EP328: An Interview Specifically for Health Care Executives, With Marshall Allen, Author of the Best Seller Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

In Episode 328, Stacey Richter talks with Marshall Allen, investigative journalist and author of the New York Times best seller Never Pay the First Bill, about what his book's success means for health care executives — and the financial toxicity that health systems risk creating for themselves when patients wise up.

WHAT YOU'LL LEARN

✅ Why patients have come to be treated as outsiders rather than customers in the health care system

✅ What upcoding is, and how billing schemes get built into the system to increase revenue

✅ The difference between making a profit and profiteering

✅ The first-order and second-order consequences health systems face when patients get organized and informed

✅ Why employers may be the "sleeping giant" that finally forces accountability

WHY THIS MATTERS

A critical mass of Americans already believe health care will bankrupt them, and a book instructing patients how to fight back just hit the New York Times best seller list. For health system leaders, that's not just a public-relations problem — it's a signal that doctors are losing trust in their own employers, reputations are taking real damage, and employers and taxpayers are starting to realize they don't have to be passive about what they're charged.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

03:35 What's the point of view that Marshall is coming from with his investigative reporting?

04:06 "How does this affect the people who are paying for it and the people who are undergoing the care?"

04:58 "There's a lot of good people working within this very messed up system."

05:12 Why are patients considered outsiders in the health care system?

05:55 "What's happened in health care is that the stakeholders treat each other more as the customer."

07:54 What is upcoding?

11:27 "These are schemes that have been created within the industry to increase revenue."

11:56 "This system is not set up for the benefit of the patient."

12:22 "On the financial side, the industry is actually oppressing the American people."

12:39 Can a critical mass of patients force health systems to become more accountable?

16:02 "We have been expected to pay whatever aggregate sum is thrown at us."

17:09 Why have patients been so passive toward this crooked health care system so far?

18:04 "They're violating the trust of the American people when they don't treat us fairly."

19:28 "It's totally legal to do that, [but] is it ethical?"

20:11 What's the difference between making a profit and profiteering?

21:43 "It's hard to argue against your own paycheck."

29:57 "The things that matter most to people are their health and their money."

33:51 What are the first-order and second-order consequences of what's happening in health care right now, and which of these consequences will actually drive change?

34:56 "When you tell the truth about what's going on … they become so ashamed … that they change their behavior."

36:10 "The patient … is not their most important customer."

39:03 "The sleeping giant is the employers."