51 HCN - Shutdown shownotes
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Joe: [00:00:00] Welcome to the Healthcare Nation Podcast. We're committed to bringing you thought leaders in the field to discuss what's new and noteworthy in the healthcare sector. Now, your host Rick Gen,

Rick: we didn't pick a fight over tariffs or tanks in Ukraine. We picked one over healthcare. 15 years after the Affordable Care Act, we're still living in its shadow, a country split between those who can afford to get sick, and those who pray they don't. And now once again, Washington has turned health coverage into a hostage situation.

Here's the reality, not the rhetoric. If Congress lets the enhanced a CA premium tax credits expire in December, the average marketplace premium for subsidized enrollees can more than double in 2026. Whether the shutdown drama is resolved, by the time you hear this podcast or not really doesn't matter.

If lawmakers didn't hardwire an extension, the cliff is still there and families hit it when 2026 rates go live. [00:01:00] Meanwhile, the shutdown has already become the longest in US history with mounting economic damage. This isn't left versus right anymore. It's stability versus fracture. A controlled demolition with patients still in the building.

And if that sounds dramatic, spend five minutes in a rural emergency department trying to transfer a sick patient who has no coverage to a higher level of care. Welcome to the secession episode of the Healthcare Nation Podcast. Today, Joe and I are going to unpack where we're going and what this situation really is all about.

Let's get into it. Welcome to the Healthcare Nation Podcast here with our producer Joe Woolworth. Joe, my good friend, how are you doing?

Joe: I'm good. I'm doing well.

Rick: It is casual Friday, as you can tell. Yes, very. One of the rare occasions when I am dressed down. Yes. On a casual Friday in

Joe: honor of the government shutdown

Rick: in honor of the shutdown.

That's it. We're not washing clothes at home. We're trying to, you know, austerity measures across the board. That's it. Mm-hmm. Right. So look, we got a lot to talk about today. [00:02:00] Really, the, not only the, the shutdown, but specifically. Its implications on healthcare delivery and what's happening there. So I know you got some questions.

Sure. We had some folks, uh, email us with some questions right when we queried our subscribers. So what do you got from me? Let's jump

Joe: in. Yeah. I know if this is an interesting topic for a lot of people, a lot of people a little scared. We were just chatting before I was telling you my personal healthcare insurance went up to like mortgage level it seems like.

Uh, so I know a lot of people. Are curious about this topic. So give us a short history. Yeah. What's, how do we get here?

Rick: And I'm sorry to hear that of course, because this is the real thing. But look, I'll give you the, the, the, the short uncomfortable history, if I could characterize it that way. First. Look, um, both parties built this system.

And you know, we try to be very objective here on the show. Sure. I'm gonna just say that, but both broke it I think as well. Maybe in different ways. Let's start with the Democrats. Look, the, the, you consider them the architects of access when it comes to the Affordable Care Act. Right. Guaranteed issues for folks, federal exchanges.[00:03:00]

Medicaid expansion across the board. Income-based subsidies, yes. They cut the uninsured roughly in half. When you look at the US, if you go back in time and look, I could be corrected, but I think my, my numbers are probably fairly up to date, the expanded coverage without expanding capacity. That's my opinion, and I think that's the problematic piece of it.

Right, and there may have been some assumption here that regulation could replace. Some of the necessities like throughput, but it couldn't. The results. Affordability, yes. But maybe more on paper than not sure when you think about it. And some of that's coming to roost. So if I was gonna sum it up on the Democratic side, uh, they supercharge the Affordable Care Act with enhanced tax credits through the American Rescue Plan with Biden, the Inflation Reduction Act.

They didn't reduce though the costs overall. They just shifted them. So the federal government picked up the difference, right? The delta between what care actually costs and what, how, you know, what [00:04:00] households and, you know, you just gave an example, can afford

Joe: at the same time, did h healthcare prices go up, uh, of for care?

Rick: You know, it across the board labor, uh, the. The cost of the infrastructure per unit cost. I hate to characterize individuals or patients like that, but they all went up.

Joe: Sure.

Rick: So those moves though, did stabilize premiums, but it didn't bend the curve. And that's exactly, to your point, didn't bend that cost curve.

Now if I switch to the Republican side, uh, look, this is an opposition, but without a replacement. Right. Is there any good ideas coming out? Not that I've seen. The repeal and replace became identity politics. Let's go back to 2017. We all remembered, you know, what went down at that particular time, and I think the unfortunate thing for the Republicans is it branded them as reckless with coverage and that did not go through this skinny repeal process.

It re probably shifted though this ideological kind of, you know, perspective that. [00:05:00] I believe folks were going through with healthcare as a right, et cetera, to more that was to one that was more arithmetic, right? More mathematically based. Washington cannot subsidize an unreformed inefficient market.

Right. I think that's where the Republicans are coming from. Yeah. If I was gonna sum up that side though, and this is my opinion, not based on let's say data. I think they're looking and, and what they see is, uh, a fiscal time bomb. There's roughly 25 to 30 billion a year in new federal outlays, let's just say 300 billion over 10 years if this extends right.

Uh, uh, and extends this artificial affordability, some price support system for an unreformed, you know, system, unre reformed market. Their argument is it just props up an inefficient system blunts competition and deepens dependency on Washington.

Joe: Sure.

Rick: So put those two perspectives together and the real fight, and you said it a a minute ago, it's that [00:06:00] each unit of healthcare now carries stacked costs.

Right? They're built in everything from labor, facilities, administration, drugs, risk management, you know, and the, the reality check here is. You can't austerity your way out of, you know, these innovative things you need to put in place and you can't sub subsidize your way to sustainability. So, I mean, long-winded, uh, answer there, but I think, uh, probably covered a lot of points there.

Joe: Is there also, I think I remember reading somewhere, hearing somewhere the, you know, kind of there's the, the acceptability or the, the change in public perception of mental health and more people using mental health as part of their healthcare costs. Also driving up. Or is that more of an insurance thing that I'm talking about?

Rick: Yeah, I think, look, mental health is always, it's always baked into the equation. The, the reality is I think that whether you look at commercial insurance or even some elements of Medicare, and certainly Medicaid, right? Three different. Products if I could, you know, again, put it that way.

Joe: Right? [00:07:00]

Rick: None of them are doing the job they should with respect to mental health or even looking at mental health on parity with say something like a clinical condition like diabetes or heart failure.

Joe: Okay.

Rick: So, uh, is it driving up costs? I think there's more recognition of it. Mm-hmm. But what we're seeing in the private markets is things like, uh, better help and these apps that are trying to address mental health issues. I would say a more entrepreneurial, you know, uh, uh, innovative way.

Joe: Sure.

Rick: But by and large, they're not covered by insurance.

Joe: So now that you kind of set the table of today's topic, we've got. Like, like a magic trick gone wrong where somebody tries to pull the cloth out from the table and leave all the stuff, but all the stuff seems to be flying here 'cause we got this big government shutdown going

Rick: on. It is, it is. It is flying and you know, uh, we've got some updates on what's happening, but as of what we know right now, Friday, right, November 7th.

It's still shut down. Yep. We, we, we know that that's happening.

Joe: And are we in record territory?

Rick: We're in record turd. It's never happened before. This is, I think, the longest shutdown [00:08:00] ever on record.

Joe: I think right now, primarily the news cycle today, the last couple days has been impact to airports. TSA

Rick: big time.

Joe: Yeah,

Rick: big time. Right.

Joe: Thousands of flights. That's, I just read it on the way.

Rick: Would not wanna be traveling right now. Yeah. Rough. I mean, that's a reality.

Joe: And so what's the impact? Let's talk about the healthcare side of it. Wow. What's, what's really at stake here with the government shutdown and its impact on healthcare?

Rick: Yeah. I think, uh, why is this shutdown different? It's kind of a subsidy cliff detonator, uh, we'll use that explosive, um, kind of example. Let's get into the math. I mentioned that a second ago, not the theatrics here. If the enhanced credits expire at the end of the year, right then average marketplace payments go up over a hundred percent.

So a plan that was 800 could go up to 1800. That's a reality. Some folks will see things in between. But I think you, you mentioned it earlier about your personal experience and it hits your pocketbook, right. For millions of working families.

Joe: Yeah.

Rick: That's like a market [00:09:00] eviction, right? It it, it's not pleasant.

And

Joe: you know, and I've heard it said that that kind of is a, is a, a move. In, in policy and stuff, like once it hits people's pocketbooks. But I think in the past we didn't have so much identity politics, and I'm wondering if that's going to change. 'cause in the past, I think you could say like, okay, once it hits a pocketbook, all of a sudden everybody's on the same team.

Rick: Yeah. Great, great point. You know, uh, 75% of Americans, uh, including many Republicans and certainly Democrats in there, they support extending the tax credits. Voters in this case, they're not seeing, you know, this as a, as a. Uh, a partisan issue. It's more of a pocketbook and a coverage issue, right? Yeah, it's, it's, it's about their own healthcare stability, so they want it fixed.

Joe: Yeah. Yeah, I agree. I, I think that's right. Um, I mean, 75%, there's no way we're pretty 50 50 right. In most things politically. Um,

Rick: yeah, absolutely. I mean, and look, the coverage loss, it could impact four to 5 million people. And, and the, there's a job component to this as well,

Joe: right?

Rick: That will ripple [00:10:00] across from, you know, uh, obviously the impact to the federal government.

We're in a shutdown, but also at the state level too.

Joe: Yeah. So as, as public. You know, perception starts to change. It usually changes a lot faster than policy, you know? Right. So it can feel a little bit slow with that. So, you know, you've called this a healthcare succession. What do you mean when you say healthcare?

Secession?

Rick: Yeah. Yeah. Let me, uh, let me break that down just so we don't scare anyone on there. And I don't get censored by by YouTube, which, which is, you're not saying there's gonna be

Joe: different healthcare for Republicans and Democrats.

Rick: I don't know. There is, there many would argue there's already different healthcare for, for a, a lot of folks out there.

But I would say this, there's a fracture line, right? Um, if we take, just take a look at states that expanded Medicaid or didn't, right? So non. Expansion states still rely heavily on the marketplace for individuals there. Right. And the loss of federal subsidies with no backup layer. They could [00:11:00] very well be the first states in their primarily red states that get really impacted, meaning their constituents, the populations of those states.

Sure. So that's, that's a, that's a, a reality. Blue states, on the other hand, let's take California, they could wrap subsidies so that they could, you know, insulate themselves. So when I think about a secession in this. Uh, since I'm thinking about, um, let's envision two kind of constructs within America with respect to coverage, one that is very cushioned, we'll say California expands wraparound so that Medi-Cal or, or the marketplace has a state assisted subsidies and the others they're exposed.

Okay. Right? So you, you get those premium increases.

Joe: So. You were talking about in the history how we got here, you know, here's what both parties contributed, and then here's both parties also kind of blew it a little bit. Yeah. So who failed and how, because I think this is what the pundits wanna do. They wanna [00:12:00] play the blame game and you know, you certainly hear.

It's what's holding up the shutdown. You've heard the president himself say, you know, over and over again, it's clearly the Democrats, it's all their fault, it's all their fault. Uh, there's usually the truth is somewhere in the middle.

Rick: Yeah. Yeah. So, and look, and, and I think here on the show, you and I have always been in the middle, right.

We, we try to be very objective. Let, let's break it down, right. Let's do a, a brand autopsy, right? Okay. Dems and, and GOP, right? And, and both of them, first of all, they blew the brief. Both definitely did, but I think if I was going, going to again, get back to each one individually, the Democrats, they won the coverage side early on, but they lost the delivery piece.

Right. It's not sustainable. We're seeing this right now. Sure. Subsidies and expansion without, you know, capacity infrastructure still creates issues with bottlenecks, payments, reimbursements. The system is very compassionate On paper. It's probably exhausted in practice. Right. Fiscally and even I would say from a [00:13:00] labor component and the folks who are in healthcare in that sense as well.

Joe: Mm-hmm.

Rick: It's just a reality on the GOP side, right? The Republican side, we've seen a decade of repeal rhetoric. We've seen this again, back to 2017, no replacement blueprint being put forward. In a 17. There was the skinny repeal, but it collapsed. Right? Yeah. And that caused a lot of brand damage, I think for the GOP.

They're, they're preaching discipline, but they need to come forth with a new program. Right. A new, a new delivery system. Right. That's what I think. And, and if we get down to individuals, voters, folks like you in the, in the vignette that you, you know, shared about your personal, uh, experience with, with the premiums going up.

Everyone wants lower premiums, right? And they want stability. They don't really care who signs this, the, you know, oh, absolutely. Whose signatures there on the law. That's, that's not the, the reality. They want it done. And right now, I think, uh, at the end of the day, Democrats can't manage it at scale. And Republicans, they need [00:14:00] to come forth with something new that's also got the compassion piece put in it.

And right now what it looks like is, uh, bureaucracy at war with itself, that's the shutdown.

Joe: Yeah. And I think for people that kinda get sick of the rhetoric side of the conversation, that's how we got here. Right. Because it, it feels like it's just talk, talk, talk. But yeah. Okay. How do we fix it?

Rick: Yeah.

Joe: Yeah.

It's a problem, right?

Rick: Yeah,

Joe: I agree. It's a big problem. Both sides agree. It's a big problem coming at it from slightly different angles, so. What would the what, what can the deal look like if, if you were in the room cutting the deal? Yeah. What would it look like? What makes sense? Yeah. Because obviously it needs to change, it's unsustainable, so there's elements of that.

That's very correct. And it also, from the standpoint of. We look at other countries and we look at their healthcare and there's kind of like this starry-eyed gaze that a lot of that would be nice that Americans have and be like, what's that like?

Rick: Right? Yeah. You know, the other side of that is be careful what you wish for, but look, uh, first thing hot off the press in terms of [00:15:00] like, one of my first points, uh, uh, apparently minority leader, uh, Chuck Schumer, uh, is going to try to connect, uh.

Uh, you know, in a, in a session with Republicans to try to end the shutdown and ask for a one year extension of the a CA tax credits that are expiring.

Joe: Okay?

Rick: I don't know if that's true or not, but it came off the, the wire, so I'm just. Communicating that. And then why usually

Joe: kind of a first step after a shutdown.

Huh? We're

Rick: getting,

Joe: we're giving ourselves a

Rick: little bit of time. Let's get there. Yeah. And, and you know, in the world of things that I would want the deal to look like and, and, uh, you know, starting with extending the credits, yes. I would say you gotta extend them for two to three years. Align with the 2026 filings.

No pricing on, on, you know, uncertainty. We need that, right? There's too much instability and I think there's a political connotation that we might talk about. The second thing is you've gotta protect middle class affordability, right? The [00:16:00] eligibility, uh, federal poverty level, uh, percentages, cap the benchmarks, premiums we've got to revisit there.

The other three I think are really tied more towards delivery and innovation, right? We've gotta think about the structure, right? Is our workforce, you know, prepared to deal with, you know, this type of reimbursement. You know, wobbly kind of boomeranging around. It's not. Fair to folks who predictably, if you're a physician, have your own practice, how do you figure this out?

Yeah, and the insurers are, you know, they're losing folks year to year. There's no continuity in any kind of managed care plans that, uh, say a, a big insurer in a state wants to do from, you know, year to year because the, their constituents, the folks who are on their plans. May be on a new, another plan next year, so why should they invest in it?

And that's, that's my take. The other side is, you know, the Medicaid side, like we gotta repair the churn because a lot of folks, you know, [00:17:00] this, uh, issue with, um, uh, redetermination dis-enrollment has created a big issue there. And finally, and you know, we've always been very bullish on this. We've got to protect the innovation.

Side of care delivery and the research engine. It doesn't play a direct part in this, but we've got to keep looking at ways that we keep innovation in the system. Otherwise, this is going to come back to on us again, because there's no imaginary savings from any kind of fantasy utilization, we've gotta have something really created.

There's no coverage swaps that dump costs back on hospitals. Hospitals cannot handle that given their margins collectively. We can't have these kind of political Gotcha games back and forth, you know, masquerading as sure as reform.

Joe: And they've gotten, they're, they almost feel like a little bit more than gotcha games right now in that like, both people are just like, cool, I'll take my ball and go home.

Right? Like, we're not fixing anything if you guys don't even come to work and it's your [00:18:00] job to fix the thing.

Rick: Yeah.

Joe: You know, that can make it a little challenging.

Rick: Yeah. And you know, speaking of work, you know, you know, entrepreneurs, small business owners, folks who have their own insurance that they have to get either in the marketplace or through Yeah.

Through some other vehicle, you know, uh, such as yourself. I mean, you get impacted by this and it's a big number, particularly if you've got. Not only your family, but employees you have to deal with.

Joe: Right. And when I get frustrated with health insurance, I can't take a month off. Right. 'cause I don't like the way it's going.

Rick: Yeah, that's right.

Joe: I still gotta go earn money so I can pay my bill.

Rick: That's reality. Right. And that's it. I hear you.

Joe: So all this happens to be happening right in the midterm Yeah. Of a 2026 midterm. It's kind of a boomerang. Um, you know, it depends on what's, what news flavor you listen to.

Rick: Yeah.

Joe: Um. It seems like we just had a good midterm election.

Some, some bellwether stuff, maybe some very predictable stuff.

Rick: Right. And, and good. There's a lot going on. Good, good. Always depends upon what side of the aisle you're on, but I would say this,

Joe: yeah,

Rick: it's good that folks went out there and, and voted [00:19:00] record

Joe: numbers.

Rick: Yeah. And if you do look at what I, what I just mentioned with respect to, you know, uh, Chuck Schumer and trying to go back to the table with the GOP.

It, maybe look for an extension on the, on the subsidies and credits. That's all. Because they're, I think, a, there is a belief on the, on the dem side that they did well, and they've got some, you know, sure. Some leverage here. Right. That's, that's, it could have gone the other way too. So we don't know. But I, I would boil it down to this, when you think about the, the midterms and just everything that's happening.

There are still flashpoint states, right? There's these hard, high marketplace non-expansion states I mentioned earlier with respect to Medicaid and, uh, everything that I think is probably more polarized on the, you know, uh, right versus left side that are gonna get hit here. Thin safety nets, lots of exposure.

There's visible pain that whether you believe the elections went well or [00:20:00] not, that individuals are facing because there's still these double to triple digit increases that folks have to deal with. We can't say, or I can't say that it's hit hospitals right now. But it is ultimately gonna impact, yeah, the hospital reimbursement.

And if you don't have coverage, you go to the emergency department, throughput, everything that goes along those lines. So I think if you look from a timing, uh, perspective, it's a, it's a brutal time depending upon what side of the aisle you're on. Whether you see this issue, as you said, as a bellwether, you know, healthcare is definitely gonna be front and center, and who's left holding, uh, that issue as the, as the party that didn't do anything about it?

Yeah. That is what the voters are gonna determine when they go. Right now. And as we move forward into 2026,

Joe: which an election cycle is always the thing, right? Whatever party's in power, the other side likes to run on how inefficient they've been in fixing one of the main issues that hits the pocketbook.

Rick: Yeah.

Joe: And um, [00:21:00] so I mean, that's pretty normal. Uh, but at the same time I heard something like most people might get a 40% increase. Which, you know, I don't remember what I heard that, so don't quote me on it. Mm-hmm. But that's, that's significant. That's not significant, like matching inflation

Rick: and my numbers were up a hundred percent.

So, uh, look, from an election, PRIs, I think if I could forecast this, and some of it's already been done, we saw this in Virginia and New Jersey, certainly at the, uh, at the governor's side, a boil over at the state level, state houses and governor races, right. Coverage loss for the average American. Equals economic pain in real time.

This is something, it's not like, oh, the price of eggs are going up. This is year to year. Your premiums are going up. This impacts everything. Sure. For, uh, the average, uh, you know, American, and don't forget here we're talking about people's health. So those who have chronic conditions depend upon the system to help them stay in a state of optimal health.

The [00:22:00] when, when you have a price tag tied to that. It is more than stressful, I think. I think we can agree on that.

Joe: Yeah. Most people's budgets don't have an extra 400 to a thousand dollars a month built in to absorb the pain of unexpected hate, um, rate hikes.

Rick: Right.

Joe: You know,

Rick: you've got it. Yeah.

Joe: So moving forward kind of Yeah.

Saw some rules of engagement here, you know? Yeah. It feels like, at least the way you hear people report on it, that we're in a healthcare kind of a, a war. Yeah. Uh, what every war. Ends with rules for peace. So I think that's what kind of people are hoping for. Great. Let's have a plan. Let's have something going on.

Yeah. What's the peace plan look like?

Rick: Yeah. Let's bring the axis and the allies together. Right, right. And bring 'em to have a, have a maybe come a conference at Malta

Joe: or just come to work and talk to each other. That'd be a great first

Rick: step. That would be a great first step. Look in no particular order, and again, so much of this podcast really, I think leans a lot on innovation [00:23:00] and forward thinking.

Uh, you know, models of care and private public partnerships. And I think first thing is, can we govern at the speed of business? I think that would make a big difference. And what do I mean by that? Healthcare moves in quarters sometimes, you know, years not, uh uh. Decades. And when you have a system that has these regulatory components that slows things down so you know, innovation slows, it could have a suffocating effect.

And we've really gotta be mindful about that. And. You know, I always think if Wall Street can approve a financial algorithm in, you know, a couple weeks, we should be able to do the same in healthcare policy. Yeah. The stakes are, you know, I, I would think higher, right? Sure, sure. So that's, that's just one thought.

Second is, you know, we've gotta stop lighting the candle at both ends. And what do I mean by that? Um, you know, we subsidize demand. We gotta also look at supply. [00:24:00] We, we, we've done things during the pandemic, like have licensure, reciprocity across states and, and telehealth. Then we take it away. You, you, we've gotta get standardized on a lot of what we're doing.

Yeah. On the innovation side. And I also think that, and I, I don't wanna be a, you know. A doomsday person, but all of this is, is a warning shot because at the end of the day, the next shock we, we may have, right? It could be a cyber issue, it could be another pandemic, could be, you know, you name it, when it comes to an economic, uh, uh, you know, uh, impact to what we're seeing as average Americans in our cost of living, that's not gonna wait for a political solution.

And when it impacts healthcare, that really can. Can put a strain on the system that could be devastating. We saw what happened with, with, uh, the pandemic, and I'm saying that because we need a resilience system. We need something that's hardwired, that's built for speed, and if a shutdown can [00:25:00] create a situation where we've got this, you know, economic angst because premiums are going up, imagine if that.

You know, expanded into care delivery itself. And we had closures, shutdowns, I mean, you name it,

Joe: right?

Rick: You know, in the opening. I, I I, it's

Joe: frustrating for 2000 flights to be canceled, but for 200 hospitals to shut down is a different thing,

Rick: right? And, uh, in the opening I mentioned, you know, if you had, uh, if you were in a rural hospital and you had a patient in the emergency department that was very sick and you needed to transfer them to a.

Uh, an institution that had a high, higher level of capability that could take care of more acute patient. One of the questions they're gonna ask is, is this an insured patient? Right? Because they're already at a facility. We don't wanna be in that situation.

Joe: Yeah. Yeah. I think, I think you're definitely right.

The, so let me ask you this. If I'm thinking in terms of the metaphor of the peace toxin. Do you think the right people are gonna be asked to be in the room? [00:26:00] And let me tell you why. 'cause we, we made almost a whole episode, didn't talk about ai. So I'll talk about AI for a second. Yeah. When we first started seeing them talk about AI in Congress, I think the perception of many was like, Ooh, these Congress people don't know.

They're not the right people to be set in the policy. Yeah.

Rick: Yeah.

Joe: So if you were building the Dream team and they were gonna work with a group of people, I'm not looking for names, but like what types of people should be weighing in on an actual plan to change it as opposed to a. Let's stop doing it your way plan, which feels like what we've got in the last three rounds.

Rick: Yeah, that's a great question. You know, uh, lemme, I'm, I'm gonna stop short of going into the territory of regulatory capture because I'm, I'm not gonna weigh in on things like that, but you could, you've gotta have the right people in the room because if you have the folks in the room who are gonna design a system that only benefits them, then they're capturing the market, right?

So we've gotta be, you know, kind of, yeah. We

Joe: don't want, we don't want just Congress people and, and people who. Use what is lobbyists? That's, that's who we don't want the only two org of [00:27:00] people in the

room.

Rick: Right. Or a, or a, you know, a a, let's say an insurance platform that's saying, we've got the cure and then we're here to fix it.

We're, we're here to fix it. So also

Joe: we're gonna do well.

Rick: Right. We're not gonna lie, do well. Right. I mean, that's, that you, you know it. And they, their motivations are completely different. So if I was to think about, you know, how do you, first of all, there's gotta be a conversation.

Joe: Mm-hmm.

Rick: And what's missing in that conversation is taking a real hard and objective look.

On the health status of most Americans. Right. And it's not good compared to other industrialized countries.

Joe: Yeah.

Rick: And when you have a shutdown and when you have concern over affordability for insurance coverage, that directly impacts for some Americans, whether they're going to afford. To get their prescription filled.

Joe: Mm-hmm.

Rick: And whoa, that's devastating if you have to choose between groceries or your prescription.

Joe: Yeah.

Rick: And that's just one example, right? If you think about what you need to do without, or going underinsured or having a high deductible, [00:28:00] which could wreck you, you know, it's still the leading. You know, cause of bankruptcy in the United States is, is the, you know, medical bills and, and the associated hit that an individual can take because they don't have that level of coverage.

So it is a big issue and let's hope this gets resolved and when we come back we'll bring everyone up to speed.

Joe: Yeah. Hopefully everything goes well. Okay. So final word

Rick: look, uh, a shut down like this and we'll use the air traffic control and the, and what's happening with flight delays as a proxy. You would not want that happening.

As you noted in an emergency department, folks are waiting for surgery. Uh, you know, an individual has a chronic condition and needs to see their, their, their provider. That's what's at stake when you really extrapolate and think about where an extended shutdown can go. Because healthcare is its own economy, right?

The health sector really is [00:29:00] its own economy and it is subject to all the levers that the regular economy is. And when you, when you really shut down certain inputs and outputs that are associated with it, you know, we could have some negative effects that we, we don't wanna see,

Joe: right?

Rick: So that's it my friend, short episode.

But I think an important one because we wanna keep folks up to date on what's going on with the shutdown and how that impacts healthcare. So, uh. Until next time, Joe.

Joe: Until next time.

Rick: The opinions expressed by the host and guests are for informational purposes only and not associated with any companies or academic institutions.

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