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Episode 2038 Transcript:

00;00;01;14 - 00;00;05;15

Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;21 - 00;00;23;19

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across USA. Here on the HIA Radio Network, you can find out more about us by going to our website. AmericasHealthcareAdvocate.com. And all of these shows are posted on 15 podcast platforms. You name it, we're probably on it.

00;00;23;19 - 00;00;45;16

Cary Hall

From Spotify to SoundCloud to Odyssey, we're on every podcast platform we think that is out there, basically. And these shows are all posted on our YouTube platform. America's Healthcare Advocate. My producers, Mr. Dave Thiessen behind the cameras, the man who puts all of this stuff together gets it on the podcast platforms set up on our YouTube platform.

00;00;45;18 - 00;01;08;19

Cary Hall

And Darren Wilhite behind the microphones here in the Audacy Studios. So if you are looking for health insurance, you're looking for Medicare or a Medicare supplement plan. Your chronologically challenged anywhere in the country. 877-385-2224. Give the lovely Carolee Steele a call over st RPS Benefits by Design. She is an expert and will be happy to help you.

00;01;08;20 - 00;01;28;15

Cary Hall

I've sent I don't know how many people of this last couple of months, and she's taken care of everybody and done a wonderful job, and I get a lot of feedback on her. Also, if you're an employer and you're looking for a solution, because if you're a small business owner right now, you're getting hammered and we know it. Give Maria Ahlers at RPS Benefits by Design a call.

00;01;28;19 - 00;01;57;11

Cary Hall

She has plans that are available through her brokerage that are not available from some of the major carriers. So if you want to explore some options, you don't even know about, that could make a huge difference for you in cost and coverage. Call Maria Ahlers at 877-385-2224. I want to take this time to announce we're back on the air in Wichita beginning February 1st of next year.

00;01;57;17 - 00;02;17;14

Cary Hall

We will be back on KNSS. It's an Audacy station. We were there for probably ten years before we went off the air down there, and we had an office down there at one time, but we're back, and I'm very happy to announce that we have five other radio stations in Kansas. We're going to be dialing up in February, and I'll be talking about that in in time to come.

00;02;17;17 - 00;02;41;20

Cary Hall

So today's show is one that, I think needed to be done. And there are probably a lot of people are not going to like some of the things I'm going to say, but it needs to be said, and I want to talk about the murder, the murder of Brian Thompson, the CEO of United Health Care. And I want to talk about where we're at in this country with what we're thinking and what we're doing, and how we're acting out on those thoughts.

00;02;41;20 - 00;03;01;04

Cary Hall

And then I'm going to talk about the actual problem that people are experiencing because they are experiencing problems with coverage, with cost, with care being denied, with care being delayed. And I'm going to go through all of that, and I'm going to explain to you why that is happening. You might be surprised what you're about to learn. So let's start off with this.

00;03;01;04 - 00;03;27;13

Cary Hall

This is out of the Wall Street Journal's review and outlook from December 7th. America's social media culture is often debased, but it reached a new low this week with the online jubilation over the murder of UnitedHealthCare CEO Brian Thompson. The moral perversity is a sign of the ugly times, all the more so because it targets private insurers for problems largely caused by the government.

00;03;27;15 - 00;03;47;23

Cary Hall

And that's what I'm going to show you today, chapter and verse, as to why that is actually the biggest part of the problem we deal with. And before I go there, let me just give you an idea. Out of the 385 million people in this country, how many of them are covered under government mandated programs? So let's go through those numbers.

00;03;47;25 - 00;04;16;06

Cary Hall

Medicare Advantage 32.8 million. Actually, Medicare Advantage plans have more people on them than original Medicare. Now, the first time that has happened in the history of the plans, but 32.8 million people on Medicare Advantage plans, ACA or Obamacare, as a lot of people call it, 16.3 million people on Obamacare, Medicaid. And this one will knock your socks off.

00;04;16;13 - 00;04;53;19

Cary Hall

92 million people on Medicaid. Medicaid exploded during Covid because the Biden administration opened it up to people in very different income brackets. And now you have 92 million people on Medicaid. That's a total of 141 million people on plans that this federal government controls. And I'll explain that as we go through the program. The unidentified shooter's motive still isn't known, but he may have dropped the hint when he used the words denied, defend and depose on his bullet casings.

00;04;53;21 - 00;05;30;18

Cary Hall

The mantra was popularized by trial lawyers suing private insurers for denying claims more than a decade ago. Social media mobs are exploiting the tragedy and proclaiming that Thompson had it coming, and people wonder why we want these executives dead, said former Washington Post columnist Taylor Lorenz on Blue Sky, a left wing social media site. People are very justified in their hatred towards the insurance CEOs because these executives are responsible for the unfathomable amount of death and suffering as someone against death and suffering,

00;05;30;18 - 00;05;43;29

Cary Hall

I think it's good to call this out and it's a broken system and the power to enable it for people to correct it by the actions that were taken by this young man in New York City, it's sad.

00;05;44;05 - 00;05;58;00

Cary Hall

It's sad that she would write something like that, and I'll read some other things as we go through the show today, there's a CBS commentator that absolutely agrees with that. It is quite remarkable how it's gotten in the media. We realize the facts and the reasons don't matter.

00;05;58;06 - 00;06;21;16

Cary Hall

When the political culture descends into Lord of the flies. If you haven't read the book, you probably should. But fixing a system is really the goal. How about looking at Washington? Private health insurance in America is far from perfect, but the insurance industry problems sparking an outcry owed mainly to government policies that distort the markets and force rationed care.

00;06;21;18 - 00;06;51;04

Cary Hall

And I'm going to give you some examples of that so that you understand that, okay? Because that's really the crux of the problem here. And I've always said this, and I'll continue to make this point the way you control cost in government run health insurance plans is you control access, you control access to specialty care, you control access to certain doctors, you control access to places that that, are out that that you don't want people to have easy access to.

00;06;51;04 - 00;07;26;22

Cary Hall

Let's put it that way. Specialty. Specialty, surgical centers, etc., etc.. The article goes on to say, start with the reality that Medicare and Medicaid, two government programs, cover about 36% of Americans, both paid doctors and hospitals below the cost of providing care. As a result, many providers won't see Medicaid patients, resulting in delayed care. A 2023 audit of California's Medicaid program found that 43% of appointments for urgent care, urgent psychiatric care for children exceeded the Medicaid standard for the state of California.

00;07;26;22 - 00;07;48;22

Cary Hall

That gives you some idea. This is just some idea of the things that we're talking about. Okay, we're going to go on in 2019, a meta analysis of state Medicaid program audit by Yale researchers found that low income patients were 3.3 times less likely to get an appointment to see a specialist than someone with private health care. Why is that?

00;07;48;23 - 00;08;09;13

Cary Hall

I'm going to go right back to what I said, because Medicaid reimburses below the actual cost of care, below the cost of care. You got 92 million people on Medicaid and Medicaid and reimburses. But so what do the doctors in the hospitals do? We're not accepting Medicaid patients. They're not mandated to take them. So we're not accept them.

00;08;09;13 - 00;08;43;25

Cary Hall

So it squeezes down the number of providers willing to see Medicaid patients. And then it causes big delays. And in some cases, people simply don't get care. The article goes on to say Medicaid patients in 2022 study by Yale doctors found that Medicaid patients had significantly less access to the highest performing cancer centers. That would be centers like MD Anderson, that would be centers like Sloan Kettering, that would be centers like Jefferson Memorial Hospital in, in in in, Philadelphia, Pennsylvania.

00;08;43;27 - 00;09;13;07

Cary Hall

That should give you some idea, but that's what's happening. Those are direct effects of government health care and what it does patients with fee for service Medicare can see most providers, though it is also losing doctors amid paltry payments. Providers compensate for the low reimbursement by increasing charges to private insurance. As an example, this this kerfuffle over the, anesthesiologists at Blue Cross and Blue Shield Anthem got into.

00;09;13;10 - 00;09;45;04

Cary Hall

So what happens in private insurance is private insurance reimburses at a level that is far greater than what Medicaid or Medicare or Medicare does. And the reason is, as an example of anesthesiology, anesthesiologists are billing 330% of what Medicare allows 330% of what Medicare allows. Think about that for a minute. Okay? If you wonder why, okay, providers are getting out of these programs for Medicaid, Medicare, etc., it's for those reasons right there.

00;09;45;04 - 00;10;03;07

Cary Hall

And they make it up on the private insurance side. But I come back to the break. We'll talk more about this, and I'll finish going through the rest of this article, which I think you're going to find fascinating. Stay tuned. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. We'll be right back after this.

00;10;03;09 - 00;10;33;10

Steve Kuker

The golden rule treat others as you want to be treated. I'm Steve Kuker and this is one of the founding principles of my firm, Senior Care Consulting. Since 2002, our value statement has included. Honor our mother and father. Respect our elders. Care for those in need. And treat your family as our own. We've been honored to help hundreds of families make one of the most difficult decisions they could ever make.

00;10;33;15 - 00;11;04;26

Steve Kuker

Serving them in their greatest time of need. If you're looking for someone who can provide you experienced and objective guidance when searching for a senior care community, reach out today and discover the services of Senior Care Consulting at 913-945-2800. Know your options and choose with care at SeniorCareConsulting.com.

00;11;09;11 - 00;11;27;09

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA here on the HIA Radio Network. If you want to comment on this show, and I'm sure I'm going to get a lot of them, but go to the website, AmericasHealthcareAdvocate.com. Send me an email. I'll be happy to read what you have to say, or even have a discussion with you.

00;11;27;14 - 00;11;51;15

Cary Hall

So the topic today is why are we killing CEOs from health insurance companies? After the death of Brian Thompson, the CEO of United Health Care, on the sidewalk in New York City. And that's what I'm talking about today. I'm talking about people. Yes, people have huge frustration with health insurance carriers, and frustrations with care, frustrations with cost and frustrations with access to care.

00;11;51;20 - 00;12;09;10

Cary Hall

But the key to understanding that is understanding the role that government has played in this. When I get into the third segment, I'm really going to talk about what happened once we passed Obamacare and where that got us. And I'm going to lay out the facts, okay. It's one thing to have an opinion. It's something else to back it up with facts.

00;12;09;14 - 00;12;34;23

Cary Hall

So let's go through how this works with the carriers and with the government programs. So Medicaid and Medicare, which represent 36% of the people in this country that are insured by ACA or whatever the case may be, Medicaid, as I said, reimburses below cost, hence, the reason so many doctors and hospitals and specialty hospitals, as the article said, will not take Medicaid patients.

00;12;35;00 - 00;13;09;02

Cary Hall

Number two, Medicare reimburses at slightly above cost. And then we have private insurance. And what winds up happening is private insurance makes up the difference with the providers for what Medicaid and Medicare does not pay. I gave you an example that they're, billing. Hospital systems are billing 330% above the Medicare reimbursement level for anesthesiology. That's what set off this kerfuffle with Anthem on anesthesiology and how that all worked.

00;13;09;04 - 00;13;35;26

Cary Hall

In addition to that, and this is what goes on in addition to that. Another problem is the Biden administration's effort to starve Medicare Advantage plans, which are administered by private insurers and offer much lower premiums with more benefits than traditional Medicare. As the feds have slashed payments, insurers are requiring prior authorization for more procedures and service. So there is the crux of part of the problem here.

00;13;35;27 - 00;13;59;01

Cary Hall

Okay. And the Biden administration, you're asking yourself why would they be cutting these programs? Well, they don't like Medicare Advantage. They've never liked it. They liked it a lot less after President Bush got done, adding in, prescription drug coverage and changing the guidelines on Medicare whenever he passed the bills that caused that. So what they've done is tried to choke it off.

00;13;59;01 - 00;14;18;16

Cary Hall

The problem is it's not working. Okay. You got 32.8 million people that are on Medicare Advantage plans that are not on original Medicare, and they do not like that. They being the federal government, which would love to have total control over this whole thing and wish these plans would go away, but they're too deeply embedded in the American culture now.

00;14;18;16 - 00;14;41;28

Cary Hall

So what do we do? We squeeze them. We cut the reimbursement levels both to the carriers and to the providers. Okay. So when you saw changes in your Medicare Advantage plan this year, you have the federal government to thank for that, okay. Because they control that. Okay. That's what you need to understand. And to illustrate this even more, if you're wondering why carriers are suffering for this, I'll give you a classic example.

00;14;42;01 - 00;15;00;20

Cary Hall

Kansas City, the Blue Cross and Blue Shield of Kansas City, which has been here for 80 some years. Okay, was a pioneer in the Medicare Advantage field, one of the first Medicare, one of the first health insurance carriers to get certified for Medicare Advantage and did a wonderful job. Guess what happened last year? They canceled the program.

00;15;00;20 - 00;15;25;23

Cary Hall

They're out. They're out. And they tried for five years to turn around the cost versus what they were charging, and they could not do it. They were completely upside down. So they bailed. And here's what happens. The smaller carriers, the regional Blue Cross plans, not the big Anthem's, not UnitedHealthCare, the largest carrier in the country, not Aetna because they have scale, but the smaller plans don't okay.

00;15;25;23 - 00;15;48;03

Cary Hall

And so they eat their lunch trying to, you know, provide the care and make a small profit margin so they can stay in business. So they simply got out of it. It was very difficult for them to do. I had conversations with the C-suite people about this over the last two years, and they finally bailed. And it was because of the interference of government and the lack of reimbursement, which they have consistently reduced.

00;15;48;03 - 00;16;09;29

Cary Hall

Okay. Now what does that do to people that are trying to get access? Well, let me give you some examples. Okay. Typically what happens is hospitals are billing now at 254% above what Medicare covers. All right. So private insurance as I said, is making up the difference here. That's the way this works. All right. And so what happens.

00;16;10;03 - 00;16;30;10

Cary Hall

Well how do we control access. How do we control costs? We control access. So let me give you a couple of examples you'll find interesting. Medicare Part A if you're in the hospital for three days, for three days inpatient and you need to go to a skilled nursing facility, the first 20 days are covered at 100%. Okay.

00;16;30;12 - 00;16;51;24

Cary Hall

Now the next 21 to 100, you pay a co-pay. But here's the real kicker if you're not making progress while you're in that skilled nursing facility, they will send you home. I can give you chapter and verse of clients of mine who've had terminal illnesses, who were in skilled nursing facilities. They didn't have the money to go into a private, skilled nursing facility.

00;16;51;29 - 00;17;12;27

Cary Hall

They had to go into one provided by the government, who literally were sent home and were dying and really needed to still have skilled nursing care. But they were cut off because the federal government did not want to spend the money to keep these people in there. That's what's going on. Let me give you another example. This happened to a friend of mine recently, okay, who came to me because, you know, I've been in this business for 30 some years.

00;17;12;29 - 00;17;26;17

Cary Hall

I got to have ear replacement. You know what they told me, Cary? I said, no, Charles. What did they tell you? He said, they told me I have to do six weeks of physical therapy and I can barely walk. But I got to do physical therapy before they're going to let me have this, let me have this surgery now.

00;17;26;17 - 00;17;46;02

Cary Hall

He had an MRI that showed his hip had deteriorated to a point where it was bone on bone, and it was causing enormous pain. He barely could walk, but he was going to go to six weeks of hell to satisfy a a bureaucratic requirement. Why? So I got to pay for six weeks of physical therapy for something. It's not going to make a nickel's worth the difference.

00;17;46;05 - 00;18;05;21

Cary Hall

Okay. When they could authorize this and get it done, I'll tell you why. Because they're trying to, A, they're slowing the access. And B, if by some miracle you get through six weeks of physical therapy and the physical therapist says, well, you know, you may not need, you may not need to get that replaced, you may have another year or two before you need to do that.

00;18;05;28 - 00;18;25;26

Cary Hall

Then that's exactly what winds up happening, because these people have to report have to report all of this to the government. When you go in to get your annual physical for Medicare and they ask you all those questions, are you safe in your home? Have you fallen down? Yeah, I mean, the list goes on and on. And what the hell business of the government is that?

00;18;25;29 - 00;18;47;27

Cary Hall

Do you drink alcohol? Do you drink coffee? That that all goes back. In case you're wondering where that's going. It's going back to CMS. Okay. It's with that data that they set these kind of parameters that cause these insurance carriers to deny care, delay care, okay, for these kinds of things. And, oh, by the way, if you're a medicaid patient, good luck.

00;18;48;00 - 00;19;10;00

Cary Hall

Good luck finding, that the kind of of treatment that you're going to need, especially if it's specialty surgical treatment, etc.. And here's a little example. If you want to see what it really costs to get medical care in this country, go up to a website for the Oklahoma Surgical Center, look up the price of a hip replacement, look up the price of a knee replacement.

00;19;10;03 - 00;19;35;25

Cary Hall

Look up the price of an elbow replacement. All their surgical prices are posted there. Try to do that with the health care system. Go take a look at Barnes-Jewish and Saint Louis or an HCA hospital, a national for profit hospital chain. Go up and look and see if they publish their prices. They don't, they don't. Now the Trump administration put through the Transparency Act, but unfortunately that's not everybody is not playing by the rules.

00;19;35;26 - 00;19;59;26

Cary Hall

Right. And if you go in and try to ask for the price of one of these procedures, believe me, you're going to have a lot of fun trying to get it because you're not going to get it. They don't release that chargemaster information almost never, unless you walk in, say I'm a cash patient, okay? And then the price is going to go through the roof because they're going to charge you over and above what they charge the carriers over and above the Medicare reimbursement deal.

00;19;59;26 - 00;20;19;07

Cary Hall

And typically it's going to be 3 to 400% higher. That's an example of the problems that we have and why we have them in this country. When I come back from the break, come and dig into this on the Obamacare side and how this all started and how we got here. Now stay tuned. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network.

00;20;19;14 - 00;20;31;00

Cary Hall

Coast to Coast Cross, USA.

00;20;31;03 - 00;21;01;01

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across the USA. My producer, Mister Dave Thiessen is behind the cameras, and Mr. Darren Wilhite behind the microphones here in the Audacy Studios. Today, we are talking about this ongoing discussion we're having in this country, this ongoing, controversy around health insurance carriers and who's responsible for the high cost, the lack of ability to access care, the delays, the denials, all the rest of it.

00;21;01;01 - 00;21;22;13

Cary Hall

That's the topic today that we're talking about. Who's really responsible for that happening? Is it the mean people at these insurance carriers, or is it being caused by the mandates handed down by the federal government through CMS, the centers for Medicaid and Medicare Services and HHS, Health and Human Services? So we're going to delve into that today, because this all started with Obamacare.

00;21;22;15 - 00;21;45;27

Cary Hall

And I'm going to show you that. So here's a piece of information I believe. And you'll see me talk about this again, that the that the real reason for all of this was to push this country into a government run health care system like the UK. Exactly like what they have in the UK. UK if you have, the national health care program there, they pay for everything.

00;21;45;29 - 00;22;11;00

Cary Hall

They also determine what you get. You don't get to go see a specialist or go see a doctor or get another opinion or go to a specialty hospital. They determine how that works. So let me give you some examples of how that works. In the UK, 6 million patients have been waiting 14 weeks for needed care, 6 million patients waiting 14 weeks.

00;22;11;03 - 00;22;35;11

Cary Hall

Sound like anything in this country? Kind of like the VA maybe, How about that? Okay. And I've mentioned many times before, I am a card carrying VA member. I don't use it, but I have it. Okay. In addition to that, 34,000 people have been waiting two years for surgical procedures. So, you know, I keep coming back to this, but I can't make this point enough times to make it clear.

00;22;35;16 - 00;22;57;18

Cary Hall

If you control access, you control cost. Why the hell do you think 6 million people are waiting 14 weeks? Because they're controlling access. Okay, that's what's going on here. And 34,000 people waiting two years. That's because they don't have the ability to get those people in for those procedures in a timely manner, because the system is jammed up.

00;22;57;21 - 00;23;17;19

Cary Hall

Okay. So now we're going to talk about this. Is it this this is I'm going to reference an article. It's called, United Health Care and the Obamacare scam. Written by Alicia Finley. And she is the science and health editor at the Wall Street Journal. She says, well, the progressives are at last acknowledging that Obamacare is a failure.

00;23;17;23 - 00;23;44;13

Cary Hall

They aren't doing so explicitly, of course, but there's social media screeds against insurers triggered by last week's murder of United Health Care CEO Brian Thompson suggests much. We've gotten to a point where health care is so inaccessible and unaffordable, people are justified in their frustration, said CBS news medical contributor Celine Gounder. This is CBS news saying it was justified.

00;23;44;19 - 00;24;05;03

Cary Hall

Are you hearing this? Are you understanding what's going on here? And you think by creating this kind of narrative, you're encouraging these people? My producer Darren Wilhite just told me a lady walked into an office in Florida and said, deny. What did she say? Deny, Oppose, Delay. Like right out of that book and what the shooter put on his bullets.

00;24;05;06 - 00;24;27;04

Cary Hall

That provider actually called the police, and she was arrested because she said, we're coming for you next. This is a narrative that's being created out there. Okay. So, the 44% of Americans say in a Gallup survey found that only 44% of Americans rate health care as good or excellent, down from 62% before Democrats passed Obamacare in 2010.

00;24;27;07 - 00;24;56;29

Cary Hall

A mere 28% of the country's insurance coverage highly rated. An 11 point decline. Obamacare may rank as the biggest political bait and switch in history. Oh, if you like your providers, you can keep them. Well, maybe that depends on whether the provider is willing to take a lower reimbursement level from it ACA plan than he can get from a different plan by another carrier, a private some other private insurance plan that may not be an ACA plan, right?

00;24;57;01 - 00;25;17;29

Cary Hall

You know, if you're wondering why we're seeing this explosion of plans like Christian Medicare, there's your answer right there. Okay? People are sick of this. Small employers are choking. Choking. If you're 1 to 50 in your company, you've got 1 to 50 employees and you're getting renewed. This year, you're renewal rates this year were probably 20, 30, 40%.

00;25;17;29 - 00;25;45;28

Cary Hall

In some cases. That's what's going on. Why? Because those plans are regulated by the government. The health insurance companies have become utilities. That's what I said was going to happen. And that is what's happened. And this article goes on to say that's exactly what's occurred here. Calling this the law has advance their political goal of expanding government control over insurers in return for lavishing Americans with subsidies to buy overpriced, lousy products.

00;25;46;01 - 00;26;08;04

Cary Hall

That's why there's so much appeal on products outside of ACA, because people are sick of this. The costs are high. If you don't get a big fat subsidy and you're trying to pay for this, it's unaffordable $2,300 a month for a husband and wife that are 55 years old under an ACA plan, if they don't get a subsidy, really, that's where we're at, okay?

00;26;08;04 - 00;26;33;21

Cary Hall

And that's the government. That's not the health insurance providers, okay? The health insurance providers are told you're allowed a 20% margin here for everything. That's not profit. That's your brick and mortar. That's your employees, that your employees benefits. That's everything you have to do has to come out of that 20%. If you make more than that, you refund that back to the policyholders and everybody clap their hands.

00;26;33;21 - 00;27;00;07

Cary Hall

When Obamacare pays. We're going to get those insurance companies. They got them right, and now you're paying the price for it. And that's what's causing a lot of this frustration and anger that people have access to these plans. Access to care is controlled through through the bureaucrats that run these programs out of Washington, DC. I'll go on to say, how about this claim people with preexisting conditions would be protected.

00;27;00;09 - 00;27;29;24

Cary Hall

Also not true. A bigger howler was the health insurance would become more affordable. What's happened with health insurance? The cost has gone up consistently across the board. Again, I go back to insurance carriers, it being charged 300 and 400% more on the private insurance side than what CMS or Medicaid is reimbursing at, because they're making up the difference for these plans that they're forced to go forward with.

00;27;29;26 - 00;27;50;10

Cary Hall

And, you know, I mentioned to you earlier in the in the in the show today that a lot of people, a lot of these carriers now are reevaluating whether they're going to stay in certain plans. I had a meeting with another high ranking, executive from a major insurance carrier two weeks ago, and she told me they may be bailing out of the ACA plans.

00;27;50;12 - 00;28;18;07

Cary Hall

I mean, seriously, okay, that's where we're at. This stuff is not working, and it's clogging up the system, and people are getting denied, and they're getting delayed and they're having to deal with it. But what do they hear when they get denied or delayed? The insurance carrier denied you. The insurance carrier delayed the care. No, the insurance carrier is following the government protocol that they must follow, okay, in order to allow you to get access to that care.

00;28;18;10 - 00;28;40;02

Cary Hall

That's why we have these pre certs. That's what this is all about. The pre cert allows them the carrier makes has to go through and lay in the protocol. But CMS and HHS are the ones that set up the criteria for the pre certs. 2 million more. A to 2 trillion more is being spent on health care now than it was in 2010.

00;28;40;07 - 00;29;07;08

Cary Hall

The Paragon Health Institute observes 2 trillion more. We've got work.. 2 trillion more. worse care, less access, less ability to get care in a timely manner. The ability, if you're Medicaid, to find a doctor who will treat you a specialist or hospital that will even take you. And we're spending $2 trillion more. So you tell me, is it working?

00;29;07;11 - 00;29;30;17

Cary Hall

Is it working? Or should we look at going back to a model where the private insurance market is is run in this country, like other things are running this country in a capitalist system and make changes that allow people that have preexisting conditions. There are ways it can be done. This was being done before. There were pools in Kansas, Missouri, Iowa, lots of other areas.

00;29;30;24 - 00;29;59;25

Cary Hall

Those are high risk pools where if you were denied coverage because of preexisting condition, you could go into the state run pool. Were they good health insurance, great health insurance? No, they weren't great, but they were full blown coverage, and they were offered access through the carriers networks. What would happen if the federal government simply came in and said, we're going to put those pools back in place and we're going to reimburse back to the state for any catastrophic illness above X number of dollars.

00;29;59;28 - 00;30;18;10

Cary Hall

You would see those plans start to make sense, that you could get rid of a lot of this nonsense we're dealing with now, but there's no appetite for that in Washington. At least there hasn't been with the current administration. Maybe that'll change. We'll see. We'll see how it all works out as we move forward. Or as President Trump likes to say.

00;30;18;13 - 00;30;42;02

Cary Hall

We'll see, we'll see. We'll see how it works. I'm hoping that Vivek Ramaswamy and, Elon Musk, this is one of the first things they're gonna look into. And fraud and waste that is paid to providers on these plans. Medicare, Medicaid is huge. I've given you the numbers before. It's huge. Okay. If they just start there, you can do a lot to improve this system.

00;30;42;02 - 00;30;54;23

Cary Hall

We'll come back after the break and wrap this up. You're listening to America's Healthcare Advocate broadcasting coast to coast across the USA.

00;30;54;26 - 00;31;17;28

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network coast to coast across USA. All right. So we're going to continue with this theme of you know what what what all of this means with, the shooting of the, and the murder of the, United Healthcare CEO in New York City, which triggered me to do this whole show.

00;31;18;00 - 00;31;40;12

Cary Hall

And I'm going to give you some examples of other things that, you know, we talked about $2 trillion more being spent. Why? So here's an example. Medicaid patients, Medicaid patients, remember, they're 92 million of them use emergency rooms as their primary care physician. In other words, your kid has a cold or you have a fever, or maybe you have a toothache.

00;31;40;13 - 00;32;09;27

Cary Hall

I'm not making any of this up, by the way they go right to the E.R.. E.R. spend on dollars is the least effective spend of of your medical dollars in this country, but is being utilized because the way the system is set up and the access to care that they have. Okay. So and here's another problem. Nearly 100 million Americans on Medicaid are tightly regulated and generously subsidized exchange plans to find doctors treatment.

00;32;09;29 - 00;32;34;00

Cary Hall

Well, there's there it is right there. That's part of the article. It's so tightly regulated and it's so difficult that doctors walk away from the plans. They don't want to deal with it because of the paperwork they have to do and what it. And because of the levels, they get reimbursement back. Obamacare requires plans to cover a myriad of government determined essential benefits, regardless of whether people need them or not.

00;32;34;02 - 00;33;04;19

Cary Hall

It also prohibits insurers from charging higher premiums based on patients health risk factors, and limits their ability to do so. For older people, the young and healthy are thus required to subsidize their elders, and while taxpayers are required to subsidize everyone on the exchanges. So again, I had, a meal with a high ranking, executive at one of the health insurance plans, and she said, you know, we can't get young people on these plans.

00;33;04;24 - 00;33;26;07

Cary Hall

We can't get them on here. I'm like, I'm yeah, I know, I know why you can't get them on because the cost is so high, even with a subsidy. So the design, okay, the design was always that we would put enough young people on the plans to counterbalance the older people. Well, it hasn't worked. That's why. The thing is upside down.

00;33;26;07 - 00;34;07;28

Cary Hall

Here's the other thing, okay? The people that are on these plans are not incentivized to take responsibility for their personal health. That's the reason why mortality rates, in in people that are younger have gone up significantly. The US is spending, as I said, $2 trillion more on health care than in 2010. Yet Americans aren't healthier. As a new paper from Paragon Health Institute observes, mortality rates for 25 to 64 year olds from major medical causes such as hypertension, diseases, diabetes and neurologic conditions climbed between 2009 and 2019 a lot.

00;34;08;00 - 00;34;29;21

Cary Hall

Okay, because none of this is working. This is government mandated health care. And that's the problem. Okay? You when the when the government steps in and decides it's going to tell the insurance carriers how to do their job, this is the result that we got, okay. And it's not going to change. The answer in Washington amongst the progressives okay.

00;34;29;21 - 00;34;50;23

Cary Hall

And I don't do politics, but I'm going to put the fault where it lies. Okay. Amongst the progressives and the Democrat Party and the Republicans that were complicit in this, we wouldn't have Obamacare if it hadn't been for John McCain. He cast the deciding vote in the Senate. And now it's turned into this giant mess. Okay. And the question is, you've got people on these subsidies.

00;34;50;23 - 00;35;20;16

Cary Hall

Well, they're never going to take these subsidies away. So how do you fix this? And the other part is carriers can't screen, okay. For people that are that have major medical issues on these ACA plans, they have to take everybody that walks the door. I remember when the plans came out, an executive at Blue Cross and Blue Shield of Kansas City told me they had 16 heart transplant surgeries in the first month, 16 because no questions asked were taking them across the board.

00;35;20;24 - 00;35;40;08

Cary Hall

That's the way that it worked. So the problem is that you've you've created this monster now. And how do you get it under control? You're not going to lay it out the way it is now. You're going to have to make significant changes in the marketplace to turn this around. One of the solutions put the plans back in the hands of the carriers and get rid of Obamacare.

00;35;40;08 - 00;36;09;03

Cary Hall

Probably will never happen because I've never seen a government program go away. Okay. Once it's in place, especially if it's giving people money. But you could go through and you could change the way it is being run. You can change the underwriting process. So people that didn't take care of themselves, that are type two diabetics, okay, morbidly obese, choose to smoke and eat foods they shouldn't eat, should pay a higher price than somebody who's in good health.

00;36;09;05 - 00;36;27;22

Cary Hall

I'm 75 years old. Okay. And I'm in pretty good health, but I take care of myself. I'm in that gym three times a week. I watch what I eat, right, I get enough sleep, I exercise, okay, these are all things you do. If you're taking responsibility, there is no incentive in the system for anybody to do that.

00;36;27;24 - 00;36;54;17

Cary Hall

That's the problem. Okay. But it's so easy when you're CBS or Taylor Lawrence or any of these other social media clowns, and they are clowns because they run their mouth without understanding what the problem is. You want to talk about this? I'll be happy to invite anybody that wants to have this conversation. Let's talk about the facts. Let's talk about, you know, the government controlling access to for 92 million people on Medicaid.

00;36;54;17 - 00;37;15;10

Cary Hall

Let's talk about trying to squeeze the Medicare Advantage plans down by cutting reimbursements to the hospitals and to the carriers, which is going to end up causing greater delays and denial of care across the board. Like the changes. If you go into a skilled nursing facility, what is somebody supposed to do when their husband is told you have to go home?

00;37;15;10 - 00;37;31;26

Cary Hall

He's not making progress? Well, wait a minute. I don't have the ability to take care of him like that. He needs care. He needs a nurse here. He needs people that can help him. Well, I'm sorry we can't help you. The CMS guidelines says he has to go home because he didn't meet the criteria, showing he was making improvement.

00;37;31;29 - 00;37;51;15

Cary Hall

Or the person needs a hip replacement, knee replacement, whatever the case may be. And they're told, well, you can have it, but but okay, so we're going to go one of two ways people we're going to go into. We're going to get into a system much more like what they have in the UK. But we're going to get into a system in this country that's going to change that.

00;37;51;15 - 00;38;10;06

Cary Hall

It may be Vivek Ramaswamy and Elon Musk have got some solutions to this, but we need solutions. The system isn't working and throwing rocks and killing insurance CEOs is not the answer to the problem. It's look at the problem, analyze the problem and come up with solutions. And now I'm going to leave you with these words of Winston Churchill.

00;38;10;09 - 00;38;26;05

Cary Hall

Private insurance is the worst form of health care except for all the others. Thank you for watching. I'm America's Healthcare Advocate, Cary Hall. Now you know.

00;38;26;08 - 00;38;32;20

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