Episode 70
May 10th, 2023
(Conversation recorded on April 13th, 2023)
Show Summary
On this episode, former Governor of Oregon and ER Doctor John Kitzhaber joins Nate to discuss the shortcomings of the medical system in the United States. With health outcomes below average compared to other developed nations and healthcare spending at nearly 20% of GDP, creating medical systems that are less costly while also keeping people healthier is critical to the well-being of the country and its citizens. Dr. Kitzhaber’s hands-on experience working in medicine and systemic perspective as a policymaker gives him a unique perspective on healthcare resource allocation, the effectiveness of medicine, and the real world effects of how we incentivize medical care. Can we extend our time horizons by making long-term investments in the most effective preventative care? How do we take care of more people with fewer resources available? Most of all, can we come together to think critically about how we can create a system that prioritizes holistic health, based in community and accessible to everyone?
About John Kitzhaber
John Kitzhaber has more than 40 years of experience in health care and health policy in both public and private sectors. He practiced as an emergency room physician for 15 years; served 14 years in the Oregon Legislature, and served three terms as Governor of the State of Oregon.
Kitzhaber is the author of the groundbreaking Oregon Health Plan, through which hundreds of thousands of low- and moderate-income Oregon families gain access to health care. During his third term as Governor, Kitzhaber was the chief architect of Oregon’s Coordinated Care Organizations, the first effort in the country created on a statewide basis to meet the Triple Aim—better health, better quality, lower cost—with a focus on community and population health.
In French, we have a motto that says that a simple drawing is often better than a long explanation. Jean-Marc Jancovici Carbone 4 President
That’s very understandable because with left atmosphere thinking, one of the problems is that you see everything as a series of problems that must have solutions. Iain McGilchrist Neuroscientist and Philosopher
We can’t have hundreds and hundreds of real relationships that are healthy because that requires time and effort and full attention and awareness of being in real relationship and conversation with the other human. Nate Hagens Director of ISEOF
This is the crux of the whole problem. Individual parts of nature are more valuable than the biocomplexity of nature. Thomas Crowther Founder Restor
Show Notes & Links to Learn More
Download transcript00:00 – John Kitzhaber Works + Info
00:23 – Healthcare is 19% of the size of our economy
00:29 – The US has lower health outcomes compared to other developed nations
00:56 – Oregon Health Plan and Coordinated Care Organization
02:36 – 12,900 per capita is spent on healthcare in the US per year
02:55 – US has the highest infant mortality rate and lower life expectancy among OECD nations
03:29 – US healthcare focuses on acute medical care rather than early life investment
03:52 – US is 4% of the global population but has 50% of the prescriptions
04:28 – The US has no limited price regulations on pharmaceuticals
04:32 – 1 of 2 nations that allows direct to consumer advertising
07:17 – Half of cancer patients will have been in collections, and 4-5% have to file bankruptcy
07:42 – [First] leading cause of bankruptcy is having to pay a medical bill
10:34 – Coby Howard
12:35 – Controversiality of OHP in Washington
14:17 – 25 cents on every dollar is wasted in terms of positive outcome in the medical system
20:13 – Medicare Advantage
20:36 – Risk Adjustment
21:04 – 31 trillion dollars in debt federally
21:25 – Healthcare is a huge lobbying force
22:25 – Issues with GDP as a measure for success
22:35 – Bhutan alternative to GDP
22:49 – WHO definition of health
24:40 – [93%] of Americans have some metabolic dysfunction
25:17 – A bulk of Americans’ lifetime healthcare costs are in the last 6 months of their life
25:45 – Epigenetics
28:28 – Other OECD nations spend more on social investments that are predictors of health
29:05 – Processed food is 3 times cheaper than ‘real’ food
29:44 – Poverty and race are huge predictors of health outcomes
30:13 – Investing in early life care will have economic returns of 7:1
31:14 – 10% of your lifetime health status is a result of involvement with the health system
37:08 – ¼ of FDA employees now work at/consult for pharmaceutical companies
37:29 – ⅔ of the 2019 members of Congress who are now retired work in the lobbying industry
42:18 – Fee-for-service reimbursement
44:56 – Thích Nhất Hạnh
