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ProPublica journalist puts 15 years of experience into how-to book for consumers, employers Date: 07/01/21


Marshall Allen

By Joseph Burns

On the ProPublica site, we’re told, “Marshall Allen investigates why we pay so much for health care in the United States and get so little in return.” It turns out that those 21 words also describe Allen’s book, “Never Pay The First Bill. And Other Ways To Fight The Health Care System And Win,” which came out June 22. 

Over 15 years of covering health care, Allen has written about a wide variety of patients who suffered harm in the deeply flawed U.S. health care system. His 288-page book sums up much of what he’s learned. The multiple-award-winning journalist also explains how consumers can protect themselves by fighting back against injuries and overcharges. Included are three chapters on how employers can protect themselves and their workers and push back against high prices and patient harm. In this “How I Did It” interview with AHCJ, he discusses what led him to write the book.

What were your goals in setting out to write, Never Pay the First Bill? 

For anybody who covers health care, you learn fast about these ongoing outrages: People are getting ripped off financially, and people are being harmed because medical errors are one of the leading causes of death in the United States. As a health care journalist, you learn about the physical and financial harm that consumers experience, and you come to the conclusion that the health system is deeply messed up and that there’s not a lot of accountability.” 

I wanted to tell the stories of patients who had negative experiences in the health care system, to offer advice on what consumers could do to prevent being harmed or overcharged, and I wanted to suggest ideas that employers could use to help save their workers from injury and surprise bills.

Was there something about your recent work that led you to do this book now?  

I’ve covered health care for 15 years and, for ProPublica, I’ve recently focused on the high cost of care for working Americans. In addition, I found that most people don’t fully appreciate just how much working Americans bear the burden of the high cost of health care. For example, Medicare pays one amount while working Americans pay two to five times more than that. 

For all of those 15 years and stretching back even longer, copayments and deductibles have been going up every year, and premiums have been rising too. Surveys from Gallup and others show that health care costs are among American consumers’ top financial concerns.  

The more I learned about these problems, and the more I wrote about them, the more I thought that at some point, I would stop being surprised about these outrageous outcomes. But, to be honest, I’m continually astonished by just how much the deck is stacked against all consumers, including the working public. 

Also, some 155 million people are covered under employer-sponsored health insurance plans, about 30 million are uninsured and there are another 30 million or so who have insurance under the Affordable Care Act, Medicaid, and other public programs. That’s a big audience of people who need help.

Were you concerned that a growing number of books have been published in recent years about our broken health care system? 

Well, yes. And, to be honest, I didn’t have a good angle for the book until after I submitted my proposal. I was not quite sure how this book would be fresh or different. But then, my editor at Penguin Random House asked if I could provide readers with some guidance about how they could navigate the health care system successfully.  

My answer was, yes, there are many things consumers can do, but doing what they need to do can be difficult and overwhelming, and those things won’t always work. But in all of my stories for ProPublica, I try to include a solution — when I can. That’s what journalists do: we investigate problems, write stories to expose those problems and then try to find somebody who’s smart and experienced enough to show how to solve those problems. When we do that, we not only help readers, but we also put a spotlight on and perhaps heap shame on the people who are doing things in a bad way.  

I knew my idea could be framed in this different way. That’s why I focused on issues beyond the problems themselves. I’m trying to point to the solutions where they exist and where people or employers can take action to solve those problems.

From there, did you have to break it up into different segments? 

Yes, I’ve tried to break it out by the most common scenarios that people face. One scenario is for people who get outrageous medical bills. How do you analyze a medical bill to see if it’s accurate and priced fairly? And then what do you do if it’s inaccurate or not priced correctly? 

Or maybe you have medical debt in collections, and a debt collector is calling you. Then, what do you do? I included a chapter on medical debt because one in six Americans has medical debt in collections.  

Insurance company denials are another huge problem, and so I wrote a chapter about that. I know that overtreatment and unnecessary care are massive problems. So I included a chapter on how to avoid unnecessary care.  

All health care journalists know these problems exist, and so I wanted to offer solutions where I could.

Did you wrestle with the idea that the health care system appears to be rigged against consumers? That theme seems to bubble up often, but it’s not something we can come right out and say without providing strong support for that argument.

So, yes, that’s right. When I was writing the book, and when I’m writing anything for publication, I’m always careful to be fair and accurate and to not sensationalize anything. I’m always checking myself by asking questions as I write. For example, I ask, ‘Can I fairly say that this system is exploiting patients’ sickness for profit?’ Yes, that’s a fair and accurate description of what’s happening in our health care system.  

I’ve done this work long enough and drilled down deep enough so that I can write with authority and confidence about how the system is rigged against consumers. Too often, I’ve seen how the health care system exploits our sickness for profit, and I’ve seen that the system is frequently based on deception. For example, hospitals are required to post their prices upfront, but many hospitals don’t comply with that law, and then hospitals gouge patients when they bill them.  

I’m just calling for fairness, and I’m doing so in a way that everything’s well documented, and I was extremely careful in my reporting.


Marshall Allen (@marshall_allen) has been a reporter for ProPublica since 2011 and is one of the creators of ProPublica’s Surgeon Scorecard, which publishes the complication rates for about 17,000 surgeons who perform eight common elective procedures. He won the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and was a Pulitzer Prize finalist for local reporting while working at the Las Vegas Sun. Before turning to journalism, Allen spent five years in full-time ministry, including three years in Nairobi, Kenya, and has a master’s degree in theology.