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HomeHealth InsuranceAs US Bumps Towards Debt Ceiling, Medicare Turns into a Bargaining Chip

As US Bumps Towards 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 creator of the critically praised reference ebook “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 needs Democrats to agree to chop spending on each applications in change for a vote to forestall the federal government from defaulting on its money owed.

In the meantime, the nation’s well being care employees — from nurses to medical doctors to pharmacists — are feeling the pressure of caring not only for the rising variety of insured sufferers looking for care, but in addition extra severely unwell sufferers who’re tough and generally 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


Learn Joanne’s tales

Tami Luhby


Learn Tami’s tales

Victoria Knight


Learn Victoria’s tales

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 battle over elevating the debt ceiling provides a preview of attainable debates this 12 months over expensive federal entitlement applications like Medicare.
  • Home Speaker Kevin McCarthy stated Republicans will defend 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 applications means to Republicans.
  • File 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 applications: evolving, rising, and turning into much less controversial over time.
  • Latest studies 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 employees are rising louder of their requires higher staffing, with a nursing strike in New York Metropolis and up to date studies 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 additional credit score, the panelists suggest their favourite well being coverage tales of the week that they suppose you need to learn, too:

Julie Rovner: Roll Name’s “NIH Lacking Prime Management at Begin of a Divided Congress,” by Ariel Cohen

Tami Luhby: CNN’s “ER on the Subject: An Inside Take a look at How NFL Medical Groups Put together for a Recreation Day Emergency,” by Nadia Kounang and Amanda Sealy

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

Victoria Knight: The Washington Submit’s “‘The Final of Us’ Zombie Fungus Is Actual, and It’s Present in Well being Dietary supplements,” by Mike Hume

Additionally talked about on this week’s podcast:

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

Stat’s “Congressional Medicare Advisers Warn of Increased Drug Costs, Regardless of New Worth Negotiation,” by John Wilkerson


Click on right here for a transcript of the episode.

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

Tamar Haspel: Plenty of us wish 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 all types of questions. Questions like: Is faux meat actually a very good various to beef? Does native meals truly matter?

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

Julie Rovner: Howdy! 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. As we speak 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 arduous the primary two weeks of the session. However there’s nonetheless loads occurring on Capitol Hill. Late final week, Home Republicans leaked to The Washington Submit a plan to pay solely a number of the nation’s payments if the standoff over elevating the debt ceiling later this 12 months leads to the U.S. truly defaulting. Republicans say they received’t agree to lift the debt ceiling, one thing that’s been completed each couple of years for many years, except Democrats conform to deep spending cuts, together with for entitlement applications 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 truly get there, in 2011, the U.S. nonetheless received its credit standing downgraded. So who blinks on this standoff? And, Tami, what occurs if no person does?

Luhby: That’s going to be a significant drawback for lots of people. I imply, the U.S. economic system, probably the worldwide economic system, world monetary markets, but in addition sensible issues like Social Safety recipients getting their funds and federal staff within the army getting paid, and Treasury bond holders getting their curiosity funds. So it will be a large 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, probably right now, urged Congress to behave shortly. However as an alternative, after all, what simply occurred was they dug their heels in on both facet. So, you already know, we now have the Republicans saying that we will’t preserve spending like we’re. We don’t have simply a limiteless bank card. We’ve got 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 realize, we’ve been right here earlier than. We haven’t truly 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 one among his members — that is among the many negotiations that he didn’t wish to conform to 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 now have to fret extra about who’s going to be main the Home, as a result of we will’t cope with the debt ceiling till we even have somebody main the Home. So that is going to be much more difficult than prior to now.

Rovner: Simply to be clear, even when we hit the debt ceiling right now, 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 folks with disabilities, and the army 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 received’t truly harm anyone. Yellen had stated 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 every part across the debt ceiling.

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

Knight: I feel it’s going to be one of many massive subjects that we’re positively 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 truly suppose they may make cuts to entitlement applications, to Medicare, Medicaid? Is that real looking? It’s sort of a combined bag. Some are like, yeah, we should always take a look at this, and a few are like, we don’t actually wish to contact it. I feel they realize it’s actually a sensitive topic. There are quite a lot of Medicare beneficiaries that don’t need the age enhance. You realize, there’s some discuss of accelerating the age to 67 quite than 65. They know that could be a sensitive topic. Final week in a press convention, McCarthy stated, “We’re Republicans; we’ll defend 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 now have 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 truly occur. So we’ll see. I’ve been speaking to Republicans on what else they wish to work on this 12 months in Congress. I feel an enormous factor shall be PBM [pharmacy benefit managers] reform. It’s an enormous subject that’s truly 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 massive well being care reform, there most likely isn’t going to be so much, as a result of we’re in a divided authorities now.

Kenen: Only one factor about how folks speak about defending Medicare and Social Safety, it doesn’t imply they don’t wish to make adjustments to it. We’ve been by way of this earlier than. Entitlement reform was the driving drive for Republicans for fairly a number of years beneath … when Paul Ryan was each, I suppose it was price range chair earlier than he was speaker. I imply, that was the factor, proper? And he wished 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 like. I imply, he had a plan, but the plan by no means received by way of wherever. It died, but it surely was an animating drive 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 wish to do. However we do know some conservative Republicans wish 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 of 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 already know, the debt ceiling isn’t our solely challenge that we now have developing. It’s going to be proper across the similar time, typically, possibly, because the fiscal 2024 price range, which can necessitate dialogue on spending cuts and will end in spending cuts and adjustments presumably to a few of our favourite well being applications. So we’ll see. But additionally simply getting again to what we had been speaking about with Medicare. Keep 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 newest forecast is. However, you already know, one thing must be completed 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 person, as Joanne factors out, ever actually has a plan as a result of it will be unpopular. Talking of which, whereas reducing entitlement applications right here remains to be only a speaking level, we now have sort of a real-life cautionary story out of France, the place the retirement age could also be raised from 62 to 64, which remains to be youthful than the 67, the U.S. retirement age is marching towards. Evidently an unintended consequence of what’s occurring in France is that employers don’t wish to rent older employees. So now they’ll’t get retirement and they’ll’t discover a job. And presently, solely half of the French inhabitants remains 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 attention-grabbing to see [if] there are precise protests, however I feel folks shall be very upset, for certain, particularly folks reaching retirement age having counted on this. So …

Kenen: They most likely wouldn’t do it like … should you’re 62, you wouldn’t [go] to 67. Once they’ve talked about these sorts of adjustments prior to now, they’ve talked about phasing it in over a lot of years or beginning it within the …

Rovner: Proper, affecting folks sooner or later.

Kenen: Proper.

Rovner: However I’m pondering not simply elevating the retirement age. I’m pondering of constructing precise massive adjustments to Medicare and even Medicaid.

Kenen: Properly, there’s two issues because the final debate about this. Properly, to start with, 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 once 65. And so they’ve been going, like, 65 and one month, 65 and two months. It’s crept up. And that was completed on a bipartisan foundation, which, after all, not an entire lot is wanting 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 date aside on debt proper now that there’s most likely going to should be some sort of saving grace down the street for anyone. So it could possibly be one more fee. And in addition 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 already know, should you’re 65 and also you’re not working, in the event that they do change the Medicare within the out years, it’s difficult what it will do to the danger 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 little bit totally different.

Rovner: Properly, 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 crucial 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 chargeable for the FDA’s price range [the Agriculture, Rural Development, Food and Drug Administration subcommittee]. Issues might get sort of attention-grabbing there, proper?

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

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

Knight: Proper, he isn’t. 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 move 12 appropriations payments. If they really wish to attempt to do this, they’re going to should do quite a lot 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 taking place with covid, what’s occurring with the abortion drugs. So I feel it’ll be actually attention-grabbing to see what occurs. It appears unlikely they’re truly going to have the ability to move 12 appropriations payments, but it surely’s simply one other factor to observe.

Rovner: I might 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 move the appropriations payments individually, which is what we had been imagined to do. I consider 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 positively proper round then. Once I began overlaying Congress, they at all times did all of it individually, however no extra.

Luhby: And so they wish to move the debt ceiling vote individually.

Rovner: Proper, precisely. Not that a lot occurring this 12 months. All proper. Properly, final week we talked about medical health 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, although enrollment by way of the federal market ended for the 12 months on Sunday. Tami, have we lastly gotten to the purpose that this program is just too massive to fail or is it at all times going to hold by a political thread?

Luhby: Properly, I feel the truth that we’re all not reporting on the weekly or biweekly enrollment numbers, saying “It’s common, 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 may be very indicative of the truth that it’s turning into a part of our well being care system. And I imply, I suppose in the future I’m not going to write down 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 try this as a result of we’re nonetheless doing it with Medicare.

Luhby: Properly, however I’m not. So … it’s attainable, though now with Medicare Benefit, I feel it’s truly price a narrative. In order that’s a separate challenge.

Rovner: Sure, that could be a separate challenge.

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

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

Luhby: There shall be chips across the edges.

Kenen: I imply, this courtroom has completed … all of us thought that litigation was over, like we thought, OK, it’s completed. They’ve … upheld it, you already know, nevertheless many occasions, transfer on. However this Supreme Court docket has completed some fairly dramatic rulings and never simply Roe [v. Wade], on many public well being measures, about gun management and the atmosphere and vaccine mandates. And, after all, you already know, clearly, Roe. Do I feel that there’s going to be one other big existential menace to the ACA arising out of this preventive care factor? No, however we didn’t suppose quite a lot of the issues that the Supreme Court docket 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 chunk us? I don’t suppose it’s probably, 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 person is.

Kenen: Proper. But it surely’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 quite a lot of political capital making an attempt to repeal it they usually couldn’t. Individuals 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 larger over time. And it will get much less controversial over time.

Rovner: Properly, we nonetheless have issues with well being care prices. And this week we now have 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 probably a results of additional pandemic funds and extra folks with medical health insurance. However in 2022, in keeping with a survey by Gallup, the 38% of sufferers reported they delayed care due to value. That was the largest enhance ever since Gallup has been maintaining monitor over the previous 20 years, up 12 share factors from 2020 and 2021. This has me scratching my head a little bit bit. Is it possibly as a result of although extra folks have insurance coverage, which we noticed from the earlier 12 months. Additionally extra have high-deductible well being plans. So maybe they don’t wish to exit and spend cash or they don’t have the cash to spend initially on their well being care. Anyone received one other concept? Victoria, I see you kind of nodding.

Knight: I imply, that’s sort of my concept is, like, I feel they simply have high-deductible plans, in order that they’re nonetheless having to pay so much 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 so much out-of-pocket. He’s had medical debt earlier than. So although extra folks have medical health insurance, it’s nonetheless an enormous challenge, 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 medication. Stat Information studies 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 medication for each the federal government and sufferers — these are ones taking impact this 12 months — we should always nonetheless count on very excessive costs on new medication. Partly that’s as a result of new Medicare cap on drug prices for sufferers. If insurers should cowl even the most costly medication, apart from these few whose worth shall be negotiated, then sufferers shall be extra probably to make use of them they usually 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 largest 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 tough. I imply, the drug pricing provisions, they solely goal 20 of the highest-cost medication. I can’t bear in mind precisely how they decide it, but it surely’s solely 20 medication and it’s carried out over years. So it’s nonetheless leaving out quite a lot of medication. We nonetheless have years to go earlier than it’s truly going into impact. And I feel drugmakers are going to attempt to discover methods round it, elevating the costs of different medication, you’re speaking about. And although 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 stated, positively a bipartisan challenge. This Congress … I feel will even have possibly some motion and we’ll see if truly laws might be handed. However I do know they wish to speak about it. So, I imply, that would assist a little bit bit. However I feel drugmakers are nonetheless an enormous purpose for lots of those prices. And so it received’t fully go away even when PBMs have some reforms.

Rovner: And definitely the American public sees drug prices as one of many largest 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 having access to medical care. The dangerous information is that the workforce to care for them is burned out, offended, and easily not massive 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 in the course of the pandemic and brought nearly all of affected person anger and frustration and generally even violence. We’re seeing fairly a number of nurses’ strikes recently, they usually’re largely not putting 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 project final week. Since I dwell within the Bronx, I spent two days with the putting nurses on the Montefiore Medical Middle, 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 issues that they wished to relay and get their phrase out. There was quite a lot of media protection as effectively. Their foremost challenge was staffing shortages. I imply, the nurses informed me about horrible working circumstances, 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 accessible within the grownup ER, a lot much less beds or cots. And each day, they feared for his or her licenses. One stated that she would fall asleep proper when she received dwelling as a result of she didn’t wish to take into consideration the day as a result of she was involved she may not wish to return the subsequent day. And he or she stated, heartbreakingly, that she was bored with 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 drugs to and doubtless deal with an emergency. So the nurses at Montefiore, apparently, they’re demanding staffing. However one factor they stored repeating to me, you already know, the leaders, was that they wished enforcement capacity of the staffing. They didn’t simply need paper staffing ratios, they usually wished to be extra concerned in recruitment. Whereas the hospitals — apparently, this isn’t essentially over in New York because it most likely received’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 may demand higher pay and staffing.

Rovner: Yeah. Properly, it’s not simply the nurses, although. Docs are burnt out by offended and generally ungrateful sufferers. Docs in coaching, too. And I noticed one story this week about how pharmacists, who’re being requested to do an increasing number of with no extra assist — an analogous story — are getting fried from coping with short-tempered and generally abusive sufferers. Is there any resolution to this, apart from folks making an attempt to behave higher? Is Congress taking a look at methods to buttress the well being care workforce? It is a massive drawback. You realize, they talked about, once they had been passing the Inexpensive Care Act, that should you’re going to provide all these folks extra insurance coverage, you’re going to wish extra well being care professionals to care for them.

Knight: Yeah.

Rovner: But we haven’t appeared to do 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 could wish 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 truly agree on. So it’s positively attainable. 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 effectively, at the least but, on this Congress.

Knight: Yeah, effectively, between the Home and the Senate. Yeah, effectively, 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 medical doctors or what specialties they go into. I imply, and, additionally, do they go to wealthy neighborhoods or poor neighborhoods? I imply, should 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 training residency fee … they’ve been speaking about reforming that since earlier than half of the folks 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 pupil debt. I imply, one purpose folks begin out saying they’re going to enter major care and find yourself being orthopedic surgeons is their debt. So it’s difficult. 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 Price range Act in 1997, they reduce the variety of residencies that Medicare would pay for with the promise — and I consider that is within the report, if not within the laws — that they’d create an all-payer program to assist pay for graduate medical training by the subsequent 12 months, 1998. Properly, now it’s 2023, they usually by no means did that.

Kenen: They meant the subsequent century.

Rovner: We’re a fifth — virtually 1 / 4 of the best way — by way of the subsequent century, they usually nonetheless haven’t completed it.

Kenen: And should you had been on the entrance traces of covid, the medical doctors and the nurses, I imply, at the start they’d no instruments. So many individuals died. They didn’t know methods to deal with it. There have been so many sufferers, you already know, 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 prefer to be in that scenario, not for 10 minutes, however for weeks and again and again …

Rovner: And months and years, in some instances.

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

Rovner: Properly, it’s clear that the pandemic experiences have created a psychological well being disaster for lots of people. Clearly, folks on the entrance traces of well being care, but in addition a lot of different folks. This week, lastly, a little bit bit of fine information for at the least one inhabitants. Beginning this week, any U.S. army 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 personal facility as effectively. They don’t even should be within the VA well being system as a result of many former members of the army are usually not truly eligible for VA well being care. That is for all veterans. It’s truly the results of a regulation handed in 2020 and signed by then-President [Donald] Trump. How a lot of distinction might this variation, at the least, make? I imply, veterans in suicidal crises are additionally, sadly, pretty widespread, aren’t they?

Kenen: Yeah, however I imply, we now have a supplier scarcity, so giving them better entry to a system that doesn’t have sufficient suppliers, I imply, will it assist? I might assume so. Is it going to repair every part? I might assume not. You realize, we don’t have sufficient suppliers, interval. And there are difficult causes for that. And that’s additionally … they’re not all medical doctors. They’re, you already know, psychologists and social employees, 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 folks had, however no person was untraumatized by the final three years. And the continued stresses. You might be well-adjusted traumatized. You possibly can be in-crisis traumatized. However we’re all on that spectrum of getting been traumatized.

Knight: Yeah.

Rovner: Properly, tons extra work to do. OK. That’s the information for this week. Now it’s time for our extra-credit phase, the place we every suggest a narrative we learn this week we expect you need to learn, too. Don’t fear should you miss it; we’ll submit the hyperlinks on the podcast web page at and in our present notes in your cellphone or different cell gadget. Victoria, why don’t you go first this week?

Knight: The story that I’m recommending is named “‘The Final of Us’ Zombie Fungus Is Actual, and It’s Present in Well being Dietary supplements.” It’s in The Washington Submit by Mike Hume. “The Final of Us” is a brand new HBO present everybody’s sort of speaking about. And, principally, folks change into zombies from this fungus. Seems that fungus is actual in actual life. It’s unfold by bugs that principally infect folks after which sort of take over their minds after which shoot little spores out. And within the present, they try this as effectively, besides they don’t unfold by spores. They unfold by bites. But it surely’s utilized in well being dietary supplements for various issues like energy, stamina, immune enhance. So it’s sort of only a enjoyable little dive right into a real-life fungus.

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

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

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

Luhby: My story is by my implausible CNN colleagues this week. It’s known as “ER on the Subject: An Inside Take a look at How NFL Medical Groups Put together for a Recreation Day Emergency.” It’s by my colleagues Nadia Kounang, Amanda Sealy, and Sanjay Gupta. Hear, I don’t know something about soccer, however I occurred to be watching TV with my husband after we flipped to the channel with the Payments-Bengals sport earlier this month, and we noticed the ambulance on the sector. 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 workforce and the medical consultants repeatedly stated that it was the care on the sector that saved Hamlin’s life. So Nadia, Amanda, and Sanjay present a uncommon behind-the-scenes take a look at how hospital-quality remedy might be given on the sector when wanted. I realized that — from the story and the video — that there are about 30 medical personnel at each sport. All groups have emergency motion plans. They run drills an hour earlier than kickoff. The medical employees from each groups overview the plan and ensure the small print. They station licensed athletic trainers to function spotters who’re positioned across the stadium to catch any accidents. After which they convey with the medical workforce on the sidelines. However then — and that is what even my husband, who’s a significant soccer fan, didn’t know this — there’s the all-important purple hat, which signifies the one who is the emergency doctor or the airway doctor, who stands alongside the 30-yard line and takes over if she or he has to return out onto the sector. And that physician stated, apparently, they’ve all of the assets accessible in an emergency room and may primarily do surgical procedure on the sector to intubate a participant. So I believed it was a captivating story and video even for non-football followers like me, and I extremely suggest them.

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

Luhby: That’s a very good level.

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

Kenen: There was a chunk 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 Concern the Handshake.” So, principally, we stopped shaking palms. We had fist bumps and, you already know, bows and all types of different stuff. And the handshake is just about again. And sure, your palms are soiled, except you’re continually washing them, your palms are soiled. However they don’t seem to be fairly as soiled as we would suppose. We’re not fairly as harmful as we might imagine. So, you already know, should you can’t get out of shaking somebody’s hand, you most likely received’t die.

Rovner: Good. Good to know. All proper. My additional credit score this week is a narrative I want I had written. It’s from Roll Name, and it’s known as “NIH Lacking Prime Management at Begin of a Divided Congress,” by Ariel Cohen. And it’s not nearly not having a substitute for Dr. Tony Fauci, who simply retired because the longtime head of the Nationwide Institute for Allergy and Infectious Illnesses final month, however about having no nominated substitute 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 generally and NIH specifically 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. Alternatively, Collins’ substitute at NIH must 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 way of the Senate was a extremely controversial factor. I think about we’re again to precisely that right now.

OK. That’s our present for this week. As at all times, should you loved the podcast, you would subscribe wherever you get your podcasts. We’d respect it should you left us a overview; that helps different folks 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 e 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 shall be again in your feed subsequent week. Till then, be wholesome.


Francis Ying
Audio producer

Emmarie Huetteman

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