An Arm and a Leg

By An Arm and a Leg

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Category: Health

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Subscribers: 378
Reviews: 6


 Jul 5, 2019

arewenotmen
 Jun 15, 2019
Love this show! Makes a difficult topic approachable and even darkly funny and entertaining. Love the host!

Filio
 Apr 30, 2019
Everything is nicely done, music, storytelling, subject, investigations ... Even thoe I'm from Europe I love this podcast


 Mar 28, 2019

notestown
 Dec 3, 2018
These stories are so relatable. Who hasn't dealt with some insane healthcare bill. And the host does a really nice job...

Description

A podcast. Because we need to talk about the cost of health care

Episode Date
Hey there! Season 3 is coming November 14. Here’s a preview.
00:02:23

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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Oct 31, 2019
A place where they do health care more cheaply and effectively. (And yes, it’s in the U.S.)
00:23:41

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, founder of Maple City Health Care Center.
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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Jul 31, 2019
An actor walks into a doctor’s office…
00:18:53


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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Jul 24, 2019
Whoa, this medical device is spying on me. In my sleep. So my insurer can deny me coverage.
00:16:58


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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Jul 17, 2019
The insane, surprising history behind insulin’s crazy price (and some hopeful signs in the wild)
00:26:36

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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Jul 10, 2019
Coming next week: The price of insulin
00:01:53

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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Jul 03, 2019
Why are drug prices so random? Meet Mr. PBM
00:18:55

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.

Oh no! Now I have to learn how prescription drug pricing works.

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 totally cracked it, man!

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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Jun 26, 2019
How much for an MRI? Well, that depends…
00:22:00

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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Jun 19, 2019
To get paid, hospitals get creative
00:15:30

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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Jun 12, 2019
We thought we had adulted properly
00:23:30

Caitlin and Corey Gaffer got a surprise letter from their insurance company — saying they were being dumped for non-payment. Except, as far as they knew, they were paid up.

As it turned out, they’d made a couple of small mistakes, which they were eager to fix. But their insurer was definitely not interested. Caitlin and Corey spent fruitless weeks on the phone.

And then, Caitlin’s pregnancy — more than six months along — ran into complications.

They scrambled for months to get covered, while racking up about $30,000 in hospital bills.

There’s a happy ending. Two, in fact.

First, their baby was born healthy (and insured) in January. She’s in the episode too, and she’s adorable.

Maggie, Corey, and Caitlin Gaffer, with Luna the dog. (Photo by Lauren Cutshall.)

Second: In March their old insurer offered an apology — and offered to reinstate them. (This was the day after a reporter called to ask the insurer for their side of the story.)

… but the whole journey was harrowing, and opens up questions about what kinds of safeguards consumers have — or should have — against getting dropped.

Welcome to Season Two!

This story — like a lot of this season — came straight from my inbox. A few days after the show launched, I got an email with the subject line “Pregnant woman and her husband in Minnesota need help.”

We’ve got new friends!

We’ve got co-producers for Season Two, Kaiser Health News. Three things to know:

First: Kaiser Health News is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor — which is a fun story I’ve written all about here.

Second: They ARE a great non-profit newsroom covering health care in America, an editorially independent project of the Kaiser Family Foundation. (There’s that name again. And again, here’s the story.)

Third: Their editor-in-chief is one of the people who inspired this show.

YEP. The whole story is worth reading. I am so pleased and proud to be working with these folks.

Catch you next time. Till then, how about…

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Jun 04, 2019
We’re back! Here’s a taste of Season 2, launching June 4.
00:02:06

Hey there! We’ve been working hard on season 2. We hope you enjoy this preview — there’s so much good (and frightening) stuff ahead.

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May 23, 2019
Is it ever appropriate to fudge a little? (Season One, episode 8)
00:21:55

Bari Tessler is a little famous as a “financial therapist,” but even she gets rattled by the price of health care.

Also: What my family is doing for health insurance next year.

This is our Season One finale. Maybe you’d like to subscribe to our newsletter, so we can keep you posted as we prepare Season Two.

Also this week: A taste from one of the most painfully-hilarious things to hit the Internet for a long time. Welcome to Our Modern Hospital, Where if You Want to Know a Price, You Can Go F*** Yourself, published by McSweeney’s.

There’s a longer excerpt, and an interview with the author, Alex Baia — that’s on our Patreon.  Thanks to Alex for permission to record excerpts, and to ttsreader for dramatizing the text for us!

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Our Team:

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Dec 19, 2018
Why are ER bills so crazy? With Sarah Kliff of Vox.com. (Season One, episode 7)
00:20:06
ER Door with Danger Sign


Emergency rooms often bill you a “cover charge” just for walking in the door, and it can be thousands of dollars.

That’s in addition to the huge markup on everything that happens there: seven bucks for a band-aid. Twenty dollars for a couple of pills.

Reporter Sarah Kliff has collected more than a thousand ER bills from her readers at Vox.

She was an expert on health care before starting this project — she covered it for years at the Washington Post before moving to Vox — but even she found plenty of surprises.


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Image adapted from a drawing posted to flickr by Wellness Corporate Solutions.

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Dec 12, 2018
Why Health Insurance Actually Sucks (Season One, episode 6)
00:16:20

Turns out, insurance companies allow — even encourage — crazy price-gouging by hospitals. For example, the leg brace Blake needed was available for $150 on Amazon. But thanks to his insurance, he paid more than $500.

Investigative reporter Jenny Gold’s work helps us understand how that kind of thing happens.

She compares health care to shopping for a gallon of milk.

“We can look at the cost of a gallon of milk at lots of different stores and decide which one is the best,” she says.At the store, there’s maybe there’s a couple different brands, with the prices on the shelf. We pick the one we want, pay on the way out.

“Now with healthcare,” she says, “the analogy would be, you go to the store for a gallon of milk. You have no idea what it costs. You don’t know what it costs at that store compared to other stores. You walk into a random store, pick out a gallon of milk, go through check-out. You still don’t know what it costs. You give them your credit card information and then a few weeks later you get a bill telling you how much they charged you.”

Super-crazy. Jenny’s reporting shows how insurance companies help to keep those prices hidden, and keep them high.

Jenny Gold works for Kaiser Health News — which, we should explain, is not part of Kaiser Permanente health care. It’s part of an independent foundation that basically runs on an endowment set up by Mr. Kaiser, more than 50 years ago.

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Dec 05, 2018
So, Robin Hood’s got an approach to medical bills. (Season One, episode 5)
00:15:26

The health-care system — especially the financial side — can feel like a Medieval torture device. So maybe it fits that workers from Renaissance fairs have come up with a work-around.

In this episode I meet Robin Hood and a woman who has made more than $2 million in medical bills… disappear.

Also, you’ve started sending us stories as voice memos. And they are awesome.

Send more! stories@armandalegshow.com.

Regular emails are nice too.  You’ve sent some powerful stories that way. We are listening.

Also, you’ve shared tips, including this CBS News story about insurance companies refusing to pay ER bills.  Super-timely, since we’ve got a story about ER bills coming up in the next couple of weeks.

You can find more information about the Rescu Foundation at the group’s website: rescufoundation.org

(Photo from the Sherwood Forest Faire Facebook Page.)

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Nov 27, 2018
Why you (and I) will likely pick the wrong health-insurance plan (Season One, episode 4)
00:18:56

Because as smart economists recently proved) it is super-confusing, and most of us can’t do the math.

But! We found glimmers of hope. So don’t be scared.

We’d like to hear how you’re choosing your health insurance for 2019 — or are you going to do without? — and what you’ve learned from past mistakes. You can scroll down and just start typing, or hit us up at insurance [[at]] arm and a leg show [[dot]] [[com]] 
EXTRA CREDIT: We’d love it if you send us a voice memo!

Finally, we’ve got some resources here — guides from some smart, friendly folks — to help you get smarter and avoid some worst-case outcomes.

    1. The basics from a smart, kind civilian: Arm and a Leg listener Anna Jo Beck gave herself an education on the topic after her husband was diagnosed with cancer (he’s fine now) — and captured what she learned in a charming, self-published booklet. For Your Health: Making Sense of American Health Insurance starts with “What is it, and do I need it?” and goes on from there. BONUS: It’s peppered with what Anna describes as “moments of cute, heartwarming distraction to keep you from wanting to totally give up hope.”
    1. Another version of the basics, from a smart journalist:  Vox.com health-care reporter Sarah Kliff published I’m a health-care reporter. Here’s how I shop for health insurance in 2015. It’s still a good primer.
  1. More advanced and detailed (also funny), from another smart journalist: Business Insider’s health editor Zachary Tracer chronicled his own decision-making — including actual math — in fall 2018: My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan.

The basic premise all around: If you can afford to think about anything but the lowest-possible monthly premium, then a good thing to think about is: Financially speaking, what’s the worst-case scenario, if I get hit by a bus or something?  

Which is not exactly a... For information regarding your data privacy, visit acast.com/privacy

Nov 21, 2018
3. How one drug got its $500,000 price tag. (With 99 Percent Invisible– Season One, episode 3)
00:24:31

The answer involves a suburban housewife, a 1970s TV star, and a Las Vegas maker of popcorn and nacho cheese sauce. Also: Wall Street.

Produced with our friends at 99 Percent Invisible.

Many thanks to Abbey Meyers, Joshua Schein, and Nora Guthrie.

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Nov 14, 2018
All the Marbles: One woman’s epic quest for health insurance (Season One, episode 2)
00:19:06

marbles-2614142_640Laura Derrick takes a drug that costs more than $500,000 a year.

So when her family was going to lose their insurance, she made crazy sacrifices… and changed the course of history.

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Nov 14, 2018
This is Water, and it sucks. Let’s talk. (Season One, episode 1)
00:19:49

When I first started talking about doing a show about the cost of health care… everybody had a story. Including me.

It’s like that famous speech by the writer David Foster Wallace called This is Water. It starts with a joke about two young fish swimming along. An older fish passes by and says, “Morning boys. How’s the water?”

He goes, then one young fish turns to the other and says, “What the hell is water?”

Sound familiar? The cost of health care is like water. We’re all surrounded by it. We don’t even see it anymore.

That’s what this show is for: To help us see the water we’re in, and figure out together how to navigate it, and keep each other good company along the way. Maybe we’ll tell some jokes– dark ones– along the way.  Welcome aboard.

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Nov 14, 2018
A podcast about the cost of health care, coming November 2018
00:03:57

The spiraling cost of medical care shapes people’s lives: The jobs we’re afraid to leave because of insurance, the risk that a trip to the doc could end in bankruptcy. It’s not healthy.

This is my story too, and that’s why I’m making this podcast. Here’s what I’ve got in mind.

An Arm and a Leg will be entertaining, empowering— even useful. As a reporter, I’ll bring my skill at finding and telling revealing, surprising stories. But the project’s big focus— since I’m in this mess too—is connecting and problem-solving, together.

You are not alone. We may be screwed, but we’re together. And if we want to get even a little bit less-screwed, we need each other. If nothing else, we can be good company to each other.

  • We can have a good, dark laugh.
  • We can offer each other empathy.
  • We can sing hilarious punk-rock campfire-songs of rage at whoever turns out to be responsible.

So I’ll be looking to you, over time, to offer up your own stories— by sending in voice memo recordings (and email, and FB posts). Also, punk-rock campfire songs.

To start, I’ll be reporting out on stuff I’ve found out on my own— stories that help us get a little less scared and confused about the mess we’re in. Early episodes will:

  • Pull back the curtain and show how the dark machinery works. A simple leg brace shows how insurance companies allow— even encourage— crazy price gouging.
  • Check out inventive hacks: Renaissance-fair workers have cooked up a creative, home-brew safety net.
  • Tell some wild stories. Like one woman’s epic quest for health insurance. To keep her family out of medical bankruptcy, she made crazy sacrifices— and tweaked history.

Over time, you’ll tell me what needs finding out.

We can’t count on single-payer or some other big fix getting enacted and coming to save our butts anytime soon. (We don’t even have to agree on single-payer.

No matter what our politics, we’re all screwed right now.) But we need each other’s help and company RIGHT NOW, just muddling through the mess we’re in.

You know what? I think it’s going to be fun.

Meanwhile:

Thanks! Talk with you soon.

Till then… take care of yourself.

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Oct 11, 2018