MTT #112: The votes are in. Will Congress finally tackle healthcare costs?

0:11Dr. Robert Pearl: Hello and welcome to Medicine the Truth, one of the four weekly podcasts in our Fixing Healthcare podcast series. I'm Jeremy Corr, host of the Popular New Books and Medicine podcast and CEO of Executive Podcast Solutions. With me is Dr. Robert Pearl. For 18 years, Robert led the Permanente Group, the nation's largest physician group. He is a healthcare contributor at Forbes, bestselling author, and professor at both the Stanford University School of Medicine and Business. His most recent book, ChatGPTMD, How AI-Empowered Patients and Doctors Can Take Back Control of American Medicine on the Impact Geordative AI Will Have in Healthcare, remains a bestseller.

0:42Dr. Robert Pearl: Information on a range of medical topics can be found on his website, robertpearlmd.com. Robbie, we're recording this just before Election Day. By the time listeners get to hear it, the votes will have been cast. As they say on Survivor, the American people will have spoken, but we can expect the analysis to last for at least the next few weeks, if not year. Can you tell people about the political and economic climate surrounding these midterms?

1:07Jeremy Corr: Jeremy, let me start by pointing out that health care affordability has dominated people's concerns in nearly all polls. It's been ahead of inflation, immigration, and the overall economy. When Americans need to write a check for their premiums or reach for their credit card to pay for their out-of-pocket expenses, when they see a doctor go to the ER, get admitted to the hospital, the magnitude of the problem stares them in the face. Even in the grocery store, some items like eggs, they're going down in cost. There's almost nothing in healthcare that recently has headed in that direction. Data from the most current surveys show the average family premium for the 160 million Americans whose employer funds the coverage.

1:52It's increased to$27 ,000.

1:56Jeremy Corr: That's 26 % more than it was a mere five years ago. And about a quarter of that total, that's paid by the worker through high deductible insurance plans, and they're becoming ever more ubiquitous. For growing number of enrollees, that means they pay for the totality of the medical care they receive in most years. And the financial impact on Americans, it's great and increasing. In multiple surveys, less than half of Americans say they can afford high quality medical care, with a third reporting that they had to cut back on living expenses, utilities, or food to pay for the medical care that they and their family needed and received.

2:41Jeremy Corr: Robert, can you break the data on voters for listeners? Jeremy, based on the data from the nonpartisan Kaiser Family Foundation, the importance of health care varies by party. For Democrats, it's their top issue. And 42 % trust the government to address the concerns. And that's compared to Republicans, who only 22 % trust the government to address their concerns. That 20-point gap between the parties, it's significantly larger than it was six months ago in April, when only 37 % of Democrats trusted the government versus 26 % for Republicans, 11 % gap. Overall, among voters, healthcare affordability is tied with gas prices for their top concern.

3:33Jeremy Corr: Voters from both parties agree that major changes in the American healthcare system are needed. In fact, the numbers are staggering. 90 % of Democrats and 75 % of Republicans say that health care requires either a complete overhaul or at least major improvements. But the views by voters from the two parties, they differ greatly on how this change should be accomplished. As an example, when it comes to Medicare for All, Democratic and Independents support the concept. 84 % of Democrats and 72 % of independents, while two-thirds of Republicans oppose Medicare for All. But even relative to this commonly discussed topic that was loudly debated in the 2020 Democratic primary and many times since, most Americans don't have a great understanding about the details.

4:26Jeremy Corr: Their understanding isn't deep and it remains malleable. As a result, when supporters of Medicare for All hear about criticism of the plan, and they hear about the delays in care, the need for higher taxes, the erosion of the current Medicare options, all of which could result, their support for the approach drops significantly. At the other end of the spectrum, one of the opponents of Medicare for All hear about guaranteed coverage as a right, reductions in premiums that they would have to pay, and less out-of-pocket expenses, the support among these critics, it rises. Independents who are likely to have a huge impact in the election results are the most difficult to read.

5:13Jeremy Corr: By a three-to-one ratio, they trust Democrats more than Republicans when it comes to addressing the health care affordability crisis. But 40 percent of independents don't trust either party. Jeremy, my sense is that the overwhelming conservative Americans is that when they become sick, they won't be able to pay for the medical care they need. Exactly how the affordability crisis is solved, that's less important compared to simply something that works. And the idea of the government paying for it sounds attractive. But at the same time, most Americans like the variety of options they're given. They appreciate the current choices that they have today.

5:57Jeremy Corr: And the idea of relinquishing all of that to the government, that becomes concerning when they hear the details of any program. And that's one of the problems with the American health care system. People like the freedom, but they don't like the prices. And preserving the former while addressing the latter, that proves difficult.

6:19Dr. Robert Pearl: Robby, given the immense interest in healthcare affordability, how is our nation responding?

6:24Jeremy Corr: Jeremy, at this point, what I see is just vast finger pointing, but almost no progress to a solution. Drug companies continue to price most new medications in the hundreds of thousands of dollars. Hospitals continue to consolidate with the intent of gaining market control and raising prices. Battles between insurers and providers are growing more intense, with AI now helping both sides, raising, not lowering, administrative costs. Doctors are joining hospital systems. They're selling their practices to private equity. Their hope is to augment their market bargaining power and drive the prices they receive for interventional procedures and office visits even higher.

7:04And our nation's demographics, they're making effective solutions

7:09Jeremy Corr: harder to implement. The population is aging with over 10 ,000 Americans turning 65 each day and becoming Medicare eligible.

7:18Dr. Robert Pearl: Robbie, can you be a bit more specific about what is happening with workers since they represent the majority of voters in America?

7:24Jeremy Corr: Jeremy, I'm happy to provide some statistics to detail the health care affordability crisis that workers face. As I said, around a quarter of the employees' total health care expenses are paid by the individual. On average, the premium contributions and out-of-pocket expenses, there's$7 ,471 per worker per year. That's up a whopping 9 % from a year ago. But the impact is even greater for individuals who work for small businesses. They pay on average$9 ,687 towards their family's coverage. with workers in companies with over 200 employees paying$6 ,840 on average. And these high costs, ones that must be paid by the worker with post-tax dollars, they translate into huge challenges for the family's economics and lifestyle.

8:25Jeremy Corr: For individuals working in larger firms, their health care costs represent approximately 25 % of their income. However, for employees and small businesses, health care accounts for 37 % of their income. Put that together with our families pay for rent, food, transportation, it's easy to recognize why workers are struggling and why we see the growing unaffordability of health care across the nation for over 100 million Americans. Medical costs don't become problematic only when people become severely ill. Surveys now show that the average deductible for an American worker is$2 ,000. As such, for a growing percentage of Americans, ones who see a physician maybe a couple of times a year, they pay out of pocket for all of their medical care every year.

9:19Jeremy Corr: It's clear that insurance in the United States isn't delivering what most Americans expect.

9:25Dr. Robert Pearl: Robbie, are Americans getting the care they deserve given the dollars that are spent?

9:29Jeremy Corr: Jeremy, that's a very important question, but it's a difficult one to give a simple answer to. The reason is that answering that question depends on how you define best medical care. Overall, based on the research done by the Independent Commonwealth Fund, the United States is a lagging country compared to pure nations. Not only do we spend almost double, nearly all other countries on a cost-for-citizen basis, but we're last in nearly all vital outcome measures. We're near the bottom on life expectancy, living five fewer years than people in half a dozen pure nations. Moreover, not only is the United States the worst in maternal mortality, but the number of deaths per 100 ,000 live births is higher than the next two wealthy nations combined.

10:19Jeremy Corr: And we trail all the other peer countries on childhood mortality as well. We've talked about these statistics. We've lamented the United States' poor quality outcomes in the past. And little is new or positive since then. But I did see an interesting study on the whole question of value. And although I know that there are problems with many of the procedures that surgeons do, I was surprised at the number of questionable outcomes that result. The research didn't come from the United States, but instead it was done on patients in Great Britain, where there's more data availability through the national healthcare registries.

11:00Jeremy Corr: However, I wouldn't be surprised if the numbers were any different in the United States than in Great Britain. For context, 6 in 10 Britons undergo surgery at some point in their life, and many of those procedures were performed by orthopedic surgeons. The researchers looked at the 10 most common orthopedic surgeries that represent a quarter of all operative interventions done in the country. Three of the 10, they were found to achieve outcomes that were superior to non-operative conservative management. Obviously, these are ones that should continue or even increase in volume. There were carpal tunnel release and tunnel joint replacements of the hips and the knees.

11:40Jeremy Corr: The other operations were judged to achieve outcomes that were no better than medication, physical therapy, and time. The complications following conservative procedures were far less than after a major surgical operation. These surgical interventions, with minimal of any overall improvement compared to non-operative care, included lumbar spine decompression for back pain and shoulder surgery. And not only were the outcomes are unimpressive, but for many patients, these procedures not only fail to improve function or decrease pain, but they actually made the problems worse. As I said, getting the care that people deserve is a complex question.

12:25Jeremy Corr: There are definitely areas in which the dollars we spend add massive value, and a few in which the medical care we provide is the best in the world. But overall, I believe that most people overestimate the value of American health care and fail to see its shortcomings. Considering the cost, there's a lot of room for improvement.

12:45Dr. Robert Pearl: We've talked about health care continuing to add jobs and that the increasing number imply that medical costs will continue to rise rapidly. What are we seeing currently?

12:55Jeremy Corr: Jeremy, as is true for most of medicine, the numbers only tell a small part of the story. What we've seen over the past year is that three-quarters of all new net jobs in the United States have been in health care. Of course, the country of the United States has added 372 ,000 health care jobs versus only 124 ,000 for the rest of the economy. That says that health care is a major support to the stable job market and that costs are likely to continue to rise in the future. However, if you look deeper, the biggest job gains are in the lowest paid part of medicine, home health aids. And much of the rest of the growth, it's in outpatient services, which, if they're replacing inpatient treatment, should theoretically lower cost, but they haven't done so yet.

13:43Jeremy Corr: Even when I put all the employment data that we have together, it's almost impossible for me to predict the likely future rate of medical inflation based on the economic employment numbers. But for all the reasons we mentioned earlier about the current poor performance, we can expect that unless something changes in the structure, care delivery, or permanent methodology of American health care, it's unlikely that either prices or costs for Americans are going to decline in the foreseeable future.

14:14Dr. Robert Pearl: Robbie, the Nobel Prize in Medicine was recently awarded. Please tell listeners about the winners and their work.

14:21Jeremy Corr: Jeremy, three individuals shared the Nobel Prize for Medicine. Two of the recipients from Berlin, Germany, worked on the same project, and the third from Stanford worked on the same opportunity, but in a very different way. Peter Hegemann and George Nagel developed a technique to use pulses of light to activate neurons in the brain. This work is the precursor to techniques that hopefully will allow blind individuals to see. The technique they developed is called optogenetics. It relies on proteins that were initially discovered in single-cell algae that are capable of opening what are called ion channels when exposed to light.

15:05Jeremy Corr: Much of the research so far has used this technique to turn on and turn off parts of the brain to understand what results in both function and dysfunction when this is done. In the future, this technique could provide vital insights to a range of conditions, ones that are poorly understood at the physiological level, including depression, autism, schizophrenia, and addiction. Theoretically, with this information, new drugs and treatments could be developed. Hageman earlier his career found one type of green algae that can recognize light, and when the light is shined on it, it moves towards it 20 times faster than would be possible with the type of vision found in the human eye.

15:49Jeremy Corr: In researching how this was possible, he recognized that the algae could accomplish it through a direct neuronal stimulation rather than the impulse having to be transmitted to a second neuron in the human who would be in the brain that would then activate the motor function. He then worked with Nagel to identify the response to a little protein. It's called chattelrhodopsin 2. The third recipient, Carl Dezeroth from Stanford, he's a psychiatrist. He wanted to understand the underlying biology for a variety of psychological problems that his patients were experiencing. Of course, directly examining the human brain in patients, that's prohibited for research endeavors.

16:33Jeremy Corr: As such, he worked with mice. In the first part of the experiment, he inserted the gene that codes for the channel rhodopsin-2 into some of the rodent's brain cells that were growing in a petri dish. Then shine blue light on it, he could detect direct activation, as he had seen in the algae. Now having shown that it was possible light to activate a neuron, his team then inserted the genes into living mice, using tiny, very amazingly small optical fibers. He was able to send pulses of light to specific neurons, and then he could observe the resulting change in behavior, depending upon whether the neuron was a stimulatory inhibitory one.

17:18Jeremy Corr: According to the Nobel Committee, prior to development of this technique, researchers could stimulate and map areas of the brain which were informative, but now they could either stimulate or inhibit individual brain cells, neurons, within bigger regions and understand how human functions at that neuronal level. In essence, scientists have now moved from anatomical representations to functional ones at the cellular level. This technique is foundational to almost every neuroscience lab in the world today, and it's already been applied to begin to understand the neural circuits involved in memory and various psychiatric diseases, including obsessive compulsive disorder and schizophrenia.

18:03Jeremy Corr: In addition, listeners may remember that we talked about a gene therapy to restore vision in patients with an inherited form of blighted called retinitis pigmentosa in the past. And we noted that in these patients, a gene editing technique had allowed partial vision to be restored. That treatment applied the same gene editing technique of inserting light-sensitive genes into humans, as was done in this Nobel Prize work on mice.

18:34Dr. Robert Pearl: Robbie, a listener wanted to know if anyone has measured the impact generative AI is having on saving lives. What can you tell her?

18:40Jeremy Corr: Jeremy, we're seeing positive impacts on this ever more powerful technology. A recent study published in the Journal of Medicine, AI applications generated prompts when there were hospitalized patients who were at risk of a major complication based based on data coming from the electronic medical record and laboratory results. When the technology identified such a situation, it notified the clinicians through the electronic health record alerts and communicated the potential life-threatening situation to the hospital's rapid response team. The study period included 23 ,132 patients, which 10 ,000 injured and three of them were hospitalized prior to the availability of the AI tool and 12 ,329.

19:26Jeremy Corr: experienced it once it was implemented. The downside to the air-generated alerts was that there are approximately 10 % more notifications that were sent to the rapid response team than before implementation. The positive result was a significant decrease in inpatient mortality, and the improvement in clinical outcomes and survival was found to occur in different types of hospitals in the healthcare system that studied the question. How about current generative AI

19:56Dr. Robert Pearl: applications for outpatients?

19:58Jeremy Corr: Jeremy, here too we're seeing early progress in the use of generative AI for patient care. An interesting pilot is happening at the Beth Israel Deaconess Medical Center in Boston. In the study, patients who are scheduled for a visit with their primary care doctor are first evaluated by a Google-generated AI chatbot. The application takes a history, discusses the possible causes of the person's symptoms, then generates a summary of the conversation. The primary care doctor then reviews the information prior to the in-person visit. The purpose of this pilot was to assess whether this pre-visit process using generative AI would be helpful for clinicians and if there were any misleading or otherwise harmful information provided.

20:49Jeremy Corr: If you just told me about the study, I would have predicted resistance from the doctors. But surprisingly, the physicians reported that the bot was helpful in 75 % of cases. The attending doctors surveyed said the bots were comparable to a high-performing medical student or resident. And similar to what we've highlighted in other contexts, the bots hallucinated only once in hundreds of conversations. And that hallucination was simply misinterpreting a date as being in the future rather than the past. The study to me indicates three things. First, the tools are becoming more competent and reliable.

21:28Jeremy Corr: Even two years ago, hallucinations were the big fear. Now, They're very rare. Second, the doctors are becoming more comfortable with the use of generative AI in the provision of medical advice and care. And finally, patients in the study who aren't yet ready to have the tools replace doctors, they were fine with clinicians using these applications as part of their evaluation and treatment process. And that's different than we saw a couple of years ago. All three indicate that not today, but at some point, Genitive AI will be able to directly provide medical expertise without human oversight. The chatbot that was used was built by researchers at Google.

22:13Jeremy Corr: It's called AMIE, A-M-I-E, short for Articulate Medical Intelligence Explorer. It's driven by Gemini, Google's large language model, but it's also been given added training specifically for clinical reasoning. Throughout the process, trained physicians monitored the conversation between the chatbot and the patient. They were prepared to stop the intervention if either the patient seemed to be bothered by what was being said or the information was inaccurate or problematic in any way. In hundreds of conversations, only five times did a doctor intervene and in none of those times did the clinician have to halt the interview.

22:55Jeremy Corr: The most worrisome of the five is when the chatbot listed cancer as part of the differential diagnosis, which by the way it was, but the patient appeared to assume that cancer was the final diagnosis. Once the person observing explained the difference between a differential diagnosis and a final diagnosis, the patient was content and satisfied I need to view what on. But this pre-visit process is likely only a part of what chatbots will do in the future. With 400 ,000 patients in the United States dying annually from misdiagnoses, the ability of the genitive applications to surface a broad differential diagnosis should be positive for both doctors and patients.

23:39Jeremy Corr: And since chatbots, unlike doctors, have unlimited at time, they'll be able to take more comprehensive histories and explore the possibility of rare but potentially dangerous diagnoses.

23:54Dr. Robert Pearl: Robbie, measles seems like a problem that's getting worse each month. Can you update listeners on what has transpired since the last time you reported on the multiple outbreaks across the U.S.?

24:04Jeremy Corr: Jeremy, unfortunately, the negative news continues. The nation is experiencing the worst measles outbreak in decades. There have been over 4 ,000 cases reported, with likely others that weren't included in the count. There have now been six deaths. What's even more disturbing is that on a national level, the most recent death failed to make headlines. I interpret that to mean that people are becoming used to these avoidable tragedies and their longer warrants coverage outside the local community. And as vaccination rates decline, the number of cases, complications and deaths from measles, they're likely to grow significantly over the next few years.

24:48Jeremy Corr: Listen as you think back to last year, when we hit the highest level of cases in over 35 years. In 2025, the full year total was 2 ,289 cases. With two months to go in 2026, the total is likely to be double last year's. And the mortality rate, it's pretty constant. One to two children die for every 1 ,000 cases. Rather than doubling down on the need for vaccination and promoting the safety of the vaccines themselves, Robert F. Kennedy Jr., the head of Health and Human Services, he's now focused on identifying vaccine complications, which will elevate people's fears about the vaccines rather than its life-saving potential.

25:33Jeremy Corr: It's not that we shouldn't monitor these vaccines, but it's been done in hundreds of thousands of patients. And the data again and again demonstrate how rare it is for a life-threatening problem to come from the vaccine itself. And recently, the measles epidemic spread to New York State.

25:55Jeremy Corr: The governor, Kathy Hochul, declared a state disaster emergency, the first one in recent times. At every place where the cases are being reported, almost all the victims haven't been vaccinated. Adding to the problem, very young children can't be vaccinated against measles because their immune system isn't yet developed. The first dose of the vaccine usually isn't given until 12 months of age. and for babies their main protection for the first year of their life against the disease which not only can be fatal but even in kids who don't die can result in blindness, deafness and brain damage. The way they're protected is through herd immunity.

26:36Jeremy Corr: This requires that over 95 percent of people in a community be vaccinated and in that way these highly vulnerable infants are unlikely to come in contact with someone who's infected. But as the unvaccinated percentage of population grows. The dangers from exposure and transmission, they're increasing exponentially, and the current measles outcomes may soon be worse. New York State has had some of the strictest rules on vaccination for public schools, requiring measles vaccination in order to begin kindergarten and excluding religious objections as the reason to not become vaccinated. High protection has been the rule as a result.

27:19Jeremy Corr: The Supreme Court signaled last year a potential willingness to force the state to loosen its restrictions. I believe the government's role should be to protect children from harm. But currently, when it comes to vaccination, federal agencies appear to be exerting pressure in the opposite direction. Jeremy, I'm particularly passionate about this topic. as my father's sister died in childhood prior to the availability of a vaccine for measles. I've seen the depth of sadness in my grandparents' eyes whenever her name was mentioned. I can't think of a greater tragedy than the death of an otherwise healthy young child.

28:00Dr. Robert Pearl: Remy, several listeners said that friends had told them about losing their health care coverage next year. Is this common, and if so, what's the reason?

28:07Jeremy Corr: Jeremy, unfortunately, the number of uninsured and the percentage of the population have both risen over the past two years. And even more worrisome are the projections for the future, in which the numbers are expected to soar as the Medicare restrictions that were enacted as part of what has been called the Big Beautiful Bill happened. Already, according to the Nonpartisan Commonwealth Fund, we've seen the uninsured rate rise from 8.9 % to 11.2 % this year alone. The big driver has been the termination of the enhanced premium tax credits for individuals on the health care exchanges. It's estimated that 4 million Americans lost coverage as a result.

28:51Jeremy Corr: Based on estimates for the Congressional Budget Office, with the Medicaid cuts piling on, By a decade from now, we're talking 2036, the number of uninsured Americans will grow by 11 million more individuals. There are two other factors that worry me that this report doesn't include. The first is that we're seeing companies drop coverage for family members beside the worker. As such, the uninsured numbers may rise faster than projected. And the second is that increasingly people can have coverage, but they can't afford to pay their out-of-pocket costs, and therefore they're skipping routine appointments and treatments that they might, and treatments that they need.

29:39Jeremy Corr: De facto, they are uninsured when it comes to all but life-threatening emergencies. As I mentioned earlier, a Gallup poll showed that one in three Americans are cutting back on their basic expenses to pay for the medical care. And half of all adults say they've gone without necessary medical services simply due to cost. That means they've skipped getting a necessary test or treatment. They failed to pick up a prescription that their doctor had prescribed. They failed to get the subspecialty care that their physician requested. The problem with addressing the growth in the number of uninsured isn't identifying the big challenges that patients face or calculating the growing coverage gaps.

30:22Jeremy Corr: So all the recommendations contained in this report will raise the cost of medical care. And that's the opposite of why the reductions were implemented in the first place. It's not that policy experts don't know how to expand coverage or ways to lower costs. It's that they can't figure out how to do both at the same time. In many ways, this was the challenge for President Obama in 2008 that I described in detail in my first book, Mistreated, why we think we're getting good health care while we're usually wrong. He recognized the difficulties with our nation's clinical quality, coverage, and cost, but he decided he could only address one problem at a time.

31:13Jeremy Corr: and he chose coverage. It worked beautifully, drove down the uninsured to historically low levels. But the problem of medical costs, that problem continued to worsen. And that's why I'm so focused on the opportunities to lower costs by improving people's health, not by skipping on medical coverage or skipping on care.

31:38Dr. Robert Pearl: Rami, speaking of rising costs, please tell listeners what is happening relative to drug prices.

31:44Jeremy Corr: Jeremy, the challenges that we discussed in the past, they are continuing. Last year, around 25 % of the new drugs that were launched in the United States had a net price above half a million dollars. And that's according to the independent nonprofit Institute for Clinical Economic Review that we usually refer to as ICER. According to ICER, this represents a 35 % increase over a three-year time frame. And based on the organization's analysis, only one in three of the new medications were cost-effective. And that analysis wasn't based on the retail price. It was based on the net price after the rebates and discounts were included.

32:28Jeremy Corr: And those price tax led to major battles between insurers and providers over coverage restrictions. As an example, almost two-thirds of prescriptions billed to Medicare were rejected, either because the medication wasn't covered or the treating clinician hadn't gone through the required pretreatment review. Robbie, any final thoughts? Jeremy, now that the election is over, although we don't yet know the results when we're recording this, the time has come for elected officials to shift from campaign promises to legislative solutions, with health care affordability being at the top of their concerns.

33:08Jeremy Corr: The next session of Congress, the one that will convene this coming January, it better be ready to not only put in place solutions, but also to communicate effectively on the steps they are taking. Voters are counting on elected officials to address the health care affordability concerns, even if it may take a couple of years to achieve success. I think we should plan to discuss the options that we think Congress has on our next Diving Deep episode. However, I'd like to offer listeners some initial thoughts for their consideration before then. I don't want anyone to think that the problem simply can't be solved.

33:54Jeremy Corr: And my first observation is that there aren't any easier quick solutions. But my second is a correlator to the first, that tweaks to the insurance system won't make a big enough difference to satisfy the economic challenges that people have. That affordability will continue unless we can take a more comprehensive solution. And when I examine all the opportunities to accomplish that, my top choices fall into two categories. I think either Congress could act to keep people healthier, doing so to reduce costs and make care more affordable, or elected officials could address the affordability crisis through increased competition, increased competition that would force insurers to compete on cost and value.

34:41Jeremy Corr: Success will allow the best to increase their market share, with the inefficient to high-priced programs going out of existence as their membership dwindles. If improved health is the solution that Congress selects, then GLPs for treatment of obesity will be necessary, for this will help avoid cardiovascular disease and prevent cancer. And with cost being the biggest limiting factor, the easiest path to expansion, and we're talking about 40 % of Americans who are obese, will be modifying the definition of shortage to include not only just physical difficulties, access to the drugs, but also economic affordability.

35:25Jeremy Corr: By expanding the definition, it will allow licensing compounding pharmacies to sell these effective weight loss drugs at less than$200 a month. And for those individuals who do develop a chronic disease, problems like hypertension, diabetes, chronic heart failure, Genitive AI offers a means to more frequently monitor blood pressure and blood glucose to obtain effective control and to reduce the likelihood of a patient experiencing a heart attack, stroke, or kidney failure. According to data from the CDC, effective control of these lifelong chronic conditions would reduce the expensive life-threatening problems by 30 % to 50%, and that would save hundreds of billions of dollars annually for the United States.

36:14Jeremy Corr: On the other hand, if Congress wants to encourage competition, the best path would be by expanding a current program called Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Established in 2020, this program allows employers to give workers the dollars that they otherwise would pay for health care coverage and allow the worker to go to a health care exchange where they could select the best option for themselves and their family. As tens of millions of individuals start buying coverage through an exchange, competition will rise. Invariably, prices will fall due to competition and value will be rewarded.

36:59Jeremy Corr: Either approach would be positive. I believe the biggest mistake elected officials could make would be to continue to believe that the current system will right itself through small tweaks or minor adjustments. those newly elected members of Congress who choose that path, they're likely to find themselves out of a job in two years, when the lives of their constituents are even more challenged by healthcare and affordability than today.

37:29Dr. Robert Pearl: As a reminder to listeners, this episode is available on our website, FixingHealthcarePodcast.com, and all podcast apps, including Apple Podcasts and Spotify. If you like the show, please rate it five stars and share it with your friends and family. To To submit a question or comment to the host, please visit the contact page on our website and send us a message on Twitter, LinkedIn, or Facebook. Thank you for listening and have a great day.