>>> FORGET E.R., NURSE JACKIE AND GRAY'S ANATOMY AND FACE IT ST.

ELSEWHERE DOESN'T HAVE A PRAYER.

HI I'M JON SCHWANTES AND ME THIS IS INDIANA LAWMAKERS.

I'M NOT A DOCTOR AND I DON'T PLAY ONE ON IT HAVE BUT THIS WEEK'S SHOW PROMISES TO BE A MEDICAL THRILLER.

SPECIALISTS WILL COLLIDE OVER DIAGNOSIS, PROGNOSES AND TREATMENTS.

SOME WILL ARGUE THAT AGGRESSIVE MEASURES ARE NEEDED STAT WHILE OTHERWISE WARN OF UNTEAMEDDED CHEMICAL WEAPONSES THAT COULD PROVE FATAL.

THE PATIENTS IN QUESTION ARE EVERYDAY HOOSIERERS AND THEIR MALADY IS BACK BREAKING HEALTH CARE COSTS.

I INVITE YOU TO UNDERSTAND IN FOR SOME LEVEL ONE DRAMA.

INDIANA LAWMAKERS, FROM THE STATE HOUSE TO YOUR HOUSE.

IS IT >>> FRUSTRATED WE THE APPARENT FAILURE OF PAST ATTEMPTS TO CONTAIN HEALTH CARE COSTS INDIANA LAWMAKERS ARE WEIGHING VARIOUS POTENTIAL REMEDIES THIS SESSION.

WHAT I GUESS THE RIGHT APPROACH, AN INCREASED 'EM FA CITY ON PHARMACY EBBING PENSION MANAGEMENT?

THE PROMOTION OF PROVIDER COMPETITION, THE PENALTIES OF HOSPITALS THAT CHARGE MORE THAN THE NATIONAL AVERAGE OR SOMETHING ALL TOGETHER DIFFERENT?

WE'LL GET A SECOND OPINION AS WELL AS A FIRST, 30 CAN FOURTH FROM OUR KNOWLEDGEABLE AND OUTSPOKEN PANEL.

DEMOCRATIC SENATOR -- MICHAEL HICKS DISTINGUISHED PROFESSOR AND THE DIRECTOR OF THE CENTER FOR BUSINESS AND CAN ECONOMIC RESEARCH AT BALL STATE UNIVERSITY.

BRIAN TABOR PRESIDENT OF THE INDIANA HOSPITAL EXTENDED FORECAST AND MATT BELL FORMER STATE REPRESENTATIVE WHO NOW SERVES AS CHIEF POLICY ANALYST FOR HOOSIERS FOR EVER AFFORDABLE HEALTH CARE.

BUCKLE UP, THIS IS GOING TO BE A LIVELY DISCUSSION.

I KNOW THAT WE CAN AGREE THAT HOW WE GOT IN THIS SITUATION AS A STATE AND I'M SURE WE'RE NOT GOING TO AGREE WITH HOW TO GET OUT OF THE PREDICKMENT.

CAN WE AGREE ON WHERE WE ARE?

ARE WE AS SOME STUDIES SUGGEST PAYING A LOT MORE THAN OTHER FOLKS IN OTHER STATES?

>> ABSOLUTELY.

I DON'T THINK THERE'S ANY DOUBT, MY WORK, THE LEGISLATURE PAID FOR WE HAVE ACADEMIC WORK OUT OF HARVARD, PRINCETON, THE YALE THAT ALL SUGGEST WE'RE AMONG THE TOP NORTH AMERICAN TERMS OF COST PER PERSON AND THE INDIVIDUALS PRICES THAT WE'RE PAYING FOR AN INDIVIDUAL SERVICE, IT'S NOT THAT WE'RE BUYING A LOT OF HEALTH CARE WHICH WOULD BE AN ARGUMENT THAT THERE ARE SICKER PEEL HERE IN INDIANA IT'S THAT THE PRICES ARE AMONG THE HIGHEST AND WE HAVE THE HIGHEST PROPRIETIESED METRO AREA IN THE COUNTRY.

>>> AND SOME STATES, BECAUSE YOU WOULD ARGUE WE'RE NUMBER ONE, MAYBE HALF THE COST OF SOME PROCEDURES IN OUR NEIGHBORS TO THE NORTH IN MICHIGAN.

>> BUT EVEN WITHIN OUR STATE IF YOU GO FROM THE AREAA.

IN WHICH IS A PERFECT MONOPOLY, ALL THE HEALTH CARE FACILITIES ARE OWNED BY ONE PROVIDER AND IT'S $21,000 TO HAVE A NATURAL DELIVERY THERE, AND YOU CROSS THE BOARDER AND IT DROPS TO SIX OR $7,000 SO IT'S DRIVEN BY A MONOPOLY.

THAT'S THE PRIMARY COST PROBLEM.

THERE ARE OTHER ISSUES, WE'RE GOING TO HEAR THAT HOOSIERS ARE SICKER THAN OTHER FOLK, WE DON'T SPEND ENOUGH ON PUBLIC HEALTH AND WE'RE GOING TO HERE THERE ARE NOT ENOUGH INSURERS, NOT ENOUGH COMPETITION IN PHARMACIST.

ALL OF THOSE ARE PARTIALLY TRUE, THE BIGGEST PROBLEM IS MONOPOLY THAT MAYBE EVERYTHING SWIM DOWN TO SECOND ORDER.

>> YOU CAN MAKE OTHER ARGUMENTS AND KNOCK THEM DOWN.

I KNOW BRIAN TABOR IS GOING TO WANT TO GET IN ON THIS TOO BECAUSE YOU MAY QUIBBLE WITH THE NUMBERS BUT ASIDE FROM ALL THE DATA POINTS AND ALL THE UNIVERSITY RESEARCH, YOU AND YOUR COLLEAGUES IN THE GENERAL ASSEMBLY HAVE SOME POLLING DATA WHICH IS YOUR MAILBOX AND YOUR PHONE LINE.

ARE CONSTITUENTS FEELING A PINCH?

>> YES, CONSTITUENTS ARE SAYING THEY DON'T UNDERSTAND THE -- HOW YOU ARRIVE AT THE COST, WE HAVE MADE SOME PROVISIONS WITH SOME TRANSPARENCY, WHERE THERE ARE SOME GOOD FAITH EFFORTS THAT ONCE ESTIMATES THAT HOSPITALS MAKE THAT WILL HELP CONSUMERS, SUPPOSEDLY HELP CONSUMERS MAYBE BETTER HEALTH CARE CHOICES BUT I'M NOT SURE HOW CLEAR THAT IS AND -- >> THAT WAS DONE BACK IN 2020.

>> THAT WAS DONE IN 2020 AND I THINK THAT WAS A CMS REQUIREMENT BUT I'M NOT SURE HOW IT FACTORS INTO THE DECISION MAKING AND HOW HEALTH CARE COSTS ARE ARRIVED AT HERE IN OUR STATE.

AND I'LL LET YOU ASK YOUR QUESTION BEFORE I GO BACK AND FORTH.

I DO AGREE WITH PROFESSOR HICKS THAT ALL THE STUDIES DO INDICATE THAT THE COST OF HEALTH CARE IN INDIANA IN TERMS OF WHAT WE PAY IS TOO HIGH, BUT I HAVE TO SAY IS THAT IS IT ALL BECAUSE OF MARKET CONCENTRATION AND ACQUISITIONS OF HOSPITALS OR DOES IT HAVE TO DO WITH THE H. OF HOOSIERS AND OUR PER CAPITA SPEND ON HOOSIERS AND PHARMACIES AND A WHOLE HOST OF OTHER FACTORS.

>> AND BRIAN TABOR FROM THE MOM ASSOCIATION, I'M GET MING ALL THE AMMUNITION ON THE TABLE, BUT AT THE RISK OF PILING ON HERE YOU REPRESENT HOOSIERS FOR AFFORDABLE CARE, REPUBLICANS HO TYPICALLY LEAVE THE MARKETPLACE TO ITSELF BUT A LOT OF STATISTIC THAT YOU AND YOUR ORGANIZATION PUT FORTH, ONE THAT CAUGHT MY ATTENDANCE, IF HOSPITALS SIMPLY WENT TO THE NATIONAL AVERAGE THAT HOOSIERS FAMILIES WOULD SAVE 2,500-DOLLARS YEAR?

>> AND THAT'S MEANINGFUL AND THAT'S WHAT MAKES THE SITUATION TODAY SO UNTENABLE FOR THE THE CONSTITUENTS AND HOOSIERS ACROSS COMMUNITIES ALL OVER THE STATE.

THERE WILL BE AN UNANIMOUS RELEASED THIS WEEKEND THAT SHOWS THAT IF WE LOWERED THE PRICE TO THE NATIONAL AVERAGE WE WOULD SAVE TWO BILLION DOLLARS A YEAR AND E-THAT WOULD RECOMMEND $1.65 BILLION WORTH OF SAVINGS.

THAT WOULD STILL LEAVE OUR HOSPITAL TWICE AS PROFITABLE AS NOT FOR PROFIT HOSPITALS ACROSS THE COUNTRY.

TO BILLION DOLLARS GOING BACK INTO THE POCKETS OF HOOSIER EMPLOYERS, HOOSIER POLICY MAKERS AND ALLOWS THEM TO MAKE BETTER DECISIONS.

>> I'M GUESSING THERE IS A LOT HERE TO BUTTH PUT FORTH THAT YOU WOULD QUIBBLE WITH.

LET'S START WITH THE DATA, IS THAT FAIR DATA OR DO YOU THINK THIS IS OLD DATA THAT CAN'T BE TRUSTED IN DO YOU AGREE THIS IS AN EXPENSIVE PLACE TO GET HEALTH CARE?

>> I THINK WHAT I WOULD SAY FIRST IS HEALTH CARE AFFORDABILITY IS SERIOUS ISSUE FOR HOOSIERS AND IT'S A SERIOUS ISSUE ACROSS THE COUNTRY AND OUR MESH ARE COMMITTED TO ADDRESSING IT.

WE'VE SEEN SIGNIFICANT.

NOWS FROM SOME OF OUR HEALTH SYSTEMS, TAKING MAJOR STEPS TOWARDS AFFORDABLE.

>> U HEALTH WHICH IS UNDER PRESSURE FROM THE HOUSE SPEAK HERB SAID THEY WOULD FREEZE THEM AT THEIR CURRENT LEVELS THROUGH 2025 BUT THEY WOULD ARGUE -- I'M GOING TO LET YOU TALK, REALLY.

>> I NEED TO ADDRESS -- ONE TO HAVE EXAMPLES THAT DR. HICKS GAVE IS A VERY OUT DATAD EXAMPLE AND IT'S ONE OF THE THINGS WHERE I DO FEEL THAT WE HAVE TO STOP CONFLATING SOME OF WHICH I THINK IS SOMETIME INTENTIONAL SOME OF THE RESULTS OF SOMETHING LIKE A RAND STUDY THAT LOOKS AT UNIT PRICE AND WHETHER OR NOT INDIANA IS AN OUTLIER IN HEALTH CARE COSTS.

SOME OF THE SAME STUDIES SHOW THE -- QUOTING THE ONE FROM THE IS IT GENERAL ASSEMBLY THAT IF YOU LOOK AT COMMERCIAL HEALTH SPENDING IN INDIANA COMPAREDDED IT HAD REST OF THE COUNTRY WE ARE AROUND THE NATIONAL AVERAGE.

BELOW OTHER NEIGHBORING STATES.

THE BERKELEY CENTER STUDY SAYS THE SAME THING.

WE CAN LOOK AT THE PREMIUMS PAID BY EMPLOYERS, THEY ARE CLOSE TO THE NATIONAL AVERAGE IN SOME CASES BELOW AND RIGHT AROUND OUR NEIGHBOR STATES.

SO WHAT WE HAVE TO DO IS TALK ABOUT A MORE HOLISTIC VIEW OF THE TOTAL SPEND, YOU CAN'T LOOK AT A PRICING STUDY AND SAY THAT MEANS THAT INDIANA'S HEALTH CARE EXPENDITURES OP A PER PERSON BASIS ARE ON OUTLIER BECAUSE THEY'RE NOT.

>> THE DATA THAT ARE ON THE TABLE YOU WOULD QUIBBLE WITH THAT?

>> I THINK THE DATA IS USE INSIDE A WAY TO AVERAGES AN AGENDA BUT I WILL NOT -- ABSOLUTELY ACKNOWLEDGE THAT HEALTH CARE SPENDING OVER ALL IS AN ISSUE THAT WE HAVE TO TACKLE AS A STATE AND AS A COUNTRY AND OUR MESHES ARE AT THE TABLE RIGHT NOW WITH THE GENERAL ASSEMBLY SAYING WE WANT TO DO OUR PART BUT IT NEEDS TO BE A HOLISTIC SOLUTION THAT INCLUDES PHARMACY, THAT INCLUDES INVESTING IN PUBLIC HEALTH.

>>> MICHAEL HICKS I READ THAT YOU SUGGEST THIS VERY NOTION THAT THIS IS A COMPLEX PROPOSITION, YOU HAVE TO HAVE A LOT OF MENTAL CAPACITY -- YOU SAID IT'S REALLY AS SIMPLE AS BUYING A CAR OR TVMENT IS THAT AN EXAGGERATION.

>> THE TRANSPARENCY OF ACTIVITIES IS A SHAM ARGUMENT SO THE A HOME WANTS YOU TO KNOW HOW MUCH IT COSTS TO HAVE A KNEE REPLACEMENT THEY WOULD HAVE A SIGN THERE JUST LIKE THEY DO IN THE COFFEE SHOP OR THEIR GIFT SHOP.

THE FACT IS THAT HAVING A KNEE REPLACE.

IN INDIANA MAYBE REQUIRES A THOUSAND DIFFERENT COMPONENT PARTS, THE ARTIFICIAL KNEE MADE TO THING THE IN PUT AND WE DON'T KNOW HOUGH THAT COSTS, I KNOW NO HOOSIER -- I ASK PEOPLE ALL THE TIME HAVE YOU BEEN TO THE TO THE TRANSPARENCY PORTAL?

WHERE IS THAT?

IF YOU WALK IN TO BUY A CAR YOU SAY HOW MUCH IS THAT HONDA CIVIC?

THEY TELL YOU THEY HAVE A THOUSAND PARTS THAT COME FROM DIFFERENT COUNTRIES, THEY DO IN A DENTAL OFFICE.

WHY?

BECAUSE THEY DON'T HAVE THE COINSURANCE, SO THIS IS PART OF THE ANTICOMPETITIVE PROBLEM THAT WE DON'T KNOW WHAT PRICES ARE AND I SAY THE DATA ARE UNAMBIGUOUS, WE KNOW HOW MUCH PEOPLE SPEND IN INDIANA.

THE PRICES -- HE'S NEVER GOING TO LIKE THE RAND STUDY, YOU CAN HAVE THAT DATA FOR YOU TOMORROW.

YOUR HOSPITALS ARE DOING PRICING ANALYSIS ON A WEEKLY OR MONTH LIMIEST TO SAY IF THEY'RE ABOVE OR BELOW WHERE THEY NEED TO BE IN TERMS OF PATIENT LOAD.

>>> SO INDIANA HAS BEEN ACKNOWLEDGED AS BEING ONE OF THE MOST TRANSITION TEAM TRANSPARENT STATES WHEN IT COMES TO PRICING.

THE GOOD WORK THE GENERAL ASSEMBLY DID IN 2020 IS HAVING AN IMPACT PACT.

>> SO YOUR SAYING THE DATA IS THERE IF PEOPLE AVAIL THEMSELVES TO IT.

>> YES, AND WE'RE STARTING TO SEE THAT COME OUT FROM THE INSURANCE COMPANIES AND THEY'VE BEEN A BIT SLOWER TO PUBLISH THEIR DATA BUT THERE ARE SOME FUNDAMENTAL DIFFERENCES IN THE HEALTH CARE.

AS AN ECONOMIST I WOULD THINK THAT DR. HICKS WOULD UNDERSTAND THE DIFFERENCE BETWEEN A PRODUCT AND A SERVICE.

THERE ARE SOME ELEMENTS OF SHOPPABLE HEALTH CARE WHICH FOR RIGHT NOW INDIVIDUALS CAN GET EASILY, IMAGING SERVICES AND OTHERS BUT I HAVE AN INDIVIDUAL IN MY FAMILY THAT HAS A SERIOUS MEDICAL CONDITION AND GOING THROUGH THAT RIGHT NOW AS A PATIENT.

AND IT'S BEEN COMPLEX, IT'S BEEN REALLY A JOURNEY IN HEALTH CARE, EACH INDIVIDUAL IS DIFFERENT.

HUMAN BEINGS ARE NOT TELEVISIONS OR CARS SO WHEN IT COMES TO HEALTH CARE THERE ARE SOME INTRINSIC DIFFERENCES ABOUT IT THAT DO MAKE IT SOMEWHAT DIFFERENT, BUT THAT BEING SAID HOSPITALS ARE ESSENTIALLY FULLY CLIMATE WITH THOSE RULES.

WE WORK WITH PATIENTS EVERY DAY TO GIVE THEM GOOD FAITH ESTIMATES OF WHAT THEIR CARE WILL BE AND WE HAVE A GOOD TRACK RECORD WHEN IT COMES TO TRANSPARENCY.

>> IF THOSE DATA DO EXIST HOW MUCH OF THE BURDEN FALLS ON THE CONSUMER WHO SAYS I HAVE EMPLOYER PROVIDED HEALTH INSURANCE, IDENTIFY MET MY DEDUCTIBLE SO IT'S A WASH TO ME, IT'S FREE.

HOW MUCH OF THE BURDEN RESIDES WITH THE CONSUMER?

>> THE GOOD NEWS THAT IT'S EASIER FOR HOOSIERS TO FIND OUT HOW HIGH PRIES ARE, AND THAT'S THE DATA.

TO DR. HICK'S POINT THEY DO TAKE ADVANTAGE OF THE TRANSITION TEAM PORTAL.

HEALTH CARE AND HOSPITAL CARE IS NOT A FREE MARKET.

IT COMPLAINT BE BECAUSE OF THE PRESENCE OF A THIRD PARTY PAYER IN THE THE MIX.

IT'S DIFFICULT AND I THINK BUSINESS SHOULD BE HELD TO ACCOUNT BECAUSE THEY HAVE NOT INSISTED ON MORE AGGRESSIVE WORK TO KEEP COSTS IN LINE.

>> WE'RE DENYING ACCESS TO THAT, THERE ARE GAG RULES -- >> NO QUESTION, THEY WERE TALK ABOUT TAKEN CARE OF IN TOT.

BUT TAKE A LOOK AT OUR SYSTEM THIS INDIANA, 60 PERCENT OF HOOSIERS LIVE WITHIN AN HOUR OF A HEALTH CARE FACILITY.

THEIR PROFITS DEPEND ONLY EACH OTHER.

WHO IS IS GOING TO POSSIBLY NEGOTIABILITY FOR LOWER RATINGS FOR A PATIENT WHEN THOSE TO PROBATIVE VALUE TO THE BASED ON HIGHER PRICES?

>> CODEPENDENT, BUT WHAT ABOUT THIS SENATOR?

END UNANIMOUS IS FLUSH WITH HOSPITALS.

BUT THERE ARE 17 I THINK OF 92 COUNTIES THAT DON'T HAVE ANY HOSPITALS.

HOW REALISTIC -- WITH ALL THE TRANSITION TEAM THAT MAY OR MAY NOT BE THERE, THAT THE THE SOLUTION OR IS THAT JUST MANDATING -- >> TO ME I THINK THE TRANSITION TEAM HELPS WITH THE NEGOTIATION BETWEEN THE SNARIERER AND THE HOSPITAL -- I THANK YOU THINK THAT TRANSPARENCY LIEUS THEM DURING THE NEGOTIATION TO KNOW WHAT THE THE PRICES ARE AND TO BE ABLE TO NEGOTIATE BETTER CONTRACTS.

NOW, I DON'T KNOW THAT CONSUMERS HAVE AVAILED THEMSELVES OF WHAT'S OUT THERE, THE INFORMATION THAT'S OUT THERE OR HOW TO USE IT AND THAT'S PROBABLY OUR FAULT IN THAT WE'VE NOT MARKETED IT ENOUGH TO EDUCATE FOLKS THAT THERE IS INFORMATION OUT THERE, THERE ARE -- YOU CAN ASK FOR AN ESTIMATE AND RECEIVE AN ESTIMATE BEFORE YOUR PROCEDURE, SO I THINK THAT THERE ARE WAYS THAT WE CAN PERHAPS BOOST THAT BUT MY CONCERN TRYING TO GET THERE BUT MY CONCERN IS WHAT YOU SAID, WE'RE FLUSH HERE IN MARION COUNTY WITH HOSPITALS THAT ARE COMPETITIVE AND I THINK THAT'S IMPORTANT BUT I THINK IN RURAL COMMUNITIES AND THEY HAVE 100 PERCENT OF THE MARKET, THAT MAKES SENSE BECAUSE COMMUNITY RURAL COMMUNITIES CAN'T SUSTAIN A NETWORK OF HOSPITALS >>> YOU'VE SUGGESTED THE LEGISLATION ENACTED THREE YEARS HAND HAD TIME TO TAKE AFFECT, THE TRANSPARENCY MEASURES ARE GOING TO PRODUCE RESULTS, IS THAT WHAT YOU'RE SAYING?

GIVEN TIME.

>> I DO DISAGREE WITH ONE OF THE POINTS THAT MR. BELL MADE ABOUT -- >> GO AHEAD.

>>> NO, ACTUALLY I AGREE THAT THERE NEED IT IS TO BE MORE ACCOUNTABILITY FOR INSURERS AND I THINK EMPLOYERS NEED TO DEMAND THAT, I THINK GETTING EMPLOYERS INVOLVED WITH HOW THEY PRESSURE HEALTH CARE.

OUR MEMBERS ARE EAGER TO WORK WITH EMPLOYERS AND WORK AROUND THE INSURERS IN MANY CASES, BUT THE -- MR. BELL'S CLIENTS ORIGINALLY SAID WE NEED TRANSPARENCY BECAUSE THAT IS GOING TO UNLEASH THE FREE MARKET.

THERE'S BEEN A SHIFT TO SAY THE FREE MARKET WOULD NEVER WORK TO WE HAVE TO NOT LET TRANSPARENCY WORK AND MOVE TO MORE HEAVY HANDED MEASURES BUT WHAT I FIND INTERESTING IS ONE OF THE CONSULTANTS FOR MR. BELL'S CLIENT WHO DUCHESS OF DEVELOPED THE EARLY POLICY PROPOSALS FOR THE GROUP NOTEED THAT PRICE TRANSPARENCY COMING FROM RAND AND OTHER DIRECTIONS, THE PRICE TRANSPARENCY DROVE NEGOTIATIONS IN FORT WAYNE BETWEEN PARK VIEW HOLT AND ANTHEM CAN THAT RESULTED IN BOTH SIDES FROM ACKNOWLEDGED HUNDREDS OF DOLLARS IN SAVINGS.

THAT HAPPENED IN 2020 SO YES THE RAND STUDY, THEIR DATA IS AS OLD AS 2018.

IT DOES NOT TAKE THAT GOO ACCOUNT, SO WE SEE PEOPLE THAT ARE ADVISERS TO HOOSIERS FOR AFFORDABLE HEALTH CARE SAY THIS IS WORKING THIS THE MARKET,% AND SO I THINK WE HAVE EVIDENCE OF IS THAT THAT DEMONSTRATES THAT WE SHOULD NOT ACT RATIONALLY% AND WE SHOULD EMBRACE TRANSITION TEAM.

>> I WANT TO MAKE SURE -- WE CAN GET UNDOUBTEDLY HUNG UP ON ANY OF THESE POINTS BUT I WANT TO MAKE SURE WE ADDRESS THE OTHER PROPOSALS OR SUGGESTED REMEDIES IN ADDITION TO TRANSPARENCY.

LET'S TALK ABOUT THE NOTION OF MONOPOLY, YOU'RE NOT SHY WITH YOUR PROCEED IN COLUMN, YOU COMPARE THESE FOLKS TO ROBBER BARRENS DURING THE GUILTED AGE AND JOHN ROCKEFELLER SO TALK ABOUT WHAT NEEDS TO HAPPEN.

WE'RE TALKING ABOUT THE NOTION THAT THE PHYSICIANS CAN'T BE FORCED INTO NON-COMPETE AGREEMENTS WHAT TIME DO YOU WARRANT TOSS HAPPEN TO BREAK THIS UP?

>> WE RANGE FROM MONOPOLIES THE U.S. DEPARTMENT OF JUSTICE SAY SHOULD HAVE NEVER GOTTEN THERE IF WE ENFORCED ANTITRUST LAWS SO WE'RE TALKING ABOUT ROBBER BARRON, THE HEALTH CARE SITUATION IS STANDARD OF N. 1911 THEY BROUGHT ALL THEIR UPSTREAM PROVIDERS SO IU HEALTH IS BUYING PHYSICIAN OFFICES AND DOWN STREAM WHERE THEY'RE BUYING CLINIC, AND IN MY MARKET THEY BOUGHT THREE HOSPITALS IN CENTRAL INDIANA.

I KNOW THE HOSPITAL ASSOCIATION -- THE FEDERAL GOVERNMENT AGREED SO THE POINT IS THIS MONOPOLY POWER MEANS THAT EVEN IF YOU HAVE MULTIPLE INSURERS THEY'RE GOING TO PRICE WHAT THEY WANT.

SO SOME OF THE THINGS THIS LEGISLATURE IS SUGGESTING WOW DECOUPLE THEM.

LET'S ELIMINATE THE NON-COMPETE COMPETE.

>> SET UP THEIR OWN TESTING LASHES FOR INSTANCE.

>> YOU CAN'T GO TO A PHYSICIAN IN MY SMALL TOWN AND GO TOOTS PHYSICIAN BECAUSE IT'S IMPOSSIBLE TO FIND A NON- -- >> DO AWAY WITH THE NOTION THAT REFERRALS HAVE TO GO INTO CERTAIN NETWORKS, AGAIN IT'S ANOTHER OPTION WOULD BE DOING AWAY WITH FACILITY FEES WHICH -- SENATOR IF YOU COULD PICK ANY OF THESE WHAT'S THE SILVER BULLET?

IS IT PHARMACY COST TRANSPARENCY?

.

>> I'M GOING TO SAY IT'S A HOLISTIC VIEW OF THE SYSTEM AND I THINK WE ATTACK INDIVIDUAL ONES -- THE NON-COMPETE FOR EXAMPLE, PRESUME MRI THAT'S GOING TO LOWER HEALTH CARE COSTS BECAUSE YOU HAVE DOCTORS DON'T HAVE TO MIGHT HAVE OUT OF OUT OF STATE BUT I'M THINKING IT WILL RESULT IN HIGH HER PROCESSES BECAUSE THERE WILL BE MORE COMPETITION AND THAT'S GOING TO RESULT IN THE HIGHEST BIDDER WHICH RAISES COSTS >>> WE'RE GET GET TO -- WE'RE RUNNING OUT OF.

>> I DISAGREE WITH THAT.

I THINK THEY ESTIMATED IT WOULD SAVE 140 BILLION-DOLLAR A YEAR IN HEALTH CARE COSTS ACROSS THE COUNTRY.

THAT'S THE BIDEN ADMINISTRATION 'S ESTIMATION.

EIGHT TO TEN MONTHS AND THAT'S BECAUSE PHYSICIANS HAVE BEEN UNHAPPY, THEY HAVE LEFT THAT COMMUNITY AND BECAUSE OF THE STRUCTURE OF THEIR NON-COMPETE THEIR OPTION IS TO MOVE OUT OF THE STATE.

WE NEED MORE ACCESS, IT'S A QUESTION OF ACCESS.

BUT I WILL TELL YOU WHAT, NOTHING IS GOING TO FIX -- TRANSPARENCY CAN'T FIX THIS PROBLEM.

THE IBJ RAN AN ARTICLE THAT LISTED THE 11 MOST EXPENSIVE CONSTRUCTION PROJECTS, THESE OF THOSE WERE IU HEALTH PROJECTS.

>>> SO IT'S INTERESTING, ONE OF THE -- WE TALKED ABOUT DR. HICKS TALKED ABOUT VERTICAL INTEGRATION AND NON-COMPETES AND THIS IDEA IT'S GOING TO ADDRESS THE PHYSICIAN SHORTAGE.

I THINK AS AN ECONOMIST YOU WOULD ACKNOWLEDGE THAT MARKET INCENTIVES ARE ULTIMATELY HA DRIVE OUTCOMES.

THERE'S A LOT OF TALK ABOUT THE RAND STUDY, VERY LITTLE TALK ABOUT WHAT THE RAND STUDY SHOWED AND HOW PHYSICIANS ARE PAID BY INSURANCE COMPANIES?

INDIANA, INDIANA IS A DIFFICULT STATE TO RECRUIT PHYSICIANS HERE, WE DON'T HAVE MOUNTAINS, WE DON'T HAVE BEACHES, FOURTH LOWEST IN THE NATION, SO THE INSURANCE COMPANIES CREATED AN ENVIRONMENT WHERE IT IS ALMOST IMPOSSIBLE FOR AN INDEPENDENT PHYSICIAN AND THEY SUGGEST THAT THEY GO IN OVERNIGHT AND CAPTURE THE RURAL HOSPITALS.

BEING PART OF THE SYSTEM ALLOWS THEM TO SURVIVE AND IT'S THE SAME THING FOR THE PHYSICIANS AND THEY ASK TO BE EMPLOYED BY THE HOSPITAL AND WHEN YOU LOOK AT VERTICAL INTEGRATION, 60,000 DOCTORS, SIX PERCENT OF THE NATIONAL PHYSICIANS SO IF WE WANT TO HELP PHYSICIANS WE NEED TO HOLD INSURANCE COMPANIES ACCOUNTABLE TO PAY THEM FAIRLY.

>> YOU MAY HAVE GOTTEN TO TALK LAST WEEK, BUT YOU DID GET TO TALK LAST.

WE'RE OUT OF TIME BECAUSE WE LAIR BARELY SCRATCHED THE SURFACE.

THANK YOU ALL VERY MUCH.

I APPRECIATE THE NOT ONLY YOU BROUGHT TO THIS AND THE YOU BE PASSION AND MY GUESTS HAVE BEEN DEMOCRATIC SENATOR JEAN BREAUX, BRIAN TABOR OF THE INDIANA HOSPITAL ASSOCIATION AND MATT BELL HEALTH CARE.

AND TIME FOR OUR WEEKLY CONVERSATION WITH ED FEIGENBAUM, PART OF HANNAH NEWS SERVICE.

ED LET'S TALK ABOUT THE POLITICS.

WE HAVE RESEARCHES FIGHTING RESEARCHES, A DEMOCRAT IN THE MIDDLE, EXPLAIN THIS TO ME.

>> THERE'S POLITICS INVOLVED IN HEALTH CARE?

WHAT'S INTERESTING ABOUT THIS JOHN, THEY WENT TO THE HOSPITALS IS A YEAR AGO AND SAID YOUR COSTS ARE WAY TOO HIGH, YOU NEED TO DO SOMETHING OR WE'RE GOING TO INTERVENE, AND NOBODY TOOK THEM SERIOUSLY WITH THAT FIRST LETTER -- THEY WANTED A RESPONSE IMMEDIATELY AND THERE WERE ONLY A COUPLE OF HOSPITAL SYSTEMS IS THAT RESPONDED AND THEY THOUGHT THEY WERE A LITTLE PATRONIZING AND THE HOUSE REPUBLICAN CONFERENCE AGENDA BILL WAS A COST CONTAINMENT BILL SO -- THEY WERE SERIOUS ABOUT THINGS AND WE'RE SEEING HOSPITALS RESPOND THAT IT WAS -- >> LIKE $416 MILLION BUT I GUESS IT'S ALL RELATIVE, SO HOW DOES THAT PLAY -- WE CAN'T ASSUME THAT JUST BECAUSE THERE'S A SUPER MAJORITY OF REPUBLICANS IT'S NOT THAT SIMPLE.

RURAL HOSPITALS WILL BE HIT THE HARDEST BUT WHERE DOES THIS GO THIS SESSION?

>> THIS SESSION PROBABLY NOWHERE, BUT EVEN THOUGH YOU WOULD THINK IT WOULD BE IT'S NOT SOMETHING THAT'S ALL THAT SAIL SALIENT TO THE HOOSIER POPULACE.

AND IF EVEN IF THEY DID THERE ARE OTHERS TO PICK UP THE SLACK.

>> INDIANA SCHOOL VOUCHER PROGRAMMED STARTS TO HELP UNDERPRIVILEGED KIDS GET A QUALITY EDUCATION.

IT'S A LESSON WE'LL DISCUSS ON THE NEXT INDIANA LAWMAKERS OF.

UNTIL NEXT WEEK, THE TAKE CARE