EP443: Let Us Never Pay the First Bill in Honor of Marshall Allen

This episode is dedicated to Marshall Allen, the investigative journalist and founder of Allen Health Academy, who passed away in May 2024. Dave Chase, founder of Health Rosetta, joins Stacey Richter to share reflections on Marshall's decade-plus of accountability journalism — including the yearlong ProPublica investigation into health insurance broker commissions that helped shape the Consolidated Appropriations Act of 2021 — and on the faith that grounded his work. After Dave's tribute, Stacey replays her original 2021 interview with Marshall about his best-selling book, Never Pay the First Bill, in which he explains upcoding, why patients are treated as outsiders in their own healthcare system, and why he considered employers healthcare's "sleeping giant."

WHAT YOU'LL LEARN

✅ How Marshall Allen's yearlong ProPublica investigation into health insurance broker commissions helped shape the Consolidated Appropriations Act of 2021, regarded by many as the most consequential employee healthcare legislation since 1943

✅ Why Marshall believed his five years in Christian ministry made him a better journalist — not in spite of his faith, but because of it

✅ What upcoding is and how it functions as one of many revenue-generating schemes built into the healthcare system

✅ Why patients are treated as outsiders rather than customers in a system where stakeholders primarily serve each other

✅ Why Marshall considered employers healthcare's "sleeping giant" — and what it would take to wake them up

WHY THIS MATTERS

Marshall Allen spent 17 years investigating why Americans pay so much for healthcare and get so little in return, and his reporting didn't stay confined to journalism — it shaped federal legislation and gave patients, employers, and health system leaders a shared language for naming problems that had long gone unnamed, from upcoding to profiteering dressed up as ordinary profit. His book, Never Pay the First Bill, turned that reporting into a practical playbook patients could use immediately, while his message to executives was equally direct: the financial toxicity a health system creates eventually becomes reputational and recruiting toxicity too. His journalism, his legislative impact, and the Allen Health Academy he founded to carry his mission forward are the legacy this episode honors.

MENTIONED IN THIS EPISODE

Encore! EP328 with Marshall Allen: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

09:28 What's the point of view that Marshall is coming from with his investigative reporting?

09:57 "How does this affect the people who are paying for it and the people who are undergoing the care?"

10:49 "There's a lot of good people working within this very messed up system."

11:03 Why are patients considered outsiders in the healthcare system?

11:45 "What's happened in healthcare is that the stakeholders treat each other more as the customer."

13:45 What is upcoding?

17:18 "These are schemes that have been created within the industry to increase revenue."

17:46 "This system is not set up for the benefit of the patient."

18:13 "On the financial side, the industry is actually oppressing the American people."

19:14 "We have been expected to pay whatever aggregate sum is thrown at us."

20:21 Why have patients been so passive toward this crooked healthcare system so far?

22:05 What's the difference between making a profit and profiteering?

29:45 What are the first-order and second-order consequences of what's happening in healthcare right now, and which of these consequences will actually drive change?

30:45 "When you tell the truth about what's going on … they become so ashamed … that they change their behavior."

32:00 "The patient … is not their most important customer."

32:50 "The sleeping giant is the employers."