Why Millions Of Americans Are Quietly Walking Away From Their Insurance

When I graduated medical school, the system wasn't perfect, but it worked. Today? One in five claims get denied. Deductibles have hit $7,500. Eighty-four million claims were turned down on the exchange last year alone. And families are paying more than ever for less and less care.

In this conversation, I sit down with someone who has spent decades inside the policy world and now spends his days helping families and small business owners walk away from traditional insurance entirely… and into something millions of Americans are quietly switching to. We talk about why your insurance card might be the most expensive piece of plastic in your wallet, why cash patients are getting better care than insured patients, and the one mindset shift that decides whether you stay trapped or take back control of your healthcare.

If you've ever stared at a hospital bill and felt sick, this episode is for you.

In this episode, you'll learn:

• The hidden reason your insurance plan keeps getting more expensive while delivering less — and what's quietly replacing it
• Why the cheapest care in America is rarely where you'd expect to find it, and what most patients never think to ask
• The single sentence you can say at any doctor or hospital that can save you thousands of dollars on the spot

Connect with Charles:

Email: frohman.charles@gmail.com

LinkedIn: Linkedin.com/in/charles-d-frohman-0034141

Chapters:

00:07 – Why Obamacare Is Failing Millions 01:27 – Meet The Guest 01:44 – The Quiet Revolution Replacing Insurance 03:30 – Why Networks Are A Trap 04:35 – The Concierge That Holds Your Hand 07:07 – Why Bundled Pricing Beats The Old System 10:13 – Inside The Cost Sharing Vendors 12:30 – Price And Quality Don't Match 17:24 – Walking Through The Plan Options 22:15 – Specialty Hospitals And The Power Of Competition 25:14 – The Health Savings Account Advantage 31:14 – Plans For The Young And Healthy 34:09 – Why People Hate On Primary Care 36:28 – How To Get A Real Deal On Prescriptions 40:19 – Why The System Is Designed To Fail Kids 47:02 – The Truth About "Nonprofit" Hospitals 51:02 – The Guarantee Nobody Talks About 53:01 – The Pure Economic Relationship 54:06 – Find Your Backstop, Take Back Control

Transcript

SPEAKER_00 0:00

Obamacare is failing millions of Americans. Many can't afford the premiums. Those that could afford the premiums can't afford the deductibles. The deductibles are $7,500 now on the bronze level. And if you can't afford your deductible, you can't use your insurance. You're one ER visit away from bankruptcy. Then there are those who are able to afford the premiums, deductibles, they file a claim in network, and then it gets denied. That happens five, it happens to one in five claims gets denied. 84 million claims were denied last year on the Affordable Care Act Exchange. This is in spite of us subsidizing insurance companies by billions of dollars. It doesn't make any sense. Then you have the young, healthy people. All of a sudden, they're starting to realize they're getting a terrible deal on the Obamacare Exchange. They're subsidizing older, sicker folks, and they're subsidizing insurance companies. All of a sudden, you have millions of Americans say, What can I do? Are there other options? Today we have a great guest. Charles Krowman's going to tell us about some great options, other than the Affordable Care Act Exchange or the Obamacare Exchange. This podcast is for educational purposes only, not medical advice, not inducement to buy any products. And you should always take the advice of a physician for your needs. Charles, thank you so much for being here today.

SPEAKER_01 1:19

James, it's great to be with you.

SPEAKER_00 1:21

Thank you so much. So, what do you do when one of these folks I just talked about is either, you know, they can't afford the Obamacare Exchange or they're frustrated with it or they had bad experience, and they come to you and they say, Can you help me out? What do you how do you start out with that?

SPEAKER_01 1:36

Well, I say, sure, I'm glad to help you out. Uh, tell me your situation. Um, and that usually gets to, excuse me, uh, me giving giving them my link with a video they can watch to understand uh the change that millions have made. Uh we're at a very interesting place in the health market because just as a lot of folks don't go to banks, but instead go to credit unions for their checking accounts and small loans, the same dynamic is now occurring with insurance. Millions have abandoned insurance for what is called medical cost sharing. Uh so it doesn't uh handcuffer choices uh like Obamacare does. There are no networks. Uh it doesn't deny a fifth of the claims, as you rightly discussed, about a problem with Obamacare insurance. And the pricing is stable. We had a slight price increase with one of our brokerage's sharing companies this year, but that's the first increase in three years. So a lot of families and small business owners who have upgraded uh from uh insurance to sharing uh aren't going back because now they have access to every every provider as a cash patient. Because one of the one of the benefits of Obamacare is that it's high deductibles have made everyone a cash patient. Because you had to spend on average $7,000 before the insurance would kick in. So, because of that, most hospitals and doctors now offer a cash price. So if you don't have networks, you can go wherever you want. And in our case, that includes worldwide and includes natural care, not just allopathic mainstream care. And people want that now, given the real epidemic in this country of chronic disease.

SPEAKER_00 3:22

The network issue is huge, and people don't realize that when they sign up for Obamacare. And you know, this is being in the insurance industry. Most people don't think about their insurance until they need it. And then all of a sudden you say, okay, someone has a cancer, they're gonna go to the best cancer hospital in town or see the best oncologist, and they find out they can't. So that's a real issue. And I'm I'm so glad that you know the people in your plans can access anybody they want to. There's a lot of freedom. The other thing that I like about your plans is it puts people in the mindset of you have to shop for your care. We have people to help you with that. And the insurance company doesn't do that, and they kind of do the opposite. Everybody thinks the insurance company is getting me the best prices. When you and I know that's not what they're there for, and that's not the case. But this way, and even though people have these large deductibles on Obamacare, most Americans don't really think about it. I have to shop for my care. They're thinking I have to run and get my insurance card. And I love that right away you're saying to people, you know what, you you're responsible on this plan. It's a very patient-empowering plan.

SPEAKER_01 4:27

You're responsible, but we but we make it easy for you. Um, every new venture uh in any market has growing pains. And one of the pains that we experienced was the intimidation our patients faced as a newly empowered cash patient. So our profits over the nine years we've been doing this have been driven into what's called a concierge shopping team. So we make it very easy putting an 800 number on your card that we encourage you to call uh just as soon as you've triaged your emergency at the ER or in the ambulance. Call our concierge, 800 number, let our experts hold your hand on how to make choices among various offered therapies, how to get a cheaper prescription if you have a maintenance med, how to access a cheaper place to get a test or a lab, or how to find a well-priced consult. Or for a surgery, we'll have different tools like healthcare blue book and other uh tools to help you find a good surgeon or a good hospital with good outcomes and a good price on a red, yellow, and green lighting system. So the concierge is how we make it easy. So it may sound like we're asking you to be more responsible, and in effect we are, but we're gonna make that change easy by letting our concierge shoppers do the shopping for you and all the negotiations for you. So all you have to do with us is say one thing to any doctor or hospital, I'm a cash patient, do you have a discount? That's all you say. You don't even have to tell them you're a member of a sharing a membership because that's just how we get your bills paid behind the scenes. And we'll negotiate with the hospital if they if we get your if you're hospitalized with an accident or a sickness, you're gonna ask for the itemized bill and submit it to us. And if there's any outlying price, we're gonna negotiate with the hospital over the course of a month. And we always arrive at an agreed upon price, and we'll give you the money to go pay. But the point is um we're gonna make it easy for you. We're gonna get a cash price, which is gonna help the market. And to your first point on the centers of excellence, if you have cancer or heart disease, you are going to want to go to a center of excellence for heart disease or cancer.

SPEAKER_00 6:47

Absolutely.

SPEAKER_01 6:47

But most of them are excluded from these ever, ever narrowing networks of Obamacare. Not so with us, uh, every center of excellence has a cash price. You can go there.

SPEAKER_00 6:59

No, I I love that. And the council here is a great point. And I wish that people on traditional insurance had the same thing because it is confusing for patients. And it's intimidating when you go to the hospital. You get this, you see it all over social media, a hundred thousand dollar bill for something that was a pretty simple treatment in a hospital. And it's amazing how high these bills can get. And is there a certain percentage of Medicare that you try to negotiate to when you're negotiating with hospitals?

SPEAKER_01 7:27

Well, um, they'll use, you know, that's the um that's sort of a hammer uh basing your pricing negotiation limits on Medicare. It is a guideline, but some of our price tools like Pratter uh and Savos and other price discourgers, they're getting a bundled price. The surgeon, the anesthesiologist, and a facility. And so we're getting actually market prices, not just uh a simple uh, you know, the the reference-based pricing is old school, and providers don't like that, and we don't either. So the the future is to have actual prices. Um, one of my customers is one of those price discorgers, Leon Wisnewski on LinkedIn, very prolific uh commenter. He's a customer of mine. And so he's getting real prices from hospitals, selling the data to corporations who self-fund. Uh so yeah, reference-based pricing, basing a price on a reference of Medicare is old school, but the future is real bundle pricing, and that's gonna drive prices a lot more down than Medicare. And it's gonna really help the ambulatory surgical centers and the cash imaging centers and the cash specialists who are a rising uh force in the healthcare market. And you know, a lower price overall is gonna be more income for a provider because you're taking out mostly the admin costs, you overhead.

SPEAKER_00 8:55

Absolutely. I mean, it takes a physician anywhere from probably three to six months to get paid. And then you have the I forget the exact name, but it's like integrity processing, or but it basically they can claw the money back months or years after you got paid. So it's crazy, you know. And I agree with you, it's much better to get the money up front. And I think all these types of alternatives to Obamacare, like the cost sharing, really gets medicine back to what it used to be and what it should be, the doctor-patient relationship, and you get everybody else out of the exam room. You don't need 50 people in there. It should be a very there's nothing simpler than a cash transaction. So I no, I love that. And I really like the idea of the bundles because it is a pain in the neck if you go to a hospital and you have a surgery or procedure, and then you just get these bills coming from months later, and you're like, what is going on? I thought I was done with that. You know, you want one bill. You know, you're gonna have your gallbladder out. You're like, give me a gallbladder bill. I don't care who is doing what, you guys figure that out on your end. So I I love the bundle pricing idea. That's very powerful with that. Well, that's important.

SPEAKER_01 10:04

That's that's really important because one of our sharing vendors will give you the money to go pay, which still could be a little bit of a hassle because of the numerous bills you mentioned that do stem from a hospitalization. Right. Another of our sharing vendors will pay the provider directly if you allow them to use healthcare blue book to find the better price, better quality, better outcome based hospital and specialists. So we have uh a carrot. Um, if you let us use these shopping tools, though we'll pay directly to the provider. That's a that's a great uh service because I like that is it I've learned it's it's a real bad hassle for patients from hospitals to deal with all these bills.

SPEAKER_00 10:47

No, I love that. Now, which talking about uh I know Zion Health is one that you use, and what other cost-sharing platforms do you use?

SPEAKER_01 10:56

Sodera um is you know, if you look at LinkedIn among all of the higher quality advisors for big corporations, all of them use the same two, like we do. Zine and Sodera. Gotcha. The rest of them are religious, which is nothing wrong with that. But Zine and Sodera are the secular ones. Um, there's a couple of new ones that uh we're starting to use um mighty well. We're experimenting with them in Brazil.

SPEAKER_00 11:24

Oh, that's funny.

SPEAKER_01 11:25

Because uh our our Miami, Florida headquarters is is run by uh, I think she's Brazilian. Um, but uh it's a big market and it's good to test uh new uh vendors in different places before you bring them onto the American market. Um I like what Mighty Well is up to. They want to really respond to the new demand, as I mentioned earlier, by patients for more integrated care. I don't know about you, uh James, but if I ever get cancer, I'm not going to an oncologist. I'm going to an In Vita in Arizona, um, or I'm going to Tijuana or Cancun, and uh I'm gonna have um alternative therapies. And increasingly that is the trend. Uh they want to have allopathy, mainstream medicine for the car accidents and the intense surgeries, but for basic care, they want to have higher quality health care, and it's not high quality right now.

SPEAKER_00 12:18

You know, the one of the interesting things at healthcare, and I think it's very unique, and patients don't really, and the public doesn't know that, is that the price and the quality don't correlate. You would think I'll get I'm gonna get this $10,000 CAT scan at a nonprofit hospital. That's gotta be better than a $350 one at the freestanding imaging center. And it's not. That's the odd thing about it. And the other thing I like too for when you're paying cash, you're seen as the customer and you're treated with respect. When you use insurance, the insurer is actually the customer, not you. So you're not treated well. So I, you know, I really like being a physician where you know we we love patients. I want the patients to be treated with respect. And I think that's very important as well.

SPEAKER_01 13:03

A couple of important things there. Um on the outcomes, we have poor outcomes in the West. Uh the chronic disease epidemic is run running rampant. Um, pills and mainstream medicine don't offer much for chronic disease. That's and that fact is sending most chronic disease patients on a journey uh searching with different healers to find out what's gonna help their psoriasis or what have you. Um and when you're a cash patient using our tools and our concierge, we're gonna get you to these uh independent physicians who are opening um ambulatory surgical centers. And I've visited these places, these surgeons are better than the one stuck in the hospital. Um they have great outcomes, the readmissions are low. And um the Green Imaging Center and the other catch imaging centers are great. They are that's what you want to get quality and outcomes. And I'll I'll warn people uh not only do networks exclude up to half of your local areas providers, that's how narrow these networks are, but the doctors who remain in the networks, they have a CD incentive to stay so inside the scope of practice because they're scared of being booted from the network if they if they think outside the box, if they practice the art of medicine. I don't know about you, James, but in my mind, medicine is not so much a science as it is as it is an art. And I want doctors doing everything they can, you know, not just listening to the pharma rep on what pill you should take, but to really look at root cause analysis.

SPEAKER_00 14:47

There's a lot of art to it. There there is. I mean, there's no doubt about it. And, you know, in my years of practice, I would take these mandates that come from up top, I would treat them very skeptically. You know, I'd you certainly look at them and say, is there merit? But a lot of times there wasn't. And, you know, I think you do have to be a skeptic, and I think every physician should be. And you see this, you'll you'll see some big landmark study come out, and then later on you find out 10 years later it was wrong because no one ever retests the landmark studies. That's one of the issues. They don't say, can we replicate this study? Does it make sense to change everything we're doing? But no one does that. So I do agree with you know, with your network idea or comments on that. And I and I'll be honest with you, when I've worked at ambulatory surgery centers, I've operated in hospitals, and most doctors operate in both. It's a lot more enjoyable to operate at a place that's owned by physicians. We think differently. You get in a hospital, what they think about is bureaucracy. They love bureaucracy. They could take a 10-minute procedure and make it last an hour. They just, that's what they do. That's how they think. And they can't think differently than that. I was on an Affordable Care Act board representing the independent physicians. And we went around the room and they said, if anybody has any ideas that will increase quality and decrease costs, let us know. So I raised my hand, and there was an independent orthopedic group in town that were the best surgeons. They had their own surgery center, they had a place where the patients could stay overnight. I said, you know what? Everybody in town knows they're better than your hospital employed ortho. You need to get out of the ortho business, send it over to them. Everybody will do better. You'll save money, and the patients will get better care. The room just went silent. And I could hear in their minds, like, okay, what we just said, we didn't really mean. We didn't mean we really are interested in quality and cutting cost. You know, everybody's just looking at me like, I can't believe that guy said that. But the reason I said it, I knew they wouldn't do it, but they had some community representatives there. These were large businessmen that did a lot of business with the hospital. I wanted them to hear it. That's why I did it. And it is important. And I really support the independent docs, especially the ones that, you know, do cash-paying businesses, go out and do direct primary care. I love that. And like you said, you know, you know what the cost is right away. I use direct primary care as well. And I'm probably not as integrative a person as you are, but the thing is, I love the people of options. So I'm fine with that. And when I was practicing, I had a patient came to me and I was an OB and she said, you know what? I went to my chiropractor. What do you think about that? And I said, Well, what did you see your chiropractor for? And she said, Well, I was having back pain. I said, Well, how's your pain now? She said, It's gone. I said, Well, then I like it. Then I'm good with that. I go, you know, it worked for you. That's all that matters. And and that man was so happy. We became good friends after that. He said, Everybody else was always talking, you know, talking poorly about me, but you kept an open mind. And, you know, whatever works for patients, I love that. But I was just wondering, could you walk me through kind of the categories of care? I was just looking on your website. You have a great website. Uh, you know, you have like central care, care plus, direct. If you could just walk me through what's kind of the differences, I think the viewers will love to know the differences of those.

SPEAKER_01 18:10

Sure. If I could make one comment on your great comments, absolutely. Absolutely.

SPEAKER_00 18:14

You can say whatever you want, Charles.

SPEAKER_01 18:16

Um on my weekly health show that you've been on, um, everyone should watch uh Jeff's uh show, um and uh James's show, excuse me. Um the um we've had a lot of DPCs. You mentioned direct primary care, and people do need to know what that is. It's um it's democratic concierge care. Uh concierge care used to be you pay a monthly, quarterly, yearly fee uh for unlimited access to a nice doctor. Uh and now that's available for anybody for a hundred bucks a month, give or take. And what I've found with the DPCs who are alipath mainstream is they have become integrated. Why? Because of the time.

SPEAKER_00 19:00

It does change your minds. No, you're right. I mean, they do, and I've talked to a lot of them about that.

SPEAKER_01 19:04

There's no limit on how long they can see you.

SPEAKER_00 19:07

No, you're right. And they love doing hour-long visits and really drilling down into specifics. Instead of just saying improve your diet, you say, okay, what is your diet? What type of exercise do you do? What's going on in your life? What are your stressors? You can really drill down in that.

SPEAKER_01 19:23

Yeah. And they've all gone a little bit integrated. Um, and they never would have thought they would have. Um, and so I am a big supporter of DPC, especially for chronic care of big families. Because then definitely the prices make sense. You know, a bunch of visits for service fever service versus a monthly fee. Um also on the reproducibility problem, you I want to emphasize that. Um the journals are full of pseudoscience that can't be reproduced. And people have to know that and that that's why medicine isn't is an art, not a science so much. Um they have to be open-minded. Uh, that's uh, and that's why personalized medicine is so popular now, is you do have to have that time to find the root cause for that person and really think about what's going to work for him or her. Um that's why the HSA is so important too, because we combine sharing with HSAs. So to answer your question, you just asked, the two main plans that we offer, we offer several, depends on how much you have in your budget. The most popular are the two sharing vendors combined with the health savings account. So the health savings account gives you the cash for your first dollar visits, for your chiropractic adjustments, or a naturopath nutrient deficiency test, uh, or you know, your DPC, now that Trump fixed it, so you can use your HSA to pay for your DPC monthly subscription fee. Or for urgent care visits, uh therapies, occupational therapies, physical therapies. So the HSA is a great tool. Congress is trying to expand it. Um, Trump and some Republicans want to redirect some of the lost Obamacare subsidies into your own personal HSA, uh, which is great. Uh, you want to have patient empowerment as much as you can uh whenever you want to reform health care. Um and you said physician ownership improves quality. That is so true. In fact, people need to know that Obamacare banned physician ownership of hospitals, of new ones. There's there's some allowances, uh, but it's called con law, certificate of need laws in the states. They need to be repealed. And if you want to know what happens when you when you repeal protectionism, look at Oklahoma. Uh, one of the surgeons in this amateur surgical center near me in Virginia is from Oklahoma. And I asked him, What is it, what does it look like in Oklahoma? He goes, It's it's full of specialty hospitals.

SPEAKER_00 22:00

It's great. No, the especially hospitals are wonderful.

SPEAKER_01 22:04

You have market specialization, free market specialization. That's a basic term in economics. Absolutely. So uh and you mentioned also CEOs in the room. That is where a lot of the innovation happens with healthcare, with direct contracting and self-funding plans. Um, and we're inserting sharing, whether it's the two combos I mentioned, uh HSA with sharing, um, into bigger companies. We do something simple with a small company called a list bill. It's not even a real group plan, which is great for the boss. All you do is pay a check. And everyone has their own individual plans as a list bill for 50 or 49 and fewer employees. If you have 50 workers, you have more headaches to comply with with the ACA. And so what solves that is what Trump expanded and called the ICRA, individual coverage health reimbursement arrangement. So that's money funnel through a uh HRA, health reimbursement arrangement, to the worker to go buy Obamacare on the exchange, which they have to do with sharing because we have a pre-existing condition phase, and that's why we're cheap. You know, $350 a month per person up to $550, $650 per per family per month. That's actually cheap. Sounds like a lot of money compared to Obamacare, especially if you're not subsidized. Uh, people without subsidies who just lost them are paying like a thousand bucks a month again, like they used to with Obamacare. So I'm getting a lot of calls now. Um, but we can insert sharing into bigger companies now if they have the ICRA. So the sick people get the Obamacare. I'm sorry. Healthy folks get the sharing. You can get both. It's called double dipping. You can be the pre-existing condition. Let me explain that. So if you've had any symptoms over the past two years, those symptoms that pre-existed enrollment are going to be phased in. So no sharing for that thyroid uh or that uh past cancer checkup you're having over the past two years, uh, no sharing for that in the first year, fifth uh 25,000 and 50,000 in years two and three, and then uh annual cap of 125,000 in year four and thereafter, or no cap with our other sharing vendor. So if you're worried about that, I'll direct you to one sharing vendor that's uh that shares more on the pre-ex on the fourth year and going forward. Um but you know, there's always gonna be a role for Obamacare as a backstop for the sick, just as like before Obamacare, you had risk pools in at least 35 states. And one might ask, why did it why did the risk pools get replaced by Obamacare? Well, because politicians didn't fund them appropriately, so they weren't as useful as they could have been. But please don't say there wasn't a safety net for the uninsurable before Obamacare. It's not true. It's just you have to actually fund it. Um, so I start off, folks, you know, they want the health savings account because you can put in four or eight grand uh a year and roll it over. So you can you can have a hundred grand by the time you retire. That's a lot of money for a nest egg. You can use that for the gaps in Medicare or the long-term care expenses, which are gonna kill you because long-term care insurance is now unaffordable. It's coming back now as a market, but it collapsed. If you don't have any long-term health care expenses when you're in retirement, you could use the HSA for a vacation or your other expenses. So the health savings account is something your CPA will ask you if you've maxed out because it has three tax advantages. That $4,000 for an individual or $8,000 for a family you put into the HSA every year is pre-tax. So that cut your taxable income. Any interest paid into it by the bank or any value you uh uh increase it with investing, it can be invested. That's not taxed, appreciation. And then a big list of IRS permissible expenses are not taxed. So it has three tax advantages. So people should not uh discount the importance of having an HSA as part of your health care. And then it if you grow it appropriately, you have a lot of money for your dental. You don't dental insurance is a ripoff. If you don't know that, you should know that. You should dental insurance is a ripoff. Just build your HSA so you have money for your cleanings, your cavities, your crowns, etc. Um, and then and then you might need some some special plans for orthodontia, uh, etc. But anyways, build the HSA so you have money that you that you control. Um, and then if you don't have a lot of money, because those are compliant plans with Obamacare, so they're a bit more expensive. The HSA combo is sharing. Uh they're the bottom ones on my little gray box with all of our sharing uh plans listed. Uh they come also because they're compliant with free uh annual wellness screenings, colonoscopy, mammogram vaccines, and a bunch of bunch of cancer cancer screenings. There's 60 of them in total. Um, a lot of folks nowadays don't really want that stuff, but most folks still do, and it's free with those two plans. Um, our next two cheapest plans um are ones that are not structured to allow the ASA. So if you don't really want to save money on the side for an ASA, just want sharing, well, we have sharing only, which is the cheapest care plus, real cheap, uh, or the direct and premium care do come with some preventive screenings that are free. You just contact a concierge, we help you find the doctor that will accept the price for the colonoscopy that will be in the ambulatory surgical center, uh, or the mammogram will be in the cash imaging place. We will steer you to a place that's not gonna cost thousands of dollars. Um so those are our plans.

SPEAKER_00 28:05

Um, I love all those plans. I love that you have options because if you I'm just thinking, if I'm 25, I'm not gonna be interested in all those screenings, you know. And then you're like, okay, I don't need to pay for that. But later on, you're like, okay, you know, family history of colon cancer, I'm 45. You know, that'd be a good plan for me. And I was looking in the state of Indiana, they have, which is a great thing, the state has a list by zip code of all the claims paid, and you could just search that. So you can put in colonoscopy. You don't need even a code, use colonoscopy, and then they'll say diagnostic, you know whatever. And in one zip code, a diagnostic colonoscopy ranged from $1,200 to $12,000. It was 10x. And I went down a list of procedures, and there's probably half of them were 10x differences, and it wasn't the best center. These are places I never heard of that were overcharging people. There's like little, and I and I'm from the Midwest, so I know this area. And I was like, okay, what do they do? It's like a saying elsewhere, a little tiny place was overcharging. And you can imagine being the employer, self-funded, and you just say, Oh my God, I paid $12,000 for a colon hospital. I could have got it for $1,200. So, you know, everybody really, if you take anything from there, from this, when you're gonna shop, always make sure it's an ambulatory surgery center, make sure it's not owned by the hospital. Can you you could be up to 35 miles away from the hospital? If the hospital owns it, they're gonna charge you a facility fee, which is a fee you should never pay and they should get rid of. But unfortunately, they have them. So make sure it could look like an urgent care, normal urgent care. And all of a sudden, in the corner, you see something that's owned by the hospital, run. Find an urgent care that's independent. Because that's that's something people get caught up in all the time, too. I do wish the HSAs, and I saw this on X, I think it's a great idea. I think we need to separate it from high deductible plans. I think you should be like an IRA. You could get $10,000 a year in an HSA. Anybody, boom, you put it in, done. Easy. Because it makes sense. People need money. And, you know, I talk about shopping for care all the time at X. Everyone says, Well, how are they going to pay for it? I don't have this money. I'm like, well, A, you're not gonna be paying, you know, $30,000 a year for your care. So all of a sudden you have money. And B, you can put in an HSA. And like you said, it's a triple threat, you know, in terms of taxes. And I'm not up on all the rules, but I know if you take money out that's not qualified before 65, there's a lot of penalties. After 65, there's not. So that's something, you know, for anybody who says, Well, I'm gonna use it for something else, you just be careful with that because you can get tripped up with that.

SPEAKER_01 30:43

Yeah, I I specifically said that in the context of retirement, uh, where the penalty uh does go away. Um, so uh yeah, there's a penalty before 65. So I I never recommend that. Um to miss to misuse the money before.

SPEAKER_00 31:00

No, no, 100%. You know what? And I like your virtual things that you have on there. So one of the things I was looking at, I think is kind of interesting. If I'm a young guy, you have essential care, which is not cost sharing, but you get virtual primary and virtual urgent care. You you also, I believe, get the concierge with that. Is that true?

SPEAKER_01 31:21

Yeah, and so you get access to the concierge.

SPEAKER_00 31:24

So I think that's a nice if you're a young guy. The other thing is the other kind of workaround is if you're not making a lot of money, you can do is look at the financial assistance policies for your hospitals in your area. There's a good chance if you're you know under 200% of the federal poverty level that they would just write off those charges anyway. So it's not as crucial for somebody, you know, who's a young person coming out of college, you don't have a lot of money. You know, that's something to look at as well. And but I love the essential thing for somebody like that because you get a lot of value. You know, people love telehealth nowadays. You know, you get that cough, cold, what's going on? You calm up. And then having a virtual shopper really helps them because things like people have no idea labs can cost you a few dollars or they could cost you hundreds of dollars for simple labs like a CBC, depending where you go. Same thing for the imaging. You can pay $40 for an x-ray, you can pay $700, and you can just get ripped off, I think, in healthcare more than anywhere else in the country, right? Any other business, I would say, right now, which is a shame.

SPEAKER_01 32:33

Yeah, a couple of things. So our concierge is gonna use tools, including Healthcare Blue Book, which I keep mentioning because they have that really cool red, green, uh, yellow lighting system uh on price and and outcomes. Because, like you said, um, the most expensive surgeons aren't always the best. Correct. And the cheapest sometimes isn't the best. You want to sort of balance the outcomes versus the price, and then you pick. So we we give you that choice. Um, as far as the free virtual uh health care that we offer for all our plans, it's not just a scratchy throat or fever in the middle of the night. It's also chronic care. So if you have ongoing chronic care, you'll have a relationship with a doctor or a nurse practitioner uh who will be there for you whenever uh going forward. So that's sort of like why I like DPC for that $100 a month fee, yeah, uh face-to-face, unlimited access when you need it, when you're sick, you have lots of needs, you're a high utilizer. Um, also, mental health is free. And uh mental health is increasing uh in in the West in America, so to have free counseling is a nice addition to that free telemed service that we mentioned, and it also includes pet triage. Um, and actually that's a popular part.

SPEAKER_00 33:55

I'm sure that is. No, that that's a really good idea. I I love that. The other thing that's kind of a misconception, and I see this all the time. Everybody, you'll be on X or LinkedIn, they'll say, well, primary care doctors are worthless, they don't do anything. And what people don't understand is when you're a primary care doctor, you're employed by a hospital, what they really want you to do is send the people on for as much testing as possible and as many specialist referrals as possible and as many procedures as possible. They don't want you to do is sit down, take time, go through things, work it out, and find out other ways. So that's why they're quote unquote not helpful. But then you, like you said, you know, they have an hour to spend with you. Everything's changed. Then they could say, okay, wait a minute, you know, I think we can, you know, go about this a few ways. And, you know, for instance, my direct primary care physician, if I come in and I, you know, I'm having something that's bothering me, some ache or pain, he'll sit there and go, you know what? I think I know what this is. I'm gonna send you to this physical therapist that he works with, and he's a great guy. And, you know, and you could tell if I went to see the orthopedic surgeon first, I'm much more likely to end up in the OR. You see the physical therapist first, you probably are never gonna go to the Ortho guy. They'll work with you, you know, they'll say, Oh, yeah, we know, and these guys are phenomenal. I love physical therapists. They go through it, they, you know, they immediately this guy, you walk in, you tell him, he hits one spot, he goes, I know exactly what this is. He shows you, educates you, gives you the, you know, the exercises, you come back, and it's always improved things. So that's what I love, you know, because they direct you there. Now, if you're employed, you're not, you're gonna get in trouble for doing that. And if they send you to physical therapists, it's got to be the one that's employed in the hospital that's gonna cost you 5x of the person who's independent. So, you know, he and he sends me to the freestanding imaging centers, and you know, he, you know, dry, that's where you get the other value from direct primary care. They can get you discounted labs, meds, they can get you to the right places. So that is also a lot of value there. And I know you guys do that as well. Could you tell me how you get people a good deal on prescription drugs? Because that's another area people are getting ripped off on.

SPEAKER_01 36:13

I'll respond to that and some other things you mentioned.

SPEAKER_00 36:15

Sure.

SPEAKER_01 36:16

Um first for the meds, that's where the majority of our concierge efforts go into is finding uh cheaper alternatives for the active ingredients in the prescriptions of our members. And we're constantly constantly changing our discount plans, um, sometimes manufacturing discounts. World meds is an old, trusted uh friend uh getting prescriptions from Commonwealth uh countries, whether it's Ireland, South Africa, uh, Canada, or even Mexico, uh delivered to your door. Uh that's a popular program a lot of companies use. There's an exemption in the import laws that allow you to do that to your door. Interesting. Um, so we're constantly uh using different because not error, not there is no one perfect discount program for the breadth of uh biologics and uh you know special specialist drugs out there for prescriptions. It it's a it is a lot of effort, time, and money going into helping our patients find cheaper drugs. But to um comment on your primary care comment, that's an important comment because um there are some primary care doctors who are going to lose business as the baby boomers age out. Um so we've discussed DPC, the subscription model, and the time they gain with you is the value that they offer you. There's there's no incentive to get you in and get you out quick. It's not fee for service. So it's really good quality care if you want to budget that. Um, urgent care, don't discount it. Uh, it's convenient for busy moms or dads. Uh, there's a reason that they're expanding um nationwide. Uh for a lot of folks, that's that's the answer. There are some fee for service old school independent primary care doctors uh out there. We've had one for years uh here in Virginia. With that health savings account, um, you have options. So uh our chiropractor is a pretty big chiropractor in Williamsburg, Virginia, and is and is the chiropractor or was until recently for the William Murray football team. So a lot of people in Williamsburg know him. Fancy office, a little on the expensive side compared to other chiropractors. Well, that's supply and demand. He has his own staff of PT, massage therapists, um, and uh a DO, an osteopath on staff who happens to be his daughter. So, you know, the integration, the new integration models occurring out there, even naturopaths. You know, there's a lot to be said for having testing of your blood and DNA, especially blood or hair or whatever, to see what nutrient deficiencies you have. Because we all know the importance of diet. Um, you should have options though out there to for your primary care. Um also don't forget your personal responsibility to be healthy. To I think the new word is ground. They say go outside, barefoot in the grass, uh, hug a tree, look at the sun. I think we're learning now that we're we've been given some bad information by dermatologist. The sun is not your enemy, the sun is your friend, especially that early morning sun. I happen to have taught yoga, so I know a lot about Eastern medicine. Um so people do want to learn more about true health, and it doesn't always come from a pill. Not just physical therapy, you mentioned, uh occupational therapy. That's there's an increased increasing demand for that for kids these days. Um but uh that's I wanted to go into that a little bit more on the primary care because that's a big topic for people.

SPEAKER_00 40:03

Absolutely.

SPEAKER_01 40:04

No, I I love as well as the med as well as the meds.

SPEAKER_00 40:07

No, no, I I agree with that. And one of the things I I kind of laugh about because people say, you know, we have all this processed food. And you know, when I was growing up, we had the same processed food, and I think we probably ate worse. Honestly, we ate a lot of junk, but everybody was outside. You know, there were three channels on the TV, there was only a few hours a week of programming for children, and you were outside. So you're most of the time you're on your bike, you're walking, you're outside all the time. And that just changed. There's very few obese people. So I grew up in the 60s in Chicago, and I I could think of one man, one adult who was obese. I mean, he stuck out in our neighborhood because I felt bad for his son because he just couldn't move around and do things with his child. Everybody else was in good shape, and nobody was going to the gym. There was no gyms, there was no Pelotons, you know, but everybody was out doing stuff all the time. And, you know, that activity is what we're supposed to do. And I feel bad when I see young kids on e-bikes, e-scooters. I want to say, no, get off those. You know, their parents, let them have a pedal bike, let them move. It's crazy. So, and obviously, screen time's a big thing for kids as well. I mean, we, you know, it's insane. So it uh, and I know China limited the number of hours that children could be on screens. So, you know, it's so I think those are important things for the kids coming up because I, you know, in our era, when you know, you've got a little gray in your hair as well, Charles. So, you know, when we were growing up, there wasn't this epidemic of ADHD and all these problems that children had. And, you know, I think we're also we're varying off a little bit, but I think, you know, it's interesting, kids are having to go to school earlier and they expect more, especially for boys. They're not ready to sit down and then they get diagnosed and they get put on medications, and it just is a spiral. And it's kind of crazy. So, you know, that that's something I think, you know, and that does affect our health down the road, but I I think getting letting kids be kids, let boys be boys when they're little, I think is very important. And, you know, I think parents are starting to hold boys back a little bit from starting school, which I think is good.

SPEAKER_01 42:18

You say it's a bit off topic, and perhaps it is directly, but indirectly is not, in that, you know, when I'm not making commissions, upgrading families and small businesses from Obamacare to sharing. I happen to be the lobbyist for the world's oldest health freedom organization. Um, so I'm very in tune with what you're saying, uh, and have been uh cajoling politicians to care more about making America healthy again. And um I think school is a part of it. In fact, um we all have our pet solution to schooling. Um definitely supporting school choice. We need more competition in in how we school because you know I'm seeing evidence that the current status quo uh is not the ideal. You see studies showing uh corporations recruiting homeschooled kids because they have more independence and adaptability skills, um, student student-led learning schools, democratic schooling, um, all these unique charter and private schools try new things. Uh definitely, I want to require more, I want to bring back a recess. I mean, I can't I have a you know young kids. I can't believe recess stops at grade uh six. Oh, really? I didn't know that. I can't it's insane, isn't it?

SPEAKER_00 43:43

Wow, yeah, that is insane.

SPEAKER_01 43:44

To me, it's crying. I want to lock up the teachers for taking away recess. I agree because the sun, that's that's our that that's our creator up there. Yeah, uh, you know, yeah, they need to be outside in God's creation. And I agree with that. And and gym class is only two. Weeks followed by health class now. I want to have PE every day.

SPEAKER_00 44:04

Yeah.

SPEAKER_01 44:05

You see those 1950s black and white films of those high schoolers climbing the wall with these pegs. Yeah. I want that every day.

SPEAKER_00 44:14

Yeah.

SPEAKER_01 44:15

I want outside gym class every day. And if you have to combine your stupid curriculum, do it. But I care more about the health and creativity and ambition of my kids and following some political order trying to re-educate us for whatever nefarious plan they have out there. Um coincidentally, if you look at a graph, because I have a weekly Zoom on healthcare and a weekly Zoom on politics, because you know I used to work in Congress. And I was there with Hillary care. I fought Hillary Care in the early 90s, and I was there with the counteroffer of Helsinki's accounts and individualization of insurance. So I've been in the trenches since then. Um, but both, if you look at the cost curves of education and health care, they're the same. They are it's all admin costs for both.

SPEAKER_00 45:08

Yep, they exploded. Absolutely. I mean, it's amazing. The highest cost curve, you know, they have that century graph where they show, you know, the index of inflation, and hospital care is at the very top, you know, and then like you said, the schools are right below there, and it's crazy. You know, I agree 100%. Once you I went to school, so I was in college in the 70s, and that was kind of the break point. At that time, and I was at a private school, most of the kids were paying for it themselves. You could work in the summer, school wasn't that expensive, and that's what people did. And right after that, they started, and I'm about the same age as Patty Murray, who's a senator from Washington. They started doing the student loan thing, and that just exploded the cost of schools. And of course, the school started adding all these fancy accoutrements, which we didn't have. You know, ours is bare bones, but you know, it does it, you don't need anything fancy to learn the basics. And so it's kind of funny to say, I remember going around with my children, we're looking for colleges, and I went around. I'm like, oh my gosh, I want to go to college now. This is beautiful. You know, you guys have it made. You know, ours is bare bones, and you know, it wasn't great dining halls and you know, that kind of thing. So yeah, I do think we're wasting a lot of money. We definitely need to balance the budget and we need to be fiscally responsible. But I love what you're doing. I think this is great to give people options. Uh I love the concierge. Did you put the time and energy into that? Because I know that's separate from the sharing plans. That's something from my understanding, your brokerage does.

SPEAKER_01 46:44

Yeah. I mean, the sharing vendors do it too. I mean, once you have you have what's called an IUA, an initial insurable amount, which is our phrase for deductible. Sure. Uh, you know, anywhere from 500 to 5,000. So that's your responsibility. But once you've paid your portion of your sickness or disease, the sharing vendor takes over and what's called a need. Um, but most healthcare expenses, uh, James, you as you know, are below a thousand or three thousand dollars. Yeah. And you you need your hand held for those uh procedures as well. Uh and negotiating the consultation uh search for your chronic disease uh root cause. It's expensive and confusing. So yeah, our brokerage uh you know adds that value uh from the first dollar until we hand you over to the uh sharing vendor if you're hospitalized. Um but you know, to me, becoming an insurance agent who doesn't sell insurance, uh I sell this sharing because it's also political. I'm an idealist. You know, um I'm creating cash patients and you can't have a supply and demand curve without prices.

SPEAKER_00 47:53

Right.

SPEAKER_01 47:54

So to me, it's nice that I'm selling sharing. I don't care what you call it. To me, it's the creation of cash patients to save the West. Uh this cartel is top-down like education, it's it's not sustainable. Um, health.

SPEAKER_00 48:11

I I agree with you. I mean, you you see these nonprofit hospital CEOs. There were in 2021, there were two of them that made over $30 million. And these are hospitals that aren't paying any taxes. So they're really a burden on the community because you think a lot of them own extensive real estate. They're not paying property tax. So guess what? Your property tax just went up. They're not paying locals tax, sales tax, income tax, federal income tax. So, I mean, really, it's a parasitic operation and they act like they're not doing the same thing the for-profit hospitals do, but their business practices are identical. One of them was the large Catholic system. They have a billion-dollar offshore private equity fund. So they're really just taking all that money they got for not paying taxes and they're putting it offshore. And, you know, they're they're doing so. That's just what people don't see. People are like, because I see this on XP, it's like, you know, healthcare should be nonprofit. I'm like, there is no nonprofit, they just game the system. You have no idea what these guys are doing, you know. I mean, they're taking out Super Bowl ads. And why you Lagoon two years ago had a Super Bowl ad. I'm like, okay, you're paying $8 million, but you can't pay taxes, you can't pay any property taxes. And you can, you know, and and some of these nonprofits will take people to collections, they'll you know, take them to court, they'll hound them. So, you know, their charity care level is very low. And that's something that is really important for patients, like I said, to know about their policies for charity care because they're supposed to tell you, but I don't really think they're doing that. So you you have to really arm yourself with that as well. But uh, but I love all the things you're doing. I think this is responsible. I think this is what we need to get back to, or that patients need to know the price of things. They shouldn't count on the insurance to really get them the best price, the best value, because that's not their interest. They're trying to make as much money for themselves as possible. And I, you know, I really want patients to know the physicians are with you. We don't want patients to get ripped off by the insurance company. When you get charged $100,000 for simple surgery, it's not going to the doc, it's going to the C-suite. So docs make this in. We we really don't care. You know, we want you to get good value. So those are all great things. But I'm just gonna close that out on this note. I really appreciate what you're doing. And I think one of the most ironic things is one of the biggest criticisms of cost sharing is there's the benefits aren't guaranteed. And I'm like, are you kidding me? You think the benefits are guaranteed with insurance plans? They can prior off you. I mean, my favorite thing is you can get a prior authorization to get it approved and then they don't pay it anyway.

SPEAKER_01 50:49

When I substack about uh healthcare uh payment, uh I tend to repeat the talking points because they have to be repeated because the uh industry dependent media repeats their talking points.

SPEAKER_00 51:02

Yes, yes.

SPEAKER_01 51:03

Um and sure, there's no guarantee of sharing with a sharing vendor, but have I experienced non-sharing? No. If it's in the guidelines that the community has agreed upon that's shareable, it will be shared. Um so you know, if you get hospitalized from uh an illegal act, no, that's not going to be shareable. Um and we we phase in pre-existing conditions, it'll be shareable after a waiting period. So we uh educate our prospects before they enroll so they they know the pros and cons. Uh and if the pre-ex phase is too risky, well then go to the exchange and get an insurance plan because uh or get both, and then after a couple years, give up the insurance plan because now there's no more phase in. You're good to go with sharing, and now you have access to any doctor. Um and yeah, even if you get a pre-authorization, there was that famous tweet that I put in my latest Substack, half of his pre-authorization approvals were not honored. That's a 50% denial rate.

SPEAKER_00 52:14

That's crazy.

SPEAKER_01 52:15

Um, and and even the doctors that remain in the network, you know, keep in mind they're gonna bend over backwards to avoid being booted from that network. Whereas if you're a cash patient dealing with a cash doctor, the two of you now have a pure economic relationship.

SPEAKER_00 52:32

Right. It's very simple. I agree with that.

SPEAKER_01 52:35

That's quality, that's where quality comes from.

SPEAKER_00 52:37

No, it does. And I love what you do at maternity. There's a six-month waiting period, but you know, the cost sharing is really well suited for maternity care, which I love that. That that's being an OB, that's a great thing. And I looked through what you covered, and it was all very reasonable. And anybody can look on you know on your website and you can look through the specifics of the care. And I also love that you say to people, this isn't for everybody, you get somebody might be better off on the ACA exchange if they're you know sick, have a lot of issues, or you know, maybe their employer is paying most of their care and they're better off there. You know, so it really comes down to finding the solution for the person, not putting everybody into one box.

SPEAKER_01 53:19

Yeah. Uh you're always gonna need a backstop. Uh, and um so finally, we have a competitor to insurance, just as people in banks can leave for credit unions. And that's good for people to have choices.

SPEAKER_00 53:34

Absolutely.

SPEAKER_01 53:35

And James, thank you for uh all you're doing. Well, thank you. About good healthcare.

SPEAKER_00 53:40

Absolutely. Thank you so much. And please, everybody, if you have any questions, let us know. I'm gonna in the show notes, I'm gonna put Charles information. So, you know, if you want to reach out to him, if you say, boy, he's a pretty reasonable guy, you know. I want to find out more about that. We'll we'll put in his information for his brokerage so you can contact him and make it easy for that. And please, you know, let us know if you have any questions. And thank you to Charles for coming on today. And thank you for all the listeners. If you made it this far, I really appreciate that. Please like and follow for more. And you can follow me on X and LinkedIn. That's where I spend most of my time. And thanks again. Appreciate it. We'll see you later. Bye bye.