UTSA Life Insurance Finance Classes 16 and 17, October 20 and 22, 2026

Overview

Professor Sweet uses health-care spending and patient outcomes to examine how weak data, financial incentives, and fragmented oversight contribute to overdiagnosis, unnecessary treatment, fraud, and high costs. Examples range from PSA screening and antidepressants to GLP-1 drugs, cesarean delivery, pharmacy benefit managers, end-of-life care, and surprise medical bills, with recurring attention to how AI, prevention, and better-aligned incentives might help.

Key takeaways

Screening does not automatically improve outcomes: the cited prostate cancer trial required 293 invitations to screening to prevent one death, while false positives and treatment complications exposed many men to harm.
Reliable health-care decisions depend on complete data; selective publication of antidepressant trials and uncertain patient-level outcomes make it difficult to know who benefits from screening or medication.
Consolidation makes health-care markets harder to assess: the cited figures place three PBMs at 80% of prescription drugs and three wholesalers at 92% of drug distribution, while vertical integration can raise prices without improving quality.
GLP-1 drugs may reduce obesity-related disease, but muscle loss, side effects, weight regain after stopping, and potentially lifelong costs complicate claims that they will reduce total spending.
End-of-life treatment can conflict with patient preferences: cited research found hospice patients often lived as long as or longer than patients receiving aggressive treatment, while more than 80% of patients said they wanted to avoid high-intensity care near death.
Financial incentives shape care choices: hospitals and clinicians are often paid for procedures rather than prevention or conversation, while exercise and patient-centered end-of-life planning may receive less institutional support.

Chapters

0:00 Paper Preparation and the Overdiagnosis Assignment

Professor Sweet encourages students to draft their health-care paper early and gives overdiagnosis extra weight because it is a major problem.
A recommended documentary examines prostate cancer, cesarean sections, breast cancer, and elderly care.
Screening can uncover indolent diseases that would never cause harm, yet clinicians may feel pressure to treat them.

5:00 PSA Screening: Benefits, Harms, and Unknowns

A prostate cancer trial found that 293 men needed to be invited for screening to prevent one death, compared with 320 for lung cancer screening.
PSA screening can lead to surgery or radiation with lasting side effects, and newer nerve-sparing procedures may cost substantially more.
The central challenge is that clinicians cannot reliably identify in advance who will benefit from screening and who will be harmed.

10:00 Prostate Cancer Overtreatment and Active Surveillance

The transcript cites a PSA false-positive rate of about 75% and a false-negative rate of about 15%, underscoring the test's limitations.
A British trial found roughly 97% 15-year survival for localized prostate cancer whether patients chose surgery, radiation, or no initial treatment.
Active surveillance can avoid immediate treatment for slow-growing cancers, though anxiety about a cancer diagnosis can make monitoring difficult.

15:00 Antidepressants, Placebo Effects, and Missing Trial Data

The cited article estimates that 10% to 15% of U.S. adults use antidepressants, and one quarter of users have taken them for at least a decade.
Long-term use can raise risks including falls, internal bleeding, strokes, and withdrawal symptoms; some drugs have also been linked to pregnancy risks.
Selective publication of favorable drug trials can bias reviews, while the cited research found substantial benefits beyond placebo for about 15% of patients.

20:00 Personalized Prescribing and AI's Potential Role

Initial SSRI selection is often trial and error, with a replacement chosen after several weeks if the first medication does not help.
AI could help develop personalized predictions using clinical outcomes and genetic or cellular data, if researchers collect reliable data.
Treatment decisions also need to account for how long a patient takes a drug and the risks of stopping it.

25:00 International Health-Care Quality and Spending Comparisons

A Commonwealth Fund chart discussed in class ranked the United Kingdom highly on quality and low on cost, while the United States spent the most.
Professor Sweet cautions that the comparison is around a decade old and that measures such as coordinated or patient-centered care are difficult to rank.
The class is encouraged to find more current international comparisons for the paper.

30:00 Health-Care Fraud, Waste, and Weak Oversight

The cited material describes U.S. health-care spending in the trillions and notes that the total amount lost to fraud is difficult to establish.
One article claims the federal government recovers eight dollars for every dollar spent on health-care fraud enforcement.
Medical records can be more valuable to criminals than credit-card numbers, and Medicare's enormous claims volume complicates oversight.

35:00 PBMs and the Expanding Health-Care Middleman Business

Pharmacy benefit managers, insurers, distributors, and other intermediaries have expanded their role between patients and treatment.
The cited figures put revenue for nine major intermediaries at nearly 45% of health-care revenue in 2022, up from 25% in 2013.
Professor Sweet flags PBMs as a potential source of added cost and limited patient value, while noting that their role requires further investigation.

40:00 Market Concentration and Vertical Integration in Health Care

The cited market figures describe three PBMs controlling 80% of prescription drugs and three wholesalers handling 92% of drug flows.
CVS's ownership of Aetna illustrates how mergers blur the boundaries between health care and financial services.
Kaiser Permanente is presented as an integrated-care model, but studies cited in class found hospital acquisitions of physician practices can raise prices without improving quality.

45:00 Health-Care Competition and Direct-to-Consumer Alternatives

Mark Cuban Cost Plus Drug Company aims to bypass intermediaries by selling generic medicines directly at a fixed markup.
Amazon, JPMorgan Chase, and Berkshire Hathaway launched Haven, which did not achieve its ambitions, while Amazon and Costco continue exploring health care.
New entrants could improve customer experience, but established health-care organizations remain powerful and difficult to displace.

50:00 GLP-1 Drugs: Potential Health Gains and High Costs

GLP-1 drugs could affect obesity-related health costs and workplace productivity, but their overall cost-effectiveness remains uncertain.
The cited estimate says about 70% of Americans are overweight, while Professor Sweet questions some projections about future obesity rates.
Coverage eligibility, side effects, patient adherence, and weight regain after stopping treatment all affect the drugs' real-world value.

55:00 Ozempic, Eli Lilly, and the GLP-1 Market

GLP-1 medicines were developed for diabetes; their weight-loss effects became apparent as patients lost weight during treatment.
A clinical trial cited in class found average weight loss of about 15% among overweight or obese patients.
The discussion identifies Eli Lilly and Novo Nordisk as major competitors and describes rapid growth in Eli Lilly's stock as investor expectations rose.

1:00:00 GLP-1 Side Effects, Muscle Loss, and Long-Term Use

Patients can lose both fat and lean muscle on GLP-1 drugs, with muscle loss a particular concern for older adults and bone health.
Weight often returns after treatment stops, creating the possibility of long-term use of a costly medication.
The cited market forecast estimates annual sales of $80 billion, while researchers explore pills and other options to make treatment more convenient.

1:05:00 Obesity, Food Environments, and Weight-Loss Challenges

Obesity is linked in the cited material to diabetes, heart disease, stroke, some cancers, and millions of deaths annually.
Diet and exercise attempts produce sustained weight loss for only a minority of people, and the Biggest Loser follow-up study found contestants' metabolisms remained slower six years later.
Professor Sweet raises processed foods, food-industry incentives, genetics, and sedentary lifestyles as possible contributors rather than attributing obesity to a lack of discipline.

1:10:00 Exercise Intensity and Conflicting Health Advice

The class discusses research suggesting that short, intense exercise may provide substantial benefits compared with longer, lower-intensity activity.
Advice about foods such as grapes and almonds can conflict, making reliable evidence and clear guidance important.
Professor Sweet describes treating everyday spaces, including stairs and airport steps, as opportunities for physical activity.

1:15:00 Cesarean Rates, Medical Need, and Overuse

The cited figures show cesarean deliveries rising from 12% of births in 2000 to 21% in 2015 globally, with rates of 32% in the United States and 44% in Latin America and the Caribbean.
The World Health Organization stated that there is no justification for regional rates above 10% to 15%, though the appropriate rate depends on medical need.
Cesareans can save lives, but unnecessary procedures can increase risks such as infection and heavy postpartum bleeding.

1:20:00 Cesarean Incentives and Hospital Variation

The class cites cesarean rates ranging from 7% to 70% among U.S. hospitals, raising questions about differences in patient populations and practice patterns.
Scheduled surgery can be more convenient and profitable than waiting for natural labor, while malpractice fears can influence obstetricians' choices.
A cited chart suggests mortality benefits flatten beyond roughly 10% to 15% cesarean rates, while very low rates in some regions may reflect inadequate access to emergency care.

1:25:00 Drug Prices, Medicare Negotiation, and Opioid Marketing

The class notes the EpiPen's price rose from about $100 to $608 and contrasts U.S. drug pricing with government price controls in Europe.
The Inflation Reduction Act of 2022 authorized Medicare negotiation for selected Part D drugs, with initial negotiated prices scheduled to take effect in 2026.
Opioid litigation alleged that companies including Johnson & Johnson used aggressive marketing and distribution practices that contributed to addiction and the U.S. opioid crisis.

1:30:00 Employer Programs for Healthier Lifestyles

The next paper topic considers how employers and society can encourage healthier eating and exercise.
Examples include on-site gyms, subsidized memberships, group exercise, bike racks, active commuting, and activity breaks for remote workers.
Japan is proposed as a comparison case because walking, public transit, school practices, and daily routines may support healthier habits.

1:35:00 Safeway and USAA: Incentivizing Employee Health

Safeway's wellness program aimed to keep health-care costs flat by encouraging employees to improve health behaviors.
USAA used workplace food pricing and subsidies to steer employees toward healthier meals and considered the potential productivity benefits.
The class debates incentives such as premium discounts, while raising concerns about employer monitoring of smoking, weight, blood pressure, and cholesterol.

1:40:00 Paying for Exercise Instead of Medication

A cited review found exercise interventions can perform comparably to drugs for coronary heart disease and may outperform some drugs for stroke outcomes.
Exercise is often inexpensive and has few side effects, but an inactive person can be injured by starting too intensely.
The class considers whether employers or insurers could pay people to exercise, potentially avoiding annual medications costing $10,000 to $20,000.

1:45:00 French Health Care and International Lifestyle Comparisons

The cited comparison says France spends about 12% of GDP on health care versus roughly 17% in the United States, while French residents live about six years longer.
France combines public coverage with employer-provided supplementary insurance and uses government fee caps for many doctors.
Students are encouraged to compare countries such as France, Japan, and Costa Rica and ask which health or system practices could transfer to the United States.

1:50:00 End-of-Life Care as a Medical and Allocation Decision

A case discussed in class describes Medicare spending more than $1 million to maintain an elderly woman with no meaningful brain activity for several months.
The case raises difficult questions about whether family members, clinicians, hospitals, or Medicare should determine when treatment stops.
The discussion frames end-of-life spending as an allocation choice involving quality of life, patient autonomy, and the possibility of using resources elsewhere.

1:55:00 Atul Gawande's On Being Mortal and Patient Autonomy

Atul Gawande's On Being Mortal argues that protecting older adults from every risk can strip away autonomy and the experiences they value.
Professor Sweet discusses allowing an older adult to keep a pet or make other personal choices even when those choices carry some risk.
The central question is whether medicine should prioritize living longer or preserving comfort, independence, and quality of life.

2:00:00 Hospice, Palliative Care, and Hospitalization Risks

The cited studies found hospice patients lived at least as long as patients receiving traditional aggressive care, and some studies found they lived longer.
About one third of patients over 70 and more than half of patients over 85 leave the hospital more disabled than when they arrived.
Hospital bed rest, sleep disruption, restrictive equipment, redundant medications, and procedures can worsen older patients' health.

2:05:00 Living Wills, CPR, and Doctors' Treatment Preferences

The class cites a survey in which more than 80% of patients said they wanted to avoid hospitalization and high-intensity treatment near the end of life, though preferences are often overridden.
Physicians are more likely to choose do-not-resuscitate orders for themselves when terminally ill than to recommend similarly aggressive care for patients.
Advance directives can help communicate preferences, but the Self-Determination Act requires hospitals to inform patients about directives rather than guaranteeing they will be followed.

2:10:00 Assisted Dying, Medicare, and Aging-Population Costs

The discussion compares assisted-dying debates in the United Kingdom, Oregon, and Canada, where Medical Assistance in Dying is known as MAID.
The class notes that a large share of lifetime medical spending occurs in the final months of life, a pressure that will grow as populations age.
Professor Sweet asks whether Medicare should set limits on procedures for very elderly patients, while emphasizing that such policies involve ethically contentious tradeoffs.

2:15:00 Surprise Medical Bills and the No Surprises Act

Examples include a $117,000 bill from a surgeon a patient did not remember meeting and a patient asked to sign a financial consent form while being wheeled into surgery.
Air ambulances can leave patients with bills exceeding $20,000, and the transcript cites a median charge above $38,000.
The federal No Surprises Act restricts many out-of-network surprise bills, but students are encouraged to investigate how effective the law is and what gaps remain.

Transcript excerpt

0:00 All right, let's start. >> [clears throat] >> I had lunch today with the tree capital and they have an intern. Probably doesn't apply to this group, but if anyone's graduating December 27th or later, let me know. If you're graduating before that, you're a little too late for interns anyway, but if you're interested, we have a really really good uh relationship with them. And last night we did our first stock pitch competition with HEB. We're trying to strengthen relationships with employers all around town, so that that event went really really well. All right, so we're going to be moving a little faster now. I encourage you really spend the next couple weeks building this paper, getting the parts that you have written. We'll be going

0:46 moving at a faster pace, but at a way that you can still keep keep track of the the data. We do have an outside speaker. I didn't pick the date yet with them, but I think I'm getting a sense of when it would make sense for him to come and speak or speak through Zoom, and I want to have a fairly decent draft of your paper. So, I would start writing a paper as if it's it's due pretty quick here just to get the pieces out of the way that you already you already know. We're on the overdiagnosis, which is a big part of the paper. It gets a lot a lot more points than the other areas because it is a major issue. I'll send you the link to the video I want you to watch this weekend. It's not uh it's not a real long I mean, it's a

1:34 regular kind of documentary hour-long type of video, but really well done. Even though it's old, it's not out of

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Related notes

Summary, takeaways, and chapters were generated by AI from the video's transcript and may contain errors. The video belongs to its creator, Professor Sweet.