How to Actually Fix US Healthcare: HSAs, Price Transparency & Real Market Signals | Crom Carmichael

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Episode Summary

Investor and startup expert Crom Carmichael presents practical solutions to fix the US healthcare system through Health Savings Accounts, price transparency, and real market signals that empower consumers and drive competition. With experience investing in 60+ startups, Crom brings a fresh perspective to healthcare reform, focusing on consumer choice, competition, and market-based solutions that can actually work in practice.

Key Topics: healthcare reform, HSAs, price transparency, market signals, health insurance, medical costs, consumer choice, competition, Crom Carmichael, healthcare policy

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Table of Contents

• Introduction and Guest Background
• Healthcare System Problems
• Health Savings Accounts (HSAs)
• Price Transparency Solutions
• Market Signals and Competition
• Consumer Empowerment
• Practical Implementation
• Conclusion and Call to Action

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Introduction and Guest Background

Crom Carmichael

Evan Meyer: [00:00:00] Hey everyone, I am excited to introduce Crom Carmichael today, a investor in 60 plus startups. The producer of the Giants of Political Thought audio program, and he has his own podcast from our generation that he just had another episode today and with some overlap around the government shutdown issue.

Evan Meyer: I'm excited to chat about that. And much more cram. How are you, sir?

Crom Carmichael: Fine, Evan, how are you?

Evan Meyer: I'm well. I am well. Tell me about what's going on here. We, we were just chatting beforehand and we're talking about this interesting overlap between your podcast and the government shutdown that's you were talking about today. Why don't we, why don't we chat about that a little bit?

Crom Carmichael: Happy to do so, Evan. Just, you know, kind of to give your audience a, a bit of a frame of reference. I'm 77 years old and, and, and, and so I've spent a lot of time during my life kind of observing things, thinking about things, and trying [00:01:00] to, trying to come up with some, some ideas and, and and principles that I can, that help guide, guide me in my thinking. there are three ways that people learn. one way is they learn from personal experiences. Another is they learn from observations of things going on around them or in real time. And then the other is they learn from history. And so, so for me my, my political thinking goes all the way back into the seventies from personal experience because the first election that I voted in was 1972. And and that was when I voted I, I voted against. George McGovern. 'cause I didn't think he would be a very good president. so when I look at the evolution of politics and I look at the economy and how it's evolved in that, in the last 50 years, it's, it's quite extraordinary. There was a Nobel Prize that was awarded in economics just a few days ago. And and to me they were awarded, [00:02:00] they were awarded the Nobel Prize for proving the obvious. And and, and, and that sounds kind of strange, but what they said was, they said, innovation is a requirement for increasing prosperity. you must have consistent innovation if you're going to have a consistent increase in the rise of prosperity. And then they went on to say that innovation can only take place in a, in a practical way. If, if, if the, if, if, if the society that you live in protects intellectual property. 'cause they said historically, they pointed out, they pointed out that Leonardo da Vinci invented the helicopter back in the 15 hundreds, but there wasn't the material to make it.

Crom Carmichael: But if, but the helicopters that fly today was actually Leonardo da Vinci kind of penciled it out and and it, and it, it, it was, it's a, it's amazing.

Evan Meyer: If, if, if only he [00:03:00] had, if only he had the, the ability to create that intellectual property.

Crom Carmichael: Well, the, if he had the ability to create it, then you had materials. Yo

Healthcare System Problems

u have engineers, you have many, many things. But, but it's just an interesting thing that ideas can be so old, yet

Evan Meyer: Yeah.

Crom Carmichael: not go anywhere. And so, so at any rate, so when I, so, so the Nobel Prize says you have to have intellectual property, you have to have free markets. And you have to have, and, and innovation, they went on to say innovation is, is inherently destructive of old ways that are less efficient. that's a key point here. They, that innovation is in, is inherently destructive of old, less efficient ways of doing things. And that that is the nature of progress. having said that, here we have a government shutdown. The government shutdown, the argument is that the Democrats, not want to allow the government to [00:04:00] operate on a continuing resolution unless Republicans will agree to essentially one and a half trillion dollars of additional spending on healthcare that would include illegal immigrants. Now, the, the the Es the question of illegal immigrants is a separate question to me than the economic question. The economic question is, do we want to spend more money on a healthcare system where, where we already spend an average, an average of $15,000 per person, that's $60,000 per family of four. And so when when you say that and you ask you, you ask the typical family of of, of two or three or four, five people, you say, how much money do you spend on healthcare a year? The typical answer will be, oh, maybe one or $2,000. And so then the question is, well, where does the 60,000 go? And the answer is, two thirds of our healthcare [00:05:00] system is paying for the payment system. It's paying for insurance, it's paying for the insurance companies, negotiating the prices, and then managing every single expenditure in the healthcare system before reimbursing the provider. And so what you have is a system that is unnatural and it, and it is inherently inefficient. And so if you continue to spend, if you put more money into it and more money into it, all you do is you increase the resistance to change, because then the beneficiaries of the inefficiency form their own special interest group. And so that's where you are. That's where we are today. And

Evan Meyer: So, so.

Crom Carmichael: reform is probably the greatest area of, of the, to improve our economy. But here's what's interesting. Most people will argue, well, our healthcare system, while it may [00:06:00] be funded by the government, it's a quote free market system, they'll say it's, it's privately owned. And it is true that, that most of the providers are privately owned. That is true, to argue that it's a free market system is incorrect for there to be free markets, there has to be, there has to be price transparency, and there has to be competition. And once you sign up to a particular plan, all the competition goes away and, and you never know the price of healthcare. Before you consume the healthcare then you're not even part of

Health Savings Accounts (HSAs)

the bargain. insurance company or the, or the government. I just have my granddaughter walk in. I'm, I'm a little busy. Could you? Thank you. That was my 3-year-old granddaughter. I have a

Evan Meyer: Hello.

Crom Carmichael: I have a new baby came last night named Reynolds and

Evan Meyer: Oh,

Crom Carmichael: and so and so we are babysitting my two granddaughters

Evan Meyer: [00:07:00] Congratulations.

Crom Carmichael: Thank you very much. I appreciate it.

Evan Meyer: That's wonderful. You must be so excited. No. Hey, that's a, that's a natural, exciting interruption. Well look, let me, let me sort of.

Crom Carmichael: Sure. Push back on that.

Evan Meyer: A couple. Yeah. Well, I don't know if I'll push back, but I'll ask a few questions that, that, that, that may get us somewhere in the solutions part of this potentially, you know, part of any system when you give money to is, are you, are you actually just providing more water in a leaky pool?

Evan Meyer: Right. I, I, I don't know. Any system can be argued that the more. You put into it if the, if there's a leak, it's just gonna drain out and depending on how big that leak is, right? So I mean, every, every NGO has some administrative cost. For example, the government is, you could say it's, cause any, anything it focuses on in, in general, any, cause it focuses on homelessness, whatever.

Evan Meyer: Well, how much goes to administration, right? There's some processing fee [00:08:00] involved in everything. And I guess the question is. When it comes to healthcare, 'cause you can't do it without a processing fee entirely. What is the acceptable amount of of processing administrative cost overhead? It, it, and it could change based on the industry.

Evan Meyer: It could change based on the system, based on the standards of what can be done right now without innovation, right. Of what the private industry is doing versus the public sector. Often they're much more efficient. What do you think in healthcare is an acceptable amount of, like, this is wasteful

Crom Carmichael: Well,

Evan Meyer: spending on, on, yeah.

Crom Carmichael: Yeah, let me, let me, let's, that's, that, that, that is the, that is the, the central question. So I'm gonna answer it this way by talking about a couple of other industries and how we take care of lower income people, and then another industry having to do with insurance.

Evan Meyer: Great.

Crom Carmichael: everybody owns a car. People who own a car [00:09:00] have car insurance. The car insurance is used only if there is an extraordinary event called a car wreck. There is no, there is no insurance for buying gasoline. There's no insurance for tires. There's no insurance for if you need brakes or a transmission. In fact, there's no insurance that helps you even buy your car. And and yet, and and so those are expenses that range anywhere from 60 or $70 to fill up your car to a couple hundred dollars a tire, to $3,50

Price Transparency Solutions

0 if your transmission breaks. And these are all things that, that the average, the average person who owns a car has to figure out and can figure out a way to pay for those things.

Crom Carmichael: But if they have a accident with their car, that becomes the only time. insurance is involved. So if we were to take that and say, let's apply that same principle to healthcare, what you would [00:10:00] say is you need healthcare. You need health insurance for the truly expensive, extraordinary events, which is called hospitalization. I'll tell you a story. Uh uh, in fact, I can tell you two very quick ones. One is when I was about 52 years old, which 25 years ago, I had my first, when you, when he hit 50, your doctor will tell you you need to have a colonoscopy. And so I had my first colonoscopy when I was 52 and at

Evan Meyer: I'm looking forward to those. I'm looking forward to those, by the way.

Crom Carmichael: they're a blast.

Crom Carmichael: Yeah, they're just, they are fun. Especially,

Evan Meyer: me I can't wait.

Crom Carmichael: Especially the day before when you have to drink all that stuff that clears you out. So anyway too much information. But, but at any rate the doctor who was going to perform the colonoscopy, I spoke with him and I said, I don't have insurance that covers this, because it was below my deductible, at [00:11:00] least I thought it was.

Crom Carmichael: And I said, do you have a cash price? he said, well, if you don't have insurance and you're gonna pay me ahead of time or at the day of service, he said, and I'll handle all of it. I'll charge you $1,200. And so I had a, I had a colonoscopy that included the anesthesiologist, the facility and the, and the doctor. And then seven years later, I had my next colonoscopy. Same doctor, same procedure, $1,200. I had the same colonoscopy with the same doctor seven years later when I was 64 and, and, or maybe it was five years later, but I was 64 just before I was going to hit Medicare. And once again, it was $1,200. Now, that particular colonoscopy, and this is why this story is so important, that particular colonoscopy took place in October of whatever year it was. I have a son who was in college and he had an uncle who had died of colon cancer. [00:12:00] And so, so colon cancer was a concern he mentioned to me upon as he was coming home for Christmas vacation, and he, he, he exercises, he's a fanatic. And and he mentions to me, he says you know, dad, I had a strange thing.

Crom Carmichael: I had some, I, I I, I had to take a poop and I had some blood in my poop. I go, really? And he says, yeah. So I call my, call my doctor and I said, look, here's his uncle's situation. Here's what happened to him. know my son's only 20 years old, but should he have a colonoscopy, given his family history, should he have a colonoscopy in order to mitigate that risk? And he said, given the family history, the answer's yes. So because he had a college insurance plan, we ran tha

Market Signals and Competition

t colonoscopy through insurance. I had just had a colonoscopy two months earlier, his colonoscopy came [00:13:00] back. You know what the EOB is the

Evan Meyer: Mm-hmm. Mm-hmm.

Crom Carmichael: you get, which says this is not a bill.

Evan Meyer: Mm-hmm.

Crom Carmichael: says that that colonoscopy cost $11,000. It would be negotiated down to 6,600. So the providers got $6,600 doing something that they did for me two months earlier for $1,200 and that, and I'm, I'm, I'm telling you that that is not a unusual, give you another circumstance. I have, I've had I've had three very small melanomas found on my skin. One over here, one over here, and then one right here. And, and my, and the dermatologist said, well, I'm gonna have to schedule you to be with a doctor who, who can, who will cut those out. He would only, he would only do one at a time. And I asked him, I said, why are you [00:14:00] doing this one at a time?

Crom Carmichael: There are three of 'em. Why can't you do it all in one visit? He said, well, I only get paid for each visit. So he got paid three times to do what he could have done. time they got three times because that's what the system is.

Evan Meyer: Yeah.

Crom Carmichael: don't have a free market when you have a government or insurance companies controlling the relationship between the patient and, and the doctor and, and also then sets the pricing. So my solution. to have widespread HSAs, health savings accounts. I hope you have a health savings account because they're, from a tax standpoint, they're fabulous.

Evan Meyer: Mm-hmm.

Crom Carmichael: so for, to have widespread HSAs and then have, have have require price for all providers up to hospitalization. I will acknowledge that hospitalization might be too complicated to [00:15:00] have price transparency initially in hospitalization, but everything else that we do, any kind of outpatient surgery, if you have a knee replacement, if you have a hip replacement, if anything that's outpatient, you ought to be able to get a quote ahead of time to pay in full out of your HSA. And

Evan Meyer: Yeah.

Crom Carmichael: reduce, would reduce the total price. 70% Evan? 70%

Evan Meyer: Wow. Well, even if you don't have an HSA, it would be transparent to say, look, just pay, if you were to pay this as is, like this is the cost of, and for basic things that you have to do once a year, that most people, you know, spend would, would get a blood test. Right. Or whatever, you know, or, or.

Crom Carmichael: your annual

Evan Meyer: Your annual.

Evan Meyer: Okay, so you do that, that's, let's just call that all 500 or $600 a year, not $6,000 a year or something. Right. So, and even if you were to pay [00:16:00] the administrative fee to even manage something that can handle just that, it shouldn't be 10 times the amount.

Crom Carmichael: But it's, but here's what's interesting. What is the administrative? The, there is an administrative fee that you can

Consumer Empowerment

identify when you buy gasoline by using your credit card or debit card and sticking it in the pump in order to pump your gas and that administrative fee. the 3% that the insurance, I mean, that the credit card company takes to move $70 from your account to the gas station's account.

Crom Carmichael: That's the administrative fee

Evan Meyer: Mm-hmm.

Crom Carmichael: it's, and it's over and done all at one time.

Evan Meyer: Yeah.

Crom Carmichael: have a 3% administrative

Evan Meyer: Yeah.

Crom Carmichael: It has a 60% administrative fee.

Evan Meyer: Right. And, but you also have to, I guess you also have to include the ability for someone to make money on it, right? So let's just say the doctor provides a service. Let's say he gets, you know, he wants to make twice as much as the, what it costs him for that 30 minutes. And if he divides all of his expenses into a [00:17:00] 30 minute interval of the office and the whatever, right?

Evan Meyer: So you've got that 30 minutes, call it a hundred dollars. I don't know, for a person to manage it, the facilities, the electricity. Right. So, so if he, we assume that he has to make money or she has to make money.

Crom Carmichael: Sure. Just like the gas station has to make money, but the administrative

Evan Meyer: Exactly.

Crom Carmichael: two or 3%. Now, a doctor,

Evan Meyer: Yeah. Right.

Crom Carmichael: Now you talk to doctors today, and I'm not talking about doctors who are in hospitals. I'm talking about all the other doctors. The ones who are in offices or do or do their surgeries in outpatient facilities. You ask them how much time they spend having to argue with insurance companies, and it's a big part of their day. That

Evan Meyer: Yeah,

Crom Carmichael: to provide documentation to get paid by the insurance company.

Evan Meyer: yeah,

Crom Carmichael: But when you buy, when you decide to buy a set of tires for your car, there's no administrator who's, who's helping you negotiate the price of the tires. You look at

Evan Meyer: [00:18:00] yeah.

Crom Carmichael: choices and you make

Evan Meyer: I.

Crom Carmichael: yourself. And it might be the

Evan Meyer: Right,

Crom Carmichael: choice, or it might be not quite the best, but you can't be that far off. Otherwise, the tire provider would go out of business.

Evan Meyer: sure. Everyone's gotta make money and everyone's trying to get in the middle of transactions. A a lot of times businesses seek to get in the middle of the transactions to provide value on both sides and get paid by everyone all the time. Right. And that's part of the.

Crom Carmichael: just a, let's talk a little bit about how the system got to where it is. 'cause that's really important. At

Evan Meyer: Yep.

Crom Carmichael: of World War ii, Roosevelt had put on wage and price controls. And at the end of the war, businesses were making a lot of money and business people went to Roosevelt and said, Mr.

Crom

Practical Implementation

Carmichael: President, we're making a lot of money. If you wanna keep price controls on, that's okay, but we'd like for you to take off the wage control so we can pay our employees more money. And [00:19:00] Roosevelt said, no wage controls will remain, but you can pay for their healthcare. And that was the beginning of the third party payment system.

Evan Meyer: Hmm.

Crom Carmichael: and, and the, and Roosevelt said, and I will let you, Mr. Business person, I will let you deduct the cost of providing health insurance to your employees. But if your employees spend their own money, they can't deduct it. so it was a natural thing given the tax policy, it was a natural thing for employees to want their employers. To pay for their health insurance and the employers would say, well, I can deduct it and Roosevelt won't let me raise their wages anyway, so I will start providing healthcare. gave, that gave rise to insurance companies. Then in the fifties, private sector unions and in the fifties, private sector unions were very, very powerful. They then negotiated into their contracts, health insurance, paid for by [00:20:00] their employer, and it was first dollar coverage. And this is a key point. So first dollar coverage means that insurance companies have to be, provide, have to be involved in every single transaction, no matter how inexpensive it would otherwise be. So, so that's where, that's where single, just 10 minute doctor visits became covered by insurance and then all of those had to then be priced and all, and then had the, then the adjudication process and all these different things to make sure that doctors aren't, quote, defrauding the system. So you have all these checks and balances and expensive, expensive. Programs put into place in order to mitigate people who would cheat. And and since the patient wasn't paying the bill, didn't care what the price was because they couldn't do anything about it anyway.

Evan Meyer: Mm. Mm-hmm.

Crom Carmichael: so then it go, then we get into the sixties. And, and then Medicare was passed, and then Medicaid was passed. And so now the, [00:21:00] the older people which represented at that time, about seven or 8% of the population, they all of a sudden now are covered by a third party payment system. And the bottom 20% on Medicaid were covered by a third party payment system. those and, and, and Medicare, by the way, when Medicare was passed. The people who supported and promoted Medicare said in 1968 that in 20 years the cost of Medicare to the federal government would be $8 billion. And in 1988, it was $80 billion, 10 times more than they projected. So then Obama, when he gets to be president, there's a lot of people who are kind of in between insurance and one thing or another, and so he devised Obamacare. And one of the, and he made a couple of promises that are famous. If you want to keep your doctor you can. If you wanna keep your insurance, you can. Those things turned out not to be e

Conclusion and Call to Action

ntirely accurate, but the [00:22:00] biggest thing he said that wasn't true was he said, if we pass Obamacare, it will reduce the cost of healthcare, insurance $2,500 a year for the average family. In fact, in the, by the, by the time Biden became president, it had gone up $10,000 a year for the average family. so, and so that's now where the angst and where the political questions are. So I'm an

Evan Meyer: sure.

Crom Carmichael: not of the shutdown, or not the shutdown, but I'm an advocate of, of recognizing that the, that the most inefficient industry we have in our country in terms of the amount of money we spend, that's completely wasted. Is healthcare and that there are ways to fix it. Now, the insurance companies would fight me like a tiger. companies would fight me like a tiger if, if, if a third party is gonna pay for it, then I'm gonna negotiate and ask for a much higher [00:23:00] price because, 'cause I don't have to answer to the consumer. And so there, so, so what do you, what do you think about what we're talking about here?

Evan Meyer: Well, I think, yeah, I think my, I think the, one of the questions I had earlier was, was what is acceptable? Right. So if we were to sum Yeah. What is an acceptable, so if we were to say it, you would normally on your own pay, you know, a thousand or $1,200 for a colonoscopy, what, what should it be for and for what service?

Evan Meyer: Right, right. Should it be $1,200 or should it be. 2000 I, you know, should what, what should they charge? Instead of 6,600, which was mentioned, that was, that, that was negotiated down to, right. Like what I, I, or do we just get rid of the system and use the system that you've kind of identified here with an HSA account?

Crom Carmichael: If, if the, if you have competition and competition requires price [00:24:00] transparency so that the consumer can look and pick and choose now, then the consumer still has to have the ability to pay, which is why I'm advocating HSA accounts

Evan Meyer: Right.

Crom Carmichael: Now let me, let me use one other industry the most. If I ask people what's more important if, if you have to have one or the other, what is more important?

Crom Carmichael: Having food or having healthcare? And they say, well, what do you mean? I said, well, if you, if if you have to choose having no food or no healthcare, which would you choose? And they say, well, heck, if it's that I have to, I choose no healthcare because I have to have food to live. I go, okay, well then food is a greater necessity than healthcare. But we don't have food insurance for the average person. We have food stamps for the, for the lower

Evan Meyer: That's interesting.

Crom Carmichael: lower income people. And so we let the, we let the market determine the price the selection [00:25:00] because by letting the average person decide what, what it's worth having in a supermarket and not,

Evan Meyer: Yeah.

Crom Carmichael: income people get the benefit of the market. To get the most, the biggest bang for their buck on the on the food stamps that they receive from government to

Evan Meyer: Sure,

Crom Carmichael: pay for their,

Evan Meyer: sure. You know, it brings apart a, another question of, of when people throw around words like you know, it was funny all of a sudden when we were, when Obamacare came out, like, now we're a socialist country. Okay, this is socialism, you know, it's. There's a lot of things that are socialized. You know, healthcare is a big one, but I, I, I don't know if that necessarily means you're becoming a socialist country.

Evan Meyer: I think people like to say that word a lot, but it bring, it does beg the question a little bit on like what it means to be free market. And in a pure free market you wouldn't have any. Regulation, I suppose, right? The purpose of government is to add regulation where there can be [00:26:00] exploitation ultimately, right?

Evan Meyer: Or, or you can create some utilitarian benefit by, by adding regulation, but it gets outta control. So it's, it's, I try to think about like it's. Almost every, I try to think of an industry that is really purely free market, and I don't know if I can think of one. And it gets me always back to the idea what is the amount we're willing to accept right of, of in each industry.

Crom Carmichael: well, it's, it's, it's what is the best way to find the best value? It's not what price we willing to accept, but what, what would, what, what what is the solution to getting the best value? And so you point out correctly so that the government regulates at some level. Most industries. So, you know, as we talked about the grocery store industry, the Food and Drug Administration regulates certainly food. Our food supply, there's a certain

Evan Meyer: Course.

Crom Carmichael: to make sure the food that's. [00:27:00] That is sold to us through supermarkets is of at least a minimum quality, which is generally a pretty high quality. And and grocery stores that sell fresh, fresh produce, if they don't sell it by the sell by date, they have to throw it away.

Evan Meyer: Yeah.

Crom Carmichael: and so the so there is regulation in the, in supermarkets that is, I call it a pretty light touch regulation, but there isn't regulation in who sets the price, and that

Evan Meyer: Mm-hmm. Yeah.

Crom Carmichael: then, and then when, when a person goes to the grocery store, when they the, the, the, the the government doesn't tell 'em what to buy. And so the, so

Evan Meyer: Yeah.

Crom Carmichael: a person who goes to the grocery store can buy what they want as long as they're willing to pay for it. They know what the price is before they pay for it, then they, when they check out to move that money from. Individual's account to the customer's account, to the grocery store account.

Crom Carmichael: If they use a debit card, it's about [00:28:00] 1%. So, so for me that that system gives you the best bang for your buck food,

Evan Meyer: Yeah,

Crom Carmichael: I

Evan Meyer: so that's an acceptable level of regulation. Food is an acceptable level of regulation. It protects us. You, you, you can charge whatever you want for a can of su for a jar of sun dried tomatoes,

Crom Carmichael: Right.

Evan Meyer: a thousand dollars. You probably won't sell 'em. But you know, it reminds me of the taxi industry before there was like Uber and, and Lyft or whatever or now Waymo and, and, and, and robo taxis coming soon.

Evan Meyer: But, but, and, and, and I'm sure some of them still work like that. I don't know for sure. I haven't, I haven't followed it in the last 10 years, but there was a time. You could not, the metered rate was like the most regulated thing in that industry. You couldn't off and you couldn't offer incentives.

Evan Meyer: There was never like buy one cab, get one free. There was like rules around this type of stuff from the metered rate to what you can offer and how they can track. It was really wild and I learned of that through my first business actually. I had, [00:29:00] it was interesting that it was part of what we were working on and I had to learn a little bit around that.

Evan Meyer: It was di uncomfortable.

Crom Carmichael: New. In New York. In New York City.

Evan Meyer: Yeah.

Crom Carmichael: to operate a taxi cab, you had to have what was called a medallion. That

Evan Meyer: Yes.

Crom Carmichael: that was fixed. It was bolted onto your taxi cab. You

Evan Meyer: It was an actual medallion.

Crom Carmichael: an actual medallion. Those medallions at one point had a market value of a million dollars.

Evan Meyer: Yeah, it was an old market around a regulated item. It's.

Crom Carmichael: Well, it wasn't the, the, the price of the medallion was unregulated, but the value of the medallion was so great. The taxi cab industry had gotten the regulators to let them charge a lot of money.

Evan Meyer: Yeah,

Crom Carmichael: so they could,

Evan Meyer: but also to get the medallion wasn't easy. Right. There was, there was, you couldn't just get a medallion. Yeah,

Crom Carmichael: cost a lot of money to

Evan Meyer: yeah.

Crom Carmichael: Well, usually bought 'em from somebody else.

Evan Meyer: Yeah.

Crom Carmichael: number 'cause the New York regulators [00:30:00] wanted to keep the, a a, a minimum number of, a certain number of taxis on the street so that every taxi cab operator. Could make a lot of money

Evan Meyer: Yeah.

Crom Carmichael: de operators in turn money to the politicians that set the regulations so that they could charge a lot of

Evan Meyer: And the wheel goes around and rounds.

Crom Carmichael: Exactly. Exactly. And so, and Uber, Uber broke that model. Uber broke that model.

Evan Meyer: Mm-hmm. I can't wait for the next one. Autonomous cars is where I get really excited about. I think it's, I, I, the first time I took a Waymo, which I don't know if they have in Nashville yet. I don't, I don't know if you have any automated

Crom Carmichael: that opportunity.

Evan Meyer: No. It'll come soon. I, I forget. There's a couple, you know, Austin and San Francisco, I forget where there's a couple of these folks doing this, but like in Waymo, in West Los Angeles.

Evan Meyer: It was maybe a year ago or two year, whatever it was. I jumped into this with a buddy and [00:31:00] it was like. I feel like it was a rite of passage a little bit. It was like, it's like one of those experiences you'll never forget because your whole life, you're used to driving a car. You can't imagine a car not having a driver.

Evan Meyer: It's almost a a, a, right. And then you do it and you're like, no way. Like, and I just. My mind was blown the first time I did it. It felt a, you know, a top memorable experience. And, and it was funny 'cause he wanted to do it with me. It was like his, he kind of knew that I was gonna have that impression and he is like, I wanna be the guy riding with you in that, in that Waymo.

Crom Carmichael: You

Evan Meyer: Um, yeah.

Crom Carmichael: interesting what innovation does. When I was going to college. My mother bought me as a, as my gift, as a gift for going away to college. She bought me what was called at that time. It was a handheld calculator made by Beau Mar. It was about that thick, it was about, it was about that big, and it could add, subtract, multiply, and divide.

Crom Carmichael: That's what it could do, and it cost [00:32:00] $125. And this is back in 19 19 68. Okay. It cost $125. Within about five or six years, had wafer thin calculators that could add, subtract, multiply, and divide that they put 'em in cereal boxes. And so they were, they were free with the cereal and, and that's what innovation does. Innovation and, and, and and patents. We'll always drive the price of a product down or, or it will keep the price close to the same and drive the value up. And, and, and that's what markets do and that's what competition does. Our healthcare industry doesn't operate by those principles, and

Evan Meyer: Right.

Crom Carmichael: it is very, very inefficient it's, and it's what's bankrupting the country.

Evan Meyer: Yeah, so bring this back to the government shutdown.

Crom Carmichael: The [00:33:00] government shutdown is over this issue of do we increase the amount of money that we spend on healthcare because fundamentally. had Obamacare that passed, and then when, when COVID hit and when Biden became president, he signed an executive order that under an emergency he declared an emergency and extended the, the the subsidies for Obamacare so that it would include families up to $500,000 in income in some areas of the country. And, and so and so now. The Democrats are saying, well, we want those subsidies that were supposed to be emergency in nature and only because of COVID, we want them to be made permanent. And in addition to that, we also want people who are in this country illegally to have a right to Obamacare. Well, how can you have, how can somebody who is here illegally having committed a crime to get here have [00:34:00] a right to something as expensive? As, as healthcare 'cause as I said, we're spending $15,000 on average a person. So if you have a

Evan Meyer: Yeah.

Crom Carmichael: four that illegally sneaks across the border, according to the Democrats, we should spend $60,000 a year on just their healthcare. And I don't think that's sustainable.

Evan Meyer: lemme ask you this. Is it the, is it the right thing to do to give people healthcare or is it for to get their future vote? Or or the people that they knows, vote or whoever. Right. Or is it both or something else?

Crom Carmichael: Now, now Evan, you have, you have gone off into an area of political philosophy that, that I absolutely love talking about, and that is the importance of constraints. I, just love this conversation by the, I'm having a great time, but I live in, I where do you live? [00:35:00] Where, where

Evan Meyer: Now I live in, I live in Los Angeles.

Crom Carmichael: Okay.

Evan Meyer: Yeah.

Crom Carmichael: then.

Crom Carmichael: I live in Tennessee. Tennessee has

Evan Meyer: Mm-hmm.

Crom Carmichael: and we have to, we are required in our constitution, we have no state income tax because of our constitution, and our constitution requires that the, that the state balance, the budget. In the seven, in the sixties, seventies and eighties, state was run by the Democrat party.

Crom Carmichael: They had a lock on the legislative branch and the executive branch, but they could not spend money beyond what they collected in revenue, and they couldn't impose an income tax, or at least they didn't believe they could. So consequently they would they would, about every three or four years, they would raise the sales tax by half a percent, and that gave them enough money to spend it on things that they wanted to spend it on. But the point

Evan Meyer: Hmm.

Crom Carmichael: they

Evan Meyer: They didn't get bond money from the, they didn't get bond money [00:36:00] from the big banks.

Crom Carmichael: No, no. We, we are a very, we are, we are a, the, we're actually the lowest indebted state in the country

Evan Meyer: Wow.

Crom Carmichael: because.

Evan Meyer: California's very good at that. We, we, that's why, that's why there's such an issue here, because we have Bank of America and all these big banks giving us these big bond monies for all these things. That's why you can't break the cycle.

Crom Carmichael: Yeah, exactly. But in Tennessee, because, because of the constraints. Because of the constraints, the party in power was limited into what it could do, and so they were forced. To sit in a room, even though every single person in that room wanted to spend more money than they were collecting in revenue, they were prohibited from doing so. And so, even though the Republicans had no power at all, Democrats acted quite responsibly they had no choice. Now, by the way, I'm not blaming Democrats per se other than just explaining the, the, the history here because human nature, [00:37:00] human nature is such. If you give people in power a way to buy votes by going into debt, to give money to people, give things to people for free many politicians will choose to do that.

Evan Meyer: Yeah.

Crom Carmichael: But if you

Evan Meyer: Yeah.

Crom Carmichael: you eliminate the opportunity to borrow, then if politicians want to give money to some people, they have to take it from somebody else. And that creates, that creates a rub. And this is the one thing that Milton Friedman got wrong. When he said that, that as an interest group got bigger and bigger, there would be natural constraints that pushed against them so that the amount of damage they could do would be limited. died before he saw the explosion in federal debt, and so it's, it's because of the ability to borrow money. That, that politicians are able to give money to people and to essentially, as you say, buy their votes. Is it wrong, morally wrong? I think it's morally [00:38:00] wrong, but it's the way our system works and, and, and so we have to work within the system and try to come up with solutions within the system. I believe

Evan Meyer: Yeah, it's, it,

Crom Carmichael: can be addressed, but please go ahead.

Evan Meyer: no, I, I, I, I, you know, you're saying a lot of very interesting things. I, I, it, and it gets a lot of times for me when it comes to, and I know you're a, a, a lover of political philosophy. All the great thinkers who have, who have tried to get. How we ought to exist. Right. You know,

Crom Carmichael: how?

Evan Meyer: starting, starting with Plato.

Evan Meyer: Yeah.

Crom Carmichael: should we, exactly. And we, by the way, in the Giants of philosophy. Which is not, we had done, we've done that also, but we haven't put that up right now. All we

Evan Meyer: Yeah.

Crom Carmichael: is the Giants of Political thought, but we did Plato, we've done Socrates, we've done Aristotle.

Evan Meyer: Yeah.

Crom Carmichael: if you, if you're interested, I'd love to come back on your podcast and talk about some of these ideas in their context of when they, when they started,

Evan Meyer: Sure.

Crom Carmichael: of years ago.[00:39:00]

Evan Meyer: Well, a lot of times I think about these folks and I say, look, if these very bright minds who have thought through this thoroughly haven't got it right yet. They've tried, they've made great contributions. Right? But no one's nailed it. No one, even the current system, it's not figured out yet. Right.

Evan Meyer: It's.

Crom Carmichael: Well,

Evan Meyer: The best quality of life for the most number of people that it's ever been.

Crom Carmichael: yes.

Evan Meyer: Because that's, we've improved. Right. But, but it's, it's far from perfect. And I think there's a level of humility that if we can accept as a society that we're still improving and we still are the best it's ever been. Like, I don't know when people thought it was better.

Evan Meyer: Like I, but in terms of quality of life, living in Nashville or Los Angeles or any major city, you know, when it comes to access to basic stuff, it's like we don't really have those issues here for most people and a lot of countries still do. But even around the world, it's the best it's the ever been for 7 billion people.

Evan Meyer: Like in terms of [00:40:00] disease, in terms of starvation levels, in terms of education levels and rights and free, the freedoms that people have. So a lot of times, you know, and, and it's why. I like to think of, well, how, what is the balance between these things that we know are wrong? Right. We know, I, I've had my own healthcare situations where it's just like even with a blood test where it's like you said, I get a free blood test.

Evan Meyer: Why do I have to call and negotiate? You charged me for the blood test. You said it was free. Now you're telling me I got the code wrong. Don't make me get into a code conversation. It's the simplest possible thing for you to do for me, and, and you're telling me I owe you money.

Crom Carmichael: Well, but if you could have, but if you could have paid for that at the time of service with a credit or debit card, then, then all of the other things that you're talking about that regarding that blood test. not happened. It's if there is a

Evan Meyer: Sure. Yeah.

Crom Carmichael: way, there, there is a web website called MDM, medical [00:41:00] doctor md

Evan Meyer: Yeah.

Crom Carmichael: md save.com. Go to that and type in, type in colonoscopy or

Evan Meyer: Okay,

Crom Carmichael: replacement, and then

Evan Meyer: great.

Crom Carmichael: zip code and

Evan Meyer: Yeah,

Crom Carmichael: doctors who are in your zip code. Who will do, who will perform that service. For that price

Evan Meyer: that's a great reference. Yeah.

Crom Carmichael: you pay MD Save and they keep 10%

Evan Meyer: Mm-hmm.

Crom Carmichael: 90% to the provider.

Evan Meyer: Great.

Crom Carmichael: And you'll be, you'll, if you get, wanna get an MRI, it'll be a few hundred dollars, not a few thousand dollars.

Evan Meyer: Right. Yeah. You know, I had even with cholesterol stuff, you know, they wanted to put me on statins when I was 20. So I have high family, whatever, right? And, and only, and I ignored it. I'm healthy. I'm as fit as I've ever been. I'm 42 now. I, I couldn't, I mean, the best health, I have no other risk factors other than this number.

Evan Meyer: And they're learning now. There's a lot that we thought not. [00:42:00] That that goes against what we thought statins were doing and some of the effects of it 20 years later. And they're learning the cholesterol's, not just the number. There's all types. There's not just, there's different types of LDL and different types of HDL.

Evan Meyer: So by the time, I guess when you hit 40. Now they give you the cardio iq, which breaks it into the things that are more relevant, right? Your A OB, which which came out was like a big thing. And like all these other levels to, so to see if there's really are risk factors. They also give you the the iodine CAT scan calcium test, right?

Evan Meyer: And, and which is really the biggest thing that if you have blockages in your arteries. That

Crom Carmichael: Oh

Evan Meyer: then that's a, that's a risk factor. But if you don't, some people just have high cholesterol and they're, they're, they're, so this is an interesting thing. Cholesterol's not really understood. I've asked heart surgeons now who are always recommending statins and all, and they're like, you know what?

Evan Meyer: I don't know anymore. It's it's complicated. It cholesterol's very important for the body, and it's [00:43:00] not quite as easy as they thought. So I haven't taken it. The statins. And I just, I was disappointed that I was learning all of this at 40. And what they wanted to do was give me statins at 20. And it's probably to prevent their risk in li you know, they're told to do it and there's, they have liability if they don't.

Evan Meyer: But that system is part of this. Like, you wanted me to go on drugs my whole life, and now I'm told by doctors, you're just fine. You're only one risk. Silly number in a, and you have no other risk factors at all,

Crom Carmichael: Well,

Evan Meyer: know?

Crom Carmichael: Like, if you like this. Study that issued more deeply. One of the companies I'm invested in, we've been selling a, a a, a very a, a, a a product that is extraction from green tea that has a super enriched, a blend of theof fla. The name of the website is sote.com, S-O-L-T-E a.com.

Crom Carmichael: And if you click our science button, you'll see a [00:44:00] a white paper that was printed 25 years ago, approximately in the archives of internal Medicine. And I've been taking just, not trying to pitch the product per se, but I'm following up on

Evan Meyer: It's okay.

Crom Carmichael: I've been taking

Evan Meyer: I, I love health stuff. Mm-hmm.

Crom Carmichael: I've been taking that product for about 25 years. I'm 77, I take zero prescription drugs. Now you, you find me some other people who are 77 who take zero prescription drugs.

Evan Meyer: Good for you.

Crom Carmichael: fantastic cardiovascular system.

Evan Meyer: Wow, good for you. I love hearing that.

Crom Carmichael: Not much hair, but a great cardiovascular system.

Evan Meyer: Hey, I can relate. I, I understand the hair thing. I understand. I was 19 when I had to start saying goodbye. I watched it fall out on my college desk. I was like, what is going on? By the time I was 21, 22, it was, but hey, I don't think I would grow it back.

Crom Carmichael: [00:45:00] there was, there was a comedian called Gallagher, and one of the, one of the comments he make is he, he was a young comedian, didn't have any hair, and he said, he said.

Evan Meyer: The watermelon guy smashing watermelons, right?

Crom Carmichael: guy. Exactly. He would say that I woke up in the morning and looked down and he saw a hair on his pillow and he said, I wondered what held it in yesterday. I thought that was a but. But he was a good comedian and he was the watermelon guy. You're exactly right.

Evan Meyer: I remember that he is a carrier and he was bald, but he had the sides in the back or something. Right. Something like that. Yeah. Well, so this has been a great conversation. I it was, I hope our audience learned a lot. I surely learned a number of great things and, and look, I think it's so important.

Evan Meyer: That people can understand nuance and see that a lot of these things just require, if you don't take too [00:46:00] staunch of a belief on what you hear on the news every day and start using a little critically thinking, you can have real intellectual conversations and come to solutions. And you can, you can, you can go back and forth and debate solutions, but that's where we need to be getting into, into intellectual debate, around solutions.

Evan Meyer: Especially around issues like help, I mean, all the big issues, but things like that. If there was a perfect right answer, I always say things wouldn't be so divided. Usually that means there's nuance and we need to narrow, you know, massage through the nuance. But, anything else you wanna leave today?

Evan Meyer: Before we go?

Crom Carmichael: As I, you know, I mentioned to you earlier, we have a, we have a a, a A from Our Generation is the name of our podcast, and we're up where most podcasts can be found. But we

Evan Meyer: Yes.

Crom Carmichael: have a website called Giants of Political thought.com. And years ago I started a company that produced and marketed, back in those [00:47:00] days, it was audio cassettes history's most influential thinkers. And that is now morphed into a streaming service that, that we, that we have. And so if somebody goes to giants of political thought.com and wants to have audio programs. On some of the most political important political thinkers in the last 300 to 400 years, and we, we cover all of them. We, we consider somebody who's a giant, a political thought, not necessarily a good thinker, but an influential thinker. And so we cover Karl Marx and the Communist Manifesto. I don't agree with him, but we do cover him. cover Rousseau in the social contract. I don't agree with him. John Locke, two treatises of government. I do agree with him. Adam Smith, wealth of Nations. I think it's very worthwhile. And then, but we also cover Thoreau Wolf, Mary Wolf, stone Craft, the Declaration of Independence, common Sense, the Federalist Papers. [00:48:00] So, and, and once you have it on your phone and you can share it with four other, four other devices, which could be four other family members. It's a tremendous bargain. And then we also have the transcripts are available and questions on, on each of the programs. The questions are divided into three, three categories, questions of fact, which is kind of important.

Crom Carmichael: Trivia of understanding, you know, what did, what did Jefferson mean when he wrote such and such. And then, and then essay questions. For example, one essay question would be if the Declaration of Independence. never been written. Could the, would the Constitution have been written the way that it was? Well,

Evan Meyer: Hmm.

Crom Carmichael: there's no exact answer to that. But it creates a discussion because the, our Constitution is a, is a document that is, I would describe it as unique in, in political history

Evan Meyer: Sure.

Crom Carmichael: how it's written and why it's written the way that it is. And [00:49:00] that's, that's a topic for another day, but a

Evan Meyer: Yeah,

Crom Carmichael: topic indeed.

Evan Meyer: for sure. Well, I hats off to you for pursuing more political philosophy and less politics. And I think that is the answer to a lot of problems is if,

Crom Carmichael: I appreciate it.

Evan Meyer: Embrace the Yes, sir. Yes sir. My pleasure. It was, this was wonderful. Have a great day. All right.

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