Kate Heilpern: Redefining the Hospital’s Role

Transcript

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University, and we’re trying to get closer to the truth about health and healthcare. Our guest today is Dr. Kate Heilpern, but first we like to check in on current hot topics in health and healthcare. It’s been hot out, Harlan, so tell me.

Harlan Krumholz: It’s been hot, Howie. It’s been hot. All right. Here, I got something good for you this week, I think. So here’s a question, what’s one of the biggest threats in America that no one ever thinks of as a threat? Sometimes people say, “What’s the biggest threat?” Some people say, “Well, the next virus or cancer, heart disease.” Those are all real threats, but this is another one, I think, that you hear about talked about in other ways, like affordability, but the truth is the cost of healthcare in America may be one of the biggest threats to our healthcare system. Premiums are rising, deductibles are rising, drug prices are rising, town budgets are getting squeezed, school budgets are getting cut—all because of this growth in healthcare. This year, according to new numbers out, the United States will spend about $5.7 trillion on healthcare. Within a decade, we’re projected to spend nearly $9 trillion, or 20% of our entire economy. One out of every five dollars our economy produces will go towards healthcare. No country in history has ever done that.

And what are we getting? And I know in your segment later, we’re going to be talking a little bit about this, but just to put this in perspective, we spend almost twice as much as a share of our economy as the average wealthy countries in the world. We spend 50% more per person than Switzerland, which is the next highest spender, and we don’t have the longest lives. We don’t have the lowest rates of preventable death. We don’t have universal access. Among the countries that the Commonwealth Fund compared last year, only the United States and Mexico still lack universal healthcare coverage. So this is looking at a wide range of countries that should be able to afford universal healthcare, we’re sort of standalone as not having that.

So maybe we’re asking the wrong question when we say, how do we spend less? Maybe we should be asking, why aren’t we getting more for what we are spending? And the pain is very obvious. The average employer-sponsored family healthcare insurance is now nearly, wait for it, $27,000 a year, and workers pay part of that directly. Employers pay the rest. But either way, it comes out of what families could eventually earn. This is an extraordinary burden in a country where most families struggle to cover an unexpected five-hundred-dollar expense. But the biggest costs are the ones that we don’t usually see. Zack Cooper’s been talking about this in terms of lower wages, more pressures on employers, less money for infrastructure. In my own town of Guilford, Connecticut, we were struggling to pass the budget. It went through three times. Funds were being stripped from education, from other vital services in town. And why? Because we’re having trouble controlling costs. And why? Because of healthcare premiums. For a large reason, it’s healthcare premiums that are taking up more and more of the town’s budget.

So the question is, what are we going to do about this? We’re happy to have remarkable new drugs, new devices, powerful imaging, gene therapies. Soon we’ll have extraordinary AI tools. The problem isn’t innovation. It’s that for some reason in other industries, innovation tends to lower costs, but innovations in healthcare tend to increase our costs. And so unless we change the way our healthcare is organized and paid for, every breakthrough becomes another opportunity to spend. It’s a public health issue. People are actually skipping medications. They can’t afford the insurance. They’re having this financial toxicity which is threatening, ultimately, their health.

So here’s a question. Why isn’t this the number one problem that every medical school is working on? Of course here at Yale, actually Zack Cooper’s put together a group that’s looking very deeply into this, trying to focus on affordability, but he’s unusual. And actually this isn’t the kind of thing that NIH would fund. AHRQ is now out of money. There’s no place that this is coming for where people are saying, “What are we going to do to solve this problem?” And so Howie, you’re the health policy expert. What do you think we should be doing about this?

Howard Forman: So first of all, I could literally take what you said today, take us back 35 years, and you would say the exact same things. And so I think it’s very important for people to realize this is an ongoing problem. This is very much what got Harris Wofford elected in Pennsylvania to the Senate seat, and I think either ’90 or ’91 when John Heinz died, it’s what helped Clinton get elected in ’92. Healthcare costs going up, compromising the ability of the average person to take home wages and afford just living expenses has been an ongoing problem. Everything you said is correct. We overpay and underdeliver compared to our peer nations. And people ask, “Why is that?” And people like Uwe Reinhardt and others have consistently said, “It’s the prices, stupid.” That’s the phrase in the United States, that we overpay for things and that our costs are too high.

I think there is a lot of truth to that. But I do think the thing that we don’t like talking about that is true of a system like ours where there’s enormous freedom for people to have the care they want to have, particularly when they’re in the upper classes of society, are limitless wants and low yields for a lot of the things that individuals do want. Whether it’s getting multiple ultrasound exams during a pregnancy, getting extra CT scans because you’re anxious, whether some of it is due to defensive medicine and the fear of being sued, whether it’s the fact that people are allowed to go to private firms and get compounded GLP-1s because they think they’re overweight, even if they’re not. There’s so many examples where the freedoms that we are proud of in this country actually do result in higher spending and higher consumption of a lot of goods and services compared with other places. And in the ER, I see it every single shift.

As we will talk about with Kate Heilpern as our guest today, imaging continues to go up. I can’t explain why it is, other than that it’s there. It has almost no cost to the physician or to the patient and therefore it gets done. So we’ve got a lot of problems there—

Harlan Krumholz: Can you put a little of that in perspective? I’m just curious. So give me some sense proportion. How much has imaging gone up in the country?

Howard Forman: So what’s interesting is there are some people who think imaging has plateaued in the last several years and it’s a miscalculation based on the way things are coded. The way I think about it is, more than half of the patients in the ER are getting advanced imaging now. The numbers of patients that are coming in and getting a CT scan, an MRI, an ultrasound, or some other study has gone up so much recently that it’s unusual for patients to pass through without getting some type of imaging.

Harlan Krumholz: This is different than when you started as a—

Howard Forman: Oh, God, yeah. I mean, as much as we used to joke that the main requirement to get a head CT was to have a head, now if you’re in a car accident and you’re not getting a head and C-spine CT, and probably a chest, abdomen, pelvis with it, you’re unusual. We’re just scanning a lot of patients. Now, does it improve the likelihood that these patients will be sent home safely, securely without some type of unforeseen complication? Yeah, but the cost is enormous to that.

Harlan Krumholz: Great. Howie, I think in a way, this has been the unsolvable problem, and the question is how do you cut waste and still keep what’s good? Anyway, I’m sure this is going to be something we’re going to keep talking about.

Howard Forman: I do want to say, because I think it’s the most unpopular thing I’ve been saying, mostly subtly online lately, and that is we’re very easy to point to insurance companies, hospitals, physicians, medical device manufacturers, pharmaceuticals, and so on, and say they’re the problem. Consumers are part of the problem. The fact that we have infinite wants and...

Harlan Krumholz: But I will just say, look, if we’ve got a way to cure you, and it’s not always a cure, but if it is something you need and we’ve got the ability to apply it, then we should. I just saw IgA nephropathy drug was just approved. That’s going to be very welcomed by the community who’s affected by it. It’s going to be $450,000 a year.

Howard Forman: That’s right.

Harlan Krumholz: These are the kind of things I wonder, who’s going to get access to that who doesn’t have really good insurance? I mean, how is this going to work?

Howard Forman: I think that we’re going to figure out how to give everybody access to it. The question is how do we differentiate between the lifesaving technologies that we absolutely must provide and then the technologies that are nice and they make your life a little bit better, but are really not lifesaving?

Harlan Krumholz: And the ones at the margin that aren’t providing any benefit that we continue to—

Howard Forman: That’s right, or maybe even harm.

Harlan Krumholz: That’s what we need to figure out.

Howard Forman: Yes.

Harlan Krumholz: All right. Let’s get onto our interview with Kate.

Howard Forman: Dr. Kate Heilpern is an emergency medicine physician and healthcare executive serving as executive vice president of Yale New Haven Health and president of Yale New Haven Hospital. Before joining Yale New Haven Health, Dr. Heilpern served as group senior vice president and chief operating officer of the NewYork-Presbyterian Weill Cornell division, where she led hospital operations through the COVID-19 pandemic. Prior to that, she spent 22 years on the faculty at Emory University School of Medicine, practicing emergency medicine and serving as chair of the Department of Emergency Medicine for 12 of those years. She received her bachelor’s degree from the University of Virginia, her MD from Emory University School of Medicine, and completed her residency in internal medicine and emergency medicine at Temple University Hospital.

We are delighted to have her return to the podcast. She was just on Episode 188, September of last year. There’s always a lot to talk about, but more so today because Yale New Haven Health is in the midst of celebrating its 200th anniversary. It really is a very exciting thing for us to be able to celebrate because if you think back historically, globally even, hospitals are a new phenomenon. They’ve only existed for a few hundred years throughout the world. And as you had mentioned to us even before we started the podcast, the first hospitals in the country served the absolutely poorest among us. But do you want to say a few words about what you have learned, in embracing this anniversary, about Yale New Haven Health and its role in our community?

Kate Heilpern: I think that what is the most exciting is that over the 200 years, this hospital has never lost its mission of care for the surrounding communities. I think that’s really important for me as hospital president and it’s very important for all the staff, the physicians, and certainly the patients. In 1812 actually, there was a contract between the town of New Haven and the New Haven Medical Society physicians to care for the poor. It took about another 14 years. And in 1826, the General Hospital of Connecticut was formed, and that is now Yale New Haven Hospital. And to your point around the history, this was only the fourth voluntary hospital in the nation at the time, which was really consistent with charitable institution and charitable care. And so we have remained rooted in that construct and that sort of sensibility about working with giving back and learning from our communities in such a great way.

Howard Forman: Let me just, quick follow-up to that. We also merged with another hospital, the Grace Hospital, in I think 1854 or something like that. Do we get to have another bicentennial in just 28 or 29 years? Because Harlan and I are there for it if we are.

Kate Heilpern: We can certainly do that. I think the celebrations are great for everybody.

Harlan Krumholz: Kate, there’s so many things to talk to you about, so much going on today with hospitals and healthcare. I wanted to focus on one thing, just to get what you think, because there’s something else which is historic. Right now, the top four positions between the hospital and the medical school are filled by women. Nancy Brown, Peg McGovern, you, and now, the acting CEO, Pam Sutton-Wallace. That’s historic. I’d really like to get to a day when we don’t even notice, but I do think it’s worth pausing for a second because I do think it represents progress. I mean, we still are at a point in medicine where so many of the senior positions are filled by men. And even though medical schools are disproportionately women now, there are more women than men who are coming through medical school, for some reason, there’s still not what you might expect with regard to people rising into these positions of leadership.

But Yale is a sterling example of outstanding individuals, by any measure, who have risen to the highest levels of our institutions. I think that’s something we’re celebrating, because no one was picked because they’re a woman, they were picked because they’re outstanding. But it happens to be that we’ve got those top four positions by extraordinary individuals who happen to be women.

Kate Heilpern: Harlan, I’m so glad that you pointed that out. And it is a point of pride, I think, and a wonderful evolution for the healthcare system here overall, and the medical school, and that alignment.

Harlan Krumholz: My hope is that the four of you, just by your presence, will stimulate a change. First, you’ll inspire so many people around here, women, who are wondering whether it’s possible to navigate systems which provide headwinds. And that in a way, we become a cradle of coaches. They become a whole generation of people who see what’s possible and then go out and fulfill their careers. And again, not because they’re women, but that as women, they see a path, because I think it’s sometimes hard, and that this isn’t just about women, it’s about a variety of other groups as well. But sometimes you wonder, is there a path when you don’t see people in positions who are like you? Again, all of these individuals are outstanding in their own right. They made it because of their excellence. But the fact is that I believe it’s harder. It’s harder as a woman right now—still.

Kate Heilpern: It can be. And let me by extension, talk a bit too about the School of Public Health leadership and the School of Nursing leadership on the Yale side.

Harlan Krumholz: Oh, gosh, what an oversight.

Kate Heilpern: Yeah. Dean Azita Emami, who is leading the Yale School of Nursing. And we’re developing really nice partnerships with the School of Nursing and a joint strategic plan, which is really wonderful. And then Dean Megan Ranney, School of Public Health, who too is an emergency medicine physician.

Harlan Krumholz: I’m embarrassed not to mention them. The top six positions across these institutions are led by amazing people who happen to be women.

Kate Heilpern: Should we also mention President Maurie McInnis?

Harlan Krumholz: Oh, my God. There you go. This just makes me think that we should be having an annual conference here about leadership and women, because I want to say that’s progress because I wasn’t even thinking through that lens. I mean, it just happened to be, as you came on, I sort of was thinking about the medical school and the hospital. But then if you really open to look, we have such a bounty of remarkable leaders who happen to be women at this institution. This has to be the leading institution, maybe in the world, at this level, that’s led by this many amazing people who happen to be women. I’m purposely not saying “women leaders” because they’re amazing people, and it’s notable that we’ve got that many people who happen to be women.

Kate Heilpern: Let’s keep on going.

Harlan Krumholz: Let’s keep on going. Yeah, that’s terrific.

Howard Forman: Let me pivot slightly and...

Harlan Krumholz: Sorry, you’re breaking into this lovefest, but actually that was really remarkable because you did enlarge my view of this. Yeah, it’s something.

Howard Forman: Hospitals nationally are under fire in a number of ways. On the one hand, patients are trying to gain access oftentimes to primary care providers, but hospitals, academic medical centers do have some stake in that. They’re under fire from policymakers who think hospitals are too expensive and part of the problem for healthcare costs. And they’re under fire within our policy system because Medicaid cuts that have already begun to happen and will continue to happen next year will aggressively, potentially at least, impact the bottom line of hospitals. Yale Haven Hospital in particular is razor-thin margins and barely recovering from COVID, just barely recovering. I saw a graph yesterday that showed that while Hartford HealthCare, our biggest competitor, has rebounded, Yale Haven Hospital is just barely peeking its head above water. Can you speak to what it’s like to be a hospital president facing all the clinical challenges on a day-to-day basis, knowing that there are so many other external challenges yet to be faced?

Kate Heilpern: Another great question. I think this really is a testament to Harlan’s prior point around the opportunities with alignment to increase to an even greater extent with the Yale School of Medicine and frankly also with the School of Nursing, because we have workforce challenges to the point around post-COVID recovery, so developing novel educational programs that can accelerate students and trainees getting into the healthcare environment is really critical, and we’re looking at all of that. And we also, to the point around being there for our communities, have to and want to be present to deliver care at the highest level possible, so it is incumbent on us. We have a duality of role in the community. We are there as a safety net. And in addition, we are there as the site to provide the highest level of quaternary care. So as you talk about margin, it is important that we grow our margin and to do so, we’re investing in programs that are incredibly important and groundbreaking.

So for example, I think about solid organ transplant and the opportunity to provide this lifesaving therapy to patients who have kidney failure, liver failure, or heart failure, so we’re making big investments there. In addition, cardiac surgery, lifesaving and now often minimally invasive procedures that are lifesaving and life-giving for patients in that space. We are investing in the recruitment of top talent. We are putting in the equipment and building the teams to provide that sort of treatment. Those sorts of case types become something that people will come to Yale New Haven Hospital for. They will get on an airplane, they will get on a bus, they will get in their car, and they will come here for this high-level quaternary care. Those are some of the strategic moves that we’re making to drive the margin for the hospital, to be there for the community, and to help balance some of the other difficult headwinds that we’re seeing from some new federal policy.

Harlan Krumholz: Kate, I love that you’re an emergency medicine doc. For the people listening—we have a large number of young physicians who listen as well—and they think about administrative positions. I was going to ask you, when you think about your hardest day as president of the hospital, does it ever compare to your hardest day in the emergency department? What do you think of as the hardest thing you faced as president, and how did that compare with your clinical life and the challenges you faced there?

Kate Heilpern: I think the hardest thing as president is sometimes being faced with the really difficult choices that we have to make that in part tie back to Howie’s previous question about razor-thin margins. And in some instances, we have to enact difficult expense reduction maneuvers. Most hospitals throughout the country have been operating on razor-thin margins, and so it gives us almost this false choice. That said, if I balance that against some of my most difficult days as an emergency medicine physician in a very busy, urban Level 1 trauma hospital, those were the moments of looking patients and families in the eye to deliver bad news, to tell them that there was a very significant abnormality on their chest X-ray that was worrisome, or that their child who had come in with an acute traumatic event had not made it through the resuscitation in the emergency department. Those are the difficult moments, and you can be trained to deliver bad news, but I used to say to myself in my 30 years of practice that sometimes the drive home just wasn’t long enough, and the cases would sit with me. You have to develop that resilience of spirit.

I think that one of the key things about being an ER doc for so long and then moving into hospital administration is this aspect of being comfortable with ambiguity—to your point, Harlan, to act on information that may be, in a way, imperfect, or we don’t have all of the information, and yet we know, particularly in the healthcare climate of today, that we’ve got to move forward and we’ve got to make decisions in a good way. I think through my decades of working with patients, families, and staff at the bedside, it’s the empathy of understanding what they’re going through. If they’re having to make the choice between paying their power bill and their electric bill or paying for their insulin, those are such difficult choices that we hope the people we’re caring for don’t have to make.

So in everything that I do now on a larger scale as president, it is trying to get the pebbles out of the shoe for those individuals, try to be there for the community as much as we can, help mitigate food insecurity, connect people to behavioral health needs, and help them with medication needs that they might have. That’s the way that I can take an individual patient or encounter in the ED, or a shift, and try to amplify that to the work I’m doing on a daily basis, running a hospital of 1,541 beds.

Harlan Krumholz: Earlier in this episode, in the segment I had, I talked a bit about the expenditures and the affordability issues that are facing the U.S. One of the things that happens is that hospitals are often portrayed as contributors to these rising costs, and yet we’re talking about these thin margins. When people come up to you—it’s not so much a defense but an explanation—how do you help them understand where hospitals stand, why the margins are so thin, and where hospitals sit with regard to this? American Hospital Association I saw that recently came out with a report around affordability, wondering how hospitals can play an active role in trying to help on these issues. I wonder if you could explain to listeners where you stand or where you think hospitals ought to be standing in this affordability moment of debate around healthcare.

Kate Heilpern: Well, hospitals, and particularly Yale New Haven Hospital, as I’ve mentioned, our mission is in part to provide care for the local community irrespective of the ability of people to contribute to the cost of their own care. And so we take that mission very, very seriously. You couple that charitable contribution with the rising cost of medical supplies and surgical supplies, the rising cost of pharmaceuticals, and sometimes in fact, the complexity of dealing with the payers in terms of the revenue that’s coming back into the hospital, and it is...

Harlan Krumholz: Isn’t it the workforce too? I mean, your labor costs are also rising.

Kate Heilpern: Labor costs are rising, and they’re rising in part because we have some shortages in very key areas. Howie and I had been talking about the rise in imaging, the sheer number of imaging studies that are done. So in thinking about that, we think about basic X-rays, ultrasound, MRIs, CAT scans, to help yield diagnoses so that we can intervene. But as the number of images requested has risen, we haven’t kept pace with the workforce of trained technologists, for example, in MRI or CT, to keep pace with the physician needs. And so when we do that, we have to pay a premium for those labor costs. And even when paying a premium, sometimes that portion of the workforce is hard to recruit, even for short-term health.

Harlan Krumholz: So then do you think hospitals are going to be able to play a role? Because you’ve got all these forces that are building up your baseline foundational costs, what it takes for you to run the place. Will there be a role for hospitals in helping to address the affordability, or do you think we’ll need to look elsewhere?

Kate Heilpern: I think hospitals can play a role in affordability. I think that there is a bit of pressure testing happening with some pilots at the federal level to say, “Can you deliver this care with a bundled payment? Or can you help to mitigate cost by working to assure that the patient won’t need to come back after a surgical procedure within 30 days or the like?” So there are some demonstration projects that are out there that are challenging the status quo, and I think in a really good way, forcing physicians and the entirety of the team to come together and say, “How can we deliver this care in a more cost-effective manner and in a more efficient way so that patients and families have information in advance for elective procedures, equipment perhaps is delivered to the home, or post-procedure, there’s more care that’s delivered in the home instead of sending somebody to an inpatient rehabilitation facility?” For example. So these are the kinds of things that I think banding together and thinking about this in a very constructive way is a role that the hospital can play in terms of affordability.

Howard Forman: Before we get to the end, I just want to give you a chance to speak about the Adams Neurosciences Tower being built, because this is the largest expansion of the hospital since we opened Smilow Cancer Hospital. It is an enormous change for the hospital, and it’s something that I think we’re all proud of and excited about. Do you want to just speak a little about what that’s going to mean for our Yale New Haven Hospital?

Kate Heilpern: The Adams Neurosciences Center is a project that’s been about 10 years in the making, and it is a marked expansion and transformation of the Saint Raphael’s campus. So the Saint Raphael’s campus is part of Yale New Haven Hospital. We are a two-campus hospital, and there have been about 500 beds at Saint Raphael’s, but we are adding two towers. We’re doubling the footprint of the emergency department. We’re adding new operating rooms, new interventional suites for cardiac and radiologic procedures, and that is all scheduled to open at the end of February of 2027. So we will be moving our first patients into this state-of-the-art facility in a matter of months. The nice thing is we’ve been able to embed the latest of smart room technology, virtual technology so that physicians, nurses, and other members of the care team can, on a large screen, interact with their patients without necessarily being in the room. This is really a testament to the incredible translational science and differentiating clinical programs of Yale Medicine, specifically in neurology and neurosurgery.

So the first phase will be a focus on neurology and neurosurgery, and we’ll do an expansion of clinical programs a little later in ’27 to include growth in heart and vascular, particularly vascular surgery and interventional cardiac care. So, very, very exciting.

Harlan Krumholz: Here’s my last question for you in the end. So when we do this podcast again in a hundred years, when Howie and I interview you in a hundred years, because all this longevity stuff’s going to pay dividends, so we’re all going to be around, can you just give me your vision of what’s a hospital going to look like in a hundred years, do you think?

Kate Heilpern: Well, we’ll be celebrating our 300th anniversary, and I think that it will really be a place where emergency care still happens, but it will predominantly be focused on procedural care and ICU care. So I would see it as really a reckoning around OR needs that couldn’t be managed in an ambulatory setting, complex interventional needs, and the patients who are very, very high-acuity. Because I imagine over the coming years to decades, we will be doing more care of patients at home. It’s certainly happening, and I think the speed with which it’s happening is impressive. But as we deploy artificial intelligence and machine learning into remote patient monitoring and some of the other things that we’ve put in place, I think hospitals will really be for acute care needs procedurally and those who are really very acutely ill.

Howard Forman: Let’s hope that is the future. That would be wonderful.

Harlan Krumholz: And do you think radiology will continue to be a... Sorry, I didn’t want to go there, but I just want... Is it going to still exist?

Howard Forman: There’ll be interventionalists, that’s for sure. Anyway, it has been a total pleasure.

Harlan Krumholz: What a pleasure. Thank you so much.

Howard Forman: We’re lucky to have you leading us. Thank you.

Kate Heilpern: Thank you.

Harlan Krumholz: Well, that was terrific. She’s amazing. Oh, my God. So articulate, incredible.

Kate Heilpern: Yeah.

Harlan Krumholz: Okay, Howie, let’s get to your segment. What’s on your mind this week?

Howard Forman: Yeah, so look, we just celebrated our nation’s 250th anniversary. Here is more to consider celebrating. Last month, the CDC reported that U.S. infant mortality fell to a new all-time low, just under 5.4 deaths per 1,000 live births in provisional 2025 data, down from about 5.5 the year before. Three decades ago, the rate was 7.5. Some of the recent gains likely trace to new tools against RSV in an infant antibody shot and a maternal vaccine, plus a continued decline in sudden infant death syndrome. The good news doesn’t stop there. Life expectancy at birth hit 79 years in 2024, the highest in American history, finally erasing the losses of the pandemic era. And it may still be climbing. Provisional data the CDC released last week show the United States death rate fell to its lowest level ever recorded in 2025, down 4.6% in a single year. A big driver of that turnaround is the overdose epidemic finally easing. Drug overdose deaths fell to roughly 70,000 in 2025, down nearly 14% from the year before, and down from a devastating peak near 110,000 just three years earlier.

Maternal mortality edged down too, to 17.9 deaths per 100,000, though that change from 2023 wasn’t statistically significant, so at least call it a return to where we were before COVID, not a leap past it. The longer arc on cancer tells a similar story. Cancer mortality has dropped 34% since its 1991 peak, averting an estimated 4.8 million deaths. And this year, the American Cancer Society reported that five-year survival across all cancers reached 70% for the first time. That’s a generation of real progress. None of this means the work is done. The gaps are still real and closing them, especially the racial and ethnic disparities that run through every one of these stories, from birth to cancer care, has to stay at the center of what we do. But not every segment has to end on a warning, so for today, let’s let ourselves celebrate something genuinely powerful: fewer babies dying, longer lives, the tide turning on overdose, and real ground gained against cancer.

Harlan Krumholz: I agree with you. I think that there are things to celebrate. The overall mortality rate, though, I’m a little more cautious about, because pandemic produced one of the largest spikes in mortality in modern American history. When something rises that dramatically, you certainly expect some rebound as the acute effects fade. I mean, there was premature deaths among the most frail, those who were the most vulnerable, those who were oldest.

Howard Forman: No question.

Harlan Krumholz: Those people were essentially removed from the denominator for—

Howard Forman: It’s 100% true.

Harlan Krumholz: ... subsequent year. And the question is whether or not this will be sustained or whether this represents the fact that overall, everything considered, the U.S. population’s a little bit healthier after millions of people died prematurely who were within years of death probably anyway. So I’m just saying I’m a little cautious about the gains.

Howard Forman: I’m more optimistic than you, but you are 100% right that the death rate, not the life expectancy, which is an actuarial figure, the death rate does get artificially depressed after you basically kill off some people.

Harlan Krumholz: Yeah, and this happened after the influenza epidemic that occurred early in the 20th century.

Howard Forman: Yes.

Harlan Krumholz: Jeremy Faust and I have been talking about this. Well, actually we think that we should probably write about what would be expected and whether this is more or less than expected. But look, it could be worse.

Howard Forman: I will tell you, when you look at the actuarial prediction for life expectancy, it has just continued the curve that we saw before the pandemic. So there was this drop-off in life expectancy because of the pandemic, but it basically is just keeping up with the curve. I think we’re making real progress. To your point, though, we are years behind our peer nations. Whether you’re talking about Hong Kong, Japan, France, England, or Israel, we are way behind them, and that is something we absolutely have to fix.

Harlan Krumholz: Yeah. Like you alluded to and suggested, and there’s a big difference between those with resources and connections...

Howard Forman: That’s right.

Harlan Krumholz: ... to ensure that they’re getting the very best health. And we’ve got this whole group of people who are health hacking and focusing on health all the time.

Howard Forman: The worried wealth.

Harlan Krumholz: The wearables, worrying about this, doing all this stuff. And we have a whole nother part of the population who are just trying to get through every day.

Howard Forman: Exactly. I agree.

Harlan Krumholz: And that’s creating a real dichotomy in terms of what their health outcomes are. So thanks very much, Howie. You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So how did we do? To give us your feedback or keep the conversation going, email us at health.veritas@yale.edu, or follow us on any of social media.

Harlan Krumholz: And we love your feedback. Give us feedback. Let us know how we’re doing. We always love to hear from you.

Howard Forman: Health & Veritas is produced with the Yale School of Management and the Yale School of Public Health. To learn about Yale SOM’s MBA for Executives program, visit som.yale.edu/emba. And to learn about the Yale School of Public Health’s Executive Master of Public Health program, visit sph.yale.edu/emph.

Harlan Krumholz: And a hat tip to our superstar undergrads, Donovan Brown and Gloria Baek, to our spectacular producer, Miranda Shafer, and to the best in the business I get to work with every week, Howie Forman. Thanks, Howie.

Howard Forman: Thank you, Harlan. Talk to you soon.

Harlan Krumholz: Talk to you soon, Howie.