 Aloha, and welcome to Business in Hawaii with Reg Baker. We're a show that broadcasts every Thursday from 2 to 2.30, from the high-tech studio offices of Think Tech Hawaii and beautiful downtown Halalulu. We're a show that focuses on success stories of businesses and individuals in Hawaii, and occasionally we talk to people that are influential in making sure that companies survive and are successful. And today is one of those days. We've got Senator Josh Green joining us today. He's been a very busy guy. He's been running all over the country and doing all kinds of neat things and getting his hands in just so many different opportunities in Hawaii to make life better. And he's a recurring guest here. So Senator, it's great to have you back on the show. Thank you, Reg. All right. Now, you've been very active. And remember, we only got 30 minutes here. So can you give us like a quick summary of some of the things that you've been working on? Sure. So I'm trying to focus as a legislator physician on a lot of different issues that will impact families all across our state. So you know me as a doctor. I still work full-time in the hospital. I'm an emergency room doc on the big island. I do all my clinical work there. I just got off a three-day shift. So I'm still seeing all the challenges that we have as a healthcare community. And that's a tough community to be doing because there's a big need out there. There is. And an individual came in the middle of the night, just two nights ago, near respiratory arrest. She needed our help. And I was so glad the nurses were there and did my part. So people stay alive because the community hospitals survive. And that's been a big part of our business environment, as you know. I followed that up with other action just a day later. I was over on Maui speaking to the Maui Medical Association and to the new administrators at Maui Memorial. As you know, this past year, we privatized the hospital. We made a decision to change directions, change course a little bit on how we do our public hospital safety net. Kaiser has taken over. And I wanted to meet with those executives and make sure that they were both living up to the promises that we have for our people, and they are. And also to see that they're going to move forward with investment, with recruitment and so on. It's good to keep an eye on that. Just make sure that people do what they say they're going to do. Yes. And there's a lot of tax dollars at stake. We're aware of that. I certainly am. There is a long-standing need on Maui for more providers. I run another part of my life is as the medical director of the Hawaii IPA, which is an independent physician association. We have 800 docs across the state. This is my private sector side, if you will. And I want to make sure of the doctors on Maui, we have 112 doctors over there that they're engaged. They're taking care of patients with another 680 here on Oahu, that they're doing all they can to take care of people who are Medicare and Medicaid. And that they're also starting good small businesses. Every doctor's office is a small business, mind you. So this is an economic driver for the state. So these things, plus my homeless initiatives, are kind of what I've been on. And then there's a little political side to me, too. Well, obviously, you've got a very large plate and a lot of different things going on. We've got a special session coming up, too. How active are you in that? Well, I'm watching it very closely. So that kind of is the, let's call it the $10 billion question. It's not the $64 million question any longer. The rail has to get completed, in my opinion. The entire special session, which will come at the end of the month, is about the rail. We have to strike a balance between, in my opinion, one person's opinion, getting this darn thing done. I don't think we need to have an artifact, a Stonehenge in Hawaii, if you will, that doesn't get done. On the other hand, the taxpayers deserve some kind of prudence here at the end. We can't have a blank checkbook. We can't have an open-ended process that doesn't have audits. We have to decide, as a legislative body, do we increase the general exercise tax or extend that tax further? And how do we address the TAT, the Transit Accommodation Tax, which is the tax on hotels as you've spoken eloquently about? And where? These are the big questions. I have a commitment to do a couple of things. One, make sure that the taxpayers aren't victimized. And two, that the project gets completed in some kind of sane way, if that's possible. Right. Well, these are all very controversial issues. And I guess, depending upon who you talk to, you're going to be getting different answers. You know, just trying to get it done in the most cost-efficient manner at this point has got to be one of the main objectives. It is, because people will speak politically about this, of course. And I know. There was plenty of reason to be totally against it, and there's plenty of reason to be totally for it, depending on what your perspective is in Hawaii. But there's no reason to walk away from a several billion dollar start and do nothing. I think that would leave a black eye on the entire business community. It wouldn't be the fault of the small businesses. It would just look like, in Hawaii, we can't get something done. I don't want to see us waste money. I also am cognizant of the fact that people don't want to see a bottomless pit of money. And so, I think, like I said earlier, it's got to get done, but it's got to get done in a way that some people can reach a comfort space with. Right. Now, it's very tough decisions to be made in the near future, and it's good to know that you're going to be kind of keeping an eye on these things for us. So that's great. You just came back from a trip? Yes, I did. Many trips now. My life is getting a little more complicated. It's not the greatest of secrets that I'm about ready to launch a statewide campaign. I did travel to D.C. and I traveled also to Washington State for very different reasons. The trip I took to Washington State was in many ways more interesting. I was invited by the University of Washington and their medical staff and their mayor to give them ideas on how to solve a homeless crisis in both their state and ours. I've spent a lot of time thinking about this as a physician and as the chair of the Human Services Committee, which is a $3 billion part of our budget each year. And I've come to the conclusion, based on facts and data, that if you look at homelessness as an economic challenge and as a health condition and you put roofs over people's heads, those who are capable of accepting services, everyone's got concerns with drug addiction, mental illness in the population. If you do that, we see a 43% savings on their health care spend. That means hundreds of millions of dollars, taxpayer dollars, can go back into the government, can be invested in whatever people's flavor of the month is, whether it could be tax credits for small businesses, it could be more primary education at elementary schools, it could be health care dollars in drug treatment. But if you actually house people, you reduce their health care costs because they're not going to the ER, see someone like me, they're not out of control on their illnesses or their drug addiction, it's the right thing to do. And I went to Washington State and met with the leaders of that state, gave the talk several times that I give, and it was great. I also toured all their facilities because I want to learn the best things that other states are doing to bring them back to Hawaii to try to help our homeless population get to a solution. Well, what have you come up with any proposed solutions to this? I mean, that's a pretty serious issue. It is. I do have a solution. The solution is the following. You look at the homeless challenge through a much broader lens than we have. The people that work on it right now are extraordinary human beings. They're heartfelt. The social service organizations do incredible work. But that's not the whole challenge, just to put people into housing. You have to actually create some continuity of service. And it has to include comprehensive health care. For example, this year, Queens Hospital, our main hospital in the state, among a couple other peers, is going to lose $97 million just Queens because of the recurrence of individuals. 30% of their ER is now populated by individuals who are homeless. 30%. And hospital beds over and over again are filled. They have to have a medical solution. So my solution puts medical care directly in hand in hand in tandem with the social services and the housing components. I'm hoping to do that with the mayor of Honolulu. What a novel thought to kind of bring all these interested parties together and have them collaborate and work together. And I was just going to comment, having 30% go through the emergency room, I mean, that is the most expensive place to go for health care. To save, to move them out of the emergency room and get them into maybe a more of a primary care type of environment could save those facilities and the state. Huge amounts of money. Yeah, let me break it down for people out there who are interested in the cost side of it because there is the humanitarian side, which we all embrace, which is to get people better care so they're not suffering. But the health economics of it are so profound, you have to look at this. And I've convened all of these individuals so everyone's on the same page. If an individual's homeless and they call the medics, it's $1,050 for the medic ride, the ambulance. If someone goes through the ER, it's a minimum of $1,200 for the ER visit. If they're held, and I'm an ER doctor, so I can tell you this is a fact, okay? If they're held overnight, it's $3,000. If someone's hospitalized for a week, it's another $30,000 because of their infections, because of the mental illness they're dealing with or the rehabilitation for their drug addiction. So the average spend for an individual right now who's homeless in the state of Hawaii approaches $80,000 per year. If instead an individual who is on the street who is having a tough moment or a tough day called the H4, which is what I'm proposing, which means hygiene on the first level, mayor's on that, health care on the second, housing on the third, and it is a humanitarian endeavor. We're getting financial support from the humanitarian philanthropic community. If you add that component, that health care component, someone can come in there to a private van which costs virtually nothing. They can get care in a fixed sense for $60, $70, and then you have support services to get them into housing. For $100 or $200, rather than potentially several thousand dollars, you get actually better services. People are familiar with the individual. I know these individuals by name, and actually you do something good for them because they get into housing rather than being right back on the street. Well, and you also have the element of some continuity and care because sometimes I think what happens is when you go into the emergency room and you handle them one time and then they resolve the immediate problem, they get discharged, re-emissions happen fairly often. Every time, one gentleman who I've spoken about at great length, he's a very, very sweet guy. He shared his name with us. I'll just call him Gary for our interview today. I won't use his last name. Gary went to the hospital 241 times last year at the Queens. His hospital bills were $1.23 million, just Gary for the year, his health care costs. And Gary's not even that sick. He has needs. He could have been housed for $18,000. He probably would have seen his health care spend drop, statewide it drops 43%. Gary's probably would have dropped 80% or more. We could have saved $900,000 on one patient alone, one human soul alone, and all that money could have been used to fund an entire staff for a homeless facility. It could have been meals for, goodness knows how many of our capuna. So we have to kind of evolve on the way we look at this. And I've proposed, and it's gonna take time, that we use Medicaid resources, as long as we can guarantee we get dollar for dollar match back. This will interest you. I didn't even get to share this with you, Reg, when we were speaking before. I was out there in DC in the following trip. And sure enough, the administration, President Trump's administration was having some meetings. And sometimes we go back and forth a little here and there. But he sent Dr. Carson, Ben Carson, who's the head of HUD out. And Dr. Carson went and spoke to the national conference on housing and housing coalitions. He proposed essentially my exact idea, which was spend the money, spend it from a reserve of monies that you have, which are Medicaid dollars, and you will get dollar for dollar back. Here, we will get my estimation, two dollars back for every dollar we spend. But if you can guarantee you get a dollar for dollar back because you're spending it right, why not take care of people? Help them with this schizophrenia. Help them with the addiction they have. Help them just with the challenges they have economically. So it's not a partisan issue even, which was gratifying to me. It's about people. And at any given time, we estimate that in our society, as many as 20% of our people are just two paychecks away from potentially being houseless. It's a constant amazement to me that there are such a large percentage of people that's essentially living paycheck to paycheck, which means they're one paycheck away from being homeless. And that's just the financial side of things. I mean, a lot of homeless, it's not just financial. I mean, there's mental issues. There's, I guess, addiction issues that are driving them out of the homes into the streets. That's right, because I've got a lot of family and friends. I even have a family member who's been afflicted by heroin addiction. And it is just tragic because you take this individual who you love so deeply and dearly and then they can't control themselves. They will be stealing. They're hurting themselves and they're hurting others around them. And sometimes all of our, we're both fathers, our fatherly instincts and our motherly instincts for the moms out there watching kick in and you just have to help and save the other family members. And there are times when you can't do all that you would. It's very difficult to make those kind of choices. Let's put this on hold for a second. We've got to go on a quick break. And when we come back, maybe we can talk a little bit more about this. This is Business in Hawaii with Reg Baker. I'm here with Josh Green today, talking a little bit about some of possible solutions that are homeless and some of his future plans we'll be right back. Ted Rawson here folks, your host on Where the Drone Leads, our weekly show at noon on Thursdays here on Think Deck. Where we talk about drones, anything to do about drones, drones, remotely piloted aircraft, unmanned air christmas, whatever you want to call them, emerging into Hawaii's economy, educational framework and our public life. We talk about things associated with the use, the misuse, technology, engineering, legislation with the local experts as well as people from across the country. Please join us noon on Thursdays and catch the latest on what's taking place in the world of drones that might affect you. Blinding all week for the day of the big game. Watching at home just doesn't feel the same. What on the list is who's gonna drive? It's nice to know you're gonna get home alive. Plan for fun and responsibility. Choose a DD. Captain of our team, it's the DD. For every game day, a sign a designated driver. Aloha and welcome back to Business in Hawaii with Reg Baker. I'm here this week talking with Senator Josh Green about some of the future plans he has as well as some possible solutions to homelessness in Hawaii. And there are some fairly simple solutions that can be both economically and socially responsible. So this is a great discussion to be having. I'm just amazed that we haven't been able to collaborate and get something like this going before. There's a lot of inertia. A lot of times people have the easy solution right in front of them and it's just too obvious but then it takes a big lift to do. That way I came up with the idea to utilize a small amount of Medicaid resource to both help people get them housed and then have savings in turn. I was sitting there on call in Kohala on duty in the hospital. I'd seen the same individual for the sixth or eighth time. I knew that I wasn't helping him as a doctor except for the few hours I saw him. And then when I went back to the state capitol and saw our budget and saw the incredible burden that repeat healthcare users use and utilize and how that impacts the budget without getting them better, I thought to myself, well, here's a simple solution. Let's actually get the housing for the individual which is less expensive and then we'll see savings and we'll help the person. So sometimes it just takes a circumstance. I was lucky enough to be a part of both of those worlds, the healthcare world and the political world. And one of the thoughts that I've had in the past that I think you and I have touched on before is sometimes when the emergency rooms in the hospitals, if we're able to cut their guest load by 30%, have them go somewhere else and take that cost out of their budget, they could be literally saving tens of millions of dollars. It would behoove them to maybe take a little piece of that and help with this process so that, you know, spend two million but save 10. Yeah. I think it's a good trade-off. It is. That's what Queens is doing. Queens is stepping up to the plate right now. I'm actually gonna leave from our talk today. I'm gonna go sit with Mayor Caldwell and continue this dialogue about the H4 program. I have a meeting with Queens on the 24th and we meet constantly with leaders from all across the state, leaders at the insurers, community, foundation leaders, business leaders. So it is sometimes the case where if you invest properly and you see bigger savings than everyone feels both good about themselves and it was a good business decision, the funniest part of this whole experience was the day that I was watching the news and I ended and listening to the news and I saw Rush Limbaugh and National Public Radio both support the same idea. And I thought to myself, if we can do it with an idea, just maybe this country can settle down a little bit and solve some problem for people who are having a tough go. You know, what we need, I think, for things to settle down a little bit is for a common goal that we can all agree on that we could all put our resources behind to make happen. Yeah, and 25% of all homeless people are kids and a very small number of people in our society, it's about 3.6%, are consuming 60% of our budget and that doesn't leave a lot of resources for other people who have need, whether it's young moms or teachers that are teaching special education. There's so many challenges which you're very familiar with as a commentator and as a business leader that we can't afford not to be funding but that means we have to be smarter. One of the things that I think we lack in government is we haven't often had the time and enough leadership to just take the calm, smart road, look at it from an economic perspective and bring all of the voices to the table and get different perspectives. I got to this idea by talking to some of our most conservative healthcare providers in the state and some of our most liberal social type people which was amazing. Well, and it's amazing how they can all come together for the common good when there is that target to shoot for. And they feel very good about it too, that in American society and political society today, there's so much rancor. And I don't even think people who are part of the fight like it most of the time. There are a couple of people out there that like to really go at it but most people would prefer to feel good about a solution and to help a lot of people. And we have to, like you said, find a common ground. If we can do that, we're a better country. Well, and I think it's rewarding to me or gives me some comfort to know that you're so proactive in all of this, which I can't help but ask, what's your future plans looking like? I mean, you kind of touched on it earlier that you're looking at other opportunities. Is there anything you can share with us? I can. In the next few days, I'll be making a major announcement. My family and I have soul searched over this. I traveled the state in the last three or four months since the legislature let out. My wife and I spent a lot of time talking about it and I do expect to announce statewide candidacy for Lieutenant Governor. I'll make the final decision in a few days. I'd like to do it in a proper way because I'd like to show what I'm gonna be as a candidate. Sometime around September 1st, I intend to tell people how I would like my supporters and people across the state to engage in the beginning of a campaign. I wanna see that people come together. I wanna see government actually work for families instead of what's often happened, which is we work at odds with families. So there's a lot of things to share and I'll give the full story around September 1st. Very good. That sounds very exciting. And I know you've already been demonstrating through your actions what your campaign and what your candidacy is gonna look like. And sometimes that counts more than just words. So it seems to be coming together quite nicely for you. It's nice. And if people are watching today, please keep and set aside a little bit of time over Labor Day weekend. I intend to make a call to action that I'll of course be participating in hour in and hour out throughout that long weekend. I think there's a lot we can do for people and there's a lot that our community wants to do for people, but we have to come together. There's lots of opportunities out there. There are. And we just need somebody to kinda help lead the charge and point us in the right direction. And I think we'll find that there's a lot of people in this community that's ready to get engaged. Oh, there's so many. I meet a lot of extraordinary leaders, whether it's Connie down at IHS to someone like you in the business community, going to DC, advocating for us, fighting for businesses. There are some great leaders across the state. And I've met a lot of nurses that I see as leaders and I see social workers as leaders. And my goodness, the teachers, what they go through. It's tough these days. We were talking about the police officers before. A lot of times people get down on police officers, but as I said to you in the break, police officers have a tough go when there are a lot of people out there on drugs and there's a lot of violence. I respect what they have to do. So they're leaders all across the state, but I do think we have to find a common ground and common purpose. And maybe that's what campaigns are about. Maybe that'll be our opportunity. Well, that's certainly the rallying call. So that'd be great. And I wanna echo your thoughts about the police officers. It's a job that not a lot of people would want to do or could do. And so for people that do step up and put themselves in that position to take care of that side of society of maybe we'd rather not see too much. I mean, it takes a special individual and we gotta support that. We do. When you see it from the perspective that we see it, whether you're in downtown Honolulu and you see how tough it can be, sometimes I've been in the hospital and someone's come in with an individual that's been very violent. Unfortunately, drugs are tough these days and the drugs cause a lot of very serious mental illness and combative behavior. I've seen, sorry, I've seen police officers cut. I've seen people be punched and bitten and they're trying to protect even the individual who's causing the violence because they don't want them to hurt more people and then all the rest of us who are in the community. So I'm very sensitive to that. It's not an easy job. And there's a few jobs that are tougher than being a police officer. No, I totally agree. And it's not only tough on that individual but also for their families because they have to put up with a lot as well. Yeah, it's dramatic too. You see when someone goes to go into a drug den, these days, as I wasn't planning on talking about opioids today, but I might as well mention it, it's one of the big problems. The opioid epidemic in our country has surged. Now we just found out the data yesterday, 18% higher death rate among teens from opioid overdoses in just one year over the next. And now the drugs are so potent that sometimes police officers, firefighters, EMTs go into a house where drug dealing is going on. The dust alone can cause an overdose. These are synthetic drugs. So they have to go in there geared up as though it's a hazmat situation. I mean, these are public servants and they're putting themselves in harm's way and they're not always positive as a family unit that they're coming home at night. So these are the kind of people that are out there and in many ways they're our leaders. I think though that they often need someone to be their voice, because they're not gonna toot their own horn. No, matter of fact, a lot of times they don't wanna talk about it at all. Right. So as far as the drug addiction, I know you mentioned 18% increase in the 18 year old groups. Yeah. How would you evaluate our situation here in Hawaii? I assume that 18% is a national national. It is, yes. So our numbers are better here in Hawaii. The good news on the opioid crisis for Hawaii is our prescribers are really cognizant of the challenge. We're the lowest prescribing community in the country, 50th out of 50 states. So we have the fewest pain pills that are put into prescription circulation per doctor per patient per year, which is great. Now that's the good news. The bad news is that two years ago, fatalities from overdose from opioids surged and exceeded the number of deaths from car accidents in our state. So it is a major problem. And part of the tragedy is it can almost completely be avoided and prevented because we don't need to have so many addictive pills out in circulation. And those who are addicted, if they don't get their pills, they go and buy heroin. And that's also terrible. So we need more drug treatment. We need the professionals to be a little bit more aware. And frankly, we have to all step up as citizens because in the United States, we have 4% of the world's population, but we consume 80% of the world's opioids, which is an incredible number. So it's a part of our culture. We've become accustomed to an attempt at a quick fix, an attempt at solutions that don't require long-term commitment, which is what addiction treatment requires. And that hurts us. And it means that we are really asking to be a culture of overdose and addiction. And that whole thing has to be reversed. I'll cut to the chase, Reg. If I do get selected, honored to be Lieutenant Governor, I'm gonna be working on two or three major issues, no matter who our governor is. And those are homelessness and a solution statewide, dealing with the opioid addiction crisis and healthcare access for everybody and working to change the economic trajectory of our state, meaning creating healthcare jobs, good middle-class jobs, jobs so that people can have housing and they don't get desperate and end up with addiction and don't end up with these other problems like becoming homeless. So that's the approach I will take and I take it as a local doctor, not as a career politician. I see the problems in front of me and I try to find a direct solution as an ER doc would. I don't typically spend a lot of time in the mindset of being a state senator. So that's what people will get from me. I can't speak to whether it is what people want yet, but I do know it's very different. Well, you know, I wish we had more time to talk, but we're at the end of the show, but I gotta just say that those three objectives that you wanna work on as Lieutenant Governor, tell you what, if you can make progress on any of those three, you got my vote for governor. Thank you, I appreciate it. Thank you, Senator. It's great to have you on the show today. This is Business in Hawaii with Reg Baker. We broadcast live every Thursday from two to two 30 from the downtown studios of Think Tech Hawaii. We have a great group of technicians here. They make the show work well every single week. And of course, we have great guests like Senator Josh Green to make the show widely watched. All right, thank you again. See you next week. Aloha.