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Single Payer Radio Dr Karen Berg Medicaid Cuts 08-07-26r1 · Single Payer Health Care

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Speaker 1: Hello, and welcome to Single Pair Radio. I'm Paul Hoppey,
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And remember, this is an all volunteer radio station and
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relies on your ideas and donations to keep us on
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the air. Before we start today's show, I'd like to
1:16
take a moment to remind you that on November three,
1:19
we're going to have what may be the most consequential
1:22
election in our lifetime. It could very well be that
1:26
the survival of our democracies at stake, So be prepared
1:29
to vote and encourage others to do the same. Once again,
1:34
doctors Mike Flynn and Gene Savely joined me as co
1:37
hosts with their special guest. So let's get started. Doctor Flynn.
1:42
Speaker 2: Yes, this is Michael Flynn, retired surgical oncologist from the
1:47
University of Louisville Department of Surgery. Let me begin with
1:52
the usual disclaimer than any comments or I make or
1:56
opinions I express represent my parsonal views and do not
2:01
represent the views of the Department of Surgery or the
2:05
University of Louisville. Jane.
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Speaker 3: This is hu Jane Shadley. I'm going to retard surgeon
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in Campbellsville, Kentucky. The comments I make do not represent
2:16
that of Taytor Regional Hospital or Jane Todd Crawford Hospital,
2:20
Northern University of Louwelle Department of Surgery.
2:24
Speaker 2: Our topic for today are multiple their medicaid issues, reproductive rights,
2:32
and all of the issues that surround the dysfunctional healthcare
2:37
system in this country, and we have a very special
2:41
guest today to help us discuss these issues. But before
2:47
I introduce her, I let me challenge our listeners to
2:52
double check our facts. We're going to be talking about
2:55
a number of issues where there are multiple publications on
3:00
just about everything. Some of the sources are the New
3:05
England Journal of Medicine and the Journal of the American
3:08
Medical Association. They've both had multiple articles on medicaid issues
3:15
and reproductive rights. Wikipedia and just get on Google. So
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our specialty guest today is Karen Berg. Doctor Berg is
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a retired assistant professor of radiology at the University of Louisville,
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and she is a Kentucky Senate representative from the twenty
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sixth district. So, Karen, thank you for coming on today.
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We're really looking forward to this conversation, especially with your
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political background. As we have with previous guests, We're going
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to give you an opportunity to make whatever comments you'd
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like to make for as long as you'd like to
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make them, and then the conversation will begin. So doctor Berg, Karen,
4:06
the floor is yours.
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Speaker 4: Thank you very much for inviting me to be here
4:12
this morning. This is a subject that is very near
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and dear to my heart. I am Karen Berg. I'm
4:20
a retired diagnostic radiologist. I've had experience working both in
4:28
not for profit medical systems like the University of Louisville
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private practice. I was a diagnostic radiologist at a small
4:38
community hospital in Charlestown for many many years, where you're
4:42
responsible for billing and collecting. And then I also have
4:46
many years of experience with the veterans the VA Medical
4:49
Center and how.
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Speaker 5: We deliver healthcare with the VA.
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Speaker 4: So I have a good, good background and understanding of
4:56
healthcare delivery systems. And now I'm an elected state senator
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and most of what we are spending our time and
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energy on up in the legislature at this point does
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have to do with Medicaid and Medicaid oversight.
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Speaker 2: All right, Jane, you want to begin the conversation.
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Speaker 3: I guess Karen. We're very glad to have you. Appreciate
5:27
all the work you've done in private practice and the
5:29
University of Louisville and Jewish and BA. My first question
5:34
is what is a big, beautiful bill going to do
5:39
to medicaid in this country and to the state of Kentucky.
5:46
Speaker 4: That's that's an excellent question. What is what the Kaiser
5:51
Family Foundation KFF has has predicted is that the twenty
5:58
twenty five federal Reconciliation Law, which otherwise goes.
6:04
Speaker 5: By the one Big or the one.
6:06
Speaker 4: Bad beautiful Bill, basically over the course of ten years,
6:13
takes nine over nine hundred billion dollars in healthcare dollars
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that have historically been paid by the federal government and
6:26
transfers the responsibility of those costs to the state government.
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Speaker 5: But does it without any alteration in tax structure.
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Speaker 4: So you know how like right now in Kentucky, our
6:39
income taxes three point five percent, whereas your federal income
6:43
tax can be thirty five percent. So what it does
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is it transfers nine hundred billion dollars of costs to
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the states, but it doesn't transfer any of the tax
6:54
revenue with it. So all of a sudden, you're looking
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at states that are facing enormous costs that there are
7:03
no way prepared.
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Speaker 5: To deal with.
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Speaker 4: The estimated ten year federal MEDICI reduction for Kentucky is
7:14
somewhere between seventeen and twenty eight billion dollars billion dollars,
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So the rough midpoint we're expecting maybe twenty two billion
7:28
dollars if the bill stays as it is. Those are
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the anticipated costs to the state of Kentucky over the
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next ten years.
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Speaker 3: Well, that's more than the entire Kentucky budget, isn't it.
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Speaker 5: Yes, it is. It's way more.
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Speaker 4: We have right now our largest rainy day fund that
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we've ever had, and that's in the millions.
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Speaker 5: That's not in the billions.
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Speaker 4: You know, we're talking huge chunks of money.
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Speaker 5: I don't know if most people understand.
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Speaker 4: Medicaid is predominantly federally funded. Depending on which program and
8:21
which state, the percentage of federal funding versus state funding changes.
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Speaker 5: Kentucky, we are takers. We take more money.
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Speaker 4: To supply medicaid from the federal government than we give.
8:40
There are other states actually that are what we call makers.
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They make more money, and so we in Kentucky, being
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a poorer state, are going to be hurt much harder
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than some of the wealthier states. And the way it
9:00
works out, truly is that the red states are going
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to get hurt the most and the blue states are
9:08
going to fare the best. And that's because the blue
9:12
states actually are makers. They make money. Red states tend
9:16
to be takers. They take federal money. Right now, Medicaid
9:21
can be matched anywhere from seventy percent federal to thirty
9:25
percent state, all the way up to ninety percent federal
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and ten percent state depending on the program. But if
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the state doesn't put up that ten percent, then we
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lose the ninety percent federal match. So you have to
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fund it in order to get the federal money. Yeah,
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it's a complicated system, okay.
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Speaker 6: In addition to.
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Speaker 2: Limiting the access to healthcare by the underserved population, there
10:05
is a significant risk to the rural hospitals that they're
10:11
for an assortment of reasons, and Gene may may want
10:14
to make a few comments about this as well. In
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addition to the healthcare issue of a hospital closing, there's
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an economic conquence consequence to this because this is often
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one of the major employers in a state. So can
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you what are your thoughts or I would really be
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interested in knowing what's in the heads of the legislators
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who live in these rural areas where these hospitals might
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be closing.
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Speaker 5: Let me tell you they understand.
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Speaker 4: Steve Meredith, who shairs health services, he's a Republican, He's
10:57
an ex CEO of a rural hospital that did close,
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and he totally understands how important it is to keep
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our rural hospitals open and solvent they. I mean, first
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of all, they provide healthcare, where if they're gone, there
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is no healthcare. They are huge economic drivers for their communities.
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Some of the biggest employers in our rural areas are
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either your healthcare systems or your school, your public school systems,
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and without those the economy fails. I believe the number
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here in Kentucky right now that we're talking about we
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have eleven hospitals I think that are at risk of
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immediate closure, and something like fourteen and potential I.
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Speaker 1: Think a bit more than that. Actually twenty, I would.
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Speaker 5: Say, yeah, that may be total.
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Speaker 2: Yeah. Now, let me make a comment that I've made
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on this program before and then asked you to respond
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to it. Now, twenty years ago, there was a general
12:16
surgeon in Louisville, and you may remember him. I'm not
12:19
going to mention his name, who had some visual issues.
12:23
He retired and ran for office and became a member
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of the House of Representatives. Yes, well, he gave a
12:34
talk at the Louisville Surgical society, and this is twenty
12:39
years ago. And he made two very strong points. Number One,
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what we've all heard many times before that making laws
12:49
is like making sausage.
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Speaker 6: And one of the examples.
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Speaker 2: He gave is that he had proposed I can't remember
12:56
what it was, a bill or something, and by the
12:59
time it had gone through all the committee system and
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everything else like that.
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Speaker 6: He voted against these he couldn't.
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Speaker 2: And the other thing he said, and he was very,
13:08
very very clear about this, is that the politicians, the legislators,
13:15
do not understand healthcare. They run their accountants, their lawyers,
13:22
they run road services and grocery stores and lumber companies,
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and they simply do not understand healthcare.
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Speaker 6: Now.
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Speaker 2: So my question to you now, is that still true
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or are some of them recognizing some of the issues.
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It sounds like that it's getting a little bit better
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than it was then.
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Speaker 4: I think it's getting a little bit better than it
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was back then, in part because I'm not the only
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healthcare provider that's up there at this point.
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Speaker 5: We have.
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Speaker 4: Several of the elected with deep in the health care system.
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But even more importantly, it is becoming such a large
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percentage of our state budget that you have to become knowledgeable.
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You if you are not knowledgeable about these delivery services
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and different options, then you're going to make big, bad mistakes,
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both in your budgeting and in your legislating. So yeah,
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I think there's more knowledge. There is still definitely a
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limit to the understanding of health care delivery systems, how
14:44
payers are paid, how hospitals stay open, how patience. You know,
14:51
there's this overwhelming thought process in Frankfurt that it's it's
14:56
the patience that are doing the fraud in Medicaid. It's like,
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it's the problem is that people are signed up from
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Medicaid who don't deserve it, and that's what they think
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the fraud is. That has nothing to do with anything
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to do with the significant financial fraud that Medicaid deals with,
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which comes from providers. It does not come from patience.
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It comes from people building intentionally systems that they know
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they shouldn't be getting paid for, but doing it anyhow
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and taking the money. So, you know, the whole work
15:42
about getting people off of Medicaid that don't belong on Medicaid,
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it's ass backwards. I'm sorry, but it is not under
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any circumstances going to solve the problems that we are
15:55
facing as a country. It is it is a waste
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of money, because it's going to cost us a lot,
16:04
a lot of money to implement these systems where people
16:07
have to reapply every six months and they have to
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show that they've worked so many hours, and they have
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to show that, you know, that for somehow they are
16:17
human enough that they deserve this.
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Speaker 2: We we've done two programs on this single payer radio
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with a doctor Barbara Casper, you may remember her as
16:32
an interness at UL and a lady named Amber who
16:37
was a Medicaid recipient who didn't want her last name mentioned.
16:42
And then what I one of the things I learned
16:46
from her was some of the administrative hassles of having
16:54
to establish eligibility were requirements and this stuff that really
17:04
it really doesn't have a you know, it represents a
17:07
fraction of all the people who are the children, the elderly,
17:13
the disabled, who are eligible eligible for How do the
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politicians have any understanding of that?
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Speaker 5: I don't know, I don't know.
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Speaker 4: I mean, these are some just some basic numbers for Kentucky.
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Speaker 5: Okay, for Kentucky.
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Speaker 4: Yeah, fifty percent of our children are covered by Medicaid. Yes,
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one out of every two children. Seventy percent of our
17:42
nursing home residents are covered by Medicaid. Medicaid also covers
17:50
severely disabled people to help them either stay at home
17:57
and out of institutions, or to help them with the
18:01
cost of their medical expenses. There is a group called
18:05
the expansion group, and it's the expansion group that my
18:10
Republican legislators are trying to target, even though honestly they're
18:17
targeting everybody because we just had a whole fiasco with
18:21
whether or not the least specialty clinic could stay open
18:24
or not. You know, that's not targeting expansion population, guys,
18:28
that's targeting the most needy of our population. So with
18:35
these expansion people, Okay, in order to be eligible for
18:41
expansion Medicaid, you have to be one hundred and thirty
18:45
eight percent of the poverty level.
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Speaker 5: Which is not much money.
18:51
Speaker 4: A family of four making forty four thousand, three hundred
18:56
and sixty seven dollars is the top top limit for
19:02
the expansion population. A family of four living on forty
19:07
four thousand dollars a year. Okay, Now, what this whole
19:15
big bill is doing is trying to get people in
19:20
that expansion population off of Medicaid by making the requirements
19:26
so onerous that people can't meet them, that you have
19:31
to reverify every six months, and guys, that cost the
19:36
state money to implement because we have to have employees
19:40
to do this for them. That you have to show
19:44
that you've been working for three months prior to eligibility,
19:49
even though the federal guidelines right now say one month.
19:52
But Kentucky, because we want to get these people off,
19:55
decided to know we're going to go with three months.
20:01
Speaker 5: The thing is, it is more.
20:05
Speaker 4: These Okay, there's so many arguments here. These are for
20:10
the most part, people that work almost somewhere between seventy
20:15
and ninety percent you're talking about the expansion Medicaid recipients
20:21
in the expansion population. The vast majority of these people work,
20:28
but they work at jobs that one do not offer healthcare,
20:35
or two offer healthcare, but it is so expensive that
20:42
they're employees who are earning minimum wage can't afford it.
20:49
And we have found out and this just blows my mind. Honestly,
20:54
some of the biggest employers in this country do that
20:59
intention intentionally offer healthcare that they know is above their
21:07
employees' ability to purchase.
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Speaker 2: That's exactly what we learned from AMBER. And they put
21:14
them on some sort of instead of a full time employee,
21:20
they're they're they're working as fart times, right.
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Speaker 4: They put them down to thirty two hours a week
21:24
and you're not eligible, or thirty six and you're not eligible.
21:27
Speaker 2: And these are companies that are making billions.
21:30
Speaker 4: Of billions of dollars and then by doing that, they
21:33
no longer have any responsibility to put in their percentage
21:38
of costs for their employees for their health care. They're
21:41
just sending them to the market, so that the government
21:46
is subsidizing these employers making tremendous profits, using tax payer money.
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Speaker 6: Exactly to do it.
22:00
Speaker 4: And it has got to be stopped.
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Speaker 1: You know, I'm fond of saying that the Walmart's healthcare
22:06
benefits that they offer to their employees are counseling on
22:11
how to get on Medicaid.
22:13
Speaker 5: Right.
22:13
Speaker 2: Well, that's one of the examples that Amber that two
22:17
of the programs.
22:18
Speaker 4: And this is I mean, guys, this expansion population, they
22:22
are not lazy. They are not people that are trying
22:26
to get something they don't deserve. For the most part,
22:30
these people are either working and cannot get covered through
22:37
their jobs. And remember, guys, this includes self employed people,
22:41
people who want to have their own business. Again, they
22:45
don't have options for private insurance that people can afford.
22:50
And then you have to understand with the private insurance market,
22:54
the premiums on average now I think are twenty six.
23:00
Speaker 5: Thousand dollars a year. Oh wow.
23:04
Speaker 4: But the copays and deductibles, particularly the deductibles. If you
23:10
have a policy with a seven thousand and eight nine
23:14
thousand dollars and you will deductible, nobody can do that.
23:21
You get sick in October, you've got nine thousand dollars,
23:24
and then all of a sudden, in January another nine
23:26
thousand dollars. This is not doable for the vast majority
23:32
of people in the United States. So we have problems
23:36
on the private health scare industry still making tremendous profits,
23:44
tremendous profits, but we have so many people that can't
23:49
access it.
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Speaker 3: Let me point out that there are also people who
23:55
are working in the medical industry of hospitals and assistant
24:01
living who are all medicaid because they make minimum wage,
24:06
so they don't have enough of income to pay for
24:12
the insurance.
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Speaker 5: Yep.
24:14
Speaker 6: Well, listen, not that I want to stop this.
24:17
Speaker 2: I think it's really important, but I'd like to I'd
24:20
like to ask you to, you know, just to get
24:23
some other issues on the table. Our listeners are not
24:27
mostly medical people, so could you kind of explain the
24:33
details of the Kentucky state anti abortion laws so that
24:39
our listeners can understand. I mean, the consequences of that
24:44
make it incredibly difficult for obstetricians and gynecologists to treat
24:49
a woman with the complications of pregnancy. And I personally
24:54
am a little confused about I mean, the way they're written,
24:58
it's so vague, confusing, it's hard to know what to do.
25:04
Speaker 4: It's very difficult, very very difficult. What Kentucky did We
25:09
passed this trigger band, which meant that as soon as
25:13
Roe fell, we lost access to abortion in the state
25:20
of Kentucky, with very very few exceptions. There is an
25:27
exception for a topic pregnancies, and an exception for miscarriages
25:35
so that you can go back and do a DNC afterwards.
25:38
And then we have an exception for the life of
25:42
the mother or it's not her health but preserving an organ.
25:50
So and that's it.
25:53
Speaker 2: Now. It was my understanding that if a woman as
25:58
say eight or ten weeks pregnant and has a miscarriage
26:03
and ruptures are membranes and the ultrasound shows a little flicker, right,
26:11
that is going to be a heart if it lives
26:15
long enough.
26:15
Speaker 5: But it's not going to because the membranes are eruptured.
26:18
Speaker 2: It is still is still flickering. They can't do the
26:23
appropriate treatment for that woman, right, well, I mean.
26:29
Speaker 4: No, And we've had cases in the state literally where
26:32
women are bleeding effusively, yes, and doctors felt that they
26:38
had to wait until there was no longer. You know,
26:44
they call it cardiac activity. It's not cardiac activity. It's
26:47
not even a four chamber heart at that point.
26:49
Speaker 6: It's flicker.
26:50
Speaker 4: It's a little flick of a flick of emotion, and
26:54
we have to wait for that to be gone in
26:58
order to take mom to the o R or the
27:02
other option.
27:04
Speaker 5: We can wait.
27:05
Speaker 4: Until mom is so unstable from her blood loss, then
27:11
we can take her neither. I mean, it's craziness.
27:15
Speaker 5: It is. It is not medicine.
27:19
Speaker 6: No, it's it's malpractice.
27:21
Speaker 5: It's malpractice.
27:22
Speaker 3: What about ruptured membranes in the second trimester? How does that?
27:31
Speaker 5: You know?
27:32
Speaker 4: What they what they want you to do. Honestly, I've
27:36
had this in committee. They have said she can just
27:41
walk around with that dead feet is in utero until
27:47
it's spontaneously excavate, you know. But the problem is you
27:53
get septic, and you get disseminated intravascular colaggilopathies, and you
28:00
we don't take patience to the brink of death intentionally
28:05
in an effort to try to bring him that back.
28:07
We try to prevent what we know is going to
28:12
happen if we don't intercede.
28:16
Speaker 5: Yeah, this is real.
28:18
Speaker 2: This is the other Another issue in my understanding, again
28:24
which is limited, is if you have a fetal anomaly
28:28
like an encephalic fetus, that's a fetus for our listeners
28:34
to understand, that doesn't.
28:36
Speaker 5: Have a brain, no brain, no head.
28:38
Speaker 2: So if this goes to term, it dies, it doesn't
28:44
live very long. And to perforce a woman to carry
28:49
an encephalic fetus to birth, it's cruel.
28:55
Speaker 6: It's cruel.
28:56
Speaker 5: It's cruel.
28:57
Speaker 4: I mean, first of all, you have all the complications
29:00
of pregnancy and childbirth with none you know, it's everything
29:04
in medicine is a risk benefit analysis. You're taking all
29:09
the risks with no benefit. The fetus is dead. Why
29:14
would you want to take those risks? And the other hand,
29:19
mom can have that that fetus dead, fetus removed from
29:25
her uterus, she can heal, and she can go home
29:28
and get pregnant again.
29:30
Speaker 5: Yes, that's what we want.
29:34
Speaker 4: We want these women to survive and be able to produce.
29:40
Speaker 2: That brings me back again to that question about the
29:43
politician's understanding healthcare, because this, the anti abortion legislation in
29:51
Kentucky is so far off the mark that, at least
29:56
in my opinion, as well as I could understand it,
29:59
and I'm limited because I'm not an obstetrician or a gynocologist.
30:04
It requires the physician dealing with the complications of pregnancy.
30:14
Speaker 6: To commit medical malpractice.
30:18
Speaker 3: It's a parent Is it not possible we could change
30:21
these few things and and and get proper treatment for
30:27
complication or pregnancy. Well, the legislatures not even listened to them.
30:32
Speaker 5: Some would and some will not. Uh.
30:35
Speaker 4: It really depends on who you are and what your
30:38
background is.
30:39
Speaker 5: I will tell you that the.
30:40
Speaker 4: Legislator who who brought the the overall maternal bill that
30:52
we passed several years ago, Nancy Tate, is not coming back.
30:57
She has opted not to run for reelection, so in
31:02
our absence.
31:03
Speaker 5: We may have some room to move.
31:07
Speaker 4: But I'll be honest, right to life in this state
31:09
is extremely, extremely strong, and extremely close, very close to
31:20
some of our more powerful electeds.
31:25
Speaker 5: In the state. And I could go into names if
31:28
you wanted me to, but I don't know if I should.
31:30
Speaker 1: I guess I have to throw out this warning. I mean,
31:32
we we are non political.
31:34
Speaker 4: Right right, so I won't use names. But you have
31:38
to understand, guys, we have politicians elected, even from Jefferson County,
31:45
who are in bed with these right to life physicians
31:51
or these right to life lobbyists, and they take a
31:54
lot of money for them, and they.
31:56
Speaker 5: Do their bidding the mother right what about the right
32:02
to life for the mother? What about the truth is
32:05
my religion? I'm Jewish.
32:07
Speaker 4: The truth is my religion requires that you in if
32:12
you have to choose, you choose the mother over the fetus.
32:17
According to Jewish law, that is what you're supposed to do.
32:21
Speaker 5: And in our laws in Kentucky prohibit that.
32:24
Speaker 2: At this point, well, let me pop something else onto
32:30
the table while we're doing this, because we could, we could,
32:34
and we may have talked about this some more. I
32:36
think private equity companies in medicine now are involved.
32:44
Speaker 6: And you mentioned.
32:47
Speaker 2: What seventy percent of Medicaid recipients are in nursing homes.
32:52
Speaker 6: Well, it's my.
32:53
Speaker 2: Understanding that that almost seventy percent of nursing homes are
32:57
run by and then is isn't that what you tell me, Jeane?
33:00
Speaker 6: I think that's.
33:01
Speaker 3: Correct, yes, and it's more than that. In south central Kentucky,
33:07
every every nursing home in my county and surrounding counties
33:11
is owned by a private equity. The interesting thing is.
33:16
Speaker 2: That they don't tell anybody, well of course, but they
33:20
run physician practices, they run the hospitals, they run hospital systems.
33:28
There was a hospital system in Boston that collapsed because
33:32
it was run by a private equity company that that
33:36
that that used that that basically sold the building that
33:41
the hospital was in and then had the medical the
33:44
medicals the medical company have to pay rent to be
33:50
in their building. And then when it collapsed, the CEO
33:53
of the private equity company turned some of these things
33:56
into the condominiums. Anyhow, can you share some of your
34:02
thoughts and.
34:03
Speaker 5: Again I think private equity and I'm going.
34:05
Speaker 2: To ask you again to how does did your fellow
34:10
politicians understand. I think they did the implications of having
34:15
a private equity company running a healthcare system.
34:20
Speaker 4: I think that the ones that are paying attention to
34:23
understand that this is a very bad, bad thing that
34:29
is happening in medicine. I mean, what these private equity companies,
34:34
What they think is that they can buy practices, They
34:38
can buy hospitals, they can buy outpatient centers and make
34:43
money off of them, where the previous people, like the
34:48
physicians that had run these centers couldn't. They think they're smarter,
34:52
they know how to handle things better. Basically, though, what
34:56
they do is they go in there, they figure out
35:00
what makes a profit for us and what doesn't. It
35:04
has nothing to do with the needs of the population,
35:08
nothing to do with the needs of the patients, nothing
35:11
honestly to do with quality of care. The bottom line
35:16
is are we going to make money? And study after
35:21
study after study after study has shown that the quality
35:27
of healthcare delivery goes down in practices that are bought
35:33
by private equity over and over and over again. I
35:39
personally think we should outlaw it. I do not think
35:43
that you should buy medical practices with the goal of
35:47
doing nothing but making a profit that is unethical and immoral,
35:55
and that it's happening in this country day in and
35:59
day out. I think my fellow legislators understand it. They
36:03
don't know how to stop it.
36:05
Speaker 1: Doctor Burghery, the Medicare for All movement across this country.
36:10
The battle cry is patients over profits. Yesss this country?
36:15
Speaker 5: Yes right?
36:16
Speaker 4: And the goal the first goal, well, the first goal
36:20
is due to no harm. But the second goal is
36:23
to take care of people, to actually provide healthcare, not
36:31
to make a profit off of people's illnesses.
36:36
Speaker 2: Let me give you an example. Just I can get
36:39
two or three of them. But there was a nursing
36:41
home in Florida that was owned by a private equity
36:47
company and there was a woman down there who had
36:50
a the Cuba de saulcer. And for our listeners, this
36:54
was an ulcer on the lower part of her back
36:58
and she got it because she was lying in bed
37:01
all the time and not being moved. Uh, they didn't
37:06
change the diaper enough, so it got infected by fecal contamination.
37:13
For our listeners, that's poop. And she died and the family, understandably,
37:20
being angry or hired a lawyer and they they ran
37:28
into this complex of administrative a nightmare. One company owned
37:36
the building, one company had the nursing home license, one
37:43
company provided the professional staff, one company provided a custodial staff,
37:51
and they and they, and there was no nobody. Nobody
37:54
took There was no responsibility.
37:56
Speaker 5: For what who provided the medical oversight?
37:58
Speaker 6: Yes, exactly, accountability, that.
38:01
Speaker 4: Is the accountability and the and the care, the actual
38:06
care of that person.
38:09
Speaker 3: All right, that's going on right here in south central Kentucky.
38:14
Go ahead, and there's a another nursing home that had
38:21
local physicians that were taking care of patients, and most
38:25
of the physicians and the patients knew each other, the
38:28
same way with the nurse practitioners that were involved. And
38:32
those people all disappeared and they brought in physicians and
38:37
nurse practitioners from out of town, which none of the
38:40
patients or family knew. Now, that creates a real problem
38:44
with continuity care and trust between patient and physician and
38:49
nurse practitioner.
38:51
Speaker 6: Uh, this is.
38:53
Speaker 3: A it's becoming a real, real, really huge problem that
38:58
we have to address.
39:00
Speaker 2: Cara.
39:00
Speaker 3: What about pharmacy benefit Managers.
39:08
Speaker 4: Because bbms honestly are the newest leech on healthcare. I
39:15
mean an appsolute freaking leech on healthcare dollars. They insinuated
39:23
themselves in between patients and their doctors, and they have
39:27
now decided based on their profits, not efficacy, not how
39:35
well a patient response, based on profit margins, which medicines
39:41
they will allow to be prescribed and which they will
39:46
which ones they will not. And guys, it's all on kickbacks.
39:52
They're getting kickbacks from the pharmaceutical companies to make these decisions.
39:57
You know, we used to when we first came up
39:59
with hospital for mularies, it was based on how well
40:03
the drug worked versus the cost of the drug.
40:07
Speaker 5: That was what we really cared about.
40:10
Speaker 4: None of that matters anymore. They none of that matters anymore.
40:16
It is all how much money they can get.
40:23
Speaker 2: And there's a very fundamental reason for all this. We
40:28
do not have a healthcare system in this country.
40:31
Speaker 5: They're not regulated.
40:32
Speaker 2: We have a health care industry which is focused and
40:36
whether it's the nine hundred for profit health insurance companies,
40:42
the partners, pharmacy benefit managers, the fact that Medicare and
40:47
I still think that's true, cannot negotiate with the drug companies.
40:51
You know, there's a couple of.
40:52
Speaker 5: Ten of them. Now I think I think it's tech.
40:55
Speaker 2: Yeah, I mean, it's just it's astonishing that this goes on.
41:01
Speaker 6: And again, I gotta go back to you with the politicians.
41:05
Speaker 2: Do they not understanding this or are they getting so
41:08
much money in contributions and donations from this company that
41:13
they don't care.
41:14
Speaker 4: The truth is the problem with PBMs is multifaceted. It
41:19
needs to be dealt with with federal legislation. But our
41:24
Congress is in capable of passing legislation of this caliber
41:32
at this point.
41:34
Speaker 5: You know our current Congress.
41:36
Speaker 4: I'm talking about the House of Representatives in DC, not
41:40
in Frankfurt. This Congress has passed fewer bills than any
41:47
congress any sit in Congress ever in the history of
41:53
the United States of America. They are completely dysfunctional. They
41:58
have all sorts of bills written, the PBM bill being
42:01
one of them, that they can't not get done.
42:08
Speaker 5: We've tried on state level.
42:10
Speaker 4: States are trying to manage pharmacy benefit managers.
42:15
Speaker 5: But it's tough. It's tough.
42:19
Speaker 4: I wrote a bill last session about step therapy. Are
42:22
you familiar with step therapy. It's where the insurance company
42:25
your doctor writes a prescription, and the insurance company can say, no,
42:29
that's too expensive a prescription.
42:31
Speaker 5: We want you.
42:32
Speaker 4: To try this first, fail it, and then we'll give
42:38
you the more expensive prescription. Like the doctor doesn't or
42:41
the healthcare provider doesn't actually know what they want and
42:46
don't actually have a reason for prescribing this over this.
42:51
So I just wrote a bill that says they're not
42:53
allowed to do that without getting the provider's input first.
42:59
The provider gets to explain to them why step therapy
43:02
is not appropriate as opposed to right now where they
43:06
just do not fill the prescription.
43:09
Speaker 5: And I think we got to pass the past it
43:11
in Illinois last year.
43:13
Speaker 4: We think we might be able to get it in
43:15
Kentucky this year, and if we can, we can go
43:17
national on that. But these are just middlemen who have
43:21
just decided that they can make more money by not
43:28
providing what the healthcare providers want for their patients. It's
43:35
just another way for them to do it.
43:37
Speaker 1: Yeah. This term is called vertical integration, and CBS right
43:44
now is the superstar of vertical integration.
43:47
Speaker 3: Yeah, well you and I healthcare is getting is pretty
43:50
close to CBS.
43:52
Speaker 4: Yeah, and I honestly think we should break up vertical integration.
43:56
I don't think it should be. I don't think you
43:58
should be able to set that. You have to use
44:02
our pharmacies, you have to use our hospitals.
44:09
Speaker 3: It's for the audience. CBS owns a health insurance company,
44:15
they own some doctors, they own a pharmacy benefit manager,
44:20
and they own a company called Signify Hell and they're
44:24
all vertically integrated.
44:27
Speaker 2: Well, that's healthcare in this country. I mean, you know
44:33
how many people are in private practice by themselves that
44:37
don't work for a hospital or a hospital system or
44:39
some other organization like that.
44:41
Speaker 6: It's awful.
44:43
Speaker 3: You can't do it. I just just in the last
44:46
few months right here in Campbellsville, I know one, two, three,
44:54
or four doctors and multiple nurse practitioners who had to
45:00
get out of private practice. They couldn't they couldn't have do.
45:02
It's impossible to them.
45:05
Speaker 5: It's very difficult. At this point.
45:07
Speaker 6: Well, let's.
45:12
Speaker 2: Well change again, horses in midstream here to kind of
45:18
a different approach. This is a program sponsored by Kentuckians
45:23
for single pair promoting Medicare for all, which we all
45:29
are here.
45:30
Speaker 6: Without getting paid.
45:34
Speaker 2: The prospect of this become a reality in this political climate,
45:39
at least to me, doesn't look very good. And so
45:44
my question to you is, what suggestions do you have
45:48
that could improve the recognition of the benefit of the
45:53
value of this nonprofit, government run health insurance program by
46:00
the public.
46:02
Speaker 6: And you're co politicians.
46:07
Speaker 5: Yeah, that's a big, big, big question. Yeah, that's that's
46:13
a really big question.
46:14
Speaker 4: I could I could ask you to break it down
46:16
into component pieces.
46:18
Speaker 6: Lets you do it whatever way you're comfortable.
46:24
Speaker 4: I think it is well established that our healthcare delivery
46:34
system in the United States is broken. For most people,
46:41
the cost of premiums and the cost of their deductibles.
46:46
Speaker 5: These are, you know, people.
46:48
Speaker 4: With private pay insurance. It's getting out of control. For
46:55
the younger people, they honestly think it's a joke. You mean,
46:59
I'm going to make this much money and then I
47:02
have to pay this much for my health insurance and
47:06
I only get to use it if I'm sick.
47:09
Speaker 5: I mean, they're thinking, I'm just not going to have
47:11
health insurance.
47:12
Speaker 4: And what happens then the whole healthcare delivery system falls apart,
47:18
because you have it costs money to run hospitals, it
47:24
costs money to train doctors, It costs money to have
47:29
nurses and equipment, and if there is nobody to pay,
47:37
nobody who can pay for that, then the whole thing
47:41
collapses and private insurance is not an option now for
47:49
a large percentage of people in this country, that entire
47:55
Medicaid expansion population, which isn't that big. It's I think
47:58
it's like seven point six million people. I think. Don't
48:01
quote me on that. That's off the top of my head.
48:04
They will be uninsured. It's not that you know they're
48:08
going to be able to switch to a private insurance
48:11
they're not. We have got to fig We have got
48:16
First of all, people have been terrified their entire lives
48:21
because they have been told by the insurance industry that
48:25
private health insurance is the only way to go, and
48:29
if we do anything other than a completely capitalistic healthcare market,
48:36
they will lose all the advantages that they have as
48:40
Americans with the best healthcare system in the world. First
48:44
of all, it's not the best healthcare system in the world,
48:47
as far from the best healthcare system in the world.
48:49
As far as our outcomes and for what we spend
48:53
versus our outcomes, we are not competitive with other major
49:00
countries at all. So the whole cost of the private
49:06
healthcare market, which is a for profit business, is actually
49:14
keeping people from getting covered. And then you go to
49:18
the public side and the only you have options that
49:24
are more affordable only if you're going to subsidize them.
49:30
And then you have legislators who say, why should I
49:34
subsidize this. Let them go and buy health insurance just
49:40
like I do. It's not the answer because it's not feasible.
49:43
They can't do it.
49:46
Speaker 6: Well.
49:47
Speaker 2: Again, I've asked Jane this question multiple times, is what
49:52
is in the heads of the people in red rural
49:56
Kentucky that keeps putting the legislatures into office. Let me
50:03
tell you pass bills that are against their economic and
50:07
health interest. Gene, you want to make a comment about
50:10
that before we let Karen respond to my comment.
50:20
Speaker 6: Jane, are you there?
50:21
Speaker 3: Yes, Yes, I do, well, I don't think. I think
50:26
it's like having cancer. You don't really think about it.
50:32
You don't know much about it until you get it,
50:36
and then it may be too late. Hopefully it's not,
50:42
but most people are not really thinking about that. And
50:50
I think there are other issues that are affecting their
50:55
votes other than just playing economics. But that may be
51:01
changing some of the inflation we're having, some of the
51:07
costs for farmers. But the main issues are, I think
51:11
in rural Kentucky are abortion, big government, uh, somebody telling
51:16
you what to do, uh, somebody telling you that you
51:21
can't go to church because there's an epidemic going on,
51:24
just like what happened this morning in the Senate condemning
51:28
doctor Fauci. Those kinds of things are are affect people
51:35
more than direct healthcare. I think I think there may
51:41
be some gradual change. It's just like the conversations we've
51:46
had with Don Henderson in the past that he says
51:50
he doesn't think anything will happen until there's a crisis,
51:54
and that crisis may really be a crisis that will
51:59
take us along long time and a lot of pain
52:02
and suffering. To get over.
52:07
Speaker 6: Your thoughts about this.
52:08
Speaker 1: I just want to say that I think Genie left
52:10
out a big one here for Kentucky, and it's the
52:12
big elephant we call racism.
52:16
Speaker 3: Well, I can tell you I was born and raised
52:19
in Taylor County. When I was a kid, there were
52:25
bathrooms for colored and white. The schools were segregated. I
52:32
can tell you coming back here and living here when
52:37
I got through my residency that that is radically changing.
52:41
Its radically changed, and I don't see much racism here
52:49
in Taylor County and the surrounding county, So I.
52:53
Speaker 1: Have to agree with you on that. But but I
52:55
will say that I've run int occasions all the time
52:57
out in public where I see it. It's kind of
53:02
I call it covert racism or latent racism. That's a
53:08
vestige of when you what you said you went through
53:11
when you were growing up. I think it's still here
53:13
and I think it's a problem for our society.
53:16
Speaker 3: Well it may if it is, it's very very suppressed
53:19
because at the hospital we have several Afro Americans nurses
53:25
and doctors, and over the forty six years I've worked
53:31
at Tairacial Hospital, I have never ever seen a problem.
53:37
I'm not saying that there could be could have been
53:40
problems that I don't know about, but it's it's it
53:44
just blows my mind how different it is. Uh, there's
53:48
interracial marriage and there's people socialized together. It is really
53:57
really different.
53:59
Speaker 2: Now let us get back. My question was how do
54:03
we get a recognition into the brains of the rural
54:08
voters and the politicians about our dysfunctional healthcare system and
54:14
the benefits of having a not for profit government run
54:19
in health insurance system.
54:22
Speaker 3: Well, the first thing I think we should do is
54:26
we have to change the government in Washington.
54:29
Speaker 6: Well, yes, Na, Frankfort as well.
54:32
Speaker 3: It right, but I don't think that we have to
54:36
concentrate on that right now. There's no possible way we
54:39
can change it right this man. But if we change
54:42
that and to change Congress in November, we may be
54:49
able to start working on it now.
54:51
Speaker 2: One of the reasons that I do this program because
54:54
I'm not getting paid for this, and it's a lot
54:56
of work getting people set up to come and do
54:59
these things. Come down here is the hope that the
55:02
information and the things that we talk about here will
55:06
penetrate some of the brains of listeners.
55:09
Speaker 6: And I get.
55:11
Speaker 2: This report from you every month, Jeane, about who's listening
55:16
to these programs, and apparently they're getting around to a
55:21
lot of different places, so you know, hopefully somebody's listening
55:25
and hopefully they're understanding.
55:27
Speaker 3: Actually I only get the report on one of the podcasts.
55:31
There are multiple ather ones that I don't have the
55:33
numbers on. But I think that we can gradually make progress,
55:40
but we not until we change the government right now.
55:47
And that's why I try to emphasize that point last
55:50
night in our meeting that we have to we have
55:54
to select who can win and get those people in
55:58
office and then start working on this.
56:02
Speaker 1: Okay, guys, we've got about two more manutes to.
56:04
Speaker 2: Go, so wow, Karen, you want to make any last
56:08
minute comments and then we'll let Paul take us out.
56:15
Speaker 4: Every human being deserves access to good quality healthcare, and
56:22
in the United States, being really probably the or one
56:28
of the wealthiest countries in the world, we don't seem
56:33
to have conquered that. We actually are doing a much
56:39
worse job than other countries that are much less affluent
56:44
than we are, and we spend a ton of money
56:49
on healthcare without getting the results that other countries get.
56:58
So we have to read think what we're doing. We
57:01
have to really allow people to open their minds, get
57:08
over the fear that they intentionally put into you growing
57:14
up that anything other than a private, for profit healthcare
57:21
network would take something away from you. And they made
57:26
that over and over and over again clear to everybody
57:30
in this country through their advertisings and their campaign everybody thought,
57:35
if we lose our private health insurance, we are going
57:38
to lose our quality healthcare, and it is not true.
57:43
We can have better health care for less money and
57:51
cover more people if we just re think our healthcare
57:59
distribution system.
58:01
Speaker 2: Thank you very much, Karen for those remarks, and thank
58:04
you very much for coming on here today to do
58:08
this program.
58:10
Speaker 1: I'd like to thank my co hosts and doctor Karen
58:13
Berg for making today's show possible, and a special thanks
58:16
to our listeners for tuning in. For more information on
58:20
today's topic, go to our website at Kyhealthcare dot org,
58:26
and don't forget. With a little more than eighty days
58:28
to the November third election, let's all start getting fired
58:32
up to go cast our vote. This is Paul Hoppey
58:35
wishing you a wonderful rest of your day,