An Arm and a Leg on Smash Notes

An Arm and a Leg podcast.

December 31, 2019

No surprise, the cost of health care is… unhealthy. Reporter Dan Weissmann digs up revealing, surprising stories-- and some straight-up hacks-- that can help us get a little less scared and confused about the mess we’re in. We may be screwed, but we’re together. Let's talk



Recently updated notes

Once you get in a medical emergency in the US, you just might be more terrified of your hospital bills than you are of the actual trauma. How messed up is that? Of course, no one has a good solution, but that is no excuse. Take a listen to the first few minutes of this episode if you want to hear a gruesome (but not really) story of one dude seriously hurting himself. Honestly, you gotta listen to this one to appreciate it fully.

Updated on July 03

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In early April, Katelyn was in a financial bind: Home sick with COVID, she hadn't been paid in weeks. And bills were due. "My landlord is kinda beating down my door right now," she said in a voicemail to our hotline.


Weeks later, Katelyn got back in touch: She had made it through, thanks to a combination of playing hardball with one company and knowing how to play nice with others.


Because of her job, she had an insider's understanding of the playing-nice process: Katelyn works in collections for a financial institution, so she knew how to ask for help. Even so, she didn't find the process easy.


She came out of the ordeal with a heck of a story, and hard-won tips for all of us.


In addition, here are a couple of resources mentioned in this story:



You can call and leave us a message too: (724) 267-6534 — that's 724 ARM N LEG

Or share stories at https://armandalegshow.com/contact/

Thanks to everybody who supports our work! Join 'em here: https://www.patreon.com/armandalegshow


 

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A listener, who has worked in health insurance for decades, wrote in. "I have listened to all the episodes in this podcast, and there are times I come away feeling bad working for the insurance company."


We talked. Along with angst, she shared insights and advice we all can use.


 

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You've probably noticed: The U.S. economy is crashing.


Something you may not have noticed, that may sound really weird: Almost half of that economic devastation comes from just one sector.

And that sector? It's health care.


If that sounds completely backwards, it is. Except in the world of how we pay for health care in this country.


Because even though we as a society need health care workers like never before, to fight COVID...

... we-as-individuals are avoiding doctors' offices and hospitals for everything else, whenever we can. Just like we're avoiding going out to eat.


And this country runs health care kind of like the restaurant industry: When people stop showing up for Sunday brunch— or for hip replacements, colonoscopies, etc. —the enterprise runs short of cash real fast.


Even folks you'd think would be the most in-demand — ER docs fighting COVID—aren't immune.


In this episode, we look at some of the extra weird details of this very-weird recession: how a couple pieces of it are working, and what they could mean. For our wallets.


We draw in this story on stuff we covered in a Season 3 episode called Can They Freaking DO That?!? It's still fun and relevant, and you can catch it right here.https://armandalegshow.com/episode/can-they-freaking-do-that/


Thanks to everyone who supports this show on Patreon! Join 'em, and we'll shout you out at the end of an episode: https://www.patreon.com/armandalegshow


 

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Anna's insurance company said it would pay 100 percent for COVID-related testing. And then they left her to pay a giant bill.

She got help, thanks to a viral tweet, but... her story exposes big loopholes in consumer protections.


And: The way people responded to her tweet was generous, moving, and... complicated. Uncomfortable. Weird. Even with everybody doing their absolute best. (And, we should say, with as happy an ending as any of us get these days.)


Anna's story gets right to the heart of some of the really weird ways that dealing with the cost of health care — ESPECIALLY in the world of COVID-19 and the Internet and everything else — just messes with our minds, and our relationships as humans.


Thanks to Carmen Heredia Rodriguez, who reported the story of Anna's bill for Kaiser Health News and kindly let me piggyback on her hard work! You can read her version at.https://khn.org/news/bill-of-the-month-covid19-tests-are-free-except-when-theyre-not/.


Send your stories our way: https://armandalegshow.com/contact/

And support our work: https://www.patreon.com/armandalegshow


 

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Ryan Gamlin spent a decade working on the financial side of health care, before going to medical school. Now, as an anesthesiologist in Los Angeles, he’s on the front lines fighting COVID-19, an experience he describes as “scary, in a way that I never expected to be scared, going to work.”


He was scared one day last summer, too, when a California wildfire came within feet of the hospital where he was working. 

And then a fleet of fire trucks showed up to protect the hospital. “City, county, park service, forest service, new trucks, old trucks, unmarked trucks.”


“As I drove home later that day through the protective ring of equipment, I realized the fundamental difference between public safety and health care. Public safety is built on latent capacity. We pay for people and equipment to stand idle, over-prepared for emergencies.”

These days, he’s been thinking back to that experience.


“We’ve left no latent capacity in health care,” he wrote in a Twitter thread


“And some part of the tragedy that’s now unfolding in this country is because of that. Because we let health care become a business. And because businesses don’t keep a hundred extra fire trucks around, their crews trained and ready, just in case.”


We talked with Ryan about his experiences for this week’s episode. With protective equipment in short supply, he said, "It felt like a fire, with no one to call."


We ALSO hear some good news, about folks who are stepping up to help — tapping their own latent capacity.


That includes people making "ear savers" for health-care workers. Turns out, if you wear a mask all day, the elastic rubs the heck out of the skin behind your ears. Some people are 3-D printing connectors that go around the back of the head.


And some people are taking a more low-tech approach. Here's a picture of my friend and neighbor Liz Feldman is the medical director at a local clinic. She's modeling ear-savers that are basically fabric headbands, with buttons sewn in to hold the masks in place, made by a retired colleague from old t-shirts and scavenged buttons.

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Lots of people have insurance plans that only cover them with certain places —providers, certain hospitals.


But: in a COVID pandemic surge, who knows if you'd end up one of those places? And if you end up someplace else... then what?


That’s the question we got from a listener named Becky in Minnesota. She's got a Bronze plan — it only covers a limited "network" of providers— and she's got a $6,000+ deductible.


With officials talking about converting sports arenas into makeshift hospitals, Becky says: "If you call an ambulance, you may not even go to a hospital, right? Let alone a hospital that is quote-unquote in your network."


We put Becky's question to one of the country’s top health-insurance nerds: Sabrina Corlette, founder and co-director of Georgetown University’s Center on Health Insurance Reforms.


Not all the answers were comforting. But they weren't all grim either. And Becky turns out to have some good advice for us all.


And, per Sabrina Corlette's advice for anybody newly out of work — and suddenly without health insurance: Go apply for Medicaid.

As promised in the episode, here's a map showing which states have expanded Medicaid so that pretty much anybody who suddenly has very little income is eligible.


Please keep your questions and stories coming: https://armandalegshow.com/contact/

Or call (724) 276-6534 — that's (724) ARM N LEG

And as always, we'd love you to join us by supporting the show on Patreon: https://www.patreon.com/armandalegshow

For information regarding your data privacy, visit acast.com/privacy

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We kick off SEASON-19, about the cost of COVID, with a dose of hope — a story about an unlikely chain of people coming together to speed PPE to a COVID hospital in Brooklyn. NYC is a couple weeks ahead of the rest of the country, we think, so there are lessons here we can all get ready to use. Especially this: Don't be afraid that what you have to offer isn't enough. Take the step in front of you, even if it's a little one.


Here's a couple ways to start


  1. You can donate to that effort to get PPE to that Brooklyn hospital here: https://www.gofundme.com/f/artcube-army-ppe-supplies

  2. There are stories like this all over, big and small. And we want as many as we can find for SEASON-19. Tell us about the ones you know at https://armandalegshow.com/contact/


... or leave a message on our hotline: (724) 276-6534. That's (724) ARM N LEG.

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We were not expecting to bring the next season out for another couple months, but... STUFF has been happening. Is happening. We're here with you. Bring us your stories and your QUESTIONS: We'll ask the smartest people we know to tell us all what they know. go to https://www.armandalegshow.com/contact OR call our **hotline**! Yep: (724) 276-6534 -- which spells 724 ARM N LEG.

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This bonus episode turns the tables: Ace reporter Sally Herships interviews Arm and a Leg host Dan Weissmann, about what he's learned so far, and what's ahead for the show. \They dig into the stories listeners are sharing -- the lessons people say they’re learning, and the lessons they’re sharing.


And Dan previews the celebrations in store as the show hits a landmark: 500 Patreon supporters! If you haven't signed up already, there's still time to join us -- sign up by March 1 -- and earn some special rewards. https://www.patreon.com/armandalegshow

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Cathryn Jakobson Ramin, an investigative reporter with a bad back, spent years researching the $100-billion back-pain industry. She found that the most commonly-prescribed treatments, including surgery, frequently do not work — and often leave people a lot worse off. She also learned what does work. Whenever someone I know says their back is killing them, I send them a link to Ramin's 2017 book, Crooked: Outwitting the Back Pain Industry. In this episode, we hit the highlights of Ramin's findings.

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How one family's tragedy became, decades later, a $1 million gift to their neighbors. This story has everything: Laughter. Tears. Family. Community. Generosity. Softball. AND: Punk rock. John Oliver. A taco bar.

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They say the problem with relying on journalists to embarrass providers into caving on crazy bills is, there aren’t enough journalists to go around. Fair. But sometimes journalists can scale up.


In Memphis, reporter Wendi Thomas found that the city’s biggest hospital routinely sued its patients over unpaid bills, despite making tidy profits. 


The hospital even sued its own badly-paid employees — a fact Thomas said was immediately visible just by visiting the court house. “You saw them, there, in their scrubs,” she said. “I could see their [hospital] badge clipped to the front of their uniforms.”


The injustices were stark. “The defendants are just outmatched,” Thomas said. “They don't have the resources of a billion dollar hospital with its own collection agency and attorneys.”


Thomas did such a good job making a stink about it that after a couple of months, the hospital dropped more than 6,500 lawsuits, and erased the debts.


“Shame is a powerful motivator,” said Thomas. “It just is. And the hospital didn't look good, so they had to address it.”

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A woman 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 a question that comes up a LOT with medical billing: Can they freaking DO that?!?


Can some random lab hit you up for money — and then threaten you with a late fee of more than $1,000??


On this episode, we go find out.


This was fun. We'll do it again. Next time you want to know, Can They Freaking DO That?!? ... get in touch.


Also: We get into a whole story in this episode about "surprise billing" — and as we were publishing this episode, news was breaking. We've got an update at https://www.patreon.com/armandalegshow

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Sarah Macsalka has seen the stories about how expensive an emergency room visit can be, even for a minor complaint.


So when her seven year-old son Cameron gashed his knee on a weekend morning in June, the ER was NOT where her family headed first.


In fact, Macsalka did just about everything she could to avoid paying a big, fat bill to get Cameron’s knee stitched up — and ultimately failed.


For instance, she took Cameron first to a local urgent-care clinic, but was told they didn't have anesthetic. So it was off to the ER.


Before signing anything, Sarah asked what it might cost and pressed hard — but got only squishy answers.


She ended up liable for $3,000 in charges. If only she had known.


“I would've said thank you very much. And walked out and gone back to our lovely urgent care and been like, 'Cameron, bite on this stick.'”


Her adventures make an entertaining parable, and they raise a big question: In a health care system where consumers are told to "shop" for the best deal, why is it so hard for us to get the information we need?


On this episode, we get some answers, thanks to a super-insider and straight shooter: Lisa Bielamowicz, a doctor who now runs Gist Healthcare, a consultancy firm where hospitals are the clients, gives us the dirt.


We'd love it if you support this show on Patreon. https://www.patreon.com/armandalegshow

For information regarding your data privacy, visit acast.com/privacy

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It would sound a LOT like Explanation of Benefits, which is a musical revue that actually played in New York City in 2019.


... so it would feature a parody of "Bills, Bills, Bills" — the 1999 Destiny's Child hit —rewritten for the age of GoFundMe.


And it would have smart, funny musical numbers tracing the long, sad history of the U.S. health care industry.


Welcome to our musical episode! And thank you to the young NYC troupe Heck No Techno for creating Explanation of Benefits.


Our episode isn't sung all the way through — it's more like the PBS documentary on Hamilton than an actual musical of its own. But that is still. Pretty. Darn. Cool. 


AND: In keeping with our theme this season of self-defense against the cost of health care, Explanation of Benefits wraps with a set of short vignettes demonstrating ways patients can work to protect themselves from excessive charges.


So we have included here an email-by-email breakdown of songwriter Emily Lowinger's successful battle to fight off a surprise medical bill.


... and we've set it off with music — timing and cues lovingly adjusted by our audio wizard, Adam — and it is a TREAT.


Go enjoy. Have a great Thanksgiving!


... and speaking of thanks: I recently spent a weekend afternoon sending thank-you cards to folks who support this show on Patreon. I'd love it if you became one: https://www.patreon.com/armandalegshow

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Meredith Balogh has spent years learning to navigate the financial side of the health-care system. She’s a type-one diabetic, she’s never had a lot of money, and for years she didn’t have health insurance.


It hasn’t been easy, but she’s become a master. 


“There's only three things that you're fighting,” she says. “Problems with competence, problems with greed and problems with maliciousness. And luckily most things are incompetence.”


She has saved herself and her family many thousands of dollars, and made a habit — even a hobby — out of helping others: Fellow diabetics, co-workers, and strangers on the Internet.


She's a health-care ninja. And she happens to be my neighbor.


Also in this episode: Our show's chief investor (and my spouse) applies some ninja-level negotiating skills to save our family more than $700 on a lost medical device. Around here, that's what we call romantic.


Thanks to our supporters on Patreon! We'd love it if you became one: https://www.patreon.com/armandalegshow

For information regarding your data privacy, visit acast.com/privacy

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Stephanie Wittels Wachs has a daughter born hearing impaired, which is how she found out insurance didn't cover hearing aids for kids. Those start at $6,000 and only last a few years. Stephanie teamed up with a few other moms to change Texas law... and won.


Stephanie is a terrific storyteller. She's the author of Everything Is Horrible and Wonderful, a memoir about grieving her brother, Harris Wittels, a writer for TV comedies like Parks and Recreation, who died of a heroin overdose.


... and she is the host of the new podcast Last Day, which uses her brother's story as a starting point for a deep and smart and very-human look at the opioid crisis. Highly recommend.


P.S. This podcast, An Arm and a Leg, is a finalist for a very-strange, very-approriate award: Best True Crime show of 2019. Because not all crimes are against the law. Let 'em know: Go vote for us right now — voting closes November 18.


Also: We'd love it if you support this show on Patreon. Thank you!

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It’s going to be REALLY fun. Wanna share this video? Here it is on Twitter, Facebook, Instagram, and Vimeo. … and here’s an audio version of the trailer https://radiopublic.com/an-arm-and-a-leg-8X4EDj/s1!b9f73

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The answer involves a suburban housewife, a 1970s TV star, and a Las Vegas maker of popcorn and nacho cheese sauce. Also: Wall Street. Produced with our friends at 99 Percent Invisible. Many thanks to Abbey Meyers, Joshua Schein, and Nora Guthrie. Find Us Online Website: https://armandalegshow.com Twitter: http://twitter.com/armandalegshow Instagram: http://instagram.com/armandalegshow Facebook: http://facebook.com/armandalegshow About Us … Continue reading "How one drug got its $500,000 price tag (with 99 Percent Invisible)"

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It’s going to be REALLY fun. Also, maybe useful. Catch you here soon!

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For our Season 2 finale, time for some inspiration. For 30 years, James Gingerich has run a super-effective clinic in Indiana, delivering great results at low cost — to high-need, low-income patients. He’s not a modest guy, and two of his brags stand out — as a study in contrasts. One is a quote from … Continue reading "A place where they do health care more cheaply and effectively. (And yes, it’s in the U.S.)"

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Researcher Saul Weiner has been sending fake patients — actors, wired for sound — into real doctors’ offices, to learn about what actually happens, especially: How well doctors really listen to their patients. He’s tallied up what doctors miss (a lot), and how much it costs (ditto).  In today’s episode, we hear what actually happened … Continue reading "An actor walks into a doctor’s office…"

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That’s the rude awakening Eric Umansky got when he called the company that provided his CPAP machine — a device that helps him breathe at night. He got mad. And he got even, in a way: Eric is an editor at the non-profit newsroom ProPublica, and he tipped a colleague —Marshall Allen, who covers health … Continue reading "Whoa, this medical device is spying on me. In my sleep. So my insurer can deny me coverage."

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The price of insulin is iconic — doubling, tripling, multiplying like crazy, for medicine Type 1 diabetics can’t live without. To understand it, we went back almost 100 years and dug up a story of sweaty Canadian researchers — swatting away flies and doing business with probable dog-nappers, on the way to a Nobel Prize… … Continue reading "The insane, surprising history behind insulin’s crazy price (and some hopeful signs in the wild)"

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As we started working on season two of this podcast, there was one topic that seemed like we just had to look at: insulin. … and I wondered:  There are stories about insulin prices everywhere.  Would we really have something to add? Something that wasn’t just more of the same? (Enraging, terrifying, depressing.) Turns out: … Continue reading "Coming next week: The price of insulin"

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I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD.  And it meant a big homework assignment for me. Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s … Continue reading "Why are drug prices so random? Meet Mr. PBM"

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This week, we look at three MRIs with four different price tags, and an enormous range.   The first two price tags come from listener Liz Salmi, who has been living with brain cancer for more than a decade. Liz gets MRI scans twice a year, to make sure the cancer isn’t growing.   A … Continue reading "How much for an MRI? Well, that depends…"

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Caitlin and Corey Gaffer got a surprise letter from their insurance company — saying they were being dumped for non-payment. Except, as far as they knew, they were paid up. As it turned out, they’d made a couple of small mistakes, which they were eager to fix. But their insurer was definitely not interested. Caitlin … Continue reading "We thought we had adulted properly"

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

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Bari Tessler is a little famous as a “financial therapist,” but even she gets rattled by the price of health care. Also: What my family is doing for health insurance next year. This is our Season One finale. Maybe you’d like to subscribe to our newsletter, so we can keep you posted as we prepare … Continue reading "Is it ever appropriate to fudge a little? (Season One, episode 8)"

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Emergency rooms often bill you a “cover charge” just for walking in the door, and it can be thousands of dollars. That’s in addition to the huge markup on everything that happens there: seven bucks for a band-aid. Twenty dollars for a couple of pills. Reporter Sarah Kliff has collected more than a thousand ER … Continue reading "Why are ER bills so crazy? With Sarah Kliff of Vox.com. (Season One, episode 7)"

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Turns out, insurance companies allow — even encourage — crazy price-gouging by hospitals. For example, the leg brace Blake needed was available for $150 on Amazon. But thanks to his insurance, he paid more than $500. Investigative reporter Jenny Gold’s work helps us understand how that kind of thing happens. She compares health care to … Continue reading "Why Health Insurance Actually Sucks (Season One, episode 6)"

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The health-care system — especially the financial side — can feel like a Medieval torture device. So maybe it fits that workers from Renaissance fairs have come up with a work-around. In this episode I meet Robin Hood and a woman who has made more than $2 million in medical bills… disappear. Also, you’ve started … Continue reading "So, Robin Hood’s got an approach to medical bills. (Season One, episode 5)"

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Because as smart economists recently proved) it is super-confusing, and most of us can’t do the math. But! We found glimmers of hope. So don’t be scared. We’d like to hear how you’re choosing your health insurance for 2019 — or are you going to do without? — and what you’ve learned from past mistakes. … Continue reading "Why you (and I) will likely pick the wrong health-insurance plan (Season One, episode 4)"

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The answer involves a suburban housewife, a 1970s TV star, and a Las Vegas maker of popcorn and nacho cheese sauce. Also: Wall Street. Produced with our friends at 99 Percent Invisible. Many thanks to Abbey Meyers, Joshua Schein, and Nora Guthrie. Find Us Online Website: http://armandalegshow.com Twitter: http://twitter.com/armandalegshow Instagram: http://instagram.com/armandalegshow Facebook: http://facebook.com/armandalegshow About Us … Continue reading "3. How one drug got its $500,000 price tag. (With 99 Percent Invisible– Season One, episode 3)"

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Laura Derrick takes a drug that costs more than $500,000 a year. So when her family was going to lose their insurance, she made crazy sacrifices… and changed the course of history. Find Us Online Website: http://armandalegshow.com Twitter: http://twitter.com/armandalegshow Instagram: http://instagram.com/armandalegshow Facebook: http://facebook.com/armandalegshow About Us Host: Dan Weissman (www.danweissmann.com) Editor: Whitney Henry-Lester (thedarlingkiller.com) Consulting Producer: Daisy Rosario (@RunDMR) Social … Continue reading "All the Marbles: One woman’s epic quest for health insurance (Season One, episode 2)"

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When I first started talking about doing a show about the cost of health care… everybody had a story. Including me. It’s like that famous speech by the writer David Foster Wallace called This is Water. It starts with a joke about two young fish swimming along. An older fish passes by and says, “Morning … Continue reading "This is Water, and it sucks. Let’s talk. (Season One, episode 1)"

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The spiraling cost of medical care shapes people’s lives: The jobs we’re afraid to leave because of insurance, the risk that a trip to the doc could end in bankruptcy. It’s not healthy. This is my story too, and that’s why I’m making this podcast. Here’s what I’ve got in mind. An Arm and a … Continue reading "A podcast about the cost of health care, coming November 2018"

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