 speaker. Really excited to introduce this man. One of the most viewed speeches in all of the 21 convention history. I've watched it multiple times. I think this was his speech back in, uh, was it Orlando a couple years ago? So without further ado, I want to bring up Dr. Doug McGuff. He's a returning speaker to the 21 convention. He's an emergency room medical doctor in Seneca, South Carolina. And he's the founder and owner of Ultimate Exercise and co-author of Body by Science and the Body by Science question and answer book. Can't wait to hear what he has to say. Help me welcome Dr. Doug. Thank you, Robbie. Appreciate it. Normally I talk about exercise and diet, but there's not anything that I can tell you about exercise that you're going to remember that Skyler did not cover beautifully yesterday in his lecture. So if you're watching this on video, go watch Skyler's talk. You will need to, you'll have everything you need to know about exercise in that talk. Likewise, with regard to diet, there is nothing that I could tell you today that you're going to remember that wasn't beautifully covered by Jolly or Dave Asprey and their talks today. So I would reference those for you. So instead of like in 2010 me telling you the how of the paleo diet and the how of exercise, I want to tell you why. And I want to do that from a very unique perspective. And that perspective is 23 years practicing in the epicenter of the implosion of the American health care system. Okay. If you care about your liberty and preserving it, you need to care about your health. Okay. Now, everyone that's sitting on an aisle seat on this side of the room, please raise your hand. Okay. Everyone look around. For those of you that are younger than 35 years old in this room, statistically speaking, this is the number of you who will be dead before you're 35. Keep your hands up. Everyone on this side of the room raise your hands. Okay. That is the number of people statistically speaking that is going to have a serious life-threatening health condition or injury before they reach age 35. That's why this is important. That's why I want to talk to you about fitness, health, and liberty, preserving personal freedom by staying out of the belly of the beast. Now, one theme that I want to make reference to as we go through all this is remember it every step of the way in this story that I'm going to tell you. When we made a mistake or did something wrong, we never go back on that mistake. This is true of individuals, but it's particularly true of bureaucracies and government. If they make a mistake, if it did not work out well, they never go back on it. They always double down and do even more of it. So medical care, what is it? What should it be versus what it is? What medical care should be is a free market exchange, a fiduciary relationship between the provider of a service and a consumer. The moment that you engage me as a physician, I should have a fiduciary relationship to you to take your best interest in the heart. But what is it actually today? What it is is a third party relationship where the provider is coerced to place the needs of a collective over the needs of an individual. Now, in a proper circumstance, when you engage me as a physician, we would be discussing both the price and the extent of the care that would be provided up front. As it stands nowadays, if a patient's coming through an ER, even with something as simple as elaceration, and they ask me, Doc, what's this going to cost me? I have no idea what to tell the patient. If you get admitted to a hospital, you have no real means of negotiating what your extent of treatment's going to be. In most cases, the extent of what's provided to you would be way beyond what you would normally negotiate under a correct provider recipient relationship. The other thing that happens is instead of you getting to decide what you want, what you don't want, whether you want a statin or not want a statin, you kind of get a take it or leave it attitude because the system is now protocol driven. If you don't fit into the protocol, you don't accept the protocol. You know, there's no negotiation. It's all or nothing. So who's to blame for all this mess? Doctors. This is an important point for all of you. Whenever anything is screwed up in your life, I want you to say four words. It is all my fault. Five words? It's all my fault. Assume responsibility for everything that screwed up in your life. Doctors did this to ourselves. The doctors that did it, did it with short term gain, short term gain in mind. And they probably knew that the consequences of this would not be born in their lifetime, but in the lifetime of future physicians and future patients. But they sought the help of the government for a short term gain and they set into motion the long term unintended consequences that has resulted in our ultimate enslavement. So what'd they do? You ever heard of Blue Cross and Blue Shield? This came about in the Great Depression. Now, before the onslaught of everything that we currently have, a lot of physicians provided a very large mass of charity care. And during the Great Depression, a calamitous economic event triggered by government regulation, not many patients were paying for their services. This is where you heard about doctors being paid in chickens and eggs and milk and whatnot because it's all people had to exchange with. The medium of exchange had gone down to that. What they devised was an insurance system whereby they were, I'm sorry, they were guaranteed to receive a payment for their services, but they bastardized what insurance actually is. What insurance should be is you pay a premium along with a lot of other people that goes into a kitty that will pay you should you encounter some catastrophic unforeseen event. But the insurance structure that they made was something to pay for everything. Routine office visits, medications, screening tests, the whole nine yards, come to the office with an earache or a sore throat. It was under the umbrella of this insurance that you paid premiums for. Furthermore, they sought a tax exempt status. What they wanted to happen was people that were buying their insurance plan was for them to be buying that with pre-tax dollars. Normally, when you buy insurance, when you buy your automobile insurance or you buy your life insurance, you buy it with post-tax dollars. That means if you made $100, government takes $40 and leaves you with $60 and you buy your premiums with that. When something is allowed to be purchased on a pre-tax basis, you get to buy it with the $100 you originally made. So in essence, you're buying at a 40% discount. Well, the government said, okay, we'll do that. But what we want in exchange for that is a community rating. Does anyone know what a community rating is? Basically, that says anyone within a geographic catchment area pays the same premium regardless of their preexisting health status. So that's created layers of what are called moral hazard. So what's moral hazard? Well, moral hazard just has to do with what your behavior is under different circumstances. Let's string a tightrope up on the top floor of this building across the street to the other building. Well, moral hazard is the difference in the way you behave on that tightrope when there's a safety net eight feet below you versus when there isn't. So people's behavior was changed by the fact that they were covered for everything. The consequences of not washing your hands or eating something that sat out for too long were now much smaller. You didn't have to pay if you got sick even for the most minor of illnesses. More importantly, you felt as if you were going to be taken care of if even you got a moral more major illness that occurred as a result of your behavior over time. So this was great for the doctors at the beginning of the medical Ponzi scheme. But not so great for those of us down the line. So what happens next? Well, remember, this is occurring in a medical market where different providers are competing within that market. So commercial insurers try to compete. Okay, people that aren't Blue Cross Blue Shield that don't have the pre tax benefit and lack of, you know, they have a lack of tax exempt status. They're forced to compete by offering a similar product. So what happens then is the concept of third party payment for medical services becomes entrenched. This essentially becomes prepaid medical care. This makes comparison shopping near impossible because you're not comparing price as you would in an open free market. It's premiums. And it creates another moral hazard that's called Friedman's quadrants. And it refers to Milton Friedman. And I wanted to have a white board up here to draw it for you. But to spare us all the rigmarole of trying to get that thing up here, let's just divide this screen into quadrants. Okay. And on one side, what we're going to have is your money. And then below is going to be someone else's money. That's the y axis. Guys don't bother. Don't worry about. So on the y axis, we're going to have your money and someone else's money. On the x axis, we're going to have yourself and someone else. So when a person spends their money on themselves, they're going to worry very much about the price. And they're going to worry about the quality of what supplied. Okay, that is where the most conservative economic calculation occurs. Now, if you're going to spend your money on someone else, you're still very concerned about price, but you're not quite so concerned about quality. You're buying a birthday present for someone you're like, I think they'll like it. Maybe they'll hate it. I'll never know. But I don't really care that much. So down in this quadrant, you're going to spend someone else's money on yourself. Okay. And that's kind of where we're starting off with this. There, you don't care so much about price, but you care about quality and you want to make darn sure that you get the quality you want. But you don't really care what it costs someone else to provide you what you want. Okay, this is sort of the equivalent of being a welfare or Medicaid recipient. And the last quadrant is the worst kind of spending you can do. And that is to spend someone else's money on someone else. When you're in that quadrant and you're spending, you don't care about the price and you don't care about the quality. And when you create a third party payer medical system, that's what you have. Okay, people are not buying their health care in a direct transaction. The health care is bought with premiums that you have no idea what the cost is and you don't care. How many of you people are employed and covered under employer insurance? Do you know how much it costs you every month? We got one guy. Do you know how much comes out of your paycheck? dollars and cents? Okay. Yeah, so it's variable. But the number of employees that actually know what's being taken out of their paycheck, and whether those are pre or post tax dollars and all sorts of elements. If you go to an ER, do you know how much money you're going to pay? Okay, so you pay $100 and then you're covered 100%. You don't have an 80 20 anything like that? Okay. Alright, so most people they don't know how much is being taken out. And they don't know what it's going to cost when they show up for care. So this creates another moral hazard, because you're down in this quadrant, you don't care about price, you don't care about quality. So the situation was made worse by the 1942 Stabilization Act, we're in the middle of World War two. A lot of America's men in the workforce are off fighting war. And the thing you got to realize about labor is like anything that's bought and sold or anything that scares it has a price. So wages could potentially go up during this time of economic hardship, which could put a real strain on employers. So there was a lot of political pressure to freeze wages. And that's what they did. But all of a sudden, employers were hamstrung for competing for a very limited labor supply. So what happened then is the government allowed import lawyers to compete for scarce labor by offering benefit such as their health insurance to not be considered wages under that wages act. So what happens then is these are pre tax dollars. And they're not taxed. So that amplifies this whole effect. Okay, so remember, price controls will always create shortages. Okay, they applied price controls on wages, which created a shortage of labor. So they had to find an end around and their end around was to offer benefits, or things that were not counted as wages under the act. So then what happens? It's the wrong button again. And I didn't go to Southwest Texas like Keith did. The IRS gets involved. In 1943, they made certain that any premiums paid by employees in a group plan were exempt from federal income tax. And they decreed that health insurance premiums are now a legitimate cost of doing business. And they can be deducted from the employer's taxable income too. So this has collectivized things both on the employee and the employer side. Okay. So collectivism is incentivize. So these tax incentives were available to anyone that got their health care collectively through employers, but it was not applied to individuals who individually bought their insurance policies for themselves, who wanted to stay independent, who wanted to try to preserve as much as possible that relationship between themselves and their doctors. So they were financially punished for trying to remain independent. So what are the logical consequences? Employees become unaware of the costs of what they're seeking. And because it's bought with pre-tax dollars, and there's no apples to apples comparison with what that really means in terms of your salary, especially since taxation rates are gradated, the first money that you make is taxed to the lower rate than the middle money that you make, which is taxed to a different rate than the top end money that you make. So it makes it very hard to perform any economic calculations. Employers ensure the group without any concern for the given individuals circumstance. So you may have very peculiar or particular health care needs based on preexisting condition, congenital problems, but it doesn't matter. They're ensuring the collective, the whole, that's their concern. There's no concern for the individual anymore. And worst of all, it feels like an entitlement. It feels like something that just comes along with being employed. When I'm employed, I have benefits. I'm covered for my health insurance. And it engenders a buffet mentality. Okay. You've paid in a certain amount for your premium. And now, when you go to a buffet, there's a lot of fruit in front of you had to pay $14 to go to the buffet. Are you really going to stick to your diet? Are you going to get your money's worth by gorging yourself? That's the problem with a buffet. That's the problem with the logical consequences of making this sort of system. So then what happens next? Well, prior to 1965, there's always been indigent care. There's always been a need to care for the poor, or the elderly who became destitute, either because of their actions or innocent of their actions. And prior to 1965, this was done on a charity basis by almost every doctor in the country. There were entire charity hospitals for providing care to the indigent. If it wasn't a charity hospital, almost every hospital in this country had a charity wing, which is separate from the rest of the hospital, where charity care was provided to those who needed it. But what Medicare and Medicaid wanted to do, they promised not to control medicine, we just want to pay the bill. But the real point of the thing was not just to take care of the elderly and the poor. The point was to spare them the humiliation of means testing. To actually spare them the humiliation of having to put their hand out and say, I need help. But that is the difference between a charitable act and an act of force. Putting your hand out and saying, can you please help me versus putting a gun to someone and say, give me this. The other thing that it did in the insurance companies rather like this is it removed anyone over 65 from the insurance pool. Okay, so you're a commercial insurance company, you just took the totality of your highest risk covered lives out of your bailiwick and you don't have to worry about it anymore. The public sector is going to take care of that. So your profit margins just went through the roof. And it shifts the costs on the government, which is you the taxpayer. Oops. So what are the logical consequences of that? Remember, at every step of this process, when we screw up, we don't go oops and go back, we go oops and double down. So what's the oops? Baby boomers. Holy crap, the hugest population explosion in the history of our country was going to come to fruition under this act. Okay. So what happened is, you're promising care to a huge number of people who paid in was extraordinarily cheap. But you've created a system where the cost of providing that care has to go up exponentially. So now you have a situation where if you're going to keep this thing propped up from one election to the next, which is very important, because that's also a demographic that votes and votes with their self interest very much in mind. If you doubt it, the baby boom generation has screwed you young guys. They know that they were at the beginning of a Ponzi scheme. And they are more than happy to pass that dead off on to you. You're going to pay for this with money you're not going to earn until you're 50 years old. Okay. So how do we keep propping this up from one election to the other? Well, we got to control costs. Well, we do that by limiting treatment to what is considered appropriate, or medically necessary, and we try to limit payment to doctors. The other thing I did is it outlawed any supplemental payment by the patient to the doctor. So they start limiting how much they pay doctors. Doctors don't want to see Medicare patients anymore. Well, a lot of people that were forced into Medicare say, eh, I'm well to do. I got plenty of money. Doc, I'll pay you the difference between what you'd get from a third party insurer, someone that pays out of pocket. I'll pay you the difference between what Medicare pays you and what you would have gotten. Well, guess what? The government will not allow the doctor to do that if he participates in Medicare. So if you take that kind of money from someone, you are subject to a federal crime that's going to send you to jail. And you're going to be subject to fines which under federal law have travel damages, which mean whatever they decide to find you, you owe three times that amount. Okay. If someone in your office finds out, there's something called Quetam, which is a whistleblower statute that says, not only do you pay travel damages, the person that rat-finked on you, whose payroll you meet, gets travel reward too. So you end up paying six times the fine that's levied against you. So this has huge teeth. Okay. So what's the next thing that happened? That wasn't enough. It didn't stop it. Next thing was DRGs, diagnosis related groups. This came about in 1982. And it was courtesy of a couple of academics by the name of Robert Federer and John Thompson, who were public health and epidemiology experts from Yale. And they came up with a system of paying doctors in what are called diagnosis related groups. And what they did was they standardized different diagnosis through this giant manual called ICD, which is, I can't remember what it stands for, International Compendium of Diseases or something of that nature. But what it boils down to is if you get admitted to the hospital and you have a certain primary diagnosis, you get a certain number of days of hospitalization and a fixed amount that they're going to pay you. And that's it. And it's a amount that's, you know, on the lowest possible end of what you could be paid for something of that complexity. Well, what that is is essentially is a price control on inpatient medical care. Remember, anytime you apply price controls, you get shortages. This created a shortage of inpatient hospital beds, because hospitals could not admit that many people into the hospital and incur those kind of losses. They had to back off on the number of people they were admitting, make the hospitals smaller, have fewer beds because they can't take that many losses under this payment system. This is why if you go back to your hometown and you look at a local community hospital, what you'll see is this dilapidated old ugly building that has maybe 134 beds in it. But right next door to it, you'll see a palatial, beautiful, bigger than the hospital outpatient surgery center or an outpatient radiology center or a blood collection transfusion center. Okay, because they're trying to divert their activities into the outpatient setting where these price controls did not exist. The other thing that happened is it triggered cost shifting. Okay, if you're going to lose that money on the inpatient side of medicine, you're going to shift costs to other areas. This is where you get your $200 aspirin in the ER. And we're trying to make up for the constraints there. You push down on a balloon on one area, it's got to expand in another. So they're trying to preserve market signaling in the presence of something that distorts it. So that's going on. The next thing that happens is what has affected my life so immensely. 1986, signed into law by one of our most conservative Republican presidents in modern history. Imtala stands for it was part of COBRA, Congressional Omnibus Reconciliation Act of 1986. This was a sub component of COBRA called Imtala, Emergency Medical Treatment and Active Labor Act of 1986. And what was happening is when you go to do a residency at a public hospital or a county hospital, residencies, you're going to specialize in internal medicine, family practice, surgery, neurosurgery, orthopedics ophthalmology. Residencies are paid for with CMS funds, with funds from the Center for Medicare Services. So that created an obligation for hospitals that had residencies because they were receiving funds and tax advantages to take care of an agent care. So in 1985, if you were a private hospital and you had an indigent person show up with a medical condition, you just tell the ambulance do a your turn, you go to the public hospital. They receive funds for this sort of care. Go get your care there. And that's what happened. And that's how the indigent paid for their medical care was by essentially being the patients for medical residents. But public funds were going to those hospitals. It was considered fair. But all of a sudden the public hospitals under the effects of DRGs were getting all these nonpaying patients coming in and suffering even further loss than the constraints of the DRGs. You had nonpaying people. Okay. So they started to scream and yell and say this was dumping. You're dumping your undesirable patients onto us simply because we're the good guys. So we signed this into law. And what it does now is it requires any emergency department, any ER to treat anyone who presents within the hospital property or 250 yards of the ER regardless of their ability to pay. What that also means is regardless of their intention to pay. How quick did you think it took people to figure out how to gain this system? Okay. You want to talk about viral spread of an idea? It happened overnight. The public hospitals were all the images emptied out. They were like what happened? Our waiting room used to be jam packed and everyone was going to the more desirable hospitals because they were given a political mandate by force that they could go get that care for free. And it has it's an unfunded mandate with severe penalties. There's no mechanism to pay an emergency position for seeing this. So what this did is it made emergency rooms the de facto national health plan for the uninsured state and local governments abrogated all responsibility for charity care. And based on statistics that were done around 2000 they said the average emergency physician was providing $138,000 a year in uncompensated care. I myself when I calculate provide approximately $350,000 in uncompensated care based on Medicare payment rates which as we've already discussed are price controlled. So that's the low end of the spectrum. Assuming that applying that I provide about $350,000 in uncompensated care about 23 to 30 percent depending on the quarter that you look at of the patients that I see pay me anything. So this resulted in further cost shifting just to survive. This is where you get your $200 aspirin in the ER. And the thing is is the law that was intended to help the poor hurt them the worst. So there was a massive influx of non-paying patients and that contributed to ER overcrowding. And most people when they think of an overcrowded ER blame this scenario for the overcrowding. But I'm here to tell you it's maybe 15% of it. Where the real overcrowding in the ER comes from is the lack of inpatient beds because of the price controls applied by DRGs. Because the people coming into the ER are sick. Okay there's a lot of minor stuff that comes through and you're always kind of turning that wheel. But there is no shortage of critically ill people coming through the ER. And you have to get them, you got to stabilize them, get them treated, get them ready to be admitted to the hospital. But guess what? There's nowhere for them to go. There's no bed upstairs. So they end up boarding in the ER. So the size of your ER's bed capacity starts to shrink. And then instead of having 20 beds to move a big backlog of patients in the waiting room through, you now have 10. And then a few more hours you got five. And then you're really host. So the real problem with the overcrowding is not just the massive influx of people coming in the front door. You got nowhere to send them upstairs because of inpatient price controls. The other thing that happens is the on-call doctors, the people you need for backup, the orthopedist for the broken hip, the neurosurgeon for the gunshot wound to the head, they stop taking call. And they stop taking call because they know that when they get a call from the ER at three in the morning there's a 70% chance that they're going to get up, go out of bed, take the risk of taking care of this patient for no compensation, finish up that surgery and go to an office that's backed up. So they stop taking call. So we got no backup for a lot of different specialties. Next thing that happens is 1996, HIPAA. That stands for Health Insurance Portability and Accountability Act of 1996. And basically what this law was to do was to give government enforcement of the Hippocratic Oath, part of which was to say anything that happens between the doctor and his patient remains confidential. And the reason for this is when you collectivize medicine the ability to keep it confidential because you're serving the collective and not the individual becomes compromised. The other thing that was happening was the government was already planning to mandate, remember this is 1996, the internet boom is going, computers are going to solve every problem on the face of the earth. So there's this huge governmental push for electronic medical records and they worried about sensitive personal information being stolen. So they imposed huge penalties if you even inadvertently violated anyone's confidentiality. I cannot practice medicine on a day-by-day basis without violating this law every time. If someone comes from a drug house or a rave party unconscious, whoever's with them, you know, some kid with pink hair and a bone in his nose, I got to drag this kid in that's remotely their friend and say here's the circumstance with this guy, he's dying right from eyes, do you know what he did? Okay, under this law that's a violation but I have to do it every day just to be able to practice. It's impossible to comply with but if you have something called a compliance program, if you hire someone to serve basically as a government rat think within your own organization then if you have a slip-up then you've at least demonstrated that it was an honest slip-up and the penalties are less severe. So you have to incur essentially a full-time equivalent of hiring a person on board to make sure that you're being HIPAA compliant and every time you go into your doctor's office the first thing they give you is this big long sheet of paper about your privacy rights that you have to sign. Anyone who's been to a doctor's office recently knows what I'm talking about but this was greasing the path for the electronic medical records which I now have to deal with. This all combined signaled the death of private practice the overhead burden from Medicare and Medicaid private insurers HIPAA it eats up all your profit margins. In the past four years 80 percent of the family practice dollar of family practice doctors in my community paid themselves no salary of the ones that did they paid their nurses and mid-level providers more money than they were able to net out of their practice. As a consequence these people were bought up by hospitals who had the scale to deal with the regulatory burden and it wasn't like they were brought in as a hostile takeover these people begged the hospital to let them be employees because they couldn't make it otherwise that's what happened. So now now what you have is medicine is collectivized both on the provider and the recipient side control is easier you have control of both sides of the equation from a government standpoint even if this was an unintended consequence you couldn't devise the more diabolical system for getting complete control ultimately this created a hospitalist movement okay if you get sick in the old days your doctor would see in the office say you're really sick you need to be in the hospital he'd do a complete history physical exam write a mission order send you over to the hospital he'd go upstairs and he'd see you from his office he'd either leave his office immediately if he's urgent or see you later in the evening after office hours but your doctor who knew you intimately would take care of you in the hospital no more okay all inpatient care has shifted to hospital employees which are hospitalists they provide the inpatient care when a patient comes in the hospital this happens because the hospital practices that became hospital employees are now under severe scrutiny to be productive within the office and if they have to come and provide inpatient care mess up their schedule their productivity falls and they get in trouble for it there's also a refusal to take call because mtala increases their exposure to making their bottom line look bad and make them look bad at the hospital and the hospital has no conception of calculating the economic value of doing something that the government's mandated that you do so the hospital has been hired to provide inpatient care and these are excellent physicians but they're excellent physicians who are under enormous pressure to practice for the collective rather than the individual and to their credit what they have done because these are doctors very smart people is they have become very creative it kind of subverting the system and making it work but what happens is the government constantly changes the rules of what they'll pay for and what they won't pay for so it's always a moving goalpost so in order to help the hospitalist the hospital is now hire case managers case managers are usually nurses that have had the good sense to get out of clinical care or social workers and they have this big manual from the government about what they will and what they won't pay for and what the diagnostic criteria for being able to be admitted into the hospital are and they help the hospitalist figure out what they can and cannot do now make no mistake if something doesn't fit this template they're not saying you can't admit the patient of the hospital you can and we do all the time they're just saying we're not going to pay for it and when the hospital is under this much financial pressure there's very huge pressure to predicate your admissions to the hospital based on what's allowed so finally the affordable the patient portability affordable care act obama care this was signed into law on march 23rd 2010 i watched it while waiting in a neurologist's office for four hours to be seen the reason i was in the neurologist office is i got a weird neuropathy i thought it was from a pinched nerve in my neck maybe from working out but my intrinsic hand muscles at feet to the point where i could no longer pinch or turn a key one day i had a patient that went into respiratory arrest i had to intubate them i used a laryngoscope to expose their vocal cords and the endotracheal to the plastic to we put down your windpipe i couldn't hold on to it as i was passing it through and i was like oh crap i got to figure this out so i was waiting to have a nerve conduction velocity done as it turns out i had something called cubital tunnel syndrome we were mandated to have electronic medical records or face severe financial penalties in terms of what medicare would pay you so huge pressure from the hospital we went to instead of voice dictation that was transcribed to this computer template that you had to mouse every little bit of the patient encounter and where it was was a desk with a glass tabletop and i was raking my own nerve over that over and over again i never thought after 20 years of education i would have the sort of job where i would have a repetitive motion injury but i was there being evaluated for it while i watched this sign in the law and the thing is everyone's just really up in arms about this thinking that this is going to do new and horrible things and it's not here's what it does is it just takes everything that's horrible about our current system and mandates that you buy into it even if you object and this is the scariest thing about the latest court case is the first time in american history someone can tax you for something you did not do you're not being taxed for taking an action you're not being taxed for producing something or selling something or bartering any sort of transaction you're being taxed for an inaction okay so this includes all the negative elements of what brought us here but the other thing it does it shuts off any escape valve for cost shifting everyone's co-opted into this thing so what's going to happen now is once these price controls are enacted and they cannot be dissipated varying by cost shifting you're going to have massive shortages it's going to be really hard to get in to see anyone or get care so if you get sick expect to be deflected to the er when you go to your doctor's office doctor's office is for routine care and simple stuff you do anything that screws up the flow of the schedule they're going to punch you to the doctor off to the er when you get to the er expect long waits because everything is being shunted there and then tall remains in effect okay call your doctor's office go out in the hall call your doctor's office on the cell phone universally they'll say if you think this is an emergency call 9-1-1 go directly to the emergency department when you get to the emergency department what's the thing the triage nurse says to you didn't you call your doctor no one wants you because you are a liability to everyone involved in the system now if you need admission it's going to be a fight we have to find a damn good reason for you to get in there we're going to have to ram the square peg into the round hole to make sure we get some sort of reimbursement for taking care of you and you'll be kicked out as soon as possible whether you're ready or not it's all protocol driven anytime you receive a treatment it will be per protocol if you come in with chest pain you're going to be discharged on a statin and if you're not discharged on a statin that's going to create the physician being flagged as an outlier and a trouble maker okay the sicker you are the more you're reviewed as a liability be prepared to be discharged prematurely coming with pneumonia not completely better but you know maybe good enough they'll send you home and right now we're experiencing multiple ambulance U-turns and what I mean by that is almost every single shift I work I will see at least one ambulance patient that was someone that was discharged from the hospital being driven home in the ambulance that has to do a U-turn and come back because they're decompensating and guess what if you're at a readmission within 48 hours they ain't paying so now the readmission is even more of a fight being a than the original admission because no matter what you do no one's getting paid but lots of people are doing the U-turn because of the premature discharges and understand this is not because the doctors aren't good these are extraordinarily smart and well-meaning people they're just operating under the constraints of enormous pressures so remember he who holds the gold makes the rules what becomes protocol is subject to lobbying groups and what treatments are approved or influenced by big pharma big agrarian you subsidize corn you end up needing lippatory you end up needing glucavants and what lands most people in the hospital is the dietary habits that are created by a big agrarian the USDA and when you get admitted to the hospital what they bring to feed you will be what the USDA says to feed you so remember getting sick it's always been a loss of control but now it means a loss of control and a loss of your liberty your doctor no longer serves you he serves the collective his compliance is strongly coerced if not forced currently it's coerced very strongly soon it will be forced and remember you're a financial law center to everyone involved it's cheaper if you die as long as the protocol was followed it's in your interest to be a quick healer that's why you want to eat the paleo diet that's why you want to do high intensity exercise that's why everything that we talk about here is so important you do not want to get in the belly of this beast so you doubt me take the airport test when you guys are flying back home look around the vast majority of people are already within the belly of the beast and that's the thing that always cracks me up when you hear you know fitness guys they get up here and say I'm going to change the health care system we're going to be more about prevention and health than we are about disease come to work with me one day you have no idea how sick people are okay I saw a 48 pound two-year-old with type two diabetes at walmart you can buy nipples that screw on to a mountain dew bottle okay look around you just walk out front look at someone out in the smoking area that's you know 100 pounds over fat and realize this person gets the flu they're going to be real sick okay the onslaught of sick people that need big pharma type interventions because it's all predicated and focused on that sort of recovery from the brink there is so much of that coming at you so fast you don't have any time to think of alternative medicine and prevention or anything like that doctors are buried by this so being fit and medication free gives you an enormous competitive advantage and it subverts dependency direct control over your life is removed that leaves you in a much more resourceful mode of being able to deal with the multiple indirect controls that are being exerted over you right now so how do you do it eat a paleo diet and you don't have to eat paleo what that means is avoid neolithic agents the disease eat nutrient dense whole foods single ingredient diet okay you should eat something that has a single ingredient broccoli meat eggs I was talking to Dave earlier and we were talking about eggs and fat and the diet and how important it was and particularly how important it was during pregnancy and gestation I said to him he said look at an egg look at a yolk everything you need to make a chicken is right there that's nutrient density eat a paleo diet find a book primal blueprint rob bulls book paleo solution the one diet by simon shawcross who spoke in London primal body and primal mind by norga goddess and the new evolution diet by art devaney all are my favorites pick anyone that appeals to you and follow it if you respond better to visual and oral presentation see my 21 convention talk on youtube 2010 I'll lay it all out for you in technical detail so you'll understand both the why and the how exercise do high intensity low force exercise with plenty of recovery what skylar told you is gospel truth okay you can read my book body by science first do no harm find bill day simon's work and read it moment arm exercise you don't want to injure yourself either it's not enough not to be sick you tear your rotator cuff guess what you're in the belly of the beast so you should avoid ballistic exercise or programs that use skill based movements in a fatiguing protocol I love the spirit of crossfit I love the notion of doing hard things builds character but what I don't love is a fatiguing protocol with skill based movements that are going to get you injured same thing with p90x or insanity workout do high intensity low force workouts because injury will put you into the belly of the beast very quickly remember when you're becoming superhuman the way to do that is to remember you're only human and biohacking everyone referred to it as cheating it's not it's not cheating you're not cheating anything Francis Bacon said it best nature to be commanded must be obeyed you're obeying nature okay when you're following a paleo diet when you're doing what Dave Ashby tells you when you're doing what skylar tanner tells you you're being a good animal a cheetah doesn't have to count as calories a lion doesn't count as calories they're in perfect metabolic and physical condition without even thinking about it the same's true for us the reason it seems like such hard work is we've become so far removed from the evolutionary dictates that made us what we were meant to be the other thing you want to do is what I call black swan avoidance or my dirty dozen plus one so let's talk about them big car regardless of how you feel about the environment and global warming if you want to survive buy the biggest freaking vehicle you can afford take it from an ER doctor force is mass times acceleration at equal speed if you got the bigger car you win okay if you can't afford a really big car just make sure your biggest risk in a car accident is to suffocate from all the airbags okay that's the number one thing is going to kill you number two do not ever get on a four wheel ATV okay that means little four wheelers that you run around on the beach that means gators okay last week 11 year old child driving a gator dead okay I had to go tell the mother and mother let him drive the thing okay if you want to die if you want to get paralyzed you want to spend the rest of your life in a wheelchair far around on those things roads are for cars okay I'm a cyclist I was a road cyclist all through college okay I had some really close calls I've known two cyclists that were friends of mine that have been killed people jogging on the road so I'd get killed all the time people are idiots people have always been idiots and my friends that got killed was before text messaging was even invented okay so find a place to do it that doesn't involve you and traffic for a pilot what does pilot mean all right you have great success in life you become a neurosurgeon orthopedic surgeon internet guru you make your millions I'm gonna take up flying only fly if you're a professional pilot if you're a part-time pilot your skills are not going to manifest well enough for you to not crash that thing and kill yourself so if you're going to be a pilot be a professional pilot having said that though even if you're an amateur pilot your chances of dying are way smaller than this one okay heel dust what does that mean that means if you're walking down the sidewalk here on four street and you see a group of young men that appeared toxicated or acting puffed up and angry across to the other side of the street don't get your ego tied up in this you don't want to die you don't want to get beat to a pulp someone tries to have a confrontation to you with you it's great if you have a concealed weapon and you can defend yourself but the better choice is always to choke them with heel dust run away just stay out of it don't do it because here's the deal if you defend yourself and you kill them do you want to go into your court system over all that no run away gas grill if your gas grill won't start walk away okay I cannot tell you how many people I have sent out on a helicopter with third-degree burns over 80 percent of their body intubated going to the burn center because they just couldn't accept that the damn thing's not starting and they let it build up and lots of gas build up and they light it and poof okay by the way I highly recommend just getting a plain old fashion grill and using charcoal feet first if you're swimming and there's a body of water don't dive in it head first okay when I did this whole Tony Robbins thing where we went out we were going to be on a tv show and it didn't work out but one of the characters in the show whose life was devastated dove into a pool in Acapulco without looking and it was a bar side pool and there was an underwater bar stool there that was made out broke his neck paralyzed himself first day of his honeymoon okay always check how deep it is that you're diving into you go feet first figure it out then if you want to dive and it's deep enough go for it ladders this is the white man's scourge I have seen more middle-aged white dudes pine box themselves trying to hang a set of freaking Christmas lights or get a shingle off the roof or whatnot then I can shake a stick at I mean it is unbelievable okay don't keep don't get on ladders hire that out if you can hire anyone to get on a ladder for less money than you make per hour do it okay retirement home the reason I say this is if you're at retirement age and all of a sudden you've decided you want your dream home find it and buy it don't build it from scratch the number of people that have died from an acute myocardial infarction or cardiac arrhythmia and they're we live in a resort area so a lot of people come to build their dream home on the lake the number of people that have died as a result of the stress of fighting with the contractor and trying to build a home from scratch at retirement age is more than I can count it's a weekly occurrence now I may be some selection bias there but find one that's already built 10 is hell no okay so you're out of shopping center and someone comes up to you it's particularly true for women pulls a gun on you and says get in the car your answer is hell no you shoot me right here in this parking lot in front of everyone with the cameras on I ain't going do not ever get a car in a car at the point of a weapon you will most certainly die but not until you have really really suffered hell no bad relationships okay 15 percent of the population statistically speaking are psychotic antisocial personality disorders okay you're going to encounter some people and when you find your interaction with them is very fatiguing or makes you emotionally upset and that's a recurrent pattern ditch that person immediately I don't care if it's an employee or a close relationship or someone that you grew up with or a family member if that is the case get away from them antisocial psychopaths will suck the soul out of your body and kill you okay very fortunately or maybe unfortunately the vast majority of antisocial psychopaths are absorbed by politics the remainder going to crime which is just a different version of it and number 12 is the lottery don't play it don't do it unearned wealth will destroy you money is the biggest truth teller in the world and if you get money that you did not earn it will take you down you got it just google stories of lottery winners you don't want to win the lottery you want to be a millionaire you want to earn it you want to earn every penny of it then you can enjoy it you want to destroy your life be a lottery winner be an nfl player nfl stands for not for long the best thing that ever happened to keith norris was a career ending knee injury okay the average life expectancy of an nfl football player is 56 years and lastly be nice and what i meant to put on this slide and somehow nice came out was be kind how many of you have ever been in the presence of someone that has actively died one two three you're very privileged okay i have been in the presence of people that have actively died tens of thousands of times this ugly mug has been the last thing that more people have seen on the face of this earth than i even dare to think about being kind is the most important thing for your health it's the most important thing for you as an individual it's the most important thing for our society people talk about capitalism being dog eat dog it's bullshit the essence of capitalism is kindness and the essence of kindness is you do not initiate force against anyone that's the essence of kindness when i went down to starbucks and i ordered a grande americano the lady said that'll be $2.63 she swiped my credit card she gave me coffee i said thank you she said thank you she wanted my money more than she wanted the coffee i wanted the coffee more than she wanted her money mutually beneficial trade is kind you want to be kind you want to be kind in every realm one of the biggest dangers with kindness is dav talked about our forebrain and um greg talked about this huge forebrain that we have it's very important for communication and it's what's lacking when you communicate over the internet or over the cell phone or by text messaging there's a very strange version of stroke called abulia when you have a stroke in the frontal lobe of your brain i can walk up and talk to the patient i speak to them and they just look at me with this deadpan face and their answer doesn't come out till 10 to 15 minutes after i asked the question but i can give them a cell phone and call them step outside the room and get a complete history from them because they're communicating in a mechanism that does not involve facial recognition and the prefrontal lobes of the brain okay realize that when you're communicating over the internet and when you're flaming someone on the internet and you're getting in these little pissing matches that you're not engaging your frontal lobe you're saying things that you would never say to someone's face because you know damn well you're likely to get punched or killed kindness matters because we all must die and no matter how you try to extend your life ultimately unless we figure something out which we may well we all must die and i'll leave you with the words of ron harris who wrote the end of faith and he said this he said consider it every person you have ever met every person you will pass in the street today is going to die living long of us living long enough each of us will suffer the loss of friends and family all are going to lose everything they love in this world why would one want to be anything but kind in the meantime the other thing is how many of you have had a personal near-death experience it's a weird thing, isn't it because all of a sudden particularly when you're young you see this huge life spanning out in front of you when you have a near-death experience it's like being a little kid holding a balloon and the balloon gets away from you and it's going and there's nothing you can do about it and it's over so being kind is everything and it's the essence of a civil society and is the essence of capitalism and that's what i advocate kindness capitalism free trade free humans is what will make medicine great again in the meantime stay out of the belly of the beast i thank you for your attention i will answer questions on any topic whether it be medicine exercise diet or anything you want to talk about i appreciate your attention questions yes sir i just wanted to comment that i was in wal-mart the other day and it really has become a caricature of insanity i mean you walk in and there's the your isle of donuts and then your isle of heartburn medication and then your isle of blood pressure reducing medication and it's just it's it's not cartoonish anymore it's actually a reality i was wondering if you what you thought of that and if you've seen it well you go where the money is and when you start when you distort market forces that's what you get and these all feed on each other in a very pathological way and you know wal-mart is kind of the er without the acute illness and and you look at these people it's like how do you get that way what you know what would you have to do to become that debased and diseased and my answer is always nothing all you have to do is nothing entropy to be battled requires the input of energy on your part on a day by day basis that is the essence of life is fighting entropy the moment you're born you're dying and the only way you stop dying is by fighting entropy and that requires the input of energy you want to turn into that all you got to do is nothing yes sir oh go ahead i'm sorry let the guy with the microphone pick thank you for that talk i thought it was very informative appreciate now given the context of this conference could you speak about maybe a 14th rule of how to protect yourselves in sexual relations as well can you be more specific what do you mean in terms of yeah i mean anything as far as if we're just i mean i'm not even talking about if we scientifically speaking if you say you might get AIDS people naturally jump to the other side and think oh i will never get AIDS i'm not going to worry about it yeah i mean could you just speak on let's say maybe numerically how likely you are or what sexual acts you should probably avoid unless you're trying to have fun well here's the real deal is first is you got to check your own motivations i always tell people the best way to find the woman of your dreams is to pursue your values okay not going out to a club not hanging out in the grocery store and you know shopping in the cucumber aisle or whatever but to actually pursue your highest values in terms of work and what you want go after what you want selfishly and there's where you'll find your soulmate there's where you'll find someone that you can do anything sexually with to express your true value about yourself and about them without running the risk of disease now if you want to get laid wear a condom okay and really in terms of any sexual activity they're all of significant risk because you're going to exchange bodily fluids and your biggest risk is not HIV and the vast majority of people that have HIV don't get AIDS now because of the retroviral therapies that we're using people live productive lifelong lives with HIV your biggest risk is risk is hepatitis C which most people are carriers of and aren't even aware of so if you're going to do it that way use a condom use a condom for everything be it but short of that go after your life don't wait okay the best advice I ever got was from a woman on her 100th birthday party and we said speech speech give us some words of wisdom she said I got three words for you do it now okay so go after your life's values and without even seeking it out your highest value and a female that you can do anything you want to actually with will appear that's my advice yes can you speak to someone who's self-employed healthy young what are their insurance options and what would you recommend currently my best recommendation for you is to buy a catastrophic only policy with a very high deductible you can fund that through a HSA or healthcare savings account I don't even bother with that I just set aside $5,000 and say okay if I have to meet that deductible so I buy an insurance policy that has a huge deductible five ten thousand dollars whatever and the moment you've paid that deductible it kicks in for a hundred percent that's what I would do in the meantime how that's going to pan out as a possibility for you in 2014 I'm not certain the other thing people don't understand about Obamacare is they think oh all these changes don't take place into 2014 please we've anticipated this coming forever you think you just flip a switch and all of a sudden we're in Obamacare the infrastructure the computing everything required to comply with this hugely intricate law you can go on the hhs.org website and pull up the actual law and see the thousands upon thousands of pages I mean it takes huge computing infrastructure to be able to deal with that and to comply with that we're already practicing under Obamacare since 2010 the moment that was signed in the law the race was on we've been doing it we're already there so but what happens once the enforcement component of that comes may determine whether you're able to do that or not yes sir I really enjoyed your talk today thank you very much and I wanted to actually ask you about the health care systems in some other countries like Australia or even the Scandinavian countries like nowhere in Sweden those countries are not bankrupt and their health care systems seems to be doing pretty well and it does take care of the whole population for almost free so I wanted to ask you how why our country or why the United States how did our system get so screwed up and well I just kind of detailed for you but let me address your question the first thing is that it's almost free it's not nothing's free in the countries where socialized medical care appears to be working you know smaller European countries Singapore you got to take into account that these are small countries with a homogeneous population okay and they're small countries with a homogeneous population that have significant capital either because of their natural resources or their inherent productivity but without exception every single socialized medical care system even the ones that appear to be successful and that people are happy with are deficit funded okay and the problem with deficit funding is that accelerates over time so eventually even in the countries with small homogeneous populations where it stands a chance of working it eventually falls apart they're just in the earlier stages of it and they got more time to buy their time Canada's often held up as a you know what we should be aiming for okay they have completely outlawed any outside their system care and I advise you just get on your computer and put in WCWL.org Western Canada waiting list.org and you will see all the mandates and you will see all the different wait times for particular health conditions when I was in the Air Force in Ohio I moonlit and in the ERs there every time I moonlit I would have someone from Canada come in that was waiting cardiac bypass excuse me having unstable angina that would come across the border and then just show up in an ER because well we have in Tallah because they probably were not going to survive until the waiting list was over so you think oh so there's you know a four to twelve week wait for a hip fracture sometimes it's eighteen weeks yeah no big deal you know we kind of take care of grandma until you know the the quote is met and she can have her surgery well guess what in that period of time she develops an open fracture sends out huge inflammatory mediators which signals for thrombosis we got to put a clot on top of this broken bone to keep from hemorrhaging through the bone marrow so all these inflammatory mediators for blood clots go out guess what grandma gets a deep venus thrombosis and while she's waiting for her hip surgery pops of pulmonary embolism big enough to block her pulmonary artery cardiac arrest grandma's dead these are the unseen consequences that never gets counted in the statistics no one ever blames the healthcare system grandma just died the guy had an M.I. and died while he was waiting for his bypass no one blames the weight on the death but it happens and it's happening every day so but if you're in a small enough population in a homogenous enough tight enough constrained area you can hide those invisible consequences even more easily so even the places where it seems to work you don't want any part of it even if it appears or feels free we're done okay guys thank you