The Privatization of Veterans' Healthcare | ft. Dr. Rachel Madley

The ALICE Crisis (pt 2): How America Can Stop Failing Its Working Families

In Part 1 of this series, Doug Griesenauer and I laid out the problem: 42% of American households are financially struggling right now, not because they aren't working, but because the federal poverty level — a formula built on 1955 grocery data — still determines who qualifies for help in 2026. Now in Part 2, we get into what we actually do about it. Doug returns to walk through the things that change practically and politically if policymakers adopt the ALICE threshold instead of the federal poverty level, and the difference is significant. Benefits phase out as families can genuinely afford to lose them instead of at an arbitrary cliff that punishes people for earning more. Financial stress drops. Workplace productivity rises. The math starts working for working families instead of against them. We also go somewhere many policy conversations won't: a hard look at whether large corporations are deliberately relying on public assistance programs to offset wages they should be paying themselves. Doug lays out a clear framework: micro solutions at the business level, meso solutions at the community level, and macro solutions at the policy level. And he makes thecase that this is NOT a partisan issue, because when you strip away the labels, most Americans across the political spectrum agree that people who work hard should be able to get by.Key topics covered: -What immediately improves for working families if ALICE replaces the federal poverty level -Why financial stability helps workers but also makes businesses more productive and the broader economy stronger -The uncomfortable question of whether corporations are subsidizing low wages with public benefits -Matthew Desmond's research on the true cost of addressing poverty — and why it's a matter of will, not budget -The two-path solution every American needs to understand: raise wages or update the support threshold OR both! -Practical steps anyone can take, including the Volunteer Income Tax Assistance Program This two-part series is essential listening for anyone who wants to understand why the American safety net fails working families, and what a better system looks like. Guest: Doug Griesenauer, VP of Community Impact, United Way Suncoast ALICE Research: unitedforalice.orgRecommended reading: Poverty by America by Matthew Desmond Take action: Call 202-224-3121 to reach your congressional representatives and tell them that healthcare costs and reform to the outdated federal poverty level are priorities If this series opened your eyes, please subscribe, share it with someone who needs to hear it, and leave us a review. Until next time — stay informed and take charge of your health. Disruptive Dialogue is hosted by Chuck Melendi, a 35-year healthcare industry veteran committed to exposing the systems failing American patients.and the people working to change them. New episodes every two weeks.

The ALICE Crisis: Why 42% of Working Americans Struggle to Make Ends Meet

Did you know that the federal poverty level was built on grocery price data from 1955 — and has never been updated to reflect how we live in America today? In this episode, Chuck sits down with Doug Griesenauer, VP of Community Impact at United Way Suncoast in central Florida, to unpack one of the most overlooked crises in our country: the gap between who our safety net programs offer to help and who actually needs it. They dig into ALICE — "Asset Limited, Income Constrained, Employed" — a research framework that reveals 55 million American households are financially struggling right now. Not because they're not working. Because the system wasn't built for how we actually live. What you'll learn in this episode: Why the federal poverty level is broken in three distinct ways — and why policymakers have known it since the 1960s What ALICE is and why it's a far more accurate picture of financial hardship in America The "fiscal cliff" (also known as the "valley of death") — why getting a raise or a promotion can actually leave working families worse off How financial instability drives people straight into the most expensive healthcare settings: emergency rooms Why 42% of America is struggling financially — and most of us never see it This isn't a conversation about handouts. It's about hardworking people — single parents, dual-income families, people working two jobs — who are doing everything right and still can't afford housing, childcare, transportation, or healthcare. That's a policy failure, not a personal one. This is Part 1 of a two-part series. Part 2 drops next week. Subscribe so you don't miss Part 2 Like if this opened your eyes Did any of these numbers surprise you? Take action: Call 202-224-3121 to reach your senators and representatives. Tell them healthcare costs and the outdated federal poverty level need to be addressed — now. CHAPTERS 00:00 Introduction — The quiet gap in America 01:50 Meet Doug Griesenauer, United Way Suncoast 03:20 Financial health IS physical health — the dental divide 04:50 What is the federal poverty level and where did it come from? 05:15 Dr. Molly Orshansky and the 1955 grocery basket 08:30 Three ways the FPL is broken: food, geography, and household type 15:00 What ALICE is and how it was built 19:10 The ALICE numbers: what it actually costs to get by by state 21:35 42% of America — 55 million households — are struggling 22:30 Why wages haven't kept up and costs keep climbing 26:30 The fiscal cliff: why a raise can make you poorer 28:10 Refusing promotions might be the smart economic choice — and that's a system failure 30:32 Chuck's call to action CONNECT & LEARN MORE 🌐 Disruptive Dialogue: www.disruptivedialogue.org 📊 ALICE Research: unitedforalice.org Disruptive Dialogue is hosted by Chuck Melendi, a 35-year healthcare industry veteran on a mission to expose the systems failing American patients — and the people trying to fix them.

Abolishing Medical Debt for 14 Million Americans — One Dollar at a Time

One in three Americans carries medical debt — and most of them have health insurance. In this episode, Chuck talks with Eva Marie Stahl of Undue Medical Debt about why insurance isn't protecting patients the way it should, what to do when the bills pile up, and how one nonprofit organization has abolished over $25 billion in medical debt for more than 14 million people. Eva brings more than two decades of health policy experience and a front-row seat to stories that bring the statistics to life: a North Carolina man hit with nearly $10,000 in bills after a brain aneurysm, a Chicago woman with sickle cell anemia still paying off hospital bills from 2017 — both insured, both blindsided. This episode covers the real drivers of medical debt, the little-known ways patients can fight back, and why medical debt reform is one of the few policy issues that polls above 80% across both political parties. Listen and learn about: * Why high-deductible health plans leave millions of insured Americans financially exposed — and why most people can't cover even a $500 surprise bill * The critical difference between medical debt and consumer debt, and why it matters for your financial protections * Practical survival tips: why you should never pay a medical bill with a credit card, how to apply for hospital financial assistance (even on a six-figure income), and how to negotiate your bill down * How unpaid medical bills become a commodity — bought and sold in bulk on an open market — and how Undue Medical Debt purchases those portfolios and cancels the debt instead of collecting it * What extraordinary collection actions (wage garnishment, property liens, lawsuits) are, and which states are moving to ban them * Results from Undue Medical Debt's national survey: 94% of voters want interest rate caps on medical debt, 80%+ want it removed from credit reports — and these numbers hold across party lines * How every $1 donated to Undue Medical Debt abolishes $100 in debt — and how you can be part of the solution 🌐 Visit UnduemedicalDebt.org [https://unduemedicaldebt.org] to donate, learn, or find out if your community has been part of an abolishment campaign. 📞 Call Congress directly at 202-224-3121 and ask your senators and representatives to support medical debt protection legislation. Disruptive Dialogue with Chuck Melendi — because the healthcare system isn't going to fix itself. Subscribe, share, and leave a review! Together, #LetsFixHealthcare. Learn more at disruptivedialogue.org.

The Privatization of Veterans' Healthcare | ft. Dr. Rachel Madley

Private insurance companies are increasingly moving into veterans' healthcare and, according to health policy expert Dr. Rachel Madley, the consequences could reshape one of America’s most successful public healthcaresystems. In this week’s episode, Chuck welcomes Dr. Madley to talk about about the growing privatization of the VA through the Veterans Community Care Program and the VA Mission Act. They explore how companies like UnitedHealth Group and Optum Serve are gaining influence inside public healthcare programs, why many experts see concerning parallels with Medicare Advantage, and what this means for veterans, taxpayers, and the future of healthcare reform in the United States. The conversation covers the economics of privatization, conflicts of interest in healthcare administration, the political influence of insurance lobbying, and why the VA often delivers better outcomes at lower cost than private systems. Dr. Madley also explains why she believes reinvesting in VA facilities and staffing would strengthen care for veterans far more effectively than outsourcing administration to private insurers. Topics include: • The VA Mission Act and Community Care• Medicare Advantage and privatization trends in public care• Healthcare lobbying and political influence• Optum Serve and vertical integration concerns• Traditional Medicare versus private insurance administration• Why veterans’ care matters to all taxpayers Our Guest Dr. Rachel Madley is Executive Director of the Center for Health and Democracy [https://www.centerforhealthanddemocracy.org/], a nonpartisan nonprofit advancing policy reforms to lower health care costs and expand access to care. She brings a rare combination of scientific expertise, Capitol Hill experience, and personal perspective as someone living with Type 1 diabetes. Notably, she contributed to the passage of the Inflation Reduction Act as Health Policy Advisor to Congresswoman Pramila Jayapal. Dr. Madley holds a PhD in Microbiology and Immunology from Columbia University and her work has been featured in The New York Times, Newsweek, and Business Insider.

PBM Insider Exposes How Billions Are Hidden From Your Health Plan | ft. Ryan Rice @Prism Health

The system controlling prescription drug pricing was designed to save money. Instead, it's costing employers billions. In this episode, Chuck sits down with Ryan Rice, CEO of Prism Health Group and former senior executive at Express Scripts and Navitas Health, for one of the most frank conversationsabout Pharmacy Benefit Managers (PBMs) you'll hear. Ryan’s firm has delivered over $1 billion in plan cost savings to his clients. He knows exactly how the game is played, and in this episode, hemexplains how we can stop losing it. If you or your employees receive health insurance through an employer, this episode is required listening. What You'll Hear: Ryan breaks down how PBMs were originally created to use collective buying power to lower drug costs ,but that mission has been quietly hollowed out as these companies grew into publicly traded giants that answer to Wall Street shareholders instead of plan members. He and Chuck walk through the mechanics of rebate manipulation: how drug manufacturers pay rebates that pass through a GPO, and how employers often receive only afraction of what they're owed. A single administrative reclassification can shift hundreds of millions of dollars. Most employers never even know it happens. They dig into the recent bipartisan 2025 Consolidated Appropriations Act and the uncomfortable truth that full enforcement doesn't kick in until 2028 at the earliest. PBMs are typically 5 to 10 years ahead of any regulatory action, backed by nearly half a billion dollars in annual lobbying and special interest contributions. But this episode isn't just a takedown. Ryan and Chuck spend significant time on solutions — specifically, a model PBM contract they've developed together that has already been accepted by several national PBMs. It gives employers the ability to terminate without cause, access claims data at themost granular level, enforce hard disclosure mandates with real penalties, and lock in aggressive pricing that doesn't erode through exclusions and fine print. Ryan and Chuck’s closing argument is direct: civil fines are the cost of doing business for billion-dollar enterprises. Criminal penalties and conflict-of-interest rules modeled on the Stark Law that already governs physicians are what can actually change behavior. Takeaways for Employers: You don't have to wait for Washington to act because a better-drafted contract is available now Claims data access isn't a courtesy; demand it as a contractual right Net per-member-per-month spend is the metric that matters, not rebate totals Larger PBMs aren't automatically better. What you've negotiated is what counts Takeaways for Employers: Your HR department and CFO may not know what's in your PBM contract, so share this episode with them. Health insurance is now the second-largest employer expense, often exceeding mortgage payments so it is worth your attention. Call the DC Congressional Switchboard at 202-224-3121 and tell your representatives and their staffers that recent legislation is a start, but real enforcement needs to follow. About Ryan Rice: Ryan Rice is the CEO and Founding Principal of Prism Health Group. He has held senior positions at Express Scripts and Navitas Health, served as a pharmacy consultant with the Birchfield Group, and was instrumental in taking aDC health system startup public. His work has delivered over $1 billion in plan cost savings and quality care outcomes. Subscribe to Disruptive Dialogue for weekly conversations on what's breaking US healthcare and how to fix it. If this episode opened your eyes, share it with your HR team, benefits consultant, or CFO. Leave a review — it helps more Americans find the information they need.