This episode, host David Nitkin takes on healthcare — an industry so big and so personal that he almost didn't tackle it, given his own history working inside the Johns Hopkins system. Drawing on interviews with seven leaders across Maryland's hospitals, physicians, regulators, and insurers, David traces the 50-year history of the "Maryland Model" — the state's unique all-payer healthcare system — from its 1970s origins through today's uncertain future, as a new federal agreement threatens to unwind the very thing that's made Maryland's healthcare financing unlike anywhere else in the country.
In this episode:
- How a 1977 deal with the federal government created Maryland's all-payer waiver — and why it's been called "a third rail" that no one in Annapolis wants to touch
- The 2014 shift to global hospital budgets under Governor O'Malley, and how it changed hospitals' incentives from volume to value
- The real numbers: reduced hospital readmissions, fewer hospital-acquired infections, and why Maryland hasn't lost a single rural hospital while nearly 200 have closed nationwide
- The new AHEAD model, and why it may mean the end of the "all-payer" system as Medicare and commercial insurers start paying different rates for the first time in 50 years
- A stark warning from a CareFirst executive describing a "game of chicken" between hospitals, insurers, and the state
- (00:00) - Cold Open
- (04:32) - Healthcare By The Numbers
- (06:49) - David's Story: A Personal Stake
- (08:08) - Origins: Hospitals On The Brink, 1960s
- (09:14) - The Waiver And The All-Payer System
- (10:40) - "A Third Rail": Why No One Touches It
- (12:29) - Cracks Begin To Show, 2011
- (14:47) - 2014: The Shift To Global Budgets
- (16:45) - How Hospitals Adapted
- (19:53) - The Old System's Weaknesses
- (21:32) - 2019: Total Cost Of Care
- (22:22) - Where Doctors Fit In
- (24:49) - The Numbers: What Actually Improved
- (28:49) - Why Rural Hospitals Haven't Closed
- (29:23) - The CareFirst Monopoly Problem
- (32:38) - 2024: Enter The AHEAD Model
- (35:05) - The End Of All-Payer?
- (36:17) - Who Pays For The Gap
- (38:39) - Hospitals: Running Out Of Easy Fixes
- (40:22) - Beyond Hospitals: Drugs, Behavioral Health, Aging
- (42:18) - Nursing Homes And The Capacity Crunch
- (43:05) - "A Game Of Chicken"
- (45:07) - The Maryland Model Goes National
- (45:56) - Closing Thoughts
- (48:41) - Team Roundtable: History And What's Next
What is Maryland Now?
Maryland Now is a podcast that goes beyond the headlines to explore the forces shaping Maryland’s politics, policy, and public life. Hosted by Dori Henry, Josh Kurtz, and David Nitkin — three veteran journalists and public‑affairs leaders with more than 60 years of combined experience — the show brings depth, context, and historical perspective to the issues facing Maryland today.
Each episode blends reporting, interviews, and insider knowledge. You’ll hear directly from the people driving decisions in Annapolis and across the state: agency heads, lawmakers, advocates, strategists, and longtime policy experts. The hosts draw on their decades covering and working in Maryland government to connect past decisions to current debates — revealing how we got here, what’s been tried before, and what’s at stake now.
Season One follows the 2026 General Assembly session and election cycle, with deep dives into housing, energy, the state budget, public health, and more. The conversations are smart, candid, and grounded in real reporting — not hot takes.
If you want to understand Maryland — its politics, its communities, and its future — Maryland Now is for YOU