Is Ozempic as Magical as It Sounds?
In a wide-ranging conversation with Ezekiel Emanuel, the policymaking physician, we discuss the massive effects of GLP-1 drugs — and what a second Trump term means for healthcare policy.
On this week’s episode of Freakonomics Radio, we talk to Ezekiel Emanuel, who is an oncologist, a medical ethicist, a professor, and a healthcare policymaker: He helped design the Affordable Care Act, better known as Obamacare, and also worked on healthcare policy in the Trump White House.
If his last name sounds familiar to you, that may be because you’ve heard his brothers on the show: Rahm Emanuel, a former Obama chief of staff and Chicago mayor (who was U.S. ambassador to Japan when we last interviewed him); and Ariel Emanuel, who runs the entertainment-and-sports firms Endeavor and TKO.
Zeke is the oldest of the Brothers Emanuel, and I wanted to speak with him about the state of American healthcare, and particularly the new class of GLP-1 drugs, like Ozempic and Wegovy, that may be about to upend it.
These drugs were developed to treat Type 2 diabetes. What made them blockbusters is that they’re also effective at helping people lose weight. But, as Emanuel tells us, that’s just the beginning: There’s evidence that they can protect patients from heart attack, stroke , kidney disease, cirrhosis, addiction, depression, and even cancer. They’re also expensive — more than $1,000 a month in the U.S. — which raises the question of who should have access to them.
When I started doing that research, my thinking was, it’s got to be the diabetic patients — they’re going to benefit the most. Well, who loses the most years of life? It turns out it’s the people with obesity, and they’re the people who are going to benefit the most from these drugs.
But as we've seen in the response to the killing of UnitedHealthcare C.E.O Brian Thompson, our healthcare system doesn’t always allocate scarce resources to the people who need them most.
Most insurance companies don’t want to cover it because it’s a big expense. The consequence is, who’s getting GLP-1s? Rich people.
You might think insurance companies would be eager to cover drugs that have so many benefits, in hopes of saving money over the long run. But that’s not how it works.
It’s not in the healthcare system’s interest to make those long-term cost savings. Say you’re sitting at United, or Humana, or a Blue Cross and Blue Shield. You have a person who you’re insuring. You’re going to spend money today for them, and the payoff’s going to dribble out in five, six, seven years. The problem is, by the time the cost savings come, they’re no longer being insured by you. The churn is so much in the insurance market that the investment horizon tends to be one year, maximum two years. We’ve created a system that perfectly disincentivizes long-term investments.
I asked Emanuel how healthcare policy might change in the upcoming Trump administration:
If I were a betting man, having worked with Donald Trump: This isn’t going to be a priority of his. He may make another run at repealing the Affordable Care Act, but that’s a joke, it’s not going to happen. Even Republicans want everyone to have health insurance. We’re not repealing the Affordable Care Act.
And we revisited a controversial essay Emanuel wrote for The Atlantic a decade ago, in which he said he’s turning down life-saving treatments once he turns 75:
People are, “Oh, the golden years!” And all the advertisements for Medicare Advantage health plans make the golden years look like I’m hiking in Montana, and beautiful vistas, and all that. That’s not what they’re like. What happens for most people is that they end up watching a lot more TV. They tend to be homebound. They get a lot of disabilities over time. That seems like a very passive life. I’m not a passive person, and I don’t think anyone wants to or should want to be a passive person.
Emanuel recently turned 67, so he still has plenty of runway. He’ll be spending some of that time working on his interpersonal skills:
I think one of my deficits, if I had to put it this way, is I can be slightly not-sufficiently-empathetic. I can be a little too dismissive. And I would like to improve those. I’d like to be more empathetic to the people around me and the people I talk to, and decrease the sarcasm in my responses.
Give this episode a listen and let me know if you think he is achieving his goals.
You can hear this week’s episode of Freakonomics Radio, “Is Ozempic as Magical as It Sounds?”, on Apple Podcasts, Spotify, or wherever you listen to podcasts. A full transcript is available on our website.
I want to also let you know that Freakonomics Radio is coming to California in 2025. We have two live shows — one in San Francisco on January 3rd and the other in Los Angeles on February 13th. For tickets, go to freakonomics.com/liveshows. I’ll be there — and I hope you will too.
Also on the Freakonomics Radio Network this week
People I (Mostly) Admire: Is There a Fair Way to Divide Us?
Moon Duchin is a math professor at Cornell University whose theoretical work has practical applications for voting and democracy. Why is striving for fair elections so difficult?
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No Stupid Questions: What Makes an Idea Interesting?
What do Karl Marx, Sigmund Freud, and Malcolm Gladwell have in common? Are interesting theories more significant than true ones? And what has been keeping Angela up at night? Plus: an important announcement about the show.
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The Economics of Everyday Things: Used Bookstores
Americans throw away 320 million books every year. How do some of them find a second life? Zachary Crockett is just browsing.
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The list of magical and miracle drugs is endless. Yet, humans are sicker than ever. Never allow government or any pretend health agency to dictate your health parameters.