Key Takeaways:
- A challenging economic climate means continuing health industry profitability is unlikely.
- The majority of Americans want systemic changes the system’s insiders resist.
- Longterm, inattention to structural flaws will result in an inadequate public utility that serves all but a few that can afford more.
This week…
- the Bureau of Labor Statistics will issue the Job Openings and Labor Turnover Report for October Tuesday and Employment Cost Index for Q3 2025 Wednesday. The November Consumer Price Index will be released next week (December 18)—all delayed by layoffs of federal workers via DOGE job cuts earlier this year
- the 8th and Final 2025 Federal Open Market Committee will meet to review data from its 12 regions and set the stage for interest rates and monetary policies in 2026.
- Individuals and small businesses face a 12/15 deadline to enroll in Marketplace coverage (that starts January 1) on the heels of last week’s deadline for seniors to enroll in Medicare Advantage and Part D.
- Wall Street analysts, lenders and private investors will be hunkered down adjusting expectations about the industry’s key challenges in 2026.
- Congress will continue to debate partisan proposals to extend tax credits that expire at year end (with compromise unlikely).
- And everyday Americans will be making holiday plans and juggling their finances for their necessities.
Observations:
- Most Americans consider healthcare a necessity that’s impossible to predict and near-impossible to afford.
- Most Americans think housing, childcare, groceries and transportation are necessities requiring payment more than healthcare.
- Most American’s think frontline caregivers—nurses, doctors, home care providers, public health professionals—are purpose driven but overwhelmed by the industry’s corporatization and ‘big business’ ethos.
- Most Americans want transformational changes to the health system that its insiders resist.
As a result, the health industry’s become an enemy to the population it’s pledged to serve. Institutional distrust for government, organized religion and big business now includes the health system, especially among young Americans..
So what?
In the citations included in today’s report and extensive polling by Gallup, Pew, Kaiser Family Foundation and others, these observations are documented. The status quo in healthcare is not working for anyone other than those who profit from its dysfunction. Investors and lenders know it: that’s why earnings for virtually every major sector in the system including not-for-profit health systems and others are at a 4-year high. That’s why the industry’s major trade groups focus on advocacy issues that protect their members’ interests leaving systemic reforms for others to solve. That’s why the majority of the healthcare workforce shares the public concern about its effectiveness.
I have long held the view that transformation is not about bad people; it’s about a flawed system. I remain optimistic industry leaders—most of whom acknowledge the system’s future is not a repeat of its past—will take the lead in its redesign. Lacking that purposeful effort, it will devolve to an underfunded public utility for all but the few who can afford something else.
Paul
PS: Tomorrow, I go under the knife. Except for a knee replacement years ago that was necessary to my mobility, my triple by-pass heart procedure is a bet I can live longer, better than if I soldiered on without it. Since July, I’ve experienced the best and worst of the system. I’ll share more (hopefully) on the other side. But as I close this chapter, I’m thankful for those who give their lives selflessly to healing. I am thankful for those who seek to do good without need of recognition and for whom financial gain is not their priority. I am thankful for my readers through the 25+ years I’ve scribed my weekly journey in healthcare. Stay tuned.
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
Patient perspective: “For years, those of us working on value-based care (VBC) have rightly focused on affordability as a system-wide challenge: reducing the total cost of care, strengthening primary care, aligning incentives between payers and providers, and driving better outcomes for every dollar spent. But this focus—while essential—can overlook the patient’s lived experience.
Patients don’t experience “total cost of care.” They experience deductibles, copays, pharmacy costs, and surprise bills. They experience the stress of choosing between paying for a medication and a utility bill. They experience the fear that an unexpected medical need could trigger financial crisis. “
Health Care Transformation Task Force Newsletter – November
Modern Healthcare on industry 3Q financial performance: “The largest American public healthcare companies outperformed other industries in the third quarter, as higher new and specialty drug use, continued demand for weight-loss drugs and strong hospital visit trends boosted earnings.
Among the 11 industry categories on the S&P 500, healthcare companies delivered the highest percentage of earnings beats in the period. It was also the best-performing quarter in more than four years for the industry.”
Healthcare earnings top S&P 500 behind drug, hospital demand – Modern Healthcare
Axios on ‘GOP Health Care Mess’: “The bottom line: With only 10 session days to go, it looks increasingly likely the health care fight will continue into next year.”
Axios Hill Leaders December 5, 2025
McKinsey on complexity of market shifts impacting healthcare: “Healthcare is still reeling from the storm unleashed by the pandemic. Now it faces another gathering storm—one emerging from fundamental shifts in the macroeconomic landscape. The trade, economic, and security structures that emerged from the post–Cold War unipolar order are giving way to a multipolar world. Intensifying geostrategic competition is leading to higher defense spending and a push to reverse the decline of the United States’ share of global manufacturing value added, which fell from about 25% in 2000 to roughly 15% in 2024. In addition, trade uncertainty is high, with a push to contain the trade deficit, which has greatly expanded over the past half century. Concurrently, the US middle class has steadily eroded, and reversing this trend is a critical priority. Between 2000 and 2018, the middle-wage employment share declined 6%, and median wages grew just 1% annually, compared with 7% for low-wage earners and 5% for high-wage earners. Simultaneously, the US federal deficit is poised to surpass $1.9 trillion in fiscal year 2025—a peacetime high—with interest costs on that debt edging closer to $1 trillion annually.
These challenges portend a period of tectonic shifts in the trade, economic, and security order. Healthcare, despite being a domestic industry, sits squarely on the fault line of these shifts.”
Future of healthcare in the US: Gathering storm 2.0 or a golden age? | McKinsey
Sen. Tim Sheehy (R-MT) on Republican health strategy: “Republicans should use their control of Congress and the White House to implement a new strategy that champions competition, deregulation, and empowering Americans over faceless government bureaucrats…
That principle applies in healthcare too. The same aspirin costs 4 cents at Walmart and $82 in a hospital two miles away because patients shop blind. Every developed country that spends half what we do on healthcare has mandatory price transparency. We don’t because the hospital lobby fights it. Let’s force hospitals to post real prices upfront, as gas stations do. Turn patients into consumers and watch costs plummet…
We now control the White House, Senate and House. There are no more excuses. Deliver an all-out affordability offensive—rip up red tape, force transparency and unleash competition—or watch the mandate evaporate by 2026. This is bigger than the next election. It’s the difference between a Republican resurgence that lasts a generation and a one-term detour. Conservative ideas work. Now we have to prove it, not with words but with results families can feel at the kitchen table and the gas pump.”
“A GOP Playbook for an Affordability Offensive – WSJ November 28, 2025
Georgetown policy analysts on price transparency impact: “Giving consumers and employers information on prices so they can be better shoppers and purchasers is a necessary step, yet it is expected to reduce prices only minimally. As such, policy makers frustrated by high health care prices will need to advance transparency in concert with other policies. Complementary approaches, such as site-neutral payments, stronger antitrust enforcement, and price regulation, have more potential to lower health care prices and rely on a foundation of improved transparency to be most effective.”
Unpacking The Price Transparency Provisions of The Patients Deserve Price Tags Act | Health Affairs
Bain on macro environment: “We are in the midst of what we call The Great Transformation, a large-scale, secular shift defined by the stunning reversal of macro forces that have shaped the world for the past three decades. Globalization is now post-globalization. Capital superabundance? No more. Abundant labor? Urbanization? No and no again. So, it would be crazy to place bets on what the future holds, right? Again, no. We explain why it’s actually imperative for CEOs to do just that.”
Global Management Consulting Firm | Bain & Company
WSJ on White House Health Policy strategies: “President Trump and some Republicans have been describing Obamacare as a gravy train for insurers…Wall Street sees it another way. Many Affordable Care Act plans are losing money this year and investors have grown increasingly bearish…Profitability has deteriorated sharply in 2025 as sicker patients—many of them transitioning from Medicaid—have driven up medical costs. Insurers have responded by implementing substantial premium increases for 2026 in an effort to restore viability, but the business remains far from attractive to investors because the enrollee pool is becoming sicker and smaller. The looming expiration of Biden-era enhanced subsidies for these insurers next year is making matters worse….
The ideas rest on the longstanding conservative belief that patients spend more prudently when the dollars feel like their own. So far, HSAs and FSAs (flexible spending accounts) have mostly benefited higher-income, healthier workers in the employer-provided insurance market…
On Wall Street, the uncertainty surrounding these Republican proposals is fueling investor anxiety—not so much over their potential mechanics, but over how they complicate bipartisan compromise. Without an extension of the enhanced tax credits—which cost roughly $30 billion annually—more than 20 million Americans are now set to face sharp premium increases in 2026, and millions are expected to drop out of coverage. With the shutdown over and Trump publicly rejecting a straightforward extension, the odds of a deal by year-end appear slim, says Ransom. That impasse has hammered pure-play ACA insurer Oscar Health OSCR 3.45%increase; green up pointing triangle, whose shares have plunged over 40% from their October peak.”
Trump Calls Obamacare Insurers Fat and Rich. Investors See Them as Vulnerable. – WSJ
White House physician on President’s health: “As part of President Donald J. Trump’s comprehensive executive physical, advanced imaging was performed because men in his age group benefit from a thorough evaluation of cardiovascular and abdominal health…
President Trump’s cardiovascular imaging is perfectly normal. There is no evidence of arterial narrowing impairing blood flow or abnormalities in the heart or major vessels. The heart chambers are normal in size, the vessel walls appear smooth and healthy, and there are no signs of inflammation or clotting. Overall, his cardiovascular system shows excellent health.
“His abdominal imaging is also perfectly normal… All major organs appear very healthy and well-perfused. Everything evaluated is functioning within normal limits with no acute or chronic concerns…this level of detailed assessment is standard for an executive physical at President Trump’s age and confirms that he remains in excellent overall health.”
White House Releases Trump’s MRI Report | MedPage Today December 1, 2025
Cannabis and culture: “What started as a subversive activity among dedicated stoners has mushroomed into a full-blown tradition. Like every other holiday, it’s gone commercial. With marijuana legal for medicinal use in 40 states and recreational use in more than half of those, the industry is seizing on the popularity of the pre-turkey toke.
This year, don’t be surprised if Grandma gets a little loopy after toasting with a cannabis-infused beverage in her wine glass, or your aunt brings two varieties of stuffing—one made with cannabis-infused rosemary oil, one without. In a way, wasn’t this inevitable for a holiday that’s always been all about the munchies?
The cousin walk, which also goes by no name and many names—“cousins walk,” “Thanksgiving walk” and “pre-dinner safety meeting”—is big enough to spur sales on what’s now known as “Green Wednesday,” a marijuana-buying version of Black Friday the day before Thanksgiving. Dispensaries say it’s often the second-biggest day for cannabis sales after the pot-celebration day 420 on April 20th.”
This Year’s Thanksgiving Surprise: Half of the Guests Are Stoned – WSJ
Generational Identity: “I fear we are turning out the most confused generation, with an affliction of contradiction. I’ve written before about Cy-Bos—cyber bohemian quitters—and Gen G—generation guilty. Now we have Gen C, for confused. You can’t blame them; look at the Sybil-like multipersonality splits at Wellesley and most universities.”
Generation C as in ‘Confused’ – WSJ
Housing and affordability: “Affordability isn’t a synonym for inflation, which is the rate of change in the overall price level. Inflation reached 9% in mid-2022 but was down to 3% in September. Though it is above the Federal Reserve’s preferred 2%, that 1 percentage point difference is probably not the crisis people have in mind.
Strictly speaking, affordability means having the resources to pay for goods and services at current prices. By that standard, the simplest metric is real (i.e., after-inflation) incomes. Real incomes fell behind when inflation shot up, then recovered as inflation receded and wages caught up. Real personal income was up 2.3% in the year through August, and real hourly wages climbed 0.8% in the year through September, both in line with the 19-year average.
Clearly, the affordability crisis can’t be captured by such macroeconomic measures. It is an amalgam of microeconomic irritants that vary by individual, time and place…
Housing is especially hard to solve. It has become much more expensive since the pandemic. From 2008 through 2021, mortgage rates were abnormally low, a product of very low inflation and aggressive Federal Reserve policies, which boosted home prices. Mortgage rates have since returned to pre-2008 norms, but housing prices haven’t yet adjusted downward, so monthly payments remain high, especially for first-time buyers.
That is slowly changing. New-home prices have slipped for the past few years, existing-home prices have stopped rising, and mortgage rates are down half a percentage point in the past year.
Housing affordability is now slightly below its pre-2008 average, according to the National Association of Realtors, so room for improvement is limited. Trump wants to stack the Fed with loyalists who will slash interest rates, but that wouldn’t return mortgage costs to prepandemic lows absent a much-worse economy. And a politicized Fed would ultimately lead to higher inflation and rates.”
Everyone Is Talking About the ‘Affordability Crisis.’ It Can’t Be Solved. – WSJ
Republican Study Committee focus on Healthcare and Housing “Congress must codify the president’s executive actions with additional legislative reforms…
Affordability: Our proposal will put power into patients’ hands by creating healthcare options that protect pre-existing conditions while giving families real alternatives to ObamaCare. We’ll expand access to health savings accounts, grant employers more flexibility to help workers find coverage that fits their needs and remove barriers to affordable generic and biosimilar drugs. These reforms will kickstart competition and give citizens control over their healthcare decisions while reducing costs.
Americans also deserve to realize the dream of home ownership. On housing, we’ll eliminate the capital-gains tax on primary home sales to expand the housing supply, convert underused federal buildings to residential use and promote mortgage portability so families aren’t trapped by rising rates.
You asked why Republicans would run for Congress if not to do something good for the country. This is why: a second reconciliation bill that reduces healthcare and housing costs for American families. That’s consequential legislation, governing with a purpose, and we intend to deliver.”
Rep. August Pfluger (R., Texas) Chairman, Republican Study Committee The GOP’s Three Goals for Reconciliation 2.0 – WSJ
WSJ Editorial Board on HHS Secretary Kennedy: “Who decided to leave Robert F. Kennedy Jr. home alone at the Health and Human Services Department? Without adults to supervise the Secretary, he’s damaging public trust in immunizations, and now the Centers for Disease Control and Prevention has been conscripted into his anti-vaccine campaign.”
RFK Jr. Turns the CDC Against Vaccines – WSJ
GAO Report: Advanced Premium Tax Credit Fraud: The GAO created 20 fictitious identities and submitted applications for health care coverage in the federal Marketplace for plan years 2024 and 2025. “Preliminary results from GAO’s ongoing covert testing suggest fraud risks in the advance premium tax credit (APTC) persist. The federal Marketplace approved coverage for nearly all of GAO’s fictitious applicants in plan years 2024 and 2025, generally consistent with similar GAO testing in plan years 2014 through 2016…
More broadly, GAO’s preliminary analyses identified vulnerabilities related to potential SSN misuse and likely unauthorized enrollment changes in federal Marketplace data for plan years 2023 and 2024…
GAO preliminarily identified weaknesses in CMS’s APTC fraud risk management as compared to leading practices. Specifically, CMS has not updated its fraud risk assessment since 2018 despite changes in the program and its controls. Further, CMS’s 2018 assessment may not fully align with leading practices, like identifying inherent fraud risks. Finally, CMS did not use its 2018 assessment to develop an antifraud strategy. Together, these weaknesses
Economy: Consumer Spending
Atlantic on Consumer Spending: “President Donald Trump has promised not only that America will be “great again” but also that it will be “healthy again,” “wealthy again,” “beautiful again,” and—crucially—“affordable again.” Now, as the country faces persistent inflation, a housing crisis, and rising prices on consumer goods, he claims that affordability is nothing more than a “con job,” an opportunistic buzzword leveraged by a rival party. “The word affordability is a Democrat scam,” he said during a Cabinet meeting on Tuesday.
Trump Campaigned on Affordability. Now He’s Calling the Idea a ‘Con Job.’ – The Atlantic
JP Morgan on household finances: “Households are going into the end of the year with weak income growth and bank balances that remain flat, after adjusting for inflation. Young people continue to underperform the typical early career growth pattern amid the slowdown in hiring, while about half of workers aged 50-54 are experiencing negative real year-over-year income growth as of October 2025. Households’ cash balances have been holding steady on a real basis, although households putting more money in higher yield alternatives may be weighing on bank balance growth. With pandemic-era excess cash liquidity in the rearview mirror, consumers are facing a holiday spending season with budgets tempered by tepid income growth but augmented by strong stock market gains—the latter highly unequally distributed. “
Real income sustains weak trend, while cash balances remain stable
Seasonal spending: “America’s biggest retailers have discovered that the consumer is far from dead. For all the hand-wringing over tariffs and a wobbling economy, shoppers are spending where they perceive value as evidenced by strong recent financial results from Walmart, Gap, T.J. Maxx TJX 2.27%increase; green up pointing triangle parent TJX and other chains.
The National Retail Federation expects retail sales in November and December to grow 3.7% to 4.2% compared with the same period a year ago, to $1.01 trillion to $1.02 trillion. That growth would be comparable to last year, when sales in the period rose 4.3% to $976 billion.”
Americans Are on a Year-End Shopping Spree – WSJ
Consumer price sensitivity hitting auto sales: “Signs of strain are beginning to show up in the data. Cars are sitting longer on dealer lots. Dealers are piling on extra discounts to make sales. Lower-income borrowers are defaulting on car loans. Americans as a whole are spending less overall on vehicle purchases than they did a year ago.
And not all shoppers are suffering. A swath of the nation’s consumers have continued to amass wealth and are bolstering industry profits as they pay top dollar for trucks and sport-utility vehicles loaded with heated steering wheels, massaging seats and advanced driver-assistance systems. Still, there are only so many Americans on the upward leg of the K-shaped economy.”
CarAmerican Consumers Lose Patience With High Car Prices – WSJ
Economy: Macro
AI impact on economy: “The turbulence that hit stocks tied to artificial intelligence last week highlights a broader risk to the economy. Growth has become so dependent on AI-related investment and wealth that if the boom turns to bust, it could take the broader economy with it.
Business investment in AI might have accounted for as much as half of the growth in gross domestic product, adjusted for inflation, in the first six months of the year. Rising AI stocks are also boosting household wealth, leading to more consumer spending, especially in recent months.
Take away AI spending, and the economy looks in worse shape. Although job growth was higher than expected in September, job creation has nonetheless slowed this year and the unemployment rate is inching up. Private business investment excluding AI-related categories is mostly flat since 2019, according to Deutsche Bank. Outside of data centers, other commercial construction, such as shopping centers or office buildings, is down.
That makes the economy more dependent on AI…. Bank of America estimates that just four companies—Microsoft, Amazon.com, Alphabet and Meta Platforms—will make $344 billion in capital expenditures this year (equivalent to roughly 1.1% of GDP), up from $228 billion last year. “
“How the U.S. Economy Became Hooked on AI Spending – WSJ
Fed’ Beige Book on economic conditions: Five takeaways from the November beige book, published Wednesday November 28, 2025 ahead of Fed meeting December 9-10:
- The job market continued to sputter
- Inflation remained stubborn—and not just because of tariffs
- Consumers appeared to pull back
- The government shutdown took a toll on federal workers
- Artificial intelligence was making its mark: AI led to booming investment in some areas—and a pullback in hiring in others. But the technology is also transforming the workplace. Some companies said they were pulling back on entry-level hiring because they are leaning more on AI to do basic tasks.
Five Key Takeaways From the Fed’s Economic Survey – WSJ
Job Reports for November 2025: “After a record-setting volume of job cuts in October, employers in November posted fewer layoffs. But reductions were 24% higher than a year ago and the highest since the COVID-19 pandemic – another sign of a volatile job market buffeted with economic challenges from slowing demand to tariff uncertainties.
- Challenger, Gray and Christmas: U.S. employers announced 71,321 job cuts in November, down 53% from the 153,074 layoffs announced in October but layoffs were up 24% from the 57,727 announced in November 2024 and the highest for a month since 2022. So far in 2025, 1.17 million people have lost their jobs. That’s the highest total the U.S. has seen since the onset of the COVID pandemic in 2020, according to a new report Thursday from the outplacement firm Challenger, Gray & Christmas.
- ADP: … “private employers eliminated 32,000 jobs last month, the biggest decline in more than two-and-a-half years. Restructuring was cited as the most common cause for the November layoffs. Closings and market and economic conditions were also heavily cited. Tariffs were blamed for 2,000 of the November cuts.
Layoffs hit highest level in 2025 since pandemic: Challenger
KFF Issue Brief: Medicaid Funding thru state Provider Taxes: “In federal fiscal year (FFY) 2024, the federal government paid 65% and states paid 35% of total Medicaid costs. States are permitted to finance the non-federal share of Medicaid spending through multiple sources, including state general funds, health-care related taxes (referred to as “provider taxes” throughout this brief), and local government funds.”
States are now facing a more tenuous fiscal climate due to slowing revenue growth, increasing spending demands, and growing fiscal uncertainty, due in part to the 2025 reconciliation law. The Medicaid provisions in the new law, including new provider taxes restrictions, are estimated to reduce federal Medicaid spending by $911 billion (or by 14%) over a decade, with wide variation in how the effects will be felt across the states…”
Five key findings from KFF 2025-2026 survey of Medicaid directors:
- All states but Alaska use provider taxes to help finance the state share of Medicaid spending. All states but Alaska finance part of the state share of Medicaid funding through at least one provider tax and 41 states have three or more provider taxes in place.
- Provider taxes are most common for institutional providers. Provider taxes fall on a wide range of provider types but are most commonfor institutional providers including hospitals (47 states), nursing facilities (45 states), and intermediate care facilities for people with intellectual or developmental disabilities (33 states).
- Changes to federal rules for provider taxes are estimated to cut federal Medicaid spending by $226 billion over 10 years. The effective prohibition on new provider taxes or increases to existing ones and the reduced provider tax limits in ACA Medicaid expansion states collectively account for $191 billion of the federal savings and will have the most widespread effects
- The effective prohibition on new or increased provider taxes could impact all states, with expected cuts to existing taxes in 31 states. All states could potentially be affected by the prohibition on new provider taxes or increases to existing ones, which will limit states’ ability to respond to the health care cuts in the 2025 reconciliation law.
- New requirements for “uniformity waivers” will force changes to provider taxes in at least seven states. The 2025 reconciliation law prohibits states from using uniformity waivers if the tax charges higher or lower rates based on the volume of Medicaid revenues or patients. The new limits on uniformity waivers will affect MCO taxes in at least seven states, with effects starting as early as April 1, 2026.
5 Key Facts About Medicaid and Provider Taxes | KFF December 1, 2025
Hospitals and Health Systems
S&P on not-for-profit hospitals 12/1/2025: “U.S. Not-For-Profit Acute Health Care 2026 Outlook: Resilient for Now, With Increased Credit Risks on The Horizon”
U.S. Not-For-Profit Acute Health Care 2026 Outlook | S&P Global Ratings
Georgetown profs on hospital profitability: “Profitability alone, however, provides an incomplete picture of financial health. Other metrics—such as liquidity and solvency—are essential to understanding a hospital’s financial standing…
Nearly 70% of hospitals operate within health systems, where an individual hospital’s financial metrics offer only a partial view of its financial condition. System-affiliated hospitals may centralize expenses across the health system, distorting hospital-specific metrics of financial health and potentially masking signs of hospital distress. To obtain a more accurate financial picture, policy makers and analysts should evaluate metrics at both the hospital and system levels.
As policy makers work to stabilize the health care system and pursue long-term reforms, a more complete and nuanced understanding of hospital finances will be essential to directing resources effectively. Achieving this requires access to standardized, reliable financial data. However, existing public sources vary widely in scope, quality, and purpose…
As hospital and health system finances grow increasingly complex, maintaining transparency will remain an ongoing challenge. Investing in centralized, publicly accessible financial reporting and robust analyses now can help states make better short-term funding decisions and lay a stronger foundation for data-driven health policy in the future.”
Sullivan Cotter on Health System Leadership: “Health care organizations face a perfect storm of financial strain, workforce fatigue, and growing community accountability,” said Aaron Sorensen, Ph.D., Senior Partner, Lotis Blue Consulting. “The leaders who will thrive are those who combine strategic clarity with empathy, operational discipline with courage, and the ability to mobilize others through trust.”
The study highlights ten essential competencies – known as the “Vital Ten” – that define future-ready CEOs. These fall across four domains validated by industry experts:
- Strategic Mindset – Anticipating disruption and positioning systems for the future.
- Execution Engine – Turning vision into measurable results.
- Cultural Leadership – Building trust and alignment among stakeholders.
- Adaptive Capacity – Leading with calm and agility amid volatility.
“These leaders see around corners, make high-quality decisions under pressure, drive measurable results, and build trust across clinicians, boards, and communities. They communicate with clarity, lead change with discipline, and navigate uncertainty with confidence. Beneath these competencies lie defining personality traits – ambition, intellectual curiosity, emotional steadiness, and interpersonal sensitivity – that enable sustained performance in volatile environments.”
Beyond these competencies, the research also examines the characteristics important for success in the job. The findings show that ambition, intellectual curiosity, emotional stability, and empathy form the foundation for sustained effectiveness in today’s complex environment.”
Press Release | The Next Chapter of Health Care Leadership – Sullivan Cotter
Insurers
AM Best on insurer profitability in 2025 and 2026: “The commercial, or employer, group business has historically been a dominant driver of earnings for health insurers, but given the higher medical trends, rate increases at renewal are expected to be material and could drive enrollment losses, shift more costs to the employee or lead to more companies converting from fully insured to self-funded, especially in small group business, which is more price sensitive.”
Jennifer Asamoah, Senior Financial Analyst, AM Best
MSN on UHG MA disenrollment strategy: “UnitedHealth’s decision to remove roughly 1 million seniors from its Medicare Advantage plans marks one of the most sweeping retrenchments in the program’s modern history, reshaping coverage for older Americans who had come to rely on the company’s scale and stability. The move crystallizes how rising medical costs, tighter government payments, and strategic business choices are converging on the people least able to absorb sudden changes in their health insurance.
UnitedHealth’s explanation for the mass disenrollment centers on rising medical costs, tighter reimbursement, and the need to prune plans that no longer pencil out, and I see those factors as part of a broader recalibration across the Medicare Advantage industry. Insurers have been warning that higher utilization of hospital care, more expensive drugs, and updated federal payment formulas are squeezing margins on plans that once looked comfortably profitable. In that context, UnitedHealth’s move to shed about 1,000,000 seniors from specific products reads less like an isolated corporate decision and more like a leading indicator of how large carriers intend to protect earnings by exiting markets or benefit designs that no longer meet their internal thresholds.”
UnitedHealth drops 1 million seniors in biggest cut in decades November 24, 2025
On CMS Star Ratings change: “The Centers for Medicare and Medicaid Services aims to cancel a new metric that’s slated to be added to the Star Ratings program next year. Insurers already struggling to achieve top star ratings, and the bonus revenue they trigger, have been concerned that Excellent Health Outcomes for All — formerly known as the health equity index — would depress their scores…
If left in place, EHO4all would rate Medicare Advantage insurers on the quality of care received by members who have low incomes, have disabilities, or qualify for both Medicare and Medicaid. It also would replace what’s known as the reward factor, which benefits insurers that consistently generate top scores. If left in place, EHO4all would rate Medicare Advantage insurers on the quality of care received by members who have low incomes, have disabilities, or qualify for both Medicare and Medicaid. It also would replace what’s known as the reward factor, which benefits insurers that consistently generate top scores.”
Note: in CMS’ proposed rule for 2027 MA star ratings measurement released last week, the Health Equity Index was not included.
Medicare Program; Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program November 28, 2025 2025-21456.pdf
Inside CMS’ Medicare Advantage star ratings proposal – Modern Healthcare
Physicians
NEJM Op Ed on vertical integration and physician practices: “ It is not clear that physicians should sell their practices to outside firms. It is also not clear that most physicians (with the exception of those who are equity holders) benefit from doing so. Furthermore, it is not clear that buyers do well with the physician practices that they acquire, have an exit strategy when the practices do not do well, or that they can survive the financial and regulatory threats facing them. Other parties may profit from vertical integration, but buyers and sellers do not. Physicians have other options, such as organizing themselves, advocating, unionizing, and leading their colleagues.”
Vertical Integration and Physicians: Caveat Venditor? Caveat Emptor? | NEJM Catalyst
Study: Direct primary care prevalence: “We assessed practice and workforce characteristics using a national sample of concierge and direct primary care practices identified through novel linkages of public and proprietary data. From 2018 to 2023, the number of direct primary care and concierge practice sites grew by 83.1% and the number of clinicians participating in them by 78.4%. The share of clinicians in concierge and direct primary care practices who were physicians declined from 67.3% to 59.7%, whereas the proportion of advanced practice clinicians increased. Approximately 60% of these clinicians participated in Medicare, suggesting concierge or hybrid practice. Independent ownership decreased from 84.0% to 59.7%, whereas corporate-affiliated practices grew by 576% during this period. The growth in these primary care models may offer substantive benefits to patients and clinicians, but it also raises broader questions about changing clinical practice and access to care.”
Polling
CBS News Poll: Public opinion about economy: Per the CBS poll of 2489 US adults conducted November 19-21, 2025:
“There’s a disconnect between how Americans hear the White House describing the economy, and what they’re feeling themselves. Most Americans (60%) say Trump describes things with prices and inflation as better than they really are vs. 27% “about as they are” and 13% “worse than they are. This comes as ratings for the overall economy continue to be low — as they’ve been for years — ticking down (to 32%) this week to their lowest mark in 2025.Prices, more generally, are still seen by most as going up (58% up, 31% stay the same and 11% down).”
KFF survey on marketplace enrollment changes: Per the KFF 2025 Marketplace Enrollees Survey (November 7-15, 2025) released last week:
“One in four Obamacare enrollees will “very likely go without” coverage next year if tax credits aren’t extended and premiums doubled for those who buy individual coverage under the Affordable Care Act.
If Congress does not extend the tax credits beyond 2025, premium payments will increase 114% on average for the 22 million people who currently get a tax credit. To better understand how people are navigating these cost increases during the 2026 Open Enrollment period, which began on November 1.”
2025 KFF Marketplace Enrollees Survey | KFF
Prescription Drugs
STAT on drug price disclosures: “The Trump administration last Tuesday evening unveiled the prices for 15 drugs that were the subject of the second year of Medicare negotiations, saying it saved $8.5 billion, or 36%, compared to what it would’ve paid last year had the negotiated prices been in effect.
The timing and process of announcing the negotiated prices seemed designed to avoid attention, unlike the splashy announcements that accompanied drug pricing deals with individual companies.
Curiously, the Medicare negotiated price for Novo Nordisk’s semaglutide is slightly higher than the price Novo voluntarily agreed to in the same program as part of its deal with the administration.”
Medicare releases new list of negotiated drug prices | STAT
Biologics’ investing strong in 2025: “The pharma biotools sector—which encompasses technologies and services for drug discovery, clinical development, biopharmaceutical manufacturing, and diagnostics—is on pace for 513 VC deals in 2025, which is well above the previous annual record of 442…
AI integration into biotech has been a major driver of this uptick as computational tools and emerging biological foundation models continue to attract significant capital. Lila Sciences, pursuing “scientific superintelligence” through autonomous labs, raised a $350 million Series A at a $1.3 billion valuation. Chai Discovery raised $70 million at a $573 million valuation for its de novo antibody design model. Other notable deals and areas of investment in Q3 included the synthetic biology & CRISPR category, headlined by Colossal Biosciences’ $120 million Series C extension.
Q3 2025 Pharma Biotools VC Trends – PitchBook
Public Health
HHS on new CDC recommendation on Hep B vaccine: “ The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) today voted 8 to 3 to recommend individual-based decision-making for parents deciding whether to give the hepatitis B vaccine birth dose to infants born to women who test negative for the virus. For those infants not receiving the birth dose, ACIP suggested in its recommendation that the initial dose be administered no earlier than two months of age.
Individual-based decision-making, known on the CDC immunization schedules as shared clinical decision-making, means that parents and health care providers should consider vaccine benefits, vaccine risks, and infection risks, and that parents consult with their health care provider and decide when or if their child will begin the hepatitis B vaccine series…
ACIP also voted to recommend that when evaluating the need for a subsequent hepatitis B vaccine dose in children, parents should consult with health care providers to decide whether to test antibody levels to hepatitis surface antigen to evaluate adequacy of protection through serology results.”
ACIP Recommends Individual-Based Decision-Making for Hepatitis B Vaccine Birth Dose in Infants Born to Women Who Test Negative for the Virus | HHS.gov December 5, 2025
NYT on vaccine policy and ACIP meeting: “It has been six months since Health Secretary Robert F. Kennedy Jr. fired all 17 members of an influential panel of vaccine advisers as part of his mission to overhaul American vaccine policy. On Friday, his handpicked replacements delivered for him, voting to end a decades-old recommendation that all newborns be vaccinated against hepatitis B.
The implications are far-reaching: Hepatitis B can be passed from mother to child and leads to chronic liver disease in most infected children. The acting director of the Centers for Disease Control and Prevention, Jim O’Neill, must now decide whether to accept the panel’s recommendation that pregnant women who test negative for the virus should consult with their health care provider and “decide when or if their child will” be vaccinated against it.
But the vote, on the second day of a two-day meeting that descended into sniping and personal insults, was about more than a single disease. It was the first step toward a major re-examination of the entire suite of vaccines given to American children; in coming meetings, more changes to the childhood schedule are likely.”
Inside RFK Jr.’s Methodical Quest to Shake Up America’s Vaccine System – The New York Times
