▶ 0:16:58The subcommittee will come to order. Good morning and welcome to Florida's beautiful 16th Congressional District for Health Subcommittee hearing. And talked to quite a few of the members up here. They're interested in taking a look at this. They want to see if they can get a place here as well. So, I'm thrilled I'm thrilled. I mean that personally. I'm thrilled to hold this important hearing focused on prevention and healthy living.
▶ 0:17:22As I speak about often, Americans spend more dollars on health care than any than any other nation. Yet, the country are get our country is getting sicker. We spent over $5 trillion, not billion, but $5 trillion on health care. Yet, six in 10 Americans have at least one chronic disease. Chronic disease like uh diseases the diabetic uh cancer, obesity are the leading causes of death in our country.
▶ 0:17:51When we look at the obesity rate, about uh of children are obese compared to in our generation, it was 3%. That's shocking to me because a lot of times you can't as many of you know the doctors, you should if you're overweight and everything when you're young, you follows you a lot of times. Um 30% of adults are are obese uh disqualifying them for military service, those from let's say 20 to 30. And at least 40% of adults are obese.
▶ 0:18:19So, obesity is projected to result in as much as $9 trillion uh in actual uh medical expenses. We must think about health care in this country differently. Patients and taxpayers are depending on it. We must train the next generation of doctors and they do such a great job here, but that's really critical to prevent chronic diseases and focus on nutrition and healthier lifestyles. We must also support a health care system that values prevention, not reaction.
▶ 0:18:49Instead of fee for service, we need to have something based on outcomes and and and values. I believe new technology will also play a key critical role uh on that in terms of prevention. Ultimately, I want people to be the CEO of their own I look forward to highlighting how my Congressional District is supporting prevention and healthy living. I look forward to discussing ways to improve the health of Americans.
▶ 0:19:20I'm pleased to recognize the gentleman from Nevada, Mr. Horsford, for his 5-minute uh remarks in in in his opening Well, good morning everyone. It's great to be with you. Uh Thank you to Chairman Buchanan for welcoming us to your beautiful home uh here in the 16th Congressional District of Florida. Uh I'm from Las Vegas.
▶ 0:19:44I don't think we could ever have a Congressional hearing outdoors in Las Uh but I wanted to be here uh out of respect uh for you, Mr. Chairman, uh for the subcommittee on health care and your work on so many important issues to improve health care outcomes.
▶ 0:20:04also because I think it is important for us to speak with one voice, Republicans and Democrats, that we believe a core message that America should be healthy. Uh, in fact, that is why members of this committee on both sides of the aisle have long championed this goal.
▶ 0:20:25We may not all agree on exactly how to get but having the core uh, mission of making healthy making America healthy is absolutely something that I support. 16 years ago, uh, we drafted, debated, and passed the most significant expansion of health care coverage in our nation's history, the Patient Protection and Affordable Care Act.
▶ 0:20:50The ACA opened the doors of our health care system to young adults, the working poor, small and independent business owners, and people with pre-existing conditions who were told that they would never have access to coverage. Moreover, it ensured that preventative care was within reach. Care that has saved countless lives and made millions healthier over those 16 years.
▶ 0:21:16But since the beginning of the year, the promise of accessible, affordable health care is slipping out of reach for far too many Americans. Take Ms. Priscilla Brown, a 48-year-old truck dispatcher from Orlando living with type 2 diabetes. Like millions of others, she is enrolled in the Affordable Care Act marketplace and relies on daily insulin to stay healthy.
▶ 0:21:42Yet rising health care costs have pushed her into a situation that no one in the wealthiest nation in in our world should Some days she takes only half or even a third of her prescribed dose in order to stretch it out. Other days she skips it entirely. Not because she wants to, because she has to in order to afford the ever-increasing cost of basic living necessities while balancing her new premium monthly expenses.
▶ 0:22:13Now, Ms. Brown's story is heartbreaking, but it is not unique. New data from the Kaiser Family Foundation shows that roughly eight in 10 Americans who, uh, re-enrolled in the Affordable Care Act marketplace this year are facing higher health uh, higher health care And for about half of them, those increases are substantial. Now, we all can agree that there's more work that has to be done. No bill is perfect.
▶ 0:22:40Um, and that is why the Florida Policy Institute estimates that a million and a half Floridians are projected to lose their health care coverage, and that is one of the reasons that I'm also here today. On top of the pre-existing 14.8% of Floridians who are already uninsured. So, I look forward to hearing the testimony from our panelists today.
▶ 0:23:05I thank each of you for your expertise, for your education, for your background, and for focusing on a wellness care system, not a sick care system. And if we all can work towards that goal of improving health care, we can make America healthy again. So, thank you very much, Chairman, for allowing me to be here with all of you today. And and thank you. Um, now I'm pleased to recognize the chairman of the Ways and Means Committee, Mr. Smith, for his opening statement.
▶ 0:23:35And he was one of the mentioned how lovely this area is being uh, your part of the world. I love my part of the world, but this is very very lovely weather. Um, thank you, Mr. Chairman. It is it is great to be here in sunny Florida and to hold our second committee hearing outside, um, which is which is good. The Natural Resources Committee could learn from from our work.
▶ 0:24:01Um, we're glad to be here today, in Vice Chairman Vern Buchanan's congressional district. Um, Chairman Buchanan is one of the strongest champions for for chronic disease prevention we have in Congress. He, uh, in fact, Vern was on a mission to make America healthy again way before it was cool and people started talking about it.
▶ 0:24:24Um, we will miss him in Congress, we'll miss his leadership on this topic, um, but we still have eight and a half months to do do a lot of work and hopefully get some things done. I also want to thank our host right here, Lake Erie College of Osteopathic Medicine. This school is one of the 53 medical schools that joined the Trump pledge to provide at least 40 hours of nutrition training to students.
▶ 0:24:53Educating our future doctors on good nutrition is critical for the patients who will one day trust them for medical the nutrition pledge is a recognition that not enough attention and resources have been paid to prevention in our health care system. Today that system incentivizes treatment of chronic disease over its prevention. That reality is simply not working.
▶ 0:25:24Despite our nation spending an astounding 5.3 trillion dollars on health care each 60% of Americans still have at least one chronic disease, heart disease, diabetes, or cancer, all of which disproportionately affect rural Americans who I represent. For Medicare beneficiaries, that number is a staggering 95%.
▶ 0:25:55That statistic should not be a surprise when Medicare only spends 5 cents of every dollar on primary care. Too often we intervene only once someone has gotten sick and and do too little to stop Americans from getting sick in the first place.
▶ 0:26:18That is why the Ways and Means Committee passed legislation that encourages more preventative care, like providing multi-cancer early detection screenings to seniors on Medicare. The Working Families Tax Cuts expanded HSAs to millions of more Americans, which allows individuals to invest in their own health and wellness.
▶ 0:26:40The Rural Health transform transformation program is investing 50 billion dollars in efforts to grow and sustain innovative care in rural But that is just a start. More has to be done to help Americans live longer, healthier lives. Medicare could expand value-based payments to improve patient outcomes while reducing the cost of wasteful medical services.
▶ 0:27:10More patients could receive new innovations in disease testing and care delivery to detect disease before it is too late. Doctors could show patients realistic ways to take care of themselves, like spending more time outdoors like we are here today. Um, I want to thank each of our witnesses for taking time away from your practices to share your experience of what is working and what is not.
▶ 0:27:40And your ideas you have to modernize health care for the benefit of all We also want to hear from everyone in the audience who took time to come There will be clipboards, um, passed around during the hearing right over there. Um, they'll be passing around, um, for you to share with the committee how preventative care has made a difference for you or a loved one or share other thoughts about today's hearing topic.
▶ 0:28:10These comments will be entered into the official record for this hearing. I want to thank you again, Mr. Chairman, for having us. Thank you, Mr. Chairman Smith. At this time I'd like to recognize my neighbor and friend from Florida's 17th congressional district, member of the health subcommittee, Congressman Steube for 1 minute. Thanks, Mr. Chairman, and thanks for having us. It's awesome to be at home and have a congressional hearing. I grew up like 15-20 minutes from here. My district's just south.
▶ 0:28:41Um, it's great to be back in Southwest Florida. I want to thank all of you that did do great things to make this area great, and I look forward to the testimony and the questions. So, thanks for being here. Thank you, Mr. Steube. I'd like to recognize our other member from Florida delegation, Congressman Bean for 1
▶ 0:28:59Thank you very much, Mr. Chairman. Very good morning to you. Good morning, Ways and Means Committee, and, uh, what a big deal it is to have you here. Ladies and gentlemen, you're here. You'll always get to say I was there that day they met on the porch. And if you, you're not wearing a hat, you should. My, uh, mom will tell you, uh, protect your skin. That's, uh, little bit of health knowledge right there. For our my colleagues that have traveled all across the country, they've asked me something and I want to explain it right now. They've asked me, what's different?
▶ 0:29:28It's feels different, it smells different. I can't quite put my finger on it. I can tell you what it is, members. It's freedom. That's exactly what it is. For all of us here, we know, uh, hanging out in the free state of Florida, uh, we enjoy it every day. So, the weather's a bonus, too, but, uh, ladies and gentlemen, welcome to the free state of Florida. Thank you, Mr. Bean. I now introduce our witnesses, Dr.
▶ 0:29:56Kaufman, and we're very excited about the You mentioned it's been 20-25 years here and with the institution, you guys have done incredible work. So, thank you personally. Christopher Davis, and we've got a chance to become friends, but we're going to be better friends going forward. He's focused on longevity and prevention. Uh Dr. Oz, uh he's uh who was the medical director of Manatee Surgical Alliance. Dr.
▶ 0:30:24Who, who is the president CEO of Moffitt Cancer Center. Uh and Scott uh Darius is the executive director of Florida Voices for Health. Thank you for joining us today. Your written statements will be made part of the record, and each of you have 5 minutes to deliver your remarks, and Dr. Kaufman, we'll start with you. Thank you, Chairman, ranking members and distinguished members of the committee.
▶ 0:30:53I'd like to really thank you for this opportunity to testify today and to share the work of the Lake Erie College of Osteopathic Medicine and the Osteopathic Medical Profession. I serve as Dean at Lake Erie College of Osteopathic Medicine in Bradenton and began my career as a physician came back to to LECOM in 2000, got my DO degree. I'm board certified in family medicine, and I've been with LECOM in medical education for 25 years.
▶ 0:31:17It's an honor to contribute to this important conversation about modern medical training and innovative care in the American people. At LECOM, our mission's clear. We're here to prepare the next generation of health care professionals through four pillars of excellence. That's excellence in education, clinical care, research, and community service with the goal of improving health outcomes for all humanity.
▶ 0:31:44This mission is reflected daily in how we educate our students, care for our patients, and partner with the communities we train and serve in. LECOM was founded in response to a national need for physicians and a more responsive model to medical education.
▶ 0:31:59We've embraced the innovation as a practical necessity to meet workforce shortages through our colleges of medicine, school of pharmacy, dentistry dentistry, podiatry, and health services One of the most distinctive elements of LECOM's approach is its commitment to multiple adult learning pathways.
▶ 0:32:17Our problem-based learning pathway places students in small groups where they learn through clinical cases, mirroring how physicians diagnose and treat patients, promoting knowledge acquisition, communication, and critical thinking skills. LECOM's pioneered accelerated, cost-conscious medical education, helping to reduce student debt while maintaining a rigorous academic standard.
▶ 0:32:39In addition to maintaining one of the lowest tuitions for private nonprofit medical schools in the US, our primary care scholars pathway for students dedicated to primary care specialties, our accelerated physician assistant pathway, the only program of its kind in the US for PAs who seek to become physicians, and the accelerated pharmacy pathway allow completion of medical school and pharmacy school in three instead of the traditional four years, cutting cost by 25% for our By lowering the financial barriers, we enable more students to pursue health
▶ 0:33:09care careers, especially in primary LECOM's educational philosophy is grounded in osteopathic medicine of treating the whole person, mind, body, and spirit, with an emphasis on preventive care. This holistic approach aligns closely with national priorities to maintain healthy lifestyles and nutrition, improve preventive care, and lessen the impact of chronic disease.
▶ 0:33:32Our programs emphasize primary care, community engagement, and service And actually, in fact, we have uh LECOM, 60% of our medical students enter into the much-needed primary care specialties while practicing in rural and underserved areas. The United States faces a critical need for a larger, better-prepared health care workforce. LECOM addresses these challenges both through scale and innovation. As the largest medical college in the nation, LECOM has expanded access to medical education while maintaining a strong focus on quality and outcomes.
▶ 0:34:03Through the tenets and following the tenets of osteopathic medicine, our admissions process go beyond just grades and performance on qualifying examinations. We look holistically at all aspects of the applicant. In fact, LECOM is one of only a handful of medical schools that has an alternative to the MCAT. The LECOM academic index score allows applicants to apply for and be admitted to the medical school without an MCAT. This approach has led us to exceptional board outcomes and to a 99.4 to 100% residency placement placement for the last 8 years.
▶ 0:34:35LECOM's impact extends beyond the classroom through its integrative academic health system by aligning education with service. LECOM creates a feedback loop in which training programs directly respond to the community health The work of the institutions like LECOM highlight several opportunities for policy makers. Support for innovation in medical education models that reduce the cost and expand access, focus on preventive health care, including nutrition, and uh rather than the reactive care that we often see, and investment in primary care in underserved communities.
▶ 0:35:06Public policy plays a critical role in enabling enabling institutions to scale these innovations by aligning incentives with outcomes such as improved population health, reduced cost, and workforce expansion. We can build a health care system that better serves all Americans. In closing, we stand as an example of how innovative education, community engagement, and integrative care delivery can come together to improve lives.
▶ 0:35:30We're proud to contribute to the health of the communities here in Florida and across the nation, and look forward to continuing to work with policy makers to ensure that every American has access to high-quality, compassionate, and effective health care. Thank you very much. And thank you, uh Dr. Davis. I do uh you're next, but I did want to mention we're very excited about what you're doing, longevity and prevention. You're a leader in this area in a region in this region, and we're very excited. I hear that from a lot of your patients, frankly. So, uh you're up.
▶ 0:36:04Well, Mr. Chairman, uh ranking member, and distinguished members of the committee, I'd like to thank you for this opportunity, first of all, to speak to all of you guys. Um I want to begin with a story. Um it's a story about a little African-American boy growing up in a small country town in Virginia uh with one stoplight. When he was just 7 years old, the little boy faced a life-threatening health crisis and his appendix ruptured, and the complications nearly took his life. He was hospitalized for weeks with tubes coming from every orifice of his body. It was terrifying. But because of the two noble surgeons, Dr.
▶ 0:36:34Teague and Dr. Gaylord, he survived. And during that illness, lying in that hospital bed, that little boy made a decision that would shape the rest of his life. He decided that one day he would become a doctor so that he could care for others the way those doctors had cared for him. Obviously, that little boy was me. Fast forward 30 years.
▶ 0:36:54After 4 years of college, 4 years of medical school, 3 years of residency, 1 year of chief residency, 2 years of NIH a year of four 2 years of cardiology fellowship, and a year of interventional cardiology fellowship, I had achieved that dream. I'd become an interventional cardiologist. I was in the cath lab opening blocked arteries, treating heart attacks, responding to cardiac arrests, saving lives in the most critical But every by every traditional standard, I'd made it. Mission accomplished, or I thought.
▶ 0:37:26Because after about a decade of practice, I began to notice something deeply troubling. Too many of the same patients were coming back through the revolving door of our health care system with the same chronic illnesses, the same preventable complications, and the same fear. That's when I had to confront the hard I was not truly practicing health care. I was practicing disease management or sick care. I realized that our system is incredibly advanced when it comes to treating after it happens.
▶ 0:37:55We have a remarkable technology. We perform extraordinary procedures. We can do things in medicine today that would have seemed miraculous just decades ago. And yet, despite all of that, Americans are getting sicker. Chronic disease is rising. Metabolic dysfunction is rising. Cardiovascular disease remains the leading cause of death. And perhaps the most concerning of all, we have unintentionally created a system where patients often feel powerless. They're told what they have.
▶ 0:38:25They're given prescriptions, but they're rarely given an understanding. They're rarely given a roadmap. They are rarely taught why their disease developed in the first place, and they're rarely empowered to take control of their own health. That realization changed everything for me. In 2018, I took a leap of faith. I had to start over. I founded Reveal Vitality and Longevity Institute because I believed there had to be a better way to deliver true health care.
▶ 0:38:52A simple but radical idea guided that What if we stopped waiting for disease and started identifying risk before it became irreversible? What if we asked not just what was happening, but why it was happening? What if we taught patients how nutrition, sleep, movement, stress, toxin exposure, and other lifestyle factors directly influence the development of this chronic disease? Today, that is exactly how I practice. Instead of relying solely on traditional labs, we go deeper.
▶ 0:39:20We use personalized, precision-based approaches, including genetic testing, micronutrient analysis, cardiometabolic biomarkers, and environmental toxin testing. I pause. We look upstream, and we involve patients in the process. The results can be profound. I've seen patients reverse metabolic dysfunction. I've seen patients regain energy, clarity, and hope. But what has moved me most is this.
▶ 0:39:48I've watched people go from fear to understanding the ownership of their own health. This is what health care should look like. But there's a problem. This level of care is still out of reach of far too many Americans. The people who need prevention the most often have least access to it. Underserved communities are often hit the hardest by chronic disease, yet they are least likely to have access to the time, testing, education, and early intervention that could change the course of their lives.
▶ 0:40:18This is not just a health care problem. This is a moral problem. Health care should not be a system that profits most when people get sicker. It should be a system that invests in keeping people well. If we truly want to modernize health care in America, then we must be willing to change what we value.
▶ 0:40:42We must reward prevention, not just We must reimburse for identifying risk not just treating disease late. We must support physicians in educating patients, not just moving them through the system. And we must build a health care model that gives every American, regardless of their income or zip code, a real opportunity to live a healthier Because in the end, the goal is not solely to help people live longer, it's to help them live better.
▶ 0:41:14With more energy, with more clarity, with more independence, with more If we truly want to empower Americans to have a healthier life, then we must stop waiting for disease and start investing in health. The question is not whether we have the knowledge to change health care. The question is whether we have the courage to do it. Thank you.
▶ 0:41:41Thank you, doctor, for your passion and what you're doing. And I'd also know that you there's a lot to be said about you really do everything you can for children, especially [snorts] children that are disadvantaged. So, God bless you. Uh with that, doc Dr. Reckase, 5 minutes. Chairman Ranking members and members of the committee, thank you for the opportunity to speak.
▶ 0:42:06As a bariatric surgeon, I see the human cost of our current health care policy every day as I treat patients with obesity and metabolic disease, conditions that drive diabetes, heart disease, hypertension, and it represents the majority of the health care spending that we do in this Our system is built to take care of ill patients, treating complications well after they occur.
▶ 0:42:30We really need to pivot our health care system towards treating earlier evidence-based treatments that will prevent these conditions. By the time patients reach my operating room, they've already suffered years of preventable treat of Treating obesity requires a coordinated approach that integrates surgery, medications, and prevention.
▶ 0:42:50Policies that support earlier screening, expand access to telehealth, and incentivize value-based care can help us intervene sooner and reduce long-term disease We already have the tools that we need to improve health care. By recognizing obesity as a chronic disease, by expanding access to effect to effective treatments, and supporting prevention and innovation, we can empower patients to live healthier lives while strengthening the sustainability of our health care system.
▶ 0:43:19We're not lacking the effective treatments, we're failing to deliver them early on. Thank you again for the opportunity to share my perspective. I'm happy to answer any questions. I did want to touch on certain topics. So, first off, treating obesity as a chronic disease. Obesity is a primary driver for type 2 diabetes, hypertension, and heart disease, yet outdated policies still treat it as a lifestyle issue rather than a biological disease.
▶ 0:43:48Congress needs to expand coverage for evidence-based treatments, including medical weight weight medical weight management and bariatric surgery to address the root cause rather than just the downstream complications. We need to expand access to proven bariatric treatments. Bariatric surgery is one of the most effective and durable treatments for severe obesity, yet access remains limited by insurance restrictions and referral barriers. Expanding access would improve outcomes and reduce long-term costs.
▶ 0:44:18Newer medications like based therapies such as semaglutide, tirzepatide have expanded our ability to treat obesity and show real promise. These therapies can produce meaningful weight loss, often in the range of 15 to 20%, and should be part of our comprehensive treatment strategy. They're important clinical advances, but they're only part of the solution.
▶ 0:44:40Surgery remains the most effective and durable option for severe obesity, typical typically producing 25 to 35% more weight loss, roughly double that of medications, and achieving higher rates of diabetes remission. These results are sustained over many years, while medications requiring ongoing use to maintain their their effect, surgery provides sustained metabolic improvement.
▶ 0:45:03As as access expands, these medications should be used thoughtfully, prescribed by appropriately trained clinicians, and integrated into long-term care focused on improving overall health, not just short-term weight loss. Despite having these effective patients and providers face significant barriers to care. Administrative requirements frequently delay, prevent timely appropriate treatment. In many cases, the delay is not due to clinical uncertainty, but to administrative friction.
▶ 0:45:34We need to incentivize preventive care over sick care. We continue to reimburse treatments of disease more than prevention. Expanding coverage for nutrition counseling, metabolic screening, and medical nutritional therapy, including Medicare access to dieticians beyond simple diabetes control and chronic kidney disease, would allow earlier intervention and reduce long-term costs. Encourage earlier screening for metabolic disease. Many patients develop complications long before receiving treatment.
▶ 0:46:05Medicare currently covers nutritional therapy and related services primarily for conditions like diabetes and kidney disease after the disease has progressed. Expanding screening to coverage such as obesity, prediabetes, metabolic disease, and fatty liver disease would improve our patients' health. This would allow earlier intervention in at-risk patients before they reach a point of crisis. They're often the earliest signs of metabolic disease, yet they remain undiagnosed and untreated.
▶ 0:46:33Aligning coverage with early disease, not just advanced complications, would improve outcomes and reduce long-term costs. In addition, expanding community-based preventive programs, continuing telehealth medicine to help patients that don't have access, and aligning aligning aligning payment models with outcomes, improve public education, and reducing stigma.
▶ 0:46:56If we want to improve health care and control long-term costs, we must treat obesity as a chronic disease, expand access to effective treatments, and intervene earlier. We must apply the same clinical rigor to obesity that we apply to diseases like cancer and heart disease. We have the treatments, but access, not science, is now the limiting factor. Thank you. Thank you, Dr. Woo. I want to just say we're excited to have you here.
▶ 0:47:24clear leader, not just here, but across the country. And thank you for your leadership as the CEO. Thank you, uh Chairman Buchanan, uh for all of your support through the years of our mission at Moffitt Cancer Center. I am Patrick Woo, the CEO of Moffitt Cancer Center, uh where our goal is and our mission is to prevent and cure cancer. We are located in Tampa, Florida, just a short drive away in this beautiful uh state of Florida.
▶ 0:47:54Uh my background, I I study the immune system against cancer. I first started at the National Cancer Institute, then at MD Anderson, and the last 5 and 1/2 years I've been here. Uh we have amazing system in our body called the immune system that's able to locate, uh recognize, and kill cancer cells. And so, that's what I've studied, the ability to stimulate our own immune system to recognize and kill cancer cells.
▶ 0:48:22And these immune cells can live in the body for decades, giving patients what they want. We've learned to take immune cells out of the body, put genes in them, uh give them back, kill the cancer, and and give patients what they want, which is long-term durable response, so they can see their grandkids grow up, they can walk their daughters down the aisle. We've seen countless patients that that have been cured uh from immunotherapy.
▶ 0:48:51the emphasis of today's panel on prevention and screening we love because if you look at all of the uh kinds of treatments, prevention is the way, the most cost-effective way, and the best outcomes that we'll have. In Moffitt Cancer Center, we've always had in our mission statement, it's our 40th year now, from day one we had our mission to contribute to the prevention and cure of cancer. We didn't just say cure of cancer, we've always focused on prevention.
▶ 0:49:1940% of cancers are preventable. Uh there's a lot of cancer, 50,000 deaths in Florida, 600,000 in America, 10 million globally every year die of cancer, and 40% are preventable. So, a lot of people talked about obesity, that's really important to it to address. Cigarette smoking, we still have millions of Americans who smoke cigarettes.
▶ 0:49:47And cigarette smoking not only causes not just lung cancer, bladder cancer, kidney cancer, pancreatic cancer, many cancers, but also heart disease. So, contributes to a lot of the morbidity and mortality in this country every year. So, we have to try to prevent cigarette smoking. And of course, uh sunburns, I'm a melanoma doctor, so I stay out in the fun sun. I got I I love the hat, uh but don't get too much sun.
▶ 0:50:12So, uh that's uh um uh and then we call secondary prevention screening. Everyone's heard of mammograms uh for breast screening. You should start those if you have average risk at 40 years old. Uh colon screening, you should start at 45 years unless you have family history, you can start earlier. Uh then um uh but one that a lot of people have not heard of is lung cancer screening.
▶ 0:50:38If you are a smoker and you get a 20-second CAT scan every year, we can catch the lung cancers early. We could save lives a year in this country alone if we could do lung cancer screening. Right now, there are millions of smokers in America and only less than 5% are getting these lung cancer screens. So, please spread the word about the importance of lung cancer screening.
▶ 0:51:06It's we we would have much better outcomes, much less therapy, and we would save the country just billions of dollars. Um the um final thing I want to talk about uh is our research at Moffitt Cancer Center on nutrition uh and exercise.
▶ 0:51:24It's the most common question my patients ask me, "Hey, what should We need better research uh because a lot of the research that's been done is, "Hey, how many uh helpings of fish have you had in the last 3 months?" Well, who remembers how many helpings of fish they had in the last 3 months? Uh so, it's very inaccurate research. And so, we have a food kitchen. I'd love for you guys to come up and visit us at Moffitt Cancer Center, see our food kitchen.
▶ 0:51:51in about an hour? Food kitchen, you said food kitchen, come up and see you. Yeah, yeah, come up and yeah, come up. Please see us and we will make you a nice breakfast uh low-carb. And uh um and uh the we we we need to study that prospectively to get accurate research on how food We're studying how food stimulates the immune system. If you have certain diets, we think some fasting diets um maybe the keto diet, which I've been on for 13 years.
▶ 0:52:21Uh we think that might uh stimulate the body's immune system. Uh so, please come visit us to look at our nutrition research. And finally, Chairman Smith uh mentioned rural areas. I want to let you know at Moffitt, we're digitizing all of our pathology. The most important thing for a good outcome in cancer is knowing what kind of cancer it is.
▶ 0:52:41And so, we're hoping that after we digitize our pathology, rural hospitals from across Florida and across America can send us their toughest cases and we'll help them to find what kind of cancer that is so that we can try to get the patients on the right treatment pathways. So, thank you. It's been an honor to be here today. Thank you, uh Mr. Darris. You're Good morning, Chairman Buchanan, uh Ranking Member Horsford, and distinguished members of the subcommittee.
▶ 0:53:11Thank you for the invitation to testify today. Uh I appreciate the opportunity to share our perspective on the healthcare system, but also to test the integrity of my wedding suit. Um Florida Voices for Health, we're a statewide health advocacy organization committed to improving access to healthcare for all Floridians. Uh and we're very fortunate to be part of a statewide coalition of organizations committed to that work. Uh as Voices, you know, our work is really bringing the the lived experiences of Floridians into the policy-making process.
▶ 0:53:40We try to empower people to share their stories for themselves and hopefully bring them to places where they can make a difference. So, this setting right here is a great example of that. Uh you know, our storytelling, it's taken us to the panhandle where my now friend Debbie struggles to have access resources for her disabled kid. It's taken us to South Florida where my friend Natasha has to take less hours at work so she doesn't lose access to her Medicaid coverage. Uh and you know, there are success stories, too.
▶ 0:54:06Just yesterday, we were visiting a free clinic uh down in Winter Park for Winter Haven where, you know, they have an innovative model where they're connecting people to transportation and food access and all the other things that we need to stay healthy. So, as you explore ways to improve the healthcare system, uh I yeah, just only want to offer a couple of things that we've learned from talking to people directly on the ground. You know, the first is that everyone's impacted by what's going on. All of us are paying a little bit more right now.
▶ 0:54:32And in Florida, where we had 4.7 million people enrolled in the ACA last year, uh the average monthly premium jumped up 30%. Now, for middle-class workers, for people who are earning just over 400%, they both had to suffer through the increase in premiums, but also lost access to enhanced premium tax credits, all tax credits. And so, they're shouldering that burden all For low-income workers in non-expansion states like Florida, there's actually a disincentive to work more.
▶ 0:54:59Uh the most a single parent can earn in Florida, the most a single parent with two kids can earn and still qualify for Medicaid is $8,000 for the year. Anyone who finds themselves making more than that, a dollar more than that, and you find yourself in what we call the coverage gap. I appreciate the focus on rural Floridians, which is where we spent on rural people. Um and rural Florida is where we spent a lot of time focused the last two, three years. Uh we've had three rural hospitals close here in Florida since March of 2020.
▶ 0:55:28When it comes to oral health, which we know is so important to the rest of our bodies, we have 6 million Floridians living in what we call dental provider shortage areas, meaning there aren't enough dentists to see them. And that's to say nothing about Florida's mental health needs, prescription drug What's that? Supports and services for people with The point is, no matter how you slice it, income, geography, race, or the specific area of healthcare, none of us goes completely unscathed.
▶ 0:55:55The scope of these systemic challenges, I think, speaks to a second truth, which is that healthcare won't be fixed with a single policy. Our system's too big and there are too many barriers that need to be addressed. You know, I appreciate the comments on modernization and innovation that this distinguished group has offered today. I'm not a doctor, I'll make that clear. Um but it's amazing to see what we're capable of and why the US is second to none when it comes to the provision of But our system, I'll say, feels a little bit like a a business that has the best product on the market, unchallenged.
▶ 0:56:25But we have one fatal flaw, and that's cuz and that's that we can't get it to people when they need it. Uh to realize the full potential of all the the models that exist here of modernization and innovation, the fundamentals of our underlying system have to be strong. The new tools and treatments won't mean much if the people who need them can't access Now, I know that that's easy for me to say. Um and comprehe- creating comprehensive policy takes a lot of people working together and working through tough questions together.
▶ 0:56:52So, I'll offer just, you know, a couple of guideposts as we work on building the system together. The first is that everyone needs to be covered, and that's just insurance math, right? We learned this as in this last year, insurers justified their premium increases. They pointed to the fact that they expected healthier people to drop off of coverage, and that made it more expensive for everyone else. The second is that we need to restore trust throughout the system. The entire healthcare system is based on a series of relationships that require trust for things to work well.
▶ 0:57:20And that's between doctors and patients, insurance companies and their insured, between the government and its people. And while, you know, trust sounds like a high-minded ideal, I'll say that it actually has concrete policy implications. Our current system of prior authorizations and step therapy protocols reflect a distrust in provider's decisions. Uh the lack of transparency in pricing makes it hard for anyone to feel like they're being treated fairly. And in programs like Medicaid, punitive work work reporting requirements reflect a lack of trust in the American people.
▶ 0:57:51And by and large, I'll tell you, the people want to work. People want to meaningfully contribute. And lastly, a strong healthcare system adapts to each community's unique needs, whether it's to meet the distinct challenges of rural communities that are just 20 minutes apart, or to figure out why the maternal mortality rate for black mothers in Florida is 51.8 per 100,000, while the overall rate in Florida is closer to 24. The solutions need to be tailored.
▶ 0:58:16So, in closing, true progress will require not just innovation, but a recommitment to the fundamentals of ensuring coverage for all, rebuilding trust, and recognizing the unique needs of every community. Thank you. Thank you for your testimony. We'll now proceed with questions and answers session. I'll begin by recognizing myself. I want to start by thanking our witnesses for sharing their time and expertise with this committee. I want to thank Leecom.
▶ 0:58:44Let's give them a round of applause for setting this up for us For hosting this wonderful event. I'm so proud proud to be able to highlight work that's being done in this region in this area for a lot of our patients and doctors and everybody else. Let me just ask one quick couple of quick questions by show of hands.
▶ 0:59:04Please raise your hand if you believe nutrition, eating real food, that's the key what that means, but ideally eating real food is key is a key component to preventing and reducing chronic Second, keep your hands raised if you believe you could do a better we could do a better job educating physicians and patients about the importance of And finally, keep your hands raised if you think insurance, Medicare, and other programs sufficiently cover prevention and
▶ 0:59:34detection tools today. Well, that's tells the story right Let me I want to run through Dr. Davis. I want to give you an opportunity cuz you've worked with your patients and a lot of different patients in this region in terms of a lot of the things that you're putting in in terms of the longevity component prevention we've talked about. How do you how do you explain what that means and how's that play out?
▶ 1:00:05With your practice. Oh, thanks for the question. Um
▶ 1:00:10I think one of the points that I want to make in that 5 minutes that we had, you it was tough to try to try to decide what to what to what to put in 5 minutes, but let me in my opinion what I've been working on for the last 4 or 5 years and I kind of stumbled into this. I wasn't looking for this, but at the end of the day chronic illness, longevity, you I would say that 90 plus percent of all chronic disease is caused by toxins that we're exposed to in our environment.
▶ 1:00:39There's a lot of talk about this, okay, but we don't really have to talk about it. I like to I can't see behind but but by show of hands I would like to know how many people have even had an environmental toxin test, metals, plastics, insecticides, pesticides, um things like that. And I can tell probably behind me and I can't see not many, right? And at the end of the day when you do testing like that and you when I do it on every single patient that comes through my door right now, okay, it makes the conversation very easy.
▶ 1:01:08Because that those toxins, those pesticides, that glyphosate, that the the metals, the mercury, those are the things that we see that cause oxidative stress, that actually contribute to chronic illness, and it diminishes our longevity. And what about longevity? Longevity is not living longer, it's living thriving, it's taking care of your grandkids, it's being active and being able to do the things that you were doing when you were 30 years old. But what causes the what the problems there? That's inflammation, oxidative stress, that's all driven by things that we're exposed to.
▶ 1:01:38And and in my practice right now it is crystal clear. I don't think there's I mean I don't have any more I mean this crystal clear and I look forward to the day when I could actually share all that all of that data. Share the data on what we really see in each and every one of us including myself. What we see that's in our system is causing these diseases. So so we have to wake up. We have to wake up and we have to start looking at where the true causes are. Dr.
▶ 1:02:07Kaufman, you talked about nutritional training for physicians. what does that mean today here at the hospital? I mean at your facility I should say Lecom. What do you when you say that? Thank you. We have a very unique curriculum here at Lecom Bradenton and in our other campuses also and part of that's problem-based learning and problem-based learning is case-based education from day one.
▶ 1:02:32So when the students come in and they're learning about a 54-year-old with chest pain, it it's more than just the symptom and the diagnosis. It's a delving into a lifestyle and the nutritional component that goes with it. So we have to we do have nutrition in our programs and we have with each case the nutritional components that go along with it. We have committed to expanding our our curriculum already. We're very proud of what we have, but we're going to expand it even further.
▶ 1:02:58And it's really a refocusing on prevention instead of reactive medicine. It's much more expensive to treat the heart attack. It's much more expensive in the terms of their quality of life after they've had a heart attack than it is to prevent it in the first place. So that's really the focus in how we give it to our students so that they understand that each disease process is not only treatable but preventable. Yeah, let me add on to that a little bit. I believe screening is a critical component of preventing diseases.
▶ 1:03:28In the house I lead bills to increase screening on lung cancer. It's unbelievable that's the biggest killer in cancer myself what I've been told, but yet we're not doing much not enough in screening in that area. For lung cancer and Alzheimer's disease, I know we have advocates in the attendance today supporting these bills and I want to thank them for all their support over the years. Dr.
▶ 1:03:51Wu, let me just you talked about prevention and you know, I've heard you said 90 50% get screened early, but I've also heard the number that 95% if they catch it early the cancers, there's a good high probability you you can take it take advantage of that live a normal life for a long time.
▶ 1:04:16Is that is there some what's your sense on terms of screening cuz it seems to me I tell everybody, you know, get a physical once a year in January minimally and you maybe some tweaks and adjustments you catch it early. My mom unfortunately had colon cancer by the time we went in it was so advanced you you couldn't do much with it. But the idea of prevention especially one of my bills is on lung prevention trying to catch that early.
▶ 1:04:41And I lost my assistant to lung cancer and her husband same thing. And so I've been around a lot of that as you get older you see a lot of that, but it just sure sure seems like we've got to do a better job of educating getting people out there to take, you know, run, you know, make sure they're doing all the right things. Well, thank you for that question, Mr. You're absolutely correct. If we can screen and catch a catch cancer early, we can cure the cancer. So I treat melanoma.
▶ 1:05:12Melanoma starts in the skin from sunburns and it can go to almost any organ in the body, but if we catch it early and cut it out, it's almost always cured at an early stage. And so the key is to catch these cancers early and thank you for all your support of lung cancer screening. One thing that would make it really much easier I know you're supporting on this is is if we can get rid of the pre-authorization for lung cancer screening.
▶ 1:05:38It just makes so much economic sense for the country and Congress did a great job helping us with mammography so that there's no pre-authorization on mammography, but if we can get rid of the pre-authorization for lung cancer screening, it would be a lot easier to go.
▶ 1:05:54We have a van with a cat scan in it and we go to church parking lots all over Florida trying to find smokers uh to get that 20-second screen, but we have to make sure they're pre-authorized which means we have to come back to the church parking lot the next week and we can't just spontaneously pull up. And so that would be of help, but thank you for your emphasis and your support of prevention and screening. Yeah, thank you. And now I recognize the gentleman from Nevada, Mr.
▶ 1:06:23Horsford for 5 minutes. Thank you, Mr. Chairman. Thank all of you for your testimony today and for being here. And I agree our health care system is at an inflection point. The status quo is not working and we need fundamental change. The question is what does that change look like and where should we start first? Um we do have one of the most advanced health care systems in the world.
▶ 1:06:52The The problem is it's leaving far too many people out. And it's not working especially for those without the resources or the connections to navigate it effectively. Mr. Darias, over the past year in a lot of the constituent town halls that I convene, my constituents tell me all the time that they don't want to go back to the status quo.
▶ 1:07:16The status quo doesn't work for them So in your testimony you note that while and innovation are worthy goals and they to fully realize their impact, the fundamentals of the underlying system must be strong. So can you talk to us about what those fundamentals should include? What is that foundation that we should be working to make sure is in place for everyone? Yeah, and I think thank you for the question.
▶ 1:07:44I think the exact answer, right, is the work that we can all do together. It's a work through exactly what that looks like, but generally speaking I think it's a system where everyone is covered. Just because that's the way insurance works. So whether it's through a patchwork of the programs that we have currently and finding ways to make those work more efficiently or if it's through a different system, right, where everyone's covered in a more streamlined way, I think that's worth pursuing.
▶ 1:08:10I think finding ways again I'll say to build trust between all the entities that are in the system How do we kind of recognize the expertise that different people have, right, whether it's providers or insurers, whatever it is. How do we recognize those that level of expertise that exists in the system and also too just trusting average people. I think so much of what we the policies that we talk about um just have a hint of distrust of working people.
▶ 1:08:40I'll say that. Again, I talked about this coverage gap that exists, right, where you have people who if they earn $9,000 they're suddenly too rich for Medicaid in Florida, but also don't qualify for tax credits in the marketplace. So all over the kind of throughout the system there are these kind of conflicting incentives, right, or just gaps that exist and I think if we sit down together and work through yeah, what the ultimate solution looks like, that's possible, but just fundamentally keeping some of those kind of guideposts in mind as we build that out. Yeah.
▶ 1:09:11I also appreciated the comments about uh clearly there needs to be more attention on the metabolic disease crisis. Um and that obesity is a biological disease, not a personal failing. Uh diabetes, kidney disease, uh all are all downstream consequences of metabolic dysfunction, and I think that is something that we need to uh tackle further.
▶ 1:09:42Um Dr. Davis, your testimony, I could feel it in your your heart, the passion that comes Um and the fact that, you know, you went into this profession thinking you were going to change it in one way, and while in it, you realized there was another approach that need to be that needed to be taken. And I fundamentally agree. We need a wellness-based uh approach, not a sick-based approach.
▶ 1:10:13So, can you talk a little about, again, the determinants of health, nutrition, environmental environmental toxin Um as you stated in your testimony, which are root causes of disease throughout our country, and where those elements should be?
▶ 1:10:36Because unfortunately, they're not a high enough priority when we're cutting research, or cutting funding, or cutting access to food, not providing access to stress or wellness um mitigation, and and other environmental issues. Can you speak a little bit more to that, please? Absolutely. Again, thanks for that question.
▶ 1:10:56Um I think I'll start by just kind of talking about how I made this transition from an interventional cardiologist, you know, doing the things that I was doing 10 years ago, uh to the type of medicine I practice now. And it started with just um really a program where we focused on five basic pillars. We focused on nutrition and movement, and detoxification, sleep, and stress And what I was doing, I had one day of a clinic where I just would help but we had a wellness program, right?
▶ 1:11:26We developed the wellness program that was a 6-month program. Uh and we basically taught people about all of those different pillars of health. Uh and very shortly, 2 3 months into doing that kind of wellness program, what we did monthly was we had the patients had the patients who had enrolled for the program, they'd come into my office, we'd sit around in the front in the in the waiting room, and we started off by saying, you know, everybody, let's go around the room, let's tell your win for the month, right?
▶ 1:11:55And it was absolutely amazing to me as we started this program how I mean, everybody would stand up and they would give their kind of what what happened, and you know, and uh things like headaches going away, their rashes going away, I lost 20 lb, I, you know, I no longer have the arthritis issues. And I remember distinctly, we had a room set up with a table up in front where we kept for doing presentations, and I used to sit in the back corner of my office.
▶ 1:12:20Now, I sat way back in the back, and I remember thinking to myself, 2 3 months in, I was like, man, I got this all wrong. Got to figure out how how how we do this. Like, how do we fix this? And so, in just the just I'm going to addressing those pillars of health and teaching them. It's about education. It's about the things that they don't know, the things that I didn't know as a physician, right? All the stuff that, you know, how many years did I tell people you need to eat a low-fat diet and go get some exercise, and then hope they come back and they're better, right?
▶ 1:12:49What what did I truly do to get them better in that visit of 7 minutes and saying, yeah, you really need to lose some weight, and with no instruction, no road map? And so, when we started to do that and we started to give them the road map and and addressing those pillars, things started to change. And so, really, that is what I think we need we need education. Physicians need education. Patients need education to empower themselves to take control of their health. Right now, they have no clue. So, that's kind of I think what we need to be focused on.
▶ 1:13:16How do we roll out wellness programs to empower people to take back their own health, right? To motivate people. I I your comment said from to move from fear to ownership, from prevention to access, to change what we value and to reward prevention, not prevent uh procedures. I think all of those are qualities that uh Chairman Buchanan and other members of this committee are working towards. He It's why he wanted us to be here to hear from all of you. Uh so, thank you again for your testimony today.
▶ 1:13:51Who? Uh I now recognize Chairman Smith for any questions he might have. Thank you. I want to I want to thank you again, Chairman Buchanan, for pushing this topic um during your time in Congress, and for for inviting us to your congressional I was reminded, listening to your of a healthcare round table that I had when I first became chairman 3 years ago in Nashville, Tennessee.
▶ 1:14:22And there was an individual there that was like, "Chairman, just remember that healthcare will follow the dollar." And Mr. Davis, your comments, um your statement, I wrote it down. I thought it was so spot-on. Um should not be a system that profits when people get sicker.
▶ 1:14:47And so, if you have the leader of of some of the biggest healthcare saying that, healthcare will follow the dollar, but if we don't use the dollar to provide preventive care, but instead provide it whenever you're very sick, where are they going to place their And so, I think this discussion is absolutely wonderful for us to be having so that we
▶ 1:15:17actually get to um fixing the broken healthcare system, because it is absolutely broken, and if anyone tells you otherwise, then they've never participated in any kind of healthcare. Um a big part of modernizing our healthcare system begins not in the halls of Congress, but in the classroom and practical medical residencies, equipping future physicians, nurses, and and other medical personnel with
▶ 1:15:48a foundation that prioritizes not just treatment, but prevention. And access to quality care that is close to home. Dr. Kaufman, thank you once again for hosting us um right here at this beautiful school, and um for this informative discussion. But 64% of colleges of osteopathic medicine require clinical rotations in rural and underserved areas.
▶ 1:16:17Doctors who train in rural areas are five times as likely to stay and practice in a rural community, helping those Americans get needed access to care.
▶ 1:16:31What more can we do to encourage this training in rural access to care, to ensure the next generation of physicians is equipped to treat the chronic diseases that disap- disproportionately affect rural Uh thank you, Mr. Chairman. So, part of that begins with with GME and a priority on rural underserved. Uh you hit you hit something right on the nose with the the type of students who become physicians who practice in rural areas.
▶ 1:17:02So, it begins with who we're accepting in medical schools. As I said earlier, it's more than just a GPA or an MCAT. We're looking for first-generation students, like myself, who had a mother who was worked in a car dealership, and a father who was a military career man, an electrician. So, these are the people that understand the value of of a medical education. They're dedicated to it. They have resiliency.
▶ 1:17:26So, if we look at just the standards of an MCAT and the GPA to get them into medical school, uh that that's not a whole-person approach. It's not an osteopathic approach of mind, body, and spirit. So, starting with the the student level, if we provide them rotations in the rural area, like you mentioned, what happens if they're exposed to that area is then they search out residencies in that area. And that Florida's done a fantastic job in expanding their residencies in the last 10 years.
▶ 1:17:52I think it was 25% uh or 30 27% five from 2016 to 2021, another 27% the next year or next 5 years. So, an amazing job. More of my students are able to stay in Florida because of the residency opportunities, but there's room to grow. So, if they do their rotations in in a rural underserved area, or a health manpower shortage area, or a needs area, and they choose to do their residencies there, then they stay in those areas to treat the communities that helped train them.
▶ 1:18:20So, my my patient or my student load has changed from their their geographical areas where they come from. In the past, I had about 60% of my students came from Florida. That's reduced, but the good news is they stay here. And the residency opportunities that they have, they've not may not have been from Florida, but they're staying in Florida, including the rural underserved areas, to treat those communities that they trained in. That's great.
▶ 1:18:45Um we have witnesses here today that are that are putting into practice treatments and and methods of care that help prevent chronic diseases that are the cause of so much patient um suffering and billions of healthcare dollars spent, as we discussed. But we must we must bring the financing side of the equation on board with a more modern system when it comes to reimbursements. Um Dr.
▶ 1:19:10Davis, can you can you share how you are practicing what you're you're preaching um and encouraging prevention, not just as a a but as an employer with your own team, and and what are the challenges and you see that would facilitate more widespread investment in preventive All right. Thanks again for that question.
▶ 1:19:36Um this is um this is a very very important question with respect to reimbursement. Uh what's been prioritized from a reimbursement perspective? Um I like to tell the story and of you know, years ago um when I'm with practicing interventional cardiology, you know, I remember making flyers uh to do peripheral vascular procedures because they paid $15,000 a procedure.
▶ 1:20:05And the reality of the matter is it wasn't that we were doing anything wrong, but the truth of the matter is we do the procedure and 6 months later they come back and it's another 10 or 15,000 dollars and 6 months later they come back and it's another 10 or 15,000 Because we never looked at the underlying root causes of those disease processes and a lot of the times the patient really didn't have any significant outcome benefit uh but there was a blockage in an artery, so we put a stent in it or did an atherectomy to fix
▶ 1:20:35I think about those days now and think about where that money could be spent with the things that we're doing with an education perspective and all of the other things that are we're doing in my practice right now. With the right testing, insurance doesn't cover environmental toxin tests. The insurance doesn't cover that uh that uh that that that micronutrient test that we're doing. Uh the genetic testing that I use on every single patient.
▶ 1:20:57If I had the money that we got paid to do those procedures to utilize on every individual, I could guarantee you that their health would be improved tremendously and the health of the nation would be improved tremendously if we had a refocus on where those dollars are spent. So and I think that that's just a cardiologist's opinion. I am sure there are things within the whole system that are the same way, right? What we are paying for and what we're not paying for, the values are all wrong. So that's where I think we need to start focusing.
▶ 1:21:26Like looking at really, what are we paying for? What are the outcomes? And what what really moves the dial? What where are we getting results? Come look at my 82-year-old who has severe coronary disease that everybody wrote off that said he you could go home and die, whose heart function is getting better and better and better with the things that we're doing now, right? So that is what we need to focus on. We need to focus the dollars on the things that really make a difference.
▶ 1:21:49New state-of-the-art procedures are are helping treat and making a real difference for Americans with chronic diseases including innovative treatments and surgeries for those struggling with Um I'm hopeful that in the future digitally assisted and robotic surgery has the potential to to bridge geographic disparities in care access and make procedures safer and more That starts with educating and training physicians to take on this innovative
▶ 1:22:20Um Dr. Reckers, I appreciate I appreciate you being here, particularly giving that much of what we are focused on today is to keep as many as patients out of your operating room as possible. Um tell us about your experience with robotic surgery and what prompted you to undergo training to perform surgeries using robotic technology.
▶ 1:22:45Additionally, where do you see this technology going in the future to eliminate access disparities and encourage innovative technology in more rural areas? So thank you for the question. I mean, it is a truly amazing time that we live in. There's so much technology and access to things that we have. Robotic surgery um has been an amazing tool for me as a surgeon. I love the idea of pairing current technology with helping patients.
▶ 1:23:14Um what got me interested in robotic surgery was the outcomes. Um we're doing surgeries on patients for colon cancer, for example, that used to stay in the hospital for 7 to 10 days that are now going home in 1 to 2 days. I never thought that'd be possible. We're actually doing bariatric surgeries faster um and I never thought that would be possible because of the robotic uh technology.
▶ 1:23:37So it's allowing surgeons to operate better, see clearer, and especially for our larger patients, instead of me carrying the weight standing over a patient, I'm sitting at a console and I'm controlling and this robot is expanding what I can do for them. Um as far as where it's headed, uh the poten- the potential's really limitless.
▶ 1:23:59You know, we're not there yet, but eventually this technology was first kind of created to be able to take care of patients miles away and maybe even in different states and different countries. So all that potential is there, but the tool, the robot doesn't matter as much as the outcomes and I think for me, we get people to go into these different specialties and provide the best care by incentivizing them with their outcomes.
▶ 1:24:25Paying more for providers that decre- decrease length of stay, get patients back home to their families, have less complications and spend less money in the hospital. Currently, we're still rewarding these complex cases that are requiring the most amount of money. So if we fix the focus on incentivizing people to do better care, keeping people out of the hospital. And as far as your question goes about keeping people out of my OR, I agree.
▶ 1:24:55I have more patients than I want. 10% of this of the country would probably benefit from bariatric surgery. There's more patients than I need. We need to prevent them but from getting sick, but uh the technology's there, but until we incentivize patients and until we make easier for providers to refer to dieticians and decrease the amount of money that patients are are having to spend, patients were afraid to go to a hospital. They're afraid to go to a provider.
▶ 1:25:24They're afraid to go to a dietician because of their co-pays and the amount of time that my office spends dealing with appeals and trying to fight for the care that patients should be getting is one of the other biggest factors. So if we change the payment structure, I think the rest will follow. Perfect. One quick question. Dr. Who, um you have been at the forefront of of cancer research and innovative care delivery. Many many patients at um seek care in line with their insurance coverage.
▶ 1:25:53Um how are you working with insurers to ensure that they offer modernized benefits and that they design coverage options that encourage prevention, innovative care, um and encourage better recovery. Thank you. That's a great question.
▶ 1:26:11Uh we're trying to work with them to emphasize this importance of prevention and screening and how uh they can actually save a lot of money in the long run and get much better outcomes if they can focus on coverage of prevention screening with as much streamlining as possible. If we have to go through a lot of pre-authorizations, it's really challenging sometimes.
▶ 1:26:33Just adds a lot of labor and bureaucracy, but I think um uh it the the it it's it's really a no-brainer in terms of the the finances of what we would save. Uh health care in this country, as you guys recognize, is uh not sustainable. Uh we have to do this. We have to focus on prevention and screening. It's our only way out and it's our way for the healthiest of Thank you. Thank you, Chairman. And thank you uh Congressman Steube, you're recognized.
▶ 1:27:03Thank you, Mr. Chairman and thank you, Chairman Buchanan and Chairman Smith for allowing us to have this field hearing in beautiful Southwest Florida. I'm glad that some of my colleagues can experience the incredible Sun Coast hospitality in the free state of Florida as business leaders and innovators continue each day to make this the best state in the country to live, work, and Southwest Florida is home to world-class providers, innovative surgeons, and one of the nation's premier cancer centers, Moffitt, and a major osteopathic medical school pipeline.
▶ 1:27:30Yet our seniors and families still face a system that too often pays for sickness instead of wellness. I hope this hearing will allow us to focus on how we realign incentives towards prevention, early intervention, and better outcomes. Southwest Florida has retirees, seasonal residents, working families, and rapidly growing suburban communities all using the same provider networks.
▶ 1:27:51What unique care coordination challenges do fast-growth regions like ours face and how can federal policy avoid a one-size-fits-all solution designed for urban academic systems? I open that up to anybody. I think one way uh to solve access is through digital access. And so it is challenging sometimes uh for us to even do telemedicine across state lines or throughout a large region.
▶ 1:28:22And so the the easier that is unified, I think it's uh the better. Uh in these rural areas, uh the importance is not just to have enough doctors there, but to give them the support that they need. And that includes things like digital pathology so we can help them diagnose, but also uh the expertise of specialists. And that only happens through that that can happen through digital support.
▶ 1:28:46And I think uh the more we can enhance that uh ability uh through the system to have digital support across the state and the country, the better for the patients. Conservatives believe that patients should be empowered to take charge of their own health, not trapped in a system that only pays once disease has advanced. How can we design better reward for individuals who engage in preventative screenings, nutrition programs, exercise, and chronic disease Dr. Reckers.
▶ 1:29:17It's true. I think um we really need to focus on prevention and I do think we need to make sure patients take care and take part in their own health care, but we have to incentivize them. So, why can't we do things like decreasing doing things like rewarding them for taking part in preventive health care? We have a system now that will pay for diabetic medications, they'll pay for high blood pressure medications, but I have to fight for my patients to get a referral for a dietitian to teach them what a calorie is, what a protein is.
▶ 1:29:48So, we have to push the responsibility on the patient to some degree, but also reward them by helping them make good choices and by doing so, it's going to help the problem overall. So, the biggest thing is really patients are afraid to come in early because they're terrified a lot of times of the cost. And even providers are again de-incentivized for sometimes referring patients for extra help because of capitation and how the health care dollars are being spent.
▶ 1:30:16So, fixing that is going to help our patients do the correct thing. Would like to add on that? Yeah, if I can jump in just to say that I believe I forgot who said it earlier, but the outcome itself is an incentive for people. Folks want to be healthy. It's the fear, just to piggyback on this, the fear of the outcome, right? That you go into a preventive screening and you get this diagnosis and now it's a thing that you have to treat ongoing.
▶ 1:30:38And I think for low-income folks, for working-class people, middle-class people who don't have comprehensive coverage, it's the fear that there's going to be more and more costs from that one thing and so, you know, ignorance is bliss sometimes. Dr. Who, Moffitt's one of the crown jewels of cancer innovation in our state. What barriers still prevent earlier screenings and faster diagnosis for Medicare age patients in Southwest Florida, particularly in suburban and rural communities? You had mentioned the prior authorization for the lung screening, but is there other things?
▶ 1:31:08I think it's education. A lot of people have not even heard of lung cancer screening and they a lot of smokers have We have a million smokers in the state of Florida and only 3% are getting lung cancer screening. The other 97% probably haven't even heard of it and their doctors may have not even heard of it. So, the more we can educate physicians and patients about screening opportunities, the better.
▶ 1:31:34Is the problem access to care, workforce shortages, patient education, or outdated payment systems? I I think it's all of those things and and education is number one, they have to know about it, but then it's hard to access and a lot of the people that need it have two jobs, they can't go take the buses to get their screening done or have someone there to help them get to the screening and and then the reimbursements an issue, but lung cancer
▶ 1:32:04screening is almost always reimbursed by many systems and I think it's mostly the education of the patients and the physicians. Thank you all for being here. I yield back. Thank you, Mr. Bean. Congressman Bean, you're recognized. Thank you very much, Mr. Chairman. Once again, good morning to you and good morning to everybody. I'm going to tell you something that you might find hard to believe. I know we're all getting along up here right now, but sometimes Congress goes out at we debate each other and we go we go hard.
▶ 1:32:34And one of the the best debaters and he's on the other side of the aisle is my friend from Nevada. Don't let his mild manneredness fool you. He is a fighter and and we're on the other side, but he said something. This is going to shock everybody. He said something that I'm totally on board with. Our current system health care is broken, unsustainable broken. We've got to find a a way to change it.
▶ 1:33:02It's it's broken on one hand, we're just a sick country. We we are sick and you compare us, if you look at United States versus other countries, we're mediocre health and in many instances we're behind the times and you look at pictures of Americans at the beach, we're all we're all heavy and you look at pictures of Europeans, they're all skinny. I don't know what that is. And then you look at the numbers, it's not just weight, but it's also chronic diseases.
▶ 1:33:29Americans, hey, we're number one, number one in chronic diseases. 42% of Americans have have two, not just one, two chronic diseases and that eats up everything. So, we're going to talk about how to have that change. So, we're sick on one hand, but we're also it's unsustainable and I look at my friend here who Mr. Smucker who we share a passion of attacking the debt. It bothers us, we're on a we're on a mission to to get it done. We can't afford it anymore.
▶ 1:33:56We we we're spending over 40% of every dollar that we're borrowing, most of it from to to fuel this mediocre system. I do know this. I As as sick as we are, I do know this, we've got world-class providers cuz if you're sick somewhere else in the in the world and have money, then you come here for treatment. So, we got to figure that out. How can we get out of the way of providers and let them do their thing?
▶ 1:34:23It it starts with uh with physicians and we're here at LECOM. I'm it's great. I've already talked to you a couple of your first-year students who have already Have you cut up the dead body yet? Yes, they have. So, that's the I know that's the first step of becoming a a physician.
▶ 1:34:38In Jacksonville, you're opening up this
▶ 1:37:24fall in Jacksonville. I'm real excited about Jacksonville we'd have less heart disease. We'd have less Alzheimer's disease. We'd have less cancer. There's a big elephant in the room that we haven't talked about here. This is not just a medical problem. This is a societal problem and the reason we don't address all of the issues with the food sources that we have, the processed foods that have all those chemicals that I'm talking about, we have to address the upstream problem as well.
▶ 1:37:49We can keep talking about how we're going to treat patients and how we can develop divvy up the money and all that type of stuff, but if we don't start at the top where the problem is starting from, then we're just going to keep shuffling things around, right? So, we can't avoid the elephant in the room of where the problems are coming from. Agricultural things, spraying all of the pesticides. Glyphosate is not even allowed in most countries. I know it all adds up and just like you about trying to fit it all in 5 minutes, that's the story of a congressman's life every day. We try to fit it in.
▶ 1:38:19So, Mr. Horsford, looking forward to working with you as we come up with a solution. Last thing and I may I can't see the clock. It's it's You're a minute over. Okay. Is there anybody I just there's so many Alzheimer's advocates sitting in the audience. Can anybody say anything to bring them hope? That's one of the most challenging diseases out there. Is anybody Dr. Who, I know you're on the cancer forefront. Anybody have any good news to bring the Alzheimer's advocates this morning?
▶ 1:38:49We just hired a dentist at Moffitt Cancer Center that studies the microbiome, the oral microbiome, the bacteria in the mouth and its influence. And research has shown that the bacteria in gingivitis is found in Alzheimer's plaques. So, since I saw that data, I am flossing every day now.
▶ 1:39:12And so, I think that that is our weak point, the gums, because bleeding gums allow the bacteria in the mouth to get to the brain. And we found the same bacteria is in brain tumors. And so um uh besides not getting sunburns, floss.
▶ 1:39:29I yield back, Mr. Chairman. I yield Just remember I gave you a lot of extra time. You know, that the sun is blocking the clock. I couldn't see it at all, so It's It's the same thing back home, too. It's the same thing. Uh anyway, uh Congressman Smith from Nebraska, you're recognized. Thank you, uh Chairman Buchanan. Vern, if I might, uh it's been great serving with Vern and his leading of a team
▶ 1:39:52uh team Buchanan and MVP for team Buchanan, Sandy. Uh great to see you here today as well. We've gotten to serve together for some time now, and I'm grateful that we can be here in your constituency uh to uh hear from uh folks with some great insights. So, thank you very much. Uh we were hearing about access. Uh I think every every comment has reflected at least somewhat on access.
▶ 1:40:15And uh I'm trying to do my part on uh on my bill to allow pharmacists to be reimbursed by Medicare uh for testing and COVID testing and treating mild treatment for COVID, flu, and strep uh to increase access. And I think can lead uh better outcomes.
▶ 1:40:34I think of, you know, the various characterizations of what Congress uh the government did some time ago uh that was called the Affordable Care Act, but uh if the name alone uh is an indicator, it it's a miserable failure. It's a colossal failure, in fact, to even consider calling it the Affordable Care Act when we know that uh even folks with some great health plans over the years, I think of the public school teachers who who don't have the health care plan that they once did.
▶ 1:41:01Uh not to mention other other groups uh that the the pressures have been so great by mandates, prohibitions, requirements, this, that, and the other, but government-centric uh that uh it has not delivered good outcomes.
▶ 1:41:15And not just cost, uh but the the fact is America's no healthier for the ACA on the books than even before, and especially uh given the warnings that the individual market would see drastically increased premiums because of the the government uh mandates. We're seeing those, and that's even with with tax credits still in place uh that have have been there for some time now and still remain.
▶ 1:41:42And so I I think we we just um there there's so much work to be done. I I can't even begin to think what we could talk about in the in these short periods of time. But if we could get more specific, uh Dr. Kaufman, you you talked about uh GME and residencies and so forth, and that this is an issue that that is heavy on my mind. I represent one of the most rural and actually remote constituencies in America, in rural Nebraska. I have 80 counties in my in my district.
▶ 1:42:10So, uh we have a lot of uh constituents uh who live far apart, a lot of cattle in between, probably, but fact of the matter is access looks different there than, say, in a more urban area, and it's all important. America's a big country, and I I fully fully realize that, but I think of of GME and Match Day, for kind of in the season of Match Day, right? Uh right about now. And that roughly 5% of the graduates won't match.
▶ 1:42:40And those those are highly qualified students who not only got into medical school, but about to graduate, and they're kind of in limbo, and and I I just I I I have to think we can do better uh on that front. And I I was just wondering, you know, GME is the biggest funder of GME is Medicare.
▶ 1:43:02Medicare's within our committee What could we do better inside Medicare, even outside Medicare, to be more efficient, if you will, at pairing medical graduates with opportunities when we know there is such a vast shortage of providers that uh what how how can we do it better, perhaps? Well, it it go goes back to the allocation of of residencies, too.
▶ 1:43:31So, we have to prioritize primary care. We have to prioritize the uh location of those residencies in the areas that they need to be. So, osteopathic medicine has a background of developing in rural America. It's the truly the only uh physician practice that is born right here in America, and that was rural. So, that's been a focus on primary care from the very beginning.
▶ 1:43:53There are caps on residencies, so what about the possibility of raising caps in these areas that are restricted because it it is a rural area. You have to train the students there. Why don't we incentivize the physicians who take students on on rotations as a tax break to to allow them to slow down their practice a little bit to bring the student in and help train them. Because again, if they train there, they're going to go to residency there, and then they're going to stay in the communities that that treat them. Mhm. Perfect.
▶ 1:44:23Thank you. Dr. Who, if you might uh elaborate, perhaps, you know, with the very rural constituency, your mobile screenings, uh have you considered how to maybe mobilize out uh where folks live a a little more distance from each other? Absolutely. I think mobile screenings are going to be important. Uh the other is to give support to these doctors because reason uh outcomes are great at Moffitt Cancer Centers, we're highly specialized.
▶ 1:44:51But you can't afford to have those highly specialized systems in all the rural communities, but we can give support. So, I already mentioned digital pathology, how a pathologist in a rural community could scan in a slide and send it into a center like Moffitt Cancer Center. The other is to give support to the doctors. Um uh I'm a medical oncologist. There's not enough medical oncologists in in the future. So, we're we're developing AI programs because it's so complicated. Every month there's new approvals, new ways to treat cancers.
▶ 1:45:20It's so complicated. We're developing an AI module to help go out into the rural communities to give them support. Very good. I'm glad you mentioned the AI portion because I think that's uh I'm excited about the future for health care as relates to artificial intelligence and mobile screenings through one's smartphone, probably. That's probably the ultimate in in mobile screenings at this point and in for the future as well. So, thanks again for your participation here, sharing your insights. I yield back.
▶ 1:45:50Congressman Estes, you're recognized. Well, thank you, Chairman Buchanan, and thank you for all of our witnesses for taking your time to be here today and and helping to share your expertise with us on the committee. You know, when we look at our nation's financial commitments, it's clear that we've allocated a massive amount of our economic resources to medical services. Yet, despite all this tremendous financial output, the overall well-being of our citizens is not keeping pace. We're effectively funding a sick care system rather than a true health care system.
▶ 1:46:21Today, a significant majority of our population is struggling with ongoing long-term illnesses, which stand as the primary drivers of mortality in this country. The burden is especially pronounced amongst our seniors. Nearly every individual enrolled in Medicare is managing at least one of these ongoing conditions. Uh consequently, our federal safety net programs are pouring in hundreds of billions of dollars each year into managing these ailments already after they've already developed.
▶ 1:46:46What is particularly frustrating is the vast majority of these long-term conditions and the tragic early loss of life they cause could be mitigated through proactive lifestyle adjustments. Yet, our current framework currently discourages that. We dedicate an an incredibly small fraction of our national health budget to proactive upstream services, and Medicare reimbursement structures fail consistently fail to reward primary care providers for keeping patients healthy.
▶ 1:47:12We're also failing at the education level as most medical students graduate without some basic mandatory coursework in clinical nutrition. In our rural communities, where specialized facilities are hours away, strong primary and preventive care isn't just an option. It It may be the only option, and it's an absolute necessity. If we want to rein in costs and truly improve the lives of Americans we serve, we must realign our health care incentives.
▶ 1:47:37We need a a system that rewards early detection, values the comprehensive care models championed by our osteopathic professionals, and gives patients the flexibility to invest in their own wellness. I'm proud to say that we have the Kansas College of Osteopathic Medicine right in my district, and they are working hard to train the next generation of physicians in the exact comprehensive patients-first models. It opened just 4 years ago, and already we're seeing some results out of that.
▶ 1:48:04I look forward to talking about how how can we improve our our system as we go You know, Dr. Davis, uh you made a significant shift in your career, moving from a reactive uh interventional cardiologist to focus on longevity medicine and stopping heart disease before it developed. As you work to identify the root causes of these conditions, um you've talked about it some earlier, but how do standard insurance and Medicare actually cover for some of the early detection screenings that you need for your patients?
▶ 1:48:34And what works and what doesn't work, and what specific policy adjustments should Congress consider to ensure that our financing models prioritize the kind of regular prevention over late-stage expensive surgeries? Well, thanks. It's a great question as well. Um I I think part of the issue is the testing that we do. I think let's just use heart disease, for example.
▶ 1:48:58I mean, we'll talk about cholesterol, and we'll talk about when you go to the doctor, we get our cholesterol checked, and the cholesterol is your total cholesterol, your LDL, your HDL, and Well, we know that there are much more advanced tests these days that look at the type of cholesterol you have, the size of the cholesterol particles, whether that cholesterol particle is oxidized or not. Those are the true type of cholesterol That's the cholesterol that actually gets involved in the vessel wall and causes heart disease.
▶ 1:49:25But, many times that testing is not covered by insurance. Now, things are getting better. Um There's There's a molecule called lipoprotein little A, which is a direct independent cause of heart disease that for years I've been measuring it for 10 years now, but for years it wasn't covered, but it is a major risk for heart disease. Um so, it it really starts with mak- getting an insurance companies to cover testing that truly is upstream and it's going to show us where the true risks are. Um I mentioned before environmental toxin tests.
▶ 1:49:54I mean, the unfortunately, the people who come to see me I don't have I don't take insurance in my practice. Uh but, the people who come to see me, they get environmental toxin testing. I can show you the mercury. We can We can do preventative screenings all day, but the mercury that causes the heart disease, the mercury that causes the Alzheimer's, the mercury that causes the cancer, like we we we have to start way upstream. Screening is great and we have to do screening, but true prevention starts at the root. Excellent. Thank you. Um Dr.
▶ 1:50:23Kaufman, we've we've talked a lot about a GME. Obviously, my district has a rural area as well as a lot of our members on here and and you've mentioned a lot talking about it and I I I don't know it you know as we look at um you know, the Medicare funded G- GME slots are really concentrated in those large urban areas and and uh we've talked about You talked about it earlier a little bit about the allocation process for those slots. Is there anything else you want to add in that dynamic of what we what we should focus on?
▶ 1:50:53I apologize if I said it already.
▶ 1:50:56I you know, I have so many thoughts running through my head as I hear all this discussion. Uh but, one of the things is is the the uh incentivizing of the students to go into primary care residencies. And we're talking about family medicine, internal medicine, pediatrics, uh and and uh family medicine, obviously. So, if if we did loan forgiveness on that debt to drive them into those areas, that would certainly help uh them to spread out across the country further than they are at this point. Okay. Excellent. Thank you. And thank you all for being here. I'll yield back, Chairman.
▶ 1:51:33Tha- Thank you, Chairman. Uh thanks uh for holding this hearing. This is a wonderful panel of uh witnesses and Chairman, I want you to know I can't see the clock, either, so because of the light. So, you'll You'll tell me. All right. I I am the last one, so uh So, uh Dr. Kaufman, you said you have a lot of thoughts running through your head. I feel the same way. I want to make a few points um and I wanted I'd like to submit something for the record. Um Dr.
▶ 1:52:01Davis, I think um your own um personal story uh in a way parallels what I think is happening in our overall medical system. Um where you've gone from the childhood illness you talked about to becoming a cardiologist and then into functional medicine focused on uh longevity.
▶ 1:52:26Um and we have a we as a medical system have focused for so long on as you put it very, very well. I'm just repeating what you said on um treating disease after um it occurs. Uh and uh the results aren't very good.
▶ 1:52:44Uh and in fact, um I think uh about 90% of our total medical cost uh are due to these major chronic diseases, cancer, uh talked about that, diabetes, talked about that, heart and Alzheimer's.
▶ 1:53:02Um costs in the US of our Medicare system or med- medical system to to be massive compared to even other other countries and our population is uh sicker. So, it's not working and we're on the on the um cusp, I think, of real change to the medical system that you're all uh talking about.
▶ 1:53:28Um and that is we now have a medical system that is starting to learn about um the microbiome as you had talked about and its impact, about our immune system, about inflammation and what that does to disease, about environmental uh toxins and the impact.
▶ 1:53:47And we're I think now have available to us um all of these new treatments that we're in the infant stage of, but it's going to dramatically change both lifespan, both um um the health of individuals as they get um older. Um and in fact, there's a this what I'd like to um uh introduce to the record, Mr.
▶ 1:54:12Chairman, is a study by Deloitte uh that was done just recently and it found that Well, I'll read it. It says, "Deloitte research shows that disease prevention investments could boost health and longevity, help secure Medicare's future, and cut US medical and drug spending by 2.2 trillion a year." To Mr. Bean's point, I we I think about the debt. I mean, this is a major driver of our annual deficit.
▶ 1:54:39And so, not only can people be healthier, but we can save uh trillions of dollars at the same time. Mr. Chairman, I'd like to submit that to the record if uh if I may. Yeah, without objection, uh so ordered. Thank you. Um and uh Dr. Davis, how much time do I have Yeah, a minute 40. Oh, I got a minute 40. All right.
▶ 1:54:59Uh I think uh the way you framed it is um really important and that is that um today these treatments we have are accessible if you've got a lot of money. And you're you're able to put the money into it. Like, people can go to your treatment and others and get IV and can get lots of longevity treatments, can we can do things with plasma and all of these.
▶ 1:55:24And I think the real challenge, and it is a moral question, I think, is how do we take that and extend it uh to the general population who may not have access to that treatment now and that we're learning that really can can work um and could begin to address um some of these um chronic diseases that we have. And all of you are doing um great work in this area, but I don't know how the how to um design a system. What was really And this is what we got to figure out.
▶ 1:55:52This is a big challenge, but what was really fascinating, I think, Dr. Ruckus and and Mr. Dar- Darius, you talked about um individuals uh being afraid to take the preventative or or or um the diagnoses, essentially, because either I don't know if it was because they're afraid of learning about an illness they might have or if it's more as as you both sort of mentioned, it's potentially about the concern about the cost.
▶ 1:56:22Um so, isn't that kind of amazing that like um our our our um our system is designed not to accommodate um what we know works. Like, literally, we don't pay for uh a screening that could prevent long-term costs for that individual or for the system.
▶ 1:56:45Um so, I don't know like I maybe I I don't know I I know I don't have much time, but I'd love to maybe get a little bit of your thoughts on on maybe a reaction to that. How do we change the system to incentivize uh that kind of prevention rather than the the uh chronic disease the the system that we have here? I may call Mr. Ruckus if you just want to address that. Yeah, I think um it's a tremendous question and we can look at other industry. You know, we look at like automotive insurance, for example.
▶ 1:57:15If you go certain period of time without getting in a wreck, your premiums go down. Why can't we have a system where if our patients are doing the right thing, seeing their primary cares early, getting their screening tests, getting their CT scans if they're smoker, getting their blood work that can help guide the direction that we can't incentivize them by either decreasing their co-pays or by decreasing their We have to help the patients do the right thing.
▶ 1:57:38And I think by controlling the money and looking what other industry has been able to do successfully, um it could help. Well, I I know I am out of time, but I think that is the question. Why can we not have this in place? And we should be working with all of you and many other experts um around the country to figure out how we can do this and to really address the the medical system and and change the medical system to to make that care accessible to everyone.
▶ 1:58:07So, thank you so wasn't going to say, but I do want to put it out there uh cuz we've talked about it quite a bit. We're We're just about done, too, which is nice. But, um as somebody that's been in business, my wife's here, for 50 years, for the first 20 years, we paid for all our employees 100%. Which is something that does not get recognized.
▶ 1:58:29Today, I hate to say it, but our operations and others, let's say a family of four is 1,500, they're picking up 500 to 750 themselves, where they never had to. So, it puts more strain in terms of how far their paycheck goes. And I just kind of throw it out. And you know, the other thing as I mentioned earlier is we all do need to take some responsibility and be the CEO of our own health. There's not enough money to go around, and that can make a big difference.
▶ 1:58:55And the I thought we also kick around is the idea is we've got to get real food, whatever that means, cuz there's a lot of trickery and all that stuff. No Well, no more sugar, but we need to really have people drive themselves to make better decisions when they go to that buffet table to make the right decisions of what's the real food and what's not. Okay, with that, I would like to thank all of our witnesses uh for appearing today before us and sharing your personal stories.
▶ 1:59:22Please be advised that members have 2 weeks to submit questions to be answered in writing. Those questions and your answers will be made part of the formal uh record uh hearing record. And with that, the committee stands adjourned. Good work. Good work, Brian.