Transcript
Katie Porter: [00:00:00] Knock, knock, hi! Knock,
Will: knock, hi!
Hello! Welcome to Knock, Knock, Hi! with the Glockenfleckens. I am Will Flannery, Glockenflecken. I am
Kristin: Kristen Flannery, also known as Lady Glockenflecken, and I apologize on Will’s behalf for anyone’s eardrums that have been bursted in this
Will: introduction. I’m fired up. Yeah,
Kristin: cuz we have a topic today. If this doesn’t get you fired up, nothing will.
You know, you might want to check your pulse. Well
Will: that, but also, uh, my afternoon got canceled because of weather. Oh, yeah. So
Kristin: that’s good.
Will: I get to watch a football game this
Kristin: afternoon. Oh, so you’re excited. Good. I’m glad to know you’ll be home. I’ve got some things that need done.
Will: But we do have a topic that’ll get your juices flowing here.
We’re talking about health care. The health care system. The health care system with [00:01:00] U. S. Senate candidate. And, uh, and U. S. Congresswoman Katie Porter. Yeah, it’s, it’s very exciting, uh, uh, the, the whiteboard extraordinaire. That’s right.
Kristin: That’s what she kind of has
Will: gone viral on social media for, visual aids, just a natural educator.
Kristin: Yes. Spells complicated things out very simply and clearly and makes it easy to understand.
Will: But, uh, you know, we’ve been, we’ve been on the healthcare reform, you know, what do you call it? The healthcare reform Bandwagon? Bandwagon. Is it a bandwagon? I think it’s a bandwagon. For quite some time, you know, you guys have, you’ve seen my video, like, you know, I love talking about the healthcare system.
Are you, does this topic interest you though? I’m just like, because you’re kind of, you come to it from a different lens, from a different viewpoint. Um, I guess, cause you’ve been through medical, my, all the medical stuff that I’ve gone through. Have you picked up on a lot of this stuff along the way?
Kristin: Well, yes, I have, you know, just [00:02:00] sort of.
from being around it, but, but I’ve also been a patient, right? Like, and not, I don’t just mean like wellness visits and stuff. I mean, like I have this weird chronic thing that nobody understands. I have had a neck surgery in my early thirties. Like, that’s weird.
Will: Yeah, you got to interact with a neurosurgeon.
Kristin: I did. Yes. I really did a real one in real life. An
Will: actual one and attending no less.
Kristin: Um, and then, yeah, I’ve seen everything that you’ve gone through. I’ve seen everything our, our children have gone through, right. And I’ve been the healthcare decision maker for them. Um, I think this is just something that affects everybody and I think it’s made overly complicated and it’s, you know, there’s all these big words and things, you know, to your point of how they picked things up.
Um, I think there are more of those than there need to be, but I think that’s why it’s so good to have people like Katie Porter, like yourself, who are kind of breaking it down and um, you know, trying to make it easier for everyone to understand. And recently, this is going to [00:03:00] sound like a plug, I guess it’s maybe a shameless plug, but um, you know, we have a blog and a newsletter now where we’re, we’re trying to take, um, Uh, the progress that you’ve made and expand on that and the ideas that you share in 30 Days of Healthcare and expand on that.
Um, so yeah, I think this is really something that’s important for everyone, whether they are in healthcare, not in healthcare, because we all have to interact with the healthcare system. And it’s a big
Will: mess. It’s a mess. And that’s it. And so that’s why we have Katie Porter here to, uh, to, to try to sort through this mess.
And one thing, one reason which we get into in the episode that, that, that we were so excited to talk with her is because she is not beholden to any corporation, right? She doesn’t, she doesn’t take lobbying money. Uh, and which allows her really just to speak freely, speak her mind, uh, really try to fight for, for positive change in the healthcare system.
So
Kristin: we get into all of that. Yeah, and to actually represent her constituents. Can you imagine? Imagine that. That’s amazing. What a novel idea. [00:04:00]
Will: So, so it was a great conversation, I hope you enjoy it. Uh, should we get to it? Let’s go. Alright, here we go. Here is Senate candidate. Katie Porter.
Today’s episode is brought to you by the Nuance Dragon Ambient Experience or DAX for short. This AI powered ambient technology helps physicians be more efficient and reduce clinical documentation burden. To learn more about how DAX Copilot can help reduce burnout and restore the joy of practicing medicine.
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All right. We are here with Congresswoman Katie Porter. Thank you so much for joining us, Katie. It’s really an honor to talk with, uh, talk with you today. Talk with us. Talk to you.
Kristin: It’s an
Katie Porter: honor to talk to you today. It’s a delight to talk with you too.
Will: Um, so, uh, we appreciate you taking the time and you, you may not know this, but [00:05:00] we actually, we have an Iowa connection here.
Katie Porter: Yes. I do. Kristen, you used to work at the University of Iowa. Is that
Kristin: right? Yes. I was going to say it’s a very obscure one. Usually they would know that he did residency at Iowa, uh, but yes, I worked at the Bell and Blank Center for Gifted Education at the University of Iowa. Wait. And you
Katie Porter: You know my history with the Bell and Blank
Kristin: Center.
I sure do. I was about to say, you were a participant in one of our programs before I got there, but uh, when you were growing up in Iowa, so. Yeah. I
Katie Porter: think I was in the first year, um, that, uh, Bell and Blank Center, it’s a, for those of you who are listening and don’t know what that is, it is a, um, basically like nerd camp.
Um, and so, um, for super smart kids, and I grew up in a very rural part of Iowa. where there was not a lot of like, well, a lot, like none, um, no enrichment education for gifted kids. And so I came and spent my summer of eighth grade following eighth grade at the University of Iowa campus back in the day.
And then my sister [00:06:00] and brother in law also did, they went to medical school at the University of Iowa. And then they did their, they did their fellowships. elsewhere, but they did their, um, and their residencies, but they did their medical education there. So they’re,
Will: they’re big on nerd camps at the University of Iowa.
Yeah,
Kristin: they really are. I mean, I am also very big on nerd camp and anything sort of like that. So that was, that was a fun connection to find it. It’s no surprise. It was a, I think it was a leadership class or a program, the Iowa Governor’s Institute. So, um,
Will: so all your success, you attribute to the Bell and Blank Center.
That’s right. That’s
Katie Porter: right. But then I actually taught at the University of Iowa as well. Um, so, I can’t, what year were you there doing your residency?
Will: Uh, 2014 to 2017. I think
Katie Porter: we I would have missed you. Because you’re so much younger. Thank you for pointing that out.
Will: I hate, I didn’t say it, all right, we just missed each other, missed connection, that’s all it is.
Um, so, so Katie, I’d love to, I’d love to start here, um, [00:07:00] with just a really easy question. How do we fix healthcare? Is that, is that easy enough? Is that, that’s an easy, that’s simple, straightforward kind of question, right? Can we, can we do that? Can we get that accomplished in the next half hour, do you think?
Well, so
Katie Porter: the answer to how to fix it, I think I can get accomplished in about 30 seconds. Getting it done, I, I sometimes despair we, we ever will, um, in this country. So, I mean, I think there are two healthcare issues. I’m just going to frame up how to fix it. One is we think about healthcare wrong. In this country, we think primarily about sickness and how to, um, fix people who are already sick instead of fixing, instead of focusing on health and wellness.
So instead of talking about health care, what Congress really does is make policy about sick care, not about health care. And I think that affects all different kinds of people. of ways that we, um, invest and don’t invest, um, in health care. And then I think the other thing is, look, you are not going to [00:08:00] have the kind of health care system that delivers healthy people and focuses on that when you have a profit driven system.
It’s just inconsistent. Um, I have a background in consumer protection and it turns out, for instance, that cheating people is really, really profitable. That’s why companies do it, right? Customers who don’t pay their bills are more profitable for banks and run up interest rates and pay their credit card minimums rather than pay it off are more profitable for banks.
It’s the same thing for healthcare. Um, sick people up to a certain point and certain kinds of sick people are actually incredibly profitable for many parts of the healthcare system.
Will: And, and on the, on the medical delivery side, you know, as a physician, you know, we, we are very much focused on, on preventive care where a lot of what we try to do.
Uh, is, is to try to keep people healthy. And so we’re just, from a fundamental standpoint, we’re at odds, right, with, with the, some of these, these big corporations that we’re, [00:09:00] we’re basically are running healthcare, it feels like at least.
Katie Porter: No, and I think, I think one of the things that’s really changed in the last, and I don’t know if you have thoughts on this from, from your experience, but I, I think, There’s been a break.
There’s really starting to be a fissure between doctors, um, who really, you know, really were kind of the, the entities, doctors that kind of formed health insurance companies back in the day, and where we are today, which is, I think, increasingly providers, doctors, nurses, and others are some of the most powerful critics of health insurance and of big pharma.
And so I really think it’s an important voice. that you have, that this podcast has, um, that, you know, Kristen has as a patient advocate, like, this is a really important perspective. So increasingly, I have doctors who are side by side with me, pushing for things like Medicare for All, pushing for things like, um, rethinking, um, treatment and reimbursement in ways that, do [00:10:00] give time for doctors, for instance, to focus on preventative care.
But as you know, we have a very kind of procedure driven reimbursement system that does not really reward doctors who went into this to help people be healthy for their time spent doing exactly that.
Will: Yeah, no, I totally agree. It’s, uh, we, we devalue. Primary care in particular, and it’s, uh, it’s just one of the many problems that, that we’re dealing with now.
And, and I, I do think, I don’t know what the, what the change was. Maybe it’s just, uh, um, just gradual over time. I don’t think we can put one thing on it that, that caused, cause you’re right. The physicians are like, we did help build this system. Absolutely. But I totally agree with you. It does seem like there’s been a change and I guess, I’m not sure like what caused that change, but it is, I do feel it happening.
Kristin: I’m sorry.
Katie Porter: One of the things is. [00:11:00] You know, I think when doctors, um, went to, um, insurance companies and kind of formed things like the early Blue Cross Blue Shield, these cooperative ideas, um, they were really well intentioned. But I think what doctors are now living with, and when I say doctors, I really mean healthcare providers broadly.
Because I think, you know, nurse practitioners and nurses and phlebotomists, I think there’s a whole ecosystem of people who make us, who deliver care, who feel this. I think what they’re now figuring out is that. Wall Street isn’t on anyone’s side but its own. And if they can squeeze a dollar out of a patient, great.
If they can squeeze a dollar out of a provider, that’s great too. And I think providers are now living with this. We’re seeing this with private equity, gobbling up, um, you know, healthcare. And so, um, I, I think that providers have kind of come around to experience a lot of the same pain and frustration that patients have been.
Will: And one of the things I wanted to talk with you about is, in [00:12:00] particular, is this consolidation that’s happening. Across healthcare because, uh, the lack of competition is, is worrisome and it’s, it’s getting worse. Um, I just read about United Healthcare and their, their, their, the amount, uh, or United Health Group, I should say, which is the overarching company that owns all these subsidiaries of United Healthcare, the amount of internal revenue from their own revenue sources.
Is, is up like 25 percent over the last year. And so that just shows you just how much consolidation, how much the vertical integration there is. And I think it’s making so many things worse. And so what, for people, a lot of my listeners. You are starting to feel, especially people in healthcare, are starting to feel kind of hopeless about, about this, uh, because you have these behemoths, this behemoth, Optum, UnitedHealthcare, and other ones, Cigna, they’re all doing this.
What, what, what are we doing? What can we do to, to fight against this and [00:13:00] what’s happening in government? Are people looking at this? I mean, I know you are and, but do you have others? that are, that are focused on this issue? Yeah, I mean,
Katie Porter: I would say that generally, President Biden’s administration, one of the really horrific things that I don’t feel like it’s talked about really ever, much less enough, is one of the things President Biden’s administration has really done is focus on competition policy.
In other words, cracking down on monopolies, challenging that the idea that every merger is somehow for the good or for the better. And so You know, it’s really hard to think of an industry today that doesn’t have a monopoly problem, right? We have monopoly problems with publishing. We have monopoly problems with travel.
We have, we have a bread monopoly in this country for crying out loud. And so something like 40 percent of all bread that we eat is all manufactured by one company. And so in some ways,
Will: In
Katie Porter: some ways, I think it would be surprising if [00:14:00] we didn’t have monopoly power and a lack of competition in healthcare.
To date, I haven’t seen the Biden administration kind of turn its competition policy focus to healthcare particularly, but they are kind of cracking down on a lot of these industries and trying to think about what to do. But I think one of the things. Um, you know, I’m old enough, I’m 50, I just turned 50, and I can remember as a kid, boy, if you could get, like, back in the day, Blue Cross, then you just knew everything would be okay.
And today, the truth is, there’s only three or four health insurance companies, and they all suck. And, you know, there’s, there’s probably an equivalent. It’s kind of like airlines. There’s only three or four of them. And mostly your experience getting to and from sucks. And of course there’s like a, you know, a bottom dweller, like a spirit.
There are a couple of those kinds of healthcare insurance companies, but in general, I would say the problem is systematic. So I do think competition would help. But the other [00:15:00] problem in healthcare is people don’t get to make choices. We don’t have a market. for healthcare. So you asked me, are we ever going to fix this?
I think one of the things we have to recognize is we can’t keep relying on market forces like consumer choice, like patient choice to fix something when in fact patients don’t have choices. We
Kristin: have no choice. Yeah, right. We don’t know how much things cost. We don’t know what our alternate alternative options are.
And
Will: you get a job and you basically have to go with whatever your job offers, right? So you’re absolutely right. One of the
Kristin: things that does make me feel a little bit hopeful at least, and I hope you’re not about to burst my bubble, but, uh, it’s okay if you do, uh, but is that you have You’ve, you know, taken this historically, um, very Republican county and you’ve been, you know, elected with Medicare for All as a major part of your platform.
And those two things, you know, are kind of, historically speaking anyway, at odds with each other. So can you talk a little bit about how, how you’ve done that? And is there anything that [00:16:00] kind of the general public or, or healthcare workers can take from your approach there to try to make these changes in healthcare?
Katie Porter: Absolutely. Absolutely. I mean, look, Medicare for All. is, would deliver the best quality care at the lowest price point with the most patient choice. Wow, it’s a winner all the way around, and we see this, I mean, we know that when people get Medicare, that cancer diagnoses jump. It’s not because all of a sudden people are getting cancer, they’re actually getting screening that is detecting that cancer.
There is no insurance company. in the United States that provides the depth of network choice that Medicare provides. That’s a, that’s a battle we have to keep fighting to make sure providers continue to take Medicare. Um, but the reality is we should all want a healthcare system that gives us the most choices and the best quality care.
at the, at the least cost. Um, and so I, I think that’s why Medicare for All makes [00:17:00] sense. It’s, it’s, it’s not a lefty McLefty kind of argument. It’s actually just common sense. It’s actually the fiscally responsible thing to do. And so I think that is an important thing to start with and to explain to people right up front.
You know, private, for every 100 we spend with a private health insurance company, 17 go to administrative costs. With Medicare, that’s about two, two to three dollars. That’s a lot of money multiplied, take that hundred dollars that I used as the example and multiply it times all of the money we’re spending.
So in one hearing, I actually had 17 ones and kind of counted them out so that people could see and then held up those bills versus. You know, the 3 we spend administratively on Medicare, and it’s everything from not advertising and sponsoring stadiums to, um, you know, not having all the complexities of billing and denying care and the things that we go through with private insurance.
Will: [00:18:00] I, I do, I like the idea of, of Medicare for all because, you know, you look at all the, you know, the richest countries in the world and we’re the only ones that really, you know, leave people behind like this, that don’t have a, a public option, um, for, for everyone. The, but these, this doesn’t happen in a vacuum, right?
One of my concerns about something like Medicare for All and like making a switch like that, just like that, is, is the healthcare worker shortage that we have. And we’re talking about all of a sudden doing a great thing, which is making sure everybody, like we lift the floor, right? We have Everybody has access to affordable health care.
How are we going to take care of all these people? Like that, that’s one thing that I, that I think about. And, and because we’ve struggled, we’re struggling with that. People are leaving health care. Doctors, nurses are leaving health care. And so we have to, we have to figure that piece out as well. Like, okay, what are we
Kristin: going to do?
Aren’t you going to be taking [00:19:00] care of them on one end or the other? You take care of them on the front end or you take care of them on the back end, but you’re going to be taking care of them. And it’s going to be worse if you wait till the back end.
Katie Porter: That’s why you married up well, because that’s exactly what I was going to say.
So look, at some point people get there. It’s just rare. Do they come in with untreated diabetes to an ER and we’re having to amputate and then try to provide disability services? Or are they getting care on the front end that is helping them prevent, um, or treat or manage that? So, you know, I think the other thing is who’s really getting squeezed is we have a lot of people who are on Medicaid.
already, as well as Medicare. And so when you add up the low income Medicaid people and the Medicare, the seniors, and then you add on the veterans and you add on the, who are in the VA system, and you add on the TRICARE for the active duty service members, we already have a lot, more than half, I believe, of our [00:20:00] population.
In some form of government health care, but even that duplicity of having those four systems is a lot. I would say with regard to health care workers, look, they are in crisis. Um, my sister and brother in law, um, are both physicians. I hear about this from them. I hear about it from doctors when I go in, um, because I can’t just go, you know, get screened.
I also have to hear about their health care frustration policies. Um, so it’s really an incentive for me to go, to go get, um, health care. You know, one of the things they’re frustrated about is insurance companies. It’s the amount of time that they spend fighting. They ask people to make follow up appointments, and the people don’t show up.
And when asked why, it’s like, well, I was on hold for 45 minutes trying to schedule that, and then I just hung up. Right? And so, I do think that, you know, we have to rethink how we fund medical education, whether having the kinds of debt that we’ve been putting on healthcare providers really serves us well.
I think it does not. Um, but, you know, I would say that I think if we move to a [00:21:00] Medicare for all system, we would face, I think, some shortages in, in, in primary care and in some of the areas where we need to be treating people earlier. Um, and I think But we would see some of these. Specialties that kind of feed on unhealthy people, hopefully over time decline,
Will: so.
Yeah, we definitely need to, I’m so glad you mentioned kind of reform of the medical education system, because it does need to be. A sea change in, in, in how that’s funded and, and the cost of medical education in particular. Um, but yeah, like we need to, uh, just primary care is in such a crisis already and, and I don’t, I don’t know what it’s going to take to, to change that.
It’s going to be. I, I find it, maybe I’m just skeptical or maybe I’m just, uh, too pessimistic, but the idea of, of having like a sudden change, like how do we get to this point? How do we get there? Is it going to be incremental change, uh, or, you know, how, how do we go about this?
Katie Porter: [00:22:00] So look, the biggest barrier to addressing the profit based healthcare system and how it kind of.
Um, Malforms, our healthcare system, is big money in politics. Um, so the answer that Kristen gave earlier I’m glad you said that, I was gonna
Kristin: ask about that.
Katie Porter: About Citizens United, I mean, look, we are Washington runs on lobbyist dollars. I don’t take lobbyist money. So, I, I meet with lobbyists when they have information to give me, but you can’t, I’m not for sale.
Um, it runs on corporate donations. I don’t take corporate PAC money, and I never have. So, I think that, you know, what we are seeing is time and time again, Washington making policy decisions based on who’s buying and paying for them, not on what’s sound policy. So I think, you know, we just saw for this first time, um, with this, with this bill allowing Medicare, for instance, to negotiate drug prices.
You know, my bill was signed in law, um, that would, [00:23:00] um, recoup, kind of get back taxpayer dollars when big pharma raises the price of medicine faster than inflation. These are already developed medications. Um, and so this is one of the first times that we’ve seen Washington stand up to Big Pharma, like, in my entire lifetime.
And so I, I do think there are, that those of us who don’t take corporate PAC money and are asking hard questions that often haven’t been asked are starting to shake things up. So I’ll just give you one example that for me was a really sort of important moment for kind of inspiring me to stay in this fight, even though it’s hard is.
and the director of the Center for Medicaid and Medicare Service, CMS, I mean these people have a great, great name, CMS, and I asked her What evidence is there that Medicare Advantage, which kind of takes Medicare and layers private insurance into the, into the stew, rather than traditional Medicare, which is just, you go to the doctor, the government [00:24:00] reimburses you, right?
So no private health insurance. Medicare Advantage is a private health insurance layer. I said, what evidence is there that this makes seniors either healthier or cost less? It doesn’t even have to do both. It just doesn’t do either of these things. Right. And you know what she said? There is no evidence.
And I said, well, why are we expanding a program that doesn’t make people healthier, give better outcomes to seniors, and doesn’t cost taxpayers less? And the answer is, of course, that big health insurance companies make a fortune off taxpayers. UnitedHealthcare, you mentioned them earlier, three in four dollars they make are taxpayer dollars.
So, one of the things I would love is to have taxpayers, forget advocating as patients, which is really important, but it’s hard to advocate as a patient because you know why? You’re sick, definitionally, or you’re scared, or you’re in crisis, you’re [00:25:00] fighting for your life. And your
Kristin: stakes are enormous,
Katie Porter: yeah.
Right? And so we need to all, as taxpayers, really be saying, who’s making, are we really, are we really getting what we’re paying for here? Um, and so I call it, instead of calling it Medicare Advantage, I call it Medicare Disadvantage, um, because the truth is, it doesn’t provide better outcomes, and it costs more.
And so we should just stop doing it. And why we’re not stopping doing it has everything to do with how most of my colleagues have funded their political career. And it’s a big difference between me and them, and I think I do ask questions differently, and I do push on things differently because of that.
Kristin: I’m so glad you do, too, because, like, the cynic in me feels like Well, everybody’s just bought and paid for these days, so, I don’t know, what can we even do? This is proof that there’s some people that are not bought and paid for. Yeah, exactly, I need, I need that every once in a while to, you know, keep some modicum of faith in the system anyway.
Katie Porter: Yeah, no, I mean, look, like, there are, my class, I was elected in 2018, [00:26:00] sort of in the wake of Trump’s election in 2016, and a lot of the members of my class didn’t take corporate money, we didn’t run our campaigns on it, and we, we haven’t gone back. Um, that said There’s an entire industry of kind of, uh, K Street lobbyists whose full time job it is to convince you that if you do not take their corporate dollars and you do not do what, you know, sort of Wall Street wants, you will not get re elected, and that’s a bunch of nonsense, and I think my ca I’ve had really tough campaigns in Orange County, and I’ve shown that very much.
Actually, what Americans want is people who fight for what’s right, who fight for them, um, and that they will respond. They will make grassroots donations and you’re able to fund your campaign and to win tough races. Yeah,
Kristin: it all sounds like the mafia, sounds like the mafia is running this
Will: country. Yeah, like I imagine like briefcases full of cash just coming into congress people’s offices and, and.
It’s so
Katie Porter: much more subtle than that, um, and I, I think that’s one of [00:27:00] the hard things is I talk a lot about corruption and I think people have this, you know, we do have that too, right? Like we had Senator Menendez with these gold bars sewn in his suit. Which is like, kind of the Mafia corruption vibe, but, um, It’s a little on the nose, yeah.
It’s a lot more subtle than that. I think it is, um, One of the things is, who are you listening to? So organize, you know, um, insurance companies have lobbyists. They come, they meet with your staff, they knock on your door. And I think you really have to work actively to counter that. So where are you getting your information about what the healthcare system needs?
Who are you listening to? And so I really try as much as I can within the boundaries of my job. To look at some of the good health policy research that’s coming out. So, um, I don’t know if you’ve covered this in your show yet, but you know, the study that came out right around, you know, Christmas, which is really when they get everyone’s attention when you have a baby, you know, showed that if you go to a hospital owned by [00:28:00] private equity, you have double the rate of coming out with an infection.
Will: I’ve talked about that, that study. That was unbelievable. Yeah. Yeah. I mean, it’s, it was actually, it wasn’t unbelievable. It’s perfectly
Kristin: logical based on how that model works,
Will: but it’s that I’m so glad that study came out. I have talked about that and, and, and basically I forgot what the percentage was, but it was statistically significant that the number of, of adverse events that happen in the hospital.
Was higher in these private equity owned. Yeah. Cause the,
Kristin: you know, they’re just making all these cuts. And so a lot of checks that are normally there get.
Will: Because, because what they, what they want to focus on, what these private equity owned hospitals want to focus on is mortality. They want everybody focused on mortality because they can show that they have less mortality.
Well, why do they have less mortality? Because they don’t admit sick patients. They skew younger. They want people that are not going to die in their hospital so they can say, look, we are safe. We are. So that’s why I’m [00:29:00] so glad that study came out, the people that did that. to look at what’s happening in the hospital, because that’s, that’s really an indicative of the quality of care that you’re getting.
Katie Porter: Well, and as you know, I mean, if you get a hospital inquired infection, or say, I think they found that you had a 30 percent or 31 percent higher likelihood of getting an infection in your central line if you needed one, then what happens to you? Broad spectrum antibiotics to the tunes of thousands of dollars, longer hospital stays.
All of that is expensive and ultimately what I really want to emphasize to people is who pays? We all pay. We all pay. Three
Will: out of four dollars, right? Three
Katie Porter: out of four dollars, right? So because, you know, those people going into those hospitals have Medicaid, they have, they have, um, Medicare, they So, we all pay, and so I think And by the way, it doesn’t exactly cause people to have a positive association with going to get care, when what they do while they’re there is get sick.
Now infections can happen, but it’s very, [00:30:00] very clear that this is driven by Staffing decisions. And I think about how it would feel to be, you know, a nurse, to be a doctor, and to think to yourself, my gosh, everyone here is getting so sick, right? The rate of infection so high. And so, um, now the question is having that study, what’s Congress going to do about it?
And the answer should clearly be crocking down on the role of private equity in health care, because they are, they may not be killing us, To your point about mortality, but they are making us sicker even as we go ostensibly to get healthcare.
Will: Absolutely. And they’re making healthcare workers more miserable.
Like, it’s, it’s, morale is, is, is
Kristin: in the tank. Yeah, they’re causing, they’re contributing to the shortage because nobody wants to work that
Will: way. It’s, it’s, and it’s so interesting from, from a physician, from a healthcare worker standpoint. Um, because you, you know, trying to get. Most of the positions out there to like take a stand against private [00:31:00] equity.
It’s been. It’s been a little bit harder than you’d think, right? Because going back to, you know, uh, you know, physicians being part of setting up the health insurance companies and basically forming the healthcare system we have way back in the day, I feel kind of a similar thing with private equity because you do have a lot of physicians that are, that are reaping enormous benefits from selling their practices to private equity.
And so it’s this, this, this kind of towing this line of, okay, well, you know, do I. How much does it take for me to look the other way and, and realize now that, okay, this is making healthcare worse. while also, but also, you know, benefiting financially from it.
Katie Porter: So I think one of the challenges is I do hear from a lot of physicians that who have had smaller practices or practice groups, maybe three or four doctors, you know, like when I grew up, my pediatrician had one doctor, it was him, Dr.
Alberts. Um, that was a very famous pediatrician in Iowa. Um, and it was [00:32:00] just him. Those are disappearing, but part of the reason they’re disappearing is health insurance companies, um, because all of the billing and the complexities and having to figure out which plans you take and don’t take. So, you know, private insurers spend about 200 billion dollars a year more on administrative costs than traditional Um, than traditional Medicare, and, and so when we think about Medicare for all, you’re thinking about saving all of that money in the switch, and so I think I would like to have more patient choice.
I would like to have, um, more doctors that I could go and see, and I think we’re not going to get there if we don’t make it administratively possible. for physicians to have practices on their own in small groups, um, the economy of scale in medicine, the bigger and bigger and bigger and the chains, all of that really serves to strengthen the hand of a handful of big corporations at the [00:33:00] expense of giving both providers and patients choices.
Will: So now I know that there’s Congress is starting to look a little bit more closely. We’ve already touched on that on like big pharma and insurance companies is, is I haven’t heard much about private equity though. Is that a focus?
Katie Porter: Yeah, I would say there’s a group of us, um, who can, you know, surprise, surprise, don’t take corporate PAC money, um, with the intention that it’s some of the same folks, by the way, who are focused on, um, Medicare advantage and what’s wrong with it, why it’s not actually an advantage.
Um, it’s some overlap there. So I look, I do think I can concretely show you that. The number and sort of who’s leading on these issues There are people who do take corporate money who are good on these issues But the the kind of energy around it is coming from people who don’t take money I would say actually I do think that congress is very focused on pharma and big pharma And you know, we have this thing now like it’s like big oil and big pharma I’ve been talking a lot about big insurance and [00:34:00] I think that needs to become Much more of a thing.
I think insurance companies sold themselves in the, in the 90s and early 2000s in the run up to the Affordable Care Act as kind of the good guy. Um, that all we needed was insurance and then everything would be okay. And the truth is, insurance doesn’t work if the out of pocket maximum is completely ridiculous.
It doesn’t work, you know, if you don’t have the savings to be able to go and meet your deductible, then that deductible might as well be 10 million instead of 5, 000. And so I, I do think that there needs to be more of a critique of Big insurance companies and whether yeah, whether Congress is focusing too much I’m trying to give everyone insurance without being willing to really look underneath that and say well We really have to be delivering this is healthy workers a healthy workforce healthy families healthy kids Dignity and aging like that’s the policy goal [00:35:00] insurance is one Having more insured people is one tool to get people there, but it’s not the goal in and of itself.
And I think that insurance has kind of sold too many people in Congress. Too many career politicians who’ve been there 20, 30 years are on the, well, like, if you have insurance, it’s okay. Whereas what I have seen in my lifetime is I can have insurance. It doesn’t mean I’m going to be able to get care. It doesn’t mean I’m going to find a provider.
You know, my sister had melanoma. And so I’m supposed to get my skin checked, like. Every six months or every year? It’s like once every five years. And the reason it’s not that I mind having someone just look at my skin, it’s because it’s so annoying to wait. You know, so I texted my dermatologist the other day, well like, she said, we have no appointments for six months.
I said, OK. Can we, can we look past six months? And she said, no, the system only lets us look six months out. Oh my goodness. So what am I supposed to do? Like get a flashlight and just be like, what month’s cancer is to me? So [00:36:00] I, I think all of those things are, you know, they’re really discouraging to providers who then have someone come in and they have to deliver bad news.
Um, and so I, I really do think we have to. Ask our elected officials, and I would encourage people who, you know, who listen to this to, to talk with their elected officials. Not, what are you doing about costs? What are you doing about insurance? How, what are you doing in Congress to make us healthy, to keep us healthy?
And so I’m really taken with, and this is a suggestion of a future guest for you if you’re interested, is I’m a big fan of Senator Cory Booker’s work on the farm bill. And looking at how Congress, um, affects to people’s nutrition through what we subsidize, what kind of food we subsidize. So he has this whole really wonderful kind of vision of if you want to have healthy people, you need to make healthy food.
affordable. And so like, stop subsidizing sugar, right? Um, start thinking [00:37:00] about, you know, are you giving people enough, um, food assistance that they can use them for some vegetables? And so I’ve actually done some things where I’ve gone into the grocery store and shown like, What you can get for fruits and vegetables, and so like, I don’t need, you know, people who are struggling and don’t have enough money, like, you can tell them over and over again how great the antioxidants are in pomegranate juice or blueberries or the omega in salmon.
They can’t afford healthy food. And so then we turn around and we have to have the conversations with them about obesity and type 2 diabetes and other things. And so he’s, he’s got a really good vision of kind of food policy as health policy that I think goes back to this sort of rewriting the Washington narrative.
It’s not about how many dollars can we funnel to insurance companies and Wall Street healthcare. It’s about can we make people healthier. Oh, it’s a big
Kristin: job.
Will: That sounds, can you explain all of this on a whiteboard to me, please?
Kristin: I was gonna say, it doesn’t surprise [00:38:00] me that you said that you had a teaching background, because that was the first thing, you know, when I saw your visual aids, you know, when you first Started using them.
I was like, that lady’s been a teacher, I bet you anything.
Will: Oh yeah. And I tell you, it spoke also to the medical crowd too, because we, we get a lot of whiteboard presentation. Oh man. I’m sure you’ve heard that feedback as well. One question I have for you is, are the whiteboards getting bigger? Because I swear, I just recently saw a screenshot of you.
It’s like the, the, the, I don’t know, it’s, it’s like four feet by five feet. It’s like enormous.
Katie Porter: from Whiteboard Earrings. Oh my goodness. They’re really, really, they’re really great. You’re leaning into it, I love it. whiteboard earrings and I have everything to my, in my district office. Um, my staff got so frustrated with me being like, this whiteboard’s too big, this whiteboard’s too small.
They were trying to like, you know, they’d buy one and then they’d be like, oh no, we just painted the wall. My district director just went to Lowe’s and [00:39:00] like got the whiteboard paint and we just painted the entire wall whiteboard. So now it really. You know, because sometimes when I’m explaining a really, really big bill, it takes a lot of whiteboard real estate, um, to get that done.
But I, you know, I think in Congress, um, one of the things that, you know, I often think about is I think there’s an effort to sometimes obfuscate these issues because we, people don’t want Americans to ask the questions. So they say, well, you know, it’s really complicated. Most of this is not that complicated.
Like, if you have health, a health industry that profits from sickness rather than wellness, you will end up with this kind of system. Right.
Kristin: Well, and I, so I have one question I want to ask before we have to wrap, but that’s just, we, you know, you hear all the time and we’ve even asked it to you today of, you know, what, basically what the question is, is, well, what can you do?
What can you and your colleagues do about all of this, but what can, or what can we as citizens do? We’ve asked that too, but what can we. as [00:40:00] whatever we are, right? This category of people. Well, I guess maybe, you know, sure, you and me, but also kind of healthcare influencers, or I don’t like that term, but you know, people with a platform.
Yeah. What can we do to help, you know, solve this problem as well?
Katie Porter: Yeah, I mean, I think it’s really important that we’re empowering everyday people to ask questions, not just about their own health, like, Does this medicine have any side effects? These are important questions. But also to ask questions about healthcare policy.
So one of the suggestions I, you know, I had was, ask your elected officials. What are you doing to make people healthy? What, right, what is the policy that you’re focusing on to, to make people healthy? I think that people should ask their, um, their elected officials if they take money from corporate PACs, if they take money, um, from, uh, pharmaceuticals.
I think they should ask whether they’re meeting with [00:41:00] Just insurance companies, just hospital chains. Are you meeting with any solo practitioner physicians? Are you meeting with, with nurses unions? Are you, like, you, you need to, or patient advocacy groups. I think elected officials need to be hearing from all of those people.
And so, I would really encourage people to engage their elected officials even more on healthcare. Um, and I think the kind of like, you know, Um, don’t destroy the Affordable Care Act. That was an important moment, but in the wake of that, we really need to be looking at what still needs to be done, and the answer is a lot.
Will: What are you doing to improve health? Like, uh, let’s
Kristin: Right. To make us healthier. Yeah, to make us healthier. Absolutely. And can that make a difference up against all this lobby money?
Katie Porter: Oh, absolutely it can. Um, because a lot of what Washington suffers from, I mean, yes, there’s this sort of bought and paid for phenomenon that we’ve talked about, but it’s also a lack sometimes of ideas and imagination.
So, I sometimes say, only half joking, that Congress [00:42:00] motto is something like, solving yesterday’s problems tomorrow, maybe. And so it’s, you know, really looking forward, so like one of the things I’m focused on is we have a huge group of people who are going to be aging into Medicare, who have had access to mental health care in a way that maybe a generation or two before didn’t.
Medicare does not have nearly enough psychiatrists, um, and therapists, and we’re not set up for that. So let’s get ahead of it, right? Let’s think about it. And so I think kind of challenging the status quo is one of the most important things that people can do is, you know, everybody should ask their elected official if Medicare spends so much less than insurance.
on administrative costs, why aren’t we in favor of that? And the, the people will have answers, but it’s, it’s an okay to question, it’s a question we all should be asking. How do we reduce administrative costs and increase care outcomes?
Will: Absolutely. It’s going to, you know, result [00:43:00] in important discussions.
Kristin: And it seems like it just makes sense to everybody, no matter what side of the aisle you’re on. That’s just good common sense.
Katie Porter: It should be. It should be. But I will tell you, like, you know, that’s not how it feels a lot of the time, um, a lot of the time there. So, but I think one of the things you guys do is really get facts out.
So, you know, the discussion we just had about infection rates in hospitals, that study, um, you know, the, the, the story I told about how Medicare advantage doesn’t. make us healthier, then why are we doing it? So I, I, you know, if private equity hospitals don’t deliver as good of outcomes, let’s stop. Let’s have less of those.
Let’s have less of those, right? So I think that data part of it is really important to then driving the policy discussion. And I think you guys are in a perfect position to, um, to help elevate some of those, those studies and some of that research and to help people figure out how does it translate into policy.
Will: We will try to do our part, but, uh, and, but thank you so much for, for being such an advocate for, for just [00:44:00] everybody getting healthcare, getting affordable healthcare. We need more people like you. So thank you for that. And before we go, you’re, you’re running for Senate. Yes, in
Katie Porter: California. California has been a state that has driven a lot of healthcare innovation, um, and also has some of the biggest healthcare inequities and challenges, and so, um, it’s an exciting race to be able to talk about what to do about healthcare, um, and, you know, to kind of I’m the only candidate elected official in my race who doesn’t take corporate money, who doesn’t take lobbyist money.
And so I think to the extent people say, you know, she’s a little different. She sounds different. She focuses on different things. There’s an explanation for that. And so I, it’s an exciting race and, um, the primary is coming up very quickly. I think we have 50 days, um, to go. And so March 5th, um, Californians need to vote.
March
Will: 5th, get out and vote. Yeah, definitely.
Kristin: Cause we need, we need people like you in Congress. We need people pointing these things out and calling it like it is.
Will: Absolutely. Well, Congresswoman Katie Porter, thank you so much for [00:45:00] joining us. It really was an honor to have you talk with us today.
Katie Porter: Awesome.
Thank you so much.
Will: Kristen, are you familiar with AI?
Kristin: Yes. I have not been living under a rock.
Will: There are AI tools for everything now. That’s right. Well, guess what? We have Precision. This is the first ever EHR integrated infectious disease AI platform. This is super cool. For any specific patient, it automatically highlights better antibiotic regimens.
It empowers clinicians to save more lives while reducing burnout, just makes their life easier. That’s pretty cool. Yeah. And also, antibiotic stewardship. Yeah. Really cool things. To see a demo of this, go to precision. com slash KKH. That’s precision spelled with an X instead of an E. So, PRX. C I S I O N dot com slash K K H.
Wow. What a force. She
Kristin: is definitely, I love it. I,
Will: I, I love the, it’s such a fresh perspective [00:46:00] of S from someone who doesn’t take the money from lobbyists. Right.
Kristin: Just the fact that there are still people that don’t do that, that’s so hopeful to me, but it shouldn’t be that surprising. I know, exactly. Right?
Well, I told
Will: you why. Can that just be a rule? Like, you go, you go to Congress, you’re not allowed to take, no one’s allowed to lobby ever. I would love that? No. Zero. Zero lobbyists. How about
Kristin: that? Well, you know, it would still happen, it would just be under
Will: the table. Easy for me to say. Yeah. I was an internet comedian, ophthalmologist, podcaster, but, you know, I can have all the wishes I want, but, you know, it’s not reality.
Yeah,
Kristin: what is that? If wishes were I don’t know what the thing is. I don’t either.
Will: I know what you’re saying. But it was super cool to just hear her perspective and, uh, we agree on a lot of things. Yeah. Yeah.
Kristin: We, we do personally with her, but also I just, I love that there are, I mean, I can think of a few other examples too, but there are these particularly women in [00:47:00] Congress who Are just these straight shooters and are willing to say it like it is and I that is refreshing to me You know because everything is always so like she said it’s it’s always so obfuscated So people that can just spell it out.
So clearly I think is desperately needed and that’s kind of what you do in your comedy, too Yeah, I
Will: mean if there’s one one if there’s one place that we need clarity, it’s with health care issues. Yeah
And so yeah, um, you know, break out those dry erase boards and get to work. All right. Um, well, let’s take a look at a medical story. Should we? All right. All right. Here we go. So we have a fan story from Sandy. Sandy says, I am a nurse and specialize in maternal child health. During clinicals. When I was in nursing school, I was assigned to the PACU at a military hospital for one shift.
What’s PACU again? PACU is post anesthesia care unit. Yep, so right after you got done with the surgery, they put you in the PACU. You go wake up. You go wake up there and you thrash about. I was [00:48:00] About bread. I think, I think I, I thrashed about. I was settling post op patients and monitoring vitals nearby when a young officer called me over to his bedside.
In recovery for an appendectomy and still groggy from anesthesia, he motioned to me Towards his crotch under the sheets and mumbled something feels warm down there I gently moved the sheets aside and realized he was hemorrhaging from his urethra
Kristin: That is not where I thought that was gonna go Oof
Will: I alerted his his nurse as well as the attending who both came to assess the situation was decided that controlling the bleeding was the Biggest concern and that the student nurse should be tasked with applying pressure to the bleeding phallus Poor students.
Kristin: They always get the worst jobs.
Will: They determined that his urethra was lacerated during removal of the catheter. Oh my gosh! And the urologist was called down to emergently place a catheter as a tamponade. In the meantime, I was left making small talk while firmly grasping a stranger’s penis in my hand.[00:49:00]
Kristin: Well, if I had a nickel ,
Will: the situations you find yourself in medicine. Oh my goodness. But I love, every time we get a story like that, um, we haven’t really had a story like that, but you know, occasionally you get some embarrassing situation story. I’m always impressed. By just how professional everyone is.
It’s true.
Kristin: I mean, what are you,
Will: what are you going to do? What are you going to do? You got to be, you got to keep it professional and then maybe down the road, you can have a laugh about it, but right in the moment, you just got to get the job done.
Kristin: That catheter part though, oh my goodness. Do you have
Will: any medical stories about holding penises?
You can send us those or any other story you might have. Knock,
Kristin: knock, hi. You need to be careful what you ask for. We’re going to get all sorts of strange, oh boy, sorry, Shahnti.
Will: Knock, knock, hi, at human content. com.
Hey, Kristen. What’s up? Name something that’s like crusty and flaky. Mmm,
Kristin: a delicious
Will: croissant. I appreciate your optimism. [00:50:00] Yeah. Yeah, you know what I was thinking? What? Demodex blepharitis.
Kristin: That is not as delicious.
Will: Do you know what these little guys are? What? These are demodex mites.
Kristin: Yeah, that’s not fun.
They’re cute
Will: though, aren’t they? Those ones are cute. If you have red itchy irritated eyelids, you might be surprised to find out that it’s a disease called demodex blepharitis caused by these little guys, demodex mites. Do you ever see those in your clinic? Yeah, occasionally. It’s not, it’s not
Kristin: uncommon.
Are they that cute when you see them under the
Will: microscope? Not quite. All right, but you can make an appointment with your eye doctor and get an eyelid exam where they can help you know for sure if what you’re suffering from is demodex blepharitis. To find out more, go to eyelidcheck. com. Again, that’s E Y E.
LIDcheck. com to get more information about demodex blepharitis and these little guys, demodex mites.
All right, let us know what you thought of the episode today, of the story, or what [00:51:00] uh, uh, Congresswoman Katie Porter had to say. We’d love to hear your thoughts about health care. Let’s hear it. Uh, we’re open to all your ideas, uh, and, uh, also let us know if you have any guests we should invite on. Yeah.
Kristin: It’s a big,
Will: complex topic. We’re looking for suggestions. Lots of ways to hit us up. Again, you can email us, knock, knock, hi, at human content. com. Uh, we also have social media network. We have social media. We have social media networks. We have lots of networks. We don’t have
Kristin: a social media network, to be clear.
We should. The Glockenplanken network.
Will: The Glockenplanken network. I don’t know. I don’t know how to make that happen. Uh, we’ll get our producers on it. Uh, you can hang out with us and our human content podcast family on Instagram and TikTok at humancontentpods. Thanks to all the great listeners leaving feedback and awesome reviews.
We love that. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out like today at LauraGarber9544 on YouTube says, one of your best yet. I learned so much. That was in regard to the palliative care [00:52:00] episode.
Kristin: Oh, with probably with Dr. Jared Rubenstein.
Will: Yeah, that was, that was a.
Fascinating.
Kristin: I have heard a lot of that kind of feedback. Yeah, people really like hearing about that. Which I like because I think there is a lot to learn about palliative care and it can be useful to lots of people. So let’s keep learning. Absolutely.
Will: Uh, full episodes of this podcast are up on my YouTube channel.
Those are video episodes. You can see our faces when we’re talking if, if you want, uh, at Deaglock Patreon, lots of cool perks, bonus episodes, or react to medical shows and movies. Uh, you can hang out with us, uh, the other members of the Knock Knock High community. Uh, we’re, we’re active in it.
Kristin: We just got to watch a couple shows the other day, and it
Will: was super fun, we’ll post a little clip from The Office, we reacted to that, it was great.
Early ad free episode access with the Patreon, uh, interactive Q& A livestream events, and much more! Maybe we’ll have an election in our Patreon group.
Kristin: Well, you are always saying how it’s a little town in there, so we do need some elected officials,
Will: I [00:53:00] suppose. Maybe you and I can go head to head as CEO of
Kristin: Patreon of race.
Will: Patreon. com slash Glockenplekken or go to Glockenplekken. com. Speaking of Patreon Community Perks, new member shout out to Michelle C. Thanks Michelle. Thanks for joining us. Shout out to all the Jonathans as always. We have Patrick with CSE, Sharon S, Omar, Edward K, Stephen G, Jonathan F, Marion W, Mr.
Grandaddy, Kaitlyn C, Brianna L, Leah D, KL, Rachel L, Keith G, JJ H, Derek N, Mary H, Susannah F, Mohammed K, Aviga, Parker, Ryan, Medical Meg, Bubbly Salt. Antique Macho! Patreon roulette, random shoutout to someone on the emergency medicine tier. We have EMP! EMP, thank you for being a patron. And thank you all for listening.
We are your hosts. Will and Kristen Flannery, also known as TheGlockenflagons. Special thanks to our guest, U. S. Senate candidate and Congresswoman, Katie Porter. Our executive producers are Will Flannery, Kristen Flannery, Aron [00:54:00] Korney, Rob Goldman, and Shahnti Brooke. Our editor and engineers, Jason Portiza.
Our music is by Omer Ben Zvi. I think this is the best outro I’ve ever done. Hmm. Well, I’m glad you think so. To learn about our Knock Knock Highest Program Disclaimer, Nothing’s Possible, Submission, Verification, Licensing, Terms, and HIPAA Release Terms! Go Glock plugin.com or reach out to us night night high human content.com with any questions, concerns, or fun medical puns.
I’m trying to like really get people going here in the, the outro, you know, like rate it screwed to the end. You’ve heard the episode, you’re ready to just take the day by the, you know what,
Kristin: if anyone’s listening on two times, you know how you can speed it up? Oh man. That’s be real fast. Then you probably are like an auctioneer or something.
Will: Yeah. Knock, knock, hi is a human content production.
Hey, Kristen, what, you know, people ask me about how tall you are. No, sometimes, but no, they asked me about Jonathan. Yes. I have
Kristin: heard people. Everybody
Will: wants a Jonathan [00:55:00] real. Can I have your Jonathan? I’m like, no, you can’t have my Jonathan. But you know what they can’t have? What’s that?
Katie Porter: DAX Copilot. Ah, yes.
And that is
Kristin: basically
Will: a Jonathan. It is. It’s like having a little Jonathan there. It’s, it’s, uh, uh, an AI powered ambient technology. It sits in the room with you and it helps, uh, create that clinical documentation while also allowing you to create a patient physician relationship that we all got into medicine to, to have.
We all want that. That’s right.
Kristin: Nobody got in to start writing notes.
Will: That’s right. And it is right now, everyone feels overwhelmed and burdened by all of this clinical documentation, uh, to where the work life balance, it just seems unattainable. So to learn more about the Nuance Dragon Ambient Experience or DAX Copilot, visit Nuance.
com slash Discover DAX. That’s N U A N C E. com slash Discover D A X.[00:56:00]
