CareTalk Podcast Episode #100 – What is the Future of Healthcare?

Will we ever get pharma pricing under control? Will value-based care catch on? Will the demand for home healthcare continue to grow? In our 100th episode of CareTalk, John and David speculate about the future of healthcare in the U.S.

David Williams:

Welcome to CareTalk, your happy home for incisive debate about healthcare business and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David Williams:

Hey, John, it’s episode number 100, and I think we should talk a little bit about trends. You’re not trending and I’m not trending, but let’s talk about what is trending. One thing is trending is about people are being vaccinated and the so-called skeptics are coming around. What do you think of that?

John Driscoll:

I think there’s almost too much news about what’s not going right. The reality, David, is that the number of people being vaccinated is going up. Because the president didn’t hit his goal of getting 70% of the country vaccinated by July shouldn’t distract from the fact that, incrementally, as the world’s going back to work, a lot more of the people who are going to work are getting vaccinated.

David Williams:

John, what I understood, I saw a recent survey and it was saying that people who were hesitant before or just waiting, well, first of all, they say, “Millions of people have been vaccinated and they seem to be doing okay.” They’re hearing from people that are pro-vaccine, notably physicians, their own physicians tend to be very pro-vaccine, friends and relatives. They’re also finding out that, hey, if I’m not vaccinated, maybe I still don’t have to wear a mask, but there are some other things I might miss out on. One person mentioned, well, they couldn’t go on a cruise unless they were vaccinated. Guess what? Going on the cruise was more important than whatever hesitancy they may have had.

John Driscoll:

Well, I think you’re reading those newspaper surveys as opposed to doing your own thinking. I mean, it was pretty clear, David, that there was always going to be a long tail. The reality of a lot of working class people is they are working one or two jobs, getting a vaccine is kind of complicated, but it shouldn’t surprise people that it’s going to take time to deliver a couple hundred million vaccinations to people. There is skepticism out there and disinformation, but more people are getting vaccinated every day. That, I think, is a cause for celebration, David.

David Williams:

Well, John, episode 100, let’s look to the future. I kind of like that because you could put your long tail between your legs in shame when your predictions come out to be-

John Driscoll:

You can just make the stuff up.

David Williams:

What do you mean make it up? You accused me of reading the newspaper, oh my God. I will admit, I’m still one of those guys that actually receives the newspaper on the doorstep.

John Driscoll:

You’re supposed to have your own opinions, David, your own opinions.

David Williams:

I have my own opinion after I read the op ed page, John.

All right, listen, let’s talk about the future. Now, I know for you the future is sort of like, “What am I having for lunch?” so let’s start easy. Let’s start with the next few years and then let’s look further ahead. What do you say? In the near term, let’s say the next few years, do you think there’s going to be just incremental change in healthcare or are we going to see more radical change?

John Driscoll:

We’re in a period of radical disruption, David. You’re going to see a re-imagining of what can happen with drugs and biology as cancer increasingly becomes a chronic condition. You’re going to see, I think, the structural shifts in value-based care. David, we’re going to finally start being able to manage the prices of the drugs that are manufactured by your friends in pharma. I think we’re in for some really radical changes in the next five years.

David Williams:

I don’t think so, John, I think it’s going to be more of the same, only a little different. I think on drug pricing, big talk, talk the talk but walk the walk, or whatever it is that’s happening isn’t going to be much, I think. You saw what I was thinking before, well, maybe this new biogen drug for Alzheimer’s here, maybe that’ll tell people, forget it, we’re going to have to cut prices. Eh, I think there’s still going to be plenty of price increases.

Value-based care, you talked about these two-sided risks. I think what happens is people love the idea of upside, so we’ll get upside. The minute you tell them, “No, we want you to take downside too,” we’ll say, “See you later, this program isn’t really for me.”

I think, John, here’s another one. The shift to the home that you love talking about, I think, you know what? It’s the same way that people were ordering out and now they’re going back to the restaurants, they’re going to go back to the hospital too.

John Driscoll:

Look, first of all, David, that shift to the home is permanent. There’s nobody who’s sick or vulnerable who will ever forget the fact that they didn’t have to put themselves at personal risk and could actually get a lot of care delivered virtually. We’re in the early innings of what can be delivered virtually and in the home, that’s going to radically expand, but we’ve permanently shifted the way people think about virtual care. At a state and health plan level, there’s a lot of skepticism about telehealth, but one of the few explosions of bipartisan support for change was a bill that Senator Brian Schatz from Hawaii came in to permanently lock in protections to provide access to telehealth for Medicare. It was a bipartisan support, even some of your friends supported it.

On drug pricing, there’s just no way we can afford the path we’re on. There’s no way we can afford annual drug increases in simple, almost commodity chemical compounds. You’re going to see these great new drugs come out, but at some point the feds are going to say, as more and more people, 10,000 people turning Medicare eligible every day, more and more people covered by Medicaid, government payers representing 51 cents out of every healthcare dollar, the breaks are going to be put on, David. You wait. It won’t quash innovation. It’ll just slow down the vacuum cleaner, maybe shut it down, that sucks all the costs out of the system and shifts it into the pockets of the corporate chieftains in pharma.

David Williams:

Well, John, I’ll stick with the dog analogy and dog metaphor here and I’ll throw you a bone, okay? Here’s my bone for you. I think that there’s a possibility of more radical change in the next couple of years on a couple of topics. One has to do with just the disaster from COVID and maybe a new pandemic, and also climate change. You see climate with this extreme heat and drought-

John Driscoll:

You’re not going to give ground on the fact that you’re wrong on drug pricing. You are wrong on the shift to the home. There will be more two-sided risk from both the federal government and the private sector. That will be part of the next phase, and you’ll see some of the most successful medical groups and hospitals will be making money with fully capitated or fully one side up. The two-sided risk that you’re referring to, it obviously is that you would keep all the money if you hit the budget and you would lose money if you don’t hit the budget. It’s the risk sharing that’s going to get pushed down. But you’re wrong on those three and so now you’re going to slither over to another topic?

David Williams:

No, John. I think you said it was some guy from Hawaii that likes to be at home. Well, no kidding. Have you ever been to somebody’s house in Hawaii? It’s pretty awesome, no wonder they don’t want to go to the hospital. They want to go to the luau and look out at the ocean. I think, fine.

But I was getting another one, John. Another reason for radical change is abortion, John. It’s going to become effectively outlawed in most parts of the country. That’s what I think could happen over the next two, three years.

John Driscoll:

Well, I don’t think it’s going to happen in most parts of the country. I think you’re going to have another big red state-blue state divide on that. Again, don’t overwork your points here, David. There’s some radical really restructuring of any access or right to choose in a number of red states. As the Republicans become more defined by the extremes, I think you’ll see that, but I think you’ll see, unfortunately, from my perspective, it will go back to where we were many years ago, where it was a state-level decision, as the access to that choice is reduced in red states. But you don’t need to just overstate things just because you lost in the first three.

David Williams:

John, I got another tactic here, which is let’s not talk about five years, let’s talk about 50 years. Pick your number, somewhere down the pike.

John Driscoll:

I suppose you don’t think anything’s going to happen then.

David Williams:

Oh no, there I’m a radical, John.

John Driscoll:

Oh, so now you’re moving to my position. Tell me what happens in 50 years, David.

David Williams:

Oh, in 50 years, John, I will be over a hundred and I’m going to be probably a cyborg at that point.

John Driscoll:

You’ll be augmented reality, you’ll be augmented David Williams. We’ll be able to remember. People talk about cyborgs, but look, we replace shoulders, we replace knees. We have recently, through some implants, are looking to see whether we can leverage folks’ systems who are paralyzed to move some of their limbs. We already regularly in baseball do a Tommy John, which is a radical resection of the way you are genetically and anatomically set up to throw a baseball. We have a number of performance enhancing drugs that people use for mental clarity. David, I think you’re going to be a very clear thinking, mechanically supported, perhaps even enhanced version of your old self.

David Williams:

Nice. Well, John, I was going to say, I hope I don’t become a figment of your imagination, where you download my brain for 99 cents on the app store And just tuck it in somewhere onto your whatever device is being used inside of your head.

John Driscoll:

It wouldn’t require much storage.

David Williams:

Yeah, exactly. I’d make it a cheap one. They say there’s a life expectancy and there’s lifespan. People have been able to live since biblical days until like 115, 120, but most people didn’t live more than 20 or 30 years.

John Driscoll:

Are you going to do the Old Testament thing for-

David Williams:

Even the New Testament, John.

John Driscoll:

Is that your [crosstalk 00:09:58]?

David Williams:

In the Old Testament some people lived to almost a thousand, but let’s just crank it back down and just say 120, but the average person is living more like into their 70s now. It could definitely get up to the 90s without doing too much more.

John Driscoll:

How strange is it, David, that we don’t treat aging as a chronic condition? The fastest growing population we’ve got in the US, from a demographic perspective, is those folks who are living beyond a hundred. We’re only now starting to really study in detail what it would take to live a longer life and increase your lifespan, which is a measure of not just time but health.

Yeah, I think what you’re going to see in the next few years is places like the National Institute of Health and academic institutions, you’re starting to see it in the private sector, are really going to treat aging is not something we can solve, you and your brain downloaded your iPhone, but something that we can extend lifespan because we study it as a cluster of things that are about physical decline. Then the same way that we can extend life in a healthy way beyond what the average European, the life that they had in 1850, by 1950, you’ve added about 30 or 40 years to the lifespan. You’re going to see, I think, that same increase, but it’s going to be based on science, David, those scientists that you don’t like to pay attention to.

David Williams:

Yeah. Well, the thing is, John, if people are still going to retire at age 65, you won’t have to change the Medicare age to have Medicare for all if people are going to go from having it from an average of 10 years to let’s say 35 years or maybe 50 years if they live that long.

John Driscoll:

Well, if we can actually crack some of these chronic diseases like diabetes, heart disease, COPD, by the combination of public health and some of the augmented things that you were talking about, I think you’re going to see lifespan and age increase, but we have to change our point of view here and look at aging itself and the illnesses associated with it as a chronic condition that we should be able to mitigate and improve with a combination of drugs, diet and behavior.

David Williams:

John, if we think beyond just lengthening your own miserable life as it is now, what superpower would you like to add? What augmentation, that we can talk about on the show, would you be stepping up for first?

John Driscoll:

Well, I think the thing that I’d like to see is for us to really dial up the way we think about maintaining people’s internal health and their musculature. I mean, the reality is that depending on diet, behavior and drugs, you could be really damaging your insides. I think we haven’t cracked all the public health opportunities there, although we have in smoking, which is directly tied to increasing lifespan and life and longevity.

But I think if we could find a way to slow the physical decline of people so they would enjoy their life more, that’s a superpower I’d like, not just for me but for a lot of aging folks, because we’ve got a lot of people with active brains and inactive bodies. If we could slow that, you’d really have a radical increase in lifespan, and I think honestly, you’d have more people working and enjoying productive lives for longer.

David Williams:

Well, I’d like to be a bit more ambitious, John. I’d like to have super hearing. Remember that book, Horton Hears a Who? Yeah, Horton Hears a Who. I think that’s probably Dr. Seuss, I don’t remember whether we’re allowed to talk about that anymore or not. But I would like to have super acuity of my hearing and be able to tune out stuff so I could go to a concert without actually having to go there, but I could hear live music wherever it might be in the world. I could just point my ear at it and I could hear somebody playing in London or something like that.

John Driscoll:

You’ve got a lot of that technology That’s starting in some of the more advanced hearing aid stuff, but what’s problematic is we don’t study it. We don’t study the positive potential impacts of growth hormone and steroids and some of these augmentations. We tend to look at health and health enhancements outside of pro sports as something that’s either out there, banned or limited. I think if we were to expand our view of what represents not just studying illness, but how to promote health, we might find that some of the technology we’re using today for people with problems with hearing could help you augment your desire and interest in hearing more live music even if you don’t want to be around the people you’d be at live music with.

We really have to change the way we look at health and illness. I mean, illness for sure needs a lot of attention, but health needs a heck of a lot more promotion and we haven’t taken this wonderful medical industrial complex, and really aimed it at that. Instead, when you talk about things like steroids or human growth hormone or some of the enhancements, we ban it and don’t study it.

David Williams:

John, you’re dancing around the Viagra, which I thought you had studied quite extensively.

John Driscoll:

Well, talk about a drug that’s changed behavior and the enjoyment of lifespan. I’m glad you brought up your favorite drug. I think that it’s probably the most successful launch ever, but it’s a great example of a drug that has enhanced the lives of millions.

David Williams:

John, the biological revolution, which you’ve touched on a little bit, I think really could have some amazing possibilities that we haven’t thought of. One though is about the merging eventually of psychiatry with physical health. There’s been huge issues with behavioral health and you see big linkages where many people that have a physical health issue also have depression. People say, “Well, maybe that’s just because you’d be depressed too if you saw what was happening with your life trajectory,” but actually these things may actually be really tied together. I think getting to the breakthrough is to really understand how the brain works and being able to tie it all together could make a gigantic difference, as big as some of these other areas like infectious disease, that can make a huge difference on wellbeing for people.

John Driscoll:

Well, there’s no question we’re learning a lot more about how irrational we are, all of us are, every day, not just you, David, through the integration of psychology and economics and behavioral economics. But what’s remarkable and what a lot of folks don’t realize is we still don’t really know at a discrete level how the brain works, how thoughts are formed and how some of these crippling diseases, we can stop them in some cases with drugs or slow them and change them with cognitive behavioral therapy. We can use your robots to help slow or limit or teach people skills around that, but if we could really understand how the brain works, I do think you’d have far more effectiveness of targeted therapy and you wouldn’t have what’s going on right now, which is we have to test a drug and hope that it works.

David Williams:

John, we haven’t made it to a hundred years yet, but we have made it to a hundred episodes. what’s your prediction about what we’ll be talking about on our 150th episode, should we be so fortunate as to make it that far?

John Driscoll:

I think radical changes in technology would be a good topic. Synthetic biology, the hardware that you’re going to put behind your ear, and some of the emerging science in extending life would all be great topics. David, we’re going to be able to grow new organs for you with synthetic biology. Think about that.

David Williams:

John, I’d say 50 episodes from now, it’s like a year from now, I’m going to stick with my original positioning. I’m going to call it 2022, a little more of the same.

John Driscoll:

2022, radical change.

David Williams:

Well, that’s it for yet another episode of CareTalk, our 100th episode. Thank you so much to our listeners for coming along on this ride with us. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. If you like what you heard, or didn’t, please leave a note and we would love you to subscribe.