WEBVTT 1 00:00:00.120 --> 00:00:06.839 Madera Community Hospital is reopening after a two plus year hiatus, 2 00:00:07.960 --> 00:00:09.839 and I want to talk about what it means why 3 00:00:09.839 --> 00:00:13.640 I closed in the first place, why I'm not necessarily 4 00:00:13.679 --> 00:00:17.640 still hopeful for its long term stability, because some of 5 00:00:17.679 --> 00:00:24.199 the same problems that led to its closure are still around. 6 00:00:26.399 --> 00:00:31.519 And this is the California healthcare landscape that is kind 7 00:00:31.559 --> 00:00:35.920 of a creation of Gavin Newsom, where we have these 8 00:00:35.960 --> 00:00:41.560 sort of insoluble problems on the front end, we sort 9 00:00:41.560 --> 00:00:45.039 of do our best to kind of fix things on 10 00:00:45.119 --> 00:00:48.039 the back end with more government spending, but eventually I'm 11 00:00:48.079 --> 00:00:53.719 not sure how that's all going to work. So let 12 00:00:53.719 --> 00:00:58.479 me explain what I mean, okay, Madera Community Hospital. Madera 13 00:00:58.560 --> 00:01:03.119 Community Hospital suffered from a couple of different problems that 14 00:01:03.200 --> 00:01:06.000 led to its closure in December of twenty twenty two. 15 00:01:06.319 --> 00:01:09.480 One of the big problems was a lack of qualified nurses, 16 00:01:09.920 --> 00:01:14.599 so this resulted in Madair Community having to rely on 17 00:01:15.159 --> 00:01:20.040 travel nurses to cover up the gaps that they had. 18 00:01:20.159 --> 00:01:27.280 So basically, travel nurses are nurses from out of the area. 19 00:01:27.359 --> 00:01:30.120 They travel to different hospitals who need coverage, and you 20 00:01:30.200 --> 00:01:33.719 have to pay a lot of money for them. It's 21 00:01:33.760 --> 00:01:39.079 more expensive than just having your own nurses, so they 22 00:01:39.120 --> 00:01:40.959 had to spend a lot of money on travel nurses. 23 00:01:43.760 --> 00:01:51.200 But the main financial problem, the sort of fundamental problem. 24 00:01:51.519 --> 00:01:53.840 Maybe at some point we could address the nursing thing 25 00:01:55.599 --> 00:01:58.239 if we could produce more nurses out of you know, 26 00:01:58.239 --> 00:02:00.519 and this is one of the arguments FIR measure that 27 00:02:00.840 --> 00:02:03.040 local hospitals in the San Laque Valley don't have enough 28 00:02:03.079 --> 00:02:06.560 nurses and that maybe Measure E could help expand Prisno 29 00:02:06.640 --> 00:02:11.159 State's capacity to produce more nurses. Now, problem with Measure 30 00:02:11.199 --> 00:02:14.479 E was that it wasn't just funding nursing. It was funding, 31 00:02:14.560 --> 00:02:17.280 you know, expanding the football stadium and just a bunch 32 00:02:17.280 --> 00:02:22.159 of other basically doing construction on everything at Frisno State. 33 00:02:22.800 --> 00:02:25.080 And I don't know that enough people were really in 34 00:02:25.120 --> 00:02:27.199 favor of an increased sales tax to pay for all 35 00:02:27.240 --> 00:02:30.240 those things. I think if Measurrey had actually just been 36 00:02:30.280 --> 00:02:35.240 focused on some of the aspects of Fresno State's life 37 00:02:35.240 --> 00:02:38.840 that produce more engineers, more nurses, et cetera, then maybe 38 00:02:38.840 --> 00:02:41.719 people would have been more open to it. But that's 39 00:02:42.159 --> 00:02:44.400 that was one of the difficulties with Measure E was 40 00:02:44.439 --> 00:02:49.080 it was in general just funding for building improvements at 41 00:02:49.080 --> 00:02:53.319 Fresno State in general, not just for the nurses and 42 00:02:54.159 --> 00:02:57.199 engineers that the proponents of Measury were putting forward. Anyway, 43 00:02:59.039 --> 00:03:02.080 even if you address the problem with not having enough 44 00:03:02.159 --> 00:03:06.759 nurses in the San Joaquin Valley, there's this problem which 45 00:03:06.800 --> 00:03:12.599 is medical, medical and the fundamental unsustainability of medical that 46 00:03:12.680 --> 00:03:22.680 Gavin Newsom has only made more unsustainable. Why well, California 47 00:03:22.719 --> 00:03:29.199 is the most overtext state in the Union. Medical is 48 00:03:29.240 --> 00:03:33.039 a payer, So within the circle of life within healthcare, 49 00:03:34.080 --> 00:03:41.840 you have the three p's payers, providers, patients. The payers 50 00:03:42.520 --> 00:03:53.000 are the insurance companies, including government payers like medical Medicare, Medical, 51 00:03:53.120 --> 00:03:57.599 though is the most significant of these. Medical is government 52 00:03:57.759 --> 00:04:03.560 funded health insurance health care coverage for anyone who is 53 00:04:03.680 --> 00:04:10.479 under a certain income threshold, a certain household income threshold, 54 00:04:12.639 --> 00:04:15.960 so they are a payer. Then you have the provider, 55 00:04:16.079 --> 00:04:18.639 which is the doctor or the nurse practitioner who is 56 00:04:18.680 --> 00:04:24.439 the one providing the service to the patient. Now, the 57 00:04:24.519 --> 00:04:29.519 patient may pay a health insurance premium for his or 58 00:04:29.519 --> 00:04:33.360 her health care, or the patient's work might pay that 59 00:04:33.439 --> 00:04:37.399 health insurance premium for the patient goes to the pay or. 60 00:04:39.920 --> 00:04:42.000 But in the case of medical patients, they're not paying 61 00:04:42.000 --> 00:04:46.879 that much that they're not paying that the government's paying that. Okay, 62 00:04:47.439 --> 00:04:49.639 So that's the circle of life. You have the payers, 63 00:04:51.519 --> 00:04:55.600 the health insurance company medical, you have the providers, you 64 00:04:55.600 --> 00:05:00.639 have the patients. The providers give the service to the patient. 65 00:05:00.839 --> 00:05:04.120 The patient pays their premium to the payer or not 66 00:05:04.240 --> 00:05:09.839 in the case of the medical, patient or taxpayers pay 67 00:05:09.959 --> 00:05:15.560 for effectively the healthcare to medical, and then the payers 68 00:05:16.199 --> 00:05:25.800 pay the providers for their services. Now, medical is funded 69 00:05:26.839 --> 00:05:33.800 partially by California state taxpayer dollars, partially by federal taxpayer dollars, 70 00:05:36.040 --> 00:05:42.360 and there is a limited pool of that money. California 71 00:05:42.439 --> 00:05:48.680 is already the most overtaxed state in the Union. There's 72 00:05:48.879 --> 00:05:52.519 just not any more water we can twist out of 73 00:05:52.519 --> 00:06:00.040 this rock. Okay. We also have lost taxpayer revenue in 74 00:05:59.800 --> 00:06:08.000 California since COVID. A lot of wealthy people who were 75 00:06:08.000 --> 00:06:11.199 paying a lot of money either in income tax or 76 00:06:11.240 --> 00:06:16.160 in capital gains tax, said enough of this, I'm out 77 00:06:16.160 --> 00:06:19.240 of here. I'm going to Nevada, there's no state income tax. 78 00:06:19.240 --> 00:06:23.720 I'm going to Arizona. I'm going to Florida. I'm going 79 00:06:23.720 --> 00:06:26.839 to Texas, I'm going to Idaho, I'm going to Utah. 80 00:06:28.000 --> 00:06:32.160 People just left California and they took their tax revenue 81 00:06:32.160 --> 00:06:38.680 with them. So the pool of money for medical patients 82 00:06:39.279 --> 00:06:46.079 is not getting any bigger, and yet the pool of 83 00:06:46.199 --> 00:06:52.600 people eligible for health insurance under medical has grown. This 84 00:06:52.639 --> 00:06:55.639 is the fruit of decisions Gavin Newsom made. Gavin Newsom 85 00:06:55.759 --> 00:06:57.680 ran for governor. What did he run for governor on? 86 00:06:57.720 --> 00:06:59.560 He ran for governor on the promise that he would 87 00:06:59.560 --> 00:07:04.000 do a single payer health care system. So in California, 88 00:07:04.199 --> 00:07:10.279 get rid of all the payers except for one. Have 89 00:07:10.360 --> 00:07:17.399 a state government run health insurance system cal care or 90 00:07:17.439 --> 00:07:21.639 whatever you want to call it, where you get rid 91 00:07:21.639 --> 00:07:24.519 of all the private insurance payers, get rid of all 92 00:07:24.560 --> 00:07:29.199 that no one gets has private health insurance. Everyone is 93 00:07:29.240 --> 00:07:39.199 covered under one payer, a single payer. Now, as a result, 94 00:07:39.319 --> 00:07:42.680 if everyone is covered under a single payer, what does 95 00:07:42.680 --> 00:07:48.560 that mean, Well, it means that everyone's money, whatever money 96 00:07:48.959 --> 00:07:53.160 is being paid right now by your job to cover 97 00:07:53.279 --> 00:07:55.639 your health insurance premium, instead, that would go to the 98 00:07:55.639 --> 00:07:59.800 government to fund this massive pool of money for providing 99 00:07:59.839 --> 00:08:03.120 health insurance for everyone in the state, every single one 100 00:08:03.160 --> 00:08:05.360 of you whose job pays for your health insurance. Instead, 101 00:08:05.680 --> 00:08:08.639 imagine all of that money, all of your taxes, and 102 00:08:08.720 --> 00:08:12.439 all of that money all going into one pool for 103 00:08:12.560 --> 00:08:21.639 covering everyone in the state, so everyone gets calcare. Now, 104 00:08:22.639 --> 00:08:24.519 I'm not here to say single payer health care is 105 00:08:24.560 --> 00:08:28.439 a great idea. There are plenty of examples of it 106 00:08:28.600 --> 00:08:32.039 not being a great idea in many respects. However, it 107 00:08:32.120 --> 00:08:38.399 does have a certain financial sensibility to it. It does 108 00:08:38.600 --> 00:08:43.399 kind of the math works out fairly well. It doesn't 109 00:08:43.440 --> 00:08:46.200 work out so that everyone gets a Cadillac as far 110 00:08:46.240 --> 00:08:49.559 as the quality of their health insurance, but everyone can 111 00:08:49.679 --> 00:08:52.799 maybe get a Honda Civic as far as the quality 112 00:08:52.840 --> 00:08:58.799 of their health insurance. And it relies on basically the 113 00:08:58.799 --> 00:09:10.480 wealthy taxpayer paying for the non wealthy. There's a certain 114 00:09:10.519 --> 00:09:17.519 financial solubility to it, all right. Gavin Newsom was elected 115 00:09:18.039 --> 00:09:21.360 saying that that's what he wanted to do. In fact, 116 00:09:21.360 --> 00:09:25.279 he had these brash proclamations in twenty eighteen about all 117 00:09:25.399 --> 00:09:28.159 these liberal politicians who say they're going to support single payer, 118 00:09:28.159 --> 00:09:29.960 and then when the going gets tough, when they actually 119 00:09:30.000 --> 00:09:32.320 come time to do it, they say that it's too 120 00:09:32.360 --> 00:09:34.320 expensive or it's not the right time, and I'm not 121 00:09:34.320 --> 00:09:37.840 going to do that. And then that's precisely what he did. 122 00:09:38.440 --> 00:09:41.919 He didn't do it because it was too expensive, and 123 00:09:41.919 --> 00:09:43.840 the going got tough, and the health insurance companies got 124 00:09:43.879 --> 00:09:45.480 to him and convinced him not to do it. So 125 00:09:45.480 --> 00:09:50.000 what did he do instead? Newsom focused on the idea, well, 126 00:09:50.159 --> 00:09:52.960 I'm not gonna do single payer. The benefit of single 127 00:09:52.960 --> 00:09:57.159 payers that everyone's covered. But what I'll do is I'll 128 00:09:57.200 --> 00:10:01.480 attain universal coverage. I'll make sure everyone eligible for health insurance. 129 00:10:02.759 --> 00:10:11.200 And he did that by progressively expanding Medicaid eligibility medical eligibility. 130 00:10:12.080 --> 00:10:14.039 And why didn't he go for single pair? He didn't 131 00:10:14.080 --> 00:10:16.399 go for single payer because he realized it would require 132 00:10:16.519 --> 00:10:19.720 a massive tax increase to do it. It would be 133 00:10:20.159 --> 00:10:23.240 enormously expensive. Now, the argument might be, well, if you 134 00:10:23.399 --> 00:10:25.840 just take all the money that people pay in health 135 00:10:25.840 --> 00:10:30.080 insurance premiums and combine it with all the money they're 136 00:10:30.080 --> 00:10:32.360 spending in their taxes right now, it's really not actually 137 00:10:32.360 --> 00:10:35.159 that significant of a tax increase. Okay, you try selling 138 00:10:35.240 --> 00:10:37.240 that to the people, and you try being a politician 139 00:10:37.279 --> 00:10:45.000 who's up for reelection, and you try selling that anyway. 140 00:10:45.120 --> 00:10:48.799 Instead of a massive tax increase and a massive reshaping 141 00:10:48.840 --> 00:10:52.360 of California health care, Newsome instead off opted for what 142 00:10:52.559 --> 00:10:56.440 was really a half measure increase. The pool of medical 143 00:10:56.600 --> 00:10:59.279 eligible people. And this is sort of the trajectory that 144 00:10:59.279 --> 00:11:03.960 Democrats have been on since Obamacare, since Obama basically abandoned 145 00:11:03.960 --> 00:11:09.360 his single payer idea for the government option idea of 146 00:11:09.399 --> 00:11:12.320 you know, lots of heavily government subsidized plans for lower 147 00:11:12.360 --> 00:11:18.600 income people, and an expansion of Medicaid eligibility. So that's 148 00:11:18.600 --> 00:11:22.360 what Newsom did. He expands Medicaid eligibility, but he doesn't 149 00:11:22.519 --> 00:11:27.360 really expand revenue into the state, either by increasing taxes 150 00:11:27.759 --> 00:11:30.879 or doing whatever is necessary to spur economic growth to 151 00:11:31.440 --> 00:11:38.879 prompt more income into the state's coffers. So medical eligibility expands, 152 00:11:40.399 --> 00:11:47.279 we have more and more and more people becoming medical eligible, 153 00:11:48.519 --> 00:11:58.399 receiving healthcare through medical but we're not increasing the resources 154 00:11:58.440 --> 00:12:06.039 available to have the payer of medical pay providers for 155 00:12:06.159 --> 00:12:16.120 their services. More people getting healthcare, but not a proportionally 156 00:12:16.200 --> 00:12:19.519 increasing pool of money to pay for their health care 157 00:12:21.960 --> 00:12:25.960 as a result, and maybe the Coup de Gras, I 158 00:12:26.000 --> 00:12:29.960 don't know that we've really understood the full impact of it. 159 00:12:29.960 --> 00:12:34.879 The Coup de Gras was expanding medical eligibility to people 160 00:12:35.039 --> 00:12:38.480 regardless of their immigration status, which was like the last thing. Basically, 161 00:12:38.879 --> 00:12:45.639 people who aren't in the country. Legally, illegal aliens are 162 00:12:45.639 --> 00:12:54.679 eligible for medical, so further expanding the pool. So medical 163 00:12:54.840 --> 00:12:59.080 hasn't gotten more money to pay for the healthcare for 164 00:12:59.320 --> 00:13:05.120 more and more and more people. This results in providers 165 00:13:05.159 --> 00:13:09.320 getting very little money as far as reimbursement for the 166 00:13:09.320 --> 00:13:12.200 care that they give. And this was the fundamental problem 167 00:13:12.360 --> 00:13:20.559 with Madera Community Hospital. Maderic Community was serving mostly lower 168 00:13:20.600 --> 00:13:29.159 income patients who were on medical. It's really hard to 169 00:13:29.360 --> 00:13:36.120 make any money serving those patients. And depending on you know, 170 00:13:36.159 --> 00:13:40.120 some of it depends on what kind of reimbursement rates 171 00:13:40.159 --> 00:13:43.399 medical sets for you or for your region, what you 172 00:13:43.399 --> 00:13:49.759 can negotiate with medical. Some of it depends on what 173 00:13:50.600 --> 00:13:55.399 area of medicine you're talking about. For example, I mean, 174 00:13:55.840 --> 00:13:58.879 I know this within Obgyancare because of starting Ourobia Clinic 175 00:13:59.200 --> 00:14:04.000 that if you do a normal you know, a normal pregnancy, 176 00:14:05.000 --> 00:14:07.840 a normal, healthy pregnancy that results in a vaginal delivery, 177 00:14:09.519 --> 00:14:13.039 a medical reimbursement for sort of the global bill for 178 00:14:13.120 --> 00:14:15.600 services throughout the course of that pregnancy, including the delivery 179 00:14:15.759 --> 00:14:19.759 is about fifteen hundred dollars. A private insurance reimbursement is 180 00:14:20.080 --> 00:14:24.039 like three times that amount. If you have like Anthem, 181 00:14:24.039 --> 00:14:27.759 Blue Cross or something, or you know you're gonna your 182 00:14:27.799 --> 00:14:33.559 reimbursement's gonna be three times greater than that. That's how 183 00:14:33.679 --> 00:14:37.399 much we're talking. Is the difference between a private insurance payer, 184 00:14:38.200 --> 00:14:41.120 a private insurance company that's providing coverage for a patient 185 00:14:41.519 --> 00:14:49.399 and medical and Maderia Community Hospital couldn't sustain that. And 186 00:14:49.679 --> 00:14:52.240 this is a problem that you see with every single 187 00:14:52.360 --> 00:14:56.879 hospital in California. Like this is why I laugh when 188 00:14:56.919 --> 00:14:59.919 I hear these stories. You know, some folks we are 189 00:15:00.120 --> 00:15:03.960 using Valley Children's, Oh they is val You know, there's 190 00:15:04.000 --> 00:15:06.679 this story about Todd Centripack, the CEO of Valley Children's, 191 00:15:07.120 --> 00:15:09.759 and the compensation he was being given, and people thought, oh, 192 00:15:09.919 --> 00:15:12.480 he's receiving way too much money in compensation, that this 193 00:15:12.519 --> 00:15:14.720 is a disproportionately high amount of money that they're giving 194 00:15:14.720 --> 00:15:21.120 to their executives. And then someone raises the question, oh, well, 195 00:15:21.759 --> 00:15:26.360 is this because of medical fraud? Is Valley Children's misappropriating 196 00:15:26.799 --> 00:15:33.480 it's medical funding. No, Valley Children's gets money from medical 197 00:15:34.080 --> 00:15:38.240 as reimbursement for services they provide patient. What they get 198 00:15:38.240 --> 00:15:43.759 from medical is barely even covering their costs. Valley children 199 00:15:43.840 --> 00:15:46.320 is not making money off of medical patients. The reason 200 00:15:46.360 --> 00:15:49.279 why Valley Children's is doing well is because of one, 201 00:15:49.840 --> 00:15:54.759 donations and grants. Two because of their investment portfolio, which 202 00:15:54.759 --> 00:15:57.080 they've done a really good job of handling. That guy's 203 00:15:57.120 --> 00:15:59.399 like Todd Centrapack, have done a really good job of handling. 204 00:16:00.600 --> 00:16:02.120 And I guess I don't know what would you rather 205 00:16:02.240 --> 00:16:06.240 have a hospital that has a highly paid executive that's 206 00:16:06.559 --> 00:16:09.919 functioning really really well and doing financially really really well 207 00:16:09.960 --> 00:16:12.679 and therefore able to provide really great care for patients, 208 00:16:12.960 --> 00:16:16.200 Or would you rather have Madera Community Hospital going out 209 00:16:16.200 --> 00:16:18.960 of business for you know, two almost two and a 210 00:16:19.000 --> 00:16:27.840 half years. So that's the fundamental problem that led to 211 00:16:27.879 --> 00:16:33.799 Madera Community's closure. And yes, they got some loans, they 212 00:16:33.799 --> 00:16:38.399 got some state assistance, more state spending to help them reopen. 213 00:16:40.159 --> 00:16:44.320 But I guess I don't know if these fundamental economic 214 00:16:44.840 --> 00:16:50.320 and insurance market problems are really gonna be resolved When 215 00:16:50.360 --> 00:16:52.759 don't we return more of the problems that the sort 216 00:16:52.759 --> 00:16:56.759 of unsustainability of medical results in. That's next on the 217 00:16:57.399 --> 00:17:03.559 on the John Girardi Show. Madera Community Hospital is reopening. 218 00:17:05.119 --> 00:17:09.359 This is a result of basically zero interest loans from 219 00:17:09.559 --> 00:17:13.640 the State of California. The distressed Hospital Loan program, which 220 00:17:13.759 --> 00:17:17.720 Annacabairo and Esmuel Dasoria helped pass through the state legislature 221 00:17:18.119 --> 00:17:22.720 in twenty twenty three. This program awarded Madera Community Hospital 222 00:17:22.759 --> 00:17:26.359 a fifty seven million dollars zero interest loan to help 223 00:17:26.359 --> 00:17:31.160 it reopen. Now, my wife laughed when she read this. 224 00:17:31.559 --> 00:17:36.480 She's the management company that's running this, that's reopening the 225 00:17:36.480 --> 00:17:41.599 hospital is called American Advanced Management, which is a Modesto 226 00:17:41.640 --> 00:17:45.799 based hospital management firm, which said it is an updated 227 00:17:45.799 --> 00:17:51.039 workflow that will quote reduce wait times and overall patient outcomes. 228 00:17:53.799 --> 00:17:57.480 It will reduce wait times and it will reduce patient outcomes. 229 00:18:00.400 --> 00:18:02.920 I mean they've been reducing patient outcomes by having zero 230 00:18:02.960 --> 00:18:04.599 patients for the last you know, almost two and a 231 00:18:04.640 --> 00:18:06.880 half years. I mean, they've done a great job, clearly, 232 00:18:06.960 --> 00:18:09.480 the folks that have I really hope the folks at 233 00:18:09.519 --> 00:18:13.920 American Advanced Management are better at patient management than they 234 00:18:13.960 --> 00:18:18.559 are at copy editing. Because they're going to reduce weight 235 00:18:18.640 --> 00:18:25.200 times and reduce overall patient outcomes. What are they going 236 00:18:25.240 --> 00:18:27.960 to just pull the plug on any patient who's, you know, 237 00:18:28.319 --> 00:18:30.960 causing them any difficulties. What are we doing? We're reducing 238 00:18:31.039 --> 00:18:42.480 outcomes anyway, This problem that we've discussed with medical impact 239 00:18:42.680 --> 00:18:46.640 certain kinds of areas of medicine more acutely. And so 240 00:18:46.839 --> 00:18:50.240 the basic problem is we have too many medical patients, 241 00:18:50.559 --> 00:18:57.000 and our pool of taxpayer dollars to pay for health 242 00:18:57.000 --> 00:19:02.119 coverage for people on medical has not grown own proportionally 243 00:19:02.240 --> 00:19:06.519 to the pool of medical people. The pool of medical 244 00:19:06.599 --> 00:19:10.160 eligible people has grown since Obamacare was passed. It grew 245 00:19:10.200 --> 00:19:13.240 more under Gavenusom, and finally Gavenuwsom expanded it to include 246 00:19:13.640 --> 00:19:18.799 people who are here in the country illegally, so illegal aliens. 247 00:19:18.920 --> 00:19:23.920 So the pool of people eligible for medical covered by 248 00:19:24.000 --> 00:19:26.440 medical has grown and grown and grown and grown. But 249 00:19:26.640 --> 00:19:30.480 the tax revenue to pay for that insurance coverage that 250 00:19:30.519 --> 00:19:35.319 has not grown, that's stayed, you know, it hasn't grown proportionally. 251 00:19:35.960 --> 00:19:39.599 So as a result, the reimbursement that medical can give 252 00:19:39.720 --> 00:19:42.079 to a provider, a doctor, a nurse, pectition or whatever 253 00:19:42.319 --> 00:19:45.319 for providing a service to a patient who has medical 254 00:19:45.400 --> 00:19:49.880 coverage is less and less and less. And as a result, 255 00:19:49.960 --> 00:19:53.759 those doctors, those nurse practitioners, those hospitals, they can't make 256 00:19:54.240 --> 00:19:58.960 money off of medical patients, certain kinds of medical patients. 257 00:20:00.079 --> 00:20:07.039 By the way, here's one area where that's true. It's 258 00:20:07.160 --> 00:20:12.279 provision of obgyn care. You know, I've gotten to know 259 00:20:12.319 --> 00:20:14.640 about this by opening our Obria Clinic, which, by the way, 260 00:20:14.839 --> 00:20:19.480 for anyone who wants to go, Friday, March twenty first. 261 00:20:19.480 --> 00:20:22.240 This Friday, We're gonna have a great fundraiser for our 262 00:20:22.279 --> 00:20:25.640 Obria Clinic at the Toka Maderra Winery out in Madera. 263 00:20:26.160 --> 00:20:28.440 You can go to Obria three six five dot org 264 00:20:28.480 --> 00:20:32.480 Obria three six five dot org. It says for twenty 265 00:20:32.480 --> 00:20:35.079 twenty four. We miss stated on the website, but it's 266 00:20:35.079 --> 00:20:37.839 for twenty twenty five. You can click there. You can 267 00:20:37.839 --> 00:20:43.480 buy tickets, you can purchase a sponsorship. This Friday, March 268 00:20:43.519 --> 00:20:45.640 twenty first at the Toka Madera Winery. A really cool 269 00:20:45.680 --> 00:20:48.559 fundraiser for our Obria Clinic. I'd love to have as 270 00:20:48.599 --> 00:20:50.640 many of my John Gerardy Show listeners as possible go. 271 00:20:52.680 --> 00:20:54.920 But one of the things I've learned, basically is that 272 00:20:56.279 --> 00:21:02.200 medical reimbursement for pregnant women, who women having their babies 273 00:21:02.599 --> 00:21:05.640 is really poor. It's so poor that it results in 274 00:21:05.880 --> 00:21:08.480 more and more doctors just don't want to take medical 275 00:21:08.599 --> 00:21:10.799 patients for care, so you have more and more women 276 00:21:10.880 --> 00:21:14.440 on medical who need care. And fewer and fewer doctors 277 00:21:14.440 --> 00:21:17.359 who want to take them because they lose money off 278 00:21:17.400 --> 00:21:21.359 medical patients. Again, the reimbursement is like a third of 279 00:21:21.359 --> 00:21:23.640 what you would get for taking care of a woman 280 00:21:23.680 --> 00:21:31.119 who has private health insurance. AAM, the company that's running 281 00:21:31.240 --> 00:21:35.160 Maderia Community Hospital for its new opening, has announced that 282 00:21:35.200 --> 00:21:39.240 the hospital will be reopening without a maternity ward. So 283 00:21:39.359 --> 00:21:42.240 Minderic Community is not going to have a maternity ward. 284 00:21:44.039 --> 00:21:47.400 The hospital's reopening partner has said its main focus will 285 00:21:47.440 --> 00:21:51.880 be financial sustainability before it decides whether it can add 286 00:21:52.359 --> 00:21:57.920 maternity services. So this is the problem. This is the 287 00:21:57.960 --> 00:22:02.119 problem with medical right here, boiled right here. Certain kinds 288 00:22:02.119 --> 00:22:08.799 of areas of medicine are so unsustainable with medical that 289 00:22:08.880 --> 00:22:11.640 here where we're going to open a general hospital without 290 00:22:11.759 --> 00:22:16.440 maternity care, no maternity care services at Madeira Community when 291 00:22:16.480 --> 00:22:21.079 it reopens. Why because they've got to demonstrate some basic 292 00:22:21.160 --> 00:22:24.160 level of financial sustainability before they add in ob services, 293 00:22:24.200 --> 00:22:29.000 because that's even less financially sustainable. If you're taking a 294 00:22:29.000 --> 00:22:33.519 bunch of medical patients to deliver their babies, you're gonna 295 00:22:33.559 --> 00:22:41.279 lose money and no one. I feel like this is 296 00:22:41.480 --> 00:22:48.640 a huge problem that this unsustainability of medical being able 297 00:22:48.720 --> 00:22:54.200 to take care of pregnant women that nobody is addressing. 298 00:22:57.519 --> 00:22:59.480 When we return, I want to talk. I want to 299 00:22:59.480 --> 00:23:05.359 talk a little bit more about this, about this fundamental 300 00:23:05.519 --> 00:23:10.440 problem with caring for pregnant women and how it ties 301 00:23:10.480 --> 00:23:12.359 in a little bit with the abortion debate that's next 302 00:23:12.400 --> 00:23:16.400 on the John Gerardy Show. A couple of weeks ago, 303 00:23:16.559 --> 00:23:20.200 I had the privilege of I've been able to get 304 00:23:20.240 --> 00:23:25.519 a couple of articles published by National Review, and I'm 305 00:23:25.599 --> 00:23:28.759 kind of in their sort of orbit as someone I 306 00:23:28.880 --> 00:23:31.680 contribute articles to them occasionally. I've had three articles published 307 00:23:31.720 --> 00:23:36.440 by them as of now, and I had this longer 308 00:23:36.480 --> 00:23:40.599 piece I wrote about messaging the pro life movement and 309 00:23:40.680 --> 00:23:44.279 being directorate Right to Life. This is obviously something I've 310 00:23:44.279 --> 00:23:48.920 thought about a lot, and I think one of the 311 00:23:48.920 --> 00:23:55.880 difficulties pro lifers are facing is basically the way most 312 00:23:56.039 --> 00:23:59.079 people think about abortion in America, insofar as they think 313 00:23:59.079 --> 00:24:01.119 about it at all. That's my other thesis is that 314 00:24:01.440 --> 00:24:04.640 people just don't like thinking about the abortion issue in general, 315 00:24:05.319 --> 00:24:07.519 and so to the extent that they do think about it, 316 00:24:07.519 --> 00:24:09.720 they think about it in brief snatches in ways that 317 00:24:09.720 --> 00:24:16.680 aren't super fundamentally like logically consistent. People think of abortion 318 00:24:16.799 --> 00:24:21.279 like this. They see a pregnant woman facing a bunch 319 00:24:21.319 --> 00:24:25.799 of burdens or challenges or difficulties, and they think, gosh, 320 00:24:25.839 --> 00:24:28.240 that would be really hard for her to continue to 321 00:24:28.279 --> 00:24:30.000 be pregnant and to have this baby and to care 322 00:24:30.039 --> 00:24:33.759 for that baby, and they therefore think abortion would be 323 00:24:34.240 --> 00:24:40.880 a compassionate thing to alleviate those burdens. This ignores the fact, however, 324 00:24:40.920 --> 00:24:44.039 that seventy percent of women don't want to have the 325 00:24:44.079 --> 00:24:47.119 abortion they have. They would rather keep the baby, but 326 00:24:47.160 --> 00:24:50.599 they feel compelled to have an abortion by financial constraints, 327 00:24:50.759 --> 00:24:56.599 pressure from their partner, whatever, in some cases outright coercion. 328 00:25:00.880 --> 00:25:05.440 And I think one of the coercive forces that women 329 00:25:05.559 --> 00:25:13.720 face is a lack of health care access. Let me 330 00:25:15.000 --> 00:25:18.200 look at and I'm prompted to think about this, but 331 00:25:18.279 --> 00:25:21.039 the news. So we have this news that Maderk Community 332 00:25:21.079 --> 00:25:24.160 Hospital is going to reopen after over two years being closed. 333 00:25:24.279 --> 00:25:29.599 It's finally reopening. It's reopening without a maternity ward. And 334 00:25:29.680 --> 00:25:33.240 this plays into what I think is a really underdiscussed 335 00:25:33.359 --> 00:25:38.240 crisis in California, in particular that in this state that 336 00:25:39.200 --> 00:25:41.720 the state does so much to pat itself on the 337 00:25:41.759 --> 00:25:45.200 back for saying that they are champions of reproductive rights. 338 00:25:45.279 --> 00:25:48.160 Gavin Newsom did this again on his Stupid podcast when 339 00:25:48.160 --> 00:25:50.119 he was talking with Charlie Kirk. He said, oh yeah, 340 00:25:50.119 --> 00:25:52.319 as everyone. No, no one's a bigger champion of reproductive 341 00:25:52.400 --> 00:25:58.079 rights than me. They're not champions of quote reproductive rights. 342 00:25:58.119 --> 00:26:02.119 What they're champions of is abortion, which last I checked, 343 00:26:02.240 --> 00:26:08.519 is a non reproductive service. The point of it is 344 00:26:08.519 --> 00:26:13.400 so that you don't reproduce to actually help someone who 345 00:26:13.440 --> 00:26:16.039 would like to reproduce, who would like to have a child. 346 00:26:16.359 --> 00:26:18.960 I think California is doing a disastrous job, and a 347 00:26:18.960 --> 00:26:24.039 lot of it has to do with medical. Let's again 348 00:26:24.279 --> 00:26:27.440 the basic economics of what's wrong with medical right now? 349 00:26:27.480 --> 00:26:30.599 What's wrong? Why did Madeira Community Hospital go out of business? 350 00:26:31.519 --> 00:26:35.160 You have a growing pool of people covered by medical 351 00:26:35.720 --> 00:26:42.599 and the pool of money state taxpayer revenue that is 352 00:26:42.839 --> 00:26:48.400 used to fund medical reimbursement to doctors. That pool of 353 00:26:48.440 --> 00:26:52.119 money isn't growing proportionally to the number of people covered 354 00:26:52.119 --> 00:26:57.400 by medical So, as a result, the reimbursements that a 355 00:26:57.440 --> 00:27:04.920 doctor or a hospital gets for providing service, providing healthcare 356 00:27:05.559 --> 00:27:10.720 to a medical covered person, that amount of money is 357 00:27:10.799 --> 00:27:14.359 smaller and smaller and very often it's barely even covering 358 00:27:14.400 --> 00:27:20.319 the cost of providing the care to the patient. One 359 00:27:20.359 --> 00:27:26.359 of the fields of medicine where this is most acutely felt, 360 00:27:26.759 --> 00:27:30.440 where you're getting very little in reimbursement for the services 361 00:27:30.480 --> 00:27:39.880 you're providing is obstetrics care for pregnant patients. It's really 362 00:27:40.160 --> 00:27:44.920 expensive to provide that care, and the reimbursement you get 363 00:27:44.960 --> 00:27:50.000 from medical is not You're losing money. Very often, you 364 00:27:50.039 --> 00:27:52.440 are losing money unless you can find a way to 365 00:27:52.480 --> 00:27:54.799 structure your practice in a very precise way where you're 366 00:27:54.839 --> 00:27:59.440 basically just a factory line, just boom boom, boom boom, 367 00:27:59.440 --> 00:28:02.200 seing patient patient, patient, patient, patient, unless you can circle 368 00:28:02.240 --> 00:28:05.599 them through like cattle, and that's going to result in 369 00:28:05.640 --> 00:28:12.039 lower quality care. It's almost impossible to make money providing 370 00:28:12.200 --> 00:28:18.160 ob care to lower income women who are on medical 371 00:28:19.599 --> 00:28:23.799 and we see this with Maderic Community. Maderic Community Hospital 372 00:28:23.839 --> 00:28:28.839 is quote reopening, but they're not gonna have their maternity 373 00:28:28.880 --> 00:28:31.640 ward open. They're not going to open up their maternity 374 00:28:31.720 --> 00:28:41.720 ward for a little while until they can figure out Apparently, 375 00:28:42.279 --> 00:28:47.519 according to their statement from AAM, American Advanced Management, which 376 00:28:47.519 --> 00:28:50.799 is the modesto based hospital management company that's reopening the hospital. 377 00:28:51.359 --> 00:28:55.839 They said. This is from the Fresno b story. AAM 378 00:28:55.920 --> 00:28:58.880 has announced that the hospital will be reopening without a 379 00:28:58.960 --> 00:29:03.200 maternity ward. The hospital's reopening partner has said its main 380 00:29:03.240 --> 00:29:07.359 focus will be financial sustainability before it decides whether it 381 00:29:07.400 --> 00:29:20.440 can add maternity services. This is a major issue. If 382 00:29:20.440 --> 00:29:24.720 you're a pregnant, lower income woman in Madera and you're 383 00:29:24.759 --> 00:29:31.240 on medical, what the hell exactly are you supposed to do? 384 00:29:31.240 --> 00:29:34.519 Do you go to Merceed to get healthcare? Do you 385 00:29:34.599 --> 00:29:37.480 have to drive to Fresno to get healthcare? To find 386 00:29:37.559 --> 00:29:42.119 somebody who will take your baby? Guys, this is why 387 00:29:42.519 --> 00:29:45.640 I at Right to Life. I started our Obria clinic. 388 00:29:47.000 --> 00:29:51.200 There are fewer and fewer doctors willing to take medical 389 00:29:51.319 --> 00:29:56.160 patients for obgyncare again because it loses money. Let me, 390 00:29:56.480 --> 00:29:58.559 I mentioned this in the first segment, but I'll say 391 00:29:58.599 --> 00:30:03.480 it again. A lot of the health insurance billing for 392 00:30:03.680 --> 00:30:07.599 a pregnant patient for her obstetric care is done globally. 393 00:30:07.640 --> 00:30:10.279 It's sort of all of her patient visits plus the 394 00:30:10.319 --> 00:30:16.519 delivery for a normal vaginal delivery, a patient who has 395 00:30:16.599 --> 00:30:20.480 all of her exams, all of her inpatient you know, 396 00:30:20.920 --> 00:30:25.880 in clinic exams plus her delivery. Your medical reimbursement is 397 00:30:25.960 --> 00:30:30.200 somewhere around fifteen hundred bucks. Your private insurance reimbursement is 398 00:30:30.400 --> 00:30:37.640 three times that amount. Doctors are losing money on these 399 00:30:37.680 --> 00:30:39.960 medical patients and as a result, they're not taking them, 400 00:30:40.119 --> 00:30:42.400 and these women have fewer and fewer places to go. 401 00:30:42.599 --> 00:30:46.079