The American Affordability Crisis — ft. Neera Tanden

Summary

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Prof G Markets – Episode Summary

Episode: The American Affordability Crisis — ft. Neera Tanden

Date: February 6, 2026
Hosts: Scott Galloway (Host 2), Ed Elson (Host 3)
Guest: Neera Tanden (President & CEO, Center for American Progress)
Main Theme:
This episode tackles the pressing issue of affordability in America—spanning housing, healthcare, and policy responses under the Trump administration. Through candid analysis and pointed critique, former White House domestic policy advisor Neera Tanden joins Scott and Ed to break down how policy decisions are affecting Americans’ everyday costs, with a frank assessment of current challenges and potential solutions.

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1. Introduction: Subscription Culture & Market Consolidation

Timestamps: 03:12–08:53

• Scott opens with a humorous yet pointed anecdote about unsubscribing from Uber, highlighting how tech platforms use market consolidation to later hike prices, contributing to affordability problems.
  • “Big tech comes in with a value proposition where they charge you 20 bucks for an Uber that cost them 40... Then they slowly but surely start raising prices.” — Scott (04:12)
  • On canceling Uber: “With the money I'm gonna save...I could lease a Mercedes G wagon...or a Range Rover.” — Scott (05:37)
• Emphasizes personal and societal awakening to creeping costs across digital services; calls for consumer awareness.
• Sets up the larger theme: rising costs in both private and public sectors and their impact on the average American.

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2. Policy Performance: Grading the Trump Administration on Affordability

Timestamps: 09:06–11:43

• Ed provides a brief professional recap for Neera, then directly asks for her assessment of the administration’s performance on affordability after one year.
• Neera’s blunt assessment:
  • Gives the Trump administration an “F,” criticizing increased tariffs as regressive sales taxes that harm working-class and poor Americans most.
  • Highlights a key healthcare concern: “President Trump is the first president in my lifetime who has actually successfully taken health care away from people... The big beautiful bill will increase costs for millions of Americans by ensuring they don't have health insurance.” — Neera Tanden (10:51)
• The discussion foregrounds affordability as not just economic but heavily influenced by policy choices contrary to stated political goals.

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3. Housing Crisis: Prices, Policy, and Political Rhetoric

Timestamps: 11:43–17:41

• The hosts play viral clips of Donald Trump explicitly stating a desire to drive housing prices up to benefit current homeowners, contradicting public messaging about affordability.
  • “There's so much talk about, oh, we're going to drive housing prices down. I don't want to drive housing prices down. I want to drive housing prices up... They can be assured that's what's going to happen.” — Trump (12:06–12:18, paraphrased)
• Neera’s reaction:
  • Points out the inherent conflict between benefiting wealthier homeowners and ordinary people seeking affordable housing.
  • Notes staggering stats: “The average age of a first time home buyer in the United States is 40 years old. Rents went up 30% from 2020 to 2023.” — Neera Tanden (13:35)
  • “For working class Americans... to say that you don't want any more housing means you want housing prices to go up. You want to make it harder to buy that home, harder to afford the rent.” — Neera (14:08)
• Ed probes whether this signals a deliberate, scarcity-driven housing policy; Neera suggests Trump’s statements reflect the interests of his wealthy supporters while ignoring ramification for social mobility and affordability.
• Neera emphasizes the central policy dilemma: incumbent wealth vs. societal opportunity.

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4. Healthcare: Complexity, Cost Drivers, and Potential Solutions

Timestamps: 20:32–27:46

• Ed frames the US healthcare system as uniquely and stubbornly expensive, with “complexity in the middle”—PBMs, insurers, opaque pricing.
  • “Why hasn't America really gotten its act together in terms of bringing healthcare costs down?” — Ed Elson (20:32)
• Neera’s 101:
  • Main reason: “The per unit cost of things in America is much more expensive... a very inflationary system.” — Neera Tanden (21:24)
  • Identifies lack of transparency and monopoly/oligopoly power among stakeholders.
  • Calls for radical transparency (e.g., hospital pricing), elimination of PBMs, and an overhaul of power dynamics.
• Solution models: Negotiated rates (à la Germany), public options, leveraging government bargaining power (Medicare drug negotiation).
  • “What we should do is have everyone be transparent...there’s a lot of self-dealing in the system.” — Neera (22:33)
• Trump’s Healthcare Moves:
  • Acknowledges minor positive steps: Trump administration's reductions in overpayments to Medicare Advantage, building (but not reversing) on Democratic initiatives for Medicare drug negotiation.

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5. Lightning Round: Policy Rapid-Fire

Timestamps: 29:06–33:41

Ed and Scott put Neera through a quick-fire round of progressive and provocative policy proposals:

• Single payer healthcare: Praises the model but supports a public option as pragmatic.
  • “If America could start over again, there’d be a lot of benefits to single payer...but it would be a radical transformation today.” — Neera (29:29)
• Wide GLP-1 drug distribution: Strongly supports, emphasizing public benefit and need for lower prices.
• $25/hr minimum wage: Suggests $20 is more realistic but insists even that would be transformational—currently, much of the country remains at $7.25/hr.
  • “I think the impetus to drive the minimum wage up is really crucial and hugely necessary.” — Neera (30:41)
• Tax reform: Favors closing capital gains loopholes, raising estate taxes, and aligning wealth/capital taxes with earned income to reduce inequality.
  • “We should not have this big differential between capital gains and traditional income that benefits very wealthy Americans.” — Neera (31:42)
• Mandatory national service: Enthusiastic support: “I love it. I wish we could get it done tomorrow.” — Neera (33:41)

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6. Tackling Inequality: Wealth Taxes and Tax Code Unrigging

Timestamps: 33:44–38:33

• Wealth tax debate: Neera supports the principle but is skeptical of feasibility at the state level (constitutional/legal hurdles, enforcement challenges).
  • “The fundamental impetus to me is how you address inequality in the country... that billionaire’s today have a billion times more political power.” — Neera (34:18)
• Advocates focusing first on tangible, achievable tax reforms: closing stepped-up basis, raising estate and capital gains taxes, undoing tax cuts that “benefited the super wealthy at the expense of labor.”
  • “We could just start off making the tax code a lot fairer by unrigging it in many ways that it’s been rigged over the last 30 years.” — Neera (37:01)
• Echoes Scott’s distinction between being “right” and being “effective.”

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7. The “Emperor for a Day” Scenario: What’s the One Fix?

Timestamp: 38:33–40:25

• Neera’s choice: If given unilateral power, she would mandate mixed-income housing in America’s wealthiest areas.
  • Points to strong evidence (Raj Chetty’s research) that “poor people who have access to wealthier places, their upward mobility goes up like this.”
  • Shares a personal story illustrating the life-changing impact of policy-driven access to good neighborhoods and schools.
  • “If I could change one thing in America just for a day...I would have a system in America where we integrated housing a lot more, allowed much more mixed income housing in places that are wealthier...” — Neera (38:52)
  • Frames housing integration as the ultimate lever for equality of opportunity.

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8. Notable Quotes & Memorable Moments

• “The administration’s cornerstone policy is tariffs. And those tariffs raise the cost of goods for most Americans... Tarifffs are essentially a version of a sales tax that is really disproportionately impacting kind of working class, poor Americans.” — Neera Tanden (09:50)
• “For working class Americans...to say that you don’t want any more housing means you want housing prices to go up. You want to make it harder to buy that home, you want to make it harder to afford the rent.” — Neera Tanden (14:08)
• “We have less economic mobility than Canada—almost half. We have less than most countries in Europe. This was a country that used to be a place where you could go as far as your talents can take you.” — Neera Tanden (32:47)
• “I would ensure that we built mixed income housing in the suburbs and wealthier parts of America... I grew up in a place where everyone went to college. I went to college... I’m here because of all those decisions.” — Neera Tanden (38:52)

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9. Conclusion

The episode offers a sobering—and actionable—portrait of America’s affordability crisis. Neera Tanden, drawing from extensive policy experience, argues that current trajectories favor entrenched wealth at the expense of opportunity and social mobility. She advocates for practical, immediate reforms in the tax code and healthcare, and frames access to mixed-income housing as a critical, systemic solution.

For those seeking clarity on America’s economic and policy crossroads, this episode delivers a “no mercy, no malice” deep-dive into why things cost what they do, who’s benefiting, and what meaningful change could look like.

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Transcript

[Narrator/Advertiser]

Support for the show comes from Fundrise. For the past seven years, there's been a room in finance most people couldn't enter. A room where you could have invested in some of the biggest names in tech companies like Airbnb and Uber before their multi billion dollar IPOs. I'm talking about venture capital. Fundrise recently took a sledgehammer to those closed doors by launching a venture capital product that's available to anyone. Their mission is to give everyone the chance to invest in the best tech and AI companies before they go public. You can visit funrise.com profg to check. Check out Funrise's venture portfolio and get in early today. All investments involve risk, including a potential loss of principal. Past performance is not indicative of future results. This is a paid advertisement.

[Host 1]

Do you ever look back on something.

[Neera Tanden]

You posted on the Internet and think.

[Host 1]

Well, that was cringe? Yeah. I mean, I look back at that.

[Neera Tanden]

Stuff and I'm just like, it's so emblematic of the era. And it's also just like, why did.

[Host 1]

I think this would age well, like in the slightest this week, Unexplained me from Vox what to do with your online regret New episodes on Sundays. Wherever you get your podcasts.

[Neera Tanden]

Megan Rapinoe here. This week on A touch more, Gotham FC's Rose Lavelle joins us to talk about FIFA's very first Champions cup, her incredible year of wins, and some of her greatest pranks of all time.

[Host 1]

Unfortunately on yours truly.

[Neera Tanden]

Plus, with the WNBA's CBA, negotiations still.

[Host 1]

Stalled, I gotta ask the question. Is it time to worry?

[Neera Tanden]

Check out the latest episode of the Touch More wherever you get your podcast. And on YouTube.

[Host 2]

Today's number one. The United Arab Emirates will send its first ever athlete to the Winter Olympics this weekend, an alpine skier who learned to ski in a Dubai shopping mall. True story. Yet I absolutely love the Winter Olympics. It's the first time where I can scream at a woman, sweep harder during the curling event and not be called a sexist.

[Host 3]

Listen to me.

[Host 2]

Markets are bigger than us.

[Host 3]

What you have here is a structural change in the wealth distribution. Cash is trash.

[Host 1]

Stocks look pretty attractive.

[Neera Tanden]

Something's going to break.

[Host 3]

Forget about it.

[Host 2]

What do you think, Ed?

[Host 3]

You didn't really give me time to laugh. Just immediately. What do you think? You gotta give it a moment. This is what they teach you in comedy school. You gotta wait a beat and wait for the audience.

[Host 2]

Is that what they teach you in comedy school? You're talking at most comical at university high school. So in bitch. The reason I'm Always a virgin until 19 and not till 40 is cause of this rocket. Sense of humor.

[Host 3]

You can always improve. You can always be better, no matter how good you are.

[Host 2]

Well, the Winter Olympics play an important social role. It's important that there's a sport or an event where only white people are allowed to play that sports that no one else can afford to learn.

[Host 3]

So that's true. That's not a joke. That's just a fact.

[Host 2]

That was social commentary in the form of humor. How are you, Ed?

[Host 3]

I'm doing very well. How are you?

[Host 2]

I'm exhausted. I'm doing this. I don't know if you've heard, but.

[Host 3]

I seem a little out of breath.

[Host 2]

I kind of started a movement and I'm about to go on Jake Tapper, and then. Anyways, I unsubscribe. I know you want to know more about me. I unsubscribed from Uber last night. And by the way, I love Uber. This was a tough one. And when you unsubscribe, which I'm sure you've already done, as you want to be part of this movement and not just virtue, signal all the fucking time, you little hipster. Brooklyn sandal died, weirdo. But I unsubscribed from Uber, and the last screen you see, it tells you how many UberEats you've ordered and how many Uber rides you've taken. Okay, Guess how many times I've ordered from Uber eats.

[Host 3]

I think it's got to be like a thousand. Am I going too high?

[Host 2]

37. I'm not big food delivery guy. And I usually use caviar. For some reason I'm using Interface. In the last 10 years, how many Ubers have I taken?

[Host 3]

That's got to be over a thousand for sure.

[Host 2]

3756. And I did some research. All right, so this is what big tech does. Big tech comes in with a value proposition where they charge you 20 bucks for an Uber that cost them 40. They try and consolidate the market, and then they slowly but surely start raising prices. So I take Uber luxury. The average Uber lux ride in 2015 was between $40 and $60. Today, by the way, Uber has raised its prices once. They consolidated the market 7 to 10% a year, twice, or treble times the rate of inflation. Now, the average Uber lux ride is $80 to $120. So $350 rides a year at an average price of about a hundred bucks. Because I'm usually going back and forth from the airport, I am spending every year $35,000 on Uber. That's true. And I realize this is a story of privilege, but what I've decided is I canceled.

[Host 3]

Clip that now I canceled Uber.

[Host 2]

I've been taking the tube and the subway in New York, which are incredible. I don't know if you knew this, but there's tunnels underground and these cars go through them on tracks and they get you where you need to go for like two or three bucks. They're just, they're really, they're seriously amazing. Some, some weird people. And also the people aren't that hot on the train. That's the only thing I would, I would, I would suggest fixing. We need more hot people on the trains.

[Host 3]

Yeah, they could make a, like a hot girls train. Maybe that would fix things.

[Host 2]

We're hot dudes. I'm fine with the hot guys. I go to Equinox at this point, I just want hot. So I figured out with the money I'm gonna save, no joke, I could lease, including parking and insurance. With the money I'm gonna save, having canceled my Uber account, I could lease a Mercedes G wagon, the new BMW i7, or a range Rover with the money I'm saving. This is all a long winded way of saying go to resist and unsubscribe and you will find out just how much money you are spending on different tech platforms that have slowly but surely increased their pricing and you don't realize how much it's costing you. Anyways, I'm getting just to really stick it to the man, I'm gonna go buy a Range Rover.

[Host 3]

But here's the question. Cause I mean, how are you getting around? Are you switching to Lyft? Cause I know you're doing this thing where you have two different subscriptions and you get rid of one of them. Is that what you're doing here?

[Host 2]

I'm not exaggerating. I've been taking the tube in the subway and I've been doing this awful thing called UberX where they have like air freshener and shitty cars and.

[Host 3]

Oh my God, you're still taking Ubers. It's just you downgraded.

[Host 2]

No, I do the Lyft. The cheap Lyft one. Lyft. It's called Lyft Walmart or something. Or Lyft Lyft. Life has not worked out the way I'd hoped, but. And a guy who doesn't know how to use Waze and is on an Android phone. God, I sound like such a douchebag right now, but I've been taking the Subway. It's incredible.

[Host 3]

Good stuff. $35,000. That's pretty good.

[Host 2]

So, anyways, um, I'm going one by one. Uber was the tough one. I'm excited about that one. I'm doing Paramount plus tonight. Tomorrow I'm going to do Apple tv. Plus I did Amazon prime on Friday. That wasn't hard. I don't order that much from Amazon. But anyways, I'm shocked to hear that. Yeah, I don't buy a lot from Amazon. What have you unsubscribed from? Given I know that how emotionally invested are you are in this movement?

[Host 3]

I haven't unsubscribed yet, but I'll. But I'm happy to hear from you what you think I should unsubscribe from. I could maybe go between Lyft and Uber.

[Host 2]

Memo. Hold on, hold on. One sec. One second, Ed. One second. Memo to file. Ed Elson review and compensation does not act like an owner is poor for morale. Music does not match the words. It's disappointing our audience.

[Host 3]

We'll see how disappointed everyone is.

[Host 2]

Let me get this. Your boss and a person you constantly say, I'm your role model, has started a movement, and you have yet to unsubscribe from anything. Do I have that right?

[Host 3]

You did get that, right. Yeah.

[Host 2]

And by the way, none of this comes for free. We just lost an advertiser who rhymes with Snapple. And we just lost, or I lost another telco advertiser that rhymes with Mint Mobile. Anyways, nothing's for free. Ed Cora. Region's like, it's really great. You're finding your virtue all of a sudden, but we're not down with that. And so, yeah, nothing's for free. Nothing's for free. Anyways. All right, let's get to our guest ad.

[Host 3]

All right, here's our conversation with Neera Tanden, President and CEO of the center for American Progress. Neera, thank you for joining us on Profit Markets.

[Neera Tanden]

Thanks for having me.

[Host 3]

So I just want to start with a quick bio of who you are. So you are the CEO of the center for American Progress. You've also worked in the White House. You are the director for the Domestic Policy Council under Biden. You also helped to create the Affordable Care act under Obama. You are a Democrat, but you have just plainly had a lot of experience in policy. So we want to focus on affordability in this episode and the policies that we're seeing from the administration so far. But just based on your experience, having worked in the White House, having worked as a policymaker how would you rate the performance of this administration one year in?

[Neera Tanden]

I think the first and foremost thing for any administration to do is to figure out how to do no harm in that arena. The administration has definitely failed. What is kind of stark is that at a time where people are concerned about really making ends meet, the administration's cornerstone policy is tariffs. And those tariffs raise the cost of goods for most Americans, a lot of small businesses, and just increased costs overall in the economy. But it's also important to remember that tariffs are essentially a version of a sales tax that is really disproportionately impacting kind of working class, poor Americans. So I think on affordability writ large, the real challenge for the administration is that it's making the problem worse. And when you really go beyond just goods like groceries or just buying like soccer balls at your local Target to, you know, things like healthcare, it's an even starker picture. So there the president is really, President Trump is the first president in my lifetime who has actually successfully taken health care away from people. It was the one big beautiful bill. Act will increase costs for millions of Americans by ensuring they don't have health insurance. The whole debate on premium tax credits, the Affordable Care act premium tax credits, is also fundamentally about affordability as well. So I am going to go with.

[Host 2]

An F. Saw that coming.

[Neera Tanden]

I know that might shock people. That might be just was like I was really changing it up there. But yeah, I'm going with a failing grade.

[Host 3]

I was expecting a D coming in. We went straight to the F. So there's a lot of different domains to dig into here. I want to dig into housing for a moment. We saw two kind of remarkable interactions last week. I'm just going to play these two clips for you and I'd love to get your reactions.

[Neera Tanden]

There's so much talk about, oh, we're going to drive housing prices down. I don't want to drive housing prices down. I want to drive housing prices up.

[Host 2]

For people that own their homes and.

[Neera Tanden]

They can be assured that's what's going to happen.

[Host 2]

We are going to give guidance at some point to see what, what is a mom and pop that someone, maybe your parents for their retirement, about 5, 10, 12 homes. So we don't want to push the mom and pops out. We just want to push everyone else out.

[Host 3]

I mean, those two clips really made the rounds. I think the clip that I'd really like to get your reaction to is Trump saying that he actually wants housing prices to go up, which is quite remarkable because it Seemed that he's been trying to present that he wants to address housing affordability. He's come up with some proposals that we can get into, but then he comes out and he just says, outright, no, I want them to go up. What do you make of that clip? How relevant and important actually is it? What does it mean for affordability writ large?

[Neera Tanden]

We get a lot of conversation from Donald Trump, but every once in a while he will just honestly tell you what he thinks about an issue. And I think this is really one of those areas. And for people who understand housing in America, one of the big challenges is that it's a difficult issue, right, because people who have bought a house, you know, a lot of people's wealth in America is in their house. And so a lot of incumbents like to keep the people who already own a home, like to actually keep housing values up and sometimes oppose the development of additional housing in their neighborhoods, et cetera. But we're really living through one of the problems with that whole system, which is today, the average age of a first time home buyer in the United States is 40 years old. Rents went up 30% from 2020 to 2023, and they've stabilized since then. And in some markets they're coming down. But people overall have got a rent shock and a housing shock. And I think it really does say a lot about the president, which is, I think the people he talks to on a regular basis, maybe the wealthiest Americans really want to keep housing values up because it is key to their wealth. But for working class Americans, middle class Americans who are trying to buy a home or trying to just make ends meet by paying, having an affordable rent, to say that you don't want any more housing means you want housing prices to go up. You want to make it harder to buy that home, you want to make it harder to afford the rent. That is what that means. And you know, I think it's just kind of a classic thing here, which is on tariffs on this policy and so much more. You know, the great irony here is the President is making life a lot harder economically for working class, middle class Americans.

[Host 3]

Do you think that that quote actually means that we are going to have a policy under Trump of not building more housing? Because, I mean, I guess something that's been interesting to me is I thought that there were just debates over what to. I thought we all agreed we want to get housing prices down. And then the debate or the divergence was like, how do you do that? Do you it by addressing interest rates? Do you Go out and buy mortgage bonds as Trump has proposed? Or do you, you know, he's even proposed that institutional investors can't buy single family homes. Do you just build more housing? That's been the whole abundance thing coming from Ezra Klein. And yet then he just says outright, no, actually, that's not our difference of opinion here. I want them to go up. Does that mean that we are actually going to see policies, you think that will actually increase the price of housing intentionally? Is that what that means?

[Neera Tanden]

My interpretation of what happened here is the President might have been talking about lowering housing costs because his advisors tell him to say he wants to lower housing costs. It is a really deep concern for Americans. It's a really deep concern for young people, like middle. You know, people are trying to buy their first home. People are in their, like, 30s, 40s. It's like a lot of his constituents, it's people who voted for Donald Trump think housing is too high. So I think that is why his political advisors had told him that. And then I think maybe he was at Mar a Lago on a Saturday night where a bunch of really rich people said, well, you know, more housing means that in my neighborhood, like Scarsdale or wherever people live, we would have more housing. And that, you know, nobody wants that. Nobody wants housing. More housing in my neighborhood, nobody wants to devalue, like my house. And I think this is an issue where you kind of have to choose. I mean, this is the issue about policymaking. And when you work in policy, you have to make a choice, oftentimes between two different groups. And I thought that clip kind of just in a way perfectly captured the President's interest, which has been a hallmark of his administration, which is to do what he needs to do for his supporters, donors network, whatever you want to call it.

[Host 3]

We'll be right back after the break. And if you're enjoying the show so far, send it to a friend. And please follow us if you haven't already.

[Narrator/Advertiser]

Support for the show comes from Fundrise. Investing in companies already in The S&P 500 can sometimes feel like you're being served someone else's leftovers. It's still a great meal, but it's hard not to imagine what the food tasted like when it was fresh out of the oven. Historically, only venture capital investors reserved access to the best tech companies in the world that hadn't gone public yet. And that meant the rest of the world simply had to sit on their hands and wait for an ipo. Fundrise says they're completely upending that dynamic with its new venture capital product. With just a ten dollar minimum investment, Fundrise's mission is to give everyone the access required to invest in the best tech and AI companies before they go public. There's nothing wrong with leftovers, but now if you want with fundrise, you can take a seat at the table alongside the biggest names in tech investing. Visit funrise.com profg to check out Funrise's venture portfolio and start investing in minutes. All investments involve risk, including the potential loss of principal. Past performance is not indicative of future results. This is a paid Advertisement.

[Host 1]

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[Host 2]

It may not feel like it, but.

[Host 3]

Trump's approval rating is some of the.

[Host 2]

Lowest in recorded history and it's fallen to new lows in recent weeks as the nation reels from recent killings of.

[Host 3]

Two anti ICE protesters in Minnesota.

[Host 2]

But not everyone thinks he's failing. This week we're hearing from Trump voters.

[Neera Tanden]

It is very unfortunate that it happened, but it's also unfortunate that the ICE is being blamed for like just murder, murdering somebody who was just so innocent, which isn't the case whatsoever. A they were provoked. B he got ran over and you know, it just, it's hard to tell what's real and what's not anymore.

[Host 3]

He's delivered on virtually every promise he's made. The economy is booming right now. He closed the border. We're not getting any more illegals in. That has been done. That was a major promise that's been done today.

[Host 2]

Explained. Listen, wherever you get your podcasts.

[Host 3]

We're back with Profg Markets. I think one thing that I always find and that we always find whenever we try to dig into healthcare is we try to figure out why are healthcare costs still so high? Why are they so much higher in America? And then we kind of do the digging and digging and then it always comes around to some answer of, oh, there's a lot of just complexity in, in the middle somewhere. There's the pharmacy benefit managers, there's the insurance companies. No one can see eye to eye on this stuff. The whole thing is just like, oh, it's really complicated. That's the explanation could you just give us a 101 on what is going on with healthcare policy in America right now and why hasn't America really gotten its act together in terms of bringing healthcare costs down?

[Neera Tanden]

The way I bottom line, healthcare costs in America is. The per unit cost of things in America is much more expensive. Going to a doctor, getting a medical device, getting a surgery is much more expensive here than in Europe or other places. Just anything you do is a lot more expensive in the United States. And the reason why it is a lot more expensive in the United States is, is essentially you have a variety of forces. Hospitals, insurers, PBMs, benefit manager, drug benefit managers, like middlemen, the drug companies, all like very few of those forces are transparent. And so it basically, the fractured system allows a bunch of people to drive up costs. A big area where things are just much more expensive in the United States is hospital care. It's just. And those hospitals often have a monopoly and no individual group has enough market power to really drive costs effectively down. So it's a very inflationary system. So I don't have a much better answer than. It's complex and that's what makes it more expensive. But essentially of a system that is super fractured and in a way everyone looks at somebody else to lower the, to be transparent, what we should do is have everyone be transparent. The hospital should be really clear on what it costs. And you know, I do think that there is an additional problem in the United States which is because people have health insurance, there are a bunch of forces like hospitals shift costs. I mean, we've insured a lot of people in the United States, particularly after the aca, but there are some people who still don't have coverage and they shift costs to others to sort of pay for that. So it's two complicated things. But what we should do is have radical transparency everywhere. Get rid of the PBMs. There's a lot of self dealing in the system as well. And that would make it a lot better.

[Host 3]

What could government do about this? Like what I'm getting is like all of these, this fractured system, all of these independent actors, everyone's blaming it on each other, pointing fingers, being opaque. Like I feel like that's exactly the domain of the government to get in there and just figure it out. What would that look like?

[Neera Tanden]

There are states that have done really effective things and I'll give an example. So it's to use the power of the government, not to set price caps, but to basically try to negotiate with all the insurers. Insurance is regulated in the United States basically at the state level for the most part. And so very similar to the German model where you have kind of bargaining between all the employers and all the insurers to set that the government kind of oversees to set lower prices for insurance. And they do the same thing with hospitals. And essentially it helps bring the whole price system down by taking negotiating power and concentrating it. And this is why I think it's important for Medicare to negotiate drug prices, because you have something that has a lot of market power able to match the power of near monopoly prescription drug companies. So I think, you know, other countries have used that model. Other countries have also done single payer, but in a system that's going to be that you imagine short of single payer, having the government help, you know, basically negotiate with employers and like bring all the employers together and renegotiate rates down in a way where companies can still be profitable. But you actually are concerned about consumer costs as well. You know, I think that's an important step.

[Host 3]

What is Trump is this administration doing on healthcare policy that is that you think is either a good idea or a bad idea? I think the one thing that I'm kind of interested in particularly is Trump Rx and from my understanding, it's, you know, this policy to theoretically get the cost of drugs down. That's also part of his whole great healthcare plan. The details are like, not very clear as to what he's actually gonna do there. But just on healthcare, what do you make of what this administration has either gotten done or not gotten done so far?

[Neera Tanden]

The Trump administration is trying to lower healthcare costs and actually lower the level of federal payments to Medicare Advantage plans. So the Trump administration recently, you know, tried to put the brakes on some overpayments to Medicare Advantage, which Medicare Advantage is a private insurance. And the Medicare system, which historically has been overcharging the federal government vis a vis, like much more than it pays for traditional Medicare fee for service Medicare that the government is just handling. So that's one area. And Trump rx, look, basically the Democrats in Congress passed Medicare drug negotiation. They have not undone that. And in some ways it seems like they're trying to act like they're building on that by lowering drug costs. But, you know, whatever, that's good. It's good that this is an area where they are trying to continue that work. And there are plenty of areas are not continuing important good work. So I think that's a really important step. I think the fact is that even Donald Trump recognizes Americans pay more for drugs, prescription drugs, than anywhere else in the world. And we do that at the same time where we spend the most money on research for prescription drugs. So consumers are paying on both ends. And I'm glad he's trying to take some steps there.

[Host 3]

We'll be right back. And for even more markets insights, sign up for our [e-mail] subscribe Foreign.

[Host 1]

This week on Net Worth and Chill. I'm talking about what happens after you've mastered the basics. How to build wealth that actually lasts for generations. With the top 1% holding nearly a third of the nation's wealth and 98% of them being men, breaking into generational wealth isn't just about getting rich. It's about changing who gets to stay rich. Plus, I'm explaining the great wealth transfer, $124 trillion about to change hands over the next 25 years, and what it means for you. I'm answering questions about calculating your net worth, whether you should rent or buy to build wealth, and how to pass your retirement accounts to your kids without losing them to probate court. Whether you're just getting started or already maxing out your 401k, this episode will show you how to think bigger than just making money today. Listen wherever you get your podcasts or watch on YouTube.com YourRichBFF.

[Host 3]

We're back with Prof. G Markets.

[Host 2]

I want to take advantage of the fact that you are sort of at the intersection of kind of a think tank. Is that how you would describe your group right now? Policy group, think tank?

[Neera Tanden]

Yes, I would say the center for American Progress is an action oriented think tank.

[Host 2]

An action tank and the fact you've worked in the Obama administration, you have a solid understanding of economics. What I want to do is sort of a lightning round here. I want to propose a series of policy ideas and get your sort of quick, 30,000 foot action oriented reaction. Are you ready? Single payer or national healthcare?

[Neera Tanden]

If America could start over again, there'd be a lot of benefits to single payer. It works well in other countries, but it would be a radical transformation today. So we support, I support more of a public option to people that would create competition for insurance companies and they'd actually have to compete on lowering costs vis a vis the government.

[Host 2]

Mass distribution of GLP1 drugs.

[Neera Tanden]

That would be great. I mean, GLP1 drugs are, they have many facets, one of which is the drug companies just kind of discovered like they basically struck gold with these drugs. They weren't expecting to invest, to have this kind of benefit, they are exceedingly expensive. They have huge costs, huge health implications. They would make Americans lives much, much better on a whole range of issues. We're discovering health, sleeping, heart conditions, as well as weight loss. So it would be fantastic to get wide distribution and much cheaper price.

[Host 2]

Federally mandated minimum wage of $25 an hour.

[Neera Tanden]

I think we're looking at things like a $20 an hour. I think the most important thing to think about here, to set a wage that people can live on and do it in a way that creates more job opportunities and doesn't give people an excuse to get rid of jobs. So, I mean, you could do $25 minimum wage and think of some regional variation. But I think the impetus to drive the minimum wage up is really crucial and hugely necessary. Just in much of the land mass of the country, it is still $7.25, just as a reminder. So think about what that's like. In most of the south, it's still $7.25. In much of the west, it's still $7. 25. And I think that is outrageous, frankly, in this day and age.

[Host 2]

Elimination of capital gains and mortgage interest, one basic income tax rate, and similar to what Reagan did.

[Neera Tanden]

I think the country over the last 20 years has seen a big increase in wealth that goes towards capital versus labor. And I mean, there's been some studies that show when you really raise capital gains, that people play games around that. But fundamentally, I think we should not have this big differential between capital gains and traditional income that benefits very wealthy Americans.

[Host 2]

Last one alternative minimum tax of 50% for anyone making over, say, 3 million a year.

[Neera Tanden]

Yeah, that sounds good. I think what I'd say here, and you know, you've talked about this yourself, I think we have a real kind of cancer in the country in declining opportunity. And I'll also say, you know, we had Raphael Warnock here at CAP a few months ago, and he was talking about, you know, essentially a spiritual crisis in the country. And he identified it really with a sense that millions of Americans, most Americans, in fact, don't think that they can, that they have a real fair shot in the country. And they might think that because it's true, that upward mobility has really declined. We have less economic mobility than Canada, almost half. We have less than most countries in Europe. This was a country that used to be a place where you could go as far as your talents can take you. So I think we have to transform our institutions to make them put that issue like opportunity for every American at the Heart of what they do. And those ideas are part of that.

[Host 2]

Last question for me. Just along the lines of the lightning round. What do you think of the idea of the notion of mandatory national service?

[Neera Tanden]

I love it. I wish we could get it done tomorrow.

[Host 3]

I would add one proposal to the lightning round. This has gotten a lot of tension recently. It's very controversial. It was proposed in California and that is a wealth tax. Specifically the one that was proposed in California would be a one time 5% wealth tax on billionaires. Basically for those wondering what is a wealth tax, it's just take your net worth and lop off 5%. What do you think of wealth taxes? Do you think they make sense? Do you think they will address inequality? What do you make of them?

[Neera Tanden]

Well, I think it's hard to do at a state level. I will say that I think the fundamental impetus to me is how you address the inequality in the country. And I, and I wanna say a little bit more about that, which is I think we've had an important conversation about inequality for over 15 years. Piketty's book came out like 15 years ago. And I think that we lose sight of how it's a corrosive effect not just on our economy, but our democracy. I mean, and that billionaire's today have the ability to have a billion times wealth of other people is one thing, but they also have a billion times more political power. So I think it is very corrosive. Now, you know, I hate to be a policy wonk here, but there is some concern that a Supreme Court will never approve of a wealth tax because we needed an amendment to even get an income tax. So I think to me the most important question is how do we use, how do we, what ideas can we have, which there are many, to reduce the kind of overwhelming political power and economic power of the very wealthiest people in America. And I would just also note if you just look at say the 1995 tax code, okay, was in the heart of the Clinton administration. It had pretty high taxes and the economy was doing very well. Okay. We were still able to have a tech boom. We had pretty high tax rates on income. We had pretty high tax rates on the highest end and on capital gains. And we didn't do these three rounds of tax cuts that George Bush did on dividends and all these other things. We're just a wealth of areas that we have cut taxes on over the last 20 to 30 years that we could undo without the Supreme Court challenge or other challenge that a wealth tax would raise. And so it might be easier to start doing those and see where we land up.

[Host 3]

I think this is hitting on what Scott often talks about, which is the difference between being right and effective. And maybe a wealth transfer fixes things. Just a one time wealth tax, but is it actually going to get done? To your point, probably almost definitely not. Are you proposing higher taxes in general, just higher tax rates? What are some of the ideas that you think are more likely to happen that would be more effective, more probable than a wealth tax?

[Neera Tanden]

So I think we should start with what our values are. Right. Like I think, you know, we should reward merit in our country. We should ensure that like people can rise, et cetera. We shouldn't make it so much easier to have benefits of capital over labor. You should reward work. So if you like, those values to me mean that you would eliminate things like stepped up basis, which is a way in which really wealthy people kind of hide money from taxes and enrich their errors. You'd have a, you should have a higher estate tax, in my view. You should have raised capital gains, you know, increase, not lower taxes on dividends. You know, there's just a whole way, there's a whole range of ways the tax code, particularly over the last 30 years, has benefited super wealthy Americans and benefited capital over labor. People are investing instead of people who are like working paycheck to paycheck. And from my perspective, I think we should start, I mean, like, you know, I think we should have a rich debate about a wealth tax. Sure. But it's complicated. It's really hard to do. People can still hide assets and income. And so I think we could just start off making the tax code a lot fairer by unrigging it in many ways that it's been rigged over 30 at least, particularly the last 30 years.

[Host 3]

If you were the emperor of America for a day. So there's no Congress, there's no checks, no balances. You can basically just do whatever you want. You've got a day to do it. What would you change in the law? What would you implement and why?

[Neera Tanden]

I would ensure that we built mixed income housing in the suburbs and wealthier parts of America. And I'll say why? I think that, you know, essentially what we've learned about poverty in America is that people who have access to like wealthier places, poorer people who have access to wealthier places, their upper mobility goes up like this. Raj Shetty has done a lot of work in this space. And you know, to be candid, this actually is a bit the story of my life. My parents got divorced when I was really young. My father left just as a kind of accident of policy. Massachusetts had passed this encouragement of low income housing in suburban areas. My mom was able to move into an apartment. We had really good schools. If she didn't have that apartment in a middle class town, I could have grown up in a place where no one went to a college. I grew up in a place where everyone went to college. I went to college. I went to eventually law school. And I'm here because of all those decisions. So if I could change one thing in America just for a day, there'd be a lot of opposition from some wealthy homeowners, but I would have a system in America where we integrated housing a lot more, allowed much more mixed income housing in places that are wealthier in the country. And I think you'd have a lot more opportunity for everyone.

[Host 3]

Neera Tanden is the President and CEO of the center for American Progress. Before Leading American Progress, Tandem was the domestic Policy advisor to President Joe Biden and Director of the Domestic Policy Council, overseeing some of the administration's signature achievements, including its efforts to lower the cost of prescription drugs and expand health insurance coverage. Previously, she was senior advisor and Staff Secretary in the White House. Neera, thank you so much. We really appreciate your time.

[Neera Tanden]

Thank you.

[Host 3]

This episode was produced by Claire Miller and Alison Weiss and engineered by Benjamin Spencer. Our research team is Dan Shalon, Isabella Kinsel, Kristen o' Donoghue and Mia Silverio. Drew Burrows is our Technical director and Catherine Dillon is our Executive producer. Thank you for listening to Profg Markets from Profg Market Media. If you liked what you heard, give us a follow. And join us for a fresh take on markets on Monday. At the World.

[Host 2]

And the Sun.