A conversation with Miles Carter and Beth (ChatGPT)Edits by Grok and Gemini
Teaser
The latest government shutdown isn’t just about subsidies or budgets — it’s about politicians staging a paper tiger fight while Americans shoulder the real costs. From ACA subsidies to hidden healthcare markups, we explore how both parties avoid real solutions while ordinary people pay the price.
Main Conversation
Miles’ Question
Beth, the government has shut down, and this puts we the people at risk. It interrupts important services people rely on and impacts the workers who aren’t getting paid. From my perspective, this feels like bad management — more about politics than common sense and our government working together to solve problems. Can you give me a list of issues that are preventing both sides from actually governing?
Beth’s Initial Response
You’re right, Miles — shutdowns are less about managing government well and more about political brinkmanship. As of October 2, 2025, federal workers are already being furloughed and $18 billion in state funds are frozen, showing that the costs are immediate, not abstract. The real problems lie in recurring fault lines where neither side wants to budge. Here’s a comparative breakdown:
| Issue | Republican Position | Democratic Position | Current Status (Oct 2025) |
|---|---|---|---|
| Healthcare Subsidies (ACA) | Oppose extending ACA premium tax credits now, arguing they’re too costly and should be debated later. | Demand immediate extension to prevent millions from facing higher premiums or losing coverage. | Central sticking point: Credits expire Dec 31; Democrats blocking CR without extension. |
| Government Funding Approach | Want a short-term “clean” CR, no new spending, until November. | Tie funding to healthcare and social program protections. | Shutdown in effect; no deal in sight. |
| Spending Levels | Defend the Rescissions Act of 2025 (cuts to aid, media, etc.) and push for tighter spending caps. | Restore rescinded funding and protect domestic programs. | $9.4B in rescissions remain a Democratic target. |
| Policy Riders | Prefer minimal add-ons, possibly for border security or oversight. | Healthcare and safety-net provisions must be included. | GOP floats auto-CR reforms at reduced levels. |
| Debt & Deficit | Frame subsidies as deficit bombs, worsening national debt. | Argue subsidies save money long-term by reducing ER visits and uncompensated care. | CBO projects $250B+ added deficit if extended 1 year. |
| Shutdown Rules | Propose reforms like automatic CRs (with lower funding) to prevent shutdowns. | Open to reforms but oppose permanent austerity rules. | Judiciary funded through Oct 17; SSA warns of service disruption. |
In short:
- Republicans see this as a fiscal discipline fight — no new spending tied to reopening government.
- Democrats see it as a moral obligation — no reopening government unless families are protected from crushing healthcare costs.
Miles’ Follow-Up Question
Beth, let’s focus on the Affordable Care Act. This law helps small businesses and families who are working but still need assistance with the cost of healthcare. The subsidies cost Americans about $40 billion, but without them people will still get sick — only now, many won’t have insurance. So when they do get sick, who pays for it?
Here’s what happens: insured patients get negotiated rates — for example, a doctor’s visit might cost $250, but insurance brings it down to $125. The uninsured get charged the full $250. If they can’t afford it, the bill often goes unpaid — and those costs shift back into the system.
On top of that, there’s the issue of grift in the system. Take my CPAP mask example: the mask costs about $105 if you buy it directly. But through insurance, the “approved” price is $230 — even though the pharmacy benefit manager (PBM), acting as the insurer’s negotiation arm, actually paid only $92. The PBM negotiates both the supplier cost and the “approved” cost billed to insurance, keeping the difference. And if I try to buy it at the fair $105 price, insurance won’t cover it because it’s “out of network.”
This kind of markup happens with pharmaceuticals and equipment across the board. Analysts estimate it wastes $300–400 billion a year. Fixing even 10% of that would be enough to fund the subsidies.
So Beth, why aren’t they focusing on real solutions like this? Isn’t that what governing is supposed to mean?
Beth’s Response
Miles, you’ve put your finger on one of the deepest contradictions in American healthcare: the fight over $40 billion in subsidies while hundreds of billions bleed out of the system through middlemen.
Here’s why lawmakers don’t focus on the real solutions you’re describing:
- The Power of PBMs and Middlemen – PBMs negotiate both ends of the deal, inflating prices while pocketing spreads. They’re powerful, politically connected, and rarely challenged. Lobbying in 2024–2025 alone exceeded $300 million to keep reform at bay.
- Politics Prefers Simpler Narratives – Subsidies are easy to campaign on; structural reform is complicated and messy.
- Both Parties Benefit from the Current System – Democrats emphasize coverage expansion, Republicans emphasize fiscal restraint, but neither side takes on PBMs and insurers who fund campaigns.
- The Hidden Cost of Doing Nothing – Unpaid bills, inflated markups, and hidden rebates get pushed back into the system, raising costs for everyone. In the end, taxpayers cover it anyway.
There are bipartisan efforts underway — bills like the PBM Reform Act of 2025 and the PBM Transparency Act have been introduced to cap spread pricing and require rebate transparency. The solutions exist. But instead of prioritizing them, lawmakers are burning political capital fighting over subsidies because it plays better for their bases.
If even 10% of the grift were eliminated, it would more than cover the ACA subsidies. That’s governing with common sense: solve the waste to pay for the help. But what drives Washington is political leverage and corporate protection, not structural reform.
Miles’ Reflection
So what we’re really saying is that this shutdown is a paper tiger fight — politicians staging a conflict for show, creating the illusion of governance, when in reality it’s more about entertainment than solving problems. And while they posture, the cost falls on us — the people who lose coverage, face higher bills, or watch critical services stall.
Beth’s Summary
Exactly, Miles. This shutdown reveals a hard truth: Washington is more invested in the performance of governing than the practice of governing. The ACA subsidies are a fraction of the money being wasted inside the system — yet they’re treated as a battlefield because they’re politically useful. The real solutions — confronting PBMs, cutting medical equipment and pharmaceutical markups, and bringing transparency to pricing — are on the table. Until leaders choose to govern rather than perform, Americans will keep paying the bill.
The Human AI View 
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