August 2, 2024 • 49 mins
On this episode of The Middle we're asking you: What can be done to bring down the cost of healthcare in America? We're joined by billionaire businessman Mark Cuban, owner of Cost Plus Drugs, and former Kansas Governor and Health and Human Services Secretary Kathleen Sebelius. The Middle's house DJ Tolliver joins as well, plus callers from around the country. #healthcare #pharma #prescriptiondrugs #universalhealthcare #singlepayer #insulin
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Episode Transcript
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Speaker 1 (00:00):
The Middle is supported by Journalism Funding Partners, a nonprofit
organization striving to increase the sustainability of local journalism by
building connections between donors and news organizations. More information on
how you can support the Middle at Listen tooth middle
dot com. Welcome to the Middle. I'm Jeremy Hobson along
(00:21):
with our house DJ Tolliver and Tolliver. I have to say, wow,
this week, we have not had an assassination attempt on
a candidate. We haven't had a candidate drop out of
the race. We actually got to do the show that
we were planning to do this week.
Speaker 2 (00:33):
While that never happens, miracles do happen. Man, look at that.
Speaker 1 (00:36):
I guess so.
Speaker 3 (00:36):
Well.
Speaker 1 (00:37):
We're talking about healthcare this hour, and more specifically how
expensive it is in this country and what can be
done about it. Is something almost everyone has experienced at
one point or another.
Speaker 4 (00:46):
Yeah.
Speaker 2 (00:46):
No, literally, I was just an urgent care on Tuesday
for a stomach thing. It was four hundred dollars, just
a walk in the door. Ooh jeez, buy me a
drink first, come on.
Speaker 1 (00:54):
Well, four hundred dollars is a lot for one person,
and when you look at the overall federal budget. The
biggest item is healthcare, which adds up to almost two
trillion dollars a year for the country. That's Medicare for seniors,
Medicaid for low income people, children's health insurance, and more. Now,
the good news is that since the Affordable Care Act
was implemented ten years ago, about ninety three percent of
Americans now have some form of health insurance. But there's
(01:16):
still a lot to be done when it comes to
bringing costs down. So that's what we'll be talking about
with two fantastic guests in a moment. But first, last week,
we asked you for your thoughts on President Biden's exit
from the presidential race and Kamala Harris's entrance. Here are
some of the voicemails we got after the show.
Speaker 3 (01:34):
My name is sam I'm from Milwaukee, Wisconsin.
Speaker 5 (01:37):
This is Mia calling from Denver, Colorado.
Speaker 6 (01:40):
HI.
Speaker 7 (01:40):
This is Chris not from Texas.
Speaker 6 (01:42):
HI.
Speaker 8 (01:43):
This is Samantha Calvin calling from Saint Louis, Missouri. Kamala
Harris has the experience to be the next president of
the United States.
Speaker 9 (01:51):
She has my vote.
Speaker 3 (01:52):
In twenty sixteen, I voted for Trump. In twenty twenty,
I voted for Biden. Before Kamala Harris decided to Ron,
I was planning to vote against Trump. Now I feel
enthusiastic enough to vote for Kamila Harris.
Speaker 10 (02:08):
I am happier to see Joe Biden step down.
Speaker 5 (02:13):
But as a former Democrat now for Middle.
Speaker 11 (02:16):
I am not completely sold on Kamala Harris.
Speaker 7 (02:20):
I mean, to me, we already did elect her when
we elected her back in twenty twenty, when she was
on the ticket with Biden. I mean, we all kind
of knew that there was a possibility this is going
to happen with Joe Biden's age, whether by natural circumstances
are pressure from the party.
Speaker 1 (02:34):
Well, thanks to everyone who called in. So now to
our topic this hour, healthcare. Why is our healthcare so expensive?
And what do you want the next president to do
about it? Tolliver, what is the number of people to
call in?
Speaker 2 (02:44):
It's eight four four four Middle, that's eight four four
four six four three three five three, or you can
write to us that listen to the Middle dot com.
Speaker 1 (02:51):
So let's meet our panel. You'll recognize businessman and entrepreneur
Mark Cuban as the part owner of the Dallas Mavericks
as well as a judge on ABC's Shark Tank, but
he's also the founder of cost Plus Drugs, a low
cost online pharmacy Mark Cuban, So great to have you
in the middle.
Speaker 12 (03:05):
Thanks for having me.
Speaker 1 (03:06):
Jereby and former Governor of Kansas, Kathleen Sibelius joins us
as well. She served as Secretary of Health and Human
Services in the Obama administration and helped roll out the
Affordable Care Act, also known as Obamacare. Secretary of Sibilius.
Great to have you on the show as well.
Speaker 9 (03:21):
Thanks, good to be with you.
Speaker 1 (03:23):
Well, before we get to the phones's, Mark Cuban, we
should explain why you're here. In your connection to the
world of tustcare. You started a company called cost Plus
Drugs two years ago to offer generic drugs to try
to cut out the middleman called a pharmacy benefit manager.
Why focus on that part of the healthcare industry.
Speaker 12 (03:41):
Because there's no transparency.
Speaker 13 (03:42):
So, you know, when we looked at the healthcare industry
and you try to figure out why are there so
many issues? You know, think about what happens when you
go to the doctor. You know, you're told you need
a prescription, and the first thing they say is what
pharmacy do you use. There's no discussion of cost, there's
no discussion of affordability. It's just the presumption that you
can afford it. And we've all heard stories or seen
(04:04):
it in action or experienced it ourselves where we're standing
at the pharmacy counter kind of terrified because we have
a high deductible plan or we have no insurance, and
we have no idea what our cost is going to be.
So we create a cost plus drugs dot Com with
a very simple premise. If you go to the website
costplus drugs dot Com and put in the name of
the medication, and we carry about twenty two hundred different
(04:27):
skews different medications, including some brands. Now, if you put
in the name of it, we'll show you our cost,
and then we'll also show you our markup, which is
fifteen percent. We'll show you how much it cost to
ship since we're mail order, and we'll show you what
we pay the pharmacy as a fee for them to
review everything. That's the first time anybody has ever been
(04:48):
completely transparent about the cost of any sale of any
medication to a patient.
Speaker 1 (04:54):
And just are you are you already seeing sorry to interrupt.
Are you already seeing impacts for patient on how much
they're paying? Have the cost come down?
Speaker 12 (05:02):
Oh yeah?
Speaker 13 (05:03):
I mean if you looked at the FTC report that
just came out on PBMs, the costs that they use
to make the point that the PBMs were ripping people
off were our prices. And so I can tell you,
you know, I had a friend who needed a drug
called droxadopo and he emailed me in a terror because
he was switching insurances and they were going to charge
(05:24):
him thirty thousand dollars every three months. I was like,
land in, let me check and see what our price is.
Sixty dollars a month, So one hundred and eighty dollars
for those three months. And I'm you know, im mattine
for chemotherapy. You know where if you walk into a
CVS right now and don't have insurance or a high deductible,
they may charge you two thousand or more dollars, and
(05:45):
depending on the strength, you might get it for anywhere
from twenty dollars to sixty dollars per month from US.
So the savings have been extraordinary and that's led to
us having, you know, filled millions of prescriptions.
Speaker 1 (05:56):
So let's talk about this the bigger issue though, of
the healthcare system in the US right now. Kathleen Sibelius,
as we as we said, you rolled out Obamacare about
ten years ago it launched. It's brought the percentage of
uninsured Americans down from about sixteen percent back then to
about seven percent now. But how do you view the
healthcare system overall right now in the US.
Speaker 14 (06:19):
Well, Jeremy, I I'll answer that question, but I'd also
like to answer what Mark is talking about, because he's
talking about a piece of the system, and it's probably
the least available, least transparent, most annoying part of the system,
and most costly at this point because drug companies frankly
(06:41):
can charge anything they want, anything they want. We have
no pricing structure in the United States. We have no
pricing mechanism up until the Inflation Reduction.
Speaker 9 (06:52):
Act was passed.
Speaker 14 (06:53):
But we don't have a healthcare system.
Speaker 9 (06:56):
We've got pieces of a puzzle.
Speaker 14 (06:58):
And for some people they get great care a lot
of the time. For most people they get sort of
hit and miscare. You've got to get to the right
doctor at the right time and the right system and
have the ability to pay for whatever it is they're recommending.
That's not a great system and it leaves way too
many people falling in the crack. So, yes, more people
(07:20):
are insured today, and that's a big step forward. At
least they have the ability to enter the system, because
before that, a lot of folks just you know, they
wouldn't get a mammogram because they couldn't afford some kind
of follow up surgery if they had breast cancer, so
they just skipped the whole system altogether. So giving people
access is really what insurance is all about, and helping
(07:43):
people pay some of their bills. But we still have
a very disjointed, very complicated system, and most people cannot
negotiate it well.
Speaker 1 (07:54):
And Mark Cuban, I remember as we covered you know,
Obamacare and talked about the health care system over many years,
a lot of your probably billionaire friends or at least
billionaire colleagues would say, well, the reason we spend so
much more than every other country on health insurance on
healthcare in this country is that we're investing in all
the R and D we get better care, etc. What
(08:16):
do you think, as a member of the private sector,
is that true? How do you view the healthcare system
overall in the US.
Speaker 12 (08:22):
So two things. My friends are the same friends I
had in high school, grade school, college.
Speaker 13 (08:26):
I don't hang around with rich people, right, those are
my boys, Those are my guys too. In terms of
you know your point, there is some truth to it, right,
There is a significant investment that's needed, particularly as we
get into the gene and cell therapies that are truly expensive.
But and this is somewhat to the Secretary's.
Speaker 12 (08:44):
Point, there is so much the.
Speaker 13 (08:47):
Whole system is an arbitrage where whether it's the pharmacy
SIBE or the medical SIBE, everybody's trying to extract something
somewhere and to try to gain the system, and they're
able to should do it, because whether you walk into
a hospital and you have no idea what the price is,
and if you have insurance the company that if your
(09:09):
employer's self insurance, they have no idea what they're going
to pay.
Speaker 12 (09:13):
If it's in work network versus out of network, it's
a different price.
Speaker 6 (09:16):
You know.
Speaker 13 (09:16):
There's just so many ways that everybody skims off the system.
Speaker 12 (09:20):
And so.
Speaker 13 (09:22):
And I go back to this all the time. The
problem is a lack of transparency because nobody knows what
to expect. The first line in every contract, whether it's
from an insurance company, a pharmacy benefit manager, even a
hospital provider, is that you're not allowed to say anything.
It's like fight club. The number one rule of healthcare
(09:43):
contracts is you can't say anything about health care contracts,
and that creates the underpinning for people to skim off
the top, the bottom in the middle.
Speaker 14 (09:52):
Okay, if I can jump in Jeremy just for a second,
because I think it's both a lack of transparency.
Speaker 9 (09:58):
I would agree with that whole heart.
Speaker 14 (10:00):
But also the notion there are lots of I say,
free market folks on the healthcare side that just say,
you know, let people will give you a chunk of
change and you go out and negotiate.
Speaker 9 (10:12):
For your health care.
Speaker 14 (10:15):
That absolutely doesn't work in the system that we have
because people have no leverage at all. To Mark's point,
a hospital down the street from me charges six different
rates depending on who the contractor is. If you've got
a big employer with a lot of patients and you're
going to send them their way, they get one price.
(10:35):
If you're an individual with no insurance, you get a
very different same bed, same hospital, same street, same doctors,
very different price. So the notion that people we don't
have a market transparency, but we also don't have an
ability for consumers to negotiate. Even if it was transparent,
they don't have any leverage.
Speaker 9 (10:56):
Well, you know, somewhat different things like Mark.
Speaker 14 (10:59):
I mean, I'm congratulating your program because you're going to
give them an ability to choose, but most people don't
have that.
Speaker 12 (11:06):
You know.
Speaker 13 (11:06):
The crazy part is that if you just walk in
with a credit cardd into the hospital will pay less
than the biggest compent.
Speaker 1 (11:14):
Wow, that's interesting, Cann Tolliver. You know, lawmakers have taken
a lot of swings over the years at our healthcare
system and trying to get more people covered.
Speaker 2 (11:23):
Yeah, and with like very different approaches. This is the
clip is from nineteen seventy one when Richard Nixon proposed
requiring employers to cover full time employees.
Speaker 4 (11:31):
I am proposing today a new national health strategy. It
helps more people pay for care, but it also expands
the supply of health services and makes them more efficient.
It emphasizes keeping people well, not just making people well.
The purpose of this program is simply this. I want
(11:53):
America to have the finest health care in the world,
and I want every American to be able to have
that care when he needs it.
Speaker 1 (12:02):
Interesting, also interesting, Tolliver, that he says when he needs it,
which is something that I guess you could say back
in the seventies, but now you would probably have to
recognize that there are not just men in this country.
So anyway, we will be back with more of the middle.
This is the Middle. I'm Jeremy Hobson. If you're just tuning,
(12:23):
in the Middle is a national call in show. We're
focused on elevating voices from the middle geographically, politically, and philosophically,
or maybe you just want to meet in the middle.
This hour, we're asking you why is our healthcare so expensive?
And what do you want the next president to do
about it? Tulliver, what's the number to call in?
Speaker 2 (12:38):
It's eight four four four Middle. That's eight four four
four six four three three five three. You can also
write to us a Listen to the Middle dot com
or on social media.
Speaker 1 (12:46):
I'm joined by a businessman and founder of cost Plus Drugs,
Mark Cuban, and former Health and Human Services Secretary Kathleen Sibilius.
And let's get to the phones. And Bob who is
in Pittsburgh. Bob, welcome to the middle go ahead.
Speaker 15 (12:58):
All right, thanks for having me on. I find this
very interesting. I'm a healthcare worker and I've seen this
from that point of view, and the system itself has failed.
For profit healthcare system has failed. It's very difficult for
people to hear, but it's true. Where we're experiencing is hypernormalization.
(13:19):
It's where the those who make a lot of money
off of it they needed to keep going. And then
basically we're in this political situation where nobody can see
a solution because the solution is running healthcare as a
public service, like the fire department, not like a business.
But the people in charge of it are trained to
(13:41):
run it like a business. We have the most expensive
healthcare system, but not the best results.
Speaker 1 (13:46):
So what do you suggest, Bob? Are you are you?
Are you saying there should be like a universal healthcare,
single payer situation?
Speaker 15 (13:53):
Yes, universal healthcare, universal health care. The Australians have a
very good system. It might work better for us. It's
very similar to to what Americans might like. You get
a basic plan, you get it covered, but then you
can or you can you can pay for prior advent
insurance if you want to jump lines for various procedures.
But this system simply isn't working.
Speaker 1 (14:15):
Yeah, let me take that to our guests, said Mark Cuban.
They can't see you, but I can, and you were
shaking your head. So your your thoughts on that idea.
Speaker 13 (14:23):
Because if you don't know, if the government doesn't know
what it's going to pay, then the people who control
healthcare can charge whatever they want. And again, you've got
to be able to demonstrate that the pricing is real.
Speaker 12 (14:38):
And right now, because of rebates, because of in network,
out of network, all.
Speaker 13 (14:43):
These different issues, nobody knows the real price of healthcare.
Speaker 1 (14:47):
Kathin Sibilius, what about What do you think about that?
I remember during the Obamacare debates that went on, a
lot of people were talking about a public option and
it never happened.
Speaker 14 (14:57):
Well, I'm sorry it didn't happen. I still remember the
day that that Joe Lieberman went on Meet the Press
and announced to Tim Russert he was not going to
vote for a public option, which was came as a
real surprise to all of us, and he was the
sixtieth vote, so it went out the window. The public
option was just really saying the government will compete with
private plans. It's what goes on right now in Medicare,
(15:19):
with Medicare advantage and Medicare Fee for service in the
running side by side with the same benefits, and private
plans can compete with the government vice versa. That's what
a public option would do, and it's really tragic that
we don't have that because it helps to competition, helps
to lower prices. What a novel idea, You know, people
can choose what a novel idea. A lot of those
(15:43):
need to be injected into healthcare. But Mark Mark has
talked about this portion of the system. I was a
insurance commissioner before I was governor. The Pharmacy benefit managers,
the PBMs, are this unknown mid man in the drug system.
They sell their services to employers and to other entities
(16:07):
saying we will get you a discount on various drugs,
and they say to the drug companies, we will help
distribute your drugs.
Speaker 9 (16:14):
They will not tell anyone they are not regulated by
the federal or the state governments.
Speaker 14 (16:19):
They will not tell anyone how much money they're taking
off the top and how much money they're making. And finally,
after years and years and years of trying. The Federal
Trade Commission and Congress is going after these guys saying,
we think you're just adding costs. You may make a discount,
but it's a discount often totally inflated rate.
Speaker 9 (16:39):
But Mark's group.
Speaker 14 (16:41):
Has the possibility of really, you know, smoking them out
real time, if you will, by putting a drug price
out and saying, you know, this is what it should cost.
Speaker 13 (16:49):
Well, just as far as say I did, Jeremy was
release our entire price list. And so by putting out
a price, a single price list in a spreadsheet form
of twenty two hundred drugs, the FTC employers passed through
PBMs that compete with the big PBMs are now able
to go and look and compare their prices and realizing
(17:11):
they're getting ripped off.
Speaker 1 (17:13):
And the big PBMs, by the way, are like express Scripts, CBS,
Care Mark, and United United Health.
Speaker 14 (17:19):
Right right, But as at AHHS I was the I
was in charge of Medicare. Medicare buys more drugs than
anyone else in the country, right, it is the largest
drug purchaser. I sat with the heads of all the
large pharmacy benefit managers in the room. They would not
give us information about what you're charging, what your discount is,
(17:42):
who gets it at what price, and they didn't have
to at that point. So it's it's finally kind of
catching up. But transparency is a piece of it.
Speaker 12 (17:51):
Let's let's do it and they become more.
Speaker 1 (17:54):
Let me just get let me get to another caller
here because the lines are full and talking to They
want to talk to you, They want to talk you.
Love it all right, Julia is Julia's in Chicago. Julia,
Welcome to the middle Go ahead, Hi.
Speaker 8 (18:07):
Thanks so much for answering my call. I just wanted
to share my personal personal experience with a little bit
of insight of what it's been like to be a
consumer under an employer sponsored healthcare program. From the time
that I was in my mid twenty to mid thirties,
very healthy. I was working for a wellness employer and
that insurance I contributed about three hundred dollars a month.
(18:30):
I had to pay sixty dollars just to go see
any specialist, so like someone from Migraine help, or if
I had to go in and you know, see an
ear nose and throat doctor, it was sixty dollars. My
prescriptions were always more than thirty dollars. Now, this was
about ten years and then about six months ago I
lost that job and had to go on to Medicaid
(18:53):
through Illinois. The experience has been so eye opening. I
have seen so much money by having Medicare and my
proscriptions are zero dollars. It's certainly not perfect. Sometimes I
get a result from the pharmacy that says, oh, this
requires prior authorization, but the medications that are covered are
(19:14):
covered one hundred percent and there's no back and forth
when I need to go see a doctor. So I
just wanted to say, what would I like the next
administration to do. It's to require legislation that requires transparency,
which is exactly what mister Cuban was saying. I think
information is power and the consumer Americans need to feel
(19:35):
more empowered in their medical choices.
Speaker 1 (19:38):
Julia, thank you so much for that call. Kathleen Sibilius
Medicaid expansion. She was talking about how she likes her
experience with Medicaid Right now, Medicaid expansion has been a
big topic of conversation. A lot of states have rejected
it because they say it costs them too much money.
What do you say to to states that are saying
we don't want to expand Medicaid and put more people
(20:01):
at a higher income level, which is still a very
low income level on Medicaid.
Speaker 14 (20:05):
Actually, Medicaid expansion has gone extremely well. I still live
in a state and I'm embarrassed to say this that
hasn't expanded, But we're one of only ten. The other
forty states have all taken out Medicaid expansion under Republican
governors and Democratic governors.
Speaker 9 (20:20):
It's the best cost.
Speaker 14 (20:21):
Sharing that any state has ever had with the federal government.
Ninety percent of the costs at the lowest level are
paid by the federal government one hundred percent when they
first enroll, and Medicaid is a very efficient program in
terms of delivering primary healthcare services. You know, the Medicaid
population is largely moms and kids. It has nursing homes,
(20:45):
it has disabled folks, but the bulk of the population
is moms and kids. Medicaid pays for fifty percent of
the bursts in the country. It pays for a variety
of services. It's a state based plan, and I'd say
it's gone extremely well. Our state has rejected it in
spite of our governor's endorsement, because of politics. It's not
(21:07):
about policy, it's not about delivering care. Is about politics,
and that's really, I think almost criminal to keep people
from healthcare because of the politics of the legislature.
Speaker 1 (21:20):
Mark Cuban, you're actually in a state as well, Texas
or that is your home state where you live. It
has the highest rate of uninsured Americans, about eighteen percent
compared to about seven percent nationally, probably somewhat because they
haven't expanded Medicaid. They're one of those states that has
not expanded. Do you think that people in Texas are
paying more for their healthcare because of that?
Speaker 13 (21:40):
Well, of course, if you're not covered, you're going to
pay more, But even worse than that, you're not going
to use the system, and far greater cost is incurred
not only by the patient, but when somebody's afraid that
Kathleen mentioned this earlier. When you're afraid to use the system,
you get sicker, and then you get to that point
where first you have to use the emergency room, and
then you have to use, you know, a hospital that
(22:03):
isn't prepared to deal with all the things that you
need and will charge you as much as they can effectively,
and so it's just it's a cascading problem that I
agree with Kathleen.
Speaker 12 (22:14):
Those ten states need to come around.
Speaker 9 (22:17):
And Jeremy Texas.
Speaker 14 (22:19):
It's more dangerous for a women to have a baby
in Texas than in many third world countries, in large
part because many of those women do not have healthcare
before they get pregnant. They have trouble getting healthcare while
they're pregnant. They're in much worse physical condition to bear children.
And we have the one of the highest rates of
maternal mortality infant mortality in the developed world, and that
(22:42):
is really, again just horrifying. But a lot of it
is because folks do not have the coverage that the
law has entitled them to since twenty fourteen.
Speaker 12 (22:52):
Now they're just a frame. It's always more expensive not
to use the system.
Speaker 1 (22:56):
Let's go to Susannah who is in Lehigh Utahs Xanna,
welcome to the middle Go ahead with Mark Cuban and
Kathleen Sibilias.
Speaker 11 (23:04):
Hi, welcome and thank you. The thing is for me
is failed the system. I'm originally from Argentina and for
two years I've been and told the doctors Ping Pong
I was the ball and charged me one thousands of
dollars misdiagnosed, and I need to flew to my country
(23:25):
to get the health care to found them for a surgery.
I have a seven thousand dollar searchery which went here.
They will cost me one hundred thousand dollars and m
or simple simple test like a m ORRI is four
thousand dollars here in state the Utah. Even if I
have insurance HSA, all they hold in Chilada that you
(23:48):
have here and health care and there is one hundred,
one hundred and fifty dollars you prevent the people get sick,
you know how you say it just now then you
scared to go to the doctor because it's scary to
found out what's going on with you, and they tell
(24:09):
you take the deal, go home, and you even have
a diagnose. I think everything need to be need to
be more human.
Speaker 1 (24:18):
Susanna, thank you, thank you so much for that. Kathleen Sibilius,
what do you think about that the doctor need to
be more human? I mean, it is interesting to hear people.
Anybody that comes in from another country always says that
their healthcare health care system is better, although often they
have long waits.
Speaker 14 (24:34):
Yeah, I think it's it's shocking to people, both people
who didn't grow up in this health system to experience it,
and they're a lot.
Speaker 9 (24:45):
Of times horrified.
Speaker 14 (24:46):
And folks who are traveling in Europe or South America
or Asia when they get sick and go into a
hospital and get a fifteen dollars bill or you know,
they have to pay for the cab ride home and
they just cannot believe, you know, they they don't have
gendarmes chasing them around the countryside. I don't think there's
any question that anybody anywhere in the world, if they
(25:07):
are very ill, want to come to the United States
for care.
Speaker 9 (25:12):
I mean, there's just no question.
Speaker 14 (25:14):
We have the best science available, we have the best
equipment available, we have the best hospitals available, we have
the best physicians, nurse practitioners, others available. If you have
resources and you're anywhere, you want to be here. But
that care isn't universal and it's not available to a
(25:34):
lot of the people who live here day in and
day out.
Speaker 1 (25:37):
Let's go to Haroun who is in Dallas. Harun, welcome
to the Middle Hi.
Speaker 16 (25:42):
Thank you for kaut taking my call. Yeah, I work
in the healthcare field, and you know, it's the honest.
I am a physician and I just want to comment,
And first of all, I'd like to applaud mister Cuban
for his cost plus A program. I think good that
people can see that and get medicines at affordable rate.
(26:04):
Only wish that more people knew about it. Whenever I
talk to my patients, you know, not many people know
about it. Aside from that, you know, I think the reason,
you know, one of the comments from one of the
callers was, you know, if doctors could be more human
and you know, doctors in this current system are currently
so stressed by all the regulations put on top of them,
(26:29):
and that you know, their reimbursement selves are tied to
generating and through putting more patients and supervising more and
more Snarus practitioners. That the burnout rate for the physicians
in this country is the highest in the world. The
suicide rate for physicians is the highest in the world.
And when you have less doctors' costs are going to
(26:50):
go up because you know, there's only so much that
certain physicians can do. What a small number of physicians
can do. Aside from that, I'm also an advocate for
either a single payer system or a public option. You know,
there should be more options for people. Multiple times I
have to, you know, try to get a peer to
(27:12):
peer to view, and there are refusals for procedures on
my patients, and very rarely do I get. You know,
it's supposed to be a peer to peer, but it's
surprising that often you may not even get a position
of the same specialty, or not even get a position. Yeah,
you know, you get a nurse practitioner or a or
a PA who has not practiced in that field. So
(27:33):
how is that a peer to peer? And you know,
you get still refused.
Speaker 1 (27:36):
Let me give our guests a chance to respond to that.
Mark Cuban a lot there. Obviously, I do want to say,
after the COVID pandemic, what an amazing thing that all
of the doctors and nurses and people in the healthcare
industry did for all of us. But also we're coming
back again to this idea of a single payer system.
I wonder whether you think that that ship has sailed
in the United States or if that's eventually where we'll
(27:58):
end up.
Speaker 13 (27:59):
No, I mean it's not saled. But again, you need
complete transparency a lot of the problems the doctor was
referring to. You've got private equity owned vertically integrated hospitals
and clinics that are looking to extract every dollar that
they can, and then you have the big insurance companies,
the Buka bucahs, who are trying to do the same
(28:21):
thing at the same time, and so they put together
programs that make it nearly impossible for doctors to do
their jobs right. Because the provider wants to run through
as many patients as they can at as high a
code of price as they can get. The insurance companies
don't even mind the higher prices, but they want to
(28:42):
charge the employers as much as they can charge, and
as a result, doctors don't get the opportunity to just
do their job. We're working on a program cost called
cost plus Wellness, where we're going to be direct contracting
with providers and tell them it's all cash paid from
the employer. There are no prest there are no other
requirements of doctors for additional documentation. We're going to trust
(29:06):
the doctors and as a result, we're getting pricing from
major providers at less than medicare pricing and so that's
going to change everything.
Speaker 1 (29:15):
We'll stand by. There are more calls coming in, but
you know, Tolliver. One of the drugs that has been
a centerpiece of the conversation about high drug costs has
been insulin, which for some Americans is now capped at
thirty five dollars a month.
Speaker 12 (29:28):
Yeah.
Speaker 2 (29:28):
And here's Illinois Senator Dick Durbin, who is my senator
for a long time. Here is in twenty nineteen grilling
pharmaceutical executive James Stancil on the soaring price of the
diabetes treatment.
Speaker 17 (29:38):
Do you have an idea what's happened to the cost
of insulin. Let's take a look at Humologue, which is
made by Eli Lilly based out of Indianapolis. Humologue in
the nineteen nineties was selling for about thirty nine dollars
a dose. It is now selling for three hundred and
twenty nine dollars a dose. And I can tell you,
having met with some people in Illinois who's ki goods
(30:00):
or facing diabetes, it is a burden which many of
them just can't handle anymore.
Speaker 1 (30:06):
Again, that was in twenty nineteen. The cost of insulin
has been capped for many Americans at thirty five dollars
a month, and TELLIVI, do you know what else people
can do for thirty five dollars a month or even no. Seriously, though,
we are looking for your help here at the Middle,
and you can go to listen to the Middle dot
com and make a tax seductrible contribution. It can be
thirty five dollars a month, or it could just be
(30:27):
thirty five dollars. It was a dollar a difference, that's
a that's a dollar day for the month, almost a
little bit more. Anyway, make a contribution. We really appreciate it,
and we'll be right back with more of your calls
on the Middle. This is the Middle. I'm Jeremy Hobson.
This hour, we're asking you why is our healthcare so expensive?
And what do you want the next president to do
(30:48):
about it? You can call us at eight four four
four Middle. I am joined by former Health and Human
Services Secretary Kathleen Sibelius and businessman and founder of cost
plus Drugs Mark Cuban. And before we go back to
the phones, Kathleen Sibilia's healthcare is very regularly politicized by
elected officials, But do you think that most Americans see
(31:09):
healthcare as a political issue.
Speaker 14 (31:13):
Now, I think most Americans see healthcare is a very
personal issue. It is the most important asset that anybody
will ever have. People are terrified that if they get
sick or a family member gets sick, that they will
not be able to provide care, that they will not
be able to afford the medicines, that they will not
be able to keep that person safe. About half the
(31:36):
people in medical bankruptcy are people who have insurance who
got into a situation where the family member was terribly.
Speaker 9 (31:45):
Ill, and the bills just keep piling up.
Speaker 14 (31:48):
And I think it's just an example of people who
thought they were doing the right thing. They bought health insurance,
they kept their health insurance, and still they can't pay
the bills when somebody gets sick. And so I think
what terrifies people is when folks just say, you know,
we're going to cancel this law, We're going to cut
millions out of Medicaid.
Speaker 9 (32:07):
We're going to make sure that you.
Speaker 14 (32:10):
Know, Medicare won't exist in the future. The government spending
too much money. Well, the government is the biggest health
insurer of people in this country. That two hundred million
people rely on Medicaid, medicare or the marketplaces right now,
that's a big chunk of the country. And you know,
folks who just want to slash that are terrifying a
(32:31):
lot of human beings.
Speaker 1 (32:33):
Let's go back to the phones at Joshua, who is
in Minneapolis. Joshua, welcome to the middle Go ahead.
Speaker 10 (32:38):
Hi, thanks for having me. You know, I'm a physician,
and you know, one of the things that I see
as adding to the cost of healthcare in this country
is that the cost of education of educating physicians, and
you know, more than just physicians, but also just anybody
(33:01):
in general. The cost of to be a physician. You
need to go to a four year college, which you know, average,
you know, could average you know, forty thousand dollars a
year for four years. Then you have to go to
medical school, which you know it's going to cost you
another fifty sixty thousand dollars a year, probably more. You know,
I don't even know.
Speaker 18 (33:20):
I went to medical school in nineteen ninety eight, so
it was different then, yeah, right, you know, it sort
of forced, it forces the hand of you know, physicians
trying to pick your career towards you know, higher paying specialties.
So you have sort of this economic incentive that physicians
(33:41):
have to make. Well, I got to pay off my loans,
so I got to go into a specialty that's going
to make me money. So you're talking about dermatology, you're
talking about orthopedics, you're talking about you know, urology, cridiology,
And in order to keep costs down, you know, you
need more primary care providers who you know, can hand
you know, handle more common conditions at a lower price.
(34:05):
You know, and then you start talking about things that
had occurred in the past with HMOs and gatekeepers, and
you know certainly that you know, people feel that that's
going to take their choice away, and then they start
streaming you know, you know, death.
Speaker 19 (34:19):
Panels and all this, and you know, I think overall
we need to broaden you know, access by having more
primary care providers. And to do that, one option is
to just lower the cost of educating people in general
rights particular.
Speaker 1 (34:36):
Yeah, great point, Joshua Mark Cuban. Just the sheer cost
of becoming a doctor and making the money that you
need to pay off now those enormous student loans probably
is one of the problems. What do you think about that.
Speaker 13 (34:50):
I think being a med school should be free. At
public universities, they're about nine thousand slots, and the cost,
you know, with room and board and everything, all in
about one hundred thousand dollars a year. So my math
might not be right, but that's about nine billion dollars.
And for nine billion dollars, you can ask those nine
thousand dollars, nine thousand doctors to work in primary care
(35:13):
in exchange for the free school. And now all of
a sudden you have more doctors competing for those slots,
so you hopefully have better doctors, and then hopefully you
can work and create more residencies which expand the pool
of doctors as well. And I think for nine billion dollars,
given where we are in the total cost of healthcare,
that's a drop in the bucket.
Speaker 14 (35:33):
So Jeremy, there is a program at the federal level
called the Commission Health Core and it is actually just
exactly what Mark described, and some states have mimicked. At
Kansas actually did the same thing where if you agree
coming out of med school that you will work in
a primary care or on an Indian reservation or at
(35:56):
a federal some of the underserved areas of the country
in a federally qualified health center in an area where
there's a lack of doctors. Your loans are paid off,
and you qualify. It's kind of the Peace Corps for
healthcare workers. So you agree that service for a limited
period of time and your loans are paid off.
Speaker 9 (36:17):
And what happens is a lot of people. First of all,
it gives, to.
Speaker 14 (36:21):
Joshua's point, the freedom to somebody coming out with debt
to choose one of the lower cost practices. They may
want to return to their hometown, they want to be
in primary care, but they think, oh my god, I've got,
you know, hundreds of thousands of dollars, I've got to
pay it off. If that debt is paid, you could
make a choice. And a lot of people stay in
those initially appointed areas because they find it very fulfilling,
(36:44):
They find it very meaningful. We're going to have to
ramp up those programs in a dramatic fashion to you.
Speaker 9 (36:50):
Know, trade off.
Speaker 14 (36:51):
If you're willing to work in primary care, if you're
willing to work in gerontology, if you're willing to become
a nurse practitioner.
Speaker 9 (36:58):
Runa.
Speaker 14 (37:01):
You your school is forgiven, and maybe upfront some of
that money so people can go to school if they
feel like they don't want the cash.
Speaker 1 (37:08):
To begin with, let's get to Emily, who's in Colorado Springs. Hi, Emily,
Welcome to the middle Go ahead.
Speaker 19 (37:15):
Hi.
Speaker 20 (37:15):
Yeah, I'm an internist here in Colorado Springs, and I
wanted to make two comments. One on Medicaid, which has
been fantastic in Colorado Springs. Because Colorado Springs expanded Medicaid.
We got a bunch of healthy, working folks on the
Medicaid rules, people out of the emergency departments and into
(37:38):
the clinic for primary care where we can do prevention
and take care of things like urinary track infections, which
cost a ton of money in the emergency department. So
we expanded Medicaid so people that you know don't make
enough money to participate in some of those healthcare exchange
(38:01):
program those can be pricey, and that just lower the
cost in Colorado for everybody.
Speaker 6 (38:11):
You know.
Speaker 20 (38:11):
I came out of Texas, where you have to be
disabled or pregnant and no specialists take Medicaid. You have
to beg favors to get a Medicaid patient seen by
a cardiologist, a neurologist, or send someone to a volunteer
clinic often and that is definitely not the case in Colorado.
I can get my patients seen by any specialists in town,
(38:35):
which is fantastic. And then I think politically, there is
this idea that Medicaid is being given to free for
everybody that you know crosses the further I legally, which
is absolutely not true. And I think we would lower
cost if people could buy into programs like Medicaid. I
(38:57):
unfortunately have patients get kicked off Meta Dead because they've
gotten a new job and now they're making sixty four
dollars a month too much, and so they fall back
into that in between pool.
Speaker 1 (39:09):
It sounds like a strong vote for medicaid in Colorado
and the Medicaid expansion there.
Speaker 14 (39:15):
Kathleen Sibelius, Emily, will you come to Kansas and not
the heads of some of our legislators.
Speaker 9 (39:21):
We're just right over the border.
Speaker 14 (39:23):
You can come over here and tell your story because
we really need to help. But I think you've just
described perfectly. To get lower income workers into Medicaid actually
lowers everybody's costs and you know, reduces the emergency room visits. Also,
you know, some of those women we were talking about
(39:43):
in Texas. They can be in healthier shape when they
decided to have a family and get pregnant, and then
they are better off, their baby is better off, they
can return to work.
Speaker 9 (39:52):
I mean, it's a win win win.
Speaker 14 (39:54):
But please come to Kansas and I'll set you up
with a little lobbying assignment.
Speaker 1 (39:59):
Perfect. Lynn is in is it high Park? Illinois? I
know there's a Hyde Park in a Highland Park, But Lynn,
you probably know I'm talking to you, so go ahead.
Speaker 5 (40:09):
Yes, yes, Hi. My name is Lynn Belski. I am
an internest as well, and I think we all need
to remember that medicine is for the patients and not
only for other people to make money. That's number one.
Number two. I went into medicine to take care of people,
(40:29):
to be human and found that in the regular system
of medicine, but it just wasn't allowed seeing patients every
ten minutes. So I am a concierge doctor, although I
do have scholarship patients who do not pay the concierge see.
And what I found is I'm able to discuss things
(40:52):
like Mark Cuban's cost plus drugs and I was able
to save one of my patients eight hundred dollars a
month on her medication by going through Mark's cost plus
drawl of that I'm grateful for. And then the other
thing is I really feel that Medicare is a wonderful
(41:15):
service and if we could lower the age that people
enter into Medicare over time, I believe that that would
be a real benefit to a lot of people.
Speaker 1 (41:28):
Yeah, Lynn, thank you, And I'm going to go right
to Mark Cuban on that you probably made his day
just now.
Speaker 13 (41:33):
Yeah, I'm glad we could help Lynn. I'll comment on
the Medicare side of things. I think there's a challenge
right now with Medicare advantage. I think a lot of
the providers of Medicare advantage are distorting the services that
are available by offering zero or low premiums. And I
would recommend to everybody out there really do your homework
(41:54):
about exactly what the plan that you're looking at buying
truly offers, because they're you know, you may get a
gym membership, you may get dental, but when it comes
down to the things that are expensive and that you
really need, if you get sick, it.
Speaker 12 (42:09):
May not be available.
Speaker 13 (42:10):
And so be very careful and good old school medicare
is not a bad thing, particularly given that there's going
to be a cap of two thousand dollars starting next year.
Speaker 1 (42:20):
Mark kibanhms focusing on it as I'm sorry, it just
popped into my head. How much do you like focusing
on this versus basketball?
Speaker 16 (42:28):
Oh?
Speaker 13 (42:29):
I love this right, just be able to help people
and change the game. You know, Kathleen might not like
hearing this, but I think medicine. I think healthcare is
going to be the easiest business I've ever been involved
with to disrupt because by just being transparent that COSTPUS wellness.
Speaker 12 (42:44):
I described direct contracting.
Speaker 13 (42:46):
We're going to publish all of our contracts, and once
everything is in the public domain, and you talk about
what should politicians do, I've recommended to the Harris team
that they require that all provider ensure, PBM and affiliated
company contracts with anybody be published and available for everybody
(43:07):
to see. Because when that happens, we truly start to
have the steps towards an efficient market.
Speaker 1 (43:14):
Sorry, Kathleen Sibilius, I cut you off there.
Speaker 14 (43:16):
What were you going to say, no, no, no, I
just I mean I first, So I don't disagree with
Mark on much of what he's saying, I'd love to
see healthcare severely disrupted because I think it really needs it,
and it shouldn't be money driven. It should be patient centric,
and we're drifting far from that. All I was going
(43:38):
to say in Medicare advantage, I think it's critical that
people look at two things and not the silver sneakers
and health and wellness programs and whether you get a
second pair of eyeglasses. You need to absolutely look at
the drug program that's part of the package and make
sure that all the drugs you take or might take
are in that. And you need to look at the
(44:00):
list of providers that are in the network to make
sure that if you have specialty providers, a cardiologists, a
special hospital, that they're in it. And a lot of
people skip that, as Mark says, look at the premium
and say, oh, this is a great deal, only to
find out that their doctor isn't in the program and
the two medications that rely on are not part of
(44:21):
the drug plan. And so those are the two things.
Speaker 13 (44:24):
The health club is great, Yeah.
Speaker 1 (44:29):
Let's get let's get one more call in here. Attila
is in Grand Forks, North North Dakota. Attilla Welcome to
the middle. Go ahead.
Speaker 6 (44:37):
Oh hi, thank you guys for having me. I'm a
hospital bised physician and I'm originally from Hungary, a very
different halfcare settings. I've been in the US twenty years
and this is most I know about healthcare. But I
do think that the American healthcare expectations are certainly much
much different than anywhere in the in the word and
(45:00):
healthcare is becoming a consumer and customer based business or
organization that we primarily take care of our customers. And
the customers here have much more needs than in any
other countries, or at least they express more needs. What
(45:22):
I mean by this is is America really I think
one of your panelists had the abdominal pain went to
the emergency room in America. If in the emergency room
somebody comes in with abdominal pain and there is five
percent chance that the patient has appendicietist, ninety five percent
chance that I know what is wrong with the patient,
(45:44):
it's a distrength, right, It is nothing to worry in America.
If there is five percent chance they will get a
cat scan. In Canada, if there is ten percent chance
we'll get a cat scan. In Europe, if there is
thirty percent chance we'll get.
Speaker 1 (46:00):
Wow, Attila, thank you so much for that call. Unfortunately
we are running out of time there. But Kathleen Sibilia
is just briefly your thoughts on the expectations there.
Speaker 14 (46:10):
Well, I think that there are a lot of high expectations.
It also is true that unfortunately, unlike other countries, the
government doesn't own the hospitals. The hospitals are freestanding and
often now are venture capital based or whatever base running
those machines twenty four to seven. Doing more MRIs, getting
more butts in beds is the way they make money.
(46:31):
So we have a lot more diagnostics done in the US,
we have a lot more tests done, we have a
lot more test charged, and I'm not sure it produces
better health outcomes, but it does pay a lot of
the capital expenses of the folks who bought those very
expensive machines.
Speaker 1 (46:47):
Okay, before we wrap up, Mark Cuban, since it's not
every day we have Mark Cuban on the show, I
want to ask you something. You have endorsed Kamala Harris
for president and in her campaign. You live in the
state of Texas, which is a state that hasn't voted
for a Democrat statewide in thirty years. First, do you
think that she should make a play at Texas, which
(47:07):
has been getting closer in recent elections? And second, why
do you think Republicans continue to do so well in Texas?
Speaker 13 (47:14):
You know, I can't really give you good answers there.
I don't really think about the political strategies behind it.
I just I support her because I like her approach,
I like her ethics. I like the fact that we
can trust her. I think that's what's been missing in
politics for too long, right, where we're not quite sure
(47:36):
that we can trust the person in charge. And I
feel like I can trust Kamla And so I couldn't
give you any of the details on the politics. I
try to avoid that side of it completely.
Speaker 1 (47:46):
And just stick to low cost drugs and basketball.
Speaker 12 (47:50):
That's all I need to do.
Speaker 19 (47:51):
Right.
Speaker 12 (47:51):
If I can help fix healthcare, yeah, I'm going to
be happy.
Speaker 1 (47:55):
Well. I want to thank my guests, a businessman and
entrepreneur Mark Cuban, founder of Cost Plus Drugs and former
governor of Kansas, and former Health and Human Service Secretary
Kathleen Sibilius. Thanks too much to both of you.
Speaker 12 (48:07):
Thank you so much.
Speaker 1 (48:08):
To be with you at Tolliver next week. We will
be talking about the role of Christianity in politics in
front of a live audience in partnership with WBHM in Birmingham, Alabama.
Speaker 2 (48:18):
That's right, and know that anything I say in Birmingham
is under the influence of a full rack of riebs. Okay,
I'm showing up loaded.
Speaker 1 (48:25):
There we go. The Middle is brought to you by
Longnock Media, distributed by Illinois Public Media in Urbana, Illinois,
and produced by Joanne Jennings, Harrison Patino, Danny Alexander, and
John Barth. Our intern is Anna Kadeshler. Our technical director
is Jason Croft. Our theme music was composed by Andrew Haig.
Thanks to the more than four hundred and ten public
radio stations that are making it possible for people across
(48:46):
the country to listen to The Middle, I'm Jeremy Hobson
and I will talk to you next week.
Speaker 10 (49:08):
Names
The Middle is supported by Journalism Funding Partners, a nonprofit
organization striving to increase the sustainability of local journalism by
building connections between donors and news organizations. More information on
how you can support the Middle at Listen tooth middle
dot com. Welcome to the Middle. I'm Jeremy Hobson along
(00:21):
with our house DJ Tolliver and Tolliver. I have to say, wow,
this week, we have not had an assassination attempt on
a candidate. We haven't had a candidate drop out of
the race. We actually got to do the show that
we were planning to do this week.
Speaker 2 (00:33):
While that never happens, miracles do happen. Man, look at that.
Speaker 1 (00:36):
I guess so.
Speaker 3 (00:36):
Well.
Speaker 1 (00:37):
We're talking about healthcare this hour, and more specifically how
expensive it is in this country and what can be
done about it. Is something almost everyone has experienced at
one point or another.
Speaker 4 (00:46):
Yeah.
Speaker 2 (00:46):
No, literally, I was just an urgent care on Tuesday
for a stomach thing. It was four hundred dollars, just
a walk in the door. Ooh jeez, buy me a
drink first, come on.
Speaker 1 (00:54):
Well, four hundred dollars is a lot for one person,
and when you look at the overall federal budget. The
biggest item is healthcare, which adds up to almost two
trillion dollars a year for the country. That's Medicare for seniors,
Medicaid for low income people, children's health insurance, and more. Now,
the good news is that since the Affordable Care Act
was implemented ten years ago, about ninety three percent of
Americans now have some form of health insurance. But there's
(01:16):
still a lot to be done when it comes to
bringing costs down. So that's what we'll be talking about
with two fantastic guests in a moment. But first, last week,
we asked you for your thoughts on President Biden's exit
from the presidential race and Kamala Harris's entrance. Here are
some of the voicemails we got after the show.
Speaker 3 (01:34):
My name is sam I'm from Milwaukee, Wisconsin.
Speaker 5 (01:37):
This is Mia calling from Denver, Colorado.
Speaker 6 (01:40):
HI.
Speaker 7 (01:40):
This is Chris not from Texas.
Speaker 6 (01:42):
HI.
Speaker 8 (01:43):
This is Samantha Calvin calling from Saint Louis, Missouri. Kamala
Harris has the experience to be the next president of
the United States.
Speaker 9 (01:51):
She has my vote.
Speaker 3 (01:52):
In twenty sixteen, I voted for Trump. In twenty twenty,
I voted for Biden. Before Kamala Harris decided to Ron,
I was planning to vote against Trump. Now I feel
enthusiastic enough to vote for Kamila Harris.
Speaker 10 (02:08):
I am happier to see Joe Biden step down.
Speaker 5 (02:13):
But as a former Democrat now for Middle.
Speaker 11 (02:16):
I am not completely sold on Kamala Harris.
Speaker 7 (02:20):
I mean, to me, we already did elect her when
we elected her back in twenty twenty, when she was
on the ticket with Biden. I mean, we all kind
of knew that there was a possibility this is going
to happen with Joe Biden's age, whether by natural circumstances
are pressure from the party.
Speaker 1 (02:34):
Well, thanks to everyone who called in. So now to
our topic this hour, healthcare. Why is our healthcare so expensive?
And what do you want the next president to do
about it? Tolliver, what is the number of people to
call in?
Speaker 2 (02:44):
It's eight four four four Middle, that's eight four four
four six four three three five three, or you can
write to us that listen to the Middle dot com.
Speaker 1 (02:51):
So let's meet our panel. You'll recognize businessman and entrepreneur
Mark Cuban as the part owner of the Dallas Mavericks
as well as a judge on ABC's Shark Tank, but
he's also the founder of cost Plus Drugs, a low
cost online pharmacy Mark Cuban, So great to have you
in the middle.
Speaker 12 (03:05):
Thanks for having me.
Speaker 1 (03:06):
Jereby and former Governor of Kansas, Kathleen Sibelius joins us
as well. She served as Secretary of Health and Human
Services in the Obama administration and helped roll out the
Affordable Care Act, also known as Obamacare. Secretary of Sibilius.
Great to have you on the show as well.
Speaker 9 (03:21):
Thanks, good to be with you.
Speaker 1 (03:23):
Well, before we get to the phones's, Mark Cuban, we
should explain why you're here. In your connection to the
world of tustcare. You started a company called cost Plus
Drugs two years ago to offer generic drugs to try
to cut out the middleman called a pharmacy benefit manager.
Why focus on that part of the healthcare industry.
Speaker 12 (03:41):
Because there's no transparency.
Speaker 13 (03:42):
So, you know, when we looked at the healthcare industry
and you try to figure out why are there so
many issues? You know, think about what happens when you
go to the doctor. You know, you're told you need
a prescription, and the first thing they say is what
pharmacy do you use. There's no discussion of cost, there's
no discussion of affordability. It's just the presumption that you
can afford it. And we've all heard stories or seen
(04:04):
it in action or experienced it ourselves where we're standing
at the pharmacy counter kind of terrified because we have
a high deductible plan or we have no insurance, and
we have no idea what our cost is going to be.
So we create a cost plus drugs dot Com with
a very simple premise. If you go to the website
costplus drugs dot Com and put in the name of
the medication, and we carry about twenty two hundred different
(04:27):
skews different medications, including some brands. Now, if you put
in the name of it, we'll show you our cost,
and then we'll also show you our markup, which is
fifteen percent. We'll show you how much it cost to
ship since we're mail order, and we'll show you what
we pay the pharmacy as a fee for them to
review everything. That's the first time anybody has ever been
(04:48):
completely transparent about the cost of any sale of any
medication to a patient.
Speaker 1 (04:54):
And just are you are you already seeing sorry to interrupt.
Are you already seeing impacts for patient on how much
they're paying? Have the cost come down?
Speaker 12 (05:02):
Oh yeah?
Speaker 13 (05:03):
I mean if you looked at the FTC report that
just came out on PBMs, the costs that they use
to make the point that the PBMs were ripping people
off were our prices. And so I can tell you,
you know, I had a friend who needed a drug
called droxadopo and he emailed me in a terror because
he was switching insurances and they were going to charge
(05:24):
him thirty thousand dollars every three months. I was like,
land in, let me check and see what our price is.
Sixty dollars a month, So one hundred and eighty dollars
for those three months. And I'm you know, im mattine
for chemotherapy. You know where if you walk into a
CVS right now and don't have insurance or a high deductible,
they may charge you two thousand or more dollars, and
(05:45):
depending on the strength, you might get it for anywhere
from twenty dollars to sixty dollars per month from US.
So the savings have been extraordinary and that's led to
us having, you know, filled millions of prescriptions.
Speaker 1 (05:56):
So let's talk about this the bigger issue though, of
the healthcare system in the US right now. Kathleen Sibelius,
as we as we said, you rolled out Obamacare about
ten years ago it launched. It's brought the percentage of
uninsured Americans down from about sixteen percent back then to
about seven percent now. But how do you view the
healthcare system overall right now in the US.
Speaker 14 (06:19):
Well, Jeremy, I I'll answer that question, but I'd also
like to answer what Mark is talking about, because he's
talking about a piece of the system, and it's probably
the least available, least transparent, most annoying part of the system,
and most costly at this point because drug companies frankly
(06:41):
can charge anything they want, anything they want. We have
no pricing structure in the United States. We have no
pricing mechanism up until the Inflation Reduction.
Speaker 9 (06:52):
Act was passed.
Speaker 14 (06:53):
But we don't have a healthcare system.
Speaker 9 (06:56):
We've got pieces of a puzzle.
Speaker 14 (06:58):
And for some people they get great care a lot
of the time. For most people they get sort of
hit and miscare. You've got to get to the right
doctor at the right time and the right system and
have the ability to pay for whatever it is they're recommending.
That's not a great system and it leaves way too
many people falling in the crack. So, yes, more people
(07:20):
are insured today, and that's a big step forward. At
least they have the ability to enter the system, because
before that, a lot of folks just you know, they
wouldn't get a mammogram because they couldn't afford some kind
of follow up surgery if they had breast cancer, so
they just skipped the whole system altogether. So giving people
access is really what insurance is all about, and helping
(07:43):
people pay some of their bills. But we still have
a very disjointed, very complicated system, and most people cannot
negotiate it well.
Speaker 1 (07:54):
And Mark Cuban, I remember as we covered you know,
Obamacare and talked about the health care system over many years,
a lot of your probably billionaire friends or at least
billionaire colleagues would say, well, the reason we spend so
much more than every other country on health insurance on
healthcare in this country is that we're investing in all
the R and D we get better care, etc. What
(08:16):
do you think, as a member of the private sector,
is that true? How do you view the healthcare system
overall in the US.
Speaker 12 (08:22):
So two things. My friends are the same friends I
had in high school, grade school, college.
Speaker 13 (08:26):
I don't hang around with rich people, right, those are
my boys, Those are my guys too. In terms of
you know your point, there is some truth to it, right,
There is a significant investment that's needed, particularly as we
get into the gene and cell therapies that are truly expensive.
But and this is somewhat to the Secretary's.
Speaker 12 (08:44):
Point, there is so much the.
Speaker 13 (08:47):
Whole system is an arbitrage where whether it's the pharmacy
SIBE or the medical SIBE, everybody's trying to extract something
somewhere and to try to gain the system, and they're
able to should do it, because whether you walk into
a hospital and you have no idea what the price is,
and if you have insurance the company that if your
(09:09):
employer's self insurance, they have no idea what they're going
to pay.
Speaker 12 (09:13):
If it's in work network versus out of network, it's
a different price.
Speaker 6 (09:16):
You know.
Speaker 13 (09:16):
There's just so many ways that everybody skims off the system.
Speaker 12 (09:20):
And so.
Speaker 13 (09:22):
And I go back to this all the time. The
problem is a lack of transparency because nobody knows what
to expect. The first line in every contract, whether it's
from an insurance company, a pharmacy benefit manager, even a
hospital provider, is that you're not allowed to say anything.
It's like fight club. The number one rule of healthcare
(09:43):
contracts is you can't say anything about health care contracts,
and that creates the underpinning for people to skim off
the top, the bottom in the middle.
Speaker 14 (09:52):
Okay, if I can jump in Jeremy just for a second,
because I think it's both a lack of transparency.
Speaker 9 (09:58):
I would agree with that whole heart.
Speaker 14 (10:00):
But also the notion there are lots of I say,
free market folks on the healthcare side that just say,
you know, let people will give you a chunk of
change and you go out and negotiate.
Speaker 9 (10:12):
For your health care.
Speaker 14 (10:15):
That absolutely doesn't work in the system that we have
because people have no leverage at all. To Mark's point,
a hospital down the street from me charges six different
rates depending on who the contractor is. If you've got
a big employer with a lot of patients and you're
going to send them their way, they get one price.
(10:35):
If you're an individual with no insurance, you get a
very different same bed, same hospital, same street, same doctors,
very different price. So the notion that people we don't
have a market transparency, but we also don't have an
ability for consumers to negotiate. Even if it was transparent,
they don't have any leverage.
Speaker 9 (10:56):
Well, you know, somewhat different things like Mark.
Speaker 14 (10:59):
I mean, I'm congratulating your program because you're going to
give them an ability to choose, but most people don't
have that.
Speaker 12 (11:06):
You know.
Speaker 13 (11:06):
The crazy part is that if you just walk in
with a credit cardd into the hospital will pay less
than the biggest compent.
Speaker 1 (11:14):
Wow, that's interesting, Cann Tolliver. You know, lawmakers have taken
a lot of swings over the years at our healthcare
system and trying to get more people covered.
Speaker 2 (11:23):
Yeah, and with like very different approaches. This is the
clip is from nineteen seventy one when Richard Nixon proposed
requiring employers to cover full time employees.
Speaker 4 (11:31):
I am proposing today a new national health strategy. It
helps more people pay for care, but it also expands
the supply of health services and makes them more efficient.
It emphasizes keeping people well, not just making people well.
The purpose of this program is simply this. I want
(11:53):
America to have the finest health care in the world,
and I want every American to be able to have
that care when he needs it.
Speaker 1 (12:02):
Interesting, also interesting, Tolliver, that he says when he needs it,
which is something that I guess you could say back
in the seventies, but now you would probably have to
recognize that there are not just men in this country.
So anyway, we will be back with more of the middle.
This is the Middle. I'm Jeremy Hobson. If you're just tuning,
(12:23):
in the Middle is a national call in show. We're
focused on elevating voices from the middle geographically, politically, and philosophically,
or maybe you just want to meet in the middle.
This hour, we're asking you why is our healthcare so expensive?
And what do you want the next president to do
about it? Tulliver, what's the number to call in?
Speaker 2 (12:38):
It's eight four four four Middle. That's eight four four
four six four three three five three. You can also
write to us a Listen to the Middle dot com
or on social media.
Speaker 1 (12:46):
I'm joined by a businessman and founder of cost Plus Drugs,
Mark Cuban, and former Health and Human Services Secretary Kathleen Sibilius.
And let's get to the phones. And Bob who is
in Pittsburgh. Bob, welcome to the middle go ahead.
Speaker 15 (12:58):
All right, thanks for having me on. I find this
very interesting. I'm a healthcare worker and I've seen this
from that point of view, and the system itself has failed.
For profit healthcare system has failed. It's very difficult for
people to hear, but it's true. Where we're experiencing is hypernormalization.
(13:19):
It's where the those who make a lot of money
off of it they needed to keep going. And then
basically we're in this political situation where nobody can see
a solution because the solution is running healthcare as a
public service, like the fire department, not like a business.
But the people in charge of it are trained to
(13:41):
run it like a business. We have the most expensive
healthcare system, but not the best results.
Speaker 1 (13:46):
So what do you suggest, Bob? Are you are you?
Are you saying there should be like a universal healthcare,
single payer situation?
Speaker 15 (13:53):
Yes, universal healthcare, universal health care. The Australians have a
very good system. It might work better for us. It's
very similar to to what Americans might like. You get
a basic plan, you get it covered, but then you
can or you can you can pay for prior advent
insurance if you want to jump lines for various procedures.
But this system simply isn't working.
Speaker 1 (14:15):
Yeah, let me take that to our guests, said Mark Cuban.
They can't see you, but I can, and you were
shaking your head. So your your thoughts on that idea.
Speaker 13 (14:23):
Because if you don't know, if the government doesn't know
what it's going to pay, then the people who control
healthcare can charge whatever they want. And again, you've got
to be able to demonstrate that the pricing is real.
Speaker 12 (14:38):
And right now, because of rebates, because of in network,
out of network, all.
Speaker 13 (14:43):
These different issues, nobody knows the real price of healthcare.
Speaker 1 (14:47):
Kathin Sibilius, what about What do you think about that?
I remember during the Obamacare debates that went on, a
lot of people were talking about a public option and
it never happened.
Speaker 14 (14:57):
Well, I'm sorry it didn't happen. I still remember the
day that that Joe Lieberman went on Meet the Press
and announced to Tim Russert he was not going to
vote for a public option, which was came as a
real surprise to all of us, and he was the
sixtieth vote, so it went out the window. The public
option was just really saying the government will compete with
private plans. It's what goes on right now in Medicare,
(15:19):
with Medicare advantage and Medicare Fee for service in the
running side by side with the same benefits, and private
plans can compete with the government vice versa. That's what
a public option would do, and it's really tragic that
we don't have that because it helps to competition, helps
to lower prices. What a novel idea, You know, people
can choose what a novel idea. A lot of those
(15:43):
need to be injected into healthcare. But Mark Mark has
talked about this portion of the system. I was a
insurance commissioner before I was governor. The Pharmacy benefit managers,
the PBMs, are this unknown mid man in the drug system.
They sell their services to employers and to other entities
(16:07):
saying we will get you a discount on various drugs,
and they say to the drug companies, we will help
distribute your drugs.
Speaker 9 (16:14):
They will not tell anyone they are not regulated by
the federal or the state governments.
Speaker 14 (16:19):
They will not tell anyone how much money they're taking
off the top and how much money they're making. And finally,
after years and years and years of trying. The Federal
Trade Commission and Congress is going after these guys saying,
we think you're just adding costs. You may make a discount,
but it's a discount often totally inflated rate.
Speaker 9 (16:39):
But Mark's group.
Speaker 14 (16:41):
Has the possibility of really, you know, smoking them out
real time, if you will, by putting a drug price
out and saying, you know, this is what it should cost.
Speaker 13 (16:49):
Well, just as far as say I did, Jeremy was
release our entire price list. And so by putting out
a price, a single price list in a spreadsheet form
of twenty two hundred drugs, the FTC employers passed through
PBMs that compete with the big PBMs are now able
to go and look and compare their prices and realizing
(17:11):
they're getting ripped off.
Speaker 1 (17:13):
And the big PBMs, by the way, are like express Scripts, CBS,
Care Mark, and United United Health.
Speaker 14 (17:19):
Right right, But as at AHHS I was the I
was in charge of Medicare. Medicare buys more drugs than
anyone else in the country, right, it is the largest
drug purchaser. I sat with the heads of all the
large pharmacy benefit managers in the room. They would not
give us information about what you're charging, what your discount is,
(17:42):
who gets it at what price, and they didn't have
to at that point. So it's it's finally kind of
catching up. But transparency is a piece of it.
Speaker 12 (17:51):
Let's let's do it and they become more.
Speaker 1 (17:54):
Let me just get let me get to another caller
here because the lines are full and talking to They
want to talk to you, They want to talk you.
Love it all right, Julia is Julia's in Chicago. Julia,
Welcome to the middle Go ahead, Hi.
Speaker 8 (18:07):
Thanks so much for answering my call. I just wanted
to share my personal personal experience with a little bit
of insight of what it's been like to be a
consumer under an employer sponsored healthcare program. From the time
that I was in my mid twenty to mid thirties,
very healthy. I was working for a wellness employer and
that insurance I contributed about three hundred dollars a month.
(18:30):
I had to pay sixty dollars just to go see
any specialist, so like someone from Migraine help, or if
I had to go in and you know, see an
ear nose and throat doctor, it was sixty dollars. My
prescriptions were always more than thirty dollars. Now, this was
about ten years and then about six months ago I
lost that job and had to go on to Medicaid
(18:53):
through Illinois. The experience has been so eye opening. I
have seen so much money by having Medicare and my
proscriptions are zero dollars. It's certainly not perfect. Sometimes I
get a result from the pharmacy that says, oh, this
requires prior authorization, but the medications that are covered are
(19:14):
covered one hundred percent and there's no back and forth
when I need to go see a doctor. So I
just wanted to say, what would I like the next
administration to do. It's to require legislation that requires transparency,
which is exactly what mister Cuban was saying. I think
information is power and the consumer Americans need to feel
(19:35):
more empowered in their medical choices.
Speaker 1 (19:38):
Julia, thank you so much for that call. Kathleen Sibilius
Medicaid expansion. She was talking about how she likes her
experience with Medicaid Right now, Medicaid expansion has been a
big topic of conversation. A lot of states have rejected
it because they say it costs them too much money.
What do you say to to states that are saying
we don't want to expand Medicaid and put more people
(20:01):
at a higher income level, which is still a very
low income level on Medicaid.
Speaker 14 (20:05):
Actually, Medicaid expansion has gone extremely well. I still live
in a state and I'm embarrassed to say this that
hasn't expanded, But we're one of only ten. The other
forty states have all taken out Medicaid expansion under Republican
governors and Democratic governors.
Speaker 9 (20:20):
It's the best cost.
Speaker 14 (20:21):
Sharing that any state has ever had with the federal government.
Ninety percent of the costs at the lowest level are
paid by the federal government one hundred percent when they
first enroll, and Medicaid is a very efficient program in
terms of delivering primary healthcare services. You know, the Medicaid
population is largely moms and kids. It has nursing homes,
(20:45):
it has disabled folks, but the bulk of the population
is moms and kids. Medicaid pays for fifty percent of
the bursts in the country. It pays for a variety
of services. It's a state based plan, and I'd say
it's gone extremely well. Our state has rejected it in
spite of our governor's endorsement, because of politics. It's not
(21:07):
about policy, it's not about delivering care. Is about politics,
and that's really, I think almost criminal to keep people
from healthcare because of the politics of the legislature.
Speaker 1 (21:20):
Mark Cuban, you're actually in a state as well, Texas
or that is your home state where you live. It
has the highest rate of uninsured Americans, about eighteen percent
compared to about seven percent nationally, probably somewhat because they
haven't expanded Medicaid. They're one of those states that has
not expanded. Do you think that people in Texas are
paying more for their healthcare because of that?
Speaker 13 (21:40):
Well, of course, if you're not covered, you're going to
pay more, But even worse than that, you're not going
to use the system, and far greater cost is incurred
not only by the patient, but when somebody's afraid that
Kathleen mentioned this earlier. When you're afraid to use the system,
you get sicker, and then you get to that point
where first you have to use the emergency room, and
then you have to use, you know, a hospital that
(22:03):
isn't prepared to deal with all the things that you
need and will charge you as much as they can effectively,
and so it's just it's a cascading problem that I
agree with Kathleen.
Speaker 12 (22:14):
Those ten states need to come around.
Speaker 9 (22:17):
And Jeremy Texas.
Speaker 14 (22:19):
It's more dangerous for a women to have a baby
in Texas than in many third world countries, in large
part because many of those women do not have healthcare
before they get pregnant. They have trouble getting healthcare while
they're pregnant. They're in much worse physical condition to bear children.
And we have the one of the highest rates of
maternal mortality infant mortality in the developed world, and that
(22:42):
is really, again just horrifying. But a lot of it
is because folks do not have the coverage that the
law has entitled them to since twenty fourteen.
Speaker 12 (22:52):
Now they're just a frame. It's always more expensive not
to use the system.
Speaker 1 (22:56):
Let's go to Susannah who is in Lehigh Utahs Xanna,
welcome to the middle Go ahead with Mark Cuban and
Kathleen Sibilias.
Speaker 11 (23:04):
Hi, welcome and thank you. The thing is for me
is failed the system. I'm originally from Argentina and for
two years I've been and told the doctors Ping Pong
I was the ball and charged me one thousands of
dollars misdiagnosed, and I need to flew to my country
(23:25):
to get the health care to found them for a surgery.
I have a seven thousand dollar searchery which went here.
They will cost me one hundred thousand dollars and m
or simple simple test like a m ORRI is four
thousand dollars here in state the Utah. Even if I
have insurance HSA, all they hold in Chilada that you
(23:48):
have here and health care and there is one hundred,
one hundred and fifty dollars you prevent the people get sick,
you know how you say it just now then you
scared to go to the doctor because it's scary to
found out what's going on with you, and they tell
(24:09):
you take the deal, go home, and you even have
a diagnose. I think everything need to be need to
be more human.
Speaker 1 (24:18):
Susanna, thank you, thank you so much for that. Kathleen Sibilius,
what do you think about that the doctor need to
be more human? I mean, it is interesting to hear people.
Anybody that comes in from another country always says that
their healthcare health care system is better, although often they
have long waits.
Speaker 14 (24:34):
Yeah, I think it's it's shocking to people, both people
who didn't grow up in this health system to experience it,
and they're a lot.
Speaker 9 (24:45):
Of times horrified.
Speaker 14 (24:46):
And folks who are traveling in Europe or South America
or Asia when they get sick and go into a
hospital and get a fifteen dollars bill or you know,
they have to pay for the cab ride home and
they just cannot believe, you know, they they don't have
gendarmes chasing them around the countryside. I don't think there's
any question that anybody anywhere in the world, if they
(25:07):
are very ill, want to come to the United States
for care.
Speaker 9 (25:12):
I mean, there's just no question.
Speaker 14 (25:14):
We have the best science available, we have the best
equipment available, we have the best hospitals available, we have
the best physicians, nurse practitioners, others available. If you have
resources and you're anywhere, you want to be here. But
that care isn't universal and it's not available to a
(25:34):
lot of the people who live here day in and
day out.
Speaker 1 (25:37):
Let's go to Haroun who is in Dallas. Harun, welcome
to the Middle Hi.
Speaker 16 (25:42):
Thank you for kaut taking my call. Yeah, I work
in the healthcare field, and you know, it's the honest.
I am a physician and I just want to comment,
And first of all, I'd like to applaud mister Cuban
for his cost plus A program. I think good that
people can see that and get medicines at affordable rate.
(26:04):
Only wish that more people knew about it. Whenever I
talk to my patients, you know, not many people know
about it. Aside from that, you know, I think the reason,
you know, one of the comments from one of the
callers was, you know, if doctors could be more human
and you know, doctors in this current system are currently
so stressed by all the regulations put on top of them,
(26:29):
and that you know, their reimbursement selves are tied to
generating and through putting more patients and supervising more and
more Snarus practitioners. That the burnout rate for the physicians
in this country is the highest in the world. The
suicide rate for physicians is the highest in the world.
And when you have less doctors' costs are going to
(26:50):
go up because you know, there's only so much that
certain physicians can do. What a small number of physicians
can do. Aside from that, I'm also an advocate for
either a single payer system or a public option. You know,
there should be more options for people. Multiple times I
have to, you know, try to get a peer to
(27:12):
peer to view, and there are refusals for procedures on
my patients, and very rarely do I get. You know,
it's supposed to be a peer to peer, but it's
surprising that often you may not even get a position
of the same specialty, or not even get a position. Yeah,
you know, you get a nurse practitioner or a or
a PA who has not practiced in that field. So
(27:33):
how is that a peer to peer? And you know,
you get still refused.
Speaker 1 (27:36):
Let me give our guests a chance to respond to that.
Mark Cuban a lot there. Obviously, I do want to say,
after the COVID pandemic, what an amazing thing that all
of the doctors and nurses and people in the healthcare
industry did for all of us. But also we're coming
back again to this idea of a single payer system.
I wonder whether you think that that ship has sailed
in the United States or if that's eventually where we'll
(27:58):
end up.
Speaker 13 (27:59):
No, I mean it's not saled. But again, you need
complete transparency a lot of the problems the doctor was
referring to. You've got private equity owned vertically integrated hospitals
and clinics that are looking to extract every dollar that
they can, and then you have the big insurance companies,
the Buka bucahs, who are trying to do the same
(28:21):
thing at the same time, and so they put together
programs that make it nearly impossible for doctors to do
their jobs right. Because the provider wants to run through
as many patients as they can at as high a
code of price as they can get. The insurance companies
don't even mind the higher prices, but they want to
(28:42):
charge the employers as much as they can charge, and
as a result, doctors don't get the opportunity to just
do their job. We're working on a program cost called
cost plus Wellness, where we're going to be direct contracting
with providers and tell them it's all cash paid from
the employer. There are no prest there are no other
requirements of doctors for additional documentation. We're going to trust
(29:06):
the doctors and as a result, we're getting pricing from
major providers at less than medicare pricing and so that's
going to change everything.
Speaker 1 (29:15):
We'll stand by. There are more calls coming in, but
you know, Tolliver. One of the drugs that has been
a centerpiece of the conversation about high drug costs has
been insulin, which for some Americans is now capped at
thirty five dollars a month.
Speaker 12 (29:28):
Yeah.
Speaker 2 (29:28):
And here's Illinois Senator Dick Durbin, who is my senator
for a long time. Here is in twenty nineteen grilling
pharmaceutical executive James Stancil on the soaring price of the
diabetes treatment.
Speaker 17 (29:38):
Do you have an idea what's happened to the cost
of insulin. Let's take a look at Humologue, which is
made by Eli Lilly based out of Indianapolis. Humologue in
the nineteen nineties was selling for about thirty nine dollars
a dose. It is now selling for three hundred and
twenty nine dollars a dose. And I can tell you,
having met with some people in Illinois who's ki goods
(30:00):
or facing diabetes, it is a burden which many of
them just can't handle anymore.
Speaker 1 (30:06):
Again, that was in twenty nineteen. The cost of insulin
has been capped for many Americans at thirty five dollars
a month, and TELLIVI, do you know what else people
can do for thirty five dollars a month or even no. Seriously, though,
we are looking for your help here at the Middle,
and you can go to listen to the Middle dot
com and make a tax seductrible contribution. It can be
thirty five dollars a month, or it could just be
(30:27):
thirty five dollars. It was a dollar a difference, that's
a that's a dollar day for the month, almost a
little bit more. Anyway, make a contribution. We really appreciate it,
and we'll be right back with more of your calls
on the Middle. This is the Middle. I'm Jeremy Hobson.
This hour, we're asking you why is our healthcare so expensive?
And what do you want the next president to do
(30:48):
about it? You can call us at eight four four
four Middle. I am joined by former Health and Human
Services Secretary Kathleen Sibelius and businessman and founder of cost
plus Drugs Mark Cuban. And before we go back to
the phones, Kathleen Sibilia's healthcare is very regularly politicized by
elected officials, But do you think that most Americans see
(31:09):
healthcare as a political issue.
Speaker 14 (31:13):
Now, I think most Americans see healthcare is a very
personal issue. It is the most important asset that anybody
will ever have. People are terrified that if they get
sick or a family member gets sick, that they will
not be able to provide care, that they will not
be able to afford the medicines, that they will not
be able to keep that person safe. About half the
(31:36):
people in medical bankruptcy are people who have insurance who
got into a situation where the family member was terribly.
Speaker 9 (31:45):
Ill, and the bills just keep piling up.
Speaker 14 (31:48):
And I think it's just an example of people who
thought they were doing the right thing. They bought health insurance,
they kept their health insurance, and still they can't pay
the bills when somebody gets sick. And so I think
what terrifies people is when folks just say, you know,
we're going to cancel this law, We're going to cut
millions out of Medicaid.
Speaker 9 (32:07):
We're going to make sure that you.
Speaker 14 (32:10):
Know, Medicare won't exist in the future. The government spending
too much money. Well, the government is the biggest health
insurer of people in this country. That two hundred million
people rely on Medicaid, medicare or the marketplaces right now,
that's a big chunk of the country. And you know,
folks who just want to slash that are terrifying a
(32:31):
lot of human beings.
Speaker 1 (32:33):
Let's go back to the phones at Joshua, who is
in Minneapolis. Joshua, welcome to the middle Go ahead.
Speaker 10 (32:38):
Hi, thanks for having me. You know, I'm a physician,
and you know, one of the things that I see
as adding to the cost of healthcare in this country
is that the cost of education of educating physicians, and
you know, more than just physicians, but also just anybody
(33:01):
in general. The cost of to be a physician. You
need to go to a four year college, which you know, average,
you know, could average you know, forty thousand dollars a
year for four years. Then you have to go to
medical school, which you know it's going to cost you
another fifty sixty thousand dollars a year, probably more. You know,
I don't even know.
Speaker 18 (33:20):
I went to medical school in nineteen ninety eight, so
it was different then, yeah, right, you know, it sort
of forced, it forces the hand of you know, physicians
trying to pick your career towards you know, higher paying specialties.
So you have sort of this economic incentive that physicians
(33:41):
have to make. Well, I got to pay off my loans,
so I got to go into a specialty that's going
to make me money. So you're talking about dermatology, you're
talking about orthopedics, you're talking about you know, urology, cridiology,
And in order to keep costs down, you know, you
need more primary care providers who you know, can hand
you know, handle more common conditions at a lower price.
(34:05):
You know, and then you start talking about things that
had occurred in the past with HMOs and gatekeepers, and
you know certainly that you know, people feel that that's
going to take their choice away, and then they start
streaming you know, you know, death.
Speaker 19 (34:19):
Panels and all this, and you know, I think overall
we need to broaden you know, access by having more
primary care providers. And to do that, one option is
to just lower the cost of educating people in general
rights particular.
Speaker 1 (34:36):
Yeah, great point, Joshua Mark Cuban. Just the sheer cost
of becoming a doctor and making the money that you
need to pay off now those enormous student loans probably
is one of the problems. What do you think about that.
Speaker 13 (34:50):
I think being a med school should be free. At
public universities, they're about nine thousand slots, and the cost,
you know, with room and board and everything, all in
about one hundred thousand dollars a year. So my math
might not be right, but that's about nine billion dollars.
And for nine billion dollars, you can ask those nine
thousand dollars, nine thousand doctors to work in primary care
(35:13):
in exchange for the free school. And now all of
a sudden you have more doctors competing for those slots,
so you hopefully have better doctors, and then hopefully you
can work and create more residencies which expand the pool
of doctors as well. And I think for nine billion dollars,
given where we are in the total cost of healthcare,
that's a drop in the bucket.
Speaker 14 (35:33):
So Jeremy, there is a program at the federal level
called the Commission Health Core and it is actually just
exactly what Mark described, and some states have mimicked. At
Kansas actually did the same thing where if you agree
coming out of med school that you will work in
a primary care or on an Indian reservation or at
(35:56):
a federal some of the underserved areas of the country
in a federally qualified health center in an area where
there's a lack of doctors. Your loans are paid off,
and you qualify. It's kind of the Peace Corps for
healthcare workers. So you agree that service for a limited
period of time and your loans are paid off.
Speaker 9 (36:17):
And what happens is a lot of people. First of all,
it gives, to.
Speaker 14 (36:21):
Joshua's point, the freedom to somebody coming out with debt
to choose one of the lower cost practices. They may
want to return to their hometown, they want to be
in primary care, but they think, oh my god, I've got,
you know, hundreds of thousands of dollars, I've got to
pay it off. If that debt is paid, you could
make a choice. And a lot of people stay in
those initially appointed areas because they find it very fulfilling,
(36:44):
They find it very meaningful. We're going to have to
ramp up those programs in a dramatic fashion to you.
Speaker 9 (36:50):
Know, trade off.
Speaker 14 (36:51):
If you're willing to work in primary care, if you're
willing to work in gerontology, if you're willing to become
a nurse practitioner.
Speaker 9 (36:58):
Runa.
Speaker 14 (37:01):
You your school is forgiven, and maybe upfront some of
that money so people can go to school if they
feel like they don't want the cash.
Speaker 1 (37:08):
To begin with, let's get to Emily, who's in Colorado Springs. Hi, Emily,
Welcome to the middle Go ahead.
Speaker 19 (37:15):
Hi.
Speaker 20 (37:15):
Yeah, I'm an internist here in Colorado Springs, and I
wanted to make two comments. One on Medicaid, which has
been fantastic in Colorado Springs. Because Colorado Springs expanded Medicaid.
We got a bunch of healthy, working folks on the
Medicaid rules, people out of the emergency departments and into
(37:38):
the clinic for primary care where we can do prevention
and take care of things like urinary track infections, which
cost a ton of money in the emergency department. So
we expanded Medicaid so people that you know don't make
enough money to participate in some of those healthcare exchange
(38:01):
program those can be pricey, and that just lower the
cost in Colorado for everybody.
Speaker 6 (38:11):
You know.
Speaker 20 (38:11):
I came out of Texas, where you have to be
disabled or pregnant and no specialists take Medicaid. You have
to beg favors to get a Medicaid patient seen by
a cardiologist, a neurologist, or send someone to a volunteer
clinic often and that is definitely not the case in Colorado.
I can get my patients seen by any specialists in town,
(38:35):
which is fantastic. And then I think politically, there is
this idea that Medicaid is being given to free for
everybody that you know crosses the further I legally, which
is absolutely not true. And I think we would lower
cost if people could buy into programs like Medicaid. I
(38:57):
unfortunately have patients get kicked off Meta Dead because they've
gotten a new job and now they're making sixty four
dollars a month too much, and so they fall back
into that in between pool.
Speaker 1 (39:09):
It sounds like a strong vote for medicaid in Colorado
and the Medicaid expansion there.
Speaker 14 (39:15):
Kathleen Sibelius, Emily, will you come to Kansas and not
the heads of some of our legislators.
Speaker 9 (39:21):
We're just right over the border.
Speaker 14 (39:23):
You can come over here and tell your story because
we really need to help. But I think you've just
described perfectly. To get lower income workers into Medicaid actually
lowers everybody's costs and you know, reduces the emergency room visits. Also,
you know, some of those women we were talking about
(39:43):
in Texas. They can be in healthier shape when they
decided to have a family and get pregnant, and then
they are better off, their baby is better off, they
can return to work.
Speaker 9 (39:52):
I mean, it's a win win win.
Speaker 14 (39:54):
But please come to Kansas and I'll set you up
with a little lobbying assignment.
Speaker 1 (39:59):
Perfect. Lynn is in is it high Park? Illinois? I
know there's a Hyde Park in a Highland Park, But Lynn,
you probably know I'm talking to you, so go ahead.
Speaker 5 (40:09):
Yes, yes, Hi. My name is Lynn Belski. I am
an internest as well, and I think we all need
to remember that medicine is for the patients and not
only for other people to make money. That's number one.
Number two. I went into medicine to take care of people,
(40:29):
to be human and found that in the regular system
of medicine, but it just wasn't allowed seeing patients every
ten minutes. So I am a concierge doctor, although I
do have scholarship patients who do not pay the concierge see.
And what I found is I'm able to discuss things
(40:52):
like Mark Cuban's cost plus drugs and I was able
to save one of my patients eight hundred dollars a
month on her medication by going through Mark's cost plus
drawl of that I'm grateful for. And then the other
thing is I really feel that Medicare is a wonderful
(41:15):
service and if we could lower the age that people
enter into Medicare over time, I believe that that would
be a real benefit to a lot of people.
Speaker 1 (41:28):
Yeah, Lynn, thank you, And I'm going to go right
to Mark Cuban on that you probably made his day
just now.
Speaker 13 (41:33):
Yeah, I'm glad we could help Lynn. I'll comment on
the Medicare side of things. I think there's a challenge
right now with Medicare advantage. I think a lot of
the providers of Medicare advantage are distorting the services that
are available by offering zero or low premiums. And I
would recommend to everybody out there really do your homework
(41:54):
about exactly what the plan that you're looking at buying
truly offers, because they're you know, you may get a
gym membership, you may get dental, but when it comes
down to the things that are expensive and that you
really need, if you get sick, it.
Speaker 12 (42:09):
May not be available.
Speaker 13 (42:10):
And so be very careful and good old school medicare
is not a bad thing, particularly given that there's going
to be a cap of two thousand dollars starting next year.
Speaker 1 (42:20):
Mark kibanhms focusing on it as I'm sorry, it just
popped into my head. How much do you like focusing
on this versus basketball?
Speaker 16 (42:28):
Oh?
Speaker 13 (42:29):
I love this right, just be able to help people
and change the game. You know, Kathleen might not like
hearing this, but I think medicine. I think healthcare is
going to be the easiest business I've ever been involved
with to disrupt because by just being transparent that COSTPUS wellness.
Speaker 12 (42:44):
I described direct contracting.
Speaker 13 (42:46):
We're going to publish all of our contracts, and once
everything is in the public domain, and you talk about
what should politicians do, I've recommended to the Harris team
that they require that all provider ensure, PBM and affiliated
company contracts with anybody be published and available for everybody
(43:07):
to see. Because when that happens, we truly start to
have the steps towards an efficient market.
Speaker 1 (43:14):
Sorry, Kathleen Sibilius, I cut you off there.
Speaker 14 (43:16):
What were you going to say, no, no, no, I
just I mean I first, So I don't disagree with
Mark on much of what he's saying, I'd love to
see healthcare severely disrupted because I think it really needs it,
and it shouldn't be money driven. It should be patient centric,
and we're drifting far from that. All I was going
(43:38):
to say in Medicare advantage, I think it's critical that
people look at two things and not the silver sneakers
and health and wellness programs and whether you get a
second pair of eyeglasses. You need to absolutely look at
the drug program that's part of the package and make
sure that all the drugs you take or might take
are in that. And you need to look at the
(44:00):
list of providers that are in the network to make
sure that if you have specialty providers, a cardiologists, a
special hospital, that they're in it. And a lot of
people skip that, as Mark says, look at the premium
and say, oh, this is a great deal, only to
find out that their doctor isn't in the program and
the two medications that rely on are not part of
(44:21):
the drug plan. And so those are the two things.
Speaker 13 (44:24):
The health club is great, Yeah.
Speaker 1 (44:29):
Let's get let's get one more call in here. Attila
is in Grand Forks, North North Dakota. Attilla Welcome to
the middle. Go ahead.
Speaker 6 (44:37):
Oh hi, thank you guys for having me. I'm a
hospital bised physician and I'm originally from Hungary, a very
different halfcare settings. I've been in the US twenty years
and this is most I know about healthcare. But I
do think that the American healthcare expectations are certainly much
much different than anywhere in the in the word and
(45:00):
healthcare is becoming a consumer and customer based business or
organization that we primarily take care of our customers. And
the customers here have much more needs than in any
other countries, or at least they express more needs. What
(45:22):
I mean by this is is America really I think
one of your panelists had the abdominal pain went to
the emergency room in America. If in the emergency room
somebody comes in with abdominal pain and there is five
percent chance that the patient has appendicietist, ninety five percent
chance that I know what is wrong with the patient,
(45:44):
it's a distrength, right, It is nothing to worry in America.
If there is five percent chance they will get a
cat scan. In Canada, if there is ten percent chance
we'll get a cat scan. In Europe, if there is
thirty percent chance we'll get.
Speaker 1 (46:00):
Wow, Attila, thank you so much for that call. Unfortunately
we are running out of time there. But Kathleen Sibilia
is just briefly your thoughts on the expectations there.
Speaker 14 (46:10):
Well, I think that there are a lot of high expectations.
It also is true that unfortunately, unlike other countries, the
government doesn't own the hospitals. The hospitals are freestanding and
often now are venture capital based or whatever base running
those machines twenty four to seven. Doing more MRIs, getting
more butts in beds is the way they make money.
(46:31):
So we have a lot more diagnostics done in the US,
we have a lot more tests done, we have a
lot more test charged, and I'm not sure it produces
better health outcomes, but it does pay a lot of
the capital expenses of the folks who bought those very
expensive machines.
Speaker 1 (46:47):
Okay, before we wrap up, Mark Cuban, since it's not
every day we have Mark Cuban on the show, I
want to ask you something. You have endorsed Kamala Harris
for president and in her campaign. You live in the
state of Texas, which is a state that hasn't voted
for a Democrat statewide in thirty years. First, do you
think that she should make a play at Texas, which
(47:07):
has been getting closer in recent elections? And second, why
do you think Republicans continue to do so well in Texas?
Speaker 13 (47:14):
You know, I can't really give you good answers there.
I don't really think about the political strategies behind it.
I just I support her because I like her approach,
I like her ethics. I like the fact that we
can trust her. I think that's what's been missing in
politics for too long, right, where we're not quite sure
(47:36):
that we can trust the person in charge. And I
feel like I can trust Kamla And so I couldn't
give you any of the details on the politics. I
try to avoid that side of it completely.
Speaker 1 (47:46):
And just stick to low cost drugs and basketball.
Speaker 12 (47:50):
That's all I need to do.
Speaker 19 (47:51):
Right.
Speaker 12 (47:51):
If I can help fix healthcare, yeah, I'm going to
be happy.
Speaker 1 (47:55):
Well. I want to thank my guests, a businessman and
entrepreneur Mark Cuban, founder of Cost Plus Drugs and former
governor of Kansas, and former Health and Human Service Secretary
Kathleen Sibilius. Thanks too much to both of you.
Speaker 12 (48:07):
Thank you so much.
Speaker 1 (48:08):
To be with you at Tolliver next week. We will
be talking about the role of Christianity in politics in
front of a live audience in partnership with WBHM in Birmingham, Alabama.
Speaker 2 (48:18):
That's right, and know that anything I say in Birmingham
is under the influence of a full rack of riebs. Okay,
I'm showing up loaded.
Speaker 1 (48:25):
There we go. The Middle is brought to you by
Longnock Media, distributed by Illinois Public Media in Urbana, Illinois,
and produced by Joanne Jennings, Harrison Patino, Danny Alexander, and
John Barth. Our intern is Anna Kadeshler. Our technical director
is Jason Croft. Our theme music was composed by Andrew Haig.
Thanks to the more than four hundred and ten public
radio stations that are making it possible for people across
(48:46):
the country to listen to The Middle, I'm Jeremy Hobson
and I will talk to you next week.
Speaker 10 (49:08):
Names
Host
Jeremy Hobson
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