The US Healthcare System is Enraging | Editor-In-Chief of KFF Health News Dr. Elisabeth Rosenthal

KKH Trailer Wide


Dr. Elisabeth Rosenthal: [00:00:00] Knock,

knock, hi! 

Will: Knock, knock, hi!

Hey everybody! Welcome to Knock, Knock, Hi! With the Glockenfleckens! I am Dr. Glockenflecken, also known as Will Flannery. I’m 

Kristin: Lady Glock and Flecken, also known as Kristen Flaherty. Took me a second to remember you’d switch up the order, and I try to match you, but you don’t always go in the same, uh, direction there.

You can’t be on your toes there. I know. I’m a little sleepy today. I didn’t get much sleep last night. Why? I don’t know, I just woke up. Did I keep you up? No, I just woke up after four hours and couldn’t get back to sleep for the rest of the 

Will: night. Was I thrashing in my sleep? 

Kristin: Not tonight. There was one recently where you were twitching a bunch.

So that woke me up. 

Will: I think I was punching something in my sleep. Oh, you’re having a dream I think 

Kristin: I was having a dream. Yeah, you do a lot of weird sleep stuff. I mean, you have a very active [00:01:00] sleep. I 

Will: do Sometimes some nights are more active than others. Yeah, whenever my heart stops beating and I start having a car.

I think 

Kristin: that was that was the Lack of 

Will: action. Well, I guess that’s true. All right. Well speaking of heart a lack of action. Actually, that’s a good potential That’s a good You just, did you make a, like a, like an electricity joke? It did. That was nice. Action, potential. Potential action. I don’t even 

Kristin: know if it made sense.

Is that, does that even apply to the heart? I don’t think so. I think it’s the brain. There’s 

Will: action potentials in the heart. Oh, of course there are. All right. Yeah. All right. Yeah. Trust me. I’m an ophthalmologist. I’m very tired. All right. Well, we should talk about Heart Month since we’re talking about hearts.

Yes, we should. Uh, so, uh, Heart Month is in February. We are in it and, uh, we want to tell you about the Nation of Lifesavers February Social Campaign. So, uh, first a little bit of stats here. Out of the 350, 000 plus cardiac arrests that happen outside the hospital each year in the U. S., do you know how many survive?[00:02:00] 


Dr. Elisabeth Rosenthal: many? 

Kristin: I know you know already. I do 

Dr. Elisabeth Rosenthal: know, but why don’t you tell me? One 

Will: in ten. Yeah, it’s not very 

Kristin: many. One in ten. I’m kind of glad I didn’t know that when when your heart stopped beating because that would have been 

Will: scarier. As one of those one out of ten. Yes, you’re welcome. Thank you so much again.

As I, I wake up every morning and I just lean over and say thank you Kristen for giving me this life and And then I 

Kristin: say, your breath stinks and take out the 

Will: trash. So yes, back to heart month. So this is, uh, we are just encouraging everybody to in February, all of our followers, everybody who has a heart.

And who has loved ones. We all have loved ones. We all, everybody’s listening. Uh, we encourage all of you to visit heart. org slash nation to learn how to perform hands only CPR by watching a two minute video. Yeah. Hands only 

Kristin: CPR. That’s what I did on you. Yeah, [00:03:00] look it worked. So you don’t do 

Will: the breaths, right?

It’s just just pumping on the chest and that teaches you it just two minutes. That’s heart. org slash slash slash Slash nation. That’s that’s a hard thing. Heart. org slash 

Kristin: nation. And a lot of our listeners and and watchers are probably Physicians who may feel like well, I don’t need to go do that because I already know how to do CPR But as we learned the hard way you might but maybe someday you will be the one that needs it And so maybe have your family members or your friends 

Will: visit I guarantee even if you’re all, you’re, if you’re listening and you’re in healthcare, I guarantee you have somebody in your life that is not and probably has never taken a class on CPR, doesn’t know anything about it, maybe doesn’t even know what it stands for.

And so those are the people that, that you send them that link heart. org slash nation and uh, and just have them watch that video. Um, and, uh, tell them you won’t talk to them ever again if they don’t watch [00:04:00] it. No, you don’t have to do that. Consider it. But it’s okay if you 

Kristin: don’t. I always have to put a plug in too, anytime we’re talking about, um, CPR and especially bystander CPR is that, you know, let’s also keep in mind that doing bystander CPR, you know, is, it takes its own toll sometimes.

And so we shouldn’t forget about those people who perform CPR after the fact. Make sure that we support 

Will: them too. So, you know, with your help, like we can, and we can increase the survival rate of all of our loved ones, of our family, of our friends. The people in our lives, uh, and around the world. So just check that out, please.

Heart. org slash nation. Now let’s get to our, our guest today. So today we’re talking to Dr. Elizabeth Rosenthal, a fascinating conversation. So she is a former emergency physician. turned journalist, long time journalist at the New York Times. Um, and so for about 22 years, she wrote for the New York Times on a variety of different things, including healthcare, and is now a senior contributing editor at KFF Health News, which is how I found her.

I read one of [00:05:00] her articles. It was like, we got to have you come on. Let’s talk healthcare. Let’s talk Let’s just have a really entirely depressing discussion about U. S. healthcare, but also quite fascinating. Uh, and now, uh, she is also an author of a New York Times bestseller, An American Sickness, How Healthcare Became Big Business and How You Can Take It Back.

So very much enjoy talking with her. Fascinating discussion. Yeah. An important 

Kristin: topic and a thing that I think. You know, the average person doesn’t know enough about, and sometimes that’s by design. So sometimes knowledge is power. 

Will: Should we get to it? Let’s do it. There she is, Dr. Elizabeth Rosenthal.

Today’s episode is brought to you by the Nuance Dragon Ambient Experience, or DAX for short. This AI powered ambient technology helps physicians be more efficient and reduce clinical documentation burden. To learn more about how DAX Copilot can help reduce burnout and restore the joy of practicing medicine.

Stick around after the [00:06:00] episode or visit Nuance. com slash Discover DAX. That’s N U A N C E. com slash Discover D A X.

All right. We are here with Dr. Elizabeth Rosenthal. Uh, should we call you Elizabeth? Yeah, that’s fine. Does that work? All right. All right. So, uh, thank you so much for joining us. Uh, I, I first found you actually on Twitter or now X, I should say, but I read, uh, one of your pieces on KFF news on the newsfeed.

I was like, I have to talk to this person because, uh, and then I learned about all your other writings, the book that you’ve written. Um, about, uh, uh, what’s called an American sickness, how healthcare became big business and how you can take it back. And I was like, this is like right up our alley. Yeah. We talk about with healthcare.

So thank you so much for being here with us. 

Dr. Elisabeth Rosenthal: Sure. Thanks. Um, I, I, I dare not ask which piece you read because some of them I’m more proud of than [00:07:00] others. And, um, you know, 

Will: well, I’ll tell you what. I’ll tell you which one I read. I read the one, uh, from Hospital to Hospitality. I think it was your mo Oh yeah, yeah.

Dr. Elisabeth Rosenthal: Your latest one. Yeah. That was, uh, you know, that’s been bugging me for years, that thing. But, um, 

Will: and this was just so our listeners know, this is about many hospitals out there that have really leaned into these, the idea that, that going to the hospital or seeking healthcare, uh, there should be this big focus on providing hospitality with.

You know, like a, you know, Michelin star food and, and, and surrounded by fine art and everything and, and taking the focus away from actual healthcare. Yeah. 

Dr. Elisabeth Rosenthal: And I was pretty shocked, you know, that started, that was a bee in my bonnet when I was back at the times and I would get to ask, you know, I would be asked to speak to a med school class or at a hospital grand rounds.

And I would go into the hospital and I would be like, They would be going like, [00:08:00] don’t you want to see the art? Like, look, the floor is a, you know, a tiled representation of the Great Lakes. And I would be like, oh, and here’s the concierge. And, you know, when I trained, like, there was no such thing as a concierge at a hospital.

And then when I was doing my book, I realized, oh no, it was before when I was still at the New York Times. Um, that some hospitals had actually hired hotel executives to really lean into that hospitality thing. Oh my gosh. And my favorite thing we did, which you should look at if you had, if you missed it, because of course most people did in those days, right before I left the New York Times, we did um, It was just a little quiz called, is this a hospital or a hotel?

And it was just 12 pictures and you could test yourself. The link is still there and no one gets, you know, you can’t tell the difference. In fact, the hospitals are probably a little more [00:09:00] upscale and it, you know, the good, the, well, I mean, now even the, the best hospitals, I’m like, Why do you guys need a spa?

I mean, people come to, you know, the Mayo Clinic or Johns Hopkins or for the, for the healthcare. Like, I’m not going there because I, I want to go. I mean, I don’t want a crappy meal, but you know, when I want a restaurant, I’ll go to a restaurant. 

Will: Right. Yeah. I noticed that, uh, whenever I was interviewing for residency programs and I walked into the front entrance at Mayo Clinic.

And I was surrounded by marble and, and, uh, and my immediate thought was, Oh, I am not dressed well enough for this place. This might not be for me, but it’s, it’s, it’s yeah, 

Dr. Elisabeth Rosenthal: go ahead. No. Did you bring your bathing suit and you know, your tennis? 

Will: I was just a little bit better than that, but, uh, but yeah, it’s, it’s, um, it’s.

And [00:10:00] you said that you’ve, it’s been a bee in your bonnet for, for quite a while now. I mean, is this, was that just in, in continuing with this vein of hospitality as healthcare? When did you, did you see a shift at some point where you felt, felt like it started to change maybe when you were practicing or, you know, or is this, do you feel like this is the more 

Dr. Elisabeth Rosenthal: recent thing?

Uh, you know, I’m, I’m kind of a dinosaur. I left practicing medicine in the mid. 90s. So then, you know, it was still, frankly, the ER was pretty kind of a gross place where I worked and I worked at a fancy hospital, you know, it, it, it could have been a little nicer. And I saw the leading edge, you know, people come in with clipboards and we did have like a VIP service.

If, you know, really important people came into the ER, they got like, I mean, they actually didn’t get anything nicer, but they got into the room quicker, but it was still the crappy stretcher and the, you know, the linoleum floors and stuff [00:11:00] like that. But it really came back to haunt me. So, so, and then I was out of the U.

S. for 10 years as a foreign correspondent. When I came back, I was like, Whoa, what’s going on here? You know, these don’t look like the places I once knew and Beyond that, um, you know over the last three or four years my husband and I have had some health issues that required Interacting with some really great hospitals And but you know, my husband has cancer and he’s doing well right now but they kept talking about our journey and I’m like This is not my idea of a journey, right?

Like, journey is when I go to Paris or when I go to the beach. You know, I’m grateful that we’re getting good care, but Fun it’s not, you know, it was, I, I said to, um, the editor who edited that piece, it’s more like, and you know, I lived in China for a [00:12:00] while. I think of it more as like Mao’s Long March. You know, you’re trudging along through the mountains without, you know, it’s, it’s just a slug and I’m grateful for it, but to try and pretend it’s a journey and how, how that rebranding has happened throughout healthcare.

of, you know, this is fun, you know, healthcare is, it’s really great. It’s great that we have it, but, you know, fun, not, not for me, at least, um, you know, I’d 

Will: say not for most people, 

Kristin: right. And I mean, there’s a push for, um, you know, patient focused and family patient centered and family centered care, right.

Which I think is. Great, but this seems like taking it too far, right, of like not what you actually need. It seems like we’re operating in the extremes right now. It’s like either it’s horrible or it’s, you know, a five star resort. But how about if we just have like a happy medium [00:13:00] where like everybody’s getting what they need, but it doesn’t need to be 

Dr. Elisabeth Rosenthal: extravagant.

Yeah, and I think that, that, that would be a good place to be, right? I, I sometimes joke, you know. Mark Cuban has done this thing with drugs, cost plus drugs, where he takes the cost of making the drug and marks it up 15 percent and sells it. Like, I kind of dream of like, Target for health care. So for, you know, no frills, like, I don’t need bottles of champagne in the room, you know.

I, I, you know, I, I want decent food, but I really don’t care. I don’t know. I live, I live in New York, so I have plenty of museums. I don’t need to go to a hospital to see art. So I just think, you know, if it was cost neutral, sure, I guess fine. You know, we could all get our healthcare at the Sheraton. You know, I think one of the reasons we pay so much for care is people are building [00:14:00] these palaces of health care when what they should be doing is building, uh, you know, institutions that are really good at delivering care, not, not, not uncomfortable, but not luxurious, um, is my thing.

If it was free, I would be like, yeah, sure. You know, bring it on, but it’s not. 

Will: Right. And this is something you’ve, you’ve just, uh, the, um, uh, healthcare costs, uh, and billing. Uh, this is an area that you’ve been interested in for quite some time. I mean, as a New York Times course, the correspondent, and, uh, you know, you, you have looked at this for.

more than 20 years and and now continuing that work with KKKH. KFF. 

Dr. Elisabeth Rosenthal: Yeah, formerly it’s like Twitter, you know, it’s KFF Health News, formerly known as 

Kristin: podcast acronym is KKH, so we’re so used to saying that. But 

Will: I’m [00:15:00] curious how you got on that path because you started as Obviously in, in healthcare, you were, you’re a practicing emergency physician.

Yeah. So what was it that really puts you on this path to, to delving into healthcare costs? 

Dr. Elisabeth Rosenthal: You know, it wasn’t initially, now I’m going to show like what a dinosaur I am, but initially I, I’d always loved writing. I did it on the side. I come from a family of doctors and I always thought it was, I liked being an 

Will: ER doctor.

I was wondering how you got into medicine from getting a masters in English at Cambridge. 

Kristin: And a bachelors in 

Dr. Elisabeth Rosenthal: history, right? It was history and biology undergrad. So I undergrad, I thought I would go to med school and then I kind of got really lucky and got this scholarship to the UK for Uh, two, which I extended to three years, and, you know, wanted to do something really different and, uh, so I did, uh, English literature there, knowing I was going to come [00:16:00] back to med school.

I’d already applied and gotten in, and the third year was because I wasn’t so sure. I was knowing I wanted to go to med school, but, um, I did. And, um, I was pretty happy as, as a doctor, but even then, and this was, remember, I, I, I trained, um, at a time when there were no drugs for AIDS, right before the, the drugs for AIDS came onto the market.

So I was in New York City, was seeing some really, really sick patients. And some problems, because some of them didn’t have good insurance coverage, you know, it’s an urban ER, and we take Emtala, we took all types, which is great, but a lot of the problems were social problems. So now here’s where I go into really, like, dinosaur land.

Um, I was writing for the New York Times on a freelance basis, and others, and um, there was something that came along called the Clinton Health Plan, [00:17:00] remember that? Probably, maybe you weren’t born. 

Will: I’ve heard the words. Yes. I guess we were, it was, uh, you know, we were young. We don’t need to go 

Dr. Elisabeth Rosenthal: into it. We don’t need to go into how much this dates me.

But, um, at the time said, uh, do you want to come on and cover that? And I was like, Sure, I’ll come on and cover that and, you know, it will pass and then I’ll go back to being an ER doctor, um, and, uh, of course it, it didn’t pass and, uh, I didn’t go back. And partly it was just that I got kind of hooked on the journalism thing and I saw, well, maybe I can make a living doing this, but, um, it was also more one of those life happens things, um, in, I guess it was.

So I’ve been practicing for a few years in the ER, and uh, New York State decided that to practice in an ER, you had to be ER [00:18:00] boarded, and I was internal medicine boarded, so I would have had to go back and It really wasn’t a big lift, but I would have had to go back and do the stuff to grandfather. And, and at the same time, my second kid was born and the night shifts were getting a little, you know, I wasn’t a very good mom when I was, you know, up all night.

So basically when the times said, come on board, I thought I would go back. And then I didn’t go back. And then my husband and I got offered like a gig to go to China. Which, um, when, when our kids were three and five and, you know, people said, well, why, why’d you do that? It was partly my joking answer, which is three quarters true or not.

No, I was really interested in going overseas. The kids were at a good age, but also I didn’t want to. figure out, like, have to figure out where my daughter would go to school in New York City, like, [00:19:00] which was a night, which is a night, perennial nightmare. 

Will: It was easier 

Dr. Elisabeth Rosenthal: to move to China. Yeah, we moved to China.

They got great educations and, or they, we made it through, uh, elementary school there. And, um, you know, and it was a fascinating story too. So, you know, what an adventure for a young family to be able to have. And at that point, I wasn’t particularly interested in health costs for me because I had good insurance, you know, people with good insurance, like, it’s hard when I tell my kids who are now in their late 20s and early 30s, like, that it used to be like this.

They’re like, wow, you’re describing the dark ages. You know, that like in the nineties, if you had employer provided insurance, your employer mostly just paid the premiums. There was, there, there weren’t deductibles. There weren’t co pays. It just covered stuff. I mean, my two, um, birthing [00:20:00] experiences, um, one of which was a C section.

I think I paid 25 bucks for a TV hookup or something like that, you know, it just was a different world. Right. And, um, and so, um, then I was overseas for about 10 years and first in, in China, whose health system I wouldn’t want to emulate, but I was there for Bird flu and SARS and, uh, all the, the, you know, and, um, Rural AIDS and all sorts of stuff that was medically related, but I was writing about other things too.

And then I had, um, a beat based in Europe where I was writing about environmental stuff and then at some point, um, you know, because the European countries were really big on climate adaptation even before we believed in climate change in this country. Um, and then, [00:21:00] um, I, you know, my editor in his wisdom, the, the, uh, head, the top editor at the New York Times was like, we don’t want you flitting around Europe anymore, which, um, it was a great gig, but, um, we want you to come back to New York.

And that happens, you know, people, once people are overseas for a long time, they’re like time to come back to New York, to the mothership. How long were you away? 10 years. How many years? 10 years. 10 years. Decade. And the thing that happened when I came back, that’s when like I got the health cost bug.

’cause that was from 97 to 2007. Right. And all of a sudden, like the Augmentin for my kids’ ear infections, which was like. cheap when it was branded was suddenly off patent and 200 bucks and my little asthma inhaler, my albuterol inhaler, which, you know, was 10 was now like with insurance. some [00:22:00] crazy number.

And, um, I was just like, wow, what, what has happened in this country? It’s gone berserk. And, um, and, and I got, I wanted to know why and what had happened. And, um, you know, I also came back in that kind of seminal year for, um, for, uh, preventive care. I had to have my first colonoscopy, right. So, um, uh, you know, this is, Uh, you know, probably not a story you need on a podcast, but anyway, it was, Oh 

Will: yeah, no, we need all of it.

We need 

Kristin: all the stories. You should have, you should see what some people have brought into this podcast. So 

Dr. Elisabeth Rosenthal: I, you know, I knew that healthcare costs have gotten expensive and there were these things called deductibles and co pays and networks. And so I went to my HR department and said, well, how do I get this?

procedure like free or cheap. And of course, meaning free or cheap to me, right? And so they [00:23:00] said, Oh, right. You just have to do a network and it’s fine. Right. So I look at the network and there’s, um, you know, Memorial Sloan Kettering Cancer Center. And I’m like, okay, fine. You know, cancer center, cancer screening.

I booked my appointment and Uh, you know, voila, you know, uh, clean colonoscopy. And then I got the EOB, which didn’t even exist before. And I’m looking at the EOB and of course, the first thing you look at is the what you owe now, and it was zero. So I was like, hooray. And then I look up the EOB and it’s like, oh my God, they charged like 12, 000, you know, because there’s.

The operating room fee, you know, the facility fee, and the anesthesia fee, and all these other fees, and I’d seen, you know, colonoscopies done in doctors offices, you know, without all the bells and whistles, and I kind of [00:24:00] had a hint that it was going to be expensive, I mean, I trained partly at memorials, so I knew, like, when they had me put on my bonnet and booties and they were wheeling me into, like, a fancy operating room and there were people in scrubs all around and monitors, but I was like, you know, whatever.


Kristin: so yeah, 

Will: Kashmir booties, Kashmir. 

Dr. Elisabeth Rosenthal: Well, yeah, that push a probe a fall and it all seems like a dream, but, um, you know, so, um, So, well, I’m, 

Will: I’m curious whenever you were in, like, cause a lot of people will compare systems in the U S to other countries, right? And I, every time I put a video out talking about the U S healthcare system and some terrible thing relating to private equity or consolidation or something, I’ll, I’ll get all these people from Europe.

You’re like, I don’t know how you do it over there. Like this is, this is unfathomable. Like it [00:25:00] sounds like a hellscape to be in the U. S. experiencing health care. So did you get a sense while you were in Europe and other parts of the world? Oh yeah. I mean, what, what worked, what didn’t work? What, you know?

Dr. Elisabeth Rosenthal: Yeah. I mean, I, I’m, you know, at that point in my life, I was a pretty. avid jogger and um, also pretty inattentive to uh, roots and sidewalks and things like that. So I had a couple of Oh no, that’s a bad combination. Yeah, I, I had a couple of falls. I um, broke a wrist in Sweden and um, you know, there, I was on New York Times Foreign Correspondent.

insurance. So they sent me to this fancy hospital, you know, I saw the orthopedist, it’s same, you know, got the x ray. He put a splint on and then they apologized, like, Oh my God, we’re so sorry. We have to charge you 400. And I was like, so that was one data point. Right. And [00:26:00] then I, my second, um, My second slip was in, um, Rome, where, uh, I ran into, uh, a branch and slit open my head, and it was a Sunday, and I asked a friend, where should I go, and he said, oh, Gemelli Hospital, that’s where the Pope goes, and I was like, Good enough for me.

Good enough for the Pope. And you know, again, they stitched it up, um, looked great and apologized for having to charge me like 112 euros, which was then about 140. So when I came back to the U. S. and was like hearing, you know, seeing all these health care prices, I was like, this is nuts. Like, and, and, you know.

What is going on? And, um, when my, uh, editor, because I’d been covering climate, said we really want you to come back and cover health care, I said the only thing I want to do is cover [00:27:00] prices and costs. And, uh, in his wisdom, he let me do this series called Paying Till It Hurts. Um, The first, um, the first installment of that series is about the cost of colonoscopies, and now you know why, um, much to the horror of, of the New York Times photo editors who are like, What are we 

Kristin: going 

Dr. Elisabeth Rosenthal: to do to do that, you know, it’s like, oh man, but you know, I, I think cause I had heard while I was overseas stories about us healthcare getting expensive and you know, the, the million dollar cancer treatment and, but I think when people read those stories, their first reaction is.

Not the system is really messed up and expensive, but like, oh, I hope I don’t get that kind of cancer because that’s really expensive. So what, what I really wanted to do in the Pain Till It Hurts series is to focus on things that we [00:28:00] all encounter, you know, a colonoscopy, getting stitches in an ER, as I had in Rome, which, you know, Um, in the U.

S. would, if you’re lucky, cost you a couple thousand, and maybe up to forty thousand if you, you know, if someone said For stitches? Yeah, if someone says Gold plated stitches. If someone says, you know, this is a lesson, if someone says, and it’s usually a kid who has a cut chin, and they say to the parent, would you like a plastic surgeon to do that?

And, you know, it’s like, no, don’t say yes to that question. I mean, if it’s in the, I, you know, I’ve had, if you need a plastic surgeon, but no one says, Oh, it’ll cost you an extra 40, 000 bucks to have it that way. Right. So, right. It’s a lack 

Will: of transparency. 

Dr. Elisabeth Rosenthal: Right. Yeah. And, and the lack of choice, um, So, you know, uh, uh, we did that series and the way we did [00:29:00] that series, which was very kind of nouveau at the time, was we put out a call out saying, anyone have experience of high hospital bills or high medical bills?

And we were flooded, you know, we were totally flooded and all the stories in that series. And all the stories in my book come from people writing to me about their billing experiences. And now, um, I’ve kept that up at, uh, What was formerly Kaiser Health News, now KFF Health News, where we do, um, this Bill of the Month project, uh, where people tell us about their medical bills.

And you know, the thing is, why have I kept at it? Um, partly when I wrote the book, naively, I thought, oh, you know, people will read this, they’ll, they’ll see what the problems are and then it will all change and the book will go out of print or something, which, you know, I’m sure was not what. My publisher wanted or, you know, [00:30:00] but, um, and it shows how naive I was.

Um, so, you know, here we are, my, our, our bill of the month project and my inbox has become kind of the garbage pail for everyone who’s had bad experiences, particularly with costs, because people don’t complain a lot about the care. You know, people generally right, like the care or did until there was all this like finagling with, uh, you know, did I really see a doctor?

I mean, now we’re seeing more people going like, wait a second. There’s a, a, a doctor’s name on this bill, but I never saw a doctor. Um, you know, so there’s, you know, the business of medicine is endlessly creative and the regulators are. You know, they, they’re a big ship that turns slowly and doesn’t catch a lot of what goes on.

So here I am, still, you know, banging my head [00:31:00] against the wall on this stuff. 

Will: Well, I want to, I want to explore, um, this, uh, you know, the topic of your book a little bit more. Let’s take a quick break. We’ll be right back.

Kristen, are you familiar with AI? Yes. 

Kristin: I have not been 

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All right, we are back [00:32:00] with Dr. Elizabeth Rosenthal. So Elizabeth. So, uh, your book, An American Sickness, How Healthcare Became Big Business and How You Can Take It Back, um, I love this and I love that you use a lot of, of real life examples of people having to, to grapple with this, these exorbitant medical bills because narratives really seem to, to just draw people in and get people to understand just how serious of a problem this is.

And so how. I guess my first question is how, how was this a hard book for you to write, just from a, like an emotional standpoint, because this is serious, you know, these are people’s lives. This is a, um, a daunting subject and can probably take quite a toll on you emotionally. Yeah, 

Dr. Elisabeth Rosenthal: I, I kind of had steam coming out of my ears for most of the time I was writing the book.

Yeah. But, um, you know, it. It, it wasn’t so hard because people had sent me these [00:33:00] stories and, you know, as a journalist, what you do is try and unpack how this happened, how this could have happened. So it was more I mean, it was, it was enraging, but it was really, I learned so much. It wasn’t like I went in thinking, Oh, I get how we got, you know, why the facility fee at Sloan Kettering costs 5, 000.

I knew it did cost that much, but I’m like, how did we get this thing called a facility fee, which no other country has, you know, if you call a 

Will: Can you give us, can you give us an example? Like what, tell us something that, that. That opened your eyes like, Whoa, I had no idea until I actually looked into it.


Dr. Elisabeth Rosenthal: well, I think, I mean, there were so many things, but one of them, they really shocked me was when I was in medical school, I had worked on a floor of, I thought I didn’t want kids. So I, you know, when I had to do [00:34:00] a pediatrics rotation, I picked teenagers. Right. And in that era, it was, um, it was a cystic fibrosis ward and it was.

A devastating three months, so You know, in the interim, um, this drug, these new drugs for cystic fibrosis had come out, which were miraculous for people with CF, right? And I’m like, well, how did those come to be? You know, it’s not a very common disease. And I learned that, um, The Cystic Fibrosis Foundation had engaged in this thing called Venture Philanthropy with a small pharmaceutical firm and this, and you know, so they had given the donations that, you know, small donors and big donors gave and paid it to this drug company.

This drug company [00:35:00] amazingly came up with these drugs, but the CF Foundation never said, Hey, we funded this research, so we should have some control over price. And, you know, so now these drugs are miraculous, but the prices are off the wall, you know? So, and it’s, it’s a perfect example of, you know, how out of whack the way we price drugs is that, you know, much, many drugs are.

You know, the basic research is done at the NIH, um, a lot of it at universities, then a pharmaceutical manufacturer brings it to market. And we have no way to limit what we pay for them. And I just had no idea. My dad was a hematologist, another small example, before Factor VIII was available, right? So, um, you know, Factor VIII has changed the lives of, uh, [00:36:00] Boys with hemophilia, they play sports.

They, you know, but they need this drug, um, you know, a million bucks a year forever. Um, you know, that’s insane. So you know how much, if it’s your kid. You’re going to, you know, people pay it because you’re not going to subject your kid to not paying it and insurers have to pay for it because it works. But in some countries where there are cost limitations, they will either negotiate down that price or if they can’t, they’ll just say we cannot treat people with this disease, which is tragic.

I mean, most just negotiate it down to a reasonable price, but, um. You know, I was shocked. I was just like, wait. And you know, the tip I got that led to that chapter on hemophilia, which was I think the last chapter in the book was from someone who’d worked from one of the companies that makes [00:37:00] factor eight.

And she told me that, you know, they had this massive sales force to kind of lure families into, you know, that drug company’s sphere because you lured a family that has two kids with hemophilia and you’ve upped your profits by two million bucks a year and it’s for life, right? So, um, it’s, it’s, it’s a really, it’s a really sick world out there and that’s a bad pun.


Will: yeah, 

Kristin: it’s so discouraging. Like, it’s so hard to have faith in humanity after, you know, hearing stories like that. Uh, it’s, it’s enraging and it’s disgusting and like, I don’t know what we can do about it though. 

Will: Well, I mean, that’s what, what do you think? I’m curious to hear your thoughts on, on the best ways or the ways, because we have We have had wins in the healthcare [00:38:00] system in terms of giving a little bit more power back to consumers, to patients, um, The first thing that jumps to my mind is the No Surprises 

Dr. Elisabeth Rosenthal: Act.

Yeah, that, that was a big one. You know, that chapter of my book is now, well, I won’t say it’s totally irrelevant because somehow, somewhat bizarrely, ground ambulances were exempt from that. And, uh, so, you know, why 

Will: is all politics? Like it was a 

Dr. Elisabeth Rosenthal: lot of local governments make money from, from ambulance rides.

You know, I was shocked by that when I, when I was practicing, you know, it was like the volunteer guys or the, you know, no one got bills for ambulances, but then cities realized, Hey, this, you know, our, our, uh, our fire departments put out fires for free, but you need a ride to the hospital. You know, no, we’re going to, you’re going to pay for that.

It’s, it’s nuts. 

Will: Right. [00:39:00] So, so it, it still seems though with that. It’s easy to just kind of feel like you just, it’s best to just give up because like nothing’s right. Like nothing can touch these billion dollar corporations. Well, that’s what they want 

Kristin: you to do. Right. 

Will: But I mean, but the point is that through legislation, that’s still like the way to fight back.

Right. Like, yeah. 

Dr. Elisabeth Rosenthal: And I, I, I do think, you know, when there was criticism of my book and it was fair, there was the. How you can take it back. The things an individual patient can do are rather limited. Like I can decide, you know, if my doctor at, you know, X big hospital system orders blood. And it’s going to go to a hospital lab, I can say no, uh, have it sent to Quest, because I don’t want to have to pay a big co pay that I know the hospital lab is going to charge more.[00:40:00] 

Um, you know, you can shop around for some things, but that’s really hard to do, like if your, if your kid is sick, are you going to like, Shop around for the the cheaper. I mean even to look for which hospital. Yeah in the moment. Yeah Yeah, 

Kristin: it’s just well even getting labs. I didn’t realize you had a choice of where they go I thought they just send them to the lab, you know This is one big lab Each place like works with a particular one and that’s what 

Dr. Elisabeth Rosenthal: you’re stuck with right and that’s you know We get a lot of bill of the months about that that you know My doctor said why don’t we just get these labs and you know one click of the computer and it goes And then suddenly it’s a, uh, you know, 1, 800 bill for routine lab work.

Um, I always say 

Kristin: And it’s not like there was anything along the way to let the patient know that that’s what it costs there. Yeah. And it costs something 

Dr. Elisabeth Rosenthal: less somewhere else. And I always say that, you know, labs are kind of like the booze of hospitals. They can mark it up to whatever they want and, [00:41:00] you know, it’s Some labs, yeah, they’re, they may be better at some place than others, but most are just kind of You know, you put the tube in the machine and it gives you a number.

So, um, so I, I think the, what you can take it back, how you can take it back was a little anemic compared to the problems. And I, so I do think, yeah, you need government. And whenever I say that, I don’t mean like everyone goes, oh, there’s too much regulation in healthcare, which is, we just regulate the wrong things, you know?

So we, we, we don’t regulate drug prices, which. is hard and we probably, we’re starting to, we’re, we’re starting to, um, you know, surprise bills, that, that was a win, you know, the, even during the Trump administration where there was the requirement that hospitals list their prices. Unfortunately, it said in a machine, transparency, [00:42:00] a machine readable format, which means that Most humans can’t actually make heads or tails of, of this, but, you know, there, there are steps in the right direction because I think the outrage among voters, I’m, I’m always surprised it’s not greater, you know, they’re, they’re more like, what can I do?

I feel helpless. I think 

Will: part of that is, is, uh, it almost seems like a lot of these corporations are purposefully trying to keep things under the radar. Oh yeah. They don’t 

Kristin: Or complicated. Right. So you have to really put in a lot of effort to be 

Will: able to understand. Yeah. It’s, and it’s even, some of these things are, I always use the example of pharmacy benefit managers.

I was like a physician, practicing physician for like five years before I even had really heard the term pharmacy benefit manager and, and I’m, I’m a physician, I’m in healthcare. And so it’s, and it’s, [00:43:00] it’s a very complicated subject, just like a lot of things in our healthcare system are. And I think.

Maybe it didn’t start out purposefully trying to be complicated, but I think it works to the advantage of some of these organizations because people just don’t know who’s to blame. 

Kristin: Sure. Well, that and just like a general sense of, you know, cynicism and distrust in our institutions and our systems right now.

It just, it does. It feels like, well, who’s supposed to fix it? The politicians? They’re the ones that implement the regulations? The legislators? Nobody has faith in our political system right now and in our representatives and whatnot. So boy, it is just easy to spiral into hopelessness. 

Dr. Elisabeth Rosenthal: Yeah, I, I agree. And I try and fight that.

And I think what you’re seeing with something like the pharmacy benefit managers is every time there’s a problem, like drug prices are too high, you know, the hospitals don’t want to pay them. There’s, there’s a new layer of middlemen who comes in. [00:44:00] And takes a cut, right? So everything spirals up, you know, I didn’t know that there were things, when you talk to the orthopedists, you know, they’re like, okay, there’s the joint manufacturers at one end of this very long chain of, of intermediaries, each one taking a little cut and you end up with a joint, uh, you know, uh, a joint replacement that’s, you know, Three times as much as in any other country and you know the orthopedists They’re partly like I mean it’s a little bit comical becomes like the circular firing squad where they go like well We deserve, you know half a million a year because the joint salesman the joint rep from You know from striker is making has a nicer house than me and we’re like, yeah, you know there’s a lot of blame to go around and [00:45:00] it’s very uncomfortable for everyone.

And I think at some level, you know, it’s very hard for the patients to coalesce and complain, except they can vote. But I’m, I’m a little surprised and we’re seeing it a little more now that the physicians who, who are also getting the raw end of this, this Byzantine system that they have to work in and deal with every day, it would make me insane.

And I know it is making a lot of, a lot of people want to leave the field, Tragic, or at least not happy. Morale 

Will: has never been lower. Right. It’s, it’s a, it’s a huge problem. Yeah. 

Kristin: Well, that’s cheerful. You want me to 

Dr. Elisabeth Rosenthal: tell you a funny story? No. 

Will: Let’s hear it. Let’s hear it. What do you got? Do you have a funny story for us?

Dr. Elisabeth Rosenthal: Uh, 

Will: hmm. How about from your, uh, anything interesting from your, uh, emergency medicine, practicing [00:46:00] medicine 

Kristin: days? Oh, yeah. I’m sure you’ve seen all 

Dr. Elisabeth Rosenthal: sorts of things. I mean, I love that. And it was, it was, um, yeah. Do you miss it? Oh, I missed. Certain things about it and everyone said, well, you know, everyone has these moments with whatever they do It’s like I should say that when my editor asked for a big rewrite on a story I’m just like I don’t need this.

I should have just yeah, but um 

Will: the other hand you’re not writing notes. 

Dr. Elisabeth Rosenthal: Yes Yes, and I I’m grateful for that but yeah, you know, our our ER was like the world in a microcosm because it was Um, on the Upper East Side of Manhattan, so we got, you know, the UN people, the fancy people and the street people and the drug deals gone bad.

I mean, I mean, I had, you know, I had, I, uh, this one, this one guy, you know, and this was kind of standard issue, you know, someone would come in with. It was usually a stab wound [00:47:00] because it’s New York and not a lot of gun violence and they’d have to go to the OR and you’d be, the nurses would be taking stuff out of the pockets and they’d be going like, you know, there’d be 20, 000 bucks and some crack vials and they’re like, damn, how did that get there?

I was just walking and you’re just like, okay, and that’s like, yeah, stop the story. But I mean, and then, you know. We would have people from the UN. Um, I had a former president who was constipated, which is my, which really impressed my kids. They were like, Oh, wow, you treated a president. And I’m like, yeah, I guess.

But it was mostly the nurses that did the work there. And, um, right. Oh my goodness. No, it was, it was, I mean, it was terrifying because you saw everything that could go wrong. When I had young kids, it was, Part of, I think, what, what kind of [00:48:00] made it so emotionally difficult was like, you know, in the ER doc, you would see the kid who got over the window guards and thought he could fly and jumped out, you know, over.

And he was miraculously, this kid was okay. Um, uh, or, you know, but then, then during the marathon, you would see the Ethiopian runner who stepped on a nail on the Brooklyn bridge. And, you know, it was just like, it was every. It was like you saw the world in every shift, and it was, it was fun that way, and I always loved diagnosing things, so that was, that was really fun too.

Um, yeah, so, I do miss it, um, I, you know, people often say, wow, going from an ER to journalism, that must, that’s like so different, and I’m, I really felt like, Hey, my interviewing classes in med school were really helpful for journalism. And once you work in a New York City ER, [00:49:00] you walk into a room and you’re not afraid to ask anyone questions, right?

And that’s a lot of what journalism is. You know, you’re the president of China, I don’t care, I’m gonna, you know, I’m not going to ask you about your constipation, but I am going to ask you about, like, human rights. And I, you know, so it, it, it, there’s 

Will: some transferable 

Dr. Elisabeth Rosenthal: skills. Yeah, yeah. Definitely.

Definitely. And, um, you know, I think a lot of journalists could do with a med school interviewing class where you. I don’t know, but you know, what you learn is, of course, you’ve been there, you don’t ask leading questions like too many people as journalists go in thinking they know the story and they don’t listen very well because the actual story is much more interesting, but they don’t hear it.

So anyway. 

Will: Well, let’s, uh, let’s take a, one more break and then we’ll come back. We have a [00:50:00] listener story that we can, we can read. So. Great.

Hey, Kristen. What’s up? Name something that’s, like, crusty and flaky. Mmm, 

Kristin: a delicious 

Will: croissant. I appreciate your optimism. Yeah. Yeah, you know what I was thinking? What? Demodex blepharitis. That is 

Kristin: not as delicious. Do you 

Will: know what these little guys are? What? These are demodex mites. 

Kristin: Yeah, that’s not fun.

They’re cute 

Will: though, aren’t they? Those ones are cute. If you have red, itchy, irritated eyelids, you might be surprised to find out that it’s a disease called demodex blepharitis, caused by these little guys, demodex mites. Do you ever see those in your clinic? Yeah, occasionally. It’s not uncommon. 

Kristin: Are they that cute when you see them under 

Dr. Elisabeth Rosenthal: the microscope?

Will: Not quite. All right, but you can make an appointment with your eye doctor and get an eyelid exam where they can help you know for sure if what you’re suffering from is demodex blepharitis. To find out more, go to EyelidCheck. com. Again, that’s E Y E L I D [00:51:00] Check. com to get more information about demodex blepharitis.

And these little guys, Demodex mites.

All right, we are back with Dr. Rosenthal. So, um, Elizabeth, we have, um, we have a story from one of our listeners that we can, uh, that we’re going to read here. Uh, neither of us know what this is about, so this is all going to be a, a A fun experience for the three of us here. Yes, 

Kristin: our producer Rob likes to try to throw us for a loop with those, 

Will: so we’ll see what we get.

Alright, so this is a story from Lucille. Lucille says, I was an RN, a nurse manager in a short procedure unit that prepped endocrinology, bronchoscopy, radiology, and OR patients. Stationed in the hospital, we did both inpatients and outpatients. An inpatient came down pre colonoscopy to the PrEP area. The PrEP was not clear.

She had soiled herself, the two nurses were cleaning her, they lifted [00:52:00] her, um, abdominal hangover. The pannus, that’s the, the belly, uh, and out flew several winged insects. Ooh, ooh. Oh, interesting. Interesting. They went on with it, but being ever the professional, these nurses, they went on with their task not missing a beat.

I can’t do that 

Kristin: job. No? As I very clearly just demonstrated. 

Dr. Elisabeth Rosenthal: Well, you know, New York City, um, you do get the, uh, cockroaches in the ear. Um, that is a, a, a thing, you know, my ear feels. I bet you do. Um, but yeah, you know, it’s funny. I, I, at some level, My husband will, like, I’ll see, like, something gross, like a, a cut, and, and, oh, he cut his palm on a bagel knife, like it’s the classic New York injury, right?

And he needed stitches, and I was like, oh, that’s so gross, you know, [00:53:00] and he’s like, He worked in an ER, like what, and I’m like, oh, you know, it can’t be grossed out. It’s different, you know, it’s just different when you’re, when it’s your job and you’re like, oh yeah, that’s a cockroach. I probably, 

Will: I probably once a week, not once a week, probably like once a month.

I’ll have somebody come in convinced like they have some kind of, of parasite like in their eye. Hmm. Or some kind of like they saw a bug in their eye. Does it turn out to be floaters? Or a worm or something. A lot of times it does turn out to be just floaters that are in the eye. Uh, but the vast majority of the time there’s nothing there.

So it’s, it’s, uh, but I always, even I feel like, what am I going to see? What am I like? That’s, that’s the all, that’s also kind of difficult. Is it scarier 

Kristin: for you to think about what you’re going to see or that whatever’s in there, you have to take out? 

Will: No, I don’t, I don’t mind the taken out. It’s like the, the initial potential shock out scare, like seeing like a worm in the eye because [00:54:00] that’s not something you see every day.

And, and so I think it’s, it’s more like the, the, the mental image you have of something and then gross. 

Dr. Elisabeth Rosenthal: Right. But then yeah, you, it’s gross, 

Will: right? It’s gross. And so, but you, but, but you’re, you take care of it. ’cause you’re a medical professional. That’s what 

Kristin: you do. Well, I can’t do any bugs in any locations.

Do you? That’s not in my skillset. But do you 

Dr. Elisabeth Rosenthal: ever worry, like, I’m gonna ask you two questions. Okay. Do you ever worry, A, it’s going to be hard to convince this person that they don’t have a bug in their eye? Um, 

Will: Oh yeah. And actually that’s, that’s a good question. Uh, because You would think so, like if they’re that convinced, but often what these, what patients need is just reassurance from a medical professional.

And like, they just, I just want to make sure, sometimes I’ll hear, I just want to make sure I’m not going blind, or I want to make sure I don’t have a worm in my eye. And so if I just, that’s all, I don’t even have to like, sometimes give an explanation for their symptoms sometimes. They’re just happy that they’re going to be fine.

And so Most of the time, [00:55:00] that’s 

Dr. Elisabeth Rosenthal: the case. Now, the second question is the hard one for physicians is like, do you ever think, okay, how much is my, well, maybe I think you’re in private practice. So if you were in an ER, like how much is this patient going to be charged to, because I can tell you, we see a lot of those bills where people literally, they have, they, they sit in the waiting room for three hours, they get bored, they leave and they get a bill because for, you know, 3000 bucks, because.

They registered and someone took their vitals. So, you know, my thing when I talk to medical schools is, or medical students or residents, is like ask your hospital how much they’re charging for X, Y, or Z. I mean, and I’m, I was guilty as, as ever when I was, you know, if, if When I practiced in an ER, it was as it is now, where I would be like, oh, why don’t we just get a CT scan?

And the reason why not is [00:56:00] because it’s going to be 14, 000 if you do it from this ER, and if they get it as an outpatient next week, it’s going to be 500. And, you know, a lot of hospitals won’t tell their residents and won’t tell. their physicians, what they’re charging. Cause they, it’s that secrecy you’re talking about, like it’s better.

To not let anyone in the system know. 

Will: Yeah. It, and never, in training, it never even crossed my mind, how much does this cost that I’m doing? I had never even thought about it. I think maybe part of that, a big part of that is, is the education piece was not given to us. Like that’s, it wasn’t a priority from the people who are training us.

So it’s not going to be a priority for us to learn that. 

Kristin: Well, do they even have that information, the ones that are training you? Probably not 

Dr. Elisabeth Rosenthal: even have that. No, I think that’s, that’s the other. That’s. That’s the business side of the hospital and they don’t want, I think, the physician side, the nursing side, the care side, to [00:57:00] know what’s being billed because there would be a rebellion, right?

I think, you know, that’s not fair. 

Will: Right. And, and I would say I am now that I. I, there’s no administrator that’s like above me. I’m in private practice, you know, I run my own clinic. Um, I am more in tune with how much things cost and feel more comfortable talking about that with patients. But a part of that’s also just my own personal experience and as a patient.

And I know that I would want to know that information. And so those conversations do become easier with people whenever you have that firsthand experience as a patient. 

Dr. Elisabeth Rosenthal: Yeah. Right. There was an ophthalmology patient, I can’t remember if she was in the book or in one of the stories, where she was on Medicare and she needed cataracts taken care of and she was offered several upgrades and this probably means something to you.

One was a toric lens and one was [00:58:00] some kind of laser scalpel use of a laser scalpel and the upgrades were like, and, you know, she said to the doctor, well, which is best. And it’s like, sure. Business class is better than, than coach. Why wouldn’t you upgrade? And, um, you know, in a pass a patient to know, and, you know, there, I think most physicians are, are, incredibly honest and want to do the right thing.

There’s a small sub segment of people who are really entrepreneurial and um, that’s that. Yeah. Yep. 

Will: And so, you know, I encourage all the, the physicians, particularly those coming up, you know, listening to just be mindful of prices and pricing. That’s just going to be more in the public awareness over time.

It’s already moving in that direction. Like people are, are starting to. understand a little bit more about the health care system, especially with all these price transparency [00:59:00] laws that are coming out. And, and so it’s just, uh, it’s going to be important, I think, for people at the point of health care to understand all this stuff.

Kristin: Well, and patients too, to know that you can ask, what is that going to cost? And is there a cheaper option? Yeah, exactly. 

Dr. Elisabeth Rosenthal: And I think the thing also very good thing, you know, I’m sure you and I all, all worry about is that some people, and we get plenty of Letters like this to emails and, uh, like I’m afraid to go see the doctor.

Like, my hip has been hurting for, you know, a year and I’m afraid to go to the doctor because I don’t know what it will cause or, you know, serious medical problems where you want to say, you should go right now. You get it. You know, people have an 8, 000 deductible plan. 500 in their bank account, you know, it’s, it’s a terrible position to put people in.[01:00:00] 

I wanted to call the book, Your Money or Your Life, but they, Oh, yeah. That’s a provocative title. It was a little too 

Will: provocative and not, Your editors are like, Ah, maybe rethink that one. Yeah. Well, um, Dr. Rosenthal, I want to thank you so much for coming on, uh, to talk with us. Again, your book is An American Sickness, How Healthcare Became Big Business.

And how you can take it back. 

Kristin: What’s next for you? Do you have a new book 

Dr. Elisabeth Rosenthal: in the wings? Writing a book is hard. So I am now, you know, I’m now transitioning to writing a bunch of columns, like the one you wrote about, you know, healthcare is hospitality and, um, I’m working on one about, uh, how many of the interventions that, I mean, this is the, God, the world of medical billing is so nuts.

Um, many of the interventions preventive informant, sorry, many of the preventive interventions that are supposed to be free under the Affordable Care Act, [01:01:00] or at least no cost to patients. Billers are figuring out ways to pay, so I have one from a woman who got a mammogram and you know, the mammogram was free, but there was an equipment charge of like, 300.

Like, okay, is there a non equipment mammogram you can do for, you know, it’s just, yeah, it’s really nutty. And, um, you know, hopefully I just hope that a little more exposure places like you and what little I can do. You know, 

Will: all I can do is write. No, keep doing it, keep writing and talking about these things.

Yeah, I don’t think it’s little. And then also, KFF Health News and NPR, they do the Bill of the Month. It’s now in its 7th year, so that’s going strong. You can hear that on your local NPR station every month. And then, uh, you are also on X, so people can follow you at Rosenthal Health. And I know you share all of your, your pieces there as well.

And check out KFF Health News, which is, I, it’s becoming [01:02:00] one of my favorite, uh, places to, to read 

Dr. Elisabeth Rosenthal: about, you know. Oh good, it’s a great bunch of people. I’m, I’m, you know, it’s a great bunch of people who think about healthcare and, uh, You know, full of good guys, so, and, and good chicks, and good, uh, you know, are actually a good team of people.

Our, um, What the Health podcast is a weekly podcast anchored by, anchored by Julie Rovner, and it’s, um, I wanted to call that Chicks Talk Health because it’s all female. Oh, nice. So, 

Will: I’m really jealous of that name. I know. 

Kristin: Me too. I’m like, oh, I wish we would have 

Dr. Elisabeth Rosenthal: thought of that. That’s so good. It’s kind of a wonky podcast, but it’s really, uh, you know, it’s really, uh, a good listen.

Thank you guys. Good to know. Yeah. Well, thanks a lot. You take care. Okay. Bye.

Will: Always love a good opportunity [01:03:00] to talk about the U. S. healthcare system. Oh, 

Kristin: yeah. It’s, uh, 

Will: it’s enraging. I think people are tired of hearing me talk about it. 

Kristin: I hope not, because we’ve got a lot more 

Will: where that came from. I’ve got an endless supply of frustration and anger. Oh, yeah, and again, I just with with dr.

Rosenthal there I I saw I read her article and I was like, oh this person like gets it And 

Kristin: so it’s really interesting that it’s because she left for 10 years I then could see how drastically it had changed in those 10 years because when you’re just living it it’s just sort of like you’re the frog in hot water that just slowly boils, you know, but to Exit and then enter so abruptly, it’s like See the difference.


Will: It really is. That’s a fascinating origin story with how to get interested in U. S. health care reading and talking about. So definitely check out her, her, um, her writing and on KFF Health News. And let us know what you thought of the episode. Let us know, let us know if you have any [01:04:00] stories. We’d love to hear those.

Great story today. Send us yours at knockknockhigh at human content. com Uh, we’d love to hear from you and let us know if you have any ideas for guests you’d like us to talk to. We get a lot of, a lot of the guests that come on, people have like mentioned, Hey, maybe you should have so and so on here. Yeah.

Let’s, let’s, let’s do it. Our audience has very good suggestions. You guys get great suggestions. Lots of ways to hit us up. Again, you can email us knockknockhigh at human content. com. Hang out with us or you could visit us on our social media platforms. You can also hang out with us there. I’m not going to tell you when I’m going to be on the social media platforms.

But you might catch it. Just hang out until I’m there. Yeah. I don’t know. That’s all I can promise you You can also hang out It’s like a Pokemon. Sure. You can also hang out with us and our human content podcast family on Instagram and TikTok at human content pods. No Pokemon there though. Uh, you can also, uh, also thanks to the great listeners.

You threw me off with the [01:05:00] Pokemon thing, leaving wonderful feedback. Thank you for the awesome reviews. We love seeing that. If you subscribe and comment on your favorite podcasting app, we’re on YouTube and give you a shout out. Like, at Dustoff1472 on YouTube said, Are producers your Jonathans? Yes. Yes, of course they are.

They talk a little bit more than a Jonathan. Perhaps a little bit too much at times. A little bit more attitude. Yeah, a little bit more attitude. A little bit more throwing their weight around. Especially Shahnti. Uh, she knows what she’s talking about. Uh, but we love them nonetheless. Uh, and then, uh, Dustoff1472 said, Enjoying the show.

Thanks for sharing. So thank you for that comment. And, uh, full video episodes of are up every week on our YouTube channel at DGlocknFleck. And we also have a Patreon. Lots of fun perks, bonus episodes where we react to medical shows and movies. Hang out with other members of the Knock Knock High community.

You You wanna be a You don’t wanna get left behind here. This is We are taking off. It’s, uh, to the moon. We are You’re going What am I talking about? 

Kristin: I [01:06:00] don’t know. You always go a little off the rails on this part. I’m always a little nervous about what you’re gonna promise. Early 

Will: ad free episode access, I can promise that, interactive Q& A livestream events, and much more, patreon.

com slash glockenfleckin or go to glockenfleckin. com Speaking of Patreon community perks, new member shout out! Ooh, my favorite time of the day, Sarah T. and Stephanie V. Thank you so much for being patrons, for joining our little drone community. That’s right, shout out as always, a virtual head nod to all the Jonathans!

Patrick, Lucia C, Sharon S, Omar, Edward K, Steven G, Jonathan F, Marion W, Mr. Grindetti, Kaitlyn C, Brianna L, Leah D, Kay L, Rachel L, Keith G, JJ H, Derek N, Mary H, Susannah F, Mohamed K, Avika, Parker, Ryan, Medical Meg, Bubbly Salt, and PINK MACHO! all. And Patreon Roulette, random shoutout to someone on the emergency medicine tier.

Doug M! Doug M, thank you for being a patron, and thank you all for listening. We’re your hosts, Will and Kristen [01:07:00] Flannery, also known as the Glockenfluckens. Special thanks to our guests, Dr. Elizabeth Rosenthal. Our executive producers are Will Flannery, Kristen Flannery, Shahnti Brooke, Rob Goldman, and Aron Korney.

I changed it up a little bit, did you notice that? I wasn’t listening to you. Do you just zone out on these outros? It’s so funny, because I look over at you, and you’re like, kind of changing your facial expression. You’re kind of like, like, you know, a little head cock, and like, you’re like, a little smile.

But inside, it’s just like a hamster on a wheel. You’re like, nothing’s 

Kristin: going on. What do I gotta get for groceries today? What’s in my email? 

Will: You are not. I’m gonna use this to my advantage from the future on here. Our editor in engineer is Jason Portizzo. Our music is by Omer Ben Zvi. To learn about our Knock Knock High’s program, disclaimer, ethics, policy, submission, verification, license, and terms of service, hit release third!

Go to glockandplugin. com or reach out to us at knockknockhigh at human content. com with any questions, concerns, or fun medical puns. Knock Knock High is a human content production. 

Dr. Elisabeth Rosenthal: [01:08:00] Hey,

Will: Kristen. What? You know what people ask me about? How tall you are. No, sometimes. But no, they ask me about Jonathan. Yes, 

Kristin: I have heard people 

Will: ask you about that. Everybody wants a Jonathan. Like, is Jonathan real? Can I have your Jonathan? I’m like, no, you can’t have my Jonathan. But you know what they can have?

What’s that? Dax Co 

Kristin: Pilot. Ah, yes. And that is basically a 

Will: Jonathan. It is like having a little Jonathan there. It’s, it’s, uh, uh, an AI powered ambient technology. It sits in the room with you and it helps create that clinical documentation while also allowing you. to create a patient physician relationship that we all got into medicine to, to have.

We all want that. That’s right. 

Kristin: Nobody got in to start writing 

Will: notes. That’s right. And it is right now, everyone feels [01:09:00] overwhelmed and burdened by all this clinical documentation, uh, to where work life balance, it just seems unattainable. Right. So to learn more about the Nuance Dragon Ambient Experience or DAX Copilot, visit nuance.

com slash discover DAX. That’s N U A N C E dot com slash discover D A X.