 You're watching the Daily Decrypt. Welcome to Currency Competition, friend. I'm your host, Amanda, and today's episode is brought to you by Node 40. Hello. Hi, Keith. Wow. How have you been? Very, very good. I've not seen a patient yet that wants to pay with Bitcoin, though, since you guys. Really? OK. Well, maybe this is. We got a lot of press, but I've not had anybody offer me Bitcoins since you all were here. All right. Well, maybe this interview can change that, because I'm not sure how many people are aware of it. But even if they are, I still wanted to talk to you, because even though the theme of the Daily Decrypt is currency competition, I believe that your operation is unique in that it believes in medical competition. Go figure, right? And so I just really think that these things are interrelated. So if you will allow me, I would like to start by telling everybody how I came into contact with you, Keith. Absolutely. So about two years ago, my man friend, my man servant, as you've also heard me call him several times, required surgery. And we were staying up in New Hampshire. And so we called all around these various clinics and hospitals or whatever, telling them what kind of surgery we needed. It was a bicep repair. And asking for a price quote. And not only did we not get a price quote, but we got mostly silences. And even we were laughed at once. We were laughed at by a hospital receptionist for asking for a price for a service. And so we started feeling kind of like down and hopeless about this. And so we contacted the Surgery Center of Oklahoma on a whim, on a weekend, actually. It was a Sunday afternoon. And we sent them an email. And we thought, OK, we'll throw this out there. Two hours later, Keith Smith himself, an anesthesiologist at the Surgery Center of Oklahoma. Am I correct you're an anesthesiologist, correct Keith? That's right. Yes, you yourself responded to us via email on a weekend within two hours with an exact dollar price quote for us. And so already we were thinking, OK, this is a horse of a different color, isn't it? And then we decided to really push the envelope. And we emailed him back and said, you wouldn't, by chance, accept payment in Bitcoin and gold, would you? And what did you say, Keith? I'll tell you what you said, in case you don't remember. You responded back, we will accept whatever form of payment is most convenient for you. That's still true. So with that lead in, tell us about your operation, Keith. Well, we've been open, you know, Oklahoma City now for 19 years in May. It doesn't seem possible. 19 years? You're shitting me. 19 years. We opened in May of 1997. And from the very beginning, decided that we would be very open and transparent with our pricing and that we would never accept a dime of money from the government. And that has not changed. Seven years ago in April, we put our prices online with the idea that we could generate some price competition and that we might actually start a price war. We also wanted to make ourselves more known to the people who actually had the sticker shock of paying their own medical bills. And we also knew something, and everybody knows, there's something terribly, terribly wrong with health care in the United States. It operates very much like a cartel. And we didn't understand all of the nuances. And I don't pretend to understand all of the nuances now. But we know a lot more about what's wrong and how the people behind the curtain line their pockets, hidden from view, the people who make a lot of money in the health care industry who do not render really any care whatsoever to patients. So our putting prices online has accomplished all three of these goals. We are now much more of a known quantity in the United States and even in Canada. People come see us from all 50 states except Hawaii and foreign countries because they find our pricing. And we've also uncovered and helped discover some of the scams that are operational in the United States health care system. And we've also got people that are printing out our price list and demanding that their local hospital step up and match our pricing where they're going to fly to Oklahoma City or drive to Oklahoma City just like you guys did. And so it's become a bit of a deflationary force as well. And all three of those were really dreams, things that we hoped for, and they've all been achieved. Well, I'm interested in hearing more about all of those things in particular who it is, the actors you have uncovered, who are making most of the money in the industry that people call health care, but not providing any of the value. And I'm not sure if this relates to it or not, but I neglected to mention to you that before we decided to come to the Surgery Center of Oklahoma for surgery, not only were there like the laughing and the silent moments on the phone when we asked for prices, but we actually did go in. And even without a price, we thought, you know, let's go see a doctor and see what he says if he thinks we should get surgery and how maybe we can start to get a feel of what we would be looking at if we go pay to get an MRI and talk to a doctor. And so we did. And this surgeon, after examining my partner, he comes in and basically tells us, I'm not interested in doing surgery on you all. And the lack of prices was so shocking to me at that point when I realized that there was no price. There was no amount of money I could offer him that I mean, short of maybe like, I guess, $100,000 cash right then and there in the office as a big secret or something. But he didn't even want our money. Why didn't he want our money? Tell us about what's going on in what people call health care. Well, the best way I think to understand the scam of the United States health care system is to start out envisioning that you're in the hospital and you've been charged $100 for an aspirin. An aspirin? Yeah, so the $100 aspirin is kind of the story that I tell that I think helps explain a lot of what's going on. The hospital charges $100 for the aspirin knowing that they're only going to be paid by the average insurance company $5 for that aspirin. And perfectly happy with that for several reasons. One is they probably paid less than a penny for that aspirin. Two, after they collect $5, they'll claim that they lost the $95 that they did not collect. And so that creates red ink, which helps maintain the fiction of their not-for-profit status. The third reason they are fine with collecting $5 on $100 aspirin charge is that that $95, they claim that they've lost, goes into a bucket called uncompensated care. This bucket is then shipped off to Washington, DC, and then they receive a kickback or a rebate from the taxpayers to the extent that they claim these losses. So I call it a reverse in-ron, where in-ron overstated their gains to their advantage. The hospitals are actually incentivized to overstate their losses. And they make more money doing so. That's why, on the one hand, the hospitals complain that all the uninsured in their emergency rooms are bankrupting them. But every time you drive by one, there's a building crane out in front, making it larger. So those two things are not consistent. They don't compute, and that's why. If you're in the insurance company shoes, this one is more counterintuitive. The insurance company is happy to receive a $100 bill from a hospital for an aspirin that they know they paid a penny for. The insurance company pays the hospital $5, and then they typically will ride into an employer group that has bought this insurance policy. And they'll ride in on their white horse and say, we beat that hospital half to death. And we discounted that $100 aspirin down to $5. We saved you $95. Typically, in these contracts, the insurance company then shares in the savings that they've achieved. And this is referred to in the industry as selling discounts or as claims repricing. So what the poor employer doesn't know is that this $5 payment was prearranged. What they also don't know is that the hospital has probably been asked by that insurance company to charge $200 for that aspirin because they achieve an even greater discount and share in a greater amount of savings with the employer who is fleeced and has no idea about any of these shenanigans that are going on. So when you think through it, you realize, well, why is someone charged $100,000 for a total knee replacement when really the hospital knows all they're going to get is $30,000? Well, that $70,000 of red ink generates a kickback, helps maintain the fiction of their not-for-profit status in the insurance company is going to charge someone to the extent that they discount these bills. The other scam. There's more? Oh, yeah. And it's easy for people to take their eye off the ball. I've been talking about this a lot lately because as disgusted as any listener right now would be with what I just said about the hospitals and insurance companies, the real culprit in this entire mess is the federal government. And that is very important to remember because everything that we hate about health care, whether it's lack of price transparency, whether it's bad access, whether it's poor quality, high price, all of those things are the responsibility of federal interventions into the health care economy. And the idea that we would want to turn the whole thing over to the folks who caused these problems in the first place is illogical. So I'm trying very hard to make sure that as all of these scams that these cronies are involved in, these are simply favors that have been purchased or auctioned off actually in Washington DC to these companies. And the real culprit is the state, an entity that has no business being involved in health care at all, I don't believe. So the other scam I talk about are the brokers, the insurance brokers. The insurance brokers many times will recommend that an insured by a policy that is not necessarily the best device and vehicle for that person or for that group, but rather the policy they wanna sell that generates the most giant undisclosed commissions to the broker or the brokerage house where he works. This is a huge problem in health care. And the brokers, the insurance brokers and the big brokerage houses are really the biggest problem in resistance to the free market movement in health care. Because as prices become more transparent than the big insurance carriers and the PPO's, they really don't have any role in the game. Yet they are the source of these undisclosed commissions to the brokers. So the sales force with boots on the ground from whom most employers derive all of their knowledge about health care is actually just a propaganda machine that's really designed and geared toward maintaining the commissions that are paid to these brokerage houses that are never revealed to the employers who are the ostensible clients of these brokerages. So those are some of the things that we've learned with the very simple, very simple goal of putting our prices online. The action of putting prices online has made all of these things very clear and the insurance companies want nothing to do with us. And we have very high quality, as you know, extremely high value. You would think an insurance company would be very compelled to send everybody here. They could not want anything more opposite because with our prices being completely transparent, they have no opportunity to sell discounts or reprice the claims. So it all kind of comes together if you think a little bit through the $100 aspirin story that that's the best way to explain the dysfunction of the health care system that I can come up with. So I see Surgery Center of Oklahoma as a competitor with these scams, as you call them. And I also see cryptocurrencies as a competitor to what I see as the scam of the non-transparent fiat money where all of this inflation is happening behind closed doors and there's no open ledger for anyone to examine to see what the real money creation has been. So I see these as parallel competing options. And I do believe if I'm not mistaken that you are part of a network of clinics or hospitals which are all seeking to compete in the same way, namely by posting prices. Tell me more about what you and your network are doing to compete with the scams. Yeah, this is an organization that I helped start with a friend named Jay Kempton called the Free Market Medical Association at www.marketmedicine.org and there's a link again for me Keith. It's www.marketmedicine.org and the idea is for this association to bring the buyers and the sellers of healthcare together without intermediaries that foul the exchange. There are intermediaries involved in the exchange but only ones who facilitate that exchange. So I think about it as like a match.com of healthcare where the buyer and the seller can find each other and prices are transparent. And the association has served as a resource to many people that are drawn to the free markets applicability and healthcare. And I have tried to help and have helped other facilities embrace the discipline of the market and walk down this path. So we don't wanna franchise. We're not trying to get rich. We want everybody to copy us so that there will truly be a free market revolution in healthcare and there will actually be price and quality competition. And anywhere that competition is allowed the same thing always happens. There's always a trend of falling prices and a trend of increasing in quality. And that's exactly what is happening in healthcare. And I think I'm very optimistic. I think that we're actually going to see a lot more of this. And it's a great thing for the people who ultimately end up being patients which is really all of us. That is so true. So Keith, is it safe to say that if someone were to return to your clinic and ask to pay in a cryptocurrency like Bitcoin that you would once again accept the payment most convenient for them? Absolutely. Pigs or chickens or crypto. And isn't it after all, the duty of the vendor to provide and accommodate the person who's paying with whatever, as long as the exchange is mutually beneficial, it's incumbent I believe on the seller to convenience the buyer, particularly if there's any competition involved. I going through that process of accepting the cryptocurrency from you and Pete, it was awesome. I mean, I learned a lot and I think I went home and told my wife I felt younger than I did the day before because it was such a cool experience. Wow. Sponsored shout out from Limoplay which is an online casino for bosses that want to use Bitcoin to play games like roulette, blackjack, slots and hundreds of other casino games. Limoplay offers a generous welcome package just for signing up and they pride themselves on their fast payouts. You can use Bitcoin to play any of their games whether you're on desktop or mobile by visiting limoplay.com. Good luck. Well Keith, please tell us if someone is more interested to learn about your surgery center or if someone is just wondering, hey, what clinics can I go to? Maybe someone's looking to get a procedure or needs some medical care of some kind that is better than perhaps what they have available where they live. How would someone embark upon this knowledge mission? Well, a patient, a prospective patient could certainly start and a good starting spot would be our website surgerycenterok.com and from there, they might look at the free market medical association whether it's their website or on Facebook. We have a pretty good presence on Facebook and that will give somebody a pretty good idea about what pricing should be, whether or not they are gonna have to travel and how far in order to get the care that they need but I foresee the free market medical association website of like-minded individuals really exploding. There's so much momentum for these ideas. It's actually, what I lie awake at night and worry about is how to accommodate the great number of people that are rushing to embrace the discipline of the free market. Wow, well, allow me to say thank you for open sourcing your model to put it in those terms. That is how cryptocurrency and open source software in general works. It's people doing something and it proves successful and their model is published open source online. They don't say, oh, I'm gonna sue you if you try to be successful like me. They like you say, here is what I did and I would benefit, I would profit by you doing the same, by also creating more wealth in society and you are a wealth creator, Keith. So thank you very much. That's funny that you bring that up. We actually got a nasty letter from a company that decided to launch a website with the idea that they would sell bundled pricing for surgeries and they sent us a letter telling us that we had to cease and desist or they'd be happy to sell us a license to continue what we've been doing for six years before they ever did this. Also been copied by University of California, Los Angeles and a big hospital system in Pennsylvania. They have websites that are basically plagiarized versions of what I have online. And I think it's wonderful. I think imitation is the sincerest form of flattery and I think it's wonderful. It's an indication of how much pressure that these big bad sort of Leviathan hospital systems are feeling from this market approach to price transparency. Right on Keith. Well, Pete wanted me to tell you hi. So I am telling you hi now from him and his bicep is plenty strong back in action. So thanks so much for your time. Thank you. Hello, thanks for having me on. I will. Thank you. Bye-bye. Today's episode is brought to you by Node 40, a hosting service for Dash's second tier of infrastructure. For a once monthly payment or a discounted payment for longer commitments, Node 40 will take care of the hardware, configuration and bandwidth required to run a Dashmaster Node. Reach out to their support staff to learn more at any time by visiting node40.com. I just wanna say thanks to y'all for watching The Daily Decrypt. Hope you enjoyed yourself and have a good day. Da-da-da-da.