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Oscar-Nominated Film Highlights Shared American, Iranian Health System Concerns

By MICHAEL MILLENSON

At the recent Academy Awards broadcast, a brief film clip from the Oscar-nominated Iranian film “It Was Just An Accident” showed a man pushing an unconscious, very pregnant woman on a gurney into a hospital emergency room. Without intending to do so, the excerpt pointed to one of the many common concerns shared by Iranians and Americans when dealing with their respective health care systems.

In the Iranian movie, a hospital desk clerk turns away the woman for lack of a payment up front with cash or a credit card. Although that kind of rejection is supposed to be illegal in America, indigent patients can be turned away if the hospital simply tells them their problem isn’t urgent. Even if accepted as self-pay, they might find themselves being billed up to 13 times what the hospital accepts from the government.

Yet it’s not just high costs and unfeeling bureaucrats that worry both Americans and Iranians – although Oscars host Conan O’Brien did joke that in the movie “Hamnet,” Shakespeare’s wife giving birth alone in the woods was “what we call in America ‘affordable health care.’” Iran is an urbanized nation of 93 million people. While the radical hostility to Western values of its clerical rulers is an important contributor to the current war with America, the society as a whole struggles with many of the same health-system problems as other developed countries, including the United States, and often approaches them in a similar way. Still, there are some exceptions unique to the Iranian context.

Consider Iranian researchers articles about diabetics’ experiences at the doctor’s office; ensuring a future supply of nurses; and health insurance utilization and expenditures for a particularly vulnerable population. Though all are topics which might equally appear in a U.S. journal, what sets them apart here is the authorship. At least one co-author of each is affiliated with an institution whose origins would seem as far away from health services research as imaginable. That’s Teheran’s Baqiyattalah University of Medical Sciences, (pictured below) which was founded by the Islamic Revolutionary Guard Corps.

By غلامرضا باقری – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18235725

Affiliation aside, Iranian researchers are typically trained much like their U.S. counterparts, and that’s reflected in both their work and the international journals where it’s published.

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Stuck in the Middle

By KIM BELLARD

Even before the war – oops: special operation, excursion, or whatever your preferred term is – with Iran started, people were complaining about how expensive things are. Home ownership for first time buyers seems out of reach. Sure, egg prices may be down from the late stages of the Biden Administration (thank you so much, bird flu!), but most of us are still dismayed by our grocery bills. Health insurance costs what a house might have cost fifty years ago and what a new car might have cost twenty years ago.

The latest findings from the West Health-Gallup Center on Healthcare in America show that a third of Americans have cut back on expenses in order to pay health care expenses. We’re stringing out their prescriptions, borrowing money, even skipping meals to pay our health care bills. Even among those with health insurance 29% are cutting back; 62% of those without health insurance are making trade-offs, and I’m surprised the latter isn’t much higher.

Similarly, Kaiser Family Foundation found that 4 in 10 Americans have not taken their prescription medications due to costs, and 6 in 10 worry about being able to afford prescription drugs for themselves or their families. Even among those with insurance, a majority worry.  

Gallop also found that Americans are delaying major life events due to their health care costs, including taking vacations (29%), surgical or medical treatments (26%), or changing jobs (18%). Even a quarter of those with family incomes over $240,000 report such delays.

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Jesse Shoplock, Inbox Health

Jesse Shoplock is SVP of Business Development at Inbox Health. They are trying to help one of the messiest parts of American health care, figuring out both how much patients owe at the point of care and how to actually help the providers get paid. As of now 70% of patients don’t know what they owe, and in some cases those patients payments are 30% of total revenue and a bug chunk of that isn’t being collected. Jess told me how they are helping practices fix that. (And in the answer to my question Jesse didn’t know, they’ve raised some $55m so far)–Matthew Holt

Ratnakar Lavu, Elevance

Ratnakar Lavu is the Chief Digital Information Officer of Elevance, the holding company of Blue Cross and Blue Shield plans in some 14 states (usually called Anthem Blue Cross). We had a great chat about what the priorities are for Elevance, and Ratnakar’s goal is to use tech to make the member experience simple. They are leaning heavily on AI and chatbots to help members inform themselves, and to help providers speed up approvals for prior auth et al. We also discussed how they work with vendors and how they help them scale.–Matthew Holt

Michael Dalton, Ovatient

Michael Dalton is CEO of Ovatient — it’s a telehealth company built on Epic that comes out of health systems (Medical University of South Carolina and Metro Health, Cleveland, OH). It does the integration and care continuity between its medical group and health systems (a little like KeyCare which also serves health system). I asked him why this is different from other telehealth companies? Those systems wanted something embedded in their own tech stack, that could bill insurance etc. Their clients are using Medicaid, cash, Blue Cross, etc. He told me about the patient experience, how they get to Ovatient and how the company works–Matthew Holt

Liberal Arts Education As a Counterbalance To Trumpian AI

By MIKE MAGEE

What’s wrong in the social science realm of health? Consider for example the mental health crises affecting teens across the nation, or the sharp decline in relationships and child bearing in young adult men and women, or the attack on vaccine policy by the wayward Kennedy, or the attempted dismantling of ACA health insurance coverage for millions, or the outright cruelty of ICE agents toward citizens and legal aliens, or the callous attitude toward Middle East casualties of soldiers and civilians by the President and the “Secretary of War”… and I could go on.

How should our nation begin to address these grievances? With our grandchildren either in or fast approaching higher education, I’ve been making a related case (as I see it) for the value and importance of a liberal arts education. In a strange way, Trump, in his attacks on the law and democracy, has instigated a resurgence of interest in history, philosophy, religion, political science, literature and the arts – even in this age of fantastical AI exuberance.

My own alma mater has been steadfast in its vision. As they state on their own website, “The liberal arts education at Le Moyne is rooted in the Jesuit tradition, which emphasizes the education of the whole person and the search for meaning and value as integral parts of an intellectual life. This commitment to a liberal arts education allows students to develop a broad range of skills and knowledge, fostering ethical leadership, service, and a commitment to social justice. The college’s Core Curriculum is central to its mission, ensuring that all students receive a thorough education in the liberal arts, which includes knowledge across multiple disciplines and the confidence to engage in intellectual inquiry as members of a global community.”

In simpler terms, LeMoyne’s front page headlines “We strive for greatness always through the eyes of goodness.” I thought of this last week as I watched James Talarico’s speech accepting his Democratic Primary nomination for Senate in Texas. In part explaining his convincing victory numbers as a result of his ability to attract a large turnout of Democrats, Independents, and Republicans, he issued what will certainly be his rallying cry: “The people of this state have given this country a little bit of hope, and a little bit of hope is a dangerous thing.”

Who is in danger? Talarico has tagged not only billionaires, but especially Christian Nationalists who he says “divide us by party, by race, by gender, by religion so that we don’t notice that they’re defunding our schools, gutting our health care and cutting taxes for themselves and their rich friends. It is the oldest strategy in the world: Divide and conquer. But we will not be conquered.”

This week CUNY Political Scientist, Peter Beinart, laid out a remarkable opinion piece in the New York Times, leaning heavily on liberal arts to make a convincing case against empire building and king Trump. In opposing  national sovereignty and international law conventions, he spotlights the President’s source of guidance – “My own morality. My own mind. It’s the only thing that can stop me.”

Beinart bolsters his case against Trump by digging deep into our own history, political science, literature and religion. Included in the journey are President William McKinley (intent on Caribbean Empire building), and his opponent, William Jennings Bryan, who claimed McKinley’s action “is not a step forward toward a broader destiny; it is a step backward, toward the narrow views of kings and emperors.” John Quincy Adams appears in 1821 stating such purposeful aggressions would undermine “the fundamental maxims of American policy (and) would insensibly change (democratic practice) from liberty to force.”

Others come forward as well including Frederick Douglass, Henry David Thoreau, Ralph Waldo Emerson, W.E.B. Du Bois, John Kenneth Galbraith. Taken into account Beinart’s impressive essay and Talarico’s acceptance speech, side by side in a short 24 hours, reminds us all that the soul of our democracy requires health, unity, and the capacity to awaken “our better angels.”

To paraphrase the LeMoyne motto, our greatness must flow from our goodness. The core of a well educated electorate is knowledge, wisdom, and values. In its absence, we are left with ignorance, greed, and hatred.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

Lauren Ranalli, Town Square Health

Lauren Ranalli is the VP of Patient & Community Engagement at Town Square Health, a brand new medical group setting itself up for the senior population. There have of course been a lot of attempts to create new primary care medical groups. Town Square has its roots in Oak Street but is adding immediate visits (during primary care visits) with specialists which the believe will close the care loops and provide better care. Their goal is to be efficient on staffing, use AI and then take risk. Personally I’m not sure that’s the best tactic…so Lauren and I had a good chat about their strategy, and how the heck we fix primary care in America–Matthew Holt

When Artificial Intelligence Starts Rewriting Reality

By BRIAN JOONDEPH

Image created by/using ChatGPT

Artificial intelligence is quickly becoming a core part of healthcare operations. It drafts clinical notes, summarizes patient visits, flags abnormal labs, triages messages, reviews imaging, helps with prior authorizations, and increasingly guides decision support. AI is no longer just a side experiment in medicine; it is becoming a key interpreter of clinical reality.

That raises an important question for physicians, administrators, and policymakers alike: Is AI accurately reflecting the real world? Or subtly reshaping it?

The data is simple. According to the U.S. Census Bureau’s July 2023 estimates, about 75 percent of Americans identify as White (including Hispanic and non-Hispanic), around 14 percent as Black or African American, roughly 6 percent as Asian, and smaller percentages as Native American, Pacific Islander, or multiracial. Hispanic or Latino individuals, who can be of any race, make up roughly 19 percent of the population.

In brief, the data are measurable, verifiable, and accessible to the public.

I recently carried out a simple experiment with broader implications beyond image creation. I asked two top AI image-generation platforms to produce a group photo that reflects the racial composition of the U.S. population based on official Census data.

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Oren Nissim, Brook.ai – Figuring out RPM

Oren Nissim is the CEO of Brook.ai which is making some waves in the remote care space. Their goal is to use remote patient monitoring to help providers reduce readmissions, and help patients stay on their care plans. For example they get more than 80% of their populations into hypertension control within 10 weeks, and reduced CHF readmissions some 90%. Late last year they raised $28m in Series B funding ($40m in so far), and Oren told me about their process and their business at the VIVE conference in Feb 2026–Matthew Holt

Miriam Paramore, RxUtility

In this quickbite interview recorded at the Feb 2026 VIVE conference, I am talking with Miriam Paramore. Miriam is building RxUtility, which is helping consumers access the lowest drug prices at the point of dispensing. That means BOTH bringing in all those manufacturers coupons and getting the lowest cash prices. How does it work? Why is drug pricing such a mess? Miriam tells all!— Matthew Holt

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