For years, Dan Weissmann had wanted to make a podcast about healthcare. He’d reported stories related to America’s healthcare system before, as a staff reporter at Marketplace and then Chicago’s WBEZ. But he thought the subject could use a fuller, more in-depth look, and he specifically wanted to explore the rising costs of healthcare. Anyone watching the news and certainly the recent Democratic presidential debates will recognize that there’s no consensus on what to do about our current system. But what can be agreed upon is that the average American is simply paying too much.
So, why does healthcare cost so much in this country? And what can we do about it? In 2017, Weissmann left his job in public radio to devote himself to answering these questions full-time. On his excellent podcast An Arm and a Leg, Weissmann has investigated everything from the variability of drug prices to whether medical devices spy on patients on behalf of insurance companies. Now on its third season, An Arm and a Leg has returned to tell the stories of people who have fought back against insurance companies and the pharmaceutical industry, and will include an aptly-titled segment called, “Can They Fucking Do That?”
I spoke with Weissmann to learn more about how An Arm and a Leg got its start, what we can expect from this latest season, and what it’s like running an independent podcast.
When did you decide to start An Arm and a Leg?
OK, there’s two tracks here. One of them is that I left my job in 2017, and because I’m committed to living in Chicago, the question was where does my career go next? Because I’m not leaving here, and the jobs are on the coasts. I was thinking I might need a new career, which I really didn’t want. I love being a reporter, but I need health insurance, so I can’t really freelance.
You were working in public radio before.
Yeah, I was doing public radio and the like. I’d done stories for 99% Invisible, Reveal, and other places, and I’d been a staff reporter at WBEZ and Marketplace. The boundary between public radio and the kind of narrative stuff I’m especially interested in was pretty fluid. But in the podcast world, all of that stuff — like salaried jobs with health insurance — was on the coasts.
LA, New York, etc.
Exactly. I thought, OK, I may need a new career. My wife has her own business, which meant my job had been to bring in the health insurance. If I was going to freelance, which I could do from Chicago, that part — the me-bringing-the-health-insurance part — wasn’t going to work. I remember talking with a friend who said, “Are you really going to give it up?”
But I thought, you know what, I’ve been pitching a series about the cost of healthcare for years — at Marketplace, at WBEZ — because this is a big and obvious pain point for much of our society. Occasionally, as a reporter, I would end up doing a story on this topic, talking to someone about their personal experience, usually a horror story, and these stories are just so dramatic. They’re so intimate, right? It’s about living and dying, and everybody who has a health crisis has a family who loves them, and who mobilizes to meet it. These stories are also about how we make it in the world, which I’ve always been interested in. And every story is actually about giant systems: major industries, public policies, the whole economy. I’m the kind of nerd to whom all that complexity just sounds amazing. Every one of these stories is super intimate and has broad implications to society. Like, amazing! Amazingly awful, which means an opportunity to make a difference.
But the people I worked for said, “That’s a cool idea, but everybody who works here has a cool idea. We’ll let you know if we want to do yours.” So after I left the job, I thought, OK, it’s going to take a while for me to ramp into a new career. Maybe in that time I could build this podcast into an actual thing. I could start this and later on it could be my career. That was the goal, the hope.
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The story starts, then, with your own search for health insurance.
I mean, you use what you have. By the time the show went into production, the clock was ticking on the health insurance I had from my old job. There’s this thing called COBRA, where you pay your former employer to stay on their health insurance. You pay the full premiums, and that’ll last you for a year and a half. After that, we had to come up with something. I looked at the plans offered on the Obamacare exchange and they didn’t cover the doctors that our family sees. We have a somewhat specific basket of pre-existing conditions and we’re tied to those providers. It turned out that seeing those doctors was going to be very expensive. My wife was building her business in a certain direction — intentionally, asking people who freelanced for her to come on staff, which meant paying them more, and spending money on a payroll service to manage the extra bureaucracy that entailed — all to be able to qualify us for group health insurance. But we didn’t know when this show launched, in the fall of 2018, whether an insurer was going to take us on as a group. There was uncertainty, and we used that build narrative suspense.
Healthcare is a major issue. Watching the Democratic presidential debates, it’s also the issue over which there’s the most disagreement. What do you think about the tone of the debate?
It’s super interesting but, to be honest, we’re purposefully tacking away from engaging with the political debate. We’re instead trying to focus on what we can all do right now, because one’s dream legislation, even if it passes, won’t come into effect for several years. Meanwhile, the system we’ve got now is shaping a lot of people’s lives — steering the careers and jobs we choose, filling our social-media feeds with GoFundMe campaigns, and costing us a TON of money. I routinely hear from people who have bills in the four figures for minor medical encounters. For some people that’s a major annoyance. For others, it’s a nightmare, life-altering. So we’re focused this season on what I’m calling financial self-defense.
Can you talk more about that?
I can tell you the stories. You know, those are the stories we looked for. So the first episode is called Mom vs. Texas. Stephanie Wittels Wachs has a daughter who was born hearing-impaired, and she quickly found out that hearing aids for kids weren’t covered by insurance — and they cost like $6,000. And they only last for a few years, then have to be replaced. So she teamed up with a few other people to get a law passed in Texas, requiring insurance to cover that kind of thing.
It was a small band of people who made a real and substantial change in the law of a big state, against serious odds. So, you know, you don’t have to wait for a presidential candidate to come and deliver wholesale change to you. People can band together and make stuff happen.
The second episode is about my neighbor, The Ninja. In our first season, we did a story about a group of Renaissance Fair workers who banded together to create a safety net for each other. They raised about half a million dollars to pay for each other’s medical bills over the last few years, but their secret weapon was that they made around $2 million in bills go away. They had this person, a former Rennie, who coaches people on how to negotiate their healthcare bills. At the end of that episode, I asked our listeners, if you know somebody like this or you are somebody like this, please get in touch. So my neighbor, who I didn’t know at the time, reached out and said I’m that person, I’m your Robin Hood. This season’s second episode tells the story of how she became that person, the ninja. It’s a tough story, and she’s a really inspiring, really lovely person. And as you’ll hear at the end of the episode, my wife applied some of these ninja tricks and saved us a bunch of money.
This season features a segment called, “Can They Fucking Do That?” Please tell me more.
So, I ask my listeners for stories and we get a lot of them, many more that we can do on the show. Many of them raise this question of, Can They Fucking Do That? For example, there was a woman who wrote in about her experience of paying for a visit to a fertility clinic. She’d gotten a bill and paid it. Then later she got this random looking, hot-pink envelope in the mail. It didn’t look like a legit bill and it was from a company she’d never heard of. They wanted something like 30 dollars from her. She ignored it, which maybe wasn’t the wisest thing to do, but a couple of months later, she gets a note from a collection agency saying that she had this debt to this company — for over a thousand dollars. It’s like, can they fucking do that?
I’m looking forward to hearing the answer. So, you’re running An Arm and a Leg independently, and I know you’ve been using Patreon. What’s that been like?
I’m really lucky. In terms of making the show independently, I started this project at a point in my career when I already knew a bunch of people. I started by calling everyone I knew and then expanding out to people that I didn’t know to ask for input and advice. So this project really started with a ton of community support, and that’s how I found my way to the people who are my collaborators. But, you know, I make the show on the enclosed sun porch behind my son’s bedroom, right? It’s no crazy set-up. But it’s not lonely because it’s a very collaborative process, and I’m lucky to have a family. That’s the kind of daily community that, when I was younger, I had to go to the office to get.
At other times in my life, I had stretches of working for myself and I found it unbearably lonely and unstructured. So, I made sure before going out on my own that I made some standing appointments with friends to take a walk every week, to have lunch every week. I sing in a punk rock glee club, too.
In terms of your listeners, do you feel you have more of a direct relationship with them?
Compared to when I was working in radio? One hundred percent. I mean, we ask for it. We say, send us your stories, send us your…money [laughs]. But also, we ask that listeners engage with us on social media. It’s awesome — we get hundreds of messages from listeners every season. People share all kinds of stories — heart-breaking, powerful stories; stories about smaller things that raise huge questions, and stories about how they’re actually using the information we’re putting out, and passing it on, including nurses who say they’re passing our information on to the patients they see. And hundreds of people are digging into their pockets to support the show because we ask. The fact that some people are giving $20 or more a month is amazing to me. And the fact that people show up with a dollar a month is almost more moving. It’s like, you’re giving me a dollar a month; you’re sending a message. People say, I’ve never done this kind of thing — supporting a project like this — and I find that super moving. I’m very grateful for it.
Jack Conway is the editor of Podcast Review