Robert Goff joins Jason Hartman to talk about the medical debt crisis. Robert is the author of “End Medical Debt: Curing America’s $1 Trillion Unpayable Healthcare Debt.” He discusses what co-insurance is and why it’s not helping like we believe it does. Jason and Robert also tackle the ‘if clause’ and ‘share the dollars’ between the surgeons and assistant surgeons. They also discuss a solution to end the overall problems and what the government can do to mitigate the issue.
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Welcome to the Holistic Survival Show with Jason Hartman. The economic storm brewing around the world is set to spill into all aspects of our lives. Are you prepared? Where are you going to turn for the critical life skills necessary to survive and prosper? The holistic survival show is your family’s insurance for a better life. Jason will teach you to think independently to understand threats and how to create the ultimate action plan. sudden change or worst case scenario, you’ll be ready. Welcome to holistic survival, your key resource for protecting the people, places and profits you care about in uncertain times. Ladies and gentlemen, your host, Jason Hartman.
Jason Hartman 1:00
It’s my pleasure to welcome Robert Goff. He is the author of a few books, including end medical debt, this is obviously a huge problem in our society. And so we’re going to talk about it today, what it means for healthcare, the future of healthcare, and what you might be able to do about it, if you have have experienced or are experiencing a medical debt crisis. Robert, welcome. How are you?
Robert Goff 1:24
Quite well. Jason, thank you so much for having me.
Jason Hartman 1:26
Good to have you on. So how big is this problem?
Robert Goff 1:30
So nationally, there, it’s estimated there’s a trillion dollars worth of consumer medical debt out there.
Jason Hartman 1:37
Okay. So that’s, that’s just slightly smaller than the student loan scam, which is about a trillion for now, I believe. So that’s a big deal when you’re looking at a country with a GDP of around 20 trillion give or take. Medical debt is a huge, huge part of this, right?
Robert Goff 1:54
It’s a huge part of it, but probably most concerning to people is the lack of awareness that Americans unless they are extremely poor and covered by Medicaid, or extremely rich, are really one accident or one illness away from potential financial ruin, because of medical debt.
Jason Hartman 2:14
Is that true? They have insurance, though.
Robert Goff 2:16
Yes, absolutely.
Jason Hartman 2:17
So tell us about that. Now, most people have insurance and they’re thinking, Well, I have insurance. I don’t have to worry about this.
Robert Goff 2:23
And they don’t. And they don’t read the policy. And they don’t see the limitations. But there are several things that occur. One of them is that we have moved back into high deductibles. Additionally, many policies have coinsurance and other limitations in terms of how you use the health care system. So you see several things occurring. First deductibles. If you look at the obama care programs that were put up, most people don’t realize that those plans all are based upon one a deductible, that deductible for many people is not affordable. And secondly, they are not 100% coverage after that deductible. The most common one sofa plan is really built around, only 80% of your healthcare needs being covered, insured and protected for those. So if you’re if you look at it, the US Treasury is said that 47 47% of Americans could not come up with $400 in an emergency. Yet the vast majority of people in this country now have deductibles between 1002 $1,000. So the deductible alone creates a financial hardship. On top of that, you have these limitations where there’s coinsurance of running to 20 30%. Were like Medicare without the wraparound policy, the patient’s Bible then for 20 to 30% of the bill,
Jason Hartman 3:50
So explain coinsurance to us.
Robert Goff 3:53
So coinsurance says, I, the insurance company will cover let’s say 80% of the cost you the patient are responsible for 20%. That’s the way Medicare was built. Medicare is not 100% coverage for people over 65.
Jason Hartman 4:11
Right. But isn’t coinsurance only up to a certain deductible limit?
Robert Goff 4:14
Ah, no, because what you have is you have the deductible, which is a front end loaded. And then there is the coinsurance and then the question is whether or not there’s a stop loss. Many of these plans, most of these plans don’t have stop losses with a person can literally have significant exposure.
Jason Hartman 4:33
So, so tell us about some of the weasel. So that’s the coinsurance there’s the deductible, the deductible doesn’t, you know, scare me too terribly much. deductible is $5,000 or whatever. So you know, you’re outside $1,000, right? Well, coinsurance could be expensive,
Robert Goff 4:49
The coinsurance and the other part, which is extremely scary is the, shall we say structural deficiencies in coverage. So the you’ve bought a policy that says we’ll cover you if and the if is only if you use certain contracted providers. So an individual says I have to go in for surgery, I made sure my hospital was par with my network. I made sure my surgeon was par with the network. Did you ask them about the assistant surgeon? Did you ask about the anesthesiologist? Did you ask about the radiologist?
Jason Hartman 5:25
Well, when my mom had surgery a few years ago, she said when they wheeled her into that operating room, she couldn’t believe how many people were in there. There we’re probably 20 people in that operating room. Yeah, I mean, it’s not your responsibility as the patient to understand all that you’re Are you contracting with the hospital? Or
Robert Goff 5:45
Well, no. So what are the odd things that we have in this country is the physicians are separately contracted from the hospitals? Yeah, we do not get a global rate. You know, in any other business, you would say, I’m contracting with you to do a job. And it’s full and complete. And if you have to use subcontractors to build that, in addition on my house, that’s fine. But you general contractor, I’m paying you. You talk.
Jason Hartman 6:09
And so the way that works in contracting, because I know all about real estate, is you get what’s called a lien release from all these subcontractors to protect you from them coming back and filing a mechanic’s lien on your property. Now, you know, this can get murky, of course, like everything, everything for complicated anymore. It’s unbelievable that go ahead.
Robert Goff 6:30
But in a hospital situation, no, there is no obligation for the physician to participate in the same insurance plans as the hospital. And what times makes things worse, and actually does make it worse is hospitals give exclusive contracts to anesthesiology, groups, radiology groups and voluntary groups. They don’t have to participate with your insurance. So you have no choice but to use them. And generally you don’t know, you know, this going in. And then all of a sudden, you find out when the bills come in, your insurance says, well, gee, you’re out of network coverage is limited. And or there is no out of network coverage. And then you end up with a battle, you know, whose responsibility wasn’t? where, you know, where is the obligation of the patient towards the obligation of the hospital? Where’s the obligation of the physicians involved? We’ve seen a situation such as a hospital that has a small group of four surgeons, the surgeons intentionally participate in different insurances. When they get a phone call from the hospital’s er that says we need a surgeon to show up, they send the one who is not par with that patient’s insurance, because it allows the physician to build whatever they want. Now, because in New York State, many other things, if you go through the emergency room, the insurance must cover you for the full thing. Yeah.
Jason Hartman 7:59
That’s the emergency room. Not outside of that.
Robert Goff 8:03
Right, this is so this is so when you look at it when it’s the person most vulnerable in the emergency. The regulations in New York and other states say well, gee, you can hold the patient Bible. So the providers in this case cut a little deal among themselves for enrichment. You had a case in Long Island, where a neurosurgeon was par with Edna. But he always brought in a friend of his who was an out of network provider, the bills for the assistant surgeon, were five times more than the participating surgeon. And you know, the word was behind the scenes, they were, you know, kind of hearing the dollars, both kinds of exploitations, put the patient at risk, put, you know, and put the healthcare system at risk. It’s an exploitation, it’s inappropriate. You have another point that there there’s another point I just want to make in terms of when it comes to exposure. Because people when you set it, you have $5,000 deductible. So what well, in New Hampshire, there was a report that came out of Dartmouth That said, the freestanding laboratory CPC basic blood test, ran $15 right. The hospital at least lab work ran $150. Now, if your physician is in independent private practice, they have a tendency to use private clinical labs, $15. If they are employed by the hospital, shall we say this a tendency to use the hospital lab, $50. Now, you just you with your $5000 deductible, which yes you can afford, you’re writing a check for $150 now. Increase the health care costs, absolutely no change in clinical outcome.
Jason Hartman 9:50
So what do we do?
Robert Goff 9:54
Here varieties for on an individual level. The first thing you have to do is understand what your health plan is actually covers.
Jason Hartman 10:02
How many pages do we have to read and try and understand to figure that out?
Robert Goff 10:07
Well, so in theory, and most policies do have a summary page upfront, that is pretty clean and clear that says this is what your deductible is, this is what your coinsurance is, this is what the network limitations our take a look at it. And then start off with understanding that deductible. And if you need to prefunded, put the money aside, make sure you know it. If you can’t afford to write a check for $2000 $5,000 great. But if you can’t just write a check to that side, well, not bad idea to put some money aside,
Jason Hartman 10:38
You do recommend medical savings accounts?
Robert Goff 10:42
I like medical savings accounts, because it allows you to pre fund that deductible, debt exposure plus the transferable they grow tax free. And is you know, people that I know who’ve had them for years, they’ve now changed jobs, it converts into the ability to take it out in retirement. So I do happen to like them, but they’re not available to everyone, and then still have to go fund them.
Jason Hartman 11:06
So save money for your health.
Robert Goff 11:09
secondly, if you are going to have care, make sure to the best of your ability that you stay within the network. Yes, it does mean asking questions. Especially if you’re entering into a facility of any kind. We we’ve seen gastroenterologist who say Oh, we’ll do your colonoscopy, we’ll use my ambulatory center, that ambulatory center may or not be par with your insurance, you need to check those out. Should you have to know in my mind, must you to protect yourself? Yes. If you’re going to have any kind of concern about the cost, be upfront with your physician. Physicians know and will work with patients in terms of trying to keep the cost down. So as I said, the physician who may be an employee of a hospital that says Gee, use the CAT scan, or is the hospital, when you say well, gee, Doctor, you know, I’m concerned about the cost knows full well where they can get a CAT scan on a private provider that’s less costly. You work with them in that regard.
Jason Hartman 12:15
I mean, this is just absurd that people should have to do this when they’re sick.
Robert Goff 12:20
I agree.
Jason Hartman 12:20
You know, I mean, life is hard enough. It’s just unbelievable. You know, if you had your way, what would be the overall solution to just end all these problems forever? Would you say government healthcare single payer? Or would you say some other system, let insurance companies sell across state lines to make the market more competitive? Or what I mean, look, you know, if you keep, I’ll just give you a little more meat to answer the question. Okay. And then then we’ve got to wrap it up. But part of the problem here definitely is that the patient is detached from the payment. I mean, when I go to the doctor, because I have insurance, if the doctor says, Well, this app, I’m like, yeah, just run every test, I don’t care. I’m not paying for it, you know, but if I go to get my dog, you know, care at the vet, I’m paying for it. So I’m paying attention, I’m a better consumer. And now granted, you might make a bad decision in front of corners and save money. That’s the scary part of it. But consumers need to be engaged in the process, but not in the way that you’re talking about the way you’re talking about is like they’re just literally defending themselves from their insurance company.
Robert Goff 13:29
Well, they should not have to defend themselves in the system. Unfortunately, I hate to say it they do. I, in a perfect world, that wouldn’t be necessary. In the short term, the best we can do is demand transparency. So that when it comes to asking the question should be, what’s the price? What’s it gonna cost me? Most insurance companies now have online calculators where you can go in and say, my physician has recommended a colonoscopy? What’s it going to cost me given all the limitations?
Jason Hartman 14:02
And I gotta say, Robert, love them or hate them. But Trump’s bill or executive order or whatever he did a couple of months
Robert Goff 14:10
Transparency. Yes.
Jason Hartman 14:11
Yeah, that is gonna happen. It’s just sick that hasn’t happened already. So you have a slump on that one?
Robert Goff 14:19
Yeah. On that one, absolutely positively. By the way, he also did a very nice job regarding end stage renal disease and changes in terms of that program for which he’s not getting the credit he deserves.
Jason Hartman 14:30
The media that hates him will never give him any credit.
Robert Goff 14:35
We, because end in stage renal disease is a good example of what’s gone wrong. Dialysis in this country, 80% of the people being treated in inventory settings very costly. Yet in most countries or advanced countries, you’re talking about 80% of them being either transplanted or in-home dialysis much less costly, better quality. But first, your question in the short term, transparency is a must. Asking questions is a must as well. In the long term, we have to break the oligarchy and the monopoly of the healthcare systems and these institutions that are buying up every component of the healthcare delivery system. And what happens in an institutional setting, Medicare is a fixed revenue stream, they really don’t have the ability increase the revenue with that. Medicaid, they lose money on
Jason Hartman 15:25
Well, they do all kinds of Medicare fraud,
Robert Goff 15:29
Well, legally, even legally, you can’t survive on Medicaid rates, it’s states have tried to balance their budget on the back of Medicaid provides. So the institution says, Look, if I’m the big dog in town, I’m the oligarchy, I’m the monopoly, I’m going to get it by demanding higher reimbursement rates from the commercial payers. And if I employ the physicians, I’m going to demand more higher rates for them to that translates into higher rates. What I would like in a more perfect world, if you will, is for the healthcare reimbursement structure to reward a providing system that is not dominated by the most costly element of the system. If money comes into the healthcare system, and the big talk is the institution, then everything is going to fund the institution and the institutional interests. preventative care is not going to be pursued. routine care is not high on their agenda, public health issues and non on an institution’s agenda. The institution’s agenda is to capture as much of revenue as possible. As a result, the things that could reduce costs, improve access, primary care, preventative care, routine care care of chronically ill, is really underfunded. And it’s not going to be funded, as long as the bulk of the dollars can be consumed by the institution.
Jason Hartman 16:55
So what do we do? What’s the solution? So it’s not let them buy up the supply chain.
Robert Goff 17:00
So in the short term, it’s to take them take and put them on, in my mind a fixed budget, that would limit me that would basically stop their ability from continuing to capture monopolize, and to put the control of the system into organizations, whether you call them networks of some kind, that have a focus of avoiding avoiding costly care. Let me give you the example. If we were in manufacturing, we would look at what goes wrong in the process that makes the piece more costly to make. We shouldn’t be doing the same thing in healthcare, we should look at care and say, what’s the most costly component hospitalization? Where could we have intervened prior to hospitalization to avoid it to begin with, and put the efforts there? If that means doing something about prenatal care and poor communities? Let’s do that. So we don’t spend hundreds of 1000s millions of dollars in high risk neonates? It doesn’t make sense not to address the causes.
Jason Hartman 18:09
Yeah, so addressing causes rather than band aid. So yeah, you know, everyone would agree with that. But the problem is, you know, you can always kick that can down the road. And there’s, you know, that’s, that’s what happens in so many parts of society unfortunately,
Robert Goff 18:22
In the short run in the short term, we have to basically do something about the oligarchies and the continued consolidation, of power and control that is going into the most expensive component of healthcare delivery.
Jason Hartman 18:35
Robert, give out your website and tell people where they can learn more your book is available with great reviews, by the way, in all the usual places.
Robert Goff 18:41
So I appreciate that very much. The book really was written as was the earlier one, to support our charity, rip medical debt, www dot rip medical debt.org. What we do and what we look to do is hospitals take their uncollected debt, they sell it for pennies on the dollar, to collection companies who try to collect the whole dollar. We buy that, that as they would buy it, but we abolish it. And because of our stack status, we abolish it without it becoming a taxable transaction to the patient. We have abolished in excess of $2 billion worth of consumer medical debt.
Jason Hartman 19:21
Wow. That’s fantastic. Good stuff. Good stuff. All right. Robert, thank you so much for joining us,
Robert Goff 19:26
Jason, thank you so much for having me.
Jason Hartman 19:33
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