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Summary:
In this episode of Care Lab, Brandy Archie and Emilia Bourland discuss the major federal job cuts affecting the U.S. Department of Health and Human Services (HHS). They explore the implications of these cuts on vital public services like Medicare, Medicaid, Meals on Wheels, and the Administration for Community Living. Through personal anecdotes and research, they highlight the importance of staying informed and holding government accountable for decisions that impact health and caregiving systems across the country.
Key Takeaway
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Massive Cuts to HHS Workforce - About 20,000 jobs have been cut from HHS, representing nearly 24% of its workforce. These cuts could significantly affect the efficiency and quality of public health services.
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Vital Agencies Affected - Agencies like the Administration for Community Living (which supports Meals on Wheels), CMS (Medicare/Medicaid), and even the FDA and NIH could be impacted—posing risks to healthcare access, oversight, and public safety.
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Institutional Knowledge Loss - Eliminating large numbers of experienced staff threatens the continuity and functioning of complex government systems, potentially leading to inefficiencies and delays in critical services.
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Real-Life Consequences - Services like Meals on Wheels not only provide nutrition but also offer daily wellness checks for vulnerable populations. Cutting support for such programs can increase healthcare costs and risks.
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Public Responsibility & Action - The hosts emphasize the power of civic engagement. Staying informed, voting in local elections, and holding representatives accountable are essential to ensuring the public's voice is heard.
Transcript
Brandy Archie
Definitely living that part in and all that head nodding. Yes. Yes. Welcome to Care Lab, everybody. We're glad to be here today. We have a serious topic, I think, but you got something unserious to talk about first?
Emilia Bourland
Hey everyone. Yeah. All this. Welcome to Care Lab.
Emilia Bourland
Yeah, yeah. mean, you know, I'm full of stupid stories, basically. So that's my that's my primary role here on Care Lab is to bring the nonsense. No, I hope that's not I hope that's I hope that's not true. But I do have nonsense to bring. OK, so so I was getting like, you know, everything together to get out the door this morning. And I had this crazy number of beverages.
Brandy Archie
Comic Relief.
Emilia Bourland
I literally had some getting in the car to go and I had to have my kids help me carry because I had four different types of drinks with me this morning. All for me. I mean, my kids had like their water bottles, too. But like, no, they were all they're all for me. So. Number one, well, number one, if I have to interrupt this episode to go to the bathroom, you know why. You'll know you'll know why. We'll edit that out.
Brandy Archie
What? All for you?
Brandy Archie
Okay, so number one.
Brandy Archie
We all know why.
Emilia Bourland
We'll edit it. We'll edit up any of my bio breaks out. But OK, so so number one, I got my water. I always. I always got to have my water. Number two, I got my tea. Have have to have my teeth like this is my this gets me through it. It is it's this. Yeah, I was coffee and now I'm tea.
Brandy Archie
You
Brandy Archie
Gotta have that.
Yes.
Brandy Archie
Okay.
Brandy Archie
This is your substitute for coffee, right? You were coffee and now you're tea.
Emilia Bourland
But today I was feeling a little bit sluggish and sometimes I like to treat myself on Friday, so I actually have a little bit of coffee too. I got myself a tiny, I brought just a tiny little one and I probably won't even drink all of it. It's just like, I still love it. It's just my little hit. And then I don't have the other container anymore because I finished it on the way, but I had a smoothie for breakfast. So that was.
Brandy Archie
In a nice cute little cup.
Brandy Archie
You just need a little hit.
Brandy Archie
So was your breakfast. So theory, that could have been a bowl of some food, it's just that cup of smoothie.
Emilia Bourland
It's hard to eat a bowl of food in the car. So, and I was short on time, hence smoothie. Because you can just, you can sip, sip and drive.
Brandy Archie
That is a lot of drinks. I'm going to say that's a lot. That's a lot.
Emilia Bourland
That's a lot. Yeah, I mean, it occurred to me as I literally had the smoothie in my pocket as I was going out the door because I didn't have enough hands and my kids didn't even have enough hands with all their stuff to help. And so it occurred to me that it was a a little ridiculous. How many beverages do you have right now?
Brandy Archie
Okay, so I do usually go out the door with more than one beverage, but it's not always for me. I decide to make my coffee at the office, one less thing to take. I always bring my water, and then sometimes I have, you're right, eating out of a bowl in the car is hard, but I do eat at least one meal a day in the car, and sometimes it goes in a cup. So I had a cup of cereal today.
Emilia Bourland
Uh-huh. that's fair.
Emilia Bourland
Mm. Do you love eating in the car? Because I actually love eating in the car.
Brandy Archie
I don't know that I love it, but it's very efficient and people who know me know that I care a lot about efficiency. So I might even be up early enough to sit and eat at the table, but I don't because I'm like, ah, I could do that while I drive. I could do something else while I'm in here. So that's horrible, but that's how it goes.
Emilia Bourland
I don't like to eat while I'm actually driving, but I do love to eat in the car. I love to sit and park and eat just by myself in the car. I don't know if that's sad or if it's...
Brandy Archie
I don't think it's sad at all. That's like getting your own time. You don't got no kids in there. You go away from your workplace. do, Zach is in the car for, in his lunch break all the time. And so he's like, he cherishes that. So I get it.
Emilia Bourland
Like
Yes.
Yeah. Yeah. I think it started after I became a mom. I was like, my gosh, there's nothing like just sitting in silence with food in my car and just eating.
Brandy Archie
Yes, it has not, I'm not gonna say this is how many times this has happened, but definitely has happened that I have sat in the car in my garage in order to avoid everybody in my house.
Emilia Bourland
that happens every night for me when I get home. I take a solid three to five minutes and I just, after I park the car in the garage, I just sit there. And eventually, if I'm there long enough, eventually my husband will come out and be like, are you okay? And I'm like, just, I'm, you know, I'm going through emails or I'm sitting listening to a radio show or something like that. But yeah, that's my, like, it's like, okay.
Brandy Archie
What are you doing?
Brandy Archie
Mm-hmm.
Emilia Bourland
changed my game face and now it's family time and we're gonna go do the other thing. We're gonna do all the other things.
Brandy Archie
Change.
Switch to home time.
Totally, those transitions are super important, I actually think.
Emilia Bourland
Okay, so as you said at the top of show, we actually do have, I think, pretty serious top about a top top abouts. We have some pretty serious. Yeah, not top us topics. Top is would be great right now, especially after all of the liquid that I have consumed. But yeah, so.
Brandy Archie
Guess that.
Brandy Archie
Although, top of the be great right now, but just go ahead.
Emilia Bourland
There obviously we have some huge changes that are happening right now and coming down the pipeline in the way that our government and our bureaucracy is structured and that is run. And I think no matter what side of the aisle that you're on, it's really important to be informed about what's happening so that we know how changes are going to affect us might affect the people that we love, our parents, our children, our neighbors.
Because when it comes down to it, the things that are affected are the things that affect everyday Americans, right? It affects people. we just think, we thought it's so important to have a good understanding of, you know, more about what's going on, how changes might affect things. And also if we don't know what we can do, if we don't know how potential changes might affect us. So Brandi, you and I...
Brandy Archie
That's right.
Emilia Bourland
both did a little bit of research, but studying up particularly into some of the cuts that are coming to the Federal Health and Human Services Department because this is Care Lab and we care about health and we care about caregivers and people. And so we thought, well, if there's something we're going to look into, we should probably get some more information about this. So we did. So yeah.
Brandy Archie
Absolutely.
Brandy Archie
We did. And this was initiated by every department has been having cuts. And so of course, at some point it was going to end up at health care because health care is one of our biggest spins in the country. And so I was shocked that we cut 20,000, well, first 10,000 and then the next day 10 more thousand employees from Health and Human Services, which is an astronomical amount in my opinion, but still a fraction of what they're
Emilia Bourland
Mm-hmm.
Brandy Archie
of the number of employees that work for this very massive organization. And so I was like, well, if you cut 20,000 people, what is that impacting? It's not like 20,000 people were working and doing nothing. So like, what is that impacting? So that led us down this like, led us down this path of understanding that more deeply. And I learned a ton of stuff about how HHS works. For example, it has like 28 different organizations within it, agencies within it that impact
our everyday lives, like all of us. And so I was like, well, that's a lot of agencies. And so what's going to happen with that? And understandably, they want to feel like there's like duplication of services happening there. And because there's 28 different agencies. So I could like, I could see that maybe, but then when I started looking about like who's getting impacted, they are actually wrapping up or closing certain whole agencies like
Emilia Bourland
Mm-hmm. Mm-hmm.
Brandy Archie
the Administration for Community Living, which maybe sounds like nothing, but it's actually the vehicle that makes sure people get meals on wheels, among many other things. But that comes right down to it.
Emilia Bourland
Which I had no idea that Meals on Wheels was a program that was administered through an agency at Health and Human Services. I didn't know that before. And that's a really impactful program. mean, people rely on that for their nutrition as a community. We rely on that to make sure that our older adults who can't go
get that food for themselves are getting fed every day. That's a big deal.
Brandy Archie
not only getting fed, but you the program's intention or even the way it started was to make sure that somebody had eyes on those older adults who can't get out, right? And so Meals on Wheels started by like having some volunteer come every day and drop off the meal every day as an excuse to be like, peep in and say, hey, how's it going? And have some part of connection. And you know, as the program has grown, not every site is able to do everyday visits, but they're doing weekly visits at the least.
Emilia Bourland
Mm-hmm.
Brandy Archie
and dropping off meals for the week. And so to have a whole, and that's not the only thing that ACE, that the Administration for Community Living does, but that's one of the ones I feel like almost everybody knows somebody who has meals on wheels. And the government says that they're not going to eliminate anybody's services. However, they are eliminating the organization that funds that service. So.
Emilia Bourland
Mm-hmm.
Brandy Archie
while it's not coming from the top down to operate on wheels and like your individual organizations in your community operate them, ACL funnels the money, makes sure that they're tracking the stats and increases the budget as they need to for getting that stuff out for that and for other things. that's very scary actually.
Emilia Bourland
Yeah, think so. Let's I think that's a great specific example to start with. Let's kind of let's pull it back to a little bit of a broader view. I think to give some a little bit bigger overview and obviously like we're not going to go into all the agencies because we don't have time in a single episode to do that. And of course, you and I aren't like we're not sitting here claiming to be ultimate experts about these things. We're we're just like two people who are
regular American citizens who like want to know what's going on and understand how these things are working, right? But let's kind of, let's pull that back a little bit because, okay, so what you said, so there were 10,000 jobs eliminated. There's another 10,000 jobs that are about to be eliminated as well. So that is actually, that's 24 % of the entire workforce of health and human services, which is pretty critical.
Brandy Archie
Yeah.
Absolutely.
Brandy Archie
Mm-hmm.
Emilia Bourland
which is pretty crazy. Let's talk about just an overview. So what are some of the other agencies that Health and Human Services oversees besides the Administration for Community Living, like you said?
Brandy Archie
Sure. There's the CDC. There's NIH, the National Institutes of Health. Sorry, CDC is Centers for Disease Control and Prevention. And we shall be familiar with them since COVID. NIH is the National Institute of Health. It funds the research that's necessary in order to new medications, stuff like that. The FDA is in HHS.
Emilia Bourland
Yeah.
Brandy Archie
Centers for Medicare and Medicaid, CMS. So everybody's on Medicare and everybody's on Medicaid is in that agency, which is also under HHS. So there are a ton of organizations. Also, I forget its actual name, but there's a whole mental health agency that's also getting cut when we already know we don't have very many mental health services in our communities. So that agency is getting cut. So there are a ton. Those are some of the bigger ones that you might've heard of.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Yeah, I think when I kind of first heard about the cuts that were happening, my initial thought was like, wait, isn't Medicare and Medicaid overseen by HHS? And then obviously doing the research that they are and then finding out that it's actually about 5 % of the staff at CMS that's going to be cut through these rule reductions. And I guess my question would just be like,
Brandy Archie
Yes.
Emilia Bourland
What are the jobs that those folks were doing? And how is that going to affect the healthcare services that so many Americans? So I wanna say, hold on, I did the research on this. So 37.8 % of Americans, of the US population is covered by either Medicare or Medicaid. And it's actually split. was surprised to it split right down the middle.
Brandy Archie
That's surprising that it's like exactly down the middle.
Emilia Bourland
Exactly down the middle. Crazy, right? So, and this is from the U.S. Census Bureau. So 18.9 % of Americans use Medicare and 18.9 % of Americans use Medicaid, including the CHIP program, which is the Children's Health Insurance Program, which makes sure that kids who maybe their families make too much money to be on Medicaid, but they can't afford other insurance and they're not insured another way.
that those kids have access to health insurance. Sometimes in some states also covers pregnant women. So, but anyway, this is a huge percent of the population that is covered by these services. And it's not just like CMS, that's the Centers for Medicare and Medicaid Services. It's not like CMS just like cuts the checks or just talks to people about benefits.
Brandy Archie
they're an operating agency.
Emilia Bourland
They're an operating agency. They're doing everything. They're overseeing. They're saying what is covered and what's not. They oversee the payments that go out. They oversee quality control. They oversee fraud and compliance. mean, they're the people, if you have a question about your Medicare, these are the people that you call to ask that question.
If you're having trouble getting a benefit paid or with a provider, that's the place you go to report that complaint and where you have any recourse. So this is a really
Brandy Archie
And that's the place that's also judging. You can use CMS Compare to see how does this nursing home stack up? How does this rehab hospital stack up? So you can decide which one's a good one to send your person to.
Emilia Bourland
Mm-hmm. And so it stands to read, like, that is such a massive, massive job that this agency is trying to complete. It stands to reason that they need some folks to do that and to do it well, and that it's really important. And that's not to say, like, here's the deal. I think that we can all agree that there are always opportunities to streamline things and
be more efficient, and certainly that's true in the government. I don't think anyone would ever argue against that. But we should know. We should know how things are actually going to be affected when we have massive, massive changes.
Brandy Archie
Yeah. And I think it's also important that like, sometimes I feel like government agencies feel ethereal. They're like up here. They're not really connected to what we do down here. And, um, cause you don't maybe necessarily, you might not have ever called CMS, know, as healthcare professionals, as a business owner, definitely have and engaged directly. But if you're on Medicare or Medicaid, you just make sure that you have your cards, you go to the place, it works, you get your healthcare. But that's because the system works. Right?
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie
And so if the system doesn't have what it needs to work, your experience is going to be significantly different. Right. And like, think the sad part, this is good and bad. So the good part is that a lot of our systems that the government manages work pretty well. And so they work so well that you don't think about it. You expect it. Right. And so you don't have an experience in this generation of not having that thing.
And so you don't have anything to compare it to. Even though everything has its problems, there's inefficiencies everywhere. Is fraud happening? Sure, because it happens everywhere. That's why we have the agencies in order to catch it, right? Because we're dealing with people and people be messing up. But what we haven't...
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Emilia Bourland
want a t-shirt that says, I want a t-shirt without people be messing up. Quote, people be messing up. Dr. Brandy Archie.
Brandy Archie
People be messing up, bro. I mean, it's what it is. Dr. Brandy. I'm not sure too, If I wear it, I'm like, aren't you Dr. Brandy? I'm like, yes, I am. This is my quote. So it's like, so when it works well, you expect it and you don't think anything about it. So when somebody takes it away or changes it significantly, it doesn't feel like.
Emilia Bourland
Yes, yes I am.
Brandy Archie
a problem because you haven't recognized the problem. And then it'll just be later once that thing has enough holes in it that doesn't work well, that then you're going to be like, yo, this is a problem. And that stemmed from all the changes that happened before. And so even if you don't see any difference, which I hope you don't in your health care today, tomorrow or next week, if you cut 20,000 people without much thought in who it is and what they're doing and there's not like already.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Yeah, genuinely.
Brandy Archie
preformed plan about how we're going to absorb all this. You're to see impacts in the next few months.
Emilia Bourland
Yeah, I mean, there's just no way that you can make major change without having some collateral damage. That's just not how it works, right? Like if you're gonna make any major change in any part of even your life as an individual, some things might be good, some things are gonna be bad. Like there is going, but there will be consequences both ways, one way or another. And so understanding the potential for those
Brandy Archie
Yes!
Emilia Bourland
consequences and what they might be, how they might affect us is a really, really important thing that we need to do. And, you know, to ask questions about, to advocate, to make sure that the things that we really need are being protected, right?
Brandy Archie
Yeah, for sure. And then I guess somebody would say like, okay, well, if there's 20,000 people that are getting left out of the equation now, then they probably had too many people to begin with. Somebody might argue that. I would also say though that because such a massive system, we're thinking about health and human services, HHS, and it has so many impacts, sometimes the only way that you connect with people is about like how it is economically, right?
Like sometimes we see, guess like, if you think about how much money you spend on utilities and the place that you live, when you write that, when you pay that bill, it might feel like, is so much money. But if you just didn't have that thing, you'd be like struggling significantly. So when we look at the balance sheet and see that like, okay, we're spending so much money on payroll to run these agencies, can't we just cut some of this? You also need to look at the other side and like, what's the benefit? So like, for example, let's go back to my Meals on Wheels example.
Emilia Bourland
Mm-hmm. Yeah, yeah.
Brandy Archie
They've studied this and the return on investment for funding Meals on Wheels is that for every dollar that the government has spent, that we have spent as taxpayers on Meals on Wheels has returned two to three dollars in healthcare savings because that person has the right nutrition, they send my checks on them, finds them before they're dead on the floor, know, gets them the help that they need, whatever. All those scenarios that occur just because of the Meals on Wheels program.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Yeah.
Brandy Archie
has a two to $3 healthcare savings for every dollar. So that's a profitable business, even though it's a nonprofit passing out money. You know what I'm saying? That's profitable to our economy. And so we're preventing hospitalizations, we're improving health outcomes. There's benefit to this. And if you haven't seen the physical benefit, because you don't have a person on wheels, we can at least recognize it from a dollar's perspective, right?
Emilia Bourland
Yeah, absolutely. And I think I like how you're bringing up this point that like, and I think we've all had this experience in our own lives. Sometimes you make an investment in order to get a return on that investment, right? In order to sometimes in order to make more dollars or get more benefit of something, you have to you have to put something into it in the first place. You can't just say if you really want to if you want to grow in your wealth, if you want to grow in your health.
Brandy Archie
Mm-hmm.
Brandy Archie
Gotta spend money to make money.
Emilia Bourland
then you have to make an investment in that. can't just say like, well, this is too much upfront. I don't want to spend it at all because then you're not making that investment. There's nothing to grow from there. Right. And if you say with people's health, we're not going to invest in that. We're not going to do the things that we need to keep people healthy. There is going to be a huge bill, even though you might be saving that one dollar to begin with. There's going to be a huge bill coming at you in the end when at some point
Brandy Archie
Mm-hmm. Mm-hmm.
Emilia Bourland
you gotta pay the piper.
Brandy Archie
Absolutely. Absolutely.
Emilia Bourland
Um, so this is interesting. was just like, during the course of our conversation, I was thinking, okay, so, so there's, there were about 80,000 people working for all of the departments at health and human services. Now there's going to be right around 60,000 people. So like we said, it's about a, it's right around a 24 % cut in jobs. And I was wondering like, okay, so 80,000 people does sound like a lot of people and it is a lot of people.
Brandy Archie
Okay.
Emilia Bourland
I was like, but I was like, how many people work at Amazon? Right. So Amazon employs. I did. So Amazon employs one point five, five, six million full time and part time employees. That that many that many people. And and of course, now Amazon is a massive company. They're doing business all over the place.
Brandy Archie
Did you look that up?
Brandy Archie
That many people?
Emilia Bourland
But their primary thing that they do is get people goods, right? Is get people, deliver packages, they get the stuff, they deliver it. So they're a huge company, but they have more or less this, a pretty tight mandate, all things considered. If you think, yeah, in terms of the work, exactly, in terms of the work that they're doing, there's like a, they have a,
Brandy Archie
Yes, deliver packages.
Brandy Archie
as far as like the work that they're doing.
Brandy Archie
Got it, got it.
Emilia Bourland
a clear scope of the services that they provide.
Health and Human Services has all of these agencies that, to your point, they run Medicare and Medicaid, which ensures almost half of the US population. So they handle the healthcare for almost half of the US population. That's one agency. They handle all of the research. They do the FDA, which is Food and Drug Administration, which does all of the drug approvals, monitors the health and safety of what you and I are eating, what we're feeding our kids, all of these things like
But I mean, they have this huge scope of services that they have to provide, that they have been providing to your point, mostly not perfectly. That's not to say that anything, there aren't improvements that could be made. And I think we all have complaints like, I wish FDA did this, or I wish Medicare did that. like, I mean, we've talked about on this program, the things that we wish that Medicare would do differently, right?
Brandy Archie
Yeah!
Brandy Archie
Mm-hmm. Mm-hmm.
Emilia Bourland
But if you think about the number of things that this agency is responsible for, that this department is responsible for, and the number of Americans that it impacts on a daily basis, this work, which is every single one of us, because we all eat, because we all need healthcare, because we all love someone who also needs those things.
because we all need medicine.
That's actually crazy that it was only 80,000 people. If you think about it, Amazon has over 1.5 million to deliver packages.
Brandy Archie
Yes! Yes!
Brandy Archie
Exactly. So it's yeah, that's that's a good way to put it in perspective. That's that's why it's important to put investments of any kind into perspective, right? Because you're putting in something even if it's not money, putting in time and working out or running whatever that might not cost you anything dollars wise, but you just got to put in the time, right? You putting in something to get something in return and if you don't connect those two things, it can feel like the investment at front is not
Emilia Bourland
Crazy.
Brandy Archie
worth it if you don't actually pay attention to the trails of it, how it gets you to the goal. And so as an investment in all of our health, not everybody, a lot of people use Amazon, me included, but not everybody uses Amazon. Everybody is impacted too much. Yes, use Amazon too much. But literally every American is impacted by something that HHS is over. Everybody. Every day. So.
Emilia Bourland
Me too, too much. Too much, I use it too much. Yeah.
Brandy Archie
to think that they're using a fraction of the employees that a private business has already hired is actually a great way to think about it.
Emilia Bourland
Yeah, mean, just if you, mean, the tiniest fraction in comparison. One of the other things that I worry about too is what kind of, because these systems are complicated actually, right? Like bureaucracy is complicated. We all know this. One of the things that we all don't like about it is all the red tape and the rules and things like that. Of course, the flip side of it is those rules are put into place as a measure of quality control, right? To make sure
that people can't take advantage of the system, that there are units of measurement to make sure that things are going the right way, to ensure that there's not corruption in the process. That's what all that red tape is for a lot of the time, even though it's frustrating. I can't remember where my thought was going with that. Great.
Brandy Archie
anything
Brandy Archie
then I will interrupt you because the red tape is important because one other thing that got cut was the Provider Relief Bureau, which was, and that just happened on April the 1st. We're recording on April the 4th. And it closed that whole agency, but that agency was actively working. Like the whole point of that agency was to recoup nearly a billion dollars for the agency that.
Emilia Bourland
Mmm.
Brandy Archie
healthcare organizations and providers misused from COVID-19 payments. So they recognized the fraud, they were rooting it out and they were working on getting the dollars back, right? It's one thing to recognize who did it. It's another thing to actually get the money back. So they were doing that and in those just efforts to like save money, getting some money back would be great on their little receipt tracker. And you just shut down that whole agency because they probably didn't pay attention to actually what it was doing. They just were like,
Provide a relief bureau, meh, get rid of it. So yeah, so it's really important to be thinking strategically about how we're changing or downsizing anything so we can get the maximum benefit.
Emilia Bourland
Yep. Yep.
Emilia Bourland
Okay, so your talking made me remember where I was going with that whole red tape thing. Point being that this stuff is complicated because there are a lot of rules involved. When we massively get rid of a lot of people who know the rules for how this stuff gets done, then how does it get done? Who steps in and has to learn everything all over again or just breaks a lot of laws?
Brandy Archie
Okay.
Brandy Archie
Hmm.
Emilia Bourland
and a lot of rules in the process of just trying to get things done. Like, I don't think that you can overstate the value of human knowledge and human wisdom when it comes to figuring out how to work through a system. Like that experience is, institutional knowledge is so incredibly valued. I would say when I'm working with clients or patients like,
Brandy Archie
Institutional knowledge.
Emilia Bourland
That's one of the number one skills that I actually bring to the table is beyond just doing the regular old, know, my job as an occupational therapist trying to help them do the things that they want and need to do. I'm also helping them to navigate the system that they're in. I'm also giving them information about what their next stage of rehab is gonna be like, the things that they need to expect there, how to get the best out of that next stage of rehab, how to advocate for themselves.
Brandy Archie
Mm-hmm.
Brandy Archie
100.
Emilia Bourland
And so, and that's not knowledge that anyone taught me in grad school or that I just showed up with. it's, this is hard one knowledge that I've learned over almost 15 years of practice that I can pass on so that it can make other people's lives easier. And when we, and if you were to like, if you were to wipe out all of that type of knowledge or a huge chunk of that type of knowledge, what
Brandy Archie
Yep.
Emilia Bourland
What happens? How do the system do this? Can the systems continue to function or do they break down? And what are the consequences of those systems breaking down? Does it mean that health care bills don't get paid and rural hospitals close, which is already a big problem? Does it mean that you can't get your surgery completed that you need for your hip replacement or for your back surgery or for whatever it is? Like, is that what that means?
Brandy Archie
already.
Emilia Bourland
And I don't think that we know all the answers to those questions yet, but they're questions that we should be asking because one of the most wonderful things about America is that we have the right to ask those questions. And in fact, it's our patriotic duty as Americans to ask these questions because we get, everyone in the world doesn't get to do this. We get to hold our government accountable.
Brandy Archie
Mmm.
Emilia Bourland
And that is an incredible right that we have that not everyone else has in the world.
Brandy Archie
Yeah, we are a representative democracy, which means our representatives are supposed to be speaking our language and sharing our needs up the chain so that things can get done. Do things get done? They're changing now, right? And so things are getting done. I don't know if they're things that I like, but they're things that are getting done. And so I think it's like so important to know that like, while it sometimes feels disconnected and that maybe you don't have a big voice.
Emilia Bourland
There, things are getting done.
Brandy Archie
You as an individual do have a voice, especially if you collaborate with the people around you in your neighborhood, in your home, to amplify that voice up to your representatives. Because while they get a lot of mail and a lot of correspondence, they should, and that's the point. And it's their job to sift through that and be like, listen, I had like a thousand calls about what's happening with HHS and I had a hundred calls about what's happening with whatever else.
Like doesn't mean that whatever is not important, but clearly my constituents think that this is a really big deal. So let's like be real intentional about how we deal with this. let's take a look at some of these opinions. That's how this thing works. And then they take those opinions up and they decide how they're to work on that. And that's how change is made. Right. And so you can't get to a thousand people without having the first one. And so while it might feel like I don't know a thousand people to call,
Emilia Bourland
Mm-hmm.
Brandy Archie
you can be one of the thousands if you actually do call or send a letter or go to a town hall or make your voice heard about these things. Otherwise, they think you don't care. And then they're just gonna do what's in their best interest. If they actually have the documentation, the push that shows that like your constituent wants this, and then if you reciprocate by not voting for them, and they don't do what you want them to do, that's how things change in America. That's how things change. So I think it's really important that, like it's the beginning of April.
Emilia Bourland
Mm-hmm.
Brandy Archie
Most people have like a local election either just happened or coming up. And that impacts you very directly, your local elections, even though you don't maybe see them on the news as strongly as like a presidential election and what's happening in our federal government. But these agencies in your community are figuring out right now how to keep doing the work that they're doing without the money and the support that they've been getting from the federal government. So they gotta make hard decisions and you should be a part of that, right? And like,
Emilia Bourland
Mm-hmm.
Brandy Archie
Okay, if they got to cut something, let's let it not be this and let's let it be this other thing, right? We agree, we're gonna say that. So make sure you're voting in your local elections to make your voice heard so that we're not just complaining about things not happening the way we want them to.
Emilia Bourland
Mm-hmm. Yeah. And I think it doesn't matter what side of the aisle you fall on or how you feel about the cuts one way or another or how you feel about, you know, anything that's going on one way or another. I think we have to be asking more questions about like, OK, if you're on, if you think this is great, government is too big, we have to cut these folks down. This is awesome.
Like, yeah, we're going to break some eggs, but at the end of the day, we're going to come out better for it. OK. We still have to ask the question about which eggs are going to be broken. What is going to happen as a result of this process? Is there a plan for how we come out better on the other side of this? Because no matter what side of the aisle that we fall on, and really, I don't think health is not a political issue.
Brandy Archie
Mm-hmm.
Emilia Bourland
This is a human issue. That's where I stand on this. Like, this isn't about politics. This is about my mom and my dad and my neighbors and my kids and all of the people in my community and my families that I love. And that's what this kind of stuff is about. So if we're going to make changes, have to really want to hold people accountable for
Brandy Archie
Lives!
Emilia Bourland
giving us specific answers about what these changes are and exactly what the impacts are gonna be. And I don't think that we should be satisfied with answers that just say, well, we're gonna make it better. We're gonna save you money and we're gonna save you money and we're gonna give you more because listen, that sounds awesome to everyone. You're gonna do more for less? I'm down with that. No one is not down for that. Like more services, less money. Yes, sign me up, please.
Brandy Archie
Yeah, without a plan.
Brandy Archie
Great!
You
Emilia Bourland
But how are we going to make that happen? Where does the rubber really meet the road? Because details matter in where that collateral damage falls. And for me personally, I don't think anyone's health should be collateral damage.
Brandy Archie
Mm, no. Totally. I mean, think about it this. If your kid came to you and said, you know what? I'm gonna do less homework, but I'm gonna get better grades. Don't worry about it. Just, I got it. And you were just like, you wouldn't just be like, that's okay. So.
Emilia Bourland
Yeah
Brandy Archie
I'm marking this right here. Ashley, hi and welcome. It's good, except for we're still recording a podcast. But when you come back in at 10 o'clock on the dot and we'll be ready for you. See you soon.
Emilia Bourland
Okay.
Ashley Mahoney
Let's look at one guys
Ashley Mahoney
So sorry!
Ashley Mahoney
Yep. Yep. I will. Bye, guys.
Brandy Archie
I forgot what I was saying. Was I saying or you saying?
Emilia Bourland
you were saying and you were talking. Yeah. Homework. Yeah.
Brandy Archie
kids, about the-
So if your kid said that to you, are you gonna just be like, sure, sounds like a plan, go ahead. Or are you gonna be like, I don't understand how that works, explain that to me. You know, like it's okay if we're gonna do something different, but I need to have a plan about how that different thing is gonna take place.
Emilia Bourland
Yeah, yeah, and maybe their plan is a really good one. But are you gonna accept that on face value and say, no, absolutely not. You're not gonna do that. You're gonna wanna know what the plan is first, right? Yeah, because that's your job as their parent. That's your job, yeah.
Brandy Archie
Could be.
Brandy Archie
No!
Brandy Archie
That's your job. That's literally your job.
Well, I hope that everybody can, I hope that people feel a little bit more knowledgeable, at least about the change, because so much change is happening so fast right now, but at least about the changes that are happening and proposed to be happening around health and human services and our healthcare in America. And I'll be the first person to tell you healthcare in America is broken. But I need, you know, plans and data and a step-by-steps that we're gonna do in order to make it improving.
Emilia Bourland
Yeah, yeah.
Brandy Archie
not just like a slash and burn. And then once we tear it down, then we'll try to rebuild it. Because while that might work for a really big legacy system like we have, it means that lives are collateral damage in the meantime. And that's just not okay. So make sure you're getting out to vote. And because only 40 % of Americans actually vote in non-presidential elections, only 60 % us vote in presidential elections, where other countries have it at 90%. So like,
your voice actually does really matter a lot because not all of us are going to vote. So please go do that and make sure you stay informed. And if you have questions, we're not experts on this topic per se, but we wanna hear what you're concerned about, because we can bring experts to the table so that we can talk more about whatever it is. So make sure you're putting that in the comments, you should like it and subscribing, share an episode with a friend, because all of that helps make sure that...
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie
These conversations get heard by the people who need it.
Emilia Bourland
Yeah, thank you so much for watching, or watching, listening, whatever. Thanks for listening and watching Care Lab, and we'll see you next time right here. Bye, everyone.
Brandy Archie
both.
Brandy Archie
Bye everybody.
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