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!

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!

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:

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.

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!):

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. 

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 ADHD
Cause: 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 disease
Cause: Fluoride in drinking water!

Problem: Fatness, depression, and cancer
Cause: Ultra Processed Foods 
Solution: Raw milk!

Problem: AIDS
Cause: Not HIV! (See his book about Anthony Faucci)

Problem: Increasing concentrations of bioavailable aluminum in the environment
Cause: 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 Kids
Cause: 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 19
Cause: 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 cognition
Cause: 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, and defended communities of color disproportionately impacted by environmental contamination.

In the 2020s, even after he had begun his second career as an aspiring politician and reliable source of health misinformation, at least some part of his brain was working right: He supported the Green New Deal, criticized Trump for his “hostility towards the environment” and he criticized geoengineering and carbon capture as “disastrous from an environmental point of view, and it also is just a subsidy for big carbon.”

While working on a case against a polluter contaminating drinking water with mercury in the early 2000s, he met a persistent group of mothers who claimed that the real problem was mercury in vaccines. He was eventually persuaded. He told Joe Rogan in 2023 “I thought, even if they’re wrong, someone should listen to them.”

RFK then hooked up with the anti-vaxxers who eventually founded the “World Mercury Project” in 2007. By 2015, he became the chair of the board for the organization, which rebranded as “Children’s Health Defense.” (Not the Children’s Defense Fund, a legit child welfare non-profit that has already put out a statement clearing up any confusion between them and Children’s Health Defense.)

In 2019, RFK Jr brought his anti-vaxx message to Samoa, where he met with government officials and spoke out publicly against the Measles vaccine. By 2020, at least 83 people had died in a massive measles outbreak caused by lowered rates of vaccination. RFK blamed the vaccine itself for the outbreak.

By 2021, a study identified RFK Jr’s personal Twitter account was as the top “superspreader” of vaccine misinformation on Twitter, responsible for 13% of all reshares of misinformation, more than three times the second most-retweeted account.

RFK Jr started out with a great deal of insight about the actual, well-documented conspiracies between big corporations and the US government to disempower people and destroy their communities. Then he fell down the rabbit hole of invented conspiracy. It’s a real problem for folks on the left. We know that corporations are evil, that the government colludes with corporate oligarchs, that the government and corporations both have a history of lying to the public about health and medicine. So it’s easy to fall into the trap of believing everything negative you hear.

What kind of actual damage can RFK Jr. do as the Secretary of Health and Human Services? Unfortunately, he will have jurisdiction over the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), Indian Health Service (IHS), and the Centers for Medicare & Medicaid Services (CMS). So get ready for snake oil, grifting, and block grants. 

Now, there’s no guarantee he will be confirmed to this role, but that will depend on a handful of GOP Senators growing a spine. We have to keep our attention on Congress, who can do even more damage: cutting Medicaid, cutting access to food stamps, and revoking all the reforms of the ACA. While the damage RFK can do at HHS is reversible when (if?) we elect a Democrat to the White House, but the damage Congress will inflict is much harder to undo.

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. It’s end-of-year giving season, so please make your way to our website and chip in!

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.

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-network providers only 25% of the time, across all the MCOs Connecticut contracted with.

Around the same time, one of the lawsuits resulted in a decision that the MCOs were subject to the Freedom of Information Act (FOIA) forcing them to give their data to the state. The state and advocates learned not only that the MCOs put up barriers to deny care, but also that providers weren’t getting paid (despite the MCOs’ claims they paid better than Medicaid rates). Providers were fed up with the MCOs and thus had no incentive to take Medicaid patients.

During the 2010 gubernatorial race, Medicaid advocates shared all this information with the candidates. They were lucky that the winner, Dannell Malloy, didn’t have any allegiance to the insurance industry. Once he was in office, Gov. Malloy responded to the 12 year campaign by Medicaid advocates by directing the state to take the risk back by going back to fee-for-service. They put out a Request for Proposal (RFP) for companies to provide administrative services for medical, dental, behavioral health, and medical transportation on a non-risk basis. Thus, those entities wouldn’t have a financial stake in denying claims and narrowing networks. The Governor also instituted a Primary Care Case Management model to actually manage care.

After 2012 Connecticut saw a huge improvement in access to providers. Removing MCOs from the program was a huge incentive for them to sign up to care for Medicaid patients. The state has saved billions of dollars. The medical loss ratio is about 97%: that means 97% of the tax dollars are going to provide care to patients, with only 3% going to overhead, marketing, lobbying, and huge salaries and bonuses for insurance company executives. The Primary Care Case Management model is really coordinating care for about 50% of patients. Today’s Connecticut Medicaid program isn’t perfect; provider rates for specialists and behavioral health providers aren’t ideal. But thanks to the work done in 2012, they know what those rates are and can address them head on.

Sheldon notes that insurance companies that sell Medicare Advantage plans operate on the same MCO model with similar results: barriers to and denial of care, and profiteering. Connecticut’s model could be applied in other states and nationwide for a Medicare for All type system.

Sheldon’s advice to other states: conduct Secret Shopper surveys! Publicize that the state isn’t holding contractors accountable for how tax dollars are being spent. Toxify the industry so politicians won’t want to be on their side.

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.

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. 

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; vote” because it implied the two are mutally exclusive; he believes activists have every right to boo, criticize, and protest failures, bad actions, and inactions of elected officials (both our enemies and friends). Yet he will also vote and get others out to vote. The work of democracy and making change has to include both booing and voting.

Booing our friends sounds counterintuitive, but is still important. Just because we supported a candidate’s election, we have to hold them accountable to do the right thing after they’re elected. Maybe we don’t criticize them as harshly as an opponent, but we have to demand they live up to the values of the people who put them in office. Elected officials are often most responsive to these demands during an election.

Organizing tactics and accountability look different during an election. Jasmine tells us about the Patients Over Profits Pledge, calling on candidates to reject campaign contributions from the corporate healthcare industry (inspired by the No Fossil Fuel Money Pledge from the climate justice movement.) During peak times when candidates are seeking donations and support is the perfect time to make these demands.

Even with a federal issue campaign like Medicare for All, the Patients Over Profits Pledge has a role in local elections. It gives activists a great opportunity to remind candidates that healthcare is an important issue in their local area. Corporate healthcare already has too much influence over our democracy and elected officials, and this is our opportunity to toxify that relationship, making it unsavory for candidates to take their dirty money.

Local elections are also important as a pipeline: your city councillor today could be your Congressperson next cycle, with a lot of sway on healthcare policy. (Post-pod fact check: VP Candidate Tim Walz wasn’t a state legislator, but in his first race for Congress he was indeed funded by many individuals employed by Mayo Clinic in Rochester, MN and by PACs representing the healthcare industry.) It’s really important that we not allow candidates’ views on healthcare to be shaped only by those in corporate healthcare. Supporting pro-M4A candidates or starting to talk about healthcare justice with candidates when they’re running for local office means that if they run for higher office you’ll already be an influence on how they perceive the healthcare industry.

Jasmine describes how activists use the Patients Over Profits Pledge to have conversations and build relationships with candidates up and down the ballot. Any voter can ask candidates in their community by asking them to sign the pledge. As more and more candidates sign on, our movement to toxify corporate healthcare grows stronger. Reach out to Jasmine’s team to get active yourself!

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here.

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 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? 

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 needed follow-up treatment until their debt is paid. 

These are not just a few bad apples. Aggressive debt collection tactics are widespread: a KHN investigation in 2022 examined billing and financial aid at 528 hospitals across the country and found: 

Medical debt doesn’t always go on your credit rating: Unpaid medical debt that is sent to collections can be reported to credit bureaus after one year, then remains on your credit report for seven years. As of a rule that went into affect April 11, 2023, medical debt can only impact your credit rating if it’s over $500. CPFD’s new rule would prevent debt of any amount from appearing. 

WATCH: If you need a moment of levity, a few years ago, John Oliver did a segment about the “grimy business” of debt collection.

How do we fix this?

Until we have a Medicare for All system that takes the profit motive out of healthcare, controls prices for care, and gives patients access to treatment with no cost at the point of delivery, we will continue looking for new and creative ways to help people survive in our messed up healthcare system. Fortunately, many Americans and even some of our elected officials are good at coming up with creative ways to help each other in times of crisis. Some solutions would be relatively simple for Federal, state or even local governments to enact:

Charity Care Eligibility: We have to hold non-profit, tax-exempt hospitals responsible for providing what’s known as “charity care.” In exchange for their tax-exempt status, non-profit hospitals are supposed to provide care and help patients determine if they’re eligible for free or reduced cost care or Medicaid. One problem is that charity care standards are vague; as a result, KFF found that charity care costs represented 1.4% or less of operating expenses at half of hospitals in 2020. Another barrier to access is that hospitals make applying for this kind of assistance overly complicated, something a patient in a health crisis rarely has the capacity to do. One solution is for the IRS to use existing authority to allow hospitals to verify patient income in real time, so they can access financial assistance or Medicaid. Hospitals could use software that’s widely available to “cut off medical debt at the source” and ensure that eligible patients receive assistance when they walk in the door for care. But they aren’t currently required to do this by federal law.

Buying and Forgiving Medical Debt: We’ve all contributed to GoFundMes to help people with medical bills by now. Another way to crowdfund medical debt: for ten years, an organization called Undue Medical Debt (formerly known as RIP Medical Debt) has offered Americans an easy way to buy up and forgive other people’s medical debt for pennies on the dollar (without lining the pockets of a corporate crowdfunding platform). Any individual can buy up medical debt for pennies on the dollar and go to sleep at night knowing they helped ease the burden on a fellow American.

Taking that idea to a new level, some cities and counties like St. Paul, Minnesota and Wayne County, Michigan have used federal ARPA dollars to buy up the medical debt of some of their residents. St Paul, MN with a population of just over 300,000 erased $100 million in medical debt for 43,000 residents. We know that when debt is erased, especially for lower-income families, that leaves more money for rent, groceries, and the other things needed to lift people out of poverty. While this doesn’t address the root cause of medical debt,

Medical Debt Cancellation Act of 2024: In May of this year, Representatives Ro Khanna of California and Rashida Tlaib of Michigan, and Senators Bernie Sanders of Vermont and Jeff Merkley of Oregon introduced legislation to eliminate $220 billion in debt, wipe it from credit reports, and limit the accrual of future debt. The bill create a grant program within the Department of Health and Human Services to to cancel medical debt, prioritizing vulnerable populations and debt owed to safety net hospitals. 

Consumer Financial Protection Bureau rulemaking to remove medical debt from credit reports: A proposed rule change by Biden Administration/Consumer Financial Protection Bureau announced on 6/11/24 would prevent almost any medical debt from appearing on credit reports. 

State Efforts: according to a 2023 Commonwealth Fund analysis, 20 states have financial assistance standards, and 27 have community benefit standards. The strength of these standards vary, as does eligibility to receive financial assistance, but several states have robust protections:

The Republican plan: Surely Donald Trump and JD Vance have a plan to address this crisis. Just kidding. Literally nothing comes up if you Google their names plus medical debt. 

Conclusion

Medical debt is a shameful part of our broken healthcare system. Relieving medical debt isn’t the solution. It is the right thing to do to relieve millions of Americans from immediate stress and hardship so they can focus on their health. But the real solution is a national health plan with price controls for providers based on what it costs to provide care, and low-to-no cost at the point of care, so patients can get care when they need it, without worrying about the debts afterward. With the patchwork of limited protections and relief on top of a system that allows unfettered profiteering by the healthcare industry, medical debt will continue to be a problem for Americans until we address the PRICE of care. Until then, we’ll keep you posted on mutual aid efforts that help Americans survive our healthcare hellscape.

Do you have a story about the way your community is coming together to support people who need healthcare? Please share it by emailing us at [email protected].

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.Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform!

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.

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. Providers are often driven to be more conservative about holding patients because of a fear of liability if they don’t. The profit motive is certainly involved, but there are other motives as well: it’s widely accepted that forced treatment helps and is good for the patient. There’s also a social tendency to isolate people we deem dangerous from the rest of society.

Jesse highlights that we spend a lot of public resources on the court process for outpatient commitment as well. There are some resources that are only available to people on a court order, which incentivizes family and clinicians to seek a court order to get those resources. Advocacy on behalf of people with mental illness tends to be dominated by families and groups with more “respectability” leading to a generally paternalistic approach to mental health laws.

Because the US doesn’t have a federal healthcare system of any kind, those of us in the Medicare for All movement tend to attribute a lot of failings to that patchwork of coverage. Rob tells us that the same critiques (“chaotic” and “patchwork”) happen in Canada because systems are run provincially. The real elephant in the room is that there’s no evidence to support involuntary mental health treatment. There’s nowhere in Canada or the US where outcomes of involuntary commitment are tracked. Money is thrown at whatever the advocates or healthcare corporations claim will work, without any scientific evidence informing a consistent standard of care across the country.

Jesse also notes that there are interactions between the mental health system and the criminal justice system that Medicare for All won’t solve. In many cases patients are committed in order to restore their competency to stand trial (rather than to restore them to wellness). As soon as they are restored to competency and relased from the mental health facility, they are returned to the criminal justice system where they won’t receive treatment and may deteriorate again. Financing won’t solve mass incarceration and perverse incentives for treatment.

While we continue to advocate for Medicare for All, in order to make mental healthcare truly equitable, our guests stress that we need to make sure the system covers more than just medicalized treatments, and we need to…

Q6: This seems like one of those problems with US healthcare that M4A can’t solve on its own – as we fight for universal healthcare, what other changes do we need to be fighting for to make mental healthcare truly equitable?

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.

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.

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:

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:

So what do these policy geniuses have to say about healthcare? Their overall goals are:

So our takeaways: ever since the GOP tried to overturn the ACA, they haven’t had a coherent health policy. Project 2025 really doesn’t move the needle. It’s mostly culture war nonsense that does not project any kind of vision of what they want to see in the future. While most opinion polls show that healthcare costs are still a major issue for American voters, they don’t touch on the topic in Project 2025. They would privatize all of our public programs, making more profits for insurance companies and putting fewer resources into patient care.

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.

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.

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 – and it looks like we might, what preventative measures should we be advocating for?

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.