Ashley:

Hi I’m Ashley, one of the producers here at Pitchfork Economics. Today’s episode is a deep dive into CalCare, the single-payer healthcare proposal in California. When we talked to Assemblymember Ash Kalra last week, the bill, AB 1400, had been moving its way through the California state legislature since early 2021. But the evening before this episode went out, the news broke that the bill did not have the necessary votes to move forward and had died in the Assembly. Assemblymember Kalra issued a statement saying quote:

“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly. However, it became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today. Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition will continue the fight for accessible, affordable, and equitable healthcare for all Californians.” /end quote

So, CalCare goes back to the drawing board for now. It’s a major fight that won’t be solved overnight. But Assemblymember Kalra is on the forefront of the battle for the future of healthcare in this country, and his thoughts about how a state-based Medicare for All program could become a blueprint for the entire country and could inspire future lawmakers to find new paths forward for health care in America.

Nick Hanauer:

Despite what lots of people believe, we have effectively the worst healthcare system in the developed world.

David Goldstein:

Roughly 23 million Americans between the ages of 19 and 64 are currently totally uninsured and another 64 million are underinsured.

Ash Kalra:

What CalCare does, it finally ends the nonsensical attachment of healthcare to employment, no premiums, no deductibles. Everyone in, nobody out.

Speaker 4:

From the home offices of Civic Ventures in downtown Seattle, this is Pitchfork Economics with Nick Hanauer, the best place to get the truth about who gets what and why.

Nick Hanauer:

I’m Nick Hanauer, founder of Civic Ventures.

David Goldstein:

I’m David Goldstein, senior fellow at Civic Ventures.

There’s a lot of great things about living in the US but our for profit, multi-payer healthcare system with big air quotes around the word system, that isn’t one of them.

Nick Hanauer:

Correct. Despite what lots of people believe, we have effectively the worst healthcare system in the developed world. We spend approximately twice as much per citizen per year as our peer nations. And even then, a huge number of our citizens aren’t included in that so called system.

David Goldstein:

Even with the Affordable Care Act, roughly 23 million Americans between the ages of 19 and 64 were currently totally uninsured and another 64 million are underinsured. And this was particularly a problem that was brought to the forefront during the COVID pandemic, where you had tens of millions of people losing their healthcare in the middle of a pandemic because they were laid off because of a pandemic.

Nick Hanauer:

Exactly. Because we have an employer based system.

David Goldstein:

Right. Which is nuts.

Nick Hanauer:

It is nuts but it is an extraordinarily profitable system for the participants in it, which is why it’s so viciously and vigorously defended. Goldie, when I think about our healthcare system, I love to reflect on this one experience I had with my daughter a couple of years ago in England and just contrasting it with our own healthcare system is to make a long story short, we were in London and went out with her little friends after she should have been in bed and fell down and cut her hand pretty badly. In any case at midnight, we were forced to rush her to the emergency room on a Saturday night, by the way, to have that taken care of. We got in very quickly and a nurse within 10 minutes had triaged her hand and established that she had to have it dealt with but she was not going to die. And I filled out a piece of paper, Goldie, that included my name, her name, the name of the hotel we were staying at, my cell phone number and what was wrong with her and that’s it. Little white piece of paper.

David Goldstein:

What? No credit card?

Nick Hanauer:

No. Nothing. We sit there for three or four hours. They very carefully x-ray her hand to make sure that no glass is in it and patch her up. And I said, “Where do I pay?” And she’s like, “You don’t have to pay.” I was like, “But I know you have an English healthcare system but I’m an American. Surely I have to pay somewhere.” And she’s like, “No.” And I’m like, “But what about the paperwork?” And she’s like, “You already filled out the piece of paper. It has your name, her name, what was wrong.” And I’m going, “What are you going to do with the paperwork?” She’s going, “Throw it away. We’re done. Your daughter is healed.” And I was just like, I couldn’t believe it.

David Goldstein:

Well, people have this experience all the time, Nick, because the first thing they ask you when you get to the emergency room is proof of insurance. And you show your proof of insurance and you get the treatment, you get about the same treatment you got in London and then a month later, you’re going to get this surprise bill from the hospital because while the emergency room was covered by your insurance, absent the deductible, that particular doctor was not in network. And so isn’t covered at all and you have no idea, but had you been a good consumer, you would’ve shopped around for the right emergency room.

Nick Hanauer:

Exactly.

David Goldstein:

And the right doctor.

Nick Hanauer:

Exactly. Well, today on the pod, we get to talk to Ash Kalra, who represents California’s 27th district, about his effort to reform healthcare in California. He introduced the assembly bill 1400 called CalCare, which is an attempt by one of the states to replace that thing which is largely a price fixing scheme with an actual healthcare system and it will be absolutely fascinating to find out what’s in that bill and what the prospects for passing it will be.

Ash Kalra:

I’m California state assembly member, Ash Kalra. I represent district 27, which is in the city of San Jose, cover about half the city of San Jose, where I grew up. And I’ve been in the legislature now going on my sixth year now. And last year I introduced AB 1400, which would bring CalCare, a single payer healthcare program to California to guarantee comprehensive care to everyone that lives in our state.

Nick Hanauer:

Well, healthcare reform is something we’re really super interested in, Ash. Can you just try to create as much context as possible for our listeners? Tell us about CalCare and why it would be superior to the existing system?

David Goldstein:

We have an existing system?

Nick Hanauer:

Well, whatever. The shit show which is American healthcare.

Ash Kalra:

Let me start with the existing system and then show the contrast because we do have the most expensive healthcare in the world. Not only that, that’s a pretty commonly known fact, about 20% of our GDP is healthcare cost. That being said, we also spend more public money for healthcare than any country in the world, which really if you think about it is pretty mind boggling given that we have so many gaps. We have millions without healthcare. We have so many that die. And the number one reason for family bankruptcies is medical bills. And that has not changed with the Affordable Care Act. Even those that are able to access to healthcare, have not been able to be free from the cost that really bring their families down. And so what we currently have is instead of a healthcare system, we have a disease management system and a for profit system that really takes advantage of catastrophic care, where they make a whole bunch to their money, not to mention the disease management aspect, which funnels so much money to pharmaceuticals.

Well, we have an employer based system so clearly we have employers that pay more than anywhere else in the world. But to be clear, the average employer pays over $20,000 a year for employees’ family health insurance. The individual is paying over $6,000 a year. And so we have a system that allows insurance companies to dictate what kind of care you get. They override doctors. Even if a doctor or a nurse suggests or recommends or prescribes a certain course of action to deal with your medical ailment, an insurance company could say no. And they just send you an email saying, “Why don’t you start a GoFundMe account.” In the wealthiest state, in the wealthiest nation on earth.

What CalCare does, it separates and finally ends the nonsensical attachment of healthcare to employment, which especially during a pandemic makes very little sense. We had millions lose their healthcare during a pandemic and it allows us to put all of our money, the state and federal funds, which already pays for more than half of healthcare in our state into one fund, combine that with a progressive taxation system. And then you have the money to give fully comprehensive care to everyone in our state, including dental, vision, hearing, including longterm care, no premiums, no deductibles, no copays, everyone in, nobody out.

David Goldstein:

Kind of like most of the rest of the world, where if you get sick, you go to a doctor and there’s no bill.

Ash Kalra:

Absolutely. And the level, I don’t think people recognize how much stress families are under. In fact, a recent survey showed the number one issue that the public wants the governor and legislature to deal with is healthcare costs. That’s above rent and mortgage, if you can imagine that, is healthcare costs more so than housing costs. And so it is the number one thing on people’s minds, on families it’s the number one stressor. It leads to homelessness. If you talk to unhoused community, you’ll find so many became unhoused because of medical issues connected to medical bills. And there obviously are plenty examples of how we could do it better and we could do it better than those other countries because our economy is so strong. We have the fifth largest economy in the world. Those other places have much weaker economies and yet are able to provide much more comprehensive care to their residents.

Nick Hanauer:

Yeah, I think it’s worth just highlighting for listeners how out of whack our healthcare system is in the United States. We spend almost 17, I think it’s 17% of GDP on healthcare costs but all of the industrialized countries, whether it’s Spain or England or Switzerland or whoever, they’re paying between eight and 11% of GDP on healthcare costs.

Ash Kalra:

And that’s for comprehensive care. We’re paying 20% for a privatized system. We’re basically subsidizing the profits of a for profit industry because even when it comes to Medicaid, Medi-Cal, they’ll say, “Well, that’s government.” But the reality is the reason why we can’t pay the same reimbursement as your Medi-Cal is because we’re competing with rates that are set by a private market. But for those that are profiting, not because of what’s needed for care.

David Goldstein:

And we’re getting worse health out outcomes than the rest of the world.

Ash Kalra:

The worst outcomes of any developed nation, the worst outcomes of any wealthy nation by far. Not even close. And in fact, the number one indicator, one of the key indicators of whether someone died from COVID was whether they had gaps in their health insurance or not. We saw life expectancy go down for the first year from June 2019 to June 2020. That only takes into account, the first few months of COVID, Black life expectancy went down 2.7 years, Latino life expectancy went down 1.9 years because they have quote, preexisting conditions, that make them more vulnerable. And no one asked the next question, well, why do they have the pre existing conditions? Because our system is not only socioeconomically disadvantageous to the poor, it’s also racist and it’s connected to environmental racism, connected to how care is given to low income communities as well.

Nick Hanauer:

Ash, can you explain in a little bit more detail how the system you proposed would work and what happens to the old system? And how will the new system work?

Ash Kalra:

The first thing to point out very clearly because the industry already has a fancy website and they’re doing a lot of fancy social media marketing against the bill is this is not a government takeover of healthcare. The service delivery will not change, similar to when my father who’s been on Medicare now for over 12 years, he’s been going to the same doctor for over 30 years. The same cardiologist. That didn’t change. The only thing that changed is he handed a Medicare card instead of his private insurance card. And so the service delivery will still be public and private just like we have now. It’s just who’s paying that changes. Instead of having well over a 100 potential payers, which makes a multi-payer system so prohibitively expensive and complicated, that’s why doctors are on the phone with insurance companies all day, you just have one payer.

And so you still get to choose your doctors. In fact, you have more options. Right now I was in an interview earlier today with that same group representing the healthcare industry saying, “Oh, with this proposal, you’re going to lose choice.” Wait a second. What kind of choice do we have now? We have a choice of very few providers that are incredibly expensive, their rates go up every year, the premiums go up, we have little control over it and we have to stay in network. They tell us what doctors we can go to and imagine being in an underserved community or a rural community where a network doesn’t reach. And so right now we don’t have choice. Right now we have healthcare rationing. And right now we have insurance companies kind of being our own private corporate bureaucracy of death panels, telling us what care we can get or not.

And so what we would have with CalCare is simplicity and right now 20% of healthcare is administrative costs that will drive down to single digits, low single digit, just like the VA and Medicare because when you only have one payer, it makes it so simple. Think about, that doesn’t even account for employers’ costs. Having HR have to deal with signing up for your insurance plan. Think about how much of time goes into that when you’re employed. And so we’re talking about simplicity, choosing your provider, choosing your doctor, nothing will change if you like the doctor you go to because they’re all going to have to accept CalCare.

David Goldstein:

What does this do to an HMO system like Kaiser in terms of changing their business model?

Ash Kalra:

Kaiser has different divisions, the payment insurance industry aspect of it will not be relevant but the service delivery for Kaiser actually works really well with CalCare because Cal care already accounts for what’s called global budgeting, which works really well for integrated systems like Kaiser. Actually I think a Kaiser system would be one of the ideal type of systems to work under a single payer system. But they’re objecting to it. They’re going to oppose it because they make billions of dollars from the insurance part of consolidation of their entire system.

Nick Hanauer:

Yeah. The other thing our listeners should know is that one of the signs of how screwed up the American system is, is that there are more people employed by the health insurance industry than there are doctors in the United States, which is absolutely insane that we have effectively deploy more people to do the paperwork associated with healthcare than the healthcare itself, which is fundamentally the problem.

Ash Kalra:

And by the way, 1% of the CalCare budget for the first five years is going to go for job retraining and getting people that do work in the insurance industry, into other suitable jobs and training or schooling. Obviously CalCare will require a lot of staff but not nearly as much as the insurance industry, as your data there clearly shows.

David Goldstein:

But I assume that is the big attack from opponents that this is going to be a job killer.

Ash Kalra:

It’s one of the attacks which is silly because you put that much more money into the economy for things other than healthcare, it creates a ton of jobs.

David Goldstein:

Of course it does.

Ash Kalra:

Other industries.

Nick Hanauer:

Of course it does. Tell us a little bit about why you? What has your path been to help lead this charge?

Ash Kalra:

Yeah, it goes back to why I even serve. Look, I never wanted to be an elected official. I know every elected official says that and my proof of that is I was a public defender for 11 years. That’s not exactly the path to, especially when I was a public defender, late 90s into the 2000s. My role, my goal in life is boiled down to two words, reduce suffering and there’s so much suffering in our healthcare system. And when I first started in the assembly, I right away coauthored the single payer bill that Senator Lara at the time had done, put forward. And I always, when that failed, I never stopped my personal mission to fight for single payer healthcare. When Trump was in office, obviously, I think it was legitimate to say we needed to preserve the ACA because it was under attack.

But as soon as Biden got elected, I think it’s time for us to actually put forth something that not only all Democrats want, all Californians, majority of Californians, majority of Americans want, which is justice in our healthcare system and not having to worry day to day as to whether they get sick. And so I think healthcare is a human right. I just don’t say it as a political mantra. I believe it to my core, in my core. And I think it’s unconscionable that we allow a healthcare system like this to exist in the wealthiest nation on earth. And we do it because of the power of the corporations that profit from it. Because we don’t divorce our politics from our money. I’m one of only two out of a 120 legislators that don’t take corporate PAC money. We have to serve the people and not just in words and in performative celebrating Dr. King, what have you. We have to do it in every ounce of our service.

Nick Hanauer:

Yeah. Ash, can you name the three big objections people have to this bill and why you think those objections are not valid? Sort of take us through what the opponents say and what your rejoinder is.

Ash Kalra:

I’ve already been on a couple interviews with some of the opponents so I already know kind of their talking points. One of the things they say is, “This is a government takeover of healthcare and you’re going to lose your choice.” And so I spoke a little bit about that but it’s not a government to take over healthcare. It’s the payment delivery system. It’s simply the payment and it actually opens up more choice. There’s no more in network out of network. Everybody’s in, nobody’s out. Currently with the insurance companies, we already lose that choice.

The other one is the cost, oh, you’re going to be taxed to death and taxes and taxes. Well, we already know that we pay the highest health tax in the world. It may not be called a tax, it may be called premiums, deductibles, copays. It may be called out of network. It may be called denial of coverage by your insurance company but we pay more than anyone else in the world. And what we’re trying to do is actually reduce the cost of healthcare.

And the third one is you’re going to lose out on something. You’re going to lose your health insurance. You’re going to lose your doctor. And it’s just not true. I think that we have the ability to actually divert our funds away from the profit taking and the administrative ways to our service providers, to our doctors, to our clinics, to our nurses and they can spend more time on patient care and not on the bureaucracy and we can make sure they’re compensated well for it.

David Goldstein:

I’d like to focus in on the cost issue for a moment, obviously. You say under CalCare there would be no premiums, no copays, no deductibles. That all sounds great but how do we pay for it? Obviously there’s a tax involved.

Ash Kalra:

There’s three ways we pay. There’s three components of the answer to that question. First of all, you’re dramatically reducing the cost. Every credible academic study shows that in California alone you’ll reduce the cost at least 10%. You’re talking about that’s 30, 40 plus billion dollars of reduced cost, most of which comes from reducing administrative costs and then also the insurance company profit taking.

Number two, a majority of our funding is already paid for by state and federal funds. We already have a ton of money that we’re putting into our healthcare system. A lot of it gets diverted to private insurance. A lot of it goes to second tier healthcare like Medi-Cal but we’re already putting a bunch of money into healthcare.

And number three is a progressive taxation system which will make up the difference of what we would need, which is still going to be far less than what we’re paying now through our premiums and through our deductibles and other associated costs. But we do have to have some taxation system to make up the difference to finally divorce our access to healthcare from employment.

Nick Hanauer:

Yeah. And your taxes may go up, but if your employer is effectively spending $20,000 for healthcare for you, plus you’re paying six, there’s a lot of room there.

Ash Kalra:

Well, for example, exactly. Like payroll, so right now the average employer pays 9.9% of their payroll for healthcare. We are going to reduce, we’re going to get rid of that and instead have a 1.25% payroll tax across the board, unless your business has less than 50 people. If you’re a truly small business, you pay nothing. If you’re more than that, you pay 1.25%. The average employer pays 2.7% of payroll on healthcare. We’re going to reduce that to nothing if you make less than 50,000, if you make more it’s 1%. And that’s marginal so if you make $55,000 a year, your costs go down from 1,400, $1,500 a year to $50 a year. And so if you make $200,000 a year, your cost will be 2,000 a year, which is far less than what individuals are paying now and far less for the company at 1.25% than what they’d be paying now as well.

Nick Hanauer:

Yeah. And I think it’s really worth highlighting again, just why the private insurance model is so corrosive to delivering high quality, low cost healthcare. The first is that these private insurance companies take a big cut of the healthcare dollar. It’s in the range of 15%, isn’t it, Ash?

Ash Kalra:

Oh, yes. And not only that.

Nick Hanauer:

And in a single payer system, like in Taiwan, those costs go from 15% to what? 2% or something like that so you save 10 to 12% off the top but there’s something even more insidious going on, which is that if you have an industry where the whole point is to take 15% of every transaction, the more each transaction costs, the more profit you make, which means that you turn the system into a price fixing scheme. Because all of the incentives are about turning mole hills into mountains. Every little thing becomes an opportunity to send somebody to a specialist and to get an MRI, turn a $10 thing into a $10,000 thing. And this is why American healthcare costs so much is that everyone in the system is incentivized to try to make everything cost more and that’s why it’s a disaster.

Ash Kalra:

Not to mention pharmaceuticals. They basically want you to get on these cholesterol medication, insulin, whatever it might be, rather than dealing with the underlying causes of those ailments. They’d rather have you on the medication for 30, 40 years. I went to my doctor a few years ago and my father has a number of ailments. He takes tons of pills every day. And my brother who’s a few years older than me had just started taking cholesterol medication the year before. And so I meet with my doctor and he’s like, “Well, looking and knowing your father’s history and seeing your brother’s numbers, your numbers are a little high, not quite there yet, maybe we can start putting you on cholesterol medication.” I’m like, “No.” Instead of talking to me about my diet or my health, they just want to get you on there.

And I don’t always blame the doctor for that because at the end of the day, I see the doctor maybe for two minutes during business now, as opposed to 20 years ago where you maybe had 10 minutes or 15 minutes. They’re just pumping people through. But there’s no doubt that there is this corrosive incentive for everybody in there, from the doctor, the drug company, the hospital, the insurance company to play a part in the system, especially because 20 some odd years ago, they deregulated the advertising and allowed them to advertise. Now when we watch TV, all we do are see drug companies advertising. They don’t even say what it’s for half the time and then we go to the doctor and say, “We want this.” And that’s why pharmaceutical sales have gone up so much dramatically up since they’ve allowed that.

Nick Hanauer:

Absolutely. We always ask this question of our guests, which is the benevolent dictator question. If you were in charge of the healthcare system in California and unconstrained by the politics, what would you do?

Ash Kalra:

I would do what I proposed. I’d have AD 1400 pass. I’d have the ACA 11 put into effect and we would be able to do so much more in bringing healthcare justice to our community. And everybody in, nobody out, we wouldn’t have people that are homeless because they became ill. We wouldn’t have the family bankruptcies being the number one reason for bankruptcy being medical bills. We wouldn’t have starkly different outcomes, including a 12 year gap in life expectancy between the rich and the poor or between different the Black, Latino community versus White community. We would actually treat healthcare like a human right.

David Goldstein:

Can you extend CalCare to Washington state?

Ash Kalra:

Well, there’s healthy competition. New York has a bill. I know in Washington there’s a movement. I would love to see all these states show the country how it’s done. And if one does it, I think it helps the others.

Nick Hanauer:

Yeah, it’d be fantastic. It would be fantastic if you guys could push this through and Oregon and Washington could align around that same system. You could have a West Coast network that was really powerful and effective.

Ash Kalra:

Absolutely. And there would be nothing that would stop us at some point of saying, for example, bargaining for pharmaceuticals. We have 40 million people here and that bargaining power, you add Oregon, Washington, Hawaii and bargain even lower. At the end of the day, I do think a state system is the way to do it because each state is very unique and as long as we get those federal funds, which is the waiver process that we’re going to have to go through as well.

David Goldstein:

Yeah. I was going to ask you about that. This does require a federal waiver on the, I guess, on the Medicaid side.

Ash Kalra:

Yeah. There’s a number of different federal programs, Medicare, Medicaid that would have to allow for an exemption, allow for a waiver. I did meet with the deputy secretary of Health and Human Services in October just to learn what the appropriate path forward is. And so that’s why we separated out the funding bill from the policy bill because you can’t even apply for a Medicare waiver until you get a legislative authority, which quite simply means you have to have a policy bill that’s passed and signed by the governor. You don’t have to have funding secured at that same point in order to seek Medicare waivers.

Nick Hanauer:

Interesting. Final question, why do you do this work?

Ash Kalra:

Such a good question. The best job I ever had as a public defender, my life was much simpler and equally gratifying at that time. But I’m the kind of person and I’ll make a parallel, although I’m a far less worthy individual but one of my favorite Americans is Frederick Douglas. And in his autobiography, he talked about the moment he realized as a child that he was slave. He likened it to being in a dungeon, a moral dungeon, and someone opens the door and he can actually now see the condition he’s in. And once that door is open, once the light shines in on that injustice, he can’t turn it off.

Again, that’s paraphrasing. Not exactly, but that had huge impact on my life where if I see an injustice, I can’t not think about it. I can’t not do something about it. And so that’s a big part of my inspiration of my life’s work as a public defender, to city council and here where I’m going to do as much as I can to reduce suffering with as much energy as I can and whether I’m successful or not, I want to make sure that that’s where my focus is as a public servant.

Nick Hanauer:

That’s a great answer.

Ash Kalra:

Thank you.

Nick Hanauer:

 Thank you so much for being with us today.

Ash Kalra:

Thank you.

Nick Hanauer:

And man, our fingers are crossed that you will be successful.

Ash Kalra:

Yeah. Thank you.

David Goldstein:

Nick, throughout our conversation with Ash, I couldn’t help but thinking back to that story you told about your daughter, just one example of your experience in a modern humane healthcare system in London compared to what millions of Americans are going through every day. Imagine that incident and multiply it millions of times, it’s happening every day and all of the hoops that people are going through, all of the fear. People may be looking at the gashed hand and saying, “Maybe I don’t have to go to the emergency room. Maybe it’ll heal by itself.” Because they don’t want to go through the cost of it or the fear of the cost of it even, not sure whether their insurance will cover it or not, if they have insurance. And how disruptive and expensive that is to our lives and to the economy as a whole.

Nick Hanauer:

That’s right. It’s absolutely crazy. And Goldie, as I mentioned in our interview, I’ve put a bunch of thinking and energy into healthcare reform. I understand intellectually what the problems are but to have it actually happen to you and to be standing there in that moment, when you realize that if the English system required me to pay, how many more people have to be standing around in order to deal with that transaction? It’s way cheaper to do it for free than it is to charge for it.

David Goldstein:

Right. But think of the expense they would’ve had to put in place to have a billing system to deal with the occasional American who strays in.

Nick Hanauer:

No, exactly. It’s just so expensive to turn healthcare into a business and so relatively cheap just to do the doctoring. Again, coming back to in America, we employ more people in the health insurance business than we do in the doctoring business. It’s nuts. It’s absolutely insane. And will there be disruptions in California and other places by transitioning to a new kind of healthcare modality? Yeah. And we need to address that in some way but just because there’s an entrenched industry that profits from this particular arrangement, doesn’t mean that the United States of America should be stuck with the worst healthcare system in the developed world forever. We have to move past this to a better system. Let’s all cross our fingers for our friend Ash. It would be fantastic, fantastic for the country to say nothing of California if California could push this through.

David Goldstein:

Lead the way.

Nick Hanauer:

And lead the way. And boy, I really hope they can make it happen. It would be a fantastic thing.

Speaker 4:

Pitchfork Economics is produced by Civic Ventures. If you like the show, make sure to subscribe, rate and review us wherever you get your podcasts. Find us on Twitter and Facebook @civicaction and Nick Hanauer. Follow our writing on medium at Civic Skunk Works and peek behind the podcast scenes on Instagram @pitchforkeconomics. As always, from our team at Civic Ventures, thanks for listening. See you next week.