The rise of cash-only care

Summary

Marketplace Morning Report

Episode: The rise of cash-only care
Date: December 16, 2025
Host: Sabri Benishour (in for David Brancaccio)

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Episode Overview

This episode covers three main economic and business news stories affecting Americans today. Topics include the ongoing weakness in the U.S. labor market amid government layoffs, Ford's pullback from electric vehicles in response to changing policies, and the accelerating trend of cash-only care in healthcare, as more people seek direct, affordable access to doctors without insurance.

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Key Discussion Points & Insights

1. U.S. Labor Market Stagnation

• Guest: David Kelly, Chief Global Strategist, JP Morgan Funds

• Timestamps: 01:02–03:10

  • The economy added just 64,000 jobs in November, softening from October's loss of 105,000 positions.
  • The unemployment rate stands at 4.6%, rising from last year and recent months.
  • Much of the recent job loss is due to government layoffs and employee buyouts, notably affecting 162,000 government workers in October.
  • Many federal workers had already left their roles following a buyout program, which contributed to these figures.
  • Private sector job creation remains sluggish, averaging only 46,000 jobs per month over the past seven months.
  • Despite the weak data, the Federal Reserve is not expected to shift its interest rate approach until at least early 2026, when income tax refunds may temporarily boost consumer spending and employment.

  Memorable Quote:
  “No, it’s a pretty grinchy report. We’ve lost jobs in three out of the last seven months and the average job growth has been 17,000 jobs per month, which is miserably low.”
  —David Kelly (01:40)

2. Ford’s Shift in Electric Vehicle Strategy

• Reporter: Nancy Marshall Genser

• Timestamps: 03:10–04:51

  • Ford is discontinuing its fully electric F150 Lightning truck and canceling other electric vehicle (EV) programs, citing:
    • Lower-than-expected demand
    • High costs
    • Regulatory changes under the Trump administration, notably the expiration of the federal EV tax credit and relaxed emissions regulations
  • The company is redirecting its focus to hybrid and gas-powered vehicles and plans to convert its battery factories to produce storage systems due to increasing energy needs from data centers.
  • Ford aims for about half of its global sales to be hybrids, EVs, or extended-range EVs by 2030.

  Notable Statement:
  “This retooling will cost Ford more than $19 billion now. The company will charge ahead with hybrids.”
  —Nancy Marshall Genser (03:46)

3. The Rise of Cash-Only Care in Healthcare

• Reporter: Alex Olgen

• Timestamps: 05:51–08:46

  • With health insurance premiums rising and Affordable Care Act subsidies diminishing for over 20 million, more people are seeking out cash-only or "direct primary care" (DPC) models.
  • Case Study:
    • Brittany Pollard, self-employed postpartum doula, dropped ACA insurance after paying thousands in deductibles for little coverage.
    • Now pays $90/month for unlimited access to her doctor, Amy Schrader, with discounted rates for labs and tests.
    • Both patient and doctor highlight greater satisfaction and financial transparency in the model.
  • Doctor’s Perspective:
    • Dr. Schrader favors the DPC model for its flexibility and ability to offer better, more attentive care.
    • Acknowledges limitations—cash-only is not a full substitute for insurance, especially for specialists or unexpected major medical needs.
    • The model is spreading rapidly: About 10% of family physicians now offer cash-only care, up threefold from recent years.
  • Industry Trend:
    • Dr. Jeffrey Davenport of the Direct Primary Care Alliance notes the model’s expansion into more specialties (pediatrics, internal medicine, rheumatology, etc.)
    • With insurance premiums set to rise further in 2026, the shift toward DPC is expected to accelerate.

  Key Perspectives:
  “I really felt listened to… Not just a problem to be fixed, you know, not just a billing code.”
  —Brittany Pollard (06:25)

  “I love saving people money. I love it when I look up the cost of a lab and I’m like, ‘this only costs $2.’”
  —Dr. Amy Schrader (07:14)

  “The resources are limited. That's a challenge to be able to hook them up with their… things like therapy or specialty care.”
  —Dr. Amy Schrader (07:34)

  “We’ve kind of reached a critical mass.”
  —Dr. Jeffrey Davenport, Direct Primary Care Alliance (08:11)

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Notable Quotes & Moments with Timestamps

• “No, it’s a pretty grinchy report. We’ve lost jobs in three out of the last seven months and the average job growth has been 17,000 jobs per month, which is miserably low.”
  —David Kelly (01:40)
• “I really felt listened to… Not just a problem to be fixed, you know, not just a billing code.”
  —Brittany Pollard (06:25)
• “I love saving people money. I love it when I look up the cost of a lab and I’m like, ‘this only costs $2.’”
  —Dr. Amy Schrader (07:14)
• “This is filling a gap. You know, I was falling through the cracks of the system and this has gotten me the support that I need so I can live my life.”
  —Amy Schrader (07:53)
• “We’ve kind of reached a critical mass.”
  —Dr. Jeffrey Davenport (08:11)

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Key Timestamps

• 01:02–03:10 — U.S. jobs report analysis with David Kelly
• 03:10–04:51 — Ford pivots away from fully electric vehicles
• 05:51–08:46 — Cash-only care feature: patient stories, doctor’s perspective, industry trend

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Summary

This episode delivers a tight briefing on major shifts in the labor market, auto industry, and healthcare, exploring both policy impacts and the human stories behind the headlines. Rising costs and regulatory changes are triggering adaptation across sectors—from Ford’s strategic shifts to Americans’ search for affordable, straightforward healthcare. The emerging preference for cash-only care, in particular, highlights the ongoing challenges and creativity in the American healthcare landscape.

Transcript

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[Sabri Benishour]

All those government layoffs and employee buyouts have hit the labor market. From Marketplace, I'm Sabri Benishour in for David Brancaccio. The U.S. economy gained 64,000 jobs in November, but it lost 105,000 in October. The unemployment rate rose to 4.6%. It was 4.4% in September and 4.2% a year ago. David Kelly is chief global strategist at JP Morgan Funds and joins us to talk about it. Good morning.

[David Kelly]

Good morning.

[Sabri Benishour]

So overall doesn't sound great. What's your take here?

[David Kelly]

No, it's a pretty grinchy report. We've lost jobs in three out of the last seven months and the average job growth has been 17,000 jobs per month, which is miserably low. Now, that was partly because of government cutbacks in the government, but even the private sector, we only saw 46,000 jobs on average created over the last seven months.

[Sabri Benishour]

Speaking of government workers, we lost 162,000 government jobs in October. How serious is it when such a huge chunk of workers is suddenly out of work?

[David Kelly]

Well, we knew this was coming because what this really is is back in the spring, a lot of federal workers took a buyout. And the way the buyout worked is you got paid through the end of September. So this is really a lot of workers who've not been actually in the office for many, many months and have many of them, I hope, of course, other jobs this stage. So the general weakness in private sector payroll employment growth does say the economy is pretty slow right now.

[Sabri Benishour]

What does this mean for the Federal Reserve and what it's going to do with interest rates.

[David Kelly]

Well, interestingly, the market expectations for the Fed in January didn't change at all on this. And I think that's partly because with all the problems of the data, we really didn't know what to expect from this report. So markets move when you have something different from expectations. We didn't have good expectations one way or the other. But I think the Fed also realizes that come early 2026, there's going to be a lot of income tax refunds and that could cause consumer spending to pick up a bit and maybe employment growth to pick up a bit. So I think we are very far from calling this a recession.

[Sabri Benishour]

David Kelly, chief global strategist at JP Morgan Funds, thank you so much. Anytime the prospects for electric vehicles have dimmed under the Trump administration. In response, Ford announced yesterday that it is scrapping some EVs and focusing on hybrid and gas powered vehicles. Marketplace's Nancy Marshall Genser has that.

[Nancy Marshall Genser]

Ford says it will no longer make its fully electric F150 Lightning truck. It's also pulling the plug on a new electric truck it was planning and electric commercial vans. Ford says this is because of lower than expected demand, high costs and regulatory changes. The Trump administration allowed an electric vehicle tax credit to expire. It's also easing up on tax tailpipe emissions regulations. This retooling will cost ford more than $19 billion now. The company will charge ahead with hybrids. The F150 Lightning will become an extended range electric vehicle with a gas powered generator. Ford says about half of its global sales will be hybrids, EVs and extended range EVs by the end of the decade. Ford says it's also repurposing its battery factories to produce storage systems which are in high demand right now as data centers increase demand for power. I'm Nancy Marshall Genser for Marketplace.

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[Sabri Benishour]

We have talked a lot on this show about how health insurance is getting more and more expensive. And that is aside from the disappearing Affordable Care act subsidies that are going to make it even more expensive for more than 20 million people. All of these factors are fueling interest in a market for cash only doctors. These are doctors who don't take insurance. They just take cash. Reporter Alex Olgen has the story.

[Alex Olgen]

In the last six weeks, Brittany Pollard has made more progress on managing her chronic pain than over the last six months. She credits her new doctor in Chicago.

[Amy Schrader]

I really felt listened to. Not just a problem to be fixed, you know, not just a billing code.

[Alex Olgen]

Pollard works for herself. She's a postpartum doula and helps families with newborn care. She used to buy insurance on the marketplace but was paying hundreds of dollars out of pocket for urgent care visits because of her $9,200 deductible.

[Amy Schrader]

Ultimately, I was paying for a plan that I never used.

[Alex Olgen]

So she dropped the coverage and signed up for what's called direct primary care, essentially a membership with a physician. Pollard pays $90 a month for unlimited appointments, calls or in office care with her doctor, Amy Schrader.

[Amy Schrader]

I feel like I can do a much better job in this model, whereas in the others I felt like I was kind of handicapped.

[Alex Olgen]

Schrader says pressure to see more patients and insurance denials often got in the way of care. Now she gets patients discounted cash rates for labs, X rays and other tests.

[Amy Schrader]

I love saving people money. I love it when I look up the cost of a lab and I'm like, this only costs $2.

[Alex Olgen]

Schrader stresses this is not a substitute for insurance. However, many of her patients are gig workers like Pollard, and they're choosing this cash only model over coverage they can't afford. But other care can be expensive for her patients.

[Amy Schrader]

The resources are limited. That's a challenge to be able to hook them up with their, yeah, things like therapy or specialty care.

[Alex Olgen]

But people who choose this often understand that going without coverage is risky. Brittany Pollard thinks about what if she gets into a car accident or has cancer?

[Amy Schrader]

This is filling a gap. You know, I was falling through the cracks of the system and this has gotten me the support that I need so I can live my life.

[Alex Olgen]

This cash only model is spreading. The American Academy of Family Physicians estimates about a tenth of their members offer it triple the amount just a few years ago.

[Marketplace Announcer]

So we've kind of reached a critical mass.

[Alex Olgen]

That's Dr. Jeffrey Davenport, President of the trade group the Direct Primary Care Alliance. He's seeing the idea spread beyond family physicians.

[Marketplace Announcer]

The pediatricians are catching fire, internal medicine doctors, even specialist internal medicine doctors, hematology, rheumatology, endocrinology.

[Alex Olgen]

Next year, monthly health insurance premiums are set to more than double for many who buy coverage on the Marketplace, and that's likely going to lead to more patients looking for cash only care. I'm Alex Olgan for Marketplace, and in.

[Sabri Benishour]

New York, I'm Sabri Benishore with the Marketplace Morning Report from APM American Public Media.

[Marketplace Announcer]

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