EP249: The War on Financial Toxicity in North Carolina, With Dale Folwell, North Carolina State Treasurer

In this episode, Stacey Richter talks with Dale Folwell, CPA, North Carolina State Treasurer, about the war on financial toxicity in North Carolina.

WHAT YOU'LL LEARN

✅ What the Clear Pricing Project is and why North Carolina's State Employees Health Plan proposed it

✅ Why some of North Carolina's largest hospital systems fought back against transparent, network-based pricing

✅ Why price secrecy, not price level alone, is the core problem Folwell is targeting

✅ How the Clear Pricing Project could actually help some rural hospitals make more money

✅ Dale Folwell's advice for other states considering similar price transparency efforts

WHY THIS MATTERS

As the fiduciary for North Carolina's $100 billion pension fund and the State Health Plan covering more than 720,000 people, Dale Folwell argues that a treasurer has a basic right to know what he's spending taxpayer money on—and that hospitals resisting transparent pricing are protecting a business model built on secrecy, not defending patient care. His central point: the only way to pay less for health care is to actually know, and then pay, less for health care.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

02:51 The North Carolina state spend on health care.

04:14 "In medical terms, why has this become acute?"

04:53 One week of work for starting North Carolina troopers and teachers out of every four is going to family health care costs.

06:05 The problem of health insurance vs health care.

06:51 "If they can do this to the largest customers in this state … imagine what they can do to them."

07:13 "This is about the industry whose whole business model is based on secrecy."

08:44 "We've already focused on the why, and now we're [focusing] on the how."

09:48 "We're trying to attack a problem. The problem is that none of [them] consume health care; it all consumes them."

13:07 What the Clear Pricing Project aims to do.

13:37 "Why is it that we don't have trust in the people of this … country to actually consume and evaluate the value and cost of things in health care when they are able, very successfully, to evaluate the value and cost of everything else in their life?"

16:31 "We're not trying to be disruptive; we're trying to fix a problem."

18:25 Why the Clear Pricing Project went the self-insured route and how that's worked for them.

23:34 Who's behind the institutions fighting transparent pricing in North Carolina.

24:49 Instances where the Clear Pricing Project could actually stand to help rural hospitals make more money.

27:15 Dale's advice for other states trying to do this.

28:52 Dale's message to health care providers out there who want to see this change to price transparency.