Slate Money: "The Stay Healthy Edition"

Date: December 26, 2015
Host: Felix Salmon (Fusion)
Co-host: Jordan Weissmann (Slate)
Guest: Harold Pollack (University of Chicago Professor, Author of "The Index Card")

Overview

This holiday episode of Slate Money centers on personal finance, health policy, and a global perspective on neglected diseases. Special guest Harold Pollack joins to discuss his famed "index card" approach to financial advice, the strengths and shortcomings of Obamacare, and the economic/ethical issues surrounding neglected diseases like Chagas, with a cameo by Martin Shkreli. The episode is candid, approachable, and interweaves practical tips with deeper policy wonkery.

Key Discussion Points & Insights

1. The Index Card: Personal Finance Made Simple

[01:28–22:58]

• Background & Viral Success

  • Harold Pollack explains the origin of his and Helaine Olen’s book, The Index Card: nine simple financial rules that fit on an index card, distilled from the overwhelming complexity of personal finance advice ([01:28]).
  • "Isn’t the financial advice industry’s fundamental dilemma that the right advice is available in the library and could be written on an index card?" – Pollack ([05:36]).

• The (Updated) Ten Commandments of Finance

  • Pollack reads through updated “commandments,” e.g.,
    • Save 10–20% of your income ([07:26])
    • Pay your credit card balance in full every month ([10:09])
    • Max out your 401(k) and other tax-advantaged accounts ([12:59])
    • Never buy or sell individual stocks ([13:56])
    • Buy inexpensive, well-diversified index mutual funds and ETFs ([14:05])
    • Make your financial advisor commit to the fiduciary standard ([14:27])
    • Buy a home only when financially ready ([17:23])
    • Insure only against catastrophic losses (not as investments) ([20:36])
    • Support the social safety net ([23:06])

• Memorable Moments

  • On the pushback to “save 20%”:
    "I got a bunch of letters from people that were basically of the form, ‘Dear Professor Pollock, I'm a 28-year-old single mom. You just told me to save 20% of my income. F*** you.' And I get that. That is really hard." – Pollack ([08:28])
  • On budgeting realism:
    “Neither Harold nor Helene are financial gurus in the get-rich-quick sense—they’re real people, open about their own past mistakes, and that’s refreshing for readers.” – Felix ([04:49])
  • On using financial advisors:
    "They make their money out of selling you investment products that are not valuable. And the things that they offer you that are valuable are actual advice..." – Pollack ([14:43])
  • On homeownership risk:
    "You can cut Starbucks, but you can’t change mortgage payments. And the fact that we were not leveraged up in our house ... saved us financially." – Pollack ([17:34])

2. Obamacare: The State & Future of U.S. Health Reform

[23:06–36:53]

• Obamacare at a Crossroads

  • Current enrollment numbers: more than 8 million, with a younger and expanding pool ([23:13]).
  • Pollack: "Obamacare is embedded in American life. We’re not going to take away insurance from people with cancer who got it because of ACA." ([25:15])
  • Praises for reducing the uninsured, improving patient safety, and slowing cost growth — but acknowledges persistent issues ([26:05]).

• Key Weaknesses & Needed Reforms

  • User experience on exchanges is still poor: “People need human help ... It’s never going to be as simple as buying a book on Amazon.” – Pollack ([27:49])
  • Deductible issues: Many buyers face steep deductibles and suboptimal plans, sometimes due to the complexity of the system ([29:11]).
  • On market-based reforms: The burden of choice is heavily shifted onto individuals, often to their detriment.
    • “No one shops for health care well — this is why we had HR departments to do it.” – Felix ([29:51])
  • Coverage gaps: The “family glitch” and subsidy cutoffs leave many families unsupported ([32:47]).
  • Political reality: “The people most helped by Medicaid are not the ones who matter in American politics ... many are nonvoters.” – Pollack ([34:52])

• Nudging & Structural Solutions

  • “There’s only so much you can do by nudging. But if you must live with a structural flaw, it’s better to nudge than not.” – Pollack ([32:09])
  • Larger subsidies and simplification would make the system far more effective and politically defensible.

3. Global Neglected Diseases, Research Incentives, and Martin Shkreli

[36:53–53:10]

• Massive NIH Boosts vs. Funding Flaws

  • Large, sudden increases in NIH funding have led to booms and busts which hurt scientific careers and research continuity ([40:16]).
  • On political sustainability: Targeting funding to politically salient issues (like Alzheimer’s) can drive support but risks ignoring high-yield basic research ([42:25]).

• Chagas Disease, FDA Incentives, and Pharma Policy

  • Chagas affects ~10M people in the Americas. Life-saving drug benznidazole is cheap elsewhere but unapproved by the FDA for Americans ([44:26]).
  • Martin Shkreli’s company attempted to exploit a voucher program incentivizing approval of "rare disease" drugs with saleable fast-track vouchers (worth hundreds of millions) — possibly a loophole since the drug is decades old ([45:56], [49:28]).
  • On loophole utilization: “It’s a loophole ... but it gets us through bureaucratic hurdles ... and helps Chagas patients.” – Pollack ([49:51])

• Larger Lessons

  • U.S. spends billions on diseases that mainly affect Americans; lesser diseases remain neglected, despite cheap prevention or cures.
  • Prevention (e.g., spraying for “kissing bugs”) is highly effective and underfunded; cross-border health integration is critical ([50:29–51:13]).
  • Drug importation bans don’t always meaningfully enhance safety but do create market inefficiencies and high prices ([52:19]).

4. Numbers Round & Holiday Reflections/Light Moments

[53:22–59:24]

• Spotify and the Beatles: Streaming’s mainstream arrival signaled by The Beatles’ catalog going online ([53:23]).
• Mariah Carey’s “All I Want for Christmas is You” hits top 20 for the first time, 20 years after release ([55:10]).
• Financial whiplash for pro athletes: The gap between a college job’s $300 check and an NFL signing check for $1M – and why large lump sums are problematic for 21-year-olds ([55:59]).
  • "We pay these guys in a way that is completely out of their comprehension ... they should be paid over longer periods." – Pollack ([57:16])

Notable Quotes with Timestamps

• On Saving Realism:
  “Dear Professor Pollock, I’m a 28-year-old single mom. You just told me to save 20% of my income. F*** you.”
  — Harold Pollack ([08:28])

• On Homeownership: “You can cut Starbucks, but you can’t change mortgage payments. And the fact that we were not leveraged up in our house ... saved us financially.”
  — Harold Pollack ([17:34])

• On Complexity of Financial & Healthcare Systems: “It’s on you, and no one is going to look after you. You have to do this yourself ... it’s a little bit depressing.”
  — Felix Salmon ([30:17])

• On Obamacare’s Embeddedness: “We’re just not going to take away the insurance from this guy with cancer at this point who got it because of ACA.”
  — Harold Pollack ([25:15])

• On Policy Shortcomings: “The people most helped by Medicaid are not the ones who matter most in American politics ... many are nonvoters.”
  — Harold Pollack ([34:52])

• On Research Incentives: "Public health and health services research have been identified with Obamacare ... hard to focus public attention on them until someone like Shkreli comes along."
  — Harold Pollack ([48:01])

Timestamps for Important Segments

• Intro and index card origins: [00:08–07:26]
• The Ten Commandments of Personal Finance: [07:26–22:58]
• Obamacare progress and challenges: [23:06–36:53]
• Research funding & neglected diseases, Chagas & Shkreli: [36:53–53:10]
• Numbers Round (music, sports & finance): [53:22–59:24]

Tone and Style

• The discussion is informal, wry, and inclusive: Pollack and hosts are self-deprecating, honest about failure, and passionate about policy.
• There’s a recurring theme of realism: acknowledge complexity but strive for simplicity in both financial and health choices.
• Humor and cultural references keep the conversation accessible (holiday jokes, self-mockery over New York real estate, playful Beatles/Mariah Carey banter).

Summary for New Listeners

This episode is a mix of practical wisdom (via the index card), unflinching policy analysis (Obamacare’s achievements and necessary reforms), and broader systemic discussions (how do we incentivize solutions to global health problems?). It’s encouraging but realistic: achieve what you can, push for bigger fixes, and don’t trust anyone else to do your homework for you—whether with your money or your health.