'Nobody Comes to This Casino and Wins.' Meet the Podcaster Taking on the Health Insurance Industry
This article is part of Money's January 2022 digital cover, which features 22 ways to make 2022 the best money year of your life. Browse all 22 articles here.
When Dan Weissmann left his public radio job in 2017, he was heartbroken and terrified. And he wasn’t just stressing over his next career move.
What he was really worried about, Weissmann says in the opening episode of his podcast, An Arm and a Leg, was “freaking health insurance.” Namely: How he was going to afford coverage for his family now that he was out of work.
“For years, our career decisions and our family decisions — many of them had been shaped by like, ‘Okay, where's the health insurance? We can't do without that,’” Weissmann says.
That’s when it hit him. Other people are in this boat too, and they could probably use some help.
As a 20-plus-year media veteran, Weissmann says health care is typically talked about through three distinct, often unhelpful, lenses: The political horse race, a personal tragedy, or as a business.
He wanted to do things differently with his podcast.
Today, Weissmann’s work focuses on the ways the American health care system silently guides our everyday choices: The random $500 bills that threaten to bankrupt us, the soul-crushing decision to stay at a bad job just to keep our insurance, and the is-this-heartburn-or-do-I-need-to-go-to-urgent-care decisions that so many of us weigh carefully against our wallets.
The topic is very personal for Weissmann, who has a congenital heart defect. His condition was a barrier to getting insurance coverage before the Affordable Care Act took full effect in 2014. Before that, insurers could exclude people like Weissmann who had certain pre-existing conditions — or charge them absurd premiums. Much has changed since then, but things are still very much broken, Weissmann says.
Now, more than three years after its launch, An Arm and a Leg is 60-plus episodes deep, and chock-full of stories designed to help listeners navigate our wild health care system.
In November, Weissmann also started a newsletter called First Aid Kit, which has bite-sized tips on paying for health care.
Money spoke with Weissmann about what you should know about health care in 2022.
Note: This conversation has been edited for length and clarity.
So I have to ask. Why does health care cost “an arm and a leg” in America?
People write big long books on this topic. I haven’t. I can’t give you an expert answer, but my shorthand — having been rooting around in this for a while — is this: Because there’s an opportunity for a lot of people to make a lot of money. Or maybe for some people to make a lot of money.
There are some big questionable players in the industry, like pharmaceutical companies, insurance companies and big health care providers. And when we encounter them in our health care system, it’s like we’re getting escorted into a casino and taken directly to the table where the World Series of Poker is being played. Except it’s a very, very arcane and specialized version of poker. And we’re playing against these giant companies who know all the rules — and in some cases, make up the rules themselves.
Nobody ever comes to this casino and wins. It’s just a question of how much we’re going to lose.
Has the Affordable Care Act changed this dynamic? Has it lived up to its namesake?
Health care political issues are very polarizing. I do my best to avoid political debates.
Personally, I do think the Affordable Care Act provides some upgrades. I can no longer be denied health insurance because of my congenital heart defect. But it's also really clear that the ACA did not fix our problems. And that's because these giant players in the industry are so good at what they do.
Even if you are a hospital administrator at a non-profit hospital — where you take your mission super seriously and your every desire is to provide the most service to the most people while causing the least financial harm — you're constrained by the fact you are essentially at that poker table, and you’re playing against all those other providers. And not just those other health care providers. You're also competing with every other pharma company. You're competing with them for market share, you're competing with them for access to capital.
You have every incentive to be at least as big a shark as everybody else.
Over the course of the dozens and dozens of interviews you’ve done for the show, what is the best or most useful advice you’ve learned?
There isn’t much one-size-fits-all advice out there because the health care world can find infinitely varied ways to screw with us. The number of distinct, ridiculous, horrible problems — or even just the annoying or expensive problems — that can come up are really endless. Which sucks.
But I would say there are some important things everyone should know. One is that we do have rights. One of them is that we have the right to an itemized bill of any [hospital] charges. Non-profit hospitals also have a legal obligation to offer a “charity care” policy, and to spell out under what circumstances they might give you a break on your bill.
Unless you’re super rich, you shouldn’t assume that you don’t qualify.
A third right is the right to see your insurance contract. This is not some summary of benefits that’s like two pages long and tentative — this is a legal document on the order of 100 pages long. It spells out exactly what your insurance’s legal obligations are. You might want to get a copy of it. It’ll probably be a project trying to get a hold of it and get an understanding of it. But so is getting stuck on hold for so long and talking to a million people who aren’t answering your questions.
How do you get people to understand and enforce these rights?
It can get pretty overwhelming. Some of the most useful advice I’ve ever sought out was from a self-defense expert about how to keep cool [when dealing with health care providers and insurance companies]. The kind of self-defense that she and her colleagues teach is referred to as “empowerment self-defense.” It’s not just punching and kicking. It's more concerned with how to deal with all kinds of threats to our safety and dignity.
It’s about how to keep cool, stay back, set boundaries and advocate for yourself without causing any more conflict than is necessary. Because it doesn't do a lot of good to get super mad at the person on the phone with you who's just a worker in a call center with a job to do and maybe a family to go home to.
What else should people know about navigating the health care system in 2022?
One piece of advice that’s really timely at the beginning of the New Year came from a listener. If you have annual screenings, try to arrange them early in the year. Because if they, God forbid, find something that would be very expensive and unpleasant to treat like cancer, at least you’re in a new year of health insurance.
A listener told me she had been diagnosed with cancer in August, which meant that her treatment started in October. And she paid all her deductibles and met her out-of-pocket maximum. But in January, the treatment wasn't done. And so that clock started all over again. And as her treatment continued, she was forking out all this money all over.
To me it's kind of a grand, horrible lesson. I am scheduling this stuff for January and February, personally.
And starting in 2022, we have one more right that's super worth knowing about: A new federal law called the No Surprises Act takes effect this year, and it addresses one of the most annoying, terrifying problems a lot of us have faced. You go to a hospital — to the ER, or to give birth, or to have surgery — and you pick a hospital that's in-network and takes your insurance. Except then, one or more of the doctors who's part of the team is out of network and doesn't take your insurance. Then, surprise! You get a great big bill from the doc totally separate from your hospital bill, and your insurance doesn't cover much of it. You end up on the hook for the rest.
This is super common with ER docs, anesthesiologists and radiologists. Basically, all those specialists that you generally don't get to choose and sometimes don't even get to meet. I've seen estimates that one out of five folks who get seen in ERs or have surgery get surprise bills, and honestly I think that could be lowballing things.
The No Surprises Act basically says: If this happens, you're not on the hook. Your insurance company has to work it out with whoever is trying to bill you.
Unfortunately, there are all kinds of caveats off the bat, like places where it doesn't apply: regular ambulances, birthing centers and some urgent-care centers. And like any other right we have in these situations, it's gonna take work to enforce this one.
Another thing I would say for this year is to get into the practice of reviewing your insurance contract if you can find it. Get good at knowing which doctors and providers are in-network for you. Get really, really, really familiar with where you would go to get care that your insurance would do best by you.
Because in the moment, God forbid you have some medical emergency, you’re not going to have time for that.
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