EXPERIENCE 22 | Gavin Kaszynski & Todd Welter - HOW TO FIX THE PROBLEMS OF THE HEALTH INSURANCE INDUSTRY

Welcome to the LOCO Experience Podcast with LOCO Think Tank Founder Kurt Bear. Listen in as Kurt digs deep into the business and life stories of business owners and thought leaders at different stages of growth from all walks of life. Launching and growing anything can be a crazy experience, so expand your thinking and level up your understanding of what it takes to find success in the world of free enterprise. Welcome back to the LOCO Experience Podcast. This is your host Kurt Bear and I'm here today with Gavin Kaczynski and Todd Welter and Gavin is the CFO of Associates and Family Medicine of Regional Medical Care Operation and Todd is the president of RT Welter and Associates in Wheatridge and thanks Todd for coming all this way and first let's just have you guys set the stage and I'll start with Gavin tell us you know what is Associates tell us give us people know about Associates tell them about that a little bit and then your role within the organization. Yeah Associates has been around since 1962 we are the currently the largest Todd can probably correct me here he knows a lot of practices but I believe we are the largest independent which means not owned by a hospital system or any or anyone else but largest physician owned family practice in Northern Colorado and it might be one of the largest in the state actually in that regard so we're still owned by our physicians independently owned law used to be yeah used to be since 1962 so it was a started off by Don Wells in 1962 he built a practice right across from pvh they actually pvh was built the same year that he moved his practice over there which is why he moved his practice there and it just he added another partner he added another partner and they just got bigger bigger Jerry Smith I mean every time I run around and I meet people which I've been doing a lot lately people say oh I know Jerry Smith I know Floyd Stevens I know Steve Burman I know all these people that were kind of some of the original like eight or 12 people in AFM so we're now one of the largest in the state and what's that mean like how many locations how many employees how many people do you see yeah it's a there's a couple ways to measure that you can measure that by number of providers and so just in in the interest of educating your listeners provider is a physician or an APP and APP means a lot of things but they're like a physician assistance or nurse practitioners or people who can there's almost doctors that don't need to make so much money but they're allowed to charge for their service yeah so a nurse can't charge for a service certainly a finance person can't charge for a healthcare service but a provider can charge for a service yeah and prescriptive authority oh there you go that's why Todd's here so your owners are all people that can charge for their services and then you're a CFO elite on the system kind of elite good thank you yes that's why I'm here Kurt but I'm no but that that actually is sort of my philosophy which is it's the we keep a very thin overhead very thin administrative team because we want to put our resources out in the clinics with the nurses and with the providers so they can take care of patients to the most efficient optimum way that they can and I sidetracked you how many providers oh yes so we're up to about like I think 82 providers at last count which is a is a pretty large group yeah I mean if you look at you know how a lot of cats to hurt because I've worked with doctors before and they are not easy to get all in the same page even two of them so 82 of them must be really hard well then so there's like 45 physicians or maybe 48 physicians now and 34 APPs are advanced advanced practice practitioners advanced professionals yeah whatever NPs and PAs yeah and and that's a that's a pretty large group in terms of another way to measure the size of a healthcare practice is number of lives covered and we do have a pretty strong position in the northern Colorado markets we have about a hundred thousand lives that we manage which is again maybe 250,000 or 300 well we don't cover all of Larmor County we're not up in Red Feather we're not up in Estus we have very little of love uncovered we've a little bit of Weld County so it's it's a it's if you look at Fort Collins it was strong market share very strong market share yeah Fort Collins well let's shift over to Todd and Todd why don't you set us up with R.T. welton associates what's that do sure we're we're we're kind of behind the scenes and the finance you know the how healthcare providers deal with payers and deal with you know strategy and those sorts of things we do a lot of different things we help my soft spot really where my heart is is helping physicians stay independent but we have a lot of other clients as well hospital systems we do a lot of work for insurance companies our company has basically five pillars we do coding education everything in healthcare has a code there's a code for what you do and there's a code for why you do it and it's very and the more clear that is to the insurance companies the more fast it goes through the juice oh no no no question about it so yeah there's a lot of things that make claims work so it that's the area we work in so coding properly documenting properly and it's it's a very calm it has become incredibly complex because you need to ask about risk going yeah I was just right and then you got doctors that don't even really want to learn how to use the iPad thing about right so there's there's coding for what you do and why you did it but there's also coding for how sick a patient is which would include age sex demographics and stuff like that but also all the all the stuff we carry around as we get older and older yeah my let's say my primary diagnosis is some kind of a heart problem but I might also have a one problem yeah I have a vascular issue I might have all those people that were marked COVID but they were really undestore when COVID came along sure yeah all of us or whatever oh COVID can we look at there yet okay this is awesome I love so we we help with coding we help with billing the functionality of billing okay we do some billing but really our forte is helping teach you to do with themselves yeah absolutely here we do and my particular expertise is the kind of interaction with the health plans so some call it contracting I think it's more relationship management where you're you know trying to get on the same page yeah so that you can work a deal and make it work for yeah we want to cover these things you know yeah we can give up some of that coverage there because it barely ever happens to our population how do we get paid for it you know you got to have money money's what makes things work so you have to you know how the money works and the methodology of payment because even the methodology itself changes from practice to practice and size and all those sorts of things we do create a ton of credentialing work credentialing is are you who you say you are so physicians and other providers facilities all of those organizations have to credentialed on an ongoing basis right what that does is it keeps kind of fraught out of the healthcare system it also keeps the creepies yeah don't go on like don't miss your continuing education correct but also don't have your license taken away in Vermont and then go practice in Colorado being more that one exactly what that is okay but also facility so is the facility clean is it does it meet all the criteria you know and so you are safe your team I think you mentioned was 30 people we have about 30 employees yeah and the specialist in various parts like this machine and yeah so and I believe encounters and stuff to mention so contracting credentialing coding work we do some practice management but again with that whole idea of you know we'll help you to fish so you can fish for yourself and yeah we do a lot of accounting like is a project will this project you know we want to open another in office yeah let's do the math let's figure out yeah so maybe a best practices hub for the financial element of healthcare in health care we call it MSO we're a management services organization okay yeah management management or manage services management services management because you're helping the management and do their thing better the alphabet soup of health care here we go yeah there you want to talk about ACOs and CIS oh we got all of it we're gonna talk about the whole thing haven't don't you he's getting chomping at the bit here so well thanks for thanks for being here and that's a good description of what your firm does well can I match him one other thing yeah so you can say I didn't know this but Todd just told me that there's a privacy around the higher education so Todd's not allowed just education Todd's not allowed to say that I was his student but I can say that I was Todd students so it's like doctor patient privilege right a patient can say oh I go to doctor you know Frankenstein but doctor Frankenstein since can't say Gavin's my patient fair right yeah so Todd was my professor would be awkward for my marriage counselor to say oh yeah I don't hurt in Jill yeah but if I say oh yeah our marriage counselor Jimry same thing Henry counseling very good guy it's been a while I don't know I'm gonna be clear for her right never yeah anyway keep going not that I don't need it but so Todd was my professor do you yes and I learned a lot from this guy no longer a professor oh him still are he's just not my student anymore right yeah they kick me out of the program I mean I graduated from the program and but anyways so that's how Todd and I got to know each other and then we've just sort I'd go so far so say we've maintained a friendship okay so we're friends now are your core ideas about health care and reform of health care Todd in much the same vein as they were back then like this is we're talking like 20 years ago if you were a college student right thanks no I went back to school late so I finished up at at DM in 2018 okay that's great soon got you yeah oh that wasn't your first one no no no you're definitely pretty old I've got a lot to learn but yeah I wrote a couple papers when I was in Todd's I used to call him professor Walter and he would always demeure at that but I can't help myself it's such an approachable guy though but I wrote some papers and I could just tell by his comments on my paper like you're the worst how did you get my club no I'm just kidding I could tell the interactions that we would have in class that that we thought a lot of like yeah about how broken health care is dysfunctional complex unnecessarily complex really and so I think that's kind of where exercise and exercise in some ways yeah very much so absolutely so that's your acquaintance that's how you guys equate yeah well I love to jump in the way back early in the program and just kind of figure out where people come from I'm a I graduated with a class of five in central North Dakota and I made my way out here and so what I'd like to know is is where would you come from Gavin third grade what were you doing third grade so I grew up in friends with Texas and third grade I was seven so I was still in friends with so I spent the first 18 years of my life in friends would okay grew up in the same hometown and I grew up with like 12 year seniors think of Windsor yeah all right it's a little bigger town around but yeah exactly yeah so it's it's a town between Houston and Galveston most of my friends parents went to you know community Houston we actually were right next door to Claire Lake so a lot of my friends dads were sorry to say dads but it was true their dads were engineers at NASA and in fact I had a few friends whose dads were astronauts wow the thaggers the Rosses they were astronauts and went up on the space shuttle that's pretty cool yeah yeah you get any like cool NASA like sweat no they weren't that good of friends okay no no t-shirts they didn't have swag but it wasn't you know no yeah no nothing like that but so that that was friends like sort of Gulf Coast we got hit by hurricanes every now and then sure sure okay and then like quick tour of like college in early years thereafter yeah once University Houston just in downtown Houston got a degree in finance finished that went to in the commercial banking at Bank of America in downtown Houston that was Bank of America it's big right American in American no it was good it was it was a way to learn about how businesses I mean it was like way to look at businesses from a numbers perspective and people to interpret the way of business was performing and trending just by looking at their you know financials and so it was it was a really good experience because BFA was a great experience because it taught me a lot about how to interpret financials you know so I still lean back on that experience yeah at least wrong foundation to yeah exactly at the time the few years after the whole ring yeah banking I mean you boring banking I was a banker for 15 years I don't know if we know that about each other I thought you're a restaurant tour well only after 15 years of banking well rest you went from out of the Frank band of the fire right out of the boring pan and into the right basically that yeah out of the boring pan into the broke pan basically so okay so finance background yeah I think stuff early on and I want to ship over to Todd before we get to into your 20s or later we don't we go all the way to third grade is that was third grade yeah okay I was also from Texas did you know that oh my god I did not know that yeah in fact I grew up I guess wake up Houston oh geez other side of Houston from you though spring memorial area so my father was in the oil business okay he was a labor negotiator he he was in HR basically for the union or for the other guys for the company okay but he other guys right he had a real soft spot for the for the labor guys though no soft spot well it's nice so you know I guess character to have in that position especially if you're the the union guys right yeah do you remember Houston very much it's been a long time but yeah I remember some was it hot when you were there was a climate change yeah mosquitoes mosquitoes yes and hurricanes every once in a while I always thought it was an excuse to drink though is it my observation water yeah he got to here it was a dime to drink other things so pretty stable background that gathered man in that hole brothers and sisters whoa these stabilizers things wow yeah in which where were you in that pecking order I always want to say to people guess but I for the list one for time sake I won't ask that I'm on the on the younger side of the family okay so I brothers and sisters that are a long retired and all those sorts of things I have two younger brothers okay so you were five out of eight or six out of eight Catholic yeah absolutely okay that's why my dad went to Notre Dame a glass school very Catholic's used to be big breeders but it doesn't seem like that this holding is too damn expensive right yeah nobody wants to be big breeders except for poor people yeah look it off that so anyway Gavin you're behind in your whiskey already I'd like to call it to the attention we'll do my best okay thank you this this is I think somewhat important to this conversation we moved to Colorado in this mid-70s okay when the company my dad worked for which back in those days was called golf oil it's now called chevron right and oh the slate thing right uh they got they got into coal is what he got into okay and their center of the universe for coal was either Denver or Pittsburgh oh I think they made a good choice right for sure so we ended up in Denver yeah really yeah it was interesting to transition that uh I guess the same principle supply on the labor front right it's uh kind of a lot of tough job kind of hard work and blue collar things absolutely yeah that should get paid well absolutely and have benefits when they get hurt and stuff like that so interesting okay and then and how old were you then I was in the reveal your age okay I'm 58 I I was in junior high school okay when we moved to Colorado yeah and then what's your like transition into the college what's your background educationally I have a beginning I wanted to be a high school teacher and so I went to Fort Lewis College down in Durango undergrad wanted to get into education until I found out what they get paid which is a bismill if anybody needs the right circle sort of sense there right well I mean in some regards some of what a lot of what we do is basically consulting work right yeah well you have to teach people and we teach people yeah yeah so it scratches that itch and you know I fortunate and thrilled to death and honored to be on the faculty of the great faculty at the University of Denver yeah and so yeah can I came back around to scratch that itch too I'm so enjoying this Kurt please keep talking to Todd because I just love learning more about him I've respected this guy for so long this has been this is fascinating I have a oh gosh I just blanked on his name I can see his face but I have a college professor that kind of acted that same role for me and we lost touch unfortunately yeah I wish it was CS Lewis he would be a good mentor to I'm thinking over yeah so college journey a little bit career start for you Todd okay um Durango huh Durango yeah I've been to Fort Lewis I love that that what a great I learned so much I mean I learned you know it's like all smaller college yeah probably big colleges do I guess but you can't sit between the cracks and store outside of class that it is inside class you know well that's where that big train is right that goes to the that's why we want to Fort Lewis narrow game yeah narrow good we're gonna do the logo train we need to look experience later for you guys but here's one of my top 10 local experiences was on our first anniversary my wife and I nearly crashed a Jeep off of a mountain because of my experience and off-roading and I see things but then we also were there for the the iron horse weekend where they race the bicycles against the train and we couldn't stay anywhere we ended up staying in a campground on Durango mountain at like eighty two hundred feet in late May and it was so cold and we thought there was bears and we had a rifle with it we put an intent with us but that was a little quick experience of my wife Jill is she's she'll follow me anywhere didn't done place anyway I love Durango so I love Durango we we've been there a dozen times probably and it's a long ass way away and so that's neat so you're early career I'm sorry I get sidetracked so I got you sidetracked kind of came out if you will out of college and all that stuff in the mid eighties and nobody thinks of this now but the mid eighties was rough yeah in terms of the economy the Ronald Reagan years were not that good no and towards the end yeah and so the only job I could find was in health care and so I got a job at a little hospital and and it was such a great place to see I just love the CEO and I learned so much from all the people that work there they were so such great people right there in Durango well this was in Denver okay and little tiny hospitals now parking lot but it existed back then right and so I did all kinds of stuff I ran the communications department for them I ran I did a we we did our own billing obviously I did billing for the hospital I did billing for the doctors there I did all kinds of stuff yeah I learned a ton so I that hospital hired a consulting firm out of Utah to come help us you know be better at what we did look same as you do know and right and I went to work for that company oh and so the CEO of the hospital was such a good guy I just he died I mean I mean the guy was what I shot him up by me John Hershberger he was a prince I mean I mean a saint and so he told me he he saw that was such a great opportunity goes not only will I allow you know because the consulting firm would never hire from a client right and he said not only will we do that but we're going to be your first client what yeah it was amazing that's so cool you know it's such an important lesson it's it I think of Dr. Sproul at AFM who hired me and gave me my shot in health care it's like your with the Schellenberger Hershberger Hershberger Hershberger sorry Hershberger it's such an important thing to remember as we you know mature and become professional and super successful like Todd is to help people who are coming up behind you you know and spark of interest or ability you know foster it yeah yeah totally I mean if you benefited from that as you were coming up then don't forget to turn around and look behind you and help people who are who are coming up and who are the next generation pay it forward exactly well and one of the things I've learned from him and others is and over and over and over again is always higher people smarter than you and because then you get that must be pretty easy for you it actually is it's quite easy so but then you end up with a much I mean I have a great staff I mean I we just celebrated one of the gals in my office has been with me for 17 years oh that's awesome yeah it's awesome I want to come back to your business story in particular Todd and I want to leave a lot of space for how do we make health care better smarter faster etc but Gavin I want to do a quick flyover because you were like doing banker stuff and this and that and that and this until you got like excited about health care and when it started taking the professor's classes here and yeah yeah well you know I always knew I was always being countered hard and so finance was my thing I when I was in banking I went back to school and got an MBA I like to joke now that that MBA expired because it was pre-internet right I remember the none of that took out anywhere what was it the it was a like go for you had to log in to go for TCP IP had to it was so hard to log on but we'd go to the library if we wanted to get on the internet right libraries are this thing that used to exist back in the day when there were books at these places and it's a long story but card catalogs and card catalogs do we decimal system where where was your MBA uh university Houston clear like actually okay yeah that we talked about clear clarity yeah so I got an MBA and from there went to work for compact computer which became healer Packard yeah and uh it's about that time that I was fortunate enough to run into a little lady named Jennifer she was a Colorado girl who'd gone to this is one of the love story let's hear the let's hear the love story we'll talk more about the family later but let's hear the quick uh why does she fall in love with you I have no idea why did he fall in love with her let's start with that she's beautiful oh just that oh physical attraction 100 percent absolutely I mean I'm not gonna be you know there's no way around it she was absolutely crazy seems she must be a little crazy well I'm a little yeah quite a bit I like to say what I'm teasing my girlfriends especially my wife uh girlfriend female friends that you can either you know our our guy friends but you can either be in a relationship with a crazy woman or you can be single and it's only what I'm looking for a spec for my wife mostly well I think my wife is crazy for agreeing to marry me way back well actually this year will be our 20th year anniversary awesome shout out to Jennifer thanks for falling in love with gal and Gavin and making them so happy yeah so my goodness I'd be a completely different person we're not for her she's amazing and no she's not crazy she's a she's a rock I'm I guess I'm supposed to be her rock but it's the other way around yeah I think that's pretty much normal honestly yeah she's my better half for sure so but she's from Colorado and so it was always our intention it was always her intention to move home and she dragged this stubborn Texan with her and so we I mean we moved for cons that was it with compact which became HP and obviously HP time had a big presence like we're trying to apply for a transfer and yeah boom boom boom done so we moved for cons I remember that first time she actually came with her dad to buy the house so they bought a house in Fort Collins we lived on the west side kind of near taft in Overland I was gonna say ponderosa driver or something like no taft in Overland or parallel taft in prospect yeah so behind oh yeah by the whole king super is there outer elementary yeah yeah just just say for it there's a safe way Drake and taft right yeah so that whole neighborhood but they bought the house because it was a super hot real estate market at the time and I never saw it I signed the papers remotely but I was in Houston it was because we had a one year old at the time right and I said before we leave Texas I'm taking my son to the beach and so my son and I went to Galveston and went to the beach for the very first time and I've still got some pictures from that and it was they're awesome but at the time my wife and my father-in-law were in Fort Collins buying us the house and so I drove to this house I had already bought it and drove to a side unseen but I remember that first time driving down prospect towards the west and it was early in the morning and it was just the most beautiful thing because it was late spring and the big ash trees were out and it was just you know they tower over prospect as you're driving west and I was just thinking my god this place is beautiful I'm home yeah I felt the same way yeah and it was just breathtaking and you're driving in the foothills or you can see them the whole time as you're coming up prospect and so I was just blown away and I was just in love with this place from the very beginning yeah that's cool yeah talk talk to me about uh talk to me about RT welter and associate so you you got into this uh management consulting business as a as a young man uh from the small hospital or whatever had a career journey there I presumed for a while and then said like most entrepreneurs I can do it better than this guy yeah I mean the guy I worked for I learned a ton from but we just he was in Utah I was in Colorado managed care what we think of as managed care today you know the insurance companies coming in and you know uh right nature most time yeah all that stuff came into town and was not in Utah and so it became obvious that it really I mean his world was not the same world as I had over here and so I gave you know I gave my resignation and I had a two-year non-compete clause so I had to kind of do that thing where you sort of pick up stuff and I picked up tons of great stuff you know I had a whole bunch of jobs all at the same time and I kind of feel like that's what I still have today yeah I do a lot of different things and for a lot of different folks and sometimes they you know we shop and sometimes they don't I've read a or listened to a book actually just finished it from the Whole Foods guy conscious leadership and he speaks about how corporations really try to get people to be specialists yeah um but to be like a CEO or a CFO or a business owner you really got to be a generalist absolutely and otherwise you can't figure the whole thing out proper yeah and uh the light I I like to repeat here long as we're on the air is a specialist just someone who knows more and more about less and less until you know everything about nothing I got this story in my life so anyway so that hurt me in my heart so Todd you you basically were kind of in the situation where if you were going to really help the the people in this managed care environment you really had to kind of start your own firm or join somebody else's here or whatever I mean there wasn't really back in those days it was accounting firms did a lot of this kind of stuff but they were accounting firms yeah a lot of taxes and this and that no offense you know Gavin but a lot of times those accountants were just old stuffy men right really didn't have any and I mean they didn't get into coding and they didn't get into all that new answers of stuff and I mean I we just constantly fat we made our share of mistakes sure and aren't the saying we have in our offices it's okay to make a mistake just don't do it twice right right so we found and still to this day find these niches of opportunity and we take advantage of them yeah you know there's need there's tons and tons of need and opportunity out there oh my god and we look for them and try to figure it out try to you know really understand stuff through and through from multiple directions right you kind of do that 360 on it and well you're a lot like like our big tanks frankly like we're it's a it's a good stuff resource hub you know you work with so many different clients with so many different kind of areas of of expertise and stuff when you learn something new you can be like hey you other 27 clients yeah do this yeah it's better right yeah and so they couldn't figure yeah they couldn't figure it out as much because there's 27 other people you know so prevalent in health care because I mean Todd might I'm sure he'll know but it was at the International Health Institute it said 30% of health care is waste and when you look at a three and a half trillion dollar industry that's yeah trillion dollars of waste right what is waste though I mean waste is somebody's margin so you got a right you know that's that's tricky stuff well and if you lay a bunch of health care people off and our insurance company employees off they're gonna have to go build bridges or something anyway yeah yeah and I know Todd knows the nuances of this but you know there's waste inefficiency and then the third party intermediaries that intervene in health care that make things so complicated there's a lot of I the way I look I agree yeah but there's a lot of fingers in the pot right and not all of them bring value right that's right yeah yeah maybe that's not 30% but it's hundreds of billions oh my god no I'm sure it's 30% I should boil it down probably in some fashion or another hey hey wait wait wait wait I just a fair time here I gotta do the shout out to the wife too oh yeah please do that's what's the loves wait whoa you're marrying why did she yeah 32 years we have two great kids actually I work with my son Mark oh that's great yeah he and I work actually quite closely together every day all day oh yeah my son I'm very proud of him he's that's great and what's your wife's name and why did she fall in love with you my wife's name is Tony she's actually from up this way up she grew up in berthed okay she we met in college okay undergrad nice she and I were in the same Spanish class and I didn't have a clue yeah one of the Spanish class before yeah she like can I look at my tutor that's a pickup line if I ever heard pretty much yeah and though what was it was it just strictly your her beauty that it drew you to her or that you knew Spanish so much better we're a great match she completes me awesome oh I feel the same come on yeah he's gonna get more kudos than you do she's a talent little bitty Italian oh I love it no and my wife is four foot eleven how tall is yours she's probably close like she I think I don't think she's five feet okay my wife towers over them she's five two and a half yeah the pocket size so we're going to get back to the the what to fix about health care and what you've learned and what you think we should do but I want to hear about Gavin's transition into health care and and specifically you mentioned Dr. Sproul that that gave you a shot at the end even though you're just some dumb banker that was like I'm curious and excited about health care I didn't say dumb banker those are your words yeah well I just thought most bankers are dumb I think I said handsome banker but dumb banker whatever I would just said that I'll go with it let's just move on yeah HP became the CFO of a meat company and Greeley which was a really great experience and I didn't realize that I was capable of being like the top financial person at a firm yeah because it's like for you like like learning how to be the boss because like it's probably the first time you create you didn't have anybody to really tell you what to do yeah I didn't even think I could do that when I was at HP you think of the CFO and you think of some blue blood you know Princeton educated you know sort of and someone told me hey I know there's meat company and Greeley that's looking for a CFO and I just like I can't do that but no I could in fact I'd learned a lot from HP and I learned a lot from banking and learned a lot from graduate school so I did and well I got lucky because there's a couple of Texans and when I saw that they talked funny they're like hey this guy yeah well no it's true I did my little bit of research and I saw that they were both from Texas the founders of the company were from Texas and so in the interview I wore a suit and boots nice and well it worked you bought a pair of boots just for the occasion and so they hired me and that was actually a really good experience a learning experience for sure because well you know life is you're winning or you're learning and so this was a learning experience because I could have done a lot better and I appreciate those guys for the patients that they had with me and went to private equity and then from there I ended up at AFM and Dr. Sprout took a took a chance on me because I didn't have a whole lot of healthcare experience but the practice was growing so quickly he wanted someone that had more business experience yeah yeah and so here's a doctor trying to be a business person and exactly I've been in business a bunch and we're curious about doctrine yeah and I think and I'm sure Todd's experiences with all the practices that he's dealt with but a lot of practice is just sort of grow organically and they take someone who was at the front desk and they say hey you're good at HR and they make them in HR and they say hey do you know numbers okay you're our accountant and so they sort of grow that way well AFM got to the point where it was like okay this is now a big complicated practice right and when he's someone who's got some business and we don't really have anybody with advanced education or experience to speak of exactly whatever exactly what do you I know you weren't looking in from the outside but what do you attribute that that real growth to oh it was years 100% the fact that Dr. Sprout took a shot at me no but not you your growth but AFM why had it grown so much in those years leading up to your arrival that was because of Gavin you have waiting for pining for Gavin the 80s when AFM was pining for no AFM had had you know it's like the Pittsburgh Steelers sort of in a way and Pittsburgh Steelers have had what like forehead coaches right in the modern era right AFM has had two physician leaders since 1962 really and it's Dr. Don Wells and Dr. Jim Sprout and they happened to be two physicians who actually understood business and were visionaries and could kind of tell where healthcare was going and also had the leadership skills to take the practice in that direction right and so 99% of it is attributed to those two gentlemen who I know them both obviously Dr. Sprout hired me but I also am fortunate to have a good relationship with Dr. Wells to amazing amazing leaders in this community I'm guessing that it's kind of a supply driven business like if you can get the physicians to want to be on your team they will draw the clients because people want good doctoring and so if you can create a good place for those physicians to be and trust you know Dr. Sprout inspired trust in those physician leaders to want to join the team or whatever certainly a lot of that but there's a lot of good practices around here who have a lot of good doctors and have historically but the difference is Dr. Wells in the 80s really latched on to what was it called peak healthcare I think it was a big HMO and they came up to Northern Colorado and no one wanted to have anything to do with it and Dr. Wells said we're going to join peak and became the exclusive provider for peak and peak got big and that's why AFM built all these practices around four columns because of that relationship exactly the population grew and grew and grew and they were exclusive to one practice yeah yeah and so it was that again that vision Dr. Wells said no this is the way healthcare is going and he did it and I'm not saying HMOs were the greatest thing to ever happen but at the time it was the right business decision to make you had to serve that marketplace right was where everybody was insured at yeah exactly whatever yeah yeah okay well that that helps to draw that out pretty good and Todd why don't we bounce to you because we're starting to get close to present day and and you're basically serving this rapidly evolving market let's uh long as we're headed that way um you know the big thing to me in the last 25 years or whatever since I've been like an insured person and paying my own bills and stuff like that is is the Obamacare kind of plan and also just kind of the general lack of you know either you're covered by a by a employer health plan or you're screwed yep is kind of the the thing and and it seems like that's the biggest shame of it like it seemed like it was this beneficial thing for society to have these employer-sponsored health plans but but really it's kind of like having easy student loans it kind of screws up the whole system and and then it leaves all these bad unintended consequences like you got fired and you're screwed yep so this all the whole thing and we we talked about this in class is um if you want to use the whiteboard professor uh you're welcome too we'll have to move your microphone over this whole concept of employer-sponsored healthcare came out of world war two back in world war two very quick yeah set the stage super quick yeah uh if you want to go back to where health kids where health calls started to break yes world war two you as kind of got screwed up was the reserve stuff and income tax system right other countries don't do it this way right we have a really kind of a weird system so it based around your employment and if in back in the day when you have lifetime employment like my father worked for the same company for the his entire life right well those days don't exist anymore right so when back in the day when in world war two the government said they put a price freeze or a wage freeze on all of the employers because you know it was we were trying to get ready to throw the war and all that kind of stuff and what that did is in order to attract a good employees they couldn't do it with wages an employer couldn't do it with wages but they could do it with benefits and so if you had really good benefits and offered healthcare benefits you could attract better employees and the other thing that is really a good thing is it's tax-free so you're the employer and for the employee so you're gonna paid right the employer I'm an employer I have 30 employees thank you good part of how I pay them is wages which are taxed but part of what I how I pay them is for is with benefits which are not taxed yeah well what I meant was that if I'm an if I'm an individual yes and want to go by health insurance it's taxed yes after tax dollars yeah so that that totally gets screwed yeah so that's the difference an employer pays for health insurance and it's tax well as the pool of one versus a pool of a bunch besides you get screwed multiple ways first of all if I'm an insurance company so let's set the foundation a little bit more though so come and not work or two yet well go ahead please or if I'm in sorry I got a thought in my head okay I have to get it out get it out or it'll fester into something else yeah if I'm in if I'm an insurance company and you come to me directly to get health insurance what am I gonna think if you send a trap for me like this person must really be desperate you know they're sending a trap they're sick a lot of risk they're sick yeah right I mean with that's a women get screwed you know if I have a woman who then they're smarter than we are when it comes to health care decisions right but if a woman goes to a health insurance company on their own and says I want health insurance the insurance company you're pregnant yeah right right so anyway so yeah the system is kind of a weird system in that it's based on employment and we haven't quite gotten away with that or from it a bomb a care or the affordable care act tried to do that but they kind of weakened it it was not a bad idea in the beginning yeah and then they really chopped it up and then Trump completely decimated it right so they should it's still the concept of it's like like driving a car if if you drive a car you have to have insurance right right right well we should really require people to have some system yeah to pay for whether it be government funds or whatever but there should be where you can't leave people hanging exactly yeah sorry sorry I'll be a way to pay for this correct I'm going to take over your podcast thank you for coming but you're dismissed I've got a cattle prod over here I think it I think the concept of health insurance and health care is an interesting one yeah health insurance is not health care is so yeah exactly and I think a lot of people confuse those two health insurance is a mechanism to finance health care yeah but the question is is it financing too much of health care today is there or is it should should be more of an insurance product like your homeowners insurance or your car insurance right that's what I feel like that there should be some kind of a base level of care that everybody just kind of gets and there could be charitable hospitals and things and maybe this then like catastrophic stuff maybe this isn't a good metaphor so I refer to the professor but you know and everyone says this about you know you don't pay you don't use auto insurance to change the tires on your car you don't use auto insurance to change your oil in your car why do we use health insurance for everything absolutely yeah is that is that that's fair okay I think so yeah I don't get a I mean even a new transmission which is a big deal I don't oh yeah file my claim for it no right yeah so the broken stuff uh the foundation of the broken stuff becomes really this employer sponsored thing and and and the and the unintended consequences of having that tax preferential that preferential tax treatment compared to paying people money maybe it's not mobile but also you can't move it from place to place who so I talked to when I talked to doctors all the time I say to them who's your customer think about that and think about it it's not as easy as you think and they'll say well they almost always 95% will say well the patient's my customer I'm like no it's not no it's not the insurance company is your customer correct so we have a third party payments system and so really they're not working on behalf of the they are because we have great doctors don't get me wrong right but really the finances of health care the customer is the payer right and so the payer is either directly the insurance company themselves in a fully funded situation right or in a self-funded situation with Gavin and I have had lots of discussions about is you might the employer themselves it's a co-op yeah basically yeah I had a favorite expression I only whipped out once in a while when I was food trucking I never did get a restaurant but I got a food trailer and I and I like to say my best customers are those that are spending other people's money absolutely just like that's exactly right and uh and it's that way in the insurance company and for me it was like oh somebody had a waiting and the in the in laws were buying perfect absolutely our company picnic I want that one you know nobody nobody's responsible for this to me goes to what I think is uh and I'm open to your suggestions here but I think the if I were to encapsulate everything it's wrong with the health care in America I think it comes down to a lack of accountability the whole system has been created to remove accountability from the patient to the provider yep right so who's the provider the doctor doctor I mean Todd was talking about this right and the payer should be the patient like in any other transaction that's not a milk anything else the the number of layers in between the buyer and the seller of health care is so enumerable that the accountability is gone yeah and so the hospital the provider to be honest the facility all the people who are charging for health care services can charge whatever they want because no one is holding them yeah what's 20% or 10% of some number and it's only fair no no no no 500% is a number right but for the patient's perspective they're like oh I might have to pay 10 or 20% you know whatever's not covered by the deductible but yeah so you talk about okay so yeah we get uh Todd might remember this better but in 2002 right around the turn of the 21st century the amount that individuals were paying for their health care was in the single digits like three to five percent recently it's gone up to 27% so when you look at stagnant wages in the US combined with you can't even wrap it increase in health care costs right there you have what's happened to the middle class in America well and there's a problem for business and business starts and things like that because I would say I've had no less than 40 conversations throughout my banking career that you know I would start my own business except for I can't like take the risk of my health care I can't afford or I would even I would retire in some cases and create a job for somebody else because I got enough finances I just can't afford to be before Medicare I can't afford to retire at 55 because I needed health care until I'm 62 or yeah yeah you can't do that on your own yeah all these unintended consequences right so um let's jump into how do we fix it like if it's this terrible problem with lack of accountability and everything that's wrong and blah blah Todd I've told that you have the answers well get Gavin stated one of the answers if we can make it more direct to the consumer that's going to help I mean part of it also is just you know human behavior we don't necessarily make the right choices well I'm sorry to interrupt but that's what whiskey over here right but that's also what I meant by accountability accountability goes two ways right Americans are unhealthy Americans make bad decisions all the time the time accountability belongs there too and why do we do that because we can't it's easy yeah yeah it's easy to go to the doctor and then give me some fix that right up yeah yeah take a pill yeah right no I think I shared this with you I had a blog post last summer give me liberty or give me health and the premise is the premise is basically if you want to have liberty you got to kind of keep your ass out of the health care system because I'll grab you and keep you and nurture you and your money and your insurance payments and put you on nine prescriptions if you allow it yeah so one of the things we have to not you guys we have to do in this country is is either decide is health care a business the delivery of health care and the financing of health care is it a business it is today it's a business or is it not so some countries Canada for example has decided it's not a business yeah okay but in Canada there was a time and I don't know if this is true or not anymore but there was a time in my career that there were more MRI machines in Denver than there were in all of Canada right so there's the bad outcomes there so you know in a socialized system like they have and and by the way we have a socialized system sure okay so but in their system and other countries that that from the outside at least kind of talk like they've controlled health care costs right they do it with time they control utilization with time you just got to wait for your you just got to wait for your shift so and when you wait sometimes sometimes sometimes you get over it yeah or you die or you die sometimes just die well it doesn't count either the cheapest patient is a dead patient right they don't spend anybody on those yeah so then in the American system in our system here what we we use money as that thing that moderates utilization and it steams a lot of people and you're right I mean with stagnant wages although you can't always say that so in this country when the economy takes off like we were maybe you know three years ago or sure even a couple years ago the economy was going green gangbusters and we could have a whole discussion on it was all on borrowed money sure but we won't get it mostly it was no I want to get into it let's wait but when the economy is going gangbusters we become a PPO market right PPO with big choices you can kind of go anywhere you want the biggest PPO of them all is Medicare yeah sure absolutely they can go anywhere everybody takes Medicare for the most part in terms of the providers and all the hospitals take Medicare you can go anywhere you want I could go tomorrow today this afternoon I could go get an MRI if I want to do sure right we have enough of them I'd find one Medicare would pay for it or PPO would pay for yeah and when the economy gets soft like it is right now March 10th 2021 right because I know this is the 10th March 11th come on time geez I'm gonna stop calling you investor it's not even drinking it's not actually water but anyway you know in economies softening right we tend to be more of an eight of an HMO market where we start to narrow choice so my solution and I think Gavin you and I are on the same page here although you know feel free to disagree is I think an HMOs that are crafted by physicians and providers and other providers are the way to go you could create especially up here in Fort Collins you could create with Fort Collins is such an interesting medical town yeah it is you guys are that this is a big practice town not every Denver is not a big practice town really yeah there's a bunch of little little I mean again the population's a lot different so there's practices just as big but there's a lot of them right right where here there's one dominant family practice AFM one dominant hospital one dominant orthopedic group right right one dominant OBGYN yeah GI all of that stuff right which is it's an interesting market it's different than the Denver market for sure and Colorado Springs and all the rest so you could you guys up here are like in the perfect place it's amazing we could create and we keep we we're working on this we will create well Todd's doing it yeah we're working on this right now is to create what really acts like an HMO but feels like a PPO but it's run by the providers and and and not that we have we don't have anything against the hospital systems that's great we got to have them they're nice you guys have a couple great hospitals sure and you need surgery centers and stuff like that right and they should be beautiful and they should be clean and they should be staffed by the best people and all of that kind of stuff but if you don't need to be there don't go there right right right there are cheaper places the rise of urgent cares like I know AFM for example the hospital at home is our hospital home it's actually an old school concept well and that's kind of not we'll pre-forecast on this COVID thing like it was all about flatten the curve and keep it under the hospital system's ability it's like well why aren't we talking about increasing the hospital system's ability and stuff like that just to expense maybe maybe so and so that's where I get educated educated so okay so actually adjacent that I've been reading a little bit and hearing about these other things where there's like a physician where they they have like 500 employees of a company and they just serve that group or whatever concierge medicine yeah or there's something along that line yeah director employer yeah that's yeah yeah yeah what how's that fit into the equation is that part of the solution absolutely yeah the idea of concierge medicine came from well I it's I don't think that's concierge medicine yeah it's a little bit different oh no I'm sorry maybe I haven't heard it's a different name yeah director employer director employer concierge is when I I'm a busy guy I don't want to wait in a waiting room yeah I want physician care I want to I want you I'll pay to have your doc I'll pay to have your cell phone and when I call you you answer yeah they would have a panel of like 800 people and those 800 people would pay that doctor whatever they want to see $50 a month every month in the doctor would say hey I'm cool with 500 people and give myself right yeah yeah sorry I thought that's what you were talking about no this so in on the commercial side so we have the Medicaid which is for poor people yeah we have Medicare which is for older people which aren't you to say old they're not really that old 65 in that old anymore yeah yeah yeah back in the day when Medicare was first developed 65 was old right you know and people I mean that's people died sure right around there usually my mother's 90 right and doing great right and she's been on Medicare for you know 40 years my wife's grandmother's 101 and she's like yeah smarter than I am yeah God bless her yeah better looking too probably you know she's pretty clean he's like Lila we love you so if if so if we go to the commercial market and when we say commercial market we mean the employer sponsored healthcare there are two parts well we'll get to the book is here in a second but there's two parts to it there's this those that are self-funded and those that are fully insured and there's you know there's gray in the middle right so a big organization any big organization that has what is it now 100 and more tend to be self-funded yeah and what self-funding means is that the the the what we think of as insured like Signa for example is about 80% ish I don't know exactly but around 80% maybe a little bit more than 80% of their customers their employers are self-funded right so Signa acts like a TPA right a third party administrator yeah they're not really an insurance stuff around they're just taking the company's money and paying it here where it needs to go they pay claims they pay claims yeah yeah they pay claims they do utilization review yeah they do meta make sure there's enough for dig into this little bit because the way this has changed over the years is is I think one of the most fascinating trends in healthcare then self-funding used to be the luxury of very large companies right think hp apple right thousand plus two thousand thousand right it's been moving down the market and you mentioned affordable character earlier that accelerated it sure and you can see the numbers and there's a report that the Colorado division of insurance puts out every year that shows the number of people who live under insurance regulated plans which means regulated by the states department of insurance and then lives that are outside of that which is Medicare and self-funded yeah Medicare's because they're regulated by the federal government and self-funded because they're regulated by Arissa or the Department of Labor right not by the division of insurance because a self-funded plan is not insurance right you just paying claims right everything enough in the reserves in case some I assume there's an insurance element in case there's like a ten million dollar cancer treatment or whatever yeah bad babies warm buff it does that stuff yeah but the way that mix has changed since 2010 yeah it's phenomenal absolutely more and more and more of us live under a self-funded plan which means your employer is directly paying your health insurance you're not health insurance health costs yeah it's spreading around in that change is changing everything in health exactly right tons of opportunity in this yeah changes going on so a little company like no interesting I have 30 employees and you have to figure probably because you know they have spouses and whatever so maybe let's say 15 of them take our insurance sure but those 15 have dependence so let's say we have 45 dependence right we're all to your point we're almost to that point I could almost become self-funded well I hear some accountability starting to spread because now the lazy slob fat ass that hasn't been to the gym in 17 years and eat two bags of cheetos for lunch every day you just described me your co-workers are like what the fuck Judas or Henry or whatever right like get your shit in the grip because you're costing the whole company more on premium yes and this goes back to the original point of our discussion which is why is it this way it's because the employers manage health care that's right not individuals and that goes back to world war two I mean this is all but if you manage your own health care if you manage your own health that's correct with care yeah you know the whole system can be a concept of wellness you know yeah why why is it the employer's role to make you healthy I don't know but it is it just seems like well if they're going to be some less other premium if they're going to be self-funded then you guaranteed that they're going to put a wellness program in place yeah if you work for an employer that has a wellness program then that is a self-insured right right they're managing that risk they're not saying united or the the book is press both shield and they're paying for your gym membership and they're right in for something to go get healthy exactly because we don't want you to get sick because it's on us like you all keep lower premiums for the foreseeable future and guess what then we have more money to give out for bonuses right all those things yeah because employers employees are not dumb to the fact that like health care costs rise and increase is like crippling their employer's ability to give them raises absolutely my company where we're a great example are we give out every quarter we give out bonuses and if there's money left over we distribute it and they love it right if they're if if costs rise right and there's no money left over then they don't get a bonus yeah yes sorry to be the bean counter here but if you look at the state of Colorado you can say and and I'm directionally I think correct but Todd feel free to correct me uh the average health care cost per capita per person in Colorado is about ten thousand dollars if you take Medicare out of that which is a big expense okay so take the old people out it goes down to about eight thousand dollars if you look at some uh self well I'll tell you I haven't spent eight thousand dollars on my health care in the last twelve years total uh I think yeah but you're a like healthy you're a stud whatever you know you're beautiful you're in a donnis yes you're in a donnis you're rock climber and you know all that anyway I mean you're amazing I mean really all getting inside if you have a stroke right there's a thousand dollars there's a twenty million I said a million dollars a million dollars yeah okay fair so liver transplant stroke and I throw you in but oh you have a baby the spends a week in the ICU that's a hundred thousand bucks all right so you know I'll stop yeah no no no but but that's it's a good point but you manage a self-funded company that manages their health care cost and I know of one who has their per capita cost down to less than four thousand dollars wow so you're talking about of the average thousands of dollars per person per year yeah that's the opportunity yeah and that's a two thousand dollar raise per person that's right year and and more money in the bank for the green money yeah real money yeah yeah totally um do you guys want to take a party break because I do um Todd I want to jump back to you and just say okay on two fronts one on the national policy like things that we should be supportive of if we're citizen legislators or whatever a question that kind of thing and then two even on the ground individually what can we do to to improve this so like on the big picture meta like what's in the national conversation what should we be talking about what should we be so ready to support this trust in your face like didn't anticipate this one like maybe macro economics yeah macro economics yeah you heard of that before a little bit okay good well I mean if you're asking me what is happening or what should what should happen I wonder the answer is yeah let's your opinion of what we should do we should get Washington out of it this health care should not be delivered now let's have a standing ovation yes I mean Colorado is not the same as Alabama Alabama it's not the same is totally is Anchorage you know Alaska so you're in favor of single pair type systems maybe your our mechanisms that if it works make that work if it works right but not one size fits all no that black I mean the $15 national minimum wage can we talk about that yeah let's talk about that too I mean it may maybe it should be 17 well 35 why would it be 35 100 I want to make $100 but it also could be five in some places right right well in Puerto Rico which is soon to be a state if you made $15 an hour is the equivalent of $68 an hour in their Caribbean economy well what about DC which can become a state $15 an hour you're broke as shit absolutely right so anyway we'll get off of that for the moment but the same thing is I think the same thing is true about health care in my very humble opinion is that the that Washington DC education health care lots of things Washington DC should step away they maybe have it's probably not a bad idea to have basic standards right basic standards just like an education but let the states figure it out I mean you learn from each other like that whole hub of best practices and then there can be things to develop and say hey we learned this in Rhode Island you guys might want to try it too and we do that to some degree there are there are some states that do stuff better than we do and we do do stuff better than they do whatever COVID great example some states have done quite well yeah are better some states have done terribly some are doing medical or economy or both both all of the above right like how do you think you're right it is health care and and public health right all those things as we have just gone through and are living through in that that this very moment is is tied to the economy right sure if we're healthy we have a better economy totally totally mentally and physically absolutely yeah so so here's my solution okay you ask yeah my solution is you may have heard this one time I and this might not work everywhere but why don't we do health care like we do schools okay we have funding we have we group together and like why did people move to and I don't know what part of town if it matters up here in Fort Collins but in the Denver metro area you might live I live in Jefferson County yeah and we moved to where we moved great schools there as we have great schools and we wanted our kids to go to great schools people moved to the Cherry Creek system because they have good school whatever right how how come the same isn't true for health care why could we have like and I'm just making up stuff but let's say the city of Fort Collins or a number right has a bore right and you're healthy people up here and so elected health board that selects the benefit plan they then go out to the market to the insured market and say sigma anthem united health care you come up with this is what we want is our benefit package bid on it yeah and so anthem blue cross mishiel might come back and say we'll bid on that we'll do it for three years will this is what it'll cost blah blah blah and you know the difference between premium and taxes right is really just spelling right totally so you know whatever if it comes out of my paycheck right if I can't buy a pizza with it yeah right so I mean and then that way we are really tied together yeah so if my neighbor if your neighbor's eat chocolate all the time it's it well if I don't see if I don't see him for a week I might go knocking his door right right and see if he's okay right and maybe go for it is it might not cost a million dollars to rehab him because he's been laying on the floor in his own vomit for exactly and maybe we'll go for a walk together and get to know each other and all that it would have benefits outside of just that because that's part of our especially now coming out of COVID nation like people are so we just if we would just learn the lesson right right we we could learn a lot from what we just are now coming through imagine if our neighborhoods were filled with people neighbors walking with each other and talking and having an enjoyable time and conversations together and talking about how I mean if there's a silver lining to COVID isn't that it that a lot of us have been spending more time at home and getting to know our families but not with your neighbors as much because that's kind of full pop because you know what's the mass policy I'll say in my neighborhood people just threw that right out the window they're walking around walking the dogs I mean we sit in front of you I mean not not as much anymore things are kind of returning to normal now but last spring last summer people would just be sitting out in their driveway and just I mean it was like a barbecue every day yeah yeah no we had some of that too I mean we're in especially when it comes to public health issues which are health issues yeah we're really are all okay together so we get questions out of it how well Washington could be a way to fund they and they are in certain parts of the economy right now they are a funding mechanism right and a regulatory body right right so you have to have this minimum standard and stuff yeah but then otherwise it's like this neighborhood kind of thing or whatever one question I had when you were describing that was I told you I grew up in North Dakota what about rural regions where they don't even have a population sample that can barely imagine I mean again it won't work that's the beauty of it is that not every state is the same right some states that are have a bunch but the doctors make way less money in North Dakota too yep right and so that's part of the equation well well they don't want according to our current system because it's like the same thing I don't know if there's a short term fix to all that but if the people don't like it then they wouldn't live there that's correct I mean overall they would vote out there again I mean make it low so to just all the super sickies go to these pockets of infestation then or I mean the people in Wyoming love Wyoming the people in Montana I mean there's 300,000 there's a lot of something like that right I don't hear them complaining about lack of I'm sure there is a lack of adequate healthcare resources in Wyoming but I don't hear that being the right the problem with healthcare in America totally is that there's not enough healthcare in Wyoming right they like Wyoming they live there they choose to live there for a reason right yeah and I'm just thinking about like in the rural environment if one person out of about 20,000 person sample got a two million dollar thing that like jacks everybody's thing up with that happens today right yeah so on those cell phone and again the school district analogy may not work for every state yeah let every state should be able to sit yeah right there are different things try different things try different things so good I just think of anything we can do to introduce more accountability into the situation so there's accountability between the person who's paying for the service which unfortunately today is split between an individual and their employer the employers are primarily the payers of services today sure and the disconnect between an employer in a hospital system right is a disconnect between me and no malaska right is my you might as well try to broad jump to Mars an employer has no way to hold a hospital system accountable in today's healthcare system there's just no way well I'm going to disagree a little bit and say Walmart probably has a way to do that right so those big employers yes or whatever but I stay corrected in this system you guys described though you could choose your provider right like you could shop your plan around to a few of these different kind of this is what times putting together who is it who's a healthcare payer to say you can only see these people right why can an individual say I want to go see this doctor I mean I think it's time that we rethink the whole system right right well I mean if there's a good doctor and it's a high performing practice then people should be able to see that person and there shouldn't be any penalties well and they should they should know that and we are yeah there should be some like credentialing and our education is who are the really good doctors and stuff like that one of the responsibilities we have as good consumers is to be educated about what we buy yeah I mean why do you buy a Volvo versus a Ford because it's safer but you know that right right but you don't how do you don't know that in healthcare I thought it was because you're a Swedish no I would like to there to be like published average rates for different procedures I was thinking about everything else you buy you go buy a TV you're gonna put some thought into that you're gonna look at reviews you're gonna do everything else we don't do that I was thinking about it and it's not just price so it you don't buy cars that way you don't buy bread that way it's it's a component value is value sure how much strain is it gonna be and the value and the quality and all the other I was thinking about estimates and construction and history like if if your doctors had to be like okay I've checked you all out and my estimate is this right here you can shop that around but if we are off the wall estimate on most people right no you're gonna go buy the cheapest thing ever every time of course not no I want the good one yeah usually if I can afford it you can go get a cheap meme from Dr. Nick Riviera from The Simpsons right but you're gonna be right back in the hospital look at this palatial studio I mean the guys got clients it's amazing yeah some of the cheapest rent in all town thanks Scott um I want to classically and our podcast as we usually do if there's any last things on the on the fix the thing or we didn't what we didn't answer was the individually individually we talked about meta stuff and get DC out of it and stuff but individually what should we be doing what should we be acting if we're a business owner or if we're a person I think individually in colorado is a little bit different we're a highly healthy population we we have great weather we love the outdoors and so that's great so we're fortunate in that regard Hawaii I think is the one state where it might beat us out in that so we're fortunate but if anyone has traveled outside of Colorado you've seen the rest of the country and it is not what's baddies and if you know Kurt's words not Gavin's I'm running for office cleared it up you patty that's what Gavin said earlier we do have Todd said it right earlier the cheapest person is a dead person the second cheapest person is a person who's not on prescription drugs who doesn't go to the hospital who doesn't need to go to the ER who goes I mean get preventative care when as they get old or get your teeth cleaned once a while get your teeth cleaned I mean that's you said yourself you haven't spent 8,000 hours on health care and you know the last 10 years of your life combined probably that's the healthiest person and that's our responsibility as an individual is to live a healthy life have a good diet stop drinking 64 ounce sugary drinks you know make make responsible choices ever if you ever drink a 32 ounce plus sugary drink and you're not on a road trip yeah stop drive yourself straight to an emergency room because you're an idiot well I mean I am running for office I did not say that that was Kurt Kurt don't you miss guided and you've been let us stray by all the advertising of it it's really I mean do what your mother told you to do right I mean do everything in moderation common sense isn't as common as we wish it was right I mean right if you sit down and eat all day long you're gonna get fat I mean that's what it all works yeah yeah yeah but also I mean let's be fair too I mean there's metabolism problem sure oh absolutely all of those sorts of things and and and some people just have rotten luck yeah totally and we have to take care of them we do we do and that's a great point Todd yeah and but but that's a great point and thank you for reminding us of that but we also know that 80% or something like that of health care costs are driven by preventable oh no question about yeah yeah and and keeping old people alive frankly but we won't talk about that I mean that was I that's why we need just here's another top 20 local experience with former CSU leader Barney Frank and he was telling us how really college Tony Frank Tony Frank sorry Barney Frank is different the whole different guy Tony college costs are pretty much rising at the same level but the percentage of the state supports has gone down and down and down right and so remember this is a rotary club so full of white hairs and stuff and I raised my hand and I was like well it seems like then as a society we've decided that like through Medicaid obligations mostly that states have decided to invest in the dying old people instead of the minds of young upwardly mobile poor people it was that an intentional choice he's like well you're crazy you said this right in the rotary club but but it's true frankly like the state budget right now a third of the state budget is consumed by Medicaid a third of everything the state of Colorado spends 10 billion dollars three and a half billion goes to Medicaid is that a lot and and that's why that's why there's less on education higher education K the draw that's why the state legislature that's where the roads have holes in them low blood transportation all of it there's pressure and everything else because more and more and more and more the state budget is being consumed by Medicaid yeah the train could go right up i7D in this no storm if we had a train yep um so I well one more thing please you you guys just mixed Medicaid and Medicare you're you're talking about Medicare old folks Medicaid for no Medicaid no I was talking about Medicaid okay okay let's talk about Medicare please just a second let's do and I I've been taught this over and over and over by a great friend and I think medical mentor of mine Dr. Sarah not bless you you know yeah great guy um and we just don't die well in this country we he says this all the time and I'll give him all the credit for it is we treat people to death yeah so we don't you know we had a governor in this dinner at what one time that made some weird suggestions and that's not what I mean but there is I mean my father had a tortured death because they just kept treating him right and at the end of the day it's the end of the day well I don't just want to go right and my grandma my grandpa like so many people that I've known in my lifetime yeah wanted to just be allowed to go instead of having to fight so hard with dignity yeah there's a lot of wrong with that yeah I'm not joke about death panels and it is a joke and I'm sorry it's a bad joke but but there is a lot to be said about how we treat people at the end of life yeah and you got to think about yourself right and when you're 85 and you're you're on your or 90 or 92 whenever your last day's number yeah how do you want to go and do you do you want to just be resuscitated and just dragged on during that time right and you want to spend your three years of torture yeah and then staying alive another month well and it's not necessarily your inheritance or anything like that your own money but do we want to be a drag on this system exactly it's society's money if it's yours or if it's not it's it's money it's being spent might add a has a lot to do with the way I think obviously for both of you it's the same absolutely but he had a huge amount of respect for the like the Native American culture at least in some tribes where it was like I'm old nobody can really take care of me anymore I can barely take over yourself we got a blizzard coming in yep I've had no yep it's time I just walk off and freeze to death yeah oh wow yeah that was kind of a cultural norm in the two tribes especially in North Dakota that's a cold blooded literally very pretty decent way I suppose when I went to school down and during oh I had a roommate that was a Native American he was a youth mountain youth and he would just disappear into the he'd take a blanket he'd disappear he's the I love this guy he was the greatest guy quiet as the breeze and he'd have a stressful day he'd just just walk out wow and just find some place to lay down and uh tranquillity yeah yeah it was a responsibility to one another you know it's two or four responsibility kind of thing yeah um as is our norm thank you I wish we could unpack all the like fixes and stuff like that but we can yeah um but we we need to hit our faith family politics stuff and the local experience so we're gonna do rapid fire um Todd I'm gonna start with you uh we talked about your wife and I forgot her name already Tony Tony nice to hear you from you um what about the rest of the family you've said you're six of eight yeah on the birth but then how about you have kids yourself and I have two kids okay um again I work with my son Mark yeah every day all day and I'm really proud of him I'm proud of my my daughter is a uh senior I'm almost you know off the hook for uh for uh you get a wedding coming up probably eventually she's she's a senior at Montana State oh awesome that's why I learned how to ski really uh bridge your bowl yeah shout out to what's her name uh Frankie Frankie yeah Francesca but Francesca or Frank we don't need and Frankie interesting yeah right Frankie yeah Mark is the name I had a older brother that died a long time ago and Mark is the first male grandchild and we all you know everybody was gonna call whoever became the first Mark and that's where he got his name but um they are great kids I'm thrilled to death and I mean you know you talk you hear sometimes just real quick this maybe part of the faith part is um you know you know when the lotto hits the big number and everybody gets excited yeah I hit the lottery every day yeah right I have a great marriage I have great kids they're all healthy yeah a lot of every yeah I feel the same I feel the same but I have three younger siblings and then three step siblings my dad remarried and all of their spouses are awesome and we all have good relationships with our wives and good healthy kids and stuff and it's like how could we be so blessed yeah yeah so uh appreciate that how about how about you Gavin what's your family's the family so uh uh my wife Jen 20 years this year uh we have two kids she's amazingly beautiful later she's hot super hot smoke and hot oh my god yeah it drives me nuts thank you like Jennifer because it's she's a cheerleader uh I was a football player although she was in Colorado and I was in Texas but we were we were yeah no she you know uh when they say um no matter what your wife looks like you always think of that uh young bride that you married yeah yeah that she still looks like that to me and she she still actually looks a lot like that it's a huge blessing isn't it um so fortunate she's amazing she's so strong and um well it keeps me honest you know and this is all that I can ask for that's a lot of work and then we have two kids Nathan who's a junior in high school so he'll he had a rough year with covid he's a good student he's a baseball player pretty good pretty good catcher and uh our daughter Tessa she's a dancer a little uh ballerina and uh she's just uh this beautiful as her mother I like to have one word description of people's kids would you like to give Nathan and Tessa one word description yeah Tessa my one word description will be asset which is Tessa backwards wow there's a lot of financial nerds exactly like that and for Nathan uh Nathan is actually not ton backwards Nathan uh it uh is a biblical name it actually means gift of God yeah he was a counselor to the king David uh he's not that's not what he is to me my one word for Nathan would be a steak the boy knows how to cook a steak nice in fact you know how you've got us son it's like it's a dad's responsibility cook steaks for his family I see I see did that responsibility but I'm like Nathan you're going to say no you're like better than I am like a steak and you have one word descriptions Todd for your two kids let me go back in to the steak in our house my wife's Italian and is an amazing cook and I just you know I'm I stay out of the kitchen you do other stuff yeah yeah so I I'm I'm super proud of my son Mark um so I'd say proud is probably the biggest thing of all and then my daughter's just amazing yeah yeah I love it I love it okay so faith born a Catholic six out of eighth and I stayed that way born a Catholic I'd say I'm still a I think of myself of the Catholic but I'm my parish priest I can't understand what the guy says he's not quite why wouldn't you so I mean with this day I mean like today yeah he's of and don't get me wrong I have he gets this he's of foreign um he's Polish I can't understand it I don't know what it's not a stuff about God and this bad stuff like that it's just about like actually I I went to grad school I had a stats teacher that way too I was like oh everybody had a stats but I said they're the worst because for the record my last name is Kiszynski so I just oh I always get to do Zinski I'm sorry no it's no it's but I'm my family's Polish I went to grad school at Regis so you know Notre Dame of the West what's your what's your heritage over here by the way where is it what are the what the let me finish this thought I'll tell you um in that going um have you ever been a massive Regis no oh my god oh is it traditional it is cool oh it's a college so it's a college mass it's awesome okay yeah I speak over there um my heritage my father is like off the boat German okay and my mom's a little bit of this a little bit of that yeah um and we said hi in 67 where I come from there you know exactly I mean my this is a really great little welter trivial be quick because we got very quick time my mother is 90 years old nice okay 91 even she went to college oh wow four years of college oh Drake University nobody did that back then right yeah it's just such a cool I love that you know so cool that's a great thing yeah um so despite the fact that you can understand your Paris priest your Catholic ended up here in there I still think of myself as that I'm proud of I you know just witness in the news the it's good thing your attention to a rack your attendance report isn't oh yeah it isn't public but yeah anyway um so I go to uh I'm very in the faith I actually played drums for the praise band at my church I do prison ministry at Stirlis correction sterling correctional facility really very very um very much a practicing Christian and and what flavor like you know what's your church you want to shout out to you yeah well I go to Redeemer Lutheran pastor Tim pastor Scott my my homie and uh very happy let's went down on harmony is that right uh Timberline Timberline Carpenter yeah right uh children of the corner of the winds were in the cornfield I remember when that was like way out in the boonies and it's quite a church now yeah it's big church and uh very happy there it's a great family my wife is actually a preschool teacher there very cool very cool little preschool so we said faith family politics uh Gavin you are running you are running you're running for city council yeah and uh in Fort Collins your district what yeah I'm used to 60 second answers so this will be quick yeah you got 90 seconds uh I did uh I'm I'm well and goes back to what we're talking about if you want healthcare yeah thank you I won't take that I can't talk about myself very long um uh I just believe in community we love Fort Collins uh I want my kids to grow up here they are growing up here but I want them to raise their kids here and I keep thinking about what kind of Fort Collins are am I going to leave for my kids kids right my grandkids I want them to stay here uh I've lived in a few places in in the country in Fort Collins is it and so I just care very deeply about this place and I believe in community we're just talking about you know uh sterling correctional facility and faith and I think it all comes back to your community yeah and I just love the way we all work together here in healthcare and business and just everything I mean the fact that I know each other we do and and you know my friend the mayor Wade Troxel said Fort Collins is that community where everyone pulls up to a four-way stop at the same time and everyone waves each other through you know we're just super nice and polite that way so I just love that and I want to keep it that way and uh yeah so I made this stupid decision to run for city council but uh a couple of roads you need to widen here I'm just saying uh it's funny there's more lanes on harmony than there is on i25 isn't that crazy I'm gonna bounce over to Todd and then I can come back to you for another politics question oh great Todd what's your what do you want to say about politics we got 90 seconds I'm proud to should be an anti-Trumper I am a I I'd like to think of myself as an old school conservative oh okay I um I did vote for Biden but only because I can't stand the thought of Trump I was just reading an article about that like the the Republican Biden crowd yeah I mean I I'm an but not the current I well the Republicans aren't conservatives I am not a today Republican right I am you cannot fear you be like a blue dog Democrat in in Colorado kind of libertarian I know I'm all about liberty yep okay you know what the role of the federal government should be almost nothing defense right that's it yeah that's it yeah we should have another whole population yeah that's it yeah and push it to the states totally um I am incredibly disappointed in what is today the Republican party you're a 14th amendment Democrat or 10th Amendment Democrat sure all everything not mentioned previously is states you want to have guns have them go whatever I just be safe if you want to be gay and get married do your thing whatever as long as you're not hurting somebody else I'm all for yeah yeah you know do all in love who you want those signs you see out there you know whatever I have I I have my blog post for March decided actually and it's uh the Makers Mark and it's like the whiskey but it's also I showed you my my my my new messenger bag um and they've got a Makers Mark on there and then the Makers like the people that like make you do stuff and there's a mark that gets left behind when you make people do stuff whether you're stalling grad or you're here in America with masks that's so funny because my campaign slogan is the four roses it is not you know that was a joke but it's cool I like it so um the local experience you guys have um you're you're the second guest last episode with uh with brothers fountain which might even be aired later because you got it I'm actually coming up and I don't later anyway we decided that we should have like a one minute or two minute like what's the most crazy experience you've had in your whole lifetime that you're willing to share with the public oh I miss interpreted I was thinking about that one of the most profound experiences profound is crazy okay does that work whatever and I was trying to and local was crazy local I was crazy yeah it's your experience like what changed you what made you um well I did have a profound moment uh actually at the pond remember when they used to have the uh concerts the jazz concerts at the pond look good series that look good series yeah thank you with Sprite when we moved here and we saw that we're trying to get integrated with the community and just kind of you know understand what you know the vibe of Fort Collins was and with my son I think we got some Popeyes chicken or something like that or um I food truck there for a couple times sorry that we didn't visit it yeah um and uh we were sitting in the lawn chairs he got out of his lawn chair he was maybe three or four and he just laid in my lap and it was the most beautiful evening on uh I think they did it on Wednesday evenings or something like that and uh I just lean back in this lawn chair with my three-year-old son laying in my lap and there was this beautiful jazz music playing and people playing in the birds chirping it was just this is my really here it was it was surrounded by all these amazing people there was it there was it it was a god experience I mean there's just no way to describe it I just said yeah god is here with me right now this is and it was just a reminder of how beautiful life is I will never forget that that qualifies thank you percent oh good it doesn't have to be some crazy whiskey driven fuel yeah it was fueled by Popeyes chicken I think yeah Popeyes chicken fuel and community and music uh it was it was it was everything came together in that one moment it was amazing Todd I'll give you a quick one from just just on the business side if you don't mind sure so I remember I used to work I mean I used to work a ton you know I still do but um I used to be one of those traveling kind of consultants in health care and there's lots of them out there sure I remember and you know made tons of money right sure and most of them wish they could just spend a little bit more time not traveling so here's my moment for that is it's money's not the most important thing in the world is I remember being in the airport and I had to be told this I was in the airport in Atlanta I didn't know where I was I traveled so much from place to place to place to place I had to ask a guy where I was you're like a rock and roll star and I would thank you Atlanta exactly I mean Detroit right you know right it was one of those and it just occurred to me that that's just not really what I want to do right you know and it was like it was life-changing on the business side of stuff yeah well I think that's great I think that's great I've never had anything like that oh my god I haven't I know where I was like what do you do about that did you change the way that you did your thing after that well yeah I stopped doing that I don't want to do that anymore and we became a lot more where I mean we we do stuff all over the country but today and this might be one of the things that has a good thing that's come out of COVID is that we don't need to be nobody expects you to be in Baltimore anymore or in Cleveland or whatever they're like yeah we can jump on it sometimes in the same day right right yeah you can have people conversations with people all over the world yeah there there are other ways to do this yeah I like it yeah well um guys it feels like I wish there was two more hours that we all had to be able to share here today and just talk about interesting things yeah but there's only a little bit more for yeah I'll fill you back up before you get out of here we don't have two more hours worth well this has been a blast Kurt I mean man I've had yeah I can't believe the time flew by it goes faster than you think it really does um so to those listening you know do the things that you can to be the most accountable to your own health that you can yeah and then spy on your neighbor and make sure they're doing the thing exactly spy on your neighbor accountability if you take anything from this podcast and get the federal government out of this shit most of the shit yeah really lots of defense everything except for defense and spy on your neighbor and spy yeah but peeking their windows see what they're doing are they doing their thank you for listening to today's episode of the local experience podcast this is Kurt Bear founder of the local think tank and hosted the local experience and I'm here with Rory Sharer local business developer and hosted the local shorts episodes we hope you heard some new ideas and business perspectives in this episode our mission and all that we do including this podcast is to share collaborative business ideas and solutions that uplift the business community subscribe and follow us for you listening to podcasts to get new episodes as they are released curious about logo you can learn more about us at localthinktakes.com where you'll find more information about our chapters business resources and events for business owners and leaders if you're looking for perspective accountability and encouragement along your business journey why not apply for a chapter near you today why not why not why not we'll catch you next time on the in-depth local experience podcast with me Kurt and with me Rory for bite-sized business lessons in the local shorts bye you