Unintended Consequences

Jesse Hendon

Unintended Consequences explores the accidental architectures that define our lives. Hosted by Jesse Hendon, this show dissects how well-meaning decisions in history created the structural traps of today —starting with the US healthcare system. We look past the politics and the "villains" to focus on the mechanics: the incentives, the obscure regulations, and the third-party transactions that broke the price signal. It’s not about mistakes; it’s about the inevitable outcomes of flawed systems.

  1. 10 HR AGO

    The Hidden Negotiability of Hospital Bills

    In the final part of our 3 part series on Hospital Pricing, we go into something practical to finish it all up! We explore how you can actually negotiate your bills, like I did! One of the most surprising revelations about hospital billing is that many bills are negotiable. This is a fact that many patients are unaware of, leading them to accept charges without question. If you're facing a medical bill, the first step is to inquire about financial assistance programs offered by hospitals. According to Jesse Hendon, a healthcare expert, simply asking, "Is this bill negotiable?" can open doors to potential savings. It's a complex system that isn't designed to be transparent and easily navigated, now you have the tools to help save money! We're exposing a light today, got let it shine!

    17 min

  2. 18 MAR

    How A Bag Of Salt Water Became A $700 Bill

    A liter of saline solution costs about $1 to manufacture. You can buy one on Amazon for $1.50. In an American hospital, that same bag shows up on your bill at anywhere from $100 to $700. This episode is the origin story of that gap. In Part 2 of our hospital pricing series, Jesse goes back to 1983 — to a Reagan-era Medicare reform that was genuinely smart, measurably effective, and accidentally engineered every absurdity on your current hospital bill. Then we follow the money through the hospital consolidation wave of the 90s and 2000s, and into a federal drug program called 340B — created to help the poorest patients, expanded to cover sixty percent of all hospitals, and now generating hundreds of millions in revenue through a pricing mechanism that looks almost identical to PBM spread pricing. Different industry. Different program. Same math. If Episode 11 was about the bill, Episode 12 is about who built the machine that produced it.

    16 min

  3. 11 MAR

    I Work in Healthcare and Still Got Played!

    In December 2023, Jesse hurt his back. Badly. Slipped disc, fractured lumbar spine, six months of sciatica — and a crash course in everything wrong with how Americans get billed for healthcare. One phone call saved him $1,500 on a single MRI. Three epidural injections failed, and the system's answer was a fourth one. A trip to the ER produced a CT scan that cost four times what the cash MRI did. Jesse works in healthcare. He knew what questions to ask, knew cash pricing was an option, knew to get second opinions. And he still probably got taken somewhere in the process. In Part 1 of our hospital pricing series, Jesse uses his own experience to pull back the curtain on facility fees, the chargemaster — the secret price list hospitals never meant for you to see — and the federal transparency rule that 70% of hospitals are simply ignoring. If you've ever gotten a hospital bill that made no sense, this episode is for you. Spoiler: the bill wasn't confusing by accident.

    14 min

  4. 3 MAR

    The People Who Fought Back

    For fifty years, the PBM system grew in the dark — processing trillions in drug transactions while staying invisible to the people paying the bills. Then a few unlikely fighters decided enough was enough. In the finale of our three-part PBM series, Jesse traces the rebellion that nobody saw coming: a state government that fired its PBM and saved $54 million in year one, a coalition of employers who made one radical demand — show us the math — and a billionaire who built a pharmacy from scratch just to prove what drugs actually cost. This episode is about what happens when people who understand a broken system get angry enough to do something about it. And it ends with a question that leads somewhere even darker than where we started.

    16 min

  5. 24 FEB

    PBM's Episode 2 of 3 - Vertical Integration

    Spread pricing, rebates and vertical integration has created structure in drug distribution that's incentivized the increase in prices to the end point consumer. In today's episode we follow the money. We look at states that have legally paid hundreds of millions of dollars from their medicaid coffers to PBM's because of spread pricing. We look at medications that cost multiples more in the US versus Europe because of rebates. We look at the vertical octopus that has resulted in the US paying WAY more than anywhere else in the world for our drugs. A process, by the way, written into the contracts...

    13 min

  6. 19 FEB

    Pharmacy Benefit Managers - Plastic Cards to World Domination

    This conversation explores the complexities of the American healthcare system, focusing on the role of Pharmacy Benefit Managers (PBMs) in drug pricing. It highlights the hidden costs associated with insurance and the evolution of PBMs from service providers to powerful intermediaries that control drug prices and access. The discussion also touches on the implications of vertical integration in healthcare and the challenges it poses for consumers.

    12 min

  7. 15 FEB

    ACA Episode 3 - Leading to 2027

    When the ACA started, a pregnant woman with no insurance from her job couldn't get covered. Today she can! However we're also going into 2027 with $12,000 MOOP's, plans changing, enrollment avenues changing and the times are changing! It's a new day for the ACA, but it definitely doesn't look like it was intended to look like.

    11 min

  8. 9 FEB

    ACA Episode 2 - Silver Loading

    In 2017 we'd just had a crazy election, the ACA was a thumbs up away from John McCain from going away and we thought the elimination of Cost Sharing Reduction funding would blow everything up. That was until a clever actuary realized we could raise prices on silver plans and save everything! On today's episode we explore what happens we explore the mechanism that saved the ACA and at some point, when fueled up with additional steroids from covid funding, almost blew everything up! Welcome to our episode on Silver Loading!

    12 min
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About

Unintended Consequences explores the accidental architectures that define our lives. Hosted by Jesse Hendon, this show dissects how well-meaning decisions in history created the structural traps of today —starting with the US healthcare system. We look past the politics and the "villains" to focus on the mechanics: the incentives, the obscure regulations, and the third-party transactions that broke the price signal. It’s not about mistakes; it’s about the inevitable outcomes of flawed systems.

Information

  • Creator
    Jesse Hendon
  • Years Active
    2k
  • Episodes
    13
  • Rating
    Clean
  • Copyright
    © Jesse Hendon
  • Show Website
    Unintended Consequences