Dr. Céline Gounder

And it will be up to the incoming administration to finalize that rule. Whether they will or not, we don't know. But then if they do, and they don't make use of that lever to negotiate down drug prices, including the GLP-1 drugs, that would have huge cost implications for Medicare. So it's a little hard to know how each of these pieces will play out.

And it will be up to the incoming administration to finalize that rule. Whether they will or not, we don't know. But then if they do, and they don't make use of that lever to negotiate down drug prices, including the GLP-1 drugs, that would have huge cost implications for Medicare. So it's a little hard to know how each of these pieces will play out.

With respect to Medicaid, you mentioned block grants to the states. That's a great way if you're looking to cut your Medicaid costs, federal spending on Medicaid, to do so. What we're also seeing are conversations about reducing the federal amount that's being provided for that. So both states and the federal government put money in for Medicaid.

With respect to Medicaid, you mentioned block grants to the states. That's a great way if you're looking to cut your Medicaid costs, federal spending on Medicaid, to do so. What we're also seeing are conversations about reducing the federal amount that's being provided for that. So both states and the federal government put money in for Medicaid.

But if we see a reduction in the federal contribution, some states that have expanded Medicaid may reverse that decision. We've seen more and more red states expand Medicaid, North Carolina, for example. And that's because there was an understanding that this actually was good for their bottom line.

But if we see a reduction in the federal contribution, some states that have expanded Medicaid may reverse that decision. We've seen more and more red states expand Medicaid, North Carolina, for example. And that's because there was an understanding that this actually was good for their bottom line.

And it had an impact not only on patients, but also on rural communities where prior to expansion of Medicaid, many rural hospitals were really in financial trouble. Many still are. But we've seen many of these facilities close. And Medicaid was a lifeline. Expansion of Medicaid was a lifeline to many of these facilities.

And it had an impact not only on patients, but also on rural communities where prior to expansion of Medicaid, many rural hospitals were really in financial trouble. Many still are. But we've seen many of these facilities close. And Medicaid was a lifeline. Expansion of Medicaid was a lifeline to many of these facilities.

to keep them open and also to keep many of those jobs at those health facilities still available. So those are some of the things that we could anticipate with respect to Medicare and Medicaid.

to keep them open and also to keep many of those jobs at those health facilities still available. So those are some of the things that we could anticipate with respect to Medicare and Medicaid.

Yeah, so it was a process of years, really, to come to this point. But I think some of it was what I experienced working in Southern Africa. I started my career working in global health and tuberculosis and HIV, was often asked to moderate town hall meetings, meetings with patient advocates, informing policymakers, both overseas as well as on the Hill in the U.S.,

Yeah, so it was a process of years, really, to come to this point. But I think some of it was what I experienced working in Southern Africa. I started my career working in global health and tuberculosis and HIV, was often asked to moderate town hall meetings, meetings with patient advocates, informing policymakers, both overseas as well as on the Hill in the U.S.,

So that sort of planted the seed. But then I had pivoted from global health to domestic health around 2012. I was an assistant commissioner of health at the New York City Department of Health. And we were dealing with massive cuts to public health funding in the aftermath of the 08-09 recession.

So that sort of planted the seed. But then I had pivoted from global health to domestic health around 2012. I was an assistant commissioner of health at the New York City Department of Health. And we were dealing with massive cuts to public health funding in the aftermath of the 08-09 recession.

And in year one on that job, I was tasked with having to cut essentially 20% of my bureau of 250 people. So 50 people out of 250, that's huge. And what I realized coming out of that was we will not fund public health if people don't even understand what it is. People at least need to understand what it is. And then you can decide, is this something valuable or not?

And in year one on that job, I was tasked with having to cut essentially 20% of my bureau of 250 people. So 50 people out of 250, that's huge. And what I realized coming out of that was we will not fund public health if people don't even understand what it is. People at least need to understand what it is. And then you can decide, is this something valuable or not?

But I would argue that coming out of the pandemic, people still don't understand what public health is. They often confuse public health and health care. And so that's really what motivated me was I wanted people to be armed with the facts, to be informed citizens, and then to make decisions, you know, however they want to based on that information.

But I would argue that coming out of the pandemic, people still don't understand what public health is. They often confuse public health and health care. And so that's really what motivated me was I wanted people to be armed with the facts, to be informed citizens, and then to make decisions, you know, however they want to based on that information.

So health care is what people are more familiar with, right? It's what happens in the clinic, in the hospital. It is very individual patient focused. Public health is largely funded by the government, which is in contrast to health care. Much of health care is in the private sector in this country. Not all of it. Medicare is a great example.

So health care is what people are more familiar with, right? It's what happens in the clinic, in the hospital. It is very individual patient focused. Public health is largely funded by the government, which is in contrast to health care. Much of health care is in the private sector in this country. Not all of it. Medicare is a great example.