8.3 Problems: The CORPORATIZATION of Healthcare

[00:00:00] Here, Taylor and I talk about the trend towards

[00:00:03] corporatization of United States health care.

[00:00:06] And by that, we mean large conglomerates.

[00:00:10] Goblin up, smaller healthcare entities,

[00:00:13] essentially trying to monopolize how health care is provided

[00:00:17] and sold to us in the United States.

[00:00:19] First, we give a general overview of insurance,

[00:00:23] talk a little bit about the Affordable Care Act,

[00:00:26] and its impact on the current corporatization, and also discuss at length HIPAA and the advent

[00:00:33] of the EHR or EMR or electronic health slash medical records, and how that has contributed

[00:00:40] to rising ancillary costs or administrative costs of health care, again, forcing more providers into working for one of these large corporations as opposed to private practice. insurance and the corporatization of medicine are really pushing us further and

[00:01:05] further away from the ability to provide good quality medical care to

[00:01:11] Americans. And lastly we discuss a little bit about ETFs or electronic

[00:01:17] transfer fees. Just another example of a middleman in health care making money off of the system without really providing

[00:01:27] much value.

[00:01:31] Somebody get this guy some help.

[00:01:40] I think a good general overview of what health insurance is and how it works.

[00:01:44] I'm referencing here a book called American Sickness.

[00:01:47] Most of what it talks about is still applicable today,

[00:01:49] but it was written, I think, in the early 2000s and a lot has changed since then.

[00:01:53] But some general overarching themes.

[00:01:56] Health insurance was invented in America originally by the Blue Cross in the early 1920s.

[00:02:02] It was a charitable thing at that point and meant to help people who were six for hospital in the early 1920s. It was a charitable thing at that point

[00:02:05] and meant to help people who were six

[00:02:08] for hospital stays in the 1920s

[00:02:10] before the advent of antibiotics

[00:02:12] or places that people who were really sick went to die.

[00:02:15] We didn't have a lot of treatments available.

[00:02:16] Antibiotics weren't readily available until the 1940s.

[00:02:19] As time and medicine progressed,

[00:02:23] eventually health insurance became widespread.

[00:02:25] The Blue Cross was still a charitable organization,

[00:02:29] but around the 1960s or 70s,

[00:02:33] new insurance companies that were for profit

[00:02:36] became to emerge and the health insurance landscape

[00:02:39] started changing a little bit.

[00:02:40] So what happens when you go to your doctor's office and

[00:02:45] are charged? There's documentation on it. I bill for a visit that I saw this

[00:02:50] patient and I bill for whatever tests that I run as well because those are

[00:02:53] additional bills. Those bills are not sent to the patient. Those bills are sent to

[00:02:58] the patient's insurance company. Whether that be a private insurance company or

[00:03:02] government-funded insurance, which is Medicare or Medicaid, depending on their age.

[00:03:07] And if they're qualified for any disabilities, if they are below the

[00:03:10] poverty line, that insurance company then decides whether they are going to pay

[00:03:15] that claim or not back to my practice.

[00:03:18] It seems pretty simple and straightforward.

[00:03:21] You bill, you send it to the insurance company.

[00:03:23] The insurance company pays you. The patient is paying their monthly premiums to the insurance company and or a deductible.

[00:03:32] What has happened in the last 20 to 30 years are some pretty complicated, convoluted things.

[00:03:39] One is the rise of high deductible insurance plans, which are basically catastrophe insurance. A high deductible

[00:03:48] means that you cannot get your medical care paid for, whether it be a visit in the office

[00:03:54] with your primary care doctor or an accident happened, you get a bike car, and you have

[00:03:59] to go to the hospital. That means if you're deductible, that fiscal year is $5,000, you

[00:04:03] have to pay $5,000 before anything's going to be paid.

[00:04:06] Depending on how high that deductible is, that can bankrupt some people.

[00:04:11] And you still have to pay for the premium and all the way up to your deductible if that

[00:04:15] does happen.

[00:04:16] We saw a lot of these higher deductible plans start to emerge with passing the Affordable

[00:04:22] Care Act.

[00:04:23] And the Affordable Care Act did a lot of good things,

[00:04:25] but it also did a lot of bad things.

[00:04:27] Private insurance changed a lot,

[00:04:29] but the Affordable Care Act monthly premiums went up very high

[00:04:33] and you saw the emergence of a lot of these catastrophe plans

[00:04:36] with very high deductibles that most patients can't pay

[00:04:40] since patients knew that those deductibles were high

[00:04:42] and they wouldn't be able to pay them.

[00:04:44] Now these patients aren't seeking medical care anymore.

[00:04:47] Which, why are we trying to reform insurance if you're de-incentivizing going to the doctor?

[00:04:52] A couple good things that the Affordable Care Act did do though is change the

[00:04:57] set requirement of, and you were talking about how your wife, how much each visit she gets

[00:05:02] 9% of. Previously before the Affordable Care Act,

[00:05:06] every dollar that was spent in health care only about 60 to 65% of it was actually going

[00:05:11] to health care. The Affordable Care Act, they made it a minimum to 80 to 85% of every dollar

[00:05:18] that is spent is going to medical care, which is a good change.

[00:05:23] It's gotten out of control in the last 20 to 30 years.

[00:05:26] One of the biggest reasons why insurance now dictates treatment and the whole payment landscape

[00:05:33] in 1996. The entirety of that HIPAA bill essentially allows EHRs or electronic health records or

[00:05:41] electronic medical records EMR to have all of your information. I just want to read a little excerpt from document titled ethical

[00:05:50] issues with EMR in its states, but the implementation of the EHR also has

[00:05:56] catalyzed a subtle transformation of the purpose of the medical record from its

[00:06:01] established role of recording a patient's medical data to its

[00:06:05] new role of providing adequate documentation to justify coding and billing payment.

[00:06:11] Traditionally, the medical record provided documentation of the patient's history, physical exam,

[00:06:17] lab and imaging data, assessment, diagnosis and plan. A well-written note contained enough

[00:06:22] detail and coherence to allow other clinicians

[00:06:26] to understand the symptoms, findings, the physicians reasoning about the diagnosis, and the

[00:06:31] treatment plan. Students in residence were taught the proper content and format of notes to

[00:06:38] achieve those quality goals. Now, however, healthcare insurers, led by Medicare, require elements of the history and

[00:06:47] examination to be documented to justify individual billing codes for payment levels.

[00:06:54] Practice managers and other administrators urge physicians to incorporate these specific

[00:06:59] data elements into their notes so that the chart documentation supports a particular

[00:07:04] billing code. To attain a reasonable level of reimbursement, physicians may need to

[00:07:09] conduct and record such items as the 14 element review of systems, which by the

[00:07:14] way the restrictions have loosened on that. And the documentation of

[00:07:18] extraneous physical exam findings that are clinically irrelevant. In other

[00:07:23] words, we are having to check all of these boxes

[00:07:27] that make the medical record a clusterfuck essentially

[00:07:32] has way more information than is useful

[00:07:34] for anybody trying to review it.

[00:07:36] When realistic, when you look at a medical record,

[00:07:39] we're really looking for two to three sentences

[00:07:40] and you're going through pages and pages.

[00:07:42] And honestly, we're probably significantly contributing to deforestation and Amazon based on

[00:07:48] how many records we have to pour through.

[00:07:52] So just to finish this excerpt, pressure to provide this unnecessary medical care and documentation

[00:07:59] has led to a gradual transformation of clinicians' behaviors to orient their notes from the appropriate

[00:08:06] goal of quality medical care to a new goal of assuring adequate reimbursement.

[00:08:12] One can't fault hospitals' medical practices and clinicians for responding to the

[00:08:17] realities of financial pressures, but these burdens have created perverse consequences

[00:08:22] that counter the medical interests of our patients

[00:08:25] by requiring clinicians to conduct and document unnecessary and wasteful procedures

[00:08:30] that can harm patients by reducing the time they have available to provide appropriate medical care.

[00:08:36] A few other issues with electronic healthcare records, paper charts obviously you just did everything yourself.

[00:08:43] Now these EHRs, you can't operate without them

[00:08:46] You need them if you're gonna own your own practice a hospital you need electronic medical records to prescribe

[00:08:52] Everything's electronic and they've become this giant industry all in themselves

[00:08:58] It seems like there's becoming a monopoly obviously a couple of very large ones epic

[00:09:07] I'm monopoly. Obviously a couple of very large ones, epic, a Thedonet, Cernor, having gleamed a little bit of this information by talking to a couple of people that are making the decisions

[00:09:12] of signing contracts for these. It's not quite a monopoly, but there's not a lot of options,

[00:09:17] especially for smaller practices, if a general family doctor wanted to open his own practice,

[00:09:23] he would not really be able to afford

[00:09:25] these larger electronic healthcare record systems.

[00:09:28] And if you're not on one of these larger ones,

[00:09:31] your life becomes a lot more difficult.

[00:09:34] It's hard to get these systems to talk to each other.

[00:09:39] They don't interface very well.

[00:09:41] So if you're at the small clinic

[00:09:42] and you're using a private system

[00:09:44] that is a little more cost effective, one of your patients goes into the hospital face very well. So if you're at the small clinic and you're using a private system that

[00:09:45] is a little more cost effective, one of your patients goes into the hospital that is using

[00:09:50] one of these larger EMRs like Epic or CERNER, they're not going to have the records from

[00:09:56] your office and it's going to be hard for that electronic healthcare center to get your

[00:10:02] records. You're going to have to fax and manually scan things in.

[00:10:07] There's gonna be delay of two to three days.

[00:10:09] And then when that patient gets out of the hospital

[00:10:12] and you're trying to figure out what exactly

[00:10:14] they went into the hospital for,

[00:10:16] what those doctors were in their thought,

[00:10:18] any of the labs or testing that was done,

[00:10:20] the same thing's gonna happen.

[00:10:22] You would think that all of these records are online,

[00:10:25] all these systems should be easily able to communicate with each other, but that's not

[00:10:29] the reality.

[00:10:30] So it won delays patient care too, as become a whole other industry in itself that's

[00:10:37] probably worth billions of dollars.

[00:10:39] And three is making it a lot harder for private practice small, mom and pop doctors to open their own practices

[00:10:46] and not be part of the giant corporate conglomerates

[00:10:49] that are able to afford those larger e-mars.

[00:10:52] Oh, and it's like pulling teeth to get medical records

[00:10:55] unless you have somebody on your staff

[00:10:58] or in your clinic that specifically does that.

[00:11:01] Most of the time I feel like people

[00:11:03] are just not gonna get the medical record. I can't tell you how many times I've been on overnight shift emitting a patient to the hospital

[00:11:10] They're from out of state. We don't have any records

[00:11:12] You find out the name of their doctor or where they've been before and you're trying to call these hospitals

[00:11:17] Do you think okay big large hospital? I can get records overnight. That's fine. There's someone there

[00:11:22] Nope, it delays patient care.

[00:11:25] You have no idea what's going on even though these hospitals have the records and the ability to

[00:11:30] send you until that patient signs a release act. Which is not true. It's not accurate. If you are

[00:11:36] treating a patient for a condition and you need to correspond with another provider who has treated that patient,

[00:11:46] you don't have to ask for the patient's permission. So many barriers and hurdles

[00:11:52] is working against good medical care. It's one of the sliest acts that has ever been passed because

[00:12:01] on the surface, it's presented as this great thing that protects everybody's health information.

[00:12:07] But what it actually does is it allows the insurance companies to have access to all of your medical records.

[00:12:16] They then can find loopholes for why they shouldn't pay for things.

[00:12:22] And let's face it, there are a lot of

[00:12:25] under-educated people out there,

[00:12:28] including myself, I've been working in healthcare

[00:12:30] for 10 years, and I still struggle with insurance.

[00:12:34] It is a complicated topic that is hard to find

[00:12:37] good information on, but I think that doctors

[00:12:40] are intentionally kept in the dark.

[00:12:42] Absolutely.

[00:12:43] Because there are so many things that go wrong

[00:12:46] and healthier because if we knew how much people

[00:12:49] were gonna be charged, it might affect our treatment

[00:12:52] and our decision-making.

[00:12:53] One of the reasons I'm glad you brought me here

[00:12:55] to talk about this overarching subject of corruption

[00:12:59] and overspending, money-wasting healthcare

[00:13:02] is something I've found in my training. I'm seven years

[00:13:06] deep into this now. I struggle with on a daily basis. Seeing the overspending that happens

[00:13:13] and wondering if I am actually making a difference doing this career or am I contributing

[00:13:20] to the overspending, the debt crisis, ruining people's lives by doing this.

[00:13:26] And it's not something that you're ever warned about

[00:13:29] when you enter this field.

[00:13:30] People that go to medical school,

[00:13:32] and not everyone, obviously some people

[00:13:34] are coming in here for job security, other reasons,

[00:13:36] but the vast majority of people I've met

[00:13:38] in my medical training generally want to help people.

[00:13:41] They entered this field because they couldn't think

[00:13:42] of another field that allows you to help people in the way you do as a physician. And you come into thinking,

[00:13:49] like, I want to do something meaningful with my work life. That was my biggest thing to be able to

[00:13:55] go to work. And at the end of the day, as in at the end of my life, say, I set out every day to

[00:14:01] help people live healthier and better lives. Yeah. But what I'm seeing right now and day in and out of training,

[00:14:09] there are specific instances where, yes, I can definitely say I helped this

[00:14:13] person, but generally looking at the system as a whole, I question it every day,

[00:14:18] whether this is really helping the public, whether we're really doing the right thing. And I see glimpses of my

[00:14:27] colleagues asking themselves the same thing. We don't really talk about it often. It's not something

[00:14:32] that's brought up and discussed among the residents, among the attendings. But I see this weight

[00:14:41] that is over all of us. Doctors don't really have control of any of this.

[00:14:46] We are now a labor force.

[00:14:47] We are a cogs in the system.

[00:14:50] Sometimes people carry that weight heavier than others.

[00:14:53] And I think it's a big point to at least address

[00:14:57] and convey to the general public

[00:14:59] that this thing's getting out of control.

[00:15:01] You can see it in the numbers of people,

[00:15:04] the percentages of people that are in private

[00:15:06] practice versus working for a big hospital system, healthcare corporation.

[00:15:12] There's fewer and fewer doctors who are working in private practice where they can dictate

[00:15:17] their own treatments and outcomes.

[00:15:19] Yeah.

[00:15:20] I don't know the exact numbers.

[00:15:21] I know it's somewhere north of 50% as high as 75% now working for

[00:15:27] some entity as opposed to in private practice and of that other 25% of doctors still working in private practice

[00:15:35] You know that there's a significant proportion of those that are in it for monetary reasons

[00:15:40] I sat next to people in medical school that you could tell right from the

[00:15:45] get-go, this person's in it for the money. They want to make as much as they can, helping

[00:15:49] people is not a top priority for them or gaining knowledge and learning how to treat things

[00:15:56] most effectively and efficiently is not a top priority. So what percent does that leave?

[00:16:03] Maybe there's some good corporations out there that really do

[00:16:06] I'm sure there are some yeah if that are looking for the long-term success as opposed to

[00:16:13] Short-term how much profit can I make this quarter versus next quarter versus the next quarter

[00:16:18] There are businesses out there that appreciate slow and steady growth and develop a reputation for providing

[00:16:26] really good medical or psychiatric care. But out of 100%, I'm skeptical, a little bit pessimistic,

[00:16:33] but I would put the number at like maybe 20%, maybe 30% of doctors who are out there trying to

[00:16:43] advance in their understanding of the illnesses that

[00:16:46] they're treating and trying to be as effective and efficient as possible.

[00:16:50] You were really close to that. That was the study that came out in 2016 from the American

[00:16:54] Academy of Medical Colleges. 74% of physicians in 2016 were employed by a hospital system.

[00:17:04] in 2016 were employed by a hospital system. So general trends, I think,

[00:17:06] in the 90s, 50% of doctors worked in private practice.

[00:17:10] Generally, the corporatization of medicine,

[00:17:13] these large corporations,

[00:17:14] and this is not just affecting medicine

[00:17:16] to affecting other fields too,

[00:17:17] but I think more deadly

[00:17:20] when it's affecting the medical field.

[00:17:22] When these larger hospital systems,

[00:17:24] these large conglomerates,

[00:17:26] acquire other hospitals,

[00:17:28] you have the advent of these electronic medical records

[00:17:31] that become very expensive and harder for these smaller

[00:17:35] private practices to buy and stay afloat.

[00:17:38] And if you're not using one of those EMRs,

[00:17:40] you're not able to communicate with the hospitals

[00:17:42] when your patients go in the hospital.

[00:17:44] There's a lot of things that limit a doctor now from being able to go out on his own and open a practice.

[00:17:51] And a lot of times they're now forced to be employed by these larger systems.

[00:17:55] And you then become a cog in the machine instead of being able to practice the way you want.

[00:18:01] This is also dangerous because doctors are the people

[00:18:05] that are getting the most training about how medicine works, the most

[00:18:10] training on treatment, and the most training on patient safety. Then that's

[00:18:14] something that's constantly brought up through my training. When we're thinking

[00:18:17] about making decisions, patient safety is always the term that's brought up to

[00:18:22] a frustrating point sometimes. When you're taking the power out of our hands and we're no longer making these decisions,

[00:18:30] who is?

[00:18:31] Right now I think the answer are CEOs of corporations, people with business degrees that don't

[00:18:37] really understand the nuance of medicine, that don't have the same training, the same care

[00:18:42] for patient's safety as these people who have literally devoted their

[00:18:46] life to a career that is focused around it. Totally different goals and values too.

[00:18:51] I mean I understand they're in a different field. Their goal, their drive is to

[00:18:55] make money for their shareholders and I get that. That works well when you're

[00:19:01] talking about selling a toy Jeep to my one-year-old son

[00:19:07] Market the shit out of that call it the greatest Jeep that's ever existed for a little kid to ride around in

[00:19:13] But when you're talking about people's health and that is the entity that is making the big decisions and

[00:19:21] It goes deeper than that. You've got the same corporate entities that own

[00:19:27] EMRs or electronic medical records. They fund medical education in the writing of these

[00:19:33] textbooks. They fund the medical journals. It's literally pervasive across every aspect

[00:19:41] of medicine. And then you've got all kinds of doctors out there

[00:19:45] that see what is happening. They know how the system works. Yet we remain

[00:19:51] powerless. We can go to the FDA. We can go to the American Psychiatric Association,

[00:19:57] the AMA. We can go to these entities, but they're so deep in the pockets of the

[00:20:04] big business interests that

[00:20:06] sometimes we got to go off the beaten path and do something crazy.

[00:20:10] Start a podcast and rent and rape to the general American public about these problems because

[00:20:16] I don't see how the system's going to change unless the American public demands change

[00:20:23] and that starts by understanding and education about it.

[00:20:27] Yeah, lifting the curtain.

[00:20:29] It has taken seven years of training to get to the point where I am where I really

[00:20:33] wow, understand and see all this and am disgusted by parts of it.

[00:20:38] I think big things to explain as far as the corporatization of medicine goes are one private equity firms

[00:20:47] and two non-profit hospitals.

[00:20:50] These are great examples of business overreaching into medicine and private equity firms

[00:20:55] are basically just private investment firms that are continuing to buy up a lot of physician

[00:21:02] practices with a private practice or becoming involved

[00:21:06] in those larger hospital conglomerates.

[00:21:08] I've got a couple of buddies that work on that side.

[00:21:10] They know that this is the system

[00:21:12] and we're just gobbling up networks of hospitals

[00:21:16] and clinics, turning them around

[00:21:18] and finding ways to make them more profitable.

[00:21:21] Yeah, exactly.

[00:21:22] That is the whole idea of a private equity firm.

[00:21:23] It's an investment company that says, we going to buy this for a certain amount of money and then we are going to

[00:21:29] increase its value and get more money out of it. So when you think about where that money's coming from,

[00:21:35] that money is coming from insurance companies, which is ultimately coming from

[00:21:39] patients. So they're trying to say we want to make more money off of people.

[00:21:46] And there's many ways telling physicians to build higher and

[00:21:50] incentivizing more procedures, causing physicians to see more

[00:21:54] patients in a day. That's not necessarily good for the

[00:21:58] patients, but it's good for the private equity firms if their

[00:22:02] ultimate goal is to make money. Again, that's not aligning with our ultimate goal

[00:22:08] of physicians, which is to help people and treat our patients.

[00:22:12] Right, but that's not the only thing that is forcing providers

[00:22:17] to operate within these big conglomerates.

[00:22:20] A good article from ProPublica titled,

[00:22:23] The Hidden Fee Costing Doctors Millions Every Year.

[00:22:26] Essentially, it but tells this story about how in August of 2017, a CMS or the Centers for Medicare

[00:22:34] and Medicaid Services posted a notice on their website. Informing insurance companies,

[00:22:40] they aren't allowed to charge physicians a fee when the companies paid the doctors for their work.

[00:22:46] Six months later, it disappeared. What they're talking about is an electronic transfer fee,

[00:22:52] because most fees paid for insurance to clinics or specific doctors or hospitals are now done

[00:22:59] electronically, but now insurers are routinely requiring doctors to kick back up to 5% if they

[00:23:08] want to be paid electronically.

[00:23:11] And then they're also mandating that the doctors be paid electronically.

[00:23:16] Even when clinics or hospitals say, okay, we'll just send us a check in the snail mail,

[00:23:22] they say, oh no, we don't actually do that.

[00:23:24] We're mandating that you pay a kickback,

[00:23:27] but we're also mandating that you have to do it electronically now.

[00:23:30] Essentially, as Terrence Gray and Anishesiologists

[00:23:33] from Maine put it, we're paying fees to get paid.

[00:23:38] This story is great because there is a urologist

[00:23:41] living up in the Bronx, I believe.

[00:23:44] Alex Steenshluger, Steen Schluger,

[00:23:48] a very long last name that I can't pronounce, Russian urologist that started to see these

[00:23:56] fees being charged to his private practice. He started to file all of these public records requests with CMS over the last seven years.

[00:24:07] He's learned a lot more about what is happening.

[00:24:10] Figured out that Matthew Albright went from CMS to Zealous.

[00:24:15] An employee for CMS helping oversee the transition from paper charge to electronic medical records.

[00:24:22] In Steen Schleuger's public records request, he started to see

[00:24:26] all bright's name and then he just so happened to see that all bright left CMS in 2017, I believe,

[00:24:34] and was high up executive in one of the companies that processes a large proportion of these electronic transfer fees called Zealous.

[00:24:45] Z-E-L-I-S.

[00:24:46] So, Steenshluger, Steenshluger very quickly figured out

[00:24:54] that Matthew Albright had this inside knowledge,

[00:24:57] this notice got taken down and essentially opened the door

[00:25:01] for companies to do this.

[00:25:03] And you gotta love this guy. Steensh Schluger, he talks about how this whole process reminds him of growing up in the

[00:25:12] Soviet Union. How his brother needed an antibiotic for a pretty simple infection, but if

[00:25:18] left untreated, could have eventually led to his demise and his death.

[00:25:25] And the doctors, when his brother went to the doctor,

[00:25:28] the doctors were asking for bribes,

[00:25:30] which was, he says, commonplace.

[00:25:32] And luckily he was able to find another doctor

[00:25:34] that was able to prescribe the antibiotics for a lesser bribe.

[00:25:38] But he says, this is not really any different

[00:25:41] than the Soviet Union rush.

[00:25:43] Back to Albright, the lawyer that had previously

[00:25:47] gotten a degree in religion when he was working at CMS.

[00:25:50] In 2012, he published a document that laid out standards

[00:25:55] for paying doctors via electronic transfer funds.

[00:25:58] The Affordable Care Act that passed and the 2010s

[00:26:01] required all insurers to offer EFTs and encouraged doctors

[00:26:04] to accept them and electronic

[00:26:05] payments quickly became the go-to method for handling medical claims.

[00:26:09] I was predicted that this would save $3 to $4.5 billion over 10 years.

[00:26:15] As this document was accepted by CMS and took off Albright became a little more famous,

[00:26:21] his career started to turn. And two years later, he landed a job at Zealous.

[00:26:28] One of these middlemen processing companies previously,

[00:26:32] all bright had been publicly against requiring any fees

[00:26:36] for these transfer funds.

[00:26:37] And then once he started working for the middleman

[00:26:39] that benefited from these transfer fees,

[00:26:42] publicly came out and said that he now is for these and actually when

[00:26:48] Schleiden Schleigen started to bring this issue up to CMS

[00:26:52] publicly released records found that all Brighton was behind the seeds vehemently arguing against him and

[00:26:58] CMS when they placed that demo in 2017 saying that we're going to stop these transfer fees

[00:27:05] They placed that memo in 2017 saying that we're going to stop these transurfies. A CMAs quickly received an email arguing that they couldn't do this.

[00:27:09] CMAs quickly removed that memo after six months of being harassed by Albright.

[00:27:14] I might have to have a Steench Luger on just so that if nothing else we know how to pronounce

[00:27:19] his name.

[00:27:20] Based on many emails and memos, he sent CMAs, and he'll probably spot him.

[00:27:24] I'd love to hear more about his upbringing, how this initially got started. Based on many emails and memos, he sent CMS and he'll probably spot him.

[00:27:25] I'd love to hear more about his upbringing, how this initially got started for him.

[00:27:31] Recently, there has been a bill proposed to the House of Representatives after this

[00:27:36] pro-public article came out actually putting a ban on ETFs in general so that these

[00:27:41] middlemen companies stop profiting off of transfer fees and adding to the large health care spending GDP that we have here in America

[00:27:48] So there is some good that's come out of this

[00:27:52] Somebody get this guy some help

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[00:28:27] Disclaimer, this podcast is for informational purposes only.

[00:28:29] The information provided in this podcast in related materials are only to educate.

[00:28:32] This information is not intended as a substitute for professional medical advice.

[00:28:35] While I am a medical doctor and many of my guests have extensive medical training and experience,

[00:28:38] nothing stated in this podcast,

[00:28:39] nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials,

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[00:28:52] or other healthcare provider if seeking medical advice, diagnosis, or treatment.

[00:28:55] Or put more simply.

[00:28:56] You need help like this guy, call your own doctor.