In this episode of Healthcare Americana, host Christopher Habig engages in a compelling discussion with Charles Sauer, President of The Market Institute. Together, they explore the intricate intersection of healthcare policy, market dynamics, and innovation, shedding light on key insights that affect the healthcare landscape.
Sauer shares his expertise on various topics, including the role of profit motive in healthcare, the concept of opportunity cost in patient care, and the impact of policy decisions on market freedom and innovation. Drawing from his experience working with physicians and policymakers, Sauer highlights the importance of understanding the profit motive beyond monetary gains and emphasizes the need for patient-centric approaches in healthcare delivery.
Listeners gain valuable insights into how policy decisions shape the healthcare industry, from Capitol Hill discussions to the everyday practice of physicians. Sauer discusses the challenges and opportunities facing the healthcare market, including the rise of direct primary care and the implications of site-neutral payments.
Tune in to this enlightening episode to gain a deeper understanding of the complexities of healthcare policy and market dynamics.
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TRANSCRIPT
[INTRODUCTION]
Announcer
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[EPISODE]
Christopher Habig
Welcome to Healthcare Americana, the podcast that brings you the latest in healthcare innovation, direct care insights and the movers and shakers of the medical world. I’m your host, Christopher Habig, CEO of Freedom Healthworks. Today, we’re talking about the intersection of policy, market freedom and healthcare innovation. Now, that might sound a little dry to a couple of people, but stick with you. I promise it is a very important topic and it is…
increasingly relevant in today’s world. Joining us is Charles Sauer, president of The Market Institute, an organization dedicated to research and education on how market principles affect the economy and in particularly, obviously, for our show, healthcare. Charles, it is great to have you with us. Welcome to Healthcare Americana.
Charles Sauer
Thanks for having me on.
Christopher Habig
Now, I want to start at the gates, you know, in stride. Let’s call it that. So, you know, when a researching episodes and bringing people in there, I always kind of get starstruck, you know, by the celebrity power that people like yourself bring to the show. So in 2018, you know, I know that seems, gosh, a lifetime ago, pre pandemic, you wrote a book called Profit Motive. And what struck me with this and why I wanted to talk about it is,
Also often in healthcare, when you mention that P word, when you mention the profit word to doctors, you can kind of see them recoil a little bit. It’s like you mentioned profit and it’s met with suspicion and indignation, even a little bit of regret. There’s a lot of physicians who say, look, I would love to provide everything for free, but I got to make a living here. And it’s almost this like regretful. I’m sorry that I have to earn a living approach to healthcare.
I’m curious, you know, after after writing a book called Profit Motive, how does that stand with you in your mind with what profit should mean in healthcare?
Charles Sauer
Well, I think that when I think that we’re like trained to think that a profit motive is bad and the word profit is bad and in doing some of some research on profit, there’s certain sections of economics that don’t even consider profit, which kind of blew my mind. But I think that the book shows that profit just isn’t something we can strive for or not strive for. Profit is actually just a given. Profit is everywhere.
And so we have to understand what that is. And when it comes to our conversation today, I think that we need to understand that the profit motive in healthcare and one of the biggest problems that I try to solve is that currently the patient is not actually the payer. And so when you apply the profit motive to healthcare, you can see that every single step along the way kind of avoids talking about the patient because they’re not the ones that are actually doing the pain. But
But I also think, and I don’t know what chapter this is in the book anymore, but early on in the book, I explained that profit is not necessarily money. Profit is something that you benefit from. So sometimes it’s having more time with your family. Sometimes it’s having less stress. Sometimes it’s having mentorship, but profit can be a lot of things besides money, but it’s something that benefits you. And so when you apply that to kind of,
of the world, you can see that, you know, you can be profit hungry and not necessarily money greedy. If you’re doing something that’s going to benefit your family and your quality of life, that can be profit hungry. And so one of the things that I think is that people get wrong is they just think of the greedy cartoon that they see in their head. And actually the cover of the book involves a, uh, the fictional like drawing of the old profiteering
a monopolist. And so I use that as kind of, you know, I call him, he’s my profit man. But I love it. And I think that more people should understand that everything they do is profit driven or and that other people is where it’s really important. Everything other people do is profit driven.
Christopher Habig
I love your definition of it. It’s not necessarily money and just trying to squeeze every last dime out of something you know you possibly can before you just strangle it to death. And it goes along with a concept that I talk about a lot in the course of Freedom Healthworks and talking to physicians and in the DPC world is the concept of opportunity cost. And you know I kind of sense you’re kind of getting there quickly from an economic standpoint.
And in your work from The Market Institute standpoint, that, you know, there’s opportunity cost in every single decision that we make. And there’s a lot of physicians who throw that concept out the window completely because they’re used to being the ones in the exam room that have to have the answers. You know, there’s nobody else to turn to when there’s this concept like, well, is this the best use of somebody’s time? And that’s kind of what I’m hearing you talk about, that, you know, profit doesn’t necessarily mean dollars and cents and squeezing out margins with somebody.
But is this the most valuable use of time, a most valuable application of your skill set, your expertise, along with that whole concept of opportunity cost?
Charles Sauer
Yeah, I mean doctors get into healthcare to treat patients and I believe that almost every doctor that I’ve ever talked to no matter how kind of
bad their situation is. In other words, how much reporting they need to do, how much time they need to spend on charts and how many patients they need to see. All doctors will say to you that there are in there for the patient. But when you start looking at, you know, the fact that, you know, if you’re an HMO doc, there are incentives not to refer to up the chain. There’s incentives in the
the system that I don’t think some people recognize, but it is this they’re seeing that opportunity costs that if they start practicing in a slightly different way, then they can have a better quality of life. And so decisions start slightly changing. But I have yet to talk to a doctor that’s like, yeah, I just work for the hospital. So I think it’s this kind of like slight change that happens in the way that people practice. And.
And that’s where, you know…
We both know a lot of direct primary care doctors and you go to a direct primary care conference and it’s excitement and smiles and freedom and you go to other doctor conferences and you don’t see the same thing. You see people that kind of come in late to dinner and leave early. They’re not as happy. And so that is a huge lifestyle change for doctors that have chosen realistically. They can end up making the same amount, but they’ve taken
taking on more risk than the other doctors. And so that’s kind of the change in profit.
Christopher Habig
There’s always the old joke that when you when you go to a physician convention or physician conference, how do you know the DPC doctors? They’re the ones smiling, right? And it just rings true, like exactly what you were saying. And and, you know, that’s one of the fun things about this very small, but very growing industry. So I want to take, you know, some time and I want you to help educate us on exactly what The Market Institute does, because it occupies a very interesting.
spot in the world. And again, it’s not just DPC specific, but you know, you found you found this kind of spot where you’re like, wow, this this is an interesting movement and you’ve gotten to know a lot of the players in the market. So let us know. Give us that kind of insight where The Market Institute fits within the industry.
Charles Sauer
So I started on Capitol Hill as, you know, kind of a young libertarian economist that didn’t necessarily know my role in the current market. I ended up working for the chairman of the Finance Committee and then I worked for Jeb Bush, the governor of Florida. And then I got the job with Dr. John Goodman, who is the founder of the National Center for Policy Analysis. And he’s also called the father of health savings accounts. And that’s kind of what taught me to talk about
about health policy. But as I started meeting on Capitol Hill, I noticed that a lot of people didn’t really follow what we were saying. And when I talked to doctors outside of those Capitol Hill meetings, they were talking about healthcare and for that matter, the problems in healthcare in a completely different way. So when I started my business and started actually talking to doctors more often, I started bringing them up to Capitol Hill to explain
explain what the actual problems were. And so that started my kind of niche of understanding the entrepreneurial side of this free market movement. So if you’re on Capitol Hill, it takes 10 to 15 years to pass a bill. And so they really need to look into the future to see where the market is going to be. And when I started talking to Keith Smith and Lee Gross and Juliet Madrigal, there was nobody on Capitol Hill.
that was having these kind of small nascent market conversations. And at the time it was a very small market. These were, Keith Smith was, you know, a wild man that nobody was doing what he was doing by just merely posting his prices online. And now we have surgery centers that are doing the same across the nation. And not only that, the thing that I find exciting is now is that there’s markets popping up to actually supply services.
to this industry, which shows that not only is it growing in numbers, but it’s also growing in substance. And so what we do is try to educate Capitol Hill on the fact that this movement is not just real and growing, but now it’s actually significant and of substance so that hopefully when they look at legislation, they don’t do something that will stop it. There was bills, pieces of Obamacare that made it a lot harder to
do this sort of thing. And hopefully if there’s another big bill, they won’t actually put policies in place that make this area harder to grow and instead actually make it easier.
Christopher Habig
It’s that conversation with legislators on the state level and federal level that it’s like, look, I don’t need you to come in here and fix things because the one size all approach has failed time and time again because there’s unintended consequences to pretty much everything a government body will do. What I tell people, you know, advisory committees, you know, Senate and congressional advisory committees, I’m just like, just just stop doing anything. Just stay out of the way and let the market flourish. But it’s like.
I don’t know. It’s like if you get elected to to to Congress or to your state assembly, it’s like you feel this need to just get in there and just kind of mess with stuff and kind of tinker around. I’m like, what are you doing? And I think that’s where we can as an industry. As it grows, we can show and hopefully this is the takeaway lesson, but I don’t have a lot of faith in it, but we could show that free market medicine is able to flourish and take off in spite of.
bad policy or in spite of unintended consequences and then actually show these people that there are elected leaders, if you will, that again, just stay out the way, let the market go. And guess what? We’re going to bring prices down and we’re going to drive access up using innovative models such as this.
Charles Sauer
Well, there wasn’t too many bright sides to COVID or for that matter, the government’s response to COVID. But one of the interesting things that we saw is the almost instant rollback of a bunch of policies that were getting in the way of access to healthcare that we had been talking about. They quickly rolled back certificate of need laws. They started putting in reimbursements for teleconferences
with people and so as soon as they started making it easier for people to actually for doctors to be doctors and see patients then the supply the access went back up but this market had been doing it for years and they had figured out how to quantify that. And like that sort of thing was not necessarily revolutionary at the time. Our local liquor stores were already emailing us about sales that were going on at the store, right? But in healthcare, it was revolutionary and especially to find a way to get paid for it. And so what we saw was Congress
Actually had to follow what we had been saying and showing now they’re rolling back those expansions as we speak and so they still haven’t seen the light but when push come came to shove at that point they saw it and changed it so I am hoping we get back to it but it is interesting to me that like What we’re talking about here when everything hit the fan is this thing are the services that had already been implemented to solve it and so I do think that we’re
in a good place when we in the future.
Christopher Habig
I’m sitting here smiling behind the microphone because I love telling people and I’m like, look, Skype’s been around since the 90s. We were able to do video calls across the ocean. And then, you know, you fast forward. It takes a massive pandemic for hospitals to start patting themselves on the back that they can actually bill for.
a video rather than making somebody come into a doctor’s office. And I’m just like, if that doesn’t show you that innovation is completely kneecapped by bad policy and bad payment, I don’t know what would actually be your wake up call. And like you said, now we’re starting to see it roll back. And I’m just like, oh, my goodness gracious, let’s go make the same mistakes again. And usually human beings wait a couple hundred years to make the same mistake. We’re going to do it within a decade.
Charles Sauer
There’s an amazing amount of health circumstances where not going to the hospital to have an appointment makes a lot of sense. And if they could have done this earlier and figured out a way to get paid, we would have a better system now and COVID would not have made as big of a change. But just building off of that, one of the main issues that I’m working on right now is site neutral payments. And that’s where hospitals currently get paid more than independent
physicians for the same exact procedures and services and that is despite the fact that they’re basically big box stores, right? You walk into a Walmart, you get cheaper prices because they buy a lot of things in bulk. Hospitals do the exact same thing and so the independent doctors offices actually have higher charges for these things but the government pays them less. Now, I don’t fight that the independent doctors offices should get paid up to the level of the hospital.
but this is another issue that’s actually causing the consolidation in the market and allows the hospitals to buy independent physicians all over the place, further breaking our system. So not only is it like just in the not being able to get paid, but in kind of the basic foundational policies and the foundations to the healthcare market where we see these things going wrong.
Christopher Habig
You’re exactly right. And I love talking about this and just how much the ACA missed the mark because they thought again, how this actually like comes about, like you have no, I don’t, it blows my mind to think that consolidation would then increase innovation and decrease the bureaucracy of making decisions. And you’re just like, wait a minute, guys. And so I think.
And I got to pull this up. I should have this bookmarked. But in about about eight, nine years ago, one of the authors of the ACA came out, did op ed in the Wall Street Journal that said, yeah, we screwed up big time. The innovation happens at those independent practice levels.
between a physician and a patient because that’s where we can move very, very quickly, not at some massive hospital system that you got to go through 14 different layers of administration to actually implement something cool. And to what you’re saying, it’s just like.
I guess I keep going back to that. Like, get out of the way. The consolidation is not the answer. And I love, I love your big box reference for hospitals. I might have to use that in future discussions because you’re exactly right. Like they should benefit from economies of scale because I’m a firm believer that hospitals are just a collection of specialists. Hospitals exist or should exist for emergent care. And that’s pretty much it. Everybody else could be.
decentralized and have their own offices and kind of be doing their own little thing right there. So it’s just a collection of these things. So I want to stay on the current event, current event topic here. Talked about site neutrality. What else are you guys seeing as major interest from your constituents and what’s really resonating on Capitol Hill right now from from The Market Institute standpoint?
Charles Sauer
So there’s a few things. I would say, interestingly, right now, healthcare is kind of, in a way, on the back burner. I think healthcare is kind of a nerdy issue. But…
And by that, I mean every time you dig into healthcare, I think that we feel it around our kitchen tables. But when you look at federal policy, they have to open up Medicare and they have to open up Medicaid. And there’s all sorts of issues when you start opening those bills up. And so they have to be in kind of a serious mood to do it. And I don’t think that we’re seeing that right now. So what we’re working on right now is actually the education process so that when the conversation
happens again and we know it will happen again because healthcare is going in the wrong direction. And it’s one of the biggest issues that we face as a country that the both the right and the left are in a better place to know what is going on on the entrepreneurship side and what is going on in the market and for that matter what’s going on with the patient. So what we’re working on is AFP has a bill out that is all about giving patients
choices and patients more freedom. We’re working on talking about the different policies in that bill and mainly we’re out as a part of that education campaign. We’re trying to get doctors to write more so that we have more doctors published and we get more media around those interviews. It’s things that doctors don’t normally have time to do, but we have funding so we’re helping push it. But the idea is that when the argument and debate does come back up and they are
able to open up those bills again, that we’re ready to put stuff down and put legislation down in a good way instead of fighting for what is the good way at the moment that it opens back up because we’ve done that the past couple of times and we’ve lost each time.
Christopher Habig
It’s we’re very familiar with the folks over the AFP and you’re talking about the personal option and that kind of stuff. I was telling Michael guys, we got to think of a better headline because what you’re fighting against is this whole Medicare for all. And really nobody knows what that actually means. But they kind of had this thing of like, oh, OK, I’m kind of pissed off at what.
Most people conceive as a free market approach to healthcare, which it’s totally not. We have really the farthest thing from it without being a completely socialized industry here. But I always tell the guys over the AFP, I’m like, you get your marketing team ramped up because you got to think of better names for this kind of stuff because we’re fighting against free ice cream on the left that says, hey, who doesn’t love going getting free ice cream? And then you come and say, well, now I want you to pay for your ice cream and it’s going to be better.
because it’s like go to the post office to get ice cream and we want ice cream shops on every single corner. Doesn’t that sound better? And they’re like, well, yeah, it probably does. So I know I’m all over the place in my references right now, but you know, I…
Charles Sauer
So I actually I do I fight with you on that one. I do I like the name personal option because I think that we can point to everything that the other side of this debate is doing and show how that those are taking away and maybe it’s better as a defensive title. But every time they come up with a bill on the other side of this, it’s taking away options from the person and makes them less of the patient. And I think that that’s important. I think that one of the
things that we’ve lost in this debate is we’ve stopped trying to win, not even trying to win. We’ve stopped thinking about the moral side of this debate and we talk about the business and we talk about the numbers and we talk about the percentages. I can tell you right before the McCain thumbs down, I actually gave a thumbs down to the same bill. I had been talking with party leadership about needing to bring in the right of center think tanks to
talk about this bill and I was frank with them. I was like look you don’t even have to listen to anybody but people need to be bought in to the bill and also they might bring up some talking points that you haven’t thought about. Well they brought us in two days before they put the bill on the floor and at that point I asked what the bill did for poor people which is a fairly generic question in healthcare and
Christopher Habig
Every healthcare question. Yeah, every healthcare debate goes there. Yeah.
Charles Sauer
And not one single person around the table could answer that question.
And it’s we are in the wrong space when we’re thinking, not you and I, but the country in general is generally in the wrong space when thinking about this debate. And so I do think just having a title that starts you off in the right direction, I think is a is a good thing. I’ll admit, maybe there’s something better if we ice cream stand ice cream stand healthcare, maybe.
Christopher Habig
I mean, you look at the and it was like we were laughing just pre show here. Like, I wonder what we got to find something we disagree on that we can actually debate about here, Charlie. So we finally found it. Right. It’s it’s the difference. Well, it’s the.
Charles Sauer
I’ll give you something, I’ll give you something else that you can disagree with me on. I did write a bill that might’ve had a better name. I helped write the world’s greatest healthcare plan. No. No.
Christopher Habig
Oh, there we go. There we go.
Perfect. See, that sounds a lot better. Nobody knows what that means, but it’s got to be good just by hearing about it, right? Like perfect, right? But I always tell people it’s the difference between shipping things with the Postal Service versus walking into UPS that you know is going to get there and you can track it, right? How long did it take the United States Postal Service to actually have tracking numbers after FedEx and UPS did it? And I go, there you go, guys. There’s your Medicare for All program right there. A lot of different parallels. And…
Where I want to take this conversation, Charlie, not to not to run away from that topic, but with all the work that The Market Institute does, it’s not just healthcare. And what I love to hear is your thoughts on how the economics of the country are affected by healthcare, because you said something a few minutes ago that, you know, healthcare is not really a big topic right now in a lot of your Capitol Hill discussions. And I’m thinking, man.
Christopher Habig
Healthcare is like the only topic because there’s so much waste and so much so many other conversations that it bleeds into from, you know, post -COVID responses from economics, health, from, you know, Americans, life spans getting shorter. There’s so many different things that go into it. It shocks me that there’s other more pressing needs on Capitol Hill rather than getting things like the world’s greatest healthcare plan passed.
So how do these things bleed into each other and all the different elements that you’re working on?
Charles Sauer
So there are not.
More pressing needs on Capitol Hill, but there’s like more pressing political issues for them to talk about I don’t I don’t exactly know if I’m saying that right but I mean, you know There’s things that are currently grabbing the headlines and they’re kind of like a distracted puppy and they see a squirrel and they run over to it and they deal with it and They aren’t in the mood for serious conversations right now. And I think that Healthcare is a serious conversation. I can tell you I
bring up healthcare and we already kind of hit on this a little bit and it was something you said a minute ago too, but in the talks to break up Facebook and Amazon and Google, the talks are that these companies are too big and they need to be broken up. And I bring it back to the healthcare debate and show that look,
The hospitals over here are actually a government created monopoly. You’re driving competition out of the market. And because I do think that innovation can happen at the big companies. Now the innovation that will take them out will.
will more likely be from a small company. But I can tell you where the innovation isn’t going to come from. A government created monopoly. Those guys, their only goal in life is to find the holes in the legislation and try to fill it with more profit. And I understand that the board that makes sense from their board’s point of view to do that. But they aren’t focused on the innovation. When you pull the government assistance at finding that profit.
profit out, then the only way for Facebook or Google to stay ahead of me in my garage is to continue to innovate. And so I’ve been applying the healthcare policies over to these other areas kind of consistently. And then you can do the same when it moves from entrepreneurship to taxes to regulations. If you look at like just talking with anybody in a DPC space about the
fear that they have on the amount of regulations that they face and trying to make sure that they’re in compliance with everything. If we pull those fears off of them, they could be they could provide better healthcare and they could also provide just more of their services, which we talked about beforehand, but supply is still a big problem in this market.
Christopher Habig
Big time, big time. And I like that approach because, you know, from our standpoint, whenever we are asked to come in and weigh in on some state legislation or anything like that, nine times out of 10, we encounter a bill that says, you know, DPC and direct specialty care are defined by one, two, three, four, five. And anything that doesn’t meet those criteria are not considered this and then subject to whatever it is. And we say, guys, hold on, let’s not build a wall around it. Let’s open that up and just say.
Actually, this is whatever insurance doesn’t cover rather than the closed minded. It’s the open minded mindset. And those go over. I don’t think we’ve ever seen like a no vote against that across all the states doing this type of stuff. So, you know, taking what you just said and say, let’s let’s open it up, build out the supply side, make it easier for people to understand rather than navigating through a minefield.
And that’s what I feel like a lot of states and a lot of the federal policy has right now. Things from, oh gosh, you know, licensing, HSA’s tax treatment. If you want to open up, you know, the floodgates for employers coming in here. Well, let’s not have employer plans that are tax advantaged over individual insurance plans or health shares. Let’s make them all tax deductible or none of them tax deductible. That’s fine. Just level the playing field.
And I think I feel like I’m shouting into the darkness, every trying to get into the void. You know, we say that kind of stuff. But, you know, I was going to, you know, kind of like last topic here saying, hey, well, how do people really get involved in The Market Institute? But you’re already there. You already mentioned earlier that, hey, we we have the resources to really amplify physician voices. You just need people to raise their damn hand.
Charles Sauer
Yeah, so we have multiple articles at a time that I’m attempting to find doctors to kind of put their name to. We found that doctors don’t have all of the time in the world to write an article, so we attempt to help them out. But the fact is, is the more that we can get doctors published and the more we can put them on media and in media telling the story of the free market, the closer we’re going to be to it. And we have the resources. The Market Institute has the resources.
right now to do that. So the more doctors that we have there raise their raise their hands, send me an email and say that they’re willing to put their their voice out there, the more that we can tell that we can tell of the free market story and start making these arguments that we need to really move the market forward. And so I don’t know, I’ve done I do a lot of writing myself, but I have more fun getting these doctors published because, you know, instead of listening to a weird economist,
hearing from somebody who deals with patients every day and has actually took an oath to help the patient to go back to profit motive. I think the readers understand that doctors are writing to benefit their patients and so it comes off as better and makes a bigger change. And so I’ve been excited to work on this project and so if you know anybody send them my way have them raise their hands. The more doctors we have the better we can do.
Christopher Habig
And if anybody is interested, I believe that is TheMarketInstitute.org to check you guys out and drop a contact. And look, if that’s not one hell of a call for volunteers to help get your voices heard, I don’t know. I don’t know what is for a meaningful cause as well.
Charles Sauer
Yeah, I mean, I over the past year, I think we’ve done about two to three million in media. We’ll do three to five in this next year. And I really think that that is helping grow not only the issue awareness on Capitol Hill, but also the awareness of what’s going on with direct primary care doctors, cash only doctors, doctors that are listing their prices online and showing kind of what this free market movement is.
doing in addition to the policies that we talk about in the articles as well.
Christopher Habig
Charles Sauer, President of The Market Institute. Charlie, it’s been a pleasure talking with you. And, you know, in some ways I’m a little happy that we found something to kind of spar on, but I appreciate what you guys are doing. There’s a lot of work to be doing. And, you know, it feels good to have momentum no matter how small that snowball is. It feels like that snowball is being pushed downhill and it’s gaining speed and gaining mass as we go.
Charles Sauer
Well, thanks for having me on. I did like sparring with you a little bit, but maybe we can find something bigger to disagree on next time.
Christopher Habig
Hey, you know what, it’s all about messaging and naming. The power of words definitely, definitely matter, especially when you’re trying to get 400 million people on board. So it’s it. We’ll put our heads together and continue the conversation. So Charlie, I appreciate you. Thanks for sharing your expertise and insights with us today. And thank you to our listeners for tuning in to Healthcare Americana. If you’re a new listener, please subscribe to our show and share this episode with somebody you think
might benefit from hearing it because, like we talked about today, it’s gonna take all of us working together to build a healthcare industry that values freedom, choice, and innovation. Once again, folks, I’m Christopher Habig. Thanks for listening.
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