Latest / Becker’s Healthcare Podcast / Challenging the Health Insurance System and Rethinking Healthcare Costs with Dr. J. Benjamin Proctor

Transcript

Challenging the Health Insurance System and Rethinking Healthcare Costs with Dr. J. Benjamin Proctor · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - Not in the abstract, but against the real
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  - It's the kind of event you leave with
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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago,
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  - and come ready to do the hard thinking.
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - This is Scott Becker with the Becker's Healthcare
• 1:00
  - Podcast.
• 1:01
  - Thrilled today to be joined by a brilliant
• 1:03
  - physician, author,
• 1:06
  - internal medicine physician,
• 1:08
  - doctor Ben
• 1:09
  - Benjamin Proctor. He practices in Iberia, Louisiana.
• 1:13
  - He's written a book, Inefficient on Purpose. I
• 1:16
  - think you'll really enjoy the discussion with doctor
• 1:18
  - Proctor. I did tremendously,
• 1:20
  - and and thank you for listening. Doctor Proctor,
• 1:22
  - can you take a moment and introduce yourself?
• 1:25
  - Yeah. So, I do work for, Iberia Medical
• 1:28
  - Center. It's a, relatively rural hospital in Southern
• 1:32
  - Louisiana in Iberia. I'm not the founder. I'm
• 1:35
  - just one of the members. I am the
• 1:37
  - medical director of our wound care center, the
• 1:40
  - advanced wound Wound Care Center at IMC.
• 1:43
  - Yeah. And I'm board certified. I've been practicing
• 1:45
  - for going on about twelve years now, in
• 1:48
  - Louisiana.
• 1:49
  - And I started writing this book about three
• 1:51
  - years ago, because I had some things that
• 1:54
  - I saw in my time in health care
• 1:55
  - that I wanted to improve on.
• 1:58
  - Well well, fantastic. And tell us a little
• 1:59
  - bit about the book and about what you're
• 2:01
  - watching in health care most closely currently.
• 2:04
  - I mean, the thing that interests me the
• 2:06
  - most is
• 2:07
  - the Medicare for all, really. That's what it
• 2:09
  - comes down to.
• 2:11
  - The way our current system set up is
• 2:14
  - very profit focused,
• 2:15
  - with our, for profit health insurers.
• 2:19
  - And that leads to, some inefficiency,
• 2:21
  - in our health care system. And that is
• 2:23
  - where I got the title of the book,
• 2:26
  - Inefficient on Purpose. That's not to say that
• 2:28
  - medicine is inefficient or hospitals are inefficient.
• 2:31
  - That's the the system itself
• 2:33
  - that,
• 2:34
  - relies on,
• 2:35
  - profits,
• 2:37
  - in health care, leads to the inefficiency
• 2:40
  - and the increased cost per capita.
• 2:44
  - America spends over 13,000
• 2:46
  - per person,
• 2:48
  - every year, you know, where other developed countries
• 2:50
  - will spend somewhere in the 5 to $7,000
• 2:53
  - per capita on their health care.
• 2:55
  - And yet despite spending the most, we have
• 2:58
  - some of the worst outcomes,
• 3:00
  - where,
• 3:02
  - our life expectancy
• 3:04
  - is by far the worst of the developed
• 3:06
  - 38,
• 3:07
  - OPEC countries. We,
• 3:10
  - we're,
• 3:11
  - you know, around the eighty to a hundred
• 3:13
  - in infant and maternal mortality rates.
• 3:17
  - And yeah. And I kinda go into detail
• 3:19
  - on why I think all of those
• 3:21
  - happen in today's health care in America. And
• 3:24
  - and let me ask you a question. The
• 3:25
  - payment system is horribly inefficient.
• 3:28
  - You got four major payers, you You got
• 3:30
  - 50 different Medicaid payers. You've got Medicare. You
• 3:33
  - got the Veterans Administration.
• 3:35
  - I mean... And then you've got lots of
• 3:36
  - a couple 100 other smaller payers. And so
• 3:39
  - running a practice today, running a house today
• 3:41
  - is is incredibly
• 3:42
  - ridiculous
• 3:43
  - in terms of efficiency because you have to
• 3:45
  - deal with so many different payment systems.
• 3:47
  - We spend as an ace about 250,000,000,000
• 3:49
  - a year in revenue cycle.
• 3:51
  - And and and so the theory that we
• 3:52
  - get to Medicare for all or coverage for
• 3:54
  - all in a simpler payment system,
• 3:57
  - obviously, is very attractive.
• 3:58
  - But but how do you deal with the
• 4:00
  - fact that even we get to a better
• 4:02
  - payment system,
• 4:03
  - we end up with still tremendous supply and
• 4:05
  - demand imbalances
• 4:07
  - where it's harder and harder,
• 4:09
  - almost impossible in one place to get primary
• 4:10
  - care doctor,
• 4:12
  - many places impossible to get the right specialist
• 4:14
  - for the right cancer,
• 4:15
  - horrendous shortages of oncologists. How do you deal
• 4:18
  - with that other side of the equation? Because
• 4:19
  - it seems to me, I don't disagree with
• 4:21
  - you on coverage for all. I'm totally on
• 4:23
  - board with coverage for all. Whether Medicare for
• 4:25
  - all is the right way to get there.
• 4:26
  - I don't know for sure. But, certainly, the
• 4:28
  - payment system is horribly inefficient.
• 4:30
  - But how do we deal with the supply
• 4:32
  - demand challenge
• 4:33
  - of, you know, not having enough OB GYNs
• 4:36
  - to staff more rural areas,
• 4:38
  - not enough oncologists to staff all of us,
• 4:40
  - and some specialties being so short. How do
• 4:43
  - you deal with a lot of those things
• 4:44
  - when you get past the payment system?
• 4:47
  - Yeah. So we are definitely,
• 4:49
  - in a physician shortage,
• 4:52
  - in a bunch of areas. You mentioned OB.
• 4:55
  - Family practice is in a shortage. Definitely not
• 4:57
  - enough oncologists, rheumatologists,
• 4:59
  - neurologists.
• 5:00
  - We can go on.
• 5:02
  - The... I I think some of that, I
• 5:05
  - do kinda touch on in the book. It
• 5:08
  - has to do with how, health care dollars
• 5:11
  - are getting, allocated. Too much of the money,
• 5:14
  - in hospitals or getting put on, what we
• 5:17
  - call BIR or billing insurance, related areas. They
• 5:20
  - are the people who have to negotiate with
• 5:23
  - those 100 different insurances that you just mentioned
• 5:27
  - to get billed,
• 5:29
  - to order tests, for the doctors, you know,
• 5:31
  - that the doctors deemed necessary to get surgeries
• 5:33
  - approved,
• 5:34
  - and paid for. You know, so The US
• 5:37
  - spends a excess of $500,000,000,000
• 5:40
  - a year on BIR
• 5:42
  - compared to other,
• 5:44
  - developed nations. So, you know, that's just one
• 5:46
  - way that, Medicare for all could
• 5:49
  - decrease some of that spending.
• 5:50
  - Then maybe we could,
• 5:53
  - improve,
• 5:54
  - physician salaries to attract more doctors. I think
• 5:58
  - also, a couple decades ago, we stopped,
• 6:01
  - opening new residencies
• 6:03
  - for doctors. You know, of course, we need
• 6:04
  - to get rid of that and start training
• 6:06
  - the future generation of doctors.
• 6:08
  - So so there's definitely... Medicare referral is just
• 6:12
  - one aspect.
• 6:14
  - I think it would improve health outcomes
• 6:17
  - by
• 6:18
  - not having to negotiate
• 6:21
  - a... With a for profit health insurance, where
• 6:23
  - on one side, they're trying to balance their
• 6:25
  - premium and their expenses
• 6:27
  - to still generate a profit for their shareholders
• 6:30
  - versus me who just sees the patient, who's
• 6:32
  - just trying to give you the test,
• 6:35
  - you know, that you need, give you the
• 6:37
  - medicine that you need. But a 100%. And
• 6:39
  - and there's so many not for profit insurers
• 6:41
  - too. But either way, we've got a bastardized
• 6:44
  - health payment system
• 6:46
  - that has led to hundreds of, you know,
• 6:49
  - stats, whether it's billing insurance payments, it's 250
• 6:53
  - or 500,000,000,000
• 6:54
  - out of a $5,400,000,000,000
• 6:56
  - amount that we're spending. It's a huge amount
• 6:58
  - and, obviously, a lot of waste there.
• 7:00
  - How do you deal with the fact that
• 7:02
  - there are so many shortages, different physicians, and
• 7:04
  - different specialties,
• 7:06
  - and yet so many of the physician societies
• 7:09
  - don't seem so excited about having us develop
• 7:11
  - more doctors that they almost viewed as competition.
• 7:14
  - So we end up with the supply demand
• 7:15
  - imbalance. Let me ask you about that question.
• 7:18
  - The next question is, what I hear from
• 7:19
  - some of the physicians is,
• 7:21
  - if we go to Medicare for all, it
• 7:23
  - will lead to a regression of payment
• 7:26
  - that they'll be getting less on average per
• 7:28
  - patient,
• 7:29
  - and part of the subsidy they still get
• 7:31
  - or cross subsidy comes from the commercial insurers,
• 7:33
  - albeit that's getting smaller and smaller. But How
• 7:36
  - do you deal with the two issues that
• 7:37
  - the specialty societies
• 7:39
  - don't seem so interested, actually, in developing more
• 7:41
  - doctors?
• 7:42
  - And the education system is also totally...
• 7:45
  - Creates great doctors, but it way too lengthy
• 7:47
  - a process.
• 7:49
  - And then third, the issue that, you know,
• 7:51
  - if we move to Medicare for all, part
• 7:53
  - of the way that physicians do okay, some
• 7:55
  - of the commercial insurers. How do you how
• 7:57
  - do you deal with some of those issues?
• 7:59
  - Yeah. Well, so the first thing is... So
• 8:02
  - so... Yeah. The the
• 8:04
  - the governing bodies in medicine...
• 8:06
  - So pretty much whenever you're a doctor, I
• 8:07
  - mean, you're essentially competing for the, quote, good
• 8:10
  - insurances.
• 8:11
  - Right?
• 8:12
  - So when you look at any one
• 8:15
  - test, you know, when somebody comes in my
• 8:17
  - office, and I see them for a outpatient
• 8:19
  - clinic visit or I do a surgery and
• 8:21
  - wound care,
• 8:23
  - doing that,
• 8:24
  - you get paid different amounts based on
• 8:28
  - what that person's insurance is. So, you know,
• 8:30
  - it's usually a 100%.
• 8:33
  - It will be a, you know, a Blue
• 8:35
  - Cross or other,
• 8:37
  - for profit. Medicare will pay roughly 90%
• 8:40
  - of that.
• 8:41
  - And then Medicaid,
• 8:43
  - you know, pays something five, 10%. I mean,
• 8:45
  - it's a incredibly small amount.
• 8:47
  - And then,
• 8:48
  - obviously, there's too many of our citizens are,
• 8:51
  - you know, don't have health insurance. And of
• 8:53
  - course, those people you're trying to, you know,
• 8:55
  - just get them to pay cash. So, yes,
• 8:57
  - what you're trying to do is you're trying
• 8:58
  - to divvy up that pie.
• 9:00
  - So, of course, if you have a current
• 9:03
  - load of positions and we're trying to compete
• 9:05
  - for that small portion of pie that is
• 9:07
  - just the private insurance and the Medicare,
• 9:10
  - and then you expand our doctor amount dramatically,
• 9:13
  - then, again, we're competing for that same small
• 9:16
  - pool. But by changing the pool to all
• 9:19
  - Americans
• 9:20
  - and then they're all treated equally,
• 9:22
  - Right? So each citizen's insurance, you know, is
• 9:26
  - Medicare now. It all pays the same amount.
• 9:28
  - But now we're gonna have all those Medicaid,
• 9:30
  - and instead of paying five or 10%, they're
• 9:32
  - paying the full amount. All those people who
• 9:34
  - used to not have insurance are now under
• 9:37
  - Medicare. They're also gonna be paying us the
• 9:39
  - full amount. So so I think that would
• 9:41
  - be the the big expansion. It's just the
• 9:43
  - total number of users who can access and
• 9:46
  - effectively utilize health care.
• 9:48
  - I think your point is well taken and
• 9:50
  - it... And I love the fact that you
• 9:51
  - don't sort of argue with the fact that
• 9:53
  - the physician specialty societies aren't so excited about
• 9:55
  - adding more doctors. And the point being, there's
• 9:57
  - lots of competition with the limited dollars that
• 9:59
  - are out there for physicians. I think your
• 10:01
  - point is so well taken. And obviously, the
• 10:02
  - Medicaid system works 50 different Medicaid plans, all
• 10:05
  - paying different amounts.
• 10:06
  - Some states okay, some states, like you said,
• 10:08
  - just awful in terms of reimbursement.
• 10:11
  - How do you also look at sort of
• 10:14
  - this this concept of, you know, we talked
• 10:17
  - a little bit about
• 10:18
  - some physicians view...
• 10:20
  - I I hear a lot of physicians that
• 10:23
  - are pro Medicare for all, but very concerned
• 10:26
  - in their... In very many physicians that are
• 10:28
  - pro, we want coverage for all. One of
• 10:30
  - the great benefits of the Affordable Care Act
• 10:32
  - was bringing down the amount of people that
• 10:34
  - are noncovered to ten percent. Now that's going
• 10:35
  - back up a little bit.
• 10:37
  - But but how do you deal with the
• 10:39
  - concept of
• 10:40
  - some physicians saying that a lot of our
• 10:43
  - reimbursement or what makes us money is those
• 10:45
  - commercial payers. So we get rid of commercial
• 10:47
  - payers, then we're all stuck with the Medicare
• 10:49
  - system. Obviously, the Medicare system
• 10:51
  - is proving to be far better than the
• 10:53
  - Medicare Advantage system. The Medicare Advantage system so
• 10:55
  - far has been a debacle. It cost more
• 10:58
  - per capita.
• 10:59
  - It's just a disaster, and it's really turning
• 11:01
  - over Medicare to those commercial payers that you're
• 11:03
  - talking about. And that's just been a disaster,
• 11:05
  - at least as far as I can tell.
• 11:07
  - Yeah. It... It's it's been the worst from
• 11:10
  - both a patient side and a doctor side,
• 11:12
  - you know, because
• 11:13
  - anytime I see a Medicare
• 11:15
  - person,
• 11:16
  - a person with Medicare insurance, now I have
• 11:18
  - to do all of these prior authorizations and
• 11:21
  - denials
• 11:22
  - and out of network providers that I didn't
• 11:24
  - have to deal with when they were just
• 11:26
  - a regular Medicare.
• 11:28
  - So so that's been a a huge issue.
• 11:30
  - The Affordable Care Act did try to
• 11:33
  - increase,
• 11:34
  - the number of people on insurance,
• 11:37
  - but, of course, as a result,
• 11:39
  - it dramatically increased the price that the average
• 11:41
  - person has to pay, you know, because again,
• 11:44
  - the the... Those insurance are still trying to
• 11:45
  - make their profit and then the Affordable Care
• 11:48
  - Act made it to where they have to
• 11:49
  - keep their profit margin at a certain amount.
• 11:52
  - So then what do they do? They have
• 11:53
  - to find ways to
• 11:56
  - convince people or to deny tests so that
• 11:58
  - they can still keep their profit margin.
• 12:01
  - I think the point you're making, doctor Proctor,
• 12:03
  - is, you know, under Medicare Advantage,
• 12:05
  - peers try to get their medical loss ratio
• 12:07
  - in a certain spot. It couldn't be too
• 12:08
  - low. It couldn't be too high. This has
• 12:10
  - led to all sorts of gaming of authorizations,
• 12:13
  - preauthorizations, denials, everything else. So... But your point
• 12:15
  - is well taken. From both the physician and
• 12:17
  - patient perspective,
• 12:19
  - sooner or later, everybody send... Tends to hate
• 12:21
  - Medicare Advantage. At start, they seem to like
• 12:23
  - it for some of the additional benefits, then
• 12:25
  - the patients tend to hate it too. The
• 12:27
  - physicians hate it, and certainly health systems are
• 12:29
  - showing that they hate it as well. So
• 12:30
  - I think that's exactly right. So so... Home
• 12:33
  - health, so my local home health won't take
• 12:36
  - Humana right now to to name one example,
• 12:38
  - because they just are,
• 12:40
  - anytime you need a home health, you know,
• 12:41
  - you wanna send somebody home to do physical
• 12:43
  - therapy or give them IV antibiotics,
• 12:45
  - they are,
• 12:47
  - denying payments. They are trying to recoup some
• 12:50
  - of the patients once they pay out. Instead
• 12:52
  - of giving somebody 10 visits, the Humana will
• 12:54
  - only authorize
• 12:55
  - four visits.
• 12:57
  - So, a lot of the home healths in
• 12:59
  - my local community are just flat out denying
• 13:01
  - anyone with Humana... Medicare Advantage,
• 13:04
  - and that's been a really big issue over
• 13:05
  - the last couple of months. No. Thank you.
• 13:07
  - And one of my worst experience with the
• 13:08
  - physical therapist was that physical therapist
• 13:11
  - deciding how much care I needed based on
• 13:13
  - how much my insurance would pay
• 13:15
  - as opposed to how much care I needed,
• 13:17
  - which are two very two very different things.
• 13:20
  - Amen. I mean, that's that's that's my whole
• 13:22
  - book is
• 13:24
  - why why is it that these
• 13:27
  - insurers who've never met you or I are
• 13:30
  - now
• 13:31
  - dictating how much care you need, what tests
• 13:33
  - you need, what medicine you need. It's... The
• 13:36
  - whole system is is is crazy, you know.
• 13:40
  - It... It's... It should be... It... It's our
• 13:42
  - job to, of course, still be good stewards
• 13:44
  - of the health care dollars,
• 13:46
  - but to to provide the best care that
• 13:49
  - we can. And I feel like based on
• 13:52
  - what insurance you come in, it's okay. This
• 13:54
  - is the best medicine for you. This is
• 13:56
  - the second best medicine for you. This is
• 13:57
  - the medicine your insurance is gonna pay for
• 13:59
  - this condition.
• 14:01
  - And and that is just something that I've
• 14:03
  - always struggled with as a doctor.
• 14:05
  - Well, I I think you just said it
• 14:06
  - so right though. There's there's the best medicine
• 14:08
  - for you, and there's the best medicine that
• 14:10
  - your insurance will pay for. And often, the
• 14:13
  - truth is somewhere in between, but the insurance
• 14:15
  - won't pay for the the upper limit of
• 14:17
  - that, which is what a patient often needs.
• 14:19
  - And at the same time, like, when Congress
• 14:21
  - yells at the big insurance companies, as they
• 14:23
  - did in hearings a few months ago,
• 14:25
  - it it seems to me so
• 14:27
  - hypocritical
• 14:28
  - because
• 14:29
  - so many of those insurers are doing exactly
• 14:32
  - what Congress asked them to do in managing
• 14:34
  - Medicare Advantage on the state level, managing Medicaid
• 14:37
  - plans
• 14:38
  - was literally... I mean, there wasn't really any
• 14:41
  - great belief,
• 14:42
  - at least unless you're really a theorist, that
• 14:45
  - the insurers are gonna provide better
• 14:47
  - care or navigate care better, manage care better.
• 14:50
  - It was really about
• 14:52
  - they're gonna do stuff the government doesn't like
• 14:54
  - to do, which is deny,
• 14:55
  - pre authorize,
• 14:57
  - etcetera,
• 14:58
  - and that's what the insurers are doing. So
• 14:59
  - when I see Congress yelling at the insurance
• 15:01
  - CEOs, CEOs yelling back at Congress, I think
• 15:03
  - they're all in, you know, in this... In
• 15:06
  - cahoots together. It seems like they're all playing
• 15:07
  - the same game together. I mean, the money
• 15:10
  - was turned over to these insurance to do
• 15:12
  - exactly what they're doing.
• 15:15
  - Yeah. So they
• 15:17
  - they they pretty much got what they asked
• 15:18
  - for. You know, of course, everyone tries to
• 15:21
  - talk about how America is a free market
• 15:23
  - system,
• 15:24
  - you know, to divide
• 15:26
  - unevenly
• 15:27
  - the resources,
• 15:28
  - you know, based on how hard you work
• 15:30
  - or how high this degree is and how
• 15:32
  - much you get paid at your job and
• 15:33
  - you may get more money or less money,
• 15:36
  - based on that. But I don't feel like
• 15:38
  - health care should fit under that umbrella. You
• 15:40
  - know, it's not, oh, you get a really
• 15:42
  - nice TV versus you get a really basic
• 15:44
  - TV. You know, everyone
• 15:46
  - deserves
• 15:47
  - good health care.
• 15:48
  - My favorite example that I use in the
• 15:50
  - book is is,
• 15:52
  - for profit firefighting.
• 15:54
  - So, you know, in ancient Rome,
• 15:56
  - before the government decided to tax and start
• 15:59
  - a
• 16:01
  - government funded
• 16:02
  - firefighting service, you used to have
• 16:05
  - for profit firefighters.
• 16:07
  - And there would be a fire outbreak in
• 16:09
  - Rome,
• 16:10
  - and they would show up and they would
• 16:12
  - just look at the owner and be like,
• 16:13
  - are you gonna pay me for my service?
• 16:16
  - Or do you have firefighting insurance? If they
• 16:19
  - said no,
• 16:20
  - those firefighters just sit there and watch the
• 16:22
  - building burn out. And I feel like that's
• 16:24
  - how I feel a lot of times in
• 16:26
  - medicine.
• 16:27
  - I feel like I I know what the
• 16:29
  - best treatment is. I know what tests you
• 16:31
  - need. I I I know...
• 16:33
  - But there's this barrier
• 16:35
  - between us on you getting what you need.
• 16:38
  - I I think the government
• 16:40
  - should take over that payment just like they
• 16:43
  - take over the payment and providing the service
• 16:45
  - of firefighting.
• 16:47
  - And let me ask you this question. Because
• 16:48
  - one of the points you're getting against Medicare
• 16:50
  - for all
• 16:51
  - is that in countries that have national health
• 16:54
  - systems,
• 16:55
  - you often end up with... I mean, the
• 16:57
  - hope is you end up with Medicare for
• 16:59
  - all and we get out of this concept
• 17:01
  - of so many different tiers of care, like
• 17:04
  - Mhmm. Based on how much money you have.
• 17:06
  - But but... And certainly in this country where
• 17:08
  - there's such a shortage supply,
• 17:10
  - you see with concierge care... And I don't
• 17:12
  - blame the physicians one bit for this. This
• 17:14
  - is their way to make a living in
• 17:15
  - many places.
• 17:16
  - But you see concierge care certainly driving a
• 17:19
  - different tier of care where, you know,
• 17:22
  - not enough primary care physicians.
• 17:24
  - So in many, many states, you can't get
• 17:26
  - a primary care physician without paying a concierge
• 17:29
  - fee.
• 17:29
  - And the idea
• 17:31
  - of, you
• 17:32
  - know, Medicare for all or coverage for all
• 17:34
  - is that we get out of that.
• 17:36
  - But but the flip side is, in so
• 17:38
  - many countries that have a socialized health system
• 17:40
  - or nationalized health system,
• 17:42
  - they've ended up with exactly the problem we
• 17:44
  - have
• 17:45
  - in that
• 17:47
  - the physicians
• 17:48
  - end up out of the system,
• 17:50
  - getting paid by the well off of the
• 17:51
  - politically connected
• 17:53
  - to provide care in private hospitals, private systems,
• 17:55
  - private other stuff.
• 17:57
  - And so rather than improving the supply demand
• 18:00
  - in a lot of those countries, the weights
• 18:01
  - are horrible unless you're wealthy, then the weights
• 18:04
  - are short. So how do you... Right. Yeah.
• 18:06
  - How do you deal with those problems like
• 18:08
  - the modernist problems?
• 18:09
  - Yeah. So look, there's always gonna be, even
• 18:12
  - with for profit firefighting. Right? So I don't
• 18:14
  - know if you remember when they had those
• 18:16
  - fires in California a year or two ago,
• 18:19
  - and people were literally paying
• 18:21
  - firefighters
• 18:22
  - from other states to, like, come in and
• 18:24
  - protect their house. But But the wealthy are
• 18:26
  - always gonna use their resources
• 18:28
  - to get the best of whatever it is.
• 18:31
  - So I I don't think that that's gonna
• 18:33
  - be any different if there is a Medicare
• 18:35
  - for Evol.
• 18:36
  - What I'm trying to do is I'm trying
• 18:37
  - to make health care better for the average
• 18:39
  - person. You know, I still think that there's
• 18:41
  - gonna be some person who wants better care.
• 18:44
  - The example I always use is the professional
• 18:46
  - athlete.
• 18:47
  - So even if we have Medicare for all,
• 18:49
  - there's still gonna be that one baseball player
• 18:53
  - who tears his
• 18:54
  - elbow ligament,
• 18:56
  - who gets a MRI that night,
• 18:58
  - who gets flown out to wherever doctor James
• 19:01
  - Andrews is and gets surgery the next morning
• 19:03
  - without a weight, has the best physical therapy.
• 19:06
  - But there's always gonna be that case. But
• 19:09
  - but I think your point
• 19:10
  - that's what I'm gonna wanna fix.
• 19:12
  - Yeah. Your point that I've that I've heard,
• 19:15
  - the the best stated by yourself and a
• 19:17
  - couple others is, look, we're not trying to
• 19:19
  - change everything. We wanna make sure that every
• 19:22
  - American gets a baseline of care
• 19:24
  - that's above the constant fight with the insurance
• 19:27
  - companies
• 19:28
  - about what they'll pay for. That everybody gets
• 19:30
  - a baseline of care, and then, you know,
• 19:32
  - what I love about your discussion is
• 19:34
  - you're not saying that it's a fix for
• 19:36
  - everything.
• 19:37
  - You're saying it gets us to at least
• 19:38
  - a a point of spot where everybody gets
• 19:41
  - care. The average American get cares.
• 19:43
  - And sure, we're not trying to demonize the
• 19:45
  - rich and say that they can't buy doctor
• 19:47
  - Andrews when they wanted to buy doctor Andrews
• 19:49
  - or doctor Joe, who is still alive. I
• 19:50
  - know he is not. But but the point
• 19:52
  - being that it it it... It's imperfect, but
• 19:57
  - the point is it gets us a spot
• 19:58
  - where hopefully we're getting a baseline kind of
• 20:00
  - coverage for everybody.
• 20:02
  - Yes. And... Yeah. And and especially the current
• 20:04
  - system where it's Medicare and Medicaid. Right? So
• 20:06
  - the only government funded systems that we have
• 20:08
  - right now or for the the people 65
• 20:11
  - are the very poor,
• 20:12
  - but they get dramatically different
• 20:15
  - coverage. So earlier, you said that how
• 20:18
  - does
• 20:19
  - someone get different care or have to travel
• 20:21
  - a long way for a, a specialist. The
• 20:23
  - only people who have to travel for a
• 20:25
  - specialist right now are people with Medicaid. Right?
• 20:27
  - So I have so many Medicaid patients
• 20:29
  - who need their back surgery, who need their
• 20:31
  - cancer treatment, and they have to go to
• 20:32
  - those tertiary centers. Right? So I live in
• 20:34
  - New Iberia. The closest tertiary center is New
• 20:36
  - Orleans or Shreveport.
• 20:38
  - Those are both roughly three hour drives away
• 20:40
  - from where I live. So those Medicaid patients,
• 20:43
  - I have to call and get them set
• 20:45
  - up at one of those tertiary
• 20:47
  - big,
• 20:48
  - you know, not for profit systems that usually
• 20:51
  - have attached med schools and all those sort
• 20:52
  - of things. Where a Medicare
• 20:55
  - patient, right, so a person 65,
• 20:57
  - yeah, we have back surgeons and
• 21:00
  - oncologists and all those sort of specialists within
• 21:02
  - our community that will see and take care
• 21:04
  - of those patients and accept their Medicare.
• 21:07
  - And that has to do again with, unfortunately,
• 21:09
  - payments. Right? So like we talked about, especially
• 21:11
  - with Louisiana Medicaid, which really does not pay,
• 21:14
  - comparable rates. But a Medicare pays 90% on
• 21:17
  - the dollar where a Medicaid will pay that
• 21:20
  - five or 10%.
• 21:21
  - So a lot of those doctors just can't
• 21:23
  - see a whole bunch of those Medicaid patients.
• 21:26
  - Oh, a 100%. They they end up having
• 21:28
  - limited spots, a few spots a week, a
• 21:30
  - couple spots a week, whatever it is because
• 21:31
  - they just can't do it. If you're getting
• 21:33
  - paid five, 10%,
• 21:34
  - the patient might as well be an indigent
• 21:35
  - patient. But... Because by the time you get
• 21:37
  - covered by the government, Medicaid pays you, it's
• 21:40
  - almost not even worth bothering to bill. You're
• 21:42
  - just really doing it. It's almost become philanthropic
• 21:45
  - work by the doctor here in the clinic
• 21:47
  - itself.
• 21:48
  - Right. Yeah. Absolutely. And then the other thing
• 21:50
  - you mentioned was, the wait periods.
• 21:53
  - So so I have a solution for that
• 21:54
  - or at least I have a proposed solution
• 21:56
  - for that. So... Yeah. So in
• 21:58
  - Canada is the biggest complaint a lot of
• 22:00
  - Americans have. So they always hear about in
• 22:03
  - Canada that whenever they decide it's time to,
• 22:05
  - like, have a surgery, right, especially a non
• 22:08
  - emergent surgery. Right? So they wanna get a
• 22:09
  - knee replacement or a hip replacement is the
• 22:11
  - common one.
• 22:12
  - If you do that in America, you know,
• 22:14
  - you can go to a surgeon and you
• 22:15
  - can get your knee replaced next week if
• 22:17
  - your your knee is in terrible shape.
• 22:19
  - In Canada, you're gonna get put on a
• 22:21
  - list and you're not gonna have to get
• 22:23
  - your knee replaced,
• 22:24
  - you know, in four months. So I think
• 22:26
  - was the average in the study.
• 22:28
  - So
• 22:30
  - the thing with Canada is Canada doesn't
• 22:33
  - get paid. The doctors and the hospitals don't
• 22:35
  - get paid by the test or by the
• 22:38
  - treatment or by the surgery.
• 22:40
  - They get lump sums. Right? So every hospital
• 22:44
  - says, oh, you take care of a 100,000
• 22:45
  - people, you get x number of dollars, and
• 22:48
  - you're gonna use that money to take care
• 22:50
  - of everybody for a year.
• 22:53
  - So a doctor in that system gets their
• 22:56
  - salary and they're not incentivized
• 22:58
  - to see five surgeries versus seven surgeries. You
• 23:01
  - kinda see what I'm getting at? Yep. Yeah.
• 23:03
  - 100%. So you would maintain... But instead of
• 23:05
  - the...... Service,
• 23:06
  - it would still be free for service.... Service.
• 23:08
  - Yeah. Which which I think is exactly right
• 23:11
  - because when you get these capsulated payments and
• 23:13
  - the insurance companies,
• 23:15
  - you know, people complain about fee for service
• 23:17
  - and doctor doing too much, under managed care
• 23:20
  - or capitated payment. It's exactly the opposite. People
• 23:23
  - try and deny care and don't do care.
• 23:25
  - I mean, there's there's challenges on both sides
• 23:27
  - of it, but
• 23:28
  - this concept of everybody becoming sort of, like,
• 23:32
  - you know, not working that hard because they're
• 23:34
  - just getting paid, like, a lump sum amount
• 23:36
  - and there's no incentive to do work, I
• 23:38
  - think, is is a... No incentive to stay
• 23:40
  - extra. Yeah. So so... Yeah. By but by
• 23:42
  - keeping that, right, again, with the current Medicare
• 23:44
  - system,
• 23:45
  - if you see... If you do four Medicare
• 23:47
  - knee surgeries, you make four knee surgery fees.
• 23:51
  - But if you do eight knee surgeries, you
• 23:53
  - get eight feet. You know what I mean?
• 23:54
  - So... Yeah. So you do that Medicare for
• 23:56
  - all you do better.
• 23:57
  - You make more money. Right? So then that
• 23:59
  - would still incentivize and I think that would
• 24:00
  - alleviate a lot of that
• 24:02
  - backlog stuff that they have in some of
• 24:04
  - those systems,
• 24:06
  - without,
• 24:07
  - you know, changing,
• 24:09
  - the the way we do medicine. Right? Still
• 24:11
  - keeping some aspects,
• 24:13
  - you know, in a quote free market.
• 24:15
  - No. And I and I... At least where
• 24:16
  - you get paid for productivity. Not, you know,
• 24:18
  - I I I love that. And and doctor
• 24:20
  - Proctor, let me ask you one more time.
• 24:22
  - Tell us the name of the book where
• 24:23
  - people can get the book so so people
• 24:26
  - hear that again if you don't mind, doctor
• 24:27
  - Proctor.
• 24:28
  - Yeah. So the book is called Inefficient on
• 24:30
  - Purpose,
• 24:31
  - Challenging the Insurance Industrial Complex.
• 24:34
  - It's available on Amazon.
• 24:36
  - You can get a paperback, hard copy, or
• 24:39
  - an ebook.
• 24:40
  - Fantastic. And when can we get you to
• 24:42
  - write a book on the educational industrial complex,
• 24:44
  - which seems to be us all, where the
• 24:46
  - incentives seem to be totally messed up as
• 24:48
  - well?
• 24:49
  - It... I I I know that that one
• 24:52
  - needs one. I absolutely agree. And then somebody
• 24:54
  - was actually talking about how our, food system
• 24:57
  - and diet also,
• 24:59
  - could be totally revamped and how obesity and
• 25:01
  - just our our diet in general. And I
• 25:03
  - was like, man, I'm really not ready to
• 25:04
  - write another book right now. But, if if
• 25:07
  - I ever decide to write another one, I
• 25:08
  - know a couple areas that would be right
• 25:10
  - for,
• 25:10
  - some disruption.
• 25:12
  - I love that. And people do know or
• 25:14
  - people that have written books now exhausting a
• 25:16
  - process is they actually get a book
• 25:18
  - written, rewritten, edited,
• 25:20
  - get it to where you want it to
• 25:21
  - be, and then get it published, work on
• 25:23
  - distribution, everything else. So I I hear you
• 25:25
  - on the exhaustion factor. Doctor Proctor, what a
• 25:27
  - complete pleasure to visit with you. Thank you
• 25:29
  - so much for joining us. Thank you so
• 25:31
  - much. Yeah. Absolutely. Thanks, Scott.