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Being Nickeled & Dimed... · Armstrong & Getty One More Thing

• 0:00
  Speaker 1: Being nickeled and dim. Do we need to adjust that
• 0:02
  Speaker 1: for inflation? It's one more thing I'm strong and more
• 0:07
  Speaker 1: before we get to that.
• 0:10
  Speaker 2: I had two six seven incidents occur to me a curb,
• 0:14
  Speaker 2: Can I try this again?
• 0:15
  Speaker 1: At me? For me?
• 0:16
  Speaker 2: I have two six seven incidents occur in my life
• 0:19
  Speaker 2: over the weekends. One I was m seeing an event
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  Speaker 2: Saturday night and I made a six to seven joke
• 0:27
  Speaker 2: in which probably three quarters of the room laughed and
• 0:32
  Speaker 2: one quarter looked around like what is he talking about?
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  Speaker 1: Which I thought was interesting.
• 0:36
  Speaker 2: And then we're at a Mexican restaurant, and you know,
• 0:39
  Speaker 2: you hound a restaurant. Sometimes they give you a little
• 0:41
  Speaker 2: of the little thing with the number on it, so
• 0:42
  Speaker 2: they don't want number you are to bring your food
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  Speaker 2: out at your table. Our number was sixty seven.
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  Speaker 1: I said, incident.
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  Speaker 2: I said, whoa dude, I don't have to pay extra
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  Speaker 2: for this? And he said, what do you mean is
• 0:56
  Speaker 2: there a problem with that? I said six seven? He said,
• 0:59
  Speaker 2: uh huh. Good for him, right, and he was like
• 1:03
  Speaker 2: mid thirties, he has a job exactly. I mentioned to
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  Speaker 2: a few other people.
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  Speaker 1: Like, oh, I want you to have to pay for that?
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  Speaker 2: I don't know remember when six seven used to be
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  Speaker 2: sixty seven and it was just a number. I do
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  Speaker 2: remember those were good times, yeah.
• 1:21
  Speaker 1: Good times, yeah yeah. So I love how this starts out.
• 1:26
  Speaker 1: I'll bet everybody can relate to this by Matthew Hennessy.
• 1:31
  Speaker 1: A young George will once asked William F. Buckley Junior,
• 1:35
  Speaker 1: how do you come up with things to write about?
• 1:38
  Speaker 1: And Buckley said to the young George will it's easy.
• 1:42
  Speaker 1: The world irritates me three times a week, which is plenty,
• 1:48
  Speaker 1: and that's the start of many columns. And he explains
• 1:50
  Speaker 1: why he's irritating in this case. But if I asked you,
• 1:55
  Speaker 1: as a like a carpenter or somebody does a fair
• 1:58
  Speaker 1: amount of home improvement work, or how much a hammer costs,
• 2:01
  Speaker 1: you could tell me roughly, or how much a I
• 2:05
  Speaker 1: don't know, microwave, good micro evoven costs. If I asked
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  Speaker 1: you to tell me how much an MRI costs, even
• 2:12
  Speaker 1: if you'd had one three days ago, you wouldn't have
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  Speaker 1: any idea. Nope, which is part of the reason our
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  Speaker 1: medical system is just so incredibly screwed up. I want
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  Speaker 1: to drag Craig, the healthcare guru, back on the air
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  Speaker 1: to talk to him about that. But anyway, Matthew Hennessy
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  Speaker 1: is writing about it was not long ago. His mother
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  Speaker 1: in law's been ill for a while. She's lived in
• 2:36
  Speaker 1: a nursing home in a rural part of the northeast, Okay.
• 2:38
  Speaker 1: Just to set the scene, long term care for memory
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  Speaker 1: loss other chronic issues, and the nursing home staff, he says,
• 2:47
  Speaker 1: are generally competent and responsive, a lot of turnover, which
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  Speaker 1: is one of the tough parts of those homes. But anyway,
• 2:54
  Speaker 1: as part of the care, a member of the nursing
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  Speaker 1: home staff takes her to regular appointments at the clinic
• 3:00
  Speaker 1: of a large medical center about thirty miles away. The
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  Speaker 1: clinic and medical center are affiliated with a prestigious nearby university,
• 3:08
  Speaker 1: which he doesn't name. He says, you'd recognize the name.
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  Speaker 1: I'm being vague because I'm not trying to get anyone
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  Speaker 1: in trouble. My irritation is with the whole system's attitude,
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  Speaker 1: not any one persons. So famous medical center, famous university.
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  Speaker 1: So mom in law gets taken to her annual checkup,
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  Speaker 1: no particular problems, no medications needed, just it was on
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  Speaker 1: the schedule. So they went in the healthcare and insurance
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  Speaker 1: lingo we've all been forced to learn and use recent years.
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  Speaker 1: This was a well visit routine. Well visits are typically
• 3:42
  Speaker 1: covered even couraged by insurance providers at no cost to
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  Speaker 1: the patient. Medicare, in this case, covered mom in law.
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  Speaker 1: When the bill for the visit came, my wife, who
• 3:53
  Speaker 1: is Mom's legal guardian, noticed two unfamiliar charges. One was
• 3:57
  Speaker 1: one hundred and fifty dollars facility fee. The other for
• 4:02
  Speaker 1: forty dollars, was itemized as the Evaluation and Management to
• 4:06
  Speaker 1: add on the E slash m add on. So just
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  Speaker 1: under two hundred dollars tacked onto a bill for a
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  Speaker 1: well visit, and his wife, to her credit, said wait
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  Speaker 1: a minute, what is this? And she wrote a polite
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  Speaker 1: note to the clinic inquiring as to the nature and
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  Speaker 1: purpose of the charges. Its reply is what irritated me,
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  Speaker 1: he writes. The evaluation and management or EM add on
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  Speaker 1: is used to account for the complexity of EM services
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  Speaker 1: that serve as the continuing focal point for all needed
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  Speaker 1: healthcare services, or with medical care services that are part
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  Speaker 1: of ongoing care related to a patient's single serious condition
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  Speaker 1: or a complex condition. Everybody has expensive headphones on. You're
• 4:53
  Speaker 1: in the radiots. Can anybody tell me what the flame
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  Speaker 1: and fuck that means?
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  Speaker 2: Yeah, it means O. Why did you charge me that?
• 5:01
  Speaker 2: Because I can, because I wanted to. That's what that means.
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  Speaker 1: I am going I'm gonna read that one more time.
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  Speaker 1: The evaluation and management add on is used to account
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  Speaker 1: for the complexity of EM services that serve as the
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  Speaker 1: continuing focal point for all needed healthcare services, or with
• 5:19
  Speaker 1: medical care services that are part of ongoing care related
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  Speaker 1: to a patient's single serious condition or a complex condition.
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  Speaker 2: Oh like Kamala Harris wrote.
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  Speaker 1: That, Yeah, yeah, if she knew more big words. Yeah,
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  Speaker 1: but so Matthew points out, I work with words for
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  Speaker 1: a living, so I'm hardwired to untangle sentences like this.
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  Speaker 1: My brain immediately begins breaking down the parts and reassembling
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  Speaker 1: them in a way that a person moderately familiar with
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  Speaker 1: the English language might find decipherable. I defy you to
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  Speaker 1: tell me what this blithering piffle actually means. Naturally, there
• 5:52
  Speaker 1: was more piffle, and it too blithered and I quote.
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  Speaker 1: The complexity captured by the evaluation and management add on
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  Speaker 1: is not in the clinical condition itself, but in the
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  Speaker 1: cognitive load and the continued responsibility of being the focal
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  Speaker 1: point for all needed services for the patient. It emphasizes
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  Speaker 1: the importance of the longitudinal relationship between the practitioner and
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  Speaker 1: the patient in the diagnosis and treatment plan.
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  Speaker 2: I'm surprised they went to the effort they did to
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  Speaker 2: write some gobbledly gook, because usually, you know, if you
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  Speaker 2: get a charge on anything, and you won't ask what
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  Speaker 2: it is just a formality, it's just routine. Let's say
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  Speaker 2: something like that, and you get what.
• 6:27
  Speaker 1: Are you gonna do? What are you gonna fight it?
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  Speaker 1: You can not pay it? What are you gonna do? Well, right,
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  Speaker 1: as he says, So the well visit, which produced no
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  Speaker 1: changes in care, no new diagnoses, no new prescriptions, it
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  Speaker 1: costs an extra two hundred dollars because well, just because.
• 6:42
  Speaker 2: I thought you were going to go this direction, because
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  Speaker 2: I Katie, you've got insurance, so you're gonna have a
• 6:46
  Speaker 2: baby and God willing, and then you know, it'll all
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  Speaker 2: just go and it'll just be a bill. You'll get
• 6:52
  Speaker 2: a bill and you'll pay it and you won't really
• 6:53
  Speaker 2: look at the why, because that's the way we all
• 6:55
  Speaker 2: do with medical bills. But I had a friend who
• 6:58
  Speaker 2: was a first kid was born. He didn't have any
• 7:00
  Speaker 2: health insurance, and so he got an itemized list of
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  Speaker 2: everything and what it costs, and was really paying attention
• 7:08
  Speaker 2: and in advance or after that after the fact, okay
• 7:13
  Speaker 2: and uh, And several of the examples that stood out,
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  Speaker 2: for instance, because I had at this point it had
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  Speaker 2: been like really recently that we had been there and
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  Speaker 2: Sam had been born, and like when they would come
• 7:26
  Speaker 2: in and say to you know, mom who's just had
• 7:29
  Speaker 2: a baby and has all worn out and everything like that,
• 7:32
  Speaker 2: are you thirsty? Can you anything? And you know, like
• 7:34
  Speaker 2: apple juice? Would that sound good or anything like that. Yeah,
• 7:36
  Speaker 2: I'd like an apple juice. It was like twenty dollars
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  Speaker 2: a piece each one of those. Wo that's not just
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  Speaker 2: a you look thirsty? Can I help you out? No,
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  Speaker 2: it's a it's it's it's an up cell.
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  Speaker 1: And I remember they'll say to dad, can we get
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  Speaker 1: you onto right?
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  Speaker 3: Sure?
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  Speaker 1: Yeah, that'd be I'd be thank you. You're thinking, hey,
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  Speaker 1: this is a good.
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  Speaker 3: Hospital, been in a nice hotel. And then the one
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  Speaker 3: that stood out the most was the little hat that
• 8:01
  Speaker 3: they put on your kid. It's a little like a
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  Speaker 3: little beanie and it's tiny because your kid is so smart.
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  Speaker 3: It weighs nothing. It's nothing.
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  Speaker 2: May have a pink one and a blue one, depending
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  Speaker 2: on the sex of your baby. Back in the day
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  Speaker 2: when we believed in those sorts of things. Now when
• 8:13
  Speaker 2: we were assigning gender, and that little cat, that little
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  Speaker 2: cap they put on the baby's head was eighty dollars.
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  Speaker 3: Oh what eh?
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  Speaker 1: You know?
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  Speaker 2: And you just you either keep it in a drawer
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  Speaker 2: as a keepsake and then forget it or throw it
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  Speaker 2: away or do whatever you do. If you knew it
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  Speaker 2: was eighty dollars and you were paying for it, you'd
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  Speaker 2: bring your own I mean, everybody would everybody, everybody pack
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  Speaker 2: a little kit to go to the hospital. If they
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  Speaker 2: knew it was going to be twenty dollars a juice
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  Speaker 2: and eighty dollars for the hat. You'd go to Target
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  Speaker 2: and buy the little thing for eight bucks, and you'd
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  Speaker 2: bring a case of juice that cost twenty dollars, and
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  Speaker 2: you'd have all those there with you if you were
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  Speaker 2: actually paying for it. Well, you are actually paying for
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  Speaker 2: it big picture, because it all goes through insurance and
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  Speaker 2: this and that and gets spread out through the system
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  Speaker 2: of blah blah blah.
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  Speaker 1: But it's unbelievable. The whole system is a mess. Oh yeah, well,
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  Speaker 1: back to the mist recharge matt asks. Imagine if your
• 9:03
  Speaker 1: dry cleaner treated you this way, how quickly would you
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  Speaker 1: take your business to the competitor across the street. Instantly? Obviously. Well,
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  Speaker 1: as we all know, healthcare and insurance don't operate like
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  Speaker 1: normal businesses, nothing but buck passing middlemen in league with
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  Speaker 1: penny pinching hospital executives. When there's trouble, they all point
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  Speaker 1: the finger at big government, which points it right back
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  Speaker 1: at them. Healthcare is ironically a diseased sector of our economy,
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  Speaker 1: where the prices are intentionally obscured and the customer is
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  Speaker 1: never right.
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  Speaker 2: And if you think the government taking it over would
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  Speaker 2: make it better, your nuts, Oh yeah, yeah, eighty dollars
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  Speaker 2: little hat would become an eight hundred dollars little hat.
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  Speaker 2: Except there wouldn't even be any paperwork to nail that down.
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  Speaker 1: No, it'd just be siphoned out of the tax revenue.
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  Speaker 1: Getting nickeled and dimed is one thing, he says, Getting
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  Speaker 1: treated like an idiot is something else. Getting exposed to
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  Speaker 1: jarger and deflect. Jargon and deflection turns ordinary people into radicals.
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  Speaker 1: American healthcare is complex, I know, but everyone involved, from
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  Speaker 1: politic and policymakers to hospital administrators, insurance companies, physicians, and
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  Speaker 1: nursing home staff should understand that ordinary people all across
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  Speaker 1: this country have had just about enough.
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  Speaker 2: Uh you know, yeah, I agree. I just think that
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  Speaker 2: the only political momentum will be for letting the government
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  Speaker 2: take it over. Then.
• 10:19
  Speaker 1: Yeah, I think you're one hundred percent right. Then I'll
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  Speaker 1: have to be treated for chronic anchor with a bunch
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  Speaker 1: of mystery charges that you poor suckers will pay for.
• 10:32
  Speaker 4: You're talking about upselling as a diabetic. They are trying
• 10:35
  Speaker 4: to sell me drugs constantly.
• 10:38
  Speaker 1: Oh really?
• 10:38
  Speaker 4: Oh yeah, and I I can exercise it off, you know,
• 10:42
  Speaker 4: the blood sugar to get it down, or you could
• 10:43
  Speaker 4: take this pill, and you know, constantly they're doing that
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  Speaker 4: to me.
• 10:47
  Speaker 1: Sure you're a hot prospect.
• 10:48
  Speaker 2: Yeah, no kidding.
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  Speaker 4: Yeah, Well, I guess that's it.