Health Chatter Podcast - Health Insurance Episode (Part 1)

Stanton Shanedling: Hello, everybody! Welcome to Health Chatter. Today's show is going to be, if you can imagine, health insurance. Barry, Clarence, Matthew, and I are all kind of laughing because it's really a complicated subject. But we're going to try to dig into it a little bit and hopefully provide some clarity for everyone. We're pretty sure that we won't be able to do it all in one show, so stay tuned.

We have a great crew, and I keep saying this for each one of our shows that we do. We have a great research gang: Maddie Levine-Wolf, Aaron Collins, Deandra Howard, and Sheridan Nygaard. All I can say is that the research they do for us, even though we're kind of semi-knowledgeable about most of these topics, they really do put together some great stuff. Matthew Campbell's our production master. He's also recording our show today, and he gets out the shows to you, the listening audience. Then, of course, there's Barry Baines, our medical advisor, and he's on this show today. It should be interesting to get his perspective on health insurance. And then, of course, Clarence Jones, my great colleague and co-host for Health Chatter. Thanks to everybody. It's truly a wonderful crew.

Human Partnership is our sponsor and have been since our very first show. You can check them out at humanpartnership.org. Great community health organization—highly recommend you check them out. They do really good work out in the community. And you can check us out at healthchatterpodcast.com where you can see all of our shows. You can see transcripts of our shows if you'd rather read them instead of listening to them. And also, we include all the background research that we use for our shows so that you can take a look at them as well. So check us out: healthchatterpodcast.com.

So with that, today we have an illustrious gang of Barry, Clarence, and I. We're going to talk about health insurance, and I'll tell you, just to start us all out: it's confusing. And I can only imagine—here we are, we've been involved in health for a long, long time, and I could say that we're at least semi-knowledgeable about health insurance. But overall, it's a really confusing mess.

So all right, Clarence, let's start with you first, because I mean, you always come at this from a community perspective. How is it that we can truly communicate in normal language so that people can really take advantage of information? So what do you think about health insurance overall? Where are we standing with this?

Clarence Jones: I think that we wanted to first establish the fact that it is confusing. I was looking at the research that Maddie had produced for us, and she had things like HMO, EPO, POS, PPO, and all these other kinds of things—HSA, I mean all these kinds of things. And as a regular person, if there is such a thing, it gets to be very confusing. I mean, for the longest time I had a hard time understanding the difference between Medicare and Medicaid. I mean, you've got all these things floating around. And as you talked about a little bit earlier, it's very conflicting and confusing. And I'm really glad that we're able to talk about this from this perspective where we can talk about it, because I think a lot of people don't have that opportunity like we're taking at this point. So that's where I'm at. That's how I'm going to enter this conversation—it's very, very confusing.

Stanton Shanedling: Barry, what's your initial thought on health insurance?

Barry: Yeah, I want to echo what Clarence said. It's very confusing because there's so much information and there's so many choices. And oftentimes when you have lots and lots of choices, it becomes paralyzing for people. It's like too many decisions that you have to make. So what I was trying to make sense of this at two levels. One of them—just to point out the list with EPOs and HMOs and POS and PPOs and all of that stuff—I think one thing is we need to at least develop a working understanding, a knowledge of what these things mean, just in general. Because if you don't know what you don't know, you don't know what questions to ask.

Stanton Shanedling: Right.

Barry: So I think there is an educational component. As I was going through this and relating it to, you know, putting on my Health Chatter hat on the team here—and I know before Matthew hit the record button we were talking that, yeah, we really need to do this—so there's an educational component. But then the other part for me, I just took the time to just jot down a few things that are major decision points for how you even get into this all. And so what I'm hoping is that our conversation, our health chattering that we're going to do, is just to highlight some of these things. And then, Stan, as you said, we're probably heading down the path of needing to do a few more shows on this to really help simplify this for our listening audience, and actually for ourselves. I mean, the three of us, we're talking about how confusing it is for us, and we're sort of related in some way to the healthcare system.

So I was just, top of my head, thinking of decision points: how old you are, whether you're employed or not, how much income you make, and also what your overall health status is based on health resources that you use. Because, depending on where you are with all this other stuff, it can have an impact on your well-being, both for accessing healthcare resources—and healthcare costs money—and so you want to be a good steward of your own resources and not get in a plan where you wind up worsening your own financial condition. And those are, like I say, just things that pop off my head. And my hope for our conversation is that we can really bring some increased knowledge to our audience and us, and really help simplify this so that it's not as confusing and terrifying.

Stanton Shanedling: Yeah.

Barry: It is, you know. But as a doctor, when I was in practice, sometimes it made a difference what you could do depending on the insurance. And as a practicing physician, there's no way you know all the ins and outs of everybody's health and health insurance. You just want to see your patient, learn about how you can help them, and then do the best you can. And then all of a sudden, oh, the health insurance they have doesn't agree with this or that, and that's another hole.

Stanton Shanedling: Yeah. So let me ask this question. When you really think about health insurance—I remember when the alphabet soup really started, it was Health Maintenance Organization, HMO. There might have been something previous to that, but certainly that was one of them. One of the first HMOs in the country was right here in Minnesota, and it was Group Health, which has since morphed into HealthPartners. But the idea behind it was that, okay, it's one thing to treat you for a medical condition, but how is it that we can help to maintain your health and provide some prevention as well? That was kind of the idea behind it. Back then, to a certain extent, many of the health plans have health maintenance aspects to them, all right, which I think is an important component of any type of health insurance. It's one thing getting treated, it's another thing how they're helping you to maintain your health. So that might be one aspect that people should look at when they consider health coverage.

All right, so here's the other thing, and Clarence and Barry, chime in on this one. It's like, for me, I'm choosing a Medicare Advantage plan—in other words, a supplement to Medicare that I have. Now I had to go through a whole choice process here because there are a lot of options that you look at. There are different providers that you can choose from. So for me—and this is what I really want you to comment on—for me, and this is what I've been telling people as well: before you start anything as far as what you should be choosing and paying for, number one is, how is it that, in my estimation, you can maintain a trusted relationship with your existing physicians, your health team? That's number one.

Number two: some plans might not carry your particular physicians or your healthcare providers. How is it that you maintain trust in your care going forward? Number two is medications. So as people age, they end up taking more medications, and that's another major variable as far as cost, to make sure that your particular health plan that you choose at least can cover your medications. Fortunately, for our listening audience, many of the medications out there have generic alternatives for them, and so that makes it cheaper.

Next, so this is the third then, and I want you guys to comment on it: the clinics and the hospitals that you prefer to have access to. All right, where do you want to go for your care? So those three things—trust with your providers, medications, and clinics and hospitals—for me, that's the basis of choice, how it is that we proceed. Go ahead, Clarence.

Clarence Jones: Yeah, so I hope I'm using the right term. So when I started to look at that, when I got into Medicare—I always struggle with that—I used a broker to help me, somebody that knew the plans. And she came together and she helped to share with me what could be of advantage, what's not of advantage. And so that was how I got through it until I could learn more about the medical plans.

I do want to share that I think the points that you brought up about medical plans are important. Number one is to choose the right plan. But in some plans, you have to use specific stores like a CVS, or they have a plan with Walgreens. And so if your plan does not have that, or you live in a place where there's a pharmaceutical desert, it creates some additional stress for you, whether you have generics or not. And so I think that part of why it's important to have this kind of conversation is that these are some of the things that are not discussed. These are some of the unwritten things that are not there. I mean, they're written, but they're not necessarily talked about. Or you know, when you get these plans and you just, "Well, I'm going to get this plan because it's the cheapest plan"—you've got to be careful about that. And I like what Barry said about being a good steward of your money. If you don't pick the right plan, you won't be a good steward because they'll get your money.

So those are the kinds of things for me that really rise up to the top: Yeah, I don't know about this stuff, so let me find somebody that knows about it that I can trust and their opinion. And the second thing is that I have to make sure that the plan that I choose, I'm in a place where I can actually get the services that I need.

Stanton Shanedling: Correct. So you, the important point is a broker. In other words, it's really hard to navigate all this stuff. It's really hard to compare and contrast one plan to the next and also all the different variables. So you're recommending having or getting a broker, right?

Clarence Jones: That, for me, for me, that worked. I'm just saying for me.

Stanton Shanedling: Me too, for me. All right, great. Barry's raising his hand. Go!

Barry: This is just a point of clarification. When you use the term broker, I think you need to clarify that we're talking about an insurance or health insurance broker, because when some people hear the term broker, they may think of something like a stockbroker. So I just wanted to make sure that everybody understands that we're talking about a health insurance broker and how you have access to or talk to them. So it was just a clarification.

Clarence Jones: A stockbroker might be willing to help you too, Barry, you know, I'm just saying though. I'm only joking, I'm only joking. Okay, go ahead.

Stanton Shanedling: All right, so let's talk a little bit about this alphabet soup for everybody. All right, so I mentioned at the beginning here: Health Maintenance Organizations, there's Point of Service, there's Preferred Provider Organizations, as well as things that we kind of know about—Medicare, Medicaid—and then there's also, add to that, supplemental insurance that you can get for particular plans like Medicare and Medicaid.

So let me read some of this as far as definitions for our listening audience, which might be at least useful so we have a common denominator of language here, at least.

Exclusive Provider Organization (EPO) is a managed care plan where services are covered only if you use physicians, specialists, or hospitals in that particular plan's network.

Health Maintenance Organization (HMO)—now Barry, I don't know if that terminology is used very much anymore. Do you hear HMO very much anymore?

Barry: You do.

Stanton Shanedling: Okay, all right. It's a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with them. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in a service area to be eligible for the coverage. And HMOs often provide integrative care and focus on prevention and wellness, which is a point I brought up earlier.

Point of Service (POS): It's a type of plan where you pay less if you use doctors, hospitals, and healthcare providers that belong in the plan's network. Point of Service plans require you to get a referral from your primary care doctor in order to see a particular specialist. This lends itself to having a good trusted relationship with your own doc, because that'll really help if you need to see a specialist in that case.

Now, one other thing that we haven't touched on yet, but let's at least put it out there: single-payer. All right, so by having a single-payer, would we cut through all of this and hopefully get rid of the confusion? What's your initial sense of that, Clarence? Do you think that confusion would be decreased if we went to single-payer, just to start the conversation?

Clarence Jones: You know, we've had this conversation for the longest time. In terms of, at least when I say "we," I mean I'm speaking about myself in terms of talking about insurance. I think, yes, for me, I just believe that a single-payer would be easier. I don't know how willing organizations are to do that. You know what I mean? The answer is, yes, I like single-payer.

Stanton Shanedling: Okay. Barry, what do you think?

Barry: Yeah, well, I'm going to talk about this—that there are advantages and disadvantages to the kind of systems you have. If you think of Medicare in this country, that is a single-payer model. It's a model where the government provides health insurance for every person who's 65—or I mean there's nuances, but in general, for everyone once you hit 65. And it consists of both hospital coverage and outpatient coverage. Everyone who's 65 or older gets that automatically.

But that still covers a limited number of benefits. Now, the good thing is that any doctor who's in the network of accepting Medicare patients, you can go wherever you want with your straight Medicare. So the big advantage is that everybody is covered for, you know, certainly some things. So that's good with single-payer.

When you look at other countries, and most of the more advanced countries all have at least a single-payer in the sense that everybody, everyone who lives in that country has health insurance. We don't have that in this country. And that's, you know, this is a personal thing—I don't like that we don't have it. But the flip side is with single-payer coverage, that's just for the insurance part. And then you also have issues of access. And with single-payer, oftentimes—as in just one example, if you lived in Canada and their national health insurance coverage that they have, everybody is covered—but for elective surgeries, so for example, let's say a knee replacement or a hip replacement, those typically are not emergency surgeries. Even though if you're the person whose hip is really hurting you or your knee is hurting you and they say, "Yeah, you need a knee replacement," waiting times oftentimes are very long.

So whereas here in the United States, if you need knee replacement, usually that could be scheduled and, within a matter of weeks to maybe a month or so—if you're in other single-payer systems in other countries, typically you may have to wait months and months and months. Overall, so there's a trade-off with that of having insurance and then with some of the downsides of that tend to be long waiting times for things.

Stanton Shanedling: So does the data really justify that? In other words, when you say long waiting times, is there data that basically says that that's actually the case in all these countries that have single-payer?

Barry: Oh, yeah. Yeah, pretty much. Yeah. Now what they've done, though, again, even in single-payer systems, they sort of have a little back door. If you have financial resources, they sort of allow you to get—you're all in the national, the single-payer system, but if you want to pay more money, you can do that. And there are private doctors who are also in the national health system or single-payer system. And, Stan, if you have the dollars and you don't want to wait six months to have a knee replacement, guess what? You can pay for going outside the single-payer system and have your knee replaced in one month.

What sort of interests me—again, it's at an individual level and a population level, and I think we clearly try and look at the public health perspective in a broader view—and just about every developed country has better health outcomes than we do in the United States, and they all pretty much essentially have single-payer systems, which again means that everybody who lives there can get healthcare. And that's not the case in the United States, or the care that people can get. If you show up in an emergency room, you'll get care, but that's why our healthcare system tends to be so expensive, because we don't have that good primary care system. Or what we were talking about before, you have an MD that you trust, that you have a relationship with. And for a lot of people, their doctor is the emergency room or the urgent care clinic, which generally tends to be more expensive than if you have an appointment with your doctor.

Stanton Shanedling: So let me ask you this. I'll use myself as an illustration. I needed to set up an appointment to see my doc for a just a physical. I called to get an appointment, and the soonest that they could get me in was, are you ready? October of this year. All right, October—it's October—

Clarence Jones: October?

Stanton Shanedling: And I'm not going to last October, I'm going to the coming up, I quote. This is for a yearly physical. It would be this October of 2025. Now I'm going to circle back to you, Barry. Excuse me, is that not a waiting time? I mean, and that's just for a simple—and that's within a system that we presently have. It's not single-payer. This is what we're dealing with in the United States. So getting appointments—and I'm just talking appointments, I'm not necessarily talking about hospitalizations for procedures—we're still dealing with that.

Barry: Yeah, those are clearly—there are a lot of access things. But again, that's a whole different issue that has to do with where we're at with shortages in our healthcare system from a provider perspective. There's a real shortage of primary care providers in terms of internists, family physicians, pediatricians, just in general. And again, I don't want to be going down the rabbit hole for why that is, but we have a lot of doctors and nurses—I mean, it's, you know. And then we had COVID, which just totally screwed everything up for just about everybody. And so all those kinds of things, again, they're issues that relate to insurance, but that's not the health insurance complication we have. Once you get insurance, then you have this other can of worms where, well, you want to get in for your annual exam and you have to wait months and months and months.

Although I know, and I've encountered the same thing, and then they also say, "But if you'd like to be on a waiting list because people cancel and you have flexibility, you can get in a lot sooner."

Stanton Shanedling: Right. So I mean, so this whole idea of, you know, in Canada you have to wait for whatever, or in countries—I think I mentioned on a previous show when I was in England doing some work over there and I got sick, I ended up—I go into the National Health Service there, I walked in, I basically say, "Hey, I need some help," and done. I mean, they took care of me. I didn't have to pay a nickel, even though I was from out of the country. So I mean, I think to a certain extent we're—and maybe I'm jumping to a conclusion here—but I think to a certain extent we are so embedded in the system that we have, the health insurance system that we have in the United States, that we're putting blinders on looking at viable alternatives that would make it a lot easier to understand, a lot cheaper, and on the other hand, everybody would have it. Anyway, Clarence, go ahead.

Clarence Jones: Yeah, you know, I almost said—I almost talked about money in my previous conversation. I mean, you asked about the single-payer. There still is, for some people, there is a monetary benefit to keeping things the way that they are. And I think that we just have to recognize that as part of the system. You know, what's best for people does not always, all the time, mean that everybody's going to get a lot of the money. And so I'm at that point of just trying to get in where I can fit in, trying to figure out what works best for me. How do I share information and hopefully that it will provide some benefits to everyone, so it's a win-win. So I know that sounds kind of like in a circle, but sometimes dealing with insurance, it's like it's a circle. I mean, I'm spinning around.

Stanton Shanedling: So, Barry, maybe you can help me with this one. All right, so just—and I just don't know the answer to this—when did Medicare start? Does anybody have a handle on that? When did it first start?

Barry: Yeah, that was the hallmark of the Johnson Administration in the 1960s. There have been, historically, multiple attempts to get a Medicare-type program. And I think even with FDR, trying to do that. So that's where—but that was the hallmark of where Medicare came about.

Stanton Shanedling: All right. So many people in the United States get their health insurance through their employer. If you do not have an employer, obviously a group of people, typically age 65 and older, right, who are retired, don't have an employer anymore—they're retired. All right, so certainly in that case, Medicare kicks in. Medicaid, we'll get to in a moment. So it became kind of a safety valve for those that were older. It's like, "Okay, what the hell do we do now? I don't have employer coverage, but at least now I have this."

So is it even reasonable—is it even reasonable that employers should have to worry about this health coverage as a benefit for their employees? Why is it linked to employment?

Barry: Yeah, actually, I know a little bit about that. And what it relates to was some tax treatment. And this was tax laws that allowed companies to offer health insurance benefits to their employees, and it wouldn't be counted as income. I don't know, again, I'm not a tax expert, but the whole thing that spawned employer health insurance was how the money was treated as a benefit. So that when I was employed, the health benefits I was getting were not treated as taxable income, and the company could deduct it all from their books. And so it was a whole tax thing. It wasn't designed because, "Oh, this is a better way to get healthcare coverage for people in the United States." If, again, I may sound a little cynical here with this, but if anybody thinks it's different than it was—you know, tax lobbies and all things like that, it's very complicated. And once that became embedded in the system, good luck trying to go in a different direction.

But I did want to say one thing that, again, relates to something that Clarence said. And I'm going to quote Teddy Roosevelt, I believe, is the person who said this. He said, "You do what you can where you are with what you have." And this is the system that we have now. So within that system, the question I would pose to us and to our listening audience is: given this is what we have right now, how do we navigate this to make this at least work for us? Now, while it's—what do they say? Think globally and act locally. We're not going to be able to solve the bigger issue. This has been bandied about for years, actually since the turn of the 20th century, way back when. Actually, I believe there was a movement to have national health insurance like in the late 1890s or 1900s or something like that. But I'll probably be proven wrong on my dates and stuff with that. But it just got quashed. And so, you know, there's just so many—this gets so embroiled in politics and legislation and laws and stuff like that—that I certainly don't feel that I have much to offer on that piece.

But with what we have, it's a very complicated system. That doesn't mean that it can't be understood in a way that helps people get the most out of what we have while we continue to work for making it more equitable. There are just, as we know from other shows we've had, so many disparities in healthcare. But let's, instead of railing against it all for something that we might not be able to accomplish in the short term, how can we do the best we can with what we have now?

Stanton Shanedling: Yeah, I agree. I agree. Yet, you know, on the flip of that is the frustration on how it is that we could make it simpler. But that's beside the point. So all right, so one thing that I'm sure a lot of us are involved with is this whole idea of open enrollment. All right, so there's a period of time every year—it usually starts in October of every year and it runs through, what is it, December, I think—where certainly, and frankly, this is true for some employers too, where you can choose your health plan and also you can change. All right, and open enrollment is, yes, for Medicare, but also there's a period of time for employers as well, because I remember at the Health Department you could choose between two or three different health plans, and there was a period of time where you had to make that choice.

Regardless, so one of the things—and the listening audience needs to understand this—is how much risk you are willing to embrace. In other words, if you're really healthy, then you might end up signing up for a plan where your deductible is a lot lower, where you're willing to assume risk. But as you get older or you get more health-related issues, then those costs go up. So the point I'm making is every year, as part of this confusion, you need to do a personal risk assessment.

Clarence Jones: And I agree with that, and I think that part of—I mean, even for me this year, my wife was on me like, "Get that plan checked out. Go talk to this lady," because, you know, I'm getting older and those kinds of things. She didn't have to remind me, but she did. But you're right, I do think that during this open enrollment period, we want to encourage our listeners to take advantage of that. I mean, to do something, to take a look, to take a real evaluation, look at their current situation, because for me, because of my advancing age—and, you know, we don't put all our business out here—but I had to make some changes.

Stanton Shanedling: Yeah.

Clarence Jones: So it was the right thing to do. And so I think that people need to understand the importance of really being honest about where they're at and make some really informed decisions.

Stanton Shanedling: Yep, yep. So, you know, Matthew is on the show here. So, Matthew, how you doing? So I want to bring in a younger perspective just for a minute or two. What is it—all right, so you're employed and you get health insurance, I assume, through your employer. So what's the health psyche that you embrace when you're dealing with health insurance? Or don't you care? Just whatever they give me, thank you very much?

Matthew (Health Chatter): Well, you know, that really can depend, as we've kind of talked about. I've kind of went through different employment scenarios over the last year, so my focus on health insurance has kind of changed. When my new insurance just started in January, I got to pick my plan and all of those things. And when I was going through those options, I mean, I'm relatively young, so I wanted to pick the cheapest option, or one of the cheaper options for me. I didn't pick the cheapest, but I kind of did that risk assessment and had, you know, like, what do I need? What do I don't need? But at the end of the day, you're kind of limited to these kind of three plans. Fortunately, through my employer, those are all within my budget and very reasonable.

But, you know, back up a little bit—for the month of December, and for kind of thinking about November, when I wasn't employed or didn't have health insurance, I kind of had to make that risk assessment of, do I want to try to get private insurance? Do I want to use COBRA? Do I want to do all these things? And then all of a sudden, health insurance was not affordable. I mean, I was looking even through Minnesota—the Minnesota marketplace, MNsure, or whatever it was—I mean, $400 a month for a deductible that was $6,000, right? And that was just insane. I mean, just, what's the point of even having insurance at that point? And I mean, the argument could be made like if I was to have some crisis come up, it would at least cover something. But you had to kind of weigh that cost and risk.

And so I would say it's that constant balance of like, what's attainable? What am I eligible for? What is affordable? And kind of balancing all that out. And it is really hard and complex because you can't predict the future. So it's definitely shifted based on kind of what the options are. And of course, coming from a public health background, I'm a little biased in that I want great health insurance and I want to be able to go to the doctor as much as possible. And my utilization rate is probably going to be a little bit higher than someone who maybe is not in public health or doesn't care about it as much.

But I can definitely see that it shifted, and I'm definitely seeing the cracks in employer-sponsored health insurance because it really makes it challenging and difficult, especially earlier in a career and for younger people like me. We're moving companies a lot more now, and there's a lot more individual contributors, or you're not technically fully employed, or you're a contractor or consultant, or whatever the case may be. What options then do you have? And that's made it really challenging, I think, over the last year for me.

Stanton Shanedling: So let me ask you something, Matthew. Back in November when you were looking and you didn't have health insurance, in the back of your head, if God forbid something was really happening to you, what were you going to do?

Matthew: Well, there was this case—I didn't know what I was going to do, but I knew that I couldn't afford the insurance rate and I couldn't afford insurance. So I mean, this sounds terrible, but there was this running joke that I had that when it was icy out and there's some steps that I have, I would always say, "I can't fall down the steps today" because I knew if I fell down those steps, I could be financially ruined for, I mean, for years.

Clarence Jones: You know.

Stanton Shanedling: And what about the idea of just, like many people do, frankly, they just show up in the emergency room?

Matthew: Well, that was another joke I had. I was like, if I go to the emergency room, my name is John Doe. I do not have a name. I don't exist. I don't have a card. I don't have an ID. I have nothing on me. Treat my broken leg and thank you very much, get me out the door. But again, I think that's kind of where the public health side of me kicked in. It's like I understood that that could potentially ruin me financially for a very long time. And so, you know...

Stanton Shanedling: I get it. So, Barry, all right, so here's Matthew, that's why I brought him into this equation here. And then what happened? You show up in the emergency room, you don't have a card, and guess what then? Somehow or other, the costs are absorbed.

Barry: Right. Well, it ultimately gets passed on to all of us in that sense. However, I can't underscore even more the conundrum, the fear, like I say, of "going down, don't fall down the steps today." Matthew, you or some of the research staff can check on this—trust but verify—I believe that the number one cause of bankruptcy, personal bankruptcy in the United States, is from medical expenses, paying medical debt. I think that's correct. And so, Matthew, you just highlighted again the concern and fear of things that could happen to really, you know, when you say it could ruin you—yeah. And then if you have this horrendous medical debt because you didn't have health insurance to take care of things, I mean, it just snowballs. And then if you have debt, then when you start to wind up getting your feet on the ground in a good way, doing that, then it hounds you. If, let's say, you want to buy a house or you need credit for getting a car, I mean, it just has all these ramifications that it's hard to connect all the dots. But that medical catastrophe that could happen is one that could haunt people for years and years and years. And again, that's why I'm a proponent that we should have at least a system where everybody is covered to prevent that.

Stanton Shanedling: Yeah.

Barry: That's what I have to say about—my heart goes out to you, Matthew, understanding some of those really hard decisions. And it's not just for Matthew, there's lots and lots of people that have that. The other point is that in today's employment environment, people change jobs a lot—a lot. Like every, they say, every year or two on average. Now, I think something like that. That's just a made up number. I don't know if it's—

Stanton Shanedling: So, Matthew, you have another comment here?

Matthew: Yeah, I was just going to say that I want to provide a little bit of context. When I made that decision, I knew that I would have health insurance again in a month. So it's like there was only a small window. But for so many people, that's not the case, and you have to think about that. Like, I knew that I could potentially be strapped with a lot of medical debt if something was to happen, but also for that month, how am I going to afford my bills? How am I going to afford my car payment? How am I going to afford my groceries? How am I going to afford all of the other essentials that are just as important?

And you kind of have to balance that. So I mean, I'm a big proponent of some sort of non-employer-sponsored health insurance system that allows us to move. And I think, especially nowadays, the job environment is so different that the benefits—and even if you do get a new job, there's often a waiting period of at least a month before anything kicks in. So if you are moving jobs every year, every other year, the benefits you had last year are no longer good this year, are no longer good in six months. I mean, it's—

Stanton Shanedling: And it also brings to bear, too, this whole concept of consistency of care.

Matthew: Right. But the doctor I had last month is now—

Stanton Shanedling: Is now not covered.

Matthew: You're covered, and—

Stanton Shanedling: Yeah, right, right, right. All right, so this is show number one on the health insurance spectrum here. We're anticipating that we'll probably have two more. We'll keep you, the listening audience, in the queue on this. But this gives you kind of the gestalt of it right now—kind of the angst underlying all the different types of health insurance that we all, good, bad, or indifferent, have to navigate. So stay tuned. All right, Clarence, last thoughts on show number one on health insurance?

Clarence Jones: I'm going to ask our listening audience, whoever is listening to this program, to send us in their comments as we talk about our next level of conversation. Because I think that there are a lot of people that will be listening to this that will have some very valid statements and comments to make. And we want to make sure that we at least consider them as we move ahead, because as we have already said, this is a very complex topic.

Stanton Shanedling: Yeah, no, that's a great comment. If you have questions, get them to us, and that'll help us to kind of navigate how we proceed with our next shows for sure on this topic. All right, Barry, what do you think?

Barry: I think we scratched the surface a little bit, and I think we were able to display the level of confusion that this creates for our communities. And I'd also—getting some feedback from listening audience and questions that they have to help shape the next couple of shows that we have on this, because I think this is an important topic. And if we at Health Chatter can help to clarify and simplify things so that people understand their options better, I think then that we'd be doing a good thing, and I like to do good things for our community if I can.

Stanton Shanedling: Amen. So, you know, it's one thing confusion, which I think there's a lot of it as it relates to this topic. But the confusion, I think, is lending itself to frustration as well, and angst, and causing people to worry. And I don't think that that's helping as well. So hopefully, going forward with our shows, we'll be able to reduce some of that angst and that worrisome aspect, at least to the point where we provide some useful information for you, the listening audience. So stay tuned. We're going to have more shows on that, and we'll keep you up to speed on when they'll be coming out.

Our next show that we're going to be putting out is on naturopathic medicine, which is kind of an alternative form of medicine—should be an interesting show. So for the health insurance part one, thanks for listening in, and everybody keep health chatting away.