#CareTalk Podcast – February 2019: Medicare for All?

#CareTalk Podcast – February 2019: Medicare for All?


– While President Trump has
been building a beautiful wall on the Mexican border
to keep out immigrants, we’ve got a beautiful blue wall
here on the Canadian border to keep out universal healthcare. – Tear down that wall. Universal coverage is coming, David. (upbeat music) – Welcome to #CareTalk. Your monthly home for incisive debate about healthcare business and policy. I’m David Williams, president
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. – Well, John, you remember
those litmus tests. Medicare for all is quickly
becoming a litmus test for presidential candidates
on the democratic side. What do ya think of it? – Well, it’s less of a litmus test than sort of a, it’s a brand extension to cover any new proposal around coverage. It’s really not Medicare for all. It is a, it’s really reflects the scream inside anyone who has to
deal with the challenges of coverage and cost for affordable coverage for all Americans. I wouldn’t get hung up
with all of the details, but what it really speaks to, you know, when three quarters of America is somehow supporting a
general Medicare for all, it’s means that the vast majority of Americans want affordable
coverage for everyone. But I think it probably
means, also, much more of a public, private mix
than you’re hearing about. What do you think? – John, I think Medicare
for all is a good label. People like Medicare. Remember in the Affordable Care Act, people came out and said,
hands off my Medicare? – Mm-hm.
– People like Medicare. And I think it’s much better tag to have on you rather than, you know, socialist, or universal
coverage, universal care, or, you know, single-payer,
or something like that. When the democrats get into trouble, is when they start
talking about eliminating private health plans, or
putting people on Medicaid. – Details. Details, details. The reality, David, is that Medicare today is a public, private mix. With private doctors and
private health insurers in Medicare, managed care,
which is working well. As well as, fee for service. The reality is, it is a system that works. And the reason why people like it, is access, coverage, some
amount of transparency. And a mix of public and private. So I think when people are
asking for Medicare for all, they’re really asking
for the kind of choices, options, coverage, and
support that they get in all the different forms of
Medicare that exist right now. – Well, we’ll have a chance to
disagree a little bit later. But I got to agree with you here, John. I saw a tweet that actually talked about, gee, which would I rather have? A coverage that, something
that pays for everything all the time, compared to what I have now? Something that sometimes
pays for part of what I have? So, I think it’s a good slogan. They should keep using it,
and it’s gonna bring them right to the White House.
– You should stop reading those tweets, ’cause that
was confusing, David. – I should stop reading it, yes. – So, David, what do you
think of this big move with home health agencies around, kind of, home-based primary care? – I mean, John, it sounds great. You know, doctor whatever is gonna come into my home and help me out. But let’s face it.
– Why are you so skeptical? – I’ll tell you why, John. Because what is this, where
is the scarcest resource? It’s the doctor, right? So you have a shortage of doctors. So have the patients come to them. I know it doesn’t look great. Have them wait in the waiting room instead of goin’ around, you know, from stuck in traffic, from
one place to the other, without their bag of stuff.
– David, David, David. Normally, you’re a futurist and you embrace the future, but the reality is-
– Yeah, maybe tomorrow. – Primary care and all of the breakdowns in coordinated care, a lot of them, particularly for chronically ill folks, can be helped with primarily primary care and care coordination
happening in the home. There are a lot of home-bound seniors, the Independence at Home Demo. Which was a big bipartisan
supportive innovation. Which doesn’t always happen in American healthcare.
– Right. – Has saved 10 times as much
money, on a per patient basis, as the Accountable Care
Organization initiative. Which was also a big
bipartisan initiative. You know, it’s saving a nearly $3,000 per Medicare participant per year. And that’s just not dollars of savings. It represents a significant improvement in the health of those folks who are chronically ill,
who are getting care. I think what you’re gonna see is not just doctors going in your home, but nurses, certified health
aides, a lot of technology. All starting to provide a supportive web for care in the home. That’s where the future is. And you better embrace it, or you’ll be left behind.
– All right, well I, I don’t wanna be left, no
American, no child left behind. But they still-
– No! No chronically ill person left behind, or outside the system. Care is coming to even your home, David. You’re looking kinda old by the moment.
– I’m gonna put an extra, I’m gonna put in a extra lock
on my door to keep it out. John, I’ll tell ya what. I’ll say, if regular
home visits of doctors, I think, isn’t gonna work. – Oh, you’re backing off. It’s gonna be too expensive. If the technology is
there, and if the protocols are in place, and if you leverage nurses and nurse practitioners,
then maybe you can do it. – You’re a Luddite. – Thanks, John.
– Care in the home is coming. – The Luddites weren’t really
against technology, were they? – Well, they (chuckles). – All right, John. So fine.
– Yes. – Now, how about, I have
an evil one for you, John. Drug rebates, finally. The government is saying,
crack down on those PBMs and their ridiculous drug
rebates, and that should take care of healthcare.
– So do you think that’s what’s driving up Pharma pricing? – That’s my understanding. – So, you think that the
people who are negotiating the discounts off of the
prices that Pharma is raising every month, Pfizer, 140 drugs last month. Pharma drives those prices up, and then somehow the
people who are negotiating the discounts are the problem? Like look, there’s clearly a problem when the-
– Clearly. – The entire system is
un-transparent in healthcare. And the rebates have not been handled in enough of a transparent way. But if you think that the
people raising the prices, big Pharma, are not
responsible for high prices, you’re just a tool (David laughs) of them. – I’m a tool of the establishment, John. – You are. And all of this conversation
about Pharma rebates is being driven by Secretary of HHS, who has done some great things, but on this one, he’s just
being the long arm of Pharma, is crawling its way through policy. The real problem here, is
Americans pay too much for drugs. Everyone knows it, and
the PBMs are just noise, and a side part of the system. – They’re just noise and they’re makin’ a lot of money from it. John, I find it offensive
that someone’s gonna decide what drug I’m gonna get, based on what rebate they can negotiate. And you know what? The rebates are going to somebody other than the end patient, who’s actually generating those rebates. That poor guy or woman-
– Well, I, no. I actually think-
– That’s gonna be like payin’ a bunch of money for this stuff. – But the proposal, the proposal to create more transparency and to
provide rebate discounts at the point of sale
is a really good idea. – Okay, thank you.
– And I think that’s gonna, but to be drawn into
this notion that somehow that’s gonna affect, by
providing direct discounts to the chronically ill, it’s
gonna affect the prices, that are going up every month, based on Pharma jacking up
prices, and extending patents, and leveraging the system
to keep a price level that is higher in the United States than any other industrialized country. You’re helping prop up a system that’s beggaring the American patient. This proposal is a good one, but let’s look at the problem here. Americans are payin’ too much
and we’ve gotta have someone, like the federal government,
start to hold the folks who are generating these monster profits, from Pharma, responsible
for reducing those profits and genuinely reinvesting
in the health of Americans. – Well, John, maybe if you gave me a rebate I’d be willing to agree with you. (John chuckling) So, John, the lightning struck
again with the Patriots, as we predicted.
– Yes. Yes, yes.
– Winning the Super Bowl. – But we always predict the Patriots. – We do, but it’s-
– It is Boston. – It’s the safe bet. How ’bout Lightning Round? Do you think that could strike again? – I’m ready. (electronic buzzing) – President Trump promised a whopping $50 million a year for childhood cancer. What would you do with all that money? – Big man Trump, a pittance. Cancer’s a $96 billion problem. Obama, in 21st century cures, put over $5 billion into the NIH to help cure cancer,
kill cancer, save cancer. This is a joke. – Listen, for 50 million
bucks I think you could hire Lebron James and take
two trips down to Mar-a-Lago. – One trip down to Mar-a-Lago. (electronic buzzing) So, David. I know you’re watching all those drug ads while you’re kind of spacing
through the daily soaps. Now we’re actually gonna have a full drug list price in the drug ads. Do you think it’ll make a difference? – Well, John, I love those
drug ads, as you know. I love, my favorite part
is the side effects. Blue urine, hallucinations,
compulsive gambling. So why not just add the price tag? And 25,000, as well. I can’t tell if that’s ’cause
of hallucination, or what. I don’t think it’ll do anything, John. – Zero. (electronic buzzing) – John, Don Trump said he’s gonna end HIV transmission by 2030. Whoa, where’s that comin’ from? – David, where does anything come from from the Donald Trump? What say you? – You know, I remember
back when he was speaking with Howard Stern in the late 90s, and he compared avoiding STDs
to his own personal Vietnam. So I think maybe 2030 he’s
gonna be out of prison and he will be wanting
HIV to be done by then. – Well, he missed Vietnam, he’s probably gonna miss this too. (electronic buzzing) – Red Sox, Patriots. We predicted the last two big winners. Should we predict the Celtics
and the Bruins winners too? – Red Sox, Patriots. Let’s quit while we’re ahead. – Actually, let’s get
Belichick in there to coach the Celtics and maybe they
can win the World Series. – Go Sox. (electronic buzzing) – Well, that’s it for yet
another edition of CareTalk. I’m David Williams, president
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. Thanks for watching. Hey there, listeners. Want more #CareTalk? There’s more to be had
in our other episodes. So be sure to look for those, and subscribe to #CareTalk
on your favorite service. (calm music)

3 thoughts on “#CareTalk Podcast – February 2019: Medicare for All?

  1. I have to say, this is one of the most fast-paced, entertaining discussions about healthcare I've seen. Kudos.

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