If you’ve been to the doctor recently, you probably know that America’s health care system, as good as it is, could really stand some improvements. That’s our topic on the Lean to the Left podcast with a top expert in healthcare, Firouz Daneshgari, M.D.

Dr. Daneshgari is a surgeon-scientist, educator and entrepreneur who has worked at the University of Colorado, Cleveland Clinic and Case Western Reserve University. He has published more than 200 scientific articles, led numerous scientific and clinical panels, and trained hundreds of students, residents, fellows and junior faculty.

Dr. Daneshgari, known as "FD", is author of “Health Guardianship, the Remedy to the Sick Care System,” a must read if you want to understand what’s gone wrong with American healthcare and would like to see a solution.

Following implementation of the Affordable Care Act and approval of its mandates by the Supreme Court, Dr. Daneshgari founded Bow Tie Medical to create systematic innovations for bringing efficiency and value into the healthcare delivery system.

"We are the most expensive healthcare system in the world," he says on the show. "We are spending twice, three to 500% more than our European or Japanese counterpart.. The reason we are the most expensive is because the healthcare is delivered through 5,000 hospitals that they have become financial institutions, that they use delivery of the clinical services as a revenue generating activities and with that they generate about 50% of waste."

That waste, he says, includes clinical services and activities that do not lead to beneficial health outcomes, although they generate revenue for the hospitals, explaining that "There are systematic misalignments between the roles of hospitals as the main providers, consumers, you and I and the third party payer."

Show Notes

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Show Transcript

[00:01:19] Dr. Daneshgari, thanks so much for joining us on the Lean to the Left Podcast. I really appreciate it. 

[00:01:26] Dr. Firouz Daneshgari: Thank you, Bob, for the invitation. It's a privilege and honor to be here. So, thank you. 

[00:01:33] Bob Gatty: America's healthcare system is the most expensive in the world. , but more money hasn't equated the better patient outcomes, right? As you explain in your book. Why is that? 

[00:01:45] Dr. Firouz Daneshgari: Very good question. I have, after talking about this for almost 15 or 20 years, I've simplified it as to this three by three elements. We are the most expensive healthcare system in the world. To give you the numbers we are spending twice, three to 500% more than our European or Japanese counterpart.

[00:02:11] We spend 11,500 per person per year called per capita, and there is spending somewhere between three to 5,000 per capita. The reason we are the most expensive is because the healthcare is delivered through 5,000 hospitals that they have become financial institutions, that they use delivery of the clinical services as a revenue generating activities and with that they generate about 50% of waste. Waste, meaning clinical services and activities that they do not lead to any health outcome for the consumer, for you and I who go to those services or use those services, but it generates revenue for them. The reason for the hospital's ability, To do generate this waste and get away with it is because there are systematic misalignments between the roles of hospitals as the main providers, consumers, you and I and the third party payer.

[00:03:23] For two third of Americans, the employers are sponsoring the healthcare. So it's called this employer-sponsored health insurance, right? For one third of Americans, the federal government is providing, if you ask me what are those three misalignments, I can explain to that or wait for your question.

[00:03:43] Bob Gatty: No, go ahead. 

[00:03:45] So 

[00:03:45] Dr. Firouz Daneshgari: the first misalignment is that if a hundred years ago, if I was a doctor and you were my patient, whether in Myrtle Beach or in or Ohio, you and I had a one-to-one interaction and I used my hands to. Describe this interaction. I, we both lived in the same neighborhood. We both bought from the same CO and butchery and bakery, and I knew your parents and your lifestyle and so forth.

[00:04:16] So when you came to me as a patient or to get the health advice before you had the symptoms or the problems, I would use all that interactions, all that knowledge base to solve your. . And if I couldn't do that technically, or professionally, I would call a colleague, I would call a surgeon to come and take your infected tooth out and so forth.

[00:04:39] So over the past a hundred years, we have built the largest industry in the country called the healthcare upon this one relationship, the relationship between the doctor and the patient. However, during this past a hundred years, this space has been spread. Has been filled, but at least 20 intermediaries. The intermediaries include the insurance companies, the brokers, the employers, or the federal government of the payers and the hospitals.

[00:05:08] And those 20 intermediaries have made it so expensive that is unaffordable by the consumer now, and they have made it frankly intolerable for the doctors. The rate of burnout among the physicians is the highest that has ever been, and the reason for this misalignment is in the majority of the markets and majority of the cities, more than 70% of the doctors are now employed by the hospitals.

[00:05:36] During the eighties and nineties. The doctors who basically used to be their charity places, they realized in order to. basically increase their revenue and keep up with their cost. They need to start hiring the doctors or their employed physicians. They started with a specialist so the urologist, orthopedic neurosurgeons, and so forth.

[00:05:59] But then soon they realize that they have to hire the primary care physicians to feed the specialist the volume they needed. This is the first misalignment I discovered when I was serving on the board of one of these major hospital systems. There were 12 big hospitals, whereas revenue of $3 billion in order to keep up our revenue, we keep expanding our recruitment of the primary care physicians. So now after that transaction, after that transition, the primary physicians have become the referral machines. So when I would go and go, let's say go a five or six physician groups, let's say hello doctors welcome to our system.

[00:06:42] This is your salary, this is your bonuses. The two weeks from then I would show up with an administrator, a couple of MBAs on. The numbers that you are seeing now doesn't doesn't support your salaries. You can't just see 20 patients, 25 patients, and spend time with them. You need to see 40, 50 patients a day.

[00:07:01] And when the doctor said, but I can't take care of them, I said, you don't need to take care of all the details. Just send them to me. I'm a urologist. As soon as a patient shows up with a little blood in their urine, don't treat 'em with antibiotics. Send them to me so I can do the cystoscopy, I can do the CT urogram, and so forth.

[00:07:20] Now we are all in the system. We want to keep the, basically this volume in the patients and keep creating new volumes. We call it a keep. So now the primary cares going back to that relationship rather than spending time with you to sort out your problems. As soon as they cannot write you a prescription or if they cannot order a test, they refer you to a hospitalist who are, or to the specialists who are working for the same hospital.

[00:07:47] Okay, you have a question, but there are two other misalignments which I'll explain later. Oh, I'm sorry. No, go ahead. Go ahead. Yeah, because 

[00:07:57] I just wanted to chime in because here in, in my own case, which I think might put it into perspective for, others, I've, since I moved to Myrtle Beach, South Carolina six, seven years ago, I've been going to a particular healthcare. Facility for my regular care. And there was a doctor there that I was seeing. A couple of years ago that practice was purchased by the hospital in the, one of the hospitals in the area.. Okay. I just had hip replacement surgery here two weeks ago. First I started out by going to my primary care physician at the same location that I'd always gone to, and I asked them, what should I do here?

[00:08:56] And after consultation, he sent me to the hospital for. For imaging. And, then to the surgeon. But it was all within that particular healthcare corporation. Yep. So if I wanted to go to another, doctor for my surgery, I could have. but it was convenient following through with his recommendation and, going to the local hospital and having the surgery done there. And now following up Is that a bad thing? Did it 

[00:09:52] increase the cost? 

[00:09:53] Lemme take your example actually to set up the second and third misalignment. Okay. So you basically went to have a hip surgery, so you started probably having some pain or walking issue and so forth.

[00:10:07] Correct. 

[00:10:07] So you go to a primary care to your family doctor and so forth, who is now an employee by that hospital. Correct. That hospital tracks every activity, every referral that primary care physician makes, and financially they reward them. How many patients they have seen, how many referrals they have made.

[00:10:28] So that primary care unbeknown to you is incentivized to send you to the same to orthopedic surgeon who works for that hospital.. That primary care is also incentivized to make sure that you will get your MRI of your hip that I suppose you had in that hospital. What he does not reveal to you and is that the cost of the MRI that you did in that hospital is almost 10 times more than the cost of MRI in an independent facility.

[00:10:58] Bob Gatty: Wow. 

[00:10:59] Dr. Firouz Daneshgari: Whereas, so the cost of mri, and these are in the books, the you can get in my town that I know the prices. You can get an mri. If you get an MRI into one of the systems that you'll pay somewhere between four to $5,000. In a same MRI with the same equipment, or probably even the better equipment and read by the same board Certified radiologist could cost between four to $500 in an independent. Wow. So that is, wow. So that is number click number one. Click number two is when he send you to that ortho bot, and I'm sure they all are very good doctors. It never asked you or occurred to you because I'm, guessing you are. You have a Medicare sponsored insurance.

[00:11:45] You are one of the one-third Americans who are paid by the federal government. They didn't tell you. , the cost of surgery recovery. The rest of it in this hospital could rank somewhere between 30 to $50,000. Whereas if you go to an independent facility where there are a bunch of orthopedic doctors that they're doing this, that cost could be somewhere between 10 to 20,000, drafting around $15,000.

[00:12:13] And I'm picking those numbers based on the numbers I have here. Okay. If. , if you understand the one concept, and that is the total cost of care. The total cost of care for your replacement was about $50,000 plus another number of cost for the MRI and so forth. Let's say again, the average is in the hospital based system.

[00:12:36] The cost of replacing the MRI ranks somewhere between 40 to $70,000. I'm gonna pick up an average of 50. that cost is three times more than the cost. If you were doing or through the help of a primary care who is not employed by the hospital, that cost could have been one third of what you paid. Wow. But that cost is masked from you a because of the third party payer.

[00:13:06] Let me ask you, tell, let me take this down to a, let's say you were, , your insurance was paid through your employer. You were working for an employer in your communication industry. And the employer has a hundred, 200 employees that total cost of care. . Now, let's say out of the 100 employees that work for that company, 10 of them have procedures like this, hip replacement, cardiac surgery, e and so forth.

[00:13:42] That total cost of care next year is gonna be counted toward the total cost of that employer and the insurance company. From whom the employer has bought the insurance to provide to you is gonna increase basically the premiums for the following year. So as you could see in the market, the rate of the premiums for employer sponsored insurance are going up between 15, 20, 25, 30%, whereas your communication company couldn't have afforded 30% increase into into that rate.

[00:14:18] What they do, they are going to shift that cost a part of that cost to you, they're gonna freeze increasing wages. At the end of the day, the employee, the individual who gets their basic insurance, we pay for that three times extra cost, either through, basically whether we get it through the employers or through the taxes we are paid for federal government to pay for the Medicare and Medicaid.. So that is the whole concept of this. The second element, the reason we are so expensive, but there's, a, I call the hospital based sick care system. The hospital have transferred into financial institutions that aim to increase their revenue, but delivering more secure services regardless of whether the services positive, affect the outcomes or not.

[00:15:10] That brings up to the second basically misalignment. That misalignment that I explained between the insurance company and the hospitals. When the cost of the hospitals is three times of what it could have been, the insurance company doesn't pay that out of their own pocket. They collect that money and they add, they increase your premium next year.

[00:15:32] Okay. That is the second misalignment, the third misalignment. is that entire transaction of the costs are somehow masked to you because if you are a Medicare beneficiary, you say Medicare is paying for that, but you have a supplemental insurance. All you care is about the deductibles or what is your paying out of the pocket.

[00:15:53] You are not seeing the, full cost of the secure system, whereas in any other big purchases, the cost of we as consumers are involved there. So when I, for going back again to the employer space. , if you knew that you are causing $50,000 cost to your employer and you had the choice of making that one third of that price, you would've behaved differently. So that is the third misalignment that there are these three misalignments, again, between the primary care and the, now they're owned by the hospitals the second. The payer who passes the buck to the consumer, they're not paying out of their pocket.

[00:16:38] And the third is this misalignment between the sponsor and the beneficiary , whether it's Medicare or it's a it's an employer. The biggest difference between the employer and the federal government is federal government can print the money, but the employers can't. No one gives them 30% increase in their revenue every year, but they have to pay for the 30% increase in the cost of delivering the health insurance.

[00:17:04] And frankly, in this day and age, majority of the employers, if not all, cannot afford not providing medical coverage because the job market is so tight. People have, and the cost of healthcare has become unaffordable. I can go on and on, bombard you with the facts, but I took your example to lay out the misalignments or just 

[00:17:29] Bob Gatty: To take that a little bit further.

[00:17:33] in my case, for example, I do have Medicare and a supplement, and I have a very good supplement. At no time during the whole process that I've been going through with this hip surgery, at no time has anyone ever said to me, this is how much it costs. Yep. Never. Yep. And and, so far this procedure, which you say, Probably cost somewhere around $50,000 altogether.

[00:18:07] So far I've paid less than 50 bucks. And, that was cuz I had to go get a walker, which I used for three days and, I had to pay for some prescription drugs that they gave me at the hospital when I left. And, that 

[00:18:28] Dr. Firouz Daneshgari: was it. 

[00:18:29] But you are let me tell you, Bob, you are paying a premium to Medicare, whether it's deducted from your social security or not.

[00:18:39] Correct. And then you're paying a premium for your supplement. Correct. But let me open your eyes to another fact from the age of 26 to age of 65 26 is based on Obamacare. We come off our parents' coverage from the age of 26 to 65 when the Medicare kicks in, an average American pays 1.2 million in their premiums and other associated costs related to healthcare.

[00:19:07] So now you are at your Medicare age, retrospectively, I say, Bob, for your children, for your grandchildren, who do you think will be a better spender of 1.2 million for them? You have just a new grandchild. He or she is gonna pay 1.2 million as you have paid for it. So the cost that you have paid is not just 50 bucks to buy the walker.

[00:19:34] You have paid all along the past 40 years and you continue to pay the premiums. The reason I'm bring this is up. The fundamental problem, and I've mentioned this in the book, is not basically a single factor problem. The fundamental problem is we have an inefficient system. We have a dysfunctional system.

[00:19:55] It's like we have a gas guzzler or, and you remember this, it happened in the car industry, right? The, gm, Ford and Chrysler. Together, the three big American manufacturers of cars. We had more than 75% if not higher of the world market. But we had gas guzzlers. We were making 10 mile per gallon because there was no other manufacturers. In seventies and eighties, Toyotas and other more efficient car manufacturers come in to the point that they lead.

[00:20:29] Now they've become, Toyota has become the number one manufacturer of the cars to the point that the GM at the 50% of the world market files for bankruptcy in 2008. So our healthcare is basically has become the gas guzzler of the world. And my whole concept here is the misalignment. So my, again, my history, as you mentioned I'm a surgeon scientist.

[00:20:59] I ranked through the rapidly, through the rank of academia until I served as the board of this major healthcare system as the chair of a successful program. That is where my eyes open to this concept. We have created the gas guzzler, and frankly, the gas guzzler doesn't care who pays for the gas, whether it's a federal government or his employer, or who rides on the car.

[00:21:25] Our number one aim has to become, to create the next generation of the healthcare that is efficient. Efficient meaning has contains all the benefits that we have. Now some of the best, if not the best trained doctors, of the best technology and so forth, but it is responsive to the market forces that creates efficiency because whenever we put the market forces, whenever the market forces are active or functioning in an industry, we create the most efficient systems. We've done that with technology, tv, clothing, housing, and so forth. So right.

[00:22:06] Bob Gatty: In your book, you describe a new model that would use the primary care infrastructure, but integrate virtual health and wellness services, and what would that accomplish and how would it work? 

[00:22:18] Dr. Firouz Daneshgari: So the, book, the whole concept of the health guardianships is or the premise of the next generation of the healthcare is we could fix this misalignment.

[00:22:31] Really. Readily without the act of Congress, if you will. The first thing is to take away the primary care away from the employment of the hospitals and the primary care could become a basically hired agent of the patient or the consumer. A movement has a started in the country called Direct primary Care that is growing massively and that is individuals like you and me, we go and pay a monthly fee to primary care and he becomes our agent of health. He basically becomes available 24 7 for us and, it will basically we realigning that whole alignment of the a hundred years ago. And financially, I can tell you, This is both good for the member for the consumer and for the doctors.

[00:23:25] The primary cares who have moved away from being the employee of the hospitals. They have the potential to make more money and they deliver a much better service to their consumers. And so that is the number one fix we make to need to make. Okay, the second part of that language. is again, I think when you were telling me that where you are in the reading the book, the transaction between the doctor and the patient doesn't have to be all in person.

[00:23:56] More than 90% of that interaction is exchange of information. Whether the information is about your symptoms, whether it's your background, and what we have done in the company I founded is we have transferred this into a virtual delivery model, and the reason for that is much more cost efficient and is much consumer friendly rather than in order for you to get a let me take you actually on your knee.

[00:24:25] No. Your knee replacement. There are a number. Elements in my mind as an orthopedic surgeon or as a primary care that I wanna know after basically your hip replacement how you're doing, right? And I, without boarding, you'll take you through the technical, in this case, the follow up of the knee surgery.

[00:24:48] Almost a hundred percent could be done virtual. , you can sit in your room, in your office, at your home. And I can sit on the other side. I can basically ask the information, ask you to show me some of the range of the motions, ask you whether you have pain or not, and so forth. This could be done virtually.

[00:25:08] It is the most efficient for you because you don't have to take off from work or whatever you're doing during the day. Drive half an hour to go and wait for half an hour in the office to be seen for five minutes. It is most efficient for me because I don't have to build that office for you to come and be visited.

[00:25:29] And that's why the chapter that you haven't read in the book, this whole concept of the digitalization, of the process of care, like it has happened in many other industries. If you remember, there was a time you and I used to go to a travel agency office to buy a ticket. . That whole pre-sale in the airline industry has transferred a hundred percent to a virtual action. We select at 3:00 AM I get up, I select the flight I wanna take, I select the seat I wanna take, and until really I put my butt in the seat, the airline industry doesn't need to see me physically.. I propose in my book that could be done in the healthcare.

[00:26:11] And the reason hasn't happened in healthcare is because the current business model of the hospital basic care system wants you to come to the office so they can click and encounter so they can get paid. So again, anyway, there is very simple solutions that I have laid out in the book that how the current system could be converted into a healthcare system away from a sick care system. 

[00:26:39] Bob Gatty: Okay. Do you want to continue and explain a little bit more about What that might involve. 

[00:26:48] Dr. Firouz Daneshgari: Sure. The second part is, again, if you are paying me again, I think I've explained the concept of the direct primary care that you pay me on a monthly fee or your employer pays me a hundred dollars per member per month, and then I delivered you the virtual care.

[00:27:09] You, I think we went through that. What that would do if I take you through your knee replacement example since you gave me that, you come in with the knee pain you come in with the with the, I'm sorry, hip pain, right? And me, I don't have any incentive to send you to orthopedic surgery as soon as I see your face, my job is to take care of your pain. I'm gonna say, Bob. Okay. What have you done? What do you do that causes the pain? You say x, Y. Bob, right? Have you tried the physical therapy and you say yes or no? I would tell you here is the surgery has this consequences. The surgery has this limitations, blah, blah, blah.

[00:27:54] So I spend as much time as I need with you to make sure that the hip or the knee replacement or any other procedure you need is absolutely needed. It's not just because I'm financially incentivized. So if I do that, and I'll tell you again, I've lived in my life, more than 30 to 50% of the surgeries are done in this country are unnecessary.

[00:28:23] So if I save, one out of two the surgeries in this country and deliver the health outcome because out of the, that out of that interaction you have with me , you wanna get rid of your knee pain, you wanna go back to your active lifestyle, right? You're not dying to have surgery, you just wanna, so my aim becomes, changes totally from benefiting from delivering a secure service to you to basically guard your health. Maintain your health, right? So I'm going to extend this to a basically larger extent, as you would read in the book,. 75% of the spend of the healthcare sick care system in this country is a spend on people with chronic conditions, okay?

[00:29:15] Chronic conditions such as obesity, diabetes, muscular, skeletal, cardiovascular, and so forth, right? Scientifically, now we know that the. The risk. Risk for me becoming obese at the age of 50 or 60. Doesn't it start at the age of 50 or 60? Goes back to when I'm 20. Goes back to my eating habits, to my activity habits.

[00:29:39] Now we have more scientific data and information on what are the risk factors for these chronic conditions. Then we know how treat them. so we don't have to wait for the age of 60 and 65. When someone becomes so obese, we have to do a bariatric surgery. We don't have to wait for the age of 50 and 60.

[00:30:00] Someone develops diabetes so we can treat them with insulin, and they have to pay, as you've heard, the prices of the insulin going through the roof. So what I'm proposing is what we did very successfully at the turn of the past century. If you remember during the past century, if you go back tonight, let's say we were 19, 21, 19 10, about a hundred, 110 years ago, the number one cause of death in the US were infectious diseases.

[00:30:29] Okay? Number two were cardiovascular. Number three, cancer. Number four, traumas. With the infectious diseases, we soon realized that rather than waiting for the patient to become infected, to get to break close or and so forth, if we go and invest in clean water, clean food, vaccination, we could eradicate the infectious diseases, and we did that very successfully.

[00:30:55] Out of that success, we created the public health.. The public health return on investment is one of the highest in any level. We are spending currently a hundred dollars per capita, per person, per year for a public health, and we eliminated the infectious disease as number one cause of death. What I propose is now we are scientifically and socially, we are at the verge of the era where if we invest in preventing the chronic conditions, we don't need to spend all this 11,000 for the sick care. So scientifically, we could help people to not, to develop chronic conditions such as obesity and diabetes and osteoarthritis and cardiovascular.

[00:31:47] over the past hundred years beyond developing the public health as we went and discovered, what is it that causes the heart attack? What is it causes the cancer, what is it the cause of Alzheimer and so forth? We've discovered a lot of information. We have business models called hospitals.

[00:32:08] Space, sick care system who benefit from delivering sick care services. What I have proposed in the book is now we have arrived at the time when we need to invest in what I call the health guardianship. So this primary care relationship extended to a virtual delivery create a saving out of delivery of a health in your guardian.

[00:32:33] And imagine if you have the health guardianship now for your children and for your grand children. You could see that we can open an era where 20, 30 years from now we can reduce the chronic conditions as we did with the infectious diseases. 

[00:32:51] Bob Gatty: Where would hospitals fit into this

[00:32:53] Dr. Firouz Daneshgari: scenario? The hospitals will shrink from the the current size that they're basically keep promoting the sick care services.

[00:33:03] To less than, frankly, less than 10% of our needs. So for those unfortunate people who their health risk medication were beyond our scientific ability to control that, or for traumas and so forth, the hospitals become the center of the seek care and that's where they are. And let me give you an actual example.

[00:33:26] The Covid gave me this confirmation that this theory is correct. , if you remember, if I take you back to May of 2020, may or June of 2020 when the virus was rapidly expanding, we didn't have a vaccine. So one day I was biking my neighborhood and I am looking at, I said, okay. Majority of people who are sitting in their houses in Lockdowns, they're following the public health recommendations of very mass social distancing.

[00:34:00] The hospitals had become the, basically the war zone, taking care of people who were unfortunate and they were sick. Most of us didn't wanna even drive within a few miles around the hospitals because we thought that the air around the hospitals are contaminated. leave alone going to a emergency room.

[00:34:18] You remember those days, right? I, you could not pay enough to a person, to me to walk into an ER of the hospital at that point. , yeah. Majority of the people's need 80 to 90% of the people who were in the middle. Their need was for the healthcare system to help me not to catch covid or remain safe if I catch the Covid.

[00:34:40] That is really, that opened my eyes that there is a need for a segment between the public health and the sick care system that are called Health Guardianship that help us from the very early age to remain healthy. That is the concept of the health guardianship. I say historically we have arrived to a point where with the combination of the job of the primary care, combine it with wellness program, nutrition, exercise, and all the scientific information we can bring together as a subscription model, as a basically fee per member per month, and so forth. We can radically change this whole scenario of wait until obesity and diabetes and cardiovascular happens, then I go for a for a treatment we can Right if, you allow me, I'll make you one example, and that is why the concept of the bow tie was born, frankly. Okay. If you Google, the bow tie is called the bow tie risk management. Okay. And what that is, actually taught in the business of school, the knot of the bow tie is the event that we want to prevent. if I bring you whether that event is a fire or whether that event is a chemical spill or it's an airline, is an airline crash, you have two choices.

[00:36:05] One is you put all your resources and efforts or majority of that on the right side of the bow tie for me who is wearing the bow tie, and that is to prevent that event. Airline industry, the very first flight took place a hundred 17, 18 years ago from Ohio the actual flight took place in Carolina.

[00:36:28] Within 118 years, we have created the safest mode of transportations. The cars kill more people underground than airplanes on the air. And the reason for that is the entire industry's focus is how I can prevent the airline crash. The entire airline thing is pre-flight checklist.

[00:36:48] Safety, safety. Safety. It is absolutely unacceptable for airline industry to prevent the airline crash by catching a fire at 30,000 feet elevation, right? Whereas in healthcare, the same is for fire. When we graduated from caves, we had lived in the structures. We realized the risk of the fire is real. So now we have adopted the fire risk medication in our daily lives.

[00:37:14] All of us have basically smoke detectors. We keep teach our kids how to prevent fire, how to escape the fire. That's why the escape is skyscrapers such as Sears Towers and the empire State. They have AST stood for decades without the major fire, whereas in healthcare, what we call a healthcare, which is really a sick care, our entire focus is after the event has happened.

[00:37:43] On the left side of the bow tie, we wait for the obesity to happen to do bariatric surgery. We wait for diabetes to happen to treat with insulin. We treat for the coronary artery disease, happen to treat it. We wait for the hip pain and the knee pain to happen to do the surgery because there are business models, hospitals that are benefiting from, basically from those service.

[00:38:09] What I propose in the book, we have reached to the time that scientifically, clinically, we could focus our attention on the right side of the bow tie, prevent all these chronic conditions. Okay, 

[00:38:24] Bob Gatty: now I have a, question for you. When you talked a minute ago about individuals paying a flat monthly fee to a physician, to in effect be their personal doctor, health Guardian to take care of, yeah. To take care of whatever. Yeah. Issues come up with that patient. Now, does the patient also maintain their health insurance so that in addition to that? 

[00:38:54] Dr. Firouz Daneshgari: Yeah, so that goes back to the business model I have developed in Bow Tie.

[00:38:59] Again, it's easier to understand for employer because the, again, the government prints money.. So go back to that employer, your former employer or if you were the employer yourself. There are a hundred employees there. If I in a hundred employees and multiplied by 10,000 per per capita, the cost for that employer is somewhere between a million to 3 million a year depending on various factors.

[00:39:35] that employer is paying that much toward the healthcare. If by realigning the relationship between the all the employees and their primary care, delivering it virtually helping you to do a effective price shopping, when you go for the knee surgery, you know you can go reduce your cost from 50,000 to 15,000.

[00:39:56] there is significant scientific data from my own company and others that this would deliver somewhere between 20 to 50% saving in that cost. Then the next question in my mind, in the the kind of evolution of the business I was developing at Bow Tie is who do I want the saving to go to? Do I want it to go to insurance company?

[00:40:22] C. , do I want this to go to the employer, to the federal government or the individual? My answer was, I want this to go to the individual because the individual consumer is the one who's paying out of their earnings or taxes. So with that concept, but for two third of Americans for that a hundred employee employer, There's the employer who is spending that one to two 3 million, right?

[00:40:47] And sharing a part of it with the employee. I want that saving go to that employee. Therefore, we have formed a, captive self insurance. So the employer becomes a, basically a client of our captive self insurance. So at the end of the year, whatever saving we have generated beyond our fee will go back to the employer..

[00:41:09] So answering your question, we have created an a a, full package for the employers who can not only improve the care and the risk mitigation of the health issues for their employees at the end they can collect the savings. What that employer is going to do with that saving frankly, is between the employer and the employees.

[00:41:34] I have some concept, but nevertheless, if we deliver that saving to the, a sponsor of the healthcare, I'm done with my with my ambition. 

[00:41:43] Bob Gatty: Okay, so what is the difference between bow tie and other providers? 

[00:41:50] Dr. Firouz Daneshgari: The bow tie, we call ourself a pay wider meaning we are the, providers, the physician, primary care, specialty cares who we take.

[00:42:01] Basically, we have a skin in the game because we wanna reduce the unnecessary care for you. The unnecessary services harms people, the medical errors have become the number three cause of death because this overzealous hospital systems. Yeah, 

[00:42:23] Bob Gatty: that I was shocked when I read that in your book.

[00:42:26] Dr. Firouz Daneshgari: I I knew it was high. Yeah. Yeah. Google it. Google it is, the data is comes from the Institute of Medicine. The So

[00:42:38] the concept is really to create an efficient interaction between the consumer and the providers. And because of that interaction, again, the data shows their significant saving because that 50% delivered that saving to the employer and the employees.

[00:42:59] And Bob, I don't really need to go anywhere outside this universe to convince the data because Europeans are doing this with 50% of the cost we are doing, and you've traveled to Europe. They're not less healthier than us. They just don't have this misalignment, they don't have this fee for service model that is driven by this 5,000 hospitals.

[00:43:25] Bob Gatty: I understand. What, has to happen in order to get a system like what you're advocating into the mainstream? 

[00:43:37] Dr. Firouz Daneshgari: I have to tell you because your title of your podcast is The Lean to the Left. Yeah. The solution is absolutely unequivocally is not a single payer system. And the reason I say that is Medicare for all our single payer system is oh, we can't fix our gas guzzler car, let's buy a car this gas guzzles for everyone.

[00:44:01] There is a, yeah. The inefficiencies of the single payer system has, we have 50 years of the data from England, from Europe, from Canada. Single payer system would lead to rationing of care without the question unless, okay. My proposal is to create the next efficient model of the healthcare system. To, convert the employer space into this space.

[00:44:27] As I explained, frankly, if this model is working for employers, the federal government will come and buy. And there are some initiatives at the Medicare level to create this alignment between the doctors and the members. To me, the future of an efficient system is the system where the relationship between the doctor and the patient are direct, number one. Number two, the free market forces are allowed to work in the system. So you as the consumer, you have control over that 1.2 million that you put through your earnings into the system, and very much like you have created efficiency in buying your car or buying your house or buying anything else, we as consumers have the ultimate control over the choice of where that money is gonna go rather than. Rather than the insurance company or the federal government, 

[00:45:21] Bob Gatty: it wouldn't this require a substantial legislative initiative in Congress. It would be 

[00:45:30] the equivalent of going through Obamacare? 

[00:45:34] Dr. Firouz Daneshgari: Not at all. Not at all. Again, not at all. No, Is a simpler example of that. is maybe what went on in the pension plans, as you remember, before 1970s, 1976 the the common condition was you and I go work for a company for 30 years, 35 years, 40 years, whatever.

[00:45:57] And right, we retire with a pension with 60, 70, 50% of our salary. What happened? The companies who were inefficient when they went. , their pension plans went bankrupt with them. What the Congress did is said now the money cannot be controlled by the company anymore. It has to be transferred to individual retirement accounts, IRAs.

[00:46:23] So that's why the majority of the newer generation, they're retiring with the IRAs and, so forth. Correct. The setup for transfer of that power. And so you and I, if you have an ira. We control the destiny of that, right? We put it in Fidelity or Vanguard or Charles Swab or whatever. Sure is the same process could be created for for healthcare to go into individual retirement account and, I'm sorry, individual health account.

[00:47:02] Okay. That I see that process is already established there. It's already established called the ira, individual Contribution Health, that President Trump started it, president Biden continuous it. So that process is, there, doesn't need an act of the Congress. Okay. Then there are a couple of other steps that could be done.

[00:47:28] But it's could be frankly done with an executive order. It's not a, the changes I propose there are no way close to the massive changes in Obamacare, frankly, if I may say Obamacare. Is called Affordable Care Act and all it did it not, it made it unaffordable, more unaffordable because of the way it was set up and so forth.

[00:47:54] Okay. Okay. 

[00:47:56] Bob Gatty: Now we've covered a, ton in this 49 minutes that we've been talking. Where can people get ahold of your book? 

[00:48:10] Dr. Firouz Daneshgari: Fd, it's on Amazon it's called Health Guardianship. And you can, it was launched on November 16th and within actually 48 hours became the Amazon bestseller in healthcare industry.

[00:48:24] And excellent. And my company, as you said is bow time medical.com and I'd love to hear challenges. I like to hear the stories and. What I'd like to say, Bob, if you allow me, is to me this has not only, again, I've spent my entire life since of age of 17 in healthcare, I've worked from the loneliness interns into the highest level of the healthcare.

[00:48:55] So to me, when I decided to step down from my very high paying job to devote the rest of my life to this, to me was historical opportunities as you see from my, okay. Reading, I'm an immigrant and I value what this country has done for me, for my family, and frankly for the rest of the world.

[00:49:20] I see this as the next biggest opportunity for Americans and American market to create the next model of the healthcare that would become the leading model for the rest of the world. As you read through the part of the book before, again, I decided to step down from my chair position. I traveled around the world to find out, to see if there is a model where we can copy and paste, because it was, to me, it was shocking.

[00:49:52] Why we is we are a smart country. We have 5% of the world population. We have generated more than 50% of the world's wealth over the past two centuries. We continuously generate more than 25% of the world's g d p. Now, despite all the challenge. , why we are spending twice as much on the same thesis and that others are spending half.

[00:50:19] So I went to China, to Taiwan, to Brazil, to everywhere to see, and I did a part of my training in Europe. So I'm well familiar with the single payer, single provider system, the Minister of Health, one of the coordinators half of in, in, Brazil. that kind of broke the news to me. In Brazil, there's a constitutional mandate to provide free healthcare to every Brazilian citizen.

[00:50:44] So we go out to dinner and I ask this gentleman, his name is Gustav. He's an orthopedic surgeon. I say, Gustav, you're in charge of the state of San Paulo, the largest state, you provide free healthcare to all your 42 million population. He said, heck no. I said, but your constitution, there's a constitutional mandate.

[00:51:03] You're liable. He said, I don't care. I don't have the money. I said, my budget. He says, my budget is $8 billion. The first 2 billion of it goes to the medications you guys keep creating and generating. And our doctors read in the books and the journals and our consumers want it. And I say Gustav, what is the solution?

[00:51:24] And this is 2010, 11. He pulls out his iPhone out of his pocket and he says, go and innovate. I said, what do you mean? He said, you guys have the largest market, the most money, some of the best brain. Go and figure out where the source of inefficiencies are. What is it that you can generate that will keep all the good of the current system and get rid of the bad bad. part of it..

[00:51:51] And during the flight to Brazil, I was reading a book from Peter Drucker. If you remember, Peter Drucker was the Dean of the Deans of the School of Business. The title of the book was Post Capitalistic Society, and the theme of the book was The capitalistic system has won the race of the past century versus the socialist system to provide wealth and prosperity..

[00:52:17] However, it is not perfect. We have not solved the inequality of the wealth distribution and poverty and the rest of it. His issue was the next model has to stand on the shoulders of the capitalistic society, not to go reverse the same agenda stands for the healthcare. We are spending 4 trillion in the, in sick care system in this country.

[00:52:43] Half of it is a waste by all the data that I coded and this other independent research. If we can create a 2 trillion saving and put that 2 trillion saving into this health guardianship to a, eliminate chronic conditions, b, prolong the life of our citizens, that will become the beacon of the remodeling of the entire system throughout the world.

[00:53:08] And I'll tell you one other piece and I'll shut up. Over the past 40 years, four companies who have become the wealthiest companies in the world, apple, Amazon, Google and, so forth. They were born out of garages. They were built and conceptualized, and that is how the healthcare is going to be remodeled in this country because in my opinion, this 5,000 hospital systems, they're stuck in their own mud.

[00:53:43] They cannot reduce their cost. They're so trapped in their own system. The innovative companies such as Bow Tie Medical, there're a bunch of 'em. Amazon just bought one of them called One Medical. The Innovations on the horizon for our remodeling happen and complete this transaction or transition from a sick care system that is gobbling up 20% of our G D P to a less than 5% or 30% of what it is, and spend the rest of the resources on keeping us healthier.

[00:54:20] Right. . 

[00:54:21] Bob Gatty: All right. Is there anything else you'd like to add because we're about to wrap this up? 

[00:54:26] Dr. Firouz Daneshgari: No, I think I have said it is I, would encourage, again, I can throw at you or the audience a lot of information that may sound disjointed, but I would repeat it again. We are the most expensive because we are generating 50% of the waste, the reason we are pre generating the waste because they're the systematic misalignments.

[00:54:47] I explained the misalignment. . There's a simple solution for realigning this misalignments and look for those in innovative companies such as Bow Tie Medical.

[00:54:57] And you have questions. Send me questions. I'm available on my website, on the link portfolio, and go from there. All right, 

[00:55:08] Bob Gatty: so you guys, you want to check out. , his book, health Guardianship. And I really do recommend it. I've, read about three quarters of it so far, and it's well written.

[00:55:25] It's an easy read it's easy to understand and I think FD's fds done a great job with it. And I thank you FD for joining us today on the Lean to the Left Podcast.


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