When my wife was hit with a sky-high deductible after a routine procedure, it brought home the stark reality of medical debt in America. This episode, featuring the veteran insights of retired insurance broker and author Robert Hertz, shines a light on the $220 billion albatross of medical debt weighing on the shoulders of Americans - a crisis that doesn't spare even those with "good" insurance. Join us as we reveal the personal and systemic challenges of navigating healthcare costs, from unexpected emergency room charges to the pitfalls of billing errors.
The healthcare system can often feel like a maze, but with Robert Hertz' expertise, we plot a course through the complexities of insurance subsidies and cost-effective medical service alternatives. We delve into the intricacies of documenting interactions with healthcare providers, the benefits of the Affordable Care Act, and the burgeoning world of telehealth and low-cost imaging centers. Our conversation is a must-listen for anyone looking to arm themselves with the knowledge to contest overcharges and make informed decisions about their healthcare coverage.
Finally, our discussion takes a critical turn as we scrutinize the trustworthiness of health-sharing companies, contrasting them with the regulated, taxpayer-funded bastions of Medicare and Medicaid. By examining healthcare systems across the globe, we uncover the contrasts and lessons that can be gleaned from international models. For anyone grappling with medical bills or seeking to understand the broader healthcare landscape, this episode is packed with invaluable insights from Robert's book "Social Insurance vs Medical Darwinism" and his blog theantidetagenda.com.
For Current and Previous Podcast Episodes, Show Notes, and Videos go to www.MedicalTruthPodcast.com
You can also find the Medical Truth Podcast on Facebook, Twitter, YouTube, Rumble, and Substack, as well as all the major podcast platforms such as Apple Podcast, Spotify, Google Podcast, Amazon Music, iHeart, and Podchaser
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Intro (00:01):
Get ready to hear the truth, the whole truth and
nothing but the truth about theUnited States healthcare system
With your host of the MedicalTruth Podcast, James Egidio.
James Egidio (00:17):
Hi, I'm James with the Medical Truth Podcast.
Welcome, I'm your host.
A CIP survey suggests thatpeople in the United States owe
at least $220 billion in medicaldebt.
Approximately 14 million people, or 6% of adults in the United
States, owe over $1,000 inmedical debt and about 3 million
(00:38):
people, or 1% of adults, owemedical debt of more than
$10,000.
My guest is an expert and wrotea book on medical debt titled
Social Insurance versus MedicalDarwinism.
It's an honor and a pleasure tohave on the Medical Truth
Podcast my guest, mr RobertHertz.
Robert, how are you doing, sir?
(01:00):
Very good.
Thank you very much, jim.
Absolutely, absolutely.
For the listeners and viewersof the Medical Truth Podcast, a
little bit about who you are andwhat you do, or what you did.
Robert Hertz (01:12):
Okay, I am a retired insurance broker living
in Minnesota and I used to sellhealth insurance and you might
say I saw the sausage being made, the things you don't want to
see being made.
One of them is legislation, theother is sausage.
I was on the inside of thehealth insurance schemes and
(01:33):
scams Not all.
I tried to advise clients toavoid them.
But I learned a lot about theindustry and since then I've
devoted myself to writing ondifferent approaches public and
private, to reduce medical debtand student debt.
But we're talking medical debttoday Medical debt.
James Egidio (01:51):
I'm sure you've seen a lot happen in the last
few years with COVID, I'm surewith when it comes to medical
debt correct.
Robert Hertz (01:58):
COVID had less of an impact than I expected.
One reason is that thegovernment gave extra money to
hospitals and told them not tocharge full to patients who came
in on an emergency basis.
The government didn't want thespectacle of some poor older
person tumbling in and oftendying from COVID and then their
heirs being slapped with a bigbill.
(02:18):
The pandemic, or COVID, had alittle less impact, but the
other impacts remain and in somerespects are getting worse now.
James Egidio (02:27):
What are some of the contributing factors as to
why people get into medical debt?
I guess that could be prettymuch an obvious question.
No, it's a very good question.
Robert Hertz (02:37):
The main thing that gets people into medical
debt is deductibles and or noinsurance.
The number of people with noinsurance has been shrinking
since the Affordable Care Act.
It's shrunk by almost 20million, and that's a great
achievement.
Even with the Affordable CareAct and with employer coverage,
many people have a deductiblethat at the low end might be
(02:57):
$500.
Hardly anybody has a deductiblethat low again and at the high
end can be $7,000 and maybe10,000 per family.
What that means is that if yougo into a hospital, you pay the
first $5,000 or $7,000 of thebill yourself, and many people,
for right or wrong, don't have$5,000 or $7,000 in a savings
(03:20):
account, and so, presto, they'rein debt.
James Egidio (03:23):
Yeah, I know my wife recently experienced that
she was going to go to aphysician for a procedure and
the deductible when she walkedout of the office was like
$3,000.
So it wasn't something that hadto be done right away.
The procedure $3,000.
Well, it's too tough yeah.
(03:44):
And she's a school teacher andsupposed to have good insurance
here in Florida.
I would think so.
Robert Hertz (03:50):
Maybe she could change plans next year.
James Egidio (03:52):
but I'm on your side.
They take a lot out of hercheck already, so it would be
even more so.
It's really criminal in a way,but I know we had this visual on
how medical debt starts whensomeone, let's say, accepts
medical care, goes for medicalcare.
Here's a listing of some of it,and I guess doctor visits and
(04:15):
diagnostic tests are up to aboutwhat?
65% according to this statistichere.
Robert Hertz (04:21):
And this is valuable information.
But what I am pretty sure of isthat the 65 and other
percentage refer to the percentof claims that resulted in debt,
and not always the amount.
The largest debts tend to beemergency room visits.
In other words, if you owe yourdoctor $200, that's no fun but
(04:41):
you can live with that.
But if you owe the emergencyroom $20,000 due to insurance
problems or just weak insurance,that's a bigger challenge to
debt.
What I'm trying to say is andI've worked with an organization
that collects information onmedical debt called RIP, medical
debt and our research showsthat the average debt might be
(05:01):
$100, and people can live withthat, but the debts at the high
end are pretty scary.
James Egidio (05:06):
Yeah, so you say emergency rooms.
What about surgeries?
Robert Hertz (05:10):
Yeah, so surgeries might be on the outpatient.
The surgeries in some cases canbe planned for maybe not three
years but a couple of years, andpeople can assemble some
resources or get a commitment ofhelp in advance.
The emergency room visits andthe emergency surgeries.
Nothing can be done.
James Egidio (05:31):
Yeah, because that's a situation where it's
just an emergency.
So, when it comes to medicaldebt, who bears the burden?
Let's say in the United States,since it's a very good question
.
Robert Hertz (05:43):
It is diverse.
I think a better way to answerit is first I'll tell you who
doesn't bear the burden and thenwe'll get to who does.
Who doesn't bear the burden arepeople, like me, on Medicare,
medicare.
The maximum debt on part A ofMedicare is $185 a year.
Part B you can have higherdebts.
It depends on whether you buywhat's called Medicare Advantage
(06:03):
or Medicare Supplements, andthat's an important discussion.
But I don't want to slow usdown.
People on Medicare don't beardebt Depends for drugs, although
that has improved.
The Biden administration passedsome new rules on prescription
drug coverage that have reducedmedical debt for seniors.
The second group of people whodon't bear medical debt are
people on Medicaid, which is thefederal and state program for
(06:26):
people with low income who don'thave any other health insurance
.
Low income generally meansunder $18,000 for a person,
under $35,000 for a family, soit's pretty low.
It keeps people out of medicaldebt because they would
generally be hopeless in tryingto pay off the debt.
The third group of people whodon't experience much medical
(06:47):
debt are those diminishingnumbers with what you might call
Cadillac insurance a $500deductible or very little co
-insurance, which is a relateddeductible.
Those plans used to be the normwhen I started selling
insurance, and even as recentlyas, say, 2010, 2012, 2013,.
But those plans are diminishingdue to the cost of premiums and
(07:11):
some minority people.
The fourth group that doesn'texperience medical debt is what
I might call the gamblers, andthere's a lot of them.
The gamblers are people whodon't have an employer plan, or
the employer plan is superexpensive, and so they say this
year I'm going to start off, I'mpretty healthy, I'm going to go
uninsured, or I might buy theskimpiest I don't blame them the
skimpiest medical temporaryplan.
(07:33):
There are what's calledtemporary medical insurance, and
the gambling is that I won'tget sick Right, get by car, and
three years out of four theymight win the gamble if they
start off healthy, but in thefourth year they might get
walloped.
So those are the people whodon't experience much debt.
The rest of them, it's a grabbag of who has high deductible
and loaded up with coverage andget sick during the year.
(07:54):
So who bears the burden then?
Oh, it's a good question.
The burden is on the patientand they have some choices.
If you would like me to getinto this, I'd be happy to Sure,
absolutely.
James Egidio (08:04):
We have a lot of time.
Robert Hertz (08:06):
The patient or I saw the patient has a bill and
it's $10,000 and they don't havethe money.
What can they do?
The first thing they can do isto contact the provider.
Don't try to run away.
The provider will catch up toyou.
And don't call the insurancecompany because in many cases
they've already made theirdetermination and we might come
back to them.
But at first you got to contactthe provider and explain to them
(08:28):
that this is the way theinsurance has shaken out and you
don't have the lump sum, nor doyou have an income which will
allow you to pay it, say, infour months.
And providers are used tohearing this and, between you
and I, they mark up their billsin expecting for some of this to
happen.
Yeah, and in some cases theprovider will agree to a monthly
payment plan that you can livewith.
(08:50):
Now maybe that's 200 months,and so after a year you would
have paid off $3,000 and theymight forgive the rest.
So the first, when you'rebearing the burden, the first
person is don't assume it's setin stone, don't assume it cannot
be improved.
Now, some providers arehardnails.
They'll say I've got acollection agency on speed dial,
we're going after you.
But that isn't all of them?
(09:11):
Yeah, so the first thing to doif you're bearing the burden is
to contact the provider and seeif they're willing to
accommodate.
I did that once when one of mysons had an emergency room visit
and they had a procedure, aprotocol all set and they sent
me out a lot of paperwork and Iprovided copies of my son's
paychecks so they could verifyhow much he made, I think.
(09:32):
I might even have to provide atax return, but I didn't have to
pay anything, nor did he, whilethis protocol was being
reviewed, and at the end theygave it they forgave it so they
forgave the entire amount.
Yeah, I think so, maybe allabout $250.
James Egidio (09:46):
Wow.
So when you say the provider,now there's a difference between
being render, having medicalservices rendered through a
doctor at a doctor's office,which is considered outpatient,
and then someone gets treated ata hospital.
So let's say, for instance, Iget rushed to the hospital for
an appendectomy surgery, right,and the final bill is $20,000,
(10:10):
which sounds about right?
Yes, it does, yeah.
And so I come back home after,let's say, two or three days in
the hospital becauseappendectomy is anymore,
probably a short stay in ahospital and I get the bill what
, maybe three or four weekslater, for $20,000.
Yes, so as a patient, what canI do if I have no insurance?
Robert Hertz (10:31):
If you have no insurance, the first step is to
contact the hospital financialaid department, and here's why
the Affordable Care Act in 2012,2013, 2014 included a provision
not widely known about thatsays if you have no insurance,
your bill must be discounted ifyou have a modest income.
Now, if your income was$200,000, and you were just a
(10:52):
gambler to fluck but that's notthe case with very many people
so if your income was $50,000,and you had no insurance, the
hospital aid department mightcut the $50,000 and a half.
Now, that's not the whole story, but it helps.
Might cut it even further.
And they don't announce this inbig letters.
They're certainly not a sign inthe ER saying if you have
(11:13):
trouble with your bill, call us.
It doesn't happen, Dr Michael A.
James Egidio (11:16):
No.
Robert Hertz (11:16):
Dr Michael A, the Affordable Care Act has that
provision.
Now let's go a step further.
Individual states have beenadding to this call this
emergency discount program forthe last seven or eight years.
By adding to it they mightstretch the dollar income
eligibility a little higher.
There's one case where there'sone state I think it might be
(11:38):
Maryland or New Jersey where youcan make up to $80,000 a year
and still get a discountedmedical bill.
It may not be wholly forgiven,but it would be discounted If
you've gone through all thosesteps and the bill is not some
ludicrous bill like $200,000,which we can talk about, but if
it's within their normal range.
Again you ask for the monthlypayment.
(11:59):
If even the monthly payment isunachievable, your last resort
would be to declare bankruptcy.
That costs about $2,000, but itwipes out medical bills and it
stays on your record.
But if you're not going to workon a bank or work for the
federal government, many I can'tsay a number, but some
employers will not, especiallyif they know why you were
bankrupt will not place a bar onyou for employment, which is
(12:22):
what people are scared of.
James Egidio (12:24):
Dr Michael A yeah, yeah, and you'll end up getting
more.
After declaring bankruptcycredit cards.
For some reason or another,they miraculously start to get
it.
Robert Hertz (12:32):
You can't declare again for another two years.
They got you where they wantyou, dr.
James Egidio (12:35):
Michael A Okay, so then you mentioned something
about, let's say, a bill like$200,000 or more.
Let's say you get diagnosedwith cancer or something.
The bill could run up to even amillion dollars.
$200,000 to a million what doyou do in that case?
Dr Michael A, the hospital willnormally back down.
Robert Hertz (12:53):
They put that number out there because they
don't necessarily know what.
I'm diversioning a little bit,but I think it's important to
know why they would bill thatmuch.
One reason is that they don'tknow especially if it's a rush
treatment case how good yourinsurance is, and so they throw
that number out there becauseyou might have an insurance
company that'll pay it, but thenumber sits out there and maybe
(13:13):
your insurance company won't payit or you have no insurance and
so it's staring you in the face.
And if they won't back down,what I recommend to people is
that they what I call go public,go to your local newspaper and
say what a hardship this is andtell the hospital you're doing
it, and I've seen situationsthat I've talked to people who
are in the business gettingmedical debt reduced.
(13:35):
The hospital may come back witha financial package before it
even hits the newspaper.
They hate that publicitybecause it exposes them in some
cases of being real hard-nosedsons of bees, and they might
incur greater supervision by thegovernment, and so it's a lot
easier for them to just cut theamount back and shut you up.
James Egidio (13:54):
You did mention about calling the insurance
provider, or even the providerthemselves, the doctor's office
or the hospital the billingdepartment at the hospital, for
that matter.
But why is it important todocument every call that you
make?
Robert Hertz (14:09):
That's a very good question.
In some cases it's because of achain of command issue.
If someone who represents theinsurance company is on the
phone and you ask them $20,000bill, doesn't my coverage better
than that?
And they say that was for youremergency epidectomy.
And you say it wasn't emergency, it was planned and it was
moderated a little bit.
And they say, oh gosh, let melook at the claim again, because
(14:30):
insurance companies aren'tperfect and nor are hospitals.
They could have submitted theclaim.
People don't know that ahospital bill because there are
so many of them every day, amajor hospital has to send out a
thousand bills a day.
It's based on codes.
They are based on numeric codesand the code might be for
appendectomy, 3407b, but all itwould take was a human being, a
(14:52):
little sloppy or just tired atthe end of the day, to put in
30407, which has a $20,000 cost.
So the first thing, the reasonto call the provider and the
insurance companies, first ofall insurance see what the
insurance company even askedthem for, the code, what code?
Resulted in a 20-thousand billand once in a while they'll say
it was code 3407B.
Then you call the provider.
It's a lot of work but it's alot of money and there are
(15:14):
people who will assist you for amodest cost in making these
calls.
Anyways, you call the providerand they say it was just I'm
making this up it was just foran appendectomy ultrasound and
that's $278, which has a cost of$5,000.
You just saved $15,000.
Since, redocument everything.
James Egidio (15:31):
Yeah, and then you also mentioned that good to be
a nuisance with these people.
Robert Hertz (15:36):
Everybody knew what I knew, in which you're now
.
They wouldn't get away with theoutrageous bills they sometimes
send and they would have toaccept more government oversight
even to apply with existinglaws.
There have been surveys done ofcharitable care cases and they
sometimes find that hospitalsjust ignored the affordable care
act rules.
They just sent everybody the$20,000 bill which, according to
(15:58):
the Affordable Care Act,because it's extra work for them
, they have to ask you what yourincome is like.
They did for my son's situation.
They have to verify the income.
It costs them money.
They have to hire not a lot ofmoney, but they have to hire.
Maybe what?
Two or three extra people at$45,000 each.
It's a chunk of change.
James Egidio (16:15):
They resist doing it and so that's where the
nuisance factor comes in, I seeSomething really interesting too
is my sister recently called upFlorida Blue, which is the Blue
Cross Blue Shield provider herein Florida.
She's not currently working,she's teaching.
She's a school teacher.
She's not teaching right now,so her income's gone down quite
(16:36):
a bit.
But we were on the phone, wewere having a conversation not
long ago and she said somethingabout only having to pay $97 a
month for Florida Blue insurance, which is almost like a
complete coverage.
It covers everything.
I said why are you paying sucha small amount?
And she says because what theytold her on the phone is
something to do with the taxcredit based on the Affordable
(16:58):
Care Act.
What does that mean?
Robert Hertz (17:00):
That's a very good question.
If you go through theAffordable Care Act, which
usually means you don't haveemployer coverage, in fact you
can't have employer coverage,Right, If you go through the
Affordable Care Act.
There's a two-step process andit's a real blessing.
The greatest thing about theAffordable Care Act is called
the subsidy, and I'm going to gothrough it because that maybe
(17:22):
was really happening to yoursister.
James Egidio (17:23):
That's exactly what it was.
Robert Hertz (17:25):
Okay, you go through the Affordable Care Act,
the two-step process.
They calculate the insurancepremium which you might call the
gross premium, what theinsurance company would charge
just based on your age and thecoverage that you want.
Then they look at your annualincome and the total premium is
generally maxed out at 8% ofyour income.
(17:45):
So if your income was $1,000 amonth because you were part-time
or because you just had a reallow-paying job, the insurance
premium you have to pay for a$600 policy is $8 of $12,000,
which happens to be about 96bucks a month.
My math isn't perfect, but yousee where I'm going.
(18:05):
Through the Affordable Care Act, your insurance premium is
capped at a percentage of yourincome.
So there are people, there aresome improvements to the
Affordable Care Act.
There are hundreds of thousandsof people today walking around
with pretty decent insurance andpaying zero.
It's a long story of how thathappens.
James Egidio (18:23):
Sure, on the flip side of that, I'm not eligible
for that type of insurance.
I went with what's called theSHARE program, so I'm using
what's called Metashare.
I know there's a couple otherdifferent programs out there.
I pay like three years awayfrom collecting Medicare
eventually at some point ateither 63 or 65.
(18:44):
It's 65.
It's five, it's about fouryears away from that.
And so what I did is I resortedto what's called Metashare for
$200 a month.
Now I'm like on the.
I look at it like being on thegambler side of what you
illustrated earlier, where I'lluse that for anything
catastrophic.
(19:04):
And the way I do it personallywith getting covered for
anything else is let's say, forinstance, I want to use
telehealth services for, let'ssay, a common cold or seasonal
allergies or something I needfor an infection or something to
get an antibiotic.
I'll use a telehealth serviceand pay out of pocket for under
(19:25):
$100 a month.
With Metashare it's free.
And then, when it comes toimaging studies, I found low
cost imaging companies.
Yeah, a company called SimonMedical, which is a national
company, nationwide SimonMedical.
I think it ultrasounds like $35.
Intro (19:43):
And the reason why I know about yeah.
James Egidio (19:44):
And the reason why I know about Simon Medical is
because I, when I had a medicalpractice I had owned a medical
practice.
It was a low cost fee forservice practice, so I was
finding all the bargains for allthe patients.
I can remember saving a patientover $10,000.
I saved her over $200,000 on asurgery for, yeah, acetabulum
(20:08):
hip reconstruction, and I workedout an agreement with the
orthopedic surgeon and this wasin Vegas when I lived there and
had the practice there, and thesurgery was $10,000.
But that's but on a smallerscale.
Another patient who spent over$3,000 in an emergency room to
(20:30):
be diagnosed with diabetes.
I was able to save that patient.
Oh my gosh, like it cost Idon't know $300 total with lab
work and everything.
Doctors visit prescriptionsBecause you made a stink no, not
even because I made a stink,because I had the resources with
the lab.
Ah, I see that's a much cheaperalternative.
(20:51):
Yes, a much, much cheaperalternative.
The medical industry itself isthe cost is so high and so
inflated, and this is, I think,one of the reasons why I
personally believe we're havingan issue with medical debt in
this country.
For that reason, even SimonMedical MRI is like $250
(21:12):
compared to $2,500.
Yeah, the hospital markups areterrible.
Yeah, even at an imaging centeroutside of, let's say, simon
Medical not a hospital MRI orCAT scan, but in an imaging
center they're like $2,500.
Sure.
Robert Hertz (21:29):
And the hospitals go around buying these providers
so they can charge that amount.
James Egidio (21:33):
Yeah, yeah, and these are services for uninsured
or underinsured patients.
A lot of these services, andeven lab work too.
Lab work is very expensive.
Again, I was able to savepatients on a female complete
blood panel thyroid and a CBCcomplete blood count.
It was costing us out of pocketabout maybe dollars and we
(21:57):
would charge the patient about$125.
Robert Hertz (22:00):
I respect what you did.
One of the big challenges andI'm sure you might have heard of
this is that sometimes thepatient and I was a patient last
year, I had a surgery last yearsometimes a patient is weakened
, they're tired, maybe they'vebeen through the surgery and
they haven't got the gumption orthe self-confidence to say to
(22:20):
the doctor that complete bloodcount which I know I need.
Why don't I go down the streetand I'll have the results in two
days and mail it to you?
It's so easy and because I'vehad good insurance, it's easy
for me.
It's so easy to say, all right,what's next?
Do the blood count?
And so good for you that youhad that.
But the one-stop shopping thing, which is what hospitals sell,
(22:40):
is pretty tempting.
James Egidio (22:41):
Yeah, we drew the blood right at the office so it
wasn't even a problem for apatient to get their routine
blood work done at the office.
When they came in I drew theblood for a mail.
It was a complete blood countCBC, tsh, testosterone and a PSA
for prostate-specific antigenblood test.
Now normally those tests therewould go for right around $1,500
(23:05):
to $2,000 for all that lab workand I was charging $175.
Robert Hertz (23:12):
Wow.
James Egidio (23:13):
Yeah, I had that practice for about 10 years.
Yeah, I operated that practicefor about 10 years, In fact.
Actually in 2000, I wrote abook called Learn how to Start a
Cash Only Medical Practice.
It was marketed towardsphysicians, Right right, yeah.
And it was outside of theconcierge model.
Because the concierge modelsays, okay, if you pay the
(23:35):
doctor, I don't know $4,000 ayear or you get everything.
Yeah, it's not that you'll justget everything, You'll have the
accessibility to that physician.
But physicians are not going tobe accessible 24 hours a day,
seven days a week.
After a while they're going toget tired of that type of
accessibility for someone whosneezes and calls the doctor at
(23:56):
three or four o'clock in themorning.
But so my question to you isgetting back to these share
programs what's your take onthose?
Robert Hertz (24:05):
I had done some reading on it and when I was in
the insurance business up tillabout five years ago, I went to
some seminars and had someexposure, and so the information
on my opinions might beoutdated, but I don't think they
are, because I haven't beenclose to them in the last few
years.
The main thing is that they areuneven, and by uneven there are
(24:26):
plans which are ethical andhonest and will.
If you have a claim, it will besubmitted to the group as a
whole, which I believe is whatyou're referring to and other
people will share in the expensebecause you'll do the same for
them, and it's a fine idea.
There have been companies notall by any means.
If I went on to Google, I couldfind the one of the worst ones.
There are companies where thefounders just kept all the money
(24:48):
, that all the premiums you paid, just went into their pockets
and they bought big cars and bighouses, and when it came time
to get others to contribute,they did nothing.
They're not very regulated,which is maybe a blessing in
some ways, but it means that you, the buyer, really have to kick
the tires, maybe ask for,describe a claim you made
recently and so on or that youpaid recently.
And if they've got a list of 20of them, I think you're in good
(25:11):
shape.
If they can't send you one,then you've got to look the
other direction.
The other thing I hope I'm notgoing too fast here, no, because
it's an important thing theother challenge is again, you
want this medical share forexpensive things, which is smart
, but the other challenge is howto deal with the hospital when
the expensive thing happens.
By how to deal with it From dayone you go into the.
(25:34):
When you go to a hospitalassuming you've got, you're not
on the stretcher, you've gotyou're going out on your day of
surgery the first place theysend you is sometimes the
billing off because they can logyou in and so on.
And you say I've got metashareand they say does that mean your
private pay?
And you say, ideally this willbe covered by the other people.
They say I'm not sure if that'sprivate pay or not and this may
not be a big deal.
But then they don't quite knowhow to code you and they also
(25:56):
don't know quite how to chargeyou.
They may have a billing schedulefor private pay and another
billing schedule for partialinsurance and it may not bother
you the day that you go in thehospital, but when it's over,
are they going to send you the$200,000 bill that they reserve
for a kind of a foreigninsurance company who doesn't
know what they're paying?
And that does happen.
The hospitals do reserve thebig bills for passive insurance
(26:19):
companies or maybe the militaryor somebody who's not going to
challenge them.
They may send you that bill andyou send that to your cohorts
like the church members of themedical share company.
Nope, we're not going to paythat.
But again, a good company willtell you how that's handled.
James Egidio (26:34):
Yeah, I was just going to say so.
It goes back to the credibilityof the company and also maybe
how long they've been inbusiness too, correct?
Robert Hertz (26:42):
It could be, although I don't think any of
them will have been.
Yeah, there's a few of themthat may have been in business
eight years, but a lot of themless.
It's not like.
James Egidio (26:50):
Signor or Retina.
Yeah, better shares been inbusiness, I think 50 years or
something like that.
That's a very good sign.
Robert Hertz (26:57):
That means they haven't been hit by government
regulators.
I think you're on good trackand they can give testimonials
that are real and they didn'tmake up the afternoon.
James Egidio (27:08):
Which would be fraud.
I'll switch over to discussingwith you a little bit about
single payer systems andhealthcare and house pay for
with taxes and that user fees,and what I want to do.
Once you illustrate that, Iwant to give a good example of
that and support of that as well.
So go ahead, okay, talkingabout single payer systems and
(27:31):
insurance with taxpayer dollars.
Robert Hertz (27:33):
People ask what is single payer?
What I say?
You've been on Medicare oryou've been on Medicaid.
You are actually in a singlepayer plan.
Single payer plan collectstaxes from the broad citizens
history involuntarily.
You don't have a choice aboutpaying your Medicare tax, about
paying your income tax, which iswhat covers part of Medicare
and all of Medicaid.
(27:54):
That's where those companies,that's where those programs get
their money.
So it's taxpayers supported.
When you need to use it, thecost you deductible, coinsurance
or whatever is dictated legallyfor all situations.
So if you're deductible underMedicare is $185.
It's $185.
Whether you go to Mayo Clinicor Joe's Dialysis down the
(28:18):
street is the same deductibleand so it's predictable.
And Medicaid and Medicare dohave some subtlety in that a
small number of providers won'ttake them.
They have to tell you inadvance.
If the provider says I'm not aparticipating provider for
Medicare, you have to ask himwhat's your fee schedule.
But they have to be explicit onthat before you start your care
(28:38):
.
So that maybe gets us started.
They are public programs withfixed deductibles and fixed
costs to you.
They are often are funded by acombination of a premium and
your taxes.
James Egidio (28:50):
I see.
So it's almost like the samesystem that you would encounter,
let's say, in Europe.
Correct, that's right.
So a lot of people would saythat are listening to this and
watching, would cringe and saysocialized medicine.
And I always thought the samething.
I'm like, oh my gosh, it's theworst thing you can do is have
socialized medicine.
And I marry my wife, who's fromItaly, right, and just recently
(29:12):
she gets online and she wantsto still maintain her health
insurance in Italy when she goesback there to visit Because she
can do that.
She's still a citizen of Italyand she's not a citizen of the
United States, but she has hergreen card here.
We just went through the wholeprocess, through immigration,
with our interview.
Robert Hertz (29:31):
Oh yeah, that's a process.
James Egidio (29:32):
Yeah, and her insurance here.
Like I was saying earlier, shehad to pay a $2,500 deductible
right Just to meet thatdeductible in order to get a
procedure done.
It's not anything emergency.
But then on the flip side,she's getting this Cadillac
insurance and not paying much inthe way of income taxes,
because she does have to paysome income taxes from some
(29:54):
income she generates from inItaly, but it's so minimal.
It's $7 a month.
But the insurance is absolutelyincredible.
She's covered like 100% oneverything, including any
illness or injury that takesplace outside of Italy while
she's traveling Not while shelives here in the United States,
but while she travels.
Yeah, and she opted for that.
(30:15):
Now that means there's noappointments or anything.
She could be seeing the sameday.
Now, if she had to go where shedidn't have to come out of
pocket with anything, she wouldnormally have to wait maybe two
or three days in Italy.
And a lot of people will saythat's the same model in Canada,
where you have to wait two orthree months in Canada, in the
(30:36):
Canadian system.
But in Italy it's not like that, thank goodness 90, and even
for someone who visits Italy asa tourist, you can get hit by a
car or get sick with the fluwhile you're in Italy, go into a
clinic as a US tourist, atourist from the United States,
and walk out with no bill.
That's right, yeah, so theirsystem.
(30:58):
It's definitely a good system,fantastic system.
Robert Hertz (31:01):
Let me explain how they do that.
A single payer plan relies on avariety of taxes to get the
money.
They need to pay claims.
They have to pay hospitals,they have to pay doctors, they
have to pay drug companies Sameas here In America, unless
you're on Medicare.
The capital that's needed topay those claims, which is a lot
of capital, you know you need$50 million to start even a
modest insurance company and anational insurance company might
(31:24):
need $2 trillion just to payeverybody.
So where do they get the money?
They get it mainly from taxes.
They have in many cases higherincome taxes than America.
They certainly have highersales taxes.
They call them value-addedtaxes.
They can be 10 or 15% of theprice of everything or garner
everything, and so those bigtaxes.
The third is they regulate thefees that doctors and hospitals
(31:47):
can charge.
Yes, and so it's a package.
We know we're going to get atrillion dollars of income.
We know that the people in ournational program are going to
have pick a number 100,000, hasto be a bigger number are going
to have 200,000 hospitalizations, and so we know that we can pay
$54,000 for eachhospitalization.
(32:09):
The hospital cannot chargeextra.
The person is not exposed toextra.
Now, where the complaint comesabout all socialized medicine is
ironic, but where it comes fromis what happens when a public
system tries to severelyeconomize, which has been true
mainly in England and Canada.
These countries decided theydidn't want a budget deficit,
and so when it came time totheir single payer plan, they
(32:32):
said we're only going to pay for90,000 surgeries a year.
The next 10,000 people have towait or we're not going to.
In those countries, almost alldoctors are employees of the
government, and so Canada had aprogram where they weren't
hiring any new doctors for twoyears.
They took their budget deficitseriously, unlike America, so I
hope that's not a toolong-winded explanation.
James Egidio (32:52):
No, not at all.
Robert Hertz (32:53):
They sound a little bit out of left field but
I think people should rememberthe happiness that you get from
American health insurance ispartly dependent on the
willingness of America to havean annual debt.
Medicare runs a debt.
Medicaid runs a big debt.
Income taxes don't cover it all.
James Egidio (33:10):
No, their system in Italy is amazing.
And the doctor the quality ofthe doctors in the medical care
is amazing.
She was telling me, like an MRIor a CAT scan there is, I don't
know, maybe three or $400,which is what I would normally
get here for a patient who'sunderinsured or uninsured.
But it's amazing In your book,a lot of this stuff we talked
about today can be found in yourbook called Social Insurance vs
(33:33):
Medical Darwinism, correct, yes, and that can be found on
Amazon, right, and I'll put alink up on my website to that
book.
And then your blog is calledtheantidetagendacom.
That's theantidetagendacom.
Robert Hertz (33:51):
That's a monthly and I have an article every
month about some aspect of debtcollege student debt, medical
debt, consumer debt, personaldebt.
I cover the waterfront, nice.
James Egidio (34:03):
I really appreciate your time.
It's been a lot of hurt,absolutely.
Thank you so much for joiningme on this episode of the
Medical Truth Podcast.
Thanks for your work and remaina good listener of yours, thank
you.
Thank you, and I'll actuallypost this on Substack, also on
Rumble.
You can find me on Rumble.
I'm actually getting ready tolaunch a medical news show here
(34:24):
in the next couple months calledMedical Truth News.
So I have all the latest newson the pharmaceutical industry
and everything else that's outthere that we hear about all the
time.
But, thank you so much for yourtime.
Appreciate it All right.
Intro (34:41):
Thanks for listening to the Medical Truth Podcast.
For the latest episode, go towwwmedicaltruthpodcastcom.
You can also find the MedicalTruth Podcast on Rumble YouTube,
as well as the major podcastplatforms like Apple Podcast,
spotify, substack and iHeart.
Get ready to hear the truth, the whole truth and
nothing but the truth about theUnited States healthcare system
With your host of the MedicalTruth Podcast, James Egidio.
James Egidio (00:17):
Hi, I'm James with the Medical Truth Podcast.
Welcome, I'm your host.
A CIP survey suggests thatpeople in the United States owe
at least $220 billion in medicaldebt.
Approximately 14 million people, or 6% of adults in the United
States, owe over $1,000 inmedical debt and about 3 million
(00:38):
people, or 1% of adults, owemedical debt of more than
$10,000.
My guest is an expert and wrotea book on medical debt titled
Social Insurance versus MedicalDarwinism.
It's an honor and a pleasure tohave on the Medical Truth
Podcast my guest, mr RobertHertz.
Robert, how are you doing, sir?
(01:00):
Very good.
Thank you very much, jim.
Absolutely, absolutely.
For the listeners and viewersof the Medical Truth Podcast, a
little bit about who you are andwhat you do, or what you did.
Robert Hertz (01:12):
Okay, I am a retired insurance broker living
in Minnesota and I used to sellhealth insurance and you might
say I saw the sausage being made, the things you don't want to
see being made.
One of them is legislation, theother is sausage.
I was on the inside of thehealth insurance schemes and
(01:33):
scams Not all.
I tried to advise clients toavoid them.
But I learned a lot about theindustry and since then I've
devoted myself to writing ondifferent approaches public and
private, to reduce medical debtand student debt.
But we're talking medical debttoday Medical debt.
James Egidio (01:51):
I'm sure you've seen a lot happen in the last
few years with COVID, I'm surewith when it comes to medical
debt correct.
Robert Hertz (01:58):
COVID had less of an impact than I expected.
One reason is that thegovernment gave extra money to
hospitals and told them not tocharge full to patients who came
in on an emergency basis.
The government didn't want thespectacle of some poor older
person tumbling in and oftendying from COVID and then their
heirs being slapped with a bigbill.
(02:18):
The pandemic, or COVID, had alittle less impact, but the
other impacts remain and in somerespects are getting worse now.
James Egidio (02:27):
What are some of the contributing factors as to
why people get into medical debt?
I guess that could be prettymuch an obvious question.
No, it's a very good question.
Robert Hertz (02:37):
The main thing that gets people into medical
debt is deductibles and or noinsurance.
The number of people with noinsurance has been shrinking
since the Affordable Care Act.
It's shrunk by almost 20million, and that's a great
achievement.
Even with the Affordable CareAct and with employer coverage,
many people have a deductiblethat at the low end might be
(02:57):
$500.
Hardly anybody has a deductiblethat low again and at the high
end can be $7,000 and maybe10,000 per family.
What that means is that if yougo into a hospital, you pay the
first $5,000 or $7,000 of thebill yourself, and many people,
for right or wrong, don't have$5,000 or $7,000 in a savings
(03:20):
account, and so, presto, they'rein debt.
James Egidio (03:23):
Yeah, I know my wife recently experienced that
she was going to go to aphysician for a procedure and
the deductible when she walkedout of the office was like
$3,000.
So it wasn't something that hadto be done right away.
The procedure $3,000.
Well, it's too tough yeah.
(03:44):
And she's a school teacher andsupposed to have good insurance
here in Florida.
I would think so.
Robert Hertz (03:50):
Maybe she could change plans next year.
James Egidio (03:52):
but I'm on your side.
They take a lot out of hercheck already, so it would be
even more so.
It's really criminal in a way,but I know we had this visual on
how medical debt starts whensomeone, let's say, accepts
medical care, goes for medicalcare.
Here's a listing of some of it,and I guess doctor visits and
(04:15):
diagnostic tests are up to aboutwhat?
65% according to this statistichere.
Robert Hertz (04:21):
And this is valuable information.
But what I am pretty sure of isthat the 65 and other
percentage refer to the percentof claims that resulted in debt,
and not always the amount.
The largest debts tend to beemergency room visits.
In other words, if you owe yourdoctor $200, that's no fun but
(04:41):
you can live with that.
But if you owe the emergencyroom $20,000 due to insurance
problems or just weak insurance,that's a bigger challenge to
debt.
What I'm trying to say is andI've worked with an organization
that collects information onmedical debt called RIP, medical
debt and our research showsthat the average debt might be
(05:01):
$100, and people can live withthat, but the debts at the high
end are pretty scary.
James Egidio (05:06):
Yeah, so you say emergency rooms.
What about surgeries?
Robert Hertz (05:10):
Yeah, so surgeries might be on the outpatient.
The surgeries in some cases canbe planned for maybe not three
years but a couple of years, andpeople can assemble some
resources or get a commitment ofhelp in advance.
The emergency room visits andthe emergency surgeries.
Nothing can be done.
James Egidio (05:31):
Yeah, because that's a situation where it's
just an emergency.
So, when it comes to medicaldebt, who bears the burden?
Let's say in the United States,since it's a very good question
.
Robert Hertz (05:43):
It is diverse.
I think a better way to answerit is first I'll tell you who
doesn't bear the burden and thenwe'll get to who does.
Who doesn't bear the burden arepeople, like me, on Medicare,
medicare.
The maximum debt on part A ofMedicare is $185 a year.
Part B you can have higherdebts.
It depends on whether you buywhat's called Medicare Advantage
(06:03):
or Medicare Supplements, andthat's an important discussion.
But I don't want to slow usdown.
People on Medicare don't beardebt Depends for drugs, although
that has improved.
The Biden administration passedsome new rules on prescription
drug coverage that have reducedmedical debt for seniors.
The second group of people whodon't bear medical debt are
people on Medicaid, which is thefederal and state program for
(06:26):
people with low income who don'thave any other health insurance
.
Low income generally meansunder $18,000 for a person,
under $35,000 for a family, soit's pretty low.
It keeps people out of medicaldebt because they would
generally be hopeless in tryingto pay off the debt.
The third group of people whodon't experience much medical
(06:47):
debt are those diminishingnumbers with what you might call
Cadillac insurance a $500deductible or very little co
-insurance, which is a relateddeductible.
Those plans used to be the normwhen I started selling
insurance, and even as recentlyas, say, 2010, 2012, 2013,.
But those plans are diminishingdue to the cost of premiums and
(07:11):
some minority people.
The fourth group that doesn'texperience medical debt is what
I might call the gamblers, andthere's a lot of them.
The gamblers are people whodon't have an employer plan, or
the employer plan is superexpensive, and so they say this
year I'm going to start off, I'mpretty healthy, I'm going to go
uninsured, or I might buy theskimpiest I don't blame them the
skimpiest medical temporaryplan.
(07:33):
There are what's calledtemporary medical insurance, and
the gambling is that I won'tget sick Right, get by car, and
three years out of four theymight win the gamble if they
start off healthy, but in thefourth year they might get
walloped.
So those are the people whodon't experience much debt.
The rest of them, it's a grabbag of who has high deductible
and loaded up with coverage andget sick during the year.
(07:54):
So who bears the burden then?
Oh, it's a good question.
The burden is on the patientand they have some choices.
If you would like me to getinto this, I'd be happy to Sure,
absolutely.
James Egidio (08:04):
We have a lot of time.
Robert Hertz (08:06):
The patient or I saw the patient has a bill and
it's $10,000 and they don't havethe money.
What can they do?
The first thing they can do isto contact the provider.
Don't try to run away.
The provider will catch up toyou.
And don't call the insurancecompany because in many cases
they've already made theirdetermination and we might come
back to them.
But at first you got to contactthe provider and explain to them
(08:28):
that this is the way theinsurance has shaken out and you
don't have the lump sum, nor doyou have an income which will
allow you to pay it, say, infour months.
And providers are used tohearing this and, between you
and I, they mark up their billsin expecting for some of this to
happen.
Yeah, and in some cases theprovider will agree to a monthly
payment plan that you can livewith.
(08:50):
Now maybe that's 200 months,and so after a year you would
have paid off $3,000 and theymight forgive the rest.
So the first, when you'rebearing the burden, the first
person is don't assume it's setin stone, don't assume it cannot
be improved.
Now, some providers arehardnails.
They'll say I've got acollection agency on speed dial,
we're going after you.
But that isn't all of them?
(09:11):
Yeah, so the first thing to doif you're bearing the burden is
to contact the provider and seeif they're willing to
accommodate.
I did that once when one of mysons had an emergency room visit
and they had a procedure, aprotocol all set and they sent
me out a lot of paperwork and Iprovided copies of my son's
paychecks so they could verifyhow much he made, I think.
(09:32):
I might even have to provide atax return, but I didn't have to
pay anything, nor did he, whilethis protocol was being
reviewed, and at the end theygave it they forgave it so they
forgave the entire amount.
Yeah, I think so, maybe allabout $250.
James Egidio (09:46):
Wow.
So when you say the provider,now there's a difference between
being render, having medicalservices rendered through a
doctor at a doctor's office,which is considered outpatient,
and then someone gets treated ata hospital.
So let's say, for instance, Iget rushed to the hospital for
an appendectomy surgery, right,and the final bill is $20,000,
(10:10):
which sounds about right?
Yes, it does, yeah.
And so I come back home after,let's say, two or three days in
the hospital becauseappendectomy is anymore,
probably a short stay in ahospital and I get the bill what
, maybe three or four weekslater, for $20,000.
Yes, so as a patient, what canI do if I have no insurance?
Robert Hertz (10:31):
If you have no insurance, the first step is to
contact the hospital financialaid department, and here's why
the Affordable Care Act in 2012,2013, 2014 included a provision
not widely known about thatsays if you have no insurance,
your bill must be discounted ifyou have a modest income.
Now, if your income was$200,000, and you were just a
(10:52):
gambler to fluck but that's notthe case with very many people
so if your income was $50,000,and you had no insurance, the
hospital aid department mightcut the $50,000 and a half.
Now, that's not the whole story, but it helps.
Might cut it even further.
And they don't announce this inbig letters.
They're certainly not a sign inthe ER saying if you have
(11:13):
trouble with your bill, call us.
It doesn't happen, Dr Michael A.
James Egidio (11:16):
No.
Robert Hertz (11:16):
Dr Michael A, the Affordable Care Act has that
provision.
Now let's go a step further.
Individual states have beenadding to this call this
emergency discount program forthe last seven or eight years.
By adding to it they mightstretch the dollar income
eligibility a little higher.
There's one case where there'sone state I think it might be
(11:38):
Maryland or New Jersey where youcan make up to $80,000 a year
and still get a discountedmedical bill.
It may not be wholly forgiven,but it would be discounted If
you've gone through all thosesteps and the bill is not some
ludicrous bill like $200,000,which we can talk about, but if
it's within their normal range.
Again you ask for the monthlypayment.
(11:59):
If even the monthly payment isunachievable, your last resort
would be to declare bankruptcy.
That costs about $2,000, but itwipes out medical bills and it
stays on your record.
But if you're not going to workon a bank or work for the
federal government, many I can'tsay a number, but some
employers will not, especiallyif they know why you were
bankrupt will not place a bar onyou for employment, which is
(12:22):
what people are scared of.
James Egidio (12:24):
Dr Michael A yeah, yeah, and you'll end up getting
more.
After declaring bankruptcycredit cards.
For some reason or another,they miraculously start to get
it.
Robert Hertz (12:32):
You can't declare again for another two years.
They got you where they wantyou, dr.
James Egidio (12:35):
Michael A Okay, so then you mentioned something
about, let's say, a bill like$200,000 or more.
Let's say you get diagnosedwith cancer or something.
The bill could run up to even amillion dollars.
$200,000 to a million what doyou do in that case?
Dr Michael A, the hospital willnormally back down.
Robert Hertz (12:53):
They put that number out there because they
don't necessarily know what.
I'm diversioning a little bit,but I think it's important to
know why they would bill thatmuch.
One reason is that they don'tknow especially if it's a rush
treatment case how good yourinsurance is, and so they throw
that number out there becauseyou might have an insurance
company that'll pay it, but thenumber sits out there and maybe
(13:13):
your insurance company won't payit or you have no insurance and
so it's staring you in the face.
And if they won't back down,what I recommend to people is
that they what I call go public,go to your local newspaper and
say what a hardship this is andtell the hospital you're doing
it, and I've seen situationsthat I've talked to people who
are in the business gettingmedical debt reduced.
(13:35):
The hospital may come back witha financial package before it
even hits the newspaper.
They hate that publicitybecause it exposes them in some
cases of being real hard-nosedsons of bees, and they might
incur greater supervision by thegovernment, and so it's a lot
easier for them to just cut theamount back and shut you up.
James Egidio (13:54):
You did mention about calling the insurance
provider, or even the providerthemselves, the doctor's office
or the hospital the billingdepartment at the hospital, for
that matter.
But why is it important todocument every call that you
make?
Robert Hertz (14:09):
That's a very good question.
In some cases it's because of achain of command issue.
If someone who represents theinsurance company is on the
phone and you ask them $20,000bill, doesn't my coverage better
than that?
And they say that was for youremergency epidectomy.
And you say it wasn't emergency, it was planned and it was
moderated a little bit.
And they say, oh gosh, let melook at the claim again, because
(14:30):
insurance companies aren'tperfect and nor are hospitals.
They could have submitted theclaim.
People don't know that ahospital bill because there are
so many of them every day, amajor hospital has to send out a
thousand bills a day.
It's based on codes.
They are based on numeric codesand the code might be for
appendectomy, 3407b, but all itwould take was a human being, a
(14:52):
little sloppy or just tired atthe end of the day, to put in
30407, which has a $20,000 cost.
So the first thing, the reasonto call the provider and the
insurance companies, first ofall insurance see what the
insurance company even askedthem for, the code, what code?
Resulted in a 20-thousand billand once in a while they'll say
it was code 3407B.
Then you call the provider.
It's a lot of work but it's alot of money and there are
(15:14):
people who will assist you for amodest cost in making these
calls.
Anyways, you call the providerand they say it was just I'm
making this up it was just foran appendectomy ultrasound and
that's $278, which has a cost of$5,000.
You just saved $15,000.
Since, redocument everything.
James Egidio (15:31):
Yeah, and then you also mentioned that good to be
a nuisance with these people.
Robert Hertz (15:36):
Everybody knew what I knew, in which you're now
.
They wouldn't get away with theoutrageous bills they sometimes
send and they would have toaccept more government oversight
even to apply with existinglaws.
There have been surveys done ofcharitable care cases and they
sometimes find that hospitalsjust ignored the affordable care
act rules.
They just sent everybody the$20,000 bill which, according to
(15:58):
the Affordable Care Act,because it's extra work for them
, they have to ask you what yourincome is like.
They did for my son's situation.
They have to verify the income.
It costs them money.
They have to hire not a lot ofmoney, but they have to hire.
Maybe what?
Two or three extra people at$45,000 each.
It's a chunk of change.
James Egidio (16:15):
They resist doing it and so that's where the
nuisance factor comes in, I seeSomething really interesting too
is my sister recently called upFlorida Blue, which is the Blue
Cross Blue Shield provider herein Florida.
She's not currently working,she's teaching.
She's a school teacher.
She's not teaching right now,so her income's gone down quite
(16:36):
a bit.
But we were on the phone, wewere having a conversation not
long ago and she said somethingabout only having to pay $97 a
month for Florida Blue insurance, which is almost like a
complete coverage.
It covers everything.
I said why are you paying sucha small amount?
And she says because what theytold her on the phone is
something to do with the taxcredit based on the Affordable
(16:58):
Care Act.
What does that mean?
Robert Hertz (17:00):
That's a very good question.
If you go through theAffordable Care Act, which
usually means you don't haveemployer coverage, in fact you
can't have employer coverage,Right, If you go through the
Affordable Care Act.
There's a two-step process andit's a real blessing.
The greatest thing about theAffordable Care Act is called
the subsidy, and I'm going to gothrough it because that maybe
(17:22):
was really happening to yoursister.
James Egidio (17:23):
That's exactly what it was.
Robert Hertz (17:25):
Okay, you go through the Affordable Care Act,
the two-step process.
They calculate the insurancepremium which you might call the
gross premium, what theinsurance company would charge
just based on your age and thecoverage that you want.
Then they look at your annualincome and the total premium is
generally maxed out at 8% ofyour income.
(17:45):
So if your income was $1,000 amonth because you were part-time
or because you just had a reallow-paying job, the insurance
premium you have to pay for a$600 policy is $8 of $12,000,
which happens to be about 96bucks a month.
My math isn't perfect, but yousee where I'm going.
(18:05):
Through the Affordable Care Act, your insurance premium is
capped at a percentage of yourincome.
So there are people, there aresome improvements to the
Affordable Care Act.
There are hundreds of thousandsof people today walking around
with pretty decent insurance andpaying zero.
It's a long story of how thathappens.
James Egidio (18:23):
Sure, on the flip side of that, I'm not eligible
for that type of insurance.
I went with what's called theSHARE program, so I'm using
what's called Metashare.
I know there's a couple otherdifferent programs out there.
I pay like three years awayfrom collecting Medicare
eventually at some point ateither 63 or 65.
(18:44):
It's 65.
It's five, it's about fouryears away from that.
And so what I did is I resortedto what's called Metashare for
$200 a month.
Now I'm like on the.
I look at it like being on thegambler side of what you
illustrated earlier, where I'lluse that for anything
catastrophic.
(19:04):
And the way I do it personallywith getting covered for
anything else is let's say, forinstance, I want to use
telehealth services for, let'ssay, a common cold or seasonal
allergies or something I needfor an infection or something to
get an antibiotic.
I'll use a telehealth serviceand pay out of pocket for under
(19:25):
$100 a month.
With Metashare it's free.
And then, when it comes toimaging studies, I found low
cost imaging companies.
Yeah, a company called SimonMedical, which is a national
company, nationwide SimonMedical.
I think it ultrasounds like $35.
Intro (19:43):
And the reason why I know about yeah.
James Egidio (19:44):
And the reason why I know about Simon Medical is
because I, when I had a medicalpractice I had owned a medical
practice.
It was a low cost fee forservice practice, so I was
finding all the bargains for allthe patients.
I can remember saving a patientover $10,000.
I saved her over $200,000 on asurgery for, yeah, acetabulum
(20:08):
hip reconstruction, and I workedout an agreement with the
orthopedic surgeon and this wasin Vegas when I lived there and
had the practice there, and thesurgery was $10,000.
But that's but on a smallerscale.
Another patient who spent over$3,000 in an emergency room to
(20:30):
be diagnosed with diabetes.
I was able to save that patient.
Oh my gosh, like it cost Idon't know $300 total with lab
work and everything.
Doctors visit prescriptionsBecause you made a stink no, not
even because I made a stink,because I had the resources with
the lab.
Ah, I see that's a much cheaperalternative.
(20:51):
Yes, a much, much cheaperalternative.
The medical industry itself isthe cost is so high and so
inflated, and this is, I think,one of the reasons why I
personally believe we're havingan issue with medical debt in
this country.
For that reason, even SimonMedical MRI is like $250
(21:12):
compared to $2,500.
Yeah, the hospital markups areterrible.
Yeah, even at an imaging centeroutside of, let's say, simon
Medical not a hospital MRI orCAT scan, but in an imaging
center they're like $2,500.
Sure.
Robert Hertz (21:29):
And the hospitals go around buying these providers
so they can charge that amount.
James Egidio (21:33):
Yeah, yeah, and these are services for uninsured
or underinsured patients.
A lot of these services, andeven lab work too.
Lab work is very expensive.
Again, I was able to savepatients on a female complete
blood panel thyroid and a CBCcomplete blood count.
It was costing us out of pocketabout maybe dollars and we
(21:57):
would charge the patient about$125.
Robert Hertz (22:00):
I respect what you did.
One of the big challenges andI'm sure you might have heard of
this is that sometimes thepatient and I was a patient last
year, I had a surgery last yearsometimes a patient is weakened
, they're tired, maybe they'vebeen through the surgery and
they haven't got the gumption orthe self-confidence to say to
(22:20):
the doctor that complete bloodcount which I know I need.
Why don't I go down the streetand I'll have the results in two
days and mail it to you?
It's so easy and because I'vehad good insurance, it's easy
for me.
It's so easy to say, all right,what's next?
Do the blood count?
And so good for you that youhad that.
But the one-stop shopping thing, which is what hospitals sell,
(22:40):
is pretty tempting.
James Egidio (22:41):
Yeah, we drew the blood right at the office so it
wasn't even a problem for apatient to get their routine
blood work done at the office.
When they came in I drew theblood for a mail.
It was a complete blood countCBC, tsh, testosterone and a PSA
for prostate-specific antigenblood test.
Now normally those tests therewould go for right around $1,500
(23:05):
to $2,000 for all that lab workand I was charging $175.
Robert Hertz (23:12):
Wow.
James Egidio (23:13):
Yeah, I had that practice for about 10 years.
Yeah, I operated that practicefor about 10 years, In fact.
Actually in 2000, I wrote abook called Learn how to Start a
Cash Only Medical Practice.
It was marketed towardsphysicians, Right right, yeah.
And it was outside of theconcierge model.
Because the concierge modelsays, okay, if you pay the
(23:35):
doctor, I don't know $4,000 ayear or you get everything.
Yeah, it's not that you'll justget everything, You'll have the
accessibility to that physician.
But physicians are not going tobe accessible 24 hours a day,
seven days a week.
After a while they're going toget tired of that type of
accessibility for someone whosneezes and calls the doctor at
(23:56):
three or four o'clock in themorning.
But so my question to you isgetting back to these share
programs what's your take onthose?
Robert Hertz (24:05):
I had done some reading on it and when I was in
the insurance business up tillabout five years ago, I went to
some seminars and had someexposure, and so the information
on my opinions might beoutdated, but I don't think they
are, because I haven't beenclose to them in the last few
years.
The main thing is that they areuneven, and by uneven there are
(24:26):
plans which are ethical andhonest and will.
If you have a claim, it will besubmitted to the group as a
whole, which I believe is whatyou're referring to and other
people will share in the expensebecause you'll do the same for
them, and it's a fine idea.
There have been companies notall by any means.
If I went on to Google, I couldfind the one of the worst ones.
There are companies where thefounders just kept all the money
(24:48):
, that all the premiums you paid, just went into their pockets
and they bought big cars and bighouses, and when it came time
to get others to contribute,they did nothing.
They're not very regulated,which is maybe a blessing in
some ways, but it means that you, the buyer, really have to kick
the tires, maybe ask for,describe a claim you made
recently and so on or that youpaid recently.
And if they've got a list of 20of them, I think you're in good
(25:11):
shape.
If they can't send you one,then you've got to look the
other direction.
The other thing I hope I'm notgoing too fast here, no, because
it's an important thing theother challenge is again, you
want this medical share forexpensive things, which is smart
, but the other challenge is howto deal with the hospital when
the expensive thing happens.
By how to deal with it From dayone you go into the.
(25:34):
When you go to a hospitalassuming you've got, you're not
on the stretcher, you've gotyou're going out on your day of
surgery the first place theysend you is sometimes the
billing off because they can logyou in and so on.
And you say I've got metashareand they say does that mean your
private pay?
And you say, ideally this willbe covered by the other people.
They say I'm not sure if that'sprivate pay or not and this may
not be a big deal.
But then they don't quite knowhow to code you and they also
(25:56):
don't know quite how to chargeyou.
They may have a billing schedulefor private pay and another
billing schedule for partialinsurance and it may not bother
you the day that you go in thehospital, but when it's over,
are they going to send you the$200,000 bill that they reserve
for a kind of a foreigninsurance company who doesn't
know what they're paying?
And that does happen.
The hospitals do reserve thebig bills for passive insurance
(26:19):
companies or maybe the militaryor somebody who's not going to
challenge them.
They may send you that bill andyou send that to your cohorts
like the church members of themedical share company.
Nope, we're not going to paythat.
But again, a good company willtell you how that's handled.
James Egidio (26:34):
Yeah, I was just going to say so.
It goes back to the credibilityof the company and also maybe
how long they've been inbusiness too, correct?
Robert Hertz (26:42):
It could be, although I don't think any of
them will have been.
Yeah, there's a few of themthat may have been in business
eight years, but a lot of themless.
It's not like.
James Egidio (26:50):
Signor or Retina.
Yeah, better shares been inbusiness, I think 50 years or
something like that.
That's a very good sign.
Robert Hertz (26:57):
That means they haven't been hit by government
regulators.
I think you're on good trackand they can give testimonials
that are real and they didn'tmake up the afternoon.
James Egidio (27:08):
Which would be fraud.
I'll switch over to discussingwith you a little bit about
single payer systems andhealthcare and house pay for
with taxes and that user fees,and what I want to do.
Once you illustrate that, Iwant to give a good example of
that and support of that as well.
So go ahead, okay, talkingabout single payer systems and
(27:31):
insurance with taxpayer dollars.
Robert Hertz (27:33):
People ask what is single payer?
What I say?
You've been on Medicare oryou've been on Medicaid.
You are actually in a singlepayer plan.
Single payer plan collectstaxes from the broad citizens
history involuntarily.
You don't have a choice aboutpaying your Medicare tax, about
paying your income tax, which iswhat covers part of Medicare
and all of Medicaid.
(27:54):
That's where those companies,that's where those programs get
their money.
So it's taxpayers supported.
When you need to use it, thecost you deductible, coinsurance
or whatever is dictated legallyfor all situations.
So if you're deductible underMedicare is $185.
It's $185.
Whether you go to Mayo Clinicor Joe's Dialysis down the
(28:18):
street is the same deductibleand so it's predictable.
And Medicaid and Medicare dohave some subtlety in that a
small number of providers won'ttake them.
They have to tell you inadvance.
If the provider says I'm not aparticipating provider for
Medicare, you have to ask himwhat's your fee schedule.
But they have to be explicit onthat before you start your care
(28:38):
.
So that maybe gets us started.
They are public programs withfixed deductibles and fixed
costs to you.
They are often are funded by acombination of a premium and
your taxes.
James Egidio (28:50):
I see.
So it's almost like the samesystem that you would encounter,
let's say, in Europe.
Correct, that's right.
So a lot of people would saythat are listening to this and
watching, would cringe and saysocialized medicine.
And I always thought the samething.
I'm like, oh my gosh, it's theworst thing you can do is have
socialized medicine.
And I marry my wife, who's fromItaly, right, and just recently
(29:12):
she gets online and she wantsto still maintain her health
insurance in Italy when she goesback there to visit Because she
can do that.
She's still a citizen of Italyand she's not a citizen of the
United States, but she has hergreen card here.
We just went through the wholeprocess, through immigration,
with our interview.
Robert Hertz (29:31):
Oh yeah, that's a process.
James Egidio (29:32):
Yeah, and her insurance here.
Like I was saying earlier, shehad to pay a $2,500 deductible
right Just to meet thatdeductible in order to get a
procedure done.
It's not anything emergency.
But then on the flip side,she's getting this Cadillac
insurance and not paying much inthe way of income taxes,
because she does have to paysome income taxes from some
(29:54):
income she generates from inItaly, but it's so minimal.
It's $7 a month.
But the insurance is absolutelyincredible.
She's covered like 100% oneverything, including any
illness or injury that takesplace outside of Italy while
she's traveling Not while shelives here in the United States,
but while she travels.
Yeah, and she opted for that.
(30:15):
Now that means there's noappointments or anything.
She could be seeing the sameday.
Now, if she had to go where shedidn't have to come out of
pocket with anything, she wouldnormally have to wait maybe two
or three days in Italy.
And a lot of people will saythat's the same model in Canada,
where you have to wait two orthree months in Canada, in the
(30:36):
Canadian system.
But in Italy it's not like that, thank goodness 90, and even
for someone who visits Italy asa tourist, you can get hit by a
car or get sick with the fluwhile you're in Italy, go into a
clinic as a US tourist, atourist from the United States,
and walk out with no bill.
That's right, yeah, so theirsystem.
(30:58):
It's definitely a good system,fantastic system.
Robert Hertz (31:01):
Let me explain how they do that.
A single payer plan relies on avariety of taxes to get the
money.
They need to pay claims.
They have to pay hospitals,they have to pay doctors, they
have to pay drug companies Sameas here In America, unless
you're on Medicare.
The capital that's needed topay those claims, which is a lot
of capital, you know you need$50 million to start even a
modest insurance company and anational insurance company might
(31:24):
need $2 trillion just to payeverybody.
So where do they get the money?
They get it mainly from taxes.
They have in many cases higherincome taxes than America.
They certainly have highersales taxes.
They call them value-addedtaxes.
They can be 10 or 15% of theprice of everything or garner
everything, and so those bigtaxes.
The third is they regulate thefees that doctors and hospitals
(31:47):
can charge.
Yes, and so it's a package.
We know we're going to get atrillion dollars of income.
We know that the people in ournational program are going to
have pick a number 100,000, hasto be a bigger number are going
to have 200,000 hospitalizations, and so we know that we can pay
$54,000 for eachhospitalization.
(32:09):
The hospital cannot chargeextra.
The person is not exposed toextra.
Now, where the complaint comesabout all socialized medicine is
ironic, but where it comes fromis what happens when a public
system tries to severelyeconomize, which has been true
mainly in England and Canada.
These countries decided theydidn't want a budget deficit,
and so when it came time totheir single payer plan, they
(32:32):
said we're only going to pay for90,000 surgeries a year.
The next 10,000 people have towait or we're not going to.
In those countries, almost alldoctors are employees of the
government, and so Canada had aprogram where they weren't
hiring any new doctors for twoyears.
They took their budget deficitseriously, unlike America, so I
hope that's not a toolong-winded explanation.
James Egidio (32:52):
No, not at all.
Robert Hertz (32:53):
They sound a little bit out of left field but
I think people should rememberthe happiness that you get from
American health insurance ispartly dependent on the
willingness of America to havean annual debt.
Medicare runs a debt.
Medicaid runs a big debt.
Income taxes don't cover it all.
James Egidio (33:10):
No, their system in Italy is amazing.
And the doctor the quality ofthe doctors in the medical care
is amazing.
She was telling me, like an MRIor a CAT scan there is, I don't
know, maybe three or $400,which is what I would normally
get here for a patient who'sunderinsured or uninsured.
But it's amazing In your book,a lot of this stuff we talked
about today can be found in yourbook called Social Insurance vs
(33:33):
Medical Darwinism, correct, yes, and that can be found on
Amazon, right, and I'll put alink up on my website to that
book.
And then your blog is calledtheantidetagendacom.
That's theantidetagendacom.
Robert Hertz (33:51):
That's a monthly and I have an article every
month about some aspect of debtcollege student debt, medical
debt, consumer debt, personaldebt.
I cover the waterfront, nice.
James Egidio (34:03):
I really appreciate your time.
It's been a lot of hurt,absolutely.
Thank you so much for joiningme on this episode of the
Medical Truth Podcast.
Thanks for your work and remaina good listener of yours, thank
you.
Thank you, and I'll actuallypost this on Substack, also on
Rumble.
You can find me on Rumble.
I'm actually getting ready tolaunch a medical news show here
(34:24):
in the next couple months calledMedical Truth News.
So I have all the latest newson the pharmaceutical industry
and everything else that's outthere that we hear about all the
time.
But, thank you so much for yourtime.
Appreciate it All right.
Intro (34:41):
Thanks for listening to the Medical Truth Podcast.
For the latest episode, go towwwmedicaltruthpodcastcom.
You can also find the MedicalTruth Podcast on Rumble YouTube,
as well as the major podcastplatforms like Apple Podcast,
spotify, substack and iHeart.
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