E 185 Healthcare Spending Waste Explained Ripped OFF Gilbert Simon MD

If you are frustrated with the soaring prices of healthcare and feel confused or powerless to make changes that benefit the average person, then listen to Dr. Gilbert Simon talk about his book Ripped Off.

a doctors perspective e 185 ripped off author gilbert md s
Dr. Gilbert Simon, MD talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast

#1 Myth of Universal Healthcare is it’s Socialized Medicine

If you are like many people, aren’t those interchangeable terms? Find out the 3 different systems – compared and contrasted. Really though, universal kind of just means everyone gets it, like universal K-12 education.

#2 Myth, The American Healthcare System is Number One

We are 11th out of the top 10 countries that are similar to ours. Life expectancy is that of Costa Rica.

#3 Myth. Healthcare would be Free

Wrong. We would pay for it by taxes.

One benefit of universal healthcare is that every hospital would be ‘in-network’ so you would not have to worry about which one is going to give you surprise exorbitant bills.

Is there some way to CAP the Profit that health insurance companies could make? He mentions that other countries do cap how much the C-levels can make by a multiple of the lowest paid worker. SO, we can’t set the amount but by the ratio.

Even worse that insurance companies is the Pharmaceutical companies.

How is that Medicare and Medicaid have different drug prices? How much do politics play a role in prices and competition.

Out of Network Charges but In Network Hospital Services

What is the back story of how you can to an in-network hospital but still get seen by out of network providers and yet we are still on the hook for those rates?

What are the 3 General Types of universal healthcare? Our GDP spends 8% on healthcare which is double other similar countries.

Price Transparency

There are laws that hospitals have ot post their prices but with the complexity and surprises of the human body, it’s hard to say just what a gallbladder removal will cost. It’s not as easy as saying all gall bladder removals in New Orleans will cost $400 (made up price).

Why the shift from private practice to being a hospital employee affiliate?

70% of doctors are no hospital employees. Part of it has to do with all the red tape and hassle of getting paid for legitimate services provided.

How do we get the EHR to talk to each other and transfer data so that redundant tests are not ordered and the doctor gets all the information they need without doing unnecessary expensive tests. 12% of the workforce is in healthcare and most of those are not administering patient care.

Is it true that big pharma has slush funds set aside for the lawsuits from drug reactions?

Ask yourself and politicians, do you know it’s broken, if so whats the course of action to fix the problem?

Show notes and the transcript can be found at https://adoctorsperspective.net/185

a doctors perspective e 185 ripped off author simon md
Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks descript!

Live from Louisiana and Sacramento, California. Today on the show, we have a doctor who's been doing this thing for 50 years as primary care. In the eighties, probably in the nineties, he was serving 40,000 low income patients.

And over all that. He decided to write a book and it's called ripped off. It's about being overt, tested overtreated and overcharged pretty much kind of makes the case that maybe we should maybe go universal healthcare, how that could work out and just all the blah money that has been spent in a poor way.

So I'm excited to dive in, please. Welcome Dr. Gilbert, Simon.

Okay. Thank you, Justin. So the career span half a century, it really does. Yes. 53 years, actually, once you, once you passed 50 years stop county, but it was 50, 53 years. And there were years where I saw the, in the medical profession undergo tremendous change.

Not to the better,

I don't even, I mean, sometimes you, I get into these interviews. I'm like, boy, there's so. Ways that we can go. And I think maybe the best way to start off is what are some of the common myths with universal healthcare? Because I can be honest. I, I lived in Germany for two years and it was other than the 40% taxes I was paying.

I mean, that hurt , but it was kind of nice to be able to just go to the hospital and pay 10 bucks to spend the night and 10 bucks for a hospital the ambulance ride and not have to necessarily worry. Going bankrupt. And my kid was sick. Maybe we just take her. We didn't have to worry about it.

Yes.

Well, the BI the biggest myth is the idea. The mistaken idea that universal healthcare is socialized medicine. It's not universal. Healthcare only means one thing. Every it's one thing. Everyone has healthcare. It's univers. like universal K through 12 universal police service, universal fire department service.

Everybody gets it. That's what universal means. It does not mean socialized medicine. And we're, we're the only industrial wealthy country in the world that does not provide universal healthcare. So, so where that's the other heaven myth is that we're outstanding. Our, our healthcare is, is number one.

Math. That's a big, big myth. We're not number one. We're far from number one when we're compared with the, with 10 other peer countries that are closely related to industrially and economically, financially, we're compared with those 10 and ranked according to healthcare outcomes, availability, the cost, a variety of things.

We come out 11th. And we've done this we've been 11 ever since we ever, since we began this comparison, our life expectancy is somewhere between Estonia and and Costa Rica. We're, we're nowhere near number one, which is the other big myth. That we're number one. We're very far from number one. The next big myth is that the healthcare.

It's free. Someone else is paying for it. And the MIS and the what, what healthcare consumer is missing is the fact that it's being paid for by their own taxes out of their own wages. They're paying for it. It comes down to that. Is there

some way to cap the profit for insurance companies? I just look at the bonuses that these CEOs make and, and it's so for profit and it's like, couldn't we just make a law, like.

We're not saying you can't make a profit. We're just saying maybe, maybe 20% is enough, not 600%.

Well, other countries also have set a cap as to how much, how much CEO can earn and as compared to the lowest earner in the company. Hm. Japan has done this for years. We don't do. We let the CEO earn as much as you can.

And it's often thousand thousand times more than lowest one earn lowest earner in his company. We can't set the amount, but, but we can't set the ratio if we had a mind to it. Mm-hmm the biggest, the biggest profits are not insurance companies. The biggest profits are in big pharma. Yeah. That's that's where they're ranking it in, in one year Pfizer bid had a 40%.

well, didn't you write in your book like Medicare, the law, the way it was passed was Medicare is not allowed to negotiate that, but Medicaid is it? Yes. Come on. This is ridiculous.

Well when, when we, when George Bush, the George W. Bush got the the Medicare improvement act which added part D the drug, the drug.

This was part of the negotiation that that's a big farmer would allow 'em to do this provided that government would not interfere with their profit making. So the VA hospital can do it. Medicaid can do it. Everyone in the world can do it except America. Wow.

I know we had some te some questions that we would like to talk about, like overtreating and where's all this stem from, but really, I only have you for so much time.

So I think I'd like to get these questions covered first, and then we can always double back or they could like just buy your book because I've read probably 70% of it and it was totally worth it. Oh, go ahead. All right. So I'm a patient. I go to the in network hospital with my in network benefits, and then I walk.

And I've got out network charges of thousands upon thousands of dollars, because it seems like the anesthesiologist that they called in that day is not a part of the network. If you're in network, shouldn't the whole hospital just be in network. Like what kinda games are they playing and how is that allowed?

Well, here's what happens. The anesthesiologists are very important people because without them, you can't do surgery. Surgery is the biggest money maker in every, any hospital. So you ha you have. allow certain, certain leeway to the anesthesiologist. And what they do is they refuse to contract with the, with the various plans.

They wanna stay independent so they can charge with whatever they feel like charging. And that's why the they're the usual ones who are come up with a surprise bill

as the doctor of excited. But as the patient, I'm not

I know, but even, but even emergency room doctors also can stay out of network. and you could find yourself in trouble, that's the most go the wrong one.

I'm going in there for a heart attack and thinking I'm going to the right hospital. And then you turn out. You're like, well, then I could have just went

anywheres often. You're not going to the hospital. Often. You're taken to the hospital. Yeah. Often they find you lying face down the sidewalk and they take you to the hospital.

It better be the right.

Sometimes I want a tattoo that just says where I'm at and then scratch it out and then get the next one. And the next one throughout your life. And you just have like a whole bunch of insurance policies on your arm. yes.

Yeah, that's happened. I mean, people have, have been taken by a well meeting neighbor to the hospital with a heart attack only to discover that it was the wrong hospital, man.

Oh man.

All right.

What about this? That's another, another reason why. I want to, I hope we hope we end up with, with Medicare for all, but in Medicare for all, every hospital is in network mm-hmm and every doctor is in network. There are no networks. We're all, we're all in this together. Yeah.

And I've seen that's the thing is I've seen it work in Germany, like, yes.

Do you have to wait a little bit longer sometimes? Sure. But they had different companies that you can purchase through is just. you had to have it, whether you had a job, then it would switched to that. If you, if you weren't working, then they had a different type of plan, but you were always kind of paying into it.

And it was a mandatory thing in life. Like there was no option to not be. And then, I dunno if you wanna spend a minute on that, like the different types of ways you could make everyone covered.

Well, there's the German way, which, which is the everybody, everybody has like a coverage. If you're not working, or if you're working for low ages, the government provides healthcare for you.

But if you're working, you can purchase your own health insurance through, through a whole bunch of, of private insurance companies. Like we have, that's only

nine

or 10% of your salary, maybe even.

It does. And it it's a big chunk, but it's, it's, it's not as big as American healthcare American healthcare costs roughly $20,000 per family per year.

Mm-hmm , it's a third of the average incomes earning earnings with a year. Plus the

deductible you have to meet

well, it helps you get deductible there's no way, no question, but also not no access to pay. Get nothing. but our, our healthcare is now causing us 18% of our gross domestic product. Well, it's double the next comp next nearest country.

Hmm. Why does ours cost so much? And why are we getting so little for it? Yeah.

What do you think about price transparency in these hospitals? Like, should we have to worry why the gallbladder doesn't just cost 400 bucks in your entire city? Like you're new Orleans. Should just cost $400 everywhere you go.

Well,

see, see, there, there are now laws that hospitals have to post their prices. The hospitals push back saying, we really can't tell what our prices are gonna be. You're going for a gallbladder. And, and while the surgeon's in there, he discovers that it really wasn't a simple gall bladder. There was cancer of the gall bladder and that, that was the problem and because a much bigger operation.

So they pushed back on this. so price transparency would be very, very helpful. It would, it would help make us a free open market, which is not, it's a, it's a broken market.

Well, to me, at least I would feel good to know, okay, it's gonna cost at least 10,000 for my shoulder repair. At least that's the minimum I can walk out in, but there's more problems you can book it.

This cost could cause all up to 50. Oh my 50,000. We've seen it. Okay. Yes. Well, at least 10 up to 50 somewhere's in the middle. Well

could be a couple hundred thousand dollars,

right? Yeah. Okay. And the last one I had that I definitely wanted to cover, especially where I'm at. There's almost no private doctors anymore.

All of 'em have either been bought out or something from, and they all are part of the hospital system are the payouts so big. Do the doctors just not want the headaches anymore? What's going on? And is it affecting us in a poor way as, as consumer. Yeah.

Wow. So overall, 70% of all doctors are ho are hospital employees.

They've, they've given up the idea of private, of their own independent, autonomous, private practice, and they become part of a hospital system. So, and why do they do it? Mostly because they're just fab with, with, with all the headaches that are now involved in conducting the practice of medicine. Hm.

The, the amount of red tape, the, the amount of effort in getting you bill paid there like 53 years ago, when I, where I first started this, there was no problem getting you, bill paid, you just said, pay the bill. And the, the person walked out and paid their bill. Now you have to have a biller. And it's usually, and, and there's usually one bill per doctor.

And then, then the bill gets denied. The insurance company doesn't wanna pay it. So, Nope, not paying. and then you'd have to say, well, why not? Well, because the birth, the, the birth patient's birth date was, was written backwards. Okay. So we back we'll do it right this time. So he goes back and forth. You appeal you reappeal and you deny the appeal.

And after a number of, of back and forth, the bill gets paid, takes a lot of time to get a bill paid mm-hmm and it's a headache. And after a while it wears you.

Somebody was on the phone for five hours, getting paid to be on the phone for five hours to get all this situated as well, when they could have been doing something way more productive.

Yes. Well, the average doctor spend six hours a week with paperwork.

Would you say that EHRs? Because a lot of 'em don't even communicate with each other, like Cerner and med soft and all that. They don't, I don't know, maybe I'm wrong, but I've heard they don't communicate. So even. You go to a different one and then you don't even have all the same records.

So now you're still having to do the over testing to reduplicate the test cuz they can't trust you and they can't trust the paper you brought in because that was six months ago or it wasn't done by us. So we don't trust it. It's like, come on,

they don't talk to each other. You're right. If, if you're lucky you're you, you practice.

Is part, part of an community of doctors who share the same, that system as the, as the major hospital that you use does mm-hmm so they, they can communicate with each other, but not with not outside that system. Yeah. So it creates a series of silos. No, nobody talking to anybody

else. And I guess there's some pushback for centralized health care.

I'm sure there's a bunch of people. Like there's no way I want all of everybody's information in one system. Like that's probably a scary situation as well.

Well, one has all of our social security numbers has, has a lot of,

lot of personal information. Oh yeah. Look at that.

yeah. Yes. It, it does simplify.

Yeah. Well, when, when Bernie Sanders was running for president a couple of years ago, and one of his talking points was that if we go to universal healthcare, we will save $380 billion right off the bat. pH that's and that you got that number from looking at the cost to administer our healthcare system.

Mm-hmm , it's, it's a staggering cost. We have an army of healthcare workers. We right now

our, the, the

percentage of, of Americans working in the healthcare industry is now 12%. That's one person, an eight works in, he. And that one person has not taken care of you he's pushing paper.

I mean, I know people that are like, I need to go get my MBA so that way I can be a hospital administrator one day and make more money and not have to treat patients all the time.

Like yes. What

that, wasn't the goal? Yes. Hospital administrators make much more than the, than the brain surgeons too. Yeah.

Oh, do you think. The, I guess the government could do pretty much anything with the insurance companies, if they would just stand up to 'em. But all the commercials out there for this drug and that drug and the amount of money they spend and the amount of money they make, couldn't they just say, Hey, you have to spend an X amount of money or percentage on public awareness of like the opioid crisis or am a B I'm a chiropractor.

So non-pharmacological treatment for back pains. Being that back pain is like the number. Number of the number one issues that people around the entire world suffer from, and it costs billions of dollars and missed work and everything else per year. And is one of the reasons why we have an opioid crisis to begin with like, couldn't we just make them put those kind of commercials on like, just with a certain percentage of their profit or some sort, I mean

the public

good.

Yeah. Yeah. You know, not just ed and stuff. No,

they're interested in the private good. And they're not, they're not really into the public good mm-hmm unless they have to be. That's what I they're very forced to. Well, Purdue Fredericks was forced to when they, when they, when they created this huge opioid crisis part, part of their penalty was providing drug over overdose and, and, and opiate addiction prevention strategies.

Hmm. But that's part of their punishments.

Did it.

No no, but it came at the back end. Didn't come as prevention. It really came afterwards.

I mean, it didn't you write in the book that there are certain pharmaceutical companies that have spent their penalties were an astronomical amount of money and it's like, they knew it going in.

They're like, ah, we can recoup this. Don't worry. Just, just push it through. We'll get sued, but it's okay. The profits that we're gonna be there, everyone has

a, has a slush fund set aside for, for when they get caught. Not

if

Goodwin yes. When every, every one of them and, and they pay their, their fines out of that fund.

Geez. So what's your take home message. We're gonna try to, what, what, is there anything that we can do is, is the loss hope, or is this more of like a open your eyes?

Yes, open your eyes become, become aware of just how bad things are, demand change. We, we, and we can't have change unless unless we have enough people who feel the urgency need to get this, get this whole system revamped, not bandaid Sur surgery, but, but the, but the whole thing needs to be redone.

Start from scratch.

So what does this mean? Do we need to. run for office. Do we have to back the candidates that, you know, ask these questions, find out what their answers and back those types of candidates become lobbyists somehow. Like what do we do? No, no, no.

You ask the questions. The when, when you almost invariably, a candidate says I'm the lower healthcare costs that's part it's.

So they also have lower healthcare costs, but lower taxes, lower healthcare costs, lower healthcare costs. Ask them how, yeah. What what's what's their. and, you know, as it turns out the, if there are candidates for office, they're not getting drug money, the drug money's going to the,

to those who are already incumbent, they're sitting in their seat.

And, and they're the ones who, who are beholden to the drug companies, not, not the, not the new candidates. So we have to get at those people and vote them out. Mm.

Do you think more doctors should run for office? Would that be helpful?

Many doctors are running for office. Now, doctors are they're more than before, than before doctors are aware of, of how bad things are.

And, and doctors are now actually favoring Medicare for all. So anybody who's any of anybody who's inside the system knows how bad it is. No, it keeps, we keep referring to the system and being the system is broken, ask anybody and they say the system is broken. Well, where is it broken? and, and how who's benefiting from the breaks.

And how can we stop this?

Would you say that, would you have a plan? Like if you were to get a, let's take this from Canada, this, from Germany, this maybe from some Asian country and then. Blend them together. Like have you, have you thought about, like, this would make quote a better plan? Like if we just pull these favorite parts from everything, like, what's your, what's your thoughts?

Yes. We, we

can look across the ocean. The Europe has every possible combination of private and public, but what the, but all of 'em have is universal mm-hmm everybody and they get good. . Yeah, so they're getting better care and ensuring more people than we are. So I don't really, I don't really care which, which take the Swiss model, the German model or French model.

The, you pick a pick a model it's better than ours and it costs less than

ours. So even if we're not blending it just, just pick one that's in the top 10,

top five. So a Jared Europe , wherever it lands will take that plan. It's still better

than America's overall plan. It's gotta be better.

It's gotta be better.

It can't be worse.

What could we do? I mean, it's, it's staggering. The amount of money that we spend that could be spent on other things that we you know, that the roads are bad, this is bad, this and that. And you're like, we don't have any money. And then all of a sudden it's like, well, if you could drop it from 18% down to, what's a good number, eight, 10%, 10%.

Yeah. With GDP, that's kind of an average

for the rest of the world. 10%, that would free up a lot of money. We could do a lot of road re paving and pay for lot of education. Now I'm

all for R and D with these pharmaceuticals, if there's not a pre financial gain, but I, it does seem sometimes that America takes, takes the profit end of it.

And then some of the other countries, they get the more reasonable prices. I guess if America were to revamp our system, some of that would have to be spread out over more of the markets to, to recoup some of that. They would lose you think, or what.

Who would, who would lose the pharmacies would lose.

Yeah.

Pfizer. If, if they're not making the record breaking profits, maybe they're like, ah, you know, maybe it's not worth re investing in new drugs now, Don, that's what they say.

Right? They don't invest new drugs. They, they, they invested in those sales and marketing. That's what they invested the the small company the small laboratory in, in Europe Holland entered England where all the, all the, all the major researchers being.

The small laboratory does the research of development. Mm. Then they get the drug out and, and, and they get past phase one, which is, which is an early phase. And it, and it passes phase one that gets the big pharma Dr. Drooling. Here's what we could, we could buy and make huge profits on them. So they then go to that company and buy it.

Oh. And they own that company. And then, then they, then they take it to phase two and, and phase three, and then then marketed and, and it's on TV every, every 10 or a few minutes. And that's how it works. That's no, that's, that's about the fifth myth that, that written the big pharma needs the profit so they can reinvest it in and research and, and development.

The big, the big money that they make is, is reinvested in buying back their share. And paying their high, high paid executives.

My goodness, everybody, listen, I hope this has got you fired up and a little annoyed and angry because this is the, that's why I set the goal. Yeah. I mean, pick up his book. It's called ripped off is Dr.

Gilbert, Simon. You can probably get on Amazon and everywhere's you get books read through it. You'll hear some of the things that we talked about and it goes in a lot more detail. It's an easy read. It's. I don't know, like he said, get out there and, and try to make the right choices when we're, when we're hiring people and we're electing politicians and everything else.

And I just, I just wanna say thank you so much for being on the show and, and enlightening us and, and diving a little bit deep on the things that I'm concerned about and as well as the highlights. And thank

you, Justin. I appreciate giving me the pedestal.

Do you have any webpage or anything you need to promote?

No.

All right. Just, just, just what the book to be bought. Red rated refu and just, I talked about

all right. Thank you so much. This was good. I, I hope it was good for you as getting all these questions answered and

oh, very good for me. I, I appreciate

it. Absolutely. Look I'll I'm gonna edit it up, make it sound pretty.

And then send you a link, send you some graphics, and if you have any social media and all that kind of stuff, you can spread it around. And that's what I'll do for you. Okay.

Yeah. Great. I haven't done Skype in so many years. I, I, I spent most of the time worry about whether I get the Skype done.

Oh, sorry about that. I started this in China. I was living in China and I, I needed to start interacting more. So I was like, what can I use? And zoom wasn't so big yet. So I was like, got used to Skype my whole systems set up for Skype. So I was like, you know what, if it ain't broke, don't fix it. And it's not complicated as much as it seems.

no,

no. So you were in China and Germany. You, yeah.

Military family? No doing chiropractic. I, I had a clinic in Colorado and it was like, I want something different and not to be my own boss. And so there was a hospital hiring in a smaller town and the Yon province of China and one year turned into multiple years cuz it was just so fun.

And I got to travel and get paid like an American and live like a king out there. Wow. Good

for you. Yeah. Why not? You never have the freedom. Like, like you see your freedom. If you. Yeah. All right, Justin. So let me know, went into the air so I can tell my, my, my children, of course, I'll

let you know. Yeah.

Yeah. Thank you. All

right. Have a good night. Okay. Bye. Bye.

About the Author
Dr. Justin Trosclair, D.C., an expert in Chiropractic Care, has been focusing on back and neck pain relief for over 12 years and has delivered treatment to more than 6000 patients. With advanced training in treating disc derangement conditions, you can count on him to keep up to date with the latest research in physical medicine for spinal pain. He has 5 years of hospital experience in China, is currently working in Germany, and had a private practice in Colorado for 6 years. Dr. Trosclair hosts a doctor to doctor interview podcast called ‘A Doctor’s Perspective‘ with over 220 episodes. During his free time he wrote 3 books. Today’s Choices Tomorrow’s Health (rebooting health in 4 categories), a Do-It- Yourself acupressure book for 40 common conditions called Needle-less Acupuncture, and a step by step guide to look like a local for Chinese dinner culture called Chinese Business Dinner Culture. If you have kids, you may be interested in his 6 series tri-lingual animal coloring book series (english, spanish and chinese).