Dec. 4, 2025

Subsidies, Fraud, and the Healthcare Trap: Medicare, Medicaid, ACA & the Battle to Fix It | World of Payne

Subsidies, Fraud, and the Healthcare Trap: Medicare, Medicaid, ACA & the Battle to Fix It | World of Payne
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America spends over $4.5 trillion a year on healthcare—more than any nation in history—yet families still feel crushed by premiums, deductibles, and confusing bills. In this explosive episode of the World of Payne podcast, we dive deep into the subsidy-driven healthcare system that touches every American: Medicare, Medicaid, and ACA subsidies. Subsidies were created to help people—seniors, low-income families, disabled Americans, and the working poor. But when you peel back the layers, you find hidden costs, administrative waste, and massive fraud that drive prices higher, fuel dependence, and drain taxpayers. In this 1.5–2 hour teleprompter-style, conservative but constructive deep dive, we break down:

  • How Medicare really works (Part A, B, C, and D) and how Medicare Advantage risk-score gaming is costing taxpayers tens of billions while driving corporate profits.
  • Why Medicaid has become both a lifeline and a loophole, with states gaming federal matching funds (FMAP), hospitals recycling money, and managed care plans inflating costs.
  • How ACA subsidies (Obamacare) impact premiums and dependence, from income-based tax credits to the "cliff removal" that quietly expanded government responsibility for healthcare costs.
  • The administrative hydra: coding chaos, prior authorizations, bloated billing departments, and a paperwork machine that consumes 25–30% of all U.S. healthcare spending while doctors and nurses drown in documentation instead of caring for patients.
  • A hard-hitting exposé on healthcare fraud and abuse:
    • Durable Medical Equipment (DME) scams and fake suppliers
    • Home health and hospice fraud
    • Upcoding, ghost patients, and falsified diagnoses
    • Medicaid managed care manipulation and state-level loopholes
    • ACA marketplace gaming, income manipulation, and hospital steering
    • Organized crime and international fraud rings targeting Medicare and Medicaid
But this episode isn't just about outrage—it's about solutions. We lay out realistic, conservative-leaning reforms that aim to heal the system without abandoning vulnerable people:
  • Administrative simplification: fewer codes, a national claims standard, real interoperability, and a serious overhaul of prior authorizations.
  • Severe crackdowns on fraud: real-time AI auditing, criminal charges for large-scale fraud, stronger whistleblower protections, and public transparency dashboards so taxpayers can finally see where the money goes.
  • Redirecting subsidies toward people rather than institutions through personalized health accounts, direct primary care, and price transparency that empower patients to make informed choices.
  • Medicaid reform that protects children, people with disabilities, and low-income seniors while closing FMAP loopholes, tightening eligibility appropriately, and linking non-disabled adults to work and training where it makes sense.
  • Medicare reform focused on reining in Medicare Advantage risk-score gaming, enforcing site-neutral payments, and making benefits more straightforward, more transparent, and less exploitable.
In the final segment, we tackle the big question: Can America ever move toward a reduced-subsidy healthcare model without harming patients? We discuss why we can't just cut and run, why we also can't keep spending unthinkingly, and what a "soft landing" strategy might look like—cleaning up corruption first, empowering patients and communities, then gradually rebalancing subsidies over time. If you're tired of being told, "That’s just the way it is,"
If you believe we can have compassion without corruption,
If you want a brutally honest but hopeful conversation about Medicare, Medicaid, the ACA, healthcare fraud, and real reform— this World of Payne episode is for you. 🔊 Listen in, share it with a friend, and be part of the push for a healthcare system that serves people—not bureaucracy, not fraudsters, and not political talking points.

Become a supporter of this podcast: https://www.spreaker.com/podcast/world-of-payne--4732235/support.

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WEBVTT

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Ladies and gentlemen, we are starting the first part of

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a twenty episode series on subsidies. This the series is

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gonna touch base on so many different subsidies in different

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ways that our government subsidizes the life that we live,

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running from farming subsidies to oil subsidies to healthcare subsidies. Yes,

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we did talk about a lot about the ACA subsidies

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in a previous episode, but we're gonna dive more into

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the actual healthcare subsidies UH, Medicare, Medicaid, Affordable Care Act again.

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But we're also gonna touch base on the different things

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that the government uses to subsidize hospitals and stuff like that.

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So it's just gonna be a lot further in depth

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jump into the subsidization of today's world and in today's

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American life. Tonight, we want to talk about something really

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that says at the center of the American kitchen table,

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something that touches every working family, every retiree, every single

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person who's ever opened a medical bill and felt their

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stomach drop. But before we dive into Medicare, Medicaid and

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the Affordable Care Act, before we peel back the layers

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of the billing codes, the bureaucratical waste, the fraud, the

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risk scoring games, and corruption that quietly digs into the

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hands of your paycheck. We need to start with the

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simple truth, a truth we don't say enough, A truth

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that really matters. Government subsidies are created with good intentions.

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They're supposed to help. They're supposed to protect the vulnerable.

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They're supposed to make care affordable. They're supposed to lift

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people up, not bury them in paperwork, dependency, or bureaucratical chokeholds.

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The painful part the politicians don't want you to talk

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about is that sometimes subsidies do help. Sometimes they save lives.

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Sometimes they are the safety unit between a family and

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total financial ruin. But here's the deeper truth. Good intentions

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do not guarantee good outcomes, and in America today, far

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too often the very subsidies meant to help people end

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up hurting them instead. Not because Americans are undeserving, not

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because the poor irresponsible, not because seniors have too many benefits,

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and not because families are asking for too much. No,

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the damage comes from something far darker, far more corrosive,

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far more destructive to our national soul. The hidden costs

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of subsidies the blooming prices, the warped incentives, the administrative

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waste that rots the system from the inside out. And

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the fraud, the abuse, the corruption that siphons billions, yes

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billions of dollars away from the people who need them

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and into the pockets of those who know how to

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manipulate the broken system. This is the heart of the

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Americans health care crisis. Not just the cost of care,

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but the cost of everything else. It's not just the

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price of the drugs, as not just insurance premiums or

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the deductibles, but the way subsidies, when combined with corruption,

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create a system that is bloated, inefficient, and painfully expensive

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for the average American. A system where compassion is preached

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but bureaucracy is practice. A system where politicians brag about

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helping people but never talk about the fact that prices

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continue to soar, access continues to shrink, and fraud continues

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to explode. A system where subsidies were supposed to be

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a life preserver but somehow morphed into an anchor. And

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tonight we're gonna call it out because you deserve the truth,

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because we can't fix what we refuse to face, and

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because America cannot heal if we continue to let corruption

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eat a national live from the inside out. Let's start here.

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The United States now spends over four point five trillion

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dollars per year in healthcare, more than any country in

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human history, more than the entire GDP of most nations,

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more than we spend on social security, more than we

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spend on defense, more than we spend on education, infrastructure,

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and public safety combined. And how did we get here?

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How did we arrive at the moment where a hospital

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can charge twelve dollars for a single tilinl where a

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CT scan costs more than a used car, where premiums

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climb year after year while coverage shrinks, and where millions

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of Americans still fuel their one emergency away from bankruptcy.

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The answer isn't simple, but it is honest. Our healthcare

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system is drowning in subsidies and simultaneously drowning because of them. Medicare, Medicaid,

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ACA premium tax credits, hospital supplemental payments, graduate medical education subsidies,

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state level carve outs, risk adjusted bonuses, billions, and federal

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matching dollars. On paper, every one of these programs exists

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for one purpose. To help Americans afford care. But here's

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the paradox. Each new dollar to make care affordable eventually

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becomes a dollar used to justify the continual raising of prices.

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Hospitals don't lower prices when subsidies increase. Insurance companies don't

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lower premiums when they receive federal boosts, and pharmaceutical companies

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don't slash drug costs when the government picks up a

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bigger share. No, what happens is simple. Subsidies raise demand.

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Demand raises prices, and prices raise subsidy requirements, and the

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cycle repeats. And who gets crushed in the middle of

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all that? You the taxpayer, the worker, the family, the

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people the system was supposed to help. Meanwhile, fraud gangs,

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corrupt executives, bloated bureaucracies, and paper pushers get richer. Let

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me say something that I need you all to hear

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loudly and clearly. Helping people is not the problem. The

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problem is the waste. The problem is the fraud. The

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problem is the abuse. The problem is the corruption at

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the heart of all of this. If we got rid

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of half the fraud, abuse, and waste in the Medicare,

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Medicaid in the ACA marketplace. America could lower taxes, expand

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targeted help for the truly vulnerable, cut premiums, and give

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working families the breathing room that they haven't felt in decades.

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Let me repeat that, eliminate corruption, America heels, eliminate waste,

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Families thrive, and eliminate fraud, and we restore the dignity

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to the people the system abandoned. Fraud is not a

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fingvictimless crime. Waste is not an accounting mistake. Corruption is

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not a political talking point. Every dollar stolen, every inflamed

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and inflated claim, every padded risk score, every fake medical

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device billing scheme comes straight out of your pocket. It

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is the money that could have lowered your taxes, the

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money that could have funded better access for disabled children,

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money that could have brought down premiums for young families,

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money that could have strengthened rural hospitals, money that could

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have used to modernize the system instead of feeding it.

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And yet the government shrugs. Politicians don't talk about it.

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Lobbyists make sure reforms never pass. Corporate interests bury the transparency, states,

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exploit loopholes for extra federal dollars in hospitals inflate charity

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care numbers while posting record revenues. Meanwhile, the American people struggle,

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the American family fights to tread water, and the American

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paycheck dissolves faster and faster every year. This isn't compassion.

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This has cruelty disguised this care. And if we want

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to heal this country, if we want to restore faith,

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restore transparency, restore affordability, restore dignity, it does not begin

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with expanding more programs. It does not begin with pouring

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more money into a leaking bucket. It does not begin

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with adding more bureaucracy on top of the already suffocating

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bureaucracy we have today. America heals by eliminating the waste,

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eliminating the fraud, and cutting off the corruption at the roots.

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America heals by making sure every taxpayer dollar actually reaches

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the people it was intended to help. Because listen, we

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don't need less compassion in this country. We don't need

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less people caring for one another. We need less corruption.

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We need less inefficiency. We need less red tape. We

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need less administrative bloat that continues to consume billions and

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produces absolutely nothing. We need a system that treats patients

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like human beings, not data fields, not billing opportunities, not

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risk adjusted scoring units, not revenue lines and a quarterly report.

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We need a healthcare system built for Americans, not for bureaucrats,

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not for scammers, not for corporate lobbyists, not for anyone

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except the people who depend on it. And that starts

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tonight right here, by telling the truth, by calling out

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the rot, by breaking the silence, and by refusing to

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pretend that everything is fine just because subsidies exist, and

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because we want to kick the can down the road.

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It's time to put an end to that, because subsidies

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are a tool, but a tool without the proper guardrails

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becomes a weapon, a weapon that wounds the people it

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was supposed to protect. Tonight, we expose the hidden costs,

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We break down the fraud, and unwind the bureaucratic mess,

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and we talk honestly about what subsidy dependence is really

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doing to this nation. Not to shame people who rely

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on these programs, but to fight for them, to build

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a system worthy of them, to demand accountability so they

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get the dignity and care that it is. Because health

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care is not about being Republican or democrat. It's not

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about ideology. It's not about anything other than the people,

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the families, and about the elderly, the disabled, the sick,

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the vulnerable, the working parent struggling to afford insulin or

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a simple doctor's visit. It's all that it matters. That's

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all that matters is these people that rely on this program.

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It's about the America we want to leave our children,

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and if we can stand together, if we can expose corruption,

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defeat waste, and rebuild this broken system, we can give

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this country something priceless, a healthcare system that works, a

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government that serves in a future where American people, not

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the bureaucracy, comes first. So tonight we dive in a medicare,

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we dive in a medicaid, and we dive into the

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ACA subsidies, along with the codebooks, the fraud networks, the

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bureaucratic labyrinth, the exploding costs, and the real numbers and

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the real reforms that we could have. Tonight we ask

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questions no politician wants to ask. What if programs meant

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to help us are being destroyed by the corruption inside

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of them, And we continue to confront the possibility that

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the path to healing this country starts with accountability, transparency,

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and the truth. America deserves better, You deserve better, And

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this conversation is where change begins. Tonight, we start at

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the beginning, at the very root of the healthcare system,

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with the three pillars that now hold up nearly half

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the country Medicare, Medicaid, and the Affordable Care Act subsidies.

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These programs are massive, They are influential, and whether you

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use them or not, whether you think you're outside the

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system or not, they touch every single American life in

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some way. Prices, premiums, hospital budgets, state taxes, federal spending,

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pharmacy costs, insurance, competition or the lack of it. Every

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part of the healthcare universe was shaped directly and indirectly

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by these programs. And the truth is they are part

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safety net and part financial trap, part life saver and

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part price inflator, par humanitarian tool, and part bureaucratic anchor.

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Let's break each one down clearly, honestly, and without political sugarcoating.

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Medicare was born out of compassion. It was created in

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nineteen sixty five at a time when seniors were being bankrupt,

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by medical bills, turned away from hospitals and unable to

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obtain private insurance at any reasonable rate. And in many ways,

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Medicare does exactly what it was created to do. It

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keeps seniors from financial ruin, it gives older Americans access

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to life saving care, and it provides stability in a

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stage of life where income is fixed and medical needs grow.

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But here's the truth. No one in Washington wants to

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say out loud, Medicare has become a beast of complexity, distortion,

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and cost manipulation. Let's break it down simply because the

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program is intentionally confusing. Part A hospital insurance free for

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most because you paid taxes your whole working life. Part

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B outpatient and doctor visits, has premiums, deductibles, co insurance,

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and the famous twenty percent that never goes away. Part

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D prescription drugs, privatized insurance plans with government rules layered

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on top. And then Part C managed care plans run

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by private insurers paid by the government. Now, let's talk

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about the distortion, cost shifting, and price and premium inflation

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when Medicare underpays hospitals and it goes and it really

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does significantly, significantly it's terrible. Hospitals shift these costs to

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the private insurance. Private insurance then shift those costs onto

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higher premiums. Employers shift those costs into wage dignation. Families

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shift them into higher deductibles and out of pocket limits.

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So even if you aren't on Medicare, you're still paying

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for Medicare every time your health insurance goes up. That

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is one of the hidden costs of subsidies. Someone always pays,

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and it's usually the working American. The Medicare advantage explosion

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because more than half of all seniors are now in

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Medicare advantage run by private insurers. And here is the

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uncomfortable truth. Medicare advantage has become one of the largest

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sources of fraud and waste in the entire healthcare system.

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Why because insurers get more money when patients are sicker

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on paper, not in reality, only on paper. So companies

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have spent the last decade mastering the art of risk

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score inflation. They send nurses into homes to find conditions.

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They hire coders to come through charts looking for anything,

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and I mean anything to build as chronic condition. They

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classify mild issues as major diagnoses. They document illnesses that

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never required treatment. And it's all legal by the letter,

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but fraudulent by the spirit. How big is this waste?

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Up to fifty to sixty billion dollars a year, more

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than the budget to several federal agencies combined. This is

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money meant to help seniors, money meant to help reduce premiums,

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money meant to strengthen Medicare. Instead, it's used for corporate bonuses,

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insurance mergers, advertising blitzes, and lobbying to keep Congress from

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fixing the loopholes. And here's the other hidden truth. The

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healthcare system itself is now dependent on Medicare dollars, even

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though Medicare underpays half the time. Hospitals build expansions to

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capture Medicare reimbursements. Doctors structure practices around Medicare billing codes.

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Drug companies negotiate prices with Medicare and mind devices. Device

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makers build products tailored to Medicare reimbursement formulas. In other words,

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the system needs Medicare and money, but also keeps raising

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prices to make up for Medicare underpayments. This is how

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subsidies create a spiral. They become the bloodstream of the

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system and simultaneously poison it at the same time. If

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Medicare is the senior pillar, Medicaid is the working class

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and vulnerable pillar, children, pregnant mothers, people with disabilities, low

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income adults, nursing home residents, people with severe chronic conditions,

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all at the core. Because at its core, Medicaid is

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one of America's most compact programs. Without it, millions of

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children wouldn't get care, millions of low income seniors would

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be abandoned, millions of disabled Americans would fall through the cracks.

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There's no debate about that. But the part Washington refuses

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to confront is this Medicaid is also the single most abused,

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most manipulated, and most budget distorting program in the entire

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United States. And it's not because the people using the program.

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It's because the people running it, bureaucrats, state agencies, lobbyist hospitals,

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and the consultants who teach states how to game federal

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matching rules. Medicaid costs are shared. Federal government pays a percentage,

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the state pays the rest. The federal portion is called

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f MAP. And here's the reverse incentive. The poorer estate

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claims to be or the more qualifying expenses it finds,

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the more money the federal government gives it. This has

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led to states inventing supplemental payments, hospitals forming shell companies,

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states recycling money through hospitals to draw down more federal dollars,

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Billions being claimed in expenses that never truly occurred. This

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is not conspiracy. This is documented, This is admitted. This

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is investigated regularly. There are entire consulting firms whose sole

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purpose is teaching states how to maximize Medicaid revenue, whether

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the care exists or not. Under expansion, states get a

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higher f MAP rate, so they aggressively enroll people, even

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people who don't meet the original intent. And again, the

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00:21:53.119 --> 00:21:58.599
people are not the problem. The system is. States realized,

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if we roll more people, we get more federal dollars.

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Hospitals realize if we classify more patients as Medicaid, we

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get more revenue. Insurer is realized, if we get more

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Medicaid managed care contracts, we get guaranteed taxpayer payments. And

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suddenly Medicaid becomes a revenue stream, a budget tool, a

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profit engine, a loophole to pull more federal money, not

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a program designed for vulnerable Americans, but a financial instrument

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for institutions. Here's the tragedy. Even with massive spending, even

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with expansion, even with billions flowing, Medicaid patients struggle to

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find doctors. Why because Medicaid underpays providers by thirty to

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fifty percent, So fewer doc doctors except Medicaid. So wait

278
00:23:02.359 --> 00:23:07.279
times grow, So patients overcrowd eers. So states spend more

279
00:23:07.319 --> 00:23:13.480
money on emergency care, so budgets explode. This is the

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cruelty of subsidies without accountability. More people covered, fewer people

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00:23:19.039 --> 00:23:23.519
actually treated. Now, let's talk about the Affordable Care Act,

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00:23:23.920 --> 00:23:27.680
a program that was promised to lower premiums, provide more

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competition and access for all. What happened. Premium skyrocket at

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one hundred to three hundred percent, competition vanished in many states,

285
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Deductibles hit seven thousand to nine thousand dollars for bronze plans.

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Insurers left the market, and subsidies ballooned into one of

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the fastest growing entitlement expenses in modern history. And then

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00:23:59.599 --> 00:24:04.319
there was the cliff removal and the dependency exploded. The

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00:24:04.359 --> 00:24:11.720
Original Care Act ACA Act capped subsidies around four hundred

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percent of the poverty line. Recent laws remove that cap.

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Now subsidies stretch upward into six figure incomes. And guess

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what insurance did. They've raised the prices because when a

293
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magic when the magic government pays more of the bill,

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the bill itself magically grows. Families appeared helped on paper,

295
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but the underlying price of the insurance continues to raise

296
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for the entire country, including those who make too much.

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00:24:49.319 --> 00:24:55.039
Air quotes guys too much to qualify. Some households intentionally

298
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limit income to maximize subsidies, some report partial gear income

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00:25:00.440 --> 00:25:06.200
to qualify, and some brokers artificially adjust estimates. Hospitals guide

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00:25:06.200 --> 00:25:11.319
it uninsured patients to ACA plans to build taxpayers. Not illegal,

301
00:25:12.359 --> 00:25:15.519
but not honest either, and it adds billions to the

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00:25:15.559 --> 00:25:25.319
subsidy load every single year. Okay, so far we've broken

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00:25:25.359 --> 00:25:30.759
down Medicare, Medicaid, and ACA individually. Now we're going to

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00:25:30.799 --> 00:25:33.359
step back and take a look at the bigger picture,

305
00:25:33.759 --> 00:25:36.839
the hidden structure beneath it all, the part the politicians

306
00:25:36.880 --> 00:25:40.839
never want to discuss because it exposes their failure and

307
00:25:40.880 --> 00:25:45.839
the incentives they helped to create. Because once you understand

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00:25:45.839 --> 00:25:50.440
the mechanics, once you see that how the subsidies themselves

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00:25:50.519 --> 00:25:54.000
operate in the real world, you suddenly see the entire

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00:25:54.079 --> 00:26:00.359
healthcare crisis completely different. Let's dive into the heart of

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this entire problem. There are three unavoidable truths about healthcare subsidies,

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whether it's a Medicare, Medicaid, or the ACA premium tax credits,

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00:26:12.680 --> 00:26:19.279
subsidies help people afford care. Yes, they do, They absolutely do.

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Seniors depend on Medicare, children depend on Medicaid, working families

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00:26:25.440 --> 00:26:30.480
depend on ACA subsidies. People with disabilities depend on government coverage.

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We are not here to pretend that those programs are

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not helping people, because they do, and they matter, and

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00:26:37.960 --> 00:26:42.759
in cases they save lives. But subsidies inflate prices for

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00:26:42.960 --> 00:26:48.680
every single American. This is the hidden, quiet, extremely destructive

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00:26:48.680 --> 00:26:52.079
side of the subsidy system. When the government pays more,

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00:26:52.160 --> 00:26:56.599
providers charge more. When providers charge more, insures raise premiums.

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When premiums rise, subsidies must increase. And when subsidies increase,

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00:27:01.359 --> 00:27:07.440
prices rise again, so that it becomes this dangerous, dangerous

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00:27:07.519 --> 00:27:12.119
loop that we see constantly around and around and around.

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00:27:12.319 --> 00:27:15.119
It's a cycle that has no breaks. This is why

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00:27:15.400 --> 00:27:19.880
Colonosky costs four hundred dollars in one country and four

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00:27:19.960 --> 00:27:23.279
thousand dollars in the US. A hip replacement costs nine

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00:27:23.319 --> 00:27:26.720
thousand dollars in a country and forty five thousand dollars

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00:27:26.720 --> 00:27:30.799
in the US. An open heart surgery may cost twelve

330
00:27:30.799 --> 00:27:33.319
thousand dollars in one country, but one hundred and thirty

331
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thousand dollars in the US. We subsidize the American healthcare

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00:27:39.480 --> 00:27:43.880
system into the stratosphere. We ejected trillions of dollars into it,

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00:27:44.119 --> 00:27:47.400
and we inflated the demand without even adding any supply.

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00:27:48.599 --> 00:27:53.440
And we removed the pressure any pressure of efficiency because

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00:27:53.559 --> 00:27:59.160
institutions new don't worry the government will cover it. This

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00:27:59.240 --> 00:28:03.160
is not compassion. This is economic distortion dressed as assistance.

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00:28:04.039 --> 00:28:10.480
Now for the third truth, subsidies create dependency. They don't empower.

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And this is where we get to the uncomfortable part.

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Politicians refuse to touch. If the government disappeared tomorrow, have

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00:28:18.559 --> 00:28:22.680
the healthcare system collapses not because care is too expensive,

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00:28:22.880 --> 00:28:27.279
but because the industry counts on subsidies. Hospitals balance budgets

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00:28:27.640 --> 00:28:32.559
based on Medicare and Medicaid dollars. Drug companies design pricing

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00:28:32.599 --> 00:28:39.160
models assuming taxpayer coverage. Insurers build networks around government reimbursement.

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States rely on Medicaid matching funds to balance their budgets.

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Subsidies were never meant to become the backbone of the

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00:28:49.240 --> 00:28:52.920
entire healthcare industry. They were supposed to be a safety net,

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00:28:53.160 --> 00:28:58.920
not a spine. But here we are tonight. I want

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00:28:59.079 --> 00:29:02.960
every listener to hear this loud and clear. Even if

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00:29:02.960 --> 00:29:07.599
you never use Medicare, even if you never enroll in Medicaid,

350
00:29:08.039 --> 00:29:13.680
even if you never take an ACA subsidy, you will

351
00:29:13.680 --> 00:29:17.640
still pay for all of it every day through three

352
00:29:18.039 --> 00:29:23.400
quiet channels. Higher insurance premiums because hospitals and doctors shift

353
00:29:23.519 --> 00:29:28.720
costs from government programs to private insurance. Lower wages because

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00:29:28.720 --> 00:29:32.880
employers pay for more health coverage and they hold back raises,

355
00:29:35.039 --> 00:29:41.319
higher taxes because subsidies escalate, fraud balloons, and waste grows.

356
00:29:42.000 --> 00:29:46.000
Congress simply borrows more. There's a reason why the median

357
00:29:46.119 --> 00:29:50.839
American family feels poorer today than they did twenty years ago.

358
00:29:51.119 --> 00:29:53.559
Health Care is a silent thief in the night. It

359
00:29:53.599 --> 00:29:57.359
steals your paycheck, your savings, your financial future, and weighs

360
00:29:57.400 --> 00:30:02.319
most Americans never see clearly because the theft is buried

361
00:30:02.839 --> 00:30:07.880
inside subsidy math. This is why you can work full

362
00:30:07.920 --> 00:30:10.119
time and still feel like you're losing ground. This is

363
00:30:10.160 --> 00:30:14.480
why small businesses suffocate. This is why premiums are bigger

364
00:30:14.519 --> 00:30:19.359
than some mortgage payments. And this is why taking a

365
00:30:19.440 --> 00:30:22.200
new job or earning a raise can price you out

366
00:30:22.200 --> 00:30:26.400
of coverage. And let me say this bluntly, this system

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00:30:26.480 --> 00:30:29.599
is not broken by accident. It is broken because too

368
00:30:29.599 --> 00:30:34.039
many people profit from it being broken. Subsidies can be good,

369
00:30:34.319 --> 00:30:38.000
Subsidies can be noble. Subsidies could be life saving. But

370
00:30:38.039 --> 00:30:42.400
when subsidies are used to mask fraud, hide waste, inflate prices,

371
00:30:42.480 --> 00:30:46.599
and in trench bureaucratic empires, they stop being a helping

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00:30:46.720 --> 00:30:51.240
hand and become handcuffs. Handcuffs on families, handcuffs on states,

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00:30:51.400 --> 00:30:57.960
handcuffs on taxpayers, handcuffs on innovation, handcuffs on the doctors

374
00:30:58.119 --> 00:31:01.720
who must navigate thousands of billion codes just to justify

375
00:31:01.880 --> 00:31:05.880
every single decision they make. Handcuffs on hospitals who are

376
00:31:05.920 --> 00:31:11.839
trapped in subsidy dependent revenue cycles, and then handcuffs on

377
00:31:11.920 --> 00:31:16.920
the entire nation. The system doesn't empower people, It traps

378
00:31:16.960 --> 00:31:21.240
them and makes them dependent on government approvals, government plans,

379
00:31:21.400 --> 00:31:27.599
government reimbursement schedules, and government bureaucracy. And that is not compassion.

380
00:31:27.720 --> 00:31:34.480
That is control. Now, if Congress eliminated fraud, abuse, and

381
00:31:34.519 --> 00:31:37.599
waste in the Medicare and Medicaid alone, it could free

382
00:31:37.680 --> 00:31:40.160
up to two hundred billion dollars a year. Let that

383
00:31:40.240 --> 00:31:43.759
sink in. What can America do with two hundred billion

384
00:31:43.839 --> 00:31:47.880
dollars not lost their corruption? Well one could. It could

385
00:31:47.880 --> 00:31:53.400
really lower taxes, expand access to disabled children, protect seniors

386
00:31:53.400 --> 00:31:58.319
without raising the retirement age, support rural hospitals, reduce premiums,

387
00:31:58.480 --> 00:32:04.920
modernize the system, help fix the VA, improve mental health treatment,

388
00:32:05.359 --> 00:32:09.920
and help communities directly instead of through bloated institutions. We

389
00:32:10.079 --> 00:32:13.119
don't need to spend more. We need to spend right.

390
00:32:13.400 --> 00:32:18.000
We need accountability, transparency, oversight, and consequences for those who

391
00:32:18.000 --> 00:32:21.480
are involved. Because think about it, if you or I

392
00:32:21.640 --> 00:32:24.480
steal one thousand dollars from the government, we go to prison.

393
00:32:25.519 --> 00:32:30.160
But when corporations steal billions, they pay a fine less

394
00:32:30.200 --> 00:32:33.960
than their profit and we get right back to business.

395
00:32:35.119 --> 00:32:39.160
How is that justice? How is that compassion? How is

396
00:32:39.160 --> 00:32:44.920
that protecting those who are vulnerable? It isn't. It's protecting

397
00:32:45.119 --> 00:32:50.240
the system at the expense of the American people. And

398
00:32:50.920 --> 00:32:58.359
you know what that ends, only shine a light. So

399
00:32:58.440 --> 00:33:04.400
here's the truth. Medicare helps, but it also distorts. Medicaid

400
00:33:04.759 --> 00:33:08.359
protects the vulnerable, but it also enables waste and fraud

401
00:33:08.400 --> 00:33:12.160
at levels we should be ashamed of. The ACA expanded

402
00:33:12.160 --> 00:33:17.640
coverage and also escalated prices, a limited competition, and grow

403
00:33:17.759 --> 00:33:22.680
subsidy dependency. These programs don't need to be destroyed. They

404
00:33:22.720 --> 00:33:27.440
need to be cleaned, reformed, audited, simplified, protected from corruption,

405
00:33:28.759 --> 00:33:35.359
transformed from bureaucratic machines into actual service programs. Because government

406
00:33:35.440 --> 00:33:39.759
can help, but only if corruption is gone, only if

407
00:33:39.759 --> 00:33:42.119
the waste is gone, only if the fraud is gone,

408
00:33:42.400 --> 00:33:45.480
and only if the focus is returned to the people

409
00:33:47.240 --> 00:33:51.599
that need help and not feeding the system who robs

410
00:33:51.599 --> 00:33:55.359
from them. And that's where we go next. We've talked

411
00:33:55.359 --> 00:33:58.240
about what subsidies are. Now we dive into why healthcare

412
00:33:58.319 --> 00:34:02.000
is so expensive in the first place, the administrative hydra

413
00:34:02.960 --> 00:34:06.799
that eats money, time, and human dignity because the price

414
00:34:06.960 --> 00:34:10.119
you pay for care is not determined by medicine, it

415
00:34:10.199 --> 00:34:14.320
is determined by bureaucracy. So let's peel back the curtain.

416
00:34:15.039 --> 00:34:22.519
The administrative hydra a creature. Washington created a creature. Health

417
00:34:22.559 --> 00:34:29.519
Care industries feed a creature that grows two heads every

418
00:34:29.559 --> 00:34:32.280
time you try to cut one off. And I want

419
00:34:32.320 --> 00:34:37.119
you to hear this with absolute clarity. America does not

420
00:34:37.239 --> 00:34:41.719
have the most expensive health care in the world because

421
00:34:41.760 --> 00:34:44.880
our doctors are the best. We have the most expensive

422
00:34:44.880 --> 00:34:47.880
health care system in the world because our bureaucracy is

423
00:34:47.920 --> 00:34:53.079
the biggest. Let's break down the hydra head by head.

424
00:34:53.679 --> 00:34:59.360
With one, we start with the administrative overload. Americans think

425
00:34:59.559 --> 00:35:03.079
healthcare costs so much because of the advanced technology, the

426
00:35:03.079 --> 00:35:06.960
groundbreaking drugs, and the cutting edge procedures, but the truth

427
00:35:07.119 --> 00:35:11.280
is far more infuriating. And trust me, guys, I thought

428
00:35:11.280 --> 00:35:18.159
the same thing. But I do believe that there are

429
00:35:18.559 --> 00:35:24.559
certain parts of our system that are beneficial. But it's

430
00:35:24.599 --> 00:35:28.360
the problem is is most of the cost is not

431
00:35:28.719 --> 00:35:31.320
due to what everybody thinks it is. It's not due

432
00:35:31.360 --> 00:35:34.800
to the technology we use, it's not due to really

433
00:35:34.880 --> 00:35:38.679
anything that has to do with the actual care itself.

434
00:35:39.840 --> 00:35:44.360
Twenty five to thirty percent of all healthcare spending is administrative,

435
00:35:44.920 --> 00:35:49.840
not clinical, not medical, not even the treatment. It's admin

436
00:35:50.519 --> 00:35:55.840
That is one point three trillion dollars a year to

437
00:35:55.880 --> 00:35:59.280
put that in perspective, that could fund the entire US

438
00:35:59.440 --> 00:36:04.920
military twice, That could eliminate federal student loans in one year,

439
00:36:05.239 --> 00:36:08.559
that could rebuild every crumbling bridge and highway in America,

440
00:36:09.079 --> 00:36:16.360
that could cut every American household a ten thousand dollars check. Instead,

441
00:36:16.599 --> 00:36:19.719
we spend it on paperwork, on compliance, on billing codes,

442
00:36:19.920 --> 00:36:24.639
on software, on audits, on people whose job is to

443
00:36:24.800 --> 00:36:28.280
argue with other people about what is billable. This is

444
00:36:28.320 --> 00:36:31.199
part of healthcare no politician wants to talk about because

445
00:36:31.280 --> 00:36:37.199
fraud is scandalous. High drug prices make headlines. Medicare is emotional,

446
00:36:37.960 --> 00:36:43.679
Medicaid is political, but administrative waste. That is the quiet thief,

447
00:36:44.000 --> 00:36:48.199
the invisible tax, the slow bleed, and it destroys American

448
00:36:48.280 --> 00:36:54.880
families without even making a single sound. Let's talk coding.

449
00:36:56.679 --> 00:37:00.599
For those listening who haven't seen the system are forced

450
00:37:00.599 --> 00:37:03.440
to navigate. Let me describe what the government expects the

451
00:37:03.480 --> 00:37:09.360
clinicians to do. Every diagnosis, procedure, injury, symptom, and clinical

452
00:37:09.440 --> 00:37:15.760
encounter must be transformed into numerical codes, not optional, not suggested,

453
00:37:16.519 --> 00:37:22.280
but required to get paid. The ICD ten Codebook contains

454
00:37:22.719 --> 00:37:28.360
seventy thousand diagnoses, codes and more. Than seventy five thousand

455
00:37:28.400 --> 00:37:33.679
procedure codes. That's right, there are codes for falling off

456
00:37:33.679 --> 00:37:37.440
a toilet, being bitten by a parrot, getting sucked into

457
00:37:37.480 --> 00:37:42.719
a jet engine, walking into a lamppost, initial encounter, walking

458
00:37:42.800 --> 00:37:48.840
into a lamppost, subsequent encounter, walking into a lampposte cekala,

459
00:37:52.119 --> 00:37:56.840
and then being struck by a fast moving turtle. This

460
00:37:56.880 --> 00:38:01.320
would be hilarious if it wasn't a multi trillion catastrophe.

461
00:38:01.880 --> 00:38:07.559
Here's the truth. Doctors don't spend most of their time

462
00:38:07.639 --> 00:38:13.039
treating patients. They spend their time documenting codes so insurers

463
00:38:13.079 --> 00:38:17.239
and governments will pay. Studies show for every one hour

464
00:38:17.400 --> 00:38:21.960
a physician spends with patients, they spend two hours on documentation.

465
00:38:22.679 --> 00:38:25.599
Primary care doctors spend three to four hours per night

466
00:38:25.719 --> 00:38:30.760
charting after work. Some hospitals now have more coders than nurses.

467
00:38:31.079 --> 00:38:38.039
This isn't healthcare. This is clerical servitude disguised as medical practice.

468
00:38:38.159 --> 00:38:42.360
And when a system demands that that much administrative labor

469
00:38:42.880 --> 00:38:49.199
costs explode, prices in flight, access shrinks, and patients lose. Now,

470
00:38:49.280 --> 00:38:52.320
let's talk about one of the most hated, cruel and

471
00:38:52.400 --> 00:38:59.079
unnecessary bottlenecks in the modern healthcare prior authorizations. These are

472
00:38:59.119 --> 00:39:03.159
requirements of post by insurance, including Medicare advantage plans, where

473
00:39:03.239 --> 00:39:08.800
doctors must get permission before prescribing medications, ordering tests, or

474
00:39:08.840 --> 00:39:14.360
performing procedures. Originally these were sold as cost control, but

475
00:39:14.440 --> 00:39:19.079
today there are weapons. Weapons used to delay care, weapons

476
00:39:19.159 --> 00:39:22.400
used to deny treatment, weapons used to shift costs back

477
00:39:22.440 --> 00:39:25.840
onto the patient, weapons used to wear down doctors until

478
00:39:25.840 --> 00:39:29.559
they give up. Across this country, people wait weeks for approvals.

479
00:39:30.480 --> 00:39:35.000
Some die waiting, some become disabled waiting, Some get even

480
00:39:35.280 --> 00:39:45.000
worse waiting. Doctors will tell you I don't fear malpractice lawyers.

481
00:39:45.239 --> 00:39:49.039
I fear insurance clerks who can overrule my medical judgment.

482
00:39:49.559 --> 00:39:52.760
And here's the darkest part. Every time a claim is denied,

483
00:39:53.000 --> 00:39:59.119
even if it's medically necessary, then ensure profits. This is

484
00:39:59.119 --> 00:40:02.239
why prior authorizedations have exploded by over four hundred percent

485
00:40:02.239 --> 00:40:07.400
in the last decade. Not because care is unsafe, not

486
00:40:07.639 --> 00:40:13.360
because care is overused, not because doctors are irresponsible, but

487
00:40:13.440 --> 00:40:17.480
because bureaucracy is profitable and the cost it falls squarely

488
00:40:17.800 --> 00:40:23.320
on you. Now we dive into one of the most

489
00:40:23.400 --> 00:40:30.559
lucrative schemes in American healthcare, risk scoring manipulation. This mostly

490
00:40:30.639 --> 00:40:35.400
affects Medicare advantage, the private version of Medicare. The government

491
00:40:35.440 --> 00:40:38.559
pays ensures more money for patients who appear to be sicker,

492
00:40:39.119 --> 00:40:43.280
not who are sicker, but who looks sicker on paper.

493
00:40:44.400 --> 00:40:47.440
This incentive is a gold mine for insurance companies. So

494
00:40:47.480 --> 00:40:50.599
what do they do. They send nurses door to door

495
00:40:50.719 --> 00:40:54.719
to hunt for diagnoses, create algorithms that can auto scan

496
00:40:54.840 --> 00:40:59.400
medical records for anything that is billable, encourage physicians to

497
00:40:59.480 --> 00:41:04.920
documents suspected conditions, reclassify mild conditions as severe, and record

498
00:41:05.039 --> 00:41:11.400
diagnoses that are never required for treatment. And then they

499
00:41:11.440 --> 00:41:17.480
add codes for conditions patients never knew they had. And

500
00:41:17.519 --> 00:41:21.360
this is why Medicare advantage plans are under federal investigation.

501
00:41:21.679 --> 00:41:24.400
This is why whistle blowers have come forward, This is

502
00:41:24.400 --> 00:41:28.679
why DOJ is suing major insurers, and this is why

503
00:41:28.760 --> 00:41:32.320
billions have been clawed back and billions more will be.

504
00:41:33.440 --> 00:41:38.880
The government itself admits Medicare advantage over billing is around

505
00:41:38.960 --> 00:41:42.639
a fifty to sixty billion dollars per year practice. That

506
00:41:42.760 --> 00:41:45.199
is not a TYPO, that is the GDP of a

507
00:41:45.280 --> 00:41:51.119
small nation. It is one of the most well known

508
00:41:51.639 --> 00:41:55.960
and greatest financial scandals in American history, and yet no

509
00:41:56.000 --> 00:41:58.679
one goes to prison, no one loses their license, and

510
00:41:58.719 --> 00:42:03.800
no one faces consequence. Instead, these same insurers get more contracts,

511
00:42:04.079 --> 00:42:10.920
more members, more federal dollar dollars, and more power because

512
00:42:10.960 --> 00:42:17.480
the system itself rewards coding manipulation. Let's talk about hospitals.

513
00:42:17.599 --> 00:42:22.119
Hospitals love telling Americans they're struggling financially, and some they

514
00:42:22.119 --> 00:42:27.599
truly are, especially the role facilities. But many large hospital

515
00:42:27.599 --> 00:42:31.239
systems they're not struggling. They're not scraping by, they're not

516
00:42:31.519 --> 00:42:37.840
barely staying open. Some are raking in billions, building luxurious expansions,

517
00:42:38.000 --> 00:42:44.519
buying up competitors, hiring lobbyists, acquiring physician groups to monopolize markets.

518
00:42:45.519 --> 00:42:51.000
How not by treating patients, but by mastering billing complexity.

519
00:42:51.639 --> 00:42:55.559
Here's a statistic that should make your blood boil. And

520
00:42:55.679 --> 00:42:59.960
the US hospitals now employ more administrative staff than nurse

521
00:43:01.239 --> 00:43:05.039
Just pause and think about that. More billers than healers,

522
00:43:05.280 --> 00:43:11.519
more coders than caregivers, more bureaucracy than bedside. For every doctor,

523
00:43:11.599 --> 00:43:18.239
there are insurance negotiators, billing auditors, claim specialists, coding teams,

524
00:43:18.400 --> 00:43:24.639
compliance officers, EHR administrators, legal consultants, data entry clerks, denial

525
00:43:24.639 --> 00:43:29.760
of management specialists, appeals coordinators, contract analysts. It takes an

526
00:43:29.920 --> 00:43:34.039
army just to navigate the healthcare system. And who pays

527
00:43:34.039 --> 00:43:37.840
for that army? You do with every claim, every bill,

528
00:43:38.079 --> 00:43:42.679
every premium, every tax. This is not a healthcare system.

529
00:43:42.920 --> 00:43:46.199
This is a revenue extraction machine built on the backs

530
00:43:46.360 --> 00:43:51.719
of sick people within this country. Let me say something

531
00:43:51.840 --> 00:43:55.000
that every politician in Washington knows, but they will never

532
00:43:55.199 --> 00:43:59.400
say it publicly. Healthcare is expensive because bureaucracy is profitable.

533
00:44:00.159 --> 00:44:05.199
Because medicine is expensive, not because nurses are overpaid, not

534
00:44:05.400 --> 00:44:10.440
because drug research cost billions. No, healthcare is expensive because

535
00:44:10.480 --> 00:44:15.760
paperwork creates profit. Coding creates profit. Complexity creates profit. Confusion

536
00:44:15.840 --> 00:44:21.800
creates profit. Denials create profit appeals, They create profit. Risk

537
00:44:21.840 --> 00:44:25.960
scoring creates profit, and the administrative barriers that they put

538
00:44:26.000 --> 00:44:30.960
in place create profit. The hydra exists because it feeds

539
00:44:31.360 --> 00:44:36.320
a multi trillion dollar beast that benefits from chaos. It

540
00:44:36.360 --> 00:44:43.039
doesn't benefit from efficiency, It benefits from slowing every process.

541
00:44:43.639 --> 00:44:47.639
Every additional dollar in subsidies disappears into this administrative vortex.

542
00:44:47.920 --> 00:44:52.599
Instead of lowering costs, subsidies don't fix the administrative waste.

543
00:44:52.679 --> 00:44:57.960
They fund administrative waste. They feed it, empower it, enlarge it,

544
00:44:58.119 --> 00:45:01.840
and solidify it. This is part of the American healthcare

545
00:45:01.840 --> 00:45:06.079
debate that the media ignores. If you don't kill administrative waste,

546
00:45:06.480 --> 00:45:10.719
no subsidy can ever make healthcare affordable. That is why

547
00:45:10.760 --> 00:45:14.440
America pays more for health care than any country on Earth,

548
00:45:14.639 --> 00:45:18.599
while ranking thirty to fortieth in outcomes for any conditions.

549
00:45:20.000 --> 00:45:23.719
We didn't build a healthcare system. We built a bureaucratic

550
00:45:23.920 --> 00:45:30.760
playground with the medical services attached. Okay, so you've now

551
00:45:30.840 --> 00:45:35.360
seen the hydra. You've seen the codebooks, the billing departments,

552
00:45:35.920 --> 00:45:40.440
the prior authorizations, the risk or manipulation, the administrative armies.

553
00:45:40.880 --> 00:45:46.480
All of it grow completely unchecked. But now we go

554
00:45:46.599 --> 00:45:50.719
deeper because the real horror of the administrative beast isn't

555
00:45:50.800 --> 00:45:55.760
just the size. It's the way it inflates prices, distorts incentives,

556
00:45:56.039 --> 00:46:00.000
and feeds off of subsidies like a parasite eating its host.

557
00:45:59.760 --> 00:46:05.119
All live in the American taxpayer, the American family, the

558
00:46:05.159 --> 00:46:09.880
working class. They're the host, they're the fuel. Let's finish

559
00:46:09.920 --> 00:46:14.000
this segment strong. There's a lot of Americans have been

560
00:46:14.000 --> 00:46:18.280
told for decades healthcare costs more because healthcare is more advanced.

561
00:46:19.039 --> 00:46:24.000
No healthcare costs more because the middleman multiplied, because the

562
00:46:24.039 --> 00:46:31.159
paperwork multiplied, because the complexity multiplied, and every layer of

563
00:46:31.159 --> 00:46:34.679
the complexity adds a markup. Let me paint a picture

564
00:46:34.719 --> 00:46:41.400
for you. You never see the army of billers, coders, deniers, auditors, claims, processors,

565
00:46:41.880 --> 00:46:45.840
and compliance officers behind your medical bill, but you're paying

566
00:46:45.960 --> 00:46:51.400
every one of their salaries, and the system forces every

567
00:46:51.400 --> 00:46:55.599
hospital to inflate list prices to cover it. Administrative overhead,

568
00:46:55.800 --> 00:47:01.480
negotiated discounts, contract disputes, legal challenge just risk proof assumptions,

569
00:47:01.880 --> 00:47:08.840
coding variations, denials and appeals, compliance audits, claims, processing requirements,

570
00:47:09.000 --> 00:47:16.559
federal reporting mandates. All of this, they all cause inflation

571
00:47:18.000 --> 00:47:22.800
to medical pricing. For example, a forty dollars medical test

572
00:47:22.880 --> 00:47:28.039
becomes a six hundred dollars medical hospital charge, not because

573
00:47:28.280 --> 00:47:33.400
the test itself changed, but because the billing pathway changed.

574
00:47:33.760 --> 00:47:36.880
Another example, a fifteen minute visit with your doctor becomes

575
00:47:36.880 --> 00:47:39.320
a three hundred and fifty dollars bill, not because the

576
00:47:39.440 --> 00:47:43.320
visit was complicated, but because the hospital has to hire

577
00:47:43.400 --> 00:47:48.079
a coder, a billing specialist, a payer contracting analyst, an

578
00:47:48.119 --> 00:47:55.559
EHR administrator, a compliance reviewer, a denial management coordinator, all

579
00:47:55.639 --> 00:48:00.840
on that visit. The doctor's time is the cheapest part

580
00:48:00.840 --> 00:48:04.280
of the equation. This is the insanity that has to

581
00:48:04.320 --> 00:48:09.960
do with the administrative hydra. The less time you spend

582
00:48:09.960 --> 00:48:13.679
with a doctor, the more time the system spends billing you.

583
00:48:15.599 --> 00:48:19.440
Here is the dangerous cycle subsidies create. The government increases

584
00:48:19.480 --> 00:48:26.360
subsidies to make care quote unquote affordable. Premium subsidies go up,

585
00:48:26.599 --> 00:48:31.639
Medicaid expansion and grows, Medicare advantage payments rise, all of it.

586
00:48:32.599 --> 00:48:37.159
Providers and insurers raise the price because they know the

587
00:48:37.199 --> 00:48:42.679
more money that's flowing, and because they know subsidies create

588
00:48:42.920 --> 00:48:47.559
revenue streams. And the big problem is the administrative complexity

589
00:48:47.639 --> 00:48:52.440
grows to chase that money. More documentation, more coding layers,

590
00:48:52.639 --> 00:48:56.360
more risk scoring, more compliance rules, and then more auditing.

591
00:48:57.199 --> 00:49:02.400
Administrative costs skyrocket, Hospitals higher, more people, ensures expand apartments.

592
00:49:03.199 --> 00:49:10.000
Consultants multiply like locusts vendors. They create new software subscriptions

593
00:49:12.159 --> 00:49:17.360
all to keep up. Prices go up again to cover

594
00:49:17.440 --> 00:49:21.519
the new administrative costs. Deductibles rise, premiums rise, out of

595
00:49:21.559 --> 00:49:27.960
pocket costs rise. Congress responds by expanding subsidies even further,

596
00:49:28.920 --> 00:49:35.440
and the cycle starts over again. This is not healthcare.

597
00:49:35.679 --> 00:49:39.119
This is a perpetual inflation machine, powered by the various

598
00:49:39.119 --> 00:49:43.079
subsidies meant to lower prices. Now, let's bring us home

599
00:49:43.119 --> 00:49:47.440
with real examples of administrative waste blowing up. Costs eight

600
00:49:47.519 --> 00:49:54.039
dollars hospital ibuprofen. Not because medication costs eight dollars, but

601
00:49:54.119 --> 00:49:57.400
because billing costs one hundred and fifty thousand dollars per

602
00:49:57.480 --> 00:50:01.760
year for the staff who handles pharmacy claims seven thousand

603
00:50:01.880 --> 00:50:05.920
dollar er visit for stitches. Not because the stitches cost

604
00:50:06.039 --> 00:50:08.639
that money, Not because the doctor putting them in or

605
00:50:08.679 --> 00:50:12.760
the nurse that help take care of you cost that much. No,

606
00:50:12.920 --> 00:50:16.519
it's because the hospital will create a facility fee based

607
00:50:16.519 --> 00:50:21.519
on federal reimbursement rules. Thirty five thousand dollars MRI in

608
00:50:21.559 --> 00:50:24.719
a hospital versus a four hundred and fifty dollars one

609
00:50:24.800 --> 00:50:29.599
at an independent imaging center, same machine, same tech, same scan.

610
00:50:30.119 --> 00:50:35.159
The difference the hospital must finance administrators, billing teams, and

611
00:50:35.199 --> 00:50:40.679
compliance departments. The independent center does not. Thirty five hundred

612
00:50:40.679 --> 00:50:43.840
dollars Kolonosky at a hospital versus eight hundred and fifty

613
00:50:43.840 --> 00:50:47.840
at a GI clinic. The procedure is identical. The billing

614
00:50:47.880 --> 00:50:52.679
infrastructure is not twenty five thousand dollars ambulance right. Why

615
00:50:52.960 --> 00:50:57.800
because ambulance coding and insurance education is one of the

616
00:50:57.840 --> 00:51:02.559
most complex billing environments in America. A ten minute telehealth

617
00:51:02.639 --> 00:51:05.760
visit costing two hundred and sixty plus dollars. There is

618
00:51:05.880 --> 00:51:09.000
nothing expensive about a doctor looking at you through a screen.

619
00:51:09.400 --> 00:51:14.639
The cost comes from EHR documentation requirements, telehealth building rules,

620
00:51:14.639 --> 00:51:23.880
compliance reviews and encoding, audits, claim submission rules, prayer payer

621
00:51:24.079 --> 00:51:30.480
education pathways, all of it. It's a bunch of it.

622
00:51:31.239 --> 00:51:33.440
It's a crock of crap. Really is really what it is?

623
00:51:34.559 --> 00:51:39.440
A ten minute conversation matched with a fifty minute of

624
00:51:39.599 --> 00:51:46.159
administrative funneling. Now, let me be blunt. This is the

625
00:51:46.199 --> 00:51:51.800
part every insider whispers privately but never says publicly or

626
00:51:52.320 --> 00:51:57.559
loud enough for anyone to hear. Healthcare organizations profit from inefficiency.

627
00:51:57.800 --> 00:52:01.840
The more complicated the system, the more justifiable high prices become.

628
00:52:02.159 --> 00:52:05.679
The more paperwork required, the more admin salaries are baked

629
00:52:05.679 --> 00:52:09.039
into bills, the more billing codes that are invented, the

630
00:52:09.039 --> 00:52:13.880
more opportunities there are to charge, the more denials that

631
00:52:13.920 --> 00:52:18.239
are issued. The more appeals are billed, the more complexity,

632
00:52:18.639 --> 00:52:24.039
the more confusion, the more people they need, the more

633
00:52:24.400 --> 00:52:30.639
the price they can justify. If you simplify the system tomorrow, Yes,

634
00:52:31.559 --> 00:52:37.239
many administrative jobs would disappear, Many consulting firms would collapse,

635
00:52:38.000 --> 00:52:44.039
many insurers lose leverage, and many, how large health systems

636
00:52:44.159 --> 00:52:49.559
lose excuses for bringing prices. So what happens. They fight

637
00:52:49.719 --> 00:52:56.039
to keep the system complicated. They lobby against simplification, and

638
00:52:56.079 --> 00:52:59.880
they oppose transparency. They flood Congress with arguments about pay

639
00:53:00.280 --> 00:53:05.559
safety and fraud prevention, when really they're protecting their revenue. Meanwhile,

640
00:53:05.679 --> 00:53:08.360
you pay the price, your family pays the price, your

641
00:53:08.360 --> 00:53:12.440
employer pays the price. Your tax dollars continue to feed

642
00:53:13.119 --> 00:53:18.760
the bureaucratical monster. America doesn't have a health care affordability

643
00:53:18.760 --> 00:53:22.840
problem as a healthcare corruption problem. America doesn't have an

644
00:53:22.960 --> 00:53:28.199
access problem. It has a bureaucratical obstruction problem. America does

645
00:53:28.400 --> 00:53:32.519
not have a compassion problem. It has a waste problem

646
00:53:32.559 --> 00:53:37.039
created by bloated institutions that feed on tax dollars. And

647
00:53:37.079 --> 00:53:42.000
here's the truth. Washington fears if we eliminated even half

648
00:53:42.239 --> 00:53:45.360
of the administrative waste health care in this country could

649
00:53:45.400 --> 00:53:51.039
immediately become affordable for almost everyone. Premiums would drop, deductibles

650
00:53:51.079 --> 00:53:54.719
would drop, cash prices would drop, hospital bills would drop.

651
00:53:55.119 --> 00:54:02.599
Physicians could see more patients. Families finally breathe a breath

652
00:54:02.880 --> 00:54:09.639
without feeling the pressure of the healthcare system. We wouldn't

653
00:54:09.719 --> 00:54:14.920
need more subsidies. We wouldn't need more bureaucracy, We wouldn't

654
00:54:14.960 --> 00:54:20.760
need more government intervention. We would need less, less waste,

655
00:54:21.159 --> 00:54:28.280
less complexity, less red tape, less administrative nonsense, and most importantly,

656
00:54:28.960 --> 00:54:36.599
less corruption. Because subsidies don't fix administrative waste. They fund it,

657
00:54:36.719 --> 00:54:41.800
they fuel it, they protect it, and until we expose

658
00:54:41.880 --> 00:54:48.920
the truth, the hydra will continue to grow. So we've

659
00:54:48.960 --> 00:54:55.559
now seen the subsidy distortion, the administrative explosion, the coding chaos,

660
00:54:55.800 --> 00:55:00.920
the risk score gaming, the price inflation, the inefficiency that

661
00:55:01.000 --> 00:55:04.679
bleeds families dry. But now we're going to take the

662
00:55:04.679 --> 00:55:10.039
gloves off because subsidies in administrative waste set the stage,

663
00:55:10.719 --> 00:55:14.280
but fraud, abuse, and corruption are the actors that are

664
00:55:14.320 --> 00:55:18.239
stealing the show. The next segment is where the fire

665
00:55:18.280 --> 00:55:21.920
gets hotter. This is where we expose the Medicare scams,

666
00:55:21.960 --> 00:55:26.880
the Medicaid loopholes, the ACA market place manipulation, the corporate

667
00:55:26.960 --> 00:55:32.400
fraud brings the provider kickbacks, the organized crime networks draining

668
00:55:32.559 --> 00:55:39.400
billions of dollars, and finally, the state's gaming the federal formulas.

669
00:55:40.440 --> 00:55:44.119
This is where we reveal the rot, name the schemes,

670
00:55:44.159 --> 00:55:48.000
and show exactly how much money is being stolen from

671
00:55:48.000 --> 00:55:53.840
the American taxpayer every single year. Because you cannot fix

672
00:55:53.880 --> 00:55:57.960
healthcare until you fix the corruption that lays deep within.

673
00:55:59.280 --> 00:56:06.559
And that's where we're gonna go next. Now, as we

674
00:56:06.559 --> 00:56:09.480
step into the darkest parts of the American healthcare system,

675
00:56:10.159 --> 00:56:15.719
the politicians try to gloss over the part. Corporations spend

676
00:56:15.800 --> 00:56:20.679
millions lobbling lobbying to cover up the park. Government agencies

677
00:56:20.840 --> 00:56:25.400
admit is happening, but can't seem to stop. Tonight, we're

678
00:56:25.440 --> 00:56:29.880
walking straight into the underbelly of the Medicare, Medicaid and

679
00:56:29.920 --> 00:56:36.400
the ACA. Because subsidies don't distort the system, administrative waste

680
00:56:36.679 --> 00:56:42.599
doesn't just inflate costs. There is another force that is

681
00:56:42.679 --> 00:56:51.199
bleeding this country dry, openly, aggressively, and relentlessly. Fraud, abuse, corruption.

682
00:56:52.400 --> 00:57:01.360
Billions stolen every year, not millions billions, not by bad apples,

683
00:57:01.639 --> 00:57:07.239
not by a handful of crooks, but by networks, by corporations,

684
00:57:07.360 --> 00:57:11.719
by hospitals, by insurance companies, by consultants, by state agencies,

685
00:57:12.440 --> 00:57:17.800
by organized crime rings, and by people who have turned

686
00:57:17.880 --> 00:57:22.719
healthcare fraud into their business model. This is the subsidy

687
00:57:22.760 --> 00:57:26.119
gold rush, a free for all fueled by government money.

688
00:57:26.440 --> 00:57:29.119
And loophole is so large you could drive a freight

689
00:57:29.159 --> 00:57:35.079
train through all of them. And the victims they're you,

690
00:57:35.079 --> 00:57:40.239
your family, every taxpayer, every honest doctor, every patient who

691
00:57:40.400 --> 00:57:47.599
actually needs help. Let's expose it all, one scheme at

692
00:57:47.639 --> 00:57:52.360
a time. When the government created Medicare in nineteen sixty five,

693
00:57:52.679 --> 00:57:55.639
it created one of the largest revenue streams in human history.

694
00:57:55.920 --> 00:58:03.800
Wherever money flows without light, without very tight oversight, criminals follow.

695
00:58:05.559 --> 00:58:10.280
In healthcare, with its complexity, coding and fragmented systems, is

696
00:58:10.320 --> 00:58:15.239
the perfect environment for fraud. Let's talk about the biggest schemes.

697
00:58:16.559 --> 00:58:26.199
Durable medical equipment scams. Durable medical equipment includes wheelchairs, braces, orthotics,

698
00:58:26.559 --> 00:58:30.800
glucose monitors, lift chairs, seapap machines, nebulizers, and it is

699
00:58:30.840 --> 00:58:34.480
one of the most abused categories in medicare. And here's

700
00:58:34.480 --> 00:58:38.559
how the scam works. Fraudsters create a fake DME company,

701
00:58:39.559 --> 00:58:43.920
They steal or buy Medicare numbers from seniors, They build

702
00:58:43.920 --> 00:58:47.480
Medicare for equipment that was never delivered, or deliver cheap

703
00:58:47.559 --> 00:58:53.800
junk or twenty dollars and built twenty five hundred. Medicare

704
00:58:53.960 --> 00:59:00.719
pays automatically because DME claims are lightly audited. And just

705
00:59:00.760 --> 00:59:04.599
one year the DOJ busted a ring that built one

706
00:59:04.679 --> 00:59:10.599
point two billion dollars through fake dome suppliers stretching from

707
00:59:10.639 --> 00:59:15.480
Florida to California. This is an accidental fraud. This is

708
00:59:15.559 --> 00:59:21.599
industrial scale theft. Next is the home health fraud. Billing

709
00:59:21.679 --> 00:59:24.679
for visits that never actually happened. Home health is another

710
00:59:24.719 --> 00:59:29.800
gold mine for fraudsters. Why because the government cannot verify

711
00:59:29.920 --> 00:59:34.320
easily whether a nurse actually showed up. Common schemes include

712
00:59:34.519 --> 00:59:37.079
billing for seven days a week when visits were two

713
00:59:37.119 --> 00:59:40.480
days a week, billing for patients who aren't home bound,

714
00:59:41.000 --> 00:59:45.639
billing for therapy never performed, paying kickbacks for patient referrals,

715
00:59:46.239 --> 00:59:52.039
using ghost employee lists, and then rolling patient signatures onto

716
00:59:52.159 --> 00:59:57.719
multiple forms. Every year, Medicare loses ten to fifteen billion

717
00:59:57.760 --> 01:00:02.760
dollars to home health fraud alone, and you, the honest taxpayer,

718
01:00:02.960 --> 01:00:10.000
you're paying for it. Then there's false diagnoses. Some clinics

719
01:00:10.039 --> 01:00:16.679
build Medicare for diagnosing conditions the patient doesn't have, depression, COPD,

720
01:00:17.280 --> 01:00:24.280
chronic kidney disease, diabetes, congestive heart failure, Alzheimer's symptoms. The

721
01:00:24.400 --> 01:00:31.280
list goes on and on. Why fake diagnoses because reimbursement

722
01:00:31.360 --> 01:00:35.400
skyrockets with each additional complex condition added to the chart.

723
01:00:36.639 --> 01:00:39.480
A patient with a simple blood pressure issue might be

724
01:00:39.519 --> 01:00:42.119
worth one hundred and fifty dollars, but a patient coded

725
01:00:42.159 --> 01:00:46.119
with four chronic conditions can be worth eight hundred to

726
01:00:46.119 --> 01:00:50.119
twelve hundred dollars. This isn't medicine, this is just profiteering.

727
01:00:51.400 --> 01:00:56.760
Then there's upcoding, turning simple visits into gold plated reimbursements.

728
01:00:58.119 --> 01:01:00.440
Upcoding is the art of billing for a high level

729
01:01:00.480 --> 01:01:04.239
service than what was actually occurred. Example, a ten percent

730
01:01:04.719 --> 01:01:08.079
a ten minute visit is built at a forty minute one.

731
01:01:08.880 --> 01:01:13.679
A routine care is billed as emergency consultation. Mild symptoms

732
01:01:13.719 --> 01:01:20.000
become complex medical decision making. This is rampant across Medicare, Medicaid,

733
01:01:20.480 --> 01:01:25.400
er services, telehealth, hospital, out patient clinics, all of them.

734
01:01:25.559 --> 01:01:29.079
And because coding is so complex, it is nearly impossible

735
01:01:29.119 --> 01:01:32.920
for patients to know they were upcoded. The Inspector General

736
01:01:32.960 --> 01:01:38.280
has documented billions in overpayments due to upcoding. Then there's

737
01:01:38.320 --> 01:01:42.880
hospice fraud. That's one of the darkest corners of Medicare,

738
01:01:43.280 --> 01:01:46.320
because hospice is meant for patients with less than six

739
01:01:46.400 --> 01:01:52.960
months to live. Yet countless hospice companies and roll healthy

740
01:01:53.000 --> 01:01:57.639
people keep patients in hospice for years, build Medicare for

741
01:01:57.920 --> 01:02:02.639
constant care. Then they go on and mislead families and

742
01:02:02.719 --> 01:02:08.079
rake in millions and billions in profit. In some states,

743
01:02:08.280 --> 01:02:14.679
hospice enrollment is outpacing the actual terminally ill population. Hospice

744
01:02:14.719 --> 01:02:18.159
fraud costs taxpayers three to five billion dollars per year,

745
01:02:18.360 --> 01:02:22.599
and worse is it causes real medical harm by blocking

746
01:02:22.639 --> 01:02:26.960
patients from receiving curative treatment. This is not just fraud,

747
01:02:27.159 --> 01:02:34.639
this is cruelty. If Medicare is the Wild West, Medicaid

748
01:02:34.679 --> 01:02:41.800
is the Amazon Rainforest of fraud, Dense, chaotic, impenetrable, and

749
01:02:41.880 --> 01:02:48.400
thriving with predators who know how to hide. Medicare fraud

750
01:02:48.599 --> 01:02:52.960
is harder to detect because states administer the program rules

751
01:02:53.039 --> 01:02:59.360
vary widely. Oversight is inconsistent, enrollment expanded massively, fraud can

752
01:02:59.440 --> 01:03:04.880
hide and seen. State budgets and eligibility checks are very weak.

753
01:03:06.079 --> 01:03:09.480
We talked about this in the last podcast that we

754
01:03:09.519 --> 01:03:16.639
did on the ACA and Medicaid programs. A lot of

755
01:03:16.679 --> 01:03:19.000
the stuff that we talked about with the Big Beautiful

756
01:03:19.000 --> 01:03:26.880
Bill and the last podcast was targeted at lowering medicaid fraud. Now,

757
01:03:26.880 --> 01:03:31.400
the state level loopholes. Medicaid uses cost sharing. Federal government

758
01:03:31.400 --> 01:03:35.559
pays a percentage, the state pays the rest. The percentage

759
01:03:35.599 --> 01:03:40.440
is f map the loophole. States can manipulate expenses to

760
01:03:40.480 --> 01:03:45.440
squeeze more federal dollars. Common schemes hospitals donating money to

761
01:03:45.559 --> 01:03:51.519
states to artificially increase match rates, states inflating provider taxes,

762
01:03:52.559 --> 01:03:57.960
shell transactions to trigger more federal payments and supplemental payments

763
01:03:58.360 --> 01:04:03.960
that far exceed actual care delivered. And then there's intergovernmental

764
01:04:04.079 --> 01:04:10.280
transfers that recycle money to create fall spending. These aren't errors,

765
01:04:10.840 --> 01:04:14.239
These are strategic manipulations worth tens of billions of dollars.

766
01:04:14.800 --> 01:04:19.320
Even the GAO, the Government Accountability Office, warrants Medicaid finance.

767
01:04:19.480 --> 01:04:23.960
Medicaids finances are so muddy that true spending is unknowable

768
01:04:24.639 --> 01:04:27.559
think about that. The federal government cannot tell you how

769
01:04:27.639 --> 01:04:33.119
much money is actually being spent on Medicaid. If that's

770
01:04:33.159 --> 01:04:40.679
not corruption, what is Medicaid manage fraud? Managed care fraud?

771
01:04:42.400 --> 01:04:48.239
States hire insurance companies to manage Medicaid. And here's the

772
01:04:48.280 --> 01:04:53.079
perverse incentive. The more sick people insurers say they have,

773
01:04:53.599 --> 01:04:58.480
the more money they get. The similarity to Medicaid to

774
01:04:58.559 --> 01:05:03.360
Medicare advantage risk scoring is not accidental. Insure as routinely

775
01:05:03.800 --> 01:05:07.880
in flight. Risk scores classify minor conditions as major, receive

776
01:05:07.960 --> 01:05:11.440
payments for patients they haven't even seen, bill for services

777
01:05:11.599 --> 01:05:15.320
never provided, and get bonuses for quality improvements that never

778
01:05:15.480 --> 01:05:22.639
actually happened. One audit found that Medicaid insure receiving payments

779
01:05:22.639 --> 01:05:26.199
for nine thousand patients who didn't even exist within their network.

780
01:05:26.599 --> 01:05:32.159
Nine thousand and no one went to jail. Medicaid pharmacy

781
01:05:32.280 --> 01:05:37.400
benefits are controlled by pharmacy benefit managers. They manipulate the

782
01:05:37.440 --> 01:05:44.519
system by overcharging states, undercutting pharmacies, pocketing, spreading spread, pricing margins,

783
01:05:45.880 --> 01:05:51.199
rebating themselves and falling and failing to pass savings onto patients. Now,

784
01:05:51.239 --> 01:05:55.079
if you think about that, let's just break down two

785
01:05:55.159 --> 01:05:59.480
of these failing to pass savings on the patients. That

786
01:05:59.559 --> 01:06:04.719
affects you directly, but undercutting pharmacies. When you start talking

787
01:06:04.760 --> 01:06:11.480
about the rural pharmacies, rural hospitals, royal hospital pharmacies, they

788
01:06:13.199 --> 01:06:16.400
by them undercutting the pharmacies. A lot of times you're

789
01:06:16.440 --> 01:06:22.679
seeing these small town pharmacies and are now now are

790
01:06:22.760 --> 01:06:25.000
or they're closing. I mean, that's really the only way

791
01:06:25.000 --> 01:06:28.119
to say. They're just closing because they can't afford to

792
01:06:28.239 --> 01:06:35.360
stay alive because of Medicaid and these private insurance not

793
01:06:36.079 --> 01:06:41.239
paying the pharmacy what they're deserved, and a lot of

794
01:06:41.239 --> 01:06:44.000
times there's times where the reimbursement isn't even enough to

795
01:06:44.039 --> 01:06:46.320
actually keep up with the drug to pay for the

796
01:06:46.360 --> 01:06:52.639
drug itself, or if it is, it's just over it.

797
01:06:52.760 --> 01:06:57.000
The er frequent flyer problem. Because Medicaid patients face long

798
01:06:57.039 --> 01:07:01.320
waits for primary care, many go straight to the emergency rooms.

799
01:07:02.039 --> 01:07:07.760
Some individuals abuse the system, but most abuse most abuse

800
01:07:07.840 --> 01:07:13.480
is caused by broken access pipeline, not actually molitious tent

801
01:07:14.559 --> 01:07:17.960
States end up paying fifteen hundred dollars for ear infections,

802
01:07:18.320 --> 01:07:22.039
three thousand dollars from migraine, seven hundred dollars for sore

803
01:07:22.119 --> 01:07:26.480
throats or four thousand dollars for minor injuries when primary

804
01:07:26.519 --> 01:07:30.239
care could have cost eighty dollars. This isn't patient fraud.

805
01:07:30.599 --> 01:07:36.079
This is system failure fraud. Now we're out of the

806
01:07:36.119 --> 01:07:44.920
ACA subsidy fraud. The income manipulation marketplace. The ACA marketplace

807
01:07:44.960 --> 01:07:50.079
created a created new avenues, avenues for fraud, most of

808
01:07:50.119 --> 01:08:00.679
them involving income estimation, eligibility, gambling, and hospital steering. Let's

809
01:08:00.719 --> 01:08:05.800
expose them. Income under reporting the easiest loophole in public policy.

810
01:08:06.920 --> 01:08:11.840
ACS subsidies are based on projected income. Projected meaning you

811
01:08:11.880 --> 01:08:16.359
can guess, you can estimate, and you can anticipate changes,

812
01:08:16.520 --> 01:08:20.680
or you can just adjust midyear. You can intentionally report

813
01:08:21.119 --> 01:08:25.319
lower than expected millions if people report incomes just low

814
01:08:25.399 --> 01:08:30.720
enough to maximize subsidies. Some brokers openly tell clients just

815
01:08:30.800 --> 01:08:33.680
list the lower end of your expected range. The IRS

816
01:08:33.760 --> 01:08:36.960
won't check until next year. This is a loophole so

817
01:08:37.199 --> 01:08:42.279
large you could subsidize an entire town through it. Hospitals

818
01:08:42.279 --> 01:08:47.920
steering patients on ACA plans hospitals discovered something interesting. Uninsured

819
01:08:47.920 --> 01:08:53.319
patient equals financial loss, ACA enrolled patient equals guaranteed revenue.

820
01:08:54.239 --> 01:08:59.640
So many hospitals guide uninsured patients through ACA enrollment, offer assistance.

821
01:08:59.680 --> 01:09:04.680
Counsels pay third parties to help patients enroll strategically, time

822
01:09:04.800 --> 01:09:09.560
enrollment during treatment, and shift financial burdens to the taxpayers.

823
01:09:09.920 --> 01:09:16.600
This is legal, but deeply unethickle broker kick so. Then

824
01:09:16.600 --> 01:09:20.439
there's also broker kickback schemes. Some brokers enroll people into

825
01:09:20.439 --> 01:09:25.680
plans they didn't request. Others fabricate income documentation. Some collect

826
01:09:25.720 --> 01:09:30.479
commissions for auto re enrolling individuals without consent. In twenty

827
01:09:30.520 --> 01:09:35.079
twenty three, CMS documented hundreds of thousands of fraudulent plans,

828
01:09:35.079 --> 01:09:38.479
which is this isn't a glitch, this is embedded corruption.

829
01:09:39.279 --> 01:09:43.800
Then there's the drug manufacturer loopholes. Drug companies steer expensive

830
01:09:43.840 --> 01:09:48.880
prescription toward ACA plans because subsidies lower patients outer pocket costs.

831
01:09:49.319 --> 01:09:54.560
The result, insurance companies raise premiums, subsidies increase the match,

832
01:09:55.000 --> 01:10:01.479
and taxpayers with the bill, not the drug companies. Then

833
01:10:01.520 --> 01:10:07.880
there's the medical mafia, the organized crime rings. This part

834
01:10:07.960 --> 01:10:12.840
shocks most Americans. International fraud rings target medicare and medicaid

835
01:10:12.920 --> 01:10:20.199
every single day. This includes Nigeria, Russia, China, the Dominican Republic, Venezuela, Malaysia,

836
01:10:21.199 --> 01:10:25.960
and you might be asking yourself how through stolen identities,

837
01:10:26.279 --> 01:10:32.479
fake medical clinics, sham telehealth companies, ghost billing operations, counterfeit providers,

838
01:10:33.479 --> 01:10:40.199
corporate shells in multiple states, and money laundering networks, all

839
01:10:40.439 --> 01:10:46.000
built to rob you of your tax money. In twenty nineteen,

840
01:10:46.479 --> 01:10:50.600
the federal government broke up telemedicine fraud ring. That's till

841
01:10:50.680 --> 01:10:55.319
one point three billion dollars one ring, one year. Organized

842
01:10:55.359 --> 01:10:59.680
crime doesn't need guns to rob America. They need billing codes.

843
01:11:02.039 --> 01:11:08.960
So we've talked about fake suppliers. We've walked through falsified diagnoses,

844
01:11:10.199 --> 01:11:14.600
risk score s games, the state level manipulation. But we're

845
01:11:14.600 --> 01:11:19.039
not done because some of the darkest fraud doesn't just

846
01:11:19.119 --> 01:11:23.279
steal money. It steals dignity, It steals safety, It steals

847
01:11:23.279 --> 01:11:26.640
the final years of some people's lives, and it flourishes

848
01:11:26.920 --> 01:11:30.479
inside the very system that claims to protect the vulnerable.

849
01:11:32.039 --> 01:11:38.399
So let's keep going. When most people hear medicaid, they

850
01:11:38.399 --> 01:11:46.800
think children, low income adults, maybe pregnant mothers. But a

851
01:11:46.840 --> 01:11:53.840
massive portion of Medicaid goes to one place, nursing homes

852
01:11:53.880 --> 01:11:57.720
and long term care. Medicaid is the dominant pair for

853
01:11:57.840 --> 01:12:02.520
nursing home residents many a system, living facilities, long term care,

854
01:12:02.560 --> 01:12:08.640
and institutions. And here's the terrible truth. Where there is

855
01:12:08.720 --> 01:12:14.640
dependency plus limited oversight, there is always abuse. Common schemes

856
01:12:14.680 --> 01:12:20.079
include billing for services not provided, charter bas therapy, monitoring

857
01:12:20.119 --> 01:12:24.279
that never occurred, upcoding levels of care, charading residents as

858
01:12:24.399 --> 01:12:29.760
needing higher intensity services to increase reimbursements, staffing fraud, claiming

859
01:12:29.840 --> 01:12:34.600
ratios that don't exist while running dangerously low actual staffing levels,

860
01:12:35.119 --> 01:12:40.600
double billing, billing Medicaid and medicare for overlapping services, neglect

861
01:12:40.680 --> 01:12:44.560
hidden as cost control, cutting care while continuing to bill

862
01:12:44.640 --> 01:12:48.439
as if full services are provided. So not only is

863
01:12:48.439 --> 01:12:51.199
your money stolen, but lives are being put at risk.

864
01:12:53.119 --> 01:12:57.640
Families believe their loved ones are being are being given

865
01:12:57.840 --> 01:13:02.159
around the clock care on paper, they are in reality

866
01:13:02.359 --> 01:13:06.640
some of the some are left sitting in soiled beds, dehydrated,

867
01:13:06.880 --> 01:13:12.399
under medicated, or ignored. This isn't fraud, this is moral bankruptcy.

868
01:13:13.800 --> 01:13:20.039
Now let's shift to another sensitive area, disability and program eligibility.

869
01:13:20.680 --> 01:13:25.560
We must be clear, there are millions of Americans with legitimate, serious,

870
01:13:25.760 --> 01:13:31.199
permanent disabilities. There are people whose conditions absolutely require government support.

871
01:13:31.640 --> 01:13:36.840
There are families who would not survive without help. Those

872
01:13:36.840 --> 01:13:41.640
are people who deserve our protection, but the system that

873
01:13:41.800 --> 01:13:44.960
was meant to help them is also wide open to abuse.

874
01:13:45.600 --> 01:13:50.520
People learn how to classify temporary conditions as permanent, exaggerate

875
01:13:50.560 --> 01:13:57.640
functional limits, optimize applications with the help of consultants, strategically

876
01:13:57.720 --> 01:14:02.560
under report income or assets, and shift work off the

877
01:14:02.600 --> 01:14:07.560
books to maintain eligibility. Again, fault lies not with individuals,

878
01:14:07.800 --> 01:14:12.479
but with a system that rewards dependency, punishes earning more,

879
01:14:12.760 --> 01:14:18.520
and allows vague standards to be stretched beyond recognition. When

880
01:14:18.560 --> 01:14:22.600
incentives say if you improve your situation, you lose benefits,

881
01:14:23.279 --> 01:14:27.079
you create a breeding ground for both unintentional dependency and

882
01:14:27.239 --> 01:14:31.720
intentional gaming. There's a form of fraud that often hides

883
01:14:31.760 --> 01:14:36.560
behind legal technicalities, and that's the kickbacks and influences schemes

884
01:14:38.000 --> 01:14:41.760
on the provider and pharmacide. This looks like consulting fees

885
01:14:41.800 --> 01:14:50.520
to doctors who prescribe certain drugs, speaker onnariums tiede directly

886
01:14:50.920 --> 01:14:56.560
superscription volume research grants that function as bribes, device makers

887
01:14:56.560 --> 01:14:59.840
giving perks for choosing their product to over cheaper alternatives,

888
01:15:00.760 --> 01:15:04.439
hospital steering referrals based on profit instead of patient need

889
01:15:05.880 --> 01:15:10.720
on paper. Everything is documented, the contracts are drafted, the

890
01:15:10.800 --> 01:15:14.199
payments are coded with clean labels. But ethically it's rotten

891
01:15:14.800 --> 01:15:18.079
because every time a doctor prescribes a more expensive drug

892
01:15:21.760 --> 01:15:26.159
to hit a sales target, every time a hospital chooses

893
01:15:26.159 --> 01:15:29.680
a price her device to satisfy a vendor agreement, that

894
01:15:29.760 --> 01:15:34.880
extra cost doesn't disappear. It doesn't vanish into some imaginary ceiling.

895
01:15:36.319 --> 01:15:40.479
You pay it through premiums, through taxes, through debt, and

896
01:15:40.600 --> 01:15:45.119
again subsidies make it easier to hide the cost. The

897
01:15:45.159 --> 01:15:48.960
federal government picks up the tab and the fraud disappears

898
01:15:49.039 --> 01:15:53.600
into the subsidy ocean. But you might be asking, why

899
01:15:53.640 --> 01:15:56.119
is it so hard to stop at this point? A

900
01:15:56.119 --> 01:16:00.039
fair question. If all fraud is happening, why doesn't the

901
01:16:00.079 --> 01:16:04.319
governments just stop it? The answer is brutal, because the

902
01:16:04.359 --> 01:16:09.000
system is too big, too complex, and too compromised. Let's

903
01:16:09.039 --> 01:16:14.560
break down the main reasons enforcement fails. Complexity is a shield.

904
01:16:15.079 --> 01:16:18.880
The same complexity that burdens honest doctors and hospitals protects

905
01:16:18.880 --> 01:16:22.720
criminals and bad actors. When the rule book is thousands

906
01:16:22.720 --> 01:16:25.840
of pages, the codebook is tens of thousands of codes,

907
01:16:26.439 --> 01:16:30.520
and the agencies are fragmented and slow. Fraudsters hiden the noise.

908
01:16:31.199 --> 01:16:36.840
Auditors cannot chase everything, Inspectors cannot read every chart, algorithms

909
01:16:36.880 --> 01:16:41.520
cannot be gained, can be gained, and data can be massaged.

910
01:16:42.159 --> 01:16:48.880
Complexity becomes the perfect camouflage. Then there's splintered oversight. Medicare

911
01:16:49.000 --> 01:16:53.760
is federal, Medicaid is federal in state. The ACA marketplace

912
01:16:53.880 --> 01:16:58.119
involves multiple agencies. Private plans have their own auditors, States

913
01:16:58.159 --> 01:17:03.680
have inspector generals, and the FED have OIG, doj CMS,

914
01:17:03.680 --> 01:17:09.239
GOO and the FBI. When everyone is responsible, no one

915
01:17:09.399 --> 01:17:14.479
is truly accountable. Cases fall between agencies, and inspectors die

916
01:17:14.520 --> 01:17:21.760
in investigations die in bureaucracy, and data isn't shared. Warnings

917
01:17:22.079 --> 01:17:28.279
go absolutely nowhere, and the fraud continues. Politicians know this.

918
01:17:28.560 --> 01:17:34.279
If you crack down too hard, providers scream, hospitals threaten closures,

919
01:17:34.640 --> 01:17:41.800
insurers threaten to exit markets, States cry about losing federal dollars.

920
01:17:42.039 --> 01:17:45.960
Advocacy groups say you're hurting the poor or attacking seniors.

921
01:17:46.279 --> 01:17:51.800
So what happens Enforcement is timid. Clawbacks are partial settlements

922
01:17:51.840 --> 01:17:59.960
replace prosecutions. Corrective action plans replace real consequences. Corporations treat

923
01:18:00.159 --> 01:18:03.840
finds like the cost of doing business. States keep gaming

924
01:18:03.880 --> 01:18:10.159
the formulas, hospitals keep their schemes, insurers tweak tactics and

925
01:18:10.319 --> 01:18:14.920
just carry on. Then there's the revolving door, another ugly

926
01:18:14.960 --> 01:18:18.840
truth that people don't want to know. People who are

927
01:18:18.920 --> 01:18:22.479
supposed to police the system often leave government and go

928
01:18:22.560 --> 01:18:26.960
work for the very companies they once investigated, and they

929
01:18:27.000 --> 01:18:30.840
come from companies, come from those companies to design rules

930
01:18:31.279 --> 01:18:38.399
that conveniently protect them. This revolving door means regulators hide

931
01:18:38.640 --> 01:18:44.640
to blow up the system. The later profit on companies

932
01:18:44.680 --> 01:18:50.000
get insider knowledge of oversight weaknesses, and enforcement becomes more

933
01:18:50.119 --> 01:18:55.079
theater than justice, and the fraud machine just continues to grow.

934
01:18:55.720 --> 01:18:59.760
Perhaps the most powerful shield of all is if we

935
01:19:00.000 --> 01:19:04.439
back down, people will lose access to care. Hospitals and

936
01:19:04.520 --> 01:19:08.840
royal communities use this argument. Large systems with thousands of

937
01:19:08.880 --> 01:19:14.479
employees use this argument. Medicaid managed care organizations use it.

938
01:19:15.399 --> 01:19:19.439
Nursing homes they use it as well. So instead of

939
01:19:19.439 --> 01:19:22.880
prison time and shutdowns, we get negotiated settlements, promises to

940
01:19:23.000 --> 01:19:27.600
do better. Now, imagine if that's how we treated regular people.

941
01:19:28.760 --> 01:19:30.800
You steal one hundred thousand dollars from the government, and

942
01:19:30.800 --> 01:19:35.399
the judge just says, just pay back five thousand, promise

943
01:19:35.479 --> 01:19:38.640
not to do it again, and we're good. That is

944
01:19:38.680 --> 01:19:44.640
how healthcare fraud is being treated at scale. Let's tie

945
01:19:44.640 --> 01:19:50.800
this all together into a single, painful reality. Fraud doesn't

946
01:19:50.880 --> 01:19:55.520
just waste money. Fraud locks in a subsidy system. Here's

947
01:19:55.560 --> 01:20:01.039
how fraud and waste drive up spending Medicare, Medicaid, ACA subsidies.

948
01:20:01.159 --> 01:20:06.279
They cost more and more year after a year. Cost

949
01:20:06.359 --> 01:20:11.000
growth creates fear. Politicians say if we cut people will suffer.

950
01:20:11.920 --> 01:20:16.520
Instead of cutting fraud, they raise spending, more subsidies, more expansion,

951
01:20:16.680 --> 01:20:21.359
more programs, and then that creates more money in the

952
01:20:21.399 --> 01:20:28.119
system that invites more fraud, new loopholes, new schemes, new actors.

953
01:20:28.520 --> 01:20:33.800
As fraud grows, administrative oversight expands, which means more paperwork,

954
01:20:34.159 --> 01:20:39.439
more bureaucracy, more hydra heads that we need to manage.

955
01:20:40.560 --> 01:20:45.079
Administrative growth increases costs even further, and once again the

956
01:20:45.159 --> 01:20:51.560
answer is ridiculous, it's more subsidies. This is a subsidy

957
01:20:51.560 --> 01:20:54.880
addiction cycle. We are not addicted to helping people. We

958
01:20:54.920 --> 01:20:58.880
are addicted to funding a broken system without demanding accountability.

959
01:20:59.039 --> 01:21:02.239
We're not trapped in passion. We are trapped in corruption.

960
01:21:03.760 --> 01:21:06.680
Let's take a moment really feel the weight of this.

961
01:21:07.319 --> 01:21:11.640
Conservative estimates say we lose hundreds of billions of dollars

962
01:21:12.000 --> 01:21:21.239
yearly to fraud, waste, abuse, administrative access and corruption, and

963
01:21:21.279 --> 01:21:25.520
subsidized healthcare. Imagine if we reclaimed even half of that

964
01:21:26.560 --> 01:21:29.960
one hundred to two hundred billion a year put back

965
01:21:29.960 --> 01:21:32.960
into America. What we could do with that money is

966
01:21:33.000 --> 01:21:36.199
lower taxes so family could keep more of their pay check.

967
01:21:36.840 --> 01:21:40.920
Strengthen truly necessary safety nets for disabled children and seniors,

968
01:21:41.279 --> 01:21:46.760
make a catastrophic coverage affordable for everyone. Fun local community

969
01:21:46.760 --> 01:21:54.239
clinics instead of bloated hospital monopolies, and support rural hospitals

970
01:21:54.239 --> 01:22:01.479
that actually care instead of empire building systems. Invest in

971
01:22:01.560 --> 01:22:09.239
mental health, addiction support for veterans, give states breathing room

972
01:22:09.319 --> 01:22:14.119
to balance budgets without cutting core services. We wouldn't have

973
01:22:14.159 --> 01:22:18.119
to choose between compassion and responsibility. We could have both,

974
01:22:19.119 --> 01:22:22.159
because the problem isn't that we take that we care

975
01:22:22.239 --> 01:22:25.279
too much. The problem is is that we tolerate too

976
01:22:25.359 --> 01:22:32.960
much corruption. So let's put this plainly. Medicare fraud is rampant,

977
01:22:33.520 --> 01:22:40.239
Medicaid fraud is systemic. ACA manipulation is widespread administrative waste

978
01:22:40.359 --> 01:22:45.720
just multiplies it. All States play games, corporations explode, exploit

979
01:22:45.760 --> 01:22:51.319
the loopholes, and organize crime feasts on our confusion. The

980
01:22:51.399 --> 01:22:55.640
victims are not the system. The victims are you, the taxpayer,

981
01:22:56.039 --> 01:22:59.800
the honest patient, the truly vulnerable person who now has

982
01:22:59.840 --> 01:23:03.840
to fight harder for care because corrupt players have drained

983
01:23:03.960 --> 01:23:08.039
all the funds. And that brings us to the turning

984
01:23:08.079 --> 01:23:11.880
point of this episode. We've exposed to sickness. Now we

985
01:23:11.960 --> 01:23:14.920
talk about the cure, not fantasy, not a sound bite,

986
01:23:15.039 --> 01:23:19.399
not burn it all to the ground. No, we're going

987
01:23:19.479 --> 01:23:24.560
to talk about real, realistic reforms that reduce waste, fight

988
01:23:24.600 --> 01:23:30.119
fraud aggressively, and simplify the healthcare administration, all while trying

989
01:23:30.159 --> 01:23:34.880
to protect the vulnerable people without choking them with bureaucracy.

990
01:23:36.279 --> 01:23:40.039
Because the answer is not to abandon seniors, not to

991
01:23:40.079 --> 01:23:44.520
abandon the poor, not to abandon people with disabilities. It

992
01:23:44.600 --> 01:23:49.199
is not to abandon the working family. The answer is

993
01:23:49.239 --> 01:23:54.560
to stop abandoning them to a corrupt system. The answer

994
01:23:54.600 --> 01:23:56.720
is to fight for them by cleaning up the mess

995
01:23:56.720 --> 01:24:02.199
that politicians, corporations, and criminals built on them. And that's

996
01:24:02.199 --> 01:24:06.720
where we go next. We spent the last hour and

997
01:24:06.760 --> 01:24:10.920
a half roughly tearing the mask off the system. We've

998
01:24:10.960 --> 01:24:15.039
talked about subsidies that distort, We've talked about the administrative hydra.

999
01:24:15.159 --> 01:24:19.560
We've exposed fraud, abuse and corruption on a massive scale.

1000
01:24:19.640 --> 01:24:22.399
But if all we do is rage that problem, we're

1001
01:24:22.479 --> 01:24:25.960
just another angry show. Tonight is not about disparates. It's

1002
01:24:25.960 --> 01:24:29.079
about direction, it's about solutions. It's about fighting for a

1003
01:24:29.119 --> 01:24:33.520
better system instead of accepting a broken one. So in

1004
01:24:33.560 --> 01:24:40.720
this segment, we're going to talk about something most politicians

1005
01:24:40.760 --> 01:24:43.279
refuse to do. We're going to talk about the real,

1006
01:24:43.359 --> 01:24:46.880
concrete reforms that could reduce spending, cut waste, crack down

1007
01:24:46.960 --> 01:24:50.840
on fraud, simplify access, and protect the vulnerable without trapping

1008
01:24:50.840 --> 01:24:55.319
them in a bureaucratic Chokehold, no fantasy, no magic ones,

1009
01:24:55.800 --> 01:24:59.880
just tough, realistic steps that a serious country could take

1010
01:25:01.479 --> 01:25:10.319
if it actually cared about the people and not about

1011
01:25:10.319 --> 01:25:14.239
protecting the system. Let's break it down. Before we talk

1012
01:25:14.279 --> 01:25:17.720
about cutting subsidies, before we talk about restructuring programs, we

1013
01:25:17.840 --> 01:25:22.920
have to attack the core of the cost structure administrative waste.

1014
01:25:23.000 --> 01:25:27.239
If we don't kill that hydra, every dollar we save

1015
01:25:27.319 --> 01:25:30.319
and fraud will likely be swallowed by the complexity of

1016
01:25:30.399 --> 01:25:35.359
the system itself. So what does real administrative simplification look like.

1017
01:25:35.720 --> 01:25:42.479
We do not need seventy thousand diagnoses codes and seventy

1018
01:25:42.520 --> 01:25:48.119
five thousand procedure codes for a functioning healthcare system. We

1019
01:25:48.159 --> 01:25:51.479
need enough codes to track meaningful differences in care, and

1020
01:25:51.520 --> 01:25:56.720
not one more. We could create a core simplified code

1021
01:25:56.760 --> 01:26:02.119
set for most routine care, reserve ultraspecific codes only for

1022
01:26:02.199 --> 01:26:08.199
true clinic and clinical necessity, ban payers from requiring micro

1023
01:26:08.399 --> 01:26:12.640
variations of code that don't impact outcomes. Build a single

1024
01:26:12.720 --> 01:26:17.199
standardization claim format across all major programs. That alone would

1025
01:26:17.199 --> 01:26:21.279
cut documentation time, reduce coding errors, slash the need for

1026
01:26:21.479 --> 01:26:27.800
massive back office staff, and lower the billing disputes. And lastly,

1027
01:26:28.000 --> 01:26:31.079
it would free up doctors to spend more time with

1028
01:26:31.159 --> 01:26:36.920
patients and less time in their charts. Now, imagine if

1029
01:26:36.920 --> 01:26:40.319
your mechanic needs seventy thousand codes just to charge you

1030
01:26:40.359 --> 01:26:45.479
for one oil change. That's what we did to doctors,

1031
01:26:46.359 --> 01:26:49.439
and then actively shocked when the bill got out of control.

1032
01:26:50.720 --> 01:26:53.680
And that's just ridiculous. We can't sit here. We can't

1033
01:26:53.680 --> 01:26:57.199
blame the people who are not to blame. You can't

1034
01:26:57.239 --> 01:26:59.680
blame your doctor for your bill, because it's not the

1035
01:26:59.720 --> 01:27:03.640
doctor that is making your bill that high. It is

1036
01:27:03.760 --> 01:27:08.880
the insurance companies, It is the federal government. It is

1037
01:27:08.920 --> 01:27:12.319
the state governments that are requiring all of this other

1038
01:27:12.560 --> 01:27:16.319
paperwork to be able to qualify for the Medicare Medicaid funds.

1039
01:27:18.439 --> 01:27:21.319
Right now, every insurer, every government program, every state has

1040
01:27:21.359 --> 01:27:25.399
its own variations of forms, requirements, claim adits, submission rules,

1041
01:27:25.960 --> 01:27:32.520
authorization lists, documentation thresholds. It's chaos by design. Reform means

1042
01:27:32.600 --> 01:27:37.520
one national claim standard for basic services, one universal format

1043
01:27:37.560 --> 01:27:42.680
for documentation, one shared set of definitions for medically necessary,

1044
01:27:43.520 --> 01:27:46.920
a rule that if a claim is acceptable under Medicare standards,

1045
01:27:47.079 --> 01:27:51.119
it is acceptable under others unless a payer can prove

1046
01:27:51.520 --> 01:27:58.600
clear documented risk. Otherwise. This doesn't kill competition, it kills redundancy.

1047
01:27:58.960 --> 01:28:03.000
Let insurers can pete on a network service innovation and value,

1048
01:28:03.199 --> 01:28:06.199
not on who can build the most confusing claim system.

1049
01:28:09.119 --> 01:28:16.279
And then we begin to look at prior authorization. We

1050
01:28:16.319 --> 01:28:19.359
talked earlier about prior authorizations and how they've become a weapon.

1051
01:28:21.000 --> 01:28:25.760
Real reform would flip the burden for common evidence based treatments.

1052
01:28:26.119 --> 01:28:29.720
The fall approval is automatic prior ofth is reserved for

1053
01:28:29.880 --> 01:28:34.159
truly high cost, high risk, or experimental care. If a

1054
01:28:34.199 --> 01:28:39.159
payer denies care, they must provide clear clinical criteria and

1055
01:28:39.279 --> 01:28:44.479
put a doctor to doctor conversation on the record. If

1056
01:28:44.479 --> 01:28:48.000
a denial is overturned on an appeal, the payer must

1057
01:28:48.359 --> 01:28:52.920
pay a financial penalty back to a patient protection fund.

1058
01:28:54.000 --> 01:28:57.000
You want to see a prior off games vanish overnight,

1059
01:28:57.720 --> 01:29:02.840
Start charging penalties for wrongful deny, and require the signatures

1060
01:29:02.840 --> 01:29:09.399
of actual physicians, not anonymous denial clerks. Doctors waste enormous

1061
01:29:09.479 --> 01:29:13.600
time re entering data, chasing records, faxing reports like as

1062
01:29:13.680 --> 01:29:16.920
nineteen eighty three. What we could do is mandate that

1063
01:29:17.000 --> 01:29:20.840
any system receiving federal dollars must be able to exchange

1064
01:29:20.880 --> 01:29:28.880
patient data through open APIs heavily fined vendors that information

1065
01:29:28.960 --> 01:29:32.960
block to protect their market share. Require that patients can

1066
01:29:33.000 --> 01:29:38.520
download their records in a simple, standardized format and share

1067
01:29:38.560 --> 01:29:43.640
them across systems. When information moves easily, administrative drag drops,

1068
01:29:44.279 --> 01:29:49.000
duplicate testing decrease, and care becomes cheaper and safer. We

1069
01:29:49.079 --> 01:29:54.079
cannot talk about the reform without talking about enforcement. Right now,

1070
01:29:54.199 --> 01:29:57.600
healthcare fraud is treated like a speeding ticket. You get

1071
01:29:57.640 --> 01:30:00.520
caught you pay a fine and you move on. That

1072
01:30:00.600 --> 01:30:04.039
has to end. Instead of waiting years to uncover schemes

1073
01:30:04.039 --> 01:30:07.760
that the government should be using serious tech, real time

1074
01:30:07.800 --> 01:30:12.880
claims and analytics that flag suspicious patterns, algorithms that spot

1075
01:30:13.000 --> 01:30:18.039
abnormal coding compared to peers, immediate holds on suspicious batches

1076
01:30:18.239 --> 01:30:24.079
for manual review, cross matching provider identities, bank accounts, and

1077
01:30:24.119 --> 01:30:28.760
physical locations to detect shell operations. I mean, we do

1078
01:30:28.840 --> 01:30:31.199
this in credit card fraud, We do it in banking.

1079
01:30:31.520 --> 01:30:35.800
We absolutely could do it in healthcare if we chose to.

1080
01:30:37.800 --> 01:30:41.960
That's the problem. We are choosing not to. When a

1081
01:30:42.000 --> 01:30:45.079
corporation or provider engages in fraud worth tens of millions

1082
01:30:45.439 --> 01:30:50.680
or more, the executives should face criminal charges, not just settlements.

1083
01:30:51.479 --> 01:30:56.199
Licenses should be revoked, not suspended. Entities convicted of major

1084
01:30:56.279 --> 01:30:59.760
fraud should be barred from billing Medicare and Medicaid for

1085
01:30:59.800 --> 01:31:04.800
a decade or more. If you steal from the American taxpayer,

1086
01:31:04.880 --> 01:31:07.520
you should not just write it off as a business expense.

1087
01:31:08.439 --> 01:31:11.199
We have to send a message healthcare fraud is not

1088
01:31:11.319 --> 01:31:15.000
a cost of doing business. It is a crime against

1089
01:31:15.039 --> 01:31:21.439
the American people, and we need to stop just sitting

1090
01:31:21.439 --> 01:31:25.840
here and allowing things like what's happening right now in

1091
01:31:25.880 --> 01:31:30.600
Minnesota to happen. We have a judge who overturned a

1092
01:31:30.720 --> 01:31:36.640
jury conviction because she thought that the evidence was just circumstantial.

1093
01:31:37.439 --> 01:31:43.079
But I'm sorry. If the jury looked at all that

1094
01:31:43.119 --> 01:31:46.319
evidence and decided that they need to be convicted, and

1095
01:31:46.359 --> 01:31:48.239
you just sat there and kind of gave them a

1096
01:31:48.239 --> 01:31:54.039
slap on the rest and overturned their conviction, you should

1097
01:31:54.039 --> 01:31:57.399
go to jail too, because there's got to be something

1098
01:31:57.600 --> 01:32:01.479
in your financials that is making you want to make

1099
01:32:01.520 --> 01:32:06.680
that decision. Because your jury had just deliberated for hours

1100
01:32:06.720 --> 01:32:11.319
and said no, a unanimous verdict has been reached and

1101
01:32:11.359 --> 01:32:13.800
we believe that these people need to go to jail.

1102
01:32:14.840 --> 01:32:17.760
But then you flip it. Some of the biggest fraud

1103
01:32:17.800 --> 01:32:22.640
cases have been exposed by insiders, nurses, coders, doctors, billers

1104
01:32:22.760 --> 01:32:25.319
who ask their careers just to tell the truth. We

1105
01:32:25.359 --> 01:32:28.600
need to make it easier to report fraud anonymously, safer

1106
01:32:28.640 --> 01:32:32.439
to come forward without retaliation, and more rewarding for those

1107
01:32:32.520 --> 01:32:40.319
who expose large scheme or large scale schemes. Bigger percentage

1108
01:32:40.359 --> 01:32:46.199
of recovery rewards, stronger legal shields, and fast track case processing.

1109
01:32:46.640 --> 01:32:49.239
If you want to stop fraud, you need an army

1110
01:32:49.279 --> 01:32:52.600
of insiders willing to blow the whistle. Now, imagine this

1111
01:32:53.840 --> 01:32:57.840
a public searchable website where you can see how much

1112
01:32:57.920 --> 01:33:02.479
every major provider builds Medicare, Medicaid, how much has been

1113
01:33:02.479 --> 01:33:06.680
clawed back for overpayments, and how much and how many

1114
01:33:06.680 --> 01:33:13.239
times they've been investigated, their settlement history, and how they

1115
01:33:13.279 --> 01:33:18.920
compare to similar institutions. Sunline is a powerful disinfectant. When

1116
01:33:18.960 --> 01:33:22.359
hospitals and ensurance know that taxpayers can see who's billing what,

1117
01:33:22.720 --> 01:33:25.520
how often they've been fined, and how much they're taking

1118
01:33:25.560 --> 01:33:30.159
from the government programs suddenly mistakes start to shrink. I

1119
01:33:30.199 --> 01:33:31.960
don't know how many times I've brought this up when

1120
01:33:32.000 --> 01:33:36.720
it comes to podcast about fraud, about abuse. The best

1121
01:33:36.720 --> 01:33:40.399
thing that you can do is transparency to the highest degree,

1122
01:33:40.720 --> 01:33:43.520
because all of the sudden, these people are too scared

1123
01:33:43.960 --> 01:33:47.079
to be doing the stuff they were doing for years.

1124
01:33:48.039 --> 01:33:53.039
Right now, most healthcare subsidies flow into insurance companies, hospital systems, intermediaries,

1125
01:33:53.159 --> 01:33:58.079
and state agencies. Very little is directed directly controlled by

1126
01:33:58.079 --> 01:34:00.800
the patient, and that has to change if we're going

1127
01:34:00.840 --> 01:34:04.600
to keep spending billions on health care. Help the money

1128
01:34:04.640 --> 01:34:09.880
should empower people, not trap them for non catastrophic everyday care.

1129
01:34:10.960 --> 01:34:15.239
We could do something radically simple. Fund tax advantaged health

1130
01:34:15.239 --> 01:34:19.039
accounts for low and middle income Americans, pair them with

1131
01:34:19.119 --> 01:34:24.960
high deductible catastrophic coverage from major events, and deposit subsidies

1132
01:34:25.000 --> 01:34:29.079
directly into those accounts instead of routing everything through insurers.

1133
01:34:29.520 --> 01:34:33.800
Allow patients to pay doctors, clinics, and pharmacies directly. This

1134
01:34:34.239 --> 01:34:39.119
cuts out administrative middleman, encourages price transparency, and lets patient

1135
01:34:39.239 --> 01:34:43.560
shop on price and quality. And it also rewards doctors

1136
01:34:43.560 --> 01:34:48.520
who run efficient, patient centered practices instead of those who

1137
01:34:48.560 --> 01:34:52.840
are inefficient who try to hide hide issues from the

1138
01:34:52.920 --> 01:34:55.880
patient and try to kind of work their way around

1139
01:34:55.920 --> 01:34:59.960
the system. Instead of drowning people in paperwork and networks

1140
01:35:00.159 --> 01:35:04.399
and formularies, we give them the ability to own their

1141
01:35:04.439 --> 01:35:09.600
care decisions. Direct primary care is a model where patients

1142
01:35:09.640 --> 01:35:12.600
pay a flat monthly fee to a primary care doctor

1143
01:35:12.680 --> 01:35:16.119
or clinic. There is no insurance billing, no coding games,

1144
01:35:16.279 --> 01:35:21.479
no prior off, just unlimited visits, messaging, and proactive care.

1145
01:35:22.239 --> 01:35:26.359
We could allow Medicaid and Medicare to pay a fixed

1146
01:35:26.640 --> 01:35:33.000
rate for these direct primary cares. Memberships were available where

1147
01:35:32.479 --> 01:35:38.079
they are available. Let the ACA subsidies be used for

1148
01:35:38.199 --> 01:35:45.439
plans that pair catastrophic coverage with DPC and reduce regulatory

1149
01:35:45.560 --> 01:35:49.960
barriers that keep small clinics from operating this way. This

1150
01:35:50.159 --> 01:35:54.520
model strips out massive amounts administrative waste and restores the

1151
01:35:54.600 --> 01:36:02.000
doctor patient relationship. We'd be foolish to keep pouring subsidies

1152
01:36:02.000 --> 01:36:05.439
into a system where no one knows what anything costs.

1153
01:36:08.279 --> 01:36:17.159
Real reform means hospitals providers must post real cash pay

1154
01:36:17.239 --> 01:36:23.359
prices online for standard services. Insurers must provide upfront cost

1155
01:36:23.520 --> 01:36:27.760
estimates for non emergency care. Failure to post or honor

1156
01:36:27.840 --> 01:36:31.800
prices results in heavy fines and clawbacks. When patients can

1157
01:36:31.840 --> 01:36:35.199
see prices, they can make choices. When they can make choices,

1158
01:36:35.319 --> 01:36:41.600
competition happens. When competition happens, we don't need as many subsidies.

1159
01:36:42.279 --> 01:36:44.800
We've talked about cutting back the administrative fat, we've talked

1160
01:36:44.840 --> 01:36:48.039
about cracking down a fraud with real teeth, and we've

1161
01:36:48.039 --> 01:36:51.600
talked about redirecting subsidies towards people instead of institutions. Now

1162
01:36:51.720 --> 01:36:57.479
let's talk about the two giants, Medicaid and Medicare, Because

1163
01:36:57.520 --> 01:37:00.039
if we're serious about fixing a system, we cannot i

1164
01:37:00.159 --> 01:37:02.560
tour around the programs that now touch one in three

1165
01:37:02.560 --> 01:37:07.119
Americans in some way, and if you want to talk

1166
01:37:07.119 --> 01:37:11.520
about it, it touches every single American because of all

1167
01:37:11.640 --> 01:37:14.199
the stuff that I talked about earlier, all the stuff

1168
01:37:14.239 --> 01:37:19.039
behind the scenes, and the way that medicare reimbursements and

1169
01:37:19.119 --> 01:37:24.800
Medicaid reimbursements affect pricing. Because if we're serious about fixing

1170
01:37:24.800 --> 01:37:29.560
the system, we need to look at these two. The

1171
01:37:29.640 --> 01:37:31.840
goal is not to rip the safety net away. The

1172
01:37:31.880 --> 01:37:34.319
goal is to reinforce it by cutting out the rot.

1173
01:37:35.680 --> 01:37:38.960
Let's start with Medicaid. Medicaid is supposed to protect children,

1174
01:37:39.000 --> 01:37:42.640
disabled Americans, low income families and seniors, and nursing homes.

1175
01:37:42.840 --> 01:37:46.720
Too often, it has become a budget gimmick, a political tool,

1176
01:37:46.960 --> 01:37:53.640
and a program, sorry, program that traps people instead of

1177
01:37:53.680 --> 01:37:59.760
lifting them. We can change that without abandoning the people

1178
01:38:00.039 --> 01:38:04.399
who truly need the help. Right now, states manipulate federal

1179
01:38:04.399 --> 01:38:08.720
matching formulas like it's a sport. If we're serious about reform,

1180
01:38:08.800 --> 01:38:11.960
we need to ban shell transactions that only exist to

1181
01:38:11.960 --> 01:38:17.000
trigger more federal dollars, Require that every supplemental payment match

1182
01:38:17.119 --> 01:38:23.359
documented care delivered to real patients, cap administrative recycling, tricks

1183
01:38:23.560 --> 01:38:28.800
between hospitals and state treasuries. This is what I discussed

1184
01:38:28.880 --> 01:38:33.640
in the previous podcast. That's that is called the California loophole.

1185
01:38:34.119 --> 01:38:40.520
They have. They use provider taxes and tax the hospitals

1186
01:38:40.560 --> 01:38:45.359
and Medicare and Medicaid providers into a loop because they

1187
01:38:45.359 --> 01:38:49.359
pull in the provider taxes, which then gets federal matching dollars,

1188
01:38:49.439 --> 01:38:52.119
and they just they then they provide a refund to

1189
01:38:52.159 --> 01:38:55.880
the hospital or a provider, and slowly you get this

1190
01:38:56.319 --> 01:39:05.840
continual circle of federal fund continually coming in audit states

1191
01:39:05.880 --> 01:39:09.960
regularly in clawback funds when they abuse the match. If

1192
01:39:09.960 --> 01:39:14.159
a state wants more Medicaid dollars, it should be because

1193
01:39:14.279 --> 01:39:17.399
real people are receiving real care, not because someone in

1194
01:39:17.399 --> 01:39:22.840
an office learned a clever accounting hack. We can protect

1195
01:39:22.840 --> 01:39:27.720
the vulnerable and still enforce basic responsibility. That means modernizing

1196
01:39:27.840 --> 01:39:32.560
eligibility checks using income and employment data already reported to

1197
01:39:32.600 --> 01:39:36.079
the tax agencies, cracking down a duplicate coverage and out

1198
01:39:36.119 --> 01:39:41.479
of state enrollment, requiring regular redetermination, but making the process clear,

1199
01:39:41.640 --> 01:39:47.920
simple and accessible. Allowing waivers for people with severe disabilities,

1200
01:39:48.119 --> 01:39:52.159
caretakers or unstable housing so they don't lose coverage due

1201
01:39:52.199 --> 01:39:56.199
to paperwork. We don't need to kick sick children off

1202
01:39:56.199 --> 01:39:58.920
of care. We do need to stop paying for people

1203
01:39:58.960 --> 01:40:04.039
who no longer qualify and never use the system. For

1204
01:40:04.159 --> 01:40:09.079
able bodied adults without dependence, Medicaid should be a hand up,

1205
01:40:09.640 --> 01:40:14.960
not a permanent hammock. Reasonable steps would be to tie

1206
01:40:14.960 --> 01:40:21.479
benefits for this group to work, job training or active

1207
01:40:21.840 --> 01:40:27.920
job search with flexibility for local conditions. Partner with employers

1208
01:40:27.920 --> 01:40:31.840
and community colleges to link Medicaid requirements to upskilling programs,

1209
01:40:32.239 --> 01:40:38.199
and offer temporary grace periods during recessions, illness, or caregiving emergencies.

1210
01:40:39.079 --> 01:40:42.000
This doesn't punish people, it invites them back into the

1211
01:40:42.039 --> 01:40:47.000
workforce and helps Medicaid be focused on the true need,

1212
01:40:47.680 --> 01:40:54.119
not long term unnecessary dependency. Instead of pouring everything into

1213
01:40:54.159 --> 01:40:59.079
giant hospital systems and managed care, insurers fund local clinics,

1214
01:40:59.359 --> 01:41:02.960
mobile healthy units, and community based practices that can see

1215
01:41:03.039 --> 01:41:07.279
patients at lower costs. Allows states to experiment with direct

1216
01:41:07.319 --> 01:41:12.359
primary care contracts for Medicaid populations, paying a flat amount

1217
01:41:12.359 --> 01:41:19.079
per person for unlimited basic care support, telehealth and underserved

1218
01:41:19.119 --> 01:41:23.239
areas with simple payment rules instead of a fifty different

1219
01:41:23.359 --> 01:41:28.199
billing requirements. The result better access, lower overhead and fewer

1220
01:41:28.520 --> 01:41:32.079
er visits for non emergencies. Now, let's talk about Medicare.

1221
01:41:33.319 --> 01:41:38.159
Medicare is a lifeline. Most seniors couldn't survive without it,

1222
01:41:38.279 --> 01:41:42.680
but the way it is currently structured, it is financially

1223
01:41:42.760 --> 01:41:51.119
unstable and easily abused. The goal is not to toss seniors overboard.

1224
01:41:51.399 --> 01:41:54.800
The goal is to keep the ship afloat without letting

1225
01:41:54.840 --> 01:41:59.640
fraudsters and corporations drill holes in the hole. We've talked

1226
01:41:59.680 --> 01:42:04.479
about how while Medicare advantage plans are profit by making

1227
01:42:04.560 --> 01:42:09.279
patients look sicker on paper, So real reform means tight

1228
01:42:09.399 --> 01:42:13.840
caps on year over year risk score increases that aren't

1229
01:42:13.880 --> 01:42:19.039
backed by objective medical evidence, independent clinical audits of high

1230
01:42:19.159 --> 01:42:23.680
risk coding clusters. A rule that Medicare advantage plans must

1231
01:42:23.800 --> 01:42:27.399
refund over payments when diagnoses are not backed by sustained

1232
01:42:27.399 --> 01:42:32.239
treatment or documented symptoms. Public reporting of risk score patterns

1233
01:42:32.239 --> 01:42:36.560
by insurers so citizens can see who's inflating the most.

1234
01:42:37.920 --> 01:42:41.359
If a Medicare advantage plans business model requires manipulating risk

1235
01:42:41.359 --> 01:42:44.560
scores to stay profitable, that plan doesn't belong in the

1236
01:42:44.560 --> 01:42:49.319
Medicare system Today, Medicare often pays more for the same

1237
01:42:49.439 --> 01:42:52.800
service if it's done in a hospital owned facility instead

1238
01:42:52.840 --> 01:42:59.560
of an independent clinic. This encourages hospital monopolies, physician practice buyouts,

1239
01:42:59.680 --> 01:43:03.800
and inflated facility fees. Reform means paying the same amount

1240
01:43:03.880 --> 01:43:06.159
for a given service regardless of whether it is on

1241
01:43:06.159 --> 01:43:10.319
a hospital outpatient department or a free standing clinic, unless

1242
01:43:10.319 --> 01:43:14.079
there is a true medical justification for the difference. Same service,

1243
01:43:14.600 --> 01:43:20.119
same reimbursement. That one change could reduce incentives for hospital consolidation,

1244
01:43:21.199 --> 01:43:27.880
lower Medicare costs, and keep more independent practices alive. Now,

1245
01:43:27.880 --> 01:43:31.079
we need to rationalize the benefit design in the metagap.

1246
01:43:33.359 --> 01:43:39.640
Seniors currently navigate part A, B, C, and D with

1247
01:43:39.800 --> 01:43:44.119
a meta gap supplemental plus a mess of premiums, deductibles,

1248
01:43:44.119 --> 01:43:47.720
and co insurances that some people believe make no sense.

1249
01:43:49.039 --> 01:43:53.439
This confusion creates openings for predatory marketing, bad plan choices,

1250
01:43:53.560 --> 01:43:58.000
and under utilization of high value care. We could streamline

1251
01:43:58.119 --> 01:44:04.399
traditional Medicare cost sharing into a similar simple single deductible

1252
01:44:04.800 --> 01:44:08.760
and co insurance pattern. Cap auto pocket costs in original

1253
01:44:08.800 --> 01:44:14.680
Medicare not just an advantage, standardize meta gap further to

1254
01:44:14.760 --> 01:44:20.439
prevent gaming confusing variations. When people actually understand their coverage,

1255
01:44:20.680 --> 01:44:24.439
they use it more wisely and scammers have fewer shadows

1256
01:44:24.520 --> 01:44:28.199
that they can hide in Medicare can lead the way

1257
01:44:28.279 --> 01:44:34.600
on simplification, Reduce documentation requirements for retuned routine low risk care,

1258
01:44:35.720 --> 01:44:41.199
expand automatic approvals for preventative services and pilot programs where

1259
01:44:41.199 --> 01:44:46.840
physicians in good standing get lighter audit burdens in exchange

1260
01:44:46.840 --> 01:44:50.800
for transparent outcome reporting. Reward the good actors and hammer

1261
01:44:50.840 --> 01:44:54.920
the bad ones. That's how you reform without strangling everyone

1262
01:44:54.960 --> 01:44:58.680
in red tape. Now, the next part is critical. Reform

1263
01:44:58.800 --> 01:45:01.880
has to answer the question, if we cut waste, if

1264
01:45:01.920 --> 01:45:04.920
we cut fraud, if we cut bureaucracy, what happens to

1265
01:45:04.920 --> 01:45:08.199
the savings, Because if the money just disappears into another

1266
01:45:08.239 --> 01:45:12.279
federal black hole, people will stop listening. So let's be

1267
01:45:12.359 --> 01:45:17.119
clear about how reclaimed dollars should be used should be

1268
01:45:17.239 --> 01:45:21.000
used for direct tax relief for working families. If we

1269
01:45:21.119 --> 01:45:24.159
recover tens or hundreds of billions of dollars each year

1270
01:45:24.199 --> 01:45:27.760
from fraud and waste, a significant portion should go straight

1271
01:45:27.800 --> 01:45:30.039
back to the people who paid it in the first place.

1272
01:45:31.039 --> 01:45:34.359
That could mean reducing payroll tax burdens related to medicare,

1273
01:45:35.640 --> 01:45:41.039
expanding the standard deduction, cutting marginal rates at the middle

1274
01:45:41.039 --> 01:45:46.159
income levels, and offering healthcare cost credits to families below

1275
01:45:46.239 --> 01:45:51.880
certain income thresholds. When citizens see that fighting corruption directly

1276
01:45:51.880 --> 01:45:54.720
lowers their tax bill, they start demanding more of it.

1277
01:45:55.840 --> 01:45:58.720
Another portion of the savings should strengthen the safety net

1278
01:45:58.800 --> 01:46:02.880
for people who genuinely cannot fend for themselves, children with

1279
01:46:03.000 --> 01:46:07.479
complex medical needs, people with severe disabilities, frail seniors with

1280
01:46:07.520 --> 01:46:11.640
no family support, veterans dealing with catastrophic injuries or service

1281
01:46:11.680 --> 01:46:15.520
related illness that might look like fully funding home and

1282
01:46:15.560 --> 01:46:19.279
community based care slots so vulnerable people don't get stuck

1283
01:46:19.319 --> 01:46:25.880
on waiting lists, improving provider payments for specific high need

1284
01:46:25.920 --> 01:46:31.880
populations to ensure access, simplifying waivers for families caring for

1285
01:46:32.039 --> 01:46:35.920
severely disabled loved ones at home. We're not cutting compassion

1286
01:46:36.279 --> 01:46:41.560
or making sure compassion stops getting stolen. Some savings should

1287
01:46:41.600 --> 01:46:45.039
go downward and not upward. Grants the local clinics that

1288
01:46:45.359 --> 01:46:51.279
actually serve patients instead of building marble lobbies. Seed funding

1289
01:46:51.479 --> 01:46:55.399
for independent pharmacy care or primary care practices and pharmacies

1290
01:46:55.680 --> 01:46:59.600
and shortage areas. Investments in mental health and addiction programs

1291
01:46:59.600 --> 01:47:04.960
account to local boards instead of distant agencies. The more

1292
01:47:05.000 --> 01:47:08.159
we push resources closer to communities, the harder it is

1293
01:47:08.199 --> 01:47:11.720
for DC bureaucracy and the national level fraud rings to

1294
01:47:12.159 --> 01:47:16.600
hijack them. If we sum up every reform tonight into

1295
01:47:16.640 --> 01:47:20.239
one simple idea, it should be this, America needs compassion

1296
01:47:20.279 --> 01:47:25.039
without corruption. We can defend medicaid and demand it stop

1297
01:47:25.079 --> 01:47:30.039
overpaying for fake risk scores, protect medicaid and demand states

1298
01:47:30.119 --> 01:47:36.720
stop playing shell games. Help working families with subsidies and

1299
01:47:36.760 --> 01:47:41.960
redesign them to empower, not trap, Support doctors and hospitals,

1300
01:47:42.199 --> 01:47:45.359
and force them to operate in a transparent, honest way.

1301
01:47:46.479 --> 01:47:51.239
It is not cruel to help and want to demand accountability.

1302
01:47:51.680 --> 01:47:56.000
It is heartless to demand, not heartless to demand efficiency.

1303
01:47:56.319 --> 01:47:59.439
It is not anti poor to demand that the system

1304
01:47:59.720 --> 01:48:06.039
meant to help the poor aren't robbing them blind. In fact,

1305
01:48:07.439 --> 01:48:10.880
the most compassionate thing we can do is to make

1306
01:48:10.880 --> 01:48:15.479
sure money meant for the vulnerable actually reaches them. Every

1307
01:48:15.520 --> 01:48:18.239
dollar stolen in fraud is a dollar that doesn't help

1308
01:48:18.680 --> 01:48:22.079
a child get insulin, a senior afford their heart medication,

1309
01:48:22.680 --> 01:48:26.680
a veteran get mental health care, or a low income

1310
01:48:26.760 --> 01:48:30.960
mom get prenatal visits. Corrush isn't in an accounting problem,

1311
01:48:30.960 --> 01:48:37.239
it's a moral problem. Now can we ever reduce subsidies?

1312
01:48:39.720 --> 01:48:43.279
So we've laid out the reforms. We've talked about the

1313
01:48:43.359 --> 01:48:47.000
simplifying the HYDRA, we've talked about crushing fraud, We've talked

1314
01:48:47.000 --> 01:48:50.920
about redirecting money towards people in relief. The next question

1315
01:48:51.000 --> 01:48:53.960
is the hardest. Can America ever move towards a system

1316
01:48:54.000 --> 01:48:59.039
with fewer subsidies without abandoning people who genuinely need to help?

1317
01:49:00.880 --> 01:49:04.800
Right now, seniors depend on Medicare, working families depend on

1318
01:49:04.880 --> 01:49:10.520
ACA subsidies, nursing homes depend on Medicaid, and hospitals depend

1319
01:49:10.560 --> 01:49:13.279
on all of it. We can't just flip a switch.

1320
01:49:13.319 --> 01:49:16.359
We can't pretend these programs don't exist. We can't yank

1321
01:49:16.439 --> 01:49:19.159
the rug out from under tens of millions of people.

1322
01:49:20.359 --> 01:49:23.439
But we also can't ignore the math. We can't ignore

1323
01:49:23.439 --> 01:49:27.079
the debt, we can't ignore the demographics. We can't ignore

1324
01:49:27.159 --> 01:49:31.039
the reality that we're marching towards a wall. So in

1325
01:49:31.039 --> 01:49:34.359
the final segment, we're gonna wrestle with a big, uncomfortable

1326
01:49:34.399 --> 01:49:38.520
truth and the necessary question, is there a way to

1327
01:49:38.560 --> 01:49:45.199
gradually rebalance the system, reduce subsidy dependence and increase personal

1328
01:49:45.319 --> 01:49:49.279
and community power, and do it without hurting the very

1329
01:49:49.319 --> 01:49:53.239
people these programs were designed to protect. We'll talk about

1330
01:49:53.279 --> 01:49:55.359
what we can't do, what we must do, and how

1331
01:49:55.359 --> 01:49:59.199
a soft landing reform path might look. We'll explore whether

1332
01:49:59.239 --> 01:50:03.359
a reduce subsidy model is possible and what it takes

1333
01:50:03.359 --> 01:50:09.439
for a morally impractic impractically acceptable because the goal is

1334
01:50:09.479 --> 01:50:13.279
not to abandon Americans. The goal is to free them.

1335
01:50:15.600 --> 01:50:20.479
We've gone deep tonight. We've exposed the distortion of subsidies.

1336
01:50:21.680 --> 01:50:25.680
We've walked through the administrative hydra We've dragged out frauded

1337
01:50:25.720 --> 01:50:30.680
abuse into the light. We've laid out real, concrete reforms

1338
01:50:30.880 --> 01:50:34.439
that could make this system smaller, cleaner, and more honest.

1339
01:50:35.720 --> 01:50:37.920
Now we step into the hardest part of the conversation,

1340
01:50:38.479 --> 01:50:41.520
the part that makes people uncomfortable, the part that separates

1341
01:50:41.520 --> 01:50:46.800
political theater from serious leadership. The question is this, can

1342
01:50:46.840 --> 01:50:50.800
America ever move toward a system with fewer subsidies without

1343
01:50:50.840 --> 01:50:53.600
harming the very people though subsidies were meant to protect?

1344
01:50:54.039 --> 01:50:58.359
Because right now, let's be honest, seniors heavily dependent on

1345
01:50:58.439 --> 01:51:03.119
Medicare hospitals to depend on government reimbursement, nursing homes depend

1346
01:51:03.159 --> 01:51:08.039
on Medicaid to survive. Millions of families depend on ACA subsidies,

1347
01:51:08.159 --> 01:51:13.840
State budgets depend on federal matching dollars. This isn't about politics.

1348
01:51:13.840 --> 01:51:17.319
It's about how we've built the entire healthcare economy and

1349
01:51:17.399 --> 01:51:20.359
we cannot pretend to just rip it out all by

1350
01:51:20.399 --> 01:51:24.520
the roots and just walk away. So tonight I'm gonna

1351
01:51:25.000 --> 01:51:29.359
I'm not trying to sell you a fantasy. I'm not

1352
01:51:29.359 --> 01:51:32.279
gonna tell you we'll just abolish all the subsidies next

1353
01:51:32.319 --> 01:51:38.159
year and magically everything's gonna just work out. That's not serious,

1354
01:51:39.159 --> 01:51:44.880
that's not moral, that's not conservative conservatism. Conservativism is about

1355
01:51:45.680 --> 01:51:49.359
ordered liberty, not reckless chaos. It's about reform with a

1356
01:51:49.479 --> 01:51:55.359
spine and conscience. So let's walk through this carefully. First,

1357
01:51:56.520 --> 01:51:59.119
we have to say what we cannot do. We cannot

1358
01:51:59.119 --> 01:52:01.399
walk into the system with a machete, hack away the

1359
01:52:01.399 --> 01:52:05.239
subsidies overnight, in the clear victory. Why Because a senior

1360
01:52:05.279 --> 01:52:07.960
living on thirteen hundred dollars a month cannot afford private

1361
01:52:07.960 --> 01:52:12.079
insurance at full market price. A child with leukemia cannot

1362
01:52:12.119 --> 01:52:15.800
wait for a ten year market transition. A low income

1363
01:52:15.800 --> 01:52:20.279
mother working two jobs cannot suddenly absorb full medical costs

1364
01:52:20.520 --> 01:52:25.640
for her family. Nursing homes would collapse if Medicaid disappeared tomorrow.

1365
01:52:26.079 --> 01:52:29.760
Entire rural hospitals would shut their doors. If we simply

1366
01:52:30.000 --> 01:52:33.960
slashed subsidies with no plan, eers would be flooded the

1367
01:52:34.000 --> 01:52:37.760
people who lost coverage. Hospitals would close in vulnerable areas,

1368
01:52:37.920 --> 01:52:42.920
People with serious conditions would fall through cracks. The poor,

1369
01:52:43.279 --> 01:52:47.600
the elderly, the disabled, the exact people these programs were

1370
01:52:47.640 --> 01:52:50.960
meant to protect, would suffer the most. And that is

1371
01:52:51.000 --> 01:52:54.520
not what we're fighting for. Our goal is not cruelty.

1372
01:52:54.840 --> 01:52:57.680
Our goal is correction. Our goal is to not punish

1373
01:52:57.720 --> 01:53:01.159
people for the broken system that they didn't Our goal

1374
01:53:01.239 --> 01:53:05.399
is to fix the system so people aren't trapped in it. So, no,

1375
01:53:06.159 --> 01:53:09.840
we can't cut and run, but that doesn't mean we're

1376
01:53:10.000 --> 01:53:14.199
stuck here forever. Now. On the other side of that

1377
01:53:14.239 --> 01:53:17.000
hard truth is another one that's just as real. We

1378
01:53:17.119 --> 01:53:21.199
also cannot sustain this forever. We cannot keep spending trillions

1379
01:53:21.199 --> 01:53:25.079
of dollars on healthcare, watching our debt climb, watching interest

1380
01:53:25.119 --> 01:53:29.760
payments swallow the budget, watching fraud explode, watching subsidies grow

1381
01:53:29.840 --> 01:53:35.079
faster than the economy itself, while pretending we can definitely

1382
01:53:35.119 --> 01:53:40.520
borrow from the future. Demographics are shifting, the population is aging,

1383
01:53:40.720 --> 01:53:50.199
Fewer workers are supporting more retirees, and eventually the math

1384
01:53:50.239 --> 01:53:55.199
stops working because chronic diseases are rising, health costs are

1385
01:53:55.239 --> 01:53:58.600
outpacing growth. And when that happens, one of two things

1386
01:53:58.680 --> 01:54:02.920
will occur. Either we'll choose to gradually reform the system,

1387
01:54:03.000 --> 01:54:06.680
rebalance it, and build something more sustainable, or we'll wait

1388
01:54:06.720 --> 01:54:10.520
till the system buckles and reforms are forced on us

1389
01:54:10.800 --> 01:54:15.800
in a crisis, sudden cuts, chaotic rationing, emergency tax hikes,

1390
01:54:15.960 --> 01:54:20.880
and pain for the most vulnerable. We cannot pretend that

1391
01:54:21.600 --> 01:54:27.760
the cliff is not coming. Or we can build a

1392
01:54:27.960 --> 01:54:35.399
softer landing. Now that's the choice. If we're serious about

1393
01:54:35.439 --> 01:54:41.399
moving forward and towards a reduced subsidy model without harming patients,

1394
01:54:41.600 --> 01:54:45.239
we need something like a soft landing strategy, not a crash,

1395
01:54:45.479 --> 01:54:50.279
not a revolution, a controlled descent into a more balanced model.

1396
01:54:50.880 --> 01:54:55.359
But what does that look like? Think in phases, not

1397
01:54:55.479 --> 01:54:59.640
flip switches. Before we reduce subsidies, we clean up the

1398
01:54:59.680 --> 01:55:04.600
system they flow through. That means slash administrative waste, shrink

1399
01:55:04.640 --> 01:55:09.119
coating complexity, crack down on fraud, with real enforcement, shut

1400
01:55:09.159 --> 01:55:14.479
down abusive risk score gaming, clean up medicaid match loopholes,

1401
01:55:15.039 --> 01:55:20.760
build transparency into every dollar spend. You do this for

1402
01:55:20.840 --> 01:55:25.039
two reasons. It proves to the American people that government

1403
01:55:25.159 --> 01:55:30.720
is serious about stewardship, not just austerity. It frees up

1404
01:55:30.760 --> 01:55:35.119
money not by hurting people, but by firing the thieves

1405
01:55:35.159 --> 01:55:39.520
in the paper pushers. If a household is in financial trouble,

1406
01:55:39.600 --> 01:55:42.920
you don't start by starving the kids. You start by

1407
01:55:42.960 --> 01:55:47.600
canceling the waste and stopping the theft. Government should do

1408
01:55:47.640 --> 01:55:53.079
the same. They run it like they're a household with

1409
01:55:53.159 --> 01:55:58.479
an infinite borrowing capacity. But I don't know of a

1410
01:55:58.560 --> 01:56:02.239
single house, and I don't care if it's our whole

1411
01:56:02.279 --> 01:56:09.359
country that has infinite borrowing capacity, I just don't. As

1412
01:56:09.399 --> 01:56:12.720
we reclaim billions from fraud and waste, we don't just

1413
01:56:12.840 --> 01:56:16.880
let it vanish into the ether. We begin shifting power

1414
01:56:17.159 --> 01:56:23.159
from institutions to individuals, from bureaucracies to communities. This looks

1415
01:56:23.239 --> 01:56:28.680
like expanding direct primary care options, funding personalized health accounts

1416
01:56:28.680 --> 01:56:33.399
for low and middle income people, supporting community clinics and

1417
01:56:33.520 --> 01:56:39.520
local health services, and requiring transparent prices so people can

1418
01:56:39.600 --> 01:56:45.880
actually shop. The goal is to build alternatives alongside existing

1419
01:56:46.000 --> 01:56:52.439
subsidy systems so people have real choice. In other words,

1420
01:56:52.920 --> 01:56:56.319
we don't push people off the government dock into open water.

1421
01:56:56.720 --> 01:57:02.680
We build the boats first. Alternatives exist. Once waste is reduced,

1422
01:57:03.239 --> 01:57:05.880
and once we've proven that we can manage money better,

1423
01:57:07.039 --> 01:57:10.079
then we start to rebalance the subsidies over time, not

1424
01:57:10.199 --> 01:57:13.359
by ripping them away from the vulnerable, but by gradually

1425
01:57:13.439 --> 01:57:18.600
lightening and tightening the eligibility for wealthier households, reducing perverse

1426
01:57:18.760 --> 01:57:23.840
incentives for overuse, and capping open ended commitments that fuel inflation,

1427
01:57:24.840 --> 01:57:28.520
encouraging people who stand on their own to do so,

1428
01:57:28.640 --> 01:57:33.520
while preserving and strengthening help for those who truly cannot,

1429
01:57:34.840 --> 01:57:38.760
for example, phasing down ACA subsidies for higher income tax

1430
01:57:38.840 --> 01:57:44.279
brackets as premiums start to stabilize, slowly tightening Medicaid expansion

1431
01:57:44.560 --> 01:57:49.239
for able bodied adults while linking them to work training

1432
01:57:49.520 --> 01:57:58.000
or other employer programs. Encouraging Medicaid or Medicare advantage reforms

1433
01:57:58.039 --> 01:58:01.920
that push plans towards true value and transparency instead of

1434
01:58:02.079 --> 01:58:06.560
endless bonus payouts. We're not shutting the door, We're narrowing

1435
01:58:06.600 --> 01:58:12.199
the opening so that people most in need remain front

1436
01:58:12.279 --> 01:58:17.640
and center. Now, let's paint a picture, not a utopia,

1437
01:58:17.840 --> 01:58:21.159
not a fantasy, a plausible version of the future where

1438
01:58:21.159 --> 01:58:25.079
subsidies still exists but don't dominate every corner of the system.

1439
01:58:25.720 --> 01:58:30.279
Imagine a world where a young family can find a

1440
01:58:30.319 --> 01:58:35.079
transparent cash price for a pediatric visit and can pay

1441
01:58:35.119 --> 01:58:38.680
it directly using a health account funded from by their

1442
01:58:38.720 --> 01:58:43.640
own contribution, plus a targeted government match if they're lower income.

1443
01:58:45.520 --> 01:58:50.399
A world where seniors can choose between simplified traditional Medicare

1444
01:58:50.600 --> 01:58:53.399
with a real out of pocket cap and a cleaned

1445
01:58:53.439 --> 01:58:57.640
up Medicare advantage system that cannot gain the numbers. A

1446
01:58:57.720 --> 01:59:01.199
world where hospitals know the be paid the same whether

1447
01:59:01.199 --> 01:59:05.439
they own the clinic or not, so they stop gobbling

1448
01:59:05.520 --> 01:59:10.000
up practices just to charge facility fees. A world where

1449
01:59:10.000 --> 01:59:14.680
Medicaid patients can see a primary care doctor without direct

1450
01:59:14.720 --> 01:59:20.920
primary care memberships, instead of waiting months for an in

1451
01:59:20.960 --> 01:59:26.359
network appointment. A world where mental health services are funded

1452
01:59:26.399 --> 01:59:30.920
through local, accountable organizations with clear outcomes not buried inside

1453
01:59:31.000 --> 01:59:36.560
opaque state contracts. A world where fraudulent providers know that

1454
01:59:36.600 --> 01:59:40.119
if they try to game risk scores or build for

1455
01:59:40.199 --> 01:59:42.800
fake equipment, there's a high chance they'll go to prison

1456
01:59:42.880 --> 01:59:47.279
and lose every dollar. In that world, we might still

1457
01:59:47.319 --> 01:59:51.680
have Medicare, Medicaid and targeted subsidies, but they're leaner, cleaner,

1458
01:59:51.840 --> 01:59:56.720
and better monitors. Citizens would have more non governmental options

1459
01:59:56.760 --> 01:59:59.880
and direct purchasing power. The role of subsidies would be

1460
02:00:00.079 --> 02:00:02.760
to catch people when they fall, not to control the

1461
02:00:02.880 --> 02:00:09.840
entire healthcare marketplace. That's not an overnight transformation. That's a

1462
02:00:09.880 --> 02:00:14.560
decade or two of serious reform. But is it possible. Yes,

1463
02:00:15.600 --> 02:00:19.199
if we're willing to be adult about it. Any talk

1464
02:00:19.239 --> 02:00:25.880
about reducing subsidies has one answer, one moral answer to

1465
02:00:25.960 --> 02:00:30.119
a moral question, what happens to the person who can't

1466
02:00:30.159 --> 02:00:34.319
make it without them? Because behind every debate about entitlements

1467
02:00:34.319 --> 02:00:37.760
and spending and subsidies are real lives. The grandma with

1468
02:00:37.800 --> 02:00:40.640
congestive heart failure, the single dad with a disabled child,

1469
02:00:40.880 --> 02:00:44.640
the veteran with PTSD and no steady job, the factory

1470
02:00:44.640 --> 02:00:48.640
worker with cancer who lost employer coverage, the rural family

1471
02:00:49.000 --> 02:00:52.680
whose only hospital is on the brink. If our reforms

1472
02:00:52.720 --> 02:00:56.840
don't account for them, we've lost the plot. So here's

1473
02:00:56.840 --> 02:00:59.680
the standard we should hold. We never reduce subsidies faster

1474
02:00:59.720 --> 02:01:03.760
than we can can increase access to non subsidized affordable options.

1475
02:01:04.079 --> 02:01:08.119
We never cut support for people with severe disabilities, catastrophic illness,

1476
02:01:08.439 --> 02:01:12.720
or no realistic path to self sufficiency unless we are

1477
02:01:12.720 --> 02:01:17.039
replacing it with something better. We tie subsidy reduction directly

1478
02:01:17.279 --> 02:01:22.720
to visible winds, lower premiums, lower taxes, clearer prices, and

1479
02:01:22.920 --> 02:01:27.039
stronger local care networks. If we do it that way,

1480
02:01:27.239 --> 02:01:33.000
we're not abandoning people. We're leading them step by step

1481
02:01:33.560 --> 02:01:38.479
out of a system that has dropped them. This isn't

1482
02:01:38.520 --> 02:01:42.920
about budgets. This is about who we are as a country.

1483
02:01:43.800 --> 02:01:47.520
Do we want a nation where bureaucracy stands between people

1484
02:01:47.520 --> 02:01:50.520
and the care that they need, where fraudsters thrive, where

1485
02:01:50.560 --> 02:01:56.079
complexity crushes small providers, where families feel powerless, or a

1486
02:01:56.159 --> 02:02:00.359
nation where systems are simple enough to be understood. Coruption

1487
02:02:00.439 --> 02:02:03.359
is hunted down instead of tolerated, power is closer to

1488
02:02:03.399 --> 02:02:07.039
the people, and subsidy programs are tight, clean and targeted

1489
02:02:07.439 --> 02:02:12.119
instead of sprawling and uncontrollable. Do we want a culture

1490
02:02:12.159 --> 02:02:16.039
where I can't survive unless the government does X, or

1491
02:02:16.119 --> 02:02:20.960
one where it's like, I'm grateful for the safety net,

1492
02:02:21.159 --> 02:02:24.520
but I also have tools, options, and a system that

1493
02:02:24.600 --> 02:02:27.000
lets me stand on my own two feet whenever possible.

1494
02:02:28.159 --> 02:02:31.520
The truth is, we always have subsidies. We always have

1495
02:02:31.640 --> 02:02:36.000
some safety net. That's not weakness, that's civilization. But the

1496
02:02:36.079 --> 02:02:39.319
question is do subsidies exist to empower people or to

1497
02:02:39.399 --> 02:02:44.399
control them? Do we exist as a narrow bridge over

1498
02:02:44.479 --> 02:02:48.560
hard times or as a permanent cage people are never

1499
02:02:48.600 --> 02:02:51.199
allowed to leave. Right now, too much of our healthcare

1500
02:02:51.239 --> 02:02:53.479
system is the cage. Too much of it is controlled.

1501
02:02:53.560 --> 02:02:56.720
Too much of it is corruption, clothes, and compassion. We

1502
02:02:57.000 --> 02:03:00.000
can do better. Let's be honest. None of these reforms

1503
02:03:00.079 --> 02:03:03.600
happen if citizens don't demand them. Politicians will always find

1504
02:03:03.640 --> 02:03:07.279
it easier to promise more subsidies, ignore fraud, kick the

1505
02:03:07.319 --> 02:03:11.279
debt down the road, and accuse anyone who talks about

1506
02:03:11.279 --> 02:03:16.880
reform of hating the poor or abandoning seniors. Corporations will

1507
02:03:16.920 --> 02:03:20.800
always lobby to keep the game tilted in their favor.

1508
02:03:21.880 --> 02:03:25.960
States will always resist losing free federal money. Bureaucracies will

1509
02:03:26.000 --> 02:03:30.560
always resist simplification. So what does it take Voters who

1510
02:03:30.600 --> 02:03:32.680
are willing to say I want a system that works,

1511
02:03:33.279 --> 02:03:36.800
not one that just spends more. Seniors who say, protect

1512
02:03:36.840 --> 02:03:40.079
my care, but stop rewarding companies that rip off Medicare

1513
02:03:40.359 --> 02:03:44.399
in my name, working families who say help is good,

1514
02:03:44.760 --> 02:03:48.960
but I also want transparency, choice in lower prices, so

1515
02:03:49.039 --> 02:03:52.760
I'm not dependent forever doctors and nurses who say we're

1516
02:03:52.840 --> 02:03:56.760
none being data entry clerks for a corrupt system, and

1517
02:03:56.840 --> 02:04:00.560
we want reform, It's going to take curve, it's going

1518
02:04:00.640 --> 02:04:04.800
to take patience, it's gonna take a willingness to look

1519
02:04:04.840 --> 02:04:07.920
beyond sound bites and slogans. But if we do that,

1520
02:04:08.159 --> 02:04:11.800
if we start telling the truth about subsidies, waste, fraud, bureaucracy,

1521
02:04:12.079 --> 02:04:16.920
and if we tie reform to real results like lower costs,

1522
02:04:17.199 --> 02:04:23.920
simpler care, and stronger communities, then yes, American move toward

1523
02:04:24.119 --> 02:04:29.239
a reduced subsidy healthcare model without leaving people behind. Not

1524
02:04:29.399 --> 02:04:33.159
by slashing the safety night, but by fixing the holes

1525
02:04:33.680 --> 02:04:39.399
in the net and building more solid ground under people's feet.

1526
02:04:41.199 --> 02:04:45.439
We've talked through the fire tonight. We looked honestly at

1527
02:04:45.479 --> 02:04:47.800
what subsidies do right and what they do wrong. We've

1528
02:04:47.880 --> 02:04:52.079
exposed administrative hydra and the subsidy gold rush. We've talked

1529
02:04:52.119 --> 02:04:54.239
about the reforms that could clean up this mess, and

1530
02:04:54.279 --> 02:04:57.680
we've wrestled with whether this country can ever grow beyond

1531
02:04:57.720 --> 02:05:00.640
the level of dependency that we see today. The answer

1532
02:05:00.760 --> 02:05:05.880
is yes, if we choose. In the closing, we're going

1533
02:05:05.960 --> 02:05:08.439
to bring this home. We're going to talk about what

1534
02:05:08.520 --> 02:05:11.720
it means, not just for policy, but for us as Americans,

1535
02:05:11.960 --> 02:05:13.800
for how we treat one another, for how we are

1536
02:05:14.000 --> 02:05:16.520
we hold our leaders accountable, and for how we build

1537
02:05:17.000 --> 02:05:19.199
trusted a system that has lost so much of it.

1538
02:05:20.199 --> 02:05:22.279
Because at the end of the day, this isn't about

1539
02:05:22.359 --> 02:05:26.119
numbers on a spreadsheet. It's about the people. It's about dignity,

1540
02:05:26.439 --> 02:05:28.880
it's about the kind of country that we want to be.

1541
02:05:30.560 --> 02:05:34.880
We've covered a lot of ground Medicare, Medicaid, ACA subsidies,

1542
02:05:35.279 --> 02:05:41.840
the administrative hydra that is those programs, fraud, abuse, corruption,

1543
02:05:42.319 --> 02:05:47.000
real reforms, hard questions about whether we can move toward

1544
02:05:47.920 --> 02:05:52.000
fewer subsidies without hurting people. But before we end, I

1545
02:05:52.039 --> 02:05:54.520
want to pull this back to the back out of

1546
02:05:54.560 --> 02:05:57.960
the policy beads and place it where it belongs, right

1547
02:05:57.960 --> 02:06:00.920
in the middle of the American heart, because this isn't

1548
02:06:00.920 --> 02:06:03.880
about programs, if this isn't about charts and budgets, this

1549
02:06:03.960 --> 02:06:08.039
is about you, your family, your parents, your kids, your

1550
02:06:08.039 --> 02:06:10.520
neighbor down the street who can't afford their medication, the

1551
02:06:10.640 --> 02:06:14.039
nurse who's exhausted, the doctor who's drowning in paperwork, the

1552
02:06:14.079 --> 02:06:16.720
small town hospital that is hanging on by a thread.

1553
02:06:17.039 --> 02:06:20.439
This is about what kind of country we want to be.

1554
02:06:21.840 --> 02:06:26.359
Let's say something clearly. Government subsidies are not evil by nature.

1555
02:06:26.560 --> 02:06:29.720
They were created to help to make sure citizens were

1556
02:06:29.760 --> 02:06:34.119
senior citizens weren't abandoned, to make sure poor children aren't

1557
02:06:34.199 --> 02:06:37.960
left without care, to make sure people with disabilities don't

1558
02:06:38.000 --> 02:06:41.159
fall through the cracks, and to make sure that families

1559
02:06:41.159 --> 02:06:47.479
can survive a diagnoses that would otherwise financially destroy them.

1560
02:06:48.279 --> 02:06:53.359
Those motives matter, that compassion matters, that desire to protect

1561
02:06:53.399 --> 02:06:57.720
the vulnerable matters. But good intentions do not grant a

1562
02:06:57.800 --> 02:07:01.720
free pass to bad outcomes. And right now, the way

1563
02:07:01.760 --> 02:07:06.199
our subsidy system works, too often it hurts the very

1564
02:07:06.239 --> 02:07:10.399
people is meant to help. Not because poor the poor

1565
02:07:10.479 --> 02:07:14.399
or lazy, not because seniors are greedy, and not because

1566
02:07:14.439 --> 02:07:19.000
families are entitled, but because we have allowed fraud, abuse,

1567
02:07:19.199 --> 02:07:23.359
and bureaucracy to wrap themselves around these programs like vines

1568
02:07:23.399 --> 02:07:27.119
around a house, until the structure itself started to crack.

1569
02:07:28.479 --> 02:07:32.199
We allowed complexity to become a shield. We allowed corruption

1570
02:07:35.600 --> 02:07:38.479
to become routine, and we allowed waste to become normal.

1571
02:07:39.159 --> 02:07:43.680
We allowed powerful interests to feed on programs meant for

1572
02:07:43.760 --> 02:07:48.119
the powerless, And then we wondered why cost gip rising,

1573
02:07:49.119 --> 02:07:54.039
why access kept shrinking, and why trust keeps collapsing. Here's

1574
02:07:54.079 --> 02:07:57.319
the truth. America does not need less compassion. America needs

1575
02:07:57.399 --> 02:07:59.960
less corruption. We don't need to care less about people,

1576
02:08:00.039 --> 02:08:02.920
but we need to care more about what is being

1577
02:08:02.960 --> 02:08:05.920
done in their name. If we kicked out fraudstres, if

1578
02:08:05.920 --> 02:08:09.840
we cut down the administrative jungle, if we shut off

1579
02:08:09.880 --> 02:08:13.800
the subsidy gold rush and demanded honesty from every hospital,

1580
02:08:14.079 --> 02:08:18.039
every insure, every agency, every state, we would have more

1581
02:08:18.079 --> 02:08:21.039
than enough to protect a vulnerable and give working families

1582
02:08:21.239 --> 02:08:25.119
room to breathe. We could lower taxes so you keep

1583
02:08:25.119 --> 02:08:29.039
more of what you earn. We could cut premiums so

1584
02:08:29.079 --> 02:08:32.640
you're not choosing between coverage and groceries. We could strengthen

1585
02:08:32.680 --> 02:08:36.760
targeted help for people who genuinely cannot stand on their own.

1586
02:08:38.159 --> 02:08:40.760
We could build a healthcare system that serves people instead

1587
02:08:40.760 --> 02:08:45.479
of systems serving itself. I want you to hear this.

1588
02:08:45.479 --> 02:08:50.119
This fight is not Republican versus Democrat. This fight is

1589
02:08:50.239 --> 02:08:55.119
honest American versus the machine. The machine says that don't

1590
02:08:55.159 --> 02:08:58.000
ask where all this money goes, just continue to send more.

1591
02:08:58.840 --> 02:09:03.560
The machine punishes transparency and rewards complexity. The machine treats

1592
02:09:03.640 --> 02:09:07.279
patients like billing units, providers like data entry clerks, and

1593
02:09:07.359 --> 02:09:10.680
taxpayers like an endless ATM. You and I, we're not

1594
02:09:10.720 --> 02:09:12.520
on the side of that machine. We are on the

1595
02:09:12.560 --> 02:09:16.439
side of the senior who wants doctors wants to see

1596
02:09:16.439 --> 02:09:19.439
her doctor without getting ten different bills, The single mom

1597
02:09:19.520 --> 02:09:22.600
who wants her child's asthma medication without a four week

1598
02:09:22.640 --> 02:09:26.159
prior authorization battle. The nurse who wants to care for

1599
02:09:26.319 --> 02:09:31.239
patients instead of clicking boxes all night long. The business

1600
02:09:31.239 --> 02:09:34.840
owner who wants to offer health coverage without bleeding out financially.

1601
02:09:35.880 --> 02:09:38.560
The taxpayer who's willing to help their neighbor but it's

1602
02:09:38.600 --> 02:09:42.800
tired of watching crooked siphon off half the pot. That's

1603
02:09:42.800 --> 02:09:45.399
who we're fighting for. So what do we do with

1604
02:09:45.479 --> 02:09:48.560
everything we've talked about tonight? We refuse to accept the

1605
02:09:48.640 --> 02:09:53.680
lie that is just how it is. We refuse to

1606
02:09:53.720 --> 02:09:57.880
accept that fraud is inevitable, that waste is inevitable, that

1607
02:09:57.960 --> 02:10:03.359
corruption is inevitable. We start demanding simpler systems, transparent prices,

1608
02:10:03.720 --> 02:10:09.079
real time fraud detection, criminal charges for large scale theft,

1609
02:10:09.600 --> 02:10:13.079
less money to bureaucracies, more money to people, subsidies that

1610
02:10:13.159 --> 02:10:17.600
empower not in prison. We start demanding leaders who talk

1611
02:10:17.720 --> 02:10:21.640
like grownups, will tell us that the truth about what

1612
02:10:21.840 --> 02:10:24.359
needs to be cleaned up, instead of buying votes with

1613
02:10:24.439 --> 02:10:28.600
promises that they know the country cannot afford. We start

1614
02:10:28.600 --> 02:10:32.960
demanding courage from our representatives, and we show some courage ourselves.

1615
02:10:34.439 --> 02:10:36.920
Talk to your friends, talk to your family, Ask your

1616
02:10:36.920 --> 02:10:39.720
doctor what they deal with behind the scenes. Look into

1617
02:10:39.800 --> 02:10:43.640
the data, follow the money, ask questions. Refuse to be

1618
02:10:43.720 --> 02:10:49.359
numbed by the complexity. Because corruption thrives on silence. It

1619
02:10:49.439 --> 02:10:52.319
thrives on confusion. It thrives when people throw up their

1620
02:10:52.319 --> 02:10:55.039
hands and say it's too big. I can't understand it.

1621
02:10:55.479 --> 02:10:59.239
You don't have to understand every code, every statute. You

1622
02:10:59.399 --> 02:11:02.520
just have to enough to say no more, clean it up,

1623
02:11:02.720 --> 02:11:05.640
make it simple, make it honest, make it human again.

1624
02:11:06.199 --> 02:11:08.760
At the end of the day, this is still our country,

1625
02:11:09.039 --> 02:11:11.840
not the government's country, not the corporation's country, not the

1626
02:11:11.880 --> 02:11:17.520
frauster's country. It is our country. We can say what

1627
02:11:17.600 --> 02:11:20.359
we need to because we still have a say we

1628
02:11:20.399 --> 02:11:22.680
still have a voice, we still have the power to

1629
02:11:22.680 --> 02:11:26.720
demand better. We can build a system where seniors are protected,

1630
02:11:26.720 --> 02:11:29.600
the poor or not forgotten, the disabled are cared for,

1631
02:11:29.960 --> 02:11:33.800
Families can thrive, doctors can practice real medicine, nurses can

1632
02:11:33.800 --> 02:11:36.840
focus on people, and taxpayers can look at their paycheck

1633
02:11:37.079 --> 02:11:40.560
and feel like the sacrifice actually means something. We can

1634
02:11:40.600 --> 02:11:43.880
build a system where compassion is real and corruption is unacceptable.

1635
02:11:44.600 --> 02:11:47.199
So as we close the night, remember this healthcare isn't

1636
02:11:47.239 --> 02:11:50.159
just about numbers. It's about dignity. It's about how we

1637
02:11:50.199 --> 02:11:53.239
treat the sick, the weak, the aging, the struggling. It's

1638
02:11:53.279 --> 02:11:56.119
about how whether or not we let a bloated, dishonest

1639
02:11:56.159 --> 02:11:59.239
system define us, and whether we stand up and say

1640
02:11:59.439 --> 02:12:03.680
we're America. We fix what's broken, We protect the vulnerable,

1641
02:12:03.920 --> 02:12:07.239
We demand accountability, We don't give up on each other.

1642
02:12:08.079 --> 02:12:10.880
We can heal this system. We can heal this country

1643
02:12:11.800 --> 02:12:16.239
not by spending this endlessly, but by spending wisely. Not

1644
02:12:16.279 --> 02:12:21.159
by expanding bureaucracy, but by expanding honesty and freedom. Not

1645
02:12:21.239 --> 02:12:24.000
by turning away those in need, but by making sure

1646
02:12:24.039 --> 02:12:33.159
that we help promise actual care. That's the fight, that's

1647
02:12:33.159 --> 02:12:36.680
the mission. And if we continue telling the truth, if

1648
02:12:36.720 --> 02:12:40.640
we keep pushing for reform, if we refuse to let

1649
02:12:40.680 --> 02:12:43.680
corruption wear a mask of compassion, then one day we

1650
02:12:43.720 --> 02:12:45.760
will look back and say we turn the system of

1651
02:12:45.800 --> 02:12:49.319
dependency and waste into a system of dignity and responsibility.

1652
02:12:49.720 --> 02:12:52.039
We didn't walk away from our people. We fought for

1653
02:12:52.119 --> 02:12:55.520
them and we won because at the end of the day,

1654
02:12:55.720 --> 02:13:00.119
we are still one nation under God with a responsibility

1655
02:13:00.159 --> 02:13:04.159
to each other. And I believe, no matter how broken

1656
02:13:04.199 --> 02:13:07.439
this healthcare system looks right now, we are capable of

1657
02:13:07.520 --> 02:13:11.760
doing what's right. Thank you guys for listening. Don't forget

1658
02:13:12.159 --> 02:13:14.439
to check out the social links below. Don't forget to

1659
02:13:14.520 --> 02:13:18.239
check out seek get Sequence dot Io forward slash P

1660
02:13:18.359 --> 02:13:22.680
two s or Valorbuilt dot us forward slash P two s.

1661
02:13:23.840 --> 02:13:27.680
Those links are also in the comments below. Don't forget

1662
02:13:27.680 --> 02:13:29.920
to check them out, and thank you for being part

1663
02:13:29.920 --> 02:13:36.399
of America that refuses to surrender to corruption and chooses

1664
02:13:36.439 --> 02:13:39.560
instead to fight for the healing. We can do this,

1665
02:13:39.800 --> 02:13:43.920
We can do this together. It's this is not a

1666
02:13:43.960 --> 02:13:47.840
fight of republican versus democrat, as I've said before, this

1667
02:13:47.920 --> 02:13:52.640
is a public This is a public fight for what

1668
02:13:52.800 --> 02:14:00.279
is necessary because we cannot continue to endlessly borrow and

1669
02:14:00.439 --> 02:14:09.960
endlessly subsidize just for it to be abused. Because the

1670
02:14:10.000 --> 02:14:13.039
one thing you need to think about is if we

1671
02:14:13.079 --> 02:14:16.960
continue to borrow and borrow and borrow, eventually our borrowing

1672
02:14:17.039 --> 02:14:18.880
is gonna run out, and then all of a sudden,

1673
02:14:18.960 --> 02:14:21.800
it just comes down to what can we afford to

1674
02:14:21.840 --> 02:14:26.039
subsidize now? And do you think that our politicians are

1675
02:14:26.119 --> 02:14:29.880
going to want to subsidize poor people, are going to

1676
02:14:29.880 --> 02:14:36.239
subsidize aging seniors. No, they're gonna want to subsidize the

1677
02:14:36.279 --> 02:14:42.800
middle ground where it's their constituents, the people that they

1678
02:14:42.880 --> 02:14:49.439
know will vote. That's who they're gonna pay to help.

1679
02:14:52.239 --> 02:14:55.720
It's time we wake up America. It's time we cut spending,

1680
02:14:56.439 --> 02:15:02.600
cut some subsidization down without leaving people to veend for

1681
02:15:02.680 --> 02:15:08.680
themselves and still allow for compassionate care and compassionate help

1682
02:15:08.920 --> 02:15:13.079
from one another. I hope you guys enjoyed this podcast.

1683
02:15:13.079 --> 02:15:14.920
I know it was a long one two hours and

1684
02:15:15.000 --> 02:15:17.359
fifteen minutes. I think is my longest podcast I've done

1685
02:15:17.439 --> 02:15:20.520
so far, But I hope that you guys now have

1686
02:15:20.560 --> 02:15:26.800
an understanding of why our medical system needs reformed. We're

1687
02:15:26.840 --> 02:15:29.560
going to cover in the next podcast is going to

1688
02:15:29.600 --> 02:15:32.880
be another medical podcast, but this actually breaks down subsidization

1689
02:15:33.319 --> 02:15:36.840
within hospitals, so stay tuned for that one, and I

1690
02:15:36.880 --> 02:15:38.920
hope you guys have a great night. Thank you guys

1691
02:15:38.960 --> 02:15:41.880
for watching. Don't forget to follow the socials, don't forget

1692
02:15:41.920 --> 02:15:48.439
to leave a rating on Apple Podcasts or Spotify or both.

1693
02:15:48.520 --> 02:15:50.119
And don't forget to share this with a friend or

1694
02:15:50.119 --> 02:15:52.840
a family member who might want to be able to

1695
02:15:52.840 --> 02:15:57.000
hear this who might might have questions about Medicare fraud,

1696
02:15:57.079 --> 02:16:01.960
Medicaid fraud, the ACA subsidy fraud, all of it. Share

1697
02:16:02.000 --> 02:16:06.600
the podcast, guys, I appreciate it. Have a good night,

1698
02:16:06.720 --> 02:16:10.000
have a good day, get out there and cut some ass.