Announcer:
0:00
Welcome to MedEvidence!, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts. Hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence!, and we're going to do something a little bit different today.
Dr. Michael Koren:
0:19
I have Andy Stansfield here today, who is in the insurance industry.
Dr. Michael Koren:
0:28
So you know, Andy, we usually have people here who are physicians or scientists or people are very involved in organized medicine those type of people. But insurance is also important in healthcare and you're going to educate us about what you do, how you try to help people navigate an incredibly complicated healthcare system, and then we're going to have some fun just talking about things in general in the insurance industry and I'm really interested in your perspective about some of the controversies that are out there.
Andy Stansfield:
0:55
Sure
Dr. Michael Koren:
0:56
And also maybe some personal advice for me.
Andy Stansfield:
0:59
Yeah.
Dr. Michael Koren:
1:00
I'm kind of at that age where I might have to think about a Medicare Advantage plan and, quite frankly, I really don't understand them very well.
Andy Stansfield:
1:07
Gotcha.
Dr. Michael Koren:
1:08
So I'm sure there are other people out there that have a similar situation to mine, and so you can help us navigate all that. So start just introduce yourself to the audience. Tell us a little bit, very briefly, about your background and how you became involved in the insurance industry for medicine.
Andy Stansfield:
1:25
Absolutely so. My name is Andy Stansfield. I operate the insurance agency Stansfield Health and Life kind of a really original name I know there, but I have a health and life insurance license here in Florida. A number of agents that also work in the agency as well. I've been doing this since the end of 2016.
Andy Stansfield:
1:45
Prior to that, I worked a lot in in the primary care space, more on sort of the administrative and business business office side of that for a large primary care provider here in Jacksonville. So I feel like it kind of gave me a real interesting perspective when I moved into the insurance world, where the bulk of the people I talked to are kind of everyday people. Everyday people either turning 65, young, all different ages, not necessarily, you know, immersed in the medical world. So they don't really understand a whole lot about what's going, what, what happens and how things work. And I saw that as a nice niche for myself, having a good background in working with medical offices and physicians and the whole operation of things. And then how do I translate how that world works to the common person out there, so that they at least understand why things happen the way they do.
Andy Stansfield:
2:35
To the best of my ability
Dr. Michael Koren:
2:36
Sure, so just help educate me. In general, you know from big picture stuff, so I don't know that much about the insurance, insurance industry. I know you have brokers, of course. Are you, are you just a specialist in healthcare, or do you do a bunch of other stuff? How does that work? People? You had to have these agencies work.
Andy Stansfield:
2:55
Absolutely so. So it all develops from the state license. You get the licenses, what they call health, health, life and annuities. I can provide all of those different types of services and products. I found a really strong niche when it comes to especially individual healthcare. Um, that would be, when I say individual healthcare, that is typically somebody who is coming into Medicare or has Medicare, typically 65 years or older. Or individuals that are not provided health insurance from an employer. I can also help employers provide coverage for their employees. So, while I can do a bunch of other things, I've really found a pretty strong niche on the individual health insurance side of things, but you still sell life insurance and other things Okay.
Dr. Michael Koren:
3:40
So you kind of do it all, but your specialty is medical insurance.
Andy Stansfield:
3:45
It is.
Andy Stansfield:
3:52
Probably about 75% of the individuals I work with are all on Medicare and it's just like I said. I can work with all the different types. It just happens to be how things have developed so far, and the other things, like your life and all that a lot of that tends to become needs after somebody takes care of their health insurance. It's usually one of the number one issues, especially going into retirement how am I going to handle my healthcare? After that comes other things, which that's probably why they grouped all these things together in one license is I can provide solutions for people on outside or beyond their healthcare as well.
Dr. Michael Koren:
4:23
Okay, so let's jump into the whole Medicare situation and the Medicare Advantage plans, and there's tremendous confusion. Yeah, I will tell you that I personally get a lot of mail, emails, phone calls. I have people blowing up my cell phone asking me to come to these educational seminars about Medicare, and it is particularly intense around my birthday. So somehow somebody seems to know what my birthday is and I'd be curious to maybe learn why people know about that. But just explain a little bit to start. What's this concept of Medicare Advantage versus other forms of Medicare?
Andy Stansfield:
5:06
Sure, sure. So probably the easiest way to describe that is Medicare started 1965. It is the government providing basic health insurance services for the elderly population 65 years and up. So at that time they provided for hospitalization services when I say provided for just helping to pay for those services and also for what they call medical services I think about inpatient or outpatient types of things and that's what it was there for. How does an average person handle the cost if they're hospitalized or if they need significant medical attention? As things have developed, even with the, you know, the inclusion of prescription medications and things like that, the complexity and the cost of things have really, really increased significantly.
Andy Stansfield:
5:56
Medicare Advantage comes in essentially is just the government subbing out their work to a private insurance company. They're trying to like uh, increase competition, increase it. You know the the business development through through the healthcare industry. So so it it. You can either get your healthcare from administered by the government, where they pay claims and things like that. Or the government says or you can work with a private insurance company. We actually fund that private insurance company and that insurance company is working with these funds to pay for your services. That's where you get a Medicare advantage. A private company is doing that and those are very much set up like any employer plan that you would have. Employer plans are provided by private insurance companies and it works very similarly, except the services that you're getting are services that were originally approved and delivered by the government for ages 65 and up. That's it. You're getting your insurance from a private company.
Dr. Michael Koren:
6:57
So I'm going to unpack a couple of things that you said, because it's really interesting and I'm also very interested in epidemiology and history in general, particularly history in medicine, and so our perspective about government insurance is a little bit different and we'll get into that than it was when these plans first came out and when Medicare was implemented in 1965, as you point out, there was a significant increase in life expectancy in the United States.
Dr. Michael Koren:
7:25
It was a hugely positive program that took people that had no resources, that ended up dying of diseases that were relatively simple to treat, and now, all of a sudden, people can be treated and if you look at the life expectancy curves in the United States, there's a pop after Medicare. So it's really a very impactful program at its basic level. And the other thing is that another piece of that was covering people on dialysis, and that was a key part of original legislation because that was a new technology that was life-saving. People with end-stage kidney disease just died before that and now all of a sudden there was a technology i. e. dialysis that allowed people to survive for years after they were diagnosed with end-stage kidney disease, and Medicare, provided that. Now, at first that was going to be a program that didn't have huge expenditure, but it turned out to be a massive program just the kidney protection piece of it
Andy Stansfield:
8:24
Sure, yeah.
Dr. Michael Koren:
8:25
And I think that's the theme that we're going to get into is that the cost of these things were always many times greater than what was anticipated. Right, not percentage. Greater times greater, sure, yeah. So anyhow, just I wanted to make those points. So, okay, so we get from 1965 to the 21st century and it gets really complex. So just break down Medicare A, B, C, D and X or whatever it is. I think Elon Musk has Medicare X now, is that right?
Andy Stansfield:
8:55
that'll be something new, I'm sure. Yeah, so it really goes back to what were the original needs. Well, if somebody is hospitalized, there's costs that are involved there. How do we handle that? That is now part A. Part A is essentially just an entity that helps to pay for hospitalization coverage charges that you would get at any hospital.
Andy Stansfield:
9:14
Part B I call like outpatient. A lot of times I refer to as a same day visits. Easy way to think If you have part A, I'm going to be staying somewhere overnight. If you have part B, this is a medical thing, I'm going to be staying somewhere overnight. If you have part B, this is a medical thing I'm getting, on a same day basis: a typical doctor visit or a lab x-ray, things like that. So part B is the entity that helps to pay for those outpatient type services um, overnight or or or or same day. And when we say that they're covered, they're not. Medicare is not paying. A hundred percent of all of these kind of goes back with something we were chatting about earlier is is, you know, there has to be room for somebody to to contribute themselves.
Andy Stansfield:
9:49
So there are definitely costs to the individual person when it comes to having Medicare part A and part B.
Dr. Michael Koren:
9:55
Right.
Andy Stansfield:
9:55
I did say outpatient and patient. Did not mention anything about prescription medications and other huge cost center as well. Right
Dr. Michael Koren:
10:00
And that's part D
Andy Stansfield:
10:01
That is part D. Yeah, D for drugs is the easiest way to think about it
Dr. Michael Koren:
10:04
What happened to C?
Andy Stansfield:
10:05
Yeah, so C actually got introduced later on. C is actually the official name of Medicare Advantage.
Dr. Michael Koren:
10:12
Ah, okay.
Andy Stansfield:
10:13
Part C. I think C is C for company, so private company, corporation. Essentially what they're doing is, when you have a Medicare Advantage plan, you're really just replacing the coverage you were getting from the government with coverage from a private insurance company. The government is overseeing that. They're requiring insurance companies to provide all the same services they would provide, but they're letting the private insurance company do that. Presumably, it was probably to help try to contain costs.
Andy Stansfield:
10:44
If you have Medicare Part A and B and you need medical service done, as long as Medicare has determined in the past that this is a medically necessary procedure, it is approved and Medicare will pay for that. You can easily see how that might be overused in certain circumstances or maybe unnecessarily used and it's very, very hard to to sort of contain that. I think that's probably the reason that that the the idea of of offloading that responsibility to a private insurance company and and sort of putting the risk on them to manage these things um, probably was a very popular idea and that's where you get your, your medicare advantage. So, um, yeah, A, B is the government, D is technically run um and it's not really administered by the government. It's it's also sent off to a private company to handle your prescription medications. But these part D companies companies that are providing a part d plan essentially are just bidding for the ability to handle that for the government.
Dr. Michael Koren:
11:40
Oh, wow, okay, interesting. Uh, the same thing with Part C. Now, as I recall, part D was passed during George W Bush's presidency, and the estimates of the cost of that turned out to be wildly underestimated.
Andy Stansfield:
11:55
Probably yeah.
Dr. Michael Koren:
11:56
As I recall now the latest wrinkle of that is the government will be directly negotiating some of these things on very popular drugs over the next few years, and we'll see where it goes from there. The US was the only major country that didn't have this type of negotiation between the government payer and the drug companies that are providing the actual molecules and products. So that's a big change, but probably in response to the fact that the cost of Part D turned out to be way more than anybody anticipated .
Dr. Michael Koren:
12:32
Yeah, so let's move on to kind of your business and how you help people.
Andy Stansfield:
12:37
Okay, yeah.
Dr. Michael Koren:
12:41
So you take somebody else in the room that may be hitting that magic age?
Dr. Michael Koren:
12:46
We won't mention names here for HIPAA reasons.
Andy Stansfield:
12:49
Sure sure.
Dr. Michael Koren:
12:50
And they come to you and they say, oh my God, andy, I'm so confused, like people tell me that I should stay away from the Advantage Plans because I won't be able to see the doctors I want. Or they tell me that, oh, you should definitely do it because you get free drugs on it and it's very confusing for people. So break it down how you take somebody that's coming up on Medicare age and help them navigate the system.
Andy Stansfield:
13:16
Yeah, absolutely so. The first place I always start with is there is not one single answer that fits everybody. If there was, we would just all do that. One single answer.
Andy Stansfield:
13:28
There are so many different iterations and varieties of plans and situations you can get into specifically because we want to have an option that works for your particular needs and your specifics. When I say particular needs, preference of doctors, what sort of medications are you on, where do you get your healthcare done? You know just what are your preferences and then, once I have a good understanding of what those are, I can help filter down and sort of eliminate the options that wouldn't have any relevance to you and your needs, preferences, things like that, and whether that is just sticking with what the government started with originally, adding something to that looking at an advantage plan from a private company. Essentially, it's a process of elimination. Let's eliminate the things that don't matter to you.
Andy Stansfield:
14:17
So I'm really interested in what benefits you I always tell people Medicare itself. The government actually regulates the commissions that an insurance agent like myself can earn on the sale of any of these types of products. So, and if it's regulated and it's exactly the same across the board, I don't have a bias. All I'm trying to do is make sure that we find the thing that fits you and your preferences the best, which I love.
Andy Stansfield:
14:43
I love that.
Andy Stansfield:
14:43
I don't have like a - you know nobody's really pushing me, "oh, sell more of this or that. You know it's really trying to figure out what are the needs of that person.
Dr. Michael Koren:
14:51
And I'm glad you brought that up, because people always wonder what the incentives are of the broker or the salesperson and again, we don't begrudge your ability to make a living. You provide a service and God bless you and thank you for what you do and you should make a living for that. But we don't know exactly how that works. You make a bunch of money on that plan and nothing on this plan, or you're neutral. It doesn't really matter.
Andy Stansfield:
15:17
It does yeah
Dr. Michael Koren:
15:17
And you have the interest of the person you're talking to at heart.
Andy Stansfield:
15:27
And I found that there are lots of different ways for people to obtain some sort of Medicare coverage or plan. You can get it from an individual local agent like myself. You can get it from somebody who calls you on the phone. That's in a call center in Oklahoma somewhere. I do find that your, your more local representation, first of all knows more of the area, kind of knows what you're talking about, but also have you know in a face-to-face type of a meeting.
Andy Stansfield:
15:44
It's very, very difficult to pull one over on somebody Like you know. If you're working one-on-one rather than over the phone like I have a lot more trust when it comes to that and I hope the other person does too. I want to do well by that person. A person in a call center might get you to enroll in something today, but they're not incentivized to keep you as their customer. I am, I'm going to see you, I go into your house, you know that that sort of thing, and I think that's a real main difference when it comes to how these products and how these plans are distributed throughout the country.
Andy Stansfield:
16:20
Unfortunately, I feel like there's a lot of regulation that that hits this industry on on how, to how they're trying to make it that sort of dynamic that we're talking about here, but the bulk of things are sold by your, your um call centers and things like that
Dr. Michael Koren:
16:34
So, and this is an interesting point um, let's say that you get involved in a plan. I think my mom had this situation I'm trying to remember details.
Dr. Michael Koren:
16:43
But she wasn't exactly excited about the plan and I think, if I remember correctly, it was sold to her through a call center and then, when she actually got to the plan, it was different than what she was told, and so she made a fuss about that and eventually, I think, was able to get out of it after a hassle. But I'm bringing this up because, as an individual that's involved in the sale of the plan, do you have any leverage after the fact? Can you help people if it turns out that the plan didn't produce the exact type of program that you expected?
Andy Stansfield:
17:19
Absolutely yeah, in fact I encourage that. I would like to know how are things going with this, what sort of what sort of issues you're running into? Another kind of plug for the local type of agent. As I'm here, you know I know what the person is dealing with. Yeah, I, there's lots of opportunities to make changes things. In fact, every single year you have an opportunity to make a change.
Andy Stansfield:
17:41
There are numerous reasons why you could make a change outside of that enrollment, general enrollment period. The longer longer you do this, the more training, the more training that agents get to know how to handle a dissatisfied you know customer with a particular thing. There may not be something we can do immediately, but the very next opportunity we have to make a change to benefit that person better, we want to take advantage of. I think your mother's experience with getting involved in something and then finding out something different later on. There's so many different factors that would go into why that happens.
Andy Stansfield:
18:16
My first thought is it's probably a brand new agent that has some sort of training thrown at them, but more likely scripts that are thrown at them, and it's a large organization trying to cram stuff through an inexperienced person into, you know, over the phone to somebody and maybe even through no fault of their own, the agent just doesn't know that they're not doing the right thing. That certainly can happen all the time and that I mean obviously, like that's sort of every young agent's experience there is I gotta be able to make a living, like you said, but and I want to do right by somebody, but I may not be getting all the information that I need to properly help this type and there's not really a real structured way of learning how to do that other than a lot of trial and error, trying to find mentors and things like that. So lots of different reasons why people get involved in something and not be happy or be very happy with stuff.
Dr. Michael Koren:
19:09
So let's focus a little bit on traditional Medicare versus Advantage and the pluses and minuses, and if a client comes to you, would there be a type of client that you would encourage to do one versus the other
Andy Stansfield:
19:24
Always,
Andy Stansfield:
19:25
Yeah, my whole presentation is always about. Here are all the different options we can do, starting from the basic options of do you keep traditional Medicare and then perhaps just add what they call a supplement to that as a policy that just pays for the cost that Medicare leaves open to you called a Medi gap easy. Or is it better to go with a private insurance company that is now administering all of your? They're paying the claims for, for your, health care needs and you're you're working through an insurance company to get that. I always go through: Why do people choose one over the other?
Andy Stansfield:
20:01
And I try to like leave it in the in the hands of the person I'm speaking to, like which sounds better to you. Here's what I, here's what my experience has been, but in the end it is your decision. I'm just here to educate you on on how how those two things work, how they can affect you positively or negatively one way or another. In general, most of the time it comes down to the first reason. I see why somebody would stick with traditional Medicare, maybe have a Medigap supplement type plan versus an Advantage plan. A lot of times it's a financial question, a personal financial question for that person. In general, your out-of-pocket expenses on a monthly basis is a little bit higher when you stick with traditional Medicare and a supplement in many, many cases. Outside of that then comes-
Dr. Michael Koren:
20:45
-and is that the trade-off?
Dr. Michael Koren:
20:46
That you have more freedom in the systems, would you say?
Andy Stansfield:
20:49
Correct?
Andy Stansfield:
20:49
Yes, yep. You're not working with an insurance company that has designated a doctor network to work within or anything like that. So a lot more flexibility. Comes with higher costs, less restriction, higher costs. That you know. Anytime there's some sort of insurance situation, I try to tell people that there's usually a give and take, if they're. If you're getting something in one place, you're being taken away in another. And this happens in all insurance you know so that's.
Andy Stansfield:
21:16
But that's kind of the whole part of the process is having people understand what are the differences between, you know, sticking with traditional or going with a private company. You know what are the pros and cons for you and your particular situation and you know, you're you're. Some people have no conditions, no, nothing to worry about, and they like being able to save money on a certain basis. Others really want that flexibility and freedom. Some people live in two different areas at the same, you know, throughout the year, and it's very difficult to maintain a plan with a confined network in one area. So all of those types of factors is what I try to go to to find the best solution for that person.
Dr. Michael Koren:
21:51
That's helpful and thank you for explaining that, sure. So let's go into an area of a little controversy. Sure, if you're up for that. Sure, we like to talk about controversies, So the truth is that there is a lot of hostility towards the insurance industry in the United States, and we were talking earlier about Luigi Mangione, who took out that frustration against the CEO of UnitedHealthcare, and the response to that's been interesting. I think most people are clearly not accepting violence as a way to deal with these issues. I think that's fair, but there's some, especially younger people that think you know, to some degree, maybe it's justified and that's an extreme case, of course, but maybe you can just talk about your experience. Do you get a lot of that? You're seeing a lot of frustration. How do you deal with it when people express those type of frustrations?
Andy Stansfield:
22:48
Yes, uh, I have seen... It's a really interesting subject because, obviously, being in this industry, you think like, well, am I, am I representing something that's good or bad for people out there? And it's a it's a constant question that I have. But then I usually come back to what are the real situations that I've come across, where I think a lot of it is just the lack of of overall knowledge of how do you pay for, how does anybody group of people pay for something that's a significant cost? And there's like the whether it's the law of unintended consequences. All these types of things happen.
Andy Stansfield:
23:24
The first thing I like to explain to somebody is all this is: is all right. If I came to you and I said I need a million dollars to take care of something, you'd probably want to know where that money is going. What's it for all of that? That's essentially what an insurance company is trying to figure out. At the same time, it's also a private company and they're there to make profits and everything, and so it's very easy for somebody to just think, well, they're only going to do this because it's for the money, you know, or they have to satisfy shareholders, or whatever those reasonings might be, but in maybe in actuality maybe its the insurance company to verify whether or not this is an expense that needs to be paid. A good example, just I can only go with like either personal examples or or like micro examples.
Andy Stansfield:
24:11
Uh, my wife had a emergency appendectomy stomach hurt for a few hours. Eventually we convinced her to go to the hospital. She was out of town. It turned into an emergency surgery the next morning, stayed in the hospital overnight. Everything went fine. It was, you know, great service, and all that. About three weeks later she got a complete denial from the insurance company.
Dr. Michael Koren:
24:31
Wow.
Andy Stansfield:
24:31
The entire process completely denied and the reasoning there, which is more than likely a maybe either AI generator, some sort of systematic way that the insurance company or maybe a computer in the insurance company determined that this was not a medically necessary thing. And, of course, being in the insurance industry, I had a little bit more clarity and I'm like it sounds to me that whatever information the insurance company got on that situation is not exactly what that situation was. And of course, when we're talking about it, it makes perfect sense. But you can also imagine somebody who's maybe not too knowledgeable about things. I got denied immediately.
Andy Stansfield:
25:10
I hate the insurance company because and I don't want, I don't know what to do about it I'm just very frustrated and I'll voice frustrations there. Of course, you know that that ended with just saying nope, something was documented incorrectly. We did have legwork to go through to make sure that we you know that the insurance company understood what the situation was, guess what it's, everything's covered and everything's fine. I think these types of situations happens a lot. It's it always happens in a in a very emotional situation Healthcare conditions, very emotional and the last thing somebody wants to do after dealing with the stress of of either themselves or a loved one going through something is. Now I have to worry about the financial side of this thing because of some entity out there, so you can just see how like a lot of emotions get you know, get flared.
Andy Stansfield:
25:52
And that's that's. I don't know if I've answered the question.
Dr. Michael Koren:
25:55
It's a fabulous example, and it's fabulous example and something like an appendectomy should be very clearly covered, Exactly yeah. But to your point, there's a lot of systems out there that don't work as intended. Right right, but I guess we could also point out the fact that insurance companies, by law, have to spend a certain amount of the premium on people.
Andy Stansfield:
26:17
Yeah, yeah.
Dr. Michael Koren:
26:18
And that's the vast majority. So their profit margin is a small percentage of the overall premium. Right, but it's going to be something, of course, right, but if they don't spend that, they have to give it back, as I understand it Sure yeah. So there are those safeguards in place, and then the other point I think is important for people to know about is that medical documentation is just very, very difficult.
Dr. Michael Koren:
26:43
Sure, and even with all these electronic medical records and other things, a lot of things get lost in the weeds or in the fact that people are just doing things quickly and putting something into a computer that may not get the right results Correct, and so I'm sure you spend a lot of time navigating all that.
Andy Stansfield:
27:02
Yeah, yeah. And if that happens, even with the customers that I work with it, you know I I like to have that open line of discussion. What's what's happened and then how? How can we figure out how you know where, where's the root of this issue coming from? And then how can I help that person get to a place where either they understand why and they accept the decision from an insurance company, or here's how to reposition what's happening there to the insurance company and get things what we need from them.
Dr. Michael Koren:
27:31
So how much of your work gets into that? I'm sure that's also a frustrating part of your job and probably something you don't necessarily get paid for. Correct, but somebody calls you oh, you sold me this policy and they turned down my appendectomy. What kind of policy did you sell me?
Andy Stansfield:
27:46
I would say it gets that intense all the time. But yeah, it's a good example of things Blessing and a curse. So it is very easy for somebody to just change their plan.
Andy Stansfield:
27:57
They get a phone call from somebody, change their plan and then now I've lost a customer. I might not even know if I've lost a customer, because if we're not communicating on a regular basis, you just may not know. Which, which is tough. So, you know, do I want somebody calling and talking about an asset? You're right, it is. It is not something I tech, you know, technically get paid for. I'm compensated to help them get into the plan and all that. But a lot of the I don't know what do you call it social work or something like that, that that goes into. But a lot of the I don't know what do you call it Social work or something like that, that that goes into. That kind of comes with the territory. You know I'd much rather have somebody ask how to handle that, because that means they're calling me first and they're not just calling somebody else and I'm just losing. I'm just losing that as a as a customer for myself.
Andy Stansfield:
28:38
So can it be frustrating at times, of course, but again, I'd rather have that than not have that, because then there is no reason to be an agent anymore at that point in time.
Dr. Michael Koren:
28:52
Well, it's a hard thing for people to understand we were talking about this before we got on air that the essential role for insurance is to allocate resources. And obviously, if all health care was free to everybody, then there would be an unlimited demand for it.
Andy Stansfield:
29:08
Right.
Dr. Michael Koren:
29:08
Yep, and it gets into a lot of really interesting issues about is health care truly a right? There's a lot of discussions about that, but I argue. When people tell me that health care is a right, especially if it's a doctor, I'll say, OK, well, if health care is a right and you're a dermatologist, I want you to look at my skin right now. Right.
Announcer:
29:27
Yeah, and I have a right to this Exactly.
Dr. Michael Koren:
29:32
So it gets a little complicated, but at the end of the day, we don't have the resources to provide everything for everybody and we have to have some mechanism in place to do that
Andy Stansfield:
29:41
Right
Dr. Michael Koren:
29:42
And I'm sure you have those conversations more than once.
Andy Stansfield:
29:45
Sure.
Dr. Michael Koren:
29:47
With your people.
Andy Stansfield:
29:47
Yeah, yeah. A lot of times it's just somebody just wants the assurance that they'll be taken care of if something happens.
Dr. Michael Koren:
29:56
Right
Andy Stansfield:
29:56
You know they just want that and they want the assurance that they'll be able to do this with somebody they already have a relationship with. You know a physician they have a relationship with, or a hospital system or whatever it is that you know. That kind of checks their boxes. You know that sort of thing. It's funny I don't really get a whole lot of. Is healthcare a right or not discussion when it comes to that, because the vast majority of people I'm working with just kind of already accept the fact.
Andy Stansfield:
30:21
I just have to have some kind of coverage. Man, I need to have something. So I'm not, I don't go broke, which is a challenge, it's just the high cost. It's interesting about the you know the mechanisms in place to sort of protect. When we talked about the insurance company have to spend a certain amount of the premium on somebody's healthcare. I think that's great. I think there also could be some tweaks to that and the fact that, well, if that is the case, then what's stopping both the physician side and the insurance side from just raising their costs? So if you're limited to a 5% profit as an insurance company, but now your 5% of $100,000?
Andy Stansfield:
31:00
is now $200,000, all right, well, and I think that that's just going to happen, because this is where we're at Right.
Dr. Michael Koren:
31:08
You use the word unintended consequence.
Andy Stansfield:
31:10
Right.
Dr. Michael Koren:
31:11
Yes, and that would be unintended consequence so you want to quote, protect the public that the insurance company is actually using the premium Right. On the other hand, then it's an incentive to increase the amount of resources being used.
Andy Stansfield:
31:25
Yeah, and we, and we we're even just discussing all of these kind of intricacies in how how this is handled for, you know, to provide health care for for everybody out there. Um, you see, there's just how many misunderstandings there are on both sides and how easy that can spark somebody from going to the crazy lengths of the Mangione guy. Like, I don't know that that's going to solve anything. I'm sure it brings up lots of discussion.
Andy Stansfield:
31:50
You know, it seems to me that the, what's called... prior authorization so that's like a big word in insurance is basically hey, we have to run this by the insurance company to see if they're going to pay for this particular service. That's where the insurance company needs to know is this a justifiable expense? Because we can't just have everything for everybody at all times, unlimited demand, but that function of an insurance company, that is what gets misconstrued into all sorts of things Death panels, and I have to assassinate this person. And it, because it's not really widely understood. It can easily flare up in all sorts of all sorts of different ways, which is why I try to go back to one person, to one person.
Andy Stansfield:
32:34
If you needed a hundred thousand dollars from me, I would probably want to know where that money's going and what's it for. And do you really need that, or do you not just like a? That's like a natural human thing, you know? So I don't know if that's going where we need to go, but that's kind of-
Dr. Michael Koren:
32:48
It's interesting and these are very complex problems but,
Dr. Michael Koren:
32:52
my editorial comment to that is I don't actually believe health care is a right, but we do have a right to choose health insurance.
Andy Stansfield:
33:03
Sure, yeah
Dr. Michael Koren:
33:03
Okay, so we should have the right to freely engage in commerce that will ultimately protect ourselves, and we're thankful for people like you to help us navigate an extremely complex system. So the last thing I want to get into is really our core mission here at MedEvidence! So MedEvidence! is medical evidence and we believe that there are truth behind the data. There's a lot of information that we generate here, running clinical trials and looking at the safety and efficacy of different drugs or devices or procedures, and I've always thought that we can use that same model to look at healthcare systems. So does a system that is an HMO type system, which is highly controlled do better than a system where it's more fee for service with co-pays.
Dr. Michael Koren:
33:50
you know, as a very simple example and I think similar things can be done when you look at expensive drugs. So I think there's sometimes a lot of frustration, anxiety, anger about the fact that you get these drugs that sometimes are just incredible in terms of the technology behind them, but that you can't access them because they cost too much and the insurance companies are telling you that it requires an outrageous copay. So I've always wondered if you can set up systems where people could make their own decisions about that, in terms of how much they want to spend for things that would be the latest and greatest. That would be far more expensive than a generic product.
Dr. Michael Koren:
34:30
And how do you do that cost sharing and actually study it in a research environment? Yeah, so again, just broadly, have you seen data on these type of things, on these systems? Does that? It may not impact you much on your day to day, but, um, I'm certainly fascinated by that and and I wonder if there's a role for people doing what you do as part of that
Andy Stansfield:
34:52
Yeah, uh.
Andy Stansfield:
34:53
So I I would say, I personally, I've not really come across any uh sort of any data or whatever on on, uh, the efficiency of an HMO type system versus just your traditional fee for service. Outside of that, I think there's probably a lot of anecdotal. You know this works great, but in other situations it doesn't. I definitely think that is a valuable thing that you're talking about to determine, you know, are the systems we have in place; Is that still working the way that we hopefully intended it to work 30 years ago? Probably the only example I can think of is I have a lot of the elder customers that I work with. If they're old enough, they remember when an HMO first started, and an HMO at that point was-
Dr. Michael Koren:
35:39
-and that's Health Maintenance Organization,
Andy Stansfield:
35:41
Yes maintenance Health Maintenance Organization.
Andy Stansfield:
35:42
Which the idea there is can you manage the health of somebody to keep them as healthy as possible for as long as possible, so they don't end up in a very expensive area of care, right? But I think previously-.
Dr. Michael Koren:
35:53
And control cost and control access is part of that. Yes, yeah.
Andy Stansfield:
35:55
Yeah, think about it. I'm giving you a chunk of money to take care of me. You got to manage that budget of money. That HMO did that, and the only way to do that is the only way to know how to control it is to know where that, where I'm going to, you know, get my health care. Um, I think or like just kind of going back to the need to determine what's more efficient or not is HMO's
Andy Stansfield:
36:16
To begin with it was a good idea on how to control costs, like hey, I, you know, I'm, I'm not going to go over this amount of money for the year if I'm the one providing money to take care of people. But there wasn't anything else in place. It wasn't like well, how are these people even staying healthier, are they not? There wasn't a lot of those things. And so HMOs at that point just said well, it's much easier to keep as much money as we want, as we can, if we're dealing with only healthier people that don't have any issues.
Andy Stansfield:
36:46
Well, that doesn't work for everybody either. So, even along the way, that's had to change. And now there's a lot of quality measures put, you know, put into place, and HMOs or any other type of organizations that's managing healthcare costs has to prove that they're doing all the things to keep their people healthy. I think there's a long way, a lot further we can go on. What are the systems that could work? And I imagine research would be probably the only way to do that, and it's a long-term research thing.
Andy Stansfield:
37:17
It's not like.
Andy Stansfield:
37:17
You can't do that overnight. You have to see across the life of somebody's experience with the healthcare system and did they turn out okay or not? What is okay, what is not?
Andy Stansfield:
37:26
A lot of those kind of questions I think would be good.
Dr. Michael Koren:
37:27
Yeah, it's interesting. So there are different sensibilities in healthcare compared to other things. So obviously, healthcare is a basic human need. Housing is a basic human need, sure, yeah, but we're very comfortable with the capitalist system in housing. So you can buy a $100,000 house, you can buy a million dollar house, or you can buy a $100 million house and they're all shelter and we're okay with people deciding how much they want to spend on their housing, but we're really not okay with that in healthcare as much. Yeah, and maybe we need to think about that paradigm in housing and how that could apply that everybody gets the basics, but somehow then you use the capitalist system for that resource allocation beyond that, sure, yeah yeah.
Dr. Michael Koren:
38:11
That's my two cents. For me, I got it. And now, Andy, this has been delightful. Is there anything else you just want to tell the MedEvidence! audience on this topic.
Andy Stansfield:
38:20
Well, first of all, I just appreciate the opportunity to come chat with you guys. This is great. I mean, I would just say in the spirit of our conversation is there's always more to the situation than you might see on the surface. So if there is a frustrating situation in your healthcare, just take a moment, step back and there's typically going to be some sort of actual explanation. Um, whatever's happened to you has probably happened to many, many other people in the past, whether it's good or bad, and there is an answer for it. You just got to find what that answer is and then, uh, and then you'll know. You'll know what to do from there. So hopefully that will help contain, you know, any sort of maybe unnecessary rage out there, things like that. There are answers. You just got to be calm enough to try to figure out what those are and you'll find yourself in that situation,
Dr. Michael Koren:
39:13
So you haven't had to travel with a personal security detail as of yet.
Andy Stansfield:
39:16
Nope, nope.
Dr. Michael Koren:
39:17
Well, that's good, You're a good guy.
Andy Stansfield:
39:19
I'm on a podcast now, so I don't know,
Dr. Michael Koren:
39:21
Andy, you're a good guy
Dr. Michael Koren:
39:22
Thank you for very valuable information. I learned a lot from you. I appreciate you being part of MedEvidence! and best of luck with your business.
Andy Stansfield:
39:28
Appreciate it. Thanks, my friend.
Announcer:
39:31
Thanks for joining the MedEvidence! podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
