50 years of health-care fights, a history lesson

Dan: Hey there. I ask myself all the time, where is this story, like why healthcare costs so freaking much, and what we can maybe do about it, where is it going? I mean, like, where might it go? Like, what might big change actually look like? And history can give us some clues or new ways to look for clues. So we’re gonna dig deep here today into the pre-history of the Affordable Care Act, and dig deep is the perfect term because our guide, Ian Coss, hosts a series called The Big Dig.

The Big Dig is a history podcast out of GBH News in Boston, and it’s mostly about, you know, well, Boston stuff, like Massachusetts stories, super rich with details. So in its first season, The Big Dig told the story of a decades long, never ending local highway improvement project that was called the Big Dig informally, and it won a Peabody, so they’ve made more seasons about other Massachusetts stories. So now the Big Dig is in the middle of its fourth season. And again, it’s a Massachusetts story, but it is not confined to Massachusetts, ’cause what started there is really the origin story of healthcare in America as we know it today.

It’s called The Big Dig: Mitt and Ted, a healthcare story, and it chronicles an unlikely alliance between a Republican, Mitt Romney, and a Democrat, the late Senator Ted Kennedy, because together, about 20 years ago, they put together a statewide healthcare reform package for Massachusetts that became a blueprint for Obamacare — the Affordable Care Act.

And so, you know, if you’re a history or politics nerd or you like long narrative podcasts with colorful characters, not to mention great regional accents, this season of The Big Dig is a huge treat, and it serves as this incredible survey of actually the last 50 years of efforts to fix American healthcare.

And, you know, spoiler alert, none of them were totally successful, to say the least. So it takes apart the politics that undermined each one.

I sat down with Ian Coss to talk about Mitt and Ted and what the series can tell us about how we got here and where we might go next.

This is An Arm and a Leg, a show about why healthcare costs so freaking much and what we can maybe do about it.

I’m Dan Weissmann, I’m a reporter. I like a challenge, so the job we’ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful

Ian Coss, welcome to An Arm and a Leg.

Ian Coss: Thank you for having me.

Dan: You begin this story in 1974. There’s a way in which I think of this story as you’re really telling like a fifty-year history in a way of, attempts to fix healthcare in America and the kinda politics of that. And so the first episode, nineteen seventy-four, I looked this up, Mitt Romney’s actually in Massachusetts. He is doing a joint MBA law degree at Harvard.

Ian Coss: Yep.

Dan: But he does not show up in your first episode.

Ian Coss: Nope.

Dan: The first episode is not Mitt and Ted. It is Dick and Ted, Dick Nixon.

Ian Coss: That’s right.

Dan: So why was this such a big moment?

Ian Coss: I wanted to start in ’74 for a couple reasons, partly because it really is the origin story of Ted Kennedy as a healthcare crusader. He, he’d been on the issue already for a little while, this is something he cared about. But in 1974, he has this experience that I think informs how he approaches every subsequent healthcare reform. So for context, 1974 is the year when Watergate really unfolds for the public, right? The burglary itself was earlier, but this is when the hearings happen. And in the midst of that, Nixon, realizing that his entire presidency, his political survival is on the line, is looking for, for some way to change the subject, right? Anything but Watergate. And he, in this moment of desperation, in his State of the Union address for 1974, proposes a healthcare reform 

Richard Nixon (1974):  …A sweeping new program that will assure comprehensive health insurance protection to millions of Americans who cannot now obtain it or afford it, with vastly improved protection against catastrophic illnesses.

Ian Coss: You know, what Nixon was proposing back in 1974 is, um, in, like, a simple sense, more progressive, more liberal than the Affordable Care Act. Um, Nixon puts it out there as an olive branch of sorts to say, like, let’s do something constructive together. Let’s, you know, let’s ignore all this noise about investigation and break-ins and Oval Office tapes. And Ted Kennedy has this decision to make, which is partly about, you know, the policy, does he wanna compromise and work with Nixon, and partly about the politics of, do I wanna hand this guy a win when we’ve got him on the ropes? And so what unfolds over that year is these secret basement negotiations.

Dan: This was one of the best, I mean, this was one of the images that really struck me the most in that. 

Ian Coss: Literally in the basement of a church. 

Dan: They’re in the basement of a in a room called The Pub, where beer is actually served according to your sources, and, and they’re there because they’re kind of hiding out. 

Ian Coss: Mm-hmm. 

Dan: They don’t want anybody to know that they’re doing this.

Ian Coss: Right.

Dan:  Why does it have to be so secretive?

Ian Coss: Well, because both Kennedy and Nixon had allies who did not want them talking. So I think Nixon obviously was desperate. He was looking for any opening to get something done. Kennedy was curious, you know, potentially open to doing something. But, when I talked to, one of Nixon’s staffers, a guy named Stuart Altman, who described this cabinet meeting where, you know, all the cabinet officials filed in, and, um, Nixon used to have– He had this row, this big long table and chairs all around it, and Nixon’s chair was, like, two inches taller than everybody else’s chair. So you can– Nixon is at the middle, and, the health secretary and labor, transportation, whatever, everybody is around. And the way Altman described it is they were just apoplectic that Nixon was proposing this healthcare plan, um, that this was socialism. This, this is not what we do. Um, so Nixon was getting it on his side. On the Democratic side, um, the way that Kennedy staffers describe it is there was a lot of resistance, um, especially among the big organized labor groups, the AFL-CIO and the UAW in particular, who took the view that we should wait and we should do it our way when we have control, not do this hodgepodge compromise thing with this guy who’s, you know, politically wounded. So they were both fighting their own bases in order to be in that room.

Dan: So they met in secret in the pub, And per your telling, they’re still meeting in the basement, like, one month before Nixon resigns, and Kennedy’s like, I’m not gonna do it. 

Ian Coss: Yeah. Kennedy is ultimately the one who walks away. And that is why, for the rest of his career, he would tell this story to his staff and describe that as the greatest regret of his political life.

Dan: Wow. One source who said it said had him saying to somebody, “That was the best deal we were ever gonna get. Nothing since has even come close.” And this is, sounds like it was at the end of his life, so after the Affordable Care Act has passed.

Ian Coss: Yeah.

Dan: Whew.

Ian Coss: And that kind of informs the way, you know, why when this opening to work with Mitt Romney comes up decades later, it, it sort of, the reason I wanted to start with that story is it helps you understand why when another opportunity, when another cycle came around, Ted Kennedy approached it very differently.

[music]

Dan (hosting): That opportunity for Mitt and Ted to work together came in 2005. But before they became allies, they were enemies. So before we get to 2005, Ian takes us to 1994. 

Mitt Romney is making his very first run for office for US Senate against Ted Kennedy, a political legend in Massachusetts. As a Republican, it sounds delusional to lots of people, except it turns out Mitt Romney is great at campaigning at this point.

He’s polished, super handsome, charismatic. 

And Kennedy is at a low point. Stories about his drinking and his personal life were everywhere, and he ends up fighting for his political life against this upstart 

Kennedy came roaring back at the very end of his campaign, beat Romney almost 60/40. But until then, he’d been tied down in Washington, fighting another, much bigger battle. Because 1994 wasn’t just Mitt Romney’s political debut, it was the next big fight over changing the US healthcare system, the thing that Kennedy cared about maybe more than anything else.

President Bill Clinton had campaigned hard on healthcare. He had deputized First Lady Hillary Clinton to develop a plan, which took most of a year, and that plan, which was more than 1,300 pages long, immediately ran into huge political trouble. 

For the podcast, Ian talked with my colleague Julie Rovner, who was already reporting on healthcare thirty years ago. She covered the whole thing.

Julie Rovner: part of the problem, is that their program was so complicated. . Even today, I’m not sure I can explain it. And it made it easy for people to demonize it. 

[music ends]

Ian Coss: What the Clinton camp did is it, uh, they essentially tried to take on all of them at once. They proposed a bill that was unpopular with the whole industry, and really, in some ways, went out of their way to kinda make the industry the bad guy. And again, your colleague, Julie Rovner, remembers this, how, you know, politically, there is a certain benefit in being able to get up there and be like, Those drug companies are ripping you off, and those insurance companies are ripping you off. You know, it’s a great soundbite. Most people tend to agree if you talk trash about an insurance company or a drug company, yeah. But, once you start taking on all of them, then they have an incredible amount of resources to bring against you. And the total, when you add up the price tag of all the lobbying and advertising done around that Clinton health care battle, it was the most expensive campaign in US political history. And when I say that, I mean, it was more expensive than the 1992 presidential race, right? More money was spent fighting the Clinton health care battle than was spent two years before in the presidential race. And so there were many, many facets to this campaign, but it becomes symbolized by these television ads about a fictitious American couple named Harry and Louise… 

[music]

Harry: Find more you like in the president’s plan? 

Louise: Yeah. 

Harry: And? 

Louise: Well, it just, it doesn’t have the choice we want. Look at this. The government picks health plans, then we have to pick a plan from their list. That’s the choice we get. 

Harry: But what if we don’t like their choices? 

[ominous sound]

Louise: If it’s not on their list… 

Harry: Well, there’s, there’s gotta be a better way.

Voiceover: There is a better way to reform. Call this toll-free number for the facts. Call today. 

[music ends]

Ian Coss: And it just, it became this phenomenon, um, in 1993, 1994, that really demonstrated just how powerful the industry could be, the healthcare industry and the insurance industry in particular, when they wanted to fight a bill.

Dan: Those players are all still very active and powerful in lobbying and trying to influence legislation. And each one, their, I can tell you, like their strategy is, to blame each other, right? The hospital’s like, “The insurance companies are preventing us from providing care. They’re low-balling us. They’re denying all your claims.” The insurance companies are like, “The hospitals and the drug companies are jacking up the price.” And the drug companies are like, “The insurance companies are denying your care, and these pharmacy benefit managers, these, these middleman companies, they’re soaking up all the profit.” And so they’re all, I call this, like, the shark versus shark. They’re all pointing fingers at each other. And every time there’s, a congressional hearing about drug prices, you know, you get this, and what you’re pointing out here about 1984 is, all of them got to be like, “Oh, well, if we’re all on the same team, then let’s play on the same team to knock you down.”

Ian Coss: And it worked. 

[music]

Dan (hosting): Ian picks up the story next about a decade later, when Mitt and Ted finally team up, and where Mitt Romney’s name becomes associated with healthcare.Mitt Romney had made a political comeback in the early aughts. He became governor in 2003, and in 2005, with a big assist from Ted Kennedy, he led a huge healthcare reform in Massachusetts. It’s a reform that a few years later became the blueprint for Obamacare.  I mean, like Obamacare, the goal of what some people call Romneycare was that everybody, or as close as possible to everybody, should have health insurance. 

So to make that happen: 1. insurance companies got barred from refusing to cover people with preexisting conditions. 2. everybody who didn’t qualify for programs like Medicaid and Medicare had to buy health insurance. And 3. the government provided subsidies for people who couldn’t afford health insurance premiums. This was basically the plan for Obamacare a few years later.

So a huge question in Ian’s story is, why did this work in Massachusetts when everything else failed on a national level? And why did it not translate to a bipartisan plan when Obama tried to take it national? ‘Cause one of the things that made Romneycare appealing to the Obama people as a model was a Republican governor had pioneered this.

And not only that, but the heart of the plan, honestly, the most controversial big government in your business part of it, had originally been proposed by a scholar from The Heritage Foundation, the conservative think tank. 

But what Ian’s story shows is it wasn’t the ideas that made Romneycare work or that made it bipartisan.

The reason it passed, the reason it was ever considered, was something else, an absolutely enormous pile of money, money that Massachusetts stood to lose. Here’s one of Romney’s top aides talking to Ian.

Brian Wheelan: Wasn’t this evangelical do good, oh, we got to cover more people or whatever the case is. It was how do I keep the money, right? Save the money.

Dan (hosting): Save the money. That’s just ahead. This season of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News.That’s a nonprofit newsroom covering health issues in America. It’s a newsroom packed with great journalists. We are honored to be their colleagues. 

[music changes]

So yeah, what brought Mitt Romney and Ted Kennedy together was a ton of federal money.

During the Clinton years, Massachusetts had gotten a uniquely generous federal deal to help rejigger its Medicaid system. That deal started with $20 million, and it grew and grew, so by the early aughts, it was a half billion dollars a year, subsidizing a huge swath of the whole medical system in Massachusetts.

And by then, Republican President George W. Bush had his own people running Medicaid in Washington, DC, one of whom, a budget hawk named Dennis Smith, asked a simple question. 

Why the heck is Medicaid sending Massachusetts a half billion dollars a year? Dennis Smith sent a letter to Massachusetts, where Mitt Romney had recently become governor, and suddenly, healthcare leapt to the top of the Romney team’s agenda.

Their assignment wasn’t find the best way to provide healthcare. It was find a way to spend that federal money that’s gonna look okay to this Republican guy, Dennis Smith. And what they found, what became Romneycare, was an idea nobody had ever liked very much, not even the guy who proposed it in 1989. That was a scholar at the Heritage Foundation named Stuart Butler. Ian talked with him. Ian talked with him.

Stuart Butler: I thought, you know, when you look at the options politically, that was the least worst option. 

Ian Coss: The least worst option.

Dan: He was like, this kinda sucks, but everything else sucks more.” 

Ian Coss: Yeah. Who’s excited about passing a law that requires people to go out and buy something?

Dan: It’s a tough sell. It’s a tough sell.

Ian Coss:  It’s not a political winner. 

Dan (hosting): But the idea found its way to Romney’s team, and they found a way to sell it to the Bush administration with a big assist from Ted Kennedy. And then they had to pass it through the Massachusetts legislature, which was not easy.

 But half a billion dollars is a big incentive, and it’s a lot of money to play with, which explains another mystery about Romneycare. 

Ian Coss: It’s like Massachusetts does this thing, and then it immediately jumps to the federal level. Right?

Dan: Mm-hmm. 

Ian Coss: Like, well, Why didn’t another state do it first?Like, why didn’t it go Massachusetts, California, New York, and then the nation? You know, ’cause a lot of policy works that way. You know, where like it starts somewhere, and then other states copy, and then it bubbles up organically. Well, what happened is, and California’s a great example of this, um, Governor Schwarzenegger in 2007, the year after Mitt Romney signs Romneycare, Schwarzenegger is like, I’m gonna do the same thing. Moderate Republican governor, progressive state, all… It checks all the boxes, right? The willpower, the resources, et cetera, et cetera. And, um, they bring in, uh, I talked to, there’s an MIT economist named, uh, Jon Gruber, who was, who advised the Romney folks. And they bring in Gruber. They fly him in from MIT. He goes and meets with Schwarzenegger. He crunches the numbers, and, uh, he comes up with a price tag for California. And, uh, as he remembers, it was $3 billion in order to do for California what Massachusetts had done. And by the way, you’re gonna have to generate that all with new taxes. Whereas Massachusetts, like you were saying, had this very unusual circumstance where there was this kinda like slush fund of Medicaid money that had to be repurposed, and they were able to repur- repurpose it into what we know as Romneycare. And Gruber told me as soon as that number came out in California, everyone was like, Oh, hell no. We’re not doing that. and the same thing happened in other states. And so what happened is that it was this model for the nation, uh, that, uh, you know, everybody’s looking at, you know, the low uninsured rate and, you know, how well things were going, but it was a model that no other state could follow, and that’s why it had to go. If the policy was going to go anywhere, it had to go to the federal level.

Dan (hosting): Which it did. But the hope of recreating Romneycare’s bipartisan coalition did not come with it. The ideas themselves had never been political winners, and this time there was not the equivalent of a half-billion-dollar windfall that everybody wanted to save. Instead, there was a price tag. And at a moment when the federal government had spent a couple of years spending big, propping up the economy after the 2008 financial crash, bailing out banks, then the auto industry, then passing a stimulus bill, Republicans were getting a big boost from the Tea Party movement. That movement opposed new spending, including on healthcare. The Affordable Care Act became a fat target. And Ted Kennedy didn’t love the Affordable Care Act himself. I mean, he wanted so much more. But he fought for it hard, even as he was dying.

Ian Coss: Uh, I mean, irony. Just the, irony of the fact that, Ted Kennedy held that Senate seat from 1962 to 2009 as, you know, and if he represented one consistent issue across those decades, it was the crusade for universal healthcare. And now the reform that he has been working towards and dreaming of for almost half a century is on the one-yard line, right? 2009, it’s so, so close. Um, Kennedy has been nudging it along, ushering it along as much as he can. He’s suffering from a malignant brain tumor. He is confined to his home on Cape Cod. He’s literally watching along on C-SPAN live as the votes are cast in the committee that he chairs. He’s raising his hand and saying, “I,” to no one because he’s sitting alone in his room ’cause he cannot be there, right? He, he is doing everything he can to push this thing forward, and he passes away,

Dan (hosting): And his death created a political crisis. All that political anger over government spending ended up with a single outlet in the fall of 2009, the special election to fill Ted Kennedy’s seat. Republican Scott Brown won, the Affordable Care Act got much harder to pass, and Scott Brown’s win previewed big Republican gains in Congress. 

And one of their biggest campaign promises for years to come was fighting to repeal the Affordable Care Act. And for a lot of them it worked.

Dan (interview): So all this talk about kind of party politics leads me to one of the things I really think about with this story that you’re telling, and this story generally, but the way that you’re telling it. This really telling quote that you mention more than once going back to 1994.

Ian Coss: Mm-hmm.

Dan: And you quote the kind of conservative activist Grover Norquist, who says like, “We don’t wanna negotiate,” try to solve healthcare with Democrats. “We want this to be,” he says, “their Stalingrad, their Gettysburg, their Waterloo.”

Ian Coss: Yep.

Dan: And, what strikes me is this idea that healthcare, there appears to be this political danger in trying to do something about it, everyone recognizes, like, this shit’s fucked up. Something’s really wrong here. Uh, people are really mad. And yet, again and again, any attempt to do something that could be good for people about healthcare, risks this huge political backlash. And I’m curious how that lands to you, um, having done all that reporting.

Ian Coss: Yeah, I mean, I think the danger of healthcare as a, just like politically as an area, is that it does affect all of us. You cannot reform the healthcare system without affecting everybody. Like, there are just so many interlocking parts. And so it becomes this very delicate issue, where it is very easy to weaponize, it is very easy to use it as a cudgel. And that’s why I was really excited to dig into the, like, the political story of Romneycare, how that was passed, because I actually think it’s a kind of inspiring story for our times of how in that moment it was, you know, there were disagreements and there were fights, and we get all into this over the, the course of the series. But that federal funding that was, threatened to be pulled, really galvanized people and it pulled together Ted Kennedy, and it pulled together Mitt Romney, and it pulled in, you know, liberal Democrats, progressive activists, the Bush administration. It really is amazing how when everybody had a political incentive to make sure that something got done, um, people can actually work together pretty well. And uh, the unfortunate reality is that most of the time the incentives are not that well aligned. Somebody involved has an incentive for it to fail. They’ll get more out of this thing failing and blaming somebody else for it than they will from it succeeding and taking credit for it. And that’s what that line means, that, you know, let it be their Stalingrad, let it be their Waterloo, their Gettysburg. We gain more by making them try and fail than helping and succeeding. 

Dan: And that question of like every… I mean, in Massachusetts, right, there’s another cudgel of like, “Do you wanna be the guy who, who lost us the half a billion dollars a year? Do you wanna be that guy?

Ian Coss: Right. Nobody wants to be that guy.

Dan: I guess I’m curious, you’ve told the story with this tremendous sweep with all these players. Like, how do you see, at this point, the kind of character of individual people in a given place and time versus, you know, the circumstances they find themselves in?

Ian Coss: I definitely feel pulled as a storyteller between, like, I wanna make it about the people, I wanna follow the people on their journey, and also the awareness that this isn’t just about Mitt and Ted, right? This isn’t just about the w- you know, that, how they had the she- sheer willpower or the, the relationship to make this happen. Um, uh, I, I think circumstance is a huge, huge part of it. Um, so I, I try to hold those things in tension, and I remember o- one of the Romney staffers told me, uh, this guy Brian Whelan, the way he described it is like, “When we came into office, we were not thinking about healthcare. I was not a healthcare person. And this, really the way this thing started was because of a crisis, because of that federal money. And that really galvanized everyone. And I think there’s some kind of lesson in there, too, ’cause it was the same thing in 1974, right? It was really, for Nixon, it was the crisis that pushes you to do something. Um, because for me, one of my takeaways in just looking at the history of healthcare reform is that the most powerful default option is always do nothing, right? Don’t disturb the status quo. Don’t poke the beast of the insurance companies or the drug companies or the hospitals or whatever it is. Um, just let it be. Uh, we all know it’s not ideal. We all know it’s not equitable. We know, all know it’s expensive, but, you know, just let it be. And so I think it’s, it’s in these moments where the status quo becomes untenable that really interesting things happen.

Dan: Having, yeah, told, looked at that story and told the story, like what, what does that suggest to you about what we might expect going forward? I mean, from where I, you know, having now been reporting this for a bunch of years, like I gotta tell you, man, this sucks. Like, and it ke- it seems to keep getting worse, and I don’t think this is just me. And you’re saying like, yeah, it looks like, you know, the incentive is generally to do nothing. 

Ian Coss: Yep. 

Dan: What does that suggest to you about what we might see going forward?

Ian Coss: I mean, the first thing that I tend to think, and this is not entirely my own observation, but, um, that the cycle is coming back around. That, you know, I said before the healthcare reform requires this alignment between politicians who are in power who wanna do something and, you know, a critical amount of pent-up frustration with the system. And I feel like it’s been a while, and the f- the frustration in the system is definitely there. It’s definitely building. It it seems like we are coming around towards another moment of alignment when somebody’s gonna take a run at this because the problems are not going away. And one of the reasons I wanted to release the series now and tell this story now is, you know, certainly people on the left, I think, are already kinda thinking about January 2029, right? Which right now is, is, I mean, it’s, this seems absurdly far away, but it’s not. Um, as a moment when it’s, regardless of what happens in the election, it’s gonna be a new administration, new day, new Congress. And what’s interesting to me is if you think about the parallels between, um, you know, the Obamacare era and now… Obama came in in 2009 with that big Democratic majority, kinda wave election following a, an unpopular Republican, president. And think about what happened in 2006. Well, of course, Romneycare happened in 2006. So we are, i-if we were thinking about our timeline as analogous to the 2000s timeline, right now, 2026 is the moment when the ideas should be forming, right? Like, in 2006, that was when the policy consensus was forming of okay, if we get to take another run at this thing, here’s how we should approach it. I’m kinda curious to look around and see, okay, 2029 is a few years away. What are the ideas?

Dan: Well, I mean, as we talk, the 2026 election is a few weeks away and, you know, you’ve got a candidate for Senate in Michigan, uh, Abdul El-Sayed, whose whole platform is Medicare, or whose biggest chunk of his platform is Medicare for All. And obviously there are people in office like Bernie Sanders, number one, who’ve been pushing that platform for a long time. I mean… 

Ian Coss: And that seems to be having a moment now in a way that it wasn’t 20 years ago. Um, like if you look at the 2008 Democratic primary, um, the only Democratic candidate who supported single-payer-Medicare-for-All was Dennis Kucinich, who was kinda like a, you know, also ran, just like 

Dan: He was not the Bernie Sanders of 2008. 

Ian Coss: No, No, he was pretty marginal. So I mean, you had obviously, you know, John Edwards back then, obviously Barack Obama, Hillary Clinton, they were all on board with the, they were all pushing, pushing the Massachusetts plan, right? The Romneycare model…

Dan: Versions of it.

Ian Coss: Slightly different shades, but, um, all based around that, that core idea. And, um, and so it is interesting to me to see how, yeah, in 2026 versus 2006, 2007, the energy around Medicare for All, around single payer is very different. It’s ve- and maybe, maybe that is the idea that finally, you know, has the critical mass of energy around it. As, as you know, there are a whole host of challenges to actually pulling that off, but there’s certainly energy around it in a way that there wasn’t 20 years ago.

[music]

Dan (hosting): I talked with Ian Coss on September 30 — that is, just a few weeks before the 2026 midterm elections. I think those elections make for an interesting follow-up to that conversation.

Before we get into that, I’ll just say:  You can find Ian’s show, The Big Dig, Season Four: Mitt and Ted, wherever you get podcasts. It’s terrific. 

Ok, now I am recording this the morning after the 2026 midterms. Like, I have no idea yet who won the Senate races in Mississippi or Alaska.  

But I do know that Abdul El-Sayed, Mr. Medicare for All — ok, Dr. Medicare for All, he’s a doctor —  won in Michigan. 

El-Sayed:  Michican, we did it!!

Dan (hosting): And it wasn’t really close. The national headlines are not about Medicare for All as an election issue.

CBS Anchor 1: Last night was no joke. The voters spoke loud and clear. 

CBS Anchor 2: Mm-hmm. 

CBS Anchor 3: Yeah, it really was. I mean, this was a categorical repudiation of President Trump’s agenda and his first two years in office… 

Dan (hosting): Which, sure. Yes. Medicare for All may not have *won* the election for Abdul El-Sayed. But it didn’t cost him the election either. 

And he wasn’t the only Democratic candidate who embraced Medicare for All — AND won. 

Troy Jackson in Maine did too. So did Peggy Flanagan in Minnesota. Not quietly either.  

Peggy Flanagan: Sometimes folks are like, “Oh gosh, Medicare for All. It’s too much.” A $16,000 deductible is too much. 

Dan (hosting): All three of these were states the Democratic Party had been desperate to win. Political experts kept Maine in their tossup column until the very end. 

But Democrats had candidates who embraced a position that — as Ian pointed out — had been considered FAR outside of the mainstream until recently. 

And in Texas — which until pretty late going hadn’t been considered a swing state, James Talarico flirted with the idea. He asked for “Medicare for Y’all” — letting people buy into Medicare.  

Just the fact that candidates in key races that could shape the United States Senate  leaned into the idea of Medicare for All — and apparently did not pay a political price. I think that means something. 

Also worth mentioning: one of the election’s big upsets was in Kansas — which hadn’t elected a Democratic senator for a century. 

And the Republican incumbent spent the last days of the election struggling to explain to voters why, in his previous job — as a doctor — he had sued more than 700 patients over medical bills.

Roger Marshall: We did have to keep the lights on, so we occasionally handed some accounts over to collection agency just like nearly every private medical practice does. 

Dan (hosting): He lost, and it wasn’t especially close. Health care may not have been the biggest issue in Kansas, but the fact that a sitting Senator felt like he had to spend so much of his time talking about it– again, I think it means something. It means — just to state the obvious: People are freaking fed up with healthcare, with prices that keep getting more shocking, with insurance companies, and, you know, for very good reason. Like we’ve covered here recently, shocking numbers of small businesses are dumping employee health insurance ’cause they can’t afford it. And insurance for employees in general keeps costing more and covering less.

As I record this, Obamacare open enrollment has just started with a new round of awful rate increases. Millions of people dropped insurance after last year’s increases, and experts predict more of the same. 

 And as we’ve reported here recently, private insurance companies running Medicare plans are making healthcare crummier and less affordable for seniors year by year.

And coming up in January, huge cuts to Medicaid passed into law last year, they’ll come into full effect. Millions more people will become uninsured No matter who won this week’s elections, we’re not gonna see massive legislation to change that this year. But we will see things get worse and worse for millions and millions of us.

Which is why I think I don’t need to keep just doing this show, keep putting out podcasts and newsletters.  We need to do a lot more. In the last few weeks, I’ve been thinking a lot about what that’ll take for us to put out more episodes, do more reporting, get our reporting out to more people, learn more, share more.

No surprise, it’s gonna take money. 

And here is where I have some good news for you. 

Not only can you help us get where we need to go — by making a donation —but right now, in the month of November, every dollar you give us —  up to $1,000 per person — counts for triple. 

That’s because we’ve just started the News Match campaign  — where the Institute for Nonprofit News raises matching funds for hundreds of independent nonprofit news outlets. 

An Arm and a Leg has been given EXTRA matching funds.  A lot of them. That’s thanks to a big match by the Jonathan Logan Family Foundation and a few generous individual donors.

Because they see how critical our work is right now, and they wanna help make sure everybody knows:

Now’s the time to pitch in. 

So they put up the money to match every donation this month two for one.

You give us 50 bucks, these matching funds turn it into 150. 

You give us 200, we get $600. 

I mean, you do not see bargains like this anymore. Am I right? 

The place to go is armandalegshow.com/support.
That’s armandalegshow.com/support. 

And your donation gets matched two to one. Let’s go!!! 

We’ll have a new episode for you in a few weeks. 

Till then, remember, armandalegshow.com/support 

and: take care of yourself 

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta and edited by Ellen Weiss.

Huge thanks to Ian Coss. Adam Raimondi is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Amanda Boyd is our operations manager. Bea Bosco is our consulting director of operations. An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF.

That’s an independent source of health policy, research, polling, and journalism. Zac Dyer is senior audio producer at KFF Health News. He is editorial liaison to this show. An Arm and a Leg is distributed by KUOW, Seattle’s NPR News station. Thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

 They allow us to accept tax-exempt donations. You can learn more about them at inn.org. And finally, thank you to everybody who supports this show financially. In a second, I’m gonna shout out the names of some folks who’ve come aboard recently. You can join in anytime at armandalegshow.com/support. And when you do, I will be delighted to put you on this roll call.

Thanks this time to some people

Our music is by Dave Weiner and Blue Dot Sessions. 

 Amanda Boyd is our Operations Manager. Bea Bosco is our consulting director of operations. 

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

An Arm and a Leg is distributed by KUOW, Seattle’s NPR news station.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

 They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

 Speaking of donations… thank you to everybody who supports this show financially. 

One more reminder:  This is an incredible time to join in at arm and a leg show, dot com, slash: support.

Thank you, SO much!!