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Beating the Healthcare System

Ralph welcomes investigative journalist, Marshall Allen, author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win,” your “guerrilla” guidebook full of practical ways to keep your costs lower and your satisfaction higher. Plus, Ralph updates the Congress Club.

Marshall Allen is an investigative reporter who has written for ProPublica and the Las Vegas Sun. He was a Pulitzer Prize finalist (with co-author Alex Richards) for his work on the quality of hospital care in Las Vegas. His Allen Health Academy provides practical tactics to empower consumers and employers. His latest book is Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.


[Change to the healthcare industry is] happening slowly. But it’s controversial, because a lot of people have been making money the same old, same old way. And when you look at all that wasteful spending in the healthcare system– that’s the paychecks, that’s the bonuses, that’s the boats and vacation homes of healthcare executives. And so there are forces that are opposing this. And this is why it is a fight.

Marshall Allen, author of Never Pay the First Bill


[American healthcare] is a product of a failed system, here. a lot of failed public policies that have been going on for decades. On the right and the left, our elected officials have completely failed the American people. And so, we’re in a position now, where I didn’t want to write another policy book. This isn’t about policies. This is about the reality of what is happening to working Americans every day.

Marshall Allen, author of Never Pay the First Bill


Internationally, this book would go in the comedy section. Because, globally, our healthcare system is a total joke

Marshall Allen, author of Never Pay the First Bill

[Change to the healthcare industry is] happening slowly. But it’s controversial, because a lot of people have been making money the same old, same old way. And when you look at all that wasteful spending in the healthcare system– that’s the paychecks, that’s the bonuses, that’s the boats and vacation homes of healthcare executives. And so there are forces that are opposing this. And this is why it is a fight.

Marshall Allen, author of Never Pay the First Bill

When you look at the pain that’s being caused to the American people, people are willing to fight back. People are willing to take the hassle. Because they’re doing this to fight for their own financial livelihood. They have to fight back, otherwise they’ll be bankrupted. And so, it is a hassle. It’s inconvenient. It’s a policy failure. It’s a failure of our elected officials. I wish it wasn’t the reality. But I think we have to do something about it. And thankfully, there’s a lot we can do.

Marshall Allen, author of Never Pay the First Bill


On the healthcare industry] We’re dealing here with a corporate crime wave that is so intricate, so gamed, so premeditated, so capable of cooling out certain objectors (such as you recommend consumers who read your book to become), that it continually gets worse. So, it’s sort of like serial bank robbers who go from one bank to another, through a city, robbing the bank. And as they leave the bank, someone says, “Stop!” And they throw a $20 bill, and keep going, and rob the next bank.

Ralph Nader

Ralph Nader Radio Hour Ep 409 Transcript (Right click to download)


  1. David Faubion says:

    Author Marshall Allen gets right to the core of our dysfunctional and thus absurdly overpriced and dangerous system of healthcare, aka sick-care.
    We should have a single-payer healthcare, and that payer ought to be corporations: domestic and foreign making us sick. Audit each company to assess how sick each makes us, and then set the dollar figure of their liability based on their culpability.
    There’s an increasingly common false rationale (lie) for keeping the status quo healthcare, the status crap that only a small fraction of people get sick enough to need and use healthcare. The fact is, so says the CDC, that 6 in 10 of USAns have a chronic disease in current treatment.
    But alas, the CDC homepage puts the onus on consumers and our bad habits. Perhaps digging deeper in the CDC site would reveal the addiction factors for much of what corporations push on us, the factor of our stressful capitalist lifestyle, and the lack of and disregard for affordable mental healthcare. The CDC’s homepage fails to cite our often fatal exposures to industrial pollution, which includes our stupid system of transportation. The CDC’s homepage doesn’t mention the endemic of increasing medical malpractice. Nor does it, at least, have a link to a CDC environmental racism/racial pollution CDC page. Get with it CDC. Further, although you do have a site search field, the results of my keyword looks were far from what I have learned from investigative journalists, muckrakers, whistleblowers, and citizens living in the misery of our industrial extractive wealth. Shame, shame, shame.

    The Oath of Hippocrates is now ‘Do no harm to corporations’, since a healthy trade makes healthy people.

  2. NooN says:

    Marshall Allen is a MAGNIFICENT ReSEARCHER.
    Thank You. It! We are in imminent NEED of HEALTH CARE for ALL.
    If we Grew a More Mature People & Country, we COULD & W0ULD Copy CANADA’s 11 page HEALTH CARE for ALL LAW.
    IF our Lawmakers were H0NEST, they would
    comply with our WRITTEN & VERBAL “REQUESTS”.
    It Seem we are paying our so Called Lawmakers,
    but the Corporations are Controlling Lawmakers.
    IF we had decent Internet here in the Mountains
    I would call the Congressional Party, but we do not seem to be Blessed with enough power to make cellular phone calls unless the receiving party is on our “Facebook MessengeR”.
    When I return to my city home, I call the Mountains senators & ask them: “What U doing with our money?”
    We need Internet 4 “Career in a Year” & “Health Care” Education.”
    As a matter of fact, these southern mountain people have acres of land surrounding their Home. I ask,
    “Where’s their S0LAR”(?) (?) Do we not want to receive money or financial credit by creating & sharing flowing energy. Why is it so EXPENSIVE that people need take out $50,000 Mortgages on their homes 1st, instead of working out a method of deducting a percentage of what they are returning the company with with what they are Creating.

  3. Glenn Fritz says:

    For Ralph,

    “Only the Super-Rich Can Save Us!” was a euphoric and inspirational book to me.

    Billionaire J B Pritzker has funded his own Illinois governor electoral campaign with $90,000,000.00 today.

    Is this possibly a life imitating art event? Or am I being delusional?

  4. Melinda Nichols says:

    Until having personally experienced the morass of so-called “healthcare” insurance greed, and how medical providers are totally beholden and abaters to a truly criminal system, I would have continued to remain only sympathetic to the plight of ‘others’. I believed that the well-intended ACA would offer a measure of interim relief until a broader universal and humane system of healthcare coverage became a reality in the U.S. But the eventual ACA passed by Congress, while it definitely provides access to essential healthcare, is no match for a universal and humane system. To qualify initially and to remain eligible for subsidized ACA, and not be tyrannized by threat of becoming ineligible, your Modified Adjusted Income has to be incredibly low, at a level hardly sustainable based on costs of living if you need a daily place to lay your head and food to eat and money for transportation or Internet and a computer to earn a modicum income. The ACA subsidies are generous, once you income qualify, but if or once you don’t, the monthly premium and out-of-pocket costs are prohibitive; they’re higher than most employer-based plans. And the kicker: the federal government pays on the ACA exchange for subsidized plans a huge monthly premium to the participating “marketplace exchange” insurers — much, much more than private employers pay to the same insurers for similar coverages. How is this? How does the federal government not have more powerful (that is, more competitive and more negotiable) buying power with medical insurers than private employers and even some state employers? Again, ACA is definitely a crucial lifeline when you qualify and remain within their income eligibility to receive the subsidized rates. But it is a flawed system that is not equally available in all parts of the country; tyrannizes by threat of losing your subsidy if your income exceeds by not much an already low income-to-cost of living ratio; tyrannizes by threat of losing subsidized ACA coverage with Medicaid coverage (if it exists in your state), which many doctors, various discipline practitioners, and facilities do not accept; and disproportionately pays corporate insurance providers seemingly obscene premiums. Insurance providers may say — and possibly with some accurate data — that the ACA exchange marketplace is a pool, on average, of more people with illnesses or preexisting conditions than employer-based pools of employees, and hence why the full ACA monthly premiums are so much higher than those of the already high employer plans. All this is to assert that the ACA and private employer insurance plans are no match for a single-payer system that is charged with providing universal access to health care. The health care system we have, as so many people have identified in this discussion, causes untold suffering to millions of people by the insurance companies (and other elements and coffers of the convoluted, administratively-laden “medical” system) through withholding, delaying, declining claims for care and by the sheer unaffordability to seek care or follow preventive care appointments (should a condition be diagnosed) for realistic fears of the out-of-pocket deductibles, co-pays, co-insurances — and the administrative expenditure of time and documentation to contend with balance billing, denials, and so forth. I appreciate this forum, the resources provided, and the contributing guests and participants. And to the indefatigable defender of justice and fairness, I want to thank Mr. Ralph Nader for identifying, inspiring, encouraging, and continually engaging on the ground with this longstanding, critical issue and so many critical issues facing humanity.

  5. Melinda Nichols says:

    In my earlier post today, I meant also to thank Marshall Allen for such dedication. Investigative reporting is essential. While I haven’t yet read this book, I have read a fairly detailed summary. In the summary of what is discussed in the book, it mentions that as patients we need to become aware of the medical procedure codes and Medicare pricing so as to negotiate our non-Medicare plans and insist with medical billing department administrators and debt collectors on not paying more than at least twice that of what Medicare allows and pays on behalf of its Medicare patients — including medications. This is quite a revelation and empowering to know. However, medical and pharmaceutical offices — practitioners, hospital and other medical facilities, and their administrators — explain away (whether explicitly or implicitly) that they are “losing money” on Medicare patient care. Whether that likely translates to their profits, in the end these medical practitioners, pharmacies, and medical facility offices are charging through the insurance and broker companies for private, state, and federal employer policies enormously high rates for monthly premiums and deductibles, plus care fees, to make up for (subsidize) what they don’t receive (or want us to believe they don’t receive to pay their costs — or “hidden egregious profits”) from Medicare allowable payments. Plus, Medicare itself is no panacea — not Original (Traditional) Medicare and certainly not Advantage Medicare plans. I have had an administrator in a medical practitioner office unwittingly reveal to me (a non-Medicare recipient) that Medicare well annual appointments don’t include hands-on examinations, e.g., such as listening to the patient’s heart and lungs with a stethoscope, etc.) but rather the physician (or PA or NP) goes through a checklist of bodily systems to ask the Medicare patient. The administrator was illustrating this as an example to compare Medicare to private plans, with the latter including hands-on examinations in annual preventive care (well appointments). Unless I misunderstood (and I have not verified the accuracy of this information with Medicare), she was saying that while abiding my accepted “standard of care” practices, when Medicare is the payee, medical administrators are permitted to adapt certain allowable protocol to reduce overhead costs and time — while still satisfying “standard of care.”. I suspect it’s the administrators in medical and practitioner offices and facilities, through their legal counsel and insurance brokers and lobbyists for the insurance and medical and pharmaceutical industries, that are finding “workarounds” to reduce Medicare services and influencing Medicare’s program, knowing the Medicare financial payment per service is below the doctor, pharmacy, or facility’s desired charge. ‘Universal Health Care for All,’ under a single-payer system that eliminates the multitude of lobbyists, insurance and broker companies, and employer Human Resource and medical/pharmaceutical/facility administrators, is an imperative.

  6. Melinda — read, study, and forget that canard, only the rich can save us. Ralph has not put these topics up on his show. Very complicated.

    Quoting —

    Stakeholder capitalism or social entrepreneurship has been cultivated in Brazil by the Aspen Institute, The Inter-American Development Bank, The International Finance Corporation, the Catholic Church through the First fund, and Oikocredit (World Council of Churches) going back at least to 2003. Brazil is one of thirty-three member nations of Sir Ronald Cohen’s Global Steering Group for Impact Investment, which was launched in 2017.

    Aspen Institute, with assistance from the University of St. Gallen in São Paulo, documented impact investing opportunities in Brazil in 2014, targeting BOP (base of pyramid) favela residents. The report identifies investment potential in the areas of education and healthcare access and banking since Brazil is one of the fifteen countries with the greatest income inequality. Favelas would be seen by venture philanthropists and social entrepreneurs as significant and potentially profitable sources of data if they can be “properly developed” with “evidence-based solutions.” This game of speculation can only proceed once rules are created, consensus is established, players are recruited, and the gameboard is set up. The human capital finance game runs on metrics.

    In the coming years, global financiers, will attempt to meld dynamic pricing and mobile payments with biometric digital identity, Internet of Body sensors, and blockchain smart contracts and then weave it all into an expansive spatial web meant to control our social and economic relations in both the material world and, through digital assets, rights and privileges, in the Metaverse, as well. Click here to listen to an interview I did with Bonnie Faulkner of Guns and Butter that goes into more detail about how impact investing connects to digital twins, and mixed reality.

    Surely it is twisted to view communities as resource deposits of untapped data, but that is the logic of end-stage capitalism. The infrastructure needed to scale human capital finance profit are ICT (Individual Communication Technology) devices including phones, tablets, and inexpensive computers like chrome books; wearable technologies and biosensors; and 5-6G used in combination with data-dashboards that verify impact data against predictions and success metrics laid out in the terms of the deals. These are all things one finds in recreation centers in the United States now, and given inroads made by the Aspen Institute, Stanford, Harvard and the like, they will very likely become standard issue in the favelas, too. Not because any of it is good for children, but because the children’s data has value, and their compliance has value.

    The Metaverse will be populated by compliant avatars. Beyond social impact, the conditioning of the young to cyborg life is going full throttle. Meanwhile for portfolio managers, children’s futures are just tranches of investment – data commodities. It’s only business.