4. The Million Dollar Baby

Subscribe to Lemonada Premium for Bonus Content

Description

Lauren Bard’s little girl, Sadie, had a 50/50 chance of survival when she was born 14 weeks premature. Luckily, Lauren is a nurse at Dignity Health, a Catholic hospital, so she had good insurance and knew how to protect herself…or so she thought. Instead, she ended up with a $1.7 million dollar bill. Dr. Ashish Jha also joins David this week to help us figure out how the heck this happened.

 

Resources from the episode:

 

Keep up with David on twitter @CHIDavidSmith

 

Have you been hit with a surprise bill or had an infuriating run-in with the health care system? If you want to submit a patient story, email us at costofcare@lemonadamedia.com or leave us a voicemail at 833-453-6662.

 

Support for this podcast comes from The Commonwealth Fund, a health care research foundation working to improve the U.S. health system. Visit commonwealthfund.org/costofcare, and stay connected by following us on TwitterLinkedIn, and Instagram. Commonwealth Fund: Affordable, quality health care. For everyone.

 

You can click this link for a full list of current sponsors and discount codes for this show and all Lemonada shows.

 

To follow along with a transcript and/or take notes for friends and family, go to http://lemonadamedia.com/show/thecostofcare/ shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

Transcript

SPEAKERS

Dr. Ashish Jha, David Smith & Lauren Bard

David Smith  00:00

Hey listeners, the COST OF CARE is a 10-part series. We think it’ll make more sense if you start from Episode 1. So go back, start there, and we’ll be here when you’re ready.

Lauren Bard 

Seeing that bill of $898,000, it just, it completely took my breath away. I was like, it was almost laughable. Like, you’ve got to be kidding me. Like, who can afford that?

David Smith 

In theory, health insurance is designed to protect us from the excessive cost of a medical catastrophe. But too often, patients find themselves stuck with the tab .

Lauren Bard 

So our total bill was $1.7 million. What family in America could pay for something like that? And especially to go through such an ordeal and so many horrific things with my child and myself? Like, why wouldn’t they make an exception?

David Smith 

This is Lauren Bard. Back in 2018, she was hospitalized with complications during her pregnancy. Her daughter Sadie was born nearly 14 weeks premature.

Lauren Bard 

She had three different holes in her heart. She had a blood transfusion. And I didn’t hold her myself until she was almost about a month old. Because she was so tiny. And honestly the first time seeing her. It was really surreal. It almost is fake. When you see a little, this little tiny baby that you’re not used to seeing, you know, I’m reaching my hand into the incubator. And when it comes to preemies, you know stimulation is a big thing for them. So a lot of times we can’t even touch them, you just kind of have to place your hand on top.

David Smith

But even as her newborn daughter fought to stay alive, another battle was looming in the distance.

Lauren Bard  02:04

Honestly, like thinking about like how much everything would cost did not even cross my mind. I was so worried about her and my own health and that never even was a thought.

David Smith

This is the COST OF CARE. I’m your host, David Smith.

Lauren Bard 

So I’ve lived in California all my life. Currently, I live in Norco, California, it’s like a little horse town in Riverside County. And we have like horse trails in front of our house, a bunch of livestock and all that. So, if you hear roosters in the background, that’s probably what it is. I have Sadie, who is now two and a half. She’s our Million Dollar Baby I’ll be talking about and then I also have a 9-year-old son named Jace.

David Smith 

Lauren has been through a lot. So I was really surprised at how smiley and upbeat she was on our Zoom call. She’s obviously a really strong, really resilient person, but then this understated down to earth kind of way. And that might be because Lauren has spent her life helping others in their times of need.

Lauren Bard 

I’m an ER nurse. And I’ve only worked at Dignity Health. So that’s where I started out my career. I’m a charge nurse there.

David Smith 

Dignity Health is the fifth largest hospital system in the US and the largest nonprofit Hospital in Lauren’s home state of California. As a seasoned nurse and mother who had experienced some issues with her first pregnancy, Lauren knew what to look out for.

Lauren Bard  04:06

When Sadie came along, I had blood pressure issues like right from the get go.

David Smith 

Her doctors weren’t concerned until her 6-month checkup when her blood pressure read 170 over 113. For those that don’t know much about blood pressure readings, that’s a dangerous level.

Lauren Bard 

They’re like, oh my gosh, you need to go to the ER right now. And I was in the hospital for 10 days. They were just trying to keep me pregnant for as long as possible.

David Smith 

But Lauren’s blood pressure never stabilized. And as the risks mounted, her doctors decided they couldn’t wait any longer. It was time to deliver Sadie.

Lauren Bard

I was 26 weeks, and I had Sadie. She was one pound six ounces at birth, was not very beathing on her own. She had a lot of complications when she was first born. Within the first two days of her being born, they said she had a 50/50 chance of living because not only of her size, but she was also bleeding in her lungs because they were super underdeveloped. So she was hemorrhaging. Thankfully, she pulled through that, but she had to be intubated four different times, within the first month of her life.

David Smith 

Tell me learn a little bit, just about the NICU, what did the environment look like? How often were you able to visit her?

Lauren Bard 

So since she was born, I was still a patient myself for 9 days. So I was in and out of going between the NICU and my room. So we were able to be there and kind of constantly go back and forth and visit her. So at least somebody was with her, almost 24/7. But I would say the first six weeks for her was probably her most trying times. It was when we went through the most difficulty when she had, you know, echocardiograms, and she had laser eye surgery, and she had, you know, just all these complications and things going wrong. In the other rooms, you’re hearing when another baby is having difficulty or maybe needs to be intubated, or something’s going wrong. So you’re hearing all that, on top of all the alarms going off in bells. So sad love to either go […], where she would stop breathing, or her oxygen levels would go really low. So you can you’re just watching the monitor and seeing it like ding ding ding, and it’s getting louder and louder and louder. As you know, her levels go down.

David Smith 

How long was Sadie in the NICU.

Lauren Bard 

I think it was 105 days, so like three and a half months. So we spent a few holidays in there.

David Smith 

I literally can’t imagine what would be going on in my head for 100. And I don’t know how you survived 105 days of that.

Lauren Bard 

You know, the nurses were always very real with us. Like, you know, they have to call us a couple times, like, hey, I think you need to come in like she’s not really doing that well. So at least they helped prepare us for those kinds of situations and really involved us in the care for her. So I think that helped to know that, that we were included in making decisions and what was best. But honestly, just like the relationships with all her different care providers really kind of helped carry us through that hard time. You know, because you’re going through so much. And you’re dealing with this new trauma of having a baby who’s possibly going to die, or it’s just a roller coaster in there, honestly.

David Smith  08:02

By this point, Lauren is in total survival mode. But even while dealing with one health emergency after the other, and the most chaotic environment imaginable, she’s still somehow found time to contact both her employer and her insurance company.

Lauren Bard

As soon as I went into the hospital, knowing that I was going to have to deliver her fairly soon. I obviously let my manager know what was going on. And also had been talking to a nurse through Anthem Blue Cross, it’s with a future moms program. So I had already been in contact with them. And I had called to let them know that I was in the hospital and then also called when I had her. And then I spoke to a case manager from Anthem as well, a few days after the birth to say, hey, you know, the situation is what’s going on. She came here really early. So my insurance company was aware that she was born.

David Smith 

According to Lauren, Anthem assured her that she and the baby would be covered under her employee plan with Dignity. So she naturally turned her attention back to Sadie.

Lauren Bard

So a little over a month later, UC Irvine had said, hey, we’re having some issues with trying to Bill your insurance. You might want to contact them because we’re having some discrepancies or some issues. So I call down to our benefit center through Dignity. And pretty much I get horrible news that I was 8 days too late of signing her up within that 31-day allotted period. Now I was like, well, I had talked to the insurance they know and they’re like, no, you didn’t sign up through Dignity’s website portal, and I was like, seriously? I was like, I didn’t even know that I needed to do that. So apparently, as an employee, you have to sign up when there’s a life event going on. And I have to register her on our website portal on top of contacting Anthem Blue Cross, so that you have to do both of those processes in order for her to be covered. And I didn’t know I needed to do that.

David Smith  10:29

So let’s pause here in case you like Lauren, consider yourself a pretty savvy person, but still got lost in the weeds just now. Basically, despite notifying Anthem Blue Cross and communicating with her supervisors at work, the coverage still did not take effect because she’d missed one small step that had only previously been mentioned in a Dignity Health employee handbook given to her six years earlier. By the time she realized the issue, the 31-day window to register her life event had closed.

Lauren Bard 

And I tried to explain that there was extraordinary circumstances like I was in the hospital myself and so much was going on. And they were very harsh and cold. And we’re like, you know, you got the information when you were hired. And you know, the process of what needs to be done. So pretty much like, you’re kind of out of luck honestly.

David Smith 

Coming up, we’ll learn how Lauren fought back.

David Smith 

Hey, listeners, we want to hear your stories. Have you been hit with a surprise bill after a procedure? Did you have a run in with the health care system that felt infuriating or unfair? Or have you struggled to find in-network providers in your area? Share your story now by calling 8334-LEMONADA. That’s 833-453-6662 or email us at costofcare@lemonadamedia.com.

David Smith  12:18

We’re back. After spending over three months in the hospital, Sadie was finally able to go home. And life went back to normal or as normal as life can really be with a newborn. But the fight for Sadie’s coverage wore on, Lauren filed two appeals, one in November of 2018. And another in July of 2019, both of which were denied. Then, almost a year later, the bills arrived.

Lauren Bard 

So they like slowly started rolling in. I think the first bill I ended up receiving was January or February of 2019. And it was like 500. And then it went to like 1000. And then it was 70,000. And then I got another bill for the $898,000. And I kept getting them. So our total bill was $1.7 million.

David Smith 

So here’s the thing, $1.7 million is an insane number to wrap your head around. But you might think to yourself 105 days in the hospital with the level of care that she and Sadie needed. Well, maybe 1.7 million is actually reasonable. But that’s just how we’ve been conditioned to think about this stuff in America. Let’s do the math on this 105 days at $1.7 million comes out to $16,190 per day. That’s not reasonable. And when you actually review the individual fees, you quickly remember how crazy it all is.

Lauren Bard 

On the back, it breaks it down of all the costs of different things like even just for the physician to put eyes on the patient. So instead of just poking their head and looking at the patient that’s $1,700. So each time, every day, multiple times a day, they’re just looking at the patient. That’s $1,700 and you think like, you know, she’s on medications and oxygen. And she’s having procedures done, like almost every day. So it’s like, kind of mind blowing to see the breakdown and how much everything really truly costs.

David Smith  14:43

What went on in your head when you got the bill for $898,000

Lauren Bard 

Honestly, it was just like, I was in shock and I kind of just felt like numb because it like really sunk in as a reality like wow, I’m probably really going to have to owe this. And I really felt like, if they’re not going to deny it now, how is little me going to be able to win? And honestly, it was a lot. I mean, there were so many days of crying and like, I don’t know, it was like just exhaustion and like, you feel so helpless. So I knew I had to do something to just figure it out. And if that meant, you know, starting to talk to people about it, like friends and family, and seeing if there was, you know, some other kind of idea that somebody else could give me. You know, that’s eventually where I came across getting in touch with Marshall.

David Smith 

The Marshall she’s talking about is none other than our favorite top, Dr. Marshall Allen, the ProPublica reporter we talked to you back in Episode 3. Lauren’s story is featured in his new book, Never Pay The First Bill. Until he got involved. Lauren was getting the cold shoulder everywhere. She even tried shaming dignity on Facebook by posting a photo of the bill. She got hundreds of comments and shares, but zero response from her employer. Marshall is like I’m going to reach out to Dignity Health media team.

Lauren Bard  16:30

Because I’m gonna let them know we’re going to write an article about this. And it’s probably not going to be very pretty. So I think it was a day or two after I got a call from the VP of operations for Dignity. And she called my cellphone. And she’s like, hey, so and so like, I heard that you were going through this, and you know, we’re gonna do what we can to fix it. Like, really? And she’s like, yeah, there were you. You went through extraordinary circumstances. And I’m like, yeah, I was saying that in my appeals. But anyway, she was like, you know, we’re gonna get you in touch with the case manager with Anthem, and we’re gonna retro actively cover it. Like, now? Because you are going to get a bad rep, because somebody was gonna tell the real truth of the story of what? Hello, human kindness, Dignity Health did to their own employee. Like, that’s what breaks my heart that they didn’t reach out because they saw a problem it was because it was going to make them look bad.

David Smith 

Quick thing. Hello, human kindness is dignity Health’s motto. We’ll get to the irony of that in just a minute. But here’s the thing that gets me about Lauren’s story. Who knows what would have happened if she hadn’t connected with a journalist who had the power to publicly shame her employer? Probably what happens to a lot of people in this country, they go broke. And that possibility kept Lauren up at night.

Lauren Bard  18:16

I’ve worked so hard at getting to where I’m at today. You know, I was a single mom for a while with my son. I went through nursing school, and I bought my own home. But literally everything would be taken away from me, I’d have to file bankruptcy, my home would probably be taken away. Like all those things where I did my due diligence, I did everything that I could or that I knew I could do. So that was like, a harsh reality to kind of swallow to be like, wow, like, I might lose everything.

David Smith 

You’ve used the term helpless a few times as we’ve been talking. What does helplessness feel like in this situation?

Lauren Bard 

I think it was really hard when I would talk to people on the phone like you’re pouring your heart out to them. And nobody’s really listening. It’s just very frustrating. Sorry, I don’t want to get emotional but it’s a lot to deal with. You have to be very mentally strong. I do have to say we have a great community of people around us, and family and friends who are super supportive and you know, prayed for us and even donated money to us when we were in the Nicki for so long. So yeah, it was a lot

David Smith  20:31

Dignity’s motto is Hello human kindness.

Lauren Bard 

Yes.

David Smith 

When you got your job at Dignity, and you marched in on your first day proud about this big exciting place you were joining and you saw those words, what did you feel then? About that motto? And then now, as you look back, and you think about Hello, human kindness, do you think about the experience you had? How do you view that motto now?

Lauren Bard 

Oh, man. It definitely made me jaded about it. It’s a little sore spot for me. But you know, if you read our mission, you know, we’re a Catholic hospital. So we actually do have sisters there. And you know, we’re supposed to care for patients to the healing ministry of Christ, you know, treating patients with respect and dignity, and just giving them excellent care. And that’s what we honestly try and do as much as we can. So I feel like, like is just as much care and heart and blood, sweat and tears I put into the company for the 6 years at that time. That of course, they would help out and employee why I wanted them one of their own charge nurses that runs the ER, it wasn’t even a thought in my mind that they want to try and help me out if I when I reached out to them initially. And for them to be so hesitant and unwilling to help was a real slap in the face.

David Smith  22:29

When we got off the Line with Lauren, I had to cancel the next two hours of my day, I even tried to get on my next call in five minutes. And I just said like, I can’t do this right now. And it happened to time with when my kids got home from school. And I just could not stop crying after hearing Lauren story. And I think it was, it was certainly because Lauren, the humaneness of Lauren’s experience was something that I think any parent can identify with, even if her experience was so far beyond anything I’ve ever lived. But the other thing that I was just indignant about was that I’ve worked with both of the companies, Lauren described, I know people at those companies, I know executives, I’ve had dinners and drinks with these people. And they’re not bad people.

David Smith 

And yet at the same time, I know that story typifies what those two companies do as a function of just normal practice in this industry. And it sucks. It was a reminder to me of why I’m doing the work I’m doing. Because Lauren’s story is not just some outlier. It’s not just some random thing that happened that we found that makes for really good podcast tape. It happens everywhere, every day, constantly, all the time. And when you hear about the profound impact it had on her psyche, her family, she weathered it, but a lot of people don’t. Regardless of the human toll, in this case, the system did exactly what the system is designed to do. After the break, we sit down with a public health expert to figure out how we can build a better system and actually hold bad actors accountable.

David Smith  24:55

So during all of Lauren’s interview, I kept having this image come back to my head over and over. And it was an image of me being at this conference a few years ago. And an executive from Dignity is on the stage with four other people. And I noticed he’s wearing a $2,000 pair of men’s Louis Vuitton shoes. He looked like a million bucks. And being on the stage, he’s talking about all the things that they’re doing for vulnerable communities and all the things that they’re doing to engage their patients in dignified ways and the progressive care that they’re providing for patients. And then when I hear this mission statement thing of Hello, human kindness, and I look at that juxtaposition. It just makes me kind of sick to my stomach. I’m not saying in any way that the man on this panel is a bad person that he’s complicit in Lauren’s story.

David Smith  26:06

I’m not saying there’s anything wrong with wearing a $2,000 pair of shoes, I have nice shoes. What I am saying is that the words this person was saying in this conference, does not match the experience of an employee of that institution. And that kind of dissonance between executives who seem to believe they’re doing one thing, and the reality of what’s going on the ground, happens everywhere. Stories like Lauren’s pissed me off, but they say so much about the system. So to calm down and dig into it, I turn to Dr. Ashish Jha. He’s a physician and Dean of the School of Public Health at Brown University. And through the pandemic, he’s become a go to source for public health wisdom. Ashish is consistently one of the clearest and most cathartic sources on my TV. So I sat down with him, took a deep breath and discussed what happens when the good intentions of nonprofit hospitals are put to the test.

David Smith 

So across the country, most of our country’s hospitals are nonprofit. And I, you know, for a decade, I have sat in board meetings and senior leadership team meetings. And there’s always this defense like, I’ve heard this 1000 times, no margin, no mission. So the justification for this is, well, David, we got to make money otherwise, we can do the mission-based things that we want to do. Do you believe that hospitals that the nonprofit entities at the provider level, are they motivated by mission? Are they motivated by community prestige and position and posture? Like what is? What is the driving force behind a nonprofits ambitions, aspirations?

Dr. Ashish Jha  28:03

Yeah, so you know, there are 4000 nonprofit hospitals who have been 80% of all the hospitals out there. And they’re very, right. They vary in their motivations. But here’s the biggest picture point I would make. One is the nonprofit hospitals. They make a lot of nonprofits every year. I mean, technically, those aren’t profits, but they’re making a lot of money. And their margins are often very, very good. But because they can’t, because they’re not for profit. They can’t make the same kind of payouts. So what they do is they find ways of spending it. So their margins always look pretty thin. And so people are like, oh, hospitals run on a 1% to 2% margin. But the truth, of course, is hospitals. I mean, not all of them and during crises like the one we’re in now, they can struggle.

Dr. Ashish Jha 

But hospitals generally over the last decade have done extremely well financially. And that money comes from somewhere and it’s, you know, and but that money is flowing into the healthcare system, and hospitals are doing well. Their executives are doing well. And I get the no margin no mission, we don’t think that hospitals will do well, if they’re like losing money. But if the question that is asked is nonprofit has a huge societal cost, right, because these people are not then paying taxes. So the question that is in front of us is, is the nonprofit status justified? And I would say for a vast majority of hospitals, absolutely not.

Dr. Ashish Jha 

They do not generate enough community value, societal value, to justify and they would be better off and everybody better off if they were just for profit. They act like for profit institutions. They go after poor people who can’t if their bills, like for profit institutions, would this just become for profit and pay your taxes. And I think it’d be better; I think it’d be a lot more transparent. I actually think that nonprofits sad, it’s not at all, there are definitely hospitals that do incredible amounts of community service and are drifting. But the nonprofit status of a lot of these places are certainly not justified.

David Smith  30:19

So what would happen if we just took away the nonprofit status of many of these hospitals? Would it actually make anything better if those hospitals are still just charging exorbitant prices?

Dr. Ashish Jha 

Yeah, it helps in two ways. One is those hospitals now paying start paying taxes. And so all of a sudden, you can improve the tax base of that community, you can actually start doing things like investing more in social determinants from those tax dollars, that maybe can improve the health of the community and reduce healthcare utilization. So there are those direct benefits. But I think the politics of what I’m laying out is probably not feasible, workable. So I think that’s, that would be better for society be better for those communities. But there’s gonna be a lot of pushback from hospitals, because nobody likes to pay taxes.

Dr. Ashish Jha 

And, they’re going to claim that they’re going to have to lay off people. Remember, most of these hospitals are often the largest employer in any congressional district. And all of that is going to drive the politics of this to go in a different direction. I mean, there are nonprofits who do terrific community service. And so I don’t know that I want all of them to be forced into being for profit, because that I think, would be bad. But what I want is very clear metrics on what constitutes community benefit. And then a real rigorous evaluation of every hospital, certainly every large hospital, to demonstrate that it is actually generating enough community benefit to justify its tax-exempt status.

Dr. Ashish Jha  32:02

It’s sort of like imagine, David, that you’re paying me nothing to be part of this podcast. But imagine I said, you know, I charge $5,000 an hour. I don’t actually but let’s say, and,  I’m donating this to you. So I am going to write $5,000 off on my taxes for doing this podcast. Like that would be brilliant. Except this nonsense. And by the way, I’m obviously not gonna do that. But it’s that kind of stuff, right? It’s that kind of stuff where you’re like, come on.

David Smith 

For the record, an hour with Dr. Jha might actually be worth $5,000. But also thank God, he’s kidding. The sad thing about this joke is that it’s not that far from reality. Just think of Lauren getting charged $1,700. Basically, every time the doctor popped in and said, Hello. these insane fees are at the root of our American system. And it’s something Ashish has studied extensively. The first time I got introduced to your work, somebody forwarded me one of your PowerPoint decks when you were at Harvard, and your deck makes the argument that in American healthcare, we don’t have a utilization problem, we have a price problem. Can you break that down?

Dr. Ashish Jha 

Absolutely. Yeah. So for a long time, I mean, we’ve known that America spends a lot more on health care than all other major industrialized countries. And there are all sorts of theories about why that is, and what the explanation is. And what I have really been struck by is how deeply ingrained these narratives are. And so a few years ago, my colleague Irene Papanicolas, and I decided that it was really important to go back and look at the work that […] had done more than 20 years ago, in a paper entitled, It’s The Prices Stupid. But now we had a lot better data across all these high-income countries.

Dr. Ashish Jha 

So we wanted to really break down what is it that explains higher health care spending in America. And basically, what we found is that Americans don’t consume much more health care than other people, they use about the same map, maybe even a touch less than a lot of other high-income countries. But their unit prices are much, much higher. We pay more for pharmaceuticals, we pay more for doctors, we may pay for more for nurses, CAT scans, Everywhere you look, we pay more for each service. We also have higher administrative costs. And you put that together and that’s why our health care spending is so much higher.

David Smith  34:32

So let’s dig into that just a little bit. What do you believe is driving those unit costs? Like what are the biggest culprits?

Dr. Ashish Jha 

Yeah, you know, what’s interesting is it’s everywhere in the healthcare system. So our CAT scans are two to three times what CAT scans in Switzerland cost if you’ve ever been to Switzerland, you know, it’s not a cheap country, right? It’s like everything in Switzerland is super expensive, except their CAT scans are half our price. And so if you stick to that instead, well, how could that be? Is it that our doctors are better than the Swiss doctors? Like I don’t know, probably not that much better. But our doctors get paid more than Swiss doctors do. So that’s a big part of the explanation. Weak government, ineffective markets. Welcome to prices in America.

David Smith 

So Americans aren’t consuming twice as much health care as everyone else. They’re just paying twice as much for it. And you would think, well, there’s a lot of us patients and only a few of these big hospital systems, shouldn’t we be able to leverage that purchasing power? Well, this goes back to something Ashish said a little earlier, these hospital systems and insurance companies are often the biggest employer in the congressional district. And so they have a ton of political leverage. So instead of getting a seat at the bargaining table, patients are stuck in the middle of a tug of war between what hospitals want and what insurance companies want.

David Smith  36:01

Fundamentally, the insurance company’s preference would be that patients were healthy, they didn’t need to use a lot of care, and they didn’t have to pay out a lot of claims. Primarily the ladder to the provider does really well, when there’s heads and beds and when people are there, and for a head to be in a bad there needs to be a medical event or situation, which means one part of the system tends to thrive on sickness and illness and one part of the system will thrive on an absence of sickness or illness. That’s a pretty fundamental misalignment.

Dr. Ashish Jha 

It is, it is, and there’s no doubt about it, that insurance companies, their motivation is keep people out of the hospital, keep people out of doctors’ offices, keep people out of the emergency room, largely because that keeps medical claims low. And, and obviously, if emergency rooms are sitting empty, it’s hard for hospitals to make any money. Everybody is focused on trying to do their part, I don’t think there’s anything wrong with that. That’s literally how markets work. The issue is that when you don’t have a whole lot of competition, and you don’t have the right set of market forces, it doesn’t land you where you want to be in terms of optimizing consumer outcomes, or spending.

David Smith 

This is what makes Lauren story so important. It’s the tug of war in action. Her doctors were there to give Sadie the best care, the hospital was there to charge as much for that care as possible. And then our employer was doing everything in their power to avoid getting stuck with the bill. According to Marshall’s, ProPublica reporting, Dignity Health sell funds, their benefits, so they’re on the hook for bills like Sadie’s. And even though they reported $6.6 billion in net assets in 2018, and pay their CEO roughly 12 million bucks a year, when it comes to paying for patient claims. They’re a little less generous.

David Smith  38:04

But here’s the thing about the tug of war between insurance companies and providers, it’s a long game. In Episode Three, we talked about the complicated, convoluted process behind medical coding. Well, it takes time to parse through all those claims and figure out who will and won’t pay. And in the midst of the administrative back and forth, the patient is usually the one left holding the bag when the dust settles. And don’t forget, every single one of us funds this system that’s rigged against us with our premiums and our tax dollars and our co pays. And then nearly every attempt to reform the system ends up falling on our shoulders, too.

Dr. Ashish Jha 

Policy solutions that often come like try to tweak one part of it in a small way. And it doesn’t, it has not moved the needle. So right now we’ve tried things like what if we put consumers into high deductible health plans, maybe that will create the financial incentive for them to be good consumers and make smart decisions? Theoretically, right. I don’t think I don’t think it’s wrong. The problem with it is if you only have information about your prices, but you don’t have alternative choices, and you don’t have quality information, and you don’t have any sense of what the payoff of is on value of these various services, you won’t be surprised that consumers make excellent choices.

Dr. Ashish Jha 

You don’t fix a wholly broken market by like tweaking one part of it, the whole thing needs. You need choices. You need good data on quality, you need good data on value. And you often need somebody to help, people navigate these things. And without all of that we’ve just thrown people into health wealth plans and we say now they have an incentive. Let’s see if the consumers can do it. And then when they can’t we say ah, people can’t be consumers and healthcare markets don’t work. And I’m like I’m not sure we really tried it but okay.

David Smith  40:00

Right. We can’t say that markets don’t work. But we can definitely confirm that the current one is totally broken. Why? Normal markets function at their best when everyone has the same information when all the stakeholders share aligned incentives, but those things don’t exist in America’s Health Care market. That’s why health care is not a normal market. And markets that aren’t normal can’t drive competition or efficiently allocate resources, like say $4 trillion dollars’ worth of resources. And when a market becomes this dysfunctional, it hurts all of us.

Lauren Bard 

There’s families across the country who have been in my situation, and haven’t been so lucky to come out on the positive end of it and have lost everything.

David Smith

Today, Lauren has enough distance from this experience that she’s just grateful to have CD. She can now affectionately call her Million Dollar Baby.

Lauren Bard 

Sadie. She’s our little firecracker. She’s super loud and outspoken. You would, I mean, as a baby, she was always like, very quiet. And now she’s just off the charts. Super independent, wants to do things her way. But very feisty. And, you know, she definitely completes our family.

David Smith

But Lauren will be the first person to tell you that the doctors and nurses at UC Irvine saved her daughter’s life, and we’re there for her and her family during their darkest hour. The question is, should that ordeal come along with a $1.7 million price tag? And should your employer be the middleman between you and your doctors? So far, we’ve looked at how the system doesn’t work for patients. Next week. We’re talking about providers to see how the current model is leaving them burned out and powerless, too.

Speaker 4 42:12

It’s surprising to many people who aren’t in the field. But even before COVID the national rate of burnout among physicians was 40 45%. I think that’s because they aren’t really, doctors today aren’t able to practice the way they really want to practice. You know who became a doctor just to do paperwork. No one.

CREDITS

The COST OF CARE is a Lemonada Original. The show is produced by Jackie Danziger and Kegan Zema. Our associate producer is Giulia Hjort. Music is by Hannis Brown. Executive producers are Stephanie Wittels Wachs, Jessica Cordova Kramer and David Smith. Help others find our show by leaving us a rating and writing a review. If you have a story to share, call us at 8334-LEMONADA or send us an email at costofcare@lemonadamedia.com. Follow us at @LemonadaMedia across all social platforms or find me on Twitter at @CHIDavidSmith. Lastly, we want to express our appreciation for the men and women who get up every day and work in this system with a passion for improving our health. We are grateful for the work you do. We’ll be back next week.

Spoil Your Inbox

Pods, news, special deals… oh my.