Listen Now: Uncared For is Back!

Summary

Podcast Summary: "Uncared For" Season 3 – Episode: "Uncared For is Back!"

Introduction In the latest episode of "Uncared For" by Lemonada Media, hosts Sujin Pak and Noam Levy delve deep into the pervasive issue of medical debt in the United States. Through personal narratives and expert insights, the episode highlights how the healthcare system often exacerbates financial burdens, even for those with insurance. This comprehensive exploration sheds light on the systemic flaws contributing to the medical debt crisis and offers perspectives on potential solutions.

Fumiko Chino and Andrew’s Story The episode centers around the poignant story of Fumiko Chino, an oncologist, and her late husband Andrew, whose battle with cancer serves as a testament to the harsh realities of medical debt.

• Meeting and Early Life Fumiko and Andrew met online in the early 2000s, both in their late twenties, and quickly became a "cool couple" immersed in art and social events ([02:36] Fumiko Chino).

• Andrew's Cancer Diagnosis Their lives took a tragic turn when Andrew was diagnosed with neuroendocrine carcinoma, an aggressive cancer that rapidly spread throughout his body. Fumiko recounts the devastating impact of the diagnosis:

  “It all changed slowly. He started having problems eating, having some episodic nausea, vomiting... And that's when they did a CT scan” ([02:36] Fumiko Chino).

• Financial Implications The initial shock of Andrew's illness was compounded by unexpected medical expenses, leading to accumulating debt:

  “It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further into the abyss” ([03:49] Fumiko Chino).

Overview of Medical Debt in the US The hosts provide alarming statistics to frame the scope of the problem:

• Prevalence:

  “100 million people in the US have some form of healthcare debt. That's 41% of US adults” ([05:45] Soojin Pak).

• Broader Definitions: Medical debt isn't limited to unpaid hospital bills but includes credit card debts for medical expenses, payment plans, and informal loans from family or friends ([07:12] Soojin Pak).

Systemic Issues in US Healthcare Despite the Affordable Care Act reducing uninsured rates, medical debt remains rampant, especially due to high deductibles:

• High Deductibles: Many insurance plans require individuals to pay thousands out-of-pocket before coverage kicks in, making even insured individuals susceptible to debt:

  “Many plans have extremely high deductibles... $5,000 deductible or even a $10,000 deductible for a family, I mean, that's devastating” ([12:02] Soojin Pak).

• Impact on Chronic Illness Patients: Counties with high rates of chronic illnesses like diabetes and heart disease correlate with elevated medical debt, highlighting how systemic issues disproportionately affect those with ongoing health needs ([06:49] Fumiko Chino).

Ripple Effects of Medical Debt Medical debt doesn't exist in isolation; it triggers a cascade of negative outcomes:

• Economic Consequences: Individuals may face difficulties renting apartments, securing loans, or maintaining employment due to poor credit scores influenced by medical debt ([38:19] Soojin Pak).

• Health Outcomes: The stress from medical debt can worsen health conditions, leading to delayed care and poorer health outcomes. Research cited in the episode shows that cancer patients with medical debt tend to have shorter lifespans compared to those without financial burdens ([12:12] Noam Levy).

• Trust in Healthcare System: The pervasive issue of medical debt erodes trust in healthcare providers and the system as a whole, as patients fear being cut off from necessary care due to unpaid bills ([40:47] Soojin Pak).

Fumiko’s Testimony and Path Forward Driven by her personal experiences, Fumiko Chino transformed her grief into action by pursuing a career in medicine with the aim of reforming the healthcare system from within.

• Senate Testimony: In July 2024, Fumiko testified before a Senate committee, emphasizing the dire need to address medical debt:

  “There are more people who are worried about the financial costs of a cancer diagnosis than from dying of cancer” ([17:07] Fumiko Chino).

• Career Transformation: Her journey led her to Duke University School of Medicine and later to the MD Anderson Cancer Center in Houston, where she applies her experiences to improve patient care and reduce financial burdens.

Solutions and Personal Level Actions The episode discusses both systemic reforms and individual strategies to mitigate medical debt:

• Policy Suggestions:

  • Reforming Health Insurance: Implementing restrictions on out-of-pocket expenses and capping charges from insurance companies and hospitals.
  • Debt Forgiveness Programs: States like New Jersey have initiated programs to forgive medical debts, though these measures are not widespread.

• Individual Actions:

  • Financial Assistance Programs: Encouraging listeners to explore hospital financial aid and negotiate payment plans ([43:26] Soojin Pak).
  • Billing Vigilance: Advising individuals to meticulously check medical bills for errors and understand their insurance coverage.
  • Avoiding Credit Card Debt: Recommending against using credit cards for medical expenses to prevent further financial strain ([42:32] Soojin Pak).

Conclusion "Uncared For" provides a compelling examination of the medical debt crisis through the lens of personal tragedy and systemic failure. Fumiko Chino's story exemplifies the urgent need for comprehensive healthcare reform to protect individuals from financial ruin due to medical expenses. The episode calls for both policymakers and individuals to take action towards a more equitable and compassionate healthcare system.

Notable Quotes:

• Fumiko Chino ([03:49]): “It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further into the abyss.”
• Soojin Pak ([05:45]): “100 million people in the US have some form of healthcare debt. That's 41% of US adults.”
• Fumiko Chino ([17:07]): “There are more people who are worried about the financial costs of a cancer diagnosis than from dying of cancer.”
• Soojin Pak ([42:32]): “Don't put big medical bills on your credit card because if you do, you are not protected the same way you are with a medical bill.”

Speaker Attribution:

• Fumiko Chino: Oncologist and husband Andrew's widow.
• Noam Levy: Senior Correspondent at KFF Health News.
• Soojin Pak: Co-host of "Uncared For."

This episode underscores the critical intersection between healthcare and financial stability, urging listeners to recognize the far-reaching impacts of medical debt and advocating for meaningful change within the system.

Transcript

[Fumiko Chino]

Hey, it's Lena Waithe. Legacy Talk is my love letter to black storytellers, artists who've changed the game and paved the way for so many of us. This season. I'm sitting down with icons like Phylicia Rashad, Loretta Devine, Ava DuVernay and more. We're talking about their journeys, their creative process and the legacies they're building every single day. Come be a part of the conversation. Season two drops July 29th. Listen to Legacy Talk wherever you get your podcast or watch us on YouTube.

[Noam Levy]

A 15 year old girl who chewed through a rope to escape a serial killer. I used my front teeth to saw.

[Soojin Pak]

On the rope in my mouth.

[Noam Levy]

He's been convicted of murdering two young women, but suspected of many more.

[Fumiko Chino]

Maybe there's another one in that area.

[Noam Levy]

And now new leads that could solve these cold cases.

[Soojin Pak]

They could be a victim that we.

[Noam Levy]

Have no idea he killed. Stolen Voices of Dole Valley breaks the silence on August 19th. Follow us now so you don't miss an episode. Lemonada Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple podcasts for just 5.99. You'll get ad free episodes and exclusive bonus content from shows like this one, as well as Wiser Than Me with Julia Louis Dreyfus, Feature Fail Better with David Duchovny, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show feed on Apple Podcasts and hit subscribe Make Life Suck Less with fewer ads with Lemonada Premium.

[Fumiko Chino]

I met Andrew online. It was in the early 2000s. It's when meeting online was still a little maybe gauche. He was a computer science PhD and I was working as the art director of an entertainment company. And we met in our late 20s and started dating.

[Noam Levy]

That's Fumiko Chino. She was living in Houston, Texas when she met Andrew, who'd eventually become her husband.

[Fumiko Chino]

He's an odd duck, you know, really bad dancer, sort of a manic mind that had a lot of things juggling all at once. And just a brilliant guy. Yeah, we were, God, dare I say it, a cool couple.

[Noam Levy]

I think you could say that.

[Fumiko Chino]

Yeah, we went to a lot of art events, a lot of music shows. We had a very active social life. We were out and about and it was just fun. We were, I always say, young and stupid. Right? We were in love. And it all changed slowly. He started having problems eating, having Some episodic nausea, vomiting. He started having a lot of abdominal pain. He had lost 35 pounds in about six months. And so that's when they did a CT scan his abdomen and they found that he had cancer kind of throughout his pancreas.

[Noam Levy]

Andrew had a fast growing tumor that had spread throughout his body. He was diagnosed with neuroendocrine carcinoma, an aggressive cancer. FICO and Andrew knew the sickness would take a toll on their lives, but they had no idea about the financial burden the cancer would force on them. Andrew's sickness would lead to thousands of dollars of medical debt.

[Fumiko Chino]

It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further into the abyss.

[Noam Levy]

4 in 10 people in the US have medical debt. 4 in 10. It reaches all corners of the country. The young and old, the uninsured, and yes, the insured. To cope with the financial burden, Americans are making impossible sacrifices and decisions every what groceries to buy, where to live, what jobs to pursue, whether or not to drain their kids college savings. From Lemonada Media, this is uncared for. I'm your host, Sujin Pak. Welcome to season three. And this season, we're looking at the many ways people in the US are literally uncared for. In a country that seems more divided than ever, there's one thing almost everyone agrees on. We need health care that doesn't feel like a fight. So we're covering it all. From medical debt to insurance denials to rural hospital closures, there are so many ways our system is failing us. We're diving into the rage, the realness and the frustration we're all feeling in this moment. And we're not holding back. For a lot of us, medical debt isn't some abstract crisis. It's something we deal with every day. Avoiding bills, putting it on your credit card, or even crowdfunding. Whether you have a chronic illness, need an expensive treatment, or were laid off and got sick, debt is unfortunately our system's go to solution. We really wanted to get a sense of how big this problem actually is.

[Soojin Pak]

100 million people in the US have some form of healthcare debt. That's 41% of US adults. And I mean, if you think about that, I mean, it's sort of mind boggling.

[Noam Levy]

Noam Levy is a senior correspondent at KFF Health News. He's been covering healthcare for about 15 years and led the sweeping investigative series Diagnosis Debt.

[Soojin Pak]

You know, medical debt is not just sort of some byproduct that you know, is generated on the side along with you extra surgical waste and stuff you throw out in the er. This is core to what the US Healthcare system does.

[Noam Levy]

Yeah, this is the business.

[Soojin Pak]

Yeah. It systematically is driving people into debt, like at an industrial scale. And if you ask people if they've ever had any healthcare debt in the last five years, that number jumps up to 57% of U.S. adults. And so that's a majority of American adults have been in debt in some form in the last five years.

[Noam Levy]

The term medical debt can mean many things. Traditionally, it's been considered unpaid or past due bills from health care providers, like an unpaid hospital bill from an emergency room visit. Sometimes those bills are sent to collection agencies or debt collectors and may have ended up on your credit report. But Noem says medical debt encompasses a lot more than that.

[Soojin Pak]

It's the bill that, like, you get from the hospital and you put it on your credit card, and then you don't pay your credit card off for six months or a year. So you're in medical debt, even though that's maybe not measured traditionally as medical debt. Or maybe you go on a payment plan, you go to the hospital, you get a $5,000 bill, and the hospital says, can you pay this off over two years? Pay us $300 a month or something like that. And that might not get measured as medical debt either. But you're like, you're on an installment plan as if you're paying off an auto loan or maybe you've borrowed from friends or family, maybe it's your parents, maybe it's a sibling. And that's not recorded as medical debt technically. But like, think about the ways that that sort of changes people's family dynamics. You know, some of that debt is relatively small, a couple hundred dollars, but some of it is enormous. 5,000, $10,000. And we found that a lot of people say they don't think they're ever going to pay it off. They're going to, like, live with it forever.

[Noam Levy]

Noam says medical debt is upending people's lives. Debt and lack of affordability causes people to delay or avoid getting care, which makes them sicker. They're also making difficult sacrifices in so many other ways.

[Soojin Pak]

Maybe they have to drain their savings, maybe they have to take on extra work. Maybe they have to change their living situation, like downsize or move in with friends or family. One of the most chilling things was the two thirds said they had to cut back on food, clothing, or other essentials as a result of a medical bill. And you Stop and think about that for a second. But we hear a lot of talk right now about social determinants of health, how economically stable, how much stable housing you have, how well you eat is much more important to your health ultimately than kind of what the hospital or the medical system does to you. And yet here we have a health care system that's supposed to be taking care of people, that is making it literally more difficult for people to put food on the table.

[Fumiko Chino]

Yeah, it's.

[Noam Levy]

I mean, these are massive, massive. Like you said, industry size numbers. Who experiences medical debt? Right. Because I think the assumption is, if you haven't really thought about this, that it's people with major complicated health issues, maybe it's people without insurance. I want to know what the full picture is, and I want to know in the last 15 years if that's changed.

[Soojin Pak]

So I think historically the idea of who was going into debt because of medical bills was like this was someone who lacked health insurance, you know, who ends up in the ER with a car accident or they get diagnosed with cancer or something like that, and, you know, they end up in debt and maybe they declare bankruptcy. And I want to be clear that that's still happening. And we know that medical debt is more prevalent among people with lower incomes, people who lack health insurance. But, but, you know, since the passage of the Affordable Care Act, Obamacare 15 years ago, the number of people without health insurance in this country has fallen significantly. I mean, it may, that may change given what's happening right now in Washington. But we, we've seen some historic gains in health care coverage, but the medical, that problem hasn't gone away. And by some measures, it may even be getting worse. And now this is a problem of the insured.

[Noam Levy]

There's a long standing assumption that if you have health insurance in the United States, health care becomes affordable. But that's simply not the case anymore. Insurance plans have changed dramatically in the past couple of decades. For instance, many plans have extremely high deductibles.

[Soojin Pak]

If you get a health plan through your employer, or you have to go out and buy it for yourself or your family, you probably have a deductible. At this point, you have to pay $1000, $2000, maybe $5000 out of pocket before your health plan will kick in and start paying the bills. And for a lot of people, like a $5,000 deductible or even a $10,000 deductible for a family, I mean, that's devastating. And we know most people don't have a lot of savings that are readily accessible. So, you know, you don't need a Nobel prize in economics to understand that if, if you owe two or three thousand dollars on your health plan and you only have $500 in the bank, you're going to end up in medical debt.

[Noam Levy]

Noam says the best predictor of medical debt is whether or not you're sick, which may seem obvious, but when you really think about that, it's just so messed up.

[Soojin Pak]

We looked at medical debt's prevalence at the county level around the country. Like, which counties had the highest levels of medical debt? And what about that county best predicted whether or not there was going to be a lot of medical debt there? And it wasn't sort of how poor the county was. It wasn't whether or not there were a lot of people who lacked health insurance. It was whether or not there were a lot of people who had chronic illnesses like diabetes and heart disease. And so when you think about that, the kind of people who are going into debt are the kind of people who, like, if you have diabetes, you have prescriptions you gotta fill, you got tests that you have to do, you gotta see your doctor regularly. You're going to rack up medical bills. We are, as a healthcare system, as a country, layering medical debt onto people who are already dealing with serious medical conditions. And we know that this is not good for people's health. I mean, there is research that actually shows that people who have cancer who go into medical debt actually die more quickly than cancer patients who don't go into debt. It's crazy.

[Fumiko Chino]

Yeah, yeah.

[Noam Levy]

The stress will kill you, as some say before. Yeah, before the diagnosis. And if it doesn't kill, it often leaves a lot of people deeply changed. That's what happened to Fumiko Chino, who we heard at the top of the episode. The debt she and her husband experienced as 20 year olds changed the course.

[Fumiko Chino]

Of her life at a certain point. Just trying to keep your husband alive, I quit my job. I was no longer opening up bills. I was just like, you go in a pile. I've got other things to deal with.

[Noam Levy]

That's next after the break.

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[Noam Levy]

System is broken in so many ways.

[Soojin Pak]

We have a health care system that's supposed to be taking care of people that is making it literally more difficult for people to put food on the table.

[Noam Levy]

So this season we'll dive into the challenges headfirst while also thinking about how we can find a better way because we all deserve better. Uncared for Season 3 from Lemonada Media available August 6th wherever you get your podcasts hi there, it's Julia Louis Dreyfus. This fall my podcast Wiser Than Me is back for Season three with even more wisdom straight from some legendary old ladies. These chickadees have a lot to teach us. Every word is a lesson in living unapologetically and focusing on the stuff that really matters. From Lemonada Media Wiser Than Me Season 3 out now. Find it wherever you get your podcast. Subscribe to Lemonada Premium in the Apple Podcasts app and listen to every episode of Season three and ad free.

[Fumiko Chino]

My name is Fumiko Chino and I'm an oncologist at Memorial Sloan Kettering Cancer Center. Every day I use advanced technologies to treat and cure patients with cancer and I also do research on how to make healthcare more affordable.

[Noam Levy]

In July 2024, Fumico Chino testified before a Senate committee as Congress looked at what it could do to end the medical debt crisis.

[Fumiko Chino]

I come today to speak to you about the harms of medical debt as an expert in the field, but also as someone who has personal experience with the financial devastation on patients and families of a cancer diagnosis. On the day after his 27th birthday, my husband Andrew started having pain and throwing up. When he was finally diagnosed, we learned that he had fast growing tumor that had spread throughout his body like she.

[Noam Levy]

Experienced with her husband's cancer diagnosis. She says that many patients are forced to literally choose between their money and their lives. And she made that clear in her testimony.

[Fumiko Chino]

There are more people who are worried about the financial costs of a cancer diagnosis than from dying of cancer. And 40% of Americans have depleted their life savings within two years of a cancer diagnosis. Debt relief is needed now.

[Noam Levy]

Today, Famiko researches the effects of health care costs on a patient's quality of life and how to improve affordability. And her work as a radiation oncologist means she sees a lot of terminally ill patients deal with the stress of debt. How do you see this stress of medical debt show up in your patients?

[Fumiko Chino]

That stress, that anxiety, it's like downward pressure that makes all symptom burdens worse. And this is not just my opinion. Research backs this up. People who have financial difficulties with their care have worse physical functioning, they have less social functioning, they have worse sleep, they have worse pain. And some of it is because they can't afford their medications, right? They can't get the appropriate, like, supportive care medications. And some of it is just that. That additional burden, that mental burden, that extra weight that they're carrying is just one more thing, right? So many patients are worried about bankrupting their family beyond even their cancer diagnosis and potential death from cancer. Their larger worry is actually what is going to be carried forward for my kids, for my family, Are we going to lose our homes? Are we going to lose our cars? I had people who were spending, like, their kids saved college tuition, right? Like in the hopes that they would actually be alive for their kids to go to college. And it's just horrifying to think about how common this is. All data points to the fact that this problem is only getting worse.

[Noam Levy]

Even though more people have health insurance, the costs of high deductibles and co pays for medical care can still cause financial challenges. And keeping up with all the bills and understanding how your health insurance works can be extremely difficult.

[Fumiko Chino]

It's infuriating for me as someone who's gone through this and understands the burden of paperwork, of having to stay on top of all these things all at once in the midst of crisis, you can understand how some things could just be lost. It's the statement that you didn't open and then suddenly you're in debt that then compounds and you're just sinking further abyss.

[Noam Levy]

That feeling of sinking into the abyss. It's a familiar feeling. For Fumo, the spiral started when her husband Andrew was diagnosed with cancer. Do you remember what you were thinking or feeling when you found out that he was as sick as he was when he got the diagnosis?

[Fumiko Chino]

I remember when they said cancer that it was like a Charlie Brown story style interaction where you hear the word cancer and then everything else is just like a wah, wah, wah, wah. I had stopped listening. They said cancer and I was out.

[Noam Levy]

At the time, Fumika was an art director of an entertainment company and Andrew was a PhD student. They were in their late 20s, that stage of life where you're career building, figuring stuff out and supposed to be having fun. Instead, the couple was now dealing with Andrew's cancer, which seemed to be getting worse by the day. And Andrew's student health insurance had a lot of holes in its coverage, holes that would lead to Famico and Andrew picking up the tab for his prescriptions.

[Fumiko Chino]

For example, he was on an anti nausea medication. We were paying $35 a pill and there were times when I would give him the medication and then like 20 minutes later he would throw it up and I would be able to see the pill and I would just be.

[Noam Levy]

Like, that's $35, $35 for each anti nausea pill, $100 for a blood thinner shot. He needed twice a day. Andrew needed these medications and others to keep his pain somewhat managed and, and to treat infections, his blood clots.

[Fumiko Chino]

So those were the immediate expenses. And so just trying to, you know, I cashed out my 401k, we borrowed money from family, that sort of thing. We would just get these just incredibly high bills and they just kept coming in the mail.

[Noam Levy]

Earlier on in his cancer diagnosis, Andrew was responding to the cancer treatment, but at some point he stopped responding to it. Famico says he just started wearing out.

[Fumiko Chino]

At a certain point you're just trying to keep your husband alive. He was having increasing nausea as the treatments kind of stopped working. He was in like the emergency room, he was in the hospital. He would get infections and just in the life sustaining function for me, I quit my job. I was no longer opening up bills. I was just like, you go in a pile. I've got other things to deal with. My husband's now on oxygen. He's just weaker. He had complications on complications. And then of course, maybe naively, we were still trying to have a wedding.

[Noam Levy]

Famiko and Andrew were already engaged when they first learned of the cancer. Their original wedding date had been set for about a year out. As Andrew got sicker though, they moved that date up and got married in Fumiko's parents living room. It was just Andrew and Fumiko and her parents.

[Fumiko Chino]

But I still wanted to gather our friends and families and have a formal wedding. And so we were still trying to do that. I think maybe intrinsically, I knew how important it was to have this celebratory event, to have all of his friends and family and my friends and family together because it was so serious and critical.

[Noam Levy]

Yeah.

[Fumiko Chino]

I remember buying all of these Christmas lights on super sale for like 75% off from target because we were like, okay, the Christmas lights are gonna be our decoration. When we were shopping for a suit for him. Cause he had lost so much weight, he needed a new suit. He had lost 65 pounds on, you know, a guy who's over 6 foot. So he was just real thin. And I knew that I didn't want to put him in a black suit because that would be, I think, too, I guess, scary. So he was in like this like, linen suit that was like light colored. He looked, you know, pretty good.

[Noam Levy]

At this point, Fumiko had quit her job and was caregiving for Andrew full time. He was vomiting all the time, losing weight, and she was working so hard to get calories in him.

[Fumiko Chino]

He.

[Noam Levy]

She knew the bills were piling up, but her focus was trying to keep him alive. So she set those huge medical bills aside. As those numbers and as that paperwork is building up, are you thinking about, at some point we're going to have to deal with this? And I don't even know what that looks like.

[Fumiko Chino]

Yeah, it was very much like a wave where you just, you know, like the first wave comes and you're like, okay, I can deal with this. I can stand steady. But then a larger wave comes and you're starting to lose your footing, and then eventually you just get swept out to sea. Right. And we were both just ashamed of the fact that we couldn't pay his bills. And it was something that we were trying to hide from my friends and my family members. I think they understood that I was out of work and he, you know, was a graduate student. So, you know, money was tight. But even then, I don't think they quite maybe understood or I shared with them like, that these bills were coming in hot and hard and, you know, and just like really terrifying. Even like a hospitalization bill. Like, you know, he was in the hospital for a week for pneumonia. It was tens of thousands of dollars.

[Noam Levy]

I have to imagine then that every time you drive to the pharmacy or like you said, he's like, I have to go to the hospital. I'm not feeling well. I mean, at that point, you're already racking up the bill in your brain before you even get there. That level of stress, frankly, I don't even know what's more stressful that or dealing with a health crisis on a day to day basis.

[Fumiko Chino]

It's not even just the pharmacy is the parking in the hospital. You know, we were paying $15 a day to just park for him to get infused with, you know, toxic chemicals that would hopefully kill more cancer than kill him. Right. So having to balance, you know, something stupid like the cost of parking with also, you know, rent and trying to make sure that we're getting his medications and figuring out, like, what's the balance here of what we can afford.

[Noam Levy]

They also never told Andrew's providers and doctors that they couldn't pay the bills. They were afraid of Andrew getting cut off from care. Fumico says it was like a black cloud hanging over them at all times.

[Fumiko Chino]

It's a very common sentiment for people who are facing large bills or unaffordable treatment is that they want to keep it from their providers because they are afraid of their providers cutting off the spigot and saying, well, you're done here. You're nothing but bad debt. You have not made any payments. And that was our main concern, is that at one point his cancer center was going to stop, that we would just stop being able to get care.

[Noam Levy]

Andrew was not going to let that happen, though even with his serious illness, he managed to get a job, one with good health insurance.

[Fumiko Chino]

Because my husband was a very brilliant person and because he did work his hardest to defend his thesis, in between being hospitalized for cancer and in between, I think, his second and third line of chemotherapy, he interviewed for positions and secured a faculty position. And so we moved to the Ann Arbor area.

[Noam Levy]

Leaving Texas meant disconnecting from their friends and support network. But Fumico says they literally had no other choice. So they moved to Michigan. His new faculty job came with much better health insurance.

[Fumiko Chino]

We moved there. He was immediately hospitalized, like basically the night we arrived.

[Noam Levy]

Wow.

[Fumiko Chino]

He never got to move into his office. He never got to actually work. He died March 4, 2007. He was 28. I was 29.

[Noam Levy]

Famico's life was turned upside down. She lost all purpose and she had no good friends near her, no support.

[Fumiko Chino]

It was just the trauma of him dying and then me being alone in a place that I did not know anyone, had no support structure and was really just all alone.

[Noam Levy]

Yeah, I'm just Thinking about all of the day to day, but also huge sacrifices. People make the impossible choices that people have to make to just live or to just die.

[Fumiko Chino]

It's this false dichotomy. It's your money or your life. But he. He lost both. Yeah, Right. So no amount of money would have kept him alive. I know that, but even if you had asked me when he was in the icu, would you pay a million dollars to keep him alive for another five minutes?

[Noam Levy]

Take it.

[Fumiko Chino]

I would have done it.

[Noam Levy]

Anybody would have. Anybody would have. So you're there alone. At what point did you realize you had to deal with this pile of paper?

[Fumiko Chino]

By the time he died, we were actually already in collections. And I knew it was a problem when I started getting phone calls, because obviously Andrew's phone wasn't active, but mine was, and I was his next of kin. And so I started getting letters in the mail and phone calls. I even got a phone call from a debt collector when I was at my husband's funeral. And so that's when I kind of knew that this would be an issue.

[Noam Levy]

Famika was being hounded by debt collectors while she was newly grieving her husband's death. She was 29 and a widow.

[Fumiko Chino]

I was barely able to keep myself alive in this time period. My sister had to move in with me because I was really not getting out of bed or really eating. And so, again, immediate pressing concerns is just survival. Right. And dealing with profound grief. At a certain point, I was, like, just ostrich ing it. I guess I was just kind of sticking my head in the ground and being like, you know what? One foot in front of the other. This is the only thing I can deal with right now, which is getting out of the house, seeing the sunlight, you know, doing something that's other than just grieving. That's, you know, sort of in that time period where I was like, okay, I need to do something with my life. I can't go back to what I was doing before. As an art director.

[Noam Levy]

Fumiko wanted to reinvent herself and found a powerful message in Andrew's death date.

[Fumiko Chino]

March 4th is the only date that's also a command.

[Noam Levy]

March 4th. To move forward with determination and purpose.

[Fumiko Chino]

I don't know when I realized that that was a message for me to reinvigorate my life. But at some point, it was like, kind of my banner call.

[Noam Levy]

After the break, we'll hear how Fumiko is helping cancer patients back at the very same time place Andrew was treated.

[Soojin Pak]

I'm Hasan Minhaj. And I have been lying to you. I only pretended to be a comedian so I could trick important people into coming on my podcast. Hasan Minhaj doesn't know to ask them the tough questions that real journalists are way too afraid to ask. People like Senator Elizabeth Warren. Is America too dumb for democracy?

[Noam Levy]

Outrageous.

[Soojin Pak]

Parenting expert Dr. Becky. How do you skip consequences without raising a psychopath?

[Noam Levy]

It's a good question.

[Soojin Pak]

Listen to Hasan Minhaj doesn't know from Lemonada Media. Wherever you get your podcasts, do you.

[Noam Levy]

Ever catch yourself wondering, who am I without my job? Can we be friends if we disagree politically? Am I a bad daughter? If you're nodding along, you'll love our brand new podcast, I Feel that Way Too, where we explore life's trickiest question through personal stories and inspiring interviews. In a world that insists on isolation, let's practice courage, healing, and hope together. Listen to I Feel that Way Too. Wherever you get your podcasts. To famico. Her and Andrew's experience revealed the gaping holes in the US Healthcare machine, a system she says is seemingly designed to put profits over people. She wanted to use her valuable lived experience for good.

[Fumiko Chino]

So that's when I sort of thought, okay, I need to go into medicine. Since I do have doctors in my family, they were like, you know, you should just go to medical school. And so that's when I started on that path to kind of think about how it would be like to actually try to join the other side, to try to just fix the system from inside.

[Noam Levy]

Wow. I mean, you've lived eight lives, you know, but before you're 30, you know what I mean? It's just like it keeps unfolding. You said you wanted to fix the system from within, and you go to med school. How old are you when you enroll into med school? You know, give me the details.

[Fumiko Chino]

I had the privilege of being able to start again. And then I had his life insurance money that actually kept me alive, paid my rent while I was trying to figure out how to, you know, dig myself out of this grief hole. His life insurance money also facilitated me going to medical school. It paid for medical school. And so I literally, you know, was trying to sell spin gold out of this straw, right, of how do I reinvent myself with purpose, Right? How do I think about turning some of this grief into action?

[Noam Levy]

Fumika went to Duke University School of Medicine, and as we talked about earlier, she's now a radiation oncologist.

[Fumiko Chino]

I'm part of curative treatment for breast cancer, but also part of palliative treatment, meaning trying to help with pain or bleeding for have metastatic disease.

[Noam Levy]

About a year ago, Fumo switched workplaces from Memorial Sloan Kettering in New York City to the MD Anderson Cancer center in Houston, the very place Andrew had received his cancer treatment.

[Fumiko Chino]

I work in the hospital where my husband was treated for cancer.

[Noam Levy]

I suppose at first getting there must have been bizarre. Stepping through those doors, there was a.

[Fumiko Chino]

Little bit of ptsd. Yeah.

[Noam Levy]

Fumiko has memories of hearing bad news in the waiting room, waiting for lab draws, constantly looking for a place for Andrew to throw up. Those feelings sometimes bubble up when she's not expecting it.

[Fumiko Chino]

I walked over from my office in my clinic to the hospital to visit a patient who was admitted, and I suddenly got such deja vu, ptsd. I had to sit down. Right. Because I had been in that hallway, but not in a good way, not as part of my job, but as someone who was just terrified that they were going to lose their husband. And I do still have those moments. But then I realized what a privilege it is for me to be able to be here, to be providing the superlative care that I know we can provide here, that we do every single day, and trying to, again, work within the system to say, what are the financial friction points for patients and how do we smooth them down? I'm never going to find the cure for cancer in my research, but what I can do is potentially find ways that more people can be cured of their cancer or for the ones who can't be cured, that they just have less suffering.

[Noam Levy]

Yeah. Cure or not, that's life changing.

[Fumiko Chino]

You know, even if I can help 1% of people, I feel like it's worth it.

[Noam Levy]

It's completely worth it. Famiko ended up transforming her life after Andrew's death, all to make the process even just a little bit better for others. She's using her lived experience, her insider perspective, to make a difference. Still, while we have people like Fumiko working to change the the system, our medical debt problem keeps growing. That's because it's not just the debt that we need to look at. It's the ripple effects of that debt. Here's Noam Levy from KFF Health News.

[Soojin Pak]

Again, many of these stories of people that we've interviewed over the years, these are people who have been responsible in their lives, and through no fault of their own, they're ended up in this incredibly financially precarious position. So if you think about that, think, like, if you get a big medical bill, you can't pay it. It gets reported to the credit Bureau. And there it is sitting on your credit score, dragging you down. And all of a sudden, because of this medical bill, you have a harder time renting an apartment or getting a mortgage, you have a harder time getting a car loan or you have to pay more, you have a harder time getting a job. And if you can't get a job or you can't get a, a decent place to live, that's going to impact your health. And maybe you're going to sort of end up with even more medical bills. And it becomes this sort of vicious circle where again, something that started that originated in a system, the healthcare system that's supposed to be taking care of you and is supposed to making you better, has set in motion this sort of cascade of events, of economic impact on your life that's actually not only making you sicker, but it's sort of preventing you from advancing economically.

[Noam Levy]

I mean, and when you speak of it in that way, and the domino effect it has on our health, on our finances, on our ability to climb up that financial ladder, that can't not have a cultural impact on us as a whole.

[Soojin Pak]

It's eroding people's trust in the medical system. And I think that's really dangerous. And the healthcare system traditionally has sort of maintained a pretty high level of trust. You know, people still trust their doctors and their nurses, but when you start kind of talking to people about their experiences getting these bills, trying to deal with hospitals, or in the worst cases, getting sued by hospitals or other medical providers because they can't pay their bills, people start thinking differently about the health care system. And you know, I would argue, like, particularly in our unsettled times, the last thing we need is for another important sort of pillar of our society to be sort of torn asunder because people no longer have faith in it.

[Noam Levy]

In January, the Biden administration finalized a rule that would have banned medical debt on credit reports, meaning lenders couldn't consider person's medical debt when deciding whether or not to give them a loan. The rule was set to go into effect in March, but in July, a federal judge reversed the rule, which means medical debt can remain on credit reports. Some states have implemented protection for people in medical debt. For instance, some already prohibit medical debt from being put on credit reports. Other states, as well as county and local level governments have pursued buying and forgiving medical debt. Like New Jersey, the state appropriations appropriated funds to cancel about a billion dollars in medical debt for its residents. But most of these protections aren't getting to the root of the issue.

[Soojin Pak]

Now, ultimately we're only going to solve this medical debt problem if we change the way health insurance is structured. And that doesn't mean like Medicare for all, it just means some restrictions on what people have to pay out of pocket. We should start by talking about protecting patients financially. And from that will come a lot of other discussions about, well, okay, what do we have to do to make sure that the costs don't bubble up somewhere else? Do we need to cap how much insurance companies can charge? Do we need to cap how much hospitals can charge? And I would argue we should be having these discussions.

[Noam Levy]

Obviously, these long term solutions, you know, they're not here. And in fact, in this current administration, arguably they're being rolled back. Are there though, smaller things people can do to avoid health care debt?

[Soojin Pak]

Don't put big medical bills on your credit card because if you do, you are not protected the same way you are with a medical bill. And a lot of states have banned medical bills from being put on your credit score. But if you've put that bill on your credit card, then it's a credit card bill and you're, you're in trouble.

[Noam Levy]

Right?

[Soojin Pak]

So try to avoid doing that. And you know, health insurance is a tough, tough landscape to navigate. It is really hard to choose the right health plan. But I, I would say if you have a choice and it's possible to avoid a big deductible, and if you can tolerate a little bit higher premium for more financial protection, that's good to do.

[Noam Levy]

Is there anything else about the medical debt crisis from your point of view that you wish more people understood?

[Soojin Pak]

You know, I think a lot of people are reluctant to talk publicly about their medical debt experiences because there's a lot of shame associated with it. Maybe they don't want people to think that they're looking for charity or looking for a handout. And as we've talked about throughout our conversation, it's everywhere. Like, you know, chances are you know somebody, if you don't have medical debt yourself, you probably know somebody who does. And I think removing the stigma a little bit so that we can talk about this more openly and kind of recognize the harm that it's doing. Hopefully we'll get, get elected officials in this country and the healthcare system to sort of confront it a little bit more directly. And it's only by people stepping forward and sharing their stories and feeling okay about it. There's nothing to be ashamed about with medical debt. You know, you didn't buy a gold ring, you shouldn't have bought you got sick and hopefully people will feel they can speak up because you know, we shouldn't tolerate this.

[Noam Levy]

Noam is right. We collectively as a country shouldn't tolerate this. And though there is often a lot of shame associated with medical debt, it doesn't have to be that way because we're all dealing with the consequences of it. Big changes like putting patient care over profits, improving health insurance coverage, and reining in the high price of medical care would help ease our medical medical debt crisis. But in the meantime, here are a few things you can do on a personal level if you're struggling with big medical bills, Check if your hospital or provider has a financial assistance program. Reach out to a patient, financial service officer or a social worker. If you qualify, you may be able to access free or sliding scale payment help with a plane ticket or gas. If you have have to travel or figure out payment plan options, you could be eligible. Even if you don't think you are, the website Dollarfor.org is a great resource for navigating a hospital's financial assistance program. That's DollarFor.org check your medical bills to make sure you're not being overcharged. It's always okay to ask providers what something is going to cost and to explain bills in plain language. And this isn't fun. But it is helpful to become familiar with your health insurance plan about what it pays for and what it doesn't, who's in network and who isn't. And then if and when you have the option to change plans to something that better fits your medical needs. There's more in cared for with Lemonada Premium. If you haven't subscribed to Lemonada Premium yet, now's the perfect time because guess what? You can listen completely ad free. Plus you'll unlock exclusive bonus content like tips from health experts and caregivers that you won't hear anywhere else. Subscribe now on Apple Podcasts or head to lemonadepremium.com to subscribe on any other app or listen ad free on Amazon Music with your prime membership. That's lemonadapremium.com Uncared for is a production of Lemonada Media. I'm your host Soojin Pak Muna Danish is our senior producer. Lisa Fu and Hannah Boomershein are our producers. Our mix is by Ivan Kurayev. Music is by Andrea Christensdotter. Jackie Danziger is our VP of Partnerships and production executive. Producers are Jessica Cordova Kramer and Stephanie Whittles. Wax this Season season of Uncared for is presented by the Commonwealth Fund a nonprofit foundation working toward a healthcare system where everyone, no matter who they are, where they live, or how much money they make, can get the health care they need. Help others find our show by leaving us a rating and writing a review. You can follow me on Instagram at SooJinPak and LemonAdaeMonadaMedia across all social platforms. Thanks so much for listening. See you next week. It's easy to feel helpless these days. So take a break from the bad news and hear from people who are doing good things to address big problems.

[Fumiko Chino]

We care about abortion access. We care about slowing down, reversing climate change. That's the approach we need to these long term systemic problems. We need the fixers.

[Noam Levy]

Feel empowered to take action. Listen to good things from lemonada Media. Available wherever you get your podcasts. Hi, I'm Erica Mahoney.

[Lena Waithe]

You don't know me, but you know.

[Noam Levy]

A version of my story. Because by now we've all felt the impact of senseless gun violence.

[Soojin Pak]

I think a stray bullet flew past me because I hear the it was.

[Fumiko Chino]

That horrible feeling of dread, something's wrong.

[Noam Levy]

Four years ago, my dad was killed in a mass shooting. My podcast, Senseless is about moving forward after the unthinkable senseless from Lemonada Media premiering June 17th.