December 10, 2025 • 27 mins
In this episode of Main Street Matters, Elaine Parker and Alfredo Ortiz sit down with former Congressman Dr. Tom Price to break down the growing healthcare crisis facing small businesses. They discuss skyrocketing health insurance premiums, the promise of association health plans, the powerful role of pharmacy benefit managers (PBMs), and why Congress must shift its focus from political gamesmanship to real solutions. Dr. Price shares his insider perspective on how market-driven healthcare reforms can lower costs, expand access, and give small business owners the relief they need.
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Speaker 1 (00:08):
America is home to thirty three million small businesses, the
beating heart of communities across the country.
Speaker 2 (00:15):
And prove that the American dream is still alive.
Speaker 1 (00:21):
This is a show about those dreamers and doers and
the communities they serve, their real life stories, their struggles
and successes, their grit, determination and passion, and the people
who fight to.
Speaker 2 (00:34):
Keep their American dream alive.
Speaker 1 (00:36):
I'm Alfred Ortiz, I'm a Lane Parker, and it's time
for another episode of main Street.
Speaker 2 (00:42):
Matters, America's Small Business Megaphone. Hi everybody, and welcome to
another episode of main Street Matters, America's Small Business Megaphone.
I'm a Lane Parker, the President of the Job Creator's
Network Foundation, and.
Speaker 1 (01:00):
I'm Alfred Ortiz, CEO of Job Creators Network.
Speaker 2 (01:03):
Small businesses are being crushed by skyrocketing healthcare premiums, but
Congress now has an opportunity to pursue reforms that will
lower costs and expand choice. Today, we are joined by
former Secretary of Health and Human Services, doctor Tom Price,
to break down what some of those ideas could be.
Welcome to the show, doctor Price.
Speaker 3 (01:24):
Hey Alane, thanks so much wonderful to be back with you.
And with Alfredo and jacn and just support so much
the incredible work that y'all are doing. So thanks so
much for the opportunity to be with you.
Speaker 2 (01:35):
Well, we've had a long partnership on healthcare, which we
appreciate so much from you and the work that we've
done together. But you've been in this fight for a
very long time when you were on the hill as
in Congress, and we've just come out of a forty
three days shutdown. The Democrats shut down the government because
of the fight over the enhanced Obamacare subsidies, and as
(01:59):
part of that agreement to reopen the government, that vote
on the subsidies is taking place tomorrow Thursday, and so
some of the the Republicans have put forth an idea
as well, So there'll be two bills voted on. It's
my understanding that neither of the bills will probably pass.
(02:21):
But what are your thoughts on what the Republicans have
put forward for a counter bill.
Speaker 3 (02:27):
Well, every one of the gray hairs on my head
has come from fighting this for health reform for the
past decades. The challenge that we have is that most
often in Washington, nobody truly addresses the root cause problems
that that that that exists, the root causes that that
have created this difficulty, and so many people having health
(02:51):
coverage and health insurance that's just basically unaffordable for them
or it doesn't do for them what they want. So
from from Democrats standpoint, what they want to do is
just continue to throw.
Speaker 4 (03:02):
Money at the at the at the at the.
Speaker 3 (03:04):
Problem and allow individuals to buy into or to get
some kind of coverage that likely doesn't solve the challenges
that they have. From a Republican standpoint, it's usually that light.
And and so I don't I don't. I think you're right.
I doubt that either of them will will get the
votes needed to pass. And I don't think that the
(03:24):
Republican plan and the Senate could actually pass the Republicans
in the House. But what we need to do is
to look at truly the causes of why we find
ourselves in the challenging situation that we do from a
health standpoint, and address those causes. And they're relatively easy
ways to do it, as both you and Alfredo know.
Speaker 4 (03:45):
Yeah.
Speaker 2 (03:46):
So, I had an off ed earlier this week in
the Orange County Register talking about some of the ideas
and that Congress could use to reform Obamacare. One of
those ideas is association health plans, and we've worked together
on this issue before. Talk to us about what association
health plans are and the efforts to get them passed.
(04:11):
I know you've worked on this in some bills in
Congress when you were there, and we've worked together on it.
Talked to us about what association plans are and what
they could do for our healthcare system.
Speaker 3 (04:21):
Yeah, I mean, it really is an important point and
question because the folks that are challenged most in our
system right now. Everybody has challenges, but the folks that
are challenged most are those that aren't getting their coverage
through their employer. The employer covered Employer sponsored insurance is
the way that vast majority of Americans gain health coverage.
(04:42):
It's about one hundred and sixty hundred and seventy million
individuals who get their health at coverage through their employer. Now,
when you go way back and see well why is it,
Why is health insurance hooked to the employer, It goes
all the way back to World War Two and the
fact that the federal government had to decide at that
time whether to try employers providing health coverage for their
(05:03):
employees as a taxable event or a non taxable event,
and they chose to treat it as a non taxable event,
which means that employers have a tax incentive to provide
a health coverage for their employees. However, that only works
mostly for the largest employers. If you're a small employer,
(05:24):
if you run a small business, if you've got just
you and your spouse, or you and some friends, or
up to ten twenty thirty individuals in your company, the
likelihood is that you can't afford health coverage for your employees.
So those individuals are thrown into what is called the
individual market trying to find health coverage for themselves and
(05:45):
for their family. Then they can actually afford because it's
not pool resources that are purchasing that coverage, the costs
are oftentimes astronomical. Association health plans address that by saying, okay,
if you don't. If you don't, if your employer doesn't
provide coverage for you, you ought to be able to
(06:05):
pool with other individuals who are in an association or
together linked together solely for the purpose of purchasing health coverage,
and then you gain the kind of numbers that are
able to drive down costs for health health coverage. It's
an incredibly powerful idea. Association health plans have been uh
have been you, We've tried to get those passed in
(06:26):
Washington for years. Individual health plans is another opportunity for that.
When you and Alfredo and I worked on this a
number of years ago, we call it personal health management accounts,
which gets away from the stigma that some folks have
for ageps or association health plans, but at all, the
(06:47):
core of it is to allow individuals who are not
necessarily associated economically in any other way other than wanting
to pool their own resources to purchase health coverage together.
Speaker 1 (06:58):
Now, mister Secretary, you know we're in DC right where
everything seems to make sense. Of course, but Obamacare was
regulated out or Obamacare cares regulated out ageps out of existence.
Speaker 4 (07:13):
Basically that's right. Why is that?
Speaker 1 (07:16):
Because it obviously seems to make sense.
Speaker 4 (07:19):
Is a great idea.
Speaker 1 (07:19):
We'll probably have a huge opportunity for small business owners
to actually help their employees out the way they want to.
Speaker 4 (07:26):
Why did Obamacare do that?
Speaker 3 (07:28):
Yeah, another great question, But it gets to the point
of what kind of problem are people in Washington trying
to solve. And the challenge that we have from the
left is that they believe that the problem in healthcare
isn't that folks don't have an opportunity to purchase coverage,
is that government doesn't control enough of health coverage or
(07:48):
health care. And so if you believe, if one believes,
if the left believes, that that is the problem, then
the last thing that you want our opportunities or plans
or programs, policies that allow for individuals or small groups
of people in small business to be able to pull
resources together to purchase coverage, because you believe on the
(08:09):
left that is that it's the government that ought to
be controlling the purchase of health coverage and the government
that ought to be supplying this health coverage so that
they can control the kind of health care that is delivered.
So that's the problem, and it really is as simple
as that. Now many folks won't admit that, but that
truly is the core of the problem on the left.
Speaker 1 (08:31):
Yeah, it seems very frustrating because there's a plan obviously
that was created. I believe Secuary A. Costa also was
working on association health plans. I think there was even
some uptake on it and some interest. But again, I mean,
now it's been stopped.
Speaker 4 (08:49):
What have you heard?
Speaker 1 (08:49):
I mean, what is the problemming? Can we restart this
process in any way, shape or form or is it
pretty much gone? Is an idea?
Speaker 3 (08:57):
No, I do think it's possible. In fact, I talked
with a member of Congress last night who was working
with the Study Committee in the House trying to fashion
what their proposal ought to be, and association health plans
is front and center on that because it actually solves
a big, big problem that we have, especially for small
business and individuals. Now, the challenge is that you've got
(09:19):
to be able to market it if you will, and
in a way that lets people know that it increases choices,
it increases responsiveness of the system, It increases innovation within
the system to provide coverage for individuals that don't have it.
It would increase access and decrease costs. But oftentimes rarely
(09:40):
do you hear folks talk about association health plans in
those terms. Which is why I'm so pleased to be
with you all the day, because the work that we
did together a number of years ago, five six years
ago on healthcare for you a program that was trying
to respond to the needs and the wishes of the
American people as it related to health care. Specify specifically
(10:02):
these personal health management accounts that would do just that,
would solve so many of these challenges that small businesses
and individuals have.
Speaker 2 (10:13):
Doctor price the average small business family plan is now
twenty six thousand dollars per year, double the PREACA costs.
How did we get here? I mean, the big problem
with the ACA, the big failure has been not what
it tried to do, but what it's failed to do,
and that's control costs. All they have done is skyrocket
(10:34):
to the point where the government has to pay these
subsidies for anyone to even be able to afford it.
Speaker 4 (10:41):
That's right.
Speaker 3 (10:42):
Another great question, and I'll sound like a broken record,
but when you put government in charge of things, the
costs do not come down. They go up because government
makes it more difficult to innovate, more difficult to run
an effective and efficient program.
Speaker 4 (10:57):
Where effective and efficient system.
Speaker 3 (11:00):
So their goal, again on the left, was is to
have government be in charge of what health coverage is
available for individuals. Now, what Obamacare did is that it
actually increased the coverage. There are fewer individuals who are
uninsured at this point, but that doesn't mean that that
individuals have greater access to health care, because even though
(11:22):
you've got an insurance card through the ADA or whatever,
you likely may not have specific health care because the deductibles,
or the copays, or or all the kinds of hurdles
that government puts in place make it much more difficult
to access that care.
Speaker 4 (11:39):
And at the same.
Speaker 3 (11:40):
Time that this individual and small group market has exploded
in costs because the cost shifting that has occurred is
no longer from individual to individual, it's from government run
programs to private health coverage that is run in the
individual and small group market, and the cost just skyrise.
Speaker 4 (12:00):
And so that's what needs to be addressed.
Speaker 3 (12:02):
The wonderful news is that we can't address it, and
association health plans or or personal health management accounts are
exactly like what would incredibly help in decreasing the cost
and increasing the access of health coverage.
Speaker 1 (12:18):
Now, Miss Sexuary, I know that the President Trump is
taking great strides and making progresses on trying to reduce
pretty much the inflation of drug costs, which is really
also another factor outside of just the healthcare plans, you
know alone, drug costs are just going through the roof,
(12:39):
and you know, it seems like part of the problem
has been this pharmacy benefit managers aka PBMs.
Speaker 4 (12:47):
And kind of the growth of that.
Speaker 1 (12:48):
Can you help us understand how PBMs have contributed to
that possibly and what we can do about it, because again,
those rising drug costs, I mean, I'm you know, I know,
I'm I I I unfortunately have to have you know,
pharmacy benefits myself, George, And I just see those drug
costs contained rise every day.
Speaker 3 (13:07):
Yeah, no, absolutely, and and and PBMs or pharmacy benefit
managers started with a basically a common sense, reasonable idea
that if you could group or or aggregate the purchasing
of drugs for a large entity of a hospital system
or a health system, and and then you could get
(13:29):
you could get the benefit of aggregating those so buying
lots of of the product, you could get the benefit
of driving down the cost and the price. The problem
is is that the PBMs have basically become the middleman
in the whole system of purchasing a medication for virtually everybody,
especially the large pharmaceutical companies.
Speaker 4 (13:49):
And and uh uh and and and.
Speaker 3 (13:51):
Then that then they they then drive up the cost
because they bump up a cost to be able to
come not just cover their costs, but to be able
to to to profit. And they basically have a monopoly
on the ability to be able to purchase medication from
the pharmaceutical companies.
Speaker 4 (14:07):
So what's the solution.
Speaker 3 (14:10):
The solution, in addition to making certain that that PBMs
are not able to charge these exorbitant fees that they charge,
it's to make certain that any savings that they realize
go directly to the individual, directly to the to the
person holding that policy. In addition, we still the United States,
still you and I and everybody here in the States
(14:31):
essentially cover the research and development for pharmaceuticals for the world.
And we do that through the incredible innovation and activity
of our pharmaceutical companies. But one of the reasons that
that happens is because the pharmaceutical companies are basically extorted
by other countries, developed countries, Western countries that say, if
(14:53):
you want to sell your pill in our country, you
can't charge more than X, and so they say, OK,
we'll do that, which shifts even more of the research
and development costs to folks in the United States. Now,
my challenge to the administration would be, this is truly
a trade problem. If you want to solve this problem,
then you don't allow those countries to do what they're
(15:16):
doing from a far pharmaceutical standpoint, as opposed to decreasing
the innovation incentives for the entire system by not allowing
pharmaceutical companies to be able to sell their drugs in
other countries for the cost that covers their services.
Speaker 1 (15:33):
Was this the conversation that was taking place and may
have actually in part gone into the One Big Beautiful Bill,
I think the topic or the phrase's most favored nation
pricing or something that is this the conversation that was
taking place.
Speaker 4 (15:49):
That's the conversation.
Speaker 3 (15:50):
But from my perspective, they focused on the wrong problem.
That is what they did is decrease the came down
to the lowest common denominator. So they said that that
that if if other countries are are paying uh X
for a certain pharmaceutical and it's lower than what what
we we are able to pay in the States, then
(16:11):
we ought to be able to to to uh pay
what other countries are are paying. The challenge with that
is that it doesn't then incentivize pharmaceutical companies right be
able to then innovate.
Speaker 4 (16:22):
And and and and and.
Speaker 3 (16:23):
Have the greatest health care ability uh in in the
world here in the United States. The real solution, as
I mentioned, is to make certain that the other countries
are paying their fair share, not that we decrease the
costs for Americans. That if we decrease the costs for Americans,
we can do that by making certain that other countries
are paying for the for their their fair share, so
(16:45):
that our costs come down as opposed to bringing everybody
down to this low and lowest common denominator.
Speaker 1 (16:51):
Again another reasonable uh uh you know idea, which of
course that's why probably it's not making it into any
any hands of Congress out here, right, because there's actually
a reasonable idea.
Speaker 4 (17:02):
Yeah, exactly exactly challenging doctor Price.
Speaker 2 (17:06):
I came across a tracker of how many R and
D projects and medicines have been pulled since the passage
of the Inflation Reduction Act, and according to Incubate, more
than fifty research programs and more than twenty five medicines
have been discontinued. That means fewer choices for patients.
Speaker 4 (17:24):
That's right.
Speaker 2 (17:25):
Do you think these types of cancelations are going to continue.
Speaker 3 (17:30):
Well, they will if you don't again, address the root causes,
the root problems that cause all of the challenges that
we have. From a pharmaceutical standpoint, we want innovation, we
want research. We want folks to be out there trying
to figure out the next great cure for diseases so
(17:52):
that we can decrease pain and suffering and mitigate the
problem of disease in this country and around the world.
But if we don't allow for financial incentives for individuals
to do.
Speaker 4 (18:04):
Just that, it won't happen.
Speaker 3 (18:07):
There's there's a reason that that the the the Nobel
Prizes for science and for biology and for medicine, that
the vast majority of them over the last fifty years
have been been awarded to Americans, folks here right here
in the United States. And the reason for that is
because we have allowed for a system that has incentivized,
(18:28):
from a financial standpoint, the ability for folks to gain
a benefit, a financial benefit from their work. If you
if you if you take that away, which is sadly
I think, is what what what is what is occurring?
If you take that away, then you won't get that benefit,
these bright folks will go do something else. They'll they'll
(18:48):
they'll work in another industry, they'll work in another in
another market. They may not even work in healthcare at all.
And and and that's a major challenge that we have.
And again, we've got to figure out why things are
the way they are and have the solutions address the cause.
Speaker 1 (19:05):
Do you think there's an opportunity for Congress to kind
of walk back some of these price controls that've kind
of crept up into uh passage of some of these
bills some of these bills.
Speaker 3 (19:15):
I do, I do absolutely, But it requires them to
stand up and and and legislator requires them to do
policy that that actually solves the challenges that that we have.
Speaker 4 (19:25):
From from my.
Speaker 3 (19:26):
Perspective, now, I don't I don't see a whole lot
of policy work being done in in in Washington. And
it saddens me because I spent a number of years
up there working with some really bright individuals and folks
who had passion about solving the the the remarkable challenges
that we have from a health standpoint and others. But
but but right now, it seems like all of that
(19:46):
has kind of been pushed pushed aside, and it's become
basically a shirts and skins game up there, and and
and uh, if you're on one team, then you can't
work with anybody on the other team, or vice versa.
And that's not the way that we solve big challenge,
a huge challenges in this country, not just in healthcare.
You talk about the debtor or the kind of really
(20:07):
difficulties that we have in the individuals being able to
realize their own American dream, but that requires policies that
have the government getting out of the way, not getting
in the way, or doing more right.
Speaker 1 (20:20):
That seems to be the fundamental difference I guess between
what we've always talked about here, which is real the
kind of market led solutions versus government led solutions right,
And it does, unfortunately seem since we've had these conversations
that we worked on it together, this has gotten worse,
not better.
Speaker 3 (20:39):
I think you're absolutely right, and I don't know how
you do that without individuals who actually appreciate and understand
why and how the United States became the leaders of
the of the free world, the leaders of the world,
and we did so because we had an ability to
fashion a financial system that incentivized innovation, incentivized creativity, incentivize
(21:03):
folks going out and creating a better mouse trap, creating
a better business. That competition, that competitive spirit, that that
competitive battle that occurs out there in the art competitive
that battle of ideas, this competition of ideas is what
is what drives incredible innovation. But sadly, from my perspective,
(21:24):
we don't seem to be incentivizing that kind of of
of of innovation or that kind of battle, that competition
that will result. You've got to the challenge that you
haven't watched is that people want to know what the
outcome is going to be before you let loose and
and and that's not the way this works. I How
folks say, if we want to know exactly where those
(21:46):
those research dollars are going in healthcare that are going
through the National Institute of Health, we want to know
what benefit that's going to provide. Well, the honest answer
is from a scientific standpoint, is that you don't know.
You've got to try, You've got to do things that
that will that will We'll try to figure out what
that new solution is, that new pill, that new medication,
that new device, that new surgical procedure, all those things
(22:09):
you may not know at the beginning. You've just got
to try and and and fail and try again. That's
so much that you talk about. Somebody that tried and
and and failed and tried again and then finally succeeded
was the founder of Job Creators Network, Bernie Marcus. I mean,
what a wonderful example he was is to to the
kind of process that you need to be able to
(22:29):
find the best solutions. And and we all miss him
terribly and I miss him personally, but that his his
his fundamental beliefs.
Speaker 4 (22:39):
Are what need to come to the four. Yeah.
Speaker 1 (22:42):
I mean it seems like lende that we have just
comes back to, like again, almost like a messaging issue,
right for for for our side of the solution, right
the consumer driven solutions, patient driven solutions, seems to we
have a messaging issue. I think here, I sit here
and I wonder why consumers aren't revolting, why our patient
(23:03):
is revolting? They I think it's so complicated now they
just don't even know where to start and how to
revolt against it other than say it's not working.
Speaker 3 (23:11):
You're right, yeah, absolutely to me at least, right and
these subsidies that were put in place. You know, they
were put in place, Increased enhanced subsidies put in place
for the purchase of through through the exchanges. The ACA
were put in place during during COVID. And if you
go back and and maybe that was the right thing
(23:32):
to do when folks were having a challenge getting covered
and getting access to care during a really, really, really
difficult time from a health standpoint. But you go back
and you can pull the tapes of the Democrats saying
this is only temporary, don't worry about it. This we
just need to make certain that the government allows individuals
provides for individuals to gain access to coverage. Right now,
This this won't last once the once the pandemic has gone,
(23:55):
these will go away. And now they're the biggest champions
of continuing this. This govern just tossing money at the problem.
They don't really care.
Speaker 4 (24:04):
That the problem solved.
Speaker 3 (24:06):
They just want to make certain the government has greater
authority and greater control over what happens with individuals and
their healthcare.
Speaker 4 (24:13):
Well, doctor price.
Speaker 2 (24:14):
Last question before we let you go, This vote taking
place this week, we know is likely to fail. We
also know that these subsidies are going to expire for
millions of Americans at the end of this year with
no solutions on the table. What are your thoughts on
just a few days left of the year as far
as the Congress being in session and coming up with
(24:37):
a solution not only for the people who are getting
these subsidies, but for all Americans so that we can
all afford our health insurance.
Speaker 4 (24:47):
Yeah.
Speaker 3 (24:49):
What needs to happen is what now I believe rarely
happens in DC, and that is working to solve a
problem incessantly. Got to keep at it. You got to
keep at it and and and taking another week off
or taking taking time off when these challenges are out
there just doesn't make any sense at all.
Speaker 4 (25:09):
Uh, there are solutions. There are wonderful solutions that are
out there.
Speaker 3 (25:13):
Uh. The Health Care for You program that that that
we put together is basically ready to go if if
folks will just dust it off and recognize that the
legislative language that that they that that that exists, that
that they could put in place right now to solve
these challenges, pick up that mantle and and and and
work to solve these challenges as opposed to looking forward
(25:34):
to the next election and figuring out how you're going
to beat the other guy over the head with with
with an issue.
Speaker 4 (25:39):
So the the the I just.
Speaker 3 (25:41):
Implore our representatives and our senators now to recognize that
these are real challenges and real people are going to
get harmed. It's to take these subsidies away. In their language,
to remove these subsidies and not provide for another alternative
that's better.
Speaker 4 (25:58):
Uh, that that exists only just doesn't make any sense
to me.
Speaker 3 (26:02):
And and and so how the left will frame it,
how the how the Democrats will frame it is that
the Republicans are taking away.
Speaker 4 (26:07):
Your health coverage. Well, that's nonsense.
Speaker 3 (26:10):
What they did is is artificially inflate the government's control
over healthcare. And so when when you remove that artificial
inflation of control over healthcare, you've got to be able
to allow individuals to utilize their own resources from a
tax advantage standpoint, just like other large employers do, to
be able to purchase coverage, Association of health plans, individual
(26:31):
health plans, personal health management accounts, all those things, doing
exactly the right thing to be able to solve this problem.
Speaker 2 (26:40):
Well, doctor Price, we miss your we miss your voice.
In Congress, they could certainly use your perspective right now.
So I hope you've got some I hope your phone
is ringing off the hook from.
Speaker 1 (26:51):
Current members here. There's an open Senate seat in Georgia
next year, so uh, maybe you shouldust off your political
side and come back.
Speaker 3 (27:02):
Talk myself into a coffin jag, and I apologize with that.
The challenges are out there and solutions exist, people just
need to embrace them.
Speaker 2 (27:09):
Absolutely well, Doctor Bryce, thank you so much for joining
us today on main Street Matters, America's small business megaphone,
and thank you all for taking the time to tune in.
mainStreet Matters is part of the Salem Podcast Network. New
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the show wherever you get your podcast from, and we'll
be back soon with another episode. Bye for now.
America is home to thirty three million small businesses, the
beating heart of communities across the country.
Speaker 2 (00:15):
And prove that the American dream is still alive.
Speaker 1 (00:21):
This is a show about those dreamers and doers and
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Speaker 2 (00:34):
Keep their American dream alive.
Speaker 1 (00:36):
I'm Alfred Ortiz, I'm a Lane Parker, and it's time
for another episode of main Street.
Speaker 2 (00:42):
Matters, America's Small Business Megaphone. Hi everybody, and welcome to
another episode of main Street Matters, America's Small Business Megaphone.
I'm a Lane Parker, the President of the Job Creator's
Network Foundation, and.
Speaker 1 (01:00):
I'm Alfred Ortiz, CEO of Job Creators Network.
Speaker 2 (01:03):
Small businesses are being crushed by skyrocketing healthcare premiums, but
Congress now has an opportunity to pursue reforms that will
lower costs and expand choice. Today, we are joined by
former Secretary of Health and Human Services, doctor Tom Price,
to break down what some of those ideas could be.
Welcome to the show, doctor Price.
Speaker 3 (01:24):
Hey Alane, thanks so much wonderful to be back with you.
And with Alfredo and jacn and just support so much
the incredible work that y'all are doing. So thanks so
much for the opportunity to be with you.
Speaker 2 (01:35):
Well, we've had a long partnership on healthcare, which we
appreciate so much from you and the work that we've
done together. But you've been in this fight for a
very long time when you were on the hill as
in Congress, and we've just come out of a forty
three days shutdown. The Democrats shut down the government because
of the fight over the enhanced Obamacare subsidies, and as
(01:59):
part of that agreement to reopen the government, that vote
on the subsidies is taking place tomorrow Thursday, and so
some of the the Republicans have put forth an idea
as well, So there'll be two bills voted on. It's
my understanding that neither of the bills will probably pass.
(02:21):
But what are your thoughts on what the Republicans have
put forward for a counter bill.
Speaker 3 (02:27):
Well, every one of the gray hairs on my head
has come from fighting this for health reform for the
past decades. The challenge that we have is that most
often in Washington, nobody truly addresses the root cause problems
that that that that exists, the root causes that that
have created this difficulty, and so many people having health
(02:51):
coverage and health insurance that's just basically unaffordable for them
or it doesn't do for them what they want. So
from from Democrats standpoint, what they want to do is
just continue to throw.
Speaker 4 (03:02):
Money at the at the at the at the.
Speaker 3 (03:04):
Problem and allow individuals to buy into or to get
some kind of coverage that likely doesn't solve the challenges
that they have. From a Republican standpoint, it's usually that light.
And and so I don't I don't. I think you're right.
I doubt that either of them will will get the
votes needed to pass. And I don't think that the
(03:24):
Republican plan and the Senate could actually pass the Republicans
in the House. But what we need to do is
to look at truly the causes of why we find
ourselves in the challenging situation that we do from a
health standpoint, and address those causes. And they're relatively easy
ways to do it, as both you and Alfredo know.
Speaker 4 (03:45):
Yeah.
Speaker 2 (03:46):
So, I had an off ed earlier this week in
the Orange County Register talking about some of the ideas
and that Congress could use to reform Obamacare. One of
those ideas is association health plans, and we've worked together
on this issue before. Talk to us about what association
health plans are and the efforts to get them passed.
(04:11):
I know you've worked on this in some bills in
Congress when you were there, and we've worked together on it.
Talked to us about what association plans are and what
they could do for our healthcare system.
Speaker 3 (04:21):
Yeah, I mean, it really is an important point and
question because the folks that are challenged most in our
system right now. Everybody has challenges, but the folks that
are challenged most are those that aren't getting their coverage
through their employer. The employer covered Employer sponsored insurance is
the way that vast majority of Americans gain health coverage.
(04:42):
It's about one hundred and sixty hundred and seventy million
individuals who get their health at coverage through their employer. Now,
when you go way back and see well why is it,
Why is health insurance hooked to the employer, It goes
all the way back to World War Two and the
fact that the federal government had to decide at that
time whether to try employers providing health coverage for their
(05:03):
employees as a taxable event or a non taxable event,
and they chose to treat it as a non taxable event,
which means that employers have a tax incentive to provide
a health coverage for their employees. However, that only works
mostly for the largest employers. If you're a small employer,
(05:24):
if you run a small business, if you've got just
you and your spouse, or you and some friends, or
up to ten twenty thirty individuals in your company, the
likelihood is that you can't afford health coverage for your employees.
So those individuals are thrown into what is called the
individual market trying to find health coverage for themselves and
(05:45):
for their family. Then they can actually afford because it's
not pool resources that are purchasing that coverage, the costs
are oftentimes astronomical. Association health plans address that by saying, okay,
if you don't. If you don't, if your employer doesn't
provide coverage for you, you ought to be able to
(06:05):
pool with other individuals who are in an association or
together linked together solely for the purpose of purchasing health coverage,
and then you gain the kind of numbers that are
able to drive down costs for health health coverage. It's
an incredibly powerful idea. Association health plans have been uh
have been you, We've tried to get those passed in
(06:26):
Washington for years. Individual health plans is another opportunity for that.
When you and Alfredo and I worked on this a
number of years ago, we call it personal health management accounts,
which gets away from the stigma that some folks have
for ageps or association health plans, but at all, the
(06:47):
core of it is to allow individuals who are not
necessarily associated economically in any other way other than wanting
to pool their own resources to purchase health coverage together.
Speaker 1 (06:58):
Now, mister Secretary, you know we're in DC right where
everything seems to make sense. Of course, but Obamacare was
regulated out or Obamacare cares regulated out ageps out of existence.
Speaker 4 (07:13):
Basically that's right. Why is that?
Speaker 1 (07:16):
Because it obviously seems to make sense.
Speaker 4 (07:19):
Is a great idea.
Speaker 1 (07:19):
We'll probably have a huge opportunity for small business owners
to actually help their employees out the way they want to.
Speaker 4 (07:26):
Why did Obamacare do that?
Speaker 3 (07:28):
Yeah, another great question, But it gets to the point
of what kind of problem are people in Washington trying
to solve. And the challenge that we have from the
left is that they believe that the problem in healthcare
isn't that folks don't have an opportunity to purchase coverage,
is that government doesn't control enough of health coverage or
(07:48):
health care. And so if you believe, if one believes,
if the left believes, that that is the problem, then
the last thing that you want our opportunities or plans
or programs, policies that allow for individuals or small groups
of people in small business to be able to pull
resources together to purchase coverage, because you believe on the
(08:09):
left that is that it's the government that ought to
be controlling the purchase of health coverage and the government
that ought to be supplying this health coverage so that
they can control the kind of health care that is delivered.
So that's the problem, and it really is as simple
as that. Now many folks won't admit that, but that
truly is the core of the problem on the left.
Speaker 1 (08:31):
Yeah, it seems very frustrating because there's a plan obviously
that was created. I believe Secuary A. Costa also was
working on association health plans. I think there was even
some uptake on it and some interest. But again, I mean,
now it's been stopped.
Speaker 4 (08:49):
What have you heard?
Speaker 1 (08:49):
I mean, what is the problemming? Can we restart this
process in any way, shape or form or is it
pretty much gone? Is an idea?
Speaker 3 (08:57):
No, I do think it's possible. In fact, I talked
with a member of Congress last night who was working
with the Study Committee in the House trying to fashion
what their proposal ought to be, and association health plans
is front and center on that because it actually solves
a big, big problem that we have, especially for small
business and individuals. Now, the challenge is that you've got
(09:19):
to be able to market it if you will, and
in a way that lets people know that it increases choices,
it increases responsiveness of the system, It increases innovation within
the system to provide coverage for individuals that don't have it.
It would increase access and decrease costs. But oftentimes rarely
(09:40):
do you hear folks talk about association health plans in
those terms. Which is why I'm so pleased to be
with you all the day, because the work that we
did together a number of years ago, five six years
ago on healthcare for you a program that was trying
to respond to the needs and the wishes of the
American people as it related to health care. Specify specifically
(10:02):
these personal health management accounts that would do just that,
would solve so many of these challenges that small businesses
and individuals have.
Speaker 2 (10:13):
Doctor price the average small business family plan is now
twenty six thousand dollars per year, double the PREACA costs.
How did we get here? I mean, the big problem
with the ACA, the big failure has been not what
it tried to do, but what it's failed to do,
and that's control costs. All they have done is skyrocket
(10:34):
to the point where the government has to pay these
subsidies for anyone to even be able to afford it.
Speaker 4 (10:41):
That's right.
Speaker 3 (10:42):
Another great question, and I'll sound like a broken record,
but when you put government in charge of things, the
costs do not come down. They go up because government
makes it more difficult to innovate, more difficult to run
an effective and efficient program.
Speaker 4 (10:57):
Where effective and efficient system.
Speaker 3 (11:00):
So their goal, again on the left, was is to
have government be in charge of what health coverage is
available for individuals. Now, what Obamacare did is that it
actually increased the coverage. There are fewer individuals who are
uninsured at this point, but that doesn't mean that that
individuals have greater access to health care, because even though
(11:22):
you've got an insurance card through the ADA or whatever,
you likely may not have specific health care because the deductibles,
or the copays, or or all the kinds of hurdles
that government puts in place make it much more difficult
to access that care.
Speaker 4 (11:39):
And at the same.
Speaker 3 (11:40):
Time that this individual and small group market has exploded
in costs because the cost shifting that has occurred is
no longer from individual to individual, it's from government run
programs to private health coverage that is run in the
individual and small group market, and the cost just skyrise.
Speaker 4 (12:00):
And so that's what needs to be addressed.
Speaker 3 (12:02):
The wonderful news is that we can't address it, and
association health plans or or personal health management accounts are
exactly like what would incredibly help in decreasing the cost
and increasing the access of health coverage.
Speaker 1 (12:18):
Now, Miss Sexuary, I know that the President Trump is
taking great strides and making progresses on trying to reduce
pretty much the inflation of drug costs, which is really
also another factor outside of just the healthcare plans, you
know alone, drug costs are just going through the roof,
(12:39):
and you know, it seems like part of the problem
has been this pharmacy benefit managers aka PBMs.
Speaker 4 (12:47):
And kind of the growth of that.
Speaker 1 (12:48):
Can you help us understand how PBMs have contributed to
that possibly and what we can do about it, because again,
those rising drug costs, I mean, I'm you know, I know,
I'm I I I unfortunately have to have you know,
pharmacy benefits myself, George, And I just see those drug
costs contained rise every day.
Speaker 3 (13:07):
Yeah, no, absolutely, and and and PBMs or pharmacy benefit
managers started with a basically a common sense, reasonable idea
that if you could group or or aggregate the purchasing
of drugs for a large entity of a hospital system
or a health system, and and then you could get
(13:29):
you could get the benefit of aggregating those so buying
lots of of the product, you could get the benefit
of driving down the cost and the price. The problem
is is that the PBMs have basically become the middleman
in the whole system of purchasing a medication for virtually everybody,
especially the large pharmaceutical companies.
Speaker 4 (13:49):
And and uh uh and and and.
Speaker 3 (13:51):
Then that then they they then drive up the cost
because they bump up a cost to be able to
come not just cover their costs, but to be able
to to to profit. And they basically have a monopoly
on the ability to be able to purchase medication from
the pharmaceutical companies.
Speaker 4 (14:07):
So what's the solution.
Speaker 3 (14:10):
The solution, in addition to making certain that that PBMs
are not able to charge these exorbitant fees that they charge,
it's to make certain that any savings that they realize
go directly to the individual, directly to the to the
person holding that policy. In addition, we still the United States,
still you and I and everybody here in the States
(14:31):
essentially cover the research and development for pharmaceuticals for the world.
And we do that through the incredible innovation and activity
of our pharmaceutical companies. But one of the reasons that
that happens is because the pharmaceutical companies are basically extorted
by other countries, developed countries, Western countries that say, if
(14:53):
you want to sell your pill in our country, you
can't charge more than X, and so they say, OK,
we'll do that, which shifts even more of the research
and development costs to folks in the United States. Now,
my challenge to the administration would be, this is truly
a trade problem. If you want to solve this problem,
then you don't allow those countries to do what they're
(15:16):
doing from a far pharmaceutical standpoint, as opposed to decreasing
the innovation incentives for the entire system by not allowing
pharmaceutical companies to be able to sell their drugs in
other countries for the cost that covers their services.
Speaker 1 (15:33):
Was this the conversation that was taking place and may
have actually in part gone into the One Big Beautiful Bill,
I think the topic or the phrase's most favored nation
pricing or something that is this the conversation that was
taking place.
Speaker 4 (15:49):
That's the conversation.
Speaker 3 (15:50):
But from my perspective, they focused on the wrong problem.
That is what they did is decrease the came down
to the lowest common denominator. So they said that that
that if if other countries are are paying uh X
for a certain pharmaceutical and it's lower than what what
we we are able to pay in the States, then
(16:11):
we ought to be able to to to uh pay
what other countries are are paying. The challenge with that
is that it doesn't then incentivize pharmaceutical companies right be
able to then innovate.
Speaker 4 (16:22):
And and and and and.
Speaker 3 (16:23):
Have the greatest health care ability uh in in the
world here in the United States. The real solution, as
I mentioned, is to make certain that the other countries
are paying their fair share, not that we decrease the
costs for Americans. That if we decrease the costs for Americans,
we can do that by making certain that other countries
are paying for the for their their fair share, so
(16:45):
that our costs come down as opposed to bringing everybody
down to this low and lowest common denominator.
Speaker 1 (16:51):
Again another reasonable uh uh you know idea, which of
course that's why probably it's not making it into any
any hands of Congress out here, right, because there's actually
a reasonable idea.
Speaker 4 (17:02):
Yeah, exactly exactly challenging doctor Price.
Speaker 2 (17:06):
I came across a tracker of how many R and
D projects and medicines have been pulled since the passage
of the Inflation Reduction Act, and according to Incubate, more
than fifty research programs and more than twenty five medicines
have been discontinued. That means fewer choices for patients.
Speaker 4 (17:24):
That's right.
Speaker 2 (17:25):
Do you think these types of cancelations are going to continue.
Speaker 3 (17:30):
Well, they will if you don't again, address the root causes,
the root problems that cause all of the challenges that
we have. From a pharmaceutical standpoint, we want innovation, we
want research. We want folks to be out there trying
to figure out the next great cure for diseases so
(17:52):
that we can decrease pain and suffering and mitigate the
problem of disease in this country and around the world.
But if we don't allow for financial incentives for individuals
to do.
Speaker 4 (18:04):
Just that, it won't happen.
Speaker 3 (18:07):
There's there's a reason that that the the the Nobel
Prizes for science and for biology and for medicine, that
the vast majority of them over the last fifty years
have been been awarded to Americans, folks here right here
in the United States. And the reason for that is
because we have allowed for a system that has incentivized,
(18:28):
from a financial standpoint, the ability for folks to gain
a benefit, a financial benefit from their work. If you
if you if you take that away, which is sadly
I think, is what what what is what is occurring?
If you take that away, then you won't get that benefit,
these bright folks will go do something else. They'll they'll
(18:48):
they'll work in another industry, they'll work in another in
another market. They may not even work in healthcare at all.
And and and that's a major challenge that we have.
And again, we've got to figure out why things are
the way they are and have the solutions address the cause.
Speaker 1 (19:05):
Do you think there's an opportunity for Congress to kind
of walk back some of these price controls that've kind
of crept up into uh passage of some of these
bills some of these bills.
Speaker 3 (19:15):
I do, I do absolutely, But it requires them to
stand up and and and legislator requires them to do
policy that that actually solves the challenges that that we have.
Speaker 4 (19:25):
From from my.
Speaker 3 (19:26):
Perspective, now, I don't I don't see a whole lot
of policy work being done in in in Washington. And
it saddens me because I spent a number of years
up there working with some really bright individuals and folks
who had passion about solving the the the remarkable challenges
that we have from a health standpoint and others. But
but but right now, it seems like all of that
(19:46):
has kind of been pushed pushed aside, and it's become
basically a shirts and skins game up there, and and
and uh, if you're on one team, then you can't
work with anybody on the other team, or vice versa.
And that's not the way that we solve big challenge,
a huge challenges in this country, not just in healthcare.
You talk about the debtor or the kind of really
(20:07):
difficulties that we have in the individuals being able to
realize their own American dream, but that requires policies that
have the government getting out of the way, not getting
in the way, or doing more right.
Speaker 1 (20:20):
That seems to be the fundamental difference I guess between
what we've always talked about here, which is real the
kind of market led solutions versus government led solutions right,
And it does, unfortunately seem since we've had these conversations
that we worked on it together, this has gotten worse,
not better.
Speaker 3 (20:39):
I think you're absolutely right, and I don't know how
you do that without individuals who actually appreciate and understand
why and how the United States became the leaders of
the of the free world, the leaders of the world,
and we did so because we had an ability to
fashion a financial system that incentivized innovation, incentivized creativity, incentivize
(21:03):
folks going out and creating a better mouse trap, creating
a better business. That competition, that competitive spirit, that that
competitive battle that occurs out there in the art competitive
that battle of ideas, this competition of ideas is what
is what drives incredible innovation. But sadly, from my perspective,
(21:24):
we don't seem to be incentivizing that kind of of
of of innovation or that kind of battle, that competition
that will result. You've got to the challenge that you
haven't watched is that people want to know what the
outcome is going to be before you let loose and
and and that's not the way this works. I How
folks say, if we want to know exactly where those
(21:46):
those research dollars are going in healthcare that are going
through the National Institute of Health, we want to know
what benefit that's going to provide. Well, the honest answer
is from a scientific standpoint, is that you don't know.
You've got to try, You've got to do things that
that will that will We'll try to figure out what
that new solution is, that new pill, that new medication,
that new device, that new surgical procedure, all those things
(22:09):
you may not know at the beginning. You've just got
to try and and and fail and try again. That's
so much that you talk about. Somebody that tried and
and and failed and tried again and then finally succeeded
was the founder of Job Creators Network, Bernie Marcus. I mean,
what a wonderful example he was is to to the
kind of process that you need to be able to
(22:29):
find the best solutions. And and we all miss him
terribly and I miss him personally, but that his his
his fundamental beliefs.
Speaker 4 (22:39):
Are what need to come to the four. Yeah.
Speaker 1 (22:42):
I mean it seems like lende that we have just
comes back to, like again, almost like a messaging issue,
right for for for our side of the solution, right
the consumer driven solutions, patient driven solutions, seems to we
have a messaging issue. I think here, I sit here
and I wonder why consumers aren't revolting, why our patient
(23:03):
is revolting? They I think it's so complicated now they
just don't even know where to start and how to
revolt against it other than say it's not working.
Speaker 3 (23:11):
You're right, yeah, absolutely to me at least, right and
these subsidies that were put in place. You know, they
were put in place, Increased enhanced subsidies put in place
for the purchase of through through the exchanges. The ACA
were put in place during during COVID. And if you
go back and and maybe that was the right thing
(23:32):
to do when folks were having a challenge getting covered
and getting access to care during a really, really, really
difficult time from a health standpoint. But you go back
and you can pull the tapes of the Democrats saying
this is only temporary, don't worry about it. This we
just need to make certain that the government allows individuals
provides for individuals to gain access to coverage. Right now,
This this won't last once the once the pandemic has gone,
(23:55):
these will go away. And now they're the biggest champions
of continuing this. This govern just tossing money at the problem.
They don't really care.
Speaker 4 (24:04):
That the problem solved.
Speaker 3 (24:06):
They just want to make certain the government has greater
authority and greater control over what happens with individuals and
their healthcare.
Speaker 4 (24:13):
Well, doctor price.
Speaker 2 (24:14):
Last question before we let you go, This vote taking
place this week, we know is likely to fail. We
also know that these subsidies are going to expire for
millions of Americans at the end of this year with
no solutions on the table. What are your thoughts on
just a few days left of the year as far
as the Congress being in session and coming up with
(24:37):
a solution not only for the people who are getting
these subsidies, but for all Americans so that we can
all afford our health insurance.
Speaker 4 (24:47):
Yeah.
Speaker 3 (24:49):
What needs to happen is what now I believe rarely
happens in DC, and that is working to solve a
problem incessantly. Got to keep at it. You got to
keep at it and and and taking another week off
or taking taking time off when these challenges are out
there just doesn't make any sense at all.
Speaker 4 (25:09):
Uh, there are solutions. There are wonderful solutions that are
out there.
Speaker 3 (25:13):
Uh. The Health Care for You program that that that
we put together is basically ready to go if if
folks will just dust it off and recognize that the
legislative language that that they that that that exists, that
that they could put in place right now to solve
these challenges, pick up that mantle and and and and
work to solve these challenges as opposed to looking forward
(25:34):
to the next election and figuring out how you're going
to beat the other guy over the head with with
with an issue.
Speaker 4 (25:39):
So the the the I just.
Speaker 3 (25:41):
Implore our representatives and our senators now to recognize that
these are real challenges and real people are going to
get harmed. It's to take these subsidies away. In their language,
to remove these subsidies and not provide for another alternative
that's better.
Speaker 4 (25:58):
Uh, that that exists only just doesn't make any sense
to me.
Speaker 3 (26:02):
And and and so how the left will frame it,
how the how the Democrats will frame it is that
the Republicans are taking away.
Speaker 4 (26:07):
Your health coverage. Well, that's nonsense.
Speaker 3 (26:10):
What they did is is artificially inflate the government's control
over healthcare. And so when when you remove that artificial
inflation of control over healthcare, you've got to be able
to allow individuals to utilize their own resources from a
tax advantage standpoint, just like other large employers do, to
be able to purchase coverage, Association of health plans, individual
(26:31):
health plans, personal health management accounts, all those things, doing
exactly the right thing to be able to solve this problem.
Speaker 2 (26:40):
Well, doctor Price, we miss your we miss your voice.
In Congress, they could certainly use your perspective right now.
So I hope you've got some I hope your phone
is ringing off the hook from.
Speaker 1 (26:51):
Current members here. There's an open Senate seat in Georgia
next year, so uh, maybe you shouldust off your political
side and come back.
Speaker 3 (27:02):
Talk myself into a coffin jag, and I apologize with that.
The challenges are out there and solutions exist, people just
need to embrace them.
Speaker 2 (27:09):
Absolutely well, Doctor Bryce, thank you so much for joining
us today on main Street Matters, America's small business megaphone,
and thank you all for taking the time to tune in.
mainStreet Matters is part of the Salem Podcast Network. New
episodes debut every Wednesday and Friday. You can subscribe to
the show wherever you get your podcast from, and we'll
be back soon with another episode. Bye for now.
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