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Editor’s Note- This is the conclusion of a two-part conversation that began with Episode 262, which can be found here on Substack as well.
Richard Helppie
So we're back to business as usual, and the health systems are getting back on their feet, we're still...
Dr. Barry Meisenberg
Trying to recapture that lost volume, which generates the margin whether you're a profit or nonprofit.
Richard Helppie
To be fair, there was a lot of deferred care during the COVID, people couldn't come in for their screenings and their treatments and that there is a bit of a backlog. On the vaccines, we did have Dr. Jim Baker on five times, renowned physician, immunologist, ran the vaccine program at Merck, and also was in the United States Army, where they were literally weaponizing viruses; very germane. For you navy men I didn't know if I should bring up the fact that he was in the army, but it was just too good of a connect like that. So any thing else under COVID, Matt or Dave, anything that we did well or what it revealed?
Dr. Matthew Nathan
You just said the operative word: Business as Usual. So when I talk to house staff and other groups and healthcare providers, and they ask me about an old guy like me who remembers when rock candy was just a nickel, the change is going to be (significant). This is a little bit trite but it’s not untrue. One of the ways that healthcare has evolved, as Barry and David said, is that doctors used to hire business experts to run their offices. And now business experts hire doctors to work in theirs. And that has, in some ways, created a better footing for supply and demand, and cost plus inventory, but it’s also put a complete business spin on the way we do it. I took a year for a Masters, the Navy sent me to the Eisenhower School of Leadership where I graduated with a Masters in the Elements of National Power. That includes our GDP, our Agriculture, our military industrial complex, our production of software and technology, and it doesn’t include healthcare. Healthcare is not looked at as an element of national power. We found that out the hard way during COVID, when it knocked us completely off our blocks. And we have no surge capacity in this country because we practice on tried and true business practices which is just in time inventory control, and minimize capital that is tied up for no good use. Barry and David both opine that, what are we doing to prevent the next one that may be around the corner or twenty yard from now. And so, I think the challenge is, we have to recognize that we cannot use totally pristine business practices in healthcare. And we have to have surpluses, we have to have surge. The military is often chided for big hospitals that are underutilized. Well, yes, until time of war, and until times of pandemics. When I was running hospitals in the military, and there was a huge influenza outbreak, perhaps an unusual one, but one that was creating tremendous morbidity and mortality, civilian hospitals in our area would call us up and ask us if they could use some of our extra ventilators. And so, that kind of surge capacity I think is pivotal in making healthcare an element of national power. One of the reasons I think physicians become so disenchanted and so disenfranchised is, they almost feel they have an adversarial position now with a lot of their patients. In the sense that in the last eighty years, vaccines have literally saved and stemmed morbidity and mortality for millions and millions of people. And yet today, some physicians feel they get up and get on a podium and talk about the goodness of vaccines and somebody will look at them and say, “Well of course you say that, because you’re a doctor.” and I’ll go, Yeah! because I’m a doctor, and I want to tell you what I think is good practice for you to protect yourself. And instead of being a beacon of somebody who is respected, they feel they are part of the ‘Deep State’ that’s being criticized for a political point of view. And that is burden that’s almost too much to bear for some providers. And so they tend to shy away from the person-to-person specialties in dealing with patients, and they run for the more remote specialties that are more valuable and contribute, but the radiology, and the pathology and the dermatology and the ophthalmology, and those are wonderful practices, and we need them but we’re having is people vote with their feet now to get away from the more contentious person-to-person bedside confrontational thing. So I think all this needs to be addressed by medical associations as well as by policy makers, but by the providers themselves. By physicians themselves. …end of speech.
Dr. Barry Meisenberg
I'd like to add to that, if I could, because it's an issue that I'm deeply concerned about. What we obviously lost [was] a lot of cohesion with the pandemic, and we met patients in the hospital who were blue from lack of oxygen, who didn't believe in COVID, and didn't want to hear that that's what they were suffering from. Or maybe they start to blame themselves for not getting a vaccine once it had been offered. What you began to see was policy people and editorialists write in medical journals and in the Washington Post, for example, that the unvaccinated should be de-prioritized for hospital care because they were responsible for their own illness. Some physicians, who were aggressively in the middle of aggressive family reaction, began to write the same thing; you're asking me to come in and I'm working so hard and I got to wear this mask and stuff all day long and you don't take care of yourself. Now, we would never say that to a smoker who got lung cancer or to someone who drank to excess and got liver cirrhosis. We don't. We don't allow ourselves to talk about that, but we did during COVID.
Richard Helppie
The difference is, though, too Barry, if I'm going to jump in and interject, the way that the mRNA vaccines were rolled out were a tragedy of government and reporting. I point out one thing, the NIH is not doing a victory lap right now about, look, we conquered COVID. They're not saying, look, the lockdowns worked, they're not saying the vaccines did this, and yet, at the beginning, they said, we found this safe and effective vaccine. And I'm thinking to myself, there hasn't been time to test it, we don't know. The right message should have been, we think this is our best chance and let's explain to people the difference between this mRNA injection and the normal way that a vaccine is produced with the live virus being killed. I think that deception and that absolutism versus this is the best option we have today, we think... because as it started to fail, we started inventing new words: breakthrough infection. No, it's not a breakthrough infection. The vaccine didn't work, and we started developing a nomenclature around policy versus going back to the fact that medicine is an art and it's a science and we've got to give ourselves time to make discoveries. When I look at it, and we talked about vents - remember, there weren't enough ventilators - what did we find out during COVID, four out of five people that got on vents died. Their blood gas [level] said they should be on a vent but they were sitting up and talking, now we got the term “happy hypoxics.” So this is where I think that we need to communicate better, that we only know what we know and that we can't represent that we've got a safe, proven medication or prevention when we haven't had time to really test it. As I said on my show, we're all in the petri dish.
Dr. Barry Meisenberg
But my concern, though, is about the lack of societal cohesion around this issue and about the lockdown.
Richard Helppie
I'm making the same point. I'm making the same point, the lack of social cohesion because of the absolutism of the position versus we have vulnerable populations. Like all of us, because of our age and that we maybe needed to be vaccinated and to limit our exposure and yet there was never a case to vaccinate a child ever, period, still doesn't exist. There was never a case to close schools and it's been proven around the world; Sweden, Florida, Great Barrington Declaration. But the bigger picture that I wanted to delve into was the COVID as it pertained to we had, all of a sudden, people couldn't go to the hospital. We were asked to treat a cohort of patients with a pandemic that we didn't really understand and at the time we needed the health system the most, the financing system would have bankrupted everybody.
Dr. David Harlan
I have three comments, I want to reflect on a couple things said. One, Rich I would challenge you a bit to say that it was a vaccine failure, as opposed to... I agree that maybe there's no case for vaccinating the very young, I agree with that. I also agree [that] absolutism is always dangerous. I think persuasion is always better, exposing the data - including the knowns and unknowns - is always the safer strategy and we didn't do that. The other point I'd like to make is you ask about what COVID did, and what we did right. For those of us in the chronic disease field who are required - in order for patients to get the medicines that they need - we are required to see them with a certain periodicity even if they don't need it; they can't get their medicines unless they see us. And so for that period, we were allowed to see people virtually, and now that COVID is behind us we've got to bring them in again. It's creating unnecessary workflow problems that we know can be managed in other ways, but the system won't let us do it.
Richard Helppie
These are great points. There are so many aspects and nuances. I will just say that based on Dr. Baker I thought that the risk-reward for me was to take the first two vaccines and the first booster, which I did, and then as more data came out and they couldn't figure out exactly what target they were aiming at, I thought, well, my risk-reward is better just doing what I always do; build up my immune system. Anybody else, any final thoughts about COVID or vaccines at all? I don't want to...
Dr. David Harlan
Just one. We all get the flu vaccine every year, because the flu strain changes every year, it mutates. But then every 50 years or so, there's a major change. I don't know if you know Rich, but in 1918, 50 million people died of the flu that year, 50 million people. When major changes like that come along the immune system can't respond fast enough. So I think getting the initial COVID vaccine probably did save lots of lives, but then the subsequent ones, now that our systems have seen COVID for the most part, even if there are genetic variants, the risk has been declining because it's not an unknown virus to us anymore.
Richard Helppie
I get my flu shot. I didn't for years, then I got the flu, and it's like, oh, you know what? I'd rather do that. Shingles vaccine, if you're over 50, get the shingles vaccine. You don't want it, it's going to go into your eyes, you don't want to get that. It's nasty.
Dr. Matthew Nathan
Rich, I would just add that when you want to talk about COVID and how we responded to it, I always ask people which COVID? The early COVID or the COVID we're dealing with now? Because the early COVID is what created all the hell that broke loose, which was people turning on their TVs and seeing refrigerator trucks parked outside of hospitals as makeshift morgues because they couldn't keep up with the people who were dying in droves from this novel virus that nobody had any defense against. If we had a time machine and we could have given all those people a vaccine, it would have just completely changed the game. Now to your point, as viruses mutate and evolve, the ones that tend to evolve and continue to pass on are the ones that are less less virulent and the ones that have less potential to kill. The ones that kill their hosts don't get propagated, the ones that make them kind of sick can get communicated. So to your point, there's more evidence now saying, okay, do we really get bang for the buck from the vaccinations? I think it's a healthy discussion to have. Nobody should be an absolutist, no physician, no policy maker, no big pharma person should be an absolutist on this. But we should have the conversation. My gripe previously, my previous comment was, I'm not even allowed to have the conversation with some people now because of the political discourse that exists over any position I take, whether it's for vaccines or against vaccines I'm immediately categorized as somebody. And then if somebody says, hey, but wait, he's a doctor, and half the people in the room go, well, let's listen to him, and the other half go, the hell with him if he's a doctor, he's already been brainwashed and is drinking the Kool-aid. At some point... let me just tell you one quick story about human nature and statistics. During the thick of COVID a patient who had an automatic implanted defibrillator, who would go into these fatal rhythms, their implantable defibrillator would shock them out of it. He called up and he said, my battery's running low. [Staff] said, well, you've got to get to the hospital and we've got to change your battery. He said, I'm afraid to go there because I'll catch COVID. And she said, you have a one out of 20 chance of dying from COVID, you probably have a 19 out of 20 chance of dying if your battery is dying. They found him dead in his bed with a dead battery in his implantable defibrillator because he was terrified of going to the hospital and catching COVID. So the irrationality that existed at that time and the hyperbole that was given to everything, we look at it with the retroscope but it's unfair because we were in a fog of war at that time. Now let's have some healthy conversations about the good, the bad, the ugly of vaccines, which unfortunately, because of the COVID discourse, is, in my opinion - this is my opinion - we're going to see the rise again of measles, possibly polio, maybe diphtheria. We're going to see these things, which exist endemically in other nations, start to blossom again in the United States, which would be sad. So that's my comment on COVID; which COVID do you want to talk about, early or later.
Dr. David Harlan
I just want to expand on what Matt said. I think this Common Bridge thing is such an important forum because you created a space for people to have legitimate discussions about these things.
Richard Helppie
What the Admiral said, I think, is right on that. Had he been the one delivering the updates, where it has that nuance of what we know, what we don't know, what point in time versus hard dictates, I think that people might have responded better. And so I think healthcare is caught up in where we are as a society and as a political system...
Dr. Barry Meisenberg
I think public health officials - and I've not been one - struggle with the issue of what they call blowing an uncertain trumpet. In communicating with the public there's a limited amount of nuance that they can deliver. And I think in some cases, they erred in not providing more nuance. Some of it, actually you look back on it, it's actually amusing now. This instruction about how many days after a case you should stay home and isolate: 14 days, 21 days, seven days. Or you remember the instruction about not opening your mail or your packages, let it sit down on your porch for two days. That might have been well intended, but in retrospect, it's amusing. But someone said, that's the state we were in. You called it a fog of war; I think it was a commotion.
Richard Helppie
It never should have been said. It was nonsense on its surface. I know people that washed their mail and stuff. This is where we need to get more clarity and it is 180 degrees from hey, a doctor said it. Well, that's a voice of authority and training versus, well, wait a minute, you must be part of the deep state. I don't have an answer for that. Let's talk about some other things. I'm going to make an omnibus question here about healthcare in general, around investments. Where should we increase or decrease, is it medical equipment, facilities, training? And then let's try to... what about the impact of information technology, like electronic medical records and possibly the use of AI. How do we train our practitioners in all this? Where should we be investing? How should we be training? What's the promise or the peril with technology?
Dr. Barry Meisenberg
Well, I will say it's both. There's both peril and promise. You know, it's like atomic energy, right? It can cut through the nonsense. It can help with some of these corporate tasks we mentioned. It can actually make doctors more efficient, but you can't replace physician judgment or personal interaction with AI. That would be my hope that we don't allow that to happen.
Dr. Matthew Nathan
But Barry, the three of us are of a generation where we grew up with... nobody wants humanity in medicine more than I do. There's nothing I relish more than talking to my own PCP about how my life is going, how I'm doing, how much sleep I'm getting, whether I'm anxious about this or that. But studies have shown that Gen-X and Gen-Z, they don't want that. It's a commodity. They want to get in, they want to get out. They don't really want the doctor asking them about their rose garden or what they do for a living. We're trying to cater to a variety of people. But to answer your question, Rich, from my perspective - and I'm very interested in the human connection in medicine - having graduated from Georgia Tech with a bio-sciences engineering major, I am very big on technology. I believe AI is going to truly be a blessing or access in routine primary care. It's going to allow, it's going to get to the point... and people go, how can you do that? I go, well, if it can drive a car through a busy city without a driver, it can figure out how to do enough transducer-based diagnostics on people with algorithms. Already, we're seeing AI make a difference in the evaluation of funny looking moles. You can be the best dermatologist in the world, but you haven't got a database of 1.2 billion moles stored that you're comparing it to, whereas AI can. We're seeing it make a difference in reading X-rays and in looking at histology on past reports. We're seeing it make a difference in the poor man's AI - which is robotics - which is the surgeon being able to operate on somebody who could be 50 miles away using robotic technology. So I think that's coming. That's going to help, that's going to be a force multiplier. It's scary right now, just like I wouldn't want my surgery done by AI, no more than I really want to get in a car that's driven by AI right now on freeway at 70 miles an hour, but it'll get there. I think we're going to get there. I think it's going to make a difference. I think technology, the challenge for educators... and Dave and Barry are famous mentors, and they have a legion of residents and medical students who would quote them and look up to them as people who set the pace. We don't want to lose the ability of this generation - which tends to be very social media-centric and doesn't have as many personal skills and talking to people about difficult subjects face to face - to lose the humanity of being able to be compassionate and being able to reach out and touch somebody on the shoulder when they're about to lose it because they've just been given bad news. We don't want people being uncomfortable and running from that. We want them to be able to feel comfortable and running to that as physicians. Not everybody shares that definition of a physician, but I do, and so I'm this dichotomy of advocating big technology - more and more ones and zeros and digitalization of healthcare - but more and more money being spent on emphasis of helping our young practitioners in nursing, allied health and physician practices to be humane and compassionate.
Dr. David Harlan
I'll just add very few comments. I believe in technology enabled care. Barry is an expert in breast cancer and certainly AI has improved the reading of mammograms immensely. But my answer to your question, Rich, is I would not want to be proscriptive about how to use AI. I would rather create an environment where a thousand ideas can be tested in practice, and let the ones that work and are effective rise to the top. I don't think we know who the winners are going to be, and it's always dangerous when we do think we know who the winners are going to be.
Richard Helppie
As I listen to you all talk about this, it's about leveraging the time of the physician, that, as we talked earlier, we're going to have fewer physicians for less hours. So leveraging with nurse practitioners, for example, and leveraging with AI, maybe someone doesn't get to the physician because it's not necessary. My father - and since you're all three navy men, I'll tell you this - my father was a sailor in World War II, and the way he described healthcare, he said, if you were sick you saw the guy who maybe had been a shoe repairman first, and he could take care of you, and you maybe went to the next guy who was a tailor if you had to get sewed up. And if you were really sick, you finally got up to see the doctor. And he said, we should do that. And I said, okay, dad, good point. We had Brian Peters on from the Michigan Health and Hospital Association saying one of the ways to deliver better care is for everybody to be able to work at the top of their license. Then I hear you all saying, we've got these allied health professionals and we can use the technology to let us be better one on one with the patient. And I just see that being carried through. Of course, it takes an educated patient to know at what point to access the system and an intelligent system to make sure we're not missing the person with the really odd mole that needs to be treated before it's horrible.
Dr. Barry Meisenberg
I watched your program with the president of the Michigan Health Association. I watched it with interest, and what he's describing as a virtue, access - I will tell you - is developed because of business. It's not good business sense to have say, an orthopedic surgeon spend 80% of his available clinic time seeing people who are non-operative - back pain, hip pain - so get the physician assistant to provide good care and refer the ones who are surgical candidates for discussion about surgery. That is maybe access creating but also is a good business decision, and you're seeing that all over. You can view it as a barrier, but it's also a way of adding access, and sometimes immediate access, to care.
Richard Helppie
I'm very encouraged by those kinds of things. Also where the sub-specialist can look at the data and say, I don't need to see this person again, I'm going to keep my time for the people that have the specific malady that I'm most focused on. Mayo Clinic, by the way, does a great job with that in that triage, and the researchers and specialists are able to see the patient cohort that they can best benefit. This has been a great conversation. I hope, by the way, we can do this again, and maybe we'll focus in on one or two questions. We're trying to kind of boil the ocean here a little bit. If you were going to look at an ideal healthcare ecosystem, what would it look like, and what are the barriers to us getting to a better place today?
Dr. Barry Meisenberg
Who wants to go first? Ecosystems is Dr. Nathan's expertise.
Dr. David Harlan
You go first, Matt, I have comments, but I'll go whenever you guys assign me.
Dr. Matthew Nathan
You're right. It's boiling the ocean. I often say with tongue in cheek, there's room on Mount Rushmore for one more face, and it's the person who can figure out how to create a healthcare ecosystem that gives access fairly to all and provides the right amount of care for the right amount of cost. Because we're not doing that well now. And I think one of the biggest impediments is, as Barry said, we didn't design it to be this way but it's evolved this way. We now have a cadre of healthcare providers who feel that they are mostly employed, if they're not employed they're still working very hard, trying to game the system the best they can, to work with insurance companies and get things approved and get things authorized and provide the care that they think their patients need, and manipulate the system to get it that way. The patients feel that way, and it's going to require contributing factors from everything we've talked about. Some of it's the onus of the patient, the onus of the patient to say, I can't have everything I want every time I want it at no cost to me, or at limited cost to me. The second thing is, we have to get physicians and other providers who have become used to - or liquored up and not happy necessarily about doing it, because burnout is tremendous right now - about the more you do, the more you make, the more care you provide, the more you make. Human nature tends to do that. We have to break that cycle. We have to get people feeling better about themselves. When I was managing physicians in the navy sector, every once in a while, not often, I'd have to go in the lunchroom and say, alright, you guys get out of here and get back to seeing patients. Although they had a great work ethic, that would happen occasionally. And when I was managing physicians in the private sector, I'd say, hey you guys, stop and take a break. Eat some lunch. You're going to work yourself to death. Because of the difference in reward systems; in the federal sector, the reward is time, whatever time you can get, because you're paid the same. In the private sector the reward is often income, and so people tend to equate that. So we have to create a sea change in the expectations of providers, make them feel part of the community. Again, make them feel that they are held in high esteem; not absolutists and not on pedestals, but held in high esteem. And that we're going to have a payment system that rewards extra years of training and extra effort and sophisticated care - such as Barry managing cancer or a surgeon doing a heart valve - but nonetheless, create the real starting event, which is preventative care, primary care, getting that child, that adolescent, that young adult, on a healthy pathway to a healthy lifestyle so that they can live until they're 80 and succumb to Barry, who's trying to manage their cancer, as opposed to their 60s dealing with heart disease. So it's going to require a sea change in our physician cadre, and physicians are the ones who have to lead that charge. You're not going to be able to do it by passing a law.
Richard Helppie
I really like that, that you've talked about the caregiver and the patient, which is kind of full circle. Dave?
Dr. David Harlan
Barry, do you want to say anything? I have ideas, but I know Barry, you have ideas. [Dr. Barry: I'll follow you.] I think Rich, what we have to do is right now, let's take, for example, this Luigi Mangione guy, who's our modern era John Brown. John Brown murdered people in Kansas over slavery, terrible thing, but he because he felt so passionate about slavery. Luigi Mangione, that whole episode, there are people, and you've heard them, even politicians, who say it's the health insurance industry, and then the health insurance industry says, oh no, no, we prevent unnecessary care and unnecessary costs. What our current system has created is an adversarial system; the doctors and the patients fighting against the pay issuers and that shouldn't be. The one thing I'd like to figure out is appropriately aligning incentives, and what you said earlier, Rich, I think is a very good place to start; get rid of the tax benefit of these hidden healthcare costs so that people see them. They need to see that this stuff isn't free and that they have a role in it. So that would be my one thing, figuring out how to align incentives toward the common goal of improved health.
Richard Helppie
Barry, anything on this one?
Dr. Barry Meisenberg
I think perhaps the most important thing we've said - that at least I spend my time really concerned about - is the way the system has demoralized the physician. It may not be visible to you if you're a consumer of healthcare but most people go to medical school for the right reason, because they want to be in a helping profession. Although there are studies that show empathy loss occurs during medical school, they still come out into the workplace with the desire to be a force for good. Then they get caught up in this system and they're told they've got to see more patients faster. You learn to ask for one problem at a time, so you can see a patient every 15 minutes. Or if you work in a hospital, there's corporate pressure to move the patient through the system faster and faster, and we've lost track of our ability to connect. In fact, Matt and Dave will know well, famous quote by one of the exemplars of our field, William Osler, who said famously, a good physician treats the disease, a great physician treats the person with a disease. And I think he actually might have got that from Maimonides, who, in fact, might have got it from Hippocrates. So it's been a truism for almost 3000 years, and the system doesn't allow us to do that, and so we end up with disappointed, morally injured physicians. I think care suffers when there's no time to get to know the person. By fixing this business driven medical decision making, we can restore the joy of medicine to our cadre of physicians who are going to have to lead this improvement in care and all these things will contribute to that improvement.
Richard Helppie
Let's get it back to that patient-physician partnership, where patient, you take care of your health and communicate and let the physician do their practice without unnecessary burdens. But also we have a societal expectation that somehow people can choose anything they want without regard to cost or effectiveness; what I've said before, that there is no benevolent bureaucracy any place in the world eager to pay for healthcare, public or private, period. And there are many people like all three of you, who are passionately wanting to deliver a healthy person, whether that's the relief from an awful disease like cancer or resolution of a chronic illness like diabetes, or if it's just can you be healthier so that you can be a better sailor for our navy. It's all this same thing; we've got some structural issues. Gentlemen, we've got time for a quick lightning round here, and I'm going to give you all 40 seconds or so. What did we not talk about today that we should have covered and/or perhaps any closing thoughts.
Dr. David Harlan
I'll close with something that's gotten me in trouble, Rich. I've quoted history lots, and I love the preamble to our Constitution that says life, liberty and the pursuit of happiness. It didn't say life, liberty and happiness, because no one can guarantee your happiness. They can give you an opportunity to pursue happiness. What I said in front of the medical school class is, if I could amend it today, I would say life, liberty and the pursuit of happiness and health, but you have to pursue it. The medical students were offended by that. What do you mean, patients have to pursue it? But I think we need to get back to that. There has to be a buy-in from all of us to promote the national health.
Dr. Barry Meisenberg
I would say that we had a pretty thorough hearing on all the issues big and small to worry about. I would close by saying that people should have confidence in healthcare delivery, because it can accomplish some pretty amazing things, even if it's not evenly distributed. And our goal is to keep what's great, fix what's poor. It's going to rely on a multi-focal group of initiatives. I think the public's got to be part of it, and their unhappiness is going to drive it.
Dr. Matthew Nathan
I agree. I mean, healthcare challenges are like the weather, everybody's talking about them. Unfortunately some people are taking it into their own hands and creating homicide as a result of it, but nobody's doing anything about it. I'm encouraged by the young people going into the healthcare practices today. I'm encouraged by the nursing students and young students doing it. They seem to be altruistic. The challenges that - and we didn't really talk about this - the challenge is that the priority today - and it's not necessarily a bad one - is time. My time is my time. We're having trouble recruiting providers to go into the practices that do get up in the middle of night and go to the hospital or do have to work every other weekend. It's just a social more. The older physicians may criticize that and say these whippersnappers don't understand what it means to be dedicated to their patients. And younger people may say you don't understand what it means to have a quality lifestyle where I have less domestic upheaval and I enjoy my children more. So we have to leverage all these things we've talked about in order to create a better balance of health for the caregiver, care for the caregiver, as well as for our patients. And I stand on what I say, which I believe it's a national disgrace if you have two zip codes; because one community is an affluent community and has insurance and third party payers and access to primary care, and the zip code over is in the under-served, run down population. Studies have clearly shown that there's a lifespan difference of as much as ten years on average in those populations. That shouldn't be happening in this country. It just shouldn't. We have the wherewithal to fix that, and I believe a lot of young people going into the practice want to do that. To Barry's and Dave's comments, they then get consumed by the way they have to practice and game the system to see the patients they want to see. And they eventually say, I can't beat them, so I'll join them. We have to have a collective philosophy among the caregivers in this country to say, I'm tired of joining them. I want to beat them, and I want to get back to a system where all people have a good shot at healthcare. There are always going to be the haves that have a little better, but the haves shouldn't have ten years more of life than somebody else. Thank you for the opportunity to talk about this. I appreciate it, and it's always a honor to be included on the same dais as David and Barry.
Richard Helppie
Gentlemen, thank you all for being on The Common Bridge. We've been talking with doctor and Admiral Matt Nathan, Dr. David Harlan and Dr. Barry Meisenberg. Even though this is probably going to be two episodes, we've only begun to cover the waterfront in healthcare. But healthcare is very important because ultimately, we're all patients at some point, and of course, we're always going to be caregivers to those that we love. With our guests today, this is your host, Rich Helppie, signing off on The Common Bridge.
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