1 00:00:00,080 --> 00:00:03,760 Speaker 1: Please join me in welcoming to the show. Craig Gottwaals, 2 00:00:04,040 --> 00:00:07,360 Speaker 1: aka the healthcare Guru. You know what, Craig, I don't 3 00:00:07,360 --> 00:00:08,879 Speaker 1: actually have your website and stuff in front of me. 4 00:00:08,920 --> 00:00:10,399 Speaker 1: I forgot to grab it, so we'll get to that 5 00:00:10,400 --> 00:00:12,319 Speaker 1: in a little bit. But how are you, my friend? 6 00:00:14,120 --> 00:00:16,200 Speaker 2: I am well, my friend, and you know, over here 7 00:00:16,239 --> 00:00:19,240 Speaker 2: at our house, we've got candles going and we're really solemn, 8 00:00:19,280 --> 00:00:21,560 Speaker 2: and it's hashtag prayers for Jack. I hope he got 9 00:00:21,560 --> 00:00:23,520 Speaker 2: the horse paste that I sent over to him. 10 00:00:24,079 --> 00:00:27,440 Speaker 1: Nah. I think he's going with more conventional care. But 11 00:00:27,480 --> 00:00:29,800 Speaker 1: i'd ask you how the bass are biting. But it's 12 00:00:29,840 --> 00:00:31,760 Speaker 1: so hot, it's like bass soup in the lakes. I'd 13 00:00:31,800 --> 00:00:34,159 Speaker 1: imagine when it gets cooler, though, We've got to we've 14 00:00:34,159 --> 00:00:35,120 Speaker 1: got to go fishing again. 15 00:00:36,080 --> 00:00:38,199 Speaker 2: Yeah. Absolutely. It was one of the best springs in 16 00:00:38,240 --> 00:00:40,480 Speaker 2: the last twenty years in northern California, so I expect 17 00:00:40,520 --> 00:00:41,640 Speaker 2: fall will be similar. 18 00:00:41,680 --> 00:00:44,240 Speaker 3: My friend, excellent, Okay, enough fish and talk. 19 00:00:44,640 --> 00:00:46,959 Speaker 1: You sent along a slide show so I could get 20 00:00:47,000 --> 00:00:49,240 Speaker 1: ready for this conversation, which I found very, very helpful 21 00:00:49,240 --> 00:00:52,080 Speaker 1: and informative. I love the quote from Warren Buffett. Buffett 22 00:00:52,479 --> 00:00:57,720 Speaker 1: medical costs are the tapeworm of American economic competitiveness. And 23 00:00:57,800 --> 00:01:00,880 Speaker 1: it's shocking some of the information gave about the rise 24 00:01:00,920 --> 00:01:03,960 Speaker 1: in healthcare costs over the last twenty twenty five years. 25 00:01:03,960 --> 00:01:05,200 Speaker 3: You want to fill us in on some of that. 26 00:01:06,280 --> 00:01:09,760 Speaker 2: Yeah, it's just devastating, Joe. You know, you guys have 27 00:01:09,840 --> 00:01:12,560 Speaker 2: covered this story in out of Stockton, California, with two 28 00:01:12,560 --> 00:01:16,679 Speaker 2: shop workers, two convenience store workers that are that are 29 00:01:16,760 --> 00:01:19,200 Speaker 2: watching a guy pill for their store, and there's a 30 00:01:19,560 --> 00:01:22,200 Speaker 2: there's a there's a guy commentating as he's filming, saying 31 00:01:22,200 --> 00:01:24,280 Speaker 2: nothing you can do, nothing, you can do, And meanwhile 32 00:01:24,319 --> 00:01:27,120 Speaker 2: this shoplifters filling a garbage can with cigarettes and all 33 00:01:27,200 --> 00:01:31,039 Speaker 2: kinds of stuff. Finally, the shopkeepers they grabbed the guy 34 00:01:31,200 --> 00:01:33,280 Speaker 2: and they just start beating his lower body and his 35 00:01:33,360 --> 00:01:36,200 Speaker 2: legs with a stick. And I think that's that's basically 36 00:01:36,240 --> 00:01:38,800 Speaker 2: where American employers are right now. They're just they're just 37 00:01:38,920 --> 00:01:42,440 Speaker 2: totally fed up with the pilfering that's been going on 38 00:01:42,440 --> 00:01:45,920 Speaker 2: on their bottom lines and American workers too. As we 39 00:01:45,959 --> 00:01:48,960 Speaker 2: look at just go ahead, sorry, Joe, go ahead. 40 00:01:48,800 --> 00:01:50,440 Speaker 1: Well no, that's okay. I just I want to get 41 00:01:50,480 --> 00:01:53,400 Speaker 1: to those That's a great metaphor. I love that you 42 00:01:53,400 --> 00:01:55,600 Speaker 1: send along a slide that in the year two thousand, 43 00:01:56,360 --> 00:01:59,559 Speaker 1: the cost of family coverage who was about twenty percent 44 00:01:59,560 --> 00:02:02,840 Speaker 1: of the tip book workers' annual salary, and now that 45 00:02:02,960 --> 00:02:09,120 Speaker 1: twenty percent is fifty four percent, which is an astounding rise. 46 00:02:10,520 --> 00:02:12,960 Speaker 2: It's just been it's something I've been in this in 47 00:02:13,000 --> 00:02:16,399 Speaker 2: this industry, Joe full time for twenty two years now. 48 00:02:16,680 --> 00:02:19,120 Speaker 2: And when I started twenty two years ago, everybody was saying, 49 00:02:19,160 --> 00:02:21,880 Speaker 2: this is unsustainable, this is unsustainable. How can we how 50 00:02:21,880 --> 00:02:24,280 Speaker 2: can we do this? And of course now we look 51 00:02:24,320 --> 00:02:26,720 Speaker 2: at you know, average pay has gone up from thirty 52 00:02:26,720 --> 00:02:29,560 Speaker 2: two thousand to forty two thousand dollars for the average worker. 53 00:02:29,919 --> 00:02:32,920 Speaker 2: But like you said, healthcare, the cost of family coverage 54 00:02:32,919 --> 00:02:35,520 Speaker 2: has gone from sixty five hundred to twenty two thousand, 55 00:02:35,639 --> 00:02:38,760 Speaker 2: five hundred, so now it gobbles up fifty four percent 56 00:02:38,760 --> 00:02:42,000 Speaker 2: of somebody's pay. One other stat just to keep the 57 00:02:42,080 --> 00:02:45,080 Speaker 2: easy one to keep in mind, premiums are up just 58 00:02:45,080 --> 00:02:48,559 Speaker 2: since the year two thousand, three hundred percent family premiums 59 00:02:48,600 --> 00:02:52,079 Speaker 2: three times average worker pay only up one hundred percent. 60 00:02:52,960 --> 00:02:55,720 Speaker 2: So it's just it's the hidden tax that we're all paying, 61 00:02:55,919 --> 00:02:58,160 Speaker 2: and it's a slow depth seven and a half percent 62 00:02:58,240 --> 00:03:01,480 Speaker 2: increases year after year after your year, when we're only 63 00:03:01,480 --> 00:03:04,200 Speaker 2: getting one to two percent on our pay. And of 64 00:03:04,200 --> 00:03:08,240 Speaker 2: course it's just it's just crushing workers and it's crushing businesses, 65 00:03:08,720 --> 00:03:09,160 Speaker 2: and it's. 66 00:03:09,040 --> 00:03:11,799 Speaker 1: Wildly out of proportion to other forms of inflation too. 67 00:03:11,880 --> 00:03:12,280 Speaker 3: Correct. 68 00:03:13,960 --> 00:03:17,520 Speaker 2: Oh, yeah, absolutely, yeah, I mean there's nothing healthcare. The 69 00:03:17,560 --> 00:03:21,320 Speaker 2: only thing that rivals healthcare to other things your local 70 00:03:21,440 --> 00:03:25,639 Speaker 2: electric company and your college tuitions. Those are the only stition. 71 00:03:26,800 --> 00:03:27,680 Speaker 2: Yeah that keep up. 72 00:03:28,480 --> 00:03:30,480 Speaker 1: Well, go ahead and take the ball and run with it. 73 00:03:30,520 --> 00:03:32,880 Speaker 1: What's the next step in understanding your stuff? What do 74 00:03:32,919 --> 00:03:33,400 Speaker 1: you have for us? 75 00:03:33,520 --> 00:03:36,600 Speaker 2: Now? Many of us, many of us felt that Obamacare 76 00:03:36,760 --> 00:03:39,040 Speaker 2: was going to really be hard on the insurance companies. 77 00:03:39,200 --> 00:03:41,600 Speaker 2: You know, many of us thought that, Okay, you're putting 78 00:03:41,640 --> 00:03:44,360 Speaker 2: all these restrictions in place, You're going to force all 79 00:03:44,360 --> 00:03:48,080 Speaker 2: these extra people onto the plans without really good leverage, 80 00:03:48,080 --> 00:03:51,160 Speaker 2: to keep them on the plans without without without necessarily 81 00:03:51,160 --> 00:03:54,880 Speaker 2: getting a whole lot more money in premium. And I'll 82 00:03:54,880 --> 00:03:57,000 Speaker 2: be the first to admit that is a topic on 83 00:03:57,080 --> 00:04:00,040 Speaker 2: Obamacare about which I couldn't have been more wrong. Joe. So, 84 00:04:01,680 --> 00:04:04,400 Speaker 2: if we just look back to two thousand and nine, 85 00:04:04,680 --> 00:04:08,560 Speaker 2: when Obamacare was first you know, written just right before 86 00:04:08,600 --> 00:04:14,440 Speaker 2: Obama signed it. You had you look at cost increases 87 00:04:14,440 --> 00:04:17,679 Speaker 2: and stock increases since that time. So from two thousand 88 00:04:17,720 --> 00:04:19,520 Speaker 2: and nine to today, just to look at the S 89 00:04:19,560 --> 00:04:21,680 Speaker 2: and P five hundred as a benchmark, it's up four 90 00:04:21,760 --> 00:04:24,400 Speaker 2: hundred and twenty two percent. That's the largest five hundred 91 00:04:24,400 --> 00:04:24,920 Speaker 2: companies in. 92 00:04:24,839 --> 00:04:26,680 Speaker 3: The US, right, Okay, got it? 93 00:04:26,760 --> 00:04:31,040 Speaker 2: The average, the average of the five largest insurance companies 94 00:04:31,120 --> 00:04:36,040 Speaker 2: medical insurers are up nineteen hundred percent over that same timeframe. 95 00:04:36,160 --> 00:04:38,560 Speaker 2: So they were in on it the whole way. They 96 00:04:38,640 --> 00:04:41,960 Speaker 2: had the game was rigged. They worked with the federal government, 97 00:04:42,040 --> 00:04:46,440 Speaker 2: with hospitals, and with pharmaceutical industry to absolutely ensure that 98 00:04:46,520 --> 00:04:49,960 Speaker 2: no matter what happened, they would remain profitable, they could 99 00:04:50,000 --> 00:04:53,600 Speaker 2: keep the very large increases, and that we the taxpayer, 100 00:04:53,600 --> 00:04:55,880 Speaker 2: would ultimately make them whole. We the taxpayer, and we 101 00:04:56,000 --> 00:04:58,080 Speaker 2: the premium payer for those of us that still get 102 00:04:58,120 --> 00:04:59,160 Speaker 2: insurance at work. 103 00:05:00,120 --> 00:05:02,440 Speaker 1: So just for people who aren't taking notes or driving 104 00:05:02,520 --> 00:05:05,680 Speaker 1: or what have you. So the SNP or the insurance 105 00:05:05,720 --> 00:05:09,320 Speaker 1: the average of the insurance carrier stock prices has more 106 00:05:09,360 --> 00:05:12,520 Speaker 1: than quadrupled the rise of the S and P five 107 00:05:12,640 --> 00:05:16,279 Speaker 1: hundred as a whole, which is crazy. Now, those of 108 00:05:16,320 --> 00:05:18,599 Speaker 1: us who believe in free markets are not shocked that 109 00:05:19,000 --> 00:05:23,800 Speaker 1: when the government became involved in a ginormous part of 110 00:05:23,839 --> 00:05:28,560 Speaker 1: the American economy, the rent seeking began, the lobbying began, 111 00:05:29,080 --> 00:05:32,520 Speaker 1: and the big powerful companies ended up getting a huge 112 00:05:32,640 --> 00:05:35,359 Speaker 1: disproportionate share of taxpayer money in a way that the 113 00:05:35,360 --> 00:05:36,880 Speaker 1: free market would never have allowed. 114 00:05:37,120 --> 00:05:42,360 Speaker 2: Would you agree, totally agree, that's exactly what happened. There 115 00:05:42,360 --> 00:05:44,839 Speaker 2: have now been books written on this topic, and it 116 00:05:44,920 --> 00:05:48,440 Speaker 2: just turns out that every single industry, whether you're looking 117 00:05:48,440 --> 00:05:54,200 Speaker 2: at hospitals, insurers, brokers, even my industry, the pharmaceutical industry, 118 00:05:54,960 --> 00:05:57,560 Speaker 2: every single one of us had a lobbying group in 119 00:05:57,680 --> 00:06:01,120 Speaker 2: DC prior to two thousand and nine. We all, all 120 00:06:01,160 --> 00:06:03,640 Speaker 2: of our lobbying groups worked with the federal government, worked 121 00:06:03,640 --> 00:06:07,960 Speaker 2: with the Obama administration, and we as a combined entity, 122 00:06:08,480 --> 00:06:11,719 Speaker 2: ensured that no matter what happened, we would be made 123 00:06:11,760 --> 00:06:14,800 Speaker 2: whole and taken care of in this process. And that's 124 00:06:14,839 --> 00:06:20,360 Speaker 2: exactly what's happened. Everybody's getting filthy rich on the provision 125 00:06:20,360 --> 00:06:24,120 Speaker 2: of health insurance while American businesses and in US workers 126 00:06:24,200 --> 00:06:26,480 Speaker 2: are struggling now to pay the bill, to the point 127 00:06:26,480 --> 00:06:29,120 Speaker 2: where the average worker sees more than half of their 128 00:06:29,160 --> 00:06:30,920 Speaker 2: pay go to premiums. 129 00:06:31,360 --> 00:06:36,640 Speaker 3: What's America's number one lobby. 130 00:06:35,560 --> 00:06:39,920 Speaker 2: Number one lobby, as reported by Axios is healthcare seven 131 00:06:40,000 --> 00:06:42,960 Speaker 2: hundred million in twenty twenty one, the last reported stat 132 00:06:43,000 --> 00:06:43,680 Speaker 2: I saw. 133 00:06:44,640 --> 00:06:47,719 Speaker 1: One year seven hundred million dollars in bribes. 134 00:06:47,839 --> 00:06:54,880 Speaker 2: Essentially, yeah, exactly exactly. And the largest client of the 135 00:06:54,880 --> 00:07:00,520 Speaker 2: healthcare industry is the federal government, primarily through Medicare and Medicaid. 136 00:07:00,920 --> 00:07:04,280 Speaker 2: So see here's this is where you get the crazy 137 00:07:04,360 --> 00:07:06,640 Speaker 2: hidden tax that we've talked about here before, and that's 138 00:07:06,680 --> 00:07:10,880 Speaker 2: the politicians don't want to just start increasing taxes willy 139 00:07:10,960 --> 00:07:14,680 Speaker 2: nilly because that's bad for reelection, so they keep Medicare 140 00:07:14,720 --> 00:07:18,600 Speaker 2: and Medicaid on a path where those reimbursements only typically 141 00:07:18,600 --> 00:07:21,840 Speaker 2: go up about one percent per year, even though true 142 00:07:21,920 --> 00:07:25,480 Speaker 2: medical inflation is roughly four percent per year. So then 143 00:07:25,520 --> 00:07:28,880 Speaker 2: what happens is hospitals have to work with insurance companies 144 00:07:28,880 --> 00:07:32,800 Speaker 2: to negotiate seven or eight percent renewal increases for employers 145 00:07:33,360 --> 00:07:35,520 Speaker 2: to cover the fact that they're not making as much 146 00:07:35,560 --> 00:07:38,120 Speaker 2: money as they would like to make for Medicare and Medicaid. 147 00:07:38,400 --> 00:07:44,680 Speaker 2: The number one customer of the insurance industry. 148 00:07:43,160 --> 00:07:46,520 Speaker 1: Right, So, okay, so the government is under the government 149 00:07:46,600 --> 00:07:50,160 Speaker 1: is underpaying, so private insurance has to weigh. 150 00:07:50,040 --> 00:07:52,360 Speaker 3: Overpay for medical care. 151 00:07:53,520 --> 00:07:54,920 Speaker 1: You know, I think I know the answer to this, 152 00:07:55,000 --> 00:07:58,280 Speaker 1: But why do the private insurance companies put up with it? 153 00:07:58,360 --> 00:08:00,280 Speaker 1: Is it because they can go ahead and go out 154 00:08:00,280 --> 00:08:02,560 Speaker 1: just for premiums and we don't see any alternative to 155 00:08:02,600 --> 00:08:04,160 Speaker 1: pay in them. 156 00:08:04,480 --> 00:08:08,480 Speaker 2: Oh? Absolutely, because the more premium we pay, the more 157 00:08:08,520 --> 00:08:11,320 Speaker 2: they make as well. Obviously, right, the more the broker makes, 158 00:08:11,360 --> 00:08:14,520 Speaker 2: the more the insurance company makes, the more the hospital makes. 159 00:08:14,840 --> 00:08:17,840 Speaker 2: So what you really see happening in healthcare generally is 160 00:08:18,280 --> 00:08:22,920 Speaker 2: hospitals will mark up the cost of a procedure. And 161 00:08:22,920 --> 00:08:25,440 Speaker 2: again this is just hospitals, not doctors. The problem is 162 00:08:25,520 --> 00:08:28,400 Speaker 2: not typically with your local doctor office, it's with facilities. 163 00:08:28,400 --> 00:08:32,800 Speaker 2: So hospitals will say we're going to pay three hundred 164 00:08:32,880 --> 00:08:36,040 Speaker 2: percent of what Medicare would pay for that shoulder surgery 165 00:08:36,080 --> 00:08:39,040 Speaker 2: as an example, and that is roughly six hundred percent 166 00:08:39,040 --> 00:08:41,400 Speaker 2: of our actual costs. And you say, well, Craig, how 167 00:08:41,400 --> 00:08:43,760 Speaker 2: do you know their costs? Well, in order for them 168 00:08:43,800 --> 00:08:46,400 Speaker 2: to receive money from the federal government through Medicare, they 169 00:08:46,400 --> 00:08:48,920 Speaker 2: have to self report their costs. So I know exactly 170 00:08:48,960 --> 00:08:52,480 Speaker 2: what their real costs are, and I know what Medicare pays. 171 00:08:52,520 --> 00:08:56,120 Speaker 2: That's all public information. So what happens is private employers 172 00:08:56,120 --> 00:09:00,720 Speaker 2: are basically paying It works out too roughly twenty dollars 173 00:09:00,720 --> 00:09:04,520 Speaker 2: per employee per month. You're paying for the privilege of 174 00:09:04,559 --> 00:09:07,360 Speaker 2: a fifty percent discount on something that's been marked up 175 00:09:07,400 --> 00:09:09,960 Speaker 2: six hundred percent. And now that's a lot of numbers, 176 00:09:09,960 --> 00:09:12,440 Speaker 2: but that's what's going on. Is you have this shell game, 177 00:09:12,480 --> 00:09:16,520 Speaker 2: you have this this obscured price tag that's hidden that says, hey, 178 00:09:16,559 --> 00:09:19,720 Speaker 2: the cost of that shoulder surgery is is you know, 179 00:09:19,960 --> 00:09:22,280 Speaker 2: we will just say it's two hundred thousand dollars and 180 00:09:22,320 --> 00:09:24,200 Speaker 2: then but you know, good news, good news, we're going 181 00:09:24,240 --> 00:09:26,600 Speaker 2: to give you a fifty percent discount. With your large 182 00:09:26,600 --> 00:09:28,320 Speaker 2: insurance plan, you're only going to have to pay one 183 00:09:28,360 --> 00:09:30,960 Speaker 2: hundred thousand dollars. But then when you get down to 184 00:09:31,280 --> 00:09:33,760 Speaker 2: the nuts and bolts of it, the actual cost to 185 00:09:33,840 --> 00:09:36,920 Speaker 2: provide that surgery is like twenty thousand dollars. 186 00:09:38,200 --> 00:09:38,680 Speaker 3: Wow. 187 00:09:38,720 --> 00:09:41,319 Speaker 2: So on a large scale in our health plans. 188 00:09:41,800 --> 00:09:42,000 Speaker 3: Wow. 189 00:09:42,080 --> 00:09:44,520 Speaker 1: Meanwhile, the government's paying a tiny fraction of that, like, 190 00:09:45,160 --> 00:09:49,079 Speaker 1: you know, way down less than you know, the hospital 191 00:09:49,080 --> 00:09:49,960 Speaker 1: could stay in business. 192 00:09:50,000 --> 00:09:50,600 Speaker 3: Probably on. 193 00:09:50,920 --> 00:09:52,880 Speaker 2: Well, well, I want to yeah, I want to be 194 00:09:52,920 --> 00:09:56,280 Speaker 2: careful about that. So I have a number of hospital clients, 195 00:09:56,280 --> 00:09:58,880 Speaker 2: and I speak with these CFOs regularly, and pretty much 196 00:09:58,920 --> 00:10:02,480 Speaker 2: across the board, every hospital chief financial officer will tell 197 00:10:02,520 --> 00:10:06,880 Speaker 2: you we can survive on Medicare. What Medicare, that's the 198 00:10:06,920 --> 00:10:08,520 Speaker 2: one we pay for the old timers. I mean, we 199 00:10:08,559 --> 00:10:10,880 Speaker 2: would have to tighten our budgets, we would have to 200 00:10:10,960 --> 00:10:13,080 Speaker 2: run more efficiently, we would have to we would cut 201 00:10:13,080 --> 00:10:15,880 Speaker 2: out some waste and abuse. But we can probably get 202 00:10:15,880 --> 00:10:19,280 Speaker 2: by at Medicare. It's Medicaid the one that we can't 203 00:10:19,280 --> 00:10:22,080 Speaker 2: because that on average across the country pays about twenty 204 00:10:22,080 --> 00:10:25,480 Speaker 2: percent less than Medicare. So now you are getting into 205 00:10:25,520 --> 00:10:28,960 Speaker 2: a position where you're like fifteen percent under their real costs. 206 00:10:29,400 --> 00:10:33,360 Speaker 2: So it's Medicare that causes the problem. Medicare. Excuse me, Medicaid, Medicare, 207 00:10:33,559 --> 00:10:34,959 Speaker 2: most hospitals can get by it. 208 00:10:35,880 --> 00:10:38,640 Speaker 3: Bass fishing tip number one. Slow down. He's always telling me, 209 00:10:38,679 --> 00:10:41,520 Speaker 3: slow down, don't slow down. 210 00:10:41,720 --> 00:10:44,440 Speaker 2: Let him come to it anyway, Right when you get 211 00:10:44,480 --> 00:10:46,720 Speaker 2: to the point where you think you cannot go any slower, 212 00:10:47,520 --> 00:10:48,360 Speaker 2: slow at the hell that. 213 00:10:48,360 --> 00:10:51,280 Speaker 3: I'm a little bit more, all right, beautiful. 214 00:10:51,559 --> 00:10:53,959 Speaker 1: So if you want to get in contact with Craig 215 00:10:54,080 --> 00:10:58,360 Speaker 1: for bass fishing tips or advice on healthcare and benefits 216 00:10:58,360 --> 00:11:00,199 Speaker 1: and that sort of thing, all the informations going to 217 00:11:00,200 --> 00:11:02,240 Speaker 1: be at Armstrong and Getty dot com will make it 218 00:11:02,240 --> 00:11:05,720 Speaker 1: easy to follow. Plus this discussion will be edited up 219 00:11:05,720 --> 00:11:07,040 Speaker 1: into an Armstrong and Getty. 220 00:11:06,760 --> 00:11:07,760 Speaker 3: Extra Large podcast. 221 00:11:07,920 --> 00:11:09,960 Speaker 1: Having said that, I'm looking at the map you sent 222 00:11:10,080 --> 00:11:14,320 Speaker 1: of employer payments for a given medical procedure as a 223 00:11:14,320 --> 00:11:18,080 Speaker 1: percentage of Medicare you poor chumps? We poor chumps with 224 00:11:18,160 --> 00:11:22,040 Speaker 1: private insurance in California are paying three hundred and eleven percent. 225 00:11:22,360 --> 00:11:24,840 Speaker 1: In Texas it's a mere two hundred and sixty nine percent, 226 00:11:25,080 --> 00:11:26,840 Speaker 1: three hundred and sixteen percent. 227 00:11:28,160 --> 00:11:29,800 Speaker 3: Is that Colorado or Nebraska? 228 00:11:29,880 --> 00:11:33,000 Speaker 1: Rather, it's three hundred and four percent Washington State, On 229 00:11:33,040 --> 00:11:36,040 Speaker 1: and on and on and then the slide you sent 230 00:11:36,040 --> 00:11:38,680 Speaker 1: about the fair price for a CT scan, for instance, 231 00:11:38,720 --> 00:11:41,720 Speaker 1: in the San Francisco Bay area, can you explain that 232 00:11:41,760 --> 00:11:42,120 Speaker 1: to us? 233 00:11:43,840 --> 00:11:46,360 Speaker 2: Yeah, so you exactly nailed it, Joe. Across the country, 234 00:11:46,600 --> 00:11:49,600 Speaker 2: we're roughly we have if we're in that thirty percent 235 00:11:49,640 --> 00:11:52,480 Speaker 2: of people that are roughly paying for our own health care, 236 00:11:52,559 --> 00:11:54,920 Speaker 2: there's only about thirty percent of us in that boat anymore. 237 00:11:55,840 --> 00:11:59,600 Speaker 2: We pay three times what the federal government pays with Medicare, 238 00:11:59,640 --> 00:12:02,280 Speaker 2: and hospital CFOs will tell you we can we can 239 00:12:02,320 --> 00:12:05,680 Speaker 2: make money on Medicare. Okay, So hospital CT scan, So 240 00:12:05,840 --> 00:12:07,760 Speaker 2: this is just I sent you a couple examples as 241 00:12:07,760 --> 00:12:09,080 Speaker 2: will just walk through one of them. This is a 242 00:12:09,120 --> 00:12:11,720 Speaker 2: real hospital in the Bay Area. We won't name any names. 243 00:12:12,520 --> 00:12:15,720 Speaker 2: They bill an average of thirty five hundred dollars for 244 00:12:15,800 --> 00:12:17,480 Speaker 2: a CT scan, and. 245 00:12:17,440 --> 00:12:19,040 Speaker 3: They're the cheapest one in the chart. 246 00:12:19,320 --> 00:12:21,439 Speaker 2: But go ahead, they're the cheapest on the chart, that's right. 247 00:12:21,800 --> 00:12:24,440 Speaker 2: They self report the cost of that two hundred and 248 00:12:24,440 --> 00:12:29,280 Speaker 2: fifty four dollars. Okay, Medicare applies its formula, so they 249 00:12:29,400 --> 00:12:31,440 Speaker 2: do a little bit of markup on the cost. Typically, 250 00:12:31,600 --> 00:12:34,280 Speaker 2: and the Medicare would pay three hundred and three dollars 251 00:12:34,440 --> 00:12:39,160 Speaker 2: for that procedure. But the average national insurance company of 252 00:12:39,200 --> 00:12:41,080 Speaker 2: which there are four or five depending on how you 253 00:12:41,160 --> 00:12:44,160 Speaker 2: count them, would would give you a fifty percent discount 254 00:12:44,160 --> 00:12:47,079 Speaker 2: off of that pie in the sky fantasy unicorn riding 255 00:12:47,200 --> 00:12:50,720 Speaker 2: cotton candy eating build rate of thirty five hundred, So 256 00:12:50,760 --> 00:12:55,400 Speaker 2: they would they would reimburse seventeen hundred for that thirty 257 00:12:55,400 --> 00:12:57,959 Speaker 2: four hundred or thirty five hundred, whatever you whatever you 258 00:12:58,040 --> 00:13:00,160 Speaker 2: want to call it. So you know, you look at 259 00:13:00,200 --> 00:13:02,040 Speaker 2: the bill, you think, wow, it's thirty five hundred. I'm 260 00:13:02,040 --> 00:13:04,400 Speaker 2: going to pay seventeen fifty. I'm getting fifty percent off. 261 00:13:04,400 --> 00:13:07,199 Speaker 2: That's awesome until you find out Medicare pays three hundred 262 00:13:07,200 --> 00:13:10,080 Speaker 2: and three dollars. And I tell you that facility operators 263 00:13:10,120 --> 00:13:12,240 Speaker 2: tell you, yeah, we can make money on Medicare. 264 00:13:13,240 --> 00:13:15,560 Speaker 1: Yeah, it's like your babysitter walks in and says, normally 265 00:13:15,559 --> 00:13:17,320 Speaker 1: I charge one hundred bucks an hour, but I'll let 266 00:13:17,400 --> 00:13:19,160 Speaker 1: you go for fifty or whatever. And you're thinking, oh, 267 00:13:19,240 --> 00:13:23,040 Speaker 1: a fifty percent discount. Not boy, I'm a chump. And 268 00:13:23,160 --> 00:13:25,440 Speaker 1: the important thing to realize, and I'm looking at the clock. 269 00:13:25,520 --> 00:13:27,600 Speaker 1: I think next segment we will get to the solution 270 00:13:27,640 --> 00:13:30,160 Speaker 1: because we barely have two minutes. But what people need 271 00:13:30,160 --> 00:13:34,960 Speaker 1: to understand is that you're paying twice, three times, four 272 00:13:35,080 --> 00:13:38,480 Speaker 1: or five six times as much as a Medicare patient does, 273 00:13:38,679 --> 00:13:42,280 Speaker 1: which still gives the medical provider a fair amount of profit. 274 00:13:43,400 --> 00:13:47,600 Speaker 1: And that enormous difference that you're paying in premiums and 275 00:13:47,679 --> 00:13:52,240 Speaker 1: everything that is a tax, that is money from you 276 00:13:53,240 --> 00:13:57,439 Speaker 1: going to pay for a government program, and I don't 277 00:13:57,480 --> 00:14:02,880 Speaker 1: think people really comprehend it that simply. Meanwhile, and if 278 00:14:02,920 --> 00:14:05,320 Speaker 1: you're just tuning in, we mentioned this last segment, the 279 00:14:05,440 --> 00:14:10,240 Speaker 1: insurance companies are making scads of money because they're in 280 00:14:10,320 --> 00:14:13,000 Speaker 1: bed with the government on the scheme, and really the 281 00:14:13,000 --> 00:14:15,200 Speaker 1: only loser is the private insurance consumer. 282 00:14:15,600 --> 00:14:16,240 Speaker 3: Am I correct? 283 00:14:17,880 --> 00:14:21,640 Speaker 2: You've got it better than any media person ever has. 284 00:14:22,080 --> 00:14:28,040 Speaker 1: Wow Wow gold star for me any anyway, So in 285 00:14:28,120 --> 00:14:32,200 Speaker 1: thirty seconds, can you describe slash tease what we're going 286 00:14:32,280 --> 00:14:36,000 Speaker 1: to talk about in the next segment, the cure to 287 00:14:36,040 --> 00:14:37,560 Speaker 1: this or reference based pricing? 288 00:14:38,600 --> 00:14:41,680 Speaker 2: Yeah, reference based pricing, fair market pricing, value based pricing. 289 00:14:41,680 --> 00:14:43,360 Speaker 2: There's a lot of different names for it because it 290 00:14:43,400 --> 00:14:47,120 Speaker 2: is so new and revolutionary. In a nutshell, if you 291 00:14:47,200 --> 00:14:49,840 Speaker 2: take the premise that they can make money on medicare, 292 00:14:50,240 --> 00:14:52,400 Speaker 2: what happens if we go ahead and just offer to 293 00:14:52,400 --> 00:14:55,040 Speaker 2: pay one hundred and forty percent of medicare, which is 294 00:14:55,040 --> 00:14:58,280 Speaker 2: still half of what your employer plan pays. We can 295 00:14:58,360 --> 00:15:01,280 Speaker 2: cut our costs darn near half at that point, right. 296 00:15:01,600 --> 00:15:04,320 Speaker 2: What happens if we do that? What kind of acceptance 297 00:15:04,360 --> 00:15:07,040 Speaker 2: will we get in the marketplace if we decide to 298 00:15:07,040 --> 00:15:11,200 Speaker 2: pay forty percent more than their largest customer, which is Medicare. 299 00:15:11,920 --> 00:15:17,560 Speaker 1: Your health insurance costs have skyrocketed. 300 00:15:16,640 --> 00:15:18,120 Speaker 3: Compared to the rate of inflation. 301 00:15:19,160 --> 00:15:25,720 Speaker 1: Your insurance premiums have skyrocketed since Obamacare passed. All those 302 00:15:25,760 --> 00:15:28,640 Speaker 1: costs to people with private insurance through their employer whatever 303 00:15:28,680 --> 00:15:34,160 Speaker 1: have gone sky high compared to inflation. Meanwhile, the profits 304 00:15:34,280 --> 00:15:39,440 Speaker 1: of the insurance carriers have been quadrupled the rise of 305 00:15:39,480 --> 00:15:44,440 Speaker 1: the S and P five hundred. They're making unimaginable amounts 306 00:15:44,440 --> 00:15:52,680 Speaker 1: of money off of you as you subsidize Medicare and Medicaid. 307 00:15:53,280 --> 00:15:56,120 Speaker 1: It's a hidden tax. You're paying hundreds or thousands of 308 00:15:56,120 --> 00:15:59,280 Speaker 1: dollars a year to pay for those government programs. 309 00:15:59,440 --> 00:16:00,640 Speaker 3: But it's not a tax. 310 00:16:01,120 --> 00:16:05,360 Speaker 1: It's your insurance premiums because your insurance company pays sky 311 00:16:05,440 --> 00:16:08,720 Speaker 1: high prices to the hospitals to cover, you know, the 312 00:16:09,240 --> 00:16:12,080 Speaker 1: government programs to make sure everybody makes plenty of profit. 313 00:16:12,280 --> 00:16:15,040 Speaker 1: And nobody's talking about this. Did I get anything wrong 314 00:16:15,080 --> 00:16:16,400 Speaker 1: in that description, Craig. 315 00:16:17,440 --> 00:16:19,400 Speaker 2: No, you do so good at that, Joe, I would 316 00:16:19,440 --> 00:16:21,400 Speaker 2: just the only nuance I would add is that is 317 00:16:21,440 --> 00:16:25,440 Speaker 2: that it's not just because of government underfunding, which we 318 00:16:25,480 --> 00:16:28,640 Speaker 2: know it certainly is with respect to Medicaid for sure, 319 00:16:29,000 --> 00:16:32,600 Speaker 2: but it's also because, hey, what this private industry likes 320 00:16:32,640 --> 00:16:37,880 Speaker 2: to do. It likes to maximize profit. So pharmaceutical companies, hospitals, insurers, 321 00:16:38,000 --> 00:16:41,200 Speaker 2: and brokers are all maximizing profit on this hidden tax 322 00:16:41,240 --> 00:16:45,000 Speaker 2: that's obfuscated by the fact that typically people don't see 323 00:16:45,000 --> 00:16:47,000 Speaker 2: the prices they pay for healthcare. They don't know. They 324 00:16:47,040 --> 00:16:49,960 Speaker 2: just know their paycheck isn't what it should be. And 325 00:16:50,040 --> 00:16:52,600 Speaker 2: so one of the things that's made this more possible 326 00:16:52,600 --> 00:16:54,680 Speaker 2: in the last few years. Joe Is and you and 327 00:16:54,720 --> 00:16:57,520 Speaker 2: I and Jack did a podcast about this probably four 328 00:16:57,600 --> 00:17:02,040 Speaker 2: years ago now where Trump put in some transparency rules 329 00:17:02,080 --> 00:17:05,440 Speaker 2: and then thankfully when Biden came into office he kept them. 330 00:17:05,760 --> 00:17:08,560 Speaker 2: So there's and I think I told you way back then. 331 00:17:08,600 --> 00:17:10,800 Speaker 2: I said this is going to be a landslide. This 332 00:17:10,880 --> 00:17:14,000 Speaker 2: is going to change healthcare forever, and now we're finally 333 00:17:14,040 --> 00:17:16,800 Speaker 2: starting to see it. That's what's going on. These employers 334 00:17:16,800 --> 00:17:19,119 Speaker 2: are taking that wooden bat like those gents in the 335 00:17:19,200 --> 00:17:22,040 Speaker 2: in the convenience store in Stockton, and they are starting 336 00:17:22,080 --> 00:17:24,960 Speaker 2: to whack away at this system that's been pillaging them 337 00:17:25,000 --> 00:17:25,560 Speaker 2: for so long. 338 00:17:26,640 --> 00:17:29,280 Speaker 1: Okay, and there's there was one more nuance I wanted 339 00:17:29,280 --> 00:17:33,720 Speaker 1: to get to it flitted out of my mind. Dang 340 00:17:33,760 --> 00:17:38,199 Speaker 1: it about the whole Oh, it doesn't matter. So so 341 00:17:38,359 --> 00:17:42,160 Speaker 1: because of that transparency that Donald J. Trump, God rests 342 00:17:42,200 --> 00:17:46,439 Speaker 1: him or God bless him, He's not dead because of 343 00:17:46,480 --> 00:17:49,919 Speaker 1: that transparency. Now that's given a tool. Oh you know 344 00:17:49,960 --> 00:17:52,720 Speaker 1: what I was going to say was, so you've got 345 00:17:52,800 --> 00:17:55,760 Speaker 1: all that profit being made, maximizing the profit in the 346 00:17:55,760 --> 00:17:58,919 Speaker 1: insurance companies, the hospitals whatever. I'm pro profit, and I 347 00:17:58,960 --> 00:18:01,879 Speaker 1: know you are too. We're pro the free market. But 348 00:18:02,000 --> 00:18:04,719 Speaker 1: this is the last thing. This is the free market. 349 00:18:04,920 --> 00:18:09,800 Speaker 1: It's accommodation of monopolies. And then the government so heavily involved. 350 00:18:10,200 --> 00:18:13,240 Speaker 1: The companies have to beg and lobby the government, and 351 00:18:13,240 --> 00:18:14,720 Speaker 1: they're all in on it together. 352 00:18:16,119 --> 00:18:19,199 Speaker 2: It's a government healthcare complex because and I'll tell you 353 00:18:19,240 --> 00:18:23,280 Speaker 2: what made this made Obamacare so bad, Joe. Prior to Obamacare, 354 00:18:23,560 --> 00:18:27,520 Speaker 2: Democrats generally wouldn't take money from the pharmaceutical industry and 355 00:18:27,520 --> 00:18:30,400 Speaker 2: from big insurers. That was kind of a thing Democrats 356 00:18:30,440 --> 00:18:34,400 Speaker 2: wouldn't do. Well. Obama changed all that because Obama realized 357 00:18:34,440 --> 00:18:36,520 Speaker 2: that to get this legislation passed, he was going to 358 00:18:36,600 --> 00:18:38,760 Speaker 2: have to take that money from those players and so 359 00:18:38,960 --> 00:18:42,280 Speaker 2: once those floodgates opened, once you had okay, now Republicans 360 00:18:42,280 --> 00:18:45,000 Speaker 2: and Democrats can dip their hands into the largest industry 361 00:18:45,040 --> 00:18:47,480 Speaker 2: in America and just take as much as they want 362 00:18:47,480 --> 00:18:52,480 Speaker 2: from lobbyists, then you had the complete proliferation of all 363 00:18:52,520 --> 00:18:58,200 Speaker 2: of this, I would say, corruption influencing any regulation or 364 00:18:58,280 --> 00:18:59,160 Speaker 2: laws we might have had. 365 00:19:00,000 --> 00:19:02,160 Speaker 1: Ok So, let's get back to the transparency that Trump 366 00:19:02,200 --> 00:19:06,960 Speaker 1: introduced and Biden continued, Now, you know the hospital self 367 00:19:06,960 --> 00:19:08,640 Speaker 1: reported costs and stuff. 368 00:19:08,800 --> 00:19:12,160 Speaker 3: So how has that been helpful? How's that been a tool? 369 00:19:13,640 --> 00:19:16,800 Speaker 2: Well, so what has happened is, and here's the free market. 370 00:19:16,880 --> 00:19:20,320 Speaker 2: There are entities called reference based repricers that have popped up, 371 00:19:20,800 --> 00:19:24,040 Speaker 2: and what they're doing is they're aggregating that data and 372 00:19:24,040 --> 00:19:28,120 Speaker 2: they're saying, Okay, we know at Hospital X, a rotator 373 00:19:28,160 --> 00:19:34,320 Speaker 2: cuff surgery is actually costs We'll say fifteen thousand dollars 374 00:19:34,640 --> 00:19:37,199 Speaker 2: and Medicare would pay twenty thousand dollars for it, but 375 00:19:37,240 --> 00:19:40,280 Speaker 2: their typical insurance company is giving them sixty thousand for it. Right, 376 00:19:40,800 --> 00:19:44,240 Speaker 2: So they're saying, Okay, don't pay an insurance company, pay us. 377 00:19:44,280 --> 00:19:47,119 Speaker 2: What we'll do is we will reprice that claim. We 378 00:19:47,200 --> 00:19:50,040 Speaker 2: will pay the claim for you, and we'll negotiate with 379 00:19:50,080 --> 00:19:53,520 Speaker 2: the provider if you get pushedback. And so we're reference 380 00:19:53,520 --> 00:19:56,640 Speaker 2: based repricing these claims. We're just cutting out insurers all 381 00:19:56,680 --> 00:19:59,120 Speaker 2: together because we're saying, no, the employer's going to self 382 00:19:59,119 --> 00:20:01,080 Speaker 2: insure this plan and we're going to pay at one 383 00:20:01,119 --> 00:20:03,800 Speaker 2: hundred and forty percent of Medicare instead of three hundred 384 00:20:03,840 --> 00:20:05,040 Speaker 2: and ten percent of Medicare. 385 00:20:05,840 --> 00:20:09,600 Speaker 1: So the hospital is not they're not making that same 386 00:20:09,680 --> 00:20:13,560 Speaker 1: crazy profit, but they're making profit. You say, it's working 387 00:20:14,160 --> 00:20:16,879 Speaker 1: to what extent our hospital's saying, okay, we'll do that 388 00:20:16,920 --> 00:20:17,520 Speaker 1: for that price. 389 00:20:19,240 --> 00:20:21,919 Speaker 2: Yeah, So depending on what part of the country you're in, 390 00:20:22,560 --> 00:20:26,040 Speaker 2: you get, we would say is one percent to ten 391 00:20:26,080 --> 00:20:28,560 Speaker 2: percent pushback. And when I say pushback, I mean the 392 00:20:28,560 --> 00:20:30,600 Speaker 2: hospital says, hey, no, one hundred and forty percent of 393 00:20:30,600 --> 00:20:33,320 Speaker 2: Medicare is not enough. We need more, we want more. 394 00:20:33,800 --> 00:20:37,040 Speaker 2: Then we get involved in negotiation. Once we get involved 395 00:20:37,040 --> 00:20:40,359 Speaker 2: in negotiation, it's ninety nine percent acceptance. And the worst 396 00:20:40,359 --> 00:20:43,640 Speaker 2: case scenario for the employer is they capitulate and they 397 00:20:43,680 --> 00:20:46,000 Speaker 2: pay what the giant insurance company would have paid. 398 00:20:46,000 --> 00:20:50,640 Speaker 3: Anyway, you see, if it almost never happens. 399 00:20:50,080 --> 00:20:52,520 Speaker 2: Well very rarely. Yeah, that you're talking about a handful 400 00:20:52,560 --> 00:20:58,280 Speaker 2: of claims per year for hundreds of employees. Yeah, because ultimately, 401 00:20:58,320 --> 00:21:00,639 Speaker 2: what you're doing is you're saying, hey, hawk, I'm going 402 00:21:00,720 --> 00:21:03,359 Speaker 2: to pay you forty percent more than your largest customer. 403 00:21:03,640 --> 00:21:05,760 Speaker 2: And if the hospital really wanted to dig in their 404 00:21:05,800 --> 00:21:09,000 Speaker 2: heels and say sue the member, sue the plan or 405 00:21:09,040 --> 00:21:12,080 Speaker 2: the employee for not paying more, ultimately you're going to 406 00:21:12,119 --> 00:21:14,040 Speaker 2: end up in a court of law and the CFO 407 00:21:14,080 --> 00:21:16,439 Speaker 2: at the hospital is going to have to testify that 408 00:21:16,560 --> 00:21:19,679 Speaker 2: somebody offering to pay forty percent more than their largest 409 00:21:19,680 --> 00:21:23,240 Speaker 2: customer is an unreasonable price and they need to do it. 410 00:21:23,480 --> 00:21:27,240 Speaker 2: And even then, we negotiate up to three hundred percent anyway, 411 00:21:27,320 --> 00:21:29,040 Speaker 2: so they would have to argue that three times what 412 00:21:29,160 --> 00:21:31,880 Speaker 2: Medicare pays is unreasonable and they can't. There's been one 413 00:21:32,000 --> 00:21:34,400 Speaker 2: case that went to the Merrit's Supreme Court of Colorado 414 00:21:34,920 --> 00:21:38,520 Speaker 2: and the hospital lost. So now you've got floggates. We've got, 415 00:21:38,520 --> 00:21:41,560 Speaker 2: like I said, instead of four or five national carriers, 416 00:21:41,560 --> 00:21:44,199 Speaker 2: we've got ten different repricers that have popped up. And 417 00:21:44,240 --> 00:21:47,520 Speaker 2: this is the wild West shoe. It is absolutely crazy 418 00:21:47,560 --> 00:21:50,120 Speaker 2: what I see going on, but in a good way, 419 00:21:51,160 --> 00:21:54,080 Speaker 2: in a wonderful way. Now this is the free market. 420 00:21:54,119 --> 00:21:56,159 Speaker 2: You've got these repriss that have popped up. You've got 421 00:21:56,160 --> 00:21:59,119 Speaker 2: employers who are early adopters grabbing that stick and willing 422 00:21:59,160 --> 00:22:01,560 Speaker 2: to whack up the person that's been pilfering them. And 423 00:22:01,600 --> 00:22:05,400 Speaker 2: we're cutting employer claim costs in half, and then once 424 00:22:05,440 --> 00:22:07,159 Speaker 2: you bake in all the other costs we have to 425 00:22:07,200 --> 00:22:10,560 Speaker 2: have for reinsurance and repricers, employers who do this are 426 00:22:10,560 --> 00:22:14,080 Speaker 2: saving twenty five to thirty five percent year one every time, 427 00:22:14,400 --> 00:22:17,720 Speaker 2: and they're not losing access to any providers. The message 428 00:22:17,720 --> 00:22:20,640 Speaker 2: to employees is, hey, if you guys insist upon going 429 00:22:20,640 --> 00:22:22,520 Speaker 2: to the top five or ten percent of providers in 430 00:22:22,560 --> 00:22:24,800 Speaker 2: your zip code, you're going to probably have to pay more. 431 00:22:24,960 --> 00:22:27,200 Speaker 2: But for ninety percent of you, you're going to see 432 00:22:27,200 --> 00:22:28,960 Speaker 2: no change to your plan at all other than we're 433 00:22:28,960 --> 00:22:30,520 Speaker 2: going to charge you a heck of a lot less 434 00:22:30,520 --> 00:22:30,800 Speaker 2: for it. 435 00:22:31,440 --> 00:22:35,000 Speaker 1: Well, and that's about the average work in man and woman. 436 00:22:35,359 --> 00:22:39,320 Speaker 1: I mean, that's where you bring it home, because you know, 437 00:22:40,440 --> 00:22:42,800 Speaker 1: and people will understand basic economics. 438 00:22:42,840 --> 00:22:43,280 Speaker 3: Get this. 439 00:22:43,800 --> 00:22:46,800 Speaker 1: If my employer has to pay through the nose for 440 00:22:46,920 --> 00:22:49,199 Speaker 1: my health insurance, it's great that they're doing it, but 441 00:22:49,200 --> 00:22:51,760 Speaker 1: that comes out of my potential salary. It all comes 442 00:22:51,760 --> 00:22:53,719 Speaker 1: out of my pocket. The part I pay comes out 443 00:22:53,760 --> 00:22:56,320 Speaker 1: of my pocket, and the part my employer plays comes 444 00:22:56,359 --> 00:22:58,439 Speaker 1: out of my pocket. Because there's a certain amount you 445 00:22:58,480 --> 00:23:00,880 Speaker 1: are worth to your employer, and instead of it going 446 00:23:00,920 --> 00:23:02,720 Speaker 1: to you, it's going to some insurance company. 447 00:23:02,720 --> 00:23:04,760 Speaker 3: Would you agree totally? 448 00:23:04,840 --> 00:23:08,000 Speaker 2: It's just total compensation, your compensation, Zach. And the problem 449 00:23:08,040 --> 00:23:10,600 Speaker 2: is right now, fifty something percent of that's going to healthcare, 450 00:23:10,600 --> 00:23:12,959 Speaker 2: when just twenty years ago it was thirty percent of it. 451 00:23:14,640 --> 00:23:17,360 Speaker 1: So as a small business person, I'm just I want 452 00:23:17,400 --> 00:23:19,040 Speaker 1: to make sure this is clear to me. This is 453 00:23:19,160 --> 00:23:21,159 Speaker 1: this reference based pricing or whatever you want to call it. 454 00:23:21,160 --> 00:23:23,200 Speaker 1: It's mostly helpful to companies that are big enough to 455 00:23:23,280 --> 00:23:25,160 Speaker 1: like self ensure pay their own claims. 456 00:23:25,400 --> 00:23:27,520 Speaker 2: Yeah, so so people ask me for a head Can 457 00:23:27,560 --> 00:23:30,280 Speaker 2: I say, general, two hundred and fifty plus employees. We 458 00:23:30,320 --> 00:23:32,560 Speaker 2: can probably do this depending on where you are. And 459 00:23:33,000 --> 00:23:35,719 Speaker 2: now some companies are smaller than that, they're already self insured. 460 00:23:35,760 --> 00:23:38,480 Speaker 2: You can do it right now, but you roughly need 461 00:23:38,600 --> 00:23:41,200 Speaker 2: two to three hundred employees to get enough to get 462 00:23:41,280 --> 00:23:43,680 Speaker 2: enough volume to be predictable, to get stop loss, et cetera. 463 00:23:43,840 --> 00:23:46,080 Speaker 2: So it's this is not a solution for you know, 464 00:23:46,080 --> 00:23:47,359 Speaker 2: a sub one hundred company. 465 00:23:47,960 --> 00:23:51,120 Speaker 1: Yeah, okay, fair enough, since I'm not in this business 466 00:23:51,160 --> 00:23:54,480 Speaker 1: and certainly don't make any money talking about this, is 467 00:23:54,520 --> 00:23:59,920 Speaker 1: there any way you could see using these same forces 468 00:24:00,080 --> 00:24:02,200 Speaker 1: to help out, you know, employees of small companies, self 469 00:24:02,200 --> 00:24:03,880 Speaker 1: employed folks down the road. 470 00:24:05,400 --> 00:24:07,879 Speaker 2: Yeah, because what's happening is and again, we're so on 471 00:24:07,920 --> 00:24:10,760 Speaker 2: the front end of this. Just a year ago, less 472 00:24:10,760 --> 00:24:12,880 Speaker 2: than two percent of companies we're doing this. Now it's 473 00:24:12,880 --> 00:24:15,200 Speaker 2: three percent of companies, and people like me are out 474 00:24:15,200 --> 00:24:18,760 Speaker 2: there hitting it hard and I'm busier than I can stand, Joe, 475 00:24:18,800 --> 00:24:22,760 Speaker 2: because it's growing so fast. But what's happening is we're 476 00:24:22,800 --> 00:24:27,480 Speaker 2: negotiating real prices, we're putting transparency on it, and ultimately 477 00:24:27,520 --> 00:24:30,600 Speaker 2: we're going to be developing new provider network that will 478 00:24:30,640 --> 00:24:32,840 Speaker 2: work for one hundred and forty percent of Medicare, so 479 00:24:32,840 --> 00:24:35,240 Speaker 2: that that small company can just do a direct contract 480 00:24:35,240 --> 00:24:37,720 Speaker 2: with the two hospitals in their neighborhood at one hundred 481 00:24:37,720 --> 00:24:39,919 Speaker 2: and forty percent of Medicare instead of three hundred and 482 00:24:39,920 --> 00:24:43,359 Speaker 2: ten percent of Medicare. So this will trickle down eventually 483 00:24:43,400 --> 00:24:46,120 Speaker 2: because we're shining a spotlight on the problem we've had 484 00:24:46,160 --> 00:24:49,480 Speaker 2: for fifty years in healthcare, and that's that we never 485 00:24:49,520 --> 00:24:50,480 Speaker 2: knew what the prices were. 486 00:24:51,119 --> 00:24:54,600 Speaker 1: I've known Craig for many, many years, and you get 487 00:24:54,680 --> 00:24:57,199 Speaker 1: so excited when you get a chance to stop the 488 00:24:57,240 --> 00:25:01,199 Speaker 1: government screwing people well, and certain private companies that are 489 00:25:01,200 --> 00:25:03,560 Speaker 1: in bed with the government. It's kind of fun to watch. 490 00:25:04,119 --> 00:25:07,480 Speaker 1: That's one of the reasons we're old friends. Craig, thank 491 00:25:07,480 --> 00:25:09,679 Speaker 1: you so much for the time. We appreciate the thoughts 492 00:25:09,920 --> 00:25:11,440 Speaker 1: and then the expertise. 493 00:25:12,760 --> 00:25:14,400 Speaker 2: Appreciate it. Joel can't wait to see you again. 494 00:25:14,720 --> 00:25:16,760 Speaker 1: All right, thanks buddy. All right, Yeah, we'll talk soon. 495 00:25:17,440 --> 00:25:20,640 Speaker 1: So if you want to ask questions or whatever. Craig's 496 00:25:20,640 --> 00:25:25,040 Speaker 1: contact information is at Armstrong and Getty dot com. 497 00:25:25,240 --> 00:25:26,439 Speaker 2: Armstrong and Getty