1 00:00:04,760 --> 00:00:08,080 Speaker 1: Welcome to the Bloomberg pm L podcast. I'm Pim Fox. 2 00:00:08,119 --> 00:00:11,200 Speaker 1: Along with my co host Lisa Abramowitz. Each day we 3 00:00:11,280 --> 00:00:14,480 Speaker 1: bring you the most important, noteworthy, and useful interviews for 4 00:00:14,520 --> 00:00:16,560 Speaker 1: you and your money, whether you're at the grocery store 5 00:00:16,800 --> 00:00:19,960 Speaker 1: or the trading floor. Find the Bloomberg p L podcast 6 00:00:20,000 --> 00:00:28,320 Speaker 1: on iTunes, SoundCloud and at Bloomberg dot com. Right now, 7 00:00:28,560 --> 00:00:31,240 Speaker 1: I want to bring in Dr Steve Miller, chief medical 8 00:00:31,360 --> 00:00:35,479 Speaker 1: officer and senior vice president at express script. It is 9 00:00:35,560 --> 00:00:37,839 Speaker 1: one of the largest companies in the country. It is 10 00:00:37,880 --> 00:00:41,239 Speaker 1: an American Fortune Fortune one hundred company, h the twentieth 11 00:00:41,360 --> 00:00:43,840 Speaker 1: largest in the US, and it is the largest pharmacy 12 00:00:43,920 --> 00:00:47,960 Speaker 1: benefit management organization in the United States. Dr Miller, I 13 00:00:48,000 --> 00:00:51,159 Speaker 1: want to start with drug pricing. We hear a lot 14 00:00:51,200 --> 00:00:54,120 Speaker 1: about you know that the price is too high? Uh 15 00:00:55,160 --> 00:00:56,520 Speaker 1: do you think do you agree? Do you think that 16 00:00:56,560 --> 00:00:59,120 Speaker 1: the cost of drugs in the US is too high? 17 00:00:59,200 --> 00:01:01,560 Speaker 1: Let's start there at least I definitely think they are. 18 00:01:01,840 --> 00:01:04,479 Speaker 1: Americans are actually should during their burdens for the rest 19 00:01:04,520 --> 00:01:06,680 Speaker 1: of the world. So we're four point six percent of 20 00:01:06,680 --> 00:01:10,560 Speaker 1: the world's population, We're thirty three of world drug spend. 21 00:01:10,600 --> 00:01:13,759 Speaker 1: We're somewhere between fifty and seventy percent of drug profits. 22 00:01:13,760 --> 00:01:16,440 Speaker 1: So we truly are funding all innovation for the rest 23 00:01:16,480 --> 00:01:19,600 Speaker 1: of the world, and they're actually freeloading on America. So 24 00:01:19,680 --> 00:01:22,360 Speaker 1: what could be done to actually bring prices down? So 25 00:01:22,560 --> 00:01:24,880 Speaker 1: you know, we've worked very hard, and there's certain things 26 00:01:24,880 --> 00:01:28,479 Speaker 1: that we can do every day, uh that, and that 27 00:01:28,640 --> 00:01:31,000 Speaker 1: patients can actually do every day. So, for instance, if 28 00:01:31,000 --> 00:01:33,920 Speaker 1: there's a generic available for a branded product, you should 29 00:01:33,920 --> 00:01:36,280 Speaker 1: be taking the generics. The FDA approves them under the 30 00:01:36,319 --> 00:01:39,360 Speaker 1: same process. They've been proven time and time again to 31 00:01:39,440 --> 00:01:42,360 Speaker 1: be equally effective. But there's also things we got to 32 00:01:42,360 --> 00:01:45,399 Speaker 1: do dramatically if we're going to continue that, and that 33 00:01:45,520 --> 00:01:48,640 Speaker 1: is we've got to make biosimilars available in this country. 34 00:01:49,120 --> 00:01:54,080 Speaker 1: So biosimilars are generic versions of the complex drugs for cancer, 35 00:01:54,160 --> 00:01:59,280 Speaker 1: rheumatoid arthritis, other diseases. American companies have been making these 36 00:01:59,320 --> 00:02:02,320 Speaker 1: drugs for Europeans. They've been taking advantage of them for 37 00:02:02,360 --> 00:02:05,680 Speaker 1: the last eight years. The discounts are somewhere between sixty 38 00:02:05,680 --> 00:02:09,560 Speaker 1: and sev yet they're unavailable in the United States and 39 00:02:09,600 --> 00:02:12,760 Speaker 1: that makes no sense. Dr Miller, You've been described as 40 00:02:12,760 --> 00:02:16,360 Speaker 1: a cost fighting ninja. You must there must be a 41 00:02:16,400 --> 00:02:19,760 Speaker 1: target on you from all of the pharmaceutical companies because 42 00:02:20,160 --> 00:02:23,040 Speaker 1: I want you to tell us about formularies and how 43 00:02:23,200 --> 00:02:25,360 Speaker 1: you arrive at the how do you go through the 44 00:02:25,400 --> 00:02:29,919 Speaker 1: process of determining which drugs are covered and how much 45 00:02:30,000 --> 00:02:33,120 Speaker 1: is paid, Because this is something that you're dealing with 46 00:02:33,200 --> 00:02:35,800 Speaker 1: by looking at your own data, not relying on the 47 00:02:35,880 --> 00:02:38,280 Speaker 1: data from let's say the drug companies or even from 48 00:02:38,280 --> 00:02:42,440 Speaker 1: healthcare providers. Yeah, so formularies are listed drugs, and that 49 00:02:42,520 --> 00:02:45,680 Speaker 1: list has to have any a drug to treat any 50 00:02:45,680 --> 00:02:48,920 Speaker 1: patient with any disease. It walks into a doctor and 51 00:02:49,000 --> 00:02:52,040 Speaker 1: so there's about twenty five thousand different products in the 52 00:02:52,120 --> 00:02:55,400 Speaker 1: United States, but it turns out that doctors need about 53 00:02:56,639 --> 00:02:59,160 Speaker 1: dred of them, and so it allows us to put 54 00:02:59,240 --> 00:03:02,000 Speaker 1: drug company against drug company to get better deals. So 55 00:03:02,040 --> 00:03:07,399 Speaker 1: the simplest example is there are six different statins like lipatore, zoe, 56 00:03:07,480 --> 00:03:11,120 Speaker 1: core crust or other things. What you do is you 57 00:03:11,200 --> 00:03:14,520 Speaker 1: say to the pharmaceutical manufacturers, I need a statun for 58 00:03:14,600 --> 00:03:18,000 Speaker 1: my patients. But the data shows that you're all equivalent 59 00:03:18,080 --> 00:03:21,440 Speaker 1: who will give us the best price, and so by 60 00:03:21,440 --> 00:03:24,480 Speaker 1: pitting them together, we can actually drive market share and 61 00:03:24,520 --> 00:03:28,320 Speaker 1: get lower prices. And so we have a process in 62 00:03:28,360 --> 00:03:33,520 Speaker 1: which our formularies are designed by external experts to express scripts, 63 00:03:33,600 --> 00:03:36,720 Speaker 1: no employees of express Scripts. The only thing they can 64 00:03:36,760 --> 00:03:41,040 Speaker 1: consider is clinical. They're not allowed to consider price. This way, 65 00:03:41,040 --> 00:03:43,880 Speaker 1: we can guarantee to our plans and our patients that 66 00:03:43,920 --> 00:03:46,600 Speaker 1: we've always put clinical first, that we always have the 67 00:03:46,680 --> 00:03:50,120 Speaker 1: right drugs available for them. But then we once we 68 00:03:50,200 --> 00:03:53,440 Speaker 1: have their parameters, can drive to the lowest net cost. So, 69 00:03:53,680 --> 00:03:57,040 Speaker 1: Dr Miller, how do you respond to, let's say a 70 00:03:57,040 --> 00:03:59,680 Speaker 1: pharmaceutical company that would say to you, by you're doing this, 71 00:04:00,240 --> 00:04:02,760 Speaker 1: you are reducing our R and D budget and you're 72 00:04:02,800 --> 00:04:06,760 Speaker 1: sort of inhibiting the production of new drugs. Yeah, so 73 00:04:06,920 --> 00:04:11,000 Speaker 1: I will tell you that the typical responses is that 74 00:04:11,080 --> 00:04:14,200 Speaker 1: you know what is we uh, there's nothing in the pipeline. 75 00:04:14,240 --> 00:04:17,760 Speaker 1: It turns out that because of American ingenuity, we have 76 00:04:17,839 --> 00:04:21,680 Speaker 1: over seven thousand products in clinical testing in the United 77 00:04:21,720 --> 00:04:24,240 Speaker 1: States right now, and that's the data according to the 78 00:04:24,240 --> 00:04:28,239 Speaker 1: pharmaceutical manufacturers. When you look at FDA approvals, two thousand 79 00:04:28,320 --> 00:04:31,200 Speaker 1: and fifteen was almost a record. You have to go 80 00:04:31,240 --> 00:04:34,320 Speaker 1: back twenty years to have that many drugs approved. So 81 00:04:34,360 --> 00:04:38,520 Speaker 1: we actually have a very vigorous drug pipeline. That's funded 82 00:04:38,560 --> 00:04:41,640 Speaker 1: by the ni H, it's funded by the pharmaceutical manufacturers, 83 00:04:41,920 --> 00:04:45,680 Speaker 1: it's funded by others. And so I'm not worried that 84 00:04:46,080 --> 00:04:48,680 Speaker 1: US trying to drive to the lowest cost. This is 85 00:04:48,680 --> 00:04:52,680 Speaker 1: still a four hundred billion dollar industry. There's plenty of 86 00:04:52,760 --> 00:04:55,800 Speaker 1: profitability there for the drug companies to do R and D. 87 00:04:56,880 --> 00:05:01,360 Speaker 1: The President has publicly come out against high drug prices. 88 00:05:01,400 --> 00:05:06,120 Speaker 1: He's singled out various pharmaceutical companies. What can the president 89 00:05:06,200 --> 00:05:10,120 Speaker 1: do without Congress? Can he do anything in order to 90 00:05:10,200 --> 00:05:14,359 Speaker 1: change drug pricing? Yeah? So we there are things that 91 00:05:14,640 --> 00:05:17,440 Speaker 1: require legislation, obviously, but there's a lot that can be 92 00:05:17,520 --> 00:05:21,839 Speaker 1: done by regulations. So the f d A, cms all 93 00:05:21,960 --> 00:05:25,800 Speaker 1: have really a lot of influence over drug pricing. So 94 00:05:25,839 --> 00:05:29,000 Speaker 1: I'll give you a couple examples. Right now, we have 95 00:05:29,120 --> 00:05:32,120 Speaker 1: a backlog of generic approvals that the f d A. 96 00:05:32,720 --> 00:05:36,560 Speaker 1: The FDA could obviously do things to accelerate those approvals. 97 00:05:36,600 --> 00:05:40,680 Speaker 1: Getting those generics out into the marketplace lowers drug prices. 98 00:05:40,720 --> 00:05:45,599 Speaker 1: We have these situations where we have only one generic 99 00:05:45,800 --> 00:05:48,800 Speaker 1: in the marketplace, they've been jacking up the price. You've 100 00:05:48,839 --> 00:05:52,479 Speaker 1: seen this with situations like Derra prim The FDA could 101 00:05:52,520 --> 00:05:57,279 Speaker 1: actually prioritize a competitor to uh DERA prim So don't 102 00:05:57,320 --> 00:06:00,560 Speaker 1: just accept the applications as they come in in but 103 00:06:00,640 --> 00:06:03,039 Speaker 1: when there's a shortage in the marketplace, put that at 104 00:06:03,080 --> 00:06:06,360 Speaker 1: the top priority list and get a competitor and faster. 105 00:06:06,560 --> 00:06:09,359 Speaker 1: So there are plenty of regulatory things that can be 106 00:06:09,360 --> 00:06:11,719 Speaker 1: done to bring down drugs. Thank you very much for 107 00:06:11,800 --> 00:06:14,600 Speaker 1: being with us. Dr Steve Miller is the Chief Medical 108 00:06:14,640 --> 00:06:18,880 Speaker 1: Officer Senior Vice president Express Scripts. Joining us here at 109 00:06:18,880 --> 00:06:22,960 Speaker 1: the National Medicare Advantage Summit taking place in Arlington, Virginia. 110 00:06:23,000 --> 00:06:39,320 Speaker 1: It is hosted by a Better Medicare Alliance. We are 111 00:06:39,320 --> 00:06:43,560 Speaker 1: broadcasting for the National Medicare Advantage Summit taking place in Arlington, Virginia, 112 00:06:43,720 --> 00:06:47,520 Speaker 1: right across the River Potomac from Washington, d C. And 113 00:06:47,560 --> 00:06:50,080 Speaker 1: here to tell us more about the healthcare system in 114 00:06:50,120 --> 00:06:52,920 Speaker 1: the United States is Tom Scully. He's a general partner 115 00:06:52,960 --> 00:06:56,360 Speaker 1: with Welsh, Carson, Anderson and Stow. He has also senior 116 00:06:56,400 --> 00:06:59,560 Speaker 1: counsel at Austin and Bird. But perhaps more importantly for 117 00:06:59,600 --> 00:07:02,320 Speaker 1: our conversation, he was the administrator of the Centers for 118 00:07:02,440 --> 00:07:09,760 Speaker 1: Medicare and Medicaid Services under President George W. Bush. And yes, 119 00:07:09,960 --> 00:07:14,680 Speaker 1: both both bushes, one push, one end push too. Um, 120 00:07:14,840 --> 00:07:18,160 Speaker 1: and you also really played a very important role in 121 00:07:18,320 --> 00:07:24,280 Speaker 1: helping to design Medicare Part D Medicare Advantage both. Right, um, so, 122 00:07:24,440 --> 00:07:26,440 Speaker 1: where do where do you? Where do you start when 123 00:07:26,520 --> 00:07:29,640 Speaker 1: you try to explain to people the current state, because 124 00:07:29,640 --> 00:07:33,200 Speaker 1: there's so many pieces to this, whether it's Medicare advantage, 125 00:07:33,200 --> 00:07:36,640 Speaker 1: whether it's supplemental, whether it's Medicare Medicaid. You say you're 126 00:07:36,680 --> 00:07:40,160 Speaker 1: on the board of a Medicaid insurance program here in 127 00:07:40,480 --> 00:07:43,640 Speaker 1: d C. How do you tease all this out so 128 00:07:43,760 --> 00:07:46,120 Speaker 1: that we can understand at least where we are and 129 00:07:46,440 --> 00:07:48,200 Speaker 1: what are some of the options to move forward to 130 00:07:48,240 --> 00:07:51,320 Speaker 1: make it better. Who would ever know healthcare was so complicated? 131 00:07:53,160 --> 00:07:57,920 Speaker 1: Well maybe maybe the best way the reason you were 132 00:07:58,000 --> 00:08:01,000 Speaker 1: you were the admit you would the administrator for the 133 00:08:01,120 --> 00:08:05,600 Speaker 1: Centers for Medicare and Medicaid Services. What does the c 134 00:08:06,120 --> 00:08:10,160 Speaker 1: m S. C MS is a giant agency in Baltimore, 135 00:08:10,200 --> 00:08:12,360 Speaker 1: which most people in Washington you know. It's in Baltimore, 136 00:08:12,600 --> 00:08:15,280 Speaker 1: and it runs Medicare and Medicaid and it also runs 137 00:08:15,320 --> 00:08:19,080 Speaker 1: the exchanges, the Obamacare exchanges, UH and a number of 138 00:08:19,120 --> 00:08:22,560 Speaker 1: other things. But it's um so you probably have seventy 139 00:08:22,600 --> 00:08:25,400 Speaker 1: seven million people. One of the four Americans roughly in 140 00:08:25,440 --> 00:08:29,520 Speaker 1: the Medicaid program, which is lower income you know, lower 141 00:08:29,520 --> 00:08:32,280 Speaker 1: income healthcare for women and kids, covers seventy the nursing 142 00:08:32,320 --> 00:08:35,560 Speaker 1: homes in the country, covers most the disabled mentally retarded 143 00:08:35,559 --> 00:08:38,240 Speaker 1: people in the country as far as mentally disabled UM 144 00:08:38,920 --> 00:08:43,240 Speaker 1: and Medicare is forty four million seniors and chronically disabled people. 145 00:08:43,280 --> 00:08:46,920 Speaker 1: So their giant programs. The combined budget for CMS with 146 00:08:47,120 --> 00:08:49,360 Speaker 1: between all of Medicare, Medicaid and the problems about one 147 00:08:49,400 --> 00:08:52,720 Speaker 1: point four trillion dollars a year, So it basically runs 148 00:08:53,679 --> 00:08:56,800 Speaker 1: about half the health care economy, and uh a lot 149 00:08:56,880 --> 00:08:58,480 Speaker 1: of it is on autopilot. So I would say n 150 00:08:59,280 --> 00:09:01,800 Speaker 1: of the you know, the these seven right people have 151 00:09:01,880 --> 00:09:04,520 Speaker 1: the job in less twenty years. Democrats Republicans were all friends, 152 00:09:04,600 --> 00:09:07,840 Speaker 1: and most of the job is running giant insurance plans 153 00:09:07,880 --> 00:09:09,839 Speaker 1: and making sure all these beneficiaries getting take care of. 154 00:09:10,120 --> 00:09:12,920 Speaker 1: And in certain periods of time, like with Obamacare or 155 00:09:12,960 --> 00:09:15,040 Speaker 1: in my case with the Party and Medicare advantage, they 156 00:09:15,080 --> 00:09:18,959 Speaker 1: get very legislative legislator in tense times, you spend time 157 00:09:19,120 --> 00:09:20,880 Speaker 1: changing the problem. So when I came in with Pushing 158 00:09:20,920 --> 00:09:24,080 Speaker 1: two thousand one, it was like called heck, I changed 159 00:09:24,120 --> 00:09:26,520 Speaker 1: the name. The CMS been a week after I got there. 160 00:09:26,880 --> 00:09:28,800 Speaker 1: You didn't want to work for HECA? No, you know 161 00:09:28,880 --> 00:09:33,000 Speaker 1: what a long story. I used to run the for 162 00:09:33,120 --> 00:09:35,319 Speaker 1: profit Hospital Association for eight c A and ten and 163 00:09:35,360 --> 00:09:37,640 Speaker 1: those guys back in the nineties, and I had a 164 00:09:37,679 --> 00:09:40,280 Speaker 1: lot of friends at HeLa. But there's a perception, fair unfair, 165 00:09:40,320 --> 00:09:42,600 Speaker 1: that there's a big slumbo and bureaucracy. So I told 166 00:09:42,640 --> 00:09:44,760 Speaker 1: my boss at the time, Tommy Toomp, said hey, let's 167 00:09:44,800 --> 00:09:47,120 Speaker 1: change the name. And there's nothing in the statute. So 168 00:09:47,200 --> 00:09:49,280 Speaker 1: we just sat around made up in her name. Well, 169 00:09:49,440 --> 00:09:50,959 Speaker 1: so you were talking about at one point for a 170 00:09:51,040 --> 00:09:54,640 Speaker 1: trillion dollar budget for all of these agencies, and you're 171 00:09:54,640 --> 00:09:57,280 Speaker 1: saying so on a pilot. Meanwhile, we're looking at budget 172 00:09:57,360 --> 00:09:59,559 Speaker 1: projections that are saying that the cost is going to 173 00:09:59,600 --> 00:10:03,640 Speaker 1: balloon as the population does age. Are there conversations that 174 00:10:03,679 --> 00:10:05,959 Speaker 1: are being had that you're involved with with the current 175 00:10:06,160 --> 00:10:11,959 Speaker 1: legislators for making feasible changes that would reduce costs over time? 176 00:10:12,960 --> 00:10:15,680 Speaker 1: And what the House bill? This is the biggest debate 177 00:10:15,720 --> 00:10:18,599 Speaker 1: in the country list you know three months is the 178 00:10:18,679 --> 00:10:22,120 Speaker 1: Paul Ryan House Bill didn't pass. So if you take Obamacare, 179 00:10:22,240 --> 00:10:24,160 Speaker 1: I'm not trying to criticize President Obama. I think he 180 00:10:24,240 --> 00:10:27,280 Speaker 1: was worthy effort to try to cover and of universal coverage. 181 00:10:27,840 --> 00:10:31,280 Speaker 1: But what happened under President Obama's healthcare plan is if 182 00:10:31,280 --> 00:10:33,600 Speaker 1: you look at before I kicked in two thousand twelve, 183 00:10:33,640 --> 00:10:36,160 Speaker 1: you had fifty five million people on the medicaid. Problem. 184 00:10:36,280 --> 00:10:38,520 Speaker 1: Between then and today, it's going from fifty five million 185 00:10:39,240 --> 00:10:42,080 Speaker 1: to seventy seven million, So two million people on Medicaid. 186 00:10:42,520 --> 00:10:44,080 Speaker 1: If you kept it going for the next ten years, 187 00:10:44,120 --> 00:10:47,080 Speaker 1: you go to ninety seven million. Current spending on Medicaid 188 00:10:47,200 --> 00:10:51,040 Speaker 1: now six hundred billion dollars a year, six hundred billion 189 00:10:51,080 --> 00:10:52,760 Speaker 1: dollars here, it's a big number already, a drums round. 190 00:10:52,760 --> 00:10:55,160 Speaker 1: It will be from six to nine hundred and fifty 191 00:10:55,280 --> 00:10:57,920 Speaker 1: billion over the next ten years. But isn't that more 192 00:10:58,080 --> 00:11:00,600 Speaker 1: of a commentary on sort of the fact that there 193 00:11:00,640 --> 00:11:03,520 Speaker 1: are people who are falling into poverty or falling into 194 00:11:03,559 --> 00:11:07,280 Speaker 1: a lower income bracket and help. No, you're President Obama did, 195 00:11:07,320 --> 00:11:09,960 Speaker 1: I'm not trying to be good pro con that bill 196 00:11:10,040 --> 00:11:14,640 Speaker 1: expanded the poverty coverage of Medicaid and mandated there was 197 00:11:14,640 --> 00:11:16,240 Speaker 1: gonna go to a hundred and thirty eight percent of 198 00:11:16,320 --> 00:11:18,600 Speaker 1: poverty in every state. The Supreme Court came out said 199 00:11:18,679 --> 00:11:20,880 Speaker 1: you can't force the states to do that. So thirty 200 00:11:20,920 --> 00:11:24,120 Speaker 1: one northern, largely democratic states took the hundred percent from 201 00:11:24,200 --> 00:11:27,920 Speaker 1: the money and expanded their problems massively, and nineteen largely southern, 202 00:11:28,440 --> 00:11:30,360 Speaker 1: more conservative states said we're not going to do it. 203 00:11:30,920 --> 00:11:32,679 Speaker 1: We don't want to have these giant new in talent problems, 204 00:11:32,720 --> 00:11:34,959 Speaker 1: and until nineteen of them skipped it. Okay. So the 205 00:11:35,040 --> 00:11:37,680 Speaker 1: real issue is what the Republicans have done. These are 206 00:11:37,760 --> 00:11:41,079 Speaker 1: big policy changes that effect have an enormous impact in 207 00:11:41,120 --> 00:11:44,120 Speaker 1: every American the economy. Republicans largely said we're gonna freeze 208 00:11:44,160 --> 00:11:46,520 Speaker 1: it where it is, So spending a Medicaid under what 209 00:11:46,600 --> 00:11:48,600 Speaker 1: Paul Ryan wanted to do would go from six hundred 210 00:11:48,640 --> 00:11:51,480 Speaker 1: billion this year to about seven d fifty billion, and 211 00:11:51,559 --> 00:11:53,240 Speaker 1: ten years if you left it on the cruise control 212 00:11:53,240 --> 00:11:55,720 Speaker 1: from Obamacare, we go from sillion to nine hundred billion. 213 00:11:56,880 --> 00:11:58,560 Speaker 1: The Republicans would freeze it where it is at about 214 00:11:58,559 --> 00:12:01,559 Speaker 1: seventies seven million people. Those are big policy issues. Do 215 00:12:01,559 --> 00:12:03,160 Speaker 1: you want to cover all those new people in those 216 00:12:03,200 --> 00:12:04,960 Speaker 1: other states? Do you want to you know, those are 217 00:12:05,080 --> 00:12:07,320 Speaker 1: you're talking about another twenty million people in the medicaid 218 00:12:07,320 --> 00:12:10,640 Speaker 1: problems that good or bad those are big, fundamental, gigantic 219 00:12:10,679 --> 00:12:13,240 Speaker 1: economic issues. So I have been to love to medicaid problem. 220 00:12:13,520 --> 00:12:16,920 Speaker 1: But every person, let's every person is paying taxes out 221 00:12:17,000 --> 00:12:19,400 Speaker 1: there listening to this, pays four thousand dollars per year. 222 00:12:19,600 --> 00:12:22,240 Speaker 1: You're not a Medicaid that is your tax contribution to 223 00:12:22,360 --> 00:12:25,880 Speaker 1: pay for Medicaid every year is four thousand dollars per taxpayer. 224 00:12:26,600 --> 00:12:28,240 Speaker 1: And you and all make a decision do you want 225 00:12:28,240 --> 00:12:30,040 Speaker 1: to cover all those people and have universal coverage. I 226 00:12:30,080 --> 00:12:32,559 Speaker 1: think it's the right thing to do. The Medicaid problems 227 00:12:32,679 --> 00:12:34,640 Speaker 1: of a mass I could you could spend hours explaining 228 00:12:34,640 --> 00:12:37,200 Speaker 1: to you how screwed up it is structurally, but it's 229 00:12:37,240 --> 00:12:38,760 Speaker 1: a wonderful problem. I happen to be a fan of 230 00:12:38,800 --> 00:12:40,800 Speaker 1: usual coverage. But how much do you want to spend where? 231 00:12:40,960 --> 00:12:43,520 Speaker 1: These are the single biggest issues in the government. Medicare 232 00:12:43,559 --> 00:12:46,680 Speaker 1: and Medicaid are the biggest problems in the governments security, 233 00:12:46,760 --> 00:12:49,720 Speaker 1: and they drive all your taxpayer spending. And these policy 234 00:12:49,720 --> 00:12:51,520 Speaker 1: issues about who you want to cover where and whose 235 00:12:51,559 --> 00:12:54,559 Speaker 1: air subsidies and who should get subsidies are massive and 236 00:12:54,600 --> 00:12:57,800 Speaker 1: they're important to people. And I know they're incredibly complicated. 237 00:12:57,880 --> 00:13:01,080 Speaker 1: Who health is so complicated, but they are the budget 238 00:13:01,240 --> 00:13:03,320 Speaker 1: and they are the governments that this is the future 239 00:13:03,360 --> 00:13:06,679 Speaker 1: of government policy. Is there a model or is there 240 00:13:06,720 --> 00:13:10,199 Speaker 1: another country that is doing something that we can learn from. 241 00:13:10,280 --> 00:13:11,839 Speaker 1: If you were given a clean I mean you're not 242 00:13:11,920 --> 00:13:13,679 Speaker 1: going to ever get a clean slate, there is no 243 00:13:13,800 --> 00:13:16,199 Speaker 1: clean slate. But if you were to be given, you know, 244 00:13:16,360 --> 00:13:18,440 Speaker 1: half a clean slate, what would you do? What would 245 00:13:18,480 --> 00:13:20,320 Speaker 1: you say? You can't? And I've been doing this forever, 246 00:13:20,400 --> 00:13:22,559 Speaker 1: and I think things changing incrementally, and I look at 247 00:13:22,880 --> 00:13:25,040 Speaker 1: I was not a big fan of Obamacare structurally, I 248 00:13:25,040 --> 00:13:26,240 Speaker 1: think he's trying to do the right thing. If you 249 00:13:26,280 --> 00:13:29,760 Speaker 1: look at President Obama's package, and I've said this publicly 250 00:13:29,800 --> 00:13:31,199 Speaker 1: a lot, it looks a hell of a lot like 251 00:13:31,280 --> 00:13:33,920 Speaker 1: that George H. W. Bush Plan that I helped design 252 00:13:34,040 --> 00:13:37,160 Speaker 1: nineteen ninety with a lot more money. So what they 253 00:13:37,200 --> 00:13:39,240 Speaker 1: were trying to do, the unerfual covers was worthy in 254 00:13:39,280 --> 00:13:41,120 Speaker 1: a in a rational goal. I think they ever did 255 00:13:41,160 --> 00:13:43,679 Speaker 1: it went too far and and and and put too 256 00:13:43,760 --> 00:13:45,679 Speaker 1: much on the structure. But they were trying to do 257 00:13:45,760 --> 00:13:47,040 Speaker 1: the right thing. And I think when you look at 258 00:13:47,080 --> 00:13:48,640 Speaker 1: the Republicans are trying to do, they're actually trying to 259 00:13:48,679 --> 00:13:52,160 Speaker 1: scale back what President Obama did. So whatever happens, the 260 00:13:52,200 --> 00:13:54,000 Speaker 1: problems are going to get bigger. It's a matter of 261 00:13:54,040 --> 00:13:56,360 Speaker 1: how much bigger. And even on the Republican bills, Medicare 262 00:13:56,400 --> 00:13:58,920 Speaker 1: and Medicator and grow dramatically. The issue is are they 263 00:13:59,000 --> 00:14:02,400 Speaker 1: gonna grow really fair star less fast so you can't 264 00:14:02,400 --> 00:14:04,920 Speaker 1: really change it. Did the Dutch have a pretty good system? Yes, 265 00:14:05,120 --> 00:14:06,719 Speaker 1: the Germans I think a pretty good system. They have 266 00:14:06,800 --> 00:14:08,559 Speaker 1: kind of neighborhood based systems. But you have to go 267 00:14:08,640 --> 00:14:11,320 Speaker 1: back to and blow the whole thing up and start 268 00:14:11,360 --> 00:14:13,760 Speaker 1: from the scratch. We have an incredibly complicated web of 269 00:14:14,400 --> 00:14:17,120 Speaker 1: multiple problems the cover people, and you really have no 270 00:14:17,240 --> 00:14:19,560 Speaker 1: choice but to build on it. Tom Scully, thank you 271 00:14:19,600 --> 00:14:21,960 Speaker 1: so much for joining us. Truly a fascinating to hear 272 00:14:21,960 --> 00:14:25,800 Speaker 1: your thoughts. Tom Scully was the head of CMS under 273 00:14:25,960 --> 00:14:29,760 Speaker 1: both President George one. Okay, you were in the White House, 274 00:14:30,600 --> 00:14:32,480 Speaker 1: but you've been making healthcare policy and you did a 275 00:14:32,640 --> 00:14:35,840 Speaker 1: Medicare party and you also did Medicare advantage, and we 276 00:14:36,000 --> 00:14:40,040 Speaker 1: really appreciate you being with He looks incredibly healthy. Like 277 00:14:40,080 --> 00:14:44,240 Speaker 1: about nine seven, Tom Scully general partner at Wells, Carson 278 00:14:44,320 --> 00:14:47,880 Speaker 1: Anderson and still also Senior council at Austin and bird 279 00:14:48,120 --> 00:14:50,760 Speaker 1: l LP. We are here broadcasting live at the National 280 00:14:50,840 --> 00:14:54,800 Speaker 1: Medicare Advantage Summit in Arlington, Virginia. It is hosted by 281 00:14:54,920 --> 00:15:12,040 Speaker 1: the Better Medicare Alliance. This is Bloomberg. We are live 282 00:15:12,120 --> 00:15:15,600 Speaker 1: at the National Medicare Advantage Summit in Arlington, Virginia, and 283 00:15:15,680 --> 00:15:18,600 Speaker 1: we are so lucky to have Dr Kvita Patel here 284 00:15:18,640 --> 00:15:21,200 Speaker 1: with us. She is a nonresident Senior Fellow at Brookings 285 00:15:21,280 --> 00:15:24,880 Speaker 1: Institute and a former advisor to the Obama White House. 286 00:15:25,200 --> 00:15:29,520 Speaker 1: She worked on the Affordable Care Act. Uh So, Dr Ptel, 287 00:15:29,600 --> 00:15:33,560 Speaker 1: you really have a clear insight into what's going on 288 00:15:33,880 --> 00:15:36,760 Speaker 1: right now? What should we pay attention to. What's the 289 00:15:36,840 --> 00:15:40,280 Speaker 1: most realistic change that could happen in short order to 290 00:15:40,840 --> 00:15:43,600 Speaker 1: the a c A Affordable Care Act. So I still 291 00:15:43,680 --> 00:15:45,880 Speaker 1: think the most realistic change is going to be no 292 00:15:46,120 --> 00:15:48,840 Speaker 1: change that we're not going to see a repeal or 293 00:15:49,080 --> 00:15:52,120 Speaker 1: something that kind of completely rips out the Affordable Care Act. 294 00:15:52,240 --> 00:15:55,040 Speaker 1: There's still a lot of discussions going on, but the 295 00:15:55,120 --> 00:15:57,600 Speaker 1: bottom line is the votes are not there right now. 296 00:15:58,280 --> 00:16:00,760 Speaker 1: Dr Ptel, maybe you could just disc ride to people 297 00:16:00,880 --> 00:16:05,720 Speaker 1: how Medicare advantage works in the health care system and 298 00:16:06,200 --> 00:16:09,800 Speaker 1: how this partnership between the public system, which is of 299 00:16:09,880 --> 00:16:13,840 Speaker 1: course Medicare UH and private insurance. How does that come 300 00:16:13,880 --> 00:16:16,600 Speaker 1: together and how does they How did that present a 301 00:16:16,760 --> 00:16:19,440 Speaker 1: challenge because most people look at this situation they go, boy, 302 00:16:20,160 --> 00:16:23,080 Speaker 1: it can't get any more complicated, right, right, So the 303 00:16:23,200 --> 00:16:27,400 Speaker 1: Medicare Advantage Program really started as a way to expand 304 00:16:27,640 --> 00:16:31,440 Speaker 1: kind of what we would call private sector choices in 305 00:16:31,600 --> 00:16:36,120 Speaker 1: insurance for Medicare beneficiaries. And that was actually done during 306 00:16:36,400 --> 00:16:41,400 Speaker 1: a Republican administration previously, the actual George H. W. Bush administration, 307 00:16:41,920 --> 00:16:44,680 Speaker 1: and that failed a little bit in its first attempt, 308 00:16:44,960 --> 00:16:46,560 Speaker 1: and then there was a little bit of a reboot 309 00:16:46,760 --> 00:16:49,800 Speaker 1: in the in the George W. Bush administration, where we 310 00:16:49,880 --> 00:16:52,000 Speaker 1: then got what we have today, which is the Medicare 311 00:16:52,000 --> 00:16:56,480 Speaker 1: Advantage Program. And basically of people in Medicare are in 312 00:16:57,080 --> 00:17:02,200 Speaker 1: private plans, which are Medicare Advance Plans, which are basically 313 00:17:02,440 --> 00:17:05,520 Speaker 1: confusing because and what if you have a family member 314 00:17:05,600 --> 00:17:07,520 Speaker 1: like I do they just get a bunch of brochures 315 00:17:07,680 --> 00:17:10,760 Speaker 1: like around October and they have all these choices, And 316 00:17:10,920 --> 00:17:14,720 Speaker 1: that's what you're referencing. But where we've gotten now is actually, 317 00:17:14,840 --> 00:17:18,320 Speaker 1: in about five years, more than half of the Medicare 318 00:17:18,400 --> 00:17:21,600 Speaker 1: beneficiaries are going to be in these Medicare advantage or 319 00:17:21,960 --> 00:17:27,400 Speaker 1: private commercial insurance plans in Medicare, then the traditional fee 320 00:17:27,480 --> 00:17:33,119 Speaker 1: for service a million people currently in Medicare correct about 321 00:17:33,160 --> 00:17:37,040 Speaker 1: fifty five to sixty million in the Medicare program. That 322 00:17:37,240 --> 00:17:39,760 Speaker 1: number is going to grow in the next five years. 323 00:17:40,119 --> 00:17:43,639 Speaker 1: But then half of the people in this program in 324 00:17:43,800 --> 00:17:47,800 Speaker 1: Medicare will be in the Medicare advantage program. How does 325 00:17:48,119 --> 00:17:52,960 Speaker 1: Medicare advantage and partnering private health insurance companies with public 326 00:17:53,040 --> 00:17:57,080 Speaker 1: ones reduce costs? So the way it reduces cost is 327 00:17:57,320 --> 00:18:00,520 Speaker 1: basically by what what the government does is it actually 328 00:18:00,600 --> 00:18:03,399 Speaker 1: pays the private insurance plan kind of a lump some 329 00:18:03,520 --> 00:18:07,119 Speaker 1: amount to take care of basically everything. Right now, at 330 00:18:07,160 --> 00:18:11,399 Speaker 1: traditional Medicare, there's hospital costs, physician costs, drug costs, and 331 00:18:11,440 --> 00:18:13,920 Speaker 1: it's all pays out of separate pockets and pieces of 332 00:18:14,040 --> 00:18:18,040 Speaker 1: the government. Pie Medicare advantage, the government pays one lump 333 00:18:18,160 --> 00:18:20,800 Speaker 1: sum to the private plan and says you take care 334 00:18:20,840 --> 00:18:23,399 Speaker 1: of everything, no matter how much it costs. And if 335 00:18:23,480 --> 00:18:26,760 Speaker 1: someone doesn't necessarily need all that money, then the plan 336 00:18:27,119 --> 00:18:30,000 Speaker 1: keeps that extra money. And what the plans will do 337 00:18:30,359 --> 00:18:32,879 Speaker 1: in a way to save money. Is they will do 338 00:18:33,040 --> 00:18:35,920 Speaker 1: really aggressive things like send a nurse out to a 339 00:18:36,000 --> 00:18:40,119 Speaker 1: patient's home to do an in home assessment and not 340 00:18:40,320 --> 00:18:42,800 Speaker 1: ever have to even see the doctor to establish kind 341 00:18:42,800 --> 00:18:45,240 Speaker 1: of what that patient needs, all in an attempt to 342 00:18:45,359 --> 00:18:49,000 Speaker 1: create a more efficient system. Okay, so talking about private 343 00:18:49,119 --> 00:18:51,399 Speaker 1: health insurers brings me back to A C A and 344 00:18:51,880 --> 00:18:55,520 Speaker 1: the path forward. The latest plan that was unveiled today 345 00:18:55,720 --> 00:18:59,439 Speaker 1: by an Alabama Republican congressman shows that there is an 346 00:18:59,480 --> 00:19:03,200 Speaker 1: attempt to try to pull out high risk pools or 347 00:19:03,240 --> 00:19:06,280 Speaker 1: sort of group people by how risky they are they 348 00:19:06,320 --> 00:19:09,040 Speaker 1: are and their pre existing conditions. Can you speak to 349 00:19:09,119 --> 00:19:11,280 Speaker 1: that and how effective that could be? Yeah? So you 350 00:19:11,359 --> 00:19:13,560 Speaker 1: remember the criticism of the American Health Care Act is 351 00:19:13,600 --> 00:19:16,160 Speaker 1: that potentially the older or sicker you are, you're gonna 352 00:19:16,160 --> 00:19:19,080 Speaker 1: have to pay potentially a thousand percent more than you 353 00:19:19,160 --> 00:19:21,960 Speaker 1: would today under the Affordable Care Act. So what's being 354 00:19:22,040 --> 00:19:26,440 Speaker 1: introduced now is ways to actually deal with sicker patients 355 00:19:26,480 --> 00:19:29,679 Speaker 1: who are older and to try to acknowledge that they 356 00:19:29,800 --> 00:19:34,240 Speaker 1: need something different than just regular old Medicare insurance. So 357 00:19:34,480 --> 00:19:37,240 Speaker 1: what you're seeing proposed um not just for Medicare but 358 00:19:37,400 --> 00:19:40,720 Speaker 1: for actually any age are these high risk pools that 359 00:19:40,960 --> 00:19:43,600 Speaker 1: take people out based on the numbers of kind of 360 00:19:44,000 --> 00:19:47,040 Speaker 1: you know, numbers of diseases that they have, or how 361 00:19:47,200 --> 00:19:50,000 Speaker 1: sick they are, based on how much money they're using 362 00:19:50,160 --> 00:19:53,879 Speaker 1: in the system, or potentially pre existing conditions, and then 363 00:19:53,960 --> 00:19:56,920 Speaker 1: charge them more. And then well if one charges them more, 364 00:19:57,119 --> 00:20:00,280 Speaker 1: but then it also puts them in a different cool 365 00:20:00,400 --> 00:20:04,080 Speaker 1: almost like medicare advantage, where it's a private insurance system 366 00:20:04,560 --> 00:20:06,840 Speaker 1: that then has to take care of them for a 367 00:20:06,920 --> 00:20:09,520 Speaker 1: dedicated amount of money. But I don't understand this works 368 00:20:09,680 --> 00:20:12,040 Speaker 1: why any insurance company would agree to take them on. 369 00:20:12,240 --> 00:20:15,040 Speaker 1: So it's yes, that's a good question. Will anyone actually 370 00:20:15,080 --> 00:20:18,040 Speaker 1: take on the sickest people in a population? If you 371 00:20:18,119 --> 00:20:20,800 Speaker 1: pay enough money, somebody will. But who's gonna put that? 372 00:20:20,880 --> 00:20:22,919 Speaker 1: This gonna put the government is so at the end 373 00:20:22,960 --> 00:20:25,800 Speaker 1: of the day, you have mentioned I obviously am a 374 00:20:25,880 --> 00:20:27,879 Speaker 1: fan of the Affordable Care Act, even with its warts 375 00:20:27,920 --> 00:20:30,720 Speaker 1: and flaws. At the end of the day, somebody has 376 00:20:30,800 --> 00:20:33,640 Speaker 1: to foot the bill. We can't skirt or get around 377 00:20:33,720 --> 00:20:36,480 Speaker 1: the fact that as a society we have to pay 378 00:20:36,560 --> 00:20:39,320 Speaker 1: for healthcare as a society, including people who are really 379 00:20:39,359 --> 00:20:42,080 Speaker 1: sick and including people who are super healthy. And that's 380 00:20:42,080 --> 00:20:44,960 Speaker 1: the bottom line. I want your thoughts on prescription drug 381 00:20:45,119 --> 00:20:49,840 Speaker 1: prices and the insurance plans around those, because the president 382 00:20:50,000 --> 00:20:53,160 Speaker 1: has the President Donald Trump has come out via tweets, 383 00:20:53,320 --> 00:20:59,159 Speaker 1: via verbal uh rhetoric, he's saying drug prices are too high. Correct. 384 00:20:59,359 --> 00:21:03,320 Speaker 1: So the emphasis on drug pricing is very interesting for 385 00:21:03,600 --> 00:21:07,080 Speaker 1: a Republican administration, and it's largely, as you mentioned, because 386 00:21:07,080 --> 00:21:11,320 Speaker 1: of President Trump's quotes. Translating that into something that will 387 00:21:11,440 --> 00:21:14,639 Speaker 1: change the way all of us receive our prescription drugs 388 00:21:15,200 --> 00:21:18,760 Speaker 1: is very hard to do. However, that's something if you 389 00:21:18,920 --> 00:21:21,879 Speaker 1: listen to all the people who work under President Trump, 390 00:21:21,920 --> 00:21:24,280 Speaker 1: they've said that this is one of the top priorities 391 00:21:24,359 --> 00:21:27,320 Speaker 1: for the White House. The way prescription drug plans work 392 00:21:27,440 --> 00:21:30,240 Speaker 1: right now, most of us in America don't even realize it. 393 00:21:30,480 --> 00:21:33,840 Speaker 1: It's a third party that deals with the way your 394 00:21:33,920 --> 00:21:38,159 Speaker 1: drugs are paid for, and those are called prescription benefit plans. 395 00:21:38,320 --> 00:21:43,080 Speaker 1: And so there's a whole different entity and industry outside 396 00:21:43,080 --> 00:21:45,720 Speaker 1: of your insurance card that actually deals with all of this. 397 00:21:46,040 --> 00:21:49,200 Speaker 1: And that's why it's complicated and I am not likely 398 00:21:49,240 --> 00:21:51,280 Speaker 1: to see a change happen soon. Well, I want to 399 00:21:51,320 --> 00:21:53,080 Speaker 1: thank you for helping us understand that at least a 400 00:21:53,119 --> 00:21:57,680 Speaker 1: little bit. Dr Kvita Patel, Nonresident Senior Fellow, Brookings Institution. 401 00:22:10,000 --> 00:22:13,080 Speaker 1: We are broadcasting at the National Medicare Advantage Summit taking 402 00:22:13,080 --> 00:22:17,439 Speaker 1: place in Arlington, Virginia, is hosted by Better Medicare Alliance. 403 00:22:17,960 --> 00:22:20,840 Speaker 1: And to turn our attention now to politics and America's 404 00:22:21,200 --> 00:22:24,320 Speaker 1: relationship with China, I want to bring in Brendan A. Hearn. 405 00:22:24,400 --> 00:22:27,480 Speaker 1: He is the chief investment officer of Crane Shares and 406 00:22:27,840 --> 00:22:31,399 Speaker 1: Brendan of course, we're all wondering about the Chinese President 407 00:22:31,480 --> 00:22:35,840 Speaker 1: Jijing Ping's visit to UH President Donald Trump's mar Alago 408 00:22:36,040 --> 00:22:39,320 Speaker 1: Club in Florida. What do you think the most pressing 409 00:22:39,440 --> 00:22:42,880 Speaker 1: topic their meeting will be. It's going to be North 410 00:22:42,960 --> 00:22:46,280 Speaker 1: Korea him. It's an area of mutual interest in an 411 00:22:46,359 --> 00:22:49,960 Speaker 1: area where there's potential a lot of potential collaboration and 412 00:22:50,040 --> 00:22:53,560 Speaker 1: coming up with a solution that is certainly a factor 413 00:22:53,680 --> 00:22:58,240 Speaker 1: for both countries. Well, so North Korea is definitely even 414 00:22:58,320 --> 00:23:01,760 Speaker 1: more on people's minds just because of the recent missile tests. 415 00:23:02,480 --> 00:23:06,439 Speaker 1: But don't both sides have a reason to not say anything. 416 00:23:06,560 --> 00:23:08,320 Speaker 1: I mean, it's the best case scenario that neither of 417 00:23:08,359 --> 00:23:10,280 Speaker 1: them say anything and they make nice and then they 418 00:23:10,520 --> 00:23:13,119 Speaker 1: have a nice photo up with each other. I agree 419 00:23:13,160 --> 00:23:15,280 Speaker 1: at Lisa. I think ultimately you want to get the 420 00:23:15,400 --> 00:23:18,800 Speaker 1: dialogue going between you know, the first and second largest 421 00:23:19,119 --> 00:23:21,840 Speaker 1: world economies leaders talking with one another, and hopefully that 422 00:23:21,920 --> 00:23:25,720 Speaker 1: sets a path for more communication um in the years 423 00:23:25,760 --> 00:23:28,960 Speaker 1: to come. You know, Brendan, one of the issues has 424 00:23:29,040 --> 00:23:33,720 Speaker 1: been Chinese acquisitions of what are considered to be essential assets. 425 00:23:34,040 --> 00:23:37,840 Speaker 1: For example, Chinese companies attempts to purchase oil companies in 426 00:23:37,880 --> 00:23:40,600 Speaker 1: the United States that was thwarted. Do you think that 427 00:23:40,680 --> 00:23:43,520 Speaker 1: there is going to be talk about the Westinghouse Toshiba 428 00:23:43,640 --> 00:23:48,560 Speaker 1: unit that is up for sale that is facing financial problems. 429 00:23:48,680 --> 00:23:52,119 Speaker 1: Good question. I believe the this is an opportunity for 430 00:23:52,200 --> 00:23:56,320 Speaker 1: President g to show Trump and and really the United 431 00:23:56,359 --> 00:23:59,920 Speaker 1: States in general about how much business China is doing 432 00:24:00,119 --> 00:24:04,160 Speaker 1: here in the US. Last year, three million tourists, three 433 00:24:04,240 --> 00:24:08,480 Speaker 1: hundred thousand Chinese students studying. China is the second larger 434 00:24:08,760 --> 00:24:12,240 Speaker 1: buyer of agricultural products, and there's US companies doing well 435 00:24:12,280 --> 00:24:14,800 Speaker 1: in China. I think this gives China opportunities to show 436 00:24:14,960 --> 00:24:17,919 Speaker 1: how they can be a good business partner. And yes, 437 00:24:18,040 --> 00:24:22,239 Speaker 1: there are sensitive sectors, you know, technology being one of them, 438 00:24:22,480 --> 00:24:26,040 Speaker 1: nuclear energy. Well, what we're talking about with Westinghouse nuclear 439 00:24:26,160 --> 00:24:31,520 Speaker 1: energy well, and China has a pollution issue. UM nuclear 440 00:24:31,720 --> 00:24:34,160 Speaker 1: is going to be is currently one of those solutions, 441 00:24:34,240 --> 00:24:38,600 Speaker 1: along with hydro wind and solar bringing Westinghouse technology to China. 442 00:24:38,800 --> 00:24:40,960 Speaker 1: They're gonna build you know, it's upwards of two dozen 443 00:24:41,240 --> 00:24:44,600 Speaker 1: nuclear plants in the years to come. And why wouldn't 444 00:24:44,640 --> 00:24:46,879 Speaker 1: that be a good thing for Westinghouse to have a 445 00:24:47,040 --> 00:24:51,000 Speaker 1: Chinese ownership, either partial or full Brennan. I imagine that 446 00:24:51,240 --> 00:24:53,160 Speaker 1: one thing that will be brought up is the trade 447 00:24:53,200 --> 00:24:56,280 Speaker 1: deficit that the US has with China. President Trump has 448 00:24:56,320 --> 00:24:59,480 Speaker 1: talked extensively about it. He has lamented how big it is, 449 00:24:59,520 --> 00:25:02,119 Speaker 1: even though it has contracted over the years. What do 450 00:25:02,200 --> 00:25:04,399 Speaker 1: you expect to come out of this particular meeting with 451 00:25:04,480 --> 00:25:07,560 Speaker 1: respect to the trade deficit. I think it sets a 452 00:25:08,119 --> 00:25:12,080 Speaker 1: this dialogue and communication going forward. I believe that you 453 00:25:12,240 --> 00:25:16,280 Speaker 1: have a little bit of a team of rivalries within 454 00:25:16,480 --> 00:25:21,120 Speaker 1: the Trump administration where you've got say, Jared Kushner, Gary Cohen, Manuchin, 455 00:25:21,200 --> 00:25:24,160 Speaker 1: and Male Pass on one side, uh more of say 456 00:25:24,200 --> 00:25:27,359 Speaker 1: the globalist trade proponents, and on the other side you 457 00:25:27,440 --> 00:25:31,080 Speaker 1: have a Steve Banion, Wilbert Ross, Peter Navarro, and so 458 00:25:31,280 --> 00:25:34,080 Speaker 1: I believe you have a little bit of, uh, the 459 00:25:34,160 --> 00:25:37,080 Speaker 1: administration finding its way between these two camps that have 460 00:25:37,200 --> 00:25:40,000 Speaker 1: divergent views. Well, hold on a second. It's really interesting 461 00:25:40,080 --> 00:25:42,920 Speaker 1: that you mentioned that because Steve Bannon, as you know, 462 00:25:43,280 --> 00:25:47,000 Speaker 1: was just removed from the National Security Council. Do you 463 00:25:47,080 --> 00:25:50,520 Speaker 1: think that that's going to affect this conversation that President 464 00:25:50,560 --> 00:25:54,399 Speaker 1: Trump has with President Jejim ping and possibly ease the 465 00:25:54,480 --> 00:25:57,639 Speaker 1: negotiations over some kind of trade contract. I think behind 466 00:25:57,720 --> 00:26:01,280 Speaker 1: the scenes that the hand, the visible hand of Henry 467 00:26:01,560 --> 00:26:05,880 Speaker 1: Kissinger is at play. Uh. He visited China in December 468 00:26:06,000 --> 00:26:08,960 Speaker 1: to help arrange this meeting. He's been meeting with the 469 00:26:09,040 --> 00:26:12,680 Speaker 1: administration to help them prep for this meeting. And and 470 00:26:12,800 --> 00:26:14,720 Speaker 1: so certainly I think you're going to see a more 471 00:26:14,880 --> 00:26:18,360 Speaker 1: balanced view potentially. I mean, time is gonna tell um 472 00:26:18,960 --> 00:26:23,119 Speaker 1: in in this course of dialogue. Now, Brendan Crane Shares 473 00:26:23,680 --> 00:26:27,159 Speaker 1: has a variety of exchange traded funds designed for a 474 00:26:27,320 --> 00:26:31,920 Speaker 1: Chinese investments. Is the Chinese you want? Is it currently 475 00:26:32,040 --> 00:26:35,359 Speaker 1: in your mind overvalued or undervalued versus the US dollar? 476 00:26:36,560 --> 00:26:38,800 Speaker 1: That's a good question, PIM. I mean, I think ultimately 477 00:26:39,119 --> 00:26:44,600 Speaker 1: interest rate differentials helped drive currencies China has slowly slightly 478 00:26:44,920 --> 00:26:47,520 Speaker 1: started the titan not the official interest rates. So so 479 00:26:47,640 --> 00:26:52,040 Speaker 1: I don't think China meets the Treasury departments uh definition 480 00:26:52,080 --> 00:26:54,840 Speaker 1: of a currency manipulator. Um. But I think if we 481 00:26:54,920 --> 00:26:59,360 Speaker 1: were in euro, yen or pound, you might say it's undervalued. Yeah, 482 00:26:59,400 --> 00:27:01,840 Speaker 1: this is going to be something that that could come 483 00:27:01,920 --> 00:27:05,400 Speaker 1: up because President Trump has said that, uh, that China 484 00:27:05,560 --> 00:27:07,680 Speaker 1: is manipulating its currency. And yet you know, you do 485 00:27:07,880 --> 00:27:10,119 Speaker 1: wonder if there was some kind of removal of some 486 00:27:10,240 --> 00:27:13,800 Speaker 1: kind of state control, the direction probably would be down 487 00:27:14,200 --> 00:27:17,720 Speaker 1: not up right. It probably would de appreciate. Beginning in 488 00:27:19,560 --> 00:27:23,000 Speaker 1: China cut the official interest rates, the FED moves to 489 00:27:23,040 --> 00:27:27,680 Speaker 1: a tightening bias the the yuan depreciates versus the dollar. 490 00:27:28,160 --> 00:27:31,040 Speaker 1: China is slowly starting to tighten up a little bit 491 00:27:31,400 --> 00:27:34,480 Speaker 1: in advance of a big political turnover at the end 492 00:27:34,520 --> 00:27:36,760 Speaker 1: of this year. This is the year of stability for 493 00:27:36,880 --> 00:27:42,280 Speaker 1: China economically, in advance of the political and leadership changes coming. Brendon, 494 00:27:42,359 --> 00:27:44,280 Speaker 1: before we, you know, sort of look at China as 495 00:27:44,320 --> 00:27:48,080 Speaker 1: a monolithic entity. Is it worth noting that they have 496 00:27:48,200 --> 00:27:52,639 Speaker 1: their own problems such as bad loans, and is it 497 00:27:52,800 --> 00:27:57,159 Speaker 1: possible that we are underestimating the issues that face the 498 00:27:57,280 --> 00:28:00,320 Speaker 1: Chinese leadership. It's not just all about the United States. Oh, 499 00:28:00,480 --> 00:28:03,720 Speaker 1: I agree, there's a domestic agenda that's been set, you know. 500 00:28:04,280 --> 00:28:06,400 Speaker 1: You know, if you one looks at the thirteen five 501 00:28:06,480 --> 00:28:10,560 Speaker 1: year Plan, the um Chinese government is very explicit and 502 00:28:10,760 --> 00:28:13,240 Speaker 1: where they want to drive not only their economy but 503 00:28:13,320 --> 00:28:16,760 Speaker 1: the society. And there there are liabilities on the balance sheet. 504 00:28:16,840 --> 00:28:19,520 Speaker 1: At the same time there's assets. And I think you 505 00:28:19,600 --> 00:28:21,760 Speaker 1: bring up a great point. China is a big country, 506 00:28:21,840 --> 00:28:24,480 Speaker 1: just not geographically, but the economy and parts of China 507 00:28:24,560 --> 00:28:27,840 Speaker 1: is doing very well right now. Domestic consumption parts of 508 00:28:27,960 --> 00:28:33,639 Speaker 1: China geared to more traditional um steal aluminum coal, you know, 509 00:28:33,840 --> 00:28:35,640 Speaker 1: a little bit of of of a tougher roach. You've 510 00:28:35,640 --> 00:28:39,360 Speaker 1: got this barbelled economy right now. So for President Jijmping, 511 00:28:39,600 --> 00:28:42,640 Speaker 1: it's an election gear. He wants to send a message 512 00:28:42,680 --> 00:28:45,840 Speaker 1: to his constituents back home. What's the best case scenario 513 00:28:46,240 --> 00:28:49,480 Speaker 1: that could emerge from this meeting for that purpose. I 514 00:28:49,560 --> 00:28:52,960 Speaker 1: think ultimately this is a sign of respect of face 515 00:28:53,480 --> 00:28:56,440 Speaker 1: and that that Trump is willing to meet with g 516 00:28:56,640 --> 00:29:00,280 Speaker 1: at this stage of his new presidency. Is a tree 517 00:29:00,360 --> 00:29:02,920 Speaker 1: in in and of itself. So I think it's a. 518 00:29:03,000 --> 00:29:05,880 Speaker 1: It's a good sign and shows something that's so important 519 00:29:05,920 --> 00:29:08,880 Speaker 1: to China, which is respect. Yeah, and so what about 520 00:29:08,920 --> 00:29:12,480 Speaker 1: for President Trump? I think ultimately Trump, you know, Trump 521 00:29:12,640 --> 00:29:16,520 Speaker 1: is going to one. He was elected with a set 522 00:29:17,000 --> 00:29:19,840 Speaker 1: agenda from the people who voted for him, and he 523 00:29:19,960 --> 00:29:22,760 Speaker 1: wants to satisfy those voters. At the same time, the 524 00:29:22,920 --> 00:29:28,160 Speaker 1: US is a global leader economically, and I think upsetting 525 00:29:28,800 --> 00:29:33,040 Speaker 1: what what will be an increasingly better mutually beneficial relationship economically, 526 00:29:33,560 --> 00:29:37,040 Speaker 1: um it especially around an area like North Korea where 527 00:29:37,160 --> 00:29:39,800 Speaker 1: China can help. Right, Brendan to Hearn, thank you so 528 00:29:39,960 --> 00:29:42,320 Speaker 1: much for joining us. This will be something that we 529 00:29:42,400 --> 00:29:44,160 Speaker 1: I am sure we'll talk to you again about soon. 530 00:29:44,200 --> 00:29:47,520 Speaker 1: Brendan to Hern is chief investment officer at Crane Shares 531 00:29:47,600 --> 00:29:50,480 Speaker 1: in New York City, talking about President Trump's meeting with 532 00:29:50,520 --> 00:29:59,200 Speaker 1: President Jejan Ping of China. Thanks for listening to the 533 00:29:59,240 --> 00:30:02,600 Speaker 1: Bloomberg p Now podcast. You can subscribe and listen to 534 00:30:02,680 --> 00:30:07,880 Speaker 1: interviews at iTunes, SoundCloud, or whatever podcast platform you prefer. 535 00:30:08,200 --> 00:30:11,440 Speaker 1: I'm Pim Fox. I'm out there on Twitter at Pim Fox. 536 00:30:11,800 --> 00:30:14,440 Speaker 1: I'm out there on Twitter at Lisa Abramo. It's one 537 00:30:14,760 --> 00:30:17,480 Speaker 1: before the podcast. You can always catch us worldwide on 538 00:30:17,520 --> 00:30:18,320 Speaker 1: Bloomberg Radio