Legality of Tariffs, Business Leaders on Mamdani, Pediatrics Under Pressure, Protein Boom

7 Nov 2025 · 48 min

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Wall Street Week - Episode Summary

Episode Title

Legality of Tariffs, Business Leaders on Mamdani, Pediatrics Under Pressure, Protein Boom

Host

David Westin

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Episode Overview In this episode of Wall Street Week, the discussion revolves around the legal implications of tariffs imposed by the Trump Administration, the challenges faced by pediatricians, the election of New York City’s mayor-elect Zohran Mamdani, and the surge in protein consumption in America.

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Key Topics Discussed

  1. Legality of Tariffs
  2. Supreme Court Arguments:
  3. The Supreme Court is evaluating whether Congress can delegate its tariff authority to the president.
  4. The International Economic Emergency Powers Act (IEEPA) is pivotal in this discussion.
  5. The key question revolves around whether "regulate" in IEEPA can be interpreted as granting the power to impose tariffs.
  • Potential Outcomes:
  • If the Court upholds the tariffs, they remain in effect.
  • If the tariffs are deemed illegal, approximately $88-$100 billion in tariffs may need to be refunded to importers.
  • Expert Insights:
  • Jennifer Hillman (Council on Foreign Relations) emphasizes that tariffs could create significant economic repercussions for businesses and consumers.
  • Larry Summers critiques tariffs as an ineffective economic policy that ultimately harms consumers and slows the economy.
  1. New York City’s Mayor-elect: Zohran Mamdani
  2. Mamdani's election raises questions about the potential impact on New York’s real estate market and business landscape.
  3. Business Community Concerns:
  4. Business leaders express skepticism regarding Mamdani’s plans to make the city more affordable, emphasizing the complexities involved.
  5. Mamdani’s proposals include universal childcare, rent control, and efficient government management.
  • Real Estate Implications:
  • The business community is concerned about the potential negative impacts of tax increases on affordability.
  • Calls for intelligent solutions to attract and retain talent and investment in New York.
  1. Challenges for Pediatricians
  2. RFK Jr.'s Claims:
  3. Health and Human Services Secretary RFK Jr. claims pediatricians profit from vaccines.
  4. Pediatricians argue that vaccination often results in financial losses due to high operational costs and low reimbursement rates.
  • Economic Viability:
  • The pediatric sector faces a workforce crisis, as reimbursement disparities push medical students away from pediatrics.
  • Advocacy for reforming the healthcare system to prioritize children's health is emphasized.
  1. The Protein Boom
  2. Growing Consumption:
  3. Americans are increasingly seeking higher protein diets, influenced by health trends and weight loss medications (GLP-1s).
  4. Reports indicate a surge in demand for protein-rich foods, particularly animal proteins like turkey.
  • Market Response:
  • New products like high-protein bars are gaining traction as convenient meal options.
  • Market dynamics are shifting due to rising prices of traditional protein sources such as beef.
  • Nutritional Insights:
  • Experts discuss the importance of balancing protein intake and its implications for health.
  • The potential for GLP-1s to alter dietary needs and consumption patterns is explored.

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Key Takeaways

  • Legal challenges to tariffs could lead to significant financial implications for importers and consumers.
  • Zohran Mamdani's policies may transform New York City but require careful navigation to avoid adverse effects on the business community.
  • The pediatric healthcare system is under financial strain, necessitating reform to ensure access to quality care for children.
  • The trend of increased protein consumption reflects changes in dietary habits and pharmaceutical advancements in weight management.

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Conclusion This episode of Wall Street Week provides a comprehensive analysis of current economic and political matters affecting the U.S. landscape, particularly focusing on tariffs, urban governance, healthcare, and dietary trends. As the discussions evolve, the implications for businesses, healthcare practitioners, and consumers remain critical to understand.

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Next Episode: Stay tuned for more insights into the stories of capitalism and their impacts!

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Transcript

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0:13Hello, I'm Stephen Carroll. I'm in Brussels where many of Europe's biggest decisions get made. And I'm Caroline Hepker in London. We're the hosts of the Bloomberg Daybreak Europe podcast. We're up early every weekday keeping an eye on what's happening across Europe and around the world. We do it early so the news is fresh, not recycled and so you know what actually matters as the day gets going. From Brussels, I'm following the politics, policy and the people shaping the European Union right now. And from London, I'm looking at what all that means for markets, money and the wider economy. We've got reporters across Europe and around the globe feeding in as stories break So whether it's geopolitics, energy, tech or markets, you're hearing it while it happens It's smart, calm and to the point And it fits into your morning You can find new episodes of the Bloomberg Daybreak Europe podcast by 7am in Dublin or 8am in Brussels, Berlin and Paris On Apple, Spotify, YouTube or wherever you get your podcasts

1:17Bloomberg Audio Studios. Podcasts. Radio. News.

1:35This is Wall Street Week. I'm David Weston bringing you stories of capitalism. Much of Wall Street joined the rest of New York this week, heading to the polls to elect a new mayor. We explore what Mamdani's win means for the financial capital of the world and specifically for real estate in the Big Apple. Plus, RFK Jr. says pediatricians are making out like bandits by pushing vaccines on children. We tell the story of why the business model is having the opposite effect and driving doctors away from ministering to the young. And everyone's looking for more protein in their diet. We explore the booming business of protein supplements and whether they're more than just another diet fad.

2:18But we start with this week's big Supreme Court argument over whether President Trump can keep those tariffs he imposed on much of the world. Jennifer Hillman of the Council on Foreign Relations takes us through what it could mean for the president to lose. I think what's really at stake most of all is whether or not the president has violated the Constitution. Because, again, we have to go all the way back to the founding of our country. You know, no taxation without representation is on that license plate on everybody in the District of Columbia. And what it really is saying is the Constitution gives to the Congress, not to the president, the power to impose taxes or tariffs.

2:58The Constitution gives to the Congress, not to the president, the right to regulate foreign commerce.

3:09all of these tariffs, again, this huge increase in taxes on Americans, without the Congress. The Constitution explicitly gives to Congress the authority to impose tariffs. Yes. Can Congress delegate that authority and has it in this statute? Right. And so the issue that is really before the court is whether or not the Congress has handed over this power that it has. It has the power to impose tariffs or duties or taxes. Did it grant that authority, hand it over to the president through the passage of this law, the International Economic Emergency Powers Act? And the decision will largely turn on one phrase in this IEPA statute, the phrase that says that the Congress delegated the authority to regulate importation or exportation.

4:02And so the issue is, can you read the word regulate to be the same thing as tax or tariff? And the argument that most people are making, that many members of Congress, that many of the business groups and many of the others that say the answer to that question is no, no, Congress did not hand over the authority, point to the fact that nowhere in this IEPA statute does the word tariff or duty appear. If the Supreme Court upholds what the president has done, then it's clear what happens. We keep charging the tariffs. What if it actually strikes it down? What is the remedy if, in fact, the court rules that these tariffs were illegal or unconstitutional?

4:42So if the court rules that the tariffs were illegal from the get-go, then the tariffs must be refunded to those that have paid them. And if we look, you know, today through at least the end of August, that means about$88 to$100 billion. dollars worth of tariffs would need to be refunded to the importers that paid those tariffs in the first instance. Because if they're unlawful, then everyone is entitled to a refund with interest. Is there a mechanism for doing that? That sounds like an enormous undertaking. There is a mechanism, but you are correct. It is an enormous undertaking. And it basically splits out into whether or not the particular import of this particular item in this particular shipment, whether or not all of the paperwork that customs has to do about those has closed or not.

5:30In the end, does all of this really matter? And we've heard from the administration, they have alternatives. I mean, you know the numbers better than I do. Section 301, Section 201, Section 337. They have a lot of different routes that they can impose various regulations and tariffs under. Yes. And again, I do think it's very clear that the president loves tariffs. And so I think if the stream court strikes down these tariffs, I do think you will see the president take up a number of these other laws and try to reimpose tariffs. But for me, there would be a pretty important distinction between them.

6:04First of all, with the one exception of the statute that's called Section 122, that would allow the president to declare that there is an emergency because we are experiencing a major balance of payments problems or currency difficulties, that would allow the president to impose a 15 percent across the board tariff on goods from every country limited to 15 percent and limited to 150 days in length unless the Congress renewed it. All of the rest of the authorities that the president could turn to are going to be different than what he's done. In the normal course, we will likely get a ruling from the Supreme Court either later this year or sometime next year on this important question.

6:47At the same time, sometimes the court likes to, as it were, duck the problem. What are the routes available to the Supreme Court? Such as, for example, there's a dispute over subject matter jurisdiction. What are the chances the Supreme Court will say, you know what, we don't need to decide this, we'll remand it for further proceedings? That can happen. To me, if the Supreme Court is going to try to take a little bit of an off-ramp, a little bit of a compromise, and again, I think you've clearly seen the Chief Justice try to find, is there some compromise? I think the compromise there may be in whether or not the court rules that there is no authority to do tariffs ever under IEPA or whether the court takes, as it's a little bit of an off ramp, a view that IEPA permits some tariffs, but potentially, for example, not the trade deficit tariffs.

7:35I mean, the court could, in essence, say we could read this word regulate importation to permit some tariffs. But what the president did in imposing this worldwide tariffs as a result of the trade deficit, he cannot do because the Congress has given him this separate authority under Section 122. The one thing that I think ought to give the court real pause about interpreting this phrase, regulate importation or exportation, is the fact that it is well established as a matter of law that you should read a word to have the same meaning within the statute. And in our Constitution, there is a ban on putting tariffs on exports.

8:18And the phrase within IEPA is regulate importation or exportation. So what the Trump administration is asking the court to do is to read that phrase. Regulate imports means tariff imports, but don't tariff exports, because that would be unconstitutional. And so they're asking the court to read that word regulate to have two entirely different meanings in the exact same phrase of the exact same statute. And that, at least to me, is a very tall order. So when I step back from it and say, you know, how likely is it that the court is going to say, yes, Trump, you can do this? I think the answer is I think they're going to say no.

9:01And I think they're going to say no largely because there are other statutes in which the president can impose tariffs. He doesn't need to twist and bend and torture this IEPA phrase in order to impose tariffs. And secondly, it is really hard to see how you read this one word regulate as having diametrically opposed meanings in the exact same phrase of the exact same statute. And yet that's what the Trump administration is saying that the court should be doing. The IEPA case is foremost one of law, but it could have enormous consequences for businesses and consumers. Former Treasury Secretary Larry Summers says the economic argument in favor of tariffs is hard to make.

9:48Look, I think the tariffs are unwise economic policy. I think on net, they push up prices. On net, they take money out of the hands of consumers, which slow the economy down. And they're, in that sense, a self-infected supply shock that makes the Fed's job, makes everybody in the economy's job harder. So I think they are, for the most part, bad policy. I don't think we've used them successfully to get important other benefits from other countries. And so the world will be better. The United States, in particular, will be better off. Indeed, the American manufacturing sector will be better off without these tariffs.

10:32The two magic words in the statute, extraordinary and unusual, it says, is what we need to do to declare this national emergency. That is at least largely a factual question. How extraordinary or unusual are these balance of trade deficits, which the president invoked? As an economist, how unusual are these trade deficits? I mean, I want to be fair, David, and recognize that there have been a lot of emergencies defined over time for a lot of different purposes, not all of which would be the kind of thing that if they happened in my family, we would call an emergency. So I think we do need to pay attention to the statutes and the history as well as that.

11:14And that's what the lawyers do and what the Supreme Court will deal with. But if you ask, is the United States in some kind of unprecedentedly disastrous situation of borrowing that is related to a lack of tariffs? The answer is absolutely not. If you ask the question, according to economics, are tariffs the right response to a foreign borrowing emergency? If there was a foreign borrowing emergency, the answer is no. The right measures would involve reducing the budget deficit, increasing the country's level of savings, for example. So I think it's pretty difficult to say that there's some aspect of the economic situation that's present today that hasn't been present for most of the last 25 years that would justify the invocation of emergency.

12:21However we got here, we certainly have a large and growing deficit and debt. One of the arguments that President Trump is making is these tariffs are helping us with that. It's bringing in revenue to reduce that debt and deficit. Just on that limited issue, is he right? The tariffs certainly are bringing in revenue, not nearly as much as he said they would. And I don't think the forecasts the administration makes that they'll get a trillion dollars of revenue over the next year or two are likely to pan out. But yes, they are bringing in revenue, but they are also having other effects. They're holding interest rates higher than they would otherwise be.

13:05They are also slowing the economy. And those things make the deficit position worse. So I'm not sure that there's an important improvement in the budget deficit as a consequence of these tariffs. And certainly if you think of the budget deficit as some kind of emergency, these tariffs would be a very odd response to that kind of emergency. Coming up, what Mayor Memdani could mean for the business of New York and particularly a real estate business that was showing signs of coming back.

13:52What's driving the markets this week? What's on investors' minds as they look ahead? Find out on the Markets Podcast from Goldman Sachs. A breakdown of market moves and macro signals in 10 minutes or less. The Markets Podcast from Goldman Sachs. Listen now.

14:18This is Scarlett Fu. And I'll Paul Sweeney, inviting you to join us for the Bloomberg Intelligence Podcast. Every day, we harness the power of Bloomberg Intelligence to bring you deep dives into the companies that are moving markets, from publicly traded companies like Apple, to those that are privately owned but known by everyone on earth, like OpenAI. Now, I helped to build Bloomberg Intelligence to what it is today, Scarlett. And now, our analysts are the best in the world, covering more than 2 ,000 global companies. That is your legacy, Paul. And we speak to those in-house experts every day.

14:47They are Bloomberg's go-to authorities on sectors, companies, and legal processes. And we do it all live each weekday, then bring you the best conversations in our daily podcast. So be sure to search for Bloomberg Intelligence on YouTube, Apple, Spotify, or anywhere else you listen. Listen in the afternoons on your way home from work to catch up on the market news you miss during the business day. That is the Bloomberg Intelligence Podcast. I'm Scarlett Fu. And I'm Paul Sweeney. Subscribe today wherever you get your podcasts.

15:18This is a story about turnarounds, for better or for worse. This week, New York City elected its next mayor. Zoran Mamdani will take office on New Year's Day with promises of big changes to come. The future is in our hands. The business community is kind of taking a wait-and-see attitude. He's a new phenomenon. And until he won the primary election in June, they really didn't know or care who he was. He was an anonymous assemblyman. Catherine Wilde is the president and CEO of Partnership for New York, a group that represents businesses in the city. The fact that, you know, what they say is, would you hire a 33-year-old kid to run a 300 ,000-person business?

16:06And the answer is no. But this is politics. He's been elected mayor. And so now the question for the business community is how to make sure he's successful and that the city thrives under his leadership. And there are two parts of being successful. One is what he wants to do and one is whether he can do it. Start with the first, because this is a really tough place to run, as you know. What does he need to be able to effectuate whatever he wants to get accomplished? Well, he wants to make the city more affordable, and he equates that to lower price of groceries, universal child care, free buses, and he talks about freezing the rent.

16:45When it gets to all of those issues, obviously the question is how you accomplish them. If you try and do it by raising taxes, which he's talked about, then the affordability crisis just gets worse because the cost of rising taxes is passed along to businesses who pass it along to consumers and all New Yorkers will pay. So we've got to find some better solutions. I was encouraged last night in his acceptance speech when he was announced as the mayor-elect with 50-plus percent of the votes. The first thing he started with, and he never mentioned raising taxes last night, he started with, well, I'm going to make a more efficient government.

17:26And that business likes to hear. One of the things we have in this country is the ability to vote with your feet, to actually leave and go someplace else. That's one of the questions we're asked more often than the other. Is it likely that particularly some of the more wealthy members of the business community will actually leave for other places like Florida? What do you think? I don't think it's likely. I mean, the real question is, will we be able to continue to attract top talent to the city? I mean, New York is a place that people want to be. There's a lot of benefits to being in New York.

17:59And as long as people don't feel they're being abused and taken advantage of, demonized, the biggest challenge right now for us is really that other states and countries are competing for our jobs, for our tax dollars. And we have to show that New York is, again, a reasonable cost place to do business and to live. The premium in the financial industry, the premium for somebody doing the same job here in New York or doing it in Tennessee or Florida or Texas, is more than 20 percent more than employers have to pay for talent to have a comparable lifestyle in New York. That's a pretty big delta. Mr.

18:45Memdani was elected in no small part on his pledge to make New York City more affordable, particularly when it comes to housing and other real estate, including a promise to freeze the rent for the two million New Yorkers living in rent-stabilized apartments. There are a number of things we can do to get the cost of rent down, the cost of building operations down, I should say. And he has said and has amended his original oversimplified one-liner, freeze the rent. I said to him months ago, how do you freeze the rent if you can't freeze the costs? And we had a discussion about how 30 % of the rent is real estate taxes.

19:28And he subsequently amended his comments to say, I understand that real estate taxes on rental housing have to come down. And said, I will be the mayor who reforms property taxes. Now, that is good news. That will help the rent stabilized units, of which there are over a million in New York City. And so that's a lot of tenants that will benefit. A mandate for a city we can afford. And a mandate for a government that delivers exactly that. I think Mamdani's brilliance is he has tapped into something that New Yorkers are frustrated by and really care about, which is costs. It's expensive to live here, particularly housing is expensive.

20:18I have young adult children in New York that are dealing with this. Owen Thomas is the CEO of BXP Properties, the largest publicly traded developer, owner, and manager of premium offices in the United States. In terms of what he's trying to do, which is bring down costs, you know, BXP, myself, we'd be fully aligned with that goal. We would welcome it and would like him to do it. I think the issue is some of the policies that he describes on how he wants to do that, I don't think are the right ones to accomplish the objective. So, for example, putting in rent controls. If you put in rent controls, that is going to prevent private capital from coming into the market and building the housing that's going to be required.

21:00New York needs hundreds of thousands of housing units. That capital is not going to come from the public sector. It has to come from the private sector. So the government needs to put in place some incentives and rules to allow that private capital to come in and fund these projects. And if that's done, I think it can be very successful. Building new apartment buildings is one way to get the price of housing down. Another is to take some of the underused office buildings and convert them to residential. After the pandemic, offices inside some of the most iconic buildings in the New York City skyline have remained vacant.

21:38Some developers say that's where they see an opportunity. There's a very broad spectrum of buildings that are out there. There are brand new AA buildings, and like you said, they are doing extraordinarily well. But there are also buildings that are older, but are loft-like, that are in places like Soho or Tribeca or Union Square. It's a lot about location. It's a lot about the physical qualities of the building. It's a lot about the owner of the building and if they've upgraded them or added amenities. So the office market is a spectrum. One of two light wells that we created, which go 25 stories down in the building.

22:14Brian Steinwurzel is the co-CEO of GFP. His firm is behind the conversion into rental apartments of J.P. Morgan's former headquarters just off Wall Street. So we are at 25 Water Street. It was a 1.1 million square foot office building that was designed to look like an IBM punch card. So it had very few windows around the building. and we bought this building at the end of December 2022 and we turned it into 1 ,320 apartments. We did this by removing most of the brick on the outside of the building and carving two light wells into the building and that allowed us to create all of these apartments and it also allowed us to take that extra floor area and build 10 stories on top of the building.

23:02We had a very ambitious plan when we bought the building and we feel very fortunate that it's come to fruition. Steinwurzel was early to the conversion business. Now the pipeline of conversions totals 81 million square feet as of May, up from 71 million square feet just months ago. An incentive called 467M gives developers like GFP a tax break for taking on the capital-intensive challenge of converting offices into apartments. What that says is, is if you start a conversion of an office building to residential, I think the project has to break ground by the middle of 26. If you do that, you can have a tax abatement for 30 years.

23:44And as a result of that rule and the oversupply of office, there are about 13 million square feet of office buildings today in New York that are being converted to residential. So I think that's a terrific example of the private sector and the public sector working together on a plan. And these conversions are perfect, right? We certainly need less office. We need more housing. The city ultimately will get more tax revenue. There's more vibrancy. There's more affordability. And there's less of an environmental impact by basically reusing a building as opposed to tearing one down and building one from scratch.

24:20And I hope this program will grow. Now, one thing that really helps with these conversions in New York is rents are so high. So you can put in the base building at a higher per square foot value and still have all the numbers work for a private investment. And that also helps. But the local regulation definitely helps as well. Although office to residential conversions could be a step in the right direction, that alone is not enough to take care of the problem. Over the last decade plus, we've recognized that we are not building enough housing in New York City. and let's face it, we're very fortunate that people want to live in New York City.

24:55This is a city that continues to grow. There are more jobs in New York City now than there ever have been in the history of the city. And so with all of these people that want to live here, we need to create more housing. And the challenge is it's still New York City. So it's very expensive to acquire land or buildings. It's very expensive to build here. And it's very complicated. We have a lot of people that live in a very close proximity to each other. And so we need to be careful about how we build so that we're becoming part of the community and not upsetting it. But with that recognition that we need to build more housing, there is much more focus on it.

25:30And we're happy to be part of the solution to these New York City's problems of creating housing. But we need a lot more than just converting office buildings to residential in order to solve this problem for our city. Mayor-elect Memdani pledges to add thousands of apartments to New York City. To have a hope of succeeding, he's going to need a good deal of help from those working under him in his new administration. We're always waiting and seeing what a new administration does. There are a lot of people that work in a city administration that make it happen. Cutting the amount of time it takes to build housing is probably one of the top things that they can do.

26:09So putting people in office that are willing to empower their departments and their divisions to actually make decisions, to review plans, to issue permits quicker are going to be things that we'll be looking to see? Or are they putting people in place that are looking to add regulation, to add obstacles or hurdles that will make creating housing more difficult? Up next, if all of us care so much about the health of our children, why do we have a business model that's driving doctors away from pediatrics? It turns out that the answer is not one that RFK Jr. wants to hear.

26:50This is Special Agent Regal, Special Agent Bradley Hall. The time is approximately 11.15 a.m. About to start consensual telephone call with Dr. Daiwa Zhang. China's Ministry of State Security is one of the most mysterious and powerful spy agencies in the world. But in 2017, the FBI got inside.

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27:31I've never seen that much evidence in my entire career, and I don't think we'll ever see that much evidence again. I now have several terabytes of an MSS officer, no doubt, no question, of his life. And that's a unicorn. This is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its vault of secrets. Listen to The Sixth Bureau from Bloomberg Podcasts starting on February 13th on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

28:13This is a story about keeping the doctors away, sometimes when we need them the most. Health and Human Services Secretary RFK Jr. claims that one of the reasons to be suspicious about vaccinations is that pediatricians are making a lot of money off of them. There's a published article out there now that says that 50 % of revenues to most pediatricians come from vaccines. The claim is headline grabbing, but it's not backed up by the facts. It turns out that far from being a profit center for pediatricians, vaccinating children is a loss leader or maybe simply a loss. I think it's really hurtful that the narrative around pediatricians profiting from vaccines continues to be put front and center.

29:04Pediatricians actually have to work extra hard to make sure that they can have all the vaccines on hand in their clinic settings and to be able to afford that. The business of vaccination is particularly expensive, not only because doctors need to buy the vaccines to have them on hand, but also because of the equipment to keep them. Dr. Ben Hoffman is a professor of pediatrics at Oregon Health and Science University in Portland and the past president of the American Academy of Pediatrics. Being able to procure, store and deliver vaccines in a clinical setting is a really complicated endeavor. And it requires resources within the clinical setting to order vaccines, whether it's from the manufacturer or a broker or from the state.

29:57The practice has to lay out the money to purchase X number of doses of a vaccine, put it in storage, and over time hope that they will give enough of the vaccine so that they make back the money they spent. So pediatricians stretch their finances to be able to have all those vaccines on hand for their patients, for the convenience, and because they know how important it is. The cost of buying and administering vaccines has been a pain point for years. In a 2017 study, 12 % of pediatric practices and 23 % of family medicine practices reported that they stopped buying at least one vaccine because of the cost.

30:41Dr. Sally Permar is pediatrician-in-chief at New York Presbyterian and chair of the Department of Pediatrics at Weill Cornell Medicine. So the field of pediatrics has really changed to the better of healthier children, fewer coming into the hospital, fewer with diseases that left them with disabilities and other illnesses. So that we know the value of vaccines, but we're left with cleaning up all of the misinformation that is really dominating the fields these days. Even here in New York, we had over 90 % of our families getting all of their shots by age five. At this point and even just in the last year, it's gone into the 80s.

31:26And it's putting not only our children at risk, but really all of us at risk. The challenge of providing children with the health care they need goes well beyond vaccinations. It's one piece of a larger picture in which pediatricians systematically are paid less, on average than other specialists. It actually is a tough job to keep a pediatric practice afloat. Pediatricians are some of the lowest paid of all physicians. In fact, they're paid 30 % lower on average than that of adult specialists who had the same number of years of training, the same amount of debt. We know that the bigger system really does not value the health of kids in the way that it needs to.

32:10Yet, we're working to address child health in the field of pediatrics on a playing field that is completely rigged and exists to support the fiscal incentives around adult health. What are those financial incentives that favor health care for adults over children? First and foremost is the way that the federal government reimburses physicians for what they do. Medicare pays providers like doctors and hospitals typically less than private insurance, but typically substantially more than Medicaid. Catherine Baker is provost at the University of Chicago, former dean of the Harris School of Public Health, and an expert in the economics of health care.

32:58Medicaid is a partnership between the states and the federal government, and Medicaid reimbursement rates for physicians and hospitals vary a lot, state to state, And that really affects whether patients who are covered by that insurance program have access to providers in that state. That difference between Medicare and Medicaid translates into a difference between how much we pay for the health care of the elderly and the health care of children. As of June, children comprise nearly 48 percent of enrollment in Medicaid and the Children's Health Insurance Program, or CHIP. Medicaid pays at about 30 % lower for their reimbursement compared to Medicare, which is available to all adults over 65.

33:41And in addition to that discrepancy, there is how we value healthcare and in particular preventative healthcare and even children's healthcare is often valued at a lower level, which translates into the reimbursement. So for example, a pediatric visit, 30 minutes with your primary care provider to do things like injury prevention, obesity prevention, vaccines, is valued at about a tenth of a orthopedic procedure that may take the same amount of time. The fact that Medicaid pays so much more poorly than Medicare translates both to payment that pediatricians receive from Medicaid, but also from commercial insurance.

34:27In most circumstances, commercial or private insurance will pay more for the same service than Medicaid will. And as a result, it can be challenging for a lot of pediatricians, especially if they're in private practices, to be able to balance their books if they're seeing a significant portion of patients who have Medicaid just because the payment is so much less. The disparity in health care between the young and the old, in reimbursement and in income, can discourage doctors from pursuing the specialty of pediatrics. If you're a medical student looking at the range of careers that you could have after medical school, you're going to put potential salary, earning potential in that consideration.

35:17And what has grown over time is of course our debt, not only starting at the undergrad level, but also at the medical school level. So education debt can be in the hundreds of thousands for new physicians that are just finishing. And that would be the same no matter what specialty you're choosing. So we are facing a pediatric workforce crisis that has been growing more severe over the last decade. In fact, we've lost 20 % of the number of U.S. medical grads that used to go into pediatrics, don't choose pediatrics anymore. Beyond discouraging the next generation of pediatricians, the economics are also driving some out of the practice.

35:58The jobs for the families are few here, so the income base is low, and a lot of the families are on Medicaid services here. Dr. Jill Neff had her own practice in southeastern Ohio for some 30 years. I did close my practice, and it took me two years to come to terms with the thought that I had to do it. It's an extremely hard decision. I feel like I am leaving them, that they have nowhere to go, that they've depended on me. And yes, many tears, many discussions. It's extremely hard. If the math of running a practice and getting paid for it isn't working well in cities, the problem is even worse in rural areas.

36:48I did talk to one of my representatives a couple years ago on this topic and asked him, you know, is there some way at all that the government can help do this? And his response was, well, the communities need to come together and come up with the money themselves to pay these physicians to come there. this town cannot come up with money to pay physicians to come here and pay off their hundreds of thousands of dollars of debt. If we are committed to ensuring our children receive all the health care they need and deserve, what has to change? Those who know best, the pediatricians, see a pressing need to reform the system.

37:29They say there's a long way to go to live up to all that we say about caring about the future of the youngest among us. So the first thing is advocacy. We need parents, grandparents, people that were once children, and that is all of us, to know about this and to talk about how this isn't the way that we think as a society. We all value children. We have children in our family that we, our families and outside our families that we know and love, but they're not being prioritized in our healthcare. And so one is just the knowing about the problem and advocating then how can we at a time that we're seeing a lot of change in health care and how our government funds health care.

38:15And when we come out of this crisis that we're in as a government about health care, can we emerge with with with new priorities that includes investing in health at the earliest stages of life for improving the trajectory of health across the whole lifespan. So that's a big one to me is the advocacy and what can we do with our policies. But the next is shifting some of the priorities of how health care has always been funded. Can we think differently about how compensation is determined so that we can have some high revenue earning areas spread to other areas that are more underfunded? So that's a harder one, but one that we should think of as hospitals and health systems.

39:06Advocacy, changing the metrics, engaging not just the government, but also philanthropy. Reforming the system will be a tall order, but the stakes could not be higher. One of the things I think is really important for people to realize is that while kids make up 30 % of the overall population, they are 100 % of our future. And I mean that in terms of our economic future and our security future. Cobbling together something with the crumbs or what's left over from the adult healthcare system is not going to work. Up next, there is no such thing as a free lunch. And when it comes to weight loss drugs, that lunch better come with extra protein.

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40:56And I'm Tim Stanovic. Subscribe today wherever you get your podcasts.

41:07This is a story about whether we can ever have too much of a good thing. Everywhere we turn these days, it seems there's another way for us to get more protein into our bodies. But how much do we need? And why do we seem to need it particularly right now? Pop-Tarts protein, why oh why? Why do we need this? High protein content. Protein drinks. Everybody wants protein. Protein is an essential macronutrient. And macronutrient just means that we need it in large amounts from our diet to help us be healthy. Joiva Barrow is a professor of molecular nutrition at Cornell. We can get them from vegetables, we can get them from soy products, and then we consume that protein, our body digests them, and then we take the essential units of the protein, we call them amino acids, and then we use them for a host of biochemical reactions to keep our body healthy and to keep our body well.

42:05In 1918, Lulu Hunt Peter's book, Diet and Health, first popularized the idea of calories in the American diet and the practice of counting those calories as a way to keep healthy and fit. Ever since, Americans have been trying to fill their plates with foods we think are good for us. But that's constantly changing. And today, Americans are eating more meat per capita than ever before. According to the U.S. Department of Agriculture, U.S. meat consumption has increased by more than 100 pounds per person since 1909. Brian Ernest is lead economist for animal protein at Cobank. The fastest growing segments in the grocery store when we look at fresh is yogurt, cottage cheese, and eggs.

42:52These three things really have kind of a halo effect when it comes to health for the consumer. Each one, I believe, is seeing double-digit sales at the grocery store here in 2025, specifically things that have stronger protein components to them, but also lend themselves very well to changes in flavor and fit a profile that accepts and adopts flavor profiles very well. Animal protein in general has seen strong growth over the last couple years. If we look over the last 10 years, with the U.S. consumer, chicken consumption has grown by nearly 19 pounds. whereas beef and pork have been relatively steady.

43:29We're seeing very strong demand overall. In fact, our value-added sales this year have been up versus last year, which is a great opportunity for us. And that goes well beyond just Thanksgiving turkeys. One of those sources of animal protein is turkey. And Jay Jandrain is the CEO of Butterball, the largest producer of turkey in the U.S. The iconic American brand has been in business since 1954. Butterball, when only the best will do. We know consumers are health conscious right now and there's a lot of focus on protein and turkey is naturally a good fit for that. It's low in fat, high in protein, and it's a very economical source of protein as well.

44:10Particularly during the holiday when you see product at about a dollar per pound, it's an incredible value for the consumer. One of the things that we're seeing particularly right now is a category that's real growth for us is our ground turkey business. And some of that is just because more and more consumers are realizing the opportunity is to use ground turkey in their everyday meals. But then also, given the incredibly high prices in beef right now, it's a very good advantage for consumers who are looking for a ground meat product to use turkey instead of ground beef. American consumption of protein from animals and other food sources is up.

44:45But so is the use of protein supplements from new companies like David Protein, maker of protein supplement bars. Its co-founder and CEO is Peter Rahal. In our first year, we'll do$150 million in sales, which I believe is the fastest growing food company. And next year, we're forecasted to$300 million plus. Before David Protein, Rahal founded RxBar, which he sold to Kellogg for$600 million in 2017. Americans, we keep jumping from different diet trends. So first there was Atkins, then there was the paleo diet, then there was Whole30, and then there was keto, fasting, plant-based had a moment. And if you look at the fundamental reason for those trends and what drove them, they're really around body composition changes or weight loss.

45:38Every January, everyone feels like they need to get back in shape, and so you're looking for diet as a solution to that. We don't want to be susceptible to those diet trends, and we wanted a position that was factual and around something that is true. But do we really need all this protein? Barrows says that for most Americans, the quantity of protein itself isn't the problem. For the average American, we recommend 10 to 35 percent of your total calories should really come from protein. And so narrowing that down to, let's say, a 2000 calorie diet, if 10 percent of that needs to come from protein, that would be 200 calories of my total protein should come from protein.

46:25And then equating that to grams of protein, that would be about 50 grams of protein for the average American. And so if you want to translate that to what that means in terms of food, if you eat a six ounce piece of steak, that's going to give you about 50 grams of protein, which is plenty for your protein needs for the entire day. What explains the recent interest in protein and why is consumption on the rise? Rahal says part of the answer is GLP-1s. For the first time, we actually don't have Americans going to a diet to lose weight. We have Americans going to a drug to lose weight. And so that's changed this whole entire pattern and how Americans are thinking about nutrition.

47:08Roughly 8 % of the U.S. population is currently on a GLP-1 weight loss drug like Ozempic or Manjaro, a share that may grow after President Trump reached a deal with drug makers this week to make their weight loss drugs more affordable. You mentioned drugs. GLP-1s are very much in the news right now. Does that change your protein needs? So there's still a lot of ongoing research about that. The emerging evidence that we're seeing is that there are some patients that take GLP-1 agonists that experience lean muscle loss, right? Lean mass going down along with, you know, the fat loss. And so the need to, let's say, can we compensate that with protein levels?

47:48And the rationale for why that happens is still under investigation. But in general, if you are losing lean mouse, we do want to replenish that and make sure you're meeting your protein needs. While they're looking to reduce the caloric intake, they may be looking to increase the protein as a portion of overall caloric intake. So protein has lent itself very well to this. And we're starting to see products on shelf that are marketed towards users of GLP-1. And these are more inclusive of protein in general. GLP-1s are changing our nutritional needs as a country, and Rahal says that's welcome news for products like David Bar, which is a high-protein, low-calorie option that retails for around$3 a bar.

48:33So the big need we're addressing with our product is to deliver as much protein with the least amount of caloric impact. How do you basically be a vehicle for protein without having a lot of consequences on both sugar and calories? What is the sugar content? Zero. zero grams of sugar. And how much protein? 28 grams. I think one of the biggest problems with protein is affordability. If you're having a high protein diet, it's very expensive. Turns out carbohydrates and fats are much less expensive. As other protein options get more expensive, I think it makes our product's position more valuable.

49:10You mentioned steak can be expensive. It's particularly expensive right now. The price of beef is really going up. Do you see that as affecting your marketplace position? Yeah, I think it helps us because one of the ways we drive consumer surplus is if you just look at what it costs to get 20 grams of protein, you know, in a steak or a salad, it's$20,$30. In our product, it's$3.25. So it's a tremendous value. And then there's no preparation. You can just eat it. As Americans consume more protein, they look increasingly for ease and convenience. We're seeing the consumers reaching out for certainly our product and turkey in general, but they're also expanding beyond the whole bird.

49:52We're seeing the frozen products that we have to offer. We're seeing bone and breast. So oftentimes we'll find consumers who are buying a whole turkey and they're supplementing it with more and other turkey products for their meal. The David Bar uses EPG, a proprietary plant-based fat component that has 92 % fewer calories than traditional bars while still delivering a similar texture and flavor. The people who buy and eat David bars, what are they eating instead of? I think they're using it as an addition. So say you have an oatmeal breakfast, it's pretty absent of protein, so you can add David on top of that and get your close to 30 grams of protein in a sitting.

50:37So I think we're bridging the gap because it's very difficult to eat, say 100 grams, 150 grams of protein a day. And so that's the problem where I think we're directly solving. Supplements like a David Barr will get more protein into your body, but is it the best way? So there's a new exciting emerging concept that's known as nutrient sequencing. So what it is, is taking our existing well-balanced diet, right? So I'm eating my right amount of carbs, I'm eating my right amount of proteins, meeting my correct amount of fats, but nutrient sequencing simply takes those food items and we change the order in which you consume those foods.

51:16We now give you the protein source first alone, tell you to wait about 10 minutes, and then we give you the carbohydrate source after that. And what we're finding is just by simply changing the order of the food, we're seeing improvements in blood glucose. We're seeing just naturally more secretion of GLP-1 in the body. We're seeing better insulin profiles just by changing the sequence or the order of the food. We prefer natural foods because it's not just only the protein that you're getting. We're getting all of the other healthy elements in the food that you don't get when it's ultra processed and you don't get if it's just like the supplement source.

51:58And Rahal does not disagree. If you talk to a nutritionists, they'll say the best thing is to eat a truly balanced diet that has all the components that you need. Recognizing a lot of people just can't do that for some of the reasons you described. Are you a second best alternative? I mean if people could really eat a balanced diet, would they be better off? I would say yes. Reason being is so if you have all the time in the world, you should eat three balanced meals and the reason is you get all your macronutrients and your micronutrients. That's just not the reality most people live in. But as in so much of life, there's the issue of not letting the bests become the enemy of the good.

52:37Protein is great, especially in a world of GLP-1s. But for some, the good of convenience and affordability may outweigh the best of simply eating three well-balanced meals a day. That does it for us here at Wall Street Week. I'm David Weston. See you next week for more stories of capitalism.

53:14This is Tom Keen inviting you to join us for the Bloomberg Surveillance Podcast. It's about making you smarter every business day. I'm Paul Sweeney. We bring you complete coverage of the U.S. market open. We cover stocks, bonds, commodities, even crypto. all the information you need to excel. And I'm Alexis Christophorus. Bloomberg Surveillance also brings you the analysis behind the headlines. We do that through conversations with the smartest names in economics, finance, investment, and international relations. We do all this live each and every weekday that bring you the best analysis in our daily podcast.

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From the publisher

This week, can Congress delegate its authority over trade and tariffs to the president? The Supreme Court questioned the Trump Administration’s argument that a statute passed by Congress gives the president the power to impose worldwide tariffs. But if the Court disagrees with the administration, who pays - and how much? And, New York City’s mayor-elect Zohran Mamdani vows to make the city more affordable, but business leaders say that it’s more complicated than it seems. Plus, Health and Human Services Secretary RFK Jr. claims doctors are reaping big profits from vaccines, but pediatricians say that’s far from the truth: high costs of running a practice, low reimbursement rates, and misinformation are pushing pediatricians to the brink. Later, why are Americans eating so much protein? President Trump reached a deal with drugmakers Eli Lilly and Novo Nordisk to make GLP-1s more accessible to more of the American population, and protein producers - new and old - could stand to gain.

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