{"id":599817,"date":"2023-01-21T12:49:47","date_gmt":"2023-01-21T18:49:47","guid":{"rendered":"https:\/\/news.sellorbuyhomefast.com\/index.php\/2023\/01\/21\/as-us-bumps-against-debt-ceiling-medicare-becomes-a-bargaining-chip\/"},"modified":"2023-01-21T12:49:47","modified_gmt":"2023-01-21T18:49:47","slug":"as-us-bumps-against-debt-ceiling-medicare-becomes-a-bargaining-chip","status":"publish","type":"post","link":"https:\/\/newsycanuse.com\/index.php\/2023\/01\/21\/as-us-bumps-against-debt-ceiling-medicare-becomes-a-bargaining-chip\/","title":{"rendered":"As US Bumps Against Debt Ceiling, Medicare Becomes a Bargaining Chip"},"content":{"rendered":"
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KHN\u2019s \u2018What the Health?\u2019
Episode Title:<\/strong> As US Bumps Against Debt Ceiling, Medicare Becomes a Bargaining Chip
Episode Number:<\/strong> 280
Published:<\/strong> Dec. 19, 2023<\/p>\n

Tamar Haspel:<\/strong> A lot of us want to eat better for the planet, but we\u2019re not always sure how to do it. I\u2019m Tamar Haspel.<\/p>\n

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Haspel:<\/strong> We\u2019re here to answer all kinds of questions. Questions like: Is fake meat really a good alternative to beef? Does local food actually matter?<\/p>\n

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Julie Rovner:<\/strong> Hello! Welcome back to KHN\u2019s \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I\u2019m joined by some of the best and smartest health reporters in Washington. We\u2019re taping this week on Thursday, Jan. 19, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.<\/p>\n

Joanne Kenen: <\/strong>Good morning, everybody.<\/p>\n

Rovner: <\/strong>Tami Luhby of CNN.<\/p>\n

Tami Luhby: <\/strong>Good morning.<\/p>\n

Rovner: <\/strong>And Victoria Knight of Axios.<\/p>\n

Victoria Knight: <\/strong>Good morning.<\/p>\n

Rovner: <\/strong>So Congress is in recess this week, but there is still plenty of news, so we\u2019ll get right to it. The new Congress is taking a breather for the MLK holiday, having worked very hard the first two weeks of the session. But there\u2019s still plenty going on on Capitol Hill. Late last week, House Republicans leaked to The Washington Post a plan to pay only some of the nation\u2019s bills if the standoff over raising the debt ceiling later this year results in the U.S. actually defaulting. Republicans say they won\u2019t agree to raise the debt ceiling, something that\u2019s been done every couple of years for decades, unless Democrats agree to deep spending cuts, including for entitlement programs like Social Security, Medicare, and Medicaid \u2014 why we<\/em> are talking about this. Democrats say that a default, even a partial one, could trigger not just a crisis in U.S. financial markets, but possibly a worldwide recession. It\u2019s worth remembering that the last time the U.S. neared a default but didn\u2019t actually get there, in 2011, the U.S. still got its credit rating downgraded. So who blinks in this standoff? And, Tami, what happens if nobody does?<\/p>\n

Luhby: <\/strong>That\u2019s going to be a major problem for a lot of people. I mean, the U.S. economy, potentially the global economy, global financial markets, but also practical things like Social Security recipients getting their payments and federal employees in the military getting paid, and Treasury bond holders getting their interest payments. So it would be a giant mess. [Treasury Secretary Janet] Yellen last week in her letter to [House Speaker Kevin] McCarthy, signaling that we were going to hit the debt ceiling, likely today, urged Congress to act quickly. But instead, of course, what just happened was they dug their heels in on either side. So, you know, we have the Republicans saying that we can\u2019t keep spending like we are. We don\u2019t have just an unlimited credit card. We have to change our behavior to save the country in the future. And the White House and Senate Democrats saying this is not a negotiable subject. You know, we\u2019ve been here before. We haven\u2019t actually crossed the line before. So we\u2019ll see what happens. But one of the differences is, this year, that McCarthy has a very narrow margin in the House. Any one of his members \u2014 this is among the negotiations that he did not want to agree to but had to after 15 rounds of voting for his job \u2014 any member can make a motion to vacate the speaker\u2019s chair. And if that happens, then we don\u2019t have to worry about the debt ceiling because we have to worry more about who\u2019s going to be leading the House, because we can\u2019t deal with the debt ceiling until we actually have someone leading the House. So this is going to be even more complicated than in the past.<\/p>\n

Rovner: <\/strong>Just to be clear, even if we hit the debt ceiling today, that doesn\u2019t mean we\u2019re going to default, right? I mean, that\u2019s not coming for several months.<\/p>\n

Luhby: <\/strong>Right. So Social Security, seniors and people with disabilities, and the military and federal employees don\u2019t have to yet worry about their payments. They\u2019re going to be paid. The Treasury secretary and Treasury Department will take what\u2019s called \u201cextraordinary measures.\u201d They\u2019re mainly just behind-the-scenes accounting maneuvers. They won\u2019t actually hurt anybody. Yellen had said that she expects these extraordinary measures in cash to last at least until early June, although she did warn that the forecast has considerable uncertainty, as does everything around the debt ceiling.<\/p>\n

Rovner: <\/strong>So, Victoria, obviously, the sides are shaping up. Is this going to be the big major health fight this year?<\/p>\n

Knight: <\/strong>I think it\u2019s going to be one of the big topics that we\u2019re definitely talking about this year in Congress. I think it\u2019s going to be a dramatic year, as we\u2019ve already seen in these first two weeks. My colleagues at Axios, we talked to some Republicans last week, asking them about: Do you actually think they will make cuts to entitlement programs, to Medicare, Medicaid? Is that realistic? It\u2019s kind of a mixed bag. Some are like, yeah, we should look at this, and some are like, we don\u2019t really want to touch it. I think they know it\u2019s really a touchy subject. There are a lot of Medicare beneficiaries that don\u2019t want the age increase. You know, there\u2019s some talk of increasing the age to 67 rather than 65. They know that is a touchy subject. Last week in a press conference, McCarthy said, \u201cWe\u2019re Republicans; we\u2019ll protect Medicare and Social Security,\u201d so they know people are talking about this. They know people are looking at it. So I think in a divided government, obviously, the Senate is in Democratic control. I think it seems pretty unlikely, but I think they\u2019re going to talk about it. And we have a new Ways and Means chairman, Jason Smith from Missouri. He\u2019s kind of a firebrand. He\u2019s talked about wanting to do reform on the U.S. spending. So I think it\u2019s something they\u2019re going to be talking about. But I don\u2019t know if that much will actually happen. So we\u2019ll see. I have been talking to Republicans on what else they want to work on this year in Congress. I think a big thing will be PBM [pharmacy benefit managers] reform. It\u2019s a big topic that\u2019s actually bipartisan. So I think that\u2019s something that we\u2019ll see. These are the middlemen in regards to between pharmacies and insurers. And they\u2019re negotiating drug prices. And we know there are going to be hearings on that. I think health care costs. There\u2019s some talk about fentanyl, scheduling. But I think in regards to big health care reform, there probably isn\u2019t going to be a lot, because we are in a divided government now.<\/p>\n

Kenen: <\/strong>Just one thing about how people talk about protecting Medicare and Social Security, it doesn\u2019t mean they don\u2019t want to make changes to it. We\u2019ve been through this before. Entitlement reform was the driving force for Republicans for quite a few years under \u2026 when Paul Ryan was both, I guess it was budget chair before he was speaker. I mean, that was the thing, right? And he wanted to make very dramatic changes to Medicare, but he called it protecting Medicare. So there\u2019s no one like Ryan with a policy really driving what it should look like. I mean, he had a plan, yet the plan never got through anywhere. It died, but it was an animating force for many years. It went away for a minute in the face of the last 10 years that were about the Affordable Care Act. So I don\u2019t think they\u2019re clear on what they want to do. But we do know some conservative Republicans want to make some kind of changes to Medicare. TBD.<\/p>\n

Rovner: <\/strong>And Tami, we know the debt ceiling isn\u2019t the only place where House Republicans are setting themselves up for deep cuts that they might not be able to make while still giving themselves the ability to cut taxes. They finessed some of this in their rules package, didn\u2019t they?<\/p>\n

Luhby: <\/strong>Yes, they did. And they made it very clear that they, in the rules, they made it harder to raise taxes. They increased it to a supermajority, 3\/5 of the House. They made it easier to cut spending in the debt ceiling and elsewhere. And, you know, the debt ceiling isn\u2019t our only issue that we have coming up. It\u2019s going to be right around the same time, generally, maybe, as the fiscal 2024 budget, which will necessitate discussion on spending cuts and may result in spending cuts and changes possibly to some of our favorite health programs. So we will see. But also just getting back to what we were talking about with Medicare. Remember, the trustees estimate that the trust fund is going to run out of money by 2028. So we\u2019ll see in a couple of months what the latest forecast is. But, you know, something needs to be done relatively soon. I mean \u2026 the years keep inching out slowly. So we keep being able to put this off. But at some point \u2026<\/p>\n

Rovner: <\/strong>Yeah, we keep getting to this sort of brinksmanship, but nobody, as Joanne points out, ever really has a plan because it would be unpopular. Speaking of which, while cutting entitlement programs here is still just a talking point, we have kind of a real-life cautionary tale out of France, where the retirement age may be raised from 62 to 64, which is still younger than the 67, the U.S. retirement age is marching toward. It seems that an unintended consequence of what\u2019s going on in France<\/a> is that employers don\u2019t want to hire older workers. So now they can\u2019t get retirement and<\/em> they can\u2019t find a job. And currently, only half of the French population is still employed by age 62, which is way lower than other members of the European Union. France is looking at protests and strikes over this. Could the same thing happen here, if we might get to that point? It\u2019s been a while since we\u2019ve seen the silver-haired set out on the street with picket signs.<\/p>\n

Knight: <\/strong>I think it would be pretty contentious, I think, if they decide to actually raise the age. It\u2019ll be interesting to see [if] there are actual protests, but I think people will be very upset, for sure, especially people reaching retirement age having counted on this. So \u2026<\/p>\n

Kenen: <\/strong>They probably wouldn\u2019t do it like \u2026 if you\u2019re 62, you wouldn\u2019t [go] to 67. When they\u2019ve talked about these kinds of changes in the past, they\u2019ve talked about phasing it in over a number of years or starting it in the \u2026<\/p>\n

Rovner: <\/strong>Right, affecting people in the future.<\/p>\n

Kenen: <\/strong>Right.<\/p>\n

Rovner: <\/strong>But I\u2019m thinking not just raising the retirement age. I\u2019m thinking of making actual big changes to Medicare or even Medicaid.<\/p>\n

Kenen: <\/strong>Well, there\u2019s two things since the last debate about this. Well, first of all, Social Security was raised and it didn\u2019t cause \u2026 it was raised slowly, a couple of months at a time over, what, a 20-year period. Is that right? Am I remembering that right, Julie?<\/p>\n

Rovner: <\/strong>Yeah, my retirement age is 66 and eight months.<\/p>\n

Kenen: <\/strong>Right. So \u2026 it used to be 65. And they\u2019ve been going, like, 65 and one month, 65 and two months. It\u2019s crept up. And that was done on a bipartisan basis, which, of course, not a whole lot is looking very bipartisan right now. But I mean, that\u2019s the other pathway we could get. We could get a commission. We could move toward some kind of changes after \u2026 last time there was a commission that failed, but the Social Security commission did work. The last Medicare commission did not. The two sides are so intractable and so far apart on debt right now that there\u2019s probably going to have to be some kind of saving grace down the road for somebody. So it could be yet another commission. And also in 2011, 2012, which was the last time there was the big debate over Medicare age, was pre-ACA [Affordable Care Act] implementation. And, you know, if you\u2019re 65 and you\u2019re not working, if they do change the Medicare in the out years, it\u2019s complicated what it would do to the risk pools and premiums and all that. But you do have an option. I mean, the Affordable Care Act would \u2026 right now you only get it to Medicare. That would have to be changed. So it\u2019s not totally the same \u2026 I\u2019m not advocating for this. I\u2019m just saying it is a slightly different world of options and the chessboard\u2019s a little different.<\/p>\n

Rovner: <\/strong>Well, clearly, we are not there yet, although we may be there in the next couple of months. Finally, on the new Congress front. Last week, we talked about some of the new committee chairs in the House and Senate. This week, House Republicans are filling out some of those critical subcommittee chairs. Rep. Andy Harris, a Republican from Maryland who\u2019s also an anesthesiologist who bragged about prescribing ivermectin for covid, will chair the Appropriations subcommittee responsible for the FDA\u2019s budget [the Agriculture, Rural Development, Food and Drug Administration subcommittee]. Things could get kind of interesting there, right?<\/p>\n

Knight: <\/strong>Yeah. And there is talk that he wanted to chair the Labor [Health and Human Services, Education] subcommittee, which would have been really interesting. He\u2019s not.<\/p>\n

Rovner: <\/strong>Which would\u2019ve been the rest<\/em> of HHS. We should point out that in the world of appropriations, FDA is with Agriculture for reasons I once tried to figure out, but they go back to the late 1940s. But the rest of HHS is the Labor HHS Appropriations subcommittee, which he won\u2019t chair.<\/p>\n

Knight: <\/strong>Right, he is not. Rep. Robert Aderholt is chairing Labor HHS. But this is, as we were talking about, they\u2019re going to have to fund the government. Republicans are talking about wanting to pass 12 appropriations bills. If they actually want to try to do that, they\u2019re going to have to do a lot of negotiations on what goes into the Labor HHS bill, what goes into the AG bill with FDA, with these chairs over the subcommittees, they\u2019re going to want certain things in there. They\u2019re going to maybe want oversight of these agencies, especially in regards to what\u2019s happening with covid, what\u2019s going on with the abortion pills. So I think it\u2019ll be really interesting to see what happens. It seems unlikely they\u2019re actually going to be able to pass 12 appropriations bills, but it\u2019s just another thing to watch.<\/p>\n

Rovner: <\/strong>I would point out that every single Congress, Republican and Democrat, comes in saying, we\u2019re going to go back to regular order. We\u2019re going to pass the appropriations bills separately, which is what we were supposed to do. I believe the last time that they passed separately, and that wasn\u2019t even all of them, was the year 2000; it was the last year of President [Bill], it might have been. It was definitely right around then. When I started covering Congress, they always<\/em> did it all separately, but no more.<\/p>\n

Luhby: <\/strong>And they want to pass the debt ceiling vote separately.<\/p>\n

Rovner: <\/strong>Right, exactly. Not that much going on this year. All right. Well, last week we talked about health insurance coverage. Now it is official. Obamacare enrollment has never been higher and there are still several weeks to go to sign up in some states, even though enrollment through the federal marketplace ended for the year on Sunday. Tami, have we finally gotten to the point that this program is too big to fail or is it always going to hang by a political thread?<\/p>\n

Luhby: <\/strong>Well, I think the fact that we\u2019re all not reporting on the weekly or biweekly enrollment numbers, saying \u201cIt\u2019s popular, people are still signing up!\u201d or under the Trump years, \u201cFewer people are signing up and it\u2019s lost interest.\u201d I think that in and of itself is very indicative of the fact that it is becoming part of our health care system. And I mean, I guess one day I\u2019m not going to write the story that says enrollment opens on Nov. 1, then another one that says it\u2019s ending on Jan. 15.<\/p>\n

Rovner: <\/strong>I think we\u2019ll always do that because we\u2019re still doing it with Medicare.<\/p>\n

Luhby: <\/strong>Well, but I\u2019m not. So \u2026 it\u2019s possible, although now with Medicare Advantage, I think it is actually worth a story. So that\u2019s a separate issue.<\/p>\n

Rovner:<\/strong> Yes, that is a separate issue.<\/p>\n

Luhby: <\/strong>But yeah, no, I mean, you know, I think it\u2019s here to stay. We\u2019ll see what [District Judge Reed] O\u2019Connor does in Texas with the preventive treatment, but \u2026<\/p>\n

Rovner: <\/strong>Yes, there will always be another lawsuit.<\/p>\n

Luhby: <\/strong>There will be chips around the edges.<\/p>\n

Kenen: <\/strong>I mean, this court has done \u2026 we all thought that litigation was over, like we thought, OK, it\u2019s done. They\u2019ve \u2026 upheld it, you know, however many times, move on. But this Supreme Court has done some pretty dramatic rulings and not just Roe [v. Wade]<\/em>, on many public health measures, about gun control and the environment and vaccine mandates. And, of course, you know, obviously, Roe<\/em>. Do I think that there\u2019s going to be another huge existential threat to the ACA arising out of this preventive care thing? No, but we didn\u2019t think a lot of the things that the Supreme Court would do. There\u2019s a real ideological shift in how they approach these issues. So politically, no, we\u2019re not going to see more repeal votes. In the wings could there be more legal issues to bite us? I don\u2019t think it\u2019s likely, but I wouldn\u2019t say never.<\/p>\n

Rovner: <\/strong>In other words, just because congressional Republicans aren\u2019t still harping on this, it doesn\u2019t mean that nobody is.<\/p>\n

Kenen: <\/strong>Right. But it\u2019s also, I mean, I agree with Tami \u2026 I wrote a similar story a year ago on the 10th anniversary: It\u2019s here. They spent a lot of political capital trying to repeal it and they could not. People do rely on it and more \u2026 Biden has made improvements to it. It\u2019s like every other American entitlement: It evolves over time. It gets bigger over time. And it gets less controversial over time.<\/p>\n

Rovner: <\/strong>Well, we still have problems with health care costs. And this week we have two sort of contradictory studies about health care costs. One from the Centers for Disease Control and Prevention found a three-percentage-point decline in the number of Americans who had trouble paying medical bills in 2021 compared to the pre-pandemic year of 2019. That\u2019s likely a result of extra pandemic payments and more people with health insurance. But in 2022, according to a survey by Gallup, the 38% of patients reported they delayed care because of cost. That was the biggest increase ever since Gallup has been keeping track over the past two decades, up 12 percentage points from 2020 and 2021. This has me scratching my head a little bit. Is it maybe because even though more people have insurance, which we saw from the previous year. Also more have high-deductible health plans. So perhaps they don\u2019t want to go out and spend money or they don\u2019t have the money to spend initially on their health care. Anybody got another theory? Victoria, I see you sort of nodding.<\/p>\n

Knight: <\/strong>I mean, that\u2019s kind of my theory is, like, I think they just have high-deductible plans, so they\u2019re still having to pay a lot out-of-pocket. And I know my brother had to get an ACA plan because he is interning for an electrician and \u2014 so he doesn\u2019t have insurance on his own, and I know that, like, it\u2019s still pretty high and he just has to pay a lot out-of-pocket. He\u2019s had medical debt before. So even though more people have health insurance, it\u2019s still a huge issue, it doesn\u2019t make that go away.<\/p>\n

Rovner: <\/strong>And speaking of high medical prices, we are going to talk about prescription drugs because you can\u2019t really talk about high prices without talking about drugs. Stat News reports this week<\/a> that some of the members of the Medicare Payment Advisory Committee, or MedPAC, are warning that even with the changes to Medicare that are designed to save money on drugs for both the government and patients \u2014 those are ones taking effect this year \u2014 we should still expect very high prices on new drugs. Partly that\u2019s due to the new Medicare cap on drug costs for patients. If insurers have to cover even the most expensive drugs, aside from those few whose price will be negotiated, then patients will be more likely to use them and they can set the price higher. Are we ever going to be able to get a handle on what the public says consistently is its biggest health spending headache? Victoria, you kind of previewed this with the talk about doing something about the middlemen, the PBMs.<\/p>\n

Knight: <\/strong>Yeah, I think it\u2019s really difficult. I mean, the drug pricing provisions, they only target 20 of the highest-cost drugs. I can\u2019t remember exactly how they determine it, but it\u2019s only 20 drugs and it\u2019s implemented over years. So it\u2019s still leaving out a lot of drugs. We still have years to go before it\u2019s actually going into effect. And I think drugmakers are going to try to find ways around it, raising the prices of other drugs, you\u2019re talking about. And even though they\u2019re hurt by the IRA [Inflation Reduction Act], they\u2019re not completely down and out. So I don\u2019t know what the answer is to rein in drug prices. I think maybe PBM reform, as I said, definitely a bipartisan issue. This Congress \u2026 I think will actually have maybe some movement and we\u2019ll see if actually legislation can be passed. But I know they want to talk about it. So, I mean, that could help a little bit. But I think drugmakers are still a huge reason for a lot of these costs. And so it won\u2019t completely go away even if PBMs have some reforms.<\/p>\n

Rovner: <\/strong>And certainly the American public sees drug costs as one of the biggest issues just because so many Americans use prescription drugs. So they see every dollar.<\/p>\n

Knight: <\/strong>Yes.<\/p>\n

Rovner: <\/strong>So the good news is that more people are getting access to medical care. The bad news is that the workforce to take care of them is burned out, angry, and simply not large enough for the task at hand. The people who\u2019ve been most outspoken about that are the nation\u2019s nurses, who\u2019ve given the majority of the care during the pandemic and taken the majority of patient anger and frustration and sometimes even violence. We\u2019re seeing quite a few nurses\u2019 strikes lately, and they\u2019re mostly not striking for higher wages, but for more help. Tami, you talked to some nurses on the picket line in New York last week. What did they tell you?<\/p>\n

Luhby: <\/strong>Yeah, I had a fun assignment last week. Since I live in the Bronx, I spent two days with the striking nurses at the Montefiore Medical Center, and there were 7,000 nurses at Mount Sinai Hospital in Manhattan and Montefiore in the Bronx that went on strike for three days. It was a party atmosphere there much of the time, but they did have serious concerns that they wanted to relay and get their word out. There was a lot of media coverage as well. Their main issue was staffing shortages. I mean, the nurses told me about terrible working conditions, particularly in the ER. Some of them had to put babies on towels on the floor of the pediatric ER or tell sick adults that they have to stand because there aren\u2019t even chairs available in the adult ER, much less beds or cots. And every day, they feared for their licenses. One said that she would go to sleep right when she got home because she didn\u2019t want to think about the day because she was concerned she might not want to go back the next day. And she said, heartbreakingly, that she was tired of apologizing to families and patients, that she was stretched too thin to deliver better care, that she was giving patients their medicines late because she had seven other patients she had to give medicine to and probably handle an emergency. So the nurses at Montefiore, interestingly, they\u2019re demanding staffing. But one thing they kept repeating to me, you know, the leaders, was that they wanted enforcement ability of the staffing. They didn\u2019t just want paper staffing ratios, and they wanted to be more involved in recruitment. While the hospitals \u2014 interestingly, this is not necessarily over in New York as it probably won\u2019t be elsewhere. These hospitals reached a tentative agreement with the unions, but there\u2019s another battle brewing. The nurses\u2019 contract for the public hospital system expires on March 2, and the union is already warning that will demand better pay and staffing.<\/p>\n

Rovner: <\/strong>Yeah. Well, it\u2019s not just the nurses, though. Doctors are burnt out by angry and sometimes ungrateful patients. Doctors in training, too. And I saw one story this week about how pharmacists, who are being asked to do more and more with no more help \u2014 a similar story \u2014 are getting fried from dealing with short-tempered and sometimes abusive patients. Is there any solution to this, other than people trying to behave better? Is Congress looking at ways to buttress the health care workforce? This is a big problem. You know, they talked about, when they were passing the Affordable Care Act, that if you\u2019re going to give all these people more insurance, you\u2019re going to need more health care professionals to take care of them.<\/p>\n

Knight: <\/strong>Yeah.<\/p>\n

Rovner: <\/strong>Yet we haven\u2019t seemed to do that.<\/p>\n

Knight: <\/strong>Yeah, I know. It\u2019s something that is being talked about. My colleague Peter [Sullivan] at Axios talked to both Sen. [Bernie] Sanders and Sen. [Bill] Cassidy about things they might want to work on on the HELP [Health, Education, Labor & Pensions] Committee. And I know that the nursing workforce shortage is one thing they do actually agree on. So it\u2019s definitely possible. I do think the medical provider workforce shortage is maybe a bipartisan area in this Congress that they could work on. But I mean, they\u2019ve been talking about it forever. And will they actually do something? I\u2019m not sure. So we\u2019ll see. But I know nursing \u2026<\/p>\n

Rovner: <\/strong>Yeah, the spirit of bipartisanship does not seem to be alive and well, at least yet, in this Congress.<\/p>\n

Knight: <\/strong>Yeah, well, between the House and the Senate. Yeah, well, we\u2019ll see.<\/p>\n

Kenen: <\/strong>But the nursing shortage is, I mean, been documented and talked about for many, many years now and hasn\u2019t changed. The doctor shortage is more controversial because there\u2019s some debate about whether it\u2019s numbers of doctors or what specialties they go into. I mean, and, also, do they go to rich neighborhoods or poor neighborhoods? I mean, if you\u2019re in a wealthy suburb, there\u2019s plenty of dermatologists. Right? But in rural areas, certain urban areas \u2026 So it\u2019s not just in quantity. It\u2019s also an allocation both by geography and specialty. Some of that Congress could theoretically deal with. I mean, the graduate medical education residency payment \u2026 they\u2019ve been talking about reforming that since before half of the people listening to this were born. There\u2019s been no resolution on a path forward. So some of these are things that Congress can nudge or fix with funding. Some of it is just things that have to happen within the medical community, some cultural shift. Also student debt. I mean, one reason people start out saying they\u2019re going to go into primary care and end up being orthopedic surgeons is their debt. So it\u2019s complicated. Some of it is Congress. Not all of it is Congress. But Congress has been talking about this for a very, very, very, very, very long time.<\/p>\n

Rovner: <\/strong>I will point out \u2014 and Joanne was with me when this happened \u2014 when Congress passed the Balanced Budget Act in 1997, they cut the number of residencies that Medicare would pay for with the promise \u2014 and I believe this is in the report, if not in the legislation \u2014 that they would create an all-payer program to help pay for graduate medical education by the next year<\/em>, 1998. Well, now it\u2019s 2023, and they never did that.<\/p>\n

Kenen: <\/strong>They meant the next century.<\/p>\n

Rovner: <\/strong>We\u2019re a fifth \u2014 almost a quarter of the way \u2014 through the next century, and they still haven\u2019t done it.<\/p>\n

Kenen: <\/strong>And if you were on the front lines of covid, the doctors and the nurses, I mean, at the beginning they had no tools. So many people died. They didn\u2019t know how to treat it. There were so many patients, you know, in New York and other places early on. I mean, it was these nurses that were holding iPads so that people could say goodbye to their loved ones. I don\u2019t think any of us can really understand what it was like to be in that situation, not for 10 minutes, but for weeks and over and over \u2026<\/p>\n

Rovner: <\/strong>And months and years,<\/em> in some cases.<\/p>\n

Kenen: <\/strong>Right. But I mean, the really bad \u2026 it\u2019s years. But these crunches, the really traumatic experiences, I mean, we\u2019ve also talked in the past about the suicide rate among health care providers. It\u2019s been not just physically exhausting, it\u2019s become emotionally unimaginable for those of us who haven\u2019t been in those ICU or ERs.<\/p>\n

Rovner: <\/strong>Well, it\u2019s clear that the pandemic experiences have created a mental health crisis for a lot of people. Clearly, people on the front lines of health care, but also lots of other people. This week, finally, a little bit of good news for at least one population. Starting this week, any U.S. military veteran in a mental health crisis can get free emergency care, not just at any VA [Department of Veterans Affairs] facility, but at any private facility as well. They don\u2019t even have to be in the VA health system because many former members of the military are not actually eligible for VA health care. This is for all veterans. It\u2019s actually the result of a law passed in 2020 and signed by then-President [Donald] Trump. How much of difference could this change, at least, make? I mean, veterans in suicidal crises are also, unfortunately, fairly common, aren\u2019t they?<\/p>\n

Kenen: <\/strong>Yeah, but I mean, we have a provider shortage, so giving them greater access to a system that doesn\u2019t have enough providers, I mean, will it help? I would assume so. Is it going to fix everything? I would assume not. You know, we don\u2019t have enough providers, period. And there are complicated reasons for that. And that\u2019s also \u2026 they\u2019re not all doctors. They\u2019re, you know, psychologists and social workers, etc. But that\u2019s a huge problem for veterans and every human being on Earth right now. I mean, everybody was traumatized. There\u2019s degrees of how much trauma people had, but nobody was untraumatized by the last three years. And the ongoing stresses. You can be well-adjusted traumatized. You could be in-crisis traumatized. But we\u2019re all on that spectrum of having been traumatized.<\/p>\n

Knight: <\/strong>Yeah.<\/p>\n

Rovner: <\/strong>Well, lots more work to do. OK. That\u2019s the news for this week. Now it is time for our extra-credit segment, where we each recommend a story we read this week we think you should read, too. Don\u2019t worry if you miss it; we will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Victoria, why don\u2019t you go first this week?<\/p>\n

Knight: <\/strong>The story that I\u2019m recommending is called \u201c\u2018The Last of Us\u2019 Zombie Fungus Is Real, and It\u2019s Found in Health Supplements<\/a>.\u201d It\u2019s in The Washington Post by Mike Hume. \u201cThe Last of Us\u201d is a new HBO show everyone\u2019s kind of talking about. And, basically, people become zombies from this fungus. Turns out that fungus is real in real life. It\u2019s spread by insects that basically infect people and then kind of take over their minds and then shoot little spores out. And in the show, they do that as well, except they don\u2019t spread by spores. They spread by bites. But it\u2019s used in health supplements for different things like strength, stamina, immune boost. So it\u2019s kind of just a fun little dive into a real-life fungus.<\/p>\n

Rovner: <\/strong>To be clear, it doesn\u2019t turn people into zombies.<\/p>\n

Knight: <\/strong>Yes. To be clear, it does not turn people into zombies. If you eat it, that will not happen to you. But it is based on a real-life fungus that does infect insects and make them zombies.<\/p>\n

Rovner: <\/strong>Yes. [laughter] It\u2019s definitely creepy. Tami.<\/p>\n

Luhby: <\/strong>My story is by my fantastic CNN colleagues this week. It\u2019s called \u201cER on the Field: An Inside Look at How NFL Medical Teams Prepare for a Game Day Emergency<\/a>.\u201d It\u2019s by my colleagues Nadia Kounang, Amanda Sealy, and Sanjay Gupta. Listen, I don\u2019t know anything about football, but I happened to be watching TV with my husband when we flipped to the channel with the Bills-Bengals game earlier this month, and we saw the ambulance on the field. So like so many others, I was closely following the story of Damar Hamlin\u2019s progress. What we heard on the news was that the team and the medical experts repeatedly said that it was the care on the field that saved Hamlin\u2019s life. So Nadia, Amanda, and Sanjay provide a rare behind-the-scenes look at how hospital-quality treatment can be given on the field when needed. I learned that \u2014 from the story and the video \u2014 that there are about 30 medical personnel at every game. All teams have emergency action plans. They run drills an hour before kickoff. The medical staff from both teams review the plan and confirm the details. They station certified athletic trainers to serve as spotters who are positioned around the stadium to catch any injuries. And then they communicate with the medical team on the sidelines. But then \u2014 and this is what even my husband, who is a major football fan, didn\u2019t know this \u2014 there\u2019s the all-important red hat, which signifies the person who is the emergency physician or the airway physician, who stands along the 30-yard line and takes over if he or she has to come out onto the field. And that doctor said, apparently, they have all the resources available in an emergency room and can essentially do surgery on the field to intubate a player. So I thought it was a fascinating story and video even for non-football fans like me, and I highly recommend them.<\/p>\n

Rovner: <\/strong>I thought it was very cool. I read it when Tami recommended it. Although my only question is what happens when there\u2019s a team, one whose color is red and there are lots of people wearing red hats on the sidelines?<\/p>\n

Luhby:<\/strong> That\u2019s a good point.<\/p>\n

Rovner:<\/strong> I assume they still can find the doctor. OK, Joanne.<\/p>\n

Kenen: <\/strong>There was a piece in The Atlantic by Katherine J. Wu called \u201cCovid Couldn\u2019t Kill the Handshake.\u201d It had a separate headline, depending on how you Googled it, saying \u201cDon\u2019t Fear the Handshake<\/a>.\u201d So, basically, we stopped shaking hands. We had fist bumps and, you know, bows and all sorts of other stuff. And the handshake is pretty much back. And yes, your hands are dirty, unless you\u2019re constantly washing them, your hands are dirty. But they are not quite as dirty as we might think. We\u2019re not quite as dangerous as we may think. So, you know, if you can\u2019t get out of shaking someone\u2019s hand, you probably won\u2019t die.<\/p>\n

Rovner: <\/strong>Good. Good to know. All right. My extra credit this week is a story I wish I had written. It\u2019s from Roll Call, and it\u2019s called \u201cNIH Missing Top Leadership at Start of a Divided Congress<\/a>,\u201d by Ariel Cohen. And it\u2019s not just about not having a replacement for Dr. Tony Fauci, who just retired as the longtime head of the National Institute for Allergy and Infectious Diseases last month, but about having no nominated replacement for Frances Collins, who stepped down as NIH [National Institutes of Health] director more than a year ago. In a year when pressure on domestic spending is likely to be severe, as we\u2019ve been discussing, and when science in general and NIH in particular are going to be under a microscope in the Republican-led House, it doesn\u2019t help to have no one ready to catch the incoming spears. On the other hand, Collins\u2019 replacement at NIH will have to be vetted by the Senate HELP Committee with a new chairman, Bernie Sanders, and a new ranking member, Bill Cassidy. I am old enough to remember when appointing a new NIH director and getting it through the Senate was a really controversial thing. I imagine we are back to exactly that today.<\/p>\n

OK. That\u2019s our show for this week. As always, if you enjoyed the podcast, you could subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review; that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying, and to our KHN webteam, who have given the podcast a spiffy new page. As always, you can email us your comments or questions. We\u2019re at whatthehealth \u2014 all one word \u2014 @kff.org. Or you can tweet me. I\u2019m still at Twitter, for now, where I\u2019m @jrovner. Tami?<\/p>\n

Luhby: <\/strong>I\u2019m @Luhby \u2014 L-U-H-B-Y<\/p>\n

Rovner: <\/strong>Victoria.<\/p>\n

Knight: <\/strong>@victoriaregisk<\/p>\n

Rovner:<\/strong> Joanne.<\/p>\n

Kenen: <\/strong>@JoanneKenen<\/p>\n

Rovner: <\/strong>We will be back in your feed next week. Until then, be healthy.<\/p>\n<\/p><\/div>\n

Read More<\/a>
\n Larisa Culton<\/p>\n","protected":false},"excerpt":{"rendered":"

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