Last week, Secretary of Health and Human Services (HHS) Robert Kennedy and Centers for Medicare and Medicaid Services (CMS) Director Mehmet Oz announced appointments to the new Healthcare Advisory Committee (HAC).
Its 18 members were selected from 400 nominees and will serve two-year terms. The group includes 4 health system executives, 5 physician leaders, 4 policy analysts, 3 “others” (including motivational speaker Tony Robbins) and 2 Ex Officio (Non‑Voting) Members (Kimberly Brandt, JD — CMS Deputy Administrator & COO Stephanie Carlton, CMS Chief of Staff).
Specifically, HAC is tasked with developing recommendations to HHS and CMS in 6 areas:
- Modernizing Medicare, Medicaid, CHIP, and Marketplace operations
- Reducing administrative burden
- Improving chronic disease prevention
- Strengthening Medicare Advantage sustainability
- Enhancing data interoperability and quality measurement
- Improving care for vulnerable populations
Unofficially, its unspoken aim is to activate policies that enable MAHA initiatives to be implemented like healthy eating, transparency, value-based incentives, personal accountability et al while reducing overall spending for health and human services programs in federal, state and local government and in households. Ambitious!
Notwithstanding lack of representation in HAC by drug and device manufacturing, nurses and mid-level licensed professionals, state and public health officials, health technology, insurers and others, HAC’s scope is comprehensive, its timing is perfect and the opportunity is huge! But here’s its reality check:
The U.S. health system is in chaos. Its long-term destination is unknown. It’s near-term is mired in political brinksmanship and discontent about its costs and affordability. It is unhealthy. Majorities in both parties, and independent voters think the system is broken but few know what a viable alternative might be. Lost but making record time!!!
Messaging from industry insiders contribute to its deteriorating condition: hospitals, insurers, drug companies and physicians blame problems on unnecessary regulations and each other. State and federal elected officials are under-informed about its trends and innovations and easily swayed by misinformation. Regulators are hamstrung by political cross-fire that limits meaningful long-term health policies. And the general population is naïve about how the system operates and easily influenced by hype. It’s everywhere: ubiquitous drug company advertising, relentless promotion of “top hospitals” (per USNWR*, 627 of America’s 5000+ are “Best”) and constant insurer plan design changes that limit restrict enrollee utilization and protect the plan’s finances.
HAC can serve an important purpose if it addresses the future of the U.S. health system in the context of trends in population health, clinical innovation, AI-enabled solutioning, capital market flows (including public and private funding), regulatory philosophy (is healthcare a right or privilege) and consumer preferences and values. Its work should begin with consensus around three fundamental issues:
- Right or Privilege: Is access to the U.S. healthcare system a fundamental right or a privilege? To whom should it be accessible? Should “right to access” policies be implemented that consider social determinants, health behaviors, personal resources and health status in structuring the system’s front door
- Health or human services or health and social services: Should federal, state and local health policy facilitate the full integration of local public health, hospital, primary and long-term care services to enable population health and reduce unnecessary spending? Is a national comparative effectiveness platform to facilitate evidence-based care management and reduce inappropriate variation necessary to integrated population health? Should social determinants of health be a mainstream element of the system’s care management strategy, or a peripheral “risk” consideration?
- Private capital and/or public capital: How should funding (capital) for healthcare services (public and private) be accessed and allocated to achieve its highest and best return for taxpayers? What’s the optimal deployment of industry capital between primary and preventive health, acute and specialized services and senior care? How should fiscal and monetary policies facilitate adequacy of funding and appropriateness of its disposition? How should private investment in healthcare products and services encouraged?
These three should be answered as HAC begins its important work. They provide needed context to address the hot button issues facing the industry this year i.e. workforce stability, insurer-hospital tension, cost escalation, hospital consolidation, price transparency, public health funding, Medicare and Medicaid policy, cybersecurity threats, price controls and others,
Looking back
In 2009, I facilitated negotiations in the White House Office of Health Reform (Executive Order 13507) seeking direction for health system transformation to reduce the system’s costs, increase access and improve quality. It came as the country faced its second-deepest economic recession in history and as unemployment reached 10%. Participants were the CEOs of the American Hospital Association. the American Medical Association, America’s Health Insurance Plans, Pharmaceutical Research and Manufacturing Association and AdvaMed along with White House staff. Discussion was robust. Results were less-so.
The Patient Protection and Affordable Care Act (March 2009) ended up doing less than hoped. It was an imperfect start to the transformation journey but a start. It prompted discussion about alternative payment models, a national quality strategy and expanded access through Medicaid expansion and marketplace insurance coverage. But is failed to define the destination for the system’s future and mechanisms to lower costs without compromising quality. Key elements were never implemented or delayed (Healthcare Workforce Modernization, Interoperability et al) and systemic transformation fell victim to the divisive political climate that paralyzed the ACA’s implementation. The reality of the system’s complexity, costs and deeply-vested self-interests took over.
Looking ahead
I hope HAC is successful but unless discussion about the 3 topics (above) precedes its deliberation, the outcome will be incremental recommendations comfortable to industry insiders but disconnected from long-term realities and opportunities. That’s reality.
Paul
*Designation as a “top 50”, “top 100”, “5-star” or “Best Hospital” is imprecise. Each sponsoring organization defines inclusion criteria and sets a weighting methodology unique to its business objective and almost all require hospitals to pay to fee for recognition. Thus, across USNWR, Leapfrog, Statistica and Healthgrades, more than 800 hospitals promote themselves as “Top 100” or “Named America’s Best.”
PS Tracking healthcare stats has been ‘my thing’ for 50 years. The context in which I assessed spending, utilization, consumer opinions and investor bets was hyper-domestic with occasional comparisons to westernized systems akin to ours and developing systems of interest to U.S. entrepreneurs. Through my White House experience, I learned politics trumps policy most of the time. And through the years, I’ve realized healthcare’s future and its economy are dependent on factors well-outside its control.
Energy and food prices are getting more attention these days as gas prices spike, but I fundamentally believe troubling signals in the U.S. housing market might be more disruptive to healthcare. In the last 12 months, overall prices were up 2.7%. Physician prices were up 2.1%, hospital prices were up 7.1% and shelter prices were up 3.0%. But healthcare is only 7% of total household spending; housing is 36%., and consumers are reacting to both.
Here’s an interesting (somewhat irreverent) take on the housing market: Healthcare Will Not Save The U.S. Economy – by K. Pow. In our business, paying attention to the oversized impact of housing on household finances and spending in the healthcare economy are requisite.
Sections in today’s report
- Quotable
- Hospitals and Nursing Homes
- Insurers
- Physicians
- Polling
- Population Health
- Prescription Drugs
Quotable
University of MI Index of Consumer Sentiment: “Consumer sentiment fell back 6% this month to its lowest level since December 2025. Declines were seen across age and political party. Consumers with middle and higher incomes and stock wealth, buffeted by both escalating gas prices and volatile financial markets in the wake of the Iran conflict, exhibited particularly large drops in sentiment. Overall, the short-run economic outlook plunged 14%, and year-ahead expected personal finances sank 10%, while declines in long-run expectations were more subdued. These patterns suggest that, at this time, consumers may not expect recent negative developments to persist far into the future. These views are subject to change, however, if the Iran conflict becomes protracted or if higher energy prices pass through to overall inflation. Interviews for this release were collected between February 17 and March 23, with about two-thirds completed after the start of the US military conflict in Iran.
Year-ahead inflation expectations climbed from 3.4% in February to 3.8% this month, the largest one-month increase since April 2025. The current reading exceeds those seen in 2024 and remains well above the 2.3-3.0% range seen in the two years pre-pandemic. Long-run inflation expectations inched down to 3.2%. In 2024, values ranged between 2.8% and 3.2%, while in 2019 and 2020, they were consistently below 2.8%. Note that for both time horizons, interviews completed after February 28th exhibited higher inflation expectations than those completed before that date (see chart, right panel). March was the grimmest month of the year so far for consumers’ economic sentiment as the Iran war raised gasoline prices and dented the stock market, the University of Michigan’s latest monthly survey found.”
The survey’s headline sentiment index decreased to 53.3, from 56.6 in February. Economists polled by The Wall Street Journal were expecting a reading of 54.
Surveys of Consumers, University of Michigan https://www.sca.isr.umich.edu
MedPage on CMS anti-fraud efforts: “In the last fiscal year, the Department of Justice reported a record number of settlements under the False Claims Act, nearly $7 billion worth. In just the 6 months ending last September, the inspector general’s office at HHS generated an impact of about two and a half billion dollars. Now that’s before most of Oz’s public campaign had fully taken hold. For every dollar spent, that’s $12.70 back.
So, the machine was already running. But what’s new is who’s in front of the camera…the biggest change is a move away from what they’d call the pay-and-chase model. That’s where the government pays claims first and recovers money later. Now, what CMS wants to do is flag suspicious billing patterns before payment goes out. But even that idea isn’t entirely new. A law passed in 2010 under former President Barack Obama directed CMS to put in place that kind of preemptive fraud detection. It’s the same kind of algorithm that credit card companies use. CMS never fully did it because they were afraid of denying legitimate claims.”
War on Medicare Fraud; Match Day Trends; Hib Rising? | MedPage Today
Modern Healthcare on Medical frailty in Medicaid: “Two small words President Donald Trump’s tax law — medical frailty — promise to have an enormous impact.
States that expanded Medicaid eligibility to working-age adults without children or disabilities under the Affordable Care Act of 2010 need to have work requirements in place by Jan. 1. Beneficiaries will have to verify that they are working, volunteering or attending school at least 80 hours each month to get and retain coverage…and most states’ laws, don’t precisely define (medical frailty). Whether states choose strict or lenient interpretations, and whether those will pass muster with federal authorities, could determine the course of Medicaid work requirements.
Federal law states that a “frail” person is someone who is blind or has a physical disability; has a substance use disorder, a disabling mental disorder or a physical, intellectual or developmental disability that significantly impairs their ability to perform one or more activities of daily living; or a serious or complex medical condition.”
Medicaid work requirements spotlight medical frailty definition – Modern Healthcare
John Barkett on price transparency: “Price transparency was sold as one of health care’s simple fixes. The aim was to show patients and employers what insurers actually pay for their care, allowing market forces to do the rest.
But as federal rules from both the current and past administrations push more hospitals and health plans to post their prices, the emerging picture becomes far messier. In some corners of the market, transparency is beginning to expose outliers and fuel new tools that steer patients to better-value care. In others, it is quietly arming providers with new leverage to demand higher payments.”
Promise, Pitfalls, and Progress of Price Transparency in US Health Care: John Barkett | AJMC
Axios on economic triple whammy: “Americans desperately want day-to-day life to be more affordable. Right now, they aren’t getting it. The pinch of high prices for food, energy, housing and more has driven seismic shifts in public opinion over the last four years. Since the onset of the Iran war, the cost of living looks likely to get worse, not better, at least in the near term.
Energy prices are surging, interest rates are on the rise, and the stock market is looking wobbly — a triple whammy for U.S. households.
The Organization for Economic Co-operation and Development this week projected U.S. inflation will reach 4.2% this year. Before the war, the international research and policy group had projected 3% U.S. inflation.”
Iran war impact: Consumers caught in triple stack of pain Axios
The Atlantic on reflective living: “None of these men (Jeff Bezos, Marc Andreessen, Peter Theil) seem to have considered the possibility that self-examination is valuable in itself. The goal has never been simply to stew, but to correct our motives, desires, and actions to avoid delusion and live ethically. Indeed, extending empathy to others isn’t even possible without first understanding ourselves. A world devoid of introspection would resemble a schoolyard full of children picking fights forever, unable to perceive how their actions affect one another.
The people who seem least interested in introspection are also those whose work is most profoundly shaping our collective reality. These are the supposed visionaries whose insatiable demand for data has disenchanted the world. They are the funders of opaque new forms of intelligence that could upend the economy or possibly exterminate us all. These are the people who most need to understand themselves. (Andreessen declined a request for an interview.)
The Very Powerful Men Who Think Introspection Is Dumb – The Atlantic
Council Capital on AI-enabled services: “We increasingly view proprietary software and intellectual property as table stakes rather than defensible assets. What AI cannot easily replicate, long-standing customer relationships, industry qualifications, trusted reputations for ROI, unique data assets, and deep integration into client workflows that would be costly and disruptive to unwind, these are the assets we pursue.
This conviction reinforces our focus on tech-enabled services over pure software. The businesses that will thrive in an AI-accelerated world are those that pair domain expertise, regulatory fluency, and operational judgment with AI as a lever for speed, accuracy, and efficiency. In this model, AI enhances the product; it is not the product. The platform standard is also evolving: modern SaaS infrastructure that is cloud-optimized, LLM-integrated, fully configurable by business users, and visually intuitive is becoming the baseline expectation, accelerating implementation, reducing engineering dependence, lowering infrastructure costs, and deepening client relationships simultaneously.”
Council Capital IV Year End Investor Letter and Portfolio Company Summary –
Hospitals and nursing homes
Point-counterpoint on state imposed hospital price controls:
Point: AHA: “Molly Smith, group vice president for policy at the American Hospital Association, said governmental control of payer programs such as Medicare and Medicaid has led to chronic underpayment. “The result has been higher prices for other payers to maintain essential services in communities, and, increasingly, the very real risk of losing services in a community,”
Counterpoint: AHIP: “Instead of looking around for someone else to blame, the hospital industry should stop the anticompetitive consolidation, opaque billing practices and unaffordable price hikes that continue to drive Americans’ premium costs higher,” said Chris Bond, a spokesperson for AHIP, the insurance trade group.”
States push hospital price cap legislation despite opposition – Modern Healthcare
Axios: 340 B status: “Major drugmakers are imposing new conditions on federal discounted drug purchases, adding another friction point to a program that’s been a perennial source of strife between Big Pharma and hospitals and clinics. The manufacturers’ new data-reporting requirements reflect the industry’s belief that providers are gaming the 340B program to boost their profits — a charge the providers dispute.
The program covers more than $81 billion in annual drug purchases. Safety net hospitals and clinics say the savings they get through the program are needed to help them stretch limited resources.
Health costs are rising for providers, too, and the 340B changes are landing as looming cuts to federal Medicaid spending squeeze their budgets.”
PK note: There’s no better example of hospital muscle than the sector’s full-throated defense of 340B drug discounts. To date, the AHA and its consortia have been successful in protecting and growing the program much to the dislike of drug manufacturers. Might the fed’s desire to change the 340B business model (above) be successful? Maybe. Hospitals have shown resilience against unwanted regulations around site neutral payments and 340B. They’ve defended large not-for-profit health systems against tax exemption cuts and maintained protections against physician-owned hospitals. Hospital price transparency mandates have had no impact on hospital spending to date nor have challenges to hospital consolidation been successful to date.
Axios Vitals 1 big thing: More upheaval in discount drug program March 28, 2026
KFF Study: Hospital Consolidation: “Hospital consolidation has been a subject of particular focus in part because spending on hospital care is the largest source of spending on health. Hospital care has also contributed more than other categories to the growth in national health spending over time, including from 2022 to 2024, when it accounted for 40% of spending growth. Consolidation may allow providers to operate more efficiently and help struggling providers keep their doors open in underserved areas, but it often reduces competition. A substantial body of evidence has found that consolidation can contribute to higher prices, with unclear effects on quality.”
KFF used 2024 RAND Hospital Data to assess hospital consolidation based on three metrics: the share of metropolitan statistical areas controlled by a small number of health systems, the level of market concentration in metropolitan areas based on the Herfindahl-Hirschman Index and the share of hospitals affiliated with health systems over time. Findings:
- One or two health systems controlled the entire market for inpatient hospital care in nearly half (47%) of metropolitan areas in 2024.
- In more than four of five metropolitan areas (83%), one or two health systems controlled more than 75 percent of the market.
- Nearly all (97% of) metropolitan areas had highly concentrated markets for inpatient hospital care when applying HHI thresholds from antitrust guidelines to MSAs.
- Most hospital markets in metropolitan areas (80%) became less competitive from 2015 to 2024 or were controlled by one health system over that entire period.
Modern Healthcare on KFF hospital study: “Consolidation has picked up speed as more hospitals in search of financial support and operational stability come together. The trend has elevated concerns about the fallout from less competition — increased prices, less access to care, and worries about patient safety and quality.”
HCA Healthcare, CommonSpirit lead metro hospital markets: KFF – Modern Healthcare
Site neutral payment status: “Congress has backed off plans to institute “site-neutral” Medicare payments for outpatient care for now, but a new law still represents a step toward curtailing billions of dollars in hospital reimbursements.
The spending and healthcare package President Donald Trump enacted this month requires health systems to obtain unique National Provider Identifiers, or NPIs, for their outpatient departments by 2028. Although the policy does not modify Medicare payments, it will arm lawmakers and regulators with detailed information about outpatient care provided at hospital-owned facilities — and its cost — to support broader site-neutral policies.”
Congress paves way for outpatient pay cuts, site-neutral reform – Modern Healthcare
Study: Nursing home staffing and quality: “We used a difference-in-differences event study design to estimate the effects of unionization on nurse staffing ratios for total nurse staffing and separately for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs), as well as the effects of unionization on the quality of care, during the period 2013–21. We found that unionization had no effect on total nurse staffing levels but had opposing effects on RNs and LPNs. Unionization increased LPN staffing by roughly 2.7 nurse hours per day in the average nursing home, but it decreased RN staffing by roughly 3.2 nurse hours per day. Despite this substitution from RNs to LPNs, we found that unionization did not appear to reduce the quality of care, a result consistent with unions increasing nurse productivity.
STAT: Home health fraud: “The Trump administration has made it clear through executive orders, public statements, and social media posts in recent months that it intends to root out health care fraud, with Medicaid being the main target.
From a financial perspective, the focus on Home and Community-Based Services (HCBS) fraud makes sense. Long-term care costs are the second-biggest source of federal Medicaid spending…
The administration’s portrayal of this home care as rife with fraud comes at a time when those services are becoming less affordable but increasingly critical for the United States’ health care system. More than 8.4 million people received HCBS in 2023, and as many as 69% of Americans are expected to use long-term care services at some point in their lives as people are living longer. Meanwhile, the administration’s 2025 tax bill will cut Medicaid funding by $1 trillion over 10 years. These facts combined with the fraud crackdown have alarmed disability advocates, who worry that it will make it harder for disabled people to access care. .
Though Centers for Medicare and Medicaid Services officials kicked off the year by aggressively denouncing fraud and announcing sweeping investigations, their strategy appears to be in flux. They have started a new federal task force and sent letters to states announcing impending investigations of Medicaid fraud. But last week, they informed Minnesota health officials that they had approved their compliance action plan to get on a path toward getting their $2 billion in federal funding dollars….”
CMS says home care fraud is rampant. What do the data show? | STAT
Insurers
KFF Survey: 2025 ACA Marketplace enrollee survey conducted February 12-March 2, 2026: % of returning marketplace enrollees who report each of the following:
- 80% are experiencing higher health care costs
- 51% express affordability concerns for emergency care or hospitalizations
- 73% are worried about affording costs for routine medical care
- 49% are Worried about affording costs for prescription drugs
- 45% say they are, or will be, cutting back on household spending to afford health care costs
- 55% say they are not confident they can afford their premium all year
Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees | KFF March 19, 2026
Medicare Advantage overpayments: “Recent actions from the Centers for Medicare & Medicaid Services (CMS) could help reduce the estimated $1.3 trillion in Medicare Advantage (MA) overpayments projected over the next decade. Specifically, CMS’s proposed rate notice would essentially flatline payment rates, while also reducing upcoding by eliminating “chart reviews” and making other technical changes. These changes could save the government $22 billion in 2027 alone, and should be allowed to go into effect as written in the proposed rate notice…the Medicare Payment Advisory Commission (MedPAC) estimates MA plans will be overpaid by about 14%, or $76 billion, in 2026..
To help address these overpayments CMS recently proposed only a 0.09% rate increase – which is far lower than last year’s 5.06% increase, or the 3.88% average increase over the past decade… Taken together, CMS estimates these changes could reduce Medicare costs by roughly $22 billion in 2027. “
Medicare Advantage in the Hot Seat-2026-03-20
Assessing Recent Regulatory Action on Medicare Advantage | Health Affairs
MedPage on prior authorization: “Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action.
Whether these changes actually fix prior authorization for patients and clinicians is an open question. Meanwhile, stakeholders are weighing the risks versus benefits of artificial intelligence (AI) to streamline processes…
Prior authorization is a form of utilization management designed to gauge the appropriateness of certain medical and pharmacy services…However, the time and expense for physicians chasing approvals and the potential harm to patients leave many wondering whether these policies serve their intended purpose.
On the clinician side, practices complete about 39 prior authorization requests per physician per week, according to a 2024 American Medical Association survey. 93% of physicians experienced delays in care while waiting for prior authorization approvals, 82% said prior authorization has sometimes led patients to abandon treatment, and 29% blamed prior authorization for delays that led to serious adverse events including hospitalizations and deaths.
Moreover, a 2023 KFF survey showed that about 16% of U.S. adults reported problems with prior authorization in the prior year.”
What to Expect for Prior Authorization in 2026 | MedPage Today
Employer coverage: broker opinion about benefits changes: Per the Benefits in Focus Broker Survey of 170 brokers that support employer decision making on dental, vision, and supplemental health benefits: employer clients. Key findings:
- Enrollment and communication are key areas carriers can focus on to support both brokers and employers.
- Brokers expect strong growth in core and supplemental benefits, reflecting broader budget optimism. More than three in four brokers (77%) expected health insurance sales to increase in the next year, alongside strong expectations for growth in group life (64 %) and supplemental health (62%). This aligned with budget expectations: 61% of brokers and 67% of employers anticipated benefits budgets will rise over the next one to two years.
- Employers value the impact benefits have on morale more than brokers do.
- Brokers believed the core reasons employers offer voluntary benefits are employee demand, talent needs, and affordability.
- Administrative complexity is a challenge to the adoption of supplemental health benefits.
Expanding the Benefits Horizon: How Brokers View Voluntary Offerings
Physicians
Study: Primary care physician stress: “Using 2012–22 survey data from primary care physicians in the United States and nine other high-income countries, we found that shares reporting stress rose across countries. By 2022, the US had one of the highest shares of primary care physicians reporting burnout (44%). Switzerland (18%) and the Netherlands (12%) had the lowest shares reporting burnout, alongside higher shares with satisfaction and lower shares with stress. Across countries, female physicians had higher odds of burnout, whereas workplace factors—including satisfaction with income and administrative workload—and better care quality were associated with reduced odds of burnout. Efforts to reduce burnout should address disparities by sex and should include systemic supports including quality initiatives, flexible work, and arrangements for patient cross-coverage; in-depth cross-national learning could reveal additional strategies.”
Axios: Immigrant physician work authorization policy change: “The Trump administration’s suspension of certain immigrants work authorization renewals is sidelining possibly thousands of foreign-born doctors…About a quarter of the U.S. physician workforce are immigrants. Rural communities especially depend on immigrant doctors to fill workforce gaps. The Citizenship and Immigration Services this winter started freezing the processing of immigration benefits like work authorization extensions for people already in the U.S. from 39 countries.
Where it stands: Visa holders have a grace period allowing them to continue working in the U.S. after applying for a renewal. For the common H-1B visa, that period is 240 days. But the freeze has scrambled arrangements, forcing doctors to take unpaid absences from their jobs. They can legally stay in the U.S. if their employer continues to sponsor them. Immigrant doctors caught in the squeeze now either have to return to their home countries, immigrate elsewhere or stay in the U.S. unable to work.”
Trump’s visa policy sidelines immigrant doctors. Here’s how
Polling
Rock Health poll: attitudes about virtual care, digital health: Per Rock Health’s 11th Consumer Adoption of Digital Health Survey of 8,000 U.S. Census-matched adults conducted December 1-25, 2025:
- 32% of respondents reported having ever turned to AI chatbots for health information—double a year ago (16%). “Other, more established digital channels for health information (e.g., online search, health websites) are still more pervasive than AI chatbots, and by comparison, grew in use by three percentage points in the past year. For many, AI has quickly become a routine partof how they manage their health.
- 64% of AI users engage with it for health questions weekly or more often.
Population Health
The Economist: Urbanization increasing: The UN’s latest figures highlight tremendous urbanization. These days 45% of humanity lives in cities (with at least 50,000 people); another 36% inhabit towns (with at least 5,000). The data also show that much of the growth is happening in middle-income Asia. Only one of the world’s ten biggest cities lies outside that continent. And only seven of the world’s 33 “megacities” (boasting over 10m people) are in rich countries. By 2050 Jakarta and Dhaka will between them add another 25m people, nearly as many as live in Australia
Why many Asian megacities are miserable places The Economist
Gallup: Workplace health: “New Gallup data confirm that the personal and professional environment of U.S. workers was worse at the end of 2025 than at any point in the past three years across several important metrics. For the first time since Gallup began tracking the life evaluation of the U.S. workforce, more workers report struggling in their lives (49%) than thriving (46%): a stark reversal from 2022 and 2023 when more than half of employees were classified as thriving. This is coupled with U.S. worker engagement dropping to the lowest level on record in the past decade at 31% engaged employees 28% of workers saying now is a good time to find a quality job, down from 70% in mid-2022. More than half of workers are actively looking for a new job or at least watching for opportunities. And nearly half of those actively searching report it has been a negative experience, with many unable to land an interview….
The data point to a workforce that is restless but largely stuck. Many workers who want to leave cite economic constraints — from pay and benefits to the difficulty of finding a comparable role — as the primary barriers to making a move. With life evaluation at a record low and job market confidence near historic lows, the conditions weighing on U.S. workers show few signs of easing.”
U.S. Worker Thriving Declines as Job Market Pessimism Grows
Grief diagnosis recognized as mental disorders: “Grief can bring waves of heartache, anger, or numbness—but for most people, those feelings gradually shift over time. For some, they don’t. The loss remains intense, persistent, and difficult to reconcile with daily life.
This condition, known as prolonged grief disorder (PGD), was added to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) in 2022. It describes a form of grief that doesn’t ease with time and interferes with a person’s ability to adapt to loss.”
Why some grief never fades | National Geographic
NEJM Study: Cigarette smoking prevalence: “Cigarette smoking among U.S. adults declined from 10.8% of the population in 2023 to 9.9% in 2024. Use of other tobacco products, including cigars and e-cigarettes, remained unchanged, and 18.8% of adults (47.7 million) used at least one tobacco product.
In 2024, 18.8% (47.67 million) of U.S. adults reported using any tobacco product, including 12.6% (31.79 million) who reported using any combustible tobacco (i.e., cigarettes and/or cigars), 9.9% (25.19 million) who reported smoking cigarettes, 7.0% (17.79 million) who reported using e-cigarettes, 3.7% (9.3 million) who reported smoking cigars, and 2.6% (6.56 million) who reported using smokeless tobacco. Prevalence of any tobacco use was highest among individuals in primary extractive (29.4%) and construction/manufacturing (28.6%) occupations, those with a General Educational Development certificate (42.8%), individuals with disabilities (21.5%), low-income groups (24.4%), and rural residents (27.0%). Men (24.1%) reported higher use than women (13.9%).”
Tobacco Product Use among U.S. Adults, 2023–2024 | NEJM Evidence
Health Affairs: Food Guideline accuracy: “The recently updated dietary guidelines for Americans, released this January by the Department of Health and Human Services (HHS), rightfully emphasize whole foods over ultraprocessed foods. But the guidelines neglect to address how that food is delivered. “Real food” can still cause chronic disease if it contains harmful chemicals lingering from processing or packaging.”
New Dietary Guidelines Neglect the Health Risks of Food Processing and Packaging | Health Affairs
Prescription drugs
Study: antipsychotic prescribing by clinician type: “In this repeated cross-sectional study (across 2013-2023), the proportion of antipsychotic prescriptions written by advanced practice registered nurses and physician assistants increased from 13.8% to 39.6%, making them the largest group of prescribers. During the same period, the proportion of antipsychotic prescriptions written by psychiatrists decreased from 48.4% to 32.4% and by primary care physicians from 33.0% to 23.8%.
