Category: Health Policy

Healthcare’s Quiet Dependence on the “Possimpible”

Mar 31, 2026

By GANESH ASAITHAMBI

In an episode of the sitcom How I Met Your Mother (HIMYM), Barney Stinson introduces a fictional word: possimpible. The possimpible combines “possible” and “impossible” and describes the extraordinary achievements by people who refuse to accept conventional limits. In modern healthcare, the possimpible is no longer a joke; it has quietly become an expectation.

Clinicians are expected to provide care that is safer, faster, and more compassionate despite rising administrative burdens, workforce shortages, and an increasingly complex patient population. These expectations often extend beyond what existing systems were designed to accommodate. The distance between what the system can provide and what patients need is increasingly filled by clinicians.

Picture this example at the end of a clinician’s day. A physician takes a seat to call a patient’s family. The phone conversation takes longer than expected with questions about their loved one’s prognosis and hesitancy about what to do next with fear about what is to come. The physician provides reassurance and guidance. The physician hangs up, only to find that note dictations are not complete and messages are still unread. None of this shows up as productivity, but it is needed to provide quality care. There are thousands of scenarios like this that take place every day in American health care.

These moments appear routine. However, they reflect something more consequential: healthcare has become quietly dependent on clinicians to stretch beyond the boundaries of the systems they work within.

Adventures in health care billing. My $51.96 zit co-insurance

Mar 30, 2026

By MATTHEW HOLT

I know my many fans love me delving into the world of why we get seemingly incorrect trivial bills in health care, and what they all mean. The long telenovella of the $39.94 bill from Labcorp is as yet stalled with One Medical apparently resubmitting the original claim with the new preventative codes on it. But even though I am continuing and expanding my role as a difficult patient this year, there are still some blasts from the past that won’t quite leave.

This particular one concerns some rather unpleasant dermatology issues. For many years I had an nasty small sore/lesion on my leg that never quite healed. Then I started getting a few more that started as zits and never quite left. My wise PCP Andrew Diamond at One Medical told me to use some antibiotic wash and referred me to a dermatologist. Unfortunately the one I was referred to was out of network for the Blue Shield HMO I was in, but one request back to One Medical and I was both sent to a dermatologist in my network and got a pre-auth in the mail from Blue Shield to go see him!

Dr Cristian Gonzalez took a quick look at my leg, decided what the problem was, and proceeded to inject, freeze and attack my various lesions. He then prescribed a cheap topical steroid for me to use, and basically after 4 visits over the summer and Fall, my legs went back to resembling a baby’s bottom–well more or less.

For each specialty visit Blue Shield had a co-pay of $85 per visit, which I handed over using my HSA card. One time the front desk said I had a balance, but when I asked them what it was for they told me it was a mistake. Until this week.

Some 4 months after my last visit I got a bill in the mail for $51.96

Given that I had made a co-pay of $85 each time, this seemed a little odd. So I took a look at my Blue Shield EOBs. (BTW they are back online, you may recall they vanished when Blue Shield cancelled and then changed my plan but the Internet never forgets….)

There a curious anomaly began to play out. Each visit generated three identical claims and three more or less identical EOBs.

Calling BS

Mar 27, 2026

By KIM BELLARD

We are living, you’d have to say, in the age of bullshit. Our politicians can’t answer the simplest of questions without spouting word salad answers aimed at running out the clock until the next question. Our corporations spew endless platitudes about their lofty goals in an attempt to distract us from their mendacious profit-seeking. And now we have AI producing endless volumes of words, an unpredictable amount of which aren’t remotely true.

For better or worse (and, trust me, it has often been for worse), I’ve always been one to ask “why,” to probe vagueness — whether it was a teacher, a boss, or a politician. Call me cynical, call me skeptical, call me inquisitive, but I have a low tolerance for bullshit, in its many forms. So I was thrilled to see that a new study suggests that employees who don’t fall for corporate bullshit may be better employees.

The study is from Shane Littrell, a postdoctoral researcher and cognitive psychologist at Cornell University, whose research “focuses primarily on how people evaluate and share knowledge, particularly the ways that misleading information (e.g., bullshit, conspiracy theories, corporate messaging) influence people’s beliefs, attitudes, and decisions.”

One wonders what he was like as a child.

His new research introduces a new tool called the Corporate Bullshit Receptivity Scale (CBSR), which was “designed to measure susceptibility to impressive-but-empty organizational rhetoric.”

His paper defines “bullshit” as “a type of semantically, logically, or epistemically dubious information that is misleadingly impressive, important, informative, or otherwise engaging,” and distinguishes it from other types of speech (such as jargon) in that “it is both functionally misleading and epistemically irresponsible.”

Assault on Scientific Integrity Is “Fundamentally Problematic.”

Mar 24, 2026

By MIKE MAGEE

This past week, U.S. District Court Judge Judge Brian E. Murphy, dealt Trump and RFK Jr. a severe blow. Not mincing word, he voided HHS vaccine schedule changes and labeled the action an assault on scientific integrity that was “fundamentally problematic.”

In early December, 2025, President Trump directed HHS Secretary Robert Kennedy to review the standing childhood immunization schedule. That schedule has historically guided the state school-entry requirements for vaccines as well as mandating no out-of-pocket costs to parents from vaccine insurers.

The order had followed Kennedy’s summary dismissal of all members of the CDC’s Advisory Committee on Immunization Practices replacing them with a suspect group of vaccine skeptics without any peer review.

Professional organizations, including the American Academy of Pediatrics and the American Medical Association quickly challenged the action in court.

Judge Murphy suspended the appointment of 13 of the 15 new vaccine panel members, and stated that only 6 of the 125 “even under the most generous reading, have any meaningful experience in vaccines.” The swift rebuke followed the evaluation of the new RFK Jr. appointed group’s work output by an independent coalition of scientific researchers which documented 60 misleading or false segments and vaccine claims in their inaugural December meeting.

AAP President Andrew Racine M.D. was quick to applaud the court’s decision, stating ““This decision effectively means that a science-based process for developing immunization recommendations is not to be trifled with and represents a critical step to restoring scientific decision-making to federal vaccine policy that has kept children healthy for years.”

The action couldn’t come soon enough according to state Public Health officials across the country who have been struggling to turn around a Measles epidemic tied to lax vaccination rates.

How Digital Narratives Shape Mental Health Outcomes

Mar 19, 2026

By SUHANA MISHRA

When discussing treatment outcomes, we usually talk about dosage, adherence, and access. Rarely do we speak about algorithms.

Yet as I began working on a scoping review examining misinformation and disinformation in mental health with a team at the Royal College of Psychiatrists led by Dr. Subodh Dave, I realized that some of the most powerful determinants of patient outcomes are not confined to clinics. They live in comment sections, short-form videos, and anonymous threads that shape people’s view on what is the “truth”. In fact, the NY Post says, “over half of top TikTok mental health videos contained misleading information”.

I chose to do this research because I’ve seen how a single online post or video can change the way someone thinks about their own mental health. I’ve witnessed my very own family members be discouraged to follow a treatment plan based on an inaccurate post sent in a WhatsApp group chat. By examining misinformation in collaboration with experts, I hope to identify practical strategies to help clinicians and public health professionals address their hidden determinants of mental health outcomes.

One of the most striking lessons that I’ve learned is that misinformation in psychiatry doesn’t always seem like a conspiracy. It can often seem like comfort. According to an ArXiv study from Cornell University, people adopt misinformation because it satisfies psychological and social needs rather than accuracy goals.

A viral post on a Reddit thread r/antipsychiatry which claimed antidepressants “numb your personality” may be rooted in one person’s difficult experience. A video on tiktok circulating discouraging medication in favor of “natural rewiring” may promise autonomy in a system that feels impersonal. These narratives spread not because they are outrageous conspiracy theories, but because they really resonate with people.

That resonance has consequences.

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

Mar 18, 2026

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.

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.

Gallup 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.