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Rural Hospitals Feeling the Pressure · Paging America

• 0:14
  SPEAKER_03: Hello, everybody.
• 0:15
  SPEAKER_03: Welcome back to Paging America,
• 0:17
  where we explore the power of profit and politics shaping
• 0:19
  American health care and
• 0:20
  SPEAKER_03: what you can do about it.
• 0:21
  SPEAKER_03: I'm your host, Miles Baker, along with Dr. Rob Davidson.
• 0:24
  SPEAKER_03: We got a great show for you today.
• 0:26
  SPEAKER_03: We're going to talk a little bit about what's going on with RFK.
• 0:29
  SPEAKER_03: And on the back half of the show,
• 0:30
  SPEAKER_03: we're going to be speaking with Dr.
• 0:31
  SPEAKER_03: Shelley Johnson,
• 0:32
  who's going to teach us about a little bit of the economics of
• 0:34
  rural hospitals and
• 0:36
  the fallout that could happen in rural places after the passage
• 0:40
  of the big,
• 0:40
  SPEAKER_03: beautiful bill.
• 0:41
  SPEAKER_03: Dr. Rob, how are you doing today?
• 0:43
  SPEAKER_03: Miles, I'm doing okay.
• 0:44
  SPEAKER_03: A couple weeks into now figuring out what's in this fucking bill,
• 0:48
  SPEAKER_03: and it just gets kind of worse every day.
• 0:51
  SPEAKER_03: So here we go.
• 0:52
  SPEAKER_03: It's a bad, weird new revelation, like every day.
• 0:55
  SPEAKER_03: Every day.
• 0:56
  SPEAKER_03: No, it's that.
• 0:57
  SPEAKER_03: Every day.
• 0:59
  SPEAKER_03: So there you go.
• 1:00
  SPEAKER_03: Yeah, and I'm in between a couple of shifts.
• 1:01
  SPEAKER_03: I worked yesterday evening.
• 1:02
  SPEAKER_03: I'm working again after this, and so...
• 1:04
  SPEAKER_03: You know,
• 1:05
  the real world of actually trying to deliver health care in a
• 1:07
  rural hospital,
• 1:08
  SPEAKER_03: that's always a bit of a challenge.
• 1:09
  SPEAKER_03: Intersects with what these assholes are doing in D.C.
• 1:12
  SPEAKER_03: And yeah,
• 1:13
  it doesn't always make me in the best mood possible when I'm
• 1:17
  heading in there,
• 1:18
  SPEAKER_03: but I try.
• 1:19
  SPEAKER_03: I find myself marveling.
• 1:20
  SPEAKER_03: So we cut all this stuff from Medicaid.
• 1:22
  SPEAKER_03: Obviously, the big, beautiful bill dominated our algorithms and our feed.
• 1:27
  SPEAKER_03: But, you know, there has been some research that suggests...
• 1:31
  large swaths of America do not understand the contents of the
• 1:36
  bill,
• 1:36
  this transformative bill.
• 1:37
  SPEAKER_03: You were right the first time, the con, right?
• 1:39
  SPEAKER_03: The con.
• 1:40
  SPEAKER_03: But go ahead.
• 1:40
  SPEAKER_03: The contents.
• 1:41
  SPEAKER_03: You paused, I think, for a fact.
• 1:42
  SPEAKER_00: Yeah, yeah, yeah.
• 1:43
  SPEAKER_00: Got it.
• 1:43
  SPEAKER_03: Yeah, yeah.
• 1:44
  But large swaths of America don't understand the contents of
• 1:48
  the bill,
• 1:49
  that sort of
• 1:49
  SPEAKER_03: Vaguely people don't like it,
• 1:51
  but like the extraordinary transfer of wealth upwards to richer
• 1:54
  people and the
• 1:56
  ending of health care for 17 million Americans is not like the
• 2:00
  first thing that
• 2:00
  SPEAKER_03: everyone points to.
• 2:02
  SPEAKER_03: And yet we are on day 10 of Jeffrey Epstein.
• 2:04
  it is dominating the coverage whereby a trillion dollars in
• 2:09
  cuts to healthcare,
• 2:10
  SPEAKER_03: 17 million people getting kicked off healthcare,
• 2:13
  SPEAKER_03: massive riches for the richest people in this country all just happened.
• 2:18
  SPEAKER_03: And not that many people noticed, not enough people noticed.
• 2:21
  So it tells us,
• 2:23
  I think there's a genuine tie in here though,
• 2:25
  because like,
• 2:26
  SPEAKER_03: Look,
• 2:27
  SPEAKER_03: if this scandal is getting some of the mega base to say,
• 2:32
  SPEAKER_03: oh,
• 2:33
  SPEAKER_03: maybe they do lie to me sometimes.
• 2:35
  SPEAKER_03: Well,
• 2:36
  SPEAKER_03: once you hear about that lie,
• 2:37
  I have some Medicaid cuts to show you because that is mostly
• 2:40
  going to be in your
• 2:41
  SPEAKER_03: communities and your clients.
• 2:42
  SPEAKER_03: Be clear,
• 2:42
  SPEAKER_03: something a lot of folks out in the media are getting wrong,
• 2:45
  SPEAKER_03: like these Medicaid cuts,
• 2:46
  SPEAKER_03: this transfer belt,
• 2:47
  SPEAKER_03: this is not a MAGA thing,
• 2:49
  SPEAKER_03: right?
• 2:49
  SPEAKER_03: Yeah.
• 2:49
  SPEAKER_03: Again,
• 2:50
  this is a Republican fever dream for decades to take health
• 2:54
  care away from poor
• 2:55
  SPEAKER_03: people and give rich people more tax cuts.
• 2:57
  They just found a willing idiot in Trump that would sign the
• 3:00
  thing because they
• 3:02
  SPEAKER_03: then do the things he wants to do.
• 3:04
  SPEAKER_03: Right.
• 3:04
  SPEAKER_03: They put on the red hats and they tell everyone,
• 3:07
  SPEAKER_03: you know,
• 3:07
  he really can fire whoever the hell he wants and he really can
• 3:11
  round up whoever the
• 3:11
  SPEAKER_03: hell he wants.
• 3:12
  So they give him cover for his insane policies and he'll sign
• 3:17
  whatever they put in front of him.
• 3:19
  SPEAKER_03: Yeah, so I think maybe you're right.
• 3:21
  Maybe it creates a rift and enough of a point where people are
• 3:23
  going to start
• 3:24
  questioning their allegiance to this individual and to this
• 3:28
  party that this
• 3:29
  individual has adopted as a part of the MAGA movement and can
• 3:31
  see some of the truth
• 3:33
  SPEAKER_03: of what they're actually doing to them.
• 3:34
  SPEAKER_03: Let's hope.
• 3:34
  Yeah,
• 3:35
  the hope is that the fever breaks for,
• 3:37
  it doesn't have to break for everyone.
• 3:38
  SPEAKER_03: It just needs to break for some people, right?
• 3:39
  SPEAKER_03: And that we end up with some folks sort of reverting to self-interest.
• 3:44
  SPEAKER_03: There you go.
• 3:45
  SPEAKER_03: Amen.
• 3:45
  SPEAKER_03: Yeah.
• 3:46
  SPEAKER_03: Anyway.
• 3:46
  SPEAKER_03: Okay.
• 3:47
  SPEAKER_03: So we got a lot to cover.
• 3:48
  I think the first thing we want to start off with is the
• 3:51
  agriculture secretary,
• 3:53
  Brooke Rollins.
• 3:54
  SPEAKER_03: I didn't know much about Brooke Rollins prior to this,
• 3:56
  but basically her take was let's put Medicaid beneficiaries to
• 4:00
  work at the farm
• 4:01
  SPEAKER_03: fields.
• 4:01
  SPEAKER_03: Why don't we throw to the clip?
• 4:02
  SPEAKER_00: We must be strategic and how we are implementing the mass deportation.
• 4:07
  SPEAKER_00: So is not to compromise our food supply.
• 4:09
  SPEAKER_00: Ultimately,
• 4:10
  SPEAKER_00: the answer on this is automation,
• 4:12
  SPEAKER_00: also some reform within the current governing structure.
• 4:15
  SPEAKER_00: And then also,
• 4:16
  when you think about there are 34 million able bodied adults in
• 4:20
  our Medicaid
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  SPEAKER_00: program.
• 4:21
  SPEAKER_00: There are plenty of workers in America.
• 4:23
  OK,
• 4:24
  so just to recap,
• 4:25
  the quote is the 34 million able bodied adults on Medicaid.
• 4:29
  SPEAKER_03: show that there's plenty of workers in America.
• 4:31
  SPEAKER_03: We're in the throes of mass deportations.
• 4:33
  SPEAKER_03: We're worried about how that affects the food supply.
• 4:35
  The idea here is that work requirements are going to push
• 4:39
  people back into the
• 4:40
  SPEAKER_03: workforce,
• 4:41
  SPEAKER_03: and that workforce is going to be picking fruits and vegetables.
• 4:45
  SPEAKER_03: Is that right?
• 4:46
  SPEAKER_03: Did I get that right?
• 4:47
  SPEAKER_03: I guess.
• 4:48
  SPEAKER_03: Right.
• 4:48
  SPEAKER_03: If you're having chest pain,
• 4:49
  SPEAKER_03: you got to go and,
• 4:50
  SPEAKER_03: you know,
• 4:50
  SPEAKER_03: you got to go pick a few strawberries,
• 4:52
  SPEAKER_03: you know,
• 4:52
  SPEAKER_03: or pick some cabbage and then we can go ahead and do the hard cath.
• 4:55
  SPEAKER_03: Like, I don't know.
• 4:56
  SPEAKER_03: I don't know what the hell these people are thinking,
• 4:58
  SPEAKER_03: you know,
• 4:58
  SPEAKER_03: like and then like to match up this incredible need of health care.
• 5:03
  SPEAKER_03: I mean, it's insane.
• 5:29
  But if they want to talk about this shit and just be
• 5:31
  ridiculous,
• 5:32
  sure,
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  you know,
• 5:33
  go for it.
• 5:33
  SPEAKER_03: You have no credentials.
• 5:34
  SPEAKER_03: You have no reason to be credible.
• 5:36
  SPEAKER_03: You're the cabinet secretary running the agriculture department, right?
• 5:40
  SPEAKER_03: You're one of those people in the room where it happens.
• 5:43
  SPEAKER_03: And this is something you're just kind of floating out there.
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  You know damn well this is not just some construct in her mind
• 5:49
  in the moment on an interview.
• 5:50
  SPEAKER_03: They've actually talked about this, right?
• 5:52
  SPEAKER_03: They're going to match.
• 5:53
  up the numbers because they're going to say it enough to get
• 5:56
  regular folks saying,
• 5:57
  SPEAKER_03: well,
• 5:57
  SPEAKER_03: yeah,
• 5:58
  SPEAKER_03: why not?
• 5:58
  SPEAKER_03: Why not just have them go pick all the vegetables?
• 6:00
  You know,
• 6:02
  we're not going to have to pay,
• 6:03
  you know,
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  20 bucks for a quart of strawberries.
• 6:05
  SPEAKER_03: We can just have those Medicaid people go do it.
• 6:07
  SPEAKER_03: I'm afraid they're going to do it for Medicare.
• 6:09
  SPEAKER_03: Now you're going to have 70-year-olds out there,
• 6:11
  SPEAKER_03: you know,
• 6:12
  SPEAKER_03: shimming up the stock to pick the fruit.
• 6:14
  SPEAKER_03: Oh, man.
• 6:15
  SPEAKER_03: Right.
• 6:15
  SPEAKER_03: Push the retirement age back.
• 6:16
  SPEAKER_03: Get in the fields.
• 6:17
  SPEAKER_03: Yeah.
• 6:17
  SPEAKER_03: Just a quick note.
• 6:19
  SPEAKER_03: 64% of adults ages 19 to 64 are covered by Medicaid already work.
• 6:23
  SPEAKER_03: So really importantly, so that number is already grossly inflated.
• 6:27
  SPEAKER_03: And then another quick stat for you.
• 6:28
  Agricultural workers usually do their tasks outdoors in all
• 6:31
  kinds of weather.
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  SPEAKER_03: Most work full time and some work more than 40 hours per week.
• 6:36
  SPEAKER_03: 66% of agricultural workers in the U.S.
• 6:37
  SPEAKER_03: are non-citizens.
• 6:39
  SPEAKER_03: That is that's a lot of people.
• 6:40
  SPEAKER_03: So, you know, there are a lot of agricultural workers in the U.S.
• 6:43
  SPEAKER_03: It's such an absurd comment.
• 6:44
  SPEAKER_03: Obviously,
• 6:45
  SPEAKER_03: we want to like we want because when they say absurd things,
• 6:48
  SPEAKER_03: sometimes they go and try to do them.
• 6:50
  SPEAKER_03: There aren't able bodied people on the Medicaid rolls.
• 6:52
  SPEAKER_03: It's just like not that many people.
• 6:54
  SPEAKER_03: Maybe there's a handful, but it's just like not that many folks.
• 6:57
  SPEAKER_03: So like on its face, it's just it's just absurd.
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  Do you think also like – because there are lots of sort of mega
• 7:04
  supporters who are
• 7:04
  SPEAKER_03: on Medicaid that's like in the realignment of the working class,
• 7:09
  SPEAKER_03: like the white working class,
• 7:10
  SPEAKER_03: folding into sort of a mega coalition.
• 7:12
  Do you think there's a lot of folks that are eager to go pick
• 7:16
  fruits and vegetables?
• 7:17
  SPEAKER_03: Yeah, of course not, right?
• 7:18
  SPEAKER_03: But this is an old trick that they've done for years, right?
• 7:21
  They get people to always think it's somebody else who's
• 7:25
  sitting on their parents'
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  SPEAKER_03: couch playing video games,
• 7:27
  SPEAKER_03: collecting Medicaid checks.
• 7:29
  SPEAKER_03: Again, let's be clear.
• 7:30
  SPEAKER_03: There are no Medicaid checks for people, right?
• 7:33
  SPEAKER_03: Medicaid is insurance.
• 7:34
  SPEAKER_03: These are people who get insurance through Medicaid because they're poor.
• 7:38
  SPEAKER_03: That's it.
• 7:39
  And anything else they're trying to distract us with is just
• 7:42
  utter bullshit.
• 7:43
  And again,
• 7:43
  it's trying to pit folks in their coalition who have Medicaid,
• 7:47
  who don't.
• 7:48
  SPEAKER_03: Yeah.
• 8:06
  SPEAKER_03: It's kind of effective, though, right?
• 8:08
  Like people,
• 8:09
  largely the population out there in polling supports work
• 8:12
  requirements.
• 8:13
  SPEAKER_03: It's like they're supporting a policy that doesn't fix a non-problem.
• 8:17
  SPEAKER_03: You know, it's insane, but it's politically potent.
• 8:21
  SPEAKER_03: In other news,
• 8:23
  SPEAKER_03: in enormous lies being told in the press about health care,
• 8:26
  SPEAKER_03: I want to throw to a clip of,
• 8:27
  SPEAKER_03: I believe it's Larry Kudlow talking to Robert F.
• 8:30
  SPEAKER_03: Kennedy Jr.
• 8:31
  SPEAKER_03: Let's check that out.
• 8:32
  He's out there saying in the New York Times and elsewhere that
• 8:35
  the Medicaid
• 8:36
  SPEAKER_02: reforms,
• 8:37
  SPEAKER_02: the eligibility reforms for able-bodied will cause 100,000 people to die.
• 8:44
  I mean,
• 8:44
  I think that's an outrageous,
• 8:46
  outrageous claim,
• 8:48
  Secretary Kennedy.
• 8:49
  SPEAKER_02: What's your take on that?
• 8:51
  SPEAKER_02: Can you fight back on that?
• 8:55
  SPEAKER_02: First of all, there's no cuts on Medicaid.
• 8:57
  SPEAKER_02: There is a diminishment
• 9:02
  SPEAKER_02: of the growth rate of Medicaid, which is bankrupting our country.
• 9:05
  And by the way,
• 9:05
  the national debt is also a determinant,
• 9:10
  a social determinant of health.
• 9:12
  If we're leaving our kids with these giant debts,
• 9:14
  they can't afford health care.
• 9:16
  SPEAKER_02: They can't afford good food.
• 9:17
  SPEAKER_03: OK, so we have cited the 100,000 deaths on this show before.
• 9:24
  SPEAKER_03: At least.
• 9:25
  SPEAKER_03: At least.
• 9:26
  SPEAKER_03: Yeah, at least.
• 9:27
  SPEAKER_03: And then at length,
• 9:29
  we have talked about the substantial cuts and the amount of
• 9:33
  people that will not
• 9:34
  SPEAKER_03: have health care.
• 9:35
  SPEAKER_03: What do we think, Rob?
• 9:36
  SPEAKER_03: Do we think RFK is just lying?
• 9:37
  SPEAKER_00: He's just lying.
• 9:38
  SPEAKER_03: So there's three problems here, right?
• 9:41
  SPEAKER_03: Larry Kudlow.
• 9:41
  SPEAKER_00: Yeah, yeah.
• 9:43
  SPEAKER_03: I don't know his background, but he's on Fox Business, right?
• 9:46
  Larry Kudlow's suggesting this is bullshit and basically
• 9:49
  leading the witness.
• 9:51
  SPEAKER_03: Like, please tell us why this is bullshit, RFK Jr.
• 9:53
  SPEAKER_03: RFK Jr.
• 9:54
  SPEAKER_03: then affirming this is bullshit and saying these aren't cuts.
• 9:58
  SPEAKER_03: These are just, I forget, diminishments in increases.
• 10:01
  SPEAKER_03: I don't know how he phrased it.
• 10:02
  SPEAKER_03: But they are cuts, right?
• 10:04
  They are enacting a big morass of red tape that will cut people
• 10:09
  from having Medicaid insurance.
• 10:11
  They are enacting policies that will not allow states to
• 10:15
  generate revenue to get
• 10:17
  matching funds from the federal government to pay for health
• 10:20
  care with Medicaid,
• 10:22
  SPEAKER_03: right?
• 10:22
  SPEAKER_03: So those are literal cuts.
• 10:24
  SPEAKER_03: So he's lying about that.
• 10:26
  SPEAKER_03: But then the last 10 seconds or so,
• 10:28
  SPEAKER_03: 15 seconds of the clip,
• 10:30
  SPEAKER_03: and we're going to get the whole clip.
• 10:31
  SPEAKER_03: I think it's 50 seconds long, so bear with it.
• 10:33
  He says,
• 10:34
  and the crippling national debt is a social determinant of
• 10:39
  health.
• 10:39
  Now,
• 10:39
  he doesn't know what the hell he's talking about with social
• 10:42
  determinants of health.
• 10:42
  SPEAKER_03: He said,
• 10:43
  because it doesn't allow our future generations to afford
• 10:46
  health care and to afford
• 10:47
  SPEAKER_03: healthy food.
• 10:49
  SPEAKER_03: Yeah.
• 10:50
  SPEAKER_03: If he believes that,
• 10:50
  take him at his word that crippling national debt is a negative
• 10:55
  impact on people's
• 10:56
  SPEAKER_03: health,
• 10:56
  SPEAKER_03: and he's a secretary of health and human services.
• 10:59
  SPEAKER_03: They added how much?
• 11:00
  SPEAKER_03: $4 trillion to the debt with this package, right?
• 11:03
  SPEAKER_03: With this one big, beautiful abomination.
• 11:06
  SPEAKER_03: They did that.
• 11:07
  So he is admitting that they are having a negative impact on
• 11:11
  people's health and
• 11:12
  SPEAKER_03: well-being and what have you.
• 11:13
  SPEAKER_03: I mean, we don't talk much about the deficit.
• 11:16
  SPEAKER_03: Neither of us are even remotely close to being experts on that.
• 11:19
  But when this idiot invokes that as a reason to cut people from
• 11:24
  from insurance and
• 11:25
  SPEAKER_03: cut people from health care,
• 11:26
  SPEAKER_03: can't have it both ways.
• 11:27
  You can't pass this bill cutting health care,
• 11:30
  but then you're handing it all to billionaires.
• 11:32
  SPEAKER_03: It's almost unimaginable.
• 11:34
  SPEAKER_03: They could continue to say this stuff, but they do.
• 11:36
  SPEAKER_03: Right.
• 11:36
  SPEAKER_03: They get a willing audience and they keep saying it.
• 11:39
  SPEAKER_03: I will just say this.
• 11:40
  SPEAKER_03: I want if there's any MPHs listening,
• 11:43
  SPEAKER_03: Masters of Public Health listening to this podcast,
• 11:46
  SPEAKER_03: he said that to break your brain.
• 11:48
  SPEAKER_03: He literally was talking.
• 11:49
  SPEAKER_03: He did.
• 11:50
  SPEAKER_03: And I am an MPH.
• 11:51
  SPEAKER_03: And it broke my brain, Miles.
• 11:52
  SPEAKER_03: Right.
• 11:53
  SPEAKER_03: Yeah.
• 11:53
  SPEAKER_03: He was trolling you specifically.
• 11:55
  SPEAKER_03: And he wanted you to have a bad date specifically.
• 11:58
  SPEAKER_03: I say that.
• 11:59
  SPEAKER_03: Yeah.
• 12:00
  SPEAKER_03: Yeah.
• 12:00
  SPEAKER_03: Right.
• 12:00
  SPEAKER_03: Because they don't like these.
• 12:01
  SPEAKER_03: They don't like that term.
• 12:02
  SPEAKER_03: Right.
• 12:03
  SPEAKER_03: They don't like the term.
• 12:04
  SPEAKER_00: Right.
• 12:04
  SPEAKER_00: I know.
• 12:05
  SPEAKER_03: Because it sounds like someone in academia made up.
• 12:08
  SPEAKER_03: Something they made up to talk about an issue.
• 12:11
  SPEAKER_03: So people like RFK Jr.
• 12:12
  SPEAKER_03: couldn't understand what the hell they were talking about.
• 12:14
  And he doesn't understand what they were talking about because
• 12:16
  the guy comes from a
• 12:17
  SPEAKER_03: life of privilege.
• 12:18
  SPEAKER_03: He has no idea what people go through.
• 12:19
  Well,
• 12:20
  in the interview we did with Dr.
• 12:22
  Johnson,
• 12:22
  you know,
• 12:23
  she does talk about this as well.
• 12:24
  So many of these folks have never walked in someone else's
• 12:27
  shoes or even imagine
• 12:29
  SPEAKER_03: what life is like in someone else's shoes.
• 12:31
  SPEAKER_03: And these social determinants of health,
• 12:33
  SPEAKER_03: like your zip code determining your access to healthy food,
• 12:36
  SPEAKER_03: your access to health care,
• 12:37
  more now than ever before with these impending cuts and rural
• 12:41
  hospitals closing.
• 12:43
  SPEAKER_03: You know, guys like RFK Jr.
• 12:44
  have never had to consider that,
• 12:46
  right,
• 12:46
  as a reality of how you get health care.
• 12:49
  SPEAKER_03: When he had a brain worm,
• 12:50
  SPEAKER_03: he didn't have to wonder,
• 12:52
  SPEAKER_03: where am I going to get my brain worm treated?
• 12:54
  SPEAKER_03: He just,
• 12:55
  SPEAKER_03: I'm sure,
• 12:55
  got to go to wherever he gets his health care because it was
• 12:58
  easy because he had
• 12:58
  SPEAKER_03: insurance.
• 12:59
  SPEAKER_03: I think they got there too late.
• 13:01
  But,
• 13:01
  you know,
• 13:01
  nonetheless,
• 13:02
  he was able to get the care he needed,
• 13:04
  apparently.
• 13:04
  SPEAKER_03: I heard a bit the other day, Rob.
• 13:06
  SPEAKER_03: I was, like, scrolling on my phone.
• 13:07
  SPEAKER_03: And I heard a bit from a comedian, RFK Jr., getting rid of pesticides.
• 13:12
  SPEAKER_03: That's actually the worm talking that the worm is doing the worm.
• 13:15
  is still commanding the commanding the top that's a worm public
• 13:18
  policy yeah that's
• 13:20
  that's pretty good we haven't talked about the worm at all on
• 13:23
  this podcast yeah we
• 13:24
  gotta talk about episode 15 is the first appearance of the
• 13:28
  brain worm controlling
• 13:29
  the secretary but that that i think the worm might be i think
• 13:32
  it's pretty obvious
• 13:33
  the worm is in charge the worm is in charge the worm is mad if
• 13:38
  anyone can make up a
• 13:39
  good good graphic or something about that we'll definitely put
• 13:42
  it in the show notes
• 13:43
  SPEAKER_03: OK,
• 13:43
  SPEAKER_03: so then we have in the – OK,
• 13:45
  so we have a funny priority given – obviously like RFK is like
• 13:51
  a lot of funny
• 13:51
  SPEAKER_03: priorities.
• 13:52
  SPEAKER_03: But coming out of the Trump administration,
• 13:54
  SPEAKER_03: I think like incredibly for public health,
• 13:57
  Donald Trump is leaning on the Coca-Cola Corporation to put
• 14:01
  real cane sugar back in
• 14:03
  SPEAKER_03: Coca-Cola and exclusively sell Coca-Cola with real cane sugar.
• 14:07
  SPEAKER_03: Donald Trump announced that the Coca-Cola Corporation agreed to that.
• 14:10
  SPEAKER_03: The Coca-Cola Corporation said we did not.
• 14:13
  SPEAKER_03: Basically, they were like, nope, we didn't do that.
• 14:15
  SPEAKER_03: Rob, what do we think?
• 14:17
  SPEAKER_03: Is that we're excited about that priority?
• 14:19
  SPEAKER_03: We're thinking that's making America healthy again?
• 14:22
  SPEAKER_03: You've had Coke with sugar, right?
• 14:24
  SPEAKER_03: You can get it in Mexico.
• 14:26
  SPEAKER_00: I had it in Haiti.
• 14:28
  We went to Haiti a couple of times to volunteer after the
• 14:30
  earthquake and do medical care there.
• 14:32
  SPEAKER_03: And we had it there, right?
• 14:33
  They had a lot of cane sugar in Haiti,
• 14:36
  and they did it right in the country.
• 14:38
  SPEAKER_03: It's amazing.
• 14:39
  SPEAKER_03: It really is amazing.
• 14:41
  SPEAKER_03: So are we just ready for this?
• 14:44
  SPEAKER_03: No, yeah.
• 14:45
  SPEAKER_03: Let's take this in two parts, right?
• 14:47
  SPEAKER_03: Three parts, maybe, right?
• 14:48
  SPEAKER_03: One part is it is fucking amazing.
• 14:50
  SPEAKER_03: And if it were a priority,
• 14:51
  SPEAKER_03: if it could happen,
• 14:53
  SPEAKER_03: that's not a bad thing for people who would drink Coke,
• 14:56
  SPEAKER_03: right?
• 14:56
  SPEAKER_03: Yeah.
• 14:57
  SPEAKER_03: So one, two, it's just his MO is stating things as being done.
• 15:03
  SPEAKER_03: Right.
• 15:03
  SPEAKER_03: He's done this with trade deals.
• 15:04
  SPEAKER_03: We got a trade deal.
• 15:05
  SPEAKER_03: We got a trade deal.
• 15:06
  SPEAKER_03: And then the country said, wait, what?
• 15:07
  SPEAKER_03: Huh?
• 15:07
  SPEAKER_03: Wait, what?
• 15:08
  SPEAKER_03: I thought we were talking about things.
• 15:09
  SPEAKER_03: So he said, this is done.
• 15:11
  SPEAKER_03: This is done.
• 15:11
  SPEAKER_03: And then Coke comes out and says, wait a minute.
• 15:12
  SPEAKER_03: What are you talking about?
• 15:13
  SPEAKER_03: Right.
• 15:14
  So I don't know if he has conversations with people and they
• 15:16
  don't actually result
• 15:17
  SPEAKER_03: in the outcomes he thinks.
• 15:19
  I don't know if he thinks he has conversations with people and
• 15:22
  then just sort of
• 15:23
  SPEAKER_03: puts them out on truth or puts them out on Twitter.
• 15:25
  Like,
• 15:25
  I don't know what actually goes on with that part of Donald
• 15:28
  Trump's brain.
• 15:29
  SPEAKER_03: You know, he is a 78-year-old man.
• 15:31
  And there's just a little other world happening where he's
• 15:34
  negotiating trade deals
• 15:36
  SPEAKER_03: and getting Coke to put sugar in their regular Coke.
• 15:40
  SPEAKER_03: And to him, that's actually happened.
• 15:42
  SPEAKER_03: I don't know.
• 15:43
  SPEAKER_03: And then the other piece of this is just like what you said,
• 15:45
  SPEAKER_03: like with everything that's happening,
• 15:46
  SPEAKER_03: right?
• 15:47
  SPEAKER_03: In particular in our world,
• 15:48
  SPEAKER_03: you know,
• 15:49
  SPEAKER_03: with this big,
• 15:50
  SPEAKER_03: beautiful abomination they passed two weeks ago.
• 15:52
  SPEAKER_03: That's the one I'm using now, big, beautiful abomination.
• 15:54
  SPEAKER_03: I heard it on a podcast I was on, so I'm going to adopt it.
• 15:57
  SPEAKER_03: With that thing they passed, it was 17 million people losing out here.
• 16:00
  SPEAKER_03: Everyone found their word for the bill after the bill passed.
• 16:04
  SPEAKER_03: Everyone like finally arrived at their like favorite message point on it.
• 16:08
  SPEAKER_03: Jesus, I...
• 16:09
  SPEAKER_03: No,
• 16:09
  SPEAKER_03: but like with that all happening,
• 16:10
  SPEAKER_03: 17 million people losing health care,
• 16:12
  SPEAKER_03: a trillion out of Medicaid,
• 16:13
  SPEAKER_03: massive transfer of wealth upward,
• 16:14
  SPEAKER_03: that this is a focus of our president is just,
• 16:18
  SPEAKER_03: I don't know,
• 16:19
  SPEAKER_03: add it to the canon of things he does that you can't believe he does,
• 16:21
  SPEAKER_03: but you still know that,
• 16:23
  SPEAKER_03: yep,
• 16:23
  SPEAKER_03: it's going to do it again.
• 16:24
  SPEAKER_03: Like, I don't know what's next.
• 16:26
  SPEAKER_03: I don't know what's next.
• 16:27
  SPEAKER_03: Beef tallow for french fries?
• 16:29
  Probably beef tallow for fast food french fries will be the
• 16:32
  next priority.
• 16:33
  SPEAKER_00: Oh, that's already happening, Rob.
• 16:34
  SPEAKER_00: No, no, but an executive order.
• 16:36
  SPEAKER_00: An executive order.
• 16:36
  SPEAKER_00: Oh, you must.
• 16:37
  SPEAKER_00: You must use beef tallow.
• 16:38
  SPEAKER_03: Or a tweet or something, right?
• 16:39
  SPEAKER_03: It has to happen.
• 16:40
  SPEAKER_03: And they've all agreed on it.
• 16:42
  SPEAKER_03: That will be the next one.
• 16:43
  SPEAKER_03: You know,
• 16:44
  SPEAKER_03: in my Chicago grocery store,
• 16:45
  SPEAKER_03: just on the edge of Wicker Park there,
• 16:47
  SPEAKER_03: tallow showed up in the meat section.
• 16:49
  SPEAKER_03: It was like one day overnight, I'm looking at jars of tallow.
• 16:54
  SPEAKER_03: I'm like, who's that for in this neighborhood?
• 16:57
  SPEAKER_03: That feels like, who is that for?
• 17:00
  SPEAKER_03: I don't know who that's for.
• 17:02
  SPEAKER_03: It's so weird.
• 17:03
  It's hard for me to tell whether RFK is following culture or
• 17:06
  culture is following
• 17:06
  SPEAKER_03: RFK,
• 17:07
  SPEAKER_03: but there's a new tallow sunscreen billboard up downtown.
• 17:10
  SPEAKER_00: Papa Free.
• 17:11
  SPEAKER_03: That's like, your sunscreen's poisoning you.
• 17:14
  SPEAKER_03: Use beef tallow sunscreen.
• 17:16
  SPEAKER_03: And I was like, I don't.
• 17:17
  SPEAKER_03: think so.
• 17:17
  SPEAKER_03: I'm not sure that that's a product that matters.
• 17:22
  SPEAKER_03: It is like good for your skin,
• 17:23
  SPEAKER_03: but it is not like necessarily like any healthier than other fats,
• 17:27
  SPEAKER_03: right?
• 17:27
  SPEAKER_03: So I don't actually know.
• 17:28
  SPEAKER_03: Yeah,
• 17:30
  SPEAKER_03: I don't know that there's any data,
• 17:31
  but there's going to be an episode that's just a half-hour rant
• 17:34
  of me talking about
• 17:35
  SPEAKER_03: people saying I did my own research.
• 17:37
  I had someone just a couple of shifts ago refuse to get their
• 17:40
  tetanus booster.
• 17:41
  SPEAKER_03: They've had several in the past, and I asked why.
• 17:43
  SPEAKER_03: They said, well, I've done my research, and I don't want to get that.
• 17:46
  SPEAKER_03: Tetanus?
• 17:47
  SPEAKER_03: Yeah, tetanus.
• 17:49
  SPEAKER_03: Tetanus.
• 17:50
  SPEAKER_03: I said, well, have you done research on tetanus?
• 17:51
  SPEAKER_03: It's pretty terrible.
• 17:52
  SPEAKER_03: I've never seen it.
• 17:53
  SPEAKER_03: I kind of don't want to.
• 17:54
  SPEAKER_03: Hope you're not the first one that I see in a couple of weeks from now.
• 17:57
  SPEAKER_03: But no,
• 17:57
  SPEAKER_03: that phrase,
• 17:58
  I did my own research to me is one of the most maddening
• 18:02
  phrases to come out of
• 18:03
  SPEAKER_03: COVID.
• 18:03
  SPEAKER_03: But now it's permeated every aspects of the Maha movement.
• 18:07
  SPEAKER_03: I did my own research.
• 18:08
  SPEAKER_03: The problem is the research they're doing is Facebook.
• 18:11
  SPEAKER_03: It's crazy.
• 18:12
  SPEAKER_03: It's crazy.
• 18:13
  SPEAKER_03: I didn't know tetanus was on the list.
• 18:15
  SPEAKER_00: It's a vaccine, right?
• 18:17
  SPEAKER_00: It's so innocuous.
• 18:18
  SPEAKER_03: Yeah.
• 18:19
  SPEAKER_03: We just had a kid come in with pertussis and unvaccinated.
• 18:22
  And then another family came in to get tested because they were
• 18:24
  exposed to the
• 18:25
  SPEAKER_03: family,
• 18:25
  SPEAKER_03: even though they did have their vaccines.
• 18:27
  SPEAKER_03: Like, yeah, it's like for real.
• 18:29
  SPEAKER_03: Pertussis.
• 18:30
  SPEAKER_03: How many, how often had you seen pertussis prior to that?
• 18:33
  SPEAKER_03: One, maybe one.
• 18:35
  SPEAKER_03: Someone from, I think it was someone who traveled from elsewhere.
• 18:37
  SPEAKER_03: Yeah.
• 18:38
  SPEAKER_03: One time.
• 18:38
  SPEAKER_03: Oh, someone from abroad.
• 18:40
  I've seen now three in the past six months,
• 18:43
  eight months,
• 18:43
  something like that.
• 18:44
  SPEAKER_03: Oh, shit.
• 18:45
  SPEAKER_03: It pops up in clusters, you know.
• 18:47
  SPEAKER_03: Yeah.
• 18:47
  SPEAKER_03: Okay.
• 18:48
  SPEAKER_03: Yeah.
• 18:49
  SPEAKER_03: That's wild.
• 18:50
  SPEAKER_03: I don't like that people are making pertussis come back.
• 18:53
  SPEAKER_03: I don't care for it.
• 18:54
  SPEAKER_03: And I wish they'd stop.
• 18:56
  SPEAKER_03: I wish they'd get their shots and stop.
• 18:58
  SPEAKER_03: Yeah.
• 18:58
  We somehow need to find a worm in his brain that will convince
• 19:02
  him that pertussis is bad.
• 19:03
  SPEAKER_03: I don't know what that worm or what that might be,
• 19:06
  SPEAKER_03: but we need to find something that can control the brain.
• 19:08
  SPEAKER_03: We've got to come up with a little cocktail.
• 19:11
  SPEAKER_00: Pro-vaccine cocktail.
• 19:12
  SPEAKER_03: Pro-pertussis and tetanus vaccine worm.
• 19:15
  SPEAKER_03: Yes, I agree.
• 19:17
  SPEAKER_00: Okay.
• 19:17
  SPEAKER_03: And a mode to deploy it.
• 19:18
  SPEAKER_03: Okay.
• 19:19
  SPEAKER_03: All right.
• 19:20
  SPEAKER_03: So we're going to get into this with Dr. Shelley Johnson after the break.
• 19:26
  Just a little news on rural hospitals as we sort of fully get
• 19:30
  our arms around them.
• 19:32
  SPEAKER_03: fallout from the big bill.
• 19:33
  300 rural hospitals may close because of the bill according to
• 19:35
  research conducted
• 19:36
  by the University of North Carolina Shep Center for Health
• 19:38
  Services Research.
• 19:40
  SPEAKER_03: Research was to be done on behalf of the Senate Democrats,
• 19:42
  revealed a letter to Republican leadership where they basically
• 19:46
  laid that out.
• 19:46
  SPEAKER_03: 338 hospitals are at risk.
• 19:48
  SPEAKER_03: American Hospital Association saying it's closer to 700.
• 19:52
  Since the provisions of the Trump budget bill don't kick in for
• 19:55
  months and years,
• 19:55
  SPEAKER_03: hospital believes they can fight to keep them from being implemented.
• 20:00
  SPEAKER_03: But it sounds like maybe some are already closing.
• 20:05
  SPEAKER_03: It sounds like that feels a little Pollyannish to me.
• 20:09
  that they're going to be able to like come back and convince
• 20:12
  either a Republican in
• 20:13
  SPEAKER_03: Senate,
• 20:14
  SPEAKER_03: Republican Congress,
• 20:16
  SPEAKER_03: or even a split Congress,
• 20:17
  SPEAKER_03: right?
• 20:18
  Like even if the Democrats have to go back and try to negotiate
• 20:21
  back filling in
• 20:23
  SPEAKER_03: some of Medicaid or some money for hospitals,
• 20:25
  that you could see Trump holding up signing the bill if we were
• 20:28
  to take back
• 20:29
  SPEAKER_03: Congress.
• 20:30
  SPEAKER_03: Yeah.
• 20:30
  SPEAKER_00: Well,
• 20:31
  SPEAKER_00: hey,
• 20:31
  SPEAKER_03: our favorite fist pumping,
• 20:33
  SPEAKER_03: weird running senator from Missouri,
• 20:35
  SPEAKER_03: Josh Hawley,
• 20:36
  SPEAKER_03: has introduced a bill in the Senate to stop Medicaid cuts.
• 20:40
  SPEAKER_03: Right.
• 20:41
  So maybe he and Lisa Murkowski can get together and figure out
• 20:44
  how they're going to
• 20:45
  SPEAKER_03: try to undo this shit that they went for.
• 20:48
  SPEAKER_03: But like, I have no I got just nothing.
• 20:50
  SPEAKER_03: They voted for this thing.
• 20:51
  SPEAKER_03: They voted it into law.
• 20:53
  SPEAKER_03: And now now he is like and he and he was one of the ones who said,
• 20:57
  SPEAKER_03: I will not vote for this because it's cutting Medicaid.
• 21:00
  SPEAKER_03: It's going to affect hospitals in the state of Missouri.
• 21:03
  SPEAKER_03: He's right.
• 21:04
  SPEAKER_03: But he did vote for it.
• 21:05
  SPEAKER_03: We're already hearing news out of Missouri.
• 21:07
  SPEAKER_03: Like the conversations,
• 21:08
  SPEAKER_03: because they are,
• 21:09
  SPEAKER_03: for those who haven't heard this before,
• 21:11
  they are constitutionally obligated to pay for Medicaid because
• 21:14
  of the way in which
• 21:15
  SPEAKER_03: they expanded Medicaid by ballot initiative as opposed to sort of just
• 21:20
  SPEAKER_03: legislatively.
• 21:21
  SPEAKER_03: So it's in their constitution.
• 21:22
  SPEAKER_03: They got to pay for Medicaid.
• 21:23
  SPEAKER_03: So they're looking at just ballot.
• 21:24
  SPEAKER_03: wild cuts to roads and public education.
• 21:27
  You're going to be like looking at like a failed state in
• 21:29
  Missouri and like where
• 21:31
  you're going to see just like a real notch back in terms of
• 21:33
  public quality of life
• 21:35
  SPEAKER_03: in Missouri because of what this does to their budget.
• 21:38
  SPEAKER_03: Yeah, it's pretty wild.
• 21:39
  SPEAKER_03: It's pretty wild.
• 21:41
  SPEAKER_03: So, hey, man, Josh Hawley, keep pumping that fish.
• 21:43
  SPEAKER_03: Let's get health care for people.
• 21:45
  SPEAKER_00: Yeah.
• 21:45
  SPEAKER_03: All right.
• 21:46
  SPEAKER_03: Well, why don't we do this?
• 21:47
  Let's take a little pause and we'll go to our interview with
• 21:49
  Dr.
• 21:49
  Shelley Johnson.
• 21:50
  We're going to learn a lot more about the pressures that rural
• 21:52
  hospitals are going
• 21:53
  SPEAKER_03: to be feeling after the consequences of the big bill.
• 21:56
  SPEAKER_03: We'll go to that now.
• 22:00
  SPEAKER_03: Hi, everyone.
• 22:00
  SPEAKER_03: Welcome back.
• 22:02
  Today's guest is Dr.
• 22:03
  Shelley Johnson,
• 22:04
  a registered nurse with an MPH,
• 22:06
  MBA,
• 22:06
  and a PhD.
• 22:07
  She brings 30 years of healthcare leadership experience to
• 22:09
  today's discussion.
• 22:10
  SPEAKER_03: She currently serves as a teaching assistant professor in the health and
• 22:13
  SPEAKER_03: kinesiology department at the University of Illinois,
• 22:15
  SPEAKER_03: Champaign-Urbana.
• 22:17
  Her previous roles included interim president and chief
• 22:19
  operating officer at
• 22:20
  SPEAKER_03: Spectrum Health Gerber Memorial Hospital,
• 22:22
  SPEAKER_03: a rural hospital part of a large health care system.
• 22:24
  Her experience with rural hospitals and her doctoral research
• 22:26
  focused specifically
• 22:27
  SPEAKER_03: on hospital community health improvement activities and their outcomes,
• 22:31
  making her uniquely qualified to discuss the intersection of
• 22:33
  policy and rural
• 22:34
  health care delivery as we discuss the fallout from the One Big
• 22:37
  Beautiful Bill Act.
• 22:39
  SPEAKER_03: Dr. Shelley Johnson, welcome to Paging America.
• 22:41
  SPEAKER_01: Thank you.
• 22:42
  SPEAKER_03: Where do we find you today?
• 22:43
  SPEAKER_01: I am in my office at the university here.
• 22:45
  SPEAKER_01: It's nice and quiet with the students being out for the summer.
• 22:48
  SPEAKER_03: That's probably some peace and quiet.
• 22:49
  Are there a lot of professor and professor types still
• 22:51
  wandering around the
• 22:52
  SPEAKER_03: university,
• 22:53
  SPEAKER_03: or is it really kind of a ghost town?
• 22:55
  SPEAKER_01: It's really kind of a ghost town.
• 22:56
  I will say they do a lot of student camps,
• 22:59
  though,
• 22:59
  for like high school,
• 23:00
  middle school.
• 23:01
  SPEAKER_01: So you still see a lot of students,
• 23:03
  SPEAKER_01: but it just doesn't have the same energy as during the school year.
• 23:05
  SPEAKER_03: So,
• 23:06
  SPEAKER_03: Shelley,
• 23:06
  we are going to talk about the fallout of the One Big Beautiful
• 23:10
  Bill Act today and
• 23:12
  SPEAKER_03: your history with
• 23:14
  SPEAKER_03: being part of hospital systems,
• 23:15
  SPEAKER_03: I think gives us sort of a unique,
• 23:17
  could give us a unique insight into some of the pressures that
• 23:21
  are facing rural
• 23:22
  SPEAKER_03: hospitals.
• 23:22
  SPEAKER_03: I want to just set up our discussions.
• 23:24
  SPEAKER_03: A letter was sent by Senator Schumer and Senator Markey to Mike Johnson,
• 23:28
  SPEAKER_03: President Trump,
• 23:29
  and the Senate Majority Leader Thun that 338 rural hospitals
• 23:33
  are in danger of
• 23:35
  SPEAKER_03: closing,
• 23:35
  SPEAKER_03: likely to close because of the Medicaid cuts.
• 23:38
  SPEAKER_03: Meanwhile,
• 23:39
  432 hospitals across the country have been identified as
• 23:42
  already being at risk even
• 23:43
  SPEAKER_03: prior to the cuts.
• 23:44
  SPEAKER_03: And then some estimates,
• 23:46
  SPEAKER_03: including from an economist that was on The Daily Show,
• 23:48
  this kind of a left-leaning economist that was on The Daily
• 23:50
  Show this Monday,
• 23:51
  SPEAKER_03: and the American Hospital Association,
• 23:53
  SPEAKER_03: so a pretty big spectrum of political actors out there,
• 23:56
  SPEAKER_03: have estimated that the number could be as high as 700.
• 24:01
  SPEAKER_03: Why are rural hospitals in so much trouble since they have cut Medicaid?
• 24:06
  Rural hospitals are unique in that they have a much higher
• 24:10
  dependence on Medicaid
• 24:11
  SPEAKER_01: than an urban hospital does.
• 24:13
  SPEAKER_01: So their peer mix is more government supported than any other.
• 24:17
  So they have less commercial Blue Castro Shield,
• 24:20
  more Medicaid and Medicare.
• 24:22
  SPEAKER_01: They also don't have necessarily the ability to have large scales.
• 24:26
  SPEAKER_01: So if you think of a small-town bookstore versus a Barnes & Noble,
• 24:29
  SPEAKER_01: their expenses are also higher.
• 24:31
  And so because government does not pay as well as commercial
• 24:34
  payers and they have a
• 24:36
  SPEAKER_01: higher cost structure,
• 24:37
  SPEAKER_01: that makes them uniquely vulnerable to cuts from the government.
• 24:41
  SPEAKER_03: Yeah.
• 24:41
  SPEAKER_03: And one argument I've heard as well, Medicaid doesn't pay enough anyways.
• 24:44
  SPEAKER_03: Why is this such a big deal?
• 24:46
  SPEAKER_03: And you said it right there.
• 24:47
  SPEAKER_03: They really don't.
• 24:48
  SPEAKER_03: But something,
• 24:49
  SPEAKER_03: if you take away Medicaid from all these folks in these places,
• 24:52
  SPEAKER_03: that then is zero.
• 24:53
  SPEAKER_03: Right.
• 24:54
  SPEAKER_03: So even not enough and them keeping themselves afloat.
• 24:57
  SPEAKER_03: But maybe, yeah, speak to that.
• 24:59
  SPEAKER_03: What happens when that reimbursement that maybe should be higher is?
• 25:02
  SPEAKER_03: for these places goes away completely.
• 25:05
  SPEAKER_03: Like where does the money come from?
• 25:06
  SPEAKER_03: What do the patients do?
• 25:07
  SPEAKER_03: Can't they just pay their bills?
• 25:09
  SPEAKER_03: I mean, that seems like the next logical step.
• 25:11
  SPEAKER_01: Well,
• 25:12
  so there's kind of a safety net if you're a not-for-profit
• 25:15
  hospital called
• 25:16
  SPEAKER_01: community benefits.
• 25:17
  SPEAKER_01: So if a patient comes in and they don't have the ability to pay,
• 25:20
  SPEAKER_01: a hospital basically has to write that off or eat that cost.
• 25:22
  SPEAKER_01: And in return, they don't pay taxes.
• 25:25
  SPEAKER_01: However,
• 25:25
  SPEAKER_01: if you look at when the ACA expanded,
• 25:28
  SPEAKER_01: those rural hospitals that were in states that expanded Medicaid,
• 25:32
  they had fewer people on the charity care or the community
• 25:36
  benefit and more people
• 25:37
  SPEAKER_01: moved to Medicaid.
• 25:39
  And so that helped them with their finances because they had at
• 25:42
  least something
• 25:42
  SPEAKER_01: coming in as opposed to nothing.
• 25:44
  SPEAKER_01: And a lot of the hospitals in states that did not expand Medicaid,
• 25:48
  those rural hospitals struggled and were more likely to close
• 25:52
  than those that were
• 25:53
  SPEAKER_01: located in Medicaid expansion states.
• 25:55
  So you kind of have the same thing going backwards now where
• 25:58
  we're taking away that
• 25:59
  SPEAKER_01: Medicaid expansion,
• 26:00
  that ACA support for the marketplace insurance and having more
• 26:05
  people then go back
• 26:05
  SPEAKER_01: onto charity care.
• 26:06
  SPEAKER_01: But,
• 26:07
  SPEAKER_01: you know,
• 26:07
  SPEAKER_01: the United States is we are one of the,
• 26:09
  SPEAKER_01: if you look across the world,
• 26:11
  we have the highest rate of medical debt that affects
• 26:14
  especially people of color
• 26:16
  SPEAKER_01: and poor people and people in rural areas.
• 26:18
  And now they are actually outside of all what we've been
• 26:20
  talking about is they're
• 26:21
  now going to make medical debt count on your credit report
• 26:24
  where they had been kind
• 26:25
  SPEAKER_01: of taking it off.
• 26:26
  So medical debt is the number one cause of bankruptcies in the
• 26:29
  United States.
• 26:30
  SPEAKER_01: So, you know, it's a big issue.
• 26:32
  And for context,
• 26:33
  I think that was just a ruling by a federal judge in Texas.
• 26:36
  Yesterday or this week that that was a Biden era policy that
• 26:41
  medical that would not
• 26:42
  SPEAKER_03: be on your credit report.
• 26:43
  SPEAKER_03: And they just basically blocked that.
• 26:45
  SPEAKER_03: So I guess we'll see.
• 26:46
  I'm not real confident the Supreme Court is going to come down
• 26:49
  on the side of
• 26:49
  SPEAKER_03: consumers and poor people.
• 26:51
  SPEAKER_03: Yeah.
• 26:51
  SPEAKER_03: But I guess remains to be seen.
• 26:52
  SPEAKER_03: But yeah, that is a huge deal that just happened.
• 26:54
  And as you said,
• 26:55
  disproportionately impacts the folks in these places where our
• 26:58
  hospitals are.
• 26:59
  SPEAKER_01: They're already struggling.
• 27:00
  SPEAKER_01: And then we just, you know, pile it on a little bit more.
• 27:02
  SPEAKER_03: Yeah.
• 27:03
  So with the financial pressure that'll come with not being able
• 27:06
  to have Medicaid be
• 27:06
  SPEAKER_03: a payor for patients that show up in rural hospitals that are sick,
• 27:10
  SPEAKER_03: it looks like Republicans had added a $50 billion for rural hospital
• 27:14
  SPEAKER_03: transformation,
• 27:15
  $25 billion to support rural hospitals in order to presumably
• 27:19
  shore up the finances
• 27:21
  SPEAKER_03: of rural hospitals.
• 27:22
  SPEAKER_03: That number sounds enormous to me.
• 27:25
  But
• 27:26
  SPEAKER_03: If it's 700 whole hospitals that are in jeopardy,
• 27:30
  I'm wondering if you can give a sense of does the scale match
• 27:34
  in your estimation?
• 27:35
  Yeah,
• 27:35
  my understanding of that program is it's rural health,
• 27:38
  not necessarily hospitals.
• 27:40
  SPEAKER_01: So FQHCs and other people can also apply.
• 27:42
  SPEAKER_01: So it doesn't necessarily go to a rural hospital.
• 27:45
  SPEAKER_01: And that money is only for five years and it doesn't even...
• 27:48
  SPEAKER_01: It doesn't even cover what they're taking away long term.
• 27:50
  SPEAKER_01: So it's kind of like a short term bonus,
• 27:52
  but long term we're going to take away most of your salary if
• 27:54
  you kind of think
• 27:55
  SPEAKER_01: about it that way.
• 27:56
  And there's not a lot of transparency on how they're going to
• 27:59
  award that money or
• 28:00
  SPEAKER_01: how they're going to divide it.
• 28:01
  SPEAKER_01: Half of it has to be equally specific.
• 28:05
  among every state so a hospital does not apply for it the state
• 28:08
  applies for it and
• 28:09
  so then if there's all 50 states apply for it then they all get
• 28:12
  an equal share for
• 28:13
  half of that amount then the other half they can do a lot and
• 28:17
  there's not a lot of
• 28:17
  transparency on what the rules are how they're gonna let people
• 28:20
  know that they were
• 28:21
  awarded well and the other piece i saw is the application
• 28:24
  period for this is like a
• 28:25
  SPEAKER_03: three-month window at the end of this year october
• 28:28
  SPEAKER_03: November, December.
• 28:29
  SPEAKER_03: So as the government does, you know, we're going to do this benefit.
• 28:32
  SPEAKER_03: But like,
• 28:33
  I can't imagine states pulling together all of the information
• 28:36
  they need to like
• 28:37
  SPEAKER_03: appropriately apply for these billions of dollars by October.
• 28:41
  SPEAKER_03: And then if you don't do it by December, you're out, right?
• 28:44
  SPEAKER_03: Wow.
• 28:45
  SPEAKER_03: Okay.
• 28:46
  SPEAKER_01: And some states,
• 28:47
  SPEAKER_01: I forget,
• 28:47
  SPEAKER_01: there's a state on the East Coast,
• 28:49
  SPEAKER_01: maybe Rhode Island,
• 28:49
  SPEAKER_01: I can't remember exactly which one,
• 28:51
  SPEAKER_01: but doesn't even have a rural hospital.
• 28:53
  SPEAKER_01: But they can still apply because maybe they have an FQHC.
• 28:56
  And so it's not necessarily well written or well understood or
• 29:00
  well clarified.
• 29:01
  SPEAKER_01: And it's a very fast turnaround.
• 29:02
  SPEAKER_01: And if I was running a hospital, I could not apply.
• 29:04
  SPEAKER_01: Even if I wanted that money, I have to wait for the state to do it.
• 29:07
  SPEAKER_01: And then the state can decide how they want to distribute that.
• 29:10
  SPEAKER_03: I was looking at the chart and so for the hospital associations chart,
• 29:13
  I'll use the more conservative number of the 338 hospitals that
• 29:17
  are in jeopardy.
• 29:18
  SPEAKER_03: An extraordinary amount were in Kentucky.
• 29:22
  There were like states that were going to take it really on the
• 29:25
  chin and they were
• 29:26
  SPEAKER_03: all – they were across the board red states.
• 29:28
  I know California had several but like it wasn't nearly as big
• 29:32
  as some of these
• 29:32
  SPEAKER_03: small to mid-sized states that have large rural populations –
• 29:36
  SPEAKER_03: Talk to us about, you've spent time in Illinois now, also in Michigan.
• 29:40
  SPEAKER_03: How's the Midwest looking?
• 29:41
  SPEAKER_01: Well, I'm sitting in Illinois.
• 29:42
  And so there are,
• 29:43
  I think,
• 29:44
  nine hospitals in Illinois that are at high risk of closure.
• 29:47
  SPEAKER_01: Okay.
• 29:48
  SPEAKER_01: There are still some even affecting us.
• 29:51
  SPEAKER_01: But yeah,
• 29:51
  SPEAKER_01: a lot of these rural states,
• 29:53
  SPEAKER_01: especially if they're red and they did not expand Medicaid,
• 29:56
  SPEAKER_01: I mean,
• 29:56
  SPEAKER_01: they already didn't expand it.
• 29:57
  SPEAKER_01: And now they're taking another hit on top of that.
• 29:59
  SPEAKER_01: So they're definitely going to be affected.
• 30:02
  SPEAKER_03: One of the folks that listen to this podcast,
• 30:04
  we have a lot of people who work on reproductive care and
• 30:06
  reproductive freedom.
• 30:08
  folks who've worked with the Committee to Protect Health Care
• 30:10
  in that way.
• 30:11
  SPEAKER_03: You talk about the U.S.
• 30:12
  having some of the worst maternal and infant mortality rates in
• 30:15
  developed nations.
• 30:16
  If we see a retraction or a closing down of sort of many rural
• 30:21
  hospitals across the
• 30:22
  SPEAKER_03: country,
• 30:22
  SPEAKER_03: how does that affect women and children in rural areas?
• 30:24
  And what does that mean for people trying to seek reproductive
• 30:27
  care in places?
• 30:29
  SPEAKER_01: touched on a topic that's very near and dear to my heart,
• 30:31
  SPEAKER_01: that we allow such poor health outcomes for our mothers and babies,
• 30:35
  SPEAKER_01: especially for as wealthy a country as we are.
• 30:37
  You know,
• 30:38
  compared to Norway or Iceland,
• 30:39
  it's absolutely ridiculous that we can't do better.
• 30:41
  SPEAKER_01: I think we can, it's just we don't have the political will to do better.
• 30:44
  SPEAKER_01: So when you run someone who ran a rural hospital, maternity wards
• 30:49
  SPEAKER_01: do not make money.
• 30:49
  Typically,
• 30:50
  almost half of all births are from Medicaid,
• 30:52
  especially in those rural areas.
• 30:54
  SPEAKER_01: So you already have a unit that financially maybe is not making money,
• 30:59
  SPEAKER_01: maybe it's costing you money to keep it open.
• 31:01
  SPEAKER_01: And now you're going to get even further cuts.
• 31:03
  SPEAKER_01: And you're looking at just the hospital surviving.
• 31:05
  And so a lot of times the decision gets made to close those
• 31:08
  maternity units.
• 31:09
  SPEAKER_01: How does that affect women and children?
• 31:11
  SPEAKER_01: Well, one, you're farther away.
• 31:12
  SPEAKER_01: If you have a maternity emergency,
• 31:14
  sometimes those are life-threatening and you have to drive
• 31:17
  farther and women can
• 31:18
  die because they're not getting the care and timely that they
• 31:21
  need and infants can
• 31:22
  SPEAKER_01: die.
• 31:23
  SPEAKER_01: On top of that,
• 31:24
  SPEAKER_01: a lot of times when hospitals close,
• 31:26
  SPEAKER_01: a lot of most employees,
• 31:28
  SPEAKER_01: I would say,
• 31:29
  SPEAKER_01: the hospital are female and a lot of them work in that community.
• 31:32
  SPEAKER_01: And so now you're not only with maternity care, you're closing that down.
• 31:35
  SPEAKER_01: You closed down the hospital.
• 31:36
  SPEAKER_01: Now you're laying off all these employees.
• 31:38
  SPEAKER_01: who are primarily female,
• 31:40
  SPEAKER_01: and now they're losing their jobs and their health insurance,
• 31:43
  SPEAKER_01: and it just spirals.
• 31:44
  SPEAKER_03: Yeah, I mean, it's impacting the entire community of closures.
• 31:47
  SPEAKER_03: I mean,
• 31:47
  SPEAKER_03: they're almost always,
• 31:48
  almost always the biggest employer of the entire town and
• 31:52
  probably the county,
• 31:53
  SPEAKER_03: right?
• 31:54
  SPEAKER_03: I know where I am.
• 31:55
  There are some manufacturing around,
• 31:57
  but the hospital is a massive employer.
• 31:59
  SPEAKER_03: And we've said it before,
• 32:00
  SPEAKER_03: when these cuts happen,
• 32:01
  SPEAKER_03: when these places close,
• 32:02
  SPEAKER_03: you can't just turn it back on.
• 32:04
  SPEAKER_03: So if there's a shift in the administration, come, you know,
• 32:07
  January 20th of 2029,
• 32:09
  you can't just sign a decree and open up hospitals.
• 32:12
  Even if you could get the funding,
• 32:14
  those communities have been decimated,
• 32:17
  right?
• 32:17
  SPEAKER_03: People are just going to leave.
• 32:18
  They're not going to stick around and wait for new
• 32:20
  administration to bring funding
• 32:22
  SPEAKER_03: back to get their hospital.
• 32:23
  SPEAKER_03: They're just going to go elsewhere.
• 32:24
  SPEAKER_01: The talent leaves.
• 32:26
  SPEAKER_01: So the doctors, the nurses, the administrators, the physical therapists.
• 32:30
  SPEAKER_01: So then it has a domino effect.
• 32:31
  SPEAKER_01: You're
• 32:34
  SPEAKER_01: you're looking at the clinics that supported it,
• 32:36
  SPEAKER_01: the pharmacies,
• 32:37
  and then all those people that had jobs and would go out to the
• 32:40
  community and spend
• 32:40
  money on gasoline and clothes and groceries and housing now
• 32:44
  don't have the money.
• 32:45
  SPEAKER_01: And so it creates,
• 32:46
  SPEAKER_01: they call it kind of a multiplying effect of when one thing closes,
• 32:50
  SPEAKER_01: then it affects the other businesses,
• 32:52
  SPEAKER_01: then they go down,
• 32:53
  SPEAKER_01: they,
• 32:53
  SPEAKER_01: most people lose their jobs.
• 32:54
  SPEAKER_01: And so it just keeps spiraling down.
• 32:56
  So hospitals are often,
• 32:57
  especially rural hospitals are often the economic anchor in a
• 33:01
  community.
• 33:01
  SPEAKER_01: And
• 33:03
  You already see sort of like stratification in the quality of
• 33:06
  care between like
• 33:06
  SPEAKER_03: major urban areas and very rural hospitals.
• 33:09
  SPEAKER_03: That's just kind of like an obvious truth.
• 33:11
  SPEAKER_03: In some places where these hospitals are going to close,
• 33:12
  SPEAKER_03: but in some places where the hospitals are not going to close,
• 33:16
  but you might see like portions of the hospital close or in a
• 33:19
  case of like
• 33:20
  SPEAKER_03: Like a maternity ward could close,
• 33:21
  but the rest of the hospital could stay open because it's like
• 33:24
  a lost center.
• 33:24
  SPEAKER_03: Is that okay?
• 33:25
  SPEAKER_03: Yep.
• 33:26
  Would you expect that there would be like additional
• 33:27
  stratification of care where
• 33:28
  you sort of have rural hospitals having like significantly
• 33:32
  lower ability to deliver
• 33:33
  SPEAKER_03: care than some of the larger systems?
• 33:35
  SPEAKER_01: Yeah.
• 33:35
  So it goes to what kind of talent you have and what kind of
• 33:38
  equipment do you have?
• 33:39
  SPEAKER_01: Because you need specialists.
• 33:41
  SPEAKER_01: The level of care...
• 33:43
  SPEAKER_01: There's kind of primary care is kind of like the basics,
• 33:46
  SPEAKER_01: and then it gets more sophisticated as you go up.
• 33:48
  SPEAKER_01: If you don't have the sophisticated people,
• 33:50
  SPEAKER_01: policies,
• 33:51
  SPEAKER_01: technology,
• 33:52
  SPEAKER_01: infrastructure,
• 33:53
  SPEAKER_01: you can't provide that in a rural area.
• 33:55
  SPEAKER_01: So a lot of what these rural hospitals are doing is now,
• 33:58
  SPEAKER_01: I mean,
• 33:58
  SPEAKER_01: there's a lot of innovation going on as far as like robotics,
• 34:01
  SPEAKER_01: where the surgeon doesn't even have to be in the room,
• 34:03
  SPEAKER_01: right?
• 34:04
  SPEAKER_01: You can use a robot, but those robots cost a million dollars.
• 34:07
  SPEAKER_03: Right.
• 34:08
  SPEAKER_01: And so, yeah, you can do it.
• 34:09
  And one of the things we did at the hospital that I was working
• 34:12
  at to help make us
• 34:14
  SPEAKER_01: sustainable is at night,
• 34:15
  SPEAKER_01: we kind of used the Teladoc.
• 34:17
  So we had the cameras and the screens and it was just at night
• 34:20
  and it wound up
• 34:21
  SPEAKER_01: working really,
• 34:21
  SPEAKER_01: really well.
• 34:22
  SPEAKER_01: So there are innovations that can happen, but...
• 34:25
  SPEAKER_01: You know,
• 34:25
  SPEAKER_01: if you want to have a back surgery,
• 34:27
  SPEAKER_01: you want somebody who's done like a lot of back surgeries,
• 34:29
  SPEAKER_01: right?
• 34:29
  SPEAKER_01: You don't want to necessarily be the first patient.
• 34:31
  SPEAKER_01: And so if I'm going to have something,
• 34:32
  SPEAKER_01: I want to go to somebody who does it really a lot and does it well.
• 34:35
  And you can't do that if you don't have the volume of patients
• 34:38
  to do it well.
• 34:39
  I saw Miles' eyes pop when he talked about a robot doing
• 34:42
  surgery without the
• 34:43
  SPEAKER_03: surgeon in the room.
• 34:44
  SPEAKER_03: They're nearby.
• 34:45
  SPEAKER_03: They're not off having lunch or something.
• 34:49
  SPEAKER_03: Call me when you're ready to close.
• 34:53
  SPEAKER_01: It's not a robot doing it by itself.
• 34:55
  SPEAKER_01: There's a surgeon.
• 34:55
  SPEAKER_01: He or she is in there making the robot move,
• 35:00
  SPEAKER_01: but they don't have to be right at the bedside anymore.
• 35:02
  SPEAKER_03: Sure.
• 35:02
  SPEAKER_03: We're headed for more robots in the future, right?
• 35:05
  SPEAKER_03: We are headed for a robot healthcare future.
• 35:07
  SPEAKER_03: Okay, that's a different show.
• 35:08
  SPEAKER_01: Well, they have robots now that can deliver your meals.
• 35:11
  SPEAKER_01: They can deliver supplies.
• 35:13
  They can,
• 35:13
  you know,
• 35:14
  they can do a lot,
• 35:15
  but no,
• 35:16
  we're not all the way there yet.
• 35:17
  SPEAKER_03: I still haven't found a robot to do my damn charts.
• 35:20
  SPEAKER_03: So once that happens, I will feel like the robots.
• 35:22
  SPEAKER_01: Not with AI.
• 35:23
  SPEAKER_01: Is AI not helping you with you?
• 35:26
  SPEAKER_03: Not yet.
• 35:27
  SPEAKER_03: I'm old.
• 35:27
  SPEAKER_03: Maybe I haven't adopted it as well.
• 35:29
  SPEAKER_01: Well,
• 35:29
  I did go to a doctor's office and they told me that the whole
• 35:32
  conversation was
• 35:33
  going to be recorded so that they could put it into the notes
• 35:36
  so the doctor didn't
• 35:36
  SPEAKER_01: have to chart.
• 35:37
  SPEAKER_01: And I thought, hmm.
• 35:38
  SPEAKER_01: But then it would only take the relevant medical or not.
• 35:40
  SPEAKER_01: Yeah.
• 35:41
  SPEAKER_03: My wife's a family doc and she does use that and it's been a lifesaver.
• 35:45
  A lot of her patients share her political views,
• 35:47
  which also are my political views.
• 35:48
  And so they bring to her those views and those concerns about
• 35:52
  what's happening.
• 35:53
  SPEAKER_03: And it does not include all of that.
• 35:54
  So it's eerily smart at picking out those pieces of what should
• 35:59
  and shouldn't be in there.
• 36:00
  SPEAKER_03: So, yeah, that's fascinating.
• 36:02
  SPEAKER_01: That should help with pajama time.
• 36:04
  SPEAKER_03: There you go.
• 36:05
  SPEAKER_03: That's interesting.
• 36:07
  This is not what today's show is about,
• 36:09
  but I have so many questions about this.
• 36:10
  SPEAKER_03: Maybe we can talk about it in a later time.
• 36:12
  Can I tell you how mad I am that there are robots that can do
• 36:15
  surgery and they
• 36:16
  still haven't figured out how to – so that I don't have to fold
• 36:18
  laundry in my
• 36:19
  SPEAKER_03: house?
• 36:19
  SPEAKER_03: Literally can't do it.
• 36:21
  SPEAKER_01: So here at the university we have –
• 36:24
  We have a house where Wendy Rogers does research for people
• 36:28
  with disabilities and
• 36:29
  SPEAKER_01: being able to age in place.
• 36:30
  SPEAKER_01: They have a robot that will empty your dishwasher for you,
• 36:33
  SPEAKER_01: fold your laundry,
• 36:35
  SPEAKER_01: cook things on the stove.
• 36:36
  SPEAKER_01: I mean, yeah.
• 36:38
  SPEAKER_03: Okay.
• 36:39
  SPEAKER_03: It's coming.
• 36:39
  SPEAKER_01: All right.
• 36:39
  SPEAKER_01: It's coming.
• 36:40
  SPEAKER_01: And if you ever want to tour, I'm happy to do virtual tours.
• 36:44
  SPEAKER_03: We'd love to come down and check it out.
• 36:45
  SPEAKER_01: Yeah.
• 36:46
  SPEAKER_01: It's pretty remarkable.
• 36:47
  SPEAKER_01: I was like...
• 36:48
  SPEAKER_01: How do I get one of those?
• 36:49
  SPEAKER_01: I mean, it'll vacuum your couch for you.
• 36:51
  SPEAKER_01: It'll vacuum.
• 36:52
  SPEAKER_01: It empties the dishwasher.
• 36:53
  SPEAKER_03: So,
• 36:54
  SPEAKER_03: Dr.
• 36:54
  SPEAKER_03: Shelley Johnson,
• 36:55
  you have the most letters of any guests we've ever had in this
• 36:57
  show after your
• 36:58
  SPEAKER_03: name.
• 36:58
  SPEAKER_03: I counted 11 letters after your name.
• 37:00
  SPEAKER_03: That's amazing.
• 37:01
  And now you are literally the foremost expert on robotics that
• 37:05
  we've ever had on this podcast.
• 37:06
  SPEAKER_01: Oh, really?
• 37:07
  SPEAKER_01: I didn't even know why.
• 37:08
  SPEAKER_01: I wasn't trying to be an expert in robotics.
• 37:10
  I don't know that you're an expert,
• 37:12
  but you're the most expert that we've had on this.
• 37:14
  SPEAKER_03: That's safe to say.
• 37:16
  SPEAKER_01: Well, and I have somewhat of a...
• 37:18
  I have somewhat of a personal interest in it because I have a
• 37:21
  family member,
• 37:22
  SPEAKER_01: she's 14,
• 37:23
  SPEAKER_01: and she has musculoskeletal dystrophy.
• 37:25
  SPEAKER_01: And it's going to affect especially her upper body.
• 37:28
  SPEAKER_01: And so when I go to some of these things,
• 37:30
  SPEAKER_01: like I'll ask,
• 37:31
  like they're creating a robot for showering for people who
• 37:34
  don't have those upper
• 37:35
  SPEAKER_01: body.
• 37:35
  And so there's kind of somewhat of a personal reason for me to
• 37:39
  really be interested
• 37:39
  in what they're doing because I know that eventually she's
• 37:43
  going to need some kind
• 37:43
  SPEAKER_01: of help like that.
• 37:44
  SPEAKER_01: So it's just kind of amazing to see what's coming out.
• 37:46
  SPEAKER_03: That's fascinating.
• 37:47
  SPEAKER_03: That's great.
• 37:48
  SPEAKER_01: Yeah, it is.
• 37:49
  SPEAKER_03: Well,
• 37:49
  it really I guess it really like I'm getting really hung up on
• 37:52
  this idea of people
• 37:54
  SPEAKER_03: having either hospital deserts or like maternity care deserts.
• 37:57
  And that I'm going to get a little political here for just a
• 37:59
  second that the
• 38:00
  Republicans who represent just very obviously most of these
• 38:03
  hospitals are in
• 38:04
  SPEAKER_03: Republican districts.
• 38:05
  Because there's a rural-urban divide with our politics just
• 38:08
  like there is with our health care.
• 38:09
  And that they're going to like increase the stratification or
• 38:13
  increase like – they
• 38:15
  really – it feels like they're – now that we're looking at
• 38:18
  these charts as to where
• 38:19
  SPEAKER_03: all of these hospitals are really – there's going to be a real problem.
• 38:22
  SPEAKER_03: It really feels like they're – they went and punished their own voters.
• 38:26
  SPEAKER_03: You know,
• 38:26
  SPEAKER_03: in a way that is like,
• 38:28
  I'm not sure there's an equivalent where politicians have done
• 38:31
  something to their
• 38:32
  SPEAKER_03: own constituencies,
• 38:33
  SPEAKER_03: at least in my memory.
• 38:34
  SPEAKER_03: Shelley,
• 38:36
  when you were running a hospital and you dealt with the sort of
• 38:39
  budgets of those
• 38:39
  SPEAKER_03: hospitals,
• 38:40
  I think like there's a big question for lots of us who are not
• 38:44
  subject matter
• 38:44
  SPEAKER_03: experts on this,
• 38:45
  SPEAKER_03: on like,
• 38:46
  SPEAKER_03: how long do we have before hospitals begin to really feel squeezed?
• 38:50
  SPEAKER_03: We know that the Medicaid cuts are pushed past the midterms.
• 38:54
  SPEAKER_01: Yeah, I think 2030 is when I read that it'll be fully in effect.
• 38:58
  SPEAKER_03: Fully in effect.
• 38:59
  SPEAKER_03: And they're sort of phased in.
• 39:01
  SPEAKER_03: But you'll start to see cuts as soon as,
• 39:03
  SPEAKER_03: you know,
• 39:04
  two months after 2026 midterms in order to shield sort of these
• 39:08
  members of Congress
• 39:09
  SPEAKER_03: from the worst of it.
• 39:10
  On what timeline would you expect that people have to start
• 39:13
  planning at these hospitals?
• 39:14
  SPEAKER_03: Because they know it's coming.
• 39:16
  SPEAKER_03: It's right now.
• 39:16
  SPEAKER_01: They start planning now.
• 39:17
  SPEAKER_01: Yeah.
• 39:18
  SPEAKER_03: Okay.
• 39:19
  SPEAKER_03: And how long,
• 39:19
  SPEAKER_03: as a general matter,
• 39:20
  SPEAKER_03: I know it'll be unique in a case-by-case basis,
• 39:23
  but how much change could you see between now and the midterms
• 39:28
  in some of these
• 39:29
  SPEAKER_03: places?
• 39:29
  Yeah,
• 39:30
  that's kind of a hard question to answer,
• 39:31
  but you have to start planning now.
• 39:33
  SPEAKER_01: How is this going to affect me?
• 39:35
  SPEAKER_01: What percentage am I getting paid by Medicaid?
• 39:37
  SPEAKER_01: How much is this going to be reduced?
• 39:39
  SPEAKER_01: What is already my margin?
• 39:40
  SPEAKER_01: What options do I have?
• 39:42
  SPEAKER_01: So now you start going into strategic discussions.
• 39:44
  SPEAKER_01: Do I merge with another health system?
• 39:46
  SPEAKER_01: Do I...
• 39:47
  SPEAKER_01: just close the doors?
• 39:48
  SPEAKER_01: Do I come up with a clinical agreement?
• 39:51
  SPEAKER_01: Do I try to find, you know, other third-party payers?
• 39:54
  SPEAKER_01: And so it really becomes a question of this strategy for that hospital,
• 39:58
  SPEAKER_01: but they have to start now because if they wait,
• 40:01
  it's going to be too late to fix it once those things are
• 40:04
  already happening.
• 40:04
  SPEAKER_03: Well, and the other thing I wondered about is like personnel decisions.
• 40:07
  SPEAKER_03: I know in our hospital,
• 40:08
  SPEAKER_03: we have specialists,
• 40:09
  SPEAKER_03: you know,
• 40:09
  SPEAKER_03: surgeons leave,
• 40:10
  SPEAKER_03: we're always in need of orthopedic surgeons.
• 40:12
  SPEAKER_03: And if one of those people leaves,
• 40:14
  SPEAKER_03: it's an expensive process to recruit a new surgeon or a new OB.
• 40:18
  SPEAKER_03: You know,
• 40:18
  SPEAKER_03: do these hospitals kind of look down the road and say,
• 40:21
  SPEAKER_03: maybe that's not an expense we should incur right now,
• 40:23
  because I don't know if we're going to be offering those
• 40:27
  services in that exact
• 40:28
  SPEAKER_03: way,
• 40:29
  SPEAKER_03: two,
• 40:29
  SPEAKER_03: three,
• 40:29
  SPEAKER_03: four years from now.
• 40:30
  SPEAKER_01: Or vice versa,
• 40:31
  is that a service line we should be adding because it's a high
• 40:34
  revenue generating
• 40:35
  that we don't currently have that we should be bringing them on
• 40:39
  because that'll
• 40:40
  help buffer some of the cost cutting that's going to happen
• 40:43
  like on my maternity
• 40:44
  SPEAKER_01: care unit.
• 40:45
  You know,
• 40:46
  I got my MBA at University of Michigan,
• 40:48
  so I did not get an MHA.
• 40:50
  SPEAKER_01: So I learned a lot of cost.
• 40:52
  SPEAKER_01: allocation methods and hospitals are not great.
• 40:55
  SPEAKER_01: I think they're getting a lot better,
• 40:56
  SPEAKER_01: but that sophistication,
• 40:58
  because it costs money to understand all your costs and the
• 41:01
  cost allocations and
• 41:02
  SPEAKER_01: all those kinds of things.
• 41:03
  So I think there's a lot of room internally for increased
• 41:06
  sophistication on
• 41:08
  understanding cost structures and what really does make money
• 41:11
  and not just making
• 41:12
  SPEAKER_01: assumptions about what makes money.
• 41:14
  SPEAKER_01: So I think there's some room there, but
• 41:15
  SPEAKER_01: Yeah,
• 41:16
  SPEAKER_01: personnel,
• 41:16
  SPEAKER_01: service lines,
• 41:17
  SPEAKER_01: decisions,
• 41:18
  SPEAKER_01: partnerships,
• 41:19
  SPEAKER_01: clinical affiliations,
• 41:20
  SPEAKER_01: EMR upgrades,
• 41:22
  SPEAKER_01: all those kind of things the hospital should be looking at now.
• 41:24
  SPEAKER_03: And we saw a hospital in Curtis,
• 41:26
  SPEAKER_03: Nebraska announced a few weeks ago,
• 41:27
  SPEAKER_03: maybe a week ago,
• 41:28
  SPEAKER_03: that they were going to be closing.
• 41:29
  And their CEO cited these cuts as a major determinant of their
• 41:34
  decision to do this.
• 41:35
  SPEAKER_03: That doesn't sound like hyperbole, right?
• 41:37
  SPEAKER_03: Like, I don't think this person would say this unless it was true.
• 41:40
  SPEAKER_03: That is a reasonable thing for people,
• 41:42
  SPEAKER_03: a decision for them to make,
• 41:44
  SPEAKER_03: even though these things aren't happening for a couple of years on paper.
• 41:47
  SPEAKER_01: Yeah,
• 41:48
  SPEAKER_01: because,
• 41:48
  SPEAKER_01: I mean,
• 41:48
  if you're already running a negative margin and you know it's
• 41:51
  just going to get
• 41:51
  SPEAKER_01: worse,
• 41:52
  why would you continue just to lose money and go in debt and
• 41:55
  have that continue
• 41:57
  when you know there's not a light at the end of the tunnel
• 41:59
  that's not going to get
• 42:00
  SPEAKER_01: better in a couple of years?
• 42:01
  SPEAKER_01: It's only going to get worse.
• 42:02
  SPEAKER_01: And so you kind of cut your losses.
• 42:04
  SPEAKER_01: Kind of that sunk cost.
• 42:05
  SPEAKER_01: You know, you've already had that.
• 42:07
  SPEAKER_01: Forget about everything in the past.
• 42:08
  It's just what is the best decision for right now and what is
• 42:12
  in the future,
• 42:12
  SPEAKER_01: regardless of what happened in the past.
• 42:14
  SPEAKER_03: Okay.
• 42:14
  SPEAKER_01: Shelley,
• 42:15
  if you could wave a magic wand and you could be advising the
• 42:19
  congressman who
• 42:20
  ultimately voted for this bill and you could sort of give them
• 42:23
  one message prior to
• 42:24
  SPEAKER_03: the vote,
• 42:25
  what would sort of your big takeaway actions for on the
• 42:28
  implications of the bill
• 42:29
  SPEAKER_03: and how would you have advised them?
• 42:30
  SPEAKER_01: You know,
• 42:31
  even we're kind of talking about finance and I'm writing a
• 42:33
  textbook finance,
• 42:34
  SPEAKER_01: textbook on finance.
• 42:36
  SPEAKER_01: I teach healthcare finance.
• 42:38
  SPEAKER_01: But what I always talk about is,
• 42:39
  SPEAKER_01: yeah,
• 42:39
  SPEAKER_01: we're talking about money,
• 42:40
  SPEAKER_01: but at the end of the day,
• 42:41
  these decisions and these things with finance really have to do
• 42:45
  with people.
• 42:46
  SPEAKER_01: and how they affect people.
• 42:48
  SPEAKER_01: And so,
• 42:49
  SPEAKER_01: yes,
• 42:49
  SPEAKER_01: we can talk about this at a policy level and the cuts and the Medicaid,
• 42:52
  SPEAKER_01: but at the end of the day,
• 42:53
  SPEAKER_01: we're talking about single moms that are struggling.
• 42:55
  SPEAKER_01: We're talking about families that are barely making it right now.
• 42:58
  And these financial decisions have an implication on the real
• 43:03
  life of people and
• 43:05
  what kind of society and what kind of government do we want to
• 43:08
  be for our most
• 43:09
  SPEAKER_01: vulnerable citizens.
• 43:10
  SPEAKER_03: Rob, do you have any questions left?
• 43:13
  SPEAKER_03: No, I really appreciate that.
• 43:14
  SPEAKER_03: And we worked together for a number of years, Shelley, in our hospital.
• 43:18
  I don't talk about the hospital I work at really ever
• 43:20
  specifically by name,
• 43:21
  but that's fine.
• 43:23
  SPEAKER_03: I appreciated you as an administrator.
• 43:25
  SPEAKER_03: As someone in the C-suite that did think about the community,
• 43:30
  SPEAKER_03: and I know some of why you left and now are in academia...
• 43:33
  It probably stemmed around some of the challenges of being that
• 43:36
  kind of an
• 43:37
  SPEAKER_03: individual,
• 43:37
  SPEAKER_03: thinking that way in a system that made it hard to do that,
• 43:40
  SPEAKER_03: I believe.
• 43:41
  SPEAKER_03: I think it's hard to say.
• 43:42
  SPEAKER_03: So I appreciate you.
• 43:44
  SPEAKER_03: Yeah,
• 43:44
  SPEAKER_03: I appreciate you taking that expertise to teaching others,
• 43:48
  SPEAKER_03: to writing a book,
• 43:49
  SPEAKER_03: to coming on here,
• 43:50
  SPEAKER_03: talking with us,
• 43:51
  SPEAKER_03: explaining things to us this way.
• 43:52
  SPEAKER_03: You can tell that despite all the letters after your name,
• 43:56
  SPEAKER_03: at the root of it all is the people you serve.
• 43:59
  It really isn't that hard to come up with what you say to those
• 44:02
  folks and wave them in.
• 44:03
  SPEAKER_03: Jaquan, it just kind of comes down to people.
• 44:06
  SPEAKER_01: Yeah, so thank you, Rob.
• 44:07
  SPEAKER_01: And I enjoyed working with you too.
• 44:09
  SPEAKER_01: So one of the roles I did was when I worked at Kishwaukee,
• 44:12
  we opened a clinic for people that didn't have insurance or on
• 44:15
  Medicaid because
• 44:16
  SPEAKER_01: there was no FQHC in the county.
• 44:18
  SPEAKER_01: And it was really rough.
• 44:19
  SPEAKER_01: And a lot of times these people come in
• 44:21
  with attitudes because they've been treated poorly and they
• 44:24
  expect to be treated
• 44:25
  poorly by you and so it was a lot of training on the frontline
• 44:28
  staff about you know
• 44:29
  be kind give them a benefit of the doubt realize you know you
• 44:33
  haven't walked in
• 44:33
  their shoes don't be judgmental about whatever they have going
• 44:36
  on and some days I
• 44:37
  would just sit out there would take my name tag off and I would
• 44:39
  just sit out in the
• 44:40
  waiting room and watch the families coming in and and really
• 44:43
  you know remember at
• 44:44
  the heart of what we're doing is for these people coming in and
• 44:47
  we don't know
• 44:48
  SPEAKER_01: their life story and what they have going on.
• 44:49
  SPEAKER_01: But, you know, it's not the point of life depending on your philosophy.
• 44:52
  SPEAKER_01: But for me, the point of life is helping other people.
• 44:55
  SPEAKER_01: And so just remembering what those people are about.
• 44:57
  SPEAKER_03: I think that might be a good place to wrap.
• 44:59
  SPEAKER_01: Okay.
• 45:00
  SPEAKER_03: Dr. Shelley Johnson, thank you so much for joining us today.
• 45:03
  SPEAKER_01: Yeah, thank you.
• 45:03
  SPEAKER_01: It was fun.
• 45:03
  And teaching us a little bit about how the inside of a rural
• 45:06
  hospital works.
• 45:07
  We didn't even get into horses and having a post and making
• 45:12
  sure you can take cash
• 45:13
  SPEAKER_01: for the Amish and getting paid.
• 45:14
  We have a hitching post outside of our hospital,
• 45:17
  hitching post for horses.
• 45:18
  SPEAKER_01: Mm-hmm.
• 45:20
  SPEAKER_03: I love that.
• 45:21
  SPEAKER_03: All right.
• 45:22
  SPEAKER_03: Thanks, Shelly.
• 45:23
  SPEAKER_01: All right.
• 45:23
  SPEAKER_01: Okay.
• 45:23
  SPEAKER_03: Thanks so much.
• 45:24
  SPEAKER_01: See you guys later.
• 45:25
  SPEAKER_01: Bye.
• 45:29
  SPEAKER_03: All right.
• 45:29
  SPEAKER_03: Well, Rob, that was a great interview with Dr. Shelley Johnson.
• 45:33
  SPEAKER_03: Thank you, Dr. Johnson, so much for coming on the show.
• 45:35
  SPEAKER_03: Absolutely.
• 45:35
  SPEAKER_03: Like I said, I've known Shelley.
• 45:37
  I worked with her for quite a while at our rural hospital,
• 45:40
  and I just love her take.
• 45:43
  SPEAKER_03: You don't see that many people in the C-suite,
• 45:45
  SPEAKER_03: the CEO,
• 45:45
  SPEAKER_03: COO,
• 45:46
  SPEAKER_03: CFO,
• 45:47
  SPEAKER_03: CNO,
• 45:47
  the C-suite of hospitals that really lead with their heart and
• 45:50
  with compassion for
• 45:51
  SPEAKER_03: the people they're serving.
• 45:52
  SPEAKER_03: Yeah.
• 45:53
  SPEAKER_03: We were sorry to lose her, but really happy to have her.
• 45:55
  She also serves on the board of the Committee to Protect
• 45:57
  Healthcare Education Fund.
• 45:59
  SPEAKER_03: She's an educator.
• 46:00
  SPEAKER_03: She's writing a book.
• 46:01
  SPEAKER_03: I think she's a great asset to the advocacy community in this space.
• 46:05
  SPEAKER_03: Yeah, that's great.
• 46:06
  SPEAKER_03: All right.
• 46:06
  SPEAKER_03: I think with that, I think we've probably taken enough people's time.
• 46:09
  SPEAKER_03: Why don't you read us out?
• 46:10
  SPEAKER_03: All right.
• 46:11
  Today's episode was written by Chris Savage,
• 46:13
  Dr.
• 46:13
  Rob Davidson,
• 46:14
  and me,
• 46:15
  Miles Baker.
• 46:16
  It was produced by Amelia Dillenschneider,
• 46:17
  Aslan Ibrahim,
• 46:19
  and Joel Bryson.
• 46:20
  SPEAKER_03: Music by Annette Somerset at Duneflower Productions.
• 46:23
  SPEAKER_03: If you enjoyed today's show,
• 46:24
  SPEAKER_03: please subscribe and leave us a rating on YouTube,
• 46:26
  SPEAKER_03: Spotify,
• 46:26
  SPEAKER_03: Apple Podcasts,
• 46:27
  SPEAKER_03: and wherever you listen.
• 46:28
  SPEAKER_03: Your support helps others discover the podcast.
• 46:30
  SPEAKER_03: And physicians, your voice matters.
• 46:32
  Join the fight for better American health care by becoming a
• 46:34
  member of the
• 46:35
  Committee to Protect Health Care at www.committeetoprotect.org
• 46:38
  to learn more about
• 46:39
  SPEAKER_03: what the organization does and how you can get involved.
• 46:41
  SPEAKER_03: And Rob, thanks so much for recording today.
• 46:43
  SPEAKER_03: We'll see you on the next one.
• 46:44
  SPEAKER_03: See you next week.