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00:00the largest U.S. base in the Middle East. They've done it before in bases in Iraq,

00:05in Syria, and elsewhere, but they went after Qatar. They brought Qatar into it. Were you surprised?

00:10Well, they had to bring somebody into it, and it's interesting that they didn't go to the UAE,

00:14where the U.S., where the Fifth Fleet is based, in part because the UAE has better relations

00:20with Israel, perhaps, and Qatar does not have as warm relations with Israel. And add to the fact

00:25that maybe they felt that, you know, the proximity of Qatar to where the missiles launched from

00:29and the ability of the Qataris to be able to intercept these missiles, maybe it was much

00:34more isolated, less likely that anything could go wrong. I mean, all of these things would factor in.

00:39And probably Iran felt, given that we've seen statements from Qatar in the past few days,

00:44talking about the brotherly love between the two nations, maybe Iran felt that this was the one

00:50quote-unquote ally with whom it had enough wiggle room to be able to do something like this. But

00:55even still, this is Iran attacking a sovereign state that was not involved in this conflict

01:00whatsoever. Yeah, I want to get to, lastly here, the question of regime change in Iran.

01:05President Trump brought the term up in a post on True Social over the weekend,

01:10seemingly kind of opening the door to that very notion vis-a-vis Iran. Vice President Vance was

01:16asked about it, kind of closing the door yet again here. With the ceasefire, do you think that

01:21that's now off the table, that the notion of a regime change in Iran will be considered by Israel,

01:28the U.S., others, or not? And I always say that, I only ask this, because do we know where the Ayatollah

01:35is? I mean, who made the call today? Who ultimately decided that they're going to participate in a

01:40ceasefire with Israel? Who in Iran is calling the shots right now?

01:45If the Ayatollah is still alive, and we have no indication that he isn't, he would be the one,

01:49the ultimate authority to sign off on a ceasefire. But it's interesting that we weren't able to hear

01:53from him earlier when early proposals were made, when the decision to fire Qatar was made that had

01:59to come with the approval of the Supreme Leader. But I want to come back to this idea of regime

02:04change. Regime change can be imposed from without, but it only endures from within, meaning

02:10other countries can come in, they can topple a government, they can impose a new government of

02:15their own. But for that government to endure, for it to take hold, for it to become an organic

02:19part of the society and the fabric of the people, it needs to have popular support, it needs to be

02:25homegrown to some extent, it needs to originate in some form from within and have the support of the

02:31public. Absent that, all of this talk about regime change is really just speculative folly. And I think

02:39that's where it needs to stay. You know, Benjamin, these Iranian figures that so many of us have now

02:45learned their names. One of whom has somewhat been absent in all of this, and correct me if I'm wrong

02:51here, but the Iranian president, Mahmoud Pazeshkian. He was just elected last year, and elected is a

02:58liberal term I'm using. After the death of his predecessor, Ebrahim Raisi, in a helicopter crash,

03:05where is he in all of this? We've heard the IRGC commanders that have been taken out, members of the

03:10Iranian Air Force, the Iranian foreign minister, the Iranian ambassador to the UN. All their names

03:16have been in the mix. The Ayatollah, of course. Where's he? Yeah, and this, you ask a great question,

03:22and this only underscores the sort of the bizarre system that is the Islamic Republic and the

03:27dysfunction of the different powers and branches in government. So under the system of the Islamic

03:33Republic, the supreme leader is, and the IRGC who he oversees, are in charge of Iran's national

03:40defense against outsiders, and also the supreme leader dictates and determines foreign policy.

03:46The president is really responsible for managing domestic affairs, and even then the supreme

03:50leader will have the ultimate say. So really, you have a position that is sort of a nominal token

03:57political position that is, you know, semi-democratically elected. Again, as you mentioned, it, you know,

04:03to what extent is always up for debate, and with extremely limited powers and virtually none when it

04:08comes to national defense, foreign relations and diplomacy, all of that more or less goes through

04:14folks that are picked or curated by the supreme leader or the supreme leader himself. So it's not

04:21a surprise, because the president is a non-factor in all matters of foreign relations.

04:26I guess hindsight's 20-20. Lastly, though, have you been surprised, knowing how weakened the regime is

04:32in Iran, that they decided multiple times a day to counterattack Israeli sites and targets for the

04:42last 12 days? Did you think they had that in them? Did you anticipate that to be their response?

04:49I was surprised, though in hindsight I shouldn't have been, at the capacity they had at their arsenal

04:56of ballistic missiles. And just when we thought maybe they had exhausted it, again, we thought they

05:00were done because they were not attacking U.S. planes flying overhead or Israeli jets flying into

05:05Iranian airspace, and yet we see this sort of last salvo of the last few hours and the devastation

05:11they can cause. What is notable but not surprising is that their proxies were all but non-existent.

05:18I'm talking about Hezbollah, Hamas, the Houthis. They were non-factors in this. So what we saw was a

05:23failure of Iran to live up to the boasts and the claims that it made, that it projected outwardly,

05:29that it made to its people, that it made to the international community, about its ability to

05:32defend its territory and to protect its leadership. It failed, I mean, on all fronts in that sense of

05:38the term. Was it able to inflict damage on Israel? Indeed, we saw that within the last hour, but

05:44nowhere near what it said it would do. Do you think, though, that feeling is felt inside Iran?

05:50Absolutely. A sense of failure?

05:51Absolutely. I mean, there's going to be a reckoning and an accounting for this.

05:56There is the absence of leaders who, you know, you have a vacuum of leadership for those who were

06:01killed and then those who are still alive and have to now justify their failure and their inaction and

06:07inability to live up to the promises they had been making for decades about the strength of their

06:11military, the strength of their armed forces, of the IRGC, of the state to withstand attacks of this

06:18kind. All of it was just fiction.

06:21I see. Benjamin Rad, we're going to leave it at that. I can't thank you enough. I'm sure we'll be

06:25talking soon.

06:26Thank you very much.

06:28Okay, in the meantime here, let's get in our final break of this hour. Still a lot more to get to

06:33when we come back.

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07:31I'll see you next week.

07:32Take care.

07:33Thank you very much.

08:47We have a new hour, almost 9 o'clock here on the West Coast, almost midnight there on the East Coast.

08:52Well, I want to kind of diverge briefly from all of the goings-on in the Middle East and get out to some news on health policy, courtesy of RFK Jr., HHS secretary, and his CMS administrator, Dr. Mehmet Oz.

09:08Before you hear from them making an announcement on health insurance policy, I want to put up this tweet here from Senator Bill Cassidy.

09:16He's the Republican of Louisiana, and he's chairman of the Senate Health Committee.

09:20And remember, the news we brought you some weeks ago, that RFK Jr. had ousted, fired all 17 members of this outside advisory panel at the CDC on vaccine safety.

09:33Well, RFK Jr. has replaced some of those individuals on that panel, and Cassidy is responding to that, saying,

09:40Although the appointees to ACIP have scientific credentials, many do not have significant experience studying microbiology, epidemiology, or immunology.

09:51In particular, some lack experience studying new technologies, such as mRNA vaccines, and may even have a preconceived bias against them.

09:58Robust and transparent scientific discussion is important, so long as it is rooted in evidence and understanding.

10:06Wednesday's meeting should not proceed with a relatively small panel, and no CDC director in place to approve the panel's recommendations.

10:13The meeting should be delayed until the panel is fully staffed, with more robust and balanced representation as required by law,

10:21including those with more direct, relevant expertise.

10:23Otherwise, ACIP's recommendations could be viewed with skepticism, which will work against the success of this administration's efforts.

10:32So, Bill Cassidy, the senator there, really going after some of the new members on what is known as the ACIP.

10:40It's the Advisory Committee on Immunization Practices.

10:43Remember, RFK Jr. ousted the previous committee and filled some of his supporters' acolytes and those who are in the same vein of his thinking when it comes to vaccines on it.

10:56Bill Cassidy is saying that that is insufficient by law, and the committee should not meet on Wednesday, as it is supposed to do.

11:05All right, in the meantime, back out live there to the White House.

11:07Speaking of RFK Jr. and Dr. Oz, you're about to listen to them make this announcement, announcing a voluntary agreement with insurance companies to change prior authorization practices,

11:18where private health insurers require patients to ask for permission before they can receive medical treatment.

11:25Let's listen.

11:28...issue in your family.

11:30Show of hands.

11:32It's about reflective of the national average.

11:34Eighty-five percent of Americans say they've had pre-auth effective in ways they wish it hadn't.

11:40It's the number one complaint, not only from patients, but providers, doctors like myself, are continually struggling with this issue.

11:46We have spoken frequently about how Health and Human Services and the agency in charge of Medicare and Medicaid and the insurance plan, CMS, is open for business.

11:56We like to have private solutions when they're feasible.

11:58And today, you're going to hear about one of the biggest ones possible, one that will address this issue of prior authorization.

12:05In 2023, the last year for which we have strong data, the Medicare Advantage program, which administers care to – total Medicare is about 68 million people.

12:18Half of that is Medicare Advantage, so it's 32 million people, a lot of folks, partially or fully denied 3.2 million claims, initial requests for prior authorization.

12:29It's a lot of people, not just numbers.

12:31Those are individuals who often, in the most vulnerable time in their lives, needed something done, and it was denied for one reason or another.

12:38Each week, on average, a physician handles about 40 of these pre-authorization issues and requests, and spends about 12 hours a week on paperwork in general, often aimed at addressing the prior authorization issue.

12:51It frustrates doctors.

12:53It sometimes results in care that is significantly delayed.

12:56It erodes public trust in the health care system.

12:59It's something that we can't tolerate.

13:00This administration, and under the leadership of Secretary Kennedy, this agency has not wanted and has been expressing its frustration.

13:08And for good reason, because of that, and because of folks who actually maybe entered into the industry because they had the right motivations at heart, we have just concluded a roundtable, one of the most impressive that I've been involved in, with the CEOs who represent about 75% of all covered lives in America.

13:27These folks represent the insurance companies that cover three-quarters of the American people, and it covers them across Medicare Advantage, across Medicaid, across commercial insurance, about 260 million people in general, in total, covered by these plans.

13:41And there were more people being added while we were in the meeting.

13:44That's how much interest there is from industry in dealing with a problem that they don't like to have in their bailiwick either.

13:50These executives explain why they are signing this pre-authorization pledge to restore common sense to the process.

13:58Now, we've spoken to these folks and others in industry about the desire for them to maybe adopt a different strategy, one that actually is discussed in the Bible and that says the meek shall inherit the earth.

14:09And I always grew up thinking meek meant weak, but that's not what meek means.

14:13Meek means you have a sharp sword, a sword that could do real damage to people around you, but you decide electively to sheathe that sword and put it away for a while so you can do goods, so you can do important things where once in a while we have to get together, even if we're competitors, and agree.

14:28And that's what these insurance companies and hospital systems have done.

14:31They've agreed to sheathe their swords to be meek for a while to come up with a better solution to a problem that plagues us all.

14:37And this transition that's not happening, this teaching that's sort of spreading, is beginning to catch fire in part because this administration has pushed so hard on these issues.

14:48We're hearing very innovative ideas.

14:50For example, could we allow some physicians to be gold card physicians because they're so good at making the right care for the right patient that maybe they don't have to go through a pre-authorization.

14:59There's some systems that don't even do pre-authorizations because they have already evolved into having ways of giving feedback to doctors so they learn when they're ordering tests and medications that aren't the right solution to a particular problem so they don't repeat those errors.

15:15At its best, that's what pre-authorization sought to do, but that's not what it's doing anymore.

15:20So for that reason, the pledge.

15:21And some of the highlights are in this chart to my right so you can at least follow along.

15:26But I'll mention the top three issues that we're focused on.

15:30The first is timely access for patients.

15:33This is a critical issue because imagine you're in a doctor's office and you've got a bad diagnosis and there's a procedure or a test or a treatment that you think is right for you.

15:40And you find out that you can't start that treatment for sometimes weeks, even longer.

15:45It's more frustrating than anything else in the process because at least that's something you do control.

15:50You don't control much else when you're in a physician's office with that kind of a crisis.

15:55And yet it's withheld.

15:55And these approvals with this new pledge will be streamlined.

15:59It will happen very quickly.

16:01Necessary care will be delivered when it's needed in the right way.

16:05So you get both quality and you'll get timing, which goes along with that quality.

16:09And you won't get that treatment after all the paperwork clears.

16:12You'll just get it because there won't be paperwork.

16:14We'll be streamlining it.

16:16Patients should not be waiting because bureaucratic hurdles are blocking their critical treatment.

16:21Second big issue is to make sure that we are saving the system with efficiency.

16:26I bring that up because one of the biggest challenges we have within CMS, which is, again, Medicare, Medicaid, the exchanges, is that it's an inefficient process by which we do things, by which we give feedback, by which we send bills and collect.

16:38The red tape creates massive problems.

16:41We want less red tape.

16:43And if we do that, we can cut tens of billions of dollars of administrative waste.

16:47It's a lot of money that we throw at solutions that don't work for us because we haven't built a digital infrastructure that's being addressed.

16:54With less red tape, that means more resources for patients, which is part of the reason these major companies got together, working together with the Health and Human Services Agency to try to take a shot at the pre-auth process.

17:07We'll standardize.

17:09We'll harmonize.

17:10We'll get folks talking together.

17:12And the pre-authorization process, if it's done correctly, for ongoing procedures, for medications and the like, will create a seamless relationship between patients and providers, which is the whole goal in the first place,

17:21to allow them to free them to get across the finish line with their treatment plans, but to do it together with the insurance entities, the folks that are responsible for these different plans.

17:32And thirdly, transparency.

17:34And transparency comes with accountability.

17:36If you now know what's going on, you now have the responsibility of dealing with it.

17:41We have common data standards.

17:43They're going to be adopted.

17:44And public dashboards are going to reveal to you and to patients what's going on.

17:49So we'll be able to audit if this is really happening, because although we're hopeful, this is hard to do.

17:54And folks sometimes change their mind.

17:55We don't want that to happen.

17:56So we're going to trust but verify by having this transparency and accountability.

18:01All the stakeholders, the payers, the providers, the patients are going to see real-world performance.

18:06And by having that, they'll be able to assess whether this is clearly and consistently accomplished.

18:12Now, the pledge is not a mandate.

18:14This is not a bill, a rule.

18:17This is not legislated.

18:18This is an opportunity for industry to show itself.

18:21Participation is voluntary.

18:23But by the fact that three-quarters of the patients in the country are already covered by participants in this pledge, it's a good start.

18:28And the response has been overwhelming, gratifyingly so.

18:32The effort took place with the government as a sponsor, as a steward, as a cheerleader.

18:37It was led by wonderful people who realized that we had an opportunity to do good.

18:42And that government, you don't have to always do it yourself.

18:44You can use the power to convene to pull together powerful interests.

18:47We have discussed extensively with individual physicians this idea.

18:51We've talked about it with health systems, with associations, with congressional partners.

18:54You'll hear from some of them in a moment.

18:56CMS is going to publish the full list of participating plans later this summer with some details of how it's going to roll out.

19:03And the initial commitments, like, for example, code reductions, the number of procedures that would have to be subjugated to preauthorization or similar limitations, the continuity of care protections to make sure that you don't lose coverage when you switch between plans.

19:17It's going to go live by January 26th.

19:20It's a fast timeline.

19:21But in seven months, we'll be able to give to the American people something they've been asking for, something that's been in the news recently because of the difficulty of obtaining it, which is the freedom from prior authorization when used incorrectly.

19:34So what's the blueprint for broader reform?

19:37Because we see this as the first of a much larger opportunity.

19:40This is getting everyone together on a pain point, a thorn in everyone's side, a pebble in our shoes.

19:45But the real opportunity is use this as the first and very important step in building a larger blueprint because it's not just about prior authorization.

19:53It's a template for administrative simplification to take the paperwork out of the process and put patients over paperwork.

20:00There is going to be a single FIRE-based electronic workflow.

20:04FIRE is a fast healthcare interoperability resource, so it's a standardized way for information exchange across systems.

20:11We'll have real-time decision-making for most electronic requests by 2027.

20:15We're going to have to work with providers, with doctors, many of whom, maybe half potentially, aren't using these kinds of technologies routinely in their office practice when they interact with insurers.

20:26We want that to change.

20:27We don't have a slowing down of the process.

20:29There shouldn't be paper.

20:31There shouldn't be faxes.

20:32There shouldn't be letters being sent.

20:34They should all be done digitally and automatically.

20:36And 90-day continuity should exist for authorizations when patients switch insurers.

20:41So you never fall through the cracks.

20:42Again, another pain point that many patient groups are bringing to us.

20:46The future is a system where carriers compete on value and outcomes.

20:51They compete on value and outcomes.

20:52They do not compete on issues like confusing portals and who can obfuscate the most and delay the process the most.

21:00That's not how they want to win, and that's not how they're going to win.

21:03We want to recognize the insurers who have done this, and they have stepped up.

21:07They're sharing data in ways that we are very honored by.

21:11They're willing to be meek in the process in ways that we had not even initially anticipated.

21:18They're accepting performance targets.

21:20They're offering commitments that go just beyond the profits that are involved in this process,

21:25although we're hopeful that we'll actually save some money through this process,

21:28because we won't be wasting the amount of money that is often spent unnecessarily when documents are sent back and forth,

21:36taking up precious time without changing the overarching results.

21:39All right, Dr. Mehmet Ozder, the administrator of EMS, that's the Center for Medicare and Medicaid Services,

21:48alongside his boss, RFK Jr., the HHS secretary, announcing this change on health insurance policy.

21:56All right, I'm Andrew Kraft.

21:58We do want to take a quick commercial break, and then when we come back,

22:01we'll get into some of these stories that we have shown you and told you throughout the day.

22:05But first, a preview of what's in store for our live coverage tomorrow.

22:09Of course, we still have these vantage points in and around Israel at the moment,

22:14live in Tel Aviv, Jerusalem, and in southern Israel, looking into the Gaza Strip,

22:18as we monitor whether or not the ceasefire President Trump announced earlier this afternoon is holding,

22:27whether any Israeli officials will publicly acknowledge they are party to the ceasefire.

22:33Iranian officials have officially weighed in on the fact that they're part of it.

22:40And we have been bringing you these scenes over Israeli skies of some of the last iterations, hopefully,

22:50of the Iranian drones and missiles that have been launched.

22:54It's being reported that in the latest salvo, some were quite destructive and quite deadly in parts of southern Israel, we're hearing.

23:04So in the meantime,

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