Health Care, Hill Reality, and Why Nobody Wants a Bad Time

Sarah Smith is off this week, so Fingers Malloy is joined by Amy Miller, a former senior Senate aide and longtime D.C. insider, for a rare thing on The Snark Factor: A calm, informed, no-hysteria conversation about health care policy.

Yes. Really.

Amy pulls back the curtain on how Capitol Hill actually works—committee power, donor pressure, political fear, and why “good policy” and “winning elections” rarely sit at the same table. Together, they break down the latest push around health care reform, prescription drug pricing, insurance subsidies, and the middlemen nobody likes but everybody has.

Along the way:

• Why Appropriations, Finance, and Judiciary are the real power committees
• What Republicans say they want to do on health care—and what they’re afraid to touch
• How COVID-era subsidies quietly rewired expectations
• Why pharmacy benefit managers keep showing up in every reform conversation
• The political math behind “lowering costs” without detonating an election year
• And why the Senate is designed, above all else, to avoid “having a bad time”

It’s wonky by Snark Factor standards—but in the best way.
Also: a quick heads-up at the end about lost audio, where to find the longer versions of this conversation, and why not everything fits into a radio segment.
More writing, audio, and the weekday Snark Factor 3 in 3 live at FingersMalloy.com.
And if you want lighter, louder, and occasionally beef-related content, check out Eat, Drink, Smoke wherever you get your podcasts.

Thanks for listening.

Courage.