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How the Debt Ceiling Can Affect Healthcare · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Here we go again with the federal debt Ceiling reached Treasury Secretary Janet Yellen has begun using extraordinary measures to pay the government's bills.
• 0:08
  David: The pressure's only gonna continue to increase until Congress passes the debt ceiling vote.
• 0:13
  David: But what does it all mean for healthcare?
• 0:15
  David: Will Medicare pay doctors and hospitals, will seniors go without their prescription drugs?
• 0:19
  David: Will the VA turn away veterans needing care?
• 0:22
  David: Will Medicaid throw millions off of coverage or is it all just a giant vegan nothing.
• 0:28
  David: Welcome to Care Talk America's home for incisive debate about healthcare, business, and policy where we're not subject to any debt ceiling, and everyone gets to be the speaker.
• 0:38
  David: I'm David Williams, president of Health Business Group.
• 0:40
  John: And I'm John Driscoll, the president of Wal of Walgreens Health.
• 0:43
  John: David, what's it up with you in the vegans?
• 0:45
  John: I mean, like, I like my no meat impossible burger every now and then with a little bit of, uh, freedom fries and cheese and like, I, I think it's pretty, pretty attractive and that's a something burger.
• 0:57
  John: And I do think we are at a different.
• 0:59
  John: Moment.
• 0:59
  John: I mean, this debt ceiling thing is a big deal.
• 1:02
  John: You know, we are now up to 31 trillion.
• 1:05
  John: We have historically always raised the debt ceiling.
• 1:08
  John: When the Republicans screwed around with this a few years ago, it actually affect, the first time affected the credit rating of the United States of America.
• 1:16
  John: And it's, and they, they, they, they, uh, they seamlessly pass and up the debt limit if there's a Republican in office.
• 1:25
  John: But I do think we're at a diff, a much more dangerous.
• 1:29
  John: , uh, in terms of the debt limit and with healthcare representing about 25% of the federal budget, um, I think you should be afraid we should be.
• 1:37
  David: I'm afraid, John, uh, not just for the country, but also for the healthcare system, as you say.
• 1:41
  David: I mean, the debt ceiling doesn't even really make sense to have it.
• 1:44
  David: Other countries don't have it.
• 1:45
  David: You borrow the money, you don't say, oh, there's a separate thing called the debt ceiling.
• 1:49
  David: Of course not.
• 1:50
  David: Um, and it's all politics and nonsense.
• 1:52
  David: However, you know, back in 2011 when this really first happened and we, the, the credit was downgraded as you.
• 1:58
  David: I'm not sure people were chasing or, or learned their lessons and we could be in, in for some tough shape.
• 2:03
  David: So let's talk about what would happen.
• 2:05
  David: Chasing health,
• 2:05
  John: chasing big, big boy word, Chas.
• 2:08
  John: Yeah.
• 2:08
  John: I mean, at the end of the day, do you really think that the Republicans have any shame?
• 2:13
  John: I mean, they've put, they, they, they, they've, they've, they've shot down any of the, almost all of the president's and the, and the Democrats desires to increase taxes to better match income and out.
• 2:26
  John: , they've carved out a very fast growing part of the budget, the defense budget at 10%, and they've got a leader who double talk talking.
• 2:34
  John: Kevin McCarthy, who told the, the, the, his fire brand conservatives, that they would cut entitlements while telling the country that he's gonna protect Medicare and Social security.
• 2:45
  John: I mean, how do you square this?
• 2:48
  David: Well, John, they had to, to burn Medicare in order to save it apparently.
• 2:51
  David: Um, so in order to do that though, let's, let's talk about what is some of the provisions, the actual, specific things that might get negotiated.
• 2:57
  John: Well, let's but be, let's, let's, let's talk about that, but, but remember all we're talking about is recognizing that we need to pay the bills we've already incurred.
• 3:05
  John: So the debt ceiling, just to be absolutely clear, the death ceiling, debt limit, whatever you want to call.
• 3:13
  John: Was a fiction that was passed by Republicans to create some budget discipline.
• 3:19
  John: When we know that if you just talk about paying the bills, you've already incurred, America's gonna pay its bills, it has to pay its bills, it has nothing to do with future budget.
• 3:28
  John: It's all about prior spending.
• 3:30
  John: So this, this whole thing is a, is a, is is a cart, is a bad cartoon of fiscal management.
• 3:36
  John: It's not about fiscal management, it's.
• 3:38
  John: Political gamesmanship.
• 3:39
  John: And I I, but I agree with you.
• 3:41
  John: I think it's a little bit scary because we've already blown through the deadline and the White House has said it won't negotiate.
• 3:48
  John: So if the White House won't negotiate and the Republicans are going after stuff, where do you think those cuts might fall, and where do you think those might fall in healthcare?
• 3:58
  David: John.
• 3:58
  David: You know, there's a lot of things that that could be, uh, knocked away.
• 4:01
  David: Uh, but some of them are gonna cost people more money, not just raising the eligibility age, but also if you do things like reveal, uh, repealing some of the out of co out-of-pocket cost limitations, like for things like insulin, yeah, that'll cost the Feds less money.
• 4:13
  David: I don't think people are gonna be happy about it.
• 4:15
  David: , you cut Medicaid.
• 4:16
  David: You know, a lot of people are just not gonna have any health insurance.
• 4:18
  David: That's not gonna do very well for the health of hospitals and physicians too.
• 4:22
  David: There's no easy way, uh, to deal with it, John.
• 4:24
  David: That's the problem.
• 4:25
  David: So, one way or the other, we have to become actually healthier.
• 4:27
  David: As a, as a country, we've gotta be more efficient in how we provide healthcare.
• 4:31
  David: And honestly, people need to get to lower acuity settings like the home.
• 4:35
  David: Like retail, pharmacy, um, and outta the hospital, John, too expensive and to use
• 4:40
  John: drugs.
• 4:41
  John: Finally, finally, you found a way to work.
• 4:43
  John: I love it, John, your job and employers in here, that's No, but it's absolutely right.
• 4:46
  John: It's if we, if we don't reimagine healthcare, it's gonna continue to cost more just because there's, we've got more complex people.
• 4:56
  John: People with complex illness getting older every day.
• 4:59
  John: Just the, the, the way the population falls costs are logically going up.
• 5:03
  John: We continue to have more and more lifesaving but more expensive drug therapies.
• 5:08
  John: I think we also have some opportunity on the specialty drug side, David, but I think the other thing that people in healthcare have to think about, particularly those who weren't around in 97, unlike you and I, is there, you know, the balanced Budget Act of 1997.
• 5:23
  John: It was kind of a layer cake cut all through healthcare, put a lot of, uh, long term anything that was sort of on a, on a thin margin and heavily indebted like nursing homes and assisted living companies into bankruptcy.
• 5:36
  John: It's sharply limited.
• 5:38
  John: Um, what, you know, a lot of the, the margins for managed care and for a lot of the intermediaries, including some of the providers, I just don't know whether that kind of shock to the system is something that healthcare can afford when so many doctors and nurses are burnt out and so many hospitals are already losing more money than they've ever lost before as they adapt to the new normal.
• 6:01
  John: Where with waves of covid, uh, an aging popul, And a, and a and a payer mix that is increasingly more Medicaid focused.
• 6:11
  John: That's the federal program, federal state program that covers the poor.
• 6:14
  John: Um, I, I do think that healthcare cannot, I don't think it'd be fair for the healthcare system to bear the brunt of a shock right now.
• 6:22
  John: And I don't think it'd, I don't think it would be healthy for healthcare.
• 6:25
  John: Uh, even though I agree with you, we could be more efficient.
• 6:28
  John: So even with all of the changes in care to the.
• 6:31
  John: And the growth of new access points and, and monitoring points like, you know, retail settings to support continuity of care and access to care.
• 6:41
  John: I mean, I think, I don't think really now is the time to be sending a shock through the system.
• 6:45
  John: I, I just think it's, it's the, uh, the unhappy accident.
• 6:50
  John: Of Conserv conservative fire brands, um, feeling like they've got some power.
• 6:55
  John: But I, I, I think what what makes me concerned about the debt ceiling is I don't see an easy way out for the speaker.
• 7:01
  John: The Senate will, will pass this easily cuz the Democrats are in, in, uh, in charge.
• 7:07
  John: Uh, and the Republicans are gonna want something for their vote.
• 7:09
  John: And I don't think there's anything easy to give.
• 7:11
  David: So John looking longer term, and I, I agree with you, I don't have a solution on the debt ceiling is, I think, Immigration is a way that we can deal with some of these problems longer term.
• 7:21
  David: You see this happening?
• 7:21
  David: Well,
• 7:22
  John: there's a, there's a popular issue on the Republican side.
• 7:24
  John: Yeah, yeah, yeah, for sure.
• 7:25
  John: To run with that one.
• 7:26
  John: Cause that's been, I mean, no problem.
• 7:28
  John: Since Reagan, we've had a hard time getting the Republicans to actually recognize that as a, uh, as a po immigration, as an essential positive to United States.
• 7:39
  John: But you're absolutely right.
• 7:40
  John: We have, we have one of the, Release valves of a lot of increase in cost and the, and the, and staff burnout would be to allow the, uh, tens of the, of thousands of qualified doctors and nurses who are currently in queue into the country to help relieve the pressure in the system.
• 7:55
  David: Exactly.
• 7:56
  David: John, and I think more broadly for the economy, if you have.
• 7:58
  David: You know, younger, healthy workers, they're coming and contributing, uh, to social security.
• 8:03
  David: They're contributing to Medicare, they're contributing in general.
• 8:06
  David: And if you don't wanna raise taxes, uh, then having a higher birth rate, having more immigration is actually the way to go.
• 8:12
  David: And it's actually one of the things that has made this country a great country, which is that you have people that are here cuz they wanna be here.
• 8:17
  David: You know, you're not seeing immigration into China, uh, even though they might not mind it in terms of, uh, increasing the size
• 8:23
  John: of their population.
• 8:23
  John: Nobody, nobody's running.
• 8:25
  John: Running to get into either China or Russia.
• 8:28
  John: Uh, but I think what you just suggested is that we could make America great again through imi, through immigrate, increasing access to immigration.
• 8:35
  John: And I agree with you.
• 8:37
  David: Yeah.
• 8:37
  David: So I think that's gonna be the least likely way, uh, for the debt ceiling to be raised.
• 8:42
  David: I think that's slightly, is it more, last, final question, John.
• 8:45
  David: Is it more or less likely that we will address the debt ceiling by loosening immigration or by issuing a trove of trillion dollar platinum commemorative coins
• 8:57
  John: in and none of the above?
• 8:59
  John: I, I, I, I think this is an issue.
• 9:00
  John: We're just gonna have to leave there.
• 9:03
  David: All right.
• 9:03
  David: Well, that's it for yet another episode of Care Talk.
• 9:06
  David: I'm David Williams, president of Health Business Group.
• 9:09
  John: And I'm John Driskell, the president of Walgreens Health.
• 9:11
  John: If you like what you heard or you didn't, please subscribe on your.