 Welcome to Business in Hawaii with Reg Baker. We broadcast live every Thursday from 2 to 2.30 in the beautiful downtown studio offices of Think Tech Hawaii in Halalulu, Hawaii, Pioneer Plaza. We're a show that focuses on success stories in Hawaii, both the companies and the individuals. There are a lot of challenges in Hawaii. There's a lot of challenges all over the country. For some reason some people seem to make it work here and they do well. And so we try to highlight those individuals and their stories and hopefully pass some of those secrets along to the audience so that they don't have to make the same mistakes. Today we have a special show every quarter. We try to have a little bit of a commentary talking about some of the current news items and how it might have an impact on business in Hawaii, possibly across the country. And today we have two guests. I've got Deilin Yanagida, who is very active in the HR industry here with Vantagio. And then we have Ray Tsuchiyama, who has lived in Hawaii almost, I think maybe even longer than I have, and has had the opportunity to see how I grow and develop and pretty much transform itself over the years. So we've got some very good interesting perspectives this year, this show. And we're going to kick it off with a topic that's been in the news the last few days and ask our guests to have a little discussion about North Korea and what's going on with North Korea and all the saber-rattling that's going on. Is there going to be any impact to Hawaii with all of this noise? Ray, why don't you lead off? Well, the North Korean crisis is not only a national, international kind of case here, but also a local one, because it affects travel. And travel is where it's all about in Hawaii because of tourism. And I think the hotel industry has to be very careful kind of monitoring the situation and because people in the Midwest or throughout the U.S. and Japan worry about the threat to Guam, and they think Guam is close by Hawaii, that there may be some kind of retaliatory action, some kind of event that happens in Hawaii. So even within the hotel industry and business in general, I think there's also, this is a wake-up time to look at, really to review disaster management also, to look at records, how redundancy and record-keeping and even evacuation of key people to other parts. So there's a lot of things to go into, but yet I think the business in general in Hawaii would rather not this really increase in, I guess, severity because it will affect tourism. Yeah, there's certainly that possibility. Now, Deilin, from a small business perspective, I mean, I go shopping all the time, you go shopping all the time, just the general business of living in Hawaii. Do you see any impact from this North Korea situation? I think that as citizens of Hawaii, we're very tuned in to the activities of anything that occurs with regards to Asian and how it affects our Asia markets, especially with the impact on tourism. But I think that people are still sitting back to see what the reaction should be. Right, to kind of see how it plays out. I know we've gotten some information to us from various sources about, you know, some of the missile defense capabilities that we have in Guam, that we've got a number of ships in the area that Japan has some ships. And of course, South Korea has got a lot of missile defense capabilities there. So whatever North Korea can come up with, there's probably multiple layers that's going to stop anything making it this far. So I think you're right. I think there's been an awareness, but not overly concerned at this point. However, it can escalate. And I hope that people can have a calm head about themselves and stop some of this cyber rattling because I'm not sure that that helps very much. You know, I am also a little bit concerned about, you know, the concern so much, but maybe even the positive results of China and Russia actually not being very vocal about this. You know, they're already supporting some of the economic sanctions that we've imposed or the UN, I should say, imposed with the agreement of Russia and China. And now with this war of words going on, I'm kind of encouraged a little bit that China and Russia are staying out of it to some degree. Well, China and Russia both want to see stability on the Korean Peninsula. That's number one. Volodolstok, a major seaport of Russia, is barely 100 miles from the North Korean border. And of course, the Yellow River is the border with China. Now, North Korea, though, is a fiercely independent country and kind of sustained itself after the Korean War, which was a devastating one back in 1953. There is no peace treaty between North Korea and the rest of the U.S. and South Korea. But they want to really be seen as a player in the global landscape. So we have to see what happens. But again, again, you're right that China and Russia are very close to whatever happens in North Korea. That's right. Well, in Japan is too. And there's a lot of interest, very high levels of interest, watching this very closely. And so I think there's probably at this point, a lot of things going on behind the scenes that we're not really proving to, you know. So let's hope that this pass, that there are no bloodshed. But I think in some ways, from my perspective, former military guy, I think we're just kicking the can down the road. At some point, something's going to have to be done. So next topic, maybe a little less controversial. Last week, we had a very interesting topic. We were supposed to talk about taxes and some of the different things that we're going to be coming up and maybe the special legislation or maybe even nationally in tax reform. But Tom Yamachika and I got a little bit tied up on the taxes as it related to heart and the rail. And we talked a little bit about the issuance of the bonds that's going to be done, which causes some concern. But Ray, you had a perspective on that. Because of all the mechanisms, several mechanisms to raise more money. It's called taxes. And one dealing with the GT, other with the hotel tax. So I go and of course, the widely not seen option of the property tax that I want to go to that level. But again, if there's also the possibility of bonds and everybody thought that it's easy to do bonds and just go out and raise money to sell bonds. But as Tom Yamachika pointed out, it's not that easy just because you're in the bond arena working with SEC. They want to see a lot more transparency in compliance to rules, regulations, finances and so forth. So it is not as easy as people thought according to Tom. Well, and I've worked for public companies in the past and I have been an auditor and I've audited public companies. And I know a lot of the disclosures are pretty comprehensive. There's always going to be secrets, but the intent is to disclose anything that could have an impact on the financial statements. And I'm I'm afraid that we haven't been that open and transparent so far with what's going on over there. So I think there's a lot of surprises that people are going to learn. What do you think about the and I know you've lived in places that had very sophisticated public transportation you know, Japan and you visited other places. You know, what do you think about the mass transit in Hawaii is are we ever going to be able to have something comparable to say Japan or Singapore in Hawaii or is our demographic or geographic too much different? It's a very complex question because in Japan or many other parts of the world, you brought up mass transit to areas that really didn't have development. And then you have development and that kind of aligned with mass transit so that you bought a place because it was near a station. That was the key and got you to where you worked or shop and so forth and came back. And that was so the same company that built the railroads or subways owned and developed areas around it for shopping balls, condoms, the housing and so forth. It was a complete deal. And this is something quite separate happening here. And if you look back in time, it's not it's not a recent phenomenon. We had trolleys and trams all over Honolulu until the post-war era. And they went up Wailai Avenue. They went by the Elks Club. There were trolleys that went to the edge of Fort Shafter. So there was an extensive trolley system and also up in Manoa and Nuanu. But those are ways to sell lots in that time, during the 20s and 30s, to be part of the development of Honolulu. Again, you're coming to an area of really of a big question. Is it about real or is it about transit? You see, that is a larger question. And how do you plan a city with a transit system or options? And because sometimes in among transit experts, they say that if a city can't get bike lanes, right, how can they get a huge mass transit line? Well, but we're also trying to pass laws and regulations for pedestrians. Apparently, we still can't get that right either. So there's, you know, and I'm being sarcastic, but, you know, we seem to have an awful lot of rules and regulations and a lot of things are being forced down our throat, whether we want them or not. And I think because we've already got a lot of this development in place and it's already there, we're we're trying to connect some of these places. But is it the most economical and efficient way to do it? You know, we had one of the best bus systems in the entire country. Are you involved with the buses? I was on the board of the bus, you know, but I didn't have anything to do with winning those awards, but, you know, we did and I was aware of it. I watched and we had some very sophisticated management. We had good ridership. It was a well oiled machine and we won a lot of awards for that. We I wish we could have spent more time looking at what we were doing successfully and see if we could enhance that or compliment that. And whether that included a a ground rail or a raised rail or some combination of supplemental routes, you know, I just I'm not sure that we went through the proper exercise to do that. And so now we're going to be stuck with this thing. Now, you and I both live on the east side. When they build this, whether it goes to Middle Street or even if it goes to Alamona, how much benefit do you anticipate getting out of this when your commute is from east side into town? Zero, zero. But yet you're paying your fair share of that, you know, that there's always going to be questions about, OK, when when we see rail done, what will happen to the increase in taxes that we were given and are we going to use that to pay off the debt, the deficit in it? And what's really going to happen? Well, I think experience will kind of lead us to the answer. You know, once taxes go up, it's really hard to bring them back down again. And once the rail is up and running, but wherever that route terminates, there's going to be a deficit that's going to have to be funded. And there's going to be bonds that have to be repaid. That money's got to come from somewhere. When we come back from break, we need to take about 60 minutes. We're going to talk a little bit about another topic that may also lead to maybe some new opportunity in Hawaii. And so we're going to take that 60 minute break. Please stay tuned. We'll be right back. This is Think Tech Hawaii raising public awareness. Let's fast. Hi. For the day of the big game, watching at home just doesn't feel the same. What on the list is who's going to drive? It's nice to know you're going to get home alive. Plan for fun and responsibility. Choose the DT. Captain of our team, it's the DT. For every game day, assign a designated driver. Aloha. My name is Steven Philip Katz. I'm a licensed marriage and family therapist, and I'm the host of Shrink Rap Hawaii, where I talk to other shrinks. Did you ever want to get your head shrunk? Well, this is the best place to come to pick one. I've been doing this. We must have 60 shows with a whole bunch of shrinks that you can look at. I'm here on Tuesdays at three o'clock every other Tuesday. I hope you are too. Aloha. Aloha and welcome back to Business in Hawaii. We're here with Reg Baker. We're here today talking with two individuals that have been on a show before, De Lin Yamagita and Ray Tsuchiyama. Both of them bring some very interesting and broad experience to the table, and we're talking about various commentary type items this week. Our next one is going to be medical tourism. Now, I know, Ray, you've been looking at this a little bit. I know I was involved with it when I was at HMAA. And De Lin would be interesting as a layperson, maybe, to get your perspective on this conversation. So, Ray, what is it that interests you about medical tourism? Well, to me, medical tourism and to be very simple to define it is that you can combine a medical procedure or treatment with a vacation for yourself and your family or friends and so forth. And usually, in real life, it means people from advanced countries going to another country to get a treatment for much cheaper in their home country. And those countries, maybe in Thailand, Singapore, even for people from some places like Europe to go to, even to the US or China and the Middle East. And my whole interest is that medical tourism for a resort-like place like Hawaii could actually increase the level of medical treatment for the community. And that's what I'm trying to kind of focus on. But in order to do that, you have to create an infrastructural ecosystem of combining services, just like a concierge at a major hotel, a resort, plus very good high quality treatment and procedures with equipment and medical doctors and nurses all in one place. And that could really increase flows of wealthy individuals from emerging countries like China and other places to come to Hawaii and pay into increasing and developing medical care for the entire community. And what's really fascinating about this is that a lot of these procedures are being paid for not through medical insurance where rates are negotiated, but through cash payments. And so for the facilities and the providers that are performing the services, they get full pop, which can be very attractive to some some businesses. You know, and before people discount this too quickly, I think it's interesting to note that in Thailand, they've got some of the most advanced medical facilities and some of the best trained physicians who as a general rule get their training in medical schools from either France or from the US. And the hospitals are all brand new. They've got the best equipment, the best facilities. They're they're operated by some of the best technicians right out of training. And they're built seamlessly with some of the resort type of facilities in the hotels that allow for a better recovery period. So it's it's popular. It's being done is being done by, you know, in various places in the world. And we might have an opportunity to explore here. What type of medical procedures are we talking about? Well, it's a full range. They can have micro surgery sometimes or plastic surgery. Some procedures that are elective like I said in the US that health insurance don't cover. And they would go about seeking those kinds of procedures or operations. Another area that's quite big, especially for Japanese, is called Ningen-Doku, which means a complete physical in many, many, you know, complete MRI, body scan, body scan, uncover any, you know, early evidence of tumors or any type of cancers or anything like that. And it's a two, three day program. And they have a lot of tests and measure all kinds of impact on your body from either from age or you take procedures. So I think that's that's an awesome area where it's preventive. It's not a procedure, but you go in and say, check me out. And then you have a vacation after that. Yeah, so there's various types. So are these are these services primarily from private physicians' offices or centers? Are we talking about our larger hospitals? They're larger hospitals and they're in like some Raffles Hospital in Singapore, which is quite famous, Bumurgaard in Bangkok. They're also in Seattle, Virginia Mason, the Mayo Clinic in Minnesota, world famous, that attracts a lot of people in Europe and the Middle East to that center in the middle of the US. So it is it is also again a full kind of intensive from intensive care to preventive to all kinds of areas. So again, it is it is a world where what Red said, when families come, they buy things. They go to hotels, cars, duty free restaurants. So they add to the economy. And that's where the tourism piece comes in. But in addition to just doing the basic procedure, you know, the recovery facilities are much nicer. They they're their suites like in very, you know, four or five star type hotels. They've got maids, they've got the skilled nursing professionals there to help you go through the recovery. And, you know, the cost of labor is much less in some of these places. And so you get a lot higher level of service for a lot less price, which makes the procedure and recovery be a better experience. So if there is a climate in Hawaii for medical tourism, how would that impact services to sage myself as a resident? If we if we shift to looking at a tourist experience, if you will, right? Because we're talking about packaging. How would that impact services to me as a citizen? Oh, I think it you will see better equipment. You will see better doctors who will see better nurses or doctors and facilities. And by people paying, you know, cash and so forth and offsets, you know, people who are on incomes or Medicaid and other patients. So that is a boon for the community. I feel that that hospitals get upgraded kind of and doctors and nurses also. So I don't think again, if you have one person who pays all in cash, you know, tens of thousands of dollars, again, that that's a good, you know, uptake to to a hospital finances. Well, and another, you know, remember that there's economies of scale and scaling going on with this so that if there are these medical tourism patients coming in, it may take these facilities 70 percent of their capabilities. You know, they may be operating at 70 percent of capacity. There's a 30 percent piece that they need to do something with. So there could be some very high end facilities with very skilled professionals that would be able to make some of these facilities and these procedures available to the local community. It may be a reduced rate to use up that unused capacity. Well, Red, you have a vast experience in in the health care industry from HMA. So what as as a consumer of medical services in Hawaii, should I be concerned that now my position is going to choose to move into that room because they have more opportunity to to make. I guess there's always going to be some possibility of that, but a lot of the procedures that are being done are elective procedures. And these are not normally going to be covered by insurance anyway. So it's going to have to be the the patients that are able to pay cash for these. You know, will some physicians possibly translate? They might, but they've got their own patient base already. They've already got the relationships. They've got their business right there. And this model is different from what's currently existing. So I think what you might see is new physicians coming into the market or coming out of the school, going over there and doing this, which doesn't address our physician shortage. But if there is an opportunity in Hawaii for physicians to make a lot more than they might be making on the mainland, I have a feeling we'll see people moving over here to be able to fill those positions. And overall, we're going to see a higher level of physicians in the marketplace. So we know that the tourists would definitely be attracted to Hawaii and what it offers as a vacation destination anyway. So if you were to layer on, you know, elective medical procedures, it could be, you know, something of interest for them. But what about the the physicians, the medical community in Hawaii? Are they open to that? Well, I think I think they're very open to it. It's just that I don't think they have experience what benefits medical tourism can bring to the hospitals. But you have a very interesting question. It's not a medical tourism has several parts to it in that hospitals just do not think of themselves as branding or marketing agents globally. So they have to tie up with companies with expertise in those markets, number one, to attract those people to come in. And they really have to do an audit of all the things necessary to keep that person in a comfortable, culturally aware language, aware, sensitive kind of experience. When they check in, is there a person who speaks their language? Nurses also, how about their entertainment on the TV? Is it in their language? How about food? You know, they allow food or special Chinese food for breakfast. You see all those questions. So there are opportunities for people in the community to become consultants, to become interpreters, to be part of the ecosystem, to provide condos, you know, and drivers and guides. There's all kinds of opportunity for a lot of different elements to come together to help support this new industry. Now, we've only got about 30 seconds left and we're going to have to wrap up. But I think this is certainly an industry worth exploring. It's got some potential. It's a clean industry. You know, it could help this, you know, our community, our Ohana all by itself. So there's a lot of reason to take a closer look at that. There's hurdles. There are things that we have to address. But, you know, let's let's take a look at it and see we can start on a small scale and grow big. All right, this is Business in Hawaii with Reg Baker. Today was our quarterly commentary. We we covered some interesting topics all the way from North Korea to medical tourism. So we've, matter of fact, maybe the conflict in North Korea might trigger a need for some medical tourism. But we broadcast live every Thursday from two to two thirty. We highlight successful individuals and businesses. Hopefully you've learned something from today's show and we look forward to seeing you again next week. Allah.