Speaker 1: Among the things I'd like to talk about with Craig
Speaker 1: got Walls. We call him Craig the healthcare Guru who
Speaker 1: has been joining us for many, many years. Attorney at
Speaker 1: law and benefit consultant Benefit Revolution. As a healthcare policy
Speaker 1: attorney with an emphasis and employment law and to benefit consultant,
Speaker 1: Craig got Walls specializes in benefit cost containment and compliance.
Speaker 1: It's his job to figure out what is actually happening
Speaker 1: and predict what is going to happen, regardless of his wants,
Speaker 1: because he's got to advise clients so they can prepare
Speaker 1: for that sort of thing. Craig, Welcome to the Armstrong
Speaker 1: and Getty Show once again. Thanks Jack. I think I
Speaker 1: think you might have surpassed Joe as best best introduction
Speaker 1: of me yet I don't know. Now it's a competition.
Speaker 1: You get no you get no benefit for that sort
Speaker 1: of flattery. Um uh. Fair to describe the mental health
Speaker 1: care situation we've got in America as a crisis, Yes,
Speaker 1: absolutely fair. It's it's been a problem for years, Jack,
Speaker 1: it's it's it's it's I mean, the backdrop of the
Speaker 1: problem that his historical setting of it is. You know,
Speaker 1: even before this recent spike, and I say recent spike,
Speaker 1: you know, going back to you know, the invention of
Speaker 1: the iPhone, the invention of social media, you can track
Speaker 1: very very large increases in the demand for mental health.
Speaker 1: But it's always been a a specialty within the health
Speaker 1: care industry that was just sort of under favored, not
Speaker 1: not compensated as well. So it's always been something that
Speaker 1: was tough to get. And then when you when you
Speaker 1: pile on top of that the just the tremendous spike
Speaker 1: in demand we've had over the past twelve fifteen years,
Speaker 1: it's it's exacerbated the problem. So how did that happen?
Speaker 1: Was it? Was it a national attitude up until fairly
Speaker 1: recently that mental health care is kind of you know,
Speaker 1: voodoo for the week. I mean just kind of a
Speaker 1: you know, a fake medical field, um, and so we
Speaker 1: didn't take it seriously enough for or what's your theory
Speaker 1: on that? Yeah, No, I think I think your characterization
Speaker 1: is fair at least for you know, maybe part of
Speaker 1: the country. And it was just I would say, you know,
Speaker 1: some people viewed it as what you said, you know,
Speaker 1: voodoo for the week, and others just viewed it as,
Speaker 1: you know, maybe not as rigorous of a discipline, a
Speaker 1: little bit more subjective, you know, not not nearly as
Speaker 1: important as like setting a bone or removing a tumor.
Speaker 1: That makes sense. Let me run through some of these
Speaker 1: numbers real quick and then you can comment on it.
Speaker 1: Um These are numbers that Craig sent me. By five,
Speaker 1: which is just two and a half years from now,
Speaker 1: we will be down about ten thousand, five hundred marriage
Speaker 1: and family therapists that we'll need but won't have, about
Speaker 1: fifteen thousand psychiatrists, which takes I don't know how many
Speaker 1: years of school to become a psychiatrist. So you know
Speaker 1: we're gonna crank come out soon. We'll be down about
Speaker 1: twenty seven thousand mental health counselors, forty nine thousand social workers,
Speaker 1: fifty eight thousand psychologists that's a pH d will be
Speaker 1: behind fifty eight thousand of those, and seventy eight thousand
Speaker 1: school counselors that we will not have. By Yeah, that's
Speaker 1: a crisis. Yeah, it absolutely is. And you know, if
Speaker 1: nothing happens in a vacuum, right, So all of the
Speaker 1: things we've talked about over the past ten years on
Speaker 1: your radio show about the problems with healthcare and the
Speaker 1: fact that government controls more and more healthcare. Uh, you
Speaker 1: know that that's that's also part of this problem. And
Speaker 1: it's I think, I think I have a streak of
Speaker 1: repeating the statistic every time I'm on your show the
Speaker 1: last year. But it's very important to remember for those
Speaker 1: listening for the first time, or for those that haven't
Speaker 1: thought much about it. We we talked about having a
Speaker 1: quote free unquote healthcare system in America, and we really don't.
Speaker 1: We have an oligopoly and that's something that's controlled by
Speaker 1: a few providers, and and that oligopoly is infected with
Speaker 1: government disease. And that government disease means that if you
Speaker 1: live in a blue state, seventeent of healthcare costs are
Speaker 1: now paid by the taxpayer. And that that blows people's
Speaker 1: minds because we think about, you know, the private insurance
Speaker 1: we have at work. But once you add together Medicare
Speaker 1: plus Medicaid plus Obamacare plus Trycare, the v A plus
Speaker 1: Obamacare subsidies of blue state healthcare is paid by taxpayers,
Speaker 1: and you say, well, gosh, I live in a red state.
Speaker 1: It's a lot better. Not it's sixty percent. WHOA I
Speaker 1: didn't realize so you know, let's call it seventy ish
Speaker 1: on average. Um uh. If I were uh a lefty
Speaker 1: who believes in, you know, government taking overall of healthcare,
Speaker 1: I wouldn't be hiding those numbers. I'd be touting them
Speaker 1: and saying, look, I don't know if you know this,
Speaker 1: but the healthcare is already that, so what are we doing? Yeah.
Speaker 1: They don't want to do that, though, because when you
Speaker 1: pull people about how satisfied they are with the healthcare system,
Speaker 1: those numbers ranked down around congressional level. I didn't know that, Okay,
Speaker 1: can I see what you mean? I see what you mean.
Speaker 1: So if you've got you you ask, if you ask
Speaker 1: do you like your doctor, that's a very high number.
Speaker 1: If you like, are you satisfied with current health care system?
Speaker 1: It's very low. Yeah. Well I'm not satisfied with it either.
Speaker 1: In it's probably I've got the same complights that everybody
Speaker 1: else does, whether it's you know, freaking the nightmare of
Speaker 1: just getting the simplest prescription and all that sort of
Speaker 1: stuff and run and everything like that. What's crazy to
Speaker 1: me is that how many of you all believe that
Speaker 1: if the government ran it it would be easier. Somehow,
Speaker 1: I mean, what is your life experience that leads you
Speaker 1: to believe that No, and I did. That's why I
Speaker 1: wanted to give you just a three specific numbers so
Speaker 1: you can understand how the government makes it worse. So,
Speaker 1: the largest demand we have for mental health right now
Speaker 1: is among the young. You know, people call them twelve
Speaker 1: to twenty five. That's the that's the biggest demand we
Speaker 1: have for healthcare. And if i can just jump in
Speaker 1: here on that, because I've been in that situation and
Speaker 1: you you know, a lot lots of my friends have, Um,
Speaker 1: you have a kid who's struggling. I mean, that's a
Speaker 1: that's a you know, you and your wife, you and
Speaker 1: your husband sitting there at night at night, tier eyed,
Speaker 1: what are we gonna do with this situation? You finally
Speaker 1: decide to pull the trigger and get help, and it's
Speaker 1: like the number one issue on your mind. You're gonna
Speaker 1: dedicate all your int this the next day and you
Speaker 1: get on the phone and you start calling people and
Speaker 1: you can't find anybody, anybody with an opening. It's it's awful,
Speaker 1: that's right. And when you and you know, I've helped
Speaker 1: clients with the issue, and I've been there myself with
Speaker 1: family members, and and then if you do find somebody,
Speaker 1: maybe they miss your appointment or they don't call you
Speaker 1: back because they're stretched so thin that that if they're
Speaker 1: hard to access. But so when we talk about well,
Speaker 1: how what's the government's role in this, you said, well, okay,
Speaker 1: the the number one coverage entity for children in America
Speaker 1: is Medicaid. That's our our our system for the low income. Now,
Speaker 1: it's always good to remember when Medicaid was first passed
Speaker 1: in the late sixties, it was designed to cover the
Speaker 1: bottom two percent of wage earners. It now covers one
Speaker 1: out of every three children born in America. That's how
Speaker 1: fast that safety net has grown into a hammock. So
Speaker 1: if we look at Medicaid, let's do this. If you
Speaker 1: if you, if you need a mental health visit, an
Speaker 1: integrated assessment including history, mental status, ETCeteras. That's the main
Speaker 1: CPT code for when you first come in. The average nationwide,
Speaker 1: and this varies greatly by zip code, but the average
Speaker 1: cost that the doctor is going to get reimbursed for
Speaker 1: that visit is a hundred and fifty dollars. Okay, Now,
Speaker 1: the average doctor visits a hundred and seventy five So
Speaker 1: you can see mental health is already twenty dollars behind
Speaker 1: an average doctor visit, but if you need that visit
Speaker 1: on Medicaid, it's only going to reimburse a hundred and
Speaker 1: five dollars. So you take a system where we already
Speaker 1: don't have enough providers because the supply is not keeping up.
Speaker 1: Our practitioners are over the age of fifty five, they're
Speaker 1: retiring faster than we're making them. And then you underpay
Speaker 1: them systematically across the board, and then you more significantly
Speaker 1: underpay them in the government reimbursement program. Will you end
Speaker 1: up with a very very broken supply and demand system,
Speaker 1: primarily because we don't have a free market. We have
Speaker 1: a government infected oligopoly. Uh, that's all very interesting. In
Speaker 1: every healthcare of mental healthcare provider or or a therapist, psychologist,
Speaker 1: whatever that I've dealt with in the last couple of years,
Speaker 1: there's no insurance involved. They're just taking cash and it's expensive.
Speaker 1: And I don't know how most people. I'm lucky, I've
Speaker 1: got a good job. I don't know how most people
Speaker 1: can even consider doing that. Um, that's a tough situation
Speaker 1: to be in. No, that's exactly right. And when you
Speaker 1: when you when you dig into a lot of these
Speaker 1: very very troubled young people that commit horrific acts of
Speaker 1: violence across the nation, a lot of times you find
Speaker 1: that they don't have the resource for private health. They're
Speaker 1: relying on that medicaid system that is systematically under reimbursing
Speaker 1: and under paying providers, and so they just don't get
Speaker 1: the help they need, or they get very very underdeserved help,
Speaker 1: you know, through maybe a school counselor when they really
Speaker 1: need a psychiatrist. You know a lot about healthcare, and UM,
Speaker 1: I apologize from asking you something that sets you up
Speaker 1: to uh to to to not know. But UM, I've
Speaker 1: been wondering for a long time. I hear about the
Speaker 1: mental health system we had back in the day that
Speaker 1: I guess we are one in the sixties and the
Speaker 1: seventies because we decided it was too oppressive and you know,
Speaker 1: people who weren't crazy were being locked up a mental
Speaker 1: institutions and given lobotomies like Jack Nicholson and all that
Speaker 1: sort of stuff, and so we did away with that.
Speaker 1: Um has that been a bad idea in retrospect? Do
Speaker 1: you think? Well? As a libertarian, I'd say no, you know,
Speaker 1: and I would, I would. I would tell you that
Speaker 1: the armstrong and getty principle that you guys have espoused
Speaker 1: over the years of society veering from guardrail to guardrail,
Speaker 1: going too far one way and then overcorrecting it, it
Speaker 1: really applies in that situation where for a period there
Speaker 1: from the you know, the mid nineteen hundreds, we had
Speaker 1: we had a system whereby it was too easy to
Speaker 1: lock people, oh yeah, or or sterilize them or whatever. Yeah, yeah,
Speaker 1: and and um so do we need to go back
Speaker 1: that far? Of course not. But have we gone too
Speaker 1: far the other way where we just we we view
Speaker 1: it as compassionate to leave one to his or her
Speaker 1: own devices on the streets of San Francisco screaming at
Speaker 1: a at a fire hydrant and and and defecating in
Speaker 1: the gutter. Yeah, we've gone too far, and society will
Speaker 1: correct this. I mean, you know, it's not all bad news.
Speaker 1: Some of these these mental health reimbursements are coming up.
Speaker 1: I mean this gap I see between what we pay
Speaker 1: for a doctor visit versus a mental health visit. That
Speaker 1: gap is shrinking every year, and there is there there
Speaker 1: are efforts both in the industry and at the federal
Speaker 1: level reimbursement wise to correct it. So I have no
Speaker 1: I have no real doubt in my head that this
Speaker 1: will eventually become less of a problem. But of course
Speaker 1: it's going to happen a lot slower than we all
Speaker 1: would like because of the giant federal bureaucracy that gets
Speaker 1: involved in muddying the waters. Right. And then then those
Speaker 1: numbers that you gave me on the shortage we're gonna
Speaker 1: have in all those different areas of mental health that's
Speaker 1: going to be here in no time, and that is well,
Speaker 1: and the demand Jack, I mean, that's the you know,
Speaker 1: just I pulled some of these statistics, and most of
Speaker 1: these statistics look at like the difference between two thousand
Speaker 1: five and two thousand seventeen, depression alone for young people
Speaker 1: is up fifty to sixty depending on which age bracket
Speaker 1: you look at. Suicidal thoughts amongst young people is up
Speaker 1: fort over that time frame. So you you know, you
Speaker 1: you say, well, we're up in the need for very
Speaker 1: serious issues, and that that supply chain is not growing.
Speaker 1: In fact, well it might be growing, but it's not
Speaker 1: growing nearly fast enough to keep up with the demand.
Speaker 1: And so you have a supply demand problem, but it
Speaker 1: can't be properly fixed because the government steps in with
Speaker 1: all kinds of rules and regulations that oftentimes even ones
Speaker 1: that are well intentioned, of course, retard the market, and
Speaker 1: the market can't respond properly, and that's why you end
Speaker 1: up with a two tiered health system. And that This
Speaker 1: is where I think liberals really need to get is
Speaker 1: to say we don't want what we have, because what
Speaker 1: we have is what you just described earlier, and that's
Speaker 1: that the people with money can afford the private care
Speaker 1: and they get it, and the people that rely on
Speaker 1: these government systems can't. I saw this headline yesterday, the
Speaker 1: Democrats are facing a political crisis right before the all
Speaker 1: you see the A RP. Do you remember that the
Speaker 1: American Rescue Plan, which had trillions of dollars of all
Speaker 1: kinds of different stuff in it, part of it was
Speaker 1: a boost in Obamacare subsidies, and that is going to
Speaker 1: expire right before the election. This is where Craig jumps
Speaker 1: in and explains what's likely to happen here. Yeah, this
Speaker 1: is a beautiful one. So Obamacare gives about sixty billion
Speaker 1: dollars a year to fourteen million Americans to buy UH
Speaker 1: subsidized healthcare in the exchanges. What the a RP did
Speaker 1: a year and a half ago was came in and said, well,
Speaker 1: that's not enough because Obamacare is not actually keeping prices down,
Speaker 1: it's just funneling more money into insurance companies from the taxpayer.
Speaker 1: So during this crisis of the pandemic, what we want
Speaker 1: to do is give an additional fifty or thirty billion
Speaker 1: dollars to those people. And primarily that money went to
Speaker 1: people making between four hundred and six hundred percent of
Speaker 1: the federal poverty Really, yeah, now that's a subsidy for
Speaker 1: a family of four that's making between a hundred and
Speaker 1: ten and a hundred and sixty dollars. That was the
Speaker 1: additional government cheese. So of course they put this thing
Speaker 1: in temporarily, knowing what they always try and do is say, well,
Speaker 1: we can't take it away now. And um, the beautiful
Speaker 1: thing is this is going This is set to expire
Speaker 1: on January one, which means it's gonna hit all the
Speaker 1: Obamacare open enrollments that are occurring this fall, literally days
Speaker 1: before the mid term elections. You could see or you
Speaker 1: will see if they don't fix this, many people in
Speaker 1: the Obamacare exchanges, of those fourteen million people are going
Speaker 1: to see thirty increases in their monthly premium whoad notice
Speaker 1: that you would notice that. And this is one of
Speaker 1: those things that they have to get some agreement from
Speaker 1: the Republicans to go along with this, and so far
Speaker 1: they have been unable to do it. Do you think
Speaker 1: the Republicans, I know, you think the Republicans are going
Speaker 1: to cave on this. Why because they always do and
Speaker 1: the Democrats are better at grabbing them. The Democrats are
Speaker 1: better at grabbing the media. And the Democrats will spend
Speaker 1: this is it's because of those evil Republicans with an
Speaker 1: economy not yet recovered that they're taking away your extra
Speaker 1: healthcare dollars. That's how it will be spun, even though
Speaker 1: it was passed as temporary band aid to help not
Speaker 1: even the low income FO six percent of the federal
Speaker 1: poverty level folks. But Republicans stink at messaging, and that's
Speaker 1: how it's going to go. I suspect. And that's just
Speaker 1: the inertia of these things. Read the book The High
Speaker 1: Cost of Good Intention, Good Intentions. I mean, it's just
Speaker 1: the way these things always go. Um are there a
Speaker 1: lot of people that like are you know the crowd
Speaker 1: you're just describing in terms of income who are using
Speaker 1: their companies health insurance that if they were going to
Speaker 1: be smart, they would go on Obamacare. Um, a few people, Jack,
Speaker 1: not many though. The way that the way that it works, Um,
Speaker 1: if you're if your company offers you affordable care, you
Speaker 1: are not supposed to qualify for Obamacare subsidies. But that's
Speaker 1: a little bit muddied the way it works, and some
Speaker 1: people end up qualifying for subsidies anyway. But for the
Speaker 1: most part that system is pretty well clamped down. Okay,
Speaker 1: thanks for your information. Is always where do people find
Speaker 1: you if they want some of your brilliance At Benny
Speaker 1: Revolution on Twitter or benefit dash Revolution on the old
Speaker 1: interweb systems. Yeah, you are a good follow on Twitter.
Speaker 1: Craig got walls appreciate your time to they think Craig.
Speaker 1: Thanks a lot. Thanks Jack,