The Dose

"Everybody who gets health care has been caught in the maw of our dysfunctional system, and I think there's an increasing demand to change it." The midterm elections are next week, and surveys show Americans remain deeply concerned about several health care issues as they head to the polls. In California, voters will consider a tax on billionaires that could help fund Medicaid in the state. In Idaho, Nevada, Virginia, and Missouri, ballot measures will decide whether those states will strengthen or roll back reproductive rights. On this episode of The Dose podcast, Dr. Joel Bervell talks with Julie Rovner, chief Washington correspondent for KFF Health News and former health policy correspondent for NPR, about what's at stake on November 3. With frustrations around health care fueling stump speeches but delivering few practical solutions, it's worth taking a look at what's actually on people's minds. "I think we are on the cusp of another major debate — the first one since the passage of the Affordable Care Act."

Dr. Elisabeth Potter was in the middle of operating on a patient with breast cancer when a nurse delivered an urgent message: UnitedHealthcare was on the line. She stepped outside the OR and took the call. It was the insurer asking why the patient, who was on the operating table, needed to stay overnight. "It felt like they had invaded a very sacred space where the priorities should be really clear, patient first always, and they were bringing these administrative questions into the moment." On The Dose podcast, Dr. Joel Bervell talks with Dr. Potter, a surgeon in Austin, Texas, about what years of fighting insurance companies, building her own surgery center, and walking the halls of Congress have taught her about how our health system actually works, and how we can change it. "Doctors should be able to spend more time being doctors," Potter says. "And patients should be able to spend less time fighting the system just to get well."

Eighty-five percent of all U.S. health care spending goes toward managing chronic diseases connected to poor diet and nutrition. Yet most doctors receive little to no meaningful training in nutrition. As a result, food and nutrition remain absent from doctor–patient conversations, with medications the default option for most ailments. On the new episode of The Dose podcast, Dr. Joel Bervell talks with Dr. Dariush Mozaffarian, director of the Food Is Medicine Institute at Tufts University, about why that gap exists, what it will take to close it, and what's presently working. Increasingly, doctors are beginning to prescribe produce or meals medically tailored to a patient's condition, with the cost covered by the patient's health plan. And a growing number of states are currently testing or planning to test food-as-medicine programs through Medicaid. Meanwhile, a third of U.S. medical schools have committed to meaningful nutrition education for doctors, something that would have been unthinkable a decade ago. "Food is the single biggest challenge and opportunity, not just in health care, but also in our economy and the environment," says Dr. Mozaffarian. "And it's all fixable."

The prospect of 900,000 New York City residents losing Medicaid coverage under H.R. 1, the tax and spending law passed by Republicans last year, amounts to "bureaucratic violence," says Dr. Alister Martin. In response, he's devised a plan that starts on the streets of Queens and builds out from there with strategically placed community health workers and people assisting with insurance enrollment. On the new episode of The Dose podcast, Dr. Joel Bervell talks with Dr. Martin, an emergency physician, former White House Fellow, and now health commissioner for 8.5 million New Yorkers. They discuss what a city can do when the federal safety net is pulled out from under its residents. "Having people be at the center of our response is critically important, because that's what's going to make a difference. You can only move at the speed of trust in public health."

Much of the AI used in health care today is tied up in helping the industry manage its revenue streams — think billing and coding assistance. But Dr. Toyin Ajayi knows there's more AI can do to help manage the health of patients. On the new episode of The Dose, Dr. Joel Bervell talks with Dr. Ajayi, a board-certified family physician and CEO of the primary care provider Cityblock Health, about the ways she is using AI to make meaningful differences in the health of the most underserved patients. Dr. Ajayi's data-driven, outcomes-based care model has already demonstrated reductions in emergency room visits and higher patient engagement — as well as lower overall costs. Now, she's using AI to scale it. "Technology, if done right, is one of the very few deflationary forces we can apply to health care costs right now." Cityblock Health

When people receive a medical diagnosis or experience a new symptom, the first thing many of us do is reach for our phone. If a doctor isn't available to provide an answer, someone else is. On The Dose podcast, host Dr. Joel Bervell talks with Dr. Mike Varshavski, a primary care physician with more than 30 million social media followers, about what it takes to fight health misinformation at scale, what health institutions still get wrong about social media, and why entertainment and education aren't opposites. Doctor Mike, as he's known, didn't set out to become a popular online figure. He says he was driven to act as he watched misinformation fill a space that medicine was too cautious to engage with. "We trust you to cut people open, to prescribe all these medicines that have potential side effects — but we don't trust you to make a video on the subject you're an expert on," he says, describing the double standard physicians face online. Show Notes: The Checkup with Doctor Mike

Dr. Kaytura Felix didn't set out to document the Black maternal health crisis. She set out to find the people who are already doing something about it. On this episode of The Dose podcast, Dr. Joel Bervell talks with Felix, founder of the Black Birthing Futures project, about what she discovered: a constellation of Black community midwives providing "deep care" — clinical, emotional, social, and spiritual support centered on care of the birthing family. "The family is the sun and all the providers are orbiting them," says Felix. But keeping the family at the center isn't easy. Felix shares what stands between deep care and the families who need it most.

Four in 10 Americans have medical debt. Most don't know there's a federal law that could eliminate it. On this episode of The Dose podcast, host Joel Bervell talks with Jared Walker about his nonprofit, Dollar For, which has helped Americans erase more than $100 million in medical debt by connecting them to the charity care programs that hospitals are legally required to offer but rarely publicize. "These hospitals are great. They're saving people's lives every single day," says Walker. "The problem is that they're also ruining people's financial lives." With Medicaid cuts on the horizon and health care costs continuing to rise, Walker explains how Dollar For's free screening tool works, why some states are doing a better job of protecting patients than others, and what it will take to make hospitals do what the law already requires.

Seventy billion dollars is flowing into health care AI, but the people building it and the patients who need it most are rarely in the same room. On this episode, host Dr. Joel Bervell talks with pediatrician, researcher, and tech optimist Dr. Ivor Horn about what responsible AI innovation in health care requires. Drawing on her work building open-access datasets and equity frameworks for machine learning, Horn says that rigorous research, community partnership, and critical thinking are not obstacles to the work of building powerful tools — they are the work. "If you build for the most vulnerable patients," Horn says, "you will build a better product for everyone."

Uterine fibroids may affect up to 80 percent of women in their lifetime, but they remain under-researched, underfunded, and routinely dismissed. Lupita Nyong'o is working to change that. "I could not believe that women were partially or wholly losing their reproductive organs because of this noncancerous tumor situation." On this episode, Dr. Joel Bervell talks with Academy Award–winning actor and activist Lupita Nyong'o about her own diagnosis, and her decision to share an MRI of her body while launching the Make Fibroids Count campaign with the Foundation for Women's Health. "I realized without research we can't get any further," Nyong'o says. "We need to understand more in order to be able to equip the doctors who can then equip the patients." Show Notes: Lupita Nyong'o Make Fibroids Count (through the Foundation for Women's Health) The White Dress Project The Fibroid Foundation