In brief: In Episode 2 of The Psychologist, Dr. Bart Rossi argues that traditional Medicare, the version Americans rarely ask to leave, should become the model for health care at every age, with private insurers allowed to compete inside it rather than replace it. He makes the case that the stress of fighting an insurer is itself a health problem, that mental health care belongs at the center of any plan, and that cutting Medicaid makes no sense. Watch the full episode below, followed by the facts behind his arguments.
What does Dr. Rossi propose?
A middle path. “You don’t hear about people on traditional Medicare who want to get off of their Medicare,” Dr. Rossi says in the episode. He proposes using traditional Medicare as the model for everyone, young and old, and letting private insurers compete against it, like today’s Medicare Advantage, but on the condition that they win customers by delivering care rather than avoiding it.
He is just as wary of the opposite extreme: a market with dozens of overlapping policies that leaves a 25-year-old or a 75-year-old unsure where to turn. His goal is a single, understandable model with enough competition to keep the government honest. “People on the right and the left,” he argues, “can actually buy into a plan” built that way.
Why does he say Medicare Advantage is not working?
Because of the gatekeeping, Dr. Rossi singles out prior authorization, the requirement that an insurer approve a treatment before a patient can receive it, even when a doctor has ordered it. The numbers support his concern. According to KFF, Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024 and fully or partially denied 4.1 million of them, or 7.7 percent, up from 6.4 percent the year before. Only about 11.5 percent of denials were appealed, but more than 80 percent of those appeals succeeded.
That last figure is the striking one. If four in five appealed denials are overturned, many unappealed denials were likely mistakes too, and the patients who absorbed them gave up. Traditional Medicare, by contrast, requires prior authorization for only a narrow set of services, about 628,000 reviews in 2024 for a program of tens of millions.
To be fair to the other side, Medicare Advantage is popular: KFF reports that about 55 percent of eligible beneficiaries chose it in 2026, often for lower premiums and extra benefits such as dental and vision coverage. Dr. Rossi’s argument isn’t that the plans should disappear, but that they should have to compete on service with a strong public option.
What does fighting your insurer do to your mental health?
This is where the psychologist’s view adds something the policy debate often misses. Health insecurity is a chronic stressor. As Dr. Rossi puts it, if you get sick or hurt and have to wonder whether your insurer will pay, “how do you go through today?”
Uncertainty that one cannot resolve through one’s own effort is among the most corrosive forms of stress. The prior authorization numbers describe a system that teaches people their efforts may not matter: a denial arrives, an appeal feels hopeless, and many stop trying, even though most appeals win. Psychologists call that pattern learned helplessness, and it is closely tied to depression. A health care system that routinely produces it is not neutral toward mental health. It is part of the problem.
Why should mental health be covered and taught in schools?
Dr. Rossi wants every mental health condition covered, arguing that treating it early lowers both medical and economic costs later. He goes further: middle schools and high schools, he says, should teach students how to deal with bullying, body shaming, anxiety and depression, the same way they teach math and science. “How about what just makes sense?” he asks, stressing that such programs need not be controversial on the right or the left.
He borrows a phrase made famous by the psychiatrist Thomas Szasz: much of what we call mental illness is really “problems in living.” In his view, helping young people handle those problems before they harden into crises is the most practical mental health policy available. It is a theme he has returned to often, including in his recent look at why one in six teens now report serious anxiety.
What is at stake with Medicaid?
Dr. Rossi calls cuts to Medicaid senseless, and the program’s reach explains why. According to KFF, Medicaid covers about 83 million people; children make up about a third of enrollees, and seniors and people with disabilities account for roughly half of spending. Medicaid is the nation’s primary payer for long-term care, covering about five in eight nursing home residents, and it covers nearly three in ten non-elderly adults with a mental illness. It also pays the doctors and hospitals that treat them, a point Dr. Rossi emphasizes.
The 2025 federal budget reconciliation law reduces that coverage. The Congressional Budget Office projects it will leave about 10 million more Americans uninsured by 2034, with work requirements driving more than half of the Medicaid-related losses. Supporters argue the changes curb spending and encourage work; critics, including Dr. Rossi, see a system shifting the cost of illness onto the people least able to bear it.
Sunshine and showers: who gets credit, and who gets criticism?
In his closing spotlight, Dr. Rossi gives Senator Bernie Sanders of Vermont the sunshine for championing Medicare for All for years, while gently faulting him for dismissing private competition rather than harnessing it.
The spotlight goes to Health and Human Services Secretary Robert F. Kennedy Jr. Dr. Rossi argues that Kennedy takes credit for familiar ideas such as balanced diets for schoolchildren, misunderstands vaccines, mental health, and Medicaid, and seems more interested in attention than in policy. He is not alone; in February the medical journal The Lancet published an editorial on Kennedy’s tenure titled “One year of failure.” Kennedy’s supporters credit him with forcing overdue attention on nutrition, food additives and chronic disease. Dr. Rossi’s verdict is that health care needs a leader who understands it.
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Sources
- The Psychologist, Episode 2: Health Care — Dr. Bart Rossi on YouTube
- Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024 — KFF
- Medicare Advantage in 2026: Enrollment Update and Key Trends — KFF
- 10 Things to Know About Medicaid — KFF
- How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State? — KFF
- “One year of failure”: The Lancet slams RFK Jr.’s first year as health chief — NPR via WBUR
