 Oh, and how you doing? Welcome to Hibachi Talk. Go to the texts are here. I'm here with my good old buddy, Ricks Mauer. R-I-X-M-A-U-R-E-R, Ricks. It's not Rick. It is not. It's Ricks. I've had to deal with that. Your name has killed me for the past 30 years. Anyway, here with me. Me longer. You longer. I'm here with Mr. Mauer and we're going to talk about the high cost of health care and a great deal of time spent in the hospital. No, but a great deal of time in the industry. So grab yourself a libation and pull up a chair and join us for a little interesting conversation about health care. Now, but you're looking at me like, you look nervous. Also, Ricks is also, you were my co-host a couple of weeks ago. A couple of weeks ago. My wife was here. Yeah, because Mr. Landing is not abandoning us, but he's always traveling. He's also got another show he does as a co-host. So we've got a spin-off. So he, Bodgy Talk has a spin-off now. It's kind of like Cheers and, you know, Frasier and everything spins off. So now he got him spinning off. So you're going to help fill in on the times that he can't be here and the times that I cannot be here. Looking forward to it. Could be a lot after all. So anyway, so how about high cost of health care? We're going to talk about a little background on you because I think it'd be good that our viewers know a little about you. That being said, however, I got a rant for a minute. Okay, it's all yours. I already got a rant for just one little minute. For all of yours. Let me give over to Gordon. Remember Roland and Martin's Laughman with the fickle finger of fate? I do. You do. So anyway, this is the fickle finger of fate. Notice I'm using this one. For the DCCA who decided a month ago, they're going to shut down Coinbase in Hawaii. Now Coinbase is a cryptocurrency trader exchange. One of many, I might add, one of many. And for some reason, which I'll go into later, maybe, they've decided that they cannot do cryptocurrency here in Hawaii unless they put in a local bank the equivalent in fiat money, which is dollars to all the currency that's out there in Hawaii in Bitcoin. That's going to be a lot of money. Do you think the banks have to keep that much money in the bank vaults? Well, my recollection is that no, they don't need to keep 100%. It's probably a tenth or so of that money. Yeah, a tenth to 12%, I think, is the numbers. But no, no. DCCA in the state of Hawaii and their infinite wisdom decide that they're going to not allow them to do business here. And so they sent everybody in Hawaii notice that we had to clear out our accounts. Now, what do you think I'm going to do when I clear out my account? Do you think there's only one Bitcoin place in the entire state? No, I don't. I think there's options for you on that. There's many. I bet there are. Now, granted, I didn't get that notice. Well, you don't have Bitcoin. Well, I might not have it in Hawaii. That is true. You might have it in other countries. Or in different states. Yes. Options. As opposed to the state of confusion. Yes. What could be the only third-world state in the country? Anyway, that was, I'm sorry, I had to deal with my little rant. No? That's fine. I think that's a good rant because one of the issues is, like I mentioned, and you did too, you can put that money not in Hawaii. Yep. Or you can put that asset not in Hawaii. But you can put that asset in another state in the United States. Or as you also mentioned, you can put that in another country. In another country? In another denomination? Yes. And that's not really good for the state of Hawaii. It's not. Again, it shows from a technological standpoint how backwards we are. Yes. And we're supposed to be forward-thinking and we're not. It shows, again, it just re-emphasizes how backward we are and how anti-business we are. Yes. And the fact that the state of Hawaii is now only being able to capture the general excise tax that comes from, say, Amazon. Now Amazon? Yes. And other large internet companies. Exactly. And the thing that I think is going to happen about this is the fact that, you know, with the legalization of medical marijuana. Yes. And they can't put their money in a federal bank. There you go. It's all cash. No credit cards. Yes. What do they do with that cash? They buy cryptocurrencies. And there's no way the state of Hawaii can tax cryptocurrencies. So what do you do? You try to close it down. Yeah. And you're not going to close it down. It's just going to go somewhere else. It's going to go somewhere else. And it's going to hurt our tax government. It could. It could. But a lot of us are in Bitcoin because, you know, there's tax benefits. Yeah. There's tax advantages. Anyway. Sorry. I rented for longer than I should. But I want to get a little background on you because, you know, you've been around for a long time. Son. Thanks, Dad. You might have been a little longer. So give me a background. So where did you go to school and, you know, a little background yourself? Okay. Yeah. I went to the University of California. And in Berkeley. At Berkeley. Yeah. It's UC Berkeley. Yeah. I'll close it now. I did graduate. I'm not going to tell you when I graduated. Because back then they didn't give out degrees. No, they did. That's part of the coming. What I will tell you is that while I was attending UC Berkeley, there were Vietnam War riots that were going on. A lot of protesting. Who was the governor? Well, the governor who signed my diploma was President Ronald Reagan. But he was, at that point in time, not the president. He was the governor of the state of California. They used to call him Ronald Ray Guns. Yes. I don't know why they did that. That's why they called him Ronald Ray Guns. Wow. So you made so... Ron and Nancy. Yeah. Ron and Nancy. I know. What an incredible couple. So that may date me. But then you've been in the healthcare industry for the same millennium for decades. You've been in this business for a long time. Decades. It was, yes, a different millennium I started. So that's true. So what capacity and where? I started out really as a Medicare auditor in the healthcare industry, primarily for hospitals. I kind of jumped the fence after that point after my auditing and joined as a controller, a hospital in the San Francisco Bay Area. Okay. From there, and now I will kind of date in 83, my family and I moved here to take the position as a vice president and controller of the Queens Medical Center. So you were vice president and controller of the Queens Medical Center. And you are one cheap son of a gun. You asked me to help you move. I will never forgive you. That's yes. Rebella Movers. We had Rebella Movers, yeah. We moved an entire house and then you told me you had some stuff under the house, which was another house. It was like 14 hours of moving. That was yes. You bought us pizzas. I did. My wife did. And beer. She did. So you went to Queens and you're a controller there. And it just so happened, I was there at the time when you came on board. Yes. That's when we first met. That's how I conned you into moving our two houses. I paid you back one night. We'll talk about that a little bit later. So you go to Queens Medical Center. And wasn't that a state of the art facility when you came in? It wasn't a state of the art facility at that point in time. But I'm going to say probably a year, maybe two years ago, they had gotten a chief financial officer who, you know, we knew each other. Yeah, a girl. After you came on board. Yeah. LJS, we're going to have him on the show one day. Oh, okay. Get ready for that one. Mr. Smith. But Larry really wanted to move the organization forward. And I know that the administration, you know, was supporting Larry to move forward and that sort of thing. So I did came in and we put in, gosh, a number of new systems. We put in actually the first electronic finance system for Queens. On a mainframe. Yes, with you guys, you know, with the IT folks. We put in a new billing system, a new charge capture system on that. There was a lot of things. Lots of things that went on. So we're talking about the cost of healthcare, right? So, I mean, this is not necessarily the cost of getting you the service. This is the cost of just running the business. Yes. The back office of running the business, if you will. And there are costs. Yes. Lots. We put the first email in the state of Hawaii in Queens Medical Center. Yes. So that was great. Another on the mainframe. Yeah. But we, you know, when we first came in, I'm going to say it was probably a year, probably in 81, 82, somewhere in that time that the first personal computers were coming. Right. And, but again, Queens, IT put in for the finance and for registration. Yeah. The first 13, 13 inch green screens. 13 inch green screens in the 13 month year. Remember, that was Larry Smith. Yes. I hated him for that. I just thought of it now. That's right. 12 months in a year. Yeah. Four-week periods. 13 of them in a year. Larry created that, which will give me a... I loved it. God love them, man. 13 months. No, I had to modify the system like crazy for it. But speaking of that, because it gives me a segue into another thing, it's got, you know, got one tech job thing. So, you know, Larry introduced a 13 month year. Yes. Well, DAGs has decided we've got a new day, how long the day will be. And Zuri's going to pop the slide out. I took a photo of it. It's up on there. So now, according to DAGs, your work day, your whole day is during 4.30 p.m. and 6 a.m., or hours by order of DAGs. So that's it. There's no 12 a.m. to 12 p.m. This is it. Now, I don't know how we're going to adjust our days, but that's it. Well, that's on a wall up the street. There's nothing else with it. It's just there. I asked a guy that was having a cigarette, you know, with his sitting and counting her steak bag. I said, what does that mean? He goes, I don't know. It begins at 4.30 in the afternoon. When do I have breakfast? When do I have breakfast? Give your union a shock. Anyway, so that one, that's, so coming back to the 13 month year and of how many hours is that in a day now? And you get nap time. Oh, that was someone else. Yeah, we won't go on that road. So again, I'm going to come back to why is it so damn expensive in health care, right? Why is it, it's not just the procedures. It's all of the things that go on in the background. Yeah. And I think it's things that go on in the background. But the other thing that can make health care expensive is that you and I are very different. And so as physicians... You're cheap, I'm not. I'll just leave it at that. I'm old, you're not. But if you have to have your knee done versus my knee done, that may be entirely different. Just because you played football, you played hockey. Yeah. Me? You went to Berkeley. You sat on the grass a lot. You sat on the grass. He's always said, sat. Here's how you, you know, when your level of pain that you can endure probably much higher than mine, you know. My level of pain as a 10 is probably maybe a four or five for you. There's nobody who sells up here. Right. So do you need a lot of pain medication when your knee is done? Me? Probably not. So there's a lot of differences that, you know, will happen that make how care is delivered to you and how it's delivered to me may be entirely different. The important thing here is very appropriate for me and very appropriate for how it comes to you. So that makes, it's not as though that, you know, we are built on a... We're all not forts. No. We're all not, whatever, Toyotas. Yeah. With that, I've got to take a Toyota break. I'm not even promoting them, whatever, unless they donate something to this organization. Gordo... What do I call you, the money? The money bags. Money bags, Maher. Money bags, Maher. We'll be back after a break. Aloha. This is Kaili Akina with the weekly Ehana Kakao. Let's work together, program on the Think Takawaii Broadcast Network Mondays at 2 o'clock p.m. Movers and shakers and great ideas. Join us. We'll see you then. Aloha. Hi. I'm Nicole Alexandre-Inos and I was born three weeks ago. Congratulations on being there for me for some of the few weeks of my life. I'm starting a new show, The Millennial Mind, every Wednesday at 2 p.m. for the month of April, where we'll go over some of the reasons why millennials are some of the most anxious and frustrated people at the moment. Ah! Hi, I'm Stephen Phillip Katz. I'm a licensed marriage and family therapist in Hawaii, and I do a show called Shrink Wrap Hawaii, where shrinks and sometimes other people come on and talk about the art and science of psychology, talking to people, relationships. So if you are curious about shrinks and want to be shrunk and don't know where to go, tune in to Shrink Wrap Hawaii. All right? All right. Aloha. I'm Dave Stevens, the host of the Cyber Underground on Think Tech Hawaii, and this is my co-host, Andrew Lanning, the security guy. Every week at 5 p.m. we'll be discussing cybersecurity, the things to look out for, and the things to do to keep yourself safe. Check us out on Think Tech Hawaii at 5 o'clock Friday. Thank you. Welcome back, folks. We appreciate you coming back to us, and right now we have a brief message from Angus. Yes, so welcome back. Hey there, Rick. Hey, how are you doing today? You know, you got a Scottish last name, you know. We fought you in 1347. It was 438. It's 38 whatever it is. I still remember what your mother did. Anyway, you know, it's a health care theme show, and I try to keep it thematic. So guess what I got? I got a great piece of technology that the hospitals can now use, and I got to show a picture. How about underwear-shaped bandages? So how neat is that? Underpants bandages. You can wear your weighty tighties on your arm, or your head, or your neck, or whatever you want. It's a great, great piece of medicine, and cheap, too. Anyway, that's all I have for my short brief message. And with that, like I say everybody, every week, let your wing gang breathe, where are you be? Aloha! We beat you in 1835. Well, thanks very much for that brief message. We really appreciate that one, Angus. So I'll turn it back to our own score. I know. We don't know where we're going to go next. There goes the alelo again. So we were talking about health care and the cost of health care, and coming back to what you talked about, the pain threshold, and so on. I'll give you an example. So, you know, I go, I have a surgery, and the doctor prescribes oxy, how do you call it? Not oxyclean, but oxycodon. It prescribes like 20 tablets. And I go to the pharmacy, and they give me a look like you wouldn't believe. Actually, I had to go to three pharmacies because no one would fill 20. Finally went to one, and they filled it, and I used one. But I had to pay for, or the insurance company had to pay for 20. Yeah. And what do I do with those other 19? And I'm not, I know, I saw that look. No. I ain't. Bitcoin, does that come into play here? Bitcoin, yeah, right. To me, that's kind of like, that's waste. Yeah. Yeah, I think that is. But again, that's where we really need to go. And probably one of the next things, well, I know that insurance companies, and certainly hospitals as well, they're really looking at how do we put together what is the best, how do we get to the best outcome? Of the, of the, Taking care of the patient. Right. Exactly. And what makes that so difficult, I think, is how different the different patients are. And so what may be an excellent outcome for you and an excellent outcome for me could be very different. Because part of it is what we talked about a little bit earlier. You may not need 20 oxycontin. Right. So if you only need four. Then why not four? Yeah, then you get four. Saved money there. For me, I may have a higher, you know, or a lower threshold for pain. And I might need those 20. Right. So it's going to cost me a little bit more. It's going to cost you a little bit less. But right now, you get prescribed the same amount as I do. So those are the kinds of things that we have to, to look at and say what can get an excellent outcome for me and what can get an excellent outcome for you and how do we, how do we go back and then look at and know that so that you get the right input. Right. And to get an excellent outcome, I get a different input to get my excellent outcome because we're different. We're different. And so, and what we're talking here then is like, is we're talking about gathering data. Data. And accumulating all of this information that would then give us knowledge. Yeah. On what we should be doing. Right. But I, And that's the, What's the term? Gargantuan data. Yeah. I like it. Gargantuan data. Yeah. Big data. Yeah. But now we're talking gargantuan data. Yeah. And how do we get the data and then how do we analyze it so that our physicians and other healthcare workers know you need less, I need more. Yeah. And to the extent that you can get a much better, you know, you can, you can still get an excellent outcome but put in fewer dollars. Well, Especially if they know your history. Right. Exactly. And to my knowledge, not many doctors, clinicians, proceduralists, I'll call them like x-ray, whatever, hospitals, insurance companies, share that data. Yeah. Right. Everybody's got it in their silo. Yeah. And so now how do I get, how do I, No, I'm getting affordable care. How do I know I'm getting the best care if they don't share the data? Exactly. HIPAA compliant data. HIPAA compliant. Encrypted data. Yeah. And how do you pull it together, because it is big data. Yeah. And how do you pull it together from, you know, the different people who own that data, you know, the insurance companies own some of that data, probably a bunch of that data. Right. The hospitals own a bunch of that data. So you're saying this work own, which makes me kind of... The doctors too. Own it. Own it. Do they own the data or do we really own it? Do I own the data? That becomes, now I'm focusing on this, like, why does the doctor, the group, the hospital, the healthcare providers think they own... Isn't that my data? Well, I think it's both. Okay. Both the provider and the patient's data. Okay. Who has, what would I say, control of that data. That's not really a good word, but who... But they... They manage it. Yeah, they manage it. It's within their purview of the data right now. It's outpatient clinics, physicians, other outpatient healthcare providers, the inpatient providers, hospitals, and the payers, primarily the insurers of that. So how do we pull all of that together? How do we pull that together? And who... What is... Who is the organization? What is the organization that can get all of that? You know what? The state of Hawaii, they're taking on Bitcoin. Why don't they take off all of that too? Well, I'll let you... In a spare time. I can't give up on that. You have a role. You've gone on a bit of a role today. But you're right. It's all of this data. Now, here's something interesting. You're talking about all the stuff that's going on in the background kind of thing, but then you still got the doctors, the surgeons, the nurses, the clinicians. And so, I'm going to throw a real hard question at you. This is going to be a tough one. What do you think percentage of the direct medical administrative staff versus the back staff? What's the cost? 50-50? For the back of the house? 20-80? I mean, I don't know. Yeah. I would say, and this is off the top of my head, I would say the front of the house where the care is delivered, you know, hands-on care. Gosh, that's got to be... I've got to say off the top of my head, I'd say 20, or I'm sorry, that would be 80%. 80%. That's hands-on care. There's... Yeah. Yeah, based on my experience in the healthcare business, and I have been there a long time and I had got clients that are healthcare, I think you're about right that 80% of the direct care is there. Yeah. And then you've got important things like nurses. Yes. I mean, they are not inexpensive, but I think they're one of the most valuable part of the whole care delivery system. They are. Absolutely the most, one of the most valuable parts because they're interacting with the patients, you know, especially on the inpatient side, you know, they're interacting all the time with the patients and the patient's family. Yeah. Yeah, that's true. And they know that, they know the patient. Absolutely. And they can be alerted if something, if they see certain things happening, whether it be from the pharmacy from the intending physician or whatever. So they're kind of a key piece, but they're not inexpensive. They are not. And that's all, I'm okay with that because they are such a key. I mean, they are, for an inpatient, they are, I would suggest, kind of a first responder. Okay. You know, because after, if I'm coming in for surgery, yeah, I want to have the best surgeon for me possible. Right. But then, after I'm out of surgery, he, the physician, he or she is going to hand me off to the, well, to the recovery room. Right. Nurses. Pre-imposed up. Yes, pre-imposed up all the time there. And then onto a floor to do my recovery. And the key folks on that, where, you know, I'm going to spend the bulk of my time is going to be by nurses in and out. How am I doing? How, not what I'm saying as much as how do I really look? How, what are my, what are my vital signs doing? Yeah. What are your fluid intakes, your fluid outtakes? All of those kinds of things. Yeah. And they'll see if I'm having a post-op problem or not. Okay. So, then again, we both agree that nurses are a key player. But one of the challenges that I've always had is like, is the travel nurses. They're from out of state. When there's graduate, I'd realize that travel nurses are experienced. There's no argument there. But you've got new nurses that are graduating from University of Hawaii who can't get a job. So, You'd say, yeah, you've hit on a key point, key point there. You want me to No, because, you know, I guess we're going to have to do this again because you're not going to believe this, but we've used up all the show. The and you're not getting paid to buy. But, you know, I couldn't use this but I had the phone. I had it, two days ago. And, I say, oh, the first thing I'd say is, the first thing I'd say is, the first thing I'd say, no, you can't use it. I can't. No. It's not He's going to be helping me co-host the show and Andrew co-host the show. And we'll continue these themes on health care. So thanks, Ray. Everybody for helping this show happen. Tonight is Boys Bunch, April Foolish Party down at Gordon Beers. If you see me there, I've still got a few tickets. I'll get you in for free, free 99. And then we've got the cyber show starting at five o'clock. I guess I'm the guest on that one. They can't find anybody. Anyway, oh, thank you for joining us. I'm Hibachi Daka. And like we say at the end of every show, one, two, three, How you doing?