Latest / Beyond Labels Premium / Episode #190: Sick Care VS. Health Care: How Doctors are Incentivized to Keep You Sick

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Episode #190: Sick Care VS. Health Care: How Doctors are Incentivized to Keep You Sick · Beyond Labels Premium

• 0:00
  SPEAKER_00: Here's the point.
• 0:00
  SPEAKER_00: The incentive in the system is to create more and more complex codes and procedures.
• 0:09
  SPEAKER_00: Because then when that doctor opens the door and comes in to see me, he knows he's going to be get a higher reimbursement.
• 0:16
  SPEAKER_00: And that, Cena, is why you can't get an answer for how much will this cost.
• 0:22
  SPEAKER_01: Hi, and welcome to Beyond Labels.
• 0:24
  SPEAKER_01: I'm Dr.
• 0:24
  SPEAKER_01: Cena McCullough, and I'm here with our favorite farmer, Joel Salatin.
• 0:29
  SPEAKER_01: And today it's really we're in Joel's world.
• 0:33
  SPEAKER_01: We're in his mind.
• 0:34
  SPEAKER_01: We are going to learn about what he's been learning and thinking about the tension in the business space between sickness care versus health care.
• 0:46
  SPEAKER_01: So I am intrigued, Joel.
• 0:49
  SPEAKER_01: Go ahead, educate me.
• 0:51
  SPEAKER_00: All right.
• 0:52
  SPEAKER_00: Well, uh, I don't, I'm not sure this will be new to you.
• 0:54
  SPEAKER_00: It might just be a different way of articulating it.
• 0:57
  SPEAKER_00: So in the last uh week or so, I've had the privilege of being in a cup doing a couple of conferences and having a couple of in-depth conversations with medical doctors who are who are struggling with the system.
• 1:14
  SPEAKER_00: Let me let me just um I think frame it this way that doctors who are thinking about where healthcare is going in this country are using the year 2030, which is not that far away, 2030 as the tip over point where we cannot afford health care anymore, in in it in its as it's in it's as it's currently designed.
• 1:43
  SPEAKER_00: And the problem is that and I'm I'm synthesizing a bunch of things that I'm that that I've heard here in the last uh week in all these conversations, and and the the conference, the healthy Tennessee conference in uh eastern Tennessee, and I was um I was down at um at Dolly's Dolly's hotel there in uh Dollywood.
• 2:07
  SPEAKER_00: Um is that our system as currently contrived does not offer any economic incentive for wellness.
• 2:23
  SPEAKER_00: In other words, the medical community.
• 2:25
  SPEAKER_00: Now, now if I stay, if I stay healthy and I don't have to, you know, go to a doctor or anything, then I personally get a you know, there's an economic incentive for me, okay, to stay well and not be sick, all right.
• 2:37
  SPEAKER_00: But but the the provider community, so this includes the doctor who is advising you, the nurse who is advising you, the hospital that's treating you, the drug companies that are obviously involved with the whole healthcare industry.
• 2:56
  SPEAKER_00: There's nothing in that entire system, Sina, that that rewards health.
• 3:06
  SPEAKER_00: So I had a fascinating conversation just Saturday with a surgeon from Lynchburg who is working with a couple of clinics uh that are trying to put together a a kind of a major um a major alternative clinic, if you will.
• 3:24
  SPEAKER_00: And I have never heard the term risk adjusted factor.
• 3:32
  SPEAKER_00: Risk adjusted factor, R-A-F-S.
• 3:36
  SPEAKER_00: So if you ever wondered why if you ask your doctor or the hospital and they want to do a procedure, what's it cost?
• 3:47
  SPEAKER_00: They don't give you an answer.
• 3:50
  SPEAKER_00: And well, you know why they don't give you an answer?
• 3:55
  SPEAKER_00: Because they don't know.
• 3:56
  SPEAKER_00: You know why they don't know?
• 3:58
  SPEAKER_00: Because the insurance companies use risk-adjusted factor scores.
• 4:04
  SPEAKER_00: R-A-F-S.
• 4:05
  SPEAKER_00: You know, see, you know, we've introduced our listeners to grass.
• 4:09
  SPEAKER_00: I anybody who's listened to us for a lot for a while now gets generally recognized as safe, grass.
• 4:16
  SPEAKER_00: I think I think we have we have beat that dog to where I think most of our listeners now are are you know 10 times smarter than anybody else because they know what grass is.
• 4:27
  SPEAKER_00: Well, I'm gonna introduce this because to me this was completely unknown, and I don't consider myself an idiot, but I I had not heard this, but it made so many things make sense.
• 4:39
  SPEAKER_00: So a risk-adjusted factor score, R-A-F-S, is an algorithm, is is what the health industry uses, the insurance industry uses it to determine the complexity of a procedure.
• 4:56
  SPEAKER_00: For example, for example, if a patient has a nosebleed and is also on blood thinner and has hypertension, that patient gets a higher risk adjusted factor score than one that just comes in with nosebleed and doesn't have a blood, isn't on a blood thinner, doesn't have hypertension and is on nothing else.
• 5:20
  SPEAKER_00: Okay?
• 5:21
  SPEAKER_00: The risk adjusted factor score creates the the compensation value that the insurance company pays the doctor.
• 5:34
  SPEAKER_00: So so uh when you are a doctor and you put in your code, so every procedure has a code, a code number that goes in, you know, a skin graft, uh, uh, uh, you know, nosebleed, uh, diabetes, whatever.
• 5:57
  SPEAKER_00: Every single thing has a code.
• 6:00
  SPEAKER_00: And and so your code, your medical history, all right, your medical history is a compilation of all these codes.
• 6:09
  SPEAKER_00: So imagine if you're a normal American and you're going to the doctor, you know, every year for a checkup and and a couple of times in between, uh, or you've had an ER visit, you know, uh, any any procedure, anything that that you that insurance would pay for goes on your record as a as an accumulating uh an accumulating risk factor, an accumulating score.
• 6:37
  SPEAKER_00: Are you with me?
• 6:38
  SPEAKER_02: Yeah.
• 6:38
  SPEAKER_00: So so as you age, as he told me, um if you if you have a low RAFS um number, then any given procedure will cost less money.
• 6:55
  SPEAKER_00: If you have a high RAFS number, then the reimbursement is more because it's a more complex situation.
• 7:03
  SPEAKER_00: You know, there are more there are more factors, you know, involved in in the thing.
• 7:08
  SPEAKER_00: So when a doctor you're starting to groan.
• 7:12
  SPEAKER_00: So so when a doctor because listen, I listen, I'm a layman and I'm a businessman, okay?
• 7:19
  SPEAKER_00: So I just was fascinated as he explained, look, I'm a doctor, I get paid per episode, all right?
• 7:26
  SPEAKER_00: But my but my episode pay is based on the complexity of the episode.
• 7:33
  SPEAKER_00: So so if I can if I can create codes that become more complex and more of them, then when patient A comes to me next time, I get more money for that episode.
• 7:47
  SPEAKER_00: And when they come to me the next time, I get more money for that episode.
• 7:51
  SPEAKER_01: Wow.
• 7:52
  SPEAKER_00: And so the so so go ahead.
• 7:57
  SPEAKER_01: So when so for instance, you said if you have a low um RAFS, the cost is less.
• 8:03
  SPEAKER_01: So that means the cost, so the doctor gets paid less, like that, the doctor and the nurse and all them, that that trickles down to gets paid less, and I get charged less for that procedure, right?
• 8:14
  SPEAKER_01: So in that sense, that incentivizes me to stay healthy because if I have less labels ticked off, I have a lower RAFS level, and so my cost would be lower.
• 8:29
  SPEAKER_01: But at the same time, it incentivizes the doctor to write down more problems.
• 8:35
  SPEAKER_01: And this makes so much sense because when you know, like they don't really, at least in my experience, they don't really let you look at your medical history chart.
• 8:43
  SPEAKER_01: Like it's like fighting tooth and nail to be able to see your own chart.
• 8:48
  SPEAKER_01: And at one point I was able to see my chart, uh, because it well, I didn't see it, but it uh my I went, I changed doctors.
• 8:56
  SPEAKER_01: Okay, and the doctor that I changed to starts reading off all of these codes.
• 9:02
  SPEAKER_02: Wow.
• 9:02
  SPEAKER_02: Uh-huh.
• 9:03
  SPEAKER_01: Yeah.
• 9:03
  SPEAKER_01: All you know, when I was going through the medical system for decades trying to figure out what's wrong.
• 9:08
  SPEAKER_01: So the the each individual specialist and doctor that I saw never diagnosed me with anything, they never told me anything, you know.
• 9:16
  SPEAKER_01: They were like, Oh, well, now I'm gonna send you to this doctor, or well, now, you know, whatever.
• 9:20
  SPEAKER_01: Like, maybe that's in your head, right?
• 9:22
  SPEAKER_01: Come and find out, they were writing codes like diagnoses in my thing.
• 9:28
  SPEAKER_01: So, like this new doctor was like, Oh, okay, back in 20 such and such, you had fibromyalgia.
• 9:33
  SPEAKER_01: And I was like, No one has ever said that word to me.
• 9:36
  SPEAKER_01: Like, but these were all in my chart.
• 9:39
  SPEAKER_00: Yeah, yeah, yeah.
• 9:41
  SPEAKER_01: That makes so much sense now.
• 9:42
  SPEAKER_01: They made more money off me.
• 9:46
  SPEAKER_00: Now I I knew about these codes long time ago when I had an accident here on the farm.
• 9:53
  SPEAKER_00: I um I cut, I I was adjusting the the hay baler chute, and uh I had my finger down there.
• 10:01
  SPEAKER_00: Take a it and and it and it it fell down because I didn't get the chain hooked up the correct way, and it pinched the fat off of my little finger.
• 10:12
  SPEAKER_00: Off of my little finger.
• 10:13
  SPEAKER_00: So, you know, when I put my my two fingers are a little bit, you know, weird.
• 10:18
  SPEAKER_00: Okay.
• 10:19
  SPEAKER_00: It didn't hit any phone.
• 10:20
  SPEAKER_00: It just it just took all the fat off the little finger.
• 10:23
  SPEAKER_00: Okay, so you know, it was a hot day, and we found we found the the piece of finger, okay, on the ground and put it in a in a little you know plastic bag of ice, and I ran into the emergency room to to get it uh re uh attached.
• 10:38
  SPEAKER_00: Okay.
• 10:39
  SPEAKER_00: So the guy that did the that did the deed, uh, he he sewed it back on.
• 10:45
  SPEAKER_00: Well, it didn't take.
• 10:46
  SPEAKER_00: It didn't, because it was too, it was it was too hot, too far gone.
• 10:49
  SPEAKER_00: Okay, it wouldn't it wouldn't reheal.
• 10:50
  SPEAKER_00: So I've got this little you know physical anomaly.
• 10:53
  SPEAKER_00: It's my only physical anomaly.
• 10:54
  SPEAKER_00: Okay.
• 10:55
  SPEAKER_00: So um makes you special.
• 10:58
  SPEAKER_00: So anyway, um uh the insurance uh at the time this was this was long, you know, tree.
• 11:09
  SPEAKER_00: We were just starting, and we had a very high deductible.
• 11:12
  SPEAKER_00: We had we that was back when you could have like a$10,000 deductible.
• 11:17
  SPEAKER_00: And what we did was as soon as we had$10,000 in savings account, we went to a$10,000 deductible.
• 11:22
  SPEAKER_00: When we got$20,000 in a savings account, we went to a$20,000 deductible.
• 11:26
  SPEAKER_00: And that and that drops your premiums way down, okay?
• 11:29
  SPEAKER_00: So we get the bill for this thing, and it's of course it's below the deductible, because we had a real high deductible.
• 11:36
  SPEAKER_00: And and the and the code, so you know, the bill was really, really high.
• 11:42
  SPEAKER_00: It was it was, you know, I don't know what, uh$2,000 or something.
• 11:45
  SPEAKER_00: And you know, we're we're talking 40 years ago, or more than 40 years ago, okay?
• 11:50
  SPEAKER_00: And um, and I and and we, you know, we uh we we went to him, we said, this can't be right.
• 11:56
  SPEAKER_00: Well, we had a doctor friend who was able to get what the the doctor had put down as the code.
• 12:05
  SPEAKER_00: Well, he had the code book.
• 12:07
  SPEAKER_00: So, you know, it's this big, thick, it's a it's a it's like a code Bible, okay?
• 12:11
  SPEAKER_00: So he looks up the code.
• 12:13
  SPEAKER_00: He says, Oh, well, this code is for if if you have to skin graft and you have to cut, you have to cut a piece of skin and graft it on something else.
• 12:25
  SPEAKER_00: This is the wrong code because he didn't have to cut anything off.
• 12:28
  SPEAKER_00: You took him the piece of skin that was already, you know, it was it was uh he didn't have to do anything.
• 12:33
  SPEAKER_00: Yeah, he just had to slap it back on there and put stitches in it.
• 12:37
  SPEAKER_00: So he used the wrong code.
• 12:38
  SPEAKER_00: So we we fought them on it and appealed on it, and we and we looked up what the insurance company would pay for that code, or what, you know, what the normal market price was for that code.
• 12:50
  SPEAKER_00: Well, instead of 2,000, it was like it was like 600, okay?
• 12:54
  SPEAKER_00: Because you didn't have two wounds now.
• 12:56
  SPEAKER_00: You just had I just had one wound, okay?
• 12:59
  SPEAKER_00: One piece of skin, one wound.
• 13:01
  SPEAKER_00: He wasn't having having to go, well, where am I going to find another piece of skin to put on this guy's pinky?
• 13:06
  SPEAKER_00: You know, he wasn't having to do that.
• 13:09
  SPEAKER_00: So we went down and we paid them$600 and said, this is it.
• 13:14
  SPEAKER_00: He put the wrong code.
• 13:15
  SPEAKER_00: Well, they they tried to take us to court.
• 13:18
  SPEAKER_00: They fought us on it, and we we we we eventually won um and and and won it.
• 13:24
  SPEAKER_00: But that's how I got for the first time in my life, I got familiar with codes.
• 13:29
  SPEAKER_00: And there's there's thousands of them, okay?
• 13:32
  SPEAKER_00: Every procedure has a code.
• 13:34
  SPEAKER_00: So I want you to think about this, that that the the entire I'm gonna say it one more time, the RAFS, all right.
• 13:43
  SPEAKER_00: Um, you know, remember that risk adjusted factor score.
• 13:48
  SPEAKER_00: The risk adjusted factor score is the is the sum total of all of your procedure codes, um when they all get added up.
• 14:02
  SPEAKER_00: Okay.
• 14:04
  SPEAKER_00: So, you know, if I mean I I so so the more the more procedure codes you have and the more complex it is, the more insurance, the more insurance pays.
• 14:19
  SPEAKER_00: So there, so the incentive, here's the point, the incentive in the system is to create more and more complex codes and procedures, because then when that doctor opens the door and comes in to see me, he knows he's gonna be uh get a higher reimbursement.
• 14:37
  SPEAKER_00: And that, Sina, is why you can't get an answer for how much will this cost.
• 14:43
  SPEAKER_01: Wow.
• 14:43
  SPEAKER_00: Because it's all based on this.
• 14:45
  SPEAKER_00: So, so I want you to, I want I so I wrote down a couple of the things that this surgeon told me.
• 14:51
  SPEAKER_00: He said the only way that our current system can survive is if RASF scores begin going down.
• 15:04
  SPEAKER_00: You you the current system, he said, is going to be out of business by twenty thirty.
• 15:14
  SPEAKER_00: It it will simply implode.
• 15:16
  SPEAKER_00: It will simply implode.
• 15:18
  SPEAKER_00: And um, so what has to happen is that doctors have to begin getting paid to drop your code score.
• 15:42
  SPEAKER_01: Okay?
• 15:43
  SPEAKER_01: Yes.
• 15:44
  SPEAKER_01: When you first started this, I wrote down um and the doctors need to be incentivized when they help people heal.
• 15:51
  SPEAKER_01: Like the incentive should be placed on taking that person who's sick and helping them get better, and then they should get like a bonus.
• 15:59
  SPEAKER_01: Like they shouldn't get paid until they've done the job.
• 16:03
  SPEAKER_00: So so so what he said is he said, we're already seeing this, we're already seeing this, that that insurance companies are going to switch from a pay per episode because it's just running them out of business.
• 16:18
  SPEAKER_00: They can't, they can't keep up with these ever increasing, you know, episodic costs, the RF RAFS.
• 16:26
  SPEAKER_00: He said, We're already seeing this that where the insurance company is going to say, we're we're we're going to compensate the our our our our insurance plan is gonna give this amount per year for this person that has insurance.
• 16:43
  SPEAKER_00: So I have an insurance, and the company says, This is what you get per year.
• 16:47
  SPEAKER_00: And when that money runs out, there's no more money.
• 16:54
  SPEAKER_00: I mean, wow you don't get treat you don't get treatment.
• 16:57
  SPEAKER_00: And he said this he said this will be in place by 2030.
• 17:05
  SPEAKER_00: And if you aren't as a doctor collaborating in this new system, you'll be out of business.
• 17:11
  SPEAKER_01: Wow.
• 17:12
  SPEAKER_01: Well, okay, so they're going to are they trying to incentivize the doctors to heal people by capping how much they're willing to help the person who has the insurance?
• 17:26
  SPEAKER_00: Yes.
• 17:27
  SPEAKER_00: Yes.
• 17:27
  SPEAKER_00: So so so what happens then, and and look, I don't have all this fleshed out, and we you know in the conversation we didn't get it all fleshed out.
• 17:35
  SPEAKER_00: But but but but the the basic idea is that if if under my insurance plan, if I don't need to see the doctor, my my the doctor, the doctor gets uh a commission, you know, a royalty, a piece of that unexpended money.
• 18:00
  SPEAKER_01: Oh does the patient get some?
• 18:03
  SPEAKER_00: Like right, you should incentivize the people to I I guess the pay the patient gets incentivized just because you don't, you know, you're not sick.
• 18:11
  SPEAKER_01: But but we pay into insurance, and so we should get some of that back, you know?
• 18:18
  SPEAKER_00: That would be great.
• 18:20
  SPEAKER_00: That that's another whole discussion.
• 18:22
  SPEAKER_00: That's a whole discussion.
• 18:23
  SPEAKER_00: Um, but you know, think about like like for let's Australia.
• 18:28
  SPEAKER_00: Australia right now, I mean, this is not medical, it's it's college, but in Australia, you uh um you can go to college free, but the college does not get paid any tuition until you get a job, and depending on the income that you get from your job, the college gets paid a percentage of that.
• 18:57
  SPEAKER_00: So if you if yeah, yeah, yeah, this this is the way it's done.
• 19:00
  SPEAKER_00: So so if you get a hundred thousand dollar job, um, and and then you know the college gets, let's just say, 10% of it.
• 19:08
  SPEAKER_00: If you get a$40,000 job, the the the college gets 2% of it.
• 19:13
  SPEAKER_00: Okay.
• 19:13
  SPEAKER_00: So it's a sliding scale down.
• 19:15
  SPEAKER_00: The less money you earn, the less percentage you have, you know, comes out of that to pay for the college.
• 19:21
  SPEAKER_00: The point is, the college does not get paid until you become vocationally successful.
• 19:26
  SPEAKER_00: Now, you can get a free education, but the college does not get paid until you have a compensatable amount of money to commission back to the college.
• 19:39
  SPEAKER_00: Guess what that does?
• 19:41
  SPEAKER_00: That makes the college really keen to prepare you for a good vocation and to be successful, to be successful uh in the actual mastery of your subject, but also to be, you know, socially uh, you know, you know, whatever, you know, not a snowflake, uh, you know, to to to to have a good work access, to all these things that make you highly employable.
• 20:09
  SPEAKER_01: Yeah.
• 20:10
  SPEAKER_01: And it incentivizes them to help with job placement, right?
• 20:14
  SPEAKER_01: Instead of just there you go, here's your diploma, like they want to help.
• 20:18
  SPEAKER_01: How long do you know?
• 20:19
  SPEAKER_01: How long does that person who graduated and got the job, how long do they have to keep paying the university a percentage of their income?
• 20:28
  SPEAKER_00: Well, uh, I don't know that.
• 20:29
  SPEAKER_00: I I'm I mean, I have a lot of friends in Australia.
• 20:32
  SPEAKER_00: I've been there a lot of times.
• 20:33
  SPEAKER_00: Um I'm assuming that there is a you know that there is some sort of a dollar amount on on your education.
• 20:41
  SPEAKER_00: And and so when that dollar amount is satisfied, then you know, then it's then it's all gone.
• 20:47
  SPEAKER_00: Uh that that's my I don't know that.
• 20:50
  SPEAKER_00: But I'm I'm sure you're not, you know, you're not indentured for commission-based uh remuneration for life.
• 20:57
  SPEAKER_01: I'm sure it passes down to your your siblings.
• 21:01
  SPEAKER_01: So your kids are.
• 21:06
  SPEAKER_01: Oh, I don't want it, please don't give it to me.
• 21:09
  SPEAKER_01: Yeah.
• 21:11
  SPEAKER_01: Yeah but yeah, that's a totally different kind of incentive for that university than what we have here in America, for sure.
• 21:20
  SPEAKER_00: Yeah, yeah.
• 21:21
  SPEAKER_00: So so um, so that that was such an interesting conversation to learn to literally learn about this RAFS thing that that was, I mean, I knew that they had codes, but I didn't know that they built up over time and became and became the the remuneration algorithm plugged into the insurance.
• 21:47
  SPEAKER_00: It's almost like a racket when you look at it that way.
• 21:50
  SPEAKER_01: It it's almost like it is, and it for for us who really believe in not identifying with labels, you know, we've talked about.
• 22:00
  SPEAKER_01: That how a doctor gives you a label and it it stays with you for life, and it's literally true, it stays on your record forever and they just accumulate.
• 22:09
  SPEAKER_01: Like right, oh my gosh.
• 22:11
  SPEAKER_01: But I I think that this is really surprising to me.
• 22:15
  SPEAKER_01: I mean, it makes a lot of sense once you lay it out based on what I've seen and experienced.
• 22:19
  SPEAKER_01: But this is really surprising to me, but not as surprising as the whole by 2030, they're gonna cap how much they're gonna they're willing to help you.
• 22:27
  SPEAKER_01: It makes sense, but I would have suspected the insurance companies would have first asked for a bailout before they did that.
• 22:35
  SPEAKER_01: You know?
• 22:36
  SPEAKER_00: Well, they they might they might, they might.
• 22:38
  SPEAKER_00: What what he was pointing out was that the the trajectory, the the cost of insurance, the cost of health care, the trajectory is is on a you know, is heading for a cliff.
• 22:51
  SPEAKER_02: Yeah.
• 22:52
  SPEAKER_00: And uh and and you just can't.
• 22:54
  SPEAKER_00: I mean, look, look at look at look at how much health care dominates people's conversations today.
• 23:01
  SPEAKER_00: I mean, people won't retire.
• 23:03
  SPEAKER_00: They don't retire because I don't want to lose my health insurance.
• 23:06
  SPEAKER_00: They or they stay in the job that they hate this job because of insurance.
• 23:11
  SPEAKER_00: I mean, it it it dominates ever it dominates everything.
• 23:16
  SPEAKER_00: And um, and it's just it's just incredible.
• 23:20
  SPEAKER_00: So so we go from that from that conversation.
• 23:24
  SPEAKER_00: Uh then I was at this um healthy Tennessee uh summit, first one they've had there, and it's one of these um, I know you're familiar with blue zones.
• 23:35
  SPEAKER_00: Um and so it's it's an attempt in this in this the um around um pigeonforge, you know, which is a tourist trap.
• 23:46
  SPEAKER_00: That county, severe county, which where is where Pigeon Forge is, they have a hundred thousand population, so relatively rural, a hundred thousand population in a whole county.
• 24:00
  SPEAKER_00: And you ready for this?
• 24:02
  SPEAKER_00: They get ten million visitors a year.
• 24:06
  SPEAKER_00: Wow, ten million tourists a year.
• 24:11
  unknown: Wow.
• 24:12
  SPEAKER_00: So they they go as far out as nine counties to get the workers needed to handle the 10 million tourists that come into Pigeon Forge.
• 24:26
  SPEAKER_01: Wow.
• 24:27
  SPEAKER_00: And let me tell you, they love Dolly Parton.
• 24:32
  SPEAKER_00: They love Dolly Parton.
• 24:35
  SPEAKER_00: Uh everybody there loves Dolly Parton, and I think Dolly loves all of them.
• 24:41
  SPEAKER_00: I mean, she she's a she's an icon, truly, in you know, in the area.
• 24:45
  SPEAKER_00: I mean, she just you know, she gives free books.
• 24:48
  SPEAKER_01: Did you know that?
• 24:48
  SPEAKER_00: Yeah, yeah, yeah, yeah.
• 24:50
  SPEAKER_01: Yeah, to the kids.
• 24:50
  SPEAKER_01: Even here in Georgia, um, you sign up for it, and like her, you know, foundation or whatever it is, they send uh like preschoolers and such a free book like every month to encourage the littles to start reading.
• 25:05
  SPEAKER_00: Yeah, yeah.
• 25:06
  SPEAKER_00: So so one of the so most of the speakers were were doctors or you know, healthcare professionals, and um, and so this whole healthcare incentive was was dominated the the the day and a half conference.
• 25:25
  SPEAKER_00: I I was I was the only non-doctor, I was I was the only farmer that spoke for sure.
• 25:31
  SPEAKER_00: But um and and one of the one of the speakers put up a slide from Sweden, and uh he was trying to make a point.
• 25:43
  SPEAKER_00: He he had this picture of a of a traffic of a street in a in a village in in a city in Sweden, and it was uh it was a speed limit sign, camera on top of the speed limit sign, and it was taking pictures of license tags.
• 25:58
  SPEAKER_00: If you exceeded the speed limit of a certain amount, then you know you'd you'd you'd get issued a fine.
• 26:03
  SPEAKER_00: You have to pay a traffic ticket, okay?
• 26:05
  SPEAKER_00: A speeding ticket.
• 26:08
  SPEAKER_00: What's interesting is that if you are the speed limit or below the license tag, your number goes into a lottery pot.
• 26:21
  SPEAKER_00: And every month they pick one license tag from that pot, and it gets a um a win, it gets a financial reward that's paid for out of the fine pot.
• 26:38
  SPEAKER_00: Whoa.
• 26:39
  SPEAKER_00: Yeah.
• 26:40
  SPEAKER_00: And I want that.
• 26:43
  SPEAKER_00: Yeah, yeah, yeah.
• 26:45
  SPEAKER_00: So um, you know, think about the number of times you've gone through one of these things and you're trying to, you know, stay the speed limit.
• 26:53
  SPEAKER_00: Um, and wouldn't it be nice to get rewarded for doing something good?
• 26:58
  SPEAKER_00: So the whole point of this was here is a here is a creative idea to, yeah, you you use a stick, but what you're really doing is using sugar.
• 27:09
  SPEAKER_00: You know, you're actually using an attracting an incentive to get people to do what's right.
• 27:17
  SPEAKER_00: And and and and his point was that in America's healthcare system, there is no incentive, there is no financial incentive for a doctor to think creatively, to to keep to keep you from coming back.
• 27:38
  SPEAKER_00: There is no incentive.
• 27:39
  SPEAKER_00: In fact, one of the speakers was a hospital administrator, he's over 716 beds, and he said, the ugly truth is every time we have an empty bed, we lose money.
• 27:56
  SPEAKER_00: I mean, when you when you think about that as a health healthcare as a business, okay, when you think about it as a business, and you have 716 beds at you know, whatever,$2,000 a night, I mean, you know, it's a it's a really sophisticated hotel, okay?
• 28:18
  SPEAKER_00: And and and and if you if you have 30 unused beds, you just lost sixty thousand dollars.
• 28:27
  SPEAKER_01: Yeah.
• 28:30
  SPEAKER_00: And so what he was pointing out was at every step of the way from the doctor visit, you know, with the with the um frequent, you know, the scores that we talked about.
• 28:45
  SPEAKER_00: The adjusted scores.
• 28:48
  SPEAKER_00: I've already forgotten it.
• 28:49
  SPEAKER_00: R A F, I remember R-A Risk adjusted factor score, okay?
• 28:55
  SPEAKER_00: RAFS, risk adjusted factor score.
• 28:58
  SPEAKER_00: I just you know that was a a bit of um elderly mind abuse.
• 29:05
  SPEAKER_00: Um you know, the combination of that at the at the doctor level, at you know, the very like, you know, the doctor visit level, all the way to the hospital at the at the actual bed level of the business, the whole system is financially incentivized for additional activity, not reduction in activity.
• 29:30
  SPEAKER_01: Yeah.
• 29:31
  SPEAKER_01: Yeah.
• 29:32
  SPEAKER_01: You know, I actually feel bad when I go to, so you know, we have a like a family doctor that and we go to the family doctor just once a year to have the well checks, because even though in this state they say that they're optional, like it's voluntary, we know that they're not.
• 29:51
  SPEAKER_01: So we go and just get the box checked that we did the well check.
• 29:55
  SPEAKER_01: And I feel bad every time that we go because we they lose money on my family.
• 30:03
  SPEAKER_01: And they know they lose money on my family.
• 30:06
  SPEAKER_01: You know, we don't take the prescription drugs, like we don't need any of these special appointments or extra appointments.
• 30:11
  SPEAKER_01: We don't even go there when we have sniffles or whatever.
• 30:14
  SPEAKER_01: And they know that.
• 30:15
  SPEAKER_01: And they're they're the doctor is very gracious and loves us.
• 30:19
  SPEAKER_01: But I do when we're checking out, I feel guilty because normally you should have people check out, they're like, okay, like so let's schedule your next appointment or whatever.
• 30:28
  SPEAKER_01: And when we check out, they're like, okay, we'll see you in a year.
• 30:31
  SPEAKER_01: Like we feel bad because we are costing them money.
• 30:35
  SPEAKER_01: And I was like, there's something wrong with that.
• 30:37
  SPEAKER_01: It we they should be high-fiving us.
• 30:39
  SPEAKER_01: Woo-hoo, like you just made me money because you're so healthy.
• 30:43
  SPEAKER_01: I don't need to see you for a year, like you know, right.
• 30:46
  SPEAKER_01: It's it's backward.
• 30:48
  SPEAKER_00: Yeah, absolutely.
• 30:49
  SPEAKER_00: And and and this whole this whole thing has developed.
• 30:54
  SPEAKER_00: I mean, you know the history of this a lot better than I, and I've learned most of what I know from you on the history.
• 31:00
  SPEAKER_00: But if you go back to before the Flexner report, which again, we've talked about numerous times on this podcast, the the hospitals and the especially the medical schools were essentially, you know, some genius healthcare guy or gal figured out how to solve a problem, you know, and they were kind of guru, you know, like like guru clinic, glute guru medical schools, you know, and most of them were used homeopathy and all sorts of things, you know, back in the day.
• 31:40
  SPEAKER_00: But but they were all built around somebody who had demonstrated um a it was a meritocracy.
• 31:48
  SPEAKER_00: It would they had demonstrated an ability to solve tuberculosis or cure, you know, measles or whatever.
• 31:57
  SPEAKER_00: And and once once we went to the and everybody paid a doctor out of your own pocket, you know, you you went and you paid a doctor out of your own pocket.
• 32:06
  SPEAKER_00: And so um, so it was a very it was a the doctor got paid for services, but the person paying for it wasn't incentivized to overuse those services.
• 32:23
  SPEAKER_00: Yeah now with so much of this money, think about how much money changes hands and the average person never even sees it.
• 32:35
  SPEAKER_00: I mean, you don't even see it come out of your paycheck, you don't, or wherever it is, you don't see it, or Obamacare or whatever, and and it just well, I go, I get this service, but nobody ever sees the money, you know, no nobody ever sees, but let me tell you, the health industry does see the money.
• 32:56
  SPEAKER_00: And and to them, this is a business, and they've got to keep that door swinging and keep the beds filled, and and and you know, and keep the services being used.
• 33:07
  SPEAKER_00: So um one of the one of the other speakers then was um was the guy uh Dan Butner, who was instrumental in developing the blue zone, the blue zone um um discovery, if you will.
• 33:29
  SPEAKER_00: And um this was a multi-year where they went around the country, around the world looking for the places where there were centenarians or at least people over 90, a lot of them living healthy, healthy into old age.
• 33:46
  SPEAKER_00: Uh you know, they didn't have cancer, heart disease, all this.
• 33:49
  SPEAKER_00: They they were, you know, they they lived until until they died.
• 33:52
  SPEAKER_00: Um but they lived, they lived, you know, uh happily, uh functionally, let's say, until they died.
• 34:00
  SPEAKER_00: And so um, so for our for our listeners, if you're not familiar with the blue zone uh concept, they found five areas, and here are the they call they call them the power nine.
• 34:14
  SPEAKER_00: The power nine.
• 34:16
  SPEAKER_00: Number one, move naturally.
• 34:18
  SPEAKER_00: So they said don't go to the gym, but live a lifestyle of movement.
• 34:22
  SPEAKER_00: And most of these communities around the world um were active gardeners, they had to walk up and down a lot of steps, and they they walked a lot of places, they didn't drive.
• 34:33
  SPEAKER_00: Um, you know, there was only one uh in in California that was a U.S.
• 34:38
  SPEAKER_00: Everything else was foreign, but move naturally.
• 34:41
  SPEAKER_00: Um, number two is purpose.
• 34:44
  SPEAKER_00: Um you know, why I wake up in the morning.
• 34:46
  SPEAKER_00: Do you know why you wake up in the morning?
• 34:49
  SPEAKER_00: You know, what what gives you purpose?
• 34:52
  SPEAKER_00: Um and and what they said is that research shows that a sense of purpose is worth up to seven years of extra life expectancy.
• 35:01
  SPEAKER_00: Wow.
• 35:02
  SPEAKER_00: That's huge, huge.
• 35:03
  SPEAKER_00: That is huge.
• 35:05
  SPEAKER_00: Number three, downshift.
• 35:08
  SPEAKER_00: So shed stress.
• 35:11
  SPEAKER_00: Um you can meditate, you can pray, you can um they they were big on on a religious, some sort of religious spiritual life.
• 35:23
  SPEAKER_00: Uh that that's a that's a big deal.
• 35:26
  SPEAKER_00: Um, so so be able to shed stress.
• 35:29
  SPEAKER_00: Uh number four, the 80% rule.
• 35:34
  SPEAKER_00: So the idea here is that you stop eating when your stomach is 80% full.
• 35:40
  SPEAKER_00: Don't just gorge yourself.
• 35:42
  SPEAKER_00: Um that that if you if you do that, uh what they said is their studies showed that if you just did that, just eat till you're 80% and then back away from the table.
• 35:56
  SPEAKER_00: The average American or the average person, the average American who adopts this loses 17 pounds in the first year.
• 36:04
  SPEAKER_00: Wow.
• 36:06
  SPEAKER_00: Just that's huge.
• 36:07
  SPEAKER_00: Yeah, just by not going until you're full full.
• 36:10
  SPEAKER_01: Just imagine carrying around seven a 17-pound weight with you.
• 36:14
  SPEAKER_01: Oh, yeah.
• 36:16
  SPEAKER_01: No, right.
• 36:16
  SPEAKER_01: I wondered.
• 36:17
  SPEAKER_01: Um, you know, so these are commonalities amongst the centenarians, uh centenarians, but I wonder if they stop, if they use the 80% rule on holidays.
• 36:28
  SPEAKER_01: Like, would they stop too?
• 36:30
  SPEAKER_01: Or like do they ever binge during one of these, you know, festive times?
• 36:34
  SPEAKER_00: Yeah, I I I have I have no idea.
• 36:37
  SPEAKER_00: Um, yeah, I don't I don't have any idea.
• 36:39
  SPEAKER_00: Of course, you know, I I've used the 80% rule to uh about about you know being perfect on your food, that that the 20% lets you enjoy your niece's you know Walmart birthday cake.
• 36:50
  SPEAKER_00: Um, you know, uh the 20%.
• 36:52
  SPEAKER_00: But anyway, yeah, uh so push away.
• 36:54
  SPEAKER_00: Number five, number five is um a slant toward plants.
• 37:00
  SPEAKER_00: Um and of course, this this vexes my right to soul as a livestock farmer.
• 37:05
  SPEAKER_00: In fact, uh, in other words, um eat eat eat um all different kinds of beans and and uh use meat more a little more sparingly.
• 37:20
  SPEAKER_01: Um and I'll add that this is the this is the main um tenet, if you will, that is highly debated.
• 37:31
  SPEAKER_00: Yes.
• 37:32
  SPEAKER_01: That this is the one where people have gone in and said they cherry-picked the footage that they showed, and you know, on on and on and on.
• 37:40
  SPEAKER_00: So yeah, you know, so so there's debate.
• 37:43
  SPEAKER_00: In fact, in fact, at this at this uh um conference, um I ran into a guy who had lost 180 pounds and he looked fit as a fiddle.
• 37:53
  SPEAKER_00: Uh he was younger than I am.
• 37:55
  SPEAKER_00: Of course, a lot of people are younger than I am now, but um anyway, he was 180, and I said, How'd you do it?
• 38:00
  SPEAKER_00: He said, I went I went carnivore, I eat one meal a day and nothing but meat.
• 38:07
  SPEAKER_01: Yeah.
• 38:07
  SPEAKER_00: And and he he he he said, I've never felt better.
• 38:10
  SPEAKER_00: And um, and and I'm not ready to say that that's the answer for everybody, but yeah, this this is the one that yeah, I'm you know, it it it it um it it vexes my soul a little bit to to hear that anyway.
• 38:22
  SPEAKER_00: Um number six, wine at five.
• 38:26
  SPEAKER_00: Uh drink a little bit of alcohol moderately, especially with friends.
• 38:33
  SPEAKER_00: Um that definitely these moderate drinkers tend to outlive non-drinkers.
• 38:39
  SPEAKER_00: That's what they found.
• 38:40
  SPEAKER_00: Number seven is the right crop.
• 38:43
  SPEAKER_01: Can I add one thing to that real quickly?
• 38:45
  SPEAKER_01: Because um, on the wine part, that I was looking through the scientific literature and for uh another podcast we recorded about examples of diseases being reversed.
• 38:58
  SPEAKER_01: And in in some of these studies, they pointed out different risk factors for developing the disease, but also they pointed out um different behaviors that may have prevented some of these diseases.
• 39:12
  SPEAKER_01: And would you know that in in several studies of rheumatoid arthritis and even one review, they said that a behavior that you could do to reduce your chance of getting rheumatoid arthritis is moderate drinking.
• 39:32
  SPEAKER_02: Wow.
• 39:33
  SPEAKER_01: Can you believe that?
• 39:34
  SPEAKER_01: I was surprised.
• 39:35
  SPEAKER_01: I was like, oh my gosh, it's in the literature.
• 39:37
  SPEAKER_01: Meanwhile, you got the US Surgeon General saying that there needs to be a label on alcohol for cancer warning and such.
• 39:44
  SPEAKER_01: But this just tells you that it's and it is so individualized.
• 39:47
  SPEAKER_01: But you can find this data in the scientific literature showing some of these cases for some people, it does prevent illnesses.
• 39:56
  SPEAKER_00: Absolutely.
• 39:57
  SPEAKER_00: Well, you know, I mean, I mean, the the famous one in the in the Bible is Paul telling Timothy and Timothy, take a little wine for your stomach.
• 40:04
  SPEAKER_00: Apparently, Timothy's stomach was upset or was having stomach issues, and Paul said, drink a little wine for your stomach.
• 40:09
  SPEAKER_00: So yeah, I think I think there is um there is definitely some some advantage, but very moderate.
• 40:16
  SPEAKER_01: And you said with friends, so not by yourself.
• 40:19
  SPEAKER_00: Like yeah, yeah.
• 40:21
  SPEAKER_00: Don't go, don't go crying your beer.
• 40:23
  SPEAKER_00: Yeah, this is not uh this is this is um and it's wine is not beer.
• 40:28
  SPEAKER_01: Yeah, it's wine, yes, for like the polyphenols and such.
• 40:31
  SPEAKER_01: That's my new thing.
• 40:32
  SPEAKER_01: I can tell Donnie, well, Joel said at five, whether anyone's here or not, I'm supposed to have some wine.
• 40:39
  SPEAKER_00: No, yeah, right, right.
• 40:41
  SPEAKER_00: So, so in in this case, the the frit the French beat the Germans.
• 40:45
  SPEAKER_00: Um French wine beat the German beer.
• 40:48
  SPEAKER_00: Okay.
• 40:48
  SPEAKER_00: Uh number seven, the right tribe.
• 40:51
  SPEAKER_00: Okay.
• 40:52
  SPEAKER_00: So so this was big.
• 40:54
  SPEAKER_00: This was uh about social circles.
• 40:57
  SPEAKER_00: And um and the question was um, do you have do you have a friend, two friends, three friends for life?
• 41:11
  SPEAKER_00: And um and and so they uh yeah, the right track you you gotta you gotta cultivate a couple friends.
• 41:18
  SPEAKER_00: Number eight is community.
• 41:20
  SPEAKER_00: Um you should be and and this had a s a very significant religious uh foundation to it, that you should be doing uh said research has shown that attending faith-based services four times a month adds four to fourteen years of life expectancy.
• 41:41
  SPEAKER_00: And and said that the choice of denomination doesn't seem to matter.
• 41:45
  SPEAKER_00: In other words, it's just that you're recognizing something bigger than me.
• 41:50
  SPEAKER_00: And you're and you're doing it in community, you're doing it in a in a social community setting.
• 41:54
  SPEAKER_01: And then finally, number I was just gonna add, which makes a lot of sense because even when people are trying to heal, there is a point where we tell them you have to take the focus off yourself, you have to take it on something greater because whatever you focus your attention on, your energy goes to that, right?
• 42:10
  SPEAKER_01: And it builds it.
• 42:11
  SPEAKER_01: So you can build more sickness by focusing too much on your health, talking about it too much.
• 42:16
  SPEAKER_01: You have to look outside yourself.
• 42:17
  SPEAKER_01: So that that makes a lot of sense to go and look outside in community, look for something that's bigger than yourself, take your mind off it, direct that attention to something positive.
• 42:28
  SPEAKER_00: Yeah, yeah.
• 42:29
  SPEAKER_00: And the final one, number nine, is loved ones first.
• 42:33
  SPEAKER_00: Um life, a life partner can add up to three years to life expectancy.
• 42:39
  SPEAKER_00: Um, they invest in, you know, children.
• 42:42
  SPEAKER_00: Um, and and this it this includes this includes taking care of your elders too.
• 42:48
  SPEAKER_00: Uh so it's both yes, both directions, uh up and down.
• 42:52
  SPEAKER_00: But um uh he then he then said, here are the eight questions that determine your longevity.
• 43:00
  SPEAKER_01: Oh, I'm ready.
• 43:00
  SPEAKER_01: I got a pencil.
• 43:01
  SPEAKER_01: I'm gonna write down my answers to see.
• 43:03
  SPEAKER_01: Wait, do you have a way to score it?
• 43:06
  SPEAKER_00: Um, yeah, well, well, if if you get all eight of them, yes, okay.
• 43:11
  SPEAKER_00: Um uh then your chances of reaching 90 are extremely high.
• 43:16
  SPEAKER_01: Okay.
• 43:17
  SPEAKER_01: Can you tell I've been indoctrinated by the school system?
• 43:21
  SPEAKER_01: Because I'm like, I got my paper and paper and pencil.
• 43:23
  SPEAKER_01: What's the scoring system?
• 43:25
  SPEAKER_00: Like all right, so here it is.
• 43:28
  SPEAKER_00: So um, yeah, and so I'm assuming, I mean, he didn't go down to all the scoring, but if it's seven or six or five or whatever, you know, it goes down, down, down.
• 43:36
  SPEAKER_00: All right, so here are the questions.
• 43:37
  SPEAKER_00: Um, number one is do you get uh at least seven hours of sleep five nights per week?
• 43:48
  SPEAKER_01: Yes.
• 43:50
  SPEAKER_01: Do you wait?
• 43:51
  SPEAKER_01: Are we both answering?
• 43:52
  SPEAKER_01: Okay, so yeah.
• 43:54
  SPEAKER_00: Yeah, yeah.
• 43:55
  SPEAKER_00: Well, yeah, I already did it, so I I know, yeah.
• 43:58
  SPEAKER_00: Yeah, so I do.
• 43:58
  SPEAKER_00: All right.
• 43:59
  SPEAKER_00: Number two.
• 44:00
  SPEAKER_01: Wait, I'm curious, how much sleep do you think you get on average a night?
• 44:04
  SPEAKER_01: And does it change seasonally?
• 44:06
  SPEAKER_00: Yeah, it does change seasonally, but for sure during the you know the late fall, winter, early spring, um, man, I get eight, eight and a half, even up to nine.
• 44:18
  SPEAKER_01: Yeah, I'm the same.
• 44:20
  SPEAKER_00: And and and listen, Cena, when I, you know, I do a lot of traveling.
• 44:23
  SPEAKER_00: I'm traveling all the time.
• 44:25
  SPEAKER_00: And I've found that for me when I travel, sleep is twice as valuable as food.
• 44:32
  SPEAKER_00: So I often when I travel, I actually fast.
• 44:35
  SPEAKER_00: I'll I'll sometimes go.
• 44:37
  SPEAKER_00: I just did another, you know, I do two days, uh, 48 hours without eating.
• 44:42
  SPEAKER_00: And um, but man, if I have a chance to sleep, if I can sleep 10 hours, you know, when I'm on the road, like, you know, say I get in at six o'clock in the evening.
• 44:52
  SPEAKER_00: If I can, if I can go to bed at eight, and let's say I don't have to get up until seven because the conference starts at eight, um, I do it.
• 45:00
  SPEAKER_00: I do it.
• 45:01
  SPEAKER_00: I I do that.
• 45:02
  SPEAKER_00: Um, yeah, people ask, how do you, you know, how do you Roy Road Warriors, you know, because I'm I'm out, you know, multiple times a month, and and um people say, hey, you know, how do you do that?
• 45:12
  SPEAKER_00: Well, I've learned that for me it's that sleep, sleep more than food.
• 45:16
  SPEAKER_00: I mean, I eat really well at home, so I got I got plenty of you know extra to carry uh when I'm when I'm gone.
• 45:23
  SPEAKER_00: All right.
• 45:24
  SPEAKER_00: So uh number two.
• 45:26
  SPEAKER_00: Number two, do you move 45 minutes every day?
• 45:32
  SPEAKER_00: Do you move 45 minutes every day?
• 45:35
  SPEAKER_00: And this is natural movement, yeah.
• 45:37
  SPEAKER_00: Yeah, it doesn't mean you're working up a sweat.
• 45:39
  SPEAKER_00: It just it just means that you're you know you're you're actively moving.
• 45:42
  SPEAKER_00: And and and I I found that I don't know about you, but that seems awfully low to me.
• 45:48
  SPEAKER_00: 45 minutes, but but but he did say every day.
• 45:52
  SPEAKER_00: In other words, this is not a one-hour workout in the gym three days a week equivalent.
• 45:59
  SPEAKER_00: It's it's every day, every day, move every day.
• 46:02
  SPEAKER_01: Okay, well, you know, a lot of people do.
• 46:04
  SPEAKER_01: They wake up and then they get in the car, they drive to work, they sit in the office, get back in the car, drive home.
• 46:11
  SPEAKER_01: So I can see how you want to get 45 minutes of movement, of natural movement, you know.
• 46:16
  SPEAKER_01: But yeah, but my answer is yes.
• 46:18
  SPEAKER_01: I mean, I chase kids around all day.
• 46:20
  SPEAKER_00: It's like yeah, yeah, yeah.
• 46:22
  SPEAKER_00: Okay, number three.
• 46:24
  SPEAKER_00: Uh, do you um do you get three servings of vegetables per day?
• 46:32
  SPEAKER_01: Well, I would say that that's not counted as part of my test because I don't agree with necessarily his number five slant.
• 46:41
  SPEAKER_00: That was the that was the one that pushed me too.
• 46:44
  SPEAKER_00: Uh uh in general, I would say yes to that, but I'm gonna say my good pastured eggs and uh pigorator pork sausage for breakfast is gonna be gonna be good with the with the vegetables.
• 46:57
  SPEAKER_01: So yes, I claim in individuality, and so I claim a yes.
• 47:02
  SPEAKER_00: Yes, I'm I'm I'm totally I'm totally with you.
• 47:05
  SPEAKER_00: Yes, yes.
• 47:06
  SPEAKER_00: All right.
• 47:06
  SPEAKER_00: Number four, oh, you'll love this one.
• 47:08
  SPEAKER_00: Um, do you abstain from unprotected sex with strangers?
• 47:15
  SPEAKER_01: We should have put a cautionary warning.
• 47:18
  SPEAKER_01: This episode's not for kids.
• 47:21
  SPEAKER_00: Well, you know what was funny?
• 47:23
  SPEAKER_00: He said when he did that in um like Palm Beach, the whole he was doing he was doing a presentation there or some sort of conference in in Florida on the beach, and you know, 200 people in the room, and everything just got silent when he asked that, and they said in a month crazy, crazy.
• 47:46
  SPEAKER_00: All right, uh, that's the only one's kind of risque.
• 47:49
  SPEAKER_00: All right, number five.
• 47:50
  SPEAKER_00: Do you have three good friends with a meaningful relationship?
• 47:58
  SPEAKER_01: Yes.
• 48:00
  SPEAKER_00: Good.
• 48:01
  SPEAKER_00: Yeah, I mean this is all about um like they they they did a bunch of uh graphs about stress factors and um and and poverty.
• 48:16
  SPEAKER_00: And one of the one of the um um speakers pointed out that half of Americans don't have enough financial and social equity to handle a flat tire.
• 48:40
  SPEAKER_00: Oh wow.
• 48:42
  SPEAKER_00: In other words, do you have a f if you have a flat tire and do you have a friend that you can call and get you to work?
• 48:50
  SPEAKER_00: This becomes a huge stress factor.
• 48:52
  SPEAKER_00: Yeah you know, uh you're you're you're in a you're in a um a singular situation.
• 48:58
  SPEAKER_00: Number six.
• 48:59
  SPEAKER_00: Number six, uh do you belong to a faith-based community and attend regularly?
• 49:08
  SPEAKER_01: Well, I guess that depends on something.
• 49:10
  SPEAKER_01: Oh, oh, of something.
• 49:11
  SPEAKER_01: Then yes.
• 49:13
  SPEAKER_00: A faith-based uh something.
• 49:15
  SPEAKER_00: All right.
• 49:15
  SPEAKER_00: Uh number seven, have you s um have you not smoked in the last five years?
• 49:24
  SPEAKER_01: Have I not?
• 49:25
  SPEAKER_01: Oh yes.
• 49:26
  SPEAKER_01: I well, I don't smoke.
• 49:27
  SPEAKER_01: So I'm like, I don't like when they put something like a knot in it.
• 49:30
  SPEAKER_01: I'm like, wait, okay, am I interpreting that question right?
• 49:33
  SPEAKER_01: But I I've never smoked.
• 49:34
  SPEAKER_00: So so the the the the positive answer here here is I haven't smoked in the last five years.
• 49:40
  SPEAKER_00: Yeah, yeah.
• 49:41
  SPEAKER_00: Um, and number eight, the final one, and and by inter interestingly, this was the most this is he said this is the biggest and most powerful of all the questions.
• 49:51
  SPEAKER_00: Do you believe and have a desire to reach 90 healthy?
• 49:58
  SPEAKER_01: Oh yeah.
• 49:59
  SPEAKER_01: I mean, you know, I already promised my teenage son that we're gonna live to 126.
• 50:06
  SPEAKER_02: So oh my, oh my, I'm not sure.
• 50:09
  SPEAKER_01: We're gonna live we're gonna live well to 126, be vibrant and healthy and independent until the final day.
• 50:19
  SPEAKER_00: Yeah.
• 50:19
  SPEAKER_01: So I said yes to all of them.
• 50:21
  SPEAKER_00: Yeah, yeah, I I did too.
• 50:23
  SPEAKER_00: I did too.
• 50:24
  SPEAKER_00: And there were only in the room of a couple hundred people.
• 50:27
  SPEAKER_00: I think when they at when he asked for a raise of hands of how many had uh all eight yeses, I think there were only five of us.
• 50:34
  SPEAKER_00: Wow.
• 50:35
  SPEAKER_00: In the whole room that could answer yes to all five of them.
• 50:39
  SPEAKER_00: So that was um that was interesting.
• 50:43
  SPEAKER_01: Yeah, that's eye-opening right there.
• 50:45
  SPEAKER_00: Yeah, he said your sense of identity is a self-fulfilling prophecy.
• 50:51
  SPEAKER_01: Ooh, that's so good.
• 50:53
  SPEAKER_00: Your sense of identity is a self-fulfilling prophecy.
• 50:58
  SPEAKER_01: And um that's like we've talked about that before.
• 51:01
  SPEAKER_01: That what you and this is biblical, that what you think, what you believe, what you speak is what you become.
• 51:09
  SPEAKER_00: Yeah.
• 51:09
  SPEAKER_00: He said, he said last year, um, so so they they conduct this uh happiness index, this happiness um index, and last year for the first time, the US fell out of the top 20 countries for a happiness index.
• 51:25
  SPEAKER_01: Oh wow.
• 51:26
  SPEAKER_00: And so what's happening is that um that the midlife crisis, the midlife crisis is now hitting Americans 20 years prematurely.
• 51:42
  SPEAKER_00: Oh wow.
• 51:44
  SPEAKER_00: So so this is why teens, late teens, 18, 19, 20, 21, are hitting what would normally be their early 40s, you know, midlife crisis that you read about, they're hitting it at 20.
• 52:00
  SPEAKER_00: And this is one of the things that's creating such a such a huge um health problem.
• 52:08
  SPEAKER_00: Um then there was a there was a panel of different folks, and um one of them was in the school system, and she said that vaping is now a huge issue.
• 52:24
  SPEAKER_00: Fourth graders, get this.
• 52:27
  SPEAKER_00: Fourth graders are vaping on the playground with stuff they brought from home.
• 52:32
  SPEAKER_01: Oh my goodness.
• 52:34
  SPEAKER_00: Vaping is cleared down in the elementary school.
• 52:36
  SPEAKER_01: Wow.
• 52:38
  SPEAKER_00: Listen to this one 81.
• 52:40
  SPEAKER_00: So these were these were um this was a school administrator, they've done these surveys.
• 52:44
  SPEAKER_00: 81% of high school students are not physically active, have were not physically active 60 minutes per day in seven days of a week, which includes a whole weekend.
• 53:00
  SPEAKER_00: 81% of high school students are not physically active 60 minutes a day in any of the seven days in a week.
• 53:11
  SPEAKER_01: Oh wow, that's crazy because I know I'm thinking back to when I was in high school, junior high, elementary school.
• 53:18
  SPEAKER_01: We were always active, you know.
• 53:20
  SPEAKER_01: Right.
• 53:21
  SPEAKER_01: I mean, you had PE, which made you do move your body, and then we were all involved in some kind of sport or extracurricular activity, or we would um we would also bike like to and from school, like oh yeah, you know.
• 53:35
  SPEAKER_00: Yeah, yeah.
• 53:36
  SPEAKER_01: I mean, we were always doing we'd walk to our friends' houses after school or whatever, like oh yeah.
• 53:42
  SPEAKER_01: This is crazy.
• 53:44
  SPEAKER_01: I didn't realize how far removed I was from what's happening, right?
• 53:49
  SPEAKER_00: Um, 77% of high school students did not eat breakfast seven days in a week.
• 53:57
  SPEAKER_01: Is that because they didn't want to or they couldn't afford it?
• 54:00
  SPEAKER_00: Who knows?
• 54:01
  SPEAKER_00: Who knows?
• 54:01
  SPEAKER_00: I don't know.
• 54:02
  SPEAKER_00: All right, listen to this.
• 54:03
  SPEAKER_00: The top non-academic needs in schools, the top non-academic needs in schools.
• 54:10
  SPEAKER_00: Number one, you want to take a guess at these?
• 54:13
  SPEAKER_00: This this is kind of fun.
• 54:15
  SPEAKER_00: So wait, so this is what the top the top non-academic needs.
• 54:19
  SPEAKER_00: So you got a school.
• 54:20
  SPEAKER_00: Oh what's the top?
• 54:22
  SPEAKER_00: So we're not talking about science and math and English.
• 54:24
  SPEAKER_00: We're talking about what what's the top non-academic need in this school, the biggest issue we're do we're dealing with in this school that's not academic.
• 54:33
  SPEAKER_01: Is this from the student's perspective or the administrator?
• 54:37
  SPEAKER_00: The whole whole the whole school, no, the whole school.
• 54:40
  SPEAKER_00: Oh uh, you know, you're you're you're a school, you're a school administrator, okay?
• 54:44
  SPEAKER_00: Here's my here's my biggest problem.
• 54:47
  SPEAKER_01: Okay, I would guess that it's probably kids on their phones.
• 54:52
  SPEAKER_01: Something with electronics.
• 54:54
  SPEAKER_00: Yeah, okay.
• 54:55
  SPEAKER_00: Uh number one is mental health.
• 54:58
  SPEAKER_01: Oh, all right.
• 54:59
  SPEAKER_01: Well, those tied together.
• 55:04
  SPEAKER_00: Yeah, you were close enough.
• 55:05
  SPEAKER_00: And you you were uh you got to first base.
• 55:08
  SPEAKER_00: Um number two, number two is bullying.
• 55:15
  SPEAKER_00: And number three, vaping.
• 55:19
  SPEAKER_00: Yeah, yeah.
• 55:21
  SPEAKER_00: Number three is vaping.
• 55:23
  SPEAKER_00: Fifte 15 of high school students have attempted suicide.
• 55:30
  SPEAKER_00: Fifteen percent high school students said they'd attempted suicide.
• 55:34
  SPEAKER_01: Well, that breaks my heart.
• 55:37
  SPEAKER_00: It does.
• 55:38
  SPEAKER_01: Oh my gosh, that there's a problem.
• 55:41
  SPEAKER_00: Yeah, yeah.
• 55:42
  SPEAKER_01: And I bet you it ties back to this uh social media, you know, uh electronics, bullying on the phone, you know, just the just being on the social media and that feeling of inferiority, you know, as you seeing these picture perfect posts go up and getting likes or thumbs down on posts.
• 56:03
  SPEAKER_01: It's oh it has far-reaching consequences that I don't think we fully uh realize.
• 56:09
  SPEAKER_00: Yeah.
• 56:10
  SPEAKER_00: Here was the one.
• 56:11
  SPEAKER_00: Um 46% of Tennesseans can't handle a financial hit as small as a flat tire.
• 56:18
  SPEAKER_00: 46% think about it.
• 56:20
  SPEAKER_00: 46% of Tennesseans can't handle a financial hit as small as a flat tire.
• 56:25
  SPEAKER_00: That's something, isn't it?
• 56:26
  SPEAKER_02: Yeah.
• 56:27
  SPEAKER_00: Um then they had uh a guy who runs the community cure out of England.
• 56:36
  SPEAKER_00: He was fascinated.
• 56:37
  SPEAKER_00: He came in on a Zoom call.
• 56:39
  SPEAKER_00: Uh James Maskell was his name.
• 56:42
  SPEAKER_00: And um he asked the question, is chronic disease reversible?
• 56:49
  SPEAKER_00: Yes.
• 56:52
  SPEAKER_00: And this was fascinating.
• 56:54
  SPEAKER_00: He said the problem we have right now is imprecise medicine.
• 56:59
  SPEAKER_00: And he went down through um the ten most popular medications in America only work for 10% of the people who take it.
• 57:13
  SPEAKER_01: Oh wow, that's staggering.
• 57:15
  SPEAKER_00: So Crestor, Crestor, you know, the the drug crestor only works in for one in 19 um people who take it.
• 57:26
  SPEAKER_02: Wow.
• 57:27
  SPEAKER_00: So so here's the thing, that they do a test.
• 57:32
  SPEAKER_00: All this stuff is obscure.
• 57:34
  SPEAKER_00: They do a test and they they they cherry pick and find you know somebody that it helps.
• 57:39
  SPEAKER_00: So they get it through FDA and they start selling it and advertising it.
• 57:46
  SPEAKER_00: But it doesn't work for most people.
• 57:48
  SPEAKER_00: And and then you have all these you have all these side effects.
• 57:52
  SPEAKER_01: Um and I don't think they're telling it.
• 57:55
  SPEAKER_01: I mean, I don't think they're forthright with oh, this works for 10% of people or whatever.
• 58:02
  SPEAKER_01: And I I would gather, I'm not even sure if the doctors know that that are prescribing it.
• 58:07
  SPEAKER_00: I think so.
• 58:08
  SPEAKER_00: Humira, humera, the drug, only works for one in four people.
• 58:12
  SPEAKER_00: Nexicom only you works in one in 24 people.
• 58:16
  SPEAKER_00: Um ad adver uh I don't know how to say all this, adver discus or something, one in 20.
• 58:24
  SPEAKER_00: Um, Remicade, one in four, Copaxone, one in 16.
• 58:30
  SPEAKER_00: I mean, he just he just had them right down the line.
• 58:32
  SPEAKER_00: It was unbelievable.
• 58:34
  SPEAKER_00: And the way he presented this, he he had had little uh little icons of people, and he had all these, you know, 24 or 16 or 10, and they were they were um just outlined, silhouetted, and the one person it worked for, you know, was was black, and so it really made a stark image, you know, to see okay, it worked for that one, but not any of these people, but all these people are taking it, you know, because it's been advertised or or or something else.
• 59:03
  SPEAKER_01: Um that's crazy.
• 59:05
  SPEAKER_00: Yeah.
• 59:06
  SPEAKER_01: And we have about a minute, Joel.
• 59:08
  SPEAKER_01: Is there something that like something that profound or that stood out to you, or any last comments or thoughts about all this?
• 59:15
  SPEAKER_01: It's a lot, it's great information, a lot.
• 59:18
  SPEAKER_00: Yeah, yeah.
• 59:19
  SPEAKER_00: So so my my takeaway of it, of the whole thing was that I was privileged to be with a bunch of people in the healthcare movement that were struggling with how to evolve, how to evolve the American healthcare movement from a business plan that incentivizes sickness to a business plan that incentivizes wellness.
• 59:53
  SPEAKER_00: I don't think anybody has the recipe yet, but I was thrilled, thrilled to be in a room with a bunch of people who recognized the the dead end that we're on and were willing to at least struggle and and and and and wrestle with this with this conundrum because it really is a conundrum.
• 1:00:16
  SPEAKER_00: How do you how do you shift, how do you shift from a from a sickness incentivized system to a health incentive?
• 1:00:25
  SPEAKER_00: It's that simple.
• 1:00:26
  SPEAKER_00: You know, it I mean it seems simple, but but it but it is profound.
• 1:00:30
  SPEAKER_01: Yeah.
• 1:00:31
  SPEAKER_00: Because we just you know, we just don't have that that kind of thing.
• 1:00:35
  SPEAKER_01: And um and it's such a complex system with so many tentacles, you know, and and all the different directions.
• 1:00:42
  SPEAKER_01: It it reminds me of trying to you know change the food supply.
• 1:00:46
  SPEAKER_01: Like it's just so interconnected, you know.
• 1:00:51
  SPEAKER_00: It truly is a Gordian's knot.
• 1:00:53
  SPEAKER_00: And uh and and it's gonna it's gonna take some time to unravel, but it's it was fun for me with the conversation with the surgeon on Saturday and then this conference all together.
• 1:01:05
  SPEAKER_00: Uh I was I'm just um um I'm enjoying whatever the the baptism of ideas, the the the baptism the the of of people who are who are willing to admit we have a problem and we don't have all the solutions yet, but but at least we're gonna we're gonna you know we're gonna throw some stuff up against the wall and see what sticks.
• 1:01:31
  SPEAKER_00: And that's very that's very positive.
• 1:01:32
  SPEAKER_00: At the end of the day, that's that's very positive, and that that's what we need.
• 1:01:36
  SPEAKER_01: Oh, I think it's great that people are talking about it and like that's where ideas are born, and they're they're coming together to talk about it in person, which is great.
• 1:01:44
  SPEAKER_01: Okay, so community question.
• 1:01:49
  SPEAKER_00: So so um my question is have you looked for or found a medical doctor who goes by the terminology of functional medicine?
• 1:02:03
  SPEAKER_00: Have you looked for or found a medical doctor who goes by the or you know, embraces the term functional medicine?
• 1:02:11
  SPEAKER_00: Because that was definitely the common denominator among the doctors here.
• 1:02:16
  SPEAKER_00: They all called themselves some some strain of functional functionality.
• 1:02:22
  SPEAKER_00: And that's what they're looking for.
• 1:02:23
  SPEAKER_00: I mean, that's what health is.
• 1:02:24
  SPEAKER_00: Health is functional, sickness is dysfunctional, okay?
• 1:02:27
  SPEAKER_00: So so so that the embrace of a functional system is in is is in direct juxtaposition to the current system, which is dysfunctional.
• 1:02:38
  SPEAKER_00: And uh, and you know, maybe that won't end up being the proper word, you know, like organic, sustainable, regenerative, you know, in agriculture.
• 1:02:46
  SPEAKER_00: Um, you know, don't know where it's gonna end up.
• 1:02:48
  SPEAKER_00: But um, but at least that's right now, that seems to be the the operative term for the doctors that are that are um questioning the system.
• 1:02:58
  SPEAKER_01: Yeah, I think that's so fascinating.
• 1:03:00
  SPEAKER_01: This whole conversation is just so fascinating.
• 1:03:03
  SPEAKER_01: Thank you, Joel, for bringing this to our attention.
• 1:03:06
  SPEAKER_01: Keep us posted and updated because uh health insurance affects all of us in one way or another.
• 1:03:12
  SPEAKER_01: So it's a universal topic.
• 1:03:14
  SPEAKER_01: All right, and for all of you out there listening, thank you so much for joining us for another episode of Beyond Labels.
• 1:03:19
  SPEAKER_01: And we look forward to connecting next week.