Episode 19: Direct Pay, Demoralized Doctors, and the Future of Healthcare - with Jessica Craig

Erik: Welcome to another episode of the Root Cause Business and Medicine podcast. Erik: And today's guest is Jessica Craig, a journalist, our second journalist that we've had on Davin. Erik: What were some of the things that you got from our discussion with her today? Davin: Well, I you know, this was a topic that we wanted to go a little deeper in, uh, in any case, which is around kind of that direct Davin: uh pay model, right?

Davin: And kind of what are some of the pros and cons or uh what what does that actually mean to different people. Davin: And so I thought it was really uh timely that there's a journalist out there raising awareness Davin: Helping people understand that there is an alternative model to the insurance-based practice, not only in primary care, but also for some of the specialists as well. Erik: Yeah, and I thought it was fun in our conversation about w where the future of business of medicine is going, right?

Erik: A lot of times we ask what's the future of functional medicine or integrated medicine. Erik: But today it was like, okay, well, how do we get this shift to happen where patients can get better quality of care, physicians can have better quality of life? Erik: And we have a better revenue generating model to cover it with insurance or not insurance, direct primary care. Erik: I thought all of those things came out and were flushed out with a very interesting discussion.

Erik: Definitely. Erik: Alright, we look forward to having you join us on today's episode. Erik: Welcome to the Root Cause Business of Medicine podcast. Erik: where we explore what's broken in healthcare and what we can do about it.

Erik: I'm Dr. Erik: Erik Lundquist and I've been practicing functional medicine for the past 15 to 20 years Erik: I'm excited to co-host this podcast with my brother, Dr. Davin: Davenlunquist, who's just beginning his journey into functional medicine. Davin: We come from different points on the path, but we do share a common goal.

Davin: We want to rethink how medicine is practiced and help others do the same. Erik: The US healthcare system is in crisis, rising costs, declining outcomes, and physician burnout at an all-time high. Erik: But you know, we found a different way. Erik: Another way.

Erik: A better way. Davin: On this podcast, we dive into real stories from medical professionals who've stepped away from the traditional model. Davin: Kinda like me. Davin: And have found a new purpose in integrative, functional, and alternative approaches to care.

Erik: These are authentic conversations with practitioners and friends who've redefined success, not just for themselves. Erik: but for their patients and communities. Erik: Whether you're a clinician feeling stuck, a student seeking direction, or just curious about what is possible, Erik: You're in the right place. Erik: This is the Root Cause Business of Medicine podcast.

Erik: Welcome back to another episode of the Root Cause Business of Medicine podcast. Erik: And today our guest is Jessica Craig. Erik: who is a health reporter for the Straight Arrow News, which is a relatively new online um news agency really dedicated to unbiased reporting Erik: And Jessica Craig has a background in infectious diseases, has lived in Africa for a period of time and is really kind of Erik: jumped into this um space of changing of medicine and and become passionate about really looking at at the scope of how medicine's changing Erik: And how new practices that seem to be popping up that seem to be thriving are all more in the cash-based model.

Erik: And so, Jessica, welcome to the podcast Jess: Thanks so much for having me. Erik: So Jessica, give us a little background on, you know, kind of how how you transitioned from infectious diseases. Erik: into reporting on the state of m business medicine and and kind of w what's going on in the cash-based med medicine world and Erik: And why that intrigued you in in and kind of lulled you into starting to write about that? Jess: Sure.

Jess: So I um worked for about a decade as uh an infection Jess: Diseases, epidemiologist and technical advisor for several US government agencies was at USAID last year when the agency closed down. Jess: Um, I'd always dabbled in journalism and I I felt really a calling at that time to give journalism, you know, my full attention. Jess: Um, I had just moved back to the United States after being overseas for a while and um I think you know it's no surprise to anyone that our healthcare system is really having a lot of challenges.

Jess: Um I think we're really Jess: facing a crisis on several fronts. Jess: Um and so I started reporting on our healthcare system and health policy and I was really wanting to explore viable solutions. Jess: I think Jess: broad political reform is probably not coming. Jess: And so I wanted to know from the physicians who are actually practicing medicine, what are some of the solutions they're excited about?

Jess: And this cash-based clinics, cash-based care model kept coming up from, you know, people of all different specialties. Jess: And so I I decided to really look into that. Jess: And um, you know, at first I thought Jess: That that sounds like a solution maybe only for a small portion of Americans, and I wanted to know if that was really true. Jess: Um, and one of our missions at Jess: straight our news is to really be bipartisan and and really explore solutions.

Jess: So I jumped into it and it was really interesting to find that it does seem like a great viable solution in some ways and certainly is taking off Erik: Yeah, I think it's really interesting how much this movement has really um taken place over the past several years. Erik: In fact, um it has tripled in the number of Erik: clinics that are that have adopted a direct primary care option. Erik: It's interesting to note that, you know, their estimates right now is that in Erik: 2035, the concierge medicine market will be around forty-six billion dollars.

Erik: And the other key uh fact that I found interesting kind of researching about this is that Erik: the dropout rate is significant and burnout rate in terms of physicians uh is w way less Erik: in those who adopt a more cash-based model than in those who are, you know, continuing to slug it out with insurance. Erik: Uh if you come across any of that kind of data or have you what what have you seen as you've kind of explored the market Jess: I think maybe from the outset I hear this question from a lot of people and there's maybe some confusion about what cash-based care is.

Jess: And I I think that's largely because cash-based care is not one thing. Jess: It's Jess: many different models that are starting to emerge. Jess: They all are, you know, founded on one central idea, which is, you know, basically that we need to get back to paying for healthcare services more directly, bypassing the healthcare industry Jess: So we see that in a few different ways. Jess: You know, we have direct primary care, which is becoming more common.

Jess: Um, you know, the exact models of how patients pay physicians varies from practice to practice, but one common one that I see is Jess: Physicians charge like a monthly subscription fee. Jess: You know, it's a hundred to a hundred and fifty dollars per month. Jess: And that covers, you know, unlimited number of visits to the clinic Jess: and all of the services that a physician can provide in a primary care setting. Jess: Um in direct primary care, we're definitely Jess: Seeing uh this is becoming more common.

Jess: I think the American Academy of Family Physicians, I believe, they do an annual survey and they found in the past four years of their members that the proportion of Jess: uh physicians who are in direct primary care has increased from three percent to eleven percent in just the past four years. Jess: And I was trying to get an estimate Jess: for my reporting of how many clinics out there are doing direct primary care and how many patients are they serving. Jess: And it's a little bit difficult to find concrete numbers, but my best estimate is there's probably twenty five hundred to three thousand cash-based clinics.

Jess: probably serving around one million Americans. Jess: So you know that's overall a pretty small chunk of the field. Jess: But there are also other types. Jess: of cash-based care.

Jess: We see specialty care, surgical centers, even some oncology clinics that are starting to pop up and they're entirely cash-based. Jess: Um, in fact, one of the um physicians I interviewed for my piece, Keith Smith, I'm sure you both know of him. Jess: He was definitely a pioneer in this field and he's an anesthesiologist who runs a surger surgery center in Oklahoma Jess: Um, so there's you know there's direct primary care, but there's also a number of specialty care uh clinics popping up.

Jess: Um and the you know the whole idea is again they don't accept health insurance. Jess: It's an upfront uh Jess: fee for a sp for a service. Jess: One of the hallmarks of these, which I find interesting, is that there is a transparent fee. Jess: You know exactly what it's going to cost when you walk in the door.

Jess: Whereas Jess: in, you know, sometimes walk into uh a doctor's office, you have no idea what's gonna what's gonna cost you. Jess: Um and then I'd say there's a somewhat dis Jess: distinct segment of cash-based care, which is more focused on longevity and optimizing health. Jess: And I I think of that a bit differently because I think it serves a slightly different patient population. Jess: and solves a slightly different uh problem with our healthcare um industry.

Jess: And you know, that's more for people who are looking for advanced diagnostics or performance focused. Jess: care as opposed to direct primary care. Jess: And so I don't think it's solving the same sort of access issue as direct primary care. Jess: But those are all those are three examples of uh like direct to consumer care.

Jess: There's also another trend of direct-to-employer contracting, which is when employers and companies again are bypassing health insurance and they're going to health providers directly and negotiating different contracts. Jess: Historically, you saw a lot of large employers doing this, Boeing, Walmart, Intel, Disney. Jess: Sometimes that was they went to a network of clinics and they negotiated a contract. Jess: Sometimes that was bringing a primary care physician onto their company campus to provide care.

Jess: But I think over time what we're seeing is as health insurance becomes increasingly unaffordable Jess: a lot of smaller companies are starting to do this too. Jess: And the latest numbers that I could find were from 2025 and they estimated that about 40% of large companies, so those are companies with more than 50,000 people. Jess: are entering into these direct negotiations with health providers. Jess: And just over 20% of small companies, which have fewer than a thousand employees, are starting to do this.

Jess: So Jess: I think when you take that all together, we're certainly seeing this is taking up a larger share of the market. Davin: What about um you know telemedicine as a segment of that? Davin: Did you look into that at all? Davin: I feel like Davin: Um, there's a lot of people that use low cost telemedicine visits as like their entry point or maybe their their own version of primary care.

Jess: Yeah, absolutely. Jess: It's telehealth, but it's also, you know, I hear from a lot of direct primary care physicians who just say their patients can call them on the phone with a question. Jess: At midnight, my child has an ear infection, so it's a lot of telehealth and it's a lot of just, you know, returning to direct communication with your physician Davin: No, I I agree. Davin: I think the direct primary care model is all inclusive, you know, um, certainly in this day and age post-COVID.

Davin: Um, but I also just wondered, you know, if Davin: the telehealth space was kind of in a way the first one to really broadly just have people pay directly, right, for a visit. Davin: Um and so I I just wondered if that was part of your analysis. Jess: Yeah, you know, I didn't find numbers on telehealth specifically. Jess: It can be difficult to find what models tell different telehealth companies are using.

Jess: Um and it's it it's difficult to find concrete numbers on all of this. Jess: Um so those are the best estimates that I can find in terms of trends. Jess: I definitely think we're seeing an increase. Jess: It's becoming more popular.

Jess: Um and I think we're also starting to see more research behind this too. Jess: So we'll probably have some better estimates of how big a trend this is. Erik: I totally agree. Erik: Well maybe break down a little bit more what what you've seen in terms of Erik: the different types of models out there from.

Erik: I mean, you you kind of gave us some broad strokes, but I think even even within, you know, the membership Erik: model sometimes people get confused like what's the difference between a DPC versus a fee for service versus a membership versus a concierge? Erik: uh versus, you know, a insurance-based membership. Erik: You know, I mean there's there's all these different maybe maybe break that down for us a little bit and what you've come across in your research and Erik: And it do you have any i i as a secondary question, do you have any uh background sleuthing that you've done to discover where in the world did we get some of these terms like concierge medicine, you know, things like that?

Jess: Yeah, you know, I think a a lot of physicians they're leaving conventional medicine and pursuing cash breaks, cornex, and I think Jess: Part of that is understanding the community that they're serving and understanding the best way to serve that community. Jess: And so I've heard all manner of unique ways of of tailoring Jess: payments and and fee for service care. Jess: I think that looks uh different depending on uh the physician and the clinic. Jess: I know Jess: Um, one clinic up in Wisconsin, you know, some some of their patients um they're in that gap where they they don't qualify for Medicaid, but they can't afford other health insurance.

Jess: And Jess: Sometimes they bring in chicken and eggs to pay their physician for services. Jess: So I really think there's a lot of flexibility and I think there's any number of different combinations and payment methods that physicians have come up with. Jess: And I think it's really about Jess: just understanding what works best for that physician and what works best for the patients that they're serving. Jess: You know, there's that direct primary care model, membership based, or um Jess: subscription based, what that what people call it.

Jess: Um but then I I think there's also when you talk about more concierge medicine, there is some element of health insurance sometimes. Jess: I think there's also, as I was mentioning, a big difference in what types of services physicians are providing from primary care all the way up to, you know, more longevity biohacking sorts of services we also see. Erik: Yeah, I know I've noticed that at least in some of the research that I've done too, that the the number one reason people seek out Erik: direct primary care programs is access to care.

Erik: Right. Erik: One of the challenges I think that we're seeing in medicine, and and I hear this from my patients, Erik: You know, okay, I referred you out to a neurologist and they can't get in to be seen for three months. Erik: Uh or even even, you know, if they want to come back in and and be seen by their primary care provider. Erik: Uh and they often end up having to go to acute care clinics or the emergency room, uh, because those clinics are so overburdened.

Erik: And a lot of what drives that is insurance reimbursement, right? Erik: At least I know in our own clinic, one of the one of the challenges that we've faced is that over the past ten years Erik: The amount of revenue that we get from insurance in terms of per visit hasn't changed at all. Erik: We continue to receive the exact same amount Erik: that we were paid in 2014 that we're getting paid today. Erik: But of course overhead has significantly increased.

Erik: So the only way you compensate by in uh in other words bringing more revenue in is to see more patients because insurance is still a volume-based practice. Erik: And so I think one of the things that that we're seeing is that part of what's driving this is the fact that that patients want better access to care. Erik: One thing. Erik: And then I think providers want to provide Erik: better care.

Erik: And you can't you can't give a patient good quality care in a seven to fifteen minute appointment, particularly if you're trying to to take a complex patient with multiple problems. Erik: trying to figure out uh what's going on uh i in their background. Erik: You just you can't get that. Erik: Is that what you're kind of seeing in your is your researching out is that kind of these two major driving forces of Erik: Patients wanting greater and better access and providers wanting to provide better care and actually have better quality of life in their practices?

Jess: Yeah, I think those are the two biggest drivers. Jess: Um physicians want their autonomy back. Jess: They want to be able to make the best decisions based on the science and the evidence and their compassion, which is why they went into medicine in the first place. Jess: I think health insurance has really stripped a lot of autonomy away from physicians and um, you know, consolidation, private equity firms buying up hospitals has also further exacerbated the problem of patient volume Jess: And then on the patient side, you know, you wait months to get in to see a doctor and you get to see your doctor for ten minutes while they have their nose in their computer the whole time, which isn't no fault of the doctor.

Jess: I understand why that is Jess: And you you don't get to address all of the problems. Jess: You maybe get to ask a few questions. Jess: And, you know, we talked uh a lot about um Jess: you know, we can address nutrition and primary care and there's there's a lot of lifestyle conversations to be had. Jess: Well you can't have that in in ten minutes and Jess: Just a few weeks ago, the Department of Health and Human Services announced that more medical schools were gonna have more nutrition training for doctors.

Jess: And well that's great, but you can't still address nutrition and everything else you need to address in 10 minutes Jess: And if there's no billing code uh ta assigned to that, then it's not going to get done. Jess: And so I think, you know Jess: Patients are really seeking better care. Jess: And I think in the vacuum of that, you see patients turning to social media or podcasts or whatever it is for information about health. Jess: Which is also driving, you know, a lot of misinformation.

Jess: I think it's driving a wedge between the patient-physician relationship. Jess: And I think physicians are just really getting burned out. Jess: I um Jess: Just reported a piece a couple of weeks ago. Jess: What started out was burnout and then it moved into moral injury and I settled on demoralization of America's doctors.

Jess: And they all and I'm sure you you all have your stories too of uh I needed to do this for a patient, but insurance would only cover this, so I had to do this and I know every doctor has that or Jess: They're fed up with having to see 30 patients a day and then go home and work for hours more spending time on all of their notes. Jess: And I asked them, um, some of some of whom have left medicine altogether, some have transitioned to cash-based clinics and Jess: I asked about some of the solutions and the majority of them pointed to cash-based care as a solution that really is emerging Jess: not only to restore autonomy to physicians, but also to empower patients and to allow them to really have time with their physician to understand their own health.

Jess: Um and then I think employers uh also have a huge advantage here too. Jess: I think the um there's a s statistic out there that Jess: The average US company spends $18,000 per employee each year on healthcare. Jess: Um imagine if they moved to a more affordable system, how much money they would be saving, and they could maybe pass those savings down and Jess: salaries could maybe keep up with inflation for once. Jess: Um so I think there's a lot of benefits to be had across the board.

Erik: Yeah, I agree. Erik: And in in talking with one CEO about that. Erik: I said, okay, so if if we if we made these changes, would that really help save money? Erik: And interestingly enough, it typically is just a handful of patients that end up driving that cost way up.

Erik: Uh, you know, you get a patient with cancer, you get a patient in a in an accident, and that's what ends up driving those is the is the Erik: Overall, the amount that that companies are spending per employee tends to be relatively low, except for those high utilizers. Erik: And and so that that makes it a challenge, right? Erik: Because they how do how do we how do we do a better job than a Erik: preventing some of these more catastrophic, I mean we're seeing more and more individuals with cancer, more and more individuals with cardiovascular disease, more individuals with strokes.

Erik: uh more individuals with autoimmune issues that are leading to um you know chronic um illnesses that are impacting Erik: uh productivity, right? Erik: And so those are the patients who really tend to drive up the overall costs for everybody. Erik: And the other ninety percent of the patients who don't have some of those issues. Erik: uh aren't.

Erik: But if we could do a better job of just even preventing some of that that ten percent, then we would keep more people in the workforce. Jess: Yeah, and uh, you know, primary care is really the foundation of our healthcare system and imagine if you had more time with your primary care physician to really Jess: prevent diseases before they came about, how much that would save everyone in the long run. Jess: And so that's where I really think cash-based care could really shine is at the primary care level.

Jess: Um, you know, it would require a bit of a mentality shift in Americans who still, you know, they're shielded a lot from the cost of health care, even when you get health insurance through your employer. Jess: You don't see that cost day to day. Jess: You know, it usually gets taken out of your salary before you get it. Jess: So there's no tangible understanding of these costs.

Jess: Um Jess: So, you know, there there will take larger shifts to really solve some of these problems, but I think primary care is a really great setting. Jess: I was Jess: interviewing a primary care physician who switched to um cash-based care a few years ago and and she said, you know, we ought to be using health insurance more like it's car insurance. Jess: You know, when you go buy gas or get your tires changed, you don't draw on your car insurance. Jess: You do that when you get into a big accident.

Jess: And so that's how she was saying we ought to see Jess: health insurance use where the primary care these are small expenses, maintenance, prevention, and then it's when you have the cancer diagnosis, the knee replacement surgery that you draw on health insurance. Jess: And so she was saying the cash-based model in primary care with the catastrophic health care plans, which are starting to come back with some new policy changes, they pair very well together. Davin: Yeah.

Davin: Go ahead. Davin: For instance Davin: Um there, you know, over the last decade or so a lot of these managed care or capitated, you know, models have evolved. Davin: So for instance, you know, um Davin: a a a large medical group may receive, you know, so many, you know, dollars per member per month um to sort of take care of a population, you know, from a primary care standpoint. Davin: Um, I don't know that those numbers reach sort of a direct primary care, you know, membership level.

Davin: Um, but you know, that might be an interesting comparison to say, hey, rather than Davin: um paying these large groups, you know, PMPM in a capitated model, you know, could you sort of shift those dollars Davin: um towards a direct primary care model. Davin: And then, you know, either, you know, the employer continues to cover that, or maybe that's carved out, you know, and the the overall cost Davin: of insurance drops and that sort of primary care carve out, if you will, could could be a nice hybrid model.

Davin: Have you seen anything like that? Davin: Do you have any data on like how much insurance is Davin: spend on primary care utilization or or any of those kinds of figures? Jess: I don't have any of those figures at my fingertips. Jess: Um but if you know you could just Jess: think of how many middlemen you would be nixing from the system if you did this.

Jess: I mean it's the insurance companies, it's the pharmacy benefit managers, is all of these intermediary companies. Jess: that have popped up to facilitate this system. Jess: I mean imagine the cost savings of just getting rid of their administrative overhead costs. Jess: That would be millions in savings right there.

Erik: Right. Erik: Well, and that's what uh you know we had a guest on um early on, Aaron Wentzel, who's a concierge medicine doc from Nashville. Erik: And one of the the things that he pointed out is right is who are who are the stakeholders involved in the care of the individual? Erik: And in a direct primary care model, the stakeholder is the patient and the physician.

Erik: There's no other stakeholders. Erik: Right. Erik: But as soon as you start bringing in a an insurance company, these you know uh b uh Erik: pharmacy benefit, you know, coordinators, uh, you have more administrators, then you have like this medical directors uh that are reviewers. Erik: uh that is there there becomes multiple stakeholders and ultimately the physician and the the the patient are beholden Erik: to these stakeholders.

Erik: They're not even the primary stakeholders in the decisions being made about the health care of that individual. Erik: And I've always thought it weird. Erik: Like, you know, nobody would go to a grocery store Erik: and load up their grocery cart, get up to the register and have them say, All right, well we'll bill your insurance for your food. Erik: And we'll let you know what your your you know your ultimate bill is.

Erik: There's a copay of $50 today, and then you'll get a bill later from your insurance to determine exactly how much you owe on the food. Erik: And then you get a bill for twice or three or four times the amount that it would cost you cash-wise to get that same kind of food. Erik: I mean, uh that that kind of a business model would never work in Erik: Any other industry. Erik: I don't know how we've allowed that to happen in medicine.

Jess: Yeah, you know, I think we took something that seemed like a great idea, health insurance, so defray some of the risk, and it's just Jess: it gotten so out of control. Jess: And I think federal regulation has also contributed to that with the the administrative burden, the reimbursements. Jess: the amount of time I there's yeah that's the estimate that more than two administrators are needed per physician providing care. Jess: Uh I think those costs Jess: are like thirty percent of healthcare spending now, just administration.

Jess: And you're right, I think the other big thing is the impact that those stakeholders have on clinical care Jess: has really eroded people's trust in our healthcare system and it has eroded quality of care. Jess: And I think that's why so many doctors are trying to leave medicine and driving our our issues of of burnout and moral injury and Jess: No one wants to go into medicine anymore and that's because of this this monster that we've created. Jess: And I don't know how uh I don't think the system can be untangled.

Jess: I think it will have to collapse Jess: Before we find real solutions, that certainly the catch-based click is sort of this parallel system that is starting to emerge Davin: No, I I think that's great. Davin: And um, you know, a couple other scenarios. Davin: Having practiced in large health systems, you know, I think Erik and I both started in the Navy, which uh you could argue is a pretty large Davin: uh health system and then um from there uh I've been you know with some community health systems and then a large you know nonprofit uh one of the largest in in the country in common spirit um Davin: And so I've seen, you know, different models um and have practiced certainly on the insurance side or or the RVU-based model, which the Navy wasn't like a typical insurance, but they still used RVUs.

Davin: uh back in the day. Davin: Um and so um but what's interesting is um here's a couple scenarios uh that I'm curious if you've come across. Davin: So one was a patient Davin: um recently who needed a prescription uh for a very, you know, a a very common medication. Davin: Um Davin: And, you know, you went to the pharmacy and they're like, oh, that uh that's not covered.

Davin: That's a you know, that your insurance is not covering that medicine. Davin: It's gonna be so it'll be a hundred and fifty dollars or something was the the cost, right? Davin: And I said, Well go back and ask them, say, well, what if you, you know, use like a good RX cash discount? Davin: You know, can they re reprocess it?

Davin: And and uh then it ended up being like fifteen dollars or something, you know Davin: And, you know, the gap there between, you know, that pharmacy benefit, you know, manager, what they're recommending, you know, the patient build the insurance for. Davin: I I guarantee you that money, that's that the difference in that gap, it's not going to the pharmacy and it's not going to the patient, certainly. Davin: It's not going to the physician. Davin: you know, who's taking that difference of a hundred dollars, you know, in the cost of that medication that was inflated, right?

Davin: So so that's one scenario that's kind of interesting. Davin: The difference between cash and insurance, like Erik alluded to. Davin: And then Davin: Um, another scenario uh uh it was in my practice with a large health system as a primary care doctor. Davin: Um Davin: you know, uh patients would call in, you know, or they would s let's say they saw me as a visit and I send them home and I prescribe some medicine, some blood pressure medicine or something.

Davin: Um and then they have a question about it a few days later, right? Davin: And so they call in and who who what does the call go, right? Davin: It goes to a call center Davin: And the call center person takes a message. Davin: And of course they're going to forward that message to my clinical team, which includes my MA.

Davin: So my MA gets the message. Davin: And, you know, she folds that message on to me. Davin: And I'm like, well, are they taking one or two pills a day? Davin: You know, whatever.

Davin: I don't know. Davin: Some question, right? Davin: And so then my MA calls the patient. Davin: And, you know, what likely happened is she probably left a message because the patient didn't answer on the first call, right?

Davin: So then the patient gets a message from the doctor's office, hey, we have a question for you. Davin: So they call back. Davin: Who do they get? Davin: The call center again, right?

Davin: So from the call center, which can't answer their question or even know why we were what we were asking in the first place Davin: You know, it's and then pretty soon patients and MAs and call center people go through the cycle three or four times. Davin: Meanwhile, I have no idea Davin: you know, I have no interaction with the patient. Davin: Right? Davin: Now in a direct primary care model, which I've practiced in, they can send me a message directly to my secure messaging app, HIPAA secure messaging app.

Davin: I get the message, I handle it, Davin: in two minutes, you know, and th there's no back and forth. Davin: So those are a couple of scenarios I've seen, you know, where the difference between insurance versus cash and then the difference between like a big complex system Davin: and just that direct access to a doctor. Davin: Um, what have you seen or found? Davin: Uh is is that mirror some some of the things you found?

Jess: Yeah, the other scenario I hear often, you know, when I first started reporting on cash based care, I thought, uh, primary care, I could see this could be this would work well in primary care, but surgery, oncology, are there really cash-based Jess: clinics out there and who is pursuing that. Jess: And I found that a a large segment of people who go there are seeking treatment because their insurance denied. Jess: their claim. Jess: Uh said they couldn't have a specific treatment or they wanted to put them on a drug that their doctor said was not the best one that they should be taking.

Jess: And so Jess: um, you know, they could afford to go seek out surgery or oncology treatment or cardiology care from a specialist and pay out of pocket. Jess: So I think that's another growing segment of people seeking out catch-based care Jess: are people who are getting denied by insurance and we have seen a pretty dramatic increase in the number of claims that insurance is denied Erik: Yeah, and I think that I think this is only gonna continue to um get worse in terms of the divide, right?

Erik: Because the more Erik: physicians who pull out and start doing cash based practices and and Gavin to your point, the reason that you can't you have the time to be able to answer that message from the patient coming in directly Erik: is because you're not having to see 25, 30, 40 patients a day and therefore necessitate having a call center Erik: Uh, because you're too busy just trying to get from one appointment to another, let alone try and answer questions for patients, right?

Erik: And so uh i i i there's gotta be a balance. Erik: But r right now we're seeing s you know, this Erik: small percentage of, you know, according to the AFP, there's at least eleven percent of the total family physician population that's now doing direct primary care. Erik: I'm my guess is that there's Erik: a greater percentage of doing some form of membership model that gives greater access and maybe doing concierge or doing fee for service or just have flat out gotten out of medicine Erik: So that's keep shrinking the number.

Erik: We have fewer people going into primary care. Erik: Um I mean I get ad I get I get at least once, maybe twice a week, um, recruiters. Erik: asking me to if I'm interested in joining some, you know, primary care practice in different parts of the country. Erik: And the amount that is you know, where I s when I first came out of the Navy, I you know, I I took a salary of one hundred and twenty thousand dollars a year, which Erik: Uh at the time I thought was okay, but now I'm getting offers for three hundred, three hundred and fifty, four hundred thousand because they're desperate, right?

Erik: And these it basically what it is is it's a hospital-owned Erik: practice and so they have the resources and all they're doing is basically plopping a primary care doctor in there because they know it's a funnel for their services, which is where they make their money. Erik: And they lose money on all of the primary care practitioners, right? Erik: So there's there's gonna be this continual divide. Erik: I agree with you.

Erik: I don't think that the the government or policy is going to correct this. Erik: What what do you think is gonna Erik: allow for the shift other than it just imploding. Erik: But do you think there's a a a a realistic way, is AI maybe the answer to try and help compensate for some of this? Erik: Is it m more just getting the message out and patients, you know, demanding better care and using their dollars, or is it corporations that Erik: the need to start putting more money into these direct primary care practices and supporting it that way.

Erik: is the best avenue or solution, or is that multiple to get to this newer place where we have better quality of care, uh better patient satisfaction, better physician uh quality of life? Erik: What what do you think? Jess: Yeah, I think there is the inherent challenge with cash-based care is that can the solution scale? Jess: And uh inherently it can't really because Jess: you know, you uh the would be inherent success of cash-based care and the draw to it is that physicians get to spend more time with patients, which means they see less patients.

Jess: Uh we already have a huge shortage of physicians, especially primary care physicians. Jess: And if you know you go from seeing a patient panel of 3,000 a year to 300, well that's really going to make our problem much worse. Jess: Um, so it's not going to be the end all be all solution on its own. Jess: Um, I think, you know, not to mention the pinch point that that's gonna create for people who do still use the health insurance model.

Jess: Um, you know, what you might have behind are the sickest people who require the most complex care, and insurance is just going to continue to increase. Jess: as you have people leaving that system. Jess: So I think we're gonna hit a real pinch point. Jess: Um I think what maybe needs to happen is that Americans Jess: Need to have just a paradigm shift in how we think about health.

Jess: And I was thinking about this a bit earlier uh just for myself Jess: you know, would I go and to a primary care doctor and pay them through a caste based model and and why do I I felt like I had some resistance to doing that myself and I was trying to think about why that is and Jess: You know, while we don't have universal health care in this country, we by and large, most Americans get health insurance through their employer. Jess: So it feels still like it's a right.

Jess: It's something that we get for free. Jess: It's a benefit. Jess: I shouldn't have to pay so much for healthcare. Jess: I shouldn't have to pay out of pocket, even though we are paying for it, uh being a part of an employer sponsored um health insurance, we just don't see it.

Jess: So I feel like there's some resistance to that and I think we just need to shift our thinking. Jess: Um, you know, there's there's arguments to be made for the free market cure, there's arguments to be made for a national health system and Jess: I actually find it interesting the number of people I've spoken with who are pro-cash-based care. Jess: Um Jess: But who are otherwise, you know, they they will talk about that and also talk about a nationalized health system. Jess: And I think short of realizing that, uh, we're going more of the market, um, the market solution Jess: Um and so I think Americans have to become comfortable with taking on that responsibility for themselves.

Jess: And um I think Jess: The more employers and companies we see uh s who stop purchasing health insurance, I think that's where the most impact could be made. Jess: I think that could really force the health industry and maybe the federal government to make changes if large employers stopped buying health insurance. Jess: Um, but there has to be that shift of like it's no longer the responsibility of your company to provide health insurance. Jess: It's the responsibility of each American to go out and find Jess: their own solution that fits their own needs.

Jess: Um so much more the going the free market way, which I find very interesting, but I think it will Jess: require Americans to think differently about our health, something that is more a personal responsibility as opposed to something that you ought to just get. Erik: Yeah, I agree. Erik: I I I'm with you. Erik: I think this is I think the where the shift is going to happen, if it's not going to happen by the whole system imploding, is in the corporate America.

Erik: Because that's where it's where it's gonna be where the money's at. Erik: And if corporations say, look, we're tired of having to spend so much of our overhead on insurance Erik: Which basically is being driven. Erik: Now I know that there are companies now. Erik: I mean, I I worked for a company for a little while that the the the way they did it is they had all control of all of their health Erik: care dollars, but they used United Health to manage that.

Erik: But and so they had a little bit more say in what could be done Erik: Uh and and it gave them a little more flexibility in determining health care for their their patients. Erik: Um but I still think the the the Erik: Until the stakeholders again come back to the patient and the physician and there's not a lot of interference between that, uh, it's gonna be tough. Erik: But the the only the patients Erik: Our population, to your point, still feel like they need insurance uh in order to get their health care paid for, and that's what the majority of individuals will do.

Erik: It's not going to come from them. Erik: I think it's going to come from corporate America, you know, big companies saying we're done. Erik: We are now going to provide we're going to put what we were Erik: placing in insurance, we're now gonna place in a catastrophic plan plus a direct primary care program. Erik: And I think then we'll start seeing shift.

Erik: As soon as that becomes an incentivized way out. Erik: Where companies can pay these low premiums, uh pay for these high deductible plans, but then they can pay for the direct primary care program. Erik: I think they'll save a lot and I think we'll continue to s see a shift in in the in the business of medicine from that standpoint. Jess: I think one of the reasons we don't hear more advocacy is because I think a lot of people don't quite understand how our health system works, and that's something that I try and explain more clearly in my reporting.

Jess: Um, I think Americans are frustrated by the system, but they don't understand all of the different layers and why healthcare just keeps getting more and more expensive. Jess: Um to your point about AI, um, you know, I do think we're going to be seeing an AI revolution. Jess: I think it's going to make things worse. Jess: I think Jess: uh we're gonna see the fastest rollout of AI in places where it can make insurance more money.

Jess: So AI is gonna start reviewing your clinical notes and un understanding where you could where the hospital might be able to get paid more or insurance is going to use it too. Jess: make sure that they're paying hospitals less. Jess: So I think that's probably how we're going to see AI be rolled out first. Jess: Um and I've heard in reporting on the Jess: piece about doctor burnout.

Jess: Um there are a number of hospitals and and big networks that are starting to use AI like ambient scribe tools which Jess: you know, some physicians think are really promising, but she pointed out, you know, hospitals that implement AI tools, they're looking for a return on investment Jess: uh and whether that's okay well you have ambient scarpes now you need to see five more patients a day or um you know Jess: We have to pass that cost on to someone. Jess: It's gotta be the patients who have to carry the cost of the millions of dollars it took to develop and implement this AI tool.

Jess: So you know, I think Jess: While there might be some light at the end of the tunnel, I think AI will make things worse before things get better. Jess: Um, unfortunately, that's that's what I've been hearing some from some physicians. Jess: um and health policy experts and I could certainly see just given how our health system is set up to incentivize financial pressures and Jess: keeping patients sick rather than healthy. Jess: I think we will see AI be used to help people make more money before things really help physicians.

Davin: I think that yeah, that tracks. Davin: Um having worked in, you know, as a CMIO in a large health system and and then also as a s as a regular kind of physician leader. Davin: on the administrative side of things, yeah, it's it's unfortunate how often uh yeah the the the biggest pockets uh get their agendas you know first Davin: Um, so yeah, I think that tracks with what what would happen with AI. Davin: Um, I am kind of curious, you know, to also hear from your perspective, having lived overseas, if that has also like if you've seen healthcare in other countries Davin: Um, I I've heard a few stories.

Davin: Like I I I'm thinking of this one story where this young man was um, you know, describing how his dad, you know, ended up in the hospital in Dubai or somewhere. Davin: I don't know. Davin: And Davin: and and how like they they couldn't afford to like get the treatments or something. Davin: Like it it seemed like something that here in America like Davin: was unheard of, right?

Davin: Like someone has like a heart attack and you just expect that someone's gonna pay for it, you know? Davin: Um, but elsewhere they were like pooling family resources and and other things to try to make sure that he could get the care that he needed. Davin: And I remember thinking, that's odd. Davin: Like it's weird that they would that burden would fall on the family.

Davin: Um, but then again, maybe that's just the type of change in thought process we need, you know, here in America. Davin: But Davin: Uh what what do you see comparing and contrasting maybe overseas compared to America? Jess: You know, I think um Jess: Obviously there are lots of different models out there. Jess: Um I was just speaking with a physician in Canada.

Jess: Uh Canada obviously has universal healthcare coverage, but uh cash Jess: Based care is evidently becoming more popular there too because there are such long wait times. Jess: So it's emerging as a solution there. Jess: I would say Jess: My experience overseas and obviously it depends on where. Jess: Um the the cost is more upfront.

Jess: Like you if you go to an emergency room here in the United States Jess: you're going to receive life-saving care, uh, in part because there's legislation around that, but you will get a monster medical bill later on. Jess: It's like a defrayed Jess: um cost and in in other countries you have to pay right there up front or you at least have to show proof of funds before they will even give you care Jess: In a lot of countries, I I used to live in Kenya. Jess: Um, so at the time they didn't have much in the way of health insurance.

Jess: Uh no, you know, they they sort of had universal health coverage. Jess: didn't cover uh, you know, nearly a fraction of the population. Jess: What I was so struck by is, you know, I walked in to get care and they said Jess: Okay, this is what it is for, you know, I had to get contacts and glasses and an eye exam. Jess: And they told me the price and it was like the equivalent of fourteen US dollars.

Jess: I thought, surely, I've just not converted Jess: local currency to USD correctly. Jess: And that was the price. Jess: I saw on one hand, it's s the price tag at the end of care that you receive overseas is so much lower than in the United States. Jess: That's one thing, but Jess: On the other hand, there is, you know, only a fraction of people can access healthcare and can even pay that $14.

Jess: So there it has its own challenges. Jess: The other thing I thought was interesting is I used to have global health insurance. Jess: So I had health insurance through a company and it covered me in every country in the world. Jess: medical evacuation, anything.

Jess: And I I just had to call them, say, can you make me an appointment? Jess: They made me an appointment the next day. Jess: I walked in, saw carrot, never paid for anything, walked back out Jess: this like global health insurance model seemed to work so much better than what we have in the United States. Jess: And it included the United States in that.

Jess: So I have wanted to do more reporting on how exactly that is working because it seemed like a very seamless Jess: system. Jess: It was far more affordable and it was easy to use. Jess: And I think there might be something there if we could just understand better what's going on there. Jess: It really worked Jess: Well, and I used that health insurance in countries you wouldn't think uh I was like, is there a hospital in this country?

Jess: I'm not sure, but it was very it was just very seamless and easy and um seemed like another potential solution Erik: Yeah, that's really interesting. Erik: I'm I'm gonna go back and share a couple of stories to highlight what you'd said previously about AI and then also just this mindset that uh we have as a society utilizing insurance. Erik: So the first with AI, and to your point, we were, you know, this was probably now six years ago. Erik: We had a meeting with one of the insurance companies.

Erik: And they were questioning our notes and whether or not they should be billed out under the the top ENM code, which is 99215 Erik: And so I was there, our office manager was there, we had some legal representative, and we had their quote unquote billing expert on the other side. Erik: But I guess she was second in the billing department, not number one. Erik: And so as we went through and we're we're we're trying to uh figure out why they weren't paying for this, uh as we went through the note and I was trying to help her understand Erik: That we were I didn't f I couldn't see why we weren't hitting all of the points that were necessary to get reimbursement for 99215.

Erik: And I asked her, I said, will you review this note and tell me where we're where we're still lacking? Erik: And her response to that was, I I don't know. Erik: We'd have to run it through the software. Erik: And I was like, wait, what do you mean you have to run it through the software?

Erik: In other words, she didn't have the capacity as a human expert in coding Erik: To be able to give me feedback about whether or not what we said we were documenting was in alignment of what we need to be reimbursed, it had to be run through the AI software first. Erik: Which is set for certain parameters and and may it set up to obviously bias them. Erik: And so they will exclude things and Erik: Maybe the way that we worded it wasn't exactly the way I AI would credit us for that.

Erik: And I thought that was a absurd. Erik: Um so here was a human couldn't give me an expert human encoding couldn't give me a response until it had gone through software. Erik: That was frustrating number one. Erik: The the second story is also interesting.

Erik: It was a and I think may have uh told this in another podcast, but Erik: There was a friend of mine who uh was working for an NBA team. Erik: And the NBA uh pr player wanted to get a more functional medicine gut test Erik: And it it and so he was asking me, I don't know how to interpret it and stuff. Erik: And I said, Well this is the company that I use. Erik: Go ahead and and and order this test and you can do it through this this company, but it you can't use insurance for it Erik: And he went back and he told the player and the players, Oh, if it's not covered by my insurance, I don't want it.

Erik: And we're talking like a three hundred and fifty dollar test. Erik: to somebody who's making millions and millions, has their own cook, has their own trainer, you know, hardly does, you know, probably doesn't even fold his own laundry, and yet he won't pay for a $350 test to find out Erik: what's going on in his gut because it's not covered by his insurance, right? Erik: That's that's the mindset that we're in from a society. Erik: Um and and it and it sets things back.

Erik: It makes things really challenging because people are, oh, why do I have to pay for my health care? Erik: No, I have insurance. Erik: And in and and so I agree. Erik: To your point, we've got to get out of this mindset from a society.

Erik: I love that you're educating people, trying to help them understand how the system works a little better, because it's only through education that we can make better decisions. Erik: Uh but yeah, it's it's it's it's a challenge. Erik: I I think there's a lot of smart people who have good solutions Erik: Uh, but ultimately it's gonna be the money that makes the difference. Erik: And where that money is gonna come from, whether it's like I said before, corporate sponsors or through government.

Erik: Uh it's not gonna be just through ideas that that is going to change this in medicine. Jess: Yeah, you know, that just reminded me of uh an interview I was Jess: dealing with a primary care physician who moved to cash-based care and she was describing how, you know, our healthcare system incentivizes Jess: Sickness. Jess: You come in, you have obesity, diabetes. Jess: Okay, here are the medications that you need to take.

Jess: Keep taking these medications. Jess: There's no time and there's no reimbursement for just Jess: discussions around nutrition or lifestyle changes and so they don't happen. Jess: Um and so the system keeps getting reimbursed and that patient stays sick. Jess: Whereas in the cash-based model, it's uh a flat fee per month, no matter how healthy or sick you are.

Jess: And so it behooves physicians to keep their patients as healthy as possible so that they don't come into the clinic as much Jess: So it's also just such a shift in keeping, you know, incentivizing keeping patients sick, which is not the goal of physicians, but it's the goal of our healthcare system versus a cash-based care which Jess: truly incentivizes keeping people healthy and that can evolve over time because you're not stuck with billing codes or the lack of billing codes.

Jess: You can adjust what each patient needs. Jess: You can adjust over time much faster than Jess: the federal government will change uh their policies on reimbursement. Jess: So I think it really just most importantly represents a huge shift. Jess: that will really benefit Americans and make us healthier.

Jess: And so I would really like to see more policies that support the movement to that direction. Jess: But as I said, it's not a the end all be all solution to our healthcare challenges in this country. Erik: Yeah, I agree. Erik: And I think, you know, hopefully, you know, the this there is a movement right now, um, and there's some who oppose it, but you know, the make a America healthy again Erik: Um, you know, some of the initiatives, uh, I just saw an ad that actually um this month, you know, if you want to apply for a grant to be able to study Erik: the impact of lifestyle and nutrition in your clinic, the they they would give you a grant to do that.

Erik: They're trying to incentivize, they're trying to move more of this Erik: I um into the the practice workplace. Erik: I I think again it's it's a challenge because right now there aren't any Erik: cost savings through insurance to incorporate more lifestyle and nutrition. Erik: You have to get it outside either by patients paying a membership or getting a grant from the government. Erik: Um, in until that really shifts, it's gonna it we're not gonna see great strides made, but at least we're starting to see some movement that's getting talked about and and at higher levels and and getting publicity and all of that's positive.

Davin: One thing um maybe you could uh include in a future article, I think if we plant some seeds out there, maybe there will be some Davin: uh people in our political leadership structures who might take notice, right? Davin: You never know, might get lucky. Davin: But something that's come up a lot is people will ask me, Davin: Um, because I think the the consumer that's interested in a direct pay model, you know, some of them are the type that are self-insured or or maybe they're going without insurance temporarily, right, while they figure things out.

Davin: um have asked me, will this count as my insurance uh requirement? Davin: Because there is an you know, a law now that says if you don't have you know, you have to be paying something for insurance or you're gonna get taxed or something, right? Davin: Um, whether or not you agree with that kind of legislature is a different topic, but given that that is a requirement, it does seem like Davin: it could be a nice compromise, right, where uh if direct primary care or other direct membership type models that at least satisfy some sort of Davin: uh healthcare coverage um could could help people with that, you know, check that box.

Davin: Uh it might help drive a little more Davin: uh in this direction um and and again raise some awareness and and at least make a small change. Davin: Uh so I don't know. Davin: What do you think about that? Jess: Yeah, my understanding is that that's not at the federal level, that's at the state level that impose those fees on people who don't have insurance.

Jess: And it is very it's a Jess: fraction of states now that still impose a fee for people who are not insured. Jess: Um you know I was uh Jess: Chatting with someone, I'm I'm reporting on a piece right now about the rise of functional medicine and and what is that and they were touching on um both functional medicine and cash-based care and Jess: They were bringing up this criticism that it introduces this, you know, one of the reasons people like functional medicine and cash-based care is because it gives the control back to patients.

Jess: And patients can feel like they're in control of their health. Jess: And and, you know, personally I I think that's a good thing. Jess: But he was saying, you know, it also Jess: introduces this element like, well, if you're sick, then you're a bad person. Jess: You haven't done everything you can to be healthy.

Jess: And I've heard that from a number of people who Jess: are, you know, see cash based care as sort of putting the the control and responsibility back on the patient and that that is maybe not the best thing to be doing. Jess: So and I think that's a a big part of the Maha movement as well is Jess: who has the freedom and responsibility over their health? Jess: Is it the healthcare system or is it the individual? Jess: And is there a component of well if individuals are responsible for their health that they're a bad person if they become sick?

Jess: And Jess: So I I've been hearing that conversation a bit more, which I think is interesting. Jess: Um, you know, personally I I think everyone has r responsibility for their own health, and I think that's one thing that the cash-based Jess: model and especially direct primary care will will help empower patients, but it will also give them the tools, which is a physician to go to with questions instead of turning to whatever Jess: whoever is saying on TikTok and well let me try that for my cancer treatment instead.

Jess: So I think there's you know, with the Maha movement we have Jess: uh the question of what is the individual's responsibility and what is the responsibility of the system. Jess: So I think we're going to start to see more conversations around that. Jess: My biggest concern, I think there are some really great elements of the Maha movement. Jess: My concern is just that science and health has become so politicized and so polarized Jess: that no matter what one side of the aisle does, the other side is going to oppose it.

Jess: And I think we're at such a time where everything is so polarized that we're not going to reach solutions, even when a solution might be warranted, because Jess: We're just gonna be feuding about politics. Jess: So, you know, as as much as I'm optimistic about cash-based clinics, my concern is that it's getting Jess: cracked up into functional medicine and maha and RFK Jr. Jess: and is going to be dismissed wholesale just because it's politicized. Davin: No, it's a vi it's a really good point.

Davin: And uh, you know, I think uh you know the the m the moral and ethical Davin: debates, you know, that that did these bring up, these topics, right? Davin: And I I think um it could go beyond healthcare, right? Davin: Like what what is someone's responsibility in their own life, whether it's for their finances or for their Davin: to take care of their children or whatever, right? Davin: Like you could draw lots of different um, you know, parallels.

Davin: Um, but I think we find that balance hopefully as a society, right? Davin: Where we say, hey, Davin: Um, there's nothing wrong with um trying to learn about the value of taking responsibility and and how good that feels and the the fulfillment and satisfaction that comes from Davin: you know, setting goals and accomplishing things and and and creating value in your own life. Davin: But then we have compassion for those that maybe are overwhelmed or that are up against, you know, Davin: uh unreasonable odds or their capacity maybe based on for whatever reason, you know, in terms of how they compare to others with their ability to manage their own resources.

Davin: I think we can have both, right? Davin: I think we can Davin: you know, encourage responsibility because of what that the consequences that brings and and you know, but not judge Davin: others who um, you know, don't have the capacity necessarily or are going through a a difficult time, right? Davin: And and uh I agree with you. Davin: It's unfortunate that these things get Davin: become a political, you know, sword to die on versus um just taking a more broad, comprehensive approach to how do we, you know, come together as humans and and help and support each other Erik: Yeah, and to you to your earlier question, Dav and too, to piggyback off what Jessica was saying, you know, there one of the things that the the policy has stated is that this year you can use your HSA to pay for direct primary care, which is Erik: I think a big boost in this area.

Erik: And the other is that there are um I'm aware of several um health share companies, which isn't insurance, but it does allow uh you can get credit for having Erik: insurance if you have a health share plan. Erik: And those health share plans are now also saying if you want to do direct primary care, we will pay up to $150 a month. Erik: for a direct primary care program out of what you're paying for us, w of course it has to meet their qualifications. Erik: I mean unfortunately a lot of them don't.

Erik: uh think that functional medicine or integrated medicine meet the qualifications. Erik: They want more conventional direct primary care programs. Erik: But nonetheless, we're at least seeing that start to emerge as possible ways that Erik: Patients can get some coverage, some catastrophic and also get their quote unquote uh health share plan to to pay for their Erik: direct primary care as they contribute on a monthly basis and participate. Erik: And I think the evidence is going to start to bear out that those individuals who participate Erik: uh from a care standpoint, um, actually probably have fewer hospitalizations, have fewer urgent care utilizations, fewer urgent emergent Erik: care uh utilizations and so the overall cost savings uh is pretty dramatic um above and beyond that.

Erik: So I it's gonna be really interesting. Erik: Well, we're coming up on an hour and Jessica, this has been a fantastic conversation. Erik: Uh it's been fun to kind of uh wax uh Erik: philosophical on a few things and theoretical and and actually you know give our our wish list out there a little bit. Erik: But I let Davin kind of bring us home with the final question here Davin: Uh Jessica, with you know what you're kind of interested in and and where you see like the needs of tr sort of like educating or opening the eyes of the American uh public, um what are some topics Davin: That you think we should explore here on the podcast or that you plan to explore through your own journalism?

Jess: Yeah, you know, going back to what I was saying about the politicization of science and health, I think Jess: something that is really important for me as a journalist and for anyone putting content out there about health is to really just acknowledge Jess: both sides of a political argument and I try and do my best to stay open minded. Jess: In fact I try and can if I have a strong position or opinion on something Jess: By the time I finish my reporting, I've been trying to convince myself to uh agree with the other side.

Jess: And um, you know, I think there's a lot of importance in exploring and asking questions and sometimes that can be demonized as Jess: being, you know, on one side of the political aisle or not. Jess: But I think, you know, really pursuing and asking questions, pursuing different perspectives is really critical, but also returning Jess: to the evidence and acknowledging what evidence we have and what evidence we don't have. Jess: Um and you know, a a lack of evidence at the outset of an idea doesn't mean that something's not going to work out, but I think it's really critical Jess: as a journalist and as communicators that we acknowledge this is an idea, this is the evidence we have, this is what we don't yet know.

Jess: I think that's a huge lesson that we learned from public health officials during the pandemic is just to say what we don't know Jess: To acknowledge that science is not black and white. Jess: Uh it's constantly evolving and we just need to embrace and acknowledge that so that our American consumers can be more aware and they can make their own decisions. Erik: Well said Erik: Love that. Erik: Well thanks, Jessica.

Erik: It was really fun to have you on the podcast. Erik: We're so grateful that you reached out and and um you know asked the Erik: to participate and we we all benefited from the discussion today and we look forward to hearing from our listeners to hear what they have to say and you know let us know what you think. Erik: Uh how is medicine going to change? Erik: Is it gonna be you know Erik: People standing up and demanding a change in healthcare, is it gonna be corporate entities that are gonna demand the change in healthcare or is it gonna come through our politicians?

Erik: You let us know by commenting in in in below and let us know what you think. Erik: So thanks Jessica and we we look forward to seeing uh your articles in the future and and and what you're continuing to write about. Jess: Thanks so much for having me.