Economist Vivian Ho has been researching the U.S. well being care system for 4 a long time. As of late, she’s centered on what she thinks are the most important burdens on the typical American: runaway hospital costs and rising medical health insurance premiums.
She has developed a technique for addressing excessive insurance coverage premiums — one which’s primarily based on giving sufferers dependable details about how a lot they, and their insurer, must pay for care. The system is already working in Massachusetts. May it’s a mannequin for the remainder of the nation?
Ho explains to Dan Weissmann, host of “An Arm and a Leg,” why she thinks this method may assist curb excessive costs and the way listeners will help show it by sharing their medical payments.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on “All Issues Thought-about,” Market, the BBC, “99 P.c Invisible,” and “Reveal,” from the Heart for Investigative Reporting.
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Emily Pisacreta
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Claire Davenport
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Adam Raymonda
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Transcript: This Well being Economist Desires Your Medical Payments
Notice: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a software however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there–
Vivian Ho is a well being economist at Rice College and the Baylor School of Drugs in Houston. And since early 2024, she’s been giving talks at… HR conferences. Which isn’t a typical gig for an economist.
Vivian Ho: Um, sure. Economists don’t often do this. We like to go discuss at our personal conferences.
Dan: However she’s been desperate to unfold a reasonably large message.
Vivian Ho: There’s a possible to avoid wasting employees, um, you already know, and workers some huge cash.
Dan: And some weeks in the past, she despatched me an electronic mail asking for assist with what she’s attempting to do:
She’s desires people to ship her hospital payments for a research she thinks may very well be a part of saving individuals a variety of moneys. She puzzled if I’d encourage individuals to pitch in.
And truthfully, I wished to say sure earlier than I even actually knew something particular concerning the research.
I ought to say: Vivian Ho has been a donor to this present. That’s truly how I met her and realized about her work. And have become sort of a fan.
Over the previous few years, she’s been digging up and publishing proof we want, to push again towards the way in which well being care retains getting increasingly more costly.
That is stuff a variety of us suspected, to say the least — stuff reporters have documented examples of — however she’s demonstrated they’re precise developments, not one-offs.
As an illustration: When nonprofit hospitals make huge income — they usually typically do – they name them surpluses– they don’t typically use that cash to assist sufferers, by giving extra charity care to scale back individuals’s payments.
In a single research, she in contrast hospital funds within the early 2010s and close to the top of the last decade. As the last decade was ending, she discovered nonprofit hospitals have been a LOT extra worthwhile than they’d been earlier than.
And so they’d gotten quite a bit richer, with like seventy % additional cash within the financial institution than they’d had earlier.
However they have been truly giving out much less charity care.
She advised me she ran that down after she bought assist understanding a giant set of knowledge that helped her see what hospitals truly do with their cash– and began to poke round in it.
Vivian Ho: I say, nicely, I’m simply gonna go take a look at, you already know, one of many native hospitals and see what it says after which I pull it up and I’m going, oh wow.
Dan: She took a peek at one hospital’s “fund steadiness” — that’s non-profit communicate for an establishment’s financial savings, like for a wet day.
Vivian Ho: The fund steadiness for one of many hospitals throughout the road from Rice College is 5 and a half billion {dollars}. And so, you already know, then it’s like, nicely, I have to take a better have a look at this.
Dan: Right here’s a pair issues she discovered: That fund steadiness — the “wet day fund” — was sufficient to run the hospital for greater than two years. And it runs a wholesome revenue margin.
And her research confirmed when she zoomed out: This isn’t a one-off. Amongst hospitals that do nicely, it’s the norm.
And this type of information — this type of EVIDENCE of how issues work, of who advantages, and the way a lot, from the completely unfair and unaffordable costs we’re all up towards — it’s ammunition.
Vivian Ho is on the lookout for individuals to share their hospital payments together with her, to be able to construct up her arsenal of data .
She’s bought a technique in thoughts for how one can deploy that info to avoid wasting lots of people a ton of cash. It’s attention-grabbing.
And: I don’t know if this particular technique will repay.
However right here’s what I do suppose: ?If we’re going to combat towards the greed and exploitation that make our well being care system so unhealthy — so lethal — we’re gonna want all of the combating energy we will get.
So, I’ve despatched Vivian Ho a hospital invoice. And on the finish of this episode I’ll encourage you to do the identical.
That is An Arm and a Leg — a present about why well being care prices so freaking a lot, and what we will perhaps do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen right here is to take probably the most enraging, terrifying, miserable components of American life, and produce you a present that’s entertaining, empowering and helpful.
Dan: Vivian Ho has been a well being economist for like 40 years. And you would say she has blended emotions.
Vivian Ho: Well being economists, they work on so many alternative issues and they’re all vital and attention-grabbing. However I do suppose the problem of the price of healthcare and the price of medical health insurance premiums is the most important drawback placing a burden on the typical American citizen. And I don’t suppose as a occupation that we spend sufficient time on that primary subject. I really feel sort of – nicely, it does make me fairly unhappy as a result of right here I’m, I’ve labored on this profession for this whole time, and issues aren’t getting higher. They’re truly getting a lot worse.
Dan: And that, she says, is why she does issues like go to HR conferences lately. She’s bought the motivation and she or he’s bought the liberty to do it.
Vivian Ho: So I’m tremendous fortunate. I’ve bought tenure at Rice and you already know, I’m a member of Nationwide Academy of Drugs. I’ve kind of achieved all the things that I wished to attain, and now it’s, it’s all about, nicely, what can we do?
Dan: She’s determined to go after what she now sees as the most important drawback. Not the ONLY drawback, however the greatest driver in costs that solely appear to go up extra yearly.
Hospital techniques are consolidating — gobbling one another up. In order that they get extra bargaining energy with insurers. They get increased costs with out essentially delivering extra worth.
Which isn’t what economists at all times count on. Greater can imply higher, extra environment friendly. That’s what Vivian Ho used to count on.
Vivian Ho: I began this complete analysis agenda kind of 10-15 years in the past, and I believed greater was going to be higher. I believed due to economies of scale and that for those who allowed hospitals to amass doctor practices, there can be much less duplication of companies, you’d get monetary savings. However then the issue is there’s no mechanism that forces a supplier to move any financial savings onto the patron. So there could also be economies of scale, it’s simply you and I as customers aren’t capable of get pleasure from any of these advantages.
Dan: That’s one thing we’ve talked about on this present. Like quite a bit. However what Vivian Ho has been capable of reveal is: At this level, the typical revenue margins for hospitals — together with “non-profit” hospitals — are literally increased than common revenue margins for insurance coverage firms.
Vivian Ho: There’s loads of rural hospitals and smaller hospitals that lose cash, however web, once you common on simply how a lot income the consolidated techniques are making and also you add them up everywhere in the nation, it’s a lot increased than what you get for the whole income of insurers.
Dan: Which isn’t to say that insurance coverage firms don’t have a BIG function to play in our struggling.
Vivian Ho: Insurers are, in some ways, not doing what they need to be for purchasers. Actually the present demonstrates that in some ways and that they’re incomes excessive income. I’ve simply seemed on the information and concluded that the hospitals are incomes a lot increased income than the insurers are, and that’s the place we’ve gotta focus our consideration.
Dan: I imply, there’s a lot to unpack there, proper? One is, wow, the hospitals are incomes increased income than insurance coverage firms, and the insurance coverage firms, by and huge, are publicly traded entities that reply to shareholders. And the vast majority of hospitals in america are, so far as the IRS is anxious not-for-profit entities.
Vivian Ho: Precisely. We’ve been doing analysis recently that sadly reveals that our not-for-profit hospitals behave quite a bit like for-profit firms.
Dan: So, okay, how can we get at that?
Vivian Ho: Oh, uh, how do we modify the conduct of what’s occurring?
Dan: Yeah.
Vivian Ho: Yeah. So…
Dan: Right here’s Vivian Ho’s recreation plan. It’s sophisticated, and I’m not ready to say, “this’ll completely work” — however there’s quite a bit that’s price realizing right here.
Particularly this:
When Vivian Ho talks to enterprise executives or HR managers, she brings out one other set of knowledge. And that is information that’s solely turn into out there in the previous few years.
Insurers now have to point out what they pay hospitals. Not the sticker worth, the negotiated worth.
So, Vivian Ho’s discuss features a slide exhibiting some particulars from three Houston hospitals. Blue Cross pays one in all them about 22 thousand {dollars} for spinal fusion surgical procedure. One other one will get 66 thousand — 3 times as a lot..
And the slide reveals: That math is analogous for different procedures.
Vivian Ho: Employers didn’t understand how totally different the costs may very well be at their native hospitals. They thought, you already know, anybody would suppose, oh, the costs couldn’t be that totally different. And now that a few of the information is beginning to make it on the market, it’s changing into clear you actually may save some huge cash.
Dan: I imply, you MAYBE may — for those who may give your employees a great purpose to go to the hospital that expenses much less.
Vivian Ho has a mannequin for a way that would work. It’s — primarily based partly on a narrative I name As soon as Upon a Time in Massachusetts.
That’s subsequent.
This episode of An Arm and a Leg is produced in partnership with KFF Well being Information. They’re a nonprofit newsroom overlaying well being points in America. Their reporters do wonderful work. They win every kind of awards yearly. We’re honored to work with them.
So, right here’s our story — As soon as Upon a Time in Massachusetts — straight from the story’s creator.
Elena Prager: I’m Elena Prager. I’m an assistant professor of economics on the Simon Enterprise College on the College of Rochester.
Dan: And whereas doing her dissertation, she got here throughout a really uncommon set of knowledge.
Elena Prager: I used to be like, wow, goldmine.
Dan: Right here’s the story: Massachusetts has an company that principally runs worker well being advantages for all state workers, and a variety of local-government employees too.
And as soon as upon a time — beginning in 2010– they tried one thing uncommon.
Elena Prager: Probably as a result of they have been fortunate, presumably as a result of they have been good, they designed their medical health insurance plans – at the least when it got here to hospital care – primarily based all the things on copays. And what which means is that you’re given a greenback quantity. Let’s say $250 or $500 and like that’s it. That’s the quantity. In the event you go to hospital A, you pay 250, you go to hospital B, you pay 500. The tip.
Dan: Which is completely totally different from how we’re used to taking a look at hospitals, proper? I imply, common insurance coverage sometimes say, “You’ll pay like 10 %, or 20 % or 30 % of regardless of the whole invoice seems to be.”
Elena Prager: And the affected person is left scratching their head being like, nicely, how do I do know what the whole invoice is gonna be? Even when the hospital tells me one thing. Like, what if one thing goes fallacious with the anesthesia? They must name in an additional specialist. There’s a complication. Extra stuff will get achieved. Prefer it’s very, very exhausting to, for a affected person and even actually a supplier, to foretell prematurely what’s gonna be achieved to them and subsequently what the worth goes to be.
Dan: So there’s no manner for me to take worth under consideration if I have to go to the hospital.
However As soon as Upon a Time in Massachusetts, there was. It was a co-pay. No matter insurance coverage plan you have been on, it labored the identical manner:
Go to hospital A — the place costs are typically increased — your copay may be 5 hundred {dollars}.
Go to hospital B — that expenses the insurance coverage plan much less for stuff — you’d pay two-fifty.
And Elena Prager discovered the information that confirmed what occurred subsequent.
Lengthy story quick, she discovered that over three years, sufferers began utilizing lower-priced hospitals extra typically. Sufferers saved cash, and so did the well being plan.
And truly, Massachusetts nonetheless runs its well being plans this manner, however–
Vivian Ho doesn’t suppose different employers can simply get their insurance coverage firms to undertake this similar mannequin.
VIVIAN HO: It’s truly a good quantity of labor.
DAN: Work for the insurance coverage firm. Doing the maths to determine which tier is which, and what the copays can be.
Vivian Ho: and naturally it will get the hospitals actually upset.
Dan: The parents in Massachusetts had a ton of leverage that the majority employers don’t have:
Elena Prager says they represented an enormous chunk of the insurance coverage market like a twelfth of it. Sufficient enterprise that it was price insurance coverage firms’ whereas to place within the work.
However now, Vivian Ho has her eye on a few new companies which can be promising to do one thing comparable.
One is definitely a subsidiary of all people’s favourite insurance coverage firm: United Healthcare. They make an app referred to as Surest.
Surest Advert: It’s straightforward to buy a trip rental or your subsequent flight, however on the subject of one thing like healthcare, not really easy. That’s why Surest is a well being plan, designed to be easy with clear upfront prices.
Dan: Right here’s how Vivian Ho describes the mechanics of this type of app.
Vivian Ho: Physician tells you it is advisable to go get an MRI, you punch an MRI, the app is aware of the place you reside, and it says, right here’s an inventory of suppliers the place you possibly can go get an MRI. After which for those who go to this explicit place, there’s no copay and there’s truly no deductible, after which for those who go to this MRI place, nicely, you already know, there’s gonna be a $25 copay or a $50 copay. Yeah. Isn’t that sort of thoughts blowing?
Dan: I inform her: That feels like I’d need that if I trusted that the place that prices my employer much less is, you already know, gonna take excellent care of me.
Vivian Ho: Proper. Properly that’s why I’m attempting to get funding to do an evaluation to take a look at the spending and high quality implications of utilizing one in all these apps.
Dan: That’s: Do individuals utilizing these apps find yourself selecting lower-cost suppliers? AND: Do they get excellent care after they do?
Vivian Ho desires to check that. However first she wants to check one thing else.
Vivian Ho: All of those apps and worth procuring functions, all of them rely upon having the proper information. Now, the insurers are required to reveal this info by federal guidelines. It’s slowly popping out. It’s not all there but, however nobody’s truly seemed to see whether or not it’s correct.
Dan: Oh.
Vivian Ho: So there’s been a variety of deal with, is the worth there or is it not there, however not is it the worth that the affected person is definitely getting billed.
Dan: And that is why Vivian Ho desires our hospital payments.
As a result of: Whether or not or not one explicit technique is gonna pan out, the information itself accommodates ammunition. One hospital will get paid twice as a lot as those throughout the road?
I imply, that’s info I need out within the open, and getting put to make use of.
However that info can solely be helpful if we all know the information is correct. And proper now, there’s no technique to know.
Insurers are publishing huge information units, however how can we *know* any person on the insurance coverage firm didn’t simply go to Chat GPT and say, “Make me a large spreadsheet with these fields on it?”
Vivian Ho says if she has sufficient ACTUAL payments — a thousand can be good, three thousand can be nice — she will be able to verify.
Truly, even higher: She desires your itemized invoice and, if she will be able to get it, the paperwork you get out of your insurance coverage firm about what they paid. The factor that claims “This isn’t a invoice.” It’s an “rationalization of advantages” — or EOB for brief.
And, she acknowledges, this isn’t a TINY ask.
Vivian Ho: I understand it’s time consuming. It does, you already know, since you gotta sit down. It’s like, what’s my password and log in, and you then’ve gotta, you already know, discover one in all these EOBs.
Dan: Oh, and also you’ve gotta cowl up all of your personally figuring out info.
Vivian Ho: We don’t wanna see your your identify and handle and so, you already know, it takes time to you, you possibly can kind of print these out and use a Sharpie and cross them out.
Dan: It does sound like an enormous drag, however I’m right here to let you know: I did it. And it took me perhaps 5 minutes.
I don’t understand how Vivian Ho’s particular technique will play out, and truthfully, neither does she.
Vivian Ho: You recognize, I’m going at this at kind of like many alternative angles.
Dan: Yeah.
Vivian Ho: So simply attempting to boost individuals’s consciousness of there are big worth variations. That is, that is what it takes to deal with the problem.
Dan: In the event you’ve gotten a hospital invoice within the final yr or so, and also you’ve bought 5 minutes — perhaps set a be aware in your calendar for once you DO have 5 minutes? — I’d find it irresistible for those who gave this a shot.
Seize a sharpie, hearth up your printer, dig up your login. Print out a invoice and an EOB, scratch out your figuring out info, take an image in your cellphone — wow, that is sounding lengthy, however truthfully, it took me 5 minutes — so do these issues, and ship the pictures to [email protected].
Vivian Ho’s bought researchers standing by.
Developing on this present: We’re gonna take a while because the yr ends, to take a look at some issues that DIDN’T suck in 2025.
Which principally means: Locations the place state governments stepped in to guard us from ripoff costs. Which, it seems, occurred!
Information archive 1: Oregonians burdened by medical payments could quickly get a break on their credit score scores.
Information archive 2: New regulation geared toward defending Maine customers from the impacts of medical debt goes into impact.
Information archive 3: Tonight Indiana governor Mike Braun indicators 10 well being care-related payments into regulation.
Dan: Occurred sufficient that it’ll take greater than only one episode to present you a great pattern.
That’s subsequent time on An Arm and a Leg.
Until then, deal with your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta — and edited by Ellen Weiss. Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Periods. Bea Bosco is our consulting director of operations.
An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in-depth journalism about well being points in America and a core program at KFF, an unbiased supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present.
An Arm and a Leg is distributed by KUOW, Seattle’s NPR information station.
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