 Believe it or not even though we are a state that is proud has a proud model of live free and die Well in healthcare you don't in New Hampshire. It's it is not free And there's not a lot of choice It's a matter of fact New Hampshire is the poster child of what is wrong in healthcare Okay, and I'll show you Some statistics that will support that but it's unfortunate. We have a great state and I was born raised here and and I can say that from the heart, but without question We are what it's wrong. We are the poster child of what is wrong in healthcare. Here's a slide of the Korean Peninsula and north of You have a lit section and you have a dark section the power of the free market freedom free market free choice Okay, it is essential to health care and improving health care the definition of free market is basically a system Where private businesses compete and as a result of competition and choice you get a Natural checks and balance on pricing where a price of whatever you purchase is a reflection of its cost Well, guess what and health care that doesn't exist at all and you will see that Okay, what we pay for health care services is no reflection of what it actually costs Because health care is void of free market principles The power of the free market I actually feel I'm speaking to like-minded people. So I'm gonna give you ammunition when you go out to Talk about the free market in health care Think about it Here are like people genetically culturally but one group lives under communism and Another group lives in a free market capitalistic system and Look at the difference You have a people you have a vibrant economy and Then you have one that is totally sleeping lights are out Okay, it's powerful It really it is what makes our country great and for some darn reason We're afraid to apply free market principles in health care. Here's the cost of care These are premiums and deductibles are rising faster than wages over the past decade. No surprise. You're all living it and Basically, what's happening is that even though people are getting raises Total their total compensation or take-home pay is not really risen They're paying more into their premiums Keep in mind Insurance premiums are part of compensation that all started the problem started in World War World War II when Basically, there were ways for wage freezes and the only way you could attract employees or compete for employees was to Offer them benefits as part of total compensation so What's happening today people are basically, you know, they're Purchase power capability is pretty much flat line because of the cost of premiums But what's also interesting here is that deductibles have gone up So think about that Right your your premiums have gone up. You think you're paying more and you're gonna get more. Well, guess what you're getting less We're in a system today where people are self-insured Except for catastrophes. All right leading cause of bankruptcy Anyone know Yeah, medical care healthcare How awful is that? That's the evil of the system we are in it bankrupts people. I like this life. Where's the money going? But I do not want to have you conclude that there's a big insurance problem. I Actually see insurance companies as the middleman Okay, they just passed my and they're not taking risk. You are the employer is All right, but look look since the affordable care act 2010 Stock at Anthem was sixty three dollars. Look what it is today. This is today 381 dollars sigma so these are the big four right affordable care act 37 bucks hope some of you invest in these companies All right sock today is 239 bucks United This was a great investment 33 dollars when affordable care act started and Now it's almost 400 bucks a share so and Let's beat on Humana. All right. They were 49 bucks share now the 415 That's incredible You really think about it and everyone thought when the affordable care act was passed At the this would have crushed the insurance companies The opposite happened what many people did not realize is that in your premium dollars if you are commercially insured Party of premium dollars goes to pay off insurance companies. I believe it's a five or six percent Immediate of your premium goes right to them. Basically, they bought them off so they would not Lobby against the passing of the affordable care act keep in mind and only passed by one vote Okay, so there was a lot of shenanigans going on to make sure that it happened. I love this slide price changes in United States as a result of goods now there's a common theme between The green if you may and the reddish Okay, can anyone pick it out? There you go Smart guy Very good. Look look at this Wherever the government is involved Free market principles Go awry Okay, and where the free market exists you actually get price depression Can you imagine if we just could say you know it the the cost curve, you know only went up like 10% Okay, it'd be you know if we even can flat line the cost of health care All right, it's the health care. It's the cost of health care It's not the you know everyone's pointing to the insurance company in premiums. It is not that The cost of care the delivery of care is insane. It is broken and These institutions keep expanding and you know why? They get paid more There's no financial reason for a college large university with a large endowment or a hospital system to stop constructing and With construction comes more people more utilities and so on and so forth Joe Manorisi talked about a couple services in health care that actually have not gone up in price Plastic surgery and corrective eye care. Does anybody know why? That's all right, it's not a covered benefit. It's cash only But cash only Isn't really the real real reason All right, the real reason is it's not a covered benefit. It's not mandated So what happens? The patient has an incentive to ask What does it cost me? health care went off the tracks around 1970 when insurance companies Got between the patient and the doctor some of you are old enough to remember When you went to the doctor or when you got a health care service, you actually received the bill You were able to make a value judgment at the time of care to say, you know what? This was worth it or it wasn't then you got the bill you paid the bill You turned around and submitted the receipt to your insurance company and they reimbursed Okay, on basically what was what was reasonable and customary was the term Okay, but the the beauty of that situation was you were now an informed individual who can make a value judgment All right, Jeff's example go to the doctor. You don't even know what the hell you're paying for all right no idea none or The person down the street what they're charging no idea Can you imagine if you had to make a value you could make a value judgment meaning you went to the doctor today in The metric for patient time face-to-face is 15 minutes How ridiculous is that and then you just had you just got billed for 250 bucks You'd go out of your mind But that doesn't happen You would say this visit wasn't worth it You didn't even put a hand on me So back to corrective eye surgery and plastic surgery what also happens in those events is that there's a in the plastic surgery It's a bundled payment that at that surgeon actually goes out and negotiates with the surgical center With the implant center depending on the procedure Okay All the parts of the transaction Okay, and he puts together a transparent price So that you see you'll know what your boobs are gonna cost so your facelifts gonna cost or whatever Okay It's true So but you use you in you shop You know Just got divorced. I think I knew a new set you get out and right you get on the internet and you go out and shop Okay And You make a value judgment Okay, and guess what the cost of plastic surgery in the last 10 years This is hardly risen at all. I wish we could say that for other elective cares Against the power of the free market Believe in it. It's what makes us great It's what we need You want to see chaos? So recently we launched the company called bizarre basically it's a technology solution Bring the free market into health care okay, I've been dabbling not that way I've been working hard in the last eight years in creating transparency in health care and Making informed consumers out of all of you These are these in New Hampshire prices. These are real prices. These are note. There's no lie here Okay, and these are bundled payments. This is all in All right MRI Negotiate a price $900 for czar average hospital price $3,250 that's average could pay as much as $5,000 Okay, the price difference on average is $2,350 Now if you're in a $5,000 deductible or 10,000 family, don't you want to know or if you're an employer Who was self-insured and you are paying dollar for dollar every claim or your municipality? You like to stay in New Hampshire city of Manchester. I think you'd want to know What your employees Are paying for as you eventually we will be paying for look at a total knee replacement though For those of us in that age group All right all in and I can say this I'm a health care provider I'm a CEO of three ambulatory surgical centers and proud to tell you we replace knees We do spine work now technology is a lot of us to do many many larger Procedures and on outpatient basis But look at that Savings average savings of $36,000 Wint you want to know as an employer? Lumbar decompression Basically people with back problems One procedure that's not up here, and I don't see is a colonoscopy most common procedure done I won't ask who's had colonoscopies here, but You should be proud It's a great procedure. It's very important. Okay Average price in our market southern New Hampshire all in is close to $10,000 Yet there are various surgical centers that can do it for $2,200 You know what the evil of that is People with high deductibles They can't get a screening for cancer We talk about the merits of having a colonoscopy and preventing cancer But people can't afford it and so Again, what's going on is evil the price of health care Remember this the price of health care is the leading obstacle to access to care and there are solutions And you know again, I'm speaking to like-minded people It is the free market and elective care and I'll be the first to tell you not all of health care Will be solved by the free market, but a whole hell of a lot of it will be elective elective care by the way as care is when you have time to make a decision it's not emergent Okay, and you have time and you need you think you need care. Okay, that is elective care So these are things that are obstacles to the free market When again the free market you need an informed consumer There's a lack of transparency President Trump put out a mandate for hospitals to start posting their prices And guess what they can happen Number one number two Even if they post your price, it isn't the whole story That may be just a facility fee Well, let's talk about the knee transplant on the knee implant You have right the knee surgery total knee replacement. You have your facility. You have the sthesis Okay, you have the surgeon you have the anesthesia group You may have lab Okay, and other Ancillary services So just posting one line item is like buying a car just for the chassis Okay, what about the rest of it and Believe it or not the shenanigans that are played in health. You may see an affordable facility fee But I've seen implant costs range from four thousand to fourteen thousand And there is no scientific difference no medical difference in the implant whatsoever, okay There's a lack of transparency big time and It is actually going to take health care providers who provide who build cars Okay, you build health care services to step up at a plate But they don't want them These large hospital systems have it well Their increase in reimbursement goes up every year and the insurance companies Maybe they don't care. They just pass that risk on to you or the employer Because they get ten percent by law of whatever the medical costs over the medical costs So as medical costs go up Their income goes up guaranteed This chaos is guaranteed to keep happening unless we intervene Who's we that's the biggest question who is we? Anyone know who's pay who actually pays for premiums People or Joe Employers Yeah, we have an employer sponsor health care system Which actually puts you the patient and the consumer further away From decision-making Many my employees have no idea what the coverage is None usually it's the wives who know because they're taking the kids right husband's Gonzo Really? Okay, unless they go for breast implants. No those husbands will know You never know these days All right So these are factors, you know again cost of care what we pay for prices is no reflection of its cost and It's just complicated by design By design and these poor doctors, you know, we're sucking the life blood out of them They're losing their passion because of the technology the haranguant to ask permission to operate I'll give you an anecdotal story. My brother's a surgeon and he's got a patient who's got a frozen shoulder and The interesting part about shoulders Is that you know, they are painful? How many have had rotator cuff repair? You'll not glad you can put your hands up The fact of the matter is He's a he's got a lady They're mid 50s. She's got a frozen shoulder. She needs surgery ASAP he has to call Some admit some intervene her mother may I system that the insurance company requires He's on the phone for 15 minutes explaining the procedure and my brother can tell all of a sudden that He's supposed to be speaking to appear. He can tell he's not speaking to appear And my brother asks what kind of physician are you? I'm a podiatrist Now this is real and discuss my brother's just hangs up Go to the patient says listen. I Just been on the phone for 15 minutes with a podiatrist ask permission to get permission operate on your shoulder You need show the surgery you go talk to your health plan and get permission And when you and when you get permission, I'll be more than happy to operate These poor docs they're getting Really really tired and there's another insidious evil in this whole dialogue One of my personal missions is to preserve private practice Because the people that are in private practice the doctors that are in private practice who have not thrown up their arms and Capitulated to the large health care systems that they compete with and yet offer far better care at a far lower price point Okay, what's going on is just seeing consolidations as Joe talked about Okay, where the guys in private practice who pay taxes these big block stores of health care don't Okay, and they compete with them and so if we don't solve for what's going on because physician Salaries haven't hasn't gone up their overhead has We don't solve for this Private practice will become extinct and that trend is going on and that will be the worst of all evils Because it is the person in private practice who feels the pressure every day to compete Who stays impressed on what's what the hell's going on who will spend time with you? and When you ask to see them they will see you if we don't Get this thing going in the right direction this issue in the right direction private practice will become extinct so Anyways, it's great talking to you. All right. I am optimistic about the future. I really really am Okay, you'll hear more about bizarre because we do have a solution. Okay, we really do so again. Thank you