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November 18, 2019
America Dissected
Healthcare Dissected pt 1: "Nobody Knew Healthcare Could Be So Complicated"

In This Episode

Throughout this series, we’ve considered how the straining relationship between science and government has led to a variety of public health issues, from the rise of superbugs to the epidemic of loneliness. Here, we take our scalpel to the most obvious problem of them all: the American healthcare system itself. Dr. Abdul El-Sayed talks with Lisa Cardillo whose scary brush with the healthcare system helps us deconstruct the business of American healthcare, where all of us are both the product and the consumer.

 

_________________________

 

ABDUL VO: Over the past eight episodes, we’ve talked about what matters in health–about the scary, the outrageous, and the just plain weird. 

 

ARCHIVAL – GWYNETH TALKS ABOUT JADE EGG

 

ABDUL VO: We’ve examined what happens when we fail science..and when government fails us.

 

CLIP FROM PREVIOUS EPISODE: MKT – KIRA: You know, you just don’t feel safe drinking water you, you never know if the pipes are getting fixed. 

 

ABDUL VO: We’ve explored some obvious health challenges, and some not so obvious ones.

 

CLIP FROM PREVIOUS EPISODE: TAPE: Klinenberg: 12:28 – Social isolation, we now know is terrifyingly dangerous. It can lead to all variety of health problems

 

ABDUL VO: But in our last two episodes, we’re going to take on the elephant in the room–a topic we haven’t hit head on, but that’s come up in almost every interview we’ve done.

 

CLIP: [00:26:06] TANYA HOTZ: This is what decides whether my child lives or dies because you can’t verify that I’m able to pay to keep my insurance going. Why are we living in the world of GoFundMe Healthcare?

 

ABDUL VO: If you’re lucky enough not to have to think about your healthcare, be thankful. But it’s still the safety net you hope will catch you when you need it. For others, who have to use it everyday, it’s all you think about. Either way, everyone can agree that the American healthcare system is A LOT.

 

ARCHIVAL:  TRUMP: “Nobody knew healthcare could be so complicated. 

 

ABDUL VO: Except maybe that guy. 

 

So yeah, most of us know that the American healthcare system is broken–but a lot of us don’t understand why–or how. 

 

See, the system is super opaque. The folks who make millions off it–off of us–would rather us stay in the dark. Because as long as you’re in the dark on how it works, it’s that much harder to realize how the system is exploiting you.

 

But no longer. Today, I want to take you on a tour of the inner workings of the health system– we’ll scrub the grime right off those opaque windows, and let some sunlight in on both the dysfunction in our system, and how we got here in the first place. 

 

This is America Dissected with Abdul El-Sayed. I’m your host. 

 

>> SERIES TITLE & THEME

 

ACT 1

 

ABDUL VO: Here’s the sad truth: despite spending a fifth of our economy on healthcare, Americans live, on average, 4 years less than people in other high income countries. Part of that is higher infant mortality, which we talked about–and increasingly, diseases of despair that lead to alcohol and opioid use and sometimes suicide.

 

But our less than stellar health outcomes also have a lot to do with the way our healthcare system is organized. And that’s because the system has a ton of problems. So how do we tackle them? Stay with me here.

 

If you’re a doctor, and a super sick patient walks into your ER, you want to sort out the problems they’re having one by one, so you can start to treat them. We call that the problem list.

 

So let’s say that super sick person arrives at the ER with a stroke — big problem — but they also have high cholesterol and high blood pressure. Of course, you gotta deal with the stroke right away – problem #1. But our problems are often connected: the high cholesterol and high blood pressure — they could very well have caused the stroke. So pretty quickly, you also want to get them under control to make sure the patient doesn’t have another stroke any time soon. 

 

Now imagine your patient is the US Healthcare system. Super sick indeed–with a loooong problem list. And guess what? Just like with the stroke, they’re all sorta intertwined. 

 

So, today, we’re gonna untangle them and get a clearer picture of the brokenness of our system– through the example of a woman whose had to get to know all those problems far too intimately. 

 

TAPE LISA – INTRO: [00:01:06] Cardillo_Lisa: My name is Lisa Cardillo.[00:01:10] Cardillo_Abdul: So and and tell me a little bit about about why we’re talking [00:01:16] Cardillo_Lisa: So I am a two-year survivor of a heart attack and cardiac arrest at the age of 36, I had a heart attack and then within 20 minutes suffered a cardiac arrest. 

ABDUL VO: Lisa lives in Southeast Michigan. And her story is intense. Before we get into it, I want to introduce the core issue on our Problem List for American Healthcare– the problem that all of the other problems lead back to: [PROBLEM SOUND!]

 

We treat health as a business in America–where the bottom line is all that matters. And we seem to be totally okay that multiple industries make A LOT of money off of sick people– the Pharma industry which we discussed earlier. The insurance industry. The hospital industry. 

 

And here’s the kicker: they don’t even sell us what we want. They sell us healthcare. But nobody actually wants healthCARE — what we want is HEALTH. 

 

The best way to have health is never to get sick in the first place. But how do you make money on that? Our current system – with all its messed up incentives – instead, gives us healthcare, because, well, you can make A LOT of money on healthcare.

 

And because it’s built on people making money, those without money are left in the dark. Nearly 10% of Americans still don’t have adequate healthcare coverage. And even for those who do?

 

Well, it’s time to hear Lisa’s story.

 

TAPE LISA – SYMPTOMS:  Abdul: Tell me about your symptoms that day. 

Cardillo_Lisa: I had no, no idea, until you know a couple minutes before. It was just a completely normal day. [00:02:45] We were actually on vacation. We had just checked in. We had only been there maybe an hour. The symptoms that I felt were a sudden and sharp burning in the center of my chest, and it felt like it was coming coming out of my back. This was a feeling that I’d never felt before in my life. And within seconds I immediately became severely sick to my stomach. [00:03:11] Which was also something very strange. I hadn’t felt nauseous before that. So it was all very sudden and things that I had never felt before. 

ABDUL VO: This was back in 2017. Lisa and her family were on vacation near Grand Rapids. 

 

Up until then, she had been perfectly healthy. No medical history. But she was having a heart attack. She just didn’t know it yet. 

 

TAPE LISA – GPS HOSPITAL:   [00:04:08] Cardillo_Lisa: Still at that point we’re thinking I’m 36 years old. I’m not having a heart attack. Let’s just get in the car and run over to an urgent care. Like I said, we were out of town. So we’re Googling, you know, where we need to go to get help. [00:04:25] I believe at that point. We got into the car and my left arm started going numb. So we started looking up the closest hospital and I saw a hospital and it said it had a heart center. So we put it in the GPS and my husband started driving, and 12 minutes later. We pulled up in front of their emergency room doors my husband [00:04:45] let me out. I walked myself in into the emergency room. I declined a wheelchair, walked up to the desk to check myself in, and that’s when 

ABDUL VO: The closest hospital was 12 minutes away. They rushed there, and Lisa walked herself into the ER, and up to the check-in desk. But then… 

TAPE LISA: I went into cardiac arrest standing up. I hit my head on the desk and then ended up on the ground. I say, I made it known that I was there because they rushed right to me and saved my life. 

ABDUL VO: Before we go further, I need to tell you more about Lisa’s family.

 

This wasn’t the first time they had to deal with a medical emergency. Just a few years earlier, her husband – 30 years-old at the time – was diagnosed with brain cancer — also out of nowhere. He was treated, and thankfully, is still alive today, cancer free. But he has to get regular MRIs every six months, to make sure it stays that way.

 

When it comes to navigating the healthcare system, Lisa and her husband — unlike a lot of people — have everything going for them. They have a steady household income, and health insurance through her husband’s employer. 

 

And that day, Lisa was also very fortunate…  

 

TAPE LISA – LUCKY HEART CENTER:   [00:07:03] I happened to walk into an emergency room that had a Heart Center, had an Interventional cardiologist who was there in moments so I do feel like I’m one of the lucky ones. 

ABDUL VO: Lisa really was lucky. She was close to a hospital with a cardiac unit—where she was more likely to get a high level of care. Had she not had that cardiac center close by, things might have turned out differently. 

 

Which brings us to Problem #2 on our American Healthcare Problem List: [PROBLEM SOUND!]

 

The Choice Illusion. When you think about it, so much of our healthcare conversation is about people scaring you that someone might take away your choice.

 

ARCHIVAL:  TRUMP: scaring people about choices. 

 

In theory, in a perfect world, you could go to any hospital you wanted to get care. But really, the idea of choices in healthcare is an illusion. So much of healthcare is emergent, meaning you don’t really have a choice in where you’ll get your care. If Lisa could have chosen where to have a heart attack, she might have chosen to be close to the Mayo Clinic or Johns Hopkins Hospital  But that’s kind of a ridiculous notion: a heart attack is, by definition, an emergency.  

 

That’s the case with a lot of our healthcare needs. And it underscores a fundamental point about healthcare– it is a decidedly unusual market. Unlike most goods — where we generally have a ton of options — when we buy healthcare, we often do it under the gun–and that limits our choices. It’d be like having to buy a car in an emergency–at the nearest dealership. No shopping around, no comparing prices.

  

Worse, the choices we do have are dwindling. Today, hospitals are consolidating–buying each other up, and shutting down the least profitable ones, especially in rural communities. 

 

ARCHIVAL – Local news piece about hospital closing, being bought out by big hospital system

 

ABDUL VO: And this is where it all comes back to money, the bottom line– of this *business* we call healthcare in America. This consolidation is leaving fewer and fewer facilities to choose from, forcing some people to drive hours to get care–hours they often don’t have to spare. If Lisa had been just a few hours north, where she and her family were headed that day, her story could have turned out radically different.  

 

As it was, when she went into cardiac arrest in the lobby of the emergency room, the doctors got right to work. 

TAPE LISA – TREATMENT FIRST COST LATER:   They gave me the defibrillator shocks that got my heart back into the correct rhythm. From there. [00:09:48] Sorry, go ahead. From there that Interventional cardiologist was called in and he took over they first ordered like a head [00:10:00] CT scan and actually CT scan of my entire body just to make sure that I hadn’t given myself any serious brain trauma, which I hadn’t and then from there. They took me to the cath lab.

[00:10:13] Cardillo_Abdul: And and this was. Entirely based on what the with the medical staff at the hospital thought you needed. 

[00:10:24] Cardillo_Lisa: Yeah, yeah at that point. I’m not sure if my husband had to sign anything or tell them. I’m sure he told them to do do whatever you have to do to save her life. So I was I was in you know, my life was in their hands.

ABDUL VO: Her life was in their hands. 

 

She needed — desperately — the tests and procedures and everything else the doctors and hospital staff gave her that day. But she had no idea it was happening. 

 

Even if she did, most of the time, we don’t quite understand just what the doctors and staff are suggesting – because, well, they’re experts and we’re not. So you go with it, cause you have to. 

 

For Lisa it turned out well. But sometimes it doesn’t. And that’s the 3rd problem on our Great American Healthcare Problem List: [PROBLEM SOUND!] upselling. 

 

You’re not the expert on what you need. The institutions selling you those things are. And because they both tell you what to buy, and then sell it to you–there’s a conflict of interest there. And this can hurt people – their health and their wallet. Because sometimes, doctors and hospitals upsell–tell us that we need healthcare that we actually don’t. This didn’t happen to Lisa — but it happens all the time in ways big and small. Because, you know, healthcare in America is about money.

 

Lisa and her husband’s bet on her medical care that day paid off – but surviving cardiac arrest wasn’t the end of her ordeal.

 

TAPE LISA:   [00:11:58] Cardillo_Abdul: And how long [00:12:00] did you end up staying in the hospital?

[00:12:03] Cardillo_Lisa: So from there things just got worse. I went into heart failure. I had cardiogenic shock and my heart couldn’t pump enough to sustain life. So within about 24 hours, they had it insert a heart pump. It’s called an Impala heart pump be inserted it through migraine and that was in place for about two days this whole time they kept me in a medically induced coma so I had no idea what was happening.[00:12:36] I wasn’t able to make any of my own medical decisions. It was all based on my husband and what the medical team thought was best for me. So it was 96 hours about four four and a half days total that I was in the medically induced coma and then from there they slowly brought me out of it. [00:13:00] And then when I was conscious enough, they told me what had happened. [00:13:06] From there. I stayed in the hospital. For another five days to recover and basically learn how to hold things again. Learn how to walk again after being in bed for that many days. It’s it’s not easy. So but it was nine days total that I was in the hospital. 

ABDUL VO: Lisa was diagnosed with a very rare condition that affects young healthy women called SCAD, spontaneous coronary artery dissection. Once she was well enough, she was discharged and then put on a number of medications. 

 

TAPE LISA:   A beta blocker an Ace inhibitor, I was on aspirin. [00:14:34] I was on blood thinners.

TAPE LISA:  [00:13:35] Cardillo_Lisa: Oh, yeah. I came home with a whole pill box. Basically, I had to I had to order a pill box that had morning noon and night, you know from somebody who had never taken any medications before I also went home on a device called a life vest which is wearable defibrillator. Before I left the hospital, they told me the first [00:14:00] six to eight weeks are most critical. [00:14:02] That’s when your chances of suffering sudden cardiac death are the most likely and so they sent me home on Zoll life vest and I wore that for five months in the event that my heart stopped again. 

ABDUL VO: She was sent home with a bunch of pills…and a bunch of bills. 

 

TAPE LISA:  [00:15:31] Cardillo_Lisa: You know, we have been through we’ve been through this before so I knew I’d have a little bit of time before the medical bills started coming. which was nice, but yeah, I knew they’d be coming and I knew they would be a lot and. They were. 

ABDUL VO: One of the biggest was for a wearable defibrillator vest… 

TAPE LISA: my heart pump that I was on. That was a over $20,000. Device that was inserted in me for for two days and I do believe it’s saved my life. [00:23:28] So in my opinion it was absolutely worth it, but that’s a lot of money my wearable. Defibrillator life vest that cost $5,000 a month and then when I finally had the defibrillator implanted in me like a permanent ICD, I believe there’s somewhere between 30 and 60 thousand dollars. So that was that was a big one, too.

ABDUL VO: All this talk of cost brings us to problem #4 on our Problem list for American healthcare: [PROBLEM SOUND!] The third party payer problem. 

In the American healthcare system, the patient–you know, the customer who’s actually getting healthcare–isn’t the one who pays for healthcare, the insurance company is. And if you think about it, that’s just plain weird. You pay a bunch of money to an insurance company, who then pays for your healthcare when you get sick. (sometimes) 

That leaves patients–especially ones in an emergency or in need of desperate care, like Lisa–very vulnerable. What’s to say that they’re actually going to pay for all the care you needed, even after you’ve paid them your monthly fee?

After the break, we’ll get into all this insurance business way more, and hear about Lisa’s continuing ordeal. Stay tuned. 

 

[AD BREAK]

 

ACT 2

 

ABDUL VO: This is the Vitals with Abdul El-Sayed, and I’m your host. We’re following Lisa, a young woman who suffered a heart attack in her 30s, and breaking down the problem list for the American healthcare system based on her experience. Before the break, we talked about how almost every problem in healthcare stems from the fact that it is a business–and that many different industries make money on it. 

 

Before we get deeper into Lisa’s story, at this point, it’s important to understand how we got the insurance system we have in the first place… 

 

ROSENTHAL TAPE – BEFORE INSURANCE: [00:25:47] Rosenthal_Elisabeth-EDIT: Sure, I think you know it and that’s really what I was looking at in my book. I wanted to know like how did we get to this crazy place that essentially nobody likes at [00:26:10] the moment and nobody thinks is a really good idea and no one would have designed it this way and yet we’re here? 

ABDUL VO: That’s a damn good question. One that Dr. Elizabeth Rosenthal — Editor in Chief of Kaiser Health News, whom we heard from a few episodes ago, is going to help us answer.

ROSENTHAL TAPE – BEFORE INSURANCE: And I think the answer is you know back in the day where people were paying more out of pocket, doctor’s visits and hospital stays were pretty cheap. Then came something called insurance, which was a good idea. You know, I don’t no one should say we shouldn’t have insurance. It’s a great idea. 

ABDUL VO:  Our current insurance system germinated way back in the 1920s. As the costs of running a modern hospital – paying educated doctors and staff – grew, the cost of hospitalization went up for patients. And hospitals started to realize, with all their empty beds, that patients simply couldn’t afford to be hospitalized.

 

Then, a hospital in Texas – Baylor University Hospital – came up with a solution and struck a deal with a group of local teachers: pay 50 cents a month to the hospital, and we’ll cover any future hospital care you might need. Adjusted for inflation–that would be $7 a month in today’s dollars. That program evolved into what we now know as Blue Cross. And during the Great Depression, when hospital wards were struggling to fill their beds, the idea spread across the country.

 

But it only covered hospital services. The other half? Blue shield? That was created to insure physician services outside the hospital, when a group of mine and lumberyard operators pooled their resources to guarantee those services for their employees. Eventually, Blue Cross and Blue Shield merged to become the company we know today. Except they charge a shit-ton more than $7 a month. And in their Michigan branch alone, their CEO made $19 million bucks last year.

 

But health insurance didn’t REALLY take off until World War II. With so many Americans fighting abroad, companies needed ways to entice the folks who stayed back to work for them. Their solution? Offer health insurance benefits. And in 1943, the IRS ruled that those benefits should be tax free. By the 1960s, 70 percent of Americans had some form of voluntary health insurance through their employer. 

 

And by the 1970s, health insurance was big business in America–but over the decades, it continued to evolve – especially as it pertains to cost… 

 

ROSENTHAL TAPE – THEN INSURANCE BUT NO CO PAY: In the 80s and into the [00:27:10] 90s Insurance basically, if you were lucky enough to have it through your employer or through the government, you didn’t pay premiums, there were no co-pays, there were no deductibles and in that setting nobody really cared how much things cost right? [00:27:16] Yeah my insurer was paying it. So I didn’t pay attention. 

ABDUL VO: Like Dr. Rosenthal said, healthcare used to be more simple–if you had insurance through your employer, you each paid something every month to your insurance company, and they then paid for your healthcare when you got sick. But then, it got a lot more complicated as costs continued to rise–insurance companies started to introduce things like deductibles and co-pays. Let’s quickly define–

 

A Premium is what you pay monthly to have insurance. A Deductible is what you pay out of pocket every year before your insurance kicks in to pay for anything else for that year. And a Co-pay is what you pay at the point of care–even after you’ve paid your deductible.

 

There are also things like “in-network” providers–healthcare providers with whom your insurance company has already negotiated prices, and “out-of-network” providers, those it hasn’t. Often, insurance companies don’t pay for services from out of network providers.

 

As Dr. Rosenthal was saying, these things that feel so commonplace in American healthcare – they weren’t always a thing. 

 

ROSENTHAL TAPE: And what happened during that time period was prices really started to escalate. [00:27:26] I remember, you know, in residency having this little asthma inhaler that was $10 and suddenly 10 years later It was $100 for no apparent reason. Except that, you know, except that the prices rise to what the market will bear. And if no one seems to be paying, the prices just go up if you’re in business. 

ABDUL VO: Remember when we talked about pharma’s absurd drug pricing? Health insurers needed a way to reduce their exposure to these skyrocketing costs. So they came up with ways to try to control their own costs– by passing them off onto patients. 

ROSENTHAL TAPE – THEN ENTER COPAYS: So, they picked prices and and [00:30:10] as long as it was, you know, the insurers were paying, they just went up and up and up. Until, and the reason I think we’re hearing a lot about it now, is then to try and control costs the insurers said, oh man, we’ve got to you know have the patients have some skin in the game. [00:30:17] So they introduced co-pays and deductibles and high-deductible plans and were paying more of our premiums. So suddenly we’re like holy cow. How did the prices get so out of control? And unfortunately, that’s how. And it’s hard to put the genie back in the box. 

ABDUL VO: Insurance companies called this “cost-sharing,” premised on the idea being that if you have to pay for some of your care, maybe you won’t use so much. But really, as Dr. Rosenthal said, these new costs were just a way to pass growing costs on to patients. 

 

And that’s the 5th problem in American healthcare– [PROBLEM SOUND!] the Problem of Expanding Costs. Because the industry is all about the money, there’s no incentive for health providers to actually reduce the costs of healthcare by, say – negotiating with hospitals or pharma to keep costs down – no, instead, insurers have mostly just passed these costs off on to patients. 

 

And that’s exactly what happened to Lisa. Before the break, Lisa had just come home from the hospital–and gotten smacked with the bills. 

 

But Lisa had been around the block before with insurance companies–when her husband had brain cancer.

 

TAPE LISA:  [00:15:59] Cardillo_Lisa: see, [00:16:00] you know, we got smart after my husband’s diagnosis and we changed our health insurance so that we didn’t have to pay quite as much in deductibles. So that helps that we have the lower deductibles with my diagnosis. I think my maximum out-of-pocket was. Maybe 7,000 for that year, but then other things come in, you know, when I went in to have a defibrillator placed in my chest the anesthesiologist wasn’t covered in network. [00:16:37] So, you know, here’s another fifteen hundred dollar bill on top of everything else. So kind of just like that one thing after another. 

ABDUL VO: The costs her insurance company wouldn’t pay were adding up fast for Lisa, who had to finance them.

 

TAPE LISA:  [00:19:14] It was medical bills from eight different hospitals or facilities and everybody wants their money and even if it’s only $100 a month for each, you know medical facility. That’s. 800 Dollars a month and that’s not something that we had planned for. 

TAPE LISA:  [00:29:17] Cardillo_Abdul: What’s crazy to me is that this is all with insurance. It’s not like you were uninsured, you had insurance. 

[00:29:23] Cardillo_Lisa: absolutely worth. You know it we had full coverage employee sponsored her employer-sponsored health insurance.

ABDUL VO: On top of Lisa’s own bills, she spent a ton of time trying to get to the bottom of the charges for her husband’s continued surveillance for his brain cancer… 

TAPE LISA:  [00:29:33] And even God knows the number of hours I spent on the phone with the insurance company and the hospitals and you know, why isn’t his brain radiation being covered? Oh, it’s because the radiologist is out of network and just jumping through hoops. And honestly crying on the phone with them sometimes to get you know, what can you do to help me? [00:29:53] How can we get this covered? We can’t pay out of pocket for 28 brain radiation [00:30:00] sessions, you know.

TAPE LISA:  [00:25:32] Cardillo_Lisa: I’m not sure. I have an answer for that. I think it’s so complicated. I just. You know what I say? – is that when your medical bills become more stressful than your husband’s brain cancer diagnosis, something is not right and it got to a point with me, you know, he is [00:26:00] trying to heal. And I’m trying to keep the bills away from him. [00:26:03] So he’s not stressed out about that.

ABDUL VO: And this gets us back to the core problem of the healthcare system: [PROBLEM SOUND! Bigger and slightly more intense] it’s all about making money, which means the incentives are ALL. FUCKED. UP. 

 

Think about it, you pay premiums ahead of time. Then when you get sick, you expect your insurance company to pay for some or all of your care — after all, you’ve been paying in! 

 

But no, the insurance company – their incentives are completely at odds with yours. They want to keep as much of your money as they can, which is how they make their profit. So they end up taking your money when you’re healthy and then doing everything they can NOT to pay for your healthcare when you need it. Because, that shit’s expensive. And they want their money.

 

So for people like Lisa and her husband, they are stuck having to fight the bureaucracy to get the care they’re already paying for.

 

Bottom line– Insurance, the way it is now, is not your friend.

 

ROSENTHAL TAPE – INSURERS INCENTIVES: This is a big misunderstanding of many patients, they’ll say like, gosh, you know my my insurer is in my corner.[00:33:43] Why did they you know pay $10,000 for my colonoscopy when I know it’s not worth that. Well again, that’s a misunderstanding of what insurers do. Basically they collect your premiums and your co-pays and [00:34:10] deductibles, and then they pay out claims, and as long as they can keep raising premiums and deductibles and passing those costs off to patients they’re fine paying out big big numbers for claims because their primary concern is keeping those giant Hospital systems and your employer satisfied enough to keep their contracts going, not how that not the Fallout on on you the patient.

ABDUL VO: So Insurance is passing the costs off on patients–people like Lisa who are the unfortunate ones who actually have to USE their insurance. 

 

But if the insurance companies aren’t your friends–maybe the doctors are? 

 

ROSENTHAL TAPE – DOCTORS DONT KNOW: I do hear a lot of and and you know people of your generation young residents going to the hospitals and saying you know, what on those order sheets.[00:37:38] I want to see how much you’re charging for that MRI, because I ordered a lot and I want to know, you know, am I are you ripping patients off? I feel bad if that’s the case, you know, they don’t get a lot they don’t get a lot of traction because they’re residents, you know, or you know, the head of their Department one guy said to me who’s in a radiology resident he said, [00:38:10] you know my department chair says on every every requisition or every reading we have to write recommend follow-up MRI. I know that’s medically not the right thing to do. I know that’s a billing thing, but I can’t even get them to tell me how much an MRI costs or and I’m kind of afraid not to do it because he’s my department chair and I’m going to be in big trouble if I don’t.

ABDUL VO: Most people don’t realize – but your doctor, when she or he orders a test for you – they don’t know how much it’s going to cost. Because that information is kept secret, or at least really hard to get to. So even though the doctors are your friends – trying to look out for you when it comes to cost– the hospitals they usually work for aren’t. So they end up being pressured to upsell, like we talked about earlier. Because you know–by this point, you should know what I’m about to say. It’s all about the bottom line.

 

ROSENTHAL TAPE – PATIENTS LOSE WHEN A DEAL CAN’T BE STRUCK:
[00:32:40] Rosenthal_Elisabeth-EDIT: you know, the bigger you are the more negotiating clout you have, it’s kind of like the Land of the Giants now and you know, first of all, poor patients who are kind of the the Pawns in this game [00:33:10] because you know, if they can’t come to a deal, the hospital and the insurer they go, you know, no deal and then you’re getting surprise bills. So the patient’s health is kind of the the the I guess the money in or not the money, the pound of Flesh that’s being negotiated here or being held hostage.  [00:33:23] I mean, sorry patients are being held hostage in these negotiations negotiations basically.

ABDUL VO: So, to summarize: We’ve got an insurance-based system that doesn’t really keep you healthy, that doesn’t want to pay for your care after you get sick, and where choice is so limited, and prices are opaque and patients are basically powerless? Not. Good.

 

I asked Lisa–who spends hours a day fighting with her insurance company about how her experience has shaped her perspective on American healthcare.

 

TAPE LISA:  [00:19:48] Cardillo_Abdul: Yeah, how has that changed your perspective on American Health Care.

[00:19:55] Cardillo_Lisa: It makes me sad. It makes me [00:20:00] envious of other people my age with young children who don’t have this burden.[00:20:09] You know, sometimes it comes between and I know it’s kind of a first world problem, but it’s like, okay. Are we going to be able to take our kids on a vacation or are we going to pay these medical bills? So they don’t send us to collections. So it’s kind of a balancing act and it’s. You know, it’s something I never expected and I’m not trained to juggle all these medical bills, but it’s just something that’s happened to us.

ABDUL VO: And yet, at the same time–she’s thankful to be alive. After all, there is nothing more valuable than life itself. 

 

TAPE LISA:  [00:22:40] Cardillo_Lisa: I can tell you about my favorite Bill and this is something that people have a lot of different medical diagnosis. My understand. So my favorite bill that I ever received was the one and it said right on it cardiopulmonary resuscitation. [00:22:57] So basically it was my bill for [00:23:00] getting CPR and. It was only like four hundred dollars. So not too bad. But you know we say that was like the best the best $400 we’ve ever spent on a medical bill 

ABDUL VO:  As Lisa reminds us, healthcare is supposed to be a thing we can rely on to get us the care we need, when we need it. It shouldn’t fail us when we need it most–or leave us suffering the financial consequences of our illness long after the physiological ones have healed. 

 

But right now, our system is sick. We pay for healthcare, rather than health. Our choices are limited by the incentives that are shutting down less profitable hospitals, and driving others to upsell us. We’ve ceded our agency to insurers who operate for their bottom line, who are colluding with hospitals to charge us for things we don’t always need–and to force us to pay absurd amounts of money for the things we do.

 

So next time your unfriendly neighborhood president says something like “NOBODY KNEW HEALTHCARE COULD BE SO COMPLICATED,” you can raise your hand and say–no sir, I did. 

 

Now that we’ve got our problem list for American healthcare– Next week, we’ll talk about how we fix it. Stay tuned.

 

America Dissected is a production of Crooked Media. Our producers are Austin Fisher, Cary Junior II, and Katie Long. Andrea B. Scott is our story editor. Our sound designer is Daniel Ramirez. Production support from Alison Falzetta (Fall-ZET-ta), Elisa (AY-lisa) Gutierrez, Kara (CARE-ah) Hart, Daniel Porcerelli (PORE-sir-el-ee), and Tara Terpstra. Fact-checking by Dr. Nicole Aiello (aye-YELL-low). The theme song is by Taka Yasuzawa (TAAK-ah Yaas-oo-ZAH-wah) and Alex Sugiura (SOO-ghee-er-ah). Our executive producers are Sarah Geismer (GUISE-mer) and Mukta Mohan (MO-haan). Special thanks to Jon Favreau, Jon Lovett, Tanya Somanader (SOW-men-ay-der) and Tommy Vietor. And I’m your host Dr Abdul El-Sayed. Thanks for listening.

America Dissected