النص الكامل لحلقة Single Payer Radio | Dr. Don Henderson | Private Equity in Healthcare | 6-26-24

experience in all those areas. 71 00:04:48.560 --> 00:04:49.720 Okay, that's great. 72 00:04:50.720 --> 00:04:54.279 Why don't we just start out, how do you define 73 00:04:54.360 --> 00:04:56.240 a private equity company? 74 00:04:58.759 --> 00:05:02.680 Yeah, well, you know, it's it's it's it's a little bit. 75 00:05:03.040 --> 00:05:04.959 If you look at the hospitals in the United States 76 00:05:05.040 --> 00:05:09.279 right now, certain hospitals, and we can talk about physician corscheses. 77 00:05:08.680 --> 00:05:09.519 After that, But. 78 00:05:11.319 --> 00:05:15.519 You say that there were approximately forty five hundred hospitals 79 00:05:15.600 --> 00:05:18.839 community hospitals in the United States, about one thousand all 80 00:05:18.839 --> 00:05:21.720 over a thousand of those, or twenty five thirty percent, 81 00:05:21.800 --> 00:05:26.920 are owned by for profit companies, and those the latest. 82 00:05:26.560 --> 00:05:30.199 Figures are that three hundred and eighty. 83 00:05:29.920 --> 00:05:33.920 Six hospitals are owned by private equity companies, so about 84 00:05:33.920 --> 00:05:37.680 a third of the for profits, which in turns for 85 00:05:37.879 --> 00:05:41.160 profits who are thirty percent of hospitals in the United 86 00:05:41.160 --> 00:05:42.639 States right now. 87 00:05:43.319 --> 00:05:48.639 So how would how would we separate a for profit 88 00:05:48.759 --> 00:05:54.439 hospital versus a hospital that's for profit. 89 00:05:54.399 --> 00:05:57.839 That owned by an equity company. And then I got 90 00:05:57.879 --> 00:06:03.519 another question. Are there not for often hospital that are 91 00:06:03.560 --> 00:06:06.959 involved in equity companies? 92 00:06:08.319 --> 00:06:08.519 Yeah? 93 00:06:08.600 --> 00:06:12.480 I think the difference between the equity players and the 94 00:06:12.519 --> 00:06:15.160 regular for profit hospital operingers. 95 00:06:15.920 --> 00:06:16.759 You know, there could be. 96 00:06:16.759 --> 00:06:19.839 Some for profit hospital I know some of the Row 97 00:06:19.920 --> 00:06:23.160 hospitals and actually of my families, and that's that's a 98 00:06:23.199 --> 00:06:28.040 small percentage. But beyond that, the regular hospital companies for 99 00:06:28.160 --> 00:06:29.639 profit or publicly traded. 100 00:06:30.319 --> 00:06:32.040 So in my career I worked for two of the 101 00:06:32.079 --> 00:06:33.000 pubblicly traded. 102 00:06:34.480 --> 00:06:38.319 So the equity, the equity isn't the showholders, but the 103 00:06:38.319 --> 00:06:41.680 private equity firms are usually closely held by just a 104 00:06:41.720 --> 00:06:45.879 few principles and it's a much more a smaller group 105 00:06:45.920 --> 00:06:46.680 of ownership. 106 00:06:47.279 --> 00:06:56.160 Now, donal let me explain my understanding of the the 107 00:06:56.199 --> 00:07:02.519 private equity situation. My understanding is this is a leveraged buyop. 108 00:07:04.519 --> 00:07:10.639 Blackstone other companies like that with billions of dollars will 109 00:07:10.680 --> 00:07:18.959 acquire a facility, there's a hospital, emergency room, a healthcare system, 110 00:07:20.199 --> 00:07:24.319 and they put up about twenty five thirty percent of 111 00:07:24.360 --> 00:07:29.480 the equity and then the other seventy seventy five percent 112 00:07:29.680 --> 00:07:35.639 then is the debt collateral, which becomes whatever the facility is, 113 00:07:35.759 --> 00:07:39.639 whether it's an emergency room or a hospital, and then 114 00:07:39.680 --> 00:07:46.439 their goal is to quote improve efficiency unquote, and I'm 115 00:07:46.480 --> 00:07:50.000 putting that in quotes because there's some questions about the 116 00:07:50.040 --> 00:07:54.079 impact of that, and then they would run this for 117 00:07:54.160 --> 00:07:57.519 a period of years and then four or five years 118 00:07:57.560 --> 00:08:02.240 down the road, sell it and move on to something else. 119 00:08:02.800 --> 00:08:05.120 So you know from this is not meant to be 120 00:08:05.160 --> 00:08:10.319 a long happy marriage. Now, is that a fair understanding 121 00:08:10.600 --> 00:08:16.120 of the circumstances of private equity in healthcare? 122 00:08:16.680 --> 00:08:19.920 Yes, and there there are any number of firms. 123 00:08:21.160 --> 00:08:24.040 There's one private equity company called a Fodel Management that 124 00:08:24.120 --> 00:08:28.040 has the largest share of these private equity hospitals. 125 00:08:28.079 --> 00:08:29.759 And yeah, I think that what you said. 126 00:08:29.680 --> 00:08:31.600 Challenge is accurate. 127 00:08:32.559 --> 00:08:35.919 There's also we forgot to mention this, but there's also 128 00:08:36.080 --> 00:08:38.279 right now recording. 129 00:08:37.840 --> 00:08:40.320 With the statistics that I saw somewhat. 130 00:08:40.080 --> 00:08:43.840 Less than a thousand physician practices and that's a that's 131 00:08:43.879 --> 00:08:49.519 an emerging trend, and especially single specialty UH physician groups 132 00:08:49.559 --> 00:08:53.759 for example orthopedics are being bought by private equity firms. 133 00:08:53.799 --> 00:08:58.799 That that number is something around a thousand practices in 134 00:08:58.840 --> 00:08:59.879 the United States right now. 135 00:09:00.960 --> 00:09:05.159 Now, when you look at their strategy which is quote 136 00:09:05.720 --> 00:09:12.200 improved efficiency unquote. That generally means that they are going 137 00:09:12.279 --> 00:09:17.440 to reduce the staff, the biggest cost of running a facility. 138 00:09:17.720 --> 00:09:21.960 And there's a lot of a lot of inequities and 139 00:09:23.120 --> 00:09:28.639 inefficiencies and running hospitals and healthcare systems. But they come 140 00:09:28.720 --> 00:09:35.559 in and they they end up with For example, I 141 00:09:35.600 --> 00:09:41.279 was reading this story about emergency rooms in which the 142 00:09:41.399 --> 00:09:47.159 main cost

of the emergency room is as a qualified 143 00:09:49.240 --> 00:09:53.600 emergency room physician. So instead of having a bunch of 144 00:09:53.639 --> 00:09:58.360 emergency room physicians, they decrease the number of emergency room 145 00:09:58.399 --> 00:10:06.720 physicians and hire nurse practitioners and medical assistance physician extenders 146 00:10:07.440 --> 00:10:13.639 who don't cost as much. But on the other hand, 147 00:10:14.559 --> 00:10:17.679 you know, the data shows that they do more tests, 148 00:10:17.840 --> 00:10:22.279 they have more difficulty making diagnoses, and the and the 149 00:10:22.519 --> 00:10:28.200 and the cost uh to the patient is higher. But 150 00:10:28.840 --> 00:10:32.600 since they've reduced the cost to the management of it, 151 00:10:32.679 --> 00:10:37.679 that's where they're making their profit. Again, is this from 152 00:10:37.720 --> 00:10:41.759 your understanding? Is this a fair statement of some of 153 00:10:41.759 --> 00:10:47.679 the consequences of how private equity works in that particular situation. 154 00:10:47.960 --> 00:10:50.519 I've got a number of other examples we can talk about. 155 00:10:52.039 --> 00:10:55.279 Yes, I think they've used you for an example I 156 00:10:55.320 --> 00:10:59.240 would say the largest expense where most hospitals is the 157 00:10:59.320 --> 00:11:03.399 nursing st and there's no question about that. 158 00:11:04.120 --> 00:11:06.320 For profit and private equip. 159 00:11:06.120 --> 00:11:12.840 Companies reduce the levels of nursing staffing. Usually that's measured 160 00:11:12.879 --> 00:11:16.200 on a pro patient day, and there's no question that 161 00:11:15.840 --> 00:11:16.679 they are. 162 00:11:16.679 --> 00:11:19.840 Very frugal with that. When I used to work for. 163 00:11:19.919 --> 00:11:23.440 For profit companies, they used to change the nursing staffing 164 00:11:23.519 --> 00:11:27.600 levels about every four hours, which obviously is going to 165 00:11:27.639 --> 00:11:30.919 result in some people being sent home early, et cetera, 166 00:11:30.960 --> 00:11:34.480 et cetera. And so that's one of the things. 167 00:11:34.240 --> 00:11:36.120 They do is very tightly outstanding. 168 00:11:37.759 --> 00:11:44.440 They also monitor the use of supplies and equipment judiciously to. 169 00:11:44.480 --> 00:11:47.679 Try to save the money. There so many other things 170 00:11:47.720 --> 00:11:48.480 that they do is. 171 00:11:48.440 --> 00:11:53.080 They eliminate nonprofit, nonprofitable business lines. One of the biggest 172 00:11:53.080 --> 00:11:56.840 ones that's created conformation in the rural areas is the elimination. 173 00:11:56.440 --> 00:12:00.799 Of ob centric services at costles about that if you 174 00:12:00.879 --> 00:12:04.000 want to UH. They streamline building. 175 00:12:03.679 --> 00:12:07.720 The collections procedures, and they're much they're much better at 176 00:12:07.720 --> 00:12:10.960 collecting than many of

them not for profits are, and 177 00:12:11.039 --> 00:12:12.399 they get some they get some. 178 00:12:13.879 --> 00:12:14.480 Juice atual. 179 00:12:14.519 --> 00:12:18.480 I've been doing that, and they also open to profitable 180 00:12:18.519 --> 00:12:24.000 business lines such as electric procedures and diagnostic equipment. So 181 00:12:24.080 --> 00:12:28.559 there's a whole uh armament of things that you could 182 00:12:28.559 --> 00:12:34.039 do to improve hospital margins. And of course, rather than investing. 183 00:12:33.639 --> 00:12:35.679 All that back in the community like the not for. 184 00:12:35.600 --> 00:12:38.960 Profit companies do, they they pretty much take as much 185 00:12:39.000 --> 00:12:42.120 as they can to make their investors happen. 186 00:12:42.559 --> 00:12:46.200 And this is basically a fundamental conflict of interest between 187 00:12:46.399 --> 00:12:50.799 between providing care and extracting profit out of healthcare. 188 00:12:53.080 --> 00:12:55.120 Well, it can be, it can be depending on the 189 00:12:55.559 --> 00:12:56.840 depending on the practitioner. 190 00:12:57.720 --> 00:13:01.000 One thing I don't know if you're wanted to learn. 191 00:13:00.879 --> 00:13:04.519 The Meetings Human Resident Study. They came up in December 192 00:13:04.559 --> 00:13:08.879 of last year, but that's where the Events Requirement and 193 00:13:09.840 --> 00:13:13.399 generally the Medical Association tried to see if there was 194 00:13:13.639 --> 00:13:17.960 an actual measurable difference in the quality of care between private. 195 00:13:17.679 --> 00:13:20.679 Act and the young hospitals and other hospitals. 196 00:13:21.480 --> 00:13:25.759 And they determined that the rates of things going wrong 197 00:13:25.960 --> 00:13:35.039 things like patient complications, hospital required infections, and other negative 198 00:13:35.080 --> 00:13:36.720 outcomes patient. 199 00:13:36.480 --> 00:13:41.039 For husband example, that the rate of deeds were much higher. 200 00:13:43.000 --> 00:13:47.159 Forty percent thegether that's just a great as not forty 201 00:13:47.200 --> 00:13:52.200 facercent patients had with these fives in the patients, so the. 202 00:13:52.240 --> 00:13:55.600 Legatives much higher these on twital events. 203 00:13:55.639 --> 00:13:58.120 And some of that was also been me staffing because 204 00:13:59.240 --> 00:14:02.120 if you have less in the patients, the necess become 205 00:14:02.200 --> 00:14:05.519 more Russian, they don't have as much type of lost patients. 206 00:14:06.360 --> 00:14:09.600 So are that co consult in the increasing the quality 207 00:14:09.720 --> 00:14:10.360 hospital care? 208 00:14:10.960 --> 00:14:13.720 Yeah, you know, no question about it. And this was 209 00:14:13.799 --> 00:14:17.360 a study that was done based on one hundred percent 210 00:14:17.519 --> 00:14:23.600 of the Medicare Part A claims in six hundred thousand 211 00:14:23.960 --> 00:14:29.240 hospitalizations and fifty two private equity acquired hospitals. And that 212 00:14:29.519 --> 00:14:34.200 data was compared with four million and change hospitalization and 213 00:14:34.279 --> 00:14:37.240 two hundred and fifty nine matched hospitals that were not 214 00:14:39.759 --> 00:14:43.679 private equity acquired. And this is just one example of 215 00:14:43.919 --> 00:14:49.879 mother many other examples of the negative impact on healthcare 216 00:14:50.879 --> 00:14:56.600 by having a health care facility owned and managed by 217 00:14:56.759 --> 00:14:59.480 private equity firm. It's really scary. 218 00:15:00.840 --> 00:15:01.480 It really is. 219 00:15:02.039 --> 00:15:06.159 I want to ask a question about groups like or 220 00:15:06.279 --> 00:15:11.679 big surgeons, urologists, other large groups dermatology. 221 00:15:10.879 --> 00:15:14.919 And er why do they get involved in this? And 222 00:15:15.480 --> 00:15:17.600 let me just give you a couple of antidotes. 223 00:15:17.759 --> 00:15:18.120 I know. 224 00:15:19.639 --> 00:15:25.000 A couple of physicians who actually done this. 225 00:15:25.240 --> 00:15:30.679 They've sold their practices, and the reason they did it 226 00:15:31.480 --> 00:15:36.440 was because they didn't have enough equity and capital to 227 00:15:36.919 --> 00:15:44.000 manage their practice, and the paperwork and the bureaucracy was 228 00:15:44.120 --> 00:15:46.799 getting so overwhelming. 229 00:15:47.279 --> 00:15:50.320 That they just didn't want to do that anymore. 230 00:15:51.200 --> 00:15:54.919 Is that an accurate assessment of why most physicians are 231 00:15:54.960 --> 00:15:55.320 doing this. 232 00:15:57.120 --> 00:15:59.559 Yeah, I've talked to some of the folks, some of 233 00:15:59.559 --> 00:16:00.279 the dot as. 234 00:16:00.200 --> 00:16:05.159 They work in the equity of practices, and I think 235 00:16:05.240 --> 00:16:07.279 a big part of it is what you pointed out, 236 00:16:07.320 --> 00:16:11.480 doctor Shiva, which is the uh, the less or less 237 00:16:11.879 --> 00:16:14.080 urd and of making work in the administry of costs 238 00:16:14.159 --> 00:16:17.440 and ox and less risk because it allows. 239 00:16:17.200 --> 00:16:21.440 Of positions to practice, you know, practice medicine without working 240 00:16:21.440 --> 00:16:23.120 about the administrative side of things. 241 00:16:23.879 --> 00:16:27.360 But what if the case, the case that's made for 242 00:16:28.559 --> 00:16:31.279 by equity when they make different positions is beyond the 243 00:16:32.320 --> 00:16:35.120 improvements in their quality of life, is of the. 244 00:16:35.120 --> 00:16:38.759 Deals administrative work. They actually claim that they can find 245 00:16:38.799 --> 00:16:42.039 a way to make more money for the practice itself. 246 00:16:43.399 --> 00:16:44.799 So usually that's. 247 00:16:44.720 --> 00:16:49.720 Done either through improved billiant collections processes, but it's also. 248

00:16:49.679 --> 00:16:56.120 Done through acquiring passive income streams. For example, and I'm 249 00:16:56.159 --> 00:16:58.840 not going to name GRIP protect the unison or whatever. 250 00:16:58.960 --> 00:17:03.480 But the most of physician owned practices that are owned 251 00:17:03.480 --> 00:17:06.640 by private equity firms always get are almost always get 252 00:17:07.240 --> 00:17:12.480 a surgery center, a captive surgery center. Interesting right now 253 00:17:12.559 --> 00:17:17.039 because with the developments of technology, hipp andeme replacements can 254 00:17:17.079 --> 00:17:20.359 be done successfully and an outpatient. 255 00:17:19.880 --> 00:17:21.640 Saying when they couldn't be done that way only a 256 00:17:21.720 --> 00:17:22.400 few years ago. 257 00:17:23.319 --> 00:17:28.680 So part of the case for bringing in physicians is 258 00:17:28.759 --> 00:17:31.279 that it's like you mentioned, doctor Sharby. 259 00:17:31.400 --> 00:17:33.720 They have a lot of equity and then they can 260 00:17:33.799 --> 00:17:38.720 buy these answer facilities, whether they be surgery centers, procedure centers, 261 00:17:39.039 --> 00:17:41.519 diagnostic centers, and then. 262 00:17:42.319 --> 00:17:46.279 The private equity firm canmit sharing revenue. The enhancement and 263 00:17:46.920 --> 00:17:50.039 that the physicians can get is a work from practice. 264 00:17:50.720 --> 00:17:55.359 Now with my understanding from some of the information that 265 00:17:55.480 --> 00:18:00.240 I found is one of the issues is once the 266 00:18:00.559 --> 00:18:07.400 private equity company controls the practice, they start encouraging people 267 00:18:08.279 --> 00:18:12.960 physicians to see more patients so that they're packing them 268 00:18:13.039 --> 00:18:18.240 in with basically time frames and seeing somebody in ten 269 00:18:18.359 --> 00:18:20.799 or fifteen minutes, as opposed to being able to go 270 00:18:20.960 --> 00:18:23.720 in there and spend as much time as you need. 271 00:18:24.039 --> 00:18:29.000 You see, if you could go into one patient and 272 00:18:29.119 --> 00:18:31.880 spend ten or fifteen minutes in there and another one 273 00:18:31.960 --> 00:18:34.640 to take forty five minutes just because some things are 274 00:18:35.079 --> 00:18:40.000 more complicated. Also, my understanding is that they do upcoding 275 00:18:41.359 --> 00:18:48.640 and they encourage the staff to upcode as much as 276 00:18:48.759 --> 00:18:55.400 possible and provide bonuses for a dermatology practice to do 277 00:18:55.599 --> 00:19:01.079 more biopsies or botox or other things like that. So 278 00:19:01.359 --> 00:19:06.279 it really changes the whole a focus of medicine from 279 00:19:06.400 --> 00:19:11.079 healthcare instead of doing things that just make more money. 280 00:19:13.119 --> 00:19:14.960 Am mine, Am I missing something here? 281 00:19:15.720 --> 00:19:17.359 Well, I'm familiar with the. 282 00:19:19.480 --> 00:19:24.799 An urgent care center and a freestanding emergency department company 283 00:19:24.920 --> 00:19:25.400 that I. 284 00:19:25.440 --> 00:19:29.200 Will beay never even give detective innocent. But you know 285 00:19:29.359 --> 00:19:31.400 we in one of the sounds I was in. 286 00:19:32.440 --> 00:19:35.480 Uh, if you know urgent cares and the emergency care 287 00:19:35.519 --> 00:19:39.519 centers in our private equity competitors. 288 00:19:39.079 --> 00:19:42.240 Had urgent care centers, our buildings. 289 00:19:42.720 --> 00:19:45.599 Our average billings for patients is something in the one 290 00:19:45.680 --> 00:19:48.839 hundred and ten or hundred twenty dollars print counter. Well, 291 00:19:48.920 --> 00:19:52.480 it wasn't unusual for our private equity competitors they read 292 00:19:52.720 --> 00:19:56.839 urgent care and emergency walking business to get tickets of 293 00:19:56.920 --> 00:20:01.880 two three hundred dollars on average for the and so 294 00:20:02.480 --> 00:20:07.559 the question is what are the bilical charges much higher 295 00:20:07.839 --> 00:20:11.519 at the firms that are private equity firms. I don't 296 00:20:11.519 --> 00:20:12.079 think it's. 297 00:20:12.000 --> 00:20:15.799 Appropriate to say that they're upcoding illegally. 298 00:20:15.440 --> 00:20:18.759 Because that would be illegal, and probably the federal government 299 00:20:18.759 --> 00:20:20.039 needs to be called at that point. 300 00:20:20.200 --> 00:20:22.759 But you could certainly manually. 301 00:20:22.480 --> 00:20:26.960 Code as long as there's a viable reason for doing it, 302 00:20:27.119 --> 00:20:30.000 and patients would come back to us at our hospital 303 00:20:30.039 --> 00:20:32.680 would say, well, why is it that the visit at 304 00:20:32.680 --> 00:20:35.559 dirgent care center costing two hundred and fifty dollars where 305 00:20:36.279 --> 00:20:38.440 you're charging is only one hundred and ten for the 306 00:20:38.480 --> 00:20:40.960 same visit, So I think you have to draw your 307 00:20:41.000 --> 00:20:42.160 own inclutions from there. 308 00:20:42.640 --> 00:20:47.880 Well, again, there's a lot of upcoding that has to 309 00:20:48.000 --> 00:20:51.559 do with things that are going on with your body 310 00:20:51.640 --> 00:20:56.240 that really aren't health issues. They're just part of getting 311 00:20:56.279 --> 00:21:01.440 older or whatever. And if you go into the an 312 00:21:01.519 --> 00:21:05.680 emergency room or an urgent care center because you've got 313 00:21:05.799 --> 00:21:09.079 to scratch on your arm and they put a bunch 314 00:21:09.119 --> 00:21:12.960 of codes in because you're diabetic and obese and have obesity, 315 00:21:13.440 --> 00:21:15.680 it doesn't have anything to do with the reason why 316 00:21:15.759 --> 00:21:18.359 they came into the urgent care center. In the first place. 317 00:21:19.000 --> 00:21:20.559 You're absolutely right about that. 318 00:21:20.759 --> 00:21:23.680 But

there's something interesting in the way that the computer 319 00:21:23.880 --> 00:21:25.960 systems are set up that. 320 00:21:27.880 --> 00:21:30.160 They automatically upcode those things. 321 00:21:30.240 --> 00:21:36.039 For example, there are some companies that take a diabetic 322 00:21:36.920 --> 00:21:43.559 and they will have questions in there about our frighters. 323 00:21:44.279 --> 00:21:48.319 They have questions in there about purple faster disease, and 324 00:21:49.319 --> 00:21:50.559 almost every way. 325 00:21:52.000 --> 00:21:54.079 Elderly has those diseases. 326 00:21:55.400 --> 00:21:59.839 You can take a diabetic and do a test called 327 00:21:59.880 --> 00:22:03.839 up waterflow, which is a test to see if somebody's 328 00:22:03.880 --> 00:22:09.279 got purple mask disease, and almost everyone's got afthoscrosis. 329 00:22:09.920 --> 00:22:10.039 Uh. 330 00:22:10.519 --> 00:22:14.519 If you're in your eighties or nineties, and so you 331 00:22:14.599 --> 00:22:15.640 can do a test that. 332 00:22:15.880 --> 00:22:19.599 This shows you got mild of purfle fask disease that 333 00:22:19.720 --> 00:22:23.200 doesn't really need to be treated except for exercise and 334 00:22:23.319 --> 00:22:29.200 maybe maybe asburn. But that changes the amount of coding 335 00:22:29.359 --> 00:22:33.599 an amount of money that you can get from the 336 00:22:33.720 --> 00:22:39.480 insurance coming in from Medicare and medicaid, and sometimes the 337 00:22:40.680 --> 00:22:45.519 computerized system uh just kind of does that on its 338 00:22:45.559 --> 00:22:50.599 own if you answer the questions that are that are requested. 339 00:22:51.519 --> 00:22:54.039 So you know, if you go to the doctor's office 340 00:22:54.119 --> 00:22:59.599 now and you've got a r I uh, they don't 341 00:22:59.680 --> 00:23:02.400 just deal with that. They got all these things programmed 342 00:23:02.480 --> 00:23:06.680 in the computer and then they'll include that into the 343 00:23:06.799 --> 00:23:10.359 final bill for you seeing a patient for a running out. 344 00:23:10.559 --> 00:23:14.480 Again, the whole purpose of this is to extract more 345 00:23:14.599 --> 00:23:18.480 money out of the healthcare system. Doesn't have any focus 346 00:23:18.759 --> 00:23:24.000 anything the reason why someone comes in to have a 347 00:23:24.119 --> 00:23:27.519 problem addressed. And then all this is these are all 348 00:23:27.640 --> 00:23:31.799 add ons onto that that that aren't that are not 349 00:23:32.039 --> 00:23:34.240 the purpose of the visit in the first place. 350 00:23:34.440 --> 00:23:38.960 They're right, and that's routine now and it's and they 351 00:23:39.079 --> 00:23:44.920 can you never realize that a tri collectual medical records 352 00:23:44.960 --> 00:23:48.000 are designed for building nothing else. 353 00:23:48.119 --> 00:23:53.640 Absolutely right. Don Let me ask you a question about 354 00:23:53.720 --> 00:23:58.079 nursing homes. It's it's

my understanding that a large proportion 355 00:23:58.559 --> 00:24:03.920 of the nursing homes and this country are run by private. 356 00:24:03.559 --> 00:24:07.359 Equity firms miners seventy line. 357 00:24:07.839 --> 00:24:14.400 Is that a fair statement. Yes, Now I'm gonna tell 358 00:24:14.440 --> 00:24:18.559 a story. Now this is again and for our listeners, 359 00:24:19.160 --> 00:24:22.119 don't take my word for this and just get online 360 00:24:22.240 --> 00:24:24.480 and go to Google or whatever you go to. There's 361 00:24:24.480 --> 00:24:32.160 a nursing home somewhere around Tampa that and there was 362 00:24:32.200 --> 00:24:34.720 a patient in the nursing home. Is run by a 363 00:24:34.799 --> 00:24:39.400 private equity firm, and they reduced the staff and there 364 00:24:39.519 --> 00:24:42.640 was patient in there who had a the cubanis ulcer 365 00:24:43.279 --> 00:24:47.079 and again from our for our listeners, this is an 366 00:24:47.160 --> 00:24:50.759 ulcer usually in the lower part of the back of 367 00:24:50.920 --> 00:24:55.440 the skin, that comes from allowing a patient to lie 368 00:24:55.599 --> 00:24:59.640 in bed on their back without being moved, and this 369 00:25:00.160 --> 00:25:06.960 contaminated by feces because they were not cleaned. They were 370 00:25:07.119 --> 00:25:11.880 laying in bed with a feegal filled diaper, and they 371 00:25:12.680 --> 00:25:18.079 got an infection and died. The family was understandably distressed 372 00:25:18.359 --> 00:25:24.119 with all of this, and they hired attorney to determine 373 00:25:24.799 --> 00:25:29.440 who was responsible for not providing this patient with decent care, 374 00:25:30.880 --> 00:25:37.839 and they ran into a nightmare administrative structure. One company 375 00:25:38.000 --> 00:25:43.279 owned the building, a second company had the license to 376 00:25:43.400 --> 00:25:49.640 run the nursing home. Another company provided the professional staff, 377 00:25:49.960 --> 00:25:56.039 and another company provided the custodial staff. And they were 378 00:25:56.160 --> 00:26:02.759 never able to identify any sort of of sense of responsibility. 379 00:26:03.039 --> 00:26:04.799 And you know, this is. 380 00:26:06.680 --> 00:26:13.720 This is really awful when you think about the goal 381 00:26:14.039 --> 00:26:20.079 of extracting profit to the extent that people are not 382 00:26:20.799 --> 00:26:25.599 people in the nursing home population. It's my understanding again, 383 00:26:25.759 --> 00:26:30.160 and I'm asking the listeners to double check this themselves, 384 00:26:31.160 --> 00:26:35.440 that the death rates are higher by ten or fifteen 385 00:26:35.559 --> 00:26:41.319 percent and nursing homes run by private equity firms done. 386 00:26:42.039 --> 00:26:45.359 Are you having any familiarity with this or any comments 387 00:26:45.559 --> 00:26:47.839 or about what I've just said. 388 00:26:49.440 --> 00:26:51.519 I don't have any treat familiarity with it. 389 00:26:51.839 --> 00:26:57.319 I didn't I r a hospital anniversary several years and 390 00:26:57.480 --> 00:26:58.799 have some experience. 391 00:26:58.319 --> 00:27:03.279 As your home executive, and you know the unfortunately think. 392 00:27:03.200 --> 00:27:05.400 About healthcare in the United States right now. Of course, 393 00:27:05.960 --> 00:27:09.400 long term care is a concerns day. It's largely the 394 00:27:09.519 --> 00:27:13.720 payet play scenario. And one of the things I've learned 395 00:27:13.759 --> 00:27:16.680 after I ran a nursing home for several years is 396 00:27:16.839 --> 00:27:22.079 that many have the higher income individuals have access to 397 00:27:23.000 --> 00:27:26.000 private firms that have a high level desent, that have 398 00:27:26.960 --> 00:27:31.319 red amenities, and they largely pay out of pocket or 399 00:27:31.759 --> 00:27:34.960 maybe cent trends they have for this top tier of 400 00:27:35.279 --> 00:27:39.240 long term care, whether it's as sistem addressing home care. 401 00:27:39.839 --> 00:27:44.319 Then you have situations where patients run out of money 402 00:27:44.400 --> 00:27:47.599 over time. You know, most people have future. 403 00:27:47.319 --> 00:27:49.960 Amounts of stavings to be able to you know, pay 404 00:27:50.039 --> 00:27:53.440 for extective care. So families run out of money and 405 00:27:53.559 --> 00:27:57.559 then they become wards of the state. Here, it's a 406 00:27:57.680 --> 00:28:01.559 very depressing scenario because you basically have to exhaust over 407 00:28:01.680 --> 00:28:05.279 the resources before you can qualify for what they call 408 00:28:05.400 --> 00:28:12.319 medicate reimbursement. So many facilities are high end and patients 409 00:28:12.359 --> 00:28:14.119 pay thousands of dollars for the months to. 410 00:28:14.119 --> 00:28:17.160 Stay there, and usually it cares good, whether it's more 411 00:28:17.200 --> 00:28:20.119 probit or not. Deprotment where you get into trouble. 412 00:28:20.039 --> 00:28:24.160 Is where many many people run out of resources and 413 00:28:24.279 --> 00:28:27.240 then they have to go to the facility that smart 414 00:28:27.240 --> 00:28:31.720 as they paid for by met Cain and Medicaid reimbursement 415 00:28:32.640 --> 00:28:38.359 is almost less than cost. When I was running a 416 00:28:38.440 --> 00:28:41.640 nursing home in Pennsylvania and we had pretty good reimbursement, 417 00:28:41.680 --> 00:28:45.440 which was in the two hundred and fifty to two hundred. 418 00:28:45.200 --> 00:28:49.119 And sixty five dollars for data for restment. But in 419 00:28:49.480 --> 00:28:50.279 many places in the. 420 00:28:50.359 --> 00:28:54.079 South, the state sets of Medicaid nursing homes rapes very well. 421 00:28:54.960 --> 00:28:59.319 And so what the results from that is the almost 422 00:28:59.359 --> 00:29:03.119 imperative cut quarters in order to keep the facility going. 423 00:29:04.319

--> 00:29:08.519 So it is a very tragic situation and it is 424 00:29:08.559 --> 00:29:09.759 totally related. 425 00:29:09.400 --> 00:29:14.319 To those people that are recipients and they have nowhere 426 00:29:14.359 --> 00:29:18.960 else to go, so the nursing homes after. 427 00:29:18.799 --> 00:29:22.759 Survival, whatever money they that cat grow them more aboud them. 428 00:29:24.160 --> 00:29:27.039 Is this an issue with in other First world countries? 429 00:29:28.440 --> 00:29:30.400 I mean, I don't know the answer to this. That's 430 00:29:30.440 --> 00:29:36.319 why I'm asking the question, because you know, my understanding 431 00:29:36.759 --> 00:29:42.279 from the little experience I've had out of the country 432 00:29:42.400 --> 00:29:46.640 that most other First world countries don't have the same 433 00:29:46.880 --> 00:29:53.920 issues that we have about profitability and healthcare. Most other 434 00:29:54.039 --> 00:30:01.160 First world countries have got a system that provides some 435 00:30:01.480 --> 00:30:10.160 kind of insurance, usually government run, that allows all of 436 00:30:10.279 --> 00:30:14.119 the citizens of the country to have at least some 437 00:30:14.440 --> 00:30:20.400 access to healthcare, whereas in this country we've got what 438 00:30:20.640 --> 00:30:23.680 thirty or forty million people who don't have health insurance. 439 00:30:24.519 --> 00:30:26.799 I'm not sure what the number is, but it's a lot. 440 00:30:27.640 --> 00:30:32.240 And the other issue in this country is medical debt 441 00:30:33.400 --> 00:30:38.960 and medical bankruptcy, which are issues that, again to my knowledge, 442 00:30:40.000 --> 00:30:50.240 are literally nonexistent or occur in such a small amount 443 00:30:50.440 --> 00:30:55.640 that they don't represent anything close to the impact that 444 00:30:55.720 --> 00:30:58.039 they have in our country. You have one hundred million 445 00:30:58.160 --> 00:31:03.200 people in the United States debt and somewhere between two 446 00:31:03.359 --> 00:31:09.240 hundred and eight hundred thousand a year filing for medical bankruptcy, 447 00:31:09.359 --> 00:31:13.200 which was the main cause of people filing for bankruptcy 448 00:31:14.079 --> 00:31:18.240 in this country. So again I'm asking the question because 449 00:31:18.279 --> 00:31:20.640 I don't have a lot of experience with that in 450 00:31:20.720 --> 00:31:23.759 other countries. I was wondering if you've got any thoughts 451 00:31:23.799 --> 00:31:28.359 about that, or whether you've had some experience, either directly 452 00:31:28.519 --> 00:31:31.319 or indirectly with some of these issues in other First 453 00:31:31.400 --> 00:31:32.119 world countries. 454 00:31:33.640 --> 00:31:36.720 Well, I think it goes back to, you know, the 455 00:31:36.880 --> 00:31:41.759 policies of these different countries years. I don't necessarily got 456 00:31:41.799 --> 00:31:45.039 direct experience of US, least for a couple of years, 457 00:31:45.119 --> 00:31:49.359 but I've studied all this is partly different studies, and 458 00:31:51.359 --> 00:31:55.000 it all gets back to the healthcare policy or the country. 459 00:31:55.119 --> 00:31:59.119 For example, if you ask me today, you're no doctor, 460 00:31:59.240 --> 00:31:59.720 not here. 461 00:31:59.720 --> 00:32:03.279 Is what is the national policy of the United States 462 00:32:04.000 --> 00:32:07.400 with regard to your health care and providing basic health 463 00:32:07.440 --> 00:32:08.680 care for its citizens. 464 00:32:09.599 --> 00:32:11.480 And if you ask a politician that which I have 465 00:32:11.920 --> 00:32:15.359 at the federal and state of local level, they'll just. 466 00:32:15.440 --> 00:32:18.799 Shrug and say, well, we want to minimize the cost 467 00:32:18.880 --> 00:32:22.960 and nitaate the status for so the den off between 468 00:32:22.960 --> 00:32:25.880 the United States and other countransys that there is a 469 00:32:26.000 --> 00:32:30.039 national health policy. For example, in the UK, there was 470 00:32:30.079 --> 00:32:35.640 a position where effort to update the national policy roles 471 00:32:35.759 --> 00:32:36.640 for the health system. 472 00:32:37.119 --> 00:32:38.720 And I think that's where the difference is. 473 00:32:39.240 --> 00:32:44.039 Our system is yes, any pass you can either don't 474 00:32:44.079 --> 00:32:47.920 have insurance or the early the national health insurance doesn't 475 00:32:47.920 --> 00:32:49.960 allow them to get access to. 476 00:32:50.000 --> 00:32:51.880 Care, especially especialty care. 477 00:32:52.359 --> 00:32:57.039 So getting back to the especially example in the UK, 478 00:32:57.559 --> 00:33:02.400 in a kingdom, for example, if you just tremendously developed 479 00:33:02.440 --> 00:33:05.960 home care system, because I would argue it's better and 480 00:33:06.079 --> 00:33:09.680 cheap to care for elderly patients in their home if 481 00:33:09.720 --> 00:33:11.480 at all possible, and the. 482 00:33:11.559 --> 00:33:15.519 UK has has a goal to do that, They've set 483 00:33:15.599 --> 00:33:16.559 up the funding to do that. 484 00:33:17.880 --> 00:33:22.160 So all this arbus for you know, a national policy 485 00:33:22.759 --> 00:33:25.759 and the roles of the system which the UK asked 486 00:33:26.319 --> 00:33:31.720 national goals, and then the funding is directed towards the 487 00:33:31.799 --> 00:33:35.640 achievement of the goals and not necessarily give it to 488 00:33:36.000 --> 00:33:37.079 for profit operators. 489 00:33:37.160 --> 00:33:37.920 If that makes sense to. 490 00:33:37.960 --> 00:33:45.000 Me, Yeah, Jean and Ian. There's a retired surgeon from 491 00:33:45.119 --> 00:33:49.799 Louisville who many years ago had some visual issues. He 492 00:33:49.960 --> 00:33:53.880 retired from general surgery and was elected to the State 493 00:33:54.279 --> 00:33:58.599 House of Representatives and about twenty years ago

he gave 494 00:33:58.680 --> 00:34:04.119 a talk at the Louisville Society. And you know, there 495 00:34:04.160 --> 00:34:08.239 were two messages I remember him taking taking away from 496 00:34:08.320 --> 00:34:12.159 it from him, and one was something we've all heard 497 00:34:12.800 --> 00:34:16.039 multiple times before that you know, making laws is like 498 00:34:16.199 --> 00:34:19.760 making sausage. And the other thing he said was very 499 00:34:19.840 --> 00:34:25.000 clear about this is the politicians do not understand healthcare. 500 00:34:26.239 --> 00:34:35.000 They run construction companies, they are run golf courses, their lawyers, 501 00:34:35.280 --> 00:34:39.159 and have a whole bunch of other professional backgrounds. And 502 00:34:39.719 --> 00:34:42.800 the time that he spending the legislature is very clear 503 00:34:42.880 --> 00:34:46.840 to him that they really don't understand the issues of 504 00:34:46.920 --> 00:34:50.079 health care. And some of the laws that have been 505 00:34:50.199 --> 00:34:56.280 passed in different states to dealing with abortion are a 506 00:34:56.400 --> 00:34:59.679 perfect example of how correct he was about. 507 00:35:01.320 --> 00:35:04.000 I would just like to point out that most people 508 00:35:04.239 --> 00:35:08.760 don't know who owned ses nursing home, for example, and 509 00:35:09.679 --> 00:35:14.440 Campbellsville and the surrounding area. I didn't know until about 510 00:35:14.519 --> 00:35:19.119 two years ago that all the nursing homes in our 511 00:35:19.280 --> 00:35:25.119 area were equity owned except one, and I had no idea. 512 00:35:26.960 --> 00:35:29.880 It's just really amazing. 513 00:35:30.519 --> 00:35:31.199 What's going on. 514 00:35:33.280 --> 00:35:37.400 The Other thing I wanted to bring up is I 515 00:35:37.559 --> 00:35:42.760 understand that one of the tactics of equity companies, let's 516 00:35:42.760 --> 00:35:45.880 say For example, a large equity company goes in and 517 00:35:46.039 --> 00:35:48.719 buys a large hospital in. 518 00:35:48.760 --> 00:35:51.360 A big city and the properties worked quite a bit 519 00:35:51.400 --> 00:35:51.800 of money. 520 00:35:52.719 --> 00:35:59.239 Well, they'll sell that property to someone and then the 521 00:35:59.480 --> 00:36:06.000 hospital and the practitioners have to pay rent to the 522 00:36:06.119 --> 00:36:11.119 people who own the hospital and the property. And that 523 00:36:11.599 --> 00:36:18.320 this I noticed there's been several instances where, uh, the 524 00:36:18.519 --> 00:36:23.000 hospital and groups of practices that have done this kind 525 00:36:23.039 --> 00:36:27.239 of thing went bankrupt the cause of the excess rent 526 00:36:27.320 --> 00:36:28.280 that were having to pay. 527 00:36:30.760 --> 00:36:31.280 It's just a. 528 00:36:31.920 --> 00:36:36.000 Device that equity companies can do to increase their income. 529 00:36:38.000 --> 00:36:42.960 Yes, I think you could definitely according some of the 530 00:36:43.320 --> 00:36:47.000 chart assets of the hospital to a third party. 531 00:36:47.800 --> 00:36:47.920 Uh. 532 00:36:48.480 --> 00:36:54.000 And like you said, that creates which hospitals kind of cash. 533 00:36:56.079 --> 00:36:59.000 But the problem is to decrease the dead and then 534 00:36:59.039 --> 00:37:03.239 that did has paid no hospitals going to operate and 535 00:37:03.360 --> 00:37:04.360 got back to the debt. 536 00:37:04.239 --> 00:37:07.119 First, and of course it gets too large and there's 537 00:37:07.159 --> 00:37:07.599 too much. 538 00:37:07.519 --> 00:37:10.760 For me a debt burden on hospital, and then that 539 00:37:10.920 --> 00:37:14.199 becomes a major operational issue. There it can lead to 540 00:37:14.280 --> 00:37:18.559 bankruptcy a business if there's a downturn. That's happened mostly 541 00:37:18.719 --> 00:37:21.559 in the world. There's two press of. 542 00:37:21.599 --> 00:37:24.519 Hospitals that are really in trouble in the United States 543 00:37:24.599 --> 00:37:24.880 right now. 544 00:37:25.039 --> 00:37:28.559 One is the general world hospitals as a whole party, 545 00:37:28.920 --> 00:37:34.000 especially in smaller rural areas, tremendously under stress. And the 546 00:37:34.079 --> 00:37:38.079 other is the inner city hospitals. There are many inner 547 00:37:38.119 --> 00:37:43.400 city facilities that have been taken over by private emplicue firms. 548 00:37:43.599 --> 00:37:47.119 And the whole idea is back to wins doctor biking 549 00:37:47.159 --> 00:37:49.760 Trips have said, which is they call it pump and 550 00:37:49.840 --> 00:37:52.840 delts some time. So the idea is, you pump up 551 00:37:52.880 --> 00:37:57.760 the revenues, you're disc the expenses, you take a very short. 552 00:37:57.599 --> 00:37:59.880 Term three five year view of that. 553 00:38:00.840 --> 00:38:05.639 Then you show a financial statement that has improved operations, 554 00:38:06.280 --> 00:38:10.679 which increases the multiple four sixty minutes the annual earnings. 555 00:38:10.280 --> 00:38:13.440 That can be aparted. These facilities can be aware for. 556 00:38:14.159 --> 00:38:21.679 So if you're scrupulous, you're you're trying to get a return, 557 00:38:21.760 --> 00:38:23.039 which is I guess recently. 558 00:38:23.119 --> 00:38:25.880 But if you're as scrupulous, you can inflate the price. 559 00:38:26.639 --> 00:38:28.679 And then when your self in the new et person 560 00:38:29.559 --> 00:38:30.360 then they find. 561 00:38:30.159 --> 00:38:34.159 Out they've they've bought picking the book, they've bought an 562 00:38:34.159 --> 00:38:38.199 asset that really not sustainable. And that's when many of 563 00:38:38.280 --> 00:38:41.440 the Royal hospitals said and the inner city hospitals have 564 00:38:41.559 --> 00:38:42.719 gone out of business Leans. 565 00:38:44.639 --> 00:38:47.880 Well, let mean it says I've spent my whole life 566 00:38:47.960 --> 00:38:51.960 in

a royal hospital and you're familiar with our community. 567 00:38:54.960 --> 00:38:58.760 What are the solutions for royal health care in America? 568 00:39:02.039 --> 00:39:05.960 Well, I think that there has to really be some 569 00:39:06.159 --> 00:39:10.559 outside assistance. And you know that's when I talk to 570 00:39:10.639 --> 00:39:14.239 go back talking about health policy. What is the health 571 00:39:14.320 --> 00:39:16.679 policy of the United States when. 572 00:39:16.639 --> 00:39:19.320 It comes to maintaining oral aalthricare. 573 00:39:20.280 --> 00:39:24.280 Years ago, during the part of the administration, there was 574 00:39:25.480 --> 00:39:30.400 a plan to create regional health planning agencies and they 575 00:39:30.480 --> 00:39:33.480 persisted for ten or twenty years after President. 576 00:39:33.280 --> 00:39:36.519 Carter the office, but they all died by the wayside. 577 00:39:37.920 --> 00:39:40.920 And so whether it's at the federal or street level, 578 00:39:41.840 --> 00:39:44.000 there has to be planning for yal healthcare and there 579 00:39:44.079 --> 00:39:49.480 has to be resources autocating to determine what the policy 580 00:39:49.519 --> 00:39:52.559 should be, what kind of facility should be built to 581 00:39:52.679 --> 00:39:57.440 serve rural communities. How are we going to recruit the providers. 582 00:39:57.920 --> 00:40:00.599 There's going to be assistance to recruit the positions and 583 00:40:00.760 --> 00:40:06.800 verses to these communities to maintain them. That just without positions, 584 00:40:06.880 --> 00:40:10.760 no more lust and exists. So it has to be 585 00:40:10.800 --> 00:40:14.280 a number of things gone, and I just am not 586 00:40:14.519 --> 00:40:18.119 very optimistic that that is at the top agenda of 587 00:40:19.079 --> 00:40:19.599 the country. 588 00:40:19.920 --> 00:40:20.079 Now. 589 00:40:20.280 --> 00:40:23.239 What will happen, which I think I've talked about during. 590 00:40:23.079 --> 00:40:27.320 The last podcast, is that many of the safety net 591 00:40:28.000 --> 00:40:33.320 funds that are funded by private donations are going to 592 00:40:33.400 --> 00:40:36.440 run out of money in the next ten years. There's 593 00:40:36.920 --> 00:40:41.199 an growing population of Medicare recipients. A few years ago 594 00:40:41.840 --> 00:40:42.760 Medicare only. 595 00:40:42.639 --> 00:40:47.159 Had forty million, but by twenty thirty with the. 596 00:40:47.159 --> 00:40:51.440 Baby group, it will be eighty million. The social security 597 00:40:51.480 --> 00:40:55.639 funds are running out of money. The Medicare program itself, 598 00:40:56.079 --> 00:40:59.320 which is funded by the tax on everybody that's. 599 00:40:59.159 --> 00:41:02.119 Working that program a scheduled the amount of money. 600 00:41:01.960 --> 00:41:06.199 In ten years sold. My believe is that politicians will 601 00:41:06.239 --> 00:41:09.760 continue to kick the can down the road until until

602 00:41:09.760 --> 00:41:15.199 there's enough of a christ politicians will be will have 603 00:41:15.760 --> 00:41:16.280 will have to. 604 00:41:16.320 --> 00:41:19.119 Add uh and at that point it might be good 605 00:41:19.159 --> 00:41:23.159 to talk about the national health policy and single payer system. 606 00:41:24.320 --> 00:41:26.920 I think you're absolutely right about that. Other countries have 607 00:41:27.039 --> 00:41:31.119 work this out. Australia has a Department of Rural Health 608 00:41:31.880 --> 00:41:35.360 that focuses on providing all of those issues that you've 609 00:41:35.440 --> 00:41:39.960 mentioned to The Australian out back and the universe. And 610 00:41:40.199 --> 00:41:44.519 UK is also with their system, which is they're no 611 00:41:44.679 --> 00:41:49.280 perfect system, but that also deals in an appropriate way 612 00:41:49.440 --> 00:41:55.679 with rural rural medicine in in Scotland, UH, England and Wales. 613 00:41:56.639 --> 00:42:00.960 So I don't know, we'll see what see what happens now. 614 00:42:01.239 --> 00:42:03.760 You know, Jane, one of the first things that I 615 00:42:03.920 --> 00:42:06.920 learned from you when we've found you wandering around and 616 00:42:10.360 --> 00:42:14.239 in the library right right behind us, and you came 617 00:42:14.360 --> 00:42:17.320 up to that meeting and showed us the data on 618 00:42:18.559 --> 00:42:23.719 you know that one third of the resources in healthcare 619 00:42:24.320 --> 00:42:28.719 is not provided, is not go for health care, I mean, 620 00:42:28.800 --> 00:42:32.360 and that's a serious issue. And what we're talking about today, 621 00:42:33.320 --> 00:42:37.039 with with all the for profit issues going on in healthcare, 622 00:42:37.239 --> 00:42:40.280 private equity is just going to make that all a 623 00:42:40.400 --> 00:42:45.519 lot worse. And uh and don you're absolutely right. I mean, 624 00:42:45.559 --> 00:42:48.840 I don't know where this how far down the rabbit 625 00:42:48.920 --> 00:42:53.239 hole we have to go before something is going to 626 00:42:53.280 --> 00:42:57.639 get done about this. We are on this radio program 627 00:42:58.519 --> 00:43:03.199 sponsored by an organization that is promoting medicare for all. 628 00:43:05.639 --> 00:43:08.880 I don't think anything's going to be done in the 629 00:43:09.000 --> 00:43:13.480 next few years with you, and I think that it 630 00:43:13.559 --> 00:43:16.480 will end up at a crisis. Don What do you 631 00:43:16.559 --> 00:43:19.760 think about system I'd like to have in Australia where 632 00:43:19.800 --> 00:43:26.719 they have the government insurance and then there are a 633 00:43:26.920 --> 00:43:30.599 certain group of people who can buy private insurance. I 634 00:43:30.760 --> 00:43:36.480 spent about three weeks in Great Britain with on a 635 00:43:36.599 --> 00:43:41.039 tour last year about this time, and about half those 636 00:43:41.119 --> 00:43:46.039 people

in Australia, and so that most of them have 637 00:43:46.239 --> 00:43:47.320 private insurance. 638 00:43:47.360 --> 00:43:51.519 That in there is the system where about two thirds 639 00:43:51.599 --> 00:43:55.159 of the people have a government insurance. 640 00:43:56.199 --> 00:44:01.639 That seemed to work fairly well in Australia, but I 641 00:44:01.719 --> 00:44:06.159 only have you know the anecdotal experiences of the people 642 00:44:06.239 --> 00:44:06.800 I talked to. 643 00:44:07.800 --> 00:44:12.239 We've had Ted Young, a surgeon from Hamilton, Ontario, on 644 00:44:12.480 --> 00:44:17.360 the program on two or three occasions and talked about 645 00:44:17.440 --> 00:44:23.719 the Canadian program. Both Australia and Candidate established their healthcare 646 00:44:23.840 --> 00:44:29.159 systems in nineteen eighty four, and again no perfect systems, 647 00:44:29.360 --> 00:44:32.639 but they both seem to be working pretty well and 648 00:44:33.719 --> 00:44:36.559 they don't have all of the issues that we're dealing 649 00:44:36.679 --> 00:44:37.599 with in this country. 650 00:44:39.199 --> 00:44:42.599 I think I think some of the best systems that 651 00:44:42.679 --> 00:44:43.320 have been designed. 652 00:44:43.360 --> 00:44:46.920 It's very ironic because many of the systems in the 653 00:44:47.000 --> 00:44:51.199 Far East are based on the American system and it's 654 00:44:51.400 --> 00:44:56.079 it's ironic that for example, you know Taiwan, for example, 655 00:44:56.199 --> 00:45:02.679 they're the government leaders came to Harvar and actually started 656 00:45:02.719 --> 00:45:03.360 working with a. 657 00:45:05.599 --> 00:45:11.000 Professorator was very knowledgeable and were also you know think 658 00:45:11.039 --> 00:45:14.920 for the same thing background. But they they designed, they 659 00:45:15.000 --> 00:45:15.679 took a clean. 660 00:45:15.519 --> 00:45:19.800 Sheet of paper, they designed their system, and I think 661 00:45:19.840 --> 00:45:23.199 it's working very well. What's interesting about the Far East, 662 00:45:23.800 --> 00:45:26.239 any of the countries in the Far East, is that. 663 00:45:27.039 --> 00:45:28.840 Healthcare has remained in private. 664 00:45:31.039 --> 00:45:36.599 Hospitals or probably the doctors doctor's own hospitals in any 665 00:45:36.679 --> 00:45:38.159 parts of the parties. 666 00:45:39.800 --> 00:45:43.719 So even though the writers are private will re enterprise. 667 00:45:44.679 --> 00:45:48.199 Uh, there's a national health insurance and the government make 668 00:45:48.239 --> 00:45:51.360 sure is that there's no tears there. 669 00:45:51.440 --> 00:45:54.840 In other words, you can't, I guess technically to go 670 00:45:54.960 --> 00:45:59.719 out and buy you know, extra services. But through all sensive. 671 00:45:59.440 --> 00:46:03.159 Purposes, there's a single level of care given to all citizens. 672 00:46:04.000 --> 00:46:06.519 But it's provided by a private system, not building an 673 00:46:06.519 --> 00:46:10.599 own system. And my own argument would be that government 674 00:46:10.719 --> 00:46:15.559 provider government provision around here is inheritan inefficient. 675 00:46:17.159 --> 00:46:23.480 It's you want people competing for care because competition groups quality, 676 00:46:24.880 --> 00:46:25.840 but you don't. 677 00:46:25.800 --> 00:46:28.840 Want to pay for care. You want to pay for 678 00:46:28.960 --> 00:46:33.000 care and a fair of a reasonable lake and so, 679 00:46:33.800 --> 00:46:37.079 and you want to coverage for everyone. So I think 680 00:46:37.119 --> 00:46:39.000 you could look at Japan, you could look at Taiwan, 681 00:46:39.559 --> 00:46:39.880 you can. 682 00:46:39.840 --> 00:46:41.079 Look at South Korea. 683 00:46:41.800 --> 00:46:45.079 All these systems were based on the American system, but 684 00:46:45.239 --> 00:46:48.519 they what they all have in commons, the national. 685 00:46:49.719 --> 00:46:52.320 Yes, and I think in some of those countries don't. 686 00:46:52.360 --> 00:46:56.000 They also have private health insurance if you want it, 687 00:46:56.519 --> 00:47:00.199 but it's not for profit. It is not for off 688 00:47:00.280 --> 00:47:06.599 a health insurance as opposed to sign a humanna and 689 00:47:06.840 --> 00:47:08.920 anthem and the kind of stuff that we have in 690 00:47:09.000 --> 00:47:12.039 this country where the CEOs are making twenty or thirty 691 00:47:12.079 --> 00:47:13.159 million dollars a year. 692 00:47:13.440 --> 00:47:17.960 When you talk about health insurance, that's really where a 693 00:47:18.039 --> 00:47:21.039 tremendous amount of waste is occurring, right because if you're 694 00:47:21.079 --> 00:47:25.239 looking at it objectively, you know that's another ten or 695 00:47:25.320 --> 00:47:27.840 fifteen percent rent that. 696 00:47:27.880 --> 00:47:30.920 The loss ratios the most self insurance. 697 00:47:30.559 --> 00:47:34.239 Companies, it's ironically they call it lost ratios, but it's 698 00:47:34.280 --> 00:47:35.159 the amount they pay for. 699 00:47:35.239 --> 00:47:36.360 Trunch medical expensive. 700 00:47:36.519 --> 00:47:39.320 They call it a medical loss ratio, which is what 701 00:47:39.519 --> 00:47:44.000 they're paying. That's what they pay they're paying for what 702 00:47:44.119 --> 00:47:44.760 they're selling. 703 00:47:45.599 --> 00:47:49.119 Yes, but that loss ratio, if it gets about eighty 704 00:47:49.159 --> 00:47:52.719 five percent into the race, and so that documents to. 705 00:47:52.719 --> 00:47:57.400 Me right there that you know a Medicaire filling under 706 00:47:57.400 --> 00:47:59.039 the traditional Medicare is two a. 707 00:47:59.039 --> 00:48:03.280 Three percent, Taiwan is less than three percent. 708 00:48:03.760 --> 00:48:07.440 Yeah, so I think that's there's ten percent savings which 709 00:48:07.440 --> 00:48:09.639 would be be as of dollars right there. 710 00:48:10.239

--> 00:48:14.039 But the problem is that politically people don't want to give. 711 00:48:13.960 --> 00:48:18.280 Up their bright and health insurance unless they are forced to. 712 00:48:19.159 --> 00:48:22.000 So I think you've got a tremendous inertia. They tried 713 00:48:22.039 --> 00:48:25.400 to go to a single care system during twenty ten, 714 00:48:25.559 --> 00:48:28.519 and it was they proposed it that it. 715 00:48:28.599 --> 00:48:31.760 Just wouldn't go. So once again, I think there's going 716 00:48:31.840 --> 00:48:33.239 to have to be a crisis spacid. 717 00:48:34.079 --> 00:48:37.760 But what about having private insurance. It's not for profit 718 00:48:38.079 --> 00:48:41.679 like it used to be. Blue Cross Boushiel used to 719 00:48:41.719 --> 00:48:46.360 be not for profit and if they access money either 720 00:48:46.440 --> 00:48:54.400 went back to increasing better care or decreasing premiums. It's 721 00:48:54.480 --> 00:48:59.599 my understanding in Germany that all the insurance is not 722 00:48:59.760 --> 00:49:02.599 for profit and you have a choice of which company 723 00:49:02.719 --> 00:49:05.960 you want to go with, but you're not paying extra money. 724 00:49:06.280 --> 00:49:09.599 It's going to stockhover that could. 725 00:49:12.039 --> 00:49:16.440 Once again, I think anything is possible with intelligent design, 726 00:49:17.079 --> 00:49:20.159 and with a clean chief paper, we could probably work 727 00:49:20.199 --> 00:49:20.920 all of this out. 728 00:49:21.119 --> 00:49:27.000 But I know that it was called during the Plan administration, 729 00:49:27.119 --> 00:49:29.880 they tried to have a discussion about it. It failed. 730 00:49:30.000 --> 00:49:34.480 I think during Obama's administration had they tried to have 731 00:49:34.559 --> 00:49:35.679 a discussion and it failed. 732 00:49:35.800 --> 00:49:38.440 So I think we're just going to have to keep, 733 00:49:39.159 --> 00:49:42.000 you know, fighting a good fight. But the one thing 734 00:49:42.039 --> 00:49:43.960 I could know is the crisis is coming, right. 735 00:49:45.519 --> 00:49:49.400 I just read something yesterday that said that by twenty fifty, 736 00:49:50.239 --> 00:49:54.639 sixty of Americans will have some kind of significant artesis. 737 00:49:55.360 --> 00:49:58.800 That's a combination of aging and sanitary lifestyles and all 738 00:49:58.840 --> 00:50:02.360 of that. So not only is the population aging out, 739 00:50:03.079 --> 00:50:06.320 living longer, there's more people on government insurance. 740 00:50:06.960 --> 00:50:10.199 On top of that, there's also health status. 741 00:50:10.519 --> 00:50:15.280 So a capitalismic crisis of the system running out of 742 00:50:15.360 --> 00:50:18.880 money is going to a correct nine percent confident that 743 00:50:19.159 --> 00:50:21.239 I just can't tell you when that's going to happen. 744 00:50:21.559 --> 00:50:25.440 Well, let me give you an example of how a 745 00:50:25.639 -->

00:50:33.119 not for profit system has worked very well. Louisville. The 746 00:50:33.360 --> 00:50:37.880 University of Louisville Hospital was run for a period of 747 00:50:38.000 --> 00:50:41.800 time the board of Directors, the board of Trustees of 748 00:50:41.840 --> 00:50:46.360 the University and its wisdom hired Humanity to run it 749 00:50:46.519 --> 00:50:49.800 for a while, and that was a nightmare from hell. 750 00:50:49.960 --> 00:50:55.079 They just used they used the charity Care Trust to 751 00:50:55.199 --> 00:50:57.880 run the hospital and sucked as much money out as 752 00:50:57.960 --> 00:51:01.079 they possibly could in any other way. They you know, 753 00:51:01.239 --> 00:51:07.519 they just did nothing to actually benefit to improve the 754 00:51:08.239 --> 00:51:13.920 facilities of the staffing. And then in its wisdom, board 755 00:51:13.960 --> 00:51:19.039 of trustees hired Columbia HCA to run the hospital, which 756 00:51:19.159 --> 00:51:23.559 was another nightmare from hell. And then they hired a 757 00:51:23.679 --> 00:51:27.960 company called Catholic Health Initiatives, which is a not for 758 00:51:28.119 --> 00:51:35.559 profit company from Denver. They went bankrupt. There is uf L, 759 00:51:36.119 --> 00:51:40.639 there was the Jewish Hospital system, and there was a 760 00:51:40.719 --> 00:51:44.760 whole bunch of hospitals. There's a psychiatric hospital, there were 761 00:51:45.800 --> 00:51:50.719 peripheral hospitals. There's a Louisville General Hospital, the University of 762 00:51:50.800 --> 00:51:59.159 Louisville Hospital. The last university president, to her credit before 763 00:51:59.280 --> 00:52:06.039 she left, put together a plan that acquired They got 764 00:52:06.159 --> 00:52:11.559 money from the state and from two Jewish foundations about 765 00:52:11.559 --> 00:52:15.639 one hundred and fifty million dollars. They put this all together. 766 00:52:16.639 --> 00:52:21.679 There this is a non profit system that has incorporated 767 00:52:21.880 --> 00:52:25.880 all of the private practitioners that were in the Jewish 768 00:52:26.000 --> 00:52:31.320 hospital system, and it is doing so well that it 769 00:52:31.480 --> 00:52:35.679 is building an extension on the hospital based upon the 770 00:52:35.840 --> 00:52:41.639 resources that they've acquired from running the system as a 771 00:52:41.760 --> 00:52:45.079 not for profit and putting the money back into the 772 00:52:45.239 --> 00:52:51.119 system as opposed to giving it to overpaid CEO's political 773 00:52:51.239 --> 00:52:57.400 contributions and investors. And it works. I mean I talked 774 00:52:57.440 --> 00:53:00.239 to Kelly about this the other day. I mean, only 775 00:53:00.280 --> 00:53:04.159 have done an outstanding job and they've got money. If 776 00:53:04.239 --> 00:53:07.280 the money that comes in doesn't go out somewhere else, 777 00:53:07.320 --> 00:53:08.480 it stays in the system. 778 00:53:09.639 --> 00:53:12.360 I think they've done an incredible job in doing that. 779 00:53:13.639 --> 00:53:18.559 Yeah, people will and the state of Kentucky need to 780 00:53:18.639 --> 00:53:23.039 be Yeah, really knowledgeable that and thankful for all. 781 00:53:26.599 --> 00:53:30.239 Done. Before we end, I want to thank you for 782 00:53:30.400 --> 00:53:34.440 your wisdom, and I hope we can get you back again. 783 00:53:35.719 --> 00:53:38.880 We'll find something else to talk about. I think you've 784 00:53:38.920 --> 00:53:44.119 got a great understanding of what's going on. And one 785 00:53:44.159 --> 00:53:46.800 of the things that we do here is we were, 786 00:53:47.400 --> 00:53:50.880 to some extent we're preaching to the choir. Jean and 787 00:53:50.960 --> 00:53:53.679 I are physicians. A lot of the guests we come 788 00:53:53.760 --> 00:53:56.519 on a physicians and it's good to have an administrator 789 00:53:57.320 --> 00:54:00.960 comes on and kind of give us a balance that 790 00:54:01.079 --> 00:54:03.400 we need with some of our ideas. 791 00:54:04.039 --> 00:54:07.079 James, I had one final question. 792 00:54:07.400 --> 00:54:07.519 Uh. 793 00:54:08.679 --> 00:54:13.599 One of the favorite concepts of for profit health companies 794 00:54:13.679 --> 00:54:16.920 now and is value based healthcare. 795 00:54:18.880 --> 00:54:20.480 John, do you know anything about that? 796 00:54:20.679 --> 00:54:25.400 And and there is there any legitimate role for this 797 00:54:25.639 --> 00:54:27.559 concept of value based healthcare? 798 00:54:28.639 --> 00:54:32.400 Yeah, I do think that there's a role for for that. Uh. 799 00:54:33.320 --> 00:54:37.440 You know, the big issue for healthcare for the years 800 00:54:37.960 --> 00:54:39.199 has been UH. 801 00:54:39.559 --> 00:54:44.400 Fee for service UH and healthy for service gives the 802 00:54:44.480 --> 00:54:46.679 providers incentives if they. 803 00:54:47.280 --> 00:54:52.159 If they are more product gives the fee for service 804 00:54:52.199 --> 00:54:54.840 to morphins you do, the more fees you get. 805 00:54:55.039 --> 00:54:59.199 So so these concepts have been around thirty to forty 806 00:54:59.320 --> 00:55:04.000 years and different types of value based here. But you 807 00:55:04.159 --> 00:55:08.119 have to have value based standards in the place because 808 00:55:08.159 --> 00:55:12.559 if you do it cappetain there's really talking about payment 809 00:55:12.920 --> 00:55:17.440 cappetated payment versus fee for service payment. So if you 810 00:55:17.559 --> 00:55:21.880 don't have qual these standards in place, it makes it 811 00:55:23.280 --> 00:55:26.320 it eliminates the temptations to the cut of corners. 812 00:55:26.400 --> 00:55:29.639 And for example, you know, the. 813 00:55:29.719 --> 00:55:34.079 Federal government has required doctors to use these hetus measures 814 00:55:34.159 --> 00:55:40.800 formIn years since twenty sixteen. And there's a candidate state 815

00:55:40.920 --> 00:55:44.280 you know, there's extra payment that comes in if they 816 00:55:44.400 --> 00:55:49.800 do these quality improvement activities. On the other hand, you know, 817 00:55:49.840 --> 00:55:53.440 there's also penalties if they fail to do them. But 818 00:55:54.079 --> 00:55:59.239 they are basing genets of medicine. Some of the doctors 819 00:55:59.280 --> 00:56:01.840 from their previous ship an argue that we can do 820 00:56:02.000 --> 00:56:06.239 the same way. It's good patient care. But these days 821 00:56:06.280 --> 00:56:09.360 it's not that I hear absolutely follow. 822 00:56:09.199 --> 00:56:10.480 These systems what you said. 823 00:56:11.239 --> 00:56:13.840 I look this up in preparation for the meeting, and 824 00:56:13.920 --> 00:56:18.880 their looks like there's about fifteen physician quality measures that 825 00:56:19.000 --> 00:56:20.159 are currently being used. 826 00:56:20.039 --> 00:56:25.880 For That sounds good, don but our group and our 827 00:56:26.000 --> 00:56:29.280 movement has found lots of things not to like about 828 00:56:29.320 --> 00:56:32.800 these programs in terms of it's just there are more 829 00:56:32.920 --> 00:56:36.920 systems there to go by, and that adds administrative cost. 830 00:56:37.440 --> 00:56:39.880 Who's going to check on these people that are checking off? 831 00:56:40.440 --> 00:56:43.480 And where the accountability comes in for people who've actually 832 00:56:44.079 --> 00:56:46.559 said that they have followed these procedures, Well. 833 00:56:46.480 --> 00:56:50.679 Well aren't aren't all these things done by there by 834 00:56:50.880 --> 00:56:56.280 for profit health insurance companies? Now the value takes care, Yes, 835 00:56:56.599 --> 00:57:02.360 the Medicare advantage, I mean they've well I didn't realize 836 00:57:02.400 --> 00:57:06.679 that this was self inflicted by Medicare, that they've hired 837 00:57:07.480 --> 00:57:13.039 the for profit insurance companies to execute these programs and 838 00:57:13.159 --> 00:57:16.920 they make money out of it. Is about to do 839 00:57:17.199 --> 00:57:18.920 nothing but medicare advantage. 840 00:57:19.320 --> 00:57:23.559 They're already doing it. Yeah, you get even the employees 841 00:57:23.679 --> 00:57:23.960 and for. 842 00:57:24.159 --> 00:57:27.880 Him Mana do not have human insurance, they can go 843 00:57:28.000 --> 00:57:30.639 outside and by uh. 844 00:57:32.079 --> 00:57:38.159 So human is nothing but advantage care and medicare. 845 00:57:38.239 --> 00:57:39.119 I didn't know that. 846 00:57:39.400 --> 00:57:39.960 Incredible. 847 00:57:40.800 --> 00:57:43.039 Yeah, I think it's like everything. 848 00:57:43.119 --> 00:57:45.280 I mean, you know, should you have for all these 849 00:57:45.320 --> 00:57:50.800 standards for physician practices and ross, yes, the jails, the 850 00:57:50.920 --> 00:57:53.880 details of how these programs are managed and whether they 851 00:57:53.960 --> 00:57:57.360 managed by for profit companies that have expects, you know, 852 00:57:57.559 --> 00:57:59.719 that have a chance to make excess profits. 853 00:57:59.760 --> 00:58:02.880 I think we probably can't talk about that anymore today 854 00:58:02.880 --> 00:58:04.280 because we're kind of burning out the time. 855 00:58:04.360 --> 00:58:09.199 But Sugar equality standards for physician practices and for hospitals. 856 00:58:10.519 --> 00:58:15.480 Oh, absolutely, no question. Don Thanks again, great, we'll do 857 00:58:15.599 --> 00:58:16.000 it again. 858 00:58:18.280 --> 00:58:21.519 Well. I'd like to thank everyone, including our listeners who 859 00:58:21.639 --> 00:58:24.480 joined us today and hope you'll tune in next time. 860 00:58:25.159 --> 00:58:25.440 Thank you,