Welcome back -- do and being directed him. It brought a minute -- would -- -- forged in the sport of virtual civil wars are used in play and got millions literally millions wrote produced throw ultimately use all those. Crossing into a lot of countries that can handle them don't want. And now we have three young for a new boards were kidnapped there have been found dead. Israel says Hamas did it and they're retaliating. At this very moment. So we'll talk to a couple of Middle East experts and and asked them. Where does all the Disco is ever going to be contained. Again get worse. And if so what does that look like. -- -- Clock or. We're gonna talk about something very important. Always admired all Austin. And Memphis with a view street. Where they give opportunities for artists musicians. -- and our writers. They give them opportunities. By -- and subsidize. And giving them grants. And we have done little bits and pieces -- several law. Or right now of the New Orleans jazz and heritage passable foundation which runs the -- and and for all organizations have brand new program to train artist but how the current drug business how to become -- on -- in New York. So we could be brought on the cause of joining. Others cities with the tremendous. Artist. Culture. Where they actually take care of that group. -- -- -- We're gonna talk about hospice care -- got -- them -- as it is. White and -- woods here. And and I always thought of it as a place you -- when you've got very limited time they get six months year. And I always does I grew up -- to begin here about my heard about primarily. By at churches or community charity organizations. But -- this article on how all dying became a multi billion dollar industry. And the article is talking about -- whose care that I was offs just where more real than than all men with a he was hoping to impose writer put this. And all the peace and a broad reaching all the riders the colts are virtually the same thing bill and welcome to shore Richard's done. On so. Barbara what a breed that the bill how's the industry has quadrupled. Since 2000. Right now hospice industry are -- but here is -- you may have a lot of. That has changed dramatically. So what was once these in. A health care business operated mostly by non profits by religious. Institutions often. There's now -- you know booming business seventeen billion dollar business operated almost entirely by for profit companies. -- Well you know it began back in the early eighties with that congress approving the Medicare hospice benefit which allowed for the better. Taxpayer dollars to fund hospice. And you know the last decade or so especially for profit companies have have you know seeing the profit opportunity. And -- a lot of would be. There are nursing homes games. Assisted living facilities have. Bought up -- that companies and there's been a big sort of mergers and acquisitions. Stated hedge funds or by auspices. And because Medicare pays 90% of all hospice -- claims he of these companies act essentially is as government contractors. In your article you -- movement. Nearly every major Haas -- corporation company. Has been accused of billing fraud. Right -- that play and that would be you know it it is the article I've. Have yet almost -- -- every major pot this company along with a lot of the smaller ones. Have been accused by the federal government and by whistle blowers and lawsuits. You know enrolling people who don't belong in hospice. Keeping people live longer than it should be. You know refusing discharge them when it seems they're getting better for example. And also in and going people and extra expense of levels of care experts is that around the clock for continuous care service which allows partners to be -- at someone's house essentially year. In a nursing home almost 24 hours a day. Had to get used to that as a taxpayer funded Serb servicemen. Went bill -- what happens it's you know it Americans to pay the cost. And what how could something like to Britain that happened and has been charged with billing fraud. I think about the two banks the moon -- recently yesterday that. Justice department of -- wrongdoing and they pleaded guilty. To ping reply and nobody name nobody in charge nobody goes to -- Look at this. Half of the corporations. Or participating. In billing fraud. As is is everything today that it's big money too big to jail. Well you know that -- at the great question and in the health -- context that you know in some states ball a topic Florida for example you know you'll. Because of the -- -- and things system works there's. A relatively small number of hospices. You know compared to those -- the population. In one of the arguments are one of the years of people who were worried about fraud in this series is that. You know the federal government might be scared bring down amber because they're afraid -- will close them leave a population. You certainly need that care some vulnerable. So you know there is that too big to fail com. Phenomenon perhaps going on there. Well when -- the Houston and correct me if Susan ought pru and -- refuse to be. Religious organizations. Terrorist organizations. Is that true and that was in place. Wives what could we go back to that. Well you know -- I think to health care system in general has changed dramatically -- you know I talked about switch from non profit or profit hospice but I mean this is also true and it. And -- hospitals have undergone the same sort of shift nursing homes. So you know I. I think at this point that it it's probably unrealistic to expect that it can revert back to being sort of system run by you know small. Small groups. So what seems to be needed currently ignored the issue reported story is that you know in the regulation regulators haven't kept up -- This change all that sort of its growth in the hospice. It used to be just for people you know mostly with cancer mostly in the lives of relatively small number of people. In this year more than a million people died while receiving hospice care. Including nearly capital miniature pitcher and so is that something has gone from sort of and it's helped. Care on this health care I mean it's very much mainstream back. But regulators haven't haven't kept up and and simply don't treat hospice says seriously or don't inspect them as often as they do other -- oh. That's interesting news progress to took such report when we can go back to where laws. But. I guarantee you purify. Did -- -- in our business they command approach and that probably why did you keep. Building broad and a business. It's in Edinburgh complicated. There. Only -- -- compute for a couple -- -- were talking with bill and Allman. Huffington Post writer. Wrote a really in depth excellent. Series on hospices. The way I think a lot of us have always thought of them. And how Horwitz progress that something. That looks to at least to be entirely different. You have somebody in house does care would you put your loved -- and also scare. It was called to Sid 01 the celebrity. Told -- anywhere in the country age six -- -- steroids says. Our ever dated a bit of yelled pretty John -- opinion -- -- -- would you put your apparel and sooner nursing home our hospital's care. 80% abuse -- hospice care. And before I read this article bugged and -- prone Harden post we're building saying. -- -- growth through -- -- out a couple of things like this sentence. Over recent three years spent 55%. Of all US hospices were cited for violation. -- error related. Of bin -- in this article you wrote. Talk about apparently that went through problems with the holes whose care and they said the hospitals corporation. Myths led the family about the purpose of hospices. How they do that. Be clear that law hospices for -- it is a very respected especially helped serve as it. Under Medicare rules it's for people with six months left the left to live. They provide palliative care meaning care to help ease pain and suffering but not any kind of curative treatments. And one of the allegations made by -- is that. In an effort to roll out many people as possible. Hospice marketers aren't telling the complete truth about what hospices for. It could lead to misunderstandings here but I think you know. I I talked to dozens of dedicated hospice nurses and professionals who -- you work really hard provide the best care possible. But it put an effective leader the only member of peace and does not on board with the hospice philosophy can be expert can be a really bad one because. They're expecting one payment that delivers another and that and that's what happened. Richard you're talking about some patients. Playing golf then and getting up and move around maybe you've been shopping and forgot where a more active how to how does that happen doomed you have to. Have a doctoral position that says we estimate six months a liberal. Well you know often. And the doctor -- who object to that the nation is an imported -- the company. In -- and -- you talk about the the people selling. They've actually. Ordered rehab centers in the hospital doctors or. Group the patient law. It's and everybody that they can determine Lance dance. Asian people with -- let live. And and they even have that fights in the -- reports over patients. Is that what Corey. Well that that a -- in some areas I mean the competence that would be the number hospices the numbers have. Has exploded and and there's real competition out there and and unfortunately in some instances the competition for patients. Has led to hit some really unseemly behavior. You know looking to patient -- obviously -- -- -- You know that -- happened in every instance but you know. -- that's certainly been reported. I've I've talked you know again and then of course this story -- talked about in the pot that nurses and marketers and made it could be all that kind of thing going on. -- and you know they'd be ultimately you know they're they're initiatives this debate who made friends with -- hot hospital discharge officers -- officials people do. You know determine -- patient can go home. And by increasing themselves that they hope is that they can get -- it was sort of a critical referral to a patient. So a lot of that happened outside of the view of a patience. But you know I think peace and he didn't know that they have actually -- besides. You know hospice. Doctor recommends if you are opposite marker protein do you mean there's in most communities have a lot of auspices. And you know you can -- -- opera. How can -- refuse to discharge a patient these these are prisons are the. When you know you have to think about the patient themselves I mean they can't refuse to admit that been allowed to refuse to chart a patient. But in some instances patients are you know nursing homes there -- members might be another state away. And the reality is is that once you're sort of in -- in sort of the orbit this company. Every health care professional you -- contact with often is that employee of that -- company -- prisoners -- hated the doctors. So you you know you end -- a situation where you don't you're not necessarily needing any sort of outside feedback so he can be can be difficult. You don't know what they -- that they can be difficult to get out especially -- really vulnerable people people that came later quotes by -- there. You know quote we attempted to what's going on I mean at the simplest thing you know you people can't talk about -- But that it's clear that things don't always like they have -- towards. So worried if a family members and those that -- We don't want anything more to do would do that does to -- That should do it in you know in you know him and hospice then and dying I mean it really emotionally charged time for people. And sometimes there's disagreement with -- to about what should be done you know for Grammy. And you know -- certainly you know came into contact with people that. These disagreements among the it would in the Stanley about what should happen next have led to you. You know really bitter fights and people not speaking to each other so I mean it they're really tense time. You know I think one take away that I had after after reporting on this is that it's really important. Plant and advance to keeping it in the next year to they remember my view popped it. You don't wait go ahead and -- to you know talk to different auspices -- and nurses and doctors. Make sure everybody in the game in the peace in this sort of on board what's the what's gonna happen next. Final question after everything you've looked when when I've read your articles. I get to fueling that laws. Or being violently broken as -- Walsh laws. And nobody's being charged -- -- being percentage real. There just seems to be a slight bit of confusion and controversy over -- is there any chance of this changing in and if not. How comfortable should people be in choosing -- does scare. We will unfortunately it's a certain looking back indicate history I -- allegations like the ones that reporting on about signing up people who don't belong are putting patients -- the facilities and I don't -- be. And it goes back. Technically ninety outside back in 1989 the first story. About the abuses in the Chicago Tribune you know more than twenty years ago. So -- you know it and you open is that you know the federal government regulators prosecutors in -- -- it's probably keep him being more aggressive. I think that is now see some of that fine to -- wit and a settlement that they they come up with a response that is lawsuit is being at a cost of doing business. He's -- You know but ultimately I think you know and hot it can be real lead. Wonderful experience for people. As long as -- informed about their rights and about. -- did you know they'd make an educated choice about. Where what hospice to choose. And win win. And when looking at all of this. Company's future mentioned as a -- it's beavis. -- -- yet the big corporations. Or they traded on the stock exchange. Are being cut is owned by chemed which is -- it publicly held company Islam it's also commit also loans plumbing company Roto-Rooter of all things. Object some of -- some of them are publicly traded some of them are privately held. It it's a real mex and of course some of them are still nonprofits and there's still a lot of non profit out there and and you know again just because your non profit doesn't mean that there are providing better care. You know one thing we did game you can find it on -- -- web site is created the tool called -- -- -- You can go in and surged pop in your area to find out when they've been inspected and what kind of violations would attack. -- in the last I mean inspectorate and there have to that's like that's one way you'd you -- -- in perspective you know him remember patient can do recent. Great job very Berrian pursuing an informative article -- -- issued to riding appreciate Colin and today you. Are. Come right Beckham will talk to -- Stephen Moses president of the and prolonged don't care long term care reform. Happens well our daily -- poll this we ask you governor Debra -- produce opinion Pope. Would you put your parents and nursing home hospice care and 73%. Of -- they options here. And I would have done the same I think controller brand into a couple of -- articles. Talking about how -- scared that that. I thought was different animal to -- you often care. Was something churches were involved in nonprofit organization local charities. And if you had six months to live envelopes you appeared can be your child shouldn't. I heard a lot of applause and a lot of praise what's been going on over the years. There applicable articles like this that says you -- announcements industry. Has quadrupled. In size since 2000. It's in seventeen. Billion dollar industry. It's an -- dollars to -- national change. That's got my attention since 2006. -- government has accused nearly every major for profit hospice company. Of building for. So to have veterans and those groups -- when Moses is ruined his. President senator pro long term care reform incorporates. Even though I've appreciated to I'm welcome. -- you. Well -- reading the wrong thing or have hat but these. Hospice. Organizations and short billing -- But I can claim to be an expert specifically on on hospice my field is long term care in general. But I was not surprised. -- the article that your producer. Sent to me that you referred to just now on there. When government becomes involved in financing. Anything -- Radical impact on the market that certainly been true. In the area of long term care in general by funding nursing home here very generously from the mid 1960s. Government funding mostly through Medicaid. Created in the institutional bias created the problem. Too many people going to nursing homes and not -- people getting here in the proper. In the home and community. Well it seems something similar is beginning to happen with Medicare fine and so. Hawks. I personally have had an excellent. Experience with -- -- Wife of nearly 45 years passed away due to primary brain cancer. In the early 2011. In 2010. In the last months of her life we've received wonderful. Assistance -- the Medicare hospice program. Nurse visiting -- help with counseling injections. Anything you might imagine. And also made it would com Dan helped me Dave my wife and even get burned and then and there it was wonderful. Help -- -- very difficult and stressful time. On the other hand. It's alarming. To see the kind of information that you just in hard it and what -- Is that. As as. Government tries to do something. Good for the people and the Indians funding at. The private industry -- naturally. Mobile licenses to take full advantage of the new revenue source. Overtime it tends to be that the government. Unions to cut back. A little bit because of the costs naturally exploded usually government doesn't. Planet heads that. An inevitable explosion in cost. So that began restricting. Access to the benefits but pride that industry is already 110%. In -- So they -- Began to find ways to enhance the reimbursement. And there are basically two ways that that can happen they cut back on the services. And so we have a problem of quality of care. Not just. In hospice but in the long term care in jail. Or. They can get out of the districts and we see that as a problem in the broader long term here marketplace to right now. Hospice is evidently very lucrative to private companies. For profit and non profit. How that's going to play out in the future with the aging of the baby boom generation. -- it is a huge demographic challenge. As its gigantic. Generation. Ages in two. The period of time when they need long term care and ultimately end of life care. So diplomats. That can put -- -- and then. Maybe if -- were asked to. Speak to solution that would that shared some of the observations we've made in the broader area. That's exactly what -- -- go and take a break but when we come back. What we call Mosul sure thing too big league but he notes locations. Well. Where you we know what to do liberal nor conservative we've really tried I tell people I think. And then we set about disproving or proving you. And it's something. Like this and and several of the subjects of a child on a regular basis all I'll say to people. -- -- -- these days in the what's the in game of that when we come back. And you look at long term care Alaska that question what what do you see happening now. Who can we'd try outs in what does the future report. Coming right back go to build bigger celebrity AM 053 yeah. Well look good there are reports in the journal of the American medical sues you and says. Or spends a moral and health care of them and -- the country that wind down a little bit over Obama here but it still. Burial. And I would submit that the one of the pieces of health care. The most of the several lovers for a corporate lot of good things about his hospice care. And ended -- at least for -- always brings up the image of charities church organizations. Taking care of people in the last six monitors -- life. And rating article on -- poked through the actually series. And basically what this they say it's no longer that way. The big industry has quadrupled since 2000 it is seventeen. Billion dollars stock traded hedge fund invested. Industry. And in the meantime. Horrible as they gears every major hospitals company. Have been charged with billing -- And those in the so that that constantly talk about small government don't trust big government. Don't want to be involved in big government since Medicare. Prudent government funding for hospice care. 9% bowl -- does care Williams with the taxpayers are paying. So if it seems like a really shifting into for an -- a lot of us thought. Which even Moses with the -- presidents and for long term care reform. That's certainly an expert in this -- statement of your barrel wouldn't reported took a break. The basic question I think to and so many issues today is who do you trust. And for the people out there that need long term care or know they're going to and a not too distant future what what's out there to frost. Well that's an excellent. Question I'd agree that it is the key question and one of the reasons that we. Now as consumers especially healthcare and long term care. Don't know who to trust. Is that the government's been trying to helpless in this area. Since 1965. At the very eastern Medicare and Medicaid Medicaid primarily for long term care. And Medicare for acute care for the elderly of course Medicaid also covers. Acute care for. Younger people poor women and children. And the unintended consequence. Of this enormous. Government investment and financing long term care for most Americans. Most Americans no longer. Feel that they have to take personal responsibility. Especially in the area of long term care. So we would somewhat obviate is that sense of concern and worries that people now about how they will pay it forward. They're here in the future. By funding the portion of healthcare that is not already financed by government through employers. -- Significant. Tax advantages. To. Getting health care insurance through the employer. We've also distorted the system we've. Created. A marketplace for health care and long term care with the public no longer looks at what the actual cost of the -- is -- and when they have to come out of pocket as doesn't happen as much. Now is that as the distant past. There are shocked that. The services should call so much. They call so much because of the distortions in the market call on government involvement in the system. And unless and until we return to. A marketplace where citizens and consumers. Are aware of what the want the services that are receiving. Cox and his a role in preventing. Health care problems have a -- in it being healthier. We're going to continue to have problems. Like we've had the past unfortunately these portable player that doesn't address any of the underlying problems the predator doubles down on the problems that we have that it is. Easy access to publicly finance. Governments subsidize. Help it. So we put the public to this to the sleet and enhance the question who couldn't trust. Is only yourself. Ronald Reagan like the city across the there -- -- further and say. Don't trust anyone. Make your own. Judgments after researching. Mark as careful. And be aware. Dependent. On promises from this. Go one step further and think a lot of Americans don't want to verify. I did a good example Mississippi. One of these small government on clips of 43%. Of all the revenues. The museum is right behind them and we still weak signal like big government. If you quote the figures whom or show. The large part of it is Medicare Medicaid Social Security whatever. They brutally the world accurate it apart and seeing the right thing what's the in game Oval Office the UC in the ability. To go back to -- system works. Well -- despair. Any likelihood that responsible. Political action world leaders to a solvent. Financial system more health care system. But at some point. You can no longer -- economic. Gravity -- the Fed can't go on printing money indefinitely without interest rates. Increasing. The government can't go on deficit spending in definitely. And once -- interest rates go up it's going to wipe out. Any. Semblance of solvency on the part of the federal government. Which. It is major funders of state initiatives in health care. And when that happens we hit a brick walls fiscal reality. A lot of people especially. Or lower middle class people are going to be. Hurt. People are going to have to come out of pocket. To purchase. Services that have. Previously been dominant they paid for the government programs. And when that happens. The it's freer markets that little. It -- -- by default. Will compel. It's more better system. Sounds -- like the bubble -- polyps or even -- do a true pleasure having you on the show I appreciate your taking the time have agreed to. -- -- -- -- -- But I feel obligated seventy more than 53 you have them. Let's go to caller Rick in blood recovered refused to call. Yeah mr. Colin -- and India has been. You know it is not rocket scientist to figure out why it is just skyrocketed the -- and personnel. Most remind it that this bill would you got terrible and and it does rocketed him out there like oh. Cilic got nickel bag -- outpatient it would be. Object -- people that activists have been most basic -- and now the full you know as they looked at two. I don't think I'm out there he's -- -- problem. I'd go out and out and I would look at it under 210 and personal. I would -- thing most people would -- and -- wants -- -- it is. Get seventeen billion dollars put into it by Medicare and all the corporations will come in and and their primary interest and profit. And it's not so much that that house loose is bad about walls throughout the concern is. The profit motive is gonna change while we've all known good called Rick I've appreciated the information. Come on right actually it was this stuff but yeah.