Madera Community Hospital is reopening after a two plus year hiatus, and I want to talk about what it means why I closed in the first place, why I'm not necessarily still hopeful for its long term stability, because some of the same problems that led to its closure are still around.
And this is the California healthcare landscape that is kind of a creation of Gavin Newsom, where we have these sort of insoluble problems on the front end, we sort of do our best to kind of fix things on the back end with more government spending, but eventually I'm not sure how that's all going to work. So let me explain what I mean, okay, Madera Community Hospital. Madera Community Hospital suffered from a couple of different problems that led to its closure in December of twenty twenty two.
One of the big problems was a lack of qualified nurses, so this resulted in Madair Community having to rely on travel nurses to cover up the gaps that they had. So basically, travel nurses are nurses from out of the area. They travel to different hospitals who need coverage, and you have to pay a lot of money for them. It's more expensive than just having your own nurses, so they had to spend a lot of money on travel nurses. But the main financial problem, the sort of fundamental problem.
Maybe at some point we could address the nursing thing if we could produce more nurses out of you know, and this is one of the arguments FIR measure that local hospitals in the San Laque Valley don't have enough nurses and that maybe Measure E could help expand Prisno State's capacity to produce more nurses. Now, problem with Measure
E was that it wasn't just funding nursing. It was funding, you know, expanding the football stadium and just a bunch of other basically doing construction on everything at Frisno State. And I don't know that enough people were really in favor of an increased sales tax to pay for all those things. I think if Measurrey had actually just been focused on some of the aspects of Fresno State's life that produce more engineers, more nurses, et cetera, then maybe
people would have been more open to it. But that's that was one of the difficulties with Measure E was it was in general just funding for building improvements at Fresno State in general, not just for the nurses and engineers that the proponents of Measury were putting forward. Anyway, even if you address the problem with not having enough nurses in the San Joaquin Valley, there's this problem which is medical, medical and the fundamental unsustainability of medical that
Gavin Newsom has only made more unsustainable. Why well, California is the most overtext state in the Union. Medical is a payer, So within the circle of life within healthcare, you have the three p's payers, providers, patients. The payers are the insurance companies, including government payers like medical Medicare, Medical,
though is the most significant of these. Medical is government funded health insurance health care coverage for anyone who is under a certain income threshold, a certain household income threshold, so they are a payer. Then you have the provider, which is the doctor or the nurse practitioner who is
the one providing the service to the patient. Now, the patient may pay a health insurance premium for his or her health care, or the patient's work might pay that health insurance premium for the patient goes to the pay or. But in the case of medical patients, they're not paying that much that they're not paying that the government's paying that. Okay, So that's the circle of life. You have the payers, the health insurance company medical, you have the providers, you
have the patients. The providers give the service to the patient. The patient pays their premium to the payer or not in the case of the medical, patient or taxpayers pay for effectively the healthcare to medical, and then the payers pay the providers for their services. Now, medical is funded partially by California state taxpayer dollars, partially by federal taxpayer dollars, and there is a limited pool of that money. California
is already the most overtaxed state in the Union. There's just not any more water we can twist out of this rock. Okay. We also have lost taxpayer revenue in California since COVID. A lot of wealthy people who were paying a lot of money either in income tax or in capital gains tax, said enough of this, I'm out of here. I'm going to Nevada, there's no state income tax. I'm going to Arizona. I'm going to Florida. I'm going to Texas, I'm going to Idaho, I'm going to Utah.
People just left California and they took their tax revenue with them. So the pool of money for medical patients is not getting any bigger, and yet the pool of people eligible for health insurance under medical has grown. This is the fruit of decisions Gavin Newsom made. Gavin Newsom ran for governor. What did he run for governor on? He ran for governor on the promise that he would do a single payer health care system. So in California,
get rid of all the payers except for one. Have a state government run health insurance system cal care or whatever you want to call it, where you get rid of all the private insurance payers, get rid of all that no one gets has private health insurance. Everyone is
covered under one payer, a single payer. Now, as a result, if everyone is covered under a single payer, what does that mean, Well, it means that everyone's money, whatever money is being paid right now by your job to cover your health insurance premium, instead, that would go to the government to fund this massive pool of money for providing health insurance for everyone in the state, every single one
of you whose job pays for your health insurance. Instead, imagine all of that money, all of your taxes, and all of that money all going into one pool for covering everyone in the state, so everyone gets calcare. Now, I'm not here to say single payer health care is a great idea. There are plenty of examples of it not being a great idea in many respects. However, it does have a certain financial sensibility to it. It does
kind of the math works out fairly well. It doesn't work out so that everyone gets a Cadillac as far as the quality of their health insurance, but everyone can maybe get a Honda Civic as far as the quality of their health insurance. And it relies on basically the wealthy taxpayer paying for the non wealthy. There's a certain financial solubility to it, all right. Gavin Newsom was elected
saying that that's what he wanted to do. In fact, he had these brash proclamations in twenty eighteen about all these liberal politicians who say they're going to support single payer, and then when the going gets tough, when they actually come time to do it, they say that it's too expensive or it's not the right time, and I'm not going to do that. And then that's precisely what he did. He didn't do it because it was too expensive, and the going got tough, and the health insurance companies got
to him and convinced him not to do it. So what did he do instead? Newsom focused on the idea, well, I'm not gonna do single payer. The benefit of single payers that everyone's covered. But what I'll do is I'll attain universal coverage. I'll make sure everyone eligible for health insurance. And he did that by progressively expanding Medicaid eligibility medical eligibility. And why didn't he go for single pair? He didn't go for single payer because he realized it would require
a massive tax increase to do it. It would be enormously expensive. Now, the argument might be, well, if you just take all the money that people pay in health insurance premiums and combine it with all the money they're spending in their taxes right now, it's really not actually that significant of a tax increase. Okay, you try selling that to the people, and you try being a politician who's up for reelection, and you try selling that anyway.
Instead of a massive tax increase and a massive reshaping of California health care, Newsome instead off opted for what was really a half measure increase. The pool of medical eligible people. And this is sort of the trajectory that Democrats have been on since Obamacare, since Obama basically abandoned his single payer idea for the government option idea of you know, lots of heavily government subsidized plans for lower income people, and an expansion of Medicaid eligibility. So that's
what Newsom did. He expands Medicaid eligibility, but he doesn't really expand revenue into the state, either by increasing taxes or doing whatever is necessary to spur economic growth to prompt more income into the state's coffers. So medical eligibility expands, we have more and more and more people becoming medical eligible, receiving healthcare through medical but we're not increasing the resources available to have the payer of medical pay providers for
their services. More people getting healthcare, but not a proportionally increasing pool of money to pay for their health care as a result, and maybe the Coup de Gras, I don't know that we've really understood the full impact of it. The Coup de Gras was expanding medical eligibility to people regardless of their immigration status, which was like the last thing. Basically, people who aren't in the country. Legally, illegal aliens are
eligible for medical, so further expanding the pool. So medical hasn't gotten more money to pay for the healthcare for more and more and more people. This results in providers getting very little money as far as reimbursement for the care that they give. And this was the fundamental problem with Madera Community Hospital. Maderic Community was serving mostly lower income patients who were on medical. It's really hard to
make any money serving those patients. And depending on you know, some of it depends on what kind of reimbursement rates medical sets for you or for your region, what you can negotiate with medical. Some of it depends on what
area of medicine you're talking about. For example, I mean, I know this within Obgyancare because of starting Ourobia Clinic that if you do a normal you know, a normal pregnancy, a normal, healthy pregnancy that results in a vaginal delivery, a medical reimbursement for sort of the global bill for services throughout the course of that pregnancy, including the delivery is about fifteen hundred dollars. A private insurance reimbursement is
like three times that amount. If you have like Anthem, Blue Cross or something, or you know you're gonna your reimbursement's gonna be three times greater than that. That's how much we're talking. Is the difference between a private insurance payer, a private insurance company that's providing coverage for a patient and medical and Maderia Community Hospital couldn't sustain that. And this is a problem that you see with every single hospital in California. Like this is why I laugh when
I hear these stories. You know, some folks we are using Valley Children's, Oh they is val You know, there's this story about Todd Centripack, the CEO of Valley Children's, and the compensation he was being given, and people thought, oh, he's receiving way too much money in compensation, that this is a disproportionately high amount of money that they're giving to their executives. And then someone raises the question, oh, well,
is this because of medical fraud? Is Valley Children's misappropriating it's medical funding. No, Valley Children's gets money from medical as reimbursement for services they provide patient. What they get from medical is barely even covering their costs. Valley children is not making money off of medical patients. The reason why Valley Children's is doing well is because of one, donations and grants. Two because of their investment portfolio, which
they've done a really good job of handling. That guy's like Todd Centrapack, have done a really good job of handling. And I guess I don't know what would you rather have a hospital that has a highly paid executive that's functioning really really well and doing financially really really well and therefore able to provide really great care for patients, Or would you rather have Madera Community Hospital going out of business for you know, two almost two and a
half years. So that's the fundamental problem that led to Madera Community's closure. And yes, they got some loans, they got some state assistance, more state spending to help them reopen. But I guess I don't know if these fundamental economic and insurance market problems are really gonna be resolved When don't we return more of the problems that the sort of unsustainability of medical results in. That's next on the on the John Girardi Show. Madera Community Hospital is reopening.
This is a result of basically zero interest loans from the State of California. The distressed Hospital Loan program, which Annacabairo and Esmuel Dasoria helped pass through the state legislature in twenty twenty three. This program awarded Madera Community Hospital a fifty seven million dollars zero interest loan to help it reopen. Now, my wife laughed when she read this.
She's the management company that's running this, that's reopening the hospital is called American Advanced Management, which is a Modesto based hospital management firm, which said it is an updated workflow that will quote reduce wait times and overall patient outcomes. It will reduce wait times and it will reduce patient outcomes. I mean they've been reducing patient outcomes by having zero patients for the last you know, almost two and a
half years. I mean, they've done a great job, clearly, the folks that have I really hope the folks at American Advanced Management are better at patient management than they are at copy editing. Because they're going to reduce weight times and reduce overall patient outcomes. What are they going to just pull the plug on any patient who's, you know, causing them any difficulties. What are we doing? We're reducing outcomes anyway, This problem that we've discussed with medical impact
certain kinds of areas of medicine more acutely. And so the basic problem is we have too many medical patients, and our pool of taxpayer dollars to pay for health coverage for people on medical has not grown own proportionally to the pool of medical people. The pool of medical eligible people has grown since Obamacare was passed. It grew more under Gavenusom, and finally Gavenuwsom expanded it to include people who are here in the country illegally, so illegal aliens.
So the pool of people eligible for medical covered by medical has grown and grown and grown and grown. But the tax revenue to pay for that insurance coverage that has not grown, that's stayed, you know, it hasn't grown proportionally. So as a result, the reimbursement that medical can give to a provider, a doctor, a nurse, pectition or whatever for providing a service to a patient who has medical
coverage is less and less and less. And as a result, those doctors, those nurse practitioners, those hospitals, they can't make money off of medical patients, certain kinds of medical patients. By the way, here's one area where that's true. It's provision of obgyn care. You know, I've gotten to know about this by opening our Obria Clinic, which, by the way, for anyone who wants to go, Friday, March twenty first.
This Friday, We're gonna have a great fundraiser for our Obria Clinic at the Toka Maderra Winery out in Madera. You can go to Obria three six five dot org Obria three six five dot org. It says for twenty twenty four. We miss stated on the website, but it's for twenty twenty five. You can click there. You can buy tickets, you can purchase a sponsorship. This Friday, March twenty first at the Toka Madera Winery. A really cool
fundraiser for our Obria Clinic. I'd love to have as many of my John Gerardy Show listeners as possible go. But one of the things I've learned, basically is that medical reimbursement for pregnant women, who women having their babies is really poor. It's so poor that it results in more and more doctors just don't want to take medical patients for care, so you have more and more women on medical who need care. And fewer and fewer doctors who want to take them because they lose money off
medical patients. Again, the reimbursement is like a third of what you would get for taking care of a woman who has private health insurance. AAM, the company that's running Maderia Community Hospital for its new opening, has announced that the hospital will be reopening without a maternity ward. So Minderic Community is not going to have a maternity ward. The hospital's reopening partner has said its main focus will be financial sustainability before it decides whether it can add
maternity services. So this is the problem. This is the problem with medical right here, boiled right here. Certain kinds of areas of medicine are so unsustainable with medical that here where we're going to open a general hospital without maternity care, no maternity care services at Madeira Community when it reopens. Why because they've got to demonstrate some basic level of financial sustainability before they add in ob services,
because that's even less financially sustainable. If you're taking a bunch of medical patients to deliver their babies, you're gonna lose money and no one. I feel like this is a huge problem that this unsustainability of medical being able to take care of pregnant women that nobody is addressing.
When we return, I want to talk. I want to talk a little bit more about this, about this fundamental problem with caring for pregnant women and how it ties in a little bit with the abortion debate that's next on the John Gerardy Show. A couple of weeks ago, I had the privilege of I've been able to get a couple of articles published by National Review, and I'm kind of in their sort of orbit as someone I
contribute articles to them occasionally. I've had three articles published by them as of now, and I had this longer piece I wrote about messaging the pro life movement and being directorate Right to Life. This is obviously something I've thought about a lot, and I think one of the difficulties pro lifers are facing is basically the way most people think about abortion in America, insofar as they think
about it at all. That's my other thesis is that people just don't like thinking about the abortion issue in general, and so to the extent that they do think about it, they think about it in brief snatches in ways that aren't super fundamentally like logically consistent. People think of abortion
like this. They see a pregnant woman facing a bunch of burdens or challenges or difficulties, and they think, gosh, that would be really hard for her to continue to be pregnant and to have this baby and to care for that baby, and they therefore think abortion would be a compassionate thing to alleviate those burdens. This ignores the fact, however, that seventy percent of women don't want to have the
abortion they have. They would rather keep the baby, but they feel compelled to have an abortion by financial constraints, pressure from their partner, whatever, in some cases outright coercion. And I think one of the coercive forces that women face is a lack of health care access. Let me look at and I'm prompted to think about this, but the news. So we have this news that Maderk Community Hospital is going to reopen after over two years being closed.
It's finally reopening. It's reopening without a maternity ward. And this plays into what I think is a really underdiscussed crisis in California, in particular that in this state that the state does so much to pat itself on the back for saying that they are champions of reproductive rights. Gavin Newsom did this again on his Stupid podcast when he was talking with Charlie Kirk. He said, oh yeah, as everyone. No, no one's a bigger champion of reproductive
rights than me. They're not champions of quote reproductive rights. What they're champions of is abortion, which last I checked, is a non reproductive service. The point of it is so that you don't reproduce to actually help someone who would like to reproduce, who would like to have a child. I think California is doing a disastrous job, and a lot of it has to do with medical. Let's again the basic economics of what's wrong with medical right now?
What's wrong? Why did Madeira Community Hospital go out of business? You have a growing pool of people covered by medical and the pool of money state taxpayer revenue that is
used to fund medical reimbursement to doctors. That pool of money isn't growing proportionally to the number of people covered by medical So, as a result, the reimbursements that a doctor or a hospital gets for providing service, providing healthcare to a medical covered person, that amount of money is smaller and smaller and very often it's barely even covering
the cost of providing the care to the patient. One of the fields of medicine where this is most acutely felt, where you're getting very little in reimbursement for the services you're providing is obstetrics care for pregnant patients. It's really expensive to provide that care, and the reimbursement you get
from medical is not You're losing money. Very often, you are losing money unless you can find a way to structure your practice in a very precise way where you're basically just a factory line, just boom boom, boom boom, seing patient patient, patient, patient, patient, unless you can circle them through like cattle, and that's going to result in lower quality care. It's almost impossible to make money providing ob care to lower income women who are on medical
and we see this with Maderic Community. Maderic Community Hospital is quote reopening, but they're not gonna have their maternity ward open. They're not going to open up their maternity ward for a little while until they can figure out Apparently, according to their statement from AAM, American Advanced Management, which is the modesto based hospital management company that's reopening the hospital.
They said. This is from the Fresno b story. AAM has announced that the hospital will be reopening without a maternity ward. The hospital's reopening partner has said its main focus will be financial sustainability before it decides whether it can add maternity services. This is a major issue. If you're a pregnant, lower income woman in Madera and you're on medical, what the hell exactly are you supposed to do? Do you go to Merceed to get healthcare? Do you
have to drive to Fresno to get healthcare? To find somebody who will take your baby? Guys, this is why I at Right to Life. I started our Obria clinic. There are fewer and fewer doctors willing to take medical patients for obgyncare again because it loses money. Let me, I mentioned this in the first segment, but I'll say it again. A lot of the health insurance billing for a pregnant patient for her obstetric care is done globally.
It's sort of all of her patient visits plus the delivery for a normal vaginal delivery, a patient who has all of her exams, all of her inpatient you know, in clinic exams plus her delivery. Your medical reimbursement is somewhere around fifteen hundred bucks. Your private insurance reimbursement is three times that amount. Doctors are losing money on these medical patients and as a result, they're not taking them, and these women have fewer and fewer places to go.
If you're in Madeira again, if you're in Madera, I don't know what you do. Maybe you have to drive down to Fresno. Maybe you can get someone from Saint Agnes to take you. Maybe you can get our Obria clinic to take you. We have patients from Madera. Maybe you can go up to Merced and find some clinic that'll take you. But here's the thing. You can open as many United Health Centers as you want. You can open as many of these Federally qualified health clinics as
you want. They're not a substitute for an obgyn clinic. They're not a substitute for a hospital that has groups of obgyns who can take patients for the whole duration of their pregnancy. These FQHCs they offer certain limited services to help care for someone, but they're not a substitute for obgyn care, and that's all these rural areas have. They have these FQHCs that pop up all over the place. They get tons of federal reimbursement, so they make money,
but they're not really providing good obgyn care. They're not really an adequate replacement for an obgyn. But there's been a ton of investment in these in these FQHCs because people who invest in them know we can make a crap ton of money on the back end because the
ensure durance, the reimbursements that an FQAHC gets. Yeah, they're taking care of medical patients, so they don't get much reimbursement from medical but they get subsidized by the federal government too, and the amount of money they get is like comically high from the Feds. There's no provision of care like that for pregnant women. None. And then I'm supposed to, as a pro lifer, tell a woman in
that situation, you need to keep your baby. How can I do that if I'm not also providing her with the health care she needs to care for her baby during pregnancy. I mean, that's why we started Obria. How could we with a straight face tell lower income women, keep your baby, but you're on your own as far as finding a doc. So we started a clinic to do that. We started a clinic so to say, keep your baby and come to us. We will take care of your baby. We will take care of you over
the course of your pregnancy. And that's sort of the other problem. Why is Madeira Community not opening its maternity ward. Often medical pay patients their lower income. They have much higher rates of obesity, They often have more difficult medical histories, much higher percentage of those patients are high risk patients.
So if anything Madeira Community, if they were to open up their maternity ward, they would have to spend more per patient for patients who are providing them with less revenue in reimbursement, don't have to pay more of their insurance coverage, et cetera. And this is just this is not just a central Valley problem. I really think this is a problem throughout California, in lower income parts of
the state. We don't have great numbers about abortion rates in California because California refuses to report its abortion numbers to the CDC, but we know it's staggering. I mean, we know the amount of abortions California has I mean California has done. California has done so much to facilitate abortion and comparatively nothing to address this financial unsustainability of medical and the gaps in care for lower income women who need prenatal care that results from it. Of course,
this contributes to abortion numbers. If you're a lower income woman and you're pregnant and you're not sure if you can take care of this baby, and you call some clinic to see if you can get an appointment to be a patient, and they tell you, well, our first available slot is four months from now. Or you can go get the abortion pill in a week and have it be mailed to your house, or just pick it up at the CBS around the corner. I don't know
if CVS actually distributes the abortion pill. Certain certain major pharmacies do. I don't think all of them do. Anyway, I mean, how are you You're obviously propelled towards that solution. You are financially pushed in that era. California's public policy, the way it's public policy has been structured, These structures of sin that we've set up push people towards abortion. And you can see it. You can see it right here. With this reopening of Mederic Community. We're all, you know,
we're all applauding it, we're all celebrating it. But this fundamental unsustainability of medical I don't know if this goes away. Azrael Dasria can pat herself on the back, Anakabairo can pat herself on the back for getting these zero interest loans from the state to help Medera Community open up. It's not changing the fundamental financial problems with medical and instead of a a normal, fully functioning hospital, you have
a hospital without a maternity ward. That's what you've got because ob care is so financially unsustainable under medical that they're not even going to try to open Maderia Community with it at the start. They have to wait and see if they can make any money first before they can build that up. When we return, why, I hope there can be a more intelligent pro life movement to actually focus on these kinds of questions with the provision of prenatal care that's next on the John Girardi Show.
A lot of people have had a lot of critiques for the pro life movement ever since Row was overturned in twenty twenty two, we've lost various state ballot initiatives about whether abortions should be legal or not, even in deep deep red states like Missouri, Ohio. We manage barely to successfully beat back pro abortion ballid initiatives in Florida, which thankfully that was only because Florida requires a sixty
percent majority to amend its constitution. Uh And in Kansas. Now, I think one of the things we need is a more intelligently messaging pro life movement. There are very few pro lifers in California who are pointing out this problem with medical that basically women have nowhere to go. And pro lifers have established so many like pregnancy resource clinics that do wonderful work, and I think it's because of you know, I don't know that pro lifers have necessarily
the money to start massive you know, obgyn clinics. Pregnancy resource clinics do a lot of really good work and help people in a lot of ways, but they're not necessarily a replacement for obgyn clinics. And that is what is needed is more and more pro lifers providing OBG yancare. So if you want to help one of those in the Fresno area and go to Obria three six five dot org. Obria three six five dot org. You can can donate there and go to our fundraiser this Friday
at the Toka Maderra Winery. Should be a great time. You can actually help women in really serious need of prenatal care. That'll do it. John girolready shows you next time on Power Talk