0:15

Pushkin. The

0:20

first time I since we all had a serious problem

0:22

that might one day lead to our doom

0:25

was when I was working on Wall Street. The

0:31

problem had to do with experts. People

0:34

making important decisions had no idea

0:37

who they should listen to or who they

0:39

shouldn't, even when millions

0:41

of dollars were at stake. I

0:43

was a twenty five year old art history major

0:45

with zero training in finance. Then

0:48

I got hired to work on Wall Street, where

0:50

I got paid hundreds of thousands of dollars

0:53

to persuade professional money managers to

0:55

do things with millions of dollars. Obviously,

0:58

I had no real idea what to do with money,

1:00

yet I was taken as the expert.

1:03

Hello, and welcome once again to this is

1:05

Wall Street here on wmi N Radio.

1:09

Today's special guest is Michael Lewis. He's

1:11

the author of The Money Culture and former bond

1:13

trader for Solomon Brother. What's in the future for yourself?

1:15

I know you're a pretty young man, aren't you. I

1:18

just turned thirty one. That young

1:20

well feel and all would say so it

1:23

feels old. In

1:25

nineteen eighty nine, I wrote a book called Liars

1:28

Poker, in which I explained

1:30

how I and a lot of other people on Wall Street

1:33

got paid a bunch of money to give advice

1:35

that was either wrong or pointless.

1:38

In this book, I proved beyond a shadow

1:40

of a doubt that I was not a

1:42

financial expert. And yet when

1:44

I hit the road to sell liars poker, people

1:47

still ask me what should

1:49

I do with my money? From

1:52

the Midwest, especially for some reason, from Ohio,

1:55

I am inundated with letters from

1:57

young people who have treated everything I've

1:59

written is sort of a how to manual, and

2:03

it's almost that they can't conceive as a book as

2:05

anything but advice and self help. All

2:10

my books are the same in one crude way.

2:13

I start out knowing very little about

2:15

the subject. I go find

2:18

actual experts, people who know

2:20

stuff, and write stories

2:22

about them. To my mind,

2:24

all I'm doing is describing great characters

2:26

in some interesting situation a financial

2:29

crisis, a professional sport and turmoil,

2:31

a pandemic. Yeah.

2:33

I learn some things about those situations,

2:36

but pretty much everything I know about, say,

2:38

the origins of the two thousand and eight financial

2:41

crisis, I know from the people

2:43

I've written about. They

2:45

are the experts. I'm just a guy

2:47

who writes books about them. Still,

2:50

the pressure from me to swan around as the

2:52

true expert is incredible. Do

2:54

you think that's what they believe? Well,

2:58

that's not true right now, but I

3:00

think do I think they believe that after they pass

3:02

this legislation that will be true? Yes,

3:04

I do think that. I do believe that.

3:07

I think that it's flattering to be

3:09

treated as the guy with the answers, more

3:11

than flattering, seductive. But

3:14

still, after a book comes out, I

3:16

usually find myself thinking, why

3:19

on earth are you asking me? Ask

3:22

the people who told me everything I know. I

3:24

pick him because I thought we should all be listening to

3:26

them. They're the ones you should ask

3:29

why were they unable to convince those in

3:31

power to do something sooner? And

3:35

I think the answer is that

3:39

this particular threat, when

3:42

you're on TV, you can never just say I

3:44

don't know. But but beyond

3:47

that, I mean, with a threat like this, he

3:49

almost requires you can't say I don't

3:51

know because you're the expert, and

3:53

you're the expert because you're on TV that

3:55

you're dealing with You're dealing with an

3:58

invisible enemy that replicates exponentially,

4:01

and by the time I'm

4:11

Michael Lewis. Welcome back to season

4:14

three of Against the Rules, where

4:16

we explore unfairness in American

4:18

life by looking at what's happened

4:20

to various characters in American life. Our

4:23

first season was about referees, Our

4:26

second was about coaches. This

4:28

season's about experts.

4:32

We're going to tell seven stories about them.

4:34

Each contains a clue to a mystery at the

4:36

heart of American life. How

4:38

come a society so great at creating

4:40

knowledge is so bad at using

4:43

it. How

4:45

can we know more and more yet behave

4:48

as if we know less and less. How

4:50

can one people be so incredibly

4:53

smart and so breathtakingly

4:55

moronic? The

4:58

experts are terrible. The

5:01

Pandemics taught us a bunch of things. That

5:03

bosses missed the office more than their employees,

5:05

That our centers for disease control aren't very

5:08

good at controlling disease. That these United

5:10

States aren't all that interested in being united

5:12

even in a crisis. Mister President, Please

5:15

listen to your public

5:17

health experts instead

5:19

of denigrating them. But the

5:21

Pandemics also taught us something about experts.

5:25

How fraught our relationship with him has become,

5:28

how hard it is for us to decide who they

5:30

are and how to use them, even

5:32

when it's a matter of life and death. But

5:35

who cares what I think. I'm not

5:37

an expert. I just find the people

5:39

who are. Hi. I'm Todd

5:41

Park, healthcare and tech entrepreneur

5:44

and former public servant. Case in point.

5:46

I've been in the succession

5:48

of situations of

5:51

great opportunity or great

5:53

crisis and had

5:56

to help figure out what to do

5:59

very quickly. Todd

6:01

Parks created three different billion dollar companies.

6:05

He solved some very big problems on behalf

6:07

of the American government. But

6:10

he built his career on a single insight

6:13

that the experts you most need are

6:15

often not who you think they are. Just

6:18

finding the expert can be incredibly difficult,

6:21

especially when all hell is breaking loose

6:24

called blue back.

6:27

In nineteen ninety seven, Todd was

6:30

a consultant fresh out of the Harvard Business

6:32

School. Like a lot of people

6:34

who go by the name of consultant, he

6:36

didn't really want to be a consultant, so

6:38

he went looking for a business idea, a

6:41

problem to solve. He and

6:43

another consultant, who was married to a

6:45

midwife, nurse and training settled

6:47

on a really big idea.

6:50

The beginning of life, specifically

6:53

pregnancy. To the

6:55

eyes of a male management consultant in

6:57

nineteen ninety seven, pregnancy is

6:59

conducted in the United States seemed wildly

7:02

inefficient. Women

7:04

and their babies were having all kinds of expensive

7:06

medical problems that could have been avoided

7:09

with better prenatal care. By

7:11

keeping women healthier during their pregnancies,

7:14

you could also make childbirth less risky

7:16

and cheaper. And so

7:18

these two twenty four year old guys set out on this

7:20

new mission. It was a bit weird.

7:23

They weren't doctors, they didn't

7:25

even have children. And essentially

7:27

the whole idea is that you

7:30

deploy a whole team of

7:32

folks, not just the doctor, but surfinder's

7:35

midwife, social worker, educator,

7:37

case manager, nutritionist to love

7:40

on a mom to be and

7:42

get her the right care, including very

7:44

importantly non clinical support.

7:47

Todd and his partner named their company Athena

7:50

Health. They hired a few

7:52

more people much like themselves, smart

7:54

young guys. They raised millions

7:56

of dollars and used some of the money to buy

7:58

a childbirth clinic in San Diego. It

8:01

mainly served women especially prone to bad

8:04

outcomes during pregnancy. Undocumented

8:06

immigrants, for instance, The

8:09

clinic was the test case for Athene of Health.

8:12

If it worked, the company would create

8:14

a lot more of them. So you

8:17

know, now, all of a literally overnight,

8:19

we are now on the hook for payroll,

8:22

rent, all of this stuff and the

8:25

revenue. That's Bob Gatewood.

8:27

Todd had hired him to help. So

8:29

almost immediately we started hemorrhaging money.

8:32

You know, claims were going out, but no

8:34

money was coming in. The first pregnancy

8:37

clinic was supposed to be like the first McDonald's

8:39

or Starbucks proof of concept.

8:42

The concept never had a chance because

8:44

they couldn't get insurance companies to pay them

8:46

to make pregnancy cheaper and better. In

8:49

fact, they couldn't really get anyone to

8:51

pay them for anything. Did you have any

8:53

sense that was going to be a problem when you started.

8:56

No, we thought, oh, billing is a solved

8:59

problem. Everybody knows how to do that. The interesting thing is

9:01

that electronic health records, the young

9:03

entrepreneurs had thought they'd bought a business with

9:06

they'd really bought was a crisis and

9:08

a cause. We then said, okay,

9:11

this is a very special practice. It's

9:13

the public health safety net for

9:15

so many women in San Diego County. We

9:18

must save this practice. We cannot allow

9:20

this practice to sink beneath the surface

9:22

of the sea. And so we got plug

9:25

all the stops and fight and figure out

9:27

how to keep this thing afloat. So you go

9:29

from like whiz bang entrepreneur

9:31

who's going to build a huge company

9:34

on the basis of an idea, to

9:36

being philanthropist

9:38

trying to save the safety net for

9:40

San Diego County. That's exactly right.

9:42

But in order to save the safety net, Todd

9:45

Park realized he and his partners had to solve

9:47

the problem that hadn't even occurred to them, the

9:50

problem of not getting paid by the health insurance

9:52

system. Those system is maybe too

9:54

kind a word for it. Essentially,

9:56

what's happened in the United States is that

9:59

you've got a lot of different health insurance companies and

10:01

they have invented a lot of different kinds of health insurance

10:04

products HMO Ppo

10:06

pos m bas pos pos

10:08

pos, all right, and then like

10:10

employers like to customize those just

10:13

for them. So there's like the ge version of

10:15

the HMO based pos product

10:17

for Wisconsin. There's not

10:20

even an alternate universe. With the

10:22

design of the US health insurance system makes

10:24

sense, you could not

10:26

build it to be more confusing. But

10:29

now that system was Todd's problem. There

10:32

are countless called them insurance

10:34

packages, like different flavors of insurance that

10:36

have probleagate across the country, each of which

10:39

has different rules associated

10:42

with it with respect to how

10:44

to build them. And these

10:47

rules are really poorly documented.

10:50

They're very opaque, they're changing

10:53

all the time, and medical

10:56

doctors and medical officers have no idea what they are

10:58

right, so they'll basically

11:00

put together a claim to bill

11:02

for their medical office visit. They'll

11:05

send in the claim and it

11:07

will get rejected. No

11:10

one insurance company set out to create

11:12

the confusion, but no one had

11:14

any incentive to clear it up. I mean,

11:16

the harder it was for doctors to figure out how to get

11:18

insurance companies to pay them, the less

11:21

the insurance companies ultimately paid out to the

11:23

doctors. Todd Park now knows this

11:25

because his last resort clinic full of pregnant

11:27

women, is getting buried under

11:29

unpaid bills. The payers send

11:32

back this thing called explanation of benefits,

11:34

which is really kind of misstormers doesn't really explain anything,

11:37

says, here's your claim. It was denied for denial

11:39

code zero five B and you look

11:41

at the code at in the legend at the bottom

11:43

of the EOB and you know it says something like,

11:45

you know, insufficient documentation or something

11:48

like something incredibly vague and not helpful. So

11:50

then you pick up the phone and you call

11:52

the health insurance company and get some port animals who also

11:54

has no idea what that code means. Right

11:57

as a super frustrating Right. But the problem

11:59

is there is a knowledge base of rules at the

12:01

payer that's totally opaque to

12:04

the doctor and frankly pretty opaque to the

12:06

payer, so they don't even know their own rules

12:09

exactly. Todd

12:11

and his fellow company founders needed

12:13

an expert, someone who had mastered

12:16

all the rules created by America's health insurance

12:18

companies, someone who knew how

12:20

to get those companies to pay a bill. Bob

12:24

Gatewood kept seeing artifacts of this expertise.

12:28

Every one of these doing offices we walked into. Every

12:31

single screen monitor was

12:33

covered in sticky nose like

12:35

the whole margin of the monitor, and

12:38

so we would always point at the sticky

12:40

notes and ask the person what's that, and

12:43

she would say, and most often a sheet she would say,

12:45

Oh, that's you know that reminds me that

12:47

if a midwife does the delivery, I have to put

12:50

a c Z modifier on the code

12:53

or you know. Here, This one reminds me that

12:55

ETNA only reimburses

12:57

for a gim visit every eighteen months,

13:00

not twelve months. So I got to remember not

13:02

to schedule an ETNA patient too soon. And

13:05

there were thousands and thousands and thousands

13:07

of these things. Medical

13:11

billing had become so complicated

13:13

that hospitals were now employing a medical

13:16

biller for each and every doctor.

13:19

Todd and Bob noticed the successful medical

13:21

billers were all of a type. Gladys

13:24

they called her super type, a you

13:27

know, won't let anything pass her, likes

13:30

to hold people accountable for their mistakes,

13:33

and it's just kind of pissed all the time, like angry

13:36

that they're not getting paid what they should. So

13:38

at that moment, given what

13:41

you're you've just learned about just

13:43

how critical Gladys is

13:45

and how important like the business

13:48

succeeds or fails on whether Gladys

13:50

is on vacation or Gladys is. This

13:53

strike you how odd it is that Gladdis

13:55

isn't valued. Well,

14:01

that's part of why she's pissed probably unless

14:04

you know, sometimes Gladys was

14:06

the wife of the surgeon, right right,

14:10

they were all women. I'm not but

14:12

I'm not being sexist. No, No, every

14:15

single one we met was a woman. But

14:17

yeah, there were a lot of pissed off Gladyses who felt

14:19

undervalued. By the late nineteen

14:22

nineties, the financial fate of entire hospitals

14:25

turned on Gladys. It

14:27

occurred to Bob and Todd Park that they

14:29

stumbled under a better business idea, find

14:32

the best Gladdys in the world. If

14:35

she actually existed. If

14:39

I had found you when you were I

14:42

don't know, twelve years old and

14:44

asked you what you were going to be when you grew up,

14:46

what might you have said? I was going to be an accountant.

14:50

This is Sue Henderson medical

14:52

biller. Seriously, it's

14:55

very very, very very

14:57

exciting. And the

14:59

reason was math was just so simple

15:01

for me. Everything about it was so incredibly

15:03

logical, and it just seemed

15:06

a great path for me. You killed

15:09

your dreams early. I

15:11

was very practical and I'm an very

15:14

very organized individual, probably

15:17

leaning a little bit on the OCD side,

15:19

and so in accounting there isn't

15:22

any gray. So if you're doing

15:24

the books, then it's a penny off. It's wrong

15:27

someplace. You have to figure out where

15:29

that penny is, and you can't just take it

15:31

and tape it into the books and then close them.

15:38

Sue Henderson discovered medical billing almost

15:41

by accident back in the nineteen eighties.

15:44

Accounting had captured her imagination. Medical

15:47

billing she found even more thrilling, which

15:50

was in and of itself kind of amazing.

15:53

You know, medical billers generally

15:56

are housed in basements

15:59

I'm not exaggerating of hospitals

16:03

or practices without a window,

16:06

and they're not appreciated. And it's

16:09

kind of fascinating because if you didn't

16:11

have medical billers, you can render all

16:13

the services you want, and if you're never going to get

16:15

paid, you're gonna go out of business. They're

16:18

definitely unappreciated across the

16:20

board. How do you explain that, given

16:23

what you just said, that you're going to go out of business

16:25

if your medical biller is no good? Because I

16:27

don't think that

16:30

I shouldn't say I don't think. I know. Doctors

16:33

are not financial people. They

16:36

care about patients. That's what they care about.

16:39

The doctor. Sue works for it don't really

16:41

get what she does or how

16:43

she does it. They just leave

16:45

her alone to play what is about to become a

16:48

very high stakes game. So

16:50

when you first get into medical billing, medical

16:52

billing isn't anything like as complicated

16:55

as is going to become correct. A

16:58

lot of medical billers were overwhelmed

17:00

by the complexity, but Sue kind

17:02

of liked it. She sat

17:04

in the basement of a hospital in northern

17:07

Massachusetts, but is

17:09

ready to fly. When

17:11

would have been the first time where you walked into

17:14

a job and you increased

17:17

the receipts because you were billing better.

17:20

Well, that definitely would have been Holy

17:22

Family Hospital. And with when and when would

17:25

that have been? That would be in the middle of my

17:27

career nineteen eighties, in

17:29

the eighties, Ye, in the eighties. Yeah,

17:32

And so that's a moment where

17:34

you walk in and just by virtue

17:36

of your command of

17:39

the complexity, you're able to generate

17:43

more payment to the hospital. It was a combination

17:45

of complexity, and it was a combination of looking

17:48

at a department

17:51

that was just so

17:55

unbelievably mismanaged.

17:58

They had a quarter of a million

18:00

dollars in unapplied

18:03

payments from the Medicaid

18:06

system sitting. What does that mean?

18:10

What does that mean? The moment

18:12

I asked the question, I knew I didn't actually want

18:15

to know the answer. Well, okay,

18:17

so what happens is Medicaid

18:20

is sending you all of these payments and

18:23

you don't have a claim to which they can to be applied.

18:26

So either you didn't send

18:28

that claim out. The

18:31

details of what Sue Henderson does, well,

18:34

even she has trouble making it sound interesting,

18:37

and she's more interested in the details than perhaps

18:39

anyone in the world. What's the secret

18:41

to getting the revenue getting the money out of

18:43

the insurance? Unfortunately, is

18:45

playing by their rules. That's

18:48

the unfortunate part. There's simply now

18:50

no way around that. And so if

18:53

they're saying you need a modifier

18:55

fifty five, you need a modifier fifty

18:57

five period, end of sentence, there's no way

19:00

around it, and it's just playing

19:02

by their rules. What's a modifier fifty

19:04

five? I

19:06

don't actually care about a modifier fifty five.

19:10

The modifier fifty five would be a

19:13

second I won't describe

19:15

it exactly, but it would be a

19:18

second procedure code that

19:20

is appropriate with the initial procedure

19:22

code. So it's there. They

19:25

are hundreds of versions of this problem

19:27

with medical billing where there's some nitty

19:30

detail that if you leave it off,

19:32

you just don't get paid. There are thousands of

19:35

them, and over

19:37

time they were basically in your head. There

19:40

were a lot of them in my head. Did

19:42

you have you run across anybody, any

19:45

medical billers who who

19:48

felt like you're equal? Oh, that's a very

19:52

I can't answer that question because

19:55

because I'm I'm quite

19:57

sure there are. I'm quite sure there are there

19:59

are other people is equally knowledgeable. Absolutely,

20:04

I don't know. You just haven't met

20:06

them. I haven't met them. Over

20:11

two decades in windowless

20:13

rooms in clinics and hospitals

20:15

in the Greater Boston area, Sue

20:17

Henderson makes herself not just valuable,

20:20

but close to irreplaceable. Then,

20:23

in the summer of nineteen ninety nine, she sees

20:25

a want ad on monster dot Com

20:28

for a medical biller from

20:31

a startup called Athena Health,

20:33

based in San Diego but with an office in Boston.

20:36

It's Todd Park, struggling startup. Sue

20:39

applies, She gets an interview,

20:42

they reject her, but a few

20:45

weeks later they call her back with

20:47

a bizarre request. He

20:49

wasn't offering me a job. He

20:52

was asking me, could I come for

20:54

lunch to meet with some

20:57

potential investors that

21:00

were coming, so that they

21:03

could kind of convince these investors that

21:05

they had somebody who knew what he or she

21:07

was doing and convinced them

21:10

that this was a good idea to invest in the company.

21:13

So they were bringing you on as

21:16

an expert in medical billing to

21:18

demonstrate to investors they knew about medical

21:20

billing. Yep. So I

21:23

said, okay, you don't

21:25

burn your bridges. So I went over and

21:28

we had lunch in the little restaurant

21:31

and I sat there for an hour and

21:33

a half, having lunch and being

21:35

grilled by these investors about

21:38

what I knew about medical billing, as

21:41

though I had already

21:43

been hired. And I

21:45

did this three times. I

21:48

didn't get paid for anything except

21:50

I had a lovely free lunch, And

21:53

finally, at the end of the three lunch

21:56

process, Bob Gatewood called and said,

21:58

we'd really like to hire you. Apparently

22:00

I had convinced everybody I knew what the heck I

22:03

was doing. Of

22:06

course she knew, and of course Todd

22:08

and Bob could see that they needed her, and

22:11

if they could just bottle her expertise, she

22:13

might make everyone rich. Welcome

22:27

back to against the rules, we

22:30

shall, I take it without the storm. There's

22:33

no reason why we shall unless

22:35

the dance blob. There's

22:41

a strange British play written in

22:43

the early nineteen hundreds called The

22:45

Admirable Creighton. It was written

22:48

by jam Barry, who's more famous for Peter

22:50

Pan. I only saw it once, but

22:52

I've never been able to get it out of my head. In

22:55

The Admirable Creighton, an upper class

22:57

British family is shipwrecked. They

22:59

all wash up on a deserted island, along

23:01

with their butler named Creighton h

23:06

Okay, then town a transport

23:09

and bring it back with him. Good my Lord. After

23:12

the shipwreck, the butler, Crichton, behaves

23:14

at first as he always has. He bows

23:17

and scrapes and speaks only when spoken to.

23:20

But on the island he's the only one

23:22

who has any idea how to survive. The

23:25

nobility or forced to admit it and defer to

23:28

him lest they starve, and

23:30

by the end he's king of the island. The

23:33

British Lord is Crichton's slave, and

23:36

his daughters are the Butler's harem in waiting,

23:39

and the Lord is freaking out. I

23:41

should give the honors, and you want abate them

23:45

with the deepest respect, my lord. The

23:54

reason I can't get the admirable Crichton out of my

23:56

head is because it's about the arbitrariness

23:58

of social status and

24:01

the way that status can disguise people's

24:03

value. Athena Health

24:05

is his own little island. Todd

24:07

parks washed up on it with Sue Anderson. But

24:10

he's a first a bit unclear about how to

24:12

maximize her value. So he

24:15

called his brother. Tyd called

24:17

me up and said, can you we need some help?

24:19

Can you help me? And so I said, of course,

24:22

because when your older

24:24

brother calls you, you basically say yes.

24:27

This is Ed Park. He was just then

24:29

a twenty two year old graduate of Harvard, where

24:32

he'd run the computer science club. And

24:34

so I packed up all my things and no

24:37

drove in my ten year

24:39

old Taylor camera in a three

24:41

day sprint out west to join him in San Diego.

24:44

It wouldn't have been a startup if there wasn't a story about

24:46

an old Toyota camera. Once

24:49

Ed stopped driving, he took a long, hard

24:51

look at the health insurance industry. We

24:54

went through and we tried to figure out what

24:57

are all these rules, and then we pretty quickly

25:00

figured out that the

25:02

rules weren't written down anywhere. The

25:05

only people who knew the rules were

25:08

people who would actually worked in the industry

25:10

and had been incredibly observant for

25:13

the last five years, people

25:16

like Sue Henderson, or perhaps

25:19

no one but Sue Henderson. Anyway,

25:22

Todd ned figured out that what Ed needed to do

25:24

was go into a room with Sue to

25:27

see if he could replicate her brain in computer

25:29

code. And so Ed drove his

25:31

camera back to the Boston suburbs. I

25:34

still remember the offices that we were

25:36

working in. There were these tiny little offices,

25:39

I think, with the requisite

25:42

three or four people to an office. She's sort of the

25:44

next office over, and I was heads

25:46

down coding, and that was like, what do I need to code

25:48

to make this thing work? And so her

25:51

job was to basically help us get paid, and my job

25:54

was to try and figure out how to write a bunch of

25:56

code to make it so that we

25:58

could start doing it in a way that was semi

26:01

replicable. For

26:04

her part, Sue was struck by just how much

26:06

was in her head that was not in theirs. Yeah,

26:08

I think, and probably

26:11

Eddie would, and he's going

26:13

to kill me because I call him Eddie all the time. I

26:16

think that Eddie probably understood

26:19

the fact that they had all his complexities.

26:21

But I think that

26:23

he thought, with

26:26

all of these brilliant programmers, that they

26:28

could figure it out all by

26:30

themselves, that they could just figure it out. It

26:32

was a few days into it when Sue realized

26:34

that Ed and I really had no idea what we were doing.

26:38

So she sets astounished, just like boys,

26:41

shut up, I'm gonna give you a little lesson,

26:43

and she taught us about like how the

26:45

accounting works. Bob

26:48

Gatewood is remembering the day on the island

26:51

when it became clear who was the admirable

26:53

Crichton. Well after she gave us that lesson,

26:55

and we're like, oh, yes, we will follow you. We

26:57

are your grasshoppers. And so, you know,

27:00

she was basically the product manager at that point, so she,

27:03

you know, she would tell us what the system needed to do

27:05

and we would go do it. And

27:07

we bought her hay hold, did you tell you about

27:09

Hazel the big print? So we

27:12

got her a big claims print and she named

27:14

it after her mother. So we have

27:16

a gladys a Hazel in the suit. So

27:21

I was sitting in one room, Sue was sitting

27:23

out over in the next room. And every day

27:26

I would code something and put it out there, and

27:28

then you know that evening Sue would

27:31

yell at me and so about

27:33

something or other. I did in sort of say like, you

27:35

can't, like I don't understand what you're

27:37

doing. You can't do that, And I'm like, what do you mean. Then she would

27:39

basically explain to me that, like, you

27:41

need to make sure that the procedure

27:44

code with the highest charge amount is

27:46

put first on the claim because the

27:48

insurance companies will like sometimes pay

27:51

the first line in the claim and not the second, third, and fourth

27:53

lines and the claim. So I'm like, I didn't know that.

27:55

Great, I'll do that, and so then I would change

27:58

it and then it would be that way from then

28:00

on. This went

28:02

on and on end

28:04

on, not for weeks or months,

28:07

for years. The

28:11

first three years, ed Park worked eighteen

28:13

hours a day. He had a sleeping bag

28:16

and slept under his desk. By

28:18

day he had listened to Sue. By

28:20

night, he had turned what was in Sue's head into

28:23

software. In the morning. I would kind

28:25

of wake up at six or

28:27

so, go to the bathroom. You know that. Do you remember

28:29

that pink soap, that the clear pink soap that you

28:31

sometimes get from from

28:33

those dispensers from a long time ago.

28:36

I basically take that stuff runs from my hair

28:38

like you know, shampoo and the sink, and

28:41

go back to my desk and keep programming. So that was

28:44

That's the kind of life I led. This

28:47

weird new version of a theme of health now

28:50

totally depends on the value of one woman's

28:52

expertise, even though no

28:54

one else had ever seen special value

28:57

in Sue Henderson or considered

28:59

the stuff in her head and expertise in

29:02

a funny way, that's why there's money to be made here.

29:05

Up until now, no one, not

29:07

even really Sue herself, has

29:09

figured out how valuable Sue is. If

29:12

I basically had asked her to go into the middle of

29:14

a room and basically gave

29:16

her a stack of paper and said, please write

29:18

out everything you know about billing, she

29:20

would not have produced the

29:23

things that were necessary for us to be successful.

29:26

Instead, she'd had a set

29:28

of experiences such that when

29:30

she got placed into a sort

29:32

of situation, which I often did.

29:35

I'd put her into a situation where somebody didn't

29:37

make sense right. Then she would basically

29:39

say she would immediately recognize that something

29:41

was wrong, and she'd basically searched her database,

29:44

her head and said and ask herself, why

29:47

is this wrong? The smart young Harvard

29:49

graduates are trying to fix a big problem

29:51

in the healthcare system, but what they're really

29:53

doing is exploiting the world's inability

29:56

to see the expert. It's

29:58

expert blindness. Sue

30:00

had a sense of moral indignation when

30:03

something was wrong, right, And so there

30:05

are some people who are essentially the unsung experts.

30:08

But you get them into a room and you present them

30:10

with something wrong and they won't tell you right,

30:13

like they're trying to read the room. They're trying

30:15

to figure out what you think the answers should be,

30:17

and they don't tell you that, like

30:20

you're full of crap. Right. Sue

30:22

did not have that problem. If

30:26

she thought it was wrong, she would say, Eddie, I think

30:28

you're wrong, and she

30:30

would tell me in no. In certain terms, you

30:32

get this sense that there are certain

30:34

things in the world. In particular for Sue

30:37

was medical billing, for which they have a

30:39

sense of moral indignation that they can't

30:41

hide. She cared a lot, Yes, she

30:43

cared a lot. Did you at any point

30:46

think or wonder if there was someone who was

30:48

even better than Sue at this

30:50

or did you think all along, Wow, we

30:52

probably have the best. I couldn't

30:55

conceive of anyone who knew more

30:57

than her Like I would say, it was three

30:59

or four years until we got to the

31:01

point where it was clear that

31:04

we had something that did justice

31:06

to the knowledge in her head. The content

31:09

of Sue Henderson's mind became a five billion

31:11

dollars software company. It has been

31:13

one month since Athena Health announced

31:16

the deal to be acquired by Veritas Capital, and Sue

31:18

got a bit rich. But in the bargain, she saved

31:21

the US economy a small fortune.

31:24

By selling medical billing software to doctor's

31:26

offices, Athena Health changed

31:28

the US healthcare system. Doctors

31:31

would never again need their own medical biller.

31:34

A single biller can now handle ten doctors.

31:38

That biller is now in effect, Sue

31:40

Henderson, Many of our doctors basically

31:42

said to us, look, you

31:45

saved my career. I would

31:47

have gone out of business if it hadn't been for

31:49

you guys. But maybe the most telling response

31:52

to the power of Sue Henderson came

31:54

from a big health insurance company. Or

31:57

anyway, that's what Todd Park thought. So

31:59

I get a call one

32:01

day from a very powerful, very

32:04

sophisticated national

32:06

health insurance company, right way above average

32:08

in terms of it technical and operational prowess.

32:11

The insurance company had a bizarre request.

32:14

They said, we'd like to license your

32:17

rules engine from you. I said, I can't

32:20

do that. I can't tell you what your competitors insurance

32:22

rules are. They said, no, no, no, we want

32:24

to license our own rules from you. The

32:28

insurance company itself didn't understand

32:30

why it paid some medical claims and

32:33

not others. It was relieved

32:35

that someone had figured it out. I said,

32:37

well, let me get this straight. You want to license

32:39

your own billing rules from us?

32:44

They said yes. I said, okay, it's

32:46

a little crazy. Can you just explain to me why? They

32:48

said, well, look, you know, I mean, we have a

32:50

bunch of different systems. We bought a bunch

32:53

of different insurers. You

32:55

know, there's a ton of spaghetti code

32:57

in these disparate systems, and we don't

32:59

really know what the hell's in there. That's

33:04

incredible. It's incredible, right, it's

33:06

incredible. And after that one

33:09

insurance coming to that, did you find others

33:11

also wanting to do it? Or we we said

33:13

we said we was too weird, we couldn't do it, Okay.

33:22

To recap this invisible

33:24

woman becomes an expert in a subject

33:26

no one really thinks of as especially

33:28

important or even

33:30

really a subject, and

33:33

her expertise changes a massive

33:35

industry in retrospect

33:39

or At any moment, were you surprised

33:43

by your value, like your

33:45

value to this new business. I

33:48

don't think most of the time that I realized

33:50

my value. I think

33:53

I was enjoying what I was doing, and

33:56

I don't think that I was thinking, Wow,

33:59

I'm I'm pretty valuable here and if

34:02

I left, they'd be in big trouble. Sue

34:08

Henderson's Todd Park's first business.

34:11

But if you ask Todd Park, that was only

34:13

the second most important things she did for him.

34:17

The most important thing she did for him was

34:19

to lead him to a bigger idea about

34:21

where to find experts, especially

34:24

in a crisis. Sue

34:28

doesn't run the healthcare system.

34:30

She doesn't run a hospital system, but she doesn't

34:32

run a physician group. She doesn't

34:34

run an insurance company, right, but she has

34:37

an incredibly good sense on the ground

34:41

of what is going on and an instinct

34:43

for what to do to make things better. Right, So in

34:46

the healthcare system, she is absolutely an

34:48

L six the

34:51

L six, the level

34:53

six, the person six levels

34:56

down from the top, the admirable

34:58

cretens. That insight became

35:01

Todd's new obsession that you might

35:03

never find the expert who knows what you badly

35:05

need to know because she's buried

35:07

under some big organization or system.

35:10

She has no status. She might

35:12

have a voice, but no one hears it. After

35:16

his experience with Sue Henderson, Todd

35:18

Park basically became known as the guy who

35:20

could find experts where no one else

35:22

thought to look. During

35:35

his first term in office, President Obama addressed

35:37

the American people. Hello, everybody,

35:40

I want to talk with you about a new consumer

35:42

website, healthcare dot gov.

35:45

It's a good resource for understanding the new law,

35:47

and it offers a few simple tools to

35:50

help you take your healthcare into

35:52

your own hands. Obamacare Americans

35:55

were now suddenly eligible to sign up for a new

35:57

health insurance marketplace online. On

36:00

October first, twenty thirteen, billions

36:04

of uninsured Americans are going online. This is

36:07

healthcare dot Gov. Hope to

36:09

enroll in the Obamacare exchanges, but the websites

36:12

have been experiencing technical glitches. Medical

36:14

that's the sound of a crisis.

36:17

Healthcare dot gov has crashed. It's

36:20

not just embarrassing, it's a political

36:22

disaster. After weeks of ignoring

36:24

it, the White House finally admitting what everyone

36:27

already knew. Healthcare dot gov is

36:29

a mess. The White House is

36:31

scrambling to find someone, anyone who

36:33

can fix this nightmare. Obama

36:36

has by now brought Todd Park in as

36:38

Chief Technology Officer for the Department

36:40

of Health and Human Services. We basically

36:43

went to CMS, the

36:46

agency in charge

36:48

of healthcare dot gov that have

36:51

been working it's heart out since

36:54

the site went live in October twenty

36:56

thirteen. Todd found

36:58

that the people in charge didn't actually know why

37:01

the site had crashed or how to fix

37:03

it. Neither did the people right

37:05

under the people in charge or

37:07

the people right under them. We went down

37:09

another layer, and then another layer, five

37:12

layers down basically, and then we finally

37:14

got to layer six,

37:16

which is where all the contractors were who were

37:18

working on the site, and found

37:22

a really really difficult and tough situation.

37:25

But long story short, at that layer

37:27

and the layer beneath that layer, right, folks

37:30

working for the people in charge of the contractors,

37:33

and folks actually one layer beneath that found

37:37

people who really understood

37:41

at least part of the picture right

37:43

and had deep domain expertise and

37:46

had an instinct about what to do. Why

37:49

the Obama administration hadn't found the people

37:51

who knew how to fix their website on their own is

37:53

a question for another day, But

37:56

this kind of thing seems to happen over and

37:58

over again. After

38:02

the healthcare dot gov debacle. Todd

38:04

always sent his tech teams into any crisis

38:07

with a specific instruction find

38:09

the l six I remember actually report

38:12

out from one of the teams. They

38:15

had been deployed to the State Department because I believe

38:17

it was the visa processing system of

38:19

America that had broken, and

38:22

that was a huge problem obviously,

38:24

And so he said, what did you do? He said, well,

38:27

I went seven layers down

38:31

and found two contractors

38:34

who actually knew what the problem

38:37

was. And he said, all I did

38:39

was basically say, Okay, I'm

38:41

going to take your solution and deliver

38:44

it seven layers up and

38:47

basically tell the people in charge, this technical

38:50

fix needs to be executed. And it was,

38:52

and then America was able

38:55

to process visas again. Have

38:59

you ever asked yourself why

39:01

you stumbled upon this pattern as

39:04

opposed to someone else? Oh,

39:07

I don't think I am you in

39:10

identifying the pattern. I

39:13

guarantee you there are L sixes

39:16

in your space and your organization, right. And

39:18

the key to your success in

39:20

addressing a problem or tapping

39:22

into an opportunity is not you. It's

39:25

not you, It is actually someone

39:27

else and L six And you

39:29

have to have the wisdom of your job is

39:31

to find the L six and let

39:34

them rock and roll. Find

39:37

the L six Not the officially

39:39

important person, not the public

39:41

person, the person on TV, not

39:44

the person that seems like he knows what he's

39:47

talking about. No, you

39:49

need to find the person who spent the last twenty

39:52

years stuffed inside some basement without windows,

39:54

quietly learning things, and

39:57

who as a result, might not be

39:59

very good at advertising themselves or

40:01

what they know. There are some

40:04

experts who, forever reason are

40:07

really terrible explaining

40:10

what is going on and what to do, either

40:12

because they're just really terrible explaining

40:14

or because they're not clear thinkers, or because they

40:17

want to keep the secret sauce for themselves. In

40:20

any given situation, you think

40:22

it will be obvious who the expert

40:24

is, it won't. We'll

40:28

go right along believing that the people who

40:30

happen to be on top are the most

40:32

important people until

40:34

we sense we cannot afford to believe

40:36

that anymore, until say, some

40:39

crisis arises, and just to

40:41

survive, you need to find

40:43

someone who actually knows the answer

40:46

to your question. Against

40:51

the Rules is written and hosted by me Michael

40:53

Lewis and produced by Catherine Girardo

40:55

and Lydia Jeancott. Julia Barton

40:58

is our editor, with additional editing by

41:00

Audrey Dilling. Beth Johnson

41:02

is our fact checker, and Mia Lobell

41:04

executive produces. Our music

41:07

is created by John Evans and Thias

41:09

Bossi of Stellwagon Symphonette.

41:12

We record our show at Berkeley Advanced Media

41:14

Studios, expertly helmed

41:16

by tofer Ruth, Thanks also

41:19

to Jacob Weisberg, Heather fag John

41:21

Snars, Carly Migliori, Christina

41:24

Sullivan, Eric Sandler, Maggie

41:26

Taylor, Nicole Morrano, Royston

41:29

Beserve, Daniela La Khan, Mary

41:32

Beth Smith, and Jason Gambrel.

41:35

Against the Rules is a production of Pushkin Industries.

41:38

Keep in touch, sign up for Pushkin's

41:41

newsletter at pushkin dot Fm, or

41:43

follow at Pushkin Pods. To

41:45

find more Pushkin podcasts, listen

41:48

on the iHeartRadio app, Apple Podcasts,

41:51

or wherever you listen to podcasts. In

41:55

case you missed it, I recently recorded

41:57

a new unabridged audiobook edition of

42:00

my first book, Liars Poker. It's

42:02

about Wall Street and how it became the place

42:04

it is. You can buy the new Liars

42:06

Poker audiobook at Pushkin dot

42:09

fm slash Liar's Poker. You

42:11

could also buy it at Audible or wherever audio

42:14

books are sold