FHC #200: Healthcare’s cost crisis, GenAI’s promise + medicine’s leadership gap

Mark Cuban approaches healthcare the same way he approaches every industry he enters: by assuming something essential is missing and then asking who benefits from keeping it that way. In American medicine, he believes that missing ingredient is transparency. Not better messaging, not smarter incentives, but simple visibility into how prices are set, who gets paid and who gets taken advantage of. Cuban is a lifelong healthcare outsider. He is a billionaire entrepreneur, NBA championship team owner and longtime Shark Tank investor. That’s what makes him the perfect guest for Season 11 of Fixing Healthcare with cohosts Dr. Robert Pearl and Jeremy Corr. This season’s guests have massive online audiences, but their value isn’t just reach. It’s their ability to listen closely to what millions of patients are experiencing, then translate those insights back into the broader medical conversation. Few guests embody that better than Cuban. He has quickly become one of the system’s most incisive critics by paying attention to what patients, employers and clinicians repeatedly say is broken. That mindset led to the creation of Cost Plus Drugs, a pharmacy built on an idea that sounds radical only because healthcare has drifted so far from it. Show patients the actual cost of a medication, add a flat 15% markup and eliminate the opaque middlemen who thrive in the dark. In this conversation, Cuban explains how a cold email from a physician opened his eyes to how hidden pharmaceutical pricing had become and why opacity itself became the opportunity. HIGHLIGHTS FROM THE INTERVIEW Why drug prices are detached from reality. Cuban breaks down how widely used medications, including GLP-1 weight-loss drugs, can cost hundreds or thousands of dollars per month despite far lower manufacturing costs. The driver, he argues, is not innovation or scarcity, but a system dominated by pharmacy benefit managers whose rebate structures reward insurers and intermediaries while excluding patients. How patients bear the greatest financial harm. With concrete examples, Cuban explains how people in deductible phases, especially those on ACA plans, often pay full retail prices while rebates flow elsewhere. Costs are spread across millions of plan holders, but the financial pain lands on the people who actually need care. Why healthcare’s complexity is intentional. From fax machines to prior authorization delays, Cuban argues that administrative friction is not accidental. It protects incumbents, drains clinician time and forces providers into the role of “subprime lenders,” all while patients struggle to navigate a system designed to obscure accountability. What he tells CEOs behind closed doors. Cuban outlines the first questions he asks corporate leaders about their pharmacy benefits, why most are not receiving the rebates they believe they are and how audits are often structured to reveal as little as possible. Transparency, he says, is the first step toward leverage. A blueprint beyond pharmaceuticals. The discussion extends into hospitals, insurance design and employer-based coverage, including Cuban’s work on cost-plus wellness contracts that publish negotiated rates so others can replicate them. His goal is not dominance. It is forcing the system to respond by making its incentives visible. Throughout the episode, Cuban’s message is blunt and consistent. Healthcare does not need more jargon, better marketing or marginal tweaks. It needs sunlight. Once pricing, incentives and risk are exposed, many of the system’s most entrenched practices become much harder to justify. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #201: Mark Cuban’s blunt diagnosis of what’s broken in healthcare appeared first on Fixing Healthcare.

In this Diving Deep episode, the 200th of episode of Fixing Healthcare, cohosts Dr. Robert Pearl and Jeremy Corr explore three interconnected themes: The biggest driver of America’s healthcare crisis. The transformative (and still largely untapped) potential of generative AI. The strategic leadership physicians must embrace if they hope to regain control of their profession and the care their patients receive. The show opens with a metaphor Pearl has returned to repeatedly in his writing: healthcare’s “invisible gorilla.” Borrowed from classic research on inattentional blindness, the image captures how policymakers, employers and healthcare leaders fixate on insurance mechanics (premiums, subsidies, deductibles) while missing the far larger problem in plain sight: the soaring cost of delivering medical care itself. From there, the conversation traces how this cost crisis ripples across society. Employers struggle to absorb rising premiums. Workers face higher out-of-pocket costs and job instability. Rural hospitals teeter on the edge of closure. And short-term fixes — from benefit design changes to temporary bailouts — fail to address the underlying mathematical problem. The hosts then turn to generative AI, not as a billing or documentation solution, but as a clinical force that could reshape care delivery and tremendously lower costs. They examine how genAI could help clinicians manage exploding medical knowledge, prevent errors, personalize inpatient care and extend high-quality monitoring into patients’ homes, particularly for chronic disease. Finally, the episode widens the lens to leadership and strategy. Drawing lessons from Nvidia and the technology sector, Pearl and Corr explore why medicine’s fragmented, short-term responses have cost physicians influence and what it would take to rebuild leverage through collaboration, accountability and value-based care. Taken together, the episode sets out to answer a defining question: With pressure mounting across the healthcare system, will medicine act strategically or wait until the crisis leaves no other choice? Helpful links What Nvidia Can Teach Doctors About Strategy, Survival (Forbes) 5 Ways GenAI Will Transform Medicine — If Clinicians Embrace It (Forbes) US Healthcare’s Biggest Problem: Overlooking The $5 Trillion Gorilla (Forbes) Monthly Musings on American Healthcare (RobertPearlMD.com) * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #200: Healthcare’s cost crisis, GenAI’s promise + medicine’s leadership gap appeared first on Fixing Healthcare.

As 2025 comes to a close, we’re flashing back to one of the year’s most listened-to episodes of Fixing Healthcare. This week, a special reading from Dr. Robert Pearl’s bestselling book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” This encore episode includes audio from Chapter 11, titled “The Road to AI-Empowered Healthcare,” followed by Chapter 11.5, a bold and thought-provoking response written by ChatGPT itself. Together, these chapters offer a vision of the future that, as Jeremy Corr notes, is “analogous to looking at a baby and trying to describe the adult who will follow.” Looking back, it’s striking how prescient both the human author and large language model turned out to be. Their commentary on the economic, political and cultural roadblocks to AI adoption feels more timely than ever, especially amid today’s headlines. In Chapter 11, Pearl lays out the promise of Healthcare 4.0, a future in which generative AI empowers patients and doctors alike to reduce inefficiencies, improve care and reclaim the human side of medicine. Chapter 11.5, penned by ChatGPT, offers a clear-eyed critique, cautioning against overreliance on tech and warning that change requires more than just innovation. It demands leadership. This flashback offers listeners a rare opportunity to hear a dialogue (human and machine) on what it will take to transform American medicine. HELPFUL LINKS ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine (Amazon) A list of Malcolm Gladwell’s 25 book recommendations (link) Robert Pearl’s Monthly Musings on American Healthcare newsletter (link) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #199: Revisiting ‘The road to AI-empowered healthcare’ from ChatGPT, MD appeared first on Fixing Healthcare.

After the Thanksgiving holiday, Dr. Robert Pearl and Jeremy Corr sit down for an “Unfiltered” discussion about gratitude with cardiologist and burnout expert Dr. Jonathan Fisher. While the discussion begins with an exploration of the science and value of gratitude, the episode then expands into an analysis of cultural trends in medicine, mental health, and the tension between individual autonomy and collective belonging. With insights drawn from emotion research, Jonathan’s own experience, and even sci-fi television, this episode touches on everything from evolutionary psychology to electronic health records — and from Lord of the Rings to generative AI. Some of the key ideas discussed: Gratitude is a mindset, a personality trait and, most importantly, a practice. Drawiong on research from Dr. Barbara Fredrickson and others to explain how gratitude triggers upward emotional spirals, helping people tap into optimism, empathy and self-trust. When life is falling apart, gratitude alone isn’t the answer. In moments of crisis, trying to force a feeling of gratitude can backfire. Instead, we should begin by choosing where to place our attention, cultivating stillness and gradually train our minds to experience positive emotions again. The real enemy of gratitude might be distraction. With much of our attention hijacked by devices, media and negativity bias, Americans today often lack the sustained focus required to feel or express authentic gratitude. There’s wisdom (and warning) in a ‘hive mind.’ The group discusses the Apple TV series Pluribus, in which a virus links humans into a hive mind of total empathy and consensus. While peaceful, the world loses all individuality, sparking a conversation about the tension between belonging and autonomy in medicine, society and self. A lesson from Samwise Gamgee: In a heartfelt final segment, Jeremy draws on Lord of the Rings to reflect on the importance of standing by loved ones in dark times. Jonathan responds with insight into isolation, empathy and the power of human connection — even when people seem lost. For more unfiltered conversation, listen to the full episode and explore these related resources: ‘Just One Heart’ (Jonathan Fisher’s newest book) ‘ChatGPT, MD’ (Robert Pearl’s newest book) Monthly Musings on American Healthcare (Robert Pearl’s newsletter) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #198: The surprising science of gratitude & the cost of conformity appeared first on Fixing Healthcare.

In this week’s episode of Medicine: The Truth, hosts Jeremy Corr and Dr. Robert Pearl examine a wide range of stories shaping American health. From new research on the lifesaving effects of health insurance to troubling vaccine policy changes in Washington, this episode offers an objective and insightful look at what’s working, what’s failing and what lies ahead. The show opens with a study that functions as a natural experiment on health coverage. When the IRS sent letters warning uninsured Americans about Affordable Care Act penalties, researchers found a striking result: those who signed up for insurance had significantly lower mortality over the next two years. For Dr. Pearl, the takeaway is clear. As political battles over insurance subsidies begin, the stakes are measured in lives saved and lives lost. From there, the hosts turn to the second round of Medicare drug price negotiations under the Inflation Reduction Act. Cuts as large as 85% will save billions of dollars, but Pearl warns that negotiating prices alone cannot fix America’s drug-pricing problem. The root issue, he notes, is the ability of manufacturers to extend monopolies for years through patent thickets, evergreening and litigation strategies that delay competition. Until those practices change, the United States will continue paying far more than any other nation. Here are more pressing stories from this month’s episode of Medicine: The Truth: Expiring ACA subsidies: Enhanced marketplace subsidies for 24 million Americans are scheduled to sunset, threatening large premium hikes. Private insurance costs: Covering a family of four now averages $27,000 per year. Employers may shift even more of the burden onto employees. U.S. health spending vs peer nations: America spends nearly $14,000 per person on healthcare, far above any comparable nation, yet underinvests in preventing and managing chronic disease complications. Measles resurgence: Falling vaccination rates and permissive school exemptions have made measles endemic again, with outbreaks in multiple states. Biosimilars and insulin pricing: The FDA plans to streamline biosimilar approvals by focusing on molecular similarity rather than repeated clinical trials. COVID infections during pregnancy: A Massachusetts study of nearly 18,000 births found higher rates of neurodevelopmental diagnoses in children whose mothers had COVID while pregnant. Social media and mental health: In a small study, young adults who reduced daily social media use from two hours to 30 minutes saw sharp drops in anxiety and depression. Obesity trends and GLP-1s: New Gallup data show adult obesity declining slightly from 40% to 37% since 2022, with the largest gains among women ages 40 to 64 (a popular demographic for drugs like Ozempic). Estrogen therapy reconsidered: The FDA has removed its black box warning from estrogen-containing products after new evidence showed substantial cardiovascular, bone and cognitive benefits when started near menopause. As the episode continues, Dr. Pearl highlights fascinating findings on peanut allergies and preterm birth disparities, looks at the likelihood of a severe flu season with the new H3N2 strain and a stern warning about the politicization of vaccine decisions. * * * Dr. Robert Pearl is the author of the new book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post MTT #101: From measles outbreaks to GLP-1 hype, the data every patient should know appeared first on Fixing Healthcare.

The Draper name is synonymous with Silicon Valley risk-taking. For decades, venture capitalist Tim Draper made bold bets on breakthrough technologies long before they went mainstream (see: Bitcoin). Today, two members of the next generation — siblings Jesse and Adam Draper — are directing that same appetite for innovation toward one of America’s most troubled industries: healthcare. Jesse, founding partner at Halogen Ventures, focuses on the “future of family,” backing companies that support women, parents and caregivers (nurses, in particular). Adam, founder of Boost VC, invests in frontier breakthroughs and “sovereign health” technologies with outsized potential. Together, they spend their days reviewing hundreds of pitches from entrepreneurs trying to solve real-world problems. And in this episode, they share what they believe patients and consumers are seeking most. This is Season 11 of Fixing Healthcare, which is dedicated to elevating voices with large public followings: people who, through their work, hear directly from communities, consumers and healthcare professionals. Neither Draper sibling is a healthcare insider. But both bring a candid, outside-in perspective shaped by global innovation, millennial tech culture and thousands of conversations with founders. Across the interview, the siblings highlight what they believe entrepreneurs are betting on: globalized innovation, new regulatory models and technologies that bypass traditional bottlenecks. Adam points to places like Prospera, a special economic zone in Honduras where companies develop treatments they can’t test in the U.S., while Jesse cites early-stage breakthroughs like Kangaroo’s artificial womb and tools that help families piece together trustworthy scientific evidence. Both describe a rising pattern of medical tourism driven by patients who feel the U.S. system is too slow, too fragmented and too expensive. Jesse also delivers the episode’s most memorable moment, describing ChatGPT as a “best friend” she consults for everything from parenting decisions to symptom interpretation. Her approach — asking AI to cite real studies and synthesize global data — reflects a generational shift in how people gather information long before seeing a doctor. In his closing remarks, Dr. Robert Pearl praises their patient-centered instincts while adding the guardrails often missing from Silicon Valley conversations. Innovation can save lives, he notes, but only when safety and cost stay in balance. Excess regulation slows progress, yet unchecked enthusiasm fuels hype and high-priced products that add little value. The central challenge, he argues, is building a healthcare system bold enough to welcome breakthrough ideas and disciplined enough to ensure they improve outcomes and lower costs, not just generate revenue. Helpful links “Japan has created the first artificial womb” (Engineerine) Prospera, Roatán ZEDE (background and news) “Healthcare Regulators’ Outdated Thinking Will Cost American Lives” (Forbes) “ChatGPT, MD: How AI-Empowered Doctors and Patients Can Take Back Control of American Medicine” (Pearl’s newest book) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #197: Artificial wombs & medical tourism – Draper siblings on healthcare’s next wave appeared first on Fixing Healthcare.

For this Thanksgiving week, we’re revisiting an important and emotionally charged episode from the first season of “Medicine: The Truth.” = When this episode debuted in 2020, the podcast was called “Coronavirus: The Truth,” which began when readers of Dr. Robert Pearl’s newsletter, “Monthly Musings on American Healthcare,” started asking for much-needed facts and context surrounding the pandemic. It was a moment hard to fathom now. Covid cases were climbing fast, the nation was exhausted and vaccines weren’t yet available. Fear and frustration were everywhere. Five years later, with vaccines protecting all but the most vulnerable, it’s worth remembering just how uncertain and divisive the world felt heading into those holidays. A big question people wanted answered was whether they should change their Thanksgiving plans. Dr. Anthony Fauci had urged Americans to avoid big gatherings. The reaction was immediate and intense. Polls showed three in four people were less excited about the holidays than the year before. Families were fighting over safety. Many felt hopeless and isolated. Against that backdrop, listeners asked the question weighing on millions: Should we gather at all? In this rerun, Dr. Robert Pearl revisits the facts that mattered most at the time: why drug makers were pausing some vaccine and treatment trials, what was happening on college campuses and why premature births had unexpectedly declined during lockdowns. He explains why he expected 500,000 Covid deaths, a number that shocked listeners in 2020 but ultimately proved accurate (by half). The episode also dives into deeper issues that shaped the national mood. Most of all, it captures the anger and divisiveness that blanketed the country. A tension that continues today. There is much our nation can learn today from the experiences of five years ago. This Thanksgiving rerun offers a powerful reminder of where we were and how far we’ve come. * * * Dr. Robert Pearl is the author of the new book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post FHC #196: Revisiting Thanksgiving 2020 at Covid’s peak appeared first on Fixing Healthcare.

This special episode of Unfiltered departs from its usual cadence and lineup as cardiologist Jonathan Fisher is joined this week by his wife, oncologist Dr. Julie Fisher. Together with hosts Jeremy Corr and Dr. Robert Pearl, the group embarks on a candid, unscripted conversation that begins with a literal and metaphorical climb. Julie and Jonathan recount their joint ascent of Mount Everest (Julie’s idea, not Jonathan’s) and then quickly moves into deeper terrain: the persistence of sexism in medicine. In this important conversation, Julie opens up about her experiences as a woman in a field where hierarchy and status remain firmly entrenched. She offers a nuanced yet unflinching account of the barriers she’s faced, from inappropriate comments and dismissiveness to more insidious forms of bias in academic and clinical settings. She describes the pressure to be more nurturing, friendly, likeable and even more accessible to patients than male colleagues. And yet, when it came time to seek a promotion, Julie was told these skills – which were both encouraged and expected – weren’t valued as much as significantly as other skills (namely, getting published in academic medical journals). To this day, these unequal pressures undermine a woman’s ability to lead with authority, to express frustration or to achieve equal footing in the medical profession. Though born from a partnership between husband and wife, this Unfiltered episode invites a broader reckoning in medicine. It is a chance to look closely and honestly at questions of power, perception and equality in American healthcare. For more unfiltered conversation, listen to the full episode and explore these related resources: Breast cancer diagnoses rising fastest among young women (Charlotte Talks interview with Julie Fisher) ‘Just One Heart’ (Jonathan Fisher’s newest book) ‘ChatGPT, MD’ (Robert Pearl’s newest book) Monthly Musings on American Healthcare (Robert Pearl’s newsletter) * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #195: Dr. Julie Fisher on medicine, marriage & misogyny appeared first on Fixing Healthcare.

Before TikTok myth-busting and Instagram reels took over the health education space, Dr. Jen Gunter dominated Twitter (now “X”) as medicine’s fiercest advocate for women’s health. Dr. Gunter built a massive following by calling out dangerous pseudoscience, exposing sexism in medicine and championing evidence‑based care. In this flashback episode of Fixing Healthcare, we revisit a standout conversation from Season 5 (air date: March 15, 2021). This one feels especially relevant during the show’s current Season 11, which highlights medical influencers who hear directly from millions of patients and can reflect those concerns and conversations back to us. With more Americans relying on influencers for answers about their bodies, brains and overall health, this rerun brings back the voice of an original myth‑buster: a physician who helped build the very space that others now occupy. Dr. Gunter, a board‑certified OB‑GYN and bestselling author of The Vagina Bible and The Menopause Manifesto, continues to use her platforms to challenge misleading products, expose medical gaslighting and normalize conversations surrounding women’s bodies. Her newest book, Blood: The Science, Medicine, and Mythology of Menstruation, takes aim at decades of cultural myth and medical misinformation about periods with the aim of replacing shame with science. In this episode, she speaks with Dr. Robert Pearl and Jeremy Corr about: the harm caused by pseudoscience and wellness influencers. the ways sexism shapes the medical system and patient care. why clinicians must fight misinformation as fiercely as disease itself. This timely flashback pairs perfectly with recent Season 11 conversations featuring Dr. Danielle Jones and Dr. Joel Bervell, two leaders in the next generation of medical myth‑busting. Listen to this episode and ask yourself: What has changed in the 4.5 years since Gunter’s original interview? What hasn’t? * * * Dr. Robert Pearl is the author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify or wherever you find podcasts. Join the conversation or suggest a guest by following the show on X and LinkedIn. The post FHC #194: A flashback to Dr. Jen Gunter’s fearless fight for truth in women’s health appeared first on Fixing Healthcare.

When this podcast launched in March 2020 as Coronavirus: The Truth, hosts Dr. Robert Pearl and Jeremy Corr set out to give listeners clear science and accurate analysis during a moment of chaos. Now, 100 episodes later, as Medicine: The Truth, the duo sit down and revisit the most important medical stories of the past five years, explaining what the nation learned, what it didn’t and what urgent questions remain. The episode opens where the show began: the early days of COVID-19, when exponential spread of the virus threatened to overwhelm U.S. hospitals. Pearl walks through the original goals of public-health measures like masking and social distancing. He reflects on what the country got right, what it got wrong, and why communication failures around testing and vaccines deepened distrust that still affects medicine today. But as the crisis evolved, so did the podcast. What began as a weekly pandemic explainer shifted into a broader analysis of why the United States spends more on healthcare than any other wealthy nation, yet it delivers worse outcomes. In this episode, the conversation moves from reflections on the pandemic to a look at some of the show’s longest-running themes: clinician burnout, workforce shortages and a healthcare system struggling to meet rising demand. Alongside the difficult news that lingers in American healthcare, episode 100 also highlights genuine progress: breakthroughs against Alzheimer’s and colon cancer, advances in prevention and diagnosis, and a growing role for generative AI. Pearl explains how GenAI could save hundreds of thousands of lives, reduce medical errors, increase healthcare affordability and alleviate clinician burnout. But, none of this will happen unless the financial incentives shift away from fee-for-service and toward value. Pearl closes with a simple message: crises will return, and science can save lives. However, success will require Americans to follow the research rather than be distracted by politics. To prepare for the next pandemic, he argues that the nation must better control chronic disease, rely on scientifically validated clinical evidence, and reward superior clinical outcomes, rather than simply the volume of care provided. The first 100 episodes of what is now Medicine: The Truth serve as clear and powerful reminders of the dedication and courage of doctors, nurses and other healthcare professionals. But they also warn of how easy it can be for the American healthcare system to lose its way. * * * Dr. Robert Pearl is the author of the new book “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine” about the impact of AI on the future of medicine. All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post MTT #100: From COVID-19 to ChatGPT, a close look at the last 5 years    appeared first on Fixing Healthcare.