Salus Health Care Forum: November 5, 2025

Another interesting recommendation was made. We should constrain health spending so it stops eroding other common goods. We should empower individuals and communities to prioritize local health care initiatives with the necessary funding to accomplish those outcomes. Then we would have an economic and cultural transformation that would incentivize and prioritize health across all sectors.

They give some very good examples of ways this recommendation has sort of been enacted in microcosms. I thought the most interesting was the Alaskan NUCA, which is a Native American health system. It was kind of nice to have that given as an example where they consolidated fragmented funding so that they could actually set metrics that mattered to them, and that they’ve met a lot of those metrics.

The health impact assessment was an interesting piece of this report. They introduced something that was new to me, but apparently it is not new to the Netherlands, or new to Canada, or new to the United Kingdom, or some other countries. This assessment parallels something with which we are familiar: environmental impact assessments. They were introduced in the United States, I think, during the early 1970s, and had a mixed review. These assessments tended to turn into very burdensome environmental constraints for growth. Yet, a more flexible health impact assessment was recommended in this report. Meaning when you’re going to do something that the health impacts should be taken into consideration. If you’re going to produce a food product, for example, the health implications would be part of what you would have to demonstrate as to the value of that product.

Bill B

Jeremy, let me ask this. The initial numbers you had in terms of decline and quality of health in the United States, are those declining numbers also found in many other parts of the world?

Jeremy

Everybody took a hit during COVID, but we took the biggest hit and we are demonstrably below our brethren in life expectancy now. At one time, certainly 50 years ago, we were the leader in life expectancy. We are now a laggard. and have experienced a more dramatic decline. This is particularly the case with certain subpopulations, some of whom are suffering a lot. They keep changing their mind about who to vote for because they’re so frustrated. It is a more dramatic decline in life expectancy that has persisted beyond COVID for us.

Bill G

This concept of stratifying different areas of our country, I think, is not new either. A few years ago, people pointed out that New Hampshire actually had world-class health statistics, and some of our states were well below most third-world countries. And a lot of people have pointed to other universal health care models. I mean, Bernie Sanders is always talking about this. But it’s true when you look at the Commonwealth report about which countries have access and coverage and can provide health more efficiently.

We’re getting back to the analysis of the Institute for the IHI analysis about what sorts of excess expense and abuse exist in our society. So, none of this thinking is very new, and it gets us back to where we started. The report is saying: let’s talk about why is it that there’s so much evidence and so little effective action?