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

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.

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)

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)

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)

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)

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)

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

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.

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.