Senior Care Academy - A Helperly Podcast
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Senior Care Academy - A Helperly Podcast
Healthcare Reform Reimagined: The Utah CARES Act with Joseph Jarvis
When a hospital CEO candidly admitted to Dr. Joseph Jarvis that they diverted non-paying patients elsewhere despite having available beds, it crystallized everything wrong with America's healthcare system. In this eye-opening conversation, Dr. Jarvis—physician, public health leader, and healthcare reform advocate—shares his groundbreaking vision for transforming healthcare access in Utah and potentially nationwide.
The Utah CARES Act represents a radical yet practical approach to healthcare reform that could eliminate the bureaucratic middlemen wasting billions while ensuring every resident receives necessary medical care without financial barriers. Dr. Jarvis artfully dismantles the "socialized medicine" critique by drawing a compelling parallel to our highway system: publicly funded, privately built, and universally accessible without anyone crying "socialism."
Perhaps most disturbing is how our current system actively punishes healthcare providers for improving patient outcomes. Dr. Jarvis shares the story of a Utah physician whose protocol dramatically reduced pneumonia hospitalizations and costs—only to see the hospital financially penalized for delivering better care. The Utah CARES Act would flip these perverse incentives, rewarding quality care rather than billable procedures.
Despite economic studies confirming the plan's fiscal soundness, political obstacles have temporarily blocked this initiative from reaching voters. But Dr. Jarvis remains undeterred, motivated by his faith and the knowledge that approximately 2,000 Utahns die unnecessarily each year due to healthcare access barriers.
Whether you're a healthcare professional frustrated by systemic dysfunction, a patient struggling with medical costs, or simply someone who believes healthcare should serve people rather than profits, this conversation offers both a sobering diagnosis of our current system and a hopeful prescription for meaningful reform. Visit www.utahcares.health to learn more, share your healthcare story, or support this vital initiative.
Welcome back to the Senior Care Academy podcast. Today we are sitting down talking to Dr Joseph Q Jarvis, a physician, a public health leader, a former state health officer and longtime advocate for meaningful health care reform. Dr Jarvis has spent decades working in medicine, public health and policy, seeing the system from every angle as a clinician, as a regulator, a teacher and as a patient advocate. He's also the author of multiple books on healthcare reform and the producer of the documentary Healing Us or US. Today we'll dive into the Utah CARES Act. What it is is, why it matters and how it could change the way that we think about health care in Utah and beyond. Joe, thanks so much for sharing some time with us today. I'm excited to talk to you. Thanks for inviting me on. I appreciate it very much.
Speaker 1:yeah, I always like to start giving the audience kind of a rundown on you. So you studied English before you became a physician. How did storytelling and English just talk about that and how it shaped the way that you talk about healthcare reform? And I think a unique thing is how you're able to express that in writing with your books and everything like that. I think a lot of times you have physicians that can't express it and then you have authors that don't know the problem well enough. So you have a cool balance that can express it and then you have authors that don't know the problem well enough.
Speaker 2:So you have a cool balance. As an English major, I enjoyed very much some of the authors and poets out there in history who were physicians, and enjoyed reading their insights. William Carlos Williams, for instance, wrote some short stories about being a pediatrician in New Jersey, and Keats, a very famous romantic poet, was a physician. Unfortunately died very young of tuberculosis. But more important than that, stories are how people connect with the important things of human life. Fiction has a lot of truth in it, even though it's not the truth per se, it's a story. So stories really make something real for people that they can embrace, hold on to, change their life around. And that is so true of something as important as changing how we do healthcare business. All big movements in the US history were fueled by storytelling. Yeah, from civil rights to the way we voted and who voted, to our current issues in the American political scene.
Speaker 1:And even all the way back to the Declaration of Independence. We sent this letter off to England saying, hey, we're not part of you anymore. You know stories Yep. Part of you anymore? You know stories, yep. Um, you've worn a lot of hats, uh clinician, regulator, teacher, educator, writer. Um, which role do you think taught you the most about what's broken in the healthcare system? And then, what's your favorite story so far that you've been able to tell about that to try to cause? I agree so much that, like you, can throw facts and figures and numbers and big scary numbers, but it's when you go back and that big scary numbers associated with this individual and how it changed their life that it actually moves people to action. So I'm curious what's roles shaped your thoughts? Um, and then, which story have you been most proud about? Trying to reform care in the US?
Speaker 2:Well, I love being a doctor who had my hands on patients, a clinician. That was a very important formative role. Going through medical training, I was a family doc first, before it was anything else in health care, but the role that taught me that there were fundamental flaws that were literally killing Americans was the role of state health officer in Nevada. That's where I went from believing, like most Americans do, that we do everything well, perhaps fast, and that our health care was better than anyone else's. That's where I realized that in fact is not the case. Anyone else. That's where I realized that in fact is not the case, and a story from that time that kind of epitomizes this.
Speaker 2:One of my roles as a state health officer was to regulate hospitals how they did, especially the most highly tech sort of services like newborn intensive care, and I went to visit the newborn intensive care unit in Las Vegas because we were trying to write regulations that would keep that level of care high and consistent. The hospital where the best newborn intensive care unit was in Nevada was a for-profit hospital. They also had good trauma care and we were trying to write regulations to improve trauma care in Nevada at the same time and had just published our regulations and asked hospitals to apply for the privilege of being the leading hospital in trauma care. This hospital, the one with the best newborn intensive care was where the president of the United States would have been taken if he had had some kind of traumatic event happen while he was visiting Nevada. So it was good. Trauma care is clearly the best, but it didn't apply for the designation.
Speaker 2:I ran into the CEO of the hospital while I was there and I said you've embarrassed the state health department. We have these regulations on trauma. We need a good leading hospital. Your hospital obviously fits the bill, but you didn't apply.
Speaker 2:The ones that did failed the test and we don't have a trauma system because of that. Why, and he said, you regulate us for how many beds we're allowed to open to patients? You give us the privilege of having as many as 430 patients. We routinely staff up to about 330 patients. We routinely staff up to about 330 patients. If a paying patient comes to our emergency room, our emergency room staff is trained to open up a bed, call in a nurse and admit that patient. If, however, a patient comes to the emergency room and can't pay for the bed, then we tell them that we're closed, we're at our limit and they are diverted elsewhere. Tell them that we're closed, we're at our limit and they are diverted elsewhere. So your regulations required the lead trauma hospital to take care of all patients with trauma regardless of ability to pay, and I'm a for-profit hospital.
Speaker 2:I can't afford to take non-paying patients, so we're not going to be your leader. And in that moment of honesty by this guy, he was basically saying his hospital was not about caring for people, it was about making as much money as possible. I realized, hey, we have a major problem on our hands.
Speaker 1:Yeah, that's a huge problem, especially because it's like a it's a little bit of a double-edged sword, where you have they're the very best, um, and there's a reason why, but, and they're making the profit and they're all that. But then on the other side of the sword you have the fact that, yeah, they have capacity and all these things, but the person can't pay. They're turning like it's a very interesting thing because on the one side, if they take the non-paying customers, they're helping them, but then who knows what happens on the other side? They lose money, so they're not as good. I don't know. It's interesting.
Speaker 2:You have to think about this a little bit differently. That non-paying customer is somebody who probably doesn't have health insurance for whatever reason, and there are a lot of reasons why that might be the case and not be the fault of the person, but you can also say about that person that he, as well as all other Americans, are the world's highest paying taxpayers for healthcare. We pay for healthcare primarily through our taxes. That person is paying the world's highest taxes for health care and they're being turned away at their moment of need for care.
Speaker 1:That's just wrong.
Speaker 2:What we need is a system that recognizes that we're already spending enough to have high-quality care for everyone and not turn people away. That's what we need.
Speaker 1:Yeah, on that note, if someone asked at dinner party to explain the Utah CARES Act in like 60 seconds, how would you explain that and how does that feed into this bigger issue of health care reform?
Speaker 2:The first, the Utah CARES Act, does three things already existing high quality, very efficient payer of health care called the Public Employees Health Plan into a universal all residents of Utah health plan. We renamed it Utah Cares. So that is a very simple statutory transformation because it exists as a private nonprofit trust fund existing at the behest of the people of Utah to pay for public employees' health care. And we'll just simply change it and say it'll pay for all Utahns' health care. So that's number one. Number two we supervise that new entity, the Utah CARES Plan, with a new commission, the Utah Health Systems Commission. We give that commission, which will be seven commissioners appointed by the governor, approved by the Senate. We give that commission, which will be seven commissioners appointed by the governor, approved by the Senate, we give them the power to oversee everything about health care, adjudicate all health care disputes, make all health care plans, budget for health care. We want them to be responsible for making sure the health system runs smoothly and is accountable to all of the people of Utah, which is what it exists for. And number three is we recreate how we finance health care. Most of the money, as I've already said, is public money and we take all of that money, which is mostly federal, and channel it to Utah Cares.
Speaker 2:The amount of money that currently comes from private employers and private individuals and is paid in for health care, we will replace with what we're calling the Utah Cares premium, which is a new gross receipts tax that will be levied on all transactions in Utah, whether for goods or services Very small percent, like less than 3%, and that money will then be diverted permanently solely to take care of healthcare needs. We will therefore tell employers from after this is fully implemented. You don't have to pay for the healthcare of your employees. You're done. You're out of the business of trying to finance healthcare. You can just work on your widgets or whatever it is that you provide as a business. So those are the three things. That's what I'd say in 60 seconds.
Speaker 1:I love that. It's a very interesting concept as far as where you're getting. So if Utah passes the Utah CARES Act, what would that look like for the everyday patient? It's like everybody in Utah is covered under it. They don't need to go and shop Aetna and da-da-da-da-da like all of them, Bringing it all the way back down to the ground floor. John Smith, down the road, what does that look like for him?
Speaker 2:Well, john Smith doesn't anymore. I mean, he never did need health insurance. What John Smith needs is care.
Speaker 1:He doesn't need health insurance.
Speaker 2:So we get rid of that middleman, that useless, wasteful, highly bureaucratic institution. That's a unique American phenomenon that is wasting 500 billion of our dollars every year. They're gone. They don't have to worry about that. They're employed.
Speaker 2:Where they're employed, how old they are, what race they are, where they live in the state of Utah, they will have financing for medically necessary care. What they need to do is pick their doctor and I don't care who it is, any licensed physician will do and if they need a physical therapist or occupational therapist, et cetera, et cetera. They pick their therapist, whoever they want to go see, and if their doctor says you need to be in a hospital, pick their therapist whoever they want to go see. And if their doctor says you need to be in a hospital, then whatever they he and you know John Smith and his doctor decide for the hospital, they get to go there. There will be no out-of-pocket expense at the time of care. You don't have a deductible, you don't have a premium to pay, you don't have a co-payment or co. -insurance. Nothing will no financial barrier to getting the care that you or your family member needs. Furthermore, the hospital and other institutions will be tasked with delivering the best care possible.
Speaker 2:One of the real flaws of our American health care system is we only do mediocre care. We have more preventable deaths in the United States by far than any other first world nation, and that's because we focus so much on the buck that we're not actually taking care of the people who come in the door. We do the right thing about half the time for the American patient. So John Smith will get the care done right the first time and therefore it'll be less expensive and John Smith will be in better health. Yeah, john Smith will be in better health.
Speaker 1:Yeah, in your documentary Healing Us, you talked about very openly critical on the profit-driven medicine. So the Utah CARES Act, how does it push against that Like? What does that look like? Now, going back to the clinician and the hospital, how does? I guess my one, the main question, is like how does the Utah cares act? Um, right, you have the bell curve, you have the, the 10%, top highest performing clinicians, you have the 64% and then you have, like the, the laggards that are not great clinicians. Um is, does the CARES Act incentivize or de-incentivize those really high performing clinicians that are like like that? That one in Nevada say that they were in Utah. I guess, how does the Utah CARES Act interact with the clinicians, the people doing the care? Dr Tim Jackson.
Speaker 2:It goes back to what I was talking about quality. I'll give you an example that dates back a few years in central Utah, a small community hospital in Ephraim. There was a family doctor there who's a friend of mine. He was in the middle of his career as the primary care doctor in this small Utah town and he noticed that people who got pneumonia in his community were not doing well. They were dying more often than they should. They were sicker than they should be. He did some research. He figured out what was missing, what had to happen, what transformation did the system need so that people didn't have these pneumonia-related problems so much? And he wrote a protocol. He went to all of his colleagues, all the other physicians in the community who were at the hospital, and they all signed on and said you're right, this is a great protocol, we will follow it. Then he went to the hospital administrator, who likewise signed on and said the hospital staff will also follow it.
Speaker 2:January 1st the following year they started the protocol and within a short period of time they had dropped the number of people who required hospitalization for pneumonia by half. They had dropped the number of hospital bed days for those who had to be admitted to the hospital by two-thirds. The costs also fell by half for the care of pneumonia. The problem that the hospital administrator had was that the reimbursement rates from the private for-profit insurance companies fell even more than did the actual cost of care. So the hospital took a financial hit for doing the right thing for the patients. Now what that says in the current system in the United States is, if you're a hospital administrator and you're trying to make a profit which a number of hospitals are for profit in Utah, and the ones who are not- for profit, act like they're for profit.
Speaker 1:Yeah, yeah, I was going to say the only difference between a oh yeah, go ahead.
Speaker 2:I was saying the only difference between a oh he's coming up.
Speaker 2:This hospital administrator realized something that's important about the current American healthcare system, and that is if you want to make the most money, you let your pneumonia patients get as sick as possible so you can sell those ICU beds where you make more profit. And our proposal, utah Cares, flips that on its head. What we will tell the hospital administrators is doctors and nurses know how to deliver best care. My friend, that family doctor. He can help you write the protocol. Doctors know what they're doing. Turn them loose and let them do the right thing for the patients. You're going to be paid on a basis of what it costs to do the right thing for patients. You're not going to be paid however much you can bill for selling as many ICU bed days. That's the transformation we're talking about.
Speaker 1:Yeah, I've seen in the skilled nursing world kind of the same thing where because of reimbursements, especially during COVID, they got a bad rap and kind of understandably so, where there was a lot of skilled nursings that would try to say, oh, they have COVID or they have something as quickly as they can to get them into a higher paying thing, to make more profit, and then they're keeping them longer. So it's the same idea of like, help the people and that's the whole point.
Speaker 2:Yeah, nursing homes are a great skilled nursing homes are a great example of another problem in related to quality of care, and that is, labor is viewed not as the way to deliver care, but as an expense that hits your bottom line and prevents you from profiting as much as possible.
Speaker 2:So they dumbed down the labor force and they reduce it. People in skilled nursing facilities are not getting the care they need and they're certainly not getting the skill level at the bedside that they need. What we're going to say to those facilities is what does it cost to really care for these patients? What do you need to do to make sure the nurses have the support that they need, that there aren't too many patients assigned for each nurse, that the nurse doesn't have to do heavy lifting without the proper number of people at the bedside to assist? How do we make sure that this goes well, not just for the patients but for the nurses? That's what we'll pay as an operating budget for the hospitals and the nursing homes and other facilities and they don't get to, you know, interdict there and make their profits the driving decision maker for all of these other insider decisions that they make, these other insider decisions that they make.
Speaker 1:Yeah, it sounds like it could be really revolutionary and awesome. I'm curious what's the toughest or the biggest pushback that you've gotten while advocating for this reform, and how are you kind of navigating that to try to actually get it pushed through legislatively?
Speaker 2:Well, the most common, most consistent over many years now and I've been in this advocacy business for 30 some odd years is people are worried about what they refer to as socialism. Isn't this socialized medicine? And the first response to that is to say no. Actually socialized medicine is where the government owns and operates all of the facilities, employs all the professionals, like the United Kingdom has its National Health Service, which is a socialized health system. The hospitals are owned by the government and the nurses and doctors are employed by the government. That's not what we're proposing.
Speaker 2:There is a socialized health care system in the United States. It's called the Veterans Hospital System. We're not proposing to replicate VA for everybody else in the country. It will be privately owned hospitals, privately delivered health care, but publicly funded. And my answer back to them about well, isn't that socialism? I said we've been doing public funding of health care for 75 years. I'm not inventing that. I'm just making sure that the public money isn't being diverted away to windfall profits in the health insurance industry and in the hospitals and pharmacies. I'm just making sure that that money is being spent actually for the care of patients in the highest quality manner. That's what we're doing.
Speaker 2:And furthermore, just because something is publicly funded doesn't mean it's a bad thing. We don't have a constitutional right to asphalt. It doesn't exist anywhere in our Constitution. And yet we have asphalt on the ground between my house and the White House, such that I can drive there without paying a toll, accessible to all Americans. And we don't call it the socialized highway system of America. That's just nonsense. That's public funding all Americans, and we don't call it the socialized highway system of America. That's just nonsense.
Speaker 2:That's public funding. Privately built roads okay, and yeah, we still maintain them with public funding, but mostly it's we hire private contractors to go do the work. That's what we're talking about Public funding. Private delivery of care.
Speaker 1:Yeah, that's a really good analogy. Deliberate delivery of care yeah, that's a really good analogy. Like just recently in my neighborhood they redid the water pipes, the water main. It's kind of an older community and the city paid for it, but it was a private construction company out there for three months working on the neighborhood. So it's a good, good analogy. You've been in advocacy, like I said, for over 30 years. What are some of the biggest improvements, some of the biggest like wins, the magnum opus or whatever, of all of your advocacy so far? And then what are the biggest? I guess we've been talking about the biggest hurdle that you have from now looking forward, but now looking back, what have been some of the biggest gains that you've seen realized?
Speaker 2:The biggest event in the entire 30-year career has been the writing, the drafting of this legislation. We were able to get a member of the Utah legislature to open a bill file and work with him, a state senator, nate Bluen. We worked with him and the staff at the Legislative Council Bureau, which works for the legislature, to draft this statute so we can actually put it out there, put it in front of the people of Utah and ask the question do you believe that every Utahn should have access finances for medically necessary care? Do you think that every child should get well child care financed, et cetera? That's the ask. We finally have it all cogently put together. That's been our most important milestone and I'm really very proud of it. We've placed that statute in its entirety on our website, utahcareshealth. Anybody can read it and anybody can comment about it. We're anxious to connect with the people of Utah and say this is what it could be.
Speaker 1:Yeah, I like that. And so the next step for you guys, it's to get a bunch of people to sign. Oh my gosh, I'm spacing on what it's called A yeah, oh, a ballot. Ok, cool, yeah, to get them. So next voting, which the next time everybody goes out to the polls Governor's office, which is what's required under state of Utah statutes.
Speaker 2:She referred the statute to the office of the legislative fiscal analyst, which is also required. They did their review and published what turned out to be a very terse, short fiscal impact statement and all it said was this could cause the state of Utah to go in the red by as much as $8 billion a year, which is totally bogus. We carefully did three economic studies that back up that what we have proposed actually will be fiscally sound. The state of Utah will not go in the red at all. But the Office of the Fiscal Analyst totally ignored our economic studies.
Speaker 2:Now I turned back after we got that statement from them. I turned back to the Lieutenant Governor's office and said well, what does that mean? Are you going to allow this to go forward and make us so that we have to explain why the fiscal analyst is wrong? And the answer initially was yeah, we'll allow you to go forward. We were still seriously considering this ballot initiative. We had, under Utah statutes, 20 calendar days to appeal that fiscal analysis, but it had to be done in court and I didn't want to spend the money on attorneys to go to the court because that's a lot of money.
Speaker 2:And I thought well, if they're going to let it go forward anyway. We'll make the court of public opinion the place where we make our arguments.
Speaker 2:On the 20th day the day our right to appeal was foreclosed, the lieutenant governor reversed herself and said no, in fact, that fiscal analysis means you're out. We're denying your application for a ballot initiative. So now we're in the position of having to appeal that decision. There's been recent news, for instance, about litigation that resulted from ballot initiatives in 2018. And there have been other people who've applied for 2026 ballot initiatives, like we did, who are appealing to the state Supreme Court. So we're now in the business of trying to raise funds so that we can sue the state of Utah in this Utah State Supreme Court to reverse this very arbitrary and capricious decision by the lieutenant governor. That's where we're at right now. We're not giving up. We want the people to join us.
Speaker 1:How do you stay motivated? You've been in it for 30 years. Things like this I'm sure have come up a lot along the way. What keeps you?
Speaker 2:motivated. It's an arduous, difficult, long-term problem. If it were just me alone, I would probably just give up. I mean, it is virtually impossible. Sometimes it feels that way.
Speaker 2:My main motivation is quite simple I'm a man of faith. I'm a believer in Jesus of Nazareth, and he went about healing. He didn't charge for pre-existing conditions and he didn't have denials based on prior authorization and he didn't charge deductibles. He basically said to people bring me your sick and injured and I will heal you. He taught all Christians how to go about taking care of the sick and he said if you visited the least of these, including the ill, you've done it unto me.
Speaker 2:This is what motivated the opening of the first three hospitals in Utah. The Episcopal Diocese opened the first hospital, the Catholic nuns of Sisters of the Holy Cross opened the second hospital and the LDS Church opened the third hospital, all because of that call from Jesus of Nazareth to care for the sick. That is a call that I hear and I feel in my heart and it's why I can't give this work up. I know that's what Christ would want us to do. We must care for the sick. Nobody must be excluded. There are four to five hundred thousand events every year in Utah where somebody desperately needs care and can't afford it because of the fact that they don't get care, that half a million people. We have 2,000 deaths unnecessary in Utah every year and that is unconscionable. Those are 2,000 stories that we need to tell and turn to all of the others in Utah and say can you stand there and do nothing? I can't Join us and let's get this done because we can afford it.
Speaker 1:Yeah, powerful, that was powerful On that. Who should reach out and how do they reach out to get involved in the Utah Cares Act?
Speaker 2:We would love to welcome all Utahns to our website. Again, that's wwwutahcareshealth. We'd love to have you come where you can find the economic studies, the statute itself, where you can learn more about what's underpinning our proposal. I post a lot of different things, either through op-ed pieces that get published, links to the film. We have our own podcast people can listen to, but, most importantly, you can join us. You can volunteer, you can tell us your story so we can help people connect through your story to the need for this change, and you can donate. As I said, we need to be able to hire an attorney, so we need funds right now. As I said, we need to be able to hire an attorney, so we need funds right now. Again, it's wwwutacareshealth.
Speaker 1:Awesome, joe or Dr Jarvis. It's been really a pleasure chatting for this last half hour. Yeah, everybody, I think should reach out and go to wwwutacareshealth. I think it's an awesome movement.
Speaker 2:Thanks so much for your time. Appreciate it. Thanks, thanks.