America’s Health Care: Affordability, AI, & Politics 11/21/25

Summary

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Squawk Pod Podcast Summary

Episode: America’s Health Care: Affordability, AI, & Politics
Date: November 21, 2025
Hosts: Becky Quick, Andrew Ross Sorkin
Featured Guests: Rep. Hakeem Jeffries (House Minority Leader), Dr. Toby Cosgrove (former Cleveland Clinic CEO)

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Overview

This episode dives into the urgent state of health care affordability in America, exploring the political gridlock over the Affordable Care Act (ACA) subsidies, the challenges hospitals and patients face as costs rise, and the promise of artificial intelligence (AI) in transforming care delivery and administration. Key voices include House Minority Leader Hakeem Jeffries, who explains the stakes and politics of the ACA "subsidy cliff," and Dr. Toby Cosgrove, who breaks down why costs keep rising—and how technology could help.

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Key Topics & Discussions

1. Market Recap & Economic Context (02:18–08:01)

• The hosts discuss recent market volatility, with the Dow, S&P 500, and NASDAQ posting their worst week since April.
  • Becky Quick: "Markets are on track for their worst week since April 4th ... this time it's a little harder to pin down. Nvidia had really strong numbers ... but those concerns about the valuations certainly dogging the markets." (02:18–03:05)
• Bitcoin has fallen for 11 consecutive sessions—a new record.
  • Andrew Ross Sorkin: “There are people who are shorting, they're not just shorting bitcoin, they're shorting MicroStrategy as the strategy.” (04:03)
• Updates on international events: President Trump’s decision to roll back tariffs on Brazilian food imports and stalled bailout plans for Argentina provide additional context for economic pressures that tie back to affordability—especially of consumer goods.

2. Biotech Industry Frustrations with the FDA (08:01–10:54)

• A coalition of biotech leaders and patient advocates have sent a letter to President Trump and federal officials expressing concern over the unpredictable FDA approval process for rare disease therapeutics.
• Drop in orphan drug approvals is cited, with worries that "China will seize our biotech leadership and America will lose jobs, investment, and the historic momentum you built." (Letter paraphrased by Becky Quick, 09:27)
• Becky Quick: “It is unusual to see an industry speak up like this about the, basically the regulator.” (10:27)

3. Political Standoff Over ACA Subsidies (13:24–24:16)

Context:

• The ACA’s enhanced premium tax credits are set to expire December 31st, which would cause sharp increases in premiums, co-pays, and deductibles.
• Senate promises a vote by mid-December; in the House, Democrats have launched a discharge petition for a 3-year extension, needing four Republicans to sign on.

Hakeem Jeffries Interview Highlights:

• What’s at Stake:
  • Hakeem Jeffries: "If [the ACA tax credits] expire, tens of millions ... are going to experience dramatically increased premiums ... In some cases, premiums ... will increase by $1,000 or $2,000 per month." (13:59)
• On the Partisan Divide:
  • Becky Quick: “It's important context to make me realize that I don't think you want to get a deal done. I think this is ... You'd like to see the rates go higher and allow the Republicans to hang themselves with that. Is that the answer?” (16:55)
  • Hakeem Jeffries: “That's absolutely a ridiculous assertion. ... Shame on you for saying that.” (17:05)
• State Impact & Republican Involvement:
  • ACA expiration affects “West Virginia, Wyoming, Alaska, Mississippi, Tennessee ... We can go through the list.” (17:29)
• On Attempts at Bipartisanship:
  • “This is not a partisan fight for us. It's a patriotic fight ... We want to sit down and have a reasonable discussion, find common ground.” (17:40)
• Why Not a One-Year Deal?
  • Becky Quick: “Why not start with a one-year extension or potentially even a two-year extension?” (16:06)
  • Jeffries: Republicans have already refused one-year extensions and “are not interested in finding a resolution to a health care crisis that they've created.” (18:56)
• Summary Soundbite:
  • Jeffries: “The cost of living crisis is out of control. But the Republican approach since day one of this presidency has been my way or the highway.” (20:42)
• Call for Cooperation:
  • "We've repeatedly said we will sit down anytime, anyplace, with any of our Republican colleagues. ... We want to find a bipartisan path forward, but we need Republicans to operate in good faith." (20:42)
• On Government Shutdown:
  • Jeffries: “We didn't shut the government down. Donald Trump and Republicans control the House, the Senate and the presidency ... the American people ... know who was responsible.” (21:56)

Notable Exchange:

• Becky Quick: “So what I'm hearing ... is that there is no middle ground. There is no bipartisanship. This is at this point, us versus them, and we are not going to agree on anything, am I?” (20:32)
• Jeffries: “No, that's absolutely not the case. We've repeatedly said we will sit down anytime, anyplace...” (20:42)

On New York’s Mayor-Elect Visit to the White House:

• Discussions will focus on the “cost of living” and “public safety.” (23:24–24:16)

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4. Health Care System Stressors & Solutions (Dr. Toby Cosgrove) (24:42–34:51)

The Cost Problem:

• Dr. Cosgrove: “Three things that are really driving the cost up. One is inflation, two is more older people, and three, there's more things we can do for people. ... Health care is getting more and more sophisticated ... premiums are going up enormously, 26% across for people ... some 16 million are going to lose coverage.” (24:42–27:50)

Prevention & Lifestyle:

• Dr. Cosgrove: “There’s prevention ... 40% of the United States is obese and that causes diabetes.” (28:06–28:44)
• GLP-1 (Ozempic-type) drugs are “part of the solution ... a fabulous drug ... but they're expensive.” (28:47–28:58)

Pharmaceutical Pricing:

• Drug costs remain high due to "evergreen" patents; generics are delayed, “so things don't get to be generic drugs, which drives up the cost.” (29:11)
• Cosgrove: “It's not going to be a single solution to this. ... we're going to have to address it uniformly.” (29:56)

Hospitals’ Financial Squeeze:

• Supplies and labor costs rising; margins razor thin.
• Cosgrove: “10% of the cost of drugs are going up, 10% of supplies are going up and 6% increase in the cost of labor.” (30:17)

Artificial Intelligence: Promise & Application

• “I think we're actually hitting on an exciting new time in health care. And that's around AI.” (01:44, expanded 30:57–33:07)
• Cosgrove: “AI brings the efficiency ... productivity of hospitals has gone continuously down. ... There’s 2 million unfilled jobs in healthcare. ... AI can bring the efficiency to healthcare.” (30:57–31:44)
• Example: Automated note-taking, billing, predicting no-shows, and managing supplies could "bring down 10–15% of the cost of health care." (31:44–31:56)
• ROI on AI investment is positive despite initial costs. (33:00)

Persistent Price Disparities:

• Andrew Ross Sorkin: “If you go in, depending on where you go to get an MRI ... some places that will charge you 1,000 bucks ... others ... 6,000 bucks or 8,000 bucks ... is that just a margin situation?”
• Cosgrove: “It's the same [machine] ... all the factors that go into managing a major hospital are expensive. ... an outpatient facility ... is more convenient and lower cost ... That's where things need to move.” (33:45–34:28)

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Notable Quotes & Memorable Moments

• Hakeem Jeffries (13:59): “The Affordable Care act tax credits are going to expire on December 31st. And if that happens, tens of millions ... are going to experience dramatically increased premiums.”
• Becky Quick (16:55): “I don't think you want to get a deal done ... you'd like to see the rates go higher and allow the Republicans to hang themselves with that. Is that the answer?”
• Hakeem Jeffries (17:05): “That's absolutely a ridiculous assertion. ... Shame on you for saying that.”
• Dr. Toby Cosgrove (27:02): “There's more things we can do for people. That's a great problem they have.”
• Dr. Toby Cosgrove (31:44): “McKinsey would say that 10 to 15% of the cost of health care in the United States can be brought down using AI. ... particularly using it in administrative work.”
• Dr. Toby Cosgrove (34:28): “An outpatient facility ... no question, is more convenient and lower cost to do it. And that's where things need to move.”

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Timestamps for Key Segments

• 02:18 – 04:03: Market volatility and Bitcoin slide
• 08:01 – 10:54: Biotech letter to FDA/administration
• 13:24 – 24:16: Hakeem Jeffries interview (ACA, politics, bipartisanship)
• 24:42 – 34:51: Dr. Toby Cosgrove interview (health system costs, prevention, AI in healthcare)

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Tone & Takeaways

• The episode is direct, urgent, and at times contentious—especially in the political debate between Becky Quick and Hakeem Jeffries.
• Jeffries is firm, portraying Republican inaction as harmful to Americans’ health and Democrats as seeking bipartisan solutions, while Quick presses on the realities of negotiation and potential political gamesmanship.
• Dr. Cosgrove is pragmatic and optimistic about healthcare’s future, especially around technology, but clear-eyed about how structural cost drivers—from aging populations to expensive innovations—complicate reform.

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Bottom Line:
This Squawk Pod episode offers a comprehensive, real-world look at the issues making American health care so unaffordable—from D.C. politics to hospital hallways—while highlighting both the frustration in stalled reforms and the hope in technological progress.

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Transcript

[Andrew Ross Sorkin]

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[Cameron Costa]

This is Squawk Pod and I'm CNBC producer Cameron Costa. On today's episode, the healthcare standstill on Capitol Hill. Looming over it all, a subsidy cliff approaches for the Affordable Care Act's insurance premiums. House Minority Leader Hakeem Jeffries joins us.

[Hakeem Jeffries]

Tens of millions of hardworking American taxpayers are going to experience dramatically increased premiums, co pays and deductibles. In some cases, premiums for health insurance will increase by $1,000 or $2,000 per month.

[Cameron Costa]

It might not be all doom and gloom though for health care. Former Cleveland Clinic CEO Dr. Toby Cosgrove.

[Dr. Toby Cosgrove]

Is looking forward to I think we're actually hitting on an exciting new time in health care and that's around AI those conversations.

[Cameron Costa]

Plus health care leaders have penned a letter to the FDA and President Trump will lower tariffs for beef, chocolate and coffee from Argentina.

[Becky Quick]

Affordability, obviously the big question.

[Cameron Costa]

It's Friday, November 21, 2025 and Squat Pod begins right now.

[Andrew Ross Sorkin]

Stand Becky by in three, two, one.

[Becky Quick]

Good morning everybody. Welcome to Squawk Box right here on cnbc. We are live from the NASDAQ Marketsite in Times Square. I'm Becky Quick along with Andrew Ross Sorkin. Joe is off today. Well, it was quite a session yesterday was we're watching. We saw a huge swing in the markets yesterday. That reversal within video led through to the rest of the market. You did see a swing of market more than 1100 points for the Dow over the course of the session, stocks were down. After that reversal by Nvidia dragged down the tech stocks, it was concerns about stock valuations. And then separately that better than expected jobs report dims hopes for a December rate cut by the Fed. For the week, the Dow and the S&P 500 each down by about 3%. The NASDAQ is down by 3.6%. In fact, the markets are on track for their worst week since April 4th. So going all the way back to when tariffs were the big concern over all of these things and this time it's a little harder to pin down. Nvidia had really strong numbers that they reported the day before. But those concerns about the valuations certainly dogging the markets. And once you start to see selling, you it's hard to stop seeing that selling. Big, big swing of about 4% at one point for, for the Nasdaq just from the highs to the lows. And then bitcoin, which continues to fall. In fact, we have now seen bitcoin, bitcoin down for 11 sessions in a row. That's the first time it's happened in, in bitcoin history. If you're looking at this this morning, it's down another 4.3% to $82,781. It's a drop of more than 30% from where we saw the highs of bitcoin earlier this year. For the one year, bitcoin is now down by about 15.8%. And if you look at some of the stocks like MicroStrategy, those shares have been under pressure too.

[Andrew Ross Sorkin]

And there's this idea, I don't know if you saw Tom Lee on the bitcoin front arguing that there are people who are shorting, they're not just shorting bitcoin, they're shorting microstrategy as the strategy.

[Becky Quick]

I'm sorry, they changed their name strategy.

[Andrew Ross Sorkin]

But they're using it as a hedge against, against bitcoin. And so he's arguing, actually that strategy is absorbing even more of the losses because of this sort of hedge that people are people are using that instrument as a hedge against their own bitcoin, which is an interesting, an interesting piece. And Ukraine's president Vladimir Zelensky saying he has now agreed to work on a peace plan drafted by the US And Russia and that he expects to talk with President Trump in the coming days. Lansky's office said he received draft plans from Washington yesterday. Reports say the proposal includes demands for Ukraine to cede territory in its eastern Donbas region in Russia to Russia. I should say removal of sanctions from Russia, a halt to war crime investigations, limits on the size of Ukraine's army, and a guarantee that Ukraine will not join Naito. In exchange, Ukraine would receive a guarantee of sovereignty and explicit security guarantee from the United States. Frozen Russian assets would be used in part to rebuild invest in Ukraine. The question is whether you think that Ukraine is going to be willing to accept all of those, all of those elements.

[Becky Quick]

Sticking in the international markets. Let's take a look at late yesterday, President Trump signing an order to remove the 40% tariffs on Brazilian food imports, including beef, coffee, cocoa and fruits. Those tariffs were added in July to punish Brazil over the prosecution of its former president, Jair Bolsonaro. That order is backdated to November 13, meaning some duties collected will have to be refunded. Brazil normally supplies a third of the coffee that's used in the United States and, and has more recently become an important supplier of beef. And if you look at the affordability, affordability issues that come with this, it's a big one. You can see coffee futures right now down by about 4%. On this news yesterday, there was media that was kind of circulating with some of this, and they spoke with Stu Leonard, I think it was the Wall Street Journal, but I could be wrong on that. But they spoke with Stu Leonard, the grocery store company that's pretty regional here, the CEO of the company saying, look, we're not going to lower coffee prices until probably the new year because we've bought enough coffee, right?

[Andrew Ross Sorkin]

They're already at the other prices.

[Becky Quick]

We've already stored this up and we've got enough to get us through the holidays. So there are those questions that come with it, too. Maybe there's a big reversal. Maybe there's some of that that can get paid back if these are backdated to November 13, maybe they get back some of the import duties that they had to put on some of these things. But affordability, obviously the big question, and watching what it means to consumers, I.

[Andrew Ross Sorkin]

Wonder how I don't, I didn't pay for my coffee this morning, but I don't know.

[Becky Quick]

You never do.

[Andrew Ross Sorkin]

I never do. But I don't know how much, how much more expensive it is. It is right at this Moment, a planned $20 billion bailout to Argentina from JP Morgan, bank of America, Citigroup is reportedly no longer under serious consideration. The Wall Street Journal said that those banks had been awaiting guidance from the Treasury Department on what guarantees and collateral they could use to shield them from losses. Now while they were waiting, congressional elections in Argentina in October bolstered Javier Miller's government and sent the country's bonds and currency rallying. The report says the banks are now focused on plans to lend Argentina around $5 billion. They're going to do that a little differently. Through a short term repurchase or repo facility, Argentina would exchange a portfolio of investments for dollars from the bank to to make an upcoming debt payment. The government then on the other end would later borrow billions from the bond market and use those proceeds to pay back the repo facility. Does that make sense? I think so.

[Becky Quick]

No, no, no. I'm still thinking it through.

[Andrew Ross Sorkin]

It's a little complicated. It's a little complicated.

[Becky Quick]

CNBC has learned that health care industry leaders have sent a letter to President Trump, to the Health and Human Services Secretary, Robert F. Kennedy Jr. And the head of the FDA, Dr. Marty McC. The leaders who are speaking up here are lodging some frustration with the FDA when it comes to approvals of potentially life saving therapeutics for rare diseases. The group of letter signatories are made up of biotech leaders, patient advocates and academics who work in the rare disease space, and they're expressing concern that the level of unpredictability inside the FDA has risen so sharply it could make biotech less willing to underwrite opportunities in the United States and to look to fund projects in other countries, the group writes to the president, unless consistency is restored, China will seize our biotech leadership and America will lose jobs, investment and the historic momentum you built. The signees include the heads of foundations and fundraising organizations, the chairman of Ovid Therapeutics and other startups. With new and promising therapeutics in the pipeline, they argue. In an era of increasing global competition and demand for rare disease therapies, US Biotech stakeholders need to share a common understanding of stable, transparent evidentiary standards to bring medicines to patients quickly and safely. The first Trump administration was known for innovation going back to Operation Warp speed back in 2020 for Covid. And this group actually starts out saying that these actions that the FDA are taking right now undermine President Trump's legacy of medical innovation that was initiated into the first term. Things like the Right to Try act, which demonstrated a strong commitment to the spirit the of spirit of medical innovation and improving patient access. The FDA has really spoken pretty positively about this. In fact, Dr. Marty McCurry was on with us recently talking about how they are trying to make sure rare disease does have options for some of these things. But this group points out. The number of approvals for new orphan drugs for rare disease has dropped pretty steadily from 12 in front of the CBER in 2023 to three this past year through November. And, and for the CDER, it's gone from 28 down to about 18 over the last couple of years. So they're just pointing to things that they think have made it more difficult in order to see what the FDA is really thinking about, make sure they've set up their clinical trials properly.

[Andrew Ross Sorkin]

How much of the problem, though, is coming from where Marty is or from RFK because he's in a battle?

[Becky Quick]

This letter is addressed to all of them. This letter is addressed to all of them. And I don't know, but it is unusual to see an industry speak up like this about the, basically the regulator.

[Andrew Ross Sorkin]

That they have to do. And it's interesting they're doing it collectively, which is the way to do it.

[Becky Quick]

There's more than 100 signatory, close to 100 signatories. I think I counted 96 or 97 on it. But it'll be interesting to see the response from the White House, if any.

[Andrew Ross Sorkin]

If any, if any, cool news. Very interesting news.

[Commercial Announcer]

Cheese will be next.

[Cameron Costa]

Coming up next on Squawk Pod, the government shutdown may have ended, but the fight over extending key Obamacare subsidies before the end of the year continues. Democrats are trying to pass an extension to go past the end of President Trump's term, and Republicans aren't fighting. House Minority Leader Hakeem Jeffries explains that strategy.

[Becky Quick]

I don't think you want to get a deal done. I think this is something where you'd like to see the rates go higher and allow the Republicans to hang themselves with that. Is that the answer?

[Hakeem Jeffries]

That's, that's absolutely, that's absolutely a ridiculous assertion. And really, three years is not going to get passed.

[Becky Quick]

So what do you do?

[Hakeem Jeffries]

Shame on you for saying that.

[Cameron Costa]

Hakeem Jeffries explains that strategy.

[Becky Quick]

I don't think you want to get a deal done. I think this is something where you'd like to see the rates go higher and allow the Republicans to hang themselves with that. Is that the answer?

[Hakeem Jeffries]

That's, that's absolutely, that's absolutely a ridiculous assertion. And really shame on you.

[Becky Quick]

Three years is not going to get passed. So what do you do?

[Hakeem Jeffries]

Shame on you for saying that.

[Commercial Announcer]

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[Andrew Ross Sorkin]

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[Cameron Costa]

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[Becky Quick]

Edu.

[Andrew Ross Sorkin]

We'Re back.

[Hakeem Jeffries]

This is Squawk Pod up and Andrew Q.

[Andrew Ross Sorkin]

You're watching Squawk Box on cnbc. I'm Andrew Rsorkin along with Becky Quick. Joe is off on this Friday morning.

[Becky Quick]

Discussions remain at a standstill over subsidies for the Affordable Care Act. Yesterday, the Senate left for the Thanksgiving holiday. Nothing that's planned at this point. So we are still in wait and see mode. Joining us right now is House Minority Leader Hakeem Jeffries to talk a little bit more about this. And sir, can you lay out without any partisan bent, kind of where things stand right now just so Americans understand what's happening.

[Hakeem Jeffries]

Well, the Affordable Care act tax credits are going to expire on December 31st. And if that happens, tens of millions of hardworking American taxpayers are going to experience dramatically increased premiums, co pays and deductibles. In some cases, premiums for health insurance will increase by $1,000 or $2,000 per month. This is for working class Americans, middle class Americans and everyday Americans. Health care will be unaffordable. People will be unable to go see a doctor when they need one. And that's unacceptable in this great country, the wealthiest country in the history of the world over in the Senate, it's my understanding that Leader Thune has recommitted to a vote on an Affordable Care act extension no later than than the second week in December. So there are ongoing discussions that are taking place in the Senate. Meanwhile, unfortunately in the House, my Republican colleagues have shown zero interest in doing anything related to the ticking time bomb of the Affordable Care act tax credits expiring. House Democrats have launched a discharge petition to try to compel an up or down vote on a straight three year extension so we can provide working class Americans with the same level of certainty that my Republican colleagues provided their billionaire donors when passing the one big ugly bill.

[Becky Quick]

Minority Leader Jeffries, let's talk about that discharge petition. You need 218 votes in the House in order to pass that. You've got 214 members in the Democratic caucus, so you only need four House Republicans to have to sign onto it to get this passed. But the idea of saying that this is a three year extension instead of a one or even two year extension has any potential. Republicans saying, forget it, this is dead on arrival. That's the opinion of Representative Don Bacon. He's a Republican from Nebraska who has been working with the idea of potentially extending for two years. But three years they say is dead on arrival. So if this is something that you want to satiate, if you want to get done, you are going to need at least some Republicans come over. Why not start with a one year extension or potentially even a two year extension?

[Hakeem Jeffries]

Wellita Schumer offered a one year extension in the context of trying to end the Trump Republican shutdown.

[Becky Quick]

That's different. I'm talking about what you have now. Let's not go back to what's done in the past and what has not been extended. If you want to get something that has actually done, you need to do something that will have bipartisan.

[Hakeem Jeffries]

You can ask me the question. You can ask me the question. I'll provide.

[Becky Quick]

You ask me the question instead of.

[Hakeem Jeffries]

Going, I'll provide the answer. No, no, I'm providing an answer in order to provide context. Republicans have repeatedly refused to take yes for an answer. It was a very reasonable multi year extension that was offered. It was a one year straight extension plus a multi year process through a bipartisan commission to more permanently resolve the Affordable Care act issue. So having that context is absolutely important. Regardless of what you may think.

[Becky Quick]

It's important context to make me realize that I don't think you want to get a deal done. I think this is. You'd like to see the rates go higher and allow the Republicans to hang themselves with that. Is that the answer?

[Hakeem Jeffries]

That's, that's absolutely, that's absolutely a ridiculous assertion. And really, three years is not going to get passed.

[Becky Quick]

So what do you do?

[Hakeem Jeffries]

Shame on you for saying that. Because we're fighting. It's not a partisan issue for us. In fact, the States that are most impacted as it relates to an Affordable Care act expiration are all Republican states. We're talking about West Virginia, Wyoming, Alaska.

[Becky Quick]

Who are contesting that.

[Hakeem Jeffries]

Mississippi. Right. Tennessee. Over and over and over again. We can go through the.

[Becky Quick]

We have some Republicans who would sign on if you guys could come up with something that actually looks like a bipartisan deal.

[Hakeem Jeffries]

Listen, this is not a partisan fight for us. It's a patriotic fight. We're fighting for every constituent, even if Republicans aren't necessarily fighting for their own constituent. We want to find a bipartisan path forward, and that is what we've repeatedly indicated we want to do. Like we want to sit down and have a reasonable discussion, find common ground to address this issue. Now, Republicans said in the House they were willing to deal with the Affordable Care act tax credit issue after the government funding agreement was reached. Well, now the government shutdown is over and there's still been no conversations with House Republican leaders.

[Becky Quick]

Mike Johnson never said that. The leader never said that. You do have Republicans, though, who would agree with you on something if it was actually bipartisan in nature. That's what I'm trying to get at.

[Hakeem Jeffries]

Actually. Mike Johnson actually did say that there was always a plan to specifically deal with the expiration of the Affordable Care act tax credits. In fact, he said that repeatedly. So I'm not sure what you're referencing.

[Becky Quick]

I think their plan is something that looks more like an hca, which I'm guessing you would say is dead on arrival too. If you wanted to set up these health care plans that are funded instead of going through the aca, I'm assuming you would say that's dead on arrival too, because there have been Republicans who've put that forward. Am I wrong in thinking you would not go along with that?

[Hakeem Jeffries]

What I'm saying is that what's in front of us is the immediate expiration of the Affordable Care act tax credits. Republicans have had all year to deal with this issue and they've refused to do it. So they're the ones who are not interested in finding a resolution to a health care crisis that they've created, including passing a bill that enacted the largest cut to Medicaid in American history. And because of their policies, hospitals, nursing homes and community based health centers are closing throughout America, including in rural parts of the country.

[Becky Quick]

Which is why it would be nice to see a one year extension so that none of these things happen immediately and give you all time to actually try and work on bipartisan situations rather than a three year extension that basically kicks it down until the next administration is here. I think both sides need to come together and find some way of getting around this. That's not necessarily saying, okay, we're going to spend $350 billion to extend, extend these tax credits without having any way of trying to get at the real problems of what is causing higher premiums, what is causing this inflationary health care environment to begin with.

[Hakeem Jeffries]

Yeah. What's interesting is that Republicans just spent trillions of dollars to provide their billionaire donors with massive tax breaks and in that same bill, cut Medicaid by the largest amount in the history of the country and also ripped $186 billion in nutritional assistance away from, from hungry children, seniors and veterans, the largest cut to snap in American history. But somehow we can't find a dime to extend the Affordable Care act tax credits even for a year because House Republican leaders have rejected a one year extension. Rejected. That's their position. Not our position, that's their position.

[Becky Quick]

So what I'm hearing, though, is that there is no middle ground. There is no bipartisanship. This is at this point, us versus them, and we are not going to agree on anything, am I?

[Hakeem Jeffries]

No, that's absolutely not the case. We've repeatedly said we will sit down anytime, anyplace, with any of our Republican colleagues. We'll even go back to the White House to sit down with President Trump. We've repeatedly offered to do it, but they've refused. Donald Trump spent more time on the golf course during the longest government shutdown in American history than he did talking to Democrats on Capitol Hill, who represent half the country. He has no interest in actually trying to find a bipartisan solution because the Republican approach, which is failing now, the American people know the country is moving in the wrong direction. The cost of living crisis is out of control. But the Republican approach, since day one of this presidency has been my way or the highway. Everybody knows it. It's one of the reasons why Republicans were rejected decisively, electorally, in the elections early this month. Yet as Democrats, we continue to say we want to find a bipartisan path forward, but we need Republicans to operate in good faith in order for that to happen.

[Becky Quick]

Minority Leader, do you think that, what do you think the, do you think you were successful in shutting down the government? Do you think you got what you wanted?

[Hakeem Jeffries]

We didn't shut the government down. Donald Trump and Republicans control the House, the Senate and the presidency. And in fact, the American people, prior to the shutdown, during the shutdown and after the shutdown, know who was responsible for the government shutting down. And in fact, in the midst of it all, Republicans refused to even sit down and have a conversation about keeping healthcare affordable for everyday Americans. And so we're going to move past it. We have an Affordable Care act tax credit expiration deadline that we need to tackle. We have a whole set of spending agreements that we need to find common ground on in advance of those agreements expiring in terms of the continuing resolution by the end of January. We just need partnership on the other side of the aisle. You know, what we have right now is that the Republicans are in the midst of an ongoing civil war. I mean, Donald Trump is fighting with Marjorie Taylor Greene. Mike Johnson and John Thune are fighting with each other. Corey Mills and Nancy Mace are fighting with each other. House Republicans are strongly disagreeing with Senate Republicans. The whole thing on the other side of the aisle is a mess. Meanwhile, as Democrats, we just want to fight for working class Americans.

[Andrew Ross Sorkin]

Minority Leader Jeffries, I'm curious, later today, the mayor elect of New York, Mondame, is going to be meeting with the president at the White House. Unclear whether we'll see it all publicly or not. I'm curious, have you spoken to him about what this meeting is going to be, how he should approach it, and if you have or even haven't, what you're advising him?

[Hakeem Jeffries]

Well, he and I had an opportunity to talk yesterday. I congratulated him on the announcement that Police Commissioner Jessica Tisch was going to remain at the helm of the nypd. I think that's a great thing for the city of New York, for every single community, and it reinforces the mayor elect's commitment to public safety for all New Yorkers. I think at the meeting, as he's publicly indicated, the two topics that will be discussed will be the affordable affordability crisis that exists, you know, in the United States of America. The cost of living is way too high. That, in fact, is the case in New York City and across the country, and public safety and how to move forward. And hopefully President Trump is going to approach the meeting with a respect for the city that allowed his family and himself to achieve significant levels of success.

[Becky Quick]

Minority Leader Jeffries, thank you for your time today. We do hope to see something accomplished with this, so we'll continue to watch. Thank you.

[Hakeem Jeffries]

Thank you.

[Cameron Costa]

Next on Squawkpod, how Capitol Hill's healthcare standstill plays out in hospitals. With former Cleveland Clinic CEO and heart surgeon Dr. Toby Cosgrove. We're tackling costs and the future of America's health.

[Dr. Toby Cosgrove]

Three things that are really driving the cost up. One is inflation, two is more older people and three, there's more things we can do for people.

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You'Re listening to Squawk Pod with Becky Quick and Andrew Ross Sorkin. Here's Becky.

[Becky Quick]

The Affordable Care Act's enhanced premium tax credits expire at the end of the year, but Congress has not yet come up with a bipartisan solution for that deadline. Joining us right now is former CEO of the Cleveland Clinic, Dr. Toby Cosgrove, a heart surgeon as well. And Toby, thanks for coming in today.

[Dr. Toby Cosgrove]

Pleasure. Nice to be with you, Becky.

[Becky Quick]

All right, let's just talk about where things stand. What is the situation with the health care system at this? What's going to happen with higher premiums? What do you think potential solutions are?

[Dr. Toby Cosgrove]

We got a big problem that's coming up right now. And the problem is that inflation has really driven up the cost of most everything. There are three things that are really driving the cost up. One is inflation, two is more older people. And three, there's more things we can do for people. And health care is the big more.

[Becky Quick]

Things we can do for people. That's a good problem to have.

[Dr. Toby Cosgrove]

That's a great problem they have. And, and health care is Getting more and more sophisticated all the time, and more things we can do. What we're seeing now is the premiums are going up enormously, 26% across for people, and. And that the premiums are going to continue up onto insurance. And this is going to be very unaffordable for lots of people. And they're going to force people out. And on top of that, there's a lot of people. Some 16 million are going to lose coverage. And this has a ripple effect all the way down through all of society and all of the economy.

[Becky Quick]

Health care costs have outpaced inflation for decades at this point. We've never been good at arresting that inflationary curve, things like this. And for higher education, too. As somebody who has worked within the system, what is the best way to try and address that?

[Dr. Toby Cosgrove]

Okay, there's really sort of three things I think we can do to address it clearly. There's prevention, and, you know, right now we have an epidemic of obesity. We have problems with smoking. Still, people have got to take better care of themselves.

[Becky Quick]

Look, the medical industry will say, hey, we have ozempic or other GLP1s to take care of them. But that's really expensive.

[Dr. Toby Cosgrove]

We do, but, you know, the problem is 40% of the United States is obese, and that causes diabetes. And, you know.

[Becky Quick]

But are the GLP1s the solution or are they part of the problem in terms of.

[Dr. Toby Cosgrove]

No, I think they're part of the solution.

[Becky Quick]

Okay.

[Dr. Toby Cosgrove]

And they're a fabulous drug and have ramifications to go over. Cardiac, renal, gi.

[Becky Quick]

But they're expensive.

[Dr. Toby Cosgrove]

They are expensive, but costs are coming down. And I think. And that gets into a whole other set of things. So the other issues about.

[Hakeem Jeffries]

How we.

[Dr. Toby Cosgrove]

Can bring down costs are going to be policy things. And for example, where are the costs, really? Well, the costs are in hospitals and doctors, and 10% of the costs are drugs. And right now what we do is have evergreens as far as drugs are concerned, and people extend the patents. And so things don't get to be generic drugs, which drives up the cost of drugs. So they're going to have to have some reform there.

[Becky Quick]

Although the pharmaceutical companies will say, look, we put in so much money into the cost of innovation that when we do get something on patent, we should be allowed to keep it, because not everything we spend actually turns out to be a drug. There are so many failures along the way.

[Dr. Toby Cosgrove]

Well, that's.

[Becky Quick]

It's funny, when you talk to anybody in the health care industry, they will point fingers in the other directions about.

[Dr. Toby Cosgrove]

Where the problem is, I think it's all of our problems. It's not going to be a single solution to this. And so we're going to have to address it uniformly. And that's just one part.

[Becky Quick]

How do we fix the hospitals? As somebody who runs a hospital and hospitals have such thin margins, what are the problems there? How do we fix it?

[Dr. Toby Cosgrove]

So in hospitals right now what you've got is 10% of the cost of, of drugs are going up, 10% of supplies are going up and 6% increase in the cost of labor. So what, what we need to do is. And we've got great news coming up and I think we're actually hitting on an exciting new time in health care. And that's around AI I think AI brings the efficiency to healthcare that we've never seen before. And over the last multiple years, the productivity of hospitals has gone continuously down. We've just added more and more people. Now we can have. And we have a shortage of people. There's 2 million unfilled jobs in healthcare. And this is an opportunity to employ AI to bring the efficiency to healthcare. Physicians, nurses, everybody.

[Andrew Ross Sorkin]

I'm talking about just the low hanging fruit is that the doctor can now just talk to their phone, tell them what's going on and have it write the report.

[Dr. Toby Cosgrove]

Ambient listening, which is absolutely terrific and has improved doctors. But that's not all. I mean, stop and think about billing in hospitals. You have people who do the coding, people who put out the bills, thousands of people working.

[Andrew Ross Sorkin]

How much of a hospital budget is that stuff?

[Becky Quick]

Well, yeah, the administrative stuff.

[Dr. Toby Cosgrove]

Okay, so a lot. And so McKinsey would say that 10 to 15% of the cost of health care in the United States can be brought down using AI. And that's particularly using it in.

[Andrew Ross Sorkin]

This is for administrative work.

[Dr. Toby Cosgrove]

Administrative work?

[Becky Quick]

Yeah, because I don't want to talk to an AI bot when I'm in the hospital bed. I still want my doctors, I still want my nurses. I don't care what you do behind scenes.

[Dr. Toby Cosgrove]

Exactly. But you also don't want your doctor spending all of his time at home and doing, catching up on the charts.

[Becky Quick]

Correct.

[Dr. Toby Cosgrove]

And 18 hours a week now are administrative stuff for doctors.

[Becky Quick]

Really? How did it get so bad and why?

[Dr. Toby Cosgrove]

Well, it's because you've got those charts to fill out, so all that can be taken away and getting much more efficient. Stop and think about supplies, having your supplies being just the right amount of supplies, about increasing efficiency in your operating room. How about scheduling, how about predicting no shows for appointments? There are hundreds of Things that you can apply AI to that will be enormously advantageous in reducing.

[Becky Quick]

But AI is also expensive. And how do the hospitals come up with the cost for paying for it? I mean, we talk all the time, the time about how expensive this stuff is, who's going to pay for it.

[Dr. Toby Cosgrove]

It is expensive, but it is going to. The ROI on it is going to be positive. There's no question about that.

[Andrew Ross Sorkin]

But can I ask a separate question? And this is just about basic care that I can't figure out. If you go in, depending on where you go to get an MRI for different, different body parts. And I'm just talking out of pocket, forget the insurance piece. There are some places that will charge you 1,000 bucks. There are other places that will charge you 6,000 bucks or 8,000 bucks. And I can't figure out for the life of me, is that just a margin situation? How much do these machines cost? Are the hospitals trying to turn them into profit centers because they're trying to amortize the cost? I mean, obviously they're trying to amortize the cost. These are not cheap machines. But just walk us through, for example, that kind of scenario.

[Dr. Toby Cosgrove]

Okay, so first of all, you have to understand that right now there is billing, and if you get an MRI in a hospital or you get an MRI by. Owned by the hospital, the insurance pays the same. But it's cheaper to do it as an outpatient.

[Andrew Ross Sorkin]

Right.

[Dr. Toby Cosgrove]

And so they. And so basically what we need to do is not have the constant pay just because you're getting an MRI someplace. You need to have it done in a cheaper place and move the patients to the outpatient. That's true.

[Andrew Ross Sorkin]

Because it's cheaper to do it in the outpatient facility because just the real estate's different. Or what are we talking? What's. What's the, the shift? It's the same machine, right?

[Dr. Toby Cosgrove]

It's. It's the same. But all, all the factors that go into managing a major hospital are, Are expensive. But an outpatient facility, no question, is more convenient and lower cost to do it. And that's where things need to move. And instinct. That's where one of the biggest growth areas has been over the last several years, has been outpatient facilities.

[Becky Quick]

Toby, Dr. Cosgrove, thank you. We appreciate your time.

[Dr. Toby Cosgrove]

My pleasure.

[Andrew Ross Sorkin]

Harrison, where to now? 1929.

[Hakeem Jeffries]

8.

[Andrew Ross Sorkin]

Andrew Ross Sorkin's book 1929 depicts stock crash figures like Jesse Livermore, who made $100 million doing this to profit from the price drops.

[Dr. Toby Cosgrove]

Harrison, what is shorting?

[Andrew Ross Sorkin]

Yes, that was. Wow.

[Becky Quick]

That's really cool.

[Andrew Ross Sorkin]

We're watching this for the first time. That was last night on Jeopardy. I have been getting a lot of texts that I didn't watch Jeopardy. Last night. I don't watch Jeopardy. Enough. Clearly. And that apparently happened.

[Becky Quick]

That is really cool. Not only that, you were one of the photo ones. There's rarely a photo or video clue that's up there.

[Andrew Ross Sorkin]

So are you, are you a big Jeopardy watcher?

[Becky Quick]

Yeah.

[Andrew Ross Sorkin]

I'm glad that they got it right on the first try.

[Becky Quick]

That was very short seller.

[Andrew Ross Sorkin]

Right. So here they are, a learned group. A learned group. Look, shorting. And Jesse Livermore was an emotional wreck of a human being. But one of the great short sellers of that time. You know what happened to Jesse Livermore?

[Becky Quick]

Well, he killed himself.

[Andrew Ross Sorkin]

He kills himself. Yeah. And it's all over, right? Yeah. Very cool. Trading, I think up and down like that can.

[Becky Quick]

Can do that to you is particularly tough. I think too.

[Andrew Ross Sorkin]

You know, by the way, this is going to sound crazy for what we had to go for most of the 1920s, the late 20s when the market was going crazy, he was out of business. Because you couldn't short.

[Becky Quick]

Yeah.

[Andrew Ross Sorkin]

Because everything was straight up. Everything was straight up.

[Becky Quick]

Right. Always a risky bet because you can lose everything and more.

[Andrew Ross Sorkin]

Everything and more.

[Dr. Toby Cosgrove]

Always.

[Andrew Ross Sorkin]

It's the hardest way to do it.

[Cameron Costa]

That's Squawk Pod for today and for the week. Squawk Box is hosted by Joe Kernan, Becky Quick and Andrew Ross Sorkin. Weekday mornings on cnbc Starting at 6am Eastern. Get the best of our TV show right into your ears when you follow Squawk Pod. We're available for free wherever you listen to podcasts. We'll meet you right back here on Monday. Have a great weekend.

[Dr. Toby Cosgrove]

We are clear.

[Andrew Ross Sorkin]

Thanks guys.

[Becky Quick]

Foreign.

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Trading at Schwab is powered by Ameritrade. Unlocking the power of thinkorswim. The award winning trading platforms loaded with features that let you dive deeper into the market. You can visualize your trades in a new light on thinkorswim desktop with robust charting and analysis tools all while you uncover new opportunities with up to the minute market news and insights. ThinkOrSwim is available on desktop, web and mobile to meet you where you are so you never miss a thing. It's built by the trading obsessed to help you trade brilliantly. Learn more at swab. Com Trading.