Latest / CareTalk: Healthcare. Unfiltered. / Why is Healthcare So Expensive in the United States?

Transcript

Why is Healthcare So Expensive in the United States? · CareTalk: Healthcare. Unfiltered.

• 0:00
  - Welcome to Care Talk, America's home for incisive debate about healthcare, business and policy.
• 0:05
  I'm David Williams, president of Health Business Group.
• 0:09
  - And I'm John Driscoll, the CEO of CareCentrix.
• 0:11
  David, big topic time.
• 0:13
  What is our topic of the day?
• 0:15
  - John, our topic is four trillion dollars.
• 0:17
  I mean our topic, John, is why is healthcare so expensive and is there anything that can be done about it?
• 0:23
  That is our topic, John.
• 0:24
  And it is funny, I mentioned the four trillion because the number keeps going up, but I remember for a while, it was two trillion, and then it went to three and then, it's over four trillion, John.
• 0:33
  That's over $12,000 per person in the US as of 2020.
• 0:40
  - Well, and it's worse than that, David, because it's not only expensive, but on a international comparison, we're spending twice as much as other countries of equivalent development.
• 0:54
  Like Norway I think is the closest, but if you look at the average of Western Europe plus Japan, we're spending twice as much, our costs are going up faster, and by the way, not with great outcomes, but just on the cost side, everything is cheaper, and in most of those countries, if not all of them, they've got much better access to healthcare.
• 1:16
  So they've got better access to healthcare that costs less and delivers a better outcome.
• 1:21
  What are we doing wrong here, David?
• 1:23
  - John, I guess the first answer is that we're doing a lot wrong.
• 1:27
  Used to be we had hard time with this conversation, right?
• 1:29
  Because we would say, yeah we spend more but the system's obviously better here.
• 1:33
  And I think what people realize now is that not only do we not get all the extra that we pay for, but we spend twice as much and we only get half as much as a result of it.
• 1:43
  I mean just a real obvious thing is actually that among the OECD countries that we're comparing ourselves with, we actually have the lowest life expectancy of the group of comparable countries.
• 1:54
  And so that alone is a big thing.
• 1:57
  I think John, what I'm gonna suggest today is that we actually go through it kind of one by one and tick off some of those key areas,'cause it's not just one thing, it's a lot of things that add up to four trillion dollars.
• 2:10
  So why don't we start off with prescription drug pricing, John?
• 2:14
  And in particular, I mean what is going on with prescription drug pricing that makes prescription drugs so expensive here?
• 2:22
  - Well, before we go there, David, I think it's worth, in addition to having the lowest life expectancy, if you look at kind of healthy years after 65, we're slightly ahead of Turkey and Mexico and slightly behind Brazil and not even close to those industrialized countries that we would consider our near peers, a Switzerland, a France, Britain.
• 2:48
  Japan's extraordinary, they have the longest life after 65.
• 2:52
  So digging into these individual components is actually pretty critical, digging in and then maybe coming up with some solutions.
• 2:59
  So let's start with prescription drugs, which is a great place to start because we are the source of the vast majority of branded and novel drugs.
• 3:09
  There's prescription drug manufacturers in the rest of the world, but we really are the innovation kings with a lot of great companies.
• 3:17
  There's some great ones in Europe and Japan, but we have the vast majority.
• 3:20
  Unfortunately, we also have the lousiest negotiating ability'cause we prevented the federal government from negotiating drug prices.
• 3:30
  And drug prices are through the roof compared to the rest of the OECD countries and they are rising faster.
• 3:40
  That's true of branded drugs.
• 3:42
  It's true of generic drugs.
• 3:44
  And if you look at novel drugs, when they are created, they're introduced at the highest possible price, in you guessed it, the US of A.
• 3:54
  David, one third of all people with chronic illness who are prescribed drugs, don't take those drugs'cause they can't afford it.
• 4:03
  So we create the drugs that serve the world, we pay the highest prices that our own citizens can't afford.
• 4:11
  - John, the Commonwealth Fund has a few recommendations, five about how to actually resolve this.
• 4:16
  The first one is actually letting the federal government negotiate drug prices, which is one thing that you are just mentioning and is part of the Inflation Reduction Act.
• 4:24
  So we're actually gonna see at least a taste of that.
• 4:27
  There's another piece that has to do with stopping patent abuse and anti-competitive practices, which means that you'd think a patent expires and the drug company might be satisfied, okay, I had it during that term, but there are some ways that they may unfairly try to extend the patent or make a deal with somebody else to keep a generic drug off the market.
• 4:46
  - Well let's pause on that because the patent protection is actually critical to protect our industry, but I think it's the Hatch-Waxman Act that created that.
• 4:56
  Patents are those protections to allow people who create new drugs that solve really big challenges, that have helped transform cancer from a deadly disease to a chronic disease.
• 5:09
  So it's really important to protect those novel formulations.
• 5:12
  And the law lays out that you should get a monopoly on being able to sell that novel drug once it's through the FDA for 14 years.
• 5:21
  Of the 12 most common branded drugs, I think with all of the fake patent litigation that big pharma lards onto their original 14 years, I think the average patented drug has got 38 years of protection.
• 5:38
  The vast majority of patent litigation, that is litigation that's where that's lawsuits generated by big pharma to protect and extend their patents.
• 5:50
  It's not to protect that first 14 year period.
• 5:53
  It's to come up with new ways to slow, delay, defer or deny the ability for competition to come in and bring those prices down.
• 6:02
  So in addition to paying the highest prices, we've allowed big pharma, and this is by the way, something that's been identified by democratic and Republican administrations, to manipulate the patent system and the litigation system around it to either extend patents for drugs that have already gotten protection, you go from an eight hour formulation to a four hour formulation of the same drug and it's considered a new patent protection or you just delay or deny or make it harder for competitors to come in by putting up a litigation wall.
• 6:36
  I think, David, this is a huge opportunity just to get big pharma to play by the rules of the game for us to, could be a focus of reform that could actually create more competition and bring down drug prices for the average, for people like you and me.
• 6:52
  - John, you were talking before about short life spans but I guess that doesn't apply to the patent side of it.
• 6:59
  Those seem to have done pretty well.
• 6:59
  You know, there's some other elements there.
• 7:01
  So the generic drugs have been successful when they get in the market in terms of reducing costs and a similar approach has been taken for so-called biosimilars, which is kind of like a generic drug for a large molecule drug, but actually, it's not exactly the same because those drugs are much more complicated, you don't have the same degree of price reduction.
• 7:23
  And I think that's actually have been a bit of a mistake to rely too much on the biosimilar market.
• 7:28
  And I think frankly, if you take a look at all the different suggestions they're making and you compare what we're doing with what's happening in other countries, could just bring the hammer down with drug price regulation and actually threaten not to cover certain drugs unless the cost comes into line.
• 7:46
  It's unclear whether we've been willing to deal with that as a country, but the answer's pretty obvious since it's everywhere else in the world.
• 7:51
  - Well, I think if you look at the fact that, I think that that branded drugs are the vast minority and by the way, let's break this into pieces so folks can track it, a branded drug that's a novel compound comes out with a brand name.
• 8:09
  And once it loses its patent protection, competitors come in.
• 8:13
  And when we're talking about those stable chemical compounds, like your typical pills and capsules, those new drugs are called generics and they have, typically, 80 to 90% cheaper than those original branded drugs.
• 8:26
  But branded drugs, even though they're the minority of the drugs prescribed today'cause generics have been very successful, they're still the vast majority of the dollars spent on prescriptions.
• 8:37
  And prices are going up unreasonably everywhere, but without that competition, to your point, allowing generic, same compound basically, but a no name or a new name versus the original name can dramatically reduce the cost.
• 8:54
  And it's happened around the world.
• 8:57
  And biosimilars are those, not unstable chemical compounds but those large molecule drugs, which often are biologics, they've got some live things to them, they have to often be infused, they're those biotech drugs that are really, again, quite transformative, but just as in the stable pills and capsules world, big pharma has prevented competition from new manufacturers that could create generics, same drug under a new name, in the biotech area, the biotech drugs, the opportunities to create biosimilars, create an almost identical, if not identical, near peer drug at a lower price, and again, big pharma has made it very hard through all kinds of restrictive, competitive behaviors, limited distribution, access to manufacturing, and again, litigation, nuisance litigation has prevented biosimilars from emerging.
• 9:57
  And I will note that as you sort of alluded to, David, in places like Europe and Korea, the biosimilar markets are actually thriving.
• 10:05
  So there are more biosimilars coming out, biotech drug prices, branded drug prices are coming down.
• 10:13
  Unless we tame this anti-competitive beast, I think it's gonna be really hard for people to invest in biosimilars and create that kind of fair market for drugs and drug pricing that exists in other parts of the world.
• 10:28
  - John, I know it can be kind of addictive to talk about drugs, but I think we should move on and have some other topics as well.
• 10:34
  You know, as important as drugs are, hospital costs are largely, it's often the largest component of the healthcare budget.
• 10:42
  And I think the hospital bill is something, when you get that in the mail, that's like the worst thing to get'cause you know it's gonna be a very big number, if not lots of pages.
• 10:52
  So I think the real question is why are hospitals so expensive?
• 10:57
  - Well I don't think, since I did too much of the talking about drugs, I'll turn it back at you.
• 11:05
  Two questions, why are hospitals so expensive and why does the price of care in a hospital, inpatient care in a local hospital or a national hospital, why does it go up?
• 11:17
  Why does it go up so much every year in price?
• 11:20
  - Well John, the reason it's so expensive in the first place is 'cause you talk about a hospital level of care, and that is by definition, something that has to be done in a place that has very ample facilities, a lot of technology, a lot of staff, a lot of physical requirements for sterilization and so on.
• 11:37
  So it's just expensive.
• 11:38
  So if you're doing something that could be done in the office or in the home, then you're probably just spending a lot more money to do it in the hospital, so that's part of the problem.
• 11:47
  Now, why does it go up so much every year?
• 11:50
  Well, a big reason for that actually is back to your issue of competition or lack thereof.
• 11:55
  And so what's happened is the hospitals have consolidated.
• 11:58
  And so it used to be, used to be various hospitals in a city.
• 12:02
  Now they become health systems and there are fewer of them.
• 12:05
  What happens there is that they then negotiate with the insurance companies.
• 12:10
  And what they do is they basically threaten, hey, you better be, if you want me to be in your network, you're gonna have to pay me a good rate'cause if you don't and I'm out of network, then I can charge you a really super high rate.
• 12:22
  So it's interesting there that that has been the strategy-- I mean, just to give you a sense, I mean that that out of network rate can be five times or more what an in-network rate is.
• 12:33
  So the threat of going out of network is a big deal.
• 12:38
  - That's right.
• 12:39
  And so interestingly, one suggestion for kind of a low touch reform of hospital pricing is to actually put a cap on the out-of-network price.
• 12:49
  So instead of it could be five times, it could some type places be even higher than that.
• 12:53
  You could just say, well just allow it to be two times maximum.
• 12:56
  So that kinda stick, threat is not as strong.
• 13:01
  There's another thing too I saw.
• 13:02
  There's some novel things now that people really care about costs.
• 13:06
  So one thing that's happened is that hospitals are supposed to provide information, so they call it price transparency, to say what are the costs that you actually have?
• 13:16
  That's not even relevant to many people, but hospitals have been very reluctant to put that information forward.
• 13:21
  I noticed in Colorado, they've got a new law that prohibits hospitals that are not complying from collecting debts.
• 13:30
  So instead of a thousand dollar a day fine, which is peanuts or less, this could actually be very serious.
• 13:36
  I want to mention one other thing, John.
• 13:38
  Even though I mentioned all the technology and the facilities of a hospital, the number one expense of a hospital is actually people.
• 13:45
  And the number one people expense is actually nurses, physicians aren't always working for the hospital.
• 13:50
  So there's a lot of nurses who work in hospitals and they have difficult job and they're well trained, but I'll point out that the compensation is also high.
• 13:59
  The median income is at least $75,000 annually.
• 14:03
  So if you have lots of nurses in the hospital, then the costs are gonna be high because of that.
• 14:09
  - You know, the one thing I'd add, David, is I do think that the hospital's mission in the United States is a complex one.
• 14:17
  And I don't think we've ever figured out how to fund it appropriately.
• 14:20
  We don't have a big public health system, which a lot of other other countries actually invest and support their public health system, the system that takes care of the poorest of the poor.
• 14:29
  We support federally qualified health centers, but hospitals are really the last mile for taking care of our poorest and our sickest and I don't think we've ever really thought about that.
• 14:39
  There's a little bit of a, there's some ways which the Federalist government slightly supports that, but that is another reason why healthcare costs go up because we're not taking care of many of poor folks, or folks who are new immigrants or folks who have had bad coverage.
• 14:58
  And we don't, that ends up being, those costs end up being born by everyone else.
• 15:03
  The other thing that I think that, because we aren't really as clear about those hospitals as really being our public health system.
• 15:11
  The second thing I would say that I think drives costs up is we also put on the responsibility of teaching and research on these hospitals.
• 15:20
  And again, I don't think we've really got a strategy there as a country, we've sort of happened into it.
• 15:25
  And without kind of looking at the total cost of what a hospital needs to do in order to take care of a community and support research, I don't think we're ever gonna get the value proposition, right?
• 15:36
  There's certainly, and obviously we've really focused on this at CareCentrix, a lot of things you can do at the home, a lot of things you can do in an ambulatory care setting, and changing the setting of care is probably gonna be the most powerful thing in terms of bringing down appropriately, changing the setting of care to a less intense, less residential model, that's what CareCentrix is really focused on, is probably your biggest tool.
• 16:00
  And call me on your issue of transparency of making the prices that a hospital has negotiated transparent, I'm not sure that's gonna work at all.
• 16:11
  I think Colorado came up with a clever solution, and certainly, hospitals collecting debts from poor people was one of the pain points of the system.
• 16:20
  I think healthcare costs are still one of the leading causes of personal bankruptcy in the United States, which is just, it's crazy as a country that we tolerate that.
• 16:30
  But I don't know that we've really figured out how to fund hospitals correctly, but I'm pretty certain that you are dead wrong in thinking that transparency is gonna lead to anything other than higher prices.
• 16:41
  You've got consolidated hospital systems that are oligopolies or monopolies in their system.
• 16:45
  We actually have a lot of rural hospitals that are really public health, doing public health mission, they can't afford to keep their doors open.
• 16:53
  You've got labor costs going through the roof.
• 16:56
  We have a limited supply of doctors and nurses and we're not increasing the supply fast enough, but I think that all, making those prices transparent or, I will say the hospitals are kicking and screaming.
• 17:08
  I think less than 10% of the hospitals currently are fully compliant with the law, but I'm not sure that making all of those prices more transparent is gonna get you what you want, David.
• 17:18
  I think it's gonna just drive costs up.
• 17:22
  - John, some interesting points on the hospital side.
• 17:25
  And I think to the extent, we really don't have a healthcare system, and the hospital is a place of first resort or, it should be last resort, and it's often first resort, go to the emergency room.
• 17:35
  It's interesting, let's talk about physicians in a minute, but one of the things that people say is, well people end up in the emergency room, they end up in the hospital because they don't have access to their physician office.
• 17:45
  That may be true, but it's also the case that we sort of advertise hospitals with certain brand names and that's where all the best equipment is and the best doctors and all that.
• 17:52
  And so people may think, hey, I'll go to the hospital, I don't have to have an appointment, and I can just get in there.
• 17:58
  So let's talk about how that relates to primary care and physicians here.
• 18:01
  So the physician component is obviously pretty big.
• 18:04
  I know some people talk about the average doctor's salary in the US, which is about $316,000 a year, which is a lot higher than the next one, which is Germany at 183,000, and then the UK.
• 18:17
  So we've got, part of what we have in terms of the cost is because we pay people more, we pay physicians more.
• 18:25
  We also tend to pay specialists pretty well.
• 18:27
  So the specialists make more like 370,000 a year compared to 250,000 in primary care.
• 18:34
  And there are a lot of specialists around.
• 18:39
  The primary care system in the US is pretty weak.
• 18:42
  You look at sort of like spend the most and get the least-- Well let's unpack that a little bit.
• 18:46
  If you're telling me the healthcare costs are high in the United States, well duh.
• 18:52
  Everything is more expensive here, David, and I mean absolutely everything.
• 18:57
  If you wanted to create a system with the highest prices in the world, you have it in the US.
• 19:01
  But one of the challenges in the US, we have roughly 70% of the doctors are specialists, to your point, they get paid a lot more, and 30% are primary care doctors.
• 19:11
  In the rest of the world, or the industrialized world it's roughly the opposite, where the vast majority of doctors are actually internists, primary care doctors, and the minority are specialists.
• 19:24
  And specialists, I remember the old joke is the generalist knows everything and does nothing and the specialist knows one thing and does it repeatedly, knows nothing and does everything.
• 19:39
  We have set ourselves up for too much specialist care and not enough chronic care management, just because the supply demand dynamics.
• 19:46
  And then we pay specialists a lot more, so not surprisingly more specialists get created.
• 19:52
  - John, one of the things that was interesting in terms of the contrast on the physician side, among the leading countries, people in the US are least likely to have a regular physician or place of care.
• 20:05
  In the US, about 43% of people say they have a longstanding relationship with their doctor, 71% in Germany so that's a big factor.
• 20:13
  And then getting back to your point about kinda access to home visits.
• 20:16
  So physicians making home visits, only about 37% in the US have access to that.
• 20:23
  And everywhere else, it's 70% or more.
• 20:26
  After hours care, it's 45% in the US versus 80 to 95% elsewhere.
• 20:30
  So it's just, there's just much better service elsewhere and the physicians are, I guess they're specializing and getting a salary, and I know a lot of 'em are working hard, but the service is lousy for the user.
• 20:43
  - Maybe do you know how to spell Amazon?
• 20:46
  I think we've got a lot of new models out there, David, that are gonna force people to flip the script on service.
• 20:52
  But I think until we get this balance of primary care and specialist care right, we're aiming for trouble.
• 21:01
  - So John, sometimes people talk about third party payments, they have multiple systems, they create waste, high administrative costs.
• 21:09
  You've got healthcare administration salaries that are high so you've got a lot of people paid to kind of push paper around, and then people are not conscious of the costs because they're not paying the bill'cause the insurance is paying it.
• 21:23
  And that's in contrast to what we hear about price transparency, shopping, in other parts of the world.
• 21:28
  So the same customer that goes to Walmart or Kohl's or Walgreens, when it comes to shopping for healthcare, they don't do it, and as a result, the costs are higher.
• 21:36
  Do you buy that argument?
• 21:38
  - I think it's really hard to shop for healthcare.
• 21:42
  You're approaching, every patient and patient family is approaching healthcare from a position of fear and vulnerability.
• 21:49
  That's not when you go through your Priceline list or Kayak or pick your bookings.com example where you're picking a planet ticket.
• 22:03
  I think it's really hard.
• 22:04
  I think it would help incrementally, but I think the notion that shopping is our savior is foolish.
• 22:11
  - You know, I agree with you, John.
• 22:12
  It's interesting.
• 22:13
  We've been talking a lot about the international comparisons here and I think it comes out.
• 22:17
  If you think about it just in the US context, you say, hey, compare the same person who goes to Walmart, how come they can't let'em shop for healthcare?
• 22:23
  But you look at all these lower cost systems around the world.
• 22:26
  Well guess what?
• 22:27
  Usually the government's paying everything.
• 22:28
  So the third party element is even greater there.
• 22:32
  So I think it's not necessarily the case about being a shopper.
• 22:37
  Now John, to be fair to the healthcare system, you got a lot of sick people to take care of.
• 22:42
  You got a lot of obese people, you got a lot of drug addicts, and you have a lot of people that are suffering from despair with the highest suicide rate.
• 22:51
  - Well, let's start with the fact, David, that we have the highest obesity rates of any industrialized country, and obesity or metabolic, 40% of all Americans qualify as obese, medically qualify as obese and that's just an unbelievable burden on the system.
• 23:07
  We have the highest number of people with multiple chronic conditions over the age of 65, chronic conditions like heart disease and asthma, diabetes.
• 23:19
  And then separately, you add on the fact that diseases of despair, alcoholism, death by alcoholism, suicide, drug overdoses have been increasing.
• 23:33
  And then it actually, you can see the declining lifespan of Americans in certain categories.
• 23:38
  We've got to get our arms around the psychosocial aspect of what's going wrong in America and the obesity epidemic or I think independent of anything you do on the cost side, we're just gonna still have more units, and frankly, more misery, which we have tools to address.
• 23:55
  We know how to solve and address serious mental illness.
• 23:57
  We know how to address most forms of addiction.
• 24:00
  We got to get our arms around it and make sure that people who need that support of care get it.
• 24:09
  - John, let's talk a little bit about medical malpractice and defensive medicine.
• 24:14
  It's a topic that we used to hear a lot about and it was often blamed for why costs are so high in the US, but I would argue, John, I'll see if you want to disagree with me that it's actually not really a factor.
• 24:25
  At most, it's probably three percent of costs.
• 24:28
  - It's a joke.
• 24:29
  I mean if you, medical malpractice premiums are going down.
• 24:33
  It's the only thing in healthcare that I've found where prices are going down is medical malpractice premiums, which is sort of crazy when you think about how much noise the right wing crazies used to make this.
• 24:44
  There's definitely more defensive medicine practiced here than in the rest of the world.
• 24:49
  I think that's also tied to the incentives where the more you do, the more you get paid.
• 24:56
  I don't think that's really tied to medical law.
• 24:59
  You can find certain cut subcategories, high risk OBs in certain jurisdictions where it's a little bit more dangerous.
• 25:07
  So it's not like the problem doesn't exist in a small way, but the notion that this is driving healthcare costs is nonsense.
• 25:14
  and we're seeing it in medical malpractice premiums going down.
• 25:17
  Those are the premiums paid by doctors to insure, to protect them against a litigation.
• 25:23
  - John, I frame the issue here that we are gonna talk about, why are healthcare costs so high in the US?
• 25:28
  But also, what can be done about it?
• 25:31
  And I want to ask, what is being done about healthcare costs and what should be done?
• 25:37
  - Well, I think you've got two different vectors.
• 25:39
  You've got public sector where the Inflation Reduction Act, which is much better than Build Back Better'cause it tells you exactly what it's supposed to be doing, has some components in there where we can direct, we actually extend and expand consistent coverage for people, that's always associated with lower costs, and we've started to just skim the edges of starting to allow the federal government to negotiate drug costs.
• 26:01
  So there are definitely some public sector solutions we should be looking at, but I also think you should be looking at where the private sector can play a role.
• 26:08
  Things like CareCentrix where we can get more care to the home.
• 26:12
  And frankly, a lot of other aspects of the healthcare sys, of our system, where if we were just to make sure that no kid was hungry, we'd increase the number of kids at school and we'd lower the rate of diabetes.
• 26:30
  Certain things like hunger, which is another area, the social determinants of health, that if we were to address just hunger, David, it would have a dramatic impact on chronic disease, particularly for poor people.
• 26:41
  And half of all the babies in America are born to Medicaid poor families.
• 26:45
  So I think it's that three part, we have to have better government solutions, we have to have smarter private sector alternatives, and we got to deal with some of these social determinate issues in order to really crack the code on not just bending the curve, but breaking the curve that seems to only go up in healthcare costs.
• 27:05
  - I mean, there is such a high cost of care that we really have to figure out how to reduce healthcare costs.
• 27:10
  I don't think it's a matter of just being able to talk about things like healthcare, price transparency, you know, it has to become much more explicit.
• 27:18
  I do think the Inflation Reduction Act is taking a good step and more than we would've expected, John, even a couple months ago, in terms of drug price negotiation, also specifically limiting insulin costs at least for Medicare beneficiaries to about $35 per month.
• 27:31
  - It's a big deal.
• 27:33
  It's a very big deal.
• 27:35
  And so much for sleepy Joe.
• 27:37
  Turns out he was just waiting for the opportunity to pounce to get three good bills passed.
• 27:42
  They're all really powerful, all good for America and I think from a healthcare perspective, good for the healthcare system and good for the health of the country.
• 27:50
  - It's like a stealthy catch on.
• 27:51
  So I want to ask a question I asked before.
• 27:53
  It's usually predictable response so we'll see this time.
• 27:57
  Are you optimistic about the future in terms of whether we're gonna be able to reduce healthcare costs?
• 28:03
  And not gonna have to ask the question again of why is healthcare so expensive in this country?
• 28:08
  - Well, you're always gonna have to ask the question, otherwise we'd be out of a job, David, but I think, no, I am optimistic and I'm optimistic for two reasons.
• 28:15
  One, I think we're getting at some of the root causes, and it's not just, they're not just in the healthcare system.
• 28:20
  And just last week, we had real progress, which was really exciting with insulin to your point and negotiating drug prices.
• 28:26
  Those are two very big things.
• 28:29
  And secondly, we have to solve this problem, it's a tax on every American.
• 28:34
  Almost 20% of GDP goes towards healthcare costs and that's unsustainable in a country where 10,000 people become Medicare eligible every day.
• 28:42
  I think you're gonna see it show up in core inflation, and I think as a country, we're gonna get our act together and focus on this.
• 28:50
  We are good at solving problems when we focus on them.
• 28:54
  What say you?
• 28:55
  - John, I gotta be a little bit optimistic here too, because you know, if something can't continue forever, it's gonna have to stop.
• 29:00
  And we're gonna have to stop with these huge increases in healthcare costs 'cause they're just too high.
• 29:07
  I think some of the government activities make sense and I think they're gonna need to do something in terms of addressing the lack of competition in the provider market in particular.
• 29:19
  Now, there's a lot of talk about big players like Amazon, Walgreens, Walmart getting into primary care.
• 29:25
  Those are big players by themselves, but those are national players and they have the opportunity perhaps to break up some of these local monopolies in a way that the feds may struggle to and the local authorities wouldn't do.
• 29:39
  So that is actually my source of optimism.
• 29:42
  Plus, since I know you're working on this problem, that makes me optimistic as well.
• 29:46
  So that's it for yet another edition of Care Talk.
• 29:49
  But today, John, we've been talking about the big stuff.
• 29:52
  You know, why is healthcare so expensive in the United States and what can be done about it?
• 29:57
  I'm David Williams, president of Health Business Group.
• 29:59
  - And I'm John Driscoll, the CEO of CareCentrix.
• 30:02
  If you like what you heard or you didn't, please subscribe on your favorite service.
• 30:05
  (upbeat music)