How can we make healthcare cheaper?

Published Aug 2, 2024, 9:00 AM

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

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 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.

While that never happens, miracles do happen. Man, look at that.

I guess so.

Well.

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.

Yeah.

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.

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 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.

My name is sam I'm from Milwaukee, Wisconsin.

This is Mia calling from Denver, Colorado.

HI.

This is Chris not from Texas.

HI.

This is Samantha Calvin calling from Saint Louis, Missouri. Kamala Harris has the experience to be the next president of the United States.

She has my vote.

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.

I am happier to see Joe Biden step down.

But as a former Democrat now for Middle.

I am not completely sold on Kamala Harris.

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.

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?

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.

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.

Thanks for having me.

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.

Thanks, good to be with you.

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.

Because there's no transparency.

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 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 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 completely transparent about the cost of any sale of any medication to a patient.

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?

Oh yeah?

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 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 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.

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.

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 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.

Act was passed.

But we don't have a healthcare system.

We've got pieces of a puzzle.

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 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 people pay some of their bills. But we still have a very disjointed, very complicated system, and most people cannot negotiate it well.

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 do you think, as a member of the private sector, is that true? How do you view the healthcare system overall in the US.

So two things. My friends are the same friends I had in high school, grade school, college.

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.

Point, there is so much the.

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 employer's self insurance, they have no idea what they're going to pay.

If it's in work network versus out of network, it's a different price.

You know.

There's just so many ways that everybody skims off the system.

And so.

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 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.

Okay, if I can jump in Jeremy just for a second, because I think it's both a lack of transparency.

I would agree with that whole heart.

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.

For your health care.

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. 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.

Well, you know, somewhat different things like Mark.

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.

You know.

The crazy part is that if you just walk in with a credit cardd into the hospital will pay less than the biggest compent.

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.

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.

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 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.

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, 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?

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.

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.

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. 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 run it like a business. We have the most expensive healthcare system, but not the best results.

So what do you suggest, Bob? Are you are you? Are you saying there should be like a universal healthcare, single payer situation?

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.

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.

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.

And right now, because of rebates, because of in network, out of network, all.

These different issues, nobody knows the real price of healthcare.

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.

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, 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 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 saying we will get you a discount on various drugs, and they say to the drug companies, we will help distribute your drugs.

They will not tell anyone they are not regulated by the federal or the state governments.

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.

But Mark's group.

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.

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 they're getting ripped off.

And the big PBMs, by the way, are like express Scripts, CBS, Care Mark, and United United Health.

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, 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.

Let's let's do it and they become more.

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.

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. 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 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 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 more empowered in their medical choices.

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 at a higher income level, which is still a very low income level on Medicaid.

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.

It's the best cost.

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, 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 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.

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?

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 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.

Those ten states need to come around.

And Jeremy Texas.

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 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.

Now they're just a frame. It's always more expensive not to use the system.

Let's go to Susannah who is in Lehigh Utahs Xanna, welcome to the middle Go ahead with Mark Cuban and Kathleen Sibilias.

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 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 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 you take the deal, go home, and you even have a diagnose. I think everything need to be need to be more human.

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.

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.

Of times horrified.

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 are very ill, want to come to the United States for care.

I mean, there's just no question.

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 lot of the people who live here day in and day out.

Let's go to Haroun who is in Dallas. Harun, welcome to the Middle Hi.

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. 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, 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 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 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 how is that a peer to peer? And you know, you get still refused.

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 end up.

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 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 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 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.

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.

Yeah.

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.

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 or facing diabetes, it is a burden which many of them just can't handle anymore.

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 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 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 healthcare as a political issue.

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 people in medical bankruptcy are people who have insurance who got into a situation where the family member was terribly.

Ill, and the bills just keep piling up.

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.

We're going to make sure that you.

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 lot of human beings.

Let's go back to the phones at Joshua, who is in Minneapolis. Joshua, welcome to the middle Go ahead.

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 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.

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 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. 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.

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.

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.

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 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.

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 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.

And what happens is a lot of people. First of all, it gives, to.

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, They find it very meaningful. We're going to have to ramp up those programs in a dramatic fashion to you.

Know, trade off.

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.

Runa.

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.

To begin with, let's get to Emily, who's in Colorado Springs. Hi, Emily, Welcome to the middle Go ahead.

Hi.

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 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 program those can be pricey, and that just lower the cost in Colorado for everybody.

You know.

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, 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 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.

It sounds like a strong vote for medicaid in Colorado and the Medicaid expansion there.

Kathleen Sibelius, Emily, will you come to Kansas and not the heads of some of our legislators.

We're just right over the border.

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 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.

I mean, it's a win win win.

But please come to Kansas and I'll set you up with a little lobbying assignment.

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.

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, 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 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 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.

Yeah, Lynn, thank you, And I'm going to go right to Mark Cuban on that you probably made his day just now.

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 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.

May not be available.

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.

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?

Oh?

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.

I described direct contracting.

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 to see. Because when that happens, we truly start to have the steps towards an efficient market.

Sorry, Kathleen Sibilius, I cut you off there.

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 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 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 the drug plan. And so those are the two things.

The health club is great, Yeah.

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.

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 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 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, 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.

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.

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. 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.

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 has been getting closer in recent elections? And second, why do you think Republicans continue to do so well in Texas?

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 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.

And just stick to low cost drugs and basketball.

That's all I need to do.

Right.

If I can help fix healthcare, yeah, I'm going to be happy.

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.

Thank you so much.

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.

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.

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 the country to listen to The Middle, I'm Jeremy Hobson and I will talk to you next week.

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The Middle with Jeremy Hobson is a national call-in talk show focused on bringing the voices of Amer 
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