Inside the Fight for Price Transparency and Real Healthcare Reform

Welcome back to Patients Win, the podcast where we flip the script on healthcare and put power back into your hands. In today’s episode, hosts Troy Reichert and Dr. Jonathan Bushman are joined by special guest Katy Talento, whose career spans from the halls of the White House to the boardrooms of sharing ministries, and who brings a unique, inside perspective on health policy, employer benefit design, and the future of care in America.

Together, they tackle pressing questions: Why are we sicker, more medicated, and more anxious than ever before, despite unprecedented spending on healthcare? What’s really driving up costs in a system “eating our economy” and “stealing the American dream from the middle class”? Katy Talento shares candid stories from her time shaping healthcare policy in the Senate and advising in the White House, gets real about the dysfunctions she witnessed, and explains how the COVID-19 pandemic sparked a powerful shift in public trust and personal health journeys.

We’ll pull back the curtain on the legislative battles over price transparency, the structural barriers holding back direct contracting and cash pay at scale, and why bold change is finally disrupting the system from both the inside out. Plus, hear Katy Talento’s uncompromising take on how America can reclaim its health and what every patient, yes, you, needs to do to start winning in today’s healthcare marketplace.

This isn’t just about politics or policy; it’s about hope, action, and a community refusing to settle for less. Let’s get started.

Timestamps:

00:00 Introduction to Patients Win podcast

06:09 Joining the 2016 transition team

08:15 Frustrations with Medicare doc fix

10:50 Debate prep for Hillary Clinton

15:40 Becoming a naturopathic doctor

17:58 Trust in primary care growth

20:28 Advocating for direct primary care

25:24 Republicans challenging private industry

29:13 Winning the policy argument

31:45 Major changes in healthcare law

34:28 Challenges with cash pay in healthcare

36:23 Challenges with TPA licensing and systems

42:14 Women's bodies under work stress

43:04 Balancing Medicine with Business Advice

45:55 Appreciating impactful healthcare work

Show Website - https://thepatientswin.com/

Primed Healthcare - https://primedhealthcare.com/

Troy Reichert - Show Host - LinkedIn - https://www.linkedin.com/in/troy-reichert-67606b5/

Dr. Jonathan Bushman - Show Host - LinkedIn - https://www.linkedin.com/in/jonathan-bushman-do-106821191

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_02 0:00

We've never been sicker, fatter, sadder, more anxious, more infertile, and yet more medicated, more treated than any population in human history. You cannot live in an unbiological way that is against the creator's design. We don't see the sun. We don't touch the grass. We live in a cortisol bat. How are we gonna lower healthcare costs? This is a fifth of the economy. It's a multi-trillion dollar industry. It's eating our economy, it's stealing the American dream from the middle class. It's just not a partisan issue. It's like the healthcare swamp versus the rest of us.

SPEAKER_01 0:49

In a system that often feels overwhelming, we're here to share stories, tools, and community showing how patients win. In every episode, we dive into the real-world examples of resilience, expert insights, and breakthroughs that are putting power back into your hands. Whether you're a provider, a patient, a broker, or a planned sponsor, this is your home for hope and actionable strategy. I'm Troy Riker with my business partner and co-host, Dr. Jonathan Bushman, and it's time to stop the madness and start winning. Today we welcome our friend Katie Talenta, who had an incredible background from the White House to sharing ministries boardrooms and university classrooms. Welcome, Katie, to Patience Win.

SPEAKER_02 1:32

Thanks so much, Troy. It's great to be here.

SPEAKER_01 1:33

Well, we have a lot to talk about today, and I know that uh you and Jonathan had some conversation last week. Where do you want to start, Jonathan?

SPEAKER_00 1:39

Yeah, well, I want to dive in. Katie, I mean, he already introduced your time in the White House, and we're gonna get to that, but I kind of want to know your background in terms of your education and what ever led you to decide to get into politics and what did that track look like before you got to where you are today?

SPEAKER_02 1:57

Yeah, so I didn't grow up like wanting to be president like lots of little Washington staffers do. I wanted to change the world and I was gonna be like a, you know, missionary or something like that. And I went to graduate school to study epidemiology. I was gonna like, you know, quarantine towns in Africa and wear spacesuits and stuff. A little time in Africa, I realized these warlords, like, they don't let us do humanitarian aid, and I'm not very good at keeping my mouth shut about that. And I this isn't cut, I'm not cut out for this. I came back to the US and said, all right, I'm gonna work on infectious disease here. And I did, I worked for a big AIDS clinic. We worked on a lot of TB and hepatitis and HIV. I was like the only straight girl at this huge clinic serving gay men. I mean, it was hilarious. But it was great, and I loved that. I still kind of am interested in it, although I think I've uh my eyes have opened up to a lot in infectious disease epidemiology. But, you know, I was just living on Capitol Hill here in DC, which for me was a big escape. I had grown up in like suburban DC and the Virginia suburbs, and I thought it was soulless, and it was just like one strip mall after another, and no town has any character or anything interesting about it. I just could not wait to get out. I think that's probably why I ran away to different continents. But so when I came back, I was like, all right, I'm moving into the city, I'm gonna get a house in the hood, I'm gonna like be Mother Teresa right here. I did a lot of inner city ministry and whatever, but the point is I lived on Capitol Hill and went to church on Capitol Hill. So what do you think is gonna happen? I mean, eventually, like my friends said, hey, these Republican senators that run this committee on health, education, labor, and pension who had just taken over that committee. Hey, we need you to do Public Health Service Act portfolio there because there are no little Republican children that grow up wanting to be public health experts. We can't find one in the whole town. I said, okay, I guess what? I don't know. I remember at my job interview, the guy who was interviewing me like stopped in the middle and said, Do you even want this job? I said, I don't know, not really. And he was our conservative Republican, so that was the right answer for him. He's like, perfect. Yeah, I started there on that committee doing public health policy, and I ended up loving it. I stayed in the Senate on and off for about 12-ish, 15 years. I was literally on and off. I kept trying to escape. At one point, I ran away and joined the nunnery. My sweet senator that I worked for at that time was Dr. Tom Coburn of Oklahoma. And he and I used to like bicker like an old married couple. I used to say that Tom Coburn drove me to the nunnery. But eventually I realized that that too I was not quite good out for. That requires more virtue and self-control than I have, but it was wonderful. Those girls are amazing. I run their health plan today. I got out, I was still on the Capitol Hill, went back into the Senate. I had a brief speechwriting stint for Michael Steele when he was chairman of the RNC. And the RNC powers that be wanted to keep him in line a little more. So they wanted him on script and they hired a speechwriter. So I did his speechwriting. That was the Tea Party cycle back in 2010. And then, I mean, I learned a lot actually about the party apparatus during that cycle because it was kind of shocking how gross they were. But I went back into the Senate working for Susan Collins, like from Coburn to Collins. But we were on, I, you know, there are many issues that I could not advise her on, but I was advising her on issues I could morally advise her on, like government oversight. So I ran the government oversight committee and we did like all this oversight and legislation on her committee. And then some of it was about healthcare, a lot of it was about healthcare. And then eventually I tried to get out again, ran the malaria control program for a little firm that worked for ExxonMobil and trying to protect their workforce overseas. Anyway, so then just when you think you're out, I got married. I'm like, we moved out to the suburbs. I'm never gonna come back into government. I've totally escaped. I'm gonna have babies now. And then, you know, just when you think you're out, you get sucked back in. So I got pulled back in one more time by this friend of mine to work for this freshman senator from North Carolina. And I was there for two years. But during that time, my friend who had recruited me, he left the office and became kind of in charge of policy for the Trump campaign. And the next time I saw him, he was disheveled, chain smoking, sleep deprived. And I was like, Do you need help? I mean, I don't want you to die. Like, what's going on? Can I help you with healthcare or abortion stuff? Or like, what how can I help you? So he pulled me in, like kind of a drowning man, like tries to pull you under, kind of. I started doing healthcare and abortion and other social issues and for the volunteer at first and then paid staff, and we were all kind of holed up in Trump Tower in fall of 2016, then into the transition team, then into the White House. That's kind of how I got there. I think that was the question.

SPEAKER_00 6:43

No, that's great. That's perfect. That's what I was that's what I was curious about. Love the connection to to Senator Coburn, had a great experience with him right about the time you would have been working with him in 2007. Um, I had him invited him as a guest to our medical school to talk about being involved in politics as a physician. I thought, who better than Tom Coburn to tell us that? I'll never forget his visit. Dan Harrigan was this field rep in Oklahoma, had helped arrange the visit. He came in on a Friday, and this was a student-led pack, and he came in and he wasn't rude at all to the administration, but he came in, gave a little wave to the administration, and turned right to the three students that were there, and he spent the next three or four minutes just talking with us. And it was a very, it was a I recognized it in the moment what he was doing. He was like, I know who invited me here, I'm here for you. And that was pretty cool. And then he, you know, he was talking back in 2007 about he pulled out a credit card and like, hey, everyone needs one of these in their wallet. It's preloaded to go buy your healthcare. Yeah. And look where we are 19 years later. We're talking about that exact same thing. I'm sure you remember those conversations with him. Like, we can do this differently. So, but I'm curious, like, along the lines that's you know, going from working with different people, Capitol Hill and different projects and all. What was the time that you realized that healthcare is really has really got system problems at the broader level? What was that moment in time that just really struck you that, okay, wow, this is a much bigger problem than what people realize?

SPEAKER_02 8:15

I remember back in 2014 or 2015, which at that point I was working for my fifth senator and the last senator I would ever work for. So my whole career prior to that, I was not quite as dialed into this problem. But to be fair, I wasn't usually doing healthcare, uh, except that the first or half my career I was doing healthcare, but then you get promoted and then you're doing all the issues and you're like managing, you're a paper pushing manager. But what I really realized is like this is a total waste of our time was when it was like a big fight back then, an annual fight over the doc fix in Medicare every year, where like were we going to like give them their annual exemption from the some law like decades ago that said they had to get, you know, their fees cut. Every year we'd have to like delay that and not do it. And the docs would spend all their lobbying effort and all their lobbying energy on that one issue. Because if they didn't, their pay was getting cut. They couldn't lobby on literally the million other issues that are of equal and you know, to the American people, more important. So it was just such a waste of their time, a waste of everyone's time. And Congress would only do it one year at a time. And I was just like, this is the dumbest thing. And I think that same fight, like there were two fights going on. There was a dock fix fight, and then the same thing, the next the other thing was site neutrality. And the hospitals eventually killed that. So we almost got site neutrality and Medicare in 2015, and then of course the hospitals, you know.

SPEAKER_00 9:47

So when you go behind the scenes, like this is something, you know, your experience is uh I'm really curious to dig into about behind the scenes and while you were in the White House and you're part of the policy team, part of the advisory team. Like, what is that like to be in the position of helping to shape policy, helping to shape even strategy from a party perspective that you hope to be able to take through in a legislative piece? What was the big takeaway there?

SPEAKER_02 10:14

Working for Donald Trump is a different kind of staffing experience than I think most White House staffers would answer. They'd answer your question differently than I am. He really set the agenda. So he would like tweet something and that, oh, this is what we're working on this week. Or he would campaign on stuff. Like I was the health policy advisor on the campaign, and he like could have cared less about anything we ever tried to staff him on. And that is sort of when I first learned that he was kind of unstaffable. But he, you know, I remember right before the third debate, you know, I was also the values staffer. I did like the pro-life stuff and gender stuff. So I did this whole like, which would be radioactive in this debate against Hillary Clinton, right? I did this like 30-page binder with like every possible question you get and all the like pastel, boring, pivot answers to all those questions. And then even though like I was super pro-life and super, you know, could socially conservative, so I was trying to steer him in the right direction, but I knew him and I knew this was the general election, so we had to be a little careful. I wrote like all this debate prep. And then he gets to the third debate and he like stands up in the middle of it and says, Well, you know, I don't know about you, but if a baby in the ninth month of the, you know, third trimester, like that, if you don't think that's murder, then, you know, that's too bad for you. Like I think she's crazy. And I was like, of course, that was nothing that I had written, but I totally agreed. It was like the greatest day ever. But what I learned was, okay, he's unstaffable, but his instincts are typically right. I later learned once I got into the White House that the way to staff him was telling him stories because he remembers stories. It's funny, I mean, I don't know what your audience will think of this, but he every time he hears the word vaccine, literally every time the word vaccine comes up in his presence, he immediately goes to this story about autism. And it's the same story I heard him say it like last week. He's still saying the story about he had this employee, and her son was like this perfect, beautiful two-year-old, and he was amazing, was perfect and nothing. Right. And then he got this vaccine and then he was gone. He was just gone. And like it he'll tell this story a million times. We had all these pharma guy, all these like pharma executives in the Oval Office to so that he could berate them about drug pricing. And at one point, like the word vaccine came up somehow, and all the other executives like just back off and they look at the guy, Ken Fraser from Merck, and they're like, Hey, Ken, you want to take this one? And poor Ken like starts talking about like whatever. I don't even remember. But the president launched into his autism story. Ultimately, it's a story that got him. So whenever I needed him to really remember something or to teach him an issue, like you can't write a memo, you just have to tell him a story about it.

SPEAKER_00 12:54

That's so interesting. That is. It is very interesting. So you were in between like 2017-2019 White House. Something happened in 2020.

SPEAKER_02 13:05

Something.

SPEAKER_00 13:06

That an epidemiologist and infectious disease would remember.

SPEAKER_02 13:09

Yes.

SPEAKER_00 13:10

I think we all the world will never forget for whatever context you want to put it in, but particularly to where you were. You had just left the White House in 2019, and then, you know, here we are in March 2020. That had to be, you know, you've helped the team, you've helped the policy, you've helped bring this forward, and you step out, and then the biggest thing happens. How did that how did you feel in the in your shoes in that moment? And having an inside perspective, but an outside responsibility.

SPEAKER_02 13:38

I mean, certainly for an infectious disease epidemiology, this is like the epidemiologist, this is like a the Super Bowl. This is also the moment like the world learns to pronounce epidemiologists, right? No one ever knew what that was. At first, I was like, darn, you know, what a bummer. Like, I wish I were in there. And now I am so grateful. Like the biggest gift God ever gave me was, you know, not being there and not having the taint of that year one or year, yeah, year one response on my conscience or anyone else's response. So I guess, you know, I wrote an article, like I published an article about how, like in March, in early March, when we didn't know what this was, we didn't know how bad it was, and we were headed toward lockdowns. And the president had just appointed Debbie Burks to like run the White House COVID whatever. And I knew Debbie Burks very well. And I had, so I published this thing like, hey, we're headed toward lockdowns. It's all gonna be like really scary, it's gonna be crazy. Debbie Burks is super awesome and she's gonna like lead us to the promised land. And it's just so funny how my thinking has evolved and over time, because I really woke up to many, many things during the pandemic that I think many of us woke up to. I'm not so sure the scientific enterprise is what we thought it was, and or the FDA approval process or the public health infrastructure, anything about it is not as advertised. And I'm really, really glad for that and really grateful. That year, remember, was also a re-elect campaign. And everyone who was like loyal to the president was inside, right? So anyone who knew anything about health who was loyal to the president was already inside. They didn't have anybody to defend his COVID record for the campaign, except me. I was it that like there was no one else, and that they could book on TV or do anything to defend his record. So I was a surrogate I was doing surrogate efforts for him a lot during that like the fall. And like some of my appearances, I look back and I'm like, wow. Like, oh boy, like what that's a spin. That's a pivot. So it's funny, but I do think that I'm just so grateful for all the silver linings that COVID brought to the world and just the waking up of the average citizenry. Again, not sure what your audience will think of this, but like just losing trust in the white coat religious cult, I think has been extremely useful. And I think it's really put them all on their toes in a way, like some have many have just like retreated into anger and like contempt of the patient population. But but I think many are starting to get a little more humble. And I think we need far, far, far more modesty and humility in medicine. So I became a naturopathic doctor during this time. I like what started my own health journey during this time. My sister, you know, one of the reasons I left was that my sister had been diagnosed with colorectal cancer. I left and she had about six months left. I was able to be with her during that time. I'm so grateful for that. I didn't quite realize why I was leaving the White House when I did. I just knew I was and that I needed to. Obviously, it became clear later. But so go watching her, she was 39, she had two tiny children, watching her go through that, I was like, well, that sure as hell isn't gonna happen to me. It really started my own health journey. I had been on this like, you know, Diet Coke, all Diet Coke vending machine diet, a cortisol bath every day. And, you know, I think that it really opened me up. That time is very precious in my life. I really went down every rabbit trail, changed everything about my life and a lot about what I how I think and what I think.

SPEAKER_00 17:07

Yeah, that's interesting. Very interesting. And thank you for sharing that about your sister. I mean, that we, you know, obviously that wasn't specific to COVID, but during that time, I know it was.

SPEAKER_02 17:18

She died before that. Thank God we weren't like in hospitals with masking and all that. I would have lost my ever-living mind. But yeah, but it was right before she died in October of 2019.

SPEAKER_00 17:27

Okay. Yeah, I hate to hear that. We get into, you know, the COVID era, my perception and experience as a physician, you really touched on it. But and I think Dr. McCary's done a good job at one point saying, hey, the primary word to describe what COVID did to us in healthcare is trust. The US healthcare system lost trust from people. The government lost trust. Our epidemiologists, even though we had a hundred million of them self-proclaimed, lost trust, right? So trust is the language of care in many ways. We think about that in primary care. It starts with trust. And, you know, I actually think that, well, we saw it in in my practice in direct care, direct primary care, while, you know, we were formulating the American Rescue Plan Act to help recover the funds for all the physicians who their fee-for-service income wasn't coming in, right? Our practice actually grew. Everyone else was suffering. And then the, you know, all the government, I hate to call it handouts, but government handouts in that case, we didn't even qualify for because we actually had an increase in our revenue and top dollar. It's because we were so accessible.

SPEAKER_01 18:38

Again, that's what it's all about.

SPEAKER_00 18:39

Speaking of your sister and her diagnosis, there was a woman just maybe a week or two into the pandemic that contacted our office looking for help. I got on the phone with her, went over her hospital records. She'd been in the hospital for like an overnight and they kicked her out because she didn't have COVID, right? And I'm looking at me going, there's something more to this, something more to this. I said, let me go get back. Let's do another CT scan and some more blood work. Long story short, she had colorectal cancer. I set up a surgical consult for her, did a direct admission to hospital, got her all of these services. She had a resection, had her post-op follow-up with me on the phone. This is crazy. Six months later, I go in to see a 19-year-old new patient. And I walk in and sitting there in the room, a lady with a mask, and she goes, You must be Dr. Bushman. And I said, Yes. And I recognize the voice. And she goes, I'm missing. And I was like, This is the first time I met her. And I had done, you know, what COVID did in that moment was we still had relationship and we had trust, and yet all of it was completely telephonic. I hadn't even seen a video of her. And I think it really opened my eyes to what we were capable of doing for people. And sometimes we're forced into it, you know. And you look back at the reflections of the time and you go, okay, yes, if you didn't take the opportunity that COVID presented to you in your particular profession, whatever that may be, to reflect on your values and what you want your life to mean going forward, then you missed one of the greatest opportunities, if you will, of a lifetime. And I love that it actually changed your personal health, you know, you recognize that. But yeah, it's an interesting thing. When we haven't really spent any time on our show talking about COVID, it's just, you know. But it's something that, you know, people kind of in certain ways want to forget at this point. I mean, we're thankful that we're in a different era, but we shouldn't forget it. We should forget what we learned from it.

SPEAKER_02 20:27

So I think that's right. And I often, when I'm in a like open enrollment meeting with people and we've put direct primary care onto their plan and we're trying to introduce it to them, and I have to explain like why and how and whatever, I always put a slide up, a picture of my sister, and I talk about how her story is a failure of primary care. Not that primary care failed her, that she didn't have competent primary care. You know, she had this symptom and then that symptom and then that symptom. And she went to different specialists and she got that symptom treated that was in front of them. And but if you'd had a direct primary care or someone, you know, even a fee-for-service primary care who's like doing primary care rather than just like a high price referral factory that they become, then you would have seen like a textbook presentation of colorectal cancer. And you know, the thing is once you start having symptoms, like it might be a little late in the game. So I don't know if that would have saved her, but it couldn't have hurt. So I think that it's really, you know, direct primary care really speaks to what opportunities were missing.

SPEAKER_00 21:27

Well, and really the experience of healthcare. And granted, thank goodness the experience is different post-COVID in some ways. Yeah. But you've noticed how telemedicine, where it went really high, has already fallen off and then not even been paid, you know, accordingly. It's kind of like we showed the world that we could do it, but then our business model didn't change, and we had to go back to that because that's what was working for all the third parties. And we gotta protect, you know, the control of that. Of course, of course. And speaking of that, I know you were involved in a lot of the conversations around price transparency, and of course, now in your World and brokering and advising. Price transparency is a big thing. But coming from your days in DC in policy, tell us a little bit about the story of how price transparency was making its ramp up there on Capitol Hill and kind of what it actually did versus what it was intended to do.

SPEAKER_02 22:17

Price transparency was never on Capitol Hill. We had to force that. But it was further down Pennsylvania Avenue that it really started. But I think that how it really started was back to Tom Coburn. There is a patient advocate out there, a force of nature named Cynthia Fisher, who you guys probably have heard of or know. Yeah. And she had made this her mission that like price transparency was going to be a thing. And like nobody could get a meeting with me. Like I was just my I was not in control of my schedule. I my friends couldn't even get hold of me. Like, you know, it was just meaning that's just our lives in the White House. And it's usually internal meetings. External people, it's not like we're lobbied all the time the way I was on Capitol Hill, where you're taking a ton of outside meetings. Inside in the executive branch, that's not the case. It was just a ton of internal meetings. Nobody could get like hold of me or on my calendar. And I kind of liked it that way. And she couldn't either. And I I'm not even sure how hard she tried, but she didn't try that hard. But uh she couldn't. And if she had tried, like I wouldn't have taken a meeting. I didn't know who she was. I didn't care. But I was told that Dr. Tom Coburn, retired senator, wanted a meeting with me. Of course, I was like, yay, oh, great. But the only reason I even took the meeting was because she, in her brilliance, had thought to bring him. The two of them were like lobbying me, basically, like, Katie, you have to do this thing. It was uh Dr. Coburn was doing it. He was like, You have to do this, you know you have to do this, really important, blah, blah, blah. And I was like just taking the meeting the way I took many meetings and the way most staffers take meetings when they feel like they're being lobbied or there's a big ask or something. In my head, I was just listening and I was planning how I was gonna say no. And all the excuses and reasons I was gonna say no. Cause we're just so busy. It's not that I didn't believe in price transparency. It was on my bucket list. Like I wanted to do it. It was like on the to-do list, but there was like, we were busy and I just didn't. And then about halfway through the meeting, just something's flipped. Just a switch went off in my head. And I was like, said to myself and had this whole dialogue inside my head, like, why are you saying no? Why don't you stop it? You know this is the right thing to do. Like, figure out how to say yes. I don't know if that was actually me having an argument with myself or maybe it was with the Holy Spirit. Anyway, I was like halfway through the meeting, I'm like, yes, of course we're gonna do this. They were asking us to do an executive order. They had a draft, but at that point I was like, all right. And I started thinking about like, how would I write those drafts? It's not this. How would I do it this other way? So that's really how it happened. That's how it started. I don't know who else Cynthia had been like lobbying. I know that she'd had some other White House meeting with like people that don't do policy. That was her like in at the time. She had met with some people and they had been like, hey, Tom Coburn wants to meet with you. Will you meet with him? God bless him. Like, you know, once Cynthia has your cell phone number, like you never, you're never free again. I remember the secretary of HHS. The secretary of HHS was Alex Azar at the time. And at some point, like he called me to yell at me. No, it was one of his deputies, I think, was like, Katie, you have to get Cynthia Fisher to stop contacting the secretary. Like, she's harassing him. I was like, no. Anyway, so she's just hilarious. But she really is a force of nature. She's relentless. To this day, she's still fighting to get price transparency improved. So, you know, all we did at that time, and it was a Herculean like epic battle inside the White House and inside HHS because most of people there were like sort of anti-regulation fiscal conservatives who didn't want to regulate the private contracts between private actors. And that was their like instinct, which I appreciate. But, you know, we have this in in the Republican Party, we'd have this sort of knee-jerk defense. Started back when we were fighting Hillary Care and like Bernie Sanders. We have this like knee-jerk instinct, knee-jerk defense of private industry and healthcare, even as over the past decade or two, like private industry has become increasingly less defensible. And that knee-jerk should not be so jerk. And I think it's starting to change, right? Like there are industries that we're starting to beat up on in all the right ways. But price transparency really was the first time that it ever happened where like Republicans were taking on private industry and calling out private industry for their corruption. It was really because the president, like, he was just so populist. He was making all of us think populist thoughts and to start adopting populism. And healthcare really cries out for that. I don't know if there are other industries that are equally bad. I would say big ag is one of them, but like definitely healthcare cries out for it. That was really the beginning. And it was led through the executive branch, really through the president, that eventually price transparency found its way to Capitol Hill too. But we did regulations first because they weren't gonna do laws. Like they don't do laws hardly ever. We did regs with the hospitals and then with the insurers. The hospitals sued us twice. They got laughed out of court twice. The insurers threatened to sue us, the PBMs, but I repeat myself, also threatened to sue us. They, you know, the Biden administration then sort of backed down on some of the regs, but for them, but with respect to drugs. But it has been, you know, at the time, people told me, Katie, people are gonna shop. Like price, they price transparency won't change anything. You're stupid. And, you know, I had like economists, like professional economists, like at the Council of Economic Advisors and the National Economics Council at the White House trying to tell me that like gravity doesn't pull objects downward, like price competition won't lower prices. Like, what are you talking about? The arguments I had to have inside the White House, we had to have like a journal club so that I could prove to them that the literature supports like price transparency, lowers costs. It was shocking because healthcare had gotten this like special status. So special, it's such a special industry that it can't, price transparency won't affect it. The whole thing was stupid. But eventually, actually, Marty's book helped. He had a pre-pub of, we had a pre-pub of per version of the price we pay. And honestly, so many people in Washington, like all we know is government programs, CMS, like Medicare, Medicaid, ACA, they don't know employer-sponsored healthcare. That was true for me too. And, you know, and there are lots of structural reasons for that in Washington. Like little healthcare policy stars don't grow up wanting to work on Department of Labor issues and ERISA and work on those committees of jurisdiction. Like those are not the cool K committees if you're in health policy. So then when we get into the executive branch and we have to staff DOL, well, we go to the committees. That's how we find political appointees, but there like aren't any ERISA experts. They're all pension experts, right? So we hire pension people to run ERISA and there's no healthcare people. It's really like a structural problem and flaw in health policy in Washington, is why Washington is not coming to save employers. Like we don't understand you. And, you know, it took me getting out before I really understood employer-sponsored healthcare, but I had an inkling of it a little bit more than my colleagues because I had met with some employers and they were crying. Huge, the biggest, like Walmart, ATT, International Paper. Like they were crying to us, whining and crying that they couldn't get their PBM claims data. I was like, oh geez, what chance does anyone have if they can't? Marty's book actually educated inside White House and HHS and DOL political appointees on how the corruption of healthcare really works. And they didn't know. And it was after that we started winning the argument a little bit more, and then finally had to do some like theatrics and guerrilla warfare to get the president to put it in this state of the union speech. And after that, the argument was won. Thank God. That's really how it happened. And it's not, you know, patients were never the intended audience for price information, at least not right now with our current system as it is. I dream of a future where that will change, but patients were never the audience. So when we get these arguments like patients are gonna shop for healthcare, you know, like, no, they're not the audience. Employers are the audience, you know, and now we're starting to see vendors using that data, trying to like pour through it and make it usable. And it's starting to work. There are some vendors that are managing to make this usable so that and actionable so that we can choose which network and you know, whether a direct contract is fair or not.

SPEAKER_00 30:04

You know, to your point, too, Katie, that's that's phenomenal detail on the price transfer. I didn't know a lot of that stuff about the history of that. I mean, I was watching the headlines, but not knowing what's going on. But I started my practice in 2019, and just a few years later, I had a visit with a hospital CEO about what I do. And there were a lot of questions. No, no, no, there were a lot of questions. I was like, look, I think people should, this is after the price transparency talks and the regulations. And at some point, he sort of cut me off and he's like, I don't really get why price transparency is like that big a deal anymore. I mean, all of our prices are listed on our website. And I was like, oh, okay. Have you looked on your website for those prices? Well, no. And I was like, they're not that easy to read. And by the way, you know what a CPT code is, and that makes you part of the 1%.

SPEAKER_02 30:52

The 1% of the 1%.

SPEAKER_00 30:54

The 1% of the 1%, exactly. So I'm like, you have to know the C you have to know what a CPT code is. Then you have to know what procedure you're actually getting to truly pro. I was like, no, that's not a good excuse.

SPEAKER_02 31:05

And it has to be like not lying lies that you put on there, which it usually is. Yeah.

SPEAKER_00 31:10

Right. And then we went one step further. Well, but people should know what their benefits are. And I'm like, again, 1% of people could state their benefits to you. They might know one part of the benefit. Well, I have like a$20 copay. That's what I know. Or I know that my deductible is such and such, but they have no idea. No idea what's in there in terms of the detail. You're right. Employers truly are the ones, and I think in a good way in the driver's seat, right? I think it's a good thing. You know, if we sit back and wait for DC to bring the change that we're all looking for in the employer space, you're right. It's not coming.

SPEAKER_02 31:45

I will say that like things have kind of changed just this year. So there was a law passed like a couple of months ago as part of the big budget bill that like literally burns down the PBM business model, like to the ground in ashes and salts the earth with its ashes. Like I don't know what's gonna happen, but I can't believe it. And then at the very end, it says like, oh, and maybe we should do this with TPAs too. I was like, well, like it is shockingly disruptive. And I don't think anyone has gotten their head around that yet. And it is the greatest thing ever. So I think the days of like I remember when, you know, healthcare, it used to be like this shirts and skins, like Democrats versus Republicans. And we would fight over like coverage, like who gets it, how much it costs, what it covers. Now it's just not a partisan issue. The healthcare swamp versus the rest of us. That's it. And all these reform issues are like 90% issues. The I one that's one of the things I loved about price transparency is like nobody can argue against it, even the ones that really want to. They can't do it prep. The greatest issue. So all these issues, and I do think there are some policies that would really help employers with respect to blowing up some anti-competitive tech provisions between networks and doctors and networks and employers. But the DOL could do that on their own. We could have regulation, and more importantly, DOJ could do that because I think these are already illegal under the Sherman Antitrust Act. DOJ is starting to get a little bit more aggressive just this year in like taking on hospitals for being shady anti-competitive actors. I think they're looking at like the lower priority contract provisions and not higher priority contract provisions that say, like, hey, you can't just pay cash and you can't contract directly if the patient has our logo on its card. But I think that they're these days are coming. I think the days of the current business model for everyone involved in the healthcare industry, except maybe you guys, are are numbered. And we're starting to see like it starts slowly and then all at once, right? And I think we're starting to see the all at once. So I'm kind of hopeful.

SPEAKER_00 33:47

No, I love it. So I mean, you've given us a little bit of optimism there. What other things do you see from the employer benefits perspective?

SPEAKER_02 33:53

Like, what are some of your most exciting things that you see on the horizon in addition to what you just Yeah, I think the thing that I'm most excited about right now is the small but growing efforts to do cash pay at scale. You know, for many, many decades. Well, not many decades, like two decades, Republicans have been like, HSAs, that's the secret. That's the answer. And which of course, voters only hear as Republicans just want me to save more for healthcare. That's their answer. Like, we lose elections every time we like say the word HSA. But anyway, like I'm not opposed to HSAs, obviously. I think they're great, whatever. I don't think they are in any way going to transform anything yet. And the reason for that is because like you have to have a high deductible health plan, which means you have to have a health plan, which means the rate you're paying with that HSA are the plans crappy, negotiated rate. Like what? And if you pay cash, then that doesn't get applied to your deductible. So how is this going to change anything? Also, the idea was that the more people paid cash, the more there would be price competition and there would be downward pressure on prices. And that therefore HSAs would like change the world in lower prices. The cash pay market is not going to change anything as it is today. There's only like uninsured moguls that pay the cash price and healthcare sharing ministry members, which is, you know, about a million people. And actually, not even that, because uh more than half the ministries use the network, not the cash price. So, anyway, I think that like the future that we all want where there's like a single price and you can pay cash, or your employer can pay cash for you, or you can pay cash for it out of your HSA, like whatever that future utopia state, which I would argue is the holy grail, like was never gonna happen until employers started paying cash, because that's the only way we scale cash pay enough that providers will compete on the basis of their cash price. Right now, they don't have to compete on the basis of their cash price. And if we were to like do things that promoted cash pay right now, like they would just say, yeah, our cash price, it's our sticker price, right? Like that's all they have to do. And then that's the end of the conversation, right? So, and that's what many of them are doing in order to like get around, you know, some shenanigans that are happening to try to pay cash more. But what I'm seeing is the underground railroad here to like the cash pay future that we all dream of is starting to be built. And one of the major obstacles to that was that like TPAs can't handle it, right? Like they're not built. Absolutely. Every vendor out there that's like negotiating direct contracts, right, Tory Record, is like, hey, we have to like get a TPA license here because we can't get a TPA to like adjudicate our bills and claims and pay these providers directly that we have this contract with. We certainly can't get cash pay to be done by a TPA. Like if we just want the patient anyway. So, you know, it's not that they didn't want to, it's just they weren't set up for that. They're set up using these like dinosaur claims adjudication and processing systems from like way back. And if you try to customize those, good luck, you're in a queue, you have to pay like a thousand bucks an hour to coders over there, and they have like 80-year-old coders because no new software developers are going into, you know, how to fix VBA or whatever, right? Claims analytics processing play. So this is all like nobody's fault, but it is a logistic obstacle that had to be overcome. And we are starting to see like, now we have TPAs that are being built on Salesforce. Now we have TPAs that are starting to like try to figure out how to let their plan sponsor employers pay cash. Those logistical barriers are being burned down very slowly. Like I know of two or three TPAs that are able to do it now. We're working with them. But so we're bringing this, you know, more and more into our field. But those logistics can be overcome. Then you have the contractual problems, right? Like I alluded to earlier. Patient walks in with a Cigna ID card on their, you know, logo on their ID card. Now the doctor is under contractual obligation. I would argue illegal, antitrust violating, anti-competitive contractual obligation to only submit that claim to Cigna and or to the EDI that's on that card. They're not the only ones, right? The employer is also in a contract with Cigna, either directly or through their TPA, independent TPA, which is offering them access to rent the Cigna network. So now you've got like the TPA's contract, you've got your own contract. It's all, this is all not allowed. In fact, we have to submit a list of exceptions to that contract. Every time we use a Cigna contract, we have to submit a list of exceptions where we're not gonna use the network that we already know about. We have this direct contract, I have this imaging vendor, I have this, and they get to approve or disapprove each one of them. If they say no, you can't use green imaging for your imaging services, we can't. And they do say that. Then we're just like, that's too much straying off the plantation if you're gonna do it for all imaging. These contract provisions, I would argue, are unenforceable, illegal, and DOJs should take a hard look at them. And only when that happens will we be able to like truly cash pay, because then you can have your network as plan B and direct contracting and cash as plan A. Right now, you can't really do that without a lot of underground activity. So, anyway, that's what I'm hopeful about because I'm seeing signs of it. I'm seeing signs of it right now. You know, people are building that underground railroad. I think there may be some policy eyeballs that are on this problem as well. So we'll see.

SPEAKER_01 39:17

You know, Katie, it's so interesting you say that about TPAs because I'm actually working with a sharing organization right now, and that is their biggest frustration. They have direct contracts, they're steering their members there, and they can't find anybody that can adjudicate the claim. They're actually talking about starting their own TPA that is the new age, the next generation of a TPA that can take cash and pay cash and account for it. So that's exactly right.

SPEAKER_02 39:41

That's exactly right. I'm on the board of a healthcare sharing ministry as well. I ran the trade group, their trade group for six years until recently. And it's a huge problem. And they are wonderful innovators who could actually solve this problem. Healthcare sharing ministry, like, we need to look to them. Like, y'all lead the way because you're the only ones who can. So I hope that they start to build this, scale this solution, this cash pay solution more broadly.

SPEAKER_00 40:04

So, what do you feel like needs to needs to change for patients to win consistently in this current environment?

SPEAKER_02 40:10

Don't be a patient. You know, I think that don't get sick.

unknown 40:17

Yeah.

SPEAKER_02 40:17

I think that Secretary Kennedy, well, before he was secretary, I think it was during his confirmation hearings. He was asked by, you know, some senator, how are we going to lower healthcare costs? And he said, need less healthcare. He's a hundred percent right. Like that is the only hope here because we're going at a trajectory. This is a fifth of the economy. It's a multi-trillion dollar industry, it's eating our economy, it's stealing the American dream from the middle class. Like, this is not sustainable. And what is not sustainable will not be sustained. You know, I don't like Medicare's bankrupt in like six years, you know. So if we don't get our own health and our extinction level chronic illness problem under control, we are going to fade away as a society, potentially as a species. I mean, if you look at our extinction level infertility rates and our sperm count decreases over the past generation, you know, uh we I am not exaggerating when I say it's extinction level. We've never been sicker, fatter, sadder, more anxious, more infertile, and yet more medicated, more treated than any hit population in human history.

SPEAKER_01 41:16

We're sicker, but we're not getting any better because of all the medications. It's not working.

SPEAKER_02 41:20

Well, and it's not, yeah, it's not even the medication's fault. I mean, they're terrible or whatever, also. But like you cannot live in an unbiological way that is against the creator's design. Like, we don't see the sun, we don't touch the grass, we live in a cortisol bath. If you think about women, we are like, we the fuel of a woman's body is safety, right? Like it is biologically designed for that. Like if you're not safe, there's no reproduction going on, there's no digestion going on, there's no like detoxification going on because you're being chased by a bear. So as soon as the bear is either dead or eats you, then your body can turn back on all those things, right? But until then, it's not gonna. Well, the bear is our Instagram account and the bear is our marriage, and the bear is our job that like is totally unbiological. Like, women are not built to go to work every day in a cubicle and never see the sun or their children or anyone who loves them and to be in this competitive, combative like environment all the time. Like, of course our bodies are gonna shut down. Like, you can't live in its cortisol bath. That is what we're doing, and therefore our bodies are like in complete meltdown. And it's obviously not just women, but I think women's bodies are uniquely designed to like only function in a secure environment. And nothing about our lives today signals to our cells that you're secure. Preach.

SPEAKER_01 42:46

Our next program, I think, we're Katie. That was just the intro. Thank you for it.

SPEAKER_00 42:52

Yeah. No, I think I mean, wonderfully said, Katie. A little, it's a lot. It's and it's true. And it gives me pause because I think about how often, well, daily, I'm having similar conversations with my patients. I had one just yesterday, business owner talking about some of those very things you were just saying. And I'm going, and they're asking, should we run this lab? Should we do this med? Should we do that? And I go, you know, let me pause as a physician for just a moment. I'm gonna turn business consultant for you and just friend, and let's just talk about what your life looks like in your business in your day-to-day life, because I don't think there's a medicine, I don't think there's a lab test that shows what's wrong, and I don't think there's a medicine that fixes any of it. And that to me, that's how my I make sure that my patients ultimately win in the conversation is I have to think big picture because you're right, it's so easy. And if the business model is going to incentivize me to do the easy thing, which is actually to order the lab because now I've done increased medical decision making, or prescribe the med because I've done increased medical decision making, or I've identified three new diagnoses which when you put them all together are. Actually, just symptoms of an overworked person who's overstressed and trying to manage their marriage, their kids, and their business. That's what the real story was, right? Rather than here's the three diagnoses, and now you're at level four and I've done these labs in this med and I'll see you back. And we'll do the same story here in a few weeks. Right.

SPEAKER_02 44:20

That's exactly right. That's exactly right.

SPEAKER_00 44:21

I mean, the business model tells you that in fee for service. That's what you're incentivized to do. It doesn't make the people doing it bad, but man, that is I I'm just reliving my past as I'm thinking about this of how often that was just like 25 times a day, you know. And I just don't do that anymore because I'm like, no, that's not the story. That's not the problem.

SPEAKER_02 44:41

Well, you're a doctor, and the Latin word for doctor is teacher, or the English word for doctor is teacher, not prescriber of symptoms suppressing drugs and cutter opener of, you know. So but those are the tools we have in the so-called practice of modern medicine, which is drugs and surgery, and you know, maybe some procedures there that aren't drugs or surgery, but this is not what's making us sick. Like we're not born with a, you know, like a rheumatoid arthritis drug deficiency. You know, we're not we're not being born with these deficiencies or like, oh, if only I had, you know, a hypertension drug. And you think about like the things that the diagnoses that we have, which are basically like just descriptions of symptoms, you know, inflammation, hypertension, insulin resistance, these are all symptoms. They're symptom, symptom, symptoms. That's what your body does when it's overstressed. I just like and yet we call these like a diagnosis and we have a bunch of drugs just to suppress them. But like then what is your body gonna do when it's needing to say, you know, what else, what other processes get turned on, like cancer? You know, anyway, I just think that what you're doing is right and it's it doesn't look, it probably feels a little incongruent because it's not like, hey, this is not exactly what the practice of medicine is, but like let's remember doctor means teacher.

SPEAKER_00 45:55

No, I appreciate that. And I appreciate the work that you're doing. Love the history, love where you've been and how that has influenced you into now the role of really working with employers, working with other advisors to find solutions that truly help patients win. And appreciate the work you're doing, appreciate you joining us today. It was a wonderful conversation. I like you getting fired up. I was I was thinking, man, we might be going somewhere here. That's great. Thanks again, Katie, for joining us. Thank you for the the hard work that you're doing to play a part in this this big system of of change right now. And I love it. Stay true to yourself. I know you will. Wish you the best in in your endeavors.

SPEAKER_02 46:29

Thanks so much, you two, right back at both of you. Thank you.

SPEAKER_01 46:32

Yeah.

SPEAKER_00 46:33

And we'll have you on again for sure.