1 00:00:00,120 --> 00:00:02,440 Speaker 1: Being nickeled and dim. Do we need to adjust that 2 00:00:02,520 --> 00:00:07,240 Speaker 1: for inflation? It's one more thing I'm strong and more 3 00:00:07,920 --> 00:00:08,879 Speaker 1: before we get to that. 4 00:00:10,320 --> 00:00:14,080 Speaker 2: I had two six seven incidents occur to me a curb, 5 00:00:14,320 --> 00:00:15,160 Speaker 2: Can I try this again? 6 00:00:15,640 --> 00:00:16,400 Speaker 1: At me? For me? 7 00:00:16,720 --> 00:00:19,440 Speaker 2: I have two six seven incidents occur in my life 8 00:00:19,560 --> 00:00:25,200 Speaker 2: over the weekends. One I was m seeing an event 9 00:00:25,239 --> 00:00:27,040 Speaker 2: Saturday night and I made a six to seven joke 10 00:00:27,080 --> 00:00:32,120 Speaker 2: in which probably three quarters of the room laughed and 11 00:00:32,320 --> 00:00:34,760 Speaker 2: one quarter looked around like what is he talking about? 12 00:00:34,760 --> 00:00:35,760 Speaker 1: Which I thought was interesting. 13 00:00:36,280 --> 00:00:39,600 Speaker 2: And then we're at a Mexican restaurant, and you know, 14 00:00:39,720 --> 00:00:41,560 Speaker 2: you hound a restaurant. Sometimes they give you a little 15 00:00:41,560 --> 00:00:42,839 Speaker 2: of the little thing with the number on it, so 16 00:00:42,880 --> 00:00:44,280 Speaker 2: they don't want number you are to bring your food 17 00:00:44,280 --> 00:00:47,840 Speaker 2: out at your table. Our number was sixty seven. 18 00:00:48,960 --> 00:00:51,080 Speaker 1: I said, incident. 19 00:00:51,440 --> 00:00:53,560 Speaker 2: I said, whoa dude, I don't have to pay extra 20 00:00:53,640 --> 00:00:56,240 Speaker 2: for this? And he said, what do you mean is 21 00:00:56,240 --> 00:00:58,480 Speaker 2: there a problem with that? I said six seven? He said, 22 00:00:59,200 --> 00:01:02,880 Speaker 2: uh huh. Good for him, right, and he was like 23 00:01:03,760 --> 00:01:09,080 Speaker 2: mid thirties, he has a job exactly. I mentioned to 24 00:01:09,080 --> 00:01:10,000 Speaker 2: a few other people. 25 00:01:09,880 --> 00:01:11,480 Speaker 1: Like, oh, I want you to have to pay for that? 26 00:01:14,319 --> 00:01:17,760 Speaker 2: I don't know remember when six seven used to be 27 00:01:18,000 --> 00:01:20,240 Speaker 2: sixty seven and it was just a number. I do 28 00:01:20,319 --> 00:01:22,000 Speaker 2: remember those were good times, yeah. 29 00:01:21,920 --> 00:01:25,640 Speaker 1: Good times, yeah yeah. So I love how this starts out. 30 00:01:26,200 --> 00:01:30,920 Speaker 1: I'll bet everybody can relate to this by Matthew Hennessy. 31 00:01:31,760 --> 00:01:34,920 Speaker 1: A young George will once asked William F. Buckley Junior, 32 00:01:35,000 --> 00:01:37,760 Speaker 1: how do you come up with things to write about? 33 00:01:38,040 --> 00:01:42,200 Speaker 1: And Buckley said to the young George will it's easy. 34 00:01:42,319 --> 00:01:47,240 Speaker 1: The world irritates me three times a week, which is plenty, 35 00:01:48,000 --> 00:01:50,640 Speaker 1: and that's the start of many columns. And he explains 36 00:01:50,840 --> 00:01:55,320 Speaker 1: why he's irritating in this case. But if I asked you, 37 00:01:55,560 --> 00:01:58,480 Speaker 1: as a like a carpenter or somebody does a fair 38 00:01:58,520 --> 00:02:01,600 Speaker 1: amount of home improvement work, or how much a hammer costs, 39 00:02:01,640 --> 00:02:05,280 Speaker 1: you could tell me roughly, or how much a I 40 00:02:05,280 --> 00:02:09,280 Speaker 1: don't know, microwave, good micro evoven costs. If I asked 41 00:02:09,280 --> 00:02:12,720 Speaker 1: you to tell me how much an MRI costs, even 42 00:02:12,760 --> 00:02:16,200 Speaker 1: if you'd had one three days ago, you wouldn't have 43 00:02:16,240 --> 00:02:18,919 Speaker 1: any idea. Nope, which is part of the reason our 44 00:02:19,000 --> 00:02:22,639 Speaker 1: medical system is just so incredibly screwed up. I want 45 00:02:22,639 --> 00:02:25,320 Speaker 1: to drag Craig, the healthcare guru, back on the air 46 00:02:25,360 --> 00:02:29,160 Speaker 1: to talk to him about that. But anyway, Matthew Hennessy 47 00:02:29,280 --> 00:02:33,840 Speaker 1: is writing about it was not long ago. His mother 48 00:02:33,919 --> 00:02:36,360 Speaker 1: in law's been ill for a while. She's lived in 49 00:02:36,400 --> 00:02:38,720 Speaker 1: a nursing home in a rural part of the northeast, Okay. 50 00:02:38,800 --> 00:02:41,880 Speaker 1: Just to set the scene, long term care for memory 51 00:02:41,919 --> 00:02:47,079 Speaker 1: loss other chronic issues, and the nursing home staff, he says, 52 00:02:47,120 --> 00:02:50,360 Speaker 1: are generally competent and responsive, a lot of turnover, which 53 00:02:50,400 --> 00:02:53,400 Speaker 1: is one of the tough parts of those homes. But anyway, 54 00:02:54,639 --> 00:02:56,720 Speaker 1: as part of the care, a member of the nursing 55 00:02:56,720 --> 00:02:59,440 Speaker 1: home staff takes her to regular appointments at the clinic 56 00:03:00,400 --> 00:03:04,400 Speaker 1: of a large medical center about thirty miles away. The 57 00:03:04,440 --> 00:03:08,279 Speaker 1: clinic and medical center are affiliated with a prestigious nearby university, 58 00:03:08,400 --> 00:03:11,639 Speaker 1: which he doesn't name. He says, you'd recognize the name. 59 00:03:11,680 --> 00:03:13,560 Speaker 1: I'm being vague because I'm not trying to get anyone 60 00:03:13,560 --> 00:03:16,560 Speaker 1: in trouble. My irritation is with the whole system's attitude, 61 00:03:16,600 --> 00:03:22,080 Speaker 1: not any one persons. So famous medical center, famous university. 62 00:03:22,720 --> 00:03:25,760 Speaker 1: So mom in law gets taken to her annual checkup, 63 00:03:26,360 --> 00:03:30,080 Speaker 1: no particular problems, no medications needed, just it was on 64 00:03:30,120 --> 00:03:32,960 Speaker 1: the schedule. So they went in the healthcare and insurance 65 00:03:33,040 --> 00:03:35,480 Speaker 1: lingo we've all been forced to learn and use recent years. 66 00:03:35,520 --> 00:03:42,480 Speaker 1: This was a well visit routine. Well visits are typically 67 00:03:42,560 --> 00:03:45,360 Speaker 1: covered even couraged by insurance providers at no cost to 68 00:03:45,400 --> 00:03:49,080 Speaker 1: the patient. Medicare, in this case, covered mom in law. 69 00:03:49,880 --> 00:03:52,920 Speaker 1: When the bill for the visit came, my wife, who 70 00:03:53,000 --> 00:03:57,280 Speaker 1: is Mom's legal guardian, noticed two unfamiliar charges. One was 71 00:03:57,320 --> 00:04:02,920 Speaker 1: one hundred and fifty dollars facility fee. The other for 72 00:04:02,920 --> 00:04:06,880 Speaker 1: forty dollars, was itemized as the Evaluation and Management to 73 00:04:06,960 --> 00:04:11,440 Speaker 1: add on the E slash m add on. So just 74 00:04:11,560 --> 00:04:15,240 Speaker 1: under two hundred dollars tacked onto a bill for a 75 00:04:15,280 --> 00:04:20,719 Speaker 1: well visit, and his wife, to her credit, said wait 76 00:04:20,760 --> 00:04:23,440 Speaker 1: a minute, what is this? And she wrote a polite 77 00:04:23,440 --> 00:04:25,359 Speaker 1: note to the clinic inquiring as to the nature and 78 00:04:25,360 --> 00:04:29,039 Speaker 1: purpose of the charges. Its reply is what irritated me, 79 00:04:29,120 --> 00:04:33,719 Speaker 1: he writes. The evaluation and management or EM add on 80 00:04:33,920 --> 00:04:36,800 Speaker 1: is used to account for the complexity of EM services 81 00:04:37,080 --> 00:04:39,839 Speaker 1: that serve as the continuing focal point for all needed 82 00:04:39,880 --> 00:04:43,000 Speaker 1: healthcare services, or with medical care services that are part 83 00:04:43,000 --> 00:04:46,680 Speaker 1: of ongoing care related to a patient's single serious condition 84 00:04:46,839 --> 00:04:53,040 Speaker 1: or a complex condition. Everybody has expensive headphones on. You're 85 00:04:53,080 --> 00:04:56,640 Speaker 1: in the radiots. Can anybody tell me what the flame 86 00:04:56,720 --> 00:04:58,240 Speaker 1: and fuck that means? 87 00:04:58,400 --> 00:05:01,159 Speaker 2: Yeah, it means O. Why did you charge me that? 88 00:05:01,279 --> 00:05:05,239 Speaker 2: Because I can, because I wanted to. That's what that means. 89 00:05:06,640 --> 00:05:08,839 Speaker 1: I am going I'm gonna read that one more time. 90 00:05:10,240 --> 00:05:13,239 Speaker 1: The evaluation and management add on is used to account 91 00:05:13,240 --> 00:05:16,279 Speaker 1: for the complexity of EM services that serve as the 92 00:05:16,320 --> 00:05:19,800 Speaker 1: continuing focal point for all needed healthcare services, or with 93 00:05:19,960 --> 00:05:22,880 Speaker 1: medical care services that are part of ongoing care related 94 00:05:22,880 --> 00:05:26,000 Speaker 1: to a patient's single serious condition or a complex condition. 95 00:05:26,240 --> 00:05:28,240 Speaker 2: Oh like Kamala Harris wrote. 96 00:05:27,960 --> 00:05:31,600 Speaker 1: That, Yeah, yeah, if she knew more big words. Yeah, 97 00:05:32,360 --> 00:05:35,760 Speaker 1: but so Matthew points out, I work with words for 98 00:05:35,839 --> 00:05:39,360 Speaker 1: a living, so I'm hardwired to untangle sentences like this. 99 00:05:39,760 --> 00:05:42,680 Speaker 1: My brain immediately begins breaking down the parts and reassembling 100 00:05:42,680 --> 00:05:44,800 Speaker 1: them in a way that a person moderately familiar with 101 00:05:44,839 --> 00:05:48,520 Speaker 1: the English language might find decipherable. I defy you to 102 00:05:48,640 --> 00:05:52,560 Speaker 1: tell me what this blithering piffle actually means. Naturally, there 103 00:05:52,640 --> 00:05:56,320 Speaker 1: was more piffle, and it too blithered and I quote. 104 00:05:57,680 --> 00:06:01,120 Speaker 1: The complexity captured by the evaluation and management add on 105 00:06:01,279 --> 00:06:03,440 Speaker 1: is not in the clinical condition itself, but in the 106 00:06:03,480 --> 00:06:06,800 Speaker 1: cognitive load and the continued responsibility of being the focal 107 00:06:06,839 --> 00:06:09,880 Speaker 1: point for all needed services for the patient. It emphasizes 108 00:06:09,920 --> 00:06:13,440 Speaker 1: the importance of the longitudinal relationship between the practitioner and 109 00:06:13,480 --> 00:06:15,680 Speaker 1: the patient in the diagnosis and treatment plan. 110 00:06:16,600 --> 00:06:18,440 Speaker 2: I'm surprised they went to the effort they did to 111 00:06:18,480 --> 00:06:20,479 Speaker 2: write some gobbledly gook, because usually, you know, if you 112 00:06:20,480 --> 00:06:22,400 Speaker 2: get a charge on anything, and you won't ask what 113 00:06:22,440 --> 00:06:25,800 Speaker 2: it is just a formality, it's just routine. Let's say 114 00:06:25,800 --> 00:06:27,080 Speaker 2: something like that, and you get what. 115 00:06:27,040 --> 00:06:28,120 Speaker 1: Are you gonna do? What are you gonna fight it? 116 00:06:28,120 --> 00:06:30,400 Speaker 1: You can not pay it? What are you gonna do? Well, right, 117 00:06:30,520 --> 00:06:33,719 Speaker 1: as he says, So the well visit, which produced no 118 00:06:33,839 --> 00:06:37,359 Speaker 1: changes in care, no new diagnoses, no new prescriptions, it 119 00:06:37,400 --> 00:06:40,760 Speaker 1: costs an extra two hundred dollars because well, just because. 120 00:06:42,120 --> 00:06:44,200 Speaker 2: I thought you were going to go this direction, because 121 00:06:44,200 --> 00:06:46,960 Speaker 2: I Katie, you've got insurance, so you're gonna have a 122 00:06:46,960 --> 00:06:50,640 Speaker 2: baby and God willing, and then you know, it'll all 123 00:06:50,680 --> 00:06:52,120 Speaker 2: just go and it'll just be a bill. You'll get 124 00:06:52,120 --> 00:06:53,800 Speaker 2: a bill and you'll pay it and you won't really 125 00:06:53,880 --> 00:06:55,880 Speaker 2: look at the why, because that's the way we all 126 00:06:55,920 --> 00:06:58,000 Speaker 2: do with medical bills. But I had a friend who 127 00:06:58,240 --> 00:07:00,599 Speaker 2: was a first kid was born. He didn't have any 128 00:07:00,600 --> 00:07:04,919 Speaker 2: health insurance, and so he got an itemized list of 129 00:07:04,960 --> 00:07:07,240 Speaker 2: everything and what it costs, and was really paying attention 130 00:07:08,520 --> 00:07:12,600 Speaker 2: and in advance or after that after the fact, okay 131 00:07:13,560 --> 00:07:17,680 Speaker 2: and uh, And several of the examples that stood out, 132 00:07:17,720 --> 00:07:20,440 Speaker 2: for instance, because I had at this point it had 133 00:07:20,440 --> 00:07:23,360 Speaker 2: been like really recently that we had been there and 134 00:07:23,560 --> 00:07:26,640 Speaker 2: Sam had been born, and like when they would come 135 00:07:26,680 --> 00:07:29,680 Speaker 2: in and say to you know, mom who's just had 136 00:07:29,680 --> 00:07:32,120 Speaker 2: a baby and has all worn out and everything like that, 137 00:07:32,280 --> 00:07:34,160 Speaker 2: are you thirsty? Can you anything? And you know, like 138 00:07:34,200 --> 00:07:36,760 Speaker 2: apple juice? Would that sound good or anything like that. Yeah, 139 00:07:36,760 --> 00:07:39,240 Speaker 2: I'd like an apple juice. It was like twenty dollars 140 00:07:39,280 --> 00:07:42,400 Speaker 2: a piece each one of those. Wo that's not just 141 00:07:42,480 --> 00:07:44,480 Speaker 2: a you look thirsty? Can I help you out? No, 142 00:07:44,600 --> 00:07:46,480 Speaker 2: it's a it's it's it's an up cell. 143 00:07:46,880 --> 00:07:50,640 Speaker 1: And I remember they'll say to dad, can we get 144 00:07:50,640 --> 00:07:51,360 Speaker 1: you onto right? 145 00:07:51,520 --> 00:07:51,680 Speaker 3: Sure? 146 00:07:51,720 --> 00:07:54,000 Speaker 1: Yeah, that'd be I'd be thank you. You're thinking, hey, 147 00:07:54,000 --> 00:07:54,600 Speaker 1: this is a good. 148 00:07:54,440 --> 00:07:58,160 Speaker 3: Hospital, been in a nice hotel. And then the one 149 00:07:58,160 --> 00:08:01,600 Speaker 3: that stood out the most was the little hat that 150 00:08:01,640 --> 00:08:03,640 Speaker 3: they put on your kid. It's a little like a 151 00:08:03,640 --> 00:08:06,480 Speaker 3: little beanie and it's tiny because your kid is so smart. 152 00:08:07,080 --> 00:08:08,320 Speaker 3: It weighs nothing. It's nothing. 153 00:08:08,480 --> 00:08:10,120 Speaker 2: May have a pink one and a blue one, depending 154 00:08:10,120 --> 00:08:11,920 Speaker 2: on the sex of your baby. Back in the day 155 00:08:11,920 --> 00:08:13,520 Speaker 2: when we believed in those sorts of things. Now when 156 00:08:13,520 --> 00:08:16,600 Speaker 2: we were assigning gender, and that little cat, that little 157 00:08:16,600 --> 00:08:19,400 Speaker 2: cap they put on the baby's head was eighty dollars. 158 00:08:19,560 --> 00:08:20,880 Speaker 3: Oh what eh? 159 00:08:21,520 --> 00:08:21,680 Speaker 1: You know? 160 00:08:21,760 --> 00:08:24,040 Speaker 2: And you just you either keep it in a drawer 161 00:08:24,080 --> 00:08:26,040 Speaker 2: as a keepsake and then forget it or throw it 162 00:08:26,040 --> 00:08:28,040 Speaker 2: away or do whatever you do. If you knew it 163 00:08:28,080 --> 00:08:30,360 Speaker 2: was eighty dollars and you were paying for it, you'd 164 00:08:30,400 --> 00:08:34,120 Speaker 2: bring your own I mean, everybody would everybody, everybody pack 165 00:08:34,200 --> 00:08:36,160 Speaker 2: a little kit to go to the hospital. If they 166 00:08:36,200 --> 00:08:37,640 Speaker 2: knew it was going to be twenty dollars a juice 167 00:08:37,679 --> 00:08:39,880 Speaker 2: and eighty dollars for the hat. You'd go to Target 168 00:08:39,920 --> 00:08:41,839 Speaker 2: and buy the little thing for eight bucks, and you'd 169 00:08:41,840 --> 00:08:44,160 Speaker 2: bring a case of juice that cost twenty dollars, and 170 00:08:44,200 --> 00:08:45,800 Speaker 2: you'd have all those there with you if you were 171 00:08:45,840 --> 00:08:48,160 Speaker 2: actually paying for it. Well, you are actually paying for 172 00:08:48,240 --> 00:08:51,480 Speaker 2: it big picture, because it all goes through insurance and 173 00:08:51,559 --> 00:08:53,720 Speaker 2: this and that and gets spread out through the system 174 00:08:53,760 --> 00:08:54,680 Speaker 2: of blah blah blah. 175 00:08:54,679 --> 00:08:59,199 Speaker 1: But it's unbelievable. The whole system is a mess. Oh yeah, well, 176 00:08:59,240 --> 00:09:03,480 Speaker 1: back to the mist recharge matt asks. Imagine if your 177 00:09:03,520 --> 00:09:05,920 Speaker 1: dry cleaner treated you this way, how quickly would you 178 00:09:05,960 --> 00:09:10,560 Speaker 1: take your business to the competitor across the street. Instantly? Obviously. Well, 179 00:09:10,600 --> 00:09:12,600 Speaker 1: as we all know, healthcare and insurance don't operate like 180 00:09:12,640 --> 00:09:16,240 Speaker 1: normal businesses, nothing but buck passing middlemen in league with 181 00:09:16,320 --> 00:09:19,520 Speaker 1: penny pinching hospital executives. When there's trouble, they all point 182 00:09:19,559 --> 00:09:22,080 Speaker 1: the finger at big government, which points it right back 183 00:09:22,120 --> 00:09:26,680 Speaker 1: at them. Healthcare is ironically a diseased sector of our economy, 184 00:09:26,800 --> 00:09:29,760 Speaker 1: where the prices are intentionally obscured and the customer is 185 00:09:29,880 --> 00:09:30,560 Speaker 1: never right. 186 00:09:30,800 --> 00:09:34,360 Speaker 2: And if you think the government taking it over would 187 00:09:34,400 --> 00:09:39,400 Speaker 2: make it better, your nuts, Oh yeah, yeah, eighty dollars 188 00:09:39,400 --> 00:09:41,600 Speaker 2: little hat would become an eight hundred dollars little hat. 189 00:09:41,640 --> 00:09:44,560 Speaker 2: Except there wouldn't even be any paperwork to nail that down. 190 00:09:45,080 --> 00:09:47,440 Speaker 1: No, it'd just be siphoned out of the tax revenue. 191 00:09:47,559 --> 00:09:50,000 Speaker 1: Getting nickeled and dimed is one thing, he says, Getting 192 00:09:50,000 --> 00:09:52,760 Speaker 1: treated like an idiot is something else. Getting exposed to 193 00:09:52,840 --> 00:09:56,800 Speaker 1: jarger and deflect. Jargon and deflection turns ordinary people into radicals. 194 00:09:57,200 --> 00:09:59,679 Speaker 1: American healthcare is complex, I know, but everyone involved, from 195 00:09:59,679 --> 00:10:03,880 Speaker 1: politic and policymakers to hospital administrators, insurance companies, physicians, and 196 00:10:03,960 --> 00:10:06,880 Speaker 1: nursing home staff should understand that ordinary people all across 197 00:10:06,880 --> 00:10:08,760 Speaker 1: this country have had just about enough. 198 00:10:11,000 --> 00:10:13,679 Speaker 2: Uh you know, yeah, I agree. I just think that 199 00:10:13,720 --> 00:10:18,200 Speaker 2: the only political momentum will be for letting the government 200 00:10:18,240 --> 00:10:18,920 Speaker 2: take it over. Then. 201 00:10:19,520 --> 00:10:22,679 Speaker 1: Yeah, I think you're one hundred percent right. Then I'll 202 00:10:22,720 --> 00:10:26,360 Speaker 1: have to be treated for chronic anchor with a bunch 203 00:10:26,440 --> 00:10:28,920 Speaker 1: of mystery charges that you poor suckers will pay for. 204 00:10:32,360 --> 00:10:35,480 Speaker 4: You're talking about upselling as a diabetic. They are trying 205 00:10:35,600 --> 00:10:37,199 Speaker 4: to sell me drugs constantly. 206 00:10:38,120 --> 00:10:38,559 Speaker 1: Oh really? 207 00:10:38,640 --> 00:10:41,680 Speaker 4: Oh yeah, and I I can exercise it off, you know, 208 00:10:42,040 --> 00:10:43,679 Speaker 4: the blood sugar to get it down, or you could 209 00:10:43,720 --> 00:10:46,600 Speaker 4: take this pill, and you know, constantly they're doing that 210 00:10:46,640 --> 00:10:46,840 Speaker 4: to me. 211 00:10:47,320 --> 00:10:48,559 Speaker 1: Sure you're a hot prospect. 212 00:10:48,760 --> 00:10:49,439 Speaker 2: Yeah, no kidding. 213 00:10:49,600 --> 00:10:52,400 Speaker 4: Yeah, Well, I guess that's it.