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All right, everybody. Welcome back. It's all in at Davos. My bestie, David Saxs,
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is here. We're having a great time. We're here. >> Can you guys catch this in the
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background? Amazing. >> It's stunning. >> This is the Davos experience. It looks
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real. I know. Well, it kind of looks like a green screen from here cuz it's just so picturesque.
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>> It's literally like a >> green screen. It is. It's the real the
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real deal. >> And we'll we'll look over the ledge here. And what you'll see is all of the
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virtue signaling ESG DEI executives. And uh you'll you'll just it's emanating
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from this entire area. And they've put solar over every single building here.
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None of it's plugged in. It's just for aesthetics. But uh we're really excited,
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David and I, um to do a bunch of interviews here. Wow. Today we've got a great one for you. And we're going to
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talk about health and we're going to talk about the health care system with none other than Dr. Midas. Uh you're the
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administrator now for CMS. You've gone from being America's doctor, dare I say,
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to being a civil servant like my friend David Saxs. Why did you choose really height of your powers career to to go
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into public service like this? >> So, I'm in the change business. You guys
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are as well. And if you're in the change business and the project you're pursuing
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is not making a significant change, then you want to move on to something else that could make the impact you desire.
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And especially in healthcare, we don't have the luxury of fooling around for
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years of our lives pursuing uh interests that don't result in meaningfully changing the the quality of life, but
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also the opportunity that the American people have. And so although I loved being a TV host, did it for 13 years, I
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love practicing surgery, which I've done my whole life till recently. Uh this is
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the best job I've ever had. And it's the best job I've had because of the people
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that I get to work with, but also because you truly do get to make the change that I desire. And I think a lot
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of folks, the reason they watch the podcast is they they want to change stuff, too. And I encourage everybody
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to, you know, take some big swings and you'll break things once in a while. But
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if you want to be able to change meaningfully the the infrastructure, whatever's bothering you, uh, you got to
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go at full speed. And this administration offers us a unique opportunity to do that. It is
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interesting, David. Um, you were used to going at a pretty fast pace as well. And
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then I think our expectation was, hey, you get into public service, it's going
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to be about consensus building and it's going to take a lot of time. Say what
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you will about Trump. Some people might not agree with every policy, but he ships. He's like a founder who ships and
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ships product fast. That's also been your experience. >> Yeah, he's hard to keep up with. I mean,
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he moves incredibly fast and it makes him really fun to work for because he wants to get things done.
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>> Yeah. >> Every day he wants to get things done. >> There's a sense of urgency.
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>> Yeah. And you know, you'll be in a meeting with the president in the Oval
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Office and you'll tell him about a problem. His first instinct is to pick up the phone
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>> and call and fix it right then and there. >> And he does that meeting after meeting,
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hour after hour, day after day, week after week. And when you compound that desire to get things done and he acts on
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it right there, it has a huge impact. and he seems to get great pleasure in bringing together especially in this
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administration which I think is distinctly different than the first first administration he was new to
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politics and he brought in a lot of career politicians that I think maybe people told him were the right people
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this time he has explicitly gone and looked for people with expertise who are proven winners in the field yourself
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included >> he wants us to carry the water and this I think across the different parts of
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the administ ministration. He wants individuals that don't have to rely on the president to tell the story all the
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time because so much of the narrative that is reflected in the media is just completely off. I'm not even saying that
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they're doing it on purpose. They literally don't understand some of the
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secondary and tertiary impact of the decisions you're making. And it's our
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job to therefore tell not just the media, but the American people what we're trying to do. And that's
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especially important if you're unorthodox in how you govern. And this is a fundamentally important reality, at
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least at CMS. David, I don't know how it is in developing AI where there probably
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wasn't a rule book before anyway, but in healthcare, you know, there have been
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doctors since the dawn of of, you know, since humans left Africa 50,000 years ago, there were doctors in the
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encampment. And so there is a way of doing things. And in government, that exists as well, but it's not always the
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right way to do things. So, for example, we have the ability to make laws. Every
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part of the administration pretty much can. We get Congress to do stuff. It doesn't always turn out the way you want
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it to turn out, and it takes a lot of time. and the negotiated final result uh sometimes falls short. You have
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rulemaking, second big area, which is, you know, administrative entities like ours can write the rules that everyone
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has to follow. We're going to pay you this much. We're not going to let these
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people do that anymore. Uh it does take some time. Uh and it's prone to lawfare.
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By that, I mean the people you're regulating, if they don't like what you're saying, they can sue you and they
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can stop you. And in this administration, if the other party doesn't like what you're doing, even if
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it's the best thing, we had a a rule that would reduce fraud, but the blue cities didn't like it because it was
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coming from someone they didn't like, the president. So, they enjoined it, and
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that's now caught up in court. Now, we'll win, but it could take years. So,
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that's the second big way, right? So, you make laws, you pass rules. The third
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way, which historically government has not used, I don't think as effectively
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as possible. And this president, because he's a great negotiator, is able to to
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push us in ways that historically not been done, is to just use the power to convene. The US government can bring
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people together who would not normally talk. They can give safe harbor to industry to come together and discuss
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problems that historically they would shy away. >> What's the great example of that? I'm
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I'm wondering if it's the drug companies who they have something to lose because
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Trump's been President Trump has been very clear. Hey, I want these prices lowered. Why are we the sucker at the
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poker table? We're paying 10 times what Canada's paying. Is that the best
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example in your experience so far? >> It's a great example. Most favored
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nation drug pricing. It specifically addresses the problem you outlined, which is we just pay a bunch more for
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the exact same product made the same factory often in America than our counterparts do here in Europe. So the
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president says we need to change that. So he says go talk to the drug companies uh create some opportunities for risk
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for them you know make some rules create some pro projects that if we were to act
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on them would really hurt them >> a little pressure >> little pressure you know build the
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crowbars and the baseball bats >> okay >> cut some trees down hone the wood but
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don't use them >> and he's very specifically said do not hurt the innovative nature of
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pharmaceuticals they are important to our nation they save lives uh We want to have the most innovative industries in
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the world because that's where the opportunities are to differentiate ourselves. It's also part of our
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national destiny. Be the best. So don't hurt the industry, but take some of the
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fat out of it. Pull it back and give it to the American people. Plus, it's the
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fair way of doing things. And metaphorically, when you think about NATO and the president saying to NATO
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countries, we're all in it together to protect ourselves against external threats. You guys got to put up more
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money. We'll put up more uh but proportionally more. It's got to be fair. And they all did that pretty much
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with one or two exceptions. He did the same thing with pharmaceuticals. He said there's an external threat which is
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Russia or you know foreign governments. There's internal threats like cancer.
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>> Yeah. >> So we want everyone to chip in. We pay in United States 8% of our GDP towards
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pharmaceutical products. >> 8% 1% of our GDP goes to drugs. That's not the health care system which I think
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is 17%. >> Right. >> 1% of it a full 6% of our healthcare goes just directly to the drug
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companies. So we want >> What's with your math? >> It's quite quite impressive.
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>> Yeah. Thank you. >> So point I only bring this up because the percentages make a difference here.
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08% >> comes from us playing blackjack. >> Calculator to this. I know you comes
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from us playing blackjack and poker together. You I've lost a lot two hours over here.
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>> I Well, I've been I've lost a lot of money to this guy and I don't play him
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in chess anymore. >> Bend but don't break. You want them to bend a little bit. Be reasonable but you
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don't want to break the industry as a doctor. >> What's the upshot of this? Because you
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hear this term affordability a lot. So the average American's going to pay less
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for their drug prices. >> We're going to pay less. The Europeans, we are telling the all the countries,
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we're in the middle of these discussions. We've just gotten the British to say yes and other countries
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are talking to us about the fact that they pay.3%. So less than half of what we paid percentwise is being spent by
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them. And and they get away with it because their people don't realize that if you get cancer, more advanced cancers
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in Europe, your survival rate's way below the US. And if you don't if you
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don't get access to the drugs, which they don't for several years on average
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that we get in the US, yes, you can get it for cheaper, but your people are paying a price. And this is going to say
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the most important message I'm going to deliver today. The most important message is don't think about healthcare
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like an expense. Think of it as an investment because if I can get the average American to work one year longer
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because I got them a medication at a better price, they didn't turn away at the drugstore or because we able to do
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something else correct >> whatever the envir the movement. We'll talk about all this, but if you can get
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the average American to work one year longer, that is worth $3 trillion to the US economy. It's massive.
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>> So, we we need to get people feeling their best, feeling that they have
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agency over their future with confidence that they're going to make a difference
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in the world so they want to keep trying to do it at the workplace. And that extra one year, which gets them closer
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to Medicare, by the way, also helps deal with other financial crises that we're
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facing as a nation. So, this is the way to think about it the right way. Get the
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actual cost of care down. Don't just pay more money into the system. Get the
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actual cost of care down so the money we're spending gets us more value. >> We're spending twice as much as these
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other countries who have universal healthcare. Now, you did point out that they get things later. So, we have a
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better system, but we pay through the nose for it. That that would be an accurate way of describing the current
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state of affairs. >> Precisely stated. Yes. >> Okay. So, how do we get every American
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healthcare? because I believe a lot of the tension we have comes from a fear from people maybe who are not as well
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off as as the people on the pod right now and they live with that fear. We don't live with that fear. We know if we
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need to get healthcare, we're going to figure it out. We'll be able to pay for
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it out of pocket or insurance will pay for it. But there are people who go bankrupt because of this. You believe in
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universal healthcare. I would assume as a doctor. >> I want everyone to have access to health
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care. But how we pay for it is the defining issue here. How do you keep the system incentivized to take care of you?
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If I tell everybody in America that you have healthare and then I tell the doctors, give them healthare, but they
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don't deal with the financial costs of then you all of a sudden start to restrict the access to care. So you can
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get the health care like you do in socialized medicine countries. You just have to wait 6 months or a year or
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longer or you don't get the care at all. And when you start having that discussion with Americans, they say,
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"Wait, wait, hold on a second. Yes, of course I want uh to get the healthcare
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for an affordable price." But the question the fundamental question is how long till I actually get the care there
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>> being denied is something they live with. So they complain about their universal healthcare. We complain about
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not having universal healthcare. What are the two or >> the thing I would look at is the flow of
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patients who seek treatment internationally. So I hear lots of stories about Canadians coming to the US
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to get treatment because they don't want to wait two years for some proced not
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just the latest to get some procedure because they could be dead in 2 years. So they come here. I don't hear any
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Americans talking about going to Canada to get treatment. >> We actually do have uh a number of
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examples of that in surgeries and treatments that you have to pay for out of pocket. Cosmetic, dental, people are
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going and this has become tourism and there are people who do change locations. Yes. for electron procedures.
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You mentioned cosmetic surgery. That's definitely a trend. >> Uh and also there's some procedures that
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we don't do in America. >> Stem cells, >> but your stem cells there that they're
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still going through the regulatory process. But the the the bigger issue is really is the one David's raising, which
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is most Americans complain that the health care system is broken. Almost none would leave the country to get top
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tier health care for a life-threatening problem. And so we have this sort of bizarre opportunity. I do think it's an
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opportunity. How do we make the top tier health care available to to folks who need it but do it at a price that is
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sustainable? And that's where I think your specialty area comes into play. Before this administration, I think
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because we didn't have the right technologies to promise convincingly that we could do this, there was a
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hesitancy to make big shifts. We're taking big swings because we think AI is
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ready. We think the tech transformation that's that's that could happen in
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healthcare is worth subsidizing. And by that I mean making it possible for top tier entrepreneurs who are building apps
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that can help you deal with the medical crisis that you're dealing with their
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diabetes. We can put money into the system to make that worth you doing. So you can get investors to support you.
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You can get a fair valuation. >> The technology to lower the price. Obviously that's a huge win. Let me ask
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you the the difficult question as a doctor. There have been studies that came out recently that not only do LLMs
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currently give better advice than the average general practitioner, they have better bedside manner and the customers
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or the patients enjoy the LLM more than they enjoyed a GP. >> Where did you see that? I haven't seen
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that. >> This is a study that came out of either Harvard or MIT. I I'll put it in the
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show notes, but this is a pretty groundbreaking. What are your thoughts if you were going to a new society? Is
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this idea that you have to go to the GP, they ask you a bunch of questions, then
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they go on their medical text, figure out what their advice is, is that the best modality or would it be better for
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the common cold for an ankle sprain to do what most Americans without insurance are doing or people who are
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self-directed? They go on a large language model. It says here's how you deal with these issues and they do it
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themselves and they can take care of a couple things. Wouldn't it be better to
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just have them do this stuff and then decide if they should go see their GP? >> I think there's a hybrid of that that
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derisks it a little bit early on. There are definitely problems with hallucination and the like that that
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Americans we very intolerant to. We actually understand if a human being who has an MD degree makes a mistake. We
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think AI is perfect >> and are completely intolerant of even a minor uh transgression. What you said
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earlier is true and these studies have been done several times now. the the the large language models do better on board
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exams. So, ab general knowledge, they're better than a doctor. They're more
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patient than a doctor. If you talk to an AI uh informed avatar, they'll answer
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the same 10 questions on diabetes all day long and not get bored. Talk to a general practitioner after they've
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talked to 10 patients with diabetes who've asked the same 10 questions, you get a little tur in your responses.
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That's just human nature. I don't want to answer the same question every time,
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but that's what patients need you to do. So I think we have the opportunity and
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we looked at some of these models. Uh in fact John Door brought a bunch of very thoughtful entrepreneurs into the
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building to talk about the possibility of us taking the average general practitioner and making them five times
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maybe even 10 times more efficient. Now here's the big deal. There are not enough GPS in America. We probably need
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two to three times more just to keep up with Europe just per capita. We're way
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below because my son just finished medical school. There aren't many kids in medical school at Colombia where he
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went who are going to become GPS. They all want to be opthalmologists and, you know, orthopedic surgeons because they
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pay a lot more >> and they got big loans for their uh >> Yeah. And they're in debt. They're in
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debt. >> Yeah. And this is even Colombia is free. If you don't, if you don't have money,
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you don't have to pay tuition at Colombia. They did that so that kids would go into general practice and
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hasn't had the desired impact yet. But the broader question is how do we allow
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AI to play a role as this transition period happens so people feel confident and one way of doing it is to allow it
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to do most of the work and then especially with agentic AI take the paperwork out of it the busy work out of
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it and feed the doctor the key information. What's the most important thing I do as a doctor? I look at you in
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the eyes and I read you and I try to connect with you. 50% of our cortex of our co high cognitive function 50% of it
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is to read your face. We're hardwired to be social animals. To understand the
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subtle little David's bored, you're not. I got to change the pacing. I got to get
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back to him. He's doing card calculations in his head. >> He was, in fairness to David, he was out
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till 1:00 a.m. They dragged him to four meetings. I was in bed at night. I have good sleep. I got my Whoop. I got my
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sleep score. I am a pillow princess like you, Dr. Oz. I hear that you're extreme
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about your sleep. >> Well, I'm a good sleep. My wife is a world-class sleeper. She brings her own
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pillows. >> Your wife is delightful, by the way. I I did an hour interview with Lisa before
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you even got on stage here. I was like, "Wow, she's impressive." >> To build on this point, I mean, I think
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it's interesting. I think we're going to get smarter doctors and smarter
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patients, and they're each going to use their own version of AI. >> So, you know, what patients are going to
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use is a is a consumer product, JBT, Grock, you know, and so forth. What's interesting, I think, is when they can
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dump in their blood panels cuz cuz AI is so good at reading PDFs, you know, just
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unstructured data. So, you dump all your stuff in it. You ask for a diagnosis, you get smarter. You can research your
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own condition. You're not wasting frankly the doctor's time by asking basic consumer. You're a better
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customer. >> So you go more educated and then the doctors they can use chat GBT or what
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have you, but actually they're using specialized much more specialized tools
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that the ones I've seen. They will give you a citation directly to a medical
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journal that you can bring. That's very important to doctors. So, you know, it's
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not hallucinating. Just getting the answer from a, you know, from a was on Joe Rogan podcast, you need to know what
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the source is, >> which is fine. If you if you get information from Joe and backwards to
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respected medical journal, >> let me ask you about this trend. >> This is self-directed healthcare.
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There's function health doing blood labs, superpower, whoop just started offering them. Aura, Apple Watch, HLEP,
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I'm an investor in that one. Full disclosure, it's doing great. These things are now putting all that data
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together and starting to tell you your life, your health span, your, you know, your actual age versus your health age.
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I don't sure what that metric is, but people are now measuring things and getting some knowledge of this and then
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going to a GP. The problem I'm having is, and I'm not price sensitive. I could
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get any concierge doctor I want. There's very few doctors who want to work like
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this at the moment. That's something's got to change. But what do you think of
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this new group of people who are doing self-directed healthcare doing two blood labs a year putting it into a database?
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Uh POVA with the 3D scans, Nico, Daniel X, new company doing a $300 full body scan. All of this is this going to be
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the paradigm shift? >> 8020 rule. If 20% of Americans do what you're saying, and they will, yeah,
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>> it'll make all of medicine function better. I'm actually concerned about the
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other end of the spectrum. Tell me >> the people who don't go to their
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doctors, Medicaid patients, Medicaid patients are twice as likely. Medicaid is the folks who are vulnerable, who
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are, you know, have made less money, uh, they're getting government health insurance, right?
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>> Medicare, >> that is our universal healthare, >> right? That's that's where we need help.
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The chance of a Medicaid patient who doesn't pay for their health care because they don't have the means to do
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it. The chance of them canceling their doctor's appointment is twice that of a
00:19:00
Medicare patient. And so, it's hard to take care of them. Now, they they have
00:19:04
two jobs. They'll get fired if they leave the job early. They don't have the
00:19:06
the the flexibility of moving their calendar around. They don't have transportation. There's lots of reasons
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they don't show. But if I can't get healthcare to them, that's a major
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crisis for us. And so the real opportunity for AI is democratizing healthcare. Yes. See, you guys are
00:19:20
already smart. You just listed off top of your head a dozen companies all doing great work. Most people have no idea
00:19:24
these companies exist or what they do exist, right? And so if I can put into to AI my labs and I don't know much
00:19:31
about healthare I can get information sent to me in a way that I can process it and at the time I'm ready to hear it.
00:19:36
Now I'll give you one more data point that might be useful. All Medicare patients, all seniors over 65, all of
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them are given a free wellness exam every year. What percentage of people take their free medical exam with?
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>> Less than 5%. >> No, it's not that bad. It's less than 50%.
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>> Less than 50%. >> Okay. But most people don't do it. It's
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there. And part of the reason we think that's happening is you don't prioritize
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it. And here's the more important data point. People who actually see their doctor think they're sicker, but they're
00:20:02
actually much healthier than people who don't see their doctor because ignorance
00:20:05
is bliss. People don't go to their doc or seek any kind of health advice think
00:20:09
that they're doing great. And actually, objectively, they're doing much worse.
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So, we have an opportunity to democratize this by saying, "Okay, I'm going to meet you where you are. You
00:20:17
don't care about going to see a doctor even though it's free. It's yours in
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this new health tech ecosystem we're building out. I'm with Amy Gleason who
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also ran Doge, you know, helping to to to roll this all out. We're making it
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easier for every tech company to participate. 600 companies have signed a pledge agreeing to interoperability and
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data transparency and to build these tools for the American people to be able to use them. Now, once I a deputize you
00:20:41
to be better equipped to take care of yourself, you change the system. Because when you ask a doctor a question, the
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first time you're the only patient, they don't pay attention. The second patient
00:20:49
who asks the same question, we change. As a physician, I'm telling you, it helps us to have patients pushing us to
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pay attention to, for example, ambient collection of information in the doctor's office. So, I get a medical
00:21:01
report on what you told me. Why? Because 50% of what a doctor tells the patient is forgotten before the patient leaves
00:21:07
the office. So, when your kid asks you, hey, what happened with the doctor? You don't remember. You're nervous. You're
00:21:12
anxious. The doctor spoke quickly. Use big words. Break all that down. And all of a sudden, information gets flowing
00:21:18
easily. Now you've got a lot more stakeholders. And who's the ultimate stakeholder? The patient. So the medical
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records who historically have been hijacked by medical record companies >> and hidden
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>> and hidden >> like how do you ever get them? >> Yeah. And all those companies now are
00:21:29
saying, "All right, we get the joke." And this is again back to the president.
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He's not fooling around in this stuff. When he tells you he wants you to share
00:21:35
data, you know he's going to come after your ass if you don't deal with this
00:21:39
problem. And so they've all come and all right, you know, we're not on the joke
00:21:42
now. The pharma companies when we're negotiating most favored nation. You know what they said when we challenged
00:21:46
them and said, "You're you're charging several times more for the same
00:21:49
products." They said, "All right, well, we knew one day you'd come knocking." We
00:21:52
knew they do. So, and we actually think the president would do something to us, so we're going to negotiate. And you
00:21:58
don't want to throw away that power. >> You know, don't beg for forgiveness.
00:22:02
Push for action. Yeah. >> You know, go make things happen. And if they don't work out, fine. You you
00:22:06
you'll get more more bites at the apple. >> Just on that point about the pledge
00:22:09
because I got to attend that event at the White House. >> You organized it.
00:22:12
>> Well, don't be modest. I mean, that's going to be a little bit too much
00:22:14
credit, but it was honestly it was you and Amy Gleason and Secretary Kennedy and you guys just happened to invite me
00:22:21
for some reason, but it was it was really interesting cuz so this is my kind of layman's understanding of it,
00:22:27
which is the law gives us the right to our own medical records, but in practice, we don't get them.
00:22:34
>> HIPPA regulated. >> Well, it's it's because the the companies that store the health records
00:22:41
Yeah. do it in proprietary formats and we don't really know how to get that data and what would we do with it even
00:22:47
if we did. So the key is to get those health records shared to all the other medical companies in the space that we
00:22:53
might want to use. Hence the power of the pledge get these 600 companies agreeing. But I think that AI is kind of
00:22:59
the magic glue here because AI is so good at reading data from different formats and translating it. So you don't
00:23:07
need like a perfect API anymore. You just get the unstructured data, dump it in, and now it just works.
00:23:13
>> Which is what we're starting to see. I'm taking my eight sleep data, my Whoop
00:23:18
data, my blood panels, and I'm putting it into all four of the major ones, asking it. I take pictures of every one
00:23:24
of my supplements or drinks. What impact will this have? Which impact will this have on sleeping?
00:23:29
>> I think that's like this gigantic win. >> Yeah. you being able to realize the
00:23:34
promise that the law gives you to actually own your own medical data, but to get it in a usable format that now
00:23:39
you can use again a chat interface to understand it. >> It's technological obscurification.
00:23:44
Let's call it what it is. They're trying to use these proprietary formats always
00:23:48
to get a technological advantage and to have a moat around their business. >> AI just decodes that and makes it usable
00:23:53
and now you can you can interact with it. Can can I bring up one other example? So, Dr. You mentioned
00:23:57
democratization. And you and I have had a conversation about certain states are actually trying to ban the use of AI to
00:24:04
be used in therapy. And I think the point you made to me is you know what there's a lot of places all over the
00:24:10
country like rural areas where there aren't psychiatrists or there isn't
00:24:15
psychiatric care. So at least AI provides a baseline level of service. It version one may not have been perfect.
00:24:23
There may have been some hallucination but it is getting better and better every year. If you ban it, then a lot of
00:24:27
people are just going to have nothing, right? I mean, >> beautifully stated. Let's just go over
00:24:31
let's unwrap that a little bit, but I'd be just at a high level say AI is coming
00:24:34
to a neighborhood near you. You're not stopping it. Yeah. >> So, it's going to be there and patients
00:24:37
are going to use it. And so, you have to engage it running from it. You know, uh,
00:24:42
you know, we we we cannot stick our head in the sand on this one. There's other
00:24:46
things you can sort of delay, but I I've encouraged every governor go full boore
00:24:49
at this, but do it in the right way. Allow professionals to function at the height of their lensure. Why don't we
00:24:55
use pharmacists better? There's probably 70,000 pharmacists, right? And think
00:25:00
about this way. Almost all Americans, 95% live within five miles of a pharmacy. There's they don't live near
00:25:06
five, you know, near a hospital usually. So, we don't have access to care in many
00:25:10
ways. If we just took AI and allowed pharmacists and doctors, GPS to function at a higher level, it itself would be
00:25:16
worth the opportunity. So, I'm not even saying advocate at all to a to a to an
00:25:20
AI agent that doesn't really understand you. we can't control. Maybe, you know,
00:25:24
some other country gets involved in it. At its very practical level, we do not have enough practitioners. There just
00:25:30
aren't enough people to take care of rural America. 60 million Americans living in rural America don't have
00:25:35
access to mental health services. Our vets commit suicide at a crazy high rate, more than we lose in war because
00:25:41
they don't have access to mental health services. Many of them do live in rural
00:25:44
America. And so, if we're going to fix those kinds of problems, which are timeconuming, you're not going to get
00:25:49
Park Avenue psychiatrists to go practice medicine. $800 an hour >> at $800 bucks an hour in the North Slope
00:25:54
of of Alaska in the winter. It's just not going to happen. And so this $50 billion investment that we as a country
00:26:01
just made just just I the money was part of the rural health the the working families tax uh cut legislation uh that
00:26:09
the president pushed through and Congress got behind. $50 billion the largest investment ever made in rural
00:26:14
healthcare through our agency was given up by the end of the calendar year. All the governors have the money and we
00:26:19
charge them to make a difference in their communities. You know, your communities, they almost all came back
00:26:23
with some AI element. They all know to really be able to get healthcare in rural America, you've got to rightsize
00:26:28
the system. Right sizing the system means, you know, you have hospitals going to work out differently. Doctors
00:26:33
will work differently with each other. But AI is the core element of so much >> and these micro hospitals just like
00:26:38
people are putting ADU units in the back of their homes to get an extra, you know, apartment for grandma and grandpa
00:26:43
or as an Airbnb. My understanding is there's a bunch of startups working on the equivalent building a micro hospital
00:26:51
a room with the central services perhaps a nurse practitioner uh who there's more
00:26:55
available and then you tele medicine in just bringing the medicine to those areas without having to build a giant
00:27:02
hospital is also a win yeah >> the micro clinics I think a huge opportunity to provide top tier care but
00:27:08
this goes beyond that we have AI supported robots >> that are going to be doing ultrasounds
00:27:14
in parts of Alabama where there are no OBS, right? >> We have drones delivering uh
00:27:19
prescription medications to the North Slope of uh of Alaska, where there are no roads, we have you have vending
00:27:25
machines that can dispense smart dispensing of medications. By the way, this is happening in other countries.
00:27:31
So, we want this to take place in America. Why not take advantage of of an opportunity through with a huge massive
00:27:37
inflow of money which the rural health transformation fund does $50 billion to start to do some innovative work in
00:27:43
rural parts of the country which are the the foundational element of who we are as a nation. Those values ripple up to
00:27:49
the rest of us. I also think that states now are talking to each other differently. Now now that you got money
00:27:54
that's out there that can be used to change the world. They start talking about AI and technology generally very
00:28:00
differently. Now, it's not a it's it's it's not a sparse research. We live in a
00:28:04
world of abundance. And AI makes it that much more abundant if we use it correctly. And it's not going to happen
00:28:08
today, but we believe by the time the administration has completed this work, we will have dramatically changed the
00:28:14
face of how Americans work with information in the health care system. Some of it's just blocking and tackling,
00:28:19
as you said, make medical record companies, not data block. Some of it's forcing uh health information systems to
00:28:25
share data more comfortably and elegantly at a at a fair price. And part of it's us putting money into the
00:28:29
system. seeding it the right way. Um but the most important thing is to make it safe to go outside.
00:28:35
>> Yeah. >> We want to make it comfortable to take financial risk to invest in these areas.
00:28:39
That's why 600 companies have invested. Every major AI company, every major foundational technology company, but all
00:28:45
a bunch of these surgeons that I that I promised, they're all rushing in. >> The three places entrepreneurs have been
00:28:50
reticent to uh take on uh to build new products and services. Education, housing, healthcare. These also happen
00:28:59
to be the ones most regulated, most controlled by the government. So to the extent you can give them access and make
00:29:06
it go faster, it's going to work. The only investments we've ever made in
00:29:10
those spaces are ones that go direct to consumer because we know going through the government, there's just not enough
00:29:14
runway for those companies to get to the other side. Let me ask you about >> We're open for business. And I got to
00:29:19
make this plug while I'm here. We want to work with industry. We believe the
00:29:22
private sector will come up with better ideas. Come work with us. And we're also
00:29:25
looking for people and we we had nine engineers. Nine engineers when we came in and all of CMS the our cobalt based
00:29:32
infrastructure built in the 70s where we don't have engineers that >> you're talking about in the department
00:29:37
you had nine engineers out of what's the denominator of employees? >> 6,500 employees and 40,000 contractors.
00:29:43
So there's you basically have an HR person in government working with a government government affairs person at
00:29:48
the company. There's no engineers there. >> 16 basis points. David, >> we took out we took $3 billion of cost
00:29:54
out there. There was a company that we fired that had build us $200 million. Not a single usable line of code. And
00:30:00
here's the good part. When we fired them, you know what they said? Nothing. >> Yeah, we knew it. We knew it.
00:30:05
>> Yeah, we were underperforming. No accountability. >> Underperforming.
00:30:08
>> God, we could go on about fraud for forever. But I want to ask you about
00:30:12
this wonder drug. Four years ago, I was listening to my friend uh Tim Ferris and
00:30:15
Kevin Rose who are biohackers and they're always on the edge of this stuff and he wanted to lose some visceral fat.
00:30:21
Kevin was in great shape and he heard about this diabetes drug OMIC and that he was going to give it a shot. He
00:30:28
dialed the pen all the way up, puked, dialed it back down, lost his visceral fat. I heard that I was like 40. I was
00:30:34
213 pounds at the time. Went to my doctor. He said, "I have no idea what you're talking about. You're not
00:30:39
diabetic, but you are fat." And I think he said, "You're a fat bastard." I think
00:30:43
I said that. And I had just gained like two or three pounds a year for 20 years.
00:30:47
And I used to be a marathon runner. I used to be 165, 170 lbs. So now 172 gazelle right now by the way.
00:30:54
>> Well I add a little muscle too. Thank you Dr. O. You look great too. Um but
00:30:57
this is a miracle drug. This in my mind we now have theoretically tens of millions of Americans have experienced
00:31:05
it. It's going to be in pill format. The the four uh horsemen of the apocalypse,
00:31:11
heart disease, >> kidney failure, liver disease, dementia. >> Dementia. These are all four of four are
00:31:18
impacted by obesity. and these GOP ones seem to be impacting them. I was like, you know what? If Trump just President
00:31:26
Trump just gave a national anybody can get this drug if they want it, I think he'd win the election. He won anyway.
00:31:32
Um, what do you think about a mandate to make it available to make the fat drug available for all Americans? Would that
00:31:39
be >> So, I'm glad you came to work today. So, uh, about two months ago in the Oval
00:31:44
Office, the president basically did that. He said that we're going to take the prices of these drugs, which are now
00:31:49
prohibitively high for many Americans, $1,200 cash pay. It's >> crazy.
00:31:54
>> It's going to be a starting price of around $200. >> Easy. >> And u with the pills, it's $150 and the
00:32:00
pills will come out. Uh the first FDA approved pills will start this month. Um and so we believe at that price
00:32:07
day >> because think carefully. That's right. It's a basically you get coffee a day.
00:32:11
At that price, we will within two years return money to the American taxpayer. It's going to save us so much money from
00:32:18
reducing hypertension, diabetes, and the downstream illnesses, the four horsemen
00:32:22
of the apocalypse that you mentioned that we will save money that we spend over half the money we I believe within
00:32:29
health care on these chronic illnesses driven by obesity. And so either directly or indirectly because you hurt
00:32:36
your knees because you're overweight or you get autoimmune problems or even cancer is linked to obesity because you
00:32:40
have a metabolically active state. All of these are going to drop precipitously. We have pretty good data
00:32:44
on this from an internal modeling. So we agreed to those prices with the two major companies Novo Nordisk and Eli
00:32:50
Liy. We will launch next week. I don't know when this podcast airs but launch
00:32:54
next week Trump RX with those products so you can cash pay at a price that is completely affordable. And here's the
00:33:00
good news. Every Medicare patient gets it for $50 co-pay. Every Medicaid patient gets it for nothing.
00:33:07
>> Amazing. >> So the people who need it the most, the folks that are most vulnerable, this is
00:33:10
what it when people say the president doesn't want to protect Medicaid, he doesn't love and cherish Medicare. It
00:33:15
drives me bonkers because he's doing more for underserved Americans than any
00:33:19
other president ever has. Giving Americans where the obesity epidemic lives, underserved Americans, you
00:33:25
vulnerable Americans who are on Medicaid access to these drugs for no out-of- pocket costs. truly democratizes the
00:33:32
weight loss issues because right now what's the number one zip code for weight loss drugs. Number one zip code
00:33:37
upper east side of Manhattan. >> I was about to say it's got to be Manhattan or LA.
00:33:40
>> LA is number two. >> Okay. >> Right. >> Cuz people can afford it or
00:33:43
>> because they're vain. >> They're vain. They want to lose two
00:33:45
pounds for their daughter's wedding and they can afford it. $1,200 a rounding
00:33:49
area. Yeah. Right. But $1,200 for someone that's not making money. You're
00:33:53
not you're just not going to take the drug and they're the ones that die
00:33:56
early. The life expectancy in rural America, I'll go back to them in vulnerable populations 9 years shorter
00:34:02
than yours in the same country. >> It's something that came out of left
00:34:06
field. What does that tell us about what's going to happen in medicine going
00:34:10
forward? Because GLPS, how long of a journey has that been and then getting to market and then you know
00:34:17
this off label use starting with people with diabetes. What is that? What is that? How does that inform you of how we
00:34:25
can make even more impact in the future? How do we make another GLP like discovery and implement it the way
00:34:31
President Trump has? >> Well, this, you know, the drug actually came, it's a poisonous uh chemical, a
00:34:36
venom actually, that was uh deciphered and found to have an impact on some of these core cells in the in the the
00:34:44
appetite system of the body, which is so fundamental to who we are that it's very
00:34:48
hard to hack the appetite. But GLP-1s are just the tip of the iceberg. There are more and more sophisticated ways for
00:34:54
us to be able to address not just appetite but addiction, addictive behavior drops at GLP-1s. So the newer
00:35:00
drugs are going to be even more effective at that. >> Red True Tide is the one you
00:35:04
>> for example, Red Tide. But the other thing I would say is the form factor
00:35:07
matters in sending someone an injection that's that goes bad in the warm weather
00:35:12
that a lot of wastage and you don't know the exact dose. the pills make it like
00:35:16
most other drugs and now the drug the price point is much lower as well. So it's easier for us to deliver that at
00:35:22
scale to the American people. So it does leapfrog us beyond today's problems and
00:35:27
this is a big theme of our administration. Don't bother fixing today's broken pipes if the world you're
00:35:32
building doesn't have pipes >> and that's what we're doing with drugs
00:35:34
like semagutide and interzepide which is the the lily product. We're also getting
00:35:39
these companies to unshore their production facility hire American workers stay innovative. This is why
00:35:44
again the president doesn't want us hurting innovation. With the same day we
00:35:47
did the first most favored nation drug um event, we had an executive order on childhood cancer. 20 beautiful children,
00:35:55
smiley bright eyes, all of whom all of whom should have been ghosts. They survived because technologies were
00:36:01
afforded to them. Don't exist in other parts of the world to keep them alive.
00:36:04
That's our goal. But I need to I'd be poorly served. I hear the bell tolling
00:36:08
if I didn't get into the other >> for whom we don't know. We probably
00:36:11
asked for the belt holes for sure for you, Jac. But >> I think that's all I think that's
00:36:16
totally for the pharma companies who don't bend the knee. >> No, actually, but the the the the issue
00:36:22
right now that is consuming us is the fraud, the waste and abuse. And >> what have you found, Dr. Oz? Tell us
00:36:28
what is the most concerning to you? >> Well, let me as a preamble w without a
00:36:33
better visibility into where the money is spent, which we need technology to be able to do
00:36:38
>> or audits. Well, audits are interesting. You can audit the spreadsheet. You can't
00:36:43
tell if the input to the spreadsheet was legitimate unless you actually go and do
00:36:47
site visits, and states don't want to do that. So, let me just give it >> Are they blocking it these states?
00:36:52
>> Of course. First of all, let me just I'll tell you that's a good question.
00:36:56
Why would you let fraud happen? It is by federal law, by federal law mandated that if you give a patient a welfare
00:37:03
program, SNAP, uh, Medicaid, you must also give them the ability to sign up to vote. So you're basically recruiting
00:37:11
voters at the same time you're giving them free government services which then
00:37:15
you might actually end up recruiting a different kind of voter like you don't
00:37:19
have a law that if you go to an NRA convention uh right for for you know gun advocates that you sign up voters right
00:37:25
you can go to that event not get signed up to vote obviously they would be probably skewing to the right so there
00:37:30
is an issue there we also have an active role of unions especially in California
00:37:35
where we have a a major problem because the unions have seemed This is all what I'm hearing from talking to people on
00:37:41
the ground seem to have gotten involved in, for example, signing up home health care workers and and personal care
00:37:46
services. There are more Americans, I believe, providing some of these homebased services that maybe might
00:37:52
exist in retail in America. We've shifted the entire employment economy towards some of these services. And
00:37:58
here's the risk. If you really want to understand why we have fraud in America,
00:38:02
when I give you things that your family used to give you, we are going to have fraud. So, your family used to drive you
00:38:09
to the doctor's office. Your family would take you home after you got home back from the hospital to make sure you
00:38:13
got well nourished and taken care of. Your family would carry the groceries up the stairs. Your family would negotiate
00:38:18
your contract with the landlord. Guess what? Healthy human services does all that for you now. All you got to do is
00:38:23
ask. And in some states, it's so easy to do that you end up with significant
00:38:27
fraud. We >> So, they have intercepted the transaction. Therefore, that's where
00:38:33
grift can occur and fraud. >> Well, the government's paying for it, >> right? So when the consumer is paying
00:38:36
for it out of their own pocket, they have their own incentive to get value for the transaction.
00:38:42
>> But when the government's paying for it, who really has the incentive to make
00:38:45
sure that value has been provided in exchange for that money? Yeah. And this is what happened in Minnesota where you
00:38:49
had a subculture. It was prim, you know, just the mathematically most of the indictments with are with Somalians. So
00:38:56
the Somalian community realized, hey, my goodness, no one's watching. >> Now there's an adage, you know, that
00:39:00
only the morons get caught in healthcare fraud because it's so easy to do. And if
00:39:05
if you get you steal $5 million uh in medic in Medicare Medicaid, you go to jail for 18 months. I mean, for many
00:39:11
people, that's a pretty good deal. >> Yeah. >> You, you know, sit in the pen for 18
00:39:14
months. But unfortunately, I'll just give you a lay of the land. There are twice as many durable medical equipment
00:39:20
providers. They sell wheelchairs and knee braces. Twi there's actually 20 times more in South Florida than
00:39:27
McDonald's. I mean, how many do you need? Turns out they're all Cuban pretty
00:39:31
much. They all seem to fly back to Cuba and escape, you know, law enforcement. They They build millions of dollars.
00:39:36
They get away with it. There >> what's the solution? There's got to be
00:39:39
really practical, easy solution. >> There are, but and I'm going to share
00:39:42
that, but let me just give you two others because you would remember these. We have seven times more hospice in
00:39:46
California. Hospice is for people at the end of their life. Seven times more hospice than was there five, six, seven
00:39:51
years ago. Seven times more. We don't have that many people dying in California. And more importantly, the
00:39:56
survival rates on hospice, again, designed for cancer patients dying within six months. The survival rate for
00:40:02
most of these hospice centers is 100%. >> Wait a second. >> They shouldn't have gone to hospice.
00:40:07
>> Exactly. >> Is the government paying for it? >> Yes. Completely paying for it. But no
00:40:11
one's dying because you're not supposed to. >> When did the government start paying for
00:40:13
that? >> Oh, 40 years ago. Okay. It was designed. >> And then what happened in the last seven
00:40:18
or 10 that the fraud just went foreign governments got involved in LA? The hospice is driven by the Russian
00:40:24
Armenian gangs. They're foreign nationals. They fly back to Russia. We had a big $15 billion bust on these guys
00:40:30
earlier in the year. Again, they all escape. The other thing is no one's watching because there's a opportunity
00:40:36
if you get into these businesses to make a lot of money and it becomes I'll give
00:40:39
you I'll just tell you a true story about uh a whistleblower. Again, I I can't prove this, but it's what he said.
00:40:45
He said that he uh he was building a beautiful mansion. He owns all these hospices. He's a doctor, but he's a
00:40:50
fraudster. Uh and so he built this puer house. They the plumber comes in and says, "Hey, you know, I hear you in the
00:40:55
hospice space." The guy says, "Yeah, I made my money in hospice." that the
00:40:58
plumber says, "You know, I've got a side hustle. I own a hospice, too."
00:41:02
>> Right? Then the carpenter hears him and he says, "Me, too. I'm in the hospice
00:41:06
business. We're all in the hospice business." Absolutely. >> So then the guy says, "Okay, well, he
00:41:10
realized he's got to get ahead of these guys." So he goes to a a major hospital
00:41:13
in LA and a doctor at the hospital, very prominent hospital that everyone's heard
00:41:17
of, says, "Hey, listen. You, if you give me $1,000 a month, I'll send hospice
00:41:21
patients to you." Which is how it's done in LA, by the way. You get paid, this
00:41:24
you send patients over. So the guy says, "Okay, but what about the actual inpatients like the people hospitalized?
00:41:28
Can I get them?" They got and the doctor says, "I can't do that because it turns
00:41:33
out the members some there are some members of the board that own hospice and they like the patients to go to
00:41:37
their centers." >> You see that the corruption starts in in organized crime, but if you tolerate it,
00:41:43
it poisons the whole system. >> And that's the bigger reason we've got a
00:41:47
problem. So what are we doing? We have a fraud uh war room. Uh I'm going to put a
00:41:52
moratorum on some of these services. We're not going to let new people sign up. Uh we're going to actively and
00:41:57
aggressively stop paying Medicaid uh if we can prove that states are not obliging their fiduciary responsibility
00:42:04
to the American people because states administer Medicaid. I pay the bills at CMS. So, we're going to stop paying on
00:42:11
behalf of the taxpayer if we don't think you're taking care of the money.
00:42:13
>> And people should know there are whistleblower laws where you get a percentage of whatever is reported and
00:42:19
they should look into that. And the fact that we have so many people in the administration now communicating that,
00:42:26
hey, we want to have you report fraud to us has changed everything. The number of
00:42:32
people reporting fraud must have gone up since >> dramatically. People in the government,
00:42:37
this is probably, you know, the part that's most rewarding to me. Many government workers are Democrats.
00:42:43
Probably most >> what they tell me again and again is they just came to government to do their
00:42:47
job. They wanted to do the right thing >> and and they were told not to do their
00:42:50
job. They were told not to focus on the fraud, to focus on getting more people signed up. But if you don't take care of
00:42:56
the fraud, this is an important message. You will kill the system. Eventually, you will destroy Medicaid. And I'm not
00:43:02
going to let that happen on our watch. Medicaid, as Hubert Humphrey said, is there to protect those at the dawn of
00:43:07
life, which are our children. 53% of kids are born into poverty. We take care of them. Those at the twilight of life,
00:43:13
those are the seniors, right? We owe it to them. Every great society takes care of the most vulnerable. We're great
00:43:17
people will do that. And he Hubert Humphrey said you got to take care of those living in the shadows. We are not
00:43:23
going to let them get hurt. When you let organized criminal elements steal at scale from the federal government, you
00:43:29
are killing those programs. We now have so many kids signed up falsely for autism that the kids with autism aren't
00:43:35
getting access to care. >> Yeah. This is the incredibly frustrating thing. Having talked to some young
00:43:40
parents who are millennials, Gen Z, they're going to work. They got two jobs. They would love to have child
00:43:47
care, but the child care dollars are being stolen. Therefore, they can't access them. And the same thing's
00:43:54
happening across the system. I think this could be just such a defining moment for America because on the other
00:44:00
side, we have socialists, lunatic communists running some of these cities who want to seize people's assets, want
00:44:08
to raise taxes before fixing fraud. This is like pouring water into a a leaky bucket. Well, you're talking about
00:44:14
California >> and New York. >> Yeah. And I couldn't help but notice
00:44:17
that Gavin Newsome arrived here at Davos yesterday. >> He's here. >> Yeah. He was encouraging European
00:44:22
leaders to defy President Trump, which is a weird thing for a governor to come here to
00:44:27
>> to basically uh advocate for foreign leaders to defy the American. >> What next? like partner with communist
00:44:35
countries for your f I mean >> but I think honestly it's all a distraction because the the real thing
00:44:41
happening in California right now is everybody knows there's massive fraud there you see that image on the internet
00:44:46
where it's an iceberg and >> the tip is Minnesota but California is the fourth largest economy in the world
00:44:52
so we know there's massive fraud I think Newsome knows there's massive fraud too
00:44:55
that's that's why he's vetoed >> audits >> I mean can we just pause for a second
00:45:00
audit >> veto audits Right. >> Who would veto an audit? >> Someone doesn't want to get caught.
00:45:06
>> A criminal. A criminal would veto it. I'm not saying he's a criminal, but
00:45:10
>> No, this is to government spending what the ban on voter ID is to elections.
00:45:15
>> Why wouldn't >> you only do that? You you you're banning the thing that helps you catch the
00:45:20
fraud. >> Yeah. >> So why would you ever do that unless you want the fraud to happen?
00:45:24
>> Exactly. It's it's Yeah. It's still >> now and now even
00:45:29
>> distraati as we say here. But California the budget's $350 billion by far the
00:45:34
biggest. >> It has doubled in the last decade >> and it's like three times per capita
00:45:40
>> two and a half times the inflation rate. Okay. And they're still running a huge
00:45:44
deficit. And that's why they're now driving all the job creators out of the
00:45:48
state with this proposed asset seizure. Wild. >> If they just clamp down on the fraud,
00:45:52
they wouldn't have this hole in their budget. Just LA County alone, just in hospice and home health care, we believe
00:45:58
it's about three and a half billion dollars. Just in those two programs in one city, there's probably 10% of all
00:46:04
home healthcare expense in America is in LA. So there's so much to do to improve
00:46:09
the system that would restore confidence. And when you have governors who are unwilling to do their job, and
00:46:15
it does make people think that listen, when smart people don't do things, it's
00:46:19
not an accident. right? >> They're not doing these things because they have ulterior motives that either
00:46:23
aren't transparent to you or they think you're not smart enough to figure out.
00:46:27
We had to ask those questions. This president is not going to tolerated, but the American people shouldn't either.
00:46:32
>> We had an interesting moment. Uh our friend Elon Musk had asked us after he
00:46:36
purchased Twitter now X to come in and we were looking at the bills trying to figure out how this company was
00:46:43
hemorrhaging cash at a level that just didn't even seem possible. And one of
00:46:47
the things was they had just signed up for tons of software and you know basically subscriptions and uh CFO comes
00:46:54
in, auditor comes in, we're all trying to figure it out and Elon said that Twitter and Elon says um
00:46:59
>> how are they paying all these? They're like oh yeah they're on credit cards. He
00:47:02
said okay um cancel all the cards. >> Yeah. >> And so we said they're like yeah cancel
00:47:07
the cards. Immediately I get three back channels from software companies who are like hey
00:47:14
um I know you're helping Elon. I saw a story in the New York Times. Um, our bill stopped getting paid. Can we come
00:47:18
in? And I'm like, yeah, we're not using your software anymore. Nobody's ever
00:47:22
used it's never been installed. The software had been You want to talk about
00:47:26
fraud at a scale that was deranged? >> This is a private company, not a private
00:47:31
company. >> Yeah. >> But your point is, look, when when no one is minding the store, bad things are
00:47:37
going to happen. And when no one has minded the store for decades and the government's paying for it, you don't
00:47:42
even have that private sector profit motive to basically be efficient. Then think about how the fraud just
00:47:49
metastasizes. It's got to be >> 20 30% >> hundreds of billions. >> It's got to be a double digit. I'm going
00:47:57
to guess 20 30% of all these fraud. >> All it took was a YouTuber with a video
00:48:02
camera to actually show up. Yeah. >> At the Minnesota daycare centers that
00:48:06
were receiving millions of Learing center. Yeah, the the Learing Center. They're all empty. Yeah.
00:48:11
>> Dozens of them. Each one's receiving millions of dollars. >> And that's one program in one state. And
00:48:15
these aren't low lives doing this. The lives are involved obviously, but these
00:48:19
are politically connected groups. >> Sophisticated. >> Yeah. And that's why I'm emphasizing
00:48:23
these are government, foreign governmentbacked efforts at times, but certainly the people doing them are
00:48:28
often foreign nationals. And we are being taken advantage of because we're like a big hippopotamus. You know, all
00:48:33
you need to penetrate Medicare and Medicaid is a beneficiary number. they can buy those and you're off to the
00:48:38
races. So, the solutions are I'm not claiming they're simple, but they're
00:48:42
eminently doable, but you have to expect it of your leaders. >> There's going to be some low hanging
00:48:46
fruit here. I can tell you you cutting off payments and saying very simply, hey, we've cut off payments. All you
00:48:53
have to do is sign this attestation that you delivered the service and I would like you to attach your driver's license
00:48:59
and passport to it and um by the way, you've been randomly selected to come into the office. We want to hear all
00:49:05
about what you're doing and jump on a Zoom call. >> Right. So, you're saying cancel the
00:49:08
credit cards. >> Yeah. >> And then >> and just let them then reopen the
00:49:12
account or tell you. >> Yeah. Come in. Yeah. We just want to reverify what's going on. Literally
00:49:17
>> zero baseline budgeting. Not saying the program is over. And that's the thing
00:49:20
that that I think Elon found when he was doing Doge is these payments were just on recurring autopay every year.
00:49:27
>> Autopay equals >> with no with no code explaining what the money was going to.
00:49:31
>> Autopay equals from that. That's all you have to know. And if you look at like
00:49:36
some of the great I mean if you want to talk about like some of the good stuff Lena Khan did and I was opposed to about
00:49:41
80% of it. One of the things she did that was really well was she said if you sign up for a service you have to be
00:49:46
able to cancel it the same way you signed up. So newspapers these bastions of virtue you'd sign up
00:49:54
for Wall Street Journal. You probably have had this experience. You try to cancel it. They're like give us a call
00:49:57
and then they you're on the phone for an hour just want to cancel it. And I asked
00:50:01
the woman, I said, "Uh, hey, can I ask you just a simple question, um, why can't I just cancel online?" They're
00:50:06
like, "Oh, well, because of fraud." I'm like, "But you took my money through the
00:50:11
website, so that's where the fraud would actually occur." She's like, "Yeah, that
00:50:14
kind of makes sense, but I'm just an operator, Mr. Calican." They said,
00:50:17
"Okay, fine." But that this is the same concept, which is if you want the money,
00:50:21
hey, why don't you come into the office and we'd love to hear how the program's
00:50:25
going. We got your check right here. Come pick it up in person. Want to hear about it. And uh can you just take a
00:50:30
picture of the service you provided? Just taking a picture of the service you provided and then send it in.
00:50:35
>> Yeah. >> How is this hard? >> And like you said, how do you argue for
00:50:38
you? California already has some of the highest tax rates in the nation. And now
00:50:42
you're arguing for more taxes, novel taxes, taxes that no one's ever seen.
00:50:46
>> Unconstitutional. >> Unconstitutional probably. And will require a massive new enforcement
00:50:51
mechanism. Before you do that, you haven't even rung the obvious fraud out of the system.
00:50:56
>> Yeah. Listen, our biggest allies, our state auditors. I met with the state
00:51:00
auditor in Minnesota. Uh confided that, you know, she's been trying to get this
00:51:04
on the radar. Uh just people didn't want to listen. And I talked to folks within
00:51:08
the agency, Healthy Human Services. U you were shuttled around. Uh one woman was actually escorted out of the
00:51:14
building for raising the reality that there was fraud. And this happened over several years. And eventually either you
00:51:20
leave if you're ethical or you be you're quiet because you don't want to get
00:51:24
fired. And you make it such a a harsh environment for anybody to just tell the truth. This reminds me of a friend of
00:51:30
mine who was uh he's a billionaire now. Tomas Pedy, you probably know him, Interactive Brokers. Uh really really
00:51:36
great guy. And he said he was growing growing up in Hungary and he said when he was young he knew that everyone was
00:51:41
lying to him. >> But that wasn't the big problem. The big problem is he knew that they knew that
00:51:46
he knew that they were lying to him, >> right? >> So pretty soon we are all in on the fact
00:51:49
that there's a big lie. >> The whole thing is corrupt. And so working in these agencies, the good
00:51:54
people are weeded out. The people who are left either don't care, aren't good
00:51:57
people, >> or complicit. >> And some of them are complicit. But I think fundamentally there was a
00:52:02
misalignment of values. And this actually was probably the most important thing we had to do in that legislation
00:52:07
last year, the working families tax cut legislation. We had to align the president with the governors. There were
00:52:12
so many ways of getting this the federal government to give you money that wasn't
00:52:16
really yours. legalized moneyaundering schemes, all kinds of things that clever consultants had figured out over the
00:52:22
years that we estimated we would have lost 5.4 trillion dollars just for Medicaid, which is again why I often
00:52:28
joke we were becoming one massive health care system with a small country attached.
00:52:31
>> Well, and if it doesn't work long term, if we don't take bold action, which
00:52:36
again a major message on a lot of things the president is doing, if you don't
00:52:38
take bold action on some of these issues, you're leaving our the next generation with a train wreck. They
00:52:44
can't fix it anymore because the train's gone way off the rails. Yeah. And just
00:52:47
think of the absolute hypocrisy. You have someone like Mandami who says he wants to increase services, provide more
00:52:53
for the citizens and they're not doing the audits. They're not fighting fraud.
00:52:58
Gavin Newsome is talking about wanting to provide more for the bottom half of society, but not doing the audits.
00:53:03
>> And frankly, this whole budget hole that is causing this now acid seizure tax, it
00:53:08
all started in 2022 >> when Newsome promised medical for all including illegal aliens. And so what
00:53:14
happened is in big beautiful bill president said listen we're not going to reimburse for illegal aliens like
00:53:21
>> think about incentives there >> right so then the SEIU uh the health
00:53:27
worker union >> they're upset because they don't want that funding cut because it indirectly
00:53:32
impacts them. So that's how this whole thing happened. Think about the layers
00:53:35
of fraud there that you've got you know the the government the government of
00:53:39
California is paying for illegal aliens probably shouldn't be doing that. I mean, if you ask the American people,
00:53:44
which is who you both work for, how many Americans believe that illegal aliens should get universal healthcare, I think
00:53:51
you're going to get like 98% are going to say absolutely not. And the 2% with purple hair in Berkeley who want
00:53:57
it. I >> I don't know what what their motivation is. >> Support them. Just to finish the point,
00:54:02
if you are going to have the politics of a Gavin Newsome and you're going to tell
00:54:06
Benal for all in the state, even illegal aliens, doesn't that create a responsibility on you to audit the
00:54:14
system and make sure it's not being abused? When you then turn a blind eye Yeah.
00:54:18
>> to the fraud and you refuse to even acknowledge it, you just pretend like it
00:54:21
doesn't exist and you veto the audits. That's doubly wrong. >> But but it doesn't hurt California. This
00:54:27
is the the part of the story that's so infuriating. You don't audit the books
00:54:30
in California because the federal government's paying anyway. So why would I audit the books to find out that my
00:54:35
people aren't getting free money from the federal government? Let's talk about
00:54:38
illegal immigrants. So Gavin Newsome was given us a hard time for threatening the
00:54:43
health insurance of illegal immigrants. Just to be very transparent, if you're
00:54:46
on Medicare, you don't get free dental. You don't get free vision. You do if
00:54:49
you're an illegal immigrant in California. >> This is the inferior. So anyway, so
00:54:52
you've got taxpayers in New Mexico, right, which is a blue state but a poor state, paying extra tax dollars to the
00:54:59
federal government that are recycled back into LA to deal with the fraud that I'm talking about. So illegal
00:55:03
immigrants, he's mad. He's mad. He's mad. He's mad. We're horrible people.
00:55:06
We're Republicans. You have no conscience. You have no heart. As soon as we made it clear we were no longer
00:55:12
going to pay for illegal immigrants in California, what did he do? He took them off Medcal. Now, he didn't take them
00:55:17
off. He took them up on the federal side. In theory, only emergency services are going to get paid for for illegal
00:55:23
immigrants in California, which is a national law >> and is and is reasonable.
00:55:26
>> Reasonable. Now, I'm I'm all we want babies delivered, car accident victims
00:55:29
hurt, get of course get healthcare, but not elective hernia surgery, cataracts, you know, you have to be an American
00:55:35
citizen who paid into the system to get these. So, anyway, so we we deal with this. Gavin says, "We're only going to
00:55:40
pay for illegal immigrants through our own state-based system." We've audited
00:55:44
him. Now, this data is coming out this week. We have now found over $1.5 billion dollar of money spent wrongly.
00:55:52
We've audited it. They're not even arguing. $1.5 billion dollars from uh
00:55:56
that California charged the federal government for illegal immigrants that they're not allowed to pay charge us
00:56:01
for. They have to pay for it themselves. He's not happy. But they're paying us
00:56:05
because they know we're right. So, you're going to see something happen very interesting in California. As soon
00:56:10
as the money is being paid by California government officials, they're going to
00:56:14
start getting more serious about this. And that's why it's so important for us
00:56:17
to say, "We're not into this anymore. I'm not going to let taxpayers in
00:56:21
Alabama and Mississippi, New Mexico, you know, our poorest states pay for the fourth largest economy in the world."
00:56:29
And they get less. >> And they get less. And you know, the immigr we're a country of immigrants.
00:56:33
You could absolutely believe in legal immigration and want the border closed. That's what we saw in the last election.
00:56:39
That was the deciding issue, I think, at the end of the day. I mean, they also picked a terrible candidate on the other
00:56:44
side and didn't have a primary. Put that aside. If you >> We had an amazing candidate, too.
00:56:48
>> Incredibly tremendous. Okay. >> The best ever. >> They're the greatest ever.
00:56:51
>> I'm minimizing. >> I'm just saying. I mean, you kind of went up against a we Anyway, put it
00:56:56
aside. You know, the the thing that I think is super important is incentives matter. You you've said this many times
00:57:02
without explicitly saying it in our conversation. The incentive for people to come to America illegally is to make
00:57:09
a better life for themselves and to have a job, employment, and these social services. If the social services aren't
00:57:17
available, you know, some number are going to stay back. And if the jobs aren't available, then why would you
00:57:22
risk it? Why would you pay one of these coyotes 5 $25,000 across the board? You wouldn't. You would get in the line to
00:57:29
do it properly. And that's a very simple solution here. You you just change the
00:57:34
incentive. make it impossible for an illegal alien to come here for those two things.
00:57:39
>> Do you know what financial value there is of having free healthcare in America?
00:57:42
>> So many will the >> I'm not going to make you guess. >> Well, I was going to say for the
00:57:46
employers I can say it's very acute to insert yourself into the relationship
00:57:50
with your employees because employees will not leave one company. They'll pick
00:57:54
the company they work for based on the healthare and they will not leave a company to pursue a better opportunity
00:57:59
in order to keep their healthare which is dysfunctional because you want talent to move. That's a uniquely Silicon
00:58:05
Valley entrepreneurial way to look at it. >> From the employer market, uh we we think
00:58:08
the money should follow the patient, but broadly speaking, because I don't I
00:58:12
don't regulate commercial insurance. For illegal immigrants, for your family,
00:58:15
it's worth about $30,000. So, there is no good reason for you to go back home
00:58:20
again if we give you worldass healthcare coverage. >> Yeah. >> So, this is a major issue for us dealing
00:58:26
with the immigration problem because you cannot send 10 million people back legally who are here illegally. The
00:58:32
president has said this, you know, I think he said it publicly, but I think he would. It would take us 200 years of
00:58:38
legal machinations to send back people who came here illegally. So, there is no legal path to expelling people who came
00:58:46
here illegally. You have to remove the incentives to stay here. Free housing, free food, free healthcare. Of course,
00:58:52
you're going to stay. >> Show me an incentive. I'll show you the outcome. If you look at the war on
00:58:56
drugs, um how unsuccessful it's been, uh people go to San Francisco for a reason
00:59:03
for their fentinel because they can buy it and there's no policing. And it is
00:59:06
exactly a function of more policing means the price of those drugs go up, which means consumption goes down. Not
00:59:14
only is there that dynamic missing in San Francisco because there's no enforcement and you can get fentinel
00:59:19
for5 or $10 a hit, they also give you housing at $800 or something to that effect per month. So the homeless
00:59:27
industrial complex has now created an incentive and everybody in that you know really tragic junky community knows that
00:59:35
and they leave Texas they leave other states to go there and then they bear the brunt of it and they are actually
00:59:41
increasing the suffering. What's your take on these new super drugs versus the
00:59:47
the rescheduling of drugs? Uh Obama wanted to do it in his second term. He didn't have the political willpower or
00:59:54
will to do it. And Trump now is saying, "Hey, maybe for cannabis we should rethink that and do what Canada's done
01:00:01
in other modern nations." How do you look at those specific drugs? Fentinyl,
01:00:07
9 or 12 overdoses a day in San Francisco at the peak. Um, and then methamphetamine, which is just another
01:00:13
>> We have good substance use disorder medications. We can't get people into
01:00:17
the programs. Uh this is why homelessness is an industrial complex and the states that have done it well. I
01:00:23
mean I know Mayor Suarez in Miami dropped the number by 90%. And he did it just by making sure that you got
01:00:29
arrested every time you peed publicly. And they don't put you in in jail. They
01:00:33
put you in in rehab. But it takes four, five, six efforts. You can't give people
01:00:37
free showers, great accommodations, lots of food, and then expect them to stop using drugs because you're enabling that
01:00:43
behavior and not expecting bad outcomes, which is what happened. But I was in the
01:00:47
in Kensington, Philadelphia, which is the drug capital of the East. And >> oh, this is where they have that other
01:00:52
super drug. I forgot the name of it. It's very pernicious. Tran. >> Yeah. Tran is a terrible drug. It it
01:00:57
creates massive ulcers on your body. And so I I was there and you know I I I I just walked the streets just talk to
01:01:02
people like, "Why are you here? Where'd you come from? Why don't you go home,
01:01:05
etc." And I I ran into a guy uh who had just saved someone's life giving them
01:01:10
the lock zone as an inhaler. And he's an ambulance driver. And I said, 'Well, you
01:01:14
know what happened? He says, 'Well, they odied. I gave it to them. And I said,
01:01:18
'Well, what did they tell you? How do they thank you when they awaken from near death, from that dark abyss of
01:01:23
darkness? And he said, they're almost always livid at me. >> Yeah, you ruined their high.
01:01:28
>> Well, not and you ruined their their escape. >> Oh, they're they're actually hoping to
01:01:33
end this suffering. >> The pain was so bad. That's why it seems nice. And that's a that's why I was
01:01:39
telling my friends in Minnesota, Minnesota nice is great when you really really mean it. But nice does not mean
01:01:45
allowing your public health system to be raped. It's not allowing people to abuse
01:01:49
themselves expecting a different outcome than what historically has happened. You
01:01:53
need to if you really love people, you might not like them, but if you really love them, you'll do something that
01:01:59
actually goes beyond like that makes you ultimately gain respect for them for you
01:02:03
and you. There's a very simple tough and if you were to take a Christian view of
01:02:07
it um and you were to talk to any of the parents, these poor parents who are suffering with a child addicted to drugs
01:02:14
and their adult child is on the street and you said to them, "We can arrest
01:02:18
them and put them in jail. Uh we can treat them incredibly severely and try to, you know, just lock them up until
01:02:25
they they say, "Thank you. Please do that." But there are a bunch of lunatics
01:02:28
who think you're harassing a homeless person who had a bad beat and you're
01:02:33
infringing on their freedom. But the parents and the family would say, "Please lock them up. That's our last
01:02:38
stitch effort." So it's not compassion. It is not Christian at all. >> I That's a faculty lounge discussion
01:02:44
with your tweed jacket on. Yeah. >> And your elbow protectors when you're
01:02:47
pontificating about people that you read about, right? >> Uh and I point that out because I'm on
01:02:52
the facult, you know, I' I've been >> You got one of those tweet you you
01:02:55
talked to those tweet. >> Yeah. I got rid of my tweet jackets. >> The elbow patches, they look terrible
01:02:59
anyway. >> But you know, you sit there and you act and this is the the crazy thing about
01:03:03
intelligence is people. The more intelligent you are, the better you are to lying to yourself and to others
01:03:09
around you because you can construe almost any data into something that has, you know, a meaning that's not really
01:03:14
there. And we have tolerated that for too long. I I actually think that's an
01:03:18
important part of President Trump's appeal. He cuts through all that BS. Don't tell me stuff that just defies
01:03:23
common sense because common sense is not so common. I think >> you you don't have to accept it. I think
01:03:29
that's the other thing that I think Trump has has I think taught some folks.
01:03:33
We do not have to accept that state of affairs. You don't have to accept and
01:03:37
the framing of it. Let's just call it what it is. You know, I've used the term
01:03:39
here on our podcast and say junkies because I grew up in New York in the 70s and ' 80s and that's what we call people
01:03:44
who are addicted to smack, junkies. It's not derogatory. It's an indication of
01:03:48
just how bad that disease is. Calling it homelessness means you're trying to solve the wrong
01:03:54
thing. Putting a junkie in a home. They have plenty of homes to go to. It's nothing to do with that.
01:03:59
>> All right. Well, look, >> we got to let Doc This How long have we
01:04:01
talking? Two hours. >> I don't know. But I got Dr. Surgeon with tips. >> All right. Let me Dr. House.
01:04:06
>> Yeah. Let me me can I >> please? >> All right. So, I just want Yeah, let me
01:04:10
just wrap this up. So, uh Dr. Oz first reached out to me during the transition because he's so intensely interested in
01:04:15
AI and he >> This is when you were transitioning. >> Yes. During my >> transition, you supported him.
01:04:21
>> I loved I love David. Yes, we all did. >> And uh he was looking for for uh names
01:04:26
of AI experts in Silicon Valley to build his advisory panel and just impressed me
01:04:30
right away with the the energy that you bring, the knowledge, the passion. You really do care about improving health
01:04:38
outcomes for all Americans and I think we are very lucky to have you in this administration. uh from the president on
01:04:44
down and I think the country is very lucky to have you could be doing many many different things but you really
01:04:49
care about this job and I think it's really incredible what you're doing.
01:04:52
Thank you for your service. >> I wanted to have you speak to us on the pods. Kind of long overdue.
01:04:57
>> Well, you're very kind to have me on. I've enjoyed it. Big fan obviously of
01:04:59
your work in part because you brought a sense of clarity to many of the issues you discussed and I want to thank you
01:05:05
David for being a you first of all using your ability to get people together. the
01:05:09
power to convene is remarkably effective, but you've also demystified a lot of this and allowed the
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administration to embrace AI and technology in general. So, God bless you. >> Great. Thank you. Thanks for being here.
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>> We'll see you next time on Allin at Davos. I'm going all in. I'm going all in.