\n<\/p>\n
[<\/em>Editor\u2019s note:<\/em><\/strong>\u00a0This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong>\u00a0Hello, from KFF Health News and WAMU Public Radio in Washington, D.C. Welcome to\u00a0What the Health?<\/em>\u00a0I\u2019m\u00a0Julie Rovner, chief Washington correspondent for KFF Health News.\u00a0And,\u00a0as always,\u00a0I\u2019m\u00a0joined by some of the best and smartest health reporters covering Washington.\u00a0We\u2019re\u00a0taping this week on Thursday,\u00a0April 23,\u00a0at 10\u00a0a.m.\u00a0As always, news happens fast, and things might have changed by the time you hear this. So here we go.\u00a0<\/p>\n Today, we are joined\u00a0via\u00a0video conference by\u00a0Sheryl\u00a0Gay Stolberg\u00a0of\u00a0The New York Times.\u00a0<\/p>\n Sheryl Gay Stolberg:<\/strong>\u00a0Hi,\u00a0Julie.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Alice Miranda\u00a0Ollstein\u00a0of Politico.\u00a0<\/p>\n Alice Miranda\u00a0Ollstein:<\/strong>\u00a0Hello.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And we welcome back to the\u00a0podcast\u00a0my former\u00a0KFF Health News colleague Victoria Knight,\u00a0now at Bloomberg.\u00a0<\/p>\n Victoria Knight:<\/strong>\u00a0Hi,\u00a0everyone.\u00a0Happy\u00a0to be back.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Later in this episode,\u00a0we\u2019ll\u00a0have the latest installment of our\u00a0\u201cHow Would You Fix It?\u201d series.\u00a0This week with David Blumenthal, a\u00a0physician, health policy expert, author,\u00a0and former Obama administration official.\u00a0He\u00a0literally wrote\u00a0the book on the history of presidents and health reform through George W.\u00a0Bush, and he has a\u00a0brand-new\u00a0book on the last three presidents and their health care policies. But first, this week\u2019s news.\u00a0\u00a0<\/p>\n So,\u00a0Health and Human Services Secretary Robert F Kennedy Jr.\u00a0on Wednesday completed his tour of Capitol Hill, having appeared before seven separate House and Senate committees in four days of hearings.\u00a0Ostensibly, Kennedy\u2019s\u00a0appearances were to answer questions about President\u00a0[Donald]\u00a0Trump\u2019s budget proposal for the Department of Health and Human Services. But,\u00a0as usual, there were lots of other topics as well,\u00a0as this was the first time the secretary appeared before some of these panels, and the first time some of these members of Congress got to question him in person\u00a0ever.\u00a0Victoria, you sat through\u00a0all of\u00a0the hearings, right? Or at least all the hearings this week. What was your big takeaway?\u00a0I guess, not as many fireworks as some of us might have been expecting?\u00a0<\/p>\n Knight:<\/strong>\u00a0Yeah,\u00a0definitely not\u00a0as many fireworks. I mean, I think that\u00a0it\u2019s\u00a0pretty clear\u00a0Kennedy has gotten a mandate in some way from the administration to watch his rhetoric, basically, especially\u00a0his vaccine rhetoric. And we even,\u00a0at Bloomberg,\u00a0we\u2019ve\u00a0had reporting directly saying that\u00a0he\u2019s\u00a0\u2026\u00a0there\u2019s\u00a0an internal memo that said, you know,\u00a0he\u2019d\u00a0keep his messaging on chronic diseases and nutrition and health care affordability, you know,\u00a0more palatable topics.\u00a0So\u00a0I think he\u00a0definitely tried\u00a0to stick to that\u00a0messaging. But there were points where\u00a0the\u00a0Kennedy that has for years been anti-vaccine came back through.\u00a0And\u00a0so\u00a0we saw that in certain lines of questioning.\u00a0And\u00a0also\u00a0he really\u00a0wasn\u2019t\u00a0able to\u00a0justify the cuts. He was there on the Hill to testify about the HHS budget, which President Trump proposed putting in still significant cuts to HHS. It\u00a0wasn\u2019t\u00a0as deep as\u00a0proposed\u00a0last year.\u00a0But there\u00a0wasn\u2019t\u00a0really any good justification that Kennedy provided, except that the U.S.\u00a0is in a lot of debt, and they need to, we need to reduce it. But he kept being,\u00a0like,\u00a0The\u00a0programs are still good<\/em>.\u00a0We need to do these programs<\/em>.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0I\u2019m\u00a0amused, because this, you know, goes back forever of when Cabinet\u00a0secretaries come up to justify cuts to their departments that they clearly\u00a0don\u2019t\u00a0want to make, and\u00a0they\u2019re\u00a0not allowed to say,\u00a0But\u00a0it\u00a0wasn\u2019t\u00a0my idea<\/em>.\u00a0\u00a0<\/p>\n Knight:<\/strong>\u00a0Well,\u00a0and also\u00a0that they know\u00a0Congress will reject it. And\u00a0so\u00a0it\u2019s,\u00a0it\u2019s\u00a0kind of all\u00a0fake\u00a0anyways.\u00a0All these congressional appropriators are like,\u00a0Yeah, this is not happening<\/em>.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah. Hence the\u00a0reason why\u00a0they get to talk about other things. I will say one thing that I noticed\u00a0is\u00a0that he was less rude to these committees than he had been in\u00a0previous\u00a0appearances on Capitol Hill.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0Really?\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah.\u00a0\u00a0<\/p>\n Stolberg:\u00a0<\/strong>I sat through\u00a0all seven of them.\u00a0Julie.\u00a0I thought he was\u00a0pretty rude.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I guess\u00a0it\u2019s\u00a0all in how you look at it. I thought he\u00a0wasn\u2019t. Yes, he was definitely still rude, but I really thought there were times when he had now sort of taken the briefing that you get, which is to try and agree with something that a member of Congress says, and says,\u00a0I will work with you<\/em>, which he hasn\u2019t done before.\u00a0He\u2019d\u00a0just been combative before.\u00a0\u00a0<\/p>\n Stolberg:\u00a0<\/strong>That\u00a0maybe is\u00a0true, but he has a habit of addressing members of Congress by their first name, which is a serious violation of protocol. And he was rebuked in the House last week for doing that with Frank Pallone, the Democrat of New Jersey.\u00a0He did apologize\u00a0for that, which I thought was interesting.\u00a0But that did not stop him from also accusing senators of,\u00a0Democrats,\u00a0of making stuff up, grandstanding,\u00a0and, you know, fake indignation.\u00a0And,\u00a0you know, he yells at them. And then at one point, Diana\u00a0Harshbarger, the Republican in the House that was chairing\u00a0the\u00a0committee, said to him, she just said,\u00a0I think\u00a0it\u2019d\u00a0be best if everybody would just simmer down<\/em>.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, there were definitely moments.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0And I would add to what Alice\u00a0[Victoria]\u00a0said, I do think that the big takeaway was that vaccines\u00a0really still\u00a0dominate his tenure. That is the defining issue of his tenure.\u00a0[Sen.\u00a0Bill]\u00a0Cassidy yesterday was very pointed in correcting Kennedy when Kennedy cited a study that he said showed that advances in or reductions in deaths from\u00a0an\u00a0infectious\u00a0disease were largely due to hygiene and sanitation, which is actually true in the first half of the 20th century, before vaccines were introduced. And the second line in that study, which\u00a0Kennedy\u00a0did not cite, was that, you know, vaccines had made an incredible difference and were extremely important. And\u00a0Cassidy had somebody look up that study in the middle of the hearing and came back to Kennedy and said,\u00a0This\u00a0is what you\u00a0didn\u2019t\u00a0say.\u00a0You took it out of context<\/em>.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, I was actually\u00a0very impressed, because first Cassidy\u00a0couldn\u2019t\u00a0find the study, and then\u00a0\u2026\u00a0<\/p>\n Stolberg:\u00a0<\/strong>I knew the study because I had\u00a0cited\u00a0it before.\u00a0<\/p>\n Rovner:<\/strong>\u00a0I had a feeling you\u00a0probably knew\u00a0it. I was trying to find it, and I\u00a0couldn\u2019t\u00a0find it.\u00a0So\u00a0I was glad that they\u00a0did.\u00a0\u00a0<\/p>\n Stolberg:\u00a0<\/strong>It\u2019s\u00a0in the\u00a0Journal\u00a0of\u00a0Pediatrics in 2000\u00a0by an author named Guyer, not David\u00a0Geier, but G-U-Y-E-R.\u00a0You can look it up.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0We could. I will\u00a0put a link to it<\/a>\u00a0in the show notes.\u00a0OK.\u00a0<\/p>\n Knight:<\/strong>\u00a0I did want to mention also, I do think Cassidy did press Kennedy on vaccines. Certainly, everyone was watching that very closely because of his hesitation last year to vote for Kennedy, and really talking about struggling with the vote,\u00a0and extracting all these commitments from Kennedy,\u00a0ostensibly to\u00a0vote for him, for HHS\u00a0secretary.\u00a0Cassidy did not mention any of those,\u00a0like Kennedy violating any of those commitments, which he clearly has. He was supposed to be in frequent contact with the\u00a0HELP\u00a0[Health, Education, Labor & Pensions Committee]\u00a0chair,\u00a0go\u00a0up to the Hill quarterly. He\u00a0hadn\u2019t\u00a0been to the\u00a0\u2014\u00a0Kennedy had not been to the Hill since September. In some of the committees, he\u00a0hadn\u2019t\u00a0been there since last year, the last budget proposal.\u00a0So\u00a0Cassidy also did not mention these childhood vaccine recommendation overhaul that Kennedy did, which is a huge deal. And he did not mention the Advisory Committee on Immunization Practices being completely overhauled as well, and all those members being fired, which are two things Cassidy said he extracted commitments from Kennedy on.\u00a0So\u00a0I just want to make that point.\u00a0Yes.\u00a0<\/p>\n Stolberg:<\/strong>\u00a0One quick on that. After the hearing, I asked Cassidy,\u00a0\u201cDo you think Kennedy has lived up to his promises to you?\u201d\u00a0And he looked at me and he said,\u00a0\u201cWe\u2019ll talk later.\u201d\u00a0<\/p>\n Rovner:<\/strong>\u00a0I would say, Alice, you\u00a0wrote\u00a0a separate story about the fix in which\u00a0Chairman\u00a0Cassidy finds himself.\u00a0He\u2019s\u00a0being challenged in a primary by\u00a0a\u00a0Republican\u00a0congresswoman\u00a0endorsed by the Make America\u00a0Healthy\u00a0Again\u00a0PAC. I thought Cassidy\u00a0was\u00a0actually more\u00a0restrained than I expected him to be in yesterday\u2019s hearings.\u00a0Although\u00a0I think I\u00a0guess it was our colleagues at\u00a0The\u00a0[Washington]\u00a0Post who thought he was\u00a0pretty combative. I mean, what did you take away from the Cassidy-Kennedy relationship?\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yeah, definitely. I mean, one thing I noticed with both Cassidy and a few other Republicans is one of the few topics where they feel comfortable really going after Kennedy and the Trump administration more broadly is abortion. They think that the administration has not done enough to restrict access to abortion pills, and so they felt more comfortable hammering Kennedy on that issue. You saw Cassidy do that. You saw\u00a0[Sen. Steve]\u00a0Daines\u00a0and a couple of other very anti-abortion senators raise that. And I think\u00a0that\u2019s\u00a0an area where they feel like\u00a0they\u2019re\u00a0more aligned with the sort of activist GOP base\u00a0than\u00a0the administration is.\u00a0And so whatever blowback they would get for questioning the administration is outweighed by their anti-abortion bona fides. So\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0Although I would say, I will interrupt before you finish and say\u00a0I thought it was interesting that the members kept doing that because I thought most of it was for show, because we knew early on, because he\u2019s been to all of these committees, that Kennedy was not going to talk about the FDA study on the abortion pill because there\u2019s pending litigation,\u00a0which is an easy out.\u00a0But they\u00a0made,\u00a0they all made their little speeches, and they knew exactly what he was going to say.\u00a0\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Oh, absolutely, absolutely. I mean, they want to be seen fighting on the issue, for sure.\u00a0I\u2019ve\u00a0talked to a lot of anti-abortion activists who say, you know,\u00a0Look,<\/em>\u00a0the Trump administration keeps saying we got to go through the process with the study<\/em>.\u00a0We got to go through the process with the courts. We got to check all the boxes.<\/em>\u00a0And the anti-abortion activists point out, you know\u00a0\u2014\u00a0correctly, I think\u00a0\u2014\u00a0that the administration has been very willing to break with protocol, and even, you know, legal procedure on a bunch of other issues, and\u00a0they\u2019re\u00a0saying\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0Which\u00a0we\u2019ll\u00a0get to\u00a0in a moment.\u00a0\u00a0<\/p>\n Ollstein:\u00a0<\/strong>\u2026\u00a0Why not us? Why are they so careful when it comes to our issue when,\u00a0clearly, they do whatever they want on other issues?<\/em>\u00a0And so, I mean, that is a fair point, and I think\u00a0it\u2019s\u00a0going to be a continuing frustration. The\u00a0dynamic we wrote about<\/a>\u00a0is the influence of the Make America\u00a0Healthy\u00a0Again,\u00a0MAHA,\u00a0as a political force.\u00a0We\u2019re\u00a0going to really get a key test of that in Cassidy\u2019s primary\u00a0that\u2019s\u00a0coming up in just a few weeks. MAHA has put a big target on him and wants to knock him out. And\u00a0my colleague and I took a\u00a0really\u00a0critical\u00a0look at their influence in the race, and\u00a0it\u2019s\u00a0sort of not\u00a0living up to the hype,\u00a0I would say.\u00a0MAHA\u00a0is not making\u00a0a big impact\u00a0financially in the race, and they are not making\u00a0a big impact,\u00a0really, in messaging. They\u00a0haven\u2019t\u00a0succeeded in putting\u00a0MAHA\u00a0issues\u00a0\u2014\u00a0like vaccines, like healthy food, chemicals in the environment\u00a0\u2014\u00a0they\u00a0haven\u2019t\u00a0made those the top issues in this race.\u00a0It\u2019s\u00a0sort of the\u00a0same bread-and-butter,\u00a0cost-of-living\u00a0Republican red meat stuff that\u00a0you\u2019re\u00a0seeing in other states.\u00a0And so,\u00a0I think, you know, we talked to a lot of people, you know, close to the situation, who said, even if Cassidy loses, it\u2019s not going to be because of\u00a0MAHA.\u00a0And\u00a0so\u00a0I\u00a0don\u2019t\u00a0know if that makes him more willing to tangle with RFK in these hearings or not.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>I did think, I thought that it was politics that made him lead with abortion, though, because he\u00a0\u2026\u00a0I mean, Louisiana, as we know, is one of the most anti-abortion\u00a0of all the anti-abortion states.\u00a0He\u2019s\u00a0been a longtime anti-abortion\u00a0crusader. This is not a new position for him, and\u00a0he\u2019s\u00a0got this primary,\u00a0so he would like to bring out his supporters. I mean\u00a0\u2026\u00a0I saw that.\u00a0It\u2019s\u00a0like, oh, aha, politically, that makes sense, even though he knew that Kennedy\u00a0wasn\u2019t\u00a0going to respond to the question.\u00a0\u00a0<\/p>\n Aside from the\u00a0secretary\u2019s continuing denial of the accusation that he is anti-vax, there was, in fact, considerable anti-vaccine-related news this week.\u00a0First,\u00a0over\u00a0at\u00a0the Defense\u00a0Department, where\u00a0Secretary Pete\u00a0Hegseth has decreed that annual flu shots will no longer be\u00a0required\u00a0for active-duty and reserve military members. This is, according to\u00a0Hegseth,\u00a0\u201cbecause your body, your faith,\u00a0and your convictions are not negotiable.\u201d\u00a0Now, flu vaccines have routinely been given to members of the military since just after World War\u00a0II\u00a0for the\u00a0fairly obvious\u00a0reason that viral infections pass easily among people who are living together in close quarters, like,\u00a0you know, members of the military. And vaccine requirements in the military,\u00a0in general,\u00a0date back to the Revolutionary War,\u00a0when George Washington ordered troops to\u00a0submit\u00a0to the then\u00a0fairly new\u00a0smallpox vaccine.\u00a0Sheryl,\u00a0you\u2019re\u00a0our public health historian at the table. Has there ever been a time when the balance between personal liberty and public health has been tilted so heavily towards personal liberty as it is right now?\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0I\u00a0don\u2019t\u00a0think so.\u00a0We\u2019ve\u00a0had anti-vaccine activism in the United States for as long as\u00a0we\u2019ve\u00a0had vaccines.\u00a0And especially at the turn of the 20th century, around the time when smallpox was\u00a0kind of racing\u00a0through Boston and other cities, there was a big anti-vaccine push. You might remember, in 1905,\u00a0the Supreme Court ruled that states could mandate vaccination to protect the public health, and that was in a case brought by a pastor in Cambridge, Massachusetts,\u00a0who\u00a0didn\u2019t\u00a0want to get vaccinated for smallpox. And then we had the\u00a0\u201960s, when, you know, vaccines were new, and public health people were touting them, and there was a big embrace of vaccination.\u00a0So\u00a0it\u2019s\u00a0very interesting\u00a0to see what\u00a0Hegseth has done.\u00a0And what came up yesterday in the HELP\u00a0Committee hearing,\u00a0where\u00a0[Sen.]\u00a0Patty Murray reminded Kennedy that during the Great\u00a0Influenza\u00a0of 1918,\u00a0the flu was very indiscriminate, and a lot of soldiers were killed. It did not strike only young people and old people. It struck down people in the prime of their life, many, many in the military. And she said that, you know, this was an issue for readiness.\u00a0And Kennedy was like,\u00a0You\u00a0think the flu is going to kill people?\u00a0Like,\u00a0the flu is not going to kill people<\/em>. And it seemed obvious to me that he did not really understand that influenza is not the same all the time, that the virus mutates, and it very well could mutate into a pandemic strain. And he himself is pushing for a universal influenza vaccine, which has been\u00a0kind of like\u00a0the dream of public health people, so we could guard against, you know, all types of flu strains.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And not have to redo the vaccine\u00a0every year.\u00a0<\/p>\n Stolberg:\u00a0<\/strong>Right. So,\u00a0in\u00a0short answer to your question, I think certainly not in the last 50 or even 100 years have we seen the ascendancy of the medical\u00a0freedom\u00a0movement and the argument that individual liberty takes precedence over the health of the community.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah. Alice,\u00a0you\u00a0wanted\u00a0to add something.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yeah.\u00a0I\u2019ve\u00a0also seen a lot of people pointing out that\u00a0it\u2019s\u00a0not like this is an\u00a0across-the-board\u00a0embrace of individual liberty. I mean, if\u00a0you\u2019re\u00a0in the military, you still\u00a0can\u2019t\u00a0grow a beard\u00a0if\u00a0you\u2019re\u00a0a man, even if you have a skin condition where shaving really hurts and is bad for your skin.\u00a0You\u00a0don\u2019t\u00a0have the personal medical freedom to transition from male to female, or female to male.\u00a0You\u00a0don\u2019t\u00a0even have the personal freedom to wear what you want, to have the hairstyle you want, and so this is\u00a0really\u00a0just\u00a0about vaccines. And,\u00a0like\u00a0Sheryl said, you know, really could threaten military readiness. There have been several wars in the past where more soldiers\u00a0died of disease than died of violent combat impacts.\u00a0So\u00a0this is\u00a0a very interesting\u00a0carve-out\u00a0that has a lot of people\u00a0worried.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Also on the vaccine front at HHS, NIH\u00a0[National Institutes of Health]\u00a0Director Jay Bhattacharya, who was actually acting in his role as acting director of the Centers for Disease Control and Prevention, has reportedly canceled publication of a study that found the covid vaccine dramatically reduced hospitalizations and emergency department visits.\u00a0Bhattacharya,\u00a0reported\u00a0both\u00a0The Washington Post<\/a>\u00a0and The New York Times,\u00a0complained that the study\u2019s\u00a0methodology\u00a0was flawed. But CDC officials say not only is it the same methodology used in the past, but it\u2019s also basically unheard of for a study approved by CDC\u2019s\u00a0own\u00a0scientists not to be published in the agency\u2019s\u00a0\u201cMorbidity and Mortality Weekly Report\u201d\u00a0once it reached the stage that this study had\u00a0reached. Is there any conclusion to be drawn here? Other than\u00a0that\u00a0the study\u2019s results contradict the\u00a0administration\u2019s position that the covid vaccine is not helpful.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0Raises\u00a0a\u00a0question about radical transparency,\u00a0that\u2019s\u00a0for sure. Secretary Kennedy came into office promising radical transparency. This\u00a0doesn\u2019t\u00a0seem radically transparent.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>No. Kennedy keeps saying\u00a0\u2014\u00a0and he said\u00a0how many times during these hearings?\u00a0\u2014\u00a0that\u00a0he\u2019s\u00a0trying to restore trust in the science agencies. And this does not strike a lot of people\u00a0as a way to\u00a0restore trust when something is canceled because you\u00a0don\u2019t\u00a0like the results. Victoria, did you want to add something?\u00a0\u00a0<\/p>\n Knight:<\/strong>\u00a0Yeah,\u00a0I mean, I think\u00a0that\u2019s\u00a0a great point. He just said multiple times throughout all these hearings, especially when Democrats were questioning him on vaccines, that\u00a0I\u2019m willing to look at studies, I\u2019m willing to look at data, I\u2019m willing to review everything<\/em>, if you\u2019re bringing up maybe things he allegedly said he had not seen before,\u00a0data or whatever. So\u00a0yeah, exactly this\u00a0goes exactly\u00a0against that.\u00a0You would think if\u00a0there\u2019s\u00a0a study showing something,\u00a0he\u2019d\u00a0be willing to view it. If that was his philosophy.\u00a0<\/p>\n Rovner:<\/strong>\u00a0We would\u00a0see. All right. Well, meanwhile, President Trump continues to make his health policy out of the White House. Last Saturday, he summoned his top health officials, plus popular podcaster Joe Rogan, to the Oval Office to sign an executive order to facilitate research into and to fast-track\u00a0FDA review of some previously banned psychedelic substances, including\u00a0ibogaine and LSD, which are legally considered to have no medicinal uses. This is\u00a0actually not\u00a0all that controversial.\u00a0It\u2019s\u00a0part of an ongoing push from researchers who say that some of these substances might well be useful for treating things like severe depression, PTSD,\u00a0and even opioid dependence. But what made this so unusual is that it was\u00a0apparently pushed\u00a0to fruition in just a matter of days by a text from Joe Rogan to President Trump.\u00a0So\u00a0what message does this send about the so-called\u00a0gold-standard science being the only thing that counts in this administration, when a podcaster with a big following that the\u00a0president wants can spring loose a major policy shift in less than a week?\u00a0<\/p>\n Stolberg:<\/strong>\u00a0So\u00a0I have a theory about\u00a0this, actually. Well, first, it is highly unusual that Trump would step in on this,\u00a0right? Like\u00a0it\u2019s\u00a0not the ordinary course of science that the\u00a0president issues these executive orders.\u00a0But Casey\u00a0Means,\u00a0who is President Trump\u2019s nominee for\u00a0surgeon\u00a0general,\u00a0has advocated the use of psilocybin, and so\u00a0has\u00a0Secretary Kennedy, for that matter.\u00a0But this is one of the things that is\u00a0kind of stalling\u00a0her nomination.\u00a0[Sen.]\u00a0Susan Collins has raised concerns about this.\u00a0I guess I just kind of wonder if Trump is trying to put his imprimatur on this research,\u00a0maybe as\u00a0a backhanded way to give her a boost? Or\u00a0maybe I\u2019m\u00a0just too Machiavellian, and\u00a0maybe\u00a0it\u2019s\u00a0just that Joe Rogan texted him, and he was like,\u00a0Yeah,\u00a0that\u2019s\u00a0a good idea<\/em>.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And it was, in\u00a0fairness,\u00a0it was already in the works.\u00a0<\/p>\n Stolberg:<\/strong>\u00a0Yeah. And, I mean, there\u00a0is\u00a0a lot of legitimate scientific reasons to do this kind of research.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And, I will say, I mean,\u00a0I\u2019ve\u00a0studied this, and I believe breaking just\u00a0today,\u00a0they\u2019re, you know, rescheduling marijuana.\u00a0Again,\u00a0all of\u00a0these technical changes are to make it easier to do the research. Part of the problem has been that because these substances were scheduled as having no medicinal uses, you\u00a0couldn\u2019t\u00a0get them to do the research.\u00a0So\u00a0one of the things that this does is make it easier.\u00a0To have Joe Rogan in the Oval Office on a Saturday morning\u00a0struck me as,\u00a0like,\u00a0OK, this is a little strange.\u00a0<\/p>\n Knight:<\/strong>\u00a0But isn\u2019t that how this administration works?\u00a0Right? I mean, I think that,\u00a0just in general,\u00a0there\u2019s\u00a0a lot of influencer types that\u00a0\u2014\u00a0I would say, Joe Rogan, podcaster, influencer type\u00a0\u2014\u00a0that just have influence in this White House because they have forged a connection with Trump.\u00a0And so,\u00a0if they say something to him, he will take that into account and change policy sometimes.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And he wants the young male demographic, which Joe Rogan very much\u00a0represents. All\u00a0right,\u00a0we\u2019re\u00a0going to take a quick break. We will be right back.\u00a0\u00a0<\/p>\n OK, we are back.\u00a0And turning to the Affordable Care Act,\u00a0despite reassurances from Trump administration officials that the lapse of the Biden-era\u00a0additional\u00a0premium tax credits\u00a0didn\u2019t\u00a0result in a big drop in coverage,\u00a0we\u2019re\u00a0getting\u00a0more data suggesting that is not the case. A new report this week from the group\u00a0representing\u00a0the 21 states that run their own marketplaces show[s]\u00a0about 900,000 enrollees dropped coverage in the first three months of this year.\u00a0Compared to last year, disenrollments are\u00a0up\u00a024%. Hardest\u00a0hit, not surprisingly, are older enrollees between\u00a0the\u00a0age\u00a055 and 64.\u00a0Their premiums are higher to begin with, so the loss of\u00a0additional\u00a0subsidies hits them harder. Meanwhile, even people who have managed to keep coverage are paying more,\u00a0as many dropped the more generous\u00a0\u201cgold\u201d\u00a0and\u00a0\u201csilver\u201d\u00a0plans,\u00a0for those with higher deductibles but lower premiums.\u00a0And those deductibles are often\u00a0eye-popping\u00a0indeed\u00a0\u2014\u00a0not just\u00a0$1,000 or $1,500 a year, but often more than five figures. I know I say this\u00a0roughly every\u00a0other week, but\u00a0I\u2019m\u00a0surprised this\u00a0isn\u2019t\u00a0making more of an impact in the national conversation. I mean, you know, I keep seeing people who say\u00a0I\u2019m\u00a0having to drop my insurance<\/em>\u00a0or, you know,\u00a0I have insurance and I\u00a0can\u2019t\u00a0afford to use it because my deductible is $10,000<\/em>.\u00a0I know it\u00a0sort of swept\u00a0into this whole\u00a0\u201caffordability\u201d\u00a0thing, but I thought this might have come up more during seven hearings with the\u00a0secretary of HHS.\u00a0\u00a0<\/p>\n Knight:<\/strong>\u00a0I mean, I think\u00a0it\u2019s\u00a0partly because there is just so much happening in the world right now that everything else is getting pushed aside in a\u00a0way,\u00a0if\u00a0it\u2019s\u00a0not related to the Iran war or gas prices or things like that. But I do think, I mean, we\u2019ll see, but Democrats, once we were starting to get\u00a0\u2014\u00a0you know, we just started to get some of this data about ACA enrollment and how it\u2019s changing now that the premium tax credit, enhanced premium tax credits, were not extended by Congress, we\u2019re just now starting to get some of the data. So I think as we see more data,\u00a0and then\u00a0we\u2019ll see even more of that going into the summer,\u00a0I think Democrats, at least, will be hitting this really hard on the campaign trail, and maybe that will permeate and become part of more of the national conversation.\u00a0We\u2019ll\u00a0see, but\u00a0they\u2019re\u00a0at least\u00a0gonna\u00a0message on it,\u00a0certainly.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, I think, you know, one of the things that\u2019s important to remember is that the administration, it\u2019s telling the truth when it says, you know, most people were still enrolled in January, because a lot of those people got auto-enrolled.\u00a0And\u00a0it takes several\u00a0months of\u00a0not paying your premiums before you can actually get kicked off your insurance.\u00a0So\u00a0in fact,\u00a0we\u2019re\u00a0only just starting to see how many people.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0This is just the beginning. And the fact that\u00a0we\u2019re\u00a0already seeing such coverage losses means that\u00a0there\u2019s\u00a0going to be more.\u00a0And I think\u00a0it\u2019s\u00a0going to have a political impact in certain contexts. I mean, there was a report\u00a0just<\/em>\u00a0about the\u00a0big drop in enrollment in Georgia, and Georgia is a major swing state with some major races coming up, and so I expect it to have\u00a0a big impact\u00a0there. And\u00a0so\u00a0I think, rather than being like a dominant national message, I think in certain places where\u00a0you\u2019re\u00a0really seeing the strain.\u00a0I\u2019ll\u00a0also point out that\u00a0it\u2019s\u00a0not just about people becoming completely uninsured.\u00a0There\u2019s\u00a0also a big shift from people being in more\u00a0comprehensive health care plans to people moving into skimpy, high-deductible health care plans.\u00a0And\u00a0that\u2019s\u00a0going to have a lot of ripple effects going forward as\u00a0well, and\u00a0going to lead to a lot of\u00a0struggle. And\u00a0so\u00a0I think it\u00a0contributes to the overall sense that people are really in financial\u00a0dire straits\u00a0and\u00a0can\u2019t\u00a0afford\u00a0basic daily life.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0We\u2019re\u00a0going to see that, coupled with a lot of Democrats talking, as they did during the hearings, about cuts to Medicaid. Kennedy insists that\u00a0we\u2019re\u00a0not cutting Medicaid, but if you talk to any rural hospital executive around the country, they will tell you that they are crumbling under the loss of Medicaid reimbursements.\u00a0And I think that those,\u00a0the Medicaid\u00a0and also\u00a0the ACA enrollments,\u00a0will\u00a0emerge\u00a0as powerful issues for Democrats.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Kennedy was repeating the age-old argument\u00a0that\u2019s\u00a0always made that if the amount of money to Medicaid goes up, it\u00a0can\u2019t\u00a0be a cut, even though that\u00a0doesn\u2019t\u00a0keep up with inflation or enrollment or the number of people. Yeah, so, I mean, it\u2019s like\u00a0\u2026\u00a0if you\u2019re paying more, if your mortgage goes up and you\u2019re paying more for it and it goes up more than you\u2019re paying,\u00a0than you\u2019re able to pay, then that\u2019s really a cut in your income.\u00a0So\u00a0it\u2019s\u00a0a perennial argument that we do see.\u00a0\u00a0<\/p>\n Stolberg:\u00a0<\/strong>It\u2019s\u00a0Washington accounting.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah. Finally, this week, there is news on the reproductive health front. In Pennsylvania, a state appellate court ruled that a 1982 ban on the use of public funds to pay for abortion violates that state\u2019s Equal Rights Amendment. Now this case could still be appealed to the state Supreme Court, but this is a\u00a0pretty significant\u00a0ruling for a very purple swing\u00a0state,\u00a0right,\u00a0Alice?\u00a0And it could lead to state-funded Medicaid coverage for\u00a0abortion,\u00a0if\u00a0it\u2019s\u00a0upheld.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0That\u2019s\u00a0right. And I will say there was a major state Supreme Court race last year, and it was all about abortion rights\u00a0\u2014\u00a0that was, like,\u00a0the dominating issue in it.\u00a0And the progressives prevailed on that message. I think\u00a0you\u2019re\u00a0really seeing, like you said, a very mixed state, a very purple state,\u00a0really being swayed in the direction of supporting abortion rights. And\u00a0we\u2019ve\u00a0seen that in a lot of states, you know, since\u00a0Dobbs<\/em>\u00a0\u2014\u00a0states\u00a0you might not expect to go in that direction.\u00a0And I think\u00a0it\u2019s\u00a0going to continue to dominate\u00a0state Supreme Court races as an issue.\u00a0You\u2019re\u00a0seeing that right now with Georgia.\u00a0I would\u00a0advise folks to\u00a0keep an eye on that.\u00a0There\u2019s\u00a0a very pro-abortion rights message for those candidates in that\u00a0race.\u00a0\u2026\u00a0But this is specifically the issue of Medicaid coverage of abortion, I think,\u00a0is going to keep coming up over and over as well, because\u00a0it\u2019s really getting at the question of, yes, you can have legal access to abortion on paper, but if you can\u2019t afford it, is it really accessible?\u00a0So\u00a0this could open up access to a lot of low-income people that would not maybe be able to afford it otherwise.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0And for the people who are wondering,\u00a0Wait\u00a0a minute, I thought Medicaid coverage of abortion is banned<\/em>\u00a0\u2014\u00a0it\u2019s\u00a0federal Medicaid coverage of abortion is banned. States may use their own money if they wish to pay for abortion, and many bluer states do.\u00a0That\u2019s\u00a0the question at hand here.\u00a0\u00a0<\/p>\n Meanwhile, in South Carolina, lawmakers are advancing a ban on abortion\u00a0that\u2019s\u00a0so strict it would subject women who have abortions to punishment, although not as severe as the punishment for those who perform abortions. I thought this was a basic tenet of the anti-abortion movement, that the women who have abortions are also victims and\u00a0shouldn\u2019t\u00a0be punished.\u00a0Is that changing?\u00a0\u00a0<\/p>\n Ollstein:<\/strong>\u00a0It\u2019s\u00a0been a very loud debate\u00a0recently. You have different wings of the anti-abortion movement who are clashing on this, and many are watching the total number of abortions in the U.S.\u00a0go up since\u00a0Dobbs,<\/em>\u00a0and say this incremental strategy where we shield\u00a0women who have abortions from prosecution and only go after the doctors. Some of the hard-liners\u00a0feel\u00a0that\u00a0that\u2019s\u00a0not working, and so they\u00a0have to\u00a0try something else\u00a0in order to\u00a0actually have\u00a0the chilling effect that they want to have and deter people from even\u00a0attempting\u00a0to get abortions. And then you have a lot of the more mainstream groups who really are against that strategy, and say that, you know,\u00a0this will just drive voters into the arms of Democrats if we look like we\u2019re the\u00a0<\/em>quote-unquote\u00a0\u201cwar on women\u201d\u00a0that we\u2019ve been accused of waging all these years<\/em>. And\u00a0so\u00a0it\u2019s\u00a0a very active\u00a0debate right now.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0I was going to say,\u00a0do you remember when Trump was running in 2015 and he said that he thought women should be punished for having abortions?\u00a0And there was a big\u00a0firestorm over it from the anti-abortion movement. And he basically\u00a0shut\u00a0up on that.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yes, I do remember that.\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0So\u00a0\u2026\u00a0you can see how things have evolved. Of course, that was, you\u00a0know, when\u00a0Roe<\/em>\u00a0was still\u00a0into\u00a0effect. Then we got\u00a0Dobbs<\/em>, and,\u00a0as Alice said, things are changing.\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yes, things are changing. All right. Well, that is this week\u2019s news, or at least as much as we have time for.\u00a0Now\u00a0we will play my\u00a0\u201cHow\u00a0Would\u00a0You\u00a0Fix It?\u201d\u00a0interview\u00a0with David Blumenthal, and then\u00a0we\u2019ll\u00a0come back and do our extra credits.\u00a0<\/p>\n I am pleased to welcome to\u00a0\u201cHow Would You Fix It?\u201d\u00a0David Blumenthal, a true\u00a0Renaissance man\u00a0of health policy. When I first met David in the 1980s,\u00a0he was teaching at Harvard Medical School, doctoring in Boston,\u00a0and writing about health policy. Since then, he has served as president of the\u00a0health\u00a0policy research organization\u00a0The Commonwealth Fund, and,\u00a0before that, as\u00a0national\u00a0coordinator for\u00a0health\u00a0information\u00a0technology in the Obama administration. In his\u00a0\u201cspare time,\u201d\u00a0air quotes, David has written countless journal and\u00a0other articles and\u00a0several books, most notably,\u00a0with political scientist James Morone,\u00a0The Heart of Power:\u00a0Health and Politics in the Oval Office<\/em>, which chronicles presidential health policies from Teddy Roosevelt through George W Bush. Now he and\u00a0Morone\u00a0are out with a\u00a0follow-up book called\u00a0Whiplash: From the Battle for Obamacare to the War on Science<\/em>, which covers the\u00a0rather eventful\u00a0last three administrations in health\u00a0care. David Blumenthal, thank you so much for joining us.\u00a0<\/p>\n David Blumenthal:<\/strong>\u00a0Oh,\u00a0it\u2019s\u00a0my pleasure. What a great introduction. Thank you so much for that.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So,\u00a0if\u00a0it\u2019s\u00a0Congress that makes the laws, why is it that the\u00a0president is so pivotal when it comes to health policy?\u00a0<\/p>\n Blumenthal:\u00a0<\/strong>Well, people forget that there is only one official in the United States who\u00a0is\u00a0elected by all the people, and that is the\u00a0president.\u00a0That gives him\u00a0\u2014\u00a0or someday her, we hope\u00a0\u2014\u00a0a legitimacy, a symbolic authority,\u00a0and an ability to rise above the din of Washington conversation to reach the American people and to build support or mobilize opposition to whatever an enterprising\u00a0congressman\u00a0or senator has in mind. Those same\u00a0congressmen\u00a0and senators really crave direction, most of them,\u00a0from the\u00a0president to know what that official\u2019s priorities are, so they can line up behind it. They also want to know what the\u00a0president might veto\u00a0before they put a lot of effort into things.\u00a0So\u00a0all those things are reasons why presidents have a level of authority which is often underappreciated, especially in health care, where the\u00a0day-to-day\u00a0conversation often focuses on what a senator or\u00a0a\u00a0congressman\u00a0or\u00a0a\u00a0committee\u00a0chairman\u00a0is saying. But in the end, unless the\u00a0president is behind something important,\u00a0it\u2019s\u00a0not going to happen in the Congress.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And\u00a0pretty much everything\u00a0major in health care has had a president spearheading it,\u00a0hasn\u2019t it?\u00a0<\/p>\n Blumenthal:<\/strong>\u00a0Exactly.\u00a0Some that have succeeded, like Medicare and Medicaid, Lyndon Johnson\u2019s proposals, and some that have not,\u00a0like the Clinton\u00a0health\u00a0plan.\u00a0And then, of course, the Affordable Care Act, which was uniquely the product of President Barack Obama\u2019s sponsorship, passion, enduring commitment, with a lot of\u00a0help from Nancy Pelosi.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Can you talk a little bit about tinkering versus major reforms, and what\u00a0you\u2019ve\u00a0learned from studying the last dozen or so major health reform debates? I know\u00a0just in the 40 years I\u2019ve been doing this, you know federal government has\u00a0gone back and forth\u00a0between\u00a0We should try to do something<\/em>\u00a0big;<\/em>\u00a0no, we can\u2019t do something big, so we should try to do something small; no, it doesn\u2019t work if we do something small, we should try\u00a0to do something big.\u00a0<\/em>It\u2019s\u00a0just been this constant swaying.\u00a0<\/p>\n Blumenthal:\u00a0<\/strong>Well, one of the stories that we tell in both of our books is the story of the dance that has gone on over the ages between proponents of major health care reform and opponents.\u00a0And this has typically been\u00a0Democratic proponents and Republican opponents. And the story is this:\u00a0Somebody in the Democratic Party proposes a massive health care reform proposal, and the Republicans scream socialism, government control, death panels, whatever, and propose an alternative that is smaller, more about free markets, more about the private sector, more about competition. The Democratic proposal goes down in flames, and then 20 years later, the Democrats come back and propose what the Republicans proposed the first time. Then the Republicans say socialism, government control,\u00a0more\u00a0limited government, more free market, more private sector.\u00a0Same\u00a0thing happens. It goes and goes and goes. What we saw with the Affordable Care Act was that the effort to get anything meaningful in the way of coverage,\u00a0with a less governmentally oriented program,\u00a0had run out its rope. There was just nowhere else for conservatives to go, which is why we got the Heritage Foundation proposing what Gov.\u00a0Mitt Romney and Ted Kennedy accepted in Massachusetts as the basis for health care reform. So I think what happened was that\u00a0\u2014\u00a0and this, I think, you saw mostly in the repeal-and-replace\u00a0failure\u00a0\u2014\u00a0the Republicans could not come up with anything that was more incremental, less comprehensive,\u00a0and still made a difference for people\u2019s insurance, especially on the issue of preexisting conditions.\u00a0<\/p>\n Rovner:\u00a0<\/strong>They were\u00a0OK\u00a0with the repeal, just not with the\u00a0replace.\u00a0<\/p>\n Blumenthal:<\/strong>\u00a0Exactly, which is a story that we tell,\u00a0in detail, in\u00a0Whiplash<\/em>. So incremental reform is the way Americans do business.\u00a0We\u2019ve\u00a0now incremented our way to a four-legged stool that can achieve universal coverage. We have employer-sponsored insurance, which, of course, is subsidized by the government. We have Medicare, which is the third rail of health\u00a0care politics. We have\u00a0Medicaid, which can be expanded if states and the federal government choose, and we have the Affordable Care Act.\u00a0And together, those got us,\u00a0during the last years\u00a0of\u00a0the Biden administration, to 93% coverage of Americans. We have the tools to increment our way now to universal coverage, and that just seems\u00a0\u2026 to\u00a0be the way Americans want to do business, at least in health care.\u00a0<\/p>\n Rovner:\u00a0<\/strong>How does that politicization of not just health insurance coverage but everything that surrounds health and health care becoming red or blue\u00a0\u2014\u00a0how\u2019s\u00a0that going to\u00a0impact\u00a0the next big health debate?\u00a0<\/p>\n Blumenthal:\u00a0<\/strong>Well,\u00a0it\u2019s\u00a0red-blue.\u00a0It\u2019s\u00a0also\u00a0\u2026\u00a0has racial overtones. It also has xenophobic overtones, with attitudes toward immigration.\u00a0All these things now run straight through health\u00a0care. I think\u00a0there\u2019s\u00a0a difference between the psychology of opposition to vaccination and suspicion of the NIH and the people who come into play when it comes to the cost-control issue. Cost control is a\u00a0bread-and-butter\u00a0issue. Vaccination is about personal freedom, the sanctity of bodies, the freedom to say no.\u00a0It has a different overtone and undertone to it. I think that the controversy over cost will be viewed much more as a traditional interest-group struggle, rather than as a red-blue struggle. And\u00a0I think\u00a0there\u2019ll\u00a0be some people from the Republican Party who will get to the point where their constituents are saying,\u00a0We\u00a0may have health insurance, but\u00a0it\u2019s\u00a0not worth a damn because our deductibles are too high and our copayments are too high. We\u00a0got\u00a0to do something<\/em>.\u00a0And I think\u00a0there\u2019s\u00a0a chance for a bipartisan solution\u00a0on\u00a0that score.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0we\u2019re\u00a0calling this series\u00a0\u201cHow Would You Fix It?\u201d\u00a0How would\u00a0you<\/em>\u00a0fix it if you could wave a wand and put aside\u00a0all of\u00a0the politics that I know you now know so well.\u00a0But if you could do one or two things to make our health system function better, what would it be?\u00a0<\/p>\n Blumenthal:\u00a0<\/strong>Well, you know, we, in\u00a0writing\u00a0the book, we spent some time with President Obama, who said, you know,\u00a0I would have loved to have had\u00a0\u201cMedicare for All,\u201d\u00a0but I knew that was impossible<\/em>.\u00a0So\u00a0we now have this Rube Goldberg apparatus providing us coverage, and I think\u00a0we\u2019re\u00a0stuck with that.\u00a0So\u00a0what I would do first is make the Affordable Care Act as generous as it should have been and got to be after the\u00a0Inflation Reduction Act. And I think if we did that and worked our way around the Supreme Court\u2019s prohibition about requiring Medicaid expansion, which we almost did in the IRA\u00a0\u2014\u00a0it\u2019s little-known, but there was an alternative to expanding Medicaid that would have made it a federal program, added to the state program, and not be\u00a0\u2026 go\u00a0crosswise with the Supreme Court.\u00a0That,\u00a0plus\u00a0\u2026\u00a0so that would be just\u00a0sort of make do\u00a0everything we can to make coverage as universal as it could be.\u00a0And then add to that a set of incremental changes that would reduce the cost of care.\u00a0That would involve, I think, more regulation of private insurance\u00a0to reduce the complexity of benefits and the complexity of billing. The Netherlands and Germany run their health systems through private insurance. They just standardize what\u00a0the private\u00a0companies offer. We could do that. In fact, the Affordable Care Act\u00a0begins\u00a0that process, especially in marketplaces like California, where private insurers are heavily regulated.\u00a0<\/p>\n The second is we need to break up the monopolies that have formed at the local level in the health\u00a0care provider system, where you have\u00a0virtually no\u00a0competition based on price or anything else. We need to change the way we pay for care much more aggressively. Artificial intelligence has enormous potential to reduce administrative costs, but it also has\u00a0an enormous\u00a0potential to run them up. If the incentives in the system are not fixed, the incentives in the\u00a0fee-for-service system will lead to\u00a0using\u00a0AI to maximize billing.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Which\u00a0we\u2019ve\u00a0already seen.\u00a0<\/p>\n Blumenthal:<\/strong>\u00a0Right,\u00a0and\u00a0not reduce administrative expenses. And\u00a0so\u00a0we need to give providers and other powerful interests an incentive to use AI to make the health\u00a0care system work better, rather than to make it generate more revenue.\u00a0So\u00a0I think those\u00a0are some of the things that\u00a0we\u2019ll\u00a0need to do.\u00a0So,\u00a0build on what we have, the four-legged stool, the foundation for universal coverage we already have, and begin to take on the cost of\u00a0care through changes that are,\u00a0for which there are precedents elsewhere in the world, but which until now, we\u2019ve been unwilling to take on.\u00a0<\/p>\n Rovner:\u00a0<\/strong>David Blumenthal,\u00a0we\u2019ll\u00a0see how this all plays out.\u00a0Thank you so much.\u00a0<\/p>\n Blumenthal:\u00a0<\/strong>Thank you, Julie.\u00a0<\/p>\n Rovner:\u00a0<\/strong>OK,\u00a0we\u2019re\u00a0back.\u00a0Now\u00a0it\u2019s\u00a0time for our\u00a0extra-credit\u00a0segment.\u00a0That\u2019s\u00a0where we each recognize a story we read this\u00a0week\u00a0we think you should read, too.\u00a0Don\u2019t\u00a0worry if you miss it. We\u00a0will\u00a0post\u00a0the links in our show notes on your phone or other mobile device.\u00a0Victoria, why don\u2019t you start us off this week?\u00a0<\/p>\n Knight:<\/strong>\u00a0Sure thing.\u00a0My story for extra credit is in\u00a0The New York Times, and the title is\u00a0\u201cA $440,000 Breast Reduction: How Doctors Cashed In on a Consumer Protection Law<\/a>,\u201d by Sarah Kliff and Margot Sanger-Katz, Sheryl\u2019s colleagues.\u00a0So\u00a0this is a really interesting look at the ramifications of the 2020\u00a0No\u00a0Surprises Act that was passed by Congress. And the whole point of this act was to protect patients from surprise medical bills. Because, you know, it still happens nowadays, but this law\u00a0helps\u00a0it. Basically, sometimes patients go to an\u00a0out-of-network\u00a0doctor,\u00a0they might\u00a0get stuck with a really, really high bill, and it\u2019s really difficult for them to pay.\u00a0So\u00a0Congress wanted to do something about it. They did, and now, basically, insurers and doctors\u00a0have to\u00a0go to an arbitrator if there is a conflict about the price of the bill, if\u00a0it\u2019s\u00a0an\u00a0out-of-network\u00a0bill.\u00a0This article really had a lot of great data points on how it seems arbitrators are really favoring doctors in these decision-making and awarding doctors with these really high amounts of money for these medical procedures.\u00a0So basically, the\u00a0doctors offer an amount of money that the medical procedure should cost, and the insurers offer one, and the arbitrator just picks one of the two prices. And\u00a0so\u00a0doctors are really getting awarded way\u00a0more.\u00a0\u2026\u00a0Some doctors are\u00a0profiting off of\u00a0this by certain types of procedures, such as breast reduction that was mentioned in the title. And\u00a0so\u00a0it was really fascinating. And a few lawmakers were interviewed, and they were like,\u00a0Well, we\u00a0didn\u2019t\u00a0really think about that happening, but at least patients are protected<\/em>. I\u00a0don\u2019t\u00a0know\u00a0if\u00a0Congress will do anything about it, but\u00a0it\u2019s\u00a0a new twist in our health\u00a0care system.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, I love this story because\u00a0there\u2019s\u00a0been complaints about the arbitration system\u00a0pretty much since\u00a0the law passed. And\u00a0I think it\u00a0takes, you know, a story like this for everybody\u00a0to\u00a0say,\u00a0Oh, my goodness, is that\u00a0what\u2019s\u00a0happening?\u00a0<\/em>Alice, why don\u2019t you go next?\u00a0<\/p>\n Ollstein:<\/strong>\u00a0Yes, I have\u00a0a[n]\u00a0analysis from\u00a0The Washington Post. It\u2019s called\u00a0\u201cWhere U.S. Science Has Been Hit Hardest After Trump\u2019s First Year<\/a>,\u201d\u00a0and it\u2019s looking at these science and research grants from the National Institutes of Health, and even though Congress has largely protected that funding and approved increases, even where the White House pushed for decreases, that money is not going out, and it\u2019s really not going out to certain researchers researching certain topics, chief among them things that impact women\u2019s health.\u00a0And this is partially,\u00a0as the article gets into,\u00a0a\u00a0result of this war on\u00a0what\u2019s\u00a0viewed as\u00a0DEI\u00a0[diversity,\u00a0equity,\u00a0and\u00a0inclusion]. And\u00a0so\u00a0research into conditions that primarily or solely\u00a0impact\u00a0women, like endometriosis,\u00a0are seen as\u00a0DEI\u00a0and are therefore getting cut. And\u00a0so\u00a0it really gets into the toll\u00a0that\u2019s\u00a0taking on these labs around the country that are, you know, potentially discovering breakthroughs, but are now in limbo and having to lay people off and has big consequences.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Another\u00a0story that made me angry.\u00a0Sheryl, you have one of Alice\u2019s stories as your extra credit.\u00a0<\/p>\n Stolberg:<\/strong>\u00a0I do.\u00a0So\u00a0this is from Politico\u00a0by\u00a0Alice and her colleague, Amanda Friedman:\u00a0\u201cTrump\u2019s Surgeon General Pick Faces Mounting GOP Opposition<\/a>.\u201d\u00a0And the reason I like this story is because it\u2019s about Casey\u00a0Means, and in how this\u00a0\u2014\u00a0there\u2019s a wave of attacks coming against her, kind of under the radar from the right, from abortion opponents, including the policy arm of the Southern Baptist Convention, and also people who, as we mentioned before, are perhaps raised questions about her embrace of psychedelics. And\u00a0I think that what\u00a0happens with Casey\u00a0Means is really\u00a0kind of a\u00a0symbol, or\u00a0it\u2019s\u00a0like a microcosm of what is going to happen with the MAHA\u00a0movement. And yesterday, after the hearing, I asked Sen.\u00a0Cassidy,\u00a0who is\u00a0kind of sitting\u00a0on Casey\u00a0Means\u2019\u00a0confirmation,\u00a0\u201cWhen are we going to see a vote on Casey\u00a0Means?\u201d\u00a0And he said,\u00a0\u201cNo comment.\u201d\u00a0So\u00a0I just think that this\u00a0is something to watch, and I\u00a0applaud\u00a0Alice and her colleague for pointing out this kind of\u00a0below-the-radar\u00a0campaign to hold her up.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, really, really good story.\u00a0All right. My extra credit,\u00a0also from one of our podcast panelists, Rachel\u00a0Roubein\u00a0at\u00a0The Washington Post.\u00a0It\u2019s\u00a0called\u00a0\u201cKitKat, Gatorade or Granola Bars? What\u2019s Banned Under New SNAP Rules Is Mixed<\/a>.\u201d\u00a0And I love this story because\u00a0it\u2019s\u00a0one of those\u00a0\u201cwhat seems simple is anything but\u201d\u00a0policy stories. What seems simple here is the idea that food stamps\u00a0shouldn\u2019t\u00a0be used to pay for unhealthy food like candy and soda. But who\u00a0determines\u00a0what\u2019s\u00a0healthy and how is that decided? Thanks to a big pilot program from the Trump administration, two dozen states have received permission to make changes to the food and drink\u00a0that\u2019s\u00a0eligible to be paid for using SNAP\u00a0[Supplemental Nutrition Assistance Program]\u00a0benefits, and 10 states have now implemented restrictions.\u00a0But\u00a0it\u2019s\u00a0a lot harder than just saying you\u00a0can\u2019t\u00a0buy soda and candy. In some states, Gatorade and even Pedialyte are ineligible, even though those are often given to nurse\u00a0sick\u00a0kids. In Iowa, KitKat and Twix bars are eligible because\u00a0they\u2019re\u00a0made with flour and so\u00a0they\u2019re\u00a0not technically candy. Some\u00a0SNAP\u00a0rules are so arbitrary that\u00a0\u2014\u00a0and this is not part of Rachel\u2019s story because it just happened\u00a0\u2014\u00a0a bipartisan group of U.S.\u00a0senators on Wednesday introduced the\u00a0\u201cHot\u00a0Rotisserie\u00a0Chicken\u00a0Act\u201d\u00a0to make sure that\u00a0Costco\u2019s famous $4.99 roasted bird remains available to those getting federal food assistance. We will watch to see if\u00a0that flies.\u00a0Sorry.\u00a0Not\u00a0really sorry.\u00a0<\/p>\n Rovner:<\/strong>\u00a0OK, that is this week\u2019s show.\u00a0Thanks to our editor\u00a0this week,\u00a0Stephanie Stapleton, and our producer-engineer, Francis Ying.\u00a0We also had production help this week from Taylor Cook.\u00a0A reminder:\u00a0What the Health?<\/em>\u00a0is now available on WAMU platforms, the NPR app, and wherever you get your podcasts \u2014 as well as, of course,\u00a0kffhealthnews.org<\/a>. Also,\u00a0as always, you can email\u00a0us\u00a0your comments or questions.\u00a0We\u2019re\u00a0at whatthehealth@kff.org.\u00a0Or you can\u00a0still\u00a0find me on\u00a0Twitter\u00a0@jrovner<\/a>, or on\u00a0Bluesky\u00a0@julierovner<\/a>.\u00a0Where are you folks these days?\u00a0Sheryl?\u00a0\u00a0<\/p>\n Stolberg:<\/strong>\u00a0I\u2019m\u00a0at\u00a0@SherylNYTon\u00a0X<\/a>, formerly Twitter, and\u00a0Bluesky<\/a>.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Victoria.\u00a0<\/p>\n Knight:<\/strong>\u00a0I\u2019m\u00a0@victoriaregisk<\/a>\u00a0on X.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Alice.\u00a0<\/p>\n Ollstein:<\/strong>\u00a0@alicemiranda<\/a>\u00a0on Bluesky\u00a0and\u00a0@AliceOllstein<\/a>\u00a0on Twitter\u00a0[X].\u00a0<\/p>\n Rovner:<\/strong>\u00a0We\u2019ll\u00a0be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n<\/p><\/div>\n