# We Are All Republicans, We Are All Federalists

Page: https://stenobird.com/podcast/i-believe-6610011/we-are-all-republicans-we-are-all-federalists
Text version: https://stenobird.com/podcast/i-believe-6610011/we-are-all-republicans-we-are-all-federalists.md
Podcast: [I Believe](https://stenobird.com/podcast/i-believe-6610011)
Published: 2026-05-19T07:21:00+00:00
Episode link: https://joelkdouglas.substack.com/p/we-are-all-republicans-we-are-all
Audio file: https://api.substack.com/feed/podcast/197388172/80eba5a8d5de61fcba598832dc7b0f72.mp3
Processing state: not_requested
JSON: https://stenobird.com/v1/public/podcasts/i-believe-6610011/episodes/we-are-all-republicans-we-are-all-federalists
Duration seconds: 1470

## Resource

Dr. Nick van Terheyden had bone pain that he could not explain. He was fifty-eight, a physician in Maryland. A specialist ordered a $350 blood test for vitamin D deficiency. The test came back positive. The deficiency was severe enough that if left untreated, it would lead to osteoporosis. Van Terheyden’s insurer was Cigna. They refused to pay for the test. The corporate medical director who signed the denial letter said the test wasn’t medically necessary. Van Terheyden read the letter, looking for the clinical reasoning. There was none. Only generic language, a response from a machine. He filed an appeal. A second medical director upheld the denial. To reimburse van Terheyden for the test that had come back positive, van Terheyden would have to prove he had a vitamin D deficiency before the test had been done. He kept investigating. Cigna used a system that flagged mismatches between billing codes and acceptable diagnoses. It let the company’s medical directors deny claims in batches without opening a patient’s file. Internal documents later showed that the doctor who rejected van Terheyden’s claim rejected roughly sixty thousand claims in a single month. Over a two-month window, Cigna physicians denied more than three hundred thousand payment requests. The average review took 1.2 seconds. It took seven months and an external medical review to force the insurer to pay the $350. Two years passed. On December 4, 2024, a man named Brian Thompson stepped out of a New York hotel and was shot dead on the sidewalk. He was the chief executive of UnitedHealthcare. Shell casings left behind were inscribed with three words: deny, defend, depose. Across demographic lines, Americans began telling their own stories. Denials, delays, bankruptcies, deaths. The shooter had read the s…

## Actions

- request_transcript: `POST https://stenobird.com/v1/public/podcasts/i-believe-6610011/episodes/we-are-all-republicans-we-are-all-federalists/transcription-requests` — Idempotently request low-priority transcript generation for this episode.
- read_markdown: `GET https://stenobird.com/podcast/i-believe-6610011/we-are-all-republicans-we-are-all-federalists.md` — Read the agent-friendly Markdown representation of this episode resource.

A page view does not enqueue transcription. Agents should invoke `request_transcript` explicitly when they need this episode processed.

## Transcript

Full transcripts are not published on public pages unless there is a clear rights basis.