Medicare for All

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.

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.

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.

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 ...

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. 

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?

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,

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 hea...

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.

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 rac...

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 c...

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.

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.

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,