Among the things I'd like to talk about with Craig got Walls. We call him Craig the healthcare Guru who has been joining us for many, many years. Attorney at law and benefit consultant Benefit Revolution. As a healthcare policy attorney with an emphasis and employment law and to benefit consultant, Craig got Walls specializes in benefit cost containment and compliance.
It's his job to figure out what is actually happening and predict what is going to happen, regardless of his wants, because he's got to advise clients so they can prepare for that sort of thing. Craig, Welcome to the Armstrong and Getty Show once again. Thanks Jack. I think I think you might have surpassed Joe as best best introduction of me yet I don't know. Now it's a competition. You get no you get no benefit for that sort
of flattery. Um uh. Fair to describe the mental health care situation we've got in America as a crisis, Yes, absolutely fair. It's it's been a problem for years, Jack, it's it's it's it's I mean, the backdrop of the problem that his historical setting of it is. You know, even before this recent spike, and I say recent spike, you know, going back to you know, the invention of the iPhone, the invention of social media, you can track very very large increases in the demand for mental health.
But it's always been a a specialty within the health care industry that was just sort of under favored, not not compensated as well. So it's always been something that was tough to get. And then when you when you pile on top of that the just the tremendous spike in demand we've had over the past twelve fifteen years, it's it's exacerbated the problem. So how did that happen? Was it? Was it a national attitude up until fairly recently that mental health care is kind of you know,
voodoo for the week. I mean just kind of a you know, a fake medical field, um, and so we didn't take it seriously enough for or what's your theory on that? Yeah, No, I think I think your characterization is fair at least for you know, maybe part of
the country. And it was just I would say, you know, some people viewed it as what you said, you know, voodoo for the week, and others just viewed it as, you know, maybe not as rigorous of a discipline, a little bit more subjective, you know, not not nearly as important as like setting a bone or removing a tumor. That makes sense. Let me run through some of these numbers real quick and then you can comment on it.
Um These are numbers that Craig sent me. By five, which is just two and a half years from now, we will be down about ten thousand, five hundred marriage and family therapists that we'll need but won't have, about fifteen thousand psychiatrists, which takes I don't know how many years of school to become a psychiatrist. So you know
we're gonna crank come out soon. We'll be down about twenty seven thousand mental health counselors, forty nine thousand social workers, fifty eight thousand psychologists that's a pH d will be behind fifty eight thousand of those, and seventy eight thousand school counselors that we will not have. By Yeah, that's
a crisis. Yeah, it absolutely is. And you know, if nothing happens in a vacuum, right, So all of the things we've talked about over the past ten years on your radio show about the problems with healthcare and the fact that government controls more and more healthcare. Uh, you know that that's that's also part of this problem. And it's I think, I think I have a streak of repeating the statistic every time I'm on your show the
last year. But it's very important to remember for those listening for the first time, or for those that haven't thought much about it. We we talked about having a quote free unquote healthcare system in America, and we really don't. We have an oligopoly and that's something that's controlled by a few providers, and and that oligopoly is infected with government disease. And that government disease means that if you live in a blue state, seventeent of healthcare costs are
now paid by the taxpayer. And that that blows people's minds because we think about, you know, the private insurance we have at work. But once you add together Medicare plus Medicaid plus Obamacare plus Trycare, the v A plus Obamacare subsidies of blue state healthcare is paid by taxpayers, and you say, well, gosh, I live in a red state. It's a lot better. Not it's sixty percent. WHOA I didn't realize so you know, let's call it seventy ish
on average. Um uh. If I were uh a lefty who believes in, you know, government taking overall of healthcare, I wouldn't be hiding those numbers. I'd be touting them and saying, look, I don't know if you know this, but the healthcare is already that, so what are we doing? Yeah. They don't want to do that, though, because when you pull people about how satisfied they are with the healthcare system, those numbers ranked down around congressional level. I didn't know that, Okay,
can I see what you mean? I see what you mean. So if you've got you you ask, if you ask do you like your doctor, that's a very high number. If you like, are you satisfied with current health care system? It's very low. Yeah. Well I'm not satisfied with it either. In it's probably I've got the same complights that everybody else does, whether it's you know, freaking the nightmare of just getting the simplest prescription and all that sort of
stuff and run and everything like that. What's crazy to me is that how many of you all believe that if the government ran it it would be easier. Somehow, I mean, what is your life experience that leads you to believe that No, and I did. That's why I wanted to give you just a three specific numbers so you can understand how the government makes it worse. So, the largest demand we have for mental health right now is among the young. You know, people call them twelve
to twenty five. That's the that's the biggest demand we have for healthcare. And if i can just jump in here on that, because I've been in that situation and you you know, a lot lots of my friends have, Um, you have a kid who's struggling. I mean, that's a that's a you know, you and your wife, you and your husband sitting there at night at night, tier eyed, what are we gonna do with this situation? You finally decide to pull the trigger and get help, and it's
like the number one issue on your mind. You're gonna dedicate all your int this the next day and you get on the phone and you start calling people and you can't find anybody, anybody with an opening. It's it's awful, that's right. And when you and you know, I've helped clients with the issue, and I've been there myself with family members, and and then if you do find somebody, maybe they miss your appointment or they don't call you back because they're stretched so thin that that if they're
hard to access. But so when we talk about well, how what's the government's role in this, you said, well, okay, the the number one coverage entity for children in America is Medicaid. That's our our our system for the low income. Now, it's always good to remember when Medicaid was first passed in the late sixties, it was designed to cover the bottom two percent of wage earners. It now covers one out of every three children born in America. That's how
fast that safety net has grown into a hammock. So if we look at Medicaid, let's do this. If you if you, if you need a mental health visit, an integrated assessment including history, mental status, ETCeteras. That's the main CPT code for when you first come in. The average nationwide, and this varies greatly by zip code, but the average cost that the doctor is going to get reimbursed for
that visit is a hundred and fifty dollars. Okay, Now, the average doctor visits a hundred and seventy five So you can see mental health is already twenty dollars behind an average doctor visit, but if you need that visit on Medicaid, it's only going to reimburse a hundred and five dollars. So you take a system where we already don't have enough providers because the supply is not keeping up. Our practitioners are over the age of fifty five, they're
retiring faster than we're making them. And then you underpay them systematically across the board, and then you more significantly underpay them in the government reimbursement program. Will you end up with a very very broken supply and demand system, primarily because we don't have a free market. We have
a government infected oligopoly. Uh, that's all very interesting. In every healthcare of mental healthcare provider or or a therapist, psychologist, whatever that I've dealt with in the last couple of years, there's no insurance involved. They're just taking cash and it's expensive. And I don't know how most people. I'm lucky, I've got a good job. I don't know how most people can even consider doing that. Um, that's a tough situation
to be in. No, that's exactly right. And when you when you when you dig into a lot of these very very troubled young people that commit horrific acts of violence across the nation, a lot of times you find
that they don't have the resource for private health. They're relying on that medicaid system that is systematically under reimbursing and under paying providers, and so they just don't get the help they need, or they get very very underdeserved help, you know, through maybe a school counselor when they really need a psychiatrist. You know a lot about healthcare, and UM, I apologize from asking you something that sets you up to uh to to to not know. But UM, I've
been wondering for a long time. I hear about the mental health system we had back in the day that I guess we are one in the sixties and the seventies because we decided it was too oppressive and you know, people who weren't crazy were being locked up a mental institutions and given lobotomies like Jack Nicholson and all that sort of stuff, and so we did away with that. Um has that been a bad idea in retrospect? Do you think? Well? As a libertarian, I'd say no, you know,
and I would, I would. I would tell you that the armstrong and getty principle that you guys have espoused over the years of society veering from guardrail to guardrail, going too far one way and then overcorrecting it, it really applies in that situation where for a period there from the you know, the mid nineteen hundreds, we had we had a system whereby it was too easy to lock people, oh yeah, or or sterilize them or whatever. Yeah, yeah, and and um so do we need to go back
that far? Of course not. But have we gone too far the other way where we just we we view it as compassionate to leave one to his or her own devices on the streets of San Francisco screaming at a at a fire hydrant and and and defecating in the gutter. Yeah, we've gone too far, and society will correct this. I mean, you know, it's not all bad news. Some of these these mental health reimbursements are coming up. I mean this gap I see between what we pay
for a doctor visit versus a mental health visit. That gap is shrinking every year, and there is there there are efforts both in the industry and at the federal level reimbursement wise to correct it. So I have no I have no real doubt in my head that this will eventually become less of a problem. But of course it's going to happen a lot slower than we all would like because of the giant federal bureaucracy that gets
involved in muddying the waters. Right. And then then those numbers that you gave me on the shortage we're gonna have in all those different areas of mental health that's going to be here in no time, and that is well, and the demand Jack, I mean, that's the you know, just I pulled some of these statistics, and most of these statistics look at like the difference between two thousand five and two thousand seventeen, depression alone for young people
is up fifty to sixty depending on which age bracket you look at. Suicidal thoughts amongst young people is up fort over that time frame. So you you know, you you say, well, we're up in the need for very serious issues, and that that supply chain is not growing. In fact, well it might be growing, but it's not growing nearly fast enough to keep up with the demand.
And so you have a supply demand problem, but it can't be properly fixed because the government steps in with all kinds of rules and regulations that oftentimes even ones that are well intentioned, of course, retard the market, and the market can't respond properly, and that's why you end
up with a two tiered health system. And that This is where I think liberals really need to get is to say we don't want what we have, because what we have is what you just described earlier, and that's that the people with money can afford the private care and they get it, and the people that rely on these government systems can't. I saw this headline yesterday, the Democrats are facing a political crisis right before the all
you see the A RP. Do you remember that the American Rescue Plan, which had trillions of dollars of all kinds of different stuff in it, part of it was a boost in Obamacare subsidies, and that is going to expire right before the election. This is where Craig jumps in and explains what's likely to happen here. Yeah, this is a beautiful one. So Obamacare gives about sixty billion dollars a year to fourteen million Americans to buy UH
subsidized healthcare in the exchanges. What the a RP did a year and a half ago was came in and said, well, that's not enough because Obamacare is not actually keeping prices down, it's just funneling more money into insurance companies from the taxpayer. So during this crisis of the pandemic, what we want to do is give an additional fifty or thirty billion
dollars to those people. And primarily that money went to people making between four hundred and six hundred percent of the federal poverty Really, yeah, now that's a subsidy for a family of four that's making between a hundred and ten and a hundred and sixty dollars. That was the additional government cheese. So of course they put this thing in temporarily, knowing what they always try and do is say, well,
we can't take it away now. And um, the beautiful thing is this is going This is set to expire on January one, which means it's gonna hit all the Obamacare open enrollments that are occurring this fall, literally days before the mid term elections. You could see or you will see if they don't fix this, many people in the Obamacare exchanges, of those fourteen million people are going to see thirty increases in their monthly premium whoad notice
that you would notice that. And this is one of those things that they have to get some agreement from the Republicans to go along with this, and so far they have been unable to do it. Do you think the Republicans, I know, you think the Republicans are going to cave on this. Why because they always do and the Democrats are better at grabbing them. The Democrats are
better at grabbing the media. And the Democrats will spend this is it's because of those evil Republicans with an economy not yet recovered that they're taking away your extra healthcare dollars. That's how it will be spun, even though it was passed as temporary band aid to help not even the low income FO six percent of the federal poverty level folks. But Republicans stink at messaging, and that's how it's going to go. I suspect. And that's just
the inertia of these things. Read the book The High Cost of Good Intention, Good Intentions. I mean, it's just the way these things always go. Um are there a lot of people that like are you know the crowd you're just describing in terms of income who are using their companies health insurance that if they were going to be smart, they would go on Obamacare. Um, a few people, Jack, not many though. The way that the way that it works, Um, if you're if your company offers you affordable care, you
are not supposed to qualify for Obamacare subsidies. But that's a little bit muddied the way it works, and some people end up qualifying for subsidies anyway. But for the most part that system is pretty well clamped down. Okay, thanks for your information. Is always where do people find you if they want some of your brilliance At Benny Revolution on Twitter or benefit dash Revolution on the old interweb systems. Yeah, you are a good follow on Twitter.
Craig got walls appreciate your time to they think Craig. Thanks a lot. Thanks Jack,