 This is St. Tech, Hawaii. Community matters here. My name is Ray Tsuchiyama, your host for another rate show business in Hawaii. In the mood for the holiday season, I'm wearing my Christmas shirt that has a date here, 1987. That was the year I got married. And I feel good that I can still fit in there. Our guest today is in the business of managing, leading, running the state of Hawaii in a statewide role as lieutenant governor. His name is Josh Green, and for years he represented West Hawaii in the Kona area. And now, after a long and active campaign season, he has been elected and inaugurated as the 14th lieutenant governor in the history of the state of Hawaii. And the first one, Jimmy Kealoha became lieutenant governor in 1959, which is probably before you were born. I was born in the 70s. So welcome to the show, lieutenant governor. I appreciate it. Now, you were also a host on St. Tech, Hawaii in the past. Yes. I had a two-year stint, and I absolutely loved it. I ran a program called Healthcare in Hawaii, which was very gratifying. I spoke to all the health leaders I could find in the state, and some of them were also social scientists and leaders in that way. So that was very informative for me, and it was a way for me to kind of keep in touch with people who had other leadership perspectives on healthcare. Now, you're very, I guess, exceptional in that in the legislature you had a MD degree. Yes. You were a doctor, and you were in the ER area. Yes. Now, you've become a lieutenant governor with a MD degree. That means that what? Well, I'll always be a doctor. So I expect that most of the medical work I do now will be more of the pro bono variety, where I work at shelters, we're starting some homeless shelters that have a heavy dose of healthcare associated with them. I think we'll talk about that. Yes. It's going to be a priority for me. There's a lot of volunteerism that I like to do, and I might peek into an ER from time to time. But it's really important to me to be able to use that perspective, which I've had all along. When I first came to Hawaii many years ago, I came with the National Health Corps, and I was responsible right out of the gate for 8,000 individuals to be their doctor. And it was that perspective that helped me to fall in love with Hawaii and also to get a glimpse into the challenges that we have. And I've used that window or that perspective all these years to inform how I participate as a legislator and now as a lieutenant governor. Now talking about Hawaii to state, you have gone from representing a local area on the island of Hawaii. And during the campaign, you visited a lot of people from Hanalei to Hilo and beyond, all that. And of course, you've come into the role with a neighbor island perspective. Any of the lieutenant governors in the past did not have that. Now coming in, what those being from the neighbor islands and bringing those perspectives and of course, talking to all those people, not only Oahu, what does that bring to your strategy or priorities in the lieutenant governor's role? That's actually a very good question and an excellent thing to discuss. For one, I'm a team member now and I'm a team member of Governor Ige who I'm very fond of and who has been very kind to me and my family. Governor is an Oahu-based leader and we serve for six years together as senators. But it's always the perspective of where you come from, which often matters most. So all those years in the trenches on the big island and spend a lot of time on Maui help me to better understand the more rural challenges that we have. Healthcare access is twice worse on the neighbor islands. We often don't have any services whatsoever in certain areas, whether they're some social services that aren't in a region or drug treatment, which isn't in a region, or access to trauma services like we have here on Oahu. So I'm very familiar with the additional needs we have. And then we have some interesting one-offs, for instance, the volcano, which when it went off and Madame Pele kind of showed us all what she's about, that impacted us tremendously and dramatically on big islands. So I hope that I can really compliment the governor as a neighbor island lieutenant governor. I hope that I can continue to go back. I'm actually scheduled to go back four or five times in the first six weeks just by sheer happenstance. I'm going to speak at the graduation in Hilo on this Saturday, and I'm going to speak at some conferences on Maui coming up. I'm going to attend a funeral for a dear friend's mom and spend time with the community that I grew to love in Hilo, which is where my in-laws are. So I'm going to keep going back just very routinely, because I don't want to lose touch, number one, with the priorities. And two, I think it's good to have that perspective in one of the two executives. Well, that's terrific. And I think we were talking before that Jimmy K. O'Loha, the first lieutenant governor, came from the island of Hawaii. And also Nelson Doi was born on the big island also. So there are connections. But the rest were all waffle-centric in this way. And so I think you bring a tremendous compliment to Governor Ike, who to me is a person of the new suburbs, the new democratic demographic center of Oahu in Pro City. And so it is a symbol of where Oahu is also going in many ways. Coming back to your campaign, who would you say really you went too often for advice and that person gave you really good insights about connecting with the community, with people, and strategy? Well, I had a great team, actually. I took a lot of friendly advice from some of the allies of Senator Schatz, who Brian appropriately needed to stay neutral in the election. But he recruited me to run for the state house back in the day when I first ran and helped me be successful then. So he's always been excellent with me. And he's a former leader of the company himself. Exactly. And so he and others were able to provide a lot of good advice. I have friends from my youth that participated in my campaign. And I had a lot of family input, too. I have a know-it-all dad and mom who are great. And I've got a son and daughter, Maya and Sam, who like to give me instructions, too. But my campaign, I had an advisor in Dr. Miskovich, who's a physician colleague, and we share a lot of same ideas. The way I approach campaigns, however, is I spend an incredible amount of time in direct personal contact on foot with people. I know a lot of people saw our ads with the family and me working in some homeless centers of Hawaii and doing that kind of work. But I spent, well, I spent eight months or so walking door to door. And I went over 25,000 pounds individually. And so it is kind of amusing to me when people bring up things like SuperPakThis and Big Donors That, which are part of the landscape. There's no question. They have very, very little impact on me because I treated 50,000 people in the big island over the years. And the margin of the election was one there. I went to 25,000 homes on Oahu. I met people in person. People were very gracious. I'm sure many of them didn't vote for me because I had great opponents. But they got to know me. And it's those kind of things that I rely on in campaigns. But I didn't campaign for more than a couple days on the neighbor islands. And I did well there because I actually worked there. And I actually cared for people there. And I think that goes a lot further than the campaign methods of today. That's terrific. And going back to what you just mentioned, and I think it's a tremendous highlight in the Chinatown community, the clinic. And we have a friend, a mutual friend in Anthony, Monathong Di, who also grew up in Kalihi, like myself, with a refugee background, as we know, a tremendous guy. Tell me how that kind of evolved as a concept and execution and where it's going. Well, I just love that. And in many ways, that's been a signature part of my life. Had I not ended up prevailing in the election, I would have helped them run those clinics. And I still will as a volunteer. What happened with the Chinatown Clinic, which is a free clinic for anyone to go to but is predominantly people by homeless individuals and patients is we started a concept called the H4, and it's growing terrifically. H4 stands for hygiene, acute health care, medical respite, which is another health care, and then housing. And the goal is, whether it's in one building, which we ultimately hope to do on Kuhili Street, or in separate segments and then have housing elsewhere, to provide services so that individuals who normally would get thick in conflicts who are homeless and normally have to use ambulance for $1,050 and 1,600 bucks to the ER and so on. And that raises insurance for everybody. It does. The average spend is $4,350 for an encounter if you're homeless in health care, you go to the hospital. We decided that we would raise money from the private sector, very generous donors like Islands Hospice and HMSA and Queens and friends. They fund this program and it hires Andy and we paint rooms with this money and buy medical beds and such and free medicines. We see somebody cost 20 bucks, 25 bucks maybe, which we don't worry about billing. We worry about caring for someone, we save thousands. And so in the run up to starting the larger facility, which we hope will start this year, we had an opportunity because the fire fighters, the guys that take care of a lot of individuals in our streets. And the police said, we have this space here, we'd love to actually start delivering some care. Within 17 days, we opened up that clinic. And now we save over $105,000 every week of Medicaid money for our taxpayers because instead of those $4,000 days in the system and 30% of all patients going to Queens were homeless, we now are decreasing that dramatically, we're taking care of people in a different setting. So that's a great ratio of cutting down costs through the number of visits to ER. That's the killer right there. We had a guy who won 241 times last year and he spent over $1.2 million. So it's hard. But can this be a template for very localized clinics in other places? Yes, I hope to do six as Lieutenant Governor and provide services all across the state. I would guess we'll do at least three on Oahu and probably one in three other locales. I think there'll certainly be need on Big Island, Hawaii seems to have need in Maui. And wherever there's any population center at all, if we can offer services, we will. Sometimes we'll just kind of airlift services in and help a couple days a week. Maybe in a mobile way, maybe through our volunteers. We do pay people quite well when we have professionals. A lot of social work support so that people can get from their healthcare need to housing if at all possible, or from their healthcare need to drug treatment. These are the challenges that we have. And it's actually, my Lieutenant Governor's initiative is going to be very focused on this nexus between the economic component of homelessness, the mental healthcare component, and the addiction component. And when you find that center circle in the middle where they all overlap, that's where you'll see me. We'll get back to the looming priorities of the Lieutenant Governor's role after this break. This is Think Tech Hawaii, raising public awareness. If I could play, so I ain't chance to play at all, you know, that's my life. I love music. That's how we do it. If you're not in control of how you see yourself, then who is? Live above the influence. I'm Jay Fidel of Think Tech. Come around every Tuesday at 2 p.m. With John, David, Ann and me, we're talking about history, history lens, right, John? Exactly. Seeing current events through the lens of the past. Absolutely. See you next time. Okay, Jay, thanks. Welcome back to this holiday edition of Business in Hawaii. We have Lieutenant Governor Josh Green on my left. And we're talking about his initiatives. The focused one in Chinatown, and now we're going to be going in a larger scope. What would be some of the big priorities for the state through the Lieutenant Governor's office? Or what is their opportunities for partnerships with the private sector? Opportunities really to lay the foundation for a longer term. You just can't solve problems tomorrow in one day. But there could be a foundation, a strategy. What would the top three be? Well, thank you for that question. I'll preface it by saying this. People have thought that Lieutenant Governorship can't be useful. Well, that is not true at all. We know that each of the Lieutenant Governors has picked something to do. But I do intend to make this an extremely dynamic position. And I'll use my medical background to inform what I do. Governor Egan, I've spoken several times. He's really been very generous with me. The first one is to address chronic homelessness. And I don't mean that specifically because homelessness, when it's an individual that flies in, 11% of our homeless come and go from other states, is not the greatest challenge that we face. It's those who have, at the same instance, addiction, mental illness, and homelessness, where they're very high utilizations of services, they're suffering greatly, they're family suffering greatly, we need to help them. So as a physician, Lieutenant Governor, I will be in the streets taking care of our individuals. I'm carving out my Wednesdays to specifically be hands-on with patients and people to find out what's their greatest challenge, to help them directly, which I think will be something that has never been seen before here in Hawaii. So that's one. So the chronic homeless challenge. But there has to be a pathway to legislation or programs and so forth. Correct. Not one-on-one. Of course, one-on-one is great. Yes. I'm larger, I guess, dealing with the problem. Yes. And to that end, and we mentioned this just a little bit before the break, I hope to open six clinics in public-private partnerships. We have the Ohana Zones designation, which the legislature, which I was a part of last year, designated $30 million to work on this problem. And that, combined with the private sector individuals that I work with and the excellent partners we already have at IHS, Connie Mitchell, Heather Lusk at Chow Project and all the other individuals who are terrific, the police and fire leadership. These are my partners, though everyone we welcome as partners, because a lot of people, for instance, a lot of nurses and doctors have asked to volunteer already. A lot of individuals who suffered drug addiction and were homeless themselves are asking to come as volunteers or even be hired to work on these projects. So I'll be using my H4 nonprofit model, which I'm now separated from as Lieutenant Governor, and those allies to help, plus the clout that I hope to bring as Lieutenant Governor. So it has to right, have legs, it has to be a 20-year plan, which is what it will be. I'm already in discussions with some of the leadership at Ohana, it will be very worthwhile. The council members have been excellent. All of them have brought something to the table, each in their own way and each... So it's a broad-based initiative, that's what you're telling me. And it's a broad society-based challenge. You know, one point, sorry, 3.6% of our Medicaid dollars, which is a $2 billion budget, are spent on, 3.6% of our people spend 61% of the budget. So that's about 13,000 to 14,000 people are consuming $1.2 billion. And that means it's a problem for all of us economically. That's correct. And it's a big problem. It's tax dollars. It's tax dollars. People who work and have to take care of the families and pay taxes. Those 13 individuals who are suffering and not doing well are consuming the better part of 15% of our entire state budget. So this is a place that's valuable for me to work on. It will be a job training program as well, which should help a lot of people get prepared to actually be in society. And so that's my primary initiative. Governor and I also spoke about the Medicare and Medicaid problems that we have and providing healthcare to those who are in that space and all of us, the physician shortage or the healthcare provider shortage, I will lead on that as well. Interestingly that's not quite as hard as the homeless crisis because that's a matter of putting the right enticements into place, the right landscape to bring nurse practitioners, physician assistants, doctors, psychologists, nurses' aides, community care workers, community health workers. All these individuals to Hawaii, which you can do through loan repayment incentives like I did, which brought me to Hawaii to work in Kau. So there are ways to attract them, you just have to execute very well on them. A question, John A. Burns Medical School at UH, how is that part of the puzzle? It's critically important and Jaros Hedges is a great dean and a great leader. His challenge is that the size of it is constrained. Size of the class? Of the school? Of the school? Of the school? Of the school? Of the school? Of the school? Of the school? We train about 66 people per year and there may be some capacity increase slightly, okay, but four year programs that are very expensive and to attract people based on the infrastructure you have is very hard at the med school. We could also expand the residency program some, but that is just small increments of increase. We have to actually attract doctors and nurses or expand our scope of practice for people like we did when I was a legislator. We let nurse practitioners become full tilt primary care providers. For the good, provide prescriptions for example. Prescriptions, mammograms, order advanced tests, usually in partnership with physicians sometimes independently. We'll need to do something similar for physician assistants, much easier to attract individuals who only had to have two years of training rather than essentially seven, four years of medical school. We'll expand responsibilities and scope of work. That's the world and that's what's happening and people are becoming more savvy consumers. There's a lot more people on the internet. Millennials don't want to see a doctor. They want to see their iPhone, right? They get all the medical advice through Google, which is not good. Not ideal, not good. But in the future they will be able to see someone in a telehealth capacity very quickly. Senator Schatz is a great leader on that issue for instance and I tried to follow. So leveraging technology, VR, AR, all kinds of applications. Absolutely. We could do a program where myself and perhaps a medical colleague could spend a half hour addressing all diabetics in the state of Hawaii and they could tune in. We could bring patients in. You could get your health care essentially through that kind of thing and you could have tens of thousands of people getting health care in a half hour. I mean, this is the kind of innovation that could occur. You still need some testing. You might need some physical exam, but a lot of it is education. So the world's changing. I like to tell people and I think you, because you're interested in politics, will find this interesting. The first campaign when I was on foot in 2004, it took me seven months to see the 7,000 voters. Okay? 7,000. That's not a large figure. No, it's not. Now. Cali is 43,000 people. Exactly. And that's how many people voted in the primary, right? So seven months to pursue that office, state house. Now flash forward 14 years. In 2018, it took me seven seconds to reach 700,000 people and across the entire state through social media and advertising and so on. I mean, things have changed that much and so a lot of things will change in health care and hopefully strategies for homelessness, which I'm becoming an expert at. I will also be working a great deal on the opioid crisis. That's another one. What bad is it? Bad. Compared to... It's not as bad at all as it is in regions like West Virginia and Pennsylvania. That's really bad. There's ground zero. That's where some whole communities are being wiped out. We have the lowest rate of prescriptions for opioids per physician to patients, lower than any other state in the country, which is great. This is good. It's great. But if you flip it and you look at it through a different lens, we also have, like most states, more individuals that died from opioid overdose than died in car accidents. And so it's quite tragic per year. So when you look at it in those terms, these are preventable deaths. We've done a lot. We passed legislation where people can get the naloxone, the reversal of the opioid medicine. We got other things going. For instance, we passed legislation to observe and have every healthcare provider check whether their patient got prescribed a lot of opioids in the previous weeks, months and days. So that decreases by about 50% of use. But there's a lot more to do. So that's the patient monitoring, right? Yeah, the patient PDMP, the patient drug monitoring program. And so it's bad enough because every time it's a teenager that we lose, it's a heartbreak for everyone, for a generation. And we noticed that, for instance, we found that half of all pills that are prescribed are consumed by someone other than the recipient of the prescription, 50%. So that tells me that we have at least 50% too many pills in circulation. Not rocket science, after all, I'm a legislator formally. You can't expect a lot of extra cerebral activity from me, right? So I think that there are things that we can do and that I'll do, but it takes work one by one. It takes, that's why I'm emphasizing that to lead by example a little bit on Wednesdays. Is it isolated or is it, you talk about the whole community, but are these opioid challenged people all over the place in many, many communities? They are. It crosses all socioeconomic boundaries. There is about a three-fold higher incidence in people who are extremely poor. A lot of that time, though, that's because they've been in a life of physical labor and so they have broken bones and bad knees and shoulders and backs. So it's hard. So it's hard for me to characterize one group versus another, but it's everywhere. Sometimes it's particularly bad in isolated communities like Kauai, where there at one point was a pill mill or a doctor that prescribed way too much. To me, it's kind of a rural area, but of course, West Virginia is very rural. Rural areas often are hard to take. It's in parallel, yes. Because what happens is if people who are addicted to pills, it goes both ways, and they can't get the prescription, then they take heroin and then they have a much harder core addiction and then they might take methamphetamine, which is very rural often, and it's created synthetically. It's created by poor communities, and it's very bad. So these problems, churn, is why I got involved in politics in the first place. I saw some traumas of individuals, little babies, two little babies that one died and one survived after trauma, both because they were neglected and weren't cared for by their parents who were in drugs. And so I thought maybe we better have a focus on drug treatment. Drugs have impact on families and in literature who are innocent to all this. And entire communities in turn, because that child who was one year old probably had 300 people at his first birthday party. And so you can imagine what that means when we lose that child. So the issues of drug addiction, trauma, and suffering in my mind are the bellwether issues for a society. If we can do better, I can't solve those problems, but if we can do a lot better, our society then knows that we've done better. And when I'm speaking to my more conservative friends, it really pays dividends. In other ways, it pays economic dividends, tourism improves, our healthcare system isn't as burdened, our families aren't tragically struck, which we all, Democrat or Republican or whatever, conservative, liberal, black, white, we all feel the same way about our loved ones. So it's very important that I focus on that issue and that I use my medical background to help with partners. And it's important that people understand that that's the perspective I come from. I will be happy to talk politics with anybody and all of those things that they bring up from time to time. But I became a physician lieutenant governor probably the day I graduated from medical school, because I knew I wanted to have a larger impact. It was unlikely it was gonna be in Hawaii. It was unlikely it would be this specific office, but it was gonna be something that focused on the social needs of society. So what I'm getting is that you're continuing passion. You're continuing passion that has propelled you in your career, into this role of the governor. And I think that's fantastic, you're hitting the ground running. That's another metaphor. Anything you'll miss from the legislature as we close down on the shop today? No, not just yet. There's some good people there, a lot of good people, and I still see them. So my door is open to everybody in the community from the legislature, from the governor's office across the hall. And I'm enjoying an increased capacity. Already a group from when I reached out to me, they were about to lose all their capacity to provide home care. I'm solving that problem with them in the real time. When drug treatment programs may or may not have enough funding, I'll find them funds and I'll fight for them. And then we'll start these initiatives. So hopefully I'll have a good impact and hopefully I'll stay focused on these tasks at hand because it's going to take a consistent focus. A lot of legs on the ground, boots on the ground and so forth. But I would love to have you in one year and in December of 2019. And we can go over what happened, what didn't happen, and kind of see where the next year will go. Can you promise me that? Of course. Okay. Thank you so much. Lieutenant Governor Josh Green on business in Hawaii. This is Ray Tuchilla. Thank you, Ray.