Season 1: Episode 13 – Why American Healthcare Is Failing: A Medical Assessment

Dear Healthcare It’s You: Episode 13

Elisha Yaghmai

Instead, we come in and say, oh, there's this little piece of it here. You know, I don't like how the hospital is doing this regulation. Oh, I don't like how the doctor does that. Another regulation. I don't like how this is being done. Documentation requirement. I don't like how this is done. We're gonna bring insurance in here. Regulate that.

Elisha Yaghmai

You know what I mean? So it's all these little piecemeal fixes, right? But you have. So it's like saying I've got a house. The House of Health Care has a cracked foundation and a collapsing roof. Right. And really needs to be bulldozed and rebuilt. Right, right. But what we instead keep doing is we repaint the door three or 4 or 5 times.

Elisha Yaghmai

Right. And we put some duct tape over the hole in the window. Right. And we're like, let's just keep this thing going because it's just too we can't get rid of this thing because if we do, there's too much disruption.

Jo O’Hanlon

Welcome back to Dear Health Care. It's you. We are back with dear health Care. It's you. I'm Joe Hamlin, and this is doctor Jack Jackman. This is our last podcast episode I feel about about ending the season. So the good we've talked about a lot of heavy stuff so far. we've been going through Elijah's journey in medical school and his residency and it's early career and beyond.

Jo O’Hanlon

talking about the healthcare business that he built from the ground up, along with some partners, and then going solo and then back with some partners. And a part of that was telling my dad part of that was a physical clinic here in Wichita, Kansas, Free State Health Care clinic. And that is now closing. And that's new. That's a new, piece of the puzzle in the plot.

Jo O’Hanlon

So was that a recent decision, or have you known that that would happen for a while?

Elisha Yaghmai

No. I mean, the decision itself was fairly recent. the build up took a long time. Yeah. And to be clear, the rural side of what we do is not closing. That's continuing. All the stuff we do in that area is going. It's the the clinic that's closing the primary care clinic.

Jo O’Hanlon

Right. What was it that brought you to that conclusion to close that?

Elisha Yaghmai

the I mean, the short description is my I tend to view things from at least medium term to long term in terms of where how I think it will play out.

Jo O’Hanlon

Elisha Yaghmai

And so, my when I looked at it from a long term perspective, I was not convinced that continuing the work that we were doing in the clinic as helpful as it was for for many people, was going to accomplish what I had wanted it to accomplish, that maybe the manuscript like it was it, it was able to help patients.

Elisha Yaghmai

It was able to, you know, it was able to do the things that you would want a clinic to do. If you're taking a clinic as sort of a business concept or as a service delivery module, it's doing those things. But it was not, in my opinion, going to get us to the change that we need on a national basis.

Elisha Yaghmai

Yeah. You know, to, to deliver better health care.

Jo O’Hanlon

Were you going into it hoping that it would make a broader change than just in the communities that you were working?

Elisha Yaghmai

Yeah, I think the so the initial, the impetus for it was and we talked before. Right. I mean, the original reason we started clinic was because the insurance companies forced us to have a physical clinic to be able to build them to do virtual care, some sort of group.

Jo O’Hanlon

That you were.

Elisha Yaghmai

Just outside school hoop. Right. But but very quickly evolved to saying, well, if we're gonna have to do this, then we might as well try to solve access to care in the urban environment. and, from from my perspective, access to care in urban environment is financial. Yeah. So the rural folks, you know, have a problem getting getting to any doctor, right?

Jo O’Hanlon

It's just not.

Elisha Yaghmai

There. Yeah, they're just not there. Right. But urban people, there's doctors all over the place. In most cases, they just can't afford to see anymore. Right. So this is the problem. And so my initial thought again very much like rural, I started with a very simple concept, which was, okay, well, people can't afford to see the doctor. so why don't we use technology to kind of create a system that would enable us to see the doctor?

Elisha Yaghmai

and to start off doing that. We borrowed a lot of things from what's called concierge medicine. Or some talk to them. They're very open about the types of techniques they use to try to help save their patients money.

Jo O’Hanlon

Other places that were doing.

Elisha Yaghmai

This, they're doing concierge type medicine, subscription medicine, being paid some amount, a monthly fee. Right. Yeah. And so, we we borrowed things in terms of how to create affordable labs and affordable imaging and things like that. Well, I say affordable, more affordable, right? More affordable than, than they would be with insurance. So, so we borrowed the concepts that they had developed in terms of how to create, more affordable labs and imaging and things like that.

Elisha Yaghmai

you know, here, again, not not as affordable as they could possibly be, but more affordable than they would be using insurance. Yeah. So instead of an MRI for $5,000, you could get an MRI for $500, right. The purchase price prices like that. Right. So that was, you know, so we utilized all those things, and we, you know, pretty quickly figured out, okay.

Elisha Yaghmai

we would need to offer even lower price points to really be accessible because what we found, what we found, we initially started, we more or less copied the same concepts that were being used by others. Yeah. What we found is that the population that we were getting were actually people that were actually pretty well off in many cases.

Elisha Yaghmai

So they were essentially coming in and saying, I want to have a doctor on, can they speed dial? I'm willing to pay a fee to do that. And then I'm gonna also maintain health insurance. Right.

Jo O’Hanlon

So it was more of a dedicated service than an affordable service.

Elisha Yaghmai

Exactly right. It was more about that. Right. And so and we can talk about concierge medicine and the different issues with it. Right. At this point, I'm not convinced it's the answer. Yeah, but there's a whole debate and discussion you can have about that a data skip that. Long story short, as we cut everything down. So we are subscription was $5 a month, right.

Elisha Yaghmai

If you came into the office of course it was $25. If you saw us online, it was a dollar a minute. Right? Yeah. These kinds of things, you could see a specialist for 75. Right. So prices that were substantially lower than that and we had control over that. And we did a lot of back end work to make those prices sustainable in some way.

Elisha Yaghmai

so we did all of that. But, you know, one of the there were there were kind of three things that we began to realize over time. So the first, the first problem was that the people that really needed this, right, people that these are often people that they're working, they can't afford health insurance. Right. And they don't make enough money where it's like, hey, you know what I can do?

Elisha Yaghmai

I can drop $500 to see the doctor or $400 right to go in. This is not that's a nonstarter for them. So they needed an affordable way to access care. And so the problem was that we're doing this. Yeah. But but oftentimes they're sitting on problems and conditions that they'd had sometimes for years that got diagnosed right, where sometimes it was a new problem.

Elisha Yaghmai

But they had waited eight months to get evaluated for it because they were trying to save up the money. And then also they find, oh my goodness, I can actually see a doctor for $25, right? You know, I'm gonna do that, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

This kind of thing was going on. So they would come in and we would find their cancer. We would find their heart disease or whatever it was. and then we would have to refer them back out. Right. And to the general health care system, which did exactly what it always does. Right. We couldn't control the price. So to go see the cardiologist is way too much money to go get a surgery was ridiculous amount.

Elisha Yaghmai

Right. So in a sense, it was that sort of frustration of saying, well, okay, I have I have now identified what is what has been causing you problems.

Jo O’Hanlon

Right. But we can't do anything about it.

Elisha Yaghmai

There's nothing I can do about it. Right. You have to have this money. And if you don't have this money, then I don't have any means to help you.

Jo O’Hanlon

So now you're just aware of how.

Elisha Yaghmai

Exactly, exactly you have a name for this problem, right? But I can't help you. Or the med that you need is, you know, $50,000 a month. Just, you know, just some ridiculous thing, right? And, you know, in our country, we've decided that that's the way it should be, right? If you're not wealthy enough to afford that, then just feels good to go die in a corner somewhere, right?

Elisha Yaghmai

This is kind of how it is. so this is what was happening, right? So we have that frustration, though, of of the initial hope of, yeah, we can help you figure this out. And then doing that right, running into the frustration of, now I need to fix it and I can't. So while we were doing that in the cash based side, we also had insurance patients coming in because at one point we looked at and said, you know what?

Elisha Yaghmai

We want to be able to help people, in particular people with public insurance. So Medicare and Medicaid, right. These people also were using a limited income. But yeah, I qualify in some way or another. and we had the same problem. So it would be, you know, Medicaid patient would come in and we'd figure something out. And then we try to we try to refer them to the necessary specialists to do the next diagnostic step or to treat, you know, and they wouldn't take them.

Elisha Yaghmai

Right, because they're like, you have I don't take Medicaid. Oh, okay. Because Medicare people would generally take but Medicaid. No, they they often won't. Right. And they won't because they feel Medicaid doesn't pay enough. right. So they wouldn't take them. So here again, we're like, well, there's only one option in town. And that option doesn't take Medicaid.

Elisha Yaghmai

So, you know, you're kind of up against it. Like, I can't help you. There's nothing I can do because I don't have that. I don't have that device. Right, right. I don't have that tool or I don't have the training necessary to do this properly. So I can't do this. So I can take you up to a certain extent.

Elisha Yaghmai

I cannot take you further. Right. And you are just out of luck because you have Comcare and nobody was taking care because doesn't pay you. So you know that that ongoing frustration. Right? So that's that's one.

Jo O’Hanlon

You seem like someone who's thinks many steps ahead and the problems that you were just describing, not on the insurance side, but on the other side in terms of not being able to control the rest of the realm of health care. Besides your round. Yeah. I mean, I'm guessing that that wasn't news to you, correct?

Elisha Yaghmai

Yeah.

Jo O’Hanlon

You had anticipated those issues, and you thought that it would be different than it did go.

Elisha Yaghmai

Yes. I thought for one, I thought we could begin to build internal capacity to meet those needs. Okay. But that didn't happen with the speed with which it needed. Like, essentially, I thought we could get there by, chopping all the wood ourselves. Use it. So this goes back to the nature of American business, right? Yeah. American business.

Elisha Yaghmai

The old school American business was you start this business, you try to build it up over time, and it takes many years, and maybe you get some investment. And American business in this era is you go out, you come up with an idea, you go out and try to find a bunch of investors to give you a whole bunch of money, right, so that you can almost drop the thing fully formed right into the marketplace.

Elisha Yaghmai

I had thought we could do this kind of old school style, right? Which was, okay, we'll start off with primary care. Right? And then eventually we'll hire a surgeon.

Jo O’Hanlon

Okay.

Elisha Yaghmai

Right. For example. And then maybe we'll hire a cardiologist or you know what I mean? Like, this kind of thing will slowly kind of get there. And the problem was that it's not necessarily that that wouldn't have worked. It's just going to take a long time to get there. Right. And the, and so my realization was this going to take a really long time, and there's just so many pieces of this.

Elisha Yaghmai

That was it. That was the one thing. Right? So there's so many more broken pieces like it's it's not just about having a surgeon. Right.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You need so many other things that back that for it to work. Right. that to do this you have to you have to come back. You have to hit it basically from the beginning with a lot more resources. Yeah. To be able to offer a much more comprehensive, essentially ecosystem into which people could enter. Yeah, that meets all the different needs.

Elisha Yaghmai

And we were not going to get there seeing one patient at a time. Right. You know, you know from a primary care clinic. Yeah. In Wichita, Kansas.

Jo O’Hanlon

Do you think that it would have gone differently not only if you had had more capital at the beginning, but I mean, you not wasted away, but in a way, it, you know, like that that has a negative connotation. You were doing so much, though, on your own for some years and financially keeping everything afloat in a way.

Jo O’Hanlon

Yeah, that obviously wasn't sustainable. Yeah. But even when you got past that point and were getting insurance and stuff, I mean, you had so much, against you. Yeah. For the, for a long haul. Yeah. I mean, at the start of this, if that hadn't been the case and you have been able to start getting insurance right away, have your partner stay in this stuff, do you feel like it's something that you would still believe in trying to flesh out, or do you think you'd still be at the same place?

Elisha Yaghmai

Yes, I think I think we could have made it had the operating environment in a different to start. Yeah. it's not a guarantee. There was at least a better chance. That's probably I would describe.

Jo O’Hanlon

I guess maybe a better question is if you could push a button and go back and have that knowledge that you could start with insurance working and thus be able to keep more people on board and not have to do so much yourself and have a different chance at it. Is it still a thing that you would put energy into or would you still want to go a different direction?

Elisha Yaghmai

At this point, I would want to. So, you know, actually, it's a tough question. I mean, if we had enough capital, I probably would be willing to take a second run at it. But but we would really need a substantial amount because of all the things you need to create to make it work. Yeah. You know,

Jo O’Hanlon

You're basically needing it sounds like with your, your thought on it of like how to bolster your practice that you had with these different components. It's, I mean, it's reinventing the wheel in a way. Yeah. A health care thing. You know, you're having to build up a whole.

Elisha Yaghmai

You need system. You need a competing health care system. Yeah. Effectively. Right. That is predicated around affordability and access and the difficulty of taking a step further than that. The difficulty beyond that is where do you get the capital to do that from? You get that from people that have money that want ultimately want to return on their own.

Jo O’Hanlon

Say they want to invest.

Elisha Yaghmai

They want to invest investment. Right? Exactly. It's not you're not building in that sense. It's not you're not building from their perspective. You're not building a public service. You're building a thing that gives them a return.

Jo O’Hanlon

Right?

Elisha Yaghmai

Relatively few people that do that are thinking about the return is a better country for my grandchildren, right? The return is I'd give you $50 million and I want 65 back. Right. It's like that, right? Yeah. And so that tension, I think is a really serious one actually in health care. And I, and I am not at this point convinced that we can get there through that means I'm not convinced at this point that health care, at least most manifestations of health care, really should be for profit, right?

Elisha Yaghmai

I'm not sure it works, I think.

Jo O’Hanlon

Which that's a change that you hadn't even thought about and.

Elisha Yaghmai

Thought about it. Yeah, I really hadn't thought about it. But over time, as I've just been exposed to it, I've seen all the different sort of moral hazard that arises out of a for profit arrangement. I'm not fully convinced. Like I can. I can understand how people can make money from it. I get that, and I can even understand what the value of it may be.

Elisha Yaghmai

And in America, talking about anything not being for profit is like, you know, sacrilegious, right? But but health care is it's a different thing. Like if you, you can't have, like people need health in a way that they don't need almost anything else in their life. Right? In other words, like if you if you want to buy a certain cereal and you can't afford it, you can find other food, right?

Elisha Yaghmai

But you cannot get a second health. Yeah. There's not a cheaper health, right, that you can have. Right. and so that's, that's the problem. And so here again, what did we see in the population were treating cheaper health. Right. Right. Oh I'm sorry. You know you're too poor to have your diabetes control. you could just lose the feeling in your feet, you know.

Elisha Yaghmai

Oh, you can't work anymore. Well, now you're a drain on society. Why aren't you paying taxes? Right? Right. Well, they can't pay taxes because their feet are rotting off. Because they can't afford your stinking expensive diabetic medications, right? You know what I mean? Whereas if you had affordable diabetic meds that they could purchase and take. Yeah, then they would keep their feet.

Elisha Yaghmai

Right. And then they could continue to work and contribute to the taxpayers. Do you know what I mean? Right. So it's this idea of in a sense, it's like the military. It's almost like if you have the military for profit, right. You're gonna have some problems very quickly, I think.

Jo O’Hanlon

Yeah, I was thinking like fire, you know, it's like it, it is health care is what it is. And it would be asinine if our fire stations.

Elisha Yaghmai

Were yes, for profit. Yes. Like.

Jo O’Hanlon

And in the same way. Yeah.

Elisha Yaghmai

It's it's that that's exactly it. Right. If you would have to pay them like your house burns because you can't pay. Which, you know, there were societies that did that, right. If you and pay them your house burned to the ground. Right. But I'm like, the reason we don't have that is because you need houses that don't burn down people to be able to contribute meaningfully to your society.

Elisha Yaghmai

Health care really falls pretty squarely into that and increasingly so. Right. And that I would say.

Jo O’Hanlon

Is that because, I mean, as as you're saying that, I'm like, okay, so, you know, fire, for instance, is for the military, funded by our government and health care, we fund by our government through insurance.

Elisha Yaghmai

We don't we don't. We fund it through employers mostly.

Jo O’Hanlon

Right. Well, true. But I mean, like, it's not it's not even it's not direct to the thing that we need though. It's to the thing that pays for the things that we need. Like it's not also.

Elisha Yaghmai

True.

Jo O’Hanlon

You know, it's not we don't have that that direct line of funding in that same way. Yeah. We've built this alternate ways that people it's multiple steps where people can make money off of it still.

Elisha Yaghmai

Yeah. Each step there's someone making money off of it. Yeah. That's exactly that's exactly the deal.

Jo O’Hanlon

And so for I mean that's how our system is built. So to have a truly profit system. Yeah I mean you're combating every aspect of that.

Elisha Yaghmai

Yes. And that so fundamental to that. Right. That thought process that you've outlined. Right, was the realization of, okay, we need a revolution. We need a new we can't incrementally improve this. It's not this. You got this big not right. You know, like Trump famously said, right. Health care is complicated, right. You know, and people made fun of it.

Elisha Yaghmai

But I was like, that's you know. Yeah, that's that's pretty much accurate. Yeah. But it's not complicated in the way that theoretical physics is complicated. Right. Or calculus is complicated. Like they're inherently just tricky in details. Right. It's complicated for bad reasons. We've made it we've made it complicated in a very in the worst sort of human way possible, which is everyone comes in and bolts on their piece.

Elisha Yaghmai

Yeah. To this monstrosity. Yeah. But at no time has anyone the society, our representatives, nobody has sat down and said, what do we want from this thing? What do we want it to do for our country? Right? And how can we arrange it so that it produces the outcome that we desire? Yeah. Instead we come in and say, oh, there's this little piece of it here.

Elisha Yaghmai

You know, I don't like how the hospital is doing this regulation. Oh, I don't like how the doctor does that, not the regulation. I don't like how this is being done. Documentation requirement. I don't like how this is done. We're going to bring insurance in here. Regulate that. You know what I mean. So it's all these little piecemeal fixes right.

Elisha Yaghmai

But you have so it's it's like saying I've got a house. The House of Health Care has a cracked foundation and a collapsing roof. Right. And really needs to be bulldozed and rebuilt. Right, right. But what we instead keep doing is we repaint the door three or 4 or 5 times. Right? And we put some duct tape over the hole in the window.

Elisha Yaghmai

Right. And we're like, let's just keep this thing going because it's just too we can't get rid of this thing because if we do, there's too much disruption, right? There's too much disruption. But there's there's a point in human society and, and human just evolution where things get to the point where they have to be swept away and replaced, and our health care system is on that list.

Elisha Yaghmai

When and where and how exactly it happens, I don't know, but it's one of those things that is has gotten two big and two tangled and two bureaucratic for its own good. Yeah. And there needs to be a time in which there is a real conversation about what do we want, who do we want it for, how do we want them to access it?

Elisha Yaghmai

What do we what outcomes should this system produce right. And have we optimize it to produce that inarguable right now that none of that is going on?

Jo O’Hanlon

Which is that like, I'm curious in terms of your your thoughts on this for the difference of demographics, like for the wealthy classes of America? Does it seem like they're satisfied with the health care, that they're satisfied?

Elisha Yaghmai

If they are satisfied because they don't understand what's going on? Right. So one of the things that we've talked about here periodically read all these kind of horror stories. And so you have different layers of people, right? We got people that are wealthy. They can they can afford health insurance. They've got solid employment or, you know, whatever it is, right?

Elisha Yaghmai

They can access care. Yeah. What they don't understand is how much garbage care they're actually getting, how many near misses there have been, how many screw ups there have been in their care, how many misdiagnoses, how many inappropriate prescriptions. All these other things are going in. So they're not actually getting the best quality care. And again, every time this comes up, people always try to nail it down to like one, you know, oh, that's a bad actor, right?

Elisha Yaghmai

It's a dumb doctor. No no, no. Almost all the time. The system is the problem when you dig into it. That's something hopefully we'll do in future. Yeah. Seasons of this. The system is the problem. The behavior is a system issue. It's not just one bad Apple stuff, right? Right. So they don't realize, yeah, you can access it.

Elisha Yaghmai

But what you don't understand is that especially you want to see it's kind of terrible. It's kind of terrible, you know, and the other doctors know it, but nobody else does. You certainly don't. And so when they send you off on whatever wild goose chase, they've sent you on this because they're not good and it's not being detected.

Elisha Yaghmai

Right. Again, why is not being detected system issue.

Jo O’Hanlon

Right, right.

Elisha Yaghmai

So, or they're making a certain, you know, that surgeon you went to see that recommended that therapy. There's a reason he recommended that therapy, but it wasn't in your best interest, I can tell you that. Right. Again, system is dictating certain types of behavior to certain choices that are being made. So you, the wealthy person, assume you got access to everybody.

Elisha Yaghmai

All the best for everything you have no idea, right? What you're actually counting when you go in, go down a level to the people that are that are not wealthy enough to do that, or where where consuming health care is a is a serious decision, right? Yeah. Should I, you know, okay. I appear to be bleeding to death like.

Elisha Yaghmai

But can I afford the E.R. right now? You know, maybe if I just, like, you know, put a tourniquet on and, like, you know, maybe I think I can not bleed to death enough, right? Right. So that I don't go bankrupt. So you have that. Right. And then we have people one tier below that socioeconomically. Right? There's just not even an option.

Elisha Yaghmai

Right? Yeah. It's just it's just not a thing. So it doesn't matter what's going on. Right. They can't right now. They have no option. They can't afford a doctor. They can't even if they want, if they can't afford the medications. Right, right. If they went to the doctor, they can't afford the testing to be done. Right? Yeah. I can tell you how many times we had things where we need.

Elisha Yaghmai

You need a Cat scan. They can't afford the $200 Cat scan. They can't afford it. Right. So we can't move the care forward. Yeah, because it's not an option for them to afford. And there are zero people trying to make that Cat scan affordable for those people. Even though I'm very sure there's a way to do it. Yeah, it no one's trying to do it.

Elisha Yaghmai

Nobody cares. Right? Yeah. And then and then because they're in pain or they're disabled by whatever the problem is, they can over time, their ability to so-called contribute to society is eroding.

Jo O’Hanlon

Right. You know, which.

Elisha Yaghmai

Ultimately is right.

Jo O’Hanlon

That was I mean, you know, so then they stop working. They're disabled. They have as much mobility. That's right. They're not able to eat as well. They're not able to I mean, there's so many different things as you're talking. That's where I'm like, I think that the wealthy classes, I may not hear as much dissent about health care from that realm, partly because they don't have some of the other pain points in our systems.

Jo O’Hanlon

And our social systems and, you know, structures in terms of what causes us to be unhealthy and need health care in the first place. You know, they're able to afford better food, right? You know, they know about nutrition, like there's these different hurdles that the classes that are under that level don't have even that preliminary access to. That just puts them in the seat of needing.

Elisha Yaghmai

The nutritional care.

Jo O’Hanlon

Yeah. So it's not just that it's not working for some people. It's really not working for anyone.

Elisha Yaghmai

It's not working for anybody, whether.

Jo O’Hanlon

They notice.

Elisha Yaghmai

It or not. And to to that point that you raised that that was a secondary issue, right, which was our people. So when you work at primary care, you work down at the grassroots level. You see people at the front line of everything. our people as a country appear to be getting sicker, worse, more unhealthy in every, every possible way.

Elisha Yaghmai

Right. So significant percentage of our country is morbidly obese. Yeah. Huge part of the reason it's not just so one is the food and what's in it, and the types of foods that are marketed and pushed. Right. but it's also, you know, people use food as a coping mechanism for all the other economic and social stressors they have in their life.

Elisha Yaghmai

Right? So all of these things are happening. And again, who does? let's just take morbid obesity, Margaret. Obesity, right, leads to all kinds of other health problems like high blood pressure, diabetes, right? You name it. Almost every health problem you can have is made worse, right, by carrying around excess weight. Yeah, a lot of people that are carrying around excess weight have economic and or psychological drivers for why that.

Elisha Yaghmai

Yeah. I'm sure you can talk about yeah. You should eat some fish and throw in a vegetable. I can't afford that. Right. Can afford it. So that's not happening. I mean the McDonald's, right. Yeah. This is what's going on.

Jo O’Hanlon

So started to say, yeah, I saw TikTok the other day of someone saying like, how often do you eat fruit? And like every day or every day like it's like it's like, yeah, you're you're supposed to eat fruit every day. And he's like, no, like once a week, like it's like. And then it comes and you know, it's like, who can afford fruit every day?

Elisha Yaghmai

That's the.

Jo O’Hanlon

Issue. Like, that's a piece of it for sure.

Elisha Yaghmai

It is. So with that context, the same people that are being afflicted by the sort of economic and social structures that are producing, healthiness, right? Or at least make people tend to become unhealthy, have the problem of once they get to that point of becoming formerly sick.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

What option they have none. Right? Right. Take another what mental health is a classic example. Right? So through all ages of everyone we see mental health has gotten worse across this country in the last just in the time I've been practicing, like it's just gotten worse and worse and worse. The young people now are like, what?

Jo O’Hanlon

What stats or things are you seeing that make you say, oh.

Elisha Yaghmai

Well, I mean, the most obvious one is no, just just suicide. The rate of suicide in young people has shot up in the last ten years. Right? But even for those who don't commit suicide, they can't tell you the number of kids we see now. They're teenagers, right? Coming in with serious problems with depression and anxiety. Right. Really serious that are really affecting their life.

Elisha Yaghmai

This was not a common thing 15, 20 years ago. It was not at that age for that age group. It was not I mean, it was something you saw intermittently, would occasionally see a suicidal teen. Right now it's like all the time, right? You would occasionally see a child that needed some kind of psychiatric help. Now it's a lot of the kids, right?

Elisha Yaghmai

We have. And then those psychological problems are manifesting in the form of various other maladaptive behaviors, be it drugs, alcohol, overeating, whatever else, it is, right, that are producing other additional physical problems. And then you say, okay, well, you you know what you need? You need therapy. You need to see a psychiatrist. Well, guess what? The psychiatrist is $250 an hour, right?

Elisha Yaghmai

Right. You know, the therapist is some ungodly amount of money. That 19 year old doesn't have that money, right? Right. So how are they going to actually be help with their problem? The answer is they're not right. They're not. How are they going to afford to take the meds that you prescribed for them? How are they going to manage the side effects for that?

Elisha Yaghmai

Who knows? Right. No one seems.

Jo O’Hanlon

To care for those meds. I mean, from people that I know that abuse them. It's like you have a time that like you're figuring it out. Yes. That's right many. It's not like one visits a psychiatrist. It's like that's many until you get your your dosage, right?

Elisha Yaghmai

That's correct. And has to be monitored. And you can monitor for side effects. And sometimes you have to make adjustments. Right. There's all these things. Right. So there's all these touches. You're going to have to have the system. But then fundamental of that or below that you ask what is going on. Right. I mean what is going on.

Elisha Yaghmai

This is even necessary in the first place. But let's say we don't know, you know, there's lots of theories, right? Because when we won't get into all that, it's just let's just say it's happening, right? Yeah. Okay, cool. It's happening. What structure do we have to help with that? It's a terrible one. Right. It's a to that.

Jo O’Hanlon

The mental health portion of health care, at least on just my layman's side of things, seems very separated from the rest of health care, too. And a lot of what I mean, aside from a psychiatrist, like in terms of therapists who are more accessible price point wise, sometimes, sometimes, and some people need to see both for the meds on one side and then therapy on the other.

Jo O’Hanlon

You know, it's like it's almost two different sectors. And like, you might not even find a therapist that's available that you like that you is on your insurance at all, even if you have insurance. Yes. So it's completely segregated. It's treated as if it's completely segregated. And it's obviously we know so much more now, but we're so integrated as human beings, right.

Elisha Yaghmai

But it is treated us. Yeah. Yes it is. And yet and yet it has the same fundamental problems. Right. Which is it's not affordable, it's not readily accessible. Right. And here again, so we can say, well, the psychiatrist, you know, cost too much money. Okay. What you have to think through something like what are you asking your psychiatrist to do?

Elisha Yaghmai

Okay. They have to have an hour long meeting with you to talk about whatever just uses as an example. then they got to write 30 more minutes about what all went on in their hour long conversation with you. What does that mean in an eight hour day? Right. They're spending a significant chunk of their day not seeing any patients.

Elisha Yaghmai

Right. So what does that mean in terms of how much they need to charge to make a competitive rate? Right? Right. And you could say, well, the rate is too high okay. Rates too high. the problem is that you don't want just anybody going into the field, right? You have to have some kind of you have to have some kind of standards to pass, right, to get into the field.

Elisha Yaghmai

But given what it is, not everybody is going to be able to do that in the first place. Right. So you could try to solve it by lowering those standards. Right. But then you're going to have some decrement in quality at some point. Right. Which you know, you know what I mean. Like gets to the point is not that, oh, I have this magical solution that's going to solve all this.

Elisha Yaghmai

Right. The point to understand is it's not just greed, right, that's driving everything. It's the way this whole thing has been constructed which forces certain behavior. Yeah. Which in turn forces additional behavior downstream. But the end solution is, man, we're in a bad situation, right? This situation is not going to work. Right. So you got rising mental health needs.

Elisha Yaghmai

You got to suddenly produce another 100,000 psychiatrist. No, that's not happening. Right. So you need to come up with a different way for that. You say I'm saying we need to ask what do we want? We want better mental health. Yeah. How are we going to get there.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

It's not by by continuing more of the same. Right, right. It's not that we know this system is breaking down and failing. It's not going to work. Now. We talked about mental health, but the same is true for diabetes and high blood pressure and heart disease and emphysema. And you know, you just every.

Jo O’Hanlon

Specialist.

Elisha Yaghmai

Everything everything is like this. Even our primary care. Right. We say what does our primary care have to do. Well because their reimbursements keep going down. Right. And again we talk about reimbursement. Doctors always focus on reimbursement. It's not it's not the reimbursement about it's again what are you asking of the doctor. Right. This this happened to me doing insurance.

Elisha Yaghmai

So if I'm seeing a certain number of patients a day right. I end up in the same situation that I was describing earlier in the hospital. Right. My choice, again, is kill myself or kill my patient. So, I see you and I order some tests, right? Okay, so the first thing is, did those tests I have to track.

Elisha Yaghmai

All because there's no unified system yet. So do some more to get some tests. Did those did you ever go, if you got those tests, were they done where the proper test done. Right. if the tests were done, did I get the result back? Yeah, right. Did I get it back in a timely manner? Right. You okay?

Elisha Yaghmai

Then I. Then I saw it, and now we need to do some more things right now that does that does that information communicated to you right. Yep. So did you follow through on it. Right. Yeah. So did that actually work.

Jo O’Hanlon

Right. And that's all assuming as for some of your former examples of like that, it was red right. Right along the way.

Elisha Yaghmai

That's right. That's assuming that, you know, if we did a CT scan it was even interpreted properly. Right? I mean, the lab was done and there was no error. That's assuming the technical stuff all works flawlessly, which is not true, right? It's not true. Right. So I have to do this. And now I have to do this for every single patient.

Elisha Yaghmai

What does that take? Because it's all a manual. They're all duct tape systems, right? They don't all talk to each other. You don't have a unified medical record I can access. Right. This is your stuff is here in here. And 14 other places all split up. So I and my staff have to invest an enormous amount of time just bird dogging stuff to find out.

Elisha Yaghmai

Oh, we made a referral. Did you ever. Did you ever get there? Did they do the scope? Yeah. So what do they find? Right. All of this stuff is going on. So it's time. And so the problem again is, is my time is being used on things that you don't need my time for.

Jo O’Hanlon

Right.

Elisha Yaghmai

Right. It's tracking. It's doing manual review and track down of information. You don't need an Indy for that right. You need a computer system. That's actually what you need. You need a unified software system for that. Right? But we don't do that. So instead what we do is we go to our primary care doctor. We say, you need to, you know, keep getting the reimbursements there for Medicare, you know, so we need you to see 35 people a day.

Elisha Yaghmai

Right. And then and then the patients are like, why does my doctor only spend five minutes with me?

Jo O’Hanlon

Right?

Elisha Yaghmai

Because they have to see 35 people a day. And then what you don't see is that after they finish the 35, they have to write a note. Yeah. How about all 35 of those encounters? Right, right. So they go home and they spend a many more hours writing. If they're doing their job properly, many more hours writing, they're writing about it or their alternative choices.

Elisha Yaghmai

Cut a bunch of corners, right? Slash this down to the absolute bare minimum, and just slap enough text on the thing to get paid right. Which is not the same as saying I did a good job medically, right? Do that right and just keep it moving, right? Yeah. So, you know, the guy who will describe them of course is very efficient, right?

Elisha Yaghmai

Because they crank through it and they crank out that work in hospitals and other clinics. I love that. Right, right. But the question is, are they doing a good job medically? I mean, there are a few people that can balance it. But for a lot of people, no, there's a contradiction between these things, right? Detail work is not usually fast.

Elisha Yaghmai

Right. So when you're working the systems that impede your ability to access the information that you need in the first place, right? So a lot of your work time is spent manually tracking down junk. Right. So this again right puts you back in an untenable situation. You have to grind yourself to dust, or you have to cut corners for your patients, or you have to do the other common complaint, right?

Elisha Yaghmai

My primary care doctor just always referred me out. They don't even listen to me. They just refer me out, right? Why are they doing that? Time?

Jo O’Hanlon

Yeah, time.

Elisha Yaghmai

They don't have time to pursue that. You know the order that 18 labs need to be done. They got to follow that up. And guess what? They don't want to follow that up because they got 37 other people that they need to do this on test today. Right. Not even for this week. For today. Right. They don't have time.

Elisha Yaghmai

But they tried to just like we tried to do this because we had cash pay patients. Right. What do you end up with? Yes. Every day you walk into a stack of paper. No joke. It's about that high. Yeah, right that you got to go through. And then as you're going through it more is coming in. Right? And then more is coming in and then more is coming in.

Elisha Yaghmai

Right. So you are being punished for trying to do the care the way it actually should be done. In the view of most of the physicians that were trying to deliver that. Right, right. All of it is a bad system. Yeah, it's bad system stacked on bad system stacked on bad system. And it perpetuates. It perpetuates because right now there are the most powerful parties in healthcare, have won this game.

Elisha Yaghmai

They're all benefiting in their own way. But the people, the users of the system, yeah, the people that deliver service in it and the people that receive service from it are for the most part losing. Yeah, over and over and over and over again. But no one cares in some fundamental way. No change is forthcoming to to fix a lot of these very fixable problems.

Jo O’Hanlon

Yeah. So do you feel like you're just throwing in the towel? It's been too much of of this losing battle of you. You finally feeling like you're putting up the white flag and being like, I got to try a different a different attack.

Elisha Yaghmai

Yes. Yeah. It's not it's not giving up on the things that need to be solved. Yeah. It is changing approach. this is actually one of the attempts at changing approach because my maybe on to.

Jo O’Hanlon

Podcast.

Elisha Yaghmai

This podcast I may be too optimistic, but my, my operating theory is that many people in this country, though they don't love the healthcare system and think it's too expensive, do not really understand how it works, why it works the way it does, and how they are being harmed by it or will be harmed by it in the future if they have not already been.

Elisha Yaghmai

So, yeah. and so I think so I would like to disseminate that knowledge to help people understand what is actually going on inside of it, in the hopes that that plus explanations of why it happens, not just what happens, but why it happens, may provoke the kind of thinking needed to create the revolution that we need. Yeah.

Elisha Yaghmai

You know, but because in the end, I am at this point pretty convinced we need we need a revolution of sorts. Yeah.

Jo O’Hanlon

I mean, you've you've continued to use the word systemic. And I think that's the appropriate phrase here. That's the appropriate definition of what we're up against in healthcare. Each of the examples you give, you're very clear along the way of saying, you know, this isn't just this isn't just one off like, this is happened here and here and here.

Jo O’Hanlon

And I can give you 100 examples. I'll point to the same systemic problem. And so, yeah, I mean, we see that throughout our society in a lot of places right now, I think we're finding it's like if you use that analogy of the house that you talked about, I, you know, there are many of our systems that are feeling like we're just holding them up.

Jo O’Hanlon

Yes, for no reason. And while it's crumbling, yes, like and yes, maybe we're being injured while it crumbles.

Elisha Yaghmai

They're being sustained for their own sake, right? They're being sustained for the sake of their existence rather than for the function that they were allegedly created to fulfill. In the case of the healthcare system, nothing was ever created. It just sort of sprang up over time. Right? You know, like weeds. And it was never organized into anything. It's just been sort of rhetoric has been retrofitted, basically.

Elisha Yaghmai

Right. Rather than rather than created with an intention.

Jo O’Hanlon

It's like a patchwork system that got institutionalized.

Elisha Yaghmai

That's correct. Yeah. Yeah, yeah. And now we just within the system, the people inside the system basically look at it so well as dysfunctional, we can't do anything about it. Right. It's just it just is how it is. Right. And that's maybe the most important thing out of this, right. For people to take. It's not gravity. It's not gravity.

Elisha Yaghmai

Humans created this system. It can be it can be unmade. Yeah. It can be completely thrown out and revised. We have the power to do it, what we actually do. But we need to unite behind understanding first what we want. Yeah. You know, and then get our act together and start organizing to create the change we want to see.

Jo O’Hanlon

So do you feel like that starts with awareness as well?

Elisha Yaghmai

I think so, yeah I'm here I think with a lot of issues. I mean think about the things that have changed positively in the society, right? Most of the time it started just first with awareness in the face of a lot of skepticism. Right? I don't know, everything is fine. Everything works. It's all proper. Right? It wasn't.

Jo O’Hanlon

Right.

Elisha Yaghmai

But we need people to understand that. Yeah, right. And then. Yeah, because the thing is, it's not like I have every perfect idea, right? My I make no claim to that. Right. But what I can tell you about of the problems and to some degree I can tell you about why the problems exists. Yeah. Now, what we need is the help of a lot of other people to look at the problem and say, oh, you know what?

Elisha Yaghmai

I have an idea, right? And I can tell you just in the microcosm, to give you an example, like we talked about how we got more cost effective telemedicine technology. Right. that was by cobbling together good ideas that people had had in other areas, right, to create a thing that solved the problem.

Jo O’Hanlon

I mean, yeah, that that stethoscope that you guys first used was already on the market not being used in this scenario, but perfect for it.

Elisha Yaghmai

It was right. This is the kind of thing right where it was created for a different purpose. But it happens to work. Right. And there are other there are other tools that really were the same. Right? They were each one was created like the creator was not necessarily thinking about the specific application of it. Right, right. But they had a good idea.

Elisha Yaghmai

They created a thing and you could pull it together. And there have been other areas, even when we were looking at things like the clinic or other other areas where some of our learning in terms of how to create a certain logistical or practical outcome was gained by looking at other industries. Yeah, we'd run into things where there wasn't a precedent for it in healthcare.

Elisha Yaghmai

It wasn't done right, or no one had really tried to do it. So we just looked at other industries and the other industry. But they solve this problem. 35 years ago. Yeah. So they would just say, well, let's just learn what they do and copy the tools, right? And bring it over here to solve the problem. So I think this is that kind of situation where we need the insight and ideas from many different people in many different fields may have nothing to do with health care.

Elisha Yaghmai

Right? But all that starts with understanding what is wrong. Yeah, why it's wrong. And then what do we actually what what would be better. Yeah. And then and then we can solve the how do we get from where we are now to what would be better.

Jo O’Hanlon

Yeah. And I think even before the, you know what is wrong like helping everybody understand how they're affected by this is a major part of it. Because like you said, whether they have vignette or not or I mean, there's been things that I've thought about as you've given different examples where I was just like, oh, that's probably what went on in this specific scenario that I was privy to, that we had no idea that that's what was happening in the background.

Jo O’Hanlon

And then you just, you know, keep us at a hospital for instead of transferring or things like that, but you know, that they may have already been affected by these issues. I guess I'm saying without even knowing it.

Elisha Yaghmai

The patients, I mean, I'll say this, the patients that I have seen killed or otherwise harmed in the healthcare system have come from all backgrounds and all walks of life is very democratic in that sense.

Jo O’Hanlon

Right?

Elisha Yaghmai

Well, anybody can be healthcare. Anybody could be armed any time in any place, you know, and a huge percentage of it will go by without any accountability or repercussion whatsoever.

Jo O’Hanlon

That's the piece, I think, for for where I'm sitting as a lay person, it's, you know, it can be daunting to think about the systemic change. But I do think that to speak to your thought of looking at other examples in other industries or just other spheres, you know, it's like there are things that seemed like they would never change.

Jo O’Hanlon

And then there's a moment and it's not really a moment. It's a build up in a build up, in a build up. And then there's a moment publicly that the pendulum swings and that all of a sudden there's awareness, there's accountability, and that accountability is what ultimately brings about change. Yeah. So that's where we're going. We're going to be expounding.

Jo O’Hanlon

You've heard so far examples from a larger story and his experience. But the next season we're going to be expounding on these topics and still looking at the cracks in the system. We'll be bringing in other voices and other stories that you can hear from others, their experiences and their insights into this. And together we continue to deal.

Jo O’Hanlon

First states phrase. We're still trying to find a better way.

Elisha Yaghmai

Yeah.

Jo O’Hanlon

So if you haven't subscribed, please do so. If you haven't seen the rest, you can feel free to catch up. We'll be having some content in between seasons that you can catch, so stay subscribed and following along and we'll see you back for season two.