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We Are All Republicans, We Are All Federalists · I Believe

0:12
unknown: Dr.
0:12
SPEAKER_01: Nick Vanter Haydn had bone pain that he could not explain.
0:16
SPEAKER_01: He was 58, a physician in Maryland, a specialist ordered a$350 blood test for vitamin D deficiency.
0:22
SPEAKER_01: The test came back positive.
0:24
SPEAKER_01: The deficiency was severe enough that if left untreated, it would lead to osteoporosis.
0:28
SPEAKER_01: Vanter Haydn's insurer was Cygna.
0:31
SPEAKER_01: They refused to pay for the test.
0:33
SPEAKER_01: The corporate medical director who signed the denial letter said the test wasn't medically necessary.
0:38
SPEAKER_01: Vanter Haydn read the letter, looking for the clinical reasoning.
0:41
SPEAKER_01: There was none.
0:42
SPEAKER_01: Only generic language.
0:44
SPEAKER_01: A response from a machine.
0:45
SPEAKER_01: He filed an appeal.
0:47
SPEAKER_01: A second medical director upheld the denial.
0:49
SPEAKER_01: To reimburse Vanter Haydn for the test that had come back positive, Vanter Haydn would have to prove he had a vitamin D deficiency before the test had been done.
0:57
SPEAKER_01: He kept investigating.
0:59
SPEAKER_01: Cygna used a system that flagged mismatches between billing codes and acceptable diagnoses.
1:04
SPEAKER_01: It let the company's medical directors deny claims in batches without opening a patient's file.
1:09
SPEAKER_01: Internal documents later showed that the doctor who rejected Vanter Heyden's claim rejected roughly 60,000 claims in a single month.
1:17
SPEAKER_01: Over a two-month window, Cygna physicians denied more than 300,000 payment requests.
1:23
SPEAKER_01: The average review took 1.2 seconds.
1:25
SPEAKER_01: It took seven months and an external medical review to force the insurer to pay the$350.
1:31
SPEAKER_01: Two years passed.
1:33
SPEAKER_01: On December 4th, 2024, a man named Brian Thompson stepped out of a New York hotel and was shot dead on the sidewalk.
1:40
SPEAKER_01: He was the chief executive of United Healthcare.
1:43
SPEAKER_01: Shell casings left behind were inscribed with three words: deny, defend, depose.
1:50
SPEAKER_01: Across demographic lines, Americans began telling their own stories.
1:54
SPEAKER_01: Denials, delays, bankruptcies, deaths.
1:57
SPEAKER_01: The shooter had read the same files Dr.
1:59
SPEAKER_01: Vanter Haydn had.
2:00
SPEAKER_01: So it turned out, had millions of others.
2:02
SPEAKER_01: The event left to question America still cannot bring itself to ask out loud.
2:06
SPEAKER_01: What would it take to build a healthcare arrangement Americans can actually live with?
2:26
SPEAKER_06: Welcome to I Believe, where we talk about America.
2:30
SPEAKER_06: I'm Joel Douglas, and I believe in America.
2:33
SPEAKER_06: Thanks for joining me.
2:39
SPEAKER_03: Act 1.
2:41
SPEAKER_03: The Body.
2:44
SPEAKER_03: In Senterville, Ohio, Tim Anderson watched his wife die for three years.
2:50
SPEAKER_03: Doctors diagnosed Mary Anderson with a myotrophic lateral sclerosis.
2:55
SPEAKER_03: ALS destroys motor neurons one at a time.
2:59
SPEAKER_03: The body loses the ability to walk, then to swallow, then to speak, then to breathe.
3:06
SPEAKER_03: The mind stays.
3:07
SPEAKER_03: The patient is awake for all of it.
3:10
SPEAKER_03: By the end, Mary could no longer move her arms or her legs.
3:15
SPEAKER_03: She could no longer eat without help.
3:17
SPEAKER_03: Her voice was going.
3:19
SPEAKER_03: Her physicians prescribed equipment to help her breathe and to help her speak.
3:25
SPEAKER_03: The Andersons were insured through United Healthcare.
3:29
SPEAKER_03: United Healthcare denied both claims.
3:32
SPEAKER_03: Tim Anderson appealed.
3:34
SPEAKER_03: The company denied the appeals.
3:36
SPEAKER_03: He appealed again.
3:38
SPEAKER_03: The denials continued.
3:40
SPEAKER_03: The medical necessity of the equipment was not in dispute among Mary's doctors.
3:45
SPEAKER_03: The diagnosis was not in dispute.
3:47
SPEAKER_03: The progression of the disease was not in dispute.
3:51
SPEAKER_03: The only substance in dispute was whether the insurer would pay.
3:55
SPEAKER_03: The Andersons could not get coverage for the machines that would have helped Mary breathe or speak.
4:01
SPEAKER_03: Toward the end, Mary communicated by blinking when Tim held up pictures.
4:07
SPEAKER_03: The family relied on donations from a local ALS group to cover what their insurance had refused.
4:14
SPEAKER_03: She died in 2022.
4:16
SPEAKER_03: After the shooting on the sidewalk in New York, Tim Anderson spoke to a reporter.
4:22
SPEAKER_03: He said this the business model for insurance is don't pay.
4:27
SPEAKER_03: When Mary could still talk, she said to me to keep fighting this.
4:30
SPEAKER_03: It needs to be exposed.
4:33
SPEAKER_03: The Andersons live in Red, rural Ohio.
4:36
SPEAKER_03: Tim Anderson is 67.
4:39
SPEAKER_03: He worked his whole adult life, paid his premiums, raised his family.
4:44
SPEAKER_03: He didn't enter the healthcare debate through ideology.
4:48
SPEAKER_03: His wife's battle brought him into it anyway.
5:00
SPEAKER_01: Seaborn was 54.
5:02
SPEAKER_01: He had been trained as a chemical engineer and had spent years in corporate work before leaving to do what he loved.
5:08
SPEAKER_01: The shop was small.
5:09
SPEAKER_01: The private insurance market for a small business owner in rural Georgia was punishing.
5:14
SPEAKER_01: For himself and his son, the premiums were close to impossible.
5:18
SPEAKER_01: In 2023, Georgia's Republican governor Brian Kemp launched a program called Pathways to Coverage.
5:24
SPEAKER_01: It was a Medicaid waiver with a work requirement.
5:27
SPEAKER_01: Eligible Georgians could enroll if they could prove they were working, studying, or volunteering at least 80 hours a month.
5:34
SPEAKER_01: The program was designed as a conservative answer to Medicaid expansion.
5:38
SPEAKER_01: It tied coverage to personal responsibility.
5:41
SPEAKER_01: Seaborne enrolled.
5:43
SPEAKER_01: He believed in what the program said it was.
5:45
SPEAKER_01: He was grateful for the coverage.
5:47
SPEAKER_01: When the governor's office asked him to film a promotional video, he agreed.
5:51
SPEAKER_01: He stood in his shop, surrounded by vintage Fords, and praised pathways as a blessing.
5:56
SPEAKER_01: The governor used the footage to argue that work requirements foster independence.
6:01
SPEAKER_01: Then the program began to fail him.
6:03
SPEAKER_01: Seaborne logged his 80 hours every month as required.
6:06
SPEAKER_01: In November, the state canceled his coverage.
6:09
SPEAKER_01: The state had quietly introduced a new form.
6:11
SPEAKER_01: It required enrollees to periodically re-enroll by re-entering the same information in a different format.
6:18
SPEAKER_01: Only an insurance executive Seaborne had met during the promotional shoot could restore his benefits.
6:22
SPEAKER_01: He had to call her directly.
6:24
SPEAKER_01: A few months later, a software glitch stopped his text alerts.
6:28
SPEAKER_01: He logged into the portal in March and discovered his coverage was set to terminate on April 1st.
6:33
SPEAKER_01: The state said he had missed an annual income statement, his policy was not yet due for renewal, he could not reach a caseworker by phone, he paid out of pocket for his family's medications while he tried to fix it.
6:43
SPEAKER_01: The Pathways program had cost Georgia taxpayers more than$86 million by then.
6:49
SPEAKER_01: More than 50 million had gone to Deloitte consulting to build the portal.
6:53
SPEAKER_01: The program had enrolled barely 3% of those eligible.
6:56
SPEAKER_01: Seaborne said this to a reporter.
7:14
SPEAKER_03: United Healthcare denied Mary Anderson's breathing machine.
7:22
SPEAKER_03: One was private corporate denial.
7:24
SPEAKER_03: One was public administrative failure.
7:27
SPEAKER_03: They are the same failure.
7:29
SPEAKER_03: In both cases, a working American did what the system asked, paid the premiums, filed the forms, logged the hours, played by the rules of the arrangement.
7:40
SPEAKER_03: In both cases, the arrangement failed to honor its own terms.
7:44
SPEAKER_03: The diagnosis, the mechanism, the grief.
7:48
SPEAKER_03: These are not partisan.
7:50
SPEAKER_03: The conservative rancher's widow and the conservative small business owner are not the only Americans this happens to.
7:58
SPEAKER_03: The diagnosis runs the country.
8:04
SPEAKER_03: It is a machine.
8:12
SPEAKER_00: Act two.
8:17
SPEAKER_00: In Holly Springs, Mississippi, Dr.
8:19
SPEAKER_00: Kenneth Williams runs the only hospital within 25 miles.
8:24
SPEAKER_00: Williams is a family physician and the chief executive of Alliance Healthcare System.
8:29
SPEAKER_00: Holly Springs is in Marshall County.
8:32
SPEAKER_00: Marshall County has about 38,000 people.
8:35
SPEAKER_00: The next closest hospital is a long drive.
8:38
SPEAKER_00: Williams has been there since 1999.
8:41
SPEAKER_00: 60 to 65% of his patients are on Medicare.
8:45
SPEAKER_00: When Medicare Advantage came into the program in 2006, the math of running his hospital changed.
8:52
SPEAKER_00: For five years before that, Alliance had been profitable.
8:56
SPEAKER_00: After Medicare Advantage took hold, the hospital lost almost$2 million in a single year.
9:02
SPEAKER_00: Denials came in patterns Williams had not seen before.
9:06
SPEAKER_00: Insurers rejected treatments his physicians ordered.
9:09
SPEAKER_00: Insurers a thousand miles away shortened stays his physicians said were necessary.
9:15
SPEAKER_00: The denials killed a geriatric psychiatry program Alliance had built to serve the county's elderly.
9:22
SPEAKER_00: The hospital had to close it.
9:24
SPEAKER_00: Williams was blunt about the system and the insurers.
9:28
SPEAKER_00: I knew that our hospital couldn't exist under the payment system it is under right now, he said.
9:34
SPEAKER_00: About the insurers, he went further.
9:37
SPEAKER_00: They don't want to reimburse for anything.
9:39
SPEAKER_00: Deny, deny, deny that they are taking over Medicare and they are taking advantage of elderly patients.
9:48
SPEAKER_00: The hospital had already ended inpatient care in March 2023.
9:53
SPEAKER_00: Then they had to close the only emergency room in Marshall County in April 2024.
9:59
SPEAKER_00: Williams kept what he could at the outpatient services, the clinic, the lab, the architecture had dismantled the rest of his hospital floor by floor.
10:10
SPEAKER_00: When a reporter asked him who suffered from the closures, he answered in two words, My patients.
10:17
SPEAKER_00: Williams does not know Dr.
10:19
SPEAKER_00: Nick Vanterheyden.
10:21
SPEAKER_00: He has never read the Pro Publisher investigation of Cygna's algorithm.
10:25
SPEAKER_00: He has not seen the internal documents showing what 1.2 seconds per claim looks like on a corporate scorecard.
10:32
SPEAKER_00: He does not need to.
10:34
SPEAKER_00: He has watched the same gears grind his county for more than 20 years.
10:38
SPEAKER_00: He watched it kill a psychiatry program for elderly people in rural Mississippi.
10:44
SPEAKER_00: He watched it nearly kill the hospital itself.
10:47
SPEAKER_00: The Maryland physician saw the algorithm.
10:50
SPEAKER_00: The Mississippi physician saw the cemetery.
10:55
SPEAKER_02: This is the architecture America built.
10:58
SPEAKER_02: Whether by design or by negligence, we built it.
11:01
SPEAKER_02: A patient gets sick, a doctor orders a test or a treatment or a piece of equipment.
11:06
SPEAKER_02: A system designed to find reasons not to pay reviews the order.
11:10
SPEAKER_02: A doctor does not.
11:12
SPEAKER_02: The reviewing doctor, if there is one, does not open the file.
11:17
SPEAKER_02: The system issues the denial.
11:19
SPEAKER_02: A second reviewer hears the appeal and upholds the first.
11:24
SPEAKER_02: The patient appeals again.
11:26
SPEAKER_02: If the patient has the time and the literacy and the energy, most do not.
11:32
SPEAKER_02: The question this architecture raises is older than the architecture itself.
11:37
SPEAKER_02: Who decides?
11:38
SPEAKER_02: Who has the authority to decide what shall be done with a human body?
11:43
SPEAKER_02: The person whose body it is, the doctor she has chosen to examine her, or a corporate medical director who has never met her and will not open her file.
11:53
SPEAKER_02: The American tradition has an answer.
11:55
SPEAKER_02: The patient and her physician.
11:58
SPEAKER_02: The body is the first property a person owns, and the right to decide what happens to it is the foundation of the right of liberty.
12:06
SPEAKER_02: No one has the authority to override that judgment.
12:09
SPEAKER_02: Not the state, not a corporation, not an actuary.
12:14
SPEAKER_02: The arrangement America built does this routinely.
12:17
SPEAKER_02: It is our business model.
12:19
SPEAKER_02: The question of who decides is only half of the moral architecture.
12:24
SPEAKER_02: The other half is older than the Republic.
12:27
SPEAKER_02: The race is not to the swift, nor the battle to the strong, nor bread to the wise.
12:32
SPEAKER_02: Time and chance happened to us all.
12:35
SPEAKER_02: Mary Anderson did not choose ALS.
12:38
SPEAKER_02: The patients in Marshall County did not choose to be born into a county that lost the only mental health service it had.
12:45
SPEAKER_02: Time and chance fell on them.
12:47
SPEAKER_02: Inside a system we built as if we believed time and chance did not exist.
12:52
SPEAKER_02: A healthcare arrangement worthy of the American tradition has to do two things at once.
12:58
SPEAKER_02: It has to preserve the liberty of the patient and the physician.
13:02
SPEAKER_02: And it has to provide a floor against the cruel net.
13:06
SPEAKER_02: The arrangement America built fails at both.
13:10
SPEAKER_02: It overrides patient and physician judgment through automatic denial, and it leaves people bankrupt when the net falls anyway.
13:18
SPEAKER_02: It violates liberty without providing security.
13:22
SPEAKER_02: It manages neither responsibility nor mercy.
13:25
SPEAKER_02: The country has lived with this long enough to recognize what it is doing.
13:30
SPEAKER_02: Tim Anderson knew when United Healthcare denied his wife's breathing machine.
13:35
SPEAKER_02: Luke Seaborne knew when Georgia's Portal canceled his coverage.
13:39
SPEAKER_02: Williams is known since 2006.
13:42
SPEAKER_02: Vanter Hayden since 2021.
13:45
SPEAKER_02: This isn't partisan.
13:47
SPEAKER_02: The architecture is the disease.
13:49
SPEAKER_02: The tougher question is, what do we do about it?
13:59
SPEAKER_01: Act three?
14:00
SPEAKER_01: The long walls?
14:03
SPEAKER_01: In Big Sandy, Montana, Shane Chauvet was working his ranch when a windstorm came up.
14:08
SPEAKER_01: Big Sandy sits on the high prairie just north of the Missouri breaks.
14:12
SPEAKER_01: 800 people, one hospital, 25 beds.
14:16
SPEAKER_01: The Big Sandy Medical Center is what the federal government calls a critical access facility.
14:21
SPEAKER_01: For the ranchers and farmers of that part of Shuto County, it is what stands between a bad day and a fatal one.
14:27
SPEAKER_01: The wind that afternoon was strong enough to tear pieces of metal off the outbuildings.
14:31
SPEAKER_01: A sheet of it caught Chauvet as it flew.
14:33
SPEAKER_01: The cut nearly took his arm off.
14:35
SPEAKER_01: His wife loaded him into a truck.
14:36
SPEAKER_01: They drove to the hospital.
14:38
SPEAKER_01: They found the emergency room doors locked.
14:40
SPEAKER_01: The wind had knocked out the power across the county, and the staff had moved to a side entrance to run the building on generators.
14:47
SPEAKER_01: Chauvet's wife pounded on the doors while his blood pooled on the ground.
14:51
SPEAKER_01: Someone heard her.
14:52
SPEAKER_01: The medical staff at Big Sandy stabilized the arm.
14:55
SPEAKER_01: Then they put Chauvet in a ground ambulance and drove him 80 miles through rain and hail.
15:01
SPEAKER_01: Chauvet credits the hospital with saving his arm and his life.
15:05
SPEAKER_01: He told a reporter what he had learned.
15:08
SPEAKER_01: I always would say, oh, they're nice to have, but now I look at the hospital and say, that's essential to our community.
15:17
SPEAKER_01: The Big Sandy Medical Center may not be there in five years.
15:20
SPEAKER_01: Since 2010, nearly 100 rural hospitals across the United States have closed.
15:26
SPEAKER_01: The reasons are not mysterious.
15:28
SPEAKER_01: Medicare Advantage and commercial insurers pay below the cost of providing care.
15:32
SPEAKER_01: The denials grind the margins to nothing.
15:35
SPEAKER_01: The closures begin with inpatient services, then the emergency room, then the doors.
15:40
SPEAKER_01: Marshall County, Mississippi, lived through this with Dr.
15:44
SPEAKER_01: Williams Hospital between 2023 and 2024.
15:48
SPEAKER_01: Chuteau County, Montana, is one storm away from watching it happen to its own.
15:54
SPEAKER_01: When the cruel nut falls on a working American in rural America, the architecture that catches him is fragile.
16:00
SPEAKER_01: The system that overrides his physician's judgment when he is sick is the same system that dismantles the hospital that will keep him alive when the wind picks up.
16:10
SPEAKER_03: The architecture that is the disease is not in question.
16:14
SPEAKER_03: The country has known what its healthcare arrangement is doing for years.
16:18
SPEAKER_03: The tougher question is, what do we do about it?
16:21
SPEAKER_03: A national single-payer healthcare system makes sense.
16:25
SPEAKER_03: Lower administrative cost, universal coverage, the bargaining leverage to discipline farmer and provider pricing, and the elimination of bureaucratic violence.
16:35
SPEAKER_03: There's nothing radical about people having health care, jobs and education.
16:41
SPEAKER_03: We find money for what we prioritize.
16:44
SPEAKER_03: An America that wanted to make this transition could do it.
16:48
SPEAKER_03: And it will fail catastrophically if one party passes it 51 to 49, because half the country will spend the next 40 years trying to dismantle it, and the instability of that fight will produce worse outcomes than the broken system it replaced.
17:04
SPEAKER_03: In May 2026, a prominent progressive leader, vying for a presidential run, describes single-payer health care in a single word.
17:14
SPEAKER_03: Forever.
17:16
SPEAKER_03: Presidents, senators, and elected officials come and go.
17:21
SPEAKER_03: Single-payer health care would outlast them all.
17:25
SPEAKER_03: This is the language of division.
17:28
SPEAKER_03: One tribe passes structural reform over the other and locks it in beyond the reach of reversal.
17:34
SPEAKER_03: And it is exactly the move that guarantees the reform's failure.
17:39
SPEAKER_03: The Affordable Care Act is the proof.
17:42
SPEAKER_03: It passed in 2010 on a party-line vote.
17:46
SPEAKER_03: Every Republican administration since has worked to dismantle it.
17:51
SPEAKER_03: Every Democratic administration has worked to expand it.
17:55
SPEAKER_03: Sixteen years later, hospitals cannot plan.
18:00
SPEAKER_03: Patients cannot plan.
18:02
SPEAKER_03: The rules change with every election.
18:05
SPEAKER_03: The instability is its failure.
18:08
SPEAKER_03: Now imagine that fight scaled to the entire healthcare economy.
18:12
SPEAKER_03: Every two years, every four years, the question reopened.
18:17
SPEAKER_03: A country that cannot agree on how to administer an insurance subsidy cannot administer a national health care system passed by half of itself over the other half.
18:28
SPEAKER_03: The alternative is consensus.
18:30
SPEAKER_03: Medicare is the proof.
18:33
SPEAKER_03: It passed in 1965 with substantial Republican support.
18:37
SPEAKER_03: 70 House Republicans, 13 Senate Republicans.
18:42
SPEAKER_03: It has survived 60 years because both parties helped build it.
18:47
SPEAKER_03: Both parties campaign on protecting it.
18:51
SPEAKER_03: The durability of consent.
18:55
SPEAKER_06: Ancient Athens and its port lay four miles apart.
18:58
SPEAKER_06: The countryside between them belonged to no one in particular and to every army that crossed it.
19:03
SPEAKER_06: After the Persian Wars, during the half century, the Athenians later called the Pentecontia.
19:09
SPEAKER_06: The city built two parallel walls along the road to the sea.
19:13
SPEAKER_06: The walls connected the city to the port.
19:15
SPEAKER_06: They made the four miles between the city and the port indistinguishable from the city itself.
19:21
SPEAKER_06: An enemy could blockade the city, and grain could come in.
19:25
SPEAKER_06: Ships could be supplied.
19:28
SPEAKER_06: The city could not be starved out so long as the walls stood.
19:31
SPEAKER_06: The walls cost a generation of argument to build.
19:34
SPEAKER_06: Sparta opposed them.
19:36
SPEAKER_06: Athenian factions opposed them.
19:38
SPEAKER_06: The Athenians built them anyway because the men who remembered the Persian invasion understood that a city cut off from its port was already lost.
19:47
SPEAKER_06: They built a cross disagreement.
19:49
SPEAKER_06: They built because the alternative was a slow surrender to anyone who could control the road.
19:55
SPEAKER_06: The framers understood this.
19:56
SPEAKER_06: The constitution that we have was the product of a long summer of argument, compromise, and the deliberate construction of an architecture meant to require ongoing consent rather than one-time victory.
20:09
SPEAKER_06: We argue about Senate representation and the Electoral College, but the small states would not have joined the Union otherwise.
20:16
SPEAKER_06: The whole document is an exercise in building across difference.
20:19
SPEAKER_06: Healthcare in America has to be built the same way, or it cannot be built at all.
20:25
SPEAKER_06: The arrangement we build cannot belong to one tribe.
20:28
SPEAKER_06: The progressive who calls single payer forever, and the conservative who calls all collective provision socialism are both refusing the harder work, which is the work of building something that survives them.
20:40
SPEAKER_06: The Republic does not run on wishes and mandates, it runs on consent.
20:45
SPEAKER_06: In March 1801, after one of the bitterest elections in American history, Thomas Jefferson stood on the Capitol steps and addressed a country that had nearly broken under the strain of the contest he had just won.
20:59
SPEAKER_06: We are all Republicans, he said.
21:01
SPEAKER_06: We are all Federalists.
21:03
SPEAKER_06: He was telling the country that the legitimacy of the new arrangement required incorporating the people who had lost the election, not ruling over them.
21:11
SPEAKER_06: Healthcare reform of any kind demands the same consensus from a generation that has mostly forgotten how to gain it.
21:17
SPEAKER_06: The architecture is the disease.
21:20
SPEAKER_06: We built it.
21:20
SPEAKER_06: We can build something else.
21:22
SPEAKER_06: We will not do it as Republicans.
21:24
SPEAKER_06: We will not do it as Democrats.
21:26
SPEAKER_06: We will do it as Americans, for we will not do it at all.