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Episode 2101 Transcript:

00;00;01;14 - 00;00;05;26

Announcer

And now America's Healthcare Advocate, Cary Hall.

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

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show Broadcasting Coast to coast across the USA. Here on the HIA Radio Network, my producer behind the microphone is Mr. Garner Cowdrey. He is here today in the Cumulus Studios. I am announcing today that we have moved our radio show to Cumulus Radio here in Kansas City.

00;00;25;22 - 00;00;45;22

Cary Hall

95.7 FM / 7:10 AM We're extremely happy to be here in these beautiful studios in this beautiful building. This is where I actually started 16 years ago. It's a little different then, but we're really happy to be here. Dave Thiessen, my producer behind the camera, puts all this together, puts it up on the 15 podcast platforms and on YouTube.

00;00;45;26 - 00;01;03;10

Cary Hall

So welcome to the show. We're happy to have you here. I also want to thank Donna Baker, Bill Ryan and Len Randazzo, the people who actually made the move and got me over here. They did a great job, made all this work very smoothly. Like I said, we're really happy to be here. We also want to welcome our newest affiliate in Topeka, Kansas.

00;01;03;12 - 00;01;24;21

Cary Hall

KMAJ 1440 AM. Very happy to be on the air up there as well. AmericasHealthcareAdvocate.com is the website. If you have a question, comment or email, please go to the website and send us an email. We would be happy to answer it. Also, if you are chronologically challenged or are looking for health insurance, the lovely Carolee Steele RPS Benefits by Design.

00;01;24;21 - 00;01;45;27

Cary Hall

Is happy to help you. 877-385-2224. All right. Today's show is a continuation of that show we did a couple of weeks ago on the murder of Brian Thompson, UnitedHealthcare CEO. And what happened was the Wall Street Journal put out a whole separate article as the follow up on this thing, and it's about two pages, three pages long.

00;01;45;29 - 00;01;57;05

Cary Hall

We're going to go through that today and talk about the things that they are saying that are going on in health care and in studio with me is my dear friend and guest, John Stockton. A little bit about John. Welcome, John.

00;01;57;05 - 00;01;58;14

John Stockton

Thank you Cary, for having me.

00;01;58;14 - 00;02;19;06

Cary Hall

Great to have you up here. John Stockton has 35 years of employee benefits, health insurance experience. John is a health care innovator and a leader that has spent his entire career in leadership and strategy roles. John has a passion around improving the quality and efficiency of health care in the United States. He's also worked extensively with health care systems, creating known product strategies.

00;02;19;07 - 00;02;48;18

Cary Hall

Now, look, the reason I asked John up here was I wanted someone who has been in this industry for a long time. He's actually been at it as long as I have. Okay, who could talk about this from the carrier side where he has been with major carriers and in this country, and can talk about how how all of this fits together and why do we have all these problems and what what is all this frustration that people are experiencing and, and venting towards the health insurance carriers, which has kind of exploded on social media.

00;02;48;19 - 00;03;10;24

Cary Hall

It's quieted down basically on traditional media, but it's it exploded on social media after this with people like Taylor Lorenz and other people, CBS commentators talking about he either deserved it or it's understandable. None of that is correct, but it's important to step behind those comments and look at the facts. So let's start off with this little piece in the Wall Street Journal.

00;03;10;25 - 00;03;31;17

Cary Hall

Actually, it's not very little, but nonetheless, that's where we'll start. So they start off by interviewing a doctor. This is interesting that he's a doctor who left UnitedHealthcare. You could call him kind of a disgruntled employee if you wanted to, but he offers an interesting perspective, which is why we're going to start there. Like most doctors, Nicholas Jones prefers to diagnose patients after examining them.

00;03;31;23 - 00;03;56;21

Cary Hall

When he worked for the UnitedHealthcare Group, the company frequently paired a checklist of potential diagnosis before he ever laid eyes on the patient. UnitedHealthcare only did that with family physicians who were in the Medicare Advantage programs and were recipients of Medicare Advantage. The software wouldn't let him move on to a second patient until he had gone through that particular checklist and did what he was supposed to do.

00;03;56;25 - 00;04;12;05

Cary Hall

Now, John, if I'm not mistaken, didn't you go in for a doctor's visit not so long ago, and you told me you're in there for about 8 or 9 minutes and the doctor turned away from you and while he was talking to you. He was over here typing in on a computer. He was doing exactly what they're talking about here.

00;04;12;05 - 00;04;13;00

Cary Hall

Am I right or wrong?

00;04;13;01 - 00;04;23;07

John Stockton

Absolutely. Yeah. The member experience right now is this the average office visits? Mine was 7 or 8 minutes and half of it. His back was to me. You know, exactly what you described.

00;04;23;07 - 00;04;43;22

Cary Hall

And that's and that that and I'm going to I'm going to go through and explain why they're doing this. They're not they're doing this for a couple of reasons, but most of it is driven by what is required of them, especially with Medicare Advantage. We're going to focus on that today, because that's what this article is about, by what's required of them, by CMS or the Centers for Medicare and Medicaid Services.

00;04;43;22 - 00;05;00;21

Cary Hall

The government, Medicare Advantage system uses private insurance to provide health benefits to seniors, disabled people. And pays companies based on how sick patients are. To cover higher costs of sicker patients in Medicare, it calculates sickness scores from information supplied by the doctors.

00;05;00;22 - 00;05;35;14

Cary Hall

So back to what John just said and what I said. They are supplying information that creates scores. What are these scores? These are the scores that are used okay by Medicare when you when you look at one of these plans and it's a four star score or it's a three star score, or it's this coveted five star, five star score, the that comes right out of this information that these doctors are providing when they're sitting in there, going through their patient portal and, and adding this information that they are required to do by UnitedHealthcare.

00;05;35;16 - 00;05;42;07

Cary Hall

Okay. So they will get higher scores which result in what. Let's go through that.

00;05;42;09 - 00;06;10;26

Cary Hall

So the scores are typically higher than those people that are on traditional Medicare. Yeah they are because on traditional Medicare the doctors are not required to do this is only required to do it on Medicare Advantage plans. All right. The journal's analysis of Medicare data from 2019 to 2022 showed the UnitedHealthcare patients increased 55% on average in their first year, versus a 7% average for Medicare Part A and Part B.

00;06;10;29 - 00;06;48;20

Cary Hall

So that's how this all ties together. All right. This is the system is set up so that in order for the carriers to get paid, all right, in order to earn that star rating that's dictated by UnitedHealth. Excuse me, that's dictated by CMS. They have to go through this process. All right. We'll keep going. All right. A spokesman for UnitedHealthcare said in a written statement that the company's practices lead to more accurate diagnosis and greater ability and greater availability of care and better health outcomes and prevention, including less hospitalization, cancer screenings and better chronic disease management.

00;06;48;23 - 00;06;51;07

Cary Hall

How do you react to that, John?

00;06;51;09 - 00;07;02;20

John Stockton

You know, Cary, it's how our system is aligned and it's it's aligned where the incentives aren't in the right direction. And it's for the wrong reasons.

00;07;02;23 - 00;07;27;13

Cary Hall

Yeah, it is. And so as a result of that, what was what this article and I'll keep going through this because I think it's important to illustrate and understand this. All right. So they go on to say in a series of articles, the journal examined practices of Medicare Advantage companies. Now I want to point something out. What's happening here is is met is these insurance carriers are setting up their own primary care practices.

00;07;27;19 - 00;07;50;24

Cary Hall

They're buying up primary care practices for hospitals doing it too. So let's go through it. UnitedHealthcare has has Optum. That's their in-house their their clinics their their primary care centers. All right. Humana has center well and Blue Cross and Blue Shield of Kansas City has Spira Care. So all of these carriers are doing this now in the Medicare Advantage system.

00;07;50;24 - 00;08;14;01

Cary Hall

Spira Care, by the way, since BlueKC is no longer in the Medicare Advantage business, those but those clinics service everybody. That signs up for a Blue Cross and Blue Shield plan that wants access to them. Let me keep going. And as I said, the series of articles, examines this whole practice. The largest among other things, the article showed that the diagnosis added by insurers increased payments for the government.

00;08;14;04 - 00;08;37;22

Cary Hall

The the killing earlier of this is interesting of Brian Thompson, chief executive of health insurance division, that's triggered the widespread public vetting about some of the practices of health insurers, UnitedHealthcare said that he was neither. I thought this was fascinating. He was neither a UnitedHealthcare patient, client. Neither were his parents. None of his family were involved in UnitedHealthcare.

00;08;37;26 - 00;09;03;01

Cary Hall

Why he chose to go after Brian Thompson. It is only known to him and God. I guess, but nonetheless, it had nothing to do with why he did it. So. But again, and and here's this is where this article is going. UnitedHealthcare is they're saying is being paid more because they're they're doing more of these, test diagnoses, all the rest of it.

00;09;03;03 - 00;09;14;15

Cary Hall

And the big question is, is it really necessary? And this goes back, John, to this star system rating, which you can sit there and you can point the finger at the carrier, but who put the system in place, John?

00;09;14;15 - 00;09;15;05

John Stockton

CMS

00;09;15;06 - 00;09;16;01

Cary Hall

Thank you.

00;09;16;03 - 00;09;37;25

John Stockton

So and you know, think about it, Cary, we spent almost $5 trillion in health care in the US. $5 trillion. And 25% of that is waste. So when you start thinking about the categories of waste, administrative waste is more than a fourth of it. Fraud and abuse is almost 10% of it. Inefficiency is almost 20% of it. It's how our system was designed.

00;09;37;28 - 00;09;46;00

John Stockton

And you know that 25% of waste on 5 trillion would pay the interest on our national debt. It's that significant?

00;09;46;02 - 00;10;08;16

Cary Hall

Yeah. Again. And you know, what I'm trying to do here obviously, is to educate the audience. And you have to understand what the genesis of all this is. When government got into health care. Okay. These are the things this started to happen. I'm only talking today about Medicare Advantage, but we can talk about traditional health insurance. You know, we can go right down the list.

00;10;08;21 - 00;10;23;04

Cary Hall

You know, it doesn't matter. Right. But you know, when you look at where we're at in this system and how we got here, a lot of that has to do with the way the system was designed by the federal government. When they brought these carriers in on these programs. Yes.

00;10;23;04 - 00;10;38;16

John Stockton

Think about it. Our system is based on sick care. It's it's after the fact treating symptoms. It's not necessarily proactive health care. And we do not compare favorably throughout the world with our peer countries in that regard.

00;10;38;18 - 00;11;13;17

Cary Hall

No. And, and, and and this in this system, you are paid for each service that you provide. So the more services the doctors and the hospitals provide, okay, the more they're going to get paid. Now, you can argue that the carriers are gaming the system if you want to look at it that way. But by the same token, if the carriers don't get a four star rating and they only get a three star rating, then you have people that are looking at, well, which carrier CMS says that the carriers that have the highest star rating are the carriers we should be dealing with.

00;11;13;20 - 00;11;17;27

John Stockton

Right. Absolutely. And that drives a lot of fraud and abuse in the process.

00;11;17;27 - 00;11;39;20

Cary Hall

That's correct. So so once again, we find ourselves in a situation where the government is overriding the decisions of of the hospitals and the doctors, and they're dictating what should be done and what shouldn't be done. We'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across USA.

00;11;39;21 - 00;11;41;27

Cary Hall

Stay tuned. We've got more. Don't go anywhere.

00;11;41;29 - 00;12;12;02

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00;12;12;08 - 00;12;48;05

Steve Kuker

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00;12;48;07 - 00;13;23;09

Cary Hall

Welcome back 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 the website AmericasHealthcareAdvocate.com. Also, all these shows are posted on 15 podcast platforms. Compliments of Mister Dave Thiessen on all the work that he does. They are also up on the YouTube platform, and I know that last show that we did on this whole UnitedHealthcare issue and how people are experiencing and reacting to, health insurance here in this country sparked a lot of commentary and got a lot of views.

00;13;23;09 - 00;13;45;16

Cary Hall

Okay. And I'm fine with that. All right. That's why I'm doing this. I'm trying to provoke people to think about this system, okay. Where we are in this system and why we are here. Because it's not the narrative that you're hearing out there. Typically on traditional media. It's not the narrative that's here in this huge, Wall Street Journal piece, which you could say is kind of a hit piece the way they did it.

00;13;45;21 - 00;14;06;18

Cary Hall

But there's some very important information here, which is why we're going through this. So let's get back at it. UnitedHealthcare has acquired dozens of medical groups over the past decade and a half. Its Optum unit now employs 10,000 physicians. Its executive has said, making it one of the nation's largest employers of doctors. It contracts with tens of thousands more.

00;14;06;21 - 00;14;24;29

Cary Hall

No other national carrier has hired, or as many ARD has quite as many doctors. Well, okay, that's kind of an interesting statement sent to the largest carrier in the United States. So nobody else would have as many. But Humana, as I said, they have center. Well, they have their own their own centers, and they also contract with doctors.

00;14;24;29 - 00;14;48;10

Cary Hall

And the blue plans do the same thing. So let's talk about this for a minute, John, because when you and I, I'm a little older than you are. A little. Yeah, a lot older, actually. But you know, but back ten years ago, 15 years ago, even you went to see your private practice physician and he and it was a privately owned primary care physician.

00;14;48;12 - 00;15;09;18

Cary Hall

And that's who you went to see? I don't know of any primary care physicians. And we're in Overland Park, Kansas, here today. We're doing the show. It's where I live is where John lives. All of the Blue Valley, health care. You go down the list of of of of primary care doctors that used to be they're either required by carriers or they're acquired by hospital.

00;15;09;18 - 00;15;11;02

Cary Hall

What's happened?

00;15;11;04 - 00;15;34;04

John Stockton

You know, it's created problems from an access perspective. Because if you think about it, what UnitedHealthcare is doing with Optum or what Humana's doing with Center Well or BlueCross Respir care is those clinicians are captive to those carriers. It's gotten harder to see your primary care physician, and then you can get into the importance of seeing your primary care physician, who's really the quarterback of all of your care.

00;15;34;06 - 00;15;52;16

John Stockton

We all understand why this is happening. You know, there's been a tremendous amount of consolidation in health care with hospital systems and provider systems and whatnot. But this, this issue about health insurance companies acquiring clinicians has created an access issue, in my opinion.

00;15;52;18 - 00;16;14;19

Cary Hall

Yeah. It has. Okay. But let's go on to the second piece, which is kind of interesting. Those higher sickness scores were back. You know, how scores continue to be brought up in this piece and talked about. And I'm back to what I said. All right. The scores are required okay. By CMS, in terms of being able to make the reimbursements, here's what's happened.

00;16;14;27 - 00;16;38;21

Cary Hall

The higher sickness scores triggered about 4.6 billion more in Medicare payments than UnitedHealth UnitedHealthcare would have received if those patients had been in line with the average for the company's Medicare Advantage plan. The system is not primarily taking care of the patient, said Doctor Emily Scott, who worked for UnitedHealthcare, in California. It's how do we get more money?

00;16;38;23 - 00;16;40;10

Cary Hall

How true is that statement, John?

00;16;40;13 - 00;16;54;14

John Stockton

It's, it is what it is. I think it's very true, Cary. And it's it's how our system was designed. It's, this fee for service just opens up a lot of opportunity for fraud and abuse, and that's exactly what you're describing.

00;16;54;21 - 00;17;17;07

Cary Hall

And so the fraud and abuse and and yet and and no one's claiming there's any kind of fraud here by UnitedHealthcare or anybody else. But what, what this article was saying is that UnitedHealthcare is gaming the system to some degree, okay. To drive more, to drive more revenue. UnitedHealthcare would say to that, okay. That they serve this is their commentary about that.

00;17;17;07 - 00;17;41;28

Cary Hall

UnitedHealthcare said it's sickness scores ten trend higher, partly because it plan serves some of the sickest and most vulnerable populations. And it showed under diagnosis under traditional Medicare led to some differences in sickness scores between the two part two parts of the program. So they're basically saying that a traditional Medicare, which is only part A, by the way, and Part B, all right.

00;17;41;29 - 00;18;10;10

Cary Hall

That's how that works. All right. The Medicare Advantage plans offer a larger group of benefits and a different way of doing it. But they're saying basically that their programs are keeping people out of the er, out of the urgent care and are diagnosing cancer and other issues sooner because they're doing all of this, which, which, they're partially required to do, but they're also doing it and they're making $4.6 billion in the process.

00;18;10;12 - 00;18;19;21

John Stockton

And one could argue and I've heard it dozens of times, Cary, we have the sickest patients. Everybody thinks they have the sickest patients. Right. But I don't think the data would necessarily prove that out.

00;18;19;24 - 00;18;39;19

Cary Hall

No, I don't either. And that's that's the whole again, the whole point in doing these is to and doing these kind of broadcasts is to explain to you what's going on behind the scenes. This is the kind of thing that you typically don't see. The average person doesn't see and doesn't understand. And the easy answer is it's all about the insurance carriers.

00;18;39;19 - 00;18;57;22

Cary Hall

No, I guess you could say it's collusion to some degree between the carriers and, and the, you know, and the government. But I'm going to go back to, you know, why they keep saying none of this would have happened if we didn't have government in the middle of these health insurance programs, right or wrong.

00;18;57;23 - 00;19;04;15

John Stockton

No, I agree with you 100%, Cary. And that's what's driving all of our inefficiency relative to our peer countries.

00;19;04;15 - 00;19;14;01

Cary Hall

So so go back to this comment. About $4.6 billion in the back to your comment about we're spending, how much more are we spending on average to the typical country?

00;19;14;01 - 00;19;33;01

John Stockton

No, we have so much institutional arrogance on how well we do in health care. In the United States. We spend 16.5% of our GDP on health care. It's it's nearly $13,000 per capita, the next highest country. We're 41% higher than.

00;19;33;03 - 00;19;33;29

Cary Hall

But we're sicker.

00;19;34;00 - 00;19;48;15

John Stockton

We’re sicker of the of the ten wealthiest countries, we are dead last. So if this system of creating these star ratings truly worked, we wouldn't be spending double our peer countries and we wouldn't be dead last in quality.

00;19;48;20 - 00;20;08;11

Cary Hall

Yeah. But unfortunately, and I think this illustrates all of that. We are we're dead last. The system isn't working again. You know, I hate to be repetitive, but, you know, this is the system that the government designed. We haven't even talked about Obamacare yet, by the way. Okay. And and ACA and all the rest of that.

00;20;08;15 - 00;20;32;05

Cary Hall

That's a whole separate topic, okay. In terms of how it drives the same kind of waste, fraud and abuse that we see here on Medicare. Medicare just happens to be more obvious, I think, when, when, when the Medicare when the Medicare trustees come out at the end of the year and say that there's over 10% waste, fraud and abuse in the entire Medicare system, I think that's something like 2 trillion.

00;20;32;11 - 00;20;47;12

Cary Hall

I can't remember the number. It's an absurd number of dollars that are wasted, because of the waste, fraud and abuse that has nothing to do with how the star system factor into it. Now you add those two components together. No wonder we're number ten.

00;20;47;19 - 00;21;00;28

John Stockton

Yeah, yeah, it's a sobering statistic when you really study it and you ask yourself, what if we spent 16.5% of our economy on health care in our peer countries are spending ten and 11? The impact of that issues profound.

00;21;00;29 - 00;21;19;24

Cary Hall

Yeah. It is it is profound. And it begs the question, how, how do we make this better? How can this be done? How can it be changed? We'll talk about that when we come back from the break in the next segment, we'll talk about, you know, there are a lot of problems here, which obviously I'm pointing out, but we need to talk about how that can change.

00;21;19;24 - 00;21;33;29

Cary Hall

And when I come back to break, that's we're going to do that. And that's one of the reasons why, as John, to be up here today, because he's truly an expert in this field. And I think it's an opportunity for you to hear and learn what we can do to improve the system here in the United States. Stay tuned.

00;21;33;29 - 00;21;53;07

Cary Hall

You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network, coast to coast across the USA. If you've got questions or comments, go to the website.

00;21;53;09 - 00;22;16;14

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across USA here on the HIA Radio Network, in studio with me, my friend and expert in health care, John Stockton. Our topic today we're starting off with this whole UnitedHealthcare issue that's been in the news. There was a big follow up article in the Wall Street Journal, and, on the UnitedHealthcare some people might call an exposé.

00;22;16;14 - 00;22;35;19

Cary Hall

I don't call it that, because they used doctors who were gone from UnitedHealthcare to make their point. And I understand that. Okay. But there's also another side to this story and the and the fact that they're making $4.6 billion more off of the Medicare Advantage plans than they were, you know, years ago by these scores and all the rest.

00;22;35;19 - 00;22;55;20

Cary Hall

But let me point out a couple of things. All right. UnitedHealthcare came back and rebutted that. Here's what they said. Well, we offer additional benefits. Now, let me explain that. So everybody understands that if you're not one of those that's chronologically challenged, and on a Medicare advantage plan. You probably don't know anything about this. But Medicare Advantage plans offer a lot of other benefits that they keep referring to.

00;22;55;25 - 00;23;14;00

Cary Hall

The difference between this and and standard Medicare Part A and Part B, well, under standard Medicare standard Medicare A and B, you don't get home health care, in-home health care if you're disabled or come out of a surgical procedure and you need it, you don't get meals in your home. You don't get gym memberships.

00;23;14;00 - 00;23;25;07

Cary Hall

Thats that Silver Sneakers that all those seasoned citizens where you see them in the gym are probably Silver Sneakers members who don't pay gym memberships. You don't get vision and you don't get dental.

00;23;25;07 - 00;23;41;19

Cary Hall

Oh, you don't get those little cash debit cards that let you go to the drugstore and buy your vitamins and your Band-Aids and all the rest of it. All of that is provided through the Medicare Advantage plans, and is provided by the carriers as incentive to get people to come on their plans.

00;23;41;23 - 00;23;58;12

Cary Hall

By the way, I'm on a Medicare supplement plan. I am not on a Medicare Advantage plan. And there's a reason for that. Okay. But I just want to be clear about this, that not all of that money, that they're making flows back into their pocket, they're adding all these benefits so that they can entice people to get on these plans.

00;23;58;16 - 00;24;22;02

Cary Hall

But this is part of the problem here. All right. So now let's go back to this this commentary about, you know, what we're spending, where we are and and how that compares to. Obviously I've used the UK system a lot in broadcasts like this where I talked about 43,000 people stacked up waiting to get surgical procedures that are waiting two years or longer.

00;24;22;05 - 00;24;41;29

Cary Hall

You know, an average patient is waiting six months to get in or six weeks, six months to get in to see a specialist, depending on what they are. So obviously that system, the system in the UK isn't particularly a working system, but let's talk about systems that where where there is a different way of doing this that is actually working.

00;24;41;29 - 00;25;01;06

John Stockton

John, I think here I think about fragmentation of health care. And I'll share my own personal story when I walk in to see my physician that I've seen for the last 30 years. Every time I walk in there, there's roughly 20 people sitting in a bullpen. They ask me the same question, can I see your ID card?

00;25;01;08 - 00;25;21;21

John Stockton

I literally tell them I don't carry an ID card. It's on my phone. They've tried to photocopy my phone. It's just the most bizarre situation. And then so my primary care physician says, do your labs. I do my labs. Well, now I have a cardiologist. I'm somewhat chronologically challenged as well. So then the cardiologist says, John, I need your labs.

00;25;21;21 - 00;25;50;03

John Stockton

I said, well, I already did my labs in this physicians. You guys work for the same company. Why don't you pull up my labs? And he said, yeah, I can't do that. That's that's our problem. You when you think about fragmentation of health care and the importance of the role of the primary care physician, I listen intently, Cary, to your one of your last podcasts on Bowtie, the role of the primary care physician and the importance of how they quarterback everything that would take out a lot of this inefficiency.

00;25;50;03 - 00;26;00;02

John Stockton

But unfortunately, now we have this shortage of primary care physicians, it's harder to get in to see them. And at the same time, they're dealing with misaligned incentives as well.

00;26;00;04 - 00;26;09;06

Cary Hall

So when I talk to a primary care physician, I've had multiples on this broadcast. And, and Doctor Firouz Daneshgari, who did the Bowtie show.

00;26;09;07 - 00;26;09;19

John Stockton

Outstanding.

00;26;09;19 - 00;26;28;16

Cary Hall

Talk about this. Back to this making money. This is the hospital systems we’re talking about now. They're not the health insurance carriers. All right. The hospital systems want them to see as many patients as they can in a day. Some of these primary care physicians I may be wrong on this, but I don't think I have as many as 10,000 patients assigned to them.

00;26;28;18 - 00;26;52;00

Cary Hall

10,000 patients. Now, I'll give you an example of a system where they don't do that. Centerwell, okay, which is the Humana system. Their docs are treating an average of 4 to 6000 people, annually. That's their whole book. And they have much more time. Spira Care, the Blue Cross and Blue Shield system. I don't know anything about the Optum system, but the spire care system I know very well.

00;26;52;02 - 00;27;18;06

Cary Hall

You know, when you go into sit down with the primary care physician, in Spira Care, you're in there for 30 minutes, 45 minutes. Sometimes it's longer than that. So they have made those changes and they are affecting that. But the flip side of that is this whole issue that we're talking about over here on the Medicare side, and then the hospital systems gobbling up because the primary care practices, because I said, hey, can you name an independent primary care?

00;27;18;06 - 00;27;19;18

John Stockton

And no, no, I can't.

00;27;19;23 - 00;27;35;27

Cary Hall

No, I cannot either. There used to be Blue Valley Medical. I mean, you could down the list over 15 or 20. You know, this Johnson County is the fourth richest county in the United States of America. We had a plethora of primary care doctors. We don't have a plethora of primary care doctors anymore.

00;27;35;27 - 00;27;39;16

John Stockton

And the cost of my office visit went up 30% when they got acquired.

00;27;39;23 - 00;27;41;29

Cary Hall

And what? Yeah. And what did you get for that?

00;27;41;29 - 00;27;46;05

John Stockton

Didn't have a whole lot of choice. I didn't get anything. Of course I got more fragmentation is what I got.

00;27;46;05 - 00;28;05;26

Cary Hall

Yeah. And the system, the system, as you said, you know, it's absurd the way that it works, that you get labs that I had the exact same thing happened to me. Okay. I went and saw a physician at a weight loss clinic because I had I was heading toward type two diabetes, and I was terrified I was going to get it.

00;28;06;04 - 00;28;23;02

Cary Hall

And so I went. I got on a program. I lost about 21 pounds total. And, and, and I have my labs done there. And I went to see my primary care physician. She goes, Cary, I don't have your labs. I said, yeah, they're over. Hartland. You sent me to Hartland, remember. Yeah, but have I don't have access to those.

00;28;23;03 - 00;28;30;27

Cary Hall

I'm like, you're kidding me, right? This is all part of why this isn't working, right? Yeah.

00;28;30;27 - 00;28;46;00

John Stockton

And your physician from Bowtie alluded to medical errors beating the third highest cause of death in the US. Our life expectancy is 31st internationally. I mean, what we're doing is not working. And you just highlighted one of the reasons why.

00;28;46;05 - 00;29;14;05

Cary Hall

So what do you see? I'm I'm praying I really am. I mean that in all sincerity when I say this. I'm praying that this new administration comes in, and that they are going to be able to take a look at this if they do nothing more. And this is, in my humble opinion, if they if Elon Musk and Vivek Ramaswamy, don't do anything else other than come in and get rid of a lot of this waste and fraud that's out there.

00;29;14;08 - 00;29;34;04

Cary Hall

Doctors gaming the system. And I mean doctors, you know, sending in false reports. These are guys that are really stealing from the system, not these situations we're talking about here, where they're driven by what CMS is requiring or HHS. But we've got all this waste and fraud. If they if they start cutting down on that, how do you think that's going to affect this whole thing?

00;29;34;04 - 00;29;35;00

Cary Hall

John.

00;29;35;02 - 00;29;56;15

John Stockton

We start cutting out the fraud that's going to everything will flow downhill from there and we'll get much more efficient. But that affects a lot of areas of our country and our economy and our defense spending and whatnot, and health care is our economy. It's 16.5% of our GDP. We have peer countries the UK, France, Japan, Germany spending 10, 11%.

00;29;56;17 - 00;29;59;29

John Stockton

Think about the fact that we spend 5% more than our peer countries.

00;30;00;00 - 00;30;01;18

Cary Hall

Almost six. Yeah.

00;30;01;20 - 00;30;24;06

Cary Hall

What what could we be doing with that money constructively versus but, you know, what we're doing here, which we're not we're not getting any results. If we if we were spending the money. All right. And you were, you could see people getting healthier and working better, then you would say to yourself, okay, you were spending a lot of money, but, hey, I'm getting something for it.

00;30;24;06 - 00;30;29;28

John Stockton

Yeah. If we had A's and B's on our report card, I don't think we'd be so upset. But we are failing miserably.

00;30;29;29 - 00;30;31;05

Cary Hall

Yeah, that's a great analogy.

00;30;31;06 - 00;30;33;13

John Stockton

I don't think a lot of people realize how bad we are.

00;30;33;18 - 00;30;52;14

Cary Hall

No. And and again, that's the purpose of doing this today. And I'm you know, doing these kinds of shows, whether it was Doctor Daneshgari or whether it was the initial show I did on the UnitedHealthcare or this piece we're examining today and the other topics we're talking about, the idea is you need to understand this system, okay?

00;30;52;14 - 00;31;12;05

Cary Hall

Because if it's going to change, the only way it's going to change is by you getting involved. And that means going to the ballot box and voting for people that are willing to make these changes. And so that comes back to how to all these carriers, okay. And all these hospital systems, have a lot of money tied up in lobbyists.

00;31;12;05 - 00;31;30;18

Cary Hall

I'm going to give you an example. And you're very familiar with this. So Trump's in office and he puts in place a bill that Congress passes and a regulation. It says hospitals have to be 100% transparent in terms of what their chargemaster is. Talk about, what is the Chargemaster? John, this ought to be good.

00;31;30;20 - 00;31;36;10

John Stockton

Is that's a tough one, you know. Yeah. There was some guidance on transparency.

00;31;36;10 - 00;31;36;19

Cary Hall

Yeah.

00;31;36;24 - 00;32;06;27

John Stockton

And, you know, the Chargemaster is pretty much where you start with, with your bill charges and, and then every insurance company negotiates discounts that start off from billed charges. And those discounts vary. You know, for the government purposes, the government setting that the cost of those discounts are are the price of health care. But I go back, Cary, to what what that whole process creates is, you know, the per capita admin in the US is three times any of our peer countries.

00;32;06;29 - 00;32;25;16

John Stockton

So this process we've set up where all these insurance companies have huge departments that spend all their time negotiating prices with health systems. So as a result, we're spending north of $1,000 per capita on admin versus Switzerland or France that are spending $300.

00;32;25;22 - 00;32;43;10

Cary Hall

Okay. Now, I hope this is starting to you know, everybody's trying to understand this, right? This is the big picture. We come back to the break. We'll continue with this topic and we'll talk about what the solutions could be. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA.

00;32;43;11 - 00;32;50;17

Cary Hall

Stay right here. We'll be right back after the break.

00;32;50;19 - 00;33;10;14

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across the USA. My producer's, Mr. Garner Calgary. He is the man behind the microphones here at the Cumulus Studios, our new flagship station here in Kansas City. 95.7 FM, 710 AM, and Dave Thiessen behind the camera, doing the excellent job that he always does.

00;33;10;19 - 00;33;28;10

Cary Hall

If you want to reach out to us, feel free to do so. Go to the website. AmericasHealthcareAdvocate.com. All the shows are posted on 15 podcast platforms. If they're out there, we're probably on it. And also on YouTube. All right. So let's go back to this. So, you know, we were on the break there.

00;33;28;10 - 00;33;48;13

Cary Hall

We talked a little bit about what role do we play in this system in terms of being accountable for our own behavior? I'm going to use myself as an example. I battled weight, for I don't know how many years, five, six last seven years. And I never had a problem. And then all of a sudden I started getting heavier.

00;33;48;16 - 00;34;05;17

Cary Hall

And I knew I had an issue. I went to my primary care doctor, and I said, I don't know what to do here. You know, I'm not sure how to manage this. I I'm headed toward type two diabetes. Terrified me. All right. I'm like, you know, I've been a gym rat. Yeah, ever since the military. All right.

00;34;05;21 - 00;34;24;20

Cary Hall

So I'm like, what? What the hell's going on? She sent me to a place called Heartland Weight Loss here in Kansas City in Overland Park. They did a great job. I had a nurse practitioner set out for me. They put me on metformin, for. I was on it for probably about four months, and it. I changed my eating habits.

00;34;24;20 - 00;34;37;08

Cary Hall

All right. I did some things that important. I cut back on my alcohol intake. I added more time in the gym. And I started changing the way that I eat. I've dropped 21 pounds. I'm putting on clothes that I haven't worn for ten years.

00;34;37;12 - 00;34;38;09

John Stockton

Know you're fighting weight care.

00;34;38;09 - 00;34;43;19

Cary Hall

I know I sleep, I put on, I'm down to 229, I haven’t been 229 since I was probably 45 years old.

00;34;43;19 - 00;34;44;08

John Stockton

Congratulations.

00;34;44;14 - 00;34;50;23

Cary Hall

The point is, I had to make some changes. Well, in this country, people don't want to get off their ass and make changes. John.

00;34;50;27 - 00;35;15;25

John Stockton

So, Cary, in 1985, there wasn't one state in the US of A that had obesity rates north of 20%. Now, today, there's not one state below 20%. And and your your change. You went in and changed lifestyle. You were accountable. This is the thing employers struggle with is, you know, how can we attack the 20 drive in the 80.

00;35;16;02 - 00;35;22;06

John Stockton

There is so much obesity out there. And it's and it's not getting better. It's getting significantly worse. Is that data shares.

00;35;22;11 - 00;35;40;17

Cary Hall

So what do you think's going to happen now. You've got you've got three people that I think are going to have a huge impact on this. Musk, Vivek Ramaswamy. And Robert Kennedy Jr. And Robert Kennedy Jr is hellbent on processed foods and changing the way we eat in this country. What do you think's going to happen with this?

00;35;40;20 - 00;36;01;17

John Stockton

You know what? What I hope happens, you know, we were just, our family was in Italy. And when when you eat in Italy or any of our peer countries versus what we eat here, it's just massive differences in the quality of food we eat. There's things that are allowed here in the USA that are not allowed in Europe.

00;36;01;19 - 00;36;24;29

John Stockton

Like those are the things. Skittles. You know, all this food coloring. You know what you see with the blue, red, yellow, green food coloring isn't allowed in Europe. Pasta is very different in Europe. Wine is very different in Europe. So I'm hoping what this new administration does is comes in and just makes our food, let's get healthy again, because right now our obesity rates are going in the wrong direction globally.

00;36;25;02 - 00;36;27;10

Cary Hall

So but how many Five Guys do they have in Italy?

00;36;27;16 - 00;36;29;18

John Stockton

Oh yeah. Not a one.

00;36;29;21 - 00;36;44;10

Cary Hall

By the way, if you don't know what Five Guys is, if you're somewhere in the country, if you have In-N-Out burger, it's the same thing. Okay. Or if you have Whataburger. It's the same thing. My point in that is that we eat that kind of food, not let's get straight here. I love In-N-Out burger.

00;36;44;12 - 00;36;55;07

Cary Hall

You know, I love a “double double” animal-style any day of the week that I'm in California or Las Vegas, and I happen to love Five Guys, but I eat it once every couple months, maybe, and that's it. Okay.

00;36;55;08 - 00;37;07;12

John Stockton

And what I noticed, Cary, the habits are very different. We drive everywhere. How many people go to the gym and exercise versus, you know, and a lot of our peer countries, these guys walk everywhere they go and they eat very differently than we eat.

00;37;07;13 - 00;37;16;01

Cary Hall

So what does that mean? You say, are you you and I talked about Italy extensively because Laurie and I are very much looking forward to going. The food difference.

00;37;16;04 - 00;37;26;20

John Stockton

I think it gets back to a lot of the additives when people go to the grocery store, they're just buying for that day and it's fresh. They're not loading up on a week of groceries. It's like we do here in the US.

00;37;26;27 - 00;37;29;04

Cary Hall

They're not going to Costco and getting to bring home.

00;37;29;07 - 00;37;38;19

John Stockton

No, everything's fresh and and they get a tremendous amount of activity that we typically do not get. And I think that's why our obesity rates are doing what they're doing.

00;37;38;24 - 00;38;12;23

Cary Hall

One of the things that I've talked about in past broadcasts on this show about eating habits is when you go to the grocery store, go to the perimeter of the grocery store, go to the produce section, go to the meat section, go to the seafood section, go to the dairy section. Those are the places that you buy your food, not up and down the aisle with what's in cans and boxes and and that's something I started to do a year ago was looking like, for instance, my wife told me the other day we were having oysters with some fresh oysters and we were going to.

00;38;12;23 - 00;38;33;02

Cary Hall

She said, get this particular cocktail sauce over at Whole Paycheck, Whole Foods. I'm sorry I call them Whole Paycheck sometimes because it's a little expensive. But she said, get the one that's called three, six, five. It's there. She said. It doesn't have any corn sirup in it. I said, you cocktail. The cocktail sauce that we've been buying has. Yes, it's corn sirup.

00;38;33;02 - 00;38;34;06

John Stockton

Which is terrible. Yeah.

00;38;34;09 - 00;38;46;14

Cary Hall

So look at any soft drink you drink. I'll bet you it's unless you're drinking zero, Dr Pepper or zero Coca-Cola or whatever Pepsi is, it's going to have corn sirup in it. Right.

00;38;46;14 - 00;39;06;01

John Stockton

Which gets back to sugar. And we consume more sugar than our peer countries as well. And I think some of the things you're getting at, Cary, is, is the fact that we need accountability. Yeah. And and is the primary care physician one of the roles in doing that for us to to make sure we're getting our activity and we're eating right, etc..

00;39;06;01 - 00;39;12;03

John Stockton

You've made some massive changes and it shows, but the general population is going in the exact opposite direction.

00;39;12;06 - 00;39;25;12

Cary Hall

Yeah. And if we're really going to affect change in this country, then then you're going to have to make those kinds of changes. They're going to make a difference or this is going to continue to keep going the way it's going. Yeah. And that's really what we're saying, isn't it.

00;39;25;15 - 00;39;33;23

John Stockton

And people taking accountability for their own actions and and having some peer support and doing that's extremely important.

00;39;33;26 - 00;39;53;28

Cary Hall

So here's here's where we're going with this. Just so you understand how does all this tie together. Here's what I'm saying. Or is the government responsible for a lot of this. You betcha. Okay. With the health insurance companies, the way they've incentivized them, the way they've structured these systems. You betcha. Okay. Are they are they

00;39;54;01 - 00;40;13;27

Cary Hall

Yeah. So there are issues here where the carriers are responsible and governments responsible. I just went through that for two shows. How about you? How about you? Where are you responsible. And that's what that's what John's talked about. Doctor Tracy Stevens, the chief cardiologist to Saint Luke's Health Care, has come on this show with me probably 30 times.

00;40;13;29 - 00;40;36;04

Cary Hall

And she's always talked about the fact that you have to take responsibility for your health care. Well, guess what? We don't now, there needs to be changes. Big changes in government and big changes by the carriers. It has to be brought on. Hopefully this new administration will do it. But there also has to be change. Like John just talked about as a result of what we are doing as individuals in this country.

00;40;36;07 - 00;40;55;11

Cary Hall

And unfortunately, we like to take the easy way out. We don't we don't do the things that we need to do. We eat a ton of process foods that we shouldn't eat. Okay. And we we have a diet and a lot of people don't exercise and didn't exercise are huge. And obesity in this country is an epidemic in children as well as adults.

00;40;55;13 - 00;40;58;25

Cary Hall

I hope all of this has made sense to you today. Thank you, John for coming in.

00;40;58;25 - 00;41;00;19

John Stockton

It's a great time of year to make some change.

00;41;00;19 - 00;41;21;18

Cary Hall

It is a great time of year to make some changes, hoping that you do that. And we're hoping that what we see come in with this new administration will do the same thing. Thank you for listening to America's Healthcare Advocate. And now I leave you with this thought from Doctor Martin Luther King. Americans must learn to live together as brothers and sisters, or we will surely perish together as fools.

00;41;21;21 - 00;41;36;08

Cary Hall

Truer words were never spoken. Thank you for listening to America's Healthcare Advocate show. Broadcasting coast to coast across USA. Goodbye, America.

00;41;36;11 - 00;41;40;24

Cary Hall