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Where we share our weekly news debriefs and discussions with industry experts. These are lo-fi recordings aimed at giving our readers more opportunities to engage with our analysis and a view into some of the conversations that shape it.
Martin: I'm excited to welcome
our next guest, Natalie Davis.
She's CEO of United States of Care, and
United States of Care is a prominent
research and advocacy organization
focused on healthcare affordability.
Natalie, welcome to the show.
How are you today?
Natalie: I'm doing well, thank you.
Thanks for having me.
Martin: We're so excited to have you.
So it has been already, I know it
feels hard to believe that it's
already almost election season.
Again, healthcare affordability
is on everyone's mind.
You just released, your organization
just released a poll mm-hmm.
Of morning consult.
I was wonder if you,
um, walk us through the
headlines on that poll.
Natalie: Sure.
So lemme just give you the five
seconds on United States of Care.
We are a policy and advocacy
organization, like you said, um, working
to make healthcare more affordable
and accessible for all people.
What makes us unique though, is that
we actually go out and talk to people
across the country to understand
what they want out of the healthcare
system, what they hate, what they
love, um, solutions they want, uh, what
they want policymakers to focus on.
And that drives our
advocacy, um, policy agenda.
So we've talked to over 30,000
people across this country.
We have a data warehouse that houses
quantitative and qualitative data
to trust, to understand things
like primary care, to trust, to
value-based care, um, et cetera.
And every time we talk to people,
the number one issue that they bring
up, like you said, is affordability.
Um, it is the buzzword of the
moment, but it is something we've
been hearing since we launched the
organization just eight years ago.
Um.
And it isn't, affordability isn't
just about affording the healthcare.
Of course, that is one
of the main concerns.
Of course, it is one of the number one
drivers of medical debt, but it's also
the emotional, um, uh, weight that
the worry about affording something,
um, really, really puts onto people.
They're, they're worried, they
can't afford their healthcare.
They're up in the middle of the
night, they're foregoing care, um,
or choosing the health plan that may
not be best for them because they're
worried about, um, what they can afford.
Um, and so we wanted to really make sure
that this, um, while it is the work that
we do across the country, really make
sure that this is top of mind for policy
makers as they, as we move into midterms.
And it was gonna start planning for 2028.
And like you said, um, we
just released this poll where.
Not surprising, but great
to put numbers behind.
71% of people agree that healthcare
costs are unaffordable for people.
Um, you know, we've talked
to people across the country.
A man in North Carolina told me about,
um, an infected injury he had on
his hand that he didn't go get, um,
treatment for because he was worried
about costs and it went septic.
We hear about these all the time when
we talk to people, and it is something
very much that they want leaders
to, to focus on and make sure that
they themselves, their health is put
forward, um, before we think about, you
know, profits or other aspects of what
makes healthcare so, um, expensive.
Kevin: Natalie, as we listen to healthcare
conversation in DC across states, there's
a whole host of policy topics that
get bantered about for payer provider
leaders, uh, price transparency, uh,
site neutral payments, things like that.
I saw a chart at the end of the,
um, the document, looking at public
sentiments across some of those kind
of commonly discussed topic areas.
I, I'd be curious how you're,
how are you framing up what those
concerns look like for midterms?
How do you think they will
impact the discussion?
Come, come this fall?
Natalie: Yeah, I think
it's a great question.
So it's very clear from the
polling that people want Congress
to focus on this, that they want
their leaders to focus on it.
69% of people agree that
Congress should ensure affordable
healthcare for everybody.
76 believe that a candidate's position
on healthcare costs is gonna help them
know who to vote for in the midterm.
So these are serious numbers.
These are things that people are gonna
want politicians to, to take serious
and talk about on the campaign trail.
Um, as you said, they're also very
clear on the solutions that they
think, um, could, could help make
healthcare more affordable for them.
Um, these are targeted changes
that we see strong political
support for across demographics.
So, you know, anywhere from.
Liberty prescription drug costs at
64% of people, um, 63% of people
requiring hospitals to post prices.
Um, as you said, facility fees
for non-hospital, um, settings.
And those fees that people are getting
more and more now in the mail at 62%
banning debt collection for hospital
price, um, violations, um, you know,
blocking anti-competitive mergers at 53%.
So we we're over half of people that are,
that have been surveyed believe that these
sort of solutions are what they want.
And I think our message to
policymakers is this is a real issue.
Um, it is, it is quat to call it a
pocketbook issue or a kitchen table
issue, but it really is what is on
people's minds and they're gonna vote
for, for who they think will take
on these issues, um, and, and really
make progress for the individuals.
Martin: It is always hard to
get anything done at the federal
level during a midterm year.
I saw that United States of Care,
Bryan: mm-hmm.
Martin: Recently announced the
Red State Affordability cohort.
I'm curious to get your kind of view
of what's going on in the states
and how that's breaking down red
versus blue and a little bit more
about the, the affordability cohort.
Natalie: Yeah, so, um, this is our Red
State, um, cohort, like you mentioned.
So United States of Care has been working
at the state level on affordability,
policy and advocacy since we started,
like I said, eight years ago.
Um, and we see states across.
The political spectrum and legislators
across the political spectrum,
taking on these affordability issues.
Our organization working in
partnership with, with local, um,
advocates and legislators, et cetera.
We've passed affordability laws,
um, 22 bills in nine states,
impacting 26 million people.
So there is a lot of experience that
we have had out in states that Congress
can look towards and others can look
towards of where we can make change.
We very specifically, like you just
mentioned, recently launched a Red
State cohort, which, um, we were able
to work with local partners to really.
Build infrastructure in states
that haven't yet tackled
these affordability issues.
Um, working in conservative political
environments where some of, um,
where individuals are facing some
of the most urgent challenges.
Um, these solutions are broadly
bipartisan, supported by voters.
We're able to show that through our
polling that we do in each state.
Um, and, you know, red states are, um,
uniquely positioned to work on this.
They have a history of pma
pragmatic, fiscally conservative
policymaking that, you know, brings
a strong foundation to action.
And we're here to make sure that they
can continue or take on new issues.
Um, and, and you'll see, we will show that
action is, is possible in these states
and that policy makers at the national
level can also take on these hard issues.
Just like you guys were just talking
about Chris Klo and others who we,
we know well, there's, there's a
lot of work that, that across the
political spectrum people can take on.
Kevin: Natalie, one of our favorite blog
posts recently that we've discussed a
lot, uh, in the community is Z Emanuel's
conversation around what we need to
sacrifice to reduce healthcare costs with,
Hmm, as I interpret it, general, general
thesis being, you know, all the various
constituents in the industry tend to think
about like, what, what I need more of to
do more of the good that I'm providing.
I need more rates, I need more
patent protection around my drugs.
I, I need these things.
But his takeaway is then to get
healthcare costs from 18% of GDP
down to a more reasonable number.
We're all gonna have to stack our
hands and collectively agree on
something that we are willing to
sacrifice, not what we need more
of.
Mm-hmm.
Um, that, that seems both directionally
like the right path to head to me, but
also a particularly challenging one from a
political perspective because it requires
everybody giving up something, which I
don't think folks tend to like to do.
Natalie: Yeah, I,
Kevin: I would be curious how you think
about that particular, particularly
when juxtaposed with the seeming
desire for incremental change.
Mm-hmm.
Um, as I, as I think about it from,
from reading the results of your poll,
how do you think those two concepts
get layered together in terms of.
What various constituencies are willing
to, to sacrifice potentially or give up in
order to reign in affordability, spending
access to care, quality, et cetera.
Natalie: Yeah, it's a great question
and I have like so many thoughts,
um, running into my head because,
um, one of the things that people are
starting to talk about more, but we've
done a lot of research on is trust.
Mm-hmm.
And why people have or do not
have trust and where trust
is actually being moved to.
Um, and when we talk to people about
the healthcare experience, there is a
boiling anger about how much they believe
profits are made off of their backs.
Um, that they do not think the
healthcare system is there for them,
that they know when somebody is,
when they, when something is billed.
It is not necessarily for better care.
It is because we have a for-profit
system and I'm putting No, no, um.
No judgment on the concept that we
do because it is the, the, you know,
healthcare system that we have created.
And yet people are feeling like
more and more they are not that
this, this healthcare system is not
there for them and it's making them
really mad, um, and really demanding
the change we just talked about.
It is also becoming extremely
dangerous in some ways.
We saw, of course, the horrible mor
murder of the United Healthcare, CEO.
I don't know if you guys saw the stats.
I think it's something like 40%
of people polled under the age
of 18 said that was acceptable.
23% of adults said it was acceptable.
And, um, a plurality of those
were Democrats who my guess is
likely believe in gun control.
So there is a undercurrent of real
anger that if something is not changed,
when it becomes, when affordability
and trust all come together, that
there is, um, there, there are really.
Um, you know, bad, bad outcomes
for individuals and can be very
deadly or unhealthy, um, outcomes
for our country or for individuals.
And so when you ask that question, I
think we need to be taking, the healthcare
system needs to be taking a look much
more closely at what they can do and wanna
do and not hold onto entrenched grounds.
And with the same talking points
that have been used by, in
different parts of industry forever.
I think one of the hard parts is that
my theory is that like we have had
this pie, um, and that we talk about a.
You know, nobody wants to have smaller
pieces of pie, but I think the pie slices
are so thin now that nobody actually has
the levers that they need in order to,
in Im impact the change that they want.
I talked to a Blue Cross Blue
Shield, um, insurance company, and
they wanted to take on prior auth.
They, as an organization,
they wanted to take it on.
They would've had to cancel like 20
different contracts and eat the, you know,
eat the cost of, um, canceling those, et
cetera because of all of the ways that all
of the middlemen and all of the different
processes and companies that are involved.
And so I think one of the biggest
problems, one big problem to add to what
you said and Zika is talking about is that
the pie slices are so thin that it's hard
to give up anything, but nobody really has
the control to have the impact that even
if they wanted to, that they could do.
Martin: Yeah.
This has been super helpful.
The poll is great.
We link to it in the comments.
If folks wanna learn more about
United States of Care, the advocacy
work that you're doing, the research
that you have, where's the best
place for them to, to find that?
Natalie: Yeah.
Come on over to United States of care.org.
You can, um, sign up for, I call
our award-winning newsletter,
even though it's one no awards.
It, it will one day 'cause it's a great,
um, very useful into your email box
every, every couple weeks with some
great information on what's happening
in policy and talking to people.
Um, you can find me on
LinkedIn at Natalie Davis.
Um, otherwise we'd love to hear from
folks and, and thanks for having me on.
Kevin: Natalie, can I sneak in?
Can I, can I sneak in one more
Martin before we let you go?
Yes.
Natalie: I,
Kevin: um, on the topic of trust, you got
me thinking about the conversation that
I hear all the time about AI these days.
Mm-hmm.
And in our circles we're tracking
along with various policy, uh,
decisions on how AI is being used
from a care delivery perspective.
Yeah.
There's a lot of conversations
around how payers are, are using ai.
There's the why wiser program
and prior auths and, and whatnot.
Um, how do you see that showing
up in these results at all?
Yeah.
In the conversations you're having
qualitatively or quantitatively
and potential impacts this fall.
Natalie: I'm so glad you asked.
And it is a place that we are
doing research on, um, and should
have something later this year.
We did a poll about a year and
a half ago on it, but we know
things change so rapidly and we're
hopeful that we can have an AI and
trust poll annually going forward.
Um, and you know, it's really interesting.
People are very torn, like 50% of
people are optimistic about AI in
healthcare, and 50% are very concerned.
And um, and when we talk to 'em about
what would make them more interested, the
concept of like, I need to trust it, which
means it needs to be transparent to me.
I need to know when it's, when
it's coming, how it's being
used, where my data is going.
We'll see if that changes over time
because we know people also are
going to chat GBT and otherwise and
using it on their own and putting
very personal information in there.
Um, we put five use
cases in front of people.
Um.
To see where their comfort level
was with AI and, and healthcare.
Um, and most people are like,
yeah, right on for back office,
you know, um, back office work.
Um, more interested, I think if I were
to tell anybody, if you wanna talk to
patients about AI and why your provider's
using ambient listening or otherwise,
like more time with their doctor.
We hear this all the time in our, any
lots of different polls or conversations,
is if you are bringing back a trusted
relationship that they had with somebody
where they are then having face-to-face
conversations 'cause there's ambient
listening or an email is better written
with more clear information for somebody
coming out of appointment through ai.
I think right now where the public is,
is they want the transparency into it.
Um.
And how people are using it are
really showing the places where
healthcare is breaking down, right?
Navigating bills, understanding,
um, lab results, uh, helping
pick the right health plan.
So I think there's a way if done
well, where patients are being asked,
what problem can we solve for you?
Um, that AI could have a benefit.
And my last is if, if you know of
anybody who's making an AI company where
it's actually bringing affordability,
making healthcare more affordable for
people, I'd love to hear about it.
'cause I haven't yet.
I ask this all the time.
And, and so far those savings,
if there are any, seem to accrue
to the system and not people.
So that would be a huge proof point.
If we can show that this
benefits people in that way,
Martin: we will keep our ears open.
Okay.
I do not have one for you off the top of
my head, but we'll keep our ears open.
Natalie, thank you so much.
Let us know when you got the AI poll
and we'll back to chat your time today.
Natalie: Thank you.
Have a day.
Bye.