Marketplace - Surprise, you've got medical bills!

Episode Date: October 9, 2026

A 2020 law aimed at eliminating surprise medical expenses has shifted some unpredictable costs away from patients. The law was supposed to incentivize jointly set reasonable prices between hospitals and insurers, but instead, there’s been a whole lot of finger pointing — and employers are left holding the bag. Also in this episode: The agriculture economy goes K-shaped, a sailor finds a support network in her solo circumnavigation, and we talk through the week’s economic headlines.Every story has an economic angle. Want some in your inbox? Subscribe to our daily or weekly newsletter.Marketplace is more than a radio show. Check out our original reporting and financial literacy content at marketplace.org — and consider making an investment in our future.Read the stories in today’s episode:The stock market isn’t the economy — except when maybe it is?In the agricultural heart of the country, it's a tale of two farm economiesHow a law to protect patients from surprise billing shifted the cost to employersCole Brauer sailed solo around the world. She plans to do it again

On the program today, we'll do our Friday thing. We'll take a look at the farm economy, and then we'll go for a sale. From American public media. This is Marketplace. In Los Angeles, I'm Kai Rizzdahl. It is Friday. Today, this one is the 9th of October good, as it always is, to have you along, everybody. So, you know what?

On the face of it, this was not a huge week in the life of the American economy. But as sometimes happens, when it is quiet, that is exactly when it is easiest to see what is really going on. So that's what we are going to do. Heather Long is the chief economist at Navy Federal Credit Union. David Gurra is at Bloomberg. Hey, you too. Hey, Kai. Hi, Kai.

Heather, let me begin with you and the labor market. You know, we had a fine-ish, me-ish jobs report last week. We had first time claims for unemployment the other day. They were really low right now. not many people losing their jobs. And so the stories came up again, including on this program, of this being a low, hire, low-fire economy. Why is it bad that it's a low-hire, low-fire economy? Well, it's great if you love your job. But if you're looking for a new opportunity, or if you're someone just entering the labor force, or maybe you took some time off and trying to get back in,

there's just not a lot of hiring going on. And another way to say low-hire, low-fire is low-opportunity. And in particular, with that latest jobs report, the only hiring going on is a little bit still in health care. And then if you want to build a data center, if you're in construction for a data center, the times are great. And that's some of the strongest wage gains in the last year. But for everybody else, it's slim pickings. And that's why a lot of Americans feel stuck right now. The silver lining is we're seeing people create their own opportunities. We're seeing that uptick in new business formation and people saying, I'm just going to create it myself.

Hmm. David Gura, I said something on the program, I think it was yesterday, which honestly, I was not expecting out of what I would ever have to say on this program. And that is that given artificial intelligence and how much the stock market is worth these days, I said maybe the stock market actually is the economy. Discuss. Stop me dead in my tracks. And I feel like this is a track. I mean, we used to work together. I've heard you say the stock market is not the economy so many times. But, no, I think that you're onto something in some respect. I mean, you look at the gains that we've seen in stocks. So many of them have been driven by big tech and AI. And you look at the economy, as Heather just said just a moment ago,

times are good if you're in the business of constructing, the vast infrastructure that's underpinning all of this AI technology for the time being. So it is reflective of that. And I think, you know, just watching the market day after day after day, you look at what's animating it, both positively and negatively. It's still energy prices to a huge extent. And that's reflected, of course, in the stock market. And then I look ahead to next week.

We're going to get these big bank earnings. And that's part of this AI story as well. You've had these banks just make a boatload of money off of SpaceX going public. And the promise here in the months ahead is you're going to have these big AI companies going public as well, and that's going to only make them do better. So you're on to something. Again, I feel nervous in saying that and going against your wise counsel of so many years. Can I add on to that?

Of course you can. Please. Go ahead. Just, you know, plus one to everything David said. But I think the other thing that's really different right now is the baby boomer wealth. You know, all that accumulated savings, 85 trillion or more, half of the stocks are now owned by baby boomers. And I think that's what's really different. It's not just the AI billionaires who are driving this stock market gains.

It's all of these baby boomers, these great. grandparents, and that's what's tricky if we do finally get a pullback in the stock market, you know, do all these grandparents stop spending? You know, that's a huge block that's been propelling consumption in this economy that doesn't really care about the labor market anymore. And again, okay, boomer. All right, look, Heather, Heather, let me stay with you because we're going to go to consumers. Consumer sentiment came out today from the University of Michigan.

It was down again. There was a study out showing consumers are planning. not to spend as much as they usually do next year. And I guess I wonder, with the benefit of your or your data insight into things at Navy Federal, are we seeing cracks in the consumer? And I know I've been asking this question for like five years, but at some point, right? It does feel like at some point, and we're finally pretty close to that point. I've sort of shifted from K-shaped economy to E-shaped economy.

It's pretty clear there's the top 20 percent's doing great, as David was just starting to on the stock market gains and wealth effect. It's also pretty clear the bottom third is strained. You can see credit card dead at the record high. You can see personal loans going up. You can see all the problems in the subprime loan market. But the real question you're asking, Kai, is what about the middle? When did they finally cave?

And we've seen the trading downtrend trend. We've seen more and more people shopping at Costco's and Sam's clubs of the world for the past two years. I think the thing I'm watching the most closely is the auto market. That has been surprisingly resilient. And the question is, that's a big purchase, right? And if you're pretty gloomy right now, you're going to put that off. And also, sorry, Justin Hode did a story for us a couple of days ago about how auto loan delinquencies are on the rise.

So that's an indicator there, you know? Mm-hmm. Yeah. David, another testament to how long you and I have known each other. we were in Athens in like 2015 walking through that main square there and we ran into each other. I don't know if you remember this. I remember that's in Tagma Square. That's exactly right.

Good for you for remembering the name. I'm asking that not because of Greece, but because of France. It was big in the news early in the week. And if you've been following sort of the French debt crisis that's happening, it's been in the news for a couple of weeks. Not that France is Greece, but European debt and the Eurozone now are sort of back in the oh my goodness category of what's going on in global finance. I think that's right. And you're seeing protests erupting across Paris and France and this frustration that social services aren't quite what people who live there think they should be. And I think

that's where you kind of get into this difficult situation where the government is under pressure to do more, to offer the people more. And of course, you have to borrow money to do that. And in this environment where it's getting more and more expensive to take on debt, you get into this really difficult cycle. And I think France is on the presbis of that. And it is part and parcel of this larger story involving bonds. Of course, we've seen them spike here in the United States as well that has to do with energy and inflation and all the rest. But it gets back to what we've heard from policymakers for many months now that, you know, you need to have flexibility when there's a crisis. And I think that's the big fear here. Are these economies equipped to deal

with a crisis given how high these yields are going? Right, right. And of course, France doesn't control its own currency, which is a huge deal. And, you know, which we do. Speaking of us, controlling our own currency and our own interest rates have the long, the Fed Minutes came out nothing spectacular in there other than they are almost uniformly hawkish and worried about inflation. Yeah, and probably not hiking in October, which we sort of already knew. But they do seem to be lining things up for December. And there were a lot of worries about inflation in even those minutes.

It wasn't just a story about the war in Iran. It was a much broader inflation story. And yeah, that's sure making 2027 look. tougher and tougher. And it will be probably. David Gura at Bloomberg and Heather Long at Navy Federal. Thanks you too on this Friday. Thanks, Kai.

Bye, Kai. Have a great weekend. Wall Street, as I said, on this Friday, traders were buying going into the weekend. Details numbers when we get there. With apologies to Charles Dickens, it is the best of farm economies. It is the worst of farm economies. The reference is right there in the title of a report from the Federal Reserve Bank of Kansas City. The title says, A Tale of Two Farm Economies.

The Kansas City Fed has in its district, Colorado, Kansas, Nebraska, Oklahoma, Wyoming, as well as parts of Missouri and New Mexico, all of which have economies tied to cattle or crops or both. And it turns out we're kind of in a K-shaped farm economy. Marketplaces, Caitlin Tan, has that story. Right now in most of the country, kind of no matter what you grow, profits are bleak, crop prices are low, fertilizer prices are high, don't even mention diesel, red diesel notwithstanding. But one ag state that's doing all right, Oklahoma. The reason for that? Cattle are selling at historic high prices because the national herd is smaller than it's been since the 1950s.

But there's still a lot of cattle in Oklahoma. Darrell Peel is with Oklahoma State University. As far as beef cows, yeah, we're number two behind Texas. Of course, big prices for cattle mean big prices for beef at the store. Even though President Trump allowed some imported, mystery beef into the country. You know, we've had all this trade stuff and a lot of noise about that, but frankly, it doesn't change the overall picture very much.

Meanwhile, in the rest of farming America, crop demand is lagging, says Nick Lewandowski with the Kansas Farmers Union. We've lost significant markets with soybeans due to the trade war. Grain sorghum is another one. We lost a good share of that market with USAID. Crop prices for farmers may be relatively low, but if you've been to the store, you're not seeing lower prices for bread or tortillas or pasta. Primarily the crops that we produce in this country are commodities and very much separate from

the food that we consume. Courtney Cowley is with the Kansas City Fed. If you look at what makes up the food dollar, only about 15 cents of that comes from the farm gate. And right now, a growing chunk of the food dollar? Diesel. I'm Caitlin Tan for Marketplace. Virtually everything about health care in this economy is complicated.

Not the care itself, usually, but the finding the doctor part, the in-network, out-of-network part, the insurance part, and related, and especially the billing part. It used to be when doctors and insurance companies were arguing over the right price for any particular care, the bill would land with the patient. Congress created a system a couple of years ago for doctors and insurers to have that discussion and leave the patient out of it. But now those bills, big ones often, are landing with companies and with public sector employers. Alex O'Gagan has more.

Month after month, Geronimo Wright saw bills for Clark County Nevada teachers' emergency care go up. Wright is the numbers guy for the teacher's health trust plan, which covers nearly 35,000 people. We were pretty shocked, and we monitor everything down to the penny. The jumping cost was coming from the arbitration process that Congress created in 2020. to protect patients from expensive surprise hospital bills. By summer 2024, Wright calculated that just the fees that the insurer charged on cases going through this dispute resolution were 7% of what the plan was already paying for teachers' emergency care. So that was kind of our big aha moment. The law was originally structured to incentivize doctors and insurers to agree on reasonable prices.

But if they just couldn't agree as a last resort, an arbitrator decides. But reality played out differently. Some large doctor's groups are running to arbitration because they're overwhelmingly winning. And because patients are protected, companies and employers are on the hook for these big bills. In this case, Teachers Health Trust. Right knew one of the doctor's groups, team health, who took a lot of cases to arbitration. So he picked up the phone and called them. We just crunched some numbers, went back and forth, and we answered a direct comment. with them within a matter of a few weeks. Over one year, the arrangement saved the plan $500,000 in just fees alone.

Team Health has a few other direct contracts and is pursuing 15 more. James Gelfand leads Eric, an industry group representing employers that pay for their own health care. He's heard of other doctors groups taking a similar approach. Strategy one is to go to the plan sponsors who are eating these arbitration costs and say, you know, we could get a network just with you via a direct contract. But the prices they offered some employers, he says, are far above market rates. When the offers have been made, many of my companies have balked at it because it felt irresponsible to accept rates that were that much higher.

Gelfand says the cost from these arbitrations are so unpredictable, it's hard for employers to plan. The city of San Antonio is $40 million over budget because of these cases. And the health plan for New York State employees is raising premiums 10%, in part, to deal with the costs. Gelfand and other employer groups say, it's time to fix the law. Lindsay Murtaugh at Brown University agrees. She wrote the rules for arbitration. I think that it's really incumbent on Congress to act here to fix that problem.

Murtaugh says key to any fix is re-centering a benchmark price for arbitrations. That was part of the original law. But doctors felt the rate was too low, so they sued over it and a judge threw it out. The result? Arbitrators are picking higher-priced doctors bids 85% of the time. Mertau worries that more doctors groups will see this success and start flooding arbitration in search of higher prices. I really worry that we're only looking at kind of the beginning of what could be a huge, huge increase in costs. Another item high on her list, and at least one member of Congress, is untangling conflicts of interest. There is concern that the same investors are funding arbitration companies and the doctor's groups winning most of the claims.

In Portland, I'm Alex Olgin for Marketplace. Coming up. You are taking care of the boat. The boat is your child. Sink or swim for reels. But first, let's do the numbers. Dow Industrial's up 423 points on the day. A touch over 8 tenths percent finished at 51,654 did the blue chips.

The NASDAQ added 172 points, about two-thirds percent, 27,366. The S&P 500 up 46.6.6 tenths percent, 78 and 11. For the week, the Dow picked up just over nine-tenths percent. The NASDAQ rose two-thirds of one percent. The S&P 500 added almost one and two-tenths of one percent. space exploration technologies, SpaceX, is paying $8 billion to buy some spectrum frequencies that can travel quite a ways and penetrate walls and such. What could possibly go wrong? That would let SpaceX's Starlink start offering mobile phone and data service here in the United States if the FCC approves.

SpaceX shot up 1 and a quarter percent. Wall Street interpreted the potential competition as bad news for existing cell carriers. T-Mobile dropped 13 and a quarter percent. Verizon turned down 8 and 3 quarter percent. percent. Delta Airlines cut its profit forecast for the year. How come you ask? Jet fuel, right? Takes a lot of fuel. Delta share is basically unchanged. American Airlines. Down three-tenths percent. Alaska. Technically, the Alaska Air Group dipped four-tenth of one percent on the day. Bonds down, yield on the tenure. T-note up 5.24 percent. You're listening to Marketplace. This is Marketplace. I'm Kai Risdahl. A couple of three years ago, late 20-23-ish, I was scrolling my Instagram, as one does, when up came a post from a woman in a solo sailing race around the world. Her name was Cole Brower. And to get to the point, she became, by the end of that race, it was called the Global Solo Challenge.

She became the first American woman to sail solo and nonstop around the planet. She has a memoir out now about the race and the boat. It's called First Light. Cole, it's good to have you on. Thank you for having me. I'm always excited to come back to NPR. Tell me, would you, about the boat, which is the title of this book? So the name of my boat is First Light, and she's a 40-foot type of racing yacht.

She's a sailboat. We have pretty high speeds, and yeah, I raced her around the planet. What's a high speed for you? Like 20 knots is, we're working around 20 knots. The boats that I'm racing now are going. closer to 40 knots. So I've definitely moved up in the world, but yeah, first light is crazy. We will get into what you're racing now. Tell me how you came to be racing this boat around the world because, I mean, you tell the story in the book, it was kind of a gutsy move on your part.

It was, I think that there was so many people that had told me no over and over and over again, like, no, you can't do this, you can't do that. You're too small. you are a woman, you don't come from the correct family, you don't have the correct last name. And eventually I was like, you know what, just, you know, F that. I'm going to have to race around the world solo if no one's going to let me sail on their boat. And that's kind of how I ended up racing around the world was I found private sponsorship, which just means that people that are interested in the campaign and what I was doing, that were willing to fund my dream.

And then you just, you go. There's no stopping. And then there, but there's also, and this is the thing that, you know, fits it into a marketplace interview, there's an entrepreneurial thing going on here too, because once you find the money, which is what, you know, entrepreneurs have to do, you had to hire a support staff. You had to hire a social media person. You had to hire a weather person. I mean, there was like a whole CEO part of this thing that you had to do before you even got out on the water.

Yeah. No, it's totally insane. That was actually the best part about having my sponsors is that when normally with sponsors, you have to give a lot of ROI back to them. And with these sponsors, they were like, no, we are purely investors in your company. You can hire whoever you want. I have to say that released me from so much pressure that I was able to be so much more creative with social media.

I was creative with who I hired. The people I brought on, they had been wanting to get an opportunity. And they ended up working so much harder than if I had hired the absolute best of the best. For those who aren't familiar or haven't followed you on the socials, what's your workday like when you're out there in the middle of the Southern Ocean or wherever you are? It's, I would say it's very similar to a mother, a newborn, like having a newborn as a mother, you wake up and immediately it's to work. It's making sure that I'm keeping up with my routine. I have to make food. I eat astronaut food. It's freeze-dried food. I wouldn't say it's the

most appetizing. Like nine months? You ate this stuff? For four months and one week. So don't worry. I'm sure it felt like nine months, right? Sometimes. But you are taking care of the boat. The boat is your child. You make sure that the boat's not trying to sink on you, that she's not crying too much, and you're fixing everything that has broken the night before. And if you don't, you know, want to fix those things, more things keep breaking and more things keep going wrong. You alluded to in a minute ago, it has to be said, you are succeeding in a sport that is really male, really rich, mostly white dudes. And as you said, you are a petite young woman. That has been a challenge. And you're pretty open about this in the book.

Yeah, I don't fit this. mold. I still don't really think I fit the mold. I've gone in a very different pathway. Even after the success you've had? Well, because it's a different type of success. I think sailing has been quite exclusive. They're very focused on keeping it almost like the best kept secret of the water. And I was like, no, I'm going to hold this door open and let all the mice run into the house. So they, I would say that the sailing world probably like half hates me and half loves me. And I think the hate is the traditionalism that sailing has been trying to perpetuate for hundreds of years. And so sometimes they don't like when I come in and try to shake

things up. Yeah. Just on the way out here, I went to your website the other day. And so first of all, you are now a co-skipper on a much bigger, faster boat, as we talked about right at the top. Like, what, like a 60 foot boat now, right? It is. Yeah, it's the Mocha 60. Okay. Also, though, and this just blew me away, you have a six-year plan for your career published out there for everybody to see that culminates in 2032 with the Vonday Globe, a solo nonstop, unassisted race around the globe in a 60-foot boat. That's wild to me that. You're just putting it out there for everybody to see. That's what I'm going to do. I am. I mean, I'm still trying to have a little bit of a personal life, I promise, like most people are. But my professional

professional life, if I put it out there, mainly most of the time it works. Because when people see that six-year plan, they go, oh, I can make that work. Let me come work for you. I want to make this happen. And so I'm in France six months out of the year training with a team that's been doing it for 10 years. And I hope to steal as many ideas. And then hopefully bring it back to America and represent the United States in the offshore racing world. Cole Brower is most of all a sailor, but also in author. Her book is called First Light. I can't recommend it highly enough. It's a great read. Cole, thanks so much. It's great to talk to you. Thank you for having me. Appreciate you. This final note on the way out today, two numbers and a fact. The first number is $6.27.

That is the price per gallon, according to AAA, of diesel fuel today. You probably knew that. Number two is 25. That's how many days until Election Day. The fact is that President Trump announced a deal with Russia today. To buy, with American dollars, their diesel. Our theme music was composed by B.J. Leatherman. Marketplace's executive producer is Nancy Fargolly. Jouan Griffith is the chief content officer. Neil Scarbrose, a vice president and general manager. And I'm Kai Rizdahl. Have yourselves a great weekend, everybody. We will see you back here on Monday, all right? This is APM.