Like arguing with physicists over whether gravity is a thing. I tell that story in detail here.

But after years, and since Spencer and I recorded this conversation only a few months ago, the economists have come around.

In June, the White House Council of Economic Advisers estimated that banning certain anti-competitive hospital contract terms could save workers and employers about $45 billion a year in premiums. Two days earlier, DOJ proposed a settlement requiring OhioHealth to stop using the challenged provisions. Its case against NewYork-Presbyterian remains open.

Welcome aboard, fellas.

But there’s another contract problem I think deserves attention.

When self-funded employers rent a network, those agreements can require them to use the network’s rates - even when an employer and provider might happily make a better deal directly.

Spencer asked whether we should even be comparing networks anymore, or stripping them of their power over price.

Now you’re speaking my language.

We spent a good chunk of the episode on why I believe those restrictions deserve antitrust scrutiny by DOJ, what a post-network world could look like, and why the endgame should be much simpler: providers competing on transparent cash prices.

We also got into my concern that AI in the exam room may be accelerating upcoding, the changes coming for PBMs and fiduciaries, and my “school choice for health care” idea: put far more of the money currently spent on someone’s coverage into an account they control and let them choose how to spend it on care and coverage.

And yes, we talked about Washington’s affection for incremental HSA changes when I’d rather see much bigger structural reform.

Watch The Full Episode Here.

Congressman Eric Burlison told me he’d never heard anyone say “the medical cartel” out loud until he heard me say it at a podium.

(And that might just be the best summary of the entire problem right there.)

Burlison represents Missouri’s 7th District and hosts Fresh Freedom, which he started in his first year in Congress and has kept going into his second term. He spent a decade inside Cox Health before he ever ran for anything, so when he talks about what hospitals have become in Springfield, it’s cuz he knows.

Nate Lucas co-hosts.

Between the two of them they let me talk for twenty minutes about kickbacks, which is more runway than I usually get on the Hill.

Here is where we ended up.

The worst actors in American health care are the nonprofit hospitals. They wear the white hat in their communities, collect the tax exemption, and plunder the working class on the way out the door. On average they spend less than three percent of revenue on actual charity, maybe a little more if you count all uncompensated care (most of which they didn’t agree to in advance out of the goodness of their hearts).

If you still think they might be the good guys, remember that Providence hired McKinsey to help them hide their charity program from the poor people the ACA requires them to serve. They’re not just one of a few bad apples, trust me.

A hospital I’m trying to do surgery for a Catholic nun whose health plan I run just doubled the demand price for a knee replacement to $80K when we tried to negotiate down from their already outrageous $40K initial demand. If she doesn’t pay cash on the day of service, they won’t see her. She would qualify for Medicaid, but her plan WANTS to pay. They just don’t want to get raped.

But tell me again, El Camino Health in Santa Clara, CA, like every other whiney hospital I ever talk to, how you’re “barely surviving.”

Let me count the cranes.

The carriers and the PBMs (but I repeat myself) are running the same play from the other side. The entire value proposition of a network is that they can get you a lower price than you could get yourself. But the opposite is true almost everywhere.

And when cash beats the negotiated rate. I can’t remember anymore what the network is for.

On the podcast, Nate asked if I have PTSD from July 28, 2017. I do. We had bought off every vote we could find in the House and turned repeal and replace into something Frankensteinian we could barely defend, and then the Senate looked at it and knew the dog wouldn’t hunt. Several of them voted no.

I am glad it failed. It was a bad bill.

What we did do, surgically, in the tax bill the next year, was zero out the individual mandate penalty. That is the pattern. Republicans keep trying to do Obamacare but slightly less of it, and then they wonder why nobody is inspired.

They asked me for a thirty-second pitch to Republicans at the end. Here it is.

We’re going to lose if we don’t do something about the affordability crisis, and health care is the biggest piece of it. If we won’t help people with the number one thing that is life and death to them, we don’t deserve power. We should go home. Nobody needs us here.

Watch the whole thing below.

Washington loves a deadline.

And if you spend enough time there, you learn the weeks before one are generally when you should start paying more attention, not less.

The Senate returns September 14. The current Farm Bill extension expires September 30, and Senate Agriculture Chairman John Boozman has said he intends to bring Farm Bill 2.0 back up shortly after lawmakers return, after it failed to advance out of committee in August.

For the moment, the pesticide liability language that caused such an uproar earlier this year is out. (Thank you to everyone who contributed to that happening by throwing a well-justified fit.) The House stripped those provisions from its bill after Anna Paulina Luna forced the issue in April, and the Senate proposal does NOT contain a comparable liability shield - yet.

That’s very good news. I’m just not declaring victory while Congress is still engaging with the bill.

Which makes my recent conversation with Jennifer Galardi and Jay Richards on RAW particularly well-timed.

We talked about the story behind my recent confession, the autism moms who came into my Senate office more than twenty years ago, the RFK Jr. meeting I later routed away from the Trump White House, and the very long road from true believer in our public-health institutions to asking considerably more uncomfortable questions about them.

But we also got into something especially relevant to the Farm Bill fight: incentives.

Markets depend on transparency, meaningful choice, accountability and some avenue of recourse when a product causes harm. Start removing those things and eventually you have to ask what mechanism is left to keep the system honest. That was the point we kept coming back to, and why I said creating that kind of liability structure around another class of products would be “the height of public health malpractice.”

We also covered informed consent, FDA labels, hospital food, and why people who publicly admit they got something wrong should probably be encouraged rather than beaten back into silence.

The whole conversation is below.

Take a listen and let me know what you think.

This conversation was recorded a few months back, but revisiting it this morning highlighted how little has changed - and what has.

In this episode I talk a lot about how nobody in Washington is coming to save employers, and that they will have to save themselves - that’s still true.

ERISA is still minded by the labor committees of Congress (no ambitious health policy staffer has ever wanted a job on the labor committees). The people who oversee coverage for 160 million Americans are still pension experts or labor wage union types.

Meanwhile, out in the real world, network contracts still say the claim goes to the carrier, the carrier’s rate is the rate, and employers and doctors/hospitals can’t cut a better deal with each other directly. This is the wall between us and a real cash pay economy.

But in just a few short months, things have moved significantly on our side of the table.

Cash pay has continued getting the attention of employers, patients and social media. It’s also becoming more “doable,” one vendor and one plan at a time. My nuns are even having luck getting seen at NYU. (Read the full story on how things are going here.)

And that is the story behind the headlines.

Nothing has been fixed for us. But some of us built around it anyway, and it’s working - slowly but surely.

Full episode below.

Matthew Zachary cleverly called our episode “Nun, Done, and Uninsured.” So before we move forward, I’d like the record to show that the nuns are very much insured.

(I’ve got the headaches and the scar tissue to prove it, Matthew, LOL.)

The trip to Manhattan was worth every minute. Matthew and I had a blast talking through some of the darkest parts of our lives and of modern American medicine. Maybe that’s because we’re both trying to fuel the same patient movement. Or maybe it’s because he’s also Gen X, so we spent the first ten minutes on nun jokes, classic rock, and the 1978 sedan my father bought me because he knew exactly how I drove.

For anyone who doesn’t know him, Matthew was diagnosed with cancer thirty years ago and then built the young adult cancer survivor movement, largely because nobody else had done it.

He opens his show with: “I’m as mad as hell and I’m not going to take this anymore.” And that’s the posture of his whole show.

We talked about our personal run-ins with medicine. How the reproductive specialists watched my ovaries for about a minute and then handed me a label without ever mentioning that my routine of four hours of sleep wasn’t going to make me more fertile. Nobody asked about the Diet Coke I was using as hydration. Nobody asked about the cortisol bath I was living in at work. And I just believed them.

Matthew shared how he went on COBRA at 22, a week after his treatment ended, and found out what insurance charges a young survivor for the privilege of staying alive.

He’s spent 30 years on the receiving end of the dysfunction. I spent 30 years trying to rewrite the rules, and now building around them.

The best stretch was about cash.

Matthew is a Cost Plus member. Four of the seven medications he takes daily are generic, and he says paying cash instead of running them through insurance saves him about $200 a month for the same pills.

Then I told him about my nuns. The way I run their health plan. How I fired Blue Cross, I fired Express Scripts, and it’s better now. And how when a sister needs an appointment at NYU, NYU says they don’t take our plan.

NYU would rather turn away a nun than take the money. Though that’s starting to change.

We also got into why change is slow.

The asymmetry of sophistication between a multi-trillion-dollar industry and a Senate health staffer who doesn’t know what he doesn’t know. Why the money in politics doesn’t corrupt so much as it guarantees the industry gets to frame the issue first. And the new fiduciary rules that could take the PBM business model apart, if anyone enforces them.

Matthew closes every episode by asking his AI which three pop culture characters his guest would be. I got Dana Scully, Michael Clayton, and Olivia Benson. I’ll take it.

Listen below, and subscribe to Out of Patients while you’re there.

I’ve followed their work since they started. Their host, Ann Forti, has been in this fight for decades, and it shows in the questions she asks.

Halfway through our conversation, Ann mentioned that her daughter is going in for knee surgery on Monday. The estimate came back at $38,000. They are cash pay, so they asked for the other number. The other number was $6,000.

That is the health care in a nutshell, and it is why a conversation about vaccine injury turns into a conversation about hospital pricing. Because once this system hurts you, you find out fast that the billing arm runs the same playbook as the clinical arm.

Ann wanted to know why nothing is moving.

Kennedy is in. Bhattacharya is in. The wins are small and the reversals are loud.

My answer is not that the good guys sold out. My answer is that there is no functioning policy process right now, and policy is being driven by bedwetting from outside entities.

Media hits, donor dinners, a chairman threatening a nomination.

In a normal White House all of that gets aired in a room with people who can push back on it. Now it goes straight to the top with nobody there to say the polling is wrong and the science is wrong and you campaigned on this. ( I wrote about this here.)

We also got into the compensation fight for the vaccine injured. My skepticism there is about Congress, not about the people doing the work.

Don’t despair. Where everything is now is not where it will be in six months.

But no one is coming from Washington to save your health.

Listen to the episode, and then go look at what React 19 is actually doing.

Kevin and Donna are both pharmacists.

Donna’s focus is deprescribing: getting people off medications that are hurting them more than helping. Kevin digs deeper on the digital health and systems side of things. They both see the consequences of good and bad health policy first hand, day in and day out. Perfect setting for a chat.

We started with some background. How I began my career as an infectious disease epidemiologist with dreams of going to Africa, wearing a space suit, and quarantining towns. How, when I got to South Sudan, I figured out I didn’t have the diplomacy skills for negotiating with warlords. And how when I came home, Capitol Hill sucked me in. All of it led me, somehow, to the White House. When I finally got out of DC, I couldn’t bear going out to shill for industry, so I decided to use my health care chops to build health plans so I could sleep at night.

Then we got into the good stuff I’ve learned through it all:

→ Why your fee-for-service doctor needs their patient panel to be sick
→ What you find underneath a health plan once you unbundle it and the conflicts of interest are finally visible
→ Why our health plans run on one nurse who knows your name instead of a call center
→ And why they incorporate direct primary care which is expensive, but not as expensive as unmanaged chronic illness.

And the most important thing, even if you don’t care about health policy at all:

Washington isn’t coming to save you. Neither is your insurance plan. And especially not the white coats at the hospital.

Nobody cares about your health more than you. Nobody is more of an expert in your body than you are. YOU are your primary care provider.

We break it all down in this episode.

Watch Here

In April 2020, you couldn’t go to church, but you could go to Walmart. (Apparently viruses travel 6 feet in some places, but not others.)

Then the FDA approved a vaccine label for a product that wasn’t even available, while extending emergency authorization for the one being injected into arms. Humm.

None of it made any sense, and I found myself asking the same question on repeat - Why?

The answer wasn’t complicated, but it was one I hadn’t been trained to see. I had to figure things out on my own like so many others.

The people best positioned to see what was actually happening were the ones who were never inside the status quo framework to begin with. People like who’d been in the game for decades.

I sat down with him last week to talk about what happens when regulators stop protecting the public and start protecting the industry - and why the people running circles around establishment thinkers during COVID were the ones we’ve all been told to ignore.

Watch Katy on RSB Show Here

That’s actually the business model. I know because I spent two decades trying to fix it. Worst of all I had to sit on the sidelines and watch it completely fail my sister.

Ray Kober had me on The Broken Healthcare Podcast to discuss what’s happening. Here’s what came up:

→ How a Mormon-turned-Catholic-turned-actual-nun ends up running health policy in the Trump White House (yes, real convent, two years).

→ How I watched my betters negotiate with warlords in South Sudan in my twenties, and why that turned out to be excellent training for negotiating with PBMs in my forties.

→ Why the fight is no longer Republicans vs. Democrats, but actually the healthcare swamp vs. the rest of us, and how for the first time in my career, the swamp is starting to lose.

→ Why the free market hasn’t failed in American healthcare. It’s actually never been tried.

→ The new federal law that just put every middleman in the country on personal notice, and why nobody in Washington is talking about it yet.

→ My sister’s hospital that did everything “by protocol” and nothing that actually helped her. And the day I decided I was never going to be a patient in this country again.

If you’ve already figured out that something is very wrong with our health system, please listen in.

You’re not crazy. You’re just early.

Specifically we discuss:

• Why I asked Tony Fauci and Francis Collins back in 2017 to take a meeting with Bobby Kennedy off-campus - and why I sent him an apology email five years later (then wrote about it.)

• Why public health doesn’t focus on “do no harm” - but rather, “cause no epidemics.”

• Why the “evangelist physician” is the most dangerous person in medicine - the lobotomy doctors, the pain management evangelists who handed us the opioid crisis, Public Health and their six feet distancing and cloth masks. All literally evangelizing.

• Why Big Pharma’s interests align with us being patients for life.

• Why “live like a human” (sleep like one, eat like one, pray like one, raise children like one) is one prescription we all need to write ourselves.

• And because Dr. Drew is Dr. Drew, we landed on Sigmund Freud. Specifically: the difference between serious mental illness and ordinary misery. Some of what we’re medicating now is ordinary misery. Ordinary misery is what makes us human. It can often tighten family bonds, deepen our relationship to God, or drive us to make a difference.

Take a listen!

My son hasn’t forgiven me for school.

He’s 22 and he still brings it up.

And this wasn’t public school. It was the best school money could buy.

I was working in the White House. Our values mattered, and so I hunted down the most faith-based, boy-centric school I could find. All boys. All male teachers. Sports in the middle of the day. Kids hanging off tree branches instead of chained to desks. I walked in and thought: this is a boy’s paradise.

He hated it. Intensely.

It wasn’t the school I picked. It was school itself.

I sat down with Casey Harper at The Washington Stand’s Outstanding podcast to talk about this - about why our boys are cratering (5x lonelier than men their age a generation ago, 70% of overdose deaths, falling behind in every educational metric we can measure), and what I wish I’d understood before I made the choices I made for my son.

We get into:

• Why I’m not sure I believe in school for boys anymore

• How we medicalized normal boy behavior of risk-taking, stick-wielding, wall-bouncing and called it a disorder

• The “chickified” culture (thanks, Rush) and now we can’t tell the difference between a boy who wants to climb a tree and a boy who needs Adderall

• Why the same fire that drives a 9-year-old to beat dents into an oak is the fire that makes a 19-year-old willing to die for his country (and what happens when we extinguish it)

• And the question I’m wrestling with live on the air: what would it actually take to homeschool my grandkids while running my businesses?

I don’t have the answers.

(I keep telling people this. They keep asking me anyway.)

I’m a Gen X mom with a son who won’t let me forget the choices I made. I’m also a naturopath who’s spent years watching the “health” system manufacture sickness in adults, and I can see how we are doing something similar to our boys in real time.

Nobody at HHS is coming to save your son. Nobody at his school is either.

His teachers are lovely women. They don’t love him.

Read the article. Watch the full conversation.

Share it with the dad getting pressured into signing his 5-year-old up for kindergarten. Send it to the mom who just filled an ADHD script and feels weird about it. Forward it to the grandparent who still thinks daycare is progress.

We’re going to have to raise this generation ourselves.

Radically. Creatively. Generationally.

Health policy stars in DC do not grow up dreaming about ERISA and the House Ed & Workforce committee. They dream about Ways & Means, or Senate Finance. So that’s where they go. Because, for decades, that’s where the health care fights happen.

And that’s why we end up fighting forever over the 20 million people in the ACA exchanges while 160 million Americans on employer-sponsored plans get fleeced by PBMs, carriers, Big Pharma and fake-charity hospitals - and nobody in this town lifts a finger for them.

Then, when a new administration shows up and needs political appointees, they go to the committees where the staffers are, and stack HHS with people who have never done serious policy work for employer-sponsored market.

Nick Solheim at American Moment had me on the Moment of Truth podcast this week and we went through all of it.

• How I watched us try to do Repeal and Replace in 2017 with a Congress that hadn’t written a replace bill (and then watched the Frankenstein that came out of that process die in the Senate - and thank God it did).

• Why price transparency actually got done (the internal fight with our own libertarian wing was brutal).

• Why insurance is now more expensive than paying cash most of the time.

• Why every time Bobby Kennedy or Marty Makary tries to do the job we hired them for, our own side lets them get torched — when what we should be doing is laying our bodies on the train tracks for them, the way the other team does for their own.

Also, the apology email I wrote to Bobby Kennedy after I helped run him out of the first Trump White House. He was gracious. I self-flagellated. You can tell I’m Catholic.

Give it a listen. Let me know what you think.

The thing I didn’t understand until I was well out of government is that the system isn’t broken. It’s working exactly as designed. It profits from your sickness. It has no structural incentive to produce your health.

I helped build parts of that machine, and I still got screwed by it - which either means I was naive, or the thing is more powerful than any of us on the inside wanted to admit.

(Both. It was both.)

What I know now - as a naturopath, as a former White House advisor, as someone who finally cleaned up her own health after watching her sister die too young - is that the best defense is to stop needing the system so much.

Sleep like a human. Eat like a human. Get some sunlight on your face. These aren’t woo. They’re species-specific requirements, and we’ve been talked out of them by a culture that profits from our dysfunction.

I spilled all the tea. Check it out and let me know what you think.

The free Diet Coke in the West Wing was the highlight of my day.

I am not joking. I would sprint over from my office multiple times before lunch to refill. I was in charge of health policy for the President of the United States, and my sole hydration was a product I’ve since described as fridge cigarettes. (I have since written a whole article about this. It is embarrassing. You should read it.)

That is who the 600 Pound Down podcast invited onto their show.

Coaches Justin and George are leading a weight loss and wellness movement comprised of people doing the hard, unglamorous work of actually changing their lives — not the Instagram version, the real version. Blue collar workers, middle class families, people who’ve been failed by the system and are figuring out what to do about it.

They are not policy wonks. They are not DC insiders. They are exactly the kind of people I spent two decades in Washington wanting to help.

So when they asked me to come on and just... tell the truth? I did.

We covered a lot of ground; here are a few of the highlights:

The medical cartel you’ve never heard of.

The AAMC, the American Association of Medical Colleges, is the trade group for medical schools. Their entire business model depends on scarcity.

Fewer doctors = higher salaries.

They fight like hell against any effort to open new medical schools, diversify curricula, or let anything other than petroleum-based pharmaceutical products count as medicine.

This isn’t conspiracy theory. I was lobbied by these people. I watched them frame issues for my colleagues before anyone else could get in the room. That’s how the game is played.

The Rockefellers figured this out in the 1930s. They needed a profitable use for petroleum byproducts. They commissioned the Flexner Report, which conveniently declared that the only legitimate medicine was the kind that prescribed petroleum-based pharmaceuticals - and formed state licensing boards to shut down every homeopathic, naturopathic, and osteopathic school that disagreed. The word “doctor” comes from the Latin for teacher, by the way. Not “prescriber of symptom-suppressing drugs.” Teacher.

We have been living inside that rebranding project ever since.

The PBMs are the real bond villains.

People assume the pharmaceutical manufacturers are the worst actors in this system. They’re not. They’re sub-demon tier. (A meaningful distinction.)

The real carnage is happening at the level of the middlemen - specifically the three PBMs that control 80% of the market: ExpressScripts, CVS Caremark, and OptumRx. Check your insurance card. If one of those logos is on it, your employer is being systematically robbed, and they probably don’t even know it.

In the Trump administration, a colleague of mine came in from the PBM industry to help us figure out how to lower drug prices. He put together a plan that would have cost the PBMs and pharmaceutical manufacturers real money.

He fell off a balcony in DC.

It was ruled a suicide. He had a family. Small kids. He was not miserable.

I’m not saying I know what happened. I’m saying nobody ever talked about it again.

Your body is not attacking you. It’s trying to save you.

We spent a long time on this one, because Justin and George’s audience lives it. The chronic pain, the infertility, the weight that won’t move no matter what. They are not random “failures.” They are your body doing exactly what it was designed to do when it thinks you’re being chased by a bear.

The problem is that the bear is your Instagram account. Your boss. Your commute. The fluorescent lights you’ve been sitting under for eight hours while eating from a vending machine because there was nothing else and you didn’t have time anyway.

Your body is not safe to reproduce. Your body is not safe to digest or detox. Your body is running every non-essential process on minimal power until the threat passes.

The threat doesn’t pass.

When I was a teenager with debilitating period symptoms, no doctor ever said: get more sleep, eat real food, reduce your stress, get outside. They just handed me birth control, which suppressed my symptoms beautifully while everything causing those symptoms festered for another two decades.

By the time I was ready to have children, the damage was done - well… maybe, but that’s a story for another time.

I am not anti-medicine. I want to be very clear about that. If you have a bullet in your belly, there is nowhere on earth I would rather be than a U.S. operating room. Broken arm? Go.

But chronic disease - the stuff that is killing us at scale, the stuff that half the country is now drowning in - conventional medicine cannot cure that. It can suppress it. Manage the decline. Slow the bleeding. But it cannot teach your body to heal, because it was never trained to do that, and the cartel that controls its curricula has a vested interest in making sure it never is.

Nobody is coming to save you from this. Washington is not coming. Your doctor is not coming.

They are working with the tools they have, inside a system designed to get paid only for those tools, and they mostly believe they’re doing the right thing.

You have to become the authority on your own body - and if you think about it honestly - you already are.

Which is either terrifying or the most liberating thing you’ve heard all week. I’m told it depends on the person.

If this kind of thing makes you furious (and it should), this is what we’re here for. Every piece I write is an attempt to hand you a weapon: something you can know, something you can do, some corner of this machine you can refuse to fund.

In this workshop, I break down how to assess each type of holistic practitioner to figure out which type is more likely to match your needs and priorities. A good match dramatically increases your likelihood of success with that type of practice. We also talk about the finances - what insurance covers, what your HSA secretly covers. How to spot red flags before you shell out too much.

Would love to know what you learn and which parts you find most helpful.

And thank you for being a paid subscriber. You’re the ones making AllBetter possible.

Katy

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(We missed you though!)

Most of us walk into the healthcare system blind. We sign forms we shouldn’t sign, don’t ask questions because we don’t know what to ask, get bills that make us want to cry and pay them because we don’t realize we can negotiate. We leave appointments confused but too intimidated to push back.

After 20 years inside the system — and my own disasters as a patient — I’ve learned a few things about fighting back.

That’s what this workshop is about.

I walk you through the financial stuff (including the one question that cuts hospital bills in half), the medical stuff (how to spot doctors worth trusting versus ones you should fire), and the mental/spiritual stuff (what to do when scary news shuts your brain off).

Thank you for being a paid subscriber. You’re the ones making AllBetter possible.

Katy

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