We’re always asking: Why do drugs cost so freaking much?

And it’s a complicated question. There are a bunch of reasons — to be sure. But in our reporting over the years, like our stories on insulin and tuberculosis drugs, experts cited one big reason over and over again:

The pharmaceutical industry wages sophisticated legal battles to keep monopoly control over their best selling, most lucrative drugs — blocking generic competition, and increasing their prices along the way.

How did it come to be this way?

In this first episode of a new series – what we’re calling An Arm and a Leg 101 – we’re doing a crash course in the history of the drug patent system.

And the rags-to-riches story of one amazing guy is going to help us do it.

Al Engelberg got schooled in the Art of the Hustle at a young age, collecting dimes at an illegal bingo game on the Atlantic City boardwalk.

Later, he’d put those street smarts to use as he sat at the negotiation table in Washington D.C., hashing out the details of a law that would usher in the generic drug industry as we know it. Then made millions from the rules he helped write.

And as he admits, his legacy is mixed.

On the one hand: The rules Al Engelberg helped write — a grand bargain between generic drugmakers and patent-holding brand pharma companies— unleashed the power of generic drugs to save Americans money.

Nine out of ten prescriptions written today get filled with a generic.

On the other hand: In the process of making his fortune, Al Engelberg discovered loopholes, gaps, and perverse incentives in that grand bargain.

Gaps that allowed brand and generic drugmakers to profit by keeping generics for many hit drugs off the market.

So we now spend more than ever on medicine — and more than 20 percent of Americans report skipping their medication because they can’t afford it.

Al Engelberg, now 86, has spent the last 30 years — and millions of his own dollars — trying to close those gaps.

“I live in a world — a pharma world — where half the people think I’m dead, and the other half wish I was,” he tells us.

You can read more of Al’s story — plus his prescription for fixing the crisis of high drug prices — in his book, Breaking the Medicine Monopolies: Reflections of a Generic Drug Pioneer.

And you can hear our earlier reporting on drug patents here:

John Green vs. Johnson & Johnson (part 1)

John Green vs. Johnson & Johnson (part 2)

The surprising history behind insulin's absurd price (and some hopeful signs in the wild)

Here's a copy of this episode's transcript.

Send your stories and questions. Or call 724 ARM-N-LEG.

And of course we’d love for you to support this show.

An Arm and a Leg 101 is made possible in part by support from Arnold Ventures.

See omnystudio.com/listener for privacy information.

This year, the price of health insurance increased dramatically for millions of people. Tens of millions. Obamacare subsidies shrunk, and premiums skyrocketed.

People asked themselves: how on earth am I supposed to make this work?

Two of those folks — attorney Nicole Wipp and skate-shop owner Noah Hulsman — tell the story of how they chose among lousy options.

Nicole chose to dump health insurance altogether — even though she could have found a way to pay for it. Noah chose to pay for coverage that sucks, because it’s all he can afford.

Each made their choice in the context of their broader stories: Noah is deeply rooted in Louisville, KY, and lives about a mile from where his grandmother started Louisville’s first skate shop, around the time he was born.

Nicole’s story includes an expensive, life-threatening medical adventure a decade ago — and a series of choices that’s taken her family from Michigan to Hawaii to South Carolina.

Reporters with KFF Health News have been talking with dozens of people all over the country about these kinds of choices for their series on the health insurance crisis, Priced Out. KFF Health News senior correspondent Renuka Rayasam, who introduced us to Nicole and Noah after writing about their stories, joins us to reflect on what these stories mean.

Read more of Renuka Rayasam’s reporting:

When Health Insurance Costs More Than the Mortgage

It’s 2026 and You’re Uninsured. Now What?

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Hey, first! We’re looking for your help. Can you take a couple minutes and fill out our Audience Survey?

We’re dying to know more about the community that’s using this show — and about what’s working for you and what you’d like to see. Let us know!

Today we’re switching it up. We’re sharing an episode from the new podcast Drug Story. In each episode, science journalist and self-described “public health nerd” Thomas Goetz goes deep on the story of a single drug — what it treats, how it came to be, and what it reveals about the business of health and disease.

On this episode: the EpiPen, a device you’ll find in classrooms, on airplanes, in glove compartments — basically everywhere — because the EpiPen can be a literal life-saver for people with severe allergies.

And of course, the EpiPen is also one of the most infamous examples of pharmaceutical profiteering gone bananas.

That part of the story makes us especially geeked to share this episode.

And there are more threads here — on the drug’s discovery, on the science of severe food allergies, and on what researchers have learned about preventing them — that Goetz does a great job of weaving together.

If you like it, new episodes of Drug Story come out every week.

We’ll be back with more Arm and a Leg in a few weeks. Meanwhile, don’t forget to help us by filling out our quick survey.

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.

See omnystudio.com/listener for privacy information.

Thirty-six hours before his wife was scheduled for a major surgery, New York Times personal finance columnist Ron Lieber got a letter in the mail that sent him reeling.

Insurance was denying prior authorization for the surgery. The only way forward would be to appeal the decision. But it was Saturday night, and the surgery was Monday morning. There wouldn’t be any time. Should they even go to the hospital?

They decided to bet on being able to reverse the denial later on, but the last minute coverage questions left Ron’s wife, New York Times reporter Jodi Kantor, going into surgery that Monday with a brand new sense of stress and anxiety.

And along with worrying how his wife's surgery would go (spoiler: it was successful), and whether they’d end up on the hook for a bajillion dollars, it left Ron to wonder why no one had given them a heads-up earlier.

He set out to find answers — and whether there might be a way to prevent these last-minute denials from sneaking up on other people.

Ron turned to his "Your Money" newsletter subscribers for ideas, and eventually published a draft letter in his New York Times column that doctors and other health care providers could give their patients to better prepare them for insurance curveballs.

Check out the column here – and consider passing it along to any health care workers whose patients you think might benefit.

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.

See omnystudio.com/listener for privacy information.

For five years, we’ve been following the work of Dollar For and its founder Jared Walker, watching them quickly scale up their efforts to help people crush medical debt by tapping into “charity care” — the financial assistance that hospitals are legally required to offer some patients.

Their work represents what a small, scrappy, thoughtful group of people can do. Last year, their tiny staff helped wipe out more than $55 million in medical bills.

As we kick off 2026, we thought it was time to check in again. After all, this will be a year when millions more people will have trouble covering their medical bills — when Dollar For’s work may become more important to more people, and when we’re hungry for more ways to help each other.

As Jared tells it, 2025 proved to be a pivotal – yet rocky – period in the organization’s story. Both their successes and their challenges put into stark relief exactly what we’re all up against.

So we go deep with Jared on what they achieved while they weathered the chaos, and what it might mean for their – and our collective – next moves.

Here's a transcript of this episode.

Check out our Starter Pack: How to wipe out your bill with charity care.

And our previous coverage of Dollar For:

• Could billions in medical debt get zapped by the legal strategy from this 60-second video? (2021)
  We talked to Jared just weeks after Dollar For first went viral. The group’s early history — they’d been working locally for years — is fascinating.
• Badass volunteers help Jared level up, in the fight to crush medical debt (2021)
  Within six months, they’d recruited volunteers and built systems.
• The Medical Bill “Negotiation Lab” (2022)
  In an experiment aimed at scaling up impact, Dollar For tried a different approach in 2022. We sat in.
• One last tip before 2024 (2023)
  Why Jared thinks you should ask for “charity care” by name -- even though, let’s face it, asking for “charity” does not feel good to most of us.
• New lessons from the fight for charity care (2024)
  Dollar For spent 2024 focusing on the big picture and starting to focus on policy advocacy.

Check out our history of charity care series (from 2021):

• A legendary lawyer sued hospitals for price-gouging their patients. And got his butt handed to him.
  Dickie Scruggs is the guy who beat Big Tobacco. But when he took on hospitals, he lost.
• The wild backstory of a tiny but crucial Obamacare provision (ft. David Axelrod)
  Charity care wasn’t part of federal law until the Affordable Care Act passed. A Republican senator made sure it was part of the ACA — before deciding he wouldn’t vote for the law.
• “We just kept right on pushing” … and laws changed
  In New York, a grieving family’s story made headlines and helped advocates catch lawmakers’ attention.
• Wait, that was legal until now?!
  In 2021, Maryland barred hospitals from suing patients who qualified for charity care.

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

See omnystudio.com/listener for privacy information.

Hey, first! If you value what we do, we need your support to keep it going in 2026.

We have SO much work ahead, and we can’t do it without you.

Every little bit counts. Here’s where you can chip in. Thank you SO much!

Our listeners have been teaming up on an incredible project – kicked off earlier this year by a med student named Thomas Sanford.

The idea: create a list of reliable resources to help with medical expenses and avoid debt, and circulate it where people might find it useful, like hospital waiting rooms.

In this episode, we hear how that project is ready to level up – and how you can bring it to people in your community.

Here’s how to help:

Send this link to anyone you think might need it: armandalegshow.com/help

Or go here to print it out, post it, pass it around, customize it for your community, or join with other volunteers: armandalegshow.com/helpers

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Hey, first! If you value what we do, this is the best-ever time to support our work.

We have SO much work ahead in 2026. Donate here.

We’re back for another look at things that – believe it or not – did NOT suck in 2025.

Specifically: new state laws from around the country aimed at protecting people from things like medical debt, insurance delays and denials, and corporate profiteering.

In this episode, we dive into two examples from opposite sides of the country to look at how laws like these get made – and in some cases, defended.

In Maine, lawmakers unanimously voted to remove medical debts from people’s credit reports. While a nationwide court ruling raises questions about the new law’s future, we’ll hear why consumer rights attorney Chi Chi Wu remains optimistic.

And in Oregon, a law aims to prevent big corporations and private equity firms from taking over medical clinics and strip-mining them for profits.

Plus, a good-news update from our team at An Arm and a Leg.

Here's a transcript of this episode.

Send your stories and questions! Or call 724 ARM-N-LEG.

And, again… we’d love for you to support this show.

See omnystudio.com/listener for privacy information.

Hey, first! If you value what we do, this is the best-ever time to support our work: This month, every donation gets matched two-for-one.

We have SO much work ahead in 2026. Donate here — and get your money matched two-for-one.

It’s probably fair to say: this is the worst year ever for picking health insurance. Premiums are skyrocketing – whether you get insurance through work or from the Obamacare marketplace.

And with enhanced subsidies almost definitely expiring, millions of people with Obamacare plans are grappling with drastic changes to their household budgets.

We’re our own case study: You’ll hear us sorting through our own options. None of them are pretty, but because we know how to read the fine print, we figured out: Some are way, way less awful than others.

And to help you do the same: We’ve boiled down our fine-print-reading expertise in this starter pack on how to pick insurance.

Also in this episode: we talk with a listener who wonders: is paying for health insurance even worth it at this point? (Her ultimate answer: Yes, but argh.)

Read Julie Appleby’s reporting for KFF Health News about what could happen if Congress changes course and extends the subsidies.

Here’s a transcript of this episode.

Send your stories and questions! Or call 724 ARM-N-LEG.

And, again… we’d love for you to support this show.

See omnystudio.com/listener for privacy information.