No Mercy / No Malice: The Fix

Host: George Hahn
Release Date: May 17, 2025

Introduction: The Looming Debt Crisis

Scott Galloway opens the episode by highlighting the unsustainable trajectory of the United States' national debt, emphasizing its intergenerational burden. He states, “We are borrowing trillions of dollars from young people in the form of deficits” (01:34). Galloway underscores the urgent need to address fiscal responsibility to ensure economic stability for future generations.

Trump’s Executive Order on Drug Prices

The episode delves into President Trump's recent executive order aimed at reducing drug prices. Galloway summarizes, “President Trump signed an executive order to lower drug prices, demanding the U.S. receive most favored Nation status from pharmaceutical companies” (02:07). The initial market reaction saw pharmaceutical stocks dip, but they quickly rebounded as the executive order was perceived as non-binding. Galloway criticizes the effectiveness of the order, describing it as “laughable” in the context of the entrenched regulatory capture within the U.S. healthcare industry.

Notable Quote:

“The announcement is laughable when set against the regulatory capture of the US Healthcare industry.” – George Hahn (02:07)

The Economic Strain of National Debt

Drawing on insights from historian Niall Ferguson, the discussion highlights the precariousness of the U.S. fiscal position. Ferguson posits, “Any great power that spends more on debt service than on defense risks ceasing to be a great power sooner or later” (02:07). Galloway elaborates on the federal budget allocations, noting that in fiscal year 2024, nearly equal funds were dedicated to defense and debt interest, symbolizing a nation’s constrained fiscal health.

Key Statistics:

• Federal Budget Allocations (FY2024):
  • Defense: $877 billion
  • Debt Interest: $878 billion

Galloway warns of projections by the Congressional Budget Office (CBO) that predict the debt-to-GDP ratio reaching 160% by the 2050s, a stark increase from the current 120%.

Political Responses and Fiscal Policies

The episode critiques the bipartisan deadlock in addressing the fiscal gap. Galloway points out that Congressional Republicans are advocating to make Trump’s tax cuts permanent, potentially adding $9 trillion to the national debt. Concurrently, Democrats resist entitlement cuts and defense spending reductions, favoring increased taxation as a solution. This impasse is described as a “kabuki dance,” undermining meaningful fiscal reform.

Notable Quote:

“The GOP refuses to acknowledge math and believes the nation will grow if we cut taxes to zero.” – George Hahn (02:07)

Health Care Costs: The Core of the Fiscal Problem

Galloway identifies healthcare expenditures as the most viable target for deficit reduction. He emphasizes that reducing healthcare costs is “the only option” (02:07). The U.S. healthcare system, with its exorbitant spending of $4.9 trillion in 2023, is criticized for inefficiency and poor outcomes despite being the most expensive.

Comparative Health Care Costs:

• Per Capita Spending: $13,432 (U.S.) vs. significantly lower averages in other nations.
• Drug Prices: U.S. pays eight times more for medications like Ozempic and Humira compared to countries like Germany and Switzerland.
• Medical Procedures: Coronary bypasses cost $89,000 in the U.S., compared to $11,000 in Spain and $18,000 in Australia.

Galloway argues that despite high spending, the U.S. lags in health outcomes, making it “the wrong kind of exceptionalism.”

Notable Quote:

“US health care is a $4.9 trillion corrupt cop.” – George Hahn (02:07)

Legislative Efforts to Curb Healthcare Costs

The discussion highlights the Inflation Reduction Act of 2022, which empowered Medicare to negotiate drug prices. This move is projected to save Medicare $6 billion and reduce out-of-pocket costs for beneficiaries by $1.5 billion. However, expanded negotiations are limited, leaving most drug prices unaddressed.

Future Prospects:

• Additional Negotiations: Biden’s HHS secretary announced that 15 more drugs, including Ozempic, will be eligible for Medicare negotiation.
• Legislative Blockades: Despite broad support, including from Senate Republicans, Democrats, and even lone socialists in the chamber, the Health Care Price Transparency Act 2.0 remains stalled due to intense lobbying from the healthcare industry.

Notable Quote:

“Why hasn't it become law? Because money is speech, and the health care industry and its lobbyists have told Congress, give us America's wallet or we will fucking kill you.” – George Hahn (02:07)

The Power of Lobbying in Healthcare

Galloway exposes the extent of lobbying influence within the healthcare sector. In 2024, U.S. businesses spent $4.4 billion on lobbying, yielding massive returns for industries. An illustrative example includes Amgen’s $5 million lobbying expenditure resulting in $500 million in Medicare payments for a single drug.

Notable Quote:

“No other industry embodies regulatory capture like the healthcare industrial complex.” – George Hahn (02:07)

Personal Narratives and Societal Impacts

Galloway shares a personal account of opting out of employer-sponsored health insurance to save $50,000 annually in premiums, highlighting the absurdity and unsustainability of rising healthcare costs. He underscores that despite being the wealthiest nation, systemic issues force individuals into financial distress over medical expenses.

Emotional Stories:

• Wedding Amidst Debt: A New York Times story recounts a bride with terminal brain cancer holding a marriage ceremony to prevent her husband from inheriting medical debt, illustrating the pervasive personal toll of the healthcare crisis.

Notable Quote:

“We live in the most prosperous nation in history. We shouldn't be asking our kids to borrow money to support their parents and grandparents’ lifestyle and our daughters.” – George Hahn (02:07)

Cultural Reflections: Revolutions and Societal Strife

Drawing parallels with the TV show Andor, Galloway reflects on societal unrest and the potential for revolution stemming from economic and social inequalities. He warns that unchecked fiscal irresponsibility and wealth inequality may lead to severe consequences, including war, famine, or societal upheaval.

Notable Quote:

“If we don't fix it, the wealth inequality at the root of America's pain will self-correct via war, famine or revolution.” – George Hahn (02:07)

Conclusion: A Call for Fiscal Responsibility

The episode concludes with a poignant reminder of the critical need for addressing the fiscal gap through sustainable policies, particularly focusing on healthcare costs. Galloway emphasizes that without decisive action, the United States risks its economic stability and the well-being of future generations.

Final Thought:

“When the adults show up, we should have a serious sit down regarding closing the fiscal gap.” – George Hahn (02:07)

Key Takeaways

• National Debt: The U.S. faces a significant debt crisis that threatens its economic future, necessitating urgent fiscal reforms.
• Healthcare Costs: Reducing healthcare expenditures is imperative for stabilizing the national budget. The current system is inefficient and costs highly.
• Political Stalemate: Bipartisan efforts are failing to address the fiscal gap, with entrenched lobbying interests blocking meaningful reforms.
• Lobbying Influence: The healthcare industry wields substantial power through lobbying, hindering legislative efforts aimed at cost transparency and reduction.
• Societal Impact: The financial strain of healthcare costs leads to personal and societal distress, highlighting the urgent need for systemic change.

Notable Quotes with Timestamps

• George Hahn: “We are borrowing trillions of dollars from young people in the form of deficits.” (01:34)
• George Hahn: “The announcement is laughable when set against the regulatory capture of the US Healthcare industry.” (02:07)
• George Hahn: “US health care is a $4.9 trillion corrupt cop.” (02:07)
• George Hahn: “Why hasn't it become law? Because money is speech, and the health care industry and its lobbyists have told Congress, give us America's wallet or we will fucking kill you.” (02:07)
• George Hahn: “No other industry embodies regulatory capture like the healthcare industrial complex.” (02:07)
• George Hahn: “We live in the most prosperous nation in history. We shouldn't be asking our kids to borrow money to support their parents and grandparents’ lifestyle and our daughters.” (02:07)
• George Hahn: “If we don't fix it, the wealth inequality at the root of America's pain will self-correct via war, famine or revolution.” (02:07)
• George Hahn: “When the adults show up, we should have a serious sit down regarding closing the fiscal gap.” (02:07)

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