Deb Gordon, Author of The Health Care Consumer’s Manifesto

Shopping for Health Care: How Consumer Can Use Purchasing Power to Get What They Need with Deb Gordon, Author of The Health Care Consumer’s Manifesto transcript powered by Sonix—easily convert your audio to text with Sonix.

Shopping for Health Care: How Consumer Can Use Purchasing Power to Get What They Need with Deb Gordon, Author of The Health Care Consumer’s Manifesto was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats.

Saul Marquez:
Hey, everyone, Saul Marquez here. Have you launched your podcast already and discovered what a pain it could be to keep up with editing, production, show notes, transcripts and operations? What if you could turn over the keys to your podcast busywork while you do the fun stuff like expanding your network and taking the industry stage? Let us edit your first episode for free so you can experience the freedom visit smooth podcasting dotcom to learn more. That smooth podcasting, dotcom to learn more.

Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez here, and today I had the privilege of hosting for the second time Miss Deb Gordon. She’s spent her career trying to level the playing field for health care consumers. If you haven’t listened to the first podcast with Deb, you’ve got to go listen to it. It’s all about the consumer and health care. She’s all about you. She’s all about your employees and how you could get the most for your health care dollar. She’s the author of the Health Care Consumers Manifesto How to Get the Most for Your Money, based on a research she conducted as a senior fellow at the Harvard Kennedy School Center for Business and Government. She’s a former health insurance executive and health care CEO. She’s an Aspen Institute health innovators fellow and an Eisenhower fellow. Her research and commentaries have appeared in USA Today, the Harvard Business Review blog and Jamma Network Open. She holds a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School, and I’m excited to dive into her work again around the Consumers Manifesto. Such a privilege to have you back on.

Deborah Gordon:
Hey, Saul, thanks so much for having me back.

Saul Marquez:
Yeah, absolutely. So you’ve been busy? I have been busy. That’s true. I spent, you know, probably a year doing research for this book and another year writing it. Not exactly that split, but I spent a good two years of my life producing this baby. And it is exciting to come back and tell you about it, because when we first met, I was just starting to think about it. I was just starting the research and listening to what consumers had to say. So I’m excited to be back to talk more about it.

Saul Marquez:
Yeah, same here. And so, Deb, obviously. So listeners, go listen to Deb’s podcast. After this, you get a deeper appreciation about her time as an insurance executive and what has inspired her work and focus in the consumer sphere. But tell us a little bit about the book, Deb. What’s the focus area? What are the takeaways at a high level?

Deborah Gordon:
Sure. So I wrote the book mainly to expose the human side of health care costs, like what is really going on for people when we go to the doctor or we’re facing an insurance decision and we have to pay for it. And, you know, I was really taken with the fact that so many people of all walks of life come to me and say, because I used to work in health insurance, they know I know something about it. And they just say, what should I do? And the most extraordinary people who’ve accomplished so much in their lives, who walk into my office at the Kennedy School at Harvard, and they like what health insurance should I buy? And I it just dawned on me that if people like that need help and it’s legitimate that they do, it’s very confusing and can be overwhelming when, like, what chance does everyone else have of making sense of these decisions? So that’s the motivation that I brought into the book.

Deborah Gordon:
And then in doing my research for it, I heard story after story of consumers. So real people who are trying to get value for their health care dollars, whether they use those kind of terms or not, I say like shopping for health care is a thing we could do. People don’t use those words and they don’t even sometimes know what I’m talking about. But, you know, I interviewed people about their experiences spending money on health care. And what I learned is that although it feels really foreign to put that into shopping terms or we know how to buy things, but we don’t know how to shop around in health care. And, you know, it doesn’t mean we’re not able to. And that’s I think the biggest takeaway is that we do actually have more power than we might even realize. And that the first step is to just ask the question, what if what if I could get what I needed? What do I need? Why do I need this? Is there an alternative and just almost like reimagine ourselves as a customer when it comes to health care. This makes doctors nervous and unhappy, by the way. But it’s not a slight against doctors. It’s just you know, what I think consumers need for whatever reason, we need permission almost to think of ourselves as entitled to get value for our health care dollars.

Saul Marquez:
Yeah, it’s a shift in mindset. Last time we were together, we were talking about how deductibles have gone through the roof for a lot of consumers, forcing us to be more mindful about where we get care. And a lot of that has to do with just the overall cost of care gone through the roof for our employers and everybody. So talk to us a little bit about that and maybe the role of the employer as it relates to getting the most out of our health care dollar.

Deborah Gordon:
So deductibles, it’s moderated a tiny bit if you look at this year over last year, but basically the same story, which is Americans now pay about a third of health care costs out of pocket and the average deductible is something like seventeen hundred dollars, which means that if you don’t have a thousand or two thousand dollars handy and you happen to need health care, you’re you’re going to be faced with a bill you can’t pay. And that is a story that was problematic for millions of Americans. It’s only more acute now. So as we go into economic turmoil, it’s only more difficult to pay for health care. So what that means is for most consumers, what that means is avoid care, even people who can afford it. There’s something about the costs when it’s when when you realize, when you finally realize that is hitting your your pocket instead of asking a lot of questions. And what will this cost and is there any way to do it for less or a better, more cost effective way to get the care I need? Most people just avoid it altogether. And so that has real health implications. And there’s a lot of a lot of studies and a lot of data that shows that these kind of consumer cost sharing strategies have, quote unquote worked in that they deter people from getting care. Now you can look at health care cost trends and see they haven’t worked overall. And you raised employers, the question of employers. And I think if I am an employer, I feel kind of nervous about this trend. So employers have pushed more costs onto their employees out of necessity because they are getting cost increases, rate increases from insurers.

Deborah Gordon:
But what’s happening is the employees. So most of the people I interviewed for my book were employed in some way. Many of them had their health insurance through a job. And because of these very high deductibles and the sense that it only goes up and so which is always paying more year after year, we’re on the hook for more of our health care costs than ever before. People start to question like, what is the value of this health insurance? And if I’m an employer and I’ve made those decisions out of necessity to manage my business and to manage my expenses, I would be starting to prepare for a backlash from employees who once they realize that either they already understand that the employer is making these decisions and they feel bitter about it, or a lot of self-insured employers are making actual coverage, benefit design decisions. Employees still, I think, typically look to the insurer and blame the health plan if someone gets denied or if a benefit isn’t as generous as they might wish it were. But actually, a lot of times it’s the employer’s discretion. So if I’m an employer, I’m going to start to, I think, feel more heat. And I might want to be prepared by really think about what do my employees need and and why why should I care and what can I do? I think we need to kind of release ourselves from a sense of helplessness at the individual level and the corporate level.

Saul Marquez:
Yeah, that’s a good call out. And I think it comes through education, you know, and best practices on how to use the benefits that you have. So talk to us a little bit about maybe the top one or two things that we could do to get the most for our money.

Deborah Gordon:
Sure. So, I mean, number one, you have to understand that it is your money. So we’re talking about consumers. Obviously, the same holds for employers. I think employers groups understand that they’ve been paying a lot for health benefits all this time. But individuals, I think, still have a sense like I have insurance. So my health care costs are kind of someone else’s problems. Obviously, that’s changing. Deductibles are the, you know, rude awakening where we we can no longer sort of ignore the fact that our health care costs come significantly out of our own pockets. So the first thing is what happens if you think about health care spending as your own money? Even people on Medicare pay some out of pocket, for example. And people on Medicare have paid into the system for years and years. And so even people who we all I think most people think Medicare is free and fully covered. Well, first of all, it’s not. And second of all, you’ve paid into it by the time you get there. You have already prepaid a good portion of those costs. So number one, think of your health care spending as your own money. And I say that that’s number one, because everything else flows from that. If you go to the store with your wallet or your apple pay or whatever, your phone, you know, you’re you’re making a decision that involves your own money. The same needs to be true. So so then if you’re at the store, you might read labels, you might check a price or look for a sale item or you might not care at all. But that’s up to you.

Saul Marquez:
Like Amazon. Like I wonder how much this is on Amazon.

Deborah Gordon:
Right. you might ask a question, is there a better way? Is there a more convenient way? I mean, it’s not only about price, it’s about getting value is in part about what are you spending, what’s the amount? Yeah, but it’s also does it work for me? Is the service or the experience giving me value?

Saul Marquez:
Yeah, I think that’s a good tip to start off with. And a lot of it has to do with, you know, the the beginning of it all. When we I guess the US, it was wartime. The they froze wage increases and kind of shifted toward, OK, we’re going to give health care and employers take care of that. And that’s the benefit. That’s how you’re getting growth as an employee. And that was the beginning of it. All right, Deb, I mean, once that happened, it became not our problem as consumers, but it became our employers problem.

Deborah Gordon:
That’s right. And not only were their wage freezes and health insurance benefits were an offset, you know, an incentive to offset those wage freezes. But there was a huge labor shortage because we were fighting a world war. And so it was really hard to find employees at all. That’s just, you know, we have record unemployment right now. That’s just you know, that’s not the situation we’re in. By the way, it hasn’t been the situation we’re in, but it’s just an outdated system that was tied to a very two things are different. One, I mean, so many things are different, don’t get me wrong. But employees are you know, we’re not as one of the important factors is that health insurance at that time was actually based on, you know, coverage for a much smaller set of services than we have today for a much lower cost, right.. As we’ve added more, you know how we cover more things. Health care costs go up. Health insurance has sort of like squeezed out as it’s been stretched and stretched and stretched. It no longer really works like insurance. And employers are still trying to use benefits and health insurance benefits to attract and retain staff. But I think some have lost sight of that’s the real goal, because if I talk to people with literally eight thousand dollar deductibles, I can assure you they don’t feel love for that employer. They don’t feel grateful. They think, what am I paying for.

Saul Marquez:
Right. Right. Yeah, that’s the that’s that’s truth right there. And so health care spending is your own money. So let’s think about that.

Deborah Gordon:
What’s what’s number two, ask the question. Whatever the question is, what does this cost? What will it cost? What is my part of that cost? What are the alternatives? What I actually I wrote a whole chapter about why is it so hard to find out health care prices and how might that be different in how could we reimagine that sort of complexity? And in that chapter, I, I sort of beg people to ask not just what will it cost, but why? Because I think there’s usually not a good answer to that question. Why? First of all, many doctors and administrators would struggle to answer the most basic question, what will this cost? But if you add why, I mean, that’s you’re going to make a lot of people uncomfortable. So I, I know a lot of consumers won’t ask that question and won’t want to be confrontational. And I don’t mean go be a jerk to your doctor. You should be gracious and appreciative to your doctor for their care and attention. But I think we are all, as consumers, entitled to know what we are expected to spend. And if it sounds crazy, I think we are expected to know why.

Saul Marquez:
Yeah, and it’s hard. And I mean, you go I mean, you go to the E.R. or you go to the urgent care and you just don’t get any straight answers.

Deborah Gordon:
And the reason would be the response would be, well, it’s really complicated. It depends on what you need and we can’t know that until we get through it. But that’s like saying I go to the store, let’s say in September or October, OK, November, because I live in a cold climate. I don’t like to think about what’s coming when it’s wintertime. So October, November, I go buy a winter coat, but I don’t get the bill I’ve committed. I’ve left my credit card, but I have to wait till the winter ends and know someone says, OK, you had this we had this much snow and this much cold. And therefore the value of your coat is seventeen thousand dollars and we’ve got your credit card. So you have to pay it like no, no, you would never go back. Yeah. But by then it’s too late. You’ve worn it all winter. Right. So what are you going to do? I think that you would never do that. So why do we do that with health care and why not? Why is it hard? I understand it’s hard, but why do we tolerate that as the response. To my point about push for the why is to try to nudge and how to put it know that consumer acceptance. Like what? I just if you have to look me in the eye and tell me something that’s nonsensical, if you’re a doctor or hospital administrator, you’re probably going to get uncomfortable. You’re probably not going to want to do that, not too often. And so I feel like if you ask enough questions, if we all ask that question, even if we individually did not get a great answer or any answer, eventually the people were asking would start to feel like a little bit ashamed I think that that’s the best I can do. I don’t want to say this again to another person standing in front of me asking me, why is my winter coat costing seventeen thousand dollars to carry the analogy forward? And those are the people who can then force the change within their own organizations.

Saul Marquez:
Yes, some good ones there. Is there a number three?

Deborah Gordon:
Yes. I think that, you know, this could be number one, I, I love all my children the same. You know, I can’t it’s hard. There’s.

Saul Marquez:
No order but the system.

Deborah Gordon:
Yeah, well, we have to speak in order. So three, but not not least important is self advocacy. So I think the the other the most successful health care consumers that I spoke to had understood that their health care destiny had a lot to do with them. That’s not to take away the expertise of our doctors and our health care professionals. But when it’s your body and your symptoms and your worries and your fears, your voice really matters. And I think so many people I also interviewed many people who just felt like they couldn’t speak, they couldn’t stand up for themselves because they didn’t want to offend or annoy the doctor or even an office manager in a clinic or something like that. And I I understand that. And I applaud people for their care and consideration for others and others feelings. But, my gosh, if it’s your body and your health is at stake and potentially your life is at stake and something does not feel right, you must speak up. Just a small example. It was a research assistant of mine who interviewed a woman who had gone to a dentist who did not wear gloves and did not, you know, apparently did not wash his hands. I mean, she didn’t know if he washed his hands. He didn’t wear gloves and she knew that was wrong. Like knew it was wrong. She still went back to the guy. You know, she finally she she finally left. She found a new dentist. But, you know, that’s blatantly bad.

Deborah Gordon:
You know, wear gloves. It’s it’s hygienic. But even in that you saw very black and white situation, she felt, you know, strange and awkward. So she asked about it, but he didn’t he just you know, it didn’t go well and she didn’t leave run screaming from the building. She she actually went back a couple of times until she could find a new dentist. And I think that’s a really, you know, nothing bad happened to her. But I think it’s a small example of that broader sense of powerlessness we have. And even I can tell you, I am not I don’t feel like a shy person on these things. And I will jump up and down and make noise and argue for myself and others as needed. But when you’re in the doctor’s office or even I have a story where I personally I went to an acupuncturist and he told me to take some herbs and I was like, OK, you know, I didn’t that’s I didn’t I just didn’t ask any questions. I took them and I. I got home and my husband’s like, what are those for? And I was like, oh, I don’t know, Right.. And I thought, like, why didn’t I ask a single question? I’m not afraid of the acupuncturist. You know, there’s no reason. I don’t believe that asking a question is offensive to him. And still, I didn’t even find my own voice. And I think asking questions and advocating for yourself are just different sides of the same coin. And they come from believing that you have a right to know and a right to voice your preferences and concerns.

Saul Marquez:
And that I think that’s a good call that Right.. And I think if we’re all honest with ourselves, we’ve been in that situation where you feel like I mean, the one that comes to mind for me very recently, like two days ago, I was driving and my son and I were in the car and it’s COVID. So you got to wear mask and gloves. And so, you know, I just had this thing. I put my son’s mask on and I put my mask on. You’re going into a gas station and I had gloves. And I’m like, do I want to seem like like do I want to seem right. that question? And we we care about what people think about us. And if you say you don’t, you got to be honest with yourself. You do. And it’s this. We’re social animals and this feeling that, oh, well, I’m going to look like, well, take Deb’s advice and it doesn’t matter.

Saul Marquez:
I put those gloves on Deb

Deborah Gordon:
Good for you.

Saul Marquez:
I’m not going to grab this door. I’m not going to like I’m just going to be safe. And but I did have that thought, you know, it’s like. Going to look like a germophobe, there’s people walking in without masks, and here I am masked up and gloved up and I said, you know what? If I end up with COVID an event, I’m not I’m not going to be really caring about what people think about me. I just want to feel better. Right. And so I just you got to do it for you people. You’ve got to do it for yourself.

Deborah Gordon:
And I think it’s a great call up that good for you for for overcoming that fear might be too strong a word, but it is like a pressure that we feel to conform and yes. Not stand out for the wrong reasons. But, you know, you didn’t you did the right thing. And if somebody noticed you, maybe they think that guy’s a germophobia. Maybe they think, hmm, I wonder if I should be wearing gloves. And so you might have done a service.

Saul Marquez:
Right.. Yeah, that’s how I feel. But yeah. And I think this is a great point. So I don’t feel like you’re inconveniencing because as a consumer you demand what’s best for you. And if you do it with Target and Amazon and everybody else, do it with your physician, do with your employer, it is your service that you’re receiving. So ask for what you deserve that. Thank you for that. It’s great, folks. Those are three of many more. But the book is The Health Care Consumers Manifesto. If you’re curious about it, check out Deb’s website. Go to Deb Gordon dot com. You’ll find information about her and her work, research the book. And there’s also a nice little button there for you to buy the book Deb. As we wrap up here, what closing thoughts would you give to the listeners and what would you say is the best place for them to reach out to you if they have any questions?

Deborah Gordon:
Sure. So I feel like never before has our individual actions or our individual control of our health been more important. I’ve always thought this I’ve thought this for a long time. Basically spent my career trying to figure out how do you how do we help people take charge of their health care and feel empowered to do so, entitled and empowered to do so. But I think covid if nothing else, it shows us that our individual health and life and well-being may depend on decisions we make. So I love your example about going to the gas station and not wanting to touch that door or the gas pump or the credit card key that’s you taking charge of your health and safety in this case. And I think that all of us are entitled to do that. And actually we must do that. No one else will look out for us the way we will look out for ourselves. And if we all look out for ourselves in the sense of making sure we get what we need, I don’t mean that it sounds very selfish. I hear myself as I hear myself, I think, oh, that sounds so selfish. But actually, I think it’s it’s not at all. I think you like in your example, you modeled good behavior. You showed others that you care for them as well as yourself. You’re protecting yourself and trying to prevent the spread of this potentially deadly disease. So just the same way as a health care consumer who acts empowered, you’re opening the door for the next person. You were showing your doctor your health insurance plan or every question you ask teaches that person you’re asking that it’s a question. You’re not the only one who has it so asking it actually, I think contributes to improving the system overall.

Saul Marquez:
And that’s awesome. Thank you. And so if folks want to ask you anything, maybe an employer is interested in getting a bunch of books from you to help their employees make great decisions to protect the bottom line and how they use their health care, but also for the obviously for the employees to make the most out of what they’re getting. What’s the best way for folks to reach out?

Deborah Gordon:
To be sure. So certainly on my website, Deb Gordon, dot com, there’s a way to reach out to me and you can always find me on Twitter at Gordondeb.

Saul Marquez:
There you have it, folks. The Health Care Consumers Manifesto. It’s our time now to get the best health care for ourselves and the best value for our health care dollar. Health care spending is your own money. Be sure to ask why and advocate for yourself. Speak up. If you feel like it’s right, then it’s right. if you like. It’s wrong and you got to speak up and so do I. Thank you for sharing your wisdom. The two years that you’ve invested, I’m sure will be fruitful for you, but also for many Americans that pick up this book. So I can’t thank you enough for sharing your knowledge with us today.

Deborah Gordon:
Saul, thank you so much for having me.

Saul Marquez:
Hey, rocket listeners, Saul Marquez here, I get what a phenomenal asset a podcast could be for your business and also how frustrating it is to navigate editing and production, monetization and achieving the ROI you’re looking for. Technical busywork shouldn’t stop you from getting your genius into the world, though. You should be able to build your brand easily with the professional podcast that gets attention, a patched up podcast could ruin your business. Let us do the technical busy work behind the scenes while you share your genius on the mic and take the industry stage. Visit smooth podcasting dotcom to learn more that smooth podcasting, dotcom to learn more.

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