We’ve got one, says Dr. Ricardo Nuila. It’s where he works.  

And it could be a model for the whole country. Yes, really. 

That’s the pitch he made in his 2023 book, The People’s Hospital: Hope and Peril in American Medicine. It’s a love letter to Houston’s Ben Taub hospital, and an argument for bringing Ben Taub’s model, efficient, innovative, and cheap, to the rest of the country.

And if that seems unlikely in today’s political climate, well: Ben Taub’s wild origin story was plenty unlikely too. 

That story takes us to the 1960s, when Dutch novelist and playwright Jan de Hartog moved to Houston. He fell in love with the bustling, futuristic home of NASA and the Astrodome. 

But he also discovered the city’s dreadful underside: a neglected charity hospital where largely African-American patients are left to seek health care in unsanitary and unsafe, hellish, conditions. 

De Hartog and a group of Quaker volunteers waged a campaign to change that, and eventually found an unlikely ally who brought it over the finish line. 

The People’s Hospital is a heck of a book. We might want to start a book group someday, just to talk about it. If you want to grab a copy, here’s a link. (Or: Audiobook, or ebook.)

Here's a transcript of this episode.

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A year-and-change later, we wanted to check back in. We talk about the “crumbling Jenga tower” of public health infrastructure, the fallout from cuts to Obamacare subsidies, and Medicaid, and what Julie sees happening in 2028 and beyond (including a whisper of hope.) 

Plus, we get an update on Julie’s growing t-shirt collection and a new series she’s starting on her health policy news podcast What the Health? 

You can read a transcript of this episode here. 

Want to dive deeper into those state Medicaid cuts we talked about? Julie did a whole episode of What the Health? about them. Listen here. 

Want weekly updates from the team, including some of our most practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. 

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But Teressa’s a fighter, and an organized one at that — ready to endure months of back and forth until she stumbled on a "secret door" to reversing her husband’s insurance denials: the external review. 

In this episode of Paper Trail, a podcast from the investigative journalists at ProPublica, health care reporter Duaa Eldeib and host Jessica Lussenhop follow Teressa's journey to discovering this powerful and little-known tool — and putting it to work.

Could an external review help you? Check out ProPublica’s write-up, which includes the types of denials eligible for this kind of appeal. 

And for more stories about appealing health insurance denials, you can check out our Starter Pack, which features episodes like this one about writing a killer appeal letter.  

Here's a transcript of this episode. 

Want weekly updates from the team, including some of our most practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. 

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Last year, we set out on a mission: Collect all the best advice about what to do when your prescription drugs cost more than you can afford. 

Our listeners wrote to us about their experiences getting around this most demoralizing — and distinctly American — problem in order to get the medicine they need.

Those responses allowed us to map a whole landscape of potential fixes — none a guaranteed solution for everyone, every time — but all worth knowing about. 

In this episode, you’ll meet some of the intrepid navigators charting the path — including a dad on a mission to afford his daughter’s epilepsy medication, a Medicare coach who helps seniors save tens of thousands of dollars on meds, a pharmaceutical sales rep with a brilliant short-term fix, and other generous and smart fellow travelers.   

We documented all their advice and more in our Prescription Drug Playbook. 

Here’s a transcript of this episode. 

Want weekly updates from the Arm and a Leg team, including more practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. 

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But as more therapists struggle to negotiate with insurers, they’re turning to tech middlemen like BetterHelp and Headway that promise to take care of the insurance admin and match them with patients. 

And these companies are sometimes recording and transcribing your sessions — and then turning around and sharing that data with social media companies and investors. And there are concerns that these confidential discussions could be used to train the next generation of chatbot therapists.

So this week, we’re bringing you an episode from our pals at Organized Money, a show about corporate consolidation and monopolies, where they speak with Linda Michaels, a psychologist and co-founder of the Psychotherapy Action Network, about the tech companies sneaking into your therapy sessions and how we got here.

And they share some good news: How one state, Illinois, passed a law in 2025 that could be a national model for encouraging more therapists to stay in-network, and ultimately, reduce reliance on these platforms. 

For more on mental health coverage: Check out our episode about Abigail Burman, an attorney and expert on mental health “ghost networks” — lists of providers that turn out to be filled with inaccuracies, making it difficult for patients to get in-network care. Plus we have a whole guide from Burman on “ghostbusting” — AKA, getting your insurance to cover your mental health care. That’s in our First Aid Kit newsletter.

Here’s a transcript of this episode. We’ll be back with more Arm and a Leg in a few weeks. 

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Here’s why the case matters: As soon as a generic version of a brand-name drug comes to market, its price typically drops by half. Within 10 years, by more than 75%. Meaning: the sooner we have access to generics, the less we pay at the pharmacy counter. 

But one of the fastest legal pathways for generic companies to get their drugs to market may be about to get a lot narrower – depending on how the court rules later this year.

Amarin, a brand-name drugmaker, has accused Hikma, a generic company, of encouraging doctors to infringe on their patent for a drug called Vascepa.  

The case revolves around the legal concept of skinny labels: a carveout in drug patent law that allows generic companies to bring drugs to market when one of the brand-name drug’s patents has expired, but others haven’t.

And it raises the (unexpected) question of whether it’s OK for a generic drug company to call their product the generic version of something. 

Legal experts help us unpack the nerdy details – including how this case came to be, and what’s at stake for both generic drug companies and anyone looking forward to one day paying less for an expensive brand-name drug. 

Want to learn how these drug monopolies work – and came to be in the first place? Check out our previous episode: Why drugs cost so much, 101: Medicine monopolies

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And it’s a complicated question. There are a bunch of reasons — to be sure. But in our reporting over the years, like our stories on insulin and tuberculosis drugs, experts cited one big reason over and over again: 

The pharmaceutical industry wages sophisticated legal battles to keep monopoly control over their best selling, most lucrative drugs — blocking generic competition, and increasing their prices along the way. 

How did it come to be this way? 

In this first episode of a new series – what we’re calling An Arm and a Leg 101 – we’re doing a crash course in the history of the drug patent system.

And the rags-to-riches story of one amazing guy is going to help us do it. 

Al Engelberg got schooled in the Art of the Hustle at a young age, collecting dimes at an illegal bingo game on the Atlantic City boardwalk. 

Later, he’d put those street smarts to use as he sat at the negotiation table in Washington D.C., hashing out the details of a law that would usher in the generic drug industry as we know it. Then made millions from the rules he helped write.

And as he admits, his legacy is mixed. 

On the one hand: The rules Al Engelberg helped write — a grand bargain between generic drugmakers and patent-holding brand pharma companies— unleashed the power of generic drugs to save Americans money. 

Nine out of ten prescriptions written today get filled with a generic.

On the other hand: In the process of making his fortune, Al Engelberg discovered loopholes, gaps, and perverse incentives in that grand bargain. 

Gaps that allowed brand and generic drugmakers to profit by keeping generics for many hit drugs off the market.  

So we now spend more than ever on medicine — and more than 20 percent of Americans report skipping their medication because they can’t afford it. 

Al Engelberg, now 86, has spent the last 30 years — and millions of his own dollars — trying to close those gaps. 

“I live in a world — a pharma world — where half the people think I’m dead, and the other half wish I was,” he tells us. 

You can read more of Al’s story — plus his prescription for fixing the crisis of high drug prices — in his book, Breaking the Medicine Monopolies: Reflections of a Generic Drug Pioneer.

And you can hear our earlier reporting on drug patents here:

John Green vs. Johnson & Johnson (part 1)

John Green vs. Johnson & Johnson (part 2)

The surprising history behind insulin's absurd price (and some hopeful signs in the wild)

Here's a copy of this episode's transcript. 

Send your stories and questions. Or call 724 ARM-N-LEG.

And of course we’d love for you to support this show.

An Arm and a Leg 101 is made possible in part by support from Arnold Ventures.

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People asked themselves: how on earth am I supposed to make this work? 

Two of those folks — attorney Nicole Wipp and skate-shop owner Noah Hulsman — tell the story of how they chose among lousy options.

Nicole chose to dump health insurance altogether — even though she could have found a way to pay for it. Noah chose to pay for coverage that sucks, because it’s all he can afford. 

Each made their choice in the context of their broader stories: Noah is deeply rooted in Louisville, KY, and lives about a mile from where his grandmother started Louisville’s first skate shop, around the time he was born.

Nicole’s story includes an expensive, life-threatening medical adventure a decade ago — and a series of choices that’s taken her family from Michigan to Hawaii to South Carolina. 

Reporters with KFF Health News have been talking with dozens of people all over the country about these kinds of choices for their series on the health insurance crisis, Priced Out. KFF Health News senior correspondent Renuka Rayasam, who introduced us to Nicole and Noah after writing about their stories, joins us to reflect on what these stories mean. 

Read more of Renuka Rayasam’s reporting:

When Health Insurance Costs More Than the Mortgage

It’s 2026 and You’re Uninsured. Now What? 

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We’re dying to know more about the community that’s using this show — and about what’s working for you and what you’d like to see. Let us know!

Today we’re switching it up. We’re sharing an episode from the new podcast Drug Story. In each episode, science journalist and self-described “public health nerd” Thomas Goetz goes deep on the story of a single drug — what it treats, how it came to be, and what it reveals about the business of health and disease. 

On this episode: the EpiPen, a device you’ll find in classrooms, on airplanes, in glove compartments — basically everywhere — because the EpiPen can be a literal life-saver for people with severe allergies.

And of course, the EpiPen is also one of the most infamous examples of pharmaceutical profiteering gone bananas. 

That part of the story makes us especially geeked to share this episode. 

And there are more threads here — on the drug’s discovery, on the science of severe food allergies, and on what researchers have learned about preventing them — that Goetz does a great job of weaving together. 

If you like it, new episodes of Drug Story come out every week. 

We’ll be back with more Arm and a Leg in a few weeks. Meanwhile, don’t forget to help us by filling out our quick survey.

Here’s a transcript of this episode.

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Insurance was denying prior authorization for the surgery. The only way forward would be to appeal the decision. But it was Saturday night, and the surgery was Monday morning. There wouldn’t be any time. Should they even go to the hospital?

They decided to bet on being able to reverse the denial later on, but the last minute coverage  questions left Ron’s wife, New York Times reporter Jodi Kantor, going into surgery that Monday with a brand new sense of stress and anxiety. 

And along with worrying how his wife's surgery would go (spoiler: it was successful), and whether they’d end up on the hook for a bajillion dollars, it left Ron to wonder why no one had given them a heads-up earlier.

He set out to find answers — and whether there might be a way to prevent these last-minute denials from sneaking up on other people. 

Ron turned to his "Your Money" newsletter subscribers for ideas, and eventually published a draft letter in his New York Times column that doctors and other health care providers could give their patients to better prepare them for insurance curveballs. 

Check out the column here – and consider passing it along to any health care workers whose patients you think might benefit. 

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show. 

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

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Their work represents what a small, scrappy, thoughtful group of people can do. Last year, their tiny staff helped wipe out more than $55 million in medical bills. 

As we kick off 2026, we thought it was time to check in again. After all, this will be a year when millions more people will have trouble covering their medical bills — when Dollar For’s work may become more important to more people, and when we’re hungry for more ways to help each other. 

As Jared tells it, 2025 proved to be a pivotal – yet rocky – period in the organization’s story. Both their successes and their challenges put into stark relief exactly what we’re all up against. 

So we go deep with Jared on what they achieved while they weathered the chaos, and what it might mean for their – and our collective – next moves.  

Here's a transcript of this episode. 

Check out our Starter Pack: How to wipe out your bill with charity care.

And our previous coverage of Dollar For:

• Could billions in medical debt get zapped by the legal strategy from this 60-second video? (2021)
  We talked to Jared just weeks after Dollar For first went viral. The group’s early history — they’d been working locally for years — is fascinating.
• Badass volunteers help Jared level up, in the fight to crush medical debt (2021)
  Within six months, they’d recruited volunteers and built systems. 
• The Medical Bill “Negotiation Lab” (2022)
  In an experiment aimed at scaling up impact, Dollar For tried a different approach in 2022. We sat in.
• One last tip before 2024 (2023)
  Why Jared thinks you should ask for “charity care” by name -- even though, let’s face it, asking for “charity” does not feel good to most of us.
• New lessons from the fight for charity care (2024)
  Dollar For spent 2024 focusing on the big picture and starting to focus on policy advocacy.

Check out our history of charity care series (from 2021): 

• A legendary lawyer sued hospitals for price-gouging their patients. And got his butt handed to him.
  Dickie Scruggs is the guy who beat Big Tobacco. But when he took on hospitals, he lost.
• The wild backstory of a tiny but crucial Obamacare provision (ft. David Axelrod)
  Charity care wasn’t part of federal law until the Affordable Care Act passed. A Republican senator made sure it was part of the ACA — before deciding he wouldn’t vote for the law.
• “We just kept right on pushing” … and laws changed
  In New York, a grieving family’s story made headlines and helped advocates catch lawmakers’ attention.
• Wait, that was legal until now?!
  In 2021, Maryland barred hospitals from suing patients who qualified for charity care.

Send your stories and questions. Or call 724 ARM-N-LEG.

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We have SO much work ahead, and we can’t do it without you.  

Every little bit counts. Here’s where you can chip in. Thank you SO much!

Our listeners have been teaming up on an incredible project – kicked off earlier this year by a med student named Thomas Sanford. 

The idea: create a list of reliable resources to help with medical expenses and avoid debt, and circulate it where people might find it useful, like hospital waiting rooms. 

In this episode, we hear how that project is ready to level up – and how you can bring it to people in your community. 

Here’s how to help: 

Send this link to anyone you think might need it: armandalegshow.com/help 

Or go here to print it out, post it, pass it around, customize it for your community, or join with other volunteers: armandalegshow.com/helpers 

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We have SO much work ahead in 2026. Donate here.

We’re back for another look at things that – believe it or not – did NOT suck in 2025. 

Specifically: new state laws from around the country aimed at protecting people from things like medical debt, insurance delays and denials, and corporate profiteering.  

In this episode, we dive into two examples from opposite sides of the country to look at how laws like these get made – and in some cases, defended. 

In Maine, lawmakers unanimously voted to remove medical debts from people’s credit reports. While a nationwide court ruling raises questions about the new law’s future, we’ll hear why consumer rights attorney Chi Chi Wu remains optimistic.  

And in Oregon, a law aims to prevent big corporations and private equity firms from taking over medical clinics and strip-mining them for profits.

Plus, a good-news update from our team at An Arm and a Leg. 

Here's a transcript of this episode. 

Send your stories and questions! Or call 724 ARM-N-LEG.

And, again… we’d love for you to support this show.

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We have SO much work ahead in 2026. Donate here — and get your money matched two-for-one.

It’s probably fair to say: this is the worst year ever for picking health insurance. Premiums are skyrocketing – whether you get insurance through work or from the Obamacare marketplace. 

And with enhanced subsidies almost definitely expiring, millions of people with Obamacare plans are grappling with drastic changes to their household budgets. 

We’re our own case study: You’ll hear us sorting through our own options. None of them are pretty, but because we know how to read the fine print, we figured out: Some are way, way less awful than others. 

And to help you do the same: We’ve boiled down our fine-print-reading expertise in this starter pack on how to pick insurance. 

Also in this episode: we talk with a listener who wonders: is paying for health insurance even worth it at this point? (Her ultimate answer: Yes, but argh.)

Read Julie Appleby’s reporting for KFF Health News about what could happen if Congress changes course and extends the subsidies. 

Here’s a transcript of this episode. 

Send your stories and questions! Or call 724 ARM-N-LEG.

And, again… we’d love for you to support this show. 

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

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We have SO much work ahead in 2026. Head to https://armandalegshow.com/support/ to donate — and get your money matched two-for-one.

This statement might shock you: some actual good things happened in 2025. Or, at least things that did not totally suck. 

Stuff like: new limits on the hoops insurance companies can make you jump through, and new protections from predatory debt collectors..  

These are just a couple examples of what state governments have been up to this year – in red, blue, and purple states alike. 

State governments can’t do it all, but across a couple of episodes, we’ll dive into a handful of meaningful wins, and learn how they came to pass. 

Today’s episode takes us to Nebraska, where the state passed aggressive new restrictions on prior authorization. 

And Virginia, where lawmakers banned wage garnishment for lots of medical debts.

Here's a transcript of this episode.

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And she’s developed a strategy for addressing high insurance premiums – one based on a real-life success story.

So when she asked us to help her gather data for a new study, we were intrigued.

We break down Vivian’s theory of change, and how sharing your medical bills with her team could help build a data arsenal for the fight ahead. 

Want to share your documents with Vivian and her team? 

You can find all details about how to send them here.  

Here’s a transcript of this episode.

Send your stories and questions! Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

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

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With input from the Arm and a Leg community — specifically folks who get our First Aid Kit newsletter — Thomas has drafted a one-page handout, packed with resources for anyone who needs help with medical bills.

It’s ready for you to use, and he wants your help making it better. 

You’ll hear all about Thomas’s story — he’s a medical resident, who started out just wanting something to hand to his own patients — in today’s mini-episode.

And now you can get involved. Thomas’s current version is great — and there’s also tons of room to improve it, with your help.

• Print out the current version and pass it around: Download it right here.
• Make suggestions for the next version: Anybody can comment on this Google doc.
• Volunteer to pitch in: Got design skills? Editorial chops? Language skills, to translate it? Other ideas?  Here’s a sign-up form.

And you can make your own adaptations! Thomas has registered it with a Creative Commons license. 

This project has been incubating in our First Aid Kit newsletter. If you’re not subscribed, this is a great time to sign up. 

Here’s a transcript of this episode. 

Send your stories and questions! Or call 724 ARM-N-LEG.

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A recent headline from KFF Health News reads: “Insurers and customers brace for double whammy to Obamacare premiums.”

We break down what those “whammies” might mean in dollars and cents for Emily and the millions of others signing up for Obamacare in 2026.  

Plus, we cover what’s happening with ACA navigators – the people charged with helping you sign up for Obamacare, and what to expect in November when open enrollment kicks off.  

Learn more about what’s coming in 2026 in our First Aid Kit newsletter. 

Check out KFF’s Obamacare premium calculator. 

Learn whether your state funds its own navigator program. 

Read a transcript of this episode.

Send your stories and questions! Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

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

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If you haven’t chipped in before, this is a great time — just click here.

OK, onwards…

Sharing a favorite from our archive – with lessons that are as relevant as ever. 

Laurie Todd calls herself The Insurance Warrior. She fights health insurance for a living. Her speciality: writing appeals when insurance companies deny high-stakes, high-dollar treatments.

Her first victory was fighting to get coverage for her own life-saving cancer surgery – which we chronicled in an episode tracing her origin story. 

Since then, she says she’s notched hundreds of other victories, and outlined her strategies in two books: Fight Your Health Insurer and Win and APPROVED: Win Your Insurance Appeal in 5 Days.

In this episode, we go deep on one of Laurie’s early, super-instructive cases, that taught Laurie one of the weirder truths about health insurance in America: fighting your health insurance often means fighting… your employer. 

And in this case, that employer was a $61 billion company. 

Want more about winning insurance appeals? Here’s our starter pack.

Here is a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

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But it didn't take long for them to realize they'd been “hustled” – ending up with bills for thousands of dollars, and leaving them no choice but to skip important medical care. 

In their series “Health Care Hustlers,” Bloomberg reporters Zach Mider and Zeke Faux uncover the exact nature of the scheme – how this couple, as well as thousands of others, signed up for health plans by unknowingly agreeing to work “fake jobs.”  

Zach and Zeke join us to unpack the many surprising layers to this business— involving a subculture of unscrupulous telemarketers, a TV-sitcom-writer-turned-investor who masterminded the idea, and the legal gray area that allows these plans to proliferate. 

Reminder: If you need to sign up for health insurance, the place to go is healthcare.gov. (As we’ve warned before: Don’t even Google it.) 

No matter what, shopping for insurance requires a ton of homework. We’ve got a guide for you in this Starter Pack.

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show.

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From the start of this podcast, we’ve been trying to answer a major question: Why do my meds cost so freaking much? And we’ve highlighted the profit-seeking games that insurance, pharma, and middlemen play all around us in more than a half dozen episodes. 

But there’s one set of players on the field that we’ve never talked about: drug distributors, and how they play a role in another reason you may not be able to get your medicine: drug shortages. 

This story comes from our friends at Organized Money, a podcast about monopolies, from writers and journalists David Dayen and Matt Stoller. 

We think you’re going to like it. 

In the meantime, check out the latest installment of our First Aid Kit newsletter for a rundown of our previous coverage of drug costs. 

Here’s a transcript of this episode.

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

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

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And of course some of you work in health care and have insider knowledge. Which we’re passing along in this second episode of The Prescription Drug Playbook.

We’ll hear from a listener who works to help seniors find healthcare, a pharma sales rep, an employee benefits advisor, and a battle-worn hospital caseworker – all bringing something a little surprising, and possibly even life-saving to the table. 

Of course—for all their advice, there is a BIG caveat: there is no one solution for everyone. This is a set of patches, workarounds, bandaids.

We deserve SO much better. But in the meantime, maybe some of these tips can help. 

Here’s a link to the Find a Health Center Tool that we told you about in the episode—it’s worth checking out!

And here's the full drug-price song by producer Claire Davenport and some robots

Find the whole Prescription Drug Playbook series – including our First Aid Kit newsletters — at armandalegshow.com/drugs

Here’s a transcript of this episode. 

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We asked our listeners how they get by in this situation, and we learned dozens of tips. And in this two-part series, we’re sharing those strategies — including some advice from experts.

The next episode drops June 30. 

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We heard from a ton of you – with stories, strategies and workarounds that surprised and encouraged us.

None of them will work for everybody. This is a set of patches and bandaids for a broken system. But if there’s one that’ll work for you, we want to help you find it. So we’re bringing you the most-complete, best-organized set of patches we can.  

In this episode — the first of two episodes — a dad named Bob tells us how he learned some hard-earned lessons. 

When Bob’s teenage daughter Mary was diagnosed with epilepsy, it took her doctors years of trial and error to find the right treatment. It finally worked, Mary's seizures stopped — and then, when Bob's insurance changed, the price tag for Mary's meds went through the roof.

What Bob did next represents one possible journey through the dizzying (and often exasperating) maze of potential workarounds for getting your medicine at a price you can afford. 

We’ve started compiling lessons from Bob’s story and others in our First Aid Kit newsletter. 

Our first installment features a price comparison spreadsheet… inspired by Bob (who we’d like to nominate for Dad of the Year). 

Here’s a transcript of this episode. 

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

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At different times, they’ve each looked to a guy named Eugene Litvak for help. He only said yes to Cincinnati — but he saved that hospital more than a hundred million dollars a year.

For the last few decades, Litvak – a Soviet émigré with a PhD in math – has been on a mission: save U.S. hospitals from financial ruin, and improve the lives of doctors, nurses, and patients.

He says he has just the formula to do it, lots of prominent experts agree, and he’s documented impressive results so far: Financial savings, fewer hospital-related deaths, lower staff turnover, and shorter wait times.

But Litvak and his allies are still struggling to convince more hospital CEOs to try his method.  

We talk with Litvak about his wild life story and how he found the fix that he says could revolutionize American hospitals. And we speak with experts to determine why more hospitals don’t try it. 

Here’s a transcript of this episode. 

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But for health care, one person is probably closer to anyone than to understanding the full picture: KFF Heath News Chief Washington Correspondent Julie Rover.    

In this episode, Julie helps us see that picture, by telling us two stories:

The first concerns a teeny part of the health care system — an obscure federal agency, one of many that the Trump administration has taken a chainsaw to.

The other is anything but obscure: Possible cuts to Medicaid —which Julie thinks Republicans will actually find very difficult to make.

Plus, reporting from Julie’s KFF Health News colleague Arthur Allen. And a cameo from one of Julie’s beloved corgis.

Check out Julie’s weekly health policy news podcast: What the Health? 

Read more from Arthur Allen on cuts to AHRQ in KFF Health News:

What’s Lost: Trump Whacks Tiny Agency That Works To Make the Nation’s Health Care Safer

Trump HHS Eliminates Office That Sets Poverty Levels Tied to Benefits for at Least 80 Million People

Here’s a transcript of this episode. 

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Here at An Arm and a Leg, we’ve been nerding out about how the show depicts the financial forces that shape the ER’s day-to-day problems like crowding, eternal wait times, and scary bills. 

For this episode, we got Dr. Alex Janke, an emergency medicine doctor and health policy researcher to nerd out with us. 

Here’s a transcript of this episode. 

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She said the stories she heard on this show had given her the advice and encouragement she needed to finally win a fight against a medical bill she didn’t owe — a battle she’d been waging for more than two years.

As Meagan tells us, those two years were filled with wild twists and turns and a lot of disappointment.

We hear what kept her motivated and encouraged despite all the setbacks – and after an insurance rep pointed her to a free legal resource — the tactic that finally led to a breakthrough. 

Here’s a resource we mention — with a spoiler alert: It’s the sample cease-and-desist letter that a lawyer shared with Meagan. 

We’ll break down the details — how a letter like this could work, in certain situations — in a future First Aid Kit newsletter.

Here’s a transcript of this episode. 

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We talked with credit counselor Lara Ceccarelli about how the CFPB has helped clients at the nonprofit where she works, and how she’s navigating the sudden change. 

And consumer-rights advocate Chi Chi Wu — an attorney with the National Consumer Law Center — describes the court battle she and her colleagues are mounting to slow down the agency’s dismantling — and where things could go from here. 

We’ll track this developing story in next week’s First Aid Kit newsletter, so if you’re not signed up, this is a great time to start: www.armandalegshow.com/firstaidkit.

Here's a transcript of this episode. 

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And allow us to introduce First Aid Kit’s new writer, Claire Davenport. 

When she was our intern last summer, she reviewed An Arm and a Leg’s entire catalog of episodes, and took notes along the way. Now she’s bringing the practical lessons from all that reporting straight to your inbox, every week. 

Get it while it’s hot: sign up for First Aid Kit here. 

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Because: Getting a case of sticker shock with a prescription happens all the time. 

So we’re asking: What have you done — or tried to do — to get the medicines you need at prices you can afford? And what did you learn that might be useful for other people to know?

Maybe you learned a strategy that actually WORKED for you. Like using a coupon or ordering drugs from online pharmacies — even pharmacies in other countries.

Maybe it was, “Man, I learned about a new way I’m getting screwed.” 

However things went, tell us about it here: armandalegshow.com/drugs

Your story can be short or long, scary or uplifting – whatever you’ve gone through to get your meds, whether it worked or not, we want to hear about it.

The more we learn about these strategies, and about new ways we’re getting beat up, the more we can work together to do something about it. 

And over the next couple of months, we’ll dig into everything you bring us, call up some experts, and start bringing you what we’re learning.

Meanwhile, if you could use some tips right now for getting a better price for your prescription, we’ve just posted a batch to our First Aid Kit newsletter – check it out here.

Fair warning: It’s a collection of band-aids — that’s what you find in a first aid kit — but it’s a start.

Here’s a transcript of this episode. 

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Now, he’s the namesake for the Shkreli Awards — a kind of Oscars for the most outrageous examples of greed, fraud, and general brokenness in American health care. 

Every year, a health care think tank called the Lown Institute ranks the top ten worst stories and holds an award ceremony to “honor” the winners. 

We’re bringing you highlights from this year’s ceremony – featuring things like human bones for sale without the consent of the deceased or their families, phantom urinary catheters, and so much more – and some reflections from the Lown Institute’s president, Dr. Vikas Saini. 

“Showing all these stories together paints a picture of a health care system in desperate need of transformation,” Saini said at the ceremony. “Not just because the stories are shocking, but because often what they're depicting, like Martin Shkreli's infamous price hike, is perfectly legal.” 

Here’s a transcript of this episode. 

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The resolution said: hospitals need to do more to guarantee charity care to patients who qualify. Legislators and regulators should make them. 

Our listener was the author of that resolution, and he told us he first learned about charity care through this podcast. 

His name is Joey Ballard and he’s an internal medicine resident at the University of Illinois-Chicago (UIC).

We talked with him about his early organizing as a medical student, bringing the resolution to the AMA, and the optimism he feels bringing the fight for charity care to the hospital he works at now.

Here’s a transcript of this episode. 

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In 1980, a young father named Denny Buehler was battling leukemia and needed to travel from Cincinnati to Seattle for treatment. To raise the money, his friends and family threw a softball tournament. 

Denny passed away a few months later. But his friends and family turned the softball tournament into a beloved tradition, and a chance to give back. For more than 40 years, they’d host the games and sell hot dogs to raise money for people in the area who needed help with medical expenses. 

Then in 2019, the Denny Beuhler Memorial Fund found a way to make the money they’d fundraise go a hundred times farther. Literally. 

Inspired by a segment on Last Week Tonight, they partnered with a group to buy up old medical debt – and erase it. 

Now in 2024, that group – now known as Undue Medical Debt – has grown its influence and helped crush billions (!) in debt.

Here’s a transcript of this episode. 

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The problem: people don’t know about it, and hospitals don’t always make it easy to access. New research suggests that the scale of this problem is huge: hospitals are failing to provide more than 14 billion dollars worth of charity care to people who qualify for it. Instead, that money becomes medical debt.

That research comes from the nonprofit Dollar For, an organization dedicated to helping people get charity care. We’ve been talking with Dollar For’s founder, Jared Walker, for years – following his team on their mission to crush medical debt, one charity care application at a time. 

Jared brings us up to speed on Dollar For’s latest research, their efforts to reach hospitals, and how new programs targeting medical debt in places like North Carolina may change things. 

That new program in North Carolina is estimated to wipe out $4 billion in medical debt. We look into how it took shape. 

Plus, we meet Clara, a listener who used her impressive research chops to get charity care from a hospital in New York. In the process, she crafted an expert charity care appeal letter, and shared a template with us. 

Use case: the hospital has denied you charity care after you applied, or offered you less than you need. Here’s the template. 

Of course, Dollar For has tons of resources, including a tool to help you quickly figure out if you qualify for help. And staff to help if you get stuck. Start here: https://dollarfor.org/help/

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News."

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Meet Holden Karau: a Bay Area software engineer who says she’s “trying to make health insurance suck a little bit less.”

So she’s created an AI tool to appeal insurance denials.

Her project, Fight Health Insurance, is a labor of love (she’s not earning money from it) and fueled by hatred (of insurance companies). 

It draws on her tech expertise and on her years of experience fighting health insurance: for gender-affirming care, for rehab after getting hit by a car, and even for her dog, Professor Timbit. 

We talked with Holden about what it took to build the tool, how it works, and what she hopes comes next.

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News.

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For the last four years, she’s been reporting on the public health effects of racism, violence, and intergenerational trauma in a small Missouri town.. The result: A new documentary and podcast series called Silence in Sikeston.   

She sat down with us to talk about the value of breaking silences and the possibility for healing. 

Here’s a transcript of this episode. 

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To See Each Other aims to complicate the narrative about small-town Americans. In this new season, host George Goehl heads to Lincoln County, Wisconsin — population, 28,000-and-some. And home to a publicly-run nursing home with a 5-star quality rating from the feds.  

A conservative county board plans to sell the home to a private operator, but senior citizens aren’t having it. They show up to board meetings, march in the Labor Day parade, and fight with… their last breath.

George goes deep into questions of aging in America, public versus private versions of long-term care, and the nuts and bolts of organizing. The show aims to put you in a fighting mood, and to think differently about aging.

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In states like Connecticut and Indiana, legislators are trying to do something about fees like these – often called “facility fees.” 

In this episode, we go deep on Kari’s bill, one of dozens that listeners have shared with us over the past few months. 

And we talk with Christine Monahan, a researcher and attorney who knows more about facility fees — and state efforts to limit them — than any other expert in the country.

Here’s a transcript of this episode. 

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The story starts the minute the hospital’s IT director finds out they’ve been hacked, and follows him and his colleagues as they scramble to keep the place running while they try to get it back online. 

It’s a fascinating adventure, and it gives us a window into the growing problem of cyberattacks in health care – why places like hospitals have become such a major target for cyber-criminals and how the industry is dealing with it. 

Click Here is a bi-weekly tech news podcast from Recorded Future News, hosted by Dina Temple-Raston. 

We’ll be back with more episodes of An Arm and a Leg in a few weeks.

Send your stories and questions. Or call 724 ARM-N-LEG.

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Then she started getting alerts on her phone from the hospital that she owed $139,000 — the full cost of her surgery. 

But Caitlyn, a legal assistant in Oklahoma, instinctively knew a cardinal rule of the American healthcare system — “never pay the first bill.” 

It’s a lesson we first heard from the journalist Marshall Allen, whose 2021 book Never Pay the First Bill serves as a how-to guide for anyone facing down a potentially bogus medical bill, and whose passing earlier this year left a giant hole in the hearts of many. 

This episode is an extended version of a recent installment of the NPR and KFF Health News series Bill of the Month. 

Here’s a transcript of this episode. 

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Something like 60 percent of people might qualify to have their hospital bills reduced or even forgiven through charity care — but of course nowhere close to 60 percent of people actually get that assistance. 

A lot of people just don’t know about it. (A survey our friends at Dollar For ran last year found that more than half of patients who might qualify for charity care had never even heard of it.)

Which raises a question: How exactly are hospitals telling you and me about charity care — you know fulfilling their legal obligation to let us know we just might qualify to have our medical bill forgiven? 

This is where you come in: we want to see a LOT of bills from hospitals. If you got one any time in the last year would you please you share it with us here? 

Even if you weren’t worried about how you’d pay — we just want to see what your hospital was saying about your options (like payment plans vs charity care). We want to see what’s in bold type and what’s in fine print.

And if you were at all worried about how to pay, we’d like to hear the story. Did anyone mention charity care to you? Or what? And how’s it going? 

We also need your help spreading the word to friends and family. Spread the word to your friends and family, share our form with them. 

Finally, if you’re looking for charity care support, or just to see if you might qualify, you can go to Dollar For’s website and use their screening tool to see if you’re eligible, and their team of amazing volunteers can take it from there. And you can find more information on charity care in our First Aid Kit newsletter.

That’s all for now. Here's a transcript of this short episode. We’ll be back with more new episodes in a few weeks. 

In the meantime, you can send us other stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

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

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Avoiding that charge required more than just a willingness to go — literally — way out of her way. Georgann Boatright has knowledge, skills, and grit that most of us don't — although we can maybe learn a thing or two from her.

More and more, people are noticing sneaky new fees like the one Georgann spotted. They’re often called “facility fees,” and they’re kind of like a cover charge for walking through the door. 

Hospitals say these fees go toward overhead on facilities with lots of specialized equipment —places like emergency rooms. But these fees have been increasing in recent years — and becoming more common: As hospitals buy up doctor’s offices, patients are starting to see them tacked onto bills for routine trips to the doctor.

We asked you to send us stories about facility fees. We heard from a ton of you and learned so much. 

We’ve got lots of stories to share. And we’re starting with this epic tale — which also involves the biggest facility fee charge we saw in all your submissions. 

Here’s a transcript of this episode. 

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Facility fees are kind of like a cover charge for visiting a health care facility, usually one owned by a hospital. And many of you have been blindsided by them. 

Some of you have been going to the same place for years, only to one day get a brand new charge, seemingly out of nowhere. Many of you only found out about a facility fee after the fact, while some of you managed to avoid one by going somewhere else. Pretty much all of you were vexed, confused, and wanted answers. 

Next week, we’ll start unpacking these stories, starting with one that’s particularly epic. 

Stay tuned! 

In the meantime, got a story or tip you want to share? Send your stories and questions. Or call 724 ARM-N-LEG.

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Turned out: A middleman was cutting their coverage — actually a middleman’s middleman — working with their insurance company. The couple’s insurer got the “discount,” and the middlemen got big fees. 

And of course this couple wasn’t alone. A recent New York Times investigation from reporter Chris Hamby documented and explained this Russian-nesting-dolls-of-middlemen scheme. 

Insurance companies (middleman #1) work with a with a company called MultiPlan (middleman #2), which slashes the amounts the insurance plans actually pay for care.

To show how it all works — and what we can maybe do about it — we dive into the hidden mechanics of health insurance.  

Here's a transcript of this episode.

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First, it’s a huge part of our health-care system. Medicaid covers a quarter of all Americans, and four in ten children. 

Second, it’s timely: In the last year, more than 20 million people have lost Medicaid — even though there’s evidence to suggest a lot of those people probably still qualify. 

More than two-thirds have been dropped for “procedural reasons” — basically, missing paperwork.

Of folks who’ve been dropped, 70 percent have ended up either uninsured, or — in most cases — back on Medicaid. 

This is all because of a process called “the unwinding” of COVID-emergency protections that kept folks from getting dropped at all for a few years. It’s been messy.

We’ve been hearing the stories of folks who got dropped, and their fights to get re-enrolled.  

In this episode, we hear about two families in Tennessee who lost coverage they were entitled to — including one family who lost their coverage after their mail got sent to a horse pasture — with help from KFF Health News reporter Brett Kelman. 

Here’s a transcript of this episode.

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We’re zooming in on charges that are becoming more and more common on your medical bills: facility fees. 

Facility fees are charges tacked onto your bill for visiting a doctor’s office or clinic related to a hospital or larger health care system… or even talking with a doctor who’s in one of those places on a telehealth visit. 

If you’ve ever seen a charge for a facility fee on your medical bill, we want to hear from you. 

... and if you haven't, we'd love your help spreading the word!

Consider sharing our posts on any of these networks:

Instagram | TikTok | Facebook | Ex-Twtitter | LinkedIn

We’ll be back with more new episodes in a few weeks. 

In the meantime, send your stories and questions. Or call 724 ARM-N-LEG.

And of course we’d love for you to support this show.

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It’s been a huge disruption, with some providers wondering if they can keep their doors open.

But thanks to their huge size and reach, the situation may have had a silver lining — for United.

Which seems like a big problem, and got us wondering: What can we maybe do about it?

The answer turns out to be: Maybe more than we think, via antitrust enforcers at the Federal Trade Commission and the U.S. Department of Justice.

Strap in for a wild ride — and then maybe check out FTC Chair Lina Khan’s talk with Jon Stewart on The Daily Show. We include some short excerpts, but the whole thing is worth a watch.

Thanks to reporters Brittany Trang (STAT News) and Maureen Tkacik (The American Prospect) for guiding us through their reporting.

And to the novelist/journalist/activist Cory Doctorow, who has been writing about antitrust enforcement for years. Here are a couple of his columns about Lina Khan and what she and other antitrust enforcers are up to.

If you want a deeper dive on the new antitrust movement: It’s summed up in a terrific (and short) book by Tim Wu, a Columbia University law professor and former White House adviser: The Curse of Bigness: Antitrust in the New Gilded Age. 

And you may be able to get it for free! If your local library uses a system called Hoopla, you can borrow it as either an audiobook or an ebook.

Super-fun tangent: Cory Doctorow and Tim Wu went to elementary school together — and apparently played a lot of Dungeons and Dragons — when they were kids in Toronto. 

Here’s a transcript of this episode. 

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Covering the American health care system means we tell some scary stories. But this episode is almost like a horror movie. 

It’s got some of Hollywood’s favorite tropes: Machines taking over. Monsters from separate franchises meeting face to face in a new movie, like Godzilla and King Kong, or Jason and Freddy. And a couple perceptive folks warning everyone, ”Hey, look, something really bad is happening!” 

Those folks are Bob and his STAT News colleague Casey Ross. The monsters are United HealthGroup — a “behemoth” as one expert called them in an episode from last year — and Medicare Advantage, which we looked at in our last episode. And the “machines” belong to United.

Bob describes what some of United’s own employees said about the result: “For some of us, it's creating this moral crisis. Like we know that we are having to listen to an algorithm to essentially kick someone out of a nursing home, even though we know that they can barely walk 20 feet.” 

Scary stuff. But Bob and Casey’s reporting has caught the eye of some powerful people in government, and right now, Medicare Advantage plans are on notice from the federal Centers for Medicare and Medicaid Services, the U.S. Senate is holding hearings, and the Department of Justice reportedly has an anti-trust investigation in the works. 

Here’s a transcript of this episode. 

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But Medicare is a lot more complicated – and costs more money – than a lot of us realize. (Also, it involves insurance companies.) And:t There will be huge, complicated decisions to make when you turn 65, that can have huge consequences. 

The biggest, and most consequential: Choosing between original Medicare and Medicare Advantage – the privatized version sold by health insurance companies that’s advertised everywhere seniors look. 

Some folks who pick Medicare Advantage later regret it — but find there are no do-overs. 

We get the scoop from Reporter Sarah Jane Tribble, who’s been covering the story for KFF Health News and the Washington Post. 

And we get a preview: What do we all need to know before we hit 65 about the choices we’ll face? There are a lot of options, and a lot of price tags. Sarah Murdoch from the Medicare Right Center gives us an outline of those choices and their consequences — and supplies both tips and resources. 

The biggest: When it’s time for you -- or anyone you care about -- to make choices around Medicare, every state has a free source of unbiased advice and information: Here’s a link to find your State Health Insurance Assistance Program (or SHIP).

Here’s a transcript of this episode. 

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It turns out, there is a lot of good news about the so-called “poster child” for the high cost of prescription drugs. But to say it costs $35 now is an oversimplification – and diabetes activists don’t think this fight is over.

Senior producer and self-proclaimed “insulin correspondent” Emily Pisacreta took a hard look at the recent developments. 

Plus, what does the explosion of drugs like Ozempic and Wegovy have to do with the price of insulin? We break it down. 

Here’s a transcript of this episode. 

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So listeners ask us all the time: How do I stay strong and fight for my rights without totally losing my s---? 

We’re bringing back one of our most useful episodes ever: How to keep your cool in a tough moment, according to a self defense expert. 

In late 2020, Dan hit up self defense expert Lauren Taylor to get strategies for standing up for yourself, and hear how she’s applied her approach in her own fight for health care coverage. 

Since then, she’s published a book! It’s called Get Empowered: A Practical Guide to Thrive, Heal, and Embrace Your Confidence in a Sexist World. 

Extra tip: At the moment, the site bookshop.org, which supports independent bookstores, has the best price.

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

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Ok, now: We’ve got a mini-episode for you today, a four-minute coda to the epic story we brought you in December.

It features a last tip for anyone who might want to ask a hospital about charity care — which, as we learned from these recent stories, is most of us.

And it comes with my big thanks for being part of this show’s community this year. You’re our reason for being, and our best sources.  

You’re also our biggest source of financial support, so I will ask one more time to pitch in now if you can. 

Thank you so much! We'll catch you in 2024.

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And… are you ready for our most-ambitious story yet? We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. 

With those partners, we’ve dug up some surprising (and possibly uplifting) news about lawsuits in three states – Maryland, New York and Wisconsin — and what that news might mean for the rest of the country.  

This is part two of a two-part series. In part one, we examined the phenomenon of hospitals suing patients in bulk – sometimes hundred or thousands at a time – over unpaid bills. 

We learned that in many cases, those patients are struggling financially, and that the lawsuits aren’t very lucrative for hospitals anyway. So why did they happen in the first place? As one former collections industry insider told us, those decisions are “philosophically based.” 

In this episode — before getting to those surprising/hopeful findings — we try to understand that “philosophy,” perhaps best described as: business-as-usual. We speak with a former hospital billing executive and a representative from the third-party collections industry. 

This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.

… and supported by the Fund for Investigative Journalism.

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We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. 

For years, we’ve been hearing about hospitals suing patients over unpaid medical bills – sometimes even in bulk, by the hundreds or thousands at a time. 

Many of the patients getting sued are already facing financial hardship, or like one couple we interviewed, already in bankruptcy. 

Judgments against patients in these suits can be life changing. But according to experts, these lawsuits don’t recoup a ton of lost revenue for hospitals. So why do they happen? And what if hospitals stopped doing it completely? 

In this episode, we talk to a former sales rep for a medical-debt collections agency — who now steers hospitals away from efforts to collect money, via lawsuits or other means, from folks who just don’t have it.

He tells hospitals: This is better for your bottom line. 

Stay tuned for part two, coming in two weeks. 

… and to preview some of what’s in it — plus a whole lot more excellent reporting — check out the Baltimore Banner’s story: Maryland hospitals stopped suing patients with unpaid bills. Will they start again?

This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.

… and supported by the Fund for Investigative Journalism.

OOH: And don’t forget. It’s prime time to make a donation and support this show. 

Here’s a transcript of this episode.

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So they came up with a plan: crowdfund a bunch of money to make a short film, starring Ellen … called “Ellen Needs Insurance,” of course.

It worked! And the movie, a 13-minute comedy, is terrific. 

Ellen and Dru sat down with us to go over how they made the whole thing happen, and how this year’s Hollywood strikes changed their perspectives. 

Here’s a transcript of this episode.

ALSO: Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it!

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Trained as a historian, Messac then set out to trace the history of this phenomenon, and the story of medical debt in the U.S.

His new book, Your Money or Your Life is the result of that research. 

Luke Messac sat down with us for a chat about how he got interested in medical debt, how medical debt became the massive problem it is today, and what he thinks people who work in health care can do to start to fix it.

ALSO: Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024.

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Just two days after we posted part 2, the activists waging that battle scored a major victory. John Green was kvelling on YouTube, of course. We’ll get you up to speed. 

And for the meat of this episode, we’ve got a guest a lot of you have been asking for: Physician/comedian Will Flanary, AKA Dr. Glaucomflecken. 

His punchy videos satirizing the absurdities and cruel complexities of the American health care system have been a fan favorite for years among An Arm and a Leg listeners (and us too).

We’re sharing a delightful and moving conversation with Dr. G and his wife, educator Kristin Flanary (AKA @LadyGlaucomflecken online), from our pals at The Nocturnists, a podcast about the experiences of health care workers. 

As the Glaucomfleckens tell Nocturnists host Dr. Emily Silverman, the inspiration behind Flanary’s most biting videos. came from the couple’s experience dealing with health insurance after he suffered a near-fatal heart attack.

Check out the Nocturnists here or wherever you get your podcasts, and Dr. Glaucomflecken’s videos on TikTok, Instagram, and YouTube. 

Send your stories and questions for An Arm and a Leg, or call 724 ARM-N-LEG.

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Quick recap: In our last episode, we learned how writer and YouTube star John Green kicked up a fight with Johnson & Johnson over a medicine called bedaquiline. And appeared to score a victory.

Here, we dig into the backstory: How everything John Green and his fans won was built on activism going back 20 years, and spanning multiple continents. 

All of it illustrates how pharma companies work the patent system to extend their legal monopolies on medicine way beyond the standard 20 years, and how that leads to high drug prices here and abroad. 

And what we can maybe do about it. 

This episode starts in 2004, when India began the process of changing its patent laws to align with global trade rules. Activists there managed to carve out exceptions to the law to prevent some of the worst patent abuses. 

Fast forward to this year, when those legal safeguards become key to unlocking new doors in the fight against TB. 

Meanwhile, the proponents of those Indian safeguards are here in the U.S., pushing for drug patent reform here. Which not only could help Americans, but also influence global standards. 

Here's a transcript of this episode. 

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The drug in question is bedaquiline, made by Johnson & Johnson. It treats drug-resistant tuberculosis, and its price has been a huge obstacle to getting it to places it’s needed most — primarily places far away from the U.S.

But the reason this TB drug costs so much overseas is also one of the main reasons that important drugs here are so expensive — drugs like insulin, Humira and… well, just about everything:  

Legalistic patent games that pharma companies have mastered. 

So, in addition to John Green — and yes, we talked with John Green — we also talked with one of the world’s leading experts on drug-patent games, Tahir Amin.

Also, John Green is a great storyteller. So hearing him tell the story of how he became obsessed with tuberculosis is bittersweet.

And in order to make sense of any of this, we had to dig into the story of how John Green and his brother Hank became (and remain) YouTube superstars. 

For more than 16 years, they’ve been building a community of “nerdfighters” — nerds fighting to make the world a better place. It’s a profoundly sweet and fun story, and everything we’re trying to do here owes them a debt. 

Oh, finally:  This is, as you’re probably guessing by now, an epic story.  It’s gonna take two full episodes of An Arm and a Leg to tell it all.  

So, we hope you enjoy part one. There’s more coming in a few weeks.

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It involves John Green, author of The Fault in Our Stars — and yes, we've got an interview with him — and a global fight against multi-drug resistant tuberculosis.

... which turns out to be directly related to fights over the prices of drugs like insulin and humira in this country.

Meanwhile, let me recommend a story from ProPublica that's related to a story we did here a few months ago.

You might remember our recent episode about United HealthGroup, and how it's become a behemoth in recent years. That story started with a complaint from a doc in New York.

... who had a lot more tips than I could run down — or fit in one episode — and they weren't all just about United.

ProPublica's Cezary Podkul took the time to verify a big one: About zillions of dollars in fees that docs are paying — dollars that ultimately come out of our pockets — just to get paid.

Oh, and: If you aren't getting our First Aid Kit newsletter, this is a great time to sign up. We've started a series about how to fight with insurance that, unfortunately, a lot of us are gonna need at some point.

We'll be back in a few weeks, with John Green, TB, and the fight over drug prices.

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We look at just how wild ambulance bills can be, with a story about three siblings who took identical ambulance rides — from the same car wreck to the same hospital — and got completely different bills. (Thanks to Bram Sable-Smith who reported the story for the Bill of the Month, a series from NPR and KFF Health News.). 

And we find out how ambulance bills ended up being so random — a story that takes us back to the 1970’s. 

Plus, what you can do if you get hit with an out-of-network ambulance bill:

• See if you can negotiate a better deal
• See if you might qualify for financial assistance. (Here’s some detailed guidance from Jared Walker of Dollar For.)
• See if you’re protected under state law. At least ten states have passed laws protecting some patients from surprise ambulance bills. Check here to see if yours is one of them. 

Want to share your thoughts on how Congress should deal with out-of-network ambulance bills? A federal advisory committee wants to hear them. You can email them here.

Here’s a transcript of this episode. 

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And: Experts say they play a big role in jacking up drug prices overall. 

But how, exactly? We took a deep dive.

This episode first went out in 2019. We’re bringing it back because PBMs are in the news these days: Congress is targeting them, in an effort to to be seen doing something about prescription drug prices. And PBMs’ sometimes-rival, the powerful pharmaceutical industry lobby, is flooding the airwaves with ads attacking them. 

There’s been a little news since 2019: Although Congress is still catching up, all 50 states have passed some laws pertaining to how PBMs work. We’ve got an update on that. 

Here’s a transcript of this episode. 

Send your stories and questions. Or call 724 ARM-N-LEG.

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Correction: A previous version of this episode misidentified the parent company of Express Scripts.

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After all, who wants the risk of being overcharged — and then having to fight for money back?

Experts gave us their best advice, including a couple of tricks to try, and a legal protection you may be able to rely on. 

Meanwhile, Elisabeth Rosenthal, senior contributing editor at KFF Health News, filled us in on the rapid growth of medical debt as a financial product, including specialized credit cards and financing plans pushed by hospitals and other providers.

They can come with steep interest rates, and (surprise, surprise) the terms aren’t always spelled out clearly. 

The federal Consumer Financial Protection Bureau has been issuing reports, including a handy FAQ, but hasn’t taken enforcement action in a decade.

Here’s a transcript of this episode. 

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Especially when we saw that the loan product — a “cash flow solution” for health care providers — was real.

The doctor’s tweet essentially accused UHG’s insurance arm of causing cash flow problems for providers in the first place, by denying claims and delaying payments — which echoes complaints we’ve heard over the years, and which the original tweet called “genius” — as in Evil Genius. When the boss who’s paying you late offers to front you money, at interest, to tide you over, it does sound like… a conflict of interest.

It turns out, because UnitedHealth Group is such a big, complex enterprise, it’s not quite that simple. 

But UnitedHealth Group’s size and complexity turns out to be the story. The company has grown into a “behemoth,” running the country’s biggest insurance company, and becoming the biggest employer of doctors, while also running big parts of the business-side back end for big chunks of the health care ecosystem. 

As one expert told us, “There's very little good news about what happens when these organizations. or these sectors of health care get bigger.” Costs and prices tend to go up, without a bump in quality.

And regulators, we learned, have struggled to keep up. 

It’s a wild ride with a sobering conclusion — and very much worth taking. 

As the expert who labeled United a behemoth wrote: “United has grown to its present immense scale largely without public knowledge.” Now we know. And knowledge is the beginning of power. 

BONUS TIP: This story reminded us of themes and insights from novelist, journalist, and activist Cory Doctorow, especially his recent book Chokepoint Capitalism and his recent essays about the “enshittification” of online life.

We also like Cory’s novels a lot, and have learned a ton from them. They’re often called science fiction, but the tech is usually present-day, or about a month into the future. His latest, Red Team Blues, is a smart, fun techno-thriller. 

Here’s a transcript of this episode. 

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A “Ghost network” is what researchers and journalists call it when your insurance plan offers a list of “in-network” providers that turns out to be bogus. 

Attorney Abigail Burman has studied this haunted phenomenon, and she’s become a part-time volunteer ghostbuster for people in her life. She’s here to share her tactics with us — including some key legal terms that can provide leverage.

Abigail has written up a guide to her strategy, and she’s given us permission to share it. You’ll find it — lightly edited, and with some additional insights from our talk with her, over on First Aid Kit.

Warning: No silver bullets here. It’s still really, really hard. But Abigail has definitely got some hard-won insights we can use. 

Here’s a transcript of this episode. 

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Her case went all the way to the Colorado Supreme Court. 

The questions before the court, and how they ruled, have potentially major implications for our legal rights when it comes to fighting unfair medical bills — and how some hospitals might be thinking about their next move. 

Here’s a transcript of the episode. 

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And it could be a model for the whole country. Yes, really. 

That’s the pitch he makes in his new book, The People’s Hospital: Hope and Peril in American Medicine. It’s a love letter to Houston’s Ben Taub hospital, and an argument for bringing Ben Taub’s model — efficient, innovative, and cheap —to the rest of the country.

And if that seems unlikely in today’s political climate, well: Ben Taub’s wild origin story was plenty unlikely too. 

That story takes us to the 1960’s, when Dutch novelist and playwright Jan de Hartog moved to Houston. He fell in love with the bustling, futuristic home of NASA and the Astrodome. 

But he also discovered the city’s dreadful underside: a neglected charity hospital where largely African-American patients are left to seek health care in unsanitary and unsafe — hellish — conditions. 

De Hartog and a group of Quaker volunteers waged a campaign to change that, and eventually found an unlikely ally who brought it over the finish line. 

The People's Hospital is a heck of a book. We might want to start a book group someday, just to talk about it. If you want to grab a copy, here’s a link. (Or: Audiobook, or ebook.)

Here’s a transcript of the episode. 

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We had help, from an expert we met by visiting a Renaissance Fair — which we did in this very fun early episode. Kaelyn Globig, head of advocacy for the Rescu Foundation, is a medical-bill wizard, and no one has taught us more.

In this story, she teaches us how to find out what Medicare pays for a given procedure — here’s the guide she shared with us — and how to use that information. 

We also got advice on dealing with debt collectors — when it makes sense to file a dispute — from April Kuenhoff, an attorney with the National Consumer Law Center. 

She shared resources too. Here are sample letters — templates you can edit:

• To tell a debt collector that you are disputing a charge. 
• To demand verification of a debt they say you owe
• To limit their legal right to harass you. 

Here’s a transcript of the episode. 

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She wrote: “I feel like I won” — and we knew we needed to talk with her.

She wants to encourage more people to try taking providers to court over unfair bills. 

“If everybody that they screw stands up,” she says, “They can't afford to pay a lawyer to defend against all of those [cases].” 

It’s an interesting idea for sure — What if more people use small claims court to fight messed-up medical bills? Like, a lot more people? — and we’ll be exploring it in the coming months. 

Meanwhile, Lauren’s story has lessons for all of us. For instance, even though she lost her case, she doesn’t expect to pay a cent. 

Here’s a transcript of the episode. 

More helpful resources

Want to try some of Lauren’s tactics? 

Looking up billing codes: The latest First Aid Kit newsletter is all about fact-checking medical bills and includes a section about examining billing codes. We'll go deeper on those codes in the next installment. 

Dealing with debt collectors: We discussed knowing your rights when dealing with debt collectors with a couple of experts in this very-fun episode.

Lauren got her dealing-with-debt-collectors playbook from journalist and friend-of-the-show Marshall Allen. His book, Never Pay the First Bill, includes a template of a letter you can send to a debt collector, challenging them to document their claim.

Exploring small claims court: We first got tipped off to this aggressive approach in a story we re-played recently: Can They Freaking Do That?!? 

... and followed up with the story of Jeffrey Fox, who successfully used small claims court to force a big hospital to refund a $2,000 charge. David vs. Goliath.  

Send your stories and questions. Or call 724 ARM-N-LEG.

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A listener named Miriam got a bill from a medical testing lab she’s never heard of, for $35. Then, a follow-up bill said if she didn’t pay up right away, that price was going up — WAY up: to $1,287. 

Which raises the kind of  question that comes up a LOT with medical billing: Can some random lab hit you up for money — and then threaten you with a late fee of more than $1,000??

We went to find out.

The answer: They can try. And a lot of the time, they’ll get away with it. But we found experts who explain how, sometimes, we can fight back— by threatening to take them to court.

If you’ve got the time and the moxie, these experts say you’re on solid legal ground, and you really can make the other side accept a fair offer.

We’ll come back to this idea next time. Meanwhile, here’s a 2020 episode with the story of a guy who took his local hospital to court, and won.

The original version of this story, from 2019, found us learning about a couple topics we went on to explored in more depth later:  Surprise bills — which we got new legal protections from in 2022— and the role of private equity in health care, both how it’s been expanding, and how some doctors are trying to fight back.  

Here's a transcript of this episode.

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We’re so lucky we get to do this work, and we couldn’t do it without our community. From sending us your stories and questions, to supporting the show financially, our listeners and subscribers are what this show runs on. Thank you. 

If you want to help us take on 2023, now is a great time to contribute. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it.

Here’s a transcript of this episode. 

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Getting insurance to pay for anything dental is usually hard, but this had us asking ourselves… is it usually this hard? 

We connected Susan with law professor Jacqueline Fox — who, when she was practicing law, fought insurers on behalf of patients. And who says Susan has “done everything right.”

We’ve started to wonder whether Susan’s troubles could be related to broader accusations against her insurer, Ambetter, the largest provider of plans on the Obamacare marketplace.  

Here’s a transcript of this episode.

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It’s a thirty minute YouTube video from a creator named Brian David Gilbert, and it’s probably the best video about health insurance we’ve ever seen. 

Brian David Gilbert is best known for his highly-detailed, hilarious videos for Polygon, a media company about video games. But when he left that job to strike out on his own, he needed new health insurance. We talked with him about how that experience turned into one of the most difficult videos he’s ever made — and this is a guy whose old job had him tracing things like Zelda storylines across decades-long franchises. 

You can watch the full video here. 

Other delightful BDG creations discussed in this episode:

• The two-minute video that launched his career.
• His 15-minute dive into the Legend of Zelda
• A cooking demo: “Welcome to my weird ice creams.” Yum.

Special thanks to Wil Williams, Sarah Ballema, Josh Rubino, and Bea Bosco for adding their voices to this episode!

AND: We’d love for you to support this show. Now is a great time to do it. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it.

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First: There’s no one answer (and few answers are settled yet). A lot depends on where you live, and where you work. 

But second: For lots of people, for a long time, insurance has rarely been a help in accessing abortion. Most people pay cash. And lots of people can’t afford to.

But there are organizations who have been tackling this issue for decades — abortion funds. 

We’re big fans of when regular people find a way to help each other survive this messed-up, profit-driven health care system — and abortion funds are a huge example of that kind of effort. There’s a lot we can learn from them. 

We talk with Oriaku Njoko, executive director of the National Network of Abortion Funds, and Tyler Barbarin, a board member with the New Orleans Abortion Fund, to learn from their experience. 

Here's a transcript of this episode.

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One listener wrote to us about his son, a student with no income. Dad asks, If the son could get charity care (financial assistance) at his local hospital….  should he bother getting health insurance? 

The big picture question: If you’re broke, and can’t get insurance from work, what are your best options? 

The big picture answer:  It totally depends!  

• Do you live in a state that expanded Medicaid?
• What are the financial-assistance policies like at the hospitals around you?
• What kind of health care do you know you’re going to need?

We had expert help here:   Karen Pollitz, a senior fellow at the Kaiser Family Foundation, and . Jared Walker, founder of Dollar For, and a super-expert on charity care.  

If you want to go deeper:

• We did a three-part series on picking health insurance in our First Aid Kit newsletter. Start here. 
• An episode from last year explored some more dos and don’ts for picking health insurance.
• In a 2018 episode, we talked with another listener — a “financial therapist” — who had her own deep questions about health insurance. 

We’d love for you to support this show. Now is a great time to do it.

This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal.

Here, go for it.

• Here’s a transcript of this episode.
• Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG

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You may have noticed, we've been keeping a slower pace for the last few months — publishing every three weeks instead of every two — since Dan recovered from COVID.

And every-three-weeks is gonna stay our default for now. Putting out the show more often was wrecking Dan's health, and some important behind-the-scenes work just wasn't getting done.

When we slowed down the podcast release schedule, we also suspended the First Aid Kit newsletter, which compiles our most-useful information for dealing with the out-of-control medical system.

Starting today, First Aid Kit is back — publishing monthly instead of every-other-week. (We're telling you, Dan was pushing too hard before.)

If you're already a subscriber, you should have a new issue in your inbox right now. If you're not a subscriber yet, why not sign up?

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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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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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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.
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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:

• Sarah Kliff and Aatish Bhatia’s reporting on non-invasive prenatal testing
• A scorching report on Natera from Hindenburg Research
• Andrew Rice’s story on Hindenburg Research: "The Last Sane Man on Wall Street" 

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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. 

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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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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.

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

• Get in touch to share a story or your thoughts.
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• Support us: Your donations are this show's biggest source of income.

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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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So some New Yorkers are suing to get that changed. 

The non-profit Upsolve wants to help people represent themselves in court when they’re being sued over debt. Their plan is to train people like pastors, social workers, and librarians and others to help people others know their rights. And iIn the Bronx, Reverend John Udo-Okon is one of those volunteers, ready to help. 

We meet the CEO of Upsolve and Reverend John to talk about their work – and why they’re suing the state of New York. 

Here’s a transcript of the episode. 

Subscribe to our newsletter, First Aid Kit. 

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If anyone could beat the sharks at this game, we’d pick Lillian Karabaic, who runs the personal finance show/community called Oh My Dollar! — and is SUPER on-top-of her stuff. 

But Lillian recently got socked with an unexpected $3,000 charge— and expects to lose her very-organized fight against it.

Understanding how Lillian got here — how pretty much any of us could, and how we can start to fight back, together — means understanding the games these big sharks are playing.

Which is exactly what we do in our latest episode, with Lillian’s expert — and often very-funny — guidance. 

This episode goes deep on a shark game called a “copay accumulator” policy. In short, they’re an invention by the insurance industry to make sure only YOUR money counts toward your yearly deductible — not any assistance you may receive from a drug company. 

One thing we learned: Finding out if your insurance plan even includes one of these policies can be extremely tough: Otherwise, Lillian — who did her extremely-good best to check for this very information — wouldn’t have gotten taken by surprise.

We’ve got a little bit of help to offer: Researchers from a nonprofit called The AIDS Institute also researched this question, looking at hundreds of plans across the country. And they developed a tip sheet a tip sheet to help guide their search: How to search online, what questions to ask if the information just isn’t online (which happens).  

More resources:

• For tips on how to avoid overpaying for drugs — when that’s possible — check out the latest edition of our First Aid Kit newsletter.
• There’s a third bunch of sharks involved in this drug-pricing game: Middleman companies called Pharmacy Benefit Managers. If you want to understand the role they play, here’s an Arm and a Leg episode about them.
• A dozen states have banned copay accumulators, and more are considering it. This short report includes a list of those dozen states. 

Here’s a transcript of the episode. 

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We'll be back in a few weeks to start the next batch of Arm and a Leg episodes. Meanwhile, we hope you'll enjoy the first episode of Half Vaxxed.

Meanwhile, don't miss our First Aid Kit newsletter, where we're sharing practical tips on surviving the world's most-expensive health care system.

Catch all of Half Vaxxed here

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Part of what makes Last Day so good is that Stephanie is a great storyteller — as well a truly tireless crusader, and a witty, real-as-they-come human being. We should know — we had her on An Arm and a Leg to talk about how she and a few other Texas moms got state laws changed to cover hearing aids for kids. (You can catch that episode here: https://armandalegshow.com/episode/mom-vs-texas/)

If you haven't already met her there, you're going to love her here.

It turns out that nearly everybody you know is either struggling with — or loves someone, or knows someone — who is struggling with some really difficult shit.

...and for some reason, we continue to keep these stories hidden away. Just eating at our insides.

This is a show about that.

• Stephanie Wittels Wachs, from Season 1, episode 1 of Last Day.

Last Day made a second season, about suicide and mental health, and its third season, about America's gun-violence epidemic, is coming this spring. You can listen to everything, and subscribe to get new episodes, here: https://lemonadamedia.com/show/lastday/

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Like, for instance: these protections only apply to care you get in a hospital. Then there’s the deceptively-named Surprise Billing Protection form they might ask you to sign. And there’s more. 

We break down what you need to know about your rights under this new law, what traps to look out for, and who to call if something smells fishy. 

Actually, here: The federal hotline for reporting No Surprises Act violations: 1-800-985-3059.

Big thanks to our guides: Patricia Kelmar, Health Care Campaigns Director at U.S. PIRG, and Julia Nigrelli from health care consulting firm Chi-Matic. 

The federal hotline for reporting No Surprises Act violations: 1-800-985-3059.

Here’s a transcript for the episode. 

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Her advice? Avoid the ER, do some research ahead of time, and ask if they’re going to do any other tests (which may not be covered 100%). 

We summed up some of her advice in a recent First Aid Kit newsletter, and then added some more COVID-test advice in this week's First Aid Kit.

Here's a transcript for this episode.

Got a story to tell, or a wild bill to share? Get in touch.

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But they’re freaking expensive and can be hard to find. What the heck happened? 

When ProPublica reporter Eric Umansky went looking for COVID tests recently, he came back empty handed. He and fellow reporter Lydia DePillis investigated, tracing the US’s rapid testing problem all the way back to the FDA and other government agencies. 

Plus, Dr. Celine Gounder talks about why these tests are so important in the first place and how best to deploy them this holiday season — if you can find some. 

Here’s a transcript of the episode. 

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UPDATE: We've pushed past the amount the NewsMatch campaign has funds to match(!)

... and we can keep going with your help. And earn a bonus.

If we raise $5,000 to match funds folks have already donated, the Knight Foundation will give us a $1,000 bonus.

Please help us now! Gotta get it done by Dec. 31. Here, go for it. 

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Jackie Fox has a lot to teach us. And class is in session.

Here’s a transcript of the episode. 

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This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News.

Holy cow, what a deal. Here, go for it. 

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While hunting for a new insurance plan, Mitra Kaboli got an offer that seemed too good to be true—but seemed to be coming from her current insurer. Mitra was skeptical, and it turns out, she had every reason to be. Dania Palanker from Georgetown University's Center on Health Insurance Reforms unpacks this sketchy scheme, and gives us the key to avoiding it: When you're searching for health insurance... skip Google. Seriously.

Then, some top health insurance nerds teach us how to really shop for health insurance: where to find the fine print and how to read it.

They also deliver some good news (for once): Thanks to subsidies in the American Rescue Plan some deals this year are actually… deals! Meaning: health insurance got more affordable for lots of people this year. Here's the subsidy calculator we mention in the episode.

Want to read all of those tips in one place? Check out First Aid Kit, the newsletter where we're summing up all the practical stuff we've been learning since this show launched. 

Here’s a transcript of the episode. 

And of course we’d love for you to support this show. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News.

Holy cow, what a deal. Here, go for it. 

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Together, Matthew, his wife Diane, and Laurie made the case for Matthew’s life. Fourteen years later, the speeches they gave in a conference room full of insurance executives are a masterclass in winning insurance appeals — and living to tell the tale. 

The battle also illustrates a lesson that Laurie Todd learned while fighting it: Fighting your health insurance often means fighting... your employer. Yep, most employers “self-insure.” 

And in this case, that employer was one of the biggest companies in the world.

Here’s a transcript of the episode. 

For the Insurance Warrior's origin story, check out our previous episode.

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This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News.

Holy cow, what a deal. Here, go for it. 

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Psst: This month, when you support this show, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News.

Holy cow. Here's the link.

Also:

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Here’s a transcript for this episode: https://armandalegshow.com/wp-content/uploads/2021/10/12-Million-Hours-An-Arm-and-a-Leg-Transcript-S6-Ep05-12.pdf

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It wasn’t illegal. Until now. How a coalition changed that. This year. 

Plus, our friends at Dollar For build their bill-crushing army, one Zoom training at a time. 

Need help applying for charity care for you or a loved one? We compiled a list of five helpful tips. 

Here's the transcript for this episode.  

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Here's a transcript for this episode.

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And of course we'd love for you to support this show.

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The national requirement to offer charity care emerged from the Obama White House’s failed courtship of GOP Senator Chuck Grassley. We hear how that failed courtship almost tanked the ACA— and how the battle over the ACA “broke America”—from former Obama adviser David Axelrod, longtime reporter Julie Rovner and a top Grassley aide. 

This is the second in a four-part series—but you can totally start right here!

The series looks at the (slow, uneven) development of legal protections for consumers (a.k.a. patients, a.k.a. people who just don't want to die and aren't Bill Gates) against outrageous medical bills and draconian collection practices.

You can listen to the first episode any time, before or after this one. It's about how a legendary lawyer—the guy who beat Big Tobacco in the 1990s—tried to sue non-profit hospitals into acting more like charities and less like loan sharks. (He lost, but it wasn't a total dead-end; that's where this episode picks up.) It's totally fun too. It's right here.

Here's a transcript for this episode. 

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For instance: We’ve been following the work of Jared Walker, who went super-viral on TikTok, spreading the word that non-profit hospitals are legally obligated to provide charity care. That obligation didn’t exist when Scruggs launched those lawsuits.

This is the start of a four-part series about how change actually happens. In this case, it’s a wild ride, and it's not done. By the end of this series, we'll meet folks today who are pushing that work forward. 

Next stop: The White House. It’s gonna be fun. 

Meanwhile, maybe you can help make change happen: Researchers at the Innovation for Justice program at the University of Arizona are looking at hospitals’ debt collection practices, and how laws or regulations could do a better job protecting people. They’re looking to talk to some people who have been sued over medical bills. If that’s you, or someone you know, here’s a link to get in touch: bit.ly/talkmeddebt. It’s a 30-minute interview. They’re not gonna release your name or anything to ANYBODY, it’s all anonymous. (And there might be a gift card in it for you.)

Here's a transcript for this episode.

Big thanks to Kindling Group for allowing us to use audio from their documentary Do No Harm in this episode. You can learn more about their work at kindlinggroup.org.

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These are stories we’ve been collecting for months—some of them for more than a year—and they’re big. 

One of them turns out to be about how change actually happens. Which for a show about the cost of health care—one that promises (and we do) to be entertaining, empowering, and useful—change is important. 

And, as horrible as things are right now, we’ve been learning: some things used to be worse. 

For instance, this year we’ve been reporting on how people can get bills forgiven by hospitals. It’s called charity care, and it’s the law. Twenty years ago, in most of the country, THIS WAS NOT A THING.

The road to making this a right took a lot of work from a lot of people. Like one of the country’s biggest lawyers—the guy who helped bring down big tobacco.

You know, big tobacco was TOUGH. And he BEAT them. But on hospitals… he totally failed.

Well, not totally. But it’s a wild ride, and we’ll be on it for a few episodes. It even takes us to the Oval Office, which is fun.

And after that… well, I’ve met a couple of people who have taken me into the GUTS of health insurance, and actually, blown my mind about what it really is.

As always, please send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG

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Jared’s non-profit, Dollar For, has got that system up and running. So: If anyone you know has a hospital bill they can’t pay, the system can quickly tell them if they might qualify for debt forgiveness, and get them started on an application. Here’s the link. Pass it around.

Also, if you want to see that original 60-second video, it's here.

Here’s the transcript for this episode. 

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Now, he's written a book … about how to fight back. It’s called “Never Pay the First Bill.” We talked—about some of his best tips, about how you can’t win ‘em all, and about why it’s worth learning all you can and giving it your best shot.

Marshall compares the U.S. health-care "system" to the bully he faced in 7th grade. Big, stupid, mean. And SOMETIMES—as he learned in junior high--you can stand up to 'em, and not get stomped. Worth. Your. Best. Shot.

Marshall is a kindred spirit—we talked to him for stories in 2019 and 2020— and the conversation is a whole vibe. He shares some “magic words” that are worth memorizing or writing down somewhere. 

Here’s one you can copy and paste, for if you ever end up in the ER. There’ll be a form they want you to sign, that says you’ll pay WHATEVER insurance doesn’t cover. If you can, X that out, and write in this instead:

I consent to appropriate treatment and (including applicable insurance payments) to be responsible for reasonable charges up to two times the Medicare rate.

(Why Medicare? Listen in for the details.)

Here’s a transcript for this episode. 

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