Medicare for All

 We're talking about Medicaid folks, the public healthcare system meant to be our social safety net for anyone who can't afford private insurance and doesn't have access to healthcare from an employer. I'm sure most of you are aware of Medicaid — but what you might not know is just how many of our friends and neighbors land in that safety net every year. Over 70 Million people in this country rely on the Medicaid program for basic healthcare. That's 20% of Americans, or one out of every five people you meet. That means that even if you are not on Medicaid, the $880 Billion in cuts to the program proposed by congress will affect you or someone you love, and not in a good way. In fact, just today, researchers at Yale and UPenn released new research stating that the Trump cuts would cause over 51,000 additional Americans to die each year. For this episode, I'm joined by Jaron Benjamin, Deputy Chief of Campaigns from Popular Democracy to break down why we all need to care about stopping the cuts and act NOW, before it's too late! https://www.youtube.com/live/I4xu6zglswc?si=OmFDD5gezpbwppNq We need YOU to join the fight to save Medicaid! Find out more about what you can do here! You can learn more about the great work happening at Popular Democracy here! Follow & Support the Pod! Don't forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! This show is a project of the Healthcare-NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

Whether you are a party planner or a community organizer, you know that since the pandemic, it has been REALLY hard to get folks out of the house. It makes sense: the news is depressing, our screen-based scrolling culture is alienating, and our politics are polarizing to the point where a casual conversation can easily escalate to throwing hands. That being said, this month has been different! In response to Trump 2.0, we're seeing an uprising of activism in the streets, with millions of Americans participating in Hands Off protests and other actions to fight back against Trump's attacks on everything from migrant rights to Medicaid. What's behind this second wave of Trump resistance? As per usual, it's a lot of ordinary people deciding they can't wait any longer for change. On today's episode, I'm talking to the leaders taking action in my local Texas community to get some perspective on Resistance 2.0 and why it's all kicking off right now! https://www.youtube.com/live/7OedeuSqD40?si=eXb6DqbW-5vz0LeS In this episode, Gillian talks with her favorite new activists from Indivisible Coastal Bend, the local Indivisible chapter in Corpus Christi, Texas. Ashley, Misty, and Stacie have always been concerned with politics, but the latest developments of the 2nd Trump Administration prompted them to take their concern to the streets and start organizing! Now these women are local leaders in the national uprising happening right now across the US, fighting against cuts to Medicaid and social security, the elimination of DEI, and the overall assault on Democracy. You can read more about the incredible work they've been doing here and here! This is an important moment for all of us in the healthcare justice movement to get together with our allies in the streets to stand up for our public healthcare and demand that we move forward toward universal healthcare, not backward, leaving even more folks out in the cold. So make sure to sign up for our Healthcare Now HEAT (Health Emergency Action Team) to get alerts about rapid response actions you can take to defend Medicaid, Medicare, the VA, reproductive healthcare, gender-affirming care, vaccines, the rights of healthcare workers, and more! Join the team here!

For this episode, we're going back to a familiar villain from podcast-past because  unfortunately, healthcare villains have a habit of staying relevant. This is a guy who made his fame by cozying up to Oprah while schilling diet pills, supplements, and medical conspiracy theories – it's Doctor Oz, who is now Trump's nominee for Director of the Center for Medicare and Medicaid Services. That's right, the man who has previously claimed that there are deadly levels of arsenic in apple juice, that most olive oil is fake, that “Reparative Therapy” can cure homosexuality, and that hydroxychloroquine cures COVID, is pretty close to running our largest public health systems. Today I'm talking with Dr. Diljeet Singh of Physicians for a National Health program about what that means for you and the country at large, and how we can do something about it!  NOTE: At the Medicare for All Podcast, we've had a brief, unplanned hiatus due to pesky technical issues – and the fact that Trump is keeping us busy in our organizing work – but we are very excited to be back! I'm flying solo right now while my regular cohost Ben is saving the environment at his 9 to 5 organizing job, but that feels like important work as well, so we're going to give him a pass and send him our love! https://www.youtube.com/live/3ZUE4sOTI_g?si=WGg97KnP-UxktIsu Our guest for this episode was the brilliant Dr. Diljeet Singh! She's a women's health advocate, an integrative gynecologic oncologist, and the President of Physicians for a National Health Program. Dr. Singh received her medical degree from Northwestern University and her master's degree from the Harvard School of Public Health. She completed an obstetrics and gynecology residency at Johns Hopkins and a gynecologic oncology fellowship at the MD Anderson Cancer Center. She completed her doctoral degree in public health on cost analysis at the University of Texas School of Public Health and an associate fellowship in integrative medicine at the University of Arizona. Dr. Singh and our friends at Physicians for a National Health Program are going all out to let folks know about the serious danger Dr. Oz poses to our national health! Check out the videos from their Dr. Oz Shadow Hearing below: https://youtube.com/playlist?list=PLO8yDO3B42TdHs6GC-PcLez2ZHfZ4CfTN&si=Q3YMJR1IEvr9uHX1 Even though it is likely that the Senate will make it official later this month, as of April 1st, Dr. Oz still hasn't been confirmed, so if you're listening to this in the next couple weeks, you may still be able to call your Senators to ask them to come to their senses! Reach their offices through the Capitol Hill switchboard: (202) 224-3121. Follow & Support the Pod! Don't forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! This show is a project of the Healthcare-NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

Listeners, what were you doing in 2004? Perhaps you were strolling down the street in low rise jeans, Uggs, and a Livestrong bracelet listening to Outkast's “Hey Ya!” Or maybe you were sitting in a movie theater ready to have your mind blown by Ashton Kutcher's tour de force performance in The Butterfly Effect. Well, the folks joining us on this week's episode of our podcast may have missed some of that stuff because they were too busy building a movement for healthcare justice! 2024 marks the 20th anniversary of Healthcare NOW, the national organization fighting for Medicare for All that brings you your favorite podcast! If you're a regular listener, you probably know that I was the Executive Director of Healthcare NOW for 11 years, and Gillian is the current Executive Director, but today we're taking it back to 2004 and talking with some of the OGs who started it all! This episode features some of our very favorite people -- the leaders in the healthcare justice movement who have made Healthcare NOW what it is today (the creator of your favorite podcast content!): Mark Dudzic is a longtime union organizer and activist.  He served as national organizer of the Labor Party from 2003 to 2007 and was a cofounder of the Labor Campaign for Single Payer in 2009.  He has been a member of the Healthcare Now board since its founding in 2004. Lindy Hern is the Chair of the Sociology Department at the University of Hawaii at Hilo and President of the Association for Applied and Clinical Sociology. She has been on the Healthcare NOW board since 2009 and is the author of “Single Payer Healthcare Reform: Grassroots Mobilization and the Turn Against Establishment Politics in the Medicare for All Movement."  Donna Smith is an advocate for single payer, improved and expanded Medicare for all. Her journalism career included work as a stringer for NEWSWEEK magazine, editing and reporting for the Black Hills Pioneer in South Dakota, as well as appearances on CNN and Bill Moyers Journal, and as one of the subjects in Michael Moore's 2007 film, SiCKO. She worked for National Nurses United and traveled more than 250,000 miles advocating for health justice. She now serves as the National Advisory Board chair for Progressive Democrats of America. Walter Tsou is a Board Advisor to Physicians for a National Health Program and on the Board of HCN.  He has been a long time single payer healthcare activist.  Walter is a former Health Commissioner of Philadelphia and Past President of the American Public Health Association. Cindy Young has been a healthcare activist for over 40 years. She has served on the Health Care Now board since 2012. In her retirement, she serves as a Vice President for the California Alliance for Retired Americans (CARA), whose principle goal is to establish a single payer system in California. If this episode doesn't give you your fill of Healthcare NOW history, you can always check out Lindy's book or this sweet tribute to our founder Marilyn Clement. And of course, if you want to keep up the good work of all these amazing folks, you can make a donation to support our work!

Well, the voters have spoken, and despite all of our recommendations to the contrary, they seem to have voted for Trump. Yeah, we're pretty sad/scared/pissed off/trying to cope by dissociating and stress eating as well. Regardless, once again, it's Trump's America and we're just living (or dying) in it. We know from experience that a Trump presidency is bad for our health, but now he has a surprising new ally in making our lives shorter and more dangerous: Robert F. Kennedy Jr.  https://www.youtube.com/watch?v=ZhwR1W_x-TA Show Notes RFK is a former presidential candidate and critic of Trump, an expert falconer, an eater of roadkill, a source of shame for the entire Kennedy family, and a “superspreader” of false information about vaccines. And now he's about to bring his mission to Make America Healthy Again to the masses as the Secretary of Health and Human Services for the entire USA. In this episode, we're going to try to figure out what the hell that means. RFK Jr has some wild ideas about medicine and public health, making some strange connections between cause and effect in our health. Let's play a game! We'll give you some health outcomes, and you guess what RFK has said is the cause of the problem (or “problem” in several cases). (Sources: BBC, HuffPo, Daily Beast)  Problem: Autism, cancer, autoimmune disorders, and ADHDCause: Vaccines!   This assertion is primarily based on the fact that SOME earlier vaccines included a preservative thimerosal, a compound that contains mercury, even though it's been debunked AND hasn't been included in children's vaccines since 2001. Problem: Arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid diseaseCause: Fluoride in drinking water! Problem: Fatness, depression, and cancerCause: Ultra Processed Foods Solution: Raw milk! Problem: AIDSCause: Not HIV! (See his book about Anthony Faucci) Problem: Increasing concentrations of bioavailable aluminum in the environmentCause: Chemtrails This one's a trick question because in a 2016, a survey of scientists showed that most of them didn't even believe that aluminum levels were increasing, let alone that chemtrails exist. Problem: Gay and Trans KidsCause: Pesticides (atrazine) in tap water. Amazing logic here: “[atrazine can] chemically castrate and forcibly feminize [frogs]... If it's doing that to frogs, there's a lot of other evidence that it's doing it to human beings as well.”   Problem: COVID 19Cause: Chinese bioweapon. His logic (from a campaign video leaked to the NY Post): “COVID-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese. We don't know if it was deliberately targeted or not, but there are papers out there that show the racial and ethnic differential and the impact of that. We do know that the Chinese are spending hundreds of millions of dollars developing ethnic bioweapons and we are developing ethnic bioweapons.” A heaping helping of anti-Asian racism with a side of antisemitism! Problem: RFK Jr's own problems with memory loss and cognitionCause: He said in a 2012 divorce deposition, “a worm that got into my brain and ate a portion of it and then died.” Also, tuna fish. He hasn't ever provided medical records to document this, but doctors say it might have happened? Despite the fact that he's about to be nominated to lead the Department of Health and Human Services, RFK Jr. isn't a doctor or a medical researcher. The brain worm explains a lot about RFK Jr's thinking, but neural parasites aside, how did this guy get to be a “public health expert” to begin with? He started as a well-respected environmental lawyer. In 1984, he began volunteering with The Hudson River Fisherman's Association, later renamed “Riverkeeper,” which inspired the global “Waterkeeper” movement. He sued big polluters, helped formulate a model for sustainable development,

We spend a lot of time griping about the insidious power of corporate health insurance in our healthcare system here. But you would expect that taxpayer funded public programs for our most vulnerable friends and neighbors are free from profiteering right?  Sadly, no. Medicaid - the public program that serves the lowest income Americans, plus some people with disabilities, and a lot of the country's long-term care - has been extensively privatized in most states. Hoping to trim budgets, most states have outsourced Medicaid recipients to “Medicaid Managed Care Organizations,” which are actually private insurance companies. And with private insurance comes the barriers to care we know all too well, like prior authorizations, denial of claims, and narrow networks. These are all part of the private insurance/public programs business model: the more care they avoid paying for, the more money from those capitated payments they get to keep. But today we have a rare ray of sunshine: a state showing there's another way to provide care, not just coverage, to some of their most vulnerable residents. In 2012 Connecticut kicked the private insurance-run Managed Care Organizations out of their Medicaid program. They took on Big Insurance and won. Our guest today will walk us through how it went down. Sheldon Toubman has been a litigation attorney for Disability Rights Connecticut since 2021, and a leader of the efforts to remove Managed Care Organizations from the state's Medicaid program. Before that, he was a staff attorney with New Haven Legal Assistance Association (NHLAA), where he spent 30 years representing and working on behalf of Medicaid enrollees. He engages in a variety of strategies on behalf of people with disabilities, from litigation to legislative advocacy and public education through media, webinars and other means. https://www.youtube.com/watch?v=zM7dRzHkVu0&t=1804s Show Notes Sheldon tells us that before 2012, Connecticut's Medicaid program was bifurcarted: eligible kids, pregnant people, and families were in a capitated Managed Care Organization (MCO) model and people with disabilities were in a fee-for-service program. (Medicaid is funded with federal dollars, but unlike Medicare, states design the programs and make all the decisions about plans.) With a fee-for-service model, the state takes on the risk. With the MCO model, the MCO receives a per-person/per-month fee (a "capitated payment") from the state, and they have to provide the care; if the patient requires less care, the MCO keeps the money, but if the patient requires more care, the MCO has to pay for the amount above the per-person/per-month fee. MCOs had a financial incentive to deny care so they could recoup more money. Beginning in the late 1990s, Medicaid advocates began a campaign of lawsuits and lobbying to remove Managed Care from their Medicaid program. Hartford, Connecticut is known as the insurace capital of the US, so this was a tough fight. Insurance companies fought this campaign because public programs are a major profit center for insurers, often more profitable than private employer-sponsored insurance. The insurance industry claimed they provided excellent care for less money, and coordinated care in a way that's not possible with the fee-for-service model. The insurance industry also ran ads about all the jobs they provide, and legislators were afraid to tangle with them. When the state asked for data about how the MCOs spent public dollars, they refused to provide it. So advocates only had anecdotal information, and it was hard to refute the claims the MCOs made about how well they served patients. One of the anecdotal complaints they heard the most was the lack of access to providers. Advocates convinced the state to check the insurance company provider network lists, so the state instituted a Secret Shopper survey to analyze them. They found that patients could get an appointment with supposed in-netw...

In case you've been asleep or under a rock for the past six months, we need to let you know two things: First, Kendrick won his beef with Drake, and second, there is a presidential election coming up. Like any presidential election year, everyone's so focused on the big showdown at the top of the ticket, but that means that a lot of the local and state races, congressional races, and referenda that will make up most of your ballot are getting ignored. Just because Anderson Cooper isn't covering your city's mayoral contest or your state's Railroad Commissioner race doesn't mean those elections aren't critically important in determining the immediate future of your community and getting important issues like healthcare on the table! So for this episode, we're going to leave the speculation about Donald and Kamala to Anderson and take our own 360 view of why we all need to get in on the down-ballot action and how we bring healthcare justice to the forefront of our election conversations.  https://www.youtube.com/watch?v=eY6SAa8LU9c Show Notes We have two guests who know their way around a Get Out the Vote Drive! Jasmine Ruddy is the Assistant Director of Campaigns for National Nurses United. She helps lead NNU's political campaigns from Medicare for All to electoral work and more! Her background is in the climate justice movement and campus/student organizing in her home state of North Carolina  Jonathan Cohn is the Policy Director at Progressive Massachusetts, which does multi-issue advocacy work. Jonathan wears many hats in the political space in Massachusetts and has been active in many progressive issue and electoral campaigns over the past little over a decade. Jasmine describes the local campaign that got her hooked: as a campus organizer for climate justice she helped win ballot measures to pass a regional transit tax. It was a concrete and tangible way to make an impact on the climate justice movement. Jonathan cut his political teeth on the Obama 2012 campaign, and got the local politics bug when Boston Mayor Tom Menino retired. Twelve candidates came forward for the first open mayoral race in 20 years. He was especially interested in public school policies and funding. He volunteered for mayoral candidate and City Council Member Felix Arroyo Jr. Ben confesses that while he loves democracy, he hates elections (#relatable). But he does find more hopefulness at the local level. He also got started in a mayoral election in Boston, but the most exciting campaign he worked on was for state house. He lived in one of the most progressive districts in the state but their state representative was a powerful, well-funded right-leaning Democrat. Ben's candidate, Nika Elugardo, a true progressive beat him despite all those advantages. Picture it: New Jersey, 1990s, tween Gillian lives in a suburb (North Plainfield) seeking to change its name to distance itself from the majority Black and Brown city of Plainfield. During a town-wide debate on the ballot measure, young Gillian spoke against renaming the city. She was quoted on the front page of the local paper: "North Plainfield shouldn't change its name. Stonybrook is just a dirty brook that divides our town, just like this issue is doing right now." The anti-name change side won and our star was born. We discuss the additional influence a voter can have when working on a local election. When races can be won or lost by a few dozen votes, the candidates care a lot more about each individual. They may knock on your door or call you seeking support, which is a great opportunity to insert the issues you care about into the election. Once your candidate gets elected, they'll remember the folks who helped them get there and you'll have more influence when lobbying them on the issues you care about. (You may even end up with a job.) Jonathan's personal philosophy is "Boo and Vote." He never liked Obama's catchphrase "don't boo; v...

The United States is unique among industrialized nations. Lucky for us, we can accumulate medical debt! Most industrialized and some developing nations have national healthcare programs that guarantee care to their residents. But we in the richest nation in the world have the freedom to get insurance through the free market, and go into debt when it doesn't cover the care we need! USA USA USA! According to the Kaiser Family Foundation (KFF), while over 90% of Americans have health insurance, we owe at least $220 billion in medical debt. Approximately 14 million people owe more than $1,000, and about 3 million owe more than $10,000. When the debt is cast more widely to those who have put medical bills on their credit cards or borrowed money to pay them, KFF found that 41% of adults have healthcare debt. According to the US Census Bureau in 2021, Black and Latinx households are disproportionately affected by medical debt.   Today we'll dive into the topic of medical debt: who has it, who profits off it, and what can we do about it?  https://www.youtube.com/watch?v=dZPd1kFbEuE Show Notes What causes medical debt? Believe it or not, our freewheeling use of the healthcare system is not to blame. In the US medical debt is caused by the high prices charged by hospitals, pharmaceutical companies, and insurance companies. While most industrialized nations have some means of controlling prices, in the United States the healthcare industry sets prices more or less however they want. As a result, according to a nationwide poll in 2022, over a five year period more than half of US adults report going into debt because of medical bills.  Debt is preventing Americans from saving for retirement, paying for college, or buying a home.  The 2022 poll found that 1 in 7 people reported being denied care due to unpaid bills. Two-thirds of those polled reported putting off necessary care due to cost.  This is all despite the Affordable Care Act expanding insurance coverage to more Americans than ever before. Insurance companies increasingly shift costs onto patients, with higher deductibles and more claim denials. According to the 2022 KFF poll, 61% of insured Americans had medical debt in the previous five years.  What makes medical debt so dangerous? We know health systems are denying care to patients who have unpaid bills. And we know people put off care so they don't incur more debt. Those barriers to care make us sicker, and they disproportionately impact people with higher rates of chronic conditions. The Commonwealth Fund found that 54% of people with employer coverage who skipped or delayed care reported getting sicker; 61% in individual market plans and 63% with Medicare reported the same. A 2024 study published in the Journal of American Medical Association found that medical debt is associated with higher mortality and premature death. What happens when you can't pay your medical debt? When you think about all the real people on the end of those medical debts, that makes it all the harder to swallow a fact that gets relatively little attention in the broader conversation. Medical debt collection is a for-profit business. In many cases, non-profit hospitals sell debts to for-profit medical debt collections agencies. Some health systems even operate their own for-profit debt collection arms. Think of it: They set the prices for their services as high as they want, and on the other end of the equation, they're making money off debt collection.  Dr. Luke Messac of Brigham and Women's Hospital testified at a July hearing of the Senate Health, Education, Labor and Pensions Committee that he learned that his and many other hospitals as well as collection agencies report sick, vulnerable patients to credit bureaus, garnish wages, seize bank accounts, and seek warrants for their arrest. And again, we have to highlight the evil practice of hospital systems that restrict patients from getting n...

Usually on the Medicare for All Podcast, we talk about people who want healthcare but can't get it, but today we're talking about people getting healthcare they have specifically refused: folks who have been involuntarily committed. For plenty of our listeners, the idea of being held against your will at a psychiatric institution feels like a nightmare from another time – something out of gothic fiction or horror movies set far in the past. But for folks struggling with mental illness in 21st century America, the terrifying prospect of psychiatric commitment is alive and well. In fact, a 2020 UCLA study found that in the 25 states where they actually keep data on this, the numbers of involuntary psych detentions have been sharply rising in recent years. Today, we're joined by two experts in this dark corner of our healthcare system to talk about why so many people are getting committed and who is reaping the benefits. https://www.youtube.com/watch?v=qjXjCSIM_2E Show Notes Originally from Massachusetts Jesse Mangan has experienced a few different psychiatric hospitalizations and has spent over two decades struggling with the impacts of those experiences, so now he produces a podcast about mental health laws called Committable. Rob Wipond is a freelance journalist who writes frequently on the interfaces between psychiatry, civil rights, policing, surveillance and privacy, and social change. His articles have been nominated for seventeen magazine and journalism awards. He is also the author of the 2023 book Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships. Jesse shares how he came to have so much (unwanted) expertise in psychiatric commitments, and how he turned that experience into a podcast, Committable. He was involuntarily committed and held longer than the standard of care dictated, past the date his insurance ran out. He was finally discharged with no real discharge plan and a big bill. Rob tells us he's been writing about mental health for a couple of decades. He says that the media typically portrays people who have been committed as really out of touch with reality, but he's found that they're far more like the rest of us. He watched his dad - who had no history of mental illness - go through a catastrophic health crisis that led to a depressive episode. Rob tells us that his dad was held and treated against his will for months. This happened in Canada where healthcare is guaranteed, so it's a more complex problem than just enacting the right financing system. A lot of people tend to think of psychiatric commitment as a barbaric tactic from the bad old days – like Nurse Ratchet in One Flew Over the Cuckoo's Nest – but this is obviously a practice that continues to this day. It's more common now for people to be held for a few days, rather than months or years on end. We only have data on these commitments from 25 states, but they show that these kind of commitments are rising dramatically. Jesse explains that due to disability rights activism and investigative journalism, a number of federal cases in the 1970s established some basic due process standards for patients. At the same time the mental health system became increasingly privatized and our understanding of mental health changed dramatically. The expense of due process became a factor - as soon as a case reaches a court hearing, private providers become more likely to release the patient because of cost. State mental health laws have given a lot of authority to law enforcement and providers to detain patients on an emergency basis without a due process check until the point the facility wants to hold the patient beyond the emergency period (in many states 72 hours). The justification for holding these patients are often very vague and broad, posing a risk to many Americans. Mental healthcare in this country isn't a clearly defined system.

If there's one thing everyone is talking about these days, it's JD Vance's affinity for couches. But if there are two things everyone is talking about, it's Vance's couches and Project 2025. You may be wondering, what is this mysterious project, and what does it have to do with me? Well, it turns out, a lot! Project 2025 is the right-wing map to a terrifying future, and if its proponents have their way, the future of healthcare is especially grim. Today, we're doing a deep dive into what this thing is and how it could change healthcare as we know it. https://www.youtube.com/watch?v=a4kYQ-Hh5pY Show Notes Gillian Mason, Healthcare-NOW's Executive Director, has read Project 2025 so you don't have to. P25 is the brainchild of the Heritage Foundation, the think tank founded in 1973 because conservative businessmen thought Richard Nixon was too liberal (remember that Nixon created the EPA and advocated for a better national health plan than Obamacare, so they weren't all wrong). They really hit their stride during the Reagan administration when they wrote his policy playbook, which they called the “Mandate for Leadership” — Reagan implemented or initiated about 60 percent of the 2,000 policy changes they recommended. They do this Mandate for Leadership report now every presidential cycle, and it's been pretty influential whenever a Republican wins. These people are unabashed fascists. We use that term a lot kind of casually but these guys literally fit the Merriam-Webster Webster dictionary definition: “a political philosophy, movement, or regime that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition.” The Heritage Foundation's whole deal is consolidating all authority in the office of the president so he can implement severe economic and social regimentation based on nationalism and barely-veiled-when-it's-not-just-blatant racism. Project 2025 It's the “Mandate for Leadership” for this election season, so it's supposed to be a template for Trump's next four years. Although reading Project 2025 would make you think it was a room full of monkeys at typewriters type situation, it was actually written by a room full of Trump's cronies. Hundreds of people contributed to writing and researching this thing, and a hefty percentage were former Trump appointees and employees of the administration. Also, VP pick JD Vance just wrote the foreword for an upcoming book by Kevin Roberts, the head of the P25 team. Vance has also been a mouthpiece for some of the wilder shit in P25. Trump claims he really doesn't know much about P25. But it's still worth talking about because COINCIDENTALLY it turns out that a lot of his policies are the same as the ones in P25. The Premise: The liberals in Washington, in cahoots with Chinese Communists and the  “totalitarian cult known today as ‘The Great Awokening'” have put “the very moral foundations of our society are in peril.” (This is not an exaggeration— it's literally all on the first page) P25 has 4 main goals: Restore the family as the centerpiece of American life and protect our children. Dismantle the administrative state and return self-governance to the American people. Defend our nation's sovereignty, borders, and bounty against global threats. Secure our God-given individual rights to live freely—what our Constitution calls ‘the Blessings of Liberty.'” All the recommendations are laid out systematically according to the different areas of the federal government they want to control (The Executive Office, Department of Homeland Security, Intelligence Services, Media Agencies, etc.) We'll mainly be focusing on healthcare today but context is important so here are a few highlights of what they're planning to give you some flavor: Reclassify most federal employees as appointees

It's our 100th episode folks, and we are celebrating the only way we know how – by sharing our predictions of the grim, apocalyptic future that surely awaits us if we fail to get our healthcare system together! That's right, we're talking about the next pandemic, and if experts are right, it's coming sooner than we think. In addition to several somewhat less familiar pathogens on the rise this summer, COVID is back, and this time it's FLiRTy. Today we'll go into some of the outbreaks currently threatening to explode into our next global disaster and explore how prepared our for-profit healthcare system is to keep us safe. Spoiler: It isn't. https://www.youtube.com/watch?v=ErXbxe4U-QQ Show Notes This emerging new pandemic situation is pretty serious, and more people should be taking it seriously. Forbes healthcare reporter Alex Knapp called this: “Hot Virus Summer.” First, COVID is up! Again! It's important to point out that COVID never really left – in 2023 75,000 people died from COVID 19, nearly 1 million were hospitalized, and plenty of people are still suffering from Long COVID. Now we have the new FLiRT variants — sexy! There are almost 34,000 new cases per week globally.  Next up: Bird Flu, which has historically tended to infect birds, is evolving and has begun to infect mammals. For now, that mostly means livestock – so far 129 dairy herds in 12 US states. As far as animals are concerned this is already a pandemic – it's impacting industries all over the world and could cause shortages of meat and dairy. You may be panicking: IS OUR CHEESE SAFE? Don't worry, most commercially available dairy products are pasteurized, which kills the virus.  There have, however, been three cases of the virus in humans reported in the US. Around the world, more than 50% of people infected with Bird Flu die from the virus. All three of those people in the US worked on farms in direct contact with birds and livestock, and right now the CDC is just limiting their warnings about Bird Flu to folks who also work in close contact with animals. BUT, scientists are warning that at any time the virus could mutate and become transmissible between humans, at which point, we would be facing epic disaster.  How likely is that to happen? In August 2023, Dr. Michael Greger said of Bird Flu, "The question is not if, but when.”  In addition to COVID and Bird Flu, Mpox (fka Monkey Pox) is having another moment, as is West Nile Virus, so there are a lot of ingredients in the virus stew we're cooking. So the best indicator of future outcomes is to look at how we've fared in similar situations in the past. Luckily (or not), the 2020 COVID outbreak is still fresh in some of our minds. You may remember that we, as a country, were not particularly well-prepared. For one, our profit-driven healthcare system creates disparities of access and care, which were exacerbated by the pandemic. Also, we don't have a truly cohesive public health program in this country. Health departments in various counties, municipalities, and states work largely independently of each other, so there was little to no coordination on surveillance and testing. We had to rely on private companies for important preventative measures like PPE and, most notably, vaccines (the research and development for which were PUBLICLY FUNDED with our tax dollars.) During pandemics, a lot of people stopped going to healthcare facilities for elective procedures and surgeries - the real moneymakers for the for-profit healthcare system. That led to layoffs of staff at the same time that patients who desperately needed care struggled to get it. In countries with a national health system, hospitals don't lose money if people stop going; they have a fixed amount to cover the operating expenses based on past history. So you don't see mass layoffs and shrinking of the healthcare workforce when they are most needed.     So if we were to do the whole pandemic over again...

It's the most wonderful time of the year! For activists in the movement to make Medicare for All a reality, this is the week when we gather to plot, scheme, and kvetch. Welcome to the 2024 Annual Medicare for All Strategy Conference, “Healthcare Beyond the Ballot Box,” organized by Healthcare NOW! For those of you who are attending the conference right now, you are getting a sneak preview of our Very Special Conference Episode! Since our theme this year is about what happens to Medicare for All in an election year — and beyond — we wanted to invite some of our favorite policy people with their fingers on the pulse of what's happening in DC to help us sort out what's happening with healthcare on Capitol Hill and what role we can play to get some justice out of DC in the coming year! https://www.youtube.com/watch?v=n36v0eTV1a8&t=1167s powerpress Our guests are Eagan Kemp and Alex Lawson. Eagan Kemp is the health care policy advocate for Public Citizen's Congress Watch division. He is an expert in health care policy and served as a senior analyst at the U.S. Government Accountability Office prior to coming to Public Citizen. Alex Lawson is the Executive Director of Social Security Works, the convening member of the Strengthen Social Security Coalition— a coalition made up of over 340 national and state organizations representing over 50 million Americans.  Show Notes With one of our major candidates being a guy who is solidly against Medicare for All and the other being Trump, is 2024 a bad federal election cycle, or the worst federal election of our lifetime, and why? Alex puts a positive spin on it: we are closer to M4A with a Biden presidency than any other Democratic presidency. He's definitely not a M4A guy, but all his other economic policies are based on Sanders-esque populism, rather than Obama-esque neo-liberalism. We've seen Biden enact serious corporate reform in several sectors, and in a second Biden administration, taking on corporate greed and sociopathy in health insurance is on the agenda. On the other hand, we know exactly what's at stake with another Trump presidency, driven entirely by profit for his billionaire friends. Eagan notes that there has been movement on Medicare in recent years, including die-hard GOPs shying away from talking about cuts to Medicare until after the election. At the same time, we're seeing Biden moving more toward the M4A movement and the folks trying to expand and improve traditional Medicare. We're seeing insurance companies running scared, feeling the pressure from our movement in a way they haven't before. Alex notes that Biden's economic vision contains a lot that Medicare for All folks can work with. Our movement worked hard to expand Medicare to include vision, hearing, and dental, which was ultimately included in Biden's Build Back Better plan. We didn't get that, but we did get prescription drug negotiations, which is a huge part of improving Medicare before we expand it to everyone. (Go back and listen to another episode where we were joined by Alex to discuss prescription drug negotiations for more details.) We've also seen a lot of good work against Medicare privatization, via Medicare Advantage, and that solidarity has moved the ball a lot - more than ever before to restrain private insurance companies. We didn't just give up when we knew Biden wouldn't sign M4A; we pivoted to expanding benefits and reversing the privatization with a lot of success. Eagan found a silver lining in - of all places - the subject of private equity in healthcare. He thinks we've passed the peak of PE ravaging healthcare, and they are now backing off the healthcare sector in part because of increased pressure from the DOJ, FTC and HHS. That's due to pressure from doctors, patients, and whistleblowers. Eagan also notes that the Trump administration pilot of throwing seniors in traditional Medicare into private relationships with providers.

We are in the middle of a resurgence of organized labor in the US. From Amazon workers to auto workers and grad students to baristas at Starbucks, everyone is getting in on the action! One of the big reasons workers are so hot to get that union card is because of… you guessed it, healthcare! Today we're going to be talking union healthcare plans – how they work and how workers have managed to use collective bargaining to resist the national erosion of healthcare access. Most importantly, we're going to take a deep dive into why, even with better healthcare, unions have been leaders in the fight for Medicare for All, and how they might save the rest of us from corporate healthcare hell. Our guest Jim McGee has spent his entire career working in union health benefits, starting with the Plumbers and Pipefitters local he belonged to in Harrisburg Pennsylvania. For the past 20 years, he has been the administrator of the health benefits plan for Amalgamated Transit Union Local 689. He's on the steering committee for the labor campaign for single payer healthcare, and he's joining us today from Bethesda, MD. https://www.youtube.com/watch?v=cNFBkHBrpUY Show Notes Jim educates us on the two types of union health plans: Unionized workers with a single employer (think nurses or teachers) earn employer-sponsored health benefits much like unorganized workplaces, but the cost and benefit sets of those plans can be negotiated if the workforce is unionized. Taft-Hartley plans are multiemployer plans that are jointly managed by multiple companies and the union within the same industry. The workers pay while they're working to have health insurance when they're not. Taft Hartleys exist in industries where there's a lot of turnover, like the building trades. A worker may have many different employers and many periods of unemployment over their careers. Typically both those options sound a lot better than what your average non-union worker is getting from their employer, though they are still subject to same rising costs and economic pressures as every other health insurance plan. Given that union members are more likely to have health coverage than non-union workers, it's interesting that unions have been at the forefront of the movement for Medicare for all. Many unions come from a rich progressive tradition that looks past the short term to the long term value of guaranteed healthcare for all workers. Jim also shares that the unions that are more exposed to competitive pressure in their environment are more likely to be supportive of Medicare for All. This is especially evident in less urban areas where locals are facing more non-union competition. Jim notes that throughout his career, healthcare has been #1 cause of strikes. Taking it off the table would not only benefit the workers, it would benefit their entire community. Small businesses and non-union employers that offer poorer or no healthcare benefits to their employees often stay afloat on the backs of the unionized employers in their community that do offer good health benefits; this is an inquitable and unsustainable system. Speaking of strikes, graduate student workers at Boston University are on strike right now over healthcare benefits among other things. Not only would Medicare for All take health insurance off the negotiating table (making more room for workers to bargain for pay, safety and other benefits), it would take away a the ability of employers to weaponize health insurance to break strikes; solidarity can crumble quickly when the employer stops paying those premiums at the first of the month. Follow and Support the Pod! Don't forget to like this episode and subscribe to The Medicare for All Podcast on  Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

The U.S. is wrestling with a massive mental health crisis - impacting young people in particular. Half of young adults and one-third of all adults report that they always feel anxious or have often felt anxiety in the past year. One-third of respondents could not get the mental health services they needed. Why? 80% say they couldn't afford the cost and more than 60% said that shame and stigma kept them away. The shortage of mental health providers also means that care can be very hard to find, even when we try hard to find it. Usually on the Medicare for All Podcast, we focus on the stories we think you need to know about. Today we decided to scrap the show and come up with a plan to get an hour of free therapy!* (*Not really. None of this information is intended as medical advice.) Our guests today are Dr. Pamela Fullerton and Lindsay Baish.  Lindsay is a therapist and an Licensed Professional Counselor (LPC) in Illinois and a certified trauma professional – and former volunteer for the podcast. Dr. Pamela Fullerton, Ph.D., is the founder and clinical director of Advocacy & Education Consulting, a counseling and consulting organization dedicated to ensuring social justice and advocacy through equitable access to mental health and well-being services. She is a Latina bilingual Certified Clinical Trauma Professional (CCTP), a Certified Dialectical Behavior Therapy professional (C-DBT), a Certified Clinical Anxiety Treatment Professional (CCATP), a Certified Grief Informed Professional (CGP), and a clinical supervisor and consultant specializing in working with BIPOC communities, undocumented communities, immigration and acculturation, trauma, anxiety, life transitions, and career counseling. In addition to being a professional writer and speaker, Dr. Fullerton is an adjunct instructor in the Counselor Education department at Northeastern Illinois University. She is also a volunteer contributing writer for three publications and runs a nonprofit to support Latinx youth in the Chicagoland area. Dr. Fullerton consults for two behavioral health advisory boards, Sinai Urban Health Institute (SUHI) and Illinois Unidos/Latino Policy Forum, providing advice and input to assist in promoting health equity and justice initiatives for underserved communities in Illinois.   https://www.youtube.com/watch?v=GGql7_NXhts Show Notes Pam tells us that counselling is a subset of psychiatry and psychology that started as a movement for career development for veterans returning from war. The profession started helping people through life transitions puts people and their lives and livelihoods at the center. Lindsay notes that a lot of the language of mental healthcare is used interchangeably, but there are distinctions: psychologists have PhDs and can provide therapists; psychiatrists have MDs and can prescribe medications. Counselors and therapists can diagnose but not prescribe. Congress passed the Mental Health Parity and Addiction Equity Act in 2008 to prevent insurers from providing worse coverage for mental health than they do for medical or surgical treatment. However, mental health providers are not usually treated the same as medical doctors when it comes to insurance coverage and payments. Historically, counselors are the newest mental health clinicians on the scene and are more limited by insurers than more established clinicians like social workers or psychologists. Insurers often only reimburse for certain therapeutic models of care (Cognitive Behavioral Therapy, for example) leaving other kinds of counseling uncovered in the midst of a crisis in mental healthcare. Pam tells us that a big part of her job is the extra work to navigate her patients' insurance plans, Medicare and Medicaid in order to get coverage for their care. Most Americans can't afford to pay out of pocket for mental healthcare. Counselors just got approved for Medicare reimbursement on January 1, 2024,

We hear it over and over again – the private sector just does it better. Whether we're talking education or healthcare or our criminal justice system, the default Republican (and sometimes Democratic) talking point is that competition in the marketplace allows the best ideas and best people (Elon Musk, lookin at you) to rise to the top and lead us to a utopian future (sponsored by Meta). But then something wild happens like the cyberattack on UnitedHealthcare, which is causing massive fallout throughout our healthcare system over the past two weeks – so much so, that the company appears to have paid a 22 million dollar ransom to the hackers who breached their system and now the federal department of Health and Human Services has had to bail them out. That kind of thing really makes you question how anyone is still making the argument that the private sector has this shit handled. This episode, we're bringing in special guest and political messaging expert Jordan Berg Powers to talk about how we talk about all of this stuff: public healthcare, private corporations, and how to message our way out of the corporate hellscape in which we currently find ourselves! Jordan Berg Powers is a consultant and the former director of Mass Alliance. Most importantly, he is coming up on 30 YEARS of experience in campaigning and organizing for progressive causes and candidates. Jordan is a return guest to the podcast, first appearing in our My Big Fat American Healthcare episode. https://www.youtube.com/watch?v=Z6QvGQja1N8 Show Notes UnitedHealthcare debacle is a little bit fun for us because we get to talk about the failures of a really shitty company, but like any healthcare debacle, there are some serious consequences. What happened here, and what does the UnitedHealth scandal look like for folks on the ground? Starting on February 21, a group of hackers breached “Change Healthcare,” which is the largest electronic medical records and medical claims processing platform in the country. About half of all Americans' health insurance claims pass through Change Healthcare, which was bought two years ago by UnitedHealthcare, the largest health insurer in the country. Following the hack, Change Healthcare shut down its entire network, leading to complete mayhem in the healthcare system, which is still ongoing: “Hospitals have been unable to check insurance benefits of in-patient stays, handle the prior authorizations needed for patient procedures and surgeries or process billing that pays for medical services. Pharmacies have struggled to determine how much to charge patients for prescriptions without access to their health insurance records, forcing some to pay for costly medications out of pocket with cash, with others unable to afford the costs.” (source) This has led to a financial crisis for many hospitals, health clinics, physicians, and pharmacies, none of whom can be reimbursed for the care they're providing, since they can't submit medical claims. Provider associations are losing their shit, and the federal government has had to intervene to try to bail providers out in the meantime.  The story keeps getting crazier and juicier: apparently UnitedHealthcare made a ransom payment of $22 million to the hackers who breached their system using BitCoin (source) - p.s. those are our healthcare premium dollars hard at work Russian hackers may now have access to almost half the country's medical records. I'm sure that won't come back to haunt anyone in the years to come! As much as we'd love to dwell on the UnitedHealthcare scandal that is unfolding, this incident really got us thinking about the broader debate over distrust of government, hatred of taxes, and bipartisan worship of market-based solutions. Jordan explains the false dichotomy of government vs marketplace, public vs private; there is no marketplace without government. The question is,

Occasional fistfights aside, most of our legislators make the choice to use their words when they're angry, and a lot of those words go into public letters they write to presidents, officials, and even each other. Despite the fact that no one else in this country has written or read a letter in decades, the public comment letter is still popular with politicians, who have elevated this obscure literary genre to a competitive sport, using these letters to demonstrate their power, build alliances, and shape policy. Today we're going to focus on one ongoing battle of letters over one of our favorite topics: the privatization of Medicare through a program known as Medicare Advantage. We'll talk about how all the players in the debate about Medicare Advantage are engaging in that battle, and how it could impact our access to healthcare! https://www.youtube.com/watch?v=MmM6HrIiS8o Show Notes We've recorded a bunch of episodes about Medicare Advantage! Medicare Advantage was created as a private, for-profit alternative to traditional (or public) Medicare, was the promise of lower costs… which never happened. Surprise: Medicare Advantage plans are FAR more expensive to taxpayers than traditional Medicare for covering the same person, costing taxpayers $7 billion more per year than if everyone were just covered by traditional Medicare. (source) It's the healthcare Joe Namath, Jimmy JJ Walker, and Big Papi are selling to seniors with big promises of coverage for vision and dental care, transportation, groceries, and more – for $0 premiums. Free shit! Private companies drain public money to provide generally substandard insurance. These companies are exploiting a legit problem in Medicare, where many seniors are forced to pay premiums for medigap plans to cover stuff like chewing and seeing. If you can't afford the premiums for Medigap coverage, but you need to chew or see, you might be forced into an Medicare Advantage plan just because that's what you can afford month-to-month. And that could be fine… until you need care and find out that the copays and deductibles are too high, there are super limited networks, or the insurance company refuses to pre-authorize your treatment. But many of these MA plans don't come through on their wild promises, and in fact, seniors end up being pushed out of MA and back into original Medicare when they are sick and actually need care. Private insurance companies love collecting money,but they hate paying money for the service they're supposed to provide. Go figure!  We put out a report about this! Taking Advantage Who's Who? AHIP: “America's Health Insurance Providers” is the trade organization for the health insurance industry. Unsurprisingly, they are big proponents of Medicare Advantage. AHIP has written their own comment letters to CMS (the Center for Medicare and Medicaid Services) advocating for expansions to the MA program since at least 2015. Lately they also began coordinating their besties in the House and the Senate to write letters on their behalf. They claim that Medicare Advantage will expand the program to more seniors, and present some of their own research: MA will bring more money into the Medicare system… because MA plan holders use less care. (nothing to brag about!) MA is serving a diverse populatio “As of 2021, approximately 59% of Hispanic or Latino/a individuals and 57% of Black individuals eligible for Medicare choose Medicare Advantage plans. Overall, 54% of Medicare beneficiaries who belong to diverse populations choose Medicare Advantage.” Turns out if you set out to exploit a diverse demographic of people, you can! In 2021, 70 members of congress signed "dear colleague" letter, initated by initiated by Reps. Val Demings (D-FL), Mike Gallagher (R-WI), Marc Veasey (D-TX), and Gus Bilirakis (R-FL).  In 2023 – 60 Senate signers – a good example of how this is insidiously bipartisan,

Here at the Medicare for All Podcast, we love calling out all the bad actors in our healthcare system – greedy insurance companies, soul-less CEOs in Big Pharma,profit-hungry “non-profit hospitals”, and all our favorite villains. Mostly, we look at the ways those predators target sick people and poor people for exploitation, but today we're looking at what happens when they start fighting each other for a bigger piece of the pie? Specifically, we're going to explore the world of hospital consolidation – that's when smaller hospitals merge to form bigger corporate entities who can battle it out with insurance companies to secure more of patients' healthcare dollars! What does hospital consolidation mean for regular people? No spoilers, but it turns out that when giant healthcare monsters go at each other, much like when Godzilla took on Mothra, it's the rest of us tiny humans who suffer! https://www.youtube.com/live/LXBGMk8HEE8?si=9cIQ6G9wkwMSYLrZ Show Notes Like every major industry in this country, healthcare is full of big corporations that will stop at nothing to get bigger, using the time-honored capitalist techniques of mergers and acquisitions to become HUGE corporations. But, of course, we live in America, where bigger is always better – what could possibly be wrong with bigger, better healthcare companies? We start out this episode with a cautionary tale from Massachusetts that began in 1994, when two of Boston's biggest hospitals merge to create a mega-corporation called “Partners Health,” which over the next two decades bought up… everything. This was a response to a national wave of insurance company mergers and consolidations, which allowed insurers to squeeze both patients and providers under “managed care.” Hospitals, not wanting to be out-squeezed, fought back with their own mergers, ostensibly so they could negotiate with insurance companies. Of course, what actually happened was something much more nefarious – and secretive. In fact, we only know any of this happened thanks to the Boston Globe's illustrious Spotlight reporting team, who dug up the truth in a 2008 article. Basically, in 2000, Dr. Samuel O. Thier, chief executive of Partners HealthCare, and William C. Van Faasen, chief executive of Blue Cross Blue Shield of Massachusetts engaged in an unwritten agreement between the two entities without putting it in writing to avoid legal implications. The agreement involved Blue Cross Blue Shield giving significant payment increases to Partners' doctors and hospitals, and in return, Partners would protect Blue Cross from allowing other insurers to pay less, effectively raising insurance prices statewide. This "market covenant" marked the beginning of a period of rapid escalation in Massachusetts insurance prices, leading to a significant annual rise in individual insurance premiums. Partners used its clout to negotiate rate increases, pressuring other insurers to match or exceed the payment increases given by Blue Cross, leading to cost increases for consumers. In turn, Partners' significant growth and influence in the healthcare industry compounded the impact of this backroom deal, leading to a substantial rise in medical costs in Massachusetts. Partners employed aggressive tactics, resulting in major payment increases benefiting a few powerful hospital companies while leaving others behind. This led to significant payment disparities, with Partners' flagship hospitals earning substantially more than other academic medical centers. Partners is an outstanding example of the evils of hospital consolidation, but it's not an anomaly. This episode was originally inspired by our friends at the Minnesota Nurses Association (shout out to Geri Katz), who last year were fighting a proposed merger of Fairview Health with Sanford Health, two giant corporations with dozens of hospitals and clinics. Fortunately, the nurses and MN patients won this fight - merger talks were abandon...

Just this Monday, we celebrated Martin Luther King Day, a tribute to one of the great leaders of the movement for racial justice – but something that often gets forgotten in the flurry of MLK quotes that become memes this time of year is that equity in healthcare was a crucial part of King's vision. Throughout his career in activism, he often stated his conviction that “Of all the forms of inequality, injustice in healthcare is the most shocking and inhuman.” Sadly, over 50 years after his death, racial inequity in healthcare is even more shocking and inhuman. Today, we're joined by public health expert Walter Tsou to do a deep dive into the horrifying world of racial health injustice, how we got here, and how we make real change. https://www.youtube.com/live/yiq7TBVYc6g?si=QCbGU114cZviZe0G Show Notes The show is joined on MLK Day by Dr. Walter Tsou - past president of the American Public Health Association and former health commissioner of Philadelphia! Gillian asks how Walter dedicated his life to health access and health equity. When Walter graduated from med school he stumbled into a job at a public health clinic in West Philadelphia that treated patients lacking private insurance or the money to afford medications, which gave him his first window into the deep economic, racial, and health divides in the U.S. This launched his career in public health advocacy. Walter served as the Health Commissioner of Philadelphia from 2000 - 2002, and to him the most stark racial inequity he had to deal with was the gap in infant mortality - black infants at that time were 2.5 to 3 times as likely to die before reaching age 1 than white infants. Walter looked up the most recent statistics in preparation for the podcast, and the number had barely changed. The traditional way that states are pretending to do something about infant mortality is to create an Office of Equity contained inside their Department of Health that has maybe two staff people. To make a real difference in infant mortality, Walter says, you have to tackle the largest social determinants of health - education, job opportunities, housing, transportation, and so on. Two or four people in an Equity Office aren't going to make a difference - it's window dressing. On top of this, Walter says, the U.S. has abandoned most of its community health work, which was widespread under LBJ's Great Society programs after WWII, when community nurses would go into communities and address social determinants of health. Gillian backs up to share some of the big-picture distressing findings from the Commonwealth Fund's scorecard on racial equity in U.S. healthcare: Provisional life expectancy report released by the CDC in 2020 shows that Black and American Indian/Alaskan Native people live fewer years on average than white people (see data here) Black/AIAN individuals more susceptible to chronic diseases like diabetes, hypertension Higher rate of pregnancy related complications, higher infant mortality rate (see our episode on maternal health for more details) Poor healthcare outcomes are driven by higher poverty rates, higher-risk environments, less access to healthcare among communities of color Less likely to have health insurance, more likely to incur medical debt, more cost-related barriers to care, less preventative care These unequal health outcomes persist across all states in the U.S. Black women are more likely to be diagnosed with breast cancer at later stages and to die from breast cancer than white women Uninsured rates are much higher in communities of color, particularly states that have not adopted Medicare expansion Black Medicare beneficiaries are more likely than white beneficiaries to be admitted to a hospital or to seek care in an emergency department for conditions typically manageable through good primary care Lower rates of vaccination - example - Black, AIAN,

It's that time again folks… time for a Mailbag Episode! We reached out to our whole audience and all our supporters to find the pressing questions on everyone's mind. Or at least we would have if Gillian hadn't been too busy eating turkey to email our list. So instead, Gillian reached out personally to some of our superfans (anyone in her contact list who had previously admitted to listening to the show once) to find out what they wanted to hear from us. And here we are, with questions about everything from Ronald Reagan to elder care to dinner table conversation from some of our favorite stans!   https://www.youtube.com/watch?v=pesLv7rekVY Show Notes Question from Liam Meyer in Massachusetts: "Maybe discuss this on your podcast: Facing Financial Ruin as Costs Soar for Elder Care - The New York Times." "You could also talk about elder care and how wildly fucked up it is. One especially galling bit is how Medicaid is basically built to just ignore cognitive stuff. Almost all metrics are about physical health so, like, if someone's grandpa **could** theoretically cook and shower themselves (ie, “He can stand up and walk, he still has hands!”), Medicaid says it all good even if grandpa doesn't know where the shower is, leaves the stove on all the time, and continually eats spoiled food." Answer: "elder care" is a vague term that mooshes together lots of kinds of care for seniors. But "long-term care" is better defined, and has been a major focus of ours in recent years, needed not only by older folks but anyone with a physical or mental disability that means they need help with day-to-day living. Most of us will need long term care at some point in our lives. What's wrong with the U.S. long-term care system? We don't have one!  Very few people are insured for long term care Medicaid covers the vast majority of long term care services - you have to be or become poor to qualify (except in California, where Medicaid asset limits will be eliminated starting January 1, 2024!) We've heard many stories of people who have had to sell homes or farms, affecting their whole family, in order to become eligible for Medicaid. Institutional bias: Medicaid will pay for long term care in a setting like a nursing home, but not home-based care which is cheaper and better for quality of life. Check our our long term care episode for much more. Questions from Geri Katz in Minnesota: "Have you listened to the 1961 Ronald Reagan Speaks Out About Socialized Medicine LP? Why has the AMA historically opposed single payer?" Answer: in 1961, before Medicare passed and before he was elected Governor of California, Reagan was a washed up actor talking about how "socialized medicine" would ruin our country. He sounds like a ghoul: “One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it.” Reagan was paid by the American Medical Association (AMA) to deliver this speech, which was printed on an LP so you could host a house party with your socialism-hating friends. The AMA has a long history of opposing healthcare reform, such as: In 1948 when Truman proposed a national healthcare program - which was supported by an estimated ⅔ of americans - the AMA decried it as socialism and used member dues to fund a political campaign against Truman's plan. After passage of Civil Rights Act in 1964, the AMA continued to allow medical societies to discriminate against physicians of color. The AMA has been involved in campaigns against Social Security, Medicare and Medicaid. The AMA is a scam! According to Dr Linda Girgis, “Perhaps the biggest example of how doctors lost their trust in the AMA is the way they are funded.

Open enrollment. Deductible. Coinsurance. HMO. Indemnity plan. If you're listening this far, you probably have a migraine already. Understanding the language of the health insurance industry, let alone selecting a health insurance plan, can be confusing, frustrating, and disheartening. But never fear - we are here to give you a crash course on everything you need to know about your insurance plan. No need to scroll through Healthcare.gov's Health Insurance glossary and risk throwing yourself out the window… We want to give you some tools here to understand what you're choosing when you pick a healthcare plan, but no one but you really knows what's best for your health, so (for better or worse) we aren't going to give any actual advice here about what healthcare plan to pick.  Also, all health insurance kind of sucks, so you will probably get screwed no matter what you pick. Basically, we're going to try to decode all the mystifying language that the insurance companies use to disguise the ways they're going to screw you so at least you'll be able to anticipate how you'll get screwed. https://www.youtube.com/watch?v=32vw4LZpelA Show Notes Names Whether you get health insurance offered by your employer, or you have to buy insurance on your own in an exchange or on healthcare.gov, or you have Medicare and you are looking at one of the privatized Medicare Advantage plans, you're going to be choosing from a series of plans that have totally incomprehensible names and acronyms, so let's start by breaking down the how the name of the plan itself will tell you something about how your insurer is going to screw you. Generally the first part of an insurance plan's name will be the name of the insurer (like “Blue Cross” or “United Health”), then you MIGHT get a word that says who is paying for the insurance plan (if it's a “Group” plan that means an employer is paying for it, an “Advantage” plan is a privatized Medicare plan), and finally there will be an acronym that only 0.005% of people in America understand - and those are the generally people making money from the plans. These acronyms will be something like HMO, HSA, PPO, EPO, or my personal favorite “GTFO” - the “get the fuck out of here that can't be a real plan” plan! Indemnity Plans (“Open Choice” or “Open Network” plans): are the opposite of managed care; you could use any doctor or hospital, there are no networks, no review of care or pre-approvals, no claims denials. These were the plans that virtually everyone had prior to the 1980s, and plans that virtually no one has today except maybe the extremely wealthy. In 1978, 95% of people had indemnity plans, then that dropped to 71% by 1988, and by 1998 it was down to 14%. Today, only 1% of workers have indemnity plans. Indemnity plans are the opposite of managed care - you can see any doctor or hospital you want, there Today, you probably wouldn't even want an indemnity plan, because the modern versions usually only pay a percentage of the cost of your care, leaving you with the rest and massive bills. Health Maintenance Organizations (HMOs) represent only 12% of insurance plans today, so after taking over in the 1990s, old school HMOs are going the way of the dinosaurs. HMOs usually limit coverage to doctors/providers who work for or contract with the HMO (“in-network”). It generally won't cover out-of-network care except in an emergency. HMOs can also be limited by location, meaning you might have to live or work in a certain area to be eligible.  Exclusive Provider Organizations (EPOs) are a new catch-phrase that are appearing more and more often, but they are VERY similar to an HMO, and you should think of them the same. In fact, that survey that only 12% of workers have HMO plans includes EPOs under the same category. EPOs often have larger networks than HMOs, and unlike HMOs, they don't require referrals to see specialists - as long as the specialist is in their very limited net...

If you've ever had an experience with the American healthcare system, you've probably walked away thinking, “Why can't we have nice things? Or even basic human things??” We get stuck on gurneys sitting in ER hallways, waiting hours for care; we skip other basic needs like food and housing to pay for the healthcare we can't skip; or we wait for months for preauthorizations from our health insurance and referrals from our doctors. Of course, for the super rich you don't have to endure any of these humiliating experiences, and they have developed some new, expensive ways to get the healthcare they need when they need it. So put up your pinkies and throw on a monocle – today we're doing a deep dive into the lifestyles of the rich and famous to find out: just how fancy is concierge healthcare, and can the rest of us get some? https://www.youtube.com/watch?v=YqwLHYrEJvo Show Notes Let's start with concierge primary care, the latest trend in fancy healthcare! What is concierge care? Some concierge plans (also called Direct Primary Care) work with existing insurance – those are the cheaper ones ($600-1000/year, aka Hyatt Care). Some you actually pay a flat fee that covers all your services. Those are the really expensive ones, which can run from $2400 to $30k per year! But what do you get for your money? 24/7 access to doctors (some promise your physicians direct phone number) Coordination of care (referrals, preauthorizations if necessary) Extra services like a health coach! Some offer really crazy shit like home visits Physicians have fewer patients and can spend at least 30 minutes with each of them. Now there are more than 1,500 Direct Primary Care practices across the country, and 1 in 5 of the top 1% buy concierge physician care. We're also seeing some hospitals, like Ben's local mega-hospital Mass General, offering "Concierge Medicine." They have dedicated concierge physicians who see fewer patients and are more accessible, available by phone or email 24 hours a day, seven days a week. You also get your own health coach and a dietician. Do you need to maintain insurance? Yes. At Mass General, your $10,000 membership fee covers a high level of "service" and "access" but not the cost of the medical care you need. Your insurance plan will cover the actual services provided by the concierge physician. That means $10,000 on top of your premiums, co-pays and deductibles. Outside of the exorbitant cost, are there downsides to concierge care? You betcha. It exacerbates the primary care provider shortage and creates two-tier system: direct primary care physicians have fewer patients, and also creates a two-tier system where rich people buy their way out of the physician shortage. Despite all the marketing claims, concierge care may not lead to better health outcomes: there is a lack of peer-reviewed studies on care outcomes in concierge practices. But when rich people get to the hospital, don't they get treated like the rest of us? Nope. Big hospital donors often get to skip the line in the ER and get VIP status. They get fancy luxury suites with fine gourmet dining, high thread count sheets, and suites with custom cabinetry. They also get the best nurse to patient ratios in town, with some luxury units assigning each patient their own nurse who has no other patients, 24/7. These luxury units can be dangerous though. When the hospital is more concerned with pleasing the patient than providing the care they need, it can result in "VIP Syndrome." There's anecdotal evidence that because some patients want to stay in their luxury accomodations instead of being moved to a specialty or more intensive unit due to their condition, they don't get the kind of care they need, which can lead to worse outcomes or even death. At least one study suggests that higher patient satisfaction is correlated with worse outcomes. VIP syndrome can lead caregivers to overtreat patients ...

Just over a month ago we lost Bob Barker, the man who taught us all about the brutal nature of capitalism one pricing game at a time. Now, thanks to the Inflation Reduction Act, the federal government is going to be playing a role in determining the prices for some of our favorite products. No, we're not talking about cars or family vacations to the Bahamas – we're talking about the prescription drugs that keep us alive! As the Biden Administration enters its own Showcase Showdown with Big Pharma, we're taking a full episode to break down what that means and whether the result will be prices we can actually afford. https://www.youtube.com/watch?v=cnxbIhEPhs0&t=1s Show Notes Our first (and only) contestant is Alex Lawson! He is the Executive Director of Social Security Works, the convening member of the Strengthen Social Security Coalition— a coalition made up of over 340 national and state organizations representing over 50 million Americans. Alex's organization played a critical role in moving the Democratic Party (mostly!) away from efforts to cut Social Security, and has been shifting the momentum towards expanding Social Security. Social Security Works is also a key ally of ours in the national fight for Medicare for All! Alex, come on down! Alex starts by telling us about the time he took a camera to PhRMA's (the Pharmaceutical Research and Manufacturers of America) office the day of the Inflation Reduction Act signing ceremony. He conducted person-on-the-street interviews, asking if they knew PhRMA spent hundreds of millions of dollars to keep Medicare from being able to negotiate drug prices, and if they had any messages for the folks in the building? Most of the responses were of the "f-you PhRMA, we got you!" variety. PhRMA has literally never lost until the Inflation Reduction Act was passed. Even though it's modest, Medicare went from having no authority over drug prices to the authority and mandate to find the fairest price for certain drugs is a huge loss to the industry. Alex wants listeners to understand that this win is as simple as it sounds. Who buys the most drugs in the world? Medicare. Why doesn't Medicare tell the pharmaceutical companies what they're willing to pay? This is called the Maximum Fair Price. No other peer nation doesn't have some kind of negotiated standard for drug prices. While our guest and hosts would prefer that Medicare be allowed to negotiate the prices of all drugs used by beneficiaries, PhRMA was successful in limiting the Inflation Reduction Act drug provisions to only apply to ten pharmaceuticals. (Still, pharmaceutical companies are suing to block the implementation of price negotiations.) Negotiating the prices for only ten drugs may seem like a drop in the bucket, but the cost of those ten drugs alone make up a huge amount of Medicare's spending on Medicare Part D. And in coming years Medicare will be able to negotiate over ten more drugs, and so on. This will squish the most excessive profiteering of the pharmaceutical industry and deliver savings of $9 or $10 billion dollars a year. We give President Biden credit for taking an aggressive stance against PhRMA to finally make good on an evergreen Democratic campaign promise to lower drug prices. But we also give ourselves some credit. First there was the debate in Congress in 2019 over HR3, the Lower Drug Costs Now Act. Advocacy by groups likes ours resulted in the House passing a robust bill that would have dramatically lowered drug costs. Then in 2021 both Healthcare-NOW and Social Security Works fought hard to win major expansions of Medicare in the Build Back Better bill (we were on track to win a lot more than prices for ten drugs). But Senators Joe Manchin and Kyrsten Sinema tanked the whole bill in the Senate. Those two battles led us to the Inflation Reduction Act aiming high from the start, and resulting in a bill that will make a big impact on drug spending by Medicare.

With all the threats facing our country – climate change, a predatory economy, corporations buying our elections, and the overt move towards fascism among the far right – you would think that politicians would be laser-focused on the existential crises descending upon us. But instead, politicians in the US are devoting a considerable amount of their energy these days to an all-out assault on the rights of transgender people. Although the war on trans people has taken many forms, from bathroom bills to restricting school curricula, one of the most chilling is the denial of basic gender-affirming healthcare. Now, in places like Texas, elected officials have gone even further by targeting healthcare access for the most vulnerable trans folks – trans kids. In this episode, we're joined by one El Paso family and a local gender-affirming care doctor who are fighting back! https://www.youtube.com/live/KeSiTiiwjsk?si=Qi8XgotSntheNIHR Show Notes Our guest today is Lori Edwards. Lori is the Director of the Intergenerational Rainbow Link at Borderland Rainbow Center in El Paso, Texas, an organization that provides a number of services to queer people in their community. Lori is a mama bear to her two trans/gender fluid teens, as well as any person who finds themselves in need of a mama bear nearby. She has a BSNS from Purdue Global, is a certified Mental Health Peer Specialist and pulls from backgrounds in both emergency medicine and education to function as a Jane of all trades who's ready to tackle the unexpected. As an El Paso native, Lori returned to the borderland with her husband to raise their children close to family. Liana, who is Lori's daughter, is a 16-year-old trans girl who loves gaming, singing (rapping in particular) and is a student athletic trainer at her high school. She is also a Girl Scout and local advocate for LGBTQ rights in her city. Along with helping the family foster for a local pug rescue, she loves spending time with her 2 cats, 2 pugs, and 4 fish. Dr. Toni Marie Ramírez is a family medicine physician with several years of experience in gender-affirming care. She received her undergraduate and medical school degree from Brown University and trained in family medicine at the Santa Rosa/UCSF family medicine residency in Northern California. She was born and raised in Socorro and moved back to El Paso in 2020 to be with family. Her work is strongly grounded in social justice and equity, valuing the power of community empowerment. As a family medicine physician and gender-affirming care provider, Toni shares that those entering the medical field with the intention to provide and contribute to the health and well-being of a community, quickly realize that the healthcare system is not set up for this. We pathologize what is outside the norm in this colonized world and the medical community ignores the healthcare disparities of the trans community. Her 10-year experience in providing care has shown that it is astonishing how little medical providers know about gender-affirming care. Gender-affirming care is not part of the curriculum in medical school, let alone residency. This allows medical providers to uphold this gender binary in medicine. Starting from the very beginning, our socialized aspects infiltrate the way medicine is practiced and taught. When it comes to the access aspect that comes from that, physicians are already not educated enough to provide such care. We live in a world that is very binary and the reason why there are so many disparities is not because of anything innate to trans or gender-diverse folks, but because of the transphobia that exists in the world and the transphobia that exists in medicine. Sometimes people don't access care because of a fear of discrimination or outright denial of care. Even in a progressive area of California, where Toni practiced, there are so many barriers to accessing care: (1) for feeling safe,

Almost every patient in America has had a frustrating experience in a hospital setting where we feel like we're on a medical conveyor belt that moves WAY too slowly. We sit for too long in a waiting room; then our nurses or doctors speak with us very briefly; we might feel more like we're filling out an online survey than we're being listened to; then we might have more waiting; and then we're pushed onto the next specialist or appointment too quickly. Of course some patients experience FAR worse disasters in hospitals. As patients, we know that something dysfunctional is going on, and it leads a lot of people to distrust their medical providers, and avoid healthcare altogether. But nurses, doctors, and other medical professionals themselves know that behind the scenes, they are being pushed to the brink by hospital corporations, and not really allowed to treat their patients to the best of their abilities. So today we're going to focus on one of the most crucial behind-the-scenes hospital policies behind patients' bad experiences: staff-to-patient ratios.  https://www.youtube.com/watch?v=am1j0n0ZEfw Show Notes Our guest today is Gerard Brogan, RMN, RGN, RN. Director of Nursing Practice at California Nurses Association/National Nurses United. Gerard has over 40 years experience as an RN. He has practiced nursing in the USA since 1984, before joining the California Nurses Association in 1994 as a Nursing Practice Representative.  He is the Director of the Nursing Practice Department for the California Nurses Association/ National Nurses United. Gerard has extensive experience in nurse-to-patient ratio legislation, having been a part of the successful campaign to establish nurse to patient ratios in California and subsequent experience in seeing the efficacy of the ratio law.  He serves as an educator for the organization, teaching classes to nurses on a variety of  topics relevant to health care in general and  the scope  of nursing  practice  and patient advocacy in particular. Most of us will be patients at some point, so unsafe staffing practices in hospitals will have an impact on us or our loved ones. Studies show you have a lower risk of death, higher risk of poor outcomes, and a higher chance of re-admission if your hospital has adequate nurse staffing and your care is guided by providers' professional judgement. Sadly, in a for-profit healthcare system care decisions are made based on more on their budget impact. You'll recognize unsafe staffing when you see it: things like long wait times, or feeling like a number instead of a whole person because your nurse doesn't have enough time with you. The nursing profession takes a holistic approach to care, looking at the entire person and the factors that contribute to their health; that takes time, which the healthcare industry doesn't want to give nurses. Improving nurse staffing levels has been the #1 priority of nurses unions (and most unorganized nurses too) across the country for more than a decade. Gerard tells us that nurses are ethically and legally obligated to be a patient advocate and provide optimal care. When that can't happen due to the business interests of the employer, healthcare workers experience moral distress. (Rather than "burnout" which implies an individual, personal defect, Gerard uses "moral distress" to determine the suffering that happens when nurses are constrained by forced beyond their control from providing the care they should.) There has been a sea change regarding nurse staffing over the last several decades. When Gerard began his career, staffing was "impeccable," he had professional autonomy and the institution's respect of his professionalism. In the 1990s when the Clinton's healthcare reform attempt failed, "let the market decide" became the dominant narrative in healthcare. Corporate interests descended on healthcare to make a buck and nurse staffing began to decline.

Today we bring you behind the scenes into our office at Healthcare NOW. Just like the TV show The Office, we have our hijinks and wacky characters, including some very smart interns! They have prepped some of their burning questions for this episode. https://www.youtube.com/watch?v=YnG1C8DOZVY First, from Intern Noah from Boston College: In your opinion, what is the most effective way to organize/advocate for Medicare for All?  Talk to one person, then another person, and then another! It doesn't start with money, marches, or celebrity endorsements (though if Oprah wants to support M4A, she should give us a call!) Those feel good, but without authentic relationships and networks, they don't make change. Unfortunately there are no shortcuts in organizing; we have to build the power ourselves. Do you have any funny stories from an experience meeting a member of congress? Gillian remembers meetings with former Republican U.S. Senator from Massachusetts, Scott Brown. Unfortunately all Senator Brown cared about was how the policy she was advocating for affected Dunkin Donuts. Gillian fondly remembers the time former U.S. Congressman Barney Frank told her that her hometown in New Jersey smelled bad. He also told a room full of constituents "the only thing that marches on Washington put pressure on is the grass in Washington, DC." Epic one-liner that we don't necessarily disagree with. (He already supported M4A so it was all good.) Intern Gulmeena, a public health student asks: When we talk about Medicare for all - are we thinking of a system with government run hospitals and government employed medical professionals? Do you think such a concept garners resistance or are people open to that paradigm shift? One of the most common attacks on M4A is to call it "socialized medicine." Very few countries actually have real socialized medicine, where insurance is public, all healthcare facilities are owned and operated publicly, and the healthcare professionals are public employees. In the United States, Medicare for All legislation does not socialize the facilities or professionals. By focusing on the payment mechanism, it would give the government a lot of power to reign in the worst parts of for-profit healthcare. Ben notes he has seen a poll showing a majority of Americans support socialized medicine, so who knows, maybe that's the future of the movement. Would Medicare for All include long term care for the elderly such as nursing homes and hospice? This has been a debate within our movement for a long time. Both M4A bills include long term care. The House version is more generous and comprehensive. The Senate bill would cover home-based long term care but not institutional. Currently most people get long term (which also includes care for people with disabilities) care through Medicaid, the healthcare program for the poorest Americans; this forces patients to spend down all their assets to qualify. Medicaid also has an institutional bias: it's much more likely to cover care in residential settings rather than homes, which is usually more expensive. If you're interested in advocacy around this issue, check out Caring Across Generations. Intern Ioanna (who hails from Greece, a country with universal healthcare): Considering that you have been a part of the movement since before Medicare for All was introduced by Sen. Sanders in 2017, how did you first hear about single payer healthcare, and what drove you into the movement at a time when it was not getting much or any (?) media attention? Back in the day of phone books and print newspapers, Gillian learned about universal healthcare from Ben! When her own employer-provided healthcare left her underinsured, a friend in the finance field told Gillian "if your job doesn't give you good health insurance, that's capitalism's way of telling you that your job isn't important and maybe you should get a new one.

It's summer, the sun is blazing, and we only have one thing on our minds - the upcoming thirtieth anniversary of the high-octane, expertly paced thriller The Fugitive, originally released August 6, 1993 starring Harrison Ford. Oh, and Medicare for All. We're always thinking about Medicare for All. Now that we mention it, isn't it funny how if we had a single-payer healthcare system, The Fugitive wouldn't exist? In a single-payer system, there would have been no nefarious pharmaceutical executive to frame Harrison Ford for murder in order to cover up the side effects of Provasic. There would have been no need for Walter White to cook meth in order to pay for his cancer treatment. In fact, a lot of our favorite movies and TV shows would be entirely without conflict. In this episode, we take a look at a uniquely American subgenre: movies where our healthcare system is the villain! Plus, we dip into the Healthcare-NOW mailbag to hear from our listeners about your favorite movies where for-profit healthcare is the bad guy. https://www.youtube.com/watch?v=nKat9vjm7tI SPOILER ALERT. Some of these movies are masterpieces, and we'll be discussing spoilers. Seriously, we advise that you pause the podcast and watch Dog Day Afternoon now. Let's discuss the uniquely American film genre that depicts the healthcare industry as the villain. One of the biggest healthcare villain blockbusters was, of course, The Fugitive (1993). Our hero Dr. Richard Kimball is falsely accused of murdering his wife. He escapes police custody and along the way uncovers the truth, that he was framed by an evil pharmaceutical executive who killed Mrs. Kimball to cover up the side effects of a profitable new drug. Fun fact: Tommy Lee Jones was the former college roommate of Vice President Al Gore. The term “healthcare industry” dates back to the 1970s, and so does the reality of for-profit healthcare. Major transformations of our healthcare system have created real-life nightmares and impossible situations for patients, and that growing widespread experience of a healthcare dystopia then creates an audience for Hollywood script writers to build drama around healthcare situations. Two of the films submitted by our members come from the very beginning of the “healthcare industry,” in the early 1970s: The Hospital (1971) stars George C. Scott and Diana Rigg. A serial killer targets doctors by making them patients in their own hospital, where they die due to hospital negligence. CW: weird sexual politics. Dog Day Afternoon (1975) starring Al Pacino and John Cazale, dramatizes a true story of two Brooklyn bank robbers, motivated to steal to pay for gender reassignment surgery for Pacino's character's partner. In 2015, real life dad Bryan Randolph of Detroit robbed a bank to pay for his 1-year-old daughter's cancer treatment after his health insurance canceled her plan. The next explosion of healthcare plots comes in the 1990s and early 2000s, when “managed care” plans and HMOs spread like wildfire, replacing traditional insurance. Intended to bring down rising healthcare costs, managed care brought us such classics as prior authorization, widespread claim denials and limited networks. This kicked off a new wave of films in the 1990s that start using health insurance villains become key plot points. The failed Clinton health reform efforts also happened in 1994, which created probably a sense of hopelessness around Congress fixing these problems. As Good As It Gets (1997): This cringefest features Jack Nicholson as a cranky, bigoted and obsessive compulsive writer. Nicholson's character can only eat at one restaurant, where he meets waitress Helen Hunt, and pays for her child's cancer treatment so she can continue to work and serve him. All kinds of toxicity, sexism, and structural inequities on display in this one. Patch Adams (1998): features Robin Williams in a real life story about a doctor whose unorthodox ways bump up agai...

As Tom Petty taught us all in the 1980s, Waiting is the Hardest Part. That's even more true when you're waiting to see a doctor for a problem that needs attention. Anyone who has ever tried to secure a doctor's appointment in this country knows that a) it's going to be harder than scoring Taylor Swift tickets and b) you are going to face serious delays before you get your care. In this episode, we're getting into the nitty gritty of wait times in the U.S. – how bad are they, how do we compare to the rest of the developed world, and why are wait times the right's favorite scare tactic when it comes to Medicare for All? https://www.youtube.com/watch?v=Y3QJH4eFXY4 The narrative attacking Medicare for All - you'll NEVER get to see a doctor and everything will be like communist Russia… or, god forbid, CANADA! This is one of the top scare tactics used by opponents of Medicare for All, but their claims about wait times aren't always based on the truth. What our opponents seem to forget is that we have wait times in the US too. Ben, Gillian and our members all have stories about wait times, including Gillian's story of being told "call back next year," and Ben's condition that worsened and turned permanent because he couldn't get an appointment for for months for an urgent matter. We heard from members with horrific conditions that prevented them from working or even do normal day to day activities, but had to wait months or even over a year for care. In our broken system, getting a wait time is actually a privilege; if you don't have insurance or can't afford the copay, you won't even get to make that far-off appointment you need. This is another reason we often end up in the emergency department. In some cases there is no other way to get medical attention for an urgent or emergent condition. The reality of how our wait times compare to other countries' is challenging to capture because the U.S. is one of the only developed countries that DOES NOT TRACK WAIT TIMES. Reporting is not required. In other countries, they track wait times for every service, and in some cases you can look up average wait times online for visits, procedures and hospitals. Research on countries with national healthcare plans shows that wait times vary dramatically, from country to country. We often don't even talk about the most critical wait times, which are ambulance response times and processing patients in emergency departments. It's hard to find good comparative data on this, but these are major weaknesses of the U.S. healthcare system. Finally, there is evidence of a major equity component here. Poor people and BIPOC have longer wait times for all services (including health services). Hispanic children have longer ED waits. Patients in poor neighborhoods have longer ambulance response times for cardiac arrest. What actually drives wait-times? Unlike the scare tactics from the right, it's not about the payment system. It's mostly about adequate supply (of providers, specialists, scanning equipment, labs, etc) and accessibility - which is different from our payment/insurance systems. In general we do pretty well at wait times for very profitable services - like MRIs and CT scans. We do very poorly at unprofitable (or low-reimbursement services) like primary care, mental health care, and substance use care. There is an exception to this, because… When it comes to wait times for particular physician specialties, including primary care, a major source of the problem is that physicians control how many medical school slots AND how many medical residency slots are available across the country, in every specialty. Economist Dean Baker calls this a “cartel.”  How would Medicare for All impact wait times in the U.S.? M4A might not directly impact wait times, but it would put into place tools that would allow us to control wait times. For starters, we could track wait time data.

Usually we spend our time on this podcast talking about our for-profit healthcare system and why we need to make healthcare a public good, but in this episode we're taking a detour into another privatized American system that should be public: our railroads! Just like in US healthcare, private companies are falling asleep at the switch on managing our railroads, and just like in the healthcare system, the failure of big corporations is costing money and lives. Today, we're joined by Michael Paul Lindsey (who goes by Paul, or Railroad Refugee on Tiktok) a locomotive engineer for 17 years. Paul is a Steering Committee member of Railroad Workers United, a huge inter-union labor caucus of railroad workers from across the country that is fighting both for Medicare for All and for making our country's railroads public. We're going to talk about the parallels between these two fights, why railroad workers support Medicare for All, and why we think everyone who's passionate about Medicare for All should also get excited about establishing public railways in this country! https://www.youtube.com/watch?v=qrNWHItT6iw Show Notes RWU has been a supporter of Medicare for All for some time because railroad workers have so much trouble keeping decent healthcare while the rail companies try to gut benefits and use healthcare as a bargaining tactic against workers. Like other corporations, railroads use the increasing cost of healthcare benefits to cut into the other pay and benefits earned by railroad workers. They consistently shift more of the cost onto the workers, while claiming the benefits are so rich they can't also provide workers with paid sick time or better time off benefits. Railroad workers, like so many other Americans, are locked into their jobs because they need the health insurance. In countries with a national health plan, workers have the basic economic freedom to leave their job if they don't like it, without worrying about healthcare. Those workers have better negotiating power because the employer can't hold healthcare over their heads. But in the U.S. railroad companies - and most large corporations - have more control over their employees because their families depend on employer-provided healthcare. Most Americans aren't very aware of railroads and commercial rail. But commercial rail is integral to the entire modern economy. A recent example in California illustrates rail's reach into our economy: Union Pacific wasn't delivering sufficient amounts of grain to Foster Farms, one of the largest chicken and turkey producers in the country. Foster Farms was days away from having to slaughter millions of chickens. Union Pacific blamed congestion, and shortages of locomotives and workers for the delays, while in fact they had cut their own resources relentlessly to buyback stock shares. Only after the Feds ordered Union Pacific to increase grain shipments was the problem resolved. So while many other industries depend on rail for their very existence, the railroad companies' focus on stock buybacks reduces their capacity to deliver goods, potentially wiping out entire industries. , reducing the capacity of railroads to deliver goods. Ultimately, taxpayers make up the difference because the cargo has to be delivered by trucks on the publicly subsidized highway system. It's important to know more about an industry with so much control over the economy. For most of American history railroads have been privately owned. However when there wasn't enough capacity to support the war effort during the First World War, the U.S. temporarily nationalized the railroads, investing heavily in upgrades at taxpayers' expense. That was all returned to private ownership after the war. Since the 1950s and 1960s railroads began to merge and consolidate, at the same time the U.S. government began investing in the competition, with subsidized interstate highways and airports.

Virtually all Americans know that our healthcare system is broken and that it's working against us. But who is the villain in this story? Who is responsible for maintaining this healthcare system, and using it to profit off of patients? If we had to round up the usual suspects in a lineup, we'd probably end up with health insurance companies and big pharma. But what about hospitals? Many people like the nurses and doctors who care for them, and associate hospitals with those care-givers. But are hospitals equally responsible for the crazy costs of health care, for our poor access to care, and for the medical debt that is like a ball & chain on our personal finances? A new documentary sets out to answer this question. It's called “American Hospitals: Healing a Broken System,” and our guest today is Wendell Potter, who is associate producer on the film. https://www.youtube.com/live/6uLfGZE26lo Today's guest Wendell Potter is the former Vice President of Corporate Communications for the health insurance company Cigna. In 2008, he resigned, hung up his pitchfork for good, and became one of the industry's most prominent whistleblowers, testifying against corrupt practices in HMOs before the U.S. Senate. Since then, he has become a prominent advocate for Medicare for All and universal health care. Gillian starts by noting that we usually ID health insurers and Big Pharma as the worst actors in our healthcare system, the "villains" behind our dysfunctional system. She asks Wendell, should we add hospitals to the list? Wendell says YES, hospitals are part of the rogue's gallery specifically because of price gouging - charging far more than they should, and more than hospitals in countries with Medicare for All are allowed to. Hospital prices bear no relationship to the cost or quality of the medical services they're providing, and many hospitals charge as much as they can get away with. They get away with it because they face much less scrutiny from employers, from Congress, the states, and even from advocates. How do they get away with this? Unlike insurers and pharma, hospitals are part of our communities, they develop one-on-one relationships with their legislators and non-profits in their area. Ben asks Wendell to tell us more about the principle crime hospitals are guilty of - price gouging - and how specifically does hospital pricing work? Hospitals charge whatever they can get away with, so even in the same zip code you'll find hospitals charging wildly different prices for the same service, like an MRI. Insurance companies have not been able to negotiate these prices down because some of these hospitals are so big they can't be left out of insurance plans, and in rural areas there might be only one hospital with absolute bargaining power. Moreover, insurance companies don't care that much about hospital costs - they're more than happy to pass those on to the rest of us in the form of higher premiums. If you have insurance, when you get a hospital bill you'll probably see an enormous $ number that represents the alleged "price" of the service you receive, then you'll see a very marked down price that your insurance actually paid, creating the impression that your insurer has negotiated a massive discount on your behalf, sometimes 60% lower or even more. If you DON'T have insurance you might get that massive bill without a discount. Wendell explains that these huge hospital list prices are completely fake. Hospitals know that these prices will be negotiated down, and almost no one will actually pay the list price, so the game is to set that number as high as they possibly can to let insurers look like they've won something. If you're uninsured you are in the worst position because you have very little bargaining power with a hospital, but even then most hospitals will reduce or even eliminate that price for uninsured people - particularly non-profits,

If you missed our annual Single Payer Strategy Conference, it's your lucky day. Today we share a conference presentation all about the impact of Private Equity on healthcare (spoiler alert: it's not good.) Our guests are Eagan Kemp, Health Care Policy Advocate at Public Citizen; Rachel Madley, Health Policy Advisor to Medicare for All Act chief author Representative Pramila Jayapal (D-WA 7); and Robert Seifert, Senior Fellow at Americans for Financial Reform. https://www.youtube.com/watch?v=y0w0pV8EvYE Show Notes Eagan talks about Public Citizen's recent report (with an emphasis on recent PE acquisitions and areas of concern, including end-of-life care, home health care, traveling nurses, reproductive care, and Medicare Privatization/ACO Reach) Robert Seifert on AFR's recent work in the space (depending on whether you want to present on the broader topic of PE in health care, you could definitely go before or after me)Rachel (as I think folks will be most excited to hear from her and be most likely will stick around for it) on Rep. Jayapal's Healthcare Ownership Transparency Act and any other PE stuff she wants to raise. https://www.citizen.org/news/action-on-predatory-private-equity-in-health-care-needed-stat-says-public-citizen/

When kids turn two or three years old, they learn to tell what is called a “primary lie,” which is lying without much sophistication or awareness of how the listener will perceive the lie (hint: you completely failed to fool your parents). But when we turn four, we learn to tell “secondary lies,” which take into account the listener's likely reaction, and are more plausible. When we turn seven or eight we learn to tell “tertiary lies,” where we also make sure our lie is consistent with surrounding facts. But not until you've asked your legislator to support Medicare for All have you experienced the apex of deception: you walk out knowing they didn't agree with you, but you're not sure if they disagree with you, or whether you've learned anything about their position on the issue! So today we are here to talk about “legislative pushback,” or evasion, or avoidance - basically the whole playbook of tactics that legislators employ to land between “yes” and “no.” We are joined by Eagan Kemp and Vinay Krishnan today. Eagan is the Health Care Policy Advocate at Public Citizen. He is an expert in health care policy, including single-payer systems, and he previously served as a senior policy analyst at the U.S. Government Accountability Office. Vinay Krishnan is the National Field Organizer for the Center for Popular Democracy. We know him as an organizer, but he's also a writer of fiction and non-fiction, and an attorney based in Brooklyn, NY. https://www.youtube.com/watch?v=N2-A6ubjVII Show Notes Medicare for All bills have not yet been introduced in the 118th Congress, the session that began in January 2023. Healthcare-NOW and our allies are starting our drive to gather co-sponsors BEFORE those bills are introduced. We expect the Medicare for All Act to be reintroduced before June in the House, and hopefully around the same time in the Senate. We aren't as dumb as Fox News conservatives like to make us seem, so we know that there isn't a great chance to pass M4A this session, but it's important to keep the momentum going by getting new cosponsors on the bill. Our past success in gaining co-sponsors has been due in large part to citizen lobbyists asking, pressuring and demanding their elected officials sign on. If you've never called your Senator or member of Congress, we have a guide! https://www.healthcare-now.org/makethecall. Some calls will be easy if you're lucky enough to be represented by die-hards like Senator Bernie Sanders (I-VT) and Representative Pramila Jayapal (D-WA-7), the chief sponsors of the bills. But for many of the rest of us, our elected officials are wishy-washy, or even reluctant to sign on to M4A, so our guests give us some strategies for these conversations. Before we get into the objections, we want you to know you don't need to be a policy or health economics expert to talk to your elected officials. If you've been victimized by the American healthcare industry, you're an expert. While we've heard some wild reasons for not supporting M4A, most objections fall into a few basic categories: Downplaying the importance of co-sponsoring the bill "Medicare for All is just a slogan that's not going anywhere so I don't need to engage" "I'm not on a committee of jurisdiction so I can't co-sponsor" "I'm on a committee of jurisdictino so I can't co-sponsor" "I'm in leadership so I don't co-sponsor bills" Strategy: these answers tell you that the suffering of people in their district isn't important enough for them to take action. Help them understand why healthcare for all is so important for their constituents. Bring personal stories; stories can help break down initial barriers and make way for a real conversation. Next time bring even more people and more stories. "I support M4A but I won't co-sponsor" Strategy: consistent follow-up, so they continually feel the pressure. Allow them to ask questions and follow up with information.

Back in 2008, the TV show Breaking Bad asked a question that is still on a lot of Americans' minds: How far would you go to pay for medical care? In Breaking Bad, the main character ends up building a meth empire to pay for his cancer treatment, which is a solution we don't necessarily endorse, but you do what you have to do. Today we're going to be talking about real life (slightly less dramatic) examples of the lengths folks are forced to go to these days to navigate our for-profit healthcare system. From TikTok to Go Fund Me to class action lawsuits and appearances on the Dr. Phil show, ordinary people may not be selling meth, but they are turning to public platforms to get the care they need. We are joined today by Jill Parkinson, who recently went viral on TikTok talking about her own health care horror story and is channeling that experience into Medicare for All activism! https://www.youtube.com/watch?v=QS1dCAqcvb0 Show Notes Jill tells us her healthcare story, which begins with long-undiagnosed stomach pain since she was a teenager. In 2021 the pain got so bad that she went to urgent care. Diagnosed with endometriosis, Jill had two surgeries. She reports she did “everything right”: got marketplace insurance, paid her premiums, and paid the full amount of her deductible and out of pocket max of $7,500 upon checking into the hospital for surgery. Following the surgery, she needed to immediately begin taking a prescription to prevent more pain and surgery yet again. She faced an epic runaround with her insurance company, the specialty pharmacy, and the hospital. Once she sorted that out, she assumed insurance would cover the full cost of the prescription, because that's what insurance is supposed to do! Even though she had met her deductible, she ended up paying $1,500 out of pocket for the prescription, and still didn't get it on time. So Jill took to TikTok, and went viral within hours. https://www.tiktok.com/@jillfrance/video/7197882383864220974 The responses to Jill's video elicited lots of advice and comments: never pay up front or even pay at all. Use Mark Cuban's Cost Plus Drugs. Getting drugs from Mexico or Canada. (Northwest Pharmacy Canada priced the same drug at $300.) People told me to get a lawyer or call state authorities. Go to the manufacturer's website for a discount. (This drug was $1,600 and the max that the manufacturer will take off is $300, making it $1,300.) "It's Obamcare's fault” Ask for a grant. “Karen as hard as you can. Karen harder than you ever have Karened in your life!!” “Hang in there, medicare is freaking awesome.” “This is why I can't quit my job. My insurance is too good.” “People with no money just don't get surgeries. We just die and the world continues on.” “When I had my son (my 3rd c section) the registration woman told me that if I didn't pay my copay before leaving, I wouldn't get to take my son home.” Would you rather have a literal pain in the ass or have a pain in the ass lawsuit? Next our hosts and guest play Would You Rather: the Healthcare Edition. Ben tells the story of Christopher McNaughton, who finally found a treatment that changed his life–but insurance company decided he wasn't worth the cost. College student Christopher McNaughton was diagnosed with ulcerative colitis, a chronic inflammatory bowel disease that has no cure. His case was particularly severe, to the point where constant debilitating pain forced him to drop out of school. After years without relief, an unusual regimen of biologic drugs at high doses finally brought his disease under control. McNaughton was insured through UnitedHealthcare (regular listeners may recall how we feel about them…). The high cost of his treatment triggered an internal “review,” wherein United's doctors claimed it was “not medically necessary.” A lawsuit filed by McNaughton's family brought to light United's relentless ...

2013 was a big year -- we had just survived 2012 (the year the Mayans thought the world was going to end), we were all doing the Harlem Shake on Vine, and -- most importantly -- our regular co-host Ben Day became the Executive Director of Healthcare NOW, the nation's leading Medicare for All advocacy organization. In this episode, Gillian interviews Ben about the past decade in the movement for healthcare justice, revisiting the highs, the lows, and the weird in-between shit! Like a lot of folks, Ben Day began his journey to Medicare for All activism as a patient. He was a graduate student in Labor Studies in his 20s when he developed a panic disorder that put him in the hospital and racked up his medical bills. He was so outraged by the experience of getting hung out to dry by the for-profit healthcare system that he decided to change course and spend his life fighting to bring down the system! Back in 2006, when Ben started as an organizer with Mass-Care, the Massachusetts campaign for Single-Payer Healthcare (This was before the term Medicare for All was commonplace in public discourse.), Massachusetts had just passed "Romneycare," a package of healthcare reform laws that became the model for the Affordable Care Act ("Obamacare"), so Ben got a preview of how trying to reform the system without eliminating the private insurance companies can go VERY wrong, resulting in limited networks and other industry tricks to keep profits high. Of course, even with that insight into how reform unfolded in Massachusetts, Ben and other single-payer healthcare activists were marginalized and dismissed as naive radicals throughout the years of debate leading up to the 2010 Affordable Care Act, as moderate Democrats consolidated their efforts into demanding the policy non-solution that refuses to die: the public option. That ended badly both for advocates of the public option and advocates of Medicare for All, who lost out in the final version of the bill, but it was a positive development for private insurers, who now had millions of new customers lining up at their doors! By the time Ben came to work for Healthcare NOW in 2013, the whole country was mired in the backlash from right wing Republicans fighting tooth-and-nail to "repeal and replace" the Affordable Care Act, which had become a political symbol of the Obama administration. Ben explains that this was a turning point for the healthcare justice movement, as regular people who hadn't been involved with politics before stood up at town halls and listening sessions across the country, not just to defend the ACA, but to push legislators further and demand Medicare for All. Since then, we've seen massive growth in support for Medicare for All, and thanks in-part to Bernie Sanders, Medicare for All has been the top issue in the past two presidential elections, and Healthcare NOW is working with thousands of activists throughout the US to make Medicare for All a reality in our lifetimes. Ben speculates that even though we still have a fight on our hands to win, there are enough of us now that we won't be marginalized or dismissed in the debate about healthcare ever again! Want to help us celebrate Ben's 10-year anniversary and make sure we get Medicare for All in a timely fashion so he doesn't have to do this job for another 10 years? Make a donation to Healthcare NOW today!

Starting on May 11, President Biden is ENDING the emergency COVID-19 regulations that have been in place since the start of the pandemic in January 2020. These regulations created (almost) a Medicare for All-type public funding system for vaccines, testing, and COVID-related care. While the pandemic itself is still raging, the end of the official Public Health Emergency (PHE) means that access to COVID prevention and care will become like any other form of care in the U.S.: whatever you can get through the private market. That means prices going up, highly inequitable access, and millions of us falling through the cracks. In addition, the public health emergency added crucially important protections for Medicaid enrollees, millions of whom will start getting kicked off their insurance in April. Brace yourself for a major healthcare catastrophe a couple of months from now. https://www.youtube.com/watch?v=h4yyY_YbOCw Show Notes The COVID-19 pandemic is still happening According to CDC: Still an Average of 40,404 new cases per week (and these numbers are surely an undercount considering how few cases are actually reported to a public health agency.) Still an average of 3,665 hospital admissions per week Still an average of 453 deaths per day Still a lot worse than flu! Among the 2,398 Pneumonia, Influenza, and Covid deaths reported for this week, 998 had COVID-19 listed as an underlying or contributing cause of death on the death certificate, and 50 listed influenza. According to William Hanage, epidemiology professor from Harvard: “It's beyond question that society has moved into a stage where the pandemic is for most of us if not over then certainly quiet. And that's a great thing. Long may it remain so. Is it the case that there is no preventable suffering? No. There is still preventable suffering and death.” Why end the Public Health Emergency when the virus is still raging? We all wish COVID-19 would go away. President Joe Biden's announcement Monday January 30th that his administration would end the PHE along with a separate COVID-19 national emergency in May, winding down services and supports. The Public Health Emergency has been really inconvenient for Republicans, so they voted for a bill in the House to end the PHE immediately. With either approach, the gradual wind-down or the abrupt end, there is no way to legislate ending the pandemic. Germs don't care about politics. What's really ending is the public health safety net for preventing and treating COVID. What were the emergency regulations, and what are the real-life consequences of ending them a few months from now? Let's start with the single most important thing that's going to happen: an estimated 15 million people are going to get kicked off of Medicaid starting in April. That's about 4.5% of the entire population of the United States. When COVID struck, the federal government essentially banned states from kicking people off of Medicaid. People get churned off of Medicaid shockingly frequently - maybe because you started earning just a little too much money, or you moved and your re-determination paperwork went to your old address, or a million other reasons. This mostly stopped during the pandemic, and Medicaid's enrollment rose - the federal government also provided increased funding to states to pay for the increased enrollment. The next regulation that's ending has to do with our old friend, Medicare Advantage plans. We've talked a lot about how privatized, for-profit Medicare Advantage plans have extremely limited networks, making it hard to get the care you need without having to travel ridiculous distances. During the COVID emergency Advantage plans were required to cover COVID-related treatments at ALL providers as in-network care. That's going to end starting in May, and if you see the wrong provider for COVID care, you could get slammed with a huge bill. What about COVID tests?

Our guest today is Rebecca Wood. Rebecca lived all over Virginia before her relocation to Massachusetts. Rebecca worked with many organizations and offices on Capitol Hill. Her healthcare work includes rallies, protests, press conferences, and conventions. Most notable, she told her and daughter Charlie's story at the introduction of Senator Sanders' Medicare For All Act of 2017 and testified before the House Ways and Means Committee hearing on Pathways to Universal Coverage in June 2019 (Rebecca's statement begins about at about 18:10). Rebecca also regularly volunteers for Remote Area Medical, which provides access to healthcare for underserved communities and is active in the push for universal school meals. https://www.youtube.com/watch?v=WK1XiF5Rco4 Show Notes CW: Medical and dental trauma We don't usually start our podcasts with data or statistics, but last week Gallup released a shocking poll that clearly reflects a new reality for the country: 38 percent of Americans now say they put off medical treatment because of the cost sometime in the past year (2021). This is a HUGE leap over just a year ago, when only 26 percent of Americans were putting off care. Gallup has been conducting this poll for over 20 years, and this is the worst we have ever seen. Even more troubling, 26 percent say they put off treatment for “very serious” conditions or “somewhat serious” conditions, and THAT is another huge leap over just a year ago, when “only” 18 percent of Americans were putting off care for very serious or somewhat serious issues. We're now three years into the pandemic, and employment rates have improved. So what the fuck is going on here that our access to healthcare is now worse than during the height of the pandemic when the economy was shut down and there were no vaccines?!? Rebecca tells a story that illustrates how delayed care hurts American families. Ten years ago her daughter Charlie was born prematurely due to Rebecca's severe early onset pre-ecclampsia, a potentially deadly condition for both mom and baby. Charlie was in the Neonatal ICU for three months. Their family had "good insurance" through Rebecca's then-husband's employer. Over the next several years, like many micro-premies Charlie needed enormous amounts of care. They faced automatic denials, outrageous deductibles and huge copays from their insurance company. Due to the high out of pocket costs for Charlie's care, they went from being financially comfortable, to going through their savings, putting off their plan to buy a home, and living paycheck to paycheck. Even worse, Rebecca had to make choices between paying for her daughter's healthcare and her own. Like so many American parents, Rebecca put Charlie's needs first, sometimes rationing her own medications and eventually putting off an important dental procedure. That delayed dental procedure led to an infection that spread to her entire mouth and jaw, forcing her to the emergency room. Doctors feared the swelling could cut off her airway. After days in the hospital, Rebecca followed up with her dentist, where she had to have all of her teeth pulled and parts of her jaw scraped away. In 2017 when the Affordable Care Act came under attack, Rebecca feared repeal would make Charlie uninsurable due to preexisting conditions. So Rebecca became a vocal activist. She used her family's experience to call out the profound policy failure that has caused so many American families to suffer. The new Gallup Poll found: “In 2022, Americans with an annual household income under $40,000 were nearly twice as likely as those with an income of $100,000 or more to say someone in their family delayed medical care for a serious condition (34% vs. 18%, respectively). Those with an income between $40,000 and less than $100,000 were similar to those in the lowest income group when it comes to postponing care, with 29% doing so. Reports of putting off care for a serious condition...

Like many of our episodes, this topic drives our hosts to use some salty language. Use your best judgment if you're listening near someone with tender ears. Hike up your trousers and throw on some long socks. We're getting into the weeds on this one. Ben and Gillian discuss the digitization of our healthcare system and its far-reaching impacts on data privacy and patient health outcomes. We trace the rise of Electronic Health Record (EHR) management systems and the corresponding $13-billion-per-year industry that emerged in the wake of the Affordable Care Act. Electronic systems that were meant to “modernize” the healthcare industry have actually led to rampant inefficiency, inflated costs, and negative health outcomes for patients. Big Healthcare and Big Tech - it's a match made in hell! https://www.youtube.com/watch?v=NSvDBcGItTk&t=1272s Show Notes History of Electronic Health Records Prior to the ACA, the HITECH Act (Health Information Technology for Economic and Clinical Health - part of the American Recovery and Reinvestment Act of 2009) created huge financial incentives for providers to transfer to EHRs. Incentives worked - in 2008, 9% of hospitals used EHRs; in 2019, 96% of hospitals use EHRs. Medical data underwent a massive transformation after the passage of the ACA in 2010. Under the ACA, the federal government invested around $36 billion to incentivize creation of Electronic Health Records (EHR) systems. The intent was to modernize and “digitize” healthcare industry by improving patient access to information, coordinating care, and reducing disparity between healthcare providers by providing access to information. Now, more healthcare data is being collected than ever before, but the systems for actually MANAGING that data are a huge mess. Digitization could have created a much more efficient system - if it had been centralized, as it is in countries where they have a single-payer healthcare system. Many countries that have single-payer healthcare systems also have one universal electronic records system. Instead of one streamlined system for managing medical records, a myriad of different EHR “vendors” flooded the market post-ACA, resulting in a patchwork, Frankenstein system where there are many different databases holding people's medical records, none of which are interoperable. This is massively infuriating, inefficient, and bad for patients. Just ask Joe Biden - he agrees! “At a 2017 meeting with health care leaders in Washington, he railed against the infuriating challenge of getting his son Beau's medical records from one hospital to another. ‘I was stunned when my son for a year was battling stage 4 glioblastoma,' said Biden. ‘I couldn't get his records. I'm the vice president of the United States of America.  … It was an absolute nightmare. It was ridiculous, absolutely ridiculous, that we're in that circumstance.'" Why are American EHRs so bad? In countries with national health programs EHRs are built to drive better quality care. In the American healthcare system, EHRs' #1 priority is driving profits. This means that EHRs were not created to support many of the things that physicians, patients, and policymakers value: better care experiences, reduced costs, or improved care quality and population health management. They were not created to make physicians better diagnosticians or more cost-effective prescribers. The reason: our health care system has mostly not rewarded these activities. They have not been mission-critical for providers or, therefore, EHR designers.  What are the negative effects that digitization/EHRs have on patients and physicians? Clinician busywork: In one study, physicians reported that they spend 4.5 hours per day completing electronic health records - time that could be spending tending to patients. Opportunity for fraud: EHRs are really optimized for billing, NOT for patient care,

It's a new year, which means everyone is coming out of the woodwork to make predictions about what's in store for 2023. In this episode, we're going to be making reckless, unverifiable claims about the future of the movement for healthcare justice, the public health crisis in this country, the political landscape, and yes – how an impending alien invasion might impact our fight for Medicare for All! https://www.youtube.com/watch?v=wbJS9RI_Oew Show Notes Gillian researched some of the predictions other folks have made about the coming year. Gillian is highly qualified to evaluate the veracity of these predictions, as an experienced Tarot reader who once filled in for the legendary Miss Cleo. The Living Nostradamus, Brazilian “Investigative Paranormal" Athos Salome, says that Elon Musk will reveal himself to be the Antichrist and start World War III! Baba Vanga, the "Nostrodamus of Bulgaria" (who predicted her own death in 1996!), says governments will ban natural birth and insist we grow babies in laboratories! Baba Vanga also predicts an alien invasion will knock the earth off it's orbit! But will they be covered by M4A? (We predict yes: everybody in, nobody out.) Noted public health experts predict an alien invasion will completely upend the fight for healthcare justice. Ben predicts that Speaker of the House Kevin McCarthy will die of a heart attack before the end of the current legislative session. Judging by the prevalence of heart disease among men in the United States, and the fact that stress is a leading risk factor for cardiovascular issues, this prediction is not too off the wall. Bringing things back to earth for a moment, what are actual public health experts and medical providers saying about what might happen in the coming year – is 2023 the year we finally get so healthy we no longer need healthcare? Triple/Quad-demic! In the fall of 2022, public health folks warned about the coming tripledemic this winter – a combo of COVID, the common flu, and RSV (a respiratory illness prevalent in children that would put additional strain on our healthcare system. Guess what? It happened and is still sort of happening! Over the holidays, available hospital beds were hard to find all over the country, and from Oregon to New Jersey, we've seen reports that local healthcare facilities are still overburdened. Even though some experts say that we're over the worst of the flu and RSV for this season, COVID infections have continued to rise going into the new year. Our friends at National Nurses United are actually calling this a “Quad-demic” because on top of all the illnesses that are circulating right now, we have drastically unsafe staffing conditions in hospitals all over the country. “During the Covid-19 pandemic, regulatory flexibility afforded the hospital industry a rationale and opportunity to adopt—and normalize—crisis standards of care, even when not in a surge—from locking up and rationing personal protective equipment (PPE) to adopting harmful staffing models like team nursing. Hospital industry mistreatment and neglect of RNs and other health care workers has also led to many health care workers to leave their respective facilities in order to protect their health, wellbeing, and licenses, which has created a staffing crisis in health care.” – NNU  Once again, viruses plus a for-profit healthcare system are really fucking us. Prospects of Passing Medicare for All? The Republican Party has a 4-seat majority in the House, and we've been watching them implode over the dry procedural task of nominating a Speaker. Things are ever-so-slightly better in the Senate this session.  It's highly unlikely any healthcare legislation will be passed and sent to the President to sign. We might be lucky if government does anything at all in 2023-24, particularly passing budgets. Both M4A bills will be re-introduced this session,

Listeners, how many times has this happened to you? You find a great doctor, you make an appointment, and you think everything is fine… until you get the dreaded call from the insurance company that your sweet new doc is “Out of Network.” Well, you aren't alone – just in the past few months, limited provider networks have been making news, as Johns Hopkins, one of the most prestigious hospitals in the country, is leaving the CareFirst Blue Cross Blue Shield network, which could impact nearly 300,000 patients in the Baltimore area. In this episode, we're going to demystify what these networks are and how they're screwing us all and uncover the depressing history of how limited provider networks came out of the longstanding American tradition of screwing immigrants. https://youtu.be/EkDSdUpAZ_o Show Notes So what are "limited networks" or "narrow networks" in your health insurance? Gillian breaks it down: When your health insurance has a limited network, it means you can only get care from a small number of physicians or hospitals that have contracted with your insurance company, and agreed to accept lower rates to treat you. If you receive care “out of network,” it will either be completely uncovered by your health insurance, or you'll have to pay a huge portion of your bill. Health plans with “broad networks” usually cover around 70% of all providers in the local area - but “narrow networks” generally cover less than 25% of available providers, some even less than 10%. It's VERY common for the largest hospital chains to be excluded - like the recent example of John Hopkins in Baltimore. The result is that you generally pay a lower premium for a limited network plan: one study found that premiums were 16% lower for narrow network plans, which honestly isn't much of a savings for the impact on patients' lives! Insurers LOVE limited network plans, because in addition to paying lower rates to providers, they also have the affect of “cherry picking” - since healthier individuals tend to opt into limited network plans, if they have a choice. Ben is currently in a limited network plan, because under the Affordable Care Act (ACA) small employers like Healthcare-NOW get subsidies for health insurance they offer to their workers, but ONLY if they offer insurance through the ACA's state exchanges. And as we'll discuss about, limited networks plans have absolutely overrun the state exchanges. The impact on Ben has been difficulty finding specialists, having long waits for specialists, and his primary care doctor basically can't coordinate his care at all, since the specialists she knows, trusts, and works with, are almost all "out of network" under his plan. Ben saw a sports medicine doctor who diagnosed his sciatica, who was in-network for him, but all of the physical therapists at the same sports medicine center - whose offices are right next to his - were out-of-network! How did this all come about? Managed care plans in the 1990s first ushered in the idea of limited networks. These were when the insurer owned their own provider network (like Kaiser Health Plan), so if you had that insurance, you could only see the providers that they “owned.” Today, there aren't a TON of traditional managed care plans like this - usually your insurance plan creates limited networks by negotiating with physicians and hospitals, and only accepting those willing to accept the lowest rates. So who is most impacted by this new incarnation of limited networks? Ben says there are THREE groups of people most impacted by limited networks today: ACA plans sold on the state exchanges - really, anyone on the “individual market,” buying health insurance on their own. Includes virtually all self-employed people, contractors, artists, without a traditional employer; Medicare Advantage plans; and Student health plans. While slightly different from the above, we're gonna add a DIS-honorable mention here for Medicaid...

The 2022 midterm elections are MOSTLY in the books - thank again Georgia, for the endless run-offs that keep on giving, every two years it seems like. You've heard the national narrative: Democrats did surprisingly well, given how parties in power usually take big losses during the mid-terms, and particularly when Biden has such low approval numbers. Today we'll talk about how healthcare did on Election Day, and how the fight over Medicare for All within the Democratic Party affected those results. https://www.youtube.com/watch?v=fuqxhi7mGtU Show Notes First the good news, some wins on single payer healthcare ballot measures: Oregon: voters approve Measure 111, a constitutional amendment enshrining access to affordable healthcare as a fundamental right. Oregon is now the first state with a constitutional obligation to provide healthcare to constituents. The amendment states that Oregon is obligated to "ensure every resident has access to cost-effective, clinically appropriate and affordable health care as a fundamental right,” but not does define what health care access looks like or how the state will fund it. South Dakota: voters approve Constitutional Amendment D, expanding Medicaid eligibility under the ACA, covering 45,000 more South Dakotans. Anybody in making less than 133 percent of the federal poverty level (about $18,000 for an individual or $36,900 for a family of four) would now qualify for Medicaid coverage. There were 12 states left that had not expanded Medicaid - and now there are 11! South Dakota is the seventh state to approve Medicaid expansion via the popular vote. (Medicaid Expansion has passed all seven times.) Some experts predict a slow rollout/implementation similar to that seen in Missouri. Arizona: voters approve Proposition 209, or the Predatory Debt Collection Act, which cuts down on interest rates on medical debt and increases the amount of assets protected from creditors. The average Arizonan with medical debt has $1,903 in collections and while 20% of white Arizonans have medical debt in collections, that number for communities of color is much higher at 39%. In Arizona, interest rates for medical debt increase by as much as 10% each year - this legislation caps the interest rate at 3%. It also protects homes, household furnishings, vehicles and bank accounts from collections or forced sale. Run by Healthcare Rising Arizona, a grassroots, labor-backed organization, this law is the first of its kind. Of course the interest groups backed by collection agencies launched a legal challenge against the ballot initiative. Sadly for them, it failed. The proposition passed by with 75% support. While it doesn't address the main issue of high medical costs, the new law will provide real relief to people struggling with medical bills. Massachusetts: a non-binding ballot policy question in favor of M4A passes in 20 state house districts. Our friends at MassCare put single-payer on the ballot, instructing state representatives to support Medicare for All. The question passed in all 20 districts. Most states don't have this tool; it doesn't require the legislator to sponsor a bill, but it can be an effective pressure tool for legislators who aren't supporters of M4A yet. Great work by our comrades at MassCare, especially former Healthcare-NOW Communications Director/current Executive Director Stephanie Nakajima. Our own Ben Day organized around this question in his own neighborhood. He found talking to voters about this ballot measure was a great way to bring new people into the movement and hear new stories about the healthcare system. The question passed by over 77% in his district, so good job, Ben! The Pros of Ballot Questions: when you put something popular like Medicare for All to a vote, you win! However, passing and implementing ballot initiatives require deep, heavy duty organizing, and a lot of follow up.

Today we're talking about the relationship between taking your vows and taking your medicine. In 2020, more than a quarter of folks who got married said they took the plunge because one of the partners involved needed health insurance, and it seems like some couples are staying together for the insurance as well. In this episode we'll break down how our healthcare system is set up to get us paired up and how Medicare for All could save you a trip down the aisle.    https://www.youtube.com/watch?v=GQdctwkzwNA Show Notes Trigger Warning: On today's episode, we're also going to be discussing some of the dark side of marriage, including domestic violence, which we know is a topic that can raise some traumatic feelings in survivors and might not be appropriate for any kids you have in the room. Of course, we also want to remind you that if you or someone you love needs help with a DV situation, you can call the National Domestic Violence Hotline at 800-799-SAFE (800-799-7233) to find resources in your area. People Don't Really Get Married for the Health Insurance Do They? A survey by Affordablehealthinsurance.com found that 26% of American couples married in 2020 said they got hitched because their partner needed the insurance. This number spiked in 2020 because of the COVID-19 pandemic. 7.7 million people lost their jobs and had to find an alternative source of health insurance.  We can't assume people ONLY got married for the insurance, but a life-altering event like COVID and the associated economic turmoil probably sped up their timelines to the altar  In that same survey, 28% of respondents making less than $50,000 a year reported they did so for the insurance. Overall income brackets are a factor here.  Sometimes people do this not because they lost a job, but because their employer's insurance changed/decided to skimp on coverage (check out this reddit story and subsequent comments: https://www.reddit.com/r/relationship_advice/comments/okjhck/married_for_insurance/) How does getting married impact access to health insurance? Marriage changes how you qualify for health insurance subsidies under the Affordable Care Act. Once you're married, your combined income determines if you are eligible for help. As a couple, you can earn a joint income of up to 400% of the federal poverty level, or $69,680, to qualify for premium subsidies. If you earn more than $69,680, you might qualify for an extended subsidy that limits your insurance cost to no more than 8.5% of your household income. The extended subsidy is in effect through 2025. Family deductibles (and out-of-pocket costs) tend to be about twice as much as those for individuals The Kaiser Family Foundation found that on average, health spending by families with large-employer health plans has increased two times faster than workers' wages over the past decade. More costs have been pushed onto employees in the form of deductibles Interestingly, in that same survey mentioned before, 69% of the couples married in 2020 for health insurance said they wished they could have stayed on separate plans! Likely because of costs. The stories of people getting married for health insurance (and love) are on the rise. Some examples:  In 2020, journalist Francesca Fontana wrote about her story of marrying her boyfriend so they could subsidize his autoimmune disease care costs (WSJ): https://www.wsj.com/articles/i-married-him-for-loveand-so-he-could-be-on-my-health-insurance-11602861266 Another story from Reddit: https://www.reddit.com/r/MomForAMinute/comments/qeesjo/gonna_marry_my_best_friend_for_health_insurance/ So your employer has control over your family's health insurance. What could go wrong? According to the Medical Expenditure Panel Survey (by AHRQ) Insurance Component survey, in 2021: 98.1% of private-sector employees worked for an employer that offers SOME dependent coverage

Everything is bigger in Texas, including medical bills and the uninsured population. The Lone Star state has the second-largest population in the country, and is among the fastest-growing as well, but all those people are stuck with THE worst healthcare system and very poor health outcomes as well. The uninsured rate is more than twice the national average. Our guest today is Sofia Sepulveda, an activist based in San Antonio, Texas, organizing for healthcare justice, environmental justice, and trans rights. She is co-chair of San Antonio's Healthcare-NOW coalition. In 2021, she was part of a successful campaign to pass legislation that expanded Medicaid for new mothers in Texas from two months to six months. She is also the co-founder of Trans Power San Antonio and sits on the board of the Transgender Education Network of Texas and the Community Advisory Board for Centro Med in San Antonio. Most importantly, she is on the board of Healthcare-NOW, the organization that hosts your favorite podcast! https://www.youtube.com/watch?v=fQjkPYi25MM Show Notes What's the Lone Star version of our crappy American healthcare system? First, they are one of only 12 states that haven't expanded Medicaid. That means that the only the neediest people qualify for Medicaid. Texas has the highest uninsured rate in the country at 18%, more than twice the national average of 8.6%. That rises to 30% uninsured among Hispanic Texans and 17% among African Americans. 11% of children in Texas are uninsured. Only 5 other states have more than 12% of their population uninsured (AK, FL, GA, MI, OK) Texas also has the largest number of residents who said they skipped healthcare they needed because of costs and fewer residents who report having a regular source of healthcare. In Texas, health insurance costs comprise a larger portion of the median income in Texas than in other states. Premium contributions were 8 percent of median income or more. Mortality rates in Texas are higher for treatable conditions, and is 74% higher among the Black population. A friend of Gillian's once said "in Texas we don't go to the doctor; we just die." Texas is ranked dead last in access to mental health care.  Why won't Texas expand Medicaid??? Around 750,000 Texans fall into the Medicaid “coverage gap” - too poor to qualify for ACA marketplace assistance, yet ineligible for Medicaid because Texas is one of only 12 states that have opted out of the expansion. In some other states, voters have bypassed elected leaders via ballot measures to adopt Medicaid Expansion. Not a thing here. Even though 64% of Texans approve of Medicaid expansion (82% of Democrats). Legislation to adopt Medicaid expansion has been introduced consistently in Texas state legislature with no success. Despite huge public support for Medicaid expansion, without support from the Governor, the bills are DOA. One bill sought to give counties or cities the right to accept the funds allocated by the CMS  Another (called the “Texas Solution”) would have set up a system where the state could receive block grants to enroll individuals in private plan using a sliding scale subsidy, rather than expanding Medicaid to cover them - this was also DOA. Structural Racism Racial health disparities exist across the US, but in Texas they are exacerbated by geography, distance, environmental factors, and a shortage of physicians.   Texas ranks last in so many healthcare measures due to structural racism. In 2021, the size of the Latinx population in Texas surpassed the white population - 40.2% of the state is Latinx, while 39.4% is white. In every states, Latinos/as are the most likely to be uninsured, and have the worst healthcare coverage, so the combination of Texas's healthcare policies, along with structural racism and a very large Latinx community, is really deadly. Much of the economy is stacked against BIPOC, especially Latinx people.

Today we're tackling Medicare Advantage, which is the option Medicare enrollees have to use a private insurance company to administer their Medicare benefits instead of the traditional public Medicare program. Almost HALF of all Medicare beneficiaries are now enrolled in Advantage plans, which represents a historic level of privatization of the almost 60-year program. Just this weekend, the New York Times published a blockbuster front-page report on everything that is wrong about Advantage plans. We'll get into all of that with our guest, Dr. Susan Rogers. Dr. Rogers spent most of her career at Stroger Hospital of Cook County (fka Cook County Hospital, the basis for blockbuster TV drama "ER") where she was a Primary Care Physician in a neighborhood clinic before becoming a hospitalist and Director of Medical Student Programs for the Department of Medicine. She is a past co-president of Health Care for All Illinois. She retired in 2014, and is now president of Physicians for a National Health Program (PNHP), a national organization of over 25,000 physicians and health professionals whose mission is to advocate for Single Payer Healthcare/Medicare for All.  https://youtu.be/oi1BUAhbx3U Show Notes Dr. Rogers tells us her advocacy for Medicare for All grew from her experience training and working at a large public safety net hospital where providers and patients made decisions about care based on need, not ability to pay. It was the best way to learn to provide care, and the best way for patients to receive care. What's the difference between Medicare and Medicare Advantage? We dig into Medicare Advantage (aka Medicare Part C) plans, and how they differ from the traditional public Medicare program. Traditional Medicare is funded by payroll taxes. Hospital coverage (Part A) is free for eligible people. There are no networks. It's a fee-for-service plan, so providers are paid for each service they provide that's medically necessary. The narrative began in the 1980's that fee-for-service was responsible for "overuse" of healthcare services. (To paraphrase Minnesota single payer hero Senator John Marty: as if people go get an extra colonoscopy just because it's paid for.) The solution was to put private insurance between the doctor and patient to prevent overuse. Medicare Advantage evolved from the introduction of private insurance into the Medicare system, resulting in every insurance company in America skimming massive profits off the top of a taxpayer funded federal program, while providing no actual care. Medicare Advantage plans are required to cover all medically necessary care, but the definition of medically necessary is defined by the insurance company based on cost, not by the physician based on medical expertise. Medicare Advantage replaces the doctor/patient relationship with someone in an insurance company office - potentially with no healthcare training - deciding what's medically necessary. Gillian shares some stories from Healthcare-NOW members who have been enrolled in Medicare Advantage plans. Common themes were delays in care, denial of coverage, limited networks, and limited pharmaceutical formularies. These features (not bugs) of Medicare Advantage can lead to serious, even deadly deterioration of a patient's health. We also heard stories of patients in need of specialty care for conditions like cancer, but few of the large academic centers or cancer institutes accept Medicare Advantage plans. The overhead cost to run traditional Medicare is about 2%. That means approximately 98% of the money in the traditional Medicare pot goes to providing care to enrollees. By law, Medicare Advantage plans only have to spend 85% of their pot on patient care, and they can keep the other 15% (this is how they afford huge executive salaries, among other "overhead.") They make that 15% slice of the pie more profitable by delaying and denying care as well as by fraudulently overc...

In this episode, we unpack Amazon's efforts to “disrupt U.S. healthcare” (apologies for the new age business lingo!). And after their spectacular failure to disrupt anything, we talk about Amazon's pivot from “disrupting” the healthcare industry to joining it. About a month ago, Amazon purchased One Medical, an in-person and virtual subscription-based healthcare service (the so-called “Netflix of healthcare”). What does Amazon's move into the healthcare industry mean for patients, and how could it impact the social movement for Medicare for All? Are we moving toward a future where you have to ask Alexa to take a look at that potentially cancerous mole on your ass? https://youtu.be/YdrQywbwjU8 Show Notes Amazon has been trying to break into the healthcare industry for some time now. What exactly are they trying to do and how successful have they been? In 2018, Amazon forms Haven with JP Morgan and Berkshire Hathaway, claiming they will “disrupt” healthcare industry by lowering costs and improving outcomes. Had completely insufficient market power or leverage to do that effectively. So then in 2019 Amazon launches Amazon Care, a “concierge care” service for its employees, quickly expanding to other employers (like Whole Foods and Hilton) who could offer Amazon Care as part of their own business's employee benefits package, and then eventually to the general public. (This is a common strategy at Amazon – they created Amazon Web Services to satisfy their own customer service needs then started selling it to other companies and now it's one of their most valuable assets.) It was abruptly shut down in late August 2022 after the One Medical merger.Most recently in July 2022, Amazon buys One Medical in an all-cash deal worth 3.9 billion One Medical has had its own problems that sound eerily familiar to the issues doctors had with Amazon Care – a model that once again stresses profits over healthcare.Basically doing with healthcare what they did with groceries by buying out Whole Foods - when Amazon Fresh wasn't catching on they simply bought out one of their biggest competitorsYou could sort of call One Medical the Whole Foods of health care rather than the “Netflix…” mostly rich people use it. Why would Amazon WANT to move into the healthcare industry, where they have zero experience? Money and hubris of course! This is the only industry in the US that always growing and seems to be recession-proof, and Amazon really believes they are capable of doing anything, even when they are batting 0-for-2 in their healthcare projects. Study in White Male Privilege! Amazon's business model emphasizes speed, convenience, and efficiency for the consumer above all else, and they seem intent to carry this forward into their healthcare ventures. What are the potential problems of applying this approach to healthcare? How is it going to affect patients? Amazon Care is a good first case study:Even before it was shut down, there was some whistleblowing going on behind the scenes as medical staff complained that the company's practices were putting profits over patients: From an August 2022 Washington Post Article: “While planning to expand Amazon Care beyond Seattle, Amazon managers wanted to avoid building a physical hub. Instead, they asked if nurses could store and dispose of medical supplies at home and stabilize patient blood samples using centrifuges in their personal cars, the two former nurses said. They said the staffers protested the ask.One Medical seems to be a perfect fit for the Amazon model, even before they were bought out:In 2021 Congress convened a special subcommittee to investigate companies like One Medical for using the pandemic to increase their revenue. In the final report, Rep James Clyburn said “Troublingly but unsurprisingly, in the chaos and confusion of the Trump Administration's mismanaged early vaccine rollout, self-interested vaccine providers like One Medical and its executives sought t...

Any regular listeners of the podcast won't be surprised to hear that Gen Xers and Millennials are going into debt for healthcare… but what if we told you that this time it's for their pets! More Americans are spending more money on healthcare for their beloved pets, which means insurance companies are getting in on the action and cashing in! Today we'll be digging into the wild world of pet insurance and what Peticare for All could mean for our four-legged friends (and zero-legged friends, and more than 4)! https://youtu.be/HGzTtPLrwWk Show Notes Why talk about pet healthcare? MOSTLY so Gillian and Ben can show off Coretta Scott Cat and Koda the Medicare for All dog. Obligatory cute pet appearances out of the way, Gillian introduces our guest for this episode: Chris Dupuis, DVM is a vet and owner of the Wheatland Animal Hospital in Neighborville Illinois. Chris definitely saw an uptick in pet ownership during the pandemic. Today, about 70% of US households own at least 1 pet, and Americans are paying a total of $32.3 billion on vet care. Gillian went down a research rabbit hole, and found that as of 2020 nearly half (47%) of pet owners had gone into debt for their pet, up from 36% in 2019. This average covers a huge generational divide, though: 66% of Gen X'ers have gone into debt for their pets, while only 23% of Baby Boomers have done so. Chris notes that one reason could be that veterinary costs have gone up a lot over the last generation, much like College tuition. Chris's dad, who founded the clinic, originally charged $8 for an exam in the late 1980s! For human health, of course most of us turn to health insurance to protect ourselves from large unexpected costs that might leave us in debt. What about pet insurance? Chris explains that pet insurance is very different: pet insurers directly reimburse pet owners for their (allowed) expenses, so vets generally don't get paid directly by insurance companies or have to deal with them at all. In Chris's experience, many of his clients buy pet insurance policies without realizing how little it actually covers, or the restrictions involved (a lot like Medicare Advantage plans!). So how bad is pet insurance? Virtually no plans will cover pre-existing conditions (which was common in human insurance plans until it was banned by the Affordable Care Act), including breeds that are frequently prone to certain health problems. There is very little regulation of pet insurance, so exclusions, deductibles, and payment limits are rampant. Both premiums and deductibles are often decided by the species, breed, gender, age and location of an animal - older pets in particular are very expensive and difficult to insure. Because of this, very few people have pet insurance: only 3.5 million (less than 2%) of pets in America were insured in 2020. Chris says that vets themselves are often not very educated on pet insurance options for their clients, in part because there are so many plans and the plan limitations are so complex. As important background, Chris explains that vets are generally underpaid (combined with massive college debts), and vet techs are EXTREMELY underpaid - sometimes earning barely more than retail workers ($15-$21/hour). This puts vet clinics in a difficult position when they have clients who can't afford to pay for urgent or emergency care for their pets. Unlike human hospitals, which receive some "uncompensated care" funds from the federal government for treating patients who can't pay, vet clinics and hospitals receive no such funds for providing free or charity care, and have very small margins. Both vets and vet techs have much higher than average suicide rates because of this stress, and there is extremely high turnover of vet techs. Chris confirms what many of us have experienced, though: there are wild variations in the costs charged by vet clinics for the same care. Chris believes the high outlier costs are in part due...

Today we're checking in on the ongoing Pennsylvania Senate race, where Medicare for All–along with crudites, poop tweets, hydroxychloroquine, and Turkish nationalism–has become a hot-button issue. This race is beyond interesting, shading into the bizarre! A lot is at stake, since control over the Senate is going to be hotly contested this midterm election, and this is the most likely seat to flip from Republican to Democrat. https://youtu.be/nRyxrm0I95c Show Notes The Democratic candidate Lieutenant Gov. John Fetterman is running against none other than Dr. Mehmet Oz, the instantly recognizable daytime talkshow host from Oprah and the Dr. Oz Show. Oz is the Trump-endorsed candidate for the GOP, and he's been producing attack ads going after Fetterman's alleged support for “socialized medicine,” but when we dug deep into Oz's own healthcare plan, we came to some verrrrry interesting and uncomfortable conclusions! The U.S. Senate is currently split exactly 50-50, with Democrats having the tie-breaking vote of Vice President Kamala Harris. This has ruined just about everything, since it let Joe Manchin and Kyrsten Sinema hold the country hostage. So any contested Senate seat is a potential big deal right now. Initially, the race was seen as something of a toss-up. BUT THEN, in a surprise move, Donald Trump endorsed Dr. Oz in the Republican primary, giving him the oomph to beat hedge fund exec Dave McCormick. (Surprising because  McCormick's campaign had many former Trump aides, including Hope Hicks.) As of this podcast, every single poll shows Fetterman with a sizable lead in the race, a lead that keeps growing: anywhere between 5% and 18%. So the stakes are high in this race, but we also care because these two candidates have been going after each other's healthcare platforms… which after taking a very close look, are actually not that far apart. The Dr. Oz Show provides general health and lifestyle advice, including promoting products to support your health. BUT, his advice is very bad as it turns out: A team of medical researchers at the University of Alberta in 2014 analyzed how many of the recommendations on the Dr. Oz Show were supported by evidence: it turns out, less than half! “evidence supported 46%, contradicted 15%, and was not found for 39%” That same year (2014), Dr. Oz was called to testify before a Senate hearing looking at false and deceptive advertising for weight-loss products. When he was called out by Sen. Claire McKaskill for promoting fake weight loss cures, he candidly replied: "I actually do personally believe in the items I talk about on the show. I passionately study them. I recognize they don't have the scientific muster to present as fact but nevertheless I would give my audience the advice I give my family all the time and I have given my family these products. Specifically the ones you mentioned, then I'm comfortable with that part.” In addition to diet pills, he's promoted a lot of wild shit over the years: the idea that there are deadly levels of Arsenic in apple juice, the claim that most olive oil is fake, the concept of “Reparative Therapy” (to "repair" LGBTQ+ people). Dr. Oz has reportedly been eyeballing a political career since as far back as 2009. Dr. Oz first jumped into politics when he became enmeshed with the Trump campaign, and then the Trump administration. His greatest contribution, as far as we can tell, is that he played a major role pushing the Trump administration to grant emergency use authorization for hydroxychloroquine, the fake and dangerous treatment for COVID. And, very unfortunately, he was successful! The FDA granted a controversial emergency use authorization for hydroxychloroquine. Just 3 months later, the FDA was forced to reverse its authorization decision, after multiple studies showed the drug was ineffective and potentially harmful to COVID patients. The Trump administration still mounted a campaign to get hyd...

Ben discusses the “Inflation Reduction Act,” which was signed into law by President Biden this past week! In last-minute negotiations between Senators Chuck Schumer and Joe Manchin, the Senate finally - after comical failures over and over this past year - passed a VERY scaled-down version of the Build Back Better bill. The “IRA” bill - clearly they intensively focus-grouped that title - is overwhelmingly a package of environmental policies, but does include some healthcare provisions for Medicare recipients. Joining us today, in a throwback-Monday episode, is Stephanie Nakajima, the Executive Director of Mass-Care: the Massachusetts Campaign for Single Payer Healthcare. https://youtu.be/IMUYN2p_Ymg Show Notes With Gillian on vacation, Stephanie rejoins to co-host this pod! Stephanie is currently the ED of Mass-Care, the Massachusetts Medicare for All organization, and through a massive grassroots effort they recently put M4A questions on the ballot in TWENTY state representative districts. The questions are non-binding, but powerful tools for convincing elected officials to support Medicare for All, if they don't already. As any show on the Inflation Reduction Act should, we begin by ridiculing the title of the bill, which has nothing to do with inflation, as well as the "IRA" acronym, which apparently no one thought about?!? Ben takes a sad walk down memory lane to recap the social provisions that HAD been included in the previous version of this legislation: the Build Back Better bill: A child tax credit up to $300 per child; child care subsidies; and free universal preschool - all out of the IRA;Paid family leave of up to 4 weeks - out;Tripling the earned income tax credit for low-income workers - out;Much of this was paid for by new taxes on the wealthy, and on big businesses Stephanie talks about the four things the Medicare for All movement pushed for to be included in Build Back Better: Let Medicare negotiate prescription drug costs, which should save billions of dollars and help pay for expanding Medicare in several ways, including;Lowering the eligibility age of Medicare to 60, or as low as we can get it;Giving traditional (public) Medicare enrollees an out-of-pocket cap, like most private insurance has; and finallyAdding dental, vision, and hearing benefits to Medicare. We had success in each of these categories except lowering the age of Medicare under BBB, but did any of this survive under the Inflation Reduction Act? Some! Here are the healthcare provisions included in the IRA: DOES allow Medicare to negotiate the prices of some prescription drugs - it starts with just 10 drugs in 2025, then increases to 20 drugs in 2029. (Medicare covers over 3,500 drugs - so less than a half of 1% of drugs will be negotiated!)We did NOT win a general out-of-pocket spending cap for Medicare recipients, but we DID win a couple of more specific caps.The bill creates an OOP prescription drug cap of $2,000 for Medicare recipients starting in 2025.The bill also caps insulin spending at $35/mo. Dems tried to extend this insulin spending cap not just to Medicare recipients, but to everyone in the country, but the Senate parliamentarian said they can't do that through a reconciliation bill (limited to federal spending and income items).Finally, although this wasn't one of our priorities in the M4A movement, the ACA subsidies that were expanded by the COVID relief bill, but were scheduled to expire at the end of this year, have been extended three more years. We had won some dental, vision, and hearing benefits under the original BBB bill, but all of that was taken out, so there is no expansion of Medicare benefits under the IRA, unfortunately! What's our overall assessment of the IRA? Stephanie says the climate provisions are enough to justify the existence of this bill. Yet it's such a missed opportunity for Dems to shore up support on one of the issues that consistently ranks amo...

Noted public health expert Lizzo teaches us that “thick thighs save lives,” but for many of us, being fat is killing us – and not for the reasons you might expect. Today we're talking about our healthcare system's impact on fat folks AND how misconceptions about fat folks impact our healthcare policy! Recent studies have shown us two things: A) that weight isn't the major driver of health that the medical industry has believed it was for a very long time, and B) that treating weight like the end-all-be-all of health actually causes fat folks to avoid seeking care, which leads to some pretty terrible health outcomes. Our guest Jordan Berg Powers, the Executive Director of Mass Alliance, has helped elect new progressive leaders across the state, recruited progressive champions to run for political office, and trained hundreds of grassroots organizers. Jordan is active in campaigns for saving public education, as well as promoting medicare for all and a more progressive tax system for the Commonwealth. https://www.youtube.com/watch?v=YzWkJidRSzw https://www.youtube.com/watch?v=KWBzyG4LLOw&ab_channel=HealthcareNOW Noted public health expert Lizzo teaches us that "thick thighs save lives." Show Notes Language note: we're saying fat and not “fluffy,” “curvy,” or “obese.” Fat is just a way of describing people –  like short or tall or red-haired. It may have negative connotations in our culture right now, but a lot of fat folks are working on reclaiming fat as a neutral term. We shouldn't need euphemisms like “fluffy” to describe what we look like. Obesity is the idea that fatness itself is a disease, which we're going to be pushing back on throughout this episode! Jordan and Gillian share their stories about they way society draws conclusions about fat people, including about their intelligence, their cleanliness, and their health. Both have experienced medical appointments where the first thing the doctor said was "have you considered losing weight" no matter the health concern that brought them in. Gillian shares another health concern that took eight years to address because doctors repeatedly blamed her weight for it. Instead of protesting, she accepted what they said, and believed that her pain was her fault and she didn't deserve to feel better until she lost weight. Jordan explains how the fatphobia he's experienced has been combined with racism. One of those doctors who told him to lose weight said it would be easier if he "stopped eating fried food" like fried chicken, even though he's a vegetarian who rarely eats fried food. Why is anti-fat bias in healthcare a problem? When it comes to healthcare, how the least of us is treated, ends up being how the rest of us are treated. Many women report their pain hasn't been believed. Many Black people avoid doctors because they've experienced racism in the healthcare system. Many fat people also avoid doctors after being blamed for their own health problems due to their weight. Their actual health concerns often go untreated, often leading to worse outcomes. The vast majority of Americans (73.6%) are considered overweight, so this isn't an insignificant problem. The most frustrating part of this approach to medical care is that science doesn't back it up. Lowering weight isn't a magic bullet. Even if it were, it has become clear to scientists that most people are not capable of losing weight permanently. Body size is largely predetermined by genetics. So it doesn't make much sense when we go to the doctor and the only treatment plan we get is “lose weight,” because for most of us, reducing our body size in a sustainable way isn't possible.  One of the most prevalent standards in healthcare, which determines much of the way a patient's care is planned, is the Body Mass Index (BMI). It simply tells the person's weight divided by their height, and categorizes them as either underweight, normal weight, or overweight.

In spring of 2007, Michael Moore released a blockbuster documentary showing the extraordinary damage the U.S. healthcare system inflicts upon ordinary Americans. Story by story, SiCKO pulled back the veil of how ordinary illness and injury, when paired with deadly healthcare profiteering, leads to suffering, financial ruin, and even death. 15 years later, together with our friends at Progressive Democrats of America, we are bringing together the patients featured in SiCKO, whose extraordinary stories impacted Congress, shaped the Affordable Care Act, and helped to launch the modern Medicare for All movement. https://www.youtube.com/watch?v=vqRCZhx_280 Show Notes Our guests today are: Donna Smith and husband Larry experienced financial ruin after multiple health crises forced them into medical debt, bankruptcy, and the loss of their home.Adrian (Campbell) Montgomery, despite being fully insured, had to drive to Canada to get affordable treatment for cervical cancer. Reggie Cervantes was a 9/11 first responder who has suffered from lung issues caused by her lifesaving work in New York City.Lee Einer was a health insurance company “hit man,” whose role was to find any loophole to avoid paying large medical bills. Since then he's become a whistleblower, shining a light on fraud and dirty tricks by the healthcare industry. SiCKO was released just in time to have a major impact on the 2008 Presidential elections, and - I think - really helped push healthcare to the top of the agenda within the Democratic Party, which won the Presidency, the House, and the Senate. This led to the Affordable Care Act, which although it preserved the profits of the healthcare industry and was FAR short of a just or affordable system, addressed exactly some of the health insurance industry's most disgusting practices that were featured in the film. Aside from the ACA, the film was also a major event in the Medicare for All social movement, which grew tremendously across the country. Gillian shares how the film convinced her that her struggles with the healthcare system wasn't just a personal problem, but a systemic problem for the whole nation. That launched her into healthcare justice organizing. Thanks in large part to SiCKO pulling back the curtain on the worst behaviors of the insurance industry, a number of those practices were banned by the Affordable Care Act, including: Denying coverage to people with pre-existing conditions;Recissions (retroactively canceling your insurance coverage); andLifetime caps or annual caps on coverage. Has anything changed for our guests? Donna shares that without the ACA she would never have been insurable, and her health forced her to leave the job that provided her with employer insurance. The expansion of Medicaid was also a huge step for people without insurance. But since then, we've seen the insurance companies make even more money, and we're facing more attacks, including the efforts to privatize Medicare. The biggest change for Donna is that she has aged into Medicare, and now knows the security of having coverage. With her previous cancer diagnoses, Adrian acknowledges that due to the ACA ban on denying coverage to patients with pre-existing conditions, she's insurable, but not much else has changed. Her insurance company vetoed her doctor's plan of care for her third bout with cancer, and made her go through a different surgery before they'd cover the hysterectomy her doctor determined she needed. She almost died during that surgery, and after all of that, it wasn't successful. Reggie also recently became eligible for Medicare, but dealing with the managed care system is still a nightmare. It took her 9 months to get approval for the care needed for uterine cancer because the insurance company disagreed with her oncologist's plan. She moved from Oklahoma because she didn't have access to specialists that she does have now in California.

https://www.youtube.com/watch?v=Bd21JObzQeI Show Notes Today we venture into the bizarro world of Medicare (the program serving those 65 and older as well as some people with disabilities) to explore the largest Medicare rate hike in history. Our guest Alex Lawson, the Executive Director of Social Security Works, will help explain what's happening. Social Security Works is the convening member of the Strengthen Social Security Coalition, which represents over 50 million Americans. SSW fights to protect and expand Social Security, Medicare, Medicaid, and to lower prescription drug prices. Today we venture into the bizarro world of Medicare (the program serving those 65 and older as well as some people with disabilities) to explore the largest Medicare rate hike in history. Our guest Alex Lawson, the Executive Director of Social Security Works, will help explain what's happening. Social Security Works is the convening member of the Strengthen Social Security Coalition, which represents over 50 million Americans. SSW fights to protect and expand Social Security, Medicare, Medicaid, and to lower prescription drug prices. Today we're talking about the massive increases in Medicare Part B (physician and outpatient services) premiums for this year. Hospital care is called Part A, and once you're eligible for Medicare you can get hospital coverage automatically. BUT for Part B, you have to pay a monthly premium - just like a private health insurance plan. There's a super shady history behind this!  The origins of the Part B premium go back to the Jim Crow era. When Medicare was first implemented, some in the South feared that Federal law would require the integration of physician offices. By requiring a premium, Part B would be a "voluntary" program and integration requirements wouldn't apply. This allowed physician offices (as well as nursing homes) to remain segregated much longer than hospitals. In 2022 Medicare Part B premium rose 14.5%, from $148.50 to $170.10 PER MONTH ($21+ increase), and the annual deductible rose from $203 to $233. For perspective, the Part B premium was less than $50 back in 2000, and there was only a $3.90 increase last year. This is the LARGEST premium price hike in Medicare history. For most American seniors, those premiums are deducted right out of their Social Security checks. For an American senior who depends on Social Security benefits of an average of $19,000 a year, those increases mean a significant cut to their income. A senior living on an income 175% of the poverty level will spend nearly 9% of his/her income this year on Part B alone. This comes down to Biogen's new Alzheimer's drug, Aduhelm. Regardless of the fact that this drug failed, Biogen put all their eggs in the Aduhelm basket. They corrupted the Food and Drug Administration (FDA) to get it approved, despite the fact there is no evidence it is effective and it can actually cause brain bleeds and death. Aduhelm is so expensive that it accounts for at least 50% of the Part B premium increase.   The drug itself initially cost $56,000(!) for one person; the price was slashed in half by Biogen because of low demand. The other costs associated with the treatment are charges for the infusion of the drug and charges for the regular brain scans that are required while taking the drug. Those brain scans are to monitor progress of the treatment, but also to make sure your brain isn't swelling up, which is a side effect 35% of clinical trial participants experienced. It's estimated that only a small fraction of Medicare beneficiaries will use this drug, which, remember, doesn't work. But to make more profits for Biogen, American seniors' premiums went up more than they ever have.   Right off the bat, the Veterans Administration declined to cover Aduhelm. Many private insurers are also limiting approval of Aduhelm. CMS - the Center for Medicare and Medicaid Services - usually follows the lead o...

Today we look at the somehow-legal world of healthcare sharing ministries, a form of health coverage where like-minded religious folks share health care costs. After a series of lawsuits and scandals, these companies are in the news again recently. We'll look at what HCSMs are, how they have flourished as insurance costs rise, and the potential risks they pose to the unsuspecting consumer. Then we'll turn the page to talk about how communities of faith are playing a key role in winning a just and equitable healthcare system. Today we look at the somehow-legal world of healthcare sharing ministries, a form of health coverage where like-minded religious folks share health care costs. After a series of lawsuits and scandals, these companies are in the news again recently. We'll look at what HCSMs are, how they have flourished as insurance costs rise, and the potential risks they pose to the unsuspecting consumer. Then we'll turn the page to talk about how communities of faith are playing a key role in winning a just and equitable healthcare system. Our guest today is the Reverend Jim Rigby. Rev. Rigby has been the pastor at St. Andrew's Presbyterian Church in Austin Texas for over 25 years. He has a love of world religions and a passion for social justice. Healthcare justice has been a part of his ministry because he believes that healthcare is the most basic right to life, along with a living wage and decent housing. https://www.youtube.com/watch?v=GeRIN9nF-to Show Notes What are Health Care Sharing Ministries? Ben explains that healthcare sharing ministries (HCSMs) are a form of health coverage in which members, who share religious beliefs, make monthly payments to cover the healthcare costs of other members. BUT they are not insurance. Insurance is supposed to cover most of your healthcare services, with cost-sharing by the patient. HCSM are much cheaper than insurance, which is why they're so alluring. But they cover much less, and only pay for a fixed amount of a service, regardless of the total cost. HCSMs, unlike insurance companies, don't take on any risk. The ministries are typically Christian. Members generally must declare their religious faith and promise not to smoke, drink alcohol excessively, or engage in extramarital sexual activity. Generally, they also do not cover abortion, mental health services, or birth control. Unlike insurance, HCSMs can deny coverage for people with pre-existing conditions. The ACA used to fine people for not having insurnace, but HCSMs were exempted from that fine even though they do not meet the federal definition of insurance. (That fine was eliminated under the Trump administration, and the Biden administration hasn't reinstated it.) HCSMs have been around since the 80s, but grew in popularity during the 90s and again after the passage of Obamacare – basically whenever we see concerted efforts to make the government responsible for more healthcare costs. “About 1.5 million Americans are members of these kinds of ministries, according to the Alliance of Health Care Sharing. Some $2 billion in medical expenses were shared through this type of ministry in 2020.  There are over 100 health sharing organizations certified by the U.S. Department of Health and Human Services for meeting the federal law's definition of a health sharing ministry.” – Reported in Catholic World Report in May 2022. Unregulated HCSMs leave people behind and contradict the religious values they claim to be based on Health insurance companies aren't well-regulated in the United States, but they still have to operate under some basic regulations. Gillian explains that there are virtually no regulations on HCSMs. As a result their practices can be exploitative. Thirty states actually have “safe harbor” rules that exempt HCSMs from the restrictions on insurance companies. In “safe harbor” states, as long as members receive a written disclaimer from the HCSM...

There's some adult language in this episode, so might not be appropriate for our youngest M4A advocates. The recent leak of what is likely to be the Supreme Court's decision to overturn Roe v. Wade has us enraged about the future of abortion and healthcare in America. Spoiler: We aren't loving the fact that five fucking reactionary clowns can take away the bodily autonomy of half the population of the US. Today, we're making the case for why abortion access and - more broadly, reproductive justice - must be part of the Medicare for all movement.  Our guest is Stephanie Nakajima, Executive Director of Mass-Care: the Massachusetts Campaign for Single-Payer Healthcare. (But most importantly: former Director of Communications for Healthcare-NOW and former co-host of the Medicare for All podcast!) Show Notes Thanks to the Hyde Amendment (passed in 1976), federal funds (like Medicaid or insurance plans for federal/state employees) cannot be used to pay for a person's abortion, unless that person became pregnant through rape, incest, or their life is in danger. This was a direct response to the original Roe v. Wade decision It has been reenacted every year since, likely because legislators feel like it's too much of a hot button issue to mess with (i.e., we should just be happy for the access that is available and try not to push it further) This isn't the case in most developed countries. For example, Ireland and Italy, which are famous for their devout Catholic populaces, even allow for publicly funded abortions.  About 87% of employer-sponsored insurance plans cover medical and surgical abortion services. However: That means only people who have private insurance have access to these services, unless you live in one of the 17 states that fund abortions through state healthcare 10 states in the US don't even allow private insurance to cover abortion (Missouri, Nebraska, Kansas, Oklahoma, North Dakota, Idaho, Utah, Indiana, Kentucky, Michigan) Stephanie has been the leading voice uplifting the importance of reproductive health in the single payer movement. Reproductive care, like most healthcare, is often out of reach for people who are uninsured or underinsured. In addition to the barriers to get an abortion (like protestors, 24 hour waiting periods, mandatory ultrasounds) the cost of the procedure. If you are poor and/or your healthcare plan is funded by the government, you are paying out of pocket for these services (the average cost of 1st trimester abortion in a non-hospital setting in the US is $508, costs increase into the thousands in later trimesters.) When we talk about "choice" we're talking about whether a person has a legal right to an abortion or will they be forced to give birth. By reframing the narrative around reproductive freedom, we broaden the conversation to include abortion rights as well as access to affordable or publicly-funded reproductive care, the right to have children, and access to services to raise and care for children like healthcare, childcare, a living wage, and paid family leave. Shifting to a Medicare for All system would have profound impacts on access to reproductive care - for better or potentially for worse - the M4A movement has NOT always had a great track record in supporting reproductive care. Many in the movement feel it's a separate issue that we should leave alone for fear of it taking down the chances of M4A. But if we don't fight for inclusion of this extremely common healthcare procedure in a M4A system, we are erasing the healthcare needs of a wide swath of the population. In 2016, Colorado's single-payer ballot initiative - Amendment 69 overlooked abortion access, which led to opposition from NARAL ProChoice Colorado and Planned Parenthood of the Rocky Mountains, which provided cover for most of the Democratic Party in the state to also oppose the ballot initiative. In large part to the catastrophic impact their single payer b...