Key Takeaways:
- The U.S. health system’s future is uncertain but outside forces will define its direction.
- 9 structural changes appear necessary to a transformed system of health that’s affordable, comprehensive and effective.
Last week, I had a 27-hour stay in a hospital emergency room waiting for an open bed and a morning at the food pantry loading boxes in anticipation of a possible SNAP program suspension surge. It wasn’t the week I expected. So much for plans!
Such is the case for health insurance coverage for millions in the U.S. as the federal government shutdown enters Week 6. Democrats are holding out for continuation of Affordable Care Act (ACA) insurance subsidies that enable 22 million to “buy” insurance cheaper, and Republicans are holding out for federal spending cuts reflected in the One Big Beautiful Act (July 2025) that included almost a trillion reduction in Medicaid appropriations thru 2036.
ACA subsidies at the heart of the shutdown successfully expanded coverage in tandem with Medicaid expansion but added to its costs and set in motion corporatization and consolidation in every sector of the health system. The pandemic exposed the structural divide between public health programs and local health systems, and insurance premium increases and prior authorization protocols precipitated hostility toward insurers and blame games between hospitals, insurers and drug companies for perpetual cost increases.
Having mediated discissions between the White House and industry trade groups as part of the ACA’s design (2009), I witnessed first hand the process of its development into law, the underlying assumptions on which it is based and the politics before and after its passage in March 2010. Its hanging chads were obvious. Its implementation stalled. Its potential to lower costs and improve quality never realized. It was a Plan disabled by special interests that rightly exploited its flaws and political brinksmanship that divided the country. But more fundamentally, it has failed to lower costs and improve affordability because it failed to integrate outside considerations—private capital, employers, technologies, clinical innovations and consumer finances—in its calculus.
Sixteen years later, healthcare is once again the eye of the economic storm. Insiders blame inconsistent regulatory enforcement and lack of adequate funding as root causes. Outsiders blame lack of cost controls. consolidation and disregard for affordability. Thus, while attention to subsidized insurance coverage and SNAP benefits might temporarily calm public waters, they’re not the solution.
All parties and all sides seem to agree the health system broken. For example, in my trustee surveys before planning sessions with Boards of health systems, medical groups and insurers, the finding is clear:
- 92% says the future of the U.S. health system in 7-10 years is fundamentally changed and not repeat of its past.
- 84% say their organizations are not prepared because short-term issues limit their ability to long-term planning.
Republicans think market forces will fix it. Democrats think federal policy will fix it. The public thinks it’s become Big Business that puts its interests before theirs. And the industry’s trade groups—AMA, AHA, AHIP, PhRMA, Adame, APHA, et al—face intense pressure from members adversely impacted by unwanted regulatory policies.
Few enjoy the luxury of long-term planning. That doesn’t excuse the need to address it. If a clear path to the system’s future is not built, incrementalism will enable its inevitable insolvency and forced re-construction.
What’s the solution? When comparing the U.S. health system to high performing systems in other high-income countries, these findings jump out:
- All spend less on healthcare services and more on social services than the U.S.
- All include government and privately-owned operators
- All fund their systems primarily through a combination of federal appropriations and private payments by employers and citizens.
- All pursue clinical standardization based on evidence.
- All are dealing with funding constraints as their governments address competing priorities.
- All are transitioning from episodic to chronic health as their populations age and healthiness erodes.
- All are focused on workforce modernization and technologic innovations to lower costs and reduce demand for specialty services.
- All enable private investment in their systems to increase competition and stimulate innovation.
- All facilitate local/regional regulatory oversight to address distinctions in demand and resources.
- All face with growing public dissatisfaction.
- All are expensive to operate.
No system is perfect. None offers a copy-paste solution for U.S. taxpayers. And even if one seemed dramatically better, it would be a generational surge rooted in futility that welcome it.
What’s the answer? At the risk of oversimplicity, the future seems most likely built on these 9 structural changes:
- Integrate social services (public health) with delivery.
- Create comprehensive primary and preventive health gatekeeping inclusive of physical and behavioral health, nutrition, prophylactic dentistry and consumer education.
- Rationalize specialty services and therapies to high value providers.
- Incentivize responsible health behaviors across the entire population.
- Increase private capital investments in healthcare.
- Modernize the workforce.
- Fund the system strategically.
- Define and disclose affordability, quality and value systemically.
- Facilitate technology-enabled self-care.
This will not happen quickly nor result from current momentum: the inertia of the status quo leans substantially toward protectionism not because it’s unaware. The risks are high. And while the majority of Americans are frustrated by its performance, there’s no referent to which look as a better mousetrap.
I anticipated last week would be pretty uneventful. It wasn’t. My Plan didn’t work out due, in part, to circumstances I didn’t foresee or control.
Healthcare’s the same. Outside forces seen or not will impact its future dramatically. Plans have to be made though Black Swans like the pandemic are inevitable. But long-term planning built on plausible bets are necessary to every healthcare organization’s future.
Paul
PS: In my unexpected stay in the hospital, I was cared-for by a wonderful nurse (Alcenise) who’s a single mom and career professional. The experience was unexpected and I don’t have a clue what it will end up costing, but I know for sure she made things better and is among many in our ranks for whom caring is more than a word.
Sections in today’s report:
- Quotables
- Corporate Healthcare
- Economy
- Hospitals
- Insurers
- Physicians
- Prescription Drugs
- Public Health
Quotables
NEJM Singh on consolidation policy change: “Although proponents often justify consolidation on the basis of its promise of greater efficiency — or even simply financial survival — empirical evidence tells a more sobering story: rising prices, mixed effects on care quality, and labor-market concentration that can suppress health care workers’ wages and mobility. Some degree of consolidation may offer benefits in the form of economies of scale, but unchecked consolidation risks undermining competition and access, particularly for vulnerable populations…
The health care system of the 2020s is being remade by financial intermediaries and corporate entities whose aim is to maximize financial returns. Antitrust enforcement, revitalized by new merger guidelines and state action, represents a critical tool for limiting the harms of corporatization that result specifically from reduced market competition. But it cannot fully address the deeper problem: a health system increasingly driven by financial returns rather than patient outcomes. Policymakers must recognize the intended purpose and limits of competition law and pursue complementary strategies that center health — not shareholder value — as the ultimate metric of system performance.”
Federal Research on Funds rate reduction October 29, 2025: “In support of its goals and in light of the shift in the balance of risks, the Committee decided to lower the target range for the federal funds rate by 1/4 percentage point to 3-3/4 to 4%. In considering additional adjustments to the target range for the federal funds rate, the Committee will carefully assess incoming data, the evolving outlook, and the balance of risks. The Committee decided to conclude the reduction of its aggregate securities holdings on December 1. The Committee is strongly committed to supporting maximum employment and returning inflation to its 2 percent objective.”
Federal Reserve Board – Federal Reserve issues FOMC statement October 29, 2925
The Economist on Trump Most Favored Nation Drug Pricing Strategy:” Few things infuriate Americans as much as drug prices. Republicans and Democrats alike agree that poorly patients are being ripped off by greedy pharma firms. They point to the act that prices for branded drugs are, on average, four times those in other rich countries…But the President’s battle (most favored nation pricing) to bring down prices is doomed to fail. Indeed, it could even make health care in America worse…”
“Why the War on Drug Pricing will Fail” The Economist October 4, 2025 www.economist.com
Bill Gates on AI compared to dot-com: ” AI has been “the biggest technical thing ever in my lifetime…In the end, something very profound happened. The world was very different. Some companies succeeded, but a lot of the companies were kind of me-too, fell behind, burning capital companies…there are a ton of these investments that will be dead ends…”
Bill Gates says we’re in an AI bubble similar to the dot-com bubble
David Johnson on AI in healthcare: “The future of AI in healthcare could look spectacular. Smarter diagnostics, reduced waste, better outcomes and more personalized care are possible. But if we’re not vigilant, the future could also look dystopian, with opaque decisions, profit-driven overload, care fragmentation, trust erosion. To keep the beasts at bay, health systems must:
- Focus relentlessly on patient value (not just cost savings).
- Demand transparency in AI models, data, outcomes.
- Ensure equitable access so smaller providers aren’t left behind.
Outcomes matter, customers count and value rules.
“Human Machine Collaboration: The Trust-Gap “Abyss” 4Sight Health
WSJ Editorial Board on FDA approval slowdown: “Our editorials criticizing the Food and Drug Administration for torpedoing promising treatments must be hitting an intracranial nerve. Proof of their potency: Commissioner Marty Makary and his deputy Vinay Prasad devoted much of a recent FDA podcast to mischaracterizing them.
We’re flattered by the attention, but the spin doctors cried fake news rather than address the substantive arguments….
An analysis by RBC Capital Markets…said drug reviews in some areas have recently become more efficient, but it found that only 73% of applications with scheduled deadlines in this year’s third quarter were approved in the same quarter, compared to an average of 87% in the previous six quarters. Rejections rose to 15% from an average of 10%, and delays to 11% from 4%. Some non-approvals owe to manufacturing problems, but another culprit is an agency brain drain…”
The Spin Doctors at the FDA – WSJ Editorial Board October 27, 2925
Corporate Healthcare
Moderna: “Today Moderna faces a crisis unlike any other in its 15-year-history. Wall Street has pushed executives to slash spending, as Covid vaccine sales have slumped and no new blockbusters have emerged…
Moderna’s market value has fallen by more than 90% — $185 billion, or a full Sony — from its 2021 peak to around $10 billion this month. Layoffs and restructurings, often undisclosed, have roiled the company. Further cuts have not been ruled out.
The story of Moderna’s great unraveling — told here in detail, with new disclosures about the pressures the company has faced and the missteps it has made — is neither simple nor finished. At the end of this year, the company will still have $6 billion in the bank, a Covid shot with more than $1 billion in sales annually, and a cancer vaccine that has tantalized oncologists and analysts alike with its potential to revive that moribund field. “They’re not going anywhere,” said Melissa Moore, Moderna’s former chief scientist of mRNA research.
Inside Moderna’s great unraveling: missteps and misfortune Stat October 30, 2025
Centene: Revenue increased 18.2% to $49.7 billion in the third quarter. Higher spending in Medicaid and the exchanges propelled the insurer’s medical loss ratio, which is the share of premiums spent on claims, to 92.7%, up from 89.2% a year before. Membership declined 2.3% to 28 million.
Centene reports $6.6B loss as costs, Medicaid pressures grow – Modern Healthcare
Nvidia Last week, the AI chipmaker today became the first company in the world to reach a $5 trillion market cap. At $5 trillion, Nvidia’s market cap is now equal to just over 15% of America’s economy. It’s worth more than the GDP of every country in the world except the U.S. and China.
Nvidia www.nvidia.com
UnitedHealth Group raised its full-year guidance Tuesday, delivering much-needed reassurance to investors after multiple poor quarters saw the company’s stock price dramatically sink. The UnitedHealthcare and Optum parent company reported that net earnings fell 59.4% to $2.54 billion and earnings from operations dropped 50.4% to $4.31 billion as revenue grew 12.2% to $113.16 billion during the third quarter. Despite declining profits, UnitedHealth Group beat Wall Street expectations for the period with $2.59 earnings per share and raised its annual earnings outlook to $14.90 earnings per share. Last December, UnitedHealth Group predicted $29.50-$30 per share in 2025 but downgraded that guidance to $24.65-$25.15 in April and then to $14.65 per share in July. As part of its strategy to restore profit margins in the segment, UnitedHealthcare has pulled back on Medicare Advantage — a key market the insurer leads by membership — and Medicare Part D prescription drug plans for 2026.
UnitedHealth raises guidance, expects lower exchange enrollment
CVS Health raised its 2025 adjusted earnings per share guidance to between $6.55 and $6.65, up from $6.30 to $6.40. The healthcare company’s adjusted earnings for the third quarter beat Wall Street’s expectations, but it swung to a net loss, hit by a $5.7 billion write-down largely related to its senior clinics business, which CVS bought in 2023 for about $10.6 billion. CVS said it would close 16 of the Oak Street locations, leaving 230, and wouldn’t open any new one’s next year.
CVS Health CVS -1.95%decrease; red down pointing triangle
GE Healthcare said third-quarter revenue rose to $5.14 billion from $4.86 billion a year earlier. The medical-technology and digital-solutions company on Wednesday said third-quarter net income fell to $446 million, or 98 cents a share, compared with $470 million, or $1.02 a share, in the same quarter a year earlier.
GE HealthCare GEHC -2.54%decrease; red down pointing triangle
GE HealthCare Tech Profit Slides as Tariffs Drag – WSJ
Economy
Hoover Institute report on healthcare spending: “Since 1995, mandatory spending has risen by $6,800 per person (in inflation-adjusted 2025 dollars). It is projected to rise by another $8,400 over the next thirty years. Discretionary spending—think national defense, federal employee compensation, and most agency spending—grew by just $1,500 per person from 1995 to 2024 and will rise by $1,400 per person through 2055.
But our previous plot omitted an important detail: Nearly half of the growth in mandatory spending came from just one source—health care.
From 1995 to 2024, Medicare, Medicaid, and the Affordable Care Act subsidies grew by $3,300 per person, accounting for 45% of the total growth in mandatory spending. The next thirty years look even worse. Health care spending will rise by $5,300 per person. Social Security will grow by $3,600 per person. All other mandatory program spending is projected to fall by $500 per person.
In short, even when discretionary spending is included, more than half of the growth in non-interest federal spending will come from just the three big federal health care programs.
Freedom Frequency Hoover Institution www.freedomfrequency.org October 29, 2025
JPMorgan on income growth: We find:
- Real income growth slowed to near-decade lows: Median income growth among 25–54-year-olds declined in early 2025 and remained low through September, hovering near decade-long lows after adjusting for inflation.
- Young workers faced the sharpest slowdown: Young people in our sample—workers aged 25–29—have experienced a more marked slowdown in income gains, potentially a function of the reduced pace of job-to-job transitions across the economy, reflected in lower hiring and quit rates.
Weakening labor market dynamism weighs especially on young workers, who rely to a greater extent on job switching to climb the career ladder… Slower wage gains add to challenges facing younger generations: their greater exposure to the decline in housing affordability and relatively late entry into a rising stock market make it harder for them to achieve financial goals.
Real income growth shifts down, especially for the young
The Atlantic on Population Growth Stagnation: “The United States has always been a nation of expansion: It has never before experienced population shrinkage year after year. If it does, it will be less rich in terms of GDP, because the economy simply shrinks when there are fewer people…
The country currently has only 2.7 workers for every Social Security beneficiary, down from 3.4 in 1990. This decline already means that the program is on the path to insolvency. ..The Social Security Administration estimates that—even with annual net immigration of at least 1.2 million a year—its trust fund will be exhausted by 2033, at which point benefits will be immediately reduced by about 23%. With even fewer workers, the day that the U.S. welfare state starts to teeter will move closer…
Yet what has poisoned the politics of migration for ordinary U.S. citizens, polls indicate, is the suspicion that it has become uncontrolled. On this key point, Trump is correct: The Biden administration oversaw, wittingly or not, an extreme surge in migration. From 2021 to 2024, the number of migrants in the country grew by 6.8 million, mostly unauthorized, accounting for 85% of growth…”
America’s Impending Population Collapse – The Atlantic October 29, 2025
Administration reduces medical debt protections: “The Trump administration took another step Tuesday to weaken protections for Americans with medical debt, issuing new guidance that threatens ongoing state efforts to keep that debt off consumers’ credit reports.
More than a dozen states, including Washington, Oregon, California, Colorado, Minnesota, Maryland, New York, and most of New England, have enacted laws in recent years to keep medical debt from affecting consumers’ credit.
And more states — including several in conservative regions of the Midwest and Mountain West — have been considering similar protections, spurred by bipartisan concerns that medical debt on a credit report can make it harder for people to get a home, a car, or a job.
Nationwide, about 100 million people have some form of health care debt, with millions burdened by $10,000 or more in unpaid bills.”
STAT Plus: Federal judge reverses rule that would have removed medical debt from credit reports
New York Times on Fed Rate Cuts: “The Federal Reserve cut interest rates on Wednesday for a second time this year, despite officials having only a partial view of how the economy is faring because of the government shutdown.
The central bank voted to lower borrowing costs by a quarter of a percentage point as the lapse in funding for the government stretched into its fifth week. Until lawmakers reach a deal, the Bureau of Labor Statistics and other agencies have stopped collecting, analyzing and publishing official statistics tracking the jobs market, consumer prices, spending and a range of other metrics.”
Fed Cuts Rates to Lowest Level Since 2022 but Casts Doubt on December Move – The New York Times
Hospitals
HealthGrades’ Top 50 Specialty Service Hospitals: “Florida has 15 hospitals included on Healthgrades’ the list.
Background: Healthgrades evaluated about 4,500 hospitals across 31 procedures and conditions for the awards. The Surgical Care Excellence Award specifically evaluates clinical outcomes across 15 in-hospital surgical procedures: back and neck surgery (except spinal fusion), back and neck surgery (spinal fusion), bowel obstruction, carotid procedures, cholecystectomy, colorectal surgeries, coronary bypass surgery, hip fracture repair, peripheral vascular bypass, prostate removal surgery, resection or replacement of abdominal aorta, total hip replacement, total knee replacement, upper gastrointestinal surgery and valve replacement surgery.
In-hospital complications, in-hospital mortality and 30-day mortality are also factored into Healthgrades’ evaluation.
PK Note: 24 of the 50 recognized by HealthGrades are owned by HCA: plausible findings???
Specialty Excellence Awards & America’s Best Hospitals for Specialty Care Awards Methodology
Insurers
Center for Budget Priorities: US average increases if premium tax credits expire at end of 2025:
| 45-year-old individual
$68,000 income 404% of FPL
|
60-year-old couple
$85,000 income 401% of FPL |
Family of 4
$130,000 income 404% of FPL
|
|
| With enhancements
current |
$5,440 | $7,225 | $11,050 |
| Without enhancements | $8,472 | $31,846 | $23,814 |
| Premium increases w/o enhancements | $3,032 | $24,641 | $12,764 |
| % Increase | 56% | 341% | 117% |
Study: Dual Eligible coverage, plan selection: “Medicare-Medicaid dual enrollees accounted for roughly a third of those programs’ spending but less than 20% of enrollment in 2021.” Researchers analyzed “dual eligible enrollment from the period 2017–22. We tracked people transitioning from Medicaid to dual enrollment and compared their pre–dual enrollment spending among Medicare plan choices. We found evidence of favorable selection. After adjustment for beneficiary characteristics, a 1% increase in medical spending reduced beneficiaries’ probability of enrolling in private plans by 1 percentage point (2.3%). The effects were driven by the highest-spending beneficiaries, who were 11 percentage points (25%) less likely to enroll in private plans. Selection appeared to be stronger among unintegrated plans (which cover Medicare but not Medicaid benefits), although higher spending on long-term services and supports reduced enrollment in all plan types. These findings highlight the need for researchers to control for underlying health status when evaluating health or spending outcomes in private plans.”
Favorable Selection Among Dually Enrolled Beneficiaries in Private Medicare Plans | Health Affairs
KFF on 2026 premium increases: “The amount health insurers charge for coverage on the ACA Marketplaces is rising 26%, on average, in 2026. In states that run their own Marketplaces, the average benchmark (second-lowest cost) silver premium, on which the tax credit calculation is based, is rising 17% next year. In states that use Healthcare.gov, these premiums are rising an average of 30%.
Most enrollees would face even sharper increases in what they pay if the ACA’s enhanced premium tax credits expire. This 26% is the increase in the amount insurers are charging, which in most cases is not what enrollees pay. 22 million out of 24 million marketplace enrollees currently receive a tax credit…
If the enhanced premium tax credits expire at the end of this year, KFF estimates that currently subsidized enrollees will see their monthly premium payments more than double, increasing by about 114%, on average. This reflects people with incomes below four times the poverty level receiving less financial assistance and those with incomes over four times poverty no longer being eligible for financial assistance at all and therefore being hit by a double whammy of lost tax credit and higher insurer premiums.”
NYT on reasons for 2026 premium increases: “The higher premiums published this week reflect a mix of factors, many tied to rising drug and hospital costs in the health care system itself. In state filings, insurers noted increased hospital prices, increased use of GLP-1 drugs to treat diabetes and obesity and the impact of tariffs. But insurance companies also said they raised prices for Obamacare plans to offset the possibility that costs would rise if the expiring subsidies discouraged younger, healthier customers from staying enrolled.”
Obamacare Prices Become Public, Highlighting Big Increases – The New York Times
Report: Physician networks in Medicare Advantage plans: “This brief examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries, by county, plan characteristics, and physician specialties, using 2022 Medicare Advantage provider directories. Results:
- Medicare Advantage enrollees were in a plan that included just under half (48%) of all physicians available to traditional Medicare beneficiaries in their area in 2022, on average.
- In counties where larger shares of the population were people of color, a smaller share of physicians available to traditional Medicare beneficiaries were in-network, on average, than in other counties (37% vs 52%).
- Even within the same county, physician networks often varied widely across plans.
- The share of physicians available to Medicare Advantage enrollees varied by specialty. Generally, larger shares of outpatient medical and surgical specialists were in plan networks than primary care physicians, with as many as 72% of ophthalmologists available to traditional Medicare beneficiaries in plan networks compared to only 55% of primary care physicians, on average.
- Medicare Advantage plan quality star ratings were not correlated with the breadth of the physician network.
Study: Post-acute care utilization in Traditional Medicare (TM) and Medicare Advantage (MA): Researchers analyzed data from 2015-2021. Results:
“The MA beneficiaries exhibited greater reductions in post-acute care use compared with TM beneficiaries, including 6.3 fewer days in SNFs and 3.6 fewer days in home health. Medicare Advantage enrollees also experienced a 1.5–percentage point lower probability of readmission and spent more time in the community in the first 100 days after hospital discharge than TM beneficiaries. Medicare Advantage beneficiaries also experienced a slightly lower mortality compared with TM beneficiaries, as well as modest functional gains.
These findings suggest that reductions in post-acute care in comparable MA and TM beneficiaries were not associated with worse outcomes.”
Turquoise report: Transparency compliance by insurers: Turquoise analyzed URLs that house machine-readable files, or MRFs, for 219 payers and assigned transparency scores to 97 payers, focusing primarily on the largest insurers. Results:
For one, 28% of the payers included in its analysis had more than 50% conflicting rates, meaning there were multiple dollar values associated with a single line item, making it impossible to tell which is the proper rate. Conflicting rates was the biggest common problem across the data files, Turquoise found.
Outlier rates, or rates that appear too high or too low to be accurate — like reporting $0.01 for a high-acuity service like an organ transplant — were also an issue…
Overall, national payers tended to perform better than payers at the state or regional level. For example, Cigna’s MRFs are 100% parsable, while UnitedHealthcare’s and Aetna’s are at 99%.
UnitedHealthcare, Cigna and Elevance all have outlier rates under 5%. CVS-owned Aetna, however, struggles with conflicting rates, reporting almost 60%, Turquoise found.
National payers OK on price transparency compliance: Turquoise Health | Healthcare Dive
PBMs
Express Scripts announces phase out of rebates: The Cigna subsidiary Express Scripts announced it will phase out prescription rebates in favor of upfront discounts.
Background: “Over the past several years, Express Scripts, CVS Caremark and Optum Rx have announced a slew of changes to their business practices that focus on some of the biggest complaints in Washington, in state capitals and in the marketplace, such as rebates, transparency, “spread pricing” and pharmacist compensation. There may be more to come.
Legislation mandating greater transparency and targeting rebates and spread pricing — when a PBM charges a health plan more for a drug than they pay pharmacies — came within hours of passing last December, and has been reintroduced.
The PBMs bills at times have been victims of unrelated political fights that kept them from the House and Senate floors. At the same time, the Pharmaceutical Care Management Association and other PBM interests have spent tens of millions of dollars lobbying against them since 2023.”
PBM legislation push not derailed by Express Scripts rebate shift – Modern Healthcare
States contract with single source PBMs:” This year, states including Minnesota, Nevada and Virginia enacted laws to use one PBM for their Medicaid managed care programs. They joined Ohio and Kentucky, which already have single PBMs, and more states have adopted comparable models or are considering similar approaches.
Under this policy framework, a state contracts with a single PBM that operates pharmaceutical benefits for all Medicaid managed care plans and their members.
While this approach to Medicaid drug benefits gives PBMs a shot at winning big contracts, it also means some insurers and PBMs will lose business.”
Insurers push back against single PBM state models – Modern Healthcare
Physicians
MedPage on medical societies: “The transition to greater physician employment by large health raises important questions about physician satisfaction and professional autonomy. On the one hand, employment by a large hospital or health system can, at times, help improve practice environments and address organizational and systems issues that previously fell on independent practitioners.
Yet, there’s a paradox: even as some workplace stressors ease, many doctors feel a loss of autonomy.
Physician trust in the organizations that employ them has eroded. Fewer than half now believe their leaders are honest or transparent. Only 47% say they trust leadership to make patient-centered decisions — a decline from 53% the year prior. This disconnect signals a deeper identity tension: the corporate healthcare environment often values efficiency, while physicians are trained to value individual patient outcomes.
The trust gap appears wider in nonprofit hospital systems than in investor-owned or private companies, a counterintuitive finding that may reflect communication styles more than structural differences. Whatever the cause, it reinforces a growing unease among employed clinicians. “
Medical Societies Are Facing an Existential Crisis | MedPage Today
Prescription Drugs
ICER: 51% increase in drug prices: The median price of newly launched prescription drugs increased 51% over two years per the Institute for Clinical and Economic Research (ICER).
The 51% median net price increase across of the 154 newly FDA-approved drugs debuted between 2022 to 2024 included drugmaker discounts, rebates, and inflation adjustments.
- The median list price, which is the publicly available price before any discounts, increased by 24% during that same time period, per the non-profit ICER’s calculations.
- ICER previously reviewed 23 of the new drugs for cost effectiveness, but the new analysis found 16 of those launched with net prices higher than the suggested upper limit for health benefits. It estimated those differences cost the US healthcare system an extra $1.3 billion to $1.5 billion in first-year spending.
- Gene and cell therapies, and cancer and endocrine/metabolic drugs were associated with significantly higher launch prices.
https://icer.org/wp-content/uploads/2025/10/ICER_2025_Launch-Price-and-Access-Final-Report
Public Health
AEI on SNAP, poverty correlation: “The ongoing federal government shutdown has put into question whether the federal government will continue to fund the Supplemental Nutrition Assistance Program (SNAP) in November. SNAP is one of the most important safety net programs in the United States, providing food assistance to 42.7 million people in an average month in 2024, at an annual cost of just over $100 billion. Policymakers often debate specific aspects of SNAP, such as the prudence of work requirements and sugary beverage restrictions, but hardly anyone has called for scrapping the program entirely….
If SNAP benefits are paid out as usual, then 38.3 million individuals would be poor. If SNAP benefits are not paid, then 41.2 million individuals would be poor, increasing the poverty population by 2.9 million. Among the 2.9 million individuals pushed into poverty, 1.1 million are children, 1.3 million are working age adults, and 0.5 million are adults aged 65 or older.”
Atlantic on NM Universal Child Care Policy: “Last month, New Mexico’s governor announced that the state would soon become the first in the country to offer universal free child care,,, Notably, the policy frames child care not as a private service but as necessary social infrastructure—the kind that, like schools and roads and libraries, should be publicly funded and available to everyone, regardless of their income. Success, then, will depend on whether the state can recruit educators quickly enough, on whether the legislature will continually approve the needed funds, on how many providers opt into the state system, and on how soon families can expect access to the child care they were promised. The state’s program is an admirable gamble—but it is still very much a gamble.”
The Atlantic on New Mexico’s Voucher System for Children:
Study: Vaccine efficacy: Researchers conducted a systematic review of U.S.-licensed immunizations against coronavirus disease 2019 (Covid-19), respiratory syncytial virus (RSV), and influenza. Findings:
“Of 17,263 identified references, 511 studies met the inclusion criteria. Covid-19 mRNA vaccines against the XBB.1.5 subvariant had pooled vaccine effectiveness against hospitalization of 46% and 50% among adults and 37% among immunocompromised adults… Influenza vaccination had a pooled vaccine effectiveness of 48% in adults between the ages of 18 and 64 years and 67% in children against hospitalization. The RSVpreF vaccine was associated with 18.2 excess cases of Guillain–Barré syndrome per million doses in older adults; a significant association with preterm birth was not observed when the vaccine was administered at 32 to 36 weeks’ gestation.
Ongoing peer-reviewed evidence supports the safety and effectiveness of immunizations against Covid-19, RSV, and influenza during the 2025–2026 season. “
Milbank on State Abortion restrictions: “The historic Dobbs v Jackson Women’s Health Organization Supreme Court decision of July 2022 abruptly ended almost 50 years of constitutionally protected access to abortion care, with legal oversight now residing within each state. As of October 2025,, 12 states have near-total bans and another 6 states restrict abortion to between 6 and 12 weeks of gestation. As such, the current legal landscape is that 18 states comprising nearly one-third of the US population have implemented restrictive abortion policy. .. The total number of abortions across the country has clearly increased; and in 2024 an estimated 155,000 women in states with bans accessed abortions in neighboring legal states. It is also apparent, however, that the number of abortions in states with restrictive laws has dramatically decreased with some states reporting zero procedures.”
The tobacco industry profitability: “ONE HUNDRED dollars invested in the tech-heavy Nasdaq index at the beginning of January 2024 would now be worth $154. If you had bought American tobacco companies, you would have made an even bigger return, pocketing $165. The share-price boom in part reflects a strange economic phenomenon. In recent years, the operating margin on a cigarette sold in America has grown from about 50% to about 60%. This year cigarette- and cigar-makers are expected to make $22bn of operating profit in the world’s largest economy.
Not bad for a dying industry. In the past decade the number of American adult smokers has fallen by 20m or so. The number of cigarettes sold has fallen by more than a third. And industry insiders expect the decline over the next decade to be even steeper. Normally, when customers vanish, an industry suffers: just look at Blockbuster or local newspapers. So how is the tobacco industry thriving? It is, in part, because cigarette manufacturers have read their textbooks. They understand price elasticities…”
