Cairn Cast Episode 4: Marshall Allen

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Welcome back to episode five of the Karen Cast. Today we have a very special guest with us here, Marshall Allen from the book that we've been covering, our muse through this whole series, Never Pay the First Bill. So as a quick reset, Taylor Rogers, Rich Haney, and got a quick bio here on Marshall. Marshall is obviously the author of Never Pay the first bill, spent 15 years investigating the healthcare system as a journalist, including a decade as reporter for ProPublica. He's actually a two time Pulitzer Prize finalist and a recipient of the Harvard Kennedy Schools Goldsmith Prize for investigative reporting. He's a stud is the long and short of this whole thing. This book has been remarkable for us. We've got friends and family who have reached out to us as a result of our series just covering this book. So we're very privileged to have Marshall here with us. Marshall, thank you for joining us.

Oh God, the honor's mine. I mean, when you guys made my book.

The source for a series of your videos, which I've been watching them all and I really enjoyed them, I mean, it's a huge honor for me for you to engage with my book at that level and talk about it and all the insights that you've shared have been really interesting. So thank you for focusing on my book and for having me here today. It's a huge honor.

Yeah, well, we feel like this is one of the more important books to come out in a long time because it's so practical. There's so many specific action steps that people can take and for the most part people just pay the first bill. And it's like we can tell them till we're blue in the face, but this is a great instruction manual. So we've got a handful of questions, a couple of quotes that we really, really like in the book. So I guess to start out with here, Marshall, how did you feel about the final product of the book and was it sort of what you envisioned when you set out on this journey?

So I was thrilled, I've been thrilled with the final product of the book. I actually didn't have this book in mind when I got my book deal. It was actually my editor at Penguin Random House, her name's Bria Sanford. She really had the vision for doing more of a how to book. I had done a lot of investigating about the healthcare industry, about the quality of care, patient safety issues, the cost of care. And I had a proposal that was kind of like not really well formed, I have to say. It didn't have a strong angle and berea was the one who said, hey, look, do a how to book. What can people do about this? And I think that's what made the book really unique. There have been a lot of books about the problems, and I've learned a ton from those books. I've really enjoyed them. But I wanted to show.

Again, Bria really spurred me to show what can we do about it? And I wanted to focus on working Americans and employers, because there is a ton that working Americans and employers can do to save themselves hundreds or thousands of dollars with every healthcare interaction. They just have to know how to navigate the pitfalls of the system, how to fight back when they're being taken advantage of. It's just stuff that people don't realize they can do because, frankly, the health care system is so messed up that most typical Americans would never expect it to be as backwards and upside down as it actually is.

Yeah, that's a great point. We get a lot of folks that think we wear tinfoil hats when we talk about this stuff. You know, we tell them stories and they're like, I mean, can't be that bad, you know?

Well, so I've been. I've been documenting these, like, absurdities for 15 years now, and I am continually still astonished at just how unfriendly and cruel this system can be. Patients. And I feel like I sound like I'm crazy, too. And that's why I have to say everything in the book is very well documented. It's objectively researched. I'm certainly coming at it from the position of the patient and the employee and the employer who are funding all of this care and not getting their money's worth. But it does sound crazy because it's so backwards and so upside down that when you start telling people how the system actually works, they're like, really? Are you kidding me? That's how it works. It really is that messed up.

So after riding on this for years, documenting the stories of things that have not benefited patients, have you. In the couple of months since the book has come out, have you been able to finally start documenting new stories, which is success stories from people who have used your book to. To their advantage?

Yes. In fact, I'm starting to document what I'm calling victory stories. And I'm posting them on my website. I'm posting them on YouTube. You can go to marshallallen.com by the way. That's my website. And I'll give you one of the best ones, one I'm going to hopefully post sometime soon. This is a young woman who went for a procedure her doctor in her hospital recommended that she get. They told her it had been approved by her insurance company. Turns out it hadn't been approved because actually what the insurance company told the hospital is that if it's an outpatient procedure, it doesn't need prior authorization. So it didn't actually get approved. She gets the procedure, she gets hit with a bill for $58,000 because they denied the treat, the coverage of it. She got the itemized bill like I recommended and instead of listening to her, they actually repriced it and they came back and they said, now you owe us $78,000. And so this actually happened while I was writing the book, while I was finishing the book. I've been talking to her for about six months now. Anyway, she just called me a few weeks ago and using the principles in the book, she was able to push back with an evidence based appeal to the insurance company. She was able to get her employer involved. Her employer put some pressure on the insurance company and they approved the $58,000 in care and then the hospital waived the additional 20,000. So this young family, two young kids, they were facing bankruptcy, just got free.

Of a save that frankly they should have never had to deal with in the first place. But that was hugely satisfying to me. It's a huge victory. And this is the kind of thing, this is like a big example. But I've talked to other people who have saved. The youth pastor at my church questioned a bill that he had received. He saved about almost $800 on that.

Another friend of mine at church had a dispute with his dentist that had gone on for years. And I have a chapter in the book about how to sue in small claims court. He filed the case in small claims court. The dentist came to him and settled the case and paid him the $300 that he had been trying to get for years. So the tactics in the book really do work. But you have to have the courage to do it. You actually have to be willing to push back. And that's true for individuals and, and it's true for employers.

Yeah, I was gonna say, I think the, the one you'd shared on the 78,000 would. Did you share that last week? Was it on LinkedIn?

Yeah, I posted on LinkedIn. I did, because she posted a review on my Amazon page for my book and it was, she wrote it so well. Like, I wish I couldn't have written it better myself, honestly, because she really did show how the principles in the book. Now I had been helping her fairhealthconsumer.org to see if you got a fair price or not. And then when you get denied by your insurance company, make an evidence based appeal, not an emotion based appeal, and bring your employer into the conversation so you can exert more pressure. So all these principles, it's really strategy and tactics for how to identify the leverage points that will work for us and actually give us.

The power that we need, frankly, to win these battles. And so she was able to put a lot of these into play and it was really, really satisfying for me to see that work out for her.

That's, that's really cool. And I'm, you know, I always grew up a big John Steinbeck fan, but John Steinbeck Never saved anybody $78,000 on a health care bill. So that's, that's quite a testament in just two months of your book being out there to have that kind of an impact on people.

Like, you know the old saying, like you can feed a man a fish or you can teach him to fish. What I'm really trying to do with patients is equip and empower them to fight these battles themselves. There are so many of these battles going on. Like as a journalist, you know, I would get emails and calls all the time and I couldn't write a story about all these cases. Nobody can keep up with the number of unfair and inaccurate bills that people are being hit with. Not to mention all the over treatment, the unnecessary care, the overpriced treatment. You can't keep up with all that. But I don't think that we have taken the health literacy of our working population seriously enough. And so my book is really this health literacy tool that is being used to hopefully equip and empower people to take on these battles themselves. And again, they need to have some encouragement, some coaching and some know how, and courage, but they can do it.

Yeah, no, that's really cool. And I think courage is definitely a resource that's in short supply for this battle. But when people harness it, it makes a world of difference. Based on everything you've kind of seen and done through this book, if you could wave a magic wand and fix one thing in the healthcare system, in the mind and spirit of the consumer, kind of across the board, what do you think would have the biggest impact?

So I think the biggest impact would be is if we could get rid of the myth that we're helpless and that there's nothing we can do about this. In each chapter of my book, I show individuals and employers who are fighting this battle and winning. So the, the title of the book is Never Pay the First Bill. But the subtitle, the last two words of the subtitle might be the most important. The subtitle is and other Ways to Fight the Health Care System and Win. The and winning part is really the most important part. And I'm trying to obliterate this myth that we just have to trust someone else to take care of this for us. We can't trust anyone else to take care of it for us. If we could, we wouldn't find ourselves in this situation. You know, no one's riding into our rescue. So I hope that policymakers can make changes that will be better for us. But I am not recommending that anybody wait around for the Democrats or the Republicans to figure this out. They have not done so. They've had decades to do it. I'm also not waiting on the health care system to fix these problems. We hear all the time about these value based payment programs, these value based initiatives where the hospitals and the insurance companies, they basically are just telling us, don't worry about it, we got it taken care of, we've got value based payment now. You know what, the costs keep going up year after year after year and frankly, the system is undermined for the public by all these deceptive schemes that are hidden, frankly, unethical ways of taking more of our money than they should. Really, they're exploiting our sickness for profit is what's happening. We should not trust that the health care system is going to take care of this either. What we need to do instead is take things into our own hands and we can do it. I think that's what I want to obliterate is this idea that we can't do this ourselves. And I hear it all the time. So I've been on this book tour, right, and one of the questions people love to ask me is, well, isn't this really hard? I mean, are people really going to be able to do this? Well, sure, a lot of people won't be able to do this, but there are about 180 million Americans who find themselves in this position right now. Working age Americans, either uninsured or in employer sponsored plans, let's say half of them were to push back, let's say 10% of them were to push back. If 10% of that 180 million pushed back, they would flip the system on its head because we each have so much more power than we can appreciate and our employers especially have a ton of power. Because they're really steering a lot more of the money. If our employers stepped up, it would be a total game changer. So I hope the book will stop allowing people to tell themselves they can't do anything. And I hope then that they'll have the courage to follow the lead of the people I document in the book who pushed back and had a victory. And the worst that can happen is that you lose the battle. You fight, but even if you lose the battle, you're just in the same position you would have been in in the first place. So you have not. We literally have nothing to lose by fighting. Yeah.

And what's really cool about this is the people that I've seen have a really big impact are the people for which it means more than just the money. And so, you know, we look at our partners here, they've been unbelievable people. The reason they're doing this, the savings are helpful and they're being passed back to employees and so forth. But the big thing is, is they were tired of getting taken advantage of, and that was the last straw. It had nothing to do. I don't say nothing to do with the savings, but it was about the principle of the matter. And I think as more principle people step up and fight back and say, we're not taking this anymore. This wouldn't fly in our industry. You know, the mortgage bank, you know, that we work with, they're one of the most highly regulated industries on the planet. They're like, how come we have to do all this just to do a, you know, to write a home loan and you guys can go out and get away with your shenanigans? So, no, that's really cool to focus in. Double click on the subtitle, you know, and other ways to fight the healthcare system and win. There was a quote. We like to do this in each episode, where we go over one of the quotes specifically from the book. And we tried to pick. Since we had you on the show, we tried to pick one of our favorites, you know, from out. That really got us thinking. So, Rich, do you want to share the quote that we came up with as this focuses on the unfought battle?

Yeah, absolutely. So the quote is, once you've undergone a service or medical treatment, the bill is on its way. There's little forgiveness. Whenever possible, our best tactic is to steer clear of problems before they occur. I'm reminded of the ancient wisdom of Sun Tzu, the Chinese general, military strategist and philosopher who wrote the Art of War, the famous book on military Strategy, the greatest victory is that of which requires no battle.

So obviously, you know, your book is about what to do when that comes, but what we've found in building health plans for companies and so forth, is to build it in such a way where you avoid the bear traps before the triage occurs. And so I guess to put a bow on all this, the question I have back to you is, how do you personally avoid the battle of stepping into these traps?

Well, so that's in that section of the book. I focus on something like avoiding unnecessary treatment if you're informed, let's say, like my wife is a great example, right, where she's in the age category where people are recommending that she get a mammogram every year. Well, she just turned 50 actually, but before she was age 50. If you look up the guidelines of the US Preventive Services Task Force, which is the most independent panel of experts that makes recommendations about when women should get mammograms, they do not recommend that women in their 40s who have no history of breast cancer, who are not in the high risk category, they do not recommend mammograms for women in that category.

When my wife is armed with that knowledge, going into another mammogram, my wife can say, no, thank you, I'll pass on the mammogram. Because there's no such thing as a typical procedure or test or scan in healthcare. You're gonna get hit with the bill. First of all, there are a lot of false positives that happen with mammograms. And so that can lead to a lot of unnecessary treatment and a lot of problems for women. And so now that she's in the 50 category, that's gonna change for her. And so she will now follow the guidelines and get it, get the treatment accordingly. And that doesn't mean that patients shouldn't have consent. Right. But you have to realize the industry is steering you in a certain direction, often based on financial incentives, especially when we're in a fee for service world where they literally eat what they kill. They don't make money unless they do stuff to you. And if you know that in advance, it can help you ask some questions where you can analyze, is this something I actually need or not? Is this something I could wait on? Could I go get a second opinion? Could I go do some other research, like look up the U.S. preventive Services Task Force guidelines and consider following those? So that's an example of avoiding the need to fight. I'm obviously, I kind of have a fighter's personality. Right. I'm confrontational. My wife is very non confrontational, but it's really easy for her just to say no thank you when they make that recommendation. Another example of avoiding the need to fight is identifying which hospitals, say in your community have fair prices and which ones are price gougers. Now we have prices published on hospital websites. If they're following the federal government's rules, that is they are now required to post prices on their websites. So let's say you need to get a colonoscopy and you're covered by United Healthcare. You can now get those prices in advance and find what is the best place to get this care with my United Healthcare coverage. And also always ask for the cash price. Again, the cash price might be even lower than if you used your United Healthcare insurance plan. So these are things that we can do that avoid the problem to begin with. And so that is something that I hope people will do as they become more informed patients.

I just had shades of my dad telling my mom when I was growing up, there's no such thing as a good deal on something you don't need. You know, when she would buy something, she would, she would use that as like, well, it was on sale. There's no such thing as a good deal and something you don't need.

I wanted to ask a quick follow right there.

Yeah, for sure.

I wanted to ask a quick follow up question. When you push back against a provider in the, in the situation like the mammogram and you say, well, preventive guidelines say that this isn't actually, you know, needed for the under age 50.

Did, did your wife or have you heard of anybody experience any pushback then from the doctor? Well, why are you even here? I'm the one who went to med school for 10 years.

Yeah. In fact, my wife got pushback from her doctor when she said that. And the doctor kind of gives her the stink eye and goes, well, you know, a lot of other guidelines would recommend that you get a mammogram. Well, those are the guidelines written by the different specialty groups that happen to just so happen to make money by doing more mammograms. So the independent guidelines recommend that you in her category that she not do it. The guidelines from people who are making money by doing mammograms would say you should get one every year. I mean, so this is where you have to expect some pushback. If the industry is incentivized to treat you and you decline treatment, they're going to put some pressure on you. And it doesn't mean that you never get a mammogram. In fact, I recommend. The question I like to tell people to ask is, what's the worst thing that can happen to me if I wait? My wife has just had the manual examination where they've checked her breast for lumps. Well, they didn't find any lumps, and she declined the mammogram. So the question then is, okay, well, what's the worst thing that will happen to me if I walk out of this office right now? Am I going to drop dead from breast cancer in the next three weeks, three months, three years? Could there be a rapidly growing tumor that is going to suddenly overtake my body in the next few weeks? Just seriously, doctor, give me the worst. What's the worst case scenario? And it Requires then that Dr. To reframe the conversation. Instead of assuming that you're going to get treatment, let's talk about what happens if I don't get treatment, and let's go down that path. And then you can gather more information from a little different perspective. But it's not surprising when they push back and are not necessarily in favor of what we do. But we have to realize doctors are human beings just like we are. I'm assuming that they want the best possible care for my wife. I'm not assuming anything nefarious. But at the same time, if that's the habit that they're in of running the assembly line so that they keep churning out mammograms whether they need them or not, then that's the assembly line. Right. But we don't have to jump on that assembly line and participate in that process unless it makes the most sense for us.

Yeah, no, it takes two to tango in that scenario. And you just highlighted something that we talk about a lot and we visit a lot about, which is this tension. We love physicians. They're the bedrock of our society. I mean, for the most part, they're just that people don't get into medicine to make money. For the most part, there are better ways to make money and more efficient ways than going to, you know, seven years of school and taking out a ton of student loan debt and everything like that. So we always try to wrestle with this tension that they're really good people. But 70% of physicians are owned by major healthcare systems. And so they have incentives that cause them to, as you mentioned, churn out maybe some unnecessary procedures or succumb to the fear and doubt that's put on them by administrators that we're going to get sued if you don't run these tests or these labs or these expensive procedures. So I guess with all of that being said, knowing that doctors for the most part are really, really phenomenal people and there's kind of this tension, is there anything that gives you hope through your writings and what you've done, Is there anything that gives you hope that we're going to make it to a better, better future place?

I have a ton of hope every time I hear of a patient pushing back and an employer pushing back. And so I've documented the wins in my book. I think it's a very hopeful book, actually. And so I have a ton of hope because I believe this system is just ripe for disruption. We have a lot of big major corporations making tens or even hundreds of billions of dollars a year by doing health care the old fashioned way, giving you treatment whether you need it or not, hiding the prices and jacking them up so high that no one can afford them. That's been the status quo. It's never really been questioned. Now people are beginning to ask those questions. People are beginning to go through different routes. Employers, advisors like yourselves are starting to design plans that avoid some of these problems. And they're having huge success. I mean, I've talked to employers who have saved 30, 40, even 50% on their healthcare costs while eliminating deductibles and premiums for their employees. And when you talk to these employers, which I have some of them in my book, they're like converts to a new religion. I mean, they are. It's like the scales have fallen from their eyes and they want to tell the story about how they did what they did. And they shake their heads at how many years went by where they were believers in, you know, the facade. Right, because it is a facade that our healthcare system has to cost this much money. It does not have to cost this much money. In fact, I spent a whole year 2017, I went on a whole quest to identify all of the wasted health care spending in our system. They estimate maybe 25% of all healthcare spending is wasted. So we're talking about about a trillion dollars of fat that we could pull out of the system. So imagine if we could lower all of our health care costs by 25% without anyone having any reduction in the quality of care they receive. Now you would have lower revenue for the big hospital chains, for the big insurance companies. They would lose revenue, believe me. Well, if you look at the studies and the research that shows all the wasteful spending, they should Lose money, we should be paying less. So I think one of the uncomfortable things people don't like to talk about is that if we're going to lower healthcare costs for real, there are going to be winners and they're going to be losers. So far, the winners have been the industry, and the losers have been the employers and the working Americans. I believe the winners should be the working Americans and the employers who are funding the system. And the losers, meaning they shouldn't keep taking more of our money than they deserve, would be the big players in the industry who are not adding a lot of value.

So that begs the question, at any point during your journey, have you come under pressure to maybe stop pressing so much, stop asking all these questions, stop writing these stories?

Not at all. And I think the reason is the industry feels invincible. I really think that they're like, you know, I came out of the newspaper industry, and I came into the newspaper industry in 2001, and in the 80s and 70s, 80s and 90s, the newspapers were making 40, 50% profit margins. I mean, they were raking in the money. Then the Internet came along. They were so dismissive of it, they didn't even pay attention to it at all. They didn't even bother to put up websites for themselves for a long time. They scorned people who published things online. They looked down on it. In fact, when I first started and our papers would have a website, everybody really looked down on you if your story appeared on the website but not in print, you know, because print was just seen as like, why would we have a website? We deliver the paper to everyone's homes. And it was a way. They brought in a lot of advertising revenue, so they didn't take the Internet seriously. I mean, think how crazy that is. And now, unfortunately, we have seen the total demise of the journalism industry, especially the local newspapers have just been decimated. And so I look at it a little bit like that. Like when I talk to people from UnitedHealthcare or Aetna or Cigna or all the big hospitals, and I do, for every story I do, when I feature a patient, I have the patient waive their HIPAA privacy rights so that I can talk to every medical person and health insurance person involved in that story, I get the story from all the different perspectives. They don't deny what I'm saying is true. Nobody has called me and said, you got it wrong in your book, because what I'm reporting is flat out honest and true. It's just that they are dismissive of it. And at the highest levels, I think they're making so much money that they feel maybe, I don't know, I'm just speculating here. Obviously I don't know what they feel, but I think they're not really concerned about me as a journalist or an author writing a book or writing some stories.

Yeah, it's funny you say that, Marshall. We had lunch probably about a month or so ago with a state representative here in Texas and talking about just what's happening in health care. One of the things he asked of us was, he's like, well, how can we help you from a policy perspective? And we said, well, number one, needs to be more transparent. Right? And he says, well, we passed that, you know, that bill. It's like, well, the.

Their fine isn't big enough. Right. They still have little to no incentive to publish their prices when they're only charging them $108,000 a year. Side note, you know, here's what else, you know, what we think. And he says, I'll be honest with you guys. The lobbying for health care is one of the strongest that I've seen. It's almost impossible to penetrate. And that what you just said, how they're so, I guess, naive or ignorant, whatever you want to call it, they don't even care about the book that you publish or the stories you write. And they don't want to change it. I mean, that gets my blood boiling.

Yeah, I mean, it's a truth. They feel very confident in what they built. The last count I heard, which, this could be wrong. I know how these things go. But was that one particular pharmacy benefit manager had 52 full time lobbyists in D.C. if you can believe that. And so they feel pretty well impenetrable, I guess, at that level.

But here's what they can't defend themselves against. They cannot defend themselves against informed patients and employers who decide to opt out of the system that they've created. And that's the thing, we do have the power and the ability to do that. And I don't mean obviously opt out entirely. I mean, you're still going to go to the doctor, go to the hospital. But when a patient sues a hospital in small claims court for an overpriced or inaccurate medical bill, it's actually quite paralyzing to that hospital system. Imagine the hospital has to hire an attorney at a cost of hundreds of dollars an hour to defend themselves against a patient's case. That might not be worth More than 100 few hundred or a few thousand dollars. The patient can win. It's just we need all the patients to actually rise up themselves. We need the employers to rise up themselves. We need employers to enter into direct contracting relationships with imaging centers or with labs or with hospitals or ambulatory surgical centers. Do direct contracts with those who will give you a fair deal and then avoid those who won't. And once you start steering your business toward the people who give you fair treatment, then that's going to be a game changer. And we're already seeing it happen. It's in its early stages, but I'm hoping that my book will inform working Americans at the grassroots level so they will have those questions bubble up to their HR department and their CFO and their CEO and they'll be like, hey, look, I can't bear these rising costs anymore. What are you doing to create a health plan that's not going to just have my compensation get sucked away into the healthcare industry every year? And employers need a little bit of that prompting. They do need to be spurred along. But if they actually were to engage, they could have huge, huge power to transform the system.

And it sounds like that really gets started with education. So, you know, it's, you've got a follow up project to the book, which is the Allen Health Academy. Is that what that's designed to do is to help equip people?

Yes. So my big vision here, I actually, so, you know, I've been on this book tour now. The book tour started months before the book even published. You know, I've been talking to a lot of advisors, a lot of brokers, and one of these advisors said to me, is there any way you could create a series of videos based on the book? The book is great, but realistically, a lot of people are not readers. They're not going to read the whole book. So create a series of videos that give the overview of these principles that you're talking about. So I've done, I've recorded now about 17 three to five minute videos. And each video focuses on a different thing that consumers need to know. And I'm showing them, hey, look, here's why this matters. If you put these principles into practice, you and your family right now could save hundreds or thousands of dollars with each healthcare interaction. And of course for employer sponsored health plans, they could save exponentially more if their people in the plan could get this type of knowledge and put it into practice. So I have videos on how to get your medical records, how to get an itemized medical bill, how to price your medical bill, how to sue in small claims court, how to avoid treatment you don't need, how to use hospital financial assistance policies, A lot of the info that people really need so that they can save money on health care and save it right now. I'm also trying to communicate it so that people will understand, oh, this is useful information. Oh, this is practical. Oh, I can do something about this right now. So again, it's boiling all this information down and we're in the process now of editing, editing those videos and also producing them. So we're going to have, they've got graphics and animation. They're going to be much more interactive than just, you know, me looking at a camera. And we're going to be launching soon, in the next weeks here, an indiegogo crowdfunding campaign that's going to hopefully fund the production of the videos just so the production value can be very high and they can be as engaging as possible. And then my goal is to roll those things out so that person in an employer sponsored health plan could get the education they need to put these things into practice right now. So I really am on this health literacy push right now. And that's what Allen Health Academy is all about.

That's great. It's a shame that we've come to this point where the system's that convoluted that we would need a series of 17 plus highly produced videos to teach us how to do these things. But I'm really glad that you're doing this work. You're so well equipped to do it. You've obviously got high levels of empathy from your time in ministry and the things that you've done and seen over the course of your life. So thank you, thank you for everything that you're doing and continue to do and we'll be front row for all of it. So we're very appreciative of your time. Rich, do you have any final thoughts or questions?

I was going to say the same thing, Marshall. I really appreciate all the work you're doing. It gives folks like us an opportunity to go out and talk to more people, bring some credibility to it. You're a heck of a lot smarter than what we are. And I just, you know, you're able to touch a lot of people with this book.

It.

Keep up the good work. That's all. You know, we ask, don't, you know, we tell people every day, don't, don't cave into the pressures that be, you know, tell you the same thing. You know, you might not have those external pressures today. From the big hospital systems. But maybe if these folks start joining in a grassroots movement and doing what you're talking about, that'll come in the future. But, you know, just please keep up the good work. We're really appreciative of it.

Well, thank you both so much. And honestly, guys, it is a huge honor for me. I mean, you don't even understand. I spent a year and a half writing this book. I've obviously been encouraging people to read it. I've been promoting it. To have you guys engage with it on this level is really satisfying to me and really fulfilling to me. So I just want to thank you very much.

Yeah, well, we. We appreciate it. We'll be in touch, obviously. And if you haven't. For those of you watching and listening, if you haven't read the book yet, please go pick up a copy of Never Pay the First Bill and Other Ways to Fight the Health System and Win by Marshall Allen. And we'll. We'll see you guys next time. Thank you, Marshall.

Thank you.

Thank you.