Saum Sutaria, M.D.

So the rise of the federal government's role in healthcare has been material and almost as rapid as the rise in healthcare costs from that perspective. So it's a very different system of consumption.

So the rise of the federal government's role in healthcare has been material and almost as rapid as the rise in healthcare costs from that perspective. So it's a very different system of consumption.

Yeah, I think there are all kinds of things in the ecosystem, including geographic diversity, state versus federal rights, and even fundamentally the drive that the American consumer has in determining their own outcome. If you look at our system today, much of its construct is based on a desire for consumer choice.

Yeah, I think there are all kinds of things in the ecosystem, including geographic diversity, state versus federal rights, and even fundamentally the drive that the American consumer has in determining their own outcome. If you look at our system today, much of its construct is based on a desire for consumer choice.

Many of these programs, these coverage programs, or some would say welfare programs that evolved like Medicare and Medicaid, were designed to solve some substantial problems. So if you go back, what happened at that time? Two things happened in the 1950s. One was there was a significant commitment to investment in hospital capacity at the time. I mean, there were people in America...

Many of these programs, these coverage programs, or some would say welfare programs that evolved like Medicare and Medicaid, were designed to solve some substantial problems. So if you go back, what happened at that time? Two things happened in the 1950s. One was there was a significant commitment to investment in hospital capacity at the time. I mean, there were people in America...

not just rural, but suburban, that did not have easy access to acute hospitalization. And the technology and ability to intervene and save lives in that setting was improving significantly. And I think at the time, there was a belief that it wasn't fair or equitable, that that access wouldn't exist.

not just rural, but suburban, that did not have easy access to acute hospitalization. And the technology and ability to intervene and save lives in that setting was improving significantly. And I think at the time, there was a belief that it wasn't fair or equitable, that that access wouldn't exist.

That's called the Hilbert Act, you referred to it earlier, which if I think about it in simple terms, it guaranteed a hospital within every 10 miles or 10 or 15 miles of every American in concept. And that's what happened. And that legislation drove our thinking in terms of access all the way until it expired in close to 2000, 1997, if I recall, from that perspective.

That's called the Hilbert Act, you referred to it earlier, which if I think about it in simple terms, it guaranteed a hospital within every 10 miles or 10 or 15 miles of every American in concept. And that's what happened. And that legislation drove our thinking in terms of access all the way until it expired in close to 2000, 1997, if I recall, from that perspective.

So we made a massive investment in infrastructure from that perspective to provide people access. Okay, and that's important. The second thing that happened, of course, is that by the time you were in the 1960s, there really wasn't a coverage mechanism for seniors.

So we made a massive investment in infrastructure from that perspective to provide people access. Okay, and that's important. The second thing that happened, of course, is that by the time you were in the 1960s, there really wasn't a coverage mechanism for seniors.

I mean, there was patchwork stuff, and there wasn't really a coverage mechanism for those with less means, what we today call Medicaid. And it got to the point, especially with the importance of the senior's power, not only of the purse, but from a political standpoint, where on average, seniors were spending a quarter of their retirement income from Social Security on healthcare.

I mean, there was patchwork stuff, and there wasn't really a coverage mechanism for those with less means, what we today call Medicaid. And it got to the point, especially with the importance of the senior's power, not only of the purse, but from a political standpoint, where on average, seniors were spending a quarter of their retirement income from Social Security on healthcare.

That wasn't sustainable. So they neither had consistent coverage. It was inequitable. And on average, a quarter of the Social Security check was being spent on healthcare. And so why Medicare and ultimately Medicaid associated with it was you had a country whose economy was growing rapidly. We could afford to take care of our seniors. And that was the decision at the time.

That wasn't sustainable. So they neither had consistent coverage. It was inequitable. And on average, a quarter of the Social Security check was being spent on healthcare. And so why Medicare and ultimately Medicaid associated with it was you had a country whose economy was growing rapidly. We could afford to take care of our seniors. And that was the decision at the time.

And it was met with great support, obviously, at the time. And so you created a system in which that coverage existed. And therefore, the federal government's expenditure jumped up significantly.

And it was met with great support, obviously, at the time. And so you created a system in which that coverage existed. And therefore, the federal government's expenditure jumped up significantly.

Yeah, well, we do pay Medicare taxes today. I mean, now there are special taxes to help fund Medicare, but it's really, it's a solvency issue.

Yeah, well, we do pay Medicare taxes today. I mean, now there are special taxes to help fund Medicare, but it's really, it's a solvency issue.