Full episode transcript.
*Please note that this podcast transcript has been autogenerated and may contain errors or inaccuracies. We recommend referring to the original audio for the most precise representation of the content.
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Stephanie Wierwille: [00:00:00] This is the no normal show brought to you by BPD. This is where we leave all things status quo, traditional old school, and boring in the dust, and celebrate the new, the powerful, the innovative, the bold, while delivering the future to healthcare’s leading brands. I’m Stephanie Rear, EVP of Engagement here at BPD, and I’m joined as always by Desiree Duncan, VP of Health Equity Inclusion, and also Chris Bevelo, chief Transformation Officer.
Hello, Dez.
Desiree Duncan: Hi. Great
Stephanie Wierwille: Hi, I’m excited. Hello, Chris.
Chris: Hello, Stephanie? Hello. Dez. Can see you both on this beautiful Monday morning.
Desiree Duncan: Is it spring yet?
Chris: Yes,
Stephanie Wierwille: Oh, the Minnesota, and says it’s spring. That’s a big deal.
Chris: spring. Yeah.
Stephanie Wierwille: Okay. Okay. It’s definitely spring in Nashville. I walked outside for two minutes this morning and I ba ba. Baked both in the glory of the sun and the birds, and [00:01:00] it was lovely. So I’m, I’m, I’m bringing a sunny attitude to this somewhat difficult, uh, topic we’re gonna talk about.
Desiree Duncan: Love
Stephanie Wierwille: So, speaking of our topics, um, we are, we have a couple quick headlines to get into. Number one, there’s some new research that, uh, we’ve done around the future of this. Chief marketing officer. And so Chris will talk to us all about that. Uh, we’re also gonna talk about the potential TV ad ban that’s happening in the pharma industry.
Um, and then our main topic today is, um, all around how the, the major shifts in US policy and potential economic wave coming at US will affect healthcare. Um, yikes. Uh, not so sunny of a topic, but it’s really important. Um, extremely important. I know it’s forefront of everyone’s minds right now. So we’re gonna get into it and, um, yeah, we’re gonna get into it.
Desiree Duncan: We should start off with the theme song from, it’s Always Sunny in Philadelphia. It’s always sunny in healthcare. It feels [00:02:00] like these
Stephanie Wierwille: Hmm mm-hmm.
Chris: That is one show I have not watched. I am, I am, get, I get a lot of, um, hard times for not having to watch that show.
Stephanie Wierwille: Okay. I haven’t either, Chris, so I’m, I’m with you. Des can teach us. Speaking of shows, uh, quickly, we’re going to, first, before we get into this, we have to close the loop on the White Lotus because I don’t, we didn’t plan for this to be a White Lotus podcast season, but it kind of turned into one ’cause all three of us were watching.
And again, it was, it was hot, hot, hot in the, in the media and in pop culture. So, uh, white Lotus has ended and we’ve gotta close the loop on that. So, um, I’ll toss it to you first, as.
Desiree Duncan: I, I don’t. Don’t know, I guess I enjoyed, but then also it was kind of like a lot of loose ends, a lot of conversation around it. But mostly what I’ve been excited about was going back to terrestrial TV times where everybody’s watching it at the same time. Because like if you didn’t watch it by, by Monday morning, it’s gonna be spoiled by all the memes [00:03:00] and all the creations on the Internets. Um, but yeah, justice for our girl, Chloe.
Stephanie Wierwille: Um, I will never look at my smoothies the same way you all know I’m drinking smoothies every time we talk. Um, so there’s that.
Desiree Duncan: You will always wash out, uh, that cup.
Stephanie Wierwille: Yes, exactly. I saw a meme, speaking of meme, says there was one that was like, um, anyone who doesn’t wash out a, a, a smoothie, uh. You know, cup before they use it should be punished. So.
Chris: Wow, I didn’t
Desiree Duncan: Well,
Chris: smoothie. Smoothie rules.
Desiree Duncan: well that’s disgusting to leave whatever gunk was in there before and just like start a new the next day with the same gunk. No, thank you.
Chris: But see, I’ve heard the actor challenged on this on of the late night shows. They’re like, why would you, why would you make, why would you use stuff from the other day? And he is like, well, I didn’t, I thought it was, I thought his brother, [00:04:00] he said, the actor said, my motivation was, I thought my brother made a protein smoothie. I remember the brother had said the day before. going to make you a man. You have to make one yourself or something like that. And so he is like, all right, fine. I guess I’ll just join the, the bro club. And he thought it was a protein. His brother had just made a protein smoothie, so he just made another protein smoothie. makes sense, doesn’t it?
Desiree Duncan: No,
Chris: inside probably would’ve been all and dry.
Desiree Duncan: exactly.
Chris: I that, that pot line, um, that was the only thing I was disappointed with. Like, this sounds macab, but I, he should have died. It’s spoil our alert. Like that’s classic White Lotus.
Classic White Lotus is an inadvertent death. If you haven’t seen the first two seasons. I won’t say who died, but they were inadvertent. You know, it was kind of like a, a collection of unfortunate moments and journeys that led to an, to a, to a inadvertent death. And that’s what that was. Even though it was, you know, it was a little more complicated. Um, [00:05:00] so, so when he came back, I was like, well, why? Why? Why did they do that? That’s weird. But I love, I love White Lotus. Now we have to switch to last of us season two, but I won’t pull you guys into that if you’re not watching it.
Stephanie Wierwille: Oh, okay. We did notice one, um, interesting brand. Well, there was a lot of brand partnerships around White Lotus, I saw away, had a whole series of white lotus bags, but one that caught my eye, we talked about, um, was Coffeemate. They launched a pina colada flavored creamer. Oops. Um, did not knowing what the plot was gonna be, it was kind of giving the Peloton moment from Sex and the city for me a little bit.
But, um, Chris, you said you actually had one of these.
Chris: Uh, we did buy some coffee mate, uh, Thai iced coffee, white lotus creamer.
Stephanie Wierwille: Okay.
Desiree Duncan: Now that
Stephanie Wierwille: Okay.
Desiree Duncan: T Ice tea, but yeah, the Pina colada, L-O-L-L-O-L-L-O-L.
Chris: colada coffee creamer to start with is a bad idea. Let’s just
Stephanie Wierwille: fair?
Chris: that. Um, yeah. And then plot twist, not not great.
Desiree Duncan: [00:06:00] don’t like
Stephanie Wierwille: Okay.
Desiree Duncan: and pineapple flavor in your coffee, Chris?
Chris: I don’t, but maybe others do. Does to
Stephanie Wierwille: So anecdotally, I guess it worked for their, for their sales if you were buying, if you were out there buying the collaboration. Um, so let’s jump into our headlines. Um, I guess that’s the last we’ll talk about White Lotus this whole year. Huh? That’s sad.
Desiree Duncan: RIP.
Stephanie Wierwille: RIP. Okay. So Chris, I would love for you to share a little bit of about what’s coming with the, um, upcoming white paper and research that BPD is producing, um, releasing very soon around the future of the Chief marketing Officer.
So tell us what, what is this and what should people be looking at for.
Chris: Yeah, so we’ve talked about this for some. Time I’ve been on the podcast talking about it. We’ve done all kinds of stuff, which I’ll recap quickly, but, uh, I, I guess it was the summer of 2023 when we first started talking about these new threats that we saw to the CMO role. Uh, we termed that Rome is [00:07:00] burning. and since then we’ve had multiple conversations. We’ve had panels at conferences. We had the Joe Public Retreat in December, which was a. Which was themed around the future of the CMO. Uh, and we have talked to a few dozen CMOs and some CEOs about what that future looks like, and that is in the. the face of challenges such as AI that is in the face of challenges such as, uh, though we’ll talk about today, how those challenges may, may change given the new world. Uh, but the idea that we have seen an historic combination of low supply of. Of those who deliver care. At the same time, we’ve seen historic highs for demand of care because of the baby boomers, uh, leaving people with full hospitals and questions like, why do we need to market if we can’t even help the people who are just walking in the door? and so we have pulled together. Uh, a very comprehensive look at [00:08:00] all of that. We have, uh, pulled all the research together, compiled all the research, uh, kind of updated those challenges because again, it was two years ago when we first started talking about them. Uh, so we update the challenges and then we, uh, more importantly, I think talk about, uh, you know, like we like to say, um, chaos isn’t a pit, chaos is a ladder.
So while there are. Material challenges to the CMO role at health systems right now. There are also incredible opportunities, uh, that emerge from our conversations. And so we spend more time on what should you should do as A CMO. And again, as we’ve said for the last couple years, uh, as the CMO goes, so goes marketing.
So this isn’t just about the CMO role, it is about marketing and its place in the health system organization and the value it brings. So we will have this paper ready. Uh, for distribution. In fact, uh, I believe we will have it ready this week. So, uh, we will post a link [00:09:00] we share out the podcast, and allow people to download it. Uh, and, uh, we would love to hear feedback when people get their hands on it get through it, see what they think.
Stephanie Wierwille: Awesome. I’m super excited about it. I’ve had a sneak peek and it is, is really thorough and really, really interesting. So Sounds like, uh, look, look for that in the show notes so you can see where to get it and when to get it.
Chris: yes, and we will cover it next week. We’ll do a deep dive on it. So if you, if you don’t like to read, apparently Gen Z or go back to the generational conversation. Gen Z doesn’t read anything, is that what I’ve told? Anyway, if you don’t want to read the thing, we will cover the main points, uh, in next week’s podcast, so stay tuned for that.
Stephanie Wierwille: Awesome. I’m excited. All right. Next headline, um, is. That there is a proposed ban for the pharma industry on TV ads. So RFK Junior has floated a potential ban. And, um, we’ll dig [00:10:00] into all of what this means and, and, and specifically what, even what do we mean by tv? But, um, the US is one of two countries that actually allow direct to consumer pharma, pharma advertising.
So the US and New Zealand and in other countries like Canada, the uk, Europe, et cetera. Um, there is. Not TV ads allowed for pharma. And the reason is because they don’t offer that same protection around the First Amendment. So Chris, you noted this has actually been floated before. This is not new. Um, uh, so we’ll, we’ll talk a little bit about that and whether we think this will actually happen.
Um, Des I would love to hear, what do you think about this? What have you been considering as you’ve seen this, this headline floating out there?
Desiree Duncan: I mean, speaking of not new, we saw this of course with cigarettes. Um, the band started at, I believe, you know, seventies, sixties, seventies, and what have you. And so in a way it feels very much in line with that. And, you know, as a consumer, as a person is health conscious. I, would almost [00:11:00] say that it’s. Definitely, you know, needed from a safety standpoint of just having folks just kind of come in, not knowing anything, but just saying, Hey, I saw this ad, like I wanna get on this particular med. The flip side of that is my, my concern as a health consumer would be, okay, am I gonna be getting pressed for these different ones?
Is this gonna, is this kind of advertising gonna be coming directly from my provider? You know, are they going to be more of the mouthpiece for this, um, more so than they may be now? Um, and then what kind of position does that then put health systems in from that standpoint? But that’s kind of where my mind goes is from that consumer mindset of, yeah, I’m tired of seeing these.
Okay, it’s gonna give you this, but then it’s gonna take away all these different things, these ads, that’s like very confusing. But I don’t know. What’s your take, Chris?
Chris: My favorite part of pharma ads are when they’re like, um, do you have headaches? Try [00:12:00] gorville. The new, the new medication from Gorville pharmacies. Side effects include headaches, like when the side effects are the same thing that you’re taking it for. Like, that’s like universal. Uh, I have two thoughts on this. Um, one, yes, as long as I’ve been in this business, which is longer than I will share right now, this has been floated at various places, usually at the state level. So, for example, being in Minnesota, uh, former governor Tim Ente in 2006, uh, floated the idea of banning in Minnesota, uh, direct to consumer pharma advertising on tv. So, and I know that, uh, we have followed it even before then and since then, and yeah, usually the courts strike it down, uh, if it ever gets to a legislative kind of thing, because it is a First Amendment. Now they, what’s interesting to DE’s point is, well, why didn’t that work for the cigarette companies?
I think the difference is cigarettes were found to be harmful and addictive, [00:13:00] and that gave people the right to whoever did it, the government, um, to ban them. Where you can’t say that about pharmaceuticals. Of course, they can be. That’s not what they’re intended. So I, I don’t know that it’ll go anywhere.
But these days, who knows? knows, like it’s a whole new world with the courts and everything. The other thing I will say is, uh, the reason why I think this is important for our audience is if it does go, if RFK Junior does have his way and the courts don’t stop him, uh, I would not be surprised if they turn their eyes to nonprofit healthcare. What’s the, what, what’s the difference? Right? What’s the difference? These are, uh, but in both cases they are just different sources of care. One’s a pharmaceutical, one’s a physical source of care. Uh, the same arguments could hold, uh, obviously, again, it’s a, it’s a market driven. System, whether we like it or not. health systems and pharmaceutical companies have to compete for [00:14:00] patients. So, I feel like, I feel like all of that is trying to treat the symptom of a bigger issue, which is the system. If you don’t like the system, that’s one thing. but you can’t blame either of these two, like it or not, for trying to do the thing they have to do to survive as organizations.
So that’s my thought.
Stephanie Wierwille: Yeah. Yeah. And I, I think it, I agree with you that it’ll, it’ll be a very small chance that this actually goes through, especially because, you know, I’m sure pharma’s already making calls, but also the ad industry, right? So this is a $5.3 billion spend, uh, in 2024 alone on TV ads that pharma spent. So that would be a huge blow to, to TV’s, uh, ad revenue.
I would actually venture to say this would, this would, we would probably see. Even more, um, uh, you know, reduction in the ability for some of these TV networks to survive. Um, but also how do we even define what is TV and the, I I think that as these conversations happen, that definition [00:15:00] will get narrow and narrower.
So maybe, maybe, maybe, you know, broadcast TV would be off the table, but I think it would be very, very far to say, okay, no streaming, no YouTube, no social video, no digital video. And so. If that happens, if there were something that goes through, it would probably be, in my opinion, pretty narrow of a definition and we would just see more ad money fuel into the digital, social streaming side of things, which I’m sure meta would be very excited about.
So, um, I, I think, Chris, your point is really interesting, which is will, will the eyes shift to nonprofit health systems? Um. And our friend, Paul Keckley, uh, author of the Keckley Report, has talked to us quite a bit about how this year he expects more eyes to be on nonprofit systems in terms of spending.
So maybe that segues us into our, our main topic here, but any last thoughts on this headline before we go into our main topic?
Chris: Just keep an eye on it, I guess.
Stephanie Wierwille: Yeah, we’ll keep monitoring it, we’ll see what happens. so we’ll move to our main topic. Um, and we’ve been covering [00:16:00] policy pretty heavily this year on the No Normal show because it is, uh, it is, it’s happening. There’s a lot of shifts happening in the policy world that’s affecting healthcare. I. So we’ve touched on it, um, a little bit over the course of the last few episodes, but we really wanna dive deeply today.
And also, just a quick reminder, uh, BPD is also producing ongoing real-time content around healthcare policy changes. We call it policy ICU, um, and you can sign up for policy ICU we’ll, we’ll drop that in the show notes as well. But it’s something that, you know, is changing by the minute, so we wanna really keep our eye on it.
Um, but in thinking about the big macro picture here, so there’s a lot that is affecting, um, the healthcare industry and it’s sort of a perfect storm or a non-perfect storm, if you will, in terms of how it affects healthcare. So first of all, we see. A really, really big change is happening to federal funding.
So we’ve talked in previous episodes about NIH, uh, cutting [00:17:00] funding, and that’s even hitting AMCs. We’ve, we, uh, we are seeing across the board where there’s growing fear of funding loss and so that, um. Is is certainly tied to the larger picture, but it’s also tied to this shift on DEI and health systems having to consider how do we talk about DEI or not talk about it in this world where you might see funding changes.
Additionally, of course, tariffs, tariffs, tariffs is. Is all anyone’s talking about. Um, you open any app and it’s all about tariffs. And so, um, that is affecting healthcare and will affect healthcare depending on how it shakes out. And then the really scary one is a potential economic downturn, which might be headed our way.
Um, that recession word is now starting to, uh, be more and more in the forefront. So all of this is coming together and creating that non-perfect storm. Um, so we’ll get into each of these. So let’s just start with federal funding first. Um, Chris, what’s been on your mind as you’ve been thinking of, of how health [00:18:00] systems need to, what they need to be watching and, and, and what can they do at this moment?
Chris: Yeah, so I’ve been talking to a lot of CMOs actually about this. Um, and it’s interesting because right now, uh, even though we have heard about the NIH cuts, uh, obviously that’s been going on for a while. The, the word I’m getting is that it’s not impacting operations yet, and that’s understandable because it’s. Uh, you know, there’s, there’s lawsuits that are fighting back. Uh, some of this is executive orders, which aren’t really laws. So, you know, there’s, there’s one system, um, that I talked to that said like, look, we’re not, we’re not acting on anything that’s not law. Right. There’s all kinds of stuff flying everywhere, and until we are forced to, we’re not gonna make any kind of changes or cuts or anything like that. All of that said, uh, most of them are also doing some significant scenario planning, uh, because they have no idea where all this will [00:19:00] go. Uh, particularly the AMCs, if we’re talking about the N-I-N-I-H funding cuts, uh, and they’re looking at, in some cases, you know, seven figure hits, maybe higher. Um, to their revenue if they lose as much as being as, as being threatened.
So, uh, we work with some of the most prestigious AMCs in the country, so it’s understandable. They have a huge source of funding from NIH where they to lose that. Uh, the other thing I, I’ll just say real quickly, we don’t have that in our, in our list, but it’s kind of like a side effect of this. Uh, one of the, one of the folks I talked to mentioned that. Um, and I don’t, we should probably look this up to see how true it is. but as this NIH funding goes, so goes some of the smartest people in our country. So NHA funding is used by top scientists, si top healthcare researchers, uh, to, to try to find everything from a cure to cancer to to the next, you know, covid vaccine, whatever it is. [00:20:00] Uh, and she mentioned that Europe is recruiting hard. So in other words, that funding goes, we’re gonna lose those people, uh, and it’s gonna be very hard to get them back. So that’s just a little side effect of that. Uh, so right now I think it’s people are taking a little bit of a wait and see, but they’re planning for some pretty big impacts.
Stephanie Wierwille: Yeah. And just to put some numbers behind, you know, what you’re saying of, of what, uh, health systems can expect. There was some, some news out of, out of the state of Minnesota. There’s another, um, shout out to your home state, Chris. Um, but the, the, the, the, um, outlet of out of Minnesota said that these NIH cuts could actually affect, um, systems like Mayo Clinic and the University of Minnesota at the tune of 50 to $60 million per year.
So. You know, that’s just one example, and that’s just because of the major ripple effect of, of these cuts. Um, so Des des as, as you’ve been looking at this from your vantage [00:21:00] point, uh, what’s, what’s hitting with you? I know you’re really close to some of the conversation, especially around some of the funding challenges specific to DEI and health equity.
Desiree Duncan: Yeah. Where some folks are kind of sitting and wait and see until they act. Absolutely have to do something. As Chris mentioned, um, those that are focused on health equity, DEI, inclusion and what have you, are having to do some preemptive work in order to just not bring any heat. Their way, essentially. and so a lot of that starts with, with language, you know, what, what term, what terminology we’re using, especially given a lot of the, um, bans that have come through some of these executive orders. Um, so as we’re looking at terms that were, you know. Uh, use quite a bit with the health, equity, diversity, what have you. Now you’ll see more of a switch to neutral language such as, you know, health access or healthcare for all. And in fact, we started to see remnants of that during the Super Bowl, uh, with some of those commercials that had huge [00:22:00] inclusion focuses.
They switched to more of a dot, dot for all. Uh, or if you’re looking at this from a talent or HR standpoint, you’re looking at, um, seeing more terminology around, you know, opportunity, workplace wellbeing, uh, emphasis on culture, um, which obviously has been having quite a, a, a time these last year or two. Um, but yeah, it’s this situation of, you know, whether you are kind of. Putting your head in the sand, trying to, um, stay under the radar. Or maybe some organizations that are kind of keeping their, um, their flags in the sand of this is the work that we’re still gonna continue to do. But so much of this is about like, how do we talk about it and like, did we talk.
Too much about it. Do we bring too much attention to it? And does that actually lead to a focus on the action or just talking about it? So my prediction is more of a seeing folks actually like, okay, we talked a lot about this, but like, what are [00:23:00] we actually doing? And so maybe this gives an opportunity to do, to enact the actual change that they’re looking for, that’s
Stephanie Wierwille: Y this is a really tough one. Yeah, it’s, it’s, I just wanna. Acknowledge, you know, our, our, our marketing and communication friends, it’s so stressful. This is so stressful. This is so difficult. This is so challenging. And you know, Kristy, your point, you know, some organizations are saying we’re not gonna change, and others are saying, Hey, we have to be proactive.
And that’s a strategic decision that’s coming from the top. And so marketing marketers and communicators are the ones that are having to. Think about the language. Des as you noted, mark marketers are the ones that are having to say, okay, what language do we use? And we need to go, you know, check out where we’re using it and how, and in some cases, they’re getting that directive top down.
And in others they actually have the ability to, um, maybe make some of those strategic decisions. So I just wanted to acknowledge this is really, really, really tough. Um, and many of our friends out there are deeply, [00:24:00] deeply, you know, struggling with it.
Desiree Duncan: Yeah, it’s felt like a several steps back. It’s felt a a bit defeating. Um. But it’s like, how do you, you know, keep going in this world that you have dedicated your life to? You know, how do you find that kind of glimmer of hope? And it’s like anywhere you can is the goal.
Stephanie Wierwille: Yeah. So one last point, um, in the overall topic of federal funding is that we’re also seeing possible Medicaid cuts. And, um, that’s gonna have a major, major impact because, um, cuts on Medicaid, um, will of course impact the, um, the ability to get paid for services. And we’ll, we’ll circle back to that in a little bit around how that may, um, also affect the affordability of care and, and what fa.
People are actually able to access. But Chris, do you wanna tell us a little bit more about what you see in this area?
Chris: Just real quickly, like, you know, right now it’s kind of like a political hot potato because you see the [00:25:00] um, bill. that passed the house calling for significant cuts, uh, to the area where Medicaid is actually funded. It doesn’t say Medicaid cuts, but the amount of cuts, um, interestingly is almost exactly the amount of Medicaid funding.
And so they’re going to have to cut that from something. And when you do the breakdown there, there’s almost no way it’s not going to impact Medicaid to one degree or another. so yeah, that’s, that’s, uh, if there’s Medicaid funding, that means there’s cuts. That means there’s people without Medicaid, but they still need care. and if it’s emergent care, hospitals have to treat them. Uh, and ethically you should help people even if it’s not emergent. So, uh, but the, those folks are in Medicaid because they don’t have a lot of money. so they’re not going to all of a sudden be able to just pay outta their own pocket. So usually that means that’s a write off for hospitals and health systems who have to deliver that care. Uh, Medicaid is not funded at a, at a, an appropriate level to start with in [00:26:00] many cases. Um, so it’s just, it’s just to your point, gonna add more financial stress. But we’ll talk about the, um, that could usually be kind of like exponentially worse, uh, as we get down to these, to the final, the final potential impact of what’s going on right now.
Stephanie Wierwille: Yes, yes. So just to put some numbers around that, um, as of, uh, uh, a couple days ago, the Kaiser Family Foundation estimates $880 billion in Medicaid cuts. So that’s some pretty significant stuff. Um, and, and again, you know, all of these things, I think. Map together in a way. There’s a little bit of gray area.
So let’s move to our next key, uh, subtopic here, which is becoming a four letter word. It’s not a four letter word, but it should. It should be. And that’s tariffs. Um, so of course everyone’s talking about tariffs and the implications to businesses, to every single industry and the constantly changing, uh.
Amount I was trying to find this morning, what is the [00:27:00] current, as of this morning, percent of tariffs across industries and it’s just changing by the hour, so I didn’t even try to pull it in. Um, but you know, this will really affect healthcare, um, specifically because health systems especially, but healthcare organizations of all kind.
Um, certainly their supply chains are global and everything from needles to syringes, to gloves to whatever it is, um, come from other countries, especially China. And so this will drive up costs for healthcare organizations and put an even more strain on the financial situation. So Chris, um, what are you seeing around tariffs?
What are you, what are you looking at regarding, uh, healthcare spending?
Chris: I am no tariff expert. All I know is what you’ve said, which is it’s all over the place. Even over this past weekend, uh, you know, there were, there were different messages coming out of the administration. I. Uh, in terms of like some carve out. So a lot of people said like, look, [00:28:00] the iPhone’s gonna be $3,500 if these tariffs stick.
So they apparently officially released carve outs for smart phones and laptops. Uh, and then I, I can’t remember if he’s the Secretary of Commerce, let Nick, um, came out and said, well, those are temporary. And so I was like, oh, well, what do you mean they’re temporary? And then President Trump came out over the weekend, said, there’s no carve outs.
It’s like, what? Like that’s just the carve out. And that’s what’s happening writ large with these, uh, even with the pause, quote unquote, that happened last week. You still had 10% universal terrorists for everybody in the entire world, and all of China’s tariffs, which are now at, is it 143% or 135? I can’t remember. Uh, how much it is. So it, it’s just very, very difficult to know what’s gonna happen. That’s, that’s all. I got ’em.
Stephanie Wierwille: Yeah.
Chris: it anywhere close to where they’re at, it’s not going to be great for healthcare systems cost-wise. That’s fair.
Stephanie Wierwille: And I think that from a, from a marketer’s [00:29:00] standpoint, I, I would, I would predict this will, this may impact budgets, right? If, if overall expenses are increasing and supplies are a major amount of overall expenses, um, which is often not seen from the patient vantage point. But, um, if, if expenses are increasing, then certainly if marketing is also seen as an expense, then how, how will that affect marketing’s budget?
So that’s something to keep an eye on. Um, okay. And the last, uh, leg of our perfect storm here is the biggest one, which is what happens if and when there is a potential economic downturn. So we don’t know that yet, right? Like I said, the word recession is being used more and more and it, it depends on what happens in the coming days and weeks around the overall policy landscape.
But, um, Chris, I thought you had a really interesting take on this around, um, maybe that. The changes that healthcare is, has been seeing as an industry in terms of its, its relation to the economy. Um, do you wanna share some of, some [00:30:00] of that take
Chris: Yeah, so it’s interesting, right before
Stephanie Wierwille: I.
Chris: this podcast, I was just looking at CNN and one of the top headlines says, top economists predicts recession in weeks if the tariff war isn’t settled. So, uh, you know, Jamie Diamond keeps increasing his, I think the last one, last week he said there’s a 50% chance, then we’ll go into recession.
Right? So just real quickly. Uh, those of us who have been around long enough, remember when healthcare was not impacted by, uh, economic downturns? It was in, in the economist language. It was what was called inelastic. So if the, if we have a recession, if we have inflation, if we have all these things. Healthcare, just the demand for healthcare that is pretty much stayed steady. Uh, two, the 2008 recession was where that really changed. And for two reasons. Uh, the, the, the lesser reason interestingly was how big the Great Recession was, right? It’s called the Great Recession ’cause it was the worst financial situation since the Great Depression. So it was number [00:31:00] two on the list in the last a hundred years. But the real change at that time, I remember this was 2008, 2009. Was that healthcare had changed. Uh, and essentially people had way more money at stake, uh, in terms of what they had to spend to receive healthcare than they had before. Uh, and so healthcare for the first time became what’s called elastic meaning as the economy goes. So healthcare can go in terms of demand. Uh, and so that’s really, again, consumer driven healthcare is the reason for that. Right? Uh, so that was in 2009. where are we at today? Right? So if that was an issue then where has healthcare gone today? So a couple statistics for you, Kaiser Family Foundation. Uh, reports that the, the premium, the health insurance premium for somebody who gets health insurance from their employer for a family was roughly $25,000 a year last year. Now, that is for, that’s the total cost. So [00:32:00] employers and employees share that, right? Uh, so you’re not paying all of that typically if you’re a, if you’re an employee, but you’re paying quite a bit of it. Uh, healthcare spending per person in 2023 for Kaiser Family, family Foundation, $14,575 a year. So that’s everything that you’re spending on, right? Uh, what does that include? That includes your health insurance premiums. That includes your deductibles, your copays, your insurance, which is called out of pocket insurance cost. Uh, it includes though, that’s not, it’s not calculated in there. Remember, you’re still paying taxes. Medicare, Medicaid, VA care, and you’re paying for anything that’s over the counter. Anything that’s not covered by insurance, right? So not including taxes. You’re paying roughly $15,000 a year.
That was 2023. It’s probably higher than that now. Um, so happens with that amount of expenditure if you’re spending $15,000 on average? Right? [00:33:00] Consider, this is statistics I just pulled. 42% of Americans have no emergency fund at all. None. They have no savings. 60% of Americans roughly only have enough savings to cover a thousand dollars and nothing more. So if your deductible is $2,000 and you have a car accident, you have uh, a, you know, a broken leg, you have a heart attack, whatever it is, and you need to blow through that $2,000 plus co-insurance, which can also be 20% on a hospital bill. Um, mo 60% of people don’t have that money. what does that mean?
Well, it’s one reason why medical debt is a leading cause of, um, bankruptcy in the us but, but how it impacts healthcare is people delay care. I. They just don’t go as often as they should, or they skip their appointments or their therapies pharmaceutically, they cut pills in half, they skip pills, they just don’t refill, and they avoid [00:34:00] non-essential care or elective care.
And there’s a lot of that that drives, uh, the top line for, for health systems. So if the economy goes down, which right now looks like a safe bet given the chaos that we’re in, uh, that’s yet another thing. On top of the tariffs we’ve talked about and on top of the federal funding, uh, that we’ve talked about that’s going to potentially hit, health systems.
And one other thing too, by the way, we don’t need to get into detail, but a lot of health systems, most health systems have two primary revenue streams most consumers don’t know about. That’s philanthropy, which obviously goes down in economic downturn and their investment income. Which right now I think the stock market’s going back up, but it’s gonna go back down.
It’s just like if the stock market stays down for the year, that’s less money for health systems too. So the non-perfect storm, Stephanie and Des.
Stephanie Wierwille: Ooh, I’m feeling the pressure. Um, I, I told you all, I was gonna bring all my emotional support beverages [00:35:00] to this, this chat. And I do, I have my coffee and my smoothie, and my water and my tea, but, oh, man. Um, I think we’re starting to see how all of this fits. Together. Right. And the major pressure, this is going to put collectively, not just any one of these topics, but all of them together on health systems, on healthcare organizations, and also more importantly on consumers.
Um, I think, Chris, as you were talking about that and just the affordability crisis coming to a head here, uh, over the weekend, I, I watched, um, the first episode of the latest Black Mirror season. And it was all about healthcare and cost. And, um, I, I don’t recommend watching it. I actually had like a complete emotional breakdown afterwards.
But if you really, really, really wanna empathize with, you know, those kinds of examples that you just shared, Chris, this episode was exactly, it was about, it was this imaginal world where health. Healthcare becomes subscription fee, and then they just keep raising your fee essentially, um, on your body. Um, so, you know, black Mirror is already ahead of the game here, um, in their way that they [00:36:00] would, but, um, this is really, really challenging and it’s, it’s an access issue.
It’s a population health issue. It’s an economic issue, and all of the above.
Chris: Well, Des I want Des to jump in. I don’t know if you saw Black Mirror too. What I would say, Stephanie, is I saw that episode and while it’s about a specific thing, it really is kind of a, a depiction of healthcare overall, right? Where healthcare is becoming. Less and less attainable financially to people, which is causing them to have to do things that are not in the best interest of their health.
The show is about a specific kind of technology and a little bit futuristic, but you could apply the lesson from it to healthcare overall. On everything I just said, did you see Black Mirror? Are you a Black Mirror fan?
Desiree Duncan: am a fan, but I have not caught up with this, uh, new season because of exactly the reasons why just laid out. Like, I don’t need that, uh, more drama. Um, but I mean, as the, I mean, there’s just so much pressure on the consumer on. All the fronts. And [00:37:00] so here’s the next level of that. I mean, with real estate, there’s like the real estate bubble.
Is there, will there be a healthcare bubble? Like what is going to be the solve here, the relief here, um, is a little bit off the wall, but I think back to the auto industry and bailouts in that particular way. I mean. Revolution. Will, the consumers, will the people start to stand? I, I guess that’s just, that’s where my mind goes about like the, you can’t keep squeezing people that have nothing. The juice is depleted. There’s nothing left in this orange. So what, what’s, what’s the game plan? What’s the end game here?
Chris: I, that’s the, that’s, we talked about that in Joe Public 2030, and I think the. Uh, takeaway unfortunately was there’s, it requires a moonshot, whatever you mean by that. Uh, that could be socialized medicine, that could be Medicare for all. Who knows what the solution is, but there [00:38:00] is, if there was no appetite for that, when we wrote that book in 2022, what’s the appetite now for that? I think I don’t need to answer that. By the way. I saw a critic who called Black mirror cynicism porn, which I thought was,
Stephanie Wierwille: Oh,
Chris: I
Stephanie Wierwille: that’s so real.
Chris: right?
Stephanie Wierwille: yeah. Yeah, that’s, I can’t handle it. It’s too much for me. I, I stopped watching it, um, for several years, and then I watched this episode. And I was like, oh, this is why I don’t watch the show. I can, it’s too much. Oh. But it’s so real. That’s why I think it hits so hard. Um, okay, so maybe we’ll just wrap with a quick little shout out.
Um, we follow Paul Keckley. I mentioned him before. He was a, um, a speaker at the Joe Public Retreat in December and Charleston that we hosted, and he’s a really great source for all of these issues. If. If you enjoyed this conversation, certainly sign up for Paul as the ICU, um, which we are covering these issues on a regular basis.
Uh, but also Paul Keckley is a really great source and I just wanted to quote him ’cause I think he [00:39:00] called some of this back in December before anybody really was really had an eye on it, um, like this. And I love his quote. He said, economic factors outside our control affect us more than those within our control.
So he was sort of giving this big macroeconomic picture. Um, you know, often, uh, in health, in healthcare, we think about our own organizations. We think about our competitors. We certainly think about policy in our own states, um, you know, cultural issues, all of that. But his point was economic factors, even like housing affect, healthcare.
Um, and he also predicted, as I noted earlier, that. Um, there will be more target aimed at nonprofit health systems, so we haven’t yet seen that, but, um, we could expect that moving forward. So he’s a great source. Um, and check out the Keckley report for more information. Okay. Any last notes, de or Chris before I wrap this, um, Sonny episode?
Chris: We’re going to have to pick the TV show to talk. I don’t know it. Apparently it’s not black, black mirror. I don’t know if it’s last of us two. Maybe [00:40:00] it’s the studio, but we’ll have to find something else. We don’t have to do this every time, but there’s so many good and or two is coming out. it’s just, it’s unbelievable.
It’s nonstop.
Desiree Duncan: This is where our, uh, what we like, kind of diverges like White Lotus is. I don’t know. I’m, I, I don’t do the speculative fiction. I. I’m sorry. I can’t, I can’t suspend belief enough to do any of that.
Stephanie Wierwille: No Harry Potter for Dez.
Desiree Duncan: No,
Stephanie Wierwille: a fun fact. I will always remember about you, Dez
Desiree Duncan: that I don’t like Harry Potter.
Stephanie Wierwille: speculative fiction. You’re the one that introduced me to that phrase, and now I think about it. When I see speculative fiction, I think of you.
Chris: funny ’cause I guess I
Stephanie Wierwille: I.
Chris: like that was redundant when you first said it, but now I see what you’re saying.
Desiree Duncan: It covers all of it.
Chris: That’s our goal before the end of 2025. We have to get de. Into and excited about some kind of specula fiction. Well, a book, a movie, a [00:41:00] TV show. We’ll get you there de we’ll
Desiree Duncan: Technically black mirror is that, so
Stephanie Wierwille: Yes.
Desiree Duncan: I’ll do that. That’s all right. Salt
Chris: Okay.
Desiree Duncan: goal
Stephanie Wierwille: oh. No. Okay.
Chris: people should send in the recommendations. Send us your recommendations if there’s something you think does, should be reading or watching speculative fiction, and
Stephanie Wierwille: Oh, that’s a fun challenge.
Desiree Duncan: Help.
Stephanie Wierwille: I love that. All right, so if you’re listening, send us the challenge, subscribe to the newsletter, the no normal rewind that recaps all these discussions and more. Um, we’ll pop several things in the show notes, including the link to policy ICU as a reminder. Um, and then also keep your eye out for the research, um, paper, the future of the CMO, which will be available early to all subscribers.
And, um, you can sign up at that link in our show notes. Or even subscribe to, um, it via BPD’s LinkedIn. Um, and uh, the email address as always that you can shoot us a note to or send in that speculative fiction example is no normal [00:42:00] at BPD Healthcare. So with that, um, everybody keep your emotional support beverages near in these times and, um, we’ll talk to you next time.
Push that no normal, and we’ll talk to you soon.
