Closing the Healthcare Affordability Gap From the Front Lines with Joseph Pollino, PA-C

Summary

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Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode: Closing the Healthcare Affordability Gap From the Front Lines with Joseph Polino, PA-C
Guest: Joseph Polino, PA-C – Primary Care Physician Associate and Healthcare Advocate
Date: February 12, 2026
Host: Scott Becker

This episode spotlights the pervasive and worsening healthcare affordability crisis in the United States. Joseph Polino draws on his unique experience as a clinician, former coroner, and EMT to discuss how financial barriers profoundly impact patient care, sharing real stories from the front lines and offering insights on both policy and practice-level solutions. The conversation is candid, impassioned, and rooted in everyday realities facing patients and providers.

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Key Discussion Points and Insights

Joseph Polino’s Background & Motivation

• Early Career Perspectives
  • Polino shares his unconventional path: deputy coroner, EMT firefighter, ER tech—experiencing the “trifecta of acute care” ([01:06]).
  • Quote: “I would go on the 911 call, and then I would sometimes take care of those patients in the ER, and then I would sometimes investigate their deaths shortly thereafter.” ([01:17])
  • Witnessed preventable deaths due to poor health management, inspiring his shift to primary care to “help patients prevent and manage their chronic disease... avoid the 911 call, avoid the ER and avoid a premature death.” ([01:50])

The Tragedy of Preventable Death and the Role of Primary Care

• Frontline Experience as Coroner & PA
  • Most deaths he investigated were preventable—rooted in patients avoiding or delaying care due to financial or systemic barriers ([02:31]).
  • Quote: “We’re kind of the cannon fodder of the healthcare system… we hear the raw stories, the struggles these folks are going through. It’s not just their own health, it’s also navigating the healthcare system.” ([02:58])
  • Clinicians now face barriers that are “increasingly... financial,” not just biological ([03:26]).

The Healthcare Affordability Gap: What It Is and Why It Matters

• Scope of the Crisis
  • Skyrocketing insurance premiums, deductibles, and out-of-pocket maximums put care out of reach even for the insured ([04:17]).
  • Clinicians are becoming “financial counselors” as much as medical providers ([04:38]).
• Underinsurance and Delayed Care
  • Many are “insured, but not covered”—having insurance that they’re afraid or unable to use ([04:44]).
  • Case Study: Patient with a high-deductible plan avoided an essential chest X-ray, resulting in ICU admission for pneumonia—a much more expensive and dangerous outcome ([05:05]).
  • Quote: “He took a gamble with his lungs and he ended up in the ICU with pneumonia for several days. And I don’t even know what that bill is going to cost him, but it could bankrupt him.” ([05:29])
  • 66% of bankruptcies tied to medical bills ([05:42]).

The Disconnect Between Coverage and Access

• Fears Around Financial Burden
  • Patients refuse preventive care, screenings, or basic diagnostics due to costs ([06:22]).
  • Quote: “They just see this enormous cost to this... it really makes it challenging for them and for us.” ([06:43])
• Downgrading of Insurance
  • Loss or reduction of ACA premium tax credits has caused premiums to spike and patients to switch to “bare bones bronze plans” with high deductibles—$7,500 on average ([07:27]).
  • Quote: “We gotta ask ourselves, what kind of a country do we want to live in?... Is that the kind of country we want to live in? And my answer to that is no.” ([07:54])

Systemic Causes: Provider Shortages & Healthcare Inflation

• Lack of Providers, Rising Costs
  • Discusses the linked issues of healthcare inflation and insufficient supply of clinicians contributing to inaccessibility ([08:19]).
  • Congressional proposal to cap student loans for PA/NP education at $100,000 branded as a “disservice” since it will discourage entry into primary care—incentives to become clinicians are decreasing, even as shortages escalate ([08:49]).
• Clinician Advocacy
  • Polino believes more clinician voices in the debate can drive change: “The more clinicians that are speaking up about this problem, I think it will go a long way into enacting some real change here.” ([09:49])

Perspectives on the Year Ahead & Personal Motivation

• Looking to 2026
  • Polino will continue amplifying patient stories and advocating for policy reform, especially around ACA credits ([10:22]).
  • Hopes Congress will act on premium tax credits to stem a potential coverage crisis ([10:49]).
  • Personal initiative: Building his platform as “the frontline PA” to inject firsthand clinical perspectives into public debate ([11:13]).
  • Quote: “At the end of the day, we’re not just stakeholders, we’re witnesses. We are seeing the human cost of these policy choices and that perspective needs to be part of the conversation.” ([11:31])

The Role of Clinician Advocacy in Personal Fulfillment

• On Staying Engaged
  • Polino sees advocacy as a fundamental responsibility; caring about patients also means caring about the system’s structure ([12:00]).
  • Expresses belief in Maslow’s hierarchy—without basic access to healthcare (“a fundamental need”), higher goals aren’t attainable ([12:23]).
  • Quote: “I want to see people being their best and innovating and driving the economy and a healthy society and... people need, they need to be taken care of. They need healthcare. That’s just a basic fundamental need and I’m going to do my part to try to advocate for that.” ([12:31])

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Notable Quotes & Memorable Moments

• “We’re kind of the cannon fodder of the healthcare system, Scott. We’re in it, we’re on the front lines, we’re in the trenches. We hear the raw stories, the struggles that these folks are going through.”
  — Joseph Polino ([02:58])

• “High deductible health care plans... these people... are insured, but they’re not covered. They’re paying a premium for a card that they can put in their wallet that they’re scared to use.”
  — Joseph Polino ([04:44])

• “He took a gamble with his lungs and he ended up in the ICU with pneumonia for several days. And I don’t even know what that bill is going to cost him, but it could bankrupt him.”
  — Joseph Polino ([05:29])

• “We gotta ask ourselves, what kind of a country do we want to live in?... People are getting sicker. People are getting unhealthy. Is that the kind of country we want to live in? And my answer to that is no.”
  — Joseph Polino ([07:54])

• “The more clinicians that are speaking up about this problem, I think it will go a long way into enacting some real change here.”
  — Joseph Polino ([09:49])

• “At the end of the day, we’re not just stakeholders, we’re witnesses. We are seeing the human cost of these policy choices and that perspective needs to be part of the conversation.” — Joseph Polino ([11:31])

• “You can’t get to the top of the pyramid and self-actualization and really pursuing the greater things in life if you’re sick, if you’re worried about getting your medicine. They need healthcare. That’s just a basic fundamental need and I’m going to do my part to try to advocate for that.” — Joseph Polino ([12:23])

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Important Segment Timestamps

• Intro & Joseph Polino’s Background: [00:38] – [02:24]
• The Tragic Impact of Neglected Care: [02:24] – [03:55]
• Defining and Illustrating the Affordability Gap: [03:55] – [06:08]
• Disconnect Between Coverage and Access: [06:08] – [08:19]
• System Solutions: Policy, Provider Shortages, and Legislation: [08:19] – [10:06]
• Personal Advocacy and 2026 Outlook: [10:06] – [11:36]
• Purpose and Fulfillment in Clinician Advocacy: [11:36] – [13:20]

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Summary Takeaways

• Healthcare affordability is the most acute and personally felt crisis in American healthcare today, with broader and deeper consequences than many realize.
• High-deductible insurance plans leave many insured individuals fearful or unable to access care, resulting in preventable illness, inflated downstream costs, and financial ruin.
• Clinicians bear witness daily to these struggles and are increasingly called to act as both caregivers and financial counselors.
• Solutions will require action at multiple levels, especially sustained clinician advocacy and attentive policy reform—such as preserving premium tax credits and supporting provider training.
• Clinician voices from the front lines, like Joseph Polino’s, are essential to highlighting the real human consequences of policy choices and to inspiring meaningful transformation in the healthcare system.

Transcript

[Announcer]

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[Joseph Polino]

In the upper right.

[Scott Becker]

This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled today to visit with a brilliant leader who's both an advocate, a physician assistant and observer of the healthcare system, and a journalist. We're joined today by Joseph Polino. Joseph, can you take a moment and introduce yourself and tell us a bit about yourself and your career? Then we're going to talk about something you write about often, which is the affordability gap in healthcare. Joseph, tell us a bit about yourself.

[Joseph Polino]

Hey, Scott, thank you for having me. I really appreciate the opportunity to talk to you and your audience. My name is Joseph Polino. I'm a primary care physician associate. I'm based in Northern Nevada. I've been practicing medicine here in the Carson Valley for about six years. It's a great community, great clinic, really great place to be. Prior to PA school, I had kind of an interesting background. I was a deputy coroner. I was an EMT firefighter and an ER technician. And I kind of viewed it as the trifecta of acute care. You know, I would go on the 911 call, and then I would sometimes take care of those patients in the er, and then I would sometimes investigate their deaths shortly thereafter. And I think through that experience, I really saw firsthand the cost of neglected and poorly managed health. And so while in school, I decided I wanted to go into primary care. I thought that was the best avenue to really help patients prevent and manage their chronic disease so they can avoid the 911 call, avoid the ER and avoid a premature death and really happy in that setting.

[Scott Becker]

Thank you. And talk for a second about being a coroner. And what was that like? What is that like?

[Joseph Polino]

Well, you know, it was tragic. I think a lot of. A lot of the times the cases we get as a medical, legal death investigator is premature death. And so you would see these people that just neglected care. They hadn't been to the doctor in a long time for various reasons. And I just, you know, my impression of a lot of that experience was those deaths were largely preventable I mean, we all do pass at some point, but a lot of the cases I was getting that that was the case. And, and that's really what inspired me to get into primary care. And, and I will just say that I think of myself and other primary care clinicians. We're. We're kind of the cannon fodder of the healthcare system, Scott. We're in it, we're on the front lines, we're in the trenches. We're really getting the real pulse of what's happening with patients. We hear the raw stories, the struggles that these folks are going through. And it's not just their own health, it's also navigating the healthcare system. So we have a unique lens and we as clinicians, we're trained that the biggest barriers to health are biological. It's bacteria, viruses, genetics. But increasingly we're seeing that the barrier is financial.

[Scott Becker]

And what could be done about that. And talk about this affordability gap. I mean, just in broad strokes, health insurance is now costing 25, 30,000 a year per family. Most people make a lot less than 80,000 a year. So we've got this horrendous affordability gap. Talk a bit about the affordability gap and what you mean by it when you talk and write about it and then talk about what could be done about it.

[Joseph Polino]

Yeah, well, you know, there's a lot of talk in, just in general right now about the affordability crisis in the country, but I would argue that there's no area where this crisis is more acute than in the healthcare system. You know, patients are really struggling out there, premiums are going up, deductibles are going up out of pocket, maximums are going up. And this is the message I'm hearing day in and day out from my patients. And increasingly, you know, me and my fellow clinicians were acting as kind of financial counselors to these people. What I focused on in my LA Times piece that was recently published was really the high deductible health care plans. And basically, these people, you know, they're insured, but they're not covered. You know, they're paying a premium for a card that they can put in their wallet that they're scared to use. And that's what I'm seeing. I highlighted a story in my article about a patient of mine who came in with a cough and some shortness of breath, and. And he wasn't acutely ill at that point, but I wanted to get a chest X ray. But, you know, to him, the chest X ray was not A necessary diagnostic test. It was a financial shock that he couldn't absorb. And he told me, you know, I'm going to pass. He had a high deductible plan and he said he would call me if he got worse. Well, he took a gamble with his lungs and he ended up in the ICU with pneumonia for several days. And I don't even know what that bill is going to cost him, but it could bankrupt him. And 66% of bankruptcies are tied to medical bills. And I hope that's. I'm glad he made it. But this is a real problem, Scott. And I think as clinicians, we need to be advocates for our patients and highlight this problem.

[Scott Becker]

Thank you. And talk about coverage, having coverage at least by a card, but not having access or being afraid to access the access. The providers. Talk about that challenge, because that seems like a very real challenge.

[Joseph Polino]

Yeah, well, it's a challenge to the patients and it's a challenge to the providers. Patients are coming in and they have a high deductible plan and they're just not wanting to do the preventative screenings, the cancer screenings, the routine labs. If they come in with a problem, they don't want to do the workup. And I don't blame them. They just see this enormous cost to this. It really makes it challenging for them and for us. I think you asked, well, what can be done about this? And I think there's a couple different ways to look at it. Way I look at it is I think there's three levels. There's policy, there's system, and then there's the exam room where I live. I think from a policy level, obviously the big thing in the news is Congress needs to, to extend the ACA premium tax credits, you know, without that. And they've already expired. So that's happened. Premiums are, have jumped 114% for marketplace enrollees. And we're looking at millions of people that are going to lose coverage. But one thing, Scott, that I think is lost in that conversation that I tried to highlight in my article is millions more people are not just going to lose insurance. They're going to downgrade to a bare bones bronze plan. That, that really is just, you know, bluntly, it's garbage. What was it, the Kaiser, the kff? Basically, they said that the average deductible now for a, a bronze plan is something like $7,500. You know, and we got to ask ourselves, what kind of a country do we want to live in? You know, people are getting sicker People are getting unhealthy. And is that. Is that the kind of country we want to live in? And my answer to that is no.

[Scott Becker]

How do we solve the issue of just healthcare inflation in total and lack of supply of providers? Because this seems to actually get into a lot of the affordability as well, that we just don't have enough doctors and nurses, physician assistants, and then just the cost seems so inflated every place. How do you solve any of that? Any thoughts on it?

[Joseph Polino]

Well, I think that it's a complex problem, but there are definitely some things that legislators can do to help with this problem. One thing in the news in regards to my profession is Congress basically is proposing that they're not going to give federal student loans over $100,000 for these graduate programs for PAs and nurse practitioners. And I think that's a real disservice. We need more providers. We need to incentivize young people in this field to want to become providers. So, look, at the end of the day, I'm a frontline pa. I'm a clinician. I'm in the exam. You know, the Congress needs to get their act together and get together and try to get some solutions to this problem. But I'm basically out here saying, this is a problem. My colleagues are seeing it. I've had a lot of fellow clinicians reach out to me and they say, you know, we're seeing the same thing here, and it's just unsustainable. But I think that the more that we speak up about this problem and the more clinicians that are speaking up about this problem, I think it will go a long way into enacting some real change here.

[Scott Becker]

No, it seems like, no question, huge problems. In trying to figure out how to solve them is just incredibly challenging. Talk about, as you look at 2026, what are you most focused on and excited about this year? Joseph?

[Joseph Polino]

Well, I'm focused on amplifying these stories. I think, like I said, as a frontline clinician, we have a window into what's really happening to American families that policymakers and executives may not always see. And I think it's our responsibility as clinicians to be advocates for our patients, both in the exam room and in the national conversation. So I'm going to keep doing that. I'm going to keep speaking out and advocating for patients, whether it's writing podcasts like this or building community around these issues. I'm really interested in watching what happens with the premium tax credits. I understand late last week, there is some talk that there may be some type of a framework agreement and I really hope that that's true. So looking forward to that. Just personally, I'm excited to keep building my platform, the frontline PA because I think clinicians have real value in these debates. And at the end of the day, we're not just stakeholders, we're witnesses. You know, we are seeing the human cost of these policy choices and that perspective needs to be a part of the conversation.

[Scott Becker]

Couldn't agree more. Joseph, What a pleasure to visit with you. What an impressive career. I want to ask you one question. You spend a lot of time just doing your day job, but also advocating for the healthcare system. Talk about how that keeps you engaged and interested and alive and how positive it is to have like both those things, not just, not just doing your day job, but so passionate about these issues too.

[Joseph Polino]

Well, I think it's part of our responsibility, Scott. I think the type of people that want to become clinicians, we really care about our patients. And like I said, it's not just my patients, it's patients in general. I think about what kind of a country I want to live in and I think about is it Maslow's hierarchy of needs, you know, you can't get to the top of the pyramid and self actualization and really pursuing the greater things in life if you're sick, if you're worried about getting your medicine. And I want to see people, you know, being their best and innovating and driving the economy and a healthy society and you know, people need, they need to be taken care of. They need health care. That's just a basic fundamental need and I'm going to do my part to try to advocate for that.

[Scott Becker]

Well, we love that. We love what you do, Joseph. Just fantastic. Thank you for taking the time to join us today on the Becker's Healthcare podcast. Again, Joseph Polina, physician assistant, works at the Great Health System, also writes and advocates on behalf of healthcare. Just fantastic your passion for what you do and what you do. Thank you for joining us today, Scott.

[Joseph Polino]

It's been a pleasure. Thank you for having me.