How will the heads of these government agencies ignite tech innovation in the healthcare industry?

We’re speaking to many healthcare tech executives, such as CEOs and doctors and academics, to see what they think.

Joining us is Dr. Ivan Rusilko, a doctor of lifestyle medicine based in Miami. He’s been practicing this more natural way to address health and fitness for more than 15 years. He’s faced critics along the way but now his once-unconventional approach to medicine is being embraced.

Highlights from the conversation:

1:28 - Traditional medicine doesn’t take a person’s lifestyle into account: “Lifestyle medicine popped up about 14 years ago. Back then, lifestyle medicine wasn't even a term, so I was the first one to market with it, basically, so it’s nice to see how everybody is using lifestyle medicine on every corner of every street of every city. But, again, it was forged through the aspect that each person has three different facets to them: it's their mentality, their physicality, and their emotionality, all of which are combined into what makes you you. The basis of what we do is we definitely focus on diagnostic testing, so we're testing a lot of things that traditional doctors won't test, things like heavy metals, neurotransmitters, food sensitivities, and a lot of very unique biomarkers for hormones and whatnot, that help give us a picture of the internal chemistry of a person. But then we take it one step further with really unique and very in depth questions when it comes to somebody's overall lifestyle. Sexual Health, relationship status, hydration, nutrition, sleep, all these different things should be forms of medicine that aren't taught at all in the traditional way of teaching medicine that I had to go out and pull myself; I had to go out, while I was in medical school, and actually become a certified nutritionist, because we spent about 30 minutes on actual nutrition, and spent about four days on cholesterol medication. So, you tend to start to see that traditional medicine falls short on what somebody's lifestyle is, they expect it to be taking a pill or having surgery.”

8:19 - Our bodies are built to live to 150 but we burn them out early: “When it comes to mental illness, we do a lot with neurodegeneration, which would be Parkinson's, Alzheimer's, dementia, things like that, and those are all symptoms of something. There's a reason that it happened. Our bodies are built to live to 150; you can look at all the research that they've done, study after study on that one, so the fact that we burn them out early, the fact that people are now walking in with Parkinson's at age 40, makes zero sense. So, everybody wants to treat the symptom of something while what we do with the diagnostic testing is we're taking it one step further and seeing what caused it. The perfect example would be mercury toxicity. I would say that's probably the biggest epidemic in this country right now, if not the world. The reason being is, back in the day, when they used to put amalgam fillings in your teeth, that's actual mercury. So, every breath you took, you were actually absorbing mercury throughout the entire time. The ADA knew this, they still did it anyway, and now it's banned across Europe. If you put an amalgam filling in your mouth, you go to jail. And the situation is, if you take a look at the rise in things like autism and Alzheimer's, things where we don't know why people get them or how it happens, and then you correlate it with things such as mercury toxicity, the introduction of mercury into the environment, the introduction of different vaccines, and everything else that goes along with it, we are causing these problems to ourselves. And the traditional, or the purest form of medicine, which I like to call precision medicine, is diagnosing, why do we have this problem? If you're depressed or if you're anxious or if you're bipolar, what's the stimulatory factor for it? Are you hormone depleted? Do you have decreased B12? Is it nutritional? Is it something like that? So, we're taking a look behind the curtain, if you will, to sit there and be like, ‘Why does this person have this?’ not just give you a bunch of medications and drown them out on it. It's basically putting a band aid on a hemorrhage.”

11:25 - The FDA is funded by user fees paid by Big Pharma: “Big Pharma doesn't heal anything, they put a band aid on a hemorrhage and expect you to be a patient for the rest of your life. Cholesterol medication, diabetic medication, none of that stuff does anything to heal you, it basically makes you a patient for life, which again, you have to take a look at from a business angel, it's a phenomenal business move: you scare people into being unhealthy, and then all of a sudden, okay, you have to be on this rest of your life. And then this medication has a side effect that needs to be managed with this medication, and so on and so forth. When the whole vaccine aspect came out with this, and then you'd have people who would question and be like, ‘well if you take a look at what COVID is, it's basically the exact same virus as influenza. And we've been trying to vaccinate against that thing since 1920 with zero luck.’ So, it’s a situation where people went two ways, they sank or swam with it. Either people sat there and said, ‘okay, maybe I should question what traditional medicine is and where it's going,’ or, ‘maybe I just shut my eyes and just believe whatever I'm told from the CDC, from the NIH, from the WHO, and all those different organizations.’ The most terrifying thing is that the FDA is funded right now, I believe it's 52% by user fees. User fees are what Big Pharma pays to the FDA. So, if you think about it, it's like Al Capone paying for the Chicago Police Department. So, it's just the people that they're paid to protect and police against are the ones that are paying their salaries. Then you have the whole revolving door policy whereas everybody in the FDA who is in a power position eventually transitions into very high paid salary jobs at these different Big Pharma companies.”

15:29 - The Trump administration is going to ruffle a lot of feathers: “Big Pharma is a gigantic industry. I mean cholesterol medication alone is billions of dollars per year. So, it's a situation where, of course, they're going to dictate things that they want people not to get healthy. Like I said, the more healthy people are, the less patients they have, and that's the scary thing. And with this new administration coming in, it's going to shake a lot feathers, because it's a situation whereas we're focusing on basic things like red dye number 40, that should never have been put into the population, fluoride and water, all this stuff, take a look at the mercury and fillings. All this stuff should never have ever made it into it, and it's not the immediate effect, it's the downstream effect. Mercury can lead to all kinds of different things, from arthritis to cancer to autoimmune neurodegeneration. So, you've just now purposely put something in somebody's mouth that we think is good for us. 'Oh, I have a cavity,' but why did you have a cavity in the first place? That should have been addressed.. And then all of a sudden, now it's just slowly polluting our system, which causes you to go to the doctor, spend more money, and Big Pharma gets bigger.”

17:57 - Government health organizations should be stripped of power: “I would love to see all these government organizations completely stripped of all the power that they have, and built from the bottom up, and really start to police Big Pharma, because, at the end of the day, they're the ones manipulating physicians into prescribing what they want. It's sad, because I always tend to joke that the more specialized the physician comes, the more in Big Pharma’s back pocket they become, because they're so focused on one specific thing. Like kidney disease, ‘I need these four different medications and somebody won't die.’ That shouldn't be your goal. Traditional medicine's main goal is the prolongation of death regardless of what your life is, whereas what we do in the wellness industry is we try to augment your life, which will eventually lead to prolonged life. So, it's just scary to sit there and see that traditional medicines' main goal is not to heal you or protect you. It's just to basically make you live as long as you can with as many medications that you're on.”

20:12 - The FDA needs to provide the reason behind what they’re doing: “I’d love the FDA to come out and go and start to go over and just like, ‘’This is what this does. Boom, boom, boom.' Give us more information about why we're taking all these things. Secondly, I like to sit and see any research funded by Big Pharma be completely wiped off the internet. Because if I'm putting out a study on a pill that I just made and I'm saying, ‘This looks great,’ of course it's going to look great, you're the one who did the study, you're paying people in positions to do it, of course it's going to look good. Because if it doesn't look good, then you're going to either manipulate the data or just not produce it. So the FDA, I'm all about policing it correctly, but you need to sit back and sit there and say, ‘Big Pharma should not be the FDA’s best friend,’ which is what they are. The revolving door policy, if you get a chance to look at that, it's one of the scariest things you ever see. Every single major FDA person, whether it's the top of the rung or a couple down, all transition into ridiculously high paying jobs into Big Pharma. And if that's not common sense nonsense, then like it's just insane. So, the FDA, if they don't disband it, which I hope they do, but if they don't, I just hope they start providing reasoning behind what they're doing, not just saying, ‘this doctor and this doctor said so.’ A bunch of these doctors actually have positions with Big Pharma, so, of course they're going to say it. So it's terrifying.”

27:56 - The goal is not to have people on medication the rest of their life: “At the end of the day, I don't want somebody on that medication the rest of their life, I want to get something fixed. That's where the whole lifestyle comes to do it: teaching people how to eat, teaching people what to avoid. Hydration, hydration, hydration: your brain's 80 to 90% water, so mostly in the elderly, they don't drink any water because they don't want to pee at night, so, you're walking around dehydrated, and you're wondering why your brain isn't functioning at a full capacity. So, as we're getting into these certain things, we're teaching them how to eat: eating once a day is not good, especially at that age, they should be eating five times a day. And sleep's the most important thing that we do here. I'm 40 years old., Ive slept 13 and a half years of my life. That's how important it is. And people don't really understand, like, 'Oh, I get four hours a night, blah, blah, blah.' But, again, is it good quality? Is it whatever it could be? So, there's a lot of stuff that goes into it. We aren't just sitting here exchanging one pill for another one, which I don't want people to think, ‘Oh, were you putting them on this.’ Our main goal is to get them on that for six to eight months, teach them how to do the actual lifestyle aspect as well. Get out, walk, do this stuff. We're giving you all this energy, you're going to feel like you're 50 again. Use it. And as we start to take things away, their body has now healed itself, and they're able to operate with not only a better physicality, but a better knowledge of what makes them them, in a healthy way."

39:31- There's no sense in being healthy if you're not going to do something with it: “Ball Deep Living is basically about living life this close, so we do deal with a lot of people who have a lot of affluence, and a lot of people with affluence don't really know how to spend their money. How to spend their money the right way, I guess you could say; they're buying cars, they're buying things that are just accumulating, so we have a lot of patients come in and, as you can see in my office, it's very bipolar, but it's all the different adventures I've taken, whether it's swimming with sharks, rhinos, all kinds of stuff, playing with tigers. But the aspect is, life is experiential, and there's no sense in being healthy if you're not going to do something with it. So, we take these people to extravagant places to do really, really weird things. An example is, I took three people to Dominica Island, which is in the West Indies, which has a resident population of sperm whales. So, these are people who have never swam in the open ocean. You jump in the water at 3,000 feet, we don't see the bottom,that alone will wake you up, and then you're actually being let out right in front of a sperm whale, or that's 50 to 60 feet, maybe even 70 if it's a male, and it comes right by you. I don't care what movie you've been in, I don't care how much money you have, or how much square footage, that can change a life, because now you're all of a sudden, like, ‘wow I've just experienced something that money can't really buy.’ You can't walk out down the store and buy this. So you start to see growth in people. And that's where the emotional part comes into health, because now you're helping people overcome fears, you're helping people see something that nobody else does, and it's making you the most interesting person in the room.”

How will the heads of these government agencies ignite tech innovation in the healthcare industry?

We’re speaking to many healthcare tech CEOs and executives to see what they think.

In 2025, we may see radical top-down changes to our healthcare system as new heads of the NIH – National Institutes of Health, HHS – Health and Human Services; the CDC – Center for Disease Control and Prevention. And the FDA – Food and Drug Administration.

How will the heads of these government agencies ignite tech innovation in the healthcare industry?

We’re speaking to many healthcare tech CEOs, scientists, academics to see what they think.

Joining us is Dr. Robert Pearl, who served as CEO of The Permanente Medical Group (Kaiser Permanente), the nation’s largest medical group, for 18 years. During his tenure, he led 12,000 physicians and 43,000 staff, overseeing the nationally acclaimed care of more than 5 million Kaiser Permanente members on the east and west coasts.

Named one of Modern Healthcare’s 50 most influential physician leaders, Pearl is an advocate for the power of integrated, prepaid, technologically advanced and physician-led healthcare delivery. More than 60,000 readers subscribe to his newsletters on healthcare, including his widely read Monthly Musings on American Healthcare.

Pearl is a clinical professor of plastic surgery at Stanford University School of Medicine and a faculty member at the Stanford Graduate School of Business, where he teaches courses on strategy and leadership and lectures on information technology and healthcare policy.

Highlights from the conversation:

3:51 – Trump’s move to cut spending outside Medicare and Social Security: “The biggest concern is going to be for two kinds of programs. The first is a variety of public health programs, because the healthcare that is done nationally requires that we have coordination, that we have information going back and forth across states, between leaders in each individual geography, and that funding is going to be at risk of being continued. And the other part that we don’t really know about yet is Medicaid. Medicaid, unlike Medicare, is paid directly from the federal government to states, and then states use it to fund about 70% of the healthcare they provide to individuals who are socioeconomically challenged, either below the poverty level or a little bit above it, after the Affordable Care Act went into play. That money is required, it’s paid on a quarterly basis, and if the states, which are required by law to balance their budget, if they do not have these dollars guaranteed, they have no choice but to cut back on the care that they provide. Whether through the actions led by Elon Musk through DOGE, there’s going to be ones that are going to cut back on Medicaid payments through the government, as well as other payments from the government, or whether they’re just going to depend upon the states to realize that they’re in a financial jeopardy, that if they don’t cut back either the coverage, or in some other way the dollars that they have, they’re going to find themselves on the hook for the difference that the federal government otherwise would pay. So, we don’t even yet know whether this is going to lead to a reduction in payments, because, remember, the payments are made differently by states, in quite a number of areas they’re made on the basis of dollars spent. In some areas they’re made on the basis of a single block grant and if those are not going to become available, then what we’re going to see is individuals losing their coverage and we could see as many as 20 million Americans who today have access to healthcare find themselves without that access, and the consequences would be devastating.”

9:51 – Reducing healthcare spending may lead to people losing coverage: “The only place you can reduce spending is in healthcare, where you have three very large parts of the federal government today. Number one, Medicaid. Medicaid is approaching $1 trillion dollars a year, it’s about $800 million right now, and you could theoretically be able to reduce the number of people there, and one of the ways that has been talked about is through work requirements. The data and the research says that work requirements don’t actually increase employment because most of the people who are getting the money are either already working or, for whatever reason, they can’t work because they either have a disability or because they have home obligations that they don’t have an alternative to achieve. But that’s one way to reduce the number of people who are covered. The second way to reduce it is that under the Affordable Care Act there was an expansion by President Obama to increase the coverage up to 138% of the poverty level; Medicare has always been covering up to the poverty level, now we’ve got 138%, and the assumption was that every state would do this, but something like 10 states have yet to do it. But in the other states, it has been expanded, and Congress could cut that back under a presidential push. Once again, what’s going to happen to these people who now are covered, but now would have a tremendous amount of out of pocket expense to be paid? And the third way you can do it is to go through block grants. So, some states are given a chunk of money to use how they want; in the Affordable Care Act, there was a lot of consistency required, a lot of regulatory requirements, but you could go back to block grants states and those states facing a budget shortage could also make a cutback. And if they cut back on Medicaid in terms of who’s covered, once again, you’re in a situation where the federal government has less expense. So, Medicaid is a big opportunity, and if they did that, the reason dollars are going to be saved is not because the program becomes more efficient and effective, it’s because people are kicked off of it.”

16:13 – Focus on chronic conditions: “What do I diagnose as the big problem in medicine today? It’s chronic disease. Chronic disease affects 60% of Americans and is 70% of healthcare costs. We’re talking about hypertension, heart failure, and diabetes. These are problems, according to the CDC, that account for 30 to 50% of heart attacks, strokes, kidney failure, and cancer. Just imagine what would happen if we had 30 to 50% fewer heart attacks, strokes, kidney failures, and cancers a year. You’d have a much more healthy nation. The USA’s longevity, which today is lagging the other nations, would start to rise. You would have people being healthier, better able to work, being able to support their families, and you would certainly watch costs plummet if we could avoid 30 to 50% of those very expensive problems to treat. So, you have to, in my opinion, move to the front of that pack, not just simply take care of the problems when they arise. So, when we look at the front of the pack, what do we see? What we see here is that one of the causes of chronic disease, as you note, is obesity. One of the causes, not of chronic disease, but its complications, is how poorly we manage these problems, bringing the blood sugar back to normal, bringing the blood pressure back to normal. We manage hypertension, which accounts for 40% of strokes, only 60% of the time effectively. Diabetes, which accounts for the number one cause of kidney failure, heart disease, attacks, leg amputations, we manage that even less than half of the time. And so here is where we have the opportunities.”

21:33 – The way you cut budgets is by increasing the quality of healthcare: “I don’t believe that just cutting allows you to get the improvement in outcomes that we need. The way you cut your budgets is by increasing the quality. So, the way you increase your quality is you have to change your healthcare delivery system. There’s no short term fix, there’s no easy fix, but it could be done over a five year time period, let’s say, moving from paying clinicians on a fee-for-service basis to a capitated basis. A single payment to take care of a population of patients. And now think about it this way: if you’re going to benefit not by doing more, but by keeping people healthy, what are you going to start to prioritize? I’m going to prioritize prevention, I’m going to prioritize better management of chronic disease, I’m going to prioritize patient safety. In my population, if I could lower the heart attacks and strokes and kidney failures and cancer by 30 to 50% my income has just gone up significantly, particularly for primary care clinicians, who are the ones who are in greatest shortage now and the ones who are best able to increase the health of people.”

24:32 – There’s an opportunity we’re completely missing around generative AI: “Right now, we have an opportunity we are completely missing around generative AI. If you’re talking about managing chronic disease, we manage chronic disease in a doctor’s office once every three to four months. This is a problem that exists every single day. The opportunity to now is to use technology to empower patients. Every technology up to this point has been technology for the doctor. If you now put technology in people’s homes, you combine that with wearable devices, we would know how your chronic diseases are doing every single day. If you came in to see me with hypertension and I prescribed medication rather than seeing it back in four months, by the end of the month, you’d have 100 readings. 92 are normal, eight are abnormal; he’s doing well because 92 are normal, terribly because eight are abnormal. No, the technology using first and second derivatives would tell us, and I can make a change in your medication at month one and be able to bring your blood pressure back to normal, bring your blood glucose back to normal. I’d be able to anticipate when your heart failure is going to get worse, so rather than going to the hospital three days from now, I intervene today. That technology is very available, it’s just that, as you know very well, until OpenAI released ChatGPT only two years ago, we didn’t have this tool, and we needed to use that tool.”

27:33 – The rise in autism might be because of environmental factors: “What we see is that it’s being diagnosed a lot more frequently but we have no idea whether it’s actually happening more commonly. So that’s the first piece. And the second one is that there are hundreds or thousands of environmental factors, and to talk about the vaccine as the cause without any scientific reason for it, it’s a nice story, but there’s no reason to think that that’s any more true than challenges with pollution in the air, or challenges within the food that we eat, or challenges within maternal health. There’s a lot of reasons why autism could be happening. So, there’s probably some environmental factors that we don’t understand, but if you look at the studies within a given year, so you’re not looking across time at diagnostic changes, but you’re looking within the time period that exists, the data fails to indicate that, and the data that demonstrated that it did had to be retracted by the British Medical Journal because the research numbers were fallacious. So, that’s not the cause. It’s definitely a big problem, don’t get me wrong, it’s a major issue, and it’s good that we’re diagnosing it more frequently, but we don’t really know what’s happened to the actual prevalence of the problem.”

31:27 – Science vs skepticism: “There’s a difference between science and skepticism. Skepticism says, ‘we think there’s a big problem here.’ Now, if you want to look at cancer as an example, where is cancer coming from? 40% of cancers come from obesity. We know the cause of cancer in 40% of patients, particularly by the way they come into breast cancer in women and a variety of other cancers that have hormonal relationships, and we have an exact scientific explanation for how this comes about. It’s a causation, it’s not just a correlation. So, if we really want to decrease cancer, that is a great way to go. We also know that the HPV vaccine is one that will prevent cervical cancer. If you are vaccinated, your chances of getting cervical cancer drop dramatically, and we can test for the virus, and if you don’t have the virus, your chances are less than 1%. That’s great progress. We’re talking about saving literally tens of thousands of lives from the past, and today there’s still 4,000 women who are dying. We shouldn’t have doubt and skepticism when the numbers are so great on one side of the balance scale and potentially small on the other. We should look at the smallest, don’t get me wrong, but we should not be delaying those situations, whereas plus-minus, we’re not quite sure, that’s a different circumstance. But when it comes to most of the vaccines we’re talking about, the data on life saving, the scientific data, the research data, is 99.9% and to withhold that at the .1%, that’s something that, to me, doesn’t make any sense.”

35:33 – Higher taxes can help tackle obesity: “We have evidence that when you impose a tax on cigarettes, cigarette smoking goes down. You impose a tax on sugary sodas, which are a major contributor to obesity, utilization, use of it goes down. If a fast food place is selling high fat, high calorie food, and we know that the likelihood is that, as a consequence of consuming that people even become obese, and we know that that’s going to account for 40% of cancers, it’s going to increase the likelihood of diabetes. It’s going to increase heart attacks and strokes and cancers and all the other parts there, we should tax it, just like if there’s something else that a company is doing that is going to harm the environment, that we’re then going to have to spend federal governments to repair, state dollars to repair, we should have that company pay for that, and that’s what I would see. And I would actually then recommend that the dollars that are used to tax these highly processed, high fat, high caloric foods then be invested in fruits and vegetables that we know are healthier for people. We know the micro ingredients that they have and make these foods more accessible. Right now, a lot of people, particularly individuals who don’t have much money, and you mentioned it earlier in this podcast, they buy fast foods, high calorie foods, because that’s the cheapest way to feed your kids. And if your kids are starving, it doesn’t matter what they eat. They need more food, they need more calories. It’s just that when you have enough ability to feed them that you have the opportunity now to move their diet from the areas that we know are unhealthy to ones that are healthy.”

39:03 – Big pharma is broken: “The biggest challenge that we have right now is that we have a broken pharmacy system in the United States. The average price of a new drug last year in the United States, $300,000 a year. It’s just not affordable. The United States spends twice as much as the other countries, we’re talking about Europe and Asia and Australia, Canada, twice as much for the exact same drugs. I don’t mean the quantity, I mean the cost of a pill. Why is that? Because the pharmaceutical industry, which lobbies and makes campaign contributions, got Congress to pass a bill saying the federal government can’t negotiate for the price of drugs that they cover under Medicare and Medicaid. Think about how absurd that is. Every other country does it and so we pay so much more. That needs to change. We also know the Pharmacy Benefits managers, the so-called PBMs, these intermediaries, are not acting in the best interest of consumers, despite what they claim, they’re figuring out ways, sometimes with a wink and a nod with the manufacturers, to be able to move higher priced drugs into the formulary where they’re going to get and able to keep, at this point, the dollars that are called rebates that should be going to the consumer, but instead are being used for the profits of the intermediaries.”

How will the heads of these government agencies ignite tech innovation in the healthcare industry?

We’re speaking to many healthcare tech CEOs to see what they think.

Joining us is Ritankar Das, Founder and CEO of Forta Health, which helps family caregivers manage their loved ones with chronic conditions. The first condition of focus is: autism.

A year ago this month, Forta raised $55 million from VCs such as Insight Ventures and Alumni Ventures.

Das believes that the government needs to recognize the potential of the family member in the future of care.

1:08 – Care delivery still involves fax machines: “One interesting thing I saw with that was, while the science and a lot of the engineering had advanced a lot, the care delivery side of it had not. So, folks were developing these advanced systems and putting it out there, and we were involved in a lot of that, but then the point of care was highly variable. I remember, in one instance, I worked on a project where we were helping a big health system manage patients who had acute kidney injury, and we were taking data off of their medical devices, their electronic health record and so forth, analyzing it on the cloud, doing pretty cutting edge work from a technology perspective, but when it went back into the clinical setting, the request was to fax the results. So, at the end of all of this, we would actually fax the results, and then they would put that on a whiteboard, and then someone would come in and cross items off a whiteboard as they addressed the situation.This was maybe four or five years ago, and I don’t think much has changed.”

7:55 – Bringing it back to the family: “What we got very interested in with this care model plus AI innovation was involving the family, and that was not in the very initial stages of the company, but as we started thinking about, ‘Hey, what is the best care model that that marries with the latest technologies?,’ it’s actually really going back to the basics, going back to human caregiving roots, which has always been within the family. No one’s going to care about outcomes more than the family members and modern technology now can allow these family members to be more effective. You no longer have to have gone to medical school for many, many years or to get other kinds of training to be effective and helpful. Now, you’re not going to replace what folks can do with all that training, that is still very necessary, and technology certainly cannot supplant any of that, but what has changed in the last, say, five or 10 years is that it’s advanced so much that a family member with some training and some support and an AI system can come in and take away some of the trial and error parts of our caregiving processes, can help get better outcomes. So, you’re adding in the system, you’re adding in training for the family members, and that addition is helping the clinicians come in.”

9: 41 – Starting with autism: “What we found was that it was an area where families were waiting a very long time for access to therapy, and they were already spending a lot of time with their children, but didn’t know what to do. They didn’t know how to spend that time effectively, how to get better outcomes, and things like that. So, we found that, ‘hey, what if we could take the medical histories and the backgrounds of children and their families and so forth, could we get much better, much more personalized treatment plans?’ And the answer was, we could. We could actually personalize it, get it a whole lot better, and take out a lot of the trial and error that is commonplace today, where folks are trying to find what type of intervention, what type of approach will work. The systems aren’t perfect, but they start you from a much better position, and, in doing so, you actually are able to then educate and train the family members and the family members don’t have to do the trial and error process.”

21:10 – The government needs to recognize the potential of the family member in the future of care: “My hope is that the new administration, and just the government at large, recognizes the real potential of the family member in the future of care broadly. We’ve seen signs of this over the past five or six years because, it’s no surprise, healthcare spending in the US is on an unsustainable pace. We spend a lot more than a lot of our peers, and our outcomes are not that good relative to a lot of our peers. In a lot of areas in chronic care the experience isn’t very good, folks are in areas where they don’t really want to be; they’d rather be at home with their family. Technology is at a point now where you can enable that to happen while getting really great outcomes and, equally importantly, perhaps lower the cost for the system and for society to get us on a sustainable path. So, my hope is, broadly, that folks recognize that and support that approach at all levels, whether it’s at the research level, at the regulatory level, and in terms of incentivizing those things. We’ve all gotten used to healthcare being a one star, two star experience, just broadly; obviously, you’re often ill when you’re interacting with the health system, so you’re not going to be in a great place, but the system broadly has let people down, and people just have come to expect very little of it. So, the type of philosophy that we want folks to engender is, how can we rethink that? And how can we do that by involving the part of the healthcare delivery that’s really good, which is great clinicians, great interventions, and great family support? How do we improve all of that?”

29:18: Healthcare spending is a failure of systems, not individuals – “There’s certainly broad system inefficiencies, no one can argue against that, because when you look at it the amount that we spend on healthcare versus the outcomes that we see just don’t match. There are many other countries that spend quite a bit less per capita and have better outcomes. It is well known that that’s the case. Then the question becomes, where specifically? I actually think it’s a lot of failure of systems, more than individuals. Most folks, at least, are doing the right thing for the folks around them, for the folks that they’re treating, the folks that they’re seeing. There’s no broad scale maliciousness going on, but the systems aren’t really fundamentally set up to succeed. If you set up an extremely overwrought system with lots and lots of machines and equipment and testing and people and infrastructure to treat something that is going to take a long time, it requires a lot of sustained empathy and support and things like that. A lot of our sick care system just isn’t set up to do that. It is simultaneously a bad experience for the folks who are getting treatment, and at the same time, it is a big area of effective waste. Where there’s a lot of potential, opportunity is rethinking from scratch what care should look like, instead of saying, ‘I see some waste there, or some inefficiency there.’ I’m sure there’s that as well at some level, in any big system you have some of that, but the big, big ones are just the fundamental structure that we have set up.”

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