0:06

You're listening to Well Now, Slice podcast on

0:08

health and wellness. I'm Kavita Patel. And

0:11

I'm Maya Feller. Kavita, have

0:13

you ever looked closely at your medical

0:15

bill? Maybe one of

0:17

those statements from your health insurance

0:19

company, it is incredibly confusing and

0:21

shocking. And when you

0:23

owe money, it's unclear how much

0:25

and for what reason. And quite

0:28

often, it's more than what you

0:30

expected. So the

0:32

explanation of benefits, that's what

0:34

I believe it's called, is

0:36

this very lengthy coded kind

0:38

of thing that shows up. And

0:41

then when you get through it, you

0:43

feel like you've got even more questions

0:45

than you had before the procedure or

0:47

visit even happened. Oh, Maya, you're singing

0:49

my siren song. I have

0:52

been spending literally decades trying

0:54

to shockingly work on making

0:57

that EOB, explanation of

0:59

benefits statement, simpler. It

1:02

may shock you to believe that before 2010, it

1:04

was even more complicated. It's

1:06

sad that what we have today is simpler.

1:09

But I have always been amazed

1:12

at a couple of things, Maya.

1:14

One, it's one of the

1:16

few industries where you're guaranteed to only

1:18

get this in paper and weeks after

1:20

the service. I know. What is

1:22

up with the weeks after the service? I'm like, can't you

1:24

just give it to me at the time of service? Correct.

1:27

Weeks after the service, one of the few where you have to wait weeks

1:29

and hope that you get the right mail and hope you wait in the

1:31

mailbox. Then when you look

1:34

at it, it's very unclear, patient

1:36

responsibility, what did your insurance company

1:38

negotiate, what did the doctor

1:40

or hospital or office charge.

1:43

And then you start to see all these other

1:45

fees in there. And I do think that it's

1:48

just unbelievable how

1:52

even people like yourself, myself, highly

1:54

educated, part of the healthcare system,

1:57

it literally looks like I'm reading in Latin. I mean,

1:59

like I. They could not tell

2:01

you are explain to someone else

2:03

what that is split but what's

2:05

your experience? So my insurance is

2:08

overseas because I'm married to someone

2:10

who has citizenship somewhere else, but

2:12

they are responsible for paying for

2:14

medical services in the domestic United

2:17

States cracks guess worldwide so it's

2:19

great health insurance. With that said,

2:21

it's interesting because four years we've

2:23

operated as south pay individuals because

2:26

we pay up front and then

2:28

were. Reimbursed by our insurance the

2:30

we've all. we've seen everything and

2:33

I ask for the I see

2:35

deeds hadn't codes so it is

2:37

the code set define whatever disease

2:40

or procedure has been done any

2:42

given day at any given time

2:44

with the provider that I'm seeing

2:47

and I need. Everything's clear and

2:49

written now and you should see

2:51

every time I ask. Nobody knows.

2:54

What to Give me and provider?

2:56

It is weeks if not months

2:58

before I receive. A bill and then

3:00

they're adjustments because they're treating me like assess

3:03

pp sent even though I'm not a self.

3:05

The pieces and so then I call back

3:07

and I see you've put a whole bunch

3:09

of adjustments in here. I want to make

3:12

sure that you wouldn't tended to put these

3:14

adjustments in and that this is it, in

3:16

fact the number that you want me to

3:19

pay. I go ahead. I p I submit

3:21

it to my insurance to Buda. I get

3:23

another bill. Sorry we made a mistake. The

3:25

bill that we sat you was correct. There

3:28

is in fact an outstanding charge. This.

3:31

Is for physicals, mammograms, pop you name

3:33

it for my kids appointments and we've

3:35

had the same insurance for the last

3:38

twenty six years and we see the

3:40

same providers for the last twenty six

3:42

years. but you decide to the system

3:45

is so upside down that they don't

3:47

even know what to do with us

3:49

or how to get us a bill.

3:52

That is he descended is finite amount

3:54

that we can pay and close it

3:56

so it's constant Itis have. Always

3:58

these open bill better in discussion

4:01

or negotiations. That's kinda how I

4:03

live. The upside is khalida any

4:05

one with M D I can

4:07

see them. And how about you can

4:10

either? While you're very I would

4:12

say both blessed and made a curse

4:14

This I can be on and yes

4:16

yes, the blessing and a curse. I

4:18

do think that yours is a slightly

4:20

occipital experience in some regards, sir. having.

4:22

The. Ability to see any Md

4:25

is definitely a typical of and mine

4:27

is probably little more tip of old

4:29

as I am kind of what I

4:31

would say majority of the country standard

4:33

employer based insurance because of my work

4:35

and it is a very basic plan.

4:37

I have a high deductible health plan

4:39

which means that it's a little cheaper

4:41

to pay for my health care because

4:43

I will take on personally the responsibility

4:45

of the first ten thousand dollars in

4:47

costs. I was as tell you that

4:49

the only reason I do that is

4:51

because I hear it was. Something called

4:53

a health savings account And long story

4:56

short I have made choices were I

4:58

know I'll pay more upfront in order

5:00

to kind of save more later. But

5:03

that's an area privilege I'll say.

5:05

So this. but what stands out

5:07

the most for me is it

5:09

with the birth of my first

5:11

child, my son, I remembered kind

5:13

of looking through pages and pages

5:15

of the bill because I've worked

5:18

on this issue and policy. And

5:20

I was just curious and I had seen

5:22

that there was initially the little box of

5:24

how much you owe the hospital initially had

5:26

thousands of dollars for the i owe this

5:28

many dollars and it was before. I have

5:31

a plan I have now so I should

5:33

not have paid that much. I knew that

5:35

I knew enough about health care I looked

5:37

found out that my anesthesiologists whom I did

5:39

not choose to be clear I went to

5:41

and hospital that was a network I went

5:44

to an obituary in that was a network

5:46

at at all the things and expert healthcare.

5:48

Consumer could and should do. And

5:50

they had the anesthesiologist on call that

5:52

was not someone I knew and nor

5:55

could I pick. and that individual was

5:57

hired by a group that was not

5:59

in network. my insurance company. So the

6:01

bill I got was about 180% higher than

6:03

one would expect and I

6:07

had a larger proportion of that was out of

6:09

pocket that I had to pay. So I

6:12

was, I would say, like one

6:14

in five Americans who get one of these

6:16

surprise medical bills. And I think

6:19

it's just, this is the world we're in Maya.

6:21

I hesitate to say this, but someone

6:24

of our health literacy, our

6:26

experience, and I dare to say it, our

6:28

Rolodex, right? You and I know people,

6:31

if we go to, if you go

6:33

to Cornell and I go to Hopkins

6:35

and something happens and we get something

6:37

funny in the mail, I

6:39

know people I can call and senior leadership there,

6:41

people in charge of their billing and I can

6:43

say, hey, this doesn't look right, can you help

6:46

me? And I will get action. 99.999% of people

6:48

do not have that luxury. So I do think

6:54

we're tackling a really important issue. And

6:56

it's why this week we really wanted

6:59

to speak to, I would say one

7:01

of America's most trusted squeaky wheels,

7:04

someone who's a very close friend of

7:06

mine, privileged to call him a friend and

7:08

the former surgeon general. And he's

7:11

going to talk about the fact that he

7:13

too was affected by what you and I

7:15

are just describing the confusion, the surprise

7:18

bill, and the fear that comes

7:20

from what happens if I can't

7:22

pay this bill or are the

7:24

effects stated. Well,

7:44

now, listen, if you're enjoying the show and

7:46

want to hear more, subscribe to our feed.

7:49

New episodes come out every Wednesday morning.

7:52

While you're there, check out our

7:54

other episodes too, like last week's

7:56

about navigating wellness and mental illness

7:58

with writer Edmondson. After Hours

8:01

and Skyn. Can do. Welcome

8:09

back you're listening to. Well now

8:11

I'm Kathy to Patel and I

8:14

my A salary. So today we're

8:16

going to talk about surprise medical

8:18

bills so many of us have

8:20

had them and bring the talk

8:22

about more with America's Doctor for

8:24

my Surgeon General to Rome and

8:26

items he served for the Trump

8:29

Administration's and honey Seventeen To Twenty

8:31

Twenty One. He recently published a

8:33

book, Crisis and Chaos Lessons from

8:35

the Front Lines of the War

8:37

Against Covered Nineteen Now Doctor. Adams

8:39

as a distinguished professor and

8:41

Director of Health Equity Initiatives

8:43

at Purdue University, and a

8:45

practicing anesthesiologists. Jerome Thank you

8:47

so much for joining us. Thank you

8:50

so much for having me of a

8:52

pleasure to be here and as you

8:54

mentioned still practicing physician was and the

8:56

operating room taking care of patients yesterday

8:58

and I hope none of them get

9:00

a surprise medical bill for my care.

9:03

A I felt so do

9:05

so. Before we get to

9:07

the meat or the heart

9:09

of our conversation we want

9:11

to ask you this question

9:13

that we always ask everyone.

9:15

And I'm very interested in hearing

9:18

your answer to Rome. How

9:20

do you define wellness? I defied

9:22

wellness release in the same way

9:24

that I think about health equity.

9:26

Well, this is gonna be something

9:28

that it's different for every person.

9:31

And really, my goal as Director

9:33

of Health Equity at Produ was

9:35

making sure everyone has a fair

9:38

opportunity to be there healthiest self.

9:40

Mentally. Spiritually physically so. For

9:42

some people, that may mean being

9:44

able to run a marathon. For.

9:47

Other people at Major mean being able

9:49

to get up and walk to the

9:51

mailbox. That may be their definition of

9:53

wellness. Wellness is really just helping people.

9:56

Understand their potential and be able

9:58

to reach it. Mm-hmm that

10:00

resonates. I love that understand your potential

10:02

and being able to reach it. Yeah,

10:04

it's a great It's a

10:06

saint which is why it resonates. I

10:08

think all right Jerome you I love

10:11

your website you start Describing

10:13

yourself probably in what the role I would say

10:15

that is your proudest You're a dad and

10:18

a doctor and the former surgeon general But

10:20

you did have a recent title added that

10:22

I noticed is not necessarily on your website,

10:24

but I think is really important Patient

10:27

with a surprise medical bill or

10:29

definitely shocking medical bill and

10:31

it turns out you're not in rare company

10:33

But can you tell us more about that

10:35

Jerome? What's sad is that it shouldn't be

10:37

this way in 2024 and

10:39

yet here we are, but tell us your story. You're right

10:42

It shouldn't be this way and

10:44

I'll walk you through a couple of

10:47

months ago in January I went to

10:49

Arizona for a conference and

10:51

while I was there I decided to go hike

10:53

up Camelback Mountain like many people do Hiked

10:56

up the mountain had a bottle of water with

10:58

me came back down felt fine Literally,

11:00

I went back to my hotel room Took

11:03

a shower then met some colleagues out for

11:05

dinner and while I was at dinner

11:07

I started to feel lightheaded and got dizzy and

11:10

I'm surrounded by medical Colleagues

11:13

I was at the Society of Critical

11:15

Care Medicine annual meeting coincidentally and

11:18

they all say you should go to the hospital and

11:20

get checked out and I

11:22

say and everyone agrees. This is probably just

11:24

dehydration dry air being

11:26

on a plane hiking up a mountain

11:29

But better to go get it checked out, which is

11:32

what we as physicians would tell a patient you know

11:34

out of an abundance of caution go get it checked

11:36

out first of all they call an ambulance because No

11:39

one wants me to want me to drive and we're out of

11:41

town So we get it we get an ambulance and

11:43

they give me fluids in the ambulance and by the time

11:46

I'm at the emergency room I'm actually feeling great. And

11:48

so we say okay. Let's do some basic labs

11:51

confirm the diagnosis They do

11:53

that give me a couple more bags of

11:55

IV fluids and in a couple of hours

11:57

We're pretty darn sure the diagnosis is dehydration

12:00

And so we have a question

12:02

about whether or not they should send me home. And

12:04

I have this conversation with my emergency room

12:06

doctors. And again, we decide out

12:08

of an abundance of caution, let's just watch

12:10

you overnight. So I leave the next morning at

12:13

about 7am. They didn't do anything

12:15

more to me overnight. Fast forward

12:17

about four to six weeks. I

12:19

get a bill that says I owe Mayo Clinic

12:21

$4,800. And

12:23

I look at this bill and I'm a medical

12:25

professional. So I start to try to dissect it.

12:28

I reach back out and ask them if they

12:30

can send me an itemized bill. That takes several

12:32

weeks to come back again. Meanwhile, I'm

12:34

stressed out about this $4,800 bill. And

12:37

they send me an itemized bill and I see

12:39

that they charged me 11 times

12:41

the market rate for a CMP, a

12:43

comprehensive metabolic panel, which for those who

12:46

aren't aware is a basic lab test.

12:48

I see that they gave me some

12:50

IV fluids. And I see that for

12:52

all that, they actually charge me, build

12:54

me $10,000. And

12:56

my insurance negotiated it down to

12:59

$4,800 that I owe because I

13:01

have a high deductible health plan and it

13:03

was January and I hadn't paid into an

13:05

HSA yet. So that's an

13:07

office of the story. And

13:10

we can dig into the different parts, but coverage,

13:12

high deductible health plans, was a part of this

13:14

story. Lack of transparency was a part of this

13:16

story. If at any point they told me we're

13:18

going to send you a bill for $10,000, I

13:21

would have said I'm going to go home and drink some Gatorade. The

13:24

lack of ability to arbitrate is

13:26

part of this story. I'm still going back

13:28

and forth with Mayo Clinic and essentially they've

13:30

told me, hey, this is what we charge.

13:33

You either pay it or we send you to collections.

13:35

That's the point I'm at as a former surgeon general.

13:38

And all this, I guess I would

13:40

summarize by saying I'm the former United

13:42

States surgeon general. I'm a

13:44

practicing physician. If this is

13:46

what I'm dealing with, the average consumer

13:49

does not stand a chance. And that

13:51

is why I talked about it,

13:53

why I publicized it, why I spoke about it in the

13:55

media. And I've been shocked at how much Every

13:58

single time I Talk about it! I Get... Hundreds

14:00

of a people replying think oh my

14:02

gosh, here's my bill. Here's what I

14:04

got charged. This is what happened to

14:07

me and it's why medical debt is

14:09

the leading cause of bankruptcy in the

14:11

United States. To Rome I could

14:13

not agree more and is something

14:16

that I see. Are among my.

14:18

Close. Circle of Friends I searched my worked

14:21

as a dietitian with my peace and saying

14:23

this is covered but not and I think

14:25

I need a prior authorization so like I.

14:27

Think you need to colleen and see

14:29

if this will be covered. However, I'm

14:31

not sure is it will be covered

14:33

and it's all. Up in this kind

14:36

of bubble of while we just

14:38

don't know. and as you said,

14:40

jerome about sixty six percent of

14:42

all bankruptcies or due to medical

14:44

costs. I mean, this is astounding.

14:46

How does that happen? And what

14:48

rights do? Peace since themselves has.

14:50

Well that's a lot of the the

14:52

belief that were having right now and

14:54

a federal and A level is what

14:56

rights should patients have an who is

14:58

actually responsible for? This was also been

15:00

fascinating. And I'm talking to

15:03

you. Interviewed us who are health

15:05

care professional is a finger pointing

15:07

this gone on. People. Say

15:09

no, It's the doctors. false. Know. It's

15:11

the insurance company's fault, No, is the

15:13

Federal government's fault for setting up the

15:16

system and on and on and on.

15:18

And I'm really, I think most of

15:20

all we should number one have transparency.

15:23

We like to tell ourselves

15:25

that. We. Value Capitalism

15:27

and marketplaces in the United States

15:30

and his health care should operate

15:32

like a marketplace at. There's no

15:34

other marketplace where you go in.

15:37

And. You try to purchase a product and they tell

15:39

you as will tell you the cost of it's six

15:41

weeks and now. After is too late

15:43

for you to say I don't want

15:46

this services products anymore of in there's

15:48

no No Wonder marketplace where if you

15:50

don't get what you were expecting. Were

15:52

you literally have no recourse whatsoever

15:55

for transparency? I think is t

15:57

for the functioning of a marketplace.

16:00

I'd offer would point out that

16:02

we're the only developed nation and

16:04

the world that has it figured

16:06

out how to give a baseline

16:08

level of health care. To. All

16:10

of our citizens without them feeling like they're going

16:13

to be. Bankrupted. By

16:15

receiving that care and that creates

16:17

problems Because And Mayo Clinic's defense

16:19

that cost shifting. They're. Looking at

16:21

me and saying oh, you can save as

16:23

much So we're going to charge you ten

16:25

thousand dollars to make up for the nine

16:27

other people who are gonna come into nice

16:29

who aren't going to pay or who don't

16:31

have insurance. And that's not

16:33

fair to me. It's not fair to

16:36

the system in a crease. All these

16:38

weird perverse incentive the cause people to

16:40

act in ways that no other nations

16:43

receive. Occurring Yes, as nuttall a distorted

16:45

and senses but it feels like even

16:47

if you can peel back one layer.

16:49

for example, like not having these things.

16:51

Got a collection of the sold in

16:53

the Root Problem And so there was

16:55

a little blip of help in Two

16:57

Thousand and Twenty Two and Congress passed

16:59

the No Surprises Act as referred to

17:01

as the An Essay most people know

17:03

the an Essay or something else. That

17:05

and policy world and a Say No

17:07

Surprises act as well some other kind

17:09

of transparency oriented regulations you're trying to

17:11

get hospitals to put their pricing. Out

17:13

there had it be more publicly available

17:16

to patients. But the whole goal was

17:18

to do something that you've talked about

17:20

for years and still feel as necessary

17:22

because eighteen percent of emergency room visits

17:24

result in at least one surprise medical

17:26

bill. That's a lot of people including

17:29

you to. this law and essay was

17:31

supposed to create a more even playing

17:33

field and allow patients with void receiving

17:35

these bills. And just as you said,

17:37

you had a little more to your

17:40

story. Do you mind telling us what

17:42

happened when you try. To challenge or

17:44

bill so you theoretically the know you

17:46

were in network probably have some rights.

17:49

but what's happened when you did interact

17:51

with the health system and say hey

17:53

this is this is not right, What

17:55

happens. I did what I recommend: Every

17:57

patient says. A mess. Patients

18:00

It's a few weeks to send me

18:02

the itemized bill. I saw the itemized

18:04

bill and I asked them questions about

18:06

several parts of the itemized bill, including

18:08

the coding, a level of care of

18:10

what they charge me, and it's up

18:12

again several weeks for them to get

18:14

back to me. Much as I

18:16

understand this, the average consumer they're sitting there

18:19

scared that they're gonna get sent to collections

18:21

of going to mess up the credit. they're

18:23

not gonna be upon us to get their

18:25

cars are blown over, there are their house

18:27

loan while all this is going on and

18:29

they get back to me and say hey

18:31

yeah we know we charge you weigh more

18:34

than what these services would typically cost if

18:36

you were to get them all a card

18:38

on the market. but. This. Is

18:40

the system that we exist in in? this is what

18:42

we charge everybody. So this is what we're gonna charge

18:44

you. I haven't had a

18:47

happy ending but and many cases you

18:49

hear people when you reach out when

18:51

you ask questions we the find mistakes

18:53

are they will negotiate down. Your

18:55

payments of I'll be honest here with you

18:58

off. I think one of the reasons the

19:00

reticent to negotiate with me and is likely

19:02

because I'm the former Surgeon General and because

19:04

at honestly I think it's actually hurting me

19:06

and I think they're in a situation now

19:08

where they're scared that if they actually give

19:10

me a concession. And it gets publicized.

19:13

Everyone's going to What one, But anyone listening to

19:15

this I want you to know that in many

19:17

cases. When you ask that question,

19:19

they will either find a mistake or they

19:21

will negotiate reveal down to something more reasonable.

19:24

And maybe you can underscored that point briefly.

19:26

That it's use actually lost in

19:28

with no insurance and had to

19:31

do the class pay. Probably would

19:33

have had a smaller bill as

19:35

possible. And the irony is that

19:37

insurance doesn't do what. It. Was

19:39

set out to do you know in the

19:41

sixties when we started with Medicare and Medicaid

19:43

and wanted to make sure everyone had access and

19:45

and the affordable care. act what it's

19:48

fascinating be perverse cost shifting

19:50

that goes on so let's

19:52

say you go into a

19:54

hospital in the actual costs

19:56

for a services twenty dollars

19:58

what they will often you is

20:01

bill you $100 for that service knowing

20:03

that almost no one is actually going

20:05

to end up paying $100 for that

20:07

service. Then they go to insurance and

20:09

insurance says, we're only going to give you half of

20:12

what you build and insurance will pay them $50. But

20:14

now many many

20:16

institutions know what they've actually been called out

20:18

on the fact that if you came in without

20:21

insurance, what many used to do and far

20:23

too many still do is they just charge the

20:25

individual $100. Exactly. And people started

20:28

to say, well, why are you charging me a

20:30

hundred dollars when I have no insurance

20:32

and the people with insurance are getting charged $50. Well,

20:36

now what many places will do is they'll

20:38

have a discounted rate if you're not insured,

20:40

and they'll say, okay, if you're not insured,

20:42

we'll charge you $40. And so you're

20:45

in this weird situation where they

20:47

may actually charge you $40 if

20:50

you have no insurance, they're charging you $50 if

20:52

you have insurance. And then, and I don't want

20:54

to get too complicated here. But this is where

20:56

high deductible health plans come into play. Because

20:59

for me, I have a $5,000

21:01

deductible. And so I'm

21:03

responsible for the first $5,000 of my

21:05

medical bill. And if they charge me $50, the

21:08

charge my insurance $50, I'm responsible

21:10

for that. So there's a very real

21:12

chance that I go in. And if

21:15

I tell them I have insurance, I

21:17

pay $50. If I tell them

21:19

I don't have insurance, I pay $40. It's

21:22

amazing, isn't it? It's mind boggling, but it's

21:24

real. And it's helpful to have listeners hear

21:27

everything at the granular level to give us

21:29

better, I think, access to

21:32

care. So

21:45

let's take a break here. When we come back, we're going to

21:47

hear more from Dr. Tarot, Madam, and his

21:49

thoughts on how to make healthcare more accessible

21:51

and affordable for all of us. You're

22:02

listening to Well Now from Slate.

22:04

I'm Kavita Patel. And I'm Maya

22:06

Feller. We're continuing our conversation with

22:08

former Surgeon General Jerome Adams about

22:11

his recent experience as the recipient

22:13

of a surprise medical bill. Okay,

22:16

so Jerome, clearly as the

22:18

former Surgeon General, you had

22:20

connections that could have helped solve this problem,

22:22

and you said it yourself. You actually think

22:25

that it's hindering you, right, in some way,

22:27

shape, or form. And you

22:29

could have solved this, perhaps, without going public. And

22:32

I'm sure that the hospital you went to wished

22:34

that you did the same. So why,

22:36

in your words, is it important to

22:38

use the platform that you have to

22:41

highlight this issue? Well, first of all, I

22:43

want to say to folks that I

22:45

am blessed. I'm fortunate in that a

22:48

$5,000 bill isn't going to prevent me

22:50

from sending my kids to school or

22:52

paying my rent or paying my car

22:54

payment. I'm not arguing with

22:56

Mayo Clinic here simply because I don't want

22:58

to pay. As a matter of fact, I

23:01

said to them, I'm perfectly fine paying a

23:03

reasonable amount, but I don't think $10,000 for

23:05

what essentially amounts to $500 worth

23:08

of services is a reasonable charge for this

23:10

bill. The reason why

23:12

I'm lifting this up is because I

23:14

grew up poor. I grew

23:16

up a minority. I grew up,

23:19

like far too many in America, in a

23:21

situation where this could be the reason that

23:23

I have to file for bankruptcy, where

23:26

it could be the difference between me being

23:28

able to purchase a new home or not

23:30

or pay rent or even put food on

23:32

the table. And so I wanted to go

23:34

through this like a regular consumer. I never

23:36

told anyone who I was until

23:40

several weeks into it when I was

23:42

like, I can't believe I'm not getting

23:44

anywhere here. And I wanted to put it out

23:46

there on social media so people could see it.

23:49

And that's really what I try to use my

23:51

platform to do is to help people understand they're

23:54

not alone, to help them understand the real

23:56

challenges in the system and break down those

23:58

different challenges in the system. and

24:00

to hopefully advocate for them. And so,

24:03

end of the day, whether or not Mayo

24:05

makes a compromise with me, what

24:07

I hope is that people understand

24:10

the system better and that

24:12

policymakers will see that this is

24:14

a problem. If I can't

24:16

navigate the system, then it

24:18

shows you that the average citizen, the

24:20

average constituent has little to no hope.

24:23

And I hope that they'll make some

24:25

meaningful changes in the system moving forward,

24:27

including more transparency, including arbitration. And Dr.

24:30

Patel mentioned the NSA, the No Surprises

24:32

Act from Congress. I think another part

24:34

of this that people need to understand

24:36

is there's only so much you can

24:39

do in DC. You

24:41

have your executive branch. There

24:43

are some things you can do by executive

24:45

order. You have your legislative branch. Most things

24:48

have to be done through legislation, particularly when

24:50

it comes to Medicare and Medicaid. You can't

24:52

just tell people to do something if the

24:54

Medicare and Medicaid laws say that you can't.

24:57

But it's important for people to also know

24:59

that a lot of the authority and enforcement

25:01

goes on at the state and local level.

25:04

And so, you have state insurance commissioners who

25:06

are in charge of looking at the way

25:09

insurance is adjudicated. I used to

25:11

run the State Department of Health in Indiana

25:13

and I regulated hospitals. So, if you have

25:15

a complaint against the hospital as opposed to

25:17

the insurance, that is typically a state issue.

25:19

And so, many different players here, and

25:21

I want people to understand the system

25:24

so that they can advocate for policies

25:26

that will help everyone moving forward. And

25:28

this hurts our country. It

25:30

hurts our country when 66% of bankruptcies

25:34

are due to medical debt. It hurts our

25:36

country when people are scared to go in

25:38

and get preventative care or to get care

25:41

early on because they're worried they're gonna get

25:43

hit with one of these bills. And

25:45

so, what happens? They show up with stage four

25:47

cancer. They show up in

25:49

diabetic ketoacidosis. They show up at

25:51

a time when it's far too late

25:54

in many cases for us to

25:56

intervene or when that intervention

25:58

ends up costing the individual. and

26:00

society much more money than if

26:02

we dealt with it upfront. We need more focus

26:04

on prevention and we can't have that focus on

26:06

prevention if people are scared of the bill. What

26:10

can people do if they're anxious, worried

26:12

about their health and they need to

26:14

seek care but they want to avoid

26:16

what happened to you? Well,

26:18

a couple of things that I would say to folks.

26:21

I would say number one, don't

26:23

wait until an emergency to understand what your

26:25

coverage options are. Thanks to

26:27

the Affordable Care Act, thanks to

26:30

in many cases states that have expanded Medicaid

26:33

or coverage, there are many

26:35

opportunities out there now to get coverage

26:37

and a lot of times people just

26:39

don't know. They just don't

26:41

know until it's too late. They don't ask

26:44

until it's too late. Number

26:47

one, understand your coverage options. Number

26:49

two, focus on prevention and

26:52

I'll be honest, I've got to own the part of this that's on

26:54

me. I should have drank more water before I

26:56

hyped up that mountain. Whether

26:59

it's drinking more water or paying

27:01

attention to your physical activity and

27:03

your diet or taking your blood

27:05

pressure medication or whatever it

27:07

is, it's better to prevent problems than it is

27:09

to have to deal with problems in the moment.

27:12

We need to think about our baseline

27:14

health of individuals and also as communities,

27:16

giving people more opportunities to make healthy

27:18

choices. Number three, if you're in

27:20

that situation because sometimes no matter what you do,

27:23

you're still going to end up in that situation,

27:25

please, please don't be afraid to go

27:27

in and get care because all

27:30

this becomes a moot point if you're not alive. I

27:33

still feel like the right thing to do was

27:35

to go in and initially get checked out. Once

27:38

you're there, understand you have a right to ask

27:40

how much is this going to cost? They

27:43

have to make a reasonable attempt to help

27:45

you understand how much it's going to cost.

27:48

Many institutions now have a patient's

27:50

bill of rights about transparency. If

27:53

You're asking that question throughout, then at

27:55

least you have some visibility and you

27:57

also then can point back to if

27:59

the... Bill comes. hey. I asked

28:01

the question because I was concerned about

28:03

this costs and you ought didn't tell

28:05

me how much this was going to

28:07

cost itself. It gives you that a

28:09

point. Back to on the back it

28:11

when that bill com. Know. That

28:13

you can continue to challenge the bill

28:16

for use it as an itemized bill

28:18

is the setting seems not right and

28:20

know that when you chance a bill

28:22

that there's multiple opportunities for that bill

28:25

to be reduced either through recognition of

28:27

mistakes or through. Negotiations and

28:29

then finally very different services out

28:31

there that you cannot reach out

28:33

to that can help you and

28:36

this negotiation process. I don't love

28:38

the fact that were stalking. Another

28:40

industry on top of a broken system. To.

28:43

Help people navigate that broken system. But we

28:45

are where we arts and so I want

28:47

people to understand that you do have a

28:49

number of options if you had that bill.

28:52

To be able to fight it. It's a good

28:54

reminder that there are other organizations. A

28:56

lot of community based organizations and sometimes

28:58

it even helps a call. I'll just

29:00

put a plugin, sir. you're kind of

29:02

local providers authors might not be your

29:05

exact provider, but often the patience or

29:07

navigators at the front desk says like

29:09

of my clinic for example, we get

29:11

us all the time and we know

29:13

groups we can direct people to to

29:15

help. This just isn't understanding your bills.

29:17

You and I speak with Other is

29:19

about health literacy and it's a very

29:22

real problem said. You. Can't really read

29:24

even the paperwork they give you because it's.

29:26

In A written for. Someone. With

29:29

a certain education or as some since

29:31

around language I couldn't agree more a

29:33

have to. I couldn't even understand my

29:35

medical bills. It was twelve pages of

29:37

very small press that I'm sitting there

29:39

parsing through with a highlighter trying to

29:41

figure okay, what did they charge me

29:43

for this and what is this code

29:45

mean? So yes, sometimes you do need

29:47

an expert and I love that's asking

29:49

your provider, asking the hospital sometimes even

29:51

if everything is correct, their groups out

29:53

there a nonprofit groups and groups and

29:55

your community that may help you with

29:58

that medical. Bill so to Rome. You

30:00

mention afraid that the system is broken

30:02

and if we step back and we

30:05

look at this from a really wide

30:07

lens and the macro sense there's a

30:09

lot about our health care systems that

30:11

doesn't work especially when were thinking about

30:14

how we pay for it is it's

30:16

as I mean like you said the

30:18

the average American consumer like it's a

30:20

struggle when we look at other i

30:23

would say developed nations nations that are

30:25

well seats they have these for decide

30:27

public health systems these systems that really

30:29

look at health care for all and

30:32

here in the last this is made

30:34

some folks like Bernie Sanders plus to

30:36

expand public. Health Care for all. Now

30:39

I know you disagree with this. Approach Can you

30:41

share little bit about why? Well first

30:43

of all, I. Completely. Agree

30:45

with Bernie Sanders. had conversations with

30:47

that with him on this. This

30:49

everyone deserves access to high quality,

30:51

affordable healthcare. And at think it's

30:53

important that we start the conversation

30:55

there because that's common ground. Few

30:57

people are gonna argue against that.

31:00

This. You start to ask yourself okay,

31:02

how do we get their how did

31:04

we get to a place where we're

31:06

giving everyone high quality, affordable healthcare and

31:08

or in some countries. His.

31:10

Through government provision of health insurance. and

31:13

there are good things in their bad

31:15

things about that. I'm literally going to

31:17

Canada and the next couple of days

31:19

and I could tell you that there

31:21

are a lot of folks in Canada

31:23

who were not happy about how long

31:25

it takes them to get access to

31:27

their health care system. For those good

31:29

things about things about the government provision

31:31

of healthcare innovations, Much of the health

31:33

care innovation that's going on on our

31:35

planet is happening in the United States.

31:38

Because. We're market based system that allows people

31:40

to profit if they come up with an

31:42

innovation that does things better or quicker. More

31:45

deliberate access to more people see

31:47

point to Rome. It is important

31:49

when people have choices right and

31:51

and I I think no one

31:53

would disagree with that exactly and

31:55

info. So here's what I have

31:57

been doing. I've really been. Trying.

32:00

Except. We. Are

32:02

in a country where twenty percent of our gdp.

32:04

Is. Health Care for a system of is

32:06

predicated on on some things that if we

32:09

were just bought it from scratch we wouldn't

32:11

do it that way but we gotta figure

32:13

out how to optimize it's in. I talked

32:15

to businesses and we saw this with the

32:17

Affordable Care Act but interestingly enough in Indiana

32:20

us when we used the Affordable Care Act

32:22

funding to expand and many concern if things

32:24

didn't. We. Did it by making the

32:26

business case you it's you and four years

32:28

and said hey, health care's your number two

32:31

expense And people not shop for work when

32:33

they're sick, people not show for work when

32:35

their kids are sick. And self

32:37

if a who's you from economic perspective

32:40

as a business owner to make sure

32:42

we have opportunities for people to get

32:44

access to high quality, affordable healthcare. Sneaking

32:47

that business case that if you're going

32:49

to keep the market based system, let's

32:51

make sure if everyone has access. To

32:53

it. That's one thing we need to do with

32:56

continue to encourage businesses. And to

32:58

understand the value of providing that but high

33:00

quality, affordable healthcare. But when I was Surgeon

33:02

General, I put out a report called Community

33:04

Health and Economic Prosperity that wasn't at all

33:07

about health care. it was about health. What?

33:09

I just said may be lost on some

33:11

people, but only about twenty percent of your

33:13

overall health is determined by your access to

33:16

healthcare. We spend a lot of our time

33:18

an inordinate amount of our time talking about

33:20

health care. But only about twenty percent of

33:22

your health is determined by healthcare. The other

33:24

eighty percent is determined by things will. Take.

33:26

Time off if you're sick, transportation, housing,

33:28

access to to fresh fruits and vegetables.

33:31

Safe places to exercise in if we

33:33

can create healthy communities And that's really

33:35

what I'm trying to get. Businesses and

33:37

politicians the understands that we will have

33:40

fewer people with diabetes. You are people

33:42

with cancer, Fewer people with heart disease.

33:45

and we won't need so much expensive health

33:47

care on the back in so focusing on

33:49

prevention i think is also of going to

33:51

be t and we can't focus on prevention

33:53

if we don't create i'm healthy communities i

33:55

could go on but those are the things

33:58

that really i'm focused on right now And

34:00

I'd rather have Mark Cuban or Jeff

34:02

Bezos or Elon Musk making the case

34:05

for health than to have the Surgeon

34:07

General of the United States because Congress

34:09

is going to listen when business owners

34:11

lean in on this topic. This

34:13

is now the time when we try to close out, but with

34:16

Jerome, it's hard to kind of close out because there's so much

34:18

we want to talk about. Let

34:20

me leave you with a couple of

34:22

final questions to answer. So number

34:24

one, there are some solutions out there. We

34:26

don't need to be totally pessimistic. Can

34:29

any that you might be working on that

34:31

you're excited about? And then for

34:33

the love of all that is public health, can

34:35

we continue to drink our milk? Well,

34:40

number one, there are solutions out there,

34:42

but you can't solve a problem that

34:44

you don't acknowledge exists. So

34:46

I want to thank you all for shining a light

34:49

on this issue. And I want

34:51

everyone to understand that no matter who you

34:53

are or where you sit, you will be

34:56

impacted if we don't address some of these

34:58

issues. But also you have levers, whether it's

35:00

as an individual or as a business owner

35:02

or as a voter to

35:05

actually help your voice be heard

35:07

and to advocate for changes that are going to

35:09

fix the broken parts of the system. Sometimes it's

35:11

just sharing your story like we're doing today. And

35:14

as I mentioned, we're not going to move

35:16

forward until businesses step up and help us

35:18

make that case for why we need to

35:21

fix this health care system because far

35:23

too often, public health and prevention

35:26

is pitted against the

35:28

business case. And I want

35:30

people to understand we saw during COVID that

35:33

you're not going to be able to be economically

35:36

viable as a society or as an

35:38

individual if you're not healthy as

35:41

a society or as an individual, which leads to

35:43

the final point that you asked, can we drink

35:45

milk? And the quick context

35:47

for that is, hey, we're looking at

35:50

2020 all over again in many ways

35:52

with bird flu, H5N1. And

35:55

you're having to weigh, okay, do we

35:58

shut down the whole dairy industry? out

36:01

of an abundance of caution, while at the

36:03

same time suffering economic harm,

36:05

and harm to people who rely on

36:07

dairy products as part of their daily

36:10

nutrition and sustenance. I'll tell you that

36:12

I had milk this morning. You don't

36:14

know what you don't know. We really

36:16

need the administration to double down on

36:18

their efforts to communicate and to share

36:20

the data that they have with the

36:22

public so that the public can be

36:24

reassured. But between the

36:26

pasteurization process, between individual and

36:28

industry food and safety protocols,

36:31

between the fact that most milk is pasteurized,

36:33

99% of all milk is pasteurized, and you

36:35

shouldn't drink raw milk, and I may get in

36:37

trouble for saying that in the same quarters, but

36:40

I just don't advise it as a public

36:42

health physician that folks drink raw milk. We

36:44

would agree with you. Do not drink raw milk.

36:46

We would agree. And the

36:48

digestive process breaks down many viruses.

36:51

And it's important for listeners to know that as

36:53

of the recording of this, no live virus has

36:56

been found in milk or eggs, even though viral

36:58

fragments have been found in some milk. I

37:00

feel like the milk is safe to consume

37:03

its low rules, and I feel like there's

37:05

a much higher risk if everyone were to

37:07

suddenly start avoiding dairy products because it's such

37:09

a part of the

37:11

American diet. And we know that when you look at

37:13

WIC, when you look at SNAP, there are kids that

37:16

would go hungry if we

37:18

literally told them to stop drinking

37:20

milk. So that's a great thing to close on because,

37:22

again, it really shows you these

37:24

trade-offs, these tough trade-offs that we

37:26

have, whether it's trying to figure out how

37:28

to pay for health care or whether it's

37:31

trying to figure out what to do in

37:33

a emerging outbreak and pandemic. It's

37:35

why we need to have these conversations. It's

37:37

why we need to realize there's not going

37:39

to be one right answer. We need to

37:41

have all parties at the table understand the

37:43

problem and work together towards solutions that help

37:46

the maximum number of people, harm

37:49

the minimum number of people, and always

37:51

have an eye to health equity and

37:53

making sure we're not unduly harming marginalized

37:55

populations. That's

38:04

a great

38:06

note to

38:09

end on. Director

38:13

Jerome Adams is a dad doctor and former

38:16

surgeon general of the United States. By the

38:18

way, unanimously confirmed, not a small feat in

38:20

this 21st century. His

38:22

book, Crisis and Chaos, Lessons from the Front Lines

38:25

of the War Against COVID-19, is out

38:27

now, has a lot of great lessons in

38:29

there for not just bird flu, but public

38:31

health in general and very accessible and

38:33

approachable no matter who you are. Jerome,

38:36

thank you so much for joining, myself and

38:38

Maya. Thank you both for having me today.

38:48

We reached out to the Mayo Clinic

38:50

in Arizona that provided care to surgeon general

38:53

Jerome Adams for their take on the situation.

38:56

The communications office provided us with

38:58

this statement. Mayo Clinic

39:00

is committed to providing high quality, high

39:02

value care for all its patients and

39:05

to ensuring that financial considerations are

39:07

not an obstacle between patients and the care

39:09

they need. Without patient

39:12

authorization, Mayo Clinic's adherence to

39:14

patient privacy laws prevents us

39:16

from discussing specific patient circumstances

39:18

or providing additional clarifying

39:21

relevant facts. And

39:26

that's our show this week. Well Now

39:29

is produced by Vic Whitley-Barryn. Ben

39:31

Richmond is SLATE's Senior Director of

39:33

Podcast Operations. Alicia Montgomery is

39:35

Vice President of Audio. We'd love to hear

39:38

from you. Email us at wellnowatslate.com. If you

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want to support this show, please consider becoming

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a SLATE class member. You'll

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get to

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listen to this show at free, as

39:50

well as your bonus materials from some of

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your other favorite SLATE podcast, like Slow Burn

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and Amicus. Be sure to tune

39:56

in next Wednesday as we tackle another piece

39:58

of wellness industry. I'm Kavita Patel

40:01

and I'm Maya Feller. Thanks for listening.