Podcast Summary: Chasing Life – “Why It Costs So Much to Get Sick”

Host: Dr. Sanjay Gupta (CNN Podcasts)
Guest: Dr. Elizabeth Rosenthal (Physician, Health Journalist, Author)
Original Air Date: October 17, 2025

Overview:

This episode tackles the underlying reasons behind the high cost of getting sick in the United States. Dr. Sanjay Gupta is joined by Dr. Elizabeth Rosenthal, a seasoned health journalist and former ER physician, to dissect the U.S. healthcare system’s history, dysfunction, current crisis, and potential paths forward. With the backdrop of a government shutdown threatening Affordable Care Act (ACA) subsidies, the conversation explores how policy, profit motives, and insurance design have contributed to unaffordable and often inadequate care.

Key Discussion Points & Insights

1. The Dire Consequences of Policy Deadlock

• The episode opens with the context of a government shutdown endangering healthcare subsidies.
• Notably, recent studies (Yale/UPenn, 2023) estimate that cutting federal health spending could lead to “51,000 preventable deaths annually” ([00:53] Dr. Sanjay Gupta), as cited by Senator Bernie Sanders.
• Dr. Rosenthal and Gupta emphasize that these numbers aren't just statistics—they reflect real human lives.

“You take 15 million people off of their health care... what do you think is going to happen to them? ...They will die.”
— Dr. Sanjay Gupta ([00:44])

2. Why the System Fails Patients: Business over Care

• Dr. Rosenthal explains that U.S. healthcare has become dominated by business interests, with hospitals now run as profit-driven entities, often to the detriment of patient experience ([06:07]).
• She illustrates with personal anecdotes—her husband, suffering from terminal cancer, faced unnecessary delays and suboptimal treatment due to resource-allocation priorities ([06:36]).

“Most hospitals run as businesses now... You try and make an appointment... two, three months out because hospitals want to run as full ships all the time, and the waits are terrible...”
— Dr. Elizabeth Rosenthal ([06:07])

• The rise in “medical debt”—100 million Americans with some form—reflects this harsh financial burden ([05:02]).

3. How Did We Get Here?

• Dr. Rosenthal traces the “unnatural evolution” of healthcare insurance from simple disability coverage to today’s labyrinthine employer-based and government programs ([08:26]).
• She calls insurance “the original sin” because it distances patients from the real costs, fueling unchecked price increases ([09:24]).

“Insurance... for many years separated the patients from the cost. So... I didn’t really care how much was being charged.”
— Dr. Elizabeth Rosenthal ([09:24])

• The 1990s brought in management consultants who advised hospitals to aggressively “unbundle” and monetize every service and supply, further inflating costs ([10:19]).

4. Cost-Sharing and Its Pitfalls

• Rising copays, deductibles (now sometimes up to $9,000/year), and coinsurance were supposed to give patients “skin in the game.”
• Instead, she argues, it’s “more like having a kidney in the game” for many Americans ([13:33]), deterring necessary care for fear of bankruptcy.

“A $7,000, $5,000 deductible when most Americans don’t have $500 in their savings account, what’s that going to do? ...I’m going to stay away from the health care system.”
— Dr. Elizabeth Rosenthal ([13:33])

5. International Comparisons & Possible Alternatives

• Other high-income countries control costs with “nonprofit insurers and more price regulation” (citing Germany and Switzerland) ([15:25]).
• The U.S. system, in contrast, keeps adding complexity rather than simplifying or regulating prices.

“Our system keeps getting more and more complicated by these kind of interventions rather than simpler.”
— Dr. Elizabeth Rosenthal ([15:25])

• Dr. Rosenthal is flexible on solutions: single payer (“Medicare for all”), lowering Medicare age, public option—all would be preferable to current dysfunction ([16:56]).

6. Physician Sentiment & Systemic Resistance

• More than half of physicians now reportedly favor a Medicare-for-all system ([19:02]).
• Systemic inertia is immense: insurers, hospitals, and pharma industry deploy much stronger lobbying and legal resources than states or patients can muster ([20:24]).

“They are way better lawyered up than states. They have way more lobbyists than states.”
— Dr. Elizabeth Rosenthal ([22:39])

• Hospitals with nonprofit status don’t necessarily act differently than for-profits, often prioritizing financial throughput over patient or community benefit.

7. The Human Toll and Political Apathy

• Despite large numbers affected, healthcare isn’t a core electoral issue because many people interact rarely and opaquely with the system ([23:48]).
• Dr. Rosenthal shares her discomfort at her work being cited in a recent high-profile, violent incident in New York, which she sees as rooted in real but misdirected public frustration ([24:40]).

“There’s just this deep well of frustration with the health care system that politicians aren’t addressing and aren’t tapping into. And I wish they would.”
— Dr. Elizabeth Rosenthal ([24:40])

8. Open Enrollment Mayhem Amid Shutdown

• With ACA premium subsidies at risk, millions may lose or be unable to afford coverage:
  • Premiums have sharply increased.
  • Subsidies are expiring, with insurers and exchanges left in chaos ([27:38], [30:19]).
• The technology and bureaucracy cannot keep up, likely causing even more to go uninsured out of confusion or desperation.

“It really is going to be just unbelievable chaos. And, you know, in the end... people are just like, I give up.”
— Dr. Elizabeth Rosenthal ([31:42])

9. Who Gets Hurt?

• Not the very poor (who qualify for Medicaid), but:
  • Working-class, self-employed, gig workers, small business employees, freelancers—the “missing middle” ([37:48]).
• Without coverage, these Americans risk medical bankruptcy, resorting to GoFundMe for care ([38:55]).

10. Looking Forward: Fixes and Frustrations

• Rosenthal is both hopeful (doctors organizing, real debate) and pessimistic (systemic inertia, lobbying power).
• If she were to write another book, she’d cover private equity, consolidation, and the limits of patient empowerment—believing real change will only come from systemic, not individual, action ([39:02]).

Notable Quotes & Memorable Moments

• “I think our health care system is broken. I think it is dysfunctional, and I think it's on the verge of collapse.”
  — Dr. Elizabeth Rosenthal ([01:18])

• “I think I said in my book it’s more like having a kidney in the game now.”
  — Dr. Elizabeth Rosenthal ([13:33])

• “More than half of physicians say they would be okay with Medicare for all. That’s a real sea change.”
  — Dr. Elizabeth Rosenthal ([19:02])

• “Hospitals... are run mostly by business people. The patients are kind of just the throughput of the organization.”
  — Dr. Elizabeth Rosenthal ([21:32])

Key Timestamps

• 00:44 — The deadly implications of subsidy cuts
• 05:02 — The human impact: medical debt and avoidance of care
• 08:26 — Historical development of U.S. insurance
• 13:33 — Dangers of excessive cost-sharing for patients
• 15:25 — International comparisons and nonprofit insurance
• 19:02 — Physician attitudes shifting on single payer
• 24:40 — Public frustration cresting into dangerous actions
• 27:38–34:46 — Breakdown of open enrollment and coverage crisis amid shutdown
• 37:48–38:55 — Who is most affected by subsidy loss and what’s at stake
• 39:02 — Rosenthal reflects on future directions for reform and research

Conclusion:

This episode delivers an urgent, wide-ranging discussion of why Americans pay so much—and get so little—for health care. Rosenthal and Gupta expose the system's historical accidents, perverse incentives, and daunting political obstacles, while warning that failure to act will only deepen the crisis. The conversation is rich with data, history, and personal insight, offering both dire warnings and pragmatic hope for change.

If you want to learn about what's driving America's health care disaster—and what could be done about it—this episode is essential listening.