Scott Hesier: Episode 353

Transcript

[0:00:20] NVN: Look, I’m going to be honest here, I can’t remember the last time I had a conversation about health insurance or healthcare that didn’t leave me completely frustrated and I certainly can’t tell you the last time I had a conversation about either of these things that I actually enjoyed. No one was more shocked than I was that the conversation you’re about to hear between myself and author Scott Hesier, was fascinating. Scott recently released a book, Healthcare Is Making Me Sick: Learn The Rules to Regain Control and Fight For Your Healthcare. Scott has spent more than 20 years working as a consultant for clients in the insurance and healthcare system and is a founding board member and senior vice president of one of the largest employee benefit companies in the country. Today, Scott is the founder of the website, uncoveredhc.com. A site that arms people with the information they need to make smart and informed health insurance and healthcare choices. Scott understands the health insurance and healthcare system in a human way that most people simply don’t. In this episode, he provides some tips for listeners, provided in actionable plain speak language, about what most of us are not doing that we could be to empower ourselves in the healthcare and insurance systems. He explains how we can make better choices in selecting our healthcare insurance plans, how we can maximize our coverage, how we can lower costs for treatment and prescriptions and how we can generally make better choices that render better health results.

[0:01:59] Scott Hesier: I started some 26 years ago with a firm and I was a partner and one of the founders and commercial insurance brokers, where I brought up the employee benefit practice. We became a regional company throughout the Midwest and did that for years to corporations of all sizes, from small employers to large mid-market to Fortune 500s. Did that for, like I said, 26 years and had great success without saving employers significant money and enhancing their programs and meeting their objectives and what struck me certainly after ACA, which is Obama care, known by many, is that the employers potentially weren’t the best avenue to affect change for employees and get to employees what they really needed. With that revelation, started looking into a number of different things differently than I had for 26 years and different sources and found a whole new versioning market incoming up in the healthcare arena that actually encouraged me and caused me to look differently and look more towards the consumer, with the goal being of empowering individuals to become consumers of healthcare, enhancing their outcomes while lowering their costs.

[0:03:06] NVN: I know I can speak for myself when I stay that that’s music to my ears because as a consumer, one of the things about healthcare and health insurance in particular, is it feels sort of beyond my control. Your book is actually subtitled Learn The Rules to Regain Control and Fight For Your Healthcare. I think that a lot of people feel like me which is we don’t have a sense of control over our healthcare and insurance. Can you talk to me a little bit about how that might be a misnomer?

[0:03:39] Scott Hesier: Well, actually, I don’t think it’s a misnomer. I think a lot of people don’t have control of their healthcare and what they’re doing, and they just go through the motions and when it happens, they’re very passive participants and that in essence is the problem we have in this country. We have a third-party dilemma as I call it in the book. You’ve got major corporations, hospital companies, insurance companies and the government sitting at the table along with pharmacy, talking about their objectives. Their objectives are legitimate, how can they meet their goals, their money, their profits, everything else and they’re all talking about it. But you and I aren’t at the table and you and I are the people that are paying for that, we’re paying our taxes for Medicare and Medicaid, we pay in our premiums, we pay in our deductibles and co-insurances. We’re paying that and our objectives are on the table. So the goal is how do you bring people to the table with heavy players like that and that intimidates 99.9% of the people out there. What I want to do is flip what I did for years for employers and show people tricks of the trade and how they can become comfortable, get more knowledge. Francis Bacon said, “Knowledge is power,” and that’s the first step. What I see happening and it’s unique, it’s kind of the perfect storm, that didn’t exist five years ago. But you have Obama Care coming in which was a generalization of cause shifting and it allowed employers to increase all their deductibles and co-insurance to their employees. I mean, you have to pay at the point of service more out of pocket. You have transparency and the egg’s been cracked, there are companies out there that are providing healthcare data, what the costs are and what outcomes are. It’s new and they’re not always as robust as we want it but they’re out there. People can get information now that they didn’t have before. Then you have the pretty much ubiquitous acceptance and utilization of, I’m holding an iPhone or any kind of phone in your hand, that allows you to access data, readily and easily and people are used to that. You start to put all those together, you have motivation because there’s pain, you have to pay more, you have actual information out there that will help you understand what’s available and what things cost, and things do cost differently, and then you have tools to access that information. I throw in one other caveat, the #metoo movement has had some very successful movements in the last couple of years with Weinstein and others, that has actually moved markets because people started talking about it. You put that all together and what I’m encouraging people to do is at a macro level as we’re talking right now, is that there is information out there, there’s tools out there and you have motivation to actually do things differently. I would add to that and say, there’s also a lot of people doing things that are reducing costs and that’s what my book goes into. It shows you people, average Joe’s, all the way up to Bezos, Buffett and Diamond, that’s Amazon, Berkshire and Chase, trying to do it differently. A pretty good company and people are trying to do it differently and it can happen. I want to help people walk through that and do it.

[0:06:30] NVN: Amazing. I want to know about all of this as a consumer. Let’s start off by talking about some of the information that’s actually available to me that I might not be aware of and where do I got to find that?

[0:06:45] Scott Hesier: Okay. If I can take a step back and maybe talk about the continuum that I address and then part of that is where you can go to find information.

[0:06:52] NVN: Absolutely.

[0:06:53] Scott Hesier: It ties into your previous question a well. How do you approach this, how can you become a consumer of healthcare if people have been historically passive? I looked at it and just said, let’ approach this like any other situation, or school project you had, or business situation. How do you approach things? You sit down, understand who you are, what your objectives are, after you’ve established your objectives, you research the market, say what’s available out there, then you talk to those people that you researched and negotiate and work with them and come up with an end solution. We’re going to do the exactly the same thing for healthcare. First thing we do is we sit back and say, healthcare and health insurance are two different things because what I hear most times is, my health insurance or my healthcare is substandard and they don’t’ say that, they say something far less pleasant. But what they’re saying is that their health insurance is too expensive, and it’s not healthcare, healthcare is the services you’re getting from your doctor and providers, health insurance is how you pay for it. First, we have to talk to people about that and the difference between the two, and then what we sit back and say is, understand who you are from a health perspective. Whether you do a health risk assessment and you get your health profile and your health history and you get your family history and you put that all together and you’ll start to have an idea of what you currently have as far as conditions. What you might have through some of your vital information that you have and what you might have from family history and once you have that, you got a good idea who you are. The next thing you know, we show people is what’s common costs are? Everything from just visiting at a doctor for the flu to having major brain surgery, a range of services. Now you know what it costs, and we sit back and say, can you afford that? How are you going to approach that? Now, for the first time you go, and most people, again 90% of the people can’t afford a catastrophic event, they’re multimillions of dollars. You now understand that and when you go to the insurance market, you have a better idea of who you are and what plan is more appropriate for you. A lot of people make a totally different decision when they know that, than when they usually go and just take either the lowest premium or the lowest deductibles and buy that and want to get done with it and move on. Now you’ve worked on the financing side, we then say, you now know who you are from a health perspective, let’s pick a doctor. And instead of just picking any old doctor, somebody down the street or somebody your mom told you about or your dad told you about or your neighbor or your work compatriot. You can start looking up based on who you are, what doctors treat what you have and who you need to be. You research them, now you’ve got providers that are more aligned with you. You do that for insurance, general practitioners, specialists. You pick those and there to your point, when you find that, there are transparency sites that are starting to do that to show you doctors and show you what their practices are, what their charges are, and the number of procedures they provide in certain areas. You can start to pick that out. The next you go to is you say, I’ve picked a doctor and everything else, now these charges are all coming in which I expect from my doctor and there’s checklist in there to say, here’s what you should be asking a doctor, here’s what a doctor should be performing for you and if they’re not, they’re not the right doctor for you. You should find another one. Then, from there, once you have a treatment plan, you need to ask them, what’s the most efficient way to pay this that gets me the best outcome. The lowest cost for the best outcome and that is a fair question to ask and again, if the doctors are good partners with you, they’re going to do that. We then talk about communicating with the doctor because if you don’t communicate effectively with your doctor, imagine going to the car mechanic, dropping your car off, and you know it rattles and you just say “Hey, there’re something rattling, I’ll see you in a couple of hours.” They’re going to run every test they can because they have no idea what to do. It’s your responsibility to talk to the physician. We teach people how to talk to their physicians, we teach them about the world of the physician, how much time the physician has, what they’re really interested in and how you can best communicate your story to them. There are ways to do that, a checklist to do that, and training that we have. We finally move to once you’ve done odds and now, you’re negotiating, you’re communicating with your doctor, you’re getting a better outcome, you’re utilizing the system effectively. Then we talk about, well, what’s one way to manage all of this? One is you buy insurance to do it, the other one is don’t get sick and as crazy as that sounds, 50% of all of the claims in America are lifestyle based. Which means, you and I have control over that. If we have control over that, we maybe need to get of the preverbal couch and do some things about it. We walk through all that about how to be preventative medicine and where you can find that and things you can do to help affect change there. And then we finally talk about alternative ways to provide insurance or creative alternative ways to fund healthcare situations. Ultimately, we also talk about retirement because what I find is just amazing is that most retirement managers do not talk about healthcare costs. Just one quick stat is after 65, when you're on Medicare, you should be expected to pay between 125,000 to $150,000 out of pocket costs. In addition to Medicare, after 65.

[0:11:38] NVN: Wow.

[0:11:39] Scott Hesier: Most financial guys do not talk about that, not all, but most. If you don’t put that in there, you are going to knock down your fund and retirement by 125 to 150. We’re doing a continuum of the whole healthcare experience and walking people through it and encouraging them to uses some of the resources we’ve put in there. Some of the reference places, the transparency sites, the tools, the techniques, the cheat sheets that we put together, to become proactive. Then we give story by story of people that do some of these things and they are successful. That encourages people to maybe look on their own to do some things.

[0:12:15] NVN: Hearing you talk, I’m a pretty logical, organized person. I can almost feel myself cringing over here because I’m realizing how illogical I am with health insurance. I’ve just sort of decided it’s the enemy. All this research you're talking about, I felt so disempowered for so long, I do exactly what you were saying people do, which is I just go on and find the cheapest thing and I’m done with it. I don’t want to think about it and then I complain when I have to use it and it doesn’t work.

[0:12:47] Scott Hesier: Exactly. I would suggest that maybe because you didn’t asses who you were before you started looking at it. If you sat back and said, here’s my health situations, here’s my family health situations, here’s what I may have, here’s what I can expect potentially to pay next year and ongoing years. Now, when you look at a healthcare plan, you can say, “I think I want to spend, I just looked up, I may have to have a procedure that would cost $50,000. Mathematically, what’s the best program to buy in?” Not necessarily it’s the premium upfront but it may be better to have a different deductible. Looking at it that way, you have your objectives established when you go look at healthcare plans and it changes the paradigm. It causes you to ask more questions. So, it takes a little pre-work and everything I write in this book is saying, none of this is easy. There’s another gentleman out there that talks about – a very famous individual that has a very successful program over there, Dave Ramsey, that talks about everything he’s written in his books, everything he tells you to do is nothing new. He puts it in a logical organized manner and he says, “If you are disciplined and do it, you will have a different outcome.” That’s basically what I’m telling people, you have to start at the beginning, which sounds overly simplified but that’s the reality, start at the beginning, who you are and when you look at it, that will help you choose where you should go. Now, there’s a lot of tools, did you even look at it? If you’re with an employer, you should ask, do they have calculators that help you make these decisions? Talk to your HR staff, I you’re not, you can go out and there’s websites that can help you if you’re going individually to help make choices. There’s concierge sites that if you wanted to buy into, they’ll help you make those choices, or you can make it on your own. The biggest thing I would say is, unlike all business situations, you want to be as close to devoid of emotion as possible and everybody gets emotional about this. Imagine when you’re looking at the healthcare and you’re on health insurance, you’re looking at it, there is anger, frustration, sense of betrayal, again, a lot of adjectives and adverbs that are none publishable but that comes out. What you have to do is you have to remove all of that emotion and do the math. It’s just a math problem.

[0:14:47] NVN: Yeah, it strikes me as so layered because first of all, I think a lot of people like you just said are coming from a preexisting state of frustration which is probably legitimate in some ways, maybe not legitimate and some other ways. But also, this become issues of mortality in some ways. If you’re really going to stop and look at yourself and your family history and think, okay, what is logical that I can anticipate? That can be difficult for some people, I’m sure.

[0:15:17] Scott Hesier: Excellent point, we can do this at the PHD level, or we can do it at you know, 101 level. No one starts at a PHD level, you start at the 101. What you want to do is get what you can get, that’s better than where you are now. You can interview your parents, your grandparents, they’ll know what the grandparents had. Put that down, now you have an idea that you may or may not be susceptible. Was there diabetes in your family, was there cancer in your family, was there heart problems in your family and how many? It’s like any problem you take, if you look at the overarching problem, and you try to solve the whole thing at once, you collapse. Take it and break it into small parts and solve each one, one at a time, and then roll them all back up together. And then the story’s told. At the same time, you know what your overall objective is so break it into units and solve by unit.

[0:16:00] NVN: Let me ask you this. This notion of empowerment with health insurance and healthcare is pretty novel to some people. Is health insurance as broken as we think it is or is the problem that we don’t understand where and how we’re empowered?

[0:16:17] Scott Hesier: It’s not broken at all. I’ll give you a statistic on that from success, success being how well is the stocks doing and those companies doing? Since Obama Care, ACA went in, excuse me, since 2013 to 2016, 2017, the stocks, pricing, of the top four major health insurers, the lowest one went up 151% with the highest one being close to 300%. While the same time period, the SMP went up 91%. Health insurance isn’t broken at all from that level and I purposely say it that way to motivate people to say, “Enough is enough.” You understand what your objectives are. Now, to be very direct, one individual calling up is not going to change a rate with – pick one of the national healthcare’s. There’s no leverage to do that. What you can do is buy the right insurance plan by knowing who you are. I’ll give you an example, I had a former associate, we put in an HSA program in probably 2005, we were early adopters. She had serious chronic health conditions that caused her to be on medications and miss work, a ton of different things, incredibly dedicated individual. She saw the health savings account program coming in, was panicked that we were taking all of our benefits away, but she sat down and did the math and she realized, the way we have structured it, that if she took the higher deductible, she was going to get a lower premium and that she was going to max out. She was going to have enough healthcare claims that she was going to go through that deductible. At which point in time, her benefits will be 100% and it was more cost advantageous to her over the year to take the significantly higher deductible plan. But it provided a cash flow problem. She wouldn’t have the cash up front, so she came up with really creative things. One is she used credit cards and two, she went to her doctors and asked for a payment plan and her doctors agreed. They stretched out her payments, so she wasn’t getting hurt on a cash flow basis. She was doing that for the whole year, the other thing she did, she looked at it and said, some of this is lifestyle based. She aggressively went after her lifestyle, did a number of different things that were successful, was able to change her medications and in essence save some money on what she was doing and felt way better anyway, she lost a fair amount of weight, among other things. She did that, she did better, nine months through the year, she’s doing pretty well cash flow wise, still owed the doctors money, went to them and said, “If I gave you cash now, will you give me a discount on the remaining amount that I owe you?” They said yes, she put everything I’m talking about all together and had control of her life. It wasn’t like insurance got cut in half or she found a miracle cure with insurance or miracle cure with healthcare. What she did is she understood her situation, she did the math, she was proactive about things she could control, and she had some tools to work with. She was in control.

[0:19:04] NVN: Now, let me ask you. Since obviously you have discussed this with many people. Is this woman’s scenario fairly common? Are most doctors willing to work with patients in that way?

[0:19:17] Scott Hesier: What I would find out is so high deductible plans since 2014 with ACA’s. That was the legitimization of cost shifting to employees and individuals. Most people on thee healthcare.gov programs have large deductible plans and that’s just the nature of the premiums. Unfortunately for a lot of cases. But because of that, the provider community knows that people are coming in, having to pay huge chunks of money out of their own pocket. This is where we talk about how to talk to your doctor. We take each one of these segments, if you go in and if you talk to your doctor and you have a relationship with your doctor and you are explaining to your doctor everything health wise you have so they can treat you well and part of the procedures that you’re asking for is cost. You are upfront with them and diplomatic on how you do and say, “Doc, you’ve got to help me because this is all on me. How can we find the best effective care?” I find most doctors will help you, they’ll find different drugs, they’ll find different treatments, they’ll work where they can. Again, not in every situation, there are unique illnesses that there’s only one source of drug, or there’s only one procedure they can do, and there’s not a lot you can do about that. Again, in 50% of our lifestyle claims, there’s a lot of claims out there you can. Doctors do work with you and what I would suggest is, if they won’t, you have the wrong doctor. You need to create a partnership with your general practitioner internist. They’re the gatekeepers to the whole system, they’ll get you into the specialists faster, better, they know where to go. They’re your first line of partnership and we strongly recommend getting a very good relationship with them and if they’re partnering with you, they should be able to help you. I’ll also say, a lot of them don’t know about a lot of things I have in the book. I share it with the doctors. Now, I’ll tell you, they share it with their next patient. The whole idea of the book is to collaborate with everybody. If we all start sharing information, we can get a movement going with this and actually have better outcomes. I’ve always said if I start an idea and I plant this seed, the idea will be so much better after 10 other people look at it and tweak it their own ways, than I could ever imagine.

[0:21:12] NVN: Prescription drugs, in terms of bringing those costs down, are you basically looking for generic forms there or are there any other ways through which you can alleviate those costs a little bit?

[0:21:23] Scott Hesier: Think about this, almost everybody spends infinitely more time buying their phone, researching, comparing, analyzing than they do in their health and health is the largest asset that you ever will have. It is your life. So, it is a such a huge disconnect for me why people don’t spend more time doing that. It is going to take an effort, like any new effort and everything that changes, it will be uncomfortable. It is example after example of people getting different outcomes. I gave the example of a one woman that changed her life and made big differences. You will start finding through transparency tools out there that services, everything from MRI to knee surgeries, are dramatically different in different locations dramatically. So maybe you want to start going to a different place. So, when you have this kind of information and you go into your doctor and talk about it, now you have a real dialogue and if you do it under your own way diplomatically, they need to respond because they are in business. If they don’t, then maybe a drive three hours to a different service. I myself just had an MRI. In the location I was in, 2,500 bucks, I drove three hours and got it for 400.

[0:22:23] NVN: Wow.

[0:22:24] Scott Hesier: There’s knee surgeries, total knee replacements in $68,000 in San Francisco. You can go to Phoenix, get them for about 40,000 less. But I go back to your question was around RX, you know that is in the press all the time and there is not enough time to talk about all the things going on RX because there is a lot that goes. But what is important is, there are tools out there. There are discount cards out there that I thought were a hoax through my whole career. I would keep those away from me. “Those aren’t real,” let me tell you they are real. You can go get deeper discounts off of your drugs than even your health care carrier who gets discounts already is getting. I have seen people go in with a topical cream for pre-cancerous pills. $200 to their healthcare, one drug discount card brought it down to 150, another one got it down to a 100 and now you just got to show your card and it is coupon free over the phone or your computer. There is also many different tax-free’s if you are on chronic conditions. I have listed out 12 or more how you can get better pricing by buying differently using these coupon tools. There is also a service out there, the Patient Assistant Program is a program that manufacturers offer deep discounts on single branded drugs. So, these are branded, they are not generic. They are single source, you can get them in only one for these situations. There is an individual on a blood thinner called Eliquis. It is $430 a month through their carrier, they got it for 10 bucks a month. Now that doesn’t happen all the time but there is this site, one of them out there is RX Hope. There’s over 350 drugs that have programs. You have to qualify for income, or you have to qualify as a high deductible plan, and you may or may not qualify but it is certainly worth the phone call.

[0:24:01] NVN: Absolutely.

[0:24:02] Scott Hesier: And then to your point is you started out generic. You always want to try generic. So you try that first but there is ways now to go and comparison shop what the cost of these are. You can go to different pharmacies in the same city and get different prices with the same drug. Same pharmacy, well I am talking about the same branded pharmacy. You can also go to the big box stores, they are trying to entice people to buy other things. They give some drugs away for free, they give some drugs away, a number of drugs for only four bucks. They aren’t common but if you start to become a shopper you can find it. So if you are willing to move around your city, you can find different costs to different pharmacies. Then the last one is a lot of people don’t know it, but the pharmacists. One of these drugs I was on and got significant reduction and a pharmacist said, “Oh your insurance plan won’t take that coupon if you do that.” I looked at him and said, “Oh yeah they will” and he said, “No, they won’t.” I said, “No, what they won’t do is I can’t run it electronically through your system but I can get a paper form and submit it to my carrier and they’ll take that and they’ll apply it to my plan.” I saved a $150 and that pharmacist looked at me and he goes, “I didn’t even know about it.” I basically did a seminar for four people standing around me on how they can save on other drugs. That is a big area and I am glad you asked it because the other thing is that is usually where people first encounter the health care system. They have done to a doctor and they get a drug and that is another whole side story on why we’re a pill popping nation. Doctors are now paid through Obama Care for patient satisfaction and it is a burden and they’re in a business where they need to do so. But what happens is, you or I going to a doctor because we are not feeling well. We want instant gratification now, what does that represent? If a doctor goes and say, “You need to go lose some weight Scott and you know you should eat different and you should exercise and you got to do all of these other things.” You’re like, “Doc, that’s going to take six months and I got to go do something myself.” What do we want? We want a pill, so they script a pill and it makes us happy and we leave. So, a lot of this is on us too and we have to recognize that.

[0:25:49] NVN: On the one hand it seems overwhelming, in some ways, on the other hand there is a lot to be said for it being on us because I mean, I have said this time and time again but it can feel so disempowering and out of your control. That is just a novel concept that any of this stuff can in anyway be on us.

[0:26:07] Scott Hesier: Well, you know it’s the definition of insanity. If you’re miserable now, confused, bewildered, angry, whatever, again any name you want to put to it, and you keep doing the same thing, do you think anything is going to change? I just encourage people if you are not happy, let us do something about it and the encouraging thing is there are things to do. So, if again, getting off the couch and try some stuff, don’t tackle the whole world. You just went to the doctor and got a drug, let’s try that. Can you get it cheaper? Because here’s what happens when somebody gets it cheaper, they are elated. They got a win. They go to the win column and they put a one and you know what that encourages them to do, is try it again. All I am asking is not people to attack this whole thing. It is where are you in the continuum and let’s take that section and apply some principles to it and see if you can get a small little win. If you get a small little win, let us take another step next time and keep building it.

[0:26:58] NVN: So, talk to me a little bit about retirement and health insurance. The numbers that you’ve sighted earlier in this conversation are staggering. How can people get creative with that especially if you’re living on retirement income?

[0:27:13] Scott Hesier: Right and it all depends on where you are in the cycle. You know if you are towards the end, it’s obviously harder than if you start out earlier and the problem with that is when you start out earlier, you have no interest from saving from when you retire. So yeah, the classic catch 22, but you want to be aware of that. You want to talk to a financial advisor. There is certainly tax deferred and tax-free vehicles through an employer, or on your own, that you can work with and then there is premium reduction programs. As an employer, they are pretty ubiquitous, pretty much everybody uses them meaning you pay your premium pre-tax versus after tax and the government will let you do that. There is HSA’s, you get an HSA you can save money and the money that is in that account is tax deferred and if you build up X amount you can invest that money. So that can be a vehicle, kind of another 401(k) type and you can put it in pre-tax. You can look at FSA’s. You can take taxes off your healthcare expenses over taxes of an individual and more people do that. You can also in creative ways look at different forms of life insurance. You could sell your life insurance plans. I mean now I am talking about more situations where you get in an unexpected situation and you don’t have the cash. You can sell any kind of life insurance policy out there from term insurance, to whole life insurance, to permanent insurance. You can sell that, but you won’t get a great price, but it is an asset that people forget about. I talk about people with credit cards, how many credit cards do you get mailed to you or offers for credit cards in a month. A lot of people get a lot of them so what I suggest is take one of them. That the nice line of credit whenever you can get and put it in a drawer and that’s your healthcare. So, the thought there is none of this is miraculously going to save you that you don’t have to pay it back. But what you don’t want to have is when you have a health condition and your cognitive reasoning drops by 70% and you add to that financial pressures that will further confuse the whole situation to what you should be thinking about as your health, you know you got a backup plan.

[0:29:01] NVN: Yeah that is the best argument for opening a new credit line I’ve ever heard. Actually, that makes so much sense because you’re right, in that moment nothing good is going to happen. It is just going to be panic settling in.

[0:29:15] Scott Hesier: Right, imagine you getting a stage four cancer diagnosis and you got a $6,000 dock when you don’t have the money. The average American can’t find an additional $400 to spend. So how are you going to come up with 6,000 and you’re worried about your kids, your family, what I’m going to do in my job and everything else. So, it’s like boom, let us take that off the table. You got to have to pay that back I get it but let us deal with your health right now. And then permanent or whole life insurance, that’s a vehicle that you can put money in. They will provide pretty good dividends and you can borrow against that. It is an asset and it is all tax deferred. So you want to talk to your accountant and bring some of these ideas up and some of them won’t like this but you should say, “I might have to spend a $125,000, are you going to help me?” Again, nothing is perfect but we got to do things differently.

[0:29:59] NVN: Why do you – I mean I don’t know if you have an answer to this but I am curious if you have a thought – why do you think that this incredibly significant cost is not coming up with financial planners, especially as people plan for retirement?

[0:30:14] Scott Hesier: After 65 I would surmise it to “Medicare is there and that takes care of everything.” You know your Medicare is there you don’t need to worry about it. That would be my guess and below, if you are working and employed, you got a healthcare plan, so people think you are covered there. So, I think it is more than hey, you are really covered. You got to come up with maybe some deductibles out of pockets, which are now significant. I think part of it is looking historically at it. And they weren’t as big of an issue, but since 2014, people have huge deductibles. Huge out of pocket costs, five to $6,000. For a family $12,000. Those are numbers that shift the playing field. I think it is just people catching up with it, meaning the industry catching up with it. The good ones are but not everybody and a lot of financial plans you have are robo-plans. They are programs, they have certain formats and if you fall into certain format that is how they are going to invest for you.

[0:31:02] NVN: This is backing up to an earlier point that you made but you were talking about how people can use concierge sights as they are finding their correct plan. You mentioned that later in your list of things people could do. To me that seems like the easy solution. Is there a reason why that is not at the top of your list? Is there some sort of drawback to taking that tact?

[0:31:23] Scott Hesier: Not a drawback but what I am trying to do is motivate people to no longer be a passive participant and be proactive. So, what I want people to do is to understand the whole process of what it takes and then, given their own circumstances, they may be too taxed to do it themselves. So, then you could buy a service that helps you do it. But it is like if you are learning piano, you got to learn the basic scales and chords and everything else before you can just jump into a song. And if you don’t know those and you just learn one song, which someone could teach you to play and you just memorize it but you don’t understand it, that is the only song you are going to play. The old adage is I would rather teach people to fish than to give them fish because they now know how to feed themselves. But with that said, there is a large segment that may be just overwhelmed, and they can’t. So then I will be providing within the website I have created uncoveredhc.com. I would provide a concierge service that people could pay on a monthly basis that will help them and there is others out there. I put two or three that people could call and look, employers if they offer those your carrier would have a concierge service to be directed. You should look at all your resources. So, what I am really trying to encourage people where they spend any money elsewhere is do it yourself because if you do it yourself, you are what you said in the beginning, you are empowered. If you are empowered, you are more in control and you’re more satisfied with your life. So now here is the other thing is we talk about a couple of catastrophic situations, you are not going to think in a catastrophic situation. If you’ve just read the book and you get a catastrophic situation, it is not going to help you because you didn’t have a couple of years to practice. So, what I really want some people to do is sit and practice this so that when they do get a catastrophic situation, they are more prepared to take it. If not, maybe that is the time you buy one of these services and what I always say is you need an advocate. If you are going into serious medical situations, you need an advocate. That can be your spouse, that can be a partner. That can be a neighbor, that can be a business associate, whatever. It can be one of these services, but you need an advocate to hear what you can’t hear and that is part of talking to doctors and everything that we talk about. It is in that chapter. You can come in with lists, you are prepared when you go in, you have people listen for you, so that you really hear what the situation is.

[0:33:28] NVN: I feel like catastrophic when it comes to this stuff too, something can be catastrophic without actually being that big of a deal. I have a two-year-old daughter and when she was about five months old, she had a fever. No big deal but she had a feveral seizure in the middle of the night. Of course, so I ended up calling 911 and an ambulance came and at the end of the day, it was not a big deal. However, financially I was like, “$2,000?” which as a new single mom feels pretty catastrophic in that moment. So, it is probably not saying anything listeners don’t know but I do just want to point out the fact that it takes so little for this stuff to really just pound you.

[0:34:10] Scott Hesier: Perfect point and this is what I was saying a little bit earlier is that everybody has their own situation to do. Catastrophic means one thing to others but what I was referring to is a catastrophic health situation, but your daughter could have been with a seizure. So, you all have to defer to what makes the most sense for health situation but what I am trying to talk about people is if you can start to train yourself to be aware of who you are, of the tools that are available, so that in non–emergency situations, you can deploy those, you will have better outcomes. Whereas if it is an emergency situation, no question, you do what you have to do. Now with the financing that you incurred maybe some of the other suggestions we said earlier might have helped you and been less concerned about it. You still would have to pay for them, and I am not suggesting a credit card interest rate is the best way to do it. But it is a way to do it and if it gets you over that situation, then that’s worthwhile and helps you be in more control.

[0:35:06] NVN: Absolutely and I think what seems to me like the biggest value there is just having that peace of mind in that moment. Well you know you are getting through the immediate aftermath of it and you don’t have to worry about that. That is one of the rare instances when a credit card interest rate seems worth it to me in the short term.

[0:35:26] Scott Hesier: Right, that is a way to approach that in any situation. There is also, and I don’t know if you would have used that, there is telemedicine. A whole another burgeoning field of finding ways to communicate with physicians, clinicians and none-traditional manners. So it is either telephone, texting, that is an enormously fast growing area of the industry and maybe that is something that you could have called. There is another person, who in fact is someone that was collaborating with the organization in the book, and writing, there was quite angry – it wasn’t quite extent you had but it had an earache on a Saturday night at two in the morning and then had them go to ER and had a $2,000 bill over an earache. I explained to them, “How about telemedicine?” Never heard of it. They could have made a call, got an Amoxicon script, gone down to a walk-in 24-hour Walgreens or CVS or whomever, and got the medicine in them. And spent, I don’t know Amoxicon is four bucks and the phone call is 45 and you can call two or three in the morning. So there’s tools out there and that’s the exciting thing out there, is there are avenues to pursue that are producing different outcomes. I run across them now almost once a week, very encouraging and who will survive is yet to be seen, but they are out there, and what you have is with one sixth of the economy being healthcare, you’ve got Silicon Valley chomping at the bits to get involved. The Amazon’s of the world, they want to bring automation and technology to make this easier to do and give better access.

[0:36:49] NVN: It is one sixth of the economy? That is a pretty stunning statistic.

[0:36:53] Scott Hesier: It is.

[0:36:53] NVN: Wow.

[0:36:54] Scott Hesier: Well just go drive around the city, look at the cranes going up and figure out who is building something.

[0:37:00] NVN: Yeah, wow.

[0:37:01] Scott Hesier: And that is one of the things that hit me. You just saw a lot of building, a lot of hospitals doing it.

[0:37:06] NVN: So, you talked about telemedicine and how that’s something that we can really be excited about right now. Is there anything else in, either the healthcare or health insurance industries, that is promising and that we can all feel really good about?

[0:37:24] Scott Hesier: The transparency sites that are out there and I have listed a number of them in my book because that is the information. You can pull them up and you get prices for services and some of them you can get doctors, how many procedures they perform in that area, which is an indicator of how good they are, or not. It is an indicator, it is not a definitive answer because volume is king. If someone has performed a thousand of those procedures, they probably have little experience. If someone has only performed five, you have to consider that. Now it is not always because that person who performed five may have been the top student at John Hopkins and studied at Mayo and been the best person in the world. But you guys start looking at factors and may come into your own conclusions. So those tools are out there and when you have those, you can have to start an intelligent question with your providers and they have to respond and when they respond, you give more information and you are starting to be involved in the decision process and that gives you, in essence, control and will give you better outcomes. The better outcome can start with this, as you just feel better because you know what’s happening. I helped a couple that is unbelievably both got cancer in the same year and were devastated and helped them get onto a concierge plan with their existing carrier, then started walking them through everything and then helped them look at they had a couple of doctors that have been recommended and look them up. And looked at their outcomes and their qualitative scores and said, “Yeah, here is the ranking of them and you have a couple of good ones and you are making good choices.” They were so relieved. It was like the credit card and you have the 5,000 or $6,000 deductible and you don’t have to worry about that anymore. So, know that they were making good decisions really, really helped them. I want to segue with that a little bit to say what encourages me every day is talking to people like that. Because there is the demand is so overwhelming for people to deal with this because of the frustrations they have. It’s just giving people a little bit of help makes them feel tremendously better. I look at that and say to me, from the world I was coming from that’s pathetic that people aren’t trying to solve this in a greater level because the demand is off the charts. But if we can reach people and start getting them more involved and they can start feeling better themselves. And then maybe find somebody, if they can’t do that, there is some other tools that they might be able to use that is just a huge service to all of us trying to deal with our health care.

[0:39:38] NVN: Absolutely. Anything else you want to share with listeners that we haven’t gotten to yet Scott?

[0:39:44] Scott Hesier: You know I’d obviously love them to buy the book and read it but I’ll also say they can do it themselves if they take the initiative and that is what I’d ask them to do, is take the initiative. Change their paradigm, there are better outcomes out there. There are tons of stories of people doing it. I’d ask you to be one and I would say if you take the initiative and you have a positive outcome tell two or three other people. Tell people about it, about how you did it. Tell them it can work because if we can do all of this, we can improve the nation’s healthcare not just our own.

[0:40:10] NVN: Thanks for joining us for this episode of Author Hour. You can find Healthcare Is Making Me Sick, on Amazon. A transcript of this episode as well as all of our previous episodes is available at authorhour.co. For more Author Hour, subscribe to this podcast on your favorite podcast subscription service. Thanks for joining us, we’ll see you next time. Same place, different author.