Fixing Healthcare Podcast

In this week’s episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl dig for the facts beneath healthcare’s biggest headlines. Today’s show opens with a problem more Americans are facing every year: rising out-of-pocket costs and the growing demand that patients pay before they receive care.

Pearl explains that the listener’s concern is increasingly the rule, not the exception. Total health costs per employee now average more than $20,000 a year, including premiums and out-of-pocket obligations. With projections for next year showing costs rising another 9% to 11%, workers are likely to shoulder an even greater financial burden.

But higher deductibles are only part of the problem. Doctors and hospitals are increasingly asking patients to pay out-of-pocket costs in advance before scheduling non-emergency procedures. Pearl says 92% of U.S. healthcare providers now either strongly encourage or require advance payment, up from 81% a year earlier. That means a patient who needs a hernia repair, gallbladder surgery, ACL repair or other painful but non-emergency procedure may be asked to pay thousands of dollars before care can proceed.

For Pearl, this is a warning sign of a larger affordability crisis. As premiums, deductibles, drug prices and hospital charges rise, medical costs are increasingly being treated like a hot potato, passed from the federal government to states, from insurers to employers and from employers to workers.

Here are the other major storylines from episode 111:

President Trump has nominated Dr. Heidi Overton to lead the FDA following Marty Makary’s departure. Her support for scaling back childhood vaccine recommendations has already drawn concern from Senate Health Committee chair Dr. Bill Cassidy.

The battle between politics and science is expanding. Pearl points to HHS hiring an Army doctor to investigate unsupported claims that thousands of U.S. service members died after receiving COVID vaccines, despite Pentagon reports finding no vaccine-related deaths.

Personalized mRNA cancer vaccines remain one of the most exciting areas in oncology. Early Moderna and Merck data in melanoma are promising, though the full results have not yet been published.

A new FDA-approved drug for advanced pancreatic cancer has generated enthusiasm because it extended life in patients who had already failed chemotherapy. But the drug is expected to cost about $480,000 a year.

The Lone Star tick is spreading beyond the Southeast into New England and the upper Midwest. Unlike the deer tick associated with Lyme disease, the Lone Star tick can trigger a potentially dangerous allergic reaction to red meat.

Measles cases are rising at a record-setting pace in 2026, with preventable deaths occurring among unvaccinated individuals. Falling immunization rates put the United States at risk of losing its measles elimination status.

Employers are bracing for the largest healthcare cost increase in two decades. Some are responding by dropping GLP-1 coverage, limiting spousal coverage or shifting more costs to workers.

New evidence from Amsterdam supports the value of long-term primary care relationships. Patients who saw the same clinician for 15 to 20 years had lower odds of emergency hospital admission, and cost reductions appeared strongest among those with relationships lasting 10 to 15 years.

In a comparison of tirzepatide and semaglutide for weight loss, Pearl says tirzepatide produced greater weight loss and slightly better A1c reduction, while semaglutide had fewer reported side effects. He emphasizes that both drugs are highly effective and that cost is often the main reason patients stop taking them.

The episode closes with Pearl’s provocative thoughts on generative AI. He says the time has come for healthcare professionals to stop denying its clinical power.

Pearl acknowledges the existential risks associated with advanced AI, but says the same capabilities also create enormous opportunities to improve outcomes, save lives and make care more accessible and affordable. American medicine, he argues, is not performing well enough to defend the status quo. Misdiagnoses, preventable medical errors and poor chronic disease control continue to kill hundreds of thousands of Americans each year.

Meanwhile, patients are already turning to ChatGPT, Claude, Gemini and other large language models when they have symptoms or medical questions, especially when doctors’ offices are closed or appointments are days or weeks away. Pearl says the question is no longer whether generative AI will provide clinical expertise to patients. As both a physician and a patient, he hopes healthcare professionals seize the opportunity before someone else does.

Tune in to hear the full discussion and subscribe to Medicine: The Truth for more fact-based analysis of the medical, scientific and policy stories shaping American healthcare.

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Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine.

Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn.

The post MTT #111: Why are patients paying more before they get care? appeared first on Fixing Healthcare.

With healthcare costs projected to rise sharply next year, Fixing Healthcare with cohosts Dr. Robert Pearl and Jeremy Corr revisits one of the most popular conversations of the year: an interview with Mark Cuban, entrepreneur, longtime Shark Tank investor, former owner of the Dallas Mavericks and founder of Cost-Plus Drugs.

Cuban has built his healthcare work around a deceptively simple idea: patients, employers and clinicians should be able to see what things actually cost.

That should not be radical. But in American healthcare, transparency can feel disruptive because so much of the system depends on complexity, opacity and hidden incentives.

In this rerun episode, co-hosts Dr. Robert Pearl and Jeremy Corr return to Cuban’s blunt diagnosis of what is broken in healthcare. His argument begins with prescription drugs, where pharmacy benefit managers, rebates, spread pricing and opaque contracts often leave patients paying far more than they should. But the conversation quickly expands beyond medications to the broader dysfunction of American medicine.

Cuban’s approach to drug pricing is straightforward. Through Cost Plus Drugs, the company shows patients the actual cost of a medication, adds a flat markup and eliminates many of the middlemen who benefit when prices are hidden. The result is a model built not on secrecy, but on visibility.

That philosophy matters even more now, as patients and employers brace for rising healthcare costs. For many Americans, affordability is no longer an abstract policy concern. It determines whether they fill a prescription, schedule a visit, delay treatment or avoid care entirely.

Cuban’s critique is that the system is not merely complicated. In many ways, it is designed to be complicated. Patients struggle to understand what they owe.

Employers often do not know whether they are receiving the rebates they were promised. Doctors waste time fighting prior authorization, billing complexity and administrative rules that make care slower and more frustrating. Meanwhile, the organizations that benefit from opacity have little incentive to simplify anything.

The episode highlights several of Cuban’s core arguments:

Drug prices are often detached from manufacturing costs, clinical value and common sense.

Patients in deductible phases, especially those with ACA plans, can bear the full financial burden while rebates and savings flow elsewhere.

Employers often assume their pharmacy benefit contracts protect them, when the details may tell a different story.

Complexity protects incumbents by making it difficult for patients, clinicians and purchasers to see who benefits from the current system.

Transparency gives patients and employers leverage by exposing prices, incentives and financial arrangements that otherwise remain hidden.

What makes Cuban’s perspective powerful is that he comes to healthcare as an outsider. He is not defending legacy structures, professional norms or institutional habits. He asks a simpler question: if the system were designed around patients, would it look anything like this? For Cuban, the answer is no.

That is why this conversation remains timely. As healthcare costs continue to rise, marginal reforms and better messaging are not enough. Patients need affordability. Employers need visibility. Clinicians need less administrative friction. And the system needs incentives that are easier to understand and harder to hide.

Cuban’s message is that healthcare does not need more opacity, more jargon or more excuses. It needs sunlight. Listen again to this conversation with Mark Cuban and decide for yourself: if transparency can lower drug costs, what else in healthcare could it change?

Helpful links:

Original Mark Cuban episode

Mark Cuban Cost Plus Drug Company

ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn.

The post FHC #229: Revisiting Mark Cuban’s prescription for lowering healthcare costs appeared first on Fixing Healthcare.

With all the turmoil surrounding healthcare and artificial intelligence, the Fixing Healthcare team is revisiting one of its most provocative conversations: an interview with entrepreneur, investor and technology visionary Vinod Khosla.

When Khosla appeared on the show in November 2024, he made a claim that drew immediate criticism from many in medicine: “The most expensive part of the healthcare system is expertise. And expertise can be tamed with AI.”

At the time, many listeners and social media commenters saw the statement as overly optimistic, even dismissive of the complexity of clinical care. Today, it sounds less like provocation and more like a prediction medicine is still struggling to absorb.

In this rerun episode, co-hosts Dr. Robert Pearl and Jeremy Corr invite listeners to hear Khosla’s remarks again in light of today’s rapidly changing AI landscape. He does not argue that technology should replace the human elements of medicine. Rather, he argues that AI can expand access to expertise, reduce the cost of routine clinical knowledge and make high-quality guidance available to more people in more places. For rural communities, patients with chronic disease and individuals waiting weeks or months for care, that possibility remains deeply consequential.

The episode also asks a larger question: What happens if healthcare moves too slowly? Listen again to this timely conversation with Vinod Khosla, and decide for yourself: Was he too optimistic about AI in medicine, or too cautious?

Helpful links:

Vinod Khosla: How venture-backed tech is transforming U.S. healthcare (FHC #153)

ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine (Pearl’s newest book)

Khosla Ventures (Official Site)

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.

The post Revisiting Vinod Khosla’s vision for AI-powered healthcare appeared first on Fixing Healthcare.

In this episode of Fixing Healthcare, Dr. Robert Pearl and Jeremy Corr welcome back Dr. Rod Rohrich, an internationally recognized plastic surgeon, former editor-in-chief of Plastic and Reconstructive Surgery and national leader in the application and safety of social media for medical advancement.

Dr. Rohrich, a returning guest (FHC #57), focuses now on the healthcare concerns most affecting Americans today. Drawing on his experience with patients, physicians and a massive social media audience, Rohrich identifies three questions he hears most often:

Can I trust my doctor?

Is this information true or merely popular?

And can AI really help me understand my health and make it better?

These questions frame a conversation about generative AI, patient empowerment, medical misinformation, physician compassion and the future of clinical practice.

Can I trust my doctor?

Rohrich says patients want the speed of AI and the accessibility of social media, but they still want the compassion and judgment of a trusted physician. He and Pearl agree that AI will not replace doctors, but it can help patients ask better questions, understand their conditions more quickly and arrive at appointments better prepared. Rohrich sees this already in plastic surgery, where patients bring questions, research and even AI-generated summaries into consultations. Used well, he says, AI can streamline the visit, clarify patient goals and help physicians focus faster on what the patient needs.

Is this information true or merely popular?

Rohrich’s social media experience gives him a clear view of the problem. Patients are bombarded with claims about longevity, sleep, fitness, supplements and medical treatments, often from influencers with no healthcare background. His practical advice is to use generative AI as a filter: ask tools like ChatGPT or Claude to evaluate claims based on peer-reviewed, evidence-based research and supporting references. Pearl connects the point to peptides, noting that enthusiasm is not the same as evidence. Both physicians argue that patients need better ways to distinguish science from marketing.

Can AI really help me understand my health and make it better?

Pearl and Rohrich see AI’s greatest promise in making care faster, more personalized and more humane. Rohrich shares how AI helped identify a postoperative infection from a patient photo and generate clearer instructions for home care. He also describes using AI to write more empathetic responses to anxious patients. Pearl adds that ambient AI tools can free doctors from computer screens, while future applications could help patients understand hospital care, test results and next steps. The goal, both agree, is not to remove humanity from medicine but to use technology to restore it.

Jeremy closes the show with a patient-centered concern: What happens when people receive lab, MRI or CT results through an online portal late at night, without a physician available to explain them? Rohrich says AI is already better than Google at providing context, but it must be used carefully because partial information can produce partial answers. Pearl argues that the answer is not to fear the technology, but to make secure, private AI tools more complete, accurate and useful for patients.

The episode ends with Drs. Pearl and Rohrich laying out a shared vision. Generative AI should not replace physicians. It should take work off their plates so they can focus on what only people can do: solve complex problems, communicate compassion and guide patients through frightening moments. For Rohrich and Pearl, AI offers a chance to make medicine faster, smarter and more human, but only if doctors and patients learn to use it well and keep evidence at the center.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn.

The post FHC #227: Dr. Rod Rohrich on social media, science and AI-powered care appeared first on Fixing Healthcare.

In this Diving Deep episode, Dr. Robert Pearl and Jeremy Corr examine two very different healthcare debates that share a common problem: when medicine lacks good evidence and aligned incentives, patients and doctors are left with bad choices.

The conversation begins with experimental peptides, a fast-growing topic on social media and in wellness circles. Dr. Pearl reviews the FDA’s ongoing debate over whether six experimental peptides should be made available to licensed compounding pharmacies. Supporters argue that Americans are already buying these substances through the gray market, often from overseas suppliers, and that regulated access would be safer. Critics argue that expanded access would encourage far more people to use products whose benefits, risks, purity and long-term safety remain uncertain.

For Pearl, both sides are partly right, which is why a simple yes or no is the wrong answer.

Saying no would not eliminate demand. It would leave many Americans buying peptides online without reliable quality control. Saying yes without conditions would create the impression of FDA approval without the scientific evidence normally required to prove safety and efficacy. Instead, Pearl argues for a third path: pair regulated access with federally coordinated research, safety reporting and controlled studies so patients, doctors and regulators can learn whether these peptides actually work and whether they are safe.

The second half of the episode turns to primary care, a specialty Pearl says is in serious trouble.

Primary care physicians are overburdened, under-resourced and underpaid compared with specialists. They face growing patient panels, administrative demands, declining autonomy and less interest from medical students entering the field.

Pearl acknowledges that primary care leaders are right to ask for more respect, more support and better compensation. But he argues that payers are unlikely to invest substantially more unless primary care can demonstrate better outcomes and lower total costs. That has not happened consistently under traditional fee-for-service or pay-for-performance programs, which reward isolated steps in care rather than overall clinical impact.

The solution is capitation. Under this model, primary care doctors would receive a prospective payment to care for a defined population rather than being paid for each visit or service. If chronic diseases are controlled, emergency department use falls and complications decline, both patients and clinicians benefit. But capitation also requires doctors to accept financial risk, organize into larger groups, adopt common clinical standards, coordinate care and empower effective physician leaders.

The episode closes with a call for national primary care societies to lead. Pearl says they can help doctors form groups, negotiate capitated contracts, purchase stop-loss protection, implement generative AI, build clinical infrastructure and spread best practices from early demonstration programs.

Across both topics, Pearl returns to the same point. Whether the issue is experimental peptides or the future of primary care, patients need evidence, doctors need accountability and the system needs incentives that reward better health.

For more, tune into this month’s episode and check out the link below.

Helpful links:

The Best FDA Decision On Peptide Authorization Isn’t Yes Or No (Forbes)

Monthly Musings on American Healthcare (RobertPearlMD.com)

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Dr. Robert Pearl is the author of ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.

Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn.

The post FHC #226: Peptides, primary care & the false choices in American medicine appeared first on Fixing Healthcare.