There is no part of the Maryland economy that is bigger or more consequential than health care. It’s the largest industry in the state by number of jobs, according to the Maryland comptroller’s office. One out of every six people employed in Maryland works in health care, 427,000 in all, includ ing 50,000 nurses and 17,000 practicing physicians. But someone has to pay all those salaries. Healthcare is expensive, and we spend more on it in the U.S. than anywhere else in the world, but we don’t get the best outcomes. Healthcare reform is a never-ending topic, and as the we head toward the 2028 elections, more leaders on the left are reviving the call for Medicare for all, and a single payer system. And you may not know this, but no state has done more healthcare reform than Maryland. We’ve been part of a massive experiment since the 1970s, which has its own name: The Maryland Model. We’ve taken unprecedented steps to control costs, setting up a whole bureaucracy that controls what hospitals can charge patients and insurance providers. We’ve created incentives to keep people healthy and out of the hospital.  We’ve paid bonuses to primary care physicians, and encouraged population health programs to prevent diabetes and asthma. Has it worked? It depends on who you ask. But we are at a precarious moment – the unique Maryland system that is the source of pride to many rests on an agreement with federal agencies – the Center for Medicare and Medicaid Innovation and the Centers for Medicare and Medicaid services – and right now that means the Trump administration. There’s a new five-year version of the Maryland Model that took effect this year – and it changes the very fundamentals of what has made Maryland unique. People are nervous. The whole system could collapse. Someone might blink first. This episode of Maryland Now will be exploring health care in Maryland – how we got here, where we are going, and what it means for and families. Here are some of the key leaders you’ll hear from in this episode: — Kristin Jones Bryce, the chief of staff and senior vice president for external affairs at the University of Maryland Medical System, and previously a chief of staff to House Speaker Michael E. Busch, who made health care a priority in Annapolis. — Dr. Joshua Sharfstein, a Harvard educated physician and a vice dean at the Johns Hopkins Bloomberg School of Public Health who has been one of the key architects of the health care financing system in Maryland. He was the health commissioner in Baltimore City when Martin O’Malley was mayor, and in O’Malley’s second term, Sharstein became the Maryland health secretary. From 2023 until recently, he was also the chairman of the HSCRC, the regulatory agency that sets hospital rates. — Melony Griffith, a former state senator from Prince George’s County and a longtime licensed clinical social worker who became president and CEO of the trade association for Hospitals, the Maryland Hospital Association, in 2023. — Gene Ransom, CEO of the Medical and Chirurgical Faculty of the State of Maryland – better known as Med Chi – since 2008. — Jon Kromm, who until recently was the executive director of the HSCRC — Marie Grant, Maryland’s insurance administrator — Kevin Heffner, president and CEO of the LifeSpan network, the association representing nursing homes, rehabilitation centers and other sub-acute care In this episode: How a 1977 deal with the federal government created Maryland’s all-payer waiver — and why it’s been called “a third rail” that no one in Annapolis wants to touch The 2014 shift to global hospital budgets under Governor O’Malley, and how it changed hospitals’ incentives from volume to value Why physician reimbursement in Maryland is the third lowest in the country The real numbers: reduced hospital readmissions, fewer hospital-acquired infections, and why Maryland hasn’t lost a single rural hospital while nearly 200 have closed nationwide The new AHEAD model, and why it may mean the end of the “all-payer” system as Medicare and commercial insurers start paying different rates for the first time in 50 years A stark warning from a CareFirst executive describing a “game of chicken” between hospitals, insurers, and the state Got a question or topic you want covered this season? Reach us at [email protected], and find us now on Facebook too. Technical support by Nate Carper, Carper Creative. Past episodes: ...read more read less