Speaker 1: Pushkin. The first time I since we all had a
Speaker 1: serious problem that might one day lead to our doom
Speaker 1: was when I was working on Wall Street. The problem
Speaker 1: had to do with experts. People making important decisions had
Speaker 1: no idea who they should listen to or who they shouldn't,
Speaker 1: even when millions of dollars were at stake. I was
Speaker 1: a twenty five year old art history major with zero
Speaker 1: training in finance. Then I got hired to work on
Speaker 1: Wall Street, where I got paid hundreds of thousands of
Speaker 1: dollars to persuade professional money managers to do things with
Speaker 1: millions of dollars. Obviously, I had no real idea what
Speaker 1: to do with money, yet I was taken as the expert. Hello,
Speaker 1: and welcome once again to this is Wall Street here
Speaker 1: on wmi N Radio. Today's special guest is Michael Lewis.
Speaker 1: He's the author of The Money Culture and former bond
Speaker 1: trader for Solomon Brother. What's in the future for yourself?
Speaker 1: I know you're a pretty young man, aren't you. I
Speaker 1: just turned thirty one. That young well feel and all
Speaker 1: would say so it feels old. In nineteen eighty nine,
Speaker 1: I wrote a book called Liars Poker, in which I
Speaker 1: explained how I and a lot of other people on
Speaker 1: Wall Street got paid a bunch of money to give
Speaker 1: advice that was either wrong or pointless. In this book,
Speaker 1: I proved beyond a shadow of a doubt that I
Speaker 1: was not a financial expert. And yet when I hit
Speaker 1: the road to sell liars poker, people still ask me
Speaker 1: what should I do with my money? From the Midwest,
Speaker 1: especially for some reason, from Ohio, I am inundated with
Speaker 1: letters from young people who have treated everything I've written
Speaker 1: is sort of a how to manual, and it's almost
Speaker 1: that they can't conceive as a book as anything but
Speaker 1: advice and self help. All my books are the same
Speaker 1: in one crude way. I start out knowing very little
Speaker 1: about the subject. I go find actual experts, people who
Speaker 1: know stuff, and write stories about them. To my mind,
Speaker 1: all I'm doing is describing great characters in some interesting
Speaker 1: situation a financial crisis, a professional sport and turmoil, a pandemic. Yeah.
Speaker 1: I learn some things about those situations, but pretty much
Speaker 1: everything I know about, say, the origins of the two
Speaker 1: thousand and eight financial crisis, I know from the people
Speaker 1: I've written about. They are the experts. I'm just a
Speaker 1: guy who writes books about them. Still, the pressure from
Speaker 1: me to swan around as the true expert is incredible.
Speaker 1: Do you think that's what they believe? Well, that's not
Speaker 1: true right now, but I think do I think they
Speaker 1: believe that after they pass this legislation that will be true? Yes,
Speaker 1: I do think that. I do believe that. I think
Speaker 1: that it's flattering to be treated as the guy with
Speaker 1: the answers, more than flattering, seductive. But still, after a
Speaker 1: book comes out, I usually find myself thinking, why on
Speaker 1: earth are you asking me? Ask the people who told
Speaker 1: me everything I know. I pick him because I thought
Speaker 1: we should all be listening to them. They're the ones
Speaker 1: you should ask why were they unable to convince those
Speaker 1: in power to do something sooner? And I think the
Speaker 1: answer is that this particular threat, when you're on TV,
Speaker 1: you can never just say I don't know. But but
Speaker 1: beyond that, I mean, with a threat like this, he
Speaker 1: almost requires you can't say I don't know because you're
Speaker 1: the expert, and you're the expert because you're on TV
Speaker 1: that you're dealing with You're dealing with an invisible enemy
Speaker 1: that replicates exponentially, and by the time I'm Michael Lewis.
Speaker 1: Welcome back to season three of Against the Rules, where
Speaker 1: we explore unfairness in American life by looking at what's
Speaker 1: happened to various characters in American life. Our first season
Speaker 1: was about referees, Our second was about coaches. This season's
Speaker 1: about experts. We're going to tell seven stories about them.
Speaker 1: Each contains a clue to a mystery at the heart
Speaker 1: of American life. How come a society so great at
Speaker 1: creating knowledge is so bad at using it. How can
Speaker 1: we know more and more yet behave as if we
Speaker 1: know less and less. How can one people be so
Speaker 1: incredibly smart and so breathtakingly moronic? The experts are terrible.
Speaker 1: The Pandemics taught us a bunch of things. That bosses
Speaker 1: missed the office more than their employees, That our centers
Speaker 1: for disease control aren't very good at controlling disease. That
Speaker 1: these United States aren't all that interested in being united
Speaker 1: even in a crisis. Mister President, Please listen to your
Speaker 1: public health experts instead of denigrating them. But the Pandemics
Speaker 1: also taught us something about experts. How fraught our relationship
Speaker 1: with him has become, how hard it is for us
Speaker 1: to decide who they are and how to use them,
Speaker 1: even when it's a matter of life and death. But
Speaker 1: who cares what I think. I'm not an expert. I
Speaker 1: just find the people who are. Hi. I'm Todd Park,
Speaker 1: healthcare and tech entrepreneur and former public servant. Case in point.
Speaker 1: I've been in the succession of situations of great opportunity
Speaker 1: or great crisis and had to help figure out what
Speaker 1: to do very quickly. Todd Parks created three different billion
Speaker 1: dollar companies. He solved some very big problems on behalf
Speaker 1: of the American government. But he built his career on
Speaker 1: a single insight that the experts you most need are
Speaker 1: often not who you think they are. Just finding the
Speaker 1: expert can be incredibly difficult, especially when all hell is
Speaker 1: breaking loose called blue back. In nineteen ninety seven, Todd
Speaker 1: was a consultant fresh out of the Harvard Business School.
Speaker 1: Like a lot of people who go by the name
Speaker 1: of consultant, he didn't really want to be a consultant,
Speaker 1: so he went looking for a business idea, a problem
Speaker 1: to solve. He and another consultant, who was married to
Speaker 1: a midwife, nurse and training settled on a really big idea.
Speaker 1: The beginning of life, specifically pregnancy. To the eyes of
Speaker 1: a male management consultant in nineteen ninety seven, pregnancy is
Speaker 1: conducted in the United States seemed wildly inefficient. Women and
Speaker 1: their babies were having all kinds of expensive medical problems
Speaker 1: that could have been avoided with better prenatal care. By
Speaker 1: keeping women healthier during their pregnancies, you could also make
Speaker 1: childbirth less risky and cheaper. And so these two twenty
Speaker 1: four year old guys set out on this new mission.
Speaker 1: It was a bit weird. They weren't doctors, they didn't
Speaker 1: even have children. And essentially the whole idea is that
Speaker 1: you deploy a whole team of folks, not just the doctor,
Speaker 1: but surfinder's midwife, social worker, educator, case manager, nutritionist to
Speaker 1: love on a mom to be and get her the
Speaker 1: right care, including very importantly non clinical support. Todd and
Speaker 1: his partner named their company Athena Health. They hired a
Speaker 1: few more people much like themselves, smart young guys. They
Speaker 1: raised millions of dollars and used some of the money
Speaker 1: to buy a childbirth clinic in San Diego. It mainly
Speaker 1: served women especially prone to bad outcomes during pregnancy. Undocumented immigrants,
Speaker 1: for instance, The clinic was the test case for Athene
Speaker 1: of Health. If it worked, the company would create a
Speaker 1: lot more of them. So you know, now, all of
Speaker 1: a literally overnight, we are now on the hook for payroll, rent,
Speaker 1: all of this stuff and the revenue. That's Bob Gatewood.
Speaker 1: Todd had hired him to help. So almost immediately we
Speaker 1: started hemorrhaging money. You know, claims were going out, but
Speaker 1: no money was coming in. The first pregnancy clinic was
Speaker 1: supposed to be like the first McDonald's or Starbucks proof
Speaker 1: of concept. The concept never had a chance because they
Speaker 1: couldn't get insurance companies to pay them to make pregnancy
Speaker 1: cheaper and better. In fact, they couldn't really get anyone
Speaker 1: to pay them for anything. Did you have any sense
Speaker 1: that was going to be a problem when you started. No,
Speaker 1: we thought, oh, billing is a solved problem. Everybody knows
Speaker 1: how to do that. The interesting thing is that electronic
Speaker 1: health records, the young entrepreneurs had thought they'd bought a
Speaker 1: business with they'd really bought was a crisis and a cause.
Speaker 1: We then said, okay, this is a very special practice.
Speaker 1: It's the public health safety net for so many women
Speaker 1: in San Diego County. We must save this practice. We
Speaker 1: cannot allow this practice to sink beneath the surface of
Speaker 1: the sea. And so we got plug all the stops
Speaker 1: and fight and figure out how to keep this thing afloat.
Speaker 1: So you go from like whiz bang entrepreneur who's going
Speaker 1: to build a huge company on the basis of an idea,
Speaker 1: to being philanthropist trying to save the safety net for
Speaker 1: San Diego County. That's exactly right. But in order to
Speaker 1: save the safety net, Todd Park realized he and his
Speaker 1: partners had to solve the problem that hadn't even occurred
Speaker 1: to them, the problem of not getting paid by the
Speaker 1: health insurance system. Those system is maybe too kind a
Speaker 1: word for it. Essentially, what's happened in the United States
Speaker 1: is that you've got a lot of different health insurance
Speaker 1: companies and they have invented a lot of different kinds
Speaker 1: of health insurance products HMO Ppo pos m bas pos
Speaker 1: pos pos, all right, and then like employers like to
Speaker 1: customize those just for them. So there's like the ge
Speaker 1: version of the HMO based pos product for Wisconsin. There's
Speaker 1: not even an alternate universe. With the design of the
Speaker 1: US health insurance system makes sense, you could not build
Speaker 1: it to be more confusing. But now that system was
Speaker 1: Todd's problem. There are countless called them insurance packages, like
Speaker 1: different flavors of insurance that have probleagate across the country,
Speaker 1: each of which has different rules associated with it with
Speaker 1: respect to how to build them. And these rules are
Speaker 1: really poorly documented. They're very opaque, they're changing all the time,
Speaker 1: and medical doctors and medical officers have no idea what
Speaker 1: they are right, so they'll basically put together a claim
Speaker 1: to bill for their medical office visit. They'll send in
Speaker 1: the claim and it will get rejected. No one insurance
Speaker 1: company set out to create the confusion, but no one
Speaker 1: had any incentive to clear it up. I mean, the
Speaker 1: harder it was for doctors to figure out how to
Speaker 1: get insurance companies to pay them, the less the insurance
Speaker 1: companies ultimately paid out to the doctors. Todd Park now
Speaker 1: knows this because his last resort clinic full of pregnant women,
Speaker 1: is getting buried under unpaid bills. The payers send back
Speaker 1: this thing called explanation of benefits, which is really kind
Speaker 1: of misstormers doesn't really explain anything, says, here's your claim.
Speaker 1: It was denied for denial code zero five B and
Speaker 1: you look at the code at in the legend at
Speaker 1: the bottom of the EOB and you know it says
Speaker 1: something like, you know, insufficient documentation or something like something
Speaker 1: incredibly vague and not helpful. So then you pick up
Speaker 1: the phone and you call the health insurance company and
Speaker 1: get some port animals who also has no idea what
Speaker 1: that code means. Right as a super frustrating Right. But
Speaker 1: the problem is there is a knowledge base of rules
Speaker 1: at the payer that's totally opaque to the doctor and
Speaker 1: frankly pretty opaque to the payer, so they don't even
Speaker 1: know their own rules exactly. Todd and his fellow company
Speaker 1: founders needed an expert, someone who had mastered all the
Speaker 1: rules created by America's health insurance companies, someone who knew
Speaker 1: how to get those companies to pay a bill. Bob
Speaker 1: Gatewood kept seeing artifacts of this expertise. Every one of
Speaker 1: these doing offices we walked into. Every single screen monitor
Speaker 1: was covered in sticky nose like the whole margin of
Speaker 1: the monitor, and so we would always point at the
Speaker 1: sticky notes and ask the person what's that, and she
Speaker 1: would say, and most often a sheet she would say, Oh,
Speaker 1: that's you know that reminds me that if a midwife
Speaker 1: does the delivery, I have to put a c Z
Speaker 1: modifier on the code or you know. Here, This one
Speaker 1: reminds me that ETNA only reimburses for a gim visit
Speaker 1: every eighteen months, not twelve months. So I got to
Speaker 1: remember not to schedule an ETNA patient too soon. And
Speaker 1: there were thousands and thousands and thousands of these things.
Speaker 1: Medical billing had become so complicated that hospitals were now
Speaker 1: employing a medical biller for each and every doctor. Todd
Speaker 1: and Bob noticed the successful medical billers were all of
Speaker 1: a type. Gladys they called her super type, a you know,
Speaker 1: won't let anything pass her, likes to hold people accountable
Speaker 1: for their mistakes, and it's just kind of pissed all
Speaker 1: the time, like angry that they're not getting paid what
Speaker 1: they should. So at that moment, given what you're you've
Speaker 1: just learned about just how critical Gladys is and how
Speaker 1: important like the business succeeds or fails on whether Gladys
Speaker 1: is on vacation or Gladys is. This strike you how
Speaker 1: odd it is that Gladdis isn't valued. Well, that's part
Speaker 1: of why she's pissed probably unless you know, sometimes Gladys
Speaker 1: was the wife of the surgeon, right right, they were
Speaker 1: all women. I'm not but I'm not being sexist. No, No,
Speaker 1: every single one we met was a woman. But yeah,
Speaker 1: there were a lot of pissed off Gladyses who felt undervalued.
Speaker 1: By the late nineteen nineties, the financial fate of entire
Speaker 1: hospitals turned on Gladys. It occurred to Bob and Todd
Speaker 1: Park that they stumbled under a better business idea, find
Speaker 1: the best Gladdys in the world. If she actually existed.
Speaker 1: If I had found you when you were I don't know,
Speaker 1: twelve years old and asked you what you were going
Speaker 1: to be when you grew up, what might you have said?
Speaker 1: I was going to be an accountant. This is Sue
Speaker 1: Henderson medical biller. Seriously, it's very very, very very exciting.
Speaker 1: And the reason was math was just so simple for me.
Speaker 1: Everything about it was so incredibly logical, and it just
Speaker 1: seemed a great path for me. You killed your dreams early.
Speaker 1: I was very practical and I'm an very very organized individual,
Speaker 1: probably leaning a little bit on the OCD side, and
Speaker 1: so in accounting there isn't any gray. So if you're
Speaker 1: doing the books, then it's a penny off. It's wrong someplace.
Speaker 1: You have to figure out where that penny is, and
Speaker 1: you can't just take it and tape it into the
Speaker 1: books and then close them. Sue Henderson discovered medical billing
Speaker 1: almost by accident back in the nineteen eighties. Accounting had
Speaker 1: captured her imagination. Medical billing she found even more thrilling,
Speaker 1: which was in and of itself kind of amazing. You know,
Speaker 1: medical billers generally are housed in basements I'm not exaggerating
Speaker 1: of hospitals or practices without a window, and they're not appreciated.
Speaker 1: And it's kind of fascinating because if you didn't have
Speaker 1: medical billers, you can render all the services you want,
Speaker 1: and if you're never going to get paid, you're gonna
Speaker 1: go out of business. They're definitely unappreciated across the board.
Speaker 1: How do you explain that, given what you just said,
Speaker 1: that you're going to go out of business if your
Speaker 1: medical biller is no good? Because I don't think that
Speaker 1: I shouldn't say I don't think. I know. Doctors are
Speaker 1: not financial people. They care about patients. That's what they
Speaker 1: care about. The doctor. Sue works for it don't really
Speaker 1: get what she does or how she does it. They
Speaker 1: just leave her alone to play what is about to
Speaker 1: become a very high stakes game. So when you first
Speaker 1: get into medical billing, medical billing isn't anything like as
Speaker 1: complicated as is going to become correct. A lot of
Speaker 1: medical billers were overwhelmed by the complexity, but Sue kind
Speaker 1: of liked it. She sat in the basement of a
Speaker 1: hospital in northern Massachusetts, but is ready to fly. When
Speaker 1: would have been the first time where you walked into
Speaker 1: a job and you increased the receipts because you were
Speaker 1: billing better. Well, that definitely would have been Holy Family Hospital.
Speaker 1: And with when and when would that have been? That
Speaker 1: would be in the middle of my career nineteen eighties,
Speaker 1: in the eighties, Ye, in the eighties. Yeah, And so
Speaker 1: that's a moment where you walk in and just by
Speaker 1: virtue of your command of the complexity, you're able to
Speaker 1: generate more payment to the hospital. It was a combination
Speaker 1: of complexity, and it was a combination of looking at
Speaker 1: a department that was just so unbelievably mismanaged. They had
Speaker 1: a quarter of a million dollars in unapplied payments from
Speaker 1: the Medicaid system sitting. What does that mean? What does
Speaker 1: that mean? The moment I asked the question, I knew
Speaker 1: I didn't actually want to know the answer. Well, okay,
Speaker 1: so what happens is Medicaid is sending you all of
Speaker 1: these payments and you don't have a claim to which
Speaker 1: they can to be applied. So either you didn't send
Speaker 1: that claim out. The details of what Sue Henderson does, well,
Speaker 1: even she has trouble making it sound interesting, and she's
Speaker 1: more interested in the details than perhaps anyone in the world.
Speaker 1: What's the secret to getting the revenue getting the money
Speaker 1: out of the insurance? Unfortunately, is playing by their rules.
Speaker 1: That's the unfortunate part. There's simply now no way around that.
Speaker 1: And so if they're saying you need a modifier fifty five,
Speaker 1: you need a modifier fifty five period, end of sentence,
Speaker 1: there's no way around it, and it's just playing by
Speaker 1: their rules. What's a modifier fifty five? I don't actually
Speaker 1: care about a modifier fifty five. The modifier fifty five
Speaker 1: would be a second I won't describe it exactly, but
Speaker 1: it would be a second procedure code that is appropriate
Speaker 1: with the initial procedure code. So it's there. They are
Speaker 1: hundreds of versions of this problem with medical billing where
Speaker 1: there's some nitty detail that if you leave it off,
Speaker 1: you just don't get paid. There are thousands of them,
Speaker 1: and over time they were basically in your head. There
Speaker 1: were a lot of them in my head. Did you
Speaker 1: have you run across anybody, any medical billers who who
Speaker 1: felt like you're equal? Oh, that's a very I can't
Speaker 1: answer that question because because I'm I'm quite sure there are.
Speaker 1: I'm quite sure there are there are other people is
Speaker 1: equally knowledgeable. Absolutely, I don't know. You just haven't met them.
Speaker 1: I haven't met them. Over two decades in windowless rooms
Speaker 1: in clinics and hospitals in the Greater Boston area, Sue
Speaker 1: Henderson makes herself not just valuable, but close to irreplaceable. Then,
Speaker 1: in the summer of nineteen ninety nine, she sees a
Speaker 1: want ad on monster dot Com for a medical biller
Speaker 1: from a startup called Athena Health, based in San Diego
Speaker 1: but with an office in Boston. It's Todd Park, struggling startup.
Speaker 1: Sue applies, She gets an interview, they reject her, but
Speaker 1: a few weeks later they call her back with a
Speaker 1: bizarre request. He wasn't offering me a job. He was
Speaker 1: asking me, could I come for lunch to meet with
Speaker 1: some potential investors that were coming, so that they could
Speaker 1: kind of convince these investors that they had somebody who
Speaker 1: knew what he or she was doing and convinced them
Speaker 1: that this was a good idea to invest in the company.
Speaker 1: So they were bringing you on as an expert in
Speaker 1: medical billing to demonstrate to investors they knew about medical billing. Yep.
Speaker 1: So I said, okay, you don't burn your bridges. So
Speaker 1: I went over and we had lunch in the little
Speaker 1: restaurant and I sat there for an hour and a half,
Speaker 1: having lunch and being grilled by these investors about what
Speaker 1: I knew about medical billing, as though I had already
Speaker 1: been hired. And I did this three times. I didn't
Speaker 1: get paid for anything except I had a lovely free lunch,
Speaker 1: And finally, at the end of the three lunch process,
Speaker 1: Bob Gatewood called and said, we'd really like to hire you.
Speaker 1: Apparently I had convinced everybody I knew what the heck
Speaker 1: I was doing. Of course she knew, and of course
Speaker 1: Todd and Bob could see that they needed her, and
Speaker 1: if they could just bottle her expertise, she might make
Speaker 1: everyone rich. Welcome back to against the rules, we shall,
Speaker 1: I take it without the storm. There's no reason why
Speaker 1: we shall unless the dance blob. There's a strange British
Speaker 1: play written in the early nineteen hundreds called The Admirable Creighton.
Speaker 1: It was written by jam Barry, who's more famous for
Speaker 1: Peter Pan. I only saw it once, but I've never
Speaker 1: been able to get it out of my head. In
Speaker 1: The Admirable Creighton, an upper class British family is shipwrecked.
Speaker 1: They all wash up on a deserted island, along with
Speaker 1: their butler named Creighton h Okay, then town a transport
Speaker 1: and bring it back with him. Good my Lord. After
Speaker 1: the shipwreck, the butler, Crichton, behaves at first as he
Speaker 1: always has. He bows and scrapes and speaks only when
Speaker 1: spoken to. But on the island he's the only one
Speaker 1: who has any idea how to survive. The nobility or
Speaker 1: forced to admit it and defer to him lest they starve,
Speaker 1: and by the end he's king of the island. The
Speaker 1: British Lord is Crichton's slave, and his daughters are the
Speaker 1: Butler's harem in waiting, and the Lord is freaking out.
Speaker 1: I should give the honors, and you want abate them
Speaker 1: with the deepest respect, my lord. The reason I can't
Speaker 1: get the admirable Crichton out of my head is because
Speaker 1: it's about the arbitrariness of social status and the way
Speaker 1: that status can disguise people's value. Athena Health is his
Speaker 1: own little island. Todd parks washed up on it with
Speaker 1: Sue Anderson. But he's a first a bit unclear about
Speaker 1: how to maximize her value. So he called his brother.
Speaker 1: Tyd called me up and said, can you we need
Speaker 1: some help? Can you help me? And so I said,
Speaker 1: of course, because when your older brother calls you, you
Speaker 1: basically say yes. This is Ed Park. He was just
Speaker 1: then a twenty two year old graduate of Harvard, where
Speaker 1: he'd run the computer science club. And so I packed
Speaker 1: up all my things and no drove in my ten
Speaker 1: year old Taylor camera in a three day sprint out
Speaker 1: west to join him in San Diego. It wouldn't have
Speaker 1: been a startup if there wasn't a story about an
Speaker 1: old Toyota camera. Once Ed stopped driving, he took a long,
Speaker 1: hard look at the health insurance industry. We went through
Speaker 1: and we tried to figure out what are all these rules,
Speaker 1: and then we pretty quickly figured out that the rules
Speaker 1: weren't written down anywhere. The only people who knew the
Speaker 1: rules were people who would actually worked in the industry
Speaker 1: and had been incredibly observant for the last five years,
Speaker 1: people like Sue Henderson, or perhaps no one but Sue Henderson. Anyway,
Speaker 1: Todd ned figured out that what Ed needed to do
Speaker 1: was go into a room with Sue to see if
Speaker 1: he could replicate her brain in computer code. And so
Speaker 1: Ed drove his camera back to the Boston suburbs. I
Speaker 1: still remember the offices that we were working in. There
Speaker 1: were these tiny little offices, I think, with the requisite
Speaker 1: three or four people to an office. She's sort of
Speaker 1: the next office over, and I was heads down coding,
Speaker 1: and that was like, what do I need to code
Speaker 1: to make this thing work? And so her job was
Speaker 1: to basically help us get paid, and my job was
Speaker 1: to try and figure out how to write a bunch
Speaker 1: of code to make it so that we could start
Speaker 1: doing it in a way that was semi replicable. For
Speaker 1: her part, Sue was struck by just how much was
Speaker 1: in her head that was not in theirs. Yeah, I think,
Speaker 1: and probably Eddie would, and he's going to kill me
Speaker 1: because I call him Eddie all the time. I think
Speaker 1: that Eddie probably understood the fact that they had all
Speaker 1: his complexities. But I think that he thought, with all
Speaker 1: of these brilliant programmers, that they could figure it out
Speaker 1: all by themselves, that they could just figure it out.
Speaker 1: It was a few days into it when Sue realized
Speaker 1: that Ed and I really had no idea what we
Speaker 1: were doing. So she sets astounished, just like boys, shut up,
Speaker 1: I'm gonna give you a little lesson, and she taught
Speaker 1: us about like how the accounting works. Bob Gatewood is
Speaker 1: remembering the day on the island when it became clear
Speaker 1: who was the admirable Crichton. Well after she gave us
Speaker 1: that lesson, and we're like, oh, yes, we will follow you.
Speaker 1: We are your grasshoppers. And so, you know, she was
Speaker 1: basically the product manager at that point, so she, you know,
Speaker 1: she would tell us what the system needed to do
Speaker 1: and we would go do it. And we bought her
Speaker 1: hay hold, did you tell you about Hazel the big print?
Speaker 1: So we got her a big claims print and she
Speaker 1: named it after her mother. So we have a gladys
Speaker 1: a Hazel in the suit. So I was sitting in
Speaker 1: one room, Sue was sitting out over in the next room.
Speaker 1: And every day I would code something and put it
Speaker 1: out there, and then you know that evening Sue would
Speaker 1: yell at me and so about something or other. I
Speaker 1: did in sort of say like, you can't, like I
Speaker 1: don't understand what you're doing. You can't do that, And
Speaker 1: I'm like, what do you mean. Then she would basically
Speaker 1: explain to me that, like, you need to make sure
Speaker 1: that the procedure code with the highest charge amount is
Speaker 1: put first on the claim because the insurance companies will
Speaker 1: like sometimes pay the first line in the claim and
Speaker 1: not the second, third, and fourth lines and the claim.
Speaker 1: So I'm like, I didn't know that. Great, I'll do that,
Speaker 1: and so then I would change it and then it
Speaker 1: would be that way from then on. This went on
Speaker 1: and on end on, not for weeks or months, for years.
Speaker 1: The first three years, ed Park worked eighteen hours a day.
Speaker 1: He had a sleeping bag and slept under his desk.
Speaker 1: By day he had listened to Sue. By night, he
Speaker 1: had turned what was in Sue's head into software. In
Speaker 1: the morning. I would kind of wake up at six
Speaker 1: or so, go to the bathroom. You know that. Do
Speaker 1: you remember that pink soap, that the clear pink soap
Speaker 1: that you sometimes get from from those dispensers from a
Speaker 1: long time ago. I basically take that stuff runs from
Speaker 1: my hair like you know, shampoo and the sink, and
Speaker 1: go back to my desk and keep programming. So that
Speaker 1: was That's the kind of life I led. This weird
Speaker 1: new version of a theme of health now totally depends
Speaker 1: on the value of one woman's expertise, even though no
Speaker 1: one else had ever seen special value in Sue Henderson
Speaker 1: or considered the stuff in her head and expertise in
Speaker 1: a funny way, that's why there's money to be made here.
Speaker 1: Up until now, no one, not even really Sue herself,
Speaker 1: has figured out how valuable Sue is. If I basically
Speaker 1: had asked her to go into the middle of a
Speaker 1: room and basically gave her a stack of paper and said,
Speaker 1: please write out everything you know about billing, she would
Speaker 1: not have produced the things that were necessary for us
Speaker 1: to be successful. Instead, she'd had a set of experiences
Speaker 1: such that when she got placed into a sort of situation,
Speaker 1: which I often did. I'd put her into a situation
Speaker 1: where somebody didn't make sense right. Then she would basically
Speaker 1: say she would immediately recognize that something was wrong, and
Speaker 1: she'd basically searched her database, her head and said and
Speaker 1: ask herself, why is this wrong? The smart young Harvard
Speaker 1: graduates are trying to fix a big problem in the
Speaker 1: healthcare system, but what they're really doing is exploiting the
Speaker 1: world's inability to see the expert. It's expert blindness. Sue
Speaker 1: had a sense of moral indignation when something was wrong, right,
Speaker 1: And so there are some people who are essentially the
Speaker 1: unsung experts. But you get them into a room and
Speaker 1: you present them with something wrong and they won't tell
Speaker 1: you right, like they're trying to read the room. They're
Speaker 1: trying to figure out what you think the answers should be,
Speaker 1: and they don't tell you that, like you're full of crap. Right.
Speaker 1: Sue did not have that problem. If she thought it
Speaker 1: was wrong, she would say, Eddie, I think you're wrong,
Speaker 1: and she would tell me in no. In certain terms,
Speaker 1: you get this sense that there are certain things in
Speaker 1: the world. In particular for Sue was medical billing, for
Speaker 1: which they have a sense of moral indignation that they
Speaker 1: can't hide. She cared a lot, Yes, she cared a lot.
Speaker 1: Did you at any point think or wonder if there
Speaker 1: was someone who was even better than Sue at this
Speaker 1: or did you think all along, Wow, we probably have
Speaker 1: the best. I couldn't conceive of anyone who knew more
Speaker 1: than her Like I would say, it was three or
Speaker 1: four years until we got to the point where it
Speaker 1: was clear that we had something that did justice to
Speaker 1: the knowledge in her head. The content of Sue Henderson's
Speaker 1: mind became a five billion dollars software company. It has
Speaker 1: been one month since Athena Health announced the deal to
Speaker 1: be acquired by Veritas Capital, and Sue got a bit rich.
Speaker 1: But in the bargain, she saved the US economy a
Speaker 1: small fortune. By selling medical billing software to doctor's offices,
Speaker 1: Athena Health changed the US healthcare system. Doctors would never
Speaker 1: again need their own medical biller. A single biller can
Speaker 1: now handle ten doctors. That biller is now in effect,
Speaker 1: Sue Henderson, Many of our doctors basically said to us, look,
Speaker 1: you saved my career. I would have gone out of
Speaker 1: business if it hadn't been for you guys. But maybe
Speaker 1: the most telling response to the power of Sue Henderson
Speaker 1: came from a big health insurance company. Or anyway, that's
Speaker 1: what Todd Park thought. So I get a call one
Speaker 1: day from a very powerful, very sophisticated national health insurance company,
Speaker 1: right way above average in terms of it technical and
Speaker 1: operational prowess. The insurance company had a bizarre request. They said,
Speaker 1: we'd like to license your rules engine from you. I said,
Speaker 1: I can't do that. I can't tell you what your
Speaker 1: competitors insurance rules are. They said, no, no, no, we
Speaker 1: want to license our own rules from you. The insurance
Speaker 1: company itself didn't understand why it paid some medical claims
Speaker 1: and not others. It was relieved that someone had figured
Speaker 1: it out. I said, well, let me get this straight.
Speaker 1: You want to license your own billing rules from us?
Speaker 1: They said yes. I said, okay, it's a little crazy.
Speaker 1: Can you just explain to me why? They said, well, look,
Speaker 1: you know, I mean, we have a bunch of different systems.
Speaker 1: We bought a bunch of different insurers. You know, there's
Speaker 1: a ton of spaghetti code in these disparate systems, and
Speaker 1: we don't really know what the hell's in there. That's incredible.
Speaker 1: It's incredible, right, it's incredible. And after that one insurance
Speaker 1: coming to that, did you find others also wanting to
Speaker 1: do it? Or we we said we said we was
Speaker 1: too weird, we couldn't do it, Okay. To recap this
Speaker 1: invisible woman becomes an expert in a subject no one
Speaker 1: really thinks of as especially important or even really a subject,
Speaker 1: and her expertise changes a massive industry in retrospect or
Speaker 1: At any moment, were you surprised by your value, like
Speaker 1: your value to this new business. I don't think most
Speaker 1: of the time that I realized my value. I think
Speaker 1: I was enjoying what I was doing, and I don't
Speaker 1: think that I was thinking, Wow, I'm I'm pretty valuable
Speaker 1: here and if I left, they'd be in big trouble.
Speaker 1: Sue Henderson's Todd Park's first business. But if you ask
Speaker 1: Todd Park, that was only the second most important things
Speaker 1: she did for him. The most important thing she did
Speaker 1: for him was to lead him to a bigger idea
Speaker 1: about where to find experts, especially in a crisis. Sue
Speaker 1: doesn't run the healthcare system. She doesn't run a hospital system,
Speaker 1: but she doesn't run a physician group. She doesn't run
Speaker 1: an insurance company, right, but she has an incredibly good
Speaker 1: sense on the ground of what is going on and
Speaker 1: an instinct for what to do to make things better. Right,
Speaker 1: So in the healthcare system, she is absolutely an L
Speaker 1: six the L six, the level six, the person six
Speaker 1: levels down from the top, the admirable cretens. That insight
Speaker 1: became Todd's new obsession that you might never find the
Speaker 1: expert who knows what you badly need to know because
Speaker 1: she's buried under some big organization or system. She has
Speaker 1: no status. She might have a voice, but no one
Speaker 1: hears it. After his experience with Sue Henderson, Todd Park
Speaker 1: basically became known as the guy who could find experts
Speaker 1: where no one else thought to look. During his first
Speaker 1: term in office, President Obama addressed the American people. Hello, everybody,
Speaker 1: I want to talk with you about a new consumer website,
Speaker 1: healthcare dot gov. It's a good resource for understanding the
Speaker 1: new law, and it offers a few simple tools to
Speaker 1: help you take your healthcare into your own hands. Obamacare
Speaker 1: Americans were now suddenly eligible to sign up for a
Speaker 1: new health insurance marketplace online. On October first, twenty thirteen,
Speaker 1: billions of uninsured Americans are going online. This is healthcare
Speaker 1: dot Gov. Hope to enroll in the Obamacare exchanges, but
Speaker 1: the websites have been experiencing technical glitches. Medical that's the
Speaker 1: sound of a crisis. Healthcare dot gov has crashed. It's
Speaker 1: not just embarrassing, it's a political disaster. After weeks of
Speaker 1: ignoring it, the White House finally admitting what everyone already knew.
Speaker 1: Healthcare dot gov is a mess. The White House is
Speaker 1: scrambling to find someone, anyone who can fix this nightmare.
Speaker 1: Obama has by now brought Todd Park in as Chief
Speaker 1: Technology Officer for the Department of Health and Human Services.
Speaker 1: We basically went to CMS, the agency in charge of
Speaker 1: healthcare dot gov that have been working it's heart out
Speaker 1: since the site went live in October twenty thirteen. Todd
Speaker 1: found that the people in charge didn't actually know why
Speaker 1: the site had crashed or how to fix it. Neither
Speaker 1: did the people right under the people in charge or
Speaker 1: the people right under them. We went down another layer,
Speaker 1: and then another layer, five layers down basically, and then
Speaker 1: we finally got to layer six, which is where all
Speaker 1: the contractors were who were working on the site, and
Speaker 1: found a really really difficult and tough situation. But long
Speaker 1: story short, at that layer and the layer beneath that layer, right,
Speaker 1: folks working for the people in charge of the contractors,
Speaker 1: and folks actually one layer beneath that found people who
Speaker 1: really understood at least part of the picture right and
Speaker 1: had deep domain expertise and had an instinct about what
Speaker 1: to do. Why the Obama administration hadn't found the people
Speaker 1: who knew how to fix their website on their own
Speaker 1: is a question for another day, But this kind of
Speaker 1: thing seems to happen over and over again. After the
Speaker 1: healthcare dot gov debacle. Todd always sent his tech teams
Speaker 1: into any crisis with a specific instruction find the l
Speaker 1: six I remember actually report out from one of the teams.
Speaker 1: They had been deployed to the State Department because I
Speaker 1: believe it was the visa processing system of America that
Speaker 1: had broken, and that was a huge problem obviously, And
Speaker 1: so he said, what did you do? He said, well,
Speaker 1: I went seven layers down and found two contractors who
Speaker 1: actually knew what the problem was. And he said, all
Speaker 1: I did was basically say, Okay, I'm going to take
Speaker 1: your solution and deliver it seven layers up and basically
Speaker 1: tell the people in charge, this technical fix needs to
Speaker 1: be executed. And it was, and then America was able
Speaker 1: to process visas again. Have you ever asked yourself why
Speaker 1: you stumbled upon this pattern as opposed to someone else? Oh,
Speaker 1: I don't think I am you in identifying the pattern.
Speaker 1: I guarantee you there are L sixes in your space
Speaker 1: and your organization, right. And the key to your success
Speaker 1: in addressing a problem or tapping into an opportunity is
Speaker 1: not you. It's not you, It is actually someone else
Speaker 1: and L six And you have to have the wisdom
Speaker 1: of your job is to find the L six and
Speaker 1: let them rock and roll. Find the L six Not
Speaker 1: the officially important person, not the public person, the person
Speaker 1: on TV, not the person that seems like he knows
Speaker 1: what he's talking about. No, you need to find the
Speaker 1: person who spent the last twenty years stuffed inside some
Speaker 1: basement without windows, quietly learning things, and who as a result,
Speaker 1: might not be very good at advertising themselves or what
Speaker 1: they know. There are some experts who, forever reason are
Speaker 1: really terrible explaining what is going on and what to do,
Speaker 1: either because they're just really terrible explaining or because they're
Speaker 1: not clear thinkers, or because they want to keep the
Speaker 1: secret sauce for themselves. In any given situation, you think
Speaker 1: it will be obvious who the expert is, it won't.
Speaker 1: We'll go right along believing that the people who happen
Speaker 1: to be on top are the most important people until
Speaker 1: we sense we cannot afford to believe that anymore, until say,
Speaker 1: some crisis arises, and just to survive, you need to
Speaker 1: find someone who actually knows the answer to your question.
Speaker 1: Against the Rules is written and hosted by me Michael
Speaker 1: Lewis and produced by Catherine Girardo and Lydia Jeancott. Julia
Speaker 1: Barton is our editor, with additional editing by Audrey Dilling.
Speaker 1: Beth Johnson is our fact checker, and Mia Lobell executive produces.
Speaker 1: Our music is created by John Evans and Thias Bossi
Speaker 1: of Stellwagon Symphonette. We record our show at Berkeley Advanced
Speaker 1: Media Studios, expertly helmed by tofer Ruth, Thanks also to
Speaker 1: Jacob Weisberg, Heather fag John Snars, Carly Migliori, Christina Sullivan,
Speaker 1: Eric Sandler, Maggie Taylor, Nicole Morrano, Royston Beserve, Daniela La Khan,
Speaker 1: Mary Beth Smith, and Jason Gambrel. Against the Rules is
Speaker 1: a production of Pushkin Industries. Keep in touch, sign up
Speaker 1: for Pushkin's newsletter at pushkin dot Fm, or follow at
Speaker 1: Pushkin Pods. To find more Pushkin podcasts, listen on the
Speaker 1: iHeartRadio app, Apple Podcasts, or wherever you listen to podcasts.
Speaker 1: In case you missed it, I recently recorded a new
Speaker 1: unabridged audiobook edition of my first book, Liars Poker. It's
Speaker 1: about Wall Street and how it became the place it is.
Speaker 1: You can buy the new Liars Poker audiobook at Pushkin
Speaker 1: dot fm slash Liar's Poker. You could also buy it
Speaker 1: at Audible or wherever audio books are sold