The $100 Billion Loophole: Why 340B Reform is Essential

R Street Institute's Jeffrey Smith Says Tobacco Harm Reduction Policy Should Focus on Science, Not Perception

On this episode of the Health Policy Podcast, Jeffrey Smith, resident senior fellow at the R Street Institute, discussed tobacco harm reduction, vaping policy, nicotine products and the role of science in shaping FDA regulation. Smith explained how his background in neuroscience and neuroplasticity led him to study nicotine and reduced-risk tobacco products, including vaping devices and nicotine pouches. Smith said combustible cigarettes remain the most dangerous nicotine delivery system and argued that reduced-risk products such as electronic nicotine delivery systems (ENDS), nicotine pouches and Swedish-style snus may help adult smokers move away from smoking-related disease. He discussed the FDA's evolving approach to vaping regulation, public confusion around nicotine products and the debate over flavored vaping products. The conversation also explored declining youth smoking rates, the political controversy surrounding vaping policy and why Smith believes policymakers should focus on scientific evidence and consumer behavior when crafting tobacco harm reduction regulations. Smith said the United States still sees roughly 500,000 smoking-related deaths annually and argued that innovation and consumer choice could play a role in reducing those numbers over time.

Patient's Rising's Terry Wilcox: The gap between FDA approval and patient access for Alzheimer's treatments

Terry Wilcox, Co-founder and CEO of Patients Rising, discusses the critical gap between FDA approval and patient access for new early-onset Alzheimer's treatments. She shares personal insights from her experience as a caregiver and explains how the ASAP Act aims to fix the policy hurdles preventing families from accessing life-changing innovation.

American Commitment's Phil Kerpen: The Hidden Drivers of Hospital Consolidation

Phil Kerpen, President of American Commitment, joins the show to discuss why hospitals often escape public blame for rising healthcare costs despite vertical price increases. He explains how tax-exempt status, "facility fees," and the consolidation of independent physician groups have eroded competition. The conversation also explores the massive lobbying power of health systems and how federal regulations like the medical loss ratio inadvertently incentivize higher spending.

Dr. Jeremy Levin: Why Biotech Is Not Big Pharma

Dr. Jeremy Levin, author of 'Biotech in the Balance,' explains why small biotech firms—not Big Pharma—are the true engines of medical discovery. He discusses the sector's unique capital risks and the growing public distrust that threatens the future of American innovation.

The $100 Billion Loophole: Why 340B Reform is Essential

Economist Wayne Winegarden joins the podcast to expose how the 340B Drug Discount Program evolved from a small safety net for rural clinics into a \$100 billion revenue engine for massive hospital systems. He explores how misaligned incentives drive up drug spending, fuel hospital consolidation, and why transparency is the first step toward reform.