A “deal” on health insurance comes with troubling strings

Dan: Hey there!  A little rough language just ahead— don’t worry, it’s beeped. And it’s super-worth it.

But if you’ve got little kids listening and you’re at all concerned— I will hold for a sec, while you hit pause. Ready? 3…. 2… 1…  

Here we go:

 

Robo: Welcome to our modern hospital where if you want to know a price you can go f*** yourself

 

Dan: Oh, man. That is the beginning of the most painfully-hilarious thing I’ve read for a long, long time. 

 

Robo-Voice: Seems you have an oozing head injury there. 

 

Dan: It hit the Internet a week or two ago, published by McSweeney’s.

 

Robo: What’s that? You want a reasonable price quote, upfront, for our services? Sorry, let me explain a hospital to you: we give you medical care, then we charge whatever the hell we want for it.

 

It actually keeps getting better. 

 

Robo: If you don’t like that, go f*** yourself and die.  

 

Dan: The minute I saw it, I emailed the author, Alex Baia. 

 

Robo: Honestly, there’s no telling what you’ll pay today. Maybe $700. Maybe $70,000. It’s a fun surprise! 

 

Dan: And he wrote back!   We talked. He’s great. More about that conversation later.

 

Also, I have promised to tell you what my family is doing for health insurance in the coming year. That’s at the end of this episode. But first, I have a story for you. 

 

This is “An Arm and a Leg,” a show about the cost of health care.  I’m Dan Weissmann. 

 

A few months ago, when this show was still an idea, my wife showed me a post by a woman named Bari Tessler. 

  

Bari is a little bit famous as a “financial therapist.”

 

In her twenties, Bari trained to be a more-traditional kind of therapist.

 

Bari: Sexuality, intimacy, body, food, grief, death, all of those kinds of topics. That’s what I thought I would be working on

 

Dan: And then, after grad school— she’s working for like 11 dollars an hour, like I guess you do when you’re a baby therapist— and her grad-school loans start coming due.

 

Bari: I just flipped out, you know, I just freaked out. I was like, wait a second. When did we talk about money in graduate school— when I was training to become a therapist? Nowhere!

 

Dan: OK, light-bulb: Money’s like all the other big, hairy, intense stuff she’d been expecting to work on. We learn how to deal with this stuff— kind of—  from our parents, who it turns out had their own conflicts.

 

Bari thought about her own memories, growing up in a Jewish family on Chicago’s North Shore, with parents who ran a business.

 

Dan: I have memories of um, them working or my dad working really hard— loving his work. But it being very stressful. He was in real estate. They owned bars with they own gay bars with my uncles. 

 

Bari: How did your Jewish family in the suburbs of Chicago, uh, end up in the business of owning multiple gay bars?

 

Dan: So, my uncle, my uncle Steve…

 

… and his life-partner Pat moved from New York to Chicago to realize a long-time dream that Steve shared with Bari’s dad: Run a bar. Or two or three.

 

Bari: They owned a lot of the main original bars on Halsted Street.

 

Dan: These are like iconic places that helped define Chicago’s boys’ town neighborhood, with names like Christopher Street, Vortex, Manhole.

 

Bari: My family owned all of those bars. Yeah.  as a kid, and having gay uncles. Yeah. I even remember them showing up at my bat mitzvah with leather pants and purple ties and I thought they were the coolest. Ever! I was so close with them.

 

Dan: So, when Bari’s an adult, she thinks about what she learned about money from her family: A business can be stressful AND it can be a way to make a positive difference in the world. To create something— a space for a community— that didn’t exist before. 

 

Bari: Yeah. It’s a great role model in that way, which I think led me to create my own work

 

Dan: Now, Bari’s been a financial therapist for 17 years. She’s published a book called The Art of Money, and she runs an online course. Full disclosure— my wife Devorah took it a couple of years ago. 

 

And this year, Bari makes a post online, asking if anyone knows a solid expert on health insurance. And she adds: “Does affordable health insurance even exist anymore?”

 

So, this financial area has the therapist… kind of rattled. I got in touch. I asked her: What happened?

 

Bari: So for 20 years now, 20 plus years we’ve been paying for our own health insurance,

 

Dan: She and her husband have their own business, they pay that directly. 

The price has been creeping up. A thousand a month, eleven hundred, twelve.

And it wasn’t feeling like such a great deal.

 

Bari: Um, about a year and a half ago, my son needed an asthma tests and we’re like, oh, we have health insurance, so yeah, let’s go do this, this asthma test in Denver. And it wound up being $1,500 out of pocket and it just felt like why is going on here?

 

Dan: And last year, it goes up ANOTHER couple hundred bucks a month. And… 

 

Bari: For some reason it was like, “That’s too much!” You know? I’d hit a limit. Something in me snapped. And I said that’s it. Or we need to explore other options here.

 

Dan: They found two things. Between them,they  kind of sub in for health insurance.

 

Barry is not wild about the arrangement.

 

I mean, actually, one of the two things, Bari really likes. 

 

It’s a local medical practice in Boulder, where she lives, with a flat, monthly fee. 278 get the family basic medical care, all-you-can-eat, seven days a week.

 

Barry: We can text them if we have an issue. My son had a toe infection, they got us in on a Sunday and the doctor looked at it and said, I’m concerned. I don’t want this to become a staph infection. It does not look good. And we did a round of antibiotics. Eight days later we’re in there, the infection is gone and I’m just so grateful and I can go in for all sorts of things there. 

 

They have a woman on staff who works with hormones in perimenopause, and that’s a whole other interview, but it’s not like I’m, I have to go to all these different specialists, we’re really excited about this. And, you know, back in the day when we were, it’s not that we’re just paying $1300, $1,500, we would also have such a hard time getting a doctor’s appointment and then we also had to do a big copay and then we also were still paying out of pocket. 

 

Dan: And this is two-seventy-eight a month for the three of them.  And… 

 

Barry: They do 70 percent of emergency room procedures. 

 

Dan: But what if something comes up that this group can’t handle? Something that needs a specialist? Something big?

 

Well, that’s the second thing Bari’s doing— and it’s the part she’s not wild about.

 

It’s this thing called a “health share.” 

 

Bari’s family chose one called “Liberty.”

 

Health shares like Liberty aren’t really insurance. They do collect money every month and then reimburse members for medical expenses. 

 

But they don’t PROMISE to reimburse, and they’re not regulated like insurance— if they deny something, there’s not a lot of recourse. And there are hard limits to how MUCH they’ll reimburse. If you run into something super-serious, super-expensive, that could be a big deal.

 

And there are things they don’t reimburse at all, including— in Liberty’s case— mental health services.

 

And they’re controversial. 

 

Like other health shares I’m aware of, Liberty identifies itself as a Christian ministry, and some of what they don’t reimburse reflects their doctrine: No abortion, no contraception. No addiction treatment.

 

You’ve probably noticed by now, Bari’s a fluid talker.

 

But when our conversation moves to this topic, things slow down. 

 

Dan: And the health share. Tell me about that. What, what, which one are you doing? 

 

Bari: We’re using liberty and…

 

Dan: This is one of the Christian ones, right? 

 

Bari: Yes. You know, I’m not Christian, I’m Jewish. I’m, but do I believe in the basic  principles of any religion? Yes. I’m the true religion. Not, not. We’re not. We’re a Christianity goes where if you’re gay then you can’t be a part of this or if you’re, you know, um, no to that. 

 

don’t, don’t they have some of these restrictions though, like, like no prenatal care if you’re not married or I’m or no, no addiction treatment.

 

So you know, we, we did a good amount of research but I, I’m sure that I don’t agree with everything that they’re saying. So it’s not ideal. And— it’s not ideal and it’s, it was one of those things where I was weighing my options of paying $1,500 that went to health insurance companies and made them wealthier and did nothing for my family or my community, or I went with a transition option while we’re figuring this out and still debating on what to do here. 

 

Dan: So, that conversation was in September, and as our show launched— and as open-enrollment for health insurance got underway— I wondered if that figuring-out process had gone any farther.

 

And when I listened back to my conversation with Bari, I realized: I had harder questions for her too, that I hadn’t asked before.

 

Her gay uncles were such formative figures— but Liberty doesn’t recognize gay marriage. How does that sit with her?

 

So, we talked again, by phone.

 

That’s right after this.

 

OK, Bari was conflicted. Where did she land? 

 

Sticking with Liberty. And still conflicted.

 

Bari: It actually goes against a lot of my beliefs or some of them, right? But it’s a lot less money and can serve my family. 

 

Dan: She hopes that she can do good with the money her family is saving.  Hundreds and hundreds of dollars a month. But…

 

Bari: I mean my husband was just saying this the other day, he wishes that there was a health share for the progressive community and not just health shares for the Christian community. I mean so far I’m grateful for what I’m getting from them but not everyone in my community and a big portion of my community, um, is the gay community and how that has always been. Um,

 

Dan: Has that come up within your community? Have people from your community been like, “hey, why are you doing this? Why are you participating in this thing that excludes people like me?” Or has that just not come up?

 

Bari: No, I haven’t brought it up. So this is, you know, this has been a year since we switched over and I think I mentioned that it’s taken me some time to feel okay about it. I felt like I was doing something secret and I’m the sly and I’m also going against our system which, I have rebellious side to me that’s. That doesn’t bother me so much, but I haven’t been screaming it from the rooftops. Like on social media. 

 

Dan: I mean, you’re, you’re, you’re coming out here. I appreciate it. And it sounds like there’s, there’s conflict, right? That on the one hand there’s a little bit triumph of like, this is this, this is a way of saying, screw you to the system at large, honoring your rebellious streak. Um, and there again  maybe some discomfort about participating in this thing that’s not actually open to everybody, including important members of your community.

 

Bari: Oh yes. Yeah, yeah. It is looked at, it’s like, oh, well we found this other creative option— which I love. Um, but oh shit, you know

 

Dan: How do you think people are going to take it? 

 

Bari: My Choice? 

 

Dan: Yeah.

 

Bari: Um, well, you know, I’m know I’m feeling as uncomfortable, I think, and, and nervous about it as when we spoke a few months ago. 

 

Yeah. I thought, my God, it’s the most vulnerable in every interview I’ve ever done. 

 

I mean, I think my biggest concern is that I just sound like an idiot and, you know, did I sound like an idiot? And that here I am, a financial therapist —  yet this one area of life is, if it’s just an area that I can’t speak to, um, and in an articulate way yet. 

 

What’s vulnerable for me is that I leave myself open, you know, I’m just leaving myself open and people could get pissed, people could feel offended, people can get hurt, you know.

 

True, yes. True. But there are not good options. So it’s like when, you know, is it ever appropriate to fudge a little, 

 

Dan: Later, that evening, on Facebook, Bari writes to tell me she called Liberty to ask about membership for same-sex couples. 

 

She says they told her something I’ve seen elsewhere— that gay people can join Liberty individually, but they can’t get the big discount Liberty offers to married couples, about 30 percent. 

 

She’s uncomfortable. She uses the word “hypocrisy.” She’s struggling with her choice, and the choice to be public about it.

 

I tell her what she’s told me: The whole system gives us lousy options. We have to live with choices we don’t like, that make us complicit in systems we do not approve of.  

 

Nothing has given me more insight into that than the emails I’ve been getting from you. 

 

And, on that— I’m going to ask your help with something.

 

I mean, I’ve got news for you about MY family’s choices for the coming year. But first. 

 

About the emails I’m getting from you every. Single. Day. 

 

I’m getting heartbreaking, infuriating stories. 

And I’m getting stories about really interesting hacks.

And I’m hearing both from what I’ll call civilians AND from doctors, from people who have worked in billing, from deep inside Big Pharma, from private equity.

 

People offering insight, inside information, volunteering to help.

 

It’s huge.  What I’ve found myself saying is, “We’re gonna need a bigger boat.”

 

We need to be able to tell MORE of these stories. Dig into more of these tips.  

 

We’re set up on system called Patreon— you may have heard me mention it— that allows regular people to make affordable, monthly contributions to projects like this. 

 

Already, every day people are signing up to help out.  A dollar a month, two dollars, five.  It’s incredible.

 

I’m asking you to help turn that amazing stream into a flood. 

 

I’d so, so like to get a thousand people backing us BY THE END OF season two. That’s a big goal. It will allow us to do the amazing things we need to do. 

 

More episodes.  Starting with season two, in the spring.

 

AND: A system for putting all this power that’s hitting my inbox— your stories, your insights, your tips— to WORK. 

 

It’s going to be big. 

 

I’m going to ask you to do Something  to help:

 

If you can, please consider backing the show on Patreon. A dollar a month, two dollars, any amount. It all counts, in a huge way. Partly because I really, really know how to stretch a dollar. If you go to our Patreon page right now, you’ll see some pictures from the world headquarters, and you’ll see just how scrappy we are. 

 

You will ALSO see my interview with Alex Baia— the guy who wrote that hilarious and painful thing for McSweeeney’s

 

Robo: Welcome to our modern american hospital…

 

Dan: And you can hear more of that piece too, just go to arm-and-a-leg-show, dot com, slash, support. 

 

Patreon will feed you updates on what we’re up to as we build season two.  (You don’t have to be a backer to see those updates, they’re for everyone— same thing goes for the Alex Baia interview—  but there will be a few bonuses for backers.)

 

Oh, and speaking of bonuses here’s the thingWhen we get to a thousand backers, we’re going to do something a little crazy and very, very awesome

 

Every single person on that list will get a miniature Doctor of Righetousness diploma from Arm N Leg University.  

 

When I say miniature, I mean: It’ll be a postcard. I told you I know how to stretch a dollar—

 

I’m going to order a thousand of these things. Just a thousand. I may never order any more. 

 

I think you’re going to want one, so that when we take over the world and fix this shit, you’ll be able to say, you were there right from the start. 

 

We’re going to do this. You’re already showing me the way.  If you can, that address is arm-and-a-leg-show, dot com, slash: support.

 

It’s going to be an amazing year. 

 

And speaking of the coming year… 

 

If you listened to our first episode, you know we started off with a little narrative suspense.

 

Because when I started this show, I really didn’t know what the heck my family would be doing for health insurance in 2019.

 

Just to recap, my wife has been self-employed for a long time, which meant I made sure to have like job-type-jobs— the kind that came with insurance.

But then I left one, and the next step, career-wise, was really to go out on my own. Except: Where would the insurance come from?  

 

We’ve got some pre-existing conditions, see certain docs for them. They’re crazy expensive, and, as I found out, they don’t take any Obamacare plans. 

 

My wife and I talked in September. She’s always said that having the right kind of job— the kind that comes with really good benefits— is like living in Sweden. 

 

Those are the kind of health benefits my old job offered, and that’s why we’re paying them really high premiums this year, so we can stay on their health insurance. 

 

Dan: We’ve been paying that premium to continue to live in Sweden this year. 

 

Devo: Mmm-hmm.

 

Dan: So we are going to be leaving Sweden.

 

Devo: Well that really sucks because I really liked living in Sweden. 

 

Dan: Yes. Right.

 

So, our hope wasMaybe we could buy Sweden type insurance through her business. 

 

She converted one of her regular contractors to an employee early this year, partly so insurance companies would look at us as a group.

 

How’d it turn out?  Well, here. This is our family— Devorah, me, and our nine year old guy— the morning after Thanksgiving, getting ready to see some family.

 

Dan: Getting your shoes on to go buy hummus and pita to bring to the family potluck. Because we’re deadbeats. 

 

Devo: Do we want these short boots or my nice tall black white? 

 

Dan: I don’t know. 

 

Kid: Are you recording this?

 

Dan: I am, but I didn’t turn on the recorder to talk about mom’s boots

 

Devo: What do you want to talk about? 

 

Dan: It’s thanksgiving. We have a lot to be thankful for it and it’s really exciting. People are responding to the podcast, which is so neat. Um, and so, uh, you know, there’s also a bit of our story that’s happened this week to be thing.

 

Devo: The email, we got the the email! We got approved, approved, approved.

 

Kid: What?

 

Devo: We got health insurance for next year for 2019

 

Dan: I was going to say: our visas for Sweden for 2019 arrive. 

 

Devo We got the what is it, the platinum or the gold plated kill your first born, or…

 

Dan: I don’t know, but I’m glad that they said yes. I mean we agreed that this is what we wanted and we know it’s going to be super expensive, but it also is, we think, the best deal for our family. 

 

Devo: It’s too legit to quit.  Does this?

Dan: You look great. With the boots, is good. Yeah. You can’t lose, can’t lose. But yeah. So it’s something to be thankful for. 

 

Devo: Oh my gosh. Is it ever. I’m so relieved. 

 

Dan: Yeah. 

 

Devo One more year in Sweden.

 

Dan: So, Devorah’s business will be paying Blue Cross Blue Shield of Illinois significantly more than our rent every month for the coming year.  

 

It’s a ton of money— but it has seemed like the best way to protect our family from the possibility of paying an UNLIMITED amount of money for health care. 

 

Because this plan covers doctors and hospitals that the Obamacare plans do not, and that we’ve been seeing and want to keep seeing.

 

Honestly, though: Since this show launched, I’ve been learning a LOT about creative hacks— from stories you’ve sent, from folks I’ve been interviewing.  I dunno if we’ll make the same choice next year.

 

So we’ll see.

 

That is it for this season of An Arm and a Leg. We will be back in the spring with Season Two, powered in significant part by the stories and tips you are sending me. 

 

You can just keep those coming— and we love voice memos stories at arm-and-a-leg-show, dot com. 

 

We’ll be checking in with updates— you’ll find us on twitter and facebook: we are arm-and-a-leg-show— and on Patreon. 

 

That’s where you’ll see the Alex Baia interview, plus more audio excerpts from his piece.  

 

Robo: Maybe you’ll go to the ER for five minutes, get no treatment, then we’ll charge you $5,000 for an ice pack and a bandage. Then your insurance company will be like, “This is nuts. We’re not paying this.” Who knows how hard you’ll get screwed? You will, in three months.

 

Dan: Of course that’s arm-and-a-leg-show, dot com, slash, support.

 

And you might want to subscribe to our newsletter.

 

YEP, we’ve got a newsletter. Another place to find updates on season two, links to everything we do, and links to a few things we’re seeing elsewhere that we think you’ll like. 

 

That one is arm-and-a-leg-show, dot com, slash, newsletter.

 

Please keep in touch. This show is the most satisfying thing I’ve ever done, and I can’t wait to bring you more stories in the spring.  

 

Till then, thank you so much for listening — and… take care of yourself.

 

This is “An Arm and a Leg,” a show about the cost of health care.  

 

This episode was produced by me, Dan Weissmann. Our editor is Whitney Henry-Lester, our consulting producer is Daisy Rosario. Our music is by Dave Winer. Adam Raymonda is our audio wizard.

 

Thanks this week to Alex BaiaHe’s got a website with more of his humor, and interviews with other funny writers. It’s hyoom dot com— that’s H-Y-O-O-M dot com.  We’ll post a link with our interview

 

And thanks to the great Chicago band Mucca Pazza. That was their tune “Lunchtrays and Goldfish” at the top of the show. 

 

Thank you to our new supporters on Patreon!  Pledge two bucks a month or more, and you get a shout-out in this spot. Thanks this week to Allison Missal, Kelley Reep, Riley Peterson, Nancy Cardona, Mike Builder, Parker Schabel, Gary Peterson, Douglas Burton, Todd Morrell, Casey Herman, Michael Slater, Michael Wolfendale, Chris Kalb, and Sea Dough.