 This is Stink Tech, Hawaii. Community matters here. Aloha, and talk story with John Wahee. Welcome back. Welcome back, everybody. We've got a great show for you today. I have as my special guest the new Lieutenant Governor of the State of Hawaii, Dr. Josh Green. Thank you, Gov. Welcome back, Josh. It's always a pleasure to talk to you. Thank you. What's it like? You've been Lieutenant Governor now for two months, roughly a little over. It's headed towards two months, and it's exciting. It's a series of moments with extraordinary people, seeing things from a new perspective, to have the executive branch perspective where I can bring a lot of additional people together is just a blessing. It's fabulous. And to be able to use the perspective I've had for years as a doctor and senator, I hope we'll make it better for the Gov. How long were you a senator? I was a senator for 10 years and a rep for four. You were in the legislature for 14 years, so you obviously know the building and many of the players in the building. I know them. I've been really gratified. They've been warm with me. We've had hearings already about the budgets and other priorities, which I'm sure we'll touch on today. So it's a lot of old friends, and I see them evolving, too. So it's an interesting time because we've got the Gov coming into his second term. You have the new Lieutenant Governor with different ideas and a lot of relationships on both sides. So tell me, you're from Maui? Big Island. Yes. I'm sorry. How can I make this? I'm from the Big Island. Why Maui? I had just slipped up. Okay. Did you have your family moved down here and all of that, or are you traveling back and forth like one of the former Lieutenant Governors, who is from Maui? Right. So I moved over here, and I have my family, though, and my children and wife are with me here on Oahu. I go back once a month to give back a little bit. We have aunties and uncles all over Big Island in Captain Cook and... Yeah, I know. Believe me. Everywhere we went, there was a relative of yours. Fantastic. So it's better, though, because I used to have to travel every single weekend. And I just thought it was better that I commit my time here full-time, where the office is, so we didn't have to spend extra resources. I didn't think that that was going to be a workable responsibility after 14 years of that for people. And I thought, also, that I should settle it down for my family, because my kids are 12 and 8, and you know how that was. Well, they're beautiful children, by the way. Beautiful children. Congratulations. You're a doctor, which everybody knows. So are you doing anything for this administration, for the EGAA administration, with regard to health care? I mean, is that something that you'll keep your hand in? Yes. So, brilliant question, actually. So, the Gov's already said a few times that he wants me to work on the health professional shortage, which means not just doctors, but nurse practitioners, physician assistants, nurses, psychologists, pharmacists, everyone. So it's going to be part of my responsibility to make sure we make Hawaii as appealing a place as possible to bring health care providers here, to grow more of our own, so they stay, to make sure their loans are more affordable, and to really beef up our programs. You know, this whole thing about student loans, which is a problem here in the whole country, as a matter of fact, I mean, what's the solution? I mean, it's really tough for people to, I don't know what medical school costs now, but it must be in the hundreds of thousands of dollars. It's a quarter of a million dollars for argument's sake, and that's a safe number. When I went to medical school, which was from 93 to 97, it cost me $140,000. And I give you that for perspective, because I got my loans forgiven through the National Health Court. That's what brought me to Hawaii. Right, right. Well, we couldn't even succeed with a program like that without helping it more. So I will be looking at- So there's no forgiveness program for student loans anymore? No, there is. In the medical? They just have to be bigger. And what we have is we've got a couple things. We still got the National Health Court for, like, rural areas and shortage areas, and we also have the Hawaii Health Court, which pays just about 10 to 15 positions a year loans back. I'd like to see that 10-fold bigger. So we can do that. If we spent $5 million a year in the state, we would get $5 million a federal match, and we could essentially have everyone get their loans repaid if they worked in Hawaii as primary care people. What a great idea. What a great idea. You know, when I was in college, it used to be that you could get at least 50 percent of your loans paid back just by doing community service, but that was open to everybody. I'd like to see that, you know, that's way above my pay grade right now, but you're speaking to my heart. Nationally, I'd love to see a national program where if people have debt for college, we forgive it if they do national service. Yeah, some kind of, in fact, wasn't that how you came to Hawaii? I would have never come to Hawaii. I might have never even visited Hawaii had I not had that opportunity. Who knows? I love it here. It's home. We met a beautiful young lady and married her. That's the best strategy for retention, but yeah, my loans were repaid because I worked in Kau for four years, and I'd like to see us do that across the state. I'd like to see us make sure that people can have debt-free loans if at all possible, if they come and serve, take care of individuals on Medicare or Medicaid. These are possibilities for the program. I'll roll out with the governor's blessing, and it really could change the landscape for us in Hawaii. When I went to law school at the University of Hawaii Richardson School of Law, before it was called the Richardson School of Law, and when Chief Justice Richardson was still around the school, but some time ago, the tuition for each semester was $500. Oh my God. It's in the thousand now, so I can imagine what it's like for medical students. If people want to give back and be in primary care, it's difficult because they'll carry that quarter of a million dollar debt, plus they have to find a home, and they have to maybe have even college education loans back to pay back. There are many problems. It's a bigger and more complex problem than just doing loan repayment, but that is probably the most effective piece of the puzzle. I had a meeting even with one of our prominent banks this morning, and they're willing to help us with this as long as we can somehow secure loans. Lots of things in the works, and as Lieutenant Governor, this is how I'm approaching it, just diving in. Once one of the main causes for the medical personnel shortage, are we losing doctors? I know, I know. This is going to sound a little anti-democrat, but anyway, I was told that I'm a big supporter of Obamacare and so forth, and actually the Hawaii system, but I was told that the increase in regulations have caused a lot of our senior doctors to just decide that they'd much rather retire. Is that a problem? It is, but it's probably a more complex, multifaceted problem than that. That probably was the thing that put them over the edge, that put them on the top. You can imagine a doc gets stage 60, they've maybe saved up enough money, and they're just making a decision, how many more years do I stay in practice, and then that tips them over the edge, which means that we should do administrative simplification, we should go... We could do something, right? Yeah, and Dr. Whithy at Japson works hard on this. The Dean of the Med School has been very good about this, Dean Hedges, and to have Gov put me as one of the point people on this will be helpful, because I do understand it quite thoroughly. It seems like the other side of the coin, though, is that all this technological innovation in the practice of medicine has made it, in a way, very efficient. I notice I see some of the younger docs who are into that sort of thing, and their medical records are much more accessible and all of this, but even they say writing so many reports and it's just overwhelming. It's a transition. Everybody has to get used to new systems. The next generation of docs will have their iPhone and they'll record something, it'll become a note, and it'll be easier, but we're in the middle. That's my doc, one of my docs right now. He's looking at his iPhone and reading my records, and I'm thinking, wow, this is really cool. Eventually, it'll pay dividends, but until then, it could give a lot of the older docs heartburn. We're just balancing this, but part of my responsibility will be to get more young docs to come to Hawaii, and I'll do it. What about nursing? What's the problem with nursing? Nursing, same thing. Nurse practitioners we want more of. Nurses we want more of. We may not have an overt shortage of nurses, but our system hasn't fully fit with all of our needs. We have more seniors that need home care. We need more advanced practice nurses, and these are hard positions to recruit for, too, because Hawaii for docs, nurses, and so on, the reimbursement salaries are lower than the national average, yet our cost of living is higher. People are committed to Hawaii. They love Hawaii. They will stay in Hawaii, but it's a very dynamic economic system, and sometimes they end up being cheaper to bring nurses from the mainland, which just breaks my heart, because why would we do that if we have home nurses who are not working? Yeah, because they're such great jobs. I mean, maybe it's hard work, but right now, it seems to be well-paying jobs, at least nursing. They're rewarding jobs. A lot of nurses will work overtime. That's necessary, because it's easier to keep people who already know their unit on the shift, and there's a lot of good money there, but it's tiring, and it's hard, hard work, so I give my kudos to every nurse out there, and certainly every doc. It is hard work. It's hard work, and they deserve all of it. I know back when I was in office, we had a nursing shortage, and our solution back then was just increase the number of nursing classes, but that was a much simpler time. We didn't have the many different categories of nurses that you apparently have today. Well, even sometimes those straightforward solutions are to your credit, because that's a smart one, and we're always looking for our nursing trainers, and sooner we bump up against capacity at some point. We can only have so many classrooms. That's the problem at Jabsum for training more docs. They would love to increase by 10, 20, 30 docs per year, but the space is finite, so we just have to continue to do all that we can in every different area. Yeah. Well, I'm glad you're taking the grabbing hold of this initiative, and the governor and you are working to do this. And also, I've got to bring talk to you about the homelessness problem in Hawaii, or the houselessness problem in some cases. And because I understand that you've been taking that on as one of your major points of attention. Yeah. Tell me a little bit about it. You bet. So I've asked the governor, and we're working through the final details to have me be, if not the point person, one of the point people for all of homelessness in Hawaii, especially the part where there are individuals who are chronically homeless with addiction and mental illness issues. Which crosses over to the help initiative. That's why it's a natural for me, right? So that's where, and I've said this a couple of times in different venues, a very small percentage of our people, about 3.6%, consumes 61% of our Medicaid resources. Wow. Which, yes, exactly. So 13,000 of our citizens consume 61%, or $1.2 billion of our Medicaid resource. And as we get a better hold of that, and when homeless individuals have to go to the ER and stay overnight when they could instead get a clinic visit, it costs thousands and thousands of dollars. And so I will be fixing that, and that's one of the things the governor has tasked me with. Also, as he unveils more details at the state of the state, we will see exactly the full scope of the problem and what I can help with. Because I'm starting free clinics around. We started one in... Aren't you already doing that on your own? I mean, if I were, one of the more interesting things about your candidacy was you were not only talking about government programs, you were actually out there in the private sector doing, what, free clinics and things where people who were having drug problems and the rest. Tell us a little bit about that. So I just figure when you elect me, you just get me. Yeah, right. And so I'm going to keep doing those things. Just I'm mindful of the boundaries, but when there are private sector individuals that are committed to helping us, and if the government can do something good, like Mayor Caldwell and Councilman Joey Manahan and others in the council did great work, careful Kunaga, to get that facility going. That's helping us on homelessness and we'll add some health care to that. We'll add some housing to that. So the government put up resources and I can bring private sector docs to volunteer and help. And, you know, it's helping Queen's Hospital and Straub and I'll peek in periodically and put my own stethoscope on and volunteer just because I like it. And when you see solutions like this work and save taxpayers money and increase services. Why not? Right. Well, we're going to take a short break now and we'll be back. And I actually want to go out, dig a little deeper in the homeless situation and what you think we can do about it. So we are going to take a short break, hang around folks, the best is yet to come. Aloha. My name is Mark Shklav. I am the host of Think Tech Hawaii's Law Across the Sea. Law Across the Sea is on Think Tech Hawaii every other Monday at 11 a.m. Please join me where my guests talk about law topics and ideas and music and Hawaii Ana all across the sea from Hawaii and back again. Aloha. Hey, Aloha. Standard energy man here on Think Tech Hawaii where community matters. This is the place to come to think about all things energy. We talk about energy for the grid, energy for vehicles, energy and transportation, energy and maritime, energy and aviation. We have all kinds of things on our show, but we always focus on hydrogen here in Hawaii because it's my favorite thing. That's what I like to do. But we talk about things that make a difference here in Hawaii, things that should be a big changer for Hawaii. And we hope that you'll join us every Friday at noon on Standard Energy Man and take a look with us at new technologies and new thoughts on how we can get clean and green in Hawaii. Aloha. Welcome back to Talk Story with John Wahee and our special guest this afternoon, Dr. Josh Green, Lieutenant Governor of the State of Hawaii. For those of you that would like to join in on the conversation, we do have a call in number. Our hotline is 808-374-2014. That is 808-374-2014. We're going to join Dr. Green and talk a little bit about the homelessness problem in the state of Hawaii. So, in fact, let me just toss it out there. Yes. What do you see as the issues? I mean, what is it that you're going to try and get your hands around as the, well, you know, your office has something that the average bureaucrat or the district rep or senator may not have, and that is the moral suasion of being elected by the entire state of Hawaii. So, how do you see grappling with all of this? Well, that was the real blessing, right, was to get the support of the whole state and to be engaged on a statewide crisis, which is homelessness, gives me a sense that I'm allowed to dive into this problem. And, of course, with the governor's blessing, as you've experienced both the lieutenant governor and governor. So, for me, the crisis is this. They've been doing a very good job decreasing the numbers of homeless. So, Scott Morshiggy, Gov, they've done a lot that's made a difference. And so, we've seen a decline in the last couple years of the total number of homeless that are out unsheltered on the street. Right. You know, say, 6,000 or 7,000 at least. And then you have another 3,000 or 4,000 individuals that are hidden. And these are the guys who are using all the medical care benefits and the rest, right? Yes, and that's the problem, right? So, I was health chair and then human services chair and the legislature. So, I've been responsible for those budgets and I know exactly what's going on. Good relationships across the board with the governor's team, Pankaj Benot, the director, director of health as well, Scott's team. So, here's the challenge. A lot of the individuals who are chronically homeless, that's about 20%. People who are for more than six months on the street unsheltered, probably on drugs or have mental illness. That combination is about 20% or 1,500 people. Those 1,500 people are hurt and they're struggling. And every time they get into trouble, they call an ambulance, it's $1,050. They go to the ER, $1,600. Now, you're almost at three grand. They stay at the hospital and it goes over $4,000 for each visit. We had one gentleman that went to the hospital named Gary, told us to share his story, went 241 times in one year. Whoa! Spent $1.2 million. And all we had to do- We could have got him paid his rent and he would have had a place. Well, to give people perspective, the good program that the mayor just started down on Kowili Street, that hygiene center, the budget's $1 million for a year. That guy that I mentioned spent $1.2 million himself. So what we do is we get roofs over people's heads, their costs drop 43%. That 1,500 individuals, some will accept help, some won't, but we begin to chop away at the problem. And we get everybody who will accept it services in the model I've been describing, which we call H4, which is hygiene. Mayor's taking care of that with the council. I guess people are to realize that it's more than just having shelter. I mean, it's also services. It's also jobs that they can do. There's so many factors. Well, the good news is we're on it because you're right. If you don't have services around it, it doesn't work. You can't get people into care, can't get the roof over their head or they go to the wind. So two years ago, I said that housing is healthcare. And what I meant was you put housing over somebody, their health improves. Right now, if you're homeless, your lifespan is 51. If you have a house, you have a roof over your head, your lifespan is 81. So you lose 30 years of life in Hawaii. Also, you cost an average of $82,000 per person per year. And you're not earning. No, and the police are engaged or you just need all these services and you need help. So the goal is to do housing first. That's the ultimate goal, which is to get everyone housing irrespective of the stuff they're struggling with. Well, there's protection. Shelter, basic need. Shelter and a social worker. But when I said healthcare could be dealt with through housing, I meant it. And so what we did was the Department of Human Services got a waiver and it amazingly got approved by the federal government. It's called an 1115 waiver. And it means that you can now use some Medicaid resources which are already spending and we're spending efficiently. You can use those on supportive housing services. So now we will use Medicaid to help people get into housing and it will decrease their costs very dramatically. In fact, it pays for itself instantaneously because the costs are so high. And that's how we'll do it. I see, you know, all you need to do is drive up Punchbowl right past Queen's Hospital, which by the way, you lived in that area. So you know what I'm talking about? Absolutely. And see all the people who came out of the hospital and just sleep on the street next door. Yes. And you can't help but, I can't help but think that it's inevitable that they're gonna be back in the hospital. In the next three days. So the thing to do is we're changing a lot of our approaches. One is we're going to allow, as we go forward, we want the medics to be able to take individuals instead of to a high cost space, just for a quick little nothing, take them to a program like the H4 or the other shelters where they can get basic healthcare, wound care maybe, a warm meal, and we can begin to get them housing. So we do that instead, it costs nothing. Penny's on the dollar. How do you get people to, and I'm gonna ask this question in a sense, for many people out there that may be listening, but also from an abundance of ignorance, okay? Because it reflects my, how do you get people to that, for example, may have some mental problems to take their meds? And how does this all work when you're dealing with the relationship between somebody who is on the street and medicine or healthcare? Well, you now ask a very, very complex question, but the short answer is, you can only do so much for some people because we do have a law now that is about community treatment. If someone's hurting and they're a danger to themselves or others, you can force them into community treatment, but that's not really what we're about. We try to get people to go in voluntarily. Right, of their own will, right? So those people will go in, you get them less expensive services, exact same services, but in a better setting, it's good for everybody, good for them, good for the system. For individuals that are having mental illness or addiction, if you can get them to care, which you can do, but we need to have community advocates and they should have legal representation. We're working with ACLU and Josh Wish and others on this. If you can get them into care, there's now better medication. This is the doctor talking. Longer acting medication where by injection, long acting, anti-psychotic medication, and people's mentation in their mind clears up. That lasts three or four weeks. And then once someone's doing a little better, they're more likely to take their meds. Then you can move them over to something a little bit more personalized. Exactly, and so you gotta go that way. You have to be gentle, but as the chairman of the Human Services and Health Committee over the years, I will tell you this. Look, I'm left a center. Everyone knows it, right? But the families themselves were saying, please do whatever you can. It's not a violation of my child's civil rights to be 40 years old, homeless, and very mentally ill on the street. In fact, the violation of their civil rights is to not get them the care they need. Right, to ignore them, you know, well, Deliston, you know, unfortunately, the idea that somebody ought to have control over their bodies and their life, which we all believe in, was used, I think, in maybe the early 80s as a way of justifying cutbacks. So what we were really talking about was we don't want to keep paying for these characters, so we'll call them human beings and put them on the street and then leave them without care. Yeah, that was intellectually dishonest from the Reagan administration, and then you were able to be part of a different revolution, which I think helped people, which was with the Clintons, and I think that that was very relevant. I don't want to disparage President Reagan, but that was a bad philosophy of healthcare. But it was done under the idea that humans ought to have a way of choosing anyway, it's so exciting to know that you, as Lieutenant Governor, and as a doctor, I've probably taken on the toughest area of the homeless crisis that exists, you know? Yeah, well, I'll run to it like you can't believe, and it's really kind of a joy for me because I've always wondered, what do you do when you suddenly have a large capacity to bring people together, to ask people to all chip in, whether it's government, private sector, colleagues, I think that overall, what we will see will be people will bind together, I'm bringing church groups together with government, I'm bringing benefactors and philanthropists together with doctors. Well, see, that's your skill, and that's what's needed in Hawaii, and that's part of our history, which, by the way, takes me to something I think that I was really interested in, and it's not all the Lieutenant Governor rushing out there to take on these tough problems, but aren't you already developing a program to give assistance to people who are in the private sector, non-profits and the like, teaching them how to go after grants? Yes, we're gonna. I think that's a fantastic innovation. Thank you, well, it was a great idea brought to us from a good friend, and basically to have an innovation center where in the Lieutenant Governor's office, what we will do is we will embed a person, we'll fund their position with friends that want to help with this program, not taxpayer money, and will you? Why not taxpayer money? That's what the taxpayers should be doing, but okay, okay, I'm not gonna knock it, I'm not gonna second get, but the idea, so you got private funds to do it. I will, yes, because I'm keeping my budget modest, and I don't wanna ask for more money, just out of a kind of a spirit of being frugal. In this case, and I understand, because I just was over there in the Senate asking the hard questions about how we're spending money. So, for now, we'll do this, we'll embed a grant leader, we'll work with nonprofits, we'll work with private sector, we'll work with our government agencies, we'll apply for grants, and we'll use the strength of the Lieutenant Governor's office to hopefully judge what would be in the best interest of our state. We will push those resources back into the communities, whether it's federal grants or other private. But you are actually helping giving technical assistance to people who want to do good for our community, and that's a Josh initiative. Thanks, well, I wanna do it because I see it as a way to really expand our capacity to help people, because it's been pretty robust already, but there are some finite challenges, which is, how do you get really a lot of people help? And if we start a lot of programs that way, it won't be a big taxpayer burden, but hopefully it'll be the right initiatives. Well, I tell you, everybody, well, who do they call? I'm gonna let you put up a, they call your office. Yeah, they call me on my cell. I mean, you know, people should. No, I mean, to take advantage of this program, should they? That's gonna be my deputy chief of staff, Jeremy Lakin, is gonna be running that program, and as we apply for these grants, we want full partners so that we won't always get them, but when we do, we'll have more capacity to help people, the only rule in my office is whatever program we're doing gotta help people, then it's met the standard of the LG's office. Well, fantastic. Josh, Doc, it's been a pleasure. Thank you for joining me this afternoon. Thank you, Guff. We'll look forward to seeing all of you two weeks from today at another talk story with John Waihe Aloha.