The Occasional Perspective - 8/6/25

The “Big Beautiful Bill” (B3) Impact on the Affordable Care Act and Medicaid – I’ll be honest. The impact of B3 on both of those important insurance capabilities will be devastating. The inaccurate alignment of certain traits (e.g., unemployed, video watching, do-nothings sitting at home) to those using the Affordable Care Act and Medicaid, is wrong. So, I was very pleased to pick up the latest issue of the New England Journal of Medicine this week with an article by Jonathan Oberland, Ph.D., a Professor in the Department of Social Medicine at the University of North Carolina who penned an excellent observation on the topic: Progress Lost – The Unraveling of Medicaid and the Affordable Care Act. Take time to read it. I clearly echo his perspective that B3 will have sharply negative effects on health outcomes throughout the nation. The health care community needs to stand up in unison to reverse a number of the changes included in the act. 

Fleeing The Country – I recently had the opportunity in the late Spring to visit New Zealand. It’s a fabulous country, but the people are what make it special. They are not only warm and welcoming but also thoughtful and engaging. I would rank them right up there with the Greeks with whom I’ve become very fond in the last decade!! So, we were on a special segment where we visited one of the national parks, and during the visit, I had the opportunity to engage on a number of topics with our “youngish” guide. Like all the others, he was informative and delightful. As we engaged, he asked what I did, and I shared my background as a physician – now retired from clinical work. During the course of the conversation, we circled around to folks moving from the USA due to the current environment, and I asked the question: “What do the New Zealanders think about Americans moving to New Zealand?” He looked at me and pondered for a moment. Then, with a quizzical face, he looked me over and replied, “Well, we are not encouraging you older Americans to move to New Zealand.” He had obviously identified the fact that I was “older.” And, I said, “Why?” His immediate reply was, “Well, you consume too much health care and we can’t afford to take care of you.” Hmmm? That’s a good social observation… For a further discussion on the topic, consider reading the recent article by Kwame Anthony Appiah in the NY Times on How Do I Tell My Rich Friends to Stop Talking About Fleeing The Country? It’s an excellent discussion…