It’s almost Election Day! This week, co-hosts Erin Stein and Dr. Gillian Goddard are talking about voting, which might sound like a strange topic for a health podcast, but it affects your health care at every level in ways you haven’t even realized. Rejected insurance claims, cancer treatments and what your kid eats for lunch as school are all impacted by elected positions.
We start at the federal level with things both congress and the president have a hand in. We explore how Medicare affects everyone’s insurance; explain what the FDA, CDC, NIH, and Department of Health and Human Services each do; and why research funding matters. We also break down how Medicare differs from Medicaid, which is funded federally but run by the states. Then we go local: why your governor, state legislature, and insurance commissioner matter, why there isn’t one UnitedHealthcare but fifty, and how your county and town affect health departments and hospitals. Erin also shares a fun and slightly alarming fact about coroners versus medical examiners.
The message is simple: your vote matters.
References:
Go Vote! Visit www.vote411.org to learn about your ballot and check your voter registration.
For more on how medical insurance companies and corporate structure, watch the Last Week Tonight with John Oliver segment about UnitedHealthcare, (note, this content is explicit): https://www.youtube.com/watch?v=h1pXm0GjLho
For more on medical examiners and coroners, watch the Last Week Tonight with John Oliver segment about Death Investigations, (note, this content is explicit): https://www.youtube.com/watch?v=hnoMsftQPY8
We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.
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Visit www.thesavvypatient.com/podcast for episode transcripts.
Watch full podcast episodes @TheSavvyPatient on Youtube.com.
Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.
This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.
TRANSCRIPT
Gillian Goddard: Hello. Welcome to The Savvy Patient.
Erin Stein: Hello everyone. Happy fall. Happy Breast Cancer Awareness Month.
Gillian Goddard: And Menopause Awareness Month.
Erin Stein: And Menopause Awareness Month. And happy almost Halloween and happy election season! Woo-hoo!
Gillian Goddard: Everybody's favorite season these days.
Erin Stein: Mm. Getting so many text messages from random candidates that want my money.
Gillian Goddard: And email from them
Erin Stein: Yeah, I feel like it's more text messages these days.
Gillian Goddard: Fair.
Erin Stein: It used to be robocalls. It used to be phone calls.
Gillian Goddard: And no one calls anymore.
Erin Stein: Not much, because no one answers.
Gillian Goddard: That is so true. As someone who calls people on the phone as a part of my job, no one answers.
Erin Stein: No one answers. Send me a text. I'll get back to you. Or I won't. That's how that works. So, we are going to talk about voting and elections.
Gillian Goddard: We are.
Erin Stein: Which might sound strange, but it directly affects your health care.
Gillian Goddard: A hundred percent and in so many more ways than I think people realize.
Erin Stein: Well, that's what we're here to do, is to make you realize. Right?
Gillian Goddard: Ha ha ha. Touché.
Erin Stein: Touché. And even me— this was Gillian's idea to do this episode. I was like, that's a great idea. And then started looking stuff up. I'm like, yeah, it really does. Like you kind of know that it does, but it really, really does, and at every level.
Gillian Goddard: Every level.
Erin Stein: And obviously we're talking about the United States specifically.
Gillian Goddard: Yes.
Erin Stein: But I think it probably does matter no matter where you live if you have elections. We'll start with the federal government. As you might imagine, they make some decisions.
Gillian Goddard: Yes. They do and they actually make some really important decisions. The biggest decisions that the federal government make that directly affect your health, is through Medicare. I'm not 65, Erin is not 65, and so why am I saying Medicare—?
Erin Stein: Not yet.
Gillian Goddard: Someday, someday.
Erin Stein: Someday.
Gillian Goddard: Sooner than I would like to think about.
Erin Stein: Yes.
Gillian Goddard: But it sounds a little funny to say that Medicare affects your health when you might not be Medicare eligible yet. But it does, and it's probably the biggest way our health is affected in the United States by the federal government, is through the Medicare system. And the reason I say that is because of two really important things. So, one is Medicare is sort of the blueprint for what bare minimum insurance coverage would be based on.
Erin Stein: Mm.
Gillian Goddard: That doesn't mean the levels of coverage, but what is covered. With the exception of things that are, you know, related to pregnancy and childhood, but related to adult general health, if Medicare covers it, typically other insurances will cover it. And other insurances might cover more than Medicare, but they don't typically cover less than Medicare.
Erin Stein: Mm.
Gillian Goddard: And so, Medicare sets an important floor…
Erin Stein: A baseline.
Gillian Goddard: A baseline for what types of care—including tests and labs and procedures—are covered by health insurance. That's a massive way the federal government is directly responsible for your health care. But it doesn't actually end there. The FDA.
Erin Stein: Yes. When we're talking about the federal government and elections impacting it, it's somewhat direct but also somewhat indirect.
Gillian Goddard: That's a great point.
Erin Stein: So, you're electing senators and congresspeople. Let's start with Congress, right? We've got two sets of people you're electing, directly voting for them and they vote on a lot of these things. Okay, so, coverage, laws, they are our lawmakers in this country. So, laws regarding health care, health insurance, what people need to be offered, but also consumer protections is another aspect that people don't think about, but it directly relates to fraudulence and bad things happening in a healthcare setting.
Gillian Goddard: Yes.
Erin Stein: So, consumer protections are also something that Congress is directly impacting. So, your representatives are one element of how elections shape these things because they are voting on bills directly impacting policy.
Gillian Goddard: Yeah.
Erin Stein: And also, you should contact them. Vote for them. I think you might get the message that we think you should vote during this episode. Please vote.
Gillian Goddard: If you come away with one message from this episode, it is please vote.
Erin Stein: Please vote. But I'm going to go further. You should vote, but you should also let your representative that you're voting for know what you want them to do.
Gillian Goddard: Because as it says in the name, they are a representative and the one of the people they are representing is you.
Erin Stein: Yes. And I am saying this to you, and I am saying this to myself. You need to let them know that you want them to vote for more healthcare coverage, more Medicare coverage, or to protect consumers from fraud. They need to hear from their constituents that this is something that matters. And nowadays you can send an email, you can call the office and leave a message. I actually think that may even be the most effective. It seems counterintuitive because nobody gets on the phone anymore. But if you took the time to get on the phone and you may get someone on the phone who works in the office, or you may leave a message, but if you say, I care about this, I want you to vote for this, or I don't want you to vote for that, this is important. If they get enough people calling them on the phone, that means something. And the people who work in the office are as important, if not more important, than the representative, I'm going to say, because they're the ones helping them do all this stuff. They have a staff, and the staff is definitely the ones listening to these phone calls yes.
Gillian Goddard: And they tabulate all of this. So, they actually collect data on how many people are calling on a given subject and they use that information to help them make decisions.
Erin Stein: Yeah, it's easy to feel like it doesn't matter and it's not going to make a difference, but it does and it can, very much so.
Gillian Goddard: It does. It does.
Erin Stein: So, then I was just going to note that the president is also someone who has a direct impact on these kinds of things, but in a more indirect way, usually.
Gillian Goddard: For sure.
Erin Stein: Because so many positions in these federal agencies, the heads of them, or the director, the secretary, the commissioner, the surgeon general, are all nominated by the president and then confirmed by Senate.
Gillian Goddard: Correct.
Erin Stein: We're talking about the Department of Health and Human Services, now the CDC, which didn't used to be the case, but as of 2025…
Gillian Goddard: National Institutes of Health
Erin Stein: National Institutes of Health, Food and Drug Administration, the FDA, which we talk about all the time and we'll talk about again. Medicare, Medicaid.
Gillian Goddard: Medicare services.
Erin Stein: Yep.
Gillian Goddard: Medicaid's a funny one and we'll get into that when we talk about states.
Erin Stein: But also, Administration for Strategic Preparedness and Response, think COVID, people.
Gillian Goddard: Yes, yes.
Erin Stein: Who decide what we do if there's a health emergency. That's pretty important.
Gillian Goddard: Yep. And who watch for signs that something may be emerging.
Erin Stein: Mm, mm. And the Surgeon General; how is the Surgeon General different from all these other things? Like what is the Surgeon General role versus the head of the health department?
Gillian Goddard: Yeah, yeah. The Surgeon General's role is really to direct policy initiative. It's almost like they're the ones telling everyone else what's important. And their job is really to be the big overarching person who's looking out for all of us. So, I always think of the Surgeon General's warning on a pack of cigarettes. When the Surgeon General makes a statement about something, it's sort of like a big global thing. And within that the Surgeon General can direct the focus of what should we be talking about. You know, in the eighties it was smoking cessation and so it's sort of these bigger public health type things. But beyond just appointing the people who run these agencies, because the people the president appoints are like the very top, and underneath all those people is a bunch of staff that are not appointed by the president, Congress and the president set the budget for all of these agencies. And so, making sure that all these agencies have the funding that they need to hire the non-appointed personnel and to have the resources that they need to do their jobs.
Erin Stein: Yes, and I would say specifically recently we've seen that directly impact a couple of these agencies who have been directed to let go of a lot of staff, to curtail a lot of research, and have been given less funding. That does directly impact all of us. There was this headline in the news about why are we studying shrimp for whatever reason? And there's a reason to study shrimp, actually. The next GLP-1 RAs might come out of studying shrimp. We got that from Gila monsters.
Gillian Goddard: That's correct.
Erin Stein: It can, I acknowledge, sound very silly, but for the most part, no one got approval to do a study if there wasn't a reason to do it.
Gillian Goddard: Correct, and when we talk about research funding, the federal government is the number two source of funding for medical research just behind pharmaceutical companies. So pharmaceutical companies spend more, but obviously they have…
Erin Stein: A financial incentive.
Gillian Goddard: A financial incentive in a specific agenda. And so, the things that get paid for through those types of things are potential drugs that would then make those pharmaceutical companies money. The NIH and the federal government and grants from the federal government fund a huge chunk of the rest of the medical research that gets done.
Erin Stein: Think about that too, because studying drugs is one thing. That's just medications.
Gillian Goddard: Or potential drugs or devices.
Erin Stein: Studying how your body works, how it reacts to aging, how menopause affects women, all these other things about medicine, other kinds of treatments that are not pharmaceuticals. That's a lot of research that needs to be done, and it's not being paid for by a pharmaceutical company.
Gillian Goddard: Right.
Erin Stein: So it is critical that it's not just the drug companies funding this research, because there's so much other research we need to do.
Gillian Goddard: Absolutely.
Erin Stein: I think it's also fair to say that it's thanks to the National Institutes of Health and federal funding largely that we have the cancer treatments we have today. There was a huge push and a lot of spending to make that happen.
Gillian Goddard: That's correct. That's correct.
Erin Stein: And so I, for example, would want to vote to have more funding for the National Institutes of Health to do this research.
Gillian Goddard: Agree.
Erin Stein: Maybe some people don't, and that's their choice, but your vote does impact that. And that is the main point we're making. But as most government things [it is] alphabet soup, and there's so many different organizations. So National Institutes of Health is directing and funding a lot of research.
Gillian Goddard: Correct. Yes.
Erin Stein: The FDA, as we've talked about before…
Gillian Goddard: It's the Food and Drug Administration and so they are responsible along with some other agencies to make sure that our food supply is safe. But they also they are the big agency that determines whether medications receive approval so that they can be marketed and sold in the United States. So, all medications that are sold as medications, whether that's over-the-counter medications or prescription medications, all of those medications have been approved by the FDA. It's not just that they get approved. But it's how they get approved that also determines how they get covered by our insurance. When the FDA makes decisions about exactly what a medication is approved for, why how what they want to see before they'll approve a medicine for a specific problem. That that has huge effects on what treatments are available to us, available as in you are able to get them, but also what treatments are approved for a specific use and that has effects on how they get covered by your insurance and what your cost to access those medications is.
Erin Stein: Right. Then there's the CDC.
Gillian Goddard: They do a lot of work around quantifying different diseases. Monitoring and quantifying how much of different things are around. So, the CDC monitors the flu. They monitor for other infectious diseases.
Erin Stein: I was going to say, it's like the flues and the poxes.
Gillian Goddard: Yes, but they also monitor the frequency of things like cancers. They're the ones who tell us how often things happen in our particular population. They're also the ones that tend to work with the local public health people who we will talk about when we talk about local government, to disseminate important public health information. This is where like the local health department understands how much flu they have in their area and that helps determine how the CDC distributes resources, for example. They're the numbers guys, as far as how much of any given health problem is out there at any given time. Very important for making sure different places have the resources that they need to take care of the people in their communities.
Erin Stein: And also, in the past they've been a trusted source of information. If you're traveling, you would check the CDC website, what diseases
Gillian Goddard: Yes. Yep.
Erin Stein: Might I need to worry about if I'm traveling to this location.
Gillian Goddard: Vaccination recommendations yeah.
Erin Stein: Is there an outbreak somewhere? You know, all of those types of things are housed there.
Gillian Goddard: They are and the CDC are the ones that work with the World Health Organization because obviously when we're talking about global health information, they're the ones that are interfacing with the World Health Organization to talk about things like, there's an Ebola outbreak in the Congo.
Erin Stein: This is the thing. Disease does not respect boundaries.
Gillian Goddard: Definitely not.
Erin Stein: So, we need to be communicating with other governments, other countries all the time because the next you know…COVID was spectacularly impactful, but it was certainly not the first infection that has come here from elsewhere or that we've passed along. Diseases move around the world all the time.
Gillian Goddard: Yes, because people move around the world all the time.
Erin Stein: There's us moving around carrying germs and viruses and whatnot.
Gillian Goddard: Exactly. Since the first person got on a boat and sailed across an ocean, we've been taking our germs with us when we go.
Erin Stein: So, the Department of Health and Human Services.
Gillian Goddard: This is where we get public health recommendations around, what we would call like lifestyle things. So here we're talking about things like the dietary recommendations and…
Erin Stein: Food pyramid.
Gillian Goddard: Yes, the food pyramid. You know, we laugh about those things because I don't know the last time you actually thought about the food pyramid when you you’re your weekly meal plan. I bet you don't make a weekly meal plan.
Erin Stein: I don't.
Gillian Goddard: We do. We feed a lot more people, but I don't think about the food pyramid every time I sit down to make a meal plan for my family. But the reason those types of things are important is because they affect things like school life. And those kinds of things.
Erin Stein: There's the notion that something might impact you directly. Like are you consulting a food pyramid when you plan your dinner? But also, there are schools, daycares, senior citizen facilities, there's rehab centers, hospitals.
Gillian Goddard: Hospitals the military. Mm-hmm. Yeah.
Erin Stein: Yes, the military, that's a big one. There are places that need guidelines to follow to provide basic, sustenance to many humans.
Gillian Goddard: Health and Human Services make a lot of public health recommendations, I would say, sort of when we think about not medications, but things like exercise. But if we go through every single thing the federal government does that affects your health, we'll be here for days. So just know that it's a lot. Those are like the headlines.
Erin Stein: Yeah. It's a lot. Those are sort of the big agencies we hear about and issue statements to us to tell us things are healthy or unhealthy. But to go back to Medicare, Medicare and Medicaid get talked about a lot in regard to politics and budgets and funding and who gets what and all of that stuff.
Gillian Goddard: They do.
Erin Stein: There's an interplay between federal and state with those programs and the difference between those two programs because it is very confusing for everyone.
Gillian Goddard: Yeah, why they name them such similar names, I do not know. Medicare is a completely federally administered program. The states actually have zero involvement in Medicare at all. Medicare is insurance for people who are either over the age of 65 or who are considered to have long-term disability, or interestingly enough, people on dialysis. So, if you have to go on kidney dialysis because you have kidney failure, you automatically go on Medicare. So those are sort of the three groups, of people that go into Medicare, obviously people over the age of 65 are the biggest, part of that pool. And you don't have to go on Medicare at 65. You become eligible for Medicare at 65. But if you're still working, you don't have to go on Medicare. And Medicare now offers three different things. It offers Part A, which is coverage if you're in the hospital, if you get admitted to the hospital for any reason. Part B is outpatient care. So, this is going to your primary doctor, going to the cardiologist, getting your mammogram, getting all your cancer screening. That's Part B. And Part D, they skipped Part C because
Erin Stein: Because
Gillian Goddard: Drugs starts with D, not with C. So, Part D is your Medicare drug plan. For a long time, there was no drug coverage under Medicare. And in the early aughts, they put in Part D. So that is coverage for prescription medications. So again, Medicare, people over 65, people with long-term disabilities who qualify under the Social Security rules, and people on dialysis. Totally administered by the federal government.
Erin Stein: Many people augment their Medicare coverage.
Gillian Goddard: They do with supplementary plans, that are often one of the retirement benefits that they receive from their employer or, they purchase a supplementary plan. But where the big hole is in coverage is often related to pharmaceuticals.
Erin Stein: And no one has dental coverage. Still a problem.
Gillian Goddard: That is true. Yes. It does not cover your teeth.
Erin Stein: That should have been Part D for dental.
Gillian Goddard: Right. I know. And I don't think it covers glasses. It covers ophthalmologic care, but not vision correction.
Erin Stein: Okay, so Medicaid.
Gillian Goddard: Medicaid is for low-income people. And it is administered completely differently. Medicaid is basically a chunk of money that the federal government gives to each of the state governments, and the state governments decide how to use that chunk of money to provide medical care to low-income people. There are some things that states have to do in order to get that money from the federal government. So that creates a minimum standard around sort of what kinds of coverage and what kinds of people have to be covered. But the states actually have a huge say in exactly who and what gets covered by Medicaid. And so, it's different in every single state who exactly is eligible, what exactly they are eligible for, but essentially the federal government gives each state a big chunk of money to use specifically for low-income people.
Erin Stein: It gets talked about a lot in political scenarios, like, well it's those people should just get a job. And then they'll have coverage. And that's not how this works.
Gillian Goddard: No.
Erin Stein: I've already encountered Medicaid dealing with older relatives and when they run out of funds, they often get transitioned from Medicare to Medicaid. And there are a lot of very specific details about that that are different, as Gillian said, per state. How to get them qualified. At what point are they qualified. And it's a pretty low financial place for you to finally qualify. You have to basically have nothing.
Gillian Goddard: It is. It is. And you know what? And what's really important about that is that Medicare provides residential care for a subacute issue. So, we're talking about like nursing home care. For, I believe up to twenty-one days. I used to know this better when I was working in hospitals and helping get people discharged. But I believe up to twenty-one days.
Erin Stein: There's a limit.
Gillian Goddard: There's a limit. It's not indefinite. From day twenty-two until you meet the criteria for your state's Medicaid, you pay for your nursing home care out of your pocket back in the day there used to be something called long term care insurance. You can't get a policy for long term care insurance anymore. But so basically from day twenty-two until you meet that threshold where you qualify for Medicaid, you are paying for nursing home care out of your pocket, basically 100%. And then when Medicaid kicks in, Medicaid then pays for the nursing.
Erin Stein: Yes, but by the time it kicks in, you have nothing left.
Gillian Goddard: Right. Correct. You have to spend pretty much all your assets
Erin Stein: Different states have different things, like maybe your home is excluded or your car.
Gillian Goddard: Yes.
Erin Stein: But not always. You might have heard the term a look-back period. Like you can't just give all your money away to your family and then say you don't have any, they look at your finances.
Gillian Goddard: Yes. Yes. Yes. Yeah.
Erin Stein: So, this is an important thing because it may affect our family members we're caring for, it may affect us in the future, but it also affects people who need help. I'm thinking of single parents, and [their] children, who are suddenly out of work, leaving abusive situations, they need help and they need care. And they also sometimes use and need Medicaid to care for themselves and their children.
Gillian Goddard: That's correct. Particularly for Medicaid for children, it's kind of separated out a lot of times, you can make a little bit more money and qualify for coverage for your children under these types of programs that are again paid for by the federal government and administered at the level of the state. The other thing I will say, and I think that this sometimes sounds a little mercenary, but it is the truth. In this country, hospitals are not allowed to turn someone away. So, if I show up at the emergency room and I have a medical problem, the hospital must provide care, regardless of my ability to pay. If you are someone who doesn't have the means to pay, sure, they'll come after you, they'll try to take you to collections and they'll try to garnish your wages and generally, you know, do what they can to recoup the charges for the services that you received. But if you can't pay, like if you don't have an income, they can't garnish your wages. And so, there is literally like a slush fund that comes from the government that covers the hospitals a little bit for those costs. Hospitals generally lose money on those people, but it is considered part of our social construct, rightfully so, that we're going to take care of those people. The problem with that is it would have been much less expensive and much more efficient and quite frankly, much more humane to treat that person's pneumonia proactively through an outpatient clinic than through the emergency room. But outpatient clinics are not under the same obligation that an emergency room is. To take care of someone regardless of ability to pay. And so, what we end up doing is paying more for less efficient care. And having people get sicker before they get the care that they need.
Erin Stein: You’re essentially saying we're forcing people to go to the emergency room; people without means can't go to the doctor's office when they first get sick and get treatment and manage it and not have to go to the emergency room. They have to get very, very ill and then go to the emergency room we're potentially doing a lot more and spending a lot more. You know, I think we should be taking care of those people. Some people don't.
Gillian Goddard: But know that regardless of how the money is being spent, it is being spent by the government.
Erin Stein: Medicaid transitions us to the state level of elections.
Gillian Goddard: It does. It does.
Erin Stein: So much of Medicaid distribution, how you qualify, how difficult it is to get it and get your benefits, is all happening at the state level.
Gillian Goddard: Correct. All kinds of things happen at the state level.
Erin Stein: So, it also matters who your governor is.
Gillian Goddard: It does. And your state legislators. Because they make a lot of decisions about your health insurance. And what your health insurance has to look like.
Erin Stein: In some states there's a state insurance commissioner who's elected.
Gillian Goddard: Mm-hmm. Mm-hmm.
Erin Stein: If you are in a state that has one of those, you should be paying attention and voting for someone who's going to do the things you want
Gillian Goddard: Yeah. One of the things that's funny about our healthcare system is we think of, like, we think UnitedHealthcare is one company. And there is one big umbrella company, but there's like 50 different UnitedHealthcares, for example, or Blue Cross Blue Shield, or whatever. There are 50 different ones of those subsidiaries of those bigger companies. Huge insurers functioning in each of the states. Because each state has their own requirements for how health insurance is administered. Quest, for example, like the place where you go to get your blood drawn, there's actually not one big Quest, but 50 little Quests under one big umbrella because how the labs have to function and regulate is also regulated at the state level. So, the state government actually has a lot of say regarding the day-to-day functioning of the healthcare delivery system, is what I would say. I'm not licensed to practice medicine by the United States; I'm licensed to practice medicine by the state of New York.
Erin Stein: So, your governor is obviously helping to select these people and drive that policy, but your state representatives are voting or introducing, drafting, legislation about this. There may be a state insurance commissioner. The state attorney general is also important, as I mentioned before, consumer protection. You know, to make sure healthcare companies, insurance companies, pharmaceutical companies are not taking advantage of people. You might have heard of something called the opioid crisis.
Gillian Goddard: Yes. Yes.
Erin Stein: The companies are not always operating ethically. So, it actually is really important that these other positions that don't obviously seem like healthcare positions are in a place to also police what's happening.
Gillian Goddard: There's also a lot of public health that happens at the state level. So, a lot of trickle down from the federal government into things like school lunches. States often have, subsidized school lunches for low-income families. And they may get money for that from the government, but they're the ones administering it and deciding where and how to spend it. There are often state level requirements around vaccination. School health often occurs at the state level. What school health looks like, including what's required, from a health perspective, for kids to be attending school. The state does a lot of public health stuff around disease too. Around monitoring for things like flu and COVID and so there's a lot of public health that happens at the state level.
Erin Stein: Then it becomes even more micro because then there's county, there's county commissioners, county executives, and your mayor for your town also influence and impact local health departments. Because everything trickles down to the town level.
Gillian Goddard: Yes. Yep. And you may also, depending on your state, you may have county hospitals or city hospitals. Depending on how your state is set up. And those hospitals fill a number of different roles, including providing more affordable healthcare for low-income people, but a lot of times the state hospital is also the trauma center in an area, or the county hospital is the trauma center in a particular area, for example.
Erin Stein: A fun fact that I'm going to throw in here that's kind of relevant but not a hundred percent. It's a little bit of a tangent. But look into whether you have a medical examiner or coroner.
Gillian Goddard: I walked by the medical examiner on my way from my office to the parking garage just yesterday evening.
Erin Stein: Because, I feel like with this episode, I'm just going to link a bunch of John Oliver Last Week Tonight episodes because he's done deep dives on many of these topics. He's done some great pieces on insurance, but also the coroner medical examiner thing. So, my husband and I have a true crime documentary that we've been working on for ages and will probably never come out. But one thing we learned while working on this is the difference between these two positions, even though we talk about them as essentially the same position because they essentially have the same function, depending on where you live, you have one or the other, and their qualifications are quite different.
Gillian Goddard: Interesting. I didn't know this. You're educating me.
Erin Stein: Ooh, this is exciting. The main difference is that a medical examiner, the clue is in the name, has to be a physician.
Gillian Goddard: Mm-hmm.
Erin Stein: Knows something about how people work and how they die. Because these people are called when there is a death and they examine it. And they say this was natural, this was heart disease, this was a murder, this was whatever, right? This is a very key, important thing that we rely upon all the time, even though it's not a fun topic, right? But the medical examiner is a physician with some training, while a coroner in some states might be required to be a physician, but in most places it's not. It is an elected random person. Yep.
Gillian Goddard: Fascinating and a little disturbing.
Erin Stein: Mm-hmm. Mm-hmm. A little disturbing. Now, to be fair, in some places they do have some requirements, eligibility requirements for a coroner, but in general, they are not required to be a doctor or have any medical knowledge of any kind. They should have some doctors working for them in the county coroner office, for example, that they rely on.
Gillian Goddard: One would hope.
Erin Stein: But there there's some not particularly well-run coroner offices in this country.
Gillian Goddard: Fascinating.
Erin Stein: If you are in a place that elects a coroner, I would vote for someone who was a doctor versus someone who was not. That's my personal preference.
Gillian Goddard: Ha ha ha. Interesting, so fascinating.
Erin Stein: Mm-hmm, mm-hmm. It's just another way of showing local elections actually matter a lot. And I think many of us are, not dismissive of it, but don't see it as important as like president or senator because it's not in the news all the time. We're not talking about it all the time. And I myself didn't think about it for a long time. But these people at your town and county level are super important.
Gillian Goddard: Yes, they really are.
Erin Stein: Super, super important and you should investigate. I have my local ballot, and I went and googled everybody on it so I could figure out what people stood for and what their platforms were so I could vote accordingly.
Gillian Goddard: Yes. So, November third is election day this year, 2026. You may have the option to vote early, depending on your state or municipality. We will link there is a couple of different websites where you can put in your zip code or your address and it will pull up all the things that will appear on your ballot so that you can do a little research before you go to the polling place or before you fill out your mail in ballot so that you can be sure that you are voting the way you want to vote. But whatever you do, vote.
Erin Stein: Vote. I'm just going to do a little recap at the end because we talked about a lot of things in a lot of detail. But just an overview, how you vote affects what you pay for your insurance because there are federal subsidies they can adjust, there are tax credits they can adjust, it affects who qualifies for Medicaid. Because Congress sets the federal requirements and then states set their own requirements on top of that. Governors and state legislatures affect that. Eligibility, what's covered, how much is covered, Medicare costs and benefits, who qualifies, and again, that's older adults and people with disabilities a lot of the time, not just older adults. And elected officials influence things like what pre-existing conditions are covered or not covered, what prescription drugs are covered or not covered, how insurers must operate as companies, how hospitals must operate as companies. All of these things are important.
Gillian Goddard: They are. And we didn't even get into HIPAA. That'll be a conversation for another time.
Erin Stein: We'll do a whole separate conversation about HIPAA there's more than just privacy, even though we think of it as privacy. As you may have gathered, there are a lot of agencies, there are a lot of laws, there are a lot of rules and regulations, and they are constantly changing because our lawmakers are constantly changing them, and you elect those lawmakers.
Gillian Goddard: Yes, you do.
Erin Stein: You do have an impact on this and it impacts you, your family, and the rest of us. So, give it some thought.
Gillian Goddard: Yes.
Erin Stein: And get a little sticker and post it on social media.
Gillian Goddard: I'll be doing that.
Erin Stein: Well, we have mail-in ballots, but I got a sticker for picking my pumpkin at the pumpkin patch. Not quite the same as I voted sticker. No.
Gillian Goddard: No, not quite the same.
Erin Stein: All right. Well, we hope you all vote. We hope this was semi-informative. And maybe it brought up a lot of questions that you have, which would be great. Send us some questions and we'll talk more about it.
Gillian Goddard: Absolutely.