Journalist and MPJI advisory committee member Marshall Allen made big moves during the Covid-19 pandemic. After a decade reporting investigative stories about health for the non-profit news outlet ProPublica, Allen joined the Office of the Inspector General at the U.S. Department of Health and Human Services as an assistant regional inspector general.
Also, Marshall has a new book out from Portfolio Penguin (edited by MPJI advisory committee member Bria Sanford) titled “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” The book has led to many media appearances and speaking events in recent months.
Marshall's worked as a Christian missionary in Kenya and attended Fuller Seminary before getting into journalism and investigative reporting. He has inspired hundreds of our students. And the MPJI lecture Marshall gave in 2016, was also edited into an opinion piece that ran in the Sunday Review section of The New York Times. MJPI executive director Paul Glader caught up with Marshall about his book and his new job. We remain grateful for his speaking and mentorship with our students in the past eight years.
Q: Hi Marshall, tell us about your new job and why you made the switch? Should we miss your bylines about outrageous practices in the health care industry? How does the new job align with your previous work?
My new job with the federal government utilizes my skillset as my investigative reporter, but in a different context. Now I have much greater access to data, interview subjects and other information, as I evaluate and inspect taxpayer-funded government health care programs and their role serving the public. I’ll still be reporting and writing and editing, but instead of stories my team and I will publish government reports that include recommendations for improvements.
I won’t be writing for ProPublica, but I’m pleased that my new job allows me to continue the work as an author and educator. My book has had a successful launch and now I’m working on launching a curriculum of health literacy videos that are based on the book. My goal is to pair the book and videos together so American can be equipped and empowered to get a better deal on health care. The content shows people how to check their medical bills for inaccuracies and overcharges; win insurance company appeals; avoid unnecessary treatment and more. If people want to learn more about the health literacy videos, I just launched an Indiegogo crowdfunding campaign to complete their production. Please partner with me to bring them to life! I will also be writing more for my own website, marshallallen.com, and publishing Victory Stories – examples of individuals and employers finding ways to get the health care they need at a lower price, or fighting the system and winning.
Q: So tell us about this book. What’s your main thesis?
“Never Pay the First Bill” is a how-to guide to help individuals and employers hack the health care system. My main thesis is that the health care system has been preying on us financially, but with the right tactics we can save hundreds or even thousands of dollars per health care interaction – without compromising the care that we need. Americans pay twice as much per person for health care compared to the citizens of other developed nations. Plus, we still have about 30 million people who are uninsured. And our outcomes are much worse!
Our ridiculous health care costs are not justified. Often they are driven up by middlemen who are marking up the cost of medicine so they can make money. There’s a lot of profiteering in the industry and it’s costing us. Working Americans and employers are the hardest hit by our country’s out-of-control health care costs. They are paying much more than they should because of billing errors, overcharges, unnecessary treatment, unjustified prices and more.
My book boosts people’s health care financial literacy so they can avoid the costly pitfalls that surround them in the health care system. I’m already seeing people save big money by putting the tactics in the book into practice. It’s been really rewarding to see people equipped and empowered and standing up for themselves and winning.
Q: It sounds revolutionary in some ways to empower people to challenge big corporations in this manner. Do you feel like a lonely voice in this cause or do you sense the revolution is being televised and picking up steam?
This movement is definitely picking up steam. People know they’re being exploited financially by the health care system. Americans say year after year that the high cost of health care is their number one financial concern. It’s so bad now that about 1 in every 5 Americans has medical debt in collections! The health care system has pushed our backs against the wall and individuals and employers are ready to try new things. The industry is filled with so much waste, and it’s been so abusive to the public, that it is ripe for disruption. And when individuals and employers put the tactics into place that I write about in my book, they are dramatically reducing the cost of their health care, while improving the quality of the care they need.
Q : You wrote about your own experience using these techniques with your father’s health care and you express a righteous indignation and sense of justice as people seek transparency and accountability from healthcare providers and insurers. How does your Christian faith inform this sense of justice?
Each of us is valuable as a person because we are made in the image of God. Every person’s life is precious. So when even a single person gets ripped off by the health care system it’s a violation of what’s right and just – and causing harm to a person who is created in God’s image. In this case, every American is paying much more than they should be for the care that they need. And in many cases the costs are so high people are unable to get the care they need.
My book’s argument is built on what’s moral and fair and ethical. Right now, what we see happening on the financial side of the health care system is legal, but it’s not ethical. For example, let’s start with the hidden prices. It’s not right to hide the price of a procedure or test from a patient at the time of service, and then hit them with a massive bill that’s many times higher than it should be. And yet, this type of overcharges are standard in our health care system. It’s also not right to raise the prices on drugs like insulin, which diabetics need to survive, without making any improvement in the drug itself. But this has also been standard practice. It’s also not right for hospitals to make billing mistakes and refuse to correct them. But this is a daily occurrence.
The health care system doesn’t give consideration to patients who are not given prices up front, or have unfairly priced insulin, or get overcharged due to a billing mistake. Those patients get sent to collections or even sued by some hospitals. They might have their wages garnished or need to declare bankruptcy. It’s an incredibly unfair situation.
The dirty secret, which is well known by people in the industry, is that the cost of health care does not have to be so high. Experts estimate that the system squanders about 25% of what we spend – on overcharges, administrative bloat, unnecessary treatment, our inefficient claims processing system and more. The solution is not for the health care system to keep demanding more money. The solution is for the system to make better use of our money.
There’s a tremendous amount of moral force behind the argument I’m making in the book. I am quite simply saying that it’s not OK to cheat people and overcharge them just because they got sick. And when a person who is being exploited or overcharged stands up for themselves, they also have a tremendous amount of moral force behind their argument. And if they persist and use the right tactics there’s a good chance they will win their argument.
Q: We appreciated that your book had specific advice for readers but also was full of data and reporting - not just how-to opining. Can you tell us about your reporting and writing methodology?
I’m careful to make sure what I report is accurate and fair. For example, when I tell stories of patients being harmed by the health care system, I have the patient waive their privacy rights for the sake of my reporting. That way I can reach out to their hospital, insurance company and doctor, to make sure I get the full story. When things get complicated, as they often do in health care journalism, I call experts who can guide me to make sure I’m not going beyond what’s true when I write. I’m also meticulous with my fact checking. I run every detail by the subjects who are in my book to make sure I presented everything correctly, in fact and in the tone of the writing.
I’m also careful to make sure the tone of what I write is not sensationalized. I know it sounds strong for me to say our system is exploiting our sickness for profit. But I have documented this so many times and in so many ways that this is quite honestly the most accurate way to frame what is happening from the point of view of the public. I can speak with this much authority because I have investigated this industry for more than 15 years and have done my homework.
Q: What impact do you hope and believe the book and your new job will allow you to make in coming years?
Marshall Allen
The OIG job gives me an incredible amount of access to information and the influence to identify ways to improve the delivery of health care in our government programs. It will take me some time to learn the process, but I plan to make the most of the opportunity. With my book and video curriculum, I want to equip and empower working Americans and employers, so they can be protected about the financially predatory practices of the health care system. No one is coming to our rescue, so each of us needs to boost our health care literacy so we can protect our money and make sure we still get the care we need. It’s already happening, and I want to bring it to scale nationally.
The McCandlish Phillips Journalism Institute is a home of journalism-related programs and majors at The King’s College in New York City. In addition to its academic programs, it hosts events and provides resources to its students, alums, friends and donors. The institute is named in honor of the legendary reporter at The New York Times who was an exemplar of standards, ethics and style in the craft of journalism and was a kind friend and mentor to those of us who knew him.