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Andy Schoonover
Stay out of the hospital at all costs unless you absolutely have to.
Alex Clark
The average American thinks that because they have health insurance, they're going to be safe and taken care of in a true emergency. I was just in a devastating car accident. I have to be rushed to the hospital right now.
Andy Schoonover
We have been, I think, kind of psyoped to think that health insurance plans will step up in the event of a very large bill. And what we are finding is that that's not actually the case. They are not incentivized to pay your bills. They're actually incentivized to deny your bills.
Alex Clark
You know by now that health insurance in America is deeply broken, corrupt even. I talked about it in my Brigham Bueller episode of this year. But you're scared to ditch it because of the what ifs. What if my child falls at the playground and breaks a leg, I get a cancer diagnosis or my husband is in a life threatening car accident. We can't afford hundreds of thousands or even millions of medical bills. I get it. Today's episode though, is going to give you the knowledge and, and most importantly, the courage to do just that and explain how. I'm talking to Andy Schoonover, founder of Crowd Health. Not an insurance company, but a platform and community that empowers you with a crowdfunding tool and a wealth of resources to efficiently manage your healthcare costs. Crowd Health isn't a sponsor of the show, at least not at this point in time. And I just love what this Christian company is doing and I think it's one of the best options out there for those of us that would rather have extra money to spend on functional medical doctors or, or chiropractors or organic food instead of insurance premiums. Watch this episode on Culture Apothecary on Spotify or real Alex Clark on YouTube. Leave a five star review right now before we start. If you never have before, it really helps us become more discoverable on the podcast apps. Please welcome Andy Schoonover, founder of Crowd Health to Culture Apothecary. Why is healthcare broken in America?
Andy Schoonover
Yeah, it's a question that everybody asks and everybody thinks that they're like they're mind blown by how complex healthcare is. And I tell people it's actually really simple. You've got the buyers of healthcare who are these big health insurance plans that people don't understand this but they actually want the price of healthcare to go up. They make more money when the price of healthcare goes up. And the sellers of healthcare, which are these big hospital systems, they want the prices to go up. So you don't need a PhD in economics to figure out if the buyer of something and the seller of something both want the price to go up. The price is going to go up. So on the health insurance side, that's the one where people don't fully understand it, but there's a law, thanks to Obamacare, that health insurance plans can only make 15% of your premiums as profit. So let's just say Your premium is $1,000. They can make $150. So how do they grow that premium or that profit? Excuse me, Your premium has to go up, which means the cost of health care actually has to go up. So the buyer and the seller of health care both want the price to go up. So that's why we're seeing just extraordinary rises in, in, in health care prices over the last decade especially.
Alex Clark
Was it always this bad or did Obamacare really make it worse?
Andy Schoonover
Oh, I mean, Obamacare definitely juiced it. Obamacare definitely juiced it. So you can see the trend and cost for health care. Once Obamacare was signed, it tweaked up. So it's very, very clear in the graph that the prices right at that point significantly went up. So it has not always been like this. This is a past 15 year phenomenon.
Alex Clark
Why in Trump's first term, wasn't he able to, like, right the wrongs of Obamacare?
Andy Schoonover
Yeah, I mean, I think he did. I mean, I think he tried to, but I don't think, and I think you've heard him say this now where he didn't have the right people around him that had the political wherewithal to actually make it happen. I also think that there's not a clear path to a new policy that can get most people on board. And so without the policy path and the people around him, he just wasn't able to do it.
Alex Clark
Your own little girl was a victim of big health insurance. What happened to your daughter that really opened your eyes to health insurance corruption in America.
Andy Schoonover
Yeah, you know, so I actually, this is my second health care company. I sold my first company, and as such, I didn't have insurance because most of us get insurance through our employer. And so I had to go and say, okay, what are my options here? And I thought my only option at the time was to get one of these Obamacare plans off the marketplace. And so I went and did that, and it was, I think it was 11 or $1,200 for me, my wife and my two girls. And I kind of joked it worked until I Had to use it. My little one, who was one at the time, was having recurring ear infections. And so we went to the pediatrician who said she had a hole in her eardrum. So in essence, I'm sure there's moms out there listening that can, that can, you know, feel this. You know, the, the fluid in her ear got so significant that it popped her eardrum.
Alex Clark
Oh, my gosh.
Andy Schoonover
So what we had to do is go get little tubes in her ears, little plastic tubes so that the, the fluid could drain out so that her eardrums wouldn't pop. And the ear, nose, and throat doctor who we went to is like, this is bad. Like, we need to get this done now. And he actually delayed his vacation by a day to do it for us. So we went and did it. We went in network, we did everything we were supposed to do, and we got a bill three or four weeks later from the hospital, and it was $8,000 for a 15 minute procedure. I was like, wait, what? $8,000 for 15 minutes? I mean, wouldn't we all love that hourly rate? And I was like, okay, well, this is what health insurance is for. Like, this is the whole point of having health insurance. And little did I know that we'd get a note about a month after that via snail mail. Funny enough that our health insurance plan said it was medically unnecessary and so they weren't going to pay for it. And so I was like, well, I know it was medically necessary because my daughter now can actually sleep through the night and she's not, you know, screaming and yelling all the time because of the pain in her ears. And so we went through two appeals processes and the insurance plan was still like, nope, we're not paying for it. So I had to stroke an $8,000 check to the local hospital.
Alex Clark
And.
Andy Schoonover
And as you can probably imagine, I was ticked. It was at that point where I was like, man, health insurance just doesn't work. And the more I, I researched it, I found this is not only not working for me, but one out of five claims that are submitted to health insurance plans are denied. So you have a 20% chance of your claim getting denied by your health insurance plan. And Unfortunately, I was one of the five. And what broke my heart is that we've got 200,000 people every year going bankrupt due to a medical issue even though they have health insurance, right? So these are people that have health insurance and are still going bankrupt. And so at that point, I was like, man, this health insurance clearly is not working. So I Actually quit my health insurance and became uninsured. And I've been living uninsured now for the last five and a half years. Delightfully uninsured, actually.
Alex Clark
Delightfully uninsured? How is that possible?
Andy Schoonover
I know people are blown away when I said this because we've all been conditioned to think that we have to have insurance. And I know that you had Brigham on, you know, a couple months ago, and he's like, well, everybody's got to have health insurance for the big ones. And I would say, no, I don't think you actually do.
Alex Clark
Okay, so you disagree with him on that?
Andy Schoonover
I dis. I do disagree with him on that.
Alex Clark
So explain why.
Andy Schoonover
Yeah, because, you know, what I found after becoming uninsured is that I actually have more negotiating power with hospitals and doctors as an individual than even United Healthcare does, which is the seventh largest company on the planet in terms of revenue. I think they had $400 billion of revenue last year. And so what I found is that if I can go in and I can pay cash for my procedures or pay the doctor directly, I was getting significantly better prices than United Health Care. And so, you know, why is that? That doesn't make sense economically. But once you started understanding that there's all this administrative expense that the government, that insurance plans that your employer introduced to the system, you can rip all that out. It's way easier for the doctor to actually get paid, and therefore, they'll give you way better prices if you pay them at the point of care. So on average, doctors spend about two days a week fighting health insurance plans to get paid. You know, imagine if you had to fight with your employer two days a week just to get paid. You know, and so they're like, oh, wow, you're going to actually pay me now. Great. I'm going to give you a way better price if you pay me at the point of care than if I have to fight with the health insurance plan.
Alex Clark
Okay, that's absolutely fascinating and so important, I think, for people to even know, because I certainly didn't know that when your daughter was denied and they said, well, this procedure wasn't medically necessary. What have you found out about health insurance companies and their thought process behind what is medically necessary and what isn't? Because in your case, like, that was medically necessary, but they said it wasn't.
Andy Schoonover
It's appalling, actually. And to go into what I mentioned earlier, where they have 15% of your premium that you can use as the profit, what they have allegedly done, this is now in the courts is that they decide on medical necessity based upon how well their profitability is doing during that year. So just imagine if healthcare costs are starting to increase and encroaching upon their 15% that they can use for profit. They dial up the medical necessity requirements or dial it down depending upon where they're at at that point of the year. So it's literally a computer algorithm that says, I'm going to make it harder to get claims approved. Claims are, you know, what we submit to a health insurance plan to say, hey, here's what happened to me, or they dial it back to make it easier, or they dial up pre authorization. So for people who don't understand, most of the time when your doctor does something significant, they have to get it authorized by the health insurance plan before they can do it. So in essence, the health insurance plan is telling you what you can and cannot do to get better. And so again, they dial up how hard it is to get that pre authorization when they get to that unprofitable level. Right. So they, they get to. Right to that level and they dial it up or dial it back again. This is allegedly. But there are people within these organizations who said, no, this is exactly what they do. They make it harder to get your bills paid when their profitability is at risk.
Alex Clark
So when you heard about this Luigi case, I mean, were you just like, I'm not even surprised I knew at some point something like this was going to happen based on what, you know about how they treat people.
Andy Schoonover
I mean, I was appalled, of course.
Alex Clark
But like, were you surprised, though, is my question.
Andy Schoonover
I'm not surprised.
Alex Clark
Yeah.
Andy Schoonover
Especially if you start understanding his case specifically where, you know, he and his, his mom both had significant health issues that were debilitating. And what the health insurance plan does is they, they string you along for a long period of time so that they. You eventually give up on some of these things. So he, from, again, what we've read during his manifesto was trying to get care for his condition. His mom was doing the same thing. And the health insurance plan were like, well, I need more documents, I need more documents, I need more documents. And eventually you're like, I give up. Yeah, you know, I give. I'm not going to fight this system because you're not going to win against UnitedHealthcare. And I think ultimately that's what led him to do what he, what he did.
Alex Clark
Does the medical industrial complex benefit from treating symptoms instead of preventing disease? And is that kind of the reason for these insane costs?
Andy Schoonover
Oh, absolutely. Absolutely. I mean, the, the incentive system with, within the system is that they want to get you on long term, chronic conditions because you become recurring revenue. And what I mean by that is you get to have to see your doctor three, four, five, six times a year, as opposed to one time a year. And so, you know, part of it too is the system is developed so that doctors don't have a whole lot of time with you. The average doctor visit is 10 minutes. So if, you know, I go into the doctor and I say I have something wrong with, with me, the only thing they can really do within 10 minutes is say, here's a prescription, go get it. You know, get your symptoms revolved.
Alex Clark
And is that on purpose?
Andy Schoonover
Well, I, I don't, I don't know what the motivation there is. I, I actually think the doctors, 95% of them actually want to do well for you, but their own, what the only thing they can do is alleviate your symptoms with prescriptions because they don't have the time to go into, you know, are you working out? Are you sleeping well? Are you, you know, what are you eating? Some of those things. You can't get in that for 10 minutes. And so their reimbursement rates have gone down, and so they just don't have the time to do it. And that's because the insurance plans do really hammer the, the individual doctors. The most of the money that we're losing in our healthcare system is with these big hospital systems, which, which really take, take us pretty good. That's where we get these $8,000 ear tube, you know, bills. Funny enough, with that ear tube bill, I had somebody reach out to me on Twitter who was an ear, nose and throat doc and said, oh, yeah, we do Those for like 12 or 1500 bucks all day long. And I was like, why the heck did I go to the hospital and do this for 8,000 when this ear, nose and throat could have done it for? Was that 75% more than 75% less?
Alex Clark
Right.
Andy Schoonover
My big recommendation for people who are listening to this is stay out of the hospital at all costs unless you absolutely have to. If you have a heart surgery, if you have an inpatient surgery, which means you have to stay overnight, you might have to go to the hospital. But if you're having knee surgery or shoulder surgery or anything like that, that's outpatient, go to find an independent doc. Those independent docs have more time for you. They will be more willing to negotiate with you on price if you're paying them directly. What I found is that these independent doctors are actually better because you don't have a hospital system who's funneling patients to you. These independent docs have to be really great docs that get patients via word of mouth. And that means they have to treat their patients really, really well. And so what we want to do with, with members of, of crowd health is trying to get people into independent docs. So if you can go and find an independent doc in your area, go and see them because they'll have more time for you and they're just generally better doctors.
Alex Clark
You kind of brought this up, but like the average American thinks that because they have health insurance, they're going to be safe and taken care of in a true emergency. I was just in a devastating car accident. I have to be rushed to the hospital right now. You know, my kid just fell at the playground, broke their arm. I had a heart attack or something. But you're saying that isn't necessarily the case, like in those crazy circumstances where the bill is going to be extraordinary. What is your solution?
Andy Schoonover
It is the case that we have been, I think, kind of psyoped to think that health insurance plans will step up in the event of a very large bill. And what we are finding is that that's not actually the case.
Alex Clark
Wow.
Andy Schoonover
And so that's where I think the big disconnect is with our society right now in healthcare, is we think we have to have these big health insurance companies. But look, they are not incentivized to pay your bills. They are actually incentivized to deny your bills or to delay your bills. And I think that's a big challenge within our, our system right now. So, yeah, that's, that's why I've decided to ditch health insurance altogether.
Alex Clark
Well, America spends more on health care than any other country in the world, and yet we have worse outcomes.
Andy Schoonover
Double.
Alex Clark
So what is really going on?
Andy Schoonover
Yeah, I mean, I think that, you know, part of it's the system and part of it is we've got the most obese nation in, in the developed world. Also there's a group of countries called the oecd. I don't know exactly what it stands for, but there's 35 of them that kind of look similar to the United States. And when you look at obesity rates of the United States versus, you know, the UK and other places like that, we're twice as obese. So if you think about it that those people are going to be more expensive and most of the decline in life span right now is as a result of the chronic conditions associated with being overweight in addition to the cost. So if you think about if you do a knee replacement on somebody who's, you know, 150 pounds versus a knee replacement for someone who's 400 pounds, that knee replacement for the 150 pound person is going to go a lot better than the 400 pound person.
Alex Clark
Right.
Andy Schoonover
And so that one's probably going to have to get it done again and again and again. And so I think kind of back to what Brigham was talking about when you talked to him a couple months ago, I think what we put in our bodies, our nutrition is atrocious, especially when compared to the rest of the world. And so I think that's a part of it.
Alex Clark
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Andy Schoonover
Yeah, I mean, I think it is this perverse incentives for the people that we trust to pay our bills are actually not acting in our best interest in economics. It's called the principal agent problem. The, the, our agent, which is the health insurance company is supposed to go and find us great rates, but in fact they're actually incentivized to see rates increase as, as we talked about. And so that's what I don't think people that understand is that all of these entities within healthcare, including the insurance companies, want to see rates go up.
Alex Clark
Why don't health insurance companies cover things like, you know, extensive blood work or a bunch of preventative type of health things?
Andy Schoonover
Yeah, and some of them do, some of them do. Under the Affordable Care act, you gotta have some. There's preventative things that they have to pay for. My theory behind this, or my desire is why don't they pay for as little as possible so that you have extra money in your pocket to go do those things and do whatever you want with?
Alex Clark
Yeah.
Andy Schoonover
You know, instead of a centralized health insurance plan telling you what you can and cannot do, why don't you set up a system in which, hey, we're only going to pay for the big stuff and that means your, your premiums, what you have to pay to the insurance company has, can go down every month because we're not going to pay for all the other stuff. But then you can go and decide what you want to use with that, that extra cash that you have that you're not paying the health insurance company. So that gives you more autonomy, more personal sovereignty over your health care as opposed to an insurance plan telling you what you can and cannot do. What Brigham was saying during your. Your podcast was, is you need to go pay out of your pocket to do some of these things. Well, what if your insurance plan, instead of $1,000 a month, was only $500 a month, so you had $500 each month to go and do what you wanted to do with your money as opposed to the insurance plan deciding what you can do with your money?
Alex Clark
Right.
Andy Schoonover
And by the way, I, when I was with insurance, I went and did my, you know, yearly metabolic, you know, testing, lab testing. I typically do it twice a year. And it was like $700 to do these testing. I went and did the exact same tests with cash, and it was like $87.
Alex Clark
What?
Andy Schoonover
So I got it for almost 90% less by going and paying in cash.
Alex Clark
How did that happen?
Andy Schoonover
Yeah, well, you know, I've got now with my current company called Crowd Health, we've got this database of all of these cash providers in your city you live in, in this Phoenix Scottsdale area. I get. I have probably 20 places in Phoenix Scottsdale that have labs that you can get full panel, everything you would need, generally for under a hundred bucks.
Alex Clark
Oh, heck, yeah. I love this.
Andy Schoonover
I, you know, had a. A family member go get a colonoscopy, and it was $5,000. We can find colonoscopies for about a thousand dollars.
Alex Clark
Whoa.
Andy Schoonover
And so what we're building is this cash pay database where you can go and get whatever you want for really reasonable prices. And, you know, you don't have to rely upon a health insurance company to, To. To do that for you. I'll give you an example where of something that people. And whether you agree with this or not, you know, in terms of this medication, that's fine. That's beside the point. But one of the things that Obamacare did was make contraception required to be paid for under the Obamacare plans. Contraception, once that happened, tripled in price.
Alex Clark
And you're talking about birth control.
Andy Schoonover
Birth control, okay. Birth control tripled in price because now this big entity is paying for it, as opposed to me and you going and shopping for what exactly we want. And so there's no market forces that are driving down these costs like we would if we went and Bought a car or we went and bought anything else. In. In the real world, health care is the only thing we don't actually, like, pay for ourselves. We just assume that the health insurance plan is going to pay for it.
Alex Clark
Yeah.
Andy Schoonover
And therefore we don't care what the price is.
Alex Clark
Yeah.
Andy Schoonover
And so if you don't care what the price is, you're going to consume as much of it as you want and you're not going to shop for it.
Alex Clark
Is it in the health insurance company's best interest for us to die earlier or to just be sick longer?
Andy Schoonover
Sick longer. Sick longer, for sure. Yeah. So, yeah, for the health, for the entire system, they make more money when you're sick longer. So again, no incentives to actually treat your chronic conditions. I'd like to tell a quick story on this because I think it's illustrative. In my first company, we were monitoring patients with diabetes at the Rio Grande Valley in Texas. So this is a largely Hispanic population. Diabetes is like 40% of the population has diabetes. And so we had a little phone that we could talk to him, little video phone, and we had a glucometer that we could actually track. And we would say, hey, listen, I know you love tortillas, but you can't have three tortillas with every meal. And they're like, I've had three tortillas with every meal since I was five. You're not gonna stop me. Right? And so we said, okay, well, let's take your blood sugars, have three tortillas, and let's take your blood sugars this week. And the next week let's do two tortillas. And the next week they did one tortilla. Well, what they saw was their blood sugars were coming down, and over a period of time, their diabetes got better. Actually, over a year, these people, 75% of the people who are diabetics became. Weren't diabetics anymore. After us treating them for a year, I went back to the health insurance plan. Who is sponsoring this? I said, look at these amazing results. And you know what they said?
Alex Clark
What?
Andy Schoonover
We're shutting it down. So what was happening, and what I found out later is we were saving so much money that the cost of healthcare was going down, which means they were making less money for treating people with chronic conditions. And that's how perverse our system is, is when you get people healthy, you actually make less money.
Alex Clark
How much of the American healthcare crisis is due to government policies and how.
Andy Schoonover
Much is just corporate greed, massive on the government policies? I mean, the amount of regulation that is required to be in healthcare is astronom.
Alex Clark
So have you heard, is RFK Jr going to be tackling this at all? Like, are we going to see anything from this administration on this front?
Andy Schoonover
Yeah, I mean, I think there's two components of this. One is cost.
Alex Clark
Okay.
Andy Schoonover
And one is consumption. Meaning, like, you know, one is cost, one is how healthy are we? I think he's tackling the how healthy are we? I don't think he's tackling. And if we are healthier, cost will. The total cost will go down. Cost per procedure probably won't impact. And in fact, they're actually giving insurance plans, Medicare plans right now a 5% increase this year when the Biden administration was giving them a two and a half percent increase. I don't agree with that. These companies should not be getting massive increases in their, in their rates. And so I'm hoping I'm working within the administration to be, you know, show them some, some avenues to really significantly reduce. Reduce costs.
Alex Clark
How intertwined are insurance companies and politicians?
Andy Schoonover
Very. Pharma and health insurance are the top two lobbyists in D.C. so what do they do? Yeah, they're at your door every single day telling you all the great things that health insurance does and doesn't allow folks like me to give them the alternative perspective. And I think most of the people in D.C. too, are conditioned to think that everybody has to have health insurance. You see these politicians going around and saying, well, all these people are uninsured. What do we do? What do we do? What do we do? I'm one of the few people that said we should have more uninsured as opposed to insured. I know that's controversial, but I think that more people should be using their own money to pay for the things that they really want in health care. And that removes the government, it removes health insurance plans, it removes the company you work for between you and your doctor.
Alex Clark
I mean, that seems to me like a very conservative principle just right there in and of itself. Like removing the government. Like, take care of yourself.
Andy Schoonover
Absolutely.
Alex Clark
You know what I mean? So for my audience, which happens to lean more politically conservative, I just. That makes sense to me.
Andy Schoonover
Yeah, just be clear. Like, your, your health care is not between you and your doctor.
Alex Clark
Right.
Andy Schoonover
You think it is, but it's not right. I always say you work for whoever pays you. Guess who pays? The doctors. The health insurance companies.
Alex Clark
So then would you. Is your position that the doctors in America are just as frustrated as the patients?
Andy Schoonover
Oh, absolutely. And, and Dr. Burnout is a, is slightly off. An all time high. The all time high was during COVID which you know, you know. But they're. And the reason why is these are like, we're spending so much time fighting health insurance plans to get our members covered, to get them what they need to better their health. And the insurance plans continue to push back, say no, create paperwork, create bureaucracy so that I can't actually treat my, my patient. If I go in there and I say, doc, I'm paying you directly, what I've seen is a sense of relief. Like, thank God, like now it's between me and you. So what do we need to do?
Alex Clark
The conclusion that young people especially kind of come to when it comes to the health insurance debate in America is they automatically say, well, there are other countries who will literally do procedures and give you health care for free. So why can't America just give us our health care for free? Now why is that also not necessarily like a grass is greener situation?
Andy Schoonover
Our number one interest in my current company, Crowd Health with outside of the United States is Canada. I mean, I get it every day, almost Canadians being like, hey, can we be members? Because I have to wait six or eight months to get my torn ACL repaired because there's a backlog of people that these doctors, you know, just can't see in Canada.
Alex Clark
So it's free, but you, you have.
Andy Schoonover
To wait, but you have to wait for it.
Alex Clark
Yeah, exactly. Which is scary. And that's like, that is the socialist kind of healthcare formula in all of these countries where they're doing it for free. And then, I mean, am I wrong to say, and sometimes the quality of care because it is free is not very great and you don't really have choices to go to different, you know, physicians and, and all that. Am I, am I wrong?
Andy Schoonover
Yeah, exactly. So I think you have like three levers. It's quality, speed and price.
Alex Clark
Yes, right.
Andy Schoonover
You can only have two out of the three. And in fact, I think that the only one that Canada has is price. They don't pay for it. Their quality is not that great. And the speed is terrible in the United States. What it is that the quality is actually pretty hot. I mean, we have the best doctors in the world. Especially if you have an acute, acute condition like you want to be in the United States. In fact, the Saudi royal family has an entire floor of a very well known New York hospital rented out just for them. You want to come to the United States speed, you can generally get what you want quickly. There are Some specialties, neurology and things like that, you have to wait. But generally you can go to the lab today and get your labs done and know what's going on with you. You know, it's the price. That's the one that the United States really struggles with. And I think that we can fix the price if we start paying directly for our healthcare in more situations.
Alex Clark
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Andy Schoonover
Yeah, absolutely. There's, there's no doubt about it.
Alex Clark
So why is that legal?
Andy Schoonover
It should not be. But again, I think that the politicians stand down to these pharmaceutical companies and these health insurance companies they have, they are so powerful. If you think about these small towns, who's the biggest employer? It's the hospitals. And so you have congressmen who are coming from these small towns who are like, okay, my biggest employer in my town, who I rely upon for donations and all these things I've got to assure, ensure that they are behind me. And so the whole medical industrial complex is focused on raising prices and they've got their into the pocketbooks of our legislators, unfortunately. And that's why these, these laws are not being changed.
Alex Clark
I mean, we're paying for health care with these premiums in these deductibles. And then we get hit with these surprise bills. Sometimes who is behind hidden charges like that?
Andy Schoonover
I think it's incompetence at the hospital, you know, and you hear these like horror stories forever and ever where you're like, I went and I was in the ER or whatever. And then I, and I thought that I was good. I thought it was all paid. And then I get a bill a year later, you know, for a, an ER visit that was in the previous. You're like, where the heck did this come from? Like, this is crazy that I would get billed a year later, but that just happens within these hospital systems. And I, I generally think that hospitals are some of the worst run organizations in the country. And so that's why I say please stay out of the hospital. Because there's actually a study that was, was out there that in the worst month of the Iraq war, you are less likely to die than from a, from being in the hospital, from a condition in which you didn't go in for, which means you got it while you were in the hospital.
Alex Clark
Oh my gosh.
Andy Schoonover
Yeah. So this is a huge problem within, within the United States hospital system.
Alex Clark
So you are tired of this, you're tired of corrupt insurance companies, healthcare companies, and so you decided to create crowd health as an alternative. So what is crowd health exactly? And how does it work?
Andy Schoonover
Yeah, and I actually did a couple things. One, I, I went to a health share first, which I know, you know, many of your audience knows what a health share is, which is a, a faith based community of people who are all funding each other's health care needs. And I, I just found that to be again, incredibly inefficient in the way that they were, they were operating.
Alex Clark
Why?
Andy Schoonover
I'll give you one example. The, I'm not going to say what it is, but the health share I was with was continued to send me to this website that apparently had really good prices. But in essence what they did is they just took the health insurance plan prices and put them on a website and said, you know, these are the prices that you should be paying. I was like, guys, no, like those are not good prices. Because I know from my experience if I go and I say I'm going to pay in cash, I'm going to get better prices, so stop telling people that this was a really good price. And so I was with them for like six months and I tried to figure it out and I was like, there's got to be a better way than this. And so I started a company called CrowdHelp, which is in essence getting a community of people together. It's based upon love your neighbor. And when somebody in your community has something going on, then you can help them. I truly believe that the government getting in between me and my neighbor has significantly reduced our, especially Christians, desire to be generous to others. And if you think about, you know, the guy on the street that you see, you know, as you drive by, you know, I'll admit there are times when I was like, man, I wonder why he's not getting government assistance you know, but in reality, it should be like, this guy is a part of my community. I should be responsible for taking care of that person. That's how I'm instructed to live. If somebody in your community is having a really hard time, then we go to them and say, hey, we need to help them. We need to love them. Well, but what has happened is the government and insurance companies have said, no, no, no, no, don't worry about them. We got it. What we're trying to say is we've got this community of people that if somebody in that community gets hurt, we're going to step up and help them.
Alex Clark
So someone's kid falls and breaks their collarbone. I mean, what does their bill look.
Andy Schoonover
Like under crowd health, breaks his collarbone, goes to the E.R. you know, gets a cast, gets all these things that. That happen. That is what we call a health event. And so our member will pay the first 500 bucks of that health event, and then we'll go. Let's just say it's $5,000. We will then go to the community and ask 45 people in the community if they will help out this family with a hundred dollars each. And if you say yes, then a hundred dollars goes from your account to their account. And after I get 45 people to say yes, you have $5,000 now in your account where you can go then and pay for this bill directly to your doctor and get way better pricing for that.
Alex Clark
So what happens if. If only 20 members say yes, and you.
Andy Schoonover
We keep going.
Alex Clark
Okay, so you just keep asking, Keep going.
Andy Schoonover
And the cool thing about it is that the family who submits their bill, we know the last 10 times that family has been asked, have they said, yes, yes, yes, yes, yes, or they said, no, no, no, no, no.
Alex Clark
Yeah. What if you have somebody that never wants to help others but now needs help?
Andy Schoonover
So. So if I came to you and I said, hey, Alex, I need you to help me, and you're like, oh, have you helped anybody else in my community? And I'm like, no, I haven't. You'd be like, what? I'm not going to help you. Like, you know, like. And so, in essence, what happens is that the people who are the takers in the community and aren't willing to support the community are the ones that don't get their bills paid. So there's a reciprocity that says, hey, look, you know, if I'm generous to others in the community, they will be generous to me. And that's a part of how our system works.
Alex Clark
When okay, so, so, so I understand this. Let's say something happens to me and I need something, but I've never helped somebody else before. Do you tell when you're going and asking those 45 members, like, hey, Alex has a problem she needs help with, do you say like, but just so you know, like, this is how many times she's helped others. Like, are you saying that to people? Oh, okay. So there's accountability. Like you need to some accountability be helping so that if it happens to you, that people are willing to help you. Okay.
Andy Schoonover
But we also allow the flexibility. So like, let's just say Alex has a tough month financially and she can't help anybody, then you can do that once in a while.
Alex Clark
Okay.
Andy Schoonover
And, and people get it. People understand that. So it's not a mandatory thing. It's totally voluntary. But this has resulted in 98% of the people that we've asked to help say yes.
Alex Clark
Could crowd health truly replace insurance companies?
Andy Schoonover
I truly believe it can because we would then go in a direct pay basis with all of our doctors. The doctors would no longer have to spend all this time and all this money, like I said, two days a week and they have three billing people per doctor just to get paid. Like all of that bureaucracy gets ripped out of the system. That's the beauty of being able to pay in cash or credit card or whatever you want to do at the point of care. And so I think if we can get back to paying at the point of care, it rips out the bureaucracy and we'll be more aware of what the actual prices is. We are paying for our, for our health care. Those are the two things I think we need to do to get health care to where, to where it, it needs to be.
Alex Clark
Does crowd health work for people with pre existing conditions or is it only for the healthy?
Andy Schoonover
Yeah, so if you have a pre existing condition, all we ask is you want you be a member of the community before you start asking. Right. So you have to be a member of the community for two years and then once your two years is up, then you can start getting it for your pre existing condition. And the reason we do that is because in the early days we had people with knee surgeries who would jump in, get their knee surgery and then jump out and then you're like, look, that's not a community. Like you can't treat a community like that. And so. But we actually have a ton of people with pre existing conditions. We have a bunch of type 1 diabetics. Type 1 diabetes is when you're either born with it or get it really early on, it's not a lifestyle condition, it's an autoimmune condition. Basically. We have a ton of those people because they've looked at crowd health and they're like, man, I'm saving so much money versus going with health insurance that I can. And crowd health is finding them their supplies and their insulin at way less than they have to do it. They would have to bought it for through health insurance that I'm saving so much that I'm willing to pay for my diabetes supplies and insulin and things like that for the first couple of years just to be a part of this community. So they're still saving money even though they have pre existing conditions. And that's a really kind of cool, cool component of this.
Alex Clark
How do you guys plan to survive in a world where health insurance giants hold all the power?
Andy Schoonover
Yeah, it's a David versus Goliath.
Alex Clark
Yeah.
Andy Schoonover
You know, this seems like, you know, spiritually out there, but I think there's favor that has been put upon us, honestly. Like, I think this is crushing the human condition in our, in our country. We're seeing it in life expectancy decline, we're seeing it in obesity. I mean, I truly believe that our health care system is limiting human thriving within our country. And I think we have to fix it.
Alex Clark
Yeah.
Andy Schoonover
And I think there's, that's, it's a mission for me. This is, I did great in my last company. I don't need to be doing this. This is truly a missional thing for me. Like I want to see my kids and my grandkids, you know, grow up in a, in a system where they actually can get good health care. And I think it's a tragedy that we're even questioning that.
Alex Clark
Okay, so I know, and you kind of said this. A lot of my audience is using the Christian health share type companies.
Andy Schoonover
Yeah.
Alex Clark
So what is going to be the pros and cons of crowd health versus those real quick?
Andy Schoonover
I think we used you or somebody. You know, this hypothetical family breaks their, their collarbone. My money is going directly to that family. It's a peer to peer transaction. Let me tell you a cool, cool story. Not cool, but cool in some ways. We have a lot of babies. Our number one expense in the community is babies. The second is active injuries, which means people are out and about doing their day to day thing and they fall off their bike or whatever. It ends up being like, those are, that's our number two. Well, with the babies, unfortunately, we have miscarriages and there's cost associated with that. And so we send this out to our community and it's all the time. We get people coming back. It's like, hey, somebody in Arizona had a miscarriage. Will you help them? We have women who reach back out and say, I've been through that. I know the pain that that family is going through. Like, instead of a hundred dollars, can I give $200? Oh, like that is. It's truly. We're building a community where people. Your money is helping another person in the community directly, not going through a centralized company. It's a peer to peer transaction. Like, that's cool. Like, I would way prefer to help that woman who had a miscarriage than I would send my money to UnitedHealthcare. So that is a huge differentiator between what we do and what health insurance plans do. For sure.
Alex Clark
Yeah.
Andy Schoonover
And most health shares are centralized. It all comes into a central place and then they disperse it out. This is a peer to peer transaction. And I think that's super, super cool.
Alex Clark
You brought up babies being a big expense. What is the crowd health process for things like labor and delivery, you know, what do you offer for home births, etc.
Andy Schoonover
Yeah. Yeah. Here's a crazy, crazy stat for you. You ready? So do you have any idea what percentage of babies are born at home in the United States? Any random guess?
Alex Clark
Like 24.
Andy Schoonover
Way less than that. 1.6% of babies are born at home.
Alex Clark
Oh my gosh. I didn't know it was that small. Yeah.
Andy Schoonover
And you know what, the number.
Alex Clark
I'm just gonna bubble with my audience like, because this is what we're all into.
Andy Schoonover
Yeah. Yeah. 1.6%. So at crowd health, 50 of babies are born at home.
Alex Clark
Let's freaking go. Yeah. Okay. That's amazing. So yeah, these are like like minded individuals who really care about health.
Andy Schoonover
Yeah. Like we, we built a community of people who are like, I'm into health. I want to release my exit the system.
Alex Clark
Yeah. Less intervention, less intervention.
Andy Schoonover
This, this baby making, this delivering of a baby is not a medical condition or a medical issue. It is a, a part of life. And so I want to do it at home. So you can do doulas, midwives, anything you need to have your baby at home. We're all about it. Go do it. And so 50% of our members have their, have their babies at home.
Alex Clark
I. Dental, or is it only other physical health?
Andy Schoonover
Yeah. So we do give you up to 300 bucks a year to go and do what? Prevention. And that's whatever you want it to look like. So if you want to use that for your eye or for your dental or for whatever, then you can go and do that. If you have direct primary care, which I don't know if you're. You're familiar with, but direct primary care, instead of going in and paying your doctor every time you see them, it's a subscription where you say, hey, I'll pay you 50 bucks a month or 100 bucks a month, and then whenever I need you, you'll be there for me. We allow you to use that prevention for that direct primary care, too. So we are going to do full dental probably next year. So if you get like a root canal or something.
Alex Clark
Yeah, braces. That's what I was wondering.
Andy Schoonover
Those types of things. We're going to be doing that in 2026, by the way. Holistic doctors, integrative doctors, naturopathic doctors, acupuncture, chiropractic. If you have a condition that requires chiropractic, like, we really want you to go do what you think is right to take care of yourself without us getting interfering. So it's. You go do what you need to do to, to solve your condition then. And that's great. For example, myself, I had a back injury. The doctor says, well, we can do surgery. And I was like, well, how much is that? And he's like, $40,000. And I was like, no, we're not doing that. And so I went to the chiropractor and I go to the chiropractor once every six months to do it, and it's totally fine. It's this little thing where my ribs kind of come in and out of their sockets. And so he, he adjusts it and it makes work fine. I was like, why wouldn't we healthcare do that?
Alex Clark
Right?
Andy Schoonover
As opposed to going and doing a $40,000 surgery which may or may not work, which going to limit my ability to function as a human being probably for the rest of my life versus me going to the chiropractor and spending 30 bucks or whatever it is once every six months. Like that's the way that we look at health care as opposed to an intervention first type of scenario.
Alex Clark
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Andy Schoonover
They're blockbuster.
Alex Clark
Okay.
Andy Schoonover
Yeah, they're blockbuster. They're Kodak. Yeah, I think they're going to be. I think, I'm hoping, I'm praying, actually, that they get eaten alive because they are one of the main culprits of this, you know, failed system.
Alex Clark
Okay, so give us your strategy, your elevator pitch to people to ditch their insurance and replace with someone like crowd Crowd health.
Andy Schoonover
Ditch your insurance. You have way more flexibility. There's no networks. You can go to whoever you want. We don't care. It's way less expensive than that health insurance. So for a family of four, it's like 640 bucks a month. For my family of four with health insurance this year, it would have been $1200. Plus I had a $14,000 deductible, which means that I have to pay $12 every month. And then if I get hurt, I got to pay the first 14,000. Yeah, right. This is $640. I paid the first $500. Whether it's cancer, whether it's ER visit, a broken arm, whatever it is, I just pay the first 500 bucks of it. And so we do that because we don't want people to be financially, you know, offset by a health condition. Everybody can come up with 500 bucks.
Alex Clark
Well, and I guess my. That's something else, like, something like cancer. I mean, we're talking about hundreds of thousands of dollars.
Andy Schoonover
Millions often times.
Alex Clark
Yeah. So, like, so how does crowd health deal with that?
Andy Schoonover
Yeah. For example, so we've had, I think like three dozen cancer cases. We had a guy shoot himself accidentally. That was a million dollar bill. We've had NICU babies, I mean, all kinds of things at this point. So, you know, and so far, if you have been a giver in addition to a taker in our community, 100% of those bills have gotten funded.
Alex Clark
The million dollars.
Andy Schoonover
Yeah, well, the million dollar bill was a crazy one because if you got a minute, I'll tell you the story because it's a good one.
Alex Clark
Tell me.
Andy Schoonover
He Was in Montana. He was in bear country. So he had a.44 revolver in his holster. He was, went out fishing, he caught a fish. He leaned down, the.44 fell out of his holster, hit the hammer perfectly. The bullet went off, went into his calf, out the back of his calf, into his thigh, out the top of his thigh, into his chest and out the back.
Alex Clark
Oh my gosh.
Andy Schoonover
He said he looked down, he saw green stuff coming from his chest, which I think is bile. I'm dock. But his wife, thank God, was with him. So she ran up to the top of the hill cuz she didn't have cell Service. She called 911, a helicopter flew in and got him, took him to the nearest hospital, which was two hours away.
Alex Clark
Oh my gosh.
Andy Schoonover
He went into a coma. Fun story. He came out of the coma, all his family was surrounding him because they thought he was going to die.
Alex Clark
Yeah.
Andy Schoonover
And the first words he said coming out of his mouth is we're pregnant. His wife was 12 weeks pregnant with their first child. And so like for some reason coming out of the coma, that's the first thing he had to tell people is we're pregnant. You know, and so they wouldn't let him fly home. So he had to drive home from Montana to California. He had sepsis on the way home. So I think it was multiple weeks in the hospital in sepsis. And so, you know, we found out about this and it ultimately met it, I think it was just short of a million dollars. We actually negotiated it down for him. So we have a team internally. If you go to the ER and you get these big hospital bills, we can negotiate them for you.
Alex Clark
Oh my God.
Andy Schoonover
And we actually have attorneys who will help you negotiate this so you don't have to worry about any of those bills from, you know, a year down the road or whatever. If you get those bills, you take our app, you take a picture, we have a system internally that pulls it all off. We've got a team that will negotiate for you. So we negotiated that bill from almost $1 million down to like 200 or $250,000, and then the crowdfunded it fully.
Alex Clark
How many members are there nationwide?
Andy Schoonover
10,000. So all those things that you hate about health insurance, which is what I hated about health insurance, we're like, we're going to figure that out for you. The other real quick thing is, one of the things I hate when I call a company, especially health insurance, is sitting on phone calls and like talking to somebody in India where I have to tell them My health event. And they're like, well, I don't. I'm not the right one. You're like. So they punt me to somebody else, and I have to wait on the phone for another three minutes. Everybody at crowd health has a care advocate. So you have one person internally, who is your person.
Alex Clark
That they know you.
Andy Schoonover
That they know you. They get to know you. You get to know them. You can have an intro call with them. So you can text them, you can call them, you can email them, and they will be the ones who will respond to you. And we do that is for accountability internally, because if you have a big health event going on, we want one person responsible for that. And they. They're the drivers. They're helping you. They're advocating on your behalf so that you don't get lost in the. The craziness of a health insurance system. Right. Like, this person is responsible for you. And so what we have found is our customers love that, because now, you know, my care advocate is Kelly. Kelly's awesome. I can call Kelly for anything that I need. I can say, hey, Kelly, where's a great place to get labs in Scottsdale? And she'll be like, oh, here's one here, here, here, and here. You know, Is there anything else I can help you with? It's like your own little personal healthcare assistant.
Alex Clark
Yeah.
Andy Schoonover
Which is really, really cool.
Alex Clark
Is there any type of person that. Crowd health would not be good for?
Andy Schoonover
Smokers.
Alex Clark
Okay.
Andy Schoonover
And if you are obese, okay. So we ask you, like, hey, you can't be smoker.
Alex Clark
No fatties allowed. That's not very politically correct.
Andy Schoonover
It's not very politically correct, but we have had people fun enough who were significantly higher than our weight limit and were so, like, fired up about what you're doing, what you're doing.
Alex Clark
They got healthy.
Andy Schoonover
They got healthy. Cool. They lost weight. And one guy even sent me a photo of him and his wife, who both had lost all this weight, who were running a triathlon. And he's like, literally, he. In his. In his message to me, he. He messaged me over X. He's like, crowd health is the reason why we got into shape.
Alex Clark
Amazing.
Andy Schoonover
And we have changed our lives.
Alex Clark
Okay. I kind of love that. And honestly, if that was a rule, I mean, but seriously, if that was a rule for all health insurances, like, you have to be healthy. You cannot be morbidly obese. And having all these medical issues.
Andy Schoonover
Incorrect. You can't get. You can't get.
Alex Clark
The folks would. That would motivate people to get better. Like, that is. I honestly, like, I think that's kind of genius.
Andy Schoonover
But if I don't have to pay for my healthcare out of pocket.
Alex Clark
Yeah.
Andy Schoonover
Then I don't care oftentimes.
Alex Clark
Right.
Andy Schoonover
You know, like, we, we kind of do care because we want to thrive as human beings, but for some reason, when it touches our pocketbook, then we are way more motivated. So what if you were, if you were obese, you had to pay more for health insurance. If you're a bad driver, you have to pay more for. For being a bad driver. Right. For your, your car insurance. Why not in healthcare, if you are a bad driver, you. You get. You get charged more.
Alex Clark
Makes sense.
Andy Schoonover
I think people would be incentivized and in fact, for us.
Alex Clark
Makes sense. For me, who just lost her dad a couple months ago due to, you know, brain cancer and heart failure and stuff, all because of lifestyle. Lifestyle choices and, and that. I mean, my dad would have been very motivated if they said, your bill's gonna be five times higher if you don't get this under control and like, get rid of the ultra processed food, get rid of, you know, whatever. Like, he. I think that would have motivated him. My dad was very, very much like, save money where I can.
Andy Schoonover
And we're taking that to the next level too. So you can actually get a discount on crowd health if you go and get your labs, and your labs are good. Oh, we're looking at two things, which is fasting insulin, which is just your insulin level in your blood after you hadn't eaten anything, because that's the. One of the leading indicators of metabolic health. And then visceral fat, which is the amount of fat that's hanging out in between your organs, which is the bat really bad fat. Like, everybody thinks it's the fat around their waist, which they are tied, but really what you want to look at is the visceral fat. So if you have low visceral fat and you have low fasting insulin, you can actually get up to a 20 discount on crowd health for being. For being healthy. We think incentives drive everything.
Alex Clark
Oh, it does?
Andy Schoonover
I believe so. We want to incentivize people to be healthy, get healthy, and improve on their health.
Alex Clark
What is your dream for what healthcare and health insurance could eventually look like in America?
Andy Schoonover
Yeah, I want to put together, and I was talking to, to one of your producers before this. You know, I want to. As crowd health grows, we're 10,000 now. I want to be a million. I want to be 2 million.
Alex Clark
Well, just wait. After this episode comes out, I would love that. I hope you told your call center.
Andy Schoonover
I would love that. You know, but what I'd love to do is, is continue this community feel where we were actually a part of our tribe. You know, like, hey, vegetarians, if you really think that you're better off than the people who eat a lot of meat, then let's have a vegetarian crowd and a carnivore crowd and a Democrat crowd and a Republican crowd. Wouldn't that be fun to see those face off? Like, hey, how can we be better? And if you want to get competitive, let's actually talk about that. Because I think that can drive behavior. You know, you can have a Christian crowd and a Jewish crowd and a Hindu crowd or whatever, and so you feel like you're a part of your community because it will change the way that you consume healthcare. We have people emailing us all the time like, we had a guy with colon cancer. He's like, I feel terrible. I got colon cancer. I don't want to burden the crowd. And we're like, what? You would never say that with UnitedHealth. Like, they actually care about the community that they're in and not burdening them with something that's big. You know, fortunately, this guy, you know, was great and got his colon cancer taken care of, and he's totally fine now, so the crowd took care of him. But you would never think that way if you were with a health insurance plan. So I think there's something behavioral. We see it in the Amish communities where these. The Amish actually have a very similar thing where they all care for themselves. They're a part of the community, they feel accountable to one another. If we can have little crowds like that for your specific tribe, I think that would be really cool.
Alex Clark
Well, I'm really interested in this. And, you know, you guys are not a sponsor of the show or anything. I just am really impressed by what you guys do, and I wanted to learn more, and I thought it would be really beneficial to my audience. Especially after my episode with Brigham explaining corruption healthcare. Like, a lot of people were asking me questions like, well, now what? I don't know what to do. I don't understand. Like, okay, he says, like, you don't necessarily need insurance the way you think you do, but now what? And, like, we didn't really answer that question in that episode because I knew that I had you coming up in the next couple months. So I was excited to kind of explore that with you. You know, I take the turning point. USA health insurance. But now I'm like, ooh, maybe I'll opt out and. And do this instead. So if people want to learn, first of all, if you contact crowd health, tell them you are calling because you heard the Culture Apothecary episode. I want them to know how many of you called because of this. But where do they go? How do they. How do they get involved?
Andy Schoonover
Yeah, go to joincrowdhealth.com and you can sign up right away. The sign up is like five minutes. It's super easy. So we're not doing any, like, pre screenings or anything like that. It's a super easy signup process. You can start whenever you want, you can end whenever you want. So it's just month to month. Or you can. There's a little appointment setter on the. On our webpage where you can set up an appointment with somebody to talk about some of the questions that you have. So, okay, join CrowdHealth.com and you can use code culture and we'll give you 99 bucks for the first three months.
Alex Clark
I didn't know that. Okay, cool. Okay, good. We'll put that in the show notes. The description of the episode too, if you forget what he just said, like, what was it? Just go back and click the description. Okay, so I ask every guest this to wrap every interview. If you could offer one remedy to heal a sick culture, physically, emotionally, or spiritually, what would that remedy be?
Andy Schoonover
Community. Yeah, I mean, I think that every time we've gone through a really hard thing in life. My wife and I lost our first daughter right after she was born. She lived for ten and a half hours. I mean, we could not have made that through without our. Our community. You know, I think we. We do have a society that's kind of like the self actualization, self sovereignty, autonomy, and it feels good. But I think, man, like, if you don't have community, then what do you. What are you doing it all for?
Alex Clark
Yeah.
Andy Schoonover
You know, I think it kind of goes right back to what Jesus talks about, which is love your neighbor. And so if you don't have a neighbor to love, you can't really love your neighbor very well. Right. So I think that just a really great community of people, man, if everybody had a great community, I think we would solve a lot of these issues.
Alex Clark
Phenomenal. Andy, thank you for coming on Culture Apothecary.
Andy Schoonover
Thanks for having me.
Alex Clark
I'd be really curious to know if anyone in my audience uses crowd health and what your experience has been discuss in the cute servatives Facebook group. I'm in there. I love to read what you have to say about each episode. Please leave a five star review and tell others why they've got to start listening to Culture Apothecary. We're on a mission to heal a sick culture twice a week, Mondays and Thursdays, where an expert guest brings their own unique remedy to do just that. Subscribe to Real Alex Clark on YouTube. Follow me on Instagram at Real Alex Clark. You can also shop show merch tpusamerch.com with code Alex Clark for 10% off. I'm Alex Clark and this is Culture Apothecary.
Culture Apothecary with Alex Clark
Episode: Ditch Traditional Health Insurance: Gain Freedom | CrowdHealth CEO Andy Schoonover
Release Date: April 25, 2025
In this compelling episode of Culture Apothecary with Alex Clark, host Alex engages in an insightful conversation with Andy Schoonover, the CEO and founder of CrowdHealth. The discussion delves deep into the inherent flaws of the American healthcare system, Andy's personal journey away from traditional health insurance, and the innovative community-driven alternative that CrowdHealth offers.
Andy Schoonover begins by addressing the fundamental question: Why is healthcare broken in America?
[02:12] Andy Schoonover: "You've got the buyers of healthcare who are these big health insurance plans... and the sellers of healthcare, which are these big hospital systems, they want the prices to go up."
He explains that both health insurance companies and hospital systems are financially incentivized to increase healthcare costs. The Affordable Care Act (Obamacare), while intended to regulate profits, inadvertently contributed to rising premiums by limiting insurers to a 15% profit margin of premiums. This constraint pressures insurers to escalate healthcare costs to grow their profits within the allowed margin.
Andy shares a pivotal personal story that exemplifies the system's failure:
[04:31] Andy Schoonover: "My little one... got an $8,000 bill from the hospital for a procedure deemed 'medically unnecessary' by our insurance."
Despite following all protocols, his daughter's necessary medical procedure was denied coverage, leading to a significant personal financial burden. This experience, coupled with statistics showing that 1 in 5 claims are denied by insurance companies—resulting in 200,000 people going bankrupt annually—prompted Andy to abandon traditional health insurance entirely.
Andy elucidates the principal-agent problem within the healthcare sector:
[19:56] Andy Schoonover: "The people that we trust to pay our bills... are actually not acting in our best interest."
Insurance companies prioritize profit over patient care, often denying claims to maintain or increase profitability. This conflict of interest undermines the very purpose of insurance, which is to provide financial protection in times of medical need.
The conversation touches upon the arbitrary nature of medical necessity determinations:
[09:22] Andy Schoonover: "They decide on medical necessity based upon how well their profitability is doing during that year."
Insurance companies employ algorithms that fluctuate the strictness of claim approvals based on their financial performance, making access to necessary medical care inconsistent and dependent on the insurer’s profit motives rather than patient needs.
Andy advocates for direct pay models, where patients pay doctors directly without intermediary insurance companies:
[07:44] Andy Schoonover: "If I can pay cash for my procedures or pay the doctor directly, I was getting significantly better prices than United Health Care."
This approach not only reduces administrative burdens and costs but also fosters a more transparent and patient-centered healthcare experience. Independent doctors, who rely on word-of-mouth and direct payments, are incentivized to provide higher-quality care.
Highlighting systemic issues, Andy discusses how the current healthcare model favors symptom treatment over disease prevention:
[12:13] Andy Schoonover: "The incentive system... they want to get you on long term, chronic conditions because you become recurring revenue."
This perpetuates a cycle of ongoing medical interventions, driving up costs and contributing to poorer health outcomes, such as increased obesity rates and related chronic conditions in the U.S., which are significantly higher compared to other developed nations.
The episode delves into the role of government policies and corporate lobbying in sustaining the dysfunctional healthcare system:
[26:01] Andy Schoonover: "The amount of regulation that is required to be in healthcare is astronomical."
Pharmaceutical companies and health insurers exert substantial influence over legislation, often prioritizing corporate profits over public health needs. This entrenched power structure stifles meaningful reform and perpetuates inefficiencies within the system.
While addressing comparisons with other countries, Andy critiques the single-payer system in Canada:
[29:27] Andy Schoonover: "You have quality, speed, and price. You can only have two out of the three."
He argues that while Canada excels in cost management, it compromises on quality and speed, with long wait times and limited choices for patients. In contrast, the U.S. offers higher quality and faster services but at exorbitant prices. Andy posits that a sustainable solution requires balancing these factors without sacrificing one for the others.
CrowdHealth emerges as a groundbreaking alternative to traditional health insurance, built on community-based crowdfunding. Unlike conventional insurers, CrowdHealth facilitates direct financial support from community members to cover healthcare costs.
Andy outlines the operational framework of CrowdHealth:
[38:06] Andy Schoonover: "Our member will pay the first $500 of that health event... then we'll go to the community and ask 45 people... to help out this family with $100 each."
When a member incurs a medical expense, the initial portion is covered by their own contributions, after which the community collectively funds the remaining costs. This peer-to-peer support system ensures that large medical bills are manageable without the overreach of traditional insurance policies.
The effectiveness of CrowdHealth is illustrated through various cases:
[54:20] Andy Schoonover: "We negotiated a nearly $1 million bill down to $200-250,000, which was fully crowdfunded."
These real-life success stories demonstrate CrowdHealth's capacity to handle significant medical expenses efficiently, providing a lifeline for members facing overwhelming bills.
CrowdHealth maintains certain eligibility criteria to sustain its community-driven model:
[41:10] Andy Schoonover: "We ask you... to be a member of the community for two years before covering pre-existing conditions."
Additionally, lifestyle factors such as smoking and obesity are considered, promoting a healthier community ethos:
[56:14] Andy Schoonover: "If you are obese... we have had people lose weight and transform their lives through CrowdHealth."
Andy envisions a future where CrowdHealth scales to millions, fostering specialized communities based on shared values and lifestyles:
[59:07] Andy Schoonover: "I want to continue this community feel where we are a part of our tribe... like vegetarians, carnivores, Christian, Jewish, etc."
This approach aims to create tightly-knit support systems that prioritize mutual aid and accountability, ultimately revolutionizing how healthcare is accessed and financed.
In wrapping up, Andy emphasizes the importance of community in healing societal and healthcare woes:
[62:10] Andy Schoonover: "Every time we've gone through a really hard thing in life... we could not have made that through without our community."
Alex echoes this sentiment, highlighting that fostering strong, supportive communities can address the emotional and financial strains imposed by the current healthcare system.
Andy Schoonover [00:00]: "Stay out of the hospital at all costs unless you absolutely have to."
Alex Clark [00:04]: "The average American thinks that because they have health insurance, they're going to be safe and taken care of in a true emergency."
Andy Schoonover [03:24]: "Obamacare definitely juiced it. So you can see the trend and cost for health care once Obamacare was signed, it tweaked up."
Andy Schoonover [07:24]: "I do disagree with him on that."
Andy Schoonover [09:22]: "They decide on medical necessity based upon how well their profitability is doing during that year."
Andy Schoonover [12:13]: "The incentive system... they want to get you on long term, chronic conditions because you become recurring revenue."
Andy Schoonover [19:56]: "The people that we trust to pay our bills are actually not acting in our best interest."
Andy Schoonover [38:06]: "Our member will pay the first $500 of that health event... then we'll go to the community and ask 45 people... to help out this family with $100 each."
Andy Schoonover [62:10]: "Every time we've gone through a really hard thing in life... we could not have made that through without our community."
This episode of Culture Apothecary serves as a crucial exposé on the systemic issues plaguing American healthcare and introduces CrowdHealth as a viable, community-centric alternative. Andy Schoonover's insights and personal experiences shed light on the potential for grassroots solutions to revolutionize healthcare access and affordability.
For listeners grappling with the complexities of the current system, this episode offers both a critique and a beacon of hope, advocating for a return to community-based support and direct patient care.