The Shutdown Shuffle

In this fever dream of an episode, Arghavan and Alyssa perform a thorough examination on America's latest government shutdown drama and the wildly contagious misinformation about immigrant healthcare that's spreading faster than a hospital norovirus. They'll decode EMTALA (that's Emergency Medical Treatment and Labor Act), dissect proposed Medicaid cuts that would make even the Grim Reaper wince, and explore how the Affordable Care Act's subsidies are hanging on by a thread thinner than hospital coffee.

The doctors also share field notes from their recent infiltration of the American Academy of Pediatrics meeting, where they witnessed pediatricians demonstrating superhuman resilience while being chronically underappreciated (seriously, these folks deserve capes). And because even physicians need a good dose of serotonin sometimes, they wrap up with a prescription for finding moments of joy in a healthcare system that often feels like it's coding.

Side effects may include: sudden clarity, unexpected laughter, and an irresistible urge to fact-check your uncle's Facebook posts about immigration.

Sources:

KFF "1.4 million lawfully present immigrants are expected to lose health coverage due to the 2025 tax and budget law"

KFF "ACA marketplace premium payments would more than double on average next year if enhanced premium tax credits expire"

JAMA Network Open "Patterns in patient encounters and emergency department capacity in California, 2011-2021"

AP "Looming health insurance spikes for millions are at the heart of the government shutdown"

CBS "The facts behind the government shutdown debate over health care and immigrants in the US legally"

NBC "GOP misleads with claim that Democrats shut down to give health care to 'illegal immigrants'"

National Immigration Law Center "Fact checking immigrants, health care, and the 2025 tax and budget law"

Thanks for listening to The Present Illness with Drs. Arghavan Salles and Alyssa Burgart!

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Read our hot takes at Arghavan’s Substack and Poppies & Propofol

Chapters

• 0:00 Introduction to The Present Illness Podcast
• 7:42 Emergency Medical Treatment and Labor Act (EMTALA)
• 14:51 Affordable Care Act and Healthcare Subsidies
• 22:48 Conclusion and Reflection on Immigration and Healthcare
• 29:53 The Economics of Pediatric Care
• 39:25 Closing Thoughts and Reflections

Transcript

Arghavan (00:01.496)
Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's a little febrile and definitely underdiagnosed. I'm Arghavan Salles, a surgeon scientist and your friendly neighborhood doom scroller in residence.

Alyssa Burgart (00:16.573)
And I'm Alyssa Burgart an anesthesiologist and bioethicist who tracks news and health law like they're EKGs, full of spikes and surprises, some of which might take us out if we don't pay attention. The Present Illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the other.

Arghavan (00:34.122)
Thanks to everyone listening, especially all our new listeners from last week. Thank you for sending us such lovely feedback and for engaging. We're so glad this resonates for folks. Extra love to our subscribers and a warm welcome to anyone who just stumbled in from the government shutdown.

Alyssa Burgart (00:49.13)
my gosh, well we're glad you're here. Let's get into it.

Arghavan (00:52.354)
Yeah, so what I thought would be really helpful to talk about today is the government shutdown because I was just scrolling as I do and there just seemed to be so much disinformation and misinformation, especially coming from our politicians, the folks who are responsible for the shutdown itself. And even for me, I was looking around, was like, wait, what is actually happening? Like, what is the actual reason? What is the thing that...

both sides could not agree on. Because if you look online, you'll see folks like Mike Johnson and JD Vance saying that the whole problem is Democrats want taxpayer money to go to funding healthcare for who they call illegal aliens. We do not endorse that term, but that's the term that they use. And when you're looking at that, I mean, if you're a physician or if you work at all in healthcare, you're thinking, what? Since when does that even happen? But I know that a lot of people don't know.

what's actually happening in healthcare. And the other thing is, as always, there's a nugget of truth in there. There is a nugget of truth in there, but gosh, it's so hard to figure out what that truth is if you're trying to just learn from social media. So I dug into it a little bit. Okay, I am not a policy wonk, but I dug into it to see what are they even talking about? So here's what I think like JD Vance and Mike Johnson, when they're talking about these people they call illegal, quote unquote, illegal aliens.

Alyssa Burgart (02:05.022)
Okay.

Arghavan (02:16.949)
What they're talking about is a group, I think, as far as I can tell, is a group of people called lawfully present immigrants. So these are immigrants, as the term implies, who have a right to be here. They have been given permission to be here. They are not undocumented. They are going through a process to be able to stay here legally, but they do not yet have, say, permanent legal status like a green card holder, or they have not yet been granted asylum, but they are in the process.

perhaps of having that evaluated. So some specific folks who are in question here, and by that I mean that Democrats are trying to make sure these folks still have coverage and Republicans are trying to kick them off of coverage, are folks who were granted a withholding of deportation, for example, meaning our legal system said they should not be deported from this country. Certain survivors of domestic violence and human trafficking.

certain folks who are members of nationally federally recognized Indian tribes. Some, this was funny to me, some conditional entrance they're called from before 1980. Folks who have been here for over 45 years.

Alyssa Burgart (03:27.165)
I can't. can't. Okay. And the other thing is, you know, I just feel like it's an important thing to say. One, you can't be an illegal human being. Like this is ridiculous. And certainly not in a country that stole all the land from all the people who were here before. So, you know, I just wanted to say that. But the other thing that I think is super important for me as a physician, and I'm guessing you share this, is that

Arghavan (03:30.718)
I know.

Alyssa Burgart (03:52.497)
You know, it's a political choice to say that we're gonna take care of any human being who needs to be cared for. And that's a political choice that I want to make. And when we think about, you know, laws like EMTALA, which is the Emergency Medical Treatment and Labor Act, that, you know, the idea is that anybody who shows up for care, for example, at a hospital, especially if it's an emergency, certainly shouldn't be denied care because we're waiting to decide if they deserve it or not. So,

Arghavan (04:17.153)
Well, I'm so glad you mentioned that because that's exactly what our vice president referenced. So he made these comments about how emergency departments are overcrowded. And he said, this is not verbatim, but basically that when you are in an emergency department looking around, you'll see quote unquote, illegal aliens who are crowding up that space and they are why you are having a harder time accessing care.

in that emergency department. So in response, many people have brought up exactly what you did, which is EMTALA, which requires physicians and hospitals to treat people who show up regardless of their insurance status.

Alyssa Burgart (04:52.464)
Well, but-

Alyssa Burgart (04:59.368)
And I think it's also super relevant to say that the idea that you look around and you can see that illegal human beings are trying to get care is just, it's like saying the quiet part out loud, that there's so many things about what this administration is trying to do to immigrants that are truly just racial profiling. If you happen to be a brown person or you happen to speak Spanish or you happen to just not speak English, then you must not have any

Arghavan (05:06.155)
Hmm

Alyssa Burgart (05:27.962)
reason to be here and you must and then that you must not deserve to have care as a human being and I just find that infuriating.

Arghavan (05:32.367)
Correct.

Arghavan (05:37.099)
It's definitely not humanitarian of him at all, but also it's the suggestion that you could tell, like if you just look around an emergency room that you could somehow tell who is undocumented and who is not. That gets back to exactly what you were saying, that the implication is anyone who doesn't look like they are of white European descent must be illegal. And again, I agree that there's no such thing as illegal people.

Alyssa Burgart (05:58.576)
We just.

Alyssa Burgart (06:02.344)
We might need to start incorporating, as we figure out this podcast thing, we might need to start incorporating some sound effects like a dog whistle.

Arghavan (06:11.027)
Yes, correct. So those are at least two of the problems with what he said, right? One, this idea that you could tell who is undocumented by looking around. Two, that those people are the reason. So three, actually. So the second is that those people would be the reason for overcrowding, which is not the case. And then three, that we should somehow not treat people who are in the emergency department, despite the fact that Imtala exists. Imtala, by the way, was signed into law by Ronald Reagan, who some may remember.

was a Republican.

Alyssa Burgart (06:42.267)
The other thing I want to draw I want to draw into this before we just because we've talked about this being the emergency medical treatment and labor act and so it's for people who are giving birth for example this is part of what means that like no matter what hospital you show up at if you happen to be in labor you're about to give birth to a baby you should have access to care and so I think it's also really important to tie this to the birthright citizenship case that happened recently because this administration also does not want

people who do not have legal status, do not want their children who are born in the United States to have birthright citizenship. And so this is also part of this whole conversation, even though it's not maybe said out loud.

Arghavan (07:22.773)
Well, and I thought you were gonna go a totally different direction because there were lawsuits that were brought by the Department of Justice prior to this administration about states such as Idaho trying to deny pregnant people care when the care they needed was abortion. And so there have been people having to be flown from Idaho to neighboring states when they are in a state of emergency, you. And so that was the whole case was centered around this idea that Imtala

Alyssa Burgart (07:36.356)
Mm-hmm.

Mm-hmm.

Arghavan (07:49.832)
demands that we provide whatever treatment is needed to stabilize people. And the state of Idaho said, no, it does not. We do not have to do that. And in this administration at the beginning of this year, they dropped that suit. So anyway, that was not the main point, but I just wanted to add that in there since we're talking about EMTALA So back to this idea of ED overcrowding, I just want to address.

Alyssa Burgart (08:12.41)
pro-pronatalism, pronatalism, it's so anti-woman. It's so anti-children, it kills me.

Arghavan (08:17.532)
It is and I love.

It's anti-life. It's anti-life. I mean, as the Pope said himself. I know, a little off the side. okay, back to... No, you're good. You're good. So the ED overcrowding issue, I do just want to address that very briefly. I know I've had a tendency to be over detailed and overwhelmed, but ED overcrowding, we do have some data that help us understand what is contributing to ED overcrowding.

Alyssa Burgart (08:22.743)
I know, I know.

Alyssa Burgart (08:27.212)
And da pope. Okay, sorry, I had to. I had to.

Alyssa Burgart (08:38.04)
Yeah, For sure.

Arghavan (08:50.474)
And it will be no surprise to anyone who works in healthcare that immigrants are not on the list of things that are causing ED overcrowding. In reality, I'll just say one study which was looking at California ED volumes from 2011 to 2021. And what they found was in that period of time, the number of hospitals that existed decreased, the number of inpatient beds decreased, the number of patients showing up in emergency departments increased,

And in particular, the number of high acuity, meaning the sickest patients increased significantly, over 60 % more. And the number of low acuity patients, meaning the least sick patients decreased significantly. So you can imagine if we have fewer hospitals, we have fewer beds, we have more sick patients, obviously that's going to result in longer wait times. And again, as you notice, immigrants were not part of that equation in any way. Okay, so back to these types of people who the Republicans don't think deserve

So we talked about some of these folk survivors of domestic violence, et cetera. There's also people who have temporary protected status, people who are here on work visas, people who are currently applying for their green card and certain other specific categories. So the point is, again, these were people who are here lawfully and there are about, according to the Kaiser Family Foundation, 1.4 million people who would lose access to health insurance if the Republicans get the version of this bill that they want.

So that's one thing that the Democrats are saying, no, we would like to cover these folks. But in the PR game that is politics, that's been turned into Democrats want your taxpayer dollars to cover these undocumented immigrants, which is really not the case. All of the groups I talked about are documented. They are working within the legal system. They are legally allowed to be here. to say that anyone should be denied healthcare is obviously atrocious.

But especially to say that folks who have every right to be here don't deserve healthcare is a level of cruelty that I cannot fathom.

Alyssa Burgart (10:57.914)
Well, and it's just the other thing is that it's really illogical. Like it's actually makes a lot more sense for a society to ensure that in general we are preventing Illness, we are preventing injuries, that we are doing things that actually, you we provide preventative care. So it actually makes more sense for us to do those things so that people don't show up with life threatening emergencies that were preventable because they didn't have access to care before.

So it's also like this circular reasoning that is just truly this othering of other people that are being scapegoated.

Arghavan (11:32.497)
Exactly. think scapegoating is exactly the right word. And that leads me to another little point that I think builds into the Republican narrative around this, which is that the only time in which the government does in some ways pay for health care for folks who are undocumented is if they do show up to the emergency department with a true state of emergency and they are treated. Hospitals have the opportunity to apply for Medicaid funds to reimburse the cost of the hospital. That money does not go to those immigrants.

it's just to basically let those hospitals keep their doors open so that they can continue to operate for everyone. And I think that's another piece where they're trying to twist that and say that that is money, that's federal taxpayer money that's going to undocumented immigrants. But again, we have the responsibility because of Imtala to treat those patients.

And of course we should morally and ethically, we have an obligation to treat those patients, but even just legally in this country, in the laws that this country has created, we have to treat those patients and getting those funds from Medicaid allows hospitals to stay open so that they can care for everyone. So that's one point, is the 1.4 million people who would immigrants who would lose access.

Alyssa Burgart (12:39.449)
I and it's also like they already cut over a trillion dollars from Medicaid and Medicare over the next 10 years. like, they're already taking away so much from society. And it's just infuriating this idea that someone needs to be deserving of basic health. It's also like,

Arghavan (12:46.212)
Medicaid.

Alyssa Burgart (13:05.497)
It makes it's frustrating as well. Like, you know, if you think about, for example, like the maha movement, the make America healthy again movement and this idea that like we should really be, you know, promoting. I think there's a lot of things that that you and I would agree with, right? We want to like prevent chronic Illness. We want to prevent, you know, preventable harm. We want to make sure that, you know, food is is safe. I mean, I think that takes regulation, but whatever. And it's just interesting.

Arghavan (13:29.809)
You

Alyssa Burgart (13:34.122)
that these are

truly opposing beliefs that have found a home in the current Republican movement. It's really fascinating, right, that you have this huge maha movement that has really brought in especially a lot of young white moms in particular. And it's all about health. It's really focused on, you know, we want our kids to be safe and all these things that we should all be able to agree are important and find.

Arghavan (13:45.681)
Mm-hmm.

Arghavan (13:55.057)
Mm-hmm.

Alyssa Burgart (14:06.071)
policy solutions that get us there. But instead, we have this completely opposing approach that actually decreases the health of families, decreases the health of children, increases maternal morbidity and mortality, increases infant morbidity and mortality. In addition to the fact that we already have whole swaths of people in America who are citizens who don't have access to any sort of healthcare support at all.

and can't be employed or they're unhoused or you know all these things that actually are really making it so that America isn't unsafe and really lacking that ability to have societal health. So it's so interesting like hearing these arguments that have to do with health care that are truly in opposition to things that apparently a bunch of people in in the you know current like Republican mix of things like you would think would find important.

Arghavan (15:04.188)
Yeah, I agree. It's quite the juxtaposition, right? On the one hand of saying we want everyone to be healthy, on the other hand, we want to revoke access to health insurance.

And I mean, as many have for now.

Alyssa Burgart (15:13.621)
We only want white people to be healthy though. What if it was just white? So gross.

Arghavan (15:16.486)
You're right, only white people. But to that point, what I was about to say is we already know that a lot of these harmful policies are going to impact people in red states more than in so-called blue states. So I just wanna share, since we got here, let me just share this. Data from Louisiana, 64 % of all births in Louisiana are paid for by Medicaid. 74 % of nursing home residents in Louisiana are on Medicaid. And yet you're exactly right that...

Alyssa Burgart (15:30.538)
Yeah.

Arghavan (15:45.39)
the budget that they would like to pass includes the $1 trillion in cuts on Medicaid. And that is the second point that the Democrats have been pushing back on. They want to restore those $1 trillion of cuts for Medicaid. And the Republicans are saying, no, to be fair, what Republicans are saying is let's have that conversation another time. And the Democrats are saying, no, this is the time. We need to have that conversation right now. And then the third point,

has to do with the ACA. So the Affordable Care Act, some call Obamacare, some people don't realize that those are the same thing, but the Affordable Care Act insurers or provides a way to access health insurance for 24 million people in this country. And 20 million out of those 24 million are using some government subsidies that help lower their premiums. And so the other thing that is,

part of the argument here is what should happen to those subsidies. And the Republicans want to eliminate all of those subsidies. So those 20 million people, all of their premiums would go up significantly. The exact amount varies by a number of factors, including what their income level is. But for the lowest income level people, I believe making less than 25,000 a year, their premiums would increase by 573 % if we eliminate those subsidies. For a couple...

60 year old couple maybe making 85,000 a year, their premiums would go up 22,000 a year. Okay, if we get rid of these subsidies.

Alyssa Burgart (17:17.653)
mean, it's just like, it's just like, this is, it's like, do they think this is monopoly money? Like, I don't understand. is it, because that's, I mean.

Arghavan (17:23.353)
Ha ha!

Alyssa Burgart (17:30.57)
I ju-

Arghavan (17:30.592)
I'm with you, it is so hard for me to wrap my head around how people could in one minute talk about how we need to get to the root cause of disease and we need to make our country healthier and in the very next minute say, but you will have to use your entire family budget to pay for your health insurance to be able to access healthcare.

Alyssa Burgart (17:53.087)
Well, and then if you don't, will be, you'll be villainized for being, you know, you can't, why don't you prioritize your health? What, you also have to pay rent? Gross. Why don't you own two houses? I just.

Arghavan (18:07.076)
Because the main problem that I think some people in this country have is that there are people in poverty. And they think that that is like a moral failing or some other personal failing to be poor. So.

Alyssa Burgart (18:12.629)
Yeah, we hate poor people.

Alyssa Burgart (18:21.99)
It is so, it is, and this comes up in my ethics consultation work so often where I get calls and people are like, well, we don't think it's a safe discharge to send this patient back to the streets, but there's like no, you know, there's no shelter available or the patient doesn't want to go to a shelter because shelters aren't safe. And I have to be like, well, yeah, it's not ethical that we don't have housing for people.

Like poverty is unethical and it is so embarrassing to me that like people dare to be like, America's the greatest country in the entire world. We're so amazing. And I'm like, and yet we have no freaking place for people to live. And like, that's bananas.

Arghavan (18:51.937)
Okay.

Arghavan (19:01.764)
Yes, and we're sending $20 billion to Argentina. Anyway, so I do want to just mention that the Medicaid cuts we talked about, the $1 trillion, the estimate is 7.5 million people will lose coverage as a result of those cuts. And when we're talking about the ACA cuts that I, or the subsidies, illuminating the subsidies for ACA access,

per the Congressional Budget Office, which is nonpartisan, that would result in about 4 million people losing access to healthcare. So these are the actual issues. The tagline or the propaganda version is Democrats want, as they use the term, illegal aliens, to have healthcare paid for by American citizens. In reality, the Democrats are advocating for keeping those ACA subsidies so that Americans who are here lawfully

can access the ACA and can have health insurance. are advocating for those cuts to Medicaid to not go through so that 7.5 million people will retain their access to healthcare. And they are advocating for restoring access to healthcare for those 1.4 million lawfully present immigrants. I do wanna just say one more thing and then I think I'm done with my factoids, which is that.

The Medicaid spending that goes to reimburse hospitals for care provided to undocumented immigrants is less than 1 % of Medicaid spending. So even if you wanted to get really hung up on that one point and say we shouldn't be doing that, it's minuscule as part of the Medicaid budget.

Alyssa Burgart (20:43.668)
also think it's just so important to realize like so many of those people who are gonna lose, like when you think about the people who are gonna lose their coverage, I want people to think of grandma and grandpa, and I want people to think about kids, and think about babies. And it's not that those are the only two groups that matter, it's just that when, I think a lot of times when we talk about like seven point something million people, you know a lot of times when we talk about jobs reports, we talk about things like that, it can be confusing to understand like well who is it?

Arghavan (20:55.064)
Mm-hmm.

Arghavan (21:13.187)
Mm-hmm.

Alyssa Burgart (21:13.32)
that's part of these numbers, like who's in that total. And when we talk about losing cuts to Medicaid and Medicare, that means cuts to kids and cuts to people who are no longer in the workforce or who have disabilities. All of these folks who have lives worth living, and when we talk about all these folks who are gonna lose coverage and the support for hospitals and long-term care facilities and places like that,

Arghavan (21:29.603)
Woohoo!

Alyssa Burgart (21:41.224)
Like people will die. Like it's not, and I, like that's not hyperbole.

Arghavan (21:46.017)
Yeah, it's not some esoteric, it's not some esoteric thing, it's not some theoretical problem. These are people's real lives. And you're exactly right, people do die without access to healthcare. And in part because they delay getting care and then they do eventually end up in that emergency department when it's really too late for us to be able to provide the care they needed and could have had access to if we had made policies that allowed them to have that access.

What I also should have stated very, very clearly, so I apologize for not saying this at the outset of this conversation, is that undocumented immigrants have no access to Medicaid, Medicare, the ACA, or CHIP. And that's been the case since 1996. So just back to that, again, that propaganda. it's terrible. To be clear, it's terrible. It's embarrassing to me that it was a Democratic president who signed that into law. But

Alyssa Burgart (22:31.815)
which is embarrassing.

Arghavan (22:41.794)
This, again, this lie that's been put out there about what Democrats are fighting for, it has never been around, and you and I, I think, would agree that maybe it should be, but it has never been around undocumented immigrants accessing healthcare. That does not seem to be something either party seems particularly interested in, unfortunately. But that's what it is.

Alyssa Burgart (23:02.79)
Well, I mean, not when you've not when you know, we've anyway, I just there's so much hatred of people who are immigrants, which makes no sense because like everyone in this country who isn't a Native American is like from immigrants. So I don't understand. I just really don't get it.

Arghavan (23:15.859)
or who didn't come over or who's not a descendant of enslaved people.

Alyssa Burgart (23:21.203)
Absolutely. it's just very, it's just such a, it's like this American mythology that seems to be so prevalent and,

Arghavan (23:34.687)
The people who came, the white European folks who came, they settled on this land. They weren't immigrants. It's those who came later like me and my family. We're immigrants, but they were settlers. So they're different. I mean, I've seen folks making that argument. Anyway, I hope this...

Alyssa Burgart (23:50.706)
Sure, sure. The main thing is not from here. Not from here.

Arghavan (23:55.489)
Correct. Correct. Not from here and funny sounding names and maybe accents and maybe different facial features and... Yeah.

Alyssa Burgart (24:07.602)
Yeah.

Arghavan (24:13.452)
There you have it. That's what's at the center of the government shutdown.

Alyssa Burgart (24:18.865)
Well, you know, it's so funny. like, I'd been following that the government was going to shut down. And I was at the American Academy of Pediatrics meeting. And we were talking about how the shutdown was going to impact kids and impact families. But then I, like, kind of forgot about it because there's so much else going on. And when I logged into my computer to start doing some work, I, you know, I went to PubMed because I do a lot of searches on PubMed. I'd get this big, bright.

banner at the top is like the government shut down and this shit might not be up to date just FYI.

Arghavan (24:53.629)
Mm-hmm. Mm-hmm. Well, not only that, but did you see that, okay, know I'm taking you guys a little bit off to the side again, but did you see that a number of government agencies have a pop-up message that says the Democrats are responsible for the shutdown?

Alyssa Burgart (24:55.311)
So.

Alyssa Burgart (25:06.706)
I mean, I believe it. I haven't seen it.

Arghavan (25:09.343)
It's a violation of something called the Hatch Act, just so folks know. Our federal agencies. I know.

Alyssa Burgart (25:13.116)
But why do we... but who cares about laws when you're just trying to, you know, destroy the government? I don't know.

Arghavan (25:20.382)
They're frivolous, the laws are frivolous, I guess. But yeah, technically it is not legal for them to have those messages up. Those government agencies are intended to, are meant to be, are required to be nonpartisan. And yet multiple of them, HUD, the Small Business Association, the USDA, I'm sure there are more I'm forgetting, have a message like that. Because it's a continuation of the efforts to erode our norms.

and to violate the laws of this country. But anyway, shall we talk more about the AAP meeting?

Alyssa Burgart (25:54.861)
my gosh, yeah, let's. So I got to go to the AAP meeting, American Academy of Pediatrics, and it was in Denver. The weather was delightful, which was lovely. Got to visit some folks that I hadn't seen in a while, which was cool. The plenary on the first major day of the conference was lit. It was fantastic. They just did a beautiful job, I think, like capturing...

Like it takes a lot. People who don't, people who are outside of medicine, I just want like for the, for the idea of the culture of medicine, like pediatricians are the nicest people. They're like the nice, like of all, it doesn't mean that every experience you've had with a pediatrician has been amazing, but like in general, like pediatricians are very nice and like kind and they don't tend to be as cranky maybe as, as, as people in other specialties might be, might be thought of.

Arghavan (26:30.058)
Mm-hmm.

Arghavan (26:39.007)
Thank

Arghavan (26:45.608)
Yeah. I think they're also the most likely to be wearing a costume. Yes.

Alyssa Burgart (26:52.913)
Oh, thousand percent. And you know that I love a unicorn outfit and that's really bringing out the peds flare. Yeah, so the and for folks who aren't familiar with Will Flannery, Dr. Glockenflocken, he wears a unicorn headband when he's impersonating pediatricians. And so there was a lot of unicorn headbands at the meeting this year, which I'm here for it.

Arghavan (27:08.244)
Thank you.

Arghavan (27:12.224)
I'm just picturing swaths of pediatricians walking down these convention hall, like the wallways, then wearing these unicorn headbands. love it so much.

Alyssa Burgart (27:17.521)
Yeah.

I want you.

Alyssa Burgart (27:24.653)
I want you to know that that is absolutely correct. That is not something, that is not an AI generated idea. that actually happened. There were people just walking around everywhere wearing unicorn headbands. It's fantastic. The other thing that happened during the meeting that was phenomenal is the president, Sue Cressley, first of all gave a fabulous, fabulous speech. I wish I could remember all the amazing things that she said.

Arghavan (27:32.767)
reasons.

Alyssa Burgart (27:51.376)
But one of things she had the entire audience do was to stand up and it was like 15,000 pediatricians at this meeting and people like me who are I'm not a pediatrician. I'm a pediatric subspecialist. So I'm like a I always joke I'm like an interloper at these meetings. I'm like, thanks for letting me be here guys But they Dr. Kressley had everybody stand up and have a cathartic bellow a scream if you will To just get out all the vibes because this was happening

Arghavan (27:57.203)
Thank

Arghavan (28:02.675)
Mm-hmm.

Arghavan (28:06.055)
Thank

Arghavan (28:17.663)
Mm-hmm.

Alyssa Burgart (28:20.817)
the week that all the Tylenol stuff, know, the Tylenol stuff, the vaccine stuff, the threats to, the attacks on kids, on immigrant kids, on Medicaid, CHIP, I mean, all these things that are really vital for kids. And kids are some of the people who are hurt really quickly by these things. And I always say, you know, kids don't vote and kids don't work. And so it's really hard to get children, people like to...

Arghavan (28:25.343)
Mm-hmm.

Arghavan (28:46.195)
Mm-hmm. Mm-hmm.

Alyssa Burgart (28:49.346)
talk about children as like a talking point, but then to actually make policies that value children and that put kids first as though we actually cared about the future of our democracy and the future of our population. So anyway, what a concept. So the meeting was actually

Arghavan (29:07.057)
What an idea. What a concept.

Alyssa Burgart (29:13.058)
I was very curious kind of like what the vibes would be and it was as expected. Many a spicy unicorn pediatrician. I had a lot of fabulous conversations with pediatricians. I talked with all of them. said, hey, like it seems like there's a lot of, you know, more and more misinformation and disinformation about kids' health, about diet, nutrition, about, you know, all sorts of things.

Arghavan (29:16.031)
Mm-hmm.

Arghavan (29:20.697)
Thank you.

Alyssa Burgart (29:37.417)
And it was really nice just like having the opportunity to be around a bunch of pediatricians from all over the country and hearing like how they are trying to navigate these conversations. How are they, you know, really doing their best to build relationships with their patients and their patients' families? And it just gave me...

Arghavan (29:52.062)
Okay. Hmm.

Alyssa Burgart (29:58.031)
Pediatricians have this true north on these issues that I think is really valuable. It's really important. And I think we're gonna need to harness that kind of energy, especially as we think about things like the Maha movement. We don't want to be in opposition to people who are interested in improving the health of people in America, but it's like we have to find ways that rely on actual evidence and

Arghavan (30:21.637)
Mm-hmm.

Alyssa Burgart (30:27.447)
that can be grounded in real conversations about the shortfalls of medicine, as you and I have talked about before, as well as the shortfalls of society in terms of what are the things that actually work and how do we lean into those things? whatever people's political affiliations are, like if you think about kids, whatever their parents believe, that shouldn't be the difference as to whether or not kids have access to healthy food and kids have access to

Arghavan (30:50.738)
Mm-hmm.

Alyssa Burgart (30:55.5)
disease prevention and kids have access to vaccination to prevent disease. So I just thought it was really, it was a very, it was a very hopeful community to be with despite all the anxiety around things that are happening.

Arghavan (31:09.598)
Hmm.

Arghavan (31:13.082)
Well, thank you for sharing that. I one of the things that I think is really impressive about pediatricians is their resilience, as they have been really attacked pretty directly for a long time now, especially by the anti-vaccine movement. And I don't know, folks listening know this, but pediatricians don't make very much money. They are amongst the lowest paid of all physicians. And there's all this rhetoric that comes out about how they're getting paid for vaccines.

Alyssa Burgart (31:30.443)
No.

Arghavan (31:39.282)
and that that's the motivation for giving children vaccines.

Alyssa Burgart (31:41.199)
So let me... and so that Dr. Kressley brought that up actually in her keynote and the collective cackle that came out of the audience.

Arghavan (31:45.406)
Thank you.

Arghavan (31:49.373)
Yes, because I don't know if people know, but many offices lose money on vaccines because of what it takes to have vaccines stored safely and appropriately and then to administer the vaccines. Often all of that costs more than the amount that they get reimbursed by insurance. They're actually providing that service not to make money, they're losing money often on it, but they're doing it because they know that's the right thing for children. I just thought it was

relevant to point that out because this narrative that and I even get I mean I'm not a pediatrician but I get these comments on my posts about how I'm getting paid to vaccinate people let me just tell you if you have a bariatric surgeon ordering your vaccines for your children like it's probably not the right place but anyway I've never I've never ordered a vaccine for a patient but right like it's so funny to me that people think I'm the one doing that but but but that rhetoric is

has been put out and repeated so often that people genuinely believe, or at least some people genuinely believe that pediatricians are making money off of vaccines. And I think to my knowledge and understanding from all the folks I've talked to, that is very, very far from the truth.

Alyssa Burgart (33:00.11)
truly the laughter in the community when people said, when that comment came up, it was hilarious. And what you were saying too, pediatricians in particular are very poorly paid. It's embarrassing. And anybody who chooses to take care of children as a subspecialist, like if you're a surgeon and you become a pediatric surgeon, you're gonna make less money. You're an anesthesiologist, you become a pedzianesthesiologist, you're gonna make less money.

Arghavan (33:24.175)
Okay.

Alyssa Burgart (33:27.861)
unless you're in a really unique situation. so pretty much anybody who chooses to take care of children is choosing to take a pay cut. And part of that is, again, because of the way that we don't value the health of children in the way that we've arranged billing. obviously, is like, turns out that capitalism in health care is not going well. It's not a good fit, because it's not

It doesn't make any sense. Like it doesn't make sense that that's the way that we think about the health of our communities.

Arghavan (33:56.804)
Yeah. Right, and I think that connects back to what we were saying too about like the ED crowding conversation that we had earlier. Like that's a good part of it too, is because everybody is, the way our hospitals are structured is around capitalism. It's all about profit, but healthcare should not be about profit. It should be about health. And we made as a country that decision a long time ago and we're now dealing with the consequences.

Alyssa Burgart (34:23.989)
Yeah, and as it's interesting too, because you know, hospitals, because we do, you know, any hospital, for example, that takes care, any hospital that has a training program, for example, as you know, has to accept money from Medicaid, they have to take Medicare and Medicaid patients. And so that means that hospitals also could make a lot more money if they didn't take care of people who are getting support from the government for their health. But the reason that we do that is because that's better for

it's better for the population. So it's, it's frustrating and hospitals run on these very narrow margins. And part of that's because of the, you know, the rise of so much administration being used to run these places. And a lot of that's around billing and what it takes to bill for these services, to work through insurance, insurance refuses to pay for so many things. So it's all this whole ecosystem of, of hospital economics is, is not working.

Arghavan (34:55.352)
Mm-hmm. Mm-hmm.

Arghavan (35:07.324)
on the internet.

Arghavan (35:14.918)
Mm-hmm.

Arghavan (35:22.09)
yeah, it's definitely not working for the American people. I think it's working for some executives, but it's not working for those of us trying to provide healthcare and those of us seeking it.

Alyssa Burgart (35:39.245)
What you want to talk about next?

Arghavan (35:40.86)
No, I think that's good. Because how long has it been? 35 minutes or something? I mean, we could, obviously we'll have to edit this part out. We could do like, on that note, what's something you're looking forward to in the next week? We could do something like that. Or you know, some people do like, what's something that's bringing you joy? Like people like to do that. Like we could do something like that if we want, or.

Alyssa Burgart (35:42.75)
Yeah, okay. yeah.

Alyssa Burgart (35:59.626)
Mmm. Mm-hmm.

Arghavan (36:07.536)
We could do, we'd need some kind of transition, but then just go into the end piece.

Alyssa Burgart (36:12.306)
Yeah, I kinda like the idea of like, what's bringing you joy?

Arghavan (36:19.206)
Let's do it.

Alyssa Burgart (36:19.21)
What's bringing you? Yeah, let me, I want to look up the name of that. I actually don't know his full name that, that TikTok I sent you.

Arghavan (36:27.954)
yeah, yeah, yeah, that was so good.

Alyssa Burgart (36:29.632)
His last name's Wells. yeah, Jesse Wells. Love him.

Arghavan (36:32.612)
Okay, you know what, then I might as well talk about this carabiner lady. Briefly.

Alyssa Burgart (36:37.068)
Okay, let me...

Arghavan (36:40.954)
Let find her username.

Alyssa Burgart (36:54.984)
Okay. Well, listen, Arghavan.

Arghavan (36:56.781)
All right, so the last thing was, sorry, go ahead.

Alyssa Burgart (37:01.225)
No, you go ahead.

Arghavan (37:02.715)
I was trying to remember which of us had said the last thing. I think it was you.

Alyssa Burgart (37:06.603)
I think it was me.

Arghavan (37:08.347)
So then do you want me to do the transition? Or do you want to do it? I don't know, okay. Well on that note, I think we've covered a lot of ground. I'd love to hear before we go, one thing that's bringing you joy.

Alyssa Burgart (37:11.795)
Yeah, sure.

Alyssa Burgart (37:24.083)
What is bringing me joy? Well, I'll tell you, you know who I love is Jesse Wells. He's on, you know, TikTok and Instagram and all that stuff, but he's, I guess it's like folk singer. I think he is the modern, like Pete Seeger. He's the modern,

like Bob Dylan, he's writing these really fun songs and he's doing it so fast. I'm so impressed. But it's just a bunch of videos of him singing about current political and culture topics out in the woods. And I think it's fantastic. He had a song recently about Tylenol that I sent you in our little text thread. And yeah, every time I see one his videos, I'm like, yeah, I'm going to listen to that guy. What about you?

Arghavan (37:58.928)
Mm.

Arghavan (38:10.501)
Yeah, I love that. Well, I'll do another similar social media thing. There is a creator named, well, I don't know what the person's name is, but the account is Jujjunction. J-U-J. I don't know. I don't even know that's how that's pronounced. Anyway, this creator, if folks haven't seen, is on TikTok and has a company around customizing carabiners. Carabiners are those little pieces that you use to like attach your water bottle onto your backpack or anyway.

look it up if you don't know what a carabiner is, this person has this company because they wanted to bring people joy in the mail. That was their whole rationale that they loved getting actual mail that wasn't like a bill. And so they decided to create this company around sending people things that they could send to their friends. They include artwork in their packages. It's very cool. But anyway, the idea is to send people something that's not.

Alyssa Burgart (38:49.802)
Okay.

Arghavan (39:04.236)
unpleasant in their mail. And this person had made a video announcing their new packaging and they were very excited about a term that they were using that was a shortened version of carabiner that happens to be a slur, a racial slur. this person, the reason it's bringing me joy is that this person's reaction to being called out and called in is really just joyful. Like they took it so seriously and

We're so apologetic and we're so used to people doubling down and saying, no, it was fine. I didn't do anything wrong. You're just too sensitive. Right. We're so used to that reaction, especially in politics, which is around us a lot right now, that it was really refreshing to see someone say, my gosh, I cannot believe I did not know that this was a racial slur. I had no idea. Thank you for telling me. I'm so, sorry. I'm going to throw all of that packaging in the waste because I don't want to offend a single person.

I'm so sorry, how can I ever regain your trust? mean, like, just so earnest and so apologetic and really taking that feedback to heart. And you just don't see it often. And so what's funny too is like, there's a lot of people, especially people of Latino, Latina origin saying, no, I want the original packaging, please send me the original packaging. I think it's hilarious. And this person is like, no, I'm not gonna do it. I'm not gonna do it because it's offensive. And I don't wanna do that. I don't wanna hurt a single person.

Alyssa Burgart (40:10.356)
Mm.

Arghavan (40:28.429)
And again, you just don't see that that often. So it gives you a little bit more faith in humanity that there are still people who really do care and who care about like strangers feelings and want to do the right thing.

Alyssa Burgart (40:42.312)
Yeah. And you know, it's so interesting too, cause I think when I'm always so fascinated when I hear people being like, well, I don't want to have to be politically correct, which is like such a nineties way to say it. But you know, I just think.

Arghavan (40:52.279)
Mm-hmm.

Alyssa Burgart (40:57.418)
It's important when we offend people that we care about their human dignity and we think like, can I make this right? Wow, that was not my goal. I think some people, their goal is to offend people and they think that's fun. I don't love that. So I'm glad you shared that story.

Arghavan (41:07.118)
Mm-hmm.

Arghavan (41:16.057)
Yeah, of course. And especially since you brought up, okay, last thing and then we'll be done. But since you brought up the politically incorrect, Pete Heksef earlier this week when he brought all the generals from around the world to listen to his speech, that's one of the things he said, that we're not going to be politically correct anymore and we're not going to be bogged down anymore by the rules of engagement. By the way, not following rules of engagement is how we got the Holocaust. So anyway, on that note,

Alyssa Burgart (41:19.274)
Hahaha!

Arghavan (41:45.878)
That's it for this week's episode. If you didn't like what you heard, this has been the House of Pod. If you liked it, don't forget to subscribe to The Present Illness and leave us a review and tell your friends or your primary care doc.

Alyssa Burgart (41:59.331)
You can follow us on social media. We're going to have all of our names at the bottom of the episode in the show notes. You can find Arghavan at ArghavanSallesMDPhD and ArghavanSallesMD. You can find me at Burgart BurgartBioethix with an X at the end. We post smart stuff and sometimes we post some spicy takes. We're both on Substack. Come check out Poppues and Propofol. That's where I'm doing a bunch of stuff. Arghavan what's your Substack called?

Arghavan (42:19.8)
it's very, I'm not a very creative person. It's just arghavan.substack.com. It's super hard to find. We will be back next week with more headlines, hot takes, and doom scrolling wrapped in some laughs.

Alyssa Burgart (42:39.401)
Well, until then, agitate, hydrate, take a nap.

Arghavan (42:43.02)
and we'll see you next time on The President Illness.