Latest / Becker’s Healthcare Podcast / Closing the Healthcare Affordability Gap From the Front Lines with Joseph Pollino, PA-C

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Closing the Healthcare Affordability Gap From the Front Lines with Joseph Pollino, PA-C · Becker’s Healthcare Podcast

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  Every year, Becker's annual meeting brings health care
• 0:04
  leaders together to unpack the most pressing issues
• 0:06
  facing the industry.
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  And every year, those conversations shift in profound
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  and unexpected ways.
• 0:12
  This April, more than 3,500
• 0:15
  healthcare executives will return to Chicago
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  for Becker's sixteenth annual meeting.
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  Seven ninety five elite speakers will offer new
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  lessons, new case studies, and predictions about what
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  comes next.
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  Join us April 13 through the sixteenth.
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  For the agenda and event details, visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
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  This is Scott Becker with the Becker's Healthcare
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  Podcast.
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  I'm thrilled today to visit with a brilliant
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  leader who's both an advocate, a physician assistant,
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  an observer with the health care system, and
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  a journalist.
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  We're joined today by Joseph Pulino.
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  Joseph, can you take a moment and introduce
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  yourself and tell us a little about yourself
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  and your career?
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  Then we're gonna talk about something you write
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  about often, which is the affordability
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  gap in health care. Joseph, tell us a
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  little bit about yourself.
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  Hey, Scott. Thank you for having me. I
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  really appreciate,
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  the opportunity to talk to you and your
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  audience.
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  My name is Joseph Pollino. I'm a primary
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  care physician associate. I'm based in Northern Nevada.
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  I've been practicing medicine here in the Carson
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  Valley for about six years.
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  It's a great community,
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  a great clinic,
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  really,
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  great place to be.
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  Prior to PA school, I I had kind
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  of an interesting background. I was a deputy
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  coroner. I was an EMT firefighter
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  and an ER technician, and
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  I I kind of viewed it as the
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  trifecta
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  of acute care.
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  You know, I would go on the 911
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  call, and then I would sometimes take care
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  of those patients in the ER,
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  and then I would sometimes investigate their deaths,
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  shortly thereafter.
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  And I think through that experience, I really
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  saw firsthand
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  the cost of neglected and poorly managed health.
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  And so,
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  while in PA school, I I decided I
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  wanted to go into primary care. I thought
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  that was
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  the best avenue to really
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  help patients prevent and manage their chronic disease
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  so they can avoid the 911 call, avoid
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  the ER, and avoid a premature death,
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  and and really happy in that setting.
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  Thank you. And and talk for a second
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  about being a coroner. What was that like?
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  Was that what what is that like?
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  Well, you know, it was tragic.
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  I think a lot of a lot of
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  the times the cases we get as a
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  medical legal death investigator
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  is premature death.
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  And so you would see these people that
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  just
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  neglected care. They hadn't been to the doctor
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  in a long time,
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  for various reasons. And
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  I just
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  you know, my impression of a lot of
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  that experience was those deaths were
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  largely preventable. I mean, we we all do
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  pass at some point.
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  Right? But a lot of the cases I
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  was getting, that that was the case, and
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  and that's really what inspired me to to
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  get into primary care. And and I will
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  just say that I think of myself and
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  other primary care clinicians, we're we're kind of
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  the cannon fodder of the health care system.
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  Scott, we're we're in it. We're on the
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  front lines. We're in the trenches. We're really
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  getting the real pulse of what's happening with
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  patients.
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  We hear the raw stories, the struggles that
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  these folks are going through, And it's not
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  just
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  their own health. It's also navigating the health
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  care system.
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  So we have a unique lens, and
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  we as clinicians, you know, we're trained that
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  the biggest barriers to health are biological. It's
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  bacteria, viruses, genetics. But,
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  increasingly,
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  we're seeing that the barrier is financial.
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  And and and what could be done about
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  that? And and talk about this affordability
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  gap. I mean, just in broad strokes, health
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  insurance is now costing $2,530,000
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  a year per family.
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  Most people make a lot less than 80,000
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  a year, so we've got this horrendous affordability
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  gap. Talk a bit about the affordability gap
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  and what you mean by it when you
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  talk and write about it, and then talk
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  about what can be done about it. Yeah.
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  Well, you know, there's a lot of talk
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  in just in general right now about the
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  affordability crisis in the country,
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  but but I would argue that there's no
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  area where this crisis is more acute than
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  in the health care system. You know, patients
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  are really struggling out there. Premiums are going
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  up. Deductibles are going up. Out of pocket
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  maximums are going up. And and this is
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  the message I'm hearing day in and day
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  out from my patients. And, increasingly,
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  you know, me and and my fellow clinicians
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  were were acting as kind of financial counselors
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  to these people.
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  What I focused on in my LA Times,
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  piece that was recently published was really the
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  high deductible health care plans.
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  And, basically, these people, you know, they're insured,
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  but they're not covered. You know? They're paying
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  a a premium for a card that they
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  can put in their wallet that they're scared
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  to use.
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  And and that's what I'm seeing. I highlighted
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  a story in my article about a patient
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  of mine who came in with a cough
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  and some shortness of breath, and and he
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  wasn't,
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  acutely ill at that point, but I I
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  wanted to get a chest X-ray. But, you
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  know, to him, the chest X-ray was not
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  a necessary diagnostic test. It was a financial
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  shock that he couldn't absorb.
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  And and he told me, you know, I'm
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  gonna pass. He had a high deductible plan,
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  and he said he would call me if
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  he got worse. Well, he took a gamble
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  with his lungs, and and he ended up
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  in the ICU with pneumonia for several days.
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  And and I don't even know what that
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  bill is gonna cost him, but, you know,
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  it could bankrupt him. And,
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  sixty six percent of bankruptcies are tied to
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  medical bills, and I I hope that's you
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  know, I'm glad he made it. But, this
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  is a real problem, Scott. And and I
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  think as clinicians, we need to be advocates
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  for our patients and and highlight this problem.
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  Thank you. And talk about coverage, having coverage
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  at least by a card,
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  but not having access or being afraid to
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  access the access, the providers. Talk about that
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  challenge because that seems like a very real
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  challenge.
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  Yeah. Well, it's a challenge to the patients,
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  and it's a challenge to the providers. You
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  know, patients are coming in, and and they
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  have a high deduct deductible plan.
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  And they're they're just not wanting to
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  to do the the preventative
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  screenings, the cancer screenings, the routine labs. If
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  they come in with a problem,
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  they're they don't wanna do the workup, and
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  I don't blame them. You know? They just
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  see, you know, this,
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  enormous cost to this. And so it really
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  makes it challenging,
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  for them and for us. And
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  I think, you know, you ask, well, what
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  can be done about this? And I think
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  there's a couple different ways to look at
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  it. And the way I look at it
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  is I think there's three levels. There's policy,
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  there's system, and then there's the exam room
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  where I live.
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  I think from a policy level, obviously, the
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  big thing in the news is congress needs
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  to,
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  to extend the ACA,
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  premium tax credits.
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  You know, without that, and they've already expired,
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  so that's happened.
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  Premiums are have jumped a 114%
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  for marketplace enrollees,
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  and we're looking at millions of people that
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  are gonna lose lose coverage. But one thing,
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  Scott, that I think is lost in that
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  conversation that I tried to highlight in my
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  article
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  is millions more people are not just gonna
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  lose insurance, they're gonna downgrade to a a
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  bare bones bronze plan
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  that that really is just,
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  you know, bluntly, it it's garbage.
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  What was it? The Kaiser the KFF, basically,
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  they said that the average deductible now for
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  a a bronze plan is something like $7,500.
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  You know? And we gotta ask ourselves, what
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  kind of a country do we wanna live
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  in? You know? People are getting sicker. People
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  are getting,
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  unhealthy.
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  And and and is that is that the
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  kind of country we wanna live in? And
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  and my answer to that is is no.
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  And and how do we solve the issue
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  of just health care inflation in total and
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  lack lack of supply of providers, because this
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  seems to actually get into a lot of
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  the affordability as well, that we just don't
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  have enough doctors and nurses, physician assistants,
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  and then just the cost seems so inflated
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  every place. How do you solve any of
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  that? Any thoughts on it?
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  Well, I think that it's a it's a
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  complex
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  problem, but there are definitely
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  some, some things that legislators
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  can do,
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  to help with this problem. One one thing
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  in the news in regards to my profession
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  is,
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  Congress basically is proposing that they're not going
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  to
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  give, federal student loans over a $100,000
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  for for these graduate,
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  programs for PAs
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  and,
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  nurse practitioners, and I think that's a a
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  real disservice.
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  We need more providers. We need to incentivize,
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  young people in this field,
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  to wanna become providers. So,
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  look, at the end of the day, you
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  know, I'm a frontline PA. I'm a clinician.
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  I'm in the exam room. You know? The
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  congress needs to get their act together and
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  and and
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  get together and try to get some solutions
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  to this problem. But I'm basically out here
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  saying, this is a problem. My colleagues are
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  seeing it. I've had a lot of, fellow
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  clinicians reach out to me, and and they
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  say, you know, we're seeing the same thing
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  here.
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  And it's just unsustainable.
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  But I think that the more that we
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  speak up about this problem,
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  and the more clinicians that are speaking up
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  about this problem,
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  I I think it will go a long
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  way into,
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  enacting some real change here.
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  No. It seems like no question. Huge problems
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  in in trying to figure out how to
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  solve them is just incredibly
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  challenging.
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  Talk about as you look at 2026,
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  what are you most focused on and excited
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  about this year, Joseph?
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  Well, I'm I'm focused on amplifying these stories.
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  I think, like I said, as a frontline
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  clinician, we have a window into what's really
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  happening to American families that the policymakers and
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  executives may not always see.
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  And I think it's, our responsibility
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  as clinicians to be advocates for our patients,
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  both in the exam room and in the
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  national conversation. So I'm gonna keep doing that.
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  I'm gonna keep speaking out and advocating for
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  patients, whether it's writing,
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  podcasts like this, or, you know, building community
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  around these issues.
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  I'm really,
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  interested in watching what happens with the premium
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  tax credits. I understand,
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  you know, late last week,
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  there there is some talk that there may
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  be some type of a framework agreement,
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  and I really hope that that's true. So
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  looking forward to that. And, just personally, I'm
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  I'm excited to keep building my platform, the
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  frontline PA,
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  because I think clinicians have real, value,
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  in these policy debates. And at the end
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  of the day, we're not just stakeholders, we're
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  witnesses.
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  You know? We are seeing the human cost
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  of these policy choices,
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  and that perspective needs to be a part
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  of the conversation.
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  Couldn't agree more. Joseph, what a pleasure to
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  visit with you. What an impressive career. I
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  I wanna ask you one question. You spend
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  a lot of time just doing your day
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  job, but also advocating for the health care
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  system.
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  Talk about how that keeps you engaged and
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  interested and alive and and how positive it
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  is to have, like, both those things, not
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  just
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  not just doing your day job, but so
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  passionate about these issues too.
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  Well, I I I think it's part of
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  our responsibility,
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  Scott. I think, you know, the
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  type of people that
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  want to become clinicians,
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  you know, they we really care about our
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  patients. And and like I said, it's not
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  just my patients. It it's patients in general.
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  You know, I
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  I think about what kind of a country
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  I wanna live in, and and I think
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  about is it, Maslow's IRP of needs.
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  You know? You can't get to the top
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  of the pyramid in self actualization
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  and and really pursuing the greater things in
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  life
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  if you're sick, if you're worried about getting
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  your medicine.
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  And I wanna see people, you know, being
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  their best and innovating and driving the economy
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  and and a healthy society.
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  And, you know, people need they they need
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  to be taken care of. They need health
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  care. That's just a basic fundamental need, and,
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  I'm gonna do my part to try to
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  advocate for that.
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  Well, we we love that. We love what
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  you do, Joseph. Just fantastic.
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  Thank you for taking the time to join
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  us today on the Becker's Healthcare podcast. Again,
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  Joseph Paulina,
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  physician assistant,
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  works with the great health system, also writes
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  and advocates
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  on behalf of health care.
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  Just a fantastic your passion for what you
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  do and what you do. Thank you for
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  joining us today.
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  Scott, it's been a pleasure. Thank you for
• 13:21
  having me.