Last week, Michigan voters chose former Detroit public health director Abdul El-Sayed as its Democratic nominee for its U.S. Senate seat—the latest in a series of wins by Democratic Socialists New York and Colorado with Minnesota Governor and DC Mayor races upcoming.
El-Sayed’s campaign focused on three aims: “Money out of politics, money in your pocket, Medicare for all.” These capture a sentiment shared by the majority of voters who vary widely on how these should be pursued.
They’re premised on a gestalt belief: the system’s not working for ordinary Americans because the influence of money subordinates the population’s wellbeing to the financial interests of the few who profit. They believe the system’s rigged. They believe insiders control the rules of the game and protect their own interests first. They believe lawyers, consultants, investors, bankers, trade groups and lobbyists use money to influence elected officials’ decisions inaccessible to those not paying them. They think fraud is rampant, politicians insincere, government oversight inept and the public easily duped or ill-equipped to respond effectively
They believe these accurate descriptions of the political system, the financial system and the healthcare system.
In that context, the El-Sayed campaign latched onto “Medicare for All”—an enticing solution to soaring health costs, variable quality and accessibility depending on personal circumstances, poor service, and lack of transparency about prices and outcomes. It’s an idea that’s floated in healthcare for decades.
Soon after Medicare began in 1965 as a national insurance program for seniors, its expansion became a popular target for progressives and concern to federal budget hawks. Proponents asserted that healthcare is a right, not a privilege, and Medicare an essential program for 74 million seniors and disabled adults currently enrolled. Conservatives counter healthcare’s a personal choice and Medicare Advantage a private solution hedge against the Medicare money pit. Through the years, members of Congress have sought to modify the program legislatively i.e. Javitz, Kennedy, Sanders, Conyers and last week, Alaska’s Kim. In the process, the program has expanded (Parts A, B, C and D), enrollment has grown and costs to the federal government have soared. Might the current attention to Medicare for All produce a different outcome? Here’s my take:
In the near term, Medicare for All will prompt more attention to fraud and add pressure on CMS (Centers for Medicare and Medicaid Services) to re-engineer its value-based purchasing programs to reduce federal spending. The allure of Medicare for All is undermined by its price-tag: employer contributions in Part A are not sustainable, and premiums and co-pays in Parts A, B, C & D increasingly unaffordable for the majority to enrollees. Like the Michigan vote last week, Medicare for All will be aspirational for a growing majority of disaffected consumers across all age and income groups but passage into law unlikely.
In 2029 and beyond, Medicare for All might be implemented as a public option i.e. the federal government may implement a single-payer option in concert with state-administered high-risk pools to stabilize coverage and shift resources to population health management. This version of Medicare for All might pass if the following conditions persist:
- Employer-based coverage shrinks in response to persistent health costs increases.
- Gen Z and working age populations replace group coverage with cheaper individual (hybrid) policies.
- One Big Beautiful Bill Medicaid cuts disable state funding for public health services.
- Physician participation in Medicare and Medicaid shrinks.
- Medical inflation exceeds 3% annually.
- Hospital and insurer consolidation is sustained at current levels without regulatory revision.
- IRS tax policies relative to insurance, caregiving costs do not change.
- The public’s confidence in the health system continues to erode.
The political system of the U.S. that oversees its healthcare is not inclined to make transformational changes that threaten its major stakeholders—hospitals, insurers, drug companies and physicians. But Medicare for All in some form is inevitable unless healthcare leaders and elected officials recognize the public’s fed up with excuses. They’re attracted to the idea of Medicare for All even if they don’t understand it.
Paul
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Population Health
- Prescription Drugs
Quotables
Abdul El-Sayed, Democratic nominee for Michigan U.S. Senate on messaging strategy: “I want to make sure that when somebody touches our campaign — in any way they touch us — that our message is clear, it’s concise and it’s consistent. Even if you’re volunteering and you’re knocking on our door, the message you’re hearing is about: “Money out of politics, money in your pocket, Medicare for all” — and this is why it matters to me. And as much as people want to pretend or act like we had a personality-driven campaign, it wasn’t. It was driven by a message. I can walk into almost any room, and I can say: “Money out of?” and everybody’s like: “Politics.” “Money in your?” “Pocket.” “Medicare for?” “All.” People know what we’re about.”
Abdul El-Sayed Talks About His Victory, Chuck Schumer and His Mom – The New York Times
Axios on hospital “hot seat”: “For all of President Trump’s talk of Big Pharma and big insurers, hospitals are emerging as the group most rocked by the policy changes of Trump 2.0…
Hospitals, on the other hand, are likely only starting to feel the financial fallout stemming from the GOP’s major Medicaid changes passed last year, and there appears to be plenty of appetite for even more hospital reforms in the future.
Between the lines: Last year’s Medicaid overhaul cracked down on how hospitals get paid by the program, limiting provider taxes and states’ ability to direct enhanced spending to facilities. Republicans also added work requirements, which are estimated to swell the uninsured population by more than 5 million.
Hospital hot seat https://www.axios.com/newsletters/axios-future-of-health-care-
Kenny Capital on unemployment misinterpretation: “Anyone else tired of all these gurus claiming the labor market is still healthy?! There’s objectively zero evidence of that.
“But Kenny- you’re wrong because the unemployment rate is still low, and it fell from 4.2 to 4.1% in July!!”
What a lazy analysis. The Unemployment Rate (U-3) is Borderline Useless
We just need to throw out that measure and start over for a myriad of reasons. In theory U3 is meant to capture so called “demand” for work because you must be actively looking for a job to qualify as being unemployed and thus in the labor force. Remember- that’s a short window of only 4 weeks.
The reality is people are staying unemployed for longer these days- again, that assumes they’re in the labor force…. mainstream media never mentions these things- or U3’s design flaws more broadly since it no longer reflects modern day workforce dynamics given its razor thin scope- is criminal in my view. But we are not a serious country- so in a dystopian, ass backwards sort of way, it all makes sense!
Healthcare: Kind of like how people STILL argue we have a “balanced” labor market with NFP growth well below trend and healthcare firmly in the driver’s seat. Hell- even when the Y/Y distribution of NFP is normalized and shown as a stacked bar chart, the medical complex’s post COVID contribution was at times higher than it’s been in ~50 years.”
(6) Healthcare, Tech, and Old Farts- the Holy Trinity
Medical economics on household financial security: “For the first time since tracking began five years ago, most Americans can no longer say they can reliably afford their health care. New data from the West Health-Gallup Healthcare Affordability Index shows a steady, years-long erosion in patients’ ability to pay for the care and medications they need, and the trend line is only pointing in one direction.
49% of U.S. adults are “Cost Secure” in 2025 – the lowest share since tracking began in 2021 and down from 61% in 2022. An estimated 2.8 million more Americans became unable to afford health care between 2024 and 2025 alone.
The pressure is not landing evenly. Some age groups are losing ground faster than others, and the gap between men and women has widened to its largest point on record. Patients managing chronic and mental health conditions, the people who most depend on consistent access to care, are also feeling the squeeze more acutely than the general population. Meanwhile, rising health spending, climbing hospital prices, and the recent expiration of enhanced ACA subsidies are compounding an already difficult picture heading into 2026.”
U.S. health care affordability hits a five-year low | Medical Economics
Alan Murray on Corporate Strategy: “The genius of America is not just its ability to invent, but also to reinvent. Silicon Valley startup culture is the envy of the world; but the re-startup culture at many of the nation’s oldest companies is equally noteworthy. These companies refuse to let their past be an anchor. They strike out to new frontiers, leaving legacy businesses behind. They heed the call to disrupt themselves, before they are disrupted.”
America’s Forever Startups ceobrief.cmail20.com/t/d-e-wojihl-hlkyhklilj-r/
Altman on healthcare affordability: “No matter which way pollsters ask the question, health care costs emerge as a top concern for voters. It’s at the top of the list of worries for voters, and one of several problems they say are affecting their family budgets, along with gas and food prices, housing costs and the cost of utilities. But it’s probably over-reading polls to say health care costs are the number one issue for voters, or that there is any single top issue. Health costs are part of a stew of affordability worries and problems driving voters now, which candidates can address separately or together. Depending on the poll and the question, one or the other may be at the top of the list. And worries and problems are not the same thing. Health care costs register most on the worries list.”
Are Health Care Costs THE Top Issue for Voters?
America’s Physician Group’s Dentzer on Medicaid medical frailty requirement: “Physicians are going to be pulled into this decision. They’re going to have this enormous role in, in effect, the decision of whether patients can retain their Medicaid coverage or not, and therefore, whether their own patients are going to be able to get the regular healthcare that they need, because if they don’t get it, they will die.
It’s a completely untenable situation. It would place physicians and other clinicians in a position that would violate almost every core principle of medical ethics — the obligation not to harm the patient, the obligation to act for the benefit of the patient, and the obligation to respect the patient’s autonomy. I mean, do you really want a physician in on the decision about whether you should work or not if you’ve got end-stage renal disease?”
Court Case Challenging Medicaid Work Rule’s ‘Frailty’ Requirement Gets Moved Up | MedPage Today
Chernow, Schnieder on system incentives: “P4P (Pay for performance) was an important step that focused attention on gaps in quality in U.S. health care, inspired interventions to address them, and promoted investments in quality-focused personnel and infrastructure. Yet returns have been disappointing, with only moderate documented improvements in care processes and health outcomes, despite substantial administrative burden and costly demands on clinician time.2
The costs and limitations of the measure–score–pay paradigm that has shaped U.S. health policy for a generation are becoming increasingly apparent. A more effective approach would be realistic about what national policy can achieve. CMS could move beyond the current paradigm by using a narrow set of high-impact measures to target improvement of low-performing but essential plans or organizations. Without such changes, the promise of value-based care is unlikely to be realized.”
Modern healthcare on hospital advocacy performance: “Hospital leaders are not eager to admit they’ve taken a pounding in Washington lately. But as earnings reports trickle in, uninsured numbers rise, provisions of the 2025 tax law kick in and some lawmakers want more cuts, the industry is acknowledging a difficult situation that challenges its storied political clout — and is fighting back.
To recap, President Donald Trump enacted a law last year that cut more than $1 trillion from the healthcare system, with the largest share coming from hospitals. Congress also rejected an extension of generous health insurance exchange subsidies, leading to significant revenue losses from a spike in the uninsured population and a rise in uncompensated care.
And Congress isn’t necessarily done cutting, especially as conservative Republicans pressure GOP leaders for even deeper spending reductions.
Perhaps more troubling for the hospital sector is that growing numbers of lawmakers have expressed negative views about the industry. Members of Congress have singled hospitals out as key drivers of rising healthcare costs and embraced remedies that include greater exposure of pricing, tougher site-neutral Medicare payment policies and curbs on the 340B Drug Pricing Program for safety-net providers.
Some lawmakers have even questioned the value of the charity care that large, nonprofit health systems deliver and floated ending the tax-exempt status many enjoy.”
Hospitals under political scrutiny fight back – Modern Healthcare
Barnes on HIPAA: “I was a young health care lawyer when the HIPAA privacy rule first came out. About 26 years later, we also have the FTC and about 23 state privacy laws trying to regulate the explosive growth of non-HIPAA health data coming from wearables, apps, patient forums, and the one billion health care queries that Google gets every single day. Enter U.S. Senate HELP Chairman Bill Cassidy, who is having a legacy moment as he prepares to leave his policymaking career: the Health Information Privacy Reform Act was reported out of his committee on August 4, 2026, which would create a brand-new federal regime for “applicable health information” (non-HIPAA-covered data). My problem with its premise — to have HHS and FTC figure out a federal floor — is that it does not preempt state laws; “more stringent” state statutes survive right on top of it…”
Only What Matters on Health Information Policy
Board member obligation to apply AI: “AI literacy is becoming part of the board’s duty of care. Three recommendations for directors:
- Turn information into intelligence. AI can help boards distill lengthy board materials, identify anomalies and surface risks or performance issues that management presentations may overlook. Directors should understand how those insights are generated and verify the quality of the underlying data.
- Challenge the default strategy. When management presents a preferred course of action, boards should ask what alternatives were considered and how AI-informed analysis shaped the recommendation. The goal is not to validate Strategy A but to test it against credible options B and C.
- Do not mistake outside support for board oversight. Auditors and consultants may use AI to identify patterns or improve analysis, but they cannot assume the board’s responsibility for long-term monitoring. At least one director should have enough business and technology experience to translate AI’s implications for strategy and risk.
Why AI Literacy Is Now a Board Duty Corporate Board Member August 7, 2026
Politico on anti-fraud funding: “Senate Finance Committee Chair Mike Crapo (R-Idaho) and ranking member Ron Wyden (D-Ore.), along with Sens. Chuck Grassley (R-Iowa) and Catherine Cortez Masto (D-Nev.), introduced a bill last Thursday that would provide $5 billion in additional funding to a federal health care fraud control program and expand its ability to crack down on Obamacare fraud.
The additional funding for the Health Care Fraud and Abuse Control Program (HCFACP) would yield at least $45 billion in net savings between 2027 and 2036, according to a Congressional Budget Office estimate obtained by POLITICO.
The effort comes as Republicans and Democrats have been at each other’s throats over who’s to blame for rising health costs ahead of the midterm elections. While Republicans have made combatting health care fraud a cornerstone of their messaging, Democrats have called it a tactic to distract voters from massive cuts to Medicaid and Obamacare enacted in the GOP’s One Big Beautiful Bill Act.”
Senators find common ground combating fraud – POLITICO August 7, 2026
Economy
BLS July 2026 Jobs Report: “Both the unemployment rate, at 4.1%, and the number of unemployed people, at 6.9 million, changed little in July. These measures also changed little over the year….
Both the labor force participation rate, at 61.4%and the employment-population ratio, at 58.9% changed little in July. Since January, the labor force participation rate declined by 0.7% and the employment-population ratio decreased by 0.5%…
Total nonfarm payroll employment changed little in July (-23,000), following an average monthly gain of 34,000 over the prior 12 months. In July, employment declined in local government education and retail trade. Employment continued to trend up in health care.
In July, employment in health care continued its upward trend (+22,000) but at a slower pace than the average monthly gain over the prior 12 months (+36,000). Employment in ambulatory health care services continued to trend up over the month (+18,000). “
Employment Situation Summary – 2026 M07 Results
WSJ on July Jobs Report: “The U.S. labor market shed jobs in July, an unexpected contraction likely to renew questions about the economy’s fundamental strength at a time when it is also facing elevated inflation.
The Labor Department’s July jobs report showed that the economy lost 23,000 jobs last month, a big shortfall versus the gain of 83,000 that economists surveyed by The Wall Street Journal had expected. Revisions to May and June payrolls numbers showed that the economy added 103,000 fewer jobs in those two months.
Government job losses pulled July’s numbers into negative territory. But private-sector hiring made a weak showing as well. Overall, private employers added just 30,000 jobs.
In a bright spot likely reflecting the boom in data centers, the construction sector added 22,000 jobs last month. Manufacturing gained 5,000. But leisure and hospitality employers cut 40,000 workers—after cutting even more in June—while retailers shed more than 19,000 employees.
Private-sector education and healthcare jobs grew by 25,000, a relatively poor result for what has been a big source of new jobs over the past year.”
U.S. Lost 23,000 Jobs in July, While Unemployment Ticked Lower – WSJ
EBRI Report: Four in 10 enrollees reported that their health care costs had increased in the past year. Among those experiencing increased costs, more than half reduced discretionary spending, one-third had difficulty paying other bills, and one-quarter reduced contributions to retirement savings.”
Higher Health Care Costs Prompt Many to Cut Spending, Reduce Saving, or Delay Care EBRI August 6, 2026 ff-560-cehcs7-6aug26.pdf
WSJ on Corporate earnings: “Strong earnings reports from the U.S.’s largest companies are powering major indexes to new highs, easing some concerns that the recent rally is overly dependent on a handful of artificial-intelligence stocks.
Some concerns.
Among the more than 440 S&P 500 companies reporting second-quarter earnings so far, 86% have beaten analysts’ estimates, according to FactSet data. Companies are reporting earnings that are around 29% higher than those estimates, on track for a record earnings surprise in data going back to 2008.
The S&P 500 is now headed for a seventh consecutive quarter of double-digit earnings growth. A run of upbeat reports from companies including Palantir Technologies, Caterpillar and Disney this past week fueled a climb that carried stock indexes to their best weekly gains since April.
Investors still have plenty of volatility-fueling worries: the on-again, off-again war with Iran and new questions about how the Federal Reserve will fight inflation. Many note that earnings growth remains heavily concentrated in energy and AI stocks, particularly skyrocketing profits at memory companies supplying the AI build-out.
But earnings season is reassuring many that a strong core of corporate profitability underpins the market’s gains. “
Blockbuster Earnings Bolster Stocks’ Record Run – WSJ
The Economist on IPO Risk: “In June SpaceX made history with a stock market debut that raised $86bn and valued Elon Musk’s rocket-maker above $2trn. The company reported better-than-expected earnings this week, but its losses and spending unnerved investors, sending its share price down. OpenAI and Anthropic may follow in going public. The Economist’s analysis suggests investors shouldn’t let themselves be lured by mega-IPOs.
Tracking more than 3,500 American flotations since 2010 showed that returns varied wildly; snapping up shares is closer to a lottery than an investment. New listings “pop” in their first day or so of trading, but then quickly fizzle out. Data compiled by Jay Ritter of the University of Florida found that firms floated between 1980 and 2024 ended up, on average, lagging the market by 21 percentage points over three years. That said, some companies buck the trend: tech firms with annual sales above $100m beat the market by 13.7 points.”
The Economist August 8, 2026 www.theeconomist.com
Hospitals
Beckers: Hospital financial challenges: “Hospital finance leaders have beaten back 340B payment cuts, site-neutral reimbursement and Medicaid rollbacks before. They have never had to model all three landing in the same fiscal year. That is the challenge in front of them now.
CMS’ proposed 2027 outpatient rule, released July 2, would cut billions from 340B drug payments and push site-neutral rates into imaging. Medicaid work requirements under HR 1 also take effect in 2027, when coverage losses are expected to accelerate. Large, for-profit health systems have already acknowledged underestimating the impact of the ACA enhanced premium tax credits’ expiration on their 2026 results. And the Health Resources and Services Administration’s revised 340B rebate pilot is set to go live Jan. 1, 2027.
Each policy carries its own advocacy campaign, legal uncertainty and chance of changing before implementation. But CFOs cannot build a 2027 budget around policy probabilities. What matters is the cumulative financial impact.”
Hospitals already losing money are about to lose more
Hospital labor costs: “Hospital and health system pay strategies are getting more deliberate in 2026. Minimum wage hikes are up sharply from last year, union contracts are settling into smaller, steadier raises instead of 2025’s double-digit jumps, and CHROs are steering dollars toward specific roles rather than spreading them evenly — a shift playing out even as national wage data shows the broader market barely moved.
Pay for hospital workers still varies by role, with a roughly 12-to-1 gap between the highest- and lowest-paid occupations. The May 2025 BLS data shows mean annual wages ranging from $37,080 for maids and housekeeping cleaners to $454,940 for cardiologists. That gap was narrower in the prior year’s data ($41,070 to $398,620, or roughly 10-to-1), suggesting the spread between the wage floor and ceiling is widening slightly rather than staying flat. “
2026 health system pay strategies are getting more targeted: 5 takeaways
Study: MA Payment rates to affiliated hospitals: Using a novel data set of vertically integrated MA plans matched with negotiated hospital pricing data, we found that in 2024, 66–73% of hospitals charged similar prices to affiliated and unaffiliated plans, but prices differed at a sizeable minority of hospitals. On average, affiliated plan prices were 5.3% higher than unaffiliated plan prices for the same procedure at the same hospital. Affiliated plan prices were higher relative to unaffiliated plan prices in the inpatient (rather than outpatient) setting, in more concentrated MA markets, and where MA hospital prices were lower relative to traditional Medicare hospital prices. Our results suggest that vertically integrated MA plans behave differently from standard MA plans, but strategies vary by market and hospital characteristics.”
Study: value-based payment program participation and hospital administrative costs: “In this cohort study, participation in mandatory value-based payment programs was associated with an annual increase in hospital administrative costs of approximately $0.85 million per hospital, with an additional $1.40 million increase associated with participation in the Comprehensive Care for Joint Replacement model. These increases corresponded to more than $3 billion in additional annual administrative costs nationally.”
Note: Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries.
AHA recommendation for RHDP: Last Wednesday, the American Hospital Association CMS to consider 4 changes to the Rural Health Transformation Program:
1- CMS should prioritize direct support for rural hospitals and providers. Specifically, the agency should lift the 15% funding cap it imposed on provider payments and the 20% cap it imposed on infrastructure and capital improvement funding for years two through five of the program. Further, CMS should allow for major building construction and renovations and equipment upgrades.
2-CMS should work with Congress to allow states to revise their initial applications and provide a longer timeline to spend obligated funds…
3- CMS (should) ensure that states and the agency itself do not enact undue administrative barriers to hospitals’ ability to receive the funds
4- CMS should ensure that the RHTP funds received by hospitals are separately reported on the Medicare cost report.
AHA to CMS: Lift caps on rural hospital transformation funds
Study: Private equity ownership of hospices: Researchers linked a national PE and PTC acquisition database to Medicare claims for a beneficiary sample for the period 2010–21 and used a difference-in-differences event study to compare acquired versus nonacquired for-profit hospices on process-based quality measures and Medicare reimbursement. Results:
“After PE acquisition, registered nurse, social worker, and home hospice aide minutes per thirty days declined 5.14%, 12.32%, and 6.62%, respectively; after PTC acquisition, registered nurse and home hospice aide minutes per thirty days declined 4.63% and 9.09%. Declines in visit minutes also were observed in the last seven days of life. Reductions in visit minutes were driven by four large acquirers. These findings highlight the need for increased transparency and oversight policies, as well as payment reforms that align reimbursement with care intensity and quality.”
340B Program Growth: “The 340B Drug Pricing Program continues to redefine the meaning of “skyrocketing.”
- For 2025, discounted purchases under the 340B program reached an astounding $100 billion—23% higher than in 2024.
- The gross-to-net difference between list prices and discounted 340B purchases—a proxy for funds available to covered entities—also grew, to $79.5 billion (+$12.0 billion).
- Hospitals again accounted for 87% of 340B purchases.
- 340B purchases are now more than 70% larger than Medicaid’s net prescription drug spending. The program now accounts for nearly one-fifth of the total U.S. gross-to-net bubble.
During DCI’s June webinar, I predicted that the 340B program would move from an era of expansion and opacity to one of transparency and accountability. But given the latest growth figures, I worry that reform of this undermanaged, out-of-control program may never happen. Has the program become too big to reform?
Drug Channels: The 340B Program Hit $100 Billion in 2025: Has It Become Too Big to Reform?
Study: hospital revenue for physician-administered Keytruda: “This study analyzed insurer expenditures and provider margins with a focus on Keytruda, the world’s largest biologic in terms of sales…Findings:
Keytruda expenditures by private insurers increased by 142% from 2020 to 2024, while the number of patients using Keytruda increased by 110%. Price markups—the ratio of the reimbursement price charged to insurers compared with the acquisition price paid to the manufacturer—averaged 173% in hospitals eligible for 340(B) discounts, 78% in hospitals not eligible for those discounts, and 16% in community-based physician practices. For hospitals eligible for 340(B) discounts, each Keytruda patient was associated with $102,680 in annual revenue, measured through insurer reimbursement, after organizational, patient, and market factors were adjusted for. Each Keytruda patient was associated with $67,825 in revenue at noneligible hospitals and $3,094 in revenue at physician practices.”
Court decision helps hospital 340B reimbursement: The U.S. District Court for the Northern District of Texas last week vacated a 2023 regulation that limited hospitals’ Medicare disproportionate-share hospital reimbursement, which helps support safety-net providers. Those hospitals may receive millions of dollars a year in additional DSH payments, which could help them manage looming Medicaid cuts and uncompensated care increases.
The rule that took effect Oct. 1, 2023, meant hospitals no longer could count hospital patients they treated using uncompensated care pool funds in DSH payment calculations. Uncompensated care cost pools are meant to help pay for and expand care for uninsured and underinsured patients. Last week’s ruling vacated the 2023 regulation.
The decision applies to hospitals in states that have supplemental payment programs for uncompensated care pools. Hospitals in states including Arizona, California, Florida, Hawaii, Kansas, Massachusetts, New Mexico, Tennessee and Texas have used those Section 1115 funding mechanisms. Hospitals stand to receive higher DSH payments from fiscal 2024 onward.
Ninth Circuit Opens Door to FCA Liability for Alleged 340B Overcharges | False Claims Act Blog
Population Health
CDC Director named: Last week, The Senate confirmed Erica Schwartz to lead the Centers for Disease Control and Prevention, which has been without a permanent leader for almost a year.
Dr. Erica Schwartz confirmed as Trump’s CDC director | AP News
Fortune on Gen Z: 68% of Gen Z say going out “isn’t worth the damage it does to my wallet,” and 62% avoid making weekend plans altogether to sidestep the financial regret that follows a night out… squeeze compounded by the fact that roughly one in three Gen Z adults still live at home, often specifically to save enough money to move out. ..
A decade ago, 52% of 18-to-26-year-olds in the U.S. described their mental health to Gallup as “excellent”; today that figure is 15%. Previous generations could reasonably expect a version of the milestones that defined adulthood. For Gen Z, those milestones aren’t a stretch goal anymore. They’re optional, or renegotiated, or gone.”
WSJ on consumer sentiment: “The downbeat mood on the economy stands in contrast to a stock market that has soared as enthusiasm over artificial intelligence has taken hold. Consumer spending has remained solid, even in the face of high gasoline prices, buoyed in part by this year’s tax cuts.
The best characterization of the economy in Trump’s second term, based on the main measures, might be “so-so.” Gross domestic product expanded at a 1.9% annual rate over the six quarters ended in June, which compares with 2.4% during former President Joe Biden’s final year in office. The unemployment rate has barely budged, edging up from 4% in January 2025 to a still-low 4.1% as of July, although job growth has slowed markedly.
Inflation is the sorest point: Consumer prices were 3.5% higher in June than a year earlier, according to the Labor Department, versus a January 2025 inflation rate of 3%. That ate away at wage gains—average hourly earnings were up 3.5% on the year in June
Americans’ feelings about the economy are decidedly worse than those numbers suggest. In several surveys, only about one-quarter of respondents rate the economy as excellent or good, while about three-quarters say it is in fair or poor shape.
One result of the sour mood: a significant reversal in views of the GOP’s ability to manage the economy. In many polls, more voters see the Democratic Party as a better economic steward than the Republican Party—a rare finding in recent years.
For the first time since 2010, Fox News polls find voters citing Democrats as better on the economy than Republicans. Democrats led by 4 points on the question in April and by 9 points in July, whereas the GOP was viewed as the better economic manager by as much as 15 points in 2022 and 2023.
But while the economy remains a strong challenge for Republicans, Democrats haven’t yet fully taken advantage. They have other problems: Democratic socialists are battling centrists over the party’s economic agenda, and polling shows voters hold dim views of the party. In the Fox News poll, for example, 69% of voters disapproved of the job Democrats are doing in Congress.”
Cost of Living Worries Give Democrats Lead Over GOP on Economy – WSJ
FDA approves MRNA-based flu vaccine: Last Wednesday, the Food and Drug Administration approved the first mRNA-based flu vaccine, called mFlusiva. The vaccine is manufactured by Moderna and was approved for use in adults 50 and older. Moderna said that it expects the vaccine to be available for the 2026-2027 respiratory virus season.
FDA approves the first mRNA flu vaccine
Economist on dementia incidence:” Last year he and some colleagues published research in the Journal of the American Medical Association showing that, whereas 40 years ago three in every ten Americans aged 85-89 had dementia, by 2024 just one in ten had it…
The single biggest risk factor for dementia is age. Prevalence doubles roughly every five years after 70. In America in 2016, for instance, just 4% of people aged 70-74 had dementia, but the rate jumped to 9% for those who were 75-79 and again to 18% for 80- to 84-year-olds. More than a quarter of those over 85 had the condition…
The Lancet Commission on Dementia, an international collaboration of leading experts, reckons that as many as 45% of dementia cases worldwide could be delayed or prevented through addressing 14 “modifiable risk factors” at various stages in life. These range from better schooling for children (insufficient education is associated with a 60% higher risk of dementia), to treating deafness, high cholesterol and depression in mid-life and avoiding social isolation when older.
For now, even the most optimistic projections still entail a rise in the total number of dementia cases over the coming decades, albeit at a far slower rate than before, as the ranks of the elderly grow. Yet there are good reasons to hope that a combination of drugs, vaccinations, lifestyle and policy changes could bend this curve further. It is even possible that the total number of people with dementia may soon begin to fall in rich countries.”
How dementia is being defeated July 9, 2026
GLP-1 benefits cost: “GLP-1 drugs accounted for 11.4% of corporate employers’ total annual claims last year, up from 6.9% in 2023, according to a 2026 survey by the International Foundation of Employee Benefit Plans, a nonprofit. Further, 36% of corporate employers covered the drugs for both diabetes and weight loss in 2026, while 60% covered them only for diabetes, the findings show.
The pullback comes as employers confront faster-rising health costs more broadly. Average health-benefit costs per employee rose 6% last year and are projected to rise 6.7% this year, according to Mercer. The growing use of costly GLP-1 medications is one of the main drivers of the increase, the benefits-consulting firm said.”
Starbucks Is Cutting GLP-1 Coverage for Weight Loss as Costs Climb – Business Insider
Jonathan Eisen, an evolutionary microbiologist at the University of California, Davis on microbiomes: “most of the claims [in this area] are bogus.” Perhaps better to save your money and invest in a jar of kimchi.”
Can you hack your gut microbiome?
Study: Health coaching in post-partum care: “Hypertensive disorders of pregnancy (HDP) affect 10% to 16% of US pregnancies and increase the risk of developing cardiovascular disease. Guidelines recommend that individuals who experience this diagnosis attend a primary care visit within 12 months post-partum to evaluate and manage cardiovascular health.
In this randomized clinical trial involving 140 postpartum women, those who received the health coaching intervention were more likely to attend a primary care visit within the first postpartum year and achieve better blood pressure control compared with control participants who received standard of care.”
Prescription Drugs
International Reference Pricing: “Mandatory IRP is a bad idea because it rests on assumptions that are unsupported by evidence and because current proposals will not reduce drug costs for most patients. Mandatory IRP may appeal to elected officials and program administrators because it appears to address affordability at a time when Americans are concerned about the cost of prescription drugs, health care, and the broader cost of living. Following through on PBM reforms and addressing the unrestrained growth of the 340B Program are more promising routes to patient affordability.”
Myths Of Mandatory International Reference Pricing for Prescription Drugs | Health Affairs
Study: development cost recovery for orphan drugs. Researchers compared clinical trial costs, worldwide revenues, and time to cost recovery for 167 drugs projected to exceed $200 million in annual Medicare spending, classified by orphan status: exempt under the Inflation Reduction Act (IRA); exempt under the One Big Beautiful Bill Act (OBBBA); subject to delay under the OBBBA; and not orphan or not qualifying for exemption or delay. Results:
“94% recovered clinical trial costs within ten years of global launch. IRA-exempt drugs were younger, had lower trial costs but comparable revenues, and recovered costs more quickly than nonqualifying drugs. OBBBA-exempt and OBBBA-delayed drugs did not differ significantly from nonqualifying drugs. Drugs benefiting from orphan protections recovered development costs at rates comparable to or faster than those of nonqualifying peers, calling into question the need to protect blockbuster orphan drugs from negotiation.”
The Economics of Orphan Blockbuster Drug Development | Health Affairs
