"Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win" (Book Review)

Consumerism / By Lance De Peralta / December 9, 2021


One of my 2021 goals was to get into the habit of book-reading.  I read three hardcover books and listened to one audiobook.  A marked improvement from last year – ZERO – ha!

"Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win," written by Marshall Allen, was the last book I read.

I added it to my book list after reading some glowing reviews on LinkedIn.  I was fortunate enough to receive a signed copy in the mail for attending a webinar where Marshall was a guest.  To hear him speak about the book - including his motivations for writing it and sharing a few nuggets from the book - was pure icing!  I came away from the webinar impressed by Marshall and looked forward to reading it.

General impressions of the book

Overall, I enjoyed it!  It was a great read for these reasons:

  • Having spent 15 years as an investigative journalist covering U.S. healthcare, Marshall pulls back the curtains and reveals some things that I was unaware of.  I've been in the healthcare industry for a long time, but I would never let ego get in the way of learning new things about it.  Thank you, Marshall!
  • Reading the inspiring testimonies from people - including Marshall and his family - who've had unpleasant experiences with our healthcare system, ranging from absurd to outright emotional / stressful, BUT who were able to push back and come out on top.  The tools, tactics, and strategies they used are laid out in the book in great detail.
  • It's chock full of stories and interviews from industry innovators and disruptors, some of whom I've been following well before the book came out.  Their insights and actions described in the book are worth their weight in gold!
  • At its core, "Never Pay the First Bill…" is a comprehensive and necessary blueprint on "healthcare consumerism" that employers, individuals & their families can (and should) follow.

Making the case for "healthcare consumerism" in America

I've spent my 20-year professional career in healthcare focused on cost containment, specifically:

  • Analyzing healthcare costs of payers (e.g., health plans) & employers.
  • Teaching these organizations how to think analytically about healthcare costs.
  • Implementing tools to help them manage their healthcare costs.

What I've learned and experienced over two decades, in a nutshell, has been the "business"-side of U.S. healthcare which is the central focus of Marshall's book.   He lays out a compelling case for why people - including folks (like me) who work in the healthcare industry - should think and act like CONSUMERS, not PATIENTS, when it comes to their medical care, health, and overall well-being.  The book's very title speaks to the undeniable truth that the U.S. healthcare system is a business, and like any enterprise, it needs two things to thrive (and survive): consumers AND revenue!  When left unchecked, this system can reap significant financial rewards and record profits at the consumer's expense - yours and mine.

The concept of "healthcare consumerism" that Marshall is advocating - something I've blogged about numerous times - is timely, relevant, and critical.  COVID and federal legislation have altered the healthcare landscape in the United States, and there's no going back.

Thanks to the pandemic, healthcare consumerism evolved rapidly.  Look no further than telehealth & mental health services.  Although they were technically available before the pandemic, the government refused to pay for them thru the massive Medicare and Medicaid programs, but prolonged isolation and disruptions to everyday life accelerated their necessity, adoption, growth, and innovation.

Meanwhile, federal legislation passed within the last few years - like the Hospital Price Transparency Rule which went into effect earlier this year and is referenced several times throughout the book - is meant to bring about additional sweeping changes to our healthcare system that began with the Affordable Care Act.

Add in a digitally connected world and you have a "recipe" for consumer success.  But success won’t happen overnight.  It’ll require some time, resourcefulness, access to information, and active participation to be an informed, savvy healthcare consumer in the 21st century.


If you or someone you know has 1) been burned by the U.S. healthcare system or 2) wants to learn about U.S. healthcare and avoid getting burned, then PLEASE read this book!  You may only be compelled to read it if you get a surprise medical bill, but that would be a mistake.  This book has information that could make you a better, more informed consumer and avoid issues in the first place.


If you're the owner or an executive of a company offering (or is considering offering) health benefits, then this book is an INDISPENSABLE resource for 1) selecting the best coverage(s) for your employees and 2) managing those benefits & their associated costs.

If there's one "criticism" of the book…

It's that some people may not want to sit down and read a "how-to" book (in this case, a 200-page book).

I get it.

Nowadays, people are accustomed to "online learning" (i.e., watching YouTube "DIY" videos).  Heck, over the course of the pandemic, I learned how to lose weight (and enjoy it!), mix drinks, and create websites by binging YouTube videos.

Thankfully, Marshall is addressing this issue.

The day after I finished reading the book (back in October), I happened to be checking my LinkedIn feed when I came across a post from Marshall (whom I follow) about a crowdfunding campaign that he created to raise funds to produce a health literacy video series called "The Never Pay Pathway" that will complement the book.  I was so glad I caught wind of the campaign because the day I viewed his post was also the deadline for donations.

I happily donated.

Coincidentally, October was "Health Literacy Month" and, for many Americans, the beginning of Open Enrollment season.

The stars were truly aligned that month!

Thank you, Marshall.  I look forward to seeing the finished product!

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