Modernized Health Care in Practice: Empowering Americans to Live Healthier Lives

The subcommittee will come to order. Good morning and welcome to Florida's beautiful sixteenth congressional district for health subcommittee hearing and uh talked to quite a few of the members up here, they're interested in taking a look at this, they wanna see if they can get a place here as well. So I'm thrill I'm thrilled, I'm I mean uh personally I'm thrilled to hold this important hearing focused on prevention and healthy living as I speak about often, Americans spend more dollars on health care than any o- than any other nation yet the country, our get- uh, our country's getting sicker. We spent over five trillion dollars, not billion, but five trillion dollars on health care, yet six in ten Americans have at least one chronic disease. Chronic disease like uh diseases of diabetic, uh cancer, obesity are the leading causes of death in our country. When we look at the obesity rate, about twenty percent uh of children are obese compared in our generation, it was three percent. That's shocking to me, uh cuz a lot of times you can't as many of you know the doctors you sh- if you're overweight and everything when you're young, you that follows you a lot of times. Um thirty percent of adults are are obese, uh disqualifying them for military service, those from let's say twenty to thirty. And at least forty percent of adults are obese. So obesity is projected to result in as much as nine trillion dollars uh in excess uh medical expenses. We must think about health care in this country differently. Patients and taxpayers are depending on it. We must train the next generation of doctors, and they do such a great job here, but it's really critical to prevent chronic diseases and focus on nutrition and healthier lifestyles. We must also support a health care system that values prevention, not reaction. Instead of fee for service, we need to have something based on outcomes and and and values. I believe new technology will also play a key critical role uh on that in terms of prevention. Ultimately, I want people to be the CEO of their own health. I look forward to highlighting how my congressional district is supporting prevention and healthy living. I look forward to discussing ways to improve the health of Americans. I'm pleased to recognize the gentleman from Nevada, Mister Horsville, for his five minute uh remarks and in in his opening statement.

Well, good morning everyone. It's great to be with you. Uh, thank you to Chairman Buchanan uh for welcoming us to your beautiful home, uh here in the sixteenth congressional district of Florida. Uh, I'm from Las Vegas. I don't think we could ever have a congressional hearing outdoors in Las Vegas. Uh, but I wanted to be here uh out of respect uh for you, Mister Chairman, uh for the subcommittee on healthcare and your work on so many important issues uh to improve healthcare outcomes. And um also because I think it is important for us to speak with one voice, Republicans and Democrats, that we believe a core message that America should be healthy. Uh in fact, that is why members of this committee on both sides of the aisle have long championed this goal. We may not all agree on exactly how to get there, but having the core uh mission of making healthy hel- making America healthy is absolutely something that I support. Sixteen years ago, uh we drafted, debated and passed the most significant expansion of healthcare coverage in our nation's history, the Patient Protection and Affordable Care Act. The ACA opened the doors of our health care system to young adults, the working poor, small and independent business owners, and people with pre-existing conditions who were told that they would never have access to coverage. Moreover, it ensured that preventative care was within reach, care that has saved countless lives and made millions healthier over those sixteen years. But since the beginning of the year, the promise of accessible, affordable health care is slipping out of reach for far too many Americans. Take Miss Priscilla Brown, a forty-eight year old truck dispatcher from Orlando, living with type two diabetes. Like millions of others, she is enrolled in the affordable care marketplace and relies on daily insulin to stay healthy. Yet rising health care costs have pushed her into a situation that no one in the wealthiest nation in in our world should face. Some days she takes only half or even a third of her prescribed dose in order to stretch it out. Other days she skips it entirely, not because she wants to, because she has to in order to afford the ever-increasing cost of basic living necessities while balancing her new premium monthly expenses. Now, Miss Brown's story is heartbreaking. but it is not unique. New data from the Kaiser Family Foundation shows that roughly eight in ten Americans who uh re-enrolled in the Affordable Care Act marketplace this year are facing higher health uh higher health care cost and for about half of them, those increases are substantial. Now we all can agree that there's more work that has to be done. No bill is perfect um and that is why the Florida Policy Institute estimates that a million and a half Floridians are projected to lose their health care coverage and that is one of the reasons that I'm also here today, on top of the pre-existing fourteen point eight percent of Floridians who are already uninsured. So, I look forward to hearing the testimony from our panelists today. I thank each of you for your expertise, for your education, for your background, and for focusing on a wellness care system, not a sick care system. And if we all can work towards that goal of improving health care, we can make America healthy again. So thank you very much, Chairman, for allowing me to be here with all of you today.

And and thank you. Uh, I'm now I'm pleased to recognize the Chairman of the Ways and Means Committee, Mister Smith, for his opening statement. And he was one of the mentioned how lovely this area is, being from uh your part of the world.

I love my part of the world, but this is very, very lovely weather. Um, thank you, Mister Chairman. It is, it is great to be here in sunny Florida and to hold our second committee hearing outside, um, which is, which is good.

Thanks.

The Natural Resources Committee could learn from, from our work. Um, we're glad to be here today, uh, in Vice Chairman Verne Buchanan's congressional district. Um, Chairman Buchanan, is one of the strongest champions for for chronic disease prevention we have in Congress. Uh, in fact, Vern was on a mission to make America healthy again way before it was cool, and people started talking about it. Um, we will miss him in Congress. We'll miss his leadership on this topic. Um, but we still have eight and a half months to do do a lot of work and hopefully get some things done. I also wanna thank our host. Right here, Lake Erie College of Osteopathic Medicine. This school is one of the fifty-three medical schools that joined the Trump administration's pledge to provide at least forty hours of nutrition training to students. Educating our future doctors on good nutrition is critical for the patients who will one day trust them for medical advice. The The nutrition pledge is a recognition that not enough attention and resources have been paid to prevention in our healthcare system. Today, that system incentivizes treatment of chronic disease over its prevention. That reality is simply not working. Despite our nation spending an astounding five point three trillion dollars on healthcare, each year sixty percent of Americans still have at least one chronic disease, heart disease, diabetes, or cancer, of which disproportionately affect rural Americans, who I represent. For Medicare beneficiaries, that number is a staggering ninety-five percent. That statistic should not be a surprise when Medicare only spends five cents of every dollar on primary care. Too often we intervene only once someone has gotten sick and and do too little to stop Americans from getting sick in the first place. That is why the Ways and Means Committee passed legislation that encourages more preventive care, like providing multi-cancer early detection screenings to seniors on Medicare. The Working Families Tax Cuts expanded HSAs, to millions of more Americans, which allows individuals to invest in their own health and wellness. The Rural Health Transf- transformation program is investing fifty billion dollars in efforts to grow and sustain innovative care in rural communities. But that is just a start. More has to be done to help Americans live longer, healthier lives. Medicare could expand value-based payments to improve patient outcomes, while reducing the cost of wasteful medical services. More patients could receive new innovations in disease testing and care delivery to detect disease before it is too late. Doctors could show patients realistic ways to take care of themselves, like spending more time outdoors, like we are here today. Um, I wanna thank each of our witnesses for taking time away from your practices, to share your experience of what is working and what is not, and your ideas you have to modernize health care for the benefit of all Americans. We also want to hear from everyone in the audience who took time to come today. There will be clipboards um passed around during the hearing right over there. Um, they'll be passing around um, for you to share with the committee how preventive care has made a difference for you or a loved one or share other thoughts about today's hearing topic. These comments will be entered into the official record for this hearing. I wanna thank you again, Mister Chairman, for having us.

Well, thank you, Mister Chairman Smith. At this time, I'd like to recognize my neighbor and friend from Florida's seventeenth congressional district. member of the health subcommittee, Congressman Stubbe, for one minute.

Thanks, Mister Chairman, and thanks for having us, it's awesome to be at home and have a congressional hearing. I grew up like fifteen, twenty minutes from here, my district's just south, um it's great to be back in Southwest Florida, I wanna thank all of you that did do great things to make this area great, and I look forward to the testimony and the questions. So, thanks for being here.

Thank you, Mister Stubbe, I'd like to recognize our other member from Florida, Delegate Congressman Bean for one minute.

Thank you very much, Mr. Chairman. Very good morning to you. Good morning Ways and Means Committee, and uh what a big deal it is to have you here. Uh, ladies and gentlemen, you're here. You'll always get to say, " I was there that day they met on the porch." And if you, uh, you're not wearing a hat, you should. My, uh, mom will tell you. Uh, protect your skin. That's a little bit of health knowledge right there. For our, my colleagues that have traveled all across the country, they've asked me something and I wanna explain it right now. They've asked me What's different? It's feels different, it smells different. I can't quite put my finger on it. I can tell you what it is, members. It's freedom. That's exactly what it is. For all of us here, we know, uh, uh, b- b- b- b- b- hanging out in the free state of Florida, uh, we enjoy it every day. So, the weather's a bonus, too, but, uh, ladies and gentlemen, welcome to the free state of Florida.

Thank you, Mr. Bean. I now introduce our witnesses. doctor kaufman and we're very excited about the you mentioned been twenty twenty five years here and with the institution you guys have done incredible work. So thank you personally. christopher davis and we've got uh chance to become friends but we wanna be better friends going forward he's focused on longevity and prevention uh doctor uh he's uh he was the medical director of manatee surgical alliance doctor who who is the President and CEO, Moffitt Cancer Center. Uh and Scott uh Darius is the Executive Director of Florida Voices for Health. Thank you for joining us today. Your written statements will be made part of the record. And each of you have five minutes to deliver your remarks. And Doctor Kaufman, we'll start with you.

Thank you, Chairman, ranking members and distinguished members of the committee. I'd like to really thank you for this opportunity to testify today and to share the work of the Lake Erie College of Osteopathic Medicine and the osteopathic medical profession. I serve as dean at Lake Erie College of Osteopathic Medicine in Bradenton, and began my career as a physician assistant, came back to to LECOM in two thousand, got my DO degree. I'm board certified in family medicine and I've been with LECOM in medical education for twenty-five years. It's an honor to contribute to this important conversation modern medical training and innovative care in the American people. At LECOM our mission's clear, we're here to prepare the next generation of health care professionals through four pillars of excellence. That's excellence in education, clinical care, research, and community service, with the goal of improving health outcomes for all humanity. This mission is reflected daily in how we educate our students, care for our patients, and partner with the communities we train and serve in. LECOM was founded in response to a national need for physicians and a more responsive model to medical education. We've embraced the innovation as a practical necessity to meet workforce shortages through our colleges of medicine, school of pharmacy, dentistry dentistry, podiatry, and health services administration. One of the most distinctive elements of LECOM's approach is its commitment to multiple adult learning pathways. Our problem-based learning pathway places students in small groups, where they learn through clinical cases, mirroring how physicians diagnose and treat patients, promoting knowledge acquisition, communication, and critical thinking skills. LECOM's pioneered accelerated, cost-conscious medical education, helping to reduce student debt while maintaining a rigorous academic standard. In addition to maintaining one of the lowest tuitions for private non-profit medical schools in the US, our primary care scholars pathway for students dedicated to primary care specialties, our accelerated physician assistant pathway, the only program of its kind in the US for PAs who seek to become physicians, and the accelerated pharmacy pathway allow completion of medical school and pharmacy school in three instead of the traditional four years, cutting cost by twenty-five percent for our students. By lowering the financial barriers, we enable more students to pursue health care careers, especially in primary care. LECOM's educational philosophy is grounded in osteopathic medicine, of treating the whole person, mind, body, and spirit, with an emphasis on preventative care. This holistic approach aligns closely with national priorities to maintain healthy lifestyles and nutrition, improve preventative care, and lessen the impact of chronic disease. Our programs emphasize primary care, community engagement and service learning, and actually in fact we have uh LECOM sixty percent of our medical students enter into the much needed primary care specialties while practicing in rural and underserved areas. The United States faces a critical need for a larger, better prepared health care workforce. LECOM addresses these challenges both through scale and innovation. As the largest medical college in the nation, LECOM has expanded access to medical education while maintaining a strong focus on quality and outcomes. Through the tenets and following the tenets of osteopathic medicine, our admissions process go beyond just grades and performance on qualifying examinations. We look holistically at all aspects, of the applicant. In fact, LECOM is one of only a handful of medical schools that has an alternative to the MCAT. The LECOM academic index score allows applicants to apply for and be admitted to the medical school without an MCAT. This approach has led us to exceptional board outcomes and to a ninety-nine point four to a hundred percent residency placement placement for the last eight years. LECOM's impact extends beyond the classroom through its integrative academic health system by aligning education with service. LECOM creates a feedback loop in which training program directly respond to the community health needs. The work of the institutions like LECOM highlight several opportunities for policy makers support for innovation of medical education models to reduce the cost and expand access focus on preventative health care including nutrition and uh rather than the reactive care that we often see, and investment in primary care and underserved communities. Public policy plays a critical role in enabling in enabling institutions to scale these innovations, by aligning incentives with outcomes such as improved population health, reduced costs, and workforce expansion. We can build a health care system that better serves all Americans. In closing, we stand as an example of how innovative education, community engagement, and integrative care delivery can come together to improve lives. We're proud to contribute to the health of the communities here in Florida and across the nation and look forward to continuing to work with policymakers to ensure that every American has access to high-quality, compassionate and effective health care. Thank you very much.

And thank you, uh, Doctor Davis. I do, uh, you're next, but I did wanna mention we're very excited about what you're doing, longevity and prevention. You're a leader in this area and a region, in this region, and we're very excited. I hear that from a lot of your patients, frankly. So, uh, you're up.

Well, Mr. Chairman, uh, Ranking Member and distinguished members of the committee, uh, I'd like to thank you for this opportunity, first of all, to speak to all of you guys. i wanna begin with a story um it's a story of a little african american boy growing up in a small country town in virginia uh with one stop light when he was just seven years old the little boy faced a life threatening health crisis and his appendix ruptured and the complications nearly took his life he was hospitalized for weeks with tubes coming from every orifice of his body it was terrifying but because of the two noble surgeons doctor teague and doctor gaylord he survived and during that illness lining that hospital bed that little boy made decision that would shape the rest of his life. He decided that one day he would become a doctor so that he could care for others the way those doctors had cared for him. Obviously, that little boy was me. Fast forward thirty years. After four years of college, four years of medical school, three years of residency, one year of chief residency, two years of NIH fellowship, a year of, four, two years of cardiology fellowship, and a year of interventional cardiology fellowship, I had achieved that dream. i've become an interventional cardiologist i was in the cath lab opening blocked arteries treating heart attacks responding to cardiac arrests saving lives in the most critical moments

mmm yes

but every by every traditional standard i'd made it mission accomplished where i thought because after about a decade of practice i began to notice something deeply troubling too many of the same patients were coming back through the revolving door of our healthcare system with the same chronic illnesses the same preventable complications and the same fear. That's when I had to confront the hard truth. I was not truly practicing health care. I was practicing disease management or sick care. I realized that our system is incredibly advanced when it comes to treating illnesses. After that happens, we have a remarkable technology, we perform extraordinary procedures, we can do things in medicine today that would have seemed miraculous just decades ago. And yet, despite all of that, Americans are getting sicker. Chronic disease is rising. Metabolic dysfunction is rising. Cardiovascular disease remains the leading cause of death. And perhaps the most concerning of all, we have unintentionally created a system where patients often feel powerless. They're told what they have. They're given prescriptions. But they're rarely given an understanding. They're rarely given a road map. They're rarely taught why their disease developed in the first place. And they're rarely empowered to take control. of their own health. That realization changed everything for me. In two thousand eighteen, I took a leap of faith. I had to start over. I founded Reveal Vitality and Longevity Institute because I believe there had to be a better way to deliver true health care. A simple but radical idea guided that decision. What if we stopped waiting for disease and started identifying risk before it became irreversible? What if we asked not just what was happening, but why it was happening? What if we taught patients how nutrition, sleep, movement, stress, toxin exposure, and other lifestyle factors directly influence the development of this chronic disease? Today, that is exactly how I practice. Instead of relying solely on traditional labs, we go deeper. We use personalized, precision-based approaches, including genetic testing, micronutrient analysis, cardiometabolic biomarkers, and environmental toxin testing. I pause. We look upstream. And we involve patients in the process. The results can be profound. I've seen patients reverse metabolic dysfunction. I've seen patients regain energy, clarity, and hope. But what has moved me most is this. I've watched people go from fear to understanding the ownership of their own health. This is what health care should look like. But there's a problem. This level of care is still out of reach of far too many Americans. The people who need prevention the most often have least access to it. Underserved communities are often hit the hardest by chronic disease, yet they are least likely to have access to the time, testing, education, and early intervention that could change the course of their lives. This is not just a health care problem. This is a moral problem. Health care should not be a system that profits most when people get sicker. It should be a system that invests in keeping people well. If we truly want to modernize healthcare in America, then we must be willing to change what we value. We must reward prevention, not just procedures. We must reimburse for identifying risk early, not just treating disease late. We must support physicians in educating patients, not just moving them through the system. And we must build a healthcare model that gives every American, regardless of their income or zip code, a real opportunity to live a healthier life. Because in the end, the goal is not simply to help people live longer, it's to help them live better. With more energy, with more clarity, with more independence, with more dignity. If we truly want to empower Americans to have a healthier life, then we must stop waiting for disease and start investing in health. The question is not whether we have the knowledge to change health care. The question is whether we have the courage to do it. Thank you.

Good. Good job, Mike.

Uh, thank you, doctor, for your passion and and what you're doing. And I'd also know that you, there's a lot to be said about you really do everything you can for children, especially trill children are a disadvantage. So, God bless you. Uh with that, D- Do- uh, Doctor R- Ruckus, uh, five minutes.

Chairman, Ranking members, and members of the committee, thank you for the opportunity to speak. As a bariatric surgeon, I see the human cost of our current health care policy every day as I treat patients with obesity and metabolic disease conditions that drive diabetes, heart disease, hypertension, and that represents a majority of the health care spending that we do in this country. Our system is built to take care of ill patients, treating complications well after they occur. We really need to pivot our health care system towards treating earlier evidence-based treatments that'll prevent these conditions. By the time patients reach my operating room, they've already suffered years of preventable treat of damage. Treating obesity requires a coordinated approach that integrates surgery, medications and prevention, policies that support earlier screening. expand access to telehealth, and incentivize value-based care can help us intervene sooner and reduce long-term disease burden. We already have the tools that we need to improve health care. By recognizing obesity as a chronic disease, by expanding access to effect to effective treatments, and supporting prevention and innovation, we can empower patients to live healthier lives while strengthening the sustainability of our health care system. were not lacking the effective treatments, were failing to deliver them early on. Thank you again for the opportunity to share my perspective. I'm happy to answer any questions. I did wanna touch on certain topics. So first off, treating obesity as a chronic disease. Obesity is a primary driver for type two diabetes, hypertension and heart disease, yet outdated policies still treat it as a lifestyle issue, rather than a biological disease. Congress needs to expand coverage for evidence-based treatments, including medical ma- weight, medical weight management and bariatric surgery to address the root cause rather than just the downstream complications. We need to expand access to proven bariatric treatments. Bariatric surgery is one of the most effective and durable treatments for severe obesity yet access remains limited by insurance restrictions and referral barriers. Expanding access would improve outcomes and reduce long-term costs. Newer medications like GLP-ones based therapies such as semaglutide or zepatide have expanded our ability to treat obesity and show real promise. These therapies can produce meaningful weight loss, often in the range of fifteen to twenty percent, and should be part of our comprehensive treatment strategy. They're important clinical advances, but they're only part of the solution. Surgery remains the most effective and durable option for severe obesity. Typical produ- producing twenty five to thirty five percent more weight loss, roughly double that of medications and achieving higher rates of diabetes remission. These results were sustained over many years while medications requiring ongoing use to maintain their their effect. Surgery provides sustained metabolic improvement. As as access expands, these medications should be used thoughtfully, prescribed by appropriately trained clinicians and integrated into long-term care focused on improving overall health. not just short-term weight loss. Despite having these effective treatments, patients and providers face significant barriers to care. Administrative requirements frequently delay prevent timely appropriate treatment. In many cases, the delay is not due to clinical uncertainty, but to administrative friction. We need to incentivize preventative care over sick care. We continue to reimburse treatments of disease more than prevention. Expanding coverage for nutrition counseling, metabolic screening, and medical nutritional therapy, including Medicare access to dietitians beyond simple diabetes control and chronic kidney disease would allow earlier intervention and reduce long-term costs. Encourage earlier screening for metabolic disease. Many patients develop complications long before receiving treatment. Medicare currently covers nutritional therapy and related services primarily for conditions like diabetes and kidney disease after the disease has progressed. Expanding screening to coverage such as obesity, prediabetes, metabolic disease and fatty liver disease would improve our patients' health. This would allow earlier intervention in at-risk patients before they reach a point of crisis. They're often the earliest signs of metabolic disease, yet they remain undiagnosed and undertreated. Aligning coverage with early disease, not just advanced complications, would improve outcomes and reduce long-term costs. In addition, expanding community-based preventative programs, continuing telehealth medicine to help patients that don't have access, and align pay- align aligning payment models with outcomes, improve public education and reducing stigma. If we want to improve health care and control long-term costs, we must treat obesity as a chronic disease, expand access to effective treatments, and intervene earlier. We must apply the same clinical rigor rigor to obesity that we apply to diseases like cancer and heart disease. We have the treatments, but access, not science, is now the limiting factor. Thank you.

Uh, thank you, Doctor Wu, I w- wanna just say we're excited to have you here, Moffitt's, uh, clear leader not just here but across the country. And thank you for your leadership as the CEO.

Thank you, uh, Chairman Buchanan.

uh for all of your support through the years of our mission at Moffitt Cancer Center. I am Patrick Hu, the CEO of Moffitt Cancer Center uh where our uh goal is and our mission is to prevent and cure cancer we are located in Tampa Florida just a short drive away in this beautiful uh state of Florida uh my background uh I study the immune system against cancer. I first started at the National Cancer Institute then at MD Anderson and in the last five and a half years I've been here and I've been working on getting better. Uh, uh, we have amazing system in our body called the immune system that's able to locate, uh, recognize and kill cancer cells. And so that's what I've studied, the ability to stimulate our own immune system to recognize and kill cancer cells. And these immune cells can live in the body for decades, giving patients what they want. We've learned to take immune cells out of the body, put genes in them, uh, give them back, kill the cancer and and give patients what they want, which is long-term durable response. So they can see their grandkids grow up, they can walk their daughters down the aisle. We've seen countless patients that that have been cured uh from immunotherapy. Uh eh the emphasis of today's panel on prevention in screening we love because if you look at all of the uh kinds of treatments prevention is the way, the most cost-effective way, best outcomes that we'll have in Moffitt Cancer Center. We've always had in our mission statement, it's our fortieth year now, from day one we had our mission to contribute to the prevention and cure of cancer. We didn't just say cure of cancer, we've always focused on prevention. Per- forty percent of cancers are preventable. Uh, there's a lot of cancer. It's fifty thousand deaths in Florida, six hundred thousand in America, ten million globally every year. of cancer and forty percent are preventable. So a lot of people talked about obesity. That's really important to a to address. Cigarette smoking, we still have millions of Americans who smoke cigarettes. And cigarette smoking not only causes not just lung cancer, bladder cancer, kidney cancer, pancreatic cancer, many cancers, but also heart disease. So contributes to a lot of the morbidity and mortality in this country every year. So we have to try to prevent cigarette smoking. And of course, uh, sunburn's, I'm a melanoma doctor. So, uh, stay out in the fun sun. I got, uh, I love the hat, uh, but don't get too much sun. So, uh, that's, uh, um, uh, and then we call secondary prevention screening. Everyone's heard of mammograms, uh, for breast screening. You should start those if you have average risk at forty years old. Uh, colon screening. You should start at forty-five years, uh, unless you have family history. You could just start earlier. Uh, then um, uh, but one that a lot of people have not heard of is lung cancer screening. If you are a smoker and you get a twenty second cat scan every year, we can catch the lung cancers early, we could save sixty thousand lives a year in this country alone if we could do lung cancer screening. Right now there are millions of smokers in America and only less than five percent are getting these lung cancer screens. about the importance of lung cancer screening. It's we we would have much better outcomes, much less therapy, and we would save the country just billions of dollars. Um the um final thing I wanna talk about uh is our research at Moffitt Cancer Center on nutrition uh and exercise. Uh it's the most common question my patients ask me, " Hey, we need better research uh because a lot of the research that's been done is hey how many uh helpings of fish have you had in the last three months well who remembers how many helpings of fish they had in the last three months

yeah people have been ok

uh so it's very inaccurate research and so we have a food kitchen i'd love for you guys to come up and visit us at moffitt cancer center see our food kitchen

it's very accurate do you have something in about an hour food kitchen you said food kitchen come up and see uh

what yeah yeah come up yeah come up

yeah yeah

Please see us and we will make you a nice breakfast, uh, low carb, and uh um and uh the we we would need to study that prospectively to get accurate research on how food, we're studying how food stimulates the immune system. If you have certain diets, we think some fasting diets, um, maybe the keto diet which I've been on for thirteen years, uh, we think that might uh stimulate the body's immune system. Uh, so please come visit us. to look at our nutrition research. And finally, Chairman Smith uh mentioned rural areas, I wanted to let you know at Moffitt we're digitizing all of our pathology. The most important thing for a good outcome in cancer is knowing what kind of cancer it is. And so we're hoping that after we digitize our pathology, rural hospitals from across Florida and across America can send us their toughest cases, and we'll help them define what kind of cancer that is, so that we can try to get the patients on the right treatment pathways. So thank you. It's been an honor to be here today.

And thank you. Uh, Mr. Derris, you're recognized.

Good morning, Chairman Buchanan, uh, Ranking Member Horsford, and distinguished members of the subcommittee. Thank you for the invitation to testify today. Uh, I appreciate the opportunity to share our perspective on the health care system, but also to test the integrity of my wedding suit. Um, Florida Voices for Health, we're a statewide health advocacy organization committed to improving access to health care for all Floridians. And we're very fortunate to be part of a statewide coalition of organizations committed to that work. Um, as voices, you know, our work is really bringing the the lived experiences of Floridians into the policy making process. We try to empower people to share their stories for themselves and hopefully bring them to places where they can make a difference. So this setting right here is a great example of that. Um. You know, our storytelling, it's taken us to the panhandle where my now friend Debbie struggles to access resources for her disabled kid. It's taken us to South Florida where my friend, uh, Tasha has to take less hours at work so she doesn't lose access to her Medicaid coverage. Uh, and you know, there are success stories too. Just yesterday we were visiting a free clinic, uh, down in Winter Park, Winter Haven, where, you know, they have, uh, an innovative model where they're connecting people to transportation and food access, and all the other things that we need to stay healthy. So, as you explore ways to improve the healthcare system, uh, I, yeah, just only wanna offer a couple of things that we've learned from talking to people directly on the ground. You know, the first is that everyone's impacted by what's going on. All of us are paying a little bit more right now and in Florida where we had four point seven million people enrolled in the ACA last year uh the average monthly premium jumped up thirty percent. Now for middle class workers, for people who are earning just over four hundred percent, they both had to suffer through the increase in premiums, but also lost access to enhanced premium tax credits, all tax credits. And so they're shouldering that burden all alone. For low-income workers in non-expansion states like Florida, there's actually a disincentive to work more. Uh, the most a single parent can earn. In Florida, the most a single parent with two kids can earn and still qualify for Medicaid, is eight thousand dollars for the year. Anyone who finds themselves making more than that, a dollar more than that, and you find yourself in what we call the coverage gap. I appreciate the focus on rural Floridians, which is where we've spent, on rural people, um, and rural Florida's where we've spent a lot of time focused the last two, three years. Um, we've had three rural hospitals closed here in Florida since March of twenty twenty. When it comes to oral health, which we know is so important to the rest of our bodies, we have six million Floridians living in what we call dental provider shortage areas, meaning there aren't enough dentists to see them. And that's to say nothing about Florida's mental health needs, prescription drug affordability, or What's that? Supports and services for people with disabilities. The point is, no matter how you slice it, income, geography, race, or the specific area of healthcare, none of us goes completely unscathed. The scope of these systemic challenges I think speaks to a second truth, which is that healthcare won't be fixed with a single policy. Our system's too big and there are too many barriers that need to be addressed. You know, I appreciate the comments on modernization and innovation that this distinguished group uh has offered today. I'm not a doctor, I'll make that clear. But it's amazing to see what we're capable of and why the US is second to none when it comes to the provision of healthcare. But our system, I'll say, feels a little bit like a a business that has the best product on the market, unchallenged. But we have one fatal flaw, and that's cuz, and that's that we can't get it to people when they need it. Uh, to realize the full potential of all the the models that exist here, uh, modernization and innovation, the fundamentals of our underlying system have to be strong. The new tools and treatments won't mean much if the people who need them can't access them. Now I know that that's easy for me to say, uh, and compreh- creating comprehensive policy takes a lot of people working together and working through tough questions together. So I'll offer just, you know, a couple of guideposts as we work on building the system together. The first is that everyone needs to be covered, and that's just insurance math, right? We learned this as in this last year insurers justified their in premium increases. They pointed to the fact that they expected healthier people to drop off of coverage and that made it more expensive for everyone else. The second is that we need to restore trust throughout the system. The entire healthcare system is based on a series of relationships that require trust for things to work well. And that's between doctors and patients, insurance companies and their insured, between the government and its people. And while, you know, trust sounds like a high-minded ideal, I'll say that it actually has concrete policy implications. Our current system of prior authorizations and step therapy protocols reflect a distrust in providers' decisions. Uh, the lack of transparency in pricing makes it hard for anyone to feel like they're being treated fairly. And in programs like Medicaid, punitive work re- work reporting requirements reflect a lack of trust in the American people. And by and large, I'll tell you, the people want to work, people wanna meaningfully contribute. And lastly, a strong health care system adapts to each community's unique needs, whether it's to meet the distinct challenges of rural communities that are just twenty minutes apart, or to figure out why the maternal mortality rate for black mothers in Florida, is fifty-one point eight per one hundred thousand, while the overall rate in Florida is closer to twenty-four. The solutions need to be tailored. So, in closing, true progress will require not just innovation, but a recommitment to the fundamentals of ensuring coverage for all, rebuilding trust, and recognizing the unique needs of every community. Thank you.

Uh, thank you for your testimony. We'll now proceed with questions and answer session. I'll begin by recognizing myself. I wanna start by thanking our witnesses for sharing their time and expertise with this committee. I wanna thank LECOM. Let's give them a round of applause for setting this up for us today. For hosting this wonderful event. I'm so pride proud to be able to highlight work that's being done in this region, in this area for a lot of our patients and doctors and everybody else. Let me just ask one quick uh couple of quick questions by show of hands. Please raise your hand if you believe nutrition, eating real food And that's the key, what that means, but e- ideally eating real full is key, is a key component to preventing and reducing chronic diseases. Second, keep your hands raised if you believe you can do a better, Awesome. we could do a better job educating physicians and patients about the importance of nutrition. And finally, keep your hands raised if you think insurance, Medicare and other programs sufficiently cover prevention and detection tools today.

Good. Good. Goes out.

well that's tells the story right there uh let me i wanna run through uh doctor davis uh i wanna give you an opportunity cause you've worked with uh patients and a lot of different patients in this region in terms of a lot of the things that you're putting in place uh in terms of the longevity component prevention we've talked about how do you how do you explain what that means and and how does that play out with your practice.

Oh, thanks for the question. Um I think one of the points that I wanna make, in that five minutes that we had, you know, uh i- it was tough to try to decide what to what to s- what to s- put in five minutes. But let me in my opinion what I've been working on for the last four or five years, and I I kinda stumbled into this, I wasn't looking for this, but at the end of the day, chronic illness, longevity, you know, I would say that ninety plus percent of all chronic disease is caused by toxins that we are exposed to in our environment. There's a lot of talk about this, but we don't really have to talk about it. Um, i like to by i can't see behind me, but by show of hands, i would like to know how many people have even had an environmental toxin test. Metals, plastics, insecticides, pesticides, um, things like that. And i can tell probably behind me and i can't see, not many, right. Uh, and at the end of the day, when you do testing like When I do it on every single patient that comes through my door right now, OK, it makes the conversation very easy. Because that those toxins, those pesticides, that glyphosate, that atrazine, the the metals, the mercury, those are the things that we see that cause oxidative stress, that actually contribute to chronic illness, and it diminishes our longevity. And what about longevity? Longevity is not living longer, it's living, it's thriving, it's taking care of your grandkids, it's being active and being able to do the things that you were doing when you were thirty years old. But what causes the the problems there? That's inflammation, oxidative stress, that's all driven by things that we're exposed to. And and in my practice right now, it is crystal clear. I don't think there is, I mean, I don't have any more, I mean, there's crystal clear. And I look forward to the day when I could actually share all that, all of that data, share the data on what we really see. And each and every one of us, including myself, uh, what we see that's in our system is causing these diseases. So so we have to wake up. We have to wake up and we have to start looking at where the true causes are.

Yeah. Doctor Kaufman, uh you talked about nutrit nutritional training for physicians, uh what does that mean today here at uh the hospital? I mean at your facility I should say, Lekom. What, when you say that

Yeah we, thank you, we have a very unique curriculum here at Lekom Bradenton and our other campuses also and Part of that's problem-based learning, and problem-based learning is case-based education from day one. So when the students come in and they're learning about a fifty-four year old with a chest pain, it it's more than just the symptom and the diagnosis, it's a delving into a lifestyle and the nutritional component that goes with it. So we have to, we do have nutrition in our programs, and we have with each case the nutritional components that go along with it. We have committed to expanding our our curriculum already, uh we're very proud of what we have but we're gonna expand it even further. And it it's really a refocusing on prevention instead of reactive medicine. It's much more expensive to treat the heart attack. It's much more expensive in the terms of their quality of life after they've had a heart attack than it is to prevent it in the first place. So that's really the focus i- and how we give it to our students so that they understand that each de- uh disease process is not only treatable but preventable.