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A Genuinely Messed Up Situation with An Arm And a ...

A Genuinely Messed Up Situation with An Arm And a Leg Podcast

I’m really excited to have on reporter Dan Weissman to talk about his freshly-launched show, An Arm And a Leg podcast, which dives into the unique stories that come from the hellscape that is American health care. But it’s not depressing – it’s a nice conversation about everyday people vs American health care. As Dan puts it “ We’re like all blind people with this giant elephant – this giant terrifying fanged venomous elephant. And we got to get our get our picture of it together.”

You’re not going to you’re not going to wake up with a five hundred thousand dollar grocery bill all of a sudden and not know how you got it. But it’s entirely possible to go into the hospital because you’ve got a pain in your side and then get an appendectomy and be looking at a six figure bill.

 

We talk about:

  • Some of the interesting ways  people are still getting health care without going through traditional insurance
  • Why Dan is focusing on storytelling with this new show
  • Middle class guilt over being on Medicaid
  • Being a Jewish person on a Christian Health Sharing Ministry plan

About An Arm And A Leg Podcast

Health care – and how much it costs – is scary.  But you’re not alone with this stuff, and knowledge is power. We may be screwed, but we’re together – and together we may figure out how to get a little less-screwed. Also (this will sound weird, but stay with us) it’s going to be fun. Take a listen. More here.

 

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About Dan Weissmann

Dan is a veteran reporter for outlets like Marketplace, 99 Percent Invisible, Planet Money, and Chicago’s WBEZ. His work reflects sophisticated reporting, an engaging narrative voice, and a knack for snappy, accurate breakdowns of complex subjects—from urban segregation to the economics of America’s largest crop to the engineering miracles that turned the Chicago River into a sewer. You can find more of his work at danweissmann.com He lives in beautiful Evanston, Illinois, with his family.

Dan Weissmann is very serious.

Things Mentioned During the Show

 

 

 

 

 

 

Other episodes you might find relevant

 

 

 

 

  • Open Enrollment is like playing Dungeons & Dragons… with a drunk dungeon master

 

 

 

 

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A genuinely messed up situation with An Arm & A Leg Podcast (transcribed by Sonix)

Lillian Karabaic: This show is supported by generous listeners like you through our patriot on this episode was underwritten by Tamsen G Association and Stephanie Powers to learn more about ways to support Oh my dollar! and get cool perks like exclusive livestreams and cat stickers you can visit ohmydollar.com/support.

Welcome to Oh my dollar! A personal finance show with a dash of glitter. Dealing with money can be scary and stressful. Here we give practical, friendly advice about money that helps you tackle the financial overwhelm. I’m your host Lillian Karabaic

Dan Weissmann: And today we are wrapping up Health Care Month with a awesome interview with Dan Weissmann. We’ve devoted multiple episodes this month to untangling the mess of money confusion and health care. And I think this one is not actionable – This is more about the stories and complex issues that go into health care. So I think it’ll be interesting even if you are a non-American listener.

Lillian Karabaic: Dan Weissmann is a veteran reporter for outlets like marketplace, Ninety nine percent invisibl,e Planet Money and Chicago’s WBEZ. His work reflects sophisticated reporting and engaging narrative voice and a knack for snappy accurate breakdowns of complex subjects from urban segregation to the economics of America’s largest crop to the engineering miracles that turned the Chicago River into a sewer. And he lives in Evanston, Illinois with his family. And I’m really excited because you’ve got a new show coming out.

Dan Weissmann: Thank you. Yes yes. It’s called An Arm and a Leg. It’s a show about the cost of health care.

Lillian Karabaic: This is so you’re making the show that I want to make. Longtime listeners of Oh My Dollar! know that there’s been kind of a running joke between my producer Will and I that I’m going to start a second podcast called “Lily rants about health care.” And I think you are doing the more professional, better job of that show that I don’t have.

Dan Weissmann: So I think there’s room for more than one. It’s a big.

Lillian Karabaic: It is a big big subject.

Dan Weissmann: Oh my God. Yeah.

Lillian Karabaic: Well and you’re you’re kind of. We’ve been having health care month all all season for the you know in tired entirety of October through November we’ve been having healthcare month on the Oh My Dollar! show and we’re wrapping it up with you.

Dan Weissmann: Thanks so much to do this. That’s great.

Lillian Karabaic: And your show just launched on November 13th so it’s fresh.

Dan Weissmann: Yeah yeah we’re right out of the gate.

Lillian Karabaic: All right. So, tell me a little bit about how you decided that you wanted to start the show and started reporting on health care. Like it is a tough topic and it’s really complex and there’s a lot going on to it. What made you want to actually tackle the issue.

Dan Weissmann: Well I wanted to – to be reporting on this topic for years, because it’s the biggest story, it’s the most important story. It’s kind of an everything story right, it’s like a it’s a story about it’s kind of it’s a business story and it’s a politics story. But most importantly, it’s a very intimate story for really, everybody. Right, like what you like when you are sick or you have a health problem or someone you love does, someone you who might be your parent or your child or your spouse or your best friend –

Dan Weissmann: And we all have this like and they have and there is a financial question about “What’s going to happen? You know, can we afford them the care that we need? Can we get the care that we need because of money? Are we going to be wiped out financially by getting the care that we need? and will it be – I mean all that stuff I mean those are the most dramatic, crazy story which we’re all familiar with partly because – we all like we’re all living like.

Lillian Karabaic: We’re humans and we’re all disintegrating slowly right because we’re made of this meat bag that we walk in.

Dan Weissmann: Well that’s true.

Lillian Karabaic: So health care – I mean that not caring about health care is a temporary condition for most humans.

Dan Weissmann: That’s that’s for sure. And you know in this country caring about your health and what kind of health care what our health care system looks like is 100 percent tied for everybody – maybe except members of Congress who have the world’s best health plan, it’s completely tied to your other big questions about your financial life because you know God forbid you stub your toe and you go to the E.R. and you get hit with a surprise umpteen thousand dollar bill like that kind of stuff. We read those stories and we know those stories because because they come to us on our Facebook feed cuz people we love have to put up Go Fund Me campaigns when they get sick. I mean that’s. It’s almost like like it’s in it’s inescapable and it’s so like as a reporter it’s all just like well that’s a juicy story partly because of all the human drama partly because like “what’s going on behind the scenes there? How’d it get like that?”

Dan Weissmann: That sounds kind of interesting. So there’s I mean it’s those it’s those two sides of it, I’ve been like oh man – Can someone please let me at this because this is like Like what? I don’t know like it’s fascinating. It’s important. And I think that there is zero shortage of stories like and there and it could it just, they just couldn’t be more important.

Lillian Karabaic: I feel like it’s one of those things where you can walk down any street and ask someone a question about health care and they will have some intensely personal story right, in America because because it is just it ends up. It’s such a broken system, it’s so broken in the U.S., that everybody knows someone that’s been screwed by it and it’s across all income levels. It’s you know it’s across so many demographics it’s it’s not just a question of, you know you can get a lot of opinion opinions on the minimum wage if you get a rich people or you get a poor people and then a bunch of people in the middle that have maybe less opinions on it but health care is really one of those things that crosses a lot of demographics, just because it is so broken.

Dan Weissmann: What was one of the things that really decided me to do the show was you know, I was I was like hmm – this is kind of a crazy idea, Maybe I should ask people to talk me out of it. And just when I just started talking to people about, the show the idea of doing it, everybody had a story right my friend Nyla who’s a great radio host and reporter, I just asked her for advice. She was like well you know I’ve spent the last year you know under treatment for breast cancer, and like there were some surprises right there was like – like before and she had like she was diagnosed with breast cancer at age 41 and she had they did everything chemo radiation surgery everything partly because it’s like you’re 41 when you’re so young back.

Dan Weissmann: But like they did everything, and she has great insurance – she’s a state employee and you know tons of surprises, righ? Like before, like just after the biopsy, before the actual surgery somebody comes up to it is like hey she gets a bill and it’s like “hey you owe us six out six thousand bucks and she’s like+.

Dan Weissmann: Well I think we actually have a clip of this so well, we’ll play this quick clip that you have the conversation you had with her.

Nyla: Sure yeah I would log on line it would say you’ve met your deductible. And then I called them and they were like “oh well we don’t actually really know if you’ve met your deductible.” And I was like What?

Dan Weissmann: Whhhat?

Nyla: And they’re like well you’ve just had so bills we assume you’ve met. I was just like what?

Dan Weissmann: Yeah. I mean that’s this is you know after she gets all these surprises there’s that there’s that. They’re like We don’t know if you’ve met your deductible. And then there’s also like this isn’t even counting like the battle she was still having when I talked with her which went on for like a year about whether they were going to reimburse her for the wig she bought when her hair fell out like you just.

Dan Weissmann: And she and that but Nyla is you know says you know at the end of our guidance she’s like, Well you know but I had a good experience because you know – I know women my right you know who you know had to do GoFundMe to pay for their chemo.

Lillian Karabaic: Well and so and GoFundMe now I think is the is technically like the second largest health care funder in the country now at this point which is which is terrifying, because- And that you know that’s based on a rough assessment of how many are in the medical tag and the total amount and they’ve done a post on that – which is which is kind of terrifying. And – and this was like you know I’m, I’m just of the generation, I’m an older millennial so I’m of the generation where I know – that the ACA hadn’t passed yet for you know the beginning of my working career and none of my friends had health insurance. Everybody I know worked in like non-profits or you know ran etsy businesses because I live in Portland. And everybody you know runs a goat farm or whatever. And, I didn’t know, I knew almost no one with health insurance but I was also engaged in like things where people ended up screwing themselves up regularly like racing children’s bikes down hills in the middle of the night, which is what I spent most of my early 20s doing on Sunday night. And.

Dan Weissmann: Like you do, yea.

Lillian Karabaic: I ran so many punk rock shows to pay for medical bills for people. And there was this belief that when the ACA passed that would stop. And in fact, it’s actually just become more professionalized with like GofundMes and everything is I no longer have to find a band to play in someone’s basement.

Lillian Karabaic: But the the expectation that things would be solved with health care reform when we didn’t reform the cost controls at the – we didn’t we didn’t reform the system we, we, we put in a lot of stopgaps that have improved things a little bit like I can get insurance now, which is great. But we didn’t we didn’t fix it, right?

Dan Weissmann: No no.

Lillian Karabaic: So many people keep wondering – why? If you don’t dive deep into this and go into very specific policies it’s easy to be like but I thought we fixed this.

Dan Weissmann: Yeah. I don’t know I, I’ve been fascinated by this for long enough. When the ACA passed I was like “Oh that’s that’s good.” I mean you know do those things right. Yeah do those things but like – I mean the whole thing is so crazy. Yeah it’s just there’s way more. That, was, you know, the kind of best the best that the people who voted for it thought they could get away with passing. Best meaning, like that wouldn’t wouldn’t subject themselves to kind of political attacks that they didn’t think they could survive. And, you know, I as it as it happened a lot of them didn’t survive it. Right the 2010 elections were a giant wave election that crushed Democrats who voted for Obamacare largely because they voted for it. That was a big yuck factor. And, so that’s you know the politics that you know the policy is one thing, the politics are another thing, and then we get to the actual stories and the money but like but that’s the. Like how, Like how why are the politics like they are like the ACA when it passed I mean my I was like, Man Well yeah. Good. Do those things. But like, Yeah we got a lot.

Dan Weissmann: There’s a lot of work to do.

Lillian Karabaic: Yeah so the one thing, that I find really interesting is looking at kind of in, in the wake of what are rising and kind of outrageous healthcare costs and and a lot of opaqueness in the system as far as how much things cost are like the ways that people are getting health care when the market is unaffordable for them. So it obviously varies a ton by state access to insurers, your location. In many zip codes in my state – You you know you only have one option for an insurer, and and so you’re really stuck with whatever the market rate that they’ve decided to set. But you’ve, you’ve done some reporting on interesting ways that people are trying to get health care without going through the traditional insurance route because they’ve been priced out of the market and this isn’t just low, low income people. This isn’t just free clinic. What are some of the interesting things that you’ve seen folks do?

Dan Weissmann: Well, I’d say there’s two there’s two stories that are especially interesting – I mean they’re all interesting. All of us are. I mean you know this is when you’re when you say, like every you can walk on any street like it is 100 percent true like nobody’s happy, nobody’s satisfied. And so, and everybody’s scared right like you have a good like if you are lucky enough to have a good plan. Now like my wife says if you have the right kind of job with like really great benefits it’s like you live in Sweden, right? Yeah but, you know, people are worried. People who live in Sweden worry that like Sweden is going to reform and turn into the United States or that where they fail they’ll get kicked out of Sweden somehow. It’s not like it’s not pretty.

Dan Weissmann: So the two stories that I would mention though are one woman I know posted to Facebook a friend of mine a few months ago that she’s like “This is my dirty secret. I’m on Medicaid and it’s the best insurance I’ve ever had.” And and one of the questions when a conversation like we talked and one of the one of the one of the questions I asked was like well why is that a dirty secret why does it make you feel dirty? Why do you feel that you had to preface it that way. And she was like “Yeah dude that’s deep.” I mean she’s much more articulate than that but there is a you know. Bracket that. And her story and tell her story which is her husband’s the CEO of a startup and the startup went through a really rocky period where there just wasn’t money to pay the founders. And you know they they bridged it in the – and the exchange. Well it actually ties into the story like this went on for more than a year. And so in fall of 2016, I guess they went on the Obamacare exchange in Michigan where they now live. And it was like “You guys are eligible for Medicaid. They’re like No no no. Oh no we couldn’t possibly.” But then the following year the exchange was again it was like “Y’all are eligible for Medicaid. They were like Yeah. OK. Yeah.” Because they couldn’t like the insurance that they’d been paying for, You know, the price went up and they just could not afford it.

Dan Weissmann: And you know what she found, the second part was super interesting which was that it was the best insurance they’d ever had. Like you know they had medical incidents. They went and saw doctors they got fixed and they did not have to pay. You know they didn’t have to worry. They they. They worried until they got the statements and they were like, Oh “we are gonna be okay.” That wasn’t a financial catastrophe for us. And and they’d had some experience with this before when they lived in Chicago. Similarly they’d been in a kind of you know poor position for a year and they’d they’d put their kids on CHIP which is the kind of program for, to insurae

Lillian Karabaic: Children’s health insurance program.

Dan Weissmann: You answer them and um and they found it was like a nightmare. They lived on the North Side of Chicago and basically that’s a big – That’s the market for health care in Chicago is such that in on the north side – is such that you know one tier of doctors is like no we don’t take Medicaid we’re talking about we need that BlueCross reimbursement rate. And so they just don’t take CHIP. And you know so then you find a doctor that took a CHIP was a hike and a hassle and they would show up and like, you know, the medical care wasn’t so great.

Dan Weissmann: And it was and it was kind of a depressing experience to be like to find themselves like shunted like, those are the equivalent of like yeah you show up at the clinic and like this is what it is and it’s like wow this is some tough stuff. And where they now live in – Traverse City, Michigan. It’s a tourist area. And so during the summer it’s flooded with rich people and the rest of the year, it’s not a rich place. It’s you know the majority of people who live there year round don’t have a lot of money at all it’s not at all uncommon to be on Medicaid. And so if you’re operating a medical practice in Traverse City, Michigan you take Medicaid.

Lillian Karabaic: Take Medicaid.

Dan Weissmann: Yeah well all the doctors take Medicaid so that was one story of just like this was our you know, it was, you know another nine months before she posted to Facebook when we talked. She was like “Yeah. And you know what. Like I had this conversation when I bring someone into my circle of trust and tell them this I often hear like, Yeah, me too, man.” So that’s one is just like there’s a you know that one of the things like when I interviewed her I was like “Do you worry?” You know she’s very politically progressive.

Dan Weissmann: And and I said “Do you worry that by by telling this story that you’re if you’re a mom and a family, you know parents have advanced degrees that as an MBA, you own a home, you know you’re you know you look like you know middle class, upper middle class people. And you say you’re on Medicaid. Do you worry that that’s like politically giving ammunition to people were like well we shouldn’t have Medicaid look at these like the hipsters on food stamps and the the NBA is on Medicaid? Yea screw this.” She was like “Yea, I kind of do that. That’s a thing.”

Lillian Karabaic: Yeah well. And so Medicaid the eligibility for Medicaid is based on monthly income and everything else on the exchanges based on annual income. And which is particularly fun if you have variable income. Yeah. Right. Myself and Will do. And the other thing is that it’s based on income not on net worth or assets. And so food stamps is one of those things where a state by state the the assets for SNAP which is another name for food stamps, is determined by your monthly income, but it’s also your assets. So in most states, you can’t have more than two thousand dollars in the bank.

Dan Weissmann: Oh Interesting!

Lillian Karabaic: And you’re after your first car and your first home, your assets are counted and that that is simply not true for Medicaid and a large part of that has to do with the fact that medical care it’s a lot different than groceries. Right. Like both are essential and necessary for being a human. But you are not going to wake- You’re not going to you’re not going to wake up with a five hundred thousand dollar grocery bill all of a sudden and not know how you got it. But it’s entirely possible to go into the hospital because you’ve got a pain in your side and then get an appendectomy and be looking at a six figure bill. You know you don’t you’re not like you don’t go to the grocery store hungry and then walk out with a hundred thousand dollar cart of groceries that you didn’t ask for. And, um, and so Medicaid is one of those interesting situations because you actually do see I see this a lot in the early retirement community. There is a lot of folks that are you know in their 30s and have you know, assets in in the millions and they qualify for Medicaid, because they don’t have a monthly income above the Medicaid threshold.

Dan Weissmann: And that’s interesting.

Lillian Karabaic: And there’s a lot of guilt about that simply because it’s frustrating to see someone, you know someone in my position, which is like I don’t make a ton of money but I make more than the Medicaid limit. So like I make $22,000 a year ish – give or take. And the Medicaid limit is sixteen thousand in in Oregon. But I have friends that have net worths literally 100 times mine and they you know they they are on Medicaid in their state. And so it’s kind of a question of like: if this system is so broken where by trying to do the best thing because cost control is so out of so opaque and so out of control that it makes the most sense to do it based on monthly income but then it kind of creates this situation where you know we wouldn’t – anyway – We talk about this all the time the show. It’s easy to go bankrupt for medical care. Unfortunately in the U.S. right. And it’s the grow in the growing cause of bankruptcy in this country. Luckily, now it can’t be included on your credit report, which is new but it’s anyway so OK. *huff*.

Lillian Karabaic: We we’ve talked about we’ve talked about the middle class guilt of for qualifying for Medicare – Medicaid but there are there’s some other interesting ways. So there’s there’s plenty of people for which their income is high enough that they don’t even qualify for the subsidy right on the exchange. But the prices are just kind of out of control. And one of the things that I find interesting, that I know you’ve done some reporting on is the concierge doctor.

Dan Weissmann: Yeah yeah yeah well this is the other story that I would I that comes to mind is this woman Bari Tessler. She’s a financial therapist she runs a course called The Art of Money and she posted to Facebook, which is kind of like so she’s that she’s an actual therapist and her deal is – Her thesis is like we don’t money is like sex and other big adult topics that like most of us need therapy around because the messages that we got as kids were so weird and conflicting. And it’s it’s a genuinely tough thing to figure out your stance on.

Dan Weissmann: And so that’s that’s her approach. She’s also a train. She also trains a bookkeeper and she’s written a book. She runs this online course. She’s done a lot of things. And she, she posted to her Facebook community early this year like “Hey does anybody have a good suggestion for affordable sustainable health insurance, the people that I in my community really need it. And she’s like and you know I do too.” And so yeah she was she was she had had it. She was like she looked at the bill for their health insurance for their family. They were like “This is too crazy.” And so that in her case it was a little bit of a choice. You know they could have continued to pay but through like we gotta get some other- This is too. This is too much. And so they did two things and one was they bought into a kind of concierge practice which is in, their case they pay something like $225 bucks a month which is real money.

Dan Weissmann: And but then it’s like all in you know it’s like all-in. It’s like the cracker. Like all you can eat buffet of regular medical care where you you know you just call you show up and you’re already, you’ve already paid. And she said, They that practice handles claims to handle 70 percent of what you might go to the E.R. for and you know I didn’t realize it was yeah quite that high. Yeah.

Lillian Karabaic: And so probably no appendectomies but any sutures or something like that.

Dan Weissmann: Yeah. You know you need an x-ray because that that you generally you go see your internist they don’t have an x-ray machine on onsite right? They’re going to send you someplace. You need bloodwork? you need. You know it’s I mean in that way it’s a little bit like it sounds. It sounds like an HMO.

Lillian Karabaic: Right.

Dan Weissmann: Right. Except, unless you have to go to a hospital. And so for that they have they’ve done this very interesting thing which is they’ve bought into what’s called a Christian health share and you may have talked about this on your show too. It’s it’s, this thing’s become more of a thing recently – where it’s not technically 1) It’s not technically insurance.

Lillian Karabaic: Right. I think their tagline is it’s like it’s Christian sharing in health care costs.

Dan Weissmann: Yeah.

Lillian Karabaic: Right. In ministry or something.

Dan Weissmann: And edit and it’s not insurance which means it’s not regulated by states like insurance.

Lillian Karabaic: And the big thing is the reason it has Christian in the name it’s actually existed way before the ACA. But the reason, one of the reasons it was growing is that there is a religious exemption to the ACA that allows you to not pay the penalty if you’re opting out for religious reasons.

Dan Weissmann: Right.

Lillian Karabaic: And so these Christian health sharing ministries have risen and they’re only Christian. I haven’t seen health sharing ministries that exist for other religions, even though theoretically that would be supported by this. And and so that you know their Christian thing is like “oh we have these prayer networks, that you know, you can you can have a prayer chain or whatever” but the but the big thing is that like it what it is supposed to help you cover is, it’s catastrophic insurance – Insurance right. Theoretically but they have no guarantee of what they’re necessarily going to cover right and they can deny you based on anything they want.

Lillian Karabaic: So similar to the short term health insurance that’s unregulated they can deny you based on pre-existing conditions. In general, they say they will do that. So one of the big things was short-term health insurance. It’s very very hard to get coverage if you are pregnant or expecting a child. You will almost be guaranteed to be rejected. But the Christian health sharing ministry is a big fan of babies. And so it, it for a lot of people it can end up making sense for covering pregnancy and they kind of structure it a lot like insurance where it’ll have like deductibles blah blah blah blah. But the big thing is that they can reject anything they want. So one of the big things is that because they are religiously based they can just decide to reject something, if they think it doesn’t fit with their beliefs so they won’t cover things like PREP or drugs for HIV/AIDS and they can just outright reject you if they don’t think it fits with a what they consider a “Christian lifestyle.” So you need to be able to go to church once a week and that you know that’s that’s – . And you can’t go to any church you need to be going to you know Christian church. And also if they decide that someone was living an unchristian life which caused – So if you get hit by a drunk driver they would just refuse to, you know, cover those medical bills from that because they would say it’s not a “Christian lifestyle” that resulted in that medical case. And so that’s one of the big things is that they can be good catastrophic coverage for a lot of folks. But you don’t have any of those protections that you do with an ACA plan. And so a lot of people have kind of cobbled those together.

Dan Weissmann: Yeah that’s been their experience I mean I think you know my impression is that at least in many cases they’re fans of babies and do a lot of pregnancy coverage, but only if you are in a heterosexual marriage.

Lillian Karabaic: Oh oh yeah. No you can’t even be in it if you’re not like you can’t you. Single mamas need not apply. And so and – let alone gay couples – so like I would just literally not be allowed on one of these. For *so many reasons.* LAUGHS.

Lillian Karabaic: Yeah which is one of the reasons that we don’t tend to tout them as an alternative because most of our listeners would just not you know – I know a little bit about my listeners – and I know most of them would not qualify for what they are describing as a “Christian lifestyle” under these Christian health sharing ministries but they’ve been really big in the south. I mean they’ve they’ve been around for a long time as sort of an alternative. A lot of evangelical Christian families tend to have a lower lower household income overall. Part of that is is that they tend to have large families and really do and also tend to live in the south which generally have lower incomes. They do have lower cost of living. And so Christian health sharing ministries have been very popular among evangelical Christians for a long time. But the ACA and that combination of the government can’t tell me what health care to get, combined with the lack of expansion of Medicaid – for – that would have covered low income families in a lot of red states has really pushed these through.

Dan Weissmann: Mm hmm hmm hmm hmm hmm hmm hmm hmm hmm.

Dan Weissmann: So now it’s super it’s.

Lillian Karabaic: So much intersecting things.

Dan Weissmann: Yeah yeah yeah yeah yeah. Fun fun fun note about Bari Tessler’s story is that in her case various Jewish and and progressive. You know I asked her like and in fact like you know in her book she writes about how she learned to learned about. Money and like the what. Who were the people who gave her what she can considers positive messages like that about having money about like what you can do with it. About how to make it.

Dan Weissmann: And the. And you know for her. Those were that was her uncle – Was it two uncles who owned a very successful string of gay bars in Chicago.

Lillian Karabaic: I wonder what gay bars, I’ve probably been to them.

Dan Weissmann: Yeah I mean yeah I mean there you certainly know them I mean I know them they’re there you know they’re great places and you know and so I was like well so Bari how do you square that with your you know with signing up to say like “Yes I’m going to follow your Christian. I agree with your Christian principles.” He’s like “well you know after. We’re just gonna we’re kind of squinting a little bit, Basically”.

Lillian Karabaic: Yeah I mean I think the big thing is that this is one of those things where it’s all fine until you really need it. And and that’s one of the fears. Which is exactly what happened with health insurance pre-ACA and still does happen today, where you know you’ll be like “oh it’s it’s fine” or like “oh I got approved for coverage” but then if you start to become expensive, they start to sniff around and the Christian health sharing ministries are gonna do the same where they’re going sniff around and gonna be like “OH… So you had a Bat Mitzvah and so we don’t need to cover this sixty thousand dollar bill that you got for chemo”.

Dan Weissmann: Yeah.

Lillian Karabaic: And or you know like oh that partner’s name that we did not realize had an F instead of an M next to it. Yeah. You know and that I mean the same thing happens with your short-term health insurance plan. They’ll approve you for coverage and then suddenly you become expensive and they go. “So you want a doctor’s appointment five years ago where you may have had some symptoms of lymphoma. So we’ve decided that’s a pre-existing condition and we’re not going to cover any of your lymphoma bills, which is the entire reason that you got this plan is for something catastrophic like that.”.

Lillian Karabaic: Yeah. So I mean that’s one of the big fears is that we were trying to solve that with regulation but we didn’t solve the cost control issues. So anyway yeah. So many feelings we’re just covering some many feelings. Okay. I wanted to talk. We we’ve got more than enough tape but it’s one of the things that I want to talk about because I know that you’re interested in in it.

Lillian Karabaic: And I talk about it a lot on this program because it affects me is one of the really frustrating things is folks that make a decent income and are otherwise healthy except for one preexisting condition that’s managed by expensive drugs, and this class of drugs is generally biologicals. Sometimes it can be something like chemo, so believe it or not someone with cancer can be otherwise pretty healthy, depending on the type of cancer and but chemo is very expensive – those drugs are very expensive. Your friend with breast cancer I was just thinking about the wigs. So I was on it I was on a relatively cheap drug but one of the side effects. It’s also used as a chemo drug in a different quantity. And one of the side effects is that you can lose your hair and I’m Greek. My hair is everywhere and I needed folic acid as a supplement for it and folic acid is a very common supplement for people on chemo because it can help you retain some of your hair and it is considered a cancer drug even though it is over-the-counter. It’s just folic acid. It’s like in it’s in bananas. Yes. Yeah yeah. And it was outrageously expensive over the counter, because it’s in this class where it’s considered a cancer drug and so it was cheaper for me to order my folic acid from Canada.

Dan Weissmann: So small.

Lillian Karabaic: Even though it’s over-the-counter and pay import taxes on it than it was to get it from the pharmacy across the street.

Dan Weissmann: Yeah yeah yeah.

Dan Weissmann: One story not from my reporting with somebody else’s reporting is like yeah I fly to a border town in California, and walk across the border to Tijuana and buy my drugs and walk back in and then the and the airfare and the days off from work, that more that I – like it’s still an extremely good deal.

Lillian Karabaic: Yeah.

Lillian Karabaic: So yeah we talked a little bit. We talked a little bit about that in the dental episode because that is also really expensive. Not at all regulated in the states as far as costs. So like people like me are exactly the kind of folks that are gonna be impossible to be covered by any of these kind of alternatives outside of the plan. And so we’re really, really stuck. We’re really, really stuck on whatever the exchange rate is. Have you seen any kind of interesting solutions that people have had. Have you seen people move states to get access to health insurance in different markets or anything?

Dan Weissmann: Not yet but if you got a story call me. Yeah. That’s a hell of a story. Yeah. I mean I’m interested.

Dan Weissmann: I’m interested. Yeah. No I mean that that’s I mean there is a story the week that it’s in our first batch that came out yesterday where a woman couldn’t get insurance, through any job where she lived in Austin, Texas and she was. – She had spent 20 the better part of 20 years waiting for a drug to come out in the United States to treat this horrible medical condition that she had and it had finally become available and she’d finally gotten a first dose. And now her family is about to lose their insurance. She went and took a job out of state. Oh yeah. While her husband was in intensive treatment for cancer and while her son was adjusting – this was the other news they got the same month to life with type 1 diabetes – had he just gotten diagnosed with, so their daughter like finished high school took care of dad and their dogs and herself while mom like newly able to like function really for the first time thanks to this drug like was working 100 hours a week for the next year and a half. ON other side of that story – a piece of that story – that makes it so amazing is that in doing so she also changed the course of history. It’s a hell of a story. It’s a really great story.

Dan Weissmann: It’s an amazing story. It’s means one of the one of the rules for this show is that the stories they got to be good stories and they they they can’t just be horror stories because we are all so horrified.

Lillian Karabaic:  we’re already horrified by health care.

Dan Weissmann: I mean it’s just like it’s all so it’s just you know it’s you know the way – the rule I made earlier was like this. The stories have to be more you know fascinating and potentially helpful and maybe entertaining, than they are in enraging and horrifying and depressing. Cause, Yeah. We got the we got the rage and horror and depression everywhere. You don’t need my show for that. So but there but I think you know the the pitches like look “we’re all screwed but we’re together. And the more we know, the more we might be able to do.” And and just having good company like we it’s like we’re walking through enemy territory together. We just we should we should stick together and I’m you know as a reporter, I’m a pretty good scout. And so that’s kind of my role. I’m looking around the next corner but I’m not a god – like you know it’s as you’re as you are figuring out talking to me. There’s a ton I don’t know – at least not yet. But I think that’s most of us. We’re like all blind people with this giant elephant this giant terrifying fanged venomous elephant. And we got to like get our get our picture of it together.

Dan Weissmann: Yeah. And both both in the both in the immediate like what are things we can do. Like how how much is it cost to fly to fly to that border town near Tijuana? Like from where I live? And in the in the bigger picture.

Lillian Karabaic: I’m really excited for the show.

Lillian Karabaic: And that’s a little taste of the kind of things that you can learn about. I’m going to ask you one not big question as the final wrap question. OK. Which is what is one thing you wish everyone knew about health care policy in America?

Dan Weissmann: My God I know.

Lillian Karabaic: Just not a big not a big question at all.

Dan Weissmann: I don’t know. I don’t know. I mean it’s very different from my. This isn’t really a show about policy, and I’m not a policy expert. This is a, you know this is – I am one guy trying to figure out as much as I can with everybody I can get in touch with by doing a podcast and by being a reporter, you know that that to engage as big a public as I can to learn as much as I can and figure stuff out, like I’m not a policy expert. I’m a, I’m, I’m a guy – but I’m like – You know I’m learning.

Lillian Karabaic: And you know people heard the stories more than you wish they understood the policy it sounds like.

Dan Weissmann: I don’t know I feel like we all have stories. I don’t mean. Yeah. I wish I wish we could all I mean this is my wish for the show is like I wish we could like get together and swap stories and take comfort in each other’s company and and swap advice and like figure out our best tricks. But also just encourage each other that like we you know we are screwed but we’re not alone.

Dan Weissmann: And yeah and the more we can be not alone together in this you know just the more hope we have like this is this is a genuinely messed up situation that we’re all in and that we don’t have an ongoing conversation about like what you’re doing on your show is awesome. And you know what I’m aiming to do you know is similarly like look we this is. – These are conversations we don’t get to have enough and we’re this is this is how we’re beginning. And I’m you know I’m a story gu,y I’m starting with stories. Let’s see where it goes.

Lillian Karabaic: All right. Well I’m super excited about the show and if people want to find it they just look for “An arm and a leg” wherever they get podcasts right?

Dan Weissmann: For sure. We’ve got a Web site called anarmandalegshow.com.

Lillian Karabaic: Awesome. All right. Well Dan it’s been a delight to have you on to unpack the terrifying maze that is health insurance, and our relationship to it.

Dan Weissmann: Thank you so much for having me. And so fun.

Lillian Karabaic: Yeah. Thank you so much and congrats on the launch of the show. And I can’t wait to hear more of the episodes as it unfolds. Thank you. Thank you.

Lillian Karabaic: All right. Well that was certainly really interesting. I’m really glad that Dan came on the show to join us and I’m happy he’s making the podcast that I wanted to make because you know he’s more professional and smarter than me. So I think that wraps our show for today our producer Will Romey, our intro music is by Aaron Parecki. And I’m Lillian Karabaic, your personal finance educator and host. Thank you for listening. Until next time remember to manage your money so it doesn’t manage you.

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