September 17, 2025 • 28 mins
When a hospital CEO candidly admitted to Dr. Joseph Jarvis that they diverted non-paying patients elsewhere despite having available beds, it crystallized everything wrong with America's healthcare system. In this eye-opening conversation, Dr. Jarvis—physician, public health leader, and healthcare reform advocate—shares his groundbreaking vision for transforming healthcare access in Utah and potentially nationwide.
The Utah CARES Act represents a radical yet practical approach to healthcare reform that could eliminate the bureaucratic middlemen wasting billions while ensuring every resident receives necessary medical care without financial barriers. Dr. Jarvis artfully dismantles the "socialized medicine" critique by drawing a compelling parallel to our highway system: publicly funded, privately built, and universally accessible without anyone crying "socialism."
Perhaps most disturbing is how our current system actively punishes healthcare providers for improving patient outcomes. Dr. Jarvis shares the story of a Utah physician whose protocol dramatically reduced pneumonia hospitalizations and costs—only to see the hospital financially penalized for delivering better care. The Utah CARES Act would flip these perverse incentives, rewarding quality care rather than billable procedures.
Despite economic studies confirming the plan's fiscal soundness, political obstacles have temporarily blocked this initiative from reaching voters. But Dr. Jarvis remains undeterred, motivated by his faith and the knowledge that approximately 2,000 Utahns die unnecessarily each year due to healthcare access barriers.
Whether you're a healthcare professional frustrated by systemic dysfunction, a patient struggling with medical costs, or simply someone who believes healthcare should serve people rather than profits, this conversation offers both a sobering diagnosis of our current system and a hopeful prescription for meaningful reform. Visit www.utahcares.health to learn more, share your healthcare story, or support this vital initiative.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Welcome back to the Senior Care Academy podcast.
Today we are sitting downtalking to Dr Joseph Q Jarvis, a
physician, a public healthleader, a former state health
officer and longtime advocatefor meaningful health care
reform.
Dr Jarvis has spent decadesworking in medicine, public
health and policy, seeing thesystem from every angle as a
clinician, as a regulator, ateacher and as a patient
(00:30):
advocate.
He's also the author ofmultiple books on healthcare
reform and the producer of thedocumentary Healing Us or US.
Today we'll dive into the UtahCARES Act.
What it is is, why it mattersand how it could change the way
that we think about health carein Utah and beyond.
Joe, thanks so much for sharingsome time with us today.
(00:51):
I'm excited to talk to you.
Thanks for inviting me on.
I appreciate it very much.
yeah, I always like to startgiving the audience kind of a
rundown on you.
So you studied English beforeyou became a physician.
How did storytelling andEnglish just talk about that and
how it shaped the way that youtalk about healthcare reform?
(01:11):
And I think a unique thing ishow you're able to express that
in writing with your books andeverything like that.
I think a lot of times you havephysicians that can't express
it and then you have authorsthat don't know the problem well
enough.
So you have a cool balance thatcan express it and then you
have authors that don't know theproblem well enough.
Speaker 2 (01:25):
So you have a cool balance.
As an English major, I enjoyedvery much some of the authors
and poets out there in historywho were physicians, and enjoyed
reading their insights.
William Carlos Williams, forinstance, wrote some short
stories about being apediatrician in New Jersey, and
Keats, a very famous romanticpoet, was a physician.
(01:46):
Unfortunately died very youngof tuberculosis.
But more important than that,stories are how people connect
with the important things ofhuman life.
Fiction has a lot of truth init, even though it's not the
truth per se, it's a story.
So stories really makesomething real for people that
(02:09):
they can embrace, hold on to,change their life around.
And that is so true ofsomething as important as
changing how we do healthcarebusiness.
All big movements in the UShistory were fueled by
storytelling.
Yeah, from civil rights to theway we voted and who voted, to
(02:32):
our current issues in theAmerican political scene.
Speaker 1 (02:35):
And even all the way back to the Declaration of
Independence.
We sent this letter off toEngland saying, hey, we're not
part of you anymore.
You know stories Yep.
Part of you anymore?
You know stories, yep.
Um, you've worn a lot of hats,uh clinician, regulator, teacher
(02:55):
, educator, writer.
Um, which role do you thinktaught you the most about what's
broken in the healthcare system?
And then, what's your favoritestory so far that you've been
able to tell about that to tryto cause?
I agree so much that, like you,can throw facts and figures and
numbers and big scary numbers,but it's when you go back and
that big scary numbersassociated with this individual
and how it changed their lifethat it actually moves people to
(03:16):
action.
So I'm curious what's rolesshaped your thoughts?
Um, and then, which story haveyou been most proud about?
Trying to reform care in the US?
Speaker 2 (03:27):
Well, I love being a doctor who had my hands on
patients, a clinician.
That was a very importantformative role.
Going through medical training,I was a family doc first,
before it was anything else inhealth care, but the role that
taught me that there werefundamental flaws that were
literally killing Americans wasthe role of state health officer
(03:48):
in Nevada.
That's where I went frombelieving, like most Americans
do, that we do everything well,perhaps fast, and that our
health care was better thananyone else's.
That's where I realized that infact is not the case.
Anyone else.
That's where I realized that infact is not the case, and a
(04:08):
story from that time that kindof epitomizes this.
One of my roles as a statehealth officer was to regulate
hospitals how they did,especially the most highly tech
sort of services like newbornintensive care, and I went to
visit the newborn intensive careunit in Las Vegas because we
were trying to write regulationsthat would keep that level of
care high and consistent.
(04:29):
The hospital where the bestnewborn intensive care unit was
in Nevada was a for-profithospital.
They also had good trauma careand we were trying to write
regulations to improve traumacare in Nevada at the same time
and had just published ourregulations and asked hospitals
to apply for the privilege ofbeing the leading hospital in
(04:51):
trauma care.
This hospital, the one with thebest newborn intensive care was
where the president of theUnited States would have been
taken if he had had some kind oftraumatic event happen while he
was visiting Nevada.
So it was good.
Trauma care is clearly the best, but it didn't apply for the
designation.
I ran into the CEO of thehospital while I was there and I
(05:13):
said you've embarrassed thestate health department.
We have these regulations ontrauma.
We need a good leading hospital.
Your hospital obviously fitsthe bill, but you didn't apply.
The ones that did failed thetest and we don't have a trauma
system because of that.
Why, and he said, you regulateus for how many beds we're
(05:33):
allowed to open to patients?
You give us the privilege ofhaving as many as 430 patients.
We routinely staff up to about330 patients.
We routinely staff up to about330 patients.
If a paying patient comes toour emergency room, our
emergency room staff is trainedto open up a bed, call in a
nurse and admit that patient.
(05:54):
If, however, a patient comes tothe emergency room and can't
pay for the bed, then we tellthem that we're closed, we're at
our limit and they are divertedelsewhere.
Tell them that we're closed,we're at our limit and they are
diverted elsewhere.
So your regulations requiredthe lead trauma hospital to take
care of all patients withtrauma regardless of ability to
pay, and I'm a for-profithospital.
(06:14):
I can't afford to takenon-paying patients, so we're
not going to be your leader.
And in that moment of honestyby this guy, he was basically
saying his hospital was notabout caring for people, it was
about making as much money aspossible.
I realized, hey, we have amajor problem on our hands.
Speaker 1 (06:34):
Yeah, that's a huge problem, especially because it's
like a it's a little bit of adouble-edged sword, where you
have they're the very best, um,and there's a reason why, but,
and they're making the profitand they're all that.
But then on the other side ofthe sword you have the fact that
, yeah, they have capacity andall these things, but the person
(06:55):
can't pay.
They're turning like it's avery interesting thing because
on the one side, if they takethe non-paying customers,
they're helping them, but thenwho knows what happens on the
other side?
They lose money, so they're notas good.
I don't know.
It's interesting.
Speaker 2 (07:10):
You have to think about this a little bit
differently.
That non-paying customer issomebody who probably doesn't
have health insurance forwhatever reason, and there are a
lot of reasons why that mightbe the case and not be the fault
of the person, but you can alsosay about that person that he,
as well as all other Americans,are the world's highest paying
taxpayers for healthcare.
(07:31):
We pay for healthcare primarilythrough our taxes.
That person is paying theworld's highest taxes for health
care and they're being turnedaway at their moment of need for
care.
Speaker 1 (07:43):
That's just wrong.
Speaker 2 (07:44):
What we need is a system that recognizes that
we're already spending enough tohave high-quality care for
everyone and not turn peopleaway.
That's what we need.
Speaker 1 (07:55):
Yeah, on that note, if someone asked at dinner party
to explain the Utah CARES Actin like 60 seconds, how would
you explain that and how doesthat feed into this bigger issue
of health care reform?
Speaker 2 (08:14):
The first, the Utah CARES Act, does three things
already existing high quality,very efficient payer of health
care called the Public EmployeesHealth Plan into a universal
all residents of Utah healthplan.
We renamed it Utah Cares.
So that is a very simplestatutory transformation because
it exists as a privatenonprofit trust fund existing at
(08:38):
the behest of the people ofUtah to pay for public
employees' health care.
And we'll just simply change itand say it'll pay for all
Utahns' health care.
So that's number one.
Number two we supervise thatnew entity, the Utah CARES Plan,
with a new commission, the UtahHealth Systems Commission.
We give that commission, whichwill be seven commissioners
(09:00):
appointed by the governor,approved by the Senate.
We give that commission, whichwill be seven commissioners
appointed by the governor,approved by the Senate, we give
them the power to overseeeverything about health care,
adjudicate all health caredisputes, make all health care
plans, budget for health care.
We want them to be responsiblefor making sure the health
system runs smoothly and isaccountable to all of the people
of Utah, which is what itexists for.
(09:20):
And number three is we recreatehow we finance health care.
Most of the money, as I'vealready said, is public money
and we take all of that money,which is mostly federal, and
channel it to Utah Cares.
The amount of money thatcurrently comes from private
employers and privateindividuals and is paid in for
(09:41):
health care, we will replacewith what we're calling the Utah
Cares premium, which is a newgross receipts tax that will be
levied on all transactions inUtah, whether for goods or
services Very small percent,like less than 3%, and that
money will then be divertedpermanently solely to take care
(10:03):
of healthcare needs.
We will therefore tellemployers from after this is
fully implemented.
You don't have to pay for thehealthcare of your employees.
You're done.
You're out of the business oftrying to finance healthcare.
You can just work on yourwidgets or whatever it is that
you provide as a business.
So those are the three things.
That's what I'd say in 60seconds.
Speaker 1 (10:24):
I love that.
It's a very interesting conceptas far as where you're getting.
So if Utah passes the UtahCARES Act, what would that look
like for the everyday patient?
It's like everybody in Utah iscovered under it.
They don't need to go and shopAetna and da-da-da-da-da like
all of them, Bringing it all theway back down to the ground
(10:46):
floor.
John Smith, down the road, whatdoes that look like for him?
Speaker 2 (10:52):
Well, john Smith doesn't anymore.
I mean, he never did needhealth insurance.
What John Smith needs is care.
Speaker 1 (10:58):
He doesn't need health insurance.
Speaker 2 (10:59):
So we get rid of that middleman, that useless,
wasteful, highly bureaucraticinstitution.
That's a unique Americanphenomenon that is wasting 500
billion of our dollars everyyear.
They're gone.
They don't have to worry aboutthat.
They're employed.
Where they're employed, how oldthey are, what race they are,
(11:21):
where they live in the state ofUtah, they will have financing
for medically necessary care.
What they need to do is picktheir doctor and I don't care
who it is, any licensedphysician will do and if they
need a physical therapist oroccupational therapist, et
cetera, et cetera.
They pick their therapist,whoever they want to go see, and
if their doctor says you needto be in a hospital, pick their
(11:41):
therapist whoever they want togo see.
And if their doctor says youneed to be in a hospital, then
whatever they he and you knowJohn Smith and his doctor decide
for the hospital, they get togo there.
There will be no out-of-pocketexpense at the time of care.
You don't have a deductible,you don't have a premium to pay,
you don't have a co-payment orco.
-insurance.
Nothing will no financialbarrier to getting the care that
(12:02):
you or your family member needs.
Furthermore, the hospital andother institutions will be
tasked with delivering the bestcare possible.
One of the real flaws of ourAmerican health care system is
we only do mediocre care.
We have more preventable deathsin the United States by far
than any other first worldnation, and that's because we
(12:22):
focus so much on the buck thatwe're not actually taking care
of the people who come in thedoor.
We do the right thing abouthalf the time for the American
patient.
So John Smith will get the caredone right the first time and
therefore it'll be lessexpensive and John Smith will be
in better health.
Yeah, john Smith will be inbetter health.
Speaker 1 (12:40):
Yeah, in your documentary Healing Us, you
talked about very openlycritical on the profit-driven
medicine.
So the Utah CARES Act, how doesit push against that Like?
What does that look like?
Now, going back to theclinician and the hospital, how
does?
I guess my one, the mainquestion, is like how does the
(13:01):
Utah cares act?
Um, right, you have the bellcurve, you have the, the 10%,
top highest performingclinicians, you have the 64% and
then you have, like the, thelaggards that are not great
clinicians.
Um is, does the CARES Actincentivize or de-incentivize
(13:23):
those really high performingclinicians that are like like
that?
That one in Nevada say thatthey were in Utah.
I guess, how does the UtahCARES Act interact with the
clinicians, the people doing thecare?
Dr Tim Jackson.
Speaker 2 (13:38):
It goes back to what I was talking about quality.
I'll give you an example thatdates back a few years in
central Utah, a small communityhospital in Ephraim.
There was a family doctor therewho's a friend of mine.
He was in the middle of hiscareer as the primary care
doctor in this small Utah townand he noticed that people who
(13:59):
got pneumonia in his communitywere not doing well.
They were dying more often thanthey should.
They were sicker than theyshould be.
He did some research.
He figured out what was missing, what had to happen, what
transformation did the systemneed so that people didn't have
these pneumonia-related problemsso much?
And he wrote a protocol.
(14:21):
He went to all of hiscolleagues, all the other
physicians in the community whowere at the hospital, and they
all signed on and said you'reright, this is a great protocol,
we will follow it.
Then he went to the hospitaladministrator, who likewise
signed on and said the hospitalstaff will also follow it.
January 1st the following yearthey started the protocol and
within a short period of timethey had dropped the number of
(14:44):
people who requiredhospitalization for pneumonia by
half.
They had dropped the number ofhospital bed days for those who
had to be admitted to thehospital by two-thirds.
The costs also fell by half forthe care of pneumonia.
The problem that the hospitaladministrator had was that the
reimbursement rates from theprivate for-profit insurance
(15:05):
companies fell even more thandid the actual cost of care.
So the hospital took afinancial hit for doing the
right thing for the patients.
Now what that says in thecurrent system in the United
States is, if you're a hospitaladministrator and you're trying
to make a profit which a numberof hospitals are for profit in
(15:26):
Utah, and the ones who are not-for profit, act like they're for
profit.
Speaker 1 (15:31):
Yeah, yeah, I was going to say the only difference
between a oh yeah, go ahead.
Speaker 2 (15:36):
I was saying the only difference between a oh he's
coming up.
This hospital administratorrealized something that's
important about the currentAmerican healthcare system, and
that is if you want to make themost money, you let your
pneumonia patients get as sickas possible so you can sell
those ICU beds where you makemore profit.
And our proposal, utah Cares,flips that on its head.
(15:58):
What we will tell the hospitaladministrators is doctors and
nurses know how to deliver bestcare.
My friend, that family doctor.
He can help you write theprotocol.
Doctors know what they're doing.
Turn them loose and let them dothe right thing for the
patients.
You're going to be paid on abasis of what it costs to do the
right thing for patients.
You're not going to be paidhowever much you can bill for
(16:20):
selling as many ICU bed days.
That's the transformation we'retalking about.
Speaker 1 (16:26):
Yeah, I've seen in the skilled nursing world kind
of the same thing where becauseof reimbursements, especially
during COVID, they got a bad rapand kind of understandably so,
where there was a lot of skillednursings that would try to say,
(16:47):
oh, they have COVID or theyhave something as quickly as
they can to get them into ahigher paying thing, to make
more profit, and then they'rekeeping them longer.
So it's the same idea of like,help the people and that's the
whole point.
Speaker 2 (17:01):
Yeah, nursing homes are a great skilled nursing
homes are a great example ofanother problem in related to
quality of care, and that is,labor is viewed not as the way
to deliver care, but as anexpense that hits your bottom
line and prevents you fromprofiting as much as possible.
So they dumbed down the laborforce and they reduce it.
(17:21):
People in skilled nursingfacilities are not getting the
care they need and they'recertainly not getting the skill
level at the bedside that theyneed.
What we're going to say tothose facilities is what does it
cost to really care for thesepatients?
What do you need to do to makesure the nurses have the support
that they need, that therearen't too many patients
(17:42):
assigned for each nurse, thatthe nurse doesn't have to do
heavy lifting without the propernumber of people at the bedside
to assist?
How do we make sure that thisgoes well, not just for the
patients but for the nurses?
That's what we'll pay as anoperating budget for the
hospitals and the nursing homesand other facilities and they
don't get to, you know,interdict there and make their
(18:05):
profits the driving decisionmaker for all of these other
insider decisions that they make, these other insider decisions
that they make.
Speaker 1 (18:12):
Yeah, it sounds like it could be really revolutionary
and awesome.
I'm curious what's the toughestor the biggest pushback that
you've gotten while advocatingfor this reform, and how are you
kind of navigating that to tryto actually get it pushed
through legislatively?
Speaker 2 (18:30):
Well, the most common , most consistent over many
years now and I've been in thisadvocacy business for 30 some
odd years is people are worriedabout what they refer to as
socialism.
Isn't this socialized medicine?
And the first response to thatis to say no.
Actually socialized medicine iswhere the government owns and
(18:51):
operates all of the facilities,employs all the professionals,
like the United Kingdom has itsNational Health Service, which
is a socialized health system.
The hospitals are owned by thegovernment and the nurses and
doctors are employed by thegovernment.
That's not what we're proposing.
There is a socialized healthcare system in the United States
.
It's called the VeteransHospital System.
(19:12):
We're not proposing toreplicate VA for everybody else
in the country.
It will be privately ownedhospitals, privately delivered
health care, but publicly funded.
And my answer back to themabout well, isn't that socialism
?
I said we've been doing publicfunding of health care for 75
years.
I'm not inventing that.
I'm just making sure that thepublic money isn't being
(19:33):
diverted away to windfallprofits in the health insurance
industry and in the hospitalsand pharmacies.
I'm just making sure that thatmoney is being spent actually
for the care of patients in thehighest quality manner.
That's what we're doing.
And furthermore, just becausesomething is publicly funded
doesn't mean it's a bad thing.
We don't have a constitutionalright to asphalt.
(19:56):
It doesn't exist anywhere inour Constitution.
And yet we have asphalt on theground between my house and the
White House, such that I candrive there without paying a
toll, accessible to allAmericans.
And we don't call it thesocialized highway system of
America.
That's just nonsense.
That's public funding allAmericans, and we don't call it
the socialized highway system ofAmerica.
That's just nonsense.
That's public funding.
Privately built roads okay, andyeah, we still maintain them
(20:19):
with public funding, but mostlyit's we hire private contractors
to go do the work.
That's what we're talking aboutPublic funding.
Private delivery of care.
Speaker 1 (20:30):
Yeah, that's a really good analogy.
Deliberate delivery of careyeah, that's a really good
analogy.
Like just recently in myneighborhood they redid the
water pipes, the water main.
It's kind of an older communityand the city paid for it, but
it was a private constructioncompany out there for three
months working on theneighborhood.
So it's a good, good analogy.
(20:50):
You've been in advocacy, like Isaid, for over 30 years.
What are some of the biggestimprovements, some of the
biggest like wins, the magnumopus or whatever, of all of your
advocacy so far?
And then what are the biggest?
I guess we've been talkingabout the biggest hurdle that
(21:11):
you have from now lookingforward, but now looking back,
what have been some of thebiggest gains that you've seen
realized?
Speaker 2 (21:18):
The biggest event in the entire 30-year career has
been the writing, the draftingof this legislation.
We were able to get a member ofthe Utah legislature to open a
bill file and work with him, astate senator, nate Bluen.
We worked with him and thestaff at the Legislative Council
(21:38):
Bureau, which works for thelegislature, to draft this
statute so we can actually putit out there, put it in front of
the people of Utah and ask thequestion do you believe that
every Utahn should have accessfinances for medically necessary
care?
Do you think that every childshould get well child care
financed, et cetera?
(21:59):
That's the ask.
We finally have it all cogentlyput together.
That's been our most importantmilestone and I'm really very
proud of it.
We've placed that statute inits entirety on our website,
utahcareshealth.
Anybody can read it and anybodycan comment about it.
We're anxious to connect withthe people of Utah and say this
(22:20):
is what it could be.
Speaker 1 (22:23):
Yeah, I like that.
And so the next step for youguys, it's to get a bunch of
people to sign.
Oh my gosh, I'm spacing on whatit's called A yeah, oh, a
ballot.
Ok, cool, yeah, to get them.
So next voting, which the nexttime everybody goes out to the
polls Governor's office, whichis what's required under state
(22:54):
of Utah statutes.
Speaker 2 (22:56):
She referred the statute to the office of the
legislative fiscal analyst,which is also required.
They did their review andpublished what turned out to be
a very terse, short fiscalimpact statement and all it said
was this could cause the stateof Utah to go in the red by as
(23:18):
much as $8 billion a year, whichis totally bogus.
We carefully did three economicstudies that back up that what
we have proposed actually willbe fiscally sound.
The state of Utah will not goin the red at all.
But the Office of the FiscalAnalyst totally ignored our
(23:39):
economic studies.
Now I turned back after we gotthat statement from them.
I turned back to the LieutenantGovernor's office and said well
, what does that mean?
Are you going to allow this togo forward and make us so that
we have to explain why thefiscal analyst is wrong?
And the answer initially wasyeah, we'll allow you to go
forward.
We were still seriouslyconsidering this ballot
(24:02):
initiative.
We had, under Utah statutes, 20calendar days to appeal that
fiscal analysis, but it had tobe done in court and I didn't
want to spend the money onattorneys to go to the court
because that's a lot of money.
And I thought well, if they'regoing to let it go forward
anyway.
We'll make the court of publicopinion the place where we make
our arguments.
(24:23):
On the 20th day the day ourright to appeal was foreclosed,
the lieutenant governor reversedherself and said no, in fact,
that fiscal analysis meansyou're out.
We're denying your applicationfor a ballot initiative.
So now we're in the position ofhaving to appeal that decision.
There's been recent news, forinstance, about litigation that
(24:46):
resulted from ballot initiativesin 2018.
And there have been otherpeople who've applied for 2026
ballot initiatives, like we did,who are appealing to the state
Supreme Court.
So we're now in the business oftrying to raise funds so that
we can sue the state of Utah inthis Utah State Supreme Court to
reverse this very arbitrary andcapricious decision by the
(25:08):
lieutenant governor.
That's where we're at right now.
We're not giving up.
We want the people to join us.
Speaker 1 (25:15):
How do you stay motivated?
You've been in it for 30 years.
Things like this I'm sure havecome up a lot along the way.
What keeps you?
Speaker 2 (25:26):
motivated.
It's an arduous, difficult,long-term problem.
If it were just me alone, Iwould probably just give up.
I mean, it is virtuallyimpossible.
Sometimes it feels that way.
My main motivation is quitesimple I'm a man of faith.
I'm a believer in Jesus ofNazareth, and he went about
(25:48):
healing.
He didn't charge forpre-existing conditions and he
didn't have denials based onprior authorization and he
didn't charge deductibles.
He basically said to peoplebring me your sick and injured
and I will heal you.
He taught all Christians how togo about taking care of the
(26:11):
sick and he said if you visitedthe least of these, including
the ill, you've done it unto me.
This is what motivated theopening of the first three
hospitals in Utah.
The Episcopal Diocese openedthe first hospital, the Catholic
nuns of Sisters of the HolyCross opened the second hospital
and the LDS Church opened thethird hospital, all because of
(26:33):
that call from Jesus of Nazarethto care for the sick.
That is a call that I hear andI feel in my heart and it's why
I can't give this work up.
I know that's what Christ wouldwant us to do.
We must care for the sick.
Nobody must be excluded.
There are four to five hundredthousand events every year in
(26:53):
Utah where somebody desperatelyneeds care and can't afford it
because of the fact that theydon't get care, that half a
million people.
We have 2,000 deathsunnecessary in Utah every year
and that is unconscionable.
Those are 2,000 stories that weneed to tell and turn to all of
the others in Utah and say canyou stand there and do nothing?
(27:15):
I can't Join us and let's getthis done because we can afford
it.
Speaker 1 (27:21):
Yeah, powerful, that was powerful On that.
Who should reach out and how dothey reach out to get involved
in the Utah Cares Act?
Speaker 2 (27:29):
We would love to welcome all Utahns to our
website.
Again, that'swwwutahcareshealth.
We'd love to have you comewhere you can find the economic
studies, the statute itself,where you can learn more about
what's underpinning our proposal.
I post a lot of differentthings, either through op-ed
(27:51):
pieces that get published, linksto the film.
We have our own podcast peoplecan listen to, but, most
importantly, you can join us.
You can volunteer, you can tellus your story so we can help
people connect through yourstory to the need for this
change, and you can donate.
As I said, we need to be ableto hire an attorney, so we need
funds right now.
As I said, we need to be ableto hire an attorney, so we need
(28:12):
funds right now.
Again, it's wwwutacareshealth.
Speaker 1 (28:19):
Awesome, joe or Dr Jarvis.
It's been really a pleasurechatting for this last half hour
.
Yeah, everybody, I think shouldreach out and go to
wwwutacareshealth.
I think it's an awesomemovement.
Speaker 2 (28:32):
Thanks so much for your time.
Appreciate it.
Thanks, thanks.
Welcome back to the Senior Care Academy podcast.
Today we are sitting downtalking to Dr Joseph Q Jarvis, a
physician, a public healthleader, a former state health
officer and longtime advocatefor meaningful health care
reform.
Dr Jarvis has spent decadesworking in medicine, public
health and policy, seeing thesystem from every angle as a
clinician, as a regulator, ateacher and as a patient
(00:30):
advocate.
He's also the author ofmultiple books on healthcare
reform and the producer of thedocumentary Healing Us or US.
Today we'll dive into the UtahCARES Act.
What it is is, why it mattersand how it could change the way
that we think about health carein Utah and beyond.
Joe, thanks so much for sharingsome time with us today.
(00:51):
I'm excited to talk to you.
Thanks for inviting me on.
I appreciate it very much.
yeah, I always like to startgiving the audience kind of a
rundown on you.
So you studied English beforeyou became a physician.
How did storytelling andEnglish just talk about that and
how it shaped the way that youtalk about healthcare reform?
(01:11):
And I think a unique thing ishow you're able to express that
in writing with your books andeverything like that.
I think a lot of times you havephysicians that can't express
it and then you have authorsthat don't know the problem well
enough.
So you have a cool balance thatcan express it and then you
have authors that don't know theproblem well enough.
Speaker 2 (01:25):
So you have a cool balance.
As an English major, I enjoyedvery much some of the authors
and poets out there in historywho were physicians, and enjoyed
reading their insights.
William Carlos Williams, forinstance, wrote some short
stories about being apediatrician in New Jersey, and
Keats, a very famous romanticpoet, was a physician.
(01:46):
Unfortunately died very youngof tuberculosis.
But more important than that,stories are how people connect
with the important things ofhuman life.
Fiction has a lot of truth init, even though it's not the
truth per se, it's a story.
So stories really makesomething real for people that
(02:09):
they can embrace, hold on to,change their life around.
And that is so true ofsomething as important as
changing how we do healthcarebusiness.
All big movements in the UShistory were fueled by
storytelling.
Yeah, from civil rights to theway we voted and who voted, to
(02:32):
our current issues in theAmerican political scene.
Speaker 1 (02:35):
And even all the way back to the Declaration of
Independence.
We sent this letter off toEngland saying, hey, we're not
part of you anymore.
You know stories Yep.
Part of you anymore?
You know stories, yep.
Um, you've worn a lot of hats,uh clinician, regulator, teacher
(02:55):
, educator, writer.
Um, which role do you thinktaught you the most about what's
broken in the healthcare system?
And then, what's your favoritestory so far that you've been
able to tell about that to tryto cause?
I agree so much that, like you,can throw facts and figures and
numbers and big scary numbers,but it's when you go back and
that big scary numbersassociated with this individual
and how it changed their lifethat it actually moves people to
(03:16):
action.
So I'm curious what's rolesshaped your thoughts?
Um, and then, which story haveyou been most proud about?
Trying to reform care in the US?
Speaker 2 (03:27):
Well, I love being a doctor who had my hands on
patients, a clinician.
That was a very importantformative role.
Going through medical training,I was a family doc first,
before it was anything else inhealth care, but the role that
taught me that there werefundamental flaws that were
literally killing Americans wasthe role of state health officer
(03:48):
in Nevada.
That's where I went frombelieving, like most Americans
do, that we do everything well,perhaps fast, and that our
health care was better thananyone else's.
That's where I realized that infact is not the case.
Anyone else.
That's where I realized that infact is not the case, and a
(04:08):
story from that time that kindof epitomizes this.
One of my roles as a statehealth officer was to regulate
hospitals how they did,especially the most highly tech
sort of services like newbornintensive care, and I went to
visit the newborn intensive careunit in Las Vegas because we
were trying to write regulationsthat would keep that level of
care high and consistent.
(04:29):
The hospital where the bestnewborn intensive care unit was
in Nevada was a for-profithospital.
They also had good trauma careand we were trying to write
regulations to improve traumacare in Nevada at the same time
and had just published ourregulations and asked hospitals
to apply for the privilege ofbeing the leading hospital in
(04:51):
trauma care.
This hospital, the one with thebest newborn intensive care was
where the president of theUnited States would have been
taken if he had had some kind oftraumatic event happen while he
was visiting Nevada.
So it was good.
Trauma care is clearly the best, but it didn't apply for the
designation.
I ran into the CEO of thehospital while I was there and I
(05:13):
said you've embarrassed thestate health department.
We have these regulations ontrauma.
We need a good leading hospital.
Your hospital obviously fitsthe bill, but you didn't apply.
The ones that did failed thetest and we don't have a trauma
system because of that.
Why, and he said, you regulateus for how many beds we're
(05:33):
allowed to open to patients?
You give us the privilege ofhaving as many as 430 patients.
We routinely staff up to about330 patients.
We routinely staff up to about330 patients.
If a paying patient comes toour emergency room, our
emergency room staff is trainedto open up a bed, call in a
nurse and admit that patient.
(05:54):
If, however, a patient comes tothe emergency room and can't
pay for the bed, then we tellthem that we're closed, we're at
our limit and they are divertedelsewhere.
Tell them that we're closed,we're at our limit and they are
diverted elsewhere.
So your regulations requiredthe lead trauma hospital to take
care of all patients withtrauma regardless of ability to
pay, and I'm a for-profithospital.
(06:14):
I can't afford to takenon-paying patients, so we're
not going to be your leader.
And in that moment of honestyby this guy, he was basically
saying his hospital was notabout caring for people, it was
about making as much money aspossible.
I realized, hey, we have amajor problem on our hands.
Speaker 1 (06:34):
Yeah, that's a huge problem, especially because it's
like a it's a little bit of adouble-edged sword, where you
have they're the very best, um,and there's a reason why, but,
and they're making the profitand they're all that.
But then on the other side ofthe sword you have the fact that
, yeah, they have capacity andall these things, but the person
(06:55):
can't pay.
They're turning like it's avery interesting thing because
on the one side, if they takethe non-paying customers,
they're helping them, but thenwho knows what happens on the
other side?
They lose money, so they're notas good.
I don't know.
It's interesting.
Speaker 2 (07:10):
You have to think about this a little bit
differently.
That non-paying customer issomebody who probably doesn't
have health insurance forwhatever reason, and there are a
lot of reasons why that mightbe the case and not be the fault
of the person, but you can alsosay about that person that he,
as well as all other Americans,are the world's highest paying
taxpayers for healthcare.
(07:31):
We pay for healthcare primarilythrough our taxes.
That person is paying theworld's highest taxes for health
care and they're being turnedaway at their moment of need for
care.
Speaker 1 (07:43):
That's just wrong.
Speaker 2 (07:44):
What we need is a system that recognizes that
we're already spending enough tohave high-quality care for
everyone and not turn peopleaway.
That's what we need.
Speaker 1 (07:55):
Yeah, on that note, if someone asked at dinner party
to explain the Utah CARES Actin like 60 seconds, how would
you explain that and how doesthat feed into this bigger issue
of health care reform?
Speaker 2 (08:14):
The first, the Utah CARES Act, does three things
already existing high quality,very efficient payer of health
care called the Public EmployeesHealth Plan into a universal
all residents of Utah healthplan.
We renamed it Utah Cares.
So that is a very simplestatutory transformation because
it exists as a privatenonprofit trust fund existing at
(08:38):
the behest of the people ofUtah to pay for public
employees' health care.
And we'll just simply change itand say it'll pay for all
Utahns' health care.
So that's number one.
Number two we supervise thatnew entity, the Utah CARES Plan,
with a new commission, the UtahHealth Systems Commission.
We give that commission, whichwill be seven commissioners
(09:00):
appointed by the governor,approved by the Senate.
We give that commission, whichwill be seven commissioners
appointed by the governor,approved by the Senate, we give
them the power to overseeeverything about health care,
adjudicate all health caredisputes, make all health care
plans, budget for health care.
We want them to be responsiblefor making sure the health
system runs smoothly and isaccountable to all of the people
of Utah, which is what itexists for.
(09:20):
And number three is we recreatehow we finance health care.
Most of the money, as I'vealready said, is public money
and we take all of that money,which is mostly federal, and
channel it to Utah Cares.
The amount of money thatcurrently comes from private
employers and privateindividuals and is paid in for
(09:41):
health care, we will replacewith what we're calling the Utah
Cares premium, which is a newgross receipts tax that will be
levied on all transactions inUtah, whether for goods or
services Very small percent,like less than 3%, and that
money will then be divertedpermanently solely to take care
(10:03):
of healthcare needs.
We will therefore tellemployers from after this is
fully implemented.
You don't have to pay for thehealthcare of your employees.
You're done.
You're out of the business oftrying to finance healthcare.
You can just work on yourwidgets or whatever it is that
you provide as a business.
So those are the three things.
That's what I'd say in 60seconds.
Speaker 1 (10:24):
I love that.
It's a very interesting conceptas far as where you're getting.
So if Utah passes the UtahCARES Act, what would that look
like for the everyday patient?
It's like everybody in Utah iscovered under it.
They don't need to go and shopAetna and da-da-da-da-da like
all of them, Bringing it all theway back down to the ground
(10:46):
floor.
John Smith, down the road, whatdoes that look like for him?
Speaker 2 (10:52):
Well, john Smith doesn't anymore.
I mean, he never did needhealth insurance.
What John Smith needs is care.
Speaker 1 (10:58):
He doesn't need health insurance.
Speaker 2 (10:59):
So we get rid of that middleman, that useless,
wasteful, highly bureaucraticinstitution.
That's a unique Americanphenomenon that is wasting 500
billion of our dollars everyyear.
They're gone.
They don't have to worry aboutthat.
They're employed.
Where they're employed, how oldthey are, what race they are,
(11:21):
where they live in the state ofUtah, they will have financing
for medically necessary care.
What they need to do is picktheir doctor and I don't care
who it is, any licensedphysician will do and if they
need a physical therapist oroccupational therapist, et
cetera, et cetera.
They pick their therapist,whoever they want to go see, and
if their doctor says you needto be in a hospital, pick their
(11:41):
therapist whoever they want togo see.
And if their doctor says youneed to be in a hospital, then
whatever they he and you knowJohn Smith and his doctor decide
for the hospital, they get togo there.
There will be no out-of-pocketexpense at the time of care.
You don't have a deductible,you don't have a premium to pay,
you don't have a co-payment orco.
-insurance.
Nothing will no financialbarrier to getting the care that
(12:02):
you or your family member needs.
Furthermore, the hospital andother institutions will be
tasked with delivering the bestcare possible.
One of the real flaws of ourAmerican health care system is
we only do mediocre care.
We have more preventable deathsin the United States by far
than any other first worldnation, and that's because we
(12:22):
focus so much on the buck thatwe're not actually taking care
of the people who come in thedoor.
We do the right thing abouthalf the time for the American
patient.
So John Smith will get the caredone right the first time and
therefore it'll be lessexpensive and John Smith will be
in better health.
Yeah, john Smith will be inbetter health.
Speaker 1 (12:40):
Yeah, in your documentary Healing Us, you
talked about very openlycritical on the profit-driven
medicine.
So the Utah CARES Act, how doesit push against that Like?
What does that look like?
Now, going back to theclinician and the hospital, how
does?
I guess my one, the mainquestion, is like how does the
(13:01):
Utah cares act?
Um, right, you have the bellcurve, you have the, the 10%,
top highest performingclinicians, you have the 64% and
then you have, like the, thelaggards that are not great
clinicians.
Um is, does the CARES Actincentivize or de-incentivize
(13:23):
those really high performingclinicians that are like like
that?
That one in Nevada say thatthey were in Utah.
I guess, how does the UtahCARES Act interact with the
clinicians, the people doing thecare?
Dr Tim Jackson.
Speaker 2 (13:38):
It goes back to what I was talking about quality.
I'll give you an example thatdates back a few years in
central Utah, a small communityhospital in Ephraim.
There was a family doctor therewho's a friend of mine.
He was in the middle of hiscareer as the primary care
doctor in this small Utah townand he noticed that people who
(13:59):
got pneumonia in his communitywere not doing well.
They were dying more often thanthey should.
They were sicker than theyshould be.
He did some research.
He figured out what was missing, what had to happen, what
transformation did the systemneed so that people didn't have
these pneumonia-related problemsso much?
And he wrote a protocol.
(14:21):
He went to all of hiscolleagues, all the other
physicians in the community whowere at the hospital, and they
all signed on and said you'reright, this is a great protocol,
we will follow it.
Then he went to the hospitaladministrator, who likewise
signed on and said the hospitalstaff will also follow it.
January 1st the following yearthey started the protocol and
within a short period of timethey had dropped the number of
(14:44):
people who requiredhospitalization for pneumonia by
half.
They had dropped the number ofhospital bed days for those who
had to be admitted to thehospital by two-thirds.
The costs also fell by half forthe care of pneumonia.
The problem that the hospitaladministrator had was that the
reimbursement rates from theprivate for-profit insurance
(15:05):
companies fell even more thandid the actual cost of care.
So the hospital took afinancial hit for doing the
right thing for the patients.
Now what that says in thecurrent system in the United
States is, if you're a hospitaladministrator and you're trying
to make a profit which a numberof hospitals are for profit in
(15:26):
Utah, and the ones who are not-for profit, act like they're for
profit.
Speaker 1 (15:31):
Yeah, yeah, I was going to say the only difference
between a oh yeah, go ahead.
Speaker 2 (15:36):
I was saying the only difference between a oh he's
coming up.
This hospital administratorrealized something that's
important about the currentAmerican healthcare system, and
that is if you want to make themost money, you let your
pneumonia patients get as sickas possible so you can sell
those ICU beds where you makemore profit.
And our proposal, utah Cares,flips that on its head.
(15:58):
What we will tell the hospitaladministrators is doctors and
nurses know how to deliver bestcare.
My friend, that family doctor.
He can help you write theprotocol.
Doctors know what they're doing.
Turn them loose and let them dothe right thing for the
patients.
You're going to be paid on abasis of what it costs to do the
right thing for patients.
You're not going to be paidhowever much you can bill for
(16:20):
selling as many ICU bed days.
That's the transformation we'retalking about.
Speaker 1 (16:26):
Yeah, I've seen in the skilled nursing world kind
of the same thing where becauseof reimbursements, especially
during COVID, they got a bad rapand kind of understandably so,
where there was a lot of skillednursings that would try to say,
(16:47):
oh, they have COVID or theyhave something as quickly as
they can to get them into ahigher paying thing, to make
more profit, and then they'rekeeping them longer.
So it's the same idea of like,help the people and that's the
whole point.
Speaker 2 (17:01):
Yeah, nursing homes are a great skilled nursing
homes are a great example ofanother problem in related to
quality of care, and that is,labor is viewed not as the way
to deliver care, but as anexpense that hits your bottom
line and prevents you fromprofiting as much as possible.
So they dumbed down the laborforce and they reduce it.
(17:21):
People in skilled nursingfacilities are not getting the
care they need and they'recertainly not getting the skill
level at the bedside that theyneed.
What we're going to say tothose facilities is what does it
cost to really care for thesepatients?
What do you need to do to makesure the nurses have the support
that they need, that therearen't too many patients
(17:42):
assigned for each nurse, thatthe nurse doesn't have to do
heavy lifting without the propernumber of people at the bedside
to assist?
How do we make sure that thisgoes well, not just for the
patients but for the nurses?
That's what we'll pay as anoperating budget for the
hospitals and the nursing homesand other facilities and they
don't get to, you know,interdict there and make their
(18:05):
profits the driving decisionmaker for all of these other
insider decisions that they make, these other insider decisions
that they make.
Speaker 1 (18:12):
Yeah, it sounds like it could be really revolutionary
and awesome.
I'm curious what's the toughestor the biggest pushback that
you've gotten while advocatingfor this reform, and how are you
kind of navigating that to tryto actually get it pushed
through legislatively?
Speaker 2 (18:30):
Well, the most common , most consistent over many
years now and I've been in thisadvocacy business for 30 some
odd years is people are worriedabout what they refer to as
socialism.
Isn't this socialized medicine?
And the first response to thatis to say no.
Actually socialized medicine iswhere the government owns and
(18:51):
operates all of the facilities,employs all the professionals,
like the United Kingdom has itsNational Health Service, which
is a socialized health system.
The hospitals are owned by thegovernment and the nurses and
doctors are employed by thegovernment.
That's not what we're proposing.
There is a socialized healthcare system in the United States
.
It's called the VeteransHospital System.
(19:12):
We're not proposing toreplicate VA for everybody else
in the country.
It will be privately ownedhospitals, privately delivered
health care, but publicly funded.
And my answer back to themabout well, isn't that socialism
?
I said we've been doing publicfunding of health care for 75
years.
I'm not inventing that.
I'm just making sure that thepublic money isn't being
(19:33):
diverted away to windfallprofits in the health insurance
industry and in the hospitalsand pharmacies.
I'm just making sure that thatmoney is being spent actually
for the care of patients in thehighest quality manner.
That's what we're doing.
And furthermore, just becausesomething is publicly funded
doesn't mean it's a bad thing.
We don't have a constitutionalright to asphalt.
(19:56):
It doesn't exist anywhere inour Constitution.
And yet we have asphalt on theground between my house and the
White House, such that I candrive there without paying a
toll, accessible to allAmericans.
And we don't call it thesocialized highway system of
America.
That's just nonsense.
That's public funding allAmericans, and we don't call it
the socialized highway system ofAmerica.
That's just nonsense.
That's public funding.
Privately built roads okay, andyeah, we still maintain them
(20:19):
with public funding, but mostlyit's we hire private contractors
to go do the work.
That's what we're talking aboutPublic funding.
Private delivery of care.
Speaker 1 (20:30):
Yeah, that's a really good analogy.
Deliberate delivery of careyeah, that's a really good
analogy.
Like just recently in myneighborhood they redid the
water pipes, the water main.
It's kind of an older communityand the city paid for it, but
it was a private constructioncompany out there for three
months working on theneighborhood.
So it's a good, good analogy.
(20:50):
You've been in advocacy, like Isaid, for over 30 years.
What are some of the biggestimprovements, some of the
biggest like wins, the magnumopus or whatever, of all of your
advocacy so far?
And then what are the biggest?
I guess we've been talkingabout the biggest hurdle that
(21:11):
you have from now lookingforward, but now looking back,
what have been some of thebiggest gains that you've seen
realized?
Speaker 2 (21:18):
The biggest event in the entire 30-year career has
been the writing, the draftingof this legislation.
We were able to get a member ofthe Utah legislature to open a
bill file and work with him, astate senator, nate Bluen.
We worked with him and thestaff at the Legislative Council
(21:38):
Bureau, which works for thelegislature, to draft this
statute so we can actually putit out there, put it in front of
the people of Utah and ask thequestion do you believe that
every Utahn should have accessfinances for medically necessary
care?
Do you think that every childshould get well child care
financed, et cetera?
(21:59):
That's the ask.
We finally have it all cogentlyput together.
That's been our most importantmilestone and I'm really very
proud of it.
We've placed that statute inits entirety on our website,
utahcareshealth.
Anybody can read it and anybodycan comment about it.
We're anxious to connect withthe people of Utah and say this
(22:20):
is what it could be.
Speaker 1 (22:23):
Yeah, I like that.
And so the next step for youguys, it's to get a bunch of
people to sign.
Oh my gosh, I'm spacing on whatit's called A yeah, oh, a
ballot.
Ok, cool, yeah, to get them.
So next voting, which the nexttime everybody goes out to the
polls Governor's office, whichis what's required under state
(22:54):
of Utah statutes.
Speaker 2 (22:56):
She referred the statute to the office of the
legislative fiscal analyst,which is also required.
They did their review andpublished what turned out to be
a very terse, short fiscalimpact statement and all it said
was this could cause the stateof Utah to go in the red by as
(23:18):
much as $8 billion a year, whichis totally bogus.
We carefully did three economicstudies that back up that what
we have proposed actually willbe fiscally sound.
The state of Utah will not goin the red at all.
But the Office of the FiscalAnalyst totally ignored our
(23:39):
economic studies.
Now I turned back after we gotthat statement from them.
I turned back to the LieutenantGovernor's office and said well
, what does that mean?
Are you going to allow this togo forward and make us so that
we have to explain why thefiscal analyst is wrong?
And the answer initially wasyeah, we'll allow you to go
forward.
We were still seriouslyconsidering this ballot
(24:02):
initiative.
We had, under Utah statutes, 20calendar days to appeal that
fiscal analysis, but it had tobe done in court and I didn't
want to spend the money onattorneys to go to the court
because that's a lot of money.
And I thought well, if they'regoing to let it go forward
anyway.
We'll make the court of publicopinion the place where we make
our arguments.
(24:23):
On the 20th day the day ourright to appeal was foreclosed,
the lieutenant governor reversedherself and said no, in fact,
that fiscal analysis meansyou're out.
We're denying your applicationfor a ballot initiative.
So now we're in the position ofhaving to appeal that decision.
There's been recent news, forinstance, about litigation that
(24:46):
resulted from ballot initiativesin 2018.
And there have been otherpeople who've applied for 2026
ballot initiatives, like we did,who are appealing to the state
Supreme Court.
So we're now in the business oftrying to raise funds so that
we can sue the state of Utah inthis Utah State Supreme Court to
reverse this very arbitrary andcapricious decision by the
(25:08):
lieutenant governor.
That's where we're at right now.
We're not giving up.
We want the people to join us.
Speaker 1 (25:15):
How do you stay motivated?
You've been in it for 30 years.
Things like this I'm sure havecome up a lot along the way.
What keeps you?
Speaker 2 (25:26):
motivated.
It's an arduous, difficult,long-term problem.
If it were just me alone, Iwould probably just give up.
I mean, it is virtuallyimpossible.
Sometimes it feels that way.
My main motivation is quitesimple I'm a man of faith.
I'm a believer in Jesus ofNazareth, and he went about
(25:48):
healing.
He didn't charge forpre-existing conditions and he
didn't have denials based onprior authorization and he
didn't charge deductibles.
He basically said to peoplebring me your sick and injured
and I will heal you.
He taught all Christians how togo about taking care of the
(26:11):
sick and he said if you visitedthe least of these, including
the ill, you've done it unto me.
This is what motivated theopening of the first three
hospitals in Utah.
The Episcopal Diocese openedthe first hospital, the Catholic
nuns of Sisters of the HolyCross opened the second hospital
and the LDS Church opened thethird hospital, all because of
(26:33):
that call from Jesus of Nazarethto care for the sick.
That is a call that I hear andI feel in my heart and it's why
I can't give this work up.
I know that's what Christ wouldwant us to do.
We must care for the sick.
Nobody must be excluded.
There are four to five hundredthousand events every year in
(26:53):
Utah where somebody desperatelyneeds care and can't afford it
because of the fact that theydon't get care, that half a
million people.
We have 2,000 deathsunnecessary in Utah every year
and that is unconscionable.
Those are 2,000 stories that weneed to tell and turn to all of
the others in Utah and say canyou stand there and do nothing?
(27:15):
I can't Join us and let's getthis done because we can afford
it.
Speaker 1 (27:21):
Yeah, powerful, that was powerful On that.
Who should reach out and how dothey reach out to get involved
in the Utah Cares Act?
Speaker 2 (27:29):
We would love to welcome all Utahns to our
website.
Again, that'swwwutahcareshealth.
We'd love to have you comewhere you can find the economic
studies, the statute itself,where you can learn more about
what's underpinning our proposal.
I post a lot of differentthings, either through op-ed
(27:51):
pieces that get published, linksto the film.
We have our own podcast peoplecan listen to, but, most
importantly, you can join us.
You can volunteer, you can tellus your story so we can help
people connect through yourstory to the need for this
change, and you can donate.
As I said, we need to be ableto hire an attorney, so we need
funds right now.
As I said, we need to be ableto hire an attorney, so we need
(28:12):
funds right now.
Again, it's wwwutacareshealth.
Speaker 1 (28:19):
Awesome, joe or Dr Jarvis.
It's been really a pleasurechatting for this last half hour
.
Yeah, everybody, I think shouldreach out and go to
wwwutacareshealth.
I think it's an awesomemovement.
Speaker 2 (28:32):
Thanks so much for your time.
Appreciate it.
Thanks, thanks.
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