Discover the Best Taxi Invoice Format for Public Relations

Taxi invoice format for Public Relations

[Music] from the lever reader supported Newsroom this is lever time I'm Arjun sing after the shooting of a health insurance CEO America has seen an outpouring of anger at the health insurance industry this sudden explosion of public rage contrast with the recent election in which both parties made sure Health Care was barely even mentioned on today's episode the big question isn't why Americans are so angry angry an insurance industry whose whole business model is based on standing between you and your medical provider and rationing care the question we're going to try and explore with an insurance industry Insider and a renowned Healthcare journalist is more vexing why hasn't this widespread anger translated into the creation of what every other industrialized nation has a system of universal guaranteed Medical Care [Music] you know I was in the industry for about 20 years altogether I joined U uh the first big insurance company in 1989 I think it was it was Humana I would go from there to the siga where I uh spent about 15 years and and wound up uh running the corporate Communications Department for for Signa this is Wendell Potter and as you could probably tell he spent a long time working working in the health insurance industry I was the company's Chief spokesman I handle Financial Communications my name was on every one of the company's Financial earnings reports uh for for 10 years I also uh worked with my peers across the industry to uh develop and Implement public policy uh strategies and PR strategies to kill any kind of healthcare reform proposals we didn't like uh both in Washington and the state capitals over the course of his career Potter watched closely is the industry manipulated the government the public and its own customers as you climb up the ladder it becomes much more apparent what really motivates these companies and at the end of the day it is all about shareholders and a handful of financial endless on Wall Street these companies are are middlemen they don't make a product they don't make any Pharmaceuticals they have figured out how to extract so much money out of what we spend as a nation on Healthcare uh to reward their shareholders there's no other country in the world that uh has a system like this that enables middlemen to uh siphon off so much money from middle class and workingclass folks uh uh that need health care but are not able to get it because of the way these companies have developed their business practices Potter blew the whistle on what he saw inside the industry over a decade ago but in the time since then American's view of the healthcare industry has only worsened today the Public's face in the healthcare industry Physicians hospitals and yes insurance providers is the lowest it's been in 24 years and that's despite the passage of the Affordable Care Act which some have described as the most significant reform of the healthc Care industry in a generation here's Joe Biden for example when he was vice president talking about it our children and our grandchildren they're going to grow up knowing that a man named Barack Obama put the final girder in the framework for a social network in this country to provide the single most important element of what people need and that is access to Good Health despite its passage Healthcare has remained a controversial and expensive thing today one out of every $5 spent in America goes towards Healthcare and even though more Americans have health insurance today than in previous decades people are still forced to spend thousands on Healthcare when they're sick and last week that frustration can boil to a fever pitch right now the search is on for the suspect after reviewing this security video showing the very moment United healthc Care Boss Brian Thompson was shot and killed in Midtown Manhattan early this morning the primary suspect is a 26-year-old man named Luigi mangion and ing to recent reports he had recently suffered from chronic back pain and in a Manifesto published earlier this week mangion allegedly Justified his decision to murder the CEO of one of the largest health insurance companies Because he believes the industry puts people over profits and he's certainly not alone this was certainly an act of violence that I don't think any of us should condone this murder that occurred uh in New York but I will say that these companies do perpetrate violence against Americans every single day in various ways and and and that is by refusing to pay for medically necessary care because they they thought they can get away with it and they have for all these years they've done business uh and have operated they the way they do with impunity that problem that Potter has identified has been known for a long time in the last decade Healthcare was front and center in our politics in 2016 and in 20120 Democratic candidates ran on the platform of Medicare for all a call for some sort of government sponsored insurance program the strengths of a Medicare for all program are not only its universality and its cost effectivess it also ends the complexity of a system which adds enormous stress at a time when people need it the least meanwhile Republicans like Donald Trump have run on an agenda of leaving Healthcare to the whims of the market which would crucially enrich the industry probably at the expense of the sickest and least wealthy individuals Obamacare was lousy healthc care always was it's not very good today and what I said that if we come up with something and we are working on things we're going to do it and we're going to replace it at the same time I shall ask them to act upon other vitally needed measures such as Aid to education which they say therefore for a national health program civil rights legislation which they say they're for in the late 1940s after the end of World War II Harry Truman inherited the presidency from Franklin D Roosevelt and when he became president he himself would call for the formation of a national health program but right around this time a private insurance system was also coming into form Healthcare and Medicine had undergone a Revolution new surgeries were being developed as were treatments but these were expensive so one idea was to pull people's resources together into a pot of money one that could be tapped to pay for the sick when they needed it in 1929 for example Hospital administrators at Baylor University in Texas created a plan where local teachers could pay0 50 cents per month for 21 days of care and that idea soon expanded to other kinds of employee groups well how about the theory that the community can afford what the individual can't oh so you've been bitten by that bug have you well the people of Parksville would pay say 10 cents each a week I could give them a medical service that's a very beautiful idea the symbol they used for this program was a simple Blue Cross and today you've probably seen that cross because it's become a Consortium of insurance providers known as Blue Cross Blue Shield but this was all private more than a decade later Truman would fail in his bid to create a national health insurance program and it would take another decade before a president took a bite at the Apple the new bill expands the 30-year-old Social Security program to provide Hospital Care Nursing Home Care home nursing service and outpatient treatment for those over 65 in 1965 president Lyndon B Johnson signed a law creating Medicare but its passage was no easy feat Johnson faced stiff opposition from forces like the American Medical Association who had long opposed the idea of a government funded insurance program insurers and other companies joined the fight but the AMA really led the charge against it to them the idea of socialized medicine just felt too reminiscent of Communism one of the traditional methods of imposing statism or socialism on a people has been by way of medicine it's very easy to disguise a medical program as a humanitarian project most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it a charge that was particularly devastating while the US was waging a war against communism abroad but Physicians and doctors were also concerned that it would over regulate them and in particular how much they might might be able to charge for their services still Johnson the skilled politician that he was managed to get it past and Harry Truman would in fact be the first enrol of Medicare in the 1980s though American healthcare costs would begin to rise more so than other developed nations in 1983 Medicare began offering fixed payments to Providers causing doctors and hospitals to find other means to generate Revenue by offering new Services as well a lot of states began to lift their own regulations on Healthcare pricing leaving it to the free market and that's where our modern system of Managed Care arguably the one that Luigi mangion was angry with begins and it was around this period that health insurance companies like United health group became publicly traded companies meaning they would answer more to Wall Street than to their own customers here's Wendell Potter again at the end of the day it is all about shareholders and a handful of financial endless on Wall Street um I used to um help plan signis investor dat and it's notable that Ryan Thompson at United Healthcare who was their CEO was in New York for that company's annual investor day it's the most important day in uh an insurance company's uh year because you are there to try to persuade shareholders who own your company that U you have a plan for profitable growth and you've got it all figured out and U the future is going to be Rosy and that they will make a lot lot more money if they stay invested in the company so um I learned all that and you know I initially like I said I was a believer in manage care but I came to understand what happened to that concept as Wall Street got really in control of our health care System these were the issues that Barack Obama said he wanted to fix when he became president and it was ostensibly what his signature piece of legislation the Affordable Care Act set out to do but like I said before the healthcare industry is still broken insurance companies are making huge profits and thousands are dying from a lack of adequate Insurance every year in my conversation with Wendell Potter one thing he mentioned was that the ACA has the insurance industry's fingerprints all over it which raised the question is it compatible to have an insurance system that is profit driven and fairly provides access to healthcare I don't think it's possible because the needs of shareholders are different from the needs of patients and the way that insurance companies are able to assure shareholders of Greater return on their investment is by doing things that makes it more difficult for people to get the care that they need there's this this thing called a medical loss ratio in health insurance and what that means is health insurance considered a loss when they pay a claim and one thing the Affordable Care Act did because I testified before Congress about how this works increasingly Wall Street was pressuring these companies to spend less and less and lesser premium dollars on on pay our claims U to the point that some insurers were using less than half of our premium dollars paying our claims congress with the passage of the ACA included a a provision that requires them to spend at least 80% or 85% depending on the the kind of of Health Plan we're talking about on on Healthcare but these companies have figured out how to gain that how to work around that in ways that have enabled them to uh amass even more profits we now have more than 100 million Americans who have medical debt and the vast majority of those people have health insurance but they're not able to get the care that they need and can afford primarily because one of these other barriers that I've referenced High out of pocket cost that was another reason why I left the insurance industry uh is because of the medical debt that these companies have created for people with insurance by making them pay increasingly High deductibles uh I was expected if I had stay on with siga to be u a leading cheerleader for these kinds of Health Plans um we were marketing them back in the day as consumer-driven health plans euphemistically we call them that because we wanted people to think that somehow Americans were just chomping at the bit to be more involved in their health care or spend more for their health care and as a consequence we have to pay hundreds if not thousands of dollars out of our own Pockets every single year [Music] after the break we'll hear why the political effort to reform the healthcare industry has often Fallen flat we'll be right [Music] back for as long as I've been alive I and certainly as long as I've been sort of paying attention and sentinent as like an adult you know there's always been our problematic Health Care system and I know this from as a historian of our Healthcare System Jonathan con is a senior National correspondent at HuffPost and the author of the book The 10year War Obamacare and the unfinished Crusade for Universal coverage there has been discussion of the problems of our health care System really since the 1930s which is pretty much when we first got a healthc care system and some would say there we've never really had a Health Care System more we have health care problems and these sort of solutions to get thrown at it that don't work or don't get enacted so people have never been happy with it the two caveats and and maybe this is something we can discuss a little later are that that's a very general statement um there are always certain people for whom it works reasonably well and feel pretty good about it and that is related to the second part which is that however my unhappy people may may be at any one point with the status quo um when you get to the discussion of fixing it of changing it of doing something um the enthusiasm for Change wanes and the consensus over what to do breaks down and that's a big reason why you know the problems persist I guess I'm I'm sort of confused Jonathan from the health insur or the hospital's perspective why not let the government basically be a giant and well-funded buyer because I would imagine that if you're looking at it from Pure monetary standpoint if you have the government now coming in saying we're going to create a national program we're going to pay all the doctors or we'll pay the insurance company who who finds that threatening is it the insurance companies who are worried that if uh if you start charging for a cheaper government plan where do we fit in the picture is it hospitals and Prov ERS who as you said are worried about autonomy but possibly the idea that the government becomes a single buyer why why would they be against or what is the push back to a a universal program yeah so that's a great question and the the answer is going to vary a lot depending on you know if you can imagine like a chart you know in your head do a chart and like the top category is which proposal are we talking about you know which point in history and then down you know which interest group and really it should be a threedimensional chart because even within the each group you know there's different constituencies so like you know for example this could be like an AP calculus problem really could I mean you know I mean truly I mean you know how you know in the 1993 for debate over President Bill Clinton's healthc care plan how you know the insurance industry felt you'd get a different answer if you were talking to a small insurance company rather than a big insurance company for example or a nonprofit versus a for-profit and the same for Physicians and you know where in the country so I mean for all of these debates it's different to just to in a very broad somewhat simplistic sense I think you could say there's a combination of things going on um there is always a concern about autonomy MH do how much is my financial operational existence within my own control and how much am I at the mercy of a political system that I may or may not be able to control um and there's the very basic less money right I mean it's going to cut my income yeah even if it doesn't cut my income right away down the road and there is an ideological component here a philosophical component this comes up a lot in the context of business you know CEOs of corporations that may have nothing to do with Healthcare you know per se they're not Healthcare companies they're factories that make widgets um but they do have to minister their health benefits for their employees or pay for them and number one they want full control over that but also let's say I'm a tech company right I employ a bunch of programmers um I'm not really worried that like the end of the day you know the government runs Healthcare sure I mean I don't need to be in the healthcare business and they want to run my benefits fine maybe it'll cost me a little moreone I don't care I'm rolling in money I I'm Apple I'm I'm Google I don't you know whatever you know what though um I don't want government telling me how to run my tech business and you know it's habit forming right you know government starts to reach into my health insurance maybe they're going to feel more emboldened to reach into what you know how I my privacy rules or my whatever and and that sounds a little paranoid yeah maybe but there are corporations out there that maybe they care about health care maybe they they can you know look at a healthcare system and say actually the government could run it better but I just don't want the government having that kind of power generally because once they start regulating going to regulate more or you know I sit on corporate boards right or I sit on the local Board of my local hospital hospitals are an interesting group in this because they're frequently thought of as you know they don't get the kind of anger you see at the insurance industry or the drug industry sometimes you know but like and you know there's lots of great hospitals there and obviously you know I mean they do incredible work but like you know Hospital lobbyists pretty powerful um yeah yeah actually um expand on that a little bit if if you could because I do see the role of hospitals come up and I it feels like a third rail sometimes because we know hospitals in our community I mean before we you know started our conversation we were talking about uh you know I was in Boston for the last 11 years and I mean in Boston hospitals are like like the church maybe second to the Catholic church because they represent institutions in the community it's where people go to get care but tell me more about the role hospitals play you know in in this uh I guess could call it the medical cost inflation that we've seen happen over the decades yeah hospitals are a wonderful window into this uh as long as you like complexity because I mean that really captures it um and Boston is a great City for it so I lived there for a long time also still a huge Red Sox fan um my older son was born at brigam and Women's Hospital which is one of the great teaching hospitals not just in Boston but in America I mean they are world famous um you know Massachusetts General they if you know the nickname MGH man's greatest hospital I mean these are you know these are these are cutting edges when you think about what I think even critics of American Healthcare would say what is the best parts of American Healthcare is that at The Cutting Edge it's incredible right and the hospitals of Boston a lot of stuff's going on there the research I mean you know if you you know The Specialist Care it's amazing and hospitals in Boston have enormous power over Healthcare pricing and in part because you know as the Market has evolved they have Consolidated into these like you know these small handful of very large Hospital networks and they have enormous power to set prices so in hospitals have are are a big part of our cost problem um as our doctors and Drug makers you know because they're all pushing I mean in a funny way one of the weird things about this and and this is why people like me in the last couple days have been like trying to sort of Spotlight what's what insurance companies do and their role and understanding why people are angry at them and also pointing out that it's a little more complicated and it seems like when it comes to like right now in our system like pushing back on doctors and hospitals and Drug makers over high prices like insurance companies do some of that and are you know the ones trying to push back down maybe not in ways we like maybe in ways that could be better and we can talk about that so that's the role of hospitals and I didn't even mention the lobbying power of hospitals which is a whole other story I I want to get back to kind of the question of the the political will to try and reform the system so the last major bite at the Apple was the Affordable Care Act now I understand that that was a landmark Bill to have been passed even in the way that it is I also heard quite a bit of public frustration with it uh you know Wendell who we heard earlier in the show said that it it did end up being a massive boost for insurance industry profits you know they had their lobbying fingerprints all over that but you you you deeply researched the fight over over that bill what exactly happened and I know this is actually a very complex you wrote a giant book about it but you know at at its core what was the um the goal of the Affordable Care Act what were some of the big ticket items that were changed and how is that Legacy viewed currently of the ACA yeah no it's a great question and yeah very complex but I think I can boil down pretty quickly cuz of what we've been talking about in part which is that so you have this impulse to get to a Universal Health Care System again back from the very beginning right Progressive Era Roosevelt Harry Truman and from that point forward the people who want to do universal healthcare they're like we're not going to give up this is an important thing we think this is the basic moral test of the society everyone should have Healthcare we're going to figure out a way to do this and what they then do is they proceed to kind of say what did we do wrong last time how do we fix for those errors how do we come up with a model that we can actually get through Congress because Truman failed so it is out of the sort of ruins of the Truman plan that Medicare emerges and it's a the simple version of this is that the Truman people the veterans are like now this was too hard to do but what if we just did the elderly because they're super sympathetic and actually insurance companies don't really want to insure them because they're bad risk so we'll just do the over 65 population and you know under almost perfect political conditions with you know Johnson winning a landslide fast majorities Democratic majorities in Congress they're able to push this through although even then they have to make all kinds of compromises to kind of subdue the opponents so for example the private insurance industry actually writes the bills is the middleman for the even traditional Medicare like the claims processing goes to the insurance companies um and there's all kinds of compromises like that um so that's how they get Medicare and so once they've done with Medicare okay we took care we addressed we didn't fully take care of but you know we've got a program now for the over 65 population we'll continue to work on improving that what do we do for everyone else and they had a Medicaid Program they created at the same time which is for poor people but it's very limited it's run by states only certain people qualify so you know there's okay how you know how do we get to the next step and there's a couple of efforts big one under Bill Clinton he you know and and people forget you know it's been forever I'm old so it feels like yesterday but um you know when he got elected did you know he was going to do a national health insurance program he gave this incredible speech before Congress a classic Bill Clinton speech and people po look great and then like a year later it fell apart and it was a disaster and it was like a total political like the whole thing felt really came apart the summer of 94 right before the 94 midterms which are like when n the contract with America and so partly gets blamed you know for that and basically like everyone in the Democratic party is like I don't want to go near Healthcare ever again like this is like it's like burn my hand we lose all our seats just let's Tinker around the edges because the Democrats got such a shellacking in that midterms and that's the reason they feel so they blamed it on kind of the healthc Care push and that's why they think contract with American the Republicans stick over yeah yeah I mean a big part obviously a lot of other stuff going on but you know big part of it right sure but you still have that core of people for whom this is their life's work you know and this is what they care about they're like okay we are going to figure out a way to get there what did we do wrong so they sit and they look at the Clinton plan they're like what' we get wrong here and probably the biggest lesson that came out of that particular the funny thing was the Clinton plan it wasn't like the Clinton people were trying to fix the errors from before also so their theory was instead of having the government take over health insurance people are down on government this is the post- Reagan Era right you know you can't do a big giant government you know if you try to do Medicare for all it's going to Spook everybody so let's have national health insurance but do it through private insurers governmental Finance it but private insurers will do it and it still didn't work and so the the next wave of Reform is like well what did we get wrong this time because we thought we were making and they said you know what we did wrong they said the problem was we were going to put everybody into this new system and you got all these people out there who have insurance already through their employers and they may be unhappy with that insurance this gets back to something we talked about the very top of the podcast so you know they may have their complaints that including some of the same complaints we're seeing now about hmos and all that stuff you know managed care but at the end of the day like they have coverage and they're going to freak out get or they'll be spooked by opponents if we try to change that so let's just let's try to get everyone Insurance simply by plugging the holes but if people have insurance let them keep it don't mess with what people have so if you got Medicare we're not going to touch it except we're going to actually add some help make the drug benefit better you got employer coverage we're not going to mess with that we're really going to focus on the people who don't have insurance because they don't have an employer policy and because of that they have to buy on their own and either they don't have enough money or they have a pre-existing condition and they and when you buy on your own this is really important if you're with an employer you know because it's a big group it doesn't matter what your health conditions are you can get onto the plan but if you are buying a policy on your own back then if you had a pre-existing condition you had a history of cancer you were diabet whatever insurance company wouldn't cover you or they charge you extra money you know so on so the Obamacare as it came to be known the whole premise was basically just plug the holes and they said we're going to take the Medicaid Program which covers low-income people but it very every state has different criteria and you have to like in a lot of states you have to be like either a child or a pregnant woman or you know instead just expand it so it covers everybody who has income below the poverty line or just above that'll that'll take care of a lot of the uninsured and then there's this gap of people who will be make too much money to qualify for Medicaid but they still can't get coverage because it's expensive you know you're making $30,000 a year that's not quite poor enough to qualify for Medicaid even under the new standard but yeah you know insurance is EXP expensive or maybe you're one of these people with pre-existing conditions so they created you know what most people now associate with Obama they created these markets they where they basically insurance companies would have to sell to anybody didn't matter if you had a pre-existing condition the policies had to meet certain standards and depending on your income you'd get extra money from the government you know as a tax credit and um this idea was kicking around it really got kicked started when uh we're going to come back to Massachusetts again uh in in 2000 uh when m Romney very important ah yes Romney car yes Mitt Romney is the governor and you know he gets together with the Democratic legislature and they pass a version of this and I really think this is important about the political situation which is if you know about I'm always been fascinated with Romney you know Romney very conservative guy you know I live in Michigan so he grew up in Michigan his dad was George Romney you know famous you know moderate govern Republican governor of Michigan r Mitt is more conservative than his father he's a genuine conservative he's a business guy you know whatever but he's very analytic he's a problem solver he's conservative but not an idog you know it's different I me his views are conservative but he's not an ideological Crusader he's a problem solver right and you know in Massachusetts you when you're a governor this is always true with Governors not always but usually Governors like kind of have to deal with whatever's on their plate they don't get to you know run around cuz you know fck stops with them it really does in a way that sometimes it doesn't you know for the president so Romney is like you know we're losing we're spending tons of money on on on Healthcare this is a really screwed up system and also there was a whole issue on the outside with like Federal funding they were going to lose so he ends up actually teaming up with of all people Ted kenned who's like liberal Ted Kenny who he had run against for Senate years before and like the icon of like you know Democratic party the patron state of universal healthcare and basically they get together and they're like look we're different ideologically but we both were practical and K Ted Kennedy was always a very practical legislator like we can get this done this can get through it won't upset the apple cart too much it can get buying from the left and the right and they do it at Massachusetts and it's like not a Panacea right I mean there still people in Massachusetts don't have health insurance and people have health insurance the out- of pocket costs are high but they do like get to almost Universal coverage and there's lots of evidence that people are better off and it happens in Massachusetts it worked and so the Obama people come and they're like this you know and actually this started in the 2008 campaign Hillary Clinton ran on the exact same plan when they were in the primaries they both were like this is the way to go this is the way what's the what's the what's the what's the Star Wars thing this is the way the uh this is the way the Mandalorian thank you thank you my son will be happy I dropped a Mandalorian reference into this um uh and this is the way and you know they knew that among other things they had a bunch of pieces like some of the DNA of the plan is like something the Heritage Foundation the conservative Heritage Foundation you know had done that back in the '90s and it was business friendly and they really much more than the Clinton people had from day one they basically went to all the special interests they went to the insurers they went to the drug makers they said look we want to get this done and we think you guys I know you're making money off the status quo but you can see this is not a sustainable system at some point it's going to break down that's not good for anybody and so the mode was make friends with a special interest don't mess with people's existing insurance if they have it and and frankly the hard part of healthcare isn't giving people insurance it's paying for that and trying to really aggressively cut cost and the Obama people were serious about that and I think speaking as an observer there's not a philosophical judgment nothing short of remarkable they were able to come in with a program that at least scored by the CBO as reducing the deficit which nobody believes they actually I mean doesn't CBO could have you know has said it a million times and people are like no that's not real no they really did they actually had a plan that would reduce the they paid for itself um but you know there's lots it didn't do even from the get-go they knew there were still going to be people without health insurance there were going to be people with health Insurance who have high deductibles they weren't going to fix all the practices of the insurance industry that people hated and by the way on top of all that like all new programs for the first few years it was really Rocky they had lots of problems most famously they the website they created the first year was like a freaking disaster oh yeah yeah healthcare.gov yeah like actually ironically you know that's there's a whole there's a great political story I to this day people say what's the closest this thing ever came to falling apart I think that's when it was and I actually think the Republicans missed who hated the affordable character you know I think they that was their chance to kill it and they could have if they hadn't quite approached it the way they did yeah I I mean so what it sounds like is it's kind of like you you take the metaphor of say that you you have a home or or you have a a kitchen in in a home and over the years the owner of the house has kind of done their own form of wiring and so they took it on their own and they connected the wires from the the kitchen light switch to the one in the living room to that goes to the TV and it's like if you even try and bring a professional electrician in the first thing they'll say is this hodgepodge is there's so many different aspects of it I don't know where to just do one fix I can't just come in and fix your light switch in the living room without basically having to like dismantle the entire system and so you know then the solution is how do you kind of address all the other problems with going on so but it sounds like what you're you're saying is that over the decades we have different components of our Health Care system that are really sucking up costs and any one effort to try and reform all of it is you're going to have such powerful special interest for for people who hope for some more political reform whether it's a Medicare for all whether it's Insurance reform I should mention whether it could be a public option politically is is there will for for some sort of Reform you know in the wake of what's happened here is there will to tackle the special interest and I guess the one that people have asked me about is the public option is that still on the table why hasn't a public option come out yet yeah yeah so I want say two things first of all I just want to say your analogy about the wiring in the house is fantastic I've been and like there's a whole analogy about a starter house that gets used in these debates because it came from like Obama and people I love that I'm going to use it partly because my house happens to be one of those houses but quite apart from that just like it's perfect um and it really works the level also of because you would say like the you know you will just Tear Down the House then and start over which you could do but then you don't have do you have another house to go in while you do no and so that's part of the problem you have to wait for the house to be built right right and who knows what problems going to be in that house so I mean your question about the public option so you know I I have learned not to be overly definitive in my political predictions and I thought that even before we ever heard of Donald Trump um I will say this my lesson that I take from the history including recent history is that change of any kind but especially big change and especially big change to healthare does not happen in a in in a flash it it happens after years of work um every major healthc care reform we have had has happened because there was groundwork laid outside advocacy and inside Congress um you know just to take one example example the prescription drug reforms of the inflation reduction act which like everything out like a you know very modest reform in the grand scheme of things you know every other country they negotiate all their drug prices we finally for one set of drugs in one program the government can negotiate but you know that's how you build on these things right I mean that's a sort of First Step that passed in 2022 um it would not have passed in 2022 if not for the fact that you know frankly starting around around like couple years after the Affordable Care Act passed there was a group of Democrats in Congress and it was Democrats not Republicans although there are Republicans who certainly care you know talk and care about prescription but these reforms were mostly Democratic reforms and I remember at the time it was a big fight in the Democratic caucus and you know the you know the the more liberal members wanted to do something the more conservative members didn't and they went back and forth it was a really bitter fight I remember at one point someone saying that why are they bothering because it was very clear the Senate wasn't going to Mitch McConnell made clear he was not going to bring up anything in the Republican Senate and Trump was kind of trump is actually on drug issues kind of weird and all over the map but you know so and I remember people saying why are they bothering and I remember saying at the time I will say I got this right I said because at some point down the road if Democrats get full control of Congress in the White House they will have laid the groundwork to do this and that's exactly what happened when they got full control after Biden gets elected they're able to take that bill and it has to go through the whole process again they have to make new com but they able to get it through so you were asking about the public option which just for your your listeners you know it's like the idea is have you have a government program that kind of operates inside the Affordable Care Act as an option it's like a little mini Medicare and it was something that the ACA was originally supposed to have it was something Obama talked about um he didn't feel that passionately about it but he supported it um there were definitely members of Congress who were hold they they had to drop it because they were basically one vote short well more than one there were a bunch of bunch of Dem in the Joe liberman Joe liberman yeah I mean Joe liberman kind of wielded the knife but there were like 5 to 10 Democrats behind him quietly say sort of a rotating villain kind of idea that they could stand behind him and he'll take the blows yeah he could take the blows cuz he was happy to be in that role and he was in a democratic you know and the other ones were like Yeah Yeah Joe go go go you know um so it's always a Joe it really is right um uh so you know not to speak ill of The Departed you know the cautionary note there I give you is that number one um I haven't heard a lot it's not something people are really focusing on right now so you'd have to kind of rebuild that sort of momentum sport number two like I think a public option you know you can make a really strong case for it whether the public option would actually address the problems people are perceiving right now is a whole other question like I can imagine a public option becoming l in a world where Democrats had a majority I mean they would need to and there's no way Republicans would go anywhere near that it's just more government in a way they just philosophically fundamentally oppose you know is there a world where Democrats could endorse something like that yes you know if they had the Congress and they had the president but we're at least four ways years away from that at this point and even then like you know I'm you know why did the public option die I mean obviously it had some conser there was philosophical opposition but let's get back to what you were talking about the hospitals hospitals hated that idea because they're like it's going to drive down our payments more and so if you imagine a world where you're trying to do the public option you got to imagine the hospitals doing the same thing they did before and we didn't talk about this but like hospitals I'm not trying to single out hospitals anymore than I want to single out insurers but hospitals are super powerful in part because in every congressional district in America they're the biggest employer they maybe not every single one but most of them and they have enormous power and the minute you talk about cutting money to them they will start saying well we're just going to have to start laying people off and our emergency room you're going to have to wait 3 days for whatever that is politically toxic for member of Congress and so it's a tough tough fight doesn't mean you shouldn't do it obviously but like I think uh you know if you're looking for ways you know to sort of improve Healthcare reform there you know where you know whether that is the best place to put your political capital is an open question we'll leave it you know I would leave that yeah well Jonathan this is a fascinating conversation glad we got to talk and thanks for taking the time to come on the show yeah know this was great and little little reliving history and a little Boston talked too which I always love to do yeah [Music] absolutely thanks for listening to another episode of lever time this episode was produced by me Arjun Singh with help from Chris Walker and editing support from Joel Warner and Lucy Dean Stockton our theme music was composed by Nick Campbell we'll be back next week with another episode of lever time 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