The U.S. health industry revolves around a flawed presumption: individuals and families are dependent on the health system to make health decisions on their behalf. It’s as basic as baseball and apple pie in our collective world view.
It’s understandable. Consumers think the system is complex. They believe the science on which diagnostics and therapeutics are based requires specialized training to grasp. They think health insurance is a hedge against unforeseen bills that can wipe them out. And they think everything in healthcare is inexplicably expensive.
This view justifies the majority of capital investments, policy changes and competitive strategies by organizations geared to protecting traditional roles and profits. It justifies guardianship of scope of practice limits controlled by medical societies because patients trust doctors more than others. It justifies pushback by hospitals, insurers and drug companies against pro-price transparency regulations arguing out-of-pocket costs matter more. It justifies mainstream media inattention to the how the health system operates preferring sensationalism (medical errors, price sticker shock, fraud) over more complicated issues. And it justifies large and growing disparities in healthcare workforce compensation ranging from hourly workers who can’t afford their own healthcare to clinicians and executives who enjoy high six figure base compensation and rich benefits awarded by board compensation committees.
It’s a flawed presumption. It’s the unintended consequence of a system designed around sick care for the elderly that working age populations are obliged to fund. Healthcare organizations should pivot because this view is a relic of healthcare’s past. Consider:
- Most consumers think the health system is fundamentally flawed because it prioritizes its business interests above their concerns and problems.
- Most think technologies—monitoring devices, AI, et al– will enable them to own their medical records, self-diagnose and monitor their health independently.
- And most –especially young and middle age consumers—think their healthcare spending should be predictable and prices transparent.
In response, most organizations in healthcare take cautious approaches i.e. “affordability” is opined as a concern but defined explicitly by few if any. “Value” is promised but left to vague, self-serving context and conditions. “Quality” is about affiliations, capabilities and processes for which compliance can be measured but results (outcomes, diagnostic accuracy, efficacy, savings, coverage adequacy, et al) — hardly accessible. And so on.
For starters, the industry must address its prices, costs and affordability in the broader context of household discretionary spending. Healthcare’s insiders are prone to mistaken notions that the household healthcare spend is somehow insulated from outside forces: that’s wrong. Household healthcare expenditures constitute 8.3% of the monthly consumer price index (CPI); housing is 35.4%, food is 13.6% and energy is 6.4%. In the last 12 months, the overall CPI increased 2.9%, healthcare services increased 4.2%, housing increased 3.6%, food increased 3.2% and energy costs increased only 0.2%. In that same period, private industry wages increased 1.0% and government wages increased 1.2%. Household financial pressures are real and pervasive. Thus, healthcare services costs are complicit in mounting household financial anxiety.
The pending loss of marketplace subsidies and escalating insurance premiums means households will be expected to spend more for healthcare. Housing market instability that hits younger and lower-middle income households hardest poses an even larger threat to household financial security and looms large in coming months. Utilization of healthcare products and services in households during economic downturns shrinks some, but discretionary spending for health services—visits, procedures, tests, premiums, OTC et al—shrinks substantially as those bills take a back seat to groceries, fuel, car payments, student loan debt, rent/mortgage payments and utilities in most households.
Healthcare organizations must rethink their orientations to patients, enrollees and users. All must embrace consumer-facing technologies that empower individuals and households to shop for healthcare products and services deliberately. In this regard, some insurers and employers seem more inclined than providers and suppliers, but solutions are not widely available. And incentives to stimulate households to choose “high value” options are illusory. Data show carrots to make prudent choices work some, but sticks seem to stimulate shopping for most preference-sensitive products and services.
The point is this: the U.S. economy is slowing. Inflation is a concern and prices for household goods and necessary services are going up. The U.S. health industry can ill-afford to take a business-as-usual approach to how our prices are set and communicated, consumer debt collection (aka “rev cycle”) is managed and how capital and programmatic priorities are evaluated.
Net Promoter Scores, Top 100 Recognition and Star Ratings matter: how organizations address household financial pressures impacts these directly and quickly. And, as never before, consumer sentiment toward healthcare’s responsiveness to their financial pressures is at an all-time low. It’s the imperative that can’t be neglected.
Paul
Note: The September 2025 CPI report from BLS is delayed due to the government shutdown and is now scheduled for release October 24, 2025.
Sections in today’s report
- Quotables
- Consumers
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
New York Times on workforce layoffs and subsidy losses: “About two-thirds of the 154,000 federal workers who took buyouts earlier this year stopped getting paid on Tuesday, according to the Office of Personnel Management. The rest will leave the payroll by the end of the year. While not all of those workers are based around Washington, the removal of this financial safety net is likely to compel more homeowners to look for jobs outside the D.C. area.” And more looming layoffs are just adding to the uncertainty.
But despite their party’s longstanding aversion to Obamacare, some Republicans appear increasingly interested in keeping at least some of the tax credits. Coverage losses are expected to occur disproportionately in Republican-governed states like Florida and Texas. And vulnerable Republican lawmakers worry about a political backlash if their constituents experience sticker shock before the midterm elections. Ten Republican House members have cosponsored legislation to extend the subsidies temporarily. Senator Lisa Murkowski, Republican of Alaska, introduced her own such bill last week. And a number of other Republican senators have expressed interest or openness to an extension. “
Why Obamacare Bills May Double Next Year – The New York Times
Cassidy challenge to AMA CPT coding ‘monopoly’: “As Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP), I am writing to seek information regarding the American Medical Association’s (AMA’s) costly monopoly over the Current Procedural Terminology® (CPT) coding system…
I am particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the health care system significant amounts of money while advancing an anti-patient agenda. The enormous revenue from offering these required tools while advocating non-evidence-based policies raises questions about the AMA’s commitment to physicians and the patients they serve…
Last year, the AMA generated over $500 million in revenue. More than half of that revenue came from the publication of books and digital content, including the annual publication of CPT codes that are used to code for medical procedures and services. CPT codes are required to be used by providers to bill for services, and the AMA has had an exclusive monopoly on publishing these codes for over 40 years. Your organization has abused this government-backed monopoly by charging exorbitant fees to anyone using the CPT code set, including doctors, hospitals, health plans, and health IT vendors. These fees inevitably are passed on by CPT users to patients in the form of higher health care costs. This is anti-patient and anti-doctor.”
Cassidy Letter to AMA on CPT Monopoly October 6, 2025
HHS on workforce reductions October 10: “HHS under the Biden administration became a bloated bureaucracy, growing its budget by 38% and its workforce by 17%. All HHS employees receiving reduction-in-force notices were designated non-essential by their respective divisions. HHS continues to close wasteful and duplicative entities, including those that are at odds with the Trump administration’s Make America Healthy Again agenda.”
Andrew Nixon
Former Surgeons General on HHS Secretary Kennedy: “As former U.S. surgeons general appointed by every Republican and Democratic president since George H.W. Bush, we have collectively spent decades in service as the Nation’s Doctor. We took two sacred oaths in our lifetimes: first, as physicians who swore to care for our patients and, second, as public servants who committed to protecting the health of all Americans.
Today, in keeping with those oaths, we are compelled to speak with one voice to say that the actions of Health and Human Services Secretary Robert F. Kennedy Jr. are endangering the health of the nation…
Secretary Kennedy is entitled to his views. But he is not entitled to put people’s health at risk. He has rejected science, misled the public and compromised the health of Americans. The nation deserves a health and human services secretary who is committed to scientific integrity and can restore morale and trust in our public health agencies. Having served at senior levels in government, we know that politics are complicated. But this is bigger than politics. It’s about putting the health of Americans first.”
Opinion | 6 U.S. surgeons general: RFK Jr. threatens the health of Americans – The Washington Post signed by Jerome Adams, Richard Carmona, Joycelyn Elders, Vivek Murthy, Antonia Novello, David Satcher
On restoring trust in the CDC: “At first glance, the recent meeting of the CDC’s Advisory Committee on Immunization Practices (ACIP) might have appeared routine — experts weighing evidence and updating the nation’s vaccine schedule. But what unfolded was anything but routine. It was rushed, politicized, and destructive to the credibility of America’s most important public health institution…. There is a broader governance imperative. The APA and FACA are not bureaucratic niceties; they are the legal architecture of public trust. They operationalize two simple propositions: decisions affecting life and health must be made in the open, and they must be explained on the merits. When those guardrails are ignored, legitimacy collapses and credibility evaporates. What remains is not only bad policy — it is unlawful policy…
ACIP was once the gold standard — rigorous, independent, and trusted across the political spectrum. That excellence has been abandoned. The rule of law demands better. So do the American people. Unless independence, transparency, and legal integrity are restored, America’s vaccine defenses will continue to unravel — and lives will be the price.”
Trusted Vaccine Guidance Has Collapsed — Along With the Rule of Law | MedPage Today
Bloomberg on Nvidia-OpenAI deal: “Two weeks ago, Nvidia Corp. agreed to invest as much as $100 billion in OpenAI to help the leading AI startup fund a data-center buildout so massive it could power a major city. OpenAI in turn committed to filling those sites with millions of Nvidia chips. The arrangement was promptly criticized for its “circular” nature.
This week, undeterred, OpenAI struck a similar deal. The ChatGPT maker on Monday inked a partnership with Nvidia rival Advanced Micro Devices Inc. to deploy tens of billions of dollars’ worth of its chips. As part of the tie-up, OpenAI is poised to become one of AMD’s largest shareholders.
Never before has so much money been spent so rapidly on a technology that, for all its potential, remains largely unproven as an avenue for profit-making. boom. At stake is virtually every corner of the economy, with the hype and buildout of AI infrastructure rippling across markets, from debt and equity to real estate and energy.”
OpenAI’s Nvidia, AMD Deals Boost $1 Trillion AI Boom With Circular Deals – Bloomberg
Bain on AI Investments in healthcare: “Healthcare organizations are doubling-down on investments in AI solutions that improve profit margins, according to a new Bain and KLAS study. Rock Health similarly issued a report that showed startups raised $9.9 billion in 2025, largely because providers are focusing on revenue cycle management solutions and payers are investing in care coordination and utilization management solutions. All of these investments reflect a health industry in trouble, turning to automation and software for a little help. We’ll see if these digital health tools help healthcare stakeholders have “no fear” to also do Tom-Cruise-like stunts and embrace the transformation of the healthcare system. Action movie heroes and investors of digital health tools will not solve all of our problems, however, as demonstrated by Leonardo DiCaprio in his new movie. When his character is scrambling to find a safe house, he runs into the same thing we all face with our digital health tools: “You know, I don’t remember that part. Let’s not nitpick over passwords.”
Healthcare IT Investment: AI Moves from Pilot to Production | Bain & Company
NAHQ on timeliness of quality focus in healthcare:” The new administration has increased its focus on efficiency and effectiveness. Healthcare executives are under tremendous pressure to solve the quality and cost conundrum. Workforce reductions are happening daily – even as organizations face extreme talent shortages. And now, the industry is in the earliest stages of grappling with the impacts of AI, which brings both extraordinary promise and serious risks. There is more work to do, and importantly, as AI is implemented, quality and safety should remain the highest priorities. The momentum in positioning quality as a strategic lever to tackle these challenges is real – but sustaining it requires continued investment in workforce development aligned to universal competency standards and adoption of new tools.”
State_Of_Healthcare_Quality_Memo-FINAL.pdf
Trilliant on system flaws: “The reputation of the U.S. healthcare system precedes itself – it is expensive, complex and inefficient. Understanding why begins with the recognition that, regardless of tax status, the ‘system’ is a collection of profit-seeking businesses treating illness – ‘no margin, no mission’ – rather than a thoughtful and comprehensive approach to promoting health.”
Allison Oakes, Ph.D., Chief Research Officer, Trilliant Health https://www.trillianthealth.com/market-research/reports/2025-health-economy-trends
NACD on creating long-term value: “Decades of research point to five principles that enable companies to consistently create long-term value. LTSE has codified the following principles into a framework that is adopted by companies that list on its exchange:
- Stakeholders. Long-term-focused companies should consider a broader group of stakeholders and the critical role they play in one another’s success.
- Strategy.Long-term-focused companies should measure success in years and decades, and prioritize long-term decision-making.
- Compensation.Long-term-focused companies should align executive compensation and board compensation with long-term performance.
- Governance. Boards of long-term-focused companies should be engaged in and have explicit oversight of long-term strategy.
- Investors. Long-term-focused companies should engage with their long-term shareholders.”
How to Navigate Competing Short- and Long-Term Pressures
The Economist on corporate innovation: “But for the most part corporate innovation is not cinematic. The myths of lone geniuses and moments of inspiration undoubtedly capture the imagination. But the reality—of problems solved by groups of determined people over many years—is an even better story. Firms make advances through sustained effort, the passage of time and teamwork… But for the most part corporate innovation is not cinematic. The myths of lone geniuses and moments of inspiration undoubtedly capture the imagination. But the reality—of problems solved by groups of determined people over many years—is an even better story
The myths of corporate innovation
Consumers
Subsidies: Impact of subsidy suspension
- Per KFF,if the subsidies are not extended, average premiums will increase by 114%, from $888 to $1,904 per year for ACA enrollees.
- Per Congressional Budget Office, 4 million fewer people will be enrolled in ACA plans a decade from now if the subsidies aren’t extended.
- Per the Urban Institute, healthcare providers’ revenue would decrease by $32.1 billion in 2026 while the demand for uncompensated care would increase by $7.7 billion.”
Deloitte: Financial wellbeing: from Deloitte’s Consumer Signals (September 2025):
- Financial well-being slumped in August 2025, continuing the slide seen throughout the year.
- The percentage of respondents expecting higher prices has plateaued in recent months, but levels remain above lows seen in 2024.
- Even as more feel financially squeezed, respondents are still making room for discretionary spending.
- Discretionary spending sentiment continues to recover, even as spending intentions for major nondiscretionary categories including housing and groceries continue on a gradual long-term uptrend.
State of the US consumer | Deloitte Insights
Bloomberg on household spending for youth sports: “Relocating a white rhino by truck costs about $1,500 — the same amount an American family with a child athlete spends on youth sports each year. Nearly a quarter of parents believe their kids can play at a high-level college, and 11% think they’ll go pro. “That mix of ambition and delusion has fueled a $40 billion youth sports industry, powered by parents who find themselves swept from casual preschool kickarounds into meltdowns over matches between 10-year-olds. It’s a level of commitment that Dick’s Sporting Goods has turned into big business…with a growth strategy built on families spending heavily for kids’ dreams of future glory.”
How AI That’s Only ‘Meh’ Could Cost Companies More Than It Saves – Bloomberg
FTC on consumer debt collection: Complaints about aggressive, threatening of abusive debt collection have skyrocketed in recent months: from 16K in Q3 2024 to 114K in 3Q 2025. Complaints are most common in Georgia, Texas and Florida.
Debt Collection | Tableau Public
Economy
BLS on September Jobs report delay: “The Bureau of Labor Statistics has recalled staff to prepare a key inflation report that is necessary to calculate the size of next year’s Social Security checks, according to a Labor Department official with knowledge of the matter.
The agency was directed by the White House Office of Management and Budget to bring back employees to assemble the September consumer price index report in time for publication by the end of the month… The data was originally scheduled to be released Oct. 15.”
BLS Recalls Staff to Ready September CPI Report by Month’s End – Bloomberg
Healthcare jobs in U.S. labor market: “The healthcare sector is a bright spot in the economy this year, driving nearly half of the nation’s employment gains, but economists and experts say immigration crackdowns and looming Medicaid cuts pose a threat to future job growth.
Employers added 487,000 jobs from January to August, according to the latest nonfarm payroll data from the Bureau of Labor Statistics (BLS). The healthcare sector accounted for 48% of that lackluster growth, expanding by about 232,000 jobs, even though the sector employs only about 11% of workers…
For now, job growth is expected to remain high, particularly among nurse practitioners, physician assistants, and home health aides, according to BLS projections.
Many healthcare jobs require years of higher education but result in high pay, with family physicians typically making more than $240,000 a year and registered nurses typically taking in about $94,000 a year.”
Healthcare’s Employment Growth Clouded by Immigration Crackdown, Medicaid Cuts | MedPage Today
Related: AI impact on jobs: Senate HELP report on AI: A report from Democrats on the Senate Health, Education, Labor and Pensions Committee found that AI warns of the rise of “artificial labor,” which it says could “reshape the economy in less than a decade.” According to the committee’s findings, 89% of fast-food jobs, 64% of accounting roles, and 47% of trucking positions could be replaced over the next ten years. The report estimates that nearly 100 million total U.S. jobs could be automated in that period.
Exclusive: AI may cut 100 million US jobs, Senate Democrats’ report finds
Housing market downturn: “There has been a spike in foreclosure activity in the housing market, with the US recording 101,513 foreclosure filings for properties in the third quarter, according to the data provider ATTOM. That reflects a slight increase from the last quarter, but a 17% jump from the third quarter of last year…Foreclosures have been rising steadily over the past several quarters. ATTOM data shows that foreclosure filings rose 11% over the first quarter and 4.8% in the second quarter. The latest quarter marks the first this year in which home loan failures have been up on a year-over-year basis…
The increase reflects broader financial stress among Americans, who are feeling the cumulative weight of inflation over recent years and a slowing job market.
Foreclosures Spike 17% in a Year Amid Mortgage Borrowing Distress – Business Insider
WSJ on consumer spending, debt: “More Americans are missing car payments amid high prices and steeper interest. About one in seven new-car buyers in September had a credit score of less than 650—the most for that month since 2016…
The percentage of new-car buyers with credit scores below 650 was nearly 14% in September, roughly one in seven people, J.D. Power said last month. That is the highest for the comparable period since 2016.
And the portion of subprime auto loans that are 60 days or more overdue on their payments hit a record of more than 6% this year, according to Fitch Ratings, while delinquency rates for other borrowers have remained relatively steady.
An estimated 1.73 million vehicles were repossessed last year, the highest total since 2009, according to data from Cox Automotive, an industry-research firm.
Delinquencies have leveled off but have remained higher than in the prepandemic period, economists say.
The amount of Consumer Portfolio Services’ outstanding loans that ended up in repossession more than doubled since 2022, to nearly $98 million, in the second quarter of this year.”
Americans Are Falling Behind on Their Car Payments – WSJ
Hospitals
Lown Institute: The Lown Institute Hospitals Index: The Institute measured overuse of spinal fusion/laminectomy and vertebroplasty at hospitals with the capacity to perform the procedure using Medicare fee-for-service (2021-2023) and Medicare Advantage (2020-2022) claims data. Highlights:
- “U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries. That’s one low-value back procedure every eight minutes.
- These low-value back procedures cost Medicare more than $1.9 billion over three years.
- Complications of spinal fusion occur in up to 18% of patients and include infection, blood clots, stroke, pneumonia, heart and lung problems, and even death.
- The top 10% of physicians by spinal fusion overuse volume accounted for 60% of the total overuse.
Vizient: Inpatient utilization
| Inpatient (IP) Utilization | Q2 2024 – Q1 2025 | Q2 2023 – Q1 2024 |
| IP % admitted from Emergency Department (ED) | 68% | 1.3% |
| IP % not admitted from ED | 32% | -2.7% |
| Average length of stay (days) | 5.49 | -0.7% |
| Mortality rate | 2.3% | -4.4% |
| 30-day readmission rate | 12.3% | 2.2% |
| Average cost per IP stay | $10,860 | 4.8% |
| Average cost per IP day | $1,977 | 5.5% |
Vizient System of CARE scorecard: Q2 2024 to Q1 2025
Insurers
CMS: CMS released Medicare Advantage star ratings on Oct. 9: “CMS is focused on continuing to improve the quality of the MA and Part D programs. As the results for the 2025 Star Ratings demonstrate, CMS continues to implement enhancements to the MA and Part D Star Ratings program to promote continual quality improvement to help ensure that Medicare enrollees receive high quality care and to incentivize plans to continue to strive for higher quality….Medicare Advantage Prescription Drug (MA-PD) contracts are rated on up to 40 unique quality and performance measures; MA-only contracts (without Part D coverage) are rated on up to 30 measures; and PDP contracts are rated on up to 12 measures. For each measure, CMS establishes thresholds called “cut points” that are used to determine whether each contract’s performance for that measure receives a 1-, 2-, 3-, 4- or 5-star rating.” Highlights:
“For MA-PDs from 2022 to 2025 after any adjustments for extreme and uncontrollable circumstances:
- Approximately 40% of MA-PDs (209 contracts) that will be offered in 2025 earned four stars or higher for their 2025 overall rating.
- Weighted by enrollment, approximately 62% of MA-PD enrollees are currently in contracts that will have four or more stars in 2025.
. average Part D ratings weighted by enrollment for stand-alone PDPs from 2022 to 2025 after any adjustments for extreme and uncontrollable circumstances.4
- Approximately 27% of PDPs (11 contracts) that will be active in 2025 received four or more stars for their 2025 Part D Rating.
- Weighted by enrollment, about 5% of PDP enrollees are currently in contracts that will have four or more stars in 2025.
Note: The annual enrollment period begins Wednesday and ends Dec. 7.
CMS https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-star-ratings
Physicians
Doximity: Compensation Gap Between Primary Care and Other Specialties, 2022-2024
| Amount Earned Over Primary Care Compensation | |||
| Specialty Type | 2022 | 2023 | 2024 |
| Surgical Specialists | +100.4% | +90.7% | +87.3% |
| Non-Surgical Specialists | +46.3% | +42.9% | +41.7% |
| Emergency Medicine | +37.6% | +32.6% | +29.9% |
| OB/GYN | +31.2% | +29.6% | +26.2% |
Doximity Physician Compensation Report 2025, August 2025
Milbank on primary care, NPs: “Nurse practitioners (NPs) are now the fastest growing health profession in the United States and comprise 47% of all US primary care clinicians…Yet challenges remain in recruiting and retaining NPs in primary care. In addition to barriers reported by primary care clinicians in most settings, NPs in particular face (1) variation in state practice regulations and institutional policies; (2) inadequate reimbursement rates from Medicare and many private insurers; and (3) a lack of federal financing for training, support, and mentoring…
According to the latest Health of US Primary Care Scorecard, as reported in The Health of US Primary Care: 2025 Scorecard Report — The Cost of Neglect, the portion of adults in the US lacking a usual source of care is at an all-time high and the country is experiencing a shortage of primary care clinicians. The number of primary care physicians per 100,000 people was 67 in 2022, compared with nearly double that (124 per 100,000) in Canada. When NPs and PAs are included, the nation still only has 103.8 primary care clinicians per 100,000 people. And the problem is getting worse: The proportion of the clinician workforce in primary care is decreasing. The Scorecard also suggests that, for the first time, NPs and PAs may be joining physicians in the trend of moving to other specialties.”
Investing in Primary Care: The Nurse Practitioner Will See You Now | Milbank Memorial Fund
Polling
2025 Bentley-Gallup Business in Society Survey: Based on interviews with 3,007 U.S. adults conducted May 5–12, 2025:
- Most Americans (65%) believe businesses are good for society, but they still expect more.
- 51% of Americans are more supportive of companies taking public stances in 2025, but most employees (60%) are uncomfortable hearing from their own employers about current events.
- Although an increasing number of Americans (31%) trust businesses to use AI responsibly, 75% still expect AI will cost people their jobs
- 37% of Americans value buying U.S.-made goods for economic and employment reasons, many (53%) think tariffs do more harm than good.
Gallup-Bentley-University Business-In-Society Survey_2025 Report.pdf
KFF Tracking Poll: Health Information and Trust (September 23-29, 2025): “Amidst a series of recent changes to federal vaccine policy, majorities of the public disapprove of Health and Human Services Secretary Robert F. Kennedy’s overall job performance (59%) as well as his handling of U.S. vaccine policy (62%). Views of Kennedy are largely partisan, with most Republicans and MAGA supporters approving of his overall job performance and his handling of vaccine policy, while large majorities of Democrats disapprove. Just one-third (35%) of adults say they trust Kennedy to provide reliable vaccine information, including 67% of Republicans, 27% of independents, and 13% of Democrats.”
Key healthcare oversight agency ratings:
- CDC: 31% excellent/good vs. 67% fair/poor
- FDA: 27% excellent/good vs. 71% fair/poor
- VA: 25% excellent/good vs. 73% fair/poor
KFF Tracking Poll on Health Information and Trust: Tylenol-Autism Link and Vaccine Policies | KFF
Americans’ Job Ratings of Six Key U.S. Agencies Worsen
The survey was conducted among 1,313 registered voters nationwide from Sept. 22 to 27, 2025
Cross-Tabs: September 2025 Times/Siena National Poll of Registered Voters – The New York Times
CBS News Poll October 1-3, 2025:
| % Approve/
% Disapprove |
Trump | Congressional DEMS | Congressional GOP |
| Handling of Government shutdown | 32/52 | 28/49 | 27/52 |
| Blame for shutdown | 39 | 31 | 39 |
Most important issue facing the country: 1-Economy and jobs (27%), 2-Inflation (21%), 3-Healthcare (15%), 4-Immigration (14%)
Prescription Drugs
On TrumpRx-Good Rx DTC plans: “It has been reported that prescription drug savings platform and online pharmacy player GoodRx has started talking to the Trump administration about piggybacking on the TrumpRx scheme, which was initially portrayed simply as a website that would help patients buy drugs directly from pharma manufacturers at discounted prices.
Pfizer has already said it will participate in TrumpRx as part of an agreement to reduce drug pricing in the US, offering savings of up to 85% on list prices, in line with the Trump administration’s drive to implement a Most Favoured Nation (MFN) pricing model for prescription drugs. It is one of several big-name pharma groups that have launched DTC sales channels for medicines that offer discounts to cash-paying customers on selected medicines…
The value of the TrumpRx platform to patients remains hard to gauge, given that an estimated 90% of people in the US have at least some forms of health insurance and – even taking into account deductibles and co-pays – sourcing drugs through their cover is likely to be cheaper than buying them directly.”
TrumpRx, BlinkRX, GoodRx – what’s going on in DTC sales? | pharmaphorum
Colorado sets payment cap on AmGen drug: “In a first-in-the-nation move, a Colorado panel has voted to limit what health plans in the state will pay for a costly arthritis treatment, a step that may encourage other states to pursue similar strategies to contain spending on prescription medicines. The landmark vote by the Colorado Prescription Drug Affordability Board creates an upper payment limit for the widely prescribed Enbrel medication, which is a blockbuster treatment sold by Amgen. As a practical matter, the decision establishes a payment ceiling for government agencies and commercial plans that provide health insurance for state residents.”
Colorado board makes first-in-the-nation move by setting a payment limit on an Amgen drug
White House: drug tariff update: The White House announced 100%
tariffs on pharmaceuticals in September, 2025 but the policy is currently not being enforced pending continuing negotiations. With US imports in 2024 totaling $210.8 billion in finished medicines and $36.2 billion in APIs, the threat of tariffs puts nearly $250 billion in trade at risk.
How Pharmaceutical Tariffs Will Affect US Health Care Costs | American Enterprise Institute – AEI
Public Health
Study: emergency care for undocumented aliens: “Proponents of the Budget Reconciliation Law of 2025 state that its trillion-dollar cuts to Medicaid will only affect care for groups whom they argue should not be receiving it, such as undocumented immigrants. Federal law, however, already prohibits undocumented immigrants from qualifying for comprehensive Medicaid, Medicare, and Marketplace options under the Affordable Care Act (ACA). A key exception is emergency Medicaid—a federally mandated but limited form of Medicaid that covers care delivered to stabilize individuals with serious medical conditions who would otherwise be eligible for Medicaid if not for their immigration status. Although emergency Medicaid primarily covers acute care services (such as labor and delivery), some states also cover dialysis and cancer treatments. Emergency Medicaid functions as a financial backstop for health systems that are required by law to deliver emergency care.” Key findings:
- Emergency Medicaid expenditures accounted for a mean of 0.4% of total Medicaid spending, at a mean cost of $9.63 per resident, a cross-sectional analysis showed.
- States with larger undocumented populations spent more on emergency Medicaid, accounting for a mean of 0.9% of state Medicaid expenditures among states with the highest undocumented population share compared with 0.1% among states with the lowest undocumented population share.
Study: Association between Medicaid expansion and cancer care: “A total of 1,423,983 cancer cases diagnosed between 2007 and 2008 and 2014 and 2015 among adults 18 to 59 years of age residing in 26 expansion and 12 non-expansion states were included. Improvements in cause-specific survival were significantly greater in expansion states among individuals residing in rural and high-poverty communities and those with pancreatic and colorectal cancers. Results were similar for OS. These findings underscore the importance of Medicaid expansion in mitigating disparities in survival outcomes.”
KFF on international comparisons: “Despite spending far more money than any peer nation, Americans live shorter lives and often face more barriers to care. Some of this disparity can be attributed to aspects of the U.S. health system, but socioeconomic, health and other factors also play a role. Drivers of U.S. Health Spending:
- The largest category of health spending in both the U.S. and comparable countries is spending on inpatient and outpatient care, which includes payments to hospitals, clinics, and physicians for services and fees such as primary care or specialist visits, surgical care, provider-administered medications, and facility fees. Americans spent $8,353 per person on inpatient and outpatient care, compared to $3,636 in peer countries, on average…
- The cost of prescription drugs is another factor that partially explains the U.S.’s higher health spending… In 2022, the U.S. spent $1,765 per capita on prescription drugs and other medical goods…
- Spending on health administrationis similarly much higher in the U.S. than in comparable countries: $1,078.44 per capita.
- The U.S. also spends moreper capita on preventive care than peer nations… In the U.S., preventive care spending more than doubled between 2019 and 2020, from $343 to $741 per capita, but subsequently declined to $649 by 2022.
- Meanwhile, the only category of spending in which the U.S. spends less than most comparable countries on a per-person basis is long-term care…
International Comparison of Health Systems | KFF
SCOTUS hears conversion therapy case: Last Tuesday, the Supreme Court heard oral arguments in 24-539 CHILES V. SALAZAR which addresses how far states can go regulating mental health treatment for gender transitioning/conversion therapy for minors. Currently, the practice is banned in 23 states, 5 states have partial bans, and 5 others mostly in the South prohibit bans on conversion therapy. On July 1, 2025, Virginia announced a rollback from a full to partial ban. The outcome will determine whether therapists’ conversations with patients are regarded as medical treatment or as a form of speech protected by the First Amendment…
The Supreme Court previously weighed in on whether states can regulate health providers’ speech in 2018, when it struck down a California law that required anti-abortion “crisis pregnancy centers” to provide women with information about how to obtain the procedure.
