because: There's a new variant going around, BA.2, which looks like it's going to bring on a new wave; we don't know how big it'll be yet, but the New York Times had some good tips recently for how to be prepared.

One was: Have a plan for getting antiviral treatment, in case you do get sick. Some docs don't like to prescribe them, and some folks shouldn't take them because of things like drug interactions. It's worth knowing your best options ahead of time.

I'm here to co-sign that advice. The rest was good too. Here's the link: https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html

Finally: Even this two-minute sick note has a highly-entertaining moment, thanks to a listener who wrote a surprising response to a recent First Aid Kit newsletter... then recorded that note as a voice memo.

So, I'll catch you in a couple weeks. Till then: Take care of yourself, for real.

And as always:

Our First Aid Kit newsletter collects the practical lessons I've learned about how to fight the awful cost of health care. You might want to subscribe.
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