Choices, costs, and challenges in US healthcare: insurance intricacies, drug pricing, economic impacts, and potential reforms | Saum Sutaria, M.D.

**Peter Attia, MD** (0:11)
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My guest this week is Dr. Saum Sutaria. Saum is the CEO of Tenet Health, healthcare service company that owns and operates hospitals, ambulatory, surgery centers, diagnostic imaging centers, and other healthcare facilities. Saum joined Tenet in 2019 after working for two decades at McKinsey & Company, where he was the leader of the healthcare and private equity practice. I should note that Saum was also one of my most important mentors at McKinsey and was the individual that recruited me out of my residency at Hopkins to join McKinsey in 2006 Saum previously held an associate clinical and faculty appointment at the University of California at San Francisco, where he also engaged in postgraduate training with a focus on internal medicine and cardiology. I wanted to have Saum on this podcast to discuss the US healthcare system for a long time. The reason is, this is one of the most complicated systems in the United States. And it's one that I just didn't feel I had a great understanding of. I certainly understood parts of it, but I couldn't put it all together. And of course, part of this is that I didn't actually spend an enormous amount of time working on healthcare when I was at McKinsey. Even though I was recruited to do it and spent some time on it, I actually spent more of my time in financial services and banking. I never really got the education maybe that I wish I did. And more importantly, enough has changed in the time that I've left, that I think it was time to have this discussion from scratch. Now, my hypothesis going into this podcast was that if you understood all the dollars that flowed into the system and all the dollars that flowed out of the system, you would understand the system. And I will tell you now that that is exactly what happened. I came away from this discussion with a really thorough understanding of this, and it has actually made it much easier for me to engage in the subsequent discussions that I've had with leaders in this field. And it's made it much easier for me to digest the information that I've been reading. And I suppose you'll be able to tell by the end of this podcast, this has become a real obsession of mine, is truly understanding US healthcare from a cost perspective, a quality perspective and access perspective, and trying to understand what it will take to make this better. In this discussion, we begin with the overview of how the US healthcare system currently works, how it is structured and how these costs flow. We also do a little bit of a comparison to how the United States compares to other developed nations. We also talk a little bit about the history of how we got here. I think until I understood the history of this going back to the 1950s and the 1960s, it was impossible for me to understand some of the baggage that we have in the current system. We looked at the intricacies of insurance, looking at private insurance, Medicare, Medicaid and the challenges of employer sponsored coverage in the United States. We speak of course about drug pricing because this is one of the major areas where the United States is at a supreme disadvantage compared to other countries. We talk about the impact drug pricing has on pharmaceutical innovation and of course, the role of PBMs in addition to the administrative burdens and what role technology may play in these areas going forward. We connect healthcare spending to the broader topic of economic issues and discuss potential reforms to the system considering what might be possible in the future. I came away from this again, I make the point in the podcast with at least my objectives met, which were I wanted to emerge from this podcast with the ability to sit down with anybody, regardless of their level of sophistication and explain what is going on with the US healthcare system economically. As I said, I came away from this feeling that my needs were met and that is entirely a credit to Saum's ability to understand and deconstruct all components of the system. His breadth of knowledge is virtually unparalleled in this regard, and I am forever in Saum's gratitude. So without further delay, please enjoy my conversation with Saum Sutaria.