I left it in the car um perfect oh. Thank you. Thank you very much. Oh. Wow guess what mar Here we go well this is just um it's, an honor and privilege to be here in this community. In particular, uh and hold this roundtable and um. I wanna. I said just a moment ago. I'm here to listen and learn mostly um, which I think is really critical part of figuring out how to represent this congressional district and you I'm gonna represent every city every town in township in this congressional district and you know it doesn't matter to me if it's a Republican idea or Democratic idea or idea from someone who has a little game that I Idea and it will help us increase access to healthcare, lower the cost of health care in this country is that's what I want to do. Many of you make of um heard the saying before that I grew up with my own family without access to health insurance for a good part of my childhood. I worked for over 22 years and the healthcare manufacturing company and I have responsibility for the health plan uh for the company that I work for eighteen thousand covered lives um four thousand Employees right here in Minnesota and as well as some of the plants from outside the United States and 12 uh. It is such an honor and thank you for joining me in the southern part of this district, Jim to have a congressman Jim himes here with me today uh the gym is the chair of what we call the new Democrats um and that is a caucus within the Democratic party that um just 20 fourth ideas um for big towns, small towns townships on how we solve the nation's um healthcare Problems uh and really improve the way we do healthcare in this country. Um the new Democrats we really consider ourselves to be um a group of people who are willing to work across the aisle on anything that's a good idea and um gem is from the Connecticut and he is just an amazing mentor to me and you know that I love to give you a chance to make a few reform so they will go around the table were you introductions great people. Thank you angie I'm addicted Wall is such a pleasure to be here. I think I've been to Minnesota before, but not a lot of it, so much fun driving in from the airport getting to get to see some of the very differently Landscape and where I come from, um I'm just so happy to be here to support angie. But then I've got a none interior motive to which is to uh to hear from all of you have to learn because of course, healthcare in the Congress have been there for 10 years now and um. I can't claim to know a ton about the challenges of rural healthcare in my district is pretty urban and suburban in southwestern Connecticut um, but my 10 year career in the Congress really encompasses the the very um at times angry the certainly always volatile discussion that we have about healthcare and, as you mentioned, the new Democrats return The chair people call us the centrist Democrats, the pragmatic, Progressive, whatever you wanna say, we really are buying large representatives of purple districts like this one, meaning we gotta listen to everybody Democrats and Republicans are not deep blue district. Um and a lot of us tend to have private express sector experience like angie as we take some of the practical approach to this and I would just say I mean I don't know I've been in politics before my election 10 years ago when I, my trial by fire a horse was the affordable care act town Hall meetings. I did 14 some of them. We got a little rambunctious and I just say that Because the new Democrats and I hope, the rest of the Congress in the next Congress will come to regard the you know the improvement of our healthcare system is something that we take very practical approach to you because, as you might imagine, I'm support of the affordable care act. I think the fact that we covered 20 million Americans that we did away with um exclusions around existing conditions. We did some good things from and I think that was all good stuff, but it is far from the finished work. You know we did not do enough to reduce the cost of the system there's still a lot of mary Without access, uh to healthcare and we can probably do better on both quality and efficiency so I'm hoping we can get away from the very angry you know the Republicans failure to repeal the affordable care act to their credit. They were they recognize how devastating that would be hopefully in the next Congress puts us in a place to say okay guys, let's set aside the wars in the last 10 years and really buckle down around efficiency and cost control and covering people who aren't yeah no card, so I'm just delighted to be here and look forward actually learn from all View on what we can take back to try to make that a reality fantastic well, I think what we should do, that is to start as a lot of us here, that, let's go around the table. Maybe just um your name and uh. What brought me to this point in terms of where you work and how you hope to help us improve the health care system so tammy would start with you we're gonna walk shopping, alright. My name is diane and, if you learn on the public health director for La County and I'm here because The people that my agency serves, I would like to see it better access and more affordable healthcare, but we have some other issues to work on um as well, such as recruitment of qualified staff. You wanna stay in our small rural areas. It's cut to compete with bigger hospitals and things that are down the room that can offer bigger salaries and so right and he had an opportunity to catch up recently a little bit on the telephone and um so I'm looking forward to learning more from you here today. Thank you susan. Thank you for being here and thank you um susan steam. I am a retired. Can healthcare industry and was reason We asked to come back and helps me almost establish a primary care clinic right to much for the same reasons that can't be have spoken of all trying to create access, try to create a affordable pair trying to bring specialty care to our small Organization into our communities and it's just uh, as adults, sale is the best has been in the community for a hundred and 25 years with a mission to serve all people within the community, especially The poor and so that drives our mission it's going and I didn't mention it and um my opening remarks, but doctor Chris Johnson um you know our panel yesterday were killed during the third as well. Jim and um uh Chris and I become friends of really because there is a public health crisis in this country that we call the opioid epidemic and doctor Johnson is doing just a whole lot to help us think through, not only how do we treat People who are addicted but how do we stop creating addicts in the first place and this is a very personal issue to me. My 21 year old son on his birth mother died of an overdose when he was seven years old and so I promise josh that this will be something that I work on in the Congress and its very personal, she made. We know that this addiction doesn't know geography. This is not an honor the norm, suburban. Our exciting role issues, such as every family, despite socioeconomic status and so thank you for being you and thanks again for inviting me to join you. another Very good thanks to everyone to be here in the community. Um. My background the words you medicine artist in st., Louis card, which is supper, was um and my moment and those who is actually goes back to two thousand three for And the worship without seeing someone like me with my training, counting County hospital in you get the courage of David. You see something beautiful in the County budget. yeah Parents not involved in my jail with car and I'm to my song this is happening in Singapore and it and That began my investigation. This crisis, um like share Minnesota Department of human services, opioid prescribing working we're focused on dealing with the the concept is probably the first place which is over prescribing of opioids without any justification to do so much scientific evidence to back it up in the Um and so we're looking at how we decrease the exposure of the population of the opioid, but my with my investigation shows, is as I learn more about that you understand that this is an American problem You don't have a good epidemic in Germany What made our system affordable to this so my advocacy on that is now turned to advocacy on like this. In general, not of your House. How do we stop creating more people don't go dependency. How do we changes system that could illness to his own population down for the unexpected. What they Well know for would be complete without one of the owners of lark toys which I had the honor and privilege of visiting recently on the small business tour of the congressional district and so um. Thank you so much for being here and a and tell us uh kind of what brought you here today so if I'm randy Brown game and um I have the pleasure of working with angie and getting to know more of a little bit during this campaign and um my family and I, on this toys In our community and have for almost 11 years and prior to back um my husband and I were working in education, arts and qualify for Minnesota care and have had alot of health through the our babies being born. Um with some assistance in terms of those healthcare um as we happen to have have three different instances in my life, thus far that without good health care. I would have been like that would have lost my home um Or just might volume and so um to reverse situations and then more recently made the entire mental health diagnosis and um and my family, my husband diagnosed with bipolar disorder after we bought a toys store and so we have learned a considerable amount about how that system works and Have been greatly informed by that process so an interview getting to know what the discussion is and how it can make things better for people like us who were struggling so thank you so much for being in random Mary, thank you so much for being here Um I'm a terrible I am from University events or um Center for changing landscapes and Minnesota design Center. I come from different from you and that is designed for you, designed and created a lot of communities are and that don't support active lifestyles and um also communities that um don't have access to healthy food and so um I've been working in um creator Minnesota Small communities to address some of these issues. um Think more broadly about health, isn't, just about uh healthcare provider so we've been is a really important it's also about the environment. the Online often really North part of the conversation about prevention so, thank you for being Rollin why I first met uh last year uh that slippery so that's right to see you. There get up well. I'm here, because more us run an all night uh I've been interested in the political world since high school. I think they they voted me. Third ticket was uh first student Council President so I can't get while that's all I have by the way But I'll look for my representative to be visible and available and the energy certainly has been both of those so when she asked me for something. She's likely to get it a little story. Jambalaya shot. We were losing a good part of our hospital We were Associated our clinic was owned by a large medical operation and they started pulling services away away and uh. We could see that we have to go somewhere world for real here, but we have a few citizens along with our city administrator, who really stepped up to the bar and uh we're gonna keep we have a nice sunny now with pharmacy. We have a nice hospital So really if I get sick or injured, I don't have to go but five minutes from my House But that's been a real community challenge to ensure that you maintain those services that will definitely wanna come back down to this end of the table. Um my name is shane um again morse invited me um my husband is a dentist in town, so that's another piece of the puzzle and I also have a uh, a son with down syndrome and then I have a chronic um auto immune disease. So there are a lot of different concerns. We have as a family on how to do all of this and make sure that throughout time You can protect your kids number one that also guarantee, as we age, that will have hair so thank you for that. Nobody does are there uh. It depends because of our summer. We tear someone coming in at any given time for solidly. They can be as many as 5 AM which for communities the size people are like what, but we have a greater drawing mary ocean. I have to tell you one thing. People don't really realize about lot of size the quality of care we've got right now and they're lucky because the next generations are coming in and taking over had we not And that I think we would be in a serious um am or serious position a color we've we've had some long term family established health clinics. Here at downtown clinics and that's to our benefit, but I see the other communities are really gonna be struggling with that I'm Michael plant in the County administrator here I don't think that summarizes any better than him. He did, but we always appreciate having the opportunity to have a form and get information out there and get that information shared with anybody that's willing to listen yeah And Joe Johnson and this provides a home nurse services here at the health and I am really pretty much sums it up for us Alright pain on tim and my location is a registered nurse from the fashion, is uh advocating for cancer patients. Um so I lost my dad to cancer and so it's a very personal issue in addition to having many friends and family affected by it, um my biggest thing is ensuring that people that have pre-existing conditions have coverage um I'm a little bit alot concern with our current uh positive changes that are coming down the pike um that are going to make that more difficult or because they our favorite it's going to be on affordable Um disaster coverage is disaster, so um but also uh. You know, focusing on things like cancer, research funding, um but then making sure things like palliative care are available in greater Minnesota um. I've heard a lot legislation that I'm so close. We just wanted to make sure because it so much when you look at the statistics. It looks like you know Minnesota has great character, access, but they're looking at the you of m booking hotmail during at those things on because some of those are Available from the hubs, they're not available in greater Minnesota so we need to advocate for hundred and so we don't have to drive to get back here will thank you so so much for being here. So the good news is you have both the sitting member of Congress and someone who certainly in seven days hope to get in there um, but so I can't really just wanna start up on this in the table with um in wabash on and say, Elizabeth what do you think We're we doing well um and what do you still need and how can the federal government and Congress um help you get. What you need to be successful here. I'll start by saying that I think that will help here is totally different to me. You know you mention about the the urban care, healthcare is healthcare. Some people say, but we have challenges and access for one transfer Patient has a issue and I think hamill Street to battle belt as far as our folks getting to the healthcare. Um, bringing in that specialty care that we need just recruitment and retention of qualified providers is a huge deal to get a decision to come from rural community and stay in the world community is a huge challenge alot of it deals with the fact that are bringing Christmas system is broken uh we're We're using everything in our power to make sure that we're um where are critical access hospital. We've just now applied to be a real health clinic. So that at least from the reimbursement standpoint, we can be viable because it is so important to us to maintain a presence in this community um mister Hall 10 min partnerships. We would not be here without the community support to get us off and right to coming up to local healthcare and then helping us with supporting uh supporting the clinic and then support Surrounding businesses within our community, that's very important as well, so we had to look at creative ways in which to bring care to this clinic. Specialty care in particular somebody just mention that I think that uh ham, because otherwise we're not going to be able people will have to drive and they're not going to get that healthcare. This is an agent community 60 percent of our patients are Medicare or medicaid that's huge For this Organization, um we also we're trying very hard to create partnerships with others were looking at other healthcare organizations with our public health organizations with those within the community. That's a huge issue. Um but really at the end of the day, a lot of it gets down to reimbursement and how do we maintain access if we can't get paid for what we're doing and so with 60 percent of your patients on Medicare medicaid um. What you're saying is reimbursement rates are too low with both of those problems and their for you 40 cents on the down for Medicare medicaid, Medicare okay so I'm gonna see the last likely promoted yeah so if you look at a typical visit to uh a primary care physician who, with a patient who has, like maybe five to 10 medications at Creek and we're, probably only getting paid 72 dollars for that visit and when our world community relies on nurse practitioners and physician systems to help staff. These clinics. They get paid eighty five percent of that fee schedule, so you can see That just really try as best we can to be creative and it is very important to this Organization to remain in the So we're looking at every way that we can win as well What are some of the services that you think uh Washington counties and a good job improving and where you still need helping us or anything the federal government can do to partner with you on that. I'm most proud, probably our home community base services system that journey is the supervisor of we've pulled together um we're very unique in the state in that regard, we pull together team of social workers and nurses that do the assessments and really help build up each others expertise um. I think what we can do better with is like sue said the reimbursement, but also you know getting transportation to our areas where we don't have a transit bus that runs for example, after hours on Saturday mornings are just pretty much runs Monday through Friday, so if you get a late clinic of For example, and you can get delayed an x-ray and then they have to read it and you're the boss is done running your stuff and put it. We don't have to do yeah got this go, lift know some of us are Super go yeah alright, but I have but you just call the mayor right so getting our our clients um the services that they need to stay healthy and happy at home, getting streams we've gotta go jacking around about that um. You know, getting an access to the things As well as that is very challenging getting um providers that come in the home to provide home care services home health, aides, filmmakers, for example, nurses, home care services. They are getting paid the so um it's hard for them to justify driving out to the rural areas to do an hours worth of work and they're not getting paid the money and so I think we need to take a look at the reimbursement for clinic side for providing in home services as well how many um that roots providers are there in the individual market place here. well The lady choices many choices you have at this point. You know, for folks who um you don't have private employer sponsored Red insurance. Medicare medicaid, just young individual marketplace is part of the. I know it was one at one point. It made me now to our know in our medicaid um market we've had um providers pull out just because they've been here half a year and it's not gonna luke reason to them and so then our own plan has um chips Ethan and help those clients with coverage and you know again it's it's poor reimbursement and they're struggling to make it to let we rather serve the people and and that's so, company based purchasing is a big um still subject here. I think, from our into it's about reimbursement alot of the providers are willing to take in more people, even though there's a certain clientele that take a little bit more time because they have transportation issues. You also need to work with the social worker off because they might have some mental health issues and some other Some other for meal from Illinois issues, um so there are safety concerns are we have to have an extra person available for transport and lift and those are all kinds of things we consider when we're making appointments for people um but I know the heart of the live load and providers. He is that they would like to serve more than the universe so low um, if you look at what we recommended as a dental group off and they say 25 percent, maybe 30 percent that do not go over that if you wanna keep your practice because now you're going into the negative, I think we Hi is 45 to 50 percent and sometimes just to try to get people through, because they're coming out with huge abscesses and infections like the stomach infections and um it's not just simple dental here we're talking like life. Now kind of cyst and stuff in there models and um that's what it's frustrating from the provider because it doesn't have to be that way you know and that you can take on everybody so, but I think the ring vs huge You've talked about mental illness and mental health. My understanding as you have learning provider in all of us Scott County. Mind that collects still you know we have yet we have had a lot of Valley mental health services in in wash odor based out of one owner that they do have a healthcare where they have somebody, but the provider is not here everyday um that's where telemedicine can really be helpful for us. We can utilize that you know you know, reverse the rights of the issue with tell this to correct Yeah and psychiatrist heart yeah it's really like to unicorn medical people there's, a reason for that. yeah Oh, I mean your orthopedic surgeon for 53 years it's so so it's a psychiatrist. You spend 30 minutes and you get to visit the should be compensated, give me one make 213 75 which is which is but if you're, if you're, a medical student, your deciding joy do I pick the 15 million dollar career we're gonna pick the two million or three million that's not a hard decision. You so it's it's not even About and don't don't ever believe, this, I will just get them home. Freaking this loans and couple of hundred pounds alright that's that is substantial, but based on what you're going to earn subsequently. That's not what make drives them to choose radiology orthopedics cardiology surgery is it's what I'm gonna do the next 25 years um and I don't have to you guys. You know when you twice as many cardiac extent as they do in Britain, but we don't have any Cardiovascular mortality so we have an industry that drives it on demand based on what gives us best, return on services in, for time and that leads to this. You know we don't have enough money to compensate from your emergency dentistry care, but we got money to support eight cardiovascular centers in tennessee so we and that's that leads to the uh in equitable distribution of of care, that does not patient the band but what the industry find that's that's bible for us permission and that's the same with Family practice, family practice is probably the lowest paid. Specialty. If you wanna College, specialty and one more specialist here, but this year I'm And they're supposed to be the gatekeepers for the care and because we don't have the primary care, physicians, that we need sometimes the gate is open as well, and I think, tell us until health is a useful tool. Um but you're not that isolated I'm in you think he tell me it's kind of insulting me it's like an hour away from the Beach nature city. You have to you know they can go and talk to someone but you have to do it on Tv right um That, along to see the dazzling that's a very imperfect, hopefully temporary solution. You should be able to part of the healing process. You talk, face to face and if you have to choose between gasoline in your car or rent to drive to an appointment and you could walk across the Street. Perhaps for temporary tell the whole thing was originally when you know, remote Alaska and then some place where it was like many hours need your isolated and you need some assistance, but now we're like contemplating I just won a half of a major population Center of different alot of transportation is she's included in this next health and you know what we need is a real transit spread to um world transit is different and that means that differences in the challenges positive um and we don't have what, in Minnesota, we have um money set aside for, for world transition, is under the lives cause. We requires a 20 percent, manage and the communities together, that 27 and It doesn't work because it's based um am I'll against And number of trips and so we need to treat it. We need a world transportation commitment and the part of the federal government. Um what does that look like in reality, mary and the other communities doing rule transportation well in this country and see that we were trying to look at it right now and learn more about what kind of plan one of the things that we're doing small companies that were working with them on this is one of the We're not really focusing on the transportation and more so we're in a couple of the other Um they have a transit system and it's called the school bus because um but it's not utilized lots of hours. Um. We also serving a time when we have new models of the words you live. We have over um so how can we look at one of the things that I'm looking at right now hope you all to pull it all is that um. If we redefined the role transit transportation for transit um And call it school bus and that College trainer community fans at the car, um transit system to call the community turning system maybe we can take some of the money. The school district invest in the school bus and music Uh for this new animal called the announce it and try to figure it out. Obviously there is some special needs in terms of lives and things that we also have disabled children. We need less. You know so how can we work this out, but anyway, nobody that I know I was really thinking of this very creative where we're trying to do here um I don't know for him, but it should be International because it's not just it's not just important to wabash County it's important everywhere and um. We we have, we have been a community or a country that has been biased towards the individual car And I can talk more about some of the other transportation, she's too, in terms of um we've had a federal highway program and we build all these highlights came from President eisenhower be impressed with the Middle schoolers. You know all of mine that I've been a long time, but we don't have the same incentives to, for communities to have a restroom and bicycle and the Middle of card. You can see um older people in one of our brand, new running on cards we've, we are here It and um and they're part of the whole person in this community, they don't have any sidewalks and this is very typical of smaller communities. The older corner of starbucks and respect and so we need to get serious about our ability. She's in those are also tied into you know walking is it is important um biking is important in terms of having a healthy lifestyle, so um so our federal highway commitment should be looking Ready to see some changes so that we can help your lifestyles are communities can I go back to the um issue of opioids and addiction here in this community describe is it been different from the rest of the country and because we're a smaller rural area, we haven't seen it as much as the metro area as of yet are part of our mental health task force in our community health needs assessment. we did some serving of our law enforcement officers and unfortunately they don't have a very good um tracking system in place yet um that they could recall three times that they have used in our can which is different. You know I've been saying our real area of seems to be more Active um general choice at this point and you can speak from the perspective, probably I would agree with that. But also we're seeing patients who just are on controlled substances period for the concert of the mats. That are now being abused as well. So at the clinic. What we're trying to do is put up put into play a plan where the patient is an active partner in that control, substance manage my with a tapered Plan and they had jumped up therapy so that we can use and It's uh it's a difficult really exciting and that patient turn around and take care of their chronic pain and other issues and, as we have again percent, mental health component that we are trust. So lack and in this area that uh from from the standpoint that we talk about mental health with House people in our because we can't find in patient that's for them. We have some for days sometimes chest and colleagues Every day to see if we can get that patient into about the customization hundred what is the nearest in patient. Uh just saint mary's or the generals, um in the patient's life possible, but we have to send them to the booth. Uh campus of South dakota so bad photo just to find that place now clinic pulse is going head bands on the elderly, their clothes that, again And it was because of financial considerations so most of the issues that we just have that we cannot get mental health care for those patients that we have especially and patient by ask 200 different to be part of the conversation. Think he's one of the original um coordinators for the crest initiative, which is a mental health funding initiative and he's working very hard to get the uh funding for American order building in rochester to take the pressure off of where the patient will present their and have all of they're needs met There there would be a small number of beds and you know uh many other tight facility to keep people safe rather than housing them and taking resources away from our local emergency rooms. They would just go directly there, but that's something that's way down the pipe. That would mean support cursor is the sound, different than some of the other places where is your hearing about her sister barely fairly yeah You know I've worked in the hospital that had the capital to invest in the new cancer Center in new bern and ask yourself did not have one Middle of that They can find all To make to make that and it's it's so it's not a lack of resources is just if you're the ceo. This room, like what I'm gonna do. I'm gonna have you know. 20 mental health beds that might lose money on and on that basis are my going to the vascular Center. We just wanted to be this profit Center so simply making their compelled by fiduciary responsibility I'm building vascular Center and if I know that they never become accountable, furniture community adverse outcomes for lack of access for mental health facilities, solutions Inc down inside That's so, they can make a business decision other countries don't do that they actually said the needs of the population of this. We have about the third or less of the number of inpatient mental health meds compared to places like Norway, your friends that actually event see that has a need and it's a very great need, as as you are probably aware of your congressional research service, just this past year, you have 12 month prevalence of mental town for mental illnesses and the population 25 percent Which means and the giving here of 25 percent of the adult population, will have some event some specials on this Earth. That will tip them from well. I'm having no difficulties to I'm heading functional, something emotion. That happen. That I'm about the same actually raises the question why can you have it is that really annoys. I was in a human experience that is uh healthy mind and experience that um and so that was one of The things we need to address the mental health is understanding that a healthy mind will get to move. It push so when I saved my life by also where is the tree. Honor so I get a lot of patients and they call and they finally decided. They wanted to address something you know, like okay I've been doing depression, anxiety, whatever want to hurt myself. It is that they wanna have an appointment there's. Nothing away little so, then they the emergency room is the only place to go, but they don't wanna go there because they um I'd only the treatment is maybe like what are you doing here the Wait is so long as this is not good. I'm not gonna give you any pain. Meds. There, like I'm a walking as I wanna feel better and we you and they turn to something else that they make them feel better. Um and then we just got this like all you know and it's tough it's like. I don't it's very difficult have access. I mean just okay sorry, reduced so that's the second point you made about for work reimburse can see a mess drives this right through through Medicare policy that private insurance companies follow that lead. I don't know him as well It seems to be comprised of thoughtful people who understand that what what's the was the blockages that prevent them from fixing the universal problem. Well, one foot remember the Medicare expansion party, two thousand three every thousand women for the Medicare from bargaining with the drug companies for that thing that I get it. I totally get that what I don't get is, if is if there's, a dramatic reimbursement incentive to over medicate around vascular issues and under provider Mental health care is that it's not a hard fix for seeing us to make. I don't working within the current budget, not likely but they the completely there's. No to the professionals and physicians to you so you know they don't charge master seat sheets that will bring the charger. These things the industry always raises their prices, like the industry, says his price And so they've always working on the cost of stands on his villas and see this just has understand semester says okay. This story makes industry makes the argument that this is the cost because they're almost of the rd into the us cost that actually happens and when I tell you to your stand point, we developed at saint jude oppression, wire gym that literally the five -year landmark clinical study new englander illness and mortality about five years guess We got a reverse look great for it. If you use pressure wire and uh utilizing fewer stance because you know where to stand and what ended up happening is it mental, understands where used positions did not adopt the technology because of humor since we're using reimbursement to hospitals and physicians as much, much higher it's a system based on volume as long as our system is based on volume um You know there were some really good pilot projects in the around outcomes, taste, reimbursement models, um mayo, clinic, um, daddy in mind into a very good job facing their healthcare based on outcomes, but as you know, mayo clinic is set up in a very forget all the other issues with mail, but it's so doctors are salary positions. You know it is not a system based on volume. You know I'm saying Someone who really solve the negative influence so we have technology that can save lives yet it's not being adopted because it lowers very much look inside and there's. No and there's. No it's enough to someone about their services Um when I'm still struggling with those we just want to take a very basic things, take drugs to have this very basic thing. How much to decide to to reimburse a primary care physician versus specialist that's, a decision they can make so the part I don't get understand that I understand that drugs in the and medical devices, but why does it seem so today we're gonna shift some of the reimbursement indiana to get away from for the pediatric surgeons and tours primary care physician that's what At the highest political levels by all the industry, special so it's very difficult, so I'll give you a tiny little tiny thing that we've been working. I've been working on is there is a something in the affordable care act. That says that we will put on, ask to be in this preventive right so Medicare will pay for it um some reason, some word like or when it set up and so now a politics found that turns into a diagnostic so now Medicare I will not pay for the polyp removal now the patient has to pay for the copay of per polyp. So now our patient bought their ugly nasty was covered and now we end up with a it's about 300 dollars per polyp. Iraq 12 hundred dollar bill on average and they're like whoa I'm not gonna go back in purple and ask them to tell all their friends and I'll they're not going to their homes and asked fees and I'm linda colon cancer which is a lot more expensive and impala removable. We have inviting this for five years to get the wording changed so that wanna take care of Pay for the Paul removable icahn give you the building number it's so fun was it because what happened in the first three years of his administration, said it's a legislative issues. Legislators have to make the change the legislator said it's, an administrative issue seamless and just make the change and we're back and forth and people are dying left and right now I feel, like because calling featuring 100 percent preventable if you get rid of the politics the private insurance agency agencies fix the problem within six months, five years later Still not covering it so I don't know what to do. It. I can't even imagine if they won't even change the word to be able to covered polyp removal. I have no idea what the President has to be the change three verses. No idea but I know I gonna do see buy and we'll tell you how much money we have spent trying to just get that one more change um and at this point, people don't believe I don't even know if they will believe when we finally promise them and it really is going to be covered um because they just And suffered with these bills and the industry guards it's conversation it's turning And the patient is at a complete disadvantage in the market place and if there's a over or anything to work, it was like patients and you have to get don't count on the has not lost 30 40 years has not delivered like other healthcare systems also in the world. We we don't live any longer than they do in Greece, yet 40 percent of the adult population, small business for the third the price and Your publishing what your your rate me finish the race isn't, everybody there because alot of time talking about as an artist, I mean not all crowns are the same least single come from different products, different makers, different quality and you know so you gotta make sure what you comparing is comparable to do not require right right so you, like pricing, transparency, alright. I mean I don't think that's the issue either because then the few people that are going to take it on some procedures because I can make it up on another Seniors they'll just fail to like my crip, does come in and buy the bananas and onions, because they're so cheap we don't care because we know you're gonna pick up, something else while you're in there I'll just give away bells. So I mean healthcare is similar. I think they get that one thing you, how many things do you see you know we'll take your annual whatever and give you this and all by the way, while you're here let's take your listen this was posted the other complications. People know what that has millions are they don't miss. They know exactly it is that but first things first, we gotta send an email on the source of the Bush okay You, gotta stand in his our harvey. He had no chest pain okay, he had what was called an executive physical, which showed up Wall motion. Abnormality on an ultrasound okay. It was not to one of the major organs muscles and the great people of cardiology has studied this for years and thousands of patients to show that unless you have the ceremony of the one of the major muscles the left maine for the left anterior descending if you have no symptoms getting percent doesn't help you get they saw this destined To the rest of the complication from the procedure, but could not have benefited because he had no chest pain unless he had concern our mental help. Thanks, like a the, if he's had that before you should never stress test without without some so that was like hat former President, could not enough knowledge to adequately represent himself in the transaction healthcare to know that the stent was not indicated got some cardiologist like the chief at the Cleveland clinic, both and I said That was not a good practice but that that is the kind of that's why patient advocacy isn't. It. It is not is not reasonable to expect patients would like not not just like oh, they got Internet. Nothing like this is a good study where they come from this confirmed who did this was a long enough outcomes of the measure the right outcomes that's what I've had to do. Some well, I just wanna say thank you to everyone here Chance to add anything like um you know what it's so stunning is it as it turns out healthcare something about it. It's not just about treating Hill health or disease. It's also about the communities. We live in and what they will kind of food. You eat what kind of habits can form um and the good news is from this conversation about transportation and you know it's actually we often simplify healthcare. Unfortunately, to uh a couple of talking points and if nothing Emails, uh I'm well aware that healthcare is complicated and that we need to do more. Listening is public officials to actually start to solve and represent our communities so thank you all for being here in July, just wanna give you a chance to um you know, say anything you have to say and gorgeous you know and tell us how we fix all this and start working together again. Well, I think it let me put me also reiterate the thanks very, very interesting for me um. I guess to thoughts number one yeah because he is critical. Thank you for doing that. You know I've Develop a little bit of a hobby. Healthcare industry, the other than being an consumers. I've got no native expertise and I speak for 750000 people and you know you've got the citizen legislator. We have a few doctors, but you know we really. We could really use. I need a lot more uh alot of advocacy alot more stories I didn't know the George W Bush story is a very powerful story um so thank you for that, make you see um if you mean, like there there's, some really hard fight. You know if you're doing something that's taking away some of these launch. You know I've always said there's, a dramatic reduction and stems like that we're gonna hear from the state companies but also seems to be a doctor appreciate is that there's room at Nelson Very um kind of room for win win efficiencies here to better lifestyles and therefore of your pathology, smarter primary care and therefore, if you are dealing with the disasters that come out of you to put on the philosophy of your dental visit. Those are those are the fights that I really wish. I could, as a lay person, we get more and more involved in these wins because he has some of their are alot stronger uh advocates in Washington pharma and billy toss in what he used to do, but they're not there does seem to be releasing my friends that would be Really terrific to do while we're facing the larger battle Actually, backup marriage before which is the money you save from multiple studies show that about 15 percent of your overall health outcomes for people who can do The rest is neighborhoods All those things that this is what makes it healthy community to healthy person If you're looking afternoon of our health population don't just saying, like having the fun consumption healthcare services, how do we, how do we get there. Well, I hope this is one among many, many opportunities that I have to be in the later discussion around important issues next time we'll schedule, three hours so yeah And that's go be available and obviously you're doing amazing work in this community and bringing your community is the reason why you have such great access to little healthcare. So thank you so much for what you've done with this Organization on this counties done to make sure that um The access to healthcare that we could give them down that we keep improving them so thank you. Angie uh, thank you for selecting water shot. One of you, uh places to hold your confidence and uh as I said earlier, visible and available and you're doing that and uh all the thank you and I plan to have town Hall meetings every month where I get yelled at two looking forward to playing the represent everybody. Thank you