Access to Health Care

Hello, everybody. Welcome to Health Chatter. Today's topic is a good one. And hopefully it'll be informative for you, the listening audience. It's about access to health care and insurance, which kind of go hand in hand. We've got a great guest with us. We'll get to her in a minute. We've got a great crew that always keeps us hopping. Maddy Levine-Wolfe, Erin Collins, Deondra Howard, Matthew Campbell, Sheridan Nygard, all do great. great work for us. They do background research, they do the marketing, they do the production for this show. So thank you to all of you guys. You're second to none and greatly, greatly appreciate the work that you do. My co-host for the show is Clarence Jones, great colleague. He's got great questions. He comes at it from a different angle than I do. which is always, it's a nice complimentary way of doing a show like this. But I'm nice when I ask those questions, Stan, right? Yeah, I know. Okay, I'm a nice guy, okay. Yeah, he's always nice. I want to guess to know that I do try to be a very nice guy when I ask these probing questions. Yeah, yeah, he's good. But from a different angle than I do. We also have a great sponsor, Human Partnership, community health organization Actually, is it statewide clearance? I forgot if it's statewide. It is statewide. Yeah, yeah, we've done some work in it. Well, yeah, you could check them out at huma We wanna thank them for sponsoring us. And also you can check us out at heal All our shows are on there. All our background research is on there if you wanna read about it. And also, many of the shows are transcribed as well. So if you're more into reading the show or listening to the show, you have a choice. So there you go. Today we have a great guest. I've known her for a long, long time and we were just chatting. And probably I've known her about as long as I've known Clarence. Dr. Lynn Blewett, whose research really focuses on healthcare policies. She's at the University of Minnesota and the School of Public Health. focusing on healthcare policy and access. And she directs the state health access data assistance center. And do you call that Shadak? Shadak. Okay. Shadak. Okay. Her expertise is in healthcare policy, access to care, which we're gonna get into some of these definitions, by the way, so everybody's clear. Looking at disparities. She's also, I remember we worked together at the State Health Department before she went to the University of Minnesota. Wonderful person, wonderful colleague, and many, many thanks for being on our show today, Glenn. Nice to have you. Thank you very much. Yeah, so let's get this thing going here. We're talking about access to healthcare slash insurance. So let's maybe start this out, but what the heck do we mean by access specifically to healthcare? Well, a lot of times people start with health insurance coverage and that this is like the mechanism to get you in to see a doctor if you have health insurance coverage. And then you, so sometimes when people talk about access to care, they're talking about access to health insurance coverage. And that's where we spend a lot of time in terms of using survey data and information to understand who's covered by what type of health insurance and then who's not covered. And that's kind of the vehicle to get access. What you really care about is that people have access to a healthcare provider to get the care that they need. But usually, I would say most people will start like, do you have health insurance coverage and what kind of health insurance coverage? And then who's in your network and who can you, who do you have access to see when you need care? So the insurance then, if I'm reading it right, is kind of the entree to the whole idea of access itself. Correct? Yes. All right. So, and then there are issues around access, but we'll get to that in a second. So can you, you know, To be honest with you, even for those of us who've been in the industry, it can be even confusing for us, okay? Because it's like, oh my God, there's private insurance, there's public coverage, it's doing this stuff yearly, you know, where you have to, you know, re-up your insurance or redefine who you're going to have for your insurance, where you get your insurance, whether lawyer or on your own. So can you kind of cover that umbrella of all these things, public, private, where you get it, etc.? Yeah, and maybe I'll just preface to say that we have one of the more complicated healthcare systems in the world. No kidding. That most, you know, most countries do provide universal access through different mechanisms. but we have kind of a patchwork of insurance. And most people in this country get their health insurance, especially under age 65, get their health insurance through their employer. So about 50% of people get coverage through their employer. And then you have your kind of supplemental coverage, which is Medicare, Medicaid. And then for those people who are working but don't have access to employer-sponsored insurance, so that could be like artists or self-employed people you know, people who work on their own, they have access to what's called direct purchase. So that's just, if you called up Blue Cross Blue Shield and said, I need a health insurance plan, what do you have to offer? So that's kind of the overview. And then of course we have the Veterans Administration's Indian Health Service, the military, TRICARE, and those are also important components, but probably less, not as many people. So, let me ask this question. Who typically, let's call it by age, who typically uses health coverage more? Is it fair to say the elderly do? Maybe 65 and older. Yes, I would say the elderly and probably the disabled, the elderly and disabled. And many of those people, especially if they're poor, will be on either Medicare or Medicaid if they're poor. And those are where the high cost, high expense people are. And the public does provide public programs for their needs, Medicare and then Medicaid. Yeah, okay. All right, Clarence, I know you've got some zingers. Here we go. Well, no, I don't have a zinger because I don't want you to give me a bad reputation. You know, you said it from the very beginning, the healthcare system is very, very complicated. you know, and I come at it from a community perspective. I guess recently was invited to be on the board of the Minnesota Community Measurement. And so we're able to take a look at the gap between systems and FQHCs. How does the community utilize the system that you have? I mean, how can we utilize that in order for us to be able to to get or to gain more access to healthcare because there is a gap. Yeah, thank you for that question, Clarence. And I missed one important part of our sort of coverage framework, which is there are about 8% of people across the country, which is, let me just check my number, 26 million who don't have health insurance coverage. And so there is what we call a safety net, free or low cost care and that's through federal and state funding. So federally qualified health centers or community health centers. We have rural immigrant programs and then like HCMC, the public hospital, which is funded by state and federal grants and financing and Medicaid does pay for some of those people in those programs, but they're very, community-based, local driven. And if you don't have health insurance, you should be able to find one of those and get either low cost or no cost care. Now, many of them don't provide access to specialist care, but they may be able to help you find somebody who would be willing to take somebody at a discount. Thank you. So you alluded to the fact. and I agree with you wholeheartedly that our system is, in the United States, is probably the most complicated anywhere in the world. I just think about somebody who wakes up one day and just says, okay, I have to get health insurance. It's just like, wow, where do I start? So let's back up on one thing. give me your thoughts about single payer. In other words, if we're really talking about trying to get rid of confusion and perhaps get rid of confusion and just make it easier overall, talk to me about single payer. Well, I like to, I don't like to use the term single payer because it... it polarizes people. Yeah, well, that's true. Single payer means government run, government sponsored healthcare. And there are some models. So England has a universal care program with public funded by public dollars. And most of the health system is publicly supported. But there are also other systems where there's a combination of public and private. entities. And so I like to refer to universal care and different ways to get to universal coverage or 100% coverage. There's different ways to get there. And I you know, I, it's so hard to, I'm 100% supportive universal coverage. And I think the United States could get there. But in this political environment, and for the political environment we've had for many years now, it's just, it's just a huge road roadblock to get there. So I'm a hundred percent supportive. I was a hundred percent supportive of Bernie Sanders who was advocating for Medicare for all. I think there's different ways to get there. One thing I do kind of come back to is the states that have tried single payer have done studies over Vermont was kind of, the states have advanced this and Minnesota kind of goes and fits and starts on a model. of universal coverage. And Vermont was a state that went kind of ahead of all the other states. And the problem was, is that transferring private funded healthcare to a public funded system requires an increase in taxes. And so when people see that explicit tax amount that costs are, you know, that would be needed to fund our healthcare system, Right now our employers, so 50% of people get their insurance through employers. We call that private insurance, right? But they get a subsidy on that, on what they contribute to. There's a huge subsidy transfer to them, but we don't see it. It's like implicit. So even though we're, you know, it's tax supported in many, many ways, we don't think of it as tax supported. So as soon as you make that explicit, and say, okay, private sector, you're not responsible for healthcare anymore. We're gonna move it to the public domain. And then we have to raise the taxes. So the employers, maybe, you know, in Vermont it was like a 40% increase in employer taxes because that's how much they contribute and they get, you know, benefit from contributing to health insurance. So my, you know, my bottom line is I don't wanna lose that private sector contribution to our health. fair coverage, which is right now provided through employers. And in some ways, it's not an economist speaking now, but I don't care if it's implicit. You know, sometimes we have to hide the taxes, because that is our foundation of our health care system, is our employer-based health care. And it makes it complex, and it's all, I can hardly describe the tax subsidy that they get. But. it's really important that the private sector contribute to the cost of the system. And if we move it into a public domain, then it becomes a political issue and very explicit. And that's, you know, the economists want to reduce that tax deduction that the employers get to make it explicit, but then we have to pay for it. And we have to move that pain for it. And so, I guess that's a long winded way of saying. I'm supporting universal coverage. I don't wanna lose the employer contribution to our health insurance coverage. And is there a way to get there by sustaining that? And one answer is Germany. That's how Germany and maybe Austria supports their health insurance is by having employer, employer mandate employers have to provide insurance. And then the government subsidizes the low income and... people who are not working. So I think there's a way to get there. There's lots of different models. But I think for our country, you know, it's gonna have to be, I don't know, I don't know what you like a huge, a huge, I don't know what the word is, transformation. Or a huge shift or a huge outcry. Like it's time. And there are different parts. You know, there have been different moments like maybe this is it. When there was a time when employers were like, we don't wanna pay for healthcare. We don't understand it. It's too costly. The costs keep going up. And if employers start to sort of bang the drum and other people, advocates who have been there all the time, there may be a point where we get some movement and some outcry. Like this is, and it feels like after COVID and now things are... costs are still going up and you know, so maybe, I don't know. At the end of my career, I'm thinking probably not in my, I tell my students, maybe not in my lifetime, but hopefully in your lifetime. Yeah, right, right. Yeah, Clarence. So Lynn, you have been described as an advocate for information access. Tell me, what does that mean? Well, you know, we, We leverage all the federal survey. There's about five or six federal surveys that provide information on health insurance coverage. And of course they measure it all different ways and have different purposes. But we leverage that for mostly for state health policy because at the federal level, and especially now Congress, I mean, they don't do anything. And so states are really where a lot of the incremental approaches to increasing access are. And so we leverage the federal data to provide states information on health insurance coverage, access to care. We do a lot in social determinants of health and provide that in a easy accessible way for people to understand sort of what do we know about our systems of care. And so we have a nice, and maybe I'll include that after we're done, you can put it on your resource lists, what we call state health compare. It's a state. It's a dashboard that you can look at different measures and compare across states or compare to the national average or get a map. And a lot of researchers use our data. A lot of state policy people use our data to provide information to policymakers and decision makers. So our kind of motto is we want to inform decisions and discussion and to do that, provide the best data available and try to be Even though I'm an advocate for universal coverage, I try to be an advocate for objective data, good data, reliable data. And that's what we've been known, we have a good reputation for that, that people can trust our data to be unbiased and the best available on this topic. So let me do a follow-up question with that. As a community member, how do we become engaged in this work? I mean, because for many of us, we are, trying to make sure that we have access to insurance for our population, how do we become engaged? You know, that's a really good question and probably something that the university and my center has done less well. We're really engaged with states and state decision makers and people who run the Medicaid programs and the community basis. We have done some work with the Blue Cross Blue Shield Foundation to provide county level information on insurance and coverage. And then they've used that with community health workers and navigators, but like when they're in a certain area, they know where the uninsured are and what they look like, what their characteristics are. But you know, we could certainly do a better job of reaching out to more community groups. And I take that as a good. reminder as I'm working my way towards retirement, that's something we could do better at. Thank you. So let me go back to this kind of theme that I called, I'll just call confusion. It's just like, and let me just take one facet of that whole ball of wax here. Yearly, every year, people are required to do open enrollment. Okay, now, what does that do? I mean, in the scheme of things, why do we have to keep going through this year in and year out? And it provides frankly angst for a lot of people, it provides confusion. Can I use, for instance, when... when you're looking at this yearly update or whatever it is, people ask, well, can I still see my same physicians, et cetera? What is it? Why is it that we have to embrace this? I mean, every year we have to go through this. Well, again, okay, so this is part of... The universal by the, excuse me, universal on the other hand, you wouldn't have to worry about that, right? Yeah. It would just continue to have it. Yeah. So, you know, our capitalistic system that we have in the US is part, is also foundation of our healthcare system. And part of that is having choice of provider, choice of health insurer, and then having consumers making informed decisions. and then having that market open up every year. And so health plans and providers compete for members. So that's part of our strategy is to have a private, private public hybrid with some elements of competition rolled in. So that open enrollment allows for that competition. And then as an employer, we have bids and the plans come. Like they compete to have the university's business. And so that's opened up. We have a contract for maybe three to five years and that's opened up every three to five years. But yes, it's a very, and in Medicare, things are changing a lot because of the managed care plans. And so you have to be, you really have to know a lot of information when you go into open enrollment or get help in. discerning among the different plans that are being offered and what they offer and how they changed from last year. And yeah, it's kind of, but that's this element of competition, which is you have informed consumers and then you have multiple supply and that you can make informed choices of the best, and again, this is sort of the ideal theory, you make the best. plan, high quality plan at a reasonable cost. And then you have to assume that consumers have all that information, which I think the whole thing falls apart because consumers don't have that information. Or they don't need, it's a little bit flawed. Or even if they had the information, they wouldn't understand it. It just keeps going on and on. Erin, you have a question for us. I have something to add on to it. The question you asked about why we do open enrollment every year really stuck with me. And Dr. Blewett, your explanation of why it happens every year was fabulous. And I thought that I could give a little insight as to why it's important. I used to be a overall very healthy person. And so a high deductible health plan was an easy choice because I'm not spending thousands of dollars on my healthcare a year until Your health changes overnight and you now have type 1 diabetes and have to spend thousands of dollars on prescriptions. You don't want to have that high deductible health plan anymore. And so I enjoyed open enrollment in 2018 when I was able to switch my health plan from a high deductible to a lower deductible because I wasn't going to want to spend five grand out of pocket every year. And now I spend only two grand out of pocket every year. So open enrollment is also great because you don't know how your health is gonna change on the flip of a coin. And that's what happened to me and that's why open enrollment is good. It's such a great- Yeah, that's a good point. Yeah, really a good personal example, thank you. Yeah. Dr. Mann, I wanna ask this question again. This is not politically loaded, but I wanna ask it anyway. A lot of people think, they have their two different choices around healthcare. They think that healthcare is either a privilege or a right. Do you get into those kinds of conversations or have you, you know, where people are just struggling with this issue, you know, because it is so complex. So is it a privilege or is it a right? And you don't have to answer if you don't want to, but I just want to ask. Oh no, it's such an important question. And you know, if you, it's in our country, it's not a right. You know, we have 26 million people who are uninsured. And so, and so. And they struggle to get, and people who are insured may be underinsured, which is they have a high deductible plan and they can't. So, and there's nowhere in our constitution, in any legislation where healthcare is listed as a right. We have the right to, what is it? Right to, what is health and wellbeing and happiness or whatever, or the right, but we don't have a technical right to healthcare. President Biden often says it's a right, but if you have a legal scholar on here, there would be, there's no right. And until that is something that everybody agrees to or we have some kind of amendment, which is, it's very frustrating for people who work in the field because if it was a right, we'd have another lever to get, we'd get those people who are not covered into some kind of system of care. If it were right, then everybody would know it, and they would understand clearly what it is that they have a right to, and whether it's universal coverage or whatever it is. And there's a part of our country that just does not like government public programs per se. And so expanding the role of government, even incrementally, like the Affordable Care Act did, it just a tiny input into reducing the uninsured was just, it's just been a huge lift and very controversial. But there are people who is like, I don't care if I'm uninsured. I don't want government public funded program. It's just a very. you have to remind them that their Medicare program is government. Yeah. Yeah, right. No kidding. I know. And this is my personal opinion. I think that a lot of people that are fighting against this are fighting against it until they need it. Until they need it, exactly. And then all of a sudden it's like, oh yeah. Then it's like, oh, then they realize that they're just like the rest of us. Yeah, things are gonna happen at some point in your life. Exactly, and life does happen. Life does happen. So let me, let me, let's play out a scenario here. Let's say I didn't have health insurance and all of a sudden I'm having chest pain and suffering from a heart attack. What happened? Do I just die in my chair or what happened? Well, if you're suffering a heart attack, you know, this is so terrible. I would, you know, have your loved one take you down to the ER. Once you're in the ER, they have to, there's a law that requires them to assess you. And if you are an emergency, if it's emergent, they have to treat you at the hospital. They can't transfer you or say, we're not gonna treat you. So if your heart attack is imminent, get you down there. Now I've kind of. Stop short of saying take an ambulance because I'm thinking the ambulance would probably charge you for that ride so, um if you need an ambulance absolutely go get it, but um, You probably have two heart attacks thinking about you know, the process or where I should go and I would right So really what happens when people have? Frankly an emergency situation there. They're uninjured they have to get to an ER and then they'd assess whether it's emergent or non-emergent. And if it's not emergent, they can deny you care or send you down to HCMC, which does happen. So if it's non-emergent, you can go, if someone came to me and said, I'm having these heart issues, I'd say go to Westside Clinic or... north, the north side one and that's a FQHC and get assessed by a primary care doc there and they can help you with the treatment plan and figure out what you need to do. Which is one of the reasons why I, you know, I asked a question about community engagement, those things is because we who are involved in community health, we run this all the time, people running down to the emergency room, they don't know, well they know the emergency room, yeah, you know, but many times They don't know other resources that they could take just in case. And then we have with reoccurring visits to the emergency room. And we need to just kind of figure out, you know, how we might be able to. And you're not going to, we're not going to be able to address every issue in every person. But I think that we need to know more information about how we can be preemptive or get in front of some of these issues. because the pathway is there. We just don't know. Yeah. We had a colleague of mine, Jeff Louie, and actually a neighbor too. He's an emergency room physician, pediatric emergency room physician. This exists, this problem exists, where kids are admitted to the ER with some kind of medical issue and they are in the foster system or what have you. And guess what? The ER then lands up being the foster home where the kids are literally living in the ER because there's no place for them to go. All right. So all of these for people who need to get into the ER for actual emergency care. Well, and the ER does become the default for many people because it's open 24 seven, it's open on the weekends, it's visit where you know hospital has one. Right. Yeah, the foster care issue, that's very sad. It's really, really sad. So, all right, Lynn, you've been studying this a long time. And I can't help think that a good academic mind can help us to, based on what you've researched, what you know, we know where the past has been. We know where we are now, this kind of state of confusion around access and insurance. What do you perceive? What do you really think is going to happen going forward? based on everything that you've done? Well, I think, you know, we're kind of, I think the Affordable Care Act was probably the last federal piece of legislation that we're gonna have for a long time. And so I think the next iteration or the next incremental changes, I think our healthcare system, as I've learned over time, has been we make changes kind of incrementally and that's... we make progress, but we also complicate the system more. So we build on what exists rather than fixing the problems and then changing them. So one of the reasons everything's so complicated is because we add on to what we already have, but that's just the way it is. So we expanded Medicaid, that's part of the Affordable Care Act. We established these marketplaces. And now it's like, okay, how can we like, just open that up just a little bit more to add more people. So we increase the eligibility levels or we open it up to additional people. So Minnesota just passed, not this year, but the prior legislative session, health insurance coverage of Medicaid type program for undocumented. So that's for children and adults. So that's a huge incremental. Now we don't get any federal money for that. That's a state only, feds will not pay for undocumented people healthcare through Medicaid or through the marketplaces. So that's, and there's about six or seven states who are doing that now saying, these people are here, they're contributing to our economy, they're showing up in our ER without any health insurance, we're gonna extend a program for them and pay for it. So there will be some premiums, there'll be some cost sharing, but that's, you know, so states are sort of like, where's the pockets? How can we address these pockets of uninsured and trying to, you know, trying to get those, you know, get those last people who are not covered into some kind of healthcare system. And, you know, people who are not covered changes. Yeah. You know, one year you can be covered and the next year you're not covered. It's like whatever. Yeah. You know, I'll tell you, you know, you know, as a public health person for my career, I was happy with the Affordable Care Act. Was it the full enchilada? Absolutely not. But I found myself saying things, at least we've got the train out of the station. And to your point, you know, all right, once the train is off the station, at least. You know, along the way we can see the ups, the downs, the sideways and make changes to an infrastructure that at least we've created it. It's better than nothing at this point. Well, we cut, so when, in 2010, when it was passed, we had 50 million people uninsured, now we have 30 million. So it reduced the uninsurance by, it provided coverage for 20 million people in essence. So- That's a lot. Oh. Yeah, so it's not a... It was a significant impact on our system. Yeah, yeah. But we still have 30 million people and we accept that as a country. Which I don't get. So Clarence, let me ask you something. So you're in the community a lot and you're talking to your colleagues and friends. What are they saying? What are they, are they confused? Are they, what's going on out in the community that you're getting kind of wind of? So I think that there are a couple of different things that I could say. One is that, you know, we do have those individuals that, you know, they have the private insurance, they have access to care. There are other people that are, they're really confused. about what's out there. There are some people that have just decided like, you know, the system is just a system. I'm gonna use the emergency room. And, you know, it's too complicated for me to kind of figure out. And so that's why it becomes, you know, important for us to know what's really going on. I mean, it's not like we can... I mean, people have to make their own choices. But I think part of our work is to give people accurate and appropriate information. That's why I was asking that question before, Len, about what's accurate, what's appropriate, and then what's actionable. And a lot of times the information out here is not actionable because it's not understandable. And so part of the challenge for us, for example, this is so funny because I was gonna ask you to define some things for me that I just, you know, these are just definitions. I'm sure you know what they are. Things like, and I've seen this before, like TRICARE, things like CHIP. It took me the longest time to understand the difference between Medicare and Medicaid, even though I'm on Medicare. You know what I mean? Sometimes I'm struggling with this. I mean, people, sometimes it's not clear. And so that's answering your question, Sam, is that it's... It's important for us who are healthcare advocates to really understand where are the resources, where can people go? And we don't, I don't. I mean, some of the stuff I'm struggling with myself. Yeah. Go ahead, Lynn. Well, I was just wondering, so there are... grants and support for what we call navigators or enrollment assisters. And your community group should know that they exist and there's a list with phone numbers and they can help explain the process and help you walk through the application process. And that's something that we should make sure the community groups get because there is- I understand, Lynn. Yeah, and understand because there's a whole lot of lists out there. And understand, yeah. And so there's no connection between the list and the people. Yeah, that's a good point. You know what I mean? So we got this list, and so it's where you can go, but there is no real interaction or relationship for people to understand, you know. What am I applying to, right? Exactly, so that's my piece of that. And I've said this before, I think that Minnesota is a phenomenal place. to live. I love Minnesota, but it has a huge disparity issue. But a lot of that is because people can't make the connections. Yeah. So, yeah, we have advocates. We have practitioners, but they don't understand either. I mean, again, making a general statement, and I'm not mad at nobody. I'm just saying. It is what it is, right? That's the struggle. And that's why we're glad to have you here, so that we can kind of talk about this. and know that we're planting seeds is what I call it. Your seed has been planted. We need help, okay? We need help. So here's another good one. You know, when older Americans are, they can apply for Medicare, I've heard from various people that they assume that, okay, once I have Medicare, great. I don't have to worry about. Anything else, I've got Medicare. Okay, then all of a sudden there's this other variable called a Medicare supplemental program, right? Or a plan. Okay, so then you're thrust into this craziness again, to yearly, by the way. And what's really interesting about a Medicare supplemental program is on a year to year basis, not only yet pick the plan, but you have to identify your risk for yourself. Well, do you think you're gonna be higher risk now that you're a year, you know, you're 72 instead of 71 or whatever? Is anything happened in the last year that, you know, should, you know, and then all of a sudden, boom, if you're put into a higher... risk. This person pays. It sounds like oh my god, you know, oh wait, I'm a higher risk, but I don't want to pay more. So put me at a lower risk and I'll just, you know, flip a coin and hope, hopefully everything will be all right. It's really unfortunate that people have to, in my estimation, have to deal with that. I agree. I think the Medicare program, I'm grateful for the part D. So that's the prescription drug coverage. Correct, correct. You know, it's wonderful, but you have to buy a separate plan. So it's, I've walked my dad through this. It just was almost impossible to sort through all that information and figure out the right thing for him to do. Right, I kind of make it analogous to, you know, elderly people trying to figure out a mobile phone, you know, the app. It's just like. Really? But again, there are a lot of resources. So senior language and there's a lot of resources again, but I take it to Clarence point art, which is you've got to know they exist. Exactly. And you have to know what to ask for. Where you have to know what to ask for. Where to start. Yeah. I'm gonna say, let me say this real quick, Lynn. Yeah, go ahead. I think the part of the key is, more intensive training for those navigators to know how to convey information to the community. I mean, I think a lot of times we go through these trainings, we go through the 30 minute, 60 minute training and people think like, well, now you got it, but you don't have it. There has to be some kind of reoccurring knowledge that's given to people. As you talked about the building upon one another, I mean, it's important for people to have additional training because you know how we learn. We don't do it the first time. So a lot of us don't do it the first time. It takes me three or four times to read something before I even get it. You know what I mean? But that's my learning style. But I think that we assume because we gave somebody a 60 minute train or a day's training that they got it, but they don't. And that's why we keep having all these gaps. That is my opinion. This is my personal opinion. So Lynn. Last thoughts, what would you really, you know, when all is said and done, when you're dealing with access, you're dealing with insurance and all these variables that we've talked about in the show today, what do you really want the public to know? I mean, you know, if there's a one-liner or a two-liner or whatever, what is it, you know, based on your expertise? Well, that's a hard one. You know, maybe that... Well, maybe that there are people that are working on these issues, that health care and health care financing, insurance access are complicated, but there are people who are devoted and dedicated to continuing to work towards universal coverage. And then students that are coming up in my program in public health are there. I mean, they are... they don't want any of this mess. Like they want things to change. And so I'm a little bit hopeful. I guess I thought we would be further along than we are now in terms of change. And you know, it's the way we do things in this country is incrementally, it's complex, but there's also people that are advocates and are working on it and you gotta find those networks and you know, you can participate if you want. Yeah, yeah, yeah. So maybe hang in there. I guess that's the best, thank you. Thank you for that summary. I think that's really it. And stay tuned. Right, hang in there and stay tuned, very good. I couldn't, I couldn't. Thank you. The one lighter, Clarence last thoughts. I was gonna say, Lynn, thank you for chatting with us because that's what this is. This is health chatter and putting up with our probing and those kinds of things. And I really appreciate the fact that, I think I saw you writing stuff down and hopefully we're planting some seeds, but your work is important and your work is important for us. And we need to know more about your work and how we as a community can be more supportive of you If we support you, it will give us information and give us access to the services. That's really what it's all about. It's about having access. And that's really what we would like to do with this program is to make sure that people understand that there are people that are working at it. You are an advocate for access. And that's what we wanna be in that place where we can support you or to provide you with additional helpers. Thank you. Thank you, Mr. Price. And the other thing I'll add to that is this. We invite you back anytime you want, like in your research or your findings, if there is something that, geez, you know, the public really needs to know about this. Here's a method, you know, through health chat or that we can get some of that information out on all the great findings that you're doing and getting in the work you do. So, use us. Okay, thanks so much. So, Lynn, thank you so much for being with us today. On one hand, you know, it's happy to be able to talk about it, and on the other hand, it's kind of sad that we aren't further along. But like I said, hang in there, right? Hang in there and stay tuned. I'm going to stay tuned. Yeah, right. To our listening audience, it's been great having you on Health Chatter today. Our next show that we'll be having is on caregiving. And we've had a show on caregiving, but we're gonna really focus on caregiver burnout, which is really, we're seeing a lot of that, unfortunately, around the country. So stay tuned for that. So again, Lynn, thank you very much. And to everybody out there in the listening world, keep Health Chatting away.