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Speaker 1: Doctor Jim Keeney, who has been with this show for

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Speaker 1: what twenty five thirty years? Maybe, all right, Jim, let's

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Speaker 1: talk about the amount of money that the government is

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Speaker 1: putting into health system, particularly and we talked about this

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Speaker 1: earlier rural healthcare, because that seems to be one of

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Speaker 1: the areas is going to be most affected and it's

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Speaker 1: money is coming in. So where's the bitch here?

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Speaker 2: Yeah, I mean, so rural hospitals are, you know, they're

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Speaker 2: kind of lifeline. We all think we don't need rural hospitals,

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Speaker 2: but we all tend to, you know, go on trips

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Speaker 2: drive and you'd say, you never know when you're actually

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Speaker 2: going to be in rural hospital, even if you live

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Speaker 2: in an urban area. But rural hospitals don't have the

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Speaker 2: same type of operation as a city hospital. We in

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Speaker 2: city hospitals, we have a certain amount of commercial insurance,

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Speaker 2: and you know, we it's well known that hospitals try

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Speaker 2: and cost shift. You know, the more money they can

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Speaker 2: make on commercial insurance is the less they have to

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Speaker 2: rely on the underpayments of Medicaid. But rural hospitals can't

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Speaker 2: do that. They are mostly Medicaid. They end up with

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Speaker 2: margins that are about two percent, so when there's any

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Speaker 2: shift in the environment, they really get in trouble fast.

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Speaker 2: And so the Big Beautiful Bill, it cut nine hundred

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Speaker 2: billion dollars out of healthcare over the next ten years,

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Speaker 2: but cut nine hundred billion out and then they announced

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Speaker 2: recently that they're going to give up fifty billion in

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Speaker 2: grants over the next five years, so about ten billion

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Speaker 2: a year in grants to rural hospitals. So it's with

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Speaker 2: interesting to me, perked out my interest because it was marketed.

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Speaker 2: It looks like it is marketed as look what we're

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Speaker 2: doing for rural hospitals. But at the end of the day,

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Speaker 2: it's a it's a bigger cut we got. We took

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Speaker 2: away nine hundred billion and we're given back fifty billion.

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Speaker 1: So that it seems that's across the board with healthcare

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Speaker 1: that under the Big Beautiful Bill, and that's certainly the

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Speaker 1: border enforcement got, you know, tons of money, and the

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Speaker 1: military got tons of money, but seems like healthcare was

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Speaker 1: one of the if not the biggest areas that were

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Speaker 1: hit the most. Buy the Big Beautiful Bill. You know,

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Speaker 1: are people in the industry, and that's you in the

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Speaker 1: medical world. Certainly you're upset, But how frightened are you

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Speaker 1: that medical care in this country is really going to

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Speaker 1: drop pretty dramatically.

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Speaker 2: Yeah, I mean this will definitely impact certain hospitals, especially

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Speaker 2: those ones they were talking about, because you know, again

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Speaker 2: no room margin for error here. And now the infrastructure

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Speaker 2: is also getting old, and so hospitals. Ideally you would

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Speaker 2: run a business with a replacement budget right where you

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Speaker 2: over time. You know, a CT scanner costs a million

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Speaker 2: dollars and at the last ten years, so you need

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Speaker 2: to put away one hundred thousand dollars a year for

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Speaker 2: ten years so that at the end of that life

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Speaker 2: cycle you can buy a new one. Nobody does that.

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Speaker 2: They don't have the money to do that. So the

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Speaker 2: infrastructure is really aging a lot. You've got a lot

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Speaker 2: of hospitals and you'll find that the CT scanner doesn't

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Speaker 2: work on a regular basis, that it spends a lot

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Speaker 2: of time in repair. You look at simple things like

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Speaker 2: the facility itself. I mean, they're all struggling with these

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Speaker 2: last range. I know multiple hospitals that struggled with water

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Speaker 2: intrusion and because their structure is just not what it

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Speaker 2: needs to be. So you know, we're all struggling people

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Speaker 2: come to the ear, they feel it because the weights

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Speaker 2: are incredible, and that's not going to get any better.

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Speaker 1: Yeah, we spend a lot of time talking about your

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Speaker 1: organization and you're now running a hospital, at least the

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Speaker 1: medical part of the hospital. And you know, I never

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Speaker 1: asked you this question, but there you are needing an

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Speaker 1: MRI machine. It's a million bucks, a million and a

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Speaker 1: half dollars. You can't afford it. Does the hospital borrow

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Speaker 1: money like any other commercial venture, to pay for big

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Speaker 1: ticket items?

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Speaker 2: Yeah, I mean there's there's two ways hospital run. The

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Speaker 2: most common is not for profit, So not for profit

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Speaker 2: can issue bonds, and then those bonds are a way

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Speaker 2: of like of taking down a loan and getting money

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Speaker 2: to pay for items like that. You try and do

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Speaker 2: fundraising as well. So a lot of times when we

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Speaker 2: do anything, you know, maybe a third of the money

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Speaker 2: or a little bit less will come from philanthropy, and

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Speaker 2: then the rast will come either from operating budget or

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Speaker 2: from things like issuing a bond if you can. There's

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Speaker 2: a lot of hospitals are already they can't do that.

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Speaker 2: They don't have any any assets or any ability to

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Speaker 2: pay back, so their rate they're bond rating is too low.

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Speaker 2: The for profit hospitals there, of course, you know they

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Speaker 2: and just you know, borrow money like anybody else can.

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Speaker 1: Hey, So when you're running your hospital, I know you

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Speaker 1: have a lot to do with budgets. How do you

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Speaker 1: take into account how do you deal with what's going

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Speaker 1: on currently politically because I'm assuming, maybe I'm long on this,

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Speaker 1: I'm assuming there are federal state grants that you can

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Speaker 1: get for medical care other than other than medical.

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Speaker 2: Yeah. Absolutely, we have the largest HIV clinic in the

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Speaker 2: country that's been there for forty years and runs off

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Speaker 2: federal grants. And you know, there are people that have

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Speaker 2: been treated there for decades and are still alive now

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Speaker 2: because of that clinic. A lot of that funding has

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Speaker 2: been cut and there are concerns about how do that

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Speaker 2: clinic maintain that without the funding that it gets. So

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Speaker 2: you know, it's it's difficult and which you're trying to

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Speaker 2: read the tea leaves what these cuts really mean because

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Speaker 2: sometimes cuts are reversed by the next administration. Can we

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Speaker 2: make it that long before before people go bankrupt or

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Speaker 2: before you have to reduce services? And again, that's what

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Speaker 2: rural hospitals and inner city hospitals that you know, disproportionately

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Speaker 2: treat the underserved. They really do struggle with well, you know,

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Speaker 2: we're gonna have to close a service line, and hospitals

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Speaker 2: close things like their pediatric ward or their obstetrics and

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Speaker 2: gynecology ward, you know, so that they can focus on

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Speaker 2: general medical health.

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Speaker 1: Jim McKinney, our medical experts been with us for almost

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Speaker 1: thirty years now. And the other topic I want to

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Speaker 1: cover is the vaccine scheduling and reporting. A lot is

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Speaker 1: I think it was yesterday that the CDC had changed.

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Speaker 1: It's the recommendation in terms of what kind of vaccines

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Speaker 1: and how often they should be given to children. And

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Speaker 1: there's a backstory to that too, because it's not just

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Speaker 1: here are the vaccines, here's what we're reporting. There's more

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Speaker 1: to it.

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Speaker 2: Jim, would you explain, Yeah, So essentially what they've done

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Speaker 2: is among the kids who are covered by Medicaid, they

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Speaker 2: no longer require the states to report immunization measures anymore so,

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Speaker 2: and as well as pregnant women who are enrolled in Medicaid.

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Speaker 2: So that's about half the population that gets vaccinations no

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Speaker 2: longer required to report this information. And you know what

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Speaker 2: it kind of does is it shows that you're going

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Speaker 2: to hide the fact that vaccination drops, that disease states

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Speaker 2: will increase. You no longer will have that data, so

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Speaker 2: it makes it more so then the arguments in the

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Speaker 2: future will be more politicized rather than based on data.

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Speaker 2: We're all going to be fighting over Oh wow, look

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Speaker 2: there's an increase in measles or there's an increase in something,

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Speaker 2: and we want to show that it's correlated at least

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Speaker 2: to drop in vaccination rates, but we won't be able

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Speaker 2: to because they're setting it up that way. So it's

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Speaker 2: very interesting what's going on. That scary stuff.

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Speaker 1: And I'm sure that any kid who is vaccinating and

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Speaker 1: gets autism where they can actually connect the dots if

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Speaker 1: they can. So let's say it happens three times across

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Speaker 1: the United States. Then we don't even know if it

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Speaker 1: happens that much because there has been no connection that's

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Speaker 1: been scientifically proven that will hit the news that the

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Speaker 1: CDC will talk about. It's And I'm asking you, do

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Speaker 1: you view it as that crazy under RFK Junior.

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Speaker 2: Yeah, yeah, I mean I think again, the whole thing

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Speaker 2: has obviously been heavily politicized. It's not based in science

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Speaker 2: or you know, the best information that we have at

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Speaker 2: this point. And again we talked about this last week,

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Speaker 2: but even the change in the vaccination schedule, we want

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Speaker 2: to be more like Denmark, well or nothing like Denmark.

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Speaker 2: They have a uniform kind of genetic population. They have

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Speaker 2: a uniform universal health care, so everyone's covered under health

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Speaker 2: care from birth to death. It's heavily recorded, so we

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Speaker 2: know exactly whether somebody got a vaccine or not if

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Speaker 2: they're in the Denmark health system. It's a completely different

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Speaker 2: animal than the United States, where we have big disparities,

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Speaker 2: pockets of people who don't have access to healthcare, who

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Speaker 2: aren't getting vaccinated or just basic health care. So a

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Speaker 2: completely different world.

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Speaker 1: Yeah. And by the way, the point in the gym

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Speaker 1: is making is Denmark they don't do vaccinations to the

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Speaker 1: extent that we do. That they do just find with

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Speaker 1: almost no vaccinations, and they do seventeen.

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Speaker 2: I mean they do a lower number. We do seventeen.

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Speaker 2: They do about eleven, So they just low and he's

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Speaker 2: lowering the number to match Denmark as if that's the

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Speaker 2: gold standard. But it's not a gold standard, okay.

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Speaker 1: Moving it's so depressing with all this Okay, moving into

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Speaker 1: a much happier note. Flu is reaching the the highest

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Speaker 1: levels in the US in twenty five years, and people

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Speaker 1: are dying like flies. Let's talk about that, because that

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Speaker 1: also is not particularly good news.

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Speaker 2: Yeah, flu is definitely increasing, so we're seeing a lot

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Speaker 2: more er visits related to it. Certain pockets of the

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Speaker 2: country are getting hit really hard. Not quite getting hit

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Speaker 2: that hard yet in southern California, but it does look

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Speaker 2: like it could rise if we follow the pattern of

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Speaker 2: other areas. So still a decent time to get a

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Speaker 2: flu shot. And of course the flu shot, you know,

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Speaker 2: the people who need it the most struggle with the

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Speaker 2: least protection from it, right, the efficacy rates in people

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Speaker 2: over sixty five or lower, But they're the people that

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Speaker 2: need it the most, people with immune compromise or other

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Speaker 2: diseases that put them at higher risk when they do

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Speaker 2: get the flu. But the best thing you can do

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Speaker 2: to try and protect yourself is to get that flu shot.

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Speaker 2: Of course, besides all the basics, right, wash your hand

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Speaker 2: and cover your mouth when you sneeze so you're not

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Speaker 2: giving it to other people, and just basic hygiene would

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Speaker 2: be will reduce your risk.

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Speaker 1: Again in the floor, how do we do in Southern

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Speaker 1: California vaccination wise relative to the rest of the country.

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Speaker 1: Do we have that information.

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Speaker 2: Yeah, I mean we're on par with the rest of

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Speaker 2: the country. We're not above or below, so we're not

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Speaker 2: one of those areas where everybody does not get the vaccine.

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Speaker 2: We're just we're kind of right on track, if anything,

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Speaker 2: a little bit higher in the rest of some of

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Speaker 2: the areas of the country.

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Speaker 1: Okay, fair enough, Jim. We will talk again, of course,

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Speaker 1: next Wednesday, and then we'll probably talk over the week

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Speaker 1: when I scream at you for something or another. Jim M. Kinney.

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Speaker 1: Always a pleasure to have with you, have us with you,

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Speaker 1: have us, you with us, or you with Yeah, you

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Speaker 1: know what I mean, all right, Jim.

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Speaker 2: Last segment.

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Speaker 1: Yeah,