Hello and welcome to smash Notes, a podcast that brings you a weekly summaries of the best part guests on the Internet this week. I'm trying something different, and I'm going to focus on one particular topic. Health care in America. Hint. It's not very good. You're going to hear a couple of segments. First, it's about hospital care and why Costs off hospital care are so widely different and how some people, even if they have insurance, a totally unable to afford the care. And then we're going to talk about vaccines. Of course, we all know vaccines cause cancer wink, wink. But in case you might want to consider vaccinate your Children,

there are some good reasons why it's a short and sweet episode on all the links to a particular segments are in show notes, and I highly encourage you to go and listen to this. Podcasts. The beauty of smash notes. You don't have to listen to the entire podcast. You can just go in, read and listen through the favorite segments and before we begin, is always a song by an artist. This time it's James Doherty, a musician from Eugene, Oregon. This is sung we are one, and, as always, the rest of the song will be at the end of the episode. Let's get going.

We are about to notes Within a core. We are two letters, and they were. Now, though it's been spoken on, the court's been sung. So let's tell all the world that way

that was James was his song. We are one gonna put a link in the show notes, and if you like it, please download it. All right. This first episode is from podcast called An Arm and a Leg, and it's a story about a woodworker who got his hand on a table saw and then went to an emergency room. Hear myself. So I screamed for about 10 seconds. I didn't feel anything just but knew what happened and then ran to a shop neighbor, leaving just like a trail of blood On the way over to him. They got me bandaged up and took me over to the urgent care because I know going to an emergency room is going to be just an obscene amount of money. But the docket urgent Care looks at Jim's finger and says, I knew I'm not the guy for this. He was like, They're probably gonna have to amputate it. You're going to have to go to an emergency room.

Jim and his friend get back in the car. That was a pretty rough drive. The pain was so excruciating that I couldn't even talk If I want to screen, I couldn't even scream. That was just I don't know which was worse. The pain or or the fear of What is this going to cost me? But there are a couple of nice surprises waiting for him first. He's not gonna lose. Doctor came in kind. Take a look at everything, correct a couple jokes and he was like, All right, I think we can set you back up. Took him an hour and 1/2 to put in 10 stitches for him to kind of find enough skin to reattach. And it works that surprise Number one. And then Jim stops at the desk on his way out to sign some paperwork,

and the person behind the counter tells me if you give us $350 if you pay through under $50 today, we'll take 60% off your bill. 60 60%. So that's why I'm thinking again, this could be 8 $9000. I'm like, Yeah, here's here's my credit card. Okay, this is kind of good news. You could seriously hurt yourself, but your hospital might still give you a break. The question remains, though. How much are they going to charge you for a procedure? What if you cut your hand?

What if it's something else? Do you know how much it costs? Let's find out. So we started out small. We called doctors and hospitals and asked them what they would accept as a cash payment for simple procedures. Some people were helpful. A lot of people hung up on us. Some people were just plain rude. They said, We don't know or our lawyers won't let us tell you that. But we did get a lot of information. We found, for example, that here in the New York area you could get an echocardiogram for $200 in Brooklyn or for $2150 in Manhattan just a few miles away. New Orleans. The same simple blood test.

$19 over here, $522. Just a few blocks away. San Francisco the same M R I $475 or $6221 just 25 miles away. Thes pricing variations existed for all the procedures and all the cities that we serve it. Then we started to ask people to tell us their health bills in partnership with public radio station W N Y C. Here in New York, we asked women to tell us the prices of their mammograms. People told us nobody would do that, that it was too personal. But in the space of three weeks, 400 women told us about their prices. We talked to people who had to sell a car to pay health built, go into bankruptcy skipper treatment because of the costs. Imagine if you could afford the diagnosis, but not the cure.

Well, that's insane. Can you imagine getting a tenfold difference between hospitals and simply because you ended at one and not in the other? You're now bankrupt. That's crazy. But that's for uninsured people, right? The people who have to pay out of pocket. If you have insurance, you're all good. All right, right. The answer is unfortunately, maybe 20% of this country's on Medicaid if your neighbors have a family of four and make less than 33,000 year than they could get Medicaid, but they can't find a doctor to see them. A study by Merritt Hawkins found that only 20% of the family doctors in Denver take any Medicaid patients.

And of those 20% some have caps like five Medicaid patients a month. Others make Medicaid patients wait months to be seen. But we'll see you today if you have Blue Cross this form of classes. Discrimination is legal. It is not just a problem. In Denver, almost half the family doctors in the country refused to see Medicaid patients. Why? Because Medicaid pays less than private insurance and because Medicaid patients are seen as more challenging. Some show up late for appointments. Some don't speak English, and some have trouble following instructions. I thought about this while in medical school. If I could design a practice that caters to low income folks instead of avoiding them, then I would have guaranteed customers and and very little competition. So after residency,

I opened up shop doing underserved medicine, not as a nonprofit but as a private practice, a small business seeing only resettled refugees. It seems like healthcare works great if you're wealthy and you may be out of luck if you're poor. We're lucky that some doctors are finding ways to make money and to help patients. Those were a couple episodes I find interesting about the state of health care. So take a look at the show notes for the links to the episodes, where you can find more segments on smash notes to read through it to listen to. And if you listen to the segments and you really like them, then please tell me why. I know why I like these episodes. But I also want to know why you're listening to them. Please, please email me your thoughts to feedback at smash nose dot com or by following at smash notes on Twitter. And now let's talk about vaccines first. I want you to hear this story as to what life was like before vaccines were available.

I am one of the increasingly rare old timers who lived during the pre vaccination era. I am the second to the last of 13 siblings, five of whom died of vaccine preventable diseases in infancy. Born to poor immigrant parents, I remember well, my mother's account of the causes of their deaths. Three from Protest Sis and two from measles. Even after many years had passed, she spoke of the death of her angels with a great deal of emotion. Imagine losing not 123 or four, but five babies. It was common in the pre vaccine era. Like our family, many families lost several Children to these diseases. We forget. Time blurs our memories of these common tragedies of yesteryear.

I remember well during the winter and spring of each year, hearing the whoop of protest sis and movie theaters, school assemblies and assorted gatherings. Today, few have ever heard this and those who have forget. I remember the summer outbreaks of polio, the crippled Children who could no longer walk or walked with limb distorted limps. As the third and fourth year medical student, I remember answering the appeals of hospital administrators who could not find the nursing staff for special duty tending to the needs of polio patients in iron lungs. We forget. I remember the awful cases of measles my own Children experienced. I remember the Children with smallpox. During the years my family lived in Pakistan, I remember those who lost their sight from lesions in their eyes. I remember those who died, We forget.

So that was a letter to the Immunization Action Coalition by E. J. Jean Ganga Rosa, who was a professor emeritus from Emory University. He wrote that letter in 2000. Well, that does not sound fun at all. So how do vaccines work? We first have to understand how our immune system works and how our bodies fight off infection. So immunologists don't hate me. I'm gonna break this down in the simplest possible way. More complicated. But these are the basics. There are two major parts to our immune system. There's a non specific, which is called the innate immune response.

And then there's a specific response, which is called the adaptive Response. Okay, the innate immune response. It's very fast on the uptake. When you get exposed to viruses or bacteria, it confined them and start to get to work really quickly. But it's not that powerful. It doesn't last that long, and it can't destroy everything. So we have a second immune response. The adaptive immune response. This is something that allows us to target very specific individual pathogens. But it takes some time. It's a little bit slow to get started. So what that means is that before your adaptive immune response kicks in,

you usually get sick. You feel crappy. Uh huh. And then you're adaptive. Immune system needs time to kick in and actually fight off that infection. But the good thing about this adaptive immune response is that it has a memory like an elephant. It never it never forgets. So anything that the adaptive immune response has responded to once the second time it's exposed to that same virus or bacteria. It can respond much more rapidly and much more effectively. Right. Okay. So, T L d r. When you inject the vaccine into your body basically putting in a dead virus and it helps your body to build the muscle memory on that virus so that next time you exposed to it, you don't have to go through the process of getting sick and learning to fight the virus. Your body would automatically know how to react to it right away,

so you don't get sick. Oh, cool. you could say, But then, what's the problem with anti vaxxers? If a bunch of people who don't get vaccinated get the disease and gets sick, what's the big deal? Well, let's find out this is from a podcast Cold science talk. You talk in the article about the fact that vaccine rates and you mentioned it earlier. They are still very high, but we do see these pockets, these regional, uh, kind of situations where you you have a lot of resistance.

So as a general rule, how would you categorize this problem? I mean, we hear a lot about it, but is it really a huge problem? I think it is, especially in some of those areas. So when we're talking about herd immunity, we're talking about the the amount of people in a population who need to be immune to block transmission of certain infections. And we usually use the term about 95% because that's the level of immunity that we need to block the most infectious pathogen, which is measles. And so when you start getting it down below 95% you have these these groups of individuals who are susceptible, especially to measles. And then if it gets lower, they're susceptible a swell to two months and and other organisms. So even though it's high overall,

as you mentioned, we do have these pockets of areas that are well below 90%. In some cases, you have communities where their vaccination rate maybe a 60% or 50% so they become very vulnerable to those those infections when they're introduced from from somebody from the outside. So most of the outbreaks that we've seen over the past few years have been, you know, people who have been traveling to places where measles is endemic, which is a lot of, you know, For example, European countries go there for vacation. They're not immunized. They come back to the United States and spread it to others in their communities. And it doesn't take very much a large population to be unvaccinated, to make the community susceptible to measles. So even though levels overall are pretty high,

you know, we do have susceptibility to some of those introduced infections and so I think that's the thing that we need. Thio gonna be focusing on is to try to keep those levels high and and keep those really severe infections like measles has the potential to be out of our communities, will them? This is the end of the vaccines argument. You heard it. It helps. It's safe, and it has a potential off keeping dangerous infections out of our communities. So take this podcast here with your anti vaxxers friends. Maybe, just maybe, we can change their mind, but with all seriousness, although that was pretty serious. One aspect that's not usually discussed when it comes to this vaccinations Vergis not vaccinating topics as how viruses mutate.

And the real problem lies in the mutation. Because if somebody who's part of not vaccinated community brings in the virus and the virus infects that community, that doesn't really affect you and I, who are vaccinated until the virus mutates. And if it mutates to the point where it can infect somebody who's already vaccinated, that's a huge problem, because that means of getting also infect somebody else who's vaccinated. And then it can quickly spread to millions and millions of people. So, yes, technically, if somebody who's not vaccinated who gets their community sick and they will die, that doesn't really affect vaccinated people until the virus changes enough, then it kills everyone else with them. Anyways, on this happy note,

this is all I've got for you this week. If you like this, or you wanna give me a comment or share something that I should bring on next episode of Smash Notes, please let me know if there are any podcast that you know about that You think it really cool and I should include instant Ashman notes. Please let me know. Once again, it's feedback at smash nose dot com. And if you're a podcaster and you'd like to promote your podcast on smash notes, please reach out. And now we are one by James Doherty. Have a great weekend. I'll see you next time.

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