Meidas Health: Former VA Secretary Dr. David Shulkin on America’s Health Care Crisis

Summary

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Podcast Summary: Meidas Health – Former VA Secretary Dr. David Shulkin on America’s Health Care Crisis

Episode Date: November 27, 2025
Podcast: The MeidasTouch Podcast
Host: Ben Meiselas (MeidasTouch Network)
Guest: Dr. David Shulkin, Former U.S. Secretary of Veterans Affairs

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Overview

In this episode, host Ben Meiselas sits down with Dr. David Shulkin, a rare bipartisan figure with experience serving as Secretary of Veterans Affairs under both Presidents Obama and Trump. The discussion zeroes in on the current health care crisis in the U.S., the looming expiration of ACA premium subsidies, policy proposals emphasizing Health Savings Accounts (HSAs), transparency in healthcare pricing, and recent controversial changes to federal education loan policy for health professionals. Dr. Shulkin’s perspectives offer a calm, nuanced, and deeply informed assessment of systemic challenges and opportunities for bipartisan action.

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Key Discussion Points & Insights

1. The State of U.S. Health Policy and the ACA Subsidies Crisis

• Crisis of Affordability & Systemic Inaction

  • Dr. Shulkin notes that ACA premium subsidies are “a band aid to a broken system that's really become unaffordable and non sustainable.” (03:46)
  • Both major political parties are criticized for not presenting comprehensive healthcare reform since the original ACA (Obamacare) legislation (03:46, 05:29).
  • The last holistic health policy reform was in 2009; “we’re really looking at thinking that developed in, you know, 2006 to 2008.” (03:46)
  • The system’s fragmentation leads to skyrocketing costs and persistent disparities with 20% of U.S. GDP spent on health, but coverage and outcomes lagging (06:32).

• Bipartisan Acknowledgment – But Piecemeal Solutions

  • Despite heated public debate, Dr. Shulkin observes that off-record, both parties “almost everybody agrees that in the absence of a different solution, the subsidies are needed just as a point of transition” (08:56).
  • Without these subsidies (set to expire December 31, 2025), millions could face crippling premium hikes—e.g., a family of four in Kentucky facing “five figure increases.” (11:12)

Notable Quote:
“Anybody who thinks that [ACA premium subsidies] is going to solve the affordability crisis for American healthcare, I think just isn't looking at it properly. ... There is no comprehensive solution being floated by either party.”
— Dr. David Shulkin (09:33)

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2. Health Savings Accounts (HSAs) and the Push for Direct Consumer Control

• Political Appeal vs. Systemic Limitations

  • Direct payments to HSAs are politically attractive: “Politicians like to be on the end. They're giving checks directly to Americans so they know where the money's coming from.” (12:11)
  • However, Dr. Shulkin warns this doesn’t tackle core issues: “Unless you went to a full system... where consumers have the right information, the transparency of cost and quality data… you're not going to see this as a solution that really begins to impact the basic issue of affordability and fragmentation.” (13:10)

• Potential Merits and Pitfalls

  • Empowering consumers can be positive if paired with true transparency and education, but stopping at HSAs is an “oversimplification” of the problem (13:48).
  • If not carefully designed, HSAs merely shift costs without resolving fragmentation or cost drivers.

Notable Quote:
“The idea is not a bad one… The idea of giving the consumer more control… Those are all good ideas. … But if it's viewed as we've now fixed the healthcare problem, I think that's going to be a oversimplification.”
— Dr. David Shulkin (13:35)

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3. The Limits of Price and Quality Transparency

• Consumer Behavior in Healthcare Markets
  • Dr. Shulkin agrees with research: even when data is available, patients rarely “shop around” for most services—typically turning to trusted friends/family or defaulting to their insurer’s network (15:33).
  • He asserts that unless people have financial “skin in the game,” and unless price/quality data is timely and understandable, behavior change won’t occur.
  • The only exception may be when patients face significant out-of-pocket costs and have the information to act (16:10).

Notable Quote:
“It’s actually a flawed measure that we’re using of whether consumers and patients actually want this information—without the financial accountability, it’s really hard to ask people to seriously use this information.”
— Dr. David Shulkin (15:46)

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4. Healthcare Workforce & Student Loan Policy Changes

• Changes & Controversy

  • The administration’s proposed cap on federal loans: $200,000 for law and medical degrees, with other professional and nursing degrees capped lower, sparks concern (17:24).
  • Nursing education in particular is affected: “currently nursing school will be decimated as a non professional degree. Lots of uproar, lots of unhappy voices out there.” (17:57)

• Dr. Shulkin’s Perspective

  • With an aging population and a growing nursing shortage, restricting support is “shortsighted policy… I was disappointed to see this and I think that this will need to be revisited.” (18:54)
  • He urges data-driven policy: “Policy should support where the needs are and the growth is.” (19:20)

Notable Quote:
“Anything that discourages [people] from [entering nursing programs] and helps defray the cost of that type of education I think is shortsighted policy.”
— Dr. David Shulkin (19:28)

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Notable Quotes & Memorable Moments

• On Political Denialism:
  “The subsidies are only going to provide some type of transition to hopefully a better system.” (05:31)

• On System Fragmentation:
  “Whenever you have such a fragmented system with different incentives to perform, you're going to get a system that essentially goes out of control. And our system is going out of control in two ways: less people being covered, and for those with coverage, affordability is out of reach.” (06:10)

• On the Quality Data Debate:
  “When you now... have a system like an HSA account where [consumers are] given the right information... and their financial decisions are going to be impacted by where they make a choice… I do think that's where consumers will begin to start using that data and changing behavior.” (16:17)

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Timestamps for Important Segments

• [01:50] Host Introduction of Dr. Shulkin and context for the episode
• [03:46] Dr. Shulkin discusses ACA subsidies as temporary fixes and lack of holistic reform
• [05:29] Elaboration on the bipartisan stalemate and systemic fragmentation
• [08:56] Political dynamics behind ACA subsidy negotiations and limitations of current solutions
• [12:11] The debate over Health Savings Accounts as a policy alternative
• [15:33] Price shopping, transparency and why most patients don’t or can’t engage
• [17:24] New loan rules for health professional education and policy impacts
• [18:54] Dr. Shulkin’s take: why cutting nursing education support is shortsighted

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Tone & Language

The conversation is earnest, analytical, and accessible—balancing policy depth with practical implications for listeners. Dr. Shulkin is calm and direct, repeatedly emphasizing the need for comprehensive, data-driven policy and bipartisan cooperation.

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Summary Takeaways

• Both political parties lack a comprehensive plan for American healthcare reform.
• ACA subsidies are a necessary stopgap—not a cure—for a deeply fragmented, unaffordable system.
• Proposals focusing on HSAs or consumer-driven solutions are not panaceas unless system transparency and behavioral incentives are aligned.
• Recent federal loan caps for health professional education risk exacerbating nursing shortages and should be reevaluated in light of demographic needs.

Dr. Shulkin’s bipartisan, pragmatic lens cuts through partisan rhetoric and underscores the urgent need for systemic, rather than piecemeal, solutions to America’s healthcare crisis.

Transcript

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[Dr. David Shulkin]

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[Host]

Mighty welcome to another episode of Midas Health. There's a lot that's happening, frankly, I think is confusing when we think about the changes or proposed changes to federal health policy from the Trump administration. And there are very few people in the country like Secretary Dr. David Shulkin to help us figure it all out, to help us navigate through this very complex policy situation. You know, Dr. Shulkin has served both President Obama and President Trump. He was most recently the Secretary of the VA for the Trump administration, served in very high senior ranking roles under the Obama administration, has been confirmed by the Senate, some of those roles to a vote of 100 to 0. I just found that out because I was warming up an audience for him in Philadelphia at a healthcare conference a few weeks ago and we had a chance to reconnect. I said I'd love to have him over at Midas Health and he graciously accepted. So I'm excited to have him join and for all of you to listen to his perspectives, especially at this really important time for the country. Secretary Shulkin, thank you for joining Midas Health.

[Dr. David Shulkin]

I'm glad to be with you today, man.

[Host]

I know there's a lot that we can cover, but I wanted to make sure our listenership had a chance to get your perspectives on everything that's happening when it comes to ACA Affordable Care act marketplaces potentially not being as hospitable to coverage as in years past. New proposals from the president suggesting that HSA Health Savings Accounts might actually be the focus of the current administration. There's a lot there. For those of the many out there who aren't spending their entire days thinking about these terms and these programs, I'm wondering your thoughts on what you're seeing and if you could help us wade through this confusion.

[Dr. David Shulkin]

I think that all of us that spend our time in healthcare understand how complicated this is. And if you now bring this up to a political level where people that don't spend their time in healthcare but are responsible for making policy for the country, take a look at it. They're frustrated too. And I think what we're seeing here is very interesting. The recent shutdown, the continued debates have really focused on ACA subsidies. But what ACA subsidies really are are a band aid to a broken system that's really become unaffordable and non sustainable. And unfortunately, what we're seeing is that neither the Republicans nor the Democrats have a plan for comprehensive reform to fix this system. And in fact, the last time that we had a holistic view of the system was back in 2009 with the advent of Obamacare, which means that we're really looking at thinking that developed in, you know, 2006 to 2008, if policy happened in 2009. And so what we're seeing is 15 years of really not addressing the systemic problems in the health care system. And I think that's where this frustration is boiling over and that's what we're seeing right now.

[Host]

Are you of the mind? You said this when I heard you in Philly at that fireside chat at Penn. And I loved it because I agreed with it. But it feels like Democrats and Republicans, to paraphrase you, neither party seems to have a plan in place for a long term fix for healthcare system. But I'm wondering if you can elaborate.

[Dr. David Shulkin]

Yeah, well, first of all, I think we are going to get there on some type of agreement on the subsidies because in the absence of a plan, the subsidies are the only thing that are going to provide some type of transition to hopefully a better system. And so what, what really needs to happen is we need to be able to have the political will to recognize that the current system of paying for units of care for the country simply isn't working. And what we really need to do is to transition to a reimbursement system at the policy level. That begins to take away the intense fragmentation of our system. That means that providers look at their job differently and are paid differently than payers who are paid differently and look at their job differently than pharmaceutical and device manufacturers who look at it differently than technology providers and service providers in the health care industry. And whenever you have such a fragmented system with different incentives to perform, you're going to get a system that essentially goes out of control. And our system is going out of control in two ways. One is we're seeing less people likely to be covered for insurance next year and the following years than we have in a long time. You're seeing even those that are covered no longer being able to afford it, with premiums going up 50, 60, 100% on small businesses and individuals. And we're seeing essentially the same gaps in quality and the same disparities in the healthcare system that we've seen for decades. And so by any measure, this is not a system that's really getting the results for the amount of money that the country's spending on it, which is close to 20% of the GDP.

[Host]

Do you ever wonder, I imagine the millions of folks that listen to Midas Touch and some fraction of which some will listen to Midas Health. The reason I wanted you to join is for many reasons, but one of which is you are a bipartisan leader. You appeal to both sides of the political aisle in ways in which I feel very few people can and do in our contemporary politics. When you have conversations not to ask you to betray confidences, but do you feel like there's a bipartisan understanding that something as simple as not extending. I'm not saying it's simple, but extending the subsidies, imperfect solution. A bunch of people would be left out of the healthcare system if it doesn't isn't extended. It strikes me that that's the only way forward. Maybe that is what they're going to land on. But for months it seems like there was an unwillingness to acknowledge that reality and the government got shut down for 40 plus days. We could fall both sides, I guess, to a certain degree. But from your vantage, is there a unanimity or a majority line of thinking among senators and congresspeople that we should be doing? We all largely agree that something needs to be done. They largely agree on the parameters of what needs to be done because it doesn't seem like that's the case from the outside looking in, but you have a different vantage.

[Dr. David Shulkin]

Well, I think that the political framing of this issue around the subsidies was an interesting one, but clearly the wrong one. Know, I do think that's the way this is. This short term political crisis is going to get solved. Because I think when you speak to people privately, almost everybody agrees that in the absence of a different solution, the subsidies are needed just as a point of transition till we can get to something else. But you know, if you think about the subsidies, it is reaching approximately 20 million Americans out of a country of close to 400 million. So it's a very small percent of Americans that this is really addressing. So anybody who thinks that this is going to solve the affordability crisis for American healthcare, I think just isn't looking at it properly. And so the problem is, is that we are facing this right now without a real alternative approach. There is no comprehensive solution being floated by either party. And so hopefully this is a wake up call. We do get the subsidy deal done to give us some time to really treat this as the crisis that it is.

[Host]

I want to pivot slightly. I suspect we're going to hear more and more about this in the weeks and months ahead, even if the subsidy issue gets extended. And for our listeners out there, Dr. Shulkin and I have been talking about these enhanced premium tax credits that became so much the focal point of the government shutdown over the last few months. You may have seen headlines saying that Democrats were wanting to negotiate on an extension before they agreed to reopen the government. And lots of hand wrinking. But these subsidies, which were passed in 2021 to make health care more affordable on these Obamacare exchanges that exist in many states across the country, were passed in 2021. They made health insurance cheaper to afford for about 24 million Americans. As you point out, Dr. Shulkin, this is a fraction of the country. They expire on December 31st of 2025 with no guarantee for extension. And what does this mean? This means for a family of four in Kentucky, we're seeing potentially five figure increases in health insurance premiums if they aren't extended. So huge consequences. I want to pivot, though. I bet many of us have already heard or will hear about health savings accounts. I saw Senator Cassidy of Louisiana suggest and be very bullish on this concept that that's where they're going to head with the plan that even if they temporarily extend tax credits to make or to extend these tax premium credits that we were just talking about, they really want to focus in on sending checks to Americans to bolster health savings accounts. From your vantage, wondering what your thoughts are on that approach, because it seems like it's a. It's an if it's an either or that they want to move towards that and away from Obamacare subsidies. And I'm wondering what your thoughts are on that.

[Dr. David Shulkin]

I certainly understand why it's politically appealing. Politicians like to be on the end. They're giving checks directly to Americans so they know where the money's coming from. And of course, our current healthcare system is anything but transparent. The money flow that happens once you pay your insurance premium and how that gets spent and dissipated I think is very difficult to follow. Just try to follow an explanation of benefits that you get from any medical service that you have. And I don't know anybody who really understands them. So I understand the simplistic nature of trying to cut the middleman out and give money directly to people to let them have control over where they spend it. But the complexity of the current system, that's not really going to solve the problem because people are still going to need their insurance plans and people are still going to see these types of cost increases. So unless you went to a full system of where money is given, the full premium dollar is given to consumers, consumers have the right information, the transparency of cost and quality data that they could make those decisions, I don't think you're going to see this as a solution that really begins to impact the basic issue of affordability and fragmentation in our system. But the idea is not a bad one. The idea of giving the consumer more control, the idea of providing the patient with the information to be able to make decisions and frankly, for the patient to have some skin in the game in terms of how they're spending their money and the accountability for that money. Those are all good ideas. And so if this is a way to start out, I'd say, you know, I would, you know, in some ways be optimistic about the start. But if it's viewed as we've now fixed the healthcare problem, I think that's going to be a oversimplification.

[Host]

I want to follow up. You brought up quality price transparency, and I'm glad you did because I wanted to get your take on this because I think that's a great goal. And I've spent some time at health technology companies for everything that's direct to consumer. And we hope that patients will compare prices and go with the best quality, lowest cost option. I read, however, and I wanted to see if you agreed with this, that short of knee surgeries and shopping around for knee surgeries, if you have a choice and you have time to plan for it, that you can shop around for the best potential price, that very few Americans seem to actually even when given the option and sometimes they're not because it's an emergency. In very few cases do people actually truly shop around. And I'm wondering, do you agree with that notion that let's say we were to give everybody their full or give them more money and move away from sort of our insurance based approach to health coverage? Do you think that the system as it stands today makes it even possible for people to know what they're paying for across a range of services?

[Dr. David Shulkin]

Yeah. So first of all, I think you do have an accurate reflection of what the health services research data has shown, which is that even given information, patients have been reluctant to rely upon the system that they have forever, which is asking your friends and family where they would go if they are sick and have been reluctant to actually use the data. But I would say it's actually a flawed measure that we're using of whether consumers and patients actually want this information. That without the financial accountability, it's really hard to ask people to seriously use this information. That in other words, people who have been studied whether they are making choices about quality data and volume data are doing this through their insurance plans and so therefore are shielded from the financial decisions. When you now if you were having a system that would open it up, like potentially an HSA account where they are given the right information at the right time in an understandable format and their financial decisions are going to be impacted by where they make a choice. In other words, do you get your CAT scan at a hospital where it may cost $2,000 or do you get your CAT scan in a freestanding imaging center where it may cost $500? I do think that's where consumers will begin to start using that data and changing behavior.

[Host]

You always make us so much smarter. Secretary Shulkin, thank you. I 100% agree with that. Before we let you go again, there's a lot out there right now. Last Friday it was reported that the current administration is changing potentially how it thinks about magnitude of loans for graduate trainings, for professional degrees. If you're pursuing a law degree or medical degree, the limits in which you can draw against the government to get a non need based loan are changing. It's $200,000 now is the maximum. So four year medical school, $200,000, three year law school, $200,000. Nursing school is now will be excluded from that maximum draw limit. And sometimes nursing school can cost up to $150,000. Based on where you go now, it's going to be $100,000 for non professional degrees. And currently nursing school will be decimated as a non professional degree. Lots of uproar, lots of unhappy voices out there and I, and I sympathize with them. But as always, you're able to cut through the noise. And I wanted to get your perspective. I know this is just for recent news here, but just your general feeling about loan for or the federal government investing in the future of the healthcare workforce and whether or not you view a decision like this as potentially shortsighted or is there a rhyme to this reason? Because I think there's a lot of people out there upset by what they're hearing.

[Dr. David Shulkin]

In government, there's always a balance between where you spend taxpayer money and the value that you're getting. But I think in this case, the data and the demographics should drive the policy. We are a society that's getting older, that's going to require more, not less, nursing care as we get older. And the workforce shortages that we already see in the American healthcare system with nurses are significant and will only grow. Policy should support where the needs are and the growth is. And so I believe policy should support additional people entering the educational system to get nursing degrees and to get healthcare degrees. And so anything that discourages them from doing that and helps defray the cost of that type of education I think is shortsighted policy. And so I was disappointed to see this and I think that this will need to be revisited.

[Host]

Secretary David Shulkin. Dr. David Shulkin, you have a career that inspires many of us, including me. I for our audience out there, there's very few people that bridge the gap in our politics the way Dr. Shulkin does. And that's why I wanted to make sure he had a chance to join all of us and just give us his calm reason perspectives on a lot of complicated topics. Dr. Shulkin, thanks for being with Midas help.

[Dr. David Shulkin]

Glad to be here.

[Host]

Thanks.

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[Dr. David Shulkin]

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