Right to the Point

#30 - The Biggest Bait and Switch in History? Obamacare.

34 min
Jan 23, 20264 months ago
Listen to Episode
Summary

Three Republican congressmen discuss the failures of the Affordable Care Act, arguing it has driven up premiums, reduced access to care, and enriched insurance companies rather than patients. They propose market-based reforms including health savings accounts, direct primary care, and removing insurance companies from the center of healthcare decision-making.

Insights
  • Despite ACA's goal to insure 25-30 million uninsured Americans, that same number remain uninsured today, suggesting structural rather than coverage-based solutions are needed
  • Insurance enrollment fraud exists where individuals are signed up without knowledge, with insurers receiving taxpayer-funded premiums for people never receiving care
  • The consolidation of healthcare into corporate entities removes physician autonomy and patient choice, reducing incentives for medical school entry and innovation
  • Healthcare costs have grown 4.5x faster than inflation since 2000, crowding out other household spending and preventing wealth-building for younger generations
  • Republicans view healthcare reform as an opportunity to differentiate from Democrats by proposing market-based solutions rather than continuing band-aid fixes to ACA
Trends
Shift from insurance-centric to patient-centric healthcare models gaining traction among policymakersDirect primary care and surgery centers demonstrating superior outcomes and cost efficiency outside traditional insurance networksHealthcare supply constraints (doctor shortage projected to reach 80,000+) becoming critical policy issueConsolidation of healthcare providers into large corporate entities reducing competition and innovationGrowing bipartisan concern about pharmaceutical benefit managers (PBMs) and hospital pricing opacityHealth savings accounts and individual ownership models emerging as preferred Republican healthcare reform strategySite-neutral pricing becoming focal point for hospital cost reduction discussionsEnhanced COVID subsidies expiring, creating political pressure to address structural ACA affordability issuesYounger generation healthcare costs preventing homeownership and wealth accumulationIncreased scrutiny of insurance company profit margins and input cost management
Topics
Affordable Care Act (ACA) structural failures and reform proposalsHealth insurance premium inflation and cost driversDirect primary care models and patient outcomesHealth savings accounts (HSAs) and individual healthcare ownershipMedical school and residency program capacity constraintsInsurance company consolidation and market powerPharmaceutical benefit manager (PBM) regulationHospital pricing transparency and site-neutral reimbursementCOVID-era healthcare subsidies and budget implicationsHealthcare fraud and waste in insurance enrollmentEmployer-sponsored health insurance reformDoctor shortage projections and medical workforce supplyPatient choice and healthcare decision-making authorityHealthcare innovation in competitive marketsRepublican Study Committee healthcare policy agenda
Companies
Insurance companies (unnamed major carriers)
Discussed as primary beneficiaries of ACA, with executives scheduled to testify before Congress on affordability issues
Oklahoma City Surgery Center
Referenced as example of direct-pay surgical facility achieving better quality and lower costs outside insurance netw...
People
Michael Cloud
U.S. Congressman from Texas, former church worker and small business owner, discussing ACA failures and healthcare re...
Kevin Hearn
U.S. Congressman from Oklahoma, former business owner, advocating for market-based healthcare solutions and ICRA legi...
Eric Burleson
Host and U.S. Congressman from Missouri, former software consultant and investment advisor, leading healthcare policy...
Tom Coburn
Late Senator from Oklahoma, cited as Tea Party pioneer who advocated for patient-centered healthcare and HSA expansion
Hillary Clinton
Referenced for 1990s healthcare reform attempt (Hillarycare) that preceded and influenced ACA design
Barack Obama
Former President, criticized for ACA implementation and broken promises about healthcare costs and doctor access
Joe Wilson
Former Congressman, referenced for 'You lie' comment during Obama healthcare speech, later validated by ACA outcomes
Donald Trump
Former President, credited with discussing healthcare choice arrangements and pharmaceutical pricing in 2019
Bobby Kennedy Jr.
Referenced as healthcare advocate whose involvement in 2024 election influenced voter support for healthcare reform
John Adams
Founding Father, quoted on constitutional liberties requiring religious faith and understanding
Quotes
"Insurance isn't care. The American people want access to care."
Michael CloudMid-episode
"Ronald Reagan said the closest thing we have on earth to eternal life is a government program."
Eric BurlesonMid-episode
"I've never talked to anybody who wants insurance. They want health care. They want the end product."
Kevin HearnMid-episode
"Health care is the one thing you have no idea what it costs you before you buy it."
Eric BurlesonLate episode
"We've got to build a system that's centered around the patient experience and let the marketplace work."
Michael CloudLate episode
Full Transcript
Hi, I'm Eric Burleson. Welcome to RSC's Right to the Point podcast. I'm your host today, Eric Burleson from Missouri, and I'm joined by two of my favorite members of Congress, Michael Cloud from Texas and Kevin Hearn from Oklahoma. And so, gentlemen, first let's start off by introducing yourself and give us a background. How in the world did you wind up in Congress? Well, there's never anything that was on my bucket list. But back in 2017, an opportunity came up. My predecessor became the NASA Administrator. So I ran along with seven other of my opponents. And as the old saying goes, I caught the car and here I am. But I spent 35 years in business, never in any political office. So just proud to be here. I'm glad you are. And And your insights are really important, especially as a, really, you had a large business. So you had a lot of employees and knowing the pains of being, you know, all of that. So that value, you bring a lot of value to the table. I appreciate that. And Michael? Yeah. What in the world caused you to run for Congress? Oh, gosh. You know, I was working at a church, loved what we were doing and helped people all the time. had a small business, nothing on the size of your scale, but just looked at what was going on in Washington and felt like I needed to get involved, really. At first, I just thought that meant volunteer. Eventually, a few years, people say you should run for office. You're thinking, I don't know about that. People say, why do you want to go to Washington? I would say, I'm not wanting to go. I'm willing to go. Then you wonder later, were you really my friend? yeah exactly like once you get here like oh man what's what's happening but uh you know it's certainly it's an honor to serve we're doing our best to make a difference and make sure we leave a better country for our kids and our grandkids awesome well i'm similar to both you guys i worked in the private sector for 22 something years and worked as a software consultant and then an investment advisor and spent most of my time on the side just ranting about government um ranting about the the lack of what you know i've always been a republican um because because i have a brain but ranting about what what what the republican party was not doing for the american people and being frustrated and as a supporter and a donor and a volunteer sometimes you just kind of get get to the point where you feel like yeah the only thing left to do is to run so here we are And now we're faced with a monumental crisis that we were blessed with being handed over to us by the Democrats, and that is Obamacare. And so I want to kind of flesh out, you know, the American people are suffering. They're seeing all these premiums go through the roof, and it's because Obamacare is a proven disaster. What do you think it was that caused Obamacare and the rates to go sky high? Well, I think you go all the way back to Hillarycare. You know, Hillary Clinton tried back in the 90s to get basically a single-payer government-ran health care, and it was a miserable failure then. So Obama learned from that, and he set us on a pathway with some really smart policy writers knowing that this would collapse the system. And, you know, he told everybody that your health care costs would go down, your access would be better, you get more doctors, you keep your doctor. All of that turned out to be very false, as we're seeing today, 15 years later. Or Joe Wilson's. Yeah, you lie. You lie. As it turns out, he was the one telling the truth, meaning Joe Wilson. And so as we go through this process now, we're now seeing what's happened. We've had less people get into the medical field. We have less access in rural America, and our premiums have skyrocketed 100% and are continuing to grow. And now we really have a health care crisis. By the way, I think it's important to note, because I was in business during that time, it was noted that there were some 25 to 30 million uninsured Americans. For everybody's reference today, there's still 25 to 30 million uninsured Americans. And the Obama administration destroyed it, and the Biden administration added on with the COVID area premium tax credits. And so we've got to quit throwing money at it. We've got to structurally change it. We've got to structurally make it more affordable for all Americans, not just a few million. And Michael, kind of the other aspects, a lot of times people are frustrated why they might be insured, quote unquote insured. At the end of the day, the product that they're getting, the health care, doesn't quite translate. Oh, exactly. You know, this is a classic case of the government steps in to actually create a problem instead of fixing it. And then says the solution is more government. And this is a case where the bill was written by insurance companies. So guess who it benefited? Insurance companies. We've been having this discussion saying we're having this health care discussion in our nation for quite some time, but it's really been about health insurance. Obamacare didn't bring care to people. It didn't open up access to care. It got more people on insurance rolls. Well, insurance isn't care. The American people want access to care. They want to be able to have access to know what they're going to pay for, to know what the price is going to be, to not have to wrestle with this insurance giant that you're having to deal with when you're trying to get access to care. And so it's a very complicated system that puts quite a burden on the American people just trying to get access to care. And it certainly hasn't made anything affordable. It's made everything a lot more expensive, actual care. Yeah. I think also, that's a great point, Michael. I think also when you think about Americans, I mean, you think about your other insurances in your life, you know, car insurance, home insurance, death insurance. It's kind of hard to fix death insurance. I guess you don't die, and that's how you do that. But when it comes to home insurance, you know if you do certain things, your house, you have a chance to control the cost of your insurance. And you can see those premiums decline. Same thing with your car insurance. If you're a better driver, you have more products on there, you can lower your cost. I think what's really mind-boggling to the American people, certainly me as a paying health insurance person, is no matter how healthy I stay or the things I can do, insurance continues to go up. I have zero control, and I have less access, less doctors. Pharmaceutical costs are going up, and there's no end in sight. And I think the insurance companies, the CEOs, have some explanations, and they're going to get a chance next week. They're coming before the Energy and Commerce Committee and the Ways and Means Committee to talk about why health care is so unaffordable, where their role is in this, why has the patient moved out of the center of the health care hub, Will, and now its insurance companies are in the middle. And they're going to get a chance to talk about this, and they better bring a great game when they come. Yeah, what you're saying is exactly right, because all the promises that we were given, first of all, you know, you can, if you like your health insurance, you can keep it. Of course, that's the famous one that was broken, but there's this idea and this concept that was pushed really by the insurance companies. Well, if we manage this and we kind of have our finger in the hole every step of the chain, we'll be able to lower costs because we're overseeing everything. Well, that's not been the case at all. Their profits have gone sky high. Prices have gone for care. has gone sky high, and the American people are left holding the bag and then having to wrestle through the process that's defined and controlled by the insurance companies. You know, the interesting thing is when you talk to insurance companies, and I've talked to the president of a couple of the insurance companies lately, and they'll tell you they hate Obamacare. So it'll be interesting to hear what they say whenever they come to the hearing, because a lot of these companies, it's a net loser for them. Do they look at their person with them and say, am I supposed to hate it, or am I supposed to love it? I don't remember. Yeah. Which is the better way to go. But, you know, the one political term that I never thought that, you know, that we would use, it was never mentioned on the campaign trail, which is the enhanced COVID era subsidies for Obamacare. And yet that's become a political hot potato. You know, I think we all kind of know why it's a bad idea to continue to fund these subsidies. What are your key thoughts about that, Kevin? Well I think the important thing for everybody that watching this remember is Republicans are not advocating in this conversation what we just saw happen over the last couple of weeks to get rid of Obamacare We're talking about the COVID era, $40 billion per year extra dollars being spent. And where the lower two tiers pay absolutely nothing, 24 million people on Obamacare. We found out through audits that 12 million never went to the doctor. So these insurance companies got 12 million premiums, 12 million individual premiums, counting billions of dollars and never had to expend a single dollar for that. And when you look at that, that 50 percent or so, that's way higher than the average. The average is like, you know, 20 or 30 percent. So there's a lot of abuse, waste, fraud and abuse in the process. And, you know, again, I think when you look at it, the Democrats did this in 21 during COVID. And then at 23 again, by their own votes, they did it for two years at a time. Now, the second time, it expired on their own watch. And so it's unfortunate that we had 17 Republicans that supported pushing this bill. Yeah, I thought I was disturbed by that vote. What are your thoughts, Mike? Yeah, very much so. Ronald Reagan said the closest thing we have on earth to eternal life is a government program. And so we all know the shtick here in D.C. it's like if you want to start a government program you first make it temporary hey it's only going to last two years it's just there to help people through you know covid in this case or you know through some sticky situation that's in the news cycle that week and then you get to the the termination date on that and oh well we can't you know stop this program you know um and this is exactly what happened in this case and then particularly uh in this case the very extension of it was an admission that the affordable care act was not affordable because the whole reason of it was like, well, people can't afford the Affordable Care Act, so we have to pass these subsidies that help underwrite the premiums of Obamacare. And so it's this circular logic that tries to defend these sort of things. And then, you know, we want people to be taken care of, but the DIMS message on this, like it's 90% of the people being affected. It's a very small percentage of it. And then we found fraud throughout the system. You mentioned, you know, half the people have never used it. Well, we've discovered a scheme through oversight and different reporting that some of the people on the program were basically signed up without their knowledge. And so they don't even know they're on it because they're not being charged a premium, but yet the insurance company is getting the premium paid by the taxpayer dollars. And it's just taxpayer dollars going straight to the insurance company. And a lot of times the person doesn't even know they're enrolled. Yeah. And it's going straight to the insurance company. We're just hoping that they, out of the goodness and the kindness of their heart, reduce people's premiums, which I don't think happens. Well, I don't think, I don't get those calls in the office, I can assure you. But you know, I mean, here we are, and now, but I honestly welcome this fight. I welcome this political debate, and I'm excited about it, because I hope our conference sees this as an opportunity to actually fix Obamacare. You know, one of the things I was so frustrated with was watching the Republicans fail to repeal Obamacare back in 2017 when they had a chance and feeling really as a Republican myself back home feeling defeated. But now that we're up here, I welcome this because I want to have that debate. A lot of times, why do you think it is, Kevin, that Republicans tend to shy away from talking about health care? Jody Aronson told me a good line. He said, it's like our away game when it comes to Republicans. I just think we're more comfortable talking about taxes, getting in the healthcare space. I think we're such free market advocates that we want people to have their own money and compete in the free market, be able to buy their own health insurance. The late Senator Tom Coburn from Muscogee, Oklahoma, is the person who got me into politics. And I remember him saying, it's amazing. He was a pretty black or white guy. And I remember him saying that... One of the greatest lawmakers to ever see throughout all of history. He was always frustrated with this place because Republicans, not Democrats, he understood Democrats, but because Republicans wouldn't tackle the problems. Part of the original Tea Party movement. He was Tea Party before Tea Party. Before it was cool, yeah, because he was part of the 94 wave, spent six years, self-term limited, came back four years later for Senate in 2004. That's when I really got to know him, flying all over the state of Oklahoma. And I remember him saying that, you know, we have got to be, we've got to have the American people involved in their health care process. You know, they can go, we can educate people to buy your car insurance. We can educate you to buy your home insurance. You talk to, you know, advisors on your life insurance. Why do we think the American people are so stupid that they can't buy their own health insurance? We need to get money back into their pockets, the HSAs, sort of a precursor to FSAs. He didn't want government all involved, but he said if we're going to be involved, let the money stay in the American people's pockets through credits. So it never comes to the federal government. It's just they forego paying taxes on it. And that was in 2007. And I carry that on my phone all the time. And when I was running for office, I used that. And it's still relevant to today. And then fast forward after Obama got to be the president, he went around and talked to all the doctor friends. And I would go to those fundraisers and stuff with him. And he predicted exactly what's happening. In fact, I just had the CEO of the largest health insurance group in America in my office right before I came over here. and I referenced Tom Coburn's comments and I said by the he starts talking he was a smart guy and all this stuff I said by the way everything he said in 07 everything he said in 2010 everything he said in 2012 is exactly what's happened less doctors fewer hospitals higher costs yeah absolutely well there's of the ideas that have been mentioned what are some of your ideas that ideas that you've heard about that you're most excited about? Well, actually, and I'm sure you weren't tossing me up for this, but your bill is one of the ones that's really good. If you think of what we make the American consumer to go through when they're trying to interact with our healthcare system, at the very outset, at the very beginning, you're kind of guessing, okay, I have so much set aside that I need to put the savings. Do I put that in my kid's education account? Do I put it into an HSA, FSA? You know, how do I, you know, and the kind of choice we leave the American people with, it's like we need to simplify that process so much, you know, just incentivize savings. And it can be applied to health care. However, you the user, the American citizen feels like it needs to be done. And then us to work at we posted a picture, a little meme we had created of a maze with a piece of cheese at the end. And I feel like a lot of the discussion around the health care system in Congress is like, how do we make that piece of cheese a little bigger at the end of the maze, which is a noble thing. And we need to have that discussion. But it's like, why don't we get rid of the maze as well, you know, so that the American people can get right to their benefits without having to wrestle with this obscene process that they have to deal with where you don't know if you're covered or not. You think you're covered when you get the procedure, but afterwards you find out you're not and you're dealing with big insurance to try to, you know, wrestle with what you thought was done. And then, It's months you're dealing with this, and it becomes a part-time job just to get the procedure done. I've never talked to anybody who wants insurance. They want health care. They want the end product. Right. And so nobody likes giving their money to insurance. They want the outcome. And yet we've made it so convoluted. We made the process, and I say we, Congress, all the idiots before us, before we got here, I say, that made it so difficult. Right, obviously. All these problems were here before. And there's a proper place for insurance and certainly catastrophic insurance and those kind of things. But we've allowed the messaging to become insurance is care, and it's not. You can have care without insurance. Now, insurance has a role and has a proper place. But if we're going to say we're having a health care discussion, it should be about how to provide access to care to the American people. Insurance can be a part of that, but it shouldn't be the door to it. So Kevin you got the ICRA language which I think is a key component of this because to me one of the bigger problems and I think a lot of the problems that the American people have with frustrations they have with the healthcare system stem from the fact that the only way that you're going to get a tax deduction is if you purchase insurance through your employer and the, and so the employer who didn't, you know, you, you went into business, sell burgers and fries. You didn't go into the business to, to pick an insurance plan for your employees. And yet that's the responsibility of the, put on the shoulders of the employer to do that, which they happily would like to make sure that their employees are healthy and have access to care. But, I mean, the whole paperwork and the headache of that, which is why I'm excited about the notion of saying to the employer, hey, all you got to do is write the check to their health savings account, and then the employees can take those dollars and run with it. Yeah, if I might, you know, just try to run through the chronological order of how insurance really came into play, back in the 40s and 50s, large corporations would say, they entice the better workers, the big automotive industries and places like that would say, we'll take care of your health by health insurance. And that's something that smaller organizations couldn't do. Actually, there's more than that. Did you know that there was a law that was put in place that was capping salaries so that they didn't have to compete for the smaller businesses? And the only way for employers, large employers to get over that was to create the benefits. And so as this has migrated forward, you know, the unions had it, you know, unions offered it as a way to circumvent, you know, the same kind of scenario you're talking about to have this advantage. And then we've sort of gone, you know, like Michael said, is that we've gone to where health care and health insurance are sort of synonymous in thought that we move, you know, when I grew up in the Ozark Mounds of Arkansas, about 100 miles south of Springfield, you know, we went to a family doc. He was 25 miles away. my mother we couldn't pay for anything he said just write it in the book and when she got a paycheck she would pay him but he was our network administrator right but he we were the patient you know and we were in the center of that decision making process and then you fast forward over the last 50 years there's you know that that distance that two or three foot distance between me and the doc is now two or three miles and there's so many people in between all the providers and all the specialties and all this kind of stuff and now what's happened is the individual has slid out of that center of the wheel and the insurance companies come in there. We need to get individuals back in control of their health care and not let corporations, businesses, and to your point, small businesses have a very difficult time of managing health care frameworks. And so this choice arrangement is something that President Trump talked about back in 2019, about giving individuals, gig workers, the ability to have a health care, you know, nice health care package that meets the marketplace requirements. but you're able to you know get your employer to give you a check but you own the policy so if you decide you're not beholden to that company anymore uh you're not an indentured servant to that company right so you can go to company to company and get a check you know that's that's your benefit negotiation so i think it's really a great way i mean it's it's something that's got a lot of traction and we pass it off the floor of the house so we need to get it done you know one of the conversations that um i think was popular coming from the last election was maha i mean i i know people that would never have voted for trump until bobby kennedy jr came on board because because for them the you know being healthy the the food that we eat the whole corruption within the within the the industry something that they cared about and so i think it was it's a i think it's still a very popular topic and something that uh was brought up to me whenever we were looking at doing these reforms is that at the end of the day we want we don't necessarily need americans to be insured we i mean we want them to have this the safety and the security of of of not having a disaster destroy their you know their entire livelihood but at the end of the day don't we just want people to be healthy right and have access to have access direct access to the doctors that they think will like some of the really neat things that are being discussed in my opinion are giving access to use direct primary care. My wife and I recently started using a direct primary care, and it is remarkably different because they actually want you there. You're not a nuisance, and they treat you well. And it's amazing to see what happens whenever people actually want to have direct access. But there's a whole lot of innovation, too, in pockets right now, just because the system kind of keeps everybody fixed into the status quo. But within that, you see little pockets where you'll have a surgery center that you can pay directly, and they usually can do it much cheaper, much more efficiently, and the quality of care is better. You've got an Oklahoma surgery center? Oklahoma City. If the prices are posted and you go write a check and you're finished and it's quality care, no shocker, the insurance companies and the local hospitals hate them. but they're physicians that came from these various hospitals because they felt they felt like uh the way the current system was going they didn't want to be a part of they want to be part of something special people fly from canada come out from texas everywhere all over that's why we that's why we've all heard about it yeah it's amazing first class quality care yeah and i mean you go to a doctor's office you think how many people are just working on paperwork you know and we've created a whole industry of paperwork as opposed to care when it comes to to doing these sorts of things and so there's a lot of innovation we can bring to it but we got to get out of this uh paradigm that we've locked ourselves into where it's all top down and and like you've said a number of times the patient's really kind of well they're almost the product in a sense i always ask people this i say you know what just give me one thing other than your health care that you buy that you don't know the cost of before you buy it yeah there's nothing right it's it's your health care is the one thing you have no idea what it costs you. You just wait until the EOB, the explanation of benefits comes in, you see that, you get the bill, and it's $100,000 and they've written off $42,730. What the heck? It's just like, pay this. Even with the EOB, you're sitting at home and a family member thinks, well, I thought it said this, and one of the people on the phone quoted me as this before I got the... But afterwards, there's enough ambiguity in it that still you're you know the insurance company comes says oh you're not covered now and you know it's you against the machine in a sense to try to to get covered and the game you know that people have to play to where you know i mean it's it's just obscene obscene the system that we built that the mayor would be about to deal with when you look at the cost that people are paying today so we we did a dive in the numbers in when my wife and i started entering the workplace after college, the year 2000, the average cost for a family in their premiums was $6,000 for the whole year. Today, it's $27,000. And you got out of college like two years ago, right? Right. So that's a lot of money. And even if you adjust the $6,000 in the year 2000 for normal inflation, the family today should only be paying around $11,000. but instead they're paying $27,000. So when people talk about this generation, the younger generation, not being able to afford a home, if you had taken the same amount and went back in time in the year 2000, I don't know that I could have afforded to buy a home because I would have been putting so much more. The insurance premiums would have been crowding out most of my take-home money. And so I think that's the situation that we're facing today. But the other aspect that's never talked about up here is the supply of healthcare. Because the industry has, in a lot of ways, they've put in place all of these schemes to limit the number of doctors, to limit what care people can provide. So you've got, in America, the number of medical school slots hasn't really risen that much over the last 100 years. And as a result, and the same thing with residency school slots, you talk to a lot of kids, And imagine running the risk, you pay a fortune to go to medical school, and then you don't get placed in a residency program that you want or any at all. And so this is a real problem in America to the point where we have an 18 doctor shortage right now in the United States and it expected to balloon to over 80 doctors that we are going to need What we're doing is we're importing all these doctors from other countries, and then we have a language barrier issue, right? But at the end of the day, what we're doing is we're telling American kids, you have no chance of getting into medical school or getting into a residency program because we've allowed the system to kind of throttle back the supply. Losing doctors while we're getting older, need more doctors. It's not a good scenario. No, not at all. And under this current is this massive move for consolidation that's very concerning too because we're removing the incentive for people to go and be physicians as well because you were a physician, you're a small business owner, you're dealing with a patient. That's why people get motivated to become a doctor. And now there's this major push to basically make them employees of large corporations, institutions, eventually insurance companies. It's very concerning because as that consolidation happens, again, the patient loses influence in the system. And so we've got to make sure that we're bucking that trend a bit and reversing that trend and doing all these things, like some of the issues you mentioned, to bring the patient back into the center of this, and it's about them getting care. I think one of the biggest challenges, and I think it's the challenge before us, the time is now, is the insurance company, we had the PBMs, the president's worked on the pharmaceutical issue. He's already talked about insurance CEOs, but we've got the healthcare system, the hospitals. Why does site neutrality? Why am I at a doctor, CEO of a large hospital say to me, I have no idea why we get three times as much for a surgery at a local surgery center than the doctor does that has it privately? I mean, 340B programs, why are those used today in not-for-profit hospitals as a funding mechanism for the operations of the hospitals? It's never meant to be that way. We have to tear this entire system down. We have to have hearings. I mean, this is all hands on deck, going back to what Congressman Arrington said. The time is now for Republicans to be in the center of this, to figure out a solution going forward, figure out what the issue is. and you have to get, you know, the CEOs of the insurance companies are going to talk about input costs. You know, the input costs come in. We have to make a margin on that. That's our job. We manage actuarials. Well, we need to look at all these input costs, if that's the case, and start bringing each one of those in and asking why are, and they're each one are going to say, what's the other person, right? So we're going to have to start putting a cap on some of these things to make them work. Yeah, what you're saying is exactly right. You know, sometimes you look at different systems or programs are working with and you're tweaking them this is one where every time we try to start with obamacare and figure out tweaks we can make to it we end up putting all these band-aids over obamacare and it's it's it's it's a patient that's not it's it's already dead it's it's not working for the american people and and we've got to build a system that's centered around the patient experience uh and uh and you know let the marketplace the insurance companies the hospitals let them work to figure out how to serve the patient yeah i think you're right like what we expect this town to do is the swampy thing to do which is is to do something that looks like it is meaningful but it really doesn't change anything exactly um but we're just going to tinker around the edges and not really take on the the issue as a whole that's what i'm worried about that's why i think what rsc is doing stepping up and saying we need to go big um We need to do something that is a sea change that benefits the American people and not tinker. Well, RIC, having been the former chair of RIC, August is doing a fantastic job. I think it's the perfect setting with the breadth of members of Congress from all of the different caucuses to come in and talk about policy, but to invite in sequentially each one of these components of the input cost of the insurance companies and them being currently the center of the wheel and start talking about this approach. and have them come in and have these 30-minute conversations, much different. And those free-flowing conversations in RSC, those are much different than hearing settings. First of all, they're not televised, so you can have a very frank, non-political conversation. Because obviously, let's be honest with ourselves, especially in oversight, some of those meetings get very political. But if you can have a policy conversation in a setting of RSC, I think you can effectuate a lot of good ideas that will come out there and have some really great solutions. and we got to build those solutions in a way like we sit in a number of these meetings and you sit here uh you know a bunch of smart people in a room talking about these issues and then i have to you know remind them like remember who we're building this for like you know i've sat in a number of these conversations and the members of congress who are dealing with these issues all the time or even the health care professionals like can barely explain it or understand it themselves because it's so complicated and convoluted and maybe it's a great system that works on paper but we've got to build a system for people who are also making life work. They're getting their kids to school every day. And it shouldn't be like you're doing your taxes or you're having to take up a part-time job to participate in the system. Whatever it is, it needs to be simple. It needs to work for the American patient. And we've got to make sure we're keeping that in mind as we deal with our policy agenda, which is another reason why Obamacare is a failure and will not work. and why, like you said, we need to go big. We need to kind of rebuild the system from scratch. All right. Well, thank you, gentlemen, for joining me. This has been a really awesome conversation, but I want to end it with, on a light note, the topic or the one thing that you know that you're right about. And I'll start. I absolutely think that people put pumpkin spice in way too many things. There's a lot of things that they put pumpkin spice in that have no business being in there. I would agree with you on that. My wife would strongly disagree with me, and that's an issue we have every season that comes up. Pumpkin spice, everything. Yeah, for sure. So do you have a topic that you know that you're right on? Yeah, actually, I do. I grew up very poorly in the Ozark Mountains of Arkansas, and no running water, no indoor plumbing until I was in the eighth grade. And so I know the binary choices is you stay on government benefits or you start working hard and you work your way out of it. And we live in the greatest country that's ever existed for that opportunity. And ultimately, you end up at American Dream, one that's not prescribed by somebody else, but it's something where it builds your internal satisfaction. And I've carried that to Congress so much so that in one of my first hearings on Ways and Means, I was talking about this same topic and how passionate I was about people should work for their benefits. They should, as we do now, as we got into one big, beautiful bill and some others. And I remember very distinctly that a Democrat member, not to name where they came, what state they're in, still in Congress, called me a racist for making that comment. And she didn't realize, but I guess I've narrowed it down when I said she didn't realize that she... She was the one making the racist statement. She was. And it was emboldened me even more to know that I was right. So nobody in Congress, nobody in my lifetime will ever change my mind to that. Awesome. Oh, man, you said something light, and this isn't light, but the first thing that came to mind is Jesus is Lord. Hey, there's no greater truth. And, yeah, you know, our liberties, the things that we hold dear, are undergirded by an understanding of faith and what it means for us. Yeah. And John Adams said, you know, we can't have these liberties. Our Constitution is written wholly and is only effective for the people who understand that. And so some of the situations we see facing is because we've walked away from that, and it's important to me to walk back. I do have one more. I would just say that birds aren't real. We all know that. And with that, thank you for joining us. 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