Why Healthcare Costs Are So High in America | Rep. Vern Buchanan

So I've asked doctors and I've asked a lot of them and they've had, they say they don't, they've never had one class on nutrition. And so if food is medicine, you believe that, I believe it. And there's not one class in terms of that. So, and that gets back to the whole thing on the incentives are, are not structured properly.

Congressman Buchanan, so wonderful to have you on the Dr. Swanson podcast. I've been waiting for this moment for a long time. You know, we've been working together over the last three, four years to try to make shifts in food policy and Medicare and health policy to address this incredible epidemic of chronic disease, which I think is a national emergency. And the good news is that we've been able to accomplish a lot. And I want to talk to you today about some of the amazing work that you've done and that we've collaborated on to actually start to move the needle and address this real crisis we have, which is obviously burdening our country with enormous suffering of chronic disease. it's costing the economy, you know, four and a half trillion dollars a year. Most of that's for chronic illness. It's threatening our national security, our kids' academic performance, and military readiness. And it's something that, you know, you personally have been very passionate about for a long time, both from the perspective of a legislator and leader in Congress, but also your own personal health. So I really kind of appreciated your commitment to this issue and your willingness to work across the aisle to get things done in a place where people think things don't happen. But, you know, Congressman, for those who don't know Congressman, I did the introduction earlier, but you're the Chair of the Ways and Means Health Subcommittee, which is probably one of the most important committees in Congress that oversees all of Medicare, which is over a trillion dollars. And, you know, you really are one of the first in Congress to make prevention and treating chronic disease with Hoodia's medicine as one of your top priorities, which is Amazing. So can you maybe start by kind of telling us why is this so important to you and why do you think we need to really focus on addressing this chronic disease epidemic with prevention and lifestyle as treatment?

Well, Mark, let me first just thank you personally. We have had a lot of opportunities to meet and visit and I'm so excited about the differences you've made on a lot of different fronts and I look forward to it. I know that we're looking at having a hearing coming up congressionally. and I'm excited about that and the possibilities there. By the way, I just wanted to mention also, I was with a young lady yesterday and she was telling me about her father or grandfather is 98 and they contribute his being 98 to you. He watched your, listens to your podcast. I'll just tell you, I thought it was kind of cute and he's actively engaged and going like heck. So I thought it was pretty, pretty big thing there.

That's very funny.

You know, I, for whatever reason, as a blue collar kid, one of eight, I just remember when I got, my wife and I got married, I met, they had a neighbor and she wrote a couple of books or something. Eldell Davis. I think I mentioned that to you. I don't know if she's been, that's a long time. I don't want to date myself too much, but I just happened to pick it up and start looking through a little bit, and a lot of it made sense to me and. Because we're in such a competitive world and I've had a family that are diabetics and heart disease and all these kinds of things. So I've tried to stay focused on that and I have my own discipline where I try to the best I can. I always say it's 80-20. But to me, it all boils down to a lot of this is diet and exercise. I'm just taking it from my own personal story. I've read a lot of books, looked at a lot of things for me personally to be able to perform at a fairly high level. I'm not a doctor or anything, but it's one of those things where I've read your books and other books and I've been doing it for 20, 30 years. And I think it gives you the slight edge, the difference. And as a competitor, whether it's in business, sports or anything else, it makes a huge difference how you feel and think and everything else. So that's why I now, being in Congress, a lot of people don't want to touch some of these difficult, challenging things like whether it's the debt and interest or what's going on in terms of healthcare. you mentioned it's over a trillion dollars just on Medicare alone. But when you look at the data, it's basically pretty shocking. I was looking at again, refreshing my memory and some of this stuff. But the obesity, for example, is 40%. For children, it's 20%. But yet we only spent 3% on prevention. And that's my whole focus has been, how do we not get cancer or heart disease to begin with? Someone mentioned to me 30 years ago, I was at a seminar in Dallas, and they mentioned that 50% of people who have their first heart attack never see the next day. Well, we've got a lot of heart disease in our family. So I'm just thinking to myself, how do you avoid that to begin with? Now, some things are genetic, you know that better than me, but there's a lot of things that can be dealt with without having to go through a difficult process. in terms of heart disease and some of these other things. So that's why I'm so excited about your leadership and where you're at. I know we're going to get into different things like processed food and stuff like that. And that's the other big thing. But diet and exercise, 80%. Then the other percent is all I just was thinking about a couple of days ago, you know, getting enough rest, stress management and all these other things. But these are two gigantic issues when you add them together, whether it's in my life, it's like 80%, I thought about it. some people might be more or less, but it makes a huge difference, those two areas in terms of what my thinking is.

Yeah, you're probably one of the healthiest congressmen I've seen. A lot of your colleagues are not so healthy. We had a group of them over to your house in Washington on the deck, and we had a wonderful meeting talking about these issues with about 14 or 15 of the members of the Health Subcommittee of the Ways and Means Committee. overseeing Medicare and they're all very excited to learn. But you're an example of what it takes to actually create good health for yourself. So, I've eaten with you, I see how you take care of yourself and exercise. It's very impressive and I think it's really helped you understand what's needed for America, which is we can't sustain this anymore. I mean, it's not a left or right issue. This is an American issue that is threatening our I think our whole nation in a way, because we are being burdened by the economic weight of the cost, which is just for diabetes alone for Medicare, I think it's a billion dollars a day, which is almost completely preventable. And the effect on just the amount of suffering.

And.

I think the CBO estimates that pretty soon the Medicare Hospital Trust Fund will be running out of money in 2035 if we don't do something about it. you know, in the next 10 years, we're going to spend just $4 trillion, just on obesity alone through the government. And most people don't realize that, you know, the government accounts for about 40% of all health care payments, whether it's through Medicare, the DOD, the Department of Defense, VA, the Health Service, federal employees, you know, all the, the, the federal and, and state programs. It's really huge amount of the health care costs. So the government has a big lever that they can pull. And so, I'm very excited about some of your initiatives around Medicare. And maybe we can talk about your new initiative, which I think is something we worked on for a while, which is this whole idea of treating chronic disease patients with food as medicine through what we call medically tailored meals. And what's really exciting is working in a bipartisan way, you've been able to get this through the committee and I'd love you to sort of share a little bit about why you're excited about that and this new Medicare demonstration project. This committee just passed this groundbreaking pilot to offer medically tailored meals to people who are leaving the hospital with chronic disease like diabetes or heart failure to really help improve their health outcomes. So tell us about why this is important and what you hope to see happening with this.

Well, in terms of food is medicine, I had a doctor say that mentioned, very successful doctor, 30-40 years practice as a heart surgeon, I think he was. And he just wrote an article on food is medicine. He said, I wrote a lot of prescriptions for drugs. But he said, I never wrote a prescription for food. And he started to rethink all of that and wrote a big article. I think it was in Forbes or something. And I called him up, I had dinner with him. But, you know, a lot of people are coming around realizing that plant-based plant-based diet can make a huge difference. And I think it's important that we make sure that what we're helping the seniors and others with, that something like a plant-based diet, because a lot of the food that we eat, you know this better than anybody, because what you've put out there and others is highly processed food. So they're not getting the nutrition that they need. And I think that's one of the biggest challenges. And that's why we're so excited about this bill and legislation. is to be able to move and help our seniors. I'm in an area in Sarasota, Tampa Bay area where we have a lot of seniors. A lot of them are 65 and older. This will make a huge difference and I'm very excited about it. It's bipartisan. And again, I just want to thank you for your leadership and all you've done in this area because it's helped fill in the blanks for a lot of the stuff that we're doing.

Yeah, I mean, it's I think you're right. the 40 hospitals that you sort of directed for the Center for Medicare Services Select to actually implement this approach will then provide the data to show that, yes, and we know the outcome is done right, that people will actually do better, they won't end up in the hospital over and over again, they'll need less medication, the cost for healthcare will go down, their quality of life will go up, And the goal really, I think, ultimately with this pilot program, isn't it, Vern, to actually help make this a benefit for all Medicare recipients, not just those who basically are struggling?

Yeah, well that's what we're trying to do is to test the pilot and we're hoping to get some good results out of it and they'll be able to spread it across the country. I know talking with folks locally, doctors and individuals, they're very enthused about it. I think it'll make a very big difference. and there's no question in my mind the whole idea of Food is Medicine is where we need to go and consider. And a lot of these programs they put out in the past just don't make a lot of sense. But this is an area we can work with a senior, especially if you think about Florida, but the country, it's going to be a big opportunity for us.

It's 100%. I mean, I was talking to some other day who has a company that basically works with Medicare Advantage. I know you're very focused on Medicare Advantage as a way to do innovative programs and they've done this with Medicare Advantage where they save $6,000 per diabetic Medicare Advantage patient and the average cost is about 9600. So you're saving almost two-thirds of the cost and if you do the math there's I think 65 million seniors on Medicare, 16.5 million have type 2 diabetes. If you save $6,000 per diabetic using this diet approach, basically helping them change their diet to reverse their diabetes, not just to prevent it, you would save $100 billion alone just for that one approach. So that's kind of the direction we're trying to get to where we can.

Help.

The folks in Congress and also the Congressional Budget Office, which scores these things as something that actually can make a difference in reducing costs. They often see prevention as a long-term issue that won't pay off in the short run. And I think what we're actually going to show hopefully with this is that this Medically Tailored Meals program can actually help and we can even expand on some of those things. So that's really pretty exciting. The other thing that I'm really excited about is this bipartisan congressional preventive health and wellness caucus that you started with Wisconsin Democratic Representative Gwen Moore. And I'd love to hear from you what your goals for the caucus are and how you think it can help enact new policies that are going to make a difference for people's lives.

Well, I just want to say Representative Moore out of Wisconsin is fantastic. We were just on a trip together, but the thought is, what can we do with this caucus? And we think we're going to be able to work both sides of the aisle to get the message out for this, for a lot of the things that we're trying to do. But the reality is, is that you talked about diabetics, I think this year is $412 billion just is the cost. And then you're looking at another for just heart disease, another $220 billion. How do we prevent that? As I mentioned, I've got family members with heart disease and different things. But I know if they had the right diet and exercise, that'd make a big difference. That's why I said early on, it's probably 80% of making those adjustments we could cut the cost. We're spending 1.2 billion a year on Medicare. That's going to go up quickly in a matter of four or five years.

You mean trillion. You mean trillion. You said trillion, but you mean trillion. It's hard to even say those numbers.

It used to be millions. Now it's billions and then trillions, but you're right. But the bottom line is that we've got to find a way to really start addressing the cost because Medicare is going to be one with today's basically 1.1 or 2 trillion, but in the near future, you're talking a trillion four or five, and you're not going to be able to pay all the bills. You're going to have to make some tough cuts. I'm an optimist. I hope by doing what we're doing will make that difference with your leadership. And we've got a big team of a lot of capable members, including both sides of the aisle, that we think we can weigh in and make it a big deal. And we've got to do it. there's been too much talk about it in the past, but now is the time for action.

I think you're right, and I think this is prevention and wellness so important because, you know, some things can help, like the recent reduction in prices with Medicare negotiating with pharma to reduce drug care, drug prices, I think is good, but it still doesn't address the fact that why do they need the drugs in the first place? Why don't we implement programs where you don't actually even have to use those drugs? For example, for diabetes, like this program was saying you can get most people off of that. that. And I think that what's really important is that in addition to the sort of work on the medically-tailored meals with this prevention wellness caucus, there's going to be hearings, we're going to be doing one in September, to raise awareness, but also to look at solutions and what can be implemented in a practical way and look at what's worked, what hasn't worked, and really look at legislation, research, and how do we really start to treat this epidemic of of food-related illness. The other thing I really think that has been exciting about what you've done is really helping doctors, actually physicians and primary care providers understand nutrition. And this is, I think, a big concern for you. And I know you've done a lot of work in trying to drive initiatives that make graduate medical education and undergraduate medical education provide nutrition education for doctors. Because food is the number one cause of why we're sick today in America. It's the number one cure and it's something doctors learn nothing about. So it's kind of all backwards and a lot of your efforts have been to try to work with Congressman McGovern. You sent a letter to the organization that accredits graduate medical education, AC GME, which is where the government spends $17 billion providing them with money with no strings attached and you're trying to get them to have some requirements. You're also working with some of the undergraduates. So I'd love to hear what your thinking is about the importance of training doctors and healthcare providers around nutrition.

It's shocking and you mentioned the idea that they get little or no education going through medical school. That's what it's been, but that's got to change and we're trying to do everything we can again on a bipartisan basis. A lot of these things aren't Democrat or Republican. issues or something we can both work on and make a big difference on. But we're very enthused about the opportunity as it relates to getting more education, encouraging more education. It needs to be a part of the curriculum or however they, you know, when you think about it. So I've asked doctors and I've asked a lot of them and they've had, they say they don't, they've never had one class on nutrition. And so food is medicine. You believe that, I believe it. and there's not one class in terms of that. So, and that gets back to the whole thing on the incentives are not structured properly with a lot of the doctors, how we pay people. Fee for service is something we have to look at differently because it's not always in the best interest of the patients in the system. And so that's something I want to continue to work on as well. Setting up the right incentives, especially someone that's been in business 30 years before I got in this business, you have to have the incentives right because if you don't, the train will go right off the rails. And that's what's happened here. We want to have people that are healthier not relying on, you know, having to take more drugs or get cut or whatever.

I think you're right. I think what you're talking about for those people listening is we have a system of healthcare right now where doctors get paid to do more stuff, not to actually get people better. And that's what we call fee for service medicine. as opposed to value-based care, which is what you're working on, which is how do we implement programs that paid providers and people doing the right thing, which is helping improve healthcare outcomes and reduce costs. So you get paid if you actually get people better, not just giving them more and more drugs or more and more surgery. And it's something that actually, there's already a lot of initiatives within current Affordable Care Act for this, but it really is more about care management. And what we're talking about here is something really even more radically different, which is how do we actually truly improve healthcare outcomes and reduce costs by making people healthier and using food as medicine to reverse chronic disease? And I think that's where the most leverage is and the most both possibility of ending suffering for people and also reducing healthcare costs. So I think this is so key. And you know, as you mentioned, education, my daughter's in medical school. She's in her fourth year of medical school. And basically the way it works is they just have to study for the exam. And if there's no nutrition test questions on the exam, they don't teach any nutrition. So basically the curriculum is all designed around passing the test. And if we change the test, we can change the curriculum. So I know that's another thing you're really working on and it's so exciting. I also wanna talk about this work you're doing around the military, which is so important. I think in military people don't realize you have to have healthy people to join the military. And right now, 70% of military recruits get rejected because they're unfit to fight because of obesity or other issues. And there's a whole group of, I think, 700 retired admirals and generals called Mission Readiness that have really stated this is a national emergency because the national security is dependent on us having a very able-bodied military. And we see not only people can't get in, because they're unfit, but actually when they're in, they're also costing huge amounts of money. I think the Department of Defense spends $1.5 billion a year on obesity-related health care costs for the military, and it loses so much. So how are you seeing we sort of address this sort of military readiness and the national security issue around this for the country?

As you mentioned, it's hard to believe, but 17 to 24 year olds, one in three can't get in the service because of obesity. And the military spend a billion five a year just trying to address the problem. And we've got to get back, you know, this whole concept, food is medicine. Exercise and medicine, I said it's 80%. You've got to be active, engage every day, and you've got to have a diet that makes some sense. More fruits and vegetables is a big part of it, not the only part of it. But, you know, it is a big risk that our country has if we can't find people that are able to serve. And so I think it's something we're going to work closely together with my Democratic friends. And this is something, again, very bipartisan. We think we can make a big difference in this space. But again, I appreciate your thoughts and ideas because there's probably a lot of different ways to approach it. But the bottom line is I get back to this, idea, 80%, you've got to get the diet and exercise right, especially the diet, because the food itself, because I, to go back on just because I missed this point a little earlier, but along the lines, what changed, really changed my life and I left part of the story out of it, is I read a book or something 20, 30 years ago and changed everything, because in the book was the equation and the equation simply said, the top line was the nutritional value of the food. The bottom line was calories. And how do you get the most nutritional food for the fewest calories? And so I started changing what I eat and how much I eat and everything else, and it made a big difference. So instead of, like a lot of people, you're like a yo-yo up and down with your weight, you can't manage it. I've never had to think about that again. But that equation most nutritional food, fewest calories, and work it at 80%. Doesn't mean you can't have an ice cream or do some other things, but the bottom line, it makes such a big difference. And that's something we could ideally simply implement and you might not cut one in, you might not get down to, you know, everybody been qualified in terms of the military, but instead of one in three, maybe it's one in ten. And I was in the military when I was 18 years old, and I remember they took a portion of the kids back then and you had to go instead of six weeks boot camp, another six weeks that I recall boot camp because they had to go to, you know, I think they call it the farm or something back then where they had basically work out and getting into a position where they were reasonably in shape to be able to serve. So we're all over this and we have a lot of, I want to say, military people in our area. I think I got 80,000 I represent. There's millions in Florida and other parts. They've done a lot for our country and made a big difference and a lot of sacrifices. And we need to step up and do the right thing here, too.

It's so important, Congressman, what you're doing and how broadly you're thinking about this. The leadership position you have, you're the vice chair of the Ways and Means Committee. For those who don't know what that is, it's essentially responsible for the allocation of a lot of the tax revenue and where the money goes. it's really an important committee. And you're the vice chair of that whole committee and you're the chair of the health subcommittee, which is really in charge of the biggest expenditures basically that the government makes around health care and the things you're doing to kind of try to shift this, the hearings you're having, the bipartisan work you're doing, I mean, it's really great. And you're having, also have had many other hearings as well. And you were talking about you know, helping with working with a lot of other representatives from both Republican and Democratic sides. And it's a thing that's really heartening to me to sort of go into commerce and help people understand that with our food fix campaign that everybody cares about this. You know, it doesn't matter who you are, where you're from, everybody's got somebody with somebody in their family or themselves has some issue. And this probably just got too big to ignore, you know, that movie too big to fail, it's just too big to ignore anymore. And I think in a way, I think you also understand the economics of it as a businessman, you came from business and you understand that we have to actually be fiscally responsible about what we're doing because we're gonna run out of money with Medicare if we don't actually do the right thing here. So I'm wondering just as we kind of close, what your thinking is around the willingness of Congress and the Senate and the White House to actually sort of move really forward on these issues and what the obstacles are and how people listening can actually participate and help support the work that you're doing and the work that's happening in Congress around shifting the narrative to around, using lifestyle and food as medicine and as prevention and treatment.

Well, as a business guy that's worked with a lot of numbers, I'm an optimist, but I'll share with you, we're 36 trillion in debt. We're running $2 trillion a year deficits, and you can't continue down this road. You mentioned these are big programs. You know, this whole thing on Medicare is over a trillion, it's 1.1 trillion. Social Security is 1.5 trillion. They're the two most important programs, probably you could argue in Washington. But at the same time, as it relates to the health portion, I think collectively working together, have this conversation, but have it with all the members of Congress and others, and we're not going to be able to change everything overnight. We're not going to be able to change everybody. But I think we can have positive change and have a big impact. And we've got to do it just because of financially, we've got to make sure we're doing the right thing. But beyond that, you want people that are healthy, feel better. You know, they live in you. There's a lot, Discussion today about longevity and everything else. And I know that's something you work on, Mark, and you've worked your whole life on. And look how young you look. And my point is, is that we've got to do everything we can to work together to address these issues. They're serious. They're big number issues. And right, the Ways and Means Committee, we do tax and trade, but we do healthcare, we do Social Security. All the big programs run through there and we've got it's time for leadership and make doing the right thing. And a lot of times it's politically not always correct, but we've got to move in the right direction. And I think if we do, we'll be able to have healthier people and cost us less money. That's my goal.

Thank you so much, Congressman. And I think maybe it would be also great to end by you sharing how important is for members of Congress to hear from their constituents and it actually makes a difference. You know, we think as people listening and the political process is somewhere out there in a space that none of us can influence, we're sort of helpless. But the truth is that your voices matter and that people in Washington listen and that, you know, change will happen the more pressure comes from the public and the constituents of various congressmen and senators and even the White House that have to hear what's going on. I mean, I recently heard someone telling me during the Obama administration, President Obama said to them, look, we want to do such and such and such around food reform or policy or ag, but we need cover. We need the public to actually kind of push back and say, this is what we want. So how does the actual individual out there listening start to change their behavior to advocate for the things that they want? Do they call the representatives? How do they do that? Can you talk about how people get more involved in the political process to support this?

Well, I always tell people, I've been in Congress going on my 10th term, but the bottom line is I'm humbled to be a congressman as a blue collar kid that grew up and built two big businesses, but at the end of the day, I'm a representative. I work for the people. It's not about me. And so I mentioned to all your viewers and everybody else listening to the program, they work for you and you need to go in and let them know this is really critically important. And the more momentum we can get helping Mark and others and all of us working together will have a huge impact on these programs. I'm convinced of it. There's no doubt in my mind because my own life and I know Mark's life and others, It makes a big difference and it's not that hard. I mean, you just got to have the education, the knowledge for a lot of people. There'll be some people that maybe don't feel the same way and want to go down the same road they're going down. But I believe there's a lot of people that want to feel better, look better and make it have more energy and everything else. And that's what we're trying to do with these programs. So I'm very excited and very enthused about where we're at, but there's a lot more progress that needs to be made.

That'S exciting. So we're going, I'm going to Washington in a few weeks. I'm going to have dinner with you and a whole bunch of members of Congress, and then we're going to do a hearing on September 18th. Everybody can listen in on that. And I'm just wondering what your hope for in that hearing is and how you envision that unfolding and what the outcomes you'd love to see from that are.

Well, first off, you gave me the dates. They're welcome to come to Washington if they want.

Come to Washington, fill up the room. yeah.

Yeah, they'll be excited about it. It'll be kind of a history. We're going to have not just Mark's going to be there, we're going to have some others, but Mark will be the leader on a lot of this. But if you can join us, it would make a huge difference to send a big message. But again, I just want to emphasize that I think that America is special and we've got this challenge and we need to work together to get on the other side of these issues, these health care issues and good people. feeling and looking better. I think cancer and heart disease can be eliminated. Mark could tell you more. He's a doctor. Not everything, but most of it. I mean, people that are a more plant-based diet and other things don't have these issues. You can go look at their blood and everything else. And I can just tell you, I'm very excited about working with Mark and working with our members. I think we'll get a lot of momentum with our bipartisan members that Mark mentioned. We're going to have dinner. We'll have probably 20 members of Congress there. I'm going to invite the ones that are could make a have an impact in the conference in general, have some of the leadership there. So I'm very excited about that. It's going to be a big hearing and we need to go down this road very aggressively to make sure we're doing the right thing by not only people represent, but the country as well financially.

Well, thank you so much, Congressman, for what you do for being the leader you are for taking the risk, because honestly, there's a lot of forces that are pushing back that don't want this to happen. So you're very courageous and to me it's been very exciting to work with you over the last few years, try to move the ball forward and I can see all the things that have happened. We've started conversation, you know, at dinner, I guess maybe three plus years ago and now look what's happened. We have the prevention wellness caucus, we have this medically tailored meals pilot program, we have efforts around military readiness, we have all kinds of programs that are being implemented that are in hearings happening. A lot of stuff is really moving. So I just want to thank you for sticking with it and being such an advocate and giving me so much hope for America. So thank you so much, Congressman, and I'll see you soon in Washington and we'll get our hands dirty and get this done.

Yeah, and let me just say, Mark, again, just thank you for your enthusiasm and what you bring to this. Your leadership is huge and I think collectively together with other members of Congress and other experts around the country, we can make a big, huge debt in this and we need to, but I look forward to the 18th.

All right. Thank you so much, Congressman. We'll see you soon.

Thank you. Thank you very much, Mark.

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