/ Patients Have Power

Healthcare is on the ballot, with Matt Cortland


Our latest Patients Have Power episode called "Midterms 2018: Healthcare is on the ballot". (You can subscribe to the podcast at Apple Podcasts, or listen to it with the media player above).

In this episode, to discuss the healthcare issues that are at stake in the upcoming midterm elections, we speak to lawyer, healthcare advocate, and professional patient, Matt Cortland. As a person living with chronic illnesses, Matt knows all too well the necessity of equitable and robust access to care in everyone's lives; as a lawyer with a Master's in Public Health, he knows the issues and the policies inside and out. Here's our conversation about American healthcare and the things that are at stake in November.

Below is a transcript of the episode for your reading pleasure!

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Aaron Jun: Hello everyone and welcome to the Patients Have Power podcast. It's your cohost, Aaron. And I have with me, Matt Cortland. On Twitter you might know him as @MattBC or Medicaid Matt. But welcome to the show, Matt Cortland.

Matt Cortland: Thank you so much for having me. It's great to finally be with you.

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Aaron Jun: Yeah. So Matt, there's so much to talk about. But I wanted to bring you on and thank you so much for making the time for us. I wanted to bring you on because with the mid-terms kinda rolling up on us pretty quick now, a lot's at stake in terms of everyone's access to healthcare. And I wanted someone knowledgeable to kinda walk through that with us and make sure that we knew all the little ins and outs.

You're one of the more vocal and specifically focused on legislation and legislation as it pertains to healthcare access in America. So I thought you'd be an absolutely perfect fit.

Matt Cortland:

Well, unfortunately when one of the major political parties makes it their mission to kill you, it does have a way of focusing your attention on what they're up to.

Aaron Jun: Yeah, well and to that point, I think the audience could do with a little bit of a quick background on who you are and where you come from. And you mentioned, it feels like someone's out to kill you. And I think the audience would be really keen to know why you feel that way and what your experiences have been.

Matt Cortland: I live with Crohn's, which is a type of inflammatory bowel disease. I was diagnosed with Crohn's when I was in college, although I've had it for much longer. Went undiagnosed and untreated through most of my childhood actually.

And when I was in college, I got thrown into the deep end of the pool. I went to school in upstate New York and got very, very sick. So sick that I needed to see a doctor and my health insurance company said there's no one up there for you to see. Your network doesn't extend that far in the jargon of health insurance. And so a friend put me in their car and drove me back to Massachusetts, where I'm from. And I started seeing physicians. I woke up from a colonoscopy with an Irish gastroenterologist screaming at me while I was high on Demerol and Versed, which is a benzo that makes you forget things.

Aaron Jun: Oh, that must've been fun.

Matt Cortland: It was. And he was screaming at you. "You have Crohn's! You don't understand." And I was like, "I can't think straight. Please, can we have this conversation later?" But that was really getting tossed into the deep end of the pool. And I didn't really understand anything about the healthcare and delivery quote un quote “system” in the United States. I was lucky to live in Massachusetts because I was able to go up to Boston, to Longwood Medical Area where some of the best hospitals and clinicians in the world are. And started a biologic drug called REMICADE, which is one of these fantastically expensive medications that worked really well for a couple of years and then it stopped working. Worked great until it didn't.

And I needed to transfer to a new biologic but it wasn't ... It was approved for sale, but it was not yet listed on label for Crohn's. So the manufacturer hadn't submitted the clinical trials proving that it was specifically effective for Crohn's disease, although they had proven it was effective for I believe ulcerative colitis. And my insurance company, my for profit health insurance company refused to approve my prescription for HUMIRA and they turned a 72 hour emergency appeal into a approximately two and a half month long campaign of stonewalling using every dirty, deceptive, underhanded tactic in the book.

So we sent them the prior authorization paperwork. They claimed they didn't get it. I sent them the prior authorization paperwork along with the signed receipt from the United States Postal Service from one of their employees saying that they got, then they said they didn't get that. And so then I would fax in everything including the original paperwork, the signed receipt from the paperwork, the signed receipt from that paperwork via fax and then they'd say they didn't get that. And then once I had stuff courier delivered by a FedEx, they would say that, "Oh, your physician isn't actually authorized to submit an appeal on your behalf." And then I would send them their own handbook that says that my physician is just presumptively authorized to submit an appeal.

And so that went on for two and a half months as I continued to get sicker and sicker and sicker. I am about six feet tall. I was down to 130 pounds. I could not eat without vomiting-

Aaron Jun: Dear God.

Matt Cortland: Yeah, it was brutal. I was in constant terrible pain. It was agony. And someone, I don't even remember who, that's how sick I was, put me in touch with a lawyer. And that lawyer sent a demand letter. And by the close of the next business day, I had in my hands the prior approval for HUMIRA. And that's when I decided that self defense really required that I go to law school. And so I changed my plans. I was gonna be a developmental psychologist. I was going to grad school. I had gotten into Columbia, which was sort of my dream since middle school to be a developmental psychologist. I had to drop out and I went to Boston University School of Public Health for a couple of years.

And then I went to law school because it wasn't enough to just understand how to read the research and speak enough medicine to navigate the system. I also needed to know how to sue health insurance companies and pharmacy benefit managers just as a self preservation thing.

Aaron Jun: You needed offense. Yeah.

Matt Cortland: Yes, I do. I really did. And if that's not an indictment of our system, I really don't know what is. You should not have to be a lawyer to get healthcare in this country.

Aaron Jun: Right. I was just at a rare patient summit down in southern California a couple of weeks ago. And personally, I don't live with any chronic conditions. And really, the only thing I have is some back pain. And I met this woman from Mississippi. And she had this daughter who couldn't make it, but her daughter's eight years old, just started TaeKwonDo, but has this incredibly rare condition where it's not even being researched, there's no clinical studies out there for her.

And she was telling me about how difficult it was even to get the nutritional supplements that her daughter needed to keep her weight up cleared by her insurance down in Mississippi. And how helpless she felt for a couple of years as she just had to battle this thing on, and on, and on. And she was telling me this story like so matter of fact like just something vaguely interesting that happened to her. And I was just so blown away by just the battle scars that she must've had and how determined she seemed to be about ... And that's why I'm gonna start ... And she concluded our conversation, "That's why I'm gonna start a non-profit for all these ... This group of diseases because I don't think anyone should have to feel this way in Mississippi where I grew up and I don't want to leave." And I'm like, "Wow." And I only bring that up because it sounds so similar to your sort of realization and your path.

Matt Cortland: And that's exactly the sort of advocacy work ... I call it retail advocacy, one patient, one family at a time, that I was doing until about 2016. The end of 2016. My training-

Aaron Jun: What happened in 2016?

Matt Cortland: Well, there was this election. You may have heard about it.

Aaron Jun: Yeah. Didn't mean to cut you off. So your training.

Matt Cortland: It was really designed to force health insurance companies to pay for exactly that sort of thing. Medical foods are this very ... To insurers, they're this weird category of things where they ... When something is classified as a medical food, they feel like they may have an excuse to not pay for it. When it is a life sustaining product for a small child, they should be required to. Of course they should be required to. No eight year old should have to suffer because a for profit or any health insurance company doesn't want to pay for a medically necessary medical food product. And that's the sort of work I was doing until in 2016, like you were just talking about, there was this election. And I realized that individual sort of retail level advocacy was increasingly insufficient to the scale of the problems that we were encountering.

Aaron Jun: Right. How long had you been in that line of advocacy work at that point?

Matt Cortland: Years, years.

Aaron Jun: Years.

Matt Cortland: Almost. Time has lost all meaning right now. There's an election in about a week and it feels like it's both years away and in five minutes. I have been in that space for about a decade.

Aaron Jun: Got it. Okay. So you have your own battle scars.

Matt Cortland: Yeah, I refer to myself as a professional patient for a reason. In 2015, I spent a month ... If you add up all the time I spent as an inpatient, it comes up to a month. I spent one twelfth of the year as a hospital inpatient. That's my record for a year, but it's not an aberration. In 2015, I guess, it also was that I went five months without eating solid food. I spent five months on TPN. Hooked up to an infusion for eight hours every night. I had a list cost of about $16,000 a week. My medical bills for 2015 and 2016 totaled about three quarters of a million dollars list price.

My medications, just meds, just outpatient medications along with any infusions of biologics, which are done in hospital facilities, cost six figures every year. This year is looking like a low year. We're gonna come in at about 150k.

Aaron Jun: Congratulations.

Matt Cortland: Right? That is genuinely low for me. Last year, I think it was about ... It was closer to 200k in 2017. And I'm talking about me because my clients, the patients that I help have obviously an absolute right to confidentiality. And I only share stories when people have specifically given me permission and they want me to share their stories. But it turns out my story is fairly representative of the sort of high price shenanigans, barriers to care that chronically ill and disabled patients have to face day in and day out all over this country.

Aaron Jun: Right. And I think that kinda segues us nicely, well not nicely, but segues us naturally into the mid-term conversation. So I was just out canvasing last weekend. And it's a relatively red district. But it seems like anyone who bothered to answer the door, sort of that one out of every 10 doors I knocked on, the folks who would come to the door, if they wanted to talk issues, it seemed like the big issue was healthcare. Across the board, whether they were democrat or republican. So I wanted to speak with you and begin kinda dissecting what's at stake here as we roll one week on into a pretty consequential midterm election.

Matt Cortland: Not to be overly dramatic, but the future of the American project, the future of the republic feels to me like what's at stake right now.

Aaron Jun: Right.

Matt Cortland: In terms of healthcare though specifically, in 2017, I traveled down to Washington D.C. because Mike Pence took to Twitter and he tweeted that the republicans, Donald Trump, Mike Pence, Mitch McConnell, were gonna save healthcare by bringing individual responsibility back as a fundamental tenant of how the system operates.

And he was in essence blaming me for having Crohn's disease. That somehow I failed as a moral actor in the world because I got sick when I was about seven or eight years old. And I just couldn't believe it. I could not believe it.

I stayed up three o'clock, four o'clock in the morning and I took to Twitter and I made a video. And I called Mike Pence out. And I said it to some photos of ... Hospital selfies are a genre that I love sharing with people because I feel like the muggles don't really have that much of an insight-

Aaron Jun: The muggles.

Matt Cortland: The muggles. The people who don't know where the best restrooms and hospitals are.

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Aaron Jun: No, you're totally right though. Before I got immersed into this world, I had no idea. How could I, right?

Matt Cortland: And until you hit those bricks on Diagon Alley, you really don't know what it's like. And so to try to give people some insight, I am in the habit of capturing the hospital selfie. And I've got a fair few of them.

And so I put them together into a video and called out Mike Pence. And how dare you? How dare you suggest that I'm sick because I'm personally irresponsible? And that video is the thing I've done that's been seen by the most people. That's seen by hundreds of thousands of people. And it made me think that I wasn't alone.

That this is actually something other people feel pretty passionate about. And so I went down to D.C. That spring and summer a few times to protest when the republicans unveiled attempt, after attempt, after attempt to repeal the Affordable Care Act, which is also commonly called Obamacare because Obamacare, while far from perfect, is a thing that really provides protections that I rely on to live my life everyday. Protections for preexisting conditions, protections for Medicaid expansion. It's, again, not a perfect piece of legislation by any option, by any measure, rather. But repealing it with their so-called Skinny Repeal Plan, which would have just repealed it without anything to come in and take its place would've led, in my opinion, to the catastrophic collapse of the American healthcare system for everyone.

So that for me really is still what this mid-term election is about. The republicans have showed us time and time again what they want to do to healthcare. And in my opinion, what they want to do is destroy it. They're not really equivocal about this. In the last week or so, they've adopted a new song which is that they're gonna fight for people with preexisting conditions, which if I wasn't so jaded and bitter at this point I would find hilarious because they've spent the last 18 months trying to repeal the laws that protect people with preexisting conditions. So the fundamental nature of the American healthcare system, whether or not we are gonna provide healthcare to everyone, just on the basis of our shared common humanity. Our shared common humanity. Whether or not we're gonna provide healthcare to each other is really what's at stake in the mid-term election for me.

And unfortunately, and I don't ... That's not empty rhetoric. I do mean this. Unfortunately, the republican party has answered that question time and time again by saying pretty clearly, they don't think I deserve healthcare. They don't think I deserve to live. Because without healthcare, let's be completely honest, I'm dead within about two years.

Aaron Jun: Right. So you mentioned the Pence thing. I remember that pretty distinctly. Where do you ... Do you have any idea or do you have any hypothesis on where this idea of individual responsibility comes from when it comes to one's health?

Matt Cortland: People much smarter than I have written about this and pined on it. There's a writer and professor of I believe cognitive science by the name of George Lakoff who has a theory about a sort of conservative world view modeled on a strick father ideology versus a more liberal world view modeled on a sort of nurturing parent ideology. He's written a very short, easy to read book called, Don't Think of an Elephant, that I highly recommend if this sort of thing interests you in how we frame debates and how we talk about healthcare. But there really is a difference fundamentally in the things that I value, which is taking care of my siblings on this planet versus the policies, the ideology that underlines a policy like you got sick because you were personally irresponsible. That just seems hateful to me. That doesn't seem like caring about one's fellow human beings.

And I would say that it fits into a policy agenda if you want lower taxes. If you don't want to pay taxes at the end of the day, if you want to keep your millions, your tens of millions, your billions of dollars for yourself, then it's easier to not pay for other people's healthcare, to not contribute, to save your money for yourself, to not contribute to schools, to not contribute to roads. It's this sort of ideology of selfishness that I think the end result of it is disastrous. It's a war of all against all in which life is nasty, brutish, and short to rip off my freshman philosophy class. To be blunt with you, I've sort of given up trying to understand. I really do feel like I care more about staying alive right now and-

Aaron Jun: I think that's pretty fair.

Matt Cortland: Right? I do too. I don't feel the need to reach out, sing Kumbaya with people who keep voting for legislation that would result in my slow and painful death.

Aaron Jun: Right. It wouldn't be a happy two years.

Matt Cortland: No. God, no. I have a habit of getting small bowel obstructions. And the small there doesn't refer to the size of the obstruction. It just means small intestine. There's nothing small about them. They're incredibly painful. It's some of the most painful experiences I've ever had in my life. And they're a medical emergency. And you need to be admitted to a hospital. And usually an NG tube, a small tube, gets shoved up your nose, down your throat, connected to a suction pump. And they suction out the contents of your guts as a first measure to keep you from dying. If they don't do that, there can be a rupture. And the contents of your intestines spill out into your body, and you become septic, and you die pretty quickly, and pretty horrendously. That's what this election is about for me. I don't want that to happen. I don't think that's unreasonable.

Aaron Jun: No, I don't think so either. So in kinda the same way that you described ... Wait. So they ... Sorry, to go back. They pull it out through your nose? The obstruction?

Matt Cortland: Yeah, it's called a nasogastric tube-

Aaron Jun: That's fun.

Matt Cortland: Right?

You generally don't want to try to shove something down someone's throat while they're conscious and it's sort of awkward to leave in place for a long time because this is a process that takes some days sometimes. And so, just the ... Yeah, so for example, I was studying. Back when I was in graduate school, I was studying late into the night and wasn't really thinking about what I was eating. And I was just eating a handful of almonds. And then I had another handful. And two days later, I found myself in a Boston area hospital with a resident snaking an NG tube up my nose, down my throat, into my stomach, and connecting it to a suction pump on the wall and sucking pieces of almonds out of me. It's truly a disgusting experience. Clogged the NG tube. And three o'clock in the morning, it was a bad scene, suffice it to say. But that is the level of care that's required to manage a disease that something ... The epidemiology is a little bit all over the place, but 1.3, 1.6 million people, something like that, have some form of inflammatory bowel disease. And we need care. We need care on an ongoing basis. And the level of care can vary, but we need access. The same thing is true of folks with rheumatoid arthritis, and multiple sclerosis, and folks living with a cancer diagnosis. It's just we all need care.

Aaron Jun: Right. So speaking of that care and access, so you kind of briefly touched on what would've happened if repeal was successful, any sort of repeal was successful in the last couple of years. Let's say come the mid-terms, the republicans retain control, what would happen on repeal? Could you walk us through sort of the systematic changes that could occur is the ACA's protections for preexisting conditions wore somehow rolled back?

Matt Cortland: Sure. And I'm comfortable answering that question because the republicans, to a large extent, have already tipped their hand. They've showed us what they want. The Trump administration recently amended some administrative rules to allow the sale of short-term health insurance plans ... These are plans that are really meant to be stop gaps for a week, two weeks, a month. But they're going to allow them to be sold for periods of time of just short of a year. And these plans, what's special about them is that they don't protect people with preexisting conditions, for example. So short-term health insurance plans don't have to cover preexisting conditions. They wouldn't cover my Crohn's disease or any of the treatments for my Crohn's disease. Any of the $5000 a month Cimzia syringes that I need or any of the other medications. They did this because they couldn't get repeal through congress. And so they did this sort of end run around congress. This sort of patch. A repeal patch as it were. That's one thing they're doing.

And another thing that they're doing at the same time is there's a lawsuit filed by the republican and attorneys general of several states that the Department of Justice has joined that seeks to strike down in federal court the core protections of the Affordable Care Act. Of Obamacare. So they are arguing in court that this court should strike down Obamacare, should strike down specifically the provision that protects people with preexisting conditions. And a preexisting condition is just a condition you've been diagnosed with or you have. You have some symptoms of, there's some evidence that you have it.

And if you think about it, if you think about health insurance like car insurance, it actually sort of makes sense. If I called up Geico and said to Geico, "Hey, I've got this Toyota Prius and it's only got 20,000 miles on it. I just bought it second hand from CarMax or whatever, can you give me a quote for insurance?" The answer that they give me is gonna be very different than if I call Geico and say, "Hey, Geico, every other Tuesday, I'm gonna drive my Toyota Prius into a tree. Just every other single Tuesday, I am gonna get about 20 feet away from a pine tree, I'm gonna step on the brake, I'm gonna floor it, and then I'm gonna let go of the brake, and I'm gonna smash my car into a pine tree." There's no risk there, right?

What their conception of insurance is doesn't apply to health insurance because they are trying to guard against this fiction that people aren't sick yet already and they don't know if they're gonna get sick. And for me and tens of others of millions ... Tens of millions of others of chronically ill folks, we know we're sick. I know that every month, I need a syringe, two syringes, and the list price of them is about $5300. I know every week I need a bottle of special antibiotics that are non-systemic and act locally in the gut. And if you add that up, it comes out to about $4000 per month. So there's no uncertainty. There's no ambiguity. And so that's really what this debate about preexisting conditions is about.

And so with this lawsuit with the states that the Trump justice quote on quote Justice Department has joined, I am a little biased. I don't have warm feelings towards Jeff Sessions, you'll have to just forgive me. And-

Aaron Jun: I'll try to understand.

Matt Cortland: Thank you. And the lawsuit and the short-term plans, we know that they don't want to protect folks with preexisting conditions. They've made that abundantly clear. And if they retain control of all of the levers of government, which they currently have, I expect at this time next year, the law will not protect people with preexisting conditions. We know at the same time from the actions of a person named, Seema Verma, who is in charge of Medicaid for the federal government, that they want to impose so called work requirements, which are actually just bureaucratic hoops designed to kick people off Medicaid. They want to impose those on as many states as possible to just get people off of Medicaid. To deny folks, some of the most vulnerable patients in this country, access to Medicaid. And how do we know that? Because they've admitted it.

When the republican governor of, I believe it was Kentucky, submitted their proposal to impose these bureaucratic requirements. They admitted that this was going to save them money because this was going to save them money because it was going to result in denying thousands of people access to Medicaid. We know it because when they set up websites for people to report their work requirements, the websites close. They have bankers hours, these websites...

Aaron Jun: Which is typical in tech.

Matt Cortland: Well, but is it? Because my Gmail doesn't go down at 11 o'clock, right?

Aaron Jun: Nor should it.

Matt Cortland: Right? And I'm not ... Look, I get it. Government contracting is cumbersome. It's burdensome. But they've given the game away. They keep saying the quiet part out loud. When you close your website on Sundays, just the entire day, you're not worked about your sequel database being corrupted. You're just looking for an excuse to make it more difficult for people who are working 40, 50, 60 hours a week either inside or outside of the home to report ... To comply with your reporting requirements so that you can take Medicaid away from them. And so they want to destroy Medicaid. They want to take away protections for people with preexisting conditions. They want to destabilize the entire marketplace.

Trump has over the last year or so made a variety of very hyper technical payment moves about how money moves between the federal government and the marketplace insurers that are just designed to scare the insurance companies so that they jack up rates. They've really ... They've given the game away to anyone who's watching. And that's why right now in the run up to the mid-terms, all of these republicans who have for the last years, just years, campaigned against Obamacare. Campaigned against the Affordable Care Act. And who have taken actions that would harm people like me with preexisting conditions are lying. They're just straight up, flat out lying and saying, "Oh, I will fight for people with preexisting conditions," because they know on the facts that they're gonna lose.

Aaron Jun: Right. So with all that being said, there's one last thing that I kinda wanted you to walk us through. And it's this idea of folks who take ... Or how should I phrase this? Non-citizens taking public assistance and then having that impact their access to healthcare.

Matt Cortland: Yeah, this, if I'm not careful, I'm gonna turn into a ball of incandescent rage and the podcast is just going to end with a popping sound as my microphone explodes from being overloaded by formerly Matt BC, now a incandescent white hat ball of rage.

The Trump Administration has taken a couple of different actions that are in my opinion incredibly racist and designed to scapegoat immigrants for the problems, the failures of leadership of the Trump Administration. To stoke racist, white nationalist sentiment amongst their base in order to turn them out for the mid-terms. One thing that the Trump Administration has done is they've built a tent city in Texas for children. It's an internment camp for children. For these children who have fled Central America, fleeing for their lives, who've made a incredibly perilous journey and arrived in our country and are asking for our help and our protection. And the Trump Administration's answer is to lock them up indefinitely. That's what this rule does. It would allow the Trump Administration to imprison children in camps indefinitely. That's galling on its face. It's immoral, it's unjust. It should light every American's hair on fire.

But even worse than that, as if that wasn't bad enough, the Trump Administration is paying for it by taking funding away from medical research. They have raided the coffers of the Department of Health and Human Services, including NIH's budget, to pay for locking children up indefinitely. Right now, that proposal, it's still a rule. It will go through the courts. It will be challenged in litigation in federal court. That rule is still open for public comment. I have written a guide, it's at kidsdontbelonginjail.com. All one word. Kidsdontbelonginjail.com.

If you want to submit comments, comments are open until November sixth.And your comment counts. The law, federal law, something called the Administrative Procedures Act requires the government to read every comment submitted. To take into account every unique position offered in those comments and to respond to them. And those comments will be part of the record when this rule, this atrocious, blatantly abuse of human rights rule ends up in federal district court. Your comments will be part of the record that a federal judge sees. So by all means, please take a few minutes, submit a comment, skip the profanity, skip all caps. You're writing to a federal judge, but take a few moments. And it's wrong. Say it's wrong.

Register your opposition because we are literally locking children up in internment camps. That's one thing the Trump Administration is doing. And they're taking money away from medical research. From clinical trials into the sorts of diseases that afflict all of us, even republicans, even old, white, powerful men who sit in the senate and congress. They get sick too. They may not know it yet, but it can happen to them. So take a few minutes, go to kidsdontbelonginjail.com. Submit a comment. Register your opposition.

The other thing that the administration has rolled out is this so called public charge rule. And this is really wonky. It's a bad name. It comes from hundreds, I think, of years. Decades, certainly, decades ago when the concept was poor people become the responsibility of the government your ... A charge as in a ward is sort of a person who is dependent upon the public. And these rules have a, again, an incredibly racist history. They were used to exclude minority groups that the white Anglo Saxon majority in America wanted to exclude. And the Trump Administration, has of course, revived them. The Trump Administration has proposed bringing public charge back into play. In full force. Expanding it.

And so what would this mean? It would mean that people who are immigrating to the United States, who are here already, have a green card, or on the path to citizenship who are playing by the rules, that this administration professes they care so very much about. People who are doing quote it the right way, who have a green card. Even those folks would be subject to this requirement that says if you don't have enough money, if you can't prove to us that there's no risk that either you or any of your family members could end up on public assistance programs like SNAP, like WIC, we will not grant you ... You can't stay here. Basically, it's you've gotta get out is what this rule said.

And that applies even if hypothetically, let's say that there's a five year old child who is a US citizen. No question about it. Born in this country, has a birth certificate, long form, short form, whatever it is Trump is into this month. And their parent is a lawful permanent resident with a green card. Well, that child, if that child uses SNAP or WIC benefits, would be SNAP at five probably, their parent could be deported. And it is a mean spirited, cruel, and vile attempt to scapegoat immigrants to this country and their loved ones by taking away healthcare, food assistance, just the basics. The very basics that we should be providing to everyone in this country. We have more than enough. We have more than enough. Taking away that help, that safety net to punish immigrants. And even they're willing to punish US citizens in order to do it, it's beyond the pail of even what ... I don't know. It's just beyond the pail.

Aaron Jun: Yeah, I mean, as an immigrant to this country and as someone who's ... If their child had been on and off assistance from the government, it's confounding to me this idea. And I think it goes back to this idea of this strange convoluted idea of responsibility as if everything is always within one's control. I definitely remember feeling a little stress from the age of seven or eight when you don't know what's going on, but you see your parents are stressed. And I can't imagine what my life trajectory would've been like if this was the policy of the government back when I was growing up. And I know by now I've paid back whatever assistance we've drawn through the years, but it's just incredible to me. And then it kinda blends into this idea of like, hey, if you're sick it's also your fault. If you're an immigrant, it's your fault. We only want the right kind of people in this country. The most able bodied, productive, tax paying, but not paying too much tax members of the society. And it's just a very strange way to view the world.

The last thing I kinda want you to talk about or would love for you to talk about before ... Maybe we can briefly touch on some hopeful notes about what could be if the democrats can rest a little bit of control back. But one last thing I want to talk about is this idea of cutting services such as Medicare to cut down on the government deficit. I'm sure you have some thoughts and research on this topic.

Matt Cortland: So first, I'm glad you're here. Let me just say that.

Aaron Jun: Thank you, I appreciate it.

Matt Cortland: I am a fan of your work. I have been following you on Twitter for quite a while. If you don't follow, get on the Twitter, people. Get on the Twitter. And it's also just a sort of logic that is not internally consistent because we can't know ahead of time. There's no way to know ahead of time which child you admit to this country, which child you give a high quality education to, which child you provide a school lunch to so that they are not hungry and they can pay attention in math class. There's no way to know which one of those children is gonna cure Alzheimer's disease. There's no way to know which one of those children is gonna cure cancer. There's no way to know which one of those children is gonna cure Crohn's disease. And I, for one, want a cure.

And that's certainly not the only reason to help those children, but even if your world view is wholly selfish, wholly self-interested, even if you don't care about anyone or anything else other than yourself, you would still think you'd realize you're a mortal. There's a really high chance that at some point in your life you're gonna get sick, you're gonna get confronted with a major illness. And you would think that you would want the best possible care, the best possible research, the best possible shot to have a fighting chance. Just I don't understand. I just fail to comprehend. I don't actually. It's their hatred of the other. But it just is not internally consistent. And so I just want to say that I'm glad you're here, and you're doing good work, and if folks aren't following you on Twitter, they should be.

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Aaron Jun: Thank you very much.

Matt Cortland: It is well known in conservative circles. And I used to not talk about this publicly, but things have changed over the last year and a half, two years. I went to the most conservative real law school in the United States. I went to George Mason University School of Law, which is a top 50 ABA ranked school. So it's not one of these liberty or regent university schools. And-

Aaron Jun: Okay, we get it. You're smart.

Matt Cortland: No, no. It's just when I say the most conservative, people think I mean that law school that Sean Hannity sends out dollar bills to fundraise for. Well, I'm still on their mailing list. Every once in a while, every few months, Sean Hannity sends me a literal dollar bill in the mail and asks me to send it back with a five or a 10 to raise money for this weird college. But in any event, they trade off with the University of Chicago for the most conservative student body. I've been inside the heart of the conservative legal movement. And it's well known that there's a strategy at play. It was articulated by a guy named Grover Norquist a couple of decades ago. I want to shrink government down to the size of putting it in a bath tub so I can drown it.

Aaron Jun: Lovely imagery.

Matt Cortland: Isn't it, though? It's family friendly. And part of the way that they do that is they run up the deficit by giving tax cuts to millionaires and billionaires like they recently did. And they tried to sell it as a middle class tax cut. I believe Paul Ryan said that a school teacher of some such is saying that with her $1.50 a week, she's able to buy a coffee. $1.50 doesn't even buy one of my pills for one day. But they run up the deficit. The deficit explodes. The government has to borrow. And then they say that they need to cut social programs in order to pay for their reckless tax cuts and other spending. It's a tried and true approach for them and the key is to resist it by electing at least one democratic house.

Matt Cortland: So there's the strategy shrink the government, explode the deficit, cut social programs like Medicare, Medicaid, and Social Security. The only way they can do that is if they control all three sort of levers, main levels of power. By which I mean the presidency, the house of representatives, and the senate. And so the future of Medicaid, the future of Medicare, the future of Social Security really depends on democrats resting control of one of those levers back. And the one that's most likely is the house. I would love it if we picked up the senate too. But the one that's most likely is the house.

And what does that mean if democrats retake the house? What does it mean if we all get out there and vote and go to our people. And when I say our people, if your family is like mine, there are certain people you're not gonna reach in your family. Uncle Ted who watches Fox News from about four o'clock until he passes out on the couch every night is not a guy that I'm telling you to go try to persuade. Your emotional, mental, physical well-being is too important to try to persuade Uncle Ted. But you know who your people are. You know who is on your side, who cares about you, and who's willing to listen.

And if you implore them, and beseech them, and ask them to vote with you, who's willing to go vote on November sixth.

And so if we all go to our people and get our voting squads together and take to the polls, and democrats retake control of the house of representatives, the worst excesses of Trumpism won't pass through the congress. What do I mean? They're not gonna be able to defund Medicare. They're not gonna be able to defund Medicaid. They're not gonna be able to repeal the existing ... The protections for folks with the preexisting conditions that are in federal law.

They need all three of those levers. And if we take one back, we stop so much of the damage that they'd be able to do over the next two years.

So that is where my hope lies right now. My hope is really in all of us coming together between now and November sixth to mobilize ourselves, to mobilize our people, and to get them to vote for our continued survival frankly, as chronically ill, as disabled people, as people who need healthcare on an ongoing basis. And so that's both a note of hope and an action item, right?

You gotta get out there and vote by November sixth. If you're in a place with early voting, go early vote. If you're not, get out there on the sixth and get your people to vote too. And that's just so incredibly important right now.

Aaron Jun: Yeah. While I was out there canvasing, the campaign was telling us that it was such a tight race that it could come down to just 10 votes. And if you could turn out just 10 people between all the shifts coming through and all the hundreds of doors ... Excuse me, doors being knocked, then that could change the entire tide. So one thing I've been saying to folks who've felt cynical in this time is just saying if you just bring two friends and vote on behalf of your healthcare or on behalf of anything that you really believe in and you feel should be protected, it might not matter in the senate this time, but it can matter so much in your district.

Matt Cortland:

It really can come down to one vote.

We saw in Virginia during the last election there in the state that a vote was tied for ... I forget the which particular Virginia district it was. But it came down to a literal coin toss. They tossed a coin to decide an election. And that election actually determined who held the majority in the Virginia legislature and the GOP won on a coin toss.

So I get it. It can feel like our vote doesn't matter. That's just not true though. More now than ever before, every single vote counts. And as an act of self-defense if nothing else, I urge you to vote.

Aaron Jun: And do you have any resources that you might point folks to? I think this would be a good time to plug where people can find you because I find you an immensely helpful resource.

Matt Cortland: I never knew how to feel about that, but I'll take it.

Aaron Jun: Yeah you're very functional in my life, Matt.

Matt Cortland: I am on Twitter. I am Matt BC. M-A-T-T, B as in Boy, C as in Cat on Twitter. And there are so many, just so many voting resources. There are more than ever before. I've been sending folks who don't know where they need to go to vote to vote.org, which is just a fantastically helpful website that if you plug in your address, it'll tell you where you need to go. And so that's something that actually I've had a problem with. I didn't know where to vote this year because I moved and my polling place moved.

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We run elections in this country sort of abnormally. It's not usual that partisan political actors are in charge of elections and democracies. The rest of the world sort of looks at us as scants. So in Canada, for example, there's something called Elections Canada, which is this government entity that's scrupulously nonpartisan that's in charge of administering free and fair elections. And in the United States right now, that's really something that we're lacking, which brings me to my second suggestion which is 866-OUR-VOTE. 866-OUR-VOTE is both a telephone number, a Twitter account, and a website as well that does independent nonpartisan election monitoring. So on election day, I will probably be in an 866-OUR-VOTE t-shirt stationed as a poll monitor somewhere in New England as an attorney watching for shenanigans. Because we have so many of those in our election. So I always urge folks before they go vote, put 866-OUR-VOTE in your phone. Be ready because there are people ready to take your call and help you through your situation. But also track whether they're seeing a pattern develop. And they have attorneys who can intercede. Who can get to the local courthouse. And if machines are down, they can get a judge to order the polls to stay open longer. If machines are switching ballots around, they can try to get a court to intervene.

When I was in law school, the first year that I went to do poll monitoring, I was up early to get to a district in the middle of Virginia. Eric Cantor's former district until he was voted out. And a day that made me very happy. And I woke up at 5:30 in the morning to see an email in my inbox from the provost of George Mason University, which is a massive public school in Virginia, telling people that the date of the election had been moved.

Aaron Jun: What?

Matt Cortland: The election had been delayed. The provost's official email account sent this out to tens of thousands of people affiliated with George Mason University. And luckily, because I was up early in the morning and I was doing election protection work, I had a phone number I could call and attorneys reached out to the school. And apparently, there was some hacking involved. And it wasn't the provost sitting down to write this email, but that's the sort of dirty trickery that we really continually see in this country. And it just astounds me. So if you are gonna go out there and vote, be sure that you have, it's a six hour vote programmed in your phone. If you see anything that doesn't seem right to you, call it in, let us know. Let them know so that we can try to have as much of a free and fair election as possible.

Aaron Jun: Well, thanks so much for that work that you do on behalf of the Democratic Process. I was in Korea, I'm from Korea. I was in Korea like a year and a half ago and they were just doing their big ... I don't know if anyone remembers, but this big recall election because basically the president was hugely corrupt so people were marching in the streets relentlessly and she finally got ... She basically went to jail. And so I arrived and my uncle picked me up. I arrived on the eve of that election. So basically two or three days before that election. And that entire time running up to the election, my uncles were needling me about how Americans take their democracy for granted. And they would look at me and go, "Well, in Korea, every vote counts for one vote. And in Korea we have the law for ... And it's this big thing. And we would never sacrifice the sanctity of our vote. And that's because we remember what it was like to be in the streets getting our heads kicked in by the police while we were protesting trying to get democracy here. And you guys in America have forgotten."

And I was like ... And this is right after 2016. And I'm just trying to think of anything to say as a retort. And there's really nothing to say other than taking it as a call to action for myself to think, okay, well I guess politics isn't impolite. It's actually really impolite and flagerently disregardant of human life to not discuss this stuff at this time when so much seems to be at stake. So I'm really glad that people like you are out there actually putting in the care and the effort to make sure that someone is doing something to stand up to some of the shenanigans that could happen.

Matt Cortland: It's not impolite to say, "I deserve to live." It's not impolite to insist that everyone in this country has a right to healthcare. It's not impolite to insist that everyone's vote deserves to be counted. And then if it is impolite, I don't want to be polite. Korea actually has ... It's funny you mention South Korea. They have something called the National Election Commission, which is one of these independent nonpartisan groups in charge of running an election that is both free and fair. And I think there is something we can really learn from the example that South Korea set in both having an EC, having that Independent Election Commission to guarantee free and fair elections, but also the engagement of the South Korean people took to the streets. Like you said, to demand that their leaders not be corrupt. And it's unfortunate that that's something that we have to take to the streets and demand these days, but it doesn't change the reality that that's what we need to do. And I use take to the streets in a metaphorical sense. I personally am not someone who can get out in the streets all of the time. There are days when my health means that I am not getting more than 10 feet from my bathroom. And so I get it, but I really mean be engaged and do what each of us can to fight for both healthcare and democracy.

And thank you for having me. It was really good to talk to you.

Aaron Jun: Thanks so much for your time. And here's to a good election result, huh?

Matt Cortland: Keeping my fingers crossed.

Aaron Jun: Yeah, alright. Thanks, Matt.

Matt Cortland: Thank you.