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The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 19 · 3 months ago

A Public Option for American Citizens

ABOUT THIS EPISODE

As a legislative strategy for a public health insurance option is starting to form in Congress, Ed Eichhorn and Dr. Tom Bellavia go over the questions posed in the discussion and what needs to be considered going forward. 

Music: 

"The Discovery" 

by The Lemming Shepards 

Exzel Music Publishing (freemusicpublicdomain.com) 

Licensed under Creative Commons: By Attribution 3.0 

http://creativecommons.org/licenses/by/3.0/  

Well, thank you for joining us today.Today, we're going to discuss an effort by Democrats in both chambers of theHouse and Senate to launch a public option. This is being led by the Senate:Health, education, Labor and pensions, chair, Pattie, Murray, a Democrat fromWashington and the House, Energy and Commerce Chair, congressman, frank,Plon, junior, a Democrat from New Jersey and in a recent article thatappeared in roll call. They are asking for support with a request forinformation to help decide on their legislative strategy. There are eightquestions that they are asking in this request for information. The firstquestion is: Who should be eligible for coverage through a public option? Howshould the benefits be structured? How should prices for health care items andservices be set? How could congress ensure that people enrolled in a publicplan have adequate access to providers? What type of premium assistance shouldbe available under a potential plan? What role states should have inadministering a federally run option? How might it interact with ManicariaMedicaid and how could a public option and address other health careobjectives like delivery system updates and reducing health and equities? We'rediscussing this today with Dr Tom Belive who's been with us several timesin the past to discuss important issues in health care. Doctor Belliveau is aproduct of a New York City, school system and graduated from New Yorkuniversities, Washington Square College, with the Bachelors in biology. Heimmediately entered the University of her own medical school and did his postgraduate training in medicine at the Hackensack University Medical Center,after serving in the United States army medical core in Texas and Virginiawhere he had reached the rank of major and also was chief of professionalservices at Kenner Army hospital, he returned to the attending staff atHackensack University Medical Center door. Belliveau has been an adviser toboth the State of New Jersey and federal governments on health careissues and was recently invited to serve as the chair of the New Jersey,Department of Health and Senior Services Task Force on Chronic KidneyDisease is board certified in Family Medicine and Correctional Medicine.He's a senior attending at the Department of Family Practice attendingat the Department of Medicine and associate professor at the Universityof Medicine and Dentistry of New Jersey, Doctor Belliveau, a member of the boardof Trustees of the New Jersey Academy of Family Practice and its foundation,the New Jersey Academy of Family Physicians in the American Academy ofFamily Physicians. He is chairman of...

Aster Health, providing hypoclineahealth information technology and application integration, services forphysicians, hospitals, patients and insurance providers. He has acted inmany additional organizations with philanthropic missions. Dr Belvi beganhis practice of family medicine and Woodridge and subsequently createdheights medical associates in Hasperena, where he still sees patients every day. Well, I want to thank you for forjoining me today, Dr Belliveau we'd like to discuss a new legislativeeffort. That's been introduced in both the Senate and the House bite thechairman of the Senate, health, education and labor and PensionsCommittee, Senator Patty, Mary and Congressman Frank Pelone, his chair ofthe Energy and Commerce Committee and they're interested in exploring theissues around setting up a public option legislatively and in an articlethat recently appeared in roll call. They asked for a request forinformation and they listed eight areas that they'd like to get responses on tohelp them to formulate their legislative activity. So I wanted toask you what you thought about these eight questions and, if you're ready tobegin, I ask you the questions. Okay, if I may just make a comment abouthealth care before we go on to this, when I was reviewing these questionshere about this public option of medicate for all and so on, it justbrings to mind that I think the public should understand why the federalgovernment is trying so hard to provide quality, health care and a much cheaperprice of possible, because the course of Salta United States is probablybetter than twenty percent of the Gd and causes a lot of havoc downstream oneverything the country does. The one thing that I recall, president trumpstaying about, Hel care was who knew that Helka was so complicated, and this area of medicate for Allandpublic option is just another attempt to try and resolve these issues ofHealth Carter for variety quality, heal care across the country. Well, these,in my opinion, so far that far gammit has tried to do, have not been verysuccessful throughout the last several years. The MS and Medicare especiallyhave tried various reimbursement programs and the attempt to get thetriple aim of you know: Better Quality, lower cost and patient satisfaction andadding the fourth name of a physician provide satisfaction which have beenunsuccessful. The amount of money, shave and ifamount of quality has been produced by the PEROGUES programs, has been here. Iconsider round in Lara, and we now know that the United States quality of careis about thirty seven to forty in the world, which is not a very good placeto be the amount of money that spent just leads me to believe that there aretoo many special interests in health care that are trying to make thingswork too many bureaucrats in it and so...

...on. So all these attempts are difficultand nobody is really shut down to have some comic sense attitude to this, andthat's how I spot with patients, legislatores positions and the public,but now referring to Medicare for all and for public option which another twoattempts to resolve the problem which I'm not so sure that they would besuccessful ether one in my opinion, medicate. All and whatever it is, it'sjust going to be too costly for the American government to sustain withoutsome input in that is, and you can't provide health care to people on asmall amount of money in today's world. It's the same problem that we have inthe Medica Monticle, where the states promise self care to the indigentpeople, but the health care that they get based on the amount of money. A lotof forth is poor and ill, and not very good in anybody's sense. Theunfortunate thing is that politicians don't want to fish up to that realityand I'm not sure there's not enough money to take care of all there, so itis a terrible problem, so any attendant at it. I welcome whether it's Medicataor public option to be desired. So the issue here is, you know, there's somepeople going to want public after we're not going to make everybody happy Tha'sfor sure, so some may one medicate for all so may want us to single payersystem. Some body want private insurance and son and it is toocomplicated to try to fit them all into one place. But as far as these thingsare concerned, if you're going to give health care, it has to be structurecorrectly. I think everybody has to have a stake in it. Patience have tostake in as well that as they have to be much more compliant andunderstanding why these broems are coming forth. So these two programs areof the public option so on WHO's going to use them because anybodyin different positions, every patients, an individual, every family- isdifferent, the briers a different financial status. So what does thegovernment really want? I provide to these people what has to be covered. Soif you're, an aftertone or your young female gonna have babies, you want tomake sure that obstancy of penal care is taking care of. Pashas is well takencare of all of injections and immunizations of taking care of thatthat little low for us. So it is a very difficult problem to answer thesequestions like this, and I think the senator and the congressman or s very intelligently, because these areserious questions to be answered so who should be eligible for the codes andpublic that action? If it's going to be a public action that should be comeright, its pery, Ger r, all then everybody has to be coin. How you goingto to say met the man. What are you going to? What are you going to carveout, I know and doing value base car we try to Carol, for instance, certaincancers or transplant medicine, because there's so high cost and can't be donein the valuable smile because they're so costin nobody's going to besuccessful at it. How advantage is to be structured again? That's got to takea lot of thought and read him out to to t actually with how is got to bestruction and how it could be working.

We will know that all these governmentprograms, no matter what they are- a fraud with danger and difficulty ingoing through the the regulations that imposed upon the health care industryto get to these things are no os. Are they going to eliminate all thesethings are or going to make it easier to do, but they're going to take theway to Barrys and they struck is, I think, a lot of use they choose have tobe considered here and how should the prices for healthy items as her as wesaid? Well, the government has that already they have a rock, they have asituation in which they said the prices. Are they correct, probably not andyou'll have arguments all all along the health industry are those reconversionsaren't a valuable at all, and then we have the issue of the course of theGlomerat on of his schools in this country who demand high prices becausethey answered to the in stachers. We don't have really too many not forprofit. Hospitals anymore, he's con elaberate on up not for profit. Theyonly think about the bottom mind so how we going to set these prices. Iremember the state in Maryland. I think that, no matter what e high school youwent to in Maryland, where it was John Happens or to Dun Caspo some town inMaryland, the prices were the same you that is still going on and now andthat's been written about quite a bit lately as a starting point on the issueof pricing in hospitals to expand to other states, but they've been doingthat since w thousand an foure. So this is such a political football. Okay, andmy feeling is- is that when he gets to health care, politicians are afraid to act. They are afraid of what thepublic is going to do if they probably think for any one minute that apolitician is going to take the way health care from them and any sense ofthe way they did in the water. So we have to overcome the fear ofpoliticians and be re Catchin, this issue and health care because we won'tgo for it at all. As I just mentioned, this has been for lifetime. It's beenmy entire lifetime in Messer, in my entire lifetime on medicine, where youhave hospitals, buying physicians, who now have to obey the laws andregulations of their voices and the stock holders, and no longer care andbe compacity caring for the patients, but following the doctrines of thecorporation which demands that they have referrals to only to themselves,because it's a bottom mind bowlar amount when you have that going on andyou eradicated the independent positions in the country. Patience in this country are nevergoing to get a fair share at good quality medicine. Why did usually thesehospital groups to all the advertising you can't go through a day would havingat least twenty ave ad rismas e radio for TV for all these hospital groups. You can tell me that every singlehospital op has the best cancer care of the country. Everybody has use news andwere report. I don't even know if they pay for that or not. The issue is, isthey have to advertise because they can't get out the quality of care on aface to face mouth? The mouth referrals from one person to another, we shouldbe the standard in health care so to...

...try and answer theach questions herefor Senator Murray and tamise prolonged they are difetto. So what will he stay?Seven administrations? How successful had been have they pen and then miseryin the medicate situation, which is in both the parcel of fifty percent inbetween the station and the federal government that hasn't worked out verywell at all. They have completely at odds and it carries all over thecountry and it varies all over the country. So how you going to get anational policy when all the states have different policies going on andlet's face it. The Administration of Medicare, I think, is about three percent and to taking care of this where private insurance is about fifteenpercent. Why is that different? You know. Where is the difference? That is,if I post, the prive insurances, have to pay stock, Ollers and dividends. Whyare we tranformed some of this enormous amount of money in advertising, worsecountry in health care, and let's put it into actually health, your delivery but say to six million dollar presidentof the hospital system salaried and make it more reasonable and take someof that money or the entire hierarchy of hospitals that has an awful load ofexecutives and caused and turned their money into health care? Why don't theycon shoulder, giving it in the State of New Jersey? I think- and I just don'thold me to the truth here, but we are very near the bottom and reimbursingthe doctor's heaters in any feral system. Okay, I think we get reimbursedhere in New Jersey, less in Alabama for Mer shippin. Could that matter? Okayand there's his reason for that as well. But all these issues have to be fixedbefore you really get a good public option and it has to be carefullythought out and has to be thought out without malice and prejudice, and Idon't know if clean get that between politicians and bury trash and somebodyto do that. So, although they try and and I recenti themen, the Englishmen and the understandin o trying to do this, but you know how is this delivery system,for instance, going to reduce half tone les? Why haven't they done that now,with all the programs they had here? They've had the AL programs on the CS.They have a program between the station, a federal government outcome. They cansixties and equites. The reason is that the cause of healthcare is enormous and add control, and every time you try to put a situationin where you want to reduce the post and to are still giving good quality.It fails because of special interest, and I would say that one of the specialinterest is to conabor tion of classical system. Suppose the countrywho become me toos to health plans and whatever they demand in price they haveto give them. Otherwise they can't be in the system of their health plan toattract patients which would be contopus to day, but in the physicianus for that matter, so trying to get a public option. It's the same problemover and over in this is a Ditto of what's gone on in the past the samequestions that should have been answered, I to the health care industrya long time ago and until they're...

...really willing to do this, it's goingto be a problem. We've got to go down the same street. Of course, the answerto these questions are going to be. You already have these questions answered,they're all over hero, Bovet they've done this ten times already, it's thesame thing. How long have they been trying to fixthe ROC at the federal level, which is the reimbursement? Why was it that work?Well, I wasn't working because there was in equities in representationamongst physicians. There was no primary care, physicians had any say inthe Rut, so people who did procedures got a lot of money and people who usetheir brains to get people under control in very little mind, and youknow, if you going to buy a quality product. Unfortunately, you got to payfor it or put programs in place that make it happen, and there are programsI can be done to make it happen, and I think that's one of the things that isposed a problem in healthy ministry is everybody's left, the patient out ofthis compasion. Nobody is allowed the patient to be able to handle the money,that's necessary to take care of them, but to give them enough to do it, andit's been now for a long time that the feral government doesn't think thatindividual Americans have enough intelligence to know what to do aboutbuying health insurance or bind the quality of can deserve the employeething, so only the employer decides what kind of help in my are. We includepatients in the three legged stool, so we can get a good health care system.Okay, why do we bring back a little bit of competition in the healthier system?Okay, why don't we get doctors in in my town here fresh? Because if there arethree doctors, hering has boast and we get into a health plan, we're all goingto get the same reimbursement for we do. It doesn't mean we're all EPI thatdoesn't mean there were all equal in quality. That doesn't mean we're allequally for passion to patience, but if you had the dollars in the patient'shands and he's willing to pay two or more out of his money to get goodquality care at a physician that has a good reputation for experience andgiving God quality. Ter think that competition competition makes everybodyhealthy. Competition makes everybody better. In every physician that I filedmy practice, I've considered them better than myself as positions. I don't want to get somebody that'sdumb it. I want always somebody at smarter thanme in health care to bring my paces to call your care. I think they do so. Iwant to do it in a very efficient man, but government does not let that happenand going into problamatin or Medicare for all were just propagating the samelicense in the health care industry. I'm sorry! If that answers some of thequestions it doesn't, but I think these are crucial to answer all thesequestions that he resting, least questions Araut Thet, all the Inter tothis a time what type of Prem Yeah Nos Wai think you know, I think, you'reright about the issues being out there.

When I look at this request forinformation for public option, I think that has something to compete withprivate insurance, not something to replace it. I because is actually likethat's what I'm saying put it out. There compete with the privateinsurance compans. Also, it needs to be done in a way. You know. I justcompleted a health care survey that I put out online and forty per cent ofthe people who responded wanted to keep the health insurance that they had,because they were satisfied with it and fine. They should be able to keep it.You know and unions that have negotiant health care systems and have gotten aparticular plan approved for you ort to be able to keep that because theyworked hard for that. But I think a public option might be a way tosimplify Obama care a little bit, and you heard that you have to pink gotupon a his morning. Right. Yes, they did. You know I think, taking the ACA offthe proverbial plate would have been extremely difficult anyway, that wouldgot to replace met yeah. So I'm glad that the Supreme Court turned down theruling that came out of a Texas. That said it should. The whole law should goaway unless you can replace it withsomething that's worth while, even though it may not be the best in theworld at least they have something m, and I got to tell you and inprofessionally speaking I got to tell you how many people don't go for healthcare because of ACA, because in high deducible sure they just lying to thepublic. You know all we give me this assurance, but if you make it that thepatient has to put out the first five and dollars it's interested in yeahwell, there was an extension, is I'm sure, you're familiar with during thelast four years of temporary insurance. That could be sold for a three monthperiod to a full year and the example that was given was a female betweentwenty and twenty five would pay twenty four ninety five a month for thecoverage. It did not include maternity benefits and the deductive was tengrand. So I spend the twenty five bucks at all. AH, exactly this exactly mypoint, there's no logical thinking that the Butacas have done in thedevelopment of healthcare deliver. The politicians of our country have put thehead in the sand. You know thinking that by giving them medicate orsomething like this is really giving them health care, it's just not givethem health care of, and besides the thing that they do, they pay you lessand they make it harder to give the patient care. I is retakes and myfeeling is that politicians do not want to face the reality. A we health careis really a bad. Well, you know. The other issue with respect of difficulty,for politicians is the health care providers that live in their district.If you want to control the price of pharmaceuticals- and you have apharmaceutical plant in your district, it's unlikely that you're going to wantto support reducing the price for pharmaceuticals because of yourrepresentation of your district. So I think this is a very challengingproblem and also you know there is a confluence of lobbyists called apartnership for America's Health Care...

Future. It includes several lobbyingorganizations and certainly, if something came into committee on publicoption, he would be there explaining why a public option really wasn't thebest thing quote for America, from the perspective of the pharmaceuticalcompanies and the hospital, a Ha and other organizations, there are part ofthat partnership to lobby for keeping things the way they are well. I think that you know. Health care is avery complicated situation too many special interest groups involved in it.I think the public has to become much more educated about health care. What'sall about, I don't mean just a delivery and what pills you got to take itdespite vest patient, but I think as purchases of health care in thiscountry and the government should put together a program which attends to thepeople, don't have the money and helps everybody that doesn't mean there hasto be one system for all, but it has to be an even playing field for everybodyto get into the system. If a medicate patient should get the same access tocare, as somebody has a gold premium, private insurance, they should have the same and that'swhat the government should strive for. But you can't impose that. Okay, youhave to really think about how they want to give those people that- and youhave to take a care of the pricing structure in the country. What does itreally cost? Let's educate patient as well as there's health, kid that isneeded versus helter. That is wanted. So you know you may want an Ma right,but you o needing them a right. Okay, so you know patience. They they bumpeda so they got a painted. The nethe first thing they wanted in RAF the NE.It's got be quiet that but look at what you put the physician in- Oh, you don'twant to give it to me I'll, go to the door Dan Street. Well, that's that's a push advertising.You know the farms industry spends twenty five billion dollars a year toadvertise he farm and certifies that they want you to prescribe so thatpatient comes in and says I want this or I want that because et al on TVright exactly so, you know there's a lot of education as to go on. You haveto start at the base. All these problems set. I just see medicate andpublic option and maybe something just start with, as you said, gettest yourfeet away, but it brought with the same danger of unsuccess as every otherthing that's gone on in the past and we haven't learned all lesbians. Yet we haven't learned all lessons onhealth care and to me sometimes I think it's that people really more afraid toput their hands around. I think you're right. I think it'scomplicated and I think it's not something that the general publicreally wants to spend their time thinking about and they haven't beendriven to become consumers of health. Here you know yeah, so we can educatethem to be good consumers of hell care. It would change the whole system of thebath right now. As an experience, I...

...could tell you that, there's a picture on a stretcherand an emergency room, he doesn't care what it costs right. It was a waringcost, just save right and I think that's why politicians are worriedabout that, no matter what changes they make, even though the system may bebare, it's going to forbid for because that guy, in the stretch is going tosay, are you trying to take away what I may have and that's the issue? You know that'swhy historically there's so much uncompensated care that occurs in thesystem, because you know people are not covered, they have a serious healthcondition. They end up on that stretcher. They get treated becausethey have to be treated, they should be treated, but there's nobody going topay for that and I'll give you a little story. Okay,I don't know. Any years ago I was a chairman of the Medicate Committee ofthe Metal Society of New Jersey can to medicate popularization, wouldn't go toprivate physicals Al Office for the most part, and private physicians really didn't want them to come becausethe amount they would get paid for a visit when I first started that wasseven thousand and seven he's got increased after fifteen years tofourteen dollars of it. Yes, the federal government in the State ofNew Jersey, for instance, didn't care if these same patients went to anemergency room feature with the minimum amount. Of course of that patient was ahundred nine dollars. Does it take a lot of intuition to fixthat problem? Right, I would say so. Let's say you inis the reimbursement to doctors to thirty dollars, just an example. A mandoctors say: okay, maybe enough to me, I my dogs, I don't lose any money, I'lltake care of them and the government would save a hundred nine dollars o his they went nowhere. Politicians werecompletely deaf to the idea to believe death. You mean you do to the fat catch. Allyou want to do is increase your ince yeah. I want to be able to care forthese people, not on my dime, because I'm not the one. That's supposed to betaken care of you. The state are supposed to be taking care of theseindigent people, not me. Personally again, it was a very, very hard fight,very, very hard fight. I give you another exam. While I was there, I got New Jersey state government toincrease health care to the medicate population by fifteen million dollars. Seven point: five million dollars ayear, one to primary care. Physicians and the seven point five milliondollars will be added in the second year to include specialist. After thefirst year. They killed it and took away the money so that left a very bad taste ofphysicians house. We can't trust to Goentoer, so there's a lot of experiences outhere that people are living with, and I think that we've got to get to thepatients. I think we have to be build an army of patients and get themeducated as to what health care is...

...really about and where the money isbelonging to and why the indigent people are being promised health carewhen they really not getting elthe question is how do you activate thispopulation to do that and, as I say, it's very verycomplicated. Well, it is, I mean you know. Most of the stories I hear wherepeople are concerned are people who have had a bad financial experiencewith health care I bust. This are quoting my book from an anonymouspatient who had a heart disease, and she said, thank God for my physiciansand my surgeons, who saved my life. But the bills are going to kill me, and youknow he had a debt of two hundred Zen Bucks. You know Bigas region forbankruptcy in America. Today is health care course. Absolutely sixty twopercent of bankruptcies every year are for health care, and you know anybodywho's going to answer that question or try to fix it. There's nobody to comingfor. Where is our government? Where is ourgovernment in this thing? Erbout has POL collams. Do we to help this thing? It's all special interest. So I thinkif we in getting program out there that educates the patient population, thenmaybe you get something done, but right now we're dead. With with the with thespecially to school lobbies. Give me another example: You've heard of the DAT position,medicine right, yes, wait! You can predict diseases coming forth. You knowa few years ago they came out with a test of doing I D and e Tes to find outif this drug would work better in the I corn myself, and we can do that testand in a class of hypertensive eyes of this would know which would work bestwith your DNA and therefore described a more appropriate medication for you,precision, medicine, personalized, medagin right, the farm of the lobbykilled that test. Why is that? Because now this is set, Ido the DNA test and you maybe their product is no longer my preference toyou, so they killed it across the ball. Iunderstand now that there are some some people trying to get that back, becauseit's a good quality care. The same thing we drugs like wafer. It may notwork for it because you are DNA, so we're spending a lot of money in thefarm sotal industry which may be for not, but the pharmaceutist ry doesn'twant to fix that they fought their test and it's none in the market anymore.The lobbyist killed it and then they made it not a Serbo at a cost of athousand dollars of the test. Well, that'll take it off the marketthat takes you off the Bote, so there's so many instances, and I don't believein in that one instance: It makes the difference of how the policies to goforward. Can you can't just go by one instance, but the issue is that healthcare is complicated and I don't see any government agent senator t HEWS, therepresentative person actually trying...

...to do well. Maybe they try to do itright, but they just boindin what's really going on. I also think what thethe senator and the Congress mere trying to do as moderates is they'retrying to move forward with something that is really a first step. Iunderstand the answers to the question: Is there posing already I've alreadyouter go you and I are on the same page doctor Belvy, there's no question thata lot of what they're asking for is is readily available to them if they justfast the right person for for the answer to the question, but I thinkit's important for us to talk about these issues, because we want ourlisteners people who are interested in health care to understand that this isa difficult issue and facing this issue is important for our country. As youknow, C M s does a projection every year about the future of health carecosts and they project. Now, within the next five years, health care will betwenty five percent of our common there's. No doubt in my mind, there'sabsolutely no that in my mind that that so it may not, it may be too low. Yeah,Oh yeah, maybe wot it could be so they did it. So you just know yes, last week,for ten days ago, I sent a letter to several members of timewise Senate andthe House, as I in them to reform the National Physicians Council forHealthier Policy, but proposed to the way it was in the past or was multispecialty doctors across the country. I asked them to make it strictly amongstprimary get physicians and the reason I did that is this. We know for a fact tothe dockmen study, which has done several years ago that every state inthe union, the head of preponderance of primary tea versus specials, had twothings: better quality and lower cost, and those days that had a high componernce of specialist and awoke upon the primary deposition was completelyopposite and that's how the state of New Jersey is. Ninety percent specialis ten percent primary and we're a of a box in costs, and those snakes are at least half andhalf were predominantly primary, because the enticin to the health aresystem is done by the primary F position and they can lead the parade of tryingto reduce close okay, because we all know- and I'm notsaying this against my collegs in specialty field, but their job is topropagate their their income again, what's necessary, what's wanted? Okay,so there are a lot of problems there, but I think that one of the the thingswould be is to have the national position counsel of primary, given itannounce that pointer in the leader in health, yet to least of quality cost,and also to get something in the winds of educating the patient population.That's just my I it's just my thoughts, but I don't see that a lot of thosethings happening in the very near future, maybe through these podcast andgetting out to the public. Maybe you can, you know, get some interest goingamongst people. Well, hopefully, we can...

...help people learn about the complexityof change and health care and the need for the change in health care. You knowin our book killing American health are that we wrote a couple of years ago. Webelieve we have a very competitive health care system and still reduce thecost of it by thirty per cent, and if we were deed cost by thirty percent,primarily on hospitals, insurance companies and pharmaceutics, we wouldstill be the most expensive health care system in the world would be a littlebit more expensive in Switzerland, which has a two part system about fortypercent of their people are in a public plan and sixty percent are in privatehealth insurance in that country. Health, Kane, United States is a sadthing right now. It's US said Stan Fairs, and I wishthat our government would really stepped to a plate and on it's reallynecessarily to help the American public in health far because without healthcare and without health, were we going to be well. I believe health careshould be a foundation for everyone in the so to lives around need to have asled foundation that you can rely on in case. You need it now. You know thereare people that go through lives very healthy and live a long life and neverrequire health care, but the other. Ninety eight percent of US need healthcare and we ought to get it when we need it and not be concerned about thecost of it. When we go together, love and they should least be affordedpreventive kid sure I mean that is the gateway to a longer life expectancy ispreventive care. You know, and the fact that you know our nation suffers from alarge obesity problem on diagnosed type, two diabetes among many other melodies.Absolutely hers is no doubt about it. Now that I'm sorry, I didn't ask youthe question specifically it's okay, but that these these these points ofview, if anybody trying to help the health are system, had to hear some ofthese issues that that I brought up to make it right. Well, I appreciate that,and you know I look forward to our next conversation and now that we've hadthis discussion about things that are very difficult and very complex. I hopethe rest of your day is a good day and thanks so much for joining us when I d,thank you for the opportunity. Any time take in a.

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