Category: Health Policy

Stuck in the Middle

Mar 17, 2026

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.

Liberal Arts Education As a Counterbalance To Trumpian AI

Mar 10, 2026

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

Mar 6, 2026

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

Mar 5, 2026

By BRIAN JOONDEPH

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.

The Vocabulary of Survival

Feb 26, 2026

By GEORGE BEAUREGARD

From 2018 to 2022, I served as a physician executive in a large health system on Long Island. During that period, I became acquainted with the Provost and Executive VP of the New York Institute of Technology. One of the university’s divisions is the New York College of Osteopathic Medicine (NYCOM), one of the largest osteopathic medical schools in the country. I saw an opportunity to provide medical students with a high-level introduction to “population health”—something not typically offered in medical school curricula and something they would certainly be dealing with in some shape or form upon completing their residencies and fellowships. With the support of the Provost and the medical school Dean, I designed an elective course for fourth-year students at NYCOM called ‘Population Health 101’, a four-week rotation through my Population Health Management division. The course was very popular amongst the students, and my staff enjoyed having students shadow them.

More recently, an opportunity arose for me to return to NYIT and present at a NYCOM’s ‘Clinical Practice Reflections’ session, a bi-monthly assembly where patients share their experiences with health care systems with students. The CPR is not an academic lecture. Its goal is to share the nuances of real patient experiences and their perspectives in their interactions with the health care system. In doing so, NYCOM hopes to highlight the importance of a caring, empathetic physician and aspects of health care delivery that are often overlooked.

After arriving, making my way to the lecture hall, and getting familiarized with how the technology worked, I watched the medical students filing in from the rear doors of the large auditorium.

Some were wearing the short white coats that serve as the indicator of their rank in the hierarchy of medicine. Many greeted their classmates with smiles and warm embraces, suggesting that they hadn’t seen each other for a while. They looked young, energetic, relaxed, and happy.

As someone who is some forty-plus years removed from his medical school days, I felt like I needed to make a connection with this audience at the start. So, my opening remarks were along the lines of the shared experience that is the first couple of years of medical school. Like mine was back in the mid-eighties, their lives are defined by volume. The volume of information. The volume of coffee. And the volume of sheer anxiety about whether they can completely memorize the entire Krebs cycle, the origin and insertion of every muscle in the human body, the Bundle of His, Purkinje Fibers, the Renin-Angiotensin System, the optic chiasm, the corpus callosum, the Loop of Henle, and the hypothalamic-pituitary-adrenal axis. Section members in the beautiful biological symphony that is the human body.

I pointed out that they were learning the vocabulary of medicine. And the vocabulary of survival. The how.

That opening seemed to resonate with the 600-plus students, as many of them were nodding their heads in a manner that suggested “Yep. This guy had to know this stuff, too.”

Will AI Solve Immunology’s Debate Over “Self vs. Non-Self?”

Feb 24, 2026

By MIKE MAGEE

In 1872, English mathematician and sometimes poet, Augustus de Morgan, wrote this catching rhyme: “Great fleas have little fleas upon their backs to bite ‘em, And little fleas have lesser fleas, and so ad infinitum.”

This truism about competition among species for access to nutrition and reproduction could have come in handy to Napoleon 60 years earlier when he tragically underestimated his enemies will to live. It wasn’t so much the stubborn Russians as it was microbes that were his undoing.

When he launched his invasion with a staggering force of 615,000 men, 200,000 horses, and 1,372 mobile guns, he appeared unstoppable. But on his way to Moscow, (according to Tolstoy’s account of the misadventure in “War and Peace”) he lost 130,000 men to Shigella dysentery. Confronted with harsh weather and a Russian force that refused to engage in defense of Moscow, Napoleon lost 2/3 of his remaining retreating force to Typhus, carried by Rickettsia prowazekki, housed in body lice embedded in his soldiers rancid clothing.

Under more favorable circumstances, the soldiers immune systems would have been their ally. Human bioengineering has evolved side by side with pathogenic microbes determined to chemically out smart their human hosts.

Humans rely on innate and adaptive mechanisms to detect and destroy pathogens. But to do so while sparing their own cells, they must be able to distinguish self from non-self. And they must adapt and remember, producing long-lived immune cells and protein receptors that allow them to “capture” and destroy repeat offenders.

If the system experiences a breakdown in self-tolerance, the protective processes may over-shoot and result in a chronic inflammatory response that destroys healthy tissues and marks the emergence of auto-immune diseases.

One special circumstance where immuno-tolerance is both normal and essential is maternal self-suppression during pregnancy which allows two separate immunologic organisms to survive intimate relations side-by-side.

Ten Ten Ten – Trying to radically fix health care in the US

Feb 12, 2026

The goal of the new non profit Ten Ten Ten founded by TJ Tedesco & Bhargav Raman is to take America from being the most expensive health system in the world with the 48th best outcomes to the top Ten in outcomes, at 10% of GDP in Ten years. Are they crazy? Is there any hope of doing this? I spent a long time in conversation with them suggesting that they probably are, but it was a great conversation to hear why they are doing this and how they think we might do this–Matthew Holt

2026: A Year for Reimagining Healthcare’s Safety Net

Feb 11, 2026

By JEFF BRANDES

To say healthcare’s safety net experienced tectonic shifts in 2025 would be an understatement. The rapid introduction of multiple and massive policy shifts left many healthcare leaders reeling with more questions than answers.

As the industry turns the corner into 2026 and the dust begins to settle, it’s time for stakeholders to respond by leveraging all resources and tools available. Current industry shifts will necessitate structural and process changes that ensure the best health outcomes for all communities.

Foundational to any strategy is a recognition that AI and automation have found their place in countering administrative burden in healthcare, and mainstream use of these tools will help speed the industry’s race to greater value. Care teams that previously spent hours reviewing documentation, identifying risk-adjustment opportunities and organizing population-level insights can now claw back the time needed to get ahead of care gaps.

In 2026, healthcare leaders must acknowledge that new realities are here to stay and will require reimagining how the industry delivers optimal care for vulnerable populations. Safety net organizations that have not invested in automation for managing routine tasks will get left behind in the new world of managing population health. By leaning into the following three strategies, stakeholders can realize the promise of value-based collaboration.

Keeping Medicaid Patients Connected to Care

Sweeping changes to Medicaid eligibility, financing, and administrative requirements will have far-reaching impacts on coverage. Current workflows that address these challenges are complex and overwhelming for many resource-strapped safety net providers—not to mention patients and families.

On the Medicaid front, infrastructures that lean into unified data and integrated workflows can help providers become more proactive in identifying those at risk of losing coverage. Specifically, tools that pair eligibility data with clinical and social risk insights can guide outreach prioritization and patient assistance. In addition, providers can use automation to build multilingual renewal campaigns that personalize patient interactions such that vulnerable populations understand their healthcare options.

Safety net providers are already seeing success with the right strategy. For example, the California Primary Care Association (CPCA) leveraged automation and analytics to mobilize outreach and support Medi-Cal renewals and new enrollments across 38 counites. From January 2024 to June 2025, the initiative reached more than 1.3 million people, achieving more than 159,000 Medi-Cal enrollments and re-enrollments.

Trust No One

Feb 10, 2026

By KIM BELLARD

You know, it’s gotten to the point when I just try to tune out the things Robert F. Kennedy Jr. says. “Schizophrenia can be cured with a keto diet”? Sure, whatever. “The war on protein is over”? Who even knew there was such a war? The carnivore diet is a great way to lose weight and gain “mental clarity”? It sure doesn’t show.

His most dangerous statements, though, are probably those related to vaccines. He was known as a vaccine skeptic – no, make that critic – long before he was named as HHS Secretary, but being Secretary put him in position to put his anti-vaccine views into action. He has revamped the committee that make vaccine recommendations, putting people on them that share his skepticism.

The committee has already made significant changes to childhood immunization schedules, and they’re not done yet. The head of the vaccine advisory committee isn’t just skeptical of measles vaccines, he’s not keen on mandating the polio vaccine either. His committee is expected to go after COVID vaccines next.

One particularly outspoken committee member, Dr. Robert Malone said: “I’m not deaf to the calls that we need to get the Covid vaccine mRNA products off the market. All I can say is, stay tuned and wait for the upcoming A.C.I.P. meeting. If the F.D.A. won’t act, there are other entities that will.” He told The New York Times that scientists or regulators who claimed COVID vaccines were safe are “either being disingenuous, or they are not considering the context or are ignorant.”

Meanwhile, RFK Jr.’s nominee for Surgeon General is, shall we say, big in the MAHA movement but not so much in medical professional circles, having placed her medical license in “inactive” status. Her own website brags that she “is considered controversial because her work challenges the economic and cultural foundations of U.S. healthcare, agriculture, and food systems.”

The impacts of these attitudes are neither academic nor far in the future: we’re already in the midst of an unprecedented measles outbreak that many attribute to the vaccine skepticism that RFK Jr. and his ilk have spawned and encouraged.

What caused me to write about this is a new poll out from KFF: Trust in the CDC and Views of Federal Childhood Vaccine Schedule Changes. Top-line finding: “the public’s trust in the CDC remains at its lowest point since the COVID-19 pandemic.” Well, you can’t be surprised by that.

“Six years ago, 85% of Americans, and 90% of Republicans, trusted the CDC. Now less than half trust the CDC on vaccines,” KFF President and CEO Drew Altman said. “The wars over COVID, science, and vaccines have left the country without a trusted national voice on vaccines, and that trust will take time to restore.”

What I found particularly interesting is that, as Dr. Altman said, pre-COVID trust in the CDC was both high and across party lines. Republicans, though, lost trust during the pandemic and basically have never recovered. It took the Trump Administration to get Democrats to lose their trust – but, in fact, their trust still remains higher (55% versus 43%). Independents hover slightly above Republicans, but well below Democrats.

Specifically, about trust in childhood vaccine recommendations only about 44% have some or a lot of faith in federal agencies such as the CDC and FDA, and that doesn’t vary much by either party ID or support for MAHA. E.g., 47% for MAHA supporters versus 43% for Not MAHA Supporters. What does it say about MAHA that believers don’t have faith what the creator of MAHA is doing?

Will HHS Enhance or Stall the Promise of Artificial Intelligence for Healthcare?

Feb 4, 2026

By STEVEN ZECOLA

In its Strategy for Artificial Intelligence (V.3), the Department of Health and Human Services (“HHS”) acknowledges that: “For too long, our Department has been bogged down by bureaucracy and busy work.” HHS promises that it will accelerate artificial intelligence (“AI”) innovation, including “accelerating drug and biologic approvals at the FDA.”

History shows that well-intended but cumulative regulatory intervention – more so than scientific complexity – is the primary deterrent to rapid technological progress. If AI is subject to the typical pattern of regulatory creep, its potential to accelerate drug discovery and development will be significantly reduced. To avoid this outcome, HHS should develop a plan that is premised on a zero-based regulatory approach. That is, each new technology such as AI should start with a clean slate and only the minimum requirements deemed necessary to show effectiveness and safety should be applied in the approval process for that technology.

The Pace of Innovation

Medical innovation has lagged the pace in the other sectors of the economy. As Dr. Scott Podolsky of Harvard Medical School observed: “Medicine in 2020 is much closer to medicine in 1970 than medicine in 1970 was to medicine in 1920.” Podolsky points to breakthroughs such as antibiotics, antihypertensives, antidepressants, antipsychotics, and steroids that have not been met with same impact as innovations in the later 50 years.

Two explanations have been offered for this phenomenon: 1) the inherent complexity of biological processes; and 2) the regulatory approval process.

As a benchmark for comparison to the following case studies, the development of 4G communications spanned less than a decade, with discussions starting around 2001, technical specifications being released in 2004, and the first commercial networks launching in 2009.

Regulatory Intervention in New Technologies

The Human Genome (Great Science Leads to Regulatory Paralysis)

The Human Genome Project (HGP) ran from 1990 to 2003, and has been lauded as one of the world’s greatest scientific achievements. The project identified the specific location of genes and DNA, creating a “roadmap” of the human genetic code and facilitating the identification of disease-related genes.

The HGP focused on balancing rapid scientific progress with ethical safeguards. Oversight was primarily managed through internal ethical programs and international data-sharing agreements rather than a single overarching legislative or regulatory body.

Under this structure, the HGP beat its target date by two years. That is to say that the complexity of the problem did not cause any delays, and progress was not impeded by the standard drug-approval bottleneck.

However, once the genetic roadmap was handed off for drug discovery and development, progress slowed dramatically.