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An Arm and a Leg

An Arm and a Leg

Author: An Arm and a Leg

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A show about why health care costs so freaking much, and what we can (maybe) do about it. Hosted by award-winning reporter Dan Weissmann (Marketplace, 99 Percent Invisible, Planet Money, Reveal).

Hosted on Acast. See acast.com/privacy for more information.

124 Episodes
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Folks who expected their health insurance to cover some out-of-network care have been getting stuck with enormous bills instead. Like one couple from Kansas City: Their insurance hung them out to dry for thousands of dollars, all while sending statements touting a “discount” the couple was supposedly getting. Turned out: A middleman was cutting their coverage — actually a middleman’s middleman — working with their insurance company. The couple’s insurer got the “discount,” and the middlemen got big fees. And of course this couple wasn’t alone. A recent New York Times investigation from reporter Chris Hamby documented and explained this Russian-nesting-dolls-of-middlemen scheme. Insurance companies (middleman #1) work with a with a company called MultiPlan (middleman #2), which slashes the amounts the insurance plans actually pay for care.To show how it all works — and what we can maybe do about it — we dive into the hidden mechanics of health insurance.  Here's a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
We’re launching a brand new project and need your help!We’re zooming in on charges that are becoming more and more common on your medical bills: facility fees. Facility fees are charges tacked onto your bill for visiting a doctor’s office or clinic related to a hospital or larger health care system… or even talking with a doctor who’s in one of those places on a telehealth visit. If you’ve ever seen a charge for a facility fee on your medical bill, we want to hear from you. ... and if you haven't, we'd love your help spreading the word!Consider sharing our posts on any of these networks:Instagram | TikTok | Facebook | Ex-Twtitter | LinkedInWe’ll be back with more new episodes in a few weeks. In the meantime, send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
The Hack

The Hack

2024-04-1121:38

When a subsidiary of the giant UnitedHealth Group got hit by a cyberattack recently, a big chunk of the country’s doctors, pharmacists, hospitals and therapists just stopped getting paid. It’s been a huge disruption, with some providers wondering if they can keep their doors open.But thanks to their huge size and reach, the situation may have had a silver lining — for United.Which seems like a big problem, and got us wondering: What can we maybe do about it?The answer turns out to be: Maybe more than we think, via antitrust enforcers at the Federal Trade Commission and the U.S. Department of Justice.Strap in for a wild ride — and then maybe check out FTC Chair Lina Khan’s talk with Jon Stewart on The Daily Show. We include some short excerpts, but the whole thing is worth a watch.Thanks to reporters Brittany Trang (STAT News) and Maureen Tkacik (The American Prospect) for guiding us through their reporting.And to the novelist/journalist/activist Cory Doctorow, who has been writing about antitrust enforcement for years. Here are a couple of his columns about Lina Khan and what she and other antitrust enforcers are up to.If you want a deeper dive on the new antitrust movement: It’s summed up in a terrific (and short) book by Tim Wu, a Columbia University law professor and former White House adviser: The Curse of Bigness: Antitrust in the New Gilded Age. And you may be able to get it for free! If your local library uses a system called Hoopla, you can borrow it as either an audiobook or an ebook.Super-fun tangent: Cory Doctorow and Tim Wu went to elementary school together — and apparently played a lot of Dungeons and Dragons — when they were kids in Toronto. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
Reporter Bob Herman from STAT News unpacks his blockbuster investigation about the country’s biggest health care company.   Covering the American health care system means we tell some scary stories. But this episode is almost like a horror movie. It’s got some of Hollywood’s favorite tropes: Machines taking over. Monsters from separate franchises meeting face to face in a new movie, like Godzilla and King Kong, or Jason and Freddy. And a couple perceptive folks warning everyone, ”Hey, look, something really bad is happening!” Those folks are Bob and his STAT News colleague Casey Ross. The monsters are United HealthGroup — a “behemoth” as one expert called them in an episode from last year — and Medicare Advantage, which we looked at in our last episode. And the “machines” belong to United.Bob describes what some of United’s own employees said about the result: “For some of us, it's creating this moral crisis. Like we know that we are having to listen to an algorithm to essentially kick someone out of a nursing home, even though we know that they can barely walk 20 feet.” Scary stuff. But Bob and Casey’s reporting has caught the eye of some powerful people in government, and right now, Medicare Advantage plans are on notice from the federal Centers for Medicare and Medicaid Services, the U.S. Senate is holding hearings, and the Department of Justice reportedly has an anti-trust investigation in the works. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
The Medicare Episode

The Medicare Episode

2024-02-2929:112

Health insurance sucks. Which leaves lots of us counting down the days until we turn 65 and can get on Medicare – the federal government’s health insurance program for seniors. But Medicare is a lot more complicated – and costs more money – than a lot of us realize. (Also, it involves insurance companies.) And:t There will be huge, complicated decisions to make when you turn 65, that can have huge consequences. The biggest, and most consequential: Choosing between original Medicare and Medicare Advantage – the privatized version sold by health insurance companies that’s advertised everywhere seniors look. Some folks who pick Medicare Advantage later regret it — but find there are no do-overs. We get the scoop from Reporter Sarah Jane Tribble, who’s been covering the story for KFF Health News and the Washington Post. And we get a preview: What do we all need to know before we hit 65 about the choices we’ll face? There are a lot of options, and a lot of price tags. Sarah Murdoch from the Medicare Right Center gives us an outline of those choices and their consequences — and supplies both tips and resources. The biggest: When it’s time for you -- or anyone you care about -- to make choices around Medicare, every state has a free source of unbiased advice and information: Here’s a link to find your State Health Insurance Assistance Program (or SHIP).Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
A listener wrote to us at the beginning of the year with a query, “I was just reading the news about the price of insulin going down to $35! Is that for everyone?”It turns out, there is a lot of good news about the so-called “poster child” for the high cost of prescription drugs. But to say it costs $35 now is an oversimplification – and diabetes activists don’t think this fight is over.Senior producer and self-proclaimed “insulin correspondent” Emily Pisacreta took a hard look at the recent developments. Plus, what does the explosion of drugs like Ozempic and Wegovy have to do with the price of insulin? We break it down. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
Dealing with the American health care system as a patient means lots of tough moments – unexpected bills, meds not covered, insurance and hospitals making you go back and forth without a clear answer, endless hold times and phone trees… the list goes on. So listeners ask us all the time: How do I stay strong and fight for my rights without totally losing my s---? We’re bringing back one of our most useful episodes ever: How to keep your cool in a tough moment, according to a self defense expert. In late 2020, Dan hit up self defense expert Lauren Taylor to get strategies for standing up for yourself, and hear how she’s applied her approach in her own fight for health care coverage. Since then, she’s published a book! It’s called Get Empowered: A Practical Guide to Thrive, Heal, and Embrace Your Confidence in a Sexist World. Extra tip: At the moment, the site bookshop.org, which supports independent bookstores, has the best price.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
Real quick: Now's the best time to support this show! Thanks to a few super-star Arm and a Leg listener/donors, your donation is matched two for one right now. Here's the link to donate.Ok, now: We’ve got a mini-episode for you today, a four-minute coda to the epic story we brought you in December.It features a last tip for anyone who might want to ask a hospital about charity care — which, as we learned from these recent stories, is most of us.And it comes with my big thanks for being part of this show’s community this year. You’re our reason for being, and our best sources.  You’re also our biggest source of financial support, so I will ask one more time to pitch in now if you can.  Thank you so much! We'll catch you in 2024. Hosted on Acast. See acast.com/privacy for more information.
Hey! The BEST time to support this show with a donation just got even better. Right now, any gift you make, up to $1,000, will be matched TWO for ONE, thanks to a few super-generous Arm and a Leg fans who’ve pooled their dough. . It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it!And… are you ready for our most-ambitious story yet? We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. With those partners, we’ve dug up some surprising (and possibly uplifting) news about lawsuits in three states – Maryland, New York and Wisconsin — and what that news might mean for the rest of the country.  This is part two of a two-part series. In part one, we examined the phenomenon of hospitals suing patients in bulk – sometimes hundred or thousands at a time – over unpaid bills. We learned that in many cases, those patients are struggling financially, and that the lawsuits aren’t very lucrative for hospitals anyway. So why did they happen in the first place? As one former collections industry insider told us, those decisions are “philosophically based.” In this episode — before getting to those surprising/hopeful findings — we try to understand that “philosophy,” perhaps best described as: business-as-usual. We speak with a former hospital billing executive and a representative from the third-party collections industry. This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.… and supported by the Fund for Investigative Journalism. Hosted on Acast. See acast.com/privacy for more information.
Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it!We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. For years, we’ve been hearing about hospitals suing patients over unpaid medical bills – sometimes even in bulk, by the hundreds or thousands at a time. Many of the patients getting sued are already facing financial hardship, or like one couple we interviewed, already in bankruptcy. Judgments against patients in these suits can be life changing. But according to experts, these lawsuits don’t recoup a ton of lost revenue for hospitals. So why do they happen? And what if hospitals stopped doing it completely? In this episode, we talk to a former sales rep for a medical-debt collections agency — who now steers hospitals away from efforts to collect money, via lawsuits or other means, from folks who just don’t have it.He tells hospitals: This is better for your bottom line. Stay tuned for part two, coming in two weeks. … and to preview some of what’s in it — plus a whole lot more excellent reporting — check out the Baltimore Banner’s story: Maryland hospitals stopped suing patients with unpaid bills. Will they start again?This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.… and supported by the Fund for Investigative Journalism.OOH: And don’t forget. It’s prime time to make a donation and support this show. Here’s a transcript of this episode. Hosted on Acast. See acast.com/privacy for more information.
Last fall, actor-writers Ellen Haun and Dru Johnston were hustling to get their health insurance sorted out for 2023. To qualify for insurance through the actor’s union, SAG-AFTRA, Ellen would have to book a little more work — doable, but not a sure bet. So they came up with a plan: crowdfund a bunch of money to make a short film, starring Ellen … called “Ellen Needs Insurance,” of course.It worked! And the movie, a 13-minute comedy, is terrific. Ellen and Dru sat down with us to go over how they made the whole thing happen, and how this year’s Hollywood strikes changed their perspectives. Here’s a transcript of this episode.ALSO: Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it! Hosted on Acast. See acast.com/privacy for more information.
In 2019, Dr. Luke Messac was a medical resident who found himself spending his day off in a courthouse archive. He’d heard about hospitals suing their own patients over unpaid medical bills. He wanted to know if the hospitals he worked in were doing the same. They were. Trained as a historian, Messac then set out to trace the history of this phenomenon, and the story of medical debt in the U.S.His new book, Your Money or Your Life is the result of that research. Luke Messac sat down with us for a chat about how he got interested in medical debt, how medical debt became the massive problem it is today, and what he thinks people who work in health care can do to start to fix it.ALSO: Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it! Hosted on Acast. See acast.com/privacy for more information.
First: an update on our recent two-parter with the writer John Green, about the global, decades-long fight to make an important tuberculosis drug more widely available. Just two days after we posted part 2, the activists waging that battle scored a major victory. John Green was kvelling on YouTube, of course. We’ll get you up to speed. And for the meat of this episode, we’ve got a guest a lot of you have been asking for: Physician/comedian Will Flanary, AKA Dr. Glaucomflecken. His punchy videos satirizing the absurdities and cruel complexities of the American health care system have been a fan favorite for years among An Arm and a Leg listeners (and us too).We’re sharing a delightful and moving conversation with Dr. G and his wife, educator Kristin Flanary (AKA @LadyGlaucomflecken online), from our pals at The Nocturnists, a podcast about the experiences of health care workers. As the Glaucomfleckens tell Nocturnists host Dr. Emily Silverman, the inspiration behind Flanary’s most biting videos. came from the couple’s experience dealing with health insurance after he suffered a near-fatal heart attack.Check out the Nocturnists here or wherever you get your podcasts, and Dr. Glaucomflecken’s videos on TikTok, Instagram, and YouTube. Send your stories and questions for An Arm and a Leg, or call 724 ARM-N-LEG.And of course we'd love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
This is part two of our globe-spanning story about drugs, patents, and YouTube megastar John Green. Quick recap: In our last episode, we learned how writer and YouTube star John Green kicked up a fight with Johnson & Johnson over a medicine called bedaquiline. And appeared to score a victory.Here, we dig into the backstory: How everything John Green and his fans won was built on activism going back 20 years, and spanning multiple continents. All of it illustrates how pharma companies work the patent system to extend their legal monopolies on medicine way beyond the standard 20 years, and how that leads to high drug prices here and abroad. And what we can maybe do about it. This episode starts in 2004, when India began the process of changing its patent laws to align with global trade rules. Activists there managed to carve out exceptions to the law to prevent some of the worst patent abuses. Fast forward to this year, when those legal safeguards become key to unlocking new doors in the fight against TB. Meanwhile, the proponents of those Indian safeguards are here in the U.S., pushing for drug patent reform here. Which not only could help Americans, but also influence global standards. Here's a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we'd love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
This episode  is special. When we heard that widely-beloved writer John Green was rallying his online community  around a fight over drug prices — and apparently making a difference — we were pumped. And this story took us in so many different directions:  Literally around the world, and then straight back home.The drug in question is bedaquiline, made by Johnson & Johnson. It treats drug-resistant tuberculosis, and its price has been a huge obstacle to getting it to places it’s needed most — primarily places far away from the U.S.But the reason this TB drug costs so much overseas is also one of the main reasons that important drugs here are so expensive — drugs like insulin, Humira and… well, just about everything:  Legalistic patent games that pharma companies have mastered. So, in addition to John Green — and yes, we talked with John Green — we also talked with one of the world’s leading experts on drug-patent games, Tahir Amin.Also, John Green is a great storyteller. So hearing him tell the story of how he became obsessed with tuberculosis is bittersweet.And in order to make sense of any of this, we had to dig into the story of how John Green and his brother Hank became (and remain) YouTube superstars. For more than 16 years, they’ve been building a community of “nerdfighters” — nerds fighting to make the world a better place. It’s a profoundly sweet and fun story, and everything we’re trying to do here owes them a debt. Oh, finally:  This is, as you’re probably guessing by now, an epic story.  It’s gonna take two full episodes of An Arm and a Leg to tell it all.  So, we hope you enjoy part one. There’s more coming in a few weeks. Hosted on Acast. See acast.com/privacy for more information.
Hey there— our next story is gonna take a little more time to cook, but it is going to be SO worth it. It involves John Green, author of The Fault in Our Stars — and yes, we've got an interview with him — and a global fight against multi-drug resistant tuberculosis.... which turns out to be directly related to fights over the prices of drugs like insulin and humira in this country.Meanwhile, let me recommend a story from ProPublica that's related to a story we did here a few months ago.You might remember our recent episode about United HealthGroup, and how it's become a behemoth in recent years. That story started with a complaint from a doc in New York.... who had a lot more tips than I could run down — or fit in one episode — and they weren't all just about United. ProPublica's Cezary Podkul took the time to verify a big one: About zillions of dollars in fees that docs are paying — dollars that ultimately come out of our pockets — just to get paid.Oh, and: If you aren't getting our First Aid Kit newsletter, this is a great time to sign up. We've started a series about how to fight with insurance that, unfortunately, a lot of us are gonna need at some point. We'll be back in a few weeks, with John Green, TB, and the fight over drug prices. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
For a year and a half now, the No Surprises Act has protected patients from some of the most outrageous out-of-network medical bills. But Congress left something pretty crucial out of the law — bills from ground ambulances. We look at just how wild ambulance bills can be, with a story about three siblings who took identical ambulance rides — from the same car wreck to the same hospital — and got completely different bills. (Thanks to Bram Sable-Smith who reported the story for the Bill of the Month, a series from NPR and KFF Health News.). And we find out how ambulance bills ended up being so random — a story that takes us back to the 1970’s. Plus, what you can do if you get hit with an out-of-network ambulance bill:See if you can negotiate a better dealSee if you might qualify for financial assistance. (Here’s some detailed guidance from Jared Walker of Dollar For.)See if you’re protected under state law. At least ten states have passed laws protecting some patients from surprise ambulance bills. Check here to see if yours is one of them. Want to share your thoughts on how Congress should deal with out-of-network ambulance bills? A federal advisory committee wants to hear them. You can email them here.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
If you’ve been told your insurance won’t cover your meds — or that you’re gonna have to pay an arm and a leg for them — you’ve met a PBM: a pharmacy benefits manager. And: Experts say they play a big role in jacking up drug prices overall. But how, exactly? We took a deep dive.This episode first went out in 2019. We’re bringing it back because PBMs are in the news these days: Congress is targeting them, in an effort to to be seen doing something about prescription drug prices. And PBMs’ sometimes-rival, the powerful pharmaceutical industry lobby, is flooding the airwaves with ads attacking them. There’s been a little news since 2019: Although Congress is still catching up, all 50 states have passed some laws pertaining to how PBMs work. We’ve got an update on that. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show.Correction: A previous version of this episode misidentified the parent company of Express Scripts. Hosted on Acast. See acast.com/privacy for more information.
Credit Card, Please

Credit Card, Please

2023-06-1521:49

A listener’s doctor wanted her credit card info up front — before her appointment. She wondered: Do I need to give it to them? We did too. After all, who wants the risk of being overcharged — and then having to fight for money back?Experts gave us their best advice, including a couple of tricks to try, and a legal protection you may be able to rely on. Meanwhile, Elisabeth Rosenthal, senior contributing editor at KFF Health News, filled us in on the rapid growth of medical debt as a financial product, including specialized credit cards and financing plans pushed by hospitals and other providers.They can come with steep interest rates, and (surprise, surprise) the terms aren’t always spelled out clearly. The federal Consumer Financial Protection Bureau has been issuing reports, including a handy FAQ, but hasn’t taken enforcement action in a decade.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
When a New York doctor tweeted recently about “payday loans” for doctors from a branch of UnitedHealth Group — which operates the giant insurance company UnitedHealthcare — we were intrigued.Especially when we saw that the loan product — a “cash flow solution” for health care providers — was real.The doctor’s tweet essentially accused UHG’s insurance arm of causing cash flow problems for providers in the first place, by denying claims and delaying payments — which echoes complaints we’ve heard over the years, and which the original tweet called “genius” — as in Evil Genius. When the boss who’s paying you late offers to front you money, at interest, to tide you over, it does sound like… a conflict of interest.It turns out, because UnitedHealth Group is such a big, complex enterprise, it’s not quite that simple. But UnitedHealth Group’s size and complexity turns out to be the story. The company has grown into a “behemoth,” running the country’s biggest insurance company, and becoming the biggest employer of doctors, while also running big parts of the business-side back end for big chunks of the health care ecosystem. As one expert told us, “There's very little good news about what happens when these organizations. or these sectors of health care get bigger.” Costs and prices tend to go up, without a bump in quality.And regulators, we learned, have struggled to keep up. It’s a wild ride with a sobering conclusion — and very much worth taking. As the expert who labeled United a behemoth wrote: “United has grown to its present immense scale largely without public knowledge.” Now we know. And knowledge is the beginning of power. BONUS TIP: This story reminded us of themes and insights from novelist, journalist, and activist Cory Doctorow, especially his recent book Chokepoint Capitalism and his recent essays about the “enshittification” of online life.We also like Cory’s novels a lot, and have learned a ton from them. They’re often called science fiction, but the tech is usually present-day, or about a month into the future. His latest, Red Team Blues, is a smart, fun techno-thriller. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.
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Comments (14)

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Nov 20th
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Andi-Roo Libecap

When you write a letter to any organization, arguing against its policies, ALWAYS include (and fail to bcc) pertinent upper echelon parties -- as well as those from below. I once wrote a letter to my children's local school, which I also copied to every single teacher in the building, the various school secretaries, the school board and their secretaries, and our local newspaper. If you want to show you mean business, and if you want a hasty response, then "Go big or go home!" This strategy is true is ANY structure -- including insurance, rental companies, etc. And if you REALLY mean business, print a hard copy and mail via a method which requires signature of receipt, along with a cover letter in which your mention your lawyer by name. It really doesn't even matter if you HAVE a lawyer -- the mere mention of "as per my lawyer's advice" will set things in motion, and sending it express mail (or whatever) shows you mean business.

Jun 16th
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Jan 22nd
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Angie Stahl

One of my favorite episodes of this podcast and across all the ones I listen to. Tiktok Mom (and her husband) are bighearted gems. Thanks for doing what you do!

Oct 3rd
Reply

Bella Quinn

so i love this podcast and have learned alot. so its pretty terrible what hospitals are doing to really sick patients. my theory if everyone stops paying insurance companies and stop paying hospitals all at the same time. maybe we could get health care that is standardized and that everyone can afford. like our justice system, we have the best healthcare system that money can buy. i really think everyone should consider my theory.

Apr 24th
Reply

E Meany

interesting podcast. Informative. Quick question, why give a trigger warning about bleeped cuss words but explicitly describe dog testing and killing in the insulin episode? I would rather hear cuss words.

Jan 6th
Reply

Simon Riley

what is the name of the tool they talk about from 12-13 min in?

Sep 13th
Reply (1)

Sheng h. davis

such a great show!!! why is this podcast not more popular?

Jan 9th
Reply (1)