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The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 19 · 7 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 ustoday. Today we're going to discuss and effort by Democrats in both chambers ofthe House and Senate to launch a public option. This is being led bythe Senate health, education, Labor and pension's chair, Patty Murray, aDemocrat from Washington, and the House Energy and Commerce Chair, Congressman Frank PoloneJunior, a Democrat from New Jersey, and in a recent article that appearedin roll call, they're asking for support with a request for information to helpdecide on their legislative strategy. There are eight questions that they are asking inthis request for information. The first question is who should be eligible for coveragethrough a public option? How should the benefits be structured? How should pricesfor healthcare items and services be set? How could congress ensure that people enrolledin a public plan have adequate access to providers? What type of premium assistanceshould be available under a potential plan? What roles states should have in administeringa federally run option? How might it interact with Medicare and Medicaid, andhow could a public option address other healthcare objectives like delivery system updates and reducinghealth and equities. We're discussing this today with Dr Tom Belivia, who's beenwith us several times in the past to discuss important issues and healthcare. DrBelli via is a product of the New York City school system and graduated fromNew York University's Washington Square college with a Bachelor's in biology. He immediately enteredthe University of Rome Medical School and did his postgraduate training in medicine at theHackensack University Medical Center. After serving in the United States army medical core inTexas and Virginia, where he reached the rank of major and also was chiefof professional services at Kenter Army hospital, he returned to the attending staff atHackensack University Medical Center. Dr Bellavia has been an advisor to both the stateof New Jersey and federal governments on healthcare issues and was recently invited to serveas the chair of the New Jersey Department of Health and Senior Services Task Forceon chronic kidney disease. He is board certified in Family Medicine and Correctional Medicine. He's a senior attending at the Department of family practice. Attending at theDepartment of Medicine and associate professor at the University of Medicine and Dentistry of NewJersey. Dr Bellavia is a member of the board of Trustees of the NewJersey Academy of Family Practice and its foundation, the New Jersey Academy of Family Physiciansand the Amer an Academy of Family Physicians. He is chairman of AustarHealth, providing HIPPOC compliant health information technology...

...and application integration services for fit positions, hospitals, patients and insurance providers. He is active in many additional organizationswith philanthropic missions. Dr Bellavia began his practice of family medicine in Woodridge andsubsequently created heights medical associates in Hasprooke Heights, where he still sees patients every day. Well, I want to thank you for joining me today, DrBell A via. Today we'd like to discuss a new legislative effort that's beenintroduced in both the Senate and the house by the chairman of the Senate health, education and Labor and Pensions Committee, Senator Patti Murray, and Congressman FrankPolone, who's chair of the Energy and Commerce Committee, and they're interested inexploring the issues around setting up a public option legislatively, and in an articlethat recently appeared in roll call they asked for request for information and they listedeight areas that they like to get responses on to help them to formulate theirlegislative activity. So I wanted to ask you what you thought about these eightquestions and if you're ready to begin, I'll ask you the questions. Okay, if I may just make a comment about healthcare before we go on.Today, when I was reviewing these questions here about this public option in Medicarefor all and so on, it just brings to mind that I think thepublic should understand why the federal government is trying so hard to provide quality healthcareat a much cheaper price than possible, because the course of fealth care inthe United States is probably better than twenty percent of the GDP and couses alot of havoc downstream on everything the country does. The one thing that Irecall president trump saying about health care was who knew that health care was socomplicated, and this area of Medicare for all and public option is just anotherattempt to try and resolve these issues of health care and provieting quality health careacross the country. All these, in my opinions, so far that thefederal government has tried to do have not been very successful. Throughout the lastseveral years, the CMS and Medicare especially, have tried various freimbursement programs in theattempt to get to triple aim of, you know, better quality and lowercost and patient satisfaction, and it in the fourth aim of a physicianprovider satisfaction, which have been unsuccessful. The amount of money saved and theamount of quality that has been produced by the federal government these programs has beenwhere I consider a rounding error, and we now know that the United Statesquality of care is about thirty seven to four in the world, which isnot a very good place debate the amount of money that's spent to just leadsme to believe that there's too many special interest in healthcare that are trying tomake things work, too many bureaucrats in it and so on. So allthese attempts are difficult and nobody's really set...

...down to have some comments sense attitudeto this and that saw us both the patients, legislators positions and the public. But now referring to Medicare for all and for public option, which anothertwo attempts to resolve the problem, which I'm not so sure that they willbe successful either. One in my opinion, medicare for all and whatever it is, is just going to be too closely for the American government to sustainwithout some input of dollars. And you can't provide healthcare to people on asmall amount of money in today's world. It's the same problem that we havein the Medicare multiplace where the states promise selfcare to the indigent people, butthe health care that they get, based on the amount of money allotted forit, is poor and ill and not very good in anybody's sense. Theunfortunate things that politicians don't want to face up to that reality. And I'msure there is not enough money to take care of all there. So itis a terrible problem. So any attempt at it I welcome, whether it'sMedicare for all or public option to be decided. So the issue here is, you know, there's some people going to want public option. We're notgoing to make everybody happy, that's for sure. So some may one medicarefor all, some may want us to single payer system. Some maybe wantprivate insurance and so on, and it is too complicated to try to fitthem all into one place. But as far as these things are concerned,if you're going to give health care, it has to be structured correctly.I think everybody has to have a stake in it. Patients have to stakethen as well. That means they have to be much more compliant and understandingwhy these programs are coming forth. So these two programs, share of thepublic option and so on. Who's going to use them? Of course,anybody in different positions, every patients and individual every families, different there rightas a different financial status. So what does the government really want to provideto these people? What has to be covered? So if you're an obstetritionor your young female going to have babies, you want to make sure that allbe taking care of. Female care is taking care of. P actusis well taken care of. All in injections and immunizations have taken care ofat little and no cost. So it is a very difficult product to answerthese questions like this, and I think the senator and the congressman are askingthe questions very intelligently, because these are serious questions to be answered. Sowho should be eligible for the courage in public option? It's going to bea public option. Everybody should be cut right. If it's better gift forall, then everybody has to be covered. How you going to segment them out? What are you going to what are you going to carve out?I know and doing value basic care, we try to carve out, forinstance, certain cancers or transplant medicine because the so high cost and can't bedone in the value based model, because they're so close that nobody's going tobe successful at it. How the advantages to be structured? Again, that'sgot to take a lot of thought and freedom out that, though. Itactually of how it's got to be structured, how it could be working. Weall know that all these government programs,...

...no matter what they are, arefraught with danger and difficulty in going through them. The regulations that areposed upon the healthcare industry to get to these things, are anyments? Arethey going to eliminate all these things that? Are you going to make it easierto do or they're going to take away the barriers? And when theystructure is I think a lot of those issues have to be considered here.And how should the prices for health guidance and SERAS BE SET? Well,the government has that already. They have a rock. They have a situationin which they set the prices or they correct. Probably not, and you'llhave arguments all along the health industry on those reimbursements, on the valuable atall. And then we have the issue of the cost of the conglomeration ofhospitals in this country who demand high prices because they answered to their stockholders.We don't have really too many not for profit hospitals anymore. These conglomerates andnot not for profit. They only think about the bottom line. So howare we going to set these prices? I remember the state of Maryland.I think that no matter what Hospool you went to in Maryland, whether itwas John Hopkins or poked on Hospitl in some town Maryland, the pressures werethe same. You know. Look, that is still going on, Iknow, and that's been written about quite a bit lately as a starting pointon the issue of pricing in hospitals to expand to other states. But they'vebeen doing that since two thousand fourty. So this is such a political footballokay, and my feeling is is that when he gets to healthcare, politiciansare afraid to act. They are afraid of what the public is going todo. If they public thanks for any one minute that a politician is goingto take away healthcare from them in any sense of the way, they're deadin the water. So we have to overcome the fear of politicians and bureaucatchin this issue and health care, because we won't go forward at all.As as as just mentioned, this has been for a lifetime. It's beenmy entire lifetime in medicine, in my entire lifetime in medicine, when youhave hospitals buying physicians who now have to obey the laws and regulations of theirbosses and the stockholders and no longer care and be compassionate and caring for thepatients, but following the doctrines of the corporation, which demands that they havereferrals to only to themselves because it's a bottom line dollar amount. When youhave that going on and you gradicated the independent positions in the country, thepatients in this country are never going to get a fair share at good qualitymedicine. Why did youse these hospital groups to all the advertiser you can't gothrough a day. Would have an at least twenty ever advertisement see the radioor TV for all these hospital groups. You can tell me that every singlehospital group has the best cancer care to country. Everybody has used news andWorld Report. I don't even know if they pay for that at like.The issue is is they have to advertise because they can't get out the qualityof care on a face to face, mouth to mouth referrals from one personto another, which should be the standing in healthcare. So to try andanswer these questions here for Senator Maury and...

Times be prolonged. They're difficult.So what role the states have? An administrators? How successful have been havethey been? And then ministry in the medicate situation, which is in botha possible of fifty percent thing between the station and the federal government. Thathasn't worked out very well at all. They are completely at odds and itvaries all over the country and it buries all over the country. So howare you going to get a national policy when all the states have different policiesgoing on? And, let's face it, the administration of Medicare, I think, is about three percent in taking care of this, where the privateinsurance is about fifteen percent. Why is that different? You know where isthe difference? That is it because the private insurances have to pay stockhold thisand dividends. Why are we transformed? Some of this enormous amount of moneyand advertising across the country and healthcare, and let's put it into actually healthcaredelivered. Let's take the six million dollar president of the hospital system salary andmake it more reasonable and take some of that money or the entire hierarchy ofhospitals that has an awfuload of executives and costs and turn that money into healthcare. Why don't they consider giving it in the state of New Jersey, Ithink in this stone, hold me to the truth here, but we arevery near the bottom in reimbursing the doctors here. We just in any federalsystem. Okay, I think we get reimburse here in New Jersey, lestin Alabama, or Mr Sipping for that matter. Okay, and this isreasons for that as well, but all these issues have to be fixed beforeyou really get a good public option and it has to be cheerfully throught outand has to be thought out without malice and prejudice, and I don't knowif we can get that between politicians and bureaucrats and somebody to do that.So although they try, and and I reckon and I to mend the Congressmenand the and the senator trying to do this, but you know, howis this delivery system, for instance, going to reduce health to equis?Why haven't they done that? That would all the programs they've had here.They've had the programs on the CMS, they have a program between the statesand federal government. How come they came six these and equalts? The reasonis that the course of healthcare is enormous and out of control and every timeyou try to put a situation in where you want to reduce the course andto are still giving good quality, it fails because of special interest and Iwould say that one of the special interest is the conglomoration of hostel system supposedthe country who become me too's to health plans and whatever they they demand inprice they have to give and otherwise they can't be in the system of thathealth plan to attract patients which would be customers to them, or the physiciansbad matter. So trying to get a public option. It's the same problemover and over again. This is a Ditto of what's going on in thepast. The same questions that should have been answered to the health care industrya long time ago, and until they're...

...really willing to do this, it'sgoing to be a problem. We're going to go down the same street.The question the answer to these questions are going to be. You already havethese questions answered. They're all over the federal government. They've done this tentimes or it. It's the same thing. How long have they been trying tofix the erupt at the federal level, which is the reimbursement? Why wasn'tthat work? Well, wasn't working because there was in equities in representationamongst physicians. There was no primary care physicians had any say in the RUCKT. So people who did procedures got a lot of money and people who usetheir brains to get people under control get very little mine. And you know, if you're going to buy a quality product, unfortunately, you got topay for it or put programs in place that make it happen. And thereare problems that can be done to make it happen and I think that oneof the things that it's cases a problem the healthcare industry is everybody's left thepatient out of the equation. Nobody has allowed the patient to be able tohandle the money that's necessary to take care of them. was to give themenough to do it. And it's been known for a long time that thefederal govern doesn't think that individual Americans have enough intelligence to know what to do. But about buying health insurance or buying the quality of care that deserves?The employee thing, so only the employee the size, what kind of healthclaim? Why do we include the patients in the three legged school so thatwe can get a good health care system? Okay. Why do we bring backa little bit of competition in the healthcare system? Okay. Why don'twe get doctors in my town here fast books? If there are three doctorshere and has vertites and we get into a health plan, we're all goingto get the same reimbursement for what we do. That doesn't mean we're allequal. That doesn't mean they were all equal in quality, that doesn't meanwe're all equal. And from passion to patients, but if you had thedollars in the patient's hands and he's willing to pay two dollars more out ofhis money to get good quality care at a physician that has good reputation forexperience and giving good quality care. Bring back competition. Competition makes everybody healthy. Competition makes everybody better. In every physician that I find my practice,I've considered him better than myself as positions. I don't want to get somebody that'sdone with me. I want always somebody that's smarter than me in healthcare to bring my patients the quality of care I think they deserve. Iwant to do it in a very efficient manner, but government does not letthat happen and going into public option will medicare from all but just propagating thesame nonsense in the healthcare industry. I'm sorry at that answer some of thequestions. It doesn't, but I think these are crucial. The answer allthese questions that they're investing these questions are out there. All the answers tothis is that what type of premium? Yeah, and those way use.I think you know. I think you're right about the issues being out there. When I look at this request for...

...information for public option, I thinkof it as something to compete with private insurance, not something to replace it. Petition is actually that's what I'm saying. PUT It out there compete with theprivate insurance companies. Also, it needs to be done in a way. You know, I just completed a healthcare survey that I put out onlineand forty percent of the people who responded wanted to keep the health insurance thatthey had because they were satisfied with it. And Fine, they should be ableto keep it, you know, and unions that have negotiating healthcare systemsand have gotten a particular plan approved, you ought to be able to keepthat because they worked hard for that. But I think a public option mightbe a way to simplify. Obama are a little bit. And you heardthat the three quote up acas money right, yes, yes, they did.You know, I think taking the ACA off the perverbial plate would havebeen extremely difficult anyway. That would have a replacement. Yeah, so I'mglad that the Supreme Court turned down the ruling that came out of access.That said, it should the whole law should go away unless you can replaceit with something that's worth while. Even though it may not be the bestin the world, at least they have something and I got to tell youthat, in professionally speaking, I got to tell you how many people don'tgo for healthcare because of ACA, because of the high deductibles? Sure theyjust ly into the public yeah, well, we give me this an insurance,but if you make it that the patient has to put out the firstfive thousand dollars, it's worthless to them. Yeah, well, there was anextension is I'm sure you're familiar with during the last four years, oftemporary insurance that could be sold for three month period to a full year,and the example that was given was a female between twenty and twenty five wouldpay four and ninety five a month for the coverage. It did not includematernity benefits and the deductible was ten grands. So why spend the twenty five monthsat all? Exactly, it's exactly my point. There's no logical thinkingthat the beaurecrets have done in the development of health care delivery, the politiciansof our country of put the head in the sand, you know, thinkingthat by giving them medic gage or something like this, is really given themhealthcare. It's not given them health care at all. And besides, thething that they do they pay less and they make it harder to give thepatients care. It's red us. It's actually and my feeling is that politiciansdo not want to face the reality of what health care is really a badwell, you know, the other issue we with respected difficulty for politicians isthe health care providers that live in their district. If you want to controlthe price of pharmaceuticals and you have a pharmaceutical plant in your district, it'sunlikely that you're going to want to support reducing the price for pharmaceuticals because ofyour representation of your district. So I think this is a very challenging problem. And also, you know, there is a confluence of lobbyists called apartnership for America's healthcare future. It includes...

...several lobbying organizations and certainly if somethingcame into committee on public option, they would be there explaining why a publicoption really wasn't the best thing, quote for America, from the perspective ofthe pharmaceutical companies and the hospital AH A and other organizations that are are partof that partnership to lobby for keeping things the way they are. Well,I think that you know healthcare is, you very complicate situation, too manyspecial interest groups involved in it. I think the public has to can becomemuch more educated about healthcare and what's all about. I don't mean you justa delivery and what pills you got to take it despite best patients, butI think as purchases of health care in this country and the government should puttogether a program which it tends to people don't have the money and helps everybody. That doesn't mean that has to be one system for all, but hasto be an even playing field for everybody to get into the system. Ifa Medicaid patient should get the same access to care as somebody has a goalpremium private insurance, they should have the same and that's what the government shouldstrive for. But you can't impose that. Okay, you have to really thinkabout how you want to give those people that and you have to takea care of the pricing structure the country. What does it really co us?That's educate patients as well as there's health care that is needed versus helpto that is wanted. So you know, you may want an MRI, butyou needed them right. Okay, so patients, they they bumped.They got to paint a day. The first thing they wanted in Mra ofthey need he's gonna be quiet that. But look at what you put thephysician in. Oh, you don't want to give it to me, I'llgo to the doctor down the street. Well, that's that's the push advertising. You know, the pharmasy industry spends twenty five billion dollars a year andadvertise to the farmer cuticles that they want you to prescribe, so that patientcomes in and says I want this or I want that because they saw iton TV right exactly. So you know, there's a lot of education has togo on. You have to start at the base all these problems.Yet I just see Medicare for all and public option and maybe something to startwhat, as you said, getting least get your feet away. But itbrought with the same danger of unsuccess as every other thing that's gone on inthe pest M and we have and learned all lessons. Yet we haven't learnedall lessons of health care and to me sometimes I think it's that people doreally more afraid to put their hands around. I think you're right. I thinkit's complicated and I think it's not something that the general public really wantsto spend their time thinking about and they haven't been driven to become consumers ofhealth care. You know. Yeah, so we can educate them to begood consumers of health care, it would change the whole system with the bad. Right now, as an experience,...

I can tell you that there's apage on a stretcher and an emergency room. He doesn't care what it costs,right and what it cost just save me, right, and I thinkthat's why politicians are worried about that. No matter what changes they make,even though the system maybe bad, it's going to fullbe if because that guyof stretches going to say, are you trying to take away what I mayhave? And that's the issue, you know. That's why, historically there'sso much uncompensated care that occurs in the system because, you know, peopleare not covered, they have a serious health condition, they end up onthat stretcher, they get treated because they have to be treated, they shouldbe treated, but there's nobody going to pay for that. And I'll giveyou a little story. Okay, I don't know how many years ago Iwas the chairman of the Medicaid Tomitty of the Medical Society of New Jersey.Okay, the medicate population wouldn't go to private physicians will for the first part, and private physicians really didn't want them to come because the amount they wouldget paid for a visit. When I first started that was seven dollars.Of its seven. He's got increase if the fifteen years to fourteen dollars.Yea. The federal government in the State of New Jersey, for instance,didn't care if these same patients went to an emergency room, fake care withthe minimum amount, of course, for that patient, was a hundred ninedollars. Does it take a lot of intuition to fix that problem? Right, I would say so. Let's say you increase the reimbursement to doctors tothirty just example. I mean doctor was say, okay, maybe enough forme to open my doors, I don't lose any money, I'll take careof and the government was save a hundred nine dollars of this. It wentnowhere. Politicians would completely deaf to the idea to believe death. You meanyou doctors, the fat catch all. You want to lose increase your income. I know I'm want to be able to care for these people, noton my dyme, because I'm not the one that's supposed to be taking careof you. The state are supposed to be taking care of these in theJim People, not me. Personal again, it was a very, very hardfight, very very hard fight. I give another example. Well,I was there. I got New Jersey state government to increase health care toto the medicate population by fifteen million dollars, seven point five million dollars a year, one to primary care physicians and then seven point five million dollars wouldbe added in the second year to include specialists. After the first year theykilled it and took away the money. So that left a very bad tasteof physicians mouth. We can't trust the government either. So there's a lotof experiences out here that people are living with and I think that we've gotto get to the patients. I think we have to build an army ofpatients and get them educated as to what...

...health care is really about and wherethe money is flowing to and why the indigen people are being promised healthcare whenthey really not getting health care. The question is, how do you activatethis population to do that? And as I say that it's very, verycomplicated. Well, it is I mean, you know, most of the storiesI hear where people are concerned are people who've had a bad financial experiencewith health care of fost there's a quote in my book from an anonymous patientto had a heart disease and she said thank God for my physicians and mysurgeons who saved my life, but the bills are going to kill me.And you know she had that of two hundredzero bucks. You know, biggestregion for the bankruptcy in America today is healthcare. Course, absolutely sixty twopercent of bankruptcies every year are for health care and you know, anybody who'sgoing to answer that question will try to fix it. There's nobody's coming forward. Where is our government? Where is our government in this day Ereld Hospitalconarmates to wet to help this thing? It's all special interests. So Ithink if we in getting program out there that educates the patient population, thenmaybe get something done. But right now we're we're dead with with the withthe special interest groups, lobbies. Give me another example. You've heard ofthe DNA testing in position medicine. Right, yes, wait, you can predictdisease is coming forth. You know, few years ago they came out witha test of doing the DNA test to find out if this drug wouldwork better in a eyecorn or myself. And we could do that test andin a class of hypertensive eyes of the ISH. We know which would workbest with your DNA and therefore describe a more appropriate medication. Feel precision medicine, personalized medicine. Right the form of lobby killed that test. Why isthat? Because now the acceptable I do that DNA test on you, maybetheir product is no longer my preference for you. So they killed it acrossthe board. I understand now that there is some some people trying to getthat back because it's a good quality care. The same thing with drugs like warfering. It may not work for you, it because you are DNA. Sowe're spending a lot of money in the farm suitable industry, which maybefor not, but the Farms who industry doesn't want to fix that say,fought that test and it's not on the market anymore. The lobbyists killed itand then they made it not unsurable at a cost of a thousand dollars atest. Well, that'll take it off the market. That takes it offthe boy so there's so many instances in and I don't believe in in thatone instance makes the difference of how the policies go follow. Okay, youcan't just go by one instance, but the issue is is that healthcare iscomplicated and I don't see any government agency, Senator, House of representative person actuallytrying to do well, maybe they're...

...trying to do what's right, butthey're just blind study that was really going on. I also think what thesenator and the Congressm are trying to do as moderates is they're trying to moveforward with something that is really a first step. I understand the answers tothe question. Is that posing already already out there? No, I youand I are on the same page, Dr Bell Bee. There's no questionthat a lot of what they're asking for is is readily available to them andthey just ask the right person for the answer to the question. But Ithink it's important for us to talk about these issues because we want our listeners, people who are interested in healthcare, to understand that this is a difficultissue and facing this issue is important for our country. As you know,it's CMS does a projection every year about the future of healthcare costs and theyproject now within the next five years health care will be twenty five percent ofour economy. There is no doubt in my mind. There's absolutely note thatin my mind that that showed it may not, it may be too low. Yeah, Oh, yeah, maybe, want it could be. So whatI did is so you just to know. Yes, lest week orten days ago, I sent a letter to several members of Congress, potentSenate, then the house, asking them to reform the National Physicians Council forHealthcare Policy, but proposed to the way it was in the past, orwas multi specialty doctors across the country. I asked them to make it strictlyamongst primary care positions. And the reason I did that is this. Weknow for a fact to the document study which is done several years ago,that every state in the union the head of preponderance of primary care versus specialisthad two things, better quality and lower costs. And those states that hada high componderance of specialist in a low upon the primary care physitions was completelyopposite. And that's how the State of New Jersey's ninety percent specialist, tenpercent primary and we're at of a boxing costs and those states that at leasthalf and half or predominantly primary, because the entrance into the healthcare system isdone by the primary care position, and they can lead to parade of tryingto reduce plussed. Okay, because we all know, and I'm at sayingthis against my colleagues and especially field, but their job is to propagate theirincome. Again, what's necessary, what's wanted? Okay, so there area lot of problems there, but I think that one of the things wouldbe is to have a national physicians canceled of primary positions, with the knowledgethat primary care is the leader in health get to at least a quality costand also to get something in the winds of educating the patient population. That'sjust my it's just my thoughts, but I don't see a lot of thosethings happening in the very near future. Maybe through these podcasting getting out tothe public, maybe can you get some...

...interest going amongst people? Well,hopefully we can help people learn about the complexity of a change in health careand the need for the change in health care. You know, in ourbook killing American health care that we were owed a couple of years ago,we believe we have a very competitive health care system and still reduce the costof it by thirty percent. And if we were good caused by thirty percent, primarily on hospitals, insurance companies and pharmaceutical companies, we would still bethe most expensive healthcare system in the world. We be a little bit more expensivethan Switzerland, which has a two part system. About forty percent oftheir people are in a public plan and sixty percent or in private health insurance. In that country. Health can unite. Station is a sad thing right now. It's a sad state of affairs and I wish that our government reallystep to the plate and it was really necessary to help the American public andhealthcare, because without health care and without health where we going to be?Well, I believe health care should be a foundation for everyone in absolutely aroundyou need to have a solid foundation that you can rely on in case youneed it. Now, you know there are people that go through lives veryhealthy and live a long life and never require healthcare, but the other ninetyeight percent of US need healthcare and we ought to get it when we needit and not be concerned about the cost of it when we go to getit back and they should least be afforded preventive kit. Sure. I meanthat is the gateway to a longer life expectancy is preventive care, you know, and the fact that you know our nation suffers from a larger B cityproblem on diagnosed type to diabetes, among many other maladies. Absolutely, there'sdon't doubt about it. Know that I'm sorry I didn't answer you the questionspecifically. It's okay, but that these that these points of view, ifanybody trying to help the healthcare system had to hear some of these issues thatI that I brought up to make it right. Well, I appreciate thatand you know, I look forward to our next conversation and now that we'vehad this 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 joiningus once of Youaid. Thank you for the opportunity any time. Take Care,.

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