Category: Blogs

By KIM BELLARD You may have heard about the microbiome, that collection of microorganisms that fill the world around, and in, us. You may have had some digestive tract issues after a round of antibiotics wreaked havoc with your gut microbiome. You may have read about the rafts of research that are making it clearer that our health is directly impacted by what is going on with our microbiome. You may even take probiotics to try to encourage the health of your microbiome. But you probably don’t realize how interconnected our microbiomes are. Research published in Nature by Beghini, et. al., mapped microbiomes of almost 2,000 individuals in 18 scattered Honduras villages. “We found substantial evidence of microbiome sharing happening among people who are not family and who don’t live together, even after accounting for other factors like diet, water sources, and medications,” said co-lead author Francesco Beghini, a postdoctoral associate at the Yale Human Nature Lab. “In fact, microbiome sharing was the strongest predictor of people’s social relationships in the villages we studied, beyond characteristics like wealth, religion, or education.” “Think of how different social niches form at a place like Yale,” said co-lead author Jackson Pullman. “You have friend groups centered on things like theater, or crew, or being physics majors. Our study indicates that the people composing these groups may be connected in ways we never previously thought, even through their microbiomes.” “What’s so fascinating is that we’re so interconnected,” said Mr. Pullman. “Those connections go beyond the social level to the microbial level.” Study senior author Nicholas Christakis, who directs the Human Nature Lab, explained that the research “reflects the ongoing pursuit of an idea we articulated in 2007, namely, that phenomena like obesity might spread not only by social contagion, but also by biological contagion, perhaps via the ordinary bacteria that inhabit human guts.” Other conditions, such as hypertension or depression, may also be spread by social transmission of the microbiome. Professor Christakis thinks the findings are of broad importance, telling Science Alert: “We believe our findings are of generic relevance, not bound to the specific location we did this work, shedding light on how human social interactions shape the nature and impact of the microbes in our bodies.” But, he added: “The sharing of microbes per se is neither good nor bad, but the sharing of particular microbes in particular circumstances can indeed be good or bad.” This research reminded me of 2015 research by Meadow, et. al., that suggested our microbiome doesn’t just exist in our gut, inside other parts our body, and on our skin, but that, in fact, we’re surrounded by a “personal microbial cloud.” Remember the Peanuts character Pigpen, who walked around in his personal dirt cloud? Well, that’s each of us, only instead of dirt we’re surrounded by our microbial cloud–and those clouds are easily discernable from each other. Dr. Meadow told BBC at the time: “We expected that we would be able to detect the human microbiome in the air around a person, but we were surprised to find that we could identify most of the occupants just by sampling their microbial cloud.” Those researchers predicted: While indoors, we are constantly interacting with microbes other people have left behind on the chairs in which we sit, in dust we perturb, and on every surface we touch. These human-microbial interactions are in addition to the microbes our pets leave in our houses, those that blow off of tree leaves and soils, those in the food we eat and the water we drink. It is becoming increasingly clear that we have evolved with these complex microbial interactions, and that we may depend on them for our well-being (Rook, 2013). It is now apparent, given the results presented here, that the microbes we encounter include those actively emitted by other humans, including our families, coworkers, and perfect strangers. Dr. Beghini and colleagues would agree, and further suggest that it’s not only indoors where we’re sharing microbes. I would be remiss if I didn’t point out new research which found that our brains, far from being sterile, are host to a diverse microbiome and that impacts to it may lead to Alzheimer’s and other forms of dementia. Could we catch Alzheimer’s from someone else’s personal microbiome cloud? It’s possible. Could we prevent or even cure it by careful curation of the brain (or gut) microbiome? Again, possible. The truth is that, despite decades of understanding that we have a microbiome, we still have a very limited understanding of what a healthy microbiome is, what causes it to not be healthy, what problems arise for us when it isn’t healthy, or what we can do to bring it (and us) to more optimal health. We’re still struggling to understand where besides our gut it plays a crucial role. We now know that we can “share” parts of our microbiome with those around us, but not quite what the mechanisms for that are–e.g., touch, sharing objects, or having our personal clouds intersect. We feel like we are where scientists were two hundred years ago in the early stages of the germ theory of disease. They knew germs impacted health, they even could connect some specific germs with specific diseases, they even had rudimentary interventions based on it, but much remained to be discovered. That led to vaccines, antibiotics, and other pharmaceuticals, all of which gave us “modern medicine,” but failed to anticipate the importance of the microbiome on our health. Similarly, we’re justifiably proud of the progress we’ve made in terms of understanding our genetic structure and its impacts on our health, but fall far short of recognizing the vastly larger genetic footprint of the microbiome with which we co-exist. A few years ago I called for “quantum theory of health”–not literally, but incorporating and surpassing “modern medicine” in the way that quantum physics upended classical physics. That kind of revolution would recognize that there is no health for us without our microbiome,

“Never hold yourself back from trying something new just because you’re afraid you won’t be good enough. You’ll never get the opportunity to do your best work if you’re not willing to first do your worst and then let yourself learn and grow.” ~Lori Deschene “I’m sorry, what did you say?” I asked my mother for the third time during our lunch together. She sighed, put down her fork, and said something that still haunts me: “I’ve gotten used to competing with your phone for your attention.” I looked down at my phone, Instagram still glowing on the screen, and saw myself through her eyes: a twenty-nine-year-old man more invested in strangers’ lives than his own mother’s stories. I’m not alone in this struggle. Studies show the average person spends two and a half hours daily on social media, with 210 million people worldwide believed to suffer from social media addiction. But statistics didn’t matter to me until I saw how my own addiction was unraveling the fabric of my life. How My Freelance Dreams Almost Died in My Social Media Feed My freelance business was crumbling, one scroll at a time. What started as “just checking Twitter for networking” turned into a daily nightmare of missed deadlines and disappointed clients. One morning, I opened my inbox to find three separate messages from clients asking about overdue projects. Was it that I was overpromising or improperly managing my time? The truth was painful: I’d spent too much time consuming other freelancers’ “success stories” on LinkedIn, taking away from doing the work to create my own. My portfolio website sat untouched for months while I obsessed over others’ perfectly curated project showcases. A long-term client who’d promised to refer me to his network quietly stopped responding to my emails after I delivered their project a week late. Projects that should have taken three focused hours stretched into two distracted days, filled with anxiety and self-doubt. Facing the Real Person Behind the Screen After losing an important client for “not meeting expectations,” I was forced to face an uncomfortable truth: Social media wasn’t my problem—it was my symptom. I was using other freelancers’ highlight reels as a form of self-sabotage. Every “hustle harder” and “how I made $10,741 last month” post became an excuse to stay paralyzed in comparison mode. Rather than pitching new clients, I’d spend hours studying other freelancers’ portfolios. Instead of improving my skills, I’d scroll through Twitter threads promising “Ten secrets to six-figure freelancing.” The harder truth? My social media addiction was masking a deeper fear: the fear of actually putting myself out there and risking real failure. It was easier to live vicariously through others’ success stories than write my own. Every time I felt the anxiety of an approaching deadline or the uncertainty of reaching out to new clients, I’d reach for my phone. The temporary escape of scrolling had become my security blanket. My wake-up call came through numbers I couldn’t ignore: I had spent 458 hours on social media in the past three months—enough time to have completed a skills boot camp, started writing a book, or acquired several new professional certifications. Instead, I had nothing to show for those hours except an intimate knowledge of strangers’ business journeys. Building a New Foundation My initial changes were small but significant: I moved my phone to another room during work hours. I created a “fear list” documenting what I was really avoiding when I reached for social media. I set up website blockers during my designated deep work hours. I established a morning routine that began with action, not consumption. The most powerful change was implementing what I call the “Create Before Consume” rule: I wasn’t allowed to look at any social media until I’d created something of value that day—whether that was client work, improving my skills, or building my own business. Each time I felt the urge to check social media, I asked myself, “Am I using this as a tool, or am I using it as an escape?” The answer was uncomfortable but transformative. Nine times out of ten, I was avoiding something important—a challenging project, a difficult client conversation, or the nagging feeling that I wasn’t living up to my potential. The shift from passive consumer to active creator wasn’t just about productivity—it was about reclaiming my identity as a professional. Each focused hour became a small victory, each completed project a testament to what I could achieve when I stopped hiding behind my screen. The Thirty-Day Journey That Changed Everything I decided to change my relationship with social media rather than avoiding it. First, I had to rewire my brain to stop associating every free moment with reaching for my phone. Instead of mindlessly scrolling, I trained myself to pause and reflect on why I was opening an app in the first place. Was it out of boredom, habit, or genuine intention? Here’s what happened during my thirty-day detox. Week 1: The Withdrawal Was Physical I started keeping a journal of the moments I reached for my phone. One entry reads: “Reached for phone forty-seven times before noon. Feel empty, anxious. Why is sitting with my own thoughts so terrifying?” Week 2: Rediscovering Lost Connections I called my mother—actually called her, not just liked her Facebook posts. We talked for two hours. She told me stories about her childhood I’d never heard before. “This is the first real conversation we’ve had in years,” she said. Week 3: The Productivity Breakthrough After being unmotivated for a couple of weeks, I discovered I could complete work in three hours that previously took all day. My clients noticed the change. One of them even told me, “Great work! It’s clear whatever you’re doing is working—keep it up!” Hearing that feedback reaffirmed just how powerful it can be to take control of your digital habits. Week 4: Finding Real Joy in Self-Development The most profound change came when I replaced mindless scrolling with

By JEFF GOLDSMITH In late June, 2024, two economists, Zarek Brot-Goldberg and Zack Cooper, from the University of Chicago and Yale respectively, released an economic analysis arguing that hospital mergers damage local economies and result in an increase in deaths by suicide and drug overdoses in the markets where mergers occur. Funded by Arnold Ventures  their study characterizes these mergers as “rent seeking activities” by hospitals seeking to use their economic power to extort financial gains from their communities without providing any value.  The Brot-Goldberg-Cooper analysis was a spin-off of a larger study decrying the lack of federal anti-trust enforcement regarding hospital mergers. These two studies used the same economic model. The data were derived from the Healthcare Cost Institute, a repository of commercial insurance claims information from three of the four largest commercial health insurers, United Healthcare, Humana and Aetna (a subsidiary of struggling pharmacy giant CVS) plus Blue Cross/Blue Shield. HCCI’s contributors account for 28% of the commercial health insurance market. The authors use a complex econometric model to manipulate a huge, multifactorial data base comprising hospital merger activity, employer health benefits data, county level employment data and morbidity and mortality statistics. This data model enabled a raft of regression analyses attempting to ferret out “associations” between the various domains of these data. Using HCCI’s data, the authors construct what they termed a  “causal chain” leading from hospital mergers to community damage during their study period–2010 to 2015.  It looked like this: hospital mergers raise prices for private insurers-these prices are passed on to employers–who respond by laying off workers–some of whom end up killing themselves. So, according to the logic, hospital mergers kill people. Using the same methodology, the authors argued that between 2007 and 2014, hospital price increases of all sorts killed ten thousand people.  A classic problem with correlational studies of this kind is their failure to clarify the direction of causality of data elements.  The model lacked a control group–comparable communities that did not experience hospital mergers during this period–because the authors argued that mergers were so pervasive they could not locate comparable communities that did not experience them.     The model focused on a subset of 304 hospital mergers from 2010 to 2015, culled from a universe of 484 mergers nationally during the same period. The authors excluded mergers of hospitals that were further than fifty miles apart, as well as hospitals with low census. The effect of these assumptions was to exclude most rural hospitals and concentrate the mergers studied in metropolitan areas and cities. The densest cluster was in the I-95 corridor between Washington DC and Boston. See the map below: According to the model, these mergers resulted in an average increase of 1.2% in hospital prices to commercial insurers, 91% of which were passed to their employer customers in those markets. This minuscule rate increase had a curiously focused and outsized effect–a $10,584 increase in the median employer’s health spending in the merged hospitals’ market. According to the model, local employers “responded” to this cost increase by reducing their payrolls by a median amount of $17,900, all through layoffs–70% more than the alleged merger cost increase. This large overage was not explained by the authors. Moreover, the layoffs took place almost immediately, in the same year as the merger-induced increases, even though many health insurance contracts are multi-year affairs, and lock hospitals in to rates for that period. At the end of the “causal chain,” 1 in 140 laid off people in those communities for whatever reason killed themselves through suicide or drug overdoses. By extrapolation, the authors accuse the perpetrators of overall hospital rate increases of killing ten thousand people in the affected communities during seven years overlapping the study period.    Failing the Test of Real World Plausibility It is difficult to know where to begin to unravel this complex web of “associations”. The biggest puzzle is the magnification of impact of a 1.2% “shock”, as the authors term it, to health benefits cost on employers. To put this in in perspective, the 1.2% average price increase is against a health benefit that amounts to about 9%, on average,  of the sample employers’  total compensation costs.* So, 1.2% increase of a 9% cost is an exactly one tenth of 1% (.001) increase in employer’s total compensation expense. Payroll and benefits are in turn perhaps 50-70% of an employer’s total operating expense. A one-tenth of a percent increase in employment costs is a mosquito bite, not a “shock”. The authors’ inferred leap from this micro-increase in employer costs to widespread layoffs is indefensible compared to real world managerial behavior. The authors ruled out the most obvious cost response–cost-shifting to workers by raising their deductibles or copayments–on the grounds that they found no changes in Health Savings Account enrollment in the sample during the five year study period. After more than quadrupling from 2006 to 2011, growth in HSA enrollment levelled off during the last four years of the study period.  Yet employer cost shifting to workers by raising their out-of-pocket spending limits accelerated during the same period. According to Kaiser/HRET’s annual survey, from 2010 to 2015, the number of workers with deductibles and co-insurance more than $2,000 doubled. Thus, the effects of any commercial  health insurance rate increases, whatever their size, were likely shared broadly across the entire covered population in the merger-affected markets. Most employers facing economic challenges bend over backwards to avoid parting company with productive, experienced workers. And they have a wide range of options to avoid doing so: raising prices, cutting hourly workers’ hours, shifting workers from employees to contractors (dodging benefits expenses altogether), pressuring other suppliers for discounts, improving productivity, finding new customers, and “shrinkflation” in their product (e.g. a half-ounce smaller Almond Joy bar for the same price ). None of these responses were measured or controlled for in the model.  Meager Exercise of Market Power If an anti-competitive exercise of market power was the goal of the mergers, then an average 1.2% rate increase struck

“Create a safe space within yourself that no one will ever find, somewhere the madness of this world can never touch.” ~Christy Ann Martine Losing my grandmother was like losing the one person who had always been my anchor. She was my steady rock, my quiet cheerleader, and the only person who truly made me feel that I was perfectly fine, just as I was. I never had to pretend around her or hide my mistakes or messiness. She had this way of being present and calm, even when life around us wasn’t, and that gave me a sense of security that, looking back, I had leaned on more than I ever realized. Her gentle spirit taught me what unconditional love looked and felt like, and without fully realizing it, I relied on her presence to keep me grounded and to make sense of things when everything else felt uncertain. In my eulogy to her at her funeral, I called her “The Mary Poppins of Grandmas, practically perfect in every way.” And she was perfect in my eyes; she always will be. When she passed, I felt an incredible emptiness; upon receiving the news, I fell to the floor. I was alone, I couldn’t muster up the strength to lift myself from the floor, and I was crying so hard I started choking. I crawled to the bathroom, thinking I was going to throw up. I was leaning up against the bathtub, sobbing, when a strange sense of peace came over me. I started to calm down, and the song “Somewhere Over the Rainbow” popped into my head, creating an earworm repeatedly playing the song. I got up from the bathroom floor, grabbed my phone, and posted a video of the song on my social media profile. I found out later that day that that song was my grandma’s favorite. It felt like I’d lost not just her but a part of myself—something I had unknowingly depended on for so long. Her love was a mirror that allowed me to see my worth; I wasn’t sure how to recognize it without her. The grief of her loss was profound, but underneath that grief, I knew something else was stirring. I needed to find the consistency she had provided, but this time, it had to come from within. My journey toward healing began with the understanding that if I wanted to feel whole, I had to become that steady, loving presence for myself. For so long, I had looked to others for validation, believing that if I gave enough, worked hard, and stayed flexible, I’d finally receive the desperately desired acceptance. But when she was gone, something clicked—I realized no one else could fill that space in my life. It was up to me to find that security within. In the beginning, it felt like too much to take on. I faced layers of emotions and beliefs that had been there for as long as I could remember, and the thought of working through all of it was intimidating. I saw how often I had tied my sense of worth to what I could offer others, how I felt I needed to prove myself through giving, and how I had relied on external reassurance instead of my inner validation. I had learned to take on the role of the fixer, the supporter, and the giver, often without realizing that I had neglected to support and care for myself. With time, I began to understand that, like my grandmother, I needed to cultivate a constant, gentle presence within me that I could turn to, no matter what. I needed to become my safe place, someone I could rely on for kindness and encouragement. One of the first steps was creating rituals that mirrored the warmth and steadiness she had always provided me. I would sit quietly each morning, meditating on gratitude and journaling about my worth before I began my day. These small, intentional acts became a way to ground myself, check in, and create a sense of stability in my life. I wasn’t naturally good at setting boundaries—I would get an anxious feeling in my stomach when it came to saying no. I was always worried that if I said no, the other person would stop coming around, or I would hurt their feelings, and I would guilt myself. Eventually, I reached a point where I knew I had to change things. I was allowing myself to be taken advantage of repeatedly. It went into a pattern of me giving too much, then resenting the other person or people involved and not realizing that the problem was me. If I didn’t start respecting my limits, I’d have nothing left to give. Little by little, I practiced saying no without offering a reason or apologizing. It wasn’t easy. It felt foreign at first, like I was somehow selfish for doing it. But with each boundary, I began to feel a new sense of inner strength that I hadn’t felt before. It was like I was finally treating myself with the same kindness I tried to give everyone else. Learning to sit with my emotions instead of running from them was the most challenging part. I understood that grief wasn’t something you just “get over.” It’s something you learn to live with. I stopped pushing away the sadness and let myself fully feel it, allowing it to come and go without judgment. There were times when it felt overwhelming, but it was also healing. In those moments, I felt almost as if she was still with me, her presence comforting me as if saying, “It’s okay to feel this. It’s okay to let yourself grieve.” Through this, I began rediscovering parts of myself I had set aside. I allowed myself to get creative again, expressing things I’d bottled up without worrying about how it would come across. I started journaling daily, writing about my dreams, fears, and memories. These weren’t just words

By MIKE MAGEE As 2025 kicks off, it’s wise to pause, and gather our thoughts as a nation. Few would argue that we’ve been through a lot over the past decade. And quite naturally, we humans are prone to blame individuals rather than circumstances (most of which have been beyond our control) for creating an environment that feels as if it is unraveling before our eyes. How should we describe our condition – dynamic, tense, complex? Is peace, contentment, and security achievable in this still young nation? Have accelerationist technocrats, armed with bitcoins and Martian fantasy, short-circuited our moment in time that had been preserved for recovery from a deadly pandemic that eliminated a million of our fellow citizens seemingly overnight? Who do we turn to for answers, now that we’ve largely lost faith and trust in our politicians, our religious leaders, and our journalists? And how exactly do you create a healthy nation? Certainly not by taking doctors and nurses offline for miscarriages, and placing local bureaucrats in exam rooms. Are they prepared to deal with life and death decisions? Are they trained to process human fear and worry? Do they know how to instill hopefulness in parents who are literally “scared to death” because their child has just been diagnosed with cancer? It certainly must require more than a baseball cap with MAHA on it to heal this nation. Historians suggest this will take time. As Stanford Professor of Law, Lawrence M. Friedman, wrote in A History of American Law, “One hundred and sixty-nine years went by between Jamestown and the Declaration of Independence. The same length of time separates 1776 and the end of World War II.” During those very early years that preceded the formal declaration and formation of the United States as a nation, our various, then British colonies, fluidly and independent of each other, did their best first to survive, and then to organize into shared communities with codified laws and regulations. It was “a study of social development unfolding over time” impacted by emotions, politics and real-time economics. At the core of the struggle (as we saw with the pandemic, and now the vaccine controversy) was a clash between the rights of the individual and those of the collective community. This clash of values has been playing out in full view over the past five years of the Covid pandemic. In 2023, Washington Post columnist, Dr. Leana Wen, asked, “Whose rights are paramount? The individual who must give up freedoms, or those around them who want to lower infection risk?” This battle between “individual liberty and communal good” is ancient and current at the same time, and still a source of conflict wherever and whenever humans attempt some version of “nation building.” In our current case, it has been further complicated purposeful misinformation and misdirection on an industrial scale. In a world of “alternative facts,” who and what do you trust? Through the past five years, public trust in doctors and nurses have managed to maintain high levels of public trust. Literally, they have been “a bridge over troubled waters.” That is why it has been such a glaringly obvious public policy blunder to forcefully separate them from the women they care for in half of the states of this nation. By compromising the health of our women, we have compromised the health of our democracy. It is useful to recall that we humans on these shores have come a long way. From the beginning on the shores of Virginia in 1607, these early wild settlements were essentially lawless – that is without laws. They also were wildly different in their dates of entry and their range of issues. Consider that more than 100 years separated the beginnings of the Massachusetts Bay colony and the colony of Georgia. And as historian Lawrence  Friedman noted, “The legal needs of a small settlement run by clergyman clinging precariously to the coast of an unknown continent were fundamentally different from the needs of a bustling commercial state.” And yet, here we are together, doing our best to push back against a manmade culture war, ignited in Florida, and designed to halt our human progress, as we pursue policies that will not only widen the gap between rich and poor, but also reward billionaire technocrats with unimaginable deregulation that will almost certainly place our citizens health and safety at risk. In many ways, the struggle to act in a civil and wise manner, that mines common values, and finds a balance between individual freedom and wise collective rules and regulations, remains our hill to climb.  Not surprisingly, RFK Jr. finds himself under a microscope. His past pronouncements, replete with his own “alternative facts,” struggles with addiction, celebrity seeking, and mixing of good and bad ideas have placed him in a well-deserved hot seat. If trust is what we need, he may not be the best choice for MAHA. As a fact starter, check out The History of American Law. It “presents the achievements and failures of the American legal system in the context of America’s commercial and working world, family practices, and attitudes toward property, government, crime, and justice.” Medicine lives and breaths at these very same interfaces. How should we describe our condition – dynamic, tense, complex? Historians might say yes to all of the above, but also that the timing is perfect. We should advantage this fluid opportunity, and make the most of it. Public Health policy, debating it and formulating it, can help us mange our differences, and make wise choices for our still young nation. This is because Public Health exists at the intersection of Law and Medicine. Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020) 2025-01-06 04:17:33

By MICHAEL MILLENSON January In a blistering commentary, the American Medical Association’s flagship journal, JAMA, condemns the corrosive effect on patient care of the profit-seeking practices of health insurers. Separately, the organization announces that it’s selling the 13 journals in its JAMA Network to a private equity firm for $375 million “in order to enhance our mission of promoting the betterment of public health.” February Quickly following up on a campaign pledge to slash the federal budget, the Trump administration announces a radical consolidation of various entities at the Department of Health and Human Services. The new organization will be known as the Agency and Bureau for Children, Drugs, Explosives, Firearms, Families and Food (ABCDEFFF). Reflecting the new president’s strong personal preferences, “alcohol” will no longer be permitted in any agency name. March Bipartisan legislation demanding transparency from Pharmacy Benefit Managers dies in committee after industry executives explain that secret rebates to PBMs are like secret political action committee contributions to politicians: they allow you to loudly proclaim you’re an “advocate” for those supposedly paying you while actually serving the interests of those who are really paying you. April Pfizer announces that its once-a-day pill version of the wildly GLP-1 agonist weight loss drugs will shortly be submitted for government approval, and also that the company is moving its headquarters from New York to Louisiana, a state with a 40 percent obesity rate. Coincidentally, Louisiana is also the home state of Republican senators Cassidy and Kennedy, senior members of the Senate committees overseeing health care and all federal appropriations. May The new private equity owners of the JAMA Network say that all staff except one editor at each journal will be replaced by ChatGPT. A source at the private equity firm tells the Wall Street Journal that OpenAI won out over Gemini “because our CEO is a Leo” and over Claude “because nobody likes the French.” June Controversial right-wing firebrand Rep. Marjorie Taylor Greene, long the subject of rumors that she’s had cosmetic surgery, is diagnosed with a serious infection after an unspecified procedure. The House quickly schedules its first hearing on medical error in over two decades, but then cancels when the American Hospital Association points out the official term for what the Georgia Republican contracted was a “healthcare-associated infection,” so it’s entirely possible she accidentally brought the infection with her to the pristine hospital. Meanwhile, with House leadership telling Members they were free to vote their conscience, a resolution to send Greene a “Get Well” card passes unanimously after deletion of the word, “Soon.” July Following through on years of promises to reveal a “really great” replacement for the Affordable Care Act, President Trump on July 4 announces the “100-100-100” Make America Healthy Again plan. In keeping with the GOP’s advocacy for “skinny” plans with low premiums that encourage “consumers” to “comparison shop,” the plan will cover 100 percent of any medical bill for up to $100 a day for a premium of just $100 a month. Separately, Elon Musk tells a meeting of health insurance executives the plan can also replace both Medicare and Medicaid, enabling the federal government to cut spending by almost as much as the market capitalization of Tesla. August Before Congress recesses, a coalition of progressive organizations issues a press release declaring that all basic health services, whether provided by government agencies or the private sector, should be “available to the entire population according to its needs.” Shortly afterwards, the coalition is forced to make an embarrassing retraction after ChatGPT alerts the lone editor of JAMA that the coalition accidentally re-released a section of the report of the Committee on the Costs of Medical Care, formed in 1927. September The Business Roundtable says its members are committed to improving the quality of health care for all employees because “quality health care is good business.” An 85-year-old freelancer for The New York Times notes that this was the exact title of a September, 1997 policy paper by a Roundtable task force in which an executive for Sears, which at the time operated over 3,500 stores, declares, “We believe that quality health care is lower-cost health care.” Sears currently has about a dozen stores. October Medicare Advantage plans step up their advertising expenditures after public opinion polls show that nobody anymore believes the portrayal of happy and healthy seniors playing pickleball instead of writing tear-soaked letters pleading for approval of hip surgery. The trade associations for hospitals, drug and device companies and PBMs call on Congress to provide greater oversight of greedy insurers. The editor of JAMA resigns after ChatGPT writes an editorial extolling the merits of MA plans run by for-profit companies. November The National Rural Health Association says that in the spirit of the Thanksgiving holiday, its members will accept live turkeys in partial payment of the medical debts that now affect 99.99 percent of all Americans after passage of the administration’s “100-100-100” Make America Healthy Again plan. A KFF survey explains that the number is not 100 percent because Congress retained conventional health insurance for itself and top federal officials and because America’s billionaires had opted for self-pay. December A Washington Post editorial declares, “The bottom line is that if we want to contain spending, we will have to make critical choices about how care is delivered, to whom, and under what conditions.” Different chatbots differ on where that quote originally came from, but agree that if any humans believe the American public is ready to make critical choices, they’re hallucinating. Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor 2025-01-05 07:33:00

“Your greatest contribution to the universe may not be something you do, but someone you raise.” ~Unknown Have you ever heard the saying, “Mama knows best” or “If mama ain’t happy, nobody’s happy”? Honestly, who decided that moms should know everything and that the entire emotional balance of the home rests solely on their shoulders? Isn’t Mom a human too? A beautiful soul navigating this life, trying to figure things out just like everyone else? How is it fair that we pile all the pressure onto this one person—the keeper of the schedules, the task doer, the tender space for everyone to fall? It’s no wonder the pressure on moms today is sky-high. We carry expectations that are impossible to meet—being nurturing yet productive, selfless yet balanced. And let’s not forget about dads, who often get a bad rap for not doing things “as well as mom.” We need to take a step back. Both parents are human. They come into parenting with their own limiting beliefs, inner critics, and childhood wounds. Being a parent doesn’t mean you automatically know what you’re doing. I’ll never forget the drive home from the hospital with my first son. I was in the backseat, staring at this tiny human, thinking, “They’re really letting us take him home?” It hit me, sitting in that glider in his nursery a few weeks later, that I had no idea what I was doing. I tried reading all the books, hoping the answers were tucked in there somewhere. But even after reading the same chapter of Healthy Sleep Habits, Happy Child at least thirty times, I still felt lost. So, I did what felt natural—I called my mom. Surely, she had the answers. But all she said was, “This too shall pass.” At the time, her words made me angry. I didn’t have time for things to pass; I needed solutions. Yet, over the years, I’ve come to realize that she didn’t have all the answers either. None of us do. This journey of figuring it out—of reading books, blogs, and consulting my mom—lasted for many years. I wanted so badly to be a good mom. I was a good mom. I loved my kids deeply, left little notes in their lunch boxes, tucked them in at night, and kept them safe with helmets and seatbelts. But as he grew, so did the struggles, and often, so did my fear. When my son was in elementary school, he began struggling terribly. At first, I thought maybe he just needed a little extra encouragement. But when he would cry at homework or tear up on our way to school, I knew it was deeper. He would rush through his work just so he could turn in his tests at the same time as the other “smarter” kids. School was overwhelming for him, and it was crushing me to watch. Eventually, he was diagnosed with ADHD and dyslexia, and a wave of conflicting emotions washed over me. I was relieved to know he had support now, but the meetings, the individualized education programs, the tutoring—all of it weighed on me. Sitting in those meetings with teachers and specialists, I’d feel a tightness in my chest and tears spilling over. I wanted him to have an easier path, but I was realizing that I couldn’t just “fix” it. I was the mother, the one who was supposed to protect him, but I was helpless in the face of these challenges he would have to navigate on his own. My heart ached for him, and I often felt ashamed of my own emotional unraveling. Reflecting back, I see how much of those tears were for him—and for me. I was spread too thin. Work was overwhelming, my marriage was strained, and I had little left to give. My life felt like a juggling act, and each new challenge threatened to tip the balance. The layers of fear, responsibility, and love were always there, piling up, and I felt the weight of every single one. And then came the teenage years. Those years where the stakes felt higher, where choices carried more weight, and where my fear around his decisions—who he spent time with, the roads he might choose—grew even stronger. I remember one day, standing in the garage in an argument with him. The tension was thick, and we were both yelling—my fear bursting out as anger. I don’t even remember what we were arguing about; it’s a blur. But the shame and guilt afterward were so clear. The truth is, every stage of my son’s life brought forward a new version of myself—a woman, a mother, learning as she went, trying her best to balance it all. My own fear of failure, of not being enough, would surface in unexpected ways. But somewhere along the journey, I realized that my fears and my need for control were driving a wedge between us. And the more I tried to grip tightly, the more I lost sight of the tender love and wonder I wanted to bring into our relationship. So, I started working on myself. I went to therapy and hired a coach—not because I was broken, but because I knew I wasn’t showing up as the parent, or the person, I wanted to be. Through my healing journey, I learned that my desire to control was rooted in fear—a fear that if I didn’t do everything perfectly, he would somehow slip through the cracks. I feared for his future, that he’d face pain or hardship. But as I began to peel back those layers, I started to see that my fear wasn’t protecting him; it was keeping me from fully loving and trusting him. As I did this inner work, something shifted. My approach softened. I wasn’t as reactive or rigid. I found that I could set boundaries from a place of love instead of fear, listen without rushing to fix, and let him make his own choices. I

“Health is the greatest possession. Contentment is the greatest treasure. Confidence is the greatest friend.” ~Lao Tzu When dealing with a serious health issue or life challenge, we can choose to navigate through it to the light or bury ourselves in its darkness. While it’s not always easy to find the light, it’s a much easier place to survive in and, in the long run, is much healthier. This way of being has helped me on my recent health journeys. Twice in the past twenty-three years, I have received the news of a breast cancer diagnosis. Both incidences were completely different and unrelated. This is my story, and how looking for the light is so important in the face of adversity. My first cancer diagnosis was in 2001 when I was forty-seven, received days before the horrific events of 9/11. DCIS, an early form of breast cancer, was discovered through my annual mammogram. I was given the choice to have a lumpectomy and radiation or a mastectomy and reconstruction. I opted for the latter because I didn’t want to spend subsequent days, months, and years worrying about a possible recurrence. Plus, back then, radiation was more dangerous and not as refined and focused as it is today. At the time, I was living in a small town in Florida and decided to travel to California for the best doctor to treat this type of cancer. It wasn’t easy being separated from my three children under the age of eighteen. In the end, it was the right choice and eventually led to a subsequent move to California, the place of my dreams. So sometimes going through difficult challenges can lead to better things. After I had surgery, my husband Simon and I stayed in California for two weeks before returning home to Florida. I slowly got used to my new body’s landscape since my diagnosis and diligently continued to go for my annual mammograms, watching my only breast being squished between those two sheets of glass. Tears would trickle down my face, triggered by the loss of the breast that fed my three children. During my meditations, I expressed gratitude for my life and remaining breast. I tried to bring the light into my life whenever possible by engaging in self-care activities. I surrounded myself with loving and thoughtful people and tried to disconnect from those who had less hopeful attitudes. Five years later, during a routine blood test, I found out that I had multiple myeloma, a rare type of blood cancer affecting the plasma cells. In short, it turns healthy cells into unhealthy ones. I had no symptoms at the time, but was told that I’d need bloodwork every three months to make sure that the disease did not progress, and that down the road there was a chance I would need to undergo treatment for this incurable type of blood cancer. The fear of enduring another cancer overcame me, and I researched the best integrative physicians in Los Angeles to help me navigate this new terrain. For eighteen years my myeloma was what was called “smoldering” because I had no symptoms, but my blood test continued to show high protein levels—a sign that the disease was present. Each day I swallowed handfuls of vitamins to ward off any further disease progression. I met and consulted with the best doctors and researchers at the Mayo Clinic and Cedar Sinai Hospital in Los Angeles. I was told that everybody’s case was different, but at one point treatment would be unavoidable. My second breast cancer diagnosis came in 2024, not long before celebrating my seventieth birthday. I was feeling fine, and it was still a few months before my scheduled annual mammogram when I noticed that my right nipple had inverted. A mammogram, biopsy, and MRI revealed lobular breast cancer, which is more aggressive than DCIS. I ended up having another mastectomy and reconstruction. Much to my chagrin, I also needed radiation. Thankfully, because my Onco Type DX Score—a score given from 0 to 100 indicating the likelihood of breast cancer returning—was low at only 9, I did not need chemotherapy. I am not generally a fearful person, although I am prone to depression and holding feelings in. I continued to try to keep clear of those who were living more in the light than in the dark because it triggered feelings of depression. The entire experience triggered reminders of my first breast cancer experience, coupled with increasing fear and sadness. Once again, I had to get used to my new personal physical landscape of implants taking the place of my real breasts. Much had evolved surgically in the twenty-three years since my last surgery, and the recovery seemed easier. The radiation, however, took a lot out of me. In addition to shrink-wrapping my newly constructed breast, I encountered sheer exhaustion during the six weeks of radiation five days a week. Unfortunately, during my hospitalization for this second mastectomy and reconstruction, my hemoglobin dropped significantly. This signaled to my doctors that my myeloma might be becoming active. They scheduled a bone marrow biopsy and found that 90% of my marrow had cancer cells. This was shocking news. My oncologist had been suggesting treatment to ward off progression, but I declined and said that I would rather wait until I was symptomatic. He had been very patient with me wanting to do it my way, combining Eastern and Western medicine, mainly because he knew that each case was different, and he honored my intuition about my body. However, he did tell me that there would be a time when he would say that I had no choice but to begin treatment, and unfortunately, it had arrived. He suggested I heal from my surgery before beginning. The hemoglobin drop made me feel very uncharacteristically tired. I had been an active person, hiking and working out with a trainer, so having no energy was very difficult for me, plus being active is also

“A leader leads by example whether he intends to or not.” ~Unknown This past year has been a journey—one that cracked me open in ways I never expected. It began with life-changing news: I was pregnant with my third child. In August, I welcomed my baby, and as I held that tiny, precious life in my arms, the weight of reality crashed over me. Something had to give. I could not keep moving at the same relentless pace, endlessly pouring myself into others, holding their pain as if it were my own, and giving until there was nothing left. If I continued like this, I would become a shell of myself—a zombie mom, moving through life on vibrate mode, disconnected, exhausted, and lost. For years, I had been the person everyone leaned on. The healer, the fixer, the one who never said no. As a therapist, it felt natural to care deeply, to hold space, and to offer whatever I had to those in need. I became so adept at giving that I forgot how to hold anything back for myself. I thought that was love. I thought that was worthiness—being the person who could carry it all. But with another baby on the way, I finally saw the truth: If I didn’t change, I would be consumed. I couldn’t keep running on empty, sacrificing myself at every turn, and still be the mother my children deserved. I couldn’t be lost to burnout and depletion. So, I made a promise to myself. I would protect my energy. I would honor my own needs. I would stop trying to be a savior. “I am not a savior; I am a leader.” This became my mantra, my anchor in moments of doubt and old patterns. It reminded me that my worth wasn’t tied to how much I gave or how many burdens I carried. Real healing wasn’t about sacrificing myself; it was about guiding and empowering others—without losing who I was in the process. But breaking free of old habits isn’t easy. The reflex to jump in, to rescue, to absorb others’ pain is deeply ingrained. It’s part of who I’ve been for so long that choosing differently feels unnatural, even selfish at times. Recently, a friend reached out in distress. Every instinct screamed at me to drop everything and save her. That’s what I always did—rush in, fix it, try to make everything better, even if it meant leaving myself drained and overwhelmed. But this time, I paused. I took a breath. I reminded myself: “I am not a savior.” So, instead of absorbing her crisis, I encouraged her to lean on other supports and tap into her own resources. I stayed present, but I didn’t make myself the solution. And let me tell you, it was hard. Guilt clawed at me. Doubt whispered that I was abandoning her, that I was failing her. I felt my inner child—the one who learned love was earned through fixing—screaming that I was making a mistake. There were moments when it felt like I might break. Watching her struggle triggered every fear and insecurity I carried. But then something remarkable happened—she found her way. She leaned on others, drew on her own resilience, and overcame the challenge. By stepping back, I hadn’t let her down—I had lifted her up. I had given her the space to find her strength, to be her own hero. And in doing so, I had freed myself from carrying a burden that was never truly mine to hold. The realization left me breathless. By not being the rescuer, I had broken a cycle—a cycle that kept me drained and others dependent. I had shown up in a different way, and it felt terrifyingly unfamiliar but profoundly right. I felt pride, relief, and a deep, aching grief. I grieved for all the times I had sacrificed myself, believing it was the only way to be worthy. I grieved for the younger me who thought love could only be earned through self-sacrifice. But I also felt hope—hope that I could lead with compassion and strength without losing myself. This journey isn’t easy. The pull to rescue, to absorb, to fix is always there, whispering that I need to be more, to do more. But I’m learning to listen to a different voice—the one that tells me my needs matter too. That I am worthy of care and boundaries. That I can lead without sacrificing myself. As I hold my new baby and navigate life with three children, I know there will be times when I slip. Times when I fall back into old patterns, when guilt gnaws at me, and when I feel the weight of everyone else’s needs pressing down. But I’m committed to choosing differently. I refuse to become the zombie mom, lost in everyone else’s expectations and needs. I deserve more. My children deserve more. When I protect my energy and honor my needs, I become the mother I want to be. I show up with love, patience, and presence. I am not a savior. I am a leader. And when I choose to break these cycles, I give others permission to do the same. I create space for those around me to find their strength. I lead by example—not by sacrificing myself, but by showing what it means to love deeply without losing who you are. So, I keep going. I choose myself, even when it feels hard. I break old patterns, even when it hurts. Because I deserve to be whole. I deserve to be honored. And those I care for deserve a version of me who leads with strength, compassion, and presence—not a shadow of who I used to be. I am not a savior. I am a leader. And that, for the first time in a long time, feels like more than enough. About Jamie Vollmoeller, LCSW Jamie Vollmoeller, LCSW is a therapist, life coach, and mom of three who deeply understands the

“If you accept a limiting belief, then it will become a truth for you.” ~Louise Hay When I first set out to create my business, I poured all my hopes and energy into it working tirelessly, learning, refining, and investing. Since childhood, I knew I wanted to do my own thing. Something that felt meaningful to me. But despite all my best efforts, the success and sense of support and steadiness I longed for always felt out of reach. I chalked it to timing, or not doing enough, or missing something others had that I couldn’t put my finger on. But all along, what was behind the stuckness was a force I’d never considered—conditioning. Conditioning is the learned behaviors and beliefs we adopt as children to feel safe, loved, and accepted. These patterns become so ingrained that we don’t realize they follow us into adulthood. But do they ever, shaping how we approach everything, including our ambitions and relationships. My own deconditioning journey has spanned years and, my goodness, the layers… but one of the densest and most sabotaging was this: I was raised to believe that being misunderstood was unsafe. My childhood experiences taught me that expressing myself with honesty or assertiveness could come at a mega cost, and I carried this lesson into my life and business (like nobody’s business), without even realizing it. As I began to share my work with the world, I felt an anxious compulsion to prove myself and my approach exhaustively. I couldn’t shake the picture of a hostile audience judging every word I wrote or spoke, so instead of focusing on how my work could solve a problem for potential clients, I was caught up in an endless loop of over-explaining, justifying, and defending my ideas—before anyone even questioned them. I wasn’t marketing my work as much as I was making a case in a courtroom of my own projection. It was the worst. It drained my energy, sabotaged my business, and made showing up for it feel like a rerun of a past I thought I’d outgrown. Seeing this and other aspects of my conditioning for what it was (distinct from me and a coping mechanism from the past) took a lot work. My unique path included estranging from toxic family dynamics, moving from Brooklyn to a very calm corner of Italy, quitting alcohol and cigarettes, and hiring a coach who understood where I came from and where I wanted to go and could go as deep with me as I knew was required. I don’t believe it’s a fair ask to release aspects of our conditioning (regardless of how limiting they are) when our lives and relationships don’t feel safe, and it took creating safety, cogency, and self-trust to start seeing all at the ways coping had kept me from thriving. The first step toward breaking free of the anxious over-explaining pattern was noticing how it felt in my body. I’d feel the anxiety rise, and then survival mode would take over whenever I tried to communicate my work with directness. More than once, my jaw would lock, my head would go fuzzy, and my throat would collapse if too much truth, confidence, or opinion came to the surface. This wasn’t a personality quirk; it was an echo of the past, manifesting in the present. Inner child work was the medicine for this—when those feelings welled up and the impulse to shut down or over-explain would come up, I’d picture little me sitting on my lap and I’d hold her through the fear, reminding her that she was feeling the past, not the present. That she wasn’t alone in this and wouldn’t be ever again. And then I’d lean in and say the thing. As I sat with those feelings, acknowledging them instead of letting them direct my actions, something shifted. I was re-parenting that vulnerable part of me that had once believed it was dangerous to be seen and heard and showing her that we could walk past those fear thresholds together. And so, we have, more and more every day. Letting go of this need to defend myself, I found both clarity and a sturdier sense of being safe in my own skin than when I only had the conditioning to protect me. And when it came to my work and business, my focus could center on what truly mattered: serving my clients and making my work clear and accessible, not to the critic within but to people, real people who are looking for change. The impact was immediate. Communicating with clients became smoother, and even tasks I’d once dreaded—like getting on sales calls—felt natural, grounded, and friendly. It opened the door to a new kind of productivity, one fueled by purpose rather than “headless chicken” survival. Thank heavens. Really. If you’re finding it difficult to make things happen as you envisioned them, it may not be about working harder or finding the perfect moment. It could be that unseen patterns of conditioning are guiding your actions, just as they were guiding mine. The beauty of recognizing these patterns is the freedom that opens up. When you let go of outdated beliefs and create space to move forward from a grounded, present, clear-eyed place, ambitions start to feel within reach because the truth is, they kind of are. What can feel impossible or out of reach or alignment becomes so much less charged and so much more achievable when we’re no longer fighting these unseen barriers. It isn’t always easy work, and it requires a commitment to challenge familiar beliefs, reach for support, and sometimes make some big changes. But if you’re willing to face your hidden patterns, you might just find that what you want is far closer than it once seemed. About Mel Wilder Melanie’s a coach whose work dismantles the hidden conditioning that keeps women stuck, helping them build thriving businesses that are as aligned as they are successful. Drawing from decades of personal