Surprisingly - or not, beyond a limited number of trade publications and policy shops the RFI has to date been ignored.

The authors 167-page paper make essentially two arguments: while the Ds diagnosis is correct in that part of the problem is how commercial insurers (termed “Big Insurance”) make money (and how much), nearly half of the RFI’s 71 propose reforms will likely cause payers to move money to unregulated subsidiaries or affiliates instead of saving it or applying the savings to actual care spending; and, by ignoring hospital prices, that substantially are responsible for both health care spending and inflation (once again think: “It’s the Prices, Stupid”), the Senate Finance Ds are ignoring over $300 billion in potential annual savings. E.g., they write, “squeeze insurer margin perfectly and the hospital price base is exactly where it was,” and “you cannot audit the pricing power of the party [hospitals] you have just cast as the injured one.”

The report deserves the attention of all serious healthcare policy students.

The authors’ work, published as INET working paper, is at: Alvelda-Ferguson-Wyden-RFI-Critique-Brainworks-INET-final.pdf.

INET is at: https://www.ineteconomics.org/.

Professor Ferguson’s bio is at: https://www.ineteconomics.org/research/experts/tferguson.

Dr. Alvelda’s bio is at: https://www.ineteconomics.org/research/experts/pAlvelda and at: https://brainworks.ai/about-us/.

Today, US healthcare is arguably the largest industry in the world’s largest economy, with a ~$7.5 trillion market cap, and is highly concentrated. As Prof McDonough cites, “America’s health care crisis is,” per Phil Longman, “brought to you by monopoly.” Think: UNH that controls approximately 2,700 global subsidiaries and affiliates.

We know the results.

In his introduction Professor McDonough appropriately cites Maya Angelou’s observation, “if you don’t know where you’ve come from, you don’t know where you are going.” Possibly more optimistic, James Baldwin phrased the idea as, “If you know whence you came, there is really no limit to where you can go."

One can hope.

Information regarding “America’s Wrong Turn” is at: https://www.press.jhu.edu/books/title/53872/americas-wrong-turn?srsltid=AfmBOoqNV4mGGs9z2P9ym233e-Bsp4EBV3SAAvJKYm2RTAKtcuAk1afm.

Prof McDonough’s Harvard Chan School of Public Health website page is at: https://hsph.harvard.edu/profile/john-e-mcdonough/.

In “Beyond Medicare for All,” Mr. Terry essentially argues healthcare can be achieved without dismantling private insurance or expanding single-payer government health delivery by creating a bifurcated or two-tiered delivery and financing model that would be led in part by independent primary care physicians.

Information about Ken Terry’s is at: https://kevinmd.com/post-author/ken-terry

Information about “Beyond Medicare for All” is at: https://physicianledreform.com/

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The answer seems to be legislating hospital price transparency. Earlier this month both the House Energy and Commerce and the Senate Health, Education Labor and Pensions (HELP) committees passed price T bills out of committee. Regarding the Senate effort, HELP Committee Chair, Dr. Bill Cassidy, stated, “I'm very optimistic that it will pass . . . and I'm confident that it will."

Information on Turquoise Health is at: https://turquoise.health/patients.

Testimony presented during the June 10 House E&C hearing noted during this interview is at: https://democrats-energycommerce.house.gov/committee-activity/hearings/hearing-lowering-health-care-costs-all-americans-examining-policies.

Vermont climate superfund legislation, followed seven months later by New York (and presently pursued by at least ten other states), is in response to climate-charged disaster events that over the ten- yr period ending in ’25 cost Vermonters upwards of ~$2 billion. The legislation, premised on a deeply entrenched polluter pay principle, e.g., modeled after the federal toxic waste Superfund program, requires so called carbon majors, here oil and gas companies, to meet their unpaid, externalized costs by making compensatory payments. New York law is targeting a $75 billion fund. These dedicated funds will generally finance climate adaptation and infrastructure resiliency. Not surprisingly, these laws face of aggressive legal challenges by among others the American Petroleum Institute, the U.S. Chamber of Commerce, West Virginia-led state attorneys general and the Trump administration that has filed federal lawsuits against both VT and NY. Among numerous related interviews, listeners will recall I discussed advances in attribution science with Stanford’s Chris Callahan in May 2025.

Information re: Vermont’s Climate Superfund Act is at: https://climatechange.vermont.gov/climate-superfund.

Information re: Vermont’s Conservation Law Foundation is at: https://www.clf.org/serving-new-england/vermont/.

(Apologies to Ms. Mihaly, at one point I call her Emily!?!)

Comments are of course welcomed.

Comments are of course welcomed.

Comments are of course welcomed.

Thank you.

With me to discuss Prof. Ghilarducci’s book is her colleague Ms. Jessica Forden an economics Ph.D. candidate at the New School’s Schwartz Center for Economic Policy Analysis.

Information on Prof. Teresa Ghilarducci’s book is at: https://press.uchicago.edu/ucp/books/book/chicago/W/bo212888995.html.

The New School’s Schwartz Center for Economic Policy (SCEPA) research publications are at: https://www.economicpolicyresearch.org/research.

Jessica Forden’s LinkedIn page is at: https://www.linkedin.com/in/jessica-forden-88b265131/.

Friedman School of Nutrition Science and Policy information is at: https://nutrition.tufts.edu/

Prof Masters’ bio is at: https://as.tufts.edu/economics/people/faculty/william-masters

Largely due to pricing failure, that costs Americans about $250 billion annually, pricing power is the consequence of an increasingly concentrated healthcare market. Think: Herfindahl-Hirschman Index scores. Hospital pricing/prices are particularly noteworthy or moreover surgical procedures and patented drugs that have risen at multiples of the annual inflation. This means those insured pay increasingly higher coverage (premiums, deductibles, copays) and are forced into medical debt or bankruptcy, forced to avoid necessary care and/or make financial trade offs. Insurance plans, here we’re discussing self-insured employee plans, that capture roughly 65% of covered workers, face similarly challenging math. For example, recently reported news found the five largest managed care plans lost $226 billion in market value over the previous 12 months. As for solutions, federal price transparency laws, though well intended, have either gone un-headed and/or lack enforcement.

Mr. Robert Andrews is the CEO of the Health Transformation Alliance (HTA), a cooperative of approximately 80 large self-insured employer health plans. HTA was founded in 2016 by four pioneering employers from American Express, Macy’s, Verizon and Caterpillar. HTA member companies are collectively responsible for more than 5 US million lives and 8 million globally spending $450 billion annually in the US market. Mr. Andrews served NJ’s 1st congressional district in the US House of Representatives from 1990 to 2014.

Information on the Health Transformation Alliance is at: https://www.htahealth.com/about-us/.

Two weeks ago Senator Cruz (R-TX) and four other Republican senators dropped their “Stop Climate Shakedown’s Act.” In part the legislation would prohibit retroactive liability, mandate dismissal of pending climate liability lawsuits in several states and preempt state authority, e.g., outlaw state climate superfund laws (think: NY and VT).

The bill was largely anticipated because the Heritage Foundation’s “Project 2025” report proposed policy recommendations designed to “dismantle legal and regulatory frameworks” in response to what the Foundation terms “woke lawfare.”

Mike Meno, The Center for Climate Integrity’s Communication Director, unpacks the who, what, why, how and where.

Information on the Center for Climate Integrity is at: https://climateintegrity.org/

See also the Center’s “No Immunity for Big Oil” page at: https://www.noimmunityforbigoil.org/

“is a cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs and making it harder and harder for state and federal governments to afford what their constituents need. Public purpose and wellbeing of ordinary people are being subordinated to the private gain of the already well off. None of this would be possible without acquiescence – and sometimes enthusiastic participation – of the politicians who are supposed to act in the interest of the public.”

The first of three Health Affairs’ Forefront essays by Katie Keith and Matthew Fielder is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-1

The second is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-2

The third is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-3

The proposed rule is at: https://www.govinfo.gov/content/pkg/FR-2026-02-11/pdf/2026-02769.pdf

CMS’ related press release is at: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule

Prof. Mussett’s 2022 work, “Entropic Philosophy, Chaos, Breakdown and Creation,” is at: https://www.bloomsbury.com/us/entropic-philosophy-9781538165188/.

Drew Dalton’s related Aeon essay published last August and discussed here, “Reality is Evil,” is at: https://aeon.co/essays/philosophers-must-reckon-with-the-meaning-of-thermodynamics.

The recently published JAMA article, “Patients Are Getting ICE-d Out of Health Care” is at: https://jamanetwork.com/journals/jama/fullarticle/2845182.

The recently published Stateline article, “Health care workers want ICE Out of Hospitals, and Blue States Are Responding,” is at: https://stateline.org/2026/02/09/health-care-workers-want-ice-out-of-hospitals-and-blue-states-are-responding/.

The Columbia University Sabin Center “Climate Backtracker” database is at: https://climate.law.columbia.edu/content/climate-backtracker.

Information on Resources for the Future is at: .https://www.rff.org/.

Dr. Hubbell’s bio is at: https://www.rff.org/people/bryan-hubbell/.

Last Friday, Prof Abraham along with 54 research colleagues published in “Advances in Atmospheric Sciences” the article, “Ocean Heat Content Sets Another Record in 2025.” Their research found that in 2025 oceans absorbed 23 zetajoules (n followed by 21 zeros) of heat (30% more than in ’2024), a finding consistent with the fact that nearly every year since the start of the millennium has sent a new ocean heat record. In turn, the authors note long-term ocean heat accumulation contributed to extreme climate-related events in 2025 that included increasingly intense tropical cyclones, hurricanes and typhoons, heavier downpours (e.g., in late October Central Vietnam received 5.5 feet of rain in 24 hours), greater flooding, landslides, wildfires, longer marine heatwaves, increasingly decimated sea life, ice sheet loss and sea level rise that in sum impacted billions around the world. As I noted in previous years, ocean surface temps are now warming 40 times faster than 40 years ago. Because ocean heat content plays a fundamental role in the Earth’s energy, water and carbon cycles, warming ocean temperatures disrupt marine life that substantially threaten the availability of food we eat and the oxygen we breathe.

Abraham and colleagues’ article, “Ocean Heat Content Sets Another Record in 2025,” is at: https://link.springer.com/article/10.1007/s00376-026-5876-0.

Information regarding “Old Before Their Time” is at: https://www.amazon.com/Old-Before-Their-Time-Investigating/dp/1032974826.

Dr. Frank Putman’s bio is at: https://www.med.unc.edu/psych/people/frank-w-putnam-md/.

Information about Prof. Alam’s book is at: https://www.press.jhu.edu/books/title/53838/care-foreigners?srsltid=AfmBOopgVAOX_1s9S7NaIMoKsXgrUS2htC4_HaE0zTYDrfQJltnIpRK7.