Long before Obama care or the Affordable Care Act -- back in the mid eighties when health care discussions. We're going on in the Clinton administration. I kept waiting to hear the voice of the doctors. There was tremendous noise from Democrats and Republicans. From insurance companies and pharmaceutical firms. Where were the doctors I have missed. Fast forward to now. We -- with the doctors in the discussions in the creation of the Affordable Care Act. If they were at the table I'm sorry I didn't hear their voice. Maybe it was muffled by the sounds of insurance companies pharmaceutical firms and those Democrats and Republicans. Interestingly recently I am hearing from doctors. A couple of weeks ago we did a program on concierge medicine. Doctors who were leaving their practices with 25123500. Patients. To start new practices. With a limit of 600. With that they say they can do what they went to medical school to do. Take care of patients. Not a ten minute visit not having patients wait weeks for an appointment. Yes these doctors take insurance and Medicare but they also charge roughly 16100 dollars a year per patient. For being on call 24 sevenths. And for spending no less than thirty minutes with each appointment. And for that extra money they'll do more than a comprehensive exam. And blood work to understand your health. Concierge medicine is very much the sound of doctors letting go of the system they had little to no hand in creating. And that can be said of another group of physicians called the -- Claude. A volunteer group of doctors. Who are speaking very clearly. That at the center of every health care choice must -- to central entities. Doctors and patients. Not politicians. On insurance companies. Doctors and patients. That's the way it was when I was growing up. What was wrong with that. Can we go back to it. Doctors and patients. And that's what we're going to talk about today with the Louisiana doctor. Who made a pretty radical change in his practice and is now a member of the -- squad. Doctor Jerod Jindal -- practices on the North Shore. Nine years ago stopped taking third party insurance whether that was private or government run and today he is a member of the -- -- And on the phone we're joined by doctor Jeffrey singer. Who was a practicing surgeon in Phoenix. And he is co chair of the Arizona -- squat so I welcome both of you thank you so much doctor singer and doctor. -- you know. Thank you. Let's start from the very top but it is fascinating to me the whole concept of this but I would like you two to explain. But what is the -- squat. Well the -- gone is basically a handful of doctors from each state that are. Talking out about deals of Obama care if you would. There's problems with their health care system. -- problems before obamacare. But all the things that obamacare was supposed to make Danner is actually going to be worse and we're gonna see that unfold over the next couple years and so -- here basically to to talk about that. And you can tell my -- my heart is in the same places my words as in nine years ago we got out of the third party payment system. And then I cannot wait to hear is I have many many questions. Doctor singer as well as your thoughts on why you joined the -- squad. -- long been advocates. Market reforms toward health care system we have and have. You true market oriented health care system and probably twenty or thirty years now everybody thinks that we have a free market system because. There are privately owned companies that act as intermediaries for the fact we don't have a market except in areas. Where there is not dominance by a third party payers so for example. You look at there is likely sick -- surgery. Or in most cases -- industry cosmetic surgery where insurance doesn't play a role. They had those areas like every other area of economy that is a market -- -- competition with the pieces acting as a consumer prices over time. Have come down its service and -- is gonna. But we have to report payments system dominating. Our healthcare system today and it doesn't matter what -- third party payers with government or. Prices immediately called the insurance companies almost as a third party that's wedged between the patient and the doctor. And you don't have a market and that patient doesn't have any. That enabled exercise control over the situation. Doctor -- and have you also gone away from the third party Payer. No I have in my practice is -- It is very difficult to -- on this I'm noticing your partner. The group surgical practice here so first of all people down -- but besides that. In the archives specialty. At this point in time in the major decision. That. The very economically difficult in my quarters to one view that this. Absolutely that's one of the things that we found as we've been talking bad about going their party for either certain specialities. Where it's very difficult for the and to do that in general surgery is one of those because. They're so much dependent on emergencies and hospital console. Where they can't really you know it's not a matter of someone save enough money to do something it's not like elective. Things in effect for myself when I go to the hospital and I get. A call from the emergency -- or console. These -- people that didn't voluntarily choose to come see me and most atomic right off the payment charge me anything. Thought I was at general surgeon I could do that go broke. A lot of proportion of our practice is illegal elective surgery but it but that means not an emergency exit plan to kind. You know things like hernia operations. Gallbladder surgery. And in fact I my group will go directly quote directly cases where you directly. With patients independence of the third party system in fact. That miracle I have an article in the Wall Street Journal that it was -- it was a great illustration of the patient company. With a -- as a routine. And he. -- the kind of insurance that now unfortunately is we it was a good time which is the kind of thing that instantly view and I grew up with. Where it was what they called major medical which is could fix them certain non emergency nine. Critical things like hernia operations but that if you get. Seriously you know -- -- -- to deduct them with a -- That that the bill for the catastrophic and so so -- schedule Israel's operation and ready for the surgeons started. The in the critical success you -- once the camp was surgery. Because you wanna pay. And that's being kind to me so if she explained that they check for the insurance and because he has this kind of its plan. The insurance paid up to -- 500 dollars for the surgeon and anesthesiologist which is no problem. And we'll pay up between 500 dollars for the use of these outpatient surgical suites. And policy for the surgical suite is 23000. Dollars for the forty minutes and so we want to give us some. Credit card with 20000 difference is we want to. So I don't look forward to explain it and that got political beliefs of crisis what doctors and we're used to negotiate with the important players. And the article to that price and so you have insurance that is to Britain since. In -- in the PP oh I'm bound by any contract to the camp was surgery. Let's startled again I'll keep you look at price. I know -- just have to -- happy to be cast by Apple's shuffle around other senators say what the best castration demand here what it is cash. Four Israel will discuss that you have insurance and we will get and then the next day for 3000 dollars -- including these. So receives 70000 dollars out of pocket by not using his third party payment plan. And I wrote about it because that illustrates the problem and -- when he was the consumers in control of the patients shopping. But it would get this surgery including the facility for 3000 dollars but. When you're dealing with the importance in theory that this simply switch between the patient and the providers. And the providers have been negotiating with this third party now with the patient. Doctor singer Hank in Iraq we have to go for break but can I get some questions for you can shoot -- you bring up so many things I want everyone to stay with this doctor -- stay with us and I know that doctor geno has some thoughts to we'll be right back I'm Angela under the W we are talking with -- doctor Jeffrey singer who was a surgeon in Phoenix. And doctor Gerard -- linked who is a doctor on the North Shore I'm gonna say at one time. Amir say Nero who ecologists see I thought a solid day the bottom line is both of these on doctors. Have are members of the -- squad and that duck squad is trying to say the system we have now. Is not proper in the difference between doctor singer and doctor -- Nolan is packaging and only. What nine years ago you said I'm no longer going to accept insurance whether it -- medical but government or private. -- that was gutsy. Yes ma'am it sure was most people predictably be bankrupt. And so when we told people about this originally thought we -- just totally nuts. And then over time as we eventually start to succeed they say what's great you can do but there's no way I can do it. And NATO air by saying all the other doctors that is are saying. Oh my god I need to do this and it's become back then less than 1% of doctors were doing this. Now it's like five or 6%. Now it'll never get more than my prediction no more than about 15% because right -- close to two thirds of doctors are employees of big health care systems. And they're stuck with the third part payment system you know they have to do whatever. -- system takes. Okay as one who has insurance and I am looking at you and I'm thinking -- might like to go to you how can I afford this out of pocket money right. Well what happens is on when someone calls my office run off the bat they will kill the patient how much the visits cost. You know unlike other doctor's office we you don't know what it's gonna cost until three months later when catcher Leo being that explanation of benefits from the insurance company. Before you even schedule the appointment my office -- play Hamachi -- -- windy calm and we finished the visit. You get a receipt kick off form. That you sign off you mail and your insurance company and then your insurance company will reimburse view based on what you're insurance is so. The price for all my patients are basically the same for the same services how much they get reimbursed varies according to what their insurance -- OK so if by. Give me how much is your office asked. Well for at a new patient visit West Bend over an hour with a patient in this is for complex. You know the highest price visit and it's 400 dollars -- offense. Than a regular visit. You know can be as low was -- -- hundred dollars. You know it just kind of depends on what we need to do. If we have a range of things he might do will give the patient range it can be as little as this are as much as this. We never charged in more than what's the highest and we quote if for some reason I have to do something more -- -- charge whatever we quoted over the phone. I think that's something you brought up about we just go win and we give a co pay. Are we sort of blinded now or. And or dole is may be a better word. Dulled by will Michael pays 25 dollars or thirty dollars or whatever it is therefore that's what it's worth when in fact. It isn't. Yeah well to give an example what you get from the other doctors like freezing -- because see your your primary care doctor. For the same thing you're -- seen before you'll get five minutes of this time. And you pay that five dollar co pay but he's gonna get 190 dollar from the insurance company. And you think about it how much he's getting paid for that amount of time. Is significantly higher than what I'm getting paid from -- Yeah if I can jump -- or -- there is actually it is mine even. No I don't wanna tune him put the way the system works -- usually they can of the insurance company as is custom because insurance companies pay -- bill absolutely so. As opposed you the patient so in most cases don't -- count which cost that it doesn't really matter -- it by the oracle. And that gets back to like my patient I think I discussed what about. It's that the bill is much higher because insurance company be it third party is not the money that has been on the basis of other people's monies all the money in the pool. So there's been other people's money on something for somebody else they're not going to be a bargaining as hard as I can be -- personal. And the doctor that we have incentive actually took to give. The money's worth that patient as the -- so we give him five dollars. Absolutely doctor senior spot alone there is a conflict of interest in the third party payment system. And I think it best illustrated by a patient that came to Simi once and and I'll be honest -- remember what -- -- -- -- before but this is before when I was still on the insurance system. He came in -- told them okay you need to do XYZ. He leaves and comes back a month or so later he tells me still has the same problem on scratched me and of Q what did you do XYZ. He says no I didn't do that. Mean in a civil okay we need do XYZ. Month so later comes back again. And he's got the same problem so -- did you do XYZ pieces no I didn't do that in certain why do you keep coming back to me and and just not doing what I recommended. It so well it was only -- five dollar co -- and -- hoping you'd say something different. Home and that's the bottom line because it is not valuable to them veer and those that the whole process is subject gated to. You don't how much you're gonna pay and how much the insurance companies gonna pay fort. The -- -- mining practices sent mail. We call it non compliance with someone doesn't do which you recommend I have almost no noncompliance and practiced. Looking at their own pockets they're much better having their money it's their health all of a sudden. Then they take responsibility. But how do you respond to those who might be saying. I need insurance I could never afford what you all are -- it's not a matter of not having insurance as a matter of getting insurance out of the triangle. Of deciding what the key areas. Almost all of my patient will most of my patients have insurance. It's just I'm not taking money from the insurance coming they're -- -- -- eliminate that conflict of interest I work from my patience not for the insurance companies like -- singer would have any of those insurance companies denied your patients. Payment we do occasionally get that but it's a lot less often you -- you think. It's also important that mentioned when we talked convention talk about third party. It could be that the insurance companies the government the case of Medicaid the insurance companies government. That's not support the principle is that whenever a third party whoever that was evident parties whether it's private insurance company. That's to be heavily Michael managed by the government as it is now or is the government itself as is Medicare Medicaid. The doctor is feeling was that the important payers are doing with the pace of the customers leave the third party Payer. And and then everything changes in the and it's available as a third -- paying the bill the patient also. Doesn't demand is much accountability because that is that is they don't have skin in the game. Yeah everybody stay with us we get to break for the news but we'll be right back I'm Angela under the WL. With two members of the docs Klein doctor Gerald -- knowing who has from the North Shore doctor Jeffrey singer from Arizona and were talking about. A couple of things one doctor -- only. No Margaret takes insurance that by itself is mind blowing I think to a lot of people. And yet he's still able to make a living. Not doctor singer does take insurance system and surgical practice. But has deep concerns about the system we now had. And yet I think many of us as patients are -- lull you into thinking this is the way it is so all of us think were paying more. Because more is being taken out of our paycheck. For health insurance. But what you all are saying or you are saying occasionally is. You know what you can get the same care you get the same new pavement saying basically. But get better care in a different system. Is that correct. Yes that's what -- it. On what I'm saying is I can provide. This same service for significantly less cost. Okay if for example if I did surgery might charges for surgery are roughly 13 214. What the charges or from my competitors and it's because -- don't take insurance. And if somebody has the money for out of pocket they can pay that or your sang. You've given this piece of paper and they send to their insurance company in hopes that they will pay part of. Right vast majority patients get reimbursed by their insurance company how much they get reimbursed is very complicated. And it depends on whether they have on a network benefits and how and how much they get reimburses how good other out of the out of network benefits. I just curious what other many other medical. Professionals wouldn't wanna go the route you're going and not have to put up with the hassle of the paperwork in the you know. -- I love it it's a little bit depends on the specialty some specialties. Let's. Like the fact that you're always said that -- Dependent on hospitals they have the kind of things that they do. -- -- -- haven't a significant number of big ticket items for example MySpace. Cancer operations do. You know major intestinal surgery that -- that it's excellent money. So it's still light I actually make myself available for cash if you wanna do that. But I also have to depend on hospitals so what happens to hospitals as well. Our -- thinking that doctors have to begin with the reported payers so I like I gave the example hostel was -- the use of an operating 23000 dollars. But -- we went to another hospital contended you know that we would start over again and it's said that. I wanted to cash settlement of insurance was the best price to equity 2000 souls. Will pull pricing including doctors' fees and say so so these these the president of the third party forces. The providers to inflate their. Rates because that's part of the negotiations. With the disappointing year. It makes it necessary to do this so negative third party here out of the way. You get it you get a much better idea what the real prices. -- -- and should -- got away from insurance -- the problem you know the basic ability but insurance is supposed to do supposed to protect you against the unpredictable. Catastrophic that cost you -- When you might hold -- insurance you buying it to insure you against that we keep the fire flood. -- buying it to -- you know simply cork incident and said the blind drapes. That's kind of the particularly -- pocket. Likely health insurance used to be back in the day but now because it's kind of complicated because of the tax structure exists and all that. We've gotten to a point where we don't have health insurance via prepaid health care. With third party activists see the prepayment. That vehicle and if we had the same kind of leaned in for food for example for example our employers. Bonus of food purchasing plan where you know we have certainly taken her paycheck. And we you'll have to justify the local paper from the supermarket and then -- little bit after it was it was a food. We got the same kind of problem yet and health care because we have a marketing we wouldn't competition. So we need to do is reform the system in the way that gets insurance. Back into its original rule where if there for the big ticket things -- children can destroy you have a lot of time to shop around -- we insurance as opposed to kicking. But -- -- everyday expenses -- annual check but -- -- -- called the kind of thing that they you know putting into the the -- -- things that. That unpredictable no occurrences your -- insurance for predictable in the own expenses. And it. Minimized in the role of the -- in those areas. Then market forces -- like all healthcare prices down so that we need that big ticket item that the insurance was for it wouldn't cost as much. You know Angela is one of the things that I think that's keeping doctors from doing this is the fear of going bankrupt. You know that they're not gonna have the patience come through -- that they have to charge large amounts of money for complex surgeries like their singer was alluding to. But one thing I would point out in my field it's neuro oncology and schoolmates or -- I do skull base surgery like creamy on amusing complex things. Debt my competitors that are on the insurance plane eons. Their charges and access for like my most expensive thing to do their charges are in excess of 7000 dollars. Where's my charges are 141000. So it's significantly lower and a lot of the guys probably can't figure out how can you do that so cheaply. And the bottom line is it because one of got all the hassle out and I've got rid of all the bureaucracy might overhead it's significantly lower. And that's one of the reasons I can do. I'm asking doctor how about you or are we need your surgeons and hospitals do you find. That's you have to shop around for hospitals that do -- patients that are placed the same issue that I -- Actually have done that have worked with the hospital and the surgery center that worked out and have gotten. Pretty significant reductions in the cost for the patients -- cash prices and the hospital every year wants to raise the prices unlike -- and you don't understand. These these are not insurance companies these -- patients paying cash so if you raise the price they're discussing now so why do you wanna turn this away. And they're like oh OK in the keep the price -- We have to take another break we'll be right back. Doctor Jeffrey singer and doctor Gerard -- only our special guests were talking about docks over talking about changes in medical care. I wish that this was two hours or three hours because I have many more questions but I do wanna ask. Is. You know we hear more and more oh -- the doctors recommended this but it's been denied my question is who's run in the show. Well if you look at the there's an insurance contract that says they will pay a certain things based on whether the have these approves. Situations and when it's denied it just means insurance company does not wanna pay for the patient have still -- get it dawn. But it's a big impediment you think you're buying insurance that's that's the funny thing about obamacare you think whenever has insurance will. You don't know how good your insurance -- you go to use it and that's when you find out when there's suddenly starting to deny things. And suddenly you pull something that you felt was good in its not there. If a doctor is saying Angela patient this is what you meet. Why that's the voice I want here. Why would make that more complicated it is has more -- doctors have been basically going out of business because they're -- keep their doors open. When trying to comply with these huge regulatory. Overhead expenses in conjunction with the decreasing reimbursements so. Like like particularly in the roughly two thirds of doctors are employees of the hospitals -- local corporate clinics. So they have to take orders from them or else we get fired. To get an ethical dilemma here too because. What would your independent independent private practice you could say to the patient I really think you need this and my obligations tactically it's somewhat patient. My best advice regardless of what the third party -- Mr. -- before. But Republicans for the hospital. I'm I have to follow orders and didn't practice -- the hospital wants to practice because the hospital. It is stated in maximizing its income -- certainly there. So that's another dilemma we have actually it was a -- -- Obama Obama kids took a dysfunctional system that was already not working. And lift all of the dysfunction in place which is basically a system that's heavily. We live on the important immediately and that is still -- probably only indicated regulations on competent. And another mistake people make is they think having health insurance is the equivalent of having health care. Tell that the people for example going on Medicaid and find that 40% of doctors don't take Medicaid. You know the other. Let me ask you both very quickly. Is health care a right. A -- something that someone else does not have to provide for you. Healthcare is something that whole team of people have to work to provide for use of who's gonna pay for all those people so it's not a right. If anything -- -- an obligation. I mean you know kids -- she's a -- at a lightning hit that you have this coming to you but if something has to be provided by another person. -- to say I have a right to health care to -- force you to go to medical school become a doctor to treat me. What I am and nobody wants to be doctor satellite to health care I guess satellite until somebody want to major in. You know it and in acting that no you can't become an acting you have to go to medical school designed to doctors -- -- -- I guess I've said this before publicly but. I think that if in the legal world -- lawyers were told by the federal government this is so much you can charge for divorces is how much you can charge for real this is how much you can charge for contract. They're there would be an -- and in essence doctors have been dictated to. This is what you gonna get and I never understood why that wants. But more important is of voting with if you like pact originally here and I to be honest with you I was younger I would do with two. I'm very and if they're -- examples. All around the country more and more doctors and scientists in Oklahoma City for example that the surgery center of Oklahoma was sort of some years back. And they it's it's an independent surgical hospital that takes no insurance whatsoever no reported payments. And overhead because of that because she wants to take Medicare you have to be electronic you have to release regulations that are extremely costly and don't really have any. Any benefit the patient care that they had lots and lots of cost and time. So they don't do that and they are short some like 20% to going to hospitals in the Oklahoma City charged. And they're they're doing great reward doctors are going picking our digital example and saying you know what I'm gonna do the same things so. I hope that you're pessimistic that originally opened more than 15%. But I think both doctors or not employed by hospitals more and more than Margaret. Saying you know I have. I professionally but one of feel good about what I do they have to divorce myself from the third party arrangement. -- -- your your great I appreciate your comments -- we had to take another break the traffic we'll be right thank god doctor Gerard on. -- -- and doctor Jeffrey singer fascinating subject it's called the -- -- I have a feeling we'll be hearing much more about it have a wonderful day everybody out here him.