MARSHALL ALLEN, GUEST: Let's talk from a biblical perspective. There is truth. And there is falsehood. When you're standing on the side of truth and what's right, you have a tremendous amount of moral force behind your argument. And so when patients are being taken advantage of and they're being wronged, and they can show with evidence that they are being wronged, there is a tremendous amount of moral force behind that argument. And do not ever, especially as Christians, we should never underestimate the power of what's true and what's right. And so even though you might not win, you will never win if you don't stand up and fight.
WARREN SMITH, HOST: I’m Warren Smith, and today you’re listening in on my conversation with Marshall Allen. He’s the author of a new book about our healthcare system: Never Pay The First Bill: And Other Ways To Fight The Health Care System And Win.
MA: I just helped a young woman who was hit with a $78,000 bill. So her husband's a truck driver. They make a decent income, but not enough money to handle a $78,000 bill. Because her insurance company had approved a procedure, the doctor then altered the procedure a little bit because he said he needed to, and you know, you want your doctor to be able to do that if it's medically necessary. The insurance company then denied payment for it, and the hospital price gouged them. So she was stuck with a $78,000 bill. The hospital and the insurance company said there's nothing we can do. They were telling her you're going to have to declare bankruptcy. I showed this woman using the insurance warriors guidance, the insurance warriors mindset, how to write a memo, how to make an appeal that was based on concrete evidence and not just emotion. And she just called me two days ago, thrilled because the insurance company had covered a portion of the bill. And the hospital had forgiven the rest of the bill. And she was now debt free. $78,000. And so you will think it's hopeless. You will think you can't do it. I'm telling you, you can. And I've documented throughout the book, the examples of people who have fought back in won and how we can follow their tactics to do the same thing.
Support for Listening In comes from Samaritan Ministries, a community of Christians who care for one another spiritually and financially when a medical need arises.
Patrick and Melody liked the idea of a group of people coming together to share medical costs, and joined Samaritan Ministries in 2017. When they welcomed twin daughters, fellow members sent money directly to them to help them pay their medical bills. When the body of Christ comes together, burdens are lifted, and God is glorified. This applies to all areas of life, including health care. More at samaritan ministries dot org slash world podcast.
WS: Marshall Allen is one of those rarest of creatures: He’s a former pastor and missionary who made a pivot to become an investigative journalist. And he rose to the top ranks of that field, spending more than a decade with the investigative non-profit ProPublica. He has been a finalist for the Pulitzer Prize, and the recipient of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting.
We will talk about his faith later in the program, and his experience being a Christian in a secular newsroom, but we want to spend the bulk of our time today talking about his new book Never Pay The First Bill.
This book sprang from a number of experiences in Marshall’s life. First, as a healthcare reporter for ProPublica, he has had a front row seat at the circus. The past decade has seen the advent of Obamacare and an explosion in healthcare costs that both pre-dated the Affordable Care Act, and has continued apace since then—to the point that healthcare, by some methods of measurement, now make up nearly 20 percent of our gross domestic product.
Secondly, Marshall Allen is a husband, father, and son. And—like all of us—has had to deal with the byzantine labyrinth that is the American health care system. In fact, that’s where we begin our conversation.
WS: You are a very committed evangelical Christian. And we can talk a little about that later. But this book is, is kind of not in that space, but in some ways, is of concern to everybody. I mean, if you are a living breathing human being, at least in the United States of America, you should be concerned about the issues that you're raising with our, related to our healthcare system.
MA: Yeah, year after year, Americans say on surveys that the high cost of health care is their number one financial concern. And so I compare it almost to like the Covid 19 pandemic. It's something that is afflicting all of us, some causing more harm than others. But all of us are suffering from this problem of high health care costs.
WS: Well, and you know, I think that first of all that I think that's exactly right. And secondly, I think probably everybody has a story, right, everybody, and probably some sort of a horror story. But I want you to tell your story, or at least the story that you opened your book with, because even though you've been covering healthcare for years, and you're an investigative reporter, this story, it may be overstating it a little bit, you can rein me in if I am. But the story you open the book with, in some ways, kind of I don't want to say radicalized you. But it gave you a real focus for talking about these issues, didn't it?
MA: Yeah, it did. I would say Warren, I mean, I've been investigating the healthcare industry for 15 years. And I've always done it from the point of view of patients. And so I have been talking to patients for 15 years, documenting the stories of people being physically and financially harmed by our healthcare system. And my background before that is that I spent five years in full time ministry. So I worked for five years on staff with Young Life, which is a large, evangelical Christian youth ministry organization. And then I went and I got a master's degree at Fuller Seminary. And I thought, my wife and I actually thought we did three years overseas in Nairobi, Kenya. And we initially thought we would be long term missionaries. So that's why I went to seminary. And sometimes people would joke, you know, when I when I went into the mainstream media, like did you give up your faith when you became a journalist, you know? The funny thing is, is that absolutely not. In fact, I would argue and I actually wrote a column about my faith for Pro Publica and The New York Times where I explained my journey from ministry to muckraking. And I argued that journalism when done with integrity, investigative reporting and journalism are actually highlighting and showcasing biblical principles as we live that out in our lives. And I think that's something we see, I think, with Ministry Watch and the work that you're doing. When journalists tell the truth, when they, you know, stand up on behalf of people are being oppressed, when they hold people to account, when they recognize the the importance and the value of each individual person's life, as a created person made in the image of God, each individual person has tremendous value. And so when we tell these people's stories, I think it is a way of living out our faith, even though it's in a context that some people, conservative Christians especially, don't usually think about and are sometimes even hostile to.
MA: So my journey started, you know, really, my, my faith is really influencing my work to a great degree. So when I started covering healthcare, I looked at it from the point of view of the patients who are engaging with this really complicated system that is not really designed for what's best for them. It's really a system of big industry stakeholders, like hospitals, insurance companies, doctors, pharmaceutical giants, all these big stakeholders really working together to really use the patient almost like an ATM machine sometimes, you know, find ways to charge and sometimes it's a fair price, right? There's a varying degree of fairness in the in the prices. But unfortunately, you do see a lot of these big players who are price gouging, frankly. And they're profiteering based on our sickness instead of making a fair profit.
WS: Yeah, well, what are the points that you In fact, we're gonna probably skip all around Marshall today, because you've got just a ton of really great information. And we can't cover it all. But I'm just going to cover some of the things that sort of leapt out at me. And one of the things that did leap out at me you were kind of getting to, I think maybe in your last answer there was that, you say that the customer is always right. But the problem is, that the patient is not the customer anymore, That that's become that is really almost at the center of what is wrong with our healthcare system. Is that a fair assessment?
MA: I think that's absolutely right. And if you as soon as you realize that, as a health care consumer, that your hospital and your insurance company do not actually consider you to be their most valuable customer, everything starts to make a lot more sense. Like I don't know if you've ever had the experience of calling your insurance company and contesting a bill that was inaccurate. But what your insurance company will do is they will always side with the doctor or the hospital, the insurers are loyal to the medical providers, because they want to keep them in their networks, they don't want to have the friction, and the pain of challenging a doctor or a hospital. So really what they'd rather do is just have you pay the bill, that's what they would really like you to do. And so when you understand that the incentives are not aligned in favor of the patient, well, then you realize, Okay, I'm gonna need to navigate the system a little differently, because we pay for all the health care costs in this country. The public does through our taxes, through our insurance premiums, and our out of pocket costs, we are funding every dollar that goes into the healthcare system. Your insurance company does not pay your medical bills, your employer does not pay your medical bills, the government does not pay your medical bills. That money is generated from you and other members of the general public. They're taking your money, and they're using it and allocating it for your health care costs. But they're taking a substantial cut out of the middle of that, and that's part of the problem that's inflating these health care prices.
WS: Well, what you just said, is very powerful to me, because in some ways, it is the, if I could put it this way, the raison d'etre for the book itself. For fighting back, for questioning. And and also it provides not only the, you know, the the reason for being of the book, but in some ways, it also provides the moral authority that I think it's important for us that the more the firm moral ground on which we can stand when we do this, that we're not just being curmudgeon, so we're not just being cheap, that that when we stand up and and demand, you know, fair services at a fair price from the health care system, we're looking after ourselves. We're looking after our family. We're looking after others that won't and can't stand up. Is that also a fair assessment?
MA: Absolutely. And I think I think lots of healthcare books have been written but I think my argument is a little bit different and it's because of my my Christian worldview. I am making a moral argument in this book and the moral argument says that it's not fair to charge people more than you should just because they got sick. It's fair to make a profit. There's nothing wrong with making a profit. In fact, we want people to make a profit so they're rewarded for their excellence. They're incentivized to innovate. But what is not fair is profiteering based on people's sickness. And unfortunately, a lot of our healthcare industry has veered into this realm of deceptive profiteering. And I'm saying that's not right. That's not okay. Because what's happening is it's driving people into bankruptcy. And they say now that one out of every six Americans has medical debt in collections. We have people hounding us. And if it's not happening to you, it's happening to people you know. Your loved ones. Your friends and your family. And so I think what's unique about my book is, is a lot, you know, a book is really an expression of who the author is, right? And so when I look at our healthcare system, I'm not looking at it, like I'm some policy wonk, who says, Oh, well, we need we need our elected officials to make some new type of public policy to fix this for us. I look at this, and I go, this is not right. And I've been documenting these stories now for so long, that, that I'm motivated to write a book to show people what they can do about it. And so it was really fun for me, because, you know, I'm very open about my faith. And I always have been, as long as I've been in journalism. And I want to be very open about it. But what's fun about a book, you know, is that you can express a lot more of your personality. And so it's not a Christian book. But it's definitely coming from from a Christian biblical worldview of right and wrong, and what's fair and what's not fair. And then also standing up for yourself, you know, that we have dignity as individuals, when we're getting trampled by a powerful institution, we have every right in fact, we have a constitutional right to stand up for ourselves. And I show people how to use small claims court even to sue a hospital that's billing you unfairly. And I think that's something more of us should be doing. It's a very effective tactic. It turns the leverage and the power into the power of the patient. And again, this is what our Constitution has set out for us to do.
WS: Marshall, I want to pivot a little bit in our conversation to pick up some of the ideas that we've been that we had to gloss over a little bit. I asked you probably, you know, at the beginning, near the beginning of the first segment about a story that opened your book, scary that you and your brother were involved with your parents in a healthcare situation where there was a conflict. Could you, briefly describe that story. What happened there?
MA: You know, like a lot of people my age, I'm almost 50 years old, my parents are aging. And so my brothers and I help care for them as they get older. And my father unfortunately has had dementia, which is declining over the years. At first, it was a slow progression. Now it's gotten more rapid. And so my mom has been his caregiver full time, now for years. And in the fall of 2019, my mom was just unable to care for my dad anymore. And so we had my dad admitted to an assisted living facility in Colorado. My brother's actually a pastor in northern Colorado. And so it was near, it was near where my brother's church is. And it was a very well appointed, pretty pricey assisted living facility. And my dad fortunately at that time, had not declined as much. And so it was a really appropriate setting of care for him. But my mom has my dad's power of attorney. Obviously, he has dementia, so she makes all the medical decisions for him. And when he was admitted, she made it clear that she was going to continue to take my dad to his regular doctor, so they should have no routine medical care given at the assisted living facility. Well, it'd been about a month or so after he had been admitted. And my mom was looking at the pharmacy records. And she saw that there was a drug, a drug called tamsulosin, which hadn't my dad wasn't supposed to be on tamsulosin. So when she looked at the pharmacy records, and she saw this drug being administered to my dad, she realized that he was given being given a drug that he shouldn't be given. And in fact, she had noticed a decline in his cognitive ability over the first month or so that he had been at the facility. So she immediately called. We, first of all, we looked up the side effects of that drug, and could see that tamsulosin can cause cognitive decline in patients with dementia. And so they immediately took my dad off that drug and he rebounded right away and he came right back. So that was really good, but this was an obvious medication error, my dad was not supposed to be on this drug. Then the second thing that happened was my mom got a call from the facility, saying that it was actually from a physician group that worked with the facility. And they said, Hey, we need your we need the Medicare number for my dad so that they can bill Medicare for an examination that occurred. And my mom said, What examination? How can you do an exam of my husband, without me being there, I have I have power of attorney, I've also been his caregiver, there should be no examinations without my consent. Well, they said that they had done an examination of my dad when he was admitted, and they had a bill outstanding of more than $400 that my mom owed, or they needed to bill it to Medicare. So it was very ironic that at the time I'm writing my book, Never Pay The First Bill and Other Ways To Fight the Healthcare System and Win, my poor mother was being afflicted by a medical error, first of all, and then number two, a bill for a procedure or for excuse me for an examination that she had never even approved.
WS: Well, I agree, it was it's ironic, but and also highly emblematic in many ways as well. But especially whenever, you know, you start unpacking the issues that you introduce, in this story. Medical error. You have story after story in your book about medical errors that people get charged for. You mentioned one, for example, where someone had surgery, and the surgeon had inadvertently left I think some gauze inside. And so it was a mistake in the first place. They had to go in and remove the gauze and they got billed for fixing the mistake that was made in the first place. So just That's right, on and on. So it brings it really brings me though to this point and this question for you, Marshall. That is a, you know, the title, the title of your book, Never Pay the First Bill, that I guess one of the lessons that we can derive both from that story that you told us some of the other lessons in the book stories in the book is, question everything. Question the bill. And, you know, understand why you are getting the procedure or the examination that you're getting. Ask how much it cost. Before if you though, I got it, I gotta say it, I want you to address this question Marshall. So I, you know, I go to McDonald's, or Burger King. And I asked how much the Whopper or the Big Mac is. And the minimum wage employee that does not typically have a high school education can give me the answer to that question.
WS: And I can ask, what's the price of the milkshake? You know, what's the price of an ice cream cone? What's the price of fries? What's the price of? And you know, and they've got an answer or, you know, maybe they have to hit their touchscreen to give an answer.
WS: They can give you. I asked a doctor who's had 25 years of education and 15 years of medical experience, what the price is of a procedure that they're about to prescribe for me, and they don't know the answer to that question.
MA: That's right.
WS: That seems crazy to me.
MA: It is crazy. And it's completely unjustified. This this is not so I another one of the reasons in chapter one, I talked about the five reasons we need to fight back.
MA: Another one of the key reasons we need to fight back is because healthcare is not broken, it was made this way. It's not because they can't give you the prices, it's because it's because they don't want to give you the prices. Because when they can hide the prices, then they can overcharge people. And by the way, working Americans are getting overcharged the most. So if someone's on Medicare or Medicaid, those government plans have negotiated prices with the hospitals and with the doctors that are usually two to five, even 10 times lower than what working Americans pay. So to take your McDonald's analogy a little farther. If I go to McDonald's as a working age person and get a Big Mac, they charge me $3 excuse me, they should charge me $3. That's the typical price. So if I go in with my mom who's on Medicare, she'll get the $3 price, my price will be anywhere from $6 to $30 for the same Big Mac. But in this case, the Big Mac might cost $1,000 for my mom, and $3,000 to $10,000 for me.
MA: And so these these prices are hidden, because when the prices are hidden, they can charge different customers, different patients, completely exorbitantly different rates. And so what I show in my book is how to find out what the lowest price other patients are paying, and then fairly ask for that yourself. Just say I don't see why you should discriminate against me because I'm a working American or because I'm covered by United or Cigna or Aetna. I would like you to please give me the price that other patients are getting. It's the same procedure. It's the same image. It's the same lab test. You don't need to charge one patient two, five, 10 times more than another.
WS: Yeah, one of the things that you've mentioned a couple of times in our conversation, Marshall and you devote an entire chapter to it in your book is this idea of suing, going to small claims court. And I want you to unpack that idea for me and for our listeners just a little bit, because I think, you know, because of your background, you know, a lot of evangelical Christians have a bit of an allergy to suing other people. I mean, in Scripture, it's talked about explicitly, you know, don't sue another brother, and in Christ. But you are a big advocate of taking people to small claims court. And so I want you to talk about why. But I want you to talk about why in the context of the story of Bill Oakley. Who was Bill Oakley, and what did he teach you about suing someone in small claims court?
MA: So let me first address the people who feel squeamish about suing someone in small claims court, I would ask them this, are you proud to be an American? Because it's our constitutional right to defend ourselves in small claims court. Our forefathers have set up our judicial system to have small claims courts in every state. And this is like, the most brilliant thing that they came up with because in what other country could a weak powerless person sue a big hospital or some powerful doctor or dentist, some wealthy person, and then you go onto a level playing field with a judge who's gonna listen to the case? And level the playing field for the for the weaker party? It's incredible. I mean, it is. I mean, it does. I'm not trying to be sappy here. But there are things about our country that are really unique and really wonderful. And a weak power, powerless person standing up to a powerful institution. That's the kind of thing that our country is built on. So let me tell you the story.
WS: Yeah, you learned that first when you were still in high school, right?
MA: When I was in high school, sometimes also people say, well, this is so complicated. How do you do it? I said, well, it's easy enough, even the teenager can do it. When I was 16 years old, I worked for a place called The Heritage Square Opera House in Golden, Colorado, which is where I grew up. It was like a dinner theater where people would come in and they'd have a nice prime rib dinner, and then go see a vaudeville style show afterward. And I was the meat carver. So I stood at the end of the buffet line, and I had a knife and I had this giant roast beef. They called it the Baron of Beef. And this thing was glistening with delicious meat juices, and it was crusted in herbs. I mean, it was a glorious piece of meat. And I would slice this meat off and I would give it to people. And I was even allowed to keep a little plate under the buffet line for myself, which I loaded up every shift and loaded with horseradish. And I loved the job. And it had great perks, eating that roast beef every night. Anyway, one night, we all show up for work. And they tell us they've shut the place down. You guys are out of a job. You're unemployed. And not only that, we don't have the money to pay you the wages that we owe you. Now, this was in the summertime. So you know, I probably had worked three weeks of you know, five hours a night or something. I think they owed me about $300. I mean, this was back, the minimum wage at this time was like $3.35 an hour, you know, this is back in the day. So we're bummed out, completely bummed out. And we're mad because we know that The Heritage Square Opera House has opened another location across town. And it's the same company, and that one is still open. So we were teenagers. We were young, but we weren't dumb. We were like, look, if you can run another business, well, then you can pay us the money you owe us. Well, a lot of it. We got together we had a little meeting some of the some of the teenagers went out and picketed the other location. And the guy who owned this business was named G. William Oakley, and he's kind of a legend in the Colorado community theater scene.
WS: Yeah, as a matter of fact, when I read that chapter in the book, I looked him up. He actually has his own Wikipedia listing. And he he is a legend kind of in that there's a kind of a species of dinner theater melodrama. Yeah, dinner theater that, he he's the guy. Out of his old vaudeville background. He's the guy that kind of originated and perpetuated that kind. So anyway, I don't mean to get off on that. But it was fascinating.
MA: Oh, it's super interesting. Right. And and G. William Oakley was this really intimidating figure to us as teenagers. I mean, we never met him, of course. He owned he owned the business. But he would he would even write and produce and star in a lot of these shows. And he would often dress in real life almost like one of the villains of the shows. Like he would wear a vest and a jacket and he would wear like kind of a top hat thing. And so he was a very intimidating guy. I had never met him. I'd never spoken to him. Anyway, we weren't getting our wages. We were not getting paid. And I remember it was my mom actually, who told me about small claims court. And she said you should sue him in small claims court. And I was like, sue him? I can barely even drive. I had no no idea what small claims court was. Well, she explained it to me. I loved the idea. I drove down to the courthouse, filled out the paperwork. I mean, you had to do it in person in those days. I wrote up a little narrative about what the complaint was. And I named him as the defendant in my lawsuit. So Marshall Allen, aged 16, against G. William Oakley, local community theater legend. Well, I, you know, I paid the money to file it, and frankly, forgot about it. Until a few weeks later, I got an a notice in the mail that we had a court date, we had a hearing. And of course, I got, I mean, that got my juices going. I was I was raring to go. I was like, okay, let's do this. I didn't know what to expect. But I pictured myself, you know, kind of arguing Perry Mason style, this making my case, right? Well, I went into that hearing, and it wasn't in a stately courtroom, it was just kind of a conference room. And I was blown away to see none other than G. William Oakley himself, sitting with his attorney at a table in this conference room where we had our hearing. I could not believe that at age 16, I had harnessed the power of the court to summon the man himself, this guy I'd never met, the owner had to show up and defend himself against me. And then I was like, game on, we got to go now. Right? his attorneys here, I'm gonna go head to head with this attorney like I'm ready. And it wasn't even that dramatic. The judge just, you know, he's probably like, an administrative hearing officer, not the judge. But he read my complaint. And he looked over at Bill Oakley, and he said, Hey, is what this kid's saying true? And Bill was like, yeah. Because basically, all I said was, he opened another business when he owed me money and so if he can run that business, he can pay me my money. And the judge looked at him and said, you need to give this kid his money. And on the spot, I got a check for the $300 or so that I was owed. And this was a really important moment for me in my life, because what I realized is sometimes the little the little guy can win. And, and also the wonder of our court system in the United States, that it's set up to allow a powerless individual to stand up to somebody much more powerful, who's taking advantage of their power. And so that's, that's a great illustration of what happens in our healthcare system. You have extremely vulnerable patients who are sickly, they didn't go, you know, buy a big screen television or take some lavish vacation they can't afford. They're just getting hit with medical bills that are two, five, 10 times higher than they should be. That's not fair. That's an abuse of power. And our small claims court gives us a platform to stand up to them. I'm sorry about my phone here. Let me try. Anyway, um.
WS: Well, Marshall, we got to land this plane at some point. And I want to I want to talk about some specific next steps. But before we do that, if you could quickly tell another couple of stories. One is - so that's that's your story of Bill Oakley and sort of your seminal moment in your life that got you into the inside of a courtroom, so to speak. And it's a story that you use to help make the case for taking people to small claims court. Two other quick stories I want you to tell. One is the story of the insurance warrior. Who is the insurance warrior?
MA: Lori Todd is the insurance warrior. This woman is legendary. And what she does is she helps people fight their appeals when they've had something that they need denied by their insurance company. And I learned so much from Lori Todd, that in my chapter of my book, where I featured her, all I could tell people is make sure you buy her book, okay, my book is going to give you an overview of her mindset. But I think her book is called Approved: How To Win Your Insurance Appeal in Five Days. This book is full of so much great knowledge about how to win an appeal against an insurance company. And I would say the number one thing people need to think about when they've had their insurance company deny something. We want to make an emotional appeal, right? Because our family needs this. We need it, our loved one needs it. People might die if they don't get the care they need or they might be 10s or even $100,000 in debt if they can't pay for this. So when you fight your appeal, it's not an emotional argument you're making to your insurance company. Your insurance company has a contractual agreement with you to provide the care that you need as long as it's medically necessary, right? Now, this doesn't mean they have to approve everything. But we're assuming that this is a wrongful denial of care that you need, because a lot of times they'll say something's experimental. Or they'll say something's not medically necessary. And you need to help them explain why it is medically necessary and why it's not experimental. So rather than make a case emotionally, make it contractually and show them how they are violating their agreement by not settling that with you and not covering the care that you need. And there's a lot more to it than that. You can read the overview of it in the chapter. But Lori Todd, the insurance warrior really is a powerhouse. And she really helps people think through how to make these appeals successfully.
WS: Well, your your account of her was compelling, and it is going to make me go read the book. I actually had a situation with my insurance company, they charged me about $12,000, for something they should have been about $1,200 literally ten times more, just asking for the bill, and saying, you know, finding mistakes on the bill, an itemized bill, which by the way, took me two requests to actually get the itemized bill. And, and they freely admitted that it was just a clerical or an administrative error. But it was the difference between literally $1,200 and $12,000. So I did that recently. To cut about a year and a half ago. Yeah, probably a year and a half, two years.
MA: That's the thing. When you get that itemized bill, you can see these errors that are very common. I mean, people don't realize the insurance industry is processing millions of claims a day. And there are so many mistakes that get made. A lot of them just honest mistakes.
MA: If we're not watching it, those things will just fly right through and then we'll get hit with bills that are way higher than they should be.
WS: Yeah, exactly right. Another person that I want you to tell us a little bit about Jeffrey Fox, who is Jeffrey Fox?
MA: Jeffrey Fox is another one of these legendary, I just call them the pioneers who are blazing the trail for the rest of us. Jeffrey is a guy whose child needed an MRI scan, I think it was. Went to UCLA. And when he got hit with the bill, the bill was much higher than what what it should have been. And so Jeffrey had successfully sued different companies in small claims court defending himself probably about a dozen times. So Jeffrey knew when he got that price gouging bill that he wasn't going to stand for it. And so he sued UCLA Health, and he won that case. And not only did he win the case, he won in his case, because they didn't even show up to defend it. I mean, imagine when you sue a hospital, they're gonna have to hire an attorney for hundreds of dollars an hour, they're gonna have to show up in court. They don't want to mess with that. So what usually happens is that they will settle that before the court date. But in his case, they didn't show up. So he got a judgment against UCLA. And then this is really a nice little flair to Jeffrey's methodology. They wouldn't pay him. And so when you look on all the small claims court websites, they have brochures that explain how to walk through the whole process. And on his brochure, you know, he needed to collect because he had won a judgment against them. And they said, in some cases, if someone's not paying you and they owe you, you can actually summon the sheriff's deputies to confiscate their property and sell it in order to pay you back. So Jeffrey wrote to UCLA and told them, I am going to have the sheriff's deputies come and confiscate your property and auction it off to pay me the money that you owe me. Because in his case, what he did, he went and he paid the bill. And then he sued them to recover the money. He demanded a refund. They wouldn't give him the refund. And then he sued them to demand the money back. He did that because he didn't want to get sent to collections. But you can also sue them before you pay the bill, as well. It's just different strategies. Anyway, as soon as they got that, notice that he was going to call the sheriff's deputies to come invade the premises, he said he got the check FedExed in the mail the next day.
WS: That’s great, that’s great. If you could give one or two pieces of advice to our listeners, as individuals to you know, kind of fight back other than the title of the book, which has never paid the first bill, let's just stipulate for the record, that that is, you know, something that we should all do, we should always question the bill, we should look at it question and push back on it. Is there anything else? What's the one other big thing?
MA: Don't assume that this is a competent system. So we get easily swayed because of the scientific, you know, medical knowledge, all the doctors are so well trained. Well, on the business side, this is an incredibly sloppy machine that is riddled with mistakes, that is processing way more information than it should on IT systems that were designed like back in the 80s and 90s. I mean, this is this is not a sophisticated network that's a well run machine. This is a bunch of fragmented individual entities processing way too much information than they should in a very sloppy way. So do not assume that the system is right. Check for yourself and verify that things are correct before you just send them money.
WS: So that's what on the individual side we should do. And I know your book really doesn't talk about public policy stuff. In fact, you specifically eschew those sort of the policy wonk perspective in your book, but I can't resist asking you because you've been covering this space for a long, long time. If you could make one or two public policy changes, what would they be?
MA: I would start by urging the hospitals to comply with the federal government's rule that went into effect on January 1 of this year, where they are now required to post their prices. And they're required to post prices for the different procedures and tests and imaging studies that they run. And they have to give you a cash price, the Medicare price, and all the prices they've negotiated with all the different insurance plans. This is game changing information, because once you see that unjustified price variation really laid out in a spreadsheet, it makes you realize how badly the American people have been getting ripped off. So I would just urge them to come to comply with that rule because many of them are not.
WS: Well, that's yeah, I think that was the gonna be my follow up. So what it sounds like what you're saying is that they are not compliant with it. So as a patient, what should we do? When should we just do we'd say, hey, I need to see that information before I'm going to pay?
MA: I would say yes, you need to comply with the federal government's rule to post your prices. And if you're not, then call that CEO, call the board members. You know, I love Warren, you talk a lot about governance of nonprofits. Hospitals have board members who are responsible under state law for the way those hospitals are run. Call the board members of those hospitals and say, ‘why is your hospital not in compliance with the federal government's rule to post prices?’ Demand it. We need to put pressure on them.
WS: Well, Marshall, one final question that doesn't have anything to do with your book. But I just well want to kind of you know circle back to the very beginning of our conversation where we started with, you know, you as an investigative journalist working mostly for secular organization, Pro Publica for many years. Have you ever encountered any pressure or pushback to either do or not do something because of your Christian faith? Have you ever felt like, uh Marshall, you know, people were thinking, well, Marshall can't do this, or, or he can't cover this, or this is a story that's not right for him because of his faith. Have you ever felt any, I don't want to say persecution, because I think that's probably too strong a word in this country when people are actually losing their lives for the faith. But any, any kind of frustration or pushback on that?
MA: No, I wouldn't say that I did. I would say, you know, there's definitely a, I was always one of the only, I would I would I would call myself like a Bible believing born again Christian, right? I'm a I actually read the Bible, I believe it's true. I have a theologically orthodox faith perspective, an evangelical Christian perspective. I never felt like anybody was like, pressuring me or anything like that, or looking down on me. What they want is good stories. And so if you're, if you're a good journalist, and you can deliver good stories, your editor is going to be happy with you. There would always be some antagonist, you know, and I think any, any believer who's out in the, in the working world, or in school, university, there's always going to be some antagonistic atheist, you know, who thinks they want to prove that they're smarter than you or that, you know, what you believe is stupid. Or they want to cause you to doubt or whatever. You're always going to get that kind of business. But those people I mean, you know, you might have picked up I like a little verbal sparring myself. And so when the atheists come at me, I welcome it. You know, I just say, look, I admire your faith to be an atheist, you know, it's amazing to look at the world and say that it just all happened by accident. I mean, there's no evidence for that worldview in that way, right? And so I, I kind of like to poke the atheists, and as much probably as they like to poke me. And eventually, they tend to get frustrated and walk away. But I never felt any persecution. I will say this, I mean, with the kind of, there's definitely a liberal bias in the media. I think it's mainly caused by a lack of Bible believing Christians in the media or more morally conservative people in the media. So I would say there are probably topics that would have been off limits, you know, if I would have pitched a giant series of stories about something pro life related, I think that would have caused some friction. So but but it wouldn't be like something that would be ignored if there was a legitimate news interest. I don't think that at all. And so I don't think that there, I didn't feel any discrimination, I mean to answer the question, just, you know, straight up. In fact, I felt it was affirmed a lot of times, you know, like when I wrote my column, which I called From Ministry to Muckraking for The New York Times and Pro Publica, and I was giving the biblical basis for investigative reporting, I mean, I had my editors asking me to add more Bible verses to my column. So I think sometimes conservative Christians are completely ignorant about the way the media works. And I also think liberals are completely ignorant about the way the Christian world works, right? There's so much ignorance on both sides. And it's proud ignorance, unfortunately. And really, what people need to do is like, hang out together a little bit more. Have real conversations with people. Have respectful conversations. And I think people would find, yeah, there's a lot of ground where we don't agree. But there's a lot of ground where we do agree. And if we would listen a little more to each other, maybe we can be a little better informed and not just, you know, lob accusations back and forth.
WS: That brings to a close my conversation with Marshall Allen. After more than a decade with ProPublica, the prize-winning investigative reporting non-profit, Allen recent took a new job with the Department of Health and Human Services. He is now the assistant regional inspector general, where he will be applying his investigative skills to fight waste, fraud, and abuse in the healthcare system with the full faith and credit of the United States Government behind him.
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The producer for today’s program is Leigh Jones. She gets technical support from Johnny Franklin, Carl Peetz and Kristen Flavin. Our executive producer is Nick Eicher. I’m your host Warren Smith. And you’ve been Listening In….
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