In this episode of Next-Gen Healthcare, we dive deep into what host Larry calls the "sickness business"—the industry built around Americans getting sick. The conversation explores the flaws in the healthcare system, its financial incentives, and what patients can do to protect themselves. Our special guest, Sonja Allen, joins us to discuss the legacy of her late husband, Marshall Allen, a Pulitzer Prize finalist and investigative journalist known for his work exposing the pitfalls of the health care industry. We discuss Marshall’s book, Never Pay the First Bill and Other Ways to Fight the Health Care System and Win, and how his work continues to empower individuals against unfair medical practices.
In this episode of Next-gen Healthcare, we dive deep into what host Larry calls the "sickness business"—the industry built around Americans getting sick. The conversation explores the flaws in the healthcare system, its financial incentives, and what patients can do to protect themselves.
Our special guest, Sonja Allen, joins us to discuss the legacy of her late husband, Marshall Allen, a Pulitzer Prize finalist and investigative journalist known for his work exposing the pitfalls of the health care industry. We discuss Marshall’s book, Never Pay the First Bill and Other Ways to Fight the Health Care System and Win, and how his work continues to empower individuals against unfair medical practices.
Chapters:
00:49 Why the healthcare system profits from sickness.
02:18 Never Pay the First Bill and the impact of Marshall Allen’s work.
05:43 Marshall’s motivations and his legacy.
09:34 Never Pay the First Bill Structure
14:33 The role of insurance companies and why upcoding is a widespread problem.
19:41 The hidden incentives behind higher medical costs and how they affect consumers.
21:25 The launch of the Allen Health Academy and its mission.
24:03 Upcoming nonprofit initiatives aimed at healthcare education.
26:47 Final thoughts and call to action for listeners.
00:00:49:01 - 00:01:02:13
Next-Gen Healthcare Podcast
Thanks for tuning in. And welcome to this episode of Next Generation Health Care. Today this episode is going to be about the sickness business, what I call the sickness business, which is you know, there's there's a whole industry.
00:01:02:13 - 00:01:22:09
Next-Gen Healthcare Podcast
It's been built around, us getting sick in America and, there's some problems with that industry. And we're going to try to, to help you understand it. And learn how to deal with it. Everyone gets sick from time to time. It's it's not fun. But we're going to talk about the business that was built around that.
00:01:22:13 - 00:01:50:10
Next-Gen Healthcare Podcast
And, curing sick and how it can how you can protect yourself from some of the unscrupulous practices that might be in that business. It was a random circumstance in April of 2024 that I was browsing through social media and discovered Marshall Allen and his book, Never Pay the First Bill and Other Ways to Fight the Health Care System and to Win, because the subject was so closely tied to optimal telehealth.
00:01:50:10 - 00:02:18:03
Next-Gen Healthcare Podcast
And what we did, I immediately got excited about it. Without hesitation, I ordered the book, and, I even reached out through social media and sent Marshall a message, asking him if you'd like to contact. By coincidence, we were both in the Dallas-Fort worth market area. Which was neither here nor there, but, but I wanted to see if I could talk to him, and there was no response, and that didn't surprise me.
00:02:18:04 - 00:02:50:08
Next-Gen Healthcare Podcast
I'm just a small business operator out here, and Marshall's, got a successful enterprise going on, so it didn't surprise me at all. But, I did eventually get an answer months later, from Sonya Allen. His wife. And I was really saddened and, of course, surprised to find out that that previous summer, Marshall had unexpectedly passed. And, that was, a tragic loss for for somebody so young.
00:02:50:10 - 00:02:56:13
Next-Gen Healthcare Podcast
My father died at a fairly young age, and and I know what that can be like for a family can be pretty devastating.
00:02:56:13 - 00:03:24:10
Next-Gen Healthcare Podcast
Sonya has graciously agreed to join us today and talk about Marshall, his book, and his substantial legacy. Before I introduce Sonia, I want to read a little about Marshall as printed on the back of his book. The book was published in 2021. Here we go. Marshall Allen is a reporter for ProPublica, where he investigates why we pay so much for health care and gets so little in return.
00:03:24:12 - 00:03:51:18
Next-Gen Healthcare Podcast
He is a Pulitzer Prize finalist and recipient of the Harvard Kennedy School's Goldsmith Prize for Investigative Reporting. He teaches investigative reporting at the Craig Newmark Graduate School of Journalism at the Sydney University of New York, and has spoken at various conferences across the country. Before becoming a journalist, he spent five years in full time ministry, including three years in Kenya.
00:03:54:17 - 00:03:56:08
Next-Gen Healthcare Podcast
We're happy to have you.
00:03:56:08 - 00:05:43:09
Next-Gen Healthcare Podcast
As I mentioned in my Prolog, he, Marshall, left a tremendous legacy, which you're going to carry forward. I think that's fantastic that you took that on. Can you share a little about Marshall as motivation to write the book and commit himself to reforming the health care industry?
00:06:26:00 - 00:06:54:00
Next-Gen Healthcare Podcast
Right. You know, you mentioned the people. He he all the people he met with that supported his, investigative process. That's actually how I met Crystal Palace. And through the book, I, we had her I interviewed her on a previous episode of the podcast. She as a patient advocate, she helped our viewers understand what patient advocacy is, and, and that she came to my attention through Marshall's book, and I was able to track her down.
00:06:54:00 - 00:07:13:18
Next-Gen Healthcare Podcast
So, you know, he had a lot of great sources. How how would you describe the impact Marshall's book had on patients in general and perhaps the the health care industry?
00:07:35:21 - 00:07:54:14
Next-Gen Healthcare Podcast
Yeah.
00:08:53:11 - 00:09:08:02
Next-Gen Healthcare Podcast
Right.
00:09:08:04 - 00:09:34:09
Next-Gen Healthcare Podcast
Yeah. Well, you know, that's one thing that that came to my attention. I mean, his background as a teacher. Of course, he investigative journalism, getting the information together and deliberate. But his background as a teacher, I mean, from the time he was in the ministry and teaching at the the university in New York, he, he put this book together as a, as a, as a textbook as a, as a tool.
00:09:34:15 - 00:09:55:18
Next-Gen Healthcare Podcast
And then he followed up with, with the, with all the recorded material that, that, people can subscribe to. People are so busy in today's world. I mean, there's all kinds of books that says, here's how, here's how you should eat or here's how you should lose weight or do this or do that. And people are so busy they can't remember all that stuff.
00:09:55:20 - 00:10:21:04
Next-Gen Healthcare Podcast
But Marshall had the foresight to to provide the tools necessary to make it, put it in an environment where it could actually be implemented and used on a practical basis. That was pretty cool. The book's broken into three parts. Can you comment? Just generally don't need to go into detail, but, comment on each of these parts and describe the subjects that cover.
00:10:51:07 - 00:11:06:02
Next-Gen Healthcare Podcast
Right.
00:11:39:10 - 00:11:53:02
Next-Gen Healthcare Podcast
Right.
00:11:53:04 - 00:12:01:09
Next-Gen Healthcare Podcast
Half of the insured people in America get their insurance through their employer. Yeah.
00:12:50:15 - 00:13:19:22
Next-Gen Healthcare Podcast
Right. Right. Right. I found that employers are poor shoppers of health insurance. I mean, they rely significantly. And Frank Marshall touches on this in the book. They rely significantly on an insurance agent to as their professional advisor in that space. And insurance agents have an agenda. I mean, you find some that are up and above board, but let's face it.
00:13:20:00 - 00:13:43:14
Next-Gen Healthcare Podcast
They, insurance agents are paid, on commissions and they get premiums and bonuses and trips to Y when they bring on new business. So it's not uncommon for, an insurance agent to tell an employer every year. Well, this year we're going to switch you from this company over to this company because that, generates a lot of revenue for them.
00:13:43:16 - 00:14:10:04
Next-Gen Healthcare Podcast
Yeah. We we would hope that that that's the that he's being sincere and that's, that's the best, solution for the company, but may not always be the case. Marshall's years of research and health care history revealed a compelling fact to me. And this. This is a moral or philosophical question. We'll compare. We'll compare our thoughts about it, perhaps.
00:14:10:04 - 00:14:33:13
Next-Gen Healthcare Podcast
But, these overcharging services in the medical industry are not clear. I mean, obviously, there's some clerical errors, but it's. This is by design. This is intentional, intentionally done to increase profit, like the coding process. You talked about coding and how he gets into coating in the first part of the book. This up coating process is far too common.
00:14:33:15 - 00:15:01:06
Next-Gen Healthcare Podcast
I just have to ask myself, in a moral society, how do you think that people actually working in health care justify their actions? They know what they're doing. Do you have any thoughts on that?
00:15:06:09 - 00:15:20:16
Next-Gen Healthcare Podcast
Right.
00:15:20:18 - 00:15:30:05
Next-Gen Healthcare Podcast
Right. Right.
00:16:01:05 - 00:16:07:04
Next-Gen Healthcare Podcast
Right.
00:16:07:06 - 00:16:27:02
Next-Gen Healthcare Podcast
Right. Exactly.
00:16:27:04 - 00:16:38:06
Next-Gen Healthcare Podcast
Right.
00:17:01:13 - 00:17:12:01
Next-Gen Healthcare Podcast
Yeah.
00:17:12:03 - 00:17:37:07
Next-Gen Healthcare Podcast
Well, there. I think it's a, you know, I, I agree with what you said. First of all, it's it has to do with a lot of lack of understanding of the capitalistic system. Somebody has to pay the bill at the end of the day, and it winds up, always winds up being the consumer. So when when, when expenses increase within a company, for instance, the government says, we want to tax big corporations.
00:17:37:07 - 00:17:57:14
Next-Gen Healthcare Podcast
We want large corporations to pay more taxes. Well, guess what? If that actually happens. I mean, first of all, the corporations provide are the main source of labor for people to earn money. But if that actually happened in those corporations pay more taxes, these corporations have to make a profit. So what do they do with that extra expense?
00:17:57:14 - 00:18:24:03
Next-Gen Healthcare Podcast
Some people can be naive enough to think, well, they just have to absorb it. No, they're not going to absorb it. They're going to pass that on to consumers. And that's exactly what happens in the health care industry when larger bills come through and the insurance company pays those bills. Pardon me. They, they pass that on that that comes in the form of to the consumer in the form of higher rates, higher deductibles, higher co-pays.
00:18:24:05 - 00:18:47:00
Next-Gen Healthcare Podcast
And it's, it's it's all always obviously put back on the consumer. In another episode, we actually touch on this the subject of coding in a little more detail. But just so our viewers right now can, can understand, you may be asking yourself, why don't the insurance companies police this up coding process and, and and restrict that process.
00:18:47:00 - 00:19:19:01
Next-Gen Healthcare Podcast
Well, there's there's a reason because they make more money too. If you, if you insurance companies are limited to how much or what percent of a claim they can take as profits. So if, if a particular medical procedure or visit is occurs and it has this basic code on it that say, generated a $5,000 insurance bill and then the, the hospital or whatever up codes it to a $50,000 bill.
00:19:19:03 - 00:19:41:09
Next-Gen Healthcare Podcast
The insurance company makes the same percentage of the 5000 as they do the 50,000. Everybody makes more money, the hospital makes more money, the insurance company makes more money. And who pays for it? The consumer. So.
00:19:41:11 - 00:19:51:10
Next-Gen Healthcare Podcast
Yeah. Yeah. I have a bigger pie.
00:19:51:12 - 00:21:01:01
Next-Gen Healthcare Podcast
That's right. And that's a. Yeah. It's been my experience to some extent. The government, watches Medicare and Medicaid expenses a little more closely than insurance companies do. But you can understand why. Moving on. Tell us a little bit about Allen Health Academy and how people can benefit. And by subscribing.
00:21:25:22 - 00:21:41:12
Next-Gen Healthcare Podcast
Right.
00:21:41:14 - 00:22:00:07
Next-Gen Healthcare Podcast
That's fantastic. You know, referring back to, the last section of the book, we talked about the employer section of the book. Can employers benefit from Allen Health Academy as well? This will be a good tool for them.
00:22:13:03 - 00:22:20:15
Next-Gen Healthcare Podcast
Right.
00:22:27:03 - 00:22:38:12
Next-Gen Healthcare Podcast
Right.
00:22:52:02 - 00:23:11:01
Next-Gen Healthcare Podcast
Right. Well, I don't know if you pointed it out before, but I'll point out the Ellen Allen Health Care Academy is the for profit portion of Allen's business. And when we say for profit, I've got to tell you this, this is dirt cheap. It's very inexpensive to use. So it's well worth the investment, as is the book.
00:23:11:02 - 00:23:44:09
Next-Gen Healthcare Podcast
I encourage everybody to take advantage of both. But, you've got another major nonprofit, project on the works and, just over the horizon. So could you share a little bit about it? I know it's, it's still in the pipeline, and you're working on it. May not want to disclose everything there is to know, but, give us a teaser about what's coming.
00:24:03:01 - 00:24:16:13
Next-Gen Healthcare Podcast
Right.
00:24:26:23 - 00:24:40:21
Next-Gen Healthcare Podcast
Right.
00:24:48:23 - 00:25:19:10
Next-Gen Healthcare Podcast
Yeah.
00:25:19:12 - 00:25:26:11
Next-Gen Healthcare Podcast
Yeah.
00:25:26:12 - 00:25:41:04
Next-Gen Healthcare Podcast
Okay.
00:25:47:10 - 00:25:59:01
Next-Gen Healthcare Podcast
Right.
00:25:59:03 - 00:26:04:04
Next-Gen Healthcare Podcast
Yeah.
00:26:04:06 - 00:26:29:01
Next-Gen Healthcare Podcast
Well. That's fantastic. I, I mean, it's, I've got it for those techies out there. I want to make it clear that this is an AI based tool. That's what, adding all the all the. That's what facilitated bringing all this information together and being able to deliver it to consumers. So it's pretty cool. I'm looking forward to trying it out and we're going to have Sonia when you release it.
00:26:29:01 - 00:26:47:22
Next-Gen Healthcare Podcast
And I think you talked about releasing it sometime next year. When you finish it, get it ready for market. We want to have you back on again to talk about it. Yeah. Yeah. I haven't held up the book yet. I should have thought of this sooner, but this is, I never pay the first bill. This is what the book looks like.
00:26:47:23 - 00:27:12:12
Next-Gen Healthcare Podcast
You can find it on any, on Amazon or any major book outlet. So by all means, I encourage everyone to go out there and check it out. It's an easy read, and you'll be, You'll be glad you did. Everybody encounters health care problems, and this will help you understand the process you're going through. And that's that's part of optimal telehealth.
00:27:12:14 - 00:27:30:06
Next-Gen Healthcare Podcast
You know, mission as well is to support people and make them, you know, help them, understand the health care industry and how to take care of their own health care and control their own health care without letting the insurance companies control it for you. So do you have any parting thoughts, that we haven't touched on?
00:27:30:06 - 00:27:52:06
Next-Gen Healthcare Podcast
Sonia?
00:28:22:01 - 00:28:44:02
Next-Gen Healthcare Podcast
Well, I'm certainly glad. And I'm sure everybody's glad that you're going to carry on Marshall's work. He had, tremendous foresight into this subject, this topic. And as you say, it's his, his passion for helping people is obvious. Thanks for coming on today. It's it's been a great conversation. And I hope, our viewers found it informative.
00:28:44:04 - 00:28:49:13
Next-Gen Healthcare Podcast
And we look forward to having you back again in the future.
00:28:49:15 - 00:28:50:07
Next-Gen Healthcare Podcast
Thank you.