There’s an old saying that “the job of newspapers is to comfort the afflicted, and to afflict the comfortable.” That means that the job of journalism, if we’re doing it right, is to help out the average humans while holding the poobahs to account.
That’s something I like to think we here at Mighty Casey Media - which means me, myself, and I - do on the regular.
Someone else who’s really truly doing that every day - that comfort/affliction thing - is Jeanne Pinder of Clear Health Costs. She grew up in newsrooms, since her family owned a local paper in Iowa, and then went on to work at papers from the Des Moines Register to the New York Times, with a stint in Moscow using her degree in Russian back before the Iron Curtain came down. She’s got mad skills.
After she left the Times, she explored the idea of entrepreneurial journalism, and wound up asking the question “what if all U.S. healthcare costs were transparent?” That led her to founding Clear Health Costs, where she’s been comforting the afflicted - which in this case is everyone who needs healthcare in America - while afflicting the comfortable, also known as the American medical-industrial complex, which at last tally was on the receiving end of a revenue bonanza that’s close to four trillion dollars a year.
Clear Health Costs has had a number of media partnerships over the last few years. One in New Orleans, a series called Cracking the Code with the Times Picayune and WVUE, the Fox affiliate in New Orleans, another with CBS News called Medical Price Roulette, which includes stories running on CBS This Morning and CBS Evening News.
I caught up with Jeanne recently, and we talked about the changes we’ve seen over the last decade, and particularly the last couple years, as the national conversation about the crazy amount of money we spend, as a nation, to get pretty crummy outcomes from our healthcare system, gets louder.
Here’s our conversation.
Casey Q: So, you've been doing this crowdsourced journalism project longer than anybody else who's been doing this. What's your sense of the zeitgeist on Clear Health Costs, both your company and the larger sense as we head into 2020 where - are we on that.
Jeanne Pinder: Yeah. So, um, something really big changed in like the last year, year and a half, I think that now all of a sudden, more and more people are willing to accept, acknowledge, and embrace this idea that people should know what stuff costs in health care. Um, we think it's partly because the burden of these surprise bills and enormous health cost is falling on more and more people. So, more and more people are aware of the topic.
It's no accident, I think, that it's on the front pages of newspapers and at the top of TV broadcasts. It makes us really happy that we were early to the party, but when we were so early to the party, back in 2011 people laughed at us. You remember?
Casey Q: Oh yeah, yeah. All the, all the dude bros, all the tech dude bros couldn't quite cast themselves in the story you were telling.
So as a result, they thought, well, this isn't a problem that anybody actually has.
Jeanne Pinder: Right, right. And I think it's also true that, um, as this issue reaches deeper into people's pockets and touches more and more sectors of society, at that time when we launched, it was possible for people to plausibly say, even though it wasn't true, people would say, Oh, well this only affects uninsured people.
And the Affordable Care Act is going to come into place. Everybody's going to be insured and everything is going to cost $20, so what you're doing is going to be irrelevant. And we were like, I don't think that's what's going to happen. But people said that does with great degrees of conviction. So, one of the things that's happened too is that, um, when people told us that only uninsured people were those who were affected by this, increasingly, as we all know, it's insured people who have high deductibles, they have high co-insurance, they have out of network, out of pocket denials, surprise bills. We had somebody come in the other day, Casey, this is gonna make you like really outraged. She has a $2,000 monthly premium for herself, her husband and two kids, and then they have a $6,700 deductible, annual, and then she has 50% co-insurance for any sick patient visit. Exactly. So preventive stuff is taken care of. Yay. But she's got 50% co-insurance. So, any sick person visit is covered only 50%. And, and! They have a kid with brain cancer. So, I had somebody else come in the other day who has decided to put the three members of his family on three separate insurance plans instead of one family plan, which took his insurance premiums annually from $34,000 and change down to $22,000 and change.
That's a huge amount of money. It's, it is funny.
Casey Q: I mean, I remember when I was uninsured at the, you know, after I finished cancer year and was trying to price out what getting insurance again would, you know, 'cause every year it was a new thing, and in my world, yeah, trying to get insurance again, and it was, this was in ... for '09, would have been somewhere in the neighborhood of $30,000, both premium, and this is just for me, for one person, both premium and deductible, in the plans that were available to me. And this hilariously was after AARP had their brand new health insurance thing that they then declined to cover me because I was A, over 50; B, female; C, had arthritis; D, it was like way down in the reasons they were declining me, was the cancer thing.
It was like, what? So, AARP for 50 and over was declining a 50 plus year old woman, and it was, what? So welcome to crazy town, but we're still in crazy town and this is, what, almost 11 years later? So, what's your sense, this is a little bit of a sidebar here, but what's your sense on the state of the insurance, the medical insurance mindset. Have you heard anything, either back channel - you don't have to identify anyone - but have you heard from anyone on the insurance side of this about WTF folks?
Jeanne Pinder: No. Insurance people don't really like to talk to us. So we haven't, but, but I get the sense that, um, two things. There's a general expectation that the sky's the limit, right?
Like, if my friend John is paying $35,000 a year in premiums, well, you know, maybe next year he could pay $42,000 or $47,000. So, so it's like, you know what, I'm wondering whether there's some conversation in the insurance industry about, in boiling the frog terms, like how much hot water really actually does wind up in killing the frog.
And also, the different things that we're seeing about new and different ways to extract money from people's pockets. We had somebody come in the other day with a hospital deductible that's separate from their general medical deductible. Oh, that was the new one on me. They had to satisfy these two deductibles in addition to their pharma deductible, in addition to out of network spending, which is so like all of these different ways that the industry is determining ways to get more money out of you.
Casey Q: Yeah. The old skin in the game thing. Well, you have to prove you have skin in the game because otherwise you're just going to be a taker and you're going to suck up all of those medical services. I don't know that many people who go for medical treatment that they don't need. You?
Jeanne Pinder: Right. No, no, I don't actually,
Casey Q: Other than the, either the, well, they call it the worried well, I just call them idiots. Yeah. You’ve had a number of projects with big media outlets now, or at least, you know, large networks.
What's been the biggest surprise there? What, what's been the, wow, we didn't expect that.
Jeanne Pinder: Oh gosh. Um, I could answer that question on many levels. One thing that we were really excited about was in Louisiana when we got legislation passed, and that made us really happy.
The, if you remember, the insurance commissioner came on the air with us as we were getting ready to launch and said he had, uh, he was talking about balance billing, which is only one of the many ways that people get taken to the cleaners in this industry. But he said, balance billing is unconscionable.
It's one of the worst consumer abuses anywhere in this country. I've had a bill in the legislature in Baton Rouge to abolish it for the last 10 years. I've given up. It's never going to pass. Those legislators are not going to go against Blue Cross Blue Shield of Louisiana and Our Lady of the Lake Hospital. And then we launched, made a ton of noise and nine weeks later, the bill passed by the convincing margin of 100 to one.
Well, what that says to me is that people have been waiting for this conversation to take place in this way, that perhaps legislators and regulators don't really understand the issues clearly until we come along and explain them. We can have a lovely story at the top of WVUE Fox 8 live, 10 o'clock news that goes on for seven minutes, focusing on that nice Nancy Dubois that we see at church on Sundays or that nice Cedric Valeary, whose son is on our soccer team, and have the, have these stories told in a way that makes sense for legislators, regulators, real people to take those voices and those incidents into the C suite, into the state house.
We never really doubted the power of journalism to do that, and we'd like to see more of it.
Casey Q: There certainly are people who have, I would almost call it been riding your coattails, because you guys sort of proved the concept. And then we now have, God, I can't, I've lost count of how many different major media outlets are doing something called, you know, crazy bill of the month or something like that.
But Hey, you know, it's like somebody has got to be first. And that was, you guys.
Jeanne Pinder: Oh, thanks. Well, we'd love to be partnering with other news organizations too. I think together we're stronger. We're happy to collaborate. This is not necessarily something that's in the DNA of most news organizations. We ... We're into competition, really. You're a news hound. You know what, it's like,
Casey Q: I know, you don't want anyone to scoop you. Right?
Jeanne Pinder: But I do think if we were all working in the same direction, another thing that we've noticed is that I think the power of this journalism is multiplied on the local level. So, if we're doing this in New Orleans where we can show people, oh, that one blood test, it could be $17 over here, $522 over there, show them a picture of the place where they got their last blood test, or where their daughter-in-law works, then it becomes much more real, much, much more actionable and much more relatable.
Casey Q: Right? I mean, it's funny during the time that you were doing, or I think you still are doing, but at the beginning, you know, the front end of the CBS This Morning and CBS Evening News, the partnership that you guys did, there was a local story here in Richmond, Virginia that I somehow, because I don't watch television news anymore, all you have to do is work in television news for about 25 years, and you realize that you'd rather tear your face off with a rusty cheese grater than watch television news anymore, so I don't, but there was a local CBS story here in Richmond, and the reason I saw it, I think, was because it was on LinkedIn or something. But I know the guy who was the focus of the story, who's a local business consultant, and he, and his family - I'm not telling tales out of school, it's already been on television - but he had joined one of those faith-based healthcare things, which, wow, has that become a giant trap door upon which one can stand. And he, before he had the surgery, he went through this whole discussion with the provider and this health-share thing, and ended up socked with a real gobsmacker of a bill and is still fighting it.
So, speaking of which, that general public thing, how do you see this really penetrating into the general public consciousness around health costs? Have you seen a focusing of the rage there? Do you see any sort of like real, like rise of ... for want of a better word, the Howard Beale effect, "we're mad as hell and we're not going to take this anymore?"
Jeanne Pinder: Yeah. People really are upset and they don't know who to talk to. We've all had the experience of, like, you had this frustrating bill and you want to talk to the hospital or the insurance company about it. The hospital says, talk to the insurance company. It's their fault. The insurance company says, talk to the hospital, it's their fault. Then somebody will inevitably chime in and say, talk to your employer. They're the ones who bought you that crappy insurance policy and knew the patient or person is we like to call them are standing there in the middle of going, you know, what am I supposed to do about this? But when we as journalists start asking those questions, inviting conversation, telling those stories in a way that people can be like, wait, that same thing happened to me, I can't believe it. Two of the stories that we did with CBS are about breast cancer screening. The first one was about a woman who has dense breast tissue. She had the regular screening mammogram, then was prescribed the second level of scrutiny, I believe it was an ultrasound, maybe an MRI. And she wound up having to pay for that somewhere in the neighborhood of $300, $400. And she was ...
Casey Q: Yeah, that would have been an ultrasound.
Jeanne Pinder: She was, why did this happen? You know, isn't it supposed to be covered? And once we ran that, all of a sudden, we had hundreds and hundreds of people coming in and saying, the same thing happened to me, to the same end. And it was, you know, several hundred, several thousand dollars. So, when we say to people, we have this thing going on, we'd like to hear your stories, and they are able to place their information, their fury, their fear into the hands of people that they know will treat it right, they think of us as their gladiators.
It's really rewarding. We say we're the happiest people in journalism these days because while we're hearing these horrible stories of what's happening to people, we are able to change things. We're able to change people's lives. I don't know if you remember the first story that we did with CBS was about a guy on Long Island who had gone to an emergency room with back pain. He was told that he, if he needed surgery immediately, if he did not do that,
Casey Q: Yeah, the do not pass go, immediate surgery drill.
Jeanne Pinder: Right. He risked paralysis if he didn't accept the surgery. So, you have the surgery and after the fact, the insurance company denied it, and he wound up with $670,000 worth of bills that the insurance company insisted that he had to pay.
He hired a billing advocate. She helped him out. By the time we talked to him, he had $220K in bills left. That were unresolved and he'd taken $49,000 out of his 401K, threatening his retirement. We put the story on the air, and two hours later, Governor Cuomo was on the phone with the CBS brass saying, "okay, we can fix that bill" It was one of his guys, it wasn't actually the governor, "I think we can fix that bill. And by the way, this reflects the fact that the surprise and emergency billing law in New York doesn't seem to be functioning as expected. We'll have some changes to that." So, in addition to, you know, changing an individual's life or changing policy on many levels, it's really rewarding.
Casey Q: And that that really is the big payoff. Do you see this? ‘Cause I think of it as institutional gaslighting that, yeah, that's for so long … and it's not, I'm not pointing at any one player here. I mean sure, the insurance companies get a fair share of the blame the hospitals ditto. And then I think employers have ended up standing on a trap door kind of … of their own making, but that that's, you know, it's like, welcome to artifacts of World War II, that health insurance through your employer thing. That's an artifact of World War II. But how do you see that institutional gaslighting thing, ending, are we getting there?
Jeanne Pinder: I, you know, I think it's journalism again. So, I'm, among the things that we're working on are stories about the role of private equity in the continuing conflagration over health costs. Private equity, you're probably aware, has ventured into the health space because. There's more money to be made here than there is in silly old stocks and bonds.
Casey Q: Somebody noticed that four trillion a year is somewhere north of five times the annual Pentagon budget, right? So, there you go.
Jeanne Pinder: Right? This what we're seeing, a really active role of private equity in emergency room docs, radiology, anesthesiology, pathology.
Quite often if you get a hospital bill, if you look at it, the hospital bill will say, you know, if you have any questions about your hospital bill to call here, but if you have any questions about radiology, anesthesiology, or emergency room doc, your pathology, these are all the numbers that you call for that.
Many of those entities are owned by private equity and private equity has taken a very active role. The two biggest companies in the rent a doc business for emergency room doctors are Team Health and Envision Health, which are owned by private equity, and which were found to have an extremely active role in a big dark money campaign to turn back the surprise and emergency billing law in Congress.
Weirdly, there was a consensus, a bipartisan consensus in Congress that this should be addressed at the federal level, and the bills seemed to be going places that it's been repeatedly undermined and short-circuited by lobbyists and this dark money campaign, heavy advertising in the states of senators and representatives who are thought to be a swing vote.
Casey Q: How do you see this working out? Do you see this working on this issue of people being endlessly gaslighted and robbed blind, particularly when they're, when they're sick? How do you see this shifting? I mean, do you have a timeline where you can see, in 10 years, are we still going to be having this conversation?
Jeanne Pinder: That's a really good question. I mean, everything takes longer than you expect it will. I do think that from what we're seeing, the changes that took place, I would say the last 18 months, maybe 24 months, that more and more people are furious and afraid about this topic, a growing sense that it's unsustainable on so many levels.
I do think that also, separate from the unsustainability, it is not right. I think this bothers people on many different levels, the sort of moral imperative that we can't ask people to choose your money or your life. This is not really who we are as a nation. Nobody's really comfortable with it.
Nobody knows where the buttons are to push to fix it, where the levers are to make change. We happen to think that journalism is one of the biggest levers that one could use. We're a little bit skeptical about legislation and regulation right now because this is an industry that is, as you know, heavily regulated, but ineffectively regulated on many of ...
Casey Q: Well, the healthcare lobby makes the Pentagon look like homeless people.
Jeanne Pinder: Right, right. Yeah. There is that. I wouldn't be able to make it prediction about the timeline, but I do think that things have changed dramatically in the last year or two and that we'll see more dramatic change. I mean, the partnership with CBS has made a ton of noise. People are paying attention. We're also partnering with WNYC Public Radio and Gothamist here in New York with a big lovely grant from the New York State Health Foundation, which, to which we are deeply respectful and thankful for their support in this. This is something that wouldn't have happened two years ago. Things are changing.
Casey Q: I mean, I think that on this, you know, state level is where we're seeing the most action about a lot of things, everything to drug pricing, to universal access to, you know, to health coverage, et cetera. So, I think that perhaps depending on what state you live in, you could either feel really hopeful or like flinging yourself off the nearest bridge. It'll depend.
Jeanne Pinder: Right. You could be somebody who lives in Vermont or Colorado where they had single payer legislation, like a real effort to that. Maybe it was too early. Maybe it'll pass in the next year or three years from now.
Casey Q: Stay tuned for updates because you know there's, if there's one thing you can guarantee is that everything will always change. So, any closing thoughts?
Jeanne Pinder: I would just invite listeners to come on over and share their prices at ClearHealthCosts.com, you can use the little orange button in the upper right-hand level that says, share your prices.
You can email us with your stories, [email protected]. If there's something that you think we need to know, tell us. We are hearing a lot from deep throats, from people inside the industry who have things that they want to say. They might want to whisper in our ears, and we're happy to listen to people who want to whisper in our ears.
Casey Q: All you leakers out there, all you whistle blowers, come on, jump in, the water’s fine.
Jeanne Pinder: I'm [email protected] - email me.
So there it is, folks - leak like good little sieves if you’re inside the comfortable castle, and if you’re among the afflicted, otherwise known as “people who rely on the American medical industrial complex for healthcare,” let Jeanne and the other folks at Clear Health Costs know if you think you’ve gotten an insane healthcare bill.
Journalists ARE gladiators. Our swords are pens and keyboards, our shields are hammered out of the First Amendment in the Bill of Rights. And we’ll fight for the rights of all Americans to know exactly what’s going on inside the castles of the comfortable.
Danny van Leeuwen, also known as Health Hats - with his diverse and prolific health experience, Danny uses his multiple hats to empower people as they travel toward their best health. To join Danny on that best health journey follow HIS Health Hats podcast on iTunes - it’s terrific!
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