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The Impact

The Impact

Author: Vox

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In Washington, DC, the story often ends when Congress passes a law. For us, that’s where the story begins. We examine the consequences of what happens when powerful people act — or fail to act. This season, Jillian Weinberger explores the big ideas from the 2020 presidential candidates: how their ideas worked, or didn’t work, in other places or at other times. Produced by Vox and the Vox Media Podcast Network.
Introducing The Impact

Introducing The Impact


The Impact is a show about how policy affects people. In Washington, the story often ends when Congress passes a law. For us, that’s where the story begins. We follow the choices that legislators, leaders, and researchers make out into the real world where they have human consequences — both positive and negative, expected and unexpected.Learn more about your ad choices. Visit
How does a Band-Aid wind up costing so much money? Why are American health care prices so incredibly high? Vox’s new podcast, the Impact, explores how policy affects real lives. This season, we’re focusing on healthcare, and we wanted to begin with one of thorniest questions in the American healthcare system: prices. In this episode, we look at how the American decision not to regulate health care prices leads to $629 Band Aids and $3,170 fees just for visiting the emergency room. We talk to doctors who think these prices are totally justified – and a health economist who doesn’t buy it. And we take a trip to the drug store to find out how much a Band-Aid should really cost. Email us your feedback to  Learn more about your ad choices. Visit
Central line infections can be deadly. And they used to be extremely common: just a decade ago, hundreds of thousands of patients got them every year. Now, that number is closer to 9,000 annually. That's still high, but it's a dramatic drop in just ten years. So how did that happen? On this episode of the Impact, we talk to the doctor who discovered that central line infections are, in nearly all cases, completely preventable. Physicians just need to follow a checklist to make sure the line stays safe and sterile. And we’ll explore why, if this infection is preventable, some hospitals still have several cases of them each year. This episode includes content that might be upsetting for listeners, so please be aware. Many thanks to Vox's Johnny Harris, who originally recorded footage for this story. For more on this topic, read Sarah’s story on central line infections from 2015. Please subscribe, leave us a rating and a review, and email us your feedback at  Learn more about your ad choices. Visit
It’s time to face the fax

It’s time to face the fax


Why are fax machines still such a staple of American health care? We talk to a pair of policy makers who hatched a plan to replace paper files and fax machines with electronic medical records. We explain why that plan backfired. And we go into clinics to understand why the fax's continued use isn't just annoying, but also sometimes harmful for patients' health. For even more fax facts, check out Sarah's text version of this story. You can send us feedback at Learn more about your ad choices. Visit
There's a well-known narrative about the opioid epidemic: pharmaceutical companies and dirty doctors pushed misinformation and addictive drugs on patients. But there's also a policy story here, about well-meaning doctors who tried to find the best solution for their patients in pain. These doctors developed and spread new policies that urged their peers to treat pain as a vital sign and measure it at every visit. That policy change helped create the nationwide opioid epidemic we’re dealing with today.  Please, subscribe and leave us a review! You can email us at, or send an ER bill at Music in this episode by Podington Bear and Chris Zabriskie, with sound effects from Berlin Atmospheres. Learn more about your ad choices. Visit
On this episode of The Impact, we’re looking at a possible future for pain treatment. It’s an idea known as “pain acceptance,” and in the wake of the opioid epidemic, it is gaining traction among American doctors. Music from Podington Bear, Kevin MacLeod and Chris Zabriskie. Learn more about your ad choices. Visit
American women are changing up their birth control. The use of IUDs and implants has increased 6000% in the United States since 2002.  That's the result of specific policy choices made in Washington and in state houses. These policies have reduced the teen pregnancy rate. They have cut the abortion rate. But they’re also at risk right now.  In this episode, we’re going to tell you how those policies came to be, how they're helping women access birth control -- and why, at this very moment, they are facing serious threats. Music in this episode by Podington Bear and Kevin MacLeod.  Email us feedback! We're at Learn more about your ad choices. Visit
The black robe effect

The black robe effect


What is the best way to care for patients with severe mental illness? The United States has struggled with this question for decades. In 1963, President Kennedy signed a law that was supposed to transfer patients with severe mental illness out of hospitals and back into their communities -- into outpatient treatment. That effort hasn't really worked. A lot these patients end up homeless. Many are in prison or jail. One recent study found that more than half of all inmates have some kind of mental illness. Summit County, Ohio, thinks it has a solution: court-ordered outpatient treatment. It’s often called Assisted Outpatient Treatment, or AOT for short. That’s sort of what President Kennedy hoped for: treatment outside of the hospital, in the community. But the treatment is enforced by the courts -- and that’s what makes it so controversial. We had music on this episode from Blue Dot Sessions, Chris Zabriske, Kevin MacLeod, and Poddington Bear. Please email us your feedback to Learn more about your ad choices. Visit
The United States has an astoundingly high maternal death rate. It is three times higher than the UK, eight times higher than Norway, and still climbing. But California does way better than the rest of the country. Over the last decade, doctors in the state have banded together and worked to bring their maternal death rate down. Today on The Impact, we'll tell you the story of that effort, and show you how it helped save one woman's life. One of our health care reporters, Julia Belluz, has done some amazing in-depth reporting on this issue. You can read her story here. Music in this episode from Chris Zabriskie. This is the last episode of this first season of The Impact. Please send us your thoughts, and your ideas for next season. We can be reached at Learn more about your ad choices. Visit
Help us make season 2!

Help us make season 2!


We're making season 2, and we need your help! We want to know about local policy experiments from around the country. These can be at the state, county, or city level, and can cover any kind of policy—environmental or housing or criminal justice.  Send us your suggestions at Learn more about your ad choices. Visit
The Impact’s second season focuses on states and cities as laboratories of democracy. Unlike our gridlocked Congress, local governments are constantly implementing exciting new policy. This season, the team crisscrossed the country to find the most interesting policy experiments and see how they are changing lives. Season two starts Friday, November 2. In the meantime, be sure to check out the first season, and email us with thoughts and questions at Learn more about your ad choices. Visit
Seattle is running the country’s most radical experiment to fix campaign finance. Last year, the city sent every resident $100 that they could donate to the local campaign of their choice. Seattle flooded its election with small donations to try to drown out the influence of big money in politics. In the first episode of our second season, we set out to discover if Seattle’s experiment made a difference for who decides to run for office, how candidates interact with voters, and who donates to campaigns. We also come across some talking dogs. Learn more about your ad choices. Visit
A decade ago, South Carolina was one of the most dangerous places in America for a baby to be born. But now, it’s taking an unconventional approach to fixing it: having pregnant women sit in circles with other pregnant women The early evidence from this experiment suggests that these group sessions might be leading to better birth outcomes, and giving South Carolina babies a healthier start to life. In this episode, we’ll try to understand what it is about these workshops that works… and why this low-tech intervention might be just what the doctor ordered. Learn more about your ad choices. Visit
While the federal government is trying to deport as many immigrants as possible, Oakland, California, is running a policy experiment to help immigrants stay in their communities. The city is giving as many immigrants as possible attorneys in court, free of charge. In this episode, find out how Oakland pulls this off when the federal government is against them — and how immigrants’ lives change when they get representation. * For more on this topic, check out Dara Lind’s coverage on Vox, including: what it means to give immigrants attorneys in immigration court; Attorney General Jeff Sessions’s role in immigration cases; deportations under Presidents Trump and Obama. Learn more about your ad choices. Visit
Food fight!

Food fight!


22% of New Yorkers are obese. In Chicago it is more than a quarter of the city. Obesity puts people at risk of diabetes, heart disease, even certain kinds of cancer. A couple of years ago, both cities decided to do something about it. But the policies they implemented were incredibly different. New York made healthy food more accessible. Chicago made sugary beverages more expensive. On this episode of the Impact: Which approach works best? Learn more about your ad choices. Visit
All across the country, it seems like a given: places with more expensive houses have nicer schools because they can pay higher taxes. That’s just how education seems to work. Except in Vermont. Two decades ago, the state passed a radical law to equalize education funding. On this episode of the Impact.... we’ll tell you how that law came about. It’s the story of one woman, Carol Brigham, her young daughter, Amanda, and their fight to save the tiny school that is the heart of their small Vermont town. Learn more about your ad choices. Visit
Leaving Baltimore behind

Leaving Baltimore behind


Baltimore is running a unique housing experiment that gives longtime residents vouchers to leave the city’s poorest, most violent neighborhoods for new homes in more affluent suburbs nearby. In this episode, we follow a mom named Alethea through this policy experiment. You’ll hear how Baltimore’s segregationist history planted the problems this program is trying to solve, why some participants are really frustrated with the initiative, and how Alethea decides whether to stay — or go. We always want to hear from you. Send us your thoughts and questions at Learn more about your ad choices. Visit
For decades, Memphis grew by bringing its suburbs into the city limits. City officials thought this suburb-gobbling policy would be an economic boon-- that it would bring in tax revenue. Instead, the policy was an economic disaster, especially for the majority black neighborhoods in the city's core. In this episode, we’ll tell you about the consequences of Memphis’ sprawl, and the city’s plan to fix its past mistakes. We always want to hear from you. Send us your thoughts and questions at Thanks to LaTonia Blankenship, Preston Hurt, and Ruby Estelle Smith. Learn more about your ad choices. Visit
Denmark gives new parents nearly a year off work after they have a baby. Most of that time can be taken by either parent — but dads take barely any time at all.  That has consequences for Danish men and women at work and at home. For the final episode of season two, the Impact travels to Denmark to find out why Danish dads are thumbing their nose at paid leave. We also discover a solution in another country, where more dads are enjoying time off with their new babies. We always want to hear from you. Send us your thoughts and questions at Learn more about your ad choices. Visit
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