How Medicare payment cuts are hurting health care

Summary

Marketplace Podcast Summary Episode: How Medicare Payment Cuts Are Hurting Health Care
Release Date: November 26, 2024
Host: Amy Scott (in place of Kai Ryssdal)

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Introduction

In this episode of Marketplace, host Amy Scott delves into the intricacies of the U.S. bond market, the outcomes of COP 29—the annual UN climate summit—and, most notably, the impact of Medicare payment cuts on the healthcare system. The episode provides a comprehensive analysis of these topics, featuring insights from financial experts, healthcare professionals, and policymakers.

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The Bond Market and Treasury Secretary Appointment

Overview: The episode begins with a discussion on the $28 trillion Treasury market, highlighting its significance in gauging the global economy and investor sentiment. The recent appointment of hedge fund billionaire Scott Besant as President-elect Donald Trump's Treasury Secretary has influenced bond yields and market perceptions.

Key Points:

• Rising Bond Yields: Since September, bond yields had been on a steady rise due to strong economic data and inflation fears post-Trump’s reelection (00:16).
• Impact of Scott Besant's Appointment: Besant is perceived as a moderating influence on potential inflationary policies, leading to a temporary decline in bond yields (02:37).
• Market Reactions: Experts like Thomas Urano from Sage Advisory note that Besant's focus on balancing tax cuts with fiscal responsibility has reassured investors, causing a "relief rally" (02:13, 02:37).

Notable Quotes:

• "Up until the announcement of hedge fund manager Scott Besant as Trump's treasury pick, investors were focused intensely on inflation..." — Amy Scott (01:54)
• "His first priority is delivering on all the tax cuts the president elect has promised instead of tariffs." — Jennifer Lee, BMO Capital Markets (02:56)

Expert Insights:

• Jennifer Lee (BMO Capital Markets): Emphasizes Besant's commitment to tax cuts and cautious approach to tariffs and spending (02:56).
• Quincy Crosby (LPL Financial): Highlights the market's need for experienced leadership to manage the federal deficit through efficient Treasury operations (03:33).

Conclusion: While Besant's appointment has provided short-term relief to bond markets, experts caution that upcoming inflation data could influence future bond yields (03:45).

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COP 29 Climate Summit Outcomes

Overview: The discussion transitions to the recent COP 29 climate summit held in Baku, Azerbaijan. Despite low expectations due to the absence of major emitters like the U.S., China, and France, some progress was made.

Key Points:

• Financial Commitments: Developed nations agreed to contribute $300 billion annually to assist poorer countries in adapting to climate change, tripling previous contributions (05:21).
• Criticism from Experts: Environmental economist Dana Fisher criticized the summit for falling short of the $1.3 trillion annual target advocated by developing nations (05:32).
• Lack of Enforcement: Kava Gillenpour from the Center for Climate and Energy Solutions pointed out the absence of punitive measures for countries failing to meet their financial commitments (06:36).

Notable Quotes:

• "Anybody who expected this 29th round of climate negotiations in a petro state theoretically to stop the climate crisis was fooling themselves." — Dana Fisher (05:21)
• "It's green smoke and mirrors. I mean, it's just, it's just performative climate action at this point." — Dana Fisher (05:32)

Expert Insights:

• Dana Fisher (American University): Views the summit as insufficient and primarily symbolic (05:21, 05:32).
• Daniel Brissett (Environmental and Energy Study Institute): Optimistic about the resilience of global efforts despite U.S. withdrawal from the Paris Agreement (06:03).

Conclusion: While COP 29 achieved modest financial commitments, experts believe much more is needed to effectively combat climate change, and future summits like COP 30 in Brazil will aim to bridge the substantial funding gap (07:01).

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How Medicare Payment Cuts Are Hurting Health Care

Overview: The core segment of the episode addresses impending Medicare payment cuts that will reduce doctors' earnings by approximately 3% starting next year unless legislative action is taken. This poses significant challenges for healthcare providers, especially those in private practices.

Key Points:

• Payment Adjustments: The Centers for Medicare and Medicaid Services (CMS) plans to adjust the physician fee schedule, decreasing reimbursements even as the cost of care rises by 3.5% annually by law (07:01).
• Impact on Private Practices: Physicians argue that reduced Medicare payments make private practice financially unsustainable, leading to reduced Medicare patient acceptance or practice closures (08:29).
• Economic Strain on Doctors: Increased operational costs coupled with declining reimbursements force doctors like Bruce Scott, president of the American Medical Association (AMA), to make difficult financial decisions (08:45).
• Variation Across Specialties: Not all medical specialties are equally affected, with overpayments for procedures and underpayments for patient care time exacerbating the issue (10:12).
• Regional Disparities: Rural areas face heightened difficulties in attracting and retaining Medicare patients, further straining local healthcare systems (09:24).

Notable Quotes:

• "Running a medical practice has been getting more expensive, especially in the last few years." — Samantha Fields (08:29)
• "Adjusted for inflation, Medicare now pays doctors almost 30% less than it did in the early 2000s." — Samantha Fields (08:50)
• "It results in overpayment for procedures and imaging and tests, and underpayment for time spent with patients." — Robert Berenson, Urban Institute (11:07)
• "At the same time, what Medicare has paid us has gone down." — Bruce Scott, AMA (08:45)

Expert Insights:

• Samantha Fields (Reporter): Highlights the financial challenges faced by doctors due to rising costs and declining Medicare reimbursements (08:29).
• Michael Chernew (Harvard Medical School): Points out that Medicare enrollees generally report better or comparable access to healthcare services compared to those with commercial insurance, despite the payment cuts (10:08).
• Robert Berenson (Urban Institute): Criticizes the current payment structure as broken, leading to financial imbalances between different medical services (11:07).

Case Studies:

• Bruce Scott (Louisville, Kentucky): Describes the fiscal hardships faced by his practice, including reduced Medicare payments and the impact of a cyber-attack that halted revenue streams (11:28).
• Mary Clark (Stillwater, Oklahoma): Observes the difficulty in finding physicians willing to accept new Medicare patients, affecting healthcare access in rural communities (09:24).

Conclusion: Without Congressional intervention, the projected Medicare payment cuts could lead to significant disruptions in healthcare delivery, particularly in private and rural practices. The decline in reimbursements not only threatens the viability of individual practices but also has broader implications for the accessibility and quality of healthcare services in the United States (12:32).

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Additional Segments

While the episode primarily focuses on the Medicare payment cuts, it also touches upon other relevant topics:

Migration Trends to the Midwest

Summary: A significant number of Americans are relocating to Midwest cities like Kansas City and Columbus, driven by factors such as increased development, affordable housing, and new job opportunities in sectors like semiconductor manufacturing.

Notable Insights:

• Jonathan Rapa (MMGR Brokerage Advisory): Attributes the uptick in Midwest development to strategic investments like Intel's new plant in Columbus, Ohio (17:31).
• Matt Kristofferson (National Association of Realtors): Highlights net migration gains in states like Ohio and Indiana due to affordability and quality of life factors (18:13).

Revival of Print Magazines

Summary: Contrary to the longstanding decline in print media, several major magazines, including The Atlantic, Saveur, Sports Illustrated, and Vice, are resurrecting their physical editions. This revival is driven by sustained reader interest and advertiser preference for print formats.

Notable Insights:

• Amanda Mull (Bloomberg Businessweek): Discusses the strategic reevaluation by publishers recognizing the ongoing demand for print among both readers and advertisers (20:11).
• Kaylee Wells (Reporter): Explains that print serves as a luxury good, appealing to higher-income, educated demographics and offering superior advertising environments (23:19).

Artistic Endeavors: The Life of a Muralist

Summary: Cindy Fletcher Holden, a muralist from Annapolis, Maryland, shares her journey and passion for creating public and private murals. She emphasizes the physical and creative challenges of the profession and the satisfaction derived from community engagement.

Notable Insights:

• Cindy Fletcher Holden: Reflects on her career's alignment with her family's legacy in mural painting and the diverse demands of different mural projects (25:05).
• Challenges Faced: Discusses the logistical aspects of mural creation, including working in various environments and the physical demands of large-scale art (26:00).

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Market and Economic Highlights

Stock Market Performance:

• Dow Jones Industrial Average: Rose 1% to close at 44,736.
• Nasdaq: Increased 0.25% to end at 19,054.
• S&P 500: Gained 18 points to finish at 5,987 (12:33).

Corporate News:

• Macy's Accounting Irregularities: The retailer uncovered at least $132 million in small package delivery expenses that were never recorded, attributed to intentional bogus entries by an employee (13:58).
• Retail Sales and Bond Yields: Despite strong current quarter sales, Macy's shares saw a decline due to past financial inconsistencies. Concurrently, bond prices rose as the 10-year Treasury note yield fell to 4.27% (13:58).

Entertainment Update:

• Box Office Performance: Wicked achieved the highest opening ever for a Broadway adaptation, grossing $114 million, while Gladiator 2 garnered $55.5 million over the weekend (25:05).

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Closing Remarks

Amy Scott wraps up the episode by highlighting the dynamic interplay between policy decisions, economic indicators, and their real-world impacts on various sectors, notably healthcare. She encourages listeners to stay informed and engaged with ongoing economic developments.

Final Note: The episode underscores the critical nature of Medicare reimbursement rates and their cascading effects on the healthcare system, emphasizing the urgent need for policy intervention to sustain quality and accessibility in medical services.

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References: Timestamps are provided alongside quotes and key points to facilitate easy navigation and verification of the discussed topics.

Transcript

[Amy Scott]

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[Mitchell Hartman]

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[Kaylee Wells]

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Sign up [e-mail] doors take us to summers Away or winter Adventures and afternoon getaways. Your dedicated Fidelity Advice can help you open those doors by working with you on a comprehensive plan to help you reach your wealth's full potential. Because doors were meant to be opened, visit fidelity.com Wealth Investment Minimum Supply Fidelity Brokerage Services LLC Member NYSE SIPC on the show today, we've got three M's, not the company Markets, magazines and murals from American Public Media. This is Marketplace in Baltimore. I'm Amy Scott in for Kai rysdal. It's Monday, November 25th. Good to have you with us. We talk about the bond market a lot on this show because the $28 trillion treasury market tells us a lot about the global economy and where investors think it's headed and and that's where we're going to start. As the market reacts to President elect Donald Trump's choice for treasury secretary, hedge fund billionaire Scott Besant. Bond yields had been rising steadily since September as strong economic data and then Trump's reelection had investors worrying about inflation. But as Marketplace's Mitchell Hartman reports, yields have been coming down more recently.

[Amy Scott]

Up until the announcement of hedge fund manager Scott Besant as Trump's treasury pick, investors were focused intensely on inflation and whether it might soon surge higher again, in part because of what the incoming Trump administration is expected to do, says Thomas Urano at Sage Advisory.

[Mitchell Hartman]

Tax cuts, tariffs, immigration, the market generally perceiving the Trump administration to embark on policy that might add to inflationary pressures.

[Amy Scott]

Add to growth, but also add to.

[Mitchell Hartman]

The deficit, brings in the question whether the Fed is going to continue cutting rates.

[Amy Scott]

There's a bit less worry now that investors expect Scott Besant to hold the most important economic position in the new administration, says Urano.

[Mitchell Hartman]

It's just a little bit of a relief rally. He's viewed more as a moderating force on some of the tax tariffs and deficit concerns.

[Amy Scott]

In particular, Besson is seen as ready to advocate for a balance between Trump's stimulatory wish list and fiscal reality, says Jennifer Lee at BMO Capital Markets.

[Mitchell Hartman]

He said his first priority is delivering on all the tax cuts the president elect has promised instead of tariffs. The fact that he also wants to cut spending is also encouraging. As opposed to spending, you know, like there's no tomorrow.

[Amy Scott]

Besant is on the record favoring gradual implementation of tariffs, which could reassure companies and consumers worried about higher import prices hitting right away. Some of the relief in markets comes simply from the fact that Besant is a seasoned Wall street hand. At a time when the federal deficit is high and likely going higher, says Quincy Crosby at LPL Financial, the need.

[Mitchell Hartman]

To raise money to pay for that deficit via auctions, for example, you need to have someone highly experienced. I mean, that's something that the market was in essence demanding.

[Amy Scott]

But the Besant rally may not last, says Crosby. We get more inflation data later this week, and if the news isn't good, treasury yields could shoot up again. I'm Mitchell Hartman for Marketplace on Wall Street.

[Mitchell Hartman]

You know what people say about Mondays? Yeah, not today. We'll have the details when we do. The COP 29, the annual UN climate summit came to a close over the weekend in Baku, Azerbaijan. Expectations were low given the absence of top world leaders from some of the largest greenhouse gas emitters, including the United States, China and France, and the fact that for the third year in a row, a petro state hosted the meeting after Egypt and the uae. In the end, there was some progress. Developed countries agreed to commit $300 billion a year to help poorer countries adapt to climate change. By a decade from now, that's three times what wealthy countries had been contributing. But as Marketplace's Kaylee Wells reports, it's far less than experts say is needed. Developing countries and their advocates wanted to see a $1.3 trillion per year commitment. American University environment professor Dana Fisher calls this year's conference a carbon infused burger.

[Kaylee Wells]

Anybody who expected this 29th round of climate negotiations in a petro state theoretically to stop the climate crisis was fooling themselves.

[Mitchell Hartman]

And Fisher says it's not like there's an agreed upon punishment if countries don't fork over their share of that money.

[Kaylee Wells]

It's green smoke and mirrors. I mean, it's just, it's just performative climate action at this point.

[Mitchell Hartman]

President Elect Trump pulled the US out of the Paris climate Agreement during his first administration, and he has promised to reverse President Biden's to recommit to the treaty. Daniel Brissett, president of the climate nonprofit Environmental and Energy Study Institute, went to the conference and didn't come away too worried.

[Samantha Fields]

The rest of the world has kind.

[Kaylee Wells]

Of been to this rodeo before and has found ways to cope.

[Mitchell Hartman]

Plus, just because the federal government pulls out doesn't mean the whole country has to.

[Kaylee Wells]

One thing that was hard to miss was the sort of the state and local government. The US Sub national message was we're still in.

[Mitchell Hartman]

Anne Brissett says much of the corporate and private sector is still in too. There's nothing legally binding about the $300 billion deal, says Kava Gillenpour of the think tank center for Climate and Energy Solutions.

[Amy Scott]

But there are political and moral repercussions, and I'm pretty confident that they will deliver against that.

[Mitchell Hartman]

Gillenpour was also at the conference where he says COP leaders produced a blueprint for their next meeting, which is essentially.

[Amy Scott]

Tasked with Getting the Incoming Cop 30 Presidency of Brazil to think about how you do move from these billions to the wider trillions.

[Mitchell Hartman]

Meaning that $1.3 trillion per year target is still on the table for next year's conference in Belem, Brazil. I'm Kaylee Wells for Marketplace. As you may have heard, we have a Marketplace podcast focused on climate change policies, solutions and your questions. You can find how we survive wherever you listen to podcasts. Starting next year, doctors will earn about 3% less money caring for older patients with Medicare unless Congress intervenes before January. And that's even though the cost of providing care is projected to rise by about three and a half percent every year by law. The Centers for Medicare and Medicaid Services makes adjustments to what's called the physician fee schedule, which determines how much doctors get paid for different services. The American Medical association and other groups representing doctors doctors are pushing back against the cuts and say they're making the math of being in private practice increasingly difficult. Marketplace's Samantha Fields has more Everything about.

[Samantha Fields]

Running a medical practice has been getting more expensive, especially in the last few years.

[Mitchell Hartman]

Staff salaries have gone up, our rent has gone up, all of our equipment.

[Samantha Fields]

Bruce Scott is an ear, nose and throat doctor in Louisville, Kentucky, and current president of the American Medical Association.

[Mitchell Hartman]

At the same time, what Medicare has paid us has gone down.

[Samantha Fields]

Adjusted for inflation, Medicare now pays doctors almost 30% less than it did in the early 2000s, according to the AMA, and Scott says that ripples through the entire healthcare system. Private insurance tends to pay significantly more than Medicare, but when Medicare rates go down, private insurance rates often do too.

[Mitchell Hartman]

As a result, physicians have made difficult choices. In some cases, it's to limit the number of Medicare patients that they're willing to see to stop accepting new Medicare patients or close their practice completely.

[Samantha Fields]

That's an issue in Stillwater, Oklahoma, where Mary Clark works as a family doctor.

[Mitchell Hartman]

We see a lot of people having a hard time finding a physician who is accepting new Medicare patients And I hear that from my staff on a weekly basis.

[Samantha Fields]

She also hears it from colleagues in other rural areas. If you're a small, independent practice, you need at least some patients with private insurance to make the math work.

[Mitchell Hartman]

You can't see every Medicare patient. It's not financially possible.

[Samantha Fields]

Michael Chernew, a professor of health policy at Harvard Medical School, says nationally, people with Medicare report they have as good, if not better, access to doctors than people with commercial insurance. That's according to a recent survey from MedPAC, the Medicare payment Advisory Commission, which he chairs.

[Amy Scott]

It can be hard to find doctors to take Medicare.

[Samantha Fields]

It can also be hard to find.

[Amy Scott]

Doctors to take commercial insurance.

[Samantha Fields]

There are huge variations in how all of this is playing out around the country and for big hospital systems versus private practices. And Robert Berenson at the Urban Institute says not all specialties are paid the same.

[Amy Scott]

There's doctors who interpret images. There's doctors who do surgery. There's doctors who spend time in office visits.

[Samantha Fields]

And some of those services are paid more highly than others.

[Amy Scott]

Have you ever had a liquid nitrogen applied to a wartime. It takes about a minute.

[Samantha Fields]

And Medicare pays dermatologists roughly $165 to do it.

[Amy Scott]

Meanwhile, the payment for 40 minutes with a very complex patient who probably has one or more chronic conditions is about the same $177.

[Samantha Fields]

Berenson says the whole process is broken.

[Amy Scott]

It results in overpayment for procedures and imaging and tests, and underpayment for time spent with patients.

[Samantha Fields]

Even with the overall decline in rates, he says, plenty of doctors are doing just fine. And big hospitals have leverage to negotiate higher rates with insurance companies. But small practices like Dr. Bruce Scott's do not. In Louisville, he says, one insurance company covers about 60% of patients with commercial plans. And that company has actually offered us.

[Mitchell Hartman]

Rates less than Medicare now, and we can't even bring them to the table to talk because they know that we can't really say no.

[Samantha Fields]

Earlier this year, Scott says a major cyber attack on the payment processing company Change Healthcare meant his practice didn't have any revenue coming in for about six weeks.

[Mitchell Hartman]

Our practice had to take out a loan to be able to pay our staff and pay our rent and all of our bills. And the physicians stopped taking paychecks for several pay periods. That's how close to the edge we are.

[Samantha Fields]

Which is why, he says, every reduction in reimbursement rates matters. I'm Samantha Fields for Marketplace.

[Mitchell Hartman]

Coming up.

[Cindy Fletcher Holden]

Over time, the hanging upside down became my trademark.

[Mitchell Hartman]

Everyone has their thing, but first let's do the numbers. The Dow Jones industrial average rose 440 points 1% to finish at 44,736. The Nasdaq added 51 points a quarter percent to close at 19,054, and the S&P 500 gained 18 points to end at 5,987. At least $132 million worth of small package delivery expenses never made it onto the books at Macy's. The retailer reported today that a lone employee intentionally made bogus accounting entries worth at least that much between the second half of 2021 and this month. It also reported that while sales are looking pretty good in the current quarter, they weren't great. During the third quarter, shares gave up 2 and 2. 10%, per Mitchell Hartman's story. Bond prices rose. The yield on the 10 year T note fell to 4.27%. You're listening to Marketplace.

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[Amy Scott]

You think about businesses growing their sales beyond forecasts, sure, you think about a product with demand, a focused brand and influence driven marketing. But an often overlooked secret is the businesses behind the business making, selling and for shoppers, buying. Simple. For millions of businesses, that business is shopify. Nobody does selling better than shopify home of the number one checkout on the planet and the not so secret secret with Shop Pay that boosts conversions up to 50%, meaning way less carts going abandoned and way more sales going. So if you're into growing your business, your commerce platform better be ready to sell wherever your customers are scrolling or scrolling on the web, in your store, in their feed, and everywhere in between. Businesses that sell more sell on Shopify. Sign up for your $1 per month trial period at shopify.com marketplace all lowercase go to shopify.com marketplace to upgrade your selling today. Shopify.com marketplace.

[Mitchell Hartman]

This is marketplace. I'm Amy Scott. If you were to move maybe to another part of town, maybe another region in the United States, where would you go? The Sunbelt gets a lot of attention for the large numbers of people relocating and buying homes in states like Arizona, Texas and Florida. But a new survey from the national association of Realtors shows another part of the country is getting a lot of love, too. The Midwest Marketplace's Elizabeth Troval explains. People moving to the Midwest are coming to cities like Kansas City and Columbus, where there's been lots of development, says Jonathan Rapa with brokerage advisory service mmgr.

[Amy Scott]

The confluence of factors that has really kind of seen development tick up in the Midwest.

[Mitchell Hartman]

Take Columbus, Ohio, where Intel is opening up a new semiconductor plant nearby, and home sales have been strong. Sean Simpson is a real estate agent there. We're seeing a lot of people come in from those California, you know, the dc, the New York, who are looking for a little bit more of an opportunity with a little bit more of an affordable housing aspect, he says. These newcomers are also willing to move further from urban centers in exchange for other perks to get the schools they.

[Amy Scott]

Want, the parks they want, the amenities.

[Samantha Fields]

They want, and also a lot of.

[Mitchell Hartman]

Them are bringing cash. Some people are also moving back to the Midwest after moving away, says Matt Kristofferson with the national association of Realtors.

[Kaylee Wells]

It was about a quarter of movers to the Midwest moved back somewhere where they previously lived.

[Mitchell Hartman]

So combining that with the point that.

[Kaylee Wells]

They'Re really driven by being close to family and friends, they're most likely moving back to their home, maybe hometown, or.

[Mitchell Hartman]

At least where their family lives. People have also moved away from the Midwest, but states like Ohio and Indiana have been seeing net migration gains, with affordability playing a role, says economist Ralph.

[Kaylee Wells]

[e-mail] places like Akron and St. Louis.

[Mitchell Hartman]

And Cleveland and Indianapolis, those are the places where you only need to make 50 to $70,000 to buy the median priced home. And he says those markets are likely to stay affordable since they're less constricted by geography and zoning laws that limit new construction. I'm Elizabeth Troval for Marketplace. Earlier this fall, the Atlantic, the American magazine publisher, did something surprising. It announced plans to increase the number of print editions it puts out each year. That's right, increase from 10 magazines to 12. The Atlantic isn't the only magazine investing in print these days this year. Saveur, if I'm saying that right. Sports Illustrated and Vice have all committed to restarting their physical editions. Amanda Mull wrote about it in Bloomberg Businessweek the other day. Amanda, good to have you back.

[Kaylee Wells]

Thanks for having me.

[Mitchell Hartman]

All right, so several magazines have actually restarted their print publications and there are some newcomers. What is going on?

[Kaylee Wells]

Right. So we're probably all pretty familiar with like the decline of print over the past 10, 15, 20 years. Over that period of time, a lot of long standing publications that had started as print magazines, you know, decades or even a century prior had phased out their print editions and tried to funnel everybody online. In the past couple of years, some of those publications have started to think twice about that decision. Just in, you know, recently, Field and Stream, Nylon, Savour, Sports Illustrated, Vice, all of these companies are like, well, hold on a second, why don't we bring back a little bit of print magazine and see how it goes?

[Mitchell Hartman]

And why do you think that is? Were readers clamoring for a print copy to hold in their hands again?

[Kaylee Wells]

Well, I think that fundamentally the issue is that people didn't stop buying print magazines and companies didn't stop printing print magazines because consumers hated them. They stopped printing them because the economics of printing physical editions of a magazine became sort of untenable. And I think that what we're seeing is the realization among publishers of periodicals that they may have moved a little too swiftly to kill off this entire arm of their business. And it turns out that advertisers really like print magazines as well. So you might not be able to print a weekly magazine anymore. And some of these companies probably can't print a monthly magazine anymore. But maybe like a quarterly magazine, there's demand for it among readers. There's demand among advertisers. So like, why not give it a try and see if it works?

[Mitchell Hartman]

You mentioned that advertisers like appearing in magazines. How are these ads different than what they might pay for online?

[Kaylee Wells]

Well, I remember when I was a kid reading magazines, there were lots of advertisements, especially in the sort of fashion realm, but also in consumer Technology and beauty and lots of different industries that were like downright artistic that people would tear out of magazines and put on their walls. These were advertisements for products, but people didn't encounter them as an inconvenience or as something that was trying to get in their way. So that is still the case. In fact, it might be even more so the case. You know, the bad online advertising or bad technology in implementing online advertising can make people think worse of your publication or of your product if you're the advertiser. And you really don't get that same capacity for blowback in a print publication because it is just a lot more standardized, it's a different user experience and there's a lot more upside. So especially for high end brands and advertisers, going that direction gives you as an advertiser a lot more control over how your ad appears, over how obtrusive it is to people, and ultimately more control over what they might think of you as a result. So there's a lot of upside for advertisers.

[Mitchell Hartman]

Well, and it's not just the advertisers who are high end. Right. You mentioned that a lot of the readers are going to be higher income, more educated. It's become kind of a luxury good.

[Kaylee Wells]

Yes, I think that a really beautifully designed magazine full of like, interesting freshly reported stories is something that is that a lot of these publications look at as particularly marketable toward a higher end subscriber, somebody who might pay $100 or $120 for an annual subscription. And then when you, when you make a sort of like sophisticated, high minded product that you can better sell to this like cohort of the population, you then make a publication that can make a really great pitch toward advertisers who are looking for people with disposable income who are looking for, you know, that same cohort of the population, essentially.

[Mitchell Hartman]

Are you subscribing to anything in print that you might have read online previously?

[Kaylee Wells]

Oh, I subscribe to tons of things. My mailman is extremely busy.

[Mitchell Hartman]

All right, well, Amanda Mull, it's always good to talk to you. She writes at Bloomberg Businessweek, which has a print edition.

[Kaylee Wells]

We do. It's beautiful.

[Mitchell Hartman]

Amanda, thanks so much.

[Kaylee Wells]

Thank Sa.

[Mitchell Hartman]

Speaking of art, when was the last time you saw a good mural? I am lucky to live in a city full of them, giving life to an otherwise dull concrete wall or office space, telling a story, making you think. For this next installment of our series, My Economy, we hear from someone who creates these works of art for a Living.

[Cindy Fletcher Holden]

My name is Cindy Fletcher Holden. I am a muralist, an artist and a sign painter and I live in Annapolis, Maryland. I graduated with a degree in painting and not quite sure what I was going to do with that, so I got a job in the sign shop and I learned the trade of hand painted lettering and got involved right away into the full career of painting names on boats. The interesting thing then was to learn the trade of sign lettering. My employer would cut out a stencil and I would literally go and hang upside down off the back of the boat and use the brush to form the letters. And over time, the hanging upside down became my trademark. My aunt asked me if I wanted some of my grandfather's art supplies. So when I went to go get them, I was shocked to see that we had all the same supplies that I had. He had lettering brushes, he had gold leaf supplies, he even had the same one shot sign paint. And as I went through his art supplies, I realized that we did the same thing. He did truck lettering, signs and murals. And I did not know this until at that point, it made me realize that this whole lettering mural painting is in my DNA. I do murals in businesses, in private homes, in private schools, in public schools. I've done a couple of public murals as a result of a contest. They're all a challenge. Each one is different. Even some of the ones that I've done that are the same logo, they might be on a different surface, some are outside. So each job requires a whole different attitude. Some are hot, cold, high up in the air. I have to learn how to drive all kinds of lifts and climb scaffolding. So I love the challenge. I'd like to keep on going for as long as I can. It's physically fun. It's great to see it finished and have people tell me that they like it, of course. So I'm very lucky. I have not had a slow down for a couple years at all. So I hope it keeps going.

[Mitchell Hartman]

Cindy Fletcher Holden, Muralist in Annapolis, Maryland. You know we can't do this series without you. Tell us what's happening in your [e-mail] myeconomy this final note on the way out today. Did you catch Glicked over the weekend? Yeah, it's no Barbenheimer, But Wicked and Gladiator 2 each did a pretty respectable business at the box office over the weekend. Wicked was by far the bigger attraction, bringing in $114 million. The biggest opening ever for a Broadway adaptation. The Gladiator sequel brought in 55 and a half million. It's a lot of popcorn. Our daily production team includes Andy Corbin, Nicholas Guillong, Alize Hasan, Maria Hollenhorst, Sarah Leeson, Sean McHenry and Sophia Terenzio. I'm Amy Scott. Hope to see you back here tomorrow. This is apm. Want to shop Walmart Black Friday deals first.

[Samantha Fields]

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[Mitchell Hartman]

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[Samantha Fields]

Shop Black Friday deals first with Walmart plus see [e-mail].