20 – Making Healthcare Better Means Fixing Our Trust Problem

Vic: [00:00:00] You’re back champion again, world champion,

Marcus: two times, two times, pulled it off. I’m sore everywhere. And you’ve been

Vic: traveling all over the country.

Marcus: Yeah, we were on the road for nine days. Uh, well, Rachel and I were on the road for seven days. Uh, we did two days in Vegas for the, for the tournament, which was so much fun.

Um, shout out to everybody who goes out to world master to compete. It’s, it’s just awesome. It’s so much fun. Uh, and yes, had another successful run. Um, So I think I’m closing out the blue belt category. I’m going to go do one more big competition in December, but hopefully next year, my professor thinks I’m worthy to be graduated to a purple belt and new challenges next year, hopefully.

Um, and we had a great time in Vegas. Then we went to San Diego, spent five days there, but what a beautiful city. Diego’s nice. Yeah. Yeah. Beautiful city. And the weather was. Perfect. It’s always perfect. Yeah. Um, and then we, uh, then we parted ways. She came back home and I went to Chicago city of Chicago [00:01:00] for the Aspen Institute health innovators fellows reunion.

And last week’s episode was, uh, sort of a broadcast of that.

Vic: Yeah. I got to listen to it. It

Marcus: was good show. So what’d you think? What’d you think?

Vic: I thought it was great. I mean, it was really interesting to be in the audience listening. I don’t know. I was really struck with Anna Higui’s take on how the, the kind of landscape has shifted where it used to be that kind of, you could make money and Medicare advantage in other places by getting the patient in the right place.

Risk category and then you were kind of done and now I think she’s right. It’s shifted to That that work is completed and now we actually have to make improvements on these patients, which is really the right It’s a sign of progress. I think and I think right,

Marcus: right

Vic: um And then I thought and cameron matthews really stole the show She she’s she’s great.

But when she ended it you let her end it I think she gave a great [00:02:00] closing line, which is we have the tools Will be You and I talk about innovation all the time. We invest in innovation. We need to keep innovating forever, but, but we have plenty of tools. We need to use them. And it kind of closed it all up with Anna saying, this is what we need to do.

Let’s make the patients better under risk contracts. And Cameron saying, we, we have, we know what to do. We just have to kind of do it.

Marcus: Yeah. Yeah, for sure. And, and I, I, I enjoyed, uh, uh, Dr. You know, perspective of when they applied. equitable care, uh, you know, and, and actually did the correct amount of screenings for black patients.

Adding that into the protocol made care better for everybody. It just shows you like racism is like, just stupid. It’s bad business. It’s stupid, you know? Um, and yeah, well, it was a great time. I mean, I had a great weekend. Yeah. So how was the weekend after that?

Vic: I mean, dude, there’s a lot of, a lot of big brains in that room.

Marcus: Yeah, and big hearts. I mean, that’s, that’s the [00:03:00] other thing. I mean, they’re, they’re all wonderfully accomplished, brilliant people. You know, you’re, you have constant imposter syndrome in that room. Like why am I here? Um, but I think what is so special about that group is that they are all. On board, um, to make the healthcare system in the United States, more equitable and higher functioning.

Um, and they’re really, really passionate about it. I mean, like, it’s just, it’s not fake at all. I mean, these people are, to me, it’s like. If everybody could see this group of people, you would know why the healthcare industry is so important for us to pour into because really, I think we do have like the best people.

You know what I mean? I think this industry has the people who care about our society, you know, and, and want everybody to be, um, okay. So, um, it was an awesome weekend, man. I mean, getting to learn from, from everybody and share our perspectives and, Record a podcast. You know, they, [00:04:00] they asked us to do it. I mean, I didn’t, it wasn’t something that I pitched.

So, you know, thanks, thanks to Tanya Harris, who, who runs the program. And

Vic: yeah, and we, I complain, we, we point out things that need to be better. There’s a lot of great work that that’s being done right now. And so every little bit helps that patient. And we need to do more, but I think that’s right.

Marcus: Yeah. So it was a great weekend.

And then I came back home Sunday night and now I feel like I’ve been shot out of a cannon all week. You know, you only have to be gone a week to just like be so behind on everything, but I’m, I’m so I’m pretty much caught up at this point, you know, it’s been a, been a sprint the last three days.

I’m excited about today’s show. Um, you know, we have, we have a lot to talk about, so we’re, we’re going to start just with a quick note on the CPI since it did come out. Um, and I, it’s kind of no news, good news. I mean, it [00:05:00] is up. It’s largely from gas prices. Yeah. Um, it means that Powell is. Not likely to reverse course.

I mean, even if he does pause, he’s not likely to fully reverse course. And so more of the same, more of what we’ve been talking about. And I will say this. Um, one thing I’ve realized in my conversations over the last week and a half, as I’ve been traveling and talking to different people is, you know, You know, we talk about the CPI and the Fed pretty much every single show, right?

And I know for us, it gets boring to like talk about it all the time. And it probably, you know, for our diehard listeners, it probably gets somewhat boring to them. But there are so many people who do not. Understand that much of what we’re experiencing in the economy right now is driven by this one thing.

And that’s why it’s so important to watch it and understand it because as an investor and like, forget about like us being venture investors. I mean, what if you were home buyer, right? You know, you’re trying to [00:06:00] strategize when’s the right time to buy a home when, you know, this is driving that, you know, this is fundamentally driving that.

So there’s so many people who don’t. Understand that and they just think interest rates are up, but they don’t really get what’s behind it, right? And so they

Vic: just hear this stock market is struggling or people are complaining about the economy. Yeah For a minute in the summer. It seemed like we might have some growth again, but then it’s been it’s been bumpy So I think that’s right.

The Fed’s not gonna they’re certainly not gonna cut. Hopefully next week. They will not do anything soon But a lot of people are expecting another small rate hike

Marcus: before the end of the year, for sure, for sure. Um, so then you found an article in the Wall Street Journal, you know, that sort of said that, I mean, I think it’s kind of interesting, right?

Because I saw that stocks got bumped up a little bit on, on the CPI news, which, you know, it just feels like there’s this, this, uh, [00:07:00] This war of attrition between wall street and the fed, right? Where the wall, wall street investors just continue to say like, we don’t believe you, you, you know, you’re not going to keep going.

And he keeps coming out of Jackson hole saying I am going to keep going. So, you know, it’s, it’s been a, it’s been an interesting game.

Vic: Wall street makes a lot more money. On the upside. Yeah, so there’s a lot of people pulling for something to happen for their own personal bonuses, right? So this article is just sort of talking about where the fed’s headed.

We already covered it. It’s not really much news I wanted just to check and see because People watch this every hour, but there’s no, there’s no real change. It is an expectation that probably paused next week and then raise in November, then we’ll suffer through the winter.

Marcus: Yeah. The real winner. Um, all right.

So we’re going to take a. Early break, because we’ve got sort of a continuous stream of stories that we, we just could not find a good place to stop. So we’re going to [00:08:00] stop now and let Doug share a little bit about Jumpstart Foundry and then we’ll come back and kind of walk through a string of stories that have happened over the last seven days.

Yes. That just fire in rapid

Doug Edwards: fire. Thanks guys for the opportunity to talk about our pre seed fund Jumpstart Foundry. My name is Doug Edwards, CEO of Jumpstart Health Investors, the parent company of Jumpstart Foundry. We’re so excited to be able to talk about, uh, early stage venture investing. Certainly the need for us to change the crazy world of healthcare in the United States.

We are spending 20 percent of our GDP north of 4 trillion a year on healthcare with suboptimal outcomes. Jumpstart Foundry exists to help us find and identify and invest in innovative companies that are going to make a difference in healthcare. In our country every year jumpstart foundry invests a fund Raises a fund and deploys that across 30 40 50 assets every year Allowing ease of access for our limited partners To invest [00:09:00] to help us make something better in healthcare.

Some of the benefits of Jumpstart Foundry is there’s no management fees. We deploy all the capital that’s raised every year in the fund. We find the best and brightest, typically around single digit percentage of companies that apply for funding from Jumpstart, and we invest in the most incredible, robust, innovative solutions and founders in the United States over the last nine years.

Jumpstart Foundry invested in nearly 200 early stage pre-seed stage companies in the country. Through those most innovative solutions the Jumpstart Foundry invests in, we also provide great returns and a great experience for our limited partners. We partner with AngelList to administer the fund, making that ease of access, not only with low minimums, but the ease of investing in venture much better.

We all know that healthcare is broken. Everyone deserves better. Come alongside us with Jumpstart Foundry, invest in making the future of healthcare better and make something better in healthcare. Thank you [00:10:00] guys. Now back to the show.

Marcus: All right, we’re back. So we’re going to, we’re going to start by setting up this string of stories with what I would kind of call sort of a Because we know all the stories that we’re about to talk about, like a seemingly disconnected story.

Um, but maybe more, you know, a follow on to, to Anna’s, um, you know, discussion around value-based care, which is Val Walgreens. Um, it has ink to deal with Pearl Health, uh, to work in partnership to help, uh, physicians to switch to value-based care. Um, you know, this, this to me sounds like a much broader.

Model of what, you know, we’ve already seen several organizations doing. So it’s, it feels a little bit like a game of catch up here. Um, but you know, what, what are your general thoughts about the strategy of Walgreens trying to assist, um, Physicians to getting into value based care arrangements?

Vic: Yeah, I think it’s necessary, [00:11:00] maybe late and not quite enough, but, but.

But the necessary piece, Walgreens is struggling, I think, they, they don’t have what CVS has, which is, you know, an integrated payer, integrated, like, whole value based care strategy. Um, and they’re trying to catch up, right? Right. Um, the, the lack of the full payer stack is tough. It’s a pretty big gap,

Marcus: but

Vic: you know, that’s hard to acquire.

Took CVS a while to

Marcus: do it. Yes. Um, so I, I mean, I, I think the thing about value based care and taking on risk is what’s underneath that is that you have to actually develop a relationship With the patient, a real relationship with the patient. I think, I think this is a lot of what both Anna and Cameron were saying, uh, in, in our show last week, right.

You know, Anna was saying it from the perspective of you need real capital [00:12:00] to do this. Cause cause this is not a technology play. You need real people to provide real services.

Vic: Software engineers can’t go to a big health system and say, We’re going to take on risk because you don’t have any capacity to actually stand behind that.

You need capital to be credible.

Marcus: You need to be credible. That’s right. That’s right. Where are the people? You need, you need actual people, right? To do this. So, and then, and then Cameron, you know, really dug into just the depth of the relationship. Yeah, that they have, um, how they are out in the community, how they surround the person with, with everything that they need such that, you know, they can be healthy and therefore cost less money, right?

I mean, it’s a pretty simple equation. I think that was the point she was trying to make. It’s a fairly simple equation. You just have to care, but you have to have simple people. Simple is not easy. No, no, they’re not the same thing, which is why city block is such a standout. I mean, that’s

Vic: where I want to.

talk about for a minute is that, um, with chronic disease, [00:13:00] you have to somehow get the patient to change some behavior,

Marcus: their

Vic: behavior. I’m 53. My behavior for 53 years has caused me to have the health situation I have right now. There’s lots of, and it’s not anything bad. I mean, like everyone’s, everyone’s health situation is an accumulation of all their choices.

Over their lifetime and chronic disease you have to start making different choices and changing your habits And in order to do that, you have to kind of partner with the patient and build trust and teach them that even though eating a salad versus a, you know, a pizza with double pepperoni and all kinds of other stuff on it is not going to be as satisfying in that moment, you will have a more rewarding life over the next 10 years or something similar.

It’s always a delay gratification. In this moment, doing something or maybe not sleeping late and going to work [00:14:00] out, you have to make a choice to improve your health, which is going to cost some energy, cost some willpower, and you have to trust your provider, trust your doctor that you’re If I do this, I’ll get the carrot at the end.

And I think that is what CityBlock has been able to do by being in the community and sort of walking alongside them. That is, it’s really hard to do.

Marcus: Yeah. And, and, and there’s so many. Things around changing behavior. We have a lot of good science around that now. Right. So, you know, um, accessibility and we, I don’t mean access to a doctor.

I mean, like, you know, am I in a food desert? You know, can I, can I get a healthy, can I get access to a healthy meal? Right. Do I actually understand what the makeup of a healthy meal? Is for me, do I, do I understand the importance of sleep? You know, so there’s, there’s, there’s access to the core fundamentals.

There’s information, right. You know, and the information has not been [00:15:00] evenly distributed. Um, and so all of this sort of gets wrapped around. You know, the, the individual through people and care, right. And, and a willingness to have discussions and to follow up and answer questions and be kind, because these kinds of transitions are very, very difficult.

You know, I mean,

Vic: difficult. And I mean, you and I are working on our health continuously. Yeah. And we don’t live in a food desert and it’s hard. Yeah. Yeah. No, this is hard stuff. It costs more time, more money to prepare a healthy food. For me and my kids are grown and so if you have and we have more time and yeah, we have time so if you have any kind of uh struggles you have A lack of money of lack of time.

You have a lack of child care your lack of all these things,

Marcus: right?

Vic: Like a transportation. Yeah, it gets much harder and it’s hard to start with And so the provider, instead of kind of, uh, [00:16:00] looking down on that, supporting that and sort of being kind and recognizing that these are hard changes and you’re going to not go on a diet for the rest of your life and never cheat.

Like you should have a, you know, I had a birthday two weeks ago. I had some cake and ice cream because it’s my birthday. Yeah, that’s right. You have to live and the providers need to sort of, that’s what I meant by walk beside them, like sort of be their partner in this process.

Marcus: Yeah, I mean, look, even, even with all of the things that we have access to, I still don’t personally feel like I’ve got the greatest setup as it pertains to, like, Like primary care, like it’s, it’s, it’s okay, but this for me, you know what I mean?

Like, we’re not even talking about like the populations that we really need to be focusing on. I’m, I’m, I’m probably classified as part of the, you know, wealthy worried, but, um, you know, it’s, it’s, I still don’t feel like I’ve got the right care set up. I mean, I just [00:17:00] being honest, I feel like I’m doing so much stuff on my own and maybe that’s the way that it’s supposed to be.

But sometimes I feel like I’m out in front of my, you know, my care team. Sometimes I feel like I’m at odds in terms of what I feel I need from a diagnostic perspective versus what they feel that I need. And that could, that could be an incentives issue. It could be a misaligned incentives issue. Um, you know, my incentive is be as healthy as I possibly can.

Their incentive is keep their business up or operating, right. You know, and there could just be structural issues there.

Vic: It’s helpful, I think, to take another industry and use it as a comparison. Because healthcare is never going to be perfect, right? But planning for retirement is done all the time. It’s a long term delay gratification.

I need to, I need to save money today. So I’ll have retirement later. And I find the financial industry does a decent job at telling me what I should do and trying to help me with that. And they don’t, reprimand me if I don’t do it. They just sort of [00:18:00] start on the next year. And so it doesn’t mean healthcare needs to be perfect, but we need to start being sort of aligned and trying to help our patients.

Um, we, we could do better personally, but I think we have a lot of advantages. I mean, I wanted to, um, talk to a cardiologist about something, um, on Monday. And I just called a friend of mine. I have his cell phone. And so, like, being in Nashville and being, you know, sort of at the income level we have and all of our friends, I mean, we have a bunch of doctor friends in town.

It’s, even though I wish my care team was Deeper, stronger, more focused on me only. I think they’re, they’re pretty good compared to what a lot of people experience.

Marcus: Right. So, so when we talk about this move to value based care, which I, when I look at this Walgreens deal, it just feels like more proof that yes, we, the industry is moving in this direction, right?

I mean, it [00:19:00] feels, you know, the panel that we had last week, um, this news, I just feel like every week there’s more indication that. The industry is ready to move to a value based care model because it feels financially, it’s really the only way we’re going to lower the cost, right? I I’m not even sure it’s because they want better outcomes, you know, unfortunately, but, but the cost pressures right now are so absolutely brutal.

Um, especially for providers that it’s pretty clear. We, we need a different incentive model. We need it. We need a different model. Now, having said that, I think everything we just said, This is the value based care is not just about an incentive model. It’s about a partnership with the patient. And that partnership has to be based in trust, right?

No different than our business partnership, right? I mean, there’s a fundamental level of trust there that we’ve. Developed over more than a decade now, right? And, um, I think that’s why our business partnership is functional. Um, so we can navigate the different things that we’re going [00:20:00] to encounter over time.

Right. Just as you would think, you know, primary care physician who would be the quarterback of a care, you know, team and, and, and the patient would have that same situation, right? They’re going to, they’re going to, Peaks and valleys and, you know, the journey of, of one’s life, right. And their lifespan and their health span.

Right. Um, so trust is really important. So we strung together a bunch of articles just from like this last week that I think tap into trust and show how much work we have to do as an industry on, on the trust side of things.

Vic: Yeah, I think that’s fair and it’s, um, it’s just the world we live in right there.

There’s a lot of political and cultural fights

Marcus: and

Vic: social

Marcus: media

Vic: that and social media and that then like, I don’t know, it pollutes healthcare a lot. I mean, I think COVID really was a lot of stress, a lot of pressure, a lot, a lot of people died. It [00:21:00] was a lot, it was a terrible event and the systems showed, showed their Stress.

Mm hmm. Cracks.

Marcus: Mm hmm.

Vic: And that has sort of continued to Escalate it in a bad way from a trust point of view, I think.

Marcus: So starting with probably the most benign, um, but, but I think also at a high level, a pretty good macro, uh, trust issue, health insurance costs are going up 6. 5%. And when you first showed me this article, you said.

You felt like that was not like that big of a number, but relative, especially given the inflation that we’re going through right now, I

Vic: saw the headline. I thought it was going to be higher. I was expecting it to be 10 to 15 or so. Yeah,

Marcus: in 2010, it was 8%. So I mean, which is not that long ago, right? But in the last over the last 10 years, it really has gone down quite a quite a bit.

And I mean, it In 2020, for obvious reasons, it hit, you know, just over 2%, but it’s pretty rapidly going back up. Yeah. So

Vic: a friend of mine, uh, listened to [00:22:00] us while she gardens. So, um, this chart goes from 2010 till today, and it starts 2010 was the highest at 8%. Bottoms at. 2020 at two and it sort of tears down to that and now it’s on the rise again.

Marcus: Yeah, yeah. And, and I think what we discussed was employers are dealing with a lot of macro level issues, right? And lots of businesses are struggling right now. And some of those macro issues are inflationary, right? Some of those macro issues are decrease in spending, like outside of services. A lot of goods businesses are really struggling.

Right. Um, you know, we’re seeing all sorts of issues with the media world. Um, and then you layer on top of that, a six point, just think about your, if you’re looking at your profit and loss statement, you know, you’re looking at your projection, your budget for next year, and you just on your spreadsheet, run an equation across that health insurance line of 6.

4 percent plus, right. That’s material. I mean, that’s material.

Vic: It’s a huge increase. Relative to we just looked at inflation at 3. [00:23:00] 7 and the fed’s trying to make that lower But then it’s a it’s a big damn base number. Yeah, so also on here. It’s on average across the country It’s fourteen thousand six hundred per employee And so six percent wouldn’t be a big deal if it was a couple hundred dollars of cost But like on probably your second biggest number on the pnl like Salary is typically biggest.

This is typically number two. It’s growing at a huge rate. And then, unrelated to this, but this weekend I was looking at some income stuff. You know what the median income is in America? Median? Yeah. The mean is messed up because people make the 1% ers skew it.

Marcus: If I had to guess, and I’m guessing, let’s see how I do.

45, 000 a year? I don’t know. That’s closer than I was. It’s 64, 000. Okay. That’s I’m glad. I’m glad it’s 64 and not 45. Yeah.

Vic: Yeah. So, um, I thought that was, [00:24:00] by the way,

Marcus: I

Vic: said 45? No. So I was expecting it to be 80 cause I’m living in fairyland. Okay.

Marcus: Let me, let me tell you why, why I said 45 before this last budget increase the starting pay for a Nashville Metro police person.

Was 40, was it was in the 45 car cop

Vic: who’s putting his life into his life in the HR.

Marcus: I mean,

Vic: it’s like, it’s

Marcus: insane, right? It’s like totally insane. You can’t live in this city for that amount of money. So, so what does that mean? I mean, it’s the people who are going to be people policing are going to be living outside of the city.

So you don’t have a community connection. Anyway, I don’t want to divert too much, but I want you to at least know where I got that number from. Yeah.

Vic: So, so it’s one, it’s, it’s, it’s too low.

Marcus: Yeah. It’s too low.

Vic: But two, part of the reason it’s difficult to give raises, I think, is that we’re paying 15, 000 in health care that the employee doesn’t really fully [00:25:00] value at that level, but it’s a cost to the company.

And so it’s just a, it’s a really high percentage of the, of the medium income too.

Marcus: Okay. So, so, so first of all, that price increase. We’ll see whether or not it drives employers to actually get more engaged, you know, given all the, all the economic pressures that are out there, but I just want to shift right to this next story because this is where I think, you know, look, price increases.

Okay. You, you might be able to justify them, whatever, but this will

Vic: think about health systems that are suffering and need to increase prices, which we agree with.

Marcus: But this is a, this is a health insurance price. That’s not health system price increasing.

Vic: That’s right. The insurance companies say that they need to raise prices because the whole system is

Marcus: correct, but that’s that’s one degree separated.

It’s it’s obfuscated, right?

Vic: And it includes drugs too, which is where we’re going

Marcus: to go. So in the Wall Street Journal, [00:26:00] uh, there was the headline of the story is generic drugs should be cheap, which, which I will agree with because that’s what I think of when I think the word generic, the patent has run out.

Right now we can lower the costs and make it more accessible. Generic drugs should be cheap. But insurers are charging thousands of dollars for them. So when I see a headline like that, first, the first thing is I’m like, Hmm, where’s the proof? You know, like the, you know, it feels like it might be a hit piece.

Somebody is like, you know, because, because generics, right. I mean, generics should be, should be cheap,

Vic: but this is, this is The Wall Street Journal. This is not like Vic Addo blog. So then we dig in.

Marcus: Yeah. So, so the, so right off the bat, I’ll just read the first two paragraphs. Right. Yeah. So the cancer drug Gleevec went generic in 2016 and can be bought today for as little as 55 a month, but many patients insurance plans are paying more than 100 times that.

So obviously, I mean, I’ve told you, I’ve got, you know, two loved ones [00:27:00] that are going through cancer right now. You’ve, you’ve got, yeah. So. Right there. I’m like set off and then, you know, CVS health and Cigna can charge 6, 600 a month or more for Gleevec prescriptions, a wall street journal analyst of pricing data found.

They are able to do that because they set the prices with pharmacies, which they sometimes own a couple of things, just to point out here. One. Um, Blue Cross Blue Shield ended their deal with, um, CVS Caremark as a PBM. And it was like two or three weeks ago. Right, exactly. And they said they were going to just fill in the gaps with Amazon and Mark Cuban cost plus.

Right. So, uh, so. And then there was the claim that you can buy this for as little as 55 a month. Now, I can’t go do the research on my own to see, is CBS, you know, and Cigna actually charging 6, 600? So I’ll just have to kind of, I’ll have to just believe what the Wall Street Journal analyst is saying here.

But I wanted to see, can we go find out whether or not you can we buy it

Vic: tonight [00:28:00]

Marcus: for 50? Right. So we went to Mark Cuban cost plus drugs online and it wasn’t very hard and we know, no, we went to five minutes, not even went to the page. He’s got a little link that says, search all medications, clicked on that, put in Gleevec, it came up with a matinib, which is a generic for Gleevec, for Gleevec, 13, 13, 13 and 40 cents for a 30 count.

Like Wow. And then, and then, like, if you scroll down on the site, this is, and, I, I mean, I have to admit, this is the first time I’ve actually gone on the site. Which shame on me, but you go down and he’s got this whole section here, you know, called transparent pricing. Your drug costs with us, you save 2, 489 on your medication.

It says retail price at other pharmacies, 2, 500. Manufacturing is seven [00:29:00] 20 is a 15 percent markup. You know, that’s, that’s where, that’s where we make our, our markup, a dollar 20, the pharmacy labor, 5, and then standard shipping, and that’s how they get to the price. I mean, this is like. This is crazy. It’s not.

It’s crazy that it exists in the existing PBM system. Well, it’s crazy that these things are going on simultaneously, right? It’s, it’s crazy that he can put on his website. I’m charging you 13 and 40 cents. You’re saving 2, 489. When have you ever seen on an e commerce site where they do a comparison shop?

Yeah. That on a 13 purchase, you’re saving 2, 500.

Vic: Right, and go up, I think it’s a 30 day, it’s a 30 day supply. Yeah, it’s 30 calories. So that’s 2, 000 every month. I mean Now maybe, I don’t know how long you take it, but it’s a ton of money. We don’t

Marcus: know dosage, and so we can’t actually say that, but

Vic: And, you know, he’s being I mean, we’re saying him, [00:30:00] Cos Plus, Cuban’s company, they are estimated at 2, 500.

The Wall Street Journal said 6, 600. Now, maybe the journal, like, cherry picked some good, some Maybe it’s the strength, right? Maybe it’s a different strength. Maybe if we

Marcus: bump the strength to 400 milligrams, okay, now it’s at 34, right, you know?

Vic: And, and,

Marcus: and

Vic: It’s a little more expensive. Yeah. 96, 000. I mean, so It’s a shit ton of money.

It’s a lot of money. But

Marcus: doesn’t it now start to make sense, the whole Blue Cross Blue Shield? Yes. I don’t know who would stay. I don’t know who would stay. You have a search engine where you could literally, like, Go see the prices and be like, uh, what’s the deal here? Yes. So, so trust now, now, if you’re an employer and you’ve got a broker that’s supposed to be like getting you the best deal and the best price brokers don’t work for you, but this is one, this is my point.

I’m brokers do not

Vic: work for the employers.

Marcus: I’m trying to outline the trust issue. Yeah. Yeah.

Vic: Right.

Marcus: They claim to work for that [00:31:00] is a full principal agent issue. We can, we can do, you can dig into that later. The annual cost is already going up six was what it was. It’s 6, 6. 8%, 6. 5,

Vic: 6.

Marcus: 5%. Okay. So it’s going on 6.

5%, which is about inflation, right? But as you said, on your second largest line item in your PNL, that’s going to be brutal. That’s going to be brutal. And then you go find out that your generics don’t have the implied low cost that you thought they did. Like that’s a trust issue. That’s a really, really, really big trust issue.

And it’s really sad around things like cancer. I mean, you know, why would you, why? Like cancer is hard enough. I mean,

Vic: I seeded a company to fix this. Okay. In 2008, I’ll change healthcare. They exposed all this. And then they now are part of UnitedHealthcare. It is a ton of money, and it’s an [00:32:00] obfuscation of, of how the actual cost and everything goes.

And so, people negotiate around the entire formulary. And, we have friends in town that, that work for PBMs, or used to work for PBMs. I’ve talked to them at length about it. They have a thousand, uh, ways to change the pricing in all different ways. And then they have rebates and volume based things and a bunch of different things.

Of course they do. It’s their entire business to do pricing. The employer does not have a chance to negotiate. It’s not, it’s not transparent like this is. So I don’t blame Blue Cross for, for just saying, forget it. We’re just gonna. Of course,

Marcus: of course. Okay. So then, then this story that I think seems somewhat disconnected, but I think actually isn’t when you talk about the cost of drugs, right?

Um, there’s a laxative shortage. So another [00:33:00] one. Shortage

Vic: and yeah. Walser journal publishes this. The, um, people that need laxatives because they are older and they yes,

Marcus: they

Vic: cannot buy them. They’re not available. And it’s because the, um, GLP 1s, Ozympic, and the others are very expensive. Mugove. They’re very expensive.

It’s, it’s around 1, 200 a month.

Marcus: Mm hmm.

Vic: And individuals have started taking a ton of laxatives in order to try to lose weight. Which is not healthy, not going to be successful, not good, terrible for your own health. And then also takes up all the supply of laxative. So people that actually need a laxative for legitimate reasons don’t have it.

And it’s,

Marcus: it’s terrible on all [00:34:00] sides. So, so I have no proof of this, but when you pulled this story up and it has this whole thing about younger, you know, consumers, um, Are picking this up because it’s, it’s their substitute. It’s their low cost substitute for we’ll go over your nose. Epic. I immediately just thought, I’m sure this is all over tick tock.

Vic: Yes.

Marcus: I’m sure social media. I’m sure this is all over social media right now.

Vic: And it it’s because, I mean, there’s a lot of reasons social media is hard, but there is no trusted body that will say. This is the proper use or that can save money on the generic drugs So we can pay for the non generic drugs that people need and I don’t know It’s

Marcus: I mean look what this is kind of an interesting thing, right?

And let’s just kind of go back to us. Do you feel like you have? straightforward [00:35:00] Information from the healthcare system on how best to keep your body weight and your, um, lean mass to fat mass ratio in check. Do, do you feel like you’ve got clear, I mean, I’ve done my information on this own research No.

From no, I’m, I’m asking from, from the, from the healthcare industry or from the, you know, the, the nutritionist? No. You know, or from the regulators or,

Vic: no, I don’t trust them. I, I do my own research. And I don’t, I don’t think anyone, I mean, I’m friends with, with my primary care doc. He’s a nice guy and I don’t, I don’t think he knows how to, how to manage my weight.

And if, and I, I, I don’t, I don’t trust him for that.

Marcus: Yeah. So, so I don’t trust tick tock either. Well, but, but younger generations do. Right. So [00:36:00] I think we’re talking about the generational divide of, you know, older populations, we’ve talked about this in previous episodes, you know, older generations are going to have more confidence and trust in, um, you know, the, the physician, sovereign, you know, You know, voice, um, whereas younger ones, you know, who are getting so screwed economically right now.

I mean, I’m some of the conversations I’ve had with, you know, 20 somethings over the last two weeks, massive confidence crisis with this, with this country, massive confidence crisis. I don’t blame them. I mean, look, they’re going into this world. We, we, we are saddling them with hundreds of thousands of dollars of debt in, in higher education.

They come out, they cannot, uh, Get a job that will offset that and put them in a position to be able to buy property the they don’t

Vic: have Property whether it’s a real estate piece of property or stocks or any any asset they lose the the

Marcus: inflation Yeah, they lose the game. They get they Yeah, [00:37:00] exactly. And then on top of all that, you know, they’re like, Oh, and we don’t care what, you know, you know, they’ll say boomers.

We don’t care what boomers think, you know, like we believe in the climate crisis, obviously. I mean, we’ve had a brutal week in the last week, you know, Libya, the

Vic: millennials are going to be living when it happens.

Marcus: Exactly. So, you know, they’re, they’re pointing that out and then, and then they’re saying, look, I mean, Is this, is this the world we’re supposed to like raise kids in, you know, I mean, we are asking them to have a hell of a lot more hope than, than we needed to have, uh, you know, to, to, to move forward in society.

Um, and so, yes, they are turning to each other and they’re turning to tick tock and that’s where they’re going to get their weight loss information.

Vic: Yeah, and, and you will lose weight. On a wax head of a massive dose of actually, but, but you don’t get any nutrition. You don’t get any, you don’t get anything.

No, it’s, it’s,

Marcus: it’s terrible. It’s terrible. It’s sad. It’s creating supply chain issues. It’s, you know, um, so again, I, I think [00:38:00] underneath all of this, it’s where does the trust lie, right? Where does it lie and where does it not lie? And what kind of dysfunctional behavior arises from having the trust in the wrong places?

Vic: Yeah. Yeah. NN. If we’re going to create a value based care, I don’t know, system, but it’ll probably be lots of little, little services. That the

Marcus: incumbents are going to try to run. The incumbents can’t run it. Well, look, to me, the incumbents are Are not just the incumbent health systems. They’re also the health insurance companies.

They’re also the Walgreens, the CVS is the world. So when I say incumbents, I mean, the entire healthcare industry, as we know it today to include retail storefronts, you know, et cetera. That’s who’s going to have the first shot at it. I mean, just by virtue of like, who’s got the capital, who’s got the contracts, who’s got the relationships, who’s got the employed physicians.

That’s, who’s going to start this. So I just want to make sure [00:39:00] when you say that, that they can’t do it first, let’s just make sure we’re aligned on who we mean when we say incumbents on this show.

Vic: Forget other shows on this show. I think we’re going to show trust issues on all of those bodies, except for health systems.

Yeah, that’s right. No, no, no, no. Last, last week. We’re going to show the health system one. The health system one. The health the health system one. So, I do have trust in that group of people in Chicago. There are really talented. Big heart, big brain people that are their calling is to solve this problem.

They’re not the incumbents. They’re not right. So those, those are not the incumbents, but that’s who has to somehow figure it out. And we’re going to need a suite of tools. We need some kind of way to get messages to people where they are on social media from an influencer that is telling them the right things, which aren’t [00:40:00] always the easiest things.

Don’t always sell the most. Whatever their sponsor is, you can, you can make money, but you also have to, I think, to be an influencer, you have to try to influence people in a, in a positive direction. We don’t have that today.

Marcus: All right. So the next story is a New York times story. And this one, like I sent it to my wife and she laughed because she was like, you know, her and my son, you know, Let make fun of this all the time because they they apparently knew this through their lived experience

Vic: They could just tell they can work to hell right,

Marcus: but here’s the headline a decongestant and cold medicines doesn’t work at all An FDA panel says and the picture is of I mean, it’s it’s our it’s our cold and and flu aisle Yeah, in the store, you know, um, you know, Tylenol, Mucinex, Benadryl, Sudafed, you know, the stuff we all reach for, um, NyQuil when, when we’re, when we’re not feeling well, and we’re looking for, for, you know, some decongestant activity, um, the Food and Drug [00:41:00] Administration had an advisory panel, um, They unanimously agreed on Tuesday that, uh, phenylephrine, which is a common decongestant ingredient used in many over the counter cold medicines is ineffective.

This ingredient has been in, uh, these Different over the, over the counter drugs. Um, how long, how long has it been in there? I

Vic: think since, what’s the year 1938.

Marcus: Yeah. I, I thought that too. I was just scrolling to see it approved. It

Vic: got approved in long time ago.

Marcus: Yeah. I mean, it’s, it’s, it’s been in these products for decades, right?

Yeah.

Vic: It, it was a, um, lesser used product in the seventies and eighties and then the, um, the. The drug problem. What’s the drug you can make with, [00:42:00] uh, the other cold? The old cold medicine behind the counter? Oh, oh.

Marcus: Um, uh, methamphetamines. Yeah. Meth

Vic: with, with all the meth scourge in the eighties and nineties.

Right. We moved that. Ingredient behind the prescription counter. Yeah. I think you don’t need a prescription, but you have to go. You can only get one. You show your ID. It’s just an involved process. And at that point, all these companies started using this other thing that was approved a long time ago by the FDA, the chemical compound.

I mean, I, I started researching this yesterday, so I’m not an expert on it by any means, but the chemical compound, I think if it isn’t an aerosol, if you, if you inhale it, It’s very effective when you put it into a pill form your digestive system kill destroys it So it literally does not get into your bloodstream period.

So how many of these pills have been taken? I think [00:43:00] last year it was about 1. 4 billion in sales with this now they have other ingredients No, no, no. No, I get it. I get it. I get it. I understand but again The FDA, I mean, I guess they’re telling us now, but it’s, it’s been 50 years. It’s been a long time.

Marcus: Yeah.

And, and look, it’s just an awful headline, right? You know, a decongestant and cold medicines doesn’t work at all. And FDA panel says, so look, I mean, we, we talked before the show. We, we understand that science is not going to get it right all the time. That’s, that’s not a scientific process. That’s not a fair expectation that every single thing gets worked out correctly.

All right. We’re going to

Vic: learn new things. Yes.

Marcus: Yes. That’s, that’s not even, that’s not even fair. So we don’t, we’re not trying to be the outrage police here. I think what we are trying to do is aggregate a series of stories. That have been released in one week to just demonstrate the collective trust [00:44:00] issues that are just brimming across the healthcare industry.

Like, forget about focusing on one segment or another segment, um, these all, all the ones we’ve talked about so far happen to be related to drugs, you know, um, whether it’s over the counter or a cancer drug, that’s, you know, critical to the extension of life.

Vic: And it’s relevant because if we go to value based care.

Yes. I don’t think we can be successful as an industry unless we get our shit together and are, are trustworthy. And that means sometimes the FDA will find a new thing that pops up that they need to correct something. Yep. But this has been a long time. And then they’re not pulling the products now.

They’re gonna keep reviewing it. And people are probably buying it today. Even though it doesn’t work.

Marcus: Yeah, no, I mean, they have not yet ordered the removal, right? Um, but if they do, it’s going to pull all these [00:45:00] products off the shelves. So that’s going to be its own sort of, you know, economic disaster. Um, you know, Johnson and Johnson did a very, very good thing when they had their crisis and they just pulled everything off of the shelves immediately.

So, you know, the ideal thing to do here, even though it will be an economic hit from a trust perspective, again, a trust perspective would be pull it if it doesn’t work. Well, the reason, the reason J

Vic: and J did that. Is because they want their brand to brand for something. Yes, absolutely. And the brand is more valuable than this quarter’s thing.

That’s right. And that’s right. And I think that, um, I don’t know. I mean, We have two different generations, at least if you don’t count the Xs. We’re both in X, but we’re so small. The boomers and the millennials Have different trust issues, different values, different values, different trust issues, and we have to try to service both of them.

Yeah You Pick either one and just start. No one [00:46:00] has trust now.

Marcus: Yeah, exactly. All right. And now I think we’re going to go to the most wretched story of trust, which is story. I had trouble. Yeah. Well, this this was shared with me from Members of the fellowship. So, you know, they’re always really good at, you know, sending stuff that matters.

This is, uh, an article in ProPublica, um, and it is, uh, it’s, it’s a criminal justice headline. Uh, the, the headline is how Columbia ignored women. Underminded, undermined prosecutors and protected a predator for more than 20 years. Um, it’s a really hard story to read. Um, you know, I’m not going to read things from it, uh, but we’ll have a link

Vic: to it, but it’s a hard story.

It’s a hard

Marcus: story. And certainly if you have experienced, um, any sexual abuse, you know, just to be understand like, like this trigger warning, for sure. There’s a, [00:47:00] there’s a lot of graphic. Commentary in, in this, in this, uh, article, but, um, the, the bottom line is, uh,

Vic: an

Marcus: OBGYN. His name is Robert Hadden.

Vic: Did a lot of really shameful, criminal, terrible things to women for 20 years.

Long time.

Marcus: Yes. And even at one point was arrested.

Vic: Yeah.

Marcus: For specifically for. For this

Vic: file. For doing this. Particular violation in his office.

Marcus: And was allowed to go back to work. Right.

Vic: Columbia is one, I mean, before today, when I read the story, I thought was one of our better institutions of higher learning and of medicine. They’re in New York City, not the capital, but kind of the capital. And it’s shameful. I [00:48:00] mean, I can’t say it any more than that. It’s just not, it’s not what that institution should be doing.

It’s not, it’s not, it’s not appropriate.

Marcus: Yeah. And, and look, uh, realizing that what I’m about to say is, um, you know, going to land differently depending on where you stand from a, from a policy perspective and from a faith perspective, but, you know, certainly the, the overturning of Roe v. Wade. Um, has created for many women in America, um, significant challenges in how they feel they are able to engage with the health care system.

Um, and I don’t, and truthfully, I don’t think that most women are all that surprised by the behavior here, but I think the cover up is probably really, really, um, hurtful. I think that’s, it’s not so much the [00:49:00] behavior. Right.

Vic: There are bad people in the world.

Marcus: That’s right.

Vic: There are predators. It’s the cover up.

There are psychopaths. They need to be caught and then put in jail and locked in a dark place or put to death. Yes. And the cover up is just what I, I can’t even get my head around, like, someone sitting in some office in Columbia and feeling like the opposite of J& J. Our brand value needs to be protected.

As we are really harming these women.

Marcus: Yeah.

Vic: Um, that’s just

Marcus: not right. W w w without, without going too deep into it, like I said, we will put the link in the show notes, um, if you were not

Vic: giving the gory details, no, no, we’re not going to do that.

Marcus: We’re not going to do that. But if, if you can manage to. You should, people should read it.

If you can manage to read that, I think, I think it is an important read. Um, but what I brought up to you, [00:50:00] because, cause you know, you, you said, how could Columbia do this, you know, like their brand. And I brought up to you that, uh, the high school that I went to had this, had basically the same thing happen.

Um, but it wasn’t, it wasn’t the healthcare issue. Um, it was our football coach. Um, so I went to poly prep, the story’s out there. Everyone knows this story. Um, so I went to poly prep in Brooklyn, New York. And, um, our, our coach was a guy named Phil Foglieta. And, um,

Vic: I

Marcus: played under him my sophomore and my junior year.

Uh, by senior year he left and, and I had coach Espo. Um, but I played, I played under Foglieta. Uh, and I had no idea this was happening. Okay, I knew how this was happening. Um, but he was molesting players on the team. And, you know, there was one guy who was in my, in my grade, and I remember one day he just like stopped coming to our school.

And he was on the team, and he was a good [00:51:00] athlete. And it was, it was years later when all this came out.

Vic: Yeah, you put it together. Well, I

Marcus: put it together and also, You know, others who were closer to the story and understood what had happened, told me they were like, Oh yeah, this person. Yeah. You know, this is what happened to them and, and, and our, you know, my alma mater, unfortunately, you know, allowed it to happen, you know, to, to so many young, young people, um, you know, for 25 years, uh, these brands, they’re trying to sort of protect their image and they forsake the people they’re actually there to serve.

Right? Um, and this to me, that that’s, that’s, that’s why the, the, the coverup was such a familiar, awful story, you know, because, um, it’s just another big brand higher education institution, um, you know, in New York, in New York that try to try to avoid this article [00:52:00] from ever coming out, right, you know, tried to prevent this article from ever coming out, but of course it was going to come out

Vic: and it’s similar in the sense that it’s a, it’s a person in a position of authority.

Like a doctor or a coach that is taking advantage of that and victimizing people that are in need of support, not, not abuse. And how, how can we stop this from happening at other institutions? I mean, I don’t know what the Columbia mission is, but they didn’t follow it.

Marcus: That’s right. I’m I’m sure I’m sure they I’m sure they violated some of their own core values.

Yeah, I don’t know the core values, but there’s no way this was not a violation of their own core values. There’s no way.

Vic: And so when I hear stories like this, I have a lot more sympathy for someone on Tiktok I don’t know if this influencer has the best ideas, but, but I, I trust [00:53:00] them. And that’s, that’s a sad, it’s sad

Marcus: for our future.

So this was one week of stories, right? Okay. Um, I think the reason why we wanted to string them together is this is one week of stories. And then also what happened this week, um, on Tuesday, September 12th, the CDC issued a press release and the headline of the press release is CDC recommends updated COVID 19 vaccine for fall winter virus season.

Now I recognize that everybody who hears this news is not hearing it amidst the backdrop of all the stories we just said there in succession, but I just wanted to, I think we wanted to juxtapose a recommendation. That if you want to be effective requires a deep level of trust, you know, we, we have such, we have such a hard time getting people to participate in democracy, go out to vote, you [00:54:00] know, it was such a hard time getting people to do the basic things that we would like them to do in society broadly, right?

And obviously this is a situation that is very, very fraught because of. You know, social media to some degree because of missteps in the communications early on in the pandemic, you know, so without making any particular comment about it, I want to, as a PSA recommend, if you’re going to like, actually learn about what this recommendation is, the press release is on the CDC site.

Yeah, we’ll link to it. You can just go there and actually read the press release, read the associated links, do not allow anyone else to interpret this for you, and then make your decision, you know, make your decision based on what is, you know, what’s, what’s best. Um, it’s really difficult for something like this to be coming out [00:55:00] in the midst of such a.

You know, distrusting environment that we have right now. And obviously we’ve got all the political culture war stuff that is, you know,

Vic: yeah, we need to bring up the red meat, real like culture war things. These are, these are mainline stories. Exactly. Yeah,

Marcus: exactly. Um, so I, I think just to circle all the way back to value based care, we talk a lot about.

Payment models, incentive structures, technology, care teams, you know, protocols, um, health coaches. We talk about all these things. Trust, you know, trust is going to be a, a really important ingredient in family based care. And we need to start figuring that one out.

Vic: And I agree that that’s probably all we can say about this press release.

Go read it for yourself. But I also say that that’s not an appropriate standard. The 330 million Americans. [00:56:00] are not in a position to read all this science and make their own determination. I am, and I’ll make my own determination for myself and my family, but it’s not, that’s not their job. That is the CDC’s job.

And they don’t have enough trust that we just sort of take their recommendations at face value. We have to dig into it.

Marcus: Yeah. So it’s, um, I just think it’s something for us to, us to consider. We, we, we don’t talk enough about. But it’s going to be very, very hard to influence people as an industry, um, to try to get forward movement.

That’s going to be measurable and meaningful and actually result in better outcomes and better, you know, um, better health, better life expectancy and lower cost. It’s gonna be very, very hard to do that. If we cannot establish, you know, social webs of trust, [00:57:00] uh, between people, it’s going to be between people at the end of the day.

Um, and we have a lot of work to do on that front and a lot of the, a lot of the old things from our industry, a lot of the old incentive models, a lot of the trickery and games that people have, you know, especially middlemen have tried to play to just ramp up their own profits that gets in the way.

Vic: Yes, that

Marcus: gets in the way of, of the, of the trust that we’re going to need to improve the health of, um, Americans.

Vic: Profit motive and misaligned sentence gets in the way. I think small minded people trying to protect their job or protect some, some imagined brand at the expense of the people that are actually supposed to be helping gets in the way. And

Marcus: the real brand is, is what you do when no one’s watching, right?

That’s the real brand. Yes.

Vic: So, I don’t know, I’m not sure what the answer is, but I think that talking about it out loud, and [00:58:00] not going to where we’re shouting and not listening.

Marcus: Right.

Vic: My, so my, my teenager has started teaching me more than I teach him now. And he, he was My wife and I were, I thought I was debating something with her and he pointed out, neither one of you are listening to anything.

You’re just sort of yelling, wouldn’t make, we’re debating something at each other, but not listening to what the other side’s saying. My 16 year old said that, and he was absolutely right. And so I think we do that. I do that at home. We definitely do that in social media. We’re just like putting stuff out there, but not really taking a minute to.

To listen to the other person without preparing what I’m going to say, I don’t know. So I think this forum and then hopefully people can talk about these stories with their family or their friends or people that they do trust. I think we have to start building trust for ourselves or in maybe small groups.

Because that’s, that’s what’s needed. [00:59:00]

Marcus: So I’m going to exhale on that. I know it was, it was a, it was a heavy show. We had a, we had a pretty, pretty lighthearted show last week. You know, kind of nice fun panels with brilliant people. No, I mean, look, I think, I think what we’re just trying to do is we’re trying to tease out the important things that we have to face and we have to deal with like, like grownups, like adults, like mature people, if we actually want to make things better and better.

In our healthcare system. So, you know, I, I, uh, I don’t regret, I don’t regret us focusing on these things. I think this is

Vic: We have to talk about the big, the big issues. I mean, it’s the elephant in the room. Like you can’t get me to take my medicine and eat right and exercise. If I don’t trust that you have my best interest at

Marcus: heart.

Totally, totally. But my, my father, you know, he, he’s, he’s, he’s 85, but, uh, you know, he went to see, um, you know, a doctor about, you know, losing weight and he came home and he just said, Marcus, I just don’t, I just don’t trust him. Yeah. I just don’t trust him. And so, so, so [01:00:00] guess how many of his instructions he followed?

Yeah. None. Zero. None. Zero. I mean, it’s important. It matters.

Vic: And he might be better off with someone who doesn’t have as many, uh, degrees, maybe at a gym or something that, that he bonds with. And, and there, that person listens to what he wants to get out of his health and they design something together.

Doctors. Should do that. Our reimbursement structure has forced them into very tight windows of time. It’s been too much time coding for billing and we need to sort of allow them to practice sort of face to face and, and listening to people too often, the patients don’t trust what’s being told.

Marcus: All right, my friend.

Uh, I think, I think we’re on for next week, right? Yeah. Yeah. We’re on for

Vic: next week. And, uh, we’ll have a new set

Marcus: of stories. Congratulations on 20 [01:01:00] shows.

Vic: Oh, thank you. 20 shows, man.

Marcus: It’s a good, good landmark. That’s the beginning. Now, like, uh, I mean, 100 is the real beginning, but 20 is a fifth of the way. So, you know,

Vic: you gotta get to 20 before you

Marcus: get to 100.

All right, man. I’ll see you next week.