views and opinions expressed in to the point are those of the host of the program and its guests.

They do not necessarily reflect the views or opinions of WGTE public media.

Health insurance in America is meant to protect us.

Instead.

Its complex, its costly, and it's confusing, leaving patients trapped in paperwork, delays and unexpected bills while life saving care hangs in the balance.

Toledo physician Doctor Jonathan Ross has long sounded the alarm about the sometimes irreversible harm these complications cause.

He advocates for a simpler, more humane approach when unnecessary complexity stands between patients and care.

The consequences can be a matter of life and death.

I'm Doni Miller.

Let's get to the point.

You know, you can connect with us on our social media pages.

You can also email me at Donnie underscore Miller at.

And for this episode and any others you'd like to see, don't hesitate to go to to the point.

I am excited to talk about this particular conversation today, and more excited and honored to have our guest, Doctor Jonathan Ross, who is the Secretary of Health Care for all Ohioans, Ohioans.

In just a moment, you will understand why.

So from your point of view, first of all, welcome.

I know how busy you are and I really appreciate your.

I appreciate the opportunity to be here and talk about some exciting stuff.

Well, this is pretty critical stuff, quite frankly.

Why don't you put the issue in brief context for our folks?

Well, we have to remember that we've been trying for almost 101 hundred years here in America.

Actually, Theodore Roosevelt was the first president to propose that we had everybody covered by health insurance, 1911.

That's how long we've been fighting over this, and we still haven't achieved it now.

There's other presidents Roosevelt second.

Roosevelt, Franklin put it up there.

Harry Truman tried twice.

We had an incremental improvement, substantial one with Medicare and Medicaid in 1965 under Lyndon Johnson.

And then we had the HMO act under Nixon.

And then we had Clinton try and fail.

And then we had Obama try and have, again, incremental success in expanding the Medicaid program, which was passed in 1965.

That's kind of the quick history.

But one of the things that's gone on as we've gone through this process is the ability to get covered for health care has gotten more and more complicated.

And and it's led to an army of people on both sides, on the provider side, with doctors and hospitals.

They've got to have people arguing to get paid.

On the other side, we've got insurance companies who have their profits and and sometimes it's just the the distrust of the provider system that's led to all this complexity.

So the disease of our system over this time has been the ever increasing amount of complexity.

And a lot of that is related to the complexity of the financing and of the administration of the health care system.

Just the other day, I looked at Saint VS, where I worked for 40 years teaching and practicing primary care, internal medicine, and hospital medicine, I just looked they've got almost 100 different insurance companies that they're contracted with.

Yes, it was in the 90s.

I counted them up.

You can go there.

You know.

What insurances do we take?

It's in the 90s okay.

It Saint vs I would guess it's there or higher at as well.

So we've got all this complexity all these contracts right.

And those contracts are just with the hospital.

Now imagine all the hospitals.

Imagine all the doctors and all the complexity of those contractual relationships that are going on, all the promises that both sides are making about paying the bills and making sure in this part of it that it's even their bill to pay.

Right.

So this complexity is actually sucking energy out of our health care system and making it way more expensive than any of our economic competitors around the globe, in particularly the organization or Economic Cooperation and Development, the OECD, that's all the rich democracies over in Europe and Australia and New Zealand, Japan, places like that.

So where's the patient in all of this?

Yeah.

Great question.

Where is the patient in all this coming to see the doctor.

And so now what we've got is we've got the insured.

Right.

But to some extent we've got the underinsured and then we've got the uninsured, and then we've got the unsure and the unsure is all of us.

Right.

Because you never know when you go in whether you're going to get a surprise bill or what's going to happen.

So this is the complexity that we're faced with.

Will your insurance even cover.

Is it even the one that's supposed to cover?

For example, if you have an automobile accident and you've got medical liability on your auto, it may have to pay before the health insurance that you've got through your job.

Okay.

So there's all this additional complexity behind the scenes where the insurers are trying to figure out who's bill it is to pay.

Often there's multiple potential ones that are involved.

So what would you say to those folks who would say, but Doctor Ross, we need this in order to make sure that the system of health care is sustainable.

Well, I think it's just the opposite.

Actually, this is sucking energy out of the system and making it less sustainable.

If we actually look at what happens when you get the financial and administrative simplicity under control, you get tremendous savings, tremendous savings.

There's probably in the range of 10 to 15% of the dollars going to health insurance industry ministration within the insurance side.

And then you've got on the flip side, you've got the doctors and hospitals with their army of people trying to get the money from the insurers.

You've got another chunk of money that's administrative in doctors and hospitals, offices, the billing offices.

So this is a tremendous amount of this administrative.

And due to the complexity and to some extent, the profiteering that's going also in the insurance industry.

You've got all this stuff that's floating around, taking money away from the system that actually, if we didn't have all this complexity, we could cover everybody for the same amount of money.

So we've really set up a system that's fairly incompatible with itself.

Well, the complexity is incompatible with any good thing.

I mean, here's here's what I would say.

There's a guy named Deming.

I don't know if you ever heard of his name.

He was a quality expert, and he went to the Japanese and talked to them about getting their cars up in quality, and they started beating us with the quality in their cars.

And he has a saying, which is every system is perfectly designed to give exactly the results that it gives.

Our system is perfectly designed to leave 30 million people out, to have 15% or so of the money wasted on administration and paperwork, and to and to have poor results to our outcomes.

If you look at comparable outcomes, I think the best one you can look at whether two one is our life expectancy.

All the other countries that have national health insurance and cover everybody, their life expectancies are better than ours.

Some of that's also because they may have a better social support network than we do here in the US.

They pay attention to the social determinants of disease more than we do, recognizing that if you don't pay attention to social determinants of health, you're going to end up paying for medical care on the other side of it, which is way more expensive.

But so you've got you've got that whole sort of situation that's going on where our outcomes are poor as well, not just outcomes, our health outcomes.

We spend twice as much as those other rich European democracies, and yet our outcomes are not as good.

There's no question about the data and the thing that really bothers me the most.

There's a statistic that they look at carefully in OECD, which the US is part of.

It's called deaths from diseases that are treatable.

Okay.

And we have made very little progress in that.

You've got a few countries that have made 20% drops in deaths due to treatable disease.

We've made like five.

So there are four times better in getting that under control.

Some of it is because we have 30 million people who have no coverage and show up late.

That's right.

You know, and some and we don't generally think about it this way, but I read an article in a recent edition of The Atlantic, and it was about a family that didn't have insurance, and they talked about how undignified the process is and how it made them feel like they were begging for something that they they felt that they had a right.

I mean, I mean, there is a Samaritan tradition that is out there in health care, right?

The parable of the Good Samaritan.

Yes.

Right.

The priest walks by the injured person on the road.

The rabbi walks by the injured person on the road.

Finally, a Samaritan who's the enemy of the Israeli Israelites.

And again, Jesus at that time was a Jew.

You know, he stops the Samaritan, the enemy stops and helps the guy who's injured by the road.

That's right.

I mean, and so that was his the answer to somebody said, who is our neighbor?

Okay.

That was the challenge that at the time of the telling of the parable of the Good Samaritan, who was our neighbor, and that was Jesus's answer, which was even your enemy, sorry, your neighbor.

And if you think about it, for doctors, let me give a kind of a terse example.

But we dug Saddam Hussein out of a rat hole over in Iraq, and our best army doctors fixed him up just so we could hang him.

Right, right.

That's.

There's no judgmental attitude allowed in in health care.

Just shouldn't be there, right?

We're not the judges of of your value.

We have no idea what the rest of your life is going to be like, and what contribution you will or won't make to society.

It's our job to say, see another suffering human being and use our skill to try and relieve that suffering.

You don't want a doctor to be judging you on the color of your eyes, or you know anything else.

Right, right.

So.

So the bottom line on it is that Samaritan tradition is being whittled away by a system that is focused on administrative baloney and profiteering.

And we as doctors and as nurses, to want to get back to where we can focus on the patient and provide the best care we know how to provide.

There's an epidemic of burnout among physicians and nurses, and I think a lot of it is because we're expected to to deal with the paperwork before we deal with the patient.

Yeah.

And I think what some folks don't really understand is that is that the expertise of physicians like yourself is being it's being challenged by folks who are less qualified.

Those folks are actually deciding in so many ways the path of treatment.

Right.

And again, is it working?

I mean, so I would challenge it on that basis.

I'd say, how's this working out for us?

Right.

30 million uninsured, the worst outcomes in the OECD.

This whole idea that doctors are doing too much, you know, we do.

Fewer visits at the hospitals are over treating.

People know we have fewer hospital days.

I mean, it's not that we're doing too much of this stuff for actually for some populations doing way too little.

Well, I know that you have investigated some models in some other places and actually have some thoughts of your own.

We're going to go to break and we come back.

Can we talk about that?

Absolutely.

All right.

You stay with us.

We will be right back.

To me, community means connecting to others.

I'm Doni Miller and welcome to the Point.

I love PBS kids.

We're a community committed to education.

Discover new ideas, dive into exciting subjects, and engage with the world around you.

I would send them personally a t shirt.

Crime doesn't pay in the old West End.

Pass it on.

That's how we cleaned up the neighborhood.

Vision loss for people is not the end.

It's the story.

It's the next chapter.

WGTE Public media invites you to get out and play day.

Monday through Friday.

It's the 419 powered by WGTE with Matt Killam, Gretchen DeBacker, I'm Kevin Mullen.

What can people expect on the show?

Give me an hour.

A reminder of why this is a great place to live, work and play.

Where you come to watch, listen and learn.

Connect with us on our social media pages.

You know how to do that.

You also know how to email me at Doni underscore Miller at wgte.org and again for this episode and any others you'd like to see.

Please go to wgte.org / To the point.

We have the amazing doctor Jonathan Ross with us today.

Doctor Ross is the Secretary of Health care for all Ohioans, has been a strong and poignant voice for equal access to health care, equal pay payment sources for folks, and is talking to us today about some models that you've seen that you like and where you'd like to see us go.

I can tell you that there are lots of models.

None of them is perfect.

Okay.

But certainly what we're doing now is the worst.

Okay.

We have the best doctors, the best nurses, the best equipment, the best research, the best medications, and the worst possible system for giving everybody to care they need.

So we need to recognize that, do a good hard look in the mirror at ourselves.

In fact, there is if people want to check this out, there's something called the mirror, Mirror Project.

You know, mirror, mirror on the wall.

Who's the best of them all?

It's from the Commonwealth Fund, and they compare all the other rich democracies in terms of how their healthcare systems are working.

We are at the bottom even though we cost twice as much.

And we talked earlier about the complexity.

So how do we make it simple?

That's the question.

If we can make it simple then we're going to make it affordable.

So and believe it or not, getting everybody in unifying the system in some way, every other every other rich country has done that.

Even if they have multiple insurers.

All those insurers have to cover the same benefit package.

All those insurers have to offer the same level of equal access.

There's a few exceptions.

There's a couple of countries that allow you to buy out of the public system to get into a for for non-critical care sooner.

So let's say you want, you know, you know, a joint replaced or something like that.

We're not going to die, right.

Yeah.

You hurt.

You're not going to die.

But you can kind of jump the line by paying extra for private insurer insurance.

Now, the problem with it is than what in the public system, when you let the doctors jump out and make a little more money seeing them in a private system, then the public people wait longer, so it actually generates longer wait times.

So.

So it's not the best idea.

And my personal opinion.

So an example of that might be Great Britain or some of the other British colonies like Australia, Malaysia.

Many of them have this sort of dual system where you've got a public system that works pretty well, and if you're critically ill, it's the same sort of response no matter what.

You've got a ruptured appendix.

You're going to get seen right away taking care of right away.

But for the things that can wait, if you're in the public system, you're probably going to wait longer to get them done than if you pay extra for a private insurance.

So I'm not real fond of that model.

Then you can look at other countries like Canada and Taiwan, France.

Many of those have national health insurance programs, but they pretty pretty effective for everybody.

And there's not a whole lot of out of pocket payment.

Does that work in any way?

We have wait times are generally criticized.

Wait times are generally everywhere for a comparison of wait times.

But right in the middle.

And you know what?

They're not counting.

Those are the wait times.

For those of us who are insured, we don't know how to count for the 30 million who are uninsured.

So you could say, well, how do you tell?

Well, you know, for all I know, the wait times are infinite.

I don't know how you average infinity into the wait times.

So the fact is, is that are we times are probably just as long or longer because on where we can measure it, like can you see a doctor within your private doctor within two days in the US, for people who are insured, it's about the same as in the European democracies.

So so the bottom line on it is wait times are here are probably longer.

When you got 30 million people, not quite 10% of our population uninsured, their weight functionally is infinite unless they're going to die and then go to a hospital and then, you know, they're going to cost more because you're taking care of them soon enough.

So so the fact is, is that on almost all these measures, what you would call an efficient, effective health care system, we are falling down.

And much of it is related to the administrative and financial complexity.

So what models do I like the best?

Guess what?

I love our Medicare system.

Not the one that's being taken over by private managed care.

I like the traditional Medicare system, and what we've done is we've looked at the simplicity of that traditional Medicare for the parts that it covers, because you have to buy an additional policy to cover the 20%.

That was compromise that Lyndon Johnson made when Medicare was founded with the doctors and with the insurance companies to to get Medicare passed, which was you have to pay 20%.

So what do you like about it?

Well, what I like about it is simplicity is everybody's in, nobody's out.

You hit the right age, you're in.

Right.

And I've talked with patients who said, no, no, no I know I need my knee replaced.

I'm 64.

Wait, I'm 65.

And I'll be because I'll have better coverage.

I mean, so it is a very effective system.

As a primary care doctor for older adults.

I never got into all this nonsense with and all this other stuff with my Medicare patients.

Okay?

I didn't practice any differently than the ones who were in an HMO, but it was a bigger hassle, right, to be on the ones who were in HMOs.

We had all the pre authorization.

And can you use the hospital or can't you.

Do they have a contract.

What ab I've had patients where they thought they were covered.

Got into the hospital and it turned out the anesthesiologist wasn't part of the plan right.

Yeah I mean craziness like that.

So so the the fact is, is this all this complexity of contractual relationships between the doctors and hospitals and the Earth, it's wasteful, tremendously wasteful.

Whereas in the traditional Medicare system, you have very little of that.

Now, in the piece that is the supplemental coverage, you're back into that private insurance system again, you're not into with that, but you're into the administrative overhead of the insurance company.

And again, you've got to make sure that that's looked at too.

But so go to simplicity cover.

Cover it all.

One system covering it all.

That would be the ideal.

And we've actually looked at that.

The Congressional Budget Office looked at a Medicare for all bill that was proposed by Sanders and Janet Paul, and they said, we can cover everybody, no co-payments or very minimal ones, no deductibles, any hospital, any doctor anywhere in the country.

It's still saves $40 billion a year over what we're doing now and covers everyone.

So so we know that that simplicity allows us to give universal coverage.

If you actually look at what that would mean for doctors, it would mean that the 30% of people, I'm sorry, 30 million people who aren't paying them are suddenly going to be paying patients, right?

They're actually going to do better.

So is the hospital even better yet would be most hospitals.

I was part of this all the time as running the outpatient clinic at Saint VS for adults.

We had to set a budget.

Well, let's just do that saying, no, we're not going to build by person, we're just going to look.

We'll look at your budget.

If it's a legit budget, we're going to give you what you need, 1/12 of it every month.

Well, you know, there's somebody out there watching who's screaming at you right now saying, but you don't get it.

This is a business.

No, they don't get it.

They business.

No, they don't get it.

It shouldn't be a business.

And that's not working out for us if we actually, you know, there's certain things that have to be in place for a product to get the benefits of the market forces.

Right.

You've got to have a good understanding of the product.

You've got to be able to choose to walk away from the deal, okay.

You've got to have the type of of of savvy to use it appropriately.

I mean, all these things are missing in the normal doctor patient relationship.

Let me let me give an idea.

Somebody comes to me.

They've got chest pain.

I'm a pretty good doc, and I examine.

I'm not sure, but listening to them, it could be their heart could just be heartburn.

It could just be in digestion or something.

Right?

I'm not going to be able to really figure that out in somebody who's at risk.

Let's take somebody who's maybe got a little bit of blood pressure, touch of diabetes, if there is such a thing.

And they're in their 60s, I'm not going to send that person home.

I'm going to say, you probably need some cardiac testing to make sure this won't kill you.

So to really get a final diagnosis, I'm going to have to do some very expensive testing.

And even, I don't know ahead of time whether that's going to work out or not.

That patient, the next thing that might happen is they might have a very abnormal stress test.

There is seeing the cardiac surgeon and having open heart surgery 200,000 bucks.

Okay.

Or they're at the drugstore picking up the the anti asset I ordered for them.

You know I mean it's like you can't know that ahead of time.

It's just not a normal product.

So so and there was a guy one Nobel Prize talking about he called it information asymmetry in healthcare with the doctors no more than the patient.

And of course we spent 20 years getting it in school doing that, sort of getting to the point where we would know more.

But but the fact is, is that you can't go ahead of time with even the most common patients that walk into your office, whether you're dealing with something really serious or not.

So how do we move away from where we are?

We're pretty entrenched in this, right?

So yeah, you're right.

So I've come to the conclusion that what we need to do is we need to do is local as we can get it.

So I've been active both nationally.

I was past president of physicians for National Health Program.

They think we should have approved expanded Medicare for all.

We've got a relationship with National Nurses United Union.

They think we should have improved, expanded Medicare for all.

But what I'm doing here in Ohio and locally, and you help me here locally, we put together care net two decades ago to at least give primary care to people.

We asked the hospitals that were getting kickers for uninsured patients coming to them from the federal government to to maybe share that out with the primary care clinics in some way and guarantee that we could at least give primary care to the citizens of Lucas County.

And that's still going on.

We still have that out there.

The other thing that we can do is we can look at Ohio particularly, and this is what we're really involved in now in health care for all Ohioans.

We can look at the Medicaid system.

Medicaid is under control of the Ohio government.

It's a partnership between the Feds and Ohio.

It's a financial partnership.

The feds mainly send money, and they've got a benefit package that you have to cover, and they've got a certain number of types of people that you have to cover, right, at a certain income level.

So you have to follow those rules.

But after that, it's kind of up to us.

We've been trying to use managed care to control costs in Medicaid and it has failed.

It has failed.

About ten years ago, Connecticut decided, no, we're just going to go back to using a single administrative group to pay the bills and help the doctors do better with quality.

They saved $4 billion over the last ten years in Connecticut.

We would save almost we could as a range half 1 billion to $1 billion a year.

So 1 billion to 2 billion every biennium in Ohio, if we change to an administrative service organization, rather than competing managed care companies, which have all this duplication and financial complexity, make it simple.

So we have about a minute and a half left.

Where can people call to find out more?

Well, you can go to our web page for health care.

For health care follow Highlands.

It used to be called Spain, Ohio spa and Spanish.

You go there.

Either one of those you'll find on the web.

The other thing you can look at, and it's out there because we just dropped a bill in cooperation, bipartisan in the Senate called the Medicare, Medicaid, sorry, Medicaid Savings Act.

And we're predicting that we're going to be able to make savings.

And as you probably know, the feds have made big cuts to Medicaid.

So those savings are going to help us keep people covered.

They're going to keep the doctors happy with being able to see Medicaid, if we can keep the incomes up.

We've built into the bill that all the savings that half 1 billion to 1 billion a year that we hope will save because Connecticut did.

We hope that what we'll see is that that money goes to treating people better in Medicaid, that they'll be keep their access, they'll be able to stay on Medicaid.

We'll be able to pay the doctors a little bit more for seeing them.

And that's all written into the bill.

This is a huge topic, huge topic.

You keep yelling.

You keep yelling.

You're doing the right thing.

Thank you.

Thank you so much for joining us today.

We really appreciate it.

We will see you next time.

On to the point.

Enjoy your day.

Announcer 1: The views and opinions expressed in to the point are those of the host of the program and its guests.

They do not necessarily reflect the views or opinions of WGTE public media.

Announcer 2: To the point is supported in part by viewers like you.

Thank you.