The Al Franken Podcast 219: Atul Gawande on Musk’s Destruction of USAID
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Apr 13, 2025 
In a compelling discussion, Atul Gawande, an American surgeon, author, and former senior official at USAID, dives into the impact of recent political decisions on U.S. foreign aid and the healthcare system. He highlights the devastating effects of funding cuts, particularly on vulnerable populations worldwide. Gawande explores the successes of the Affordable Care Act amidst challenges and the urgent need for systemic reforms in healthcare access. He also shares insights from his experience during the COVID-19 pandemic and the ripple effects on global health initiatives.
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McAllen vs. El Paso Healthcare
- Atul Gawande's 2009 New Yorker article compared McAllen and El Paso, Texas, regarding healthcare costs.
- McAllen had much higher expenses despite worse outcomes, attributed to a business-driven healthcare model.
Business Incentives in Healthcare
- Business incentives in healthcare can override professional ones, leading to unnecessary tests and procedures.
- Places like Mayo Clinic and Kaiser Permanente offer alternative approaches to control overuse.
Pre-Existing Conditions and the ACA
- Gawande's son's pre-existing heart condition highlighted the importance of the Affordable Care Act (ACA).
- The ACA removed pre-existing condition exclusions, enabling access to insurance.
