America’s Health Policy Sitcom: When Doctor Mike and a Former CMS Exec Pretend Patients Are the Priority

Sixteen years ago, a woman paid more for insurance than a man because the system decided her uterus was a pre-existing condition. Dr. Mike and Chiquita Brooks-LaSure kicked off their YouTube chat with this fact.

And before I go further, I need to say this: I’ve been a fan of Dr. Mike since he first started on YouTube. He’s one of the most credible, trusted, authentic, empathetic, and reputationally untarnished medical professionals and patient advocates around. He deserves all his cred. He gives a master class in diplomacy, aplomb, professionalism, and interview skills with every episode. I applaud him for tackling this “101” explainer series. He gets some grace and a mulligan because he is not a bankrupt cancer patient who lost everything trying to live.

Now, on to the dissection.

They called it progress that today insurers can’t price-gouge you for having ovaries. Sure. But if you actually get cancer, you still end up bankrupt or fighting your insurer like it’s a hobby you never wanted.

They spent an hour tossing around words like “coverage” and “access.” You could drink every time they said “Medicaid expansion,” and you’d black out before they touched the real rot. Medicaid expansion didn’t fix the Medicaid experience. If you think signing up is a nightmare, wait until you need treatment approval. Wait until you need a drug that isn’t on the formulary. Wait until you learn you only have theoretical access to care.

Brooks-LaSure called the Affordable Care Act “transformational.” Which it was. There is no denying how groundbreaking it was and what it did, especially for young adults facing cancer what with neutering pre-existing condition and increasing COBRA benefits to age 26.

But let’s look deeper into that transformation.

Millions gained insurance cards. But oncology clinics keep posting signs that say “We don’t accept Marketplace plans.” Cancer patients with these plans sit in waiting rooms for six hours only to be told their treatment isn’t covered.

I know people who mortgaged their futures because the fine print ate them alive.

They trotted out the line that patients “shouldn’t have to worry” about cost. Then they wrapped it in a neat bow and moved on. They didn’t grapple with why it still happens. They didn’t press on the collusion between insurers, PBMs, and hospitals that turns every appointment into a billing circus. They didn’t mention how Medicaid pays hospitals less than cost, so you get treated like a problem, not a patient.

They brushed past drug pricing.

Brooks-LaSure said the Inflation Reduction Act would start negotiating drug prices in 2026. She said it with pride, like a kid showing off a finger painting. You think a metastatic breast cancer patient has time to wait for relief? You think parents rationing insulin care about pilot programs? Policy timelines are measured in election cycles. A tumor measures time in weeks.

Dr. Mike tried to steer toward patients. (And bravo for that)

You could see him squirm a little when the answers turned into press release material. He asked about mental health coverage. She gave the same sanitized optimism. The truth is, you can have coverage on paper and no actual access. Therapists don’t take Medicaid. They don’t take Marketplace plans. They don’t take your calls when your insurer pays them a quarter of their rate.

Here’s what you won’t hear in their conversation:

• Medicaid expansion didn’t protect people from medical bankruptcy. Nearly half of all cancer patients still drain their savings to stay alive.

• Industry keep gaming the patent system to block generics. CMS can’t claw back those billions fast enough to help you today.

• Every state’s Medicaid program is a snowflake of dysfunction. You can move across a state line and lose your coverage.

• Cancer patients still fight to prove their lives are worth covering.

The American Healthcare System treats patients like actuarial liabilities.

These two mean well, but they are likely not in the waiting room with you when the insurance company says no. They likely don’t get the call when your pharmacy benefit manager denies the only chemo you respond to.

They said patients deserve better. True. But that line came with no ownership. No urgency. Just a tidy package of hope and spin.

If you have cancer, you don’t have time for spin. You don’t have time for an incremental rollout of pilot programs. You don’t have time to watch another election cycle burn through promises while your body burns through options.

Ask yourself: Who benefits when people keep waiting politely?

I stopped waiting a long time ago.

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Fact Checks and Receipts:

1. Gender Rating Pre-ACA: True. Before the ACA, women could pay up to 50% more for identical coverage.

2. Medicaid Expansion Impact: True that expansion reduced uninsured rates. False that it guarantees access to care without barriers. Providers often don’t accept Medicaid due to low reimbursement.

3. Drug Negotiation Timeline: True. The Inflation Reduction Act starts price negotiations in 2026.

4. Medical Bankruptcy Among Cancer Patients: Study in JCO Oncology Practice shows 42% of cancer patients exhaust life savings within 2 years of diagnosis.

5. Mental Health Access: Kaiser Family Foundation reports over half of psychiatrists refuse insurance altogether.

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Questions They Never Asked:

• Why does “coverage” rarely mean “care”?

• What is CMS doing to force insurers to pay for FDA-approved treatments without delay?

• Why does Medicaid have different rules in every state?

• How will you hold PBMs accountable for drug access manipulation?

• What happens to patients waiting for price negotiations when they need drugs today?

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Bottom Line:

They call this progress. I call it a performance. You deserve more than a policy highlight reel. You deserve a system that values your life over the quarterly statements. If that makes me the angry patient in the room, good. Somebody has to be.