In brief: Dems and GOPers both wrong about healthcare | Physician trainees literally going hungry | Uplifting points of 2025 light

Democrats want to keep Obamacare going. Republicans want to replace it, ideally with health savings accounts. Regardless of which approach holds sway this week—or whenever—either one would be woefully shortsighted. 

That’s the opinion of a former director of the U.S. Office of Management and Budget. The solution to rising health-insurance premiums isn’t “backstopping Obamacare or haggling over what might replace it,” contends Peter Orszag, who led the OMB under President Barack Obama and is now chairman and CEO of Lazard, the largest independent investment bank in the world. Neither party’s go-to strategy would work, Orszag believes, because “the real issue is the total cost of healthcare.” The New York Times published Orszag’s commentary Dec. 16. Among his most compelling points are these five:

• If more of the cost burden is carried by insurance companies, it will inevitably be shifted back to consumers. The shift will trace to insurers’ need to please their shareholders, Orszag maintains. Meanwhile, “if more of the burden is placed on the government in the form of ever-greater subsidies, it will ultimately be passed back to taxpayers.”
   
• High-cost, high-complexity cases drive the vast majority of overall health care spending. According to 2022 data from the Agency for Healthcare Research and Quality, the costliest 5% of the population accounts for about half of all healthcare spending, while the most expensive 1% drives more than 21% of costs. “In complex cases, patients often lack the expertise to evaluate the necessity or quality of proposed treatments and procedures, and they rely heavily on doctor recommendations,” Orszag notes. “That means physician discretion—as opposed to patient choice—plays an outsized role in overall spending levels.” 
   
• The next generation of AI that supports clinical decisions will need to be deployed more rapidly. Research published in recent years indicates that AI-integrated tools are already minimizing unnecessary procedures in specialties like oncology and cardiology. “On the legal side, that means making malpractice standards more uniform nationwide,” Orszag remarks. “The solution is not blanket immunity for physicians, which erodes accountability. Rather, physicians who follow certified, evidence-based guidelines should be presumed to have met the standard of care and be shielded from liability.”
   
• As much as one quarter of healthcare spending in the U.S. is wasteful. With premiums for a family of four with employer-sponsored health coverage amounting to more than $26,000 per year on average, Orszag comments, eliminating waste through more evidence-based approaches to care could save such families thousands annually.
   
• This won’t be easy. “Most Americans under 65 have employer-based health coverage, and many may be reluctant to tinker with the system, despite recognizing that their premiums keep increasing,” Orszag projects. “But a real fix is not found in the debate over who pays the needlessly bloated bill. Unless we actually address what makes healthcare so expensive, the fight we’re having today will keep coming back around.”
   
  • Hear him out in full here. 

On any given day, 1 of every 7 physician trainees is experiencing food insecurity.

So found eight researchers from five medical schools who surveyed more than 1,600 residents and fellows at four U.S. sites. The team also noted an elevated rate of self-reported burnout among the nutritionally deficient trainees. JAMA Network Open published the study Dec. 17. Lead author Larissa Thomas, MD, MPH, of UC-San Francisco and colleagues define food insecurity as “having uncertain access to food or not having enough food at some point in the last year.” The authors note several nuances in their findings that might help finetune interventions. Examples: 

• Food insecurity among physician trainees working in large urban areas tends to mirror food insecurity among the general populations in those settings. “It is not clear from our data whether this finding is due entirely to increased cost of living for the geographic location or is also related to indirect expenses specific to medical training,” Thomas and co-researchers remark in their discussion. “Despite being at or above the U.S. average, resident and fellow salaries, particularly at lower postgraduate years, have been shown to be potentially insufficient for a living wage depending on factors such as geographic region, household size, and living expenses such as food, housing and transportation costs.”
   
• The association of burnout with food insecurity among physician trainees largely owes to the stress of making ends meet—on top of keeping up with the demands of residency and/or fellowship.“For those experiencing food insecurity, for example, social isolation and loneliness may result from an effort to avoid social events that require spending money, potentially compounding a lack of belonging or community,” the researchers write. “These factors may also contribute to the finding in this study that residents and fellows experiencing food insecurity were less likely to report intention to stay at their institution.”
   
• Effective interventions might consist of either a.) directly decreasing the slice of income spent on food or b.) cutting other costs that limit funds available for food. “Institutions could, for example, expand free or low-cost food access on-site (including outside of typical mealtimes to account for the 24/7 nature of resident work),” Thomas and colleagues write. “In addition, institutions could ensure that salaries are commensurate with local living expenses, provide additional benefits to increase available income for food and build mechanisms to support groups that may be at higher risk for food insecurity.” 
   
  • The study is available in full for free.

Bless the editorial staff at MM+M for supplying a bright spot to pierce the recent darkness. 

The M’s stand for Medical Marketing and Media. The lift comes from the team’s list of five healthcare developments from 2025 for which they’re grateful as 2026 closes in. Editor-in-Chief Jameson Fleming kicks off the proceedings with his favorite, “Everything we’ve learned about Alzheimer’s disease.” 

• Fleming recalls watching his grandmother decline after receiving her diagnosis many years ago. “I was left with an assumption (and a whole lot of anxiety) that someday my dad will receive that same diagnosis,” he writes. “But what we know about the risk of Alzheimer’s has drastically changed. … Scientists are rapidly closing in on understanding the mechanics of Alzheimer’s disease, and 2026 will likely usher in results on how to best combine treatments and how to most effectively deliver them.” Enjoy the rest. 

Also worthwhile:

• Sick in a hospital town, Part 1 of 5: The business of care (ProPublica) 
   
• Will a fentanyl vaccine work? We’ll know soon (American Council on Science and Health) 
   
• Workplace insurance is a good deal for employers (Axios)

From HealthExec’s sibling news outlets:

• Shared meals help department boost radiologist wellbeing (Radiology Business)
   
• Surgeons use modified ‘frozen elephant trunk’ technique for first heart surgery of its kind (Cardiovascular Business)