Dan Weissmann is right there with you. He’s got the pre-existing condition. He’s had to find health insurance on his own. He’s seen the dollar signs and zeroes on his medical bills and wondered how he’d be able to afford that.
Like anyone who’s entered the haunted house known as healthcare in America, with the possibility of deductibles and denials lurking around every corner, Weissmann emerged with scary stories. But he’d rather share yours. The 52-year-old Chicagoan and veteran radio reporter hosts a podcast called, aptly enough, An Arm and a Leg, about the horrors, yes, but also how to navigate the system and even beat it.
Now in its fourth season, and funded in part by listener support and Kaiser Health News, “An Arm and a Leg” has tackled debt collectors, bogus medical bills, $3,000 stitches, choosing health insurance, getting dumped by your health insurer, why this procedures costs this here and that there, and how to triumph in small claims court. Consumer advocates, former insurance company employees, and attorneys put in appearances. The title of Season 3, Episode 5, pretty much sums it up: Can They Freaking Do That?
The fast-paced episodes come in at under 30 minutes each, and they don’t just terrify, they also educate and entertain. Weissmann is empathetic and amusing, calm and incredulous. He’d be a good guy to find yourself sitting next to in a hospital waiting room, full of constructive advice he’s picked up along the way but adamant that he himself has no claim to expertise.
NPLB Executive Editor Lynda Gorov spoke by telephone with Weissmann, who worked in anecdotes from different episodes to underscore the ludicrousness of what average people are up against. Here is an edited transcript of their two-hour-plus conversation.
NPLB: You’ve reported on so many subjects. How’d you decide to focus on healthcare?
Weissmann: It’s on everyone’s mind all the time everywhere. To me, it’s so obvious. These are the questions we ask ourselves: Not just can I leave a job, but can I afford to take this other job; can we ever think about starting an enterprise of our own. And that’s just when you’re facing an array of positive choices in your life. For lots of people, the question is: What happens if I ever need to actually see a doctor. You’re taking your financial life in your hands.
NPLB: But what’s your reason for choosing healthcare costs seeing it as something you could keep going week after week?
Weissmann: There’s two things – a long run-up and an immediate precipitating event.
The first is I left a job a long time ago and thought I would freelance for a minute and immediately was like, ‘Crap. Healthcare.’ This was pre-Obamacare days. It was really expensive. Also I have a minor heart defect and was uninsurable. I had to sign up for a state risk pool. It left me feeling pretty precarious and it was super expensive. So I’ve been aware in that sense ever since.
I got interested in it as a [radio] reporter about a dozen years ago. One day one of my colleagues was like, ‘Hey, Dan, we’d like you to take this hour, we’ve got someone whose dad died in a nursing home.’ By end of it, she was crying, I was crying, it was incredibly wrenching. As best as I can recall, her dad had been in long-term care and it wasn’t very good and they were waiting until he turned 65 and might qualify for better benefits. Over the course of say a year she got phone calls multiple times saying her dad was in the emergency room, he was dehydrated, eventually he died. It was eye opening.
As a reporter I was like this, ‘This is a big deal.’ It struck me as under witnessed, as something we don’t have enough robust conversation about. It raised a lot of public policy questions and questions for us as a society, but was also intimate and emotional and moving – essentially all the reasons I ever wanted to be a reporter.
NPLB: Did people immediately respond to the idea?
Weissmann: No, of course not. The answer tended to be, ‘That’s a cool idea, we’ll let you know.’
It takes resources. I wasn’t in a position to go make a show of my own, and nobody was lining up to make it a project for me.
The first minute of the first podcast, listen to it. I talk about how it wasn’t just heartbreaking to leave a job I loved, it was terrifying. Why? Health insurance.
NPLB: OK, so the money didn’t just show up. But when you told friends you were thinking about a show on healthcare and money in America, what did they think?
Weissmann: I had lunch with my friend Peter, the real estate developer. He was like, ‘Did I tell you about the time I had kidney stones. I resisted going to the hospital until the very last minute, I let them talk me into a CAT scan to tell me what I already knew I had.’ He also had a $13,000 deductible. He’s a real estate developer, he negotiates for a living, he’s a shark, and yet even he feels like he didn’t have any say in it.
I had a friend with breast cancer. At the end of the year, she got a bunch of bills. Insurance had said she’d met her deductible and then…they said she was wrong.
We read the horror stories in the paper, but we live with this bull all the time, all of us. These are people in decent health, with good jobs and good insurance. Yes, they’re paying money that seems outrageous and that they feel lucky to able to afford.
NPLB: You stay focused on the stories and solutions people share with you but stay away from policy discussions. Is that intentional?
Weissmann: You can shoot yourself really fast into our polarized national politics. You’re either for Medicare for all, or you think Medicare is socialized medicine. We all have the same problems and none of us has the power to flip a switch and make what we want happen.
I’m just a guy. I’m not the person to evaluate the big ideas and say they are correct, or that Bernie Sanders’ ideas are right or wrong or that other people are wrong. That’s not my bag.
NPLB: So what’s your idea of the perfect guest, the perfect show?
Weissmann: We’ve gotten more focused. It’s evolved.
I cast a very broad net at first. The first episode is the origin story. The second is one person’s story and epic encounter with the medical system and doing her bit to change the course of history to keep her family from going under from medical bills.
After two seasons, I started saying, ‘We should look at self-defense,’ what we can do for ourselves because the calvary isn’t coming. At that point, it was summer 2019, the presidential election was in view, and even if your dream candidate wins along with a Congress that can enact your dream plan, it’s still a year-and-a-half away at best. Even with the political will, it’s not going to happen quickly. So people need to know these things they can do themselves.
NPLB: Did you have to find the guests before? Do they find you now?
Weissmann: I’ve said from the outset that the crummiest thing is I’m never going to run out of material.
I was going to Texas to meet the Renaissance fair people because that’s where they were doing their thing that time of the year. I had to interview them on Friday and Monday but on Saturday and Sunday they would be juggling and selling turkey legs. I posted on Facebook: Who do I know in Austin, Texas, with a story about healthcare? Laura was one of two people I followed up on, and her story was so powerful and important.
The problem has always been selection, curation, which of the endless numbers of stories will allow me to produce something that’s entertaining and empowering and maybe useful and reveals to me something that I’m curious about.
NPLB: What’s the episode you recommend most to people?
Weissmann: The one that set the mold of what I’m doing now is Can They Freaking Do That? It started with a question from a listener. She’d gone to a clinic and paid their bill and then got this other thing that said it was a bill. It wasn’t clear what it was for. It wasn’t from the clinic, it was pink, she thought it looked bogus, she ignored it. They followed up and said, ‘If you don’t pay us, it will go up to $1,200.’ She said that definitely can’t be real, ignored that, and a couple months later got a notice from a bill collector. [Here Weissmann laughs a low, rueful laugh, and adds that he shouldn’t be laughing.]
I was like, that can’t be right. We did two things in order to describe what happened. We talked about surprise bills. You go someplace that you think is covered by your insurance and they subcontract something out. It’s wildly inflated, you’re on the hook. It’s so outrageous that even the United States Congress had been taking notice. They were actually looking like they might do something until [Doctor Patient Unity, a lobbying group funded by a private equity firm that owns doctor staffing companies, released its targeted political ads]. Then it came to a dead stop.
The second question was: Does this woman have any recourse. We ended up talking to a law professor who said, no, you don’t have to pay an amount they just made up. That’s like shooting fish in a barrel from a contract law perspective. Another woman said she had successfully used small claims court to fight these kinds of battles. It was hilarious and it was mind blowing and it was hopefully really useful.
These are things that anybody can do. They take time and organization but you can totally do it.
NPLB: Was the woman who got this bill really grateful for the help?
Weissmann: It was too late for her. She had already paid.
To be honest, the whole system is built to screw with you. It’s not that we have the tool to solve any problem. We totally don’t. It turns out we do have more tools than most of us knew about.
NPLB: What’s the best piece of advice you can give people?
Weissmann: This is the whole show right now. We spent a season doing COVID shows. We came back, and right now the whole show is one hack at a time. The episode we released yesterday is about a guy who took a hospital to small claims court and won. In a way he’s a ringer, his dad was a lawyer, he’s not a lawyer but he’s kind of made a practice of standing up for himself. He said he learns from every case.
The most recent thing that I learned, the thing I learned today, was about a woman who got an estimate before surgery and she said it sounded too low. She called a second time, and they said, no, really, it’s the price. Then she got the bill.
I learned that when they say something and it’s wrong, it’s called promissory estoppel. It’s a doctrine where in contract law, if someone says, if you do this with me, I’ll give you this price, you’ve relied on their promise and they can’t turn around and rip you off.
NPLB: What’s one of the wildest things you’ve learned doing the show?
Weissmann: That often you don’t have to go to court. You send a letter.
There are books for going rates for given procedures. You can send a demand letter and demand the going rate if you get a bill that’s higher. You say, I’m going to make you an offer. Small claims court isn’t just for when the other side owes you money. In this case, you can tell a judge to make them take the going rate and go away. That is a thing that courts do.
And they accept it because to defend themselves they’d have to send someone to court. It’s more lucrative for them to send letters threatening to ruin your credit because a lot of people will just pay.
NPLB: What would you tell potential listeners?
Weissmann: I’m proud of what we do. I bring a journalist’s tools to this. I’ve been a reporter for a very long time. I thought at the beginning I could do it all myself. But it became apparent that I would need an editor and help. Part of my work here is finding money to make it happen.
NPLB: How do you and your family have health insurance since you left public radio?
Weissmann: While I was off starting this project, my wife and I were hedging bets and she basically asked somebody who’d been doing regular freelance work for her to come on staff so we were able to apply for health insurance for group coverage, which was an expensive thing to do. We were lucky to have that option.
NPLB: Last question - Are you happy with it?
Weissmann: Yes. I mean yes and no, right? We need good insurance. I have this heart thing I need checked out every year, and the sticker price on that is more than $10,000. No insurance plan on the exchange in Illinois covers the place where I’ve been seen for 25 years, which is one of the very few places that specializes in seeing adults with congenital heart defects.
I think for anybody to say they like their health insurance…what’s to like? It allows you to get medical care and protects you from astronomic bills. But that’s only if it works right.
Lynda Gorov is executive editor of No Patient Left Behind.
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