As US Bumps In opposition to Debt Ceiling, Medicare Turns into a Bargaining Chip

The Host

Julie Rovner


Learn Julie’s tales.

Julie Rovner is chief Washington correspondent and host of KHN’s weekly well being coverage information podcast, “What the Well being?” A famous skilled on well being coverage points, Julie is the writer of the critically praised reference guide “Well being Care Politics and Coverage A to Z,” now in its third version.

Whereas repealing the Inexpensive Care Act appears to have fallen off congressional Republicans’ to-do record for 2023, plans to chop Medicare and Medicaid are again. The GOP desires Democrats to agree to chop spending on each packages in alternate for a vote to forestall the federal government from defaulting on its money owed.

In the meantime, the nation’s well being care staff — from nurses to docs to pharmacists — are feeling the pressure of caring not only for the rising variety of insured sufferers searching for care, but additionally extra severely sick sufferers who’re troublesome and typically even violent.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico, Tami Luhby of CNN, and Victoria Knight of Axios.


Joanne Kenen
Johns Hopkins Bloomberg College of Public Well being and Politico


Read Joanne’s stories

Tami Luhby


Read Tami’s stories

Victoria Knight


Read Victoria’s stories

Among the many takeaways from this week’s episode:

  • Conservative Home Republicans are hoping to capitalize on their new legislative clout to slash authorities spending, because the struggle over elevating the debt ceiling provides a preview of doable debates this 12 months over pricey federal entitlement packages like Medicare.
  • Home Speaker Kevin McCarthy mentioned Republicans will shield Medicare and Social Safety, however the elevation of conservative firebrands — like the brand new chair of the highly effective Home Methods and Means Committee — raises questions on what “defending” these packages means to Republicans.
  • Report numbers of People enrolled for insurance coverage protection this 12 months beneath the Inexpensive Care Act. Years after congressional Republicans final tried to repeal it, the as soon as extremely controversial program also called Obamacare seems to be following the trajectory of different established federal entitlement packages: evolving, rising, and turning into much less controversial over time.
  • Latest stories present that whereas People had much less bother paying for well being care final 12 months, many nonetheless delayed care as a consequence of prices. The findings spotlight that being insured shouldn’t be sufficient to maintain care inexpensive for a lot of People.
  • Well being care staff are rising louder of their requires higher staffing, with a nursing strike in New York Metropolis and up to date stories about pharmacist burnout offering a number of the newest arguments for the way widespread staffing points could also be harming affected person care. There’s bipartisan settlement in Congress for addressing the nursing scarcity, however what they’d do is one other query.

Plus, for further credit score, the panelists advocate their favourite well being coverage tales of the week that they suppose it is best to learn, too:

Julie Rovner: Roll Name’s “NIH Missing Top Leadership at Start of a Divided Congress,” by Ariel Cohen

Tami Luhby: CNN’s “ER on the Field: An Inside Look at How NFL Medical Teams Prepare for a Game Day Emergency,” by Nadia Kounang and Amanda Sealy

Joanne Kenen: The Atlantic’s “Don’t Fear the Handshake,” by Katherine J. Wu

Victoria Knight: The Washington Publish’s “‘The Last of Us’ Zombie Fungus Is Real, and It’s Found in Health Supplements,” by Mike Hume

Additionally talked about on this week’s podcast:

The New York Instances’ “As France Moves to Delay Retirement, Older Workers Are in a Quandary,” by Liz Alderman

Stat’s “Congressional Medicare Advisers Warn of Higher Drug Prices, Despite New Price Negotiation,” by John Wilkerson

Click on to Broaden

Episode 280 Transcript

KHN’s ‘What the Well being?’Episode Title: As US Bumps In opposition to Debt Ceiling, Medicare Turns into a Bargaining ChipEpisode Quantity: 280Printed: Dec. 19, 2023

Tamar Haspel: A number of us need to eat higher for the planet, however we’re not at all times certain methods to do it. I’m Tamar Haspel.

Michael Grunwald: And I’m Michael Grunwald. And that is “Climavores,” a present about consuming on a altering planet.

Haspel: We’re right here to reply every kind of questions. Questions like: Is pretend meat actually an excellent different to beef? Does native meals really matter?

Grunwald: You may comply with us or subscribe on Stitcher, Apple Podcasts, Spotify, or wherever you hear.

Julie Rovner: Hi there! Welcome again to KHN’s “What the Well being?” I’m Julie Rovner, chief Washington correspondent at Kaiser Well being Information. And I’m joined by a number of the finest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 19, at 10 a.m. As at all times, information occurs quick, and issues may need modified by the point you hear this. So right here we go. At this time we’re joined through video convention by Joanne Kenen of the Johns Hopkins Bloomberg College of Public Well being and Politico.

Joanne Kenen: Good morning, all people.

Rovner: Tami Luhby of CNN.

Tami Luhby: Good morning.

Rovner: And Victoria Knight of Axios.

Victoria Knight: Good morning.

Rovner: So Congress is in recess this week, however there may be nonetheless loads of information, so we’ll get proper to it. The brand new Congress is taking a breather for the MLK vacation, having labored very exhausting the primary two weeks of the session. However there’s nonetheless lots occurring on Capitol Hill. Late final week, Home Republicans leaked to The Washington Publish a plan to pay solely a number of the nation’s payments if the standoff over elevating the debt ceiling later this 12 months ends in the U.S. really defaulting. Republicans say they gained’t agree to lift the debt ceiling, one thing that’s been achieved each couple of years for many years, until Democrats comply with deep spending cuts, together with for entitlement packages like Social Safety, Medicare, and Medicaid — why we are speaking about this. Democrats say {that a} default, even a partial one, might set off not only a disaster in U.S. monetary markets, however presumably a worldwide recession. It’s price remembering that the final time the U.S. neared a default however didn’t really get there, in 2011, the U.S. nonetheless bought its credit standing downgraded. So who blinks on this standoff? And, Tami, what occurs if no one does?

Luhby: That’s going to be a serious drawback for lots of people. I imply, the U.S. financial system, doubtlessly the worldwide financial system, world monetary markets, but additionally sensible issues like Social Safety recipients getting their funds and federal staff within the navy getting paid, and Treasury bond holders getting their curiosity funds. So it will be an enormous mess. [Treasury Secretary Janet] Yellen final week in her letter to [House Speaker Kevin] McCarthy, signaling that we had been going to hit the debt ceiling, doubtless right this moment, urged Congress to behave shortly. However as an alternative, after all, what simply occurred was they dug their heels in on both aspect. So, you recognize, we have now the Republicans saying that we are able to’t preserve spending like we’re. We don’t have simply a vast bank card. We’ve to vary our habits to save lots of the nation sooner or later. And the White Home and Senate Democrats saying this isn’t a negotiable topic. You understand, we’ve been right here earlier than. We haven’t really crossed the road earlier than. So we’ll see what occurs. However one of many variations is, this 12 months, that McCarthy has a really slender margin within the Home. Any certainly one of his members — that is among the many negotiations that he didn’t need to comply with however needed to after 15 rounds of voting for his job — any member could make a movement to vacate the speaker’s chair. And if that occurs, then we don’t have to fret in regards to the debt ceiling as a result of we have now to fret extra about who’s going to be main the Home, as a result of we are able to’t cope with the debt ceiling till we even have somebody main the Home. So that is going to be much more sophisticated than previously.

Rovner: Simply to be clear, even when we hit the debt ceiling right this moment, that doesn’t imply we’re going to default, proper? I imply, that’s not coming for a number of months.

Luhby: Proper. So Social Safety, seniors and other people with disabilities, and the navy and federal staff don’t should but fear about their funds. They’re going to be paid. The Treasury secretary and Treasury Division will take what’s known as “extraordinary measures.” They’re primarily simply behind-the-scenes accounting maneuvers. They gained’t really harm anyone. Yellen had mentioned that she expects these extraordinary measures in money to final at the least till early June, though she did warn that the forecast has appreciable uncertainty, as does the whole lot across the debt ceiling.

Rovner: So, Victoria, clearly, the perimeters are shaping up. Is that this going to be the large main well being struggle this 12 months?

Knight: I feel it’s going to be one of many huge matters that we’re undoubtedly speaking about this 12 months in Congress. I feel it’s going to be a dramatic 12 months, as we’ve already seen in these first two weeks. My colleagues at Axios, we talked to some Republicans final week, asking them about: Do you really suppose they’ll make cuts to entitlement packages, to Medicare, Medicaid? Is that lifelike? It’s sort of a combined bag. Some are like, yeah, we must always have a look at this, and a few are like, we don’t actually need to contact it. I feel they understand it’s actually a sensitive topic. There are plenty of Medicare beneficiaries that don’t need the age enhance. You understand, there’s some discuss of accelerating the age to 67 quite than 65. They know that may be a sensitive topic. Final week in a press convention, McCarthy mentioned, “We’re Republicans; we’ll shield Medicare and Social Safety,” in order that they know individuals are speaking about this. They know individuals are taking a look at it. So I feel in a divided authorities, clearly, the Senate is in Democratic management. I feel it appears fairly unlikely, however I feel they’re going to speak about it. And we have now a brand new Methods and Means chairman, Jason Smith from Missouri. He’s sort of a firebrand. He’s talked about eager to do reform on the U.S. spending. So I feel it’s one thing they’re going to be speaking about. However I don’t know if that a lot will really occur. So we’ll see. I’ve been speaking to Republicans on what else they need to work on this 12 months in Congress. I feel an enormous factor can be PBM [pharmacy benefit managers] reform. It’s an enormous matter that’s really bipartisan. So I feel that’s one thing that we’ll see. These are the middlemen with regard to between pharmacies and insurers. And so they’re negotiating drug costs. And we all know there are going to be hearings on that. I feel well being care prices. There’s some speak about fentanyl, scheduling. However I feel with regard to huge well being care reform, there in all probability isn’t going to be rather a lot, as a result of we’re in a divided authorities now.

Kenen: Only one factor about how individuals speak about defending Medicare and Social Safety, it doesn’t imply they don’t need to make adjustments to it. We’ve been by this earlier than. Entitlement reform was the driving power for Republicans for fairly just a few years beneath … when Paul Ryan was each, I suppose it was funds chair earlier than he was speaker. I imply, that was the factor, proper? And he needed to make very dramatic adjustments to Medicare, however he known as it defending Medicare. So there’s nobody like Ryan with a coverage actually driving what it ought to appear to be. I imply, he had a plan, but the plan by no means bought by anyplace. It died, nevertheless it was an animating power for a few years. It went away for a minute within the face of the final 10 years that had been in regards to the Inexpensive Care Act. So I don’t suppose they’re clear on what they need to do. However we do know some conservative Republicans need to make some sort of adjustments to Medicare. TBD.

Rovner: And Tami, we all know the debt ceiling isn’t the one place the place Home Republicans are setting themselves up for deep cuts that they may not be capable to make whereas nonetheless giving themselves the power to chop taxes. They finessed a few of this of their guidelines package deal, didn’t they?

Luhby: Sure, they did. And so they made it very clear that they, within the guidelines, they made it tougher to lift taxes. They elevated it to a supermajority, 3/5 of the Home. They made it simpler to chop spending within the debt ceiling and elsewhere. And, you recognize, the debt ceiling isn’t our solely difficulty that we have now developing. It’s going to be proper across the similar time, typically, possibly, because the fiscal 2024 funds, which can necessitate dialogue on spending cuts and will end in spending cuts and adjustments presumably to a few of our favourite well being packages. So we are going to see. But additionally simply getting again to what we had been speaking about with Medicare. Bear in mind, the trustees estimate that the belief fund goes to expire of cash by 2028. So we’ll see in a few months what the most recent forecast is. However, you recognize, one thing must be achieved comparatively quickly. I imply … the years preserve inching out slowly. So we preserve with the ability to put this off. However in some unspecified time in the future …

Rovner: Yeah, we preserve attending to this kind of brinksmanship, however no one, as Joanne factors out, ever actually has a plan as a result of it will be unpopular. Talking of which, whereas reducing entitlement packages right here continues to be only a speaking level, we have now sort of a real-life cautionary story out of France, the place the retirement age could also be raised from 62 to 64, which continues to be youthful than the 67, the U.S. retirement age is marching towards. Evidently an unintended consequence of what’s going on in France is that employers don’t need to rent older staff. So now they’ll’t get retirement and they’ll’t discover a job. And at the moment, solely half of the French inhabitants continues to be employed by age 62, which is means decrease than different members of the European Union. France is taking a look at protests and strikes over this. Might the identical factor occur right here, if we would get to that time? It’s been some time since we’ve seen the silver-haired set out on the road with picket indicators.

Knight: I feel it will be fairly contentious, I feel, in the event that they determine to really increase the age. It’ll be fascinating to see [if] there are precise protests, however I feel individuals can be very upset, for certain, particularly individuals reaching retirement age having counted on this. So …

Kenen: They in all probability wouldn’t do it like … when you’re 62, you wouldn’t [go] to 67. After they’ve talked about these sorts of adjustments previously, they’ve talked about phasing it in over numerous years or beginning it within the …

Rovner: Proper, affecting individuals sooner or later.

Kenen: Proper.

Rovner: However I’m considering not simply elevating the retirement age. I’m considering of creating precise huge adjustments to Medicare and even Medicaid.

Kenen: Nicely, there’s two issues because the final debate about this. Nicely, initially, Social Safety was raised and it didn’t trigger … it was raised slowly, a few months at a time over, what, a 20-year interval. Is that proper? Am I remembering that proper, Julie?

Rovner: Yeah, my retirement age is 66 and eight months.

Kenen: Proper. So … it was 65. And so they’ve been going, like, 65 and one month, 65 and two months. It’s crept up. And that was achieved on a bipartisan foundation, which, after all, not an entire lot is trying very bipartisan proper now. However I imply, that’s the opposite pathway we might get. We might get a fee. We might transfer towards some sort of adjustments after … final time there was a fee that failed, however the Social Safety fee did work. The final Medicare fee didn’t. The 2 sides are so intractable and to this point aside on debt proper now that there’s in all probability going to should be some sort of saving grace down the highway for any person. So it may very well be one more fee. And likewise in 2011, 2012, which was the final time there was the large debate over Medicare age, was pre-ACA [Affordable Care Act] implementation. And, you recognize, when you’re 65 and also you’re not working, in the event that they do change the Medicare within the out years, it’s sophisticated what it will do to the chance swimming pools and premiums and all that. However you do have an possibility. I imply, the Inexpensive Care Act would … proper now you solely get it to Medicare. That must be modified. So it’s not completely the identical … I’m not advocating for this. I’m simply saying it’s a barely totally different world of choices and the chessboard’s a bit totally different.

Rovner: Nicely, clearly, we aren’t there but, though we could also be there within the subsequent couple of months. Lastly, on the brand new Congress entrance. Final week, we talked about a number of the new committee chairs within the Home and Senate. This week, Home Republicans are filling out a few of these essential subcommittee chairs. Rep. Andy Harris, a Republican from Maryland who’s additionally an anesthesiologist who bragged about prescribing ivermectin for covid, will chair the Appropriations subcommittee answerable for the FDA’s funds [the Agriculture, Rural Development, Food and Drug Administration subcommittee]. Issues might get sort of fascinating there, proper?

Knight: Yeah. And there may be discuss that he needed to chair the Labor [Health and Human Services, Education] subcommittee, which might have been actually fascinating. He’s not.

Rovner: Which might’ve been the relaxation of HHS. We should always level out that on the planet of appropriations, FDA is with Agriculture for causes I as soon as tried to determine, however they return to the late Forties. However the remainder of HHS is the Labor HHS Appropriations subcommittee, which he gained’t chair.

Knight: Proper, he’s not. Rep. Robert Aderholt is chairing Labor HHS. However that is, as we had been speaking about, they’re going to should fund the federal government. Republicans are speaking about eager to go 12 appropriations payments. If they really need to attempt to try this, they’re going to should do plenty of negotiations on what goes into the Labor HHS invoice, what goes into the AG invoice with FDA, with these chairs over the subcommittees, they’re going to need sure issues in there. They’re going to possibly need oversight of those companies, particularly with regard to what’s occurring with covid, what’s occurring with the abortion capsules. So I feel it’ll be actually fascinating to see what occurs. It appears unlikely they’re really going to have the ability to go 12 appropriations payments, nevertheless it’s simply one other factor to observe.

Rovner: I’d level out that each single Congress, Republican and Democrat, is available in saying, we’re going to return to common order. We’re going to go the appropriations payments individually, which is what we had been imagined to do. I imagine the final time that they handed individually, and that wasn’t even all of them, was the 12 months 2000; it was the final 12 months of President [Bill], it may need been. It was undoubtedly proper round then. After I began overlaying Congress, they at all times did all of it individually, however no extra.

Luhby: And so they need to go the debt ceiling vote individually.

Rovner: Proper, precisely. Not that a lot occurring this 12 months. All proper. Nicely, final week we talked about medical insurance protection. Now it’s official. Obamacare enrollment has by no means been larger and there are nonetheless a number of weeks to go to enroll in some states, though enrollment by the federal market ended for the 12 months on Sunday. Tami, have we lastly gotten to the purpose that this program is simply too huge to fail or is it at all times going to hold by a political thread?

Luhby: Nicely, I feel the truth that we’re all not reporting on the weekly or biweekly enrollment numbers, saying “It’s in style, individuals are nonetheless signing up!” or beneath the Trump years, “Fewer individuals are signing up and it’s misplaced curiosity.” I feel that in and of itself could be very indicative of the truth that it’s turning into a part of our well being care system. And I imply, I suppose someday I’m not going to put in writing the story that claims enrollment opens on Nov. 1, then one other one that claims it’s ending on Jan. 15.

Rovner: I feel we’ll at all times do this as a result of we’re nonetheless doing it with Medicare.

Luhby: Nicely, however I’m not. So … it’s doable, though now with Medicare Benefit, I feel it’s really price a narrative. In order that’s a separate difficulty.

Rovner: Sure, that may be a separate difficulty.

Luhby: However yeah, no, I imply, you recognize, I feel it’s right here to remain. We’ll see what [District Judge Reed] O’Connor does in Texas with the preventive therapy, however …

Rovner: Sure, there’ll at all times be one other lawsuit.

Luhby: There can be chips across the edges.

Kenen: I imply, this courtroom has achieved … all of us thought that litigation was over, like we thought, OK, it’s achieved. They’ve … upheld it, you recognize, nevertheless many instances, transfer on. However this Supreme Courtroom has achieved some fairly dramatic rulings and never simply Roe [v. Wade], on many public well being measures, about gun management and the surroundings and vaccine mandates. And, after all, you recognize, clearly, Roe. Do I feel that there’s going to be one other enormous existential risk to the ACA arising out of this preventive care factor? No, however we didn’t suppose plenty of the issues that the Supreme Courtroom would do. There’s an actual ideological shift in how they strategy these points. So politically, no, we’re not going to see extra repeal votes. Within the wings might there be extra authorized points to chew us? I don’t suppose it’s doubtless, however I wouldn’t say by no means.

Rovner: In different phrases, simply because congressional Republicans aren’t nonetheless harping on this, it doesn’t imply that no one is.

Kenen: Proper. However it’s additionally, I imply, I agree with Tami … I wrote an analogous story a 12 months in the past on the tenth anniversary: It’s right here. They spent plenty of political capital making an attempt to repeal it and so they couldn’t. Folks do depend on it and extra … Biden has made enhancements to it. It’s like each different American entitlement: It evolves over time. It will get greater over time. And it will get much less controversial over time.

Rovner: Nicely, we nonetheless have issues with well being care prices. And this week we have now two kind of contradictory research about well being care prices. One from the Facilities for Illness Management and Prevention discovered a three-percentage-point decline within the variety of People who had bother paying medical payments in 2021 in comparison with the pre-pandemic 12 months of 2019. That’s doubtless a results of further pandemic funds and extra individuals with medical insurance. However in 2022, in response to a survey by Gallup, the 38% of sufferers reported they delayed care due to price. That was the largest enhance ever since Gallup has been protecting monitor over the previous 20 years, up 12 share factors from 2020 and 2021. This has me scratching my head a bit bit. Is it possibly as a result of though extra individuals have insurance coverage, which we noticed from the earlier 12 months. Additionally extra have high-deductible well being plans. So maybe they don’t need to exit and spend cash or they don’t have the cash to spend initially on their well being care. Anyone bought one other idea? Victoria, I see you kind of nodding.

Knight: I imply, that’s sort of my idea is, like, I feel they simply have high-deductible plans, in order that they’re nonetheless having to pay rather a lot out-of-pocket. And I do know my brother needed to get an ACA plan as a result of he’s interning for an electrician and — so he doesn’t have insurance coverage on his personal, and I do know that, like, it’s nonetheless fairly excessive and he simply has to pay rather a lot out-of-pocket. He’s had medical debt earlier than. So though extra individuals have medical insurance, it’s nonetheless an enormous difficulty, it doesn’t make that go away.

Rovner: And talking of excessive medical costs, we’re going to speak about prescribed drugs as a result of you’ll be able to’t actually speak about excessive costs with out speaking about medicine. Stat News reports this week that a number of the members of the Medicare Cost Advisory Committee, or MedPAC, are warning that even with the adjustments to Medicare which are designed to economize on medicine for each the federal government and sufferers — these are ones taking impact this 12 months — we must always nonetheless count on very excessive costs on new medicine. Partly that’s as a result of new Medicare cap on drug prices for sufferers. If insurers should cowl even the costliest medicine, other than these few whose value can be negotiated, then sufferers can be extra doubtless to make use of them and so they can set the worth larger. Are we ever going to have the ability to get a deal with on what the general public says persistently is its greatest well being spending headache? Victoria, you sort of previewed this with the speak about doing one thing in regards to the middlemen, the PBMs.

Knight: Yeah, I feel it’s actually troublesome. I imply, the drug pricing provisions, they solely goal 20 of the highest-cost medicine. I can’t keep in mind precisely how they decide it, nevertheless it’s solely 20 medicine and it’s carried out over years. So it’s nonetheless leaving out plenty of medicine. We nonetheless have years to go earlier than it’s really going into impact. And I feel drugmakers are going to attempt to discover methods round it, elevating the costs of different medicine, you’re speaking about. And though they’re harm by the IRA [Inflation Reduction Act], they’re not fully down and out. So I don’t know what the reply is to rein in drug costs. I feel possibly PBM reform, as I mentioned, undoubtedly a bipartisan difficulty. This Congress … I feel will even have possibly some motion and we’ll see if really laws might be handed. However I do know they need to speak about it. So, I imply, that might assist a bit bit. However I feel drugmakers are nonetheless an enormous motive for lots of those prices. And so it gained’t fully go away even when PBMs have some reforms.

Rovner: And definitely the American public sees drug prices as one of many greatest points simply because so many People use prescribed drugs. In order that they see each greenback.

Knight: Sure.

Rovner: So the excellent news is that extra individuals are gaining access to medical care. The unhealthy information is that the workforce to maintain them is burned out, offended, and easily not giant sufficient for the duty at hand. The individuals who’ve been most outspoken about which are the nation’s nurses, who’ve given nearly all of the care through the pandemic and brought nearly all of affected person anger and frustration and typically even violence. We’re seeing fairly just a few nurses’ strikes recently, and so they’re principally not placing for larger wages, however for extra assist. Tami, you talked to some nurses on the picket line in New York final week. What did they let you know?

Luhby: Yeah, I had a enjoyable task final week. Since I stay within the Bronx, I spent two days with the placing nurses on the Montefiore Medical Heart, and there have been 7,000 nurses at Mount Sinai Hospital in Manhattan and Montefiore within the Bronx that went on strike for 3 days. It was a celebration ambiance there a lot of the time, however they did have critical considerations that they needed to relay and get their phrase out. There was plenty of media protection as nicely. Their major difficulty was staffing shortages. I imply, the nurses advised me about horrible working situations, notably within the ER. A few of them needed to put infants on towels on the ground of the pediatric ER or inform sick adults that they’ve to face as a result of there aren’t even chairs out there within the grownup ER, a lot much less beds or cots. And each day, they feared for his or her licenses. One mentioned that she would fall asleep proper when she bought house as a result of she didn’t need to take into consideration the day as a result of she was involved she may not need to return the subsequent day. And he or she mentioned, heartbreakingly, that she was uninterested in apologizing to households and sufferers, that she was stretched too skinny to ship higher care, that she was giving sufferers their medicines late as a result of she had seven different sufferers she needed to give medication to and doubtless deal with an emergency. So the nurses at Montefiore, curiously, they’re demanding staffing. However one factor they saved repeating to me, you recognize, the leaders, was that they needed enforcement capacity of the staffing. They didn’t simply need paper staffing ratios, and so they needed to be extra concerned in recruitment. Whereas the hospitals — curiously, this isn’t essentially over in New York because it in all probability gained’t be elsewhere. These hospitals reached a tentative settlement with the unions, however there’s one other battle brewing. The nurses’ contract for the general public hospital system expires on March 2, and the union is already warning that can demand higher pay and staffing.

Rovner: Yeah. Nicely, it’s not simply the nurses, although. Medical doctors are burnt out by offended and typically ungrateful sufferers. Medical doctors in coaching, too. And I noticed one story this week about how pharmacists, who’re being requested to do increasingly more with no extra assist — an analogous story — are getting fried from coping with short-tempered and typically abusive sufferers. Is there any answer to this, aside from individuals making an attempt to behave higher? Is Congress taking a look at methods to buttress the well being care workforce? This can be a huge drawback. You understand, they talked about, after they had been passing the Inexpensive Care Act, that when you’re going to present all these individuals extra insurance coverage, you’re going to wish extra well being care professionals to maintain them.

Knight: Yeah.

Rovner: But we haven’t appeared to try this.

Knight: Yeah, I do know. It’s one thing that’s being talked about. My colleague Peter [Sullivan] at Axios talked to each Sen. [Bernie] Sanders and Sen. [Bill] Cassidy about issues they may need to work on on the HELP [Health, Education, Labor & Pensions] Committee. And I do know that the nursing workforce scarcity is one factor they do really agree on. So it’s undoubtedly doable. I do suppose the medical supplier workforce scarcity is possibly a bipartisan space on this Congress that they may work on. However I imply, they’ve been speaking about it ceaselessly. And can they really do one thing? I’m undecided. So we’ll see. However I do know nursing …

Rovner: Yeah, the spirit of bipartisanship doesn’t appear to be alive and nicely, at the least but, on this Congress.

Knight: Yeah, nicely, between the Home and the Senate. Yeah, nicely, we’ll see.

Kenen: However the nursing scarcity is, I imply, been documented and talked about for a lot of, a few years now and hasn’t modified. The physician scarcity is extra controversial as a result of there’s some debate about whether or not it’s numbers of docs or what specialties they go into. I imply, and, additionally, do they go to wealthy neighborhoods or poor neighborhoods? I imply, when you’re in a rich suburb, there’s loads of dermatologists. Proper? However in rural areas, sure city areas … So it’s not simply in amount. It’s additionally an allocation each by geography and specialty. A few of that Congress might theoretically cope with. I imply, the graduate medical schooling residency cost … they’ve been speaking about reforming that since earlier than half of the individuals listening to this had been born. There’s been no decision on a path ahead. So a few of these are issues that Congress can nudge or repair with funding. A few of it’s simply issues that should occur throughout the medical group, some cultural shift. Additionally scholar debt. I imply, one motive individuals begin out saying they’re going to enter major care and find yourself being orthopedic surgeons is their debt. So it’s sophisticated. A few of it’s Congress. Not all of it’s Congress. However Congress has been speaking about this for a really, very, very, very, very very long time.

Rovner: I’ll level out — and Joanne was with me when this occurred — when Congress handed the Balanced Funds Act in 1997, they lower the variety of residencies that Medicare would pay for with the promise — and I imagine that is within the report, if not within the laws — that they’d create an all-payer program to assist pay for graduate medical schooling by the subsequent 12 months, 1998. Nicely, now it’s 2023, and so they by no means did that.

Kenen: They meant the subsequent century.

Rovner: We’re a fifth — nearly 1 / 4 of the way in which — by the subsequent century, and so they nonetheless haven’t achieved it.

Kenen: And when you had been on the entrance traces of covid, the docs and the nurses, I imply, in the beginning they’d no instruments. So many individuals died. They didn’t know methods to deal with it. There have been so many sufferers, you recognize, in New York and different locations early on. I imply, it was these nurses that had been holding iPads so that individuals might say goodbye to their family members. I don’t suppose any of us can actually perceive what it was wish to be in that scenario, not for 10 minutes, however for weeks and time and again …

Rovner: And months and years, in some instances.

Kenen: Proper. However I imply, the actually unhealthy … it’s years. However these crunches, the actually traumatic experiences, I imply, we’ve additionally talked previously in regards to the suicide price amongst well being care suppliers. It’s been not simply bodily exhausting, it’s grow to be emotionally unimaginable for these of us who haven’t been in these ICU or ERs.

Rovner: Nicely, it’s clear that the pandemic experiences have created a psychological well being disaster for lots of people. Clearly, individuals on the entrance traces of well being care, but additionally a lot of different individuals. This week, lastly, a bit bit of excellent information for at the least one inhabitants. Beginning this week, any U.S. navy veteran in a psychological well being disaster can get free emergency care, not simply at any VA [Department of Veterans Affairs] facility, however at any non-public facility as nicely. They don’t even should be within the VA well being system as a result of many former members of the navy aren’t really eligible for VA well being care. That is for all veterans. It’s really the results of a regulation handed in 2020 and signed by then-President [Donald] Trump. How a lot of distinction might this modification, at the least, make? I imply, veterans in suicidal crises are additionally, sadly, pretty widespread, aren’t they?

Kenen: Yeah, however I imply, we have now a supplier scarcity, so giving them better entry to a system that doesn’t have sufficient suppliers, I imply, will it assist? I’d assume so. Is it going to repair the whole lot? I’d assume not. You understand, we don’t have sufficient suppliers, interval. And there are sophisticated causes for that. And that’s additionally … they’re not all docs. They’re, you recognize, psychologists and social staff, and so on. However that’s an enormous drawback for veterans and each human being on Earth proper now. I imply, all people was traumatized. There’s levels of how a lot trauma individuals had, however no one was untraumatized by the final three years. And the continuing stresses. You might be well-adjusted traumatized. You may be in-crisis traumatized. However we’re all on that spectrum of getting been traumatized.

Knight: Yeah.

Rovner: Nicely, heaps extra work to do. OK. That’s the information for this week. Now it’s time for our extra-credit section, the place we every advocate a narrative we learn this week we predict it is best to learn, too. Don’t fear when you miss it; we are going to publish the hyperlinks on the podcast web page at and in our present notes in your telephone or different cellular gadget. Victoria, why don’t you go first this week?

Knight: The story that I’m recommending is named “‘The Last of Us’ Zombie Fungus Is Real, and It’s Found in Health Supplements.” It’s in The Washington Publish by Mike Hume. “The Final of Us” is a brand new HBO present everybody’s sort of speaking about. And, principally, individuals grow to be zombies from this fungus. Seems that fungus is actual in actual life. It’s unfold by bugs that principally infect individuals after which sort of take over their minds after which shoot little spores out. And within the present, they do this as nicely, besides they don’t unfold by spores. They unfold by bites. However it’s utilized in well being dietary supplements for various issues like power, stamina, immune increase. So it’s sort of only a enjoyable little dive right into a real-life fungus.

Rovner: To be clear, it doesn’t flip individuals into zombies.

Knight: Sure. To be clear, it doesn’t flip individuals into zombies. In the event you eat it, that won’t occur to you. However it’s based mostly on a real-life fungus that does infect bugs and make them zombies.

Rovner: Sure. [laughter] It’s undoubtedly creepy. Tami.

Luhby: My story is by my implausible CNN colleagues this week. It’s known as “ER on the Field: An Inside Look at How NFL Medical Teams Prepare for a Game Day Emergency.” It’s by my colleagues Nadia Kounang, Amanda Sealy, and Sanjay Gupta. Pay attention, I don’t know something about soccer, however I occurred to be watching TV with my husband once we flipped to the channel with the Payments-Bengals recreation earlier this month, and we noticed the ambulance on the sphere. So like so many others, I used to be carefully following the story of Damar Hamlin’s progress. What we heard on the information was that the crew and the medical consultants repeatedly mentioned that it was the care on the sphere that saved Hamlin’s life. So Nadia, Amanda, and Sanjay present a uncommon behind-the-scenes have a look at how hospital-quality therapy might be given on the sphere when wanted. I discovered that — from the story and the video — that there are about 30 medical personnel at each recreation. All groups have emergency motion plans. They run drills an hour earlier than kickoff. The medical workers from each groups evaluate the plan and make sure the main points. They station licensed athletic trainers to function spotters who’re positioned across the stadium to catch any accidents. After which they impart with the medical crew on the sidelines. However then — and that is what even my husband, who’s a serious soccer fan, didn’t know this — there’s the all-important purple hat, which signifies the one that is the emergency doctor or the airway doctor, who stands alongside the 30-yard line and takes over if she or he has to come back out onto the sphere. And that physician mentioned, apparently, they’ve all of the sources out there in an emergency room and might basically do surgical procedure on the sphere to intubate a participant. So I assumed it was an interesting story and video even for non-football followers like me, and I extremely advocate them.

Rovner: I assumed it was very cool. I learn it when Tami advisable it. Though my solely query is what occurs when there’s a crew, one whose shade is purple and there are many individuals carrying purple hats on the sidelines?

Luhby: That’s an excellent level.

Rovner: I assume they nonetheless can discover the physician. OK, Joanne.

Kenen: There was a bit in The Atlantic by Katherine J. Wu known as “Covid Couldn’t Kill the Handshake.” It had a separate headline, relying on the way you Googled it, saying “Don’t Fear the Handshake.” So, principally, we stopped shaking palms. We had fist bumps and, you recognize, bows and all kinds of different stuff. And the handshake is just about again. And sure, your palms are soiled, until you’re continuously washing them, your palms are soiled. However they aren’t fairly as soiled as we would suppose. We’re not fairly as harmful as we might imagine. So, you recognize, when you can’t get out of shaking somebody’s hand, you in all probability gained’t die.

Rovner: Good. Good to know. All proper. My further credit score this week is a narrative I want I had written. It’s from Roll Name, and it’s known as “NIH Missing Top Leadership at Start of a Divided Congress,” by Ariel Cohen. And it’s not nearly not having a alternative for Dr. Tony Fauci, who simply retired because the longtime head of the Nationwide Institute for Allergy and Infectious Ailments final month, however about having no nominated alternative for Frances Collins, who stepped down as NIH [National Institutes of Health] director greater than a 12 months in the past. In a 12 months when stress on home spending is prone to be extreme, as we’ve been discussing, and when science typically and NIH particularly are going to be beneath a microscope within the Republican-led Home, it doesn’t assist to have nobody able to catch the incoming spears. However, Collins’ alternative at NIH should be vetted by the Senate HELP Committee with a brand new chairman, Bernie Sanders, and a brand new rating member, Invoice Cassidy. I’m sufficiently old to recollect when appointing a brand new NIH director and getting it by the Senate was a very controversial factor. I think about we’re again to precisely that right this moment.

OK. That’s our present for this week. As at all times, when you loved the podcast, you can subscribe wherever you get your podcasts. We’d respect it when you left us a evaluate; that helps different individuals discover us, too. Particular thanks, as at all times, to our ever-patient producer, Francis Ying, and to our KHN webteam, who’ve given the podcast a spiffy new web page. As at all times, you’ll be able to electronic mail us your feedback or questions. We’re at whatthehealth — all one phrase — Or you’ll be able to tweet me. I’m nonetheless at Twitter, for now, the place I’m @jrovner. Tami?

Luhby: I’m @Luhby — L-U-H-B-Y

Rovner: Victoria.

Knight: @victoriaregisk

Rovner: Joanne.

Kenen: @JoanneKenen

Rovner: We can be again in your feed subsequent week. Till then, be wholesome.


Francis Ying
Audio producer

Emmarie Huetteman

To listen to all our podcasts, click on right here.

And subscribe to KHN’s What the Well being? on SpotifyApple PodcastsStitcherPocket Casts, or wherever you hearken to podcasts.

Open chat
Thank you for contacting us, more info please chat.