Mehmet Oz 医生谈美国医疗体系改革与欺诈 | Davos 现场

All right, everybody. Welcome back. It's All-In at Davos. My bestie, David Sacks, is here. We're having a great time. We're here.

Can you guys catch this in the background? Amazing.

It's stunning.

This is the Davos experience. It looks real.

I know. Well, it kind of looks like a green screen from here because it's just so picturesque.

It's literally like a green screen.

It is. It's the real deal.

We'll look over the ledge here, and what you'll see is all of the virtue-signaling ESG and DEI executives. It's emanating from this entire area. They've put solar over every single building here. None of it's plugged in; it's just for aesthetics.

We're really excited, David and I, to do a bunch of interviews here. Today, we've got a great one for you. We're going to talk about health, and we're going to talk about the health care system with none other than Dr. Mehmet Oz. You're the administrator now for CMS. You've gone from being America's doctor, dare I say, to being a civil servant like my friend David Sacks. Why did you choose, really at the height of your powers and career, to go into public service like this?

So, I'm in the change business. You guys are as well. If you're in the change business and the project you're pursuing is not making a significant change, then you want to move on to something else that could make the impact you desire.

Especially in health care, we don't have the luxury of fooling around for years of our lives pursuing interests that don't result in meaningfully changing the quality of life, but also the opportunity that the American people have. Although I loved being a TV host—I did it for 13 years—and I love practicing surgery, which I've done my whole life until recently, this is the best job I've ever had.

It's the best job I've had because of the people that I get to work with, but also because you truly do get to make the change that I desire. I think a lot of folks who watch the podcast want to change stuff, too. I encourage everybody to take some big swings. You'll break things once in a while, but if you want to be able to change meaningfully the infrastructure—whatever's bothering you—you've got to go at full speed. This administration offers us a unique opportunity to do that.

It is interesting, David. You were used to going at a pretty fast pace as well. I think our expectation was, hey, you get into public service, it's going to be about consensus building and it's going to take a lot of time.

Say what you will about Trump. Some people might not agree with every policy, but he ships. He's like a founder who ships and ships product fast. That's also been your experience?

Yeah, he's hard to keep up with. He moves incredibly fast, and it makes him really fun to work for because he wants to get things done. Every day, he wants to get things done.

You'll be in a meeting with the president in the Oval Office and you'll tell him about a problem. His first instinct is to pick up the phone and call and fix it right then and there. He does that meeting after meeting, hour after hour, day after day, week after week. When you compound that desire to get things done with the fact that he acts on it right there, it has a huge impact.

He seems to get great pleasure in bringing people together, especially in this administration, which I think is distinctly different from the first. In the first administration, he was new to politics and he brought in a lot of career politicians whom people may have told him were the right people. This time, he has explicitly gone and looked for people with expertise who are proven winners in the field, yourself included.

He wants us to carry the water, and this, I think, is true across the different parts of the administration. He wants individuals who don't have to rely on the president to tell the story all the time, because so much of the narrative that is reflected in the media is just completely off.

I'm not even saying that they're doing it on purpose. They literally don't understand some of the secondary and tertiary impacts of the decisions you're making. It's our job to therefore tell not just the media, but the American people, what we're trying to do. That's especially important if you're unorthodox in how you govern.

This is a fundamentally important reality, at least at CMS. David, I don't know how it is in developing AI, where there probably wasn't a rule book before anyway, but in health care, there have been doctors since the dawn of humanity. Since humans left Africa 50,000 years ago, there were doctors in the encampment. There is a way of doing things.

In government, that exists as well, but it's not always the right way to do things. For example, we have the ability to make laws. Every part of the administration pretty much can. We can get Congress to do stuff. It doesn't always turn out the way you want it to turn out, and it takes a lot of time. The negotiated final result sometimes falls short.

You have rulemaking, the second big area. Administrative entities like ours can write the rules that everyone has to follow: We're going to pay you this much. We're not going to let these people do that anymore. It does take some time, and it's prone to lawfare. By that, I mean the people you're regulating, if they don't like what you're saying, can sue you and can stop you.

In this administration, if the other party doesn't like what you're doing, even if it's the best thing, they can stop it. We had a rule that would reduce fraud, but the blue cities didn't like it because it was coming from someone they didn't like—the president. So they enjoined it, and that's now caught up in court. We'll win, but it could take years.

That's the second big way: You make laws, you pass rules. The third way, which historically government has not used as effectively as possible, is to use the power to convene. This president, because he's a great negotiator, is able to push us in ways that historically have not been done.

The U.S. government can bring people together who would not normally talk. They can give safe harbor to industry to come together and discuss problems that historically they would shy away from.

What's the great example of that? I'm wondering if it's the drug companies. They have something to lose because President Trump has been very clear: Hey, I want these prices lowered. Why are we the sucker at the poker table? We're paying 10 times what Canada is paying. Is that the best example in your experience so far?

It's a great example. Most-favored-nation drug pricing specifically addresses the problem you outlined, which is that we pay a bunch more in the United States for the exact same product, made in the same factory—often in America—than our counterparts do here in Europe.

The president says we need to change that. So he says, go talk to the drug companies, create some opportunities for risk for them, make some rules, create some projects that, if we were to act on them, would really hurt them.

A little pressure.

A little pressure. Build the crowbars and the baseball bats. Cut some trees down, hone the wood, but don't use them.

He's very specifically said, do not hurt the innovative nature of pharmaceuticals. They are important to our nation. They save lives. We want to have the most innovative industries in the world because that's where the opportunities are to differentiate ourselves. It's also part of our national destiny: Be the best.

So don't hurt the industry, but take some of the fat out of it. Pull it back and give it to the American people. Plus, it's the fair way of doing things.

Metaphorically, when you think about NATO and the president saying to NATO countries, we're all in it together to protect ourselves against external threats. You guys have to put up more money. We'll put up more, but proportionally more. It's got to be fair. They all did that pretty much, with one or two exceptions.

He did the same thing with pharmaceuticals. He said there's an external threat, which is Russia or foreign governments. There are internal threats, like cancer.

Yeah.

So we want everyone to chip in. We pay, in the United States, 1% of our GDP toward pharmaceutical products.

1% of our GDP goes to drugs. That's not the health care system, which I think is 17%.

Right. A full 6% of our health care goes directly to the drug companies. So we want—

What's with your math?

It's quite impressive.

Yeah, thank you.

The point is, I only bring this up because the percentages make a difference here.

0.8% comes from us playing blackjack and poker together. I've lost a lot to this guy over here.

Well, I've lost a lot of money to this guy, and I don't play him in chess anymore.

Bend, but don't break. You want them to bend a little bit. Be reasonable, but you don't want to break the industry as a doctor.

What's the upshot of this? You hear this term “affordability” a lot. Is the average American going to pay less for their drug prices?

We're going to pay less. We're telling all the countries—we're in the middle of these discussions—we've just gotten the British to say yes, and other countries are talking to us about the fact that they pay 0.3%. So less than half of what we pay, percentage-wise, is being spent by them.

They get away with it because their people don't realize that if you get cancer, particularly with more advanced cancers in Europe, your survival rate is way below the U.S.

And if you don’t get access to the drugs, which they don’t get for several years on average after we get them in the US, yes, you can get them for cheaper, but your people are paying a price. This is going to be the most important message I’m going to deliver today: don’t think about health care like an expense. Think of it as an investment, because if I can get the average American to work 1 year longer because I got them a medication at a better price and they didn’t turn away at the drugstore, or because we were able to do something else correctly, that is worth $3 trillion to the US economy. It’s massive.

We’ll talk about all this, but if you can get the average American to work 1 year longer, that is worth $3 trillion to the US economy. It’s massive.

We need to get people feeling their best, feeling that they have agency over their future, with confidence that they’re going to make a difference in the world, so they want to keep trying to do it in the workplace. That extra 1 year, which gets them closer to Medicare, by the way, also helps deal with other financial crises that we’re facing as a nation.

This is the way to think about it the right way: get the actual cost of care down. Don’t just pay more money into the system. Get the actual cost of care down so the money we’re spending gets us more value.

We’re spending twice as much as these other countries who have universal health care. Now, you did point out that they get things later. So, we have a better system, but we pay through the nose for it. That would be an accurate way of describing the current state of affairs.

Precisely stated. Yes.

Okay. So, how do we get health care for every American? I believe a lot of the tension we have comes from a fear among people who are not as well-off as the people on the pod right now. They live with that fear. We don’t live with that fear. We know if we need to get health care, we’re going to figure it out. We’ll be able to pay for it out of pocket, or insurance will pay for it. But there are people who go bankrupt because of this. You believe in universal health care. I would assume that as a doctor.

I want everyone to have access to health care. But how we pay for it is the defining issue here. How do you keep the system incentivized to take care of you? If I tell everybody in America that you have health care, and then I tell the doctors, “Give them health care,” but they don’t deal with the financial costs, then you all of a sudden start to restrict access to care.

You can get the health care like you do in socialized-medicine countries; you just have to wait 6 months or a year or longer, or you don’t get the care at all. When you start having that discussion with Americans, they say, “Wait, hold on a second. Yes, of course I want to get health care for an affordable price.” But the fundamental question is: how long until I actually get the care?

Being denied is something they live with. So they complain about their universal health care; we complain about not having universal health care.

The thing I would look at is the flow of patients who seek treatment internationally. I hear lots of stories about Canadians coming to the US to get treatment because they don’t want to wait 2 years for some procedure. They could be dead in 2 years, so they come here. I don’t hear any Americans talking about going to Canada to get treatment.

We actually do have a number of examples of that in surgeries and treatments that you have to pay for out of pocket. Cosmetic and dental procedures—people are going, and this has become medical tourism. There are people who do change locations for elective procedures. You mentioned cosmetic surgery. That’s definitely a trend.

There are also some procedures that we don’t do in America.

Stem cells.

But your stem cells are still going through the regulatory process. The bigger issue is really the one David’s raising, which is that most Americans complain that the health care system is broken. Almost none would leave the country to get top-tier health care for a life-threatening problem.

We have this sort of bizarre opportunity. I do think it’s an opportunity. How do we make top-tier health care available to folks who need it, but do it at a price that is sustainable? That’s where I think your specialty area comes into play.

Before this administration, I think because we didn’t have the right technologies to promise convincingly that we could do this, there was a hesitancy to make big shifts. We’re taking big swings because we think AI is ready. We think the tech transformation that could happen in health care is worth subsidizing.

By that, I mean making it possible for top-tier entrepreneurs who are building apps that can help you deal with the medical crisis you’re dealing with, including diabetes, to get support. We can put money into the system to make that worth doing. Then you can get investors to support you, and you can get a fair valuation.

The technology to lower the price—obviously, that’s a huge win. Let me ask you the difficult question as a doctor. There have been studies that came out recently that not only do LLMs currently give better advice than the average general practitioner, but they also have better bedside manner, and the customers, or the patients, enjoy the LLM more than they enjoyed a GP.

Where did you see that? I haven’t seen that.

This is a study that came out of either Harvard or MIT. I’ll put it in the show notes, but this is pretty groundbreaking. What are your thoughts if you were designing a new society? Is the idea that you have to go to the GP, they ask you a bunch of questions, then they go to their medical texts to figure out what their advice is, the best modality? Or would it be better, for the common cold or an ankle sprain, to do what most Americans without insurance are doing, or what people who are self-directed are doing? They go on a large language model, it says, “Here’s how you deal with these issues,” and they do it themselves. They can take care of a couple of things. Wouldn’t it be better to have them do this stuff and then decide if they should go see their GP?

I think there’s a hybrid of that that de-risks it a little bit early on. There are definitely problems with hallucination and the like that Americans are very intolerant of. We actually understand if a human being who has an MD degree makes a mistake. We think AI is perfect and are completely intolerant of even a minor transgression.

What you said earlier is true, and these studies have been done several times now. The large language models do better on board exams. So, in general knowledge, they’re better than a doctor. They’re more patient than a doctor. If you talk to an AI-informed avatar, it’ll answer the same 10 questions on diabetes all day long and not get bored.

Talk to a general practitioner after they’ve talked to 10 patients with diabetes who’ve asked the same 10 questions, and you get a little terse in your responses. That’s just human nature. I don’t want to answer the same question every time, but that’s what patients need you to do.

I think we have the opportunity, and we looked at some of these models. In fact, John Doerr brought a bunch of very thoughtful entrepreneurs into the building to talk about the possibility of taking the average general practitioner and making them 5 times, maybe even 10 times, more efficient.

Now, here’s the big deal: there are not enough GPs in America. We probably need 2 to 3 times more just to keep up with Europe, per capita. We’re way below because my son just finished medical school. There aren’t many kids in medical school at Columbia, where he went, who are going to become GPs. They all want to be ophthalmologists and orthopedic surgeons because they pay a lot more.

And they got big loans for their education.

Yeah. And they’re in debt. They’re in debt.

Yeah. And even Columbia is free. If you don’t have money, you don’t have to pay tuition at Columbia. They did that so that kids would go into general practice, and it hasn’t had the desired impact yet.

But the broader question is: how do we allow AI to play a role as this transition period happens so people feel confident? One way of doing it is to allow it to do most of the work and then, especially with agentic AI, take the paperwork out of it, take the busywork out of it, and feed the doctor the key information.

What’s the most important thing I do as a doctor? I look at you in the eyes, I read you, and I try to connect with you. Fifty percent of our cortex—of our high cognitive function—50% of it is to read your face. We’re hardwired to be social animals, to understand the subtle little cues: David’s bored; you’re not. I have to change the pacing. I have to get back to him. He’s doing card calculations in his head.

He was, in fairness to David, out until 1:00 a.m. They dragged him to 4 meetings. I was in bed at night. I have good sleep. I got my Whoop. I got my sleep score. I am a pillow princess like you, Dr. Oz. I hear that you’re extreme about your sleep.

Well, I’m a good sleeper. My wife is a world-class sleeper. She brings her own pillows.

Your wife is delightful, by the way. I did an hour interview with Lisa before you even got on stage here. I was like, “Wow, she’s impressive.”

To build on this point, I think it’s interesting. I think we’re going to get smarter doctors and smarter patients, and they’re each going to use their own version of AI.

So, you know, what patients are going to use is a consumer product: ChatGPT, Grok, and so forth. What’s interesting, I think, is when they can dump in their blood panels, because AI is so good at reading PDFs and unstructured data.

So, you dump all your stuff in it. You ask for a diagnosis, you get smarter. You can research your own condition.

So, you go in more educated, and the doctors can use ChatGPT or whatever. But they're actually using much more specialized tools than the ones I've seen. They'll give you a citation directly to a medical journal that you can bring. That's very important to doctors.

So, it's not hallucinating. It's getting the answer from a source. If it was on the Joe Rogan podcast, you need to know what the source is.

Which is fine. If you get information from Joe and trace it back to a respected medical journal, that's fine.

Let me ask you about this trend.

This is self-directed health care. There's Function Health doing blood labs, Superpower, WHOOP just started offering them, Oura, Apple Watch, HLEP [?]—I'm an investor in that one, full disclosure, and it's doing great.

These things are now putting all that data together and starting to tell you your life span, your health span, your actual age versus your health age. I'm not sure what that metric is, but people are now measuring things and getting some knowledge of this and then going to a GP.

The problem I'm having is—and I'm not price-sensitive; I could get any concierge doctor I want—there are very few doctors who want to work like this at the moment. Something's got to change. What do you think of this new group of people who are doing self-directed health care, doing 2 blood labs a year, and putting it into a database?

Prenuvo with the 3D scans, Neko, Daniel Ek's new company doing a $300 full-body scan—all of this. Is this going to be the paradigm shift?

80/20 rule. If 20% of Americans do what you're saying—and they will, yeah—

It'll make all of medicine function better. I'm actually concerned about the other end of the spectrum. Tell me.

The people who don't go to their doctors: Medicaid patients. Medicaid patients are twice as likely—

Medicaid is for folks who are vulnerable, who have made less money. They're getting government health insurance, right?

Medicare—

That is our universal health care—

Right? That's where we need help. The chance of a Medicaid patient who doesn't pay for their health care because they don't have the means to do it—the chance of them canceling their doctor's appointment is twice that of a Medicare patient.

And so, it's hard to take care of them. They have 2 jobs. They'll get fired if they leave the job early. They don't have the flexibility of moving their calendar around. They don't have transportation. There are lots of reasons they don't show.

But if I can't get health care to them, that's a major crisis for us. The real opportunity for AI is democratizing health care.

Yes. See, you guys are already smart. You just listed off a dozen companies, all doing great work. Most people have no idea these companies exist or what they do.

If I can put my labs into AI—and I don't know much about health care—I can get information sent to me in a way that I can process it and at the time I'm ready to hear it.

Now, I'll give you one more data point that might be useful. All Medicare patients—all seniors over 65—are given a free wellness exam every year. What percentage of people take their free medical exam?

Less than 5%.

No, it's not that bad. It's less than 50%.

Less than 50%.

Okay, but most people don't do it. It's there. Part of the reason we think that's happening is that you don't prioritize it.

Here's the more important data point: People who actually see their doctor think they're sicker, but they're actually much healthier than people who don't see their doctor, because ignorance is bliss. People who don't go to their doctor or seek any kind of health advice think that they're doing great. Actually, objectively, they're doing much worse.

So, we have an opportunity to democratize this by saying, "Okay, I'm going to meet you where you are. You don't care about going to see a doctor even though it's free. It's yours in this new health tech ecosystem we're building out."

I'm with Amy Gleason, who also ran DOGE, helping to roll this all out. We're making it easier for every tech company to participate. Six hundred companies have signed a pledge agreeing to interoperability and data transparency and to build these tools for the American people to be able to use them.

Once I deputize you to be better equipped to take care of yourself, you change the system. When you ask a doctor a question, the first time you're the only patient, they don't pay attention. The second patient who asks the same question, we change.

As a physician, I'm telling you, it helps us to have patients pushing us to pay attention to, for example, ambient collection of information in the doctor's office. I get a medical report on what you told me. Why? Because 50% of what a doctor tells the patient is forgotten before the patient leaves the office.

So, when your kid asks you, "Hey, what happened with the doctor?" you don't remember. You're nervous and anxious. The doctor spoke quickly and used big words. Break all that down, and all of a sudden, information gets flowing easily.

Now you've got a lot more stakeholders. Who's the ultimate stakeholder? The patient. So, the medical records that historically have been hijacked by medical record companies—

And hidden—

Like, how do you ever get them?

Yeah. All those companies are now saying, "All right, we get the joke." And this is, again, back to the president: He's not fooling around in this stuff. When he tells you he wants you to share data, you know he's going to come after your ass if you don't deal with this problem.

They've all come around: "All right, we're in on the joke now." The pharma companies, when we're negotiating most-favored-nation pricing—you know what they said when we challenged them and said, "You're charging several times more for the same products"? They said, "All right, well, we knew one day you'd come knocking."

We knew they'd do it. We actually think the president would do something to us, so we're going to negotiate. You don't want to throw away that power.

You know, don't beg for forgiveness. Push for action. Yeah.

Go make things happen. If they don't work out, fine. You'll get more bites at the apple.

Just on that point about the pledge, I got to attend that event at the White House.

You organized it.

Well, don't be modest. I mean, that's going to be a little bit too much credit, but it was honestly you, Amy Gleason, and Secretary Kennedy. You guys just happened to invite me for some reason.

HIPAA-regulated.

Well, it's because the companies that store the health records do it in proprietary formats, and we don't really know how to get that data or what we would do with it even if we did.

So, the key is to get those health records shared with all the other medical companies in the space that we might want to use. Hence the power of the pledge: Get these 600 companies agreeing.

I think AI is the magic glue here because AI is so good at reading data from different formats and translating it. You don't need a perfect API anymore. You just get the unstructured data, dump it in, and now it just works.

Which is what we're starting to see. I'm taking my Eight Sleep data, my WHOOP data, and my blood panels, and I'm putting it into all 4 of the major ones and asking it. I take pictures of every one of my supplements or drinks and ask, "What impact will this have? Which impact will this have on sleeping?"

I think that's a gigantic win.

Yeah, you being able to realize the promise that the law gives you—to actually own your own medical data—but to get it in a usable format that now you can use, again, a chat interface to understand it.

It's technological obfuscation. Let's call it what it is. They're trying to use these proprietary formats to get a technological advantage and to have a moat around their business.

AI just decodes that and makes it usable, and now you can interact with it.

Can I bring up one other example? Dr. Oz, you mentioned democratization. You and I have had a conversation about how certain states are actually trying to ban the use of AI in therapy.

I think the point you made to me is, you know what, there are a lot of places all over the country, like rural areas, where there aren't psychiatrists or psychiatric care. At least AI provides a baseline level of service. Version 1 may not have been perfect. There may have been some hallucinations, but it is getting better and better every year.

If you ban it, then a lot of people are just going to have nothing, right? I mean—

Beautifully stated. Let's unwrap that a little bit, but I'd just, at a high level, say AI is coming to a neighborhood near you. You're not stopping it.

It's going to be there, and patients are going to use it. You have to engage it, not run from it. We cannot stick our head in the sand on this one.

There are other things you can delay, but I've encouraged every governor to go full bore at this. Do it in the right way. Allow professionals to function at the height of their licensure.

Why don't we use pharmacists better? There are probably 70,000 pharmacists, right? Think about it this way: Almost all Americans—95%—live within 5 miles of a pharmacy.

They don’t live within 5 miles of a hospital, usually. So we don’t have access to care in many ways. If we just took AI and allowed pharmacists and doctors to function at a higher level, it would itself be worth the opportunity.

I’m not even saying to abdicate at all to an AI agent that doesn’t really understand you, that we can’t control. Maybe some other country gets involved in it. At its very practical level, we do not have enough practitioners. There just aren’t enough people to take care of rural America.

Sixty million Americans living in rural America don’t have access to mental health services. Our vets commit suicide at a crazy high rate—more than we lose in war—because they don’t have access to mental health services. Many of them do live in rural America.

If we’re going to fix those kinds of problems, which are time-consuming, you’re not going to get Park Avenue psychiatrists to go practice medicine for $800 an hour.

At $800 an hour in the North Slope of Alaska in the winter, it’s just not going to happen.

This $50 billion investment that we as a country just made—the money was part of the Working Families Tax Cut legislation that the president pushed through and Congress got behind—is the largest investment ever made in rural health care through our agency. It was given out by the end of the calendar year. All the governors have the money, and we charged them to make a difference in their communities.

The plans for their communities almost all came back with some AI element. They all know that to really be able to get health care in rural America, you’ve got to right-size the system. Right-sizing the system means hospitals are going to work differently, and doctors will work differently with each other. AI is the core element of so much.

And these micro-hospitals, just like people are putting ADU units in the back of their homes to get an extra apartment for Grandma and Grandpa or as an Airbnb—my understanding is there are a bunch of startups working on the equivalent: building a micro-hospital, a room with the central services, perhaps a nurse practitioner, of whom there are more available, and then using telemedicine to bring medicine to those areas without having to build a giant hospital. That’s also a win, yeah?

The micro-clinics, I think, are a huge opportunity to provide top-tier care. But this goes beyond that. We have AI-supported robots—

They’re going to be doing ultrasounds in parts of Alabama where there are no OBs, right?

We have drones delivering prescription medications to the North Slope of Alaska, where there are no roads. We have vending machines that can dispense medications intelligently. By the way, this is happening in other countries.

So we want this to take place in America. Why not take advantage of an opportunity with a huge, massive inflow of money? The Rural Health Transformation Program provides $50 billion to start doing innovative work in rural parts of the country, which are the foundational element of who we are as a nation. Those values ripple up to the rest of us.

I also think that states are now talking to each other differently. Now that there’s money out there that can be used to change the world, they’re talking about AI and technology generally very differently. It’s not scarce research. We live in a world of abundance, and AI makes it that much more abundant if we use it correctly.

It’s not going to happen today, but we believe that by the time the administration has completed this work, we will have dramatically changed the face of how Americans work with information in the health care system. Some of it is just blocking and tackling, as you said: making medical-record companies not data blockers. Some of it is forcing health information systems to share data more comfortably and elegantly at a fair price. Part of it is us putting money into the system, seeding it the right way.

But the most important thing is to make it safe to go outside.

Yeah.

We want to make it comfortable to take financial risk and invest in these areas. That’s why 600 companies have invested. Every major AI company, every major foundational technology company, and a whole bunch of these surgeons that I promised—they’re all rushing in.

The 3 places entrepreneurs have been reticent to build new products and services are education, housing, and health care. These also happen to be the ones most regulated and most controlled by the government. To the extent you can give them access and make it go faster, it’s going to work.

The only investments we’ve ever made in those spaces are ones that go direct to consumer, because we know that going through the government, there’s just not enough runway for those companies to get to the other side. Let me ask you about—

We’re open for business. I’ve got to make this plug while I’m here: We want to work with industry. We believe the private sector will come up with better ideas. Come work with us.

We’re also looking for people. We had 9 engineers when we came in, and all of CMS’s COBOL-based infrastructure was built in the ’70s. We don’t have engineers—

You’re talking about in the department—you had 9 engineers out of what’s the denominator of employees?

6,500 employees and 40,000 contractors. So basically, you have an HR person in government working with a government-affairs person at the company. There are no engineers there.

16 basis points. David—

We took $3 billion of cost out there. There was a company that we fired that had billed us $200 million. Not a single usable line of code. And here’s the good part: When we fired them, you know what they said? Nothing.

Yeah, we knew it.

Yeah, we were underperforming. No accountability.

Underperforming. God, we could go on about fraud forever, but I want to ask you about this wonder drug.

4 years ago, I was listening to my friends Tim Ferriss and Kevin Rose, who are biohackers and are always on the edge of this stuff. Kevin wanted to lose some visceral fat. He was in great shape, and he heard about this diabetes drug, Ozempic, and decided to give it a shot. He dialed the pen all the way up, puked, dialed it back down, and lost his visceral fat.

I heard that. I was, like, 40. I was 213 pounds at the time. I went to my doctor, and he said, “I have no idea what you’re talking about. You’re not diabetic, but you are fat.” I think he said, “You’re a fat bastard.” I think I said that.

I had just gained 2 or 3 pounds a year for 20 years. I used to be a marathon runner. I used to be 165 to 170 pounds. So now I’m 172, a gazelle right now, by the way.

Well, I add a little muscle, too.

Thank you, Dr. O. You look great, too. But this is a miracle drug. In my mind, we now have theoretically tens of millions of Americans who have experienced it, and it’s going to be in pill format.

The 4 horsemen of the apocalypse—heart disease—

Kidney failure, liver disease, dementia.

Dementia. These are all 4 impacted by obesity, and these GLP-1s seem to be impacting them.

I was thinking, if President Trump just made it national—anybody can get this drug if they want it—I think he’d win the election. He won anyway.

What do you think about a mandate to make the weight-loss drug available to all Americans? Would that be—

I’m glad you came to work today. About 2 months ago, in the Oval Office, the president basically did that. He said that we’re going to take the prices of these drugs, which are now prohibitively high for many Americans—$1,200 cash pay—

It’s crazy.

It’s going to be a starting price of around $200.

Easy.

And with the pills, it’s $150, and the pills will come out. The first FDA-approved pills will start this month. We believe at that price—

Because think carefully. That’s right. It’s basically a coffee a day.

At that price, within 2 years we will return money to the American taxpayer. It’s going to save us so much money from reducing hypertension, diabetes, and the downstream illnesses—the 4 horsemen of the apocalypse that you mentioned—that we will save money that we spend.

We spend over half the money, I believe, within health care on these chronic illnesses driven by obesity. Either directly or indirectly, because you hurt your knees because you’re overweight, or you get autoimmune problems, or even cancer is linked to obesity because you have a metabolically active state. All of these are going to drop precipitously. We have pretty good data on this from internal modeling.

We agreed to those prices with the 2 major companies, Novo Nordisk and Eli Lilly. We will launch next week, TrumpRx, with those products. I don’t know when this podcast airs, but you can cash-pay at a price that is completely affordable.

And here’s the good news: Every Medicare patient gets it for a $50 copay. Every Medicaid patient gets it for nothing.

Amazing.

So the people who need it the most, the folks who are most vulnerable—this is what drives me bonkers when people say the president doesn’t want to protect Medicaid or that he doesn’t love and cherish Medicare. He’s doing more for underserved Americans than any other president ever has.

He’s giving Americans where the obesity epidemic lives—underserved Americans, vulnerable Americans who are on Medicaid—access to these drugs for no out-of-pocket costs. It truly democratizes the weight-loss issue, because right now, what’s the number 1 ZIP code for weight-loss drugs? The Upper East Side of Manhattan.

I was about to say it’s got to be Manhattan or L.A.

Los Angeles is number 2.

Okay.

Right.

Because people can afford it, or—

Because they're vain.

They're vain. They want to lose 2 pounds for their daughter's wedding, and they can afford it—$1,200, a rounding error. But $1,200 for someone who isn't making money? You're just not going to take the drug, and they're the ones who die early.

The life expectancy in rural America—I’ll go back to vulnerable populations—is 9 years shorter than yours in the same country.

It's something that came out of left field. What does that tell us about what's going to happen in medicine going forward? With GLP-1s, how long of a journey has that been, getting to market, and then this off-label use starting with people with diabetes? What is that? How does that inform you of how we can make even more impact in the future? How do we make another GLP-1-like discovery and implement it the way President Trump has?

Well, the drug actually came from a poisonous chemical—a venom, actually—that was deciphered and found to have an impact on some of these core cells in the appetite system of the body, which is so fundamental to who we are that it's very hard to hack the appetite. But GLP-1s are just the tip of the iceberg. There are more and more sophisticated ways for us to be able to address not just appetite but addiction. Addictive behavior drops with GLP-1s, so the newer drugs are going to be even more effective at that.

Retatrutide is the one you—

For example, retatrutide. But the other thing I would say is that the form factor matters. Sending someone an injection that goes bad in the warm weather creates a lot of wastage, and you don't know the exact dose. The pills make it like most other drugs, and now the drug price point is much lower as well. So it's easier for us to deliver that at scale to the American people.

It does leapfrog us beyond today's problems, and this is a big theme of our administration: Don't bother fixing today's broken pipes if the world you're building doesn't have pipes.

And that's what we're doing with drugs like semaglutide and tirzepatide, which is the Lilly product. We're also getting these companies to onshore their production facilities, hire American workers, and stay innovative. This is why, again, the president doesn't want us hurting innovation.

The same day we did the first most-favored-nation drug event, we had an executive order on childhood cancer. There were 20 beautiful children, with smiley, bright eyes, all of whom should have been ghosts. They survived because technologies were afforded to them that don't exist in other parts of the world to keep them alive. That's our goal.

But I'd be poorly served if I didn't get into the other issue.

For whom, we don't know. We probably asked for whom the bell tolls, for sure, for you, Jase. But—

I think that's totally for the pharma companies who don't bend the knee.

No, actually. But the issue right now that is consuming us is fraud, waste, and abuse.

What have you found, Dr. Oz? Tell us what is most concerning to you.

Well, let me, as a preamble, say that without better visibility into where the money is spent—which we need technology to be able to provide—

Or audits.

Audits are interesting. You can audit the spreadsheet, but you can't tell if the input to the spreadsheet was legitimate unless you actually go and do site visits, and states don't want to do that.

Are these states blocking it?

Of course. First of all, let me tell you, that's a good question: Why would you let fraud happen? It is mandated by federal law that if you give a patient a welfare program—SNAP or Medicaid—you must also give them the ability to sign up to vote.

So you're basically recruiting voters at the same time you're giving them free government services, which then you might actually end up recruiting a different kind of voter. You don't have a law that says if you go to an NRA convention for gun advocates, you sign up voters, right? You can go to that event and not get signed up to vote. Obviously, they would probably be skewing to the right, so there is an issue there.

There is also an active role of unions, especially in California, where we have a major problem because the unions have seemed—this is all what I'm hearing from talking to people on the ground—to have gotten involved in, for example, signing up home health care workers and personal care services.

There are more Americans, I believe, providing some of these home-based services than might exist in retail in America. We've shifted the entire employment economy toward some of these services.

And here's the risk: When I give you things that your family used to give you, we are going to have fraud. Your family used to drive you to the doctor's office. Your family would take you home after you got back from the hospital to make sure you got well-nourished and taken care of. Your family would carry the groceries up the stairs. Your family would negotiate your contract with the landlord.

Guess what? Health and human services does all that for you now. All you have to do is ask. And in some states, it's so easy to do that you end up with significant fraud.

So they have intercepted the transaction. Therefore, that's where graft and fraud can occur.

Well, the government's paying for it.

Right. So when the consumer is paying for it out of their own pocket, they have their own incentive to get value for the transaction.

But when the government's paying for it, who really has the incentive to make sure that value has been provided in exchange for that money?

Yeah.

And this is what happened in Minnesota, where you had a subculture. Most of the indictments, mathematically, were with Somalis. The Somali community realized, “My goodness, no one's watching.”

Now, there's an adage that only the morons get caught in health care fraud because it's so easy to do. If you steal $5 million in Medicare or Medicaid, you go to jail for 18 months. For many people, that's a pretty good deal. You sit in the pen for 18 months.

But unfortunately, I'll just give you a lay of the land. There are twice as many durable medical equipment providers—they sell wheelchairs and knee braces—as McDonald's. There are actually 20 times more in South Florida than McDonald's. I mean, how many do you need?

Turns out they're all Cuban, pretty much. They all seem to fly back to Cuba and escape law enforcement. They bill millions of dollars. They get away with it.

What's the solution? There's got to be a really practical, easy solution.

There is, but let me just give you 2 others, because you would remember these. We have 7 times more hospice in California than there were 5, 6, or 7 years ago. Seven times more. We don't have that many people dying in California.

More importantly, the survival rate in hospice—again, designed for cancer patients dying within 6 months—the survival rate for most of these hospice centers is 100%.

Wait a second.

They shouldn't have gone to hospice.

Exactly. Is the government paying for it?

Yes, completely paying for it. But no one's dying, because you're not supposed to.

When did the government start paying for that?

Oh, 40 years ago.

Okay. It was designed—

And then what happened in the last 7 or 10 years that the fraud just went foreign? Governments got involved in Los Angeles?

The hospice business is driven by Russian-Armenian gangs. They're foreign nationals. They fly back to Russia. We had a big $15 billion bust on these guys earlier in the year. Again, they all escape.

The other thing is no one's watching, because there's an opportunity, if you get into these businesses, to make a lot of money. It becomes—I’ll tell you a true story about a whistleblower. Again, I can't prove this, but it's what he said.

He said that he was building a beautiful mansion. He owns all these hospices. He's a doctor, but he's a fraudster, and so he built this beautiful house. The plumber comes in and says, “Hey, I hear you're in the hospice space.” The guy says, “Yeah, I made my money in hospice.” Then the plumber says, “You know, I've got a side hustle. I own a hospice, too.”

Right? Then the carpenter hears him and says, “Me, too. I'm in the hospice business. We're all in the hospice business.” Absolutely.

So then the guy says, “Okay,” and he realizes he's got to get ahead of these guys. He goes to a major hospital in Los Angeles, a very prominent hospital that everyone's heard of, and a doctor says, “Hey, listen. If you give me $1,000 a month, I'll send hospice patients to you.”

That's how it's done in Los Angeles, by the way. You get paid to send patients over. So the guy says, “Okay, but what about the actual inpatients—the people hospitalized? Can I get them?”

Then the doctor says, “I can't do that, because it turns out some members of the board own hospices, and they like the patients to go to their centers.”

You see, the corruption starts in organized crime, but if you tolerate it, it poisons the whole system.

And that's the bigger reason we've got a problem. So what are we doing? We have a fraud war room. I'm going to put a moratorium on some of these services. We're not going to let new people sign up.

We’re going to actively and aggressively stop paying Medicaid if we can prove that states are not honoring their fiduciary responsibility to the American people, because states administer Medicaid. I pay the bills at CMS. So, we’re going to stop paying on behalf of the taxpayer if we don’t think you’re taking care of the money.

People should know there are whistleblower laws where you get a percentage of whatever is reported, and they should look into that. And the fact that we have so many people in the administration now communicating that, hey, we want to have you report fraud to us, has changed everything. The number of people reporting fraud must have gone up since—

Dramatically. People in the government—this is probably the part that’s most rewarding to me. Many government workers are Democrats. Probably most of them.

What they tell me again and again is they just came to government to do their job. They wanted to do the right thing—

—and they were told not to do their job. They were told not to focus on the fraud, but to focus on getting more people signed up. But if you don’t take care of the fraud—this is an important message—you will kill the system. Eventually, you will destroy Medicaid, and I’m not going to let that happen on our watch.

Medicaid, as Hubert Humphrey said, is there to protect those at the dawn of life, which are our children. 53% of kids are born into poverty. We take care of them. Those at the twilight of life, those are the seniors, right? We owe it to them. Every great society takes care of the most vulnerable. We’re great people; we’ll do that. Hubert Humphrey said you’ve got to take care of those living in the shadows. We are not going to let them get hurt.

When you let organized criminal elements steal at scale from the federal government, you are killing those programs. We now have so many kids signed up falsely for autism that the kids with autism aren’t getting access to care.

Yeah. This is the incredibly frustrating thing. Having talked to some young parents who are millennials and Gen Z, they’re going to work. They’ve got 2 jobs. They would love to have child care, but the child care dollars are being stolen; therefore, they can’t access them.

And the same thing’s happening across the system. I think this could be such a defining moment for America, because on the other side, we have socialists, lunatic communists running some of these cities who want to seize people’s assets and want to raise taxes before fixing fraud. This is like pouring water into a leaky bucket.

Well, you’re talking about California—

—and New York. Yeah, and I couldn’t help but notice that Gavin Newsom arrived here at Davos yesterday.

He’s here.

Yeah. He was encouraging European leaders to defy President Trump, which is a weird thing for a governor to come here to—

—to basically advocate for foreign leaders to defy the American—

What next? Partner with communist countries for your f—

I mean—

—but I think, honestly, it’s all a distraction, because the real thing happening in California right now is everybody knows there’s massive fraud there. You see that image on the internet where it’s an iceberg, and the tip is Minnesota, but California is the 4th-largest economy in the world, so we know there’s massive fraud. I think Newsom knows there’s massive fraud, too. That’s why he’s vetoed—

Audits.

I mean, can we just pause for a second? Audit—

Veto audits. Right.

Who would veto an audit?

Someone doesn’t want to get caught.

A criminal. [laughter] A criminal would veto it. I’m not saying he’s a criminal, but—

No, this is to government spending what the ban on voter ID is to elections.

Why wouldn’t—

—you only do that? You’re banning the thing that helps you catch the fraud.

Yeah.

So why would you ever do that unless you want the fraud to happen?

Exactly. It’s— it’s—

Yeah. It’s still—

Now, and now even—

Distracted, as we say here.

But California—the budget’s $350 billion, by far the biggest.

It has doubled in the last decade—

—and it’s like 3 times per capita—

—2.5 times the inflation rate. Okay. And they’re still running a huge deficit. And that’s why they’re now driving all the job creators out of the state with this proposed asset seizure. Wild.

If they just clamp down on the fraud, they wouldn’t have this hole in their budget. Just LA County alone, just in hospice and home health care, we believe it’s about $3.5 billion. Just in those 2 programs in 1 city, there’s probably 10% of all home health care expense in America in LA.

So there’s so much to do to improve the system that would restore confidence. And when you have governors who are unwilling to do their job, it does make people think that, listen, when smart people don’t do things, it’s not an accident, right?

They’re not doing these things because they have ulterior motives that either aren’t transparent to you, or they think you’re not smart enough to figure out.

We had to ask those questions. This president is not going to tolerate it, but the American people shouldn’t either.

We had an interesting moment. Our friend Elon Musk had asked us, after he purchased Twitter, now X, to come in, and we were looking at the bills trying to figure out how this company was hemorrhaging cash at a level that just didn’t even seem possible.

One of the things was they had just signed up for tons of software and basically subscriptions. The CFO comes in, the auditor comes in, and we’re all trying to figure it out. Elon said—

How are they paying for all these?

They’re like, “Oh, yeah, they’re on credit cards.” He said, “Okay, cancel all the cards.”

Yeah. So we said, “Cancel the cards.” Immediately, I get 3 back channels from software companies who are like, “Hey, I know you’re helping Elon. I saw a story in The New York Times. Our bill stopped getting paid. Can we come in?”

And I’m like, “Yeah, we’re not using your software anymore. Nobody’s ever used it. It’s never been installed.”

This is a private company, not a public company.

Yeah.

But your point is, look, when no one is minding the store, bad things are going to happen. And when no one has minded the store for decades, and the government’s paying for it, you don’t even have that private-sector profit motive to basically be efficient. Then think about how the fraud just metastasizes.

It’s got to be—

20–30%.

Hundreds of billions.

It’s got to be double-digit. I’m going to guess 20–30% of all this fraud.

All it took was a YouTuber with a video camera to actually show up at the Minnesota daycare centers that were receiving millions of dollars.

Yeah, the Quality Learning Center. They’re all empty.

Yeah.

Dozens of them. Each one’s receiving millions of dollars. And that’s 1 program in 1 state. These aren’t lowlifes doing this. Lowlifes are involved, obviously, but these are politically connected groups.

Sophisticated.

Yeah. And that’s why I’m emphasizing: these are government- or foreign-government-backed efforts at times, but certainly the people doing them are often foreign nationals. We are being taken advantage of because we’re like a big hippopotamus. All you need to penetrate Medicare and Medicaid is a beneficiary number. They can buy those, and you’re off to the races.

The solutions are—I’m not claiming they’re simple—but they’re eminently doable. You have to expect it of your leaders.

There’s going to be some low-hanging fruit here. I can tell you, cutting off payments and saying very simply, “Hey, we’ve cut off payments. All you have to do is sign this attestation that you delivered the service, and I would like you to attach your driver’s license and passport to it. By the way, you’ve been randomly selected to come into the office. We want to hear all about what you’re doing, and jump on a Zoom call.”

Right. So you’re saying cancel the credit cards.

Yeah.

And just let them then reopen the account or tell you—

Yeah. Come in. We just want to reverify what’s going on. Literally, zero-based budgeting. We’re not saying the program is over. That’s the thing that I think Elon found when he was doing DOGE: these payments were just on recurring autopay every year.

Autopay equals—

—with no code explaining what the money was going to.

Autopay equals fraud. That’s all you have to know.

And if you look at some of the good stuff Lina Khan did—and I was opposed to about 80% of it—one of the things she did really well was say that if you sign up for a service, you have to be able to cancel it the same way you signed up.

So, newspapers, these bastions of virtue—you sign up for The Wall Street Journal. You’ve probably had this experience. You try to cancel it, and they’re like, “Give us a call.” Then you’re on the phone for an hour just trying to cancel it.

I asked the woman, “Hey, can I ask you just a simple question? Why can’t I just cancel online?”

They’re like, “Oh, well, because of fraud.”

I’m like, “But you took my money through the website, so that’s where the fraud would actually occur.”

She’s like, “Yeah, that kind of makes sense, but I’m just an operator, Mr. Calacanis.”

They said, “Okay, fine.”

But this is the same concept: if you want the money, hey, why don’t you come into the office? We’d love to hear how the program’s going. We’ve got your check right here.

Come pick it up in person. We want to hear about it. Can you just take a picture of the service you provided and send it in?

Yeah.

How is this hard?

And like you said, how do you argue for it? California already has some of the highest tax rates in the nation, and now you're arguing for more taxes—novel taxes, taxes that no one's ever seen. Unconstitutional.

Unconstitutional, probably. And it will require a massive new enforcement mechanism. Before you do that, you haven't even wrung the obvious fraud out of the system.

Yeah. Listen, our biggest allies are our state auditors. I met with the state auditor in Minnesota, who confided that she's been trying to get this on the radar, but people just didn't want to listen. And I talked to folks within the agency, Health and Human Services. You were shuttled around. One woman was actually escorted out of the building for raising the reality that there was fraud.

This happened over several years. Eventually, either you leave if you're ethical or you're quiet because you don't want to get fired, and you make it such a harsh environment for anybody to just tell the truth. This reminds me of a friend of mine who's a billionaire now, Thomas Peterffy. You probably know him from Interactive Brokers. He's a really, really great guy. He said he was growing up in Hungary, and when he was young, he knew that everyone was lying to him.

But that wasn't the big problem. The big problem is he knew that they knew that he knew that they were lying to him—

Right?

So pretty soon, we are all in on the fact that there's a big lie.

The whole thing is corrupt. And so, working in these agencies, the good people are weeded out. The people who are left either don't care or aren't good people—

—or complicit.

And some of them are complicit. But I think fundamentally there was a misalignment of values. This actually was probably the most important thing we had to do in that legislation last year, the Working Families Tax Cut legislation. We had to align the president with the governors.

There were so many ways of getting the federal government to give you money that wasn't really yours—legalized money-laundering schemes, all kinds of things that clever consultants had figured out over the years—that we estimated we would have lost $5.4 trillion just for Medicaid. Which is again why I often joke we were becoming 1 massive health care system with a small country attached.

Well, if it doesn't work long term, if we don't take bold action—which again is a major message on a lot of things the president is doing—you're leaving the next generation with a train wreck. They can't fix it anymore because the train's gone way off the rails.

And frankly, this whole budget hole that's causing this asset-seizure tax all started in 2022.

When Newsom promised Medi-Cal for all, including illegal aliens.

And so what happened is, in the One Big Beautiful Bill, the president said, "Listen, we're not going to reimburse for illegal aliens."

Think about the incentives there, right?

So then the SEIU, the health worker union, was upset because they didn't want that funding cut because it indirectly impacts them. So that's how this whole thing happened.

Think about the layers of fraud there. The government of California is paying for illegal aliens, which it probably shouldn't be doing. If you ask the American people—which is who you both work for—how many Americans believe that illegal aliens should get universal health care, I think you're going to get 98% saying, "Absolutely not."

And the 2% with purple hair in Berkeley—I don't know what their motivation is.

Support them. Just to finish the point, if you're going to have the politics of a Gavin Newsom and tell people that you want Medi-Cal for all in the state, even illegal aliens, doesn't that create a responsibility on you to audit the system and make sure it's not being abused? When you then turn a blind eye to the fraud and refuse to even acknowledge it, you just pretend like it doesn't exist and veto the audits, that's doubly wrong.

But it doesn't hurt California. This is the part of the story that's so infuriating. You don't audit the books in California because the federal government is paying anyway. So why would I audit the books to find out that my people aren't getting free money from the federal government?

Let's talk about illegal immigrants. Gavin Newsom was giving us a hard time for threatening the health insurance of illegal immigrants. Just to be very transparent, if you're on Medicare, you don't get free dental. You don't get free vision. You do if you're an illegal immigrant in California.

This is the infuriating part. So anyway, you've got taxpayers in New Mexico, which is a blue state but a poor state, paying extra tax dollars to the federal government that are recycled back into Los Angeles to deal with the fraud that I'm talking about.

And they get less.

And you know, we're a country of immigrants. You could absolutely believe in legal immigration and want the border closed. That's what we saw in the last election. That was the deciding issue, I think, at the end of the day. They also picked a terrible candidate on the other side and didn't have a primary. Put that aside.

We had an amazing candidate, too.

Incredibly tremendous. Okay.

The best ever.

They're the greatest ever.

I'm minimizing.

I'm just saying. I mean, you kind of went up against a—anyway, put it aside. The thing that I think is super important is incentives matter. You've said this many times without explicitly saying it in our conversation.

The incentive for people to come to America illegally is to make a better life for themselves, have a job and employment, and access these social services. If the social services aren't available, some number are going to stay back. And if the jobs aren't available, then why would you risk it? Why would you pay one of these coyotes $5,000 to $25,000? You wouldn't. You would get in line to do it properly. That's a very simple solution here: You just change the incentive. Make it impossible for an illegal alien to come here for those 2 things.

Do you know what financial value there is to having free health care in America?

I'm not going to make you guess. From the employer market, we think the money should follow the patient, but broadly speaking, because I don't regulate commercial insurance, for illegal immigrants—for your family—it's worth about $30,000.

Well, I was going to say, for employers, I can say it's very accretive to insert yourself into the relationship with your employees. Employees will not leave one company. They'll pick the company they work for based on the health care, and they will not leave a company to pursue a better opportunity in order to keep their health care, which is dysfunctional because you want talent to move. That's a uniquely Silicon Valley, entrepreneurial way to look at it.

Yeah.

So this is a major issue for us in dealing with the immigration problem, because you cannot send 10 million people back legally who are here illegally. The president has said this publicly. It would take us 200 years of legal machinations to send back people who came here illegally. So there is no legal path to expelling people who came here illegally.

You have to remove the incentives to stay here: free housing, free food, and free healthcare. Of course, you're going to stay.

Show me an incentive; I'll show you the outcome. If you look at the war on drugs, how unsuccessful it's been, people go to San Francisco for a reason—for their fentanyl—because they can buy it and there's no policing. And it is exactly a function of more policing: the price of those drugs goes up, which means consumption goes down.

Not only is that dynamic missing in San Francisco because there's no enforcement and you can get fentanyl for $5 or $10 a hit, they also give you housing at $800 or something to that effect per month. So, the homeless industrial complex has now created an incentive, and everybody in that really tragic junkie community knows that. They leave Texas; they leave other states to go there, and then they bear the brunt of it, and they are actually increasing the suffering.

What's your take on these new super drugs versus the rescheduling of drugs? Obama wanted to do it in his second term. He didn't have the political willpower or will to do it. And Trump now is saying, “Hey, maybe for cannabis we should rethink that and do what Canada has done and other modern nations.” How do you look at those specific drugs? Fentanyl—9 or 12 overdoses a day in San Francisco at the peak—and methamphetamine?

We have good substance use disorder medications. We can't get people into the programs. This is why homelessness is an industrial complex. I know Mayor Suarez in Miami dropped the number by 90%. He did it just by making sure that you got arrested every time you peed publicly.

They don't put you in jail; they put you in rehab. But it takes 4, 5, or 6 efforts. You can't give people free showers, great accommodations, and lots of food, and then expect them to stop using drugs, because you're enabling that behavior and not expecting bad outcomes, which is what happened.

But I was in Kensington, Philadelphia, which is the drug capital of the East. And—

Oh, this is where they have that other super drug. I forgot the name of it. It's very pernicious. Tranq.

Yeah. Tranq is a terrible drug. It creates massive ulcers on your body.

So, I was there, and I just walked the streets and talked to people: “Why are you here? Where'd you come from? Why don't you go home?” I ran into a guy who had just saved someone's life by giving them Narcan through an inhaler. He's an ambulance driver.

I said, “Well, what happened?” He said, “Well, they OD'd. I gave it to them.” And I said, “What did they tell you? How did they thank you when they awakened from near death, from that dark abyss of darkness?” And he said, “They're almost always livid at me.”

Yeah, you ruined their high.

Well, no—you ruined their escape.

Oh, they're actually hoping to end this suffering.

The pain was so bad. That's why it seems nice. And that's why I was telling my friends in Minnesota: Minnesota Nice is great when you really, really mean it.

But nice does not mean allowing your public health system to be raped. It does not mean allowing people to abuse themselves and expecting a different outcome than what has historically happened.

If you really love people, you might not like them, but if you really love them, you'll do something that actually goes beyond liking them, that makes you ultimately gain respect—for them, for you, and for yourself.

There's a very simple test. If you were to take a Christian view of it and talk to any of the parents—these poor parents who are suffering with a child addicted to drugs, whose adult child is on the street—and you said to them, “We can arrest them and put them in jail. We can treat them incredibly severely and try to lock them up until they say, ‘Thank you. Please do that.’”

But there are a bunch of lunatics who think you're harassing a homeless person who had a bad beat and you're infringing on their freedom. The parents and the family would say, “Please lock them up. That's our last-ditch effort.” So, it's not compassion. It is not Christian at all.

That's a faculty-lounge discussion with your tweed jacket on. And your elbow protectors when you're pontificating about people that you read about, right?

I point that out because I'm on the faculty, you know. I've been—

You've got one of those tweed jackets?

Yeah. I got rid of my tweed jackets.

The elbow patches—they look terrible anyway.

But you know, you sit there and you act—and this is the crazy thing about intelligence: the more intelligent you are, the better you are at lying to yourself and to others around you, because you can construe almost any data into something that has a meaning that's not really there.

We have tolerated that for too long. I actually think that's an important part of President Trump's appeal. He cuts through all that BS. Don't tell me stuff that just defies common sense, because common sense is not so common. I think—

You don't have to accept it. I think that's the other thing that Trump has taught some folks: we do not have to accept that state of affairs. You don't have to accept the framing of it. Let's just call it what it is.

I've used the term here on our podcast and said “junkies” because I grew up in New York in the '70s and '80s, and that's what we called people who were addicted to smack: junkies. It's not derogatory. It's an indication of just how bad that disease is.

Calling it homelessness means you're trying to solve the wrong thing. Putting a junkie in a home—they have plenty of homes to go to. It has nothing to do with that.

All right. Well, look—

We've got to let Doc go. How long have we been talking? 2 hours.

I don't know, but I've got Dr. Oz with tips.

All right, let me—Dr. Oz.

Yeah, let me—can I—

Please?

All right. So, I just want—yeah, let me just wrap this up. Dr. Oz first reached out to me during the transition because he's so intensely interested in AI, and he—

This is when you were transitioning.

Yes. During my transition, you supported him.

I loved—I love David. Yes, we all did.

He was looking for names of AI experts in Silicon Valley to build his advisory panel, and he just impressed me right away with the energy that you bring, the knowledge, the passion. You really do care about improving health outcomes for all Americans, and I think we are very lucky to have you in this administration, from the president on down.

I think the country is very lucky to have you. You could be doing many, many different things, but you really care about this job, and I think it's really incredible what you're doing. Thank you for your service. I wanted to have you speak to us on the pod. It's kind of long overdue.

Well, you're very kind to have me on. I've enjoyed it. I'm a big fan, obviously, of your work, in part because you brought a sense of clarity to many of the issues you discussed.

And I want to thank you, David, first of all, for using your ability to get people together. The power to convene is remarkably effective, but you've also demystified a lot of this and allowed the administration to embrace AI and technology in general. So, God bless you.

Great. Thank you. Thanks for being here.