2022 in Review

Dan: Hey there. It has been a heck of a year. It’s time to celebrate, or at least remember, I got together with members of the Arm and a leg editorial team recently to look back on the stories that left their mark on us. Well, we got together virtually.

Emily: Dan, are you recording on Zoom?

Dan: I’m recording from Zoom,

Emily: Fab

Dan: This is An Arm and a Leg — a show about why healthcare costs so freaking much, and what we can maybe do about it. I’m Dan Weismann.

Marian: I’m Marian Wang. I edit the Arm and a Leg podcast.

Emily: I’m Emily Pisacreta. I am a producer and reporter for An Arm and a Leg

Gabi: And I’m Gabrielle Healy. I edit First Aid Kit, our newsletter

Dan: And we’re journalists and we like a challenge. So our job here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful. And welcome to our debrief.

I’m super happy to have y’all here and we’re, gonna talk about some of the things that we’ve done and covered and seen this year that have left the biggest impressions on us. And Emily, I think you volunteered to go first.

Emily: Yeah, it was really exciting this year to be able to do a story about insulin, which I have focused on for a long time in my research and my writing. And that also is the medicine that I have to take every day to stay alive. We looked at California’s initiative to make its own insulin, and I was sort of reminded of one of the sort of behind the scenes moments that I’m not even sure if I told you guys about. I was talking to one of my sources, Chris Noble, who works for an organization called Health Access California, and all of a sudden I heard my phone beeping, like it’s crazy alarm just honking at me telling me my blood sugar is low.

And I had to say, Hey, um, this is really weird. I can’t believe I’m interviewing another diabetic and telling him that I have to pause because my blood sugar is low. And I’m pretty sure you know, the alarm from my Dexcom continuous glucose monitor is like on the recording somewhere. But, I learned so much too. Just looking at the budget for this program, one of the big questions we had was, is this money that California is setting aside like reasonable, or is this another like, empty promise from a bunch of politicians about insulin? And so it was cool to sort of stress test it and look at other kinds of obstacles that the program could be facing, you know, really because diabetics are tired of being used as a political talking point. So I was really grateful that we got to, dig into those details

Dan: well, yeah, thank you so much for that story. I can’t imagine anybody being more determined, , to get. to the bottom of it and anybody more determined to make sure that we were not giving anybody too much credit for solving something that is still not

Emily: for sure.

Marian: yeah, Emily, your insulin story was so fun to work together on just because I could tell how much it meant to you. And I had a sort of similar experience when in July we were editing the Netter story.

Dan: Netra is a company that specializes in non-invasive prenatal testing, screening for serious genetic disorders. We’d heard from a listener about their pretty awful sounding billing practices, and while we were working on this story, They took a big hit when a Wall Street investment company alleged that messed up billing jerking around both patients and insurers amounted to netter’s business model when a New York Times story raised questions about the accuracy of non-invasive prenatal tests that hurt Netter two. And while we were looking at all of that, it was hitting Marion in kind of a personal way, although our team didn’t know it at the time.

Marian: I hadn’t told anyone that I was pregnant, it was just, you know, it was too early. But it was just funny to like be editing with you and then two days later go to my doctor’s office and she’s like, okay, well we’re gonna run these prenatal tests now. And I was like, wait, wait, wait. What company are we using? And she said, Natera. And I said, that’s so funny. I was just editing a story about them and I told her about it. I asked if she had read the New York Times story about prenatal testing and she had, and so she actually told me, you know, if I encountered any funny business with the billing, that I should go to her. And she said she knows the Natera rep. And I quote, we send them way too much business for them to be doing that. So I will get the rep to fix it if you have any issues.

Emily: Wow.

Marian: yeah. So it was very helpful both to like talk through some of the science and some of my concerns on the efficacy of the tests, but also just to be like, Hey, you know, when are your providers ever connected to your billing issues at all?

But because we had been editing that story and it was on my brain, we had a very upfront conversation about it.

Dan: Marian. I was trying to remember, as we got ready for this conversation, I was like, did I find out that you were pregnant, like in our last edit for that story? I feel like Emily and I were on Zoom and,

Emily: I already knew. She already told me.

Marian: It actually slipped out when Emily and I were talking and when earlier edit, because I was like, oh yeah, I’m kind of going through this. And then I was like, wait, that just gives it away.

Emily: That was the most exciting edit ever.

Dan: Gabi’s got a story that reminds her of the reporting we did for the First Aid Kit newsletter she edits, a story about the No Surprises Act. Which outlawed “surprise bills” — but only under a pretty specific definition. Which is:

Where you go someplace like a hospital that’s in your insurance network, but gets seen by a doctor who isn’t in your insurance network.

So before the law surprise that doctor could charge you anything and you’d be on the hook without necessarily getting much help from your insurance.

Which was a widespread, terrible problem — and is now supposed to be over. .

But the medical-billing world can contain all kinds of unpleasant, and unfair surprises, like the one Gabi describes here.

Gabi: So I was sitting at my kitchen table, I was living in New Hampshire at the time, and when you’re a journalist, you know, if a random number calls you pick up, right? Could be a source, could be somebody, you know what I mean? You gotta pick up. So I get a number from a 2 0 2 number and I’m like, well, like.

You know, I don’t know, like whatever could be something. And so I pick up, it’s somebody calling me, it’s a debt collector calling me for therapy bills that I had already paid to the therapist that I was seeing back when I lived in dc. And, they were like, you know, you owe, you know, however much it was, it was, you know, not a payment that I was prepared to make at that time.

And I said, look, hey, like I’ve already paid this for real. Like, and they were like, well, we need to see the proof. And you know, when you’re moving, like, uh, you know, you could lose stuff. You could like find stuff, you know, it’s, it’s just really hard to stay organized.

And I was like, this is, I don’t need these receipts cuz I’ve already paid like da da. Keep everything. That’s a big message, that’s a big thing that we should be telling everyone all the time. But I was like, okay. So I dug through all my stuff and finally found the receipts that I had gotten, um, you know, for paying for these therapy bills. And, um, you know, it was just. Surprising and shocking. It really like kind of took a lot of time, you know? And I was, you know, I was afraid.I was like, I know how it could affect our credit.

So, uh, you know, that experience was something that, um, really stuck with me and, and keep track of your mail and make sure that you keep everything, especially when you’re moving, you think you wanna throw that old receipt out. Just, just keep it just in case.

Dan: were these paper receipts that you’d hung onto cuz

Gabi: for real, for real. I, I wanna tell you this, I’m not, I would not describe myself as a super organized person out outside of work (and we can talk about that later) But, , yeah, no, I had, I had the paper receipt that time, but, um, it was scary and, you know, it’s familiar to many of us, so I was, yeah, that’s my story.

Dan: I mean, it’s just a reminder of what an unfair burden it is on us to like, keep incredible records of everything and be able to display them at a moment’s notice and to have essentially the burden of proof. on us about whether we owe something or not is a lot, and, and, and to know our rights, right? because nobody’s, nobody’s telling us that necessarily. So. Yeah. Good on you.

So I can’t really pick a story that we did cuz I was looking at the stories. But I was like, I’m super proud that we did all of these and feel really good about them.

But I have updates on a couple of stories that we covered, this year. And they both involve court cases. That. Progressed since we covered them. So in. We looked at a nonprofit called Up Solve and they were suing the New York State Attorney General’s office for the right to help people who were being sued over debts, including and maybe especially medical debts. And they wanted to train people, like pastors and social workers to give basic legal advice. Like there’s a form you’re supposed to fill out if you’re being sued in New York, and it asks you certain questions that some of them are kind of clear, but if you’re a non-lawyer some of them are not so clear how you might wanna respond. But even just advising people how to fill out that form would in their analysis amount to practicing law without a license, which is illegal. So they were asking the court to tell the State Attorney General not to prosecute them, cuz they said, giving people this kind of advice , should be considered protected by the First Amendment.

And so that was in March and the update. The court agreed, uh, in May absolve got a preliminary injunction banning the state from prosecuting people. They train, they even held a training and then, uh, the New York Attorney General’s office appealed, which absolve says they expected, and these things do not move with lightning speed.

So, you know, that was in June. The appeal was filed. The state filed a brief in October and UPS Solve is scheduled to file a response in early January. So we’ll be watching, that’s what we know.

And then in June we covered a group of emergency room doctors who are basically suing to get private equity investors and managers kicked out of their ERs.

So in lots of emergency rooms, the doctors are employed by management companies owned by big investment firms that wanna juice profits and the American Academy of Emergency Medicine is arguing this lawsuit. They filed that doctors at at least one emergency room where they have a relationship are being told how to treat patients by the private equity owners who now employ those doctors, and that this arrangement violates a state law against the corporate practice of medicine. And the private equity firm put forth a bunch of arguments telling the court the case should be dismissed without a trial. And just before our episode, the judge said, Nope, disagree. The case can go forward. And that was where things stood in June. And since then, it’s been mostly procedural stuff. Like I mentioned, these cases don’t move quickly, right?

So in late October the court set a date for a trial to start January 12th, 2024.

Emily: Wow.

Dan: So yeah.

Marian: All right. We’ll be waiting for a while.

Dan: Yeah, so that, something to look forward to.

And that was our year end story meeting. We did talk for a minute about what else we’ll be looking forward to in the coming year. Marian had a response worth sharing.

Marian: Well,

I am gonna be out of commission for a little while. Um, so I guess in 2023, most immediately, I’m looking forward to meeting my. First born, um,

yeah, in January or February if she decides to take that long. Um, and I will be following with excitement, the work that you guys do from a distance, um, and probably dealing with my own set of medical bills,

Dan: Yeah,

Emily: no,

Marian: I will have many reasons to be listening.

Dan: And I am looking forward to a lot this year— though a new addition to my family isn’t one of them.

We have some pretty exciting stories coming up. There’s some real fighting and some real fun ahead. And of course I can’t go without saying. Thank you. Thank you for listening. Thank you for supporting our work with your dollars. As we release this, there’s still a couple days left in 2022. It is absolutely still a great time to donate. Thanks to extra matching dollars from some super supporters, your donations can still be matched. I’d love it if you help us take advantage. We’ve got a lot of work to do in 2023. Gonna do you proud? The place to go is Arm and a Leg show.com/support. That’s Arm and a Leg show.com/support. Thank you so much.

I’m wishing you the happiest, healthiest 2023 we can imagine ourselves getting. We all deserve it. I’ll catch you soon. Take care of your self.

This episode of An Arm and a Leg was produced by me, Dan Weissmann,

With help from Emily Pisacreta

and edited by Marian Wang.

Daisy Rosario is our consulting managing producer.

Adam Raymonda is our audio wizard.

Our music is by Dave Winer and Blue Dot Sessions.

Gabrielle Healy is our managing editor for audience. She edits the First Aid Kit

Newsletter.

Bea Bosco is our consulting director of operations.

Sarah Ballema is our operations manager.

This season of an arm and a leg is a co production with Kaiser health news.

That’s a nonprofit news service about healthcare in America,

an editorially-independent program of the Kaiser family foundation.

KHN is not affiliated with Kaiser Permanente, the big healthcare outfit.

They share an ancestor: The 20th century industrialist Henry J Kaiser.

When he died, he left half his money to the foundation that later created Kaiser

health news.

You can learn more about him and Kaiser health news at arm and a leg show dot

com slash Kaiser.

Zach Dyer is senior audio producer and Tarena Lofton is audience engagement

producer at KHN

— they are editorial liaisons to this show.

Thanks to Public Narrative —

That’s a Chicago-based group that helps journalists and non-profits tell better

stories—

for serving as our fiscal sponsor,

allowing us to accept tax-exempt donations.

You can learn more about Public Narrative at

www dot public narrative dot org.

And thanks to everybody who supports this show financially.

In fact, it’s time to shout out some of the people who have made new donations or increased their gift recently— I’m recording this pretty far ahead of time, so if your name’s not here, WE WILL GET YOU NEXT TIME.

Thanks this time to: [names redacted]