Being Nickeled & Dimed...

Summary

Armstrong & Getty On Demand

Episode: Being Nickeled & Dimed...

Date: November 10, 2025
Host: iHeartPodcasts

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Overview

This episode dives into the frustrating experience of being “nickeled and dimed,” particularly within the American healthcare system. Drawing from personal anecdotes and a recent essay by Matthew Hennessy, Armstrong and Getty lament the opaque, arbitrary, and excessive charges patients face, highlighting how jargon-filled explanations and lack of transparency turn everyday people against the system. The conversation blends personal stories, humor, and pointed commentary on the dysfunctions of American healthcare and consumer experiences.

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Key Discussion Points & Insights

The “67 Incident” – Humor in Everyday Annoyances

• [01:41 – 02:56]
  • Armstrong and Getty joke about “incidents” that annoyed Armstrong over the weekend, joking about the prevalence of the number 67 in his life and relating it to being “nickeled and dimed.”
  • Light-hearted riff: confusion over numbers at a restaurant, playfully exaggerated with “how much did you have to pay for that?” to poke fun at extra, unexplained charges in daily life.
  • Memorable quote:
    • Armstrong: “Remember when 67 used to be 67 and it was just a number? I do remember. Those were good times. Yeah.” [02:43]

The World Will Always Irritate You – Source of Commentary

• [03:59 – 04:46]
  • Getty shares a story from Matthew Hennessy, referencing an old tale where William F. Buckley Jr. tells George Will, “The world irritates me three times a week, which is plenty.”
    • Insight: Annoyances are an endless source of commentary.
  • Shifts to discussion about understanding the cost of everyday things: “If I asked you to tell me how much an MRI costs ... even if you’d had one three days ago, you wouldn’t have any idea?”

The Absurdity and Opacity of Healthcare Billing

• [04:46 – 12:47]
  • Getty reads from Matthew Hennessy’s essay about the high and mysterious charges related to his mother-in-law’s routine medical visit:
    • $150 “facility fee” and $40 “evaluation and management add on” for a simple checkup.
    • The response from the clinic is filled with jargon (“blithering piffle”) that neither host nor listeners can decipher.
    • Notable quote:
      • Armstrong: “Why’d you charge me that? Because I can. Because I wanted to. That’s what that means.” [07:33]
    • Getty mocks the convoluted official explanation, poking fun at its complexity and lack of clarity.
    • The hosts connect this experience to the universally frustrating, almost comical lack of transparency in medical billing.

Personal Anecdotes: The Shocking Cost of Healthcare Basics

• Armstrong describes a friend’s experience (having no insurance during childbirth) and discovering the absurd price tags for hospital items:
  • $20 per apple juice, $80 for a newborn’s cap.
  • Memorable quote:
    • Armstrong: “That little cap they put on the baby’s head was $80.” [10:49]
    • “If you knew it was $80 and you were paying for it, you’d bring your own... you’d have all those there with you if you were actually paying for it.” [10:54]

Why Can’t We Shop for Healthcare?

• The hosts lament, “If your dry cleaner treated you this way… you’d take your business elsewhere. Instantly!” [11:33]
• Contrast with health care, where customers have no power: “Nothing but buck passing middlemen in league with penny pinching hospital executives…” [11:33]
• The system is rigged for confusion, making the customer powerless and angry.

Government Solutions: Worse or Better?

• Armstrong: “If you think the government taking it over would make it better, you’re nuts.” [12:05]
• Getty jokes that government control would turn an $80 little hat into an $800 one, just paid invisibly through taxes.
• Insight: Both agree that further government intervention is unlikely to solve the underlying problems and may even exacerbate them.

The Emotional Toll and Upselling in Medicine

• Getty: “Getting treated like an idiot is something else. Getting exposed to jargon and deflection turns ordinary people into radicals.” [12:19]
• Armstrong, a diabetic, discusses constant upselling of drugs: “Oh yeah, and I can exercise it off… or you could take this pill… constantly doing that to me.” [13:13]
• Getty sums up: “Yeah, you’re a hot prospect.” [13:23]

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Notable Quotes & Timestamps

• “Remember when 67 used to be 67 and it was just a number? I do remember. Those were good times. Yeah.”
  — Armstrong & Getty [02:43]
• “If I asked you to tell me how much an MRI costs… even if you’d had one three days ago, you wouldn’t have any idea?”
  — Getty [04:46]
• “Why’d you charge me that? Because I can. Because I wanted to. That’s what that means.”
  — Armstrong [07:33]
• “Oh, sounds like Kamala Harris wrote that. Yeah… if she knew more big words.”
  — Armstrong & Getty satirizing medical jargon [08:01]
• “That little cap they put on the baby’s head was $80… If you knew it was $80 and you were paying for it, you’d bring your own…”
  — Armstrong [10:49–10:54]
• “If you think the government taking it over would make it better, you’re nuts.”
  — Armstrong [12:05]
• “Getting treated like an idiot is something else. Getting exposed to jargon and deflection turns ordinary people into radicals.”
  — Getty [12:19]

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Structure & Tone

The tone is humorous, exasperated, and conversational, mixing personal stories, readings from an op-ed, and wry observational humor. The absurdity and frustration of the modern consumer (especially patient) experience is at center stage.

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Segment Timestamps

| Timestamp | Segment Description | |-----------|----------------------------------------------------------------| | 01:41 | Armstrong's "67 incidents" anecdote | | 03:59 | Story of Buckley & Will—irritation as fuel for commentary | | 04:46 | Introduction of Hennessy essay – medical billing frustrations | | 07:33 | Armstrong decodes “evaluation & management add on” charge | | 10:49 | Hospital item pricing horror stories | | 11:33 | Comparison to other businesses & lack of healthcare options | | 12:05 | Debate on government involvement in healthcare | | 12:19 | Final reflections & the emotional toll | | 13:13 | Armstrong’s experience with medical upselling |

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Conclusion

If you’ve ever felt frustrated, bewildered, or outright angered by mysterious surcharges—especially in healthcare—this episode will have you nodding along, laughing, and possibly clenching your fists. The hosts’ blend of real-life anecdotes, incisive reading, and lively banter makes for a sharp critique of a system that seems designed to keep the customer confused, annoyed, and perpetually “nickeled and dimed.”

Transcript

[Armstrong]

This is an iHeart podcast.

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[Getty]

Being nickeled and dimed. We need to adjust that for inflation. It's one more thing.

[Armstrong]

Armstrong and Getty.

[Getty]

One more thing before we get to.

[Armstrong]

That had two, six, seven incidents occur to me. Occur.

[Getty]

Occur.

[Armstrong]

Can I try this again?

[Getty]

At me. For me, beyond me.

[Armstrong]

Two, six, seven incidents occur in my life over the weekends. One I was emceeing an event Saturday night and I made a 6, 7 joke in which probably 3/4 of the room laughed and 1/4 looked around like what is he talking about? Which I thought was interesting. And then we're at a Mexican restaurant and you know you how in a restaurant sometimes they give you a little the little thing with a number on it so they know what number you are to bring your food out to your table. Our number was 67.

[Getty]

And I said siete incident.

[Armstrong]

I said whoa, dude, I don't have to pay extra for this. And he said what do you mean? Is there a problem with that? I said six, seven. He said huh, good for him, right? And he was like mid-30s.

[Getty]

He has a job exactly I mentioned.

[Armstrong]

To a few other people like oh, how much did you have to pay for that? I don't know. Remember when 67 used to be 67 and it was just a number? I do remember. Those were good times. Yeah.

[Getty]

Good times. Yeah. Yeah.

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[Getty]

So I love how this starts out. I'll bet everybody can relate to this. By Matthew Hennessy A young George Will once asked William F. Buckley Jr. How do you come up with things to write about? And Buckley said to the young George Will, it's easy. The world irritates me three times a week, which is plenty, and that's the start of many columns. And he explains why he's irritating in this case. But if I asked you, as a carpenter or somebody who does a fair amount of home improvement work, how much a hammer costs, you could tell me roughly, or how much a, I don't know, microwave, good microwave oven costs. If I asked you to tell me how much an MRI costs?

[Armstrong]

No idea.

[Getty]

Even if you'd had one three days ago, you wouldn't have any idea?

[Armstrong]

Nope.

[Getty]

Which is part of the reason our medical system is just so incredibly screwed up. I want to drag Craig the health care guru back on the air to talk to him about that. But anyway, this Matthew Hennessy is writing about it was not long ago. His mother in law has been ill for a while. She's lived in a nursing home in a rural part of the Northeast. Okay, just set the scene. Long term care for memory loss, other chronic issues, and the nursing home staff, he says, are generally competent and responsive. A lot of turnover, which is one of the tough parts of those Homes. But anyway, as part of the care, a member of the nursing home staff takes her to regular appointments at the clinic of a large medical center about 30 miles away. The clinic and medical center are affiliated with a prestigious nearby university, which he doesn't name. He says you'd recognize the name. I'm being vague because I'm not trying to get anyone in trouble. My irritation is with the whole system's attitude. Not any one person's. So famous medical center, famous university. So mom in law gets taken to her annual checkup. No particular problems, no medications needed, just it was on the schedule. So they went. In the health care and insurance lingo we've all been forced to learn and use recent years, this was a well visit routine. Well visits are typically covered, even encouraged by insurance providers at no cost to the patient. Medicare in this case, covered mom in law. When the bill for the visit came, my wife, who is mom's legal guardian, noticed two unfamiliar charges. One was $150 facility fee. The other for $40, was itemized as the evaluation and management add on. The E M add on. So just under $200 tacked onto a bill for a well visit. And his wife, to her credit, said, wait a minute, what is this? And she wrote a polite note to the clinic inquiring as to the nature and purpose of the charges. Its reply is what irritated me. He writes, the evaluation and management, or EM add on is used to account for the complexity of EM services that serve as the continuing focal point for all needed healthcare services or with medical care services that are part of ongoing care related to a patient's s single serious condition or a complex condition. Everybody has expensive headphones on here in the radio ranch. Can anybody tell me what the flaming fuck that means?

[Armstrong]

Yeah, means no. Why'd you charge me that? Because I can. Because I wanted to. That's what that means.

[Getty]

I am going to. I'm going to read that one more time. The evaluation and management add on is used to account for the complexity of EM services that serve as the continuing focus focal point for all needed health care services or with medical care services that are part of ongoing care related to a patient's single serious condition or a complex condition.

[Armstrong]

Oh, sounds like Kamala Harris wrote that. Yeah.

[Getty]

Yeah. If she knew more big words. Yeah, but so Matthew points out, I work with words for a living, so I'm hardwired to untangle sentences like this. My brain immediately begins breaking down the parts and reassembling them in a way that a person moderately familiar with the English language might find decipherable. I defy you to tell me what this blithering piffle actually means. Naturally, there was more piffle. And it too blithered, and I quote, the complexity captured by the evaluation and management add on is not in the clinical condition itself, but in the cognitive load and the continued responsibility of being the focal point for all needed services for the patient. It emphasizes the importance of the longitudinal relationship between the practitioner and the patient in the diagnosis and treatment plan.

[Armstrong]

I'm surprised they went to the effort they did to write some gobbledygook, because usually, you know, if you get a charge on anything and you ask what it is, it's just. It's just a formality. It's just. It's routine. Let's say something like that. And you get, what are you gonna do? What are you gonna fight it? You can not pay it. What are you gonna do?

[Getty]

All right, as he says. So the well visit, which produced no changes in care, no. No diagnoses, no new prescriptions, it cost an extra 200 because. Well, just because.

[Armstrong]

I thought you're gonna go this direction because I. Katie, you've got insurance, so you're gonna have a baby and God willing. And then, you know, it'll all just go, and it'll just be a bill. You'll get a bill and you'll pay it, and you won't really look at the why, because that's the way we all do with medical bills. But I had a friend who is first kid was born, he didn't have any health insurance. And so he got an itemized list of everything and what it cost and was really paying attention. And in advance or after the fact? After the fact.

[Getty]

Okay.

[Armstrong]

And. And several of the examples that stood out, for instance, because I had at this point, it had been like really recently that we had been there and Sam had been born. And like, when they would come in and say to, you know, mom, who's just had a baby and is all worn out and everything like that, are you thirsty? Can you. Anything and, you know, like apple juice? Would that sound good or anything like that? Yeah, I'd like an apple juice. It was like $20 a piece each one of those. That's not just a. You look thirsty. Can I help you out? No, it's a. It's. It's. It's an upsell.

[Getty]

And I remember often they'll say to dad, can we get you on too?

[Armstrong]

Right. Sure. Yeah, that'd be good. That'd be.

[Getty]

Thank you. You're thinking, hey, this is a good hospital. They really take care of their patients.

[Armstrong]

Like being in a nice hotel. And then the one that stood out the most was the little hat that they put on your kid. It's a little, like a little beanie and it's tiny because Your kid is 3 grams. It weighs nothing. It's a nothing. They have a pink one and a blue one depending on the sex of your baby. Back in the day when we believed in those sorts of things. Yeah.

[Podcast Advertiser 1]

When we were assigning gender.

[Armstrong]

And that little cap, that little cap they put on the baby's head was $80.

[Podcast Advertiser 1]

Oh, what?

[Armstrong]

Yeah. Anyhow. And you just, you either keep it in a drawer as a keepsake and then forget it or throw it away or do whatever you do. If you knew it was $80 and you were paying for it, you'd bring your own. I mean, everybody would everybody, everybody pack a little kit to go to the hospital if they knew it was going to be $20 of juice and $80 for the hat, you'd go to Target and buy the little thing for eight bucks and you'd bring a case of juice that cost $20 and you'd have all those there with you if you were actually paying for it. Well, you are actually paying for it. Big picture. Because it all goes through insurance and this and that and gets spread out through the system and blah, blah, blah. But it's unbelievable. The whole system is a mess.

[Getty]

Oh, yeah. Well, back to the mystery charge. Matt asks, imagine if your dry cleaner treated you this way. How quickly would you take your business to the competitor across the street? Instantly, obviously. Well, as we all know, health care and insurance don't operate like normal businesses. Nothing but buck passing middlemen in league with penny pinching hospital executives. When there's trouble, they all point the finger at big government, which points it right back at them. Health care is ironically, a diseased sector of our economy where the prices are intentionally obscured and the customer.

[Armstrong]

Right. And if you think the government taking it over would make it better, you're nuts.

[Getty]

Oh yeah.

[Armstrong]

$80 little hat would become an $800 little hat. Except there wouldn't even be any paperwork to, to nail that down.

[Getty]

No, it'd just be siphoned out of the tax revenue. Getting nickeled and dimed is one thing, he says. Getting treated like an idiot is something else. Getting exposed to jargon, jargon and deflection turns ordinary people into radicals. American health care is complex, I know, but everyone involved, from politicians and policymakers to hospital administrators, insurance companies, physicians and nursing home staff should understand that ordinary people all across this country have had just about enough.

[Armstrong]

Yeah, I agree. I just think that the only political momentum will be for letting the government take it over then.

[Getty]

Yeah, I think you're 100% right. Then I'll have to be treated for chronic anger with a bunch of mystery charges that you poor suckers will pay for for. You're talking about upselling. As a diabetic. They are trying to sell me drugs constantly, I'll bet. Oh, really?

[Armstrong]

Oh, yeah.

[Getty]

And I. I can exercise it off, you know, the blood sugar to get it down. Or you could take this pill and.

[Armstrong]

You know, constantly doing that to me. I'm sure.

[Getty]

Yeah, you're a hot prospect.

[Armstrong]

Yeah, no kidding. Yeah.

[Getty]

Well, I guess that's it. This is an I Heart podcast.