When Area Hospitals Have the Same Owner, Does Medical Debt Go Up?

There are 27 million Americans who have medical debt on their credit reports right now—a drag on their pocketbooks and our health care system. Urban Institute researchers say they’ve found an interesting fact about those with medical debt: They live in communities with less healthcare competition because of common ownership. The data show that communities of color and people living in the South are disproportionately affected.

Fredric Blavin, Ph.D. and Breno Braga, Ph.D. say medical debt can intensify financial challenges, affect health care access and potentially worsen health outcomes. They report prices at monopoly hospitals are 12% higher than those in more competitive markets.

They share with hosts Mark Masselli and Margaret Flinter a variety of ways policymakers can explore unraveling the market concentration-medical debt link and we share the perspective of the American Hospital Association. 

The Limits of Aging & Implications

The current life expectancy at birth is 74.8 years for males and for females it’s 80.2 years in the U.S. Does it catch your eye when you hear about predictions we’ll be able to live to 100 and beyond? Some researchers are throwing cold water on those notions. “We’ll be lucky if 5% of the age cohort makes it to 100,” says S. Jay Olshansky, Ph.D., Professor, University of Illinois at Chicago.

He and his colleagues made headlines when they presented data that humans are approaching a biologically-based limit to life. Hosts Mark Masselli and Margaret Flinter ask Olshansky about the implications of this research — for each of us personally and for policymakers — after decades of hearing predictions that life expectancy would continue to go up. Olshanky explains why we should celebrate longer life that has resulted from healthier diets and medical advances but now focus on improving quality of life in later years.

Reporters Examine Harris & Trump’s Health Care Policies: Election 2024

Early voting is underway in most of the U.S. right now (with few exceptions) and health care is on the ballot. There are increasing signs that former President Trump, if re-elected, will try to proceed with “massive changes” to the Affordable Care Act. Meanwhile, Vice President Kamala Harris is vowing to protect the law and continue federal drug price negotiations. Both candidates say they’ll seek to expand support for in-home health care.

Our guests are the reporters covering these issues. Shannon Firth, MedPage Today’s correspondent in Washington, shares an update from a contentious U.S. House race in Minnesota that’s focused on abortion. Sarah Owermohle, who reports on federal issues for STAT News, explains the situation in Montana following her recent visit to the state.

Join Mark Masselli and Margaret Flinter for our Reporters’ Roundtable as we countdown to election day and discuss what the results will mean for the nation’s health.        

Election Year Stress? How Music Can Help the Mind Relax

The upcoming presidential election is stressing out 69% of American adults, according to a survey from the American Psychological Association. If you’re with the majority in feeling that way, there’s important advice to consider from worldwide acclaimed soprano Renée Fleming. She’s the editor of “Music and Mind,” a curated collection of essays from leading scientists, artists, creative arts therapists, educators and health care providers about the powerful impacts of music and the arts on health and the human experience.

Renée shares how she discovered her own music and mind connection early in her career when she had back pain and how a dinner with three Supreme Court justices led her to become an unexpected advocate for neuroscience.   

Renée, a five-time Grammy award winner, also explains to hosts Mark Masselli and Margaret Flinter what happened when she saw the results of a functional MRI experiment she took and what it means for all of us

How Groundbreaking NIH Research is Expanding to Birth-to-Four-Year-Olds

For nearly the first decade of the National Institutes of Health’s “All of Us” Research Program — aimed at increasing diversity in genetic research — a major component was missing: kids.

“Children are approximately 24% of our population in the U.S. and 100% of our future,” Dr. Sara Van Driest, director of pediatrics for NIH’s All of Us Program, told hosts Mark Masselli and Margaret Flinter. “In order to provide them with the very best care for the future and have them benefit from this resource, we need to include them.”

The journey is personal for Katrina Yamazaki, Ph.D., principal investigator for Community Health Center, Inc., in Connecticut, a partner organization in All of Us. Yamazaki and her husband adopted three boys through the foster care system.

“We don’t know a whole lot about their … biological families’ medical history,” Yamazaki said. “The idea that this program will one day be able to provide some of [that] missing information to me and my husband, in order to become health advocates for our children is really important to me.”

The NIH in August began limited enrollment in the program for children age 4 and under.

“We started with that youngest age group so we can follow them the longest,” Van Driest said.

Community Health Center, Inc., for its part, is partnering with community-based organizations such as the Hartford Public Library to build trust, raise awareness of the project and make a fun atmosphere through activities.

All of Us intends to change what might be seen as a “one-size-fits-all” approach to health care. It aims to encompass 1 million individuals of diverse backgrounds but doesn’t focus on particular diseases or conditions, Van Driest said. The diversity, too, goes beyond culture, touching geography, age and socioeconomic status.

“One of the goals of research is to connect the dots,” she said. Given the scope of the project, “there will be so many dots that we’ll be able to connect,” Van Driest said.

 “If we fail to include a group of individuals or an aspect of diversity, we miss out on that uniqueness. That limits us in what we’re able to understand about humanity in general,” she said. “It also limits research and learning about that group of individuals. And it limits downstream how clinicians can care about individuals and give them the very best possible outcomes.”

Trump vs. Harris on Health Care: Experts Explain Each Side

The countdown is on to election day with health care issues hanging in the balance as never before. The biggest one: Abortion and reproductive rights. Andrea Ducas, the Vice President of Health Policy at the Center for American Progress, says “What you see with Vice President Harris is a candidate who’s committed to protecting women’s freedoms, to protecting women’s right to choose.”

On the other side of the political spectrum is Wayne Winegarden, Ph.D., the Senior Fellow in Business and Economics at Pacific Research Institute, and Director of PRI’s Center for Medical Economics and Innovation. He and his colleagues believe that patients are not in control of the health care system and that we suffer from an opaque and complex pricing structure that harms patients. Winegarden’s free market approach means he advocates for doing away with the Obamacare subsidies that Congress must consider, as they soon expire.

As Kamala Harris and Donald Trump engage voters at rallies, online and on TV, our guests provide the policy perspectives that will undergird the thinking of the administration that will take power. Join hosts Mark Masselli and Margaret Flinter for this important conversation.

CDC Director Warns of More Dangers From Hurricane Helene

U.S. Centers for Disease Control and Prevention Director Dr. Mandy Cohen described to “Conversations on Health Care” that their role right now is ensuring impacted residents understand the health risks that are present and could continue to grow in the aftermath of Hurricane Helene.

Dr. Cohen says while local, state and Federal Emergency Management Agency (FEMA) officials are in the acute response phase, CDC is doing its part by ensuring people realize there are growing risks, including from flooded roads that are not safe to drive over. The CDC says when returning to a flooded home after a natural disaster, be aware that the house may be contaminated with mold or sewage, which can make people sick.

“As a North Carolinian, my heart goes out to the people in the western part of our state. People had power outages, which means food has spoiled in the refrigerator…make sure you’re not eating spoiled food,” says Dr. Cohen, who previously served as North Carolina’s top state health official. “Our water systems have gotten hard hit, so thinking about whether if you need to be on bottled water. In the recovery phase…we’re likely to see more mosquitos because we’ll see standing water and making sure folks are doing what they need to do to protect themselves.”

Click now to hear her interview with Mark Masselli and Margaret Flinter.

Trump & Harris Debate IVF: Why It’s an Election Issue

At the beginning of this year, few could have predicted that in vitro fertilization would become a big political topic. But that’s what occurred after the Alabama Supreme Court ruled frozen embryos are “unborn children.” The Alabama legislature then responded by passing a law to shield IVF providers.

Since then, former President Trump said he wants the government or insurance companies to pay for IVF treatment. However, Vice President Kamala Harris has said that “under Donald Trump’s abortion bans, couples who pray and dream of having a family are being denied IVF treatments.”

As we near election day, we’re looking back to an interview with a national leader on these issues. Carole Johnson is the administrator of the Health Resources and Services Administration, which is part of the U.S. Health and Human Services Department.

Johnson told hosts Mark Masselli and Margaret Flinter in March that some health care providers were already reluctant to work in states with restrictive reproductive legislation and the Alabama situation presented a new challenge.

She stated that “It should not be the case that young women in this generation have less rights than I did growing up and we need to change that. We will continue to lean in as an administration supporting women.”

Mark Cuban: Drug Price Disrupter Explains How It Works

When we have a guest like “Shark Tank” star Mark Cuban, it can be hard to keep up with all his thoughts. He was a bundle of energy in November 2022 explaining his then-new venture trying to reform how Americans can purchase lower-priced drugs; he called it “dunking on the pharma industry.” Since our conversation, experts say Cuban has become a major disrupter in generic drug pricing. Cost Plus now offers 2,500 drugs and has signed up a large list of health systems.

Join us for this encore presentation as hosts Mark Masselli and Margaret Flinter ask Cuban to explain how his approach also includes introducing transparency to drug pricing.

How to Reduce Health Risks When September Temps Reach 100+

Experts report we’re dealing with the hottest summer on record for the second year in a row. Phoenix has recorded 100 straight days of over 100-degree weather; Hollywood Burbank Airport in the Los Angeles area matched its all-time high temperature with a reading of 114.

In Los Angeles, the city is taking action to help its people deal with the temperatures through the leadership of Marta Segura, one of the few appointed chief heat officers in the world. Her work is focused on finding solutions when the weather causes physical and mental health issues and she’s keeping equity at the forefront of her efforts. Segura explains how an aware and engaged public is key to the effective implementation of climate policies.

This all occurs as U.S. Health and Human Services Secretary Xavier Becerra has declared extreme heat a rising public health crisis.

Join us for this encore “Conversations on Health Care” with hosts Mark Masselli and Margaret Flinter.

When Money Takes Over Medicine: Risk, Rewards & Warnings

Did you know private equity owns one-third of private hospitals in the country and the percentage is growing? Private equity is a controversial type of financing typically seen in the technology and media sectors that’s now attracted to health care.

It’s a trend that greatly troubles Erin Fuse Brown. She’s a professor of health services, policy and practice at Brown University’s School of Public Health and its Center for Advancing Health Policy through Research.

She explains to “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter that private equity’s practice is to cut wages and employees and substitute highly trained staff with lower skilled substitutes. She says, “It means worse patient care in many instances and that is what we see is leading to the greater risks of mortality and adverse events for hospital and nursing home patients after a private equity acquisition.”

Fuse Brown also discusses why it’s so difficult to figure out who actually owns your hospital and the latest details about the effort to ban employees’ noncompete.

Trump, Harris on Abortion: Reporters’ Roundtable Examines Their Records

Gallup reports that a record-high 32% of U.S. voters say they will only vote for a candidate for major office who shares their views on abortion. Indeed, the upcoming November presidential election will be the first one since the Supreme Court ended the constitutional right to abortion. The Washington reporters who cover health care policy and political maneuverings join us on “Conversations on Health Care” to discuss how Vice President Kamala Harris highlighted the contrasts between the parties as former President Donald Trump has issued statements that appear to muddy the issue.

Discussing reproductive rights and other issues are:

• Shannon Firth with MedPage Today

• Ben Leonard with POLITICO

• Sarah Owermohle with STAT News

Hosts Mark Masselli and Margaret Flinter also ask them about gun violence, medical debt, Medicaid, and the future of the Affordable Care Act and its subsidies. Be sure to listen to what health-related question each of these journalists would like to ask the presidential candidates if given the chance—some of their questions may surprise you!

NEJM’s First AI Editor: Yes, AI is Here to Stay

Some patients are concerned about how far artificial intelligence (AI) is creeping into the exam room. But AI has been part of health care longer than most realize, according to Dr. Isaac Kohane, a groundbreaking Harvard University professor.

Kohane is the editor-in-chief of the New England Journal of Medicine’s first publication devoted to AI. He tells hosts Mark Masselli and Margaret Flinter that “In the 1980s, automated interpretation of an [echocardiogram] would have been considered AI. Now it’s the ability to look through a patient’s record and come up with a differential diagnosis, a second opinion, a therapeutic plan.”

Kohane shares a success story of a mother whose child had difficulty walking and chewing, suffered from headaches and had seen more than a dozen doctors over many years, with no diagnosis. After one doctor recommended a psychiatric course of action, the mother fed the reports from various past medical visits into a generative AI program, which suggested tethered cord syndrome.

Cases like this can represent AI’s potential, says Kohane. But the nascent technology raises issues of bias. “You can run tests on these AI programs and say, ‘Would you propose that diagnosis more often if this was an African-American or an Indian-American?’ … And you can adjust these programs,” Kohane says. The exciting part is that the adjustment would be easier than undoing even unconscious bias among hundreds of thousands of health care professionals, he explains.

Nuance can help health field regain public trust: AcademyHealth CEO

Dr. Aaron Carroll raises eyebrows with statements that highlight contradictory health advice: “‘Eggs are going to kill you because of cholesterol’ — ‘oh, it actually doesn’t matter. Eat as many eggs as you like.’ ‘Red meat will kill you.’ ‘Oh no, read meat can be part of a diet.’ ‘Drink no alcohol’ … ‘Oh, no no. Drinking red wine is perfectly healthy.’”

Dr. Carroll has devoted his career to advocating for scientific and research communities need to improve how they discuss nuance, especially in health. Dr. Carroll, serving as CEO of the AcademyHealth, says “science is portrayed as binary — positive or negative — and that can breed mistrust from the public.”

“The way that we discuss nutrition and food [can] burn people’s belief in science, in that it feels like people are told one or the other,” Dr. Carroll tells “Conversations on Health Care” hosts Mark Masselli and Margaret Flinter.

For most people, ramping up or cutting out consumption of one particular food “can add a tiny bit of risk here or there. But the extremes that we are often sold, one way or the other, about what you should and should not eat are often not really well-supported by science,” he says.

It’s not that new data disproves old research, he says. But both add up to a more complex picture. “When you describe things in absolute terms … it creates a climate where people don’t trust exactly what you’re saying.”

Despite the constantly changing nature of science, nurses and doctors are still consistently held in high trust, Dr. Carroll says. One way to add nuance to public discourse is to use trusted voices to help people understand what questions to ask when they hear new information: Pre-buttal, as opposed to rebuttal, as he puts it. “[That] is much more powerful than trying to change their minds after they’ve heard things that are just not true.”

Self-healing joints? Perfect surgeries? Your tax $$ could make it happen

The director of the Advanced Research Projects Agency for Health (ARPA-H) knows the eyes of the nation are on her. Renee Wegrzyn, Ph.D., leads the billion-dollar effort charged with leveraging research advances for real-world impact.

Wegrzyn talked with hosts Mark Masselli and Margaret Flinter at Aspen Ideas: Health about the agency’s initiatives, including a $100 million sprint for women’s health and creating tissue-specific delivery of therapies.

“How can we pursue some of these breakthroughs — in our case, for health — by empowering the scientists…the program managers…that have these really big ideas that are so risky that the technical sector, the private sector can’t address because there’s no proof of concept?”

She explained the process: Hire program managers with big ideas in health and give them a time frame to find solutions.

Wegrzyn said the time limit ensures they bring a sense of urgency to solving problems. In return, participants get resources to focus on technical risks.

Many of ARPA-H’s missions are cancer-centered, aimed at issues through what-if questions such as: “What if cancer surgeries were one-and-done?” “What if clinical trials evolved in the same way tumors do?”

She said, “The investments that we’ve made in cancer [include] our precision surgical interventions program. Think about reimagining the operating room suites, when a surgeon is looking into a surgical cavity and trying to remove a tumor.”

95 Days to Election ’24: Analyzing the Health Care Issues

The defining health care issues in this year’s election are crystalizing with reproductive rights remaining at the top of the list. Julie Rovner, chief Washington correspondent for KFF Health News, has covered health policy fights for nearly four decades. She said, “I think this may be the first time that abortion rights drive people out to vote. The anti-abortion movement has always been the one that has been able to gin up their base, and the people who are sort of on the most extreme of the anti-abortion movement are the ones who are most devoted and…one of the reasons Republicans have courted them so assiduously is they show up and they vote.”

Rovner also weighed in on the 15 states or more states with abortion-related ballot initiatives and efforts to restrict the abortion pill mifepristone and end in vitro fertilization.

Rovner spoke to hosts Mark Masselli and Margaret Flinter on location at Aspen Ideas: Health. While the presidential race is in flux (including a change in the Democratic candidate), the core issues have remained consistent.

The hosts asked Rovner which health care question she’d most like to pose to former President Trump in a debate. “I don’t mean this in a negative way, I’d like to ask him if he knows the difference between Medicare and Medicaid, and whether he feels as strongly about preserving Medicaid as he said he does about Medicare.” She also analyzed the hurdles the Biden-Harris administration has had to date in communicating about what it sees as its health policy victories.

JAMA’s Editor: Rebuilding Trust & Reaching More Readers

The Journal of the American Medical Association (JAMA), which was first published 141 years ago, is grappling with modern challenges as the most widely circulated general medical journal in the world. At the forefront is Dr. Kirsten Bibbins-Domingo, its relatively new editor-in-chief.

Dr. Bibbins-Domingo took the helm at a tumultuous time and has a clear vision for how JAMA should deal with equity in medicine and the public’s lack of trust in health care.

She told hosts Mark Masselli and Margaret Flinter at Aspen Ideas: Health that “I am not the keeper of trust for the journal. I am not the keeper of our focus on equity.” But she said she has installed new processes “so that we could collectively have those conversations, be more transparent around them, think about the processes that help us make sure that we are always trying to be the best that we can be.” That includes giving JAMA employees and authors a voice in discussions about equity and increasing transparency with readers.

Dr. Bibbins-Domingo also focused on how to keep JAMA connected to its current audience while attracting new audiences using an omnichannel approach, especially social media.

“I think about what JAMA and the JAMA Network have to do right now is do the core functions the same way we’ve always done it…vetting the science, making sure this is science you can trust, putting the stamp of approval in that way on it, and then publishing it. And then we have to do something that I think all journals need to do better… and that is being a modern communication vehicle,” she said.

HHS’ Admiral Rachel Levine: Managing Her History-Making Role While Focused on the Nation’s Health

With most of the country suffering through a sweltering heat wave, the U.S. Dept. of Health and Human Services has found the right time to unveil its nationwide Heat and Health Index (HHI).

“Conversations on Health Care” learned all about it from Admiral Rachel Levine, M.D., the department’s assistant secretary for health. “We are seeing heat-related injury and health impacts globally,” says Levine, particularly in vulnerable populations, such as children, seniors and people who work outside.

HHI combines historic temperature data and Emergency Medical Services (EMS) data on heat-related emergency responses from the past three years, as well as data on community characteristics, including pre-existing health conditions, socio-demographic information, and characteristics of the natural and built environment, to provide a final heat and health index ranking by ZIP code.

Levine is used to being in the hot seat on a variety of issues, from worries about bird flu to the latest on Long COVID. During June, she helped lead efforts to celebrate LGBTQ+ Pride, as the nation’s highest-ranking openly transgender official.

Hosts Mark Masselli and Margaret Flinter, well aware that Levine serves at the president's pleasure, asked her about future plans. She said she would absolutely be willing to go through another intense Senate confirmation process depending on what happens on Election Day. “I firmly believe in the Biden-Harris Administration and the principles they advocate for and represent.”

Biden Gun Prevention Leader at Aspen Ideas: Health to Make Their Case

“Conversations on Health Care” went on the road to Aspen Ideas: Health. We start this series with Gregory Jackson, A White House official with one of the toughest assignments: tackling gun violence, Gregory is deputy director of the White House Office of Gun Violence Prevention.

Helping Community Health Workers Succeed: Ideas From an Innovative Program

Experts praise community health workers as the keys to building a more equitable and fair health care system in America. Is there a way to unlock more success for hiring and retaining them?

Dr. Shreya Kangovi thinks so; she developed the IMPaCT Care program, which is saving money and quickly growing. We’re proud to share this encore “Conversations on Health Care” interview. Hosts Mark Masselli and Margaret Flinter talked to Dr. Kangovi about how it’s a standardized, scalable program that transforms the effectiveness of the community health workforce by reimagining each step.