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by An Arm and a Leg
An Arm and a Leg is a podcast about why health care costs so freaking much and what we can (maybe) do about it. If you’ve ever been surprised by a medical bill, you’re in good company. But as our team of seasoned journalists has learned from years of reporting — you’re not always helpless. We don’t have all the answers, but we’ll offer you tools and big picture insights with plenty of humor and heart. An Arm and a Leg is co-produced with KFF Health News and distributed in partnership with KUOW. You can support An Arm and a Leg by donating at armandalegshow.com/support/ Show Credits: Created, hosted, and produced by Dan Weissmann with senior producer Emily Pisacreta and engagement producer Claire Davenport, edited by Ellen Weiss. Audio wizard: Adam Raymonda. Music is by Dave Weiner and Blue Dot Sessions. Bea Bosco is our consulting director of operations. Lynne Johnson is our operations manager.
Latest Episodes
The most recent episodes — sign up to get AI-powered summaries of each one.
- 2 weeks ago34 min
System meltdown: employer-sponsored health insurance
Employer-sponsored health insurance covers 165.6 million Americans. It’s the default. For lots of workers, it’s a key reason to accept a job offer, or to stay in a job. But that system is slowly imploding. As premiums have grown explosively — the average employer plan now prices out at $27,000 for family coverage — businesses have passed more costs onto their workers. And, as STAT News reporter Bob Herman wrote in July: America's Small Businesses are Giving Up on Health Insurance. That story kicked off a series, Out of Pocket, Out of Reach, with a subtitle that says it all: “How America's Employer-Based Healthcare System Continues to Crumble in Slow Motion.” Bob covers the business of health care for STAT News. His rigorous investigative journalism recently earned him the coveted title of “UnitedHealth’s least favorite reporter.” He joins us to unpack how the skyrocketing cost of providing health insurance is affecting companies large and small. And he talks with Dan about how the hidden nature of those costs obscures our understanding of just how much the larger health care system is squeezing out of us, eroding our wages and even our freedom to leave crappy jobs. Here's a transcript of this episode. Subscribe to our newsletter, First Aid Kit. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.Support the show: https://armandalegshow.com/support/See omnystudio.com/listener for privacy information.
- Aug 13, 202628 min
A Texas doctor’s love letter to ‘the People’s Hospital’ (from 2023)
We’re bringing back a favorite episode from 2023 that raises a question as relevant as ever: What if we had a decent, publicly-funded health system, available to everybody, with or without insurance? We’ve got one, says Dr. Ricardo Nuila. It’s where he works. And it could be a model for the whole country. Yes, really. That’s the pitch he made in his 2023 book, The People’s Hospital: Hope and Peril in American Medicine. It’s a love letter to Houston’s Ben Taub hospital, and an argument for bringing Ben Taub’s model, efficient, innovative, and cheap, to the rest of the country. And if that seems unlikely in today’s political climate, well: Ben Taub’s wild origin story was plenty unlikely too. That story takes us to the 1960s, when Dutch novelist and playwright Jan de Hartog moved to Houston. He fell in love with the bustling, futuristic home of NASA and the Astrodome. But he also discovered the city’s dreadful underside: a neglected charity hospital where largely African-American patients are left to seek health care in unsanitary and unsafe, hellish, conditions. De Hartog and a group of Quaker volunteers waged a campaign to change that, and eventually found an unlikely ally who brought it over the finish line. The People’s Hospital is a heck of a book. We might want to start a book group someday, just to talk about it. If you want to grab a copy, here’s a link. (Or: Audiobook, or ebook.) Here's a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG. And of course we’d love for you to support this show.Support the show: https://armandalegshow.com/support/See omnystudio.com/listener for privacy information.
- Jul 23, 202629 min
Julie Rovner is worried: Checking in with a veteran DC reporter.
Last May, just a few months into the second Trump Administration, changes to federal health programs were happening at a bewildering pace. We brought in KFF Heath News Chief Washington Correspondent Julie Rover to help give us — and you — a big picture look at what some changes would mean. A year-and-change later, we wanted to check back in. We talk about the “crumbling Jenga tower” of public health infrastructure, the fallout from cuts to Obamacare subsidies, and Medicaid, and what Julie sees happening in 2028 and beyond (including a whisper of hope.) Plus, we get an update on Julie’s growing t-shirt collection and a new series she’s starting on her health policy news podcast What the Health? You can read a transcript of this episode here. Want to dive deeper into those state Medicaid cuts we talked about? Julie did a whole episode of What the Health? about them. Listen here. Want weekly updates from the team, including some of our most practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.
- Jul 2, 202641 min
How to Fight a Health Insurance Denial With a Little-Known Tool (from ProPublica’s "Paper Trail")
After her husband L was hospitalized for a severe mental health crisis, Teressa barely had a moment to breathe before the health insurance denials started coming in, burying their family in medical debt. But Teressa’s a fighter, and an organized one at that — ready to endure months of back and forth until she stumbled on a "secret door" to reversing her husband’s insurance denials: the external review. In this episode of Paper Trail, a podcast from the investigative journalists at ProPublica, health care reporter Duaa Eldeib and host Jessica Lussenhop follow Teressa's journey to discovering this powerful and little-known tool — and putting it to work. Could an external review help you? Check out ProPublica’s write-up, which includes the types of denials eligible for this kind of appeal. And for more stories about appealing health insurance denials, you can check out our Starter Pack, which features episodes like this one about writing a killer appeal letter. Here's a transcript of this episode. Want weekly updates from the team, including some of our most practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.
- Jun 11, 202644 min
The Prescription Drug Playbook (Full Version)
While we’re busy working on some big projects this summer, we’re re-releasing some of our most ambitious and useful reporting to date. Last year, we set out on a mission: Collect all the best advice about what to do when your prescription drugs cost more than you can afford. Our listeners wrote to us about their experiences getting around this most demoralizing — and distinctly American — problem in order to get the medicine they need. Those responses allowed us to map a whole landscape of potential fixes — none a guaranteed solution for everyone, every time — but all worth knowing about. In this episode, you’ll meet some of the intrepid navigators charting the path — including a dad on a mission to afford his daughter’s epilepsy medication, a Medicare coach who helps seniors save tens of thousands of dollars on meds, a pharmaceutical sales rep with a brilliant short-term fix, and other generous and smart fellow travelers. We documented all their advice and more in our Prescription Drug Playbook. Here’s a transcript of this episode. Want weekly updates from the Arm and a Leg team, including more practical advice for dealing with the outrageous cost of health care? Sign up for our newsletter, First Aid Kit. Send your stories and questions! Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.
- May 21, 202656 min
The Chatbot Will See You Now: Big Tech In Therapy (from Organized Money)
One place you might assume is safe from prying ears is your therapy session. But as more therapists struggle to negotiate with insurers, they’re turning to tech middlemen like BetterHelp and Headway that promise to take care of the insurance admin and match them with patients. And these companies are sometimes recording and transcribing your sessions — and then turning around and sharing that data with social media companies and investors. And there are concerns that these confidential discussions could be used to train the next generation of chatbot therapists. So this week, we’re bringing you an episode from our pals at Organized Money, a show about corporate consolidation and monopolies, where they speak with Linda Michaels, a psychologist and co-founder of the Psychotherapy Action Network, about the tech companies sneaking into your therapy sessions and how we got here. And they share some good news: How one state, Illinois, passed a law in 2025 that could be a national model for encouraging more therapists to stay in-network, and ultimately, reduce reliance on these platforms. For more on mental health coverage: Check out our episode about Abigail Burman, an attorney and expert on mental health “ghost networks” — lists of providers that turn out to be filled with inaccuracies, making it difficult for patients to get in-network care. Plus we have a whole guide from Burman on “ghostbusting” — AKA, getting your insurance to cover your mental health care. That’s in our First Aid Kit newsletter. Here’s a transcript of this episode. We’ll be back with more Arm and a Leg in a few weeks. Send your stories and questions. Or call 724 ARM-N-LEG. Of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.
- Apr 27, 202618 min
The Supreme Court case that could slow generic drugs
It’s a case you’ve (probably) never heard of: This week, the Supreme Court is hearing oral arguments in Hikma v. Amarin — a legal battle that could impact how much you ultimately pay for prescription drugs. Here’s why the case matters: As soon as a generic version of a brand-name drug comes to market, its price typically drops by half. Within 10 years, by more than 75%. Meaning: the sooner we have access to generics, the less we pay at the pharmacy counter. But one of the fastest legal pathways for generic companies to get their drugs to market may be about to get a lot narrower – depending on how the court rules later this year. Amarin, a brand-name drugmaker, has accused Hikma, a generic company, of encouraging doctors to infringe on their patent for a drug called Vascepa. The case revolves around the legal concept of skinny labels: a carveout in drug patent law that allows generic companies to bring drugs to market when one of the brand-name drug’s patents has expired, but others haven’t. And it raises the (unexpected) question of whether it’s OK for a generic drug company to call their product the generic version of something. Legal experts help us unpack the nerdy details – including how this case came to be, and what’s at stake for both generic drug companies and anyone looking forward to one day paying less for an expensive brand-name drug. Want to learn how these drug monopolies work – and came to be in the first place? Check out our previous episode: Why drugs cost so much, 101: Medicine monopolies Here's a copy of this episode's transcript. Send your stories and questions. Or call 724 ARM-N-LEG. And of course we’d love for you to support this show.See omnystudio.com/listener for privacy information.
- Apr 9, 202634 min
Why drugs cost so much, 101: Medicine monopolies
We’re always asking: Why do drugs cost so freaking much? And it’s a complicated question. There are a bunch of reasons — to be sure. But in our reporting over the years, like our stories on insulin and tuberculosis drugs, experts cited one big reason over and over again: The pharmaceutical industry wages sophisticated legal battles to keep monopoly control over their best selling, most lucrative drugs — blocking generic competition, and increasing their prices along the way. How did it come to be this way? In this first episode of a new series – what we’re calling An Arm and a Leg 101 – we’re doing a crash course in the history of the drug patent system. And the rags-to-riches story of one amazing guy is going to help us do it. Al Engelberg got schooled in the Art of the Hustle at a young age, collecting dimes at an illegal bingo game on the Atlantic City boardwalk. Later, he’d put those street smarts to use as he sat at the negotiation table in Washington D.C., hashing out the details of a law that would usher in the generic drug industry as we know it. Then made millions from the rules he helped write. And as he admits, his legacy is mixed. On the one hand: The rules Al Engelberg helped write — a grand bargain between generic drugmakers and patent-holding brand pharma companies— unleashed the power of generic drugs to save Americans money. Nine out of ten prescriptions written today get filled with a generic. On the other hand: In the process of making his fortune, Al Engelberg discovered loopholes, gaps, and perverse incentives in that grand bargain. Gaps that allowed brand and generic drugmakers to profit by keeping generics for many hit drugs off the market. So we now spend more than ever on medicine — and more than 20 percent of Americans report skipping their medication because they can’t afford it. Al Engelberg, now 86, has spent the last 30 years — and millions of his own dollars — trying to close those gaps. “I live in a world — a pharma world — where half the people think I’m dead, and the other half wish I was,” he tells us. You can read more of Al’s story — plus his prescription for fixing the crisis of high drug prices — in his book, Breaking the Medicine Monopolies: Reflections of a Generic Drug Pioneer. And you can hear our earlier reporting on drug patents here: John Green vs. Johnson & Johnson (part 1) John Green vs. Johnson & Johnson (part 2) The surprising history behind insulin's absurd price (and some hopeful signs in the wild) Here's a copy of this episode's transcript. Send your stories and questions. Or call 724 ARM-N-LEG. And of course we’d love for you to support this show. An Arm and a Leg 101 is made possible in part by support from Arnold Ventures.See omnystudio.com/listener for privacy information.
About An Arm and a Leg
An Arm and a Leg is a podcast about why health care costs so freaking much and what we can (maybe) do about it. If you’ve ever been surprised by a medical bill, you’re in good company. But as our team of seasoned journalists has learned from years of reporting — you’re not always helpless. We don’t have all the answers, but we’ll offer you tools and big picture insights with plenty of humor and heart. An Arm and a Leg is co-produced with KFF Health News and distributed in partnership with KUOW. You can support An Arm and a Leg by donating at armandalegshow.com/support/ Show Credits: Created, hosted, and produced by Dan Weissmann with senior producer Emily Pisacreta and engagement producer Claire Davenport, edited by Ellen Weiss. Audio wizard: Adam Raymonda. Music is by Dave Weiner and Blue Dot Sessions. Bea Bosco is our consulting director of operations. Lynne Johnson is our operations manager.
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