Medicare for All activist Ady Barkan, left paralyzed and unable to speak by ALS, delivered a powerful indictment of the “fundamentally broken” for-profit U.S. healthcare system in his remarks at the Democratic National Convention Tuesday night, decrying a status quo that saddles Americans with massive costs while providing inadequate treatment.
Using a voice-generating device attached to his wheelchair, Barkan relayed his experiences navigating America’s fragmented and dysfunctional insurance system since his diagnosis in 2016 and said the Covid-19 crisis has shined a spotlight on “the tragic consequences” of the nation’s failure to guarantee healthcare to all as a right.
“In the midst of a pandemic, nearly 100 million Americans do not have sufficient health insurance,” said Barkan. “And even good insurance does not cover essential needs like long-term care. Our loved ones are dying in unsafe nursing homes, our nurses are overwhelmed and unprotected, and our essential workers are treated as dispensable.”
“We live in the richest country in history, and yet we do not guarantee this most basic human right,” Barkan continued. “Everyone living in America should get the healthcare they need, regardless of their employment status or ability to pay.”
Condemning congressional Republicans and President Donald Trump for continuing their push to strip healthcare from millions amid a global pandemic, Barkan said “we all have a profound obligation to act—not only to vote, but to make sure that our friends, family, and neighbors vote as well.”
“We must elect Joe Biden,” added Barkan, who has publicly challenged the former vice president on his failure to support Medicare for All. “Each of us must be a hero for our communities, for our country, and then, with a compassionate and intelligent president, we must act together and put on his desk a bill that guarantees us all the healthcare we deserve.”
As health care costs rise, patients aren’t just shouldering higher bills. They’re bearing more and more responsibility for getting information.
Americans are facing a health care affordability crunch on multiple fronts. In 2025, the Republican-controlled Congress approved a sweeping tax law that scaled back premium subsidies for Americans accessing care through the Affordable Care Act starting in 2026. As a result, millions on ACA plans now face much higher premiums, with many dropping out or expecting to drop out and risk going uninsured as premiums surge. By March 2026, about 1 in 10 people on ACA plans had dropped out, and that share is expected to rise.
Nearly half of U.S. adults now report difficulty affording health care. Together, these shifts are accelerating the “consumerization” of health care. Patients now have the ability to comparison shop, evaluate options and manage costs – but often without clear pricing. In this environment, knowing how to ask the right questions may be one of the most important tools patients have.
We are professors who study how perceptions of health care costs shape patients’ decisions about their care. Our research examines how factors such as price-transparency regulations influence patient choices. Across our work, we consistently hear from patients about rising costs and how conversations about price with their providers too often never happen.
Why speaking up about cost matters
When one of us took our child to the doctor for pink eye, the pediatrician quickly sent a prescription for antibiotic drops to the pharmacy. At the pickup, the pharmacist dropped the news that the drops would cost more than US$300. A follow-up phone call to the doctor’s office, however, yielded important information: A generic version of the same medication offered the same treatment and the same results, but at a fraction of the price.
That quick phone call saved her a lot of money. It also raised a broader question: Why don’t more people have these conversations about cost? In fact, one study shows that cost conversations occur in only about 30% of medical visits.
These discussions aren’t just for medications. They can be crucial when a recommended procedure has multiple alternatives; when out-of-pocket costs might affect whether you follow through on care; or when a sudden medical bill could create financial strain. Speaking up about price can help patients stay healthier and avoid the all-too-common trade-off between medical care and household expenses.
The study mentioned above also found that doctors and patients identified ways to reduce out-of-pocket costs – such as switching to a generic drug or adjusting the timing of care – in nearly half of those cases. Importantly, these conversations were typically brief and did not compromise the quality of care, the researchers found.
Patients actually prefer doctors who bring up costs, other research has found. Still, most patients remain hesitant. While a majority say they want to discuss cost, only a minority actually do, often waiting until a bill arrives – often when it’s too late to consider alternatives. That’s why it’s important that consumers feel empowered to ask the right questions. Here are three that can help make care more affordable.
One of the simplest ways to reduce drug costs is to ask whether a less expensive option is available. Brand-name medications can cost significantly more than generics, even when they are equally effective. One industry survey estimated that 90% of all prescriptions filled in 2024 were generic or biosimilar, but these accounted for only 12% of drug spending.
In many cases, physicians can substitute a generic drug or recommend a similar treatment that achieves the same outcome at a lower price. And when no direct generic exists, there may be therapeutic alternatives worth considering. For example, if a brand-name eye drop or inhaler isn’t available in generic form, doctors can often prescribe a different medication in the same class that works just as well but costs far less. Research on physician–patient cost conversations shows that switching to lower-cost, clinically similar alternatives within the same drug class is a common strategy for reducing out-of-pocket spending without compromising care.
Is there any financial assistance available?
Some hospitals and large health systems have specific programs aimed at making care more affordable for lower-income patients. In many states, government programs address this same goal. These programs often offer discounts on care, but they can be complex to navigate and require significant paperwork. Many health care offices have staff who are knowledgeable about these programs and can help patients determine eligibility and sometimes even assist with applications, although the Trump administration has cut funding.
Patients can often find these programs through hospital or health system websites, which typically include financial assistance or “charity care” pages outlining eligibility and how to apply. State Medicaid offices and insurance marketplaces are also key entry points for coverage and subsidy programs. Nonprofit organizations and patient advocacy groups may also offer or list assistance tailored to specific conditions or medications.
It’s also important to remember that for prescription medications, what you’re quoted isn’t always the final price. Many medications come with options to reduce costs, including manufacturer coupons, copay assistance programs and patient assistance programs. Doctors’ offices and pharmacists may also know practical ways to save money, such as using a different pharmacy, switching to mail order or adjusting how a prescription is written. Asking about these options can uncover savings that aren’t immediately obvious.
What will this cost me, and are there other options?
Health care pricing is often opaque, and costs can vary widely depending on where and how care is delivered. Asking up front about your expected out-of-pocket cost can help you avoid surprises later.
This question also opens the door to alternatives. For example, patients may be able to choose a lower-cost imaging center, opt for outpatient rather than hospital-based care, or delay nonurgent services until insurance coverage improves.
Speaking up is part of taking care of your health
Health care decisions shouldn’t feel like a choice between your well-being and your wallet. A brief, honest conversation about cost can lead to more affordable and more sustainable care.
Physicians can’t address financial concerns they don’t hear about, and most want to help their patients access care they can realistically follow through on. As costs continue to shift toward the patient’s burden, asking these questions isn’t just helpful – it’s essential.
The next time you’re handed a prescription or a referral, remember: One simple question about price could make all the difference.
We all know that moment when the alarm goes off in the morning and you start thinking about who you wouldn’t murder for another five minutes (another 10 minutes?!) of sleep. You hit the snooze button, and your eyes drift closed again, only to be thrown open as the alarm sounds one more time. While those extra few moments of sleep might feel wonderful at the time, they’re never as good as simply waking up and staying up and can even cause more harm than good.
“The name for the uncomfortable feeling on awakening is ‘sleep inertia,’” writes Dr. Keith Roach in The Detroit News. Sleep inertia is that feeling of zombie-like grogginess you get when you wake up again shortly after being up once before, like when you hit the snooze button or take a nap. According to Sleep Foundation, it can also include “disorientation, drowsiness, and cognitive impairment that immediately follows waking.” Though going back to sleep might feel nice for a short time, you’d actually be better off for the rest of the day by just getting out of bed, especially if you wake up naturally feeling well-rested, Roach continues.
While there’s not an explicit understanding of why sleep inertia happens, according to the Sleep Foundation, it could be related to a disturbance of NREM sleep, non-rapid eye movement sleep, which is “an essential part of the sleep cycle,” that’s important because it’s when the body takes time to repair itself. When you disrupt NREM sleep, then, you disrupt the body’s replenishing capabilities. This brings on that groggy feeling, because 10 minutes isn’t just 10 minutes; your body’s actually resetting itself for anywhere from 30 minutes to some four hours. What you end up doing, according to Dr. Sam Wagg of Fix Medical Group in San Diego, is trading 10 minutes for an even longer period of time to recover, and it just isn’t worth it. “Pressing snooze can make sleep inertia worse because of the repeated forced awakenings,” says psychiatrist Dr. Tracey Marks. “Our brains don’t like waking up and going back to sleep and waking up again in a short time period.”
Luckily, with modern advents, you don’t have to do this on your own. As Dr. Marks shares, there are several ways to make waking up easier. One of them is by choosing relaxing sounds to wake up to, and allowing them to slowly increase volume while the alarm goes off. Another is choosing a regular time to rise, weekends included. “This keeps your body clock in sync,” she says. You can also choose to wake up to natural light or invest in a sunrise alarm clock. Last but not least, Dr. Marks says, you actually have to get up and “move around so that your body can know it’s time to start the day.”
According to the Sleep Foundation, you can also limit caffeine, make sure the room is cool, and reduce the use of substances like cigarettes and alcohol. Another useful warrior against sleep inertia is bedding that enhances your sleeping experience. This can include “natural, breathable fibers like wool, down, cotton, linen and silk…[that] feel soft and comfortable for your body,” Apartment Therapyshares.
And while a cool, cozy bed nestled in soft light and music sounds like something you may never want to leave, it will actually help you get out of bed feeling that much more rested and ready to take on the day, leaving sleep inertia in the dust.
This article originally appeared last year. It has been updated.
Friends can help us with all kinds of things in life. How could I forget moving that piano for friends in Chicago? Fortunately, none of us ended up in the ER.
One of the most important things friends do, though, might seem surprising: They help us get to know ourselves.
Both in their 50s, Cindy and Ann had been friends since the second grade. Year after year, they never missed a birthday. Cindy would give Ann gourmet popcorn or maybe a sweatshirt from her alma mater, while Ann would give Cindy a special book on a topic that interested her, or maybe an old batch of family recipes. At one point, it dawned on Cindy just how thoughtful Ann’s gifts were. It wasn’t about the cost. “She really thinks about my life and what I’m doing,” Cindy said. “It’s amazing. Ann is just really thoughtful.”
Cindy had always imagined herself as a thoughtful person, too. But in comparing the kinds of gifts they sent to each other, she realized that she was not thinking about Ann in the way that Ann was thinking about her. And so began her deliberate process of becoming more thoughtful – as a result of the self-insight she had gained from her friendship with Ann.
As a philosopher and philosophical counselor, I’ve noticed the pronounced connection between friendship and self-knowledge in my counseling practice. Cindy and Ann are one example among many. I’ve come to the conclusion that to really know yourself, it’s necessary to have good friends.
The link between self-knowledge and friendship was key for Aristotle, too, more than 2,000 years ago. “Eudaimonia” – roughly translated as living well, or happiness – often remains elusive, yet Aristotle believed it didn’t have to be. Eudaimonia is largely within people’s control, he said, so long as they aim at the right targets.
Two of those targets are knowing yourself and having good friends. The two are tied together – you can’t develop self-knowledge in a vacuum. Happiness, for Aristotle, can never be a solitary pursuit.
Knowing – and befriending – yourself
Humans have a highly developed capacity to think about their thinking. This is possible because of a split in human consciousness: There is consciousness, and there is consciousness of consciousness – what is known as reflection or metacognition. Metacognition allows us to step back and note our thoughts and feelings, analyzing them almost as if they belonged to someone else.
This split makes reason, self-knowledge and morality possible. We can deliberate about our thoughts, feelings and potential actions.
Self-knowledge isn’t the same as being intellectual or even intelligent. Instead, it’s about using self-awareness and reason to develop character.
In Aristotle’s view, character arises from developing habits that lead to intellectual and moral virtue, so that personal integrity is possible. This, in turn, builds self-trust and self-respect, as you learn to rely on yourself to do what is right – what Aristotle called “enkratēs,” or continence.
In other words, self-knowledge is developing a good relationship with yourself. In your own internal dialogue, you become another trusted friend to yourself, based on what you’ve seen in your friendships: virtues like generosity, courage, truthfulness and prudence. Self-knowledge and moral development are tied together and realized in community, as underscored by Aristotle scholarJoseph Owens.
Friendship based on character
Aristotle recognized three types of friendship. Some are based on utility, like a study-group friend. Others are based on pleasure, such as friends in an antique car club.
The third and highest form of friendship, which can last a lifetime, is based on virtue, or “arete.”
In these situations, Aristotle wrote, a friend becomes “another self.” These friendships are based on mutual goodwill and love for the other person’s character; they are not fundamentally transactional. Instead, they are anchored in care and concern for the other.
Such friendships are few, but foster self-knowledge. As philosopher Mavis Biss emphasizes, a good friend has a perspective on you that you yourself do not. You can step back and analyze your desires, thoughts and feelings, but you can never actually observe yourself.
That means self-knowledge always has a social dimension. True friends enhance each other’s insight and capacity for virtue. As you get to know your friend, you get to know yourself – and are challenged to become a better version of yourself.
“To perceive and to know a friend, therefore, is necessarily in a manner to perceive and in a manner to know oneself,” Aristotle wrote in the “Eudemian Ethics.” The friend is a mirror that helps refine our thinking, perception and moral understanding.
In the end, what makes eudaimonia – the good life – possible? For Aristotle, it’s using reason to become our best selves. Knowledge and self-knowledge are the most desirable of all things, Aristotle argued: “One always desires to live because one always desires to know, and because one wishes to be oneself the object known.”
The desire to know and be known is part of the quest for happiness. Knowledge of self, others and everything else is interconnected. For Aristotle, relationships are a portal into the realms of the vast and mysterious universe.
