Medicare for All Benjamin Day and Stephanie Nakajima - Healthcare-NOW

Any regular listeners of the podcast won’t be surprised to hear that Gen Xers and Millennials are going into debt for healthcare… but what if we told you that this time it’s for their pets! More Americans are spending more money on healthcare for their beloved pets, which means insurance companies are getting in on the action and cashing in! Today we’ll be digging into the wild world of pet insurance and what Peticare for All could mean for our four-legged friends (and zero-legged friends, and more than 4)!









https://youtu.be/HGzTtPLrwWk

























Show Notes







Why talk about pet healthcare? MOSTLY so Gillian and Ben can show off Coretta Scott Cat and Koda the Medicare for All dog. Obligatory cute pet appearances out of the way, Gillian introduces our guest for this episode: Chris Dupuis, DVM is a vet and owner of the Wheatland Animal Hospital in Neighborville Illinois.







Chris definitely saw an uptick in pet ownership during the pandemic. Today, about 70% of US households own at least 1 pet, and Americans are paying a total of $32.3 billion on vet care.







Gillian went down a research rabbit hole, and found that as of 2020 nearly half (47%) of pet owners had gone into debt for their pet, up from 36% in 2019. This average covers a huge generational divide, though: 66% of Gen X'ers have gone into debt for their pets, while only 23% of Baby Boomers have done so.







Chris notes that one reason could be that veterinary costs have gone up a lot over the last generation, much like College tuition. Chris's dad, who founded the clinic, originally charged $8 for an exam in the late 1980s!







For human health, of course most of us turn to health insurance to protect ourselves from large unexpected costs that might leave us in debt. What about pet insurance? Chris explains that pet insurance is very different: pet insurers directly reimburse pet owners for their (allowed) expenses, so vets generally don't get paid directly by insurance companies or have to deal with them at all. In Chris's experience, many of his clients buy pet insurance policies without realizing how little it actually covers, or the restrictions involved (a lot like Medicare Advantage plans!).







So how bad is pet insurance? Virtually no plans will cover pre-existing conditions (which was common in human insurance plans until it was banned by the Affordable Care Act), including breeds that are frequently prone to certain health problems. There is very little regulation of pet insurance, so exclusions, deductibles, and payment limits are rampant. Both premiums and deductibles are often decided by the species, breed, gender, age and location of an animal - older pets in particular are very expensive and difficult to insure.







Because of this, very few people have pet insurance: only 3.5 million (less than 2%) of pets in America were insured in 2020. Chris says that vets themselves are often not very educated on pet insurance options for their clients, in part because there are so many plans and the plan limitations are so complex.







As important background, Chris explains that vets are generally underpaid (combined with massive college debts), and vet techs are EXTREMELY underpaid - sometimes earning barely more than retail workers ($15-$21/hour). This puts vet clinics in a difficult position when they have clients who can't afford to pay for urgent or emergency care for their pets. Unlike human hospitals, which receive some "uncompensated care" funds from the federal government for treating patients who can't pay, vet clinics and hospitals receive no such funds for providing free or charity care, and have very small margins.

Today we’re checking in on the ongoing Pennsylvania Senate race, where Medicare for All–along with crudites, poop tweets, hydroxychloroquine, and Turkish nationalism–has become a hot-button issue. This race is beyond interesting, shading into the bizarre! A lot is at stake, since control over the Senate is going to be hotly contested this midterm election, and this is the most likely seat to flip from Republican to Democrat.









https://youtu.be/nRyxrm0I95c

























Show Notes







The Democratic candidate Lieutenant Gov. John Fetterman is running against none other than Dr. Mehmet Oz, the instantly recognizable daytime talkshow host from Oprah and the Dr. Oz Show. Oz is the Trump-endorsed candidate for the GOP, and he’s been producing attack ads going after Fetterman’s alleged support for “socialized medicine,” but when we dug deep into Oz’s own healthcare plan, we came to some verrrrry interesting and uncomfortable conclusions!







The U.S. Senate is currently split exactly 50-50, with Democrats having the tie-breaking vote of Vice President Kamala Harris. This has ruined just about everything, since it let Joe Manchin and Kyrsten Sinema hold the country hostage. So any contested Senate seat is a potential big deal right now.







Initially, the race was seen as something of a toss-up. BUT THEN, in a surprise move, Donald Trump endorsed Dr. Oz in the Republican primary, giving him the oomph to beat hedge fund exec Dave McCormick. (Surprising because  McCormick’s campaign had many former Trump aides, including Hope Hicks.)







As of this podcast, every single poll shows Fetterman with a sizable lead in the race, a lead that keeps growing: anywhere between 5% and 18%.







So the stakes are high in this race, but we also care because these two candidates have been going after each other’s healthcare platforms… which after taking a very close look, are actually not that far apart.







The Dr. Oz Show provides general health and lifestyle advice, including promoting products to support your health. BUT, his advice is very bad as it turns out: A team of medical researchers at the University of Alberta in 2014 analyzed how many of the recommendations on the Dr. Oz Show were supported by evidence: it turns out, less than half! “evidence supported 46%, contradicted 15%, and was not found for 39%”







That same year (2014), Dr. Oz was called to testify before a Senate hearing looking at false and deceptive advertising for weight-loss products. When he was called out by Sen. Claire McKaskill for promoting fake weight loss cures, he candidly replied: "I actually do personally believe in the items I talk about on the show. I passionately study them. I recognize they don't have the scientific muster to present as fact but nevertheless I would give my audience the advice I give my family all the time and I have given my family these products. Specifically the ones you mentioned, then I'm comfortable with that part.”







In addition to diet pills, he’s promoted a lot of wild shit over the years: the idea that there are deadly levels of Arsenic in apple juice, the claim that most olive oil is fake, the concept of “Reparative Therapy” (to "repair" LGBTQ+ people).







Dr. Oz has reportedly been eyeballing a political career since as far back as 2009. Dr. Oz first jumped into politics when he became enmeshed with the Trump campaign, and then the Trump administration.







His greatest contribution, as far as we can tell, is that he played a major role pushing the Trump administration to grant emergency use authorization for hydroxychloroquine, the fake and dangerous treatment for COVID. And,

Ben discusses the “Inflation Reduction Act,” which was signed into law by President Biden this past week! In last-minute negotiations between Senators Chuck Schumer and Joe Manchin, the Senate finally - after comical failures over and over this past year - passed a VERY scaled-down version of the Build Back Better bill. The “IRA” bill - clearly they intensively focus-grouped that title - is overwhelmingly a package of environmental policies, but does include some healthcare provisions for Medicare recipients.







Joining us today, in a throwback-Monday episode, is Stephanie Nakajima, the Executive Director of Mass-Care: the Massachusetts Campaign for Single Payer Healthcare.









https://youtu.be/IMUYN2p_Ymg

























Show Notes







With Gillian on vacation, Stephanie rejoins to co-host this pod! Stephanie is currently the ED of Mass-Care, the Massachusetts Medicare for All organization, and through a massive grassroots effort they recently put M4A questions on the ballot in TWENTY state representative districts. The questions are non-binding, but powerful tools for convincing elected officials to support Medicare for All, if they don't already.







As any show on the Inflation Reduction Act should, we begin by ridiculing the title of the bill, which has nothing to do with inflation, as well as the "IRA" acronym, which apparently no one thought about?!?







Ben takes a sad walk down memory lane to recap the social provisions that HAD been included in the previous version of this legislation: the Build Back Better bill:







A child tax credit up to $300 per child; child care subsidies; and free universal preschool - all out of the IRA;Paid family leave of up to 4 weeks - out;Tripling the earned income tax credit for low-income workers - out;Much of this was paid for by new taxes on the wealthy, and on big businesses







Stephanie talks about the four things the Medicare for All movement pushed for to be included in Build Back Better:







Let Medicare negotiate prescription drug costs, which should save billions of dollars and help pay for expanding Medicare in several ways, including;Lowering the eligibility age of Medicare to 60, or as low as we can get it;Giving traditional (public) Medicare enrollees an out-of-pocket cap, like most private insurance has; and finallyAdding dental, vision, and hearing benefits to Medicare.







We had success in each of these categories except lowering the age of Medicare under BBB, but did any of this survive under the Inflation Reduction Act? Some!







Here are the healthcare provisions included in the IRA:







DOES allow Medicare to negotiate the prices of some prescription drugs - it starts with just 10 drugs in 2025, then increases to 20 drugs in 2029. (Medicare covers over 3,500 drugs - so less than a half of 1% of drugs will be negotiated!)We did NOT win a general out-of-pocket spending cap for Medicare recipients, but we DID win a couple of more specific caps.The bill creates an OOP prescription drug cap of $2,000 for Medicare recipients starting in 2025.The bill also caps insulin spending at $35/mo. Dems tried to extend this insulin spending cap not just to Medicare recipients, but to everyone in the country, but the Senate parliamentarian said they can’t do that through a reconciliation bill (limited to federal spending and income items).Finally, although this wasn’t one of our priorities in the M4A movement, the ACA subsidies that were expanded by the COVID relief bill, but were scheduled to expire at the end of this year, have been extended three more years.







We had won some dental, vision,

Noted public health expert Lizzo teaches us that “thick thighs save lives,” but for many of us, being fat is killing us – and not for the reasons you might expect.







Today we’re talking about our healthcare system’s impact on fat folks AND how misconceptions about fat folks impact our healthcare policy! Recent studies have shown us two things: A) that weight isn’t the major driver of health that the medical industry has believed it was for a very long time, and B) that treating weight like the end-all-be-all of health actually causes fat folks to avoid seeking care, which leads to some pretty terrible health outcomes.







Our guest Jordan Berg Powers, the Executive Director of Mass Alliance, has helped elect new progressive leaders across the state, recruited progressive champions to run for political office, and trained hundreds of grassroots organizers. Jordan is active in campaigns for saving public education, as well as promoting medicare for all and a more progressive tax system for the Commonwealth.









https://www.youtube.com/watch?v=YzWkJidRSzw











https://www.youtube.com/watch?v=KWBzyG4LLOw&ab_channel=HealthcareNOW

















Noted public health expert Lizzo teaches us that "thick thighs save lives."















Show Notes







Language note: we’re saying fat and not “fluffy,” “curvy,” or “obese.” Fat is just a way of describing people –  like short or tall or red-haired. It may have negative connotations in our culture right now, but a lot of fat folks are working on reclaiming fat as a neutral term. We shouldn’t need euphemisms like “fluffy” to describe what we look like. Obesity is the idea that fatness itself is a disease, which we’re going to be pushing back on throughout this episode!







Jordan and Gillian share their stories about they way society draws conclusions about fat people, including about their intelligence, their cleanliness, and their health. Both have experienced medical appointments where the first thing the doctor said was "have you considered losing weight" no matter the health concern that brought them in. Gillian shares another health concern that took eight years to address because doctors repeatedly blamed her weight for it. Instead of protesting, she accepted what they said, and believed that her pain was her fault and she didn't deserve to feel better until she lost weight.







Jordan explains how the fatphobia he's experienced has been combined with racism. One of those doctors who told him to lose weight said it would be easier if he "stopped eating fried food" like fried chicken, even though he's a vegetarian who rarely eats fried food.







Why is anti-fat bias in healthcare a problem?







When it comes to healthcare, how the least of us is treated, ends up being how the rest of us are treated. Many women report their pain hasn't been believed. Many Black people avoid doctors because they've experienced racism in the healthcare system. Many fat people also avoid doctors after being blamed for their own health problems due to their weight. Their actual health concerns often go untreated, often leading to worse outcomes. The vast majority of Americans (73.6%) are considered overweight, so this isn't an insignificant problem.







The most frustrating part of this approach to medical care is that science doesn't back it up. Lowering weight isn’t a magic bullet. Even if it were, it has become clear to scientists that most people are not capable of losing weight permanently. Body size is largely predetermined by genetics. So it doesn’t make much sense when we go to the doctor and the only treatment plan we get is “lose weight,

In spring of 2007, Michael Moore released a blockbuster documentary showing the extraordinary damage the U.S. healthcare system inflicts upon ordinary Americans. Story by story, SiCKO pulled back the veil of how ordinary illness and injury, when paired with deadly healthcare profiteering, leads to suffering, financial ruin, and even death.







15 years later, together with our friends at Progressive Democrats of America, we are bringing together the patients featured in SiCKO, whose extraordinary stories impacted Congress, shaped the Affordable Care Act, and helped to launch the modern Medicare for All movement.

















https://www.youtube.com/watch?v=vqRCZhx_280

















Show Notes







Our guests today are:







Donna Smith and husband Larry experienced financial ruin after multiple health crises forced them into medical debt, bankruptcy, and the loss of their home.Adrian (Campbell) Montgomery, despite being fully insured, had to drive to Canada to get affordable treatment for cervical cancer. Reggie Cervantes was a 9/11 first responder who has suffered from lung issues caused by her lifesaving work in New York City.Lee Einer was a health insurance company “hit man,” whose role was to find any loophole to avoid paying large medical bills. Since then he's become a whistleblower, shining a light on fraud and dirty tricks by the healthcare industry.







SiCKO was released just in time to have a major impact on the 2008 Presidential elections, and - I think - really helped push healthcare to the top of the agenda within the Democratic Party, which won the Presidency, the House, and the Senate. This led to the Affordable Care Act, which although it preserved the profits of the healthcare industry and was FAR short of a just or affordable system, addressed exactly some of the health insurance industry’s most disgusting practices that were featured in the film.







Aside from the ACA, the film was also a major event in the Medicare for All social movement, which grew tremendously across the country. Gillian shares how the film convinced her that her struggles with the healthcare system wasn't just a personal problem, but a systemic problem for the whole nation. That launched her into healthcare justice organizing.







Thanks in large part to SiCKO pulling back the curtain on the worst behaviors of the insurance industry, a number of those practices were banned by the Affordable Care Act, including:







Denying coverage to people with pre-existing conditions;Recissions (retroactively canceling your insurance coverage); andLifetime caps or annual caps on coverage.







Has anything changed for our guests?







Donna shares that without the ACA she would never have been insurable, and her health forced her to leave the job that provided her with employer insurance. The expansion of Medicaid was also a huge step for people without insurance. But since then, we've seen the insurance companies make even more money, and we're facing more attacks, including the efforts to privatize Medicare. The biggest change for Donna is that she has aged into Medicare, and now knows the security of having coverage.







With her previous cancer diagnoses, Adrian acknowledges that due to the ACA ban on denying coverage to patients with pre-existing conditions, she's insurable, but not much else has changed. Her insurance company vetoed her doctor's plan of care for her third bout with cancer, and made her go through a different surgery before they'd cover the hysterectomy her doctor determined she needed. She almost died during that surgery, and after all of that, it wasn't successful.

https://www.youtube.com/watch?v=Bd21JObzQeI

























Show Notes







Today we venture into the bizarro world of Medicare (the program serving those 65 and older as well as some people with disabilities) to explore the largest Medicare rate hike in history. Our guest Alex Lawson, the Executive Director of Social Security Works, will help explain what's happening. Social Security Works is the convening member of the Strengthen Social Security Coalition, which represents over 50 million Americans. SSW fights to protect and expand Social Security, Medicare, Medicaid, and to lower prescription drug prices.







Today we venture into the bizarro world of Medicare (the program serving those 65 and older as well as some people with disabilities) to explore the largest Medicare rate hike in history. Our guest Alex Lawson, the Executive Director of Social Security Works, will help explain what's happening. Social Security Works is the convening member of the Strengthen Social Security Coalition, which represents over 50 million Americans. SSW fights to protect and expand Social Security, Medicare, Medicaid, and to lower prescription drug prices.







Today we’re talking about the massive increases in Medicare Part B (physician and outpatient services) premiums for this year. Hospital care is called Part A, and once you’re eligible for Medicare you can get hospital coverage automatically. BUT for Part B, you have to pay a monthly premium - just like a private health insurance plan. There’s a super shady history behind this! 







The origins of the Part B premium go back to the Jim Crow era. When Medicare was first implemented, some in the South feared that Federal law would require the integration of physician offices. By requiring a premium, Part B would be a "voluntary" program and integration requirements wouldn't apply. This allowed physician offices (as well as nursing homes) to remain segregated much longer than hospitals.







In 2022 Medicare Part B premium rose 14.5%, from $148.50 to $170.10 PER MONTH ($21+ increase), and the annual deductible rose from $203 to $233. For perspective, the Part B premium was less than $50 back in 2000, and there was only a $3.90 increase last year. This is the LARGEST premium price hike in Medicare history.







For most American seniors, those premiums are deducted right out of their Social Security checks. For an American senior who depends on Social Security benefits of an average of $19,000 a year, those increases mean a significant cut to their income. A senior living on an income 175% of the poverty level will spend nearly 9% of his/her income this year on Part B alone.







This comes down to Biogen's new Alzheimer's drug, Aduhelm. Regardless of the fact that this drug failed, Biogen put all their eggs in the Aduhelm basket. They corrupted the Food and Drug Administration (FDA) to get it approved, despite the fact there is no evidence it is effective and it can actually cause brain bleeds and death.







Aduhelm is so expensive that it accounts for at least 50% of the Part B premium increase.  







The drug itself initially cost $56,000(!) for one person; the price was slashed in half by Biogen because of low demand. The other costs associated with the treatment are charges for the infusion of the drug and charges for the regular brain scans that are required while taking the drug. Those brain scans are to monitor progress of the treatment, but also to make sure your brain isn’t swelling up, which is a side effect 35% of clinical trial participants experienced.







It’s estimated that only a small fraction of Medicare beneficiaries will use this drug, which, remember, doesn't work.