Hi, I'm Jesse Hirsch.

Welcome to Metaviews, recorded live in front of an automated audience.

And today we're going to speak about what I think is a rather pressing issue, which is the future of health policy.

You know, paradoxically, here at mediviews, we talk a lot about policy because, of course, we try to engage people in an inclusive, participatory reflect when it comes to policy.

But healthcare policy is often even more difficult to engage, folks, even though it's something we are all engaged in, something we all have a stake in, something we should all, quite frankly, take more interest in.

So I say this, Greg, because we start every Metaviews episode with the news.

This is partly because Metaviews publishes a daily newsletter.

Today's issue actually deals with the crackdown on immigration policy and speculating that that might impact food security and the food supply chain.

Especially in California.

We're hearing reports of high levels of absenteeism where people are just not showing up to work because they don't want to take the chance of, you know, getting into trouble with the law.

But usually in our news segment, Greg, this is where we throw to our guest and say, is there any news that you're following?

Is there?

This could be local news, this could be world news, this could be health news.

And it's really meant as a way to sort of find out what our guest is looking at, but in particular, ask them, what do you think our audience should be paying attention to?

Yes.

Well, first, thanks for having me on, Jesse.

Appreciate being with you.

My pleasure.

And for the news, there's so much of it, it's a bit overwhelming.

So I just tried to figure out whether I wanted to take a big picture view or I thought I'm just going to go a little bit more localized as far as an issue goes and some of the compelling, huge stories going on around, you know, Trump and appointments, things like that.

It's semi glutides, okay, drugs, Ozempic, WeGovy, that offer that might be the miracle drugs of the 21st century.

And there's so much of healthcare that's just like that, that offering tremendous promise for making just incredible changes in the trajectory of human life and experience.

And then meanwhile, we're in the middle of questions about who gets it and how and when and if and for how much.

And some of this was going on today is actually around compound pharmacies and will some of the emergencies that were declared that allowed some version of those substances to get to more people because there wasn't enough of Them, well, maybe that's not going to be allowed to happen anymore.

And what does that mean?

And who's going to get this stuff?

And just, I think represents just a whole number of other areas of human development that we have to figure out.

The social questions about how we get this stuff to people and is it fair or is it the type of stuff that will tear apart societies because it is so unfair?

Right on.

That's a fantastic way to frame it.

And you know, when I initially booked you, I sort of mentioned that, you know, I'm Canadian and many of our listeners are Canadian.

But to your point, one of the wrinkles of Canadian healthcare, of course, is drugs and prescription drugs in that they are not often covered, it's the end user, the patient who has to provide the cost.

So we have similar debates, especially around some of the emerging really powerful medicines that can be expensive.

Right.

And whether they are covered under our provincial health plans or our provincial drug plans.

So I agree with you, these are really important debates, especially given the power, the healing effects, the quality of life changes.

But you did sort of allude at the start there, as you were kind of brainstorming what you were gonna answer.

I will ask a completely different follow up question still within our topic of the news.

Cuz while we're recording this on Tuesday, it'll probably be released on Wednesday, which happens to be the nomination hearing for RFK Jr.

In terms of what is the exact cabinet position?

Is it Secretary of Health, is that correct?

Yes, the primary federal agency for health and running its massive federal agency.

And he is obviously a controversial, polarizing, if not terrifying figure to run to have such office.

I'm curious whether you have any comments or thoughts on either the nomination process or what happens if, if he ends up becoming the secretary.

I think I have, like most Americans, a lot of bewilderment and confusion over the whole thing.

For me, when I look at it, he's such a contradiction because on the one hand he rejects, you know, hundreds of years of medical science around things as basic as social distancing and vaccines.

And you're in terror of going back to the dark ages of how we dealt with infectious diseases because of that.

And then meanwhile he jumps onto another issue, which is one that most Americans, including me, looked at.

Well, we're never going to do anything about that, which is the horrible problem of what's in our food, food additives and subsidies that go into why that is the case.

And he says he wants to tackle that.

And that's what's going to be what's going to make America healthy again.

And you know, there's authors that have approached that, but very few politicians that even breathe those words.

And you go, well, what do I think of that?

That could be amazing.

But if it's at the choice or the cost of no longer having vaccines for the childhood ailments that killed half of the globe just 100 years ago, that's probably not a bet worth making.

It is an interesting Faustian bargain, and I'm not convinced that he could deliver on industry reform or sort of changing the way that food is produced at scale.

But hopefully this is me looking for the silver lining.

Hopefully it encourages people to think about health policy.

Hopefully it encourages people to think, hey, maybe this is something in a democratic society we should be paying more closer attention to and engaging.

Now, our second segment on every meta views we call WTF or what's the Future?

And it's partly because we are a future centric podcast, but also because we like our guests to kind of share what's on their event horizon.

And your news answer was, to your credit, kind of future centric.

I mean, granted, it dealt with the present in terms of some of the medicines that are available and the policies around access.

But you were alluding to really the impact they could have if they were as widely available, if we had perhaps even greater literacy so people understood the options.

I've given you enough time to brainstorm an answer.

What do you see in the future?

What are you looking at that you think our audience should know more about?

Well, when I first heard the wtf, I thought it was something else, but I could still use the same same heading for it.

It still is the possibilities of future.

I'm an optimist, maybe cursed by that.

So I do tend to think of what's going on technologically around and some of the other systems around health and what we're showing is possible.

But I think I'm as troubled by the what I said earlier about what happens if we don't do this right, and the possibility that it is actually inequality around health and the expectation of life that can really just destroy the fabric that is our society.

Do you want to elaborate on that a bit?

And I say that because I think you and I sort of understand the dynamics of that equality of that perhaps impact on longevity.

But elaborate on the social dynamics, the social impact in terms of, to your point, people being really upset and alienated when this kind of medicine is not accessible and equitable.

All right, well, let's take it out of the example I started with at the beginning, because that's still more about diabetes and weight management and that's more of chronic disease management, which might not be as persuasive.

To make my point, let's take it to cancer.

Some pick your deadly cancer.

And there are technologies out there that have been developing, especially over the last decade, even the last five years, that are showing incredible promise to cure a variety of cancers.

Many of these are prescription drug based.

These doses run sometimes as much as $30,000 a dose, which you receive maybe every month or every other month, just an incredible amount of money.

And so if you're going to say that, well, who gets that?

You know, there's not going to be enough of that to go around.

And who gets it?

And if it's just all the really wealthy people, is that going to be something that the people that don't have all that money would say, well, that's okay, I appreciate they got a lot of money so they should be allowed to live.

Or is it going to be those that control the government or control your church or.

I mean, you can go through so many devices.

I do think that for me, the emerging issue of the ages in health policy is about control, not money.

The systems in America, these health systems are getting bigger and bigger.

It's not like they need more money, they want more control.

And so this, when you start talking about control, you start talking about how people look at a society and accept it or not.

And for many years, and I probably say as an American, we've accepted the benefits and the limits of our model, but I could see it already starting to fray and this is where I would expect it to go at its worst.

Well, and also I think the emotions that we tend to ascribe to healthcare, we tend to ascribe to our health, to the well being of our family members, is an incendiary dynamic to what you describe, right?

That when you start losing loved ones, when you start losing family members, I think that's when people really get upset.

Now, I like to structure sort of each interview we have here on Metaview.

This is Prez, our turkey coming in to roost.

Sort of describing our feature interview around kind of three pillars.

I tend to look at the guest and I take three themes that I want to wrap the conversation around.

And in our case, I thought it would be healthcare pandemics and policy.

Right.

As sort of three ways, hopefully that we can get into some really interesting ideas and conversation because what you were just describing there kind of again, Reminded me of what it's like to be a Canadian looking at the US Healthcare system.

Because on the one hand, we like to tell ourselves at least we won't be bankrupted if we get cancer, or at least a trip to the emergency room isn't going to be a big hit.

But on the flip side, we see such a gap between the high end and the low end of American medicine that the high end is really exceptional.

Like if you look at elite American medicine, elite American medical research, it's really quite impressive and I think to what you're describing, that if that gap between the top and the bottom becomes so extreme, is there a threat of the system breaking as a whole, right of there just being such a gap between what is available to the wealthy and what is available to everyone else?

To what extent is that already happening?

To what extent is there already a kind of breeding resentment or a frustration that people can't get the care that they require?

Yes, it's been breeding for quite a while and it actually used to be a lot worse.

Just go back about 20 years passed what we call the Affordable Care act or Obamacare, depending how one likes to look at it.

And what that reflected was U.S.

policy, which was we had this incredibly high end level of care for people that were in the system.

But and I have traveled around the globe and looked at other health systems and one of the defining things about the American system is the opposite of that, which is we had so many people that were outside of the system.

We called them the uninsured, but there were even more underinsured.

So there's just millions and millions of Americans who were left out of the system entirely, where all the great things that were going on.

And so a lot of our work as Americans trying to make our system better was trying to address how we deal with those gaps.

Well, most of our efforts went by the wayside.

We couldn't politically get them there.

But the Affordable Care act, not a perfect piece of legislation in my mind at all.

But the one thing it did do is actually finally close the gap of the uninsured by creating a number of different structural ways to get more people into the system.

And at least the high end contention over the system started to tamp down a bit.

And it has and it's continued because it through the first Trump administration, they wanted to kill that, but didn't, couldn't.

And then Biden reinforced a lot of those pieces, sometimes, well, sometimes poorly.

But again, it was not completely out of whack.

And there's still way fewer, way fewer uninsured Americans than there were going back into the 1990s.

And that has been sort of one of the key characteristics of our system.

And weakness.

Well, you don't have to go very far to extrapolate on just the discussions that are going on in Washington, D.C.

right now to look where that might actually be.

The good old days, meaning the 90s.

Right.

And I do suspect that it really will start to stretch our ability to keep it together.

Because again, what I'm saying is that meanwhile, medicine has moved on into what might be a new age of incredible development.

And so that gap only becomes bigger as more and more people are unable to access those benefits.

Although let me throw you a curveball which is to what extent are people aware of the benefits?

Like as patients, you almost have a certain literacy to know, to ask about something like Ozempic, to have a certain level of patient advocacy or someone in your family advocating on behalf of you.

And it strikes me that it's not just about access to medicine, but access to the knowledge to know how to ask for that medicine.

Is that also a problem when you're sort of relying upon privatized means of educating people around their own healthcare and their own healthcare options?

I think it's a short term problem.

I think there's a lot of Americans don't have a clear idea of what's going on in the revolution in American and worldwide thought about health care.

But it's only going to be for so long.

You can't keep things like curing cancer sort of secret.

Yeah.

You can pin media all you want or not allow government officials to say it.

I have a feeling that word's going to get out.

Yeah, well, I mean, as a tangent to that, you know, stem cell therapy, it strikes me as sort of its own kind of revolution.

But it's obviously nowhere near accessible in terms of the average patient.

Do you think that that's a peril?

Cancer's a big one because it touches so many people and the media would be all over it.

It would be such a sensational title.

But it strikes me that what's happening with stem cell therapy is widespread in wealthy circles.

If you know, you know.

But I don't know a lot of people who understand or even know the word stem cells or the impact that it could have.

I'm curious if you see that as an analogy or perhaps an aberration.

I think it's a good one.

As you get into some of the more isolated piece of this, it's more Technologically, most of this stuff I barely understand.

I'm not a scientist.

I just sort of grasp it enough in concepts to be able to manage it.

But the one thing that does equalize all this is that more and more what's happening is people are having to take care of their relatives and friends and loved ones on their own.

We used to just be able to ship them off to nursing homes and go visit them once a year or twice a year.

Well, that's not going to be the model much longer.

It already is breaking down.

And the more you have to actually see the misery and the difficulty of caring for those folks, I think that's going to counterbalance whatever areas of ignorance people might have about that.

As soon as they see that, they might start asking even more questions and maybe want to understand.

Well, and perhaps then another area like cancer that kind of touches everyone eventually is cognitive decline.

Yes, that's exactly what I was thinking of.

And the extent to which there are now drugs that can treat Parkinson's, that can treat early Alzheimer's, that are again, expensive and not necessarily accessible, yet we are, I think, in our families, in our communities, going to have contact with people who are experiencing dementia or who are having that kind of cognitive decline again, where.

And my semi pluto example from the beginning is that some of the research is out there is suggesting that those semi glutides might have a profound impact on exactly those diseases.

Well, and to your point about anticipating the transformation of elder care and the transformation of retirement homes, do you see similar changes when it comes to institutions and how healthcare is delivered?

And I say this in the sense that it felt to me the 20th century was about bricks and mortar, about hospitals, but the potential now is perhaps more community clinic or perhaps more even home care.

If we were to fantasize of some utopia, do you see that kind of happening either in a good way or a bad way, in terms of how healthcare is either falling apart or transforming itself, depending on your perspective?

Well, I do see the institutional base of healthcare being bricks and mortar, kind of reconceptualizing itself, but that's not necessarily good because it's mostly reconceptualizing itself, not for the care of the patient, but for the benefit of the systems that profit from it primarily.

So at some level the two intersect.

But I would say a lot of the current innovation is really about how to control the costs of the system and the providers and to make it convenient and manageable for them, not for the individuals that are going to be affected by it there's one change into American health policy that I would advocate for and have been advocating for most of my career.

It's to build the system around the patients and the people, not the medical providers and the insurers and the government.

And we continue to do exactly the opposite.

Right on.

And I want to come back to that sort of subject of patient centric care, even better, you know, patient managed healthcare systems.

But let me take a quick and relevant tangent to talk about your use of fiction and the way in which you use storytelling and you use fiction as a way to make these subjects accessible.

I'm a policy wonk.

So right away we started into our conversation.

I was like, well what about RFK Jr.

What about this?

But most people, they may not feel as comfortable getting into the weeds that way.

So talk a little bit about the way in which you've used fiction and storytelling as, you know, a more accessible way to get people interested in these issues.

Yes.

So I spent a 40 plus year career working in the policy world trying to change things and doing some good.

And when I sort of stepped aside from my last big job and looked at everything, I said, you know, the system is still screwed up and I'd like to find some other ways to get through.

And I said, but I want to try to do it a different way.

And I said, well, I think I still want to do the same things, which is try to convince the public will that they want a different system and engage them.

And I'm going like, well, I also have 40 years of experience in knowing that not that many people really want to talk about this or explore it.

So I said, well, I've always wanted to write a book novel.

And that's sort of where the two things came together.

The notion of just sort of using entertainment as a way to get people to engage, flip your messages in around fun and entertainment, even if it's as explosive a topic as healthcare.

Is there a way to do that?

And my three books so far have been experiments about whether I can kind of put the two things together.

And I continue to believe it's possible.

Whether these are the perfect books or not yet I'm not sure, but I'll let the readers gauge that.

But so far of engaging people and now I'm even encouraged because.

And you can't make up reality.

It's things like what's going on in the Trump administration or the assassination of insurance executive on the streets of Manhattan.

I mean, suddenly the crazy stuff in my books doesn't seem so crazy.

Quite the opposite.

It probably increases the appetite for these types of stories and allows this kind of second or third career as an authority to have a lot of Runway right because you can't make this stuff up.

And yet that allows you as an author to get even deeper into it.

And I wanted to use the role of fiction and the role of storytelling as a kind of segue to talk about pandemics because I would say a lot of people still have a lot of trauma associated with the COVID pandemic.

And as someone who watches the news, I've got my eyes on a potential avian flu pandemic, which I sure hope doesn't happen.

But nonetheless, the epidemiologists are going, hey, let's keep an eye here.

So I'm curious on first, the health policy level, to what extent did America's experience with COVID ongoing cause of course it's not over.

How has that made health policy complicated?

And I'm obviously being a little facetious when I say complicated.

Totally fucked up is perhaps another way to phrase it.

But again, as someone who has a multi decade career in health policy, give me your sense of what the pandemic did to the way in which these health debates and these policy debates happen.

Yeah.

So this would be the session you show that I would say is WTF for certainly America, but even the globe.

Because it really was this change of.

We have experts who are out there trying to help us stay healthy that are going to work on issues like pandemics.

And suddenly they became the enemy.

Not to be trusted, but even the enemy.

And suddenly we were looking for answers in our ideologies, in our politicians, in profiteers, in crazy snake oil salesmen who had a microphone.

It was just mind boggling to me.

A huge part of my career has been sort of being ready for exactly the types of things that happen.

Avian flus and these viruses that will mutate.

My last job was I was the CEO of the Arizona Hospital Association.

One of the things I brought to that association was trying to coordinate all the hospitals and with the state government and other medical facilities and providers, how do we respond to exactly something like what happened?

And there's, I thought that's about when I left my job saying, well, we should be ready, we should be ready in America, because I know some of the plans we have for these things.

And with all those things in place, that's not what we did.

And then when it got hopelessly fucked up, the, of course what actually happened became a whole different thing because it's who you were listening to.

And it was sort of just crazy talk.

But my second book is called the COVID Murders and it really wasn't so much about COVID It was just to reflect upon a time period where everything just went off the rails entirely and nothing made sense.

And.

But we still.

Those threads are still there.

If not, they're probably even worse.

It's where you get the RFK side that denies vaccines, as if somehow the COVID vaccine was a dangerous vaccine, which it isn't and wasn't beneficial, which it was.

And that we still have this whole reality, certainly in America, that believes that it was the problem.

And it's sort of hard to move forward when you have so many people in these isolated pockets where they don't really talk.

So again, can art and books help bring people together?

I hope.

But that might be something that requires something more, which is a rediscovery of trust in society that transcends, I think, anything I've sort of dealt with in my career.

Although part of what we sort of deal with on meta views is the role of storytelling and trust building, right.

That you can't really use the old school, top down lecture mode.

You have to create stories that people enter on their own accord.

And in that story, in that journey, then they realize, oh wait, it's not the vaccine that created all that damage, it was Covid that created all that damage.

Right.

Because it is a kind of displaced blame.

They're blaming the vaccine for what the disease itself is kind of unleashing.

But allow me then to throw you a very difficult policy question which because you are now in a kind of semi retired or fictional position, you can answer this without the constraints of a contemporary decision maker.

But in the wake of that shit show that we experienced, what do you see as pandemic preparedness now?

It feels that so many of the options that we would have imagined before COVID when it comes to how we handle a pandemic, how we have again, preparedness, it feels a lot of those options are just not available because of not just the misinformed public, but a falsely politicized public that adds all sorts of extra constraints to public health officials who are charged with anticipating what to do when this happens again.

Yes.

So two part answer.

My first answer is prayer as policy, because I don't think we're ready.

I don't think we could safely make it through something of that proportions.

And, and the truth is Covid actually wasn't the big one.

It turned out to be somewhat benign relative to what we thought it could be.

So if something worse, I mean, just can't even imagine it, you're not, I mean, right now the CDC is not allowed to talk to the public in the United States.

The United States is not allowed to be part of the World Health Organization order of failings.

It has.

But can you somehow have an infrastructure that can respond to viral disease spread if you're not even talking?

I don't think so.

So I'm just terrified by the possibility.

The other one gets the optimist side of me of looking at the potential of social breakdown.

I would like to believe that it just can't sustain if that becomes the case, that somehow these ridiculous political and ideological divides have to go away in the interest of sanity and the preservation of the human species.

Well, and let's use that then as a way to imagine the alternative.

Because where I do see that kind of justice coming is a patient led model, A patient centric model.

And as crazy, as insane as the current regime's approach to health policy is, the light at the end of the tunnel is the more that patients suffer, the more that patients or families and advocates of patients experience these bad outcomes, the more likely they are to organize, the more likely they are to be vocal and get around that.

So again, on the policy level, as a policy question, and let's go short term here before we go long term, what are the low hanging fruit that could help us shift towards a patient centric system that could help us shift, and I don't even mean on a governance level, I really just mean initially on a cultural level, get to a point where we're putting patients at the center and recognizing that that's where we start building a system around the needs, the concerns, the identities of the patient themselves.

Right?

Well, as a short term proposition, I would say the only place really to go is to try to build within the American somewhat it's a global thing, but American certainly tradition around community organizations that if you really want to find where trust is the greatest, it's when people are among those they perceive to be like them.

Whether that's geographic, more local communities, or whether it's around where you worship or don't, or clubs, bowling clubs, or you know, just it's getting into those units and somehow trying to atomize those smaller groups to say, you know, we get together to bowl some frames, but gee, maybe we should figure out how we don't get this pandemic that's going around the globe while we're here.

And that's what I would say somehow try to get it out to that level and maybe in all the other dysfunction and all the attacks, maybe that would be allowed to foster that believing in some cynical plan to disrupt the Trump revolution or whatever it might be.

So that's where I'd go there.

I think longer term, there's other ways to do it structurally.

I've had to posit some of these from my books, even where I try to come up with solutions to some of the problems I lay out.

So let me just give you one example.

National Institutes of Health in America is one of the leading, you know, conglomerates of research on the globe.

Well, even, even this week they're in paper because apparently the Trump administration is trying to push out people who have long term standing there, which could, you know, destroy a lot of research.

Yeah, I'm trying to think of something good about that.

Well, one of my proposals for how would you get American healthcare policy on track was to you should we should create another institute within the Institutes of Health, and that should be the institute, basically Patient Centered Care, where you have the best minds in America trying to figure out how you actually build what you just described.

And how would you set up the models where that's what would be recreated in communities and places around the country.

We would know how to do something that we already do know how to do some of that we just don't think about intentionally doing it.

Well, that could never happen with a lot of the Institutes of Health people there.

Maybe if everybody's gone, we can do that because it's circling completely open book.

I don't know, maybe that's not so optimistic.

But again, we're trying to find the phoenix in the ashes here.

Right.

Given that things are on fire.

But it also reminded me during the pandemic, or I shouldn't say during the pandemic, we're still in the pandemic.

During the lockdown part of the COVID pandemic, I spent a lot of time kind of connecting to the disability justice movements.

And, you know, when everyone was locked down, it certainly gave an increased visibility to people who experience disability because they're online often anyway, and they were in a position of quasi leadership.

To what extent can we, in trying to achieve what you're describing, how do we further destigmatize disability or how do we normalize disability in the sense that if we all live long enough, we're all going to be disabled at some point.

So rather than othering people who experience disabilities, how do we kind of Empower them to be the leaders of the kind of system that you're describing.

At the very least on a research level.

Right.

In terms of the way that we think about the types of participatory research models that are out there.

Yeah, that's a great idea.

I hadn't really thought about it that way.

I think we do have a lot to learn.

Usually we have these divisions because people are not really aware of people in those circumstances, whatever it is.

So mine again is find these communities and start to cross fertilize them.

And again, not global level national trade associations, but where they live and breathe and relate to each other.

And I suspect a lot of these things will break down just like Republicans and Democrats in our country.

I don't know how your divides work there, but the more you put people in a room, you know, we see the television shows where they're all fighting and yelling at each other, but my experience is still we try to find a way to be civil with those that don't really agree with us and even find times with those we want to be friends with.

A way to try to somehow have a conversation.

I think it's still the basic elements of being a human being might do what we want to draw on when we start to get eaten up by viruses.

Well, and we're kind of talking on a utopia level, dare I say it, when it comes to patients and practitioners.

But it struck me when you were saying that that even within medicine itself there's often not a lot of interdisciplinary talk or interprofessional collaboration.

There's still kind of silos and status within the healthcare milieu.

Have you thought about policies that try to address that, that try to foster more collaborative care and team based care?

Especially when dealing with an aging society where it's never one thing you're dealing with, it's the complications of multiple diagnosis that as we age, often make healthcare more complicated and more expensive.

Yes.

I would say for most of my career and even my first book, that was more the issue I was focused in on, which is the fragmentation of American medical care, why it got that way and how to solve it.

It got that way out of the very same thing that created its incredible growth, which was scientific discovery.

There's discovery around certain things that it actually helped to have.

Scientists and then physicians who organized by specialty to conglomerate around.

Well, it's those very threads that somehow took our system to such complex and inefficient plateaus that we couldn't put it back together.

So you kind of have to try to deal with that.

But all along there have been solutions out there.

Even going back to america in the 1920s, there was a study group that called the committee on the Committee on the Cost of Medical Care which was saying how do you somehow put the genie back in the bottle?

And one of their primary Recommendations out of 5 was Group Medical practice.

That instead of having these physicians and groups of specialties or individuals was more the case back when they wrote the report.

You actually somehow put them where they're working together as a team.

And many of that was rejected.

It's actually coming back in a different way now.

Bit too organized maybe by health systems who are employing them, which is a different model of trying to build collaboration than what I'm talking about.

But there's ways to do it.

And so yes, I think we can do that.

I think we have to do that if we want to get at the effectiveness and the efficiency questions.

We've been off more on the survivability questions, I think, than those, although the.

Survivability seems to be the pertinent issue given the current climate.

But as a tangent, I want to come back to the universality issue, but as a tangent and feel free to take a pass on this if you think it's either loaded or not in your wheelhouse.

But there's a lot of rhetoric around AI and healthcare.

Part of this rhetoric is the tech companies wanting to be in the healthcare space, wanting to, I would assume, get access to healthcare data and patient data.

But as someone who looks at healthcare from a meta view, right, From a system level, from a policy level, how much weight or how much substance do you put into some of these AI claims and AI potential when it comes to revolutionizing healthcare as we know it?

So this was almost my answer to your question about the news when I thought about it today, because I have been observing the AI phenomena quite a bit.

Even as an author, I'm seeing it pop up in some of classes and how we're supposed to deal with it too.

But my take on it is it's another one of those incredible tools out there that will contribute and maybe even greatly accelerate some of these scientific discoveries around cancer and other things that threaten our lives and experience when we are alive.

But what it mostly made me think of is much of my career I used to was blessed to be able to attend all these big conferences and the positions I held where I'd hear people get together and talk about what they can do to change the world.

And the last five, ten Years of my career, a lot of it was around this thing called big data where these big healthcare companies would come in and say we're buying up all the healthcare data and we're putting it together in these pools where just a handful of us, we'll be able to get at it and we're going to be able to change the world for the betterment of mankind.

And by the way, it'll help us out too.

Well, having watched all that for more than 10 years, I've watched earlier things which is around just computers and watching the same type of conversation about how we're going to make everything better for people in the world because we're going to take patient data and put it all together.

Well, the beneficial sides of that to humanity and systems never seems to show what mostly has showed the ability of man to somehow take things and profit from them.

So I'm highly suspicious of whether AI will be corralled such and controlled such that it will lead to the beneficial aspects more than the continuation of human greed and the ability to aggregate wealth.

Well, as an aside, I remember the same thing said about 5G, right?

That 5G was going to accomplish all that and all it did was increase our monthly bill.

Yeah, I did want to come back to the notion of universality.

And here in Canada, universality, while a bit of a myth compared to, or perhaps that's unfair, it's more aspirational.

Right.

It's something that we hold as a virtue or a value of our system, but when you get into the nuts and bolts, isn't always there.

And it strikes me that a lot of what we've been talking about today, whether it's the revolution in medicine, the potential of new organization of delivering medical care, let alone whether the patient is at the center or leading it, how is universality either focused on or moved towards within this larger policy framework?

Often that could be on an issue of just cost.

But I think we've been uncovering additional barriers than just cost when it comes to making healthcare universal, making access to healthcare universal.

So what do you look for when it comes to policy mechanisms or even policy ideals that help us put the attention back on universality at a moment in time when it feels like we're headed in the opposite direction?

Yes.

I've been spending a lot of time thinking about exactly this question, starting with, well, what is it about the universality, to use your term.

And I've tended now think about it more as what's fair.

And people can have different trips as fair, but it's just a statement.

It sort of captures sort of maybe the essence of it for me that it's fair that again people will accept it individually, collectively.

And so I've sort of more thrown out polemics and the crazy thing for me is one that I've been working on quite a bit in my books and I've used it just because I thought it would expose the question, but now I'm wondering if maybe it's the answer.

Is one of my policy prescripts in my first book for making the American health care system better was that one of the ten point part of the ten point plan one was that we would have a national healthcare lottery for those that couldn't buy these high end technologies that would save their life.

They could enter the lottery like we do for the financial lottery and everybody would get a draw to see if they're the one that gets the cancer drug or whatever it is.

And I was sort of semi serious, but I thought it would bring out the point and sort of force the conversation about what we might do.

Well, my most recent book is called Death Panels and the sub theme is really about the allocation of life saving technology.

And I decided to set the fictional tale in Las Vegas basically to set up the proposition of isn't this exactly what we should be doing?

Which is essentially creating a Las Vegas like mode to figuring out who gets what in terms of American health care services and geez, maybe that is a better answer than the stuff we're playing around with right now, which is money or that you're politically connected or God knows what other things we're we're going to come up with to figure out who gets those cancer drugs.

So I'm starting to think more and more about maybe that's right, that's scary.

I mean if you want to push it even further, it'd be like a cryptocurrency scam, right?

To see who gets the procedure, who gets the operation.

I think I've got my fifth book now.

Yeah, there you go.

You know, we, I like to end every meta views episode with shout outs.

Partly because, you know, we believe in the we stand on the shoulders of giants principle, but also because, you know, in the spirit of being intuitive, we like to throw to the guest and say, you know, who do you want to shout out?

Is there someone out there that you think deserves more recognition or that you want our audience to know more about?

In my books and now I would say that it's the same thing that for all the time I spend criticizing the health care system in America and around the globe, even.

It's the men and women who work in the healthcare system tirelessly, courageously, with all their hearts, in almost all cases, trying to do the right thing for people in a terribly flawed system that produces bad results many times that aren't their fault, but just getting up and continuing to do it.

They are the heroes of the pandemic.

They're the heroes of the.

Of our past, and they're going to be the heroes of the future, too.

And so God bless them for doing it.

It's probably work I wouldn't be capable of doing, but I've seen so many of them do it.

And I just have such respect for, for what they've done and what they contribute and what they give up in their own lives to be able to do that.

Right on.

Well, it kind of suggests maybe a future episode that we'll have to do, which is the future of health education, of how to make it easier for people who want to be that kind of hero to find the career, to find a job.

And I say this because, again, we're recording this on a Tuesday.

It'll air on the Wednesday where the provincial government, the Ontario government, is going to call an election.

And I think the biggest promise that the government is going to make is for more family doctors because we have a shortage of family doctors here in Ontario, like RFK Jr.

I don't think they're gonna follow through on that promise, but it's nice that they're floating it out there at least.

So, you know.

Thanks again, Greg, for joining us.

Thanks to everyone who followed along.

Meta Views is accessible on social media platforms.

We'll have links to Greg's book in the show notes or in the YouTube notes.

And we'll be back soon with hopefully more gripping, enthralling conversations about policy and why policy is so important to our lives.

I'm being a little facetious, but I'm not, and Metaview's listeners understand that.

So thanks again.

We'll see everybody soon.