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In a world of unbridled self-interest or where self-interest becomes the basis for reason, where integrity is abandoned, where there exists a striking absence of and/or contempt for moral analysis, virtue and empathy and where cynicism becomes inevitable, power compromises the law and evil no longer needs to be justified. These realities, for example, help explain a projected 14+ million deaths by 2030 via US AID funding cuts, the US quitting the WHO and the Paris accord, cutting Medicaid funding by ~$1 trillion, reducing projected ACA enrollment by nearly 50%, disappearing AHRQ, crippling the CDC and dismantling the EPA. As Prof Neiman argues, “In all the words written in an attempt to understand the present crisis, what’s striking is the scarcity of moral analysis.” “Trump and his ilk could never have come to power without one belief: Moral concepts are for suckers who don’t know they’re being conned.” Professor Susan Neiman bios are at: https://www.susan-neiman.com/ and at: https://en.wikipedia.org/wiki/Susan_Neiman. Info on “Call It Evil” is at: https://wwnorton.com/books/9781324131045. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

On July 30 Senate Finance Committee Democrats issued an 86-page Request for Information (RFI) titled, “Health Coverage That Works for Everyone.” As Ranking Democratic Member Ron Wyden explained, much like the Finance Committee’s 2008 white papers that laid the groundwork for the ACA, this RFI constitutes an essential blueprint for necessary and immediate federal healthcare reform. Surprisingly - or not, beyond a limited number of trade publications and policy shops the RFI has to date been ignored. The authors 167-page paper make essentially two arguments: while the Ds diagnosis is correct in that part of the problem is how commercial insurers (termed “Big Insurance”) make money (and how much), nearly half of the RFI’s 71 propose reforms will likely cause payers to move money to unregulated subsidiaries or affiliates instead of saving it or applying the savings to actual care spending; and, by ignoring hospital prices, that substantially are responsible for both health care spending and inflation (once again think: “It’s the Prices, Stupid”), the Senate Finance Ds are ignoring over $300 billion in potential annual savings. E.g., they write, “squeeze insurer margin perfectly and the hospital price base is exactly where it was,” and “you cannot audit the pricing power of the party [hospitals] you have just cast as the injured one.” The report deserves the attention of all serious healthcare policy students. The authors’ work, published as INET working paper, is at: Alvelda-Ferguson-Wyden-RFI-Critique-Brainworks-INET-final.pdf. INET is at: https://www.ineteconomics.org/. Professor Ferguson’s bio is at: https://www.ineteconomics.org/research/experts/tferguson. Dr. Alvelda’s bio is at: https://www.ineteconomics.org/research/experts/pAlvelda and at: https://brainworks.ai/about-us/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Beginning in the 1970s and 1980s (think, e.g., Hayek, Friedman, Reagan, Stockman and Clinton), US policymakers decided healthcare should be defined like any other commercial or market commodity. It’s not, think: Ken Arrow. Therefore, national policymakers under the mantra of the financialization of everything or privatization included healthcare (think: Medicare Advantage); largely per Robert Bork’s book, “The Anti-Trust Paradox” policymakers freed healthcare of anti trust enforcement and increasingly deregulated healthcare (think: the employer-sponsored insurance (EIS) system). Today, US healthcare is arguably the largest industry in the world’s largest economy, with a ~$7.5 trillion market cap, and is highly concentrated. As Prof McDonough cites, “America’s health care crisis is,” per Phil Longman, “brought to you by monopoly.” Think: UNH that controls approximately 2,700 global subsidiaries and affiliates. We know the results. In his introduction Professor McDonough appropriately cites Maya Angelou’s observation, “if you don’t know where you’ve come from, you don’t know where you are going.” Possibly more optimistic, James Baldwin phrased the idea as, “If you know whence you came, there is really no limit to where you can go." One can hope. Information regarding “America’s Wrong Turn” is at: https://www.press.jhu.edu/books/title/53872/americas-wrong-turn?srsltid=AfmBOoqNV4mGGs9z2P9ym233e-Bsp4EBV3SAAvJKYm2RTAKtcuAk1afm. Prof McDonough’s Harvard Chan School of Public Health website page is at: https://hsph.harvard.edu/profile/john-e-mcdonough/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

With the Congress adjourned for summer recess and the mid-terms now 83 days away, August is a good time to discuss substantive or systematic HC reform. Listeners, and/or anyone paying attention to mid-term campaigns and primaries (think: Dr. Abdul El-Sayed) are well aware healthcare is again on life-support largely due to increasing unaffordability and political acquiescence. In “Beyond Medicare for All,” Mr. Terry essentially argues healthcare can be achieved without dismantling private insurance or expanding single-payer government health delivery by creating a bifurcated or two-tiered delivery and financing model that would be led in part by independent primary care physicians. Information about Ken Terry’s is at: https://kevinmd.com/post-author/ken-terry Information about “Beyond Medicare for All” is at: https://physicianledreform.com/ . This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

As everyone is well aware, healthcare, particularly acute care (think: hospitals) has become increasingly more unaffordable. For the four-year period ending next year ERISA or employer-sponsored health insurance plans will increase employee premiums by ~25%; this year the average employee family premium is ~$27,000; by the end of this year six million are expected to lose ACA coverage; and, to really on one’s surprise a recent survey found less half of Americans, regardless of income, believe they have the ability to pay for needed medical visits. The answer seems to be legislating hospital price transparency. Earlier this month both the House Energy and Commerce and the Senate Health, Education Labor and Pensions (HELP) committees passed price T bills out of committee. Regarding the Senate effort, HELP Committee Chair, Dr. Bill Cassidy, stated, “I'm very optimistic that it will pass . . . and I'm confident that it will." Information on Turquoise Health is at: https://turquoise.health/patients. Testimony presented during the June 10 House E&C hearing noted during this interview is at: https://democrats-energycommerce.house.gov/committee-activity/hearings/hearing-lowering-health-care-costs-all-americans-examining-policies. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

In May 2024, Vermont enacted entirely unprecedented legislation that attempts to mitigate climate-charged disaster events and associated financial fallout inflicted on Vermont residents. Vermont climate superfund legislation, followed seven months later by New York (and presently pursued by at least ten other states), is in response to climate-charged disaster events that over the ten- yr period ending in ’25 cost Vermonters upwards of ~$2 billion. The legislation, premised on a deeply entrenched polluter pay principle, e.g., modeled after the federal toxic waste Superfund program, requires so called carbon majors, here oil and gas companies, to meet their unpaid, externalized costs by making compensatory payments. New York law is targeting a $75 billion fund. These dedicated funds will generally finance climate adaptation and infrastructure resiliency. Not surprisingly, these laws face of aggressive legal challenges by among others the American Petroleum Institute, the U.S. Chamber of Commerce, West Virginia-led state attorneys general and the Trump administration that has filed federal lawsuits against both VT and NY. Among numerous related interviews, listeners will recall I discussed advances in attribution science with Stanford’s Chris Callahan in May 2025. Information re: Vermont’s Climate Superfund Act is at: https://climatechange.vermont.gov/climate-superfund. Information re: Vermont’s Conservation Law Foundation is at: https://www.clf.org/serving-new-england/vermont/. (Apologies to Ms. Mihaly, at one point I call her Emily!?!) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

During this podcast I read part two of a draft, yet-to-be-published essay titled, “Institutional Betrayal: HHS and the National Academy of Medicine’s Failure to Decarbonize the US healthcare Industry.” That the window formally closed in January 2025 means healthcare will not approach reducing its greenhouse gas emissions by 50% in 2030. HHS will continue to intentionally fund the industry’s harm-treat-harm business model meaning healthcare is by design traumatic. Iatrogenesis is built-in. Americans will become increasingly consumed by, not consumers of, healthcare. Comments are of course welcomed. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

During this podcast I read part one of a draft, yet-to-be-published essay titled, “Institutional Betrayal: HHS and the National Academy of Medicine’s Failure to Decarbonize the US healthcare Industry.” That the window formally closed in January 2025 means healthcare will not approach reducing its greenhouse gas emissions by 50% in 2030. HHS will continue to intentionally fund the industry’s harm-treat-harm business model meaning healthcare is by design traumatic. Iatrogenesis is built-in. Americans will become increasingly consumed by, not consumers of, healthcare. Comments are of course welcomed. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

This is the first of a two-part reading of a yet-to-be-published essay presently titled, “Institutional Failure: HHS and the National Academy of Medicine’s Failure to Decarbonize Healthcare.” Comments are of course welcomed. Thank you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Unlike most rich countries or advanced economies the US does not define healthcare, including long term care, as a universal social risk – despite the fact we all get sick, no one knows their health status tomorrow, approximately 85% of Medicare beneficiaries have at least one chronic condition and life expectancy at birth is approximately 79 years. Medicare does not provide long term care, Social Security replaces just 43% of the average workers’ wages and only approximately 40% of retirees receive income from some form of employer or personal retirement plan. With me to discuss Prof. Ghilarducci’s book is her colleague Ms. Jessica Forden an economics Ph.D. candidate at the New School’s Schwartz Center for Economic Policy Analysis. Information on Prof. Teresa Ghilarducci’s book is at: https://press.uchicago.edu/ucp/books/book/chicago/W/bo212888995.html. The New School’s Schwartz Center for Economic Policy (SCEPA) research publications are at: https://www.economicpolicyresearch.org/research. Jessica Forden’s LinkedIn page is at: https://www.linkedin.com/in/jessica-forden-88b265131/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

To state the obvious nutrition is considered the cornerstone of public health, a, if not the, primary preventative measure against chronic disease. Nevertheless, the OBBBA cut SNAP funding by an estimated $187 billion; since the start of the pandemic food prices have increased by roughly 30%; and, going forward are at risk due to uncertain trade policy, global shocks including the ongoing war in Iran, water supply/access and widespread drought and other climate-related issues include the looming super El Nino event that is expected to disrupt planting cycles worldwide and breach thermal safety margins - causing most major crops to suffer further yield declines. Add to all this the questionable science behind the MAHA movement. Friedman School of Nutrition Science and Policy information is at: https://nutrition.tufts.edu/ Prof Masters’ bio is at: https://as.tufts.edu/economics/people/faculty/william-masters This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Not surprisingly healthcare affordability has risen to the top or #1 mid-term election campaign issue. Largely due to pricing failure, that costs Americans about $250 billion annually, pricing power is the consequence of an increasingly concentrated healthcare market. Think: Herfindahl-Hirschman Index scores. Hospital pricing/prices are particularly noteworthy or moreover surgical procedures and patented drugs that have risen at multiples of the annual inflation. This means those insured pay increasingly higher coverage (premiums, deductibles, copays) and are forced into medical debt or bankruptcy, forced to avoid necessary care and/or make financial trade offs. Insurance plans, here we’re discussing self-insured employee plans, that capture roughly 65% of covered workers, face similarly challenging math. For example, recently reported news found the five largest managed care plans lost $226 billion in market value over the previous 12 months. As for solutions, federal price transparency laws, though well intended, have either gone un-headed and/or lack enforcement. Mr. Robert Andrews is the CEO of the Health Transformation Alliance (HTA), a cooperative of approximately 80 large self-insured employer health plans. HTA was founded in 2016 by four pioneering employers from American Express, Macy’s, Verizon and Caterpillar. HTA member companies are collectively responsible for more than 5 US million lives and 8 million globally spending $450 billion annually in the US market. Mr. Andrews served NJ’s 1st congressional district in the US House of Representatives from 1990 to 2014. Information on the Health Transformation Alliance is at: https://www.htahealth.com/about-us/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Per my May 2025 interview with Stanford’s Chris Callahan regarding his April 2025 “Nature” article titled, “Carbon Majors and the Scientific Case for Climate Liability,” we know that among the 90 companies responsible for 63% of industrial GHG emissions over the past 200 years, 83 are fossil fuel companies. Two weeks ago Senator Cruz (R-TX) and four other Republican senators dropped their “Stop Climate Shakedown’s Act.” In part the legislation would prohibit retroactive liability, mandate dismissal of pending climate liability lawsuits in several states and preempt state authority, e.g., outlaw state climate superfund laws (think: NY and VT). The bill was largely anticipated because the Heritage Foundation’s “Project 2025” report proposed policy recommendations designed to “dismantle legal and regulatory frameworks” in response to what the Foundation terms “woke lawfare.” Mike Meno, The Center for Climate Integrity’s Communication Director, unpacks the who, what, why, how and where. Information on the Center for Climate Integrity is at: https://climateintegrity.org/ See also the Center’s “No Immunity for Big Oil” page at: https://www.noimmunityforbigoil.org/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listeners are all well aware US healthcare is increasingly unaffordable. Among other stats nearly 50% of Americas are either uninsured, at 8% or 27 million, or underinsured, at 41% or 120 million. Upwards of 4.8 million Americans are expected to drop their ACA coverage; the average commercial family plan comes w/a $6,800 annual premium and 42% of Americans are now enrolled in high-deductible commercial health plans. As a result 36% of all adults now skip or postpone medical care. Though I’ve likely previously cited, the Noble Prize-winning Princeton economist Angus Deaton concluded in 2020, the US healthcare industry, “is a cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs and making it harder and harder for state and federal governments to afford what their constituents need. Public purpose and wellbeing of ordinary people are being subordinated to the private gain of the already well off. None of this would be possible without acquiescence – and sometimes enthusiastic participation – of the politicians who are supposed to act in the interest of the public.” This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Over the past 12 years the Affordable Care Act (ACA) has reduced the total number of uninsured Americans and low-income individuals more specifically by over 50% and by over 66% for young adults. In 2025 the ACA insured a record breaking 45 million Americans: 24 million through the federal and state exchanges; and, 21 million via the ACA’s expansion of the Medicaid program. Having been under nearly continual attack by Republicans, the proposed 2027 ACA rule, announced February 9th (with comments due March 13), was highly anticipated. Within a week after it was announced, Professor Keith and her colleague Matthew Fielder authored three lengthy essays unpacking numerous proposed rule provisions. Top of line the authors noted the proposed, if finalized, will decrease marketplace enrollment by 2 million in 2027 (marketplace enrollment is already down this year by one million due to the Congress’s refusal or failure to extend COVID-era enhanced premium tax credits) and will increase ACA-related reporting & record keeping by approximately $1.34 billion every year. The first of three Health Affairs’ Forefront essays by Katie Keith and Matthew Fielder is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-1 The second is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-2 The third is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-3 The proposed rule is at: https://www.govinfo.gov/content/pkg/FR-2026-02-11/pdf/2026-02769.pdf CMS’ related press release is at: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com