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Public Health On Call

1003 - The U.S.'s Insurance-Based Health Care System

Public Health On Call

The Johns Hopkins Bloomberg School of Public Health

News, Health & Fitness, Medicine

4.6 • 644 Ratings

🗓️ 29 January 2026

⏱️ 21 minutes

🧾️ Download transcript

Summary

About this episode:

The U.S. takes a unique approach to health care by tying coverage to employment. This has led to high rates of uninsured Americans, the creation of the Affordable Care Act, and ongoing fights about health care spending culminating in a government shutdown late last year. In this episode: Jonathan Cohn details the health care debate happening in Washington right now, the nuances of universal coverage in other countries, and what might come next for health insurance in the U.S.

Guests:

Jonathan Cohn is a writer for The Bulwark and the author of "The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage".

Host:

Stephanie Desmon, MA, is a former journalist, author, and the director of public relations and communications for the Johns Hopkins Center for Communication Programs.

Show links and related content:

Transcript information:

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Transcript

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0:00.0

Welcome to Public Health On Call, a podcast from the Johns Hopkins Bloomberg School of Public Health,

0:05.9

where we bring evidence, experience, and perspective to make sense of today's leading health challenges.

0:16.3

If you have questions or ideas for us, please send an email to public health question at jh.h.u.edu.

0:23.8

That's public health question at jh.u.org for future podcast episodes.

0:31.2

Hey listeners, it's Lindsay Smith-Rogers. Today, health insurance.

0:35.4

Jonathan Cohn is a journalist and author known for his extensive writing

0:38.8

on the health care system and the politics surrounding it. Today, he joined Stephanie Desmond to discuss

0:43.7

health insurance. What do recent government cuts mean for people who can no longer afford it? Why is

0:50.0

health care in many countries considered a basic right? and why has that never been the case in the

0:54.4

United States? Let's listen. Jonathan Cohn, thanks so much for joining me. Stephanie, thank you.

1:00.2

I am a huge fan of this podcast, so I'm very excited to be on it. I'm a fan of yours, so the admiration is

1:06.9

mutual. I wanted to talk today about health insurance in America. A very big topic,

1:13.0

obviously, to cover a short amount of time. When last I spoke about this on the podcast, there was

1:18.4

a great concern that the subsidies that had been given to people who have Obamacare, which is

1:24.3

from the Affordable Care Act insurance, that they were going to lose their subsidies

1:28.7

and that many, many millions of people would likely be unable to afford health insurance anymore.

1:33.8

I also know that the government shut down over this last year. So I'm wondering if you could

1:37.9

give a quick look at the landscape of where those subsidies are now and what's happening to people.

1:43.4

Yeah, yeah, sure, sure. So just to sort of

1:45.4

set the stage, you know, the Affordable Care Act has a bunch of different provisions in order to

1:49.9

make insurance more available to people who don't have employer coverage or make too much money

1:54.6

to qualify for Medicaid. We created these insurance exchanges. If you buy insurance, this way,

...

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