The Stories That Made an Impact in 2023

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode! 

Dan Gorenstein: This year, like every year, we brought you the stories of people trying to navigate through our complicated health care system in some way.  

A patient crushed under a massive ambulance bill. 

Precious Mae Clark: Where am I going to get $7, 000? Why is this so high? Why are you sending me another bill?

DG: State officials trying to make care more affordable. 

David Seltz: You don’t want to go too far, right? One person’s health care cost containment is another person’s revenue reduction. 

DG: And inmates finally getting health insurance before they leave incarceration.   

Shira Shavit: There’s a major disruption. And so that disruption leads people to becoming sicker and potentially dying in the community.

DG: Today, some of our favorite stories and the their impact; 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

***

DG: You may be wondering why do an end-of-the-year look back episode. A few reasons.  

One. Shannon Crane, who runs our annual audience survey, tells us that you value journalism that centers evidence, tells stories and helps break down the complicated, costly and often counterintuitive world of health care.  

So we’ve designed today’s show to give you a better sense of how Tradeoffs has had an impact this year.

Two. We want you to be excited about the work we do and that enthusiasm will inspire you to become a first-time donor, or keep up your generous to support the show 

Three and most important. Tradeoffs is more than a collection of reporters, engineers and folks running operations and marketing.

Our show is you, the doctors and nurses, the policy wonks and researchers, the patients and industry insiders, the students and elected officials who listen, pitch stories, give great feedback and share the work.  

Today’s episode, I think, demonstrates how we come together – this community of health policy decision makers and journalists – to have more honest health policy conversations and grapple with some of the toughest problems our country faces.  

We’re going to do that by having each of our reporter/producers walk us through an episode that they think packed a punch. 

We’ll kick things off with Ryan Levi who is coming to us from his home in Washington D.C. Ryan, How are you sir?

Ryan Levi: Hey there Dan. 

DG: Ryan, what’s the story that you have teed up for us? 

RL: Yea Dan, back in February, we put out a story about how for the first time, the federal government was providing Medicaid to some people before they left prison, jail or juvenile facilities.

DG: And this was a big deal because for as long as Medicaid has been covering low-income and disabled people in the U.S., nearly 60 years, people who were incarcerated were effectively banned from using the program.

RL: Exactly. Which meant that many of the 600,000 people released from prison each year rejoined society with serious health needs but no access to health care.

To help us and our audience fully appreciate what that experience is like, we talked with a man named Lee Reed. Lee was 62 and he had just been released after 20 years in California prisons. 

And he had agonizing back pain. 

Here’s a clip from that episode.

Lee Reed: Imagine somebody standing on your foot and you can’t stop that pain. And they’re just going to stand there. They’re not going to get up off of it. It’s going to be there when you wake up. It’s going to be there when you go to sleep. Half the time I never even got out of the bed while I was in prison because I couldn’t stand up, it was so painful.

RL: You’ll probably remember, Dan, that Lee knew he needed back surgery. The doctors in prison had told him that.

But he spent his first two nights sleeping in a parking garage stairwell with his walker as a blanket.

It took weeks for him to see a doctor and 6 months for him to get his surgery. All the while he was homeless and unable to work and restart his life.

DG: I remember Lee’s story being pretty hard to hear, the pain in his voice was just so clear. And it really epitomized the problem that policymakers are trying to solve by offering Medicaid to people like Lee before they leave incarceration.

The hope being that making sure people have insurance and a connection to a doctor who they trust before they get out will mean they get the care they need quickly and not suffer like Lee did.

RL: That’s right. And what made this story so exciting to me was it’s a relatively new policy so it’s something that lots of policymakers could actually learn about from us.

In fact, Jami Snyder, the former director of Arizona’s Medicaid program told us she listened to that episode for exactly that reason.  

Jami Snyder: We would regularly, as an executive team, use the information from the episodes to inform our policy discussions…We really were able to draw on some of the discussions from different Medicaid leaders across the country when we were having conversations about really, tough issues around coverage, around benefits, around reimbursement.

DG: What I appreciate about what Jami said is that she and her team relied on our Medicaid episodes…the one about prisons, and others…to help them think about what they wanted to do in their state.

That’s exactly the kind of impact we set out to have when we launched the show back in 2019.  

DG: Thanks for your great reporting Ryan. 

RL: No problem Dan  

DG: Sticking with stories about state’s as these health policy laboratories, that brings me to a story from reporter producer Alex Olgin in her home in Portland, Oregon. 

What is up Alex Olgin. Hello. 

Alex Olgin: Hello Dan Gorenstein.

DG: Ok Alex, you spent some time this year looking at one of these state experiments. Tell us about the results.  

AO: Happy to. As we all know, health care prices keep climbing. Which is one reason nationwide spending keeps going up it’s expected to grow more than 5 percent a year over the next decade. Faster than the whole US economy. 

So when I heard a state agency forced one of the biggest, most prestigious hospitals – Massachusetts General – to cut prices I found it super interesting. 

I’d like to play a clip from the episode which originally dropped in February.

We’ll pick up the action with state official David Seltz explaining that Mass General had agreed to reduce costs by $200m. 

David Seltz: This is the first performance improvement plan like this that I know of in the entire country. So, when you break new ground…it can be scary. But it is also thrilling to see how this process will continue to play out.

AO: We profiled Massachusetts, Dan, because a handful of other states are looking to it as a model for limiting health care spending. 

And here’s an interesting fact – those nine states make up 20 percent of our country’s total population. 

DG: Really appreciate Alex. Thanks so much. 

AO: You’re welcome Dan. 

DG: Here’s what I appreciate. Alex took something super wonky – one state trying to curb health spending – and tell a compelling story about it. That is a tall task.

After the piece ran we heard from Christine Haran at the health care foundation, Milbank Memorial Fund. Milbank helps other states tackle prices. And Christine told us our episode nailed the delicate balance of not harming industry while trying to make care more affordable. Look, very few newsrooms even want to take on this important story let alone have the journalism chops to pull it off.

The feedback we got from both Jami and Christine tells us – and you – that experts in the field rely on our work to inform their work. It’s hard to imagine a bigger compliment.

After the break we hear from senior producer Leslie Walker on one of her favorite stories, and some episode-inspired research. 

MIDROLL

DG: Before the break we talked about how people like Jami Snyder and Christine Haran rely on the show. 

Another reason you tell us, you trust Tradeoffs is because we dig into the real world, well, ‘tradeoffs’ in health policy.

We work hard to prioritize both sides of a story, which is exactly what we did with this next episode, and that comes from Senior Producer Leslie Walker. She’s based near the beach in San Francisco.  Surf’s up, Leslie? 

Leslie Walker: Hey Dan 

DG: Leslie, you looked into surprise ambulance bills costing patients hundreds … sometimes thousands of dollars. We partnered with health care news outlet STAT to do this story. So Leslie, tell us about the reporting.

LW: These ambulance charges can be really hard to avoid, like if you’re in a coma or a car crash how can you know if you’re taking an ambulance covered by your insurance?

So even patients with great insurance like Precious Mae Clark in Columbus Ohio are getting tagged with these big, unexpected bills.

Precious Mae Clark: I thought I was prepared. I thought I covered my bases. But this ambulance bill, it rocked my world.

LW: Precious had reached out to STAT reporter Bob Herman for help clearing a $7,000 charge for an ambulance ride she assumed her insurance would cover.

LW: I worked with Bob and his colleague Tara Bannow  to go beyond that one bill, help STAT’s readers and our listeners understand why patients get these kinds of surprise charges and why putting an end to is harder than it sounds.

One big reason: a huge chunk of these ambulance fees, Dan, don’t go to your typical health care corporations.

They go to public agencies like the fire station down the street.

So I flew to Southern California to visit one of those fire stations and better understand what all this money is going to.

Here’s a clip from the episode featuring Oceanside Fire’s deputy chief Pete Lawrence.

Pete Lawrence: The cost of readiness for public and private EMS providers is a huge cost for us, whether they go on a broken finger or on a cardiac arrest [call]. You don’t have the ability to say, “Leave us a message and we’ll call you back as soon as the unit’s available.”

LW: We go on in the episode to explain that Pete’s costs run about $1200 per ride, but the unit typically only gets half that. A level that puts Chief Pete in this tough spot, hit up patients or seek taxpayer dollars. 

DG: Right, as you say in the piece, that’s money that could instead go to libraries, parks or whatever. 

LW: Exactly. And you know, I was proud of the work we did on this episode, in part, because to paraphrase one of our sources, it’s easy to say we should shield patients from these surprise charges. 

And a lot of other reporting on ambulance bills has made that case very clearly.

It’s much harder to answer the question: Who should pick up the tab instead and how much should insurers or taxpayers pay for this potentially life saving service? And I thought we really tried to wrestle with that question in an honest way.

DG: Thanks Leslie

LW: You’re welcome Dan. 

Oh and Dan, before I go, there’s one other thing I gotta say about this episode. I really loved the sound design. Check this out. 

PC: Where am I going to get $7, 000? Maybe this is an error. Why is this so high? Was my insurance used by someone else? Why are you sending me another bill? $7? $7? $7,000? It kind of, like, clogged my brain.

LW: The man behind that creativity is Andrew Parella.

AP: Hark! A producer calls. To the Bat-studio!

SFX: revving engine, foots on stairs, door crashes open

DG: (Chuckling) Parrella the red light is on dude, we’re recording.

AP: Sorry, bud! Got a little carried away there! I just love this stuff.

SFX: Door closes

DG: One of the things we’re most proud of at Tradeoffs – beyond the lovely sound design from Andrew Parrella and Cedric Wilson – is the fact that our journalism is used in more than 55 college and university classrooms around the country. 

Now, one of my favorite episodes of the year. 

It starts with University of Minnesota health economist Hannah Neprash on her couch back in 2021. She just put her toddler down for a nap and put on our episode about ransomware attacks on hospitals. 

Listening to that story, Hannah realized that it was impossible to predict where a ransomware attack would hit and when. 

HN: Which, as terrible as it sounds, got my research spidey sense tingling because it suggested that maybe there was a natural experiment to study here.

DG: Hannah’s spidey sense was tingling because she realized that if these ransomware attacks were effectively random, researchers like her could more easily study their impacts.

DG: This fall, we did an update on the ransomware attacks harming hospitals and patients. For that show we talked with Hannah about how she turned her spidey sense into a research study.  

In October, she and her co-authors released a paper that found if an older American is in the hospital when an attack hits the chance they’ll die in the hospital goes up by as much as 20 to 35 percent.

Hannah used to work on Capitol Hill, and as part of that episode she talked about the role of evidence informing policy.

HN: I’ve seen how valuable it is to put cold, hard numbers behind squishy assumptions and beliefs. So I’m hoping that adding some evidence to this policy debate can essentially light a fire to get something done soon.

DG: We launched Tradeoffs, in part, to highlight the importance of health policy research.

So when I found out a health economist published a paper inspired by our journalism, I was psyched.

That brings me back to this super cool health policy community we’re all in. 

As we wind down 2023, we know: 

Health policy decision makers, elected leaders, and folks just interested in health care find value in our work. 

We blend data with storytelling – so people can get the facts and appreciate the economic and human stakes. We do this to help our country have smarter, more honest, healthcare conversations. 

2024 is shaping up to be a busy year. We’ll cover the elections, crisis care, and ongoing research.

Amy Finkelstein: These are too important problems to to not keep working on. But they’re also too important problems to just declare victory without evidence.

DG: Finally, I want to shout out the rest of the team. 

Editors Cate Cahan and Deborah Franklin. Research Reporter Soleil Shah. Kate Sepe in Operations. Kathryn Dugal who heads up Marketing and Audience engagement. Pam Garcia who keeps the books clean. And, of course, Executive Director Jessica Silverman. 

Thanks to our advisory board and our governing board! It takes a lot of work from a lot of people to make Tradeoffs shine!

Your gift today – $5 or $500 – helps us keep this important journalism rolling. Become a Tradeoffs supporter today and your dollar will go farther with a special dollar to dollar match. 

Wanna know more about impact, check out our 2023 Impact Report on our website Tradeoffs dot org. 

Go to Tradeoffs dot org slash donate to make your gift today. And thanks.

I’m Dan Gorenstein. This is Tradeoffs.