Dirty Little Secrets: Telling the Truth on Healthcare

The U.S. healthcare system isn't broken. It's working exactly as designed — the problem is what it was designed to do. Hannah Mamuszka and Lena Chaihorsky have spent their careers trying to get better diagnostics, data, and drugs to the patients who need them — and running headfirst into a system built to spend more and deliver less. On Dirty Little Secrets, they expose the financial misincentives hiding underneath American healthcare: the rebate machine that inflates drug prices, the middlemen who profit from confusion, the tests that could save lives and money but go unused, and the reasons your premiums climb every single year. This isn't abstract policy talk. It's the stuff they've seen firsthand across two decades in diagnostics and precision medicine — a urine test that could spare men unnecessary biopsies, shelved because biopsies pay better; a generic drug that jumps from $40 to $370 overnight; a system where nobody actually gets paid to find the answer. Stories that are hard to believe, but true, and backed with sources. Each episode takes on one dirty little secret and makes it make sense: How pharmacy benefit managers (PBMs) really set drug prices — and why your insurance company might be the reason you can't get the drug your doctor prescribed Why nearly all of us carry gene variants that change how we respond to medication, and how testing once could end years of trial-and-error prescribing How the "diagnostic odyssey" became a revenue stream, and who profits when a diagnosis takes seven years Why insurers aren't rewarded for saving money — and what the medical loss ratio has to do with your paycheck What self-funded employers, empowered patients, and transparent pricing could change Along the way, Hannah and Lena talk with the people building a better way — PBM reformers, precision-medicine pioneers, benefits leaders, and entrepreneurs who've decided the status quo isn't good enough. The goal isn't just to make you angry. Because mad isn't a strategy. It's to help you ask sharper questions, advocate for yourself and your family, and finally understand how the money really moves in American healthcare. New episodes regularly. Like, subscribe, and send us your questions — we read them, and we answer them on the show.

Dirty Little Secrets: Telling the Truth on Healthcare is a business podcast hosted by Unknown Host, with 0 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Unknown Host hosts Dirty Little Secrets: Telling the Truth on Healthcare, a business show with 0 episodes published.

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  Episode #4

  Ending Trial-and-Error Medicine

  Aug 26, 202635 minS1

  <p>Hannah Mamuszka and Lena Chaihorsky interview Kristine Ashcraft, a molecular biologist who has worked in pharmacogenomics (PGx) since 2000, first at Genelex, one of the earliest labs to offer the testing, and later as founder of the clinical-decision-support tool YouScript. Ashcraft traces the field's slow adoption despite strong evidence, explaining how most people carry gene variants affecting how they metabolize common drugs, using a "liver highway" analogy: some people have fewer or more "lanes" (enzyme activity), and drugs, foods, and other medications can shut lanes down. YouScript's clinical studies showed large reductions in hospitalizations, ER visits, and deaths, and the...

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  Dirty Little Secrets: Telling the Truth on Healthcare

  Mad is not a strategy: The CPA who makes the case pharmacogenomics

  Aug 10, 202642 minS0

  <p>Hannah Mamuszka and Lena Chaihorsky talk with Jane Cheshire Gilbert, a CPA who spent two decades running the health plan for the Teachers' Retirement System of Kentucky (TRS) and became an unlikely pioneer in pharmacogenomics. Serving tens of thousands of retired teachers — many in their 80s and 90s, on an average of 15 medications — Gilbert treated genetic testing not as a clinical curiosity but as a fiduciary tool: if a plan is paying full price for a blood thinner or antidepressant a member's body can't use, everyone loses. She recounts building a program with Coriell Life Sciences and the Know Your...

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  Episode #2

  Diagnostics are the GPS of the Healthcare System We Refuse to Use

  Aug 10, 202620 minS1

  <p>Hannah Mamuszka and Lena Chaihorsky make the case that diagnostics — not just drugs — are the key to controlling healthcare spending, and that the U.S. systematically underuses them. They lay the groundwork for the series: primary diagnosis (what's actually causing your symptoms), the "diagnosis of exclusion" trap, and two kinds of tests that determine whether a prescribed drug will work for you — pharmacogenomic tests (how your genes affect drug metabolism) and response-predicting diagnostics (whether you'll respond at all). The recurring villain is economics: insurers balk at a $200 test to protect a $10 prescription, ignoring the clinical and downstream costs; physicians skip t...

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  Episode #1

  Why We're Doing This: The Financial Misincentives Behind U.S. Healthcare

  Aug 10, 202630 minS1

  <p>In the debut episode of Dirty Little Secrets, Hannah Mamuszka and Lena Chaihorsky introduce themselves and the podcast's central thesis: that the U.S. healthcare system is built on financial incentives that reward treatment over prevention and volume over value, systematically blocking patients from the best data-driven care. Mamuszka, a molecular biologist who moved from cancer drug development into diagnostics, and Chaihorsky, who came to the field through math and finance, each recount early-career moments when validated science was undervalued by the payment system — a high-risk-pregnancy test reimbursed at $11, and a urine test that could spare men unnecessary prostate bi...

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