Why Is Healthcare So Expensive? Dr. Tony Dale

Show notes

Why Is Healthcare So Expensive? Dr. Tony Dale on Fixing It From the Inside Out

Why is healthcare so expensive in the U.S.? Physician and entrepreneur Dr. Tony Dale, author of The Cure for Healthcare and co-founder of Sedera, joins Dr. John Oberg and Randy Lorensen to explain what's broken and what patients can do.

A knee injury pulled Tony from clinical medicine into the economics of healthcare. He explains who the system fails (mostly people in the middle), the middlemen behind rising costs, and why the U.S. spends far more per person than other countries. The three also debate whether healthcare is a right and compare socialized medicine with the U.S. system.

After the break, the focus turns to patients. Tony explains what insurance actually is, and uses an oil-change analogy to show why most health insurance isn't really insurance. He covers shopping for an MRI, paying cash for labs, asking for the price, and what employers can do.

He closes with direct primary care, how to choose a doctor, curiosity as a tool, and medical cost sharing as a way to bear one another's burdens.

Direct Primary Care, Medical Cost Sharing and What Patients Can Do

What you'll discover:

Why U.S. healthcare costs so much, and who the system fails
Is healthcare a right? Socialized medicine versus U.S. medicine
What insurance really is, and the oil-change analogy
How to shop for care and ask for the cash price
Direct primary care: what it costs and how to choose a doctor
Medical cost sharing as an alternative

This episode is for educational purposes only and isn't medical advice.

Timestamps

[00:00] Welcome Dr. Tony Dale
[01:31] A knee injury that started it all
[02:54] From clinical medicine to healthcare economics
[04:18] Who the system fails: the middle
[05:43] Middlemen, drug prices and hospital costs
[07:09] Technology and other cost drivers
[08:32] The Cure for Healthcare
[09:54] When health became the top priority
[14:07] Is healthcare a right?
[16:55] The right to life and life-saving care
[18:19] Access to care around the world
[21:06] Lessons from his early career
[23:53] Socialized medicine versus U.S. medicine
[26:40] Why the U.S. spends nearly twice as much per person
[29:28] What England gets right
[32:16] Rigor in published research
[35:05] A gift given freely versus something taken
[37:50] What can patients do?
[39:13] What insurance is, and what health insurance isn't
[41:59] The oil-change analogy
[43:21] When doctors go outside the system
[46:10] Shopping for an MRI
[48:57] Paying cash for labs
[50:19] Billing practices on both sides
[53:11] Most people in healthcare mean well
[54:36] A surprising bill
[57:26] What employers can do
[1:01:38] Asking for the price
[1:03:00] Probing and asking questions
[1:05:48] Hospital cash prices
[1:09:58] Clinical quality
[1:11:22] What direct primary care costs
[1:12:45] Choosing a direct primary care doctor
[1:14:07] Alternatives to the latest drug
[1:16:53] How long research takes to reach practice
[1:18:16] Big takeaways
[1:19:40] Curiosity as a tool
[1:21:04] Medical cost sharing: bearing one another's burdens
[1:22:27] Cost sharing and the Affordable Care Act
[1:25:15] True insurance
[1:28:01] Wrap-up

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About Dr. Tony Dale

Dr. Tony Dale is a physician and entrepreneur, the author of The Cure for Healthcare, and a co-founder of Sedera Health. He's a longtime friend of the hosts.

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Related episodes

Meet the hosts: Randy Lorensen · Dr. John Oberg · Anthony Marino

Transcript

A full transcript is below. It was generated automatically from the episode audio, so expect some spelling errors in names and terms.

[00:07] abundance I am Dr. John Oberg joining me as always my co-host Randy Lorensen Randy big question today why settle for less that is a good question yeah and I don't have a single good reason for you okay we let's not settle for less all right very good I'm excited about today's episode I've known Tony Dale a long time you known Tony a long time too yeah yeah yeah so so full disclosure for the listeners here so Tony and I have worked together for a long time uh Tony welcome to the show we're so glad to have you thank you so much it's a delight to be here uh rule number one no telling where the the bodies are buried I've long since forgotten at my age that is the right answer that is the right answer T Tony and I started a company called sedera Health back in was it 2014 that 2014 officially started although we started before that uh we we began thinking around it yeah way way before then yeah what what an amazing uh ride we've had with that company and we're here to talk about Healthcare and so it's worth noting Tony is a medical doctor trained in uh Great Britain correct in London in London Royal Hospital of St Bartholomew yeah and and it really has an amazing story of mission work and how Mission and Medicine fit together and uh at some point we'll have you back and tell the whole story of how your family ended up here in the US really amazing uh but you've been working in healthcare and it started with a knee injury uh it did start with a knee injury that was back I think in 1996 yeah tell tell us the story real quick okay well I was even in those days which I guess is 30 years almost now I was trying to keep up with the kids on the basketball court and failing uh you can still beat them in tennis by the way I know that uh no in in pickle ball pickle okay yeah pickle ball um but uh anyway I I tore my medial miniscus that's one of the sort of cushioning cartilage inside your knee uh went to see an orthopedic surgeon because I I knew pretty much for sure what was going on he confirmed it MRI Etc and uh so because uh I I was an immigrant and uh looking after myself for healthc care uh I was very concerned what it might cost and I asked him and he told me it would cost about $2,000 uh now he didn't lie to me uh but almost $155,000 and we're talking 1996 terms so maybe more like $40,000 now uh that's when the bills stopped coming and what he meant was he was going to charge you $2,000 he was going to charge me $2,000 he forgot about the anesthesiologist and the operating room and the nurses and whoever else charges you in these things he he did I guess he thought like most doctors I'm not interested in really what the cost is I'm here trying to help help you on the clinical side uh but I was interested on the uh on the economic side uh and and so it made a big difference to me what it was going to cost yeah and you've showed charts when you've talked about these types of issues that we're going to get into today today we're going to talk about the Health Care system and we're going to talk about um everyone I think agrees the Health Care system is broken from one perspective or another there's lots of people so we're not going to kind of get into that debate and and there's lots of different people that think about like um philosophical ways to fix the system today we want to dive into the ways that each individual can find their own abundance inside of a scenario and so you showed charts about what discretionary income has been spent on Healthcare in the mid90s and today are you able to you know charts I'm talking about where you talk about how much discretionary income the person an American should have and how much they really do have and how healthare costs have grown can you speak to that for a minute I I I can I I think the simplest way to think of it is that in terms of real uh money that you or I have disposable all of that money over the last 30 years years uh has been going into the increasing cost of Health Care so we've had increasing discretionary income As Americans and all of that increase has actually not been felt by us because it's being spent in healthcare instead uh for let's call call it broadly speaking everybody in the middle class not for the real poor not for the real Rich okay uh but for almost everybody else in the middle whatever increases in income they might have have has been gobbled up by their medical and that's just because the Physicians are getting paid better uh I think you'll find most of my physician colleagues would hotly decry that idea I think it's not true I was just being provocative yes complete completely agree with you that that is not the case yeah it's not clinical care no uh it I mean to go into this in any depth uh is probably what we're going to find ourselves talking about this morning but uh no the uh it's definitely not because medical incomes have dri atically gone out it's because of all sorts of other things yeah and and so well hold on for the listener such as because I think I think the average person is they don't do the research you did right they go in the bills more they complain they assume it goes to the doctor and the aage the average person listening doesn't know where it goes so where does it go okay well it goes to all sorts of places and we're looking at everything from what it cost to provide health care for all the people who aren't paying for it out of their own pocket uh to what the employers are having to provide through the health insurance they provide for their employees to what anything from the pharmacy benefit managers who are a group of middlemen in the middle of what goes on with the increasing drug costs uh to what the hospital systems are are doing to make sure that they maintain their uh revenue streams uh but also when you get behind that when you start looking at the ownership of the home Hospital Systems uh and then when you look at what that has done to the doctors because the ownership uh of let's call it the infrastructure of Health Care uh is increasingly not owned by any doctors but it's owned by all sorts of other entities so when you look at what they're doing to increase their profits that that's all a part of the system so what I'm hearing from the outside because I don't have the same understanding of this as the two of you it's a whole bunch of middlemen between patient and the actual provider middlemen middle women bureaucracy in middle yes that again that's just part of it so I mean you talk about bureaucracy uh I think the increase in the number of non-medical people who take part in your health care has dramatically escalated and the charts on that are you know just astounding over the last 30 years uh so yes uh you know know what whatever bureaucracy gets its hands on it becomes self reinforcing and becomes more and more bloated over time uh but there are other things that we have to be equally aware of the increase in technology uh has dramatically increased the number of avenues where things can become expensive uh and that has an impact that you have to think about and think through because I'm not saying the technology is bad uh but if the difference between having an MRI and not having an MRI is almost negligible in terms of how you're going to be treated then do you have the MRI because for one person in 10,000 it'll discover something else that's going on that's important uh and you have to look at all of these things and they're impact on the healthare cost an MRI versus an x-ray where an x-ray may be good enough you know yes and and then you know people you know people I've heard people ask like if if I can have a million doll drug that extends My Life by a month at the end of my life doesn't everyone have a right to that and then you get into a conversation about healthc care rights and then death panels and it's it understandably spirals into very difficult complex conversations quickly a lot of which you uncover in your book the cure for healthcare you talk a lot about these conversations and ways that that an individual and groups of people can and find more abundance in the healthcare system and start to solve some of these problems themselves uh I I do and you know the the title is the cure for healthcare was deliberate uh because it's not a one- siiz fits all but it is a each one of us must begin to take meaningful personal responsibility for what's going on in our lives and the starting place for curing Health Care is why don't we just healthy yeah that's near and dear to my heart obviously with some of the work that I'm doing but that um easier said than done uh definitely easier said than done you know when I uh more recently injured my back and it ended up in surgery uh you know recovering from that process at that point the surgery I was 73 I guess no 72 um you know you take two or three months off let alone almost a year that I had not had any serious exercise because of what was going on in my back um it's it's a tough choice to decide I've got to get back to being as fit or maybe fitter than I was before yeah but it's worth every part of the energy and effort that you put into it but it sucks I mean I'm talking from firsthand experience I took off maybe not a year more like 10 years um and I just I was you know 60 pounds overweight and uh and in health my my own personal health was like number two or three on my priority list and it didn't change for years until it became like the number one most important thing I was going to work on for a year and I got really serious about it and it was it it was physically difficult it it is but you know pretty much all choices are difficult yeah uh and uh the choice to be healthy is one of those that uh takes takes time it takes dedication it takes commitment and there's going to be pain associated with it absolutely including economic pain yeah what's the what's the saying the uh the the easy choice now is makes things worse in the long run and the hard choice now usually makes things easier in the long run I'm screwing up saying but that's the I think that's right of it I think that applies to health and working out and fitness and everything with it yeah there's trade-offs right and I think I think I was talking to one of my kids recently about um comfort and and whether Comfort was the goal or not the goal and so um I I think comfort in seasons and for moments is a good thing but I think that if Comfort is the end all Beall you can really end up in a bad place um and I was talking to someone even this morning about the different types of stress we experience in our bodies and our lives and distress being bad stress and UST stress being positive stress that happens when you lift weights and do you know you grow your mental resiliency you you experience EU stress UST stress and that we don't talk in those terms often enough and certainly I didn't teach my kids about the differences in UST stress and distress in those terms growing up but understanding how to lean into healthy stress for the benefit of growth like we do when we're lifting weights or building mental resilience or emotional resilience anyway I think I think there's a whole lot there we could unpack maybe at a different time so Tony let's let's back up to the Health Care system because I think you know Randy and I want the listener to leave this episode with like what can we do to impact uh you know this kind of ball of twine that's tangled up today there's as I thought through today I was thinking there's three big stakeholder groups inside of healthcare you have the patient you've got the provider and that can be a doctor a hospital you know all the people that invest in that all that stuff and you've got the payer which is like the insurance company the tpas the investors in those companies those are like the three big stakeholder sets as I saw it is that similar to the way you see the world um it would be similar I would probably add others um uh you know philosophically speaking the role of government in healthcare pretty much all over the world is going to have some significant impact in terms of how it's handled yeah I thought about them as a payer but you're talking about as a regulator yes yeah okay that's great I mean call they're they're creating an environment in which this all operates uh so I think that's important uh but no I think your your focus uh and the first one you called uh you know called out is the patient yeah I think that's the place to start because when we are willing to take responsibility for our own health care so being healthy and then the care we need in when situations beyond our control you know come our way which they will to everybody uh then that's going to make a huge difference to what goes on and I think when I when I talk to patients about this in in our Medical Clinic one of the things I call out is just I acknowledge like we're in a system that's tough and and you can agree it's it's a terrible system but the best in the world or you could think it's the worst in the world that doesn't change the fact it's the system we're in and making the best of a bad situation is still there there are things within our control and things not within our control and if we focus our energy on the things we can control we at least have a hope of making a difference we we certainly do and uh there's an awful lot that we can choose to bring into our control uh whether you're talking about you know the physical fitness and other things you know to to help create a healthy lifestyle or whether you're talking about you know just sensible economic planning uh and you know a lot of this comes back to philosophic questions um you know many people try to describe healthc care as a right um I don't know I I I have my own question marks on that and that's speaking as a physician and as someone who comes from a line of Physicians most of us you know in terms of my lineage uh Physicians who chose to be involved in missions work and working with the poor or working with people in countries where there are far less privileges than we have over here uh and you know when over here we try and Define it as a right usually mean what we mean by that is we want someone else to take responsibility no rights come with responsibilities uh and we need to start with what's my responsibility yes A friend of mine recently said you can have you can make how I'm going to screw it up but essentially he said is you can create an environment where everyone gets an equal starting place or you can create an environment where everyone gets an equal ending place but it's really impossible to create an environment where everyone gets the same starting place and the start the same ending Place yeah and look when I look at this I see the people that are saying it's a right are rightfully in my opinion they're upset with the system we have and they think it's not fair right and why does a rich person get better health care than a poor person and and they're they're angry I think they're angry at the wrong thing and they don't un they just they don't understand and you know my answer to them or my question I guess to anybody that thinks that is for it to be a right somebody has to provide it you're asking somebody else to do the work whether it's the physician the administrator in the hospital whoever and my real question about rights would be what percentage of their work do you have a right to right without paying it which is a well I I love the way the American you know Founders put put this they say we have the right the life liberty and the pursuit of happiness okay that's that's really putting the responsibility I think pretty clearly uh on each of us and you know in in more sort of economic terms or the sort of language that is used nowadays there's an awful lot of talk about Equity rather than equality uh and uh we need equal opportunity that doesn't mean we're all going to end up the same place because we're not all choosing to do the same things uh and you know there are many things I've given up so I can do the things that I do do and so I don't gain the capabilities or the opportunities that others do in some areas but then I create new and fresh opportunities for what I believe I'm called but isn't I mean I'm going to play The Devil's Advocate and so it's like but the right to life means that if if there's life saving care and I'm an American paying you know taxes or you know or just a citizen here don't don't I have a right to life-saving care well uh maybe and maybe not um I mean let let's go to the other end of that question which would be end of life uh all of us are going to come to a place where uh you know our life is going to end uh can I rail at God that he's decided that my time is over uh I guess you can rail at him but it's not not going to make any difference uh you know that's that's just part of the world that we live in uh and so the idea that something is a right uh to me talks more to my obligation to fulfill what that right might provide rather than someone else's obligation towards me so that I mean that would be a place I think others might have a philosophical difference with you yeah yeah and we can get into a whole debate about that absolutely but but so I'm going to go back to like but if I'm if I'm sick and I'm at the emergency room like the government has said that if I show up in an ER I need to be treated if life-threatening I think that's totally appropriate in a society that can afford it and here in the states we can absolutely afford it uh but I've spent a lot of time in you know the Far East and in Africa and other places uh and for most of the world uh they would love to have access even to the most basic of Medical Care uh but it isn't an inherent right in that sense as their societies become more affluent uh as they begin to take a greater responsibility for the poor among them and whatever uh you know that different societies are going to need uh then people will begin to experience some of these blessings of abundance okay but it doesn't come without a price and America has paid a price over centuries to develop a system where people have access to all sorts of things now you know when we then look at that and we talk about what is their right um even that's not simple uh you know does a person have a right to endless abundant care uh because that right can get unbelievably expensive in our countries you know the Western sort of societies where we have access to an extraordinary abundance of medic IAL care uh but much of it is I would describe as in a gray area between uh what we absolutely need and what is only going to be available for people who you know have themselves have unlimited resources yeah I I think that's I mean there's a whole bunch of things to unpack there right I think my um my father-in-law passed away you know relatively recently and uh heart condition and he was in a card ICU and there was a number of procedures they could have done to try to revive and bring him out of a a coma um but the percentage chance was so infantes low and and we knew that he was not in a place where he would want that type of thing done and so the cost wasn't the determining Factor but the reality is that we probably could have spent a million dollars in taxpayer money hoping for something that was statistically not going like you know less than % or something like that and you talked earlier about like one in 10,000 like um that so I think the family made the right call based on the you know the father's wishes but there are a lot of Physicians who um would question how much end of Life Care is appropriate you know that the these are difficult areas and maybe I could tell you a story um when I first qualified for Medical School uh going into my sort of internship time uh my first rotation was uh in the whole sort of General era area of medicine as compared to surgery uh and I worked for a really fine physician who was absolutely awesome with the patients but I noticed very early on he would never be honest with the patients about the fact that they were dying uh and so one day you know having worked with him now for three four five months uh I pulled him aside and I I said you know sir because you know I'm I'm very Junior I'm at the bottom of the totem pole in terms of a qualified doctor he's super experienced I'm way more competent than I am uh but I said you know sir I noticed that you know even with these patients who from our point of view are obviously dying you never talk with them about that you never help them prepare for that uh and he said oh I'm I'm frightened to talk to people about that now I I have to be a person of faith I you know I take my my faith in Jesus very seriously uh and it immediately made me think of a verse I think it comes in Hebrews where it says that uh Satan through fear of death Keeps Us subject to lifelong bondage and I thought wow that is so true for patience uh almost every patient facing surgery is terrified even though that they know the surgeon is a great you know surgeon it's org they're they're terrified because of what they're going through and putting their life so to speak in someone else's hands even more so when you move into end of life stuff people are terrified because they don't know what's coming sure and so if we don't deal with some of the fundamental questions then we try to cover them up with false hope uh and the endless money and the endless Medical Care spent to prolong life for a week a month a year is Raising all sorts of challenging economic questions that wouldn't be there in a context where actually to do well in this life is great but to do well in the next is even better so I want to come back to that in a minute I want to kind of keep going I want to dive deeper into what some people are terming death panels and and how we kind of because you know at the end of life where someone is certain to die in the next day it's easy to make that decision but where you have a younger patient where like that that gets to be a real Sticky Wicket really quickly a lot of people think this has been solved by socialized medicine in other countries and um is is it uh Ezekiel Emanuel or Emanuel Ezekiel what Ezekiel Ezekiel Emanuel who is a real expert in the space around like different Health Care Systems around the world he's written a book talking about the pros and cons of different Health Care Systems would you say that um Americans generally have a really good understanding of socialized medicine versus US medicine or there are some myths we should bust today to help people understand kind of what what the reality is in other parts of the world and then what we can do to to kind of take better agency over our own experience okay that that's a really great question John and um let let me try and answer it by saying I come from a socialized medical system so the British system the National Health Service you know if you think back to the the London Olympics in 2012 all the banners that were everywhere for the world to see on the televisions was you know how proud Britain was of the NHS and yet here we are you know just 12 years past that 13 years past that uh and it's crumbling at the scenes uh it actually began in 1948 uh and there was enormous hope uh and it has produced something at some level much fairer uh and one of the things I loved about my experience of the British Health System uh was I never met someone who lost their home uh over an illness yeah you know th those sort of decisions those are some really good things that happen but does it produce Better Health Care I think you probably see more English people trying to come over to America to get health care if they can afford it than you do Americans going over to England to get health care even though they can afford it does England have a private Health Care system that lays on top of the socialized system it does why don't we hear about that more often uh because the people who believe in socialism don't want you to hear about it uh including most of the British politicians who had happily used the the private system uh when they felt it was to their own Advantage so I mean skeptically I could say that's the Haves and the Have Nots again well it is and you know whether it's medicine whether it's education or whatever you know you you you see two-tier systems uh because people want choice for what they've created for themselves uh and then you have to start asking philosophically or you're not even going to allow people that choice uh so you know over here we still have those choices available but they're not available in every part of the world I mean if you move through socialism into communism uh then you're going to be at the other end of the sort of economic uh philosophy of of what should happen and the choices themselves are removed uh now if you look at the care uh then you start finding all sorts of other very very interesting things America spends approaching twice as much on Health Care per person as any of the other industrialized countries in the world but it does not provide twice the quality okay in fact there's only a marginal Improvement and in fact in in some things like longev ity life expectancy uh some of the other Western countries are are doing better so is that because it's more socialized medicine or what's what do you think is causing that I doubt it's because they're doing more socialized medicine it's probably because they have you know more of a a national feeling in terms of what's healthy so you know what are the rates of obesity and these types of things that you would see in other nations and some people would Randy I'm dominating here just jump in stop me if you want to but I think a lot of people would point to like they don't allow genetic modified foods and like there's there's other things that are more kind of related to food supply than medicine in the traditional Viewpoint and maybe there's some thought that maybe that's driving some of the longevity rather than the actual Health Care policy strictly speaking and it it may be I think that's one of the encouraging things about what's happening over here at the moment uh is that you know we we have someone in the form of you know Robert F Kennedy uh that uh is very actively and consciously saying hey look we at least need to do open transparent scientific study on these things now you know some people will call them an antia or whatever maybe he is at his heart I I have no idea uh but I love the idea that we bring openness and transparency and that we're looking for change rather than just letting the status quo dominate uh how we approach things and certainly over here in terms of the food supply that's going to be dominated by the the providers and I don't really mean the farmers there I mean the big commercial interests that control what goes on yeah and listeners if you haven't listened to our episode from Matt leek uh on Fiat food great time to go back and hear about how um you know sometimes the science we think we're getting isn't the science we're really getting and how the scientific method maybe needs a little bit of a reboot in some places so great episode on Fiat food Tony if you haven't listened to the episode we have on Fiat food we'll get you linked to that but it's really thank you episode five I believe yeah it's uh great um yeah I as we talk about this there's so much of this that I just think God it's so messy there's there's so many variables and you know the thing about like if I think I heard the other day that the US is the only of the G7 Nations where the lifespan has actually been decreasing not increasing and you know how many variables there's just there's so many variables and identifying one of them is is almost impossible but even I was thinking as you were talking about in England one of the things you love and this is incredible right like people aren't losing their house because of medical bills but in my mind I thought huh right before the show you and I were talking about how high the tax system was in England because of having to pay higher taxes in order to afford the health care how many people don't have a home or can't afford a home because of the higher taxes to pay for the healthare right and and how do you compare the how do you compare those two numbers and and this is where you know different nations come to different conclusions right obviously Europe is much more of a a mixed economy uh although America is far more mixed than most people realize I mean when you look at something as I was going to say as straightforward at least straightforward in terms of who's doing the paying as health care almost 50% of all healthare in the United States is paid for by the government okay which let me rephrase that is paid for by you and I through our taxes uh so when to be fair I saw a note recently that 50% of Americans pay taxes and 50% don't I have not fact checked that by the way so someone will need to fact check in fact I'll try to fact check I'm pretty sure that's right but I just think that's a I just want to have an intellectually honest conversation around it and it's that intellectual honesty uh that you know made me say what I said about RFK or whatever now again don't don't get me wrong I don't know him well enough or even what he stands for to to know you know whether his own scientific views are intellectually honest but what I do know is that the utter lack of transparency we've had especially in the scientific realm as sort of shown by all of the things that happened during covid uh and it's absolutely refreshing to think that you know that Stanford uh Professor who is behind the great barington declaration is now you know head of CMS is it or you know Kennedy is head of HS or you know Marty McCary is uh you know head of whichever it is the the um the research division my mind's gone blank NIH is he take over ni absolutely so you know here are people who they've come to prominence because they stood against the scientific crowd and yet they themselves represent the epitome of what the men should look like well I can't give you science behind this but my own just reading scientific journals over the last four years and looking at like the rigor from articles written in the 70s ' 80s 90s and the art art rigor from some of the recent articles um not to say every article has less rigor but I would say that my just heuristic experience is there seems to be less academic rigor in things being published today um both around the science the the method itself and then also the um the call outs of correlation versus CA ation and then just um there I mean there is definitely conflicts disclosures but those are you know generally not as deeply laid out as one might hope completely agree and you know part part of that obviously is the I don't know the astounding impact of the sort of political correctness movement uh in the scientific world uh and I I think that's a tragedy because it actually unfortunately then makes a skeptical IAL of all sorts of things that maybe the last thing we need is skepticism I mean look at the way polio has been handled or small pox or whatever tremendous things have happened uh but now the public is very skeptical of the the medical and Allied professions and other Sciences as well because there's all this hidden stuff uh where people are not allowed to speak against the status quo by the way a little fact check this is grock right so take it for what it's worth but in 2022 just over 40% of Americans paid no or household sorry of households so 40% just over 40% of Americans paid zero federal income tax and I also asked it to tell me the percentage of Americans that are net positive taxpayers right that basically are paying more than they're taking out and that number is more in the only 20 to 30% which really means 70 to 80% are so about 40% of the people pay nothing and there's about another 30 to 40% that take more than they put in room to argue that you want to do some Equalization that you know you want you want to see people able to take more uh because they need more uh but you know th this comes to things that absolutely impact Health Care as well uh that part of the the choices there in an abundant Society is that when we're looking for how we can give rather than receive okay that'll impact all sorts of things so you know someone like myself I've been very blessed I don't mind the fact that I've paid you know far more than most people pay taxes but I would mind if they tried to take it to a place where it disincentivizes me to be creative in the way I've tried to be with my life I think there's a difference between a gift given freely and a something taken right and they may have the both the same net impact from a value perspective but there is a there's an emotional component to that for sure too and absolutely yeah and so but that also means like when I give a gift freely if someone does something that I would view as squandering that gift I can only judge that as squandering if I haven't truly given the gift freely does that make other words a gift given with strings is not really a gift but if I'm being taxed on it then I think I do have a right to make a judgment about how those dollars are being you know stewarded right as a so I think I think there's some but again I think we're getting off the topic of today's but to take that a step further sure I mean Tony has given freely of a lot of on top of the taxes right and done different things and has been very generous compare that to what the government has done with your money right like yeah I I mean the sort of stuff yeah that is is coming out now through you know the department of government efficiency or whatever uh is astounding uh the the complete lack of respect for the fact that someone has worked hard to pay that tax off and to have it squandered on all sorts of ridiculous fluff is is crazy I I just you would you would you would have been a much better Steward of that Capital than than them right and almost anybody would have been generally speaking we all look after our own money better than we look after other caps yeah so I think as we if we looked at kind of the problems that are happening Tony there there's a whole lot of systemic problems you know like I think a lot of people have questions about Pharmacy benefits management and the role they play inside of the Health Care System but the average consumer probably doesn't know a whole lot about Pharmacy benefits man it's a little bit of a blackbox for the average consumer patient person and so I I think about like you know let's I want to talk about before we take a break just um rights versus entitlement a little more I want want to talk a little bit about like what's a healthy perspective that we might offer to a listener who may have a um not as much information as they did coming into this podcast today like what's what's the highlighted information we want them to have to kind of view this really difficult you know spectrum of Health Care rights and what what should I expect from my society and my community around me and then when we come back from the break I want to really dive into what can the patient do about it that's it's actionable to make it better even inside a difficult system that may not get fixed in our lifetime hopefully we'll make it better but it may not and so what can I do about that immediately so those are the that's the direction Randy if you're cool with that we kind of yeah I would like I I would like to before the break dig a little deeper into the problem okay right because I think I think you guys inherently understand the problem better than myself and a lot of the people listening so I would like to yeah I would like to go a little deeper into the specifics of the of why is it so expensive right the you know if you think about if you're a I call him kid I guess you know young adult right if you're a 30-year-old young adult and you're just struggling to get by why the hell is it so expensive I mean I'm thinking you know I mean what I pay annually in insurance is you know it's it's out of hand it it's it's really it's it's it's borderline insane and somebody that's just starting out that is a big burden to lift so I think they just want to know why are we in this situation a little more as well Antony if I could PR to you can you start by talking about um the word insurance and kind of draw the distinction between health insurance and Property and Casualty Insurance for The Listener I think when I heard that from you the first time that was really eye openening for me okay well let let's start there what what is insurance and then based on that what is health insurance or what might become uh insurance is supposed to be uh the opportunity to protect yourself from risk of something that is unlikely to happen but which if it did happen would have catastrophic consequences so let's take a couple of obvious examples and then we can sort of morph that over to the medical side uh you know Society has decided in virtually every country that people should have Auto Insurance uh and it's kind of up to you whether you're going to take an insurance that covers yourself but they want to make sure that your insurance covers any damage you might do to other people when you get behind the wheel and now it's relatively unlikely that that'll happen uh but if it happened you'll be grateful that you had the insurance and so we choose to to pay out on that and it has a a positive insurance benefit so maybe maybe one more example I have insurance so that if the roof of my house blows off in a storm uh I don't all of a sudden have to find the 30,000 or whatever it would cost to put a new roof on it's highly unlikely it's going to happen but I happily pay that insurance make my own choice to pay that insurance every year because if it happened I would rather have paid you know my $500 a year for the roof coverage than I would to now face a $30,000 bill so it's an unexpected event that has a catastrophic impact okay but when you move to health insurance we could and we probably should have real Insurance I.E insurance against the unexpected which is catastrophic okay but what it has morphed into is a highly expensive way of prepaying for what we know is going to happen so let's again try and make that real easy to understand let's say that we paid for oil changes in our cars the same way we paid for health insurance so it was going to be done with paperwork with regulation it was going to be paid by a third party I wasn't going to pay it quick Loop or whatever it might be but I you know they were going to have to build the government for it who were going to write back and say but you for forgot to put in the odometer reading we don't know if it's been 5,000 miles we're refusing to pay and you know all of a sudden an oil change instead of being $50 would probably be $500 and that's easy for us to internalize but now turn that just say to an ordinary medical event okay I know that I'm going to go to a doctor maybe once a year with something that I was worried enough about that I went to the doctor now I'm very blessed that I'm basically healthy and I guess being a doctor myself you know that may not be a very good example but you know I'm talking about you you describe the 30-year-old who is wondering why he pays so much so why why insured against that that's neither unexpected nor catastrophic if I want to go to a doctor let's just go to the doctor and cut out the middlemen because if you take the ordinary family doctor for every family doctor in the practice there are four other staff members supporting that family doctor of which two of the other four uh are going to be supporting this crazy system we have where it's a third party payer whether that third party payer is the government or the insurance company and so there's enormous expense built in that doesn't need to be built in and we know it's enormous because when doctors decide to go outside the system for example direct primary care doctors or membership based doctors for about the same cost as belonging to a gym you can have unlimited access to a family doctor who will see you whenever you need to and so and the doctor makes less the doctor makes more money the the patient ends up paying less money and the administrative cost is generally cut by 75% in those offices one person supporting one to two Physicians or providers versus um three to four people per provider absolutely and it's better care because the doctor can spend 45 minutes or an hour with the patient and frequently does and the doctor has half the panel usually half the number of patients are looking after or or even less than half maybe a quarter of a panel yep so so I I think that begins to raise the real question of what is health insurance the trouble is because we think more in terms of Rights and okay we've allowed the whole system to Mor to where it's my right I'm an employee I I should have high quality insurance paid for by my employer well you can pretend it's paid for by your employer but actually it's paid for by you because now you don't get it in your wage packet I mean would would the typical family man who's you know paying 20 25,000 foring to the a their family foundation for their family's Healthcare prefer to have it in their wage package where they can make their choices and where they could belong if they want to to one of the medical cost sharing programs or they could choose between different types of real insurance and maybe only pay you know five or eight or 10,000 instead of 20 or 25 or 30,000 uh but at the moment most people don't have those choices because they've not taken the responsibility or not been allowed to take the responsibility to make good choices for themselves I recently saw an executive who valued health insurance more than a 40 or $50,000 difference in their wages and the insurance was you know $1,500 a month or whatever it was and was the math just didn't make sense to me at all but that's how ingrained that's how ingrained this emotional process is and I'm not making a value judgment about what someone should believe but I am making a value judgment about our ability to look at the math and just again have the intellectually honest information and then make the decision because if someone understood that and then made that decision I'd fully support that what I don't support is someone not fully being able to see the math and understand how that plays out for their family so I mean let's just give another example because you're trying to understand should we call it in layman's terms why things are so expensive so you know if you go here in Austin to get an MRI at you know either the Satan medical system or the St David medical system let's say that you're going to pay uh $3,500 for that MRI okay but when the free market jumps in such as an entity like green Imaging they do what price line did they said oh look most of the MRIs are sitting with Surplus time and capacity not being used with technicians who are being paid with Surplus time and capacity because they're not being used uh so let's just rent the the Surplus time and capacity and let's let's get it fair for everybody it it gives extra money that wouldn't have been earned by the hospital wouldn't have been earned by the tech guy it reduces the cost for the patient and all of a sudden the 3500 look at things like that and say if if you multiply that out to everything that's happening in medical care which is pretty much the truth uh then all of a sudden we're paying massively above what we need to pay so we need to shine the light of transparency on what could be done when you open things up to free enterprise and to creative uh approaches and what does happen when everything gets overburdened by bureaucracy well I think I think there's a flip side I just want to play The Other Side to that too which was a hospital has a different side of care reimbursement Randy so that like um part of the reason that MRI costs more is because they're required by the government to see uninsured people in their emergency room and so part of the justification is I need to charge higher rates and and again I I can argue both sides of this pretty um effectively like I so I understand that argument the flip side of that argument is that you know you might have a hospital that charges a cash pay patient um a much lower price than they charge a payer like United Healthcare because they can in order with the same justification and we can get into all kinds of like questions around you know what does that look like from a price fixing perspective not legally but like what you know how how fair is it to have Dynamic pricing because someone will pay more like there's all kinds of philosophical questions that opens up how I you said 3500 is is just a ballpark figure for a hospital what was it at Green Imaging what do they charge ballpark 350 yeah it depends what kind of MRI but yeah I think you can get it for a 10th to a fth yeah wow yeah it makes me think I just signed up okay so I could have gone in my insurance would have mostly covered regular blood work I'm blessed enough I could afford to get something better right so I got this really robust package that I got to pay for out of pocket but it's 150 instead of whatever the regular blood work is 30 or 50 markers this is 150 in a bunch of deeper tests and with that they I get they do it twice by the way where in the past when I've got blood work done they do it once here they want to do it twice to be able to compare and see if it's just you know an outlier day they then follow up in six months and I think I get so there's four different tests throughout the year each time I talk to one of their Physicians and I can call them I think anytime I want um 500 bucks what would that cost through if an insurance company is paying for all of that and I'm I'm sure it's impossible to exactly say because I don't I'm not smart enough to be able to tell you what the tests are but it it would probably be the same factor of 10 yeah I mean you have if you have if you have four level three enm visits you're talking about 400 and some dollars four sets of blood panels I don't know what blood panels you got but you might be another let's call it uh $320 then you have audio visits in between like I I think you know definitely more right like I think and again you you got to support all of the bilding practices on both sides on the physician side but then you have all the people on the payer side that are being paid to receive all that billing paperwork and then you have all the people that are being paid to try to watch out for fraud waste and abuse then you've got the compliance arms that deal with like the doctors talking to the doctors trying to keep costs down it's it's there's a lot there's a lot to the system yeah I mean that's one person my regular insurance covers four people right but I pay way more than that monthly and this is a yeah I I did it and I thought well this is actually really a huge bargain so whether it's 10x or 5x or 15x but then when you go to and again I think but to Tony's point about like catastrophic events when you have somebody who has cancer and they have you know unexpected uh you know lifesaving treatment needed right you're not going to find a cash pay and a um and a kind of fee for service pay that are radically different although today there are groups looking for bundled services that are saying how do we reduce the cost in in the high expense areas of medicine like maternity care and cancer and help me out Tony there's there's a bunch of other bundled services that are really high all all sorts of surgical care is now you know done in bundled ways yeah uh so even in the high cost things uh there's so much smoke and mirrors and there're different entities that should we say take advantage of the system I mean if you took something like oncology the you know the cost of drugs in oncology compared with the actual cost is amazing well part part of my frustr frustration is not the part of my observation is that if you talk to any one person in the system I don't know that I could point to someone there's obviously Bad actors occasionally it's a pretty small number of Bad actors if I had to guess pretty small number but lots of people with blinders on trying to solve the problem that's a part of their job description and and it's without thought to the unintended consequences are fixing the system at large and and not a whole lot of people looking at the system at large saying how do we ring this out and really solve this problem in a way that makes sense across the entire system because because I I don't mean I've met a lot of doctors and I've never met you know a doctor who specifically is a bad actor saying I'm G to you know Screw the little guy by doing this or you know people I know that work in um the payers even the payer groups you know the big payer groups of the World they generally want to help people like they they really are and they have a limited scope of you know whether it's education training experience what I mean not a whole lot of people get paid to look at the system at large I I i' I'd really like to underline what you're saying there because I'm I'm guessing that you know 95% 98% of those working within the Health Care System but you're talking doctors administrators you know nurses people who clean the ward you know what whatever it might be I I'm guessing that the vast majority really want to serve the patient but and it's a big butt when a system has become perfected at what it does which is extracting money from people at their most vulnerable points the system itself corrupts the work that you find yourself doing so one one brief story a friend of mine very very distinguished uh surgeon uh a friend of his uh on the board of a major Hospital you know well I I think I mentioned it in the book he was at the Cleveland Clinic and uh you know just distinguished uh and one of the board members uh uh needed to get um a a vasectomy uh and so asked his friend because he was you know in that realm my friend said oh yeah you know I'll I'll arrange for you to see one of the people here uh and uh six weeks later he sees the board member and ask how it went board member said oh it went fine but he said I've been keeping in my pocket this so that you would know one of the consequences and he handed him the $99,000 for a vasectomy and my friend thought to himself and if I'd sent him to the local Family Planning Clinic could have been done for 50 okay now it's the system that corrupts people and my friend the surgeon said and I realized that I was like a financial serial killer that I do incredible work for my patients except economically I destroy them and he's now on the other side of the table kind of like you know I've spent so much of my life you know when I first began looking into this whole what the things cost I mean I I remember one set of hospital bills for someone who had had a a simple uh you know appendix removal no complications nothing and they had almost $50,000 in bills uh and you know I looked at these things okay well he had uh on on it it showed that while he was in hospital he had been dispensed I think it was 50 it might have been 25 tyol oh yeah guess what the 25 Tylenol in the gift store in the same building that would have cost like $25 and it or an Amazon would have cost five yeah yeah I mean so it it's the system has become corrupting and again forgive me sort of putting Faith up front but when you look philosophically at what goes on here you know the Bible actually says the whole world World lies in the power of the evil one and it's like there's something inherent in the system that we as people allow ourselves to get corrupted and part of that for people in the system is I've got to identify myself as that Financial serial killar and say what am I going to do about it how am I going to have an impact and if we all did that we would find ways to change the system so think when we come back from the break Tony we'll talk about what people can do as business owners and patients to kind of help move the system we can dive into the faith component if you'd like we'll talk about like the the non-faith pieces as well and uh when we come back let's talk about action steps like what are the things people can do to go from a lack of abundance to an overwhelming abundance as a result of the way they interact with the health care System even while it's broken without having to change all of it there are steps we can take today to move that in the right direction so listeners stick around we'll be right back okay listeners we are back uh hopefully you didn't go too far Dr Tony Dale here talking with us about Healthcare Tony you know we talked a lot about some of the problems the system and and now it's time to talk about like what can we do about it individually and you know you've known me for a long time I'm really passionate about like the system truly not what we want it to be but what can we do about it today and there are things we can do about it today to create personal abundance economic risk mitigation for ourselves individually for our families what's the best way for us to dive into this topic about like how we take agency both both clinically and economically with our own Healthcare you know uh among many other things for people who seriously want to uh find a way that they can not only influence their own health but other people's as well uh there are a couple of books that I might mention okay um one is by a friend and colleague Matt ort uh and his book is called don't feed the beast uh I've got it right here I don't know if you're camera will pick it up but uh let me oh I'm sorry there let me put it up where people can see it okay save your company don't feed the beast by Matt or it's ohrt if you didn't see that real quickly yeah uh this book really is written I would say particularly for those who are in business uh and especially if they have responsibilities head of HR Chief Financial Officer or CEO though uh cuz the Beast that he's referring to is the health care System yeah and what keeps it alive and keeps it growing is that everybody is feeding it and especially since the Affordable Care Act came in that actually mandated by law that everybody had to feed the beast and he's not an author by training he actually worked in the space uh 100% uh he was head of HR for a large steel entity and uh it it's amazing what he was able to do and uh in the back in the state of Wisconsin where he's from you know what he's built with many many companies now uh then uh a second one I'd mention is the price we pay by Marty McCary uh and we'll probably come back to that so I'm not going to say too much more uh except that there is a price we pay if we ignore these things uh and it's not a good price uh and Marty exposes a lot of the sort of underlying issues uh that have so dramatically uh raised the cost of Health Care and gives you a lot of good thinking about what you can do about it there's a third book real quick Marty McCary just so people don't who don't know who he is surgeon from John's Hopkins one of the most respected uh Med schools uh medical communities and Marty comes really highly thought of clinically and then done a lot of writing in this space so I just want to put a plug in there for a great book now head of National Institutes of Health yeah that that that little role yeah that little role what a what a yeah a big responsibility you're talking someone right at the top academically and scientifically of what's going on in medical care uh then there's another one I I'm not sure I know the right uh the accurate title off hand but uh how I think of it is never pay the first bill or never pay the bill because everything about medical pricing obscure and it's deliberately so so never pay the first bill by Marshall Allen perfect yeah okay never pay the first bill and other ways to fight the health care yep something uh and so you need to understand that the bill that you're given does not need to be the final bill it's not a true price because there was no true transparency to start with in terms of how you approach the price you know typically if you ask the doctor oh what's something going to cost like you know I told that story of me asking the orthopedic surgeon he told me $2,000 uh even his answer he wasn't lying it was an honest answer for his bit when we subsequently had a a conversation about that after the event I pointed out that that meant in terms of the time that he spent with me he was earning about 4 million a year uh now I'm sure he wasn't earning 4 million a year and to be honest I wouldn't begrudge it to him if he was he you know he's a good doctor and I value that but I value the transparency that lets us know and as patients we need to take the responsibility again for saying I should ask and if they don't know the answer then I'm going to dig a little bit harder uh because imagine if you went to a car dealership to buy a car and they said well look you know you're you're certainly welcome to take the car off the lot today um but we just need to get you know your name and address and uh credit card and you know other financial information because uh we we don't know quite what you're going to pay for it yet or imagine and this is not untypical that you could go to one dealership and you could pay 35,000 for your car and in the same town you could go to another dealership and get exactly the same car 85,000 or 350,000 you would feel cheated uh and unfortunately that's currently the way the the medical system is set up and so you have to be willing to start probing and pushing and asking questions which are sometimes uncomfortable when I began doing this this sort of stuff oh I guess at this stage 30 years ago to to help people um many times they said to me oh but don't challenge the doctor's bill because you know he's really good uh and I said yeah and I think I've been a really good doctor as well but that doesn't mean that I haven't overcharged people uh because I didn't understand the system uh and so begin to take personal accountability and you'll find that just by asking you can find uh all sorts of ways to impact uh what the costs are going to be I think there's really good news in that right because America is a system and a we're we're a community of of consumers in the sense that we know how to buy things and we like to buy things and so I think if I was trying to give people hope around that it would be like we're we're pretty decent at this as a country and so we can actually be a part of the solution by just asking for it doesn't need to be rude or or combative or doesn't have to be a hard adversarial negotiation it can just be asking for real transparency and asking for why um I did this with you know one of the hospital bills for my family and I got the CFO of the hospital on smaller Hospital on the phone and I just said why and they said I don't know and I just was very gracious them I was like well no problem can we figure that out and then we can and the price of course came to reasonable when they were confronted with just can you help explain this to me like real genuine curiosity I wasn't upset I wasn't angry I wasn't feeling entitled I just said hey look can like can you just please help me understand and if they don't understand it then just not backing down from that John let let me tell another story again I want your listeners to know that uh by doing the simple things we're describing here asking uh we we can do so much to protect ourselves um I think of a friend uh he was CEO of a company and I knew him through a local round table and uh his daughter had been injured uh in a a sporting thing you know had injured her ankle and needed surgery uh and he had a high deductible insurance plan uh so uh he uh his deductible was going to be $5,000 yep so he reached out to me cuz he knew what I did and he said Tony is there anything I should be doing here at the time you were running a group called The Caris group that was doing medical bill negotiation for payers is probably an important thing to know so he reached out knowing what you were doing for a living right right so um uh I said to him well you know you've got a $5,000 deductible but nowadays this wasn't true 20 30 years ago when I began uh doing this stuff but nowadays nearly all hospitals have a cash price uh I said why don't you reach out to the hospital and just ask them hey if I don't use my insurance at at all uh what would it cost for me to pay cash and the hospital told him oh it would cost you 3500 just to pay cash less than his deductible even though he had insurance so with his insurance a partial payment was $5,000 with cash the full payment was 35 and by the way to the hospitals I guess on the on the hospital's balance sheet just to emotionally like they it may have taken them half a year or a year to collect their money and they valued having that cash today but that still I mean Ys yakes yeah I I can relate to this by the way that so if we go back Welly this was during my poker days and I did not have insurance and I broke my face playing football 16 bones titanium plates um no insurance and I went to a doctor he and I thought well we're working on my face I think I want a good surgeon here so I he referred me to somebody I asked him who the best was he gave me three names and said pick any of these I clearly you got a good one cuz you're looking better now yeah he just it's only It could only go up from where it started um so I went in and I remember this guy I went through the initial thing and I get done and I said okay how much is this going to cost and I said I don't have any insurance this is out of pocket he's like oh or no originally he said I believe it was $16,500 just his surgery cost right right yeah and I said look I I I'm paying out of pocket and he goes well we could go to 10 and I just like and and look I I didn't have insurance but I wasn't completely broke and I said okay I'm talking green $0000 bills like I will go home and get them now and bring cash and he dropped he dropped a $3500 as I recall I mean this whole thing happened about as fast as I'm telling this story and I remember thinking to myself I thought I could get this for two grand and this guy's going to be working on my face for 6 hours so 3500 sounds great like I I didn't want him unmotivated either well so that was that but then the hospital part came in and I they did he did surgery I was in the hospital for under 24 hours I left at 5 6:00 the next morning the minute they'd let me out and and I got a for 66,000 or something along those lines for one night in the hospital yeah and when I went back with a followup with him I said um okay I knew it wasn't going to be free but I I just hadn't really anticipated that part and he told but you know bless his heart he told me exactly what to do he said go talk to these people and I don't remember what we ended up getting it but it ended up being I don't know I I mean I think it was less than 10 grand Allin I mean I think I paid the hospital 3 4,000 whatever it was to get it taken care of but they gave me and like you said about the Tylenol there was they gave me a little stupid thing of ice cream and I think the ice cream was and I could have bought a lot of gallons of better ice cream and you know IVs were ungod everything in there was ungodly expensive so so Tony with I mean this is true for the economics piece of it doctors um they have a CH you know I bought a friend of mine that was a physician at mug one time and said please don't confuse your Google search with my degree right because I mean there's a lot of people that self- diagnose incorrectly they get a lot of bad information they come in with a lot of worries and you know on the one hand it's great that patients want to be involved in their care and they want to understand um and doctors don't get a free pass anymore they don't have the same level of trust they had 50 60 years ago um and you have doctors that that you know who I think should be willing to have a conversation with the patient about their clinical care how does any of this kind of work into the clinical care to make sure that people are getting the right you know clinical care I can tell you our experiences in our Clinic too I'm happy to bounce this ball back and forth yeah I do um I I I think where I would start in terms of how does this apply to clinical Care by saying start thinking differently about how you want to manage your medical care and I I love your example there on the on you know the mug you gave to the doctor that you know don't confuse your Google search with my my um I would suggest you start your Care by saying to yourself I want a doctor who really knows me by name and who values me as a patient I wonder where I can find that well unfortunately it's probably not through whatever Network and whatever that your insurance company you know directs you to uh so I'm now of Medicare age and they direct me to choose from certain doctors and I don't know who any of them are uh so I accept whoever they assigned me to but I also choose to pay for a direct primary care position what if someone's not in a place to be able to afford that is there a way to do this when someone can't afford that type of care okay well let let's talk about what we afford it's $100 a month or maybe less that's relatively cheap nowadays okay that's uh if you're a smoker that's far less than you're probably spending on your cigarettes if you go to a gym that's probably roughly equivalent to what you do uh you spend at a gym if you're retired if you can get high quality clinical Care by adding $100 a month to uh your overall Medical bills you probably will have dropped your health care costs by way more than whatever deductibles you're now not paying because you're not going to the doctor because your direct primary care physician is taking care of so how do I find one of those uh well uh type direct primary care or DPC into Google uh along with your zip code and see what comes up and if you can't find it there call one of your friends who has some medical background and ask them if they know anything about it now lots of doctors don't it's still a new enough movement uh but and check out virtual Primary Care too VPC virtual primary VPC is not as and say not as personal not in person but and you want to make sure that you have a VPC where you're getting the same position or provider every single time like that's some vpcs use rotating positions some do not I have a strong pre preference to a VPC who uses the same physician patient relationship each time and I would underline that you know having worked myself as a family doctor for many years I know how incredibly important it is to know the patients to know their medical history uh to know what you know medic they might already be on all of this now the reason this is so important isn't just that it dramatically improves the clinical care you will get from your family doctor but now you have a doctor who knows you who is quarterbacking your care and most of the the quality dpcs direct primary care or VPC virtual primary care doctors uh that work in this fashion uh they're already working with you on a cache basis and they understand that that means you you know what's going on in the healthc care world and you want to make sure that you're navigated to the right people so now if they need to send you to a Cardiologist they can almost certainly because of their local knowledge and experience put you with a local cardiologist who understands the cash pay patient well means candyy my my DPC I have a DPC doctor as well we'll talk about what medicines we're using and if there's alternative medicines and but I ask him like hey who's the last drug drug rep you saw and like let's make sure that we're not just you know using the latest drug you've heard about but like what other Alternatives exist what are the what are the side effects because there are some drugs that are older that might have worse side effects I might be willing to spend more or not willing to spend more on different medicines but we have the time to talk through all of that and then make changes and then there have been times it's like hey I'm going to prescribe this medicine at this level but we may actually start you off at a lower dosage and and that medicine May last for two months and so but there's a lot more communication about what's happening and I'm not scared to call because I know that I'm going to get somebody on the phone pretty quickly um without the hassle that I would have so I mean I'm sure there are other things that we could you know discuss and describe here but I would honestly say in my experience erience the best thing you can do both for your clinical care and for your economic care is find a good direct primary care physician and now work with them to direct all of your medical care and what about other things like I think about like writing your questions down so you don't get nervous and because some doctors can not mean to be in a hurry but they can still seem in a hurry for a patient and kind of in and out of the room okay well again uh you can choose your doctors mhm uh and so uh you know something as simple as does the doctor look at you or is he just spending all his time looking at his computer uh I I think those are important questions Now understand again the system has forced people in a certain direction please don't think that I'm saying the doctor is a bad doctor because all they do is that they seem to sit there and you know type into the computer uh but we do have choices and this is personal responsibility uh and so if your doctor isn't comfy answering questions or is hurrying you or whatever um again find a way to be polite and friendly but to say Doc you know I I I can sense you're really under pressure today uh you know is it working or would it help you if I came back uh but if they're really not interesting sorry not not interested in that sort of thing then look around ask your friends find out where you can find the sort of doctor that you want to have looking after or even just saying I feel rushed will often slow many Physicians down and kind of snap them out of that that moment so even if you you know if you don't feel like you have the time energy like I just saying hey I feel rushed and then having a list of written questions can be a really helpful way of uh and and about not just the condition symptoms but about the medicines and you know um it's it's look it takes I think I saw a number somewhere that it takes 17 years for a medical Innovation to get fully pushed out into the system and that means some people are ahead of the curve some people are behind the curve and it's reasonable to ask questions and and I've gone in asking questions thinking I know a direction and learned new things that I didn't know and so I don't want to confuse my Google search with their medical degree either but I do want to go slow enough to understand my own care and yeah and and I want to encourage you don't despise your your research on Google or maybe use chat GPT or whatever it might be uh because the the information out there now is astounding yeah uh and so you know my wife and I were both Physicians but uh we happily go out there and look at what's happening because it's impossible that 17year figure John you gave is accurate I've heard it elsewhere uh you know the typical doctor does not know almost everything that is going on in their field because they haven't researched it since medical school there so much of it happening today so fast yeah and so if you had kind of one we've heard a couple things today about you know thing takeaways one is to ask questions about the economics two is to make sure you select a doctor and consider a DPC any of other big takeaways that you would have for a today always be a learner yeah uh and uh especially when you're you're dealing with Physicians you know they they're almost taught to be arrogant I I don't know how else to put it if you saw Patch Adams you you saw a wonderful example of you know someone trying to uh humanize uh you know other doctors and I I trained in a medical school it was very like you know what you saw in Patch Adams for its snobbery uh but recognize that there are people just like you and they really respond to friendliness they really respond to friendliness uh and so if there's something you want to ask them find a way to put it not that you're in any sense denigrating what they've done and how much you appreciate what they've already done but you're wondering about so you know because of our background in in medicine when we want to raise an issue that a doctor we're dealing with because my wife's had a number of things over recent years where we've needed to go deep into certain things um we've always been very careful to appreciate the expertise that they already represent and then ask them but you know I I've been learning about this and I'm wondering Cur genuine curiosity is a really powerful tool and uh our experience is that a doctors are willing to listen and to take the time and actually end up enjoying being with you yeah when you ask questions that's fantastic let's um I feel like we've got a really good handle on this one of the things you and I talked about for years is this concept of medical cost sharing you brought it up earlier in the episode can we just wind things up by explaining like what what a medical cost sharing product is what that looks like why it came about and uh you know how how Innovation like this could help us move for is as patients look to use Innovative Concepts how this could move some of the system in the right direction well back in the late 80s early 990s um various uh religious groups mainly sort of Evangelical Christians began saying there must be ways that we can help each other on our medical cost got to bust Ton's chops the Catholic church has been doing this for hundreds if not thousands of years but go ahead there we are and and 100% it it go because it goes right back to sort of New Testament teachings yeah so full marks for the Catholics for keeping the light alive one time one time so um the idea is uh based on you know I think is a verse in Galatians where it says bear one another's burdens and so fulfill the law of Christ and so why not like the Amish do or some other sort of uh shall we say very ancient type groups uh they just say we're going to put together our money and when Joe has a problem or Sally has a problem we're going to pay for it together uh so these groups began organizing that and they became known as healthc care sharing or medical cost sharing organizations and they had grown enough impetus by the time that the Affordable Care Act came in that they were actually recognized within the Affordable Care Act but they generally speaking were only available to people who could sign their statement of faith now i' had done Millions hundreds of millions of of dollars worth of uh medical Cost Containment work for these groups uh and so when the Affordable Care C act came in but I saw that they were uh only protecting the religious groups I thought well that's not appropriate you know if we have something good and it's working and I'd done hundreds of millions of dollars of Cost Containment work not only for these groups but for Insurance Groups uh I thought no I'd like to see this available to everybody and so I began uh initially encouraging those groups to consider whether they would take uh in people who didn't sign their statement of faith but they were they weren't ready for the risk of that because they might have lost their exemption under the Affordable Care Act uh so I and others began pioneering what would it look like uh to take this sharing approach where we literally share each other's medical costs in a highly organized fashion and we agree as people who are taking care of each other that we're going to live certain Lifestyles that you know where if if I'm getting drunk I'm I'm risking being a drunk driver and so we're not going to agree to share the the medical bills for a drunk driving accident because our people all commit that they won't do that uh and so where people would take responsibility then we all could trust each other to share in each other's Med medical costs and so this approach has has grown and uh now is also used all over the country about a million people in the US or so give or take two million Pro probably closer to 2 million I would think from what we can although we don't know accurately yeah and so this is the type of innovation that if we allow Innovation to happen is going to drive cost down in the Health Care system and hopefully give people a little bit more of that discretionary income back that that's definitely the case and and for individuals these sorts of approaches uh where we have our own choices I think are wonderful things uh in in the group Market where you know the vast majority of people here who have any type of private insurance or or employees getting it through their their work um very similar approaches to what I've described can be done within the self-funded world uh and that uh book I mentioned earlier by Matt ort uh on you know don't feed the beast uh save your company uh I would strongly encourage any of you with business backgrounds to look at what can be done within the self-funded world uh and if you need help in that uh you certainly could could uh you know reach out back through uh the podcast and uh we would be delighted to find ways to help you yeah the My Hope for this episode is that people come in and learn that there's hope even though the system is what it is like if we can be again to use the same term intellectually honest about what really is happening in the system and we could complain about it for days weeks months and not be done complaining about it like there's a lot to complain about but there are things that can be done in the face of adversity that do make things while not perfect certainly better absolutely well and I use this in my company right I mean use this in my when when I'm saying my insurance I'm really talking about this but it strikes me I'm I'm glad earlier explained the insurance and how it works with a car and the oil change analogy and all that right and and what we're talking about here is true insurance right it's a it's a combination of the cash pay that you talked about earlier and help from the community for catastrophic not getting the oil change on your car but if you crash your car or in this case your body yeah well I mean when you describe something as true Insurance uh word words have meaning and in a regulatory environment we have to be careful uh what meaning we assign to words when you so when you say that Healthcare sharing is true Insurance in English I would say that's true in leges that is not true okay fair enough in legales uh insurance is what the government defines it to be uh and it includes all sorts of things that historically or economically have not been insurance but yeah we we live in a world which was described by George Orwell uh and it's called double speak but there to get back to the place hope we can find abundance in this world we've got to look for it it's a little it's a little like a pig going through poop to find truffles um if that's if that's really a thing I've only been truffle hunting once and I don't recall being in poop I mostly dirt but I I think the reality is we can find some we can find some abundance here if we're willing to look if you own a company if you're an individual like it exists there's places to do it you can do it by talking with your providers by clinically economically like there are lots of ways that that people can be helped here and um they're not they're not inordinately hard to do like it's things we can do by being genuinely curious asking some good questions like and taking agency right just being responsible and saying there are there's enough things that I can do and work on that while it's true there's plenty to complain about I'm going to focus on those things where I can actually make things a little better for myself and you decide to do that in an area like this your health will become abundant and your finances will become abundant yeah and probably improves your mental health too if we're you know focus on gratitude versus complaints and things get a little better so that's a topic for a different day Tony I got say you know as you know love talking to you always great to see you I think this has been just a wonderful episode So Randy anything else you want to add no I mean I I can't get the picture of the pig going through the poop looking for truffles out of my head but it was dirt it was dirt that I but anyway uh no it's been fantastic and I and I'm hoping listeners got as much out of it as I did and yeah you know getting it just getting some actual takeaways steps and things they can do to improve their health and like you said their finances and everything with it is uh is fantastic so thank you so much gu I'm guessing we're going to get a bunch of questions Tony we're going to have to bring you back there's other topics that surround this that are so interesting and excited to get to those topics Tony Dale has a book called the cure for health care you should read it it's amazing uh it's got just a really uh great great storyline in it uh Marty McCary uh the price we pay Matt ort don't feed the beast save your company so um some great books to read through and put these in the show notes yeah definitely we'll put some links in the show notes for you as well and so well and as always listeners thank you so much um you know can't do any of this without you and please subscribe on your favorite podcast player download tell your friends give us five stars however you would like to to do that we would appreciate we'll take any or all of the above so great thanks everyone thank you for letting me come yeah of course thank

Fixing Healthcare From the Inside Out with Dr. Tony Dale

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