Vax passports?!; hospitals slow-walk pricing rules; The day Pres Reagan was shot | The Nation Speaks

[Music] thank you today on the nation speaks is getting a vaccine your passport to a more normal life or would a vaccine passport just create new problems Medical Treatments most of us have no idea what they'll cost before we get them hospitals we're supposed to change that starting January 1st did they and 40 years ago President Ronald Reagan was shot and nearly died we go back to that fateful day with President Reagan's fateful biographer hello and welcome to the nation speaks I'm your host Cindy Drew care vaccine passports there are already The New Normal in some countries most notably Israel and they're being seriously considered in others like the UK and the European Union in the United States President Biden has directed his cabinet to assess their feasibility the idea of the passport is that you need to show proof of covid-19 immunization to do things like go to a sporting event go to a bar go to a gym or fly may sound simple enough but implementing them raises a whole host of thorny medical ethical and practical issues we have three guests with us today to help us sort through it all here to talk to us more about the medical side of the equation is Gerald commission he's the CEO of todos medical that's selling covet testing and developing new coveted related products including an immune supplement Gerald welcome thank you for having me um maybe we could start by you just explaining what what's the principle behind having a vaccine passport well the idea of having a vaccine passport is really to reduce the risk associated with different activities so you know if you think about it from a public health perspective you're really all these steps wearing a mask you know hand sanitizer six feet away they're all designed to create layers of mitigation to the potential spread people who are vaccinated who congregate together they will represent a much lower risk pool than everybody else because they've had this uh layer of protection that other people don't have now you know some people may have it because of a prior covet infection and there's been some uh desire to test people who've been previously infected with covet to see if they have antibodies that compare with vaccine levels of antibodies let me ask you about that that doesn't seem to be part of the equation for any of these passports the ones they're you know looking at in Europe and Israel's why is that do you think well I think it's just administratively difficult to uh administer it's certainly not a scientific question it's definitely uh just a public policy perspective uh you know the easiest way for every for the to show compliance is for everybody to go through the same process you know whether you've been vaccinated whether you've had covid or recovered or not vaccinated is really the easiest things for people to do even though it may not necessarily be required so I think you know in general they're just trying to create a standard one standard one simple message that everyone follows that is you know vaccinate vaccinate vaccinate um and so that's the reason why these passports are are being pushed but over time you know like everything else there's going to have to be some adjustments for the realities of uh of the biology right I can imagine two different things that makes me think of so one of them is that we don't even know how long these vaccines last for yet yeah well that's going to be a big option you know one of the things that's coming up and we're hearing more and more uh with the folks that we deal with on the testing side is people who are you know especially in the New York area people who were infected with covid a year ago who had been having antibodies they're starting to lose those antibodies and so now they're starting to ask questions like well am I still immune can I look at a a t cell test to see you know if I still have adaptive immunity for coven um so you know over time it's going to have to adjust because uh the reality is we don't know a lot about how long these magazines are maintained especially in populations that are immunocompromised and prone to having lower levels of immunity and that's going to be something that people deal with you know as as the science becomes clearer so would you expect from a medical standpoint that the immunity to last different lengths of time in different people I mean people there's different vaccines people who have immunity from having been ill themselves is that the scenario uh yeah listen absolutely you know the reason why uh people who are older are more prone to uh getting sick is because they have a lower immune response and there's no reason to believe that that's any different here with covid especially given the higher mortality rates among the uh older population and those who are at risk so you know it's very much going to be the uh scenario that we're going to learn a lot about who is getting reinfected how quickly are we getting reinfected and whether or not you know multiple vaccinations will do anything as time goes on we start to learn more about boosters and obviously as these variants uh begin to take hold uh that you know it's going to change how we look at immunity there's obviously a lot of concern about some of these variants especially ones that have been shown to have a greater ability to overcome uh vaccines like we saw in AstraZeneca trial in South Africa as we're seeing with um the P1 variant out of Brazil so as those you know spread and as other similar variants pop up in New York or in California um you know we're going to learn a lot and and there are already trials that are beginning to test if you know booster shots and other additional vaccines could prime the pump um so you know I think that's obviously a very important effort but one of the reasons why we chose to get into the space of immunity is because you know that can't be the only solution uh for us on an individual basis to protect ourselves so you know we've all seen that we're trying to build our immunity we found a dietary supplement that we feel has the really strong potential to further protect people especially with circulating coronaviruses and and so adding you know these immune boosting types of supplements to your regimen is something that you can do for yourself to help protect you to the extent possible so how do you think you can kind of Market that message if people it feels like because of this vaccinate vaccinate vaccinate message that most people are like okay I'm good get a vaccine and I'm good and you know be protective then I can go places so how are you going to get a message across it actually you need to take care of your health and generally boost your immune system all of those kinds of things do you think they go counter to each other um no I don't think they go counter to each other I think that you know people who know that they have you know somewhat of a weaker immune system they self-select so you know we think that um it's very much you know in line with the way things had been going before covid and it's just an acceleration of Trends where people you know Pharmaceuticals vaccines there's been you know people looking for alternatives to some of those Solutions um certainly vaccines it's very difficult to get Alternatives but uh with regards to Pharmaceuticals different things that can help boost your immune system so do you think there's any public policy Health policy room for someone who doesn't have a lot of risk factors they're young they're healthy they're taking care of themselves taking supplements they don't want to take a vaccine because there are some risks involved and you know they feel like even if they get coveted it's not going to be so bad but do you think there's a kind of public policy room um you know something in conjunction with passports or who knows what that could address those kinds of people um I think uh from a practical standpoint you know if the people who are choosing not to get the vaccine um they're already built into uh the strategy you know herd immunity comes once you hit you know 70 80 90 whatever that number is and you know by definition a certain number of people are going to get vaccinated and if you don't get vaccinated and you go out you eventually will get coveted and therefore you know some immunity will build up um you know if if that's going to be if you're going to be in an at-risk environment so you know whether we like it or not it's built into the models I think as more and more people get vaccinated and hopefully we reach some threshold levels that you know other Alternatives will be able to be used to kind of mitigate the risk and that unvaccinated population and therefore still you know really help to reduce the spread and we've got to wrap up but let me just ask you one more medical question is it possible to get the vaccine but also not be not have the antibodies develop hence not be protected actually oh absolutely you know that's something that you see in people who are immunocompromised um and you know certain people have been reinfected so you know if if covid doesn't protect you then the vaccine is unlikely to protect you but that's a small number of people so I think you know it's it's certainly as you get vaccinated it's certain we believe and we think it's very prudent to you know test yourself you know are you developing antibodies what threshold do they go to after you've been vaccinated and then um you know do they stay there or do they start to come down and you know do they start to come down to levels that that make you concerned we think you know monitoring you know your covet status is going to be important you know in the months ahead because that will guide probably some decision making with regards to getting vaccinated again you know a booster shot um there's a lot of reasons why that makes sense so we think that you know right now the message is vaccinated vaccinated vaccinate but over time the message is going to shift to vaccinate and monitor yourself and so we've positioned ourselves there we have a relationship with a company called additex that's developed a very very precise method to measure antibodies and is adding T cell and b-cell Immunity to determine whether you've developed longer term adaptive immunity which could protect you you know for a more extended period of time okay sorry I have to ask you one last question before we wrap up here are there to monitor yourselves are there a quick and inexpensive ways to do that uh so right now there are some rapid tests that are being developed just to see if you have antibodies the threshold and the types of antibodies on those rapid tests are not really uh outlined but you know some information is better than no information so yeah there are some of those tests out there on the market and then you can you can do uh more quantitative tests that give you kind of a a better profile of your uh immune status and those are the types of things that you would maybe take once a quarter so it really depends on how where you are you are about covid um and and you know what your risk level is and really if you've been vaccinated to be able or previously infected to be able to want to monitor that type of uh activity all right got it thank you so much for joining us today Gerald thank you very much so thinking simply about immunity we just heard why Public Health officials will prefer a policy that sends that one simple message of vaccinate vaccinate vaccinate even if we know that vaccines aren't 100 effective or all that necessary for 100 of the population so that's one part of the equation but there are others too including many ethical and practical considerations our next two guests need to do a great deal of thinking about these issues joining us now is Dr Sarah Chan she's an expert in bioethics at the University of edinburgh's College of Medicine and Jeff Price probably the world's top expert on Aviation Security and Airport management welcome to you both good morning Dr Chen I'd like to start with you since the idea of vaccine passports is a lot more advanced in the UK it's already been a hot topic for a little while there what are the top one or two sticking points for people in that debate well I think first of all we need to be careful about putting if you like too many eggs in the vaccination basket so checking vaccination status is one tool that could help us to reduce the international spread of covid that could be caused by travel but it's not the only tool we have and it won't necessarily be the most effective so as you've just heard from Dr Thomas Young at the moment we have limited data on how effective vaccines are going to be at controlling the spread of covert so we know they're individually protective they probably reduce transmission but they might not suppress it entirely and we also don't know if the vaccines we currently have will be effective against all the new variants that could emerge so I think pinning all our hopes on and putting all our efforts into vaccine passports as the main solution to opening up travel might be the wrong strategy and if we put too much emphasis on passports as the sole strategy I think we risk creating a false sense of security that might uh lead people actually to increase their personal risk behaviors so they think well we're vaccinated we'll stop wearing masks we'll stop observing social distancing and then at a broader policy level I think that focus on passports might also distract from other measures including promoting vaccination as a widespread measure itself structural and social interventions to address the wider effects of the pandemic such as education mental health and so forth so I think that what the first concern is just practicality is this where we should be focusing our efforts and I'm not sure it is so how about you Jeff from the airline Industries perspective what's their perspective on the prospect of vaccine passports really the perspective comes down to infrastructure and how much training is going to be required to go into this there's was a time back in the late 80s where uh airplane Pan Am 103 blue upcoming out of uh out of Heathrow and immediately the United States tried to implement these security questions process that were asked by the airline ticket agents and it was basically did you pack your bag yourself did anyone to ask you to carry something if your bag's been out of your control and what they really did is they took an Israeli process and they watered it down extensively and then they tried to implement it and get the same results and it was just disastrous it didn't work and I can very much see the same type of situation forming here is there's going to be a lot of infrastructure that needs to be put into place in a tremendous amount of training for the ticket agents for gate agents for all the people within the airline system that as do okay how do I vet whatever this new credential is and I just in all honesty got my second uh covet vaccine shot yesterday and I was looking at the card that they gave me for my shot and uh frankly I think it's not really difficult to duplicate and they said well take a picture of it at least keep that with you in case you're asked and I'm like well I have Photoshop too so I mean there's a lot of technical uh technical technical problems involved in this and I I really wonder is this so much infrastructure to try and uh really it's it's a solution looking for a problem I think we should be doing other things that aren't so infrastructure heavy and so Personnel heavy so that's your point of view let me just quickly ask um Dr Chen we'll go back to you but this is uh your point of view from you know security and inflammation perspective but it seems like a lot of airlines want it or getting on board with it because they want people back in the air is that is that true Jeff oh okay so I'll get back to Dr tannerman I know she wanted to jump in on something no problem the uh I think it's true to an extent uh the airlines in fact actually Pan Am implemented uh the Israeli security let's just call them profiling strategies that's what they were and there was a lot of Passenger pushback to that but it got people flying Pan Am again for a period of time and I think the airlines are saying yes we're all for this but I think what you'll find as we move closer to this they're going to want somebody else to do this vetting they're going to want to put this on TSA they're going to want to put this on the airport operator and even if they decide okay we'll do it ourselves I I suspect that once the costs start Rising on this they're they're going to water down the procedure to the point where it's ineffective interesting all right Dr Tam back to you so I think Jeff's completely right there I I think vaccine passports are a disproportionately technologically heavy solution and they're likely to be a waste of resources but beyond that I think there are also serious ethical concerns uh I think it that it's an unnecessarily divisive approach and I think it's going to create uh more unfairness and inequality in an already unequal Society so just to expand on that um I think the the problem with even talking about vaccine passports in this way is that it puts the focus on the individual so the very idea of a passport is that it's about my individual rights and entitlements it's a selfish approach it promotes an ethos of every person for themselves me first me me what am I allowed to do and what we should actually be focusing on from a public health point of view with vaccination is the collective benefits to the population so vaccination shouldn't be about can I go to the pub can I go on a holiday this year it should be about fulfilling my duty to protect others in a Cooperative effort by global Society for the benefit of humanity and in fact if we start deciding who's allowed to freely participate in society based on individual vaccination status we're really trying to put the responsibility onto individuals to be vaccinated and that in turn assumes that whether or not a person has been vaccinated is wholly a matter of their own completely free choice and that's just not the case in fact vaccination is going to be dependent on a whole load of other factors beyond people's control such as ability to access the vaccine pre-existing health conditions and so forth so in fact it would be extremely unfair to start limiting what people can do and where they can go based on individual vaccination status now I said it would be divisive we've seen consistently throughout this pandemic and we know from past experience that trying to assign blame and responsibility to individuals for protecting or failing to protect their own health it's just less effective than strategies that try and address the structural factors that facilitate collective approaches to promote in public health and that's what we should be looking for in this case right and those you know differences or even across countries I mean Dr tedro's head of who said the other day that he doesn't want the vaccine passports because there's some countries poorer countries that don't have any vaccines yet or very little and you know young healthy people will want to travel in richer countries so they'll be running to get their vaccines and so that'll create distribution issues yeah absolutely the effect on worsening inequalities is likely to bite the hardest at the level of global Society um so when we take into account as you said vast disparities in access to vaccination and the potential issues created by the existence of multiple vaccines is something we need to talk about um people in Low Middle income countries are already disadvantaged with respect to Health Care generally they're further disadvantaged with respect to covid because they have less access to vaccinations so are we saying we should compound that and make it worse by imposing even further restrictions on their freedom of movement and then if we start to have not just one form of vaccine passport but let's say different passports depending on which vaccine people have had so we're starting to see you know differences in which vaccines are approved in which countries based on uh who they're made by where they're made Etc what if we start to have different passports depending on which vaccine people have had so we've seen China has has suggested that people who've had the Chinese vaccine are going to be given preferential access to to being able to enter the country so really here we're talking about creating new categories of global disadvantage we're turning people into second and third class bio citizens and I think that's deeply deeply concerning and Jeff um I know that you know the flight attendants and airport or Airline officials having them enforce mask um mandates is already pretty problematic um from that perspective how do you think you know they react to having to enforce because I can imagine too you know as Dr Thomas was talking about you know different vaccinations you know have different Effectiveness then someone's like I'm pregnant I can't take it I think I'm pregnant so I didn't take it um you know et cetera et cetera I can just imagine so many different scenarios absolutely we're talking about putting a lot of responsibility on people that really didn't sign up for this and aren't really necessarily qualified to make a lot of these decisions I remember early on TSA did an initiative where they wanted to take everybody's temperature as they were coming into the checkpoint and if your temperature was too high well then you weren't flying that day so but there was no back into the infrastructure of that it was okay I'm going to send you back to the ticket counter for a refund do you get a note how does that work and they didn't have all that back-end structure in place and even if they had had it all you're doing is backing up lines even more in slumming Aviation down even further and as Dr Chan pointed out that we're really creating several tiers of individuals out there one of the benefits of Aviation is if you have an airport you have access to the world's air transportation system in some way shape or form and and that is across it's across borders that's across uh to a certain extent Financial lines because as long as you've got an airport you at least have access now your putting in an additional barrier to entry into the aviation system and then you're asking people who are not qualified to make these decisions it really is is that the ticket agent's responsibility and nothing against it take an agent or an airport operator or a flight attendant I mean I've been in these positions before in these various roles capacities enforcing the mass mandate has been horrendous on the industry because what do you do when someone doesn't wear a mask well if you're a flight attendant you're telling the captain the Captain's Landing the plane prematurely where it's not supposed to be and now we got to get cops on board involved off because someone doesn't want to wear a mask how's that play out if the ticket counter when the exact situation is well I I think I might be pregnant so I didn't get the vaccine well who gets to make that call at this point a ticket agent at the airlines that's that's what their level of qualification is is determine that so I think you're creating a lot of of unnecessary processes I think the airlines are going down the wrong path on this this is not not the way to go with this it's not solving the problem so we just have about two minutes left Dr 10 I want to ask you what do you think the the best policy should be in order to you know stop the spread internationally but do something you know reasonable the best way to make sure the vaccine the the virus can't spread internationally is to make sure everybody has access to vaccination at a global level and that's where we should be focusing our efforts and what do you think the airline position should be at this point Jeff well I think the airline position should be let's get people back flying but let's do it in a way that is reasonable and practical and instead of coming up with the solution to go look for a problem now to solve and not thinking about the back end of this let's come up with solutions that are actually effective when TSA tried that pilot program the CDC came right out and said that doesn't work so I think we really need to listen to The Experts on this excellent all right thank you both so much for joining us today I really appreciate it thank you thank you coming up after the break hospitals they're required to post all of their prices online but are they we'll find out but first this week President Joe Biden held his first press conference taking questions from reporters so for America q a we asked regular Americans what they would ask the president if they had the chance [Music] where is the help that supposedly I'm supposed to get I lost my job a year ago because of the pandemic I used to work for a theme park I probably asked someone I guess future plans are like where he wants to have the country like what changes he wants like wants to make over the next like four years he says it over the news but like I feel like him saying it directly to you one-on-one would be a different answer maybe President Biden when are we going to get rid of these masks oh is he gonna support a small business because they suffer so much in the pandemic era he hooked up the mass mandate go back to normal I say President Biden are you aware of the situation at our Southern border and what are you going to do to fix it he needs to put a lot of energy a lot of thought to work on peace I don't know if I'm the appropriate person to ask that question I don't know leave office Josh I don't know I think Joe Biden is doing an awesome job I love him I picked them and I think I like that he has unity and that he um he's different are we getting another stimulus check because I need some money just keep bringing out those vaccines and you know the more the more that people get vaccinated the faster we can get rid of these I have so many questions for him is he going to be better than Trump that's my that's the total of the questions why he not do as he promised to be he said I will be the president on both sides no Democrat no Republican this is what his plan is for the economy for the next four years what does he think about the whole vaccination if he like wants everyone to get it and whatnot just how your body is going to react to it and what's going to happen foreign [Music] Hospital price transparency is meant to help you shop around for treatments and not be shocked when the bill comes we don't buy anything else without knowing the price first so why hasn't it been that way in medicine so how is this new rule working out our next two guests are here to answer that joining us now to tell us how it's going is David ballett he's the director of right on Healthcare with the Texas public policy Foundation he was also CEO of a hospital and a Healthcare Executive for nearly 20 years and Seth Denson business and Market analyst with focus on a with a focus on Health Care sector as the CEO and founder of DDP advisors gentlemen welcome good to be here thank you so the Trump Administration required hospitals to make their prices transparent to help consumers shop around that went into that went into practice in January so it's been a few months now and I want to get a sense from you how that's going um Seth why don't you start us out from our consumer point of view has it been helpful uh no uh no it it really hasn't I mean I think what we're seeing by and large Nationwide is many of these hospitals are complying with the law great but how you comply well that's a different story I mean they're putting this information out there but they're doing it in a way that the average consumers just quite frankly couldn't understand I mean most most consumers don't know what 20 ICD-10 codes go into a knee replacement so if I'm going to a hospital hospital systems website to try to determine what the true cost of that which I may be getting unless I have uh Quantum Physics degree in Health Care numbers I'm probably not going to be able to figure it out so do you think or maybe David you can answer this is this uh kind of willful non-compliance by the hospitals or is it just that complicated oh no it's absolutely willful non-compliance they stand to do much much better financially by not showing you the price and they've gone to Great Lengths to to show their cards they don't want us to know the price they've sued the Trump Administration in court they took it to the Appellate Court just this week in the Wall Street Journal we've seen that they're actively using uh coding Specialists to try to prevent you from being able to do a search of those who say they're being compliant from from being able to find those prices so this is absolutely willful non-compliance even from those that are saying that they're complying yeah I I tried myself to go online I went to two or three hospitals and tried to find a knee replacement the cost and I was I was confounded I mean I got there at some places but I still wasn't sure what I was looking at um Seth is that have you heard from consumers who have been trying to shop around what their experience is yeah I mean the same experience that you're seeing today in that you know they don't really know what to look for and that's the reality and it was just mentioned just a moment ago right the hospitals are are getting Tech uh people to coders to come in and make sure that search engines like Google and bling and these others can't even search for these prices either so all of that is part of this uh this ambiguity that the hospital systems for years have been able to profit off of and for the average consumer again they don't know exactly what they're looking for you look for a knee price well okay well what's bundled what's unbundled is the anesthesiologist involved in that is that is the surgical assistant is this a facility charge there's a lot of moving Parts in this and then then you got to add in okay what's my network insurance contract say to this and I mean there's just so many moving parts and right now the hospital systems don't want to comply and I think if there's one other thing I would say to this is that unfortunately and while I love that the Trump Administration took this step I'm not demeaning this step I think it's a great step but the juice just wasn't worth the squeeze the fine for non-compliance was 300 a day that's a rounding error for a lot of these hospitals so I think this was a good step but so much more needs to be done so our hospital so if hospitals are putting something online that's not searchable and not that helpful I guess they're getting around that 300 fine is that right well they are and they're getting around the Optics of saying that they're non-compliant sorry Dave go ahead no I was going to say it's the compliance just because they're putting out average prices or they're putting out uh something that that they say that they're meeting compliance with it doesn't mean that they're complying with the letter of the law and frankly just like Seth was saying they're willing to pay the penalty so they want to look good and be able to protect themselves at the same time and they're happy to pay the penalty it's less than a hundred and ten thousand dollars a year a Seth said that surrounding air for many of the hospitals and they're happy to pay the fine the good thing is that many states now are taking this on and codifying it at the state level and making those penalties much more punitive so actually David let me ask you from a public policy standpoint would there have been a better way to write that law initially knowing some of these outcomes would be likely well in it's important for the audience to understand it's not a law uh it's there it's a condition of of the ACA but what we're looking at what the president Trump did is is he he put in an executive order what those prices are the ACA says that the prices must be must be listed initially the hospitals were putting out their their big charge Master prices those big hyper-inflated charges that people just you know they scare the and frighten us when we see these hundred and two hundred thousand dollar charges but that's not what president Trump and the administration really set out to do they're looking at the real prices the negotiated rates between insurers and hospitals and so that's that's what we're looking at now and Seth you were at you were mentioning earlier that it there are a lot of moving Parts in this so is it even possible for the hospitals to list something meaningful well it certainly is but we have to go back to the basics because what we're going to need to go back to is is a recognition of how our insurance contracts work listen we I I call for an advocated for in my book The Cure the elimination of insurance contract networks they don't provide any value originally when they came into play they were to try to steer people to hospitals with a discount off of the charge Master which originally was supposed to be accurate it's not now because it's overly inflated but so you really got to go back to the fundamentals listen an MRI is an MRI is an MRI regardless of whether or not I've got Blue Cross United Healthcare signature and Aetna so until we have real Insurance reform where insurance starts to work like what we call an Indemnity program where it's reimbursing the charge unfortunately I don't know that we'll get to a place unless there is a very searchable database almost like an Amazon for a knee replacement under United Healthcare that I can go search and I can get the average prices there are some in the private sector that do this they'll take network data and start to break it down and Eliza but those systems cost money many employers buy them for their employees but the end of the day the American Consumer still has to use them so what is Seth what are the insurance companies think of all this do they want or not want price transparency no no they listen if you look at the average stock price of a health insurance company says the passage of the Affordable Care Act uh massive triple digits some of them over a thousand percent United Health Group posted just last year and over a thousand percent stock price increase since the patches this is working well what happened as a result of the Affordable Care Act was it took the health insurance industry and the Health Care Systems which historically been in conflict with one another and aligned them the health insurer is now the finance company the Health Care system for them to continue to generate more profits they actually want claims to go up and they hide behind the veil of confidentiality in these contracts to make sure the consumer doesn't know what's going on and everyone in the system except for the consumer is rewarded for it so David is a former CEO of a hospital is there any incentive for a hospital to put down there to get you know more business competition would you have not complied had you still been CEO of a hospital well when I when I was there I actually looked for opportunities to provide discounted rates for cash patients unfortunately that's the only way that you can do it because there are so many laws that that um make it more difficult under the insurance auspices so what I did do and what many organizations are doing now actually more and more are let's let's talk about MRIs and CAT scans the way Seth just brought up uh you know honestly they could be so affordable you wouldn't even need the insurance insurance has driven up the cost of MRIs and CAT scans uh I I in the state of Texas I could get a 250 CAT scan I could get a 400 MRI those are things that you wouldn't normally even need uh insurance for because you would have to pay the money pay those dollar amounts out of your deductible and in fact the negotiated rate for a CAT scan or MRI is thousands of dollars not hundreds so it's just it's not only Insurance reform that we need to look at we need to look at making health care more affordable again and in order to do that price transparency is is the first step needed to make people consumers of of the healthcare sector but uh yeah no absolutely we would certainly have done that uh in in my facilities but it's difficult nowadays because they stand to lose a lot of money especially on bigger surgeries okay so just to ask each of you before we wrap up how would you recommend going about this to get the intended outcomes of you know Trace price transparency that's going to be helpful to Consumers yeah again I think you've got to start legislatively at Insurance reform it's not likely that's going to happen just because you know you've got the healthcare Lobby by and large when you add in Pharma and some of these others it's bigger than oil defense and tobacco combined so those folks in Washington may not get it done but if you are going to put forth a law like this that requires transparency or an executive action as David mentioned you've got to make sure that there's some there's some skin in the game uh and and if you want to take what's on the books now you've got to increase the skin in the game for the hospital systems otherwise they just won't comply okay David and you mentioned doing something at the state level too can states do more I do I do believe that I do believe in increasing the skin in the game but I don't have as much faith in in the legislative um uh impact that they'll have in making this better I think the real uh benefit that'll impact the cost in health care is really going to be the patient and the employer once they have prices they're going to be the ones to go out and demand of their insurers and of their Hospital networks bundled pricing decreased rates based on who's getting the best price and so when they get engaged which they should because look most most organizations most businesses health care expenses are their second or third line item it's a big expense to our nation's small and medium-sized employers and large employers so it's time for them to get engaged in this issue and and uh to use their their influence use their uh their uh their leverage to make a difference do you see anyone doing that is there movement there I do there there are a number of organizations that are using cost sharing organizations they're using they're changing the way that they offer the benefits where the insurance is functioning more like insurance but the employer is implementing uh models like direct primary care they're using Ambulatory Surgery centers and if you use the surgery center that has a reduced bundled rate the employer will will remove any type of co-insurance or deductible and it'll be a zero out of pocket for their employees so they're motivating them by giving them good incentives interesting all right any final words to wrap up here Seth no I would just agree with that completely we see that in employers that we represent all the time and they're doing it more and more often they're seeing a better result matter of fact on average the employees that are implementing these strategies for the last number of years we'll call it three to five years they've been doing it are seeing flat Trend in the healthcare space it's one of those key areas where an employee gets a better experience the employer reduces their costs simultaneously so I'm glad David brought that up because it's very important the key to this is in that consumer Market engaged employees who are getting access to the system through their employer and the more that they'll engage and stop getting out of just the insurances the end-all be-all the more we'll start moving the needle excellent all right thank you both so much for joining us today thank you so much coming up after the break we go back to the day President Ronald Reagan was shot but first here's America q a where we ask people if they think kids are getting a good education in America today [Music] other countries yes but not all of the children in America I think it depends on the area no uh definitely not there's a lot of people that go to school and they learn all kinds of you know academic subjects but ultimately they don't learn the most basic skills that they need to succeed in life no I don't think that kids in America are getting the education they deserve oh that's a really loaded question um I know that everybody in America deserves a free and appropriate education by law I feel it depends on what state you live in and it also depends on whether you live in an affluent neighborhood versus a lower income neighborhood I think that teachers are working very hard to do the best that they can under the circumstances I think yes because uh because at school they're teaching kids a lot about different stuff and about the world I think that it's a bit of a disadvantage right now because they are from um you know a lot of kids are virtual I feel like it basically depends on whatever class you're in because I feel like the students on the higher class have a better Advantage when it comes to education but lower class students and some middle class students don't have that same Advantage I think it depends on where they're coming yes oh we have a free public education system that every child is entitled to it's basic not every country in the world has that my father how my father used to teach me in all no no not at this time due to covet no I don't necessarily know the statistics but I know we're not ranked top in the world I think that we could do a lot more to support public education in America no recently because I I was also in school and it would mostly be teachers forcing something upon you then actually you know they trying to do something along with you not the public schools I think private schools are the better choice Christian Schools especially I think education kind of brings people towards One path where people need to diverge and figure out what they want to do I would say a fairly getting good education I think the parochial schools are doing a better job reading and writing is way more emphasized than some other part especially if you compare to the Asian part of the world where there's a lot more emphasis on the math side the other beauty of the program over here is they have always advanced classes so there's much more flexible that's the part I like it yeah I think especially Warwick County all the school systems are all consistently rated really highly not particularly I think there's too much propaganda in the public schools with uh a lot of left-wing teachers spouting this notion Trends maybe fleeting values Timeless we now bring you this new clothing brand [Music] classic design and luxurious comfort our way of Sharing Hope and inspiration from the world of shenyon we bring you shenyon dancer wear it with honor [Music] just about 40 years ago on March 30th 1981 a newly inaugurated President Ronald Reagan was almost killed by an Assassin's bullet it was a very close call and an unwelcome reminder of the murder of President John F Kennedy a mere 18 years earlier fortunately President Reagan fully recovered and went on to serve two terms but the dramatic episode certainly had a lasting impact to take us back to that day we're joined Now by Craig Shirley he's a presidential historian and the author of not one but four books on President Ronald Reagan Craig welcome back to the show thank you Cindy thank you very much for asking me so we're going to play the footage now of the assassination attempt back in 1981 and I'd like you to tell us what exactly we're seeing okay well you're seeing John Hinckley he's got a uh 22 caliber and he's firing six shots at President Reagan uh and he hits uh several other bystanders and uh and security Personnel uh including uh Jim Brady who was uh devastated with the headshot and one shot ricocheted off of the limousine and cut into President Reagan's chest the left side of his chest and on the way to the hospital a lung collapsed he lost a lot of blood in his body something like half of the blood in his body and he almost died uh they hadn't met the speedy work of the of the surgeons and his own personal physique uh Ronald Reagan would have died that day but yet he did walk into the hospital that he rejected right yeah he uh he insisted on walking into the hospital and as soon as he got in the hospital he collapsed and almost went to shock which is a very dangerous proposition uh but he didn't uh fortunately but did but it did collapse once in the inside the hospital his own Pride wouldn't let him be taken in a wheelchair or on a gurney or should be carried in like that something like that whatsoever he only he only collapsed once inside the hospital amazing one of the other remarkable things I I remember reading is he's also he was cracking jokes actually right after it happened as well right it was very yes he was when he was on going under the knife and when he was having surgery and after surgery he was writing down he couldn't talk because he had they had to cut a hole in his throat for uh for the oxygen to pass into his lungs but he had a pad of paper and a pen and he wrote notes that he gave to a Lynn knappsinger and then Lynn Nasser passed it on to the Press uh there were many uh jokes at the time like he said to uh at one point he was told that the government is functioning normally and he responded in writing what makes you think I'd be happy about that uh you know just just stuff like that just and it passed along and of course millions of people heard about this so it was very reassuring to the American people that Ronald Reagan could be as light-hearted as he was was in that traumatic tie at that traumatic time did he also say or is this a myth that he said to the surgeon I hope you're all Republicans no that's absolutely that's absolutely true uh he had a position Dr Howard Giordano who was about to uh cut into Reagan's chest to remove the bullet and Reagan said to his attending physicians and he said before they before he went under the knife he said he turned to the Physicians and he said I hope some of you fellas are Republicans and uh Dr Giordano responded Mr President today we're all Republicans and it was very unifying moment in our nation's history wow yeah and this was just you know 70 days into his presidency so um you know the American people really got to see what this man was made of the absolutely uh you know and it performed a bond with the American people that hadn't existed before Reagan was brand new he was untested who was his Challenge and uh something he responded to quite well and the American people carried a level of infection for him they hadn't had before I think we all know about the great love between Nancy Reagan and Ronald Reagan what can you tell us about Nancy's reaction that day and the days that ensued yeah that's a good question uh Cindy she was of course like the rest of the country she was horrified this is not just the president this is her husband and she immediately rushed to her side and stayed inside pretty much the whole time he was there at George Washington Hospital uh and after in the days afterwards she met with the Secret Service uh department heads and gave the unsured hell about protecting the president and ensuring insisting that this never happened to him again and she was quite Frank in in her anger and quite franking her uh her comments to the Secret Service what changed in terms of protocols after this oh uh a lot actually uh the president intermingled with the American people far less than Reagan did uh in 1981 uh is that there were more Secret Service agents so it was less uh of him walking in public protective service around him at all times and really John Kennedy's assassination in 1963 and then 17 years old 18 years later Reagan's attempted assassination really uh uh brought home the reality of the modern world to the Secret Service and they they increased their budget they got more more people men and women they uh they they limited uh his the president's access to the American people uh they really downplayed it so that's one of the sad consequences to the to the modern world that we live in is the mer the people don't have the personal contact with the president that they used to have that they did have say in Dwight Eisenhower's time or Franklin Roosevelt's time or Harry Truman's time even though uh two of them uh were were the victims of of the secession attempts is that it was really uh the JFK assassination and then the attempted assassination Reagan that brought it home to the Secret Service and all the protective detail around the president which is that he is not just one of us he has to be kept at a distance and kept protected so this never happened again yeah it is remarkable looking back at the footage of him just walking out of the hotel and being right there on the street yeah it really is and that's the way the presidency was from George Washington's time uh up until up until Reagan's time was the president of whoever who was was out in the open and often mingled with the America with the American people uh right back to Lincoln's time and even before they they would interview prospective job applicants and uh and settled disputes and uh and and pretty much act as a normal human being there wasn't a gate around the white house uh complex that only came in the 1930s when reptile was President people used to go to the White House and the federal bureaucrats used to pick there at lunch and uh and the president was a much more down-to-earth Common Man uh in that era than they are now now the whole bureaucracy has been built up around the president both uh the Civil Service side and on the defensive side to ensure this never both befalls the president again one of the other things that happened that day is that the Secretary of State Alexander Hague declared himself in charge which was a bit unusual can you tell us about that yeah it was complete Mayhem as you can imagine Cindy uh between the the people who are attending to Reagan and the people who were at the White House and don't forget too this was the height of the Cold War the Soviet Union was adding this very carefully and a lot of people thought of the the time the Soviet Union was behind the assassination attempt on on Reagan because he was such a strong cold warrior uh which it wasn't true but a lot of people thought at the time and uh they had uh had a press conference A hurried organized press conference that was not very well organized and Al Hague mistakenly said that I'm in charge here which was not true he's the Vice President Bush who's on in an airplane I was way back to Washington uh and then the speaker of the house uh you know constitutional and then the Senate Pro tem of of the U.S Senate so it would have been going to pass to a tip on Neil if it had gone that far but it fortunately didn't but the secretary of state is is long down the list not not not the second or third person online as Hague mistakenly said and added to an Era of this real surreal added air atmosphere to Washington in the world and the nation that day Cindy and uh Al Hayes sweaty composure really added to it and it didn't add a lot that is a footnote you might know Reagan uh didn't like Al Hague and he wrote in his Diaries Al Hague resigned a year later at Reagan's assistance and Rayden Reagan wrote in his diaries that night that Al Hagan resigned and then wrote the only thing we disagreed about was who was president that's a great line um yeah so I want to go for a moment to the Assassin John Hinckley Jr because this wasn't a political assassination as all the others in the past had been no it was not it was it was for the bizarre reason I'm trying to impress a Hollywood Starlet that he had a crush on and had been stalking her uh and uh and it was it was to try he'd watch the movie Taxi Driver over and over and over starring Robert De Niro is a man going crazy trying to oppress a young attractive campaign worker and uh his way of doing it was to try to assassinate the politicians she was working for and so Hinckley got the idea from watching this movie over and over and over uh of assassinating Reagan to try to impress Jody Foster and of course it didn't work and they ever made a huge price that day unfortunately John Hinckley didn't he only went to a mental institution and then went was freed and this for killing Jim Brady and and almost killing uh the president of the United States right Jim Brady died how many years after I mean from injuries because of these guys several years ago but the coroner reported he died something like 20 years after the assassination in town and the coroner report when Jim passed away Jim was an old friend of mine uh with Coroner's report when he passed away uh Cindy said that he died as a result of a homicide so John Hinckley is a is a proven murderer but and yet he's walking around on the street today down here in Virginia uh and Justice was never was never served unlike in this case to say like Sirhan Sirhan who's still in prison for uh the assassination of Robert Kennedy back in 1968. right so five years ago Hinckley was released that's correct yes and so he and he never served hard time Justice was never served despite everybody writing letters to the judges including Mrs Reagan Nancy Reagan writing letters the judges pleading the Hinckley be put behind bars and be kept away the Reagan family because they thought he had bad intentions but one of the amazing things is that Ronald Reagan actually wanted to meet him to forgive him personally and his doctors didn't think that was a good idea John Hinckley Jr's doctors nope that's true uh he uh he uh Reagan had been shot and he thought a long hard about it um he he prayed and he forgave John Hinckley uh and uh he actually I as I wrote in one of my books uh that he won to meet with John Hinckley and uh he never did on the advice of the psychiatrist at Saint Elizabeth Hospital because they said it would simply be an act of empowering uh of John Hinckley that he wouldn't understand that Reagan was trying to forgive him that Hinkle would see it as some kind of vindication for himself or empowerment of himself so we've got to wrap up but one last question I have to ask you since you've written four books on Ronald Reagan obviously you know a lot about the man in his legacy what do you think would have been different I've worked for him too and you worked for him so what do you think would have been different had John Hinckley Jr succeeded in his assassination attempt well you know that is a great question um uh I think everything would change if George Bush had become president the end of the Cold War would not have happened as quickly as it did as it did under Reagan uh the economy would have been different under a President Bush early on say in 1981 than what it was under Ronald Reagan your attitude my attitude our American people attitudes toward government freedom and our personal relationship with our government would would have been uh would have been fundamentally different fundamentally different George Bush basically believed in government and Ronald Reagan didn't and it was Reagan's philosophy that carried the day in 1980 and 1984. all right well thank you so much for joining us today Craig we really appreciate it you bet my pleasure and that's all for today's show thank you so much for watching the nation speaks join us every Saturday 11 A.M to noon Eastern and from all of us here have a great week [Music] don't let YouTube decide what information you get that's your choice YouTube is deleting our videos and cuts you off from a source of honest reporting make sure you don't lose access to ntd's news content and take a quick moment to subscribe to our newsletter so no matter what happens here you'll keep your access to a trustworthy news source