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Speaker 1: Because four hours. Simply enough, this is Armstrong and Getty

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Speaker 1: extra large. So I'm excited about this because, according to

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Speaker 1: our expert here Um, this is maybe the best thing

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Speaker 1: that's happened to healthcare in modern times. It hasn't happened yet, Jack,

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Speaker 1: hasn't happened yet, but we'll get into it could be

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Speaker 1: a game changer. I'm very excited about it. Craig got

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Speaker 1: Walls is an attorney and a benefits expert and a

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Speaker 1: longtime friend of the Armstrong and Getty Show. We have

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Speaker 1: designated him Craig the healthcare Guru, not healthcare gangster, like

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Speaker 1: you'd like to be known. Now. That's why I'm here

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Speaker 1: in my robe, in my my head gear today and

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Speaker 1: you're guru where. So listen. We want to talk about

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Speaker 1: this proposed regulation. I guess it is right from the

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Speaker 1: Trump administration. Exactly that would say is say essentially what

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Speaker 1: the proposed regulation would essentially say that all of us

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Speaker 1: consumers of healthcare have the right to know the exact

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Speaker 1: price that's already been negotiated between our insurance company and

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Speaker 1: our medical provider before we go into the doctor's office. Well,

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Speaker 1: let's let's get to a little history. Lest here because

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Speaker 1: we've talked about this on the show before, and I've

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Speaker 1: always wondered, like when I was born, Yeah, and and

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Speaker 1: my parents did what was their bill like then? I mean,

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Speaker 1: what did they did they give? Well, I've seen it.

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Speaker 1: It's it's itemized, its specific after the service's birthday, right exactly. So,

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Speaker 1: because he didn't used to be like this. Yeah, yeah,

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Speaker 1: Well I think you're I think you're kind of getting out.

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Speaker 1: Why is it, like, why is it tied to employers?

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Speaker 1: And why is it so darn expensive? I think is

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Speaker 1: kind of complicated. Yeah, why is it like everything else?

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Speaker 1: Why isn't it like everything else I do? Where If

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Speaker 1: I take my truck in and they say, oh, it's

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Speaker 1: the breaks up there on the thing, it's just a

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Speaker 1: break job costs, and I know what it costs. And

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Speaker 1: if I want to go across town and they say

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Speaker 1: they'll do it to seventy five, I can either choose

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Speaker 1: to do it they're or not or whatever. But why

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Speaker 1: doesn't it work that way with healthcare? Well, a lot

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Speaker 1: of people don't know that the there's a number of

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Speaker 1: reasons that led to the growth of the current modern

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Speaker 1: employer driven healthcare system in America. UM turning from an

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Speaker 1: agrarian to an industrial revolution was one reason employers started saying, hey,

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Speaker 1: it's a good idea for us to have a health

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Speaker 1: insurance policy so that when when Joe Getty cuts a

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Speaker 1: finger off at the assembly line, we can get him

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Speaker 1: back at work as soon as possible. I really need

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Speaker 1: to focus a thumb, right, yeah, you know. Uh. On

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Speaker 1: top of that, you had, you know, the development of

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Speaker 1: unions and a few other things that led to it

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Speaker 1: being a good idea. Employers thought it was a good

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Speaker 1: idea to provide health insurance policies at work. Well, the

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Speaker 1: big thing that led to the explosion of health insurance

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Speaker 1: in the workplace, and what I would call now really

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Speaker 1: not insurance but prepaid medical providing is World War Two.

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Speaker 1: And a lot of people don't know that. But what

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Speaker 1: happened in World yeah we can, that's right. What happened

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Speaker 1: in World War two was we had wage freezes. There

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Speaker 1: was a war on you know, as they said, and

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Speaker 1: it's a wonderful life, and so all of our resources

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Speaker 1: in theory, we're supposed to go to the funding the

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Speaker 1: war effort. But what the government did is they said, however,

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Speaker 1: you can go ahead and recruit that top talent and

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Speaker 1: do what you need to do to retain employees by

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Speaker 1: providing them benefits. And furthermore, we are not going to

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Speaker 1: tax benefits. So what happened. So I'm a working I'm

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Speaker 1: better off with health insurance than i am another, you know,

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Speaker 1: twenty bucks in my paycheck. That's right, absolutely better. I

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Speaker 1: mean that's true still today. I mean that's that's the

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Speaker 1: big thing about health insurance is that if your employer

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Speaker 1: gives you a hundred dollars worth of health insurance, that's

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Speaker 1: more valuable to you than a hundred dollars of pay

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Speaker 1: because it's not going to be taxed thirty right, and

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Speaker 1: it won't go up my nose like, oh, that's right.

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Speaker 1: I usually don't talk about my cocaine use on the

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Speaker 1: I'm not I'm not a cocaine addict anyway, so um okay.

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Speaker 1: So obviously that caught on. It led to an explosion

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Speaker 1: of the providing of health care benefits during World War

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Speaker 1: two and shortly thereafter. And then what happened was because

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Speaker 1: markets do work, and economies work, and businesses respond to

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Speaker 1: tax in incentives, what employers started to realize was, well,

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Speaker 1: you know, we have these traditional health insurance plans with

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Speaker 1: large deductibles where the employee might pay of the service rendered.

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Speaker 1: But if I want to give Jack Armstrong a raise,

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Speaker 1: I as an employer and Jack are both better off

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Speaker 1: if I give him that raise with health insurance because

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Speaker 1: there will be no tax consequence on that raise. So

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Speaker 1: employers from the end of World War Two all the

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Speaker 1: way up to current day have increasingly provided richer and

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Speaker 1: richer and richer and richer health care policies. Where we

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Speaker 1: got to the point in the nineties were a lot

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Speaker 1: of people in America had five dollar co pays and

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Speaker 1: then nothing else because it was all what I would

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Speaker 1: call prepaid medical plake care. At that it's not insurance.

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Speaker 1: It's like a radical club. It would be like you

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Speaker 1: pay a membership. When I worked at UPS, which was

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Speaker 1: the best insurance I've ever had, which was in around

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Speaker 1: the nineties, UM, everything was everything all the time, dental

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Speaker 1: and medical ey. That was absolutely the trend for the

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Speaker 1: big unionized shops, public and players, etcetera. And you you

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Speaker 1: you had that going on UM because it was the

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Speaker 1: it was an outgrowth of World War two and this

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Speaker 1: tax treatment where it was just the right way to

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Speaker 1: do things because you were circumventing the tax code. The

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Speaker 1: way to think about it, too, is people think about insurance. Remember,

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Speaker 1: for insurance on our boat, our car, our home, we

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Speaker 1: have a big deductible. We pay all the little stuff ourselves,

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Speaker 1: so we still care what that mechanic charges us. We

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Speaker 1: don't ensure oil changes. That's you know, that's a good point.

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Speaker 1: That is one of the big differences right there that

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Speaker 1: hadn't occurred to me. It's all the little stuff like

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Speaker 1: having a cold or whatever. And I I don't even

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Speaker 1: think about calling my insurance company and saying I need

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Speaker 1: new break beads. Um. Yeah, interesting. But for healthcare, I

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Speaker 1: don't think it. Well, it would be prohibitively expensive, I

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Speaker 1: would think, because you wouldn't know what people are going

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Speaker 1: to do with their cars and the rest of it.

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Speaker 1: But so, okay, go ahead, you're gonna you're gonna say

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Speaker 1: something about that. But well, what I don't understand is

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Speaker 1: I can't understand how it can be economical for anybody,

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Speaker 1: any at any point in the chain the companies that

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Speaker 1: anybody to operate like this. Why doesn't the company that

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Speaker 1: insures us, because we're the you know, the main company,

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Speaker 1: one of the companies we have a contract with we

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Speaker 1: have health insurance through UM and we're very grateful for it. UM.

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Speaker 1: Why aren't they like super crazy into how much stuff

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Speaker 1: costs or well, I'm sure you'll explain it to us,

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Speaker 1: But well they are, I mean they are on the

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Speaker 1: back end. They they you know, your insurance company, whoever

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Speaker 1: that may be, is negotiating with all of the hospitals

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Speaker 1: nationwide and they agree to prices behind the scenes. But

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Speaker 1: there are so many incentives built into the system that

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Speaker 1: taking a step back, UM, remember one of the things

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Speaker 1: Obamacare did that we've covered over the years is Obamacare,

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Speaker 1: for a period of like six years now, has guaranteed

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Speaker 1: that insurance companies will be made whole. Now that's phasing out,

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Speaker 1: that's going away. Those those those reimbursements on the back

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Speaker 1: end where insurance come ppanies that took in Obamacare enrollees

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Speaker 1: when they lost money because those enrollees were sicker, those

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Speaker 1: insurance companies were made whole. So you you actually don't

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Speaker 1: have a very big incentive for those insurance companies to

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Speaker 1: keep prices down anymore because they've been made whole. They've

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Speaker 1: been made whole, and there's there's formulas in place for

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Speaker 1: how these premiums are derived. That that keep those premiums

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Speaker 1: fairly high. But on the whole, you know, when you're

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Speaker 1: talking about say the four national p p O s um,

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Speaker 1: those p pos do care. They you know, A does

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Speaker 1: want to be a little bit below B and a

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Speaker 1: little bit below sea, etcetera. But the the getting back

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Speaker 1: to the number one problem in healthcare that we talked

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Speaker 1: about a few days ago on your show, the number

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Speaker 1: one problem is because of this system that's grown out

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Speaker 1: of World War two, out of tax treatment, out of

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Speaker 1: insurance companies and employers wanting to provide you with these

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Speaker 1: really bloated prepaid plans. We the end users, the people

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Speaker 1: that are actually going out into the hospital chain to

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Speaker 1: buy health insurance, we don't know the price of what

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Speaker 1: we're having on on a day to day basis. I

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Speaker 1: went and got a blood draw yesterday and I don't

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Speaker 1: have any idea what that cost me. That's exactly no,

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Speaker 1: I didn't. And it doesn't even come up in the process, right,

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Speaker 1: it doesn't come up in the process and put my

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Speaker 1: name down, they called my name. I went, well, I

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Speaker 1: get a bill. I don't know. Sometimes I do, sometimes

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Speaker 1: I don't. I don't have any ideas exactly, and the

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Speaker 1: whole system is set up that way. The whole system

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Speaker 1: is set up that way dating back to World War Two?

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Speaker 1: Who cares? Well? Who cares you mean? Why do we care? Okay? Well,

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Speaker 1: when the when the end user of a market doesn't

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Speaker 1: know the price, and really that price is being paid

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Speaker 1: through reduction in your pay right, because remember this gets

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Speaker 1: paid two ways. One way is through premiums. The other

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Speaker 1: way is through what you pay at point of service. Well,

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Speaker 1: that whole what you pay at point of service has

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Speaker 1: been over the years reduced down to almost nothing. Now.

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Speaker 1: The nice thing is, and I facetiously joke that Obamacare

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Speaker 1: has done something good for healthcare because what Obamacare did

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Speaker 1: was started making this stuff so ex spensive at the

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Speaker 1: point of service that we started to care. And with

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Speaker 1: our deductibles so high, that's when I first started noticing

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Speaker 1: what things cost. With the deductible, I started getting bills.

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Speaker 1: Holy cow, it Sam fell down and hurt his arm,

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Speaker 1: and I thought I might have broken it. So I

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Speaker 1: took him in and it cost me eighteen hundred dollars.

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Speaker 1: Next time, I'm gonna wait a day and see if

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Speaker 1: he's okay. I mean, I didn't used to do that

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Speaker 1: because I wasn't I wasn't paying that. That's right, we're

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Speaker 1: starting to care, which is a good thing. But but

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Speaker 1: getting back to just just they weren't expecting that, were they?

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Speaker 1: That was like an unintended concept. It wasn't. But but

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Speaker 1: we're in really in looking back at Obamacare, in hindsight,

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Speaker 1: the whole thing was set up to make to try

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Speaker 1: and make everybody happy, to try and make hospitals happy,

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Speaker 1: to try and make insurance companies happy, to try and

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Speaker 1: get more people covered. There were a few things built

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Speaker 1: in to try and contain costs, but as we've talked

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Speaker 1: about over the years, those things were either regulatory lee negated,

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Speaker 1: or ignored or delayed, and so all that cost containment's

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Speaker 1: gone out the window and it's just being built into

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Speaker 1: our taxes and our deficit as a country. Now you

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Speaker 1: get you another layer of who's paying for what to

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Speaker 1: make it even more obscure. That's right, And you say, well,

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Speaker 1: why do we care, Well, we care because national debt

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Speaker 1: is obviously that's a more nebulous thing. How much do

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Speaker 1: people really care about our national debt? Not a lot.

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Speaker 1: But it suppresses your wages because what's happening is health

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Speaker 1: care is costing your employer in the neighborhood of six

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Speaker 1: to nine more over the last twenty years and total

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Speaker 1: or per year, per year, we talk about wages being flat,

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Speaker 1: that might have all gotten eaten up in the healthcare.

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Speaker 1: It's absolutely the case, Jack, Because about the media, I've

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Speaker 1: never I've never heard in any of these arguments about

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Speaker 1: wages have been flat for so many decades talking about well,

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Speaker 1: actually they've gone up and that they're paying more for

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Speaker 1: the health care because health insurance is eating them up,

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Speaker 1: and employers, up until the last decade or so, employers

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Speaker 1: have been okay to do it because when an employer

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Speaker 1: gives you that calm sensation is healthcare, not only do

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Speaker 1: you not pay tax on it, but neither does your employer.

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Speaker 1: He doesn't pay payroll taxes when he gives you these

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Speaker 1: bloated health insurance plans. So well, no employer likes to

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Speaker 1: pay more for something if they don't have to. The

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Speaker 1: employers aren't They don't have a tremendous incentive the way

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Speaker 1: they should have to keep those costs downs. So your

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Speaker 1: health care inflation is depressing your wages. And that's what's

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Speaker 1: been going on now for a few decades. Wow, that's

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Speaker 1: really interesting. That's a huge point. So um so, so

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Speaker 1: this gets too how do we fix it right? And

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Speaker 1: what we talked about on the radio show was there's

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Speaker 1: two huge problems in healthcare. We've just covered them. One,

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Speaker 1: we don't know the price when we're buying. And in

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Speaker 1: every market, the consumer needs to know the price of

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Speaker 1: what they're buying, or the market perverts. It doesn't work well,

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Speaker 1: you end up with oligopolies and monopolies and inefficiencies. And

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Speaker 1: what we have in healthcare is a four company driven oligopoly.

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Speaker 1: There's four insurers nationwide, so we don't know the price.

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Speaker 1: The second problem that com cay to understand is that

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Speaker 1: if there was only one grocery store in my town

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Speaker 1: and I go and buy my groceries and I don't

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Speaker 1: get a bill at the time, I just load up

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Speaker 1: my cart and buy my groceries, and it's kind of

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Speaker 1: just factored into my life. Experienced spences somewhere. I don't

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Speaker 1: even know how much God they'd be charging freaking who

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Speaker 1: knows what for a tomato, anything they could get away with. Yeah,

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Speaker 1: So an olagopoly is the word cartel too strong? No,

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Speaker 1: a cartel is what grows out of an oligopoly by

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Speaker 1: effectively every time because you only have a few providers

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Speaker 1: that control the whole market. And eventually, even if they're

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Speaker 1: not having eye to eye wink communication, they start to

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Speaker 1: let prices creep up, and they start not to be

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Speaker 1: as aggressive as they might be on pricing because they

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Speaker 1: know that if all four people do it, everybody ends

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Speaker 1: up better off. And so that's what's that's where we're

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Speaker 1: at with healthcare in America by and large. Well, yeah,

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Speaker 1: and if you have only three other companies to monitor,

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Speaker 1: and you see, okay, everybody's creeping up. Okay, we're cool. Yeah,

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Speaker 1: that's right. And so that the first problem is we

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Speaker 1: don't know the price. The second problem is, up until recently,

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Speaker 1: we haven't really cared what that price was because, like

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Speaker 1: Jack was saying, when he when he worked in his

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Speaker 1: younger days, he had a plan that cost zero when

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Speaker 1: he went to the doctor. So if he didn't feel well,

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Speaker 1: he went to the doctor, he went to the e er.

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Speaker 1: If the doctor wasn't open, he went to the emergency

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Speaker 1: room that day, and maybe paid ten times what a

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Speaker 1: doctor visit what a cost. Because he didn't matter to Jack,

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Speaker 1: it didn't cost him a nickel. So we just kept

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Speaker 1: doing this over and over in America, and now we've

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Speaker 1: got this system. We don't know what it costs, we

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Speaker 1: don't care what it costs. The tax code is set

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Speaker 1: up such that the employer doesn't care as much as

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Speaker 1: they should, and it's depressing our wages. But we don't

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Speaker 1: see that. So nobody really really understands the linkage of

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Speaker 1: all these things. So what then happened over the last

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Speaker 1: three weeks with the Trump administration and it's proposed regulation

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Speaker 1: uh starting And it's I think it's worth going into

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Speaker 1: some of the legislative history because it's pretty interesting how

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Speaker 1: the sausage gets made with with with regulations. Right, So,

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Speaker 1: as we recall, statutes are things passed by Congress signed

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Speaker 1: by the president. It's what the Constitution has had in

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Speaker 1: mind since the very beginning of our country. Right, So,

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Speaker 1: one hundred years after the signing of our Constitution, the

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Speaker 1: very first regulatory agency was created. We didn't have regulations.

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Speaker 1: They are contemplated in the Constitution. They didn't exist in

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Speaker 1: the first hundred years of America. What's a regulation is

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Speaker 1: when Congress, as our good friend Tim standards might might say,

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Speaker 1: Congress passes a law that says there shall be no

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Speaker 1: bad things, and hereby I create an agency called the

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Speaker 1: Bad Things Agency to make sure no bad things happen.

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Speaker 1: And the President then goes ahead and appoints ahead of

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Speaker 1: that agency. That agency hires up, in many cases tens

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Speaker 1: and tens of thousands of people, and they write rules,

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Speaker 1: not laws, rules which have the force of law on

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Speaker 1: all of us the citizen read. But because they're not

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Speaker 1: called the law down have to go through the legislature.

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Speaker 1: And that's right, we don't hear about generally. Generally the

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Speaker 1: law says in the head of the agency will pass

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Speaker 1: such rules as are necessary to make sure there are

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Speaker 1: no bad things. That's exactly right. And um, so that

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Speaker 1: that occurred in the seventeen eighties. The very first it

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Speaker 1: was the Interstate Commerce Commission, I believe, the very first

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Speaker 1: administrative agency was created. And then a hundred years later,

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Speaker 1: in like the early nineteen eighties, the Supreme Court finally

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Speaker 1: looked century had looked well, d I was gonna let

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Speaker 1: it go. But Joe's sort of personally, I thought it

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Speaker 1: was the seventeen eighties. Seventeen eighties, we signed our constitution

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Speaker 1: a hundred years later was administrative agency hundred years after

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Speaker 1: like a Supreme Court course, I believe it was nineteen

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Speaker 1: eighty four. But yeah, um, the Chevron case and the

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Speaker 1: Chevron case, when our Supreme Court looked at this, and

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Speaker 1: you you still to this day have law professors that

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Speaker 1: maintain administrative law is not constitutional. Yeah. Now, when the

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Speaker 1: Supreme Court looked at the Supreme Court said, okay, administrative

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Speaker 1: law is constitutional and we will uphold it as legitimate

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Speaker 1: so long as a the statute at hand does not

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Speaker 1: expressly contradict what the administrative agency said. In other words,

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Speaker 1: it's not so clear. You know that they the water

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Speaker 1: is black, and then the other guy says the water

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Speaker 1: is blue. You know you can't have and then be

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Speaker 1: as long as the administrative agency is addressing something that

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Speaker 1: the statute doesn't expressly prohibit, it will be valid so

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Speaker 1: long as it's reasonable or just rational. And then the

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Speaker 1: court and then the Court said, even if we the

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Speaker 1: Court disagree with how the administrative agency interpreted this, it

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Speaker 1: shall be valid as long as it's reasonable or rational

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Speaker 1: and it's addressing something that is open to interpret. So

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Speaker 1: that's the great Chevron case. And I'm like hanging about.

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Speaker 1: That's the two that had to do with bathrooms again exactly,

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Speaker 1: and not having that juice stuff in there when you

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Speaker 1: want right, there should be a sentence for that. Um,

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Speaker 1: So that tell me if I'm wrong? Doesn't that give

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Speaker 1: unelected bureaucrats vast, vast powers tremendous amounts of well, and

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Speaker 1: what happens if I violate an e P A rule

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Speaker 1: for instance? It's not a law, it was just a

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Speaker 1: role passed by them. Can they send people with guns

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Speaker 1: to take my money or put me in a cage? Yes,

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Speaker 1: but that's not that's not why do we even have

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Speaker 1: a legislature, I guess to pass the original statute that

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Speaker 1: then you attached ten regulations to exactly. And the argument

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Speaker 1: for the legal scholars that would say regulations are necessary is, oh, well,

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Speaker 1: our country is so much more complicated than it was

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Speaker 1: when we signed our constitution that as we grew in

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Speaker 1: size and scope, we needed experts. We needed experts at

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Speaker 1: the federal level that would flesh out all the rules

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Speaker 1: and regulations necessary for we the citizen rate to follow

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Speaker 1: the law. That's the argument for it. And so we

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Speaker 1: have now. And to give you just one example of

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Speaker 1: how regulations work. Obamacare when it was signed into law

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Speaker 1: in two thousand nine, was two thousand, four hundred pages.

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Speaker 1: The regulations now implementing Obamacare are in the neighborhood of

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Speaker 1: forty thousand pages forty thousand pages of regulations, and if

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Speaker 1: they hold true to the same ratio that Medicare Medicaid did,

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Speaker 1: which is the closest analogy we have for Obamacare, we

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Speaker 1: will end up with something like a hundred and twenty

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Speaker 1: thousand pages of Obamacare regulations. Yeah, it's exactly like the

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Speaker 1: tax code. The other way to look at it is

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Speaker 1: every year we produce a federal register. The Federal Register

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Speaker 1: is a compilation of Supreme Court cases, laws, and regulations.

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Speaker 1: Overwhelmingly it's regulations, right, because those other things don't fill

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Speaker 1: nearly as many pages. Our Federal Register grows by sixty

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Speaker 1: to ninety thousand pages every single year. It's just federal

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Speaker 1: laws and rules. That's that's astonishing. Yeah, speaking of that,

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Speaker 1: you tell me, would now be a good time to

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Speaker 1: start talking about how there's, uh, there's this legislative slash

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Speaker 1: financial sleight of hand that Congress engages in with like

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Speaker 1: Medicaid and Medican Medicare. How's how they get away with

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Speaker 1: it's certainly helpful. Yeah, this is one of the most

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Speaker 1: interesting things, interesting conversations Craig and I have ever had

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Speaker 1: through the years of riding mountain bikes up and down

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Speaker 1: hills and fishing in the rest of it. Um so,

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Speaker 1: oh boy, it dates back to the early nineties. Roughly,

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Speaker 1: let's do this one nineteen nineties, so this one's only

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Speaker 1: about thirty years old. Um. The medical Well, first off,

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Speaker 1: take a step back when Medicare was passed in the

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Speaker 1: early to mid sixties. Uh, that was an lb J

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Speaker 1: great society. That that's right. So nineteen sixties again, we'll

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Speaker 1: get the decade right for Joe. Um the and I

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Speaker 1: forget what the exact number was, but Congress projected what

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Speaker 1: it would cost in nineteen nineties. They were off by

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Speaker 1: a factor of eleven. Yeah, factor of eleven. So in

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Speaker 1: the nineties it became Bush one. And then and then

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Speaker 1: Clinton's problem of what are we gonna do to rain

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Speaker 1: in the pricing on Medicare because it was running up

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Speaker 1: enormous death it was Yeah, because healthcare inflation in America,

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Speaker 1: like true inflation, like if you really were paying an

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Speaker 1: actual price for your hip replacement is roughly right for

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Speaker 1: the Gerry aric so shut up. So what's it's roughly

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Speaker 1: four percent per year to four and a half and

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Speaker 1: that's been true for at least twenty years. I'm sorry.

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Speaker 1: That's general inflation or healthcare and health care inflation, general

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Speaker 1: inflations less well, depending upon who you listen to. That's

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Speaker 1: a whole another podcast. Um. So, Medicare and Medicaid were

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Speaker 1: growing quickly as we hit the nineties and and eating

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Speaker 1: up our budget a factor of eleven times more than

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Speaker 1: they ever projected. So, uh, there were and eating up

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Speaker 1: your wages. If you're rutting just for inflation, cost of

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Speaker 1: inflation is averaging around too most of the time. You

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Speaker 1: know you're coming out behind every year. So they there

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Speaker 1: was legislation in place that said, starting in and they

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Speaker 1: picked a year five years out the late nineties, we're

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Speaker 1: gonna start cutting what we pay doctors in Medicare and

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Speaker 1: Medicaid by like half a percent per year for a decade. Right. Well,

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Speaker 1: the problem was, by the time they got to that year,

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Speaker 1: which was in the late nineties, private insurance plans were

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Speaker 1: already paying doctors thirty to forty percent more for the

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Speaker 1: same procedures. And now Medicare and Medicaid we're gonna start

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Speaker 1: reducing what they paid to doctors by half a percent

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Speaker 1: per year. And I'm guessing the doctors weren't really thrilled

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Speaker 1: with that. And that's right. So you already have something

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Speaker 1: like half of doctors in America will not take a

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Speaker 1: Medicaid patient, and something like twenty of doctors in America

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Speaker 1: won't take a Medicare patient. And that's because medicare the

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Speaker 1: one that we used to cover the seniors. It generally

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Speaker 1: pays more than Medicaid in the majority of stage. So

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Speaker 1: does it happen where like I've had the same doctor

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Speaker 1: now for twenty some years. If I was about to

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Speaker 1: turn what age do you have to be to get

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Speaker 1: on sixty five? So say I'm sixty four. Next year

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Speaker 1: I qualify and I do. He might say, no, I

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Speaker 1: don't really want you as a patient anymore. That happens,

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Speaker 1: That actually can happen. It's rare. It's rare because normal

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Speaker 1: and then okay, so he quits, I go to find

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Speaker 1: another doctor. There might not be any doctors around that

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Speaker 1: want me. Yeah, now, because there's no money in it.

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Speaker 1: There there might not be with Medicare again we're talking

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Speaker 1: about that's the one we've all in theory paid for

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Speaker 1: all of our lives and covered the cost of So

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Speaker 1: they try to keep the reimbursements on Medicare somewhat realistic

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Speaker 1: because they don't want that. They don't want Medicare is

428
00:22:32,440 --> 00:22:34,800
Speaker 1: for everybody that gets old, everybody that gets over six.

429
00:22:34,800 --> 00:22:36,480
Speaker 1: But if you're old and poor or just poor, you

430
00:22:36,480 --> 00:22:38,040
Speaker 1: don't even have to be old. If you're just poor,

431
00:22:38,119 --> 00:22:41,480
Speaker 1: you get Medicaid. Yeah, and in California, for example, they

432
00:22:41,520 --> 00:22:45,000
Speaker 1: call it uh medical, which makes it kind of complicated

433
00:22:45,080 --> 00:22:48,119
Speaker 1: to the vernacular. Okay, but anyway, so the red what

434
00:22:48,160 --> 00:22:50,760
Speaker 1: do you actually what they what they actually pay the

435
00:22:50,840 --> 00:22:55,360
Speaker 1: doctors is a little paltry for Medicare, and seriously paltry

436
00:22:55,359 --> 00:22:57,679
Speaker 1: for Medicaid. And that's where we left. Paltry from Medicare,

437
00:22:57,720 --> 00:23:00,960
Speaker 1: seriously paltry from Medicaid. And yeah, you the real answer

438
00:23:01,080 --> 00:23:03,840
Speaker 1: is you might have less doctors to choose from when

439
00:23:03,880 --> 00:23:06,159
Speaker 1: you hit sixty five right now. But so anyway, we

440
00:23:06,160 --> 00:23:09,720
Speaker 1: were at the point where Congress, which already was screwing

441
00:23:09,760 --> 00:23:12,040
Speaker 1: doctors a little bit, announced that we're gonna cut it

442
00:23:12,080 --> 00:23:14,840
Speaker 1: back every single year, and you're gonna take it every

443
00:23:14,880 --> 00:23:19,320
Speaker 1: white coated bastards every time, every time the federal government,

444
00:23:19,840 --> 00:23:23,200
Speaker 1: for you can from the mid nineteen nineties all the

445
00:23:23,200 --> 00:23:26,879
Speaker 1: way up to the passage of this yeah like this

446
00:23:28,560 --> 00:23:30,960
Speaker 1: so so for a fifteen year period from the mid

447
00:23:31,040 --> 00:23:34,639
Speaker 1: nineties to the passage of Obamacare, the what we were

448
00:23:34,640 --> 00:23:36,840
Speaker 1: paying the doctors in the government programs was supposed to

449
00:23:36,840 --> 00:23:39,159
Speaker 1: go down by half a percent per year to save

450
00:23:39,359 --> 00:23:43,600
Speaker 1: to save program the budget of the program. Right. However,

451
00:23:44,440 --> 00:23:47,840
Speaker 1: all the politicians knew that if we did that, we'd

452
00:23:47,840 --> 00:23:50,280
Speaker 1: have seniors riding in the streets because they wouldn't be

453
00:23:50,320 --> 00:23:52,680
Speaker 1: able to find doctors. Be an interesting right to watch,

454
00:23:52,680 --> 00:23:55,560
Speaker 1: But I understand what you're yeah, uh, seniors threatening not

455
00:23:55,600 --> 00:24:00,159
Speaker 1: to vote. I guess be So every year or a

456
00:24:00,200 --> 00:24:02,560
Speaker 1: year and a half, or two years or six months,

457
00:24:02,760 --> 00:24:05,280
Speaker 1: as we'd come up with these budget battles that were

458
00:24:05,280 --> 00:24:08,200
Speaker 1: so used to seeing at the federal level, they would

459
00:24:08,720 --> 00:24:11,720
Speaker 1: they would sunset that provision. They would say, well, yes,

460
00:24:11,760 --> 00:24:13,760
Speaker 1: we're due to cut Medicare by one and a half

461
00:24:13,800 --> 00:24:15,360
Speaker 1: percent at this point, but we're not going to cut

462
00:24:15,359 --> 00:24:17,879
Speaker 1: anything over the next year and a half. And that

463
00:24:17,960 --> 00:24:20,600
Speaker 1: was always part of these quick, little short budget battles

464
00:24:20,600 --> 00:24:23,800
Speaker 1: that we're seeing and well it was mentioned, but only

465
00:24:23,880 --> 00:24:26,960
Speaker 1: true healthcare walks knew what was going on, right it was.

466
00:24:27,200 --> 00:24:29,119
Speaker 1: It was because it would it would be stated in

467
00:24:29,160 --> 00:24:31,480
Speaker 1: a newspaper article like, yeah, we're not going to raid

468
00:24:31,480 --> 00:24:33,080
Speaker 1: Medicare to do that. We're not gonna put in the

469
00:24:33,080 --> 00:24:35,520
Speaker 1: Medicare cuts, even though those cuts were already in the law,

470
00:24:35,560 --> 00:24:37,320
Speaker 1: to make the budget look like it was real. Right,

471
00:24:37,760 --> 00:24:39,920
Speaker 1: all right, So you get to the passage of Obamacare.

472
00:24:40,320 --> 00:24:43,359
Speaker 1: In Obamacare, to help make it look like Obamacare was

473
00:24:43,400 --> 00:24:45,639
Speaker 1: only going to cost a trillion dollars and not the

474
00:24:45,640 --> 00:24:49,080
Speaker 1: two trillion it's at now, they built right into the

475
00:24:49,119 --> 00:24:52,080
Speaker 1: financial assumption of yeah, well, as soon as we pass Obamacare,

476
00:24:52,119 --> 00:24:54,800
Speaker 1: we're actually going to put in the Medicare cuts. And

477
00:24:54,840 --> 00:24:56,840
Speaker 1: when we put in the Medicare and Medicaid cuts, that's

478
00:24:56,840 --> 00:24:59,680
Speaker 1: gonna save us a trillion dollars immediately. So this law

479
00:24:59,760 --> 00:25:01,800
Speaker 1: that probably is going to cost two trillion dollars will

480
00:25:01,800 --> 00:25:03,800
Speaker 1: only be one trillion dollars because we're gonna stick it

481
00:25:03,880 --> 00:25:05,920
Speaker 1: to the doctors. Finally, that's right, We're finally going to

482
00:25:06,000 --> 00:25:07,760
Speaker 1: put in these cuts that we've been kicking down the

483
00:25:07,840 --> 00:25:10,840
Speaker 1: road for fifteen years over four different presidents of two

484
00:25:10,880 --> 00:25:14,200
Speaker 1: to both parties. Right, it was just so fake, so phony.

485
00:25:15,000 --> 00:25:16,840
Speaker 1: It was. It was the Medicare cuts that were just

486
00:25:16,920 --> 00:25:20,080
Speaker 1: never going to happen. So ultimately, over the last few years,

487
00:25:20,119 --> 00:25:22,360
Speaker 1: they've addressed this and they've put in a system now

488
00:25:22,359 --> 00:25:26,040
Speaker 1: where Medicare ballpark. These things grow at about one percent

489
00:25:26,080 --> 00:25:28,760
Speaker 1: per year instead of we're supposed to cut it half

490
00:25:28,760 --> 00:25:31,320
Speaker 1: a percent per year. But think about that. I told

491
00:25:31,320 --> 00:25:33,679
Speaker 1: you health care is going up at four percent to

492
00:25:33,760 --> 00:25:37,200
Speaker 1: four and a half percent every year. Right, Medicare and Medicaid,

493
00:25:37,240 --> 00:25:39,520
Speaker 1: the largest purchaser of healthcare in the country, are only

494
00:25:39,560 --> 00:25:42,000
Speaker 1: gonna pay one percent more per year. So it's an

495
00:25:42,000 --> 00:25:44,879
Speaker 1: effective cut. Well, it's a cut, but where do you

496
00:25:44,960 --> 00:25:47,600
Speaker 1: make up the difference? So before we get to the

497
00:25:47,680 --> 00:25:52,359
Speaker 1: where do you make up the difference? Employer plans. So,

498
00:25:52,760 --> 00:25:56,360
Speaker 1: in order for hospitals and doctors providers to be made

499
00:25:56,400 --> 00:25:59,760
Speaker 1: whole and to not start leaving the system in droves,

500
00:26:00,280 --> 00:26:03,560
Speaker 1: employer plans have for twenty years been paying six to

501
00:26:03,680 --> 00:26:06,600
Speaker 1: nine percent more every year to make up for the

502
00:26:06,640 --> 00:26:12,040
Speaker 1: fact that Medicare and Medicaid woefully underpay those same providers. Wow,

503
00:26:12,200 --> 00:26:16,480
Speaker 1: why do the employers put up with that? Uh? Because

504
00:26:16,520 --> 00:26:20,520
Speaker 1: the insurance, Yeah, the insured, the ali gopol exactly. The market,

505
00:26:20,640 --> 00:26:23,080
Speaker 1: the broken market does it and employers are kind of

506
00:26:23,119 --> 00:26:26,439
Speaker 1: forced to eat what's there. So before we get to

507
00:26:26,920 --> 00:26:29,879
Speaker 1: this great game changing thing that may have happened in

508
00:26:29,880 --> 00:26:34,520
Speaker 1: the Trump administration, most people don't, you know, pay attention

509
00:26:34,560 --> 00:26:37,520
Speaker 1: to the stuff you're just talking about, right, either have

510
00:26:37,600 --> 00:26:39,760
Speaker 1: the capacity or the interest to pay attention to it.

511
00:26:40,320 --> 00:26:43,640
Speaker 1: But since you do, the more into it you get.

512
00:26:43,960 --> 00:26:46,160
Speaker 1: How much And I know the answer to this question

513
00:26:46,160 --> 00:26:47,960
Speaker 1: because I know you and we've talked about it over

514
00:26:48,000 --> 00:26:51,760
Speaker 1: the years, but how much how much confidence do you

515
00:26:51,760 --> 00:26:54,080
Speaker 1: have in our political system at all when it sounds

516
00:26:54,080 --> 00:26:57,159
Speaker 1: like they're out and out misleading, if not lying to

517
00:26:57,280 --> 00:27:01,480
Speaker 1: us for decades now and fudging numbers here and there

518
00:27:01,520 --> 00:27:04,600
Speaker 1: just to try to patchwork hold it together because everybody

519
00:27:04,720 --> 00:27:07,400
Speaker 1: knew there was no chance they were gonna have those

520
00:27:07,520 --> 00:27:12,399
Speaker 1: enormous cuts, and they just count on the fact that

521
00:27:12,440 --> 00:27:15,080
Speaker 1: the average voter is certainly not in the weeds enough

522
00:27:15,119 --> 00:27:17,639
Speaker 1: to know, and the average child sure can't catch on

523
00:27:17,720 --> 00:27:20,119
Speaker 1: that they're gonna get stuck with the bill. Right, and

524
00:27:20,200 --> 00:27:22,840
Speaker 1: both parties engaged in it for fifteen years before, I mean,

525
00:27:22,920 --> 00:27:25,040
Speaker 1: the the big one was Obamacare when they counted on

526
00:27:25,080 --> 00:27:27,000
Speaker 1: a trillion dollars of savings that weren't going to be there.

527
00:27:27,040 --> 00:27:29,240
Speaker 1: How much of it do you think Trump understood when

528
00:27:29,240 --> 00:27:34,080
Speaker 1: he was running. I mean, I'm not I'm not trying

529
00:27:34,080 --> 00:27:35,920
Speaker 1: to Trump bash at all. Yeah, that's a tough because

530
00:27:35,960 --> 00:27:37,840
Speaker 1: I know for a fact from reading you know, some

531
00:27:37,920 --> 00:27:40,119
Speaker 1: of the various reporting on it, that Obama didn't know

532
00:27:40,160 --> 00:27:43,119
Speaker 1: that much about healthcare until I mentioned it offhanded. A

533
00:27:43,200 --> 00:27:45,520
Speaker 1: party got a good reaction that decided, I think, on myke,

534
00:27:45,520 --> 00:27:47,359
Speaker 1: healthcare big deal. I mean, that's how it started. And

535
00:27:47,400 --> 00:27:50,040
Speaker 1: then he started having experts come in and learning about it.

536
00:27:50,080 --> 00:27:52,439
Speaker 1: But I just remember in the debate of debate stage

537
00:27:52,720 --> 00:27:56,000
Speaker 1: and Marco Rubio mock him, mocking Trump saying, every debate

538
00:27:56,080 --> 00:27:57,720
Speaker 1: you talk about these circles, and then you know, you

539
00:27:57,800 --> 00:28:02,879
Speaker 1: see what that means selling healthcare across state line. My

540
00:28:02,960 --> 00:28:04,960
Speaker 1: only point being that most people aren't paying attention to

541
00:28:05,040 --> 00:28:07,960
Speaker 1: politicians either know we aren't paying attention, or or don't

542
00:28:08,000 --> 00:28:12,080
Speaker 1: they don't even care to learn it themselves. To answer

543
00:28:12,119 --> 00:28:14,399
Speaker 1: you a couple of questions, they're one. I don't I

544
00:28:14,480 --> 00:28:19,119
Speaker 1: honestly don't think any president coming in really has a

545
00:28:19,240 --> 00:28:22,560
Speaker 1: very decent grasp on any of this at all unless

546
00:28:22,600 --> 00:28:24,240
Speaker 1: they you know, unless they were to come in as

547
00:28:24,280 --> 00:28:27,080
Speaker 1: having been on a healthcare oversight committee in Congress, unless

548
00:28:27,080 --> 00:28:29,679
Speaker 1: you came out of that world, right right. They just don't.

549
00:28:30,200 --> 00:28:33,919
Speaker 1: It's it's too complicated and it doesn't take Look, a

550
00:28:33,920 --> 00:28:35,760
Speaker 1: president can be up to speed on it within months,

551
00:28:35,840 --> 00:28:38,840
Speaker 1: because the one thing President Trump has is is he's

552
00:28:38,880 --> 00:28:42,600
Speaker 1: appointed good people to HHS. Salazar knows what he's doing.

553
00:28:42,800 --> 00:28:45,000
Speaker 1: And that's where we that's why we're at where we're at,

554
00:28:45,000 --> 00:28:48,160
Speaker 1: where there's some hope now. But my confidence that the

555
00:28:48,240 --> 00:28:51,000
Speaker 1: current climate of political systems is going to fix this

556
00:28:51,720 --> 00:28:56,520
Speaker 1: incredibly low. I mean incredibly low. I how much let

557
00:28:56,560 --> 00:28:59,440
Speaker 1: me ask you, guys, as an expert, as experts on

558
00:28:59,480 --> 00:29:02,720
Speaker 1: his politics, how much how much? How much confidence to

559
00:29:02,840 --> 00:29:06,080
Speaker 1: either of you have, for example, that our current political

560
00:29:06,080 --> 00:29:09,520
Speaker 1: system is going to fix our federal budget? Alright? Zero?

561
00:29:09,640 --> 00:29:12,320
Speaker 1: Right now? You know, listen, I don't defend politicians much,

562
00:29:12,400 --> 00:29:15,280
Speaker 1: but I think it would be electoral suicide anybody told

563
00:29:15,280 --> 00:29:19,320
Speaker 1: the truth the people we are getting precisely the government

564
00:29:19,360 --> 00:29:22,520
Speaker 1: we deserve, with an allowance for there's a certain percentage

565
00:29:22,520 --> 00:29:26,400
Speaker 1: of you know, graft from lobbyists and indirect graft, you know,

566
00:29:26,480 --> 00:29:30,440
Speaker 1: campaign contributions and stuff that you can't blame on the people,

567
00:29:30,520 --> 00:29:33,880
Speaker 1: per se. But no, anybody who treats the American people

568
00:29:33,920 --> 00:29:35,960
Speaker 1: like adults and says, all right, here's a problem, here's

569
00:29:36,160 --> 00:29:39,040
Speaker 1: here's the math, and here's the issue. We're just there's

570
00:29:39,960 --> 00:29:42,760
Speaker 1: we're not Santa Claus. We can't. We don't have elves

571
00:29:42,880 --> 00:29:44,959
Speaker 1: making benefits. Sure, I don't want to get too far

572
00:29:44,960 --> 00:29:47,040
Speaker 1: off topic here, but we remember in the Republican debate,

573
00:29:47,080 --> 00:29:49,200
Speaker 1: any if Chris Christie I Ran Paul the only two

574
00:29:49,240 --> 00:29:51,440
Speaker 1: people to ever mentioned you know, this sort of stuff here,

575
00:29:51,600 --> 00:29:57,360
Speaker 1: they're just they're like, shut up down the debate with

576
00:29:57,400 --> 00:30:00,040
Speaker 1: that crap. Here's here's a here's a good example, a

577
00:30:00,320 --> 00:30:03,600
Speaker 1: good example in this context. In healthcare, we've talked about

578
00:30:03,600 --> 00:30:06,880
Speaker 1: and you've heard about the Cadillac tax associated with Obamacare.

579
00:30:06,960 --> 00:30:10,400
Speaker 1: Now a quick recap for folks on the Cadillac taxes. Um.

580
00:30:10,520 --> 00:30:13,360
Speaker 1: When Obamacare passed, they put in a provision that said, look,

581
00:30:13,680 --> 00:30:16,880
Speaker 1: when we we've got to stop employers from providing these

582
00:30:16,920 --> 00:30:20,360
Speaker 1: super rich zero dollar copay types of plans that are

583
00:30:20,360 --> 00:30:23,800
Speaker 1: eating up wages in the budget. Okay, so what we're

584
00:30:23,800 --> 00:30:27,680
Speaker 1: gonna do is we're gonna start taxing healthcare plans when

585
00:30:27,720 --> 00:30:31,240
Speaker 1: those healthcare plans exceed a threshold of roughly ten thousand

586
00:30:31,240 --> 00:30:34,000
Speaker 1: dollars per individual per year or twenty seven thousand dollars

587
00:30:34,040 --> 00:30:37,360
Speaker 1: per family. And that was supposed to start originally in ten.

588
00:30:37,360 --> 00:30:39,680
Speaker 1: They couldn't agree on that. They kicked it outen they've

589
00:30:39,720 --> 00:30:42,880
Speaker 1: kicked it out they I think now it's kicked out two.

590
00:30:42,960 --> 00:30:44,440
Speaker 1: But this is the one I've said. Look, this will

591
00:30:44,480 --> 00:30:46,280
Speaker 1: never pass, This will never go into law as it

592
00:30:46,320 --> 00:30:48,240
Speaker 1: was written, or I'll eat Jack's truck that he didn't

593
00:30:48,280 --> 00:30:53,480
Speaker 1: eat the last time. But but here's the thing. If

594
00:30:53,520 --> 00:30:57,040
Speaker 1: you're an economist looking at this problem on on how

595
00:30:57,160 --> 00:30:59,640
Speaker 1: you work with the market we have and try to

596
00:30:59,720 --> 00:31:03,160
Speaker 1: fix health care, you I hate to say this. I

597
00:31:03,240 --> 00:31:05,200
Speaker 1: hate to say this, and you're allowed to punch me

598
00:31:05,240 --> 00:31:07,080
Speaker 1: in the stomach after we get out of here. Yes,

599
00:31:07,480 --> 00:31:11,320
Speaker 1: you probably should put some kind of tax on healthcare

600
00:31:11,640 --> 00:31:15,080
Speaker 1: and make up for it by reducing overall income taxes

601
00:31:15,120 --> 00:31:17,960
Speaker 1: so that you could stay budget neutral. But if you

602
00:31:18,040 --> 00:31:20,520
Speaker 1: don't put a tax on healthcare, you don't fix the

603
00:31:20,560 --> 00:31:24,280
Speaker 1: broken incentive for employers to provide you your compensation that's

604
00:31:24,320 --> 00:31:28,760
Speaker 1: overwhelmingly healthcare dollars. Wow, Okay, you see what I'm saying.

605
00:31:29,600 --> 00:31:33,000
Speaker 1: And all of everybody on the right latched onto the

606
00:31:33,080 --> 00:31:35,600
Speaker 1: Cadillac tax is bad because we're going to tax your healthcare,

607
00:31:35,680 --> 00:31:38,680
Speaker 1: and it got demagogued into even the Democrats going, we're

608
00:31:38,680 --> 00:31:42,200
Speaker 1: not doing this. But it was really a sound economic principle,

609
00:31:42,280 --> 00:31:44,640
Speaker 1: and that's that you can't have this part of pay

610
00:31:44,720 --> 00:31:46,719
Speaker 1: not be taxed and this part of pay be taxed

611
00:31:47,080 --> 00:31:50,280
Speaker 1: because the market will end up pushing healthcare up, which

612
00:31:50,320 --> 00:31:53,560
Speaker 1: is what it's done, right, It's artificially inflated, right, just

613
00:31:53,640 --> 00:31:56,920
Speaker 1: like college all the flow of college money for instances

614
00:31:57,000 --> 00:31:59,920
Speaker 1: led to the skyrocket. But you have nobody, there's no

615
00:32:00,000 --> 00:32:02,440
Speaker 1: no but he left, not even President Obama himself that

616
00:32:02,480 --> 00:32:06,840
Speaker 1: would defend the Catillac tacks because it doesn't get you reelected.

617
00:32:07,000 --> 00:32:09,720
Speaker 1: Yeah yeah, all right, Well, speaking of presidents sold Donald

618
00:32:09,760 --> 00:32:12,960
Speaker 1: J and Salazar over there, hhs. They they want to

619
00:32:12,960 --> 00:32:17,120
Speaker 1: bring transparency to healthcare spending a fair descriptions, right, and

620
00:32:17,160 --> 00:32:18,840
Speaker 1: they've they've made a lot of noise about that over

621
00:32:18,880 --> 00:32:22,160
Speaker 1: the last few months. In particular, so in two thousand

622
00:32:22,280 --> 00:32:27,160
Speaker 1: nine Congress past the Stimulus Package era. If you remember

623
00:32:27,200 --> 00:32:30,400
Speaker 1: that one, Obama's great stimulus all kinds of stuff in it.

624
00:32:30,880 --> 00:32:33,560
Speaker 1: One of the things stuffed into the stimulus package was

625
00:32:33,640 --> 00:32:37,240
Speaker 1: a hippo high tech law. It's just all this really

626
00:32:37,240 --> 00:32:40,320
Speaker 1: did was dealt with all of the technology around healthcare privacy.

627
00:32:40,840 --> 00:32:43,360
Speaker 1: And it was that part was not controversial at all.

628
00:32:43,360 --> 00:32:44,880
Speaker 1: It's like, hey, if we're gonna put all of your

629
00:32:44,880 --> 00:32:47,560
Speaker 1: healthcare online, we need to do certain things to guard

630
00:32:47,600 --> 00:32:49,640
Speaker 1: it so that the Russians aren't hacking it and spraying

631
00:32:49,640 --> 00:32:52,720
Speaker 1: it everywhere for example. Well, that was great. So that

632
00:32:52,720 --> 00:32:56,600
Speaker 1: passed in two thousand nine. In two thousand sixteen, an

633
00:32:56,640 --> 00:32:59,280
Speaker 1: outgrowth of that law was this new law that was

634
00:32:59,320 --> 00:33:03,000
Speaker 1: passed written by a Democrat from Oregon, passed by I

635
00:33:03,000 --> 00:33:05,440
Speaker 1: think everybody but like five people in the House of

636
00:33:05,440 --> 00:33:08,040
Speaker 1: Representatives voted for it, and that was called the twenty

637
00:33:08,120 --> 00:33:12,320
Speaker 1: one Century Cures Act. Again, just much more detail and

638
00:33:12,440 --> 00:33:16,800
Speaker 1: rigorous guarding of I T. Information technology as it relates

639
00:33:16,840 --> 00:33:19,480
Speaker 1: to healthcare, the kind of things that you must know

640
00:33:19,560 --> 00:33:21,560
Speaker 1: as a patient and the kind of things that nobody

641
00:33:21,640 --> 00:33:23,440
Speaker 1: is allowed to know about you as a patient. Okay,

642
00:33:23,520 --> 00:33:27,240
Speaker 1: again very non controversial. Everybody voted for it. Well, as

643
00:33:27,280 --> 00:33:30,160
Speaker 1: these things go, of course, that said, and we delegate

644
00:33:30,200 --> 00:33:33,520
Speaker 1: to HHS the right and the authority to write the

645
00:33:33,600 --> 00:33:37,200
Speaker 1: regulations to implement what we want done here. That law itself,

646
00:33:37,280 --> 00:33:40,880
Speaker 1: that particular statute was like three something pages. Well, we're

647
00:33:40,880 --> 00:33:43,880
Speaker 1: already getting many hundreds of pages now coming out on

648
00:33:43,960 --> 00:33:47,480
Speaker 1: that Act. Again. When they passed this, Obama was president

649
00:33:47,520 --> 00:33:49,400
Speaker 1: and HHS was run by at the time, I believe

650
00:33:49,400 --> 00:33:52,160
Speaker 1: it was sibelious, right. These were Democrats. So Congress is thinking,

651
00:33:52,200 --> 00:33:54,560
Speaker 1: a great, we're gonna have the Obama administration writing these

652
00:33:54,600 --> 00:33:59,240
Speaker 1: rules on healthcare privacy. The Trump administration is getting around

653
00:33:59,280 --> 00:34:02,040
Speaker 1: getting around to it's spin on those regulations, and that's

654
00:34:02,040 --> 00:34:04,560
Speaker 1: what came out in the last three weeks. We're seven

655
00:34:04,640 --> 00:34:09,280
Speaker 1: hundred plus pages of regulations implementing that high tech hip

656
00:34:09,280 --> 00:34:13,560
Speaker 1: a Privacy Medical Privacy Act, all of it, but about

657
00:34:13,719 --> 00:34:15,800
Speaker 1: one and a half pages in the in the middle

658
00:34:16,239 --> 00:34:20,960
Speaker 1: really deal with all of this information technology data transfer.

659
00:34:21,440 --> 00:34:23,120
Speaker 1: In the middle of it, though they do say, look,

660
00:34:23,160 --> 00:34:26,400
Speaker 1: it's it's we believe. HHS says, we believe we have

661
00:34:26,480 --> 00:34:29,879
Speaker 1: the authority under this Act to go ahead and um

662
00:34:29,880 --> 00:34:32,840
Speaker 1: to weigh in on what exactly a patient has a

663
00:34:32,920 --> 00:34:34,839
Speaker 1: right to know with respect to the pricing that they're

664
00:34:34,840 --> 00:34:36,440
Speaker 1: going to be expected to pay when they go to

665
00:34:36,480 --> 00:34:40,239
Speaker 1: the doctor's office. And this has become relevant right as

666
00:34:40,280 --> 00:34:42,959
Speaker 1: a side effective Obamacare, in my opinion, because when Jack

667
00:34:43,000 --> 00:34:46,399
Speaker 1: had zero dollar copays, the patient didn't care what things cost.

668
00:34:46,480 --> 00:34:49,120
Speaker 1: But now you guys have talked about there's ten tho

669
00:34:49,360 --> 00:34:52,600
Speaker 1: dollar deductibles out there and people are starting to pay

670
00:34:52,600 --> 00:34:54,880
Speaker 1: their own money for care, and they give a darn right.

671
00:34:54,960 --> 00:34:58,680
Speaker 1: So what it said was, we believe the patients have

672
00:34:58,800 --> 00:35:00,840
Speaker 1: the right not just before where they go to the doctor,

673
00:35:00,880 --> 00:35:03,200
Speaker 1: but even when they pick a plan at their open enrollment.

674
00:35:03,520 --> 00:35:05,520
Speaker 1: We believe the patients have the right to know what

675
00:35:05,640 --> 00:35:08,520
Speaker 1: these prices are that they're signing up for. So we

676
00:35:08,600 --> 00:35:13,600
Speaker 1: think the privately negotiated secret pricing between the four major

677
00:35:13,640 --> 00:35:17,359
Speaker 1: insurance companies and all of the hospitals must be made

678
00:35:17,400 --> 00:35:22,400
Speaker 1: publicly available two consumers of health care in general, and

679
00:35:22,440 --> 00:35:25,799
Speaker 1: they've been advance in advance, in advance so that you

680
00:35:25,800 --> 00:35:28,000
Speaker 1: can even use it in open enrollment to decide do

681
00:35:28,040 --> 00:35:30,359
Speaker 1: you want to pick carrier air carrier be or how

682
00:35:30,400 --> 00:35:32,319
Speaker 1: about so if I'm going to go get a blood

683
00:35:32,400 --> 00:35:34,120
Speaker 1: draw like I did yesterday, if I figure out is

684
00:35:34,120 --> 00:35:35,719
Speaker 1: it cheaper to do it over in this town or

685
00:35:35,719 --> 00:35:38,680
Speaker 1: in this town or over here, I'm getting into blood

686
00:35:38,719 --> 00:35:44,439
Speaker 1: draw and they're gonna analyze exactly causing a kid or huge.

687
00:35:44,480 --> 00:35:46,600
Speaker 1: I actually sat in on us on a webinar the

688
00:35:46,600 --> 00:35:50,760
Speaker 1: other day where, uh, you know, the four big carriers

689
00:35:50,760 --> 00:35:53,360
Speaker 1: are no big secret. It's United Healthcare, Signa, Etna, and

690
00:35:53,400 --> 00:35:55,640
Speaker 1: the Blues Blue Cross, Blue Shield. Well, you could be

691
00:35:55,680 --> 00:35:58,480
Speaker 1: with SIGNA as an example, just picking one, and you

692
00:35:58,480 --> 00:36:00,600
Speaker 1: could have SIGNA is your is your provider, and you

693
00:36:00,680 --> 00:36:03,040
Speaker 1: might have six hospitals in your town that you can

694
00:36:03,080 --> 00:36:06,440
Speaker 1: go to with SIGNA. And even in the SIGNA negotiated

695
00:36:06,520 --> 00:36:08,440
Speaker 1: rates for your blood draw or your m R I,

696
00:36:09,000 --> 00:36:12,840
Speaker 1: you might see it's three fifty dollars here and three thousand,

697
00:36:12,880 --> 00:36:15,920
Speaker 1: five hundred over there just for that. Yeah, even within

698
00:36:16,480 --> 00:36:19,080
Speaker 1: one carrier network, when I was shopping around for trying

699
00:36:19,120 --> 00:36:21,680
Speaker 1: to get my whatever, they're gonna scan me to see

700
00:36:21,680 --> 00:36:25,759
Speaker 1: if I had any tumors or whatever. Uh, that's the same,

701
00:36:25,800 --> 00:36:28,080
Speaker 1: the same hospital network, just different towns. It was four

702
00:36:28,680 --> 00:36:30,680
Speaker 1: cheaper to drive over to this other town and get

703
00:36:30,680 --> 00:36:32,359
Speaker 1: it done. That's crazy. Was gonna pay for it myself

704
00:36:32,360 --> 00:36:34,640
Speaker 1: because insurance was gonna cover yet, so I cared, and

705
00:36:34,640 --> 00:36:36,520
Speaker 1: so I looked into it. And if you really if

706
00:36:36,560 --> 00:36:38,600
Speaker 1: I really looked into it. They would tell me, but

707
00:36:38,640 --> 00:36:41,600
Speaker 1: it was four in dollars cheaper just to drive fifteen miles.

708
00:36:42,320 --> 00:36:46,319
Speaker 1: And that's actually when there's certain things like doctor office visits,

709
00:36:46,360 --> 00:36:48,560
Speaker 1: they don't very much, they might vary twenty or thirty percent.

710
00:36:48,640 --> 00:36:50,200
Speaker 1: But when you get to like m R Eyes and

711
00:36:50,239 --> 00:36:52,479
Speaker 1: some of these high tech imaging things, they can vary

712
00:36:52,480 --> 00:36:56,560
Speaker 1: by a tenfold factor. It's crazy, it's it's truly. I

713
00:36:56,560 --> 00:36:58,520
Speaker 1: would like to get off on a tangent for how

714
00:36:58,520 --> 00:37:04,319
Speaker 1: that can be. I mean, well, why does anybody not gouge? Yeah, well,

715
00:37:04,400 --> 00:37:07,839
Speaker 1: that gets down to bargaining power of that hospital with

716
00:37:07,880 --> 00:37:12,280
Speaker 1: respect to that carrier. So like in you know, um,

717
00:37:12,560 --> 00:37:17,200
Speaker 1: certain geographic areas. Uh, well, Northern California is a good example.

718
00:37:17,200 --> 00:37:19,360
Speaker 1: If you compare northern and southern California. I think it

719
00:37:19,360 --> 00:37:24,280
Speaker 1: would surprise you to know healthcare is cheaper in Southern

720
00:37:24,320 --> 00:37:27,000
Speaker 1: California on average. And you say, well, why is that?

721
00:37:27,760 --> 00:37:30,760
Speaker 1: It's simply supply and demand down there. You have more

722
00:37:30,960 --> 00:37:34,160
Speaker 1: doctors and facilities per capita there than you have in

723
00:37:34,200 --> 00:37:37,200
Speaker 1: more some of these rural parts of Northern California, so

724
00:37:37,239 --> 00:37:39,759
Speaker 1: you actually pay more for healthcare in Northern California then

725
00:37:39,760 --> 00:37:41,560
Speaker 1: when you get into really you drill down into very

726
00:37:41,560 --> 00:37:45,399
Speaker 1: specific cities, you might find a particular city where one

727
00:37:45,480 --> 00:37:49,560
Speaker 1: health chain dominates, right, and that health chain, like, if

728
00:37:49,600 --> 00:37:51,920
Speaker 1: you don't have that health chain, that hospital chain in

729
00:37:51,960 --> 00:37:55,239
Speaker 1: your network, you're gonna suffer as an insurer. So you

730
00:37:55,719 --> 00:37:58,239
Speaker 1: put up with the fact that they build quite a

731
00:37:58,239 --> 00:38:00,319
Speaker 1: bit more for them. M m R I there R I,

732
00:38:00,440 --> 00:38:06,000
Speaker 1: then company b S m R I. Yeah. So how

733
00:38:06,040 --> 00:38:08,680
Speaker 1: how likely do you think this can actually happen? That's

734
00:38:08,800 --> 00:38:13,040
Speaker 1: this Trump administration effort to get some transparency and and

735
00:38:13,040 --> 00:38:15,400
Speaker 1: what's the opposition going to look like? Yeah, I think

736
00:38:15,600 --> 00:38:18,320
Speaker 1: who's opposed to it? Why? How would Yeah, who's opposed

737
00:38:18,360 --> 00:38:22,080
Speaker 1: to it? Um? It's it's really I think the first

738
00:38:22,120 --> 00:38:24,319
Speaker 1: time I've seen in my twenty year career in this

739
00:38:24,360 --> 00:38:30,160
Speaker 1: field that UM, you actually have powerful politicians, in this case,

740
00:38:30,200 --> 00:38:33,160
Speaker 1: the president and an administrative agency, not a politician per

741
00:38:33,160 --> 00:38:36,120
Speaker 1: se at the at the HHS level, but the the

742
00:38:36,200 --> 00:38:41,640
Speaker 1: regulatory body doing this. It's for the because essentially both

743
00:38:41,680 --> 00:38:44,560
Speaker 1: parties have not wanted to touch this because, as we've

744
00:38:44,560 --> 00:38:50,360
Speaker 1: talked about again before, UM, healthcare is the U. S

745
00:38:50,400 --> 00:38:53,439
Speaker 1: economy approaching the U S economy, and it's the second

746
00:38:53,560 --> 00:38:56,920
Speaker 1: or third lobbying group in the world. And there are

747
00:38:57,200 --> 00:38:59,919
Speaker 1: very very powerful people in both of our political party

748
00:39:00,040 --> 00:39:02,920
Speaker 1: that get a lot of money through healthcare packs. And

749
00:39:03,000 --> 00:39:06,000
Speaker 1: so this is not when you have an oligopoly. When

750
00:39:06,000 --> 00:39:09,200
Speaker 1: you have an inefficient market that's benefiting the large insurers

751
00:39:09,200 --> 00:39:12,960
Speaker 1: and the hospitals, they don't want this price transparency out

752
00:39:13,000 --> 00:39:17,040
Speaker 1: there because the more individuals start to shop based on price,

753
00:39:17,360 --> 00:39:20,919
Speaker 1: the more you get the unleashing of the free market system,

754
00:39:21,120 --> 00:39:24,600
Speaker 1: prices will be driven down. So I think we've got

755
00:39:24,680 --> 00:39:27,680
Speaker 1: the best chance we've ever had at this kind of transparency.

756
00:39:27,920 --> 00:39:32,080
Speaker 1: First of all, Um, I think this regulation may not pass,

757
00:39:32,200 --> 00:39:34,400
Speaker 1: or it may pass and then get immediately challenged in

758
00:39:34,440 --> 00:39:37,480
Speaker 1: the courts and get killed. But I think it's incredibly

759
00:39:37,520 --> 00:39:40,760
Speaker 1: good and of just a wonderful sign that we're talking

760
00:39:40,800 --> 00:39:43,480
Speaker 1: about it and it's out there and somebody actually did it.

761
00:39:43,960 --> 00:39:46,440
Speaker 1: Because it's it's at least in my industry, it's getting

762
00:39:46,480 --> 00:39:48,400
Speaker 1: noise now I know it's really not making although I

763
00:39:48,400 --> 00:39:50,360
Speaker 1: did see the New York Times and NPR follow up

764
00:39:50,360 --> 00:39:53,480
Speaker 1: on the Wall Street Journal, quick quick question, what do

765
00:39:53,480 --> 00:39:56,160
Speaker 1: you mean it might it might not pass because it's

766
00:39:56,160 --> 00:39:59,240
Speaker 1: a regulation, Well, it's a proposed regulation, So I shouldn't

767
00:39:59,280 --> 00:40:01,880
Speaker 1: say passed, they might not draft it as such. So

768
00:40:02,200 --> 00:40:04,640
Speaker 1: they proposed some language, they proposed a bunch of questions

769
00:40:04,680 --> 00:40:07,600
Speaker 1: about should this be transparent, should that be transparent? How

770
00:40:07,600 --> 00:40:10,040
Speaker 1: should we display these prices? What would be the best

771
00:40:10,040 --> 00:40:11,960
Speaker 1: way to do it? And then they said we reserve

772
00:40:12,040 --> 00:40:14,080
Speaker 1: the right to issue our final decision on this on

773
00:40:14,160 --> 00:40:16,680
Speaker 1: May three, and so so there's probably a lot of

774
00:40:16,719 --> 00:40:18,960
Speaker 1: behind the scenes pressure being implied. And so whether or

775
00:40:19,000 --> 00:40:20,520
Speaker 1: not they have the guts to fight it off or not,

776
00:40:20,560 --> 00:40:23,560
Speaker 1: I suppose tons of it. There's there's there's absolutely no

777
00:40:23,600 --> 00:40:26,200
Speaker 1: doubt there's a third whether or not that's actually going

778
00:40:26,200 --> 00:40:28,080
Speaker 1: to be a regulation, A third or fourth I forget

779
00:40:28,080 --> 00:40:29,920
Speaker 1: which so one of the other. So that's coming up,

780
00:40:30,000 --> 00:40:32,160
Speaker 1: that's coming up. Yeah, So if if if it turns

781
00:40:32,160 --> 00:40:34,120
Speaker 1: out May third, you you bring it up on the

782
00:40:34,160 --> 00:40:37,200
Speaker 1: website and it's it's now a regulation, um, which is

783
00:40:37,239 --> 00:40:39,320
Speaker 1: like a law. As we were talking about, it immediately

784
00:40:39,320 --> 00:40:44,399
Speaker 1: gets challenged by numerous large, powerful entities, and uh call

785
00:40:44,480 --> 00:40:47,439
Speaker 1: that illegal for me knowing what the price of something is, well,

786
00:40:47,719 --> 00:40:51,480
Speaker 1: its interfering in a private contract, Jack, there are I'm

787
00:40:51,520 --> 00:40:55,359
Speaker 1: a lover of liberty. That's right there. There are, there is.

788
00:40:55,520 --> 00:41:01,120
Speaker 1: There definitely is a libertarian aversion to saying the government

789
00:41:01,520 --> 00:41:04,480
Speaker 1: must make you disclose something that's in a private contract

790
00:41:04,520 --> 00:41:06,920
Speaker 1: between an insurance company and a hospital. Yeah, but if

791
00:41:06,920 --> 00:41:10,040
Speaker 1: there's a cartel exactly that I mean, that's why I

792
00:41:10,160 --> 00:41:12,120
Speaker 1: that's why I added the whole addendum to my article

793
00:41:12,200 --> 00:41:14,360
Speaker 1: on Look, this is not the way I would normally

794
00:41:14,360 --> 00:41:17,080
Speaker 1: go about solving this problem. But I work in this market,

795
00:41:17,120 --> 00:41:19,000
Speaker 1: I live in this world. I see what healthcare pricing

796
00:41:19,080 --> 00:41:22,400
Speaker 1: is doing to employers and individuals, and we have an oligopoly.

797
00:41:22,680 --> 00:41:25,359
Speaker 1: People aren't afraid to say that word out loud enough.

798
00:41:25,680 --> 00:41:27,799
Speaker 1: We have an oligopoly. We have a broken market. And

799
00:41:27,800 --> 00:41:29,799
Speaker 1: when you have a broken market, that is one of

800
00:41:29,800 --> 00:41:32,520
Speaker 1: the legitimate tenants of government to step in and put

801
00:41:32,600 --> 00:41:36,720
Speaker 1: rules in place to open up transparency and unbreak the market,

802
00:41:36,800 --> 00:41:40,640
Speaker 1: for lack of a better word. But so I'm trying

803
00:41:40,640 --> 00:41:42,839
Speaker 1: to think politically. I don't know if they'll it'll ever

804
00:41:42,880 --> 00:41:44,960
Speaker 1: reach them, if they'll ever understand it enough or to

805
00:41:45,000 --> 00:41:46,800
Speaker 1: lover hit the campaign traw, but it seems like the

806
00:41:46,880 --> 00:41:50,120
Speaker 1: sort of thing that Trump's for and Elizabeth Warren would

807
00:41:50,160 --> 00:41:53,120
Speaker 1: be for. Yeah, I think that's right. I think that's right.

808
00:41:53,160 --> 00:41:56,120
Speaker 1: I think you're going nobody. Well, let's look at the

809
00:41:56,520 --> 00:41:59,719
Speaker 1: you're right, and actually you name any of the candidates.

810
00:41:59,760 --> 00:42:04,040
Speaker 1: Can you picture a candidate offering up an argument against it?

811
00:42:05,000 --> 00:42:07,600
Speaker 1: Tell what that's possibly Rand Paul if he wants to

812
00:42:07,640 --> 00:42:11,160
Speaker 1: be super libertarians stay out of you know, business constitu

813
00:42:11,440 --> 00:42:13,120
Speaker 1: Here is at the end of the stage with this

814
00:42:13,960 --> 00:42:20,200
Speaker 1: ugly curly hair. It's um they okay, uh. This this

815
00:42:20,280 --> 00:42:24,319
Speaker 1: regulation is similar to not exactly actually quite different, but

816
00:42:24,360 --> 00:42:27,399
Speaker 1: it's similar to another regulation the Trump administration set forth

817
00:42:27,400 --> 00:42:29,879
Speaker 1: back in December that wanted to do the same thing

818
00:42:29,920 --> 00:42:32,880
Speaker 1: with respect to r X pricing drugs. And you know,

819
00:42:32,880 --> 00:42:36,680
Speaker 1: on its surface, that looks great, but I actually Tim

820
00:42:36,680 --> 00:42:39,239
Speaker 1: Sanderford wrote an article. Tim the lawyer, our friend from

821
00:42:39,280 --> 00:42:43,719
Speaker 1: the Goldwater Institute, one of the nation's leading young constitutional scholars.

822
00:42:43,719 --> 00:42:47,600
Speaker 1: He wrote an opinion based upon that regulation that Goldwater

823
00:42:47,680 --> 00:42:51,120
Speaker 1: does not support transparency in this case A because they

824
00:42:51,160 --> 00:42:55,400
Speaker 1: believe it's unconstitutional and be because it would be horribly

825
00:42:55,480 --> 00:42:59,480
Speaker 1: misleading and it would actually create more confusion. And I

826
00:42:59,560 --> 00:43:02,279
Speaker 1: agree with that because of the fact that drugs are

827
00:43:02,320 --> 00:43:06,200
Speaker 1: done so differently with rebates that you really really can

828
00:43:06,280 --> 00:43:08,439
Speaker 1: hide the p and something that's written in that world

829
00:43:08,520 --> 00:43:11,279
Speaker 1: has to be done so specifically that otherwise you will

830
00:43:11,320 --> 00:43:14,799
Speaker 1: make a bigger mess. Okay, interesting the P P E

831
00:43:14,880 --> 00:43:20,120
Speaker 1: A or pe both? Stop it? Thinking back to Joseph,

832
00:43:20,120 --> 00:43:23,759
Speaker 1: a second kind of follow his logic, hide the p

833
00:43:24,080 --> 00:43:27,080
Speaker 1: Is that a P E A? Or is that? What's that?

834
00:43:27,280 --> 00:43:29,000
Speaker 1: What's the origin of that phrase? I don't think I

835
00:43:29,040 --> 00:43:34,480
Speaker 1: know that phrase? Is that the princess card Monty? I

836
00:43:34,480 --> 00:43:36,960
Speaker 1: thought it was the princess laying upon the mattress. She

837
00:43:37,080 --> 00:43:39,320
Speaker 1: was so delicate she could feel well, she could feel

838
00:43:39,320 --> 00:43:41,560
Speaker 1: the pe read that book just last night to my children.

839
00:43:42,120 --> 00:43:44,160
Speaker 1: Is that the princess? And I don't think that's where

840
00:43:44,200 --> 00:43:45,680
Speaker 1: the hide the pea came from? The or maybe it did.

841
00:43:45,680 --> 00:43:48,400
Speaker 1: I don't know. Maybe I'm familiar with hide the salami,

842
00:43:48,480 --> 00:43:54,080
Speaker 1: but that's a completely different well. Um, Actually, wasn't the

843
00:43:56,440 --> 00:43:58,600
Speaker 1: Wasn't the the actual point of the princess in the

844
00:43:58,640 --> 00:44:01,040
Speaker 1: Peace story? Isn't it? The pit of the way most

845
00:44:01,080 --> 00:44:04,960
Speaker 1: people take it? I remember he marries her because she's

846
00:44:05,000 --> 00:44:07,360
Speaker 1: so delicate and fair that she could feel the p

847
00:44:07,520 --> 00:44:09,759
Speaker 1: even when they're under all those mattresses, which to me

848
00:44:09,920 --> 00:44:17,600
Speaker 1: makes her a crazy person's freight. That's exactly it. I

849
00:44:17,600 --> 00:44:19,919
Speaker 1: could swear I read at some point that the point

850
00:44:19,960 --> 00:44:23,080
Speaker 1: of the original story was the opposite of it. Maybe

851
00:44:23,080 --> 00:44:25,480
Speaker 1: it's changed through Yeah, I can't remember, so I shouldn't

852
00:44:25,520 --> 00:44:26,759
Speaker 1: have brought it up. So I don't know where the

853
00:44:26,760 --> 00:44:31,360
Speaker 1: origin is. Obviously, unless idea what he's talking about. Anyway

854
00:44:31,400 --> 00:44:32,680
Speaker 1: back to it. It It will become a low it will

855
00:44:32,680 --> 00:44:35,560
Speaker 1: become a regulation. But who will challenge it. Elizabeth Warren

856
00:44:35,560 --> 00:44:37,160
Speaker 1: and Trump could be on the same side of this,

857
00:44:37,239 --> 00:44:38,880
Speaker 1: and all the candidates they could be. I think I

858
00:44:38,880 --> 00:44:40,920
Speaker 1: think you're going to see more of the mainstream of

859
00:44:40,960 --> 00:44:43,200
Speaker 1: both parties be the ones that come out against it,

860
00:44:43,440 --> 00:44:45,920
Speaker 1: and they'll make arguments around the fact that it was

861
00:44:45,960 --> 00:44:48,160
Speaker 1: poorly drafted and it can be done. They'll they'll do

862
00:44:48,239 --> 00:44:51,400
Speaker 1: the perfect is the enemy of good argument that works

863
00:44:51,440 --> 00:44:55,759
Speaker 1: so drives me crazy. That happens with any attempt at

864
00:44:55,760 --> 00:44:59,319
Speaker 1: tax reform is the perfect good to we better just

865
00:44:59,400 --> 00:45:02,279
Speaker 1: leave it cry And if I have, if I have

866
00:45:02,480 --> 00:45:05,400
Speaker 1: a bone of contention with my my fellow libertarian brothers

867
00:45:05,400 --> 00:45:07,800
Speaker 1: that I love so much, it is that the perfect

868
00:45:07,880 --> 00:45:10,640
Speaker 1: is the enemy of good argument really becomes blocking in

869
00:45:10,680 --> 00:45:13,040
Speaker 1: the libertarian world more often than i'd like to see,

870
00:45:14,200 --> 00:45:16,000
Speaker 1: and you know, it's funny you get this from some

871
00:45:16,080 --> 00:45:20,200
Speaker 1: of our friends, and you get it from AOC mocking incrementalism,

872
00:45:21,000 --> 00:45:25,520
Speaker 1: you know, mocking the small measure, the steps closer, the look.

873
00:45:25,680 --> 00:45:28,719
Speaker 1: That's all you get. So it's really all there is.

874
00:45:29,200 --> 00:45:32,800
Speaker 1: And on this regulation, it may very well be unconstitutional,

875
00:45:33,000 --> 00:45:35,600
Speaker 1: right it. Maybe I can see how it would be. Unfortunately,

876
00:45:36,000 --> 00:45:39,719
Speaker 1: it's too too far outside the scope of the original law. Pass. No, no,

877
00:45:39,840 --> 00:45:41,560
Speaker 1: not not for that reason. I think just because you're

878
00:45:41,600 --> 00:45:45,120
Speaker 1: you're you're getting into private contract unnecessarily without having proven

879
00:45:45,120 --> 00:45:49,400
Speaker 1: there's an oligopoly beforehand, etcetera. There needs to be some

880
00:45:49,440 --> 00:45:51,120
Speaker 1: set up. I think a little bit more for you

881
00:45:51,200 --> 00:45:54,000
Speaker 1: freaking laws where you gotta tell me how many calories

882
00:45:54,000 --> 00:45:55,839
Speaker 1: are in my hamburg or that you have to buy

883
00:45:55,880 --> 00:45:58,600
Speaker 1: private health insurance. Right, I mean, at least it could

884
00:45:58,640 --> 00:46:00,080
Speaker 1: go to the Supreme Court, and I would admit it

885
00:46:00,080 --> 00:46:02,839
Speaker 1: that it could lose. But I'm not even on this one.

886
00:46:03,320 --> 00:46:06,600
Speaker 1: I would leave the constitutional issue to my friend Tim Sander,

887
00:46:06,680 --> 00:46:08,840
Speaker 1: for who knows the Constitution much better than I. I

888
00:46:08,840 --> 00:46:12,240
Speaker 1: don't even care. I'm coming at this from a tactician saying,

889
00:46:12,680 --> 00:46:15,240
Speaker 1: past the regulation, let's fight about it in court and lose,

890
00:46:15,320 --> 00:46:17,360
Speaker 1: but let's at least get the issue out there. I

891
00:46:17,840 --> 00:46:19,799
Speaker 1: could see that too. That's the only thing I care

892
00:46:19,840 --> 00:46:21,960
Speaker 1: about is getting us out there. That's a good point.

893
00:46:22,760 --> 00:46:24,800
Speaker 1: I don't That's why I hate to say it. I

894
00:46:25,120 --> 00:46:27,719
Speaker 1: don't care. I don't want to say that. But one

895
00:46:27,800 --> 00:46:29,960
Speaker 1: might be inclined to say I don't care and care

896
00:46:30,000 --> 00:46:40,120
Speaker 1: about the podcast. Time on the podcast doesn't go ahead

897
00:46:40,160 --> 00:46:44,360
Speaker 1: and done for um, because let it go through the courts,

898
00:46:44,400 --> 00:46:46,600
Speaker 1: let it get all kinds of media, and then meantime,

899
00:46:46,680 --> 00:46:49,440
Speaker 1: let Congress write laws saying you know what, transparency is

900
00:46:49,440 --> 00:46:52,040
Speaker 1: a good idea. Let's let's get ao C together with

901
00:46:52,160 --> 00:46:53,839
Speaker 1: Ran Paul and write this thing so that it can

902
00:46:53,880 --> 00:46:59,080
Speaker 1: be done. Because the only thing, guys, I truly when

903
00:46:59,120 --> 00:47:01,320
Speaker 1: when we talk about how care, the two biggest problems

904
00:47:01,360 --> 00:47:04,080
Speaker 1: we've had for nearly a hundred years in America is

905
00:47:04,200 --> 00:47:06,040
Speaker 1: we don't know the price and we don't care. That

906
00:47:06,120 --> 00:47:08,680
Speaker 1: don't care is getting fixed as the prices go this high.

907
00:47:08,840 --> 00:47:13,160
Speaker 1: I know that's perverted encounter before it's getting fixed. The

908
00:47:13,280 --> 00:47:15,719
Speaker 1: don't know the price is the only thing that has

909
00:47:15,760 --> 00:47:18,319
Speaker 1: a chance of keeping us from going to single pay

910
00:47:18,320 --> 00:47:21,239
Speaker 1: all healthcare. It's the only thing, the only It's like

911
00:47:21,320 --> 00:47:23,400
Speaker 1: the only thing that could defeat the Soviet Union was

912
00:47:23,400 --> 00:47:25,400
Speaker 1: blue jeans and a free market. The same thing is

913
00:47:25,440 --> 00:47:28,160
Speaker 1: true with health care. We need transparency. We have to

914
00:47:28,239 --> 00:47:30,960
Speaker 1: know what this price is and guess what. And this

915
00:47:31,080 --> 00:47:33,160
Speaker 1: I wrote about this on my in my article, and

916
00:47:33,160 --> 00:47:34,920
Speaker 1: I noticed Jack kind of skipped over it when he

917
00:47:34,920 --> 00:47:38,000
Speaker 1: was quoting for him from it because it is controversial. Well,

918
00:47:38,920 --> 00:47:40,880
Speaker 1: I would say, the next thing you do, if you

919
00:47:40,920 --> 00:47:43,680
Speaker 1: can get this transparency, is you change all of our

920
00:47:43,719 --> 00:47:46,279
Speaker 1: insurance plans. You put in something like a ten thous

921
00:47:46,440 --> 00:47:49,760
Speaker 1: dollar deductible for all of us. But then you also

922
00:47:49,840 --> 00:47:53,120
Speaker 1: have employers maybe give you five thousand dollars cash in

923
00:47:53,200 --> 00:47:56,239
Speaker 1: a health savings or a health reimbursement account. That's your money.

924
00:47:56,239 --> 00:47:58,759
Speaker 1: That can be a chance to spend the money and

925
00:47:58,760 --> 00:48:01,160
Speaker 1: realize what it costs. Just so you so you have

926
00:48:01,200 --> 00:48:03,200
Speaker 1: a ten thousand dollar deductible, but we're gonna give you

927
00:48:03,239 --> 00:48:05,520
Speaker 1: the first five that's all going to be tax deductible.

928
00:48:06,040 --> 00:48:08,799
Speaker 1: And now you are consuming your health care and you

929
00:48:08,840 --> 00:48:11,000
Speaker 1: have an incentive to save because any of that five

930
00:48:11,040 --> 00:48:13,520
Speaker 1: that you don't spend rolls over year year year, and

931
00:48:13,560 --> 00:48:16,200
Speaker 1: the employer benefits because you're not gonna blow through that

932
00:48:16,239 --> 00:48:19,040
Speaker 1: five girl, and the employer benefits because you're not buying

933
00:48:19,040 --> 00:48:21,520
Speaker 1: a policy that's a ten dollar co pay. You're buying

934
00:48:21,520 --> 00:48:24,200
Speaker 1: the policy that doesn't even start until you've spent ten cames.

935
00:48:24,200 --> 00:48:26,000
Speaker 1: I'm sorry, I should have finished the thought. You're not

936
00:48:26,000 --> 00:48:28,400
Speaker 1: going to blow through the five girl and then start

937
00:48:28,440 --> 00:48:30,839
Speaker 1: getting into the place where they are paying. That's right.

938
00:48:31,360 --> 00:48:33,839
Speaker 1: We already have plans like this in place, but they

939
00:48:33,880 --> 00:48:37,840
Speaker 1: don't work as well as they could because the transparency sucks.

940
00:48:37,880 --> 00:48:40,400
Speaker 1: You know, you know. The problem often gets down to

941
00:48:40,400 --> 00:48:43,279
Speaker 1: how stupid people are are uninformed. I can't. I find

942
00:48:43,280 --> 00:48:44,880
Speaker 1: it hard to believe that people are stupider than they

943
00:48:44,960 --> 00:48:46,319
Speaker 1: used to be. Is there any reason to think that

944
00:48:47,600 --> 00:48:55,440
Speaker 1: the lower Yeah, we can make a list, Well, I

945
00:48:55,600 --> 00:48:57,440
Speaker 1: just mean brain power. I think the brain power is

946
00:48:57,480 --> 00:49:00,200
Speaker 1: the same, but like the knowledge, because it's similar to

947
00:49:00,239 --> 00:49:04,040
Speaker 1: the thing about Well there, he's the idioccuracy argument. The

948
00:49:04,080 --> 00:49:07,200
Speaker 1: smartest people are having fewer children, people are having more

949
00:49:07,600 --> 00:49:11,279
Speaker 1: easily answered. Your question is yes, that's easily quantifiable. That

950
00:49:11,400 --> 00:49:14,320
Speaker 1: is true. Well you just said damn. But it reminds

951
00:49:14,320 --> 00:49:17,480
Speaker 1: me of the argument there on the whole Uh, people's

952
00:49:17,520 --> 00:49:20,120
Speaker 1: tax refunds are smaller, so they think their taxes went up.

953
00:49:20,560 --> 00:49:23,799
Speaker 1: I'm right, So it's all about the tax refund on

954
00:49:23,840 --> 00:49:25,839
Speaker 1: the health insurance. For so long, it's been about what's

955
00:49:25,840 --> 00:49:28,200
Speaker 1: my copay or or my or my monthly and they

956
00:49:28,280 --> 00:49:31,319
Speaker 1: know how my paycheck is stagnating and my deductibles ten

957
00:49:31,360 --> 00:49:34,200
Speaker 1: thousand dollars. But I'm not smart enough to know that, right.

958
00:49:34,800 --> 00:49:37,160
Speaker 1: And that's that's what makes this argument really hard, is

959
00:49:37,200 --> 00:49:39,279
Speaker 1: because I would say the right the right way you

960
00:49:39,320 --> 00:49:41,680
Speaker 1: do fix this is you put in some sort of

961
00:49:41,719 --> 00:49:43,799
Speaker 1: Cadillac tacks. I know it sounds horrible to hear me

962
00:49:43,840 --> 00:49:46,320
Speaker 1: say that, but you also then make it the norm

963
00:49:46,400 --> 00:49:48,960
Speaker 1: that we have like ten thousand dollar deductibles with five

964
00:49:48,960 --> 00:49:51,200
Speaker 1: thousand dollar pots of money we spend on the front end,

965
00:49:51,480 --> 00:49:54,279
Speaker 1: because the vast majority of families do not spend five

966
00:49:54,280 --> 00:49:56,560
Speaker 1: thousand dollars on healthcare in a given year. Of course,

967
00:49:56,600 --> 00:49:58,920
Speaker 1: the top ten percent do, but you know, they'll have

968
00:49:59,000 --> 00:50:01,280
Speaker 1: insurance over the top, and they'll learn to be consumers

969
00:50:01,280 --> 00:50:04,319
Speaker 1: on all the low end stuff. And that's what that's

970
00:50:04,360 --> 00:50:07,400
Speaker 1: the one arrow I see in the quiver against this

971
00:50:07,560 --> 00:50:11,279
Speaker 1: march towards socialism. We have in everything, but in healthcare too.

972
00:50:11,280 --> 00:50:16,279
Speaker 1: Of course, interesting big stuff and we'll know in May

973
00:50:16,680 --> 00:50:19,319
Speaker 1: May three or fourth, although then it could be tied

974
00:50:19,400 --> 00:50:21,359
Speaker 1: up in the courts for quite some time. It will

975
00:50:21,440 --> 00:50:25,239
Speaker 1: be it's on the radar screen. Yeah. My final question, uh,

976
00:50:25,719 --> 00:50:30,239
Speaker 1: what what is the most common mistake amateur bass fisherman make?

977
00:50:31,080 --> 00:50:33,960
Speaker 1: Since you're an expert bass fisherman, do you do you

978
00:50:34,239 --> 00:50:37,440
Speaker 1: refer to yourself as a professional bass fisherman or semi professional?

979
00:50:38,040 --> 00:50:40,439
Speaker 1: You could say semi professional. Yeah, I at one point

980
00:50:40,480 --> 00:50:42,960
Speaker 1: in time I had had sponsors. I had like eleven

981
00:50:43,120 --> 00:50:48,319
Speaker 1: or twelve different sponsors and professional. Sure. The problem is

982
00:50:48,400 --> 00:50:51,120
Speaker 1: time wise, I only now have a couple sponsors, and

983
00:50:51,160 --> 00:50:53,719
Speaker 1: I don't do it for profit anymore. But I did

984
00:50:53,760 --> 00:50:55,800
Speaker 1: at one point in my life, and and I'm very

985
00:50:55,920 --> 00:50:58,440
Speaker 1: you know, not only have I fished in those tournaments,

986
00:50:58,480 --> 00:51:01,000
Speaker 1: but you know I was the host in the m

987
00:51:01,040 --> 00:51:02,960
Speaker 1: C of a TV show for a couple of years.

988
00:51:03,840 --> 00:51:06,239
Speaker 1: I've written many articles in that world. At Number one

989
00:51:06,280 --> 00:51:11,319
Speaker 1: mistake ruin the day, Well, he yanked him into outer

990
00:51:11,400 --> 00:51:19,120
Speaker 1: space by their face. Number one mistake all fishermen make. Um,

991
00:51:19,200 --> 00:51:22,000
Speaker 1: certainly bass, but I think all is moving too fast.

992
00:51:22,719 --> 00:51:26,080
Speaker 1: So when it's leaving the ya, you mean leaving the

993
00:51:26,120 --> 00:51:29,480
Speaker 1: location too faster? Moving your body, moving the bait or

994
00:51:29,520 --> 00:51:32,759
Speaker 1: the lure to Okay, yeah, it's uh. One of the

995
00:51:32,880 --> 00:51:34,759
Speaker 1: one of the wonderful old timers that taught me how

996
00:51:34,760 --> 00:51:36,960
Speaker 1: to bass fish. Joe was diving into the voice. There

997
00:51:37,280 --> 00:51:39,400
Speaker 1: was was a gentleman by the name of John Gray.

998
00:51:39,480 --> 00:51:42,320
Speaker 1: He still lives up on Trinity Lake up in northern California.

999
00:51:42,360 --> 00:51:44,680
Speaker 1: He came from Maine, and he would describe himself as

1000
00:51:44,719 --> 00:51:47,279
Speaker 1: an old main Yankee and I think he smoked about

1001
00:51:47,320 --> 00:51:50,440
Speaker 1: seven packs of cigarettes a day and just a super

1002
00:51:50,440 --> 00:51:54,600
Speaker 1: great character. But he would say, when the fishings too slow,

1003
00:51:55,120 --> 00:51:57,840
Speaker 1: you gotta slow down, slow down. And then when you

1004
00:51:57,880 --> 00:52:00,879
Speaker 1: think you're moving too slow, low at the f down

1005
00:52:00,960 --> 00:52:04,799
Speaker 1: some more. There you go. And so that that is

1006
00:52:04,840 --> 00:52:08,279
Speaker 1: a number one thing I see people just moving their

1007
00:52:08,320 --> 00:52:11,160
Speaker 1: baits too quickly for the water. Yeah, there's a little

1008
00:52:11,200 --> 00:52:12,880
Speaker 1: tip for you. I wish you had more respect for

1009
00:52:12,880 --> 00:52:19,520
Speaker 1: the Constitution, but that's a pretty good tip, right, Greig

1010
00:52:19,600 --> 00:52:22,400
Speaker 1: got Wall's fabulous Gregg, Thanks dude, Thank you, guys man.

1011
00:52:22,440 --> 00:52:25,360
Speaker 1: I appreciate it. Extra large