WEBVTT - Voodoo For The Weak? - Craig Gottwals Talks to A&G

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<v Speaker 1>Among the things I'd like to talk about with Craig

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<v Speaker 1>got Walls. We call him Craig the healthcare Guru who

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<v Speaker 1>has been joining us for many, many years. Attorney at

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<v Speaker 1>law and benefit consultant Benefit Revolution. As a healthcare policy

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<v Speaker 1>attorney with an emphasis and employment law and to benefit consultant,

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<v Speaker 1>Craig got Walls specializes in benefit cost containment and compliance.

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<v Speaker 1>It's his job to figure out what is actually happening

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<v Speaker 1>and predict what is going to happen, regardless of his wants,

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<v Speaker 1>because he's got to advise clients so they can prepare

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<v Speaker 1>for that sort of thing. Craig, Welcome to the Armstrong

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<v Speaker 1>and Getty Show once again. Thanks Jack. I think I

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<v Speaker 1>think you might have surpassed Joe as best best introduction

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<v Speaker 1>of me yet I don't know. Now it's a competition.

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<v Speaker 1>You get no you get no benefit for that sort

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<v Speaker 1>of flattery. Um uh. Fair to describe the mental health

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<v Speaker 1>care situation we've got in America as a crisis, Yes,

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<v Speaker 1>absolutely fair. It's it's been a problem for years, Jack,

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<v Speaker 1>it's it's it's it's I mean, the backdrop of the

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<v Speaker 1>problem that his historical setting of it is. You know,

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<v Speaker 1>even before this recent spike, and I say recent spike,

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<v Speaker 1>you know, going back to you know, the invention of

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<v Speaker 1>the iPhone, the invention of social media, you can track

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<v Speaker 1>very very large increases in the demand for mental health.

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<v Speaker 1>But it's always been a a specialty within the health

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<v Speaker 1>care industry that was just sort of under favored, not

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<v Speaker 1>not compensated as well. So it's always been something that

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<v Speaker 1>was tough to get. And then when you when you

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<v Speaker 1>pile on top of that the just the tremendous spike

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<v Speaker 1>in demand we've had over the past twelve fifteen years,

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<v Speaker 1>it's it's exacerbated the problem. So how did that happen?

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<v Speaker 1>Was it? Was it a national attitude up until fairly

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<v Speaker 1>recently that mental health care is kind of you know,

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<v Speaker 1>voodoo for the week. I mean just kind of a

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<v Speaker 1>you know, a fake medical field, um, and so we

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<v Speaker 1>didn't take it seriously enough for or what's your theory

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<v Speaker 1>on that? Yeah, No, I think I think your characterization

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<v Speaker 1>is fair at least for you know, maybe part of

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<v Speaker 1>the country. And it was just I would say, you know,

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<v Speaker 1>some people viewed it as what you said, you know,

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<v Speaker 1>voodoo for the week, and others just viewed it as,

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<v Speaker 1>you know, maybe not as rigorous of a discipline, a

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<v Speaker 1>little bit more subjective, you know, not not nearly as

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<v Speaker 1>important as like setting a bone or removing a tumor.

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<v Speaker 1>That makes sense. Let me run through some of these

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<v Speaker 1>numbers real quick and then you can comment on it.

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<v Speaker 1>Um These are numbers that Craig sent me. By five,

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<v Speaker 1>which is just two and a half years from now,

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<v Speaker 1>we will be down about ten thousand, five hundred marriage

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<v Speaker 1>and family therapists that we'll need but won't have, about

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<v Speaker 1>fifteen thousand psychiatrists, which takes I don't know how many

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<v Speaker 1>years of school to become a psychiatrist. So you know

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<v Speaker 1>we're gonna crank come out soon. We'll be down about

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<v Speaker 1>twenty seven thousand mental health counselors, forty nine thousand social workers,

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<v Speaker 1>fifty eight thousand psychologists that's a pH d will be

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<v Speaker 1>behind fifty eight thousand of those, and seventy eight thousand

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<v Speaker 1>school counselors that we will not have. By Yeah, that's

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<v Speaker 1>a crisis. Yeah, it absolutely is. And you know, if

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<v Speaker 1>nothing happens in a vacuum, right, So all of the

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<v Speaker 1>things we've talked about over the past ten years on

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<v Speaker 1>your radio show about the problems with healthcare and the

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<v Speaker 1>fact that government controls more and more healthcare. Uh, you

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<v Speaker 1>know that that's that's also part of this problem. And

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<v Speaker 1>it's I think, I think I have a streak of

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<v Speaker 1>repeating the statistic every time I'm on your show the

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<v Speaker 1>last year. But it's very important to remember for those

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<v Speaker 1>listening for the first time, or for those that haven't

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<v Speaker 1>thought much about it. We we talked about having a

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<v Speaker 1>quote free unquote healthcare system in America, and we really don't.

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<v Speaker 1>We have an oligopoly and that's something that's controlled by

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<v Speaker 1>a few providers, and and that oligopoly is infected with

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<v Speaker 1>government disease. And that government disease means that if you

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<v Speaker 1>live in a blue state, seventeent of healthcare costs are

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<v Speaker 1>now paid by the taxpayer. And that that blows people's

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<v Speaker 1>minds because we think about, you know, the private insurance

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<v Speaker 1>we have at work. But once you add together Medicare

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<v Speaker 1>plus Medicaid plus Obamacare plus Trycare, the v A plus

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<v Speaker 1>Obamacare subsidies of blue state healthcare is paid by taxpayers,

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<v Speaker 1>and you say, well, gosh, I live in a red state.

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<v Speaker 1>It's a lot better. Not it's sixty percent. WHOA I

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<v Speaker 1>didn't realize so you know, let's call it seventy ish

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<v Speaker 1>on average. Um uh. If I were uh a lefty

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<v Speaker 1>who believes in, you know, government taking overall of healthcare,

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<v Speaker 1>I wouldn't be hiding those numbers. I'd be touting them

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<v Speaker 1>and saying, look, I don't know if you know this,

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<v Speaker 1>but the healthcare is already that, so what are we doing? Yeah.

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<v Speaker 1>They don't want to do that, though, because when you

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<v Speaker 1>pull people about how satisfied they are with the healthcare system,

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<v Speaker 1>those numbers ranked down around congressional level. I didn't know that, Okay,

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<v Speaker 1>can I see what you mean? I see what you mean.

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<v Speaker 1>So if you've got you you ask, if you ask

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<v Speaker 1>do you like your doctor, that's a very high number.

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<v Speaker 1>If you like, are you satisfied with current health care system?

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<v Speaker 1>It's very low. Yeah. Well I'm not satisfied with it either.

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<v Speaker 1>In it's probably I've got the same complights that everybody

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<v Speaker 1>else does, whether it's you know, freaking the nightmare of

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<v Speaker 1>just getting the simplest prescription and all that sort of

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<v Speaker 1>stuff and run and everything like that. What's crazy to

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<v Speaker 1>me is that how many of you all believe that

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<v Speaker 1>if the government ran it it would be easier. Somehow,

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<v Speaker 1>I mean, what is your life experience that leads you

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<v Speaker 1>to believe that No, and I did. That's why I

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<v Speaker 1>wanted to give you just a three specific numbers so

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<v Speaker 1>you can understand how the government makes it worse. So,

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<v Speaker 1>the largest demand we have for mental health right now

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<v Speaker 1>is among the young. You know, people call them twelve

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<v Speaker 1>to twenty five. That's the that's the biggest demand we

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<v Speaker 1>have for healthcare. And if i can just jump in

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<v Speaker 1>here on that, because I've been in that situation and

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<v Speaker 1>you you know, a lot lots of my friends have, Um,

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<v Speaker 1>you have a kid who's struggling. I mean, that's a

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<v Speaker 1>that's a you know, you and your wife, you and

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<v Speaker 1>your husband sitting there at night at night, tier eyed,

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<v Speaker 1>what are we gonna do with this situation? You finally

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<v Speaker 1>decide to pull the trigger and get help, and it's

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<v Speaker 1>like the number one issue on your mind. You're gonna

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<v Speaker 1>dedicate all your int this the next day and you

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<v Speaker 1>get on the phone and you start calling people and

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<v Speaker 1>you can't find anybody, anybody with an opening. It's it's awful,

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<v Speaker 1>that's right. And when you and you know, I've helped

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<v Speaker 1>clients with the issue, and I've been there myself with

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<v Speaker 1>family members, and and then if you do find somebody,

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<v Speaker 1>maybe they miss your appointment or they don't call you

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<v Speaker 1>back because they're stretched so thin that that if they're

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<v Speaker 1>hard to access. But so when we talk about well,

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<v Speaker 1>how what's the government's role in this, you said, well, okay,

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<v Speaker 1>the the number one coverage entity for children in America

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<v Speaker 1>is Medicaid. That's our our our system for the low income. Now,

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<v Speaker 1>it's always good to remember when Medicaid was first passed

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<v Speaker 1>in the late sixties, it was designed to cover the

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<v Speaker 1>bottom two percent of wage earners. It now covers one

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<v Speaker 1>out of every three children born in America. That's how

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<v Speaker 1>fast that safety net has grown into a hammock. So

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<v Speaker 1>if we look at Medicaid, let's do this. If you

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<v Speaker 1>if you, if you need a mental health visit, an

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<v Speaker 1>integrated assessment including history, mental status, ETCeteras. That's the main

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<v Speaker 1>CPT code for when you first come in. The average nationwide,

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<v Speaker 1>and this varies greatly by zip code, but the average

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<v Speaker 1>cost that the doctor is going to get reimbursed for

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<v Speaker 1>that visit is a hundred and fifty dollars. Okay, Now,

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<v Speaker 1>the average doctor visits a hundred and seventy five So

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<v Speaker 1>you can see mental health is already twenty dollars behind

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<v Speaker 1>an average doctor visit, but if you need that visit

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<v Speaker 1>on Medicaid, it's only going to reimburse a hundred and

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<v Speaker 1>five dollars. So you take a system where we already

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<v Speaker 1>don't have enough providers because the supply is not keeping up.

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<v Speaker 1>Our practitioners are over the age of fifty five, they're

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<v Speaker 1>retiring faster than we're making them. And then you underpay

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<v Speaker 1>them systematically across the board, and then you more significantly

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<v Speaker 1>underpay them in the government reimbursement program. Will you end

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<v Speaker 1>up with a very very broken supply and demand system,

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<v Speaker 1>primarily because we don't have a free market. We have

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<v Speaker 1>a government infected oligopoly. Uh, that's all very interesting. In

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<v Speaker 1>every healthcare of mental healthcare provider or or a therapist, psychologist,

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<v Speaker 1>whatever that I've dealt with in the last couple of years,

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<v Speaker 1>there's no insurance involved. They're just taking cash and it's expensive.

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<v Speaker 1>And I don't know how most people. I'm lucky, I've

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<v Speaker 1>got a good job. I don't know how most people

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<v Speaker 1>can even consider doing that. Um, that's a tough situation

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<v Speaker 1>to be in. No, that's exactly right. And when you

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<v Speaker 1>when you when you dig into a lot of these

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<v Speaker 1>very very troubled young people that commit horrific acts of

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<v Speaker 1>violence across the nation, a lot of times you find

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<v Speaker 1>that they don't have the resource for private health. They're

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<v Speaker 1>relying on that medicaid system that is systematically under reimbursing

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<v Speaker 1>and under paying providers, and so they just don't get

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<v Speaker 1>the help they need, or they get very very underdeserved help,

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<v Speaker 1>you know, through maybe a school counselor when they really

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<v Speaker 1>need a psychiatrist. You know a lot about healthcare, and UM,

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<v Speaker 1>I apologize from asking you something that sets you up

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<v Speaker 1>to uh to to to not know. But UM, I've

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<v Speaker 1>been wondering for a long time. I hear about the

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<v Speaker 1>mental health system we had back in the day that

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<v Speaker 1>I guess we are one in the sixties and the

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<v Speaker 1>seventies because we decided it was too oppressive and you know,

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<v Speaker 1>people who weren't crazy were being locked up a mental

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<v Speaker 1>institutions and given lobotomies like Jack Nicholson and all that

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<v Speaker 1>sort of stuff, and so we did away with that.

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<v Speaker 1>Um has that been a bad idea in retrospect? Do

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<v Speaker 1>you think? Well? As a libertarian, I'd say no, you know,

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<v Speaker 1>and I would, I would. I would tell you that

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<v Speaker 1>the armstrong and getty principle that you guys have espoused

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<v Speaker 1>over the years of society veering from guardrail to guardrail,

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<v Speaker 1>going too far one way and then overcorrecting it, it

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<v Speaker 1>really applies in that situation where for a period there

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<v Speaker 1>from the you know, the mid nineteen hundreds, we had

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<v Speaker 1>we had a system whereby it was too easy to

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<v Speaker 1>lock people, oh yeah, or or sterilize them or whatever. Yeah, yeah,

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<v Speaker 1>and and um so do we need to go back

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<v Speaker 1>that far? Of course not. But have we gone too

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<v Speaker 1>far the other way where we just we we view

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<v Speaker 1>it as compassionate to leave one to his or her

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<v Speaker 1>own devices on the streets of San Francisco screaming at

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<v Speaker 1>a at a fire hydrant and and and defecating in

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<v Speaker 1>the gutter. Yeah, we've gone too far, and society will

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<v Speaker 1>correct this. I mean, you know, it's not all bad news.

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<v Speaker 1>Some of these these mental health reimbursements are coming up.

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<v Speaker 1>I mean this gap I see between what we pay

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<v Speaker 1>for a doctor visit versus a mental health visit. That

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<v Speaker 1>gap is shrinking every year, and there is there there

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<v Speaker 1>are efforts both in the industry and at the federal

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<v Speaker 1>level reimbursement wise to correct it. So I have no

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<v Speaker 1>I have no real doubt in my head that this

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<v Speaker 1>will eventually become less of a problem. But of course

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<v Speaker 1>it's going to happen a lot slower than we all

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<v Speaker 1>would like because of the giant federal bureaucracy that gets

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<v Speaker 1>involved in muddying the waters. Right. And then then those

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<v Speaker 1>numbers that you gave me on the shortage we're gonna

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<v Speaker 1>have in all those different areas of mental health that's

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<v Speaker 1>going to be here in no time, and that is well,

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<v Speaker 1>and the demand Jack, I mean, that's the you know,

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<v Speaker 1>just I pulled some of these statistics, and most of

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<v Speaker 1>these statistics look at like the difference between two thousand

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<v Speaker 1>five and two thousand seventeen, depression alone for young people

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<v Speaker 1>is up fifty to sixty depending on which age bracket

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<v Speaker 1>you look at. Suicidal thoughts amongst young people is up

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<v Speaker 1>fort over that time frame. So you you know, you

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<v Speaker 1>you say, well, we're up in the need for very

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<v Speaker 1>serious issues, and that that supply chain is not growing.

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<v Speaker 1>In fact, well it might be growing, but it's not

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<v Speaker 1>growing nearly fast enough to keep up with the demand.

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<v Speaker 1>And so you have a supply demand problem, but it

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<v Speaker 1>can't be properly fixed because the government steps in with

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<v Speaker 1>all kinds of rules and regulations that oftentimes even ones

0:11:34.000 --> 0:11:36.600
<v Speaker 1>that are well intentioned, of course, retard the market, and

0:11:36.960 --> 0:11:39.640
<v Speaker 1>the market can't respond properly, and that's why you end

0:11:39.720 --> 0:11:42.000
<v Speaker 1>up with a two tiered health system. And that This

0:11:42.040 --> 0:11:43.920
<v Speaker 1>is where I think liberals really need to get is

0:11:43.960 --> 0:11:46.440
<v Speaker 1>to say we don't want what we have, because what

0:11:46.480 --> 0:11:48.600
<v Speaker 1>we have is what you just described earlier, and that's

0:11:48.640 --> 0:11:51.360
<v Speaker 1>that the people with money can afford the private care

0:11:51.600 --> 0:11:53.680
<v Speaker 1>and they get it, and the people that rely on

0:11:53.720 --> 0:11:56.400
<v Speaker 1>these government systems can't. I saw this headline yesterday, the

0:11:56.440 --> 0:11:59.880
<v Speaker 1>Democrats are facing a political crisis right before the all

0:12:00.520 --> 0:12:02.600
<v Speaker 1>you see the A RP. Do you remember that the

0:12:02.600 --> 0:12:04.880
<v Speaker 1>American Rescue Plan, which had trillions of dollars of all

0:12:04.920 --> 0:12:06.720
<v Speaker 1>kinds of different stuff in it, part of it was

0:12:06.760 --> 0:12:10.000
<v Speaker 1>a boost in Obamacare subsidies, and that is going to

0:12:10.080 --> 0:12:13.160
<v Speaker 1>expire right before the election. This is where Craig jumps

0:12:13.160 --> 0:12:17.440
<v Speaker 1>in and explains what's likely to happen here. Yeah, this

0:12:17.559 --> 0:12:21.440
<v Speaker 1>is a beautiful one. So Obamacare gives about sixty billion

0:12:21.480 --> 0:12:24.840
<v Speaker 1>dollars a year to fourteen million Americans to buy UH

0:12:25.000 --> 0:12:28.440
<v Speaker 1>subsidized healthcare in the exchanges. What the a RP did

0:12:28.480 --> 0:12:30.880
<v Speaker 1>a year and a half ago was came in and said, well,

0:12:30.880 --> 0:12:34.120
<v Speaker 1>that's not enough because Obamacare is not actually keeping prices down,

0:12:34.160 --> 0:12:37.600
<v Speaker 1>it's just funneling more money into insurance companies from the taxpayer.

0:12:38.240 --> 0:12:41.120
<v Speaker 1>So during this crisis of the pandemic, what we want

0:12:41.120 --> 0:12:44.200
<v Speaker 1>to do is give an additional fifty or thirty billion

0:12:44.240 --> 0:12:47.840
<v Speaker 1>dollars to those people. And primarily that money went to

0:12:48.559 --> 0:12:52.320
<v Speaker 1>people making between four hundred and six hundred percent of

0:12:52.360 --> 0:12:57.040
<v Speaker 1>the federal poverty Really, yeah, now that's a subsidy for

0:12:57.080 --> 0:12:59.360
<v Speaker 1>a family of four that's making between a hundred and

0:12:59.400 --> 0:13:01.880
<v Speaker 1>ten and a hundred and sixty dollars. That was the

0:13:01.920 --> 0:13:05.959
<v Speaker 1>additional government cheese. So of course they put this thing

0:13:06.120 --> 0:13:09.640
<v Speaker 1>in temporarily, knowing what they always try and do is say, well,

0:13:09.720 --> 0:13:13.079
<v Speaker 1>we can't take it away now. And um, the beautiful

0:13:13.120 --> 0:13:15.480
<v Speaker 1>thing is this is going This is set to expire

0:13:15.800 --> 0:13:19.360
<v Speaker 1>on January one, which means it's gonna hit all the

0:13:19.400 --> 0:13:23.560
<v Speaker 1>Obamacare open enrollments that are occurring this fall, literally days

0:13:23.800 --> 0:13:27.200
<v Speaker 1>before the mid term elections. You could see or you

0:13:27.280 --> 0:13:29.760
<v Speaker 1>will see if they don't fix this, many people in

0:13:29.760 --> 0:13:32.560
<v Speaker 1>the Obamacare exchanges, of those fourteen million people are going

0:13:32.600 --> 0:13:39.400
<v Speaker 1>to see thirty increases in their monthly premium whoad notice

0:13:39.440 --> 0:13:42.240
<v Speaker 1>that you would notice that. And this is one of

0:13:42.280 --> 0:13:44.360
<v Speaker 1>those things that they have to get some agreement from

0:13:44.360 --> 0:13:46.600
<v Speaker 1>the Republicans to go along with this, and so far

0:13:46.679 --> 0:13:48.559
<v Speaker 1>they have been unable to do it. Do you think

0:13:48.559 --> 0:13:51.120
<v Speaker 1>the Republicans, I know, you think the Republicans are going

0:13:51.160 --> 0:13:54.360
<v Speaker 1>to cave on this. Why because they always do and

0:13:54.360 --> 0:13:57.400
<v Speaker 1>the Democrats are better at grabbing them. The Democrats are

0:13:57.400 --> 0:13:59.679
<v Speaker 1>better at grabbing the media. And the Democrats will spend

0:13:59.679 --> 0:14:02.719
<v Speaker 1>this is it's because of those evil Republicans with an

0:14:02.720 --> 0:14:06.000
<v Speaker 1>economy not yet recovered that they're taking away your extra

0:14:06.240 --> 0:14:08.839
<v Speaker 1>healthcare dollars. That's how it will be spun, even though

0:14:08.880 --> 0:14:12.120
<v Speaker 1>it was passed as temporary band aid to help not

0:14:12.200 --> 0:14:15.120
<v Speaker 1>even the low income FO six percent of the federal

0:14:15.120 --> 0:14:19.000
<v Speaker 1>poverty level folks. But Republicans stink at messaging, and that's

0:14:19.000 --> 0:14:20.840
<v Speaker 1>how it's going to go. I suspect. And that's just

0:14:20.880 --> 0:14:23.080
<v Speaker 1>the inertia of these things. Read the book The High

0:14:23.080 --> 0:14:25.480
<v Speaker 1>Cost of Good Intention, Good Intentions. I mean, it's just

0:14:25.560 --> 0:14:28.240
<v Speaker 1>the way these things always go. Um are there a

0:14:28.240 --> 0:14:31.320
<v Speaker 1>lot of people that like are you know the crowd

0:14:31.360 --> 0:14:33.720
<v Speaker 1>you're just describing in terms of income who are using

0:14:33.760 --> 0:14:37.400
<v Speaker 1>their companies health insurance that if they were going to

0:14:37.520 --> 0:14:44.000
<v Speaker 1>be smart, they would go on Obamacare. Um, a few people, Jack,

0:14:44.080 --> 0:14:46.640
<v Speaker 1>not many though. The way that the way that it works, Um,

0:14:46.680 --> 0:14:49.600
<v Speaker 1>if you're if your company offers you affordable care, you

0:14:49.640 --> 0:14:53.280
<v Speaker 1>are not supposed to qualify for Obamacare subsidies. But that's

0:14:53.320 --> 0:14:54.920
<v Speaker 1>a little bit muddied the way it works, and some

0:14:54.960 --> 0:14:58.040
<v Speaker 1>people end up qualifying for subsidies anyway. But for the

0:14:58.080 --> 0:15:01.320
<v Speaker 1>most part that system is pretty well clamped down. Okay,

0:15:01.320 --> 0:15:03.720
<v Speaker 1>thanks for your information. Is always where do people find

0:15:03.800 --> 0:15:08.120
<v Speaker 1>you if they want some of your brilliance At Benny

0:15:08.160 --> 0:15:12.720
<v Speaker 1>Revolution on Twitter or benefit dash Revolution on the old

0:15:12.920 --> 0:15:15.600
<v Speaker 1>interweb systems. Yeah, you are a good follow on Twitter.

0:15:15.720 --> 0:15:18.200
<v Speaker 1>Craig got walls appreciate your time to they think Craig.

0:15:18.240 --> 0:15:19.480
<v Speaker 1>Thanks a lot. Thanks Jack,