Ep. 16: Senate's $3.3 Trillion Healthcare Debacle: Dr. Bricker Breaks Down the Dismantling of Medicaid

Dr. Eric Bricker returns for Part 2 of our analysis of the "One Big Beautiful Bill" and the timing couldn't be more critical. Just as the Senate moves toward a final vote, the nonpartisan Congressional Budget Office reported Sunday (6/29/25) that the Senate version would add at least $3.3 trillion to the national debt over the next decade.

 This internal medicine physician and founder of AHealthcareZ (400+ healthcare finance videos, 100,000+ subscribers) delivers his signature straight-talk analysis on what will be the most earth-shattering healthcare legislation in decades. Dr. Bricker exposes how this bill would strip Medicaid coverage from 11-16 million Americans while dismantling the state funding mechanisms that keep safety-net hospitals alive.

 Dr. Bricker and the VHV guys discuss:

•  How "provider tax safe harbors" being cut from 6% to 3% will trigger massive prior authorization increases

•  Why hospital systems will face a "double squeeze": less Medicaid revenue AND higher debt refinancing costs

•  The brutal politics behind using patient care as a "political pawn" to fund tax cuts

•  How charity care programs could become the only lifeline for millions of Americans

•  Why even Republican senators are questioning these Medicaid cuts

 Dr. Bricker's urgent message to physicians: "The age of passivity is over. No one is coming to save you or your patients." He provides concrete actions healthcare professionals can take locally while this legislative earthquake unfolds in Washington.

 From work requirements that target caregivers to state-directed payment caps that will bankrupt safety-net hospitals, this episode breaks down thousands of legislative pages into what every healthcare leader needs to know before the Senate votes.

Introduction and Guest Welcome

Welcome back to Value Health Voices. This is the second of our series of two episodes with Dr. Eric Bricker. For this episode, we’d like to start by having our listeners imagine the bill that is working its way through Congress right now. It is in the news every single day—the so-called "big beautiful bill." Imagine that. It could actually leave about 11 million to as many as 16 million people uninsured. It could slash, according to the nonpartisan Congressional Budget Office, nearly $1 trillion in federal healthcare spending over the next decade while dismantling a number of tools states use to fund their Medicaid programs, which, as we talked about in our previous episode with Dr. Bricker, is the healthcare coverage mechanism for low-income people.

This week, we are excited to have him back to dissect both the House and the Senate’s proposed budget reconciliation bill. This really would be, if it passes, what you might call a legislative earthquake. It threatens to end a number of things, including the state-directed payments that we covered in the last program. It would also have impacts and changes even to Obamacare or the ACA, which passed during President Obama's tenure in the White House. Our role in this episode is to try to translate what is thousands of legislative pages into a clear idea for you all about what this bill means if enacted.

Amar, for those listeners who had not tuned into last week’s episode, Dr. Eric Bricker is with us as our guest, and we are big fans of his. He is an internal medicine physician, healthcare finance educator, and founder of AHealthcareZ, which is his content shop where you can find over 300 healthcare finance instructional videos. He has over a hundred thousand followers on both LinkedIn and YouTube, which is how we found him and have learned from him over the years. We are very excited to have him back on.

Awesome. Thank you, gentlemen, for having me, and thank you to all the listeners for tuning in.

Impact of Budget Reconciliation on Medicaid

We talked quite a lot about Medicaid in our previous episode with you. Let’s get right into the GOP budget reconciliation bill and what its key healthcare proposals are.

Big picture, it is a massive decrease in spending on Medicaid. I am not a political expert or a political strategist. I'm not saying that those decisions to slash Medicaid are justified or unjustified. There is a diversity of opinions about that amongst doctors and hospital administrators. It’s totally fine to have whatever opinion you want. But to Anthony’s point at the beginning, this massive decrease in Medicaid funding would result in estimates of around 10 or 11 million Americans that are currently on Medicaid subsequently losing their Medicaid coverage as a result.

It would do a number of things. I also mentioned the ACA; it would cut subsidies that folks who are on the lower end of income use to purchase their insurance on the exchanges. It would shorten enrollment periods. There are some obstacles put in here that really prevent individuals from going through the mechanisms that they currently go through to get their care. I think it’s important that we say this because this has been plainly stated: this is not the opinion of Amar, myself, or Dr. Bricker. A key objective of this bill in cutting these costs and taking the funding out of the Medicaid program is to offset, I guess we can call it, making permanent the tax cuts that were passed in the first term of the current president, President Trump.

Real-World Impacts on Public Hospitals

Specifically for the clinicians and the hospital administrators who are watching this, in terms of how this would directly impact your patients, your practice, and your hospital system, there is another book that I could recommend. Anthony, in the previous episode, you mentioned The Hospital by Brian Alexander. Fantastic book, highly recommend it. There is another book called The People's Hospital about Ben Taub in Houston. Ben Taub is the large county hospital in Houston. Chicago has Cook County Hospital. Back in the 90s, there was a show, ER, and that is kind of where George Clooney got famous. That is actually partly where I did my training, at Cook County Hospital. That’s the big hospital in Chicago.

Then there is Bellevue and a whole bunch of these others, like the famous Jacobi in New York City. There is Grady Memorial in Atlanta. It was super important for Ben Taub when their patients were coming in that they would put them, if they were eligible, on the "Harris Health Plan." If you remember back to the previous episode, this is one of these Medicaid managed care organizations. The Harris Health Plan would get money from the state of Texas. The state of Texas would get money from the federal government, then give it to the Harris Health Plan. The Harris Health Plan would then be the insurance card for the people coming into Ben Taub Hospital.

It would allow these patients to get access to—I'm speaking with a couple of radiation oncologists—a lot of cancer care that they otherwise would not have had access to. This is where, literally, if that federal funding gets reduced, a lot of the times what happens is people will come into the hospital and they’ll be taken care of because they typically come in through the ER. There is this rule called EMTALA that says the hospital has to take care of and stabilize a patient regardless of their ability to pay. But the problem comes in the follow-up, either at discharge from the ER or at discharge from the hospital. If you have to be hospitalized and you don't have any sort of coverage at all like Medicaid, then your follow-up is essentially zero.

This is where in the book The People's Hospital, there were people that they could not get on the Harris Health Plan Texas Medicaid program, and so their follow-up plan was essentially nothing. There was one woman in the story who was a burn victim and she didn't need hospitalization anymore, but she needed massive outpatient care for her burns. Couldn't get it.

Analyzing Medicaid Work Requirements

It is definitely on my to-read list this summer because it sounds very interesting. To your question, maybe we can go step by step because it’s such massive legislation. We can start with the work requirement. The House bill had a work requirement and the Senate bill expanded on that work requirement. The idea behind it is that if you are decreasing funds, the way to not decrease services is maybe make fewer people eligible for those funds. If you change the eligibility requirements, shrink them, and introduce a work requirement, then there will be fewer people eligible. The Senate bill requires parents of children over age 14 to be working in order to receive Medicaid, which is expanded even on the House bill.

I will add one thing to that. The House bill said a Medicaid recipient needs to work 80 hours a month to satisfy the work requirement and that you would be exempted from that if you had any child of any age. The Senate bill left the number of hours alone but said if your kids are older than 14, no exemption—you have to work.

Is Healthcare a Right? The Physician's Perspective

Ultimately, again, this podcast is not going to solve this issue, but do the American people believe that access to healthcare is a right or not? In my opinion, that is what it ultimately comes down to. There are absolutely doctors in America that think that healthcare is not a right. That’s okay. I am not judging them. Obviously, the majority of doctors in America would think that healthcare is a right, but there are physicians who do not. The important thing to keep in mind in their arguments is that the ability for an individual to engage in self-destructive behavior is limitless. How in the world can we expect to ask people to pay for other people's self-destructive behavior?

Anybody who is a doctor has seen people engage in massively self-destructive behavior. How do we finance that? I don't know. I don't have the answer to that. I remember very clearly when I was an intern in California. There is a very extensive program in California to make sure that anybody with HIV or AIDS can get their medications and can have help to take them correctly. It was incredible the extent to which patients, despite those tremendous services, would still not avail themselves of it. That would be presented again and again to the hospital for long, complicated admissions. I remember doing a lumbar puncture about 30 times to one patient during my internal medicine rotation as a result of his cryptococcal meningitis which developed from not taking his medications.

Anybody who has gone through residency or is a practicing physician knows this. What do hospitals have? They have a smoking lounge. What do patients do? They go down to the smoking lounge with their IV pole smoking cigarettes. There are drug dealers in the smoking lounge because it’s outside. Selling drugs in the smoking lounge. You come back and your patient is gorked out of their mind. You have to give them Narcan because they were doing drugs in the smoking lounge. It is impossible.

Caregivers, Vulnerable Populations, and Charity Care

I guess the counter would be the other group of physicians, medical societies, and the American Hospital Association who do believe healthcare is a right to some degree. They say that with this work requirement, people obviously are not going to get care. What is interesting about the work requirement, and what people don't realize, is a lot of the population that is not working fits into a specific group. It’s not people who can't work necessarily because they're not physically able; it’s because they are women taking care of either elderly parents or young children. That’s the largest group of people who might end up being affected by this work requirement and end up losing insurance. Some of them are the sole providers for their family's insurance. Entire families could lose insurance because someone is trying to take care of their parents or young children.

This is where I have seen a practical solution to this problem. I am in no way implying that people with low income are all on drugs; that previous example is obviously for a very small percentage of people who engage in that behavior. There are going to be families of low income where they are going to lose coverage. Often there are a number of circumstances, whether it is health-related or because they have to be a full-time caregiver of an early dementia family member who has total needs in their activities of daily living. You’ve got a single parent in many cases who is stretched in a multi-generational family. They’ve got their mom or dad that has Alzheimer's, plus they have their child that might have a congenital illness. They quote-unquote "could" work, but they can't because their work is being a full-time, unreimbursed caregiver.

We've all seen those patients. What I have seen happen is that when they don't have insurance—because of course we all practiced medicine before the ACA, and there were gobs of uninsured people—a hospital system had a very astute and organized charity care process where the individual and their family could receive healthcare in the absence of health insurance. Not just inpatient care, but outpatient care and follow-up visits. They had specific rules around income and assets. If you met those requirements, you would get your care at that hospital system for free. The hospital systems that sincerely wanted to make their care available to people who did not have insurance coverage worked.

On the flip side, there are other hospital systems that have very disorganized charity care programs. There are also hospital systems that do not advertise or promote their charity care programs in any way, shape, or form. As an uninsured, low-income patient, you essentially were rolling the dice. As an internist, I will tell you that one of the things about patients without health insurance is that if you are a low-income man with no kids in a lot of places, you are not going to get health coverage. It’s not going to happen.

I had a patient once who was a 22-year-old guy from Louisiana. He would come into the ER all the time. His platelet count was 4,000. Everyone was doing a work-up, but no one could ever figure out why. He would bleed for a while and then he would be left out. That guy is not getting Medicaid. Platelets of four, he’s not getting Medicaid. That guy needed to be on the hospital's charity care program.

Why am I saying this? I don't expect any physician or hospital administrator to individually have power over the "big beautiful bill." We’re not close to Washington, D.C., necessarily. But we can affect change locally and we can affect change within our own hospital system's charity care program. We as physicians can educate our own patients about the hospital's charity care program. I'll be honest with you, the hospital administration might not like us telling our patients about it, but it's very important. We became doctors to help patients. I did not become a doctor to help other doctors or to help hospital administrators. Sometimes helping patients means pissing off your fellow physicians and the hospital administrators. You have the power to do stuff. Your power is not to lament the big beautiful bill in Washington; your power is to help your individual patient sign up for the charity care program at your hospital.

Proposed Changes to Provider Taxes

That’s a great message. I knew that starting off with the work requirement part of all this discussion would be provocative because there are so many nuances to it. The two of you covered them beautifully.

Another aspect of this bill, perhaps not as provocative as the work requirement but still important, is the domino effects. The next one is how these proposed versions of this legislation would affect the provider tax issue. Just to remind our listeners, we spoke about this in the prior episode with Dr. Bricker. One of the key mechanisms at the state level for states to be able to have enough money for their patients is by paying into a tax. The hospitals pay into it, perhaps nursing homes or other entities. The federal government takes those funds, increases the amount of money—doubling it in some cases—and then sends those monies back to the state to help fund the program. The House bill said we are going to ban new or increased provider taxes, but more or less keep the ones that already exist.

This is a theme here now that we’ll cover a few times. The Senate bill goes much further. It does something very interesting regarding a component of provider taxes called the "safe harbor." Let's say a big hospital system had total revenues from patient care of $10 million. If the amount of tax you paid was up to 6% of that $10 million, and that was the way the state operated the program, the federal government would ask no questions. That’s a so-called safe harbor. But what the Senate wants to do is ratchet that down all the way to 3%. All this is meant to be pressure on the funding mechanism so that the federal government has less exposure to money coming out of the federal treasury to fund the Medicaid program.

Let's walk that through and say that passes. What would that look like for a particular hospital system or a particular physician, whether you're in Washington, Maryland, or Ohio? If that were to happen, then the overall pool to that state would go down. Most of that money is going out to the managed care organizations (MCOs) that the individuals are signing up for. Let's use round numbers: say it is $800 per member per month that the managed care organization is getting. Now, as a result of this, maybe they're only going to be able to get $750 per member per month. That means the managed care organization is going to need to ratchet back down their reimbursement to the docs and the hospitals.

Those contracts between the MCOs and the hospitals take a year and a half to negotiate. They don't renegotiate them every year; usually every three to five years. If this passes, the reimbursement doesn't magically change overnight. They don't have a clause that says, "If they pass the big beautiful bill, we're just going to automatically decrease your reimbursement by 6%." It’s still going to be 30 bucks or 60 bucks a visit. But they use prior authorization like a rheostat to closely control payment.

These MCOs have medical loss ratios (MLRs). In a lot of states, just like for ACA plans and Medicare Advantage plans, it's 85%. Interestingly, in other states, it's 88% or 90%. You better believe that they are going to then dial their prior authorizations to closely match their MLR in that $750 per member per month rate as opposed to the $800 rate. What you as an individual hospital and physician would likely see is a higher denial rate on your services requiring prior authorization.

Anticipating Increased Claims Denials

To Anthony’s point, you will see denials after service. The insurance companies are just going to deny the claims. Major insurance carriers have effectively said, "We're just going to deny every third claim. If the hospital system or the doctor resubmits it, we'll pay it, but we're going to pick every third claim and deny it because we can." Your denials are probably going to go up.

Lastly, they are also likely to delay payment. Often the accounts receivable for an individual practice or hospital system is 30, 45, or 60 days. You submit the claim on July 1st, you’re not going to get paid until September 1st. They might extend that out to September 15th or October 1st. Those are going to be the subtle changes. The insurance carrier, your partners, your patients, and the politicians aren't going to tell you that. But as a clinician, especially if you work in oncology, that is probably what you are going to see.

They are kind of going to be doing a lot of the same techniques that Medicare Advantage is doing. Once again, to counter that, hospitals or provider groups will have to hire more administrative support to navigate further denials and claims management resulting from these provider taxes. I will say, it’s not unanimous in the GOP. There have been Republican senators who have also been a little critical about these changes to provider taxes, such as Senator Hawley.

State-Directed Payments and Political Power

I did want to transition and talk about some other aspects. One is the limits on the state-directed payment programs that we spoke about in the previous episode. That is how the states drive money to the providers along with other forms of supplemental payments, whether they be disparate care payments or payments for undocumented immigrants. Some states that are expansion states can get up to 90% of the federal match, and some of that money goes to undocumented immigrants. Those states would have their match reduced to 80%. In addition, the state-directed payments would be capped at a max of Medicare rates in those expansion states, and to 10% over Medicare rates in those non-expansion states.

Before you jump into that, Dr. Bricker, I wanted to call out the part in the previous episode on state-directed payments. I’ll say mea culpa, I singled out a couple of states. The reason I did that is not because I have anything against Tennessee or Washington, but because the state-directed payments in Tennessee have gotten the Medicaid reimbursement rates up to like two times Medicare. Even higher—up in the commercial range. What Amar just went through is that this bill would end all that.

This is the tricky situation where, if there is another healthcare book recommendation—I don't read these books, I listen to them on audio. If you're a physician or a busy professional, get an Audible account. Use your time in your car to listen to these books because you don't have spare time. The Hospital is available as an audiobook, The People's Hospital is available, and then the other book is called Rules for Rulers. It is all about political power, written by an NYU professor who is also part of the Hoover Institute at Stanford, Bruce Bueno de Mesquita. He advises major presidential candidates in America, politicians in foreign countries, and the CIA. He is the world's foremost expert on political power.

Anytime we talk about federal funding for healthcare, it is important to keep in mind that this is an exertion of political power. A politician is not going to come out and say, "I am using these funds to gain or maintain political power." They're going to say, "I'm doing this to help people." By the way, he consults with conservatives and liberals; he'll take your money regardless. But the politician playbook is to gather the resources—the money—and give that money to people who can help you.

When you as a politician are trying to give out money to state programs, it is because you want to ingratiate yourself with those people. If you are subsequently not giving money to state programs because you are decreasing taxes, it is because you're trying to ingratiate yourself with the people who were paying the taxes. As a physician, the reason this is important is because it helps to understand that the financing of the care for your patients is a political tool. Your patients are a political pawn in that process. We as physicians are too.

I’ll give you a specific example of that because I can speak about it personally. In Illinois, at Cook County Hospital, it was the joke amongst the physicians: "Don't ever order any tests on Election Day because all of the employees at Cook County Hospital will be voting." They will not be at work because they were voting for their jobs. They wanted to make sure that the taxes in Cook County that paid for their jobs were supported by the candidates running for office. So do not order an X-ray or an MRI on Election Day because you will not find an employee in that hospital to do it.

That is so interesting. Just know generally, when it comes to political funding, there is the reason that sounds good and then there is the real reason. We can definitely link to these three books in the show notes.

State Budget Trade-offs and Resource Allocation

One of the things about this too, thinking about all the pieces on the board and the downstream consequences: if we think about the impact to state-directed payments, FMAP, and other supplemental payments, all of this is decreasing the amount of funds that states have at their disposal to fund the Medicaid program. Sadly, what is going to happen is the states are going to be forced to compress and fund less of the other things they pay for. Those things are education, roadway funds, and other infrastructure. KFF just put out a great survey that they did before the Senate bill came out; only 35% of Americans they surveyed supported the bill. I have a feeling that support would go down if you said, "Funds for your schools and roads are going to be cut."

To a certain extent, the positive thing that would come out of that is: do you know what one of the state's major expenses is? The health insurance for their own state employees. You want to talk about waste? Maybe the states would actually do something to run their own state employee health insurance program more effectively.

There was a state that did that. Mitch Daniels did that in the state of Indiana. They dramatically reduced the cost of the employee state plan in Indiana. And guess what they did with the money? They served the people of Indiana. Shocking.

I've never lived in Indiana, but you bring it up as an example of good government in the United States, an example that approximates the kind of government you see in some Scandinavian nations where they have good governance ingrained in their culture.

It’s like pain causes change. One of the things physicians are very good at is we are very good autodidacts. We can teach ourselves and we are resourceful. It is not the wind, it is the set of the sails. Whatever the policy wind is—conservative or liberal—let's say the bill passes. Guess what happens in four years? They might do something completely the opposite way. The issue is the set of the sails of each individual physician and what you are going to do about it. What can you do in your immediate locus of control within your practice, with your partners, and with your patients to affect change specifically there?

There is a huge list of things you can do as an individual to improve patient care that is beyond just, "I'm your doctor and I just want to see patients." Let's get you involved in the hospital's charity care program. Every hospital administrator in America is going to hate me for saying that, but that is one of the number one things you can do.

Medicaid Waivers and Value-Based Care Models

If this does get struck down, I think that brings us to an interesting topic about the Medicare/Medicaid waivers. States right now have mechanisms, like in Arkansas with the work requirement, using these waivers. There is the 1115 waiver, where they have flexibility to create different restrictions as long as it is budget-neutral. Then there is the 1915 waiver, which can apply to managed care, where you can limit provider choice similar to utilization management. These waivers can still help contain some of these costs, which is the justification for this bill.

These waivers are essentially around states trying to do innovative programs. Ultimately, in terms of providing better patient care that is lower cost, there are hospital systems that are engaged—whether with the states or with the managed care organizations directly—where they are essentially taking on risk for that Medicaid population. Instead of sending a bill and going through prior authorization, they say, "Look, we're going to take care of a thousand Medicaid people and you're just going to write us a check for $20 or $30 million for the year, and we're going to take it from there."

They are saying, "Instead of trying to more efficiently treat the disease that's coming in through the ER, let's create community-based programs that prevent people from coming into the ER in the first place." Anthony, you and I have talked about this before. This is where the Ochsner Health System, based out of New Orleans but across Mississippi and southern Alabama as well, has essentially left the four walls of their hospital system. They've created programs where the hospital employees themselves are doing home visits and they've got a huge nursing call center making outbound calls.

It’s not that they are trying to take care of the same number of patients coming into the ER; they're actually trying to keep people out of the hospital. You said something very important previously, which is that it changes the quote-unquote "heads in beds" model. Because the hospital is getting a fixed $20 million for these thousand people, if the head is in the bed or not is not what the hospital cares about. The hospital wants to keep people healthy because that way they keep a larger amount of that $20 million.

It’s the famous Peter Drucker line. There is nothing more inefficient than trying to more efficiently deliver services that shouldn't be delivered in the first place. Let's not try to do more efficient CHF discharge planning; let's kick the CHF people out of the hospital, period. This has been done already. That required tremendous leadership at Ochsner to tell the physicians, nurses, and staff that they needed to change. That is very hard to do at most hospital systems in America because they are so large and, interestingly, they do not have an organized chain of command. If you go into hospital administration and ask "Who is in charge?", it’s actually hard to answer. Physicians will say, "I got three bosses and I don't know who my real boss is."

Hospital systems have a very hard time changing because they are large and they are more like loose confederacies—like America before the Constitution. They have Articles of Confederacy as opposed to a Constitution where there is a president and Congress. We all think, "Oh, well, this all makes sense." No, hospitals don't work that way.

You have a much more compelling way of saying it than I was going to. They have 47 different ways to do the same thing. No standard work. How can you ever learn and get better if nobody knows what standard is being followed to get from A to Z? As long as the outcome is okay, that's fine, but you forfeit the chance to learn anything. As physicians, we need to be involved in changing that. That is not somebody else's job to fix.

National Debt and Interest Rate Implications

One of the analyses of this bill that really caught my eye involves two components. One is that the funding cuts to Medicaid would particularly hurt states that happen to be poor and states where there is a plurality of voters who support the Republican base. That’s just political commentary. The other thing I find more important is the analysis of the numbers: cutting Medicaid expenses, making permanent the tax cuts—a little kicker to the economy, maybe a couple tenths of a percentage point on GDP—in exchange for a $2 trillion, maybe as much as $3 trillion impact on the debt. The question is, how do we deal with that?

On this issue of healthcare finance intersecting with overall public finance and public debt, it’s like "boring squared," so hold on to your hats. When the overall debt rate goes up, that essentially increases long-term interest rates. The ten-year Treasury is the benchmark for that. The Federal Reserve does not set the rates for the ten-year Treasury; it’s a market for debt. Are foreign countries going to buy our debt or not? The more debt we go into, the less attractive our debt becomes. Therefore, we have to pay higher interest rates to entice people to buy our debt. The reason the 10-year interest rate is so important is because that sets the rates for things like your mortgage. People were getting 2.5% or 3% mortgages, and now they are north of 6% or 7% because that 10-year rate has gone up.

Hospitals also have a ton of debt. Nonprofit hospitals have a ton of debt. The model for debt is not that you pay it back; the model is you refinance it. You get a new loan to pay for your old loan. In the early 70s, interest rates in America spiked to 20-25%. Over the previous 50 years, interest rates marched down to a low of 2%. Hospital systems could always refinance their debt at a lower interest rate. That works until they have to refinance at a higher percent. If I have to refinance at 6% or 7% instead of 5%, the interest payments the hospital systems have to pay are going up. They are going to get doubly squeezed.

Not only are they going to have less reimbursement from the scavenger hunt, but they’re also going to have lower overall margins because their interest cost is going to go up. As a physician, you are not going to change that. But you can set your sails. You’ve got this wind of higher interest payments squeezing the hospital. So maybe you could do things like identify the frequent flyers in your ER.

In Washington D.C., they did this. They had a group of about 75 people that would call 911 multiple times a day—like 720 times a year per person. What they did was they just parked a car in front of that person's house and said, "You need to go somewhere? We'll just take you somewhere." They found it was dramatically cheaper to just put a car in front of those 70 people's houses than it was to have them call 911 multiple times a day.

Physicians are creative. Typically, the ER doctor is like, "Look, I got my 12-hour shift. Joe’s in here again. Hey Joe, how you doing? You want a turkey sandwich?" Nothing is ever done about Joe coming into the ER. Maybe they would start to do something about Joe.

Conclusion and Future Outlook

That is a great analogy or at least a great connection to make to this whole discussion. We’ve talked about this bill at length with a number of great parallels from real-world examples. Is there anything we’ve left out?

I think one of the key summaries of this whole discussion is that the people who are doing well right now playing that scavenger hunt game maximizing their revenue are going to find new creative solutions. But instead of looking for ways for scavenging, it’ll be looking for ways for cost containment. We are going to shift from maximizing revenue to containing costs.

I agree. This is why the expansion of finance-related healthcare podcasts and content is incredibly helpful, and it’s being done more and more by physicians. Clinical content is great, but now we are getting out of our swimming lanes—which is exactly what we’re supposed to be doing—into these other areas because they profoundly impact patient care. We’re not going to talk about the ALLHAT trial and 875 patients randomized; we're actually starting to have discussions around money flows that are impacting patient care and things that we can do individually. What you two are doing with this podcast is incredibly important. All I can say is that it makes me incredibly optimistic about the future.

I appreciate those words. There are reasons to be optimistic. We really look at the work you do as a model for what we're trying to do. If you weren't previously a listener or follower of Dr. Bricker’s, go and find his content—AHealthcareZ on YouTube and LinkedIn. It’s great stuff.

Super. Really appreciate it, guys, and all the listeners. Thank you so much.