The Present Illness

So Much Poop, So Little Healthcare Access

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 42

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Explosive diarrhea? The Clown Car of the Apocalypse is at it again. ICE keeps killing people. Millions give up their health insurance because it’s too expensive. 

Mitch McConnell essay by Moira Donegan


ICE's Extrajudicial Killings


ACA Enrollment


Extras


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Credits

  • Production by Arghavan Salles & Alyssa Burgart
  • Editing by Alyssa Burgart
  • Music by Joseph Uphoff
  • Social Media by Arghavan Salles

Don’t take medical advice from random people on a podcast. This show is for informational purposes, is meant to be fun, and is certainly not medical advice. Please, take your medical questions to a qualified professional. Nothing we say represents our employers or anyone else. 

listen, to all of our listeners, all of you who have been with us as we share these you know, these stories of what are coming out of the federal government in terms of public health, you too are more qualified to run the CDC. Than Doctor Schwartz, you're welcome. Yeah, there, fellow nerds. Welcome back to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's a little febrile and definitely underdiagnosed. I'm Arghavan Salles, a surgeon scientist, and your friendly neighborhood doom scroller in residence. And I'm Alyssa Burgart, an anesthesiologist and bioethicist who and health law like their EKGs full of spikes and surprises. The present illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the As notory listeners, we often talk about tough topics that can be intense, they can be activating, they can be a lot. So if you need to take a break, we totally get it. Absolutely. And we want to give a big thank you to everyone who's listening you found us with some extra love to our subscribers and a special warm welcome to anyone who just stumbled in from the outbreak of explosive diarrhea that we're all enjoying. my goodness. Arghavan, for people who have not heard about the amount of poop that's happening in America right now, can you can you give just like a quick summary? Yes, I can. And I do want to just point out that some people are calling it trumparia. ~ some people are calling it dumparia. So I invite folks to be creative about how you refer to this problem. But the issue is cyclosporiasis. Okay, so cyclospora, it's a ~ parasite that lays eggs on produce. And yeah, lovely. I hope nobody's eating while they're listening. So we now have. Over 7,000 known or suspected cases of cyclosporiasis just from the last few That is about double what we normally see in an entire year. So definitely notable. A lot of the cases are in Michigan.~ about I think half of those cases roughly are in Michigan, and with some in Ohio, that seems to be kind of like where most of it is But we are seeing cases everywhere, including in California. Now, it is true that it's not uncommon to see some. Errant cases here and there in the summer. But this is a much bigger outbreak than usual. And one of the things that is one of the reasons that people are concerned about it is that last year, when the government decided that many of the things we do aren't necessary, that they're wasteful,~ is that they cut back on what was mandated to be tracked, what food foodborne pathogens were mandated to be tracked by. State governments and so on. And so one of the pathogens that was no longer required to be tracked was Cyclospora. In addition, Campylobacter, Listeria, Shigella, Vibrio, and Eurisinia are all pathogens that we are no longer requiring anybody to track. And so I think that that has not caused this outbreak, of course, but it has contributed to it being more difficult to find the source. This has been going on for weeks now, and we still do not know as of July 16th when we're recording this where it's from. They think maybe it might be coming from lettuce or bag salad, but still no idea of what company or source, like what farm, whatever. Nobody knows. And and the common places where cyclospora is found are lettuce, bag salad, snow peas, basil, cilantro, green onions, and raspberries. But really, it can be on any fruit or vegetable that's not cooked. So the only way to really make sure you you're not consuming it is to cook everything. But of course, like who wants to cook a peach? Like you want to eat a fresh peach in the summer or like I said, raspberries, ~ salad, a cooked Well also like it's yeah, it's hard to wash those kinds of things. Exactly. And so the cyclospora do tend to be more sticky on things like leaves, like lettuce leaves, than and on raspberries, but there's these little nooks and crannies, than say like on a cherry, although it's not impossible to get it from a cherry. Anyway, so the recommendations ~ are to wash your hands before and after handling produce, also to wash your produce, but there is no vinegar, salt, any treatment that will kill the cyclospora except for heat. up to 158 degrees. ~ so that means, you know, people can do whatever they they think is reasonable and people have different levels of risk tolerance. For me personally, I am, this is not medical advice, but for me personally, I am avoiding uncooked leafy greens at this time.~ if you're having something like cherries or cucumber melons, you just need to scrub the outside things that you can easily remove the peel of, like banana or oranges, you know, those are Going to be lower risk because you're getting rid of the source, especially if you're washing your hands before and after. Anyway, so that's what to know.~ I'm hopeful that soon enough we will actually be able to know what the source Part of the challenge is that the symptoms develop two to 14 days after consumption. So if you're one of these public health workers who's trying to figure out okay, like today you had this, you tested positive for cyclosporiasis. What did you they have to ask, what did you eat over the last two weeks? Very hard for folks to recall.~ and that's making it harder to track things down. So anyway, stay safe out there. Well, you know, I'll tell ya, I use a food delivery service for, you know, especially weeks when I'm working in the hospital, and it's real salad forward. So I think I'm gonna cancel that for the foreseeable future. I think it's time for me to just not do that I mean for a little while. You know, like I I I think that's very reasonable. Others might say, Well, we don't have that many cases in California. What's really the big deal? But like the p the other problem with it is so I don't know where they're getting the lettuce. Correct. And it's hard to know. so there is a treatment for it in in case folks are worried. It is treated with antibiotics, but and it good news is it's unlikely to result in fatalities, although we have had over a hundred people hospitalized already because of it.~ but one of the main issues But I don't I don't need to have something risk me dying in order for me to desire to avoid it. I agree. And it and it can cause weeks of watery explosive diarrhea. I don't want one day of that, much less weeks. I want zero episodes. I want zero ever in my whole life. Yeah. Me too. Me too. Yep. I would like to never, ever have that. Well, you know, I agree. I agree. what you know, this is making me think about our very first episode where we talked about how the Trump administration has created the clown car of the apocalypse. We are we are destroying public health. Mm-hmm. This administration is doing absolutely everything it can to make it so that the government Which when it's functioning effectively, you really don't have to think about it. Like I have never once in my life, probably other than maybe like in a med school infectious disease class, I have not had to think about this at all. But now, look at us. Let's get a whole podcast thing. Making it famous. Yeah, we're talking about it on the podcast. I I have a post about it on my Instagram. You know, like yeah, it's a lot of talk. I will just point out for folks that ~ because you you also might find this interesting. Emily Oster wrote an opinion piece that was published in the New York Times yesterday saying it's not a big deal. It's not a big deal. Don't need to worry about it. And I would just like to remind folks that she is an economist. She has no expertise in public health or science or medicine.~ anyway, on that note, perhaps we should move on to Our main topics? wait. I think that sounds great. I mean, and while you were doing this, I did cancel the food delivery. Yeah. I think that's wise. And I forgot we were gonna do a quick update on Mitch McConnell. Do we wanna do that? gosh, turns out he's not apparently dead, which I mean, there's still rumors abound, but you know, they so we we had our episode last week where there was a lot of rumors that, like, was he brain dead? He'd been hospitalized for three weeks, no. nobody knew where he, you know, what was happening, was he really alive, Mm-hmm. or was it all a ruse? And then this photo was released of him and his wife. He's holding what appears to be I forgot I think it was the Washington Post ~ newspaper. Yeah. Yeah. And multiple like people who do image forensics say that it is that the metadata indicates that it is a real photograph. ~ I saw a report today claiming that the white that his wife was seen leaving a~ skilled nursing facility where apparently he's staying. But again like There's no reason that there needed to be all of this rampant speculation. I'm I'm actually really concerned at the amount of speculation that apparently legitimate journalists just sort of propelled out into the world. Well, it's it's a bit it's a bit odd, right? Because multiple reputable sources reported cardiac arrest and CPR. Mm-hmm. And alongside that photo that you're referencing, they put out a statement. He Mitch McConnell or his office, whatever, put out a statement wherein he supposed yeah, They need a fall. he says that there was no CPR, there's no cardiac arrest. In fact, there were almost no injuries. He fell ~ at his house and right. He says he didn't lose consciousness, well, according to the statement. Right, according to the statement, and had no concussion, no broken bones, nothing. And yet remained in the hospital for several weeks because he says that he then caught a quote unquote mild pneumonia. Now, i i I don't know. It's all it's it's still honestly very suspicious to me. I don't I can't put together why even a frail person after a fall with zero Mm. would be in the hospital for weeks and then being transferred to a rehab. So I do feel still that. They are not being ~ forthcoming in terms of what's happening. Yeah. Well and But it does seem like he's alive. I don't know. It seems like it. The I mean, and the other thing that came out after we had already ~ recorded and released our episode was the video footage of his neighbor videoed videotaping or with their phone. I don't know what we call that phone taping. recording. One of his neighbors recorded him being supposedly Recording. him being uploaded, you know, loaded into a ambulance and it seemed very casual, like no one seemed to be in a hurry. Mm-hmm. Yeah. And it wasn't a body bag. And so I and it's and the report said that I couldn't see his face, but the the neighbor apparently reported that he was not wearing an oxygen mask. And so again, I'm like going, all of these reports that we've heard that it is cardiac arrest. And the report that we ~ like I said, I had listened to the audio from the ~ the EMS report implying that it that Yeah, yeah. he was found down and that it was a cardiac event. Now it must be that that turned out to not be correct, even if that's what was initially called in. I guess that's that's possible. Anyway, it remains a mystery. But in the interim time, of course, last Saturday, Lindsey Graham drops dead of a supposedly, as we've heard, that he had ~ well, did you hear how the president referred to what happened? All I heard from the president was that he said, Well, this is gonna make it tougher to pass the Save America Act. That's what I heard from the president. He when he so when the president was asked about how Lindsey Graham had died, he said some part of his body exploded. And I mean, that's not necessarily like wrong, but it is also very not specific. So apparently ~ Lindsey Graham had developed~ an aortic dissection. And died from that. And that's a very serious cardiac condition. And especially if it's in the the most common kind is when it's in the ascending aorta, which supplies blood to your brain.~ anyway, so apparently he had that. There was a lot of speculation because he's just come back from the Ukraine that perhaps he was murdered by the Russians and all of this, but ~ you know, we're being told that he had a cardiac that he had a aortic dissection, and that certainly is a way that people Drop dead, it has a very high mortality rate. That's right. Yeah. So now his sister is taking over. But also his office released it like the same day. Yes, his the the notification came out late Saturday night,~ early s on West Coast time, early Sunday morning, east coast time. And ~ his sister's already been sworn in to replace him. Isn't that interesting? my gosh. And the fact I mean the fact that you can just throw in just some random relative, are you kidding me? What is anyway. Yeah. So he was highly specialized. So highly specialized that his sister, who's probably still plan planning his funeral, because you know, he didn't have a a partner, not not one that was legal anyway,~ and no children. So she's still gotta deal with that. And now she's gotta be a senator, apparently. Anyway, all sorts of things going on there that we could spend a lot of time on. But we have we actually have two other topics that we're trying We do, we do, we do. Well, to talk about today. but I wanted to tell you, I I ran into a friend recently who's a hepatologist, Mm. and she said, I like to get all of my health news filtered through your show. She's she loves the podcast, she's enjoying it, and so keep listening. If you like your news gossipy, here you go. so today's topics we are going to talk about two main topics. One of them is an update on Just more illegal violent behavior from ICE and how they're terrorizing And then we're gonna also talk about decisions from both the GOP and the how choices they've made are really destroying access to the Affordable Care Act for millions of Americans. And we're gonna talk about what the future of that means for healthcare. Amazing. So very little to cover in so much time. but let's yeah, as we do always ~ pick these big big things that Casual. we try to cover ~ in a relatively short amount of time. But so let's jump into the ice situation.~ I wanted to talk about this because there have been new developments in what's been happening with ice after Obviously earlier this year, we all had a lot of attention on what was happening with ice in Minnesota and then also in Chicago with their midway~ blitz. and or I think that might have been actually last fall. But anyway, we've there have been periods where we're all paying more attention to ice and periods where we're paying less attention to ice. And it's important to note that ice continues, nevertheless, to be terrorizing, as you said, communities. And they've come back into kind of greater public awareness. In the last couple of weeks, because of two more people they have killed during their, you know, attempted roundups of immigrants. So one I want to draw people's attention to is a man named Lorenzo Salgado Rajo, who was 52 years old, living in Houston,~ has been in the States for 35 years and~ owns a construction company, was taking workers and himself to a work site in the morning and was pulled over. By ICE and they shot him and he died of his injuries. The three other men who were in the vehicle were detained by ICE. One of them is his brother. ~ they, as far as I know, remain detained today. Lorenzo had three sons, ~ who are all US citizens for whatever that's worth.~ one of them learned about his father's death by hearing his voice on a clip on Facebook. ~ where he reportedly was saying, they're killing me. ~ which is absolutely devastating that that would be how you hear about a federal agency and its agents killing your father who was on his way to work. ~ they apparently were not actually looking for Lorenzo Salgado Arajo. They were looking for who knows who, but somebody else. now, of course, the ICE agents had their own version of the story saying that he had That Lorenzo had tried to run them over. We've heard this story before.~ And the witnesses who were in the vehicle say that's not what happened at and that there was no one in front of the car, and that there was no ramming of an ICE vehicle or anything like that. The city of Houston is now doing its own independent investigation because it there has not been information forthcoming from ICE or the FBI.~ So that happened on July. Seventh, I should mention that Mr. Arajo was originally from Mexico, and the president of Mexico has expressed, even prior to this, a lot of concern about what is happening to Mexican immigrants in the United States and is calling for investigations.~ so yeah, that happened on July 7th. And then this week, ~ a young man in Maine met the same type of fate. ~ this man's name is I believe it's pronounced Joan Sebastian Guerrero, is he was Colombian originally and is here with a work authorization. Has a had a wife and a three-year-old daughter. The three-year-old daughter reportedly was in the car with him wearing her bluey pajamas when I you know tried to detain him. Again, turns out he was also not the person they were looking for. And they killed him. ~ he worked in food delivery. They You know, of course, same story that he was using his vehicle as a weapon. Well, originally, I should clarify that that is what they originally said that he was using his vehicle as a weapon. And then they changed the story,~ DHS when they put out a official statement about it. They said that because he was trying to drive away from the agents,~ that they shot him out of concern for public safety. And I wanna point out that the threat to public safety is these ICE agents, not Any of these immigrants who they have detained and another case is shot and~ what's interesting since we talked about Graham Platiner, or one interesting thing since we talked about Graham Plattiner last week is that Susan Collins, ~ who's of course one of the senators for Maine, expressed her concern right over what had happened. But this is after she voted for a bill allotting 70 billion with a B dollars to ICE without making any changes to the agency. And so I wanted to raise these two stories because in January, when ICE agents shot and killed Renee Good and Alex Predi, you know, it was all over the news, rightfully so. and these two cases I I'm certainly seeing, but I don't think they're getting anywhere near the same level of coverage. Mm-hmm. Also, as I was, you know, reading, as I've been reading about these cases,~ You know, ICE has been responsible for the death of somewhere between eight and eleven. It's hard to get precise numbers,~ people dying as they're trying to detain them. and we we don't know about all of them. There's two other people who they shot and killed ~ during traffic stops. One is very bizarre. ~ Ruben Ray Martinez is the man's name. He was a US citizen killed in Texas in March of 2025, but they did not release that information for about a year. Well, and we know that last year was the deadliest year for people in ICE detention and fifty people were reported as dead. And then when you bring up cases like this where they like they're just hiding the data. So you can't even be certain about the data you have, Okay. which is why we're relying on so much independent reporting ~ from folks. Yes. And another man, Silverio Viegas Gonzalez, who was a Mexican immigrant, was shot while driving away from ICE agents in Chicago in September. And it's really important for people to know, I think, that even police, the ICE agents are not police, but even police are not supposed to shoot at people, let's say a criminal. let's say a domestic violence committer or like a a thief or whatever. They're not supposed to shoot at those people when they're driving away.~ much less immigrants who are doing nothing wrong ~ and were on their way to work as Mr. Arajo and Mr. Guerrero both were. That is not like the appropriate next step if someone seems they're trying to evade you. No, because somebody who's leaving is not threatening you. Correct. And so that's why, you know, when DHS for ~ the case in Maine, when they revised their statement, they said that th there was a concern for public safety. But what's the concern for public safety when a man is just driving a Shooting someone in the back is the most cowardly act of I mean, even amongst people who who are like gun proponents, shooting someone in the back like you're a coward. You're you're a fucking coward. Mm-hmm. Mm-hmm. And there's I want to point out something that's come up a lot in the conversations online about these cases, which is, you know, that these are not the people they were looking for. I want to point out that even if they were the people they were looking for, it is still not appropriate to kill somebody because you think they may Also unacceptable. be here with undocumented status. Okay. Neither of these people was committing any sort of crime.~ they were just you know going about their day. And it is and it is unlawful to it I mean, these are just extrajudicial executions. Mm-hmm. Correct. And and there's been a lot of talk, especially with ~ Mr. Guerrero, that he was here, you know, with his work authorization and he was ~ we believe, working on getting asylum. ~ and even if he hadn't, right? That's still not a reason to shoot somebody. And if you've seen the whoever's seen the video, you see that they they shoot him, he is dead. They drag him out of the car, lay him on the concrete, and handcuff his limp body while his daughter is in the back of the car.~ and on the same block where they live, by the way. ~ so I just wanted to draw attention to the fact that ICE continues despite all the attention, all the uproar that happened earlier this year. They don't care. They continue to do basically the same things. And I will say that after, I think it was on either late Monday or early Tuesday, there was a notice that had gone out that they were going to stop doing traffic stops, because that's what many of these cases have been traffic stops. Yeah. And the next day, the president was like, that's dumb. Of course, we're going to keep doing traffic stops. This is really important work that we're doing. Our country's never been safe for blah, blah, blah, blah, blah. So even that precaution that they could have taken, which probably would have actually been impactful. the president did not want them to take because it's important it's more important that we terrorize communities and that we demonize immigrants than that we stop killing people, as you said, extrajudicially in the streets.~ I continue to be a So it turns so it turns out that Tom Homan hasn't made anything better after the after Bovino's exit shocked. Well, not only that, but when they asked him about these two cases, he said they're not even a bump in the road. That was the phrase that he used. This is not even a bump in the road because they have this~ whatever sacred mission or whatever, you know. ~ the people in Maine and in Houston Maine, it was a small town called Biddeford.~ the people in that town and the people in Houston have been. protesting, coming out in the streets. They have massive memorials for these two men who unjustly lost their lives.~ you know, they're they're doing what they can to fight for justice locally, but this is a obviously a massive federal agency with a huge budget that is that has gone far beyond whatever it was originally intended to do. And you know, we've talked before about the training that they're not getting adequate. training like anyway, there's lots of things that we've discussed before about the structural issues with the agency, but at this point in time, I think abolish ice is a moderate position. I mean, I that abolish ice like doesn't even come close to being enough. Yeah, well, we also need all of these people to be held accountable. I mean, it's worth noting that not a single ICE agent who has been involved in any of these shootings has been suspended, fired, put on trial, arrested, nothing. You know, in many of these cases, we don't even find out the name. They don't even release the name to us. But even in the cases where we have, because of social media sleuthing largely, found out who the person is, there has been no consequence. For them. And that's part of the issue, right? That even if there's public outrage, but there's no accountability, then why would ICE agents feel that they need to follow the law? They've been told, and and JD Vance, even just, I believe, last week, said as they were he were, they were asking him about the the ICE agent who shot and killed Renee Good.~ he said, nope, there's there's nothing there, they have complete immunity. So basically they've set up this, you know, force, this militia that is going to carry out the president's little xenophobic racist missions and cannot be held accountable. That's what they're trying to say. And we cannot, as the public, to whom these legislators are are supposed to be accountable, like we cannot be letting this happen. You know, I ~ We've we've I've s talked before about oftentimes my joy is around, you know, music or whatever. And ~ Jesse Wells has, you know, become a real voice in especially in like Americana music for writing a lot of really ~ important protest music, for this for this terrible era that we are currently living in. And he wrote a whole a whole song called Join Ice. So I'm gonna put that I'm gonna put that in ~ in the show notes.~ and it's all about like who are these people who think this is a great idea that they're gonna they're gonna join it because it's got great benefits. Yeah, let's go tie people up and murder people. Mm-hmm. It's got it's got a great benefit plan.~ I am you know and we've this this obviously keeps coming up, but you know, Hannah Arrentz, the banality of evil and how she, you know, German philosopher wrote about that ~ in the aftermath of World War Two and how it's like, you know, pencil pushing regular people just, you know, going out, paying their bills, just driving trucks, and you know, We do. participating in a genocide and justifying it. And Mm-hmm.~ this you know, ICE is just one more example of how. All these people who work for ICE, they're out they're out on those government rolls getting that getting that getting those paychecks, and their job is to terrorize people in this country and and clearly to to have no problem and no accountability murdering people in this country. So ~ the banality of evil strikes again. Yeah, and the last thing I'll say on this before we go into the next topic is that, you know, folks may remember that there was a demand back ~ earlier this year for them to for ICE agents to be wearing body cam ~ body cameras so that Mm. we could have footage of these incidents because it's become so clear that they lie about what is happening. and supposedly they were Mm. I mean the DHS has said that they were not wearing body cameras for these incidents. But I did see somebody had a photo of the agents, I believe, in in Maine, and it looked very much like they had body cameras on their bodies. So either they weren't on or they're lying to us about whether that footage exists. ~ Well, and I mean, you know, talk about being like a pro surveillance state, in which case only when it's convenient. Yeah. Well, and I remember when that when that was the like Democrats solution Fuck eyes. to this was like, well, they should wear body cameras. That was never gonna be sufficient. That was never gonna be sufficient. Abolishing them was the only answer that was going to make any sense and protect our communities. And I think the the so so called, you know, moderate Democrats who want to like play along with the Republicans, they are as responsible for the undoing of this country. And And also, like to connect back to what we were just talking about, many of these folks put out these very sympathetic statements about Lindsey death. You know, court like saying that he was the funniest senator, please. I'm sorry, no. even Kamel Harris put out something that was like very nice. And we we will never change and get rid of this authoritarian state if that is what our so-called opposition party is doing, to mourn the death of someone who. Is responsible in many ways for the overturning of Roe versus Wade, who is in favor of killing anyone and everyone. I mean, the American way will be to make a statue of him. Well, you know, they're putting a Charlie Kirk statue up in in in Times Square. Anyway, separate topic. just I saw that that's gonna happen on September 10th, the anniversary of his death. ~ anyway, I I just continue to be outraged at what is happening with ICE and d disappointed is not a strong enough word for what the Democrats Mm mm. are not doing to try to protect the people of this country from the hatred coming from the other side.~ but I think that's enough for this topic today. Yes. Fuck ice, that's what I gotta say. Absolutely. That's why I will continue to list this podcast as explicit. Yeah. You know, free speech. All right, let's ~ let's take a let's take a little cleansing breath. Mm-hmm. And talk about how people are losing health care.~ It's terrible. Another cheery topic. Let's do it.~ So ~ the Affordable Care Act, also known as Obamacare. ~ there was a projection that was out. So so there's the the one big beautiful bill, the worst bill, the ugliest bill, the most disgusting bill, that unfortunately passed not this just past~ July fourth, but the previous one.~ you know, voted to cut Medicare and Medicaid subsidies voted to completely change a bunch of things around ~ Obamacare. Federal subsidies are one of the things that was lost in that argument.~ the longest federal shutdown, the Democrats were like really holding fast to keeping the government shut down. And then those little chickens gave it up. And so unfortunately, those subsidies lapsed. Mm-hmm. So back in ~ back in January is when people started seeing those much higher to their health care. So people who Don't have employer-based health insurance, but who are not poor enough to be on Medicare and Medicaid, could buy health insurance on these health and health insurance exchanges. And people went from paying three, I don't know four hundred dollars a month to like all of a sudden having to pay $1,500,$2,000 or more dollars per month. And so there were projections that were made last year before this went into suggesting that there would probably be about 14 million Americans who would drop that health insurance through the marketplace, but over the course of eight years, which is still catastrophic. But unfortunately, so it's it's only July. So it's only been we're only in the seventh month of this. And already multi-millions of people have have dropped their ACA coverage. And it's it's projected to be up to five million people by the end of this year. So that's already almost half of what the overall projections were going to be for eight years. So this is a far more accelerated loss of coverage than expected. And people who work in emergency rooms are already seeing, you know, more and more patients showing up later in their conditions, worse diseases, worse symptoms, because they haven't been able to afford to get any sort of care otherwise. And so there's lots of people who have chosen not to sign up for care. And what this also means, you know, part of how insurance is supposed to work is that you want to have a large pool of people that includes healthy people and people who are who are ill, Mm-hmm. so that if you have enough people who are young and healthy, it helps to offset the costs of folks who need more care. And then if you're somebody who's young and healthy who like suddenly needs more care in an unexpected way, you're also covered. And so of course, the people who Are making this calculus, right? They're like, I can't afford to do this. I would have to like not pay my rent or not be able to afford food. The people who who are easiest able to say, hey, I'm just going to drop this health insurance are people who are young and healthy. And in addition to obviously people who are Mm-hmm. not in that category, who are like, well, I really don't have any other option. And so they're going to be able, they're just going to have to focus on getting emergency care and maybe they're able to get care in some like federally subsidized healthcare but those are those are places are being are already overrun. so anyway, this is it's absolutely terrible. Mm-hmm. and there's some states, for example, where like the worst data that's come out, Kaiser Family Foundation did a big ~ analysis. And like in Ohio and Oklahoma, their population of people who are enrolled in the ACA shrank by nearly a~ and so that means that you have again far fewer people in that overall pool to be able to share ~ the the with the burdens of cost across Mm-hmm.~ across the population. And the people who have the the largest group of people who have dropped their sign offs ~ pardon me dropped their signups for ACA About 27% are people whose incomes are just above something that's called the subsidy cliff. So people who they're they're wealthy enough that they they qualify for Medicare and Medicaid, but they're not wealthy enough to be able to really afford this increase in cost. Uh-huh. And so these are people who are generally four to five hundred percent above the federal poverty limit. So that group is only three percent of planned selections in 2025. But almost 30% of those people were like, I'm out. I can't do this. So with the raisin deductibles, it's just, it's a big mess. ~ this is gonna, this is gonna be a huge problem in ERs across the country. Every state is impacted. and you know, Mm-hmm. the in the original Affordable Care Act, there were these like bronze level plan, silver level plan, and gold level plan. And so with ACA subsidies, families were able to afford the better. better part of that plan. Back before the ACA, you used to be able to get something called catastrophic health insurance, which when I was 18, that was all I could afford. Mm-hmm. And then that was a stretch, but I could afford catastrophic health insurance. The bronze level is really barely, barely more than that. It's really just to cover essentially catastrophes. And so for people who can even afford the bronze level plan, it's really insufficient coverage. And For folks who, you know, again, people who are in that four to five hundred percent above the poverty level, with the amount of deductibles that you would have to pay to access care, sometimes it's just cheaper to roll the dice and be like, well, if I need to have like one appointment with a doctor for the year, it's gonna cost me less. So why bother? And you're really just hoping that you don't get hospitalized. Yeah. I mean, this is the position we knew that that people were gonna be put into, intentionally put into by our legislators. And it's really sad to see it play out exactly as predicted or worse, Mm-hmm. when again, it was predicted, you know? Mm-hmm. And I one of the struggles that I have with this, or like the Safe America Act that we talked about ~ briefly before, Mm. but we've talked about in the past,~ Is the people who are most likely to be impacted are not really the liberals in Blue Cities for the most part. Do you know what I mean? Like the disproportionate impact is going Mm-hmm. to the populations who voted for this, essentially. And I don't know how they reconcile that for themselves. I don't think there's enough people who are understanding what's actually right? Because there's all this rhetoric about whose fault things are, or even just lies. I mean, there's so many lies. Like if you listen to any, well, Trump is gonna have a speech today. Actually, I don't really care much for whatever he's gonna say. I think he's supposed to be talking about, yeah, the good old 2020 election. because it's 2026 now. ~ anyway. Anytime he gives a talk, he talks about how prices are down. Prices are down, the stock market's doing great, everybody's thriving. And yet people are living in he they can he can say what he wants, but people are living in reality where the grocery store prices are outrageous. And like just small example. This is a very privileged example. But I was at Nordstrom, they have a big sale this time of year. They gave us a coupon that was for like one drink. Per person, but it was worth up to $10. And I was like, $10, that's pretty generous for like one drink. Because what I what was I thinking is how much like a coffee drink. This is not not alcoholic beverages, right? It's like coffee, tea, juice. And I was like, that's so nice. Like that's a very generous allotment. And then when I went to go see to get to get my free drink, I was like, ~ because like even an iced tea is seven dollars now. An iced tea. That used to be like $3, not that long ago. ~ because it's it's water in a tea bag. Mm. Like, what are we doing? ~ anyway, I was like, I see. So that is actually how much a drink costs now is like this $10. That's why they did $10, not because they're trying to be extra nice. Anyway, my point is we are living in reality where we go to the grocery store and we see how much things cost. Like I had to buy craft singles, which are not like cheese really, but I had to buy them for my dog to give him his medications. And it was like $7 for a 16-slice pack of craft singles that again aren't even cheese. ~ so we're seeing these prices, we're we're filling up our tanks with gas. We are seeing how expensive everything is. Our salaries are not keeping up with the increase in prices. Yet every time they tune in to this, you know, something that he says, he's talking about how everything's great. Everything's great, prices are down, everyone's thriving.~ and I d I genuinely don't know how they process that that difference, that discrepancy. I don't know. But ~ all I know is we could have had healthcare, but instead we got a war with Iran and explosive diarrhea. Mm-hmm. And the screw worm. Don't forget the screw worm in Texas.~ and we already talked about the screw worm, one of our other most disgusting episodes, the freaking New World Screwworm screw worm.~ anyway, so listen, That's great. we ~ I believe in in healthcare for all people. I believe that healthcare is a human right. Yeah. I do not believe that anyone should have to make a choice about whether or not they can eat or whether their children or themselves can go get regular just regular health care.~ this is absolutely Unacceptable. We deserve better. We gotta vote all these jackasses out of office and get what we deserve. Mm-hmm. Get these corporations under control. Health care for all. Medicare for all. Give it to me. Absolutely. I mean again, I think that's also actually honestly like a moderate position that everyone should have.~ yes, I don't think that we're asking that much. The fact that we still have to beg for the most basic things in this country Mm-hmm. The greatest country in the world, and yet people are like, Melissa. I would love to be the greatest country in the world, but I don't it ain't it ain't this one. All right. All right. It is sure it's not as of today. Arghavan, real quick. Let let's we we've decided there's so many stories we never get to talk about. We are gonna do like rapid fire. Mm-hmm. We're gonna try that. Rapid fire. Rapid. Yeah. Give me, ~ give me two sentences on Nolan Wells. Okay, Nolan Well Wells was 18 years old. That's already one sentence. Nolan Wells practicing. We're practicing, it's fine. Nolan Wells ~ went to an island on July 4th with some friends. They were boating. The boat and the friends came back. The friends notably were all white. Nolan was black. The friends all made it back home. Nolan Wells did not. And his body was found on that island a couple of days There is And they did not report anything, right? It wasn't until like 11 p.m. that night they called his mom. We've gotten some more information since this first happened. So they called his mom. She had to track.~ I should have mentioned they had his phone. So they left their version of the story that he wanted to stay on the island and they needed to come back with their boat, but they had his phone. Why anyone would have stayed on an island without their phone, without any way to communicate with anyone, doesn't make sense. And supposedly he was staying back to talk to a girl. Again, wouldn't he want her number? Wouldn't he want to text her to make sure he had the right number? Whatever. It none of it makes sense. Also he's on an island. So anyway, she tracked it kind of does sound like that. So it kinda sounds like murder. And and so her the mom, Nolan's mom, Christine Onesley was only able to find the phone because she tracked it. The friends did not admit that they had the phone. And she tracked it and had to send someone to that person's house who then denied that they had it. And she and they're like, it's here.~ and then they eventually found it. And there were questions about whether they had deleted things off of Snapchat, where Nolan typically posted quite a lot and there was nothing. And she found that his mom found that very suspicious that there would be nothing on his Snap from the entire day when he had been out having fun.~ anyway, the reason that we are tracking this story and talking about the story briefly, although more than two sentences, is that this is part of. Nolan's story is part of an ongoing, I don't even know what to call it, like epidemic of young black people disappearing or being murdered. Mm. We've seen multiple young black people hung in trees ~ in New York and in the South, and they're being called suicides.~ they're yeah. There's a lot more there, obviously, but for a rapid version of this, there is there are a lot of black people being harmed by the people around them, people in their lives, people in the streets. We don't really know. And they're not getting much media attention. Like everyone probably has heard of Gabby Petito, one white woman who disappeared, had been killed by her partner. I would guess that a lot of people haven't even heard of Nolan Wells. And so ~ is there an independent investigation going on? Do we do we trust what's happening? Yeah, so so his family Cause I know that we we wanted to talk about this last week, but we felt that there wasn't enough information and that's why we were like, well, we should at least say something. Yeah. ~ his family has hired Ben Crump, who is an attorney who often helps out with issues involving civil rights disparately impacting black people.~ and they've called for an independent investigation. They have ~ Tyler Perry and Colin Kaepernick sub are supporting them and had paid for an independent autopsy.~ so that is in the works. I had not seen the outcome of that yet.~ Okay. as of today. But his family are so impressive in how vocal they have been. I mean, they've been on ~ I don't remember if it was the Today Show or the Good Morning America, you know, like national television saying, Hey, what happened to our son is not okay. And we need to figure out what the story is here.~ and they This is not a new issue of like how black families do not get the attention that they deserve or e anywhere near the amount of attention that a white person gets. Mm-hmm. Mm-hmm. And yet we continue to see this persistence ~ in in the mainstream media as unacceptable. ~ Yeah. So that's as much as we have time for today on that, Yeah. but we'll be keeping an eye on on Nolan's story and hoping that his family gets information that helps them understand what happened in that in those last hours of his life. My heart goes out to his family.~ okay. CDC director Dr. Absolutely. Schwartz, Eric Dr. Erica Schwartz. Yeah. Doc. Yes. So Dr. Schwartz had her hearing yesterday ~ with the Senate and was asked a lot of questions. My takeaway from this is yeah, So cringe. it was terrible. It was terrible. But just a real quick background, she is an MD. she also has a JD and she also has a master's in public health. She ~ has served in the US public health services for a long time.~ so it in many ways. seems on paper a better candidate than the last one that we had talked about.~ however, in this hearing, she really was given a lot of easy wins that she sidestepped, like just saying I mean she was supposedly she was supposedly put forward as like an easy to confirm candidate. She was like qualified, she's an actual doctor. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. And yet, ~ when she was asked about vaccines, for example, she she could not forthrightly say that she will stand by the evidence that vaccines are effective, no matter what RFK Jr. or the president or anyone else says. She she could not say that. She did say she would stand by the science, but then wouldn't connect those dots. She Acted as though she had never heard of multiple things that have gone on. So ~ the previous CDC director had stepped down when RFK Jr. had asked her basically to make unscientific recommendations. And so mm-hmm. And so when they asked Dr. Yeah, Doctor Monterez. Schwartz, like, what would she do if she were put in this position where she was asked to say something that was inaccurate, she said, Well, I don't think that they would do that. Like they being RFK Jr. are the president. And well, first she said Well, she sp and she specifically said that she was like, I don't believe the president would ever ask me to lie. He's like, What planet are you on, lady? Yeah, well, and first she said, that's a hypothetical. I'm not going address it. And the person who was asking the question was like, no, we have the emails. Do you need me to show you the emails? And then she said, no, they wouldn't do that. But they already they already did it. The the committee would not play. And what I will say is you and I are clearly more qualified to run the CDC than Dr. Schwartz based on the based on what we saw, because we have some moral compasses. embarrassing. It is embarrassing. And the but the other thing I would say, listen, to all of our listeners, all of you who have been with us as we share these you know, these stories of what are coming out of the federal government in terms of public health, you too are more qualified to run the CDC. Than Doctor Schwartz, you're welcome. Yeah, because she said she didn't know about that situation. She said she didn't know about the changes that had been made to the CDC's website, basically walking back the statements that previously existed, clearly stating that there was no link between vaccines and autism. Now there's like more skepticism around that on the official CDC website. She said she'd never seen that, wasn't aware of that change. ~ anyway, there were multiple things that literally anyone who's listened to our podcast would know about that she acted like she'd never heard about, had no idea about. And it is worth noting that she works for United Healthcare, everyone's favorite massive healthcare company, and made $850,000 in salary, at least there, not counting other benefits and perks and stocks and bonuses.~ What are we doing, man, working in academics? Yeah, I think we should like go to United Healthcare. Yeah, Again, the moral compass thing is gonna be a problem for us. yeah, that's that is the challenge. Anyway, so that that's the brief version of the story on on Dr. All right. Schwartz. do you want to talk about Hegset? Well, you know what I what I am worried about? I'm so well, really quickly, I just want to say, you know, one of the things I'm really worried about. So Bill Cassidy, like the man was losing his mind. Did you see him? He was like, Stop repeating these lies. And he was like banging his pencil on the, you know, on the podium. And, you know, he is he is he's a lame duck. He is not gonna be able to whatever the next jamoke is that they bring into to run for this role of in being in charge of the CDC, or if they just leave Jay Botaracharya to just continue to be like a ghost. direct fake director or whatever. Yeah.~ it also means that without having him on the committee, like, are they even gonna bother trying to put in somebody else? Are they gonna bother trying to put in somebody who might actually get confirmed? I'm not sure they're gonna bother. Anyway. Yeah, I don't know. And and I will just say that they asked her about the cyclosporiasis outbreak and she said she didn't know. It was unclear whether she didn't know about the outbreak or if she didn't know about the changes that we talked about to the pathogen monitoring, foodborne pathogen monitoring. And she also ~ said that she didn't know they asked her about the it's hard Does she know anything? to tell because they asked her about the mRNA funding, research funding. Like, you know, yeah, she didn't know what that was. hundreds of millions of dollars were invoked and she said she didn't know about that. Anyway. That's that's her story. Do you wanna tell us about ~ the testosterone and yeah? Anyway, Pete Heg. Listen, listen, Pete Heggsith, you know, the quote unquote director of war, because he doesn't want to be the director of defense, because you know, that's whatever. Anyway, he has ~ he has now put together ~ a requirement that anyone Girly. in the military who is over the age of 30 will be required to have testosterone testing done. And it can optionally be done if you're under 30. And then they're gonna offer hormone replacement, testosterone replacement therapy. So, ~ He's calling this part of military readiness. He's saying that, you know, HRT is what's gonna help people, you know, work at their peak performance in the military. Mm-hmm. And I find all of this so upsetting as, you know, we have talked a lot on this show about how this same government is just going in an all-out social war, if you will, against all trans people of all ages and trying to prevent trans from having access. To hormone replacement therapy that is evidence-based and that will support their Mm-hmm. w their resilience and well-being. But apparently we want to give out a lot of testosterone to a bunch of~ people in the military. And ~ you know, and then you have a bunch of women who are still struggling to get access to any sort of hormone replacement therapy despite experiencing debilitating symptoms of menopause. So, ~ you know, just one more dumbass thing that our government has decided to prioritize. Let's talk. My favorite was a photo of him struggling to do a a a pull-up and then the headline Pete Heg says mandates testosterone testing for the military. Yes, I do love it when the journalists troll. I do love it. ~ all right. Tell me about the OMB update. I loved it. Okay. Yeah. So we wanted to do a very quick update on we talked weeks ago about the proposed regulations for the Office of Management and Budget to change. drastically change how federal grants for research are administered. They wanted to put political appointees in charge of everything to be able to cancel grants at any time because they just don't like them anymore. They wanted to stop all foreign collaborations, not allow people to attend conferences, not allow people to pay for their research to be published, all sorts of terrible things that would really negatively impact science. And we had asked at that time that folks would submit a comment And as did I mean many people ask for folks to submit comments and almost 500,000 people did the comment period ended on July 13th, and it was a total of 496,775 comments that were submitted. So I just thought that was quite impressive and I I think well done to everybody for putting in those comments.~ so you found an analysis that said almost all of these comments were negative comments. ~ so it's not just, you know, a bunch of people who are J the Russell Vott's friends like being like, I love Russell Vott, I love fascism. You know, it was actually mostly people who care about science saying, please do not do this. So, you know, it will be interesting to see what the response will be. They do have an obligation to respond to the comments and to ~ you know, amend their plan in some way. I mean, theoretically, in a normally functioning government, anyway, that's what should be happening next. Anyway, that's it. All right, let's ~ let's do our prescriptions. Take two and call me in the morning. Arghavan, what do you prescribe to the people? Okay, I watched this week or last week, whenever. In recent days, Margot's Got Money Troubles, which is a a series on ~ Apple, it's so good. Apple TV. And it is so very good. So it's El Fanning, Michelle Pfeiffer, Greg Kinnear, ~ who plays who plays her dad? Nick Offerman. He's so very good. Nick Offerman is so good. Anyway. They're all amazing and the story is ~ you know, I you you inform me that it's based on a book. It's so unique and delightful. And Margot is a true hero in her own way. She's a young woman just trying to make it in this this terrible, terrible world. it does have a a little academics crossover. not a not a happy one, but there's an academics crossover there for people who work in academia. and anyway. It was recommended to me and it was an excellent recommendation. So I'm going to pass that recommendation on to our audience. yeah, how about you? Fabulous. Fabulous. ~ So I am very, very excited that ~ I have it's it's it feels kind of meta, right? Because like we talk about how we're gonna give a prescription for joy. And there is a healthcare doctor, her her handle's called ebony.bell and She says that she's providing a prescription for transphobia, and it's called Manya Biz, as in mind your own business. Yeah.~ and it's very funny. It's all set up to be. So it starts off with some creator who's transphobe for sure and saying something very offensive. And then this physician comes on in her in her white coat. She uses a giant pencil, which is also just funny. And it's a whole infomercial on how mine biz can really improve your sense Yeah. of well being because you'll be minding your own business. And I love it and I will make sure to put it in the show notes for the people. Yeah, I thought it was hilarious. And she does do it like, you know, are you having da-da-da-da-da? Maybe mine you've is right for you. You know? ~ with my new biz, you get Well and then she has and then she has well and she has somebody who comes on to be like a satisfied patient who's like, I used to really worry about other people's gender and now I just mind my own business. It's great with mind ya biz. Anyway, so good. I agree. It's very well done. Yeah. I just I happened upon it independently from you, but I agree it was it was very well done.~ Alright. Well I think that's it. Yeah, that's it for this week's episode. If you didn't like what you heard, this has been the Redman Group podcast. If you liked it, don't forget to subscribe to the present illness, leave us a review, and tell other folks to tune in as well. Follow us on TikTok, Instagram, and YouTube at the Present Illness, and you can stay on top of all of our TPI related news. We will be back next week with more headlines, hot takes and doom scrolling, hopefully wrapped in some laugh. Until then, agitate, hydrate, and take a nap. We'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Burgart, editing by Alyssa Burgart, social media by Arghavan Salles, original music by Joseph Uphoff Don't take medical advice from random people on a podcast. This show is for informational purposes. It's meant to be fun, and it is certainly not medical advice. Please take your Your medical questions to a qualified professional. This podcast is our hobby. It does not represent the opinion of our employers or anyone but ourselves.

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Alyssa Burgart, MD, MA

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Arghavan Salles, MD, PhD

Host