WEBVTT 00:02.610 --> 00:08.970 This is the human action podcast where we debunk the economic political and even cultural myths of the days 00:08.970 --> 00:11.890 Here's your host dr. 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You go to a mises.org slash human action 24 00:56.290 --> 00:57.630 Okay, let's get into the interview 00:58.370 --> 01:00.470 Well, Keith welcome to the human action podcast 01:01.230 --> 01:03.690 Thanks for having me. It's always fun to talk to you 01:04.230 --> 01:05.070 Yeah, likewise 01:06.090 --> 01:08.030 So I think so on these episodes 01:08.590 --> 01:11.230 Keith dr. Smith on these on this episode 01:11.230 --> 01:14.570 We don't do or this podcast I should say we don't do a pre-record introduction 01:14.570 --> 01:17.710 So I I'm not going to be able to give the listeners who don't know who you are 01:17.710 --> 01:20.290 An explanation of who you are other surgery center of Oklahoma 01:20.290 --> 01:22.410 And especially because it's so relevant 01:23.130 --> 01:24.850 To what we're going to be talking about 01:24.850 --> 01:29.170 Can you just explain and don't be shy like go ahead and you know 01:29.170 --> 01:31.390 Feel free to take some time just to explain 01:31.390 --> 01:35.610 What it is that you guys do, you know, what your your particular specialty is 01:35.610 --> 01:37.690 And also maybe just give some real world examples 01:37.690 --> 01:40.750 So people understand like when you are able to deliver 01:41.450 --> 01:44.590 Procedures at a lower price like what kind of savings we're talking about 01:45.810 --> 01:53.270 Sure. Um, so I'm I'm Keith Smith. I'm an anesthesiologist. I have a full-time anesthesia practice 01:54.030 --> 01:58.070 Uh, I started my private practice in 1990 01:59.010 --> 02:03.110 Um here in Oklahoma City and it did not take long 02:03.510 --> 02:05.290 For me to realize that 02:06.670 --> 02:10.890 That the medical practice that I'd hoped for was not 02:11.410 --> 02:14.650 Not really uh coming coming to fruition 02:15.370 --> 02:17.210 It became very clear 02:17.930 --> 02:20.330 That it was extremely difficult 02:21.110 --> 02:26.790 Uh to to do to take care of patients without the interference of 02:26.790 --> 02:31.930 Many outside factors government included it also became very clear 02:32.490 --> 02:35.690 That hospitals were not my friend 02:35.690 --> 02:39.370 They weren't any physicians friend and that the physicians really 02:39.730 --> 02:41.890 Were pretty disenfranchised 02:42.650 --> 02:43.190 um 02:43.470 --> 02:45.030 In 1992 02:45.530 --> 02:47.290 George Bush the elder 02:47.850 --> 02:50.750 Uh decided to inflict 02:50.750 --> 02:58.630 A tool on the industry called the resource-based relative value scale, which really unmasked 02:58.630 --> 03:02.430 Uh the complete uh control over the industry 03:03.190 --> 03:06.750 For which the government had lusted for so long 03:07.230 --> 03:15.070 But essentially in collusion with some economists at Harvard they decided they could place a price 03:15.730 --> 03:19.250 On every single service provided by a physician 03:19.950 --> 03:25.210 Um and the rumors of this you know obvious to the audience on your show 03:25.650 --> 03:29.610 So they got them all wrong. Uh, they got a lot of them. Um 03:30.030 --> 03:31.770 There were too too high 03:32.730 --> 03:35.550 And so there was a proliferation of 03:36.010 --> 03:42.390 In abundance of availability of procedures for which medicare decided to overpay 03:43.060 --> 03:46.790 And likewise, um, no mystery. There was a shortage 03:47.720 --> 03:51.010 Of a lot of procedures that were underpaid 03:51.010 --> 03:57.150 An anesthesia of cardiac anesthesia in particular my specialty being one of them 03:57.820 --> 03:58.250 so 03:59.220 --> 04:02.770 physician fees felt drastically at this time 04:03.480 --> 04:05.070 Just to give an example 04:06.360 --> 04:08.610 As a cardiac anesthesiologist 04:08.610 --> 04:14.390 I was paid $1,100 for the service I provided for an open heart surgery 04:14.850 --> 04:17.170 From 1990 until 92 04:17.590 --> 04:21.530 In 92 with resource-based relative value scale 04:22.290 --> 04:25.250 Infliction number one that that was cut in half 04:25.910 --> 04:27.850 So I was paid $550 04:28.910 --> 04:30.670 After that not satisfied 04:31.390 --> 04:33.390 That the cuts had been drastic enough 04:34.010 --> 04:34.870 The government 04:35.430 --> 04:37.790 And I believe this was under the clinton regime 04:38.610 --> 04:39.930 inflicted part two 04:41.070 --> 04:45.810 So the last open heart surgery for which I provided anesthesia service 04:45.810 --> 04:47.670 I was paid less than $300 04:48.450 --> 04:53.790 The last medicare beneficiary I provided anesthesia to for knee replacement 04:54.390 --> 04:55.930 I was paid $78 04:56.930 --> 05:01.270 And I'd become familiar with the mesis institute and 05:01.850 --> 05:07.570 You know romp all and had done enough reading about economics at that time to realize 05:08.610 --> 05:09.930 That this was not personal 05:10.690 --> 05:15.350 These are prices, you know, these are signals in the marketplace and they were 05:15.910 --> 05:20.330 These signals were telling me what they thought I was worth and I thought it was 05:20.930 --> 05:22.190 um, it was only 05:22.830 --> 05:26.850 Rational of me to respond with a signal of my own 05:26.850 --> 05:28.230 So I quit 05:28.230 --> 05:33.050 And I didn't quit taking care of medicare patients. I just quit filing claims 05:33.630 --> 05:36.430 Uh, I didn't want to legitimize that 05:36.430 --> 05:37.950 That system 05:38.870 --> 05:42.470 Which I come to believe by that time was a Ponzi scheme 05:43.150 --> 05:43.970 but I also 05:44.650 --> 05:50.090 Realized the government didn't have any money and I was the you know, the recipient of stolen property if I did 05:50.710 --> 05:51.590 accept that money 05:52.230 --> 05:52.550 so 05:53.710 --> 05:57.430 I I began ideologically really to mature 05:58.070 --> 06:04.530 And and my thinking about you know, the world and economics was being radically 06:04.530 --> 06:09.690 challenged by not being paid for complicated services that I was providing 06:10.370 --> 06:17.030 Um, but simultaneously I saw the administrative staff of the hospitals where I work balloon 06:17.830 --> 06:23.470 Uh, they were building on to the hospital. There were many more very expensive suits in the hall 06:24.130 --> 06:24.710 um 06:25.190 --> 06:26.350 They were buying out 06:27.130 --> 06:27.510 hospitals 06:28.250 --> 06:31.790 That were their competitors. They were buying physician practices 06:32.530 --> 06:35.070 They were sponsoring sports franchises 06:35.630 --> 06:38.790 College and professional there were billboards going up everywhere 06:39.250 --> 06:40.430 And simultaneously 06:40.990 --> 06:48.530 The so-called not-for-profit hospitals were complaining that they were going broke that the poor malving continues to this day 06:49.370 --> 06:49.730 So 06:50.510 --> 06:53.630 It was clear they were making wild amounts of money 06:54.270 --> 06:56.090 physicians were being short changed 06:57.090 --> 06:59.610 And then in the old days, you know 06:59.610 --> 07:03.970 A physician could go to the medical records department and look at a chart 07:04.810 --> 07:11.510 And on the right side of the paper chart where all that was all the clinical information on the left side was all the financial information 07:12.230 --> 07:15.110 So it became very clear that patients 07:15.110 --> 07:20.530 I was anesthetizing for routine procedures tonsillectomy carpal tunnel gallbladder 07:21.310 --> 07:23.570 Those patients were being bankrupted 07:24.110 --> 07:27.650 By these hospitals with the bills that they were being sent 07:28.510 --> 07:34.990 For very routine procedures and it I I began to feel like an accessory to the crime 07:34.990 --> 07:36.510 and so 07:37.210 --> 07:40.510 A like-minded anesthesiologist and I walked away 07:41.090 --> 07:44.870 um in 1997 just sick of being part of this 07:45.450 --> 07:50.050 And knowing really in our hearts that we could do things cheaper and better 07:50.850 --> 07:55.610 Uh, we walked away and we bought a burnout surgery center that was about to fail 07:56.130 --> 07:57.930 And we actually bought it on a hunting trip 07:58.550 --> 07:59.150 and 07:59.830 --> 08:02.430 And we opened up in may of 1997 08:03.410 --> 08:05.730 With the mission of providing 08:05.730 --> 08:07.930 You know the best care possible 08:08.570 --> 08:13.570 At a reasonable price. We also pledged we've never accepted dog money from the government 08:13.570 --> 08:17.050 And that patients would always know prior to arrival 08:17.710 --> 08:19.590 What they were going to pay us 08:20.150 --> 08:28.310 The the most awful part of all of this prior to our departure was that these poor malignant hospitals in order to legitimize their narrative 08:28.950 --> 08:30.730 They began denying 08:31.570 --> 08:36.510 Physicians surgeons in particular the tools that were required to take care of patients 08:37.110 --> 08:39.270 So it was time to get out 08:39.750 --> 08:41.590 And we did in 1997 08:42.350 --> 08:43.950 Uh, I'm not a businessman 08:45.130 --> 08:46.970 Our performer was 08:47.450 --> 08:54.730 You know, if if they're charging 30 000 for a carpal tunnel release, we think we can do it for less than that and maybe better 08:55.450 --> 08:58.470 Um, and we had no idea how correct we were 08:59.090 --> 09:02.450 So we started quoting prices, uh over the phone 09:03.290 --> 09:06.670 The first week we were open to patients who called 09:07.390 --> 09:10.490 With no concept of how radical that was 09:10.490 --> 09:16.270 We weren't just quoting prices for the surgery center. We were quoting all inclusive prices, which included 09:17.190 --> 09:18.850 anesthesia and the surgeon 09:19.530 --> 09:27.370 And we were only to discover as time went by that these prices we were quoting which were which were profitable prices 09:27.990 --> 09:29.310 Uh were one-tenth 09:29.950 --> 09:34.610 Or less than that, uh of the so-called not-for-profit hospitals 09:35.290 --> 09:39.770 Um, we were attacked as you know, uh just mercilessly 09:40.430 --> 09:44.390 By the hospitals who we embarrassed with these, you know 09:44.390 --> 09:45.150 very 09:45.150 --> 09:47.410 Very affordable prices 09:48.150 --> 09:51.930 We were attacked by the insurance industry, which we didn't understand at the time 09:52.750 --> 09:56.870 Because we we were out of network with all insurance plants. They all hated us 09:57.550 --> 10:01.250 Um, we were attacked by the state health department here in oklahoma 10:01.850 --> 10:03.870 And all of these attacks backfired 10:05.290 --> 10:08.630 That legislators particularly the democrats 10:09.570 --> 10:12.630 Saw us in oklahoma as an underdog 10:12.630 --> 10:16.250 And the republicans were all bought off by the big hospitals 10:16.790 --> 10:18.970 And they were the ones really that were attacking us 10:18.970 --> 10:21.990 But the the democrat saw us as the champion of the poor 10:21.990 --> 10:27.910 You know the affordable prices and you know, I'd walk into their office and tell them I didn't want their money 10:28.570 --> 10:31.550 I didn't want to think from them. I just wanted to be left alone 10:32.110 --> 10:40.370 Uh and that message I resounded with them. They really liked it. So our first defenders from the vicious attacks were 10:40.370 --> 10:42.950 Were people you would say were on the left 10:43.570 --> 10:50.170 Um, the republicans came on later when waving the free market flags seemed like a popular thing to do 10:51.390 --> 10:58.030 Sonya things went along great. Um, we built the huge facility we now occupy 10:58.870 --> 11:00.150 in 2003 11:00.950 --> 11:02.390 um and 11:03.870 --> 11:08.490 And then the insurance commissioner and the carriers in the hospital stumbled 11:09.290 --> 11:10.970 On a way to hurt us 11:10.970 --> 11:13.570 They stacked deductibles 11:14.020 --> 11:19.690 And what that means now we were out of network with everyone and we were filing out of network claims 11:20.200 --> 11:21.690 for patients as a courtesy 11:22.490 --> 11:29.290 But what they did is they disallowed any insurance benefit for a patient who came to our facility 11:29.960 --> 11:33.770 Out of network unless they had already met their in network deductible 11:33.770 --> 11:40.990 So they stacked these deductibles on top of each other which put us out of financial reach for many of the patients that 11:41.910 --> 11:47.390 Prior to that time, uh, would come to our facility. So our waiting room emptied 11:47.930 --> 11:52.670 Uh, little rockwells laughed at me that there is such a thing as a waiting room. I think that's fun 11:53.210 --> 11:53.550 but 11:54.270 --> 11:57.390 It emptied and I mean we almost went out of business and I 11:57.970 --> 12:01.110 I remember thinking at the time, you know, we're cheaper. We're better 12:01.930 --> 12:02.990 In a free market 12:03.630 --> 12:08.270 There should be a line around the block. I mean, we should be as busy as anybody 12:09.150 --> 12:15.550 And so in 2009, um, almost in a last act of defiance, I posted 12:16.290 --> 12:21.170 All of the prices we'd quoted over the phone up into that time on a website 12:22.870 --> 12:26.830 Also not with no clue really at the time 12:26.830 --> 12:28.910 How radical that was 12:29.550 --> 12:34.950 And what the effects would be I did have three goals in mind though when I did that one 12:35.630 --> 12:36.590 was to make 12:37.430 --> 12:39.050 Make us more visible 12:39.690 --> 12:45.230 To patients who had sticker shot, you know, they had a high deductible or no insurance 12:45.970 --> 12:49.850 member of a self-funded health plan a member of a cost-sharing ministry 12:50.470 --> 12:54.570 Um, I also wanted to start a price war because I was mad 12:54.570 --> 13:00.150 Uh, this was too this too hard being a doctor. It's too hard taking care of patients and 13:00.150 --> 13:04.530 You know, just trying to run us out of business constantly and and I was pissed 13:04.530 --> 13:07.970 So I thought, you know, these so-called not-for-profit hospitals 13:08.650 --> 13:12.990 That are charging 10x what I'm charging have got some explaining to do 13:13.690 --> 13:18.330 And and I want someone who lives in isla or main or california 13:18.870 --> 13:24.230 To print my price and walk in to the hospital and say match this or I'm traveling no coma city 13:24.230 --> 13:25.930 We really wanted to start that 13:26.710 --> 13:32.430 And the last thing is I wanted to understand or better understand some of the scams at play 13:33.250 --> 13:38.570 That kept the market from functioning as it should and I would argue all of those 13:38.570 --> 13:45.470 Goals have been achieved. So that's kind of our story and how I did it and why I did it 13:45.470 --> 13:47.290 And it's just been a wild success 13:48.550 --> 13:53.830 Okay, so just to make so people understand so by you doing that then is that what solved your problem? 13:53.870 --> 13:57.470 And you guys flourished because now you had people literally flying in and getting 13:58.230 --> 14:01.730 Operations there once you you went public with your pricing. That's right 14:01.730 --> 14:06.530 So post the prices and the first patients to take advantage of it were canadiens 14:06.530 --> 14:10.070 You know, and that was instructive in itself. You know, these are people that have 14:10.550 --> 14:11.970 Coverage whatever that means 14:12.570 --> 14:17.470 They just don't have access to the care many of them require we have two canadiens this week 14:18.810 --> 14:23.770 Be having surgery at our place. So yeah, uninsured patients traveled from 14:24.190 --> 14:26.090 out of state and then 14:26.870 --> 14:30.410 I became acquainted with people in the self funded 14:31.370 --> 14:37.010 Industry some employers in all 50 states will fly their employees to Oklahoma City 14:37.890 --> 14:41.530 Pay all their travel expense them and a companion 14:43.130 --> 14:47.990 Lodging incidentals pay all the surgery expense a wave all out of pocket 14:48.570 --> 14:51.550 And they still save just vast sums 14:53.230 --> 14:58.330 Yeah, I remember you explaining like a typical case where it would make sense for someone to you know 14:58.330 --> 15:03.950 Fly like you say bring a companion and then recover like in a local hotel for a week 15:04.530 --> 15:06.510 Before they you know should travel again 15:06.510 --> 15:10.350 Move wherever they got a hip surgery or something and still that was just a lot cheaper 15:11.020 --> 15:14.910 Than what they're they would pay even though they had quote good health coverage 15:15.450 --> 15:17.790 Like just what they would be on the hook for let alone 15:17.790 --> 15:22.210 You know what this official price was that their local hospital was charging the insurance company 15:22.770 --> 15:28.410 Yeah, that that's exactly right. You know, we we've seen someone needed a carpal tunnel release 15:28.410 --> 15:32.850 That's a very minor surgery and they would fly to see us from Idaho 15:33.790 --> 15:35.550 Because they were going to have to pay 15:36.070 --> 15:43.730 10 or $12,000 for this procedure and I think my price on the website is $2,950 for everything 15:44.410 --> 15:47.190 And so yeah, they could afford to fly to see us 15:48.070 --> 15:48.930 The latest 15:50.650 --> 15:57.010 Trend which I can say is a trend because we've seen this more and more are the denials 15:58.190 --> 16:02.450 That patients are facing those that have what they thought, you know 16:02.450 --> 16:09.550 It was good insurance even people with Medicare. They're just being denied the care that they obviously require 16:10.150 --> 16:11.130 We had a 16:11.810 --> 16:13.070 very well-to-do 16:14.370 --> 16:14.930 developer 16:15.670 --> 16:19.590 Who had you know a blue cross plan that he just thought was wonderful 16:20.290 --> 16:24.210 Well, he had a torn meniscus and a locked knee. I mean he couldn't walk 16:24.850 --> 16:27.530 And they said they needed three weeks 16:27.530 --> 16:31.930 To review all of his medical records before they could provide payment authorization 16:32.460 --> 16:38.730 He just came it paid our cash price, which I think was 4,000 certain facility anesthesia 16:39.450 --> 16:41.650 And got his procedure done the next day 16:41.650 --> 16:45.770 And he had a bucket handle tear of his meniscus and a locked knee 16:45.770 --> 16:49.690 So we're seeing more and more patients that have insurance 16:50.520 --> 16:56.430 But I've just thrown up their hands in frustration because they they can't get the care they need 16:57.670 --> 16:59.430 Okay. Well, so thank you for that 17:00.050 --> 17:06.650 Quick summary and so now that the listeners have more of a context of you know, who you are and and why I wanted you for this episode 17:06.650 --> 17:08.410 Let's just review. So of course 17:08.910 --> 17:12.050 the you know, shocking events of the last few weeks the 17:12.930 --> 17:15.150 apparent assassination of brian thompson the 17:15.690 --> 17:17.990 CEO of united health and 17:18.730 --> 17:24.030 Luigi Mangione has been arrested and is the alleged suspect and he 17:24.800 --> 17:28.530 Has this manifesto and one of the the things early on in this is this 17:29.150 --> 17:30.030 claim that 17:30.750 --> 17:31.910 Hey, the u.s 17:31.910 --> 17:35.890 Spends the most in the world on health care per capita 17:36.560 --> 17:39.190 And yet its life expectancy is like 40 second 17:39.680 --> 17:41.370 And so this was taken as 17:42.030 --> 17:43.910 proof among you know progressive 17:44.870 --> 17:47.090 Fans of of the shooter 17:47.090 --> 17:51.310 But whether it's luigi or not. I know that that's a controversy online right now 17:51.910 --> 17:55.950 Um to say yeah, this guy's a hero standing up at these these health insurance companies are 17:56.750 --> 17:59.730 Basically murderers and this is just a guy fighting back and just basically 18:00.270 --> 18:02.430 Hey, look around the world you idiot americans 18:02.850 --> 18:03.710 can't you see 18:04.710 --> 18:06.530 Capitalism does not work when it comes to 18:06.970 --> 18:10.270 Medical care like a lot of them probably don't think capitalism works for anything 18:10.270 --> 18:15.590 But they say particularly it's crazy that you know, it's obviously it's the profit motive that is making health care 18:15.590 --> 18:20.570 So expensive in the u.s. And we don't even get anything for it. It's not like we have better health care than 18:21.150 --> 18:28.590 The europeans do so a lot there. I realize but I think you know, you're the perfect person just help us walk through this and understand 18:29.210 --> 18:34.670 You know, there's obviously some element of you can understand why people have that reaction given the horror stories that you've seen 18:34.670 --> 18:37.070 And that many of us have experienced but yet 18:37.950 --> 18:41.190 Presumably you don't think that yet. That's right. That's basically capitalism is the problem here 18:42.310 --> 18:44.030 Yeah, the problem is not 18:44.530 --> 18:47.930 The free market the problem is the absence of the free market 18:47.930 --> 18:51.370 The problem is there's there's not enough competition 18:52.050 --> 18:55.270 And that's why the prices are what they are 18:56.530 --> 19:03.430 The other problem is there's so many variables and moving parts that are not considered by those who make these claims 19:03.970 --> 19:09.070 You know, if you take car wrecks and homicides out of the out of the number 19:09.850 --> 19:16.070 Then the death rate changes drastically and you know, there are a lot of places a lot of countries where people drive cars 19:16.070 --> 19:20.910 Like they do right, you know in texas and california and all over the united states 19:21.710 --> 19:22.850 the other thing is 19:23.670 --> 19:24.370 You know 19:24.370 --> 19:27.390 Hey, hey, Keith. Let me just stop because that's that's a critical point 19:27.390 --> 19:29.970 I just want to make sure people didn't miss that so you're saying 19:30.570 --> 19:35.830 Yeah, like one leg of that one-two punch critique is to say look at how much the u.s 19:35.830 --> 19:41.250 Spends and what do we have to show for it? Yeah, life expectancy is like 40 seconds something like that and among, you know 19:41.250 --> 19:45.930 OECD nations it's not very good the inter and but your point is 19:46.990 --> 19:53.590 A lot of what's driving those headline figures is that many americans die in automobile accidents 19:54.210 --> 19:57.170 And from gunshot wounds. So, you know, we can talk 19:57.730 --> 20:00.770 So a separate conversation about what you know, why are there so many shootings? 20:00.890 --> 20:03.470 But clearly it's not the fault of the health care system 20:03.950 --> 20:09.870 If more americans tend to get in car accidents then europeans do like that's clearly not the fault of you know 20:09.870 --> 20:11.630 Our operating rooms or something 20:12.250 --> 20:14.970 Yeah, and and you know the other point that 20:15.930 --> 20:18.970 Underbinds that argument is the overall health 20:18.970 --> 20:23.870 of people in the united states people people in the united states are 20:24.530 --> 20:26.690 More affluent and they eat more 20:27.470 --> 20:28.110 so 20:28.110 --> 20:34.390 And they probably don't eat as healthy as is due in some country. So and that's not the fault 20:34.970 --> 20:38.070 Of the health care system. That's that's not now 20:38.490 --> 20:41.550 Is is that a reason that more is spent? Yes 20:42.250 --> 20:46.150 But the other thing you have to keep in mind is the extent to which 20:46.150 --> 20:48.410 Our culture in this country 20:49.350 --> 20:53.670 Is geared toward making sure people don't perish 20:54.190 --> 20:58.370 When they might survive with a care intervention 20:58.910 --> 21:02.650 And many of those interventions are just simply not available 21:03.310 --> 21:07.590 In countries and they don't really count those against the mortality 21:08.070 --> 21:13.370 There's an extremely aggressive euthanasia movement in canada 21:13.370 --> 21:15.290 And in the uk 21:16.160 --> 21:19.550 You get diagnosed with a chronic disease at a certain age 21:20.320 --> 21:25.630 You're that's problematic there for your survival. They don't count those against mortality 21:26.460 --> 21:29.310 statistics at all or newborns 21:29.760 --> 21:30.710 You know, they're premature 21:31.710 --> 21:37.590 They're they're heroic efforts in the united states and there are all over the world, but particularly here 21:38.730 --> 21:42.730 To ensure that those that those little babies survive 21:43.470 --> 21:45.250 In a lot of countries they don't count 21:45.250 --> 21:52.010 They don't count those in the denominator. So, you know that you you take all of those things into account 21:52.610 --> 21:53.350 I'm not a 21:54.350 --> 21:58.330 Mathematician or statistician that I know those variables move the needle 21:58.950 --> 22:02.270 Way off of 40 second in the in the world 22:03.310 --> 22:06.190 Okay, so I I guess big picture 22:06.870 --> 22:07.270 Is it 22:09.690 --> 22:12.810 Is it true that like a very wealthy person 22:13.390 --> 22:16.050 Who's got something that requires very expert care? 22:16.770 --> 22:20.310 Are they necessarily come in the united states or is it like no you could count? 22:20.390 --> 22:23.230 There's 10 countries or maybe if you're saying you you're not sure 22:23.230 --> 22:24.250 I mean, obviously 22:24.810 --> 22:27.930 I don't I'm not expecting you to be an expert on the world's healthcare systems 22:28.770 --> 22:34.170 No, I I know for a fact I I I would say I do have my finger on the pulse 22:34.170 --> 22:36.330 Of what is called medical tourism 22:36.970 --> 22:44.570 Uh people traveled Oklahoma city from all over the world. We we have uh two patients coming from cameroon 22:44.570 --> 22:45.330 Next month 22:45.910 --> 22:51.690 So they come from all over the world. They've come from uk france, germany, africa 22:52.410 --> 22:53.090 canada 22:54.070 --> 22:57.750 Just all over the place to secure care at my facility 22:58.510 --> 23:01.370 There are places that have names 23:01.870 --> 23:06.430 Like indy anderson cleveland clinic slone kettering mayo 23:07.290 --> 23:08.010 hopkins 23:08.930 --> 23:13.070 For for pediatric cardiac procedure stanford 23:13.070 --> 23:18.830 Are there people traveled from all over the world boston children's uh to go to these 23:19.570 --> 23:24.030 To go to these medical centers to secure care because it's the best in the world 23:24.030 --> 23:25.450 I mean as some of these 23:26.130 --> 23:32.830 You know, if you need uh pancreas surgery, then you're at slone kettering indy anderson or you're at johns hopkins 23:32.830 --> 23:36.750 Those are the best places in the world to to get that care 23:37.310 --> 23:41.890 So, you know that the quality of the care I would argue is sporadic 23:42.610 --> 23:46.170 But the best care I think that you can receive 23:47.050 --> 23:49.570 Is is in the united states the reason 23:50.070 --> 23:56.050 The quality is sporadic and the prices are as high as they are though is the absence of market competition 23:56.050 --> 23:59.090 And that's the government's fault by far far away 23:59.850 --> 24:04.750 They're driving the getaway car every single time someone gets ripped off in this system 24:04.750 --> 24:09.390 So the idea of throwing the keys to them and letting them take it all over 24:09.970 --> 24:11.130 Is is insane 24:12.710 --> 24:16.150 Okay, well, thank you for that. Um again, I didn't want to put words in your mouth, but I'm glad 24:16.150 --> 24:18.630 It's interesting to hear you say that um, so 24:19.570 --> 24:24.270 Can you just help us to understand? I mean, so you I think you kind of alluded to it 24:24.270 --> 24:27.710 early on when you were just giving your initial answer to my my 24:28.290 --> 24:29.130 introductory question 24:30.470 --> 24:34.350 That somebody might think that the insurers would love you like, oh, yeah 24:34.350 --> 24:37.050 We're we're covering people and if they can get care from 24:37.650 --> 24:41.410 You know, uh, the surgery center of oklahoma, then we don't have to make as high pre like 24:41.410 --> 24:46.410 You know, then we could charge lower premiums and you know, we should encourage all of our patients 24:46.410 --> 24:47.390 They should be in network 24:47.390 --> 24:50.730 We should try to funnel everybody to you guys as much as possible 24:50.730 --> 24:53.310 One might have thought that would be what would happen 24:53.310 --> 24:54.570 But that's not what's going on 24:54.570 --> 24:56.750 So can you explain that because that's kind of a mystery 24:57.310 --> 24:58.250 prima facia 24:58.810 --> 25:01.030 Yeah, I was terribly confused by this 25:01.690 --> 25:04.330 And when all the pieces came together 25:04.970 --> 25:05.790 Thanks to 25:06.430 --> 25:09.610 My education by some of the people in the industry 25:10.430 --> 25:14.550 Um, I actually made a video called the $100 aspirin 25:14.550 --> 25:20.890 To explain it in case after my explanation now anybody wants to review 25:21.830 --> 25:22.430 essentially 25:23.810 --> 25:25.130 The answer is 25:25.850 --> 25:30.290 That insurance companies don't just make money by 25:30.830 --> 25:32.650 collecting premiums 25:32.650 --> 25:35.190 paying claims and pocketing the difference 25:35.730 --> 25:37.130 They also make money 25:37.850 --> 25:38.310 by 25:39.510 --> 25:42.510 Charging for the discounts that they can achieve 25:43.120 --> 25:45.030 So if a hospital 25:46.180 --> 25:48.190 Sends a hundred thousand dollar bill 25:48.940 --> 25:53.870 To an insurance company the insurance company pays them. Let's say 20,000 25:54.180 --> 25:56.430 The insurance company then claims 25:57.180 --> 26:00.390 That they saved the employer plan 26:00.980 --> 26:03.990 $80,000 and they charge a commission 26:04.580 --> 26:07.350 To the extent that those savings are achieved 26:08.140 --> 26:12.230 So and it's usually 20 25 percent 26:12.950 --> 26:14.450 So if you think through that 26:15.450 --> 26:18.410 The insurance company actually wants 26:19.630 --> 26:21.470 A 200,000 dollar bill 26:22.210 --> 26:28.910 And then except 20,000 and then they can claim that they saved the employer plan 180,000 26:28.910 --> 26:31.610 So the incentives are completely wrong 26:32.470 --> 26:36.890 You know and that explains why the insurance companies hate me because if I say 26:36.890 --> 26:42.350 A knee arthroscopy at surgery center of Oklahoma is $3,740 26:44.590 --> 26:49.150 There is no that's a missed opportunity for them. I mean they have no 26:49.690 --> 26:52.190 Price to discount. They have no way to 26:52.930 --> 26:57.370 Reprice the claim. That's what that's the terminology used 26:57.370 --> 26:59.330 I call it skimming 27:00.010 --> 27:02.170 But it's ticket scalping 27:02.170 --> 27:08.050 Of my apologies to ticket scalpers because that's actually more honest work than what they're doing 27:08.810 --> 27:12.650 It's it is uh, it's they call it claims repricing 27:13.270 --> 27:14.310 and someone 27:15.510 --> 27:21.030 Runs a hundred thousand dollar bill through a shredder and there's 20,000 on the other side 27:21.770 --> 27:26.490 And they claim that they saved an employer plan 80,000 now keep in mind 27:27.010 --> 27:31.910 The hospital receives 20,000 dollars and claim they're going broke 27:32.610 --> 27:34.610 Because after all they have rendered 27:35.210 --> 27:39.050 A hundred thousand dollars of care and did not receive payment 27:39.630 --> 27:41.230 For 80 percent of it 27:42.210 --> 27:44.850 Well, the 20,000 dollars they receive 27:45.370 --> 27:51.090 Is eight to ten times what I would receive at the surgery center for the same service 27:51.750 --> 27:55.890 So our online prices are one eighth to one tenth 27:56.490 --> 28:00.230 Of what the hospitals actually receive even after that discount 28:01.150 --> 28:08.050 Now the hospitals are happy to say they lost 80,000 because they need all the red ink 28:08.590 --> 28:10.750 That they can find to justify 28:11.510 --> 28:15.610 They're not for profit status and not for profit doesn't mean they're not making a profit 28:15.610 --> 28:19.910 It just means don't pay tax. So they're just trying to justify 28:20.510 --> 28:22.050 They're no tax 28:22.790 --> 28:24.610 status with all of this red ink 28:25.190 --> 28:26.890 And then the federal government pays 28:26.890 --> 28:33.090 Not for profit hospitals a kickback every year to the extent that they make these outrageous claims 28:33.090 --> 28:35.970 So they put all of these lost claims in a bucket 28:36.710 --> 28:39.570 And kick it off to dc and then they get a 28:40.370 --> 28:42.730 Disproportionate share hospital payment 28:43.610 --> 28:46.070 To the extent that they claim these losses 28:46.070 --> 28:51.650 So the insurance companies are incentivized to seek out the highest price they can find 28:52.450 --> 28:53.570 And the hospitals 28:54.370 --> 28:55.570 Are happy 28:56.230 --> 28:58.590 More than happy to give it to them 28:58.590 --> 29:02.550 And and that explains why they hate me because there's no 29:03.050 --> 29:06.210 You know, the insurance companies missed opportunity with me 29:06.210 --> 29:11.450 Hospitals hate me because now the jig is up, you know, the prices are online 29:11.450 --> 29:14.950 And the you know, why can't you do this for 29:14.950 --> 29:18.470 You know one tenth and you know, they're doing it for a tenth 29:19.110 --> 29:23.990 And and they're making a profit. How do you charge in 10 times and not making a profit? So 29:23.990 --> 29:25.650 That that's the scam 29:27.470 --> 29:28.870 Okay, and so then I guess 29:29.490 --> 29:31.610 Kind of going along with that too. I think that 29:32.750 --> 29:35.350 Both all the big players in this system like 29:36.050 --> 29:38.550 The individual feeling as if 29:38.550 --> 29:41.690 Oh, just on my own with my own, you know 29:41.690 --> 29:44.490 Savings that I have have swirled away over the years 29:44.950 --> 29:48.310 If I get hit with a catastrophic illness or some kind of surgery that I need 29:48.910 --> 29:52.670 I'm wiped out. I'm I'm personally bankrupt. That's why I absolutely need 29:52.670 --> 29:53.470 That's right 29:53.470 --> 29:56.110 My health insurance because otherwise I'm dead in the water 29:56.590 --> 30:01.770 And so and and I'm you know, the big players like the blue classes where they they let want people thinking that that 30:01.770 --> 30:04.810 Oh, yeah, you totally need us and even like you're saying they even the major employers 30:05.410 --> 30:09.590 You know need, you know, that the health insurance company comes in and say, oh, wow 30:09.590 --> 30:10.150 It's a good thing 30:10.150 --> 30:13.670 We outsource this to you know, those big insurance health insurance companies because they're out there 30:13.670 --> 30:19.450 You know going to bat force looking how much they talk down these crazy hospital bills. That's right. The fear 30:20.150 --> 30:20.650 definitely 30:21.330 --> 30:24.710 Helps the system continue the good news 30:25.130 --> 30:27.910 Is that their nightmare has begun? 30:28.290 --> 30:30.090 It's actually well underway 30:30.750 --> 30:31.650 You know, we call 30:32.210 --> 30:36.110 blue united signal and we call these networks or ppo's 30:36.750 --> 30:42.050 And people are beginning to figure out that if they contract directly 30:42.050 --> 30:43.790 With somebody like me 30:44.300 --> 30:52.790 They can shove that network aside and all of the network access fees all of the repricing and skimming 30:53.480 --> 30:57.970 And they can pay me directly and just save huge sums 30:58.560 --> 31:04.430 So the nightmare for the carriers has actually begun and it has been delivered 31:04.960 --> 31:10.610 By the free market not by government not by anybody else, but 31:10.610 --> 31:18.950 You know enterprising individuals have just gone to giant employers and I'm one of them and you said, you know, here is 31:18.950 --> 31:20.150 Here is what I do 31:20.670 --> 31:22.530 And here is what I charge for it 31:22.530 --> 31:27.090 Do you want to just shove all the middlemen to the curb and pay me directly? 31:27.710 --> 31:29.890 And save 80 or more percent? 31:30.510 --> 31:36.630 And so then the nightmare for the carriers really has begun these networks are not able 31:37.390 --> 31:38.950 to instill the fear 31:39.730 --> 31:41.670 in the buyers that they have 31:42.930 --> 31:47.930 Traditionally and so you'll see reference-based pricing rbp 31:48.690 --> 31:55.490 And that's where an employer health plan says, you know, we'll pay 140 percent of Medicare to a hospital 31:55.490 --> 31:58.970 That's all you're going to get and they're not going to we're not going to pay you anymore 31:59.530 --> 32:01.010 And we don't need a network 32:01.630 --> 32:06.230 We don't need blue united signal and humanity to adjudicate this for us 32:06.230 --> 32:07.970 Just that's just what we're going to pay 32:08.370 --> 32:14.850 And there is no network and and that nightmare really has begun for the carriers. I don't I don't know how they're going to respond to it 32:15.870 --> 32:16.490 Yeah, I mean 32:16.490 --> 32:20.430 I want to say at this point you I could have said it earlier too, but 32:21.470 --> 32:23.750 The trump card that I play whenever, you know 32:23.750 --> 32:26.950 In this latest controversy and came up when this hit the news cycle again 32:27.370 --> 32:30.730 Is looked at what I'm going to say isn't going to prove what the solution is 32:30.730 --> 32:34.290 But for people to say, oh, yeah, this is free market capitalism for you. I don't say 32:34.990 --> 32:41.450 Can you imagine if in the car market, you know, you needed a new car or used one wherever you go to the dealership 32:41.450 --> 32:45.110 You pick the thing you say, yeah, let's go. Yes. Yeah, it's got the size I want or whatever. Okay 32:45.110 --> 32:46.510 I'm gonna have some kids. Yeah, okay, sure 32:46.510 --> 32:48.830 And then it wasn't until you signed the deal 32:49.230 --> 32:52.630 And it was your car and now you owed them money for it 32:52.630 --> 32:55.330 And then the dealership would tell you how much the vehicle cost 32:55.750 --> 33:00.670 Can you possibly imagine how much more expensive vehicles would be in that setting and yet for most people? 33:00.670 --> 33:04.370 That's how healthcare works. You literally don't know what it's going to be until afterward 33:04.370 --> 33:08.390 And you're not in a very good bargaining position because you're you know in agony or something 33:08.390 --> 33:14.750 Yeah, and as my friend Jay Kempton says the steering wheel and the tires you find out after the purchase are not included 33:15.250 --> 33:22.670 Yeah, all these bills start raining in after you've purchased it. So it's insane. No, there's nothing 33:23.210 --> 33:27.750 There is nothing that resembles the market in the traditional industry 33:28.380 --> 33:34.010 And keep in mind there are two economic models at play one the traditional model 33:34.710 --> 33:36.950 Is how do I maximize revenue? 33:37.650 --> 33:40.410 They're all I get emails every day from people 33:41.110 --> 33:42.390 Trying to coach me 33:42.940 --> 33:47.690 And you know, this is how you can make more money how you can get more blood out of the turnip 33:47.690 --> 33:54.410 You know how you maximize your profit from hand surgery. I saw that in a new magazine today 33:55.120 --> 33:56.110 the other model 33:56.890 --> 33:59.210 Is how do I deliver maximum value? 34:00.010 --> 34:05.350 And value in the eyes of the buyer that you know true subjective value 34:05.350 --> 34:07.870 And that's the model that I champion 34:08.510 --> 34:13.750 And it is very creepy for the folks who are trying to generate maximum profit 34:14.550 --> 34:20.470 Because if the buyer has sticker shock, they're not competitive when they're just trying to rip people off at every turn 34:22.170 --> 34:23.390 Okay, so can you 34:23.910 --> 34:28.230 Give us an idea. So for example, I you had the the free market medical association 34:28.230 --> 34:32.070 I was a speaker at one of those events and it was I was very glad to see 34:32.630 --> 34:37.230 It's not just that you know, you're a voice in the wilderness that you you know, you're attracting 34:37.230 --> 34:39.630 You're building a movement and you know, you and your your 34:40.170 --> 34:43.590 Colleagues and so forth and other people are getting involved but yet still 34:44.470 --> 34:47.730 It seems like why how come there aren't 50 34:47.730 --> 34:53.450 Surgery centers modeled after you like after, you know, your story's been around for a while. Is there some, you know, what am I missing? 34:54.930 --> 34:58.010 Well, there are two answers to that the first one is 34:58.830 --> 35:02.210 You really have to acknowledge the headwinds 35:02.210 --> 35:05.870 That the traditional industry and the government provide 35:05.870 --> 35:09.770 It's very difficult to start a facility 35:10.310 --> 35:12.530 to get the capital for it and to 35:12.530 --> 35:18.950 Heard a bunch of doctors, you know surgeons and you know to standing behind a single idea 35:19.630 --> 35:20.770 It's very risky 35:21.290 --> 35:25.470 They you know, you know, you're going to be attacked and maybe slaughtered 35:25.470 --> 35:28.530 So the headwinds are very very strong 35:29.150 --> 35:32.210 The good news is there are a lot of people like me 35:32.210 --> 35:38.850 Now i'm a little bit of a unicorn not entirely i'm proud to say because I don't have any carrier contracts 35:39.380 --> 35:43.930 We don't work with blue united signet and the humana. We don't work with any of them and 35:43.930 --> 35:49.630 We've never accepted a dime of federal money. So and all my prices are online 35:50.160 --> 35:52.950 So that makes us a little bit of a unicorn 35:53.380 --> 35:59.770 But not entirely renovo health in wisconsin well bridge surgery center in indianapolis 36:00.850 --> 36:03.490 Veritas surgery center in moscow, Idaho 36:04.110 --> 36:10.750 There's a facility in st. George, uton. They are texas free market surgery center. They all have prices online 36:11.690 --> 36:15.770 What's really interesting is there are a lot of facilities 36:16.390 --> 36:18.990 Like mine that just don't post their prices 36:18.990 --> 36:22.670 But if you call them on the phone, they'll tell you how much the service is 36:22.670 --> 36:29.010 And the reason for that is they are still accepting payments from blue united signet etna 36:29.730 --> 36:31.070 and they're afraid 36:31.630 --> 36:34.030 Of blue united signet etna 36:34.030 --> 36:38.770 They're afraid of those contracts. We're going to get canceled if they post prices online 36:39.450 --> 36:41.230 And the carriers have threatened 36:41.770 --> 36:45.910 facilities like mine that if you're going to post prices then you know 36:45.910 --> 36:50.410 You may have a problem with your contract with us and then they lose access to all these patients 36:51.150 --> 36:51.450 so 36:52.090 --> 36:53.690 You know that there are degrees 36:54.450 --> 36:58.130 But there are hospitals that are responding to my pricing 36:58.130 --> 37:02.970 I'm I'm happy to say the market is putting pressure on a lot of hospitals 37:03.510 --> 37:05.290 Who are not just nefarious? 37:05.630 --> 37:11.830 As satans, they they would like to help patients for a reasonable price. They just don't know how to do it 37:12.590 --> 37:16.270 I actually run a billing clearing house that is helping 37:16.850 --> 37:20.470 Uh, price hospitals that would otherwise price gouge people 37:21.350 --> 37:25.390 Into oblivion and we're helping them create and implement 37:26.090 --> 37:29.230 Bundled prices for affordable high quality care 37:29.870 --> 37:35.190 So this movement is alive and well, but there are a lot most of the people are still in the closet 37:35.790 --> 37:37.070 Because they're fearful 37:37.570 --> 37:42.050 Of the blowback that that would come at them from through the industry 37:44.130 --> 37:49.010 Okay, can you give us a sense to like is that just going to grow and eventually solve the problem? 37:49.050 --> 37:52.530 Or is it more that like you guys are great for 37:53.110 --> 37:55.270 I don't know if low-hanging fruit is the right word 37:55.270 --> 38:00.110 But do you understand like is it a kind of thing where oh, yeah kind of routine somebody comes in and outpatient care 38:00.110 --> 38:02.730 You guys are great for that. But yeah, like if you got to get 38:03.590 --> 38:07.730 Double bypass surgery or something you you have to suck it up and go to these big 38:08.730 --> 38:11.410 Hospitals and you know, you need your standard insurance coverage 38:12.230 --> 38:19.070 So right after I posted the website in 2009, um, I met a canadian broker 38:19.590 --> 38:27.250 Uh, who essentially helps canadians cross the border into the united states to secure care unavailable to them 38:28.190 --> 38:32.750 And he called me one day and he said he's not a clinician. He's not a physician 38:32.750 --> 38:34.850 He said how much for a triple bypass? 38:35.690 --> 38:39.870 And I said, well, I I run it outpatient surgery center. But let me make a call 38:40.560 --> 38:42.970 So I called a friend of mine who runs 38:43.520 --> 38:44.970 A cardiac hospital 38:45.630 --> 38:47.570 That is physician run 38:47.570 --> 38:53.190 And I said I asked him how much for a triple bypass 38:53.910 --> 38:58.630 And he said damn it. I knew you were going to call me after you posted this site 38:58.630 --> 39:01.810 And I don't have don't have an answer for you. Give me an hour 39:02.530 --> 39:08.970 So he called me back in an hour and said 32,000 and I said for what he said for everything 39:09.650 --> 39:15.490 So I called this canadian broker back and said it's 32,000 and he said man, we're going to get him on the way 39:15.490 --> 39:18.270 There's a waiting list obviously in canada 39:19.150 --> 39:23.390 For that and so that patient came down now 32,000 is a lot of money 39:24.090 --> 39:30.290 But when you think about somebody paying 1500 a month for insurance premiums with a $10,000 deductible 39:30.290 --> 39:32.510 That's two years of premiums 39:32.510 --> 39:38.310 Um, so somebody banks two years of premiums. They can buy open heart surgery out of pocket 39:39.090 --> 39:43.370 And same with colon cancer same with brain tumors 39:43.990 --> 39:45.510 My clearing house 39:46.410 --> 39:48.250 Is helping people secure 39:48.930 --> 39:51.690 This very complicated inpatient care 39:51.690 --> 39:55.870 For reasonable pricing and people are willing to grant 39:56.510 --> 40:02.170 Reasonable pricing because they're going to be paid. You're going to be paid quickly and without all the hassles 40:02.890 --> 40:08.490 And in really threats of non-payment they they encounter when they deal with traditional insurance 40:10.370 --> 40:13.870 Okay, well, so that's that's encouraging. We'll have to hear that this next one 40:14.410 --> 40:19.130 I don't know how you want to take this and maybe it's not going to be clear what I'm trying to get across here, but 40:20.670 --> 40:23.450 Depending on who you're reading. It's it's like, oh, yeah 40:25.490 --> 40:31.950 There's just outright villains and there's all these greedy people that knowingly are just skimming off the top and you know 40:31.950 --> 40:33.890 Just bringing everybody dry 40:34.410 --> 40:36.530 Whereas other people it's more of a just you know 40:36.530 --> 40:38.250 Hey, it's not that there's some 40:39.110 --> 40:39.510 central 40:40.410 --> 40:45.390 Malevolent force here. It's just kind of you know, there's there's not a lot of people that are all getting rich off this 40:45.390 --> 40:47.250 It's not that the doctors are overpaid 40:47.250 --> 40:50.730 There's a lot of staff and then yeah, there's way too much, you know bureaucracy 40:50.730 --> 40:53.870 But those people all you know, given the way the system works 40:53.870 --> 40:57.230 You need somebody to push the paper around and you got to have a whole team of people 40:57.730 --> 41:00.550 Tracking down patients because they don't pay because the bills are so outrageous 41:00.550 --> 41:03.330 It's kind of like a you know a self-fulfilling prophecy 41:03.770 --> 41:08.350 Where the you know the bills are so big that no one's like I'm not paying that and then that's you know partly why 41:08.870 --> 41:13.090 The bills have to be so big because people know yet. We're not going to get paid for three years on this procedure 41:13.090 --> 41:15.230 We're doing so can you just give us a sense? 41:15.430 --> 41:17.090 Do you understand the question I'm trying to get it like 41:17.550 --> 41:23.010 Is it just a crazy system that everyone just finds themselves in or is it like no 41:23.010 --> 41:25.890 There's really a hundred decision makers and they could turn this 41:25.890 --> 41:30.390 Ship around if they wanted to and they just don't want to because they like, you know bilking everybody 41:30.390 --> 41:37.310 You know the the insurance companies the hospitals the price gouging hospitals big pharma 41:38.040 --> 41:42.550 They they deserve all of the thumping that they get 41:43.200 --> 41:49.010 But it's so important. I think for everyone to remember who the true 41:49.560 --> 41:50.630 culprit is 41:50.630 --> 41:52.410 That's the federal government 41:52.860 --> 41:55.690 This system everyone hates 41:56.290 --> 42:00.030 Is downstream of an auction in dc 42:00.570 --> 42:07.770 That if the auctioneers have sold all of these favors to the highest industry bidders 42:08.850 --> 42:13.290 So all of the big industry players have paid dearly 42:13.770 --> 42:17.650 For the ability to fleece essentially 42:18.510 --> 42:21.930 The the american public a lot of the revenue 42:22.330 --> 42:26.530 That these insurance carriers and hospitals receive comes from the federal government 42:26.530 --> 42:28.950 They're directly plugged into the trough 42:29.650 --> 42:35.250 In addition to fleecing americans directly they fleece everyone indirectly 42:36.210 --> 42:42.870 So it's it's the game. I mean it is it is what it is. It's it's working exactly 42:43.530 --> 42:47.970 As it was designed by these people who have cobbled it all together 42:48.650 --> 42:50.630 And I don't think it's fixable 42:51.250 --> 42:53.830 I think it is it is completely unfixable 42:54.370 --> 42:55.950 I think it can be destroyed 42:56.410 --> 43:00.070 But the only way it'll be destroyed is if there's a market alternative 43:00.490 --> 43:02.170 And that's what I focused on 43:02.170 --> 43:06.690 You know it's you know have market discipline regulate 43:07.490 --> 43:13.630 This industry not the corrupt feds and regulators. They they're all completely 43:14.410 --> 43:16.890 Bought into this system. That's a disaster 43:17.710 --> 43:19.690 So I don't think it's fixable 43:20.190 --> 43:24.590 But there are a lot of people who do not provide direct patient care 43:25.410 --> 43:27.130 There are a lot of people that are not 43:27.950 --> 43:30.470 Providing value of any any kind 43:31.070 --> 43:32.090 They're getting rich 43:32.830 --> 43:34.470 And I'm here to tell you 43:34.470 --> 43:40.290 Physicians are not generally in that group. The doctors are not getting rich 43:40.290 --> 43:44.030 The doctors pay has been stagnant or dropping 43:44.670 --> 43:45.470 For years 43:45.470 --> 43:49.470 But if you if you walk outside, you don't have to walk very far 43:50.010 --> 43:52.310 Before you see a gigantic crane 43:52.990 --> 43:57.450 Building on to a not-for-profit hospital or putting up a new billboard 43:57.450 --> 43:59.970 Or you go to a professional 44:00.850 --> 44:01.910 sports game 44:02.490 --> 44:07.030 Some kind and you know, there's all the advertising that is so expensive 44:07.550 --> 44:12.270 And and so you can follow that money, you know, are these people inherently evil? 44:13.390 --> 44:17.950 I'm inclined and many of my friends will be disappointed for me to say this 44:18.470 --> 44:23.610 I'm inclined to agree for the most part with my friend Marty McCary 44:24.310 --> 44:25.670 that these are 44:26.310 --> 44:26.950 oftentimes 44:27.870 --> 44:28.550 initially 44:29.230 --> 44:32.030 Well-intentioned people well-intentioned 44:32.030 --> 44:32.910 people who 44:32.910 --> 44:38.890 Who get into this industry for the right reasons and then they're consumed by it 44:39.640 --> 44:40.030 and 44:40.580 --> 44:45.850 And you know in fairness the headwinds to change anything are so 44:46.600 --> 44:52.870 So vicious and all of the resistance to change comes from dc 44:53.420 --> 44:57.050 And I I think it's important for people to remember this because 44:57.790 --> 45:03.450 The government is responsible for every part of this health care system people hate 45:04.010 --> 45:06.590 That they are the ultimate culprit. So 45:07.490 --> 45:08.330 You know, we have 45:09.050 --> 45:15.870 My friend Jim Epstein from Reason magazine told me one time the way he finds a great story is he looks for industry 45:16.650 --> 45:22.310 Consolidation and that's the business of government is to crush competition. So we have consolidation 45:23.060 --> 45:25.750 Not a huge number of new 45:25.750 --> 45:28.690 Upstart competitors trying to get into the game 45:29.190 --> 45:35.270 You know after obama care there were four insurance companies basically before then there were a whole bunch 45:35.270 --> 45:39.550 So what do you expect is going to happen the pricing? Well, that was just a huge favor 45:40.160 --> 45:43.010 To the industry and the industry lobbied for it 45:43.010 --> 45:48.470 And everyone everyone was bought off the AMA was bought off in the early 90s 45:49.190 --> 45:51.070 Big pharma was bought off 45:51.490 --> 45:54.030 during obama care when 45:54.850 --> 45:57.790 When they promised them to make imported 45:58.710 --> 46:02.650 Biologic drugs illegal for 20 years 46:03.090 --> 46:03.490 And 46:04.470 --> 46:09.350 Systematic the hospitals were bought off by obama care when they promised to make 46:09.870 --> 46:12.390 physician ownership of hospitals illegal 46:13.490 --> 46:18.150 And all of these favors are passed out that protect them from competition and 46:19.210 --> 46:24.550 You know, are there people seeking these favors to the disadvantage of their competitors? Absolutely 46:25.110 --> 46:28.550 But I mean that's been going on in every industry in this country forever 46:30.370 --> 46:35.650 Okay, well, I guess the last question I have for you is uh, and this this is an 46:35.650 --> 46:41.330 interesting moment in history here because not just me personally but lots of people who are going to hear this interview 46:42.390 --> 46:50.750 May have inroads into, you know a way to run things up that the vaguerama swami or ylan musk is going to be able to get a hold of 46:51.190 --> 46:51.870 so if 46:52.750 --> 46:54.590 Trump's team were to ask you 46:55.170 --> 46:58.150 Well, yeah, we we listen to this we totally we're on board. We got a lot of 46:58.790 --> 47:02.330 Entrepreneurs who are involved in the transition team. What what can we do that? 47:03.010 --> 47:06.250 You know and again, you can couch in terms of politically possible or not 47:06.250 --> 47:10.410 You know, however you want to answer the question, but what can we do to make this better? 47:11.370 --> 47:13.770 There are some things that could help 47:13.770 --> 47:14.770 um 47:15.210 --> 47:19.750 A little bit, but again the system that's cobbled together 47:20.230 --> 47:26.250 Is designed to work the way it works. So fixing it means dismantling it 47:27.750 --> 47:32.950 Dismantling it begins with removing price controls for instance 47:34.410 --> 47:38.930 Physicians are only allowed to charge medicare patients 47:38.930 --> 47:40.390 a certain amount 47:40.920 --> 47:45.690 And that has that price control has caused real access issues 47:46.240 --> 47:50.310 For medicare beneficiaries. So they need to remove price controls 47:50.700 --> 48:00.110 And then begin to completely dismantle the medicare regulatory machine, which essentially calls all of the shots 48:00.760 --> 48:02.010 um, you know 48:02.380 --> 48:04.150 We need more insurance 48:04.870 --> 48:08.390 Companies we act, you know, these big companies they need competitors 48:08.390 --> 48:13.230 They don't have competitors out there because of this minimum loss ratio 48:13.790 --> 48:16.590 You know, this giant companies can stand 48:17.090 --> 48:24.330 This 30% minimum loss ratio, but the little ones can't and that's why that's why that was part of obama care 48:24.810 --> 48:25.970 Can you explain what that is? 48:26.750 --> 48:26.810 so 48:27.670 --> 48:31.130 You know, this sounds great and it's just it's horrible 48:31.130 --> 48:35.290 But an insurance company was not allowed to keep 48:35.810 --> 48:39.870 More than 30 of its revenue as administrative overhead 48:40.750 --> 48:43.310 Well, if you're a trillion dollar company 48:43.790 --> 48:46.490 Then that's a lot of money for administrative overhead 48:46.490 --> 48:51.930 But if you're a small insurance company 30 year in year out may not be enough 48:52.450 --> 48:56.870 So that was that's the reason we have four insurance companies. There were only four 48:57.470 --> 48:58.610 That could endure 48:59.250 --> 49:01.070 That this minimum loss ratio 49:01.070 --> 49:01.870 so 49:02.690 --> 49:06.190 That's that needs to go away, you know, I I tell people 49:06.990 --> 49:13.410 That the way to fix it is to not not pass any new laws, but to repeal 49:13.410 --> 49:18.590 All the ones that have been passed up to this point that apply to the industry 49:19.150 --> 49:20.070 and high tech 49:20.730 --> 49:23.950 A high tech that required basically the use of electronic 49:23.950 --> 49:29.150 electronic medical records when it was not clear at all that there was a market for them 49:29.150 --> 49:33.770 And instead what we ended up with is this electronic medical record 49:34.310 --> 49:38.750 In which it's almost impossible to find any pertinent information whatsoever 49:39.450 --> 49:42.630 So there there's a lot that needs to be undone 49:43.410 --> 49:51.470 Before anything innovative should even be considered and then all of the sandbagging and roadblocks 49:51.470 --> 49:54.250 That stand in the way of entrepreneurs 49:55.430 --> 49:58.270 Rising up and starting 49:58.970 --> 50:05.530 You know facilities that are willing like mine, you know, they're willing to endure the discipline of the market 50:06.190 --> 50:11.010 That's really what will make the the horrible system that's been called together 50:11.690 --> 50:12.030 change 50:13.570 --> 50:17.370 Okay, well, that's a I guess good spot to end this discussion on 50:17.370 --> 50:17.610 Uh 50:18.530 --> 50:22.210 Folks, my guess has been dr. Keith Smith at the surgery center of oklahoma key 50:22.210 --> 50:26.410 Thanks so much for what you've been doing and taking the time to come help us understand it 50:26.870 --> 50:28.750 Thank you, bob. Thanks for having me 50:29.570 --> 50:32.270 Thank you everybody for tuning in. We'll see you next time 50:34.650 --> 50:39.090 Check back next week for a new episode of the human action podcast in the meantime 50:39.090 --> 50:42.350 You can find more content like this on leases.org