The Paradocs Podcast with Eric Larson

Are you a decision maker at your business? If you're a CEO, CFO, the head of HR, or perhaps the owner of a small, medium or large business then you owe it to yourself to check out this fairly simple solution to save over 50% on your health care spend.

Health insurance is usually one of the biggest overhead expenses after salaries for any company and it affects the bottom line of nearly every business. Imagine what your company could do if it paid out less than 50% in its health care spend - while also maintaining a similar if not improved plan for employees.

Before you scoff and say that there is no way you can provide your employees high quality care at less than half the cost, just remember that only about 25% of every dollar spent in health care actually goes to caring for patients. There's plenty of room to cut.

Why Health Insurance Is So Expensive?The reasons for expensive insurance is obviously a complicated question. However, it's simplest to think of it in just a few ways - especially when we look for ways to bypass the rotten system to save real money for our business.

The insurance companies make money by paying out a lot in claims. This seems illogical at first glance but makes a lot of sense once you realize that the insurance companies are only allowed to use 15-20% of the total they pay out in claims towards profit and overhead. Therefore, the more in claims payouts, the higher amount they can profit.

Pharmacy benefit managers (PBMs) hang onto the rebates. Instead of passing on the volume discounts (or rebates) onto the employers and employees they keep that percentage of charges. Just like the insurance companies, the more that is paid out in charges the greater revenue they get to keep leading to ever increasing pharmaceutical prices.

Insurance brokers primarily make their money through commissions from the insurance companies. This incentive leads them to find only solutions for your company that involve large insurers. The only way you can actually save money is to bypass the traditional means of creating a health plan which most brokers are not aligned to do.

Building a Better Health Plan?What becomes readily obvious as far as solutions go is that you must create your own self-funded health plan and find transparent PBMs and rational contracting to pay for services. Very few companies are prepared to do this which is why you need to find insurance brokers and third party administrators who can set it up for you. There are plenty around, you just need to seek them out.

I've had two on in the past whom I reference in the show. Of course, they are hardly an exhaustive list of players in the field but they would be a good start for anyone investigating these solutions for their business: Katy Talento of All Better Health and David Contorno of Epowered Benefits.  

show notesEpisode 176: Today's show

Episode 111: Katy Talento tells us how she saves businesses money.

Episode 150: David Contorno explains his business model.

Episode 043: How PBMs jack up drug prices.

All Better Health: Katy Talento's business where she helps others create their own health care plans.

E Powered Benefits: David Contorno's business helping others create health care solutions.

We Are Libertarians: The Paradocs is a proud partner and member of this outstanding podcast network.

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YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page.

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COVID has reshaped the world and China holds a unique position in the world's approach to combatting pandemics and in the fact that it was first described in the city of Wuhan. We may never know exactly where or how COVID originated in China but we can be certain that the unprecedented strategy to 'lockdown' was one that originated in China.

The Lockdown

Before when the COVID pandemic was just a regional epidemic in China, the CCP embarked upon a zero-COVID policy where they took extreme measures of shutting down their economy. As an authoritarian government they were able to use extreme measures to prevent the movement of people. This was accomplished by sealing citizens in buildings and delivering essential goods (sometimes) with very harsh penalties if people tried to escape.

How is the Lockdown Going?

Jennifer Zeng is familiar with the CCP as one who has escaped a political prison to the United States where she now reports on the Chinese government. And that government's zero COVID policies seem to be taking their toll on their citizens as they are well into the third year of rolling severe restrictions. Protests are occurring all over the country and unlike the Tiananmen Square in Beijing in 1989 they aren't isolated in just one city. The CCP is faced with troubling questions as to whether it can really trust the military? Would easing the restrictions embolden people and lead to increased calls for freedoms?

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History is a funny thing. Often, we think we know what happened either as we experience it personally or have trusted sources that give us an account. However, it depends on who is relaying the information, and the prior biases and perspectives. The goal of a good historian is to gather information from multiple sources and figure out what happened and why it played out the way it did. In today's episode we focus on why the US ended up with a third party payer system left to the insurance companies to dictate payment and generally how physicians can practice medicine.

It Begins with InsuranceDr. Christy Chapin has focused her research on the history of health care which includes insurance and finance. She believes that you must understand how we got to where we are today with insurance (private and public) dictating how medicine is practiced through payment mechanisms. It's easy to look at Medicare and Medicaid and assume that there was always a large influence on health care's practice through insurance reimbursement - but that's not the case. In fact, most doctors assume it was the decade or two before the creation of Medicare in 1965 that insurance really came to be a big player in health care.

Actually it Begins with the AMAThe standard story is that wage controls coming out of WW II left employers with limited ways of attracting top talent since they couldn't adjust employee incomes easily so they resorted to offering benefits like health insurance to entice the ones they wanted. Although that story is a handy explanation, it isn't really borne out by the evidence either in uptake in the frequency of health insurance being offered to employees or its use more broadly in the marketplace. In fact, the creation of health insurance product came from the AMA as they looked to thread the needle and avoid corporate interests taking over medicine (worked out great, huh?) and a federal nationalization.

Unfortunately, the AMA, by squashing all other physician led ways of organizing the delivery of health care, removed all other alternatives to their preferred method - insurance. Initially, the insurance companies agreed to not limit any claims, pay in full whatever charged by the physician, and pay wherever the charges originated (ie, the physician's own lab, etc.). This led to cost over runs and then the endless government fixes including governmental insurance (Medicare/Medicaid) and the resulting changing of the landscape of medicine.

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It's been a while since I've done an episode and it's mainly because I've had a COVID rant percolating for some time. So I just had to let it out now that the president (accidentally?) mentioned that the pandemic of COVID-19 is over. In this episode, I cover mandates, vaccines, public health policy and much more. A frank discussion with you about where we are and where we need to go as a country with this irritating virus and resulting policies. This is an expansion on my speech from episode 156 and a broader discussion with Dr. David Graham in episode 143.

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In survey after survey, the number one satisfier for physicians - by a long way - is their relationship with patients. Anything you can do to improve or deepen that relationship makes the work better and decreases the incidence of burnout. Obviously, barriers put in the way that detract from creating a deeper relationship with patients makes the job of medicine less desirable. One way a lot of doctors have gone is to practice using a direct care model which removes many of the obstacles in place within modern medicine from forming that all important bond with their patients.

Getting Help to Start a DPC PracticeUnfortunately, doctors don't usually receive training in how to run a business and set up a practice like this. Even if they have heard about direct primary care (DPC) there are a lot of things to overcome to start up. First, they need to understand how the model works and what space, supplies, and equipment they need to begin. Second, they need to find ways of bringing patients in the door which requires marketing and sales. Finally, there is a lot they need to learn as far as running the practice since most of their training probably came in an academic setting or at the very least, an insurance based model for providing care.

That's where today's guest, Chris Habig of Freedom Healthworks, comes in. He and his brother started the business initially to help their parents (who are primary care physicians) rekindle their love of medicine. What they've built is a company that helps doctors at every stage of the process setup, start, and run a DPC practice. Doctors can use as little or as much of their services as they feel they need but essentially Chris and his team take away a lot of the unknowns and help navigating medicine in this space.

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Occasionally, you come across an interview or subject that blows you away with incredible claims that are both out in the open - and yet invisible. Today's guest is an author and expert witness for some of the biggest pharmaceutical cases of this century, Dr. John Abramson. He reveals the rot that centers not only in the pharmaceutical industry but also the institutions that are constructed to serve as its guardrails - the medical journals, federal agencies, and guideline committees. In some

What Would Physicians Say if They Knew Medical Journals Had No Access to Data for Peer Review?The most stunning aspect of the whole conversation centered around how the most prestigious medical journals conducted peer review without all of the clinical data. This means if anything was misrepresented or omitted there is no check on the truth of the claims from the study. Essentially, the journal and its reviewers are relying on the good faith submission of all important details from the study designers who are usually paid employees or have research paid for by the pharmaceutical manufacturers. 

The most famous landmark case was with Pfizer withholding adverse event data (or misclassifying them to avoid statistical significance) on cardiovascular events (heart attacks and strokes) with their medication, Vioxx. Only when Pfizer was sued in a huge class action lawsuit did the actual clinical data get revealed showing that they had seen a signal for adverse events but intentionally did not disclose it (or the raw data) to the medical journal reviewers. Worse yet, once the error was presented, the medical journals spent very little time discussing the error. According to Dr. Abramson, this is in large part because up to 40% or more of medical journal revenue comes from study reprints. This financial incentive to find positive results and publish makes for a twisted system that incentivizes the promotion of new medications and devices when they may not be safe or very useful.

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What is one common difference between the hiring process of most professionals with advanced degrees and those in sports and talent industries? The use of talent agents. People dedicated to finding their clients jobs, negotiating the terms, and essentially doing all of the analytical work to determine market value for the "talent." 

What if the Talent were Physicians?Raised by a physician mother, my guest today is Ethan Nkana, who didn't enter the world of medicine as a doctor but instead got his JD and MBA to enter the world of hospital administration. Ethan cut his teeth negotiating physician contracts, running operations, and more for hospitals. But he decided to get out and start a business working on the other side of the table with physicians in the negotiation process. His model is simple in that he uses the same as talent agents for musicians, artists, and athletes except his clients are doctors. 

Ethan brings his knowledge at the Rocky Mountain Physician Agency of what hospitals want, where their pain points are, and what they worry about to help doctors maximize their compensation or work situation. Fortunately for Ethan, there are plenty of physicians now employed and looking for more.

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I confess that I hold a lot of biases when it comes to various surgical specialties. One such bias is that orthopedic surgeons - especially trauma - are not deep thinkers. My guest today completely turns that prejudice on its head as we discuss the role of nutrition and vitality in disease and recovery rates.

Setting the Hammer DownObviously, an orthopedic trauma surgery focuses their care on treating patients with fractures sustained in injuries. However, Dr. Miller now looks beyond the obvious mechanical or lab-based problems that patients present with. He uses some principles of functional medicine to seek the answers to what might afflict his patients. For instance, perhaps the pain in their joint isn't from arthritis but from a dietary problem.

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In 1973, the US Supreme Court ruled on the Roe v. Wade case and concluded that Americans have a constitutional right to an abortion up to viability of the fetus. That has been the law of the land... until now (or at least very soon).

Roe v. Wade OverturnedA few weeks ago, a draft majority decision by the Court was leaked which showed that there was a majority of justices on the Supreme Court who were going to rule in favor of the state of Mississippi in their challenge to the Roe decision from nearly 50 years ago. Effectively, overturning the Roe decision would revert back the power to regulate abortions from the federal to the state level. Many states have been anticipating or preparing for the eventuality of this decision and have created 'trigger laws' which go into effect if and when Roe is reversed. Most of those states make abortion more restricted or outright illegal. However, some states have liberalized abortion making it legal right up until birth.

Challenges for the StatesElizabeth Nolan Brown, Senior Editor at Reason magazine, lays out a few of the problems with this ruling coming back to the states. Primarily, although the states can regulate what happens in their borders, it is very difficult for them to restrict what people do in other states. For instance, can states really stop women from crossing the state line and getting an abortion? Can they prevent mail order morning after pills?

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What would you do if you were fired by your employer over something you had said on social media? Would you be able to survive or would you have to scramble to find work? That scenario is exactly what was faced by today's guest, general surgeon Dr. Buck Parker. And his solution was a surprising one.

Seeds of an EntrepreneurIt doesn't appear that Dr. Parker never set out to find ways to be financially secure outside of medicine. His path through medical school and his general surgery residency seemed fairly traditional. However, there were signs that he had an entrepreneurial streak about him as he began a very small online business selling gym equipment. Following that, he landed a role on a reality TV series which led to another starring role on a second show.

Aside from practicing clinically as an acute care and trauma surgeon, Dr. Parker leveraged his appearances on TV and built up a following on social media through Instagram and YouTube. And that's where the trouble began.

Losing Your JobDr. Parker's termination within his hospital system in 2020 happened a lot like the old joke in bankruptcy. "How do you go bankrupt? Gradually and then suddenly."

Parker's CMO had been very upset with his YouTube channel and social media presence for some time and when Parker published a video stating that the highest risks for COVID are those who are obese, elderly, and with medical co-morbidities, it was the final straw. Perhaps it was because the video went viral and the light it shone on an institution that didn't want any attention paid to it. No matter the reason, it was the end of the line for Dr. Parker's Salt Lake City surgical career.

Overcoming Job Loss as a MinerPerhaps by happenstance, Dr. Parker had researched and eventually took the plunge to mine bitcoin. Fortunately for him, the price of bitcoin exploded from a few thousand a coin to tens of thousands from the time he started to the time he had been let go. It more than supplemented his income lost as a surgeon and gave him the financial freedom to be able to walk away and not worry about scrambling to get another job.

It's now been almost 18 months since being let go and the CMO has been replaced and the hospital has been busy. So busy they actually asked him to return but he declined. For right now, Dr. Parker doesn't see himself going back to medicine but time will tell.

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