�Թϲ�����

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for �Թϲ�����, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Dec. 12, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Alice Miranda Ollstein of Politico. 

Alice Miranda Ollstein: Hello. 

Rovner: Rachel Cohrs Zhang of Stat News. 

Rachel Cohrs Zhang: Hi, everyone. 

Rovner: And Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Good morning. 

Rovner: Later in this episode we’ll have my interview with Francis Collins, former director of the National Institutes of Health, an agency expected to be even more in the news than usual in 2025. But first, this week’s news. Obviously the biggest news of the week is the building backlash over the shocking midtown Manhattan shooting last week of UnitedHealthcare CEO Brian Thompson, who was on his way to United’s annual investor meeting. 

There is still a lot to be uncovered, but we now know New York authorities have charged 26-year-old Luigi Mangione, an Ivy League-educated native of Baltimore, Maryland, with the murder. Mangione, who was arrested after being spotted in an Altoona, Pennsylvania, McDonald’s, was found with a 3D-printed ghost gun that New York detectives have linked to the murder weapon and what some have described as a manifesto but was really more of a memo detailing his complaints about the nation’s health care system in general and UnitedHealthcare in particular. He was reportedly a chronic-pain sufferer who recently had back surgery. 

Now we have spent a lot of time on this podcast talking about how big United has become. Thompson was actually only the CEO of the insurance company, not the behemoth UnitedHealth Group that also includes Optum, which made headlines earlier this year as the owner of the claims processor whose hack shut down much of the health care system for a month or two. But this particular act of violence appears to have touched a nerve in the public at large, who’ve been moved to tell their own all too common stories of mistreatment at the hands of the health care system. 

Is this going to be a blip? Or is this maybe the start of a broader conversation this nation really needs to have about kind of the sorry state of our health system that obviously can’t be fixed by individuals shooting executives on the streets of New York City? 

Raman: I think this does open up kind of a larger conversation. I mean, even just last week we had a lot of backlash when Anthem had decided to limit some of their anesthesia coverage for surgeries, and there was a lot of backlash and they kind of reversed course on that. 

Rovner: Yeah, we’ll talk about that in a second. 

Raman: This kind of builds on just the general — I think people are upset with the state of insurance, whether it’s the price or the coverage or who has it, who doesn’t. And it’s not something that I’ve seen before that people are just this reactive over something like this when it’s someone in business and in health versus something much more political or related to war or something where I’ve seen kind of similar reactions. So this both seems unique but seems like it’s kind of unleashed something in people that they’re having a lot of thoughts and that it could open something up bigger for the future. 

Cohrs Zhang: Yeah, I think the narrative from Democrats for a very long time has been, Look at how many people are insured, and I think this really kind of brought out the sentiment that we’ve known has existed, that insurance doesn’t make health care affordable for people, necessarily. 

Rovner: Or even accessible. 

Cohrs Zhang: Right. Right. And so I think, not to say that insurance isn’t important or better than not having insurance, but I think just the way plans are structured, and I think we’re kind of looping back to the idea that maybe just getting everyone, quote-unquote, “check the box” insured isn’t going to fix things. 

Rovner: So I am the person here who covered the first big managed-care backlash in the 1990s, which was, I will have to say, a simpler time, because at that point it really was the insurance companies who were kind of the bad guys in the narratives. They were, you know, it was sort of the beginning of bringing for-profit insurance to health care, and there was a lot of rather crude denials, ways to restrict people from getting care that they were particularly not used to. I think people are more used to it now. And there was a really big backlash. And it still took until 2010 when the Affordable Care Act passed that we got what was the so-called Patient’s Bill of Rights, the requirement for insurers to cover people with preexisting conditions, which had not existed before. So I mean, even when things were even more difficult, it was a very, very, very long fight. 

Now, I think, Rachel, as you were suggesting, it’s a lot more complicated. Sometimes insurers are the good guys in this. Sandhya, you mentioned the Anthem Blue Cross sort of brief episode last week where anesthesiologists publicized the fact that Anthem had wanted to cut off payment for surgeries that ran long, basically, that they would only pay for a certain amount of anesthesia for each procedure. And of course immediately there was a backlash and patients thought that, Well, if they’re not going to pay for the anesthesia, then we’re going to have to pay for it, when in fact what Anthem was trying to do was cut back on how much anesthesiologists were being paid, because they thought they were sometimes padding their bills. 

So in fact, this was the insurance company trying to save patients money, but it wasn’t taken that way and Anthem immediately walked it back. Which brings me to my — how hard is all of this going to be to explain to the public, who is rightfully angry about the mess that the health care system is, that it’s a lot more complicated than just yelling at the insurance companies? 

Raman: I think it’s a really difficult thing to kind of parse down to folks. I mean, what people see on a day-to-day is: How much am I paying for my premiums, for my family or for myself? And those have been going up. They’ve been going up more than inflation. And so that is what people get their paychecks and they see, and the top cause of bankruptcy right now is health-related debt. These are the things that I think people are thinking about on a day-to-day basis rather than thinking about a little bit more into the weeds of, if you have employer-based insurance, did they negotiate these things to be covered under this plan? Because plans are so different, depending on where you get insurance. So I think that explaining a lot of that down for folks is going to be difficult because the pocketbook thing is really going to be what’s upfront for folks that are thinking about something like this. 

Rovner: I think access is an issue, too, though. I’m finding that I’m starting to hear more than anecdotally that people that just cannot find mental health providers, primary care providers. It takes months to get an appointment with a specialist. One of the big arguments against “Medicare for All” or any kind of sort of government-run health care is that they end up rationing care. Well, we seem to have the worst of both worlds, where we’re having rationed care and profit-making in health care, that those things are not going together very well. 

Ollstein: Right. I was absolutely going to agree. We have the long waits and bureaucracy of a single-payer system, but we have the crazy-high prices and exclusions of a fully private system. And so it’s really no wonder that there is a lot of outpouring of frustration in the wake of this violence and people saying that they understand where it’s coming from because of their own experiences. 

Rovner: Well, hopefully this might move to a more productive conversation that, as I say, needs to be had. Well, given all of the news, you would be forgiven for not realizing that Congress has been back in town for the last two weeks and now has, checks notes, eight days until the government shuts down, unless lawmakers agree on a temporary spending bill, and 20 days until a whole raft of health-related programs lose their authority and/or funding. Sandhya, what’s the latest on this very lame lame-duck Congress. 

Raman: So we are still in a very similar place to probably the last time that I’ve talked about this in that we have so much to do and a limited number of days. The big thing is still funding the government, which we are tied to Dec. 20 for getting a CR or something longer, and it’s looking very much like at this point we’re going to get another continuing resolution, temporary funding, until next year after the new administration and everything takes effect. 

I think what’s still up in the air is just what little things will be tied to that. And you talk to members of Congress over the last few days, a lot of that is still in flux. There’s a lot of health care things that they’d like to get added, depending on who you talk to, House or Senate, Republican or Democrat. And it’s looking a lot likely that anything big is going to be added to that rather than a lot of the things that we see year after year extending different Medicare and Medicaid programs and kinds of things like that rather than getting some of the bigger stuff that they wanted to do across the finish line. 

Rovner: I’m getting all these emails about telehealth authority. One presumes that will find its way into something because it’s popular, right? 

Raman: I think so. I think that really with telehealth, it is so popular, both sides, I don’t feel like telehealth won’t get included in some way. It’s more just how long, just because of the price tag of it. One of the big things that [they] have been struggling with right now is finding offsets for all the things that they want to pay for, and telehealth is expensive. So doing a longer-term telehealth extension just requires agreement on finding ways to pay for it. And that’s more of the issue. I think it’s an issue honestly with a lot of these programs where they are bipartisan, popular things they want to extend for longer amounts of time. They just have to find the money to pay for it, and that’s where the heads are butting. 

But I think in order to get things done by the 20th, we should be seeing something coming in the next few days in order to get it through both chambers. 

Rovner: Well, one of the must-pass bills before the end of the Congress is the National Defense Authorization Act, which usually does not involve very many health issues but now is apparently in limbo over a provision regarding medical care for transgender minors. How is that part of the DOD [Department of Defense] bill? 

Raman: So the NDAA, the House passed the compromise version yesterday, and that has caused some friction because they, a), cut some of the IVF [in vitro fertilization] coverage things through Tricare that were included in the Senate and House armed services bills, which is kind of an issue because it would mean federal civilian employees get eligible for IVF but not the military. But also it includes a provision banning coverage of gender-affirming care for minors. 

And it passed, but there has been a lot of Democrat opposition to this. They’re not OK with this even though this is the compromise bill, and while it did get through the House, I think it’s going to be interesting to see how this plays out. This has been such a hot-button issue, and it’s one of the things that we really have to get done this year. It would be pretty unprecedented to not get that done. 

Rovner: And just to clarify, these are minor children of people covered by DOD health care. 

Raman: Yes. Yes. 

Rovner: Which is a lot of people. 

Raman: Yeah. 

Rovner: All right, well, turning briefly to the next Congress, which starts in just a couple of weeks, Congressman Brett Guthrie of Kentucky will become the next chairman of the powerful House Energy and Commerce Committee, which oversees, in the House, Medicaid, part of Medicare, and all of the public health service. Guthrie is currently chair of the panel’s health subcommittee, so his elevation will open up that position as well. What are Guthrie’s health priorities, and who’s likely to replace him at the subcommittee? 

Raman: I mean, the time that he has been the health committee chairman, or when he was the ranking member before, he’s been pretty active on covid oversight, health care costs, opioids, things like that. And he’s said that some of these and just looking at ways to cut costs are things that he’s looking forward to next year. Since he’s been elevated to that, he gets to pick who the subcommittee chairs will be. And so far we’ve had Reps. Buddy Carter, Gus Bilirakis, and Morgan Griffith express that they’re interested in being health subcommittee chairs. They’re all already subcommittee chairs of other subcommittees, so we’re going to have a shuffle regardless, depending on who he picks, and he can pick at any time. 

Cohrs Zhang: Yeah, I would add that Guthrie has been a pretty big supporter of Medicare Advantage as well, which I think will just be important to note as we move forward and think about how the Republican Party is shifting on those issues. 

Rovner: Yeah, and obviously Medicare Advantage and private running of public programs I think will be a continuing issue over the next year. Well, moving on to [Donald] Trump 2.0, the president-elect gave to NBC’s “Meet the Press” host Kristen Welker last week that covered a wide range of issues. On health care, Trump continued to wander all over the map, repeating that his administration has, quote, “concepts of a plan” to replace the Affordable Care Act, which he said it “stinks” and “It’s lousy.” But he also insisted incorrectly that he saved the ACA rather than the fact that he tried to repeal and then weaken it. Do we have any clue what he might like to do? He did say that, quote, “we have the biggest health care companies” looking at his concepts of a plan, as if that’s reassuring to people right now? 

Ollstein: I think it’s pretty clear and it’s been clear through the campaign that this is not a priority for him. His priorities are immigration, trade, tariffs, those kinds of things, law enforcement. This is so far down on the list. So it makes sense that there’s not a fully fleshed-out plan, although of course the health of millions of people depend on it. And so I would expect that the most important thing for determining what actually happens is who are appointed to maybe these mid-level positions who actually get into the nuts and bolts of these health care programs. 

Rovner: Yeah, and we’ll talk about RFK Jr. [Robert F. Kennedy Jr.] in a minute, but we have talked about it. Sometimes it’s not even the heads of these underling agencies, but you’re right, the people who end up sort of running each individual program who sort of determine how big this is going to be. 

Cohrs Zhang: Yeah, certainly. I think what we’ve seen so far in the selection of some of these higher-level officials is a test of loyalty and how they perform on TV, not any sort of cohesive policy agenda. So I think we definitely could see some similar disagreements. We’re already seeing disagreements bubble to the surface among advisers and people who’ve been appointed. So I think that as we saw during Trump 1, there will be this kind of power struggle to figure out who has influence, who has the president’s ear, who can make friends in the White House. But I just think it’s way too early for us to figure out which ideology will win out here. 

Ollstein: I mean, even people who have expressed strong views of what should happen, like RFK Jr., a lot of the things he’s calling for are things that already are happening. Like studying vaccine safety — that already happens. Other things he’s calling for aren’t under the purview of HHS [the Department of Health and Human Services] at all. They’re under the purview of USDA [the Department of Agriculture] or other agencies. And so even people like him who do somewhat have an agenda that has been made public, it’s not clear what they would be able to actually do within the job they could or could not actually have. And that leaves all of the other folks who don’t have as defined an agenda. So it’s a real question mark for all of us. 

Rovner: Stay on this Trump interview, because there was a lot there. The president-elect also had some provocative things to say about reproductive health, on IVF, which he kept calling just “fertilization.” He described completely incorrectly what happened in Alabama and then suggested that, quote, “ideally the insurance companies would pay for it, the fertilization,” talking about IVF, like that wouldn’t have any impact on cost for anyone. On abortion he seemed to say that he would not restrict the availability of abortion pills. He seemed pretty firm about that. What do we think about either of these suggestions? 

Ollstein: Well, and I want to compare it also to he did with Time magazine that’s out on Thursday for being named Time Person of the Year. And again in that he had a long back-and-forth about abortion pill availability, but like classic Trump, very all over the place, noncommittal, saying, I promise to not restrict the availability, but then saying: We’ll see. We’ll take a look at it. Some of these sort of verbal tics that he often has that leave a lot of doors open to things in the future. And so I think both this and the TV sit-down interview don’t give a lot of confidence to either side. I’m hearing from the anti-abortion world — not a lot of strong confidence that he’ll do what they want. And obviously the progressives have no confidence in his abortion rights plans or records. So I think, just again, a lot of murky area here. 

Rovner: An awful lot of wait-and-see. Well, meanwhile, Alice, about how the incoming administration has still not officially started the transition process at HHS. Why is that important here in almost mid-December? 

Ollstein: So it’s the combination of they’ve nominated a bunch of people with no government experience, and even those who have government experience in Congress don’t have executive branch experience, which is totally different. HHS is this huge, complicated bureaucracy, and even people who have worked in it for years tell me they’re always discovering new protocols and hoops they have to jump through and stuff. And so it’s a combination of Trump has nominated a bunch of people who don’t know the landscape and they’re not using this period to get to know the landscape, which is what traditionally happens during the transition. 

Traditionally, very soon after the election, the incoming administration sends what’s known as landing teams to the different agencies to start talking to the career officials and get to know the budget and the workforce and what’s where and who they have to talk to to do what and what rules are in the middle of being crafted and what deadlines are on the horizon, what crises they might have to inherit and deal with. 

And all of that work happens before Inauguration Day so that the new administration can come in and hit the ground running. None of that is happening. They have not sent the landing teams yet. They have not started this work yet, and the transition is going to be half over soon. And so that has some health experts really concerned about things like handling bird flu and being able to know how to monitor that and keep the American people safe. I mean, that’s just one of many, many examples. 

Rovner: Speaking of people who might end up running the department, apparently there are even more doubts that are being raised about Robert F. Kennedy Jr., Trump’s pick for HHS secretary. Not that Republican senators are likely to care very much, but 75 Nobel laureates have written a letter urging senators to vote no on the pick, writing that RFK Jr. would, quote, “put the public’s health in jeopardy and undermine America’s global leadership in the health sciences.” What are you guys hearing about this nomination — in trouble or not? The headlines are still about the Department of Defense nominee and Tulsi Gabbard for head of national intelligence. Where’s RFK Jr. on this list of senators who are concerned? 

Raman: He’s expected to come to the Senate to meet with various folks next week, and I think that will also provide some answers that we’re kind of looking for, giving all of them a chance to meet with him, ask some of their specific concerns. I do think that with him and with a lot of the question marks that we have and just gaps in traditional experience, those things that Alice has kind of outlined, is we will see a lot more during the confirmation hearings when even if one person doesn’t ask it, the other one does. 

So even I think that there have been some Republicans that have been wanting clarity on him and his stance on abortion, because he’s been a little back and forth on some of that. So regardless if a Democrat asks it in one sense or if a Republican asks another sense, that kind of puts that issue directly on the table for them to look at. So I think some of that will be really crucial in looking at that next year, but even just next week when we have him meeting with the various senators to get more concrete details. 

Cohrs Zhang: And I think it’s happening in a broader context, like you said with these other nominees, and I think we have seen a shift this week with the Trump transition where they have taken a much more aggressive stance with the Senate that they’re not going to be backing down. And I think it becomes less about any individual candidate and more about this big-picture power struggle over who is going to have influence in this Republican-led Washington. So I think the details of any policy issue could matter less than this larger power struggle. 

Rovner: Yeah, I think you’re probably right. Well, in other news this week, a Trump-appointed federal district court judge in North Dakota has temporarily blocked so-called DACA [Deferred Action for Childhood Arrivals] recipients, those undocumented now young adults who were brought to the U.S. by their parents as children, from signing up for coverage under the Affordable Care Act, at least in the 19 red states whose attorneys general signed onto this lawsuit. The DACA population, which is about half a million people, have lived legally but under a cloud since the Obama administration. 

This year under a new rule from the Biden administration, they were made eligible for ACA coverage and between a hundred thousand and 150,000 of them were expected to sign up. According to my colleague Julie Appleby, it’s not clear if those who have already signed up will lose that coverage, which of course doesn’t start until January, and it’s also not clear what happens now. Would you anticipate that the Trump administration would continue this lawsuit to try to keep these people eligible? Trump did say in his “Meet the Press” interview that he wants to do something for the DACA population. They seem to be sort of the one group of undocumented people that he seems sympathetic to. 

Ollstein: Again, I think that who Trump appoints to various agency positions will determine policy much more than himself and his ever-shifting ideology on so many things. And we know that he has nominated a bunch of really hard-line anti-immigrant folks to these various positions, folks who not only want to very aggressively go after the undocumented population but even are questioning birthright citizenship, are talking about mixed-status families and what should happen to them in a very punitive way. So I would imagine not a lot of interest in helping this population from those officials. Of course, anything can happen. 

Rovner: And yeah I should point out, even though this is an Affordable Care Act issue, the decisions are going to be made by those who oversee DACA and those who oversee lawsuits. And it’s going to be elsewhere I think in the administration about what happens to this. But while we are on the subject of lawsuits this week, let’s turn to abortion. Remember that abortion case out of Idaho that the Supreme Court kicked back to the lower court last summer saying they shouldn’t have taken it yet? Well, it got a hearing at that lower court this week. Alice, remind us what this case is about and what, if anything, we learned from this week’s activity. 

Ollstein: So this case involving the Biden administration challenging Idaho for violating a Reagan-era patient protection law known as EMTALA [the Emergency Medical Treatment and Labor Act], which basically requires any hospital that receives Medicare funding to treat whoever comes to their doors in a crisis in an emergency, give them whatever stabilizing treatment is needed, and not turn them away because of their lack of insurance or who they are or anything like that. 

So the Biden administration has said that Idaho’s near-total abortion ban, which it has been enforcing even in emergency circumstances and turning patients away, flying patients out of state, they said that that violates this law. Idaho says: No, it doesn’t. You’re trying to turn this law into an abortion mandate. And so this went all the way up to the Supreme Court earlier this year. The Supreme Court said: Actually, we shouldn’t get involved yet. Sorry. Sorry for taking the case. Our bad. Send it back and try again later. 

Rovner: “Improvidently granted” is the phrase that gets used, that the Supreme Court uses. I love that. 

Ollstein: Yeah, DIG — dismissed as improvidently granted. And so this went back down to the district court level. Now it’s back at the circuit court level. It very well could go back to the Supreme Court level. But I think the most important thing is that there’s going to be a new administration before that happens. And so the expectation is that this will not continue as it is now with the administration arguing against Idaho’s practices. 

So there’s just a lot of ways this could go. The Trump administration could settle with Idaho and say, “It’s fine what you’re doing.” They could change their EMTALA guidance and then argue in court that the lawsuit is moot because of that change in guidance. Or they could just drop the case because it’s a case brought by the Justice Department. They could just say, “No, we’re dropping out.” 

Now, it’s also likely that some other entity could try to intervene to keep this alive. And one of the hospitals in Idaho got time to argue in the case this week and basically said as much, said that they could and would explore becoming the challenger in this case if the federal government switched sides or decided to bow out, because this hospital is obviously impacted by this clash between state and federal policy. 

Rovner: Yeah, I expect there’s going to be a lot of lawsuit musical chairs coming in the first months of 2025, which we will keep an eye on. All right, that is the news for this week. Now we will play my interview with Francis Collins, then we’ll come back and do our extra credits. 

I am so pleased to welcome to the podcast Dr. Francis Collins, former director of the National Institutes of Health and former White House science adviser and former director of the National Human Genome Institute, who led the effort to map the human genome. He also has a new book out this holiday season called “The Road to Wisdom: On Truth, Science, Faith, and Trust.” Dr. Collins, it’s so great to have you here. 

Francis Collins: Hey, Julie. It’s great to be with you. We go way back on a lot of interesting topics in health and medical research, and let’s get into it here. 

Rovner: I want to start with some very basics because we have lots of student listeners and people who know a lot about health policy but less about science. So what is the NIH, and how does it work? 

Collins: It is the largest supporter of biomedical research in the world. The National Institutes of Health, supported by the taxpayers with money that’s allocated every year by the Congress, is the main way in which, in the United States, we support basic medical research trying to understand the details about how life works and how sometimes things go wrong and disease happens, and then carries those discoveries forward to what you might call the translational part. Take those basic findings and try to see how could they actually improve human health in the clinic. 

And then working with industry, make sure if there’s an idea then for an intervention of some sort that it gets tested rigorously in clinical trials. And if it works, then it’s available to everybody. So when you look at what’s happened over the course of many decades in terms of advances in human health, like the fact that reductions in heart attacks and strokes have happened rather dramatically, the cancer death rates are falling every year. Where does that come from? An awful lot of that is because of the NIH and the thousands and thousands of people who work on this area supported by those dollars that come from NIH, both a little bit in our own location in Bethesda, Maryland, but most of the money goes out to all those universities and institutes across the country and some outside the country. 

Eighty-five percent of the dollars are given out to people who write grant applications with their best and brightest and boldest ideas, and they get sent and reviewed by peers who have scientific expertise to be able to assess what’s most likely to make real progress happen. And then if you get the award, you have three to five years of funding to pursue that idea and see what you can learn. Unfortunately, even though the budget for NIH has been reasonably well treated, especially in the last, oh, eight or nine years, it’s still the case that most applications that come into NIH get rejected. Only about 20% of them can be actually paid for with the current budget we have. So, sad to say, a lot of good ideas are left on the table. 

Rovner: And yet for more than three decades now, the NIH has been kind of a bipartisan darling with strong financial support from Democrats and Republicans in both the White House and in Congress. Now we have an administration coming in that’s calling for some big changes. Could NIH honestly use some reimagining? It’s been a while. 

Collins: Oh, sure. I mean, I was privileged to be the NIH director for 12 years. I did some reimagining myself in that space. One of the first things I did when I got started was to create a whole new part of NIH called NCATS, the National Center for Advancing Translational Science, because it seemed that some of these really exciting basic science discoveries just sort of landed with a thud instead of moving forward into clinical applications. NCATS has done a lot to try to change that. 

So yeah, there’s always been this sense of, this is the crown jewel of the federal government. But it could even be better. So let’s try to work on that. I hope that’s what’s going to happen in this next iteration. Find things to fix. If it’s more an idea of let’s just blow the whole thing up and start over, then I’m opposed, because I think the rest of the world just has this great admiration for NIH. Many of them would say this is the most amazing engine for medical discovery that the world has ever known. Let’s certainly optimize it if we need to. 

But my goodness, the track record is phenomenal. And the track record is both about advances in health and it’s also about economic growth, which people are rightly concerned about as well. Every dollar that NIH gives out in a grant returns $8.38 in that return on investment to the economy within a few years. So if you wanted to just say, “Well, let’s just try to grow the economy,” and didn’t even care about health, NIH would still be one of your best bets. 

Rovner: So one of the things that Robert F. Kennedy Jr., who’s Trump’s pick to lead HHS, has talked about is taking a break from the federal government researching infectious diseases and concentrating on chronic diseases instead. Do you think that’s a good idea for the NIH? 

Collins: Well, NIH does a lot on chronic diseases. Let’s be clear about that. Infectious disease has certainly gotten a lot of attention because of covid and the controversies around that. Although let me also step back and say what was done during covid, the development of a vaccine in 11 months that is estimated to have saved 3.2 million lives in the U.S. alone, is one of the most amazing scientific achievements ever and shouldn’t be somehow pushed aside as if that wasn’t a big deal. That was a huge deal. 

But infectious diseases are still out there, and with everything that we see now with things like H5N1, there’s a lot of work that needs to be done. Sure, chronic diseases deserve a lot of attention, but let’s look at what’s happening there with cancer, with Alzheimer’s disease, with diabetes, with heart disease. Those are huge current investments at NIH. Could we look at them closely and ask, are they being absolutely optimally spent? That’s always an appropriate question to ask, but it’s not as if this has been sort of ignored. 

Look at the project that I had something to do with starting called All of Us, which is an effort to look at all kinds of illnesses in a million people, a very diverse group, and figure out how not to just do a better job of treating chronic disease but how to prevent it. That’s an incredibly powerful resource that’s now beginning to build a lot of momentum. And there’s a place where maybe even a little bit more attention to All of Us could be helpful because we could go faster. 

Rovner: So it’s not just either/or. 

Collins: No, it shouldn’t be either/or. And I mean, look around your own family and the people you care about. What are the diseases that still need answers? There’s plenty of them, and they’re not all in one category or another. This is what NIH has always been charged to do. Look across the entire landscape, rare diseases as well as common diseases, infectious diseases, as well as things that are maybe caused by environment or diet. All of that has to be the purview, otherwise we’re not really serving all the people. 

Rovner: Dr. Francis Collins, thank you so much for joining us. I hope we can call on you again. 

Collins: Please do, Julie. It’s always great to talk to you. Thanks for everything you’re doing to spread the word about what we can do about health care. We can do a lot. 

Rovner: I hope so. Thank you. 

OK, we’re back. And now it’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry. If you miss it, we will put the links in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week? 

Cohrs Zhang: Sure. So my piece is in ProPublica. The headline is “” by J. David McSwane. And I love his reporting. I was an intern at the Austin American-Statesman when he was doing some of his investigations there on Medicaid, and it’s been just so cool to watch his career grow at ProPublica. I think this story was the perfect example of how to take just a terrifying example of a doctor who truly just doesn’t have patients’ best interest at heart and is kind of the caricature of the money-hungry-specialist kind of doctor who’s really doing harm to patients and making that more general. Because I think as reporters, we all hear stories that are so tragic and terrible but don’t kind of tell that larger story. 

But I think he did a great job explaining how when rural hospitals close and there’s fewer and fewer options for patients, that an individual facility can become the only option for people, in Montana in this case. And when facilities are struggling and they’re not financially supported, then you have, quote-unquote, “high performers” who bring in a lot of income, who have disproportionate power. We see that in all sorts of organizations, universities, like any organization where high performers, I think, get away with way more than your average doctor or person or employee. But I think in this case, he just did such a great job explaining how all of these financial incentives created this opportunity for this one doctor to just do so much harm to patients. So I thought it was really well done. 

Rovner: It’s also really well written, quite the riveting story. Sandhya. 

Raman: So my pick this week is “.” And it’s by Usha Lee McFarling at Stat. And she did a really fascinating dispatch from Lisbon about how Portugal and the U.S. had really different life expectancies. In 1960 the U.S. had 10 years on Portugal, and now Portugal leads by four, but they’ve been spending a lot less money on their health care. And so she has a great look at some of the complicated factors as to why that’s happening, how they’re approaching prevention. And this is on public health and primary care and home health. And it’s a good read. 

Rovner: Alice. 

Ollstein: I have a piece from CNN which is off of a new CDC [Centers for Disease Control and Prevention] report. The title is “.” And the new data show that in 2022 and 2023, so the first years where these state abortion bans across the country were going into place, just over a third of women of reproductive age received any family planning services at all over the previous 12 months, which is sort of staggering because there have been so many reports of a surge in interest in birth control and a surge of orders and people seeking services, anecdotally, in the wake of these restrictions going into place or in anticipation of the restrictions going into place. 

And I know this covers ’22 and ’23, so I’d be really curious about ’24 because we also heard there was another surge of interest around the election, so would be interested to see that. But I think this really shows that access is really, really bad out there for a lot of reasons. And the article walks through some of them, including states that haven’t expanded Medicaid, and so people can’t pay for birth control with insurance. And additionally, there are just these provider deserts that are getting worse and worse in a lot of parts of the country. Clinics that used to do abortions and other services in these red states can’t keep their doors open, have shut down. And so these patients in these areas are left with very little access to any reproductive health care services in the wake of these abortion bans. And so something definitely to keep an eye on. 

Rovner: And of course, as I have talked about, providers leaving some of these states, too. So even it’s not just the clinics — there’s actually no one there to work in the clinics. My extra credit this week is a policy brief from my colleagues here on the analysis side of KFF. It’s called, the very exciting, “,” by Jeannie Fuglesten Biniek, Alex Cottrill, Nolan Sroczynski, and Tricia Neuman. And while President-elect Trump has vowed on the one hand not to, quote, “cut Medicare,” what this shows us again is that one reason Medicare Advantage seems cheaper is that it tends to attract healthier people who need less care and that when those people get sick and need care and chafe at their limited provider options in Medicare Advantage, they tend to switch back to traditional fee-for-service Medicare and end up costing more. 

So the government is overpaying for them while they’re in Medicare Advantage and then paying even more when they switch back than it would’ve if they’d been in traditional Medicare all along. This is just one of a lot of things about Medicare that could put the program on a better long-term financial footing if it got addressed. So we will see if Congress actually wants to talk about Medicare next year. 

All right, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks again this week to our temporary production team, Taylor Cook and Lonnie Ro, as well as our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, , and increasingly at Bluesky, . Where are you guys these days? Alice? 

Ollstein: I’m on Bluesky, , and still on X, . 

Rovner: Sandhya. 

Raman: I’m on Bluesky, , and on X, . 

Rovner: Rachel. 

Cohrs Zhang: I’m on X, , and on as well, so you can find me there. 

Rovner: We will be back in your feed next week. Until then, be healthy.