Saum Sutaria, M.D.

I think the second thing, and probably from my perspective, the more important thing, is that if what we've talked about here today bears some degree of accuracy around what the drivers of healthcare costs are now and are going to be, it's really about health status, chronic disease, aging, drug costs related to the chronic disease, the demand. Coverage is not what's lacking today.

I think the second thing, and probably from my perspective, the more important thing, is that if what we've talked about here today bears some degree of accuracy around what the drivers of healthcare costs are now and are going to be, it's really about health status, chronic disease, aging, drug costs related to the chronic disease, the demand. Coverage is not what's lacking today.

Models of coverage is not what's lacking today.

Models of coverage is not what's lacking today.

What you would rather call that would be price controls. If your argument is you want to put them on Medicare because Medicare reimburses less than everybody else, commercial insurance or whatever costs, yeah, then you should just call it we're going to have a price control. But then we're moving to a supply-side intervention.

What you would rather call that would be price controls. If your argument is you want to put them on Medicare because Medicare reimburses less than everybody else, commercial insurance or whatever costs, yeah, then you should just call it we're going to have a price control. But then we're moving to a supply-side intervention.

That's a supply-side intervention that says we're going to constrain everybody's access and choice. The reimbursement is going to come down. and the infrastructure will survive or not survive, and what's left will be what you can access. That's a different choice because that's what it would do. It would be a buy-down. Remember one thing, and we haven't really talked about it that much.

That's a supply-side intervention that says we're going to constrain everybody's access and choice. The reimbursement is going to come down. and the infrastructure will survive or not survive, and what's left will be what you can access. That's a different choice because that's what it would do. It would be a buy-down. Remember one thing, and we haven't really talked about it that much.

This system is built on a lot of cross-subsidies. healthy people in our model of insurance cross-subsidize our fellow citizens who happen to be ill in some period of time. In the same way, employer-sponsored insurance, which reimburses healthcare at a higher level than Medicare or Medicaid, overcomes the unit cost under-reimbursement Of government healthcare.

This system is built on a lot of cross-subsidies. healthy people in our model of insurance cross-subsidize our fellow citizens who happen to be ill in some period of time. In the same way, employer-sponsored insurance, which reimburses healthcare at a higher level than Medicare or Medicaid, overcomes the unit cost under-reimbursement Of government healthcare.

This goes back to the concept, the government already behaves as a monopsony here. They under-reimbursed. What you get paid from Medicaid, if you're a doctor or Medicare, may be below your cost relative. It's cross-subsidized.

This goes back to the concept, the government already behaves as a monopsony here. They under-reimbursed. What you get paid from Medicaid, if you're a doctor or Medicare, may be below your cost relative. It's cross-subsidized.

And that cross-subsidy creates this dynamic where you can't have one go away without the other. That's why I'm so concerned about the notion that our number of 40 to 65-year-olds relative to the people that are getting the benefit from government that somewhat under-reimburses unit care of cost is going down. The people generating the economic rents to cross-subsidize the other side is going down.

And that cross-subsidy creates this dynamic where you can't have one go away without the other. That's why I'm so concerned about the notion that our number of 40 to 65-year-olds relative to the people that are getting the benefit from government that somewhat under-reimburses unit care of cost is going down. The people generating the economic rents to cross-subsidize the other side is going down.

And what does that mean for our economy if healthcare expenditures are growing this quickly? I mean, that's the essence of this discussion. And by the way, I haven't answered your question with any reasonable solution to how to cut 25%. I mean, you probably need somebody from totally outside the system to come up with an idea for that kind of cut.

And what does that mean for our economy if healthcare expenditures are growing this quickly? I mean, that's the essence of this discussion. And by the way, I haven't answered your question with any reasonable solution to how to cut 25%. I mean, you probably need somebody from totally outside the system to come up with an idea for that kind of cut.

I am much more optimistic about the notion that healthcare expenditure inflation could be reduced to a level that is somewhat closer to GDP growth.

I am much more optimistic about the notion that healthcare expenditure inflation could be reduced to a level that is somewhat closer to GDP growth.

That sounds a little fatalist in terms of where we are. I mean, my framing would be we value quality, access, choice, and innovation, and we're willing to pay for it. It has not deterred the US economy to date in terms of being not only the leading but the fastest growing economy. And our problem that we need to solve societally is about, in the U.S., it's about two things, as we outlined.

That sounds a little fatalist in terms of where we are. I mean, my framing would be we value quality, access, choice, and innovation, and we're willing to pay for it. It has not deterred the US economy to date in terms of being not only the leading but the fastest growing economy. And our problem that we need to solve societally is about, in the U.S., it's about two things, as we outlined.