The Health Guardianship Podcast

Jon Hernandez
[00:00:08] Firouz D.: Let me introduce a person who has become a friend and a mentor and advisor, uh, [00:00:15] over the this year, uh, john Hernandez.
The insight, uh, [00:01:00] insightfulness and the depth of knowledge and breadth of knowledge, uh, that I found John has into this space is really, I I thought I have met a person who, uh, not only sees [00:01:15] what I, what we are trying to build at the Bow High Medical, but actually has seen some of the results, both, uh, uh, negative and positive.
since then, I think John and I have, uh, exchanged a lot of ideas. So with that, I think from my side introduction, I'm going to ask John to actually do a part [00:01:45] of his own introduction. His, uh, uh, John is an person. He's a technology person, but, uh, you know, how he joined the Uh, the rebel camp in the healthcare and where he is now.
I would love to hear from [00:02:00] him.
[00:02:02] Jon Hernandez: Well, thank you so much, doctor. I really appreciate those kind words. Um, I have thoroughly enjoyed meeting you throughout this period of time and, uh, and like minds and the way we've been processing through this together as a [00:02:15] team, um, over the past year has just been extremely, um, humbling and, and, uh, another, uh, Great way to understand where we are going in solving for the problems of health care.
So by way of background, um, I, I've spent a [00:02:30] 30 year career. It's actually over 30 years. I'm surprised right now. I'm getting up in age, but over 30 years in health care. I would block it up into three incremental parts. The first 10 years of my career, very much on the [00:02:45] technology side, as you mentioned, uh, doctor, it was very much focused in on basically electronifying the healthcare world, right?
Everything, uh, in the late eighties, going into the early nineties had a lot to do with paper based information flow and everything was being printed out of printers and [00:03:00] submitted to insurance companies. Um, and so my career actually was founded around the idea of how do I take paper based information converted into the electronic world and submit it electronically into the front door of an insurance company.
So a very simple process. Um, but [00:03:15] it became, you know, widely figured out that claims clearing houses had to be eventually developed and built out over time. To help, you know, ensure that the information going from a doctor's office or a hospital into an insurance company [00:03:30] was being properly processed. Um, they have what they call adjudication processes and then payment arrangements and how things get paid in health care became all part of that entire experience and building up a claims clearinghouse puts you right in the middle [00:03:45] of knowing how to bill to an insurance company and know how to get paid from an insurance company.
for having me. Or lack thereof, uh, not always did a claim being submitted to an insurance company result in a claim payment. Oftentimes they'd be rejected or denied for particular reasons [00:04:00] based on a multitude of different reasons. So understanding what the claims process actually was built on. Um, and before HIPAA came about, you know, there was, um, literally hundreds, if not thousands of different ways to transact [00:04:15] information in healthcare.
In later years, clearly post HIPAA with all of our security and privacy and standard and standards and interoperability requirements, it became a lot easier to understand how to process that information, um, electronically using [00:04:30] ANSI standards. Um, but what you'll find is being in the thick of data and understanding medical information and how it gets filed to an insurance company and back again, it was where my career started.
Um, and, and you'll [00:04:45] find that foundationally, when you understand, um, how things are adjudicated, how things are paid, um, the contract arrangements that are established, there's things called fee schedules, you know, how doctors set their rates for delivering care [00:05:00] or charge masters and how hospitals are setting their rates for delivering care.
And those contract arrangements and how those contracts are established between hospitals, doctors and insurance companies was all part of the foundation of where my career had [00:05:15] started. So I think that's very important to know and understand is that in the early days, um, You know, before, before, um, everybody was kind of, you know, figuring out that misalignment was happening in health care, there, [00:05:30] there was data that had to come about to figure out where and how those misaligned, misalignments are being formulated.
Um, now I'm going to fast forward. If I may, um, into the next 10 years. So 10, 10 year block number two was, [00:05:45] um, now moving on to the next level. When you start thinking about, um, where the government comes into play, um, and there's government reimbursement and how hospitals that are seeing what they call disproportionate, um, number of patients.
Population for [00:06:00] Medicare and Medicaid. So if you have a hospital like inner city hospitals and different geographies where they're seeing high volumes of Medicare Medicaid patients, those Medicare and Medicaid patients are they hospitals receive much lower rates, much [00:06:15] lower income streams off of the higher risk populations.
And so what challenges a hospital is to maintain financial sustainability for those that are seeing proportionately way more government based or government programmed [00:06:30] patients than those that we consider to be commercial based patients. Commercial being those that are Tied to United Healthcare or Aetna or Cygnus of the world.
Those are what we refer to as commercial based. So they have different contract and different payment arrangements that are sitting inside of the [00:06:45] commercial world than they did in the government world. But when a hospital is disproportionate in seeing a higher volume of one over the other, then they ask the government to come in and help subsidize the costs for that hospital to operate and [00:07:00] function.
And that's what they would then have to build up what we called government reimbursement packages or disbursements. Proportionate share evaluations. It is a lot of again, manual processes and building these packages that you would share with the government. The government would qualify you as a hospital [00:07:15] package, and then submit that back to the hospital.
And this would often resulted millions of dollars that would then enter into the bank account of hospitals, um, to help offset that lack of commercial reimbursement. Um, so then [00:07:30] you do that. Hospital over hospital over thousands of hospitals now across the country, you have to automate that world. So I spent a lot of time helping to automate the packaging process for how data got submitted to the government, the packaging elements that that met criteria for [00:07:45] the government to recognize what it was going to pay you.
And then the hospitals would receive payments accordingly. That again was another area of process where you start to understand Where there are challenges and potential misalignments between, [00:08:00] um, what you're actually delivering services and the type of services that you're rendering that you want to render and the reimbursements again, or the lack thereof.
with different contract and payment arrangements that are [00:08:15] oftentimes not supportive or at scale with each other. So you start to see and you start to recognize, you know, where are there elements for things that we had built into our healthcare system that, that over time aren't necessarily the most healthy [00:08:30] way to build an economic structure to help support our providers and hospitals and delivering the best possible care, the economics.
We're not necessarily well aligned with what we were looking to deliver in the form of clinical outcome. So
[00:08:44] Josh Taylor: you have these two, [00:08:45] those are, you have these two 20 year blocks and, but the throughput seems to be the claim event. Like you're looking at when someone is actually getting the care. And on the front end of that first 10 year block, you're verifying, verifying that the claim [00:09:00] is there, making sure that the insurance payment's there, but you're kind of getting, uh, waterboarded in to the insurance industry by seeing this flood of data, and then you're on the other side, on the provider side, essentially, making sure [00:09:15] that health systems are getting reimbursed.
There's a tremendous amount of data in that 20 year period that you're seeing. What was the thing that started to stand out to you as far as the patterns and how data is used inside of our healthcare system?
[00:09:52] Jon Hernandez: So[a] what you'll find is hospitals then in the 2000s, and I agree, they're trying to solve, right? And it was, um, well, how do we [00:10:00] drive and deliver more money into our institutions? And how do we bring a different disproportionate share of cases that are coming through our front door to help up our revenue opportunity in connection with communities and populations?
So at [00:10:15] hospitals then, um, and there's been waves, ebbs and flows of hospitals buying Physician practices. So if you replay the mid 2000s, hospitals then started to buy and acquire professional service lines. And these [00:10:30] are the cardiovascular health centers, the primary care, the orthopedic groups, right? They ended up developing out acquisition strategies to go buy as many.
Um, what we call fee for service, professional [00:10:45] based position practices under ownership. So many hospitals across the country started developing out these strategies to acquire. And through those acquisitions, we found that those provider practices that were sitting under the [00:11:00] umbrella of a hospital had the ability to charge higher rates.
Because they're sitting under hospital contracts and when you fall under a hospital contract, you have an opportunity to charge often times. You know, [00:11:15] double, if not triple the rate of what you would normally bill as a standard cardio. If you're a cardiologist and you build an insurance company as an independent practice, you would typically charge at a specific billable rate that's defined to your practice, [00:11:30] but falling under a hospital and now being owned by a hospital, those same rates you could then charge under a hospital contract.
Sometimes two to three times higher than you would have under an independent same exact services performing, seeing [00:11:45] the same exact patients. But just because you shift under a hospital arrangement, all of a sudden your fees are exponentially higher than before. So then hospitals got that as that was basically.
For lack of a better [00:12:00] word, a game that started to be played by the hospitals to go acquire as many physician practices that they can get a hold of and bring them into what they called, uh, under a management service organization. But then they had all their professional fees being run under an [00:12:15] MSO. And then they had all their facility fees that they would then maintain separate facility contracts with, but all under a structure that allowed them to optimize their reimbursements.
So replaying my history then, right? You started off in the [00:12:30] claims and claims reimbursement and electron, electronifying information so you could have data. Then you go into the government world and you understand what the government was either paying or not paying into these facilities. Then you go into the phase three of then hospitals acquiring physician practices and now [00:12:45] there's, it's a lot of numbers, numbers games that are happening.
And the other thing that I would mention while I'm on that topic is when you employ doctors now, because doctors that are now working for a health system, they have what they called work RVUs. [00:13:00] relative value units. And these work RVUs were basically structurally tied to your physician contracts that would optimize and incentivize doctors to deliver certain elements of, of relative value to a [00:13:15] patient that would, that would get them more money from an insurance company as a, as an outcome.
And then the doctor's bonus structures. Through an incentive model would then also receive money to, um, to help, you know, [00:13:30] justify. Higher work RVU and higher billing and coding initiatives. So there's, there's a lot of things that, you know, when you build an economic model and you connect it into these contract arrangements between hospitals and insurance companies, [00:13:45] it all trickles down from there.
And then misalignment starts to happen all the way down to the root, which is where the provider is seeing a patient and how that experience is then being supported, what that doctor's doing at point of care. It escalates
[00:14:06] Firouz D.: as the chair.
My job. Actually, I had the RVU target on forehead of every, every doctor, every faculty member, and they [00:14:15] knew it. I knew it that as soon as they come down below that RVU, that means they're basically we're losing money. And so the RVU was a magic for me. Magic has turned into a magic term among [00:14:30] the doctors, surgeons and all the things.
What's your view this month? What's your average of you? And I have become a selling point, actually, when the doctors wanted to go from one provider to another provider. So it's [00:14:45] the in the RVU is really the atomic level, uh, concept of creating this misalignment that the doctor's attention had turned from the outcomes.
Uh, that I, I'm there to generate and the problem solving [00:15:00] I'm there to solve for my patient to how much hour a year can I, I, can I generate
[00:15:07] Jon Hernandez: Absolutely right. Doctor. That's absolutely right. hospitals that own and operate physician practices tended to look at primary care and urgent care centers as a way to connect to.
A direct [00:15:30] patient need,
But primary care over time had been neglected. We've really [00:16:00] pushed, you know, our communities, our people in these communities down these higher cost pathways, both urgent care and emergency room was designed almost by hospitals to allow easy points of entry to get these people coming through. [00:16:15] Clearly, the reimbursements and how much they get paid for urgent care level services and ER related services is much, much higher again, exponentially higher than just leaning on a proficient primary care solution to be your initial point of entry.[00:16:30]
And so what you ended up having is hospitals owning primary care practices for the wrong reasons, in my opinion. It was a, um, typically a lost leader initiative. Primary care practices were losing money, [00:16:45] not necessarily caring because if your primary care doctor functionally was pretty much there to refer patients into higher cost pathways of care, then the job for a primary care doctor in an eight minute visit.
[00:17:00] primarily was a patient referral.
So primary care for me [00:18:15] became a, a area for me to say, I want to focus and see if I can't change the behavior of what a primary care physician. is doing at point of care for patients to help optimize the value in that [00:18:30] relationship to re engage and empower doctors to leverage their licensing, leverage their education, leverage their, their wants to actually do better for their patients.
I do believe a large number of our primary care physicians across this [00:18:45] country today want the ability to connect with their patients at the deepest level possible. But we had yet to be able to provide them a platform by which they can have the time and to deliver the quality and the value in that relationship [00:19:00] between themselves and the patient.
So my first run at that was to build my own MSO and to go bring [00:20:15] primary care practices under relationship with an outside of a hospital independent operating solution that allowed us an opportunity to redefine that experience, redefine the economics and redefine a patient [00:20:30] provider relationship, but all still not knowing the market just yet in a fee for service insurance based world.
So living in that insurance based world, you're only as good as your insurance contracts. So rather, we were seeing [00:20:45] 15, 20, sometimes 25, 000 patient visits a month. So we were, we had a lot of visits that we had to manage trying to figure out how to build value. We had financial contracts in place that were being 100 percent paid for by the insurance companies.
So [00:21:00] the only way for us to drive financial sustainability was to build what we call vertical integration. Vertical integration means you can't just deliver family level services or family care service or general services. You have to do a lot more than that. You have to deliver [00:21:15] urgent care level services, behavioral health services, occupational medicine services.
You have to have your own imaging capabilities, your own lab and pharmacy capabilities. You have to be robust and vertically integrated across a multitude [00:21:30] of subspecialties within a primary care world. That would then at that point help support financial sustainability with a much with, with as much diversity in your revenue streams as you can get.
So then you could help offset the risk.
But in a fee for service world, this [00:22:00] is, this is, this is what that ends up resulting in. You're only as good as your insurance contract. So literally a couple of weeks before Christmas, 2013, I had my CFO walk into my office one day and he says, I have, I don't have. [00:22:15] I don't have a very good picture for the financial outlook going into 2014.
I thought we had enough capital to put the work. And invest in this initiative that we were after. And the [00:22:45] very first words that came out of his mouth a couple of weeks before Christmas was, we're having a horrible flu season. Those words echoed in my head over and over and over again.
I said, wait a minute. Your definition of why we're not going to have financial sustainability in 2014 is based on the idea that we're having a horrible flu season in 2013. But if we all [00:23:15] recall, 2013, we did not have a horrible flu season. W e didn't have enough sick people in the world, was the interpretation of what he was saying.
We need more sick [00:23:30] people coming out of that holiday season in order for them to show up at our health centers, so we can get paid by an insurance company to deliver financial sustainability [b]for the entire
[00:23:40] Josh Taylor: following year. The definition of horrible was not what any patient would ever think [00:23:45] of as horrible.
It was a horrible revenue. Correct.
[00:23:50] Jon Hernandez: Exactly right. So that was when everything kind of burst in my head. And it was a period of time where I sat back and honestly reflected on, [00:24:00] are we capable of building value back in a patient provider relationship while still sitting in a fee for service insurance based world, The answer is no.
So that changed my entire thinking.
[00:24:55] Josh Taylor: what was the first thing you had to unwind? [00:25:00] After that revelation, obviously you said there was a reset, but what was the first thing that you started to address?
[00:25:10] Jon Hernandez: So the first thing that I, well, clearly, um, I was part owner of that business at the [00:25:15] time. So the very first thing was I told my partners, they had to buy me out because I was no longer interested in being a partner and investor in something that I no longer had a heart or passion for. So, uh, that was the very first thing I had to address and that happened rather [00:25:30] quickly.
The next thing was there was a couple of areas of our business that, um, that we were being paid outside of an insurance world, occupational health was an area by which we had employers paying us [00:25:45] to do exams, physical exams, like wellness initiatives, screenings, biometric screenings, health risk assessments.
So there was employers that were actually hiring us. And these are fire departments, police departments, [00:26:00] city, county government that would allow us to come in and pay us outside of an insurance product to deliver a stack of services that had nothing to do with insurance based reimbursement. And if you think about [00:26:15] 2014, a lot of employers were actually buying wellness programs.
So it was about education and now learning where all the money was, you know, where things were being paid. [00:27:00] Where the employers were engaging to help support their employee and the families in connection with their employee lives. And then understanding the types of arrangements, we call them direct pay arrangements, where outside of an insurance based product, people were willing to pay for [00:27:15] access to health care.
You as a patient could put a credit card on file with a primary care physician [00:27:30] and receive same day, next day access to health care, 24 by 7 access to your provider and have the ability to show up at a health center and receive, um, a, a, um, an entire encounter, an entire visit [00:27:45] without any copay or deductible coming out of your pocket, which is your traditional insurance product experience.
So that's where the last 10 years of my life, um, and my career has been spent, which is really thoroughly understanding things that I hadn't yet experienced in the first 20 years. [00:28:30] Right. I didn't, I never held a conversation with a benefit advisor or an insurance broker in the first 20 years of my career.
But in the, in the past 10 years, I've literally had thousands upon thousands of conversations with benefit [00:28:45] advisors and insurance brokers first 20 years. I had not talked directly to an employer about their healthcare needs or saving money or delivering better quality, higher clinical outcomes the last 10 years.
Thousands and thousands of [00:29:00] conversations with employers of all shapes and sizes, groups of two to groups of a hundred thousand and everything in the middle, talking about how you can do direct pay and cash pay arrangements in, in this new economic world. [00:29:15] And it's basically a way of disconnecting out of a traditional benefit design that most benefit advisors would be selling and reconnecting a completely alternative benefit package.
And then we, we as a care provider sit [00:29:30] alongside and next to adjacent to a benefit plan that is complimentary and supportive to us delivering a better care outcome. So that's the evolution of where today, 10 years later, the market is, is now headed. [00:29:45]
[00:29:45] Firouz D.: So, John, this was fascinating. Josh, as you could see why that the.
Aha moment that came to my mind now. Now it's filled with the actual history of John has gone. You know, she came in [00:30:00] from the payment part to the understanding the diseases or the misalignment that the fee for service has created. And then taking it apart that what part of the fee for service has to become a direct pay, starting with primary [00:30:15] care and escalating it to the other parts
I call it an essential care, a good old family doctor with the direct pay access to a specialty care. Um, for most, if [00:32:15] not all the outpatient surgery. Leaving the only thing behind is the this inpatient trauma and unpredictable inpatient cases. And we have a proposal. Actually, I think John would [00:32:30] agree with me if we can say it here that we can deliver this actually for.
Almost less than 50 percent of the current costs. You know, we say that subscription could go more than less than 100 a month and the pool of money that can [00:32:45] pay for this check pay for outpatient could go for less than 500 a month. That would effectively cut the existing cost to, uh, to about 50 percent of what it is now.
So I want to spend [00:33:00] maybe the next few minutes and we have to Is, uh, now we have kind of converged the, uh, the ideas is what would be John's, um, Uh, predictions, if you will, or [00:33:15] view of what are the next steps. where do you think the challenges are and what are the next step really [00:36:30] to Bring this free market, uh, as a into the market.
[00:36:37] Jon Hernandez: Yeah, quite the question. Um, I would say that, you know, we have the balance of this year and next year as a [00:36:45] very pivotal point in time. Um, we now have grown our space up.
This direct pay space, there's these arrangements that we've been building out. And what Bowtie has accomplished with your, with your [00:37:00] programming. We're now 10 years and we're, we're now making significant inroads on modifying the economics and delivering now officially delivering quantified value and better clinical outcomes.
Doctors are spending more time with patients. [00:37:15] Their, their, their behavior and connection with patient care is getting us to higher quality, better outcomes. We have cost reduction. We mentioned 30, 40, 50 percent depending. On the size of a group as, as far as it relates to savings. So we're, we have a track [00:37:30] record now, we have validation, we have credibility, we have a lot of things right now working in our favor.
Which means the government is looking at it, hospitals are looking at it, and insurance companies are looking at it more than ever before. This year, [00:37:45] officially, These organizations are turning the corner. They didn't believe in what we were doing. They didn't think we would exist in 10 years. They didn't think that any of what we would be accomplishing in today's world would actually happen.
It's happening and it's happening in a big way. And [00:38:00] they're paying attention to what it is we're doing now. I believe over the next. Call it 18 months or so. We are going to see, I think, a very pivotal moment in time by which a lot of transformative work is going to be done. And we're going to not only continue to set the example, but we're going to [00:38:15] broaden our capabilities to the next level.
When you think about surgeons and specialists that are in health care, that are now looking to, it's no longer primary care. It's now specialists and surgeons that are adapting and moving their practices to alternative [00:38:30] payment. And these, these models that we've built as a benchmark for how we can deliver alternative payment and cash pay direct pay arrangements into our communities.
We're going to continue to see doctors moving into this model with, [00:38:45] with way more momentum and way more thrust than we've ever seen. So that's going to be a big thing that's going to be happening in, in next year's timeframe. I also think. Social determinants of health and how we're managing to social determinants of health [00:39:00] at the government level and with the amount of settlement money that's coming into that's come into our states.
There's literally billions of dollars that have been infused into our states to help figure out how to bring into lens our social determinant. [00:39:15] And managing better to our social determinants of health requirements and putting money to work to help communities as a whole. We've been focused on employer by employer, person by person for the past 10 years.
But I believe the government is now going to [00:39:30] engage, see what we've done, and look to how we can help solve for some of the major challenges in connection with social determinants of health. And we're going to now have a top down push and have the two markets start to come together. All the work that we've spent the last 10 years [00:39:45] doing from a bottom up approach is now going to start to impact our top down and we're going to be squeezing it in the middle, building these new programs and economic strategies into populations in broader, in broader scope.
And that's going to be happening [00:40:00] the balance of this year going into next year. So you're going to have a government lens looking at it completely different than they've seen it before. They're going to be using the funding that they've been able to capture through settlement arrangements. We're then going to be bringing our model that's already been vetted and [00:40:15] validated into relationship with these initiatives and tie it all together in, in one solution stack.
So that is where we're headed. That is where trajectory is going to take us, I believe. And it's not a three year window. I believe [00:40:30] within about a year and a half, you're going to see some major differences in the way we deliver health care to our communities.
[00:40:35] Firouz D.: I agree. John, you explained it very elegantly.
I agree. I think really, the job of government is not to [00:40:45] innovate, you know, is to come and support the innovations that have created the value. And I think Uh, after almost 14 years that the CMS Office of Innovation has opened, I think the pivotal moment is arriving, that the look at [00:41:00] efficient models, as you said, the direct payment models to come and adopt.
And if I may add on top of that, this whole concept of the virtual delivery of this essential care, the primary care. Is [00:41:15] going to address the issue of the medical deserts and the rural areas that are suffering from the shortage of access to providers. And as you said, again, under the government program, the expansion of the [00:41:30] Medicaid has a lot of money on it, but doesn't have a system to deliver that care.
Uh, bidding, I think, and I agree with the short time frame, uh, within the next 18 months or two years that these dots are going to get connected and [00:41:45] hopefully a new pattern of an efficient, uh, healthcare delivery and, uh, this beautiful country will be created.
Um, want to thank John for joining us. If you have closing comments or Josh, uh, share those with us. Otherwise, this has been a fantastic conversation.
[00:43:14] Josh Taylor: [00:43:15] Thanks, John.
[00:43:17] Jon Hernandez: Yeah, this has been great. I really appreciate you guys, uh, inviting me to this time together in this session. Um, um, I'd love to, uh, entertain, you know, any questions or anybody in your audience that would like to get more [00:43:30] details on things that we're doing in the most creative way and most innovative, innovative way possible.
I would love to, uh, to chat with any of your audience members on that topic.
[00:43:39] Firouz D.: Yeah, we will plan for that, John. I think after we've completed the first series, uh, then we will bring all [00:43:45] the. Uh, basically keynote people and then open it up to really an open question and answer or question and answer that our, uh, members or, you know, audience, a general audience has, that's, that was great.
[00:43:58] Jon Hernandez: Awesome. Awesome. [00:44:00] Well, this is fun guys. Really appreciate it.
Firouz very excited about the conversation today with john hernandez Uh, we had a very engaging conversation.
I mean you can tell his passion about fixing Health care fixing sick [00:45:15] care, um in our system He's definitely aligned with what we're doing inside of the rebel camp of health care You
[00:45:23] Firouz D.: I agree. I agree. And frankly, to me, as a, as a person who's just spent his entire life in healthcare, it's just [00:45:30] a breath of fresh air, meeting people from other parts of the industry who've come, you know, from I.
T., from technology, come in. And as he said, Explained nicely from the payment side to see the same diseases, the [00:45:45] symptoms of the same disease from the different angle and then remain very hopeful and interested and keep digging in into for for solution rather than giving up. And I think that is really the.
Uh, cornerstone of [00:46:00] people in the rebel camp, as you call it, people who haven't given up on our hopes for fixing our health care. And I think as the result is very correct that we will have a solution in hand or samples of the solution in hand that will take off. [00:46:15]
[00:46:15] Josh Taylor: Yeah, I think, uh, there's so many different facets to the problem.
We often miss the fact that there's so many different facets to the solution and him approaching it from a data standpoint. As you were saying, you've been approaching it from a delivery of care standpoint. [00:46:30] Uh, it's just awesome to see, uh, that we're, all the streams seem to be coalescing. We're all forming one giant river.
[00:46:37] Firouz D.: And I really like his suggestion of, you know, opening this up. I think at one point I can see that, you know, in a [00:46:45] webinar or something, you know, other, uh, participants, you know, Alex Acosta, him, you know, two or three people sit around and open it up to all the brokers, employers, frankly, advocates of single payer system, whoever is [00:47:00] there, come on, basically ask us question and let us challenge this great idea.
[00:47:05] Josh Taylor: Well, excited to be sharing and let's dive into the episode. [c]

[a]Tighten the gap before the “so”
[b]Opening clip of the episode
[c]Intro to the podcast episdoe