The Chris Voss Show - The Chris Voss Show Podcast – The People’s Hospital: Hope and Peril in American Medicine by M.D. Ricardo Nuila

Episode Date: May 9, 2023

The People's Hospital: Hope and Peril in American Medicine by M.D. Ricardo Nuila https://amzn.to/44LfjSM Where does one go without health insurance, when turned away by hospitals, clinics, and doctors? In The People’s Hospital, physician Ricardo Nuila’s stunning debut, we follow the lives of five uninsured Houstonians as their struggle for survival leads them to a hospital where insurance comes second to genuine care. First, we meet Stephen, the restaurant franchise manager who signed up for his company’s lowest priced plan, only to find himself facing insurmountable costs after a cancer diagnosis. Then Christian—a young college student and retail worker who can’t seem to get an accurate diagnosis, let alone treatment, for his debilitating knee pain. Geronimo, thirty-six years old, has liver failure, but his meager disability check disqualifies him for Medicaid—and puts a life-saving transplant just out of reach. Roxana, who’s lived in the community without a visa for more than two decades, suffers from complications related to her cancer treatment. And finally, there’s Ebonie, a young mother whose high-risk pregnancy endangers her life. Whether due to immigration status, income, or the vagaries of state Medicaid law, all five are denied access to care. For all five, this exclusion could prove life-threatening. Each patient eventually lands at Ben Taub, the county hospital where Dr. Nuila has worked for over a decade. Nuila delves with empathy into the experiences of his patients, braiding their dramas into a singular narrative that contradicts the established idea that the only way to receive good healthcare is with good insurance. As readers follow the movingly rendered twists and turns in each patient’s story, it’s impossible to deny that our system is broken—and that Ben Taub’s innovative model, which emphasizes people over payments, could help light the path forward.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. The CEOs, authors, thought leaders, visionaries, and motivators. Get ready, get ready, strap yourself in. Keep your hands, arms, and legs inside the vehicle at all times because you're about to go on a monster education roller coaster with your brain. Now, here's your host, Chris Voss. Hi, folks. It's Voss here from thechrisvossshow.com, thechrisvossshow.com. Welcome to the big show, my family and friends. We certainly appreciate you guys coming by. The Chris Voss Show is the family that loves you but doesn't judge you.

Maybe not as harshly as your mother-in-law. I'm sure she's wonderful. Thanks for tuning in, folks. As always, please refer to the show to your family, friends, or relatives. Go to Goodreads.com, 4S Chris Voss, YouTube.com, 4S Chris Voss, LinkedIn.com, 4S Chris Voss. You can even find the chris voss show podcast on tiktok and me of course on tiktok as well uh check out the new ai podcast at ai uh chris voss.com uh today we have an amazing author on the show his newest book just came out may

i'm sorry march 14th 2023 uh i can't believe we're in may already uh so that's why that slipped out i'm just i'm in denial about the whole thing i'm still in march actually probably february uh but his newest book just came out the people's hospital hope and peril in american medicine dr ricardo nuwila is on the show with us today he going to be talking about his amazing book and everything that goes into it and his insight. He is a teacher and practicing doctor at Ben Taub in Houston. He is an associate professor of medicine and, let's see, associate professor of medicine, medical ethics and health policy at Baylor College of Medicine. His writings appear in articles published in Texas Monthly, The Houston Chronicle, The New Yorker, The Atlantic, and of course, the New England Journal of Medicine. His short stories have appeared in the Best American Short Stories anthology as well as McSweeney's.

Welcome to the show. How are you, sir? Thanks, Chris. I'm doing great. Thanks for having me on the show. And thanks for coming. There you go. So give us a.com. Where can people find you on the interwebs to find out more about you? RicardoNuila.com and on Twitter, I'm at RicoNuila and same on Instagram, at Rico Nwila. Rico is just, I grew up in Texas and everybody called me growing up Rico Suave. We were talking about it before the show, you know,

Ricky Ricardo, the Rico. So it's Rico Nwila at, on Twitter and Instagram. There you go. Well, I mean, I mean,

there's a lot of great people that are really elegant who are named Ricardo or, you know, Ricky. I mean, you know, we, we talked about Lucy and Ricky. Andardo or you know ricky i mean you know we talked about uh lucy and and ricky and then uh you know i i always remember ricardo montalban from fantasy island

and and from the naked gun series yeah that guy had class class very elegant guy he got the ladies i'm pretty sure so uh tell us about what motivated you to want to write this book. Yeah, I work as a hospitalist, which is an internal medicine doctor at the public hospital in Houston, Texas. And that is the flagship hospital for a healthcare system, a public healthcare system in Houston. It's not a type of health care that Americans usually encounter. And it took me years to figure that out. But basically, it's a health care system that's designed for people who can't afford health care. Texas has 25% of people in Texas don't have health insurance.

They slip through the cracks. They can't afford health care. And so they've ended up coming to this health care system in Houston. And I wrote the book for a lot of reasons. One of them is, A, because they've been shoved out of hospitals and they're odysseys. I really wanted to render that story, like those stories of just what it feels like to be told to leave an emergency room to prepay 600 bucks just to get a diagnosis to be cast aside when you get a cancer diagnosis. But I also thought it was a book to that was important because it demonstrates that the public system can work. We work in a hospital

where we feel proud of what we do. And we actually, a lot of the patients have said this is when they get insurance, a lot of them stay at this hospital. So the hospital addresses these two major, major problems that are the cause of our healthcare problems, which are, it's too expensive to get healthcare in America and not everybody is covered. And so it just made sense to me that I need to write a book about this, really with the stories at the center of it, just to tell Americans how health care can be different, how it could be modeled after something like what we do in Houston. There you go. So give us a little bit of your origin story. What made you want to become a doctor and get into this field? Well, I was born into a family of doctors. My dad was a doctor. His brother, my grandfather. My

grandfather was from, my family's from El Salvador. My grandfather might've been the first Salvadoran to attend a Harvard Medical School to get a public health degree. So I come from this lineage of doctors. And I was kind of that high school kid that was uh just kind of going to follow along in the footprints not just because not because I felt pressure but just because it just seemed like a good field I will say this it was in the 1990s Houston Houston Rockets were the world champion so I was really really wanting to be the Houston Rockets doctor. And what happened is during college, it became clear that my dad's as a doctor, as an OB-GYN, he started to feel beat down by the insurance companies. I mean, he started practice in Houston in the 80s. And he started with like two employees, a nurse and somebody, a receptionist.

His practice grew. But by the time I was applying, he had three people purely for insurance companies. Wow. And one of them was his mom. His mom was like a, you know, Chicago born, depression era raised woman. I mean, kind of the perfect person you want to sick on insurance companies, to be honest, like relentless, right? How he, by the time I was applying, I was just like thinking that medicine is just not really a great profession. It's clock in, clock out. It's transactional. It's all about insurance work. And it was really until I started to learn at this hospital where I started to encounter the stories the people there where I was like wait a minute health care could be different because you don't get it's not that you're being judged by how much money you bring into the hospital

your job at the public hospital is to take care of the person in front of you and so I loved it I started to love it and and. And I decided that that was the place that I wanted to practice medicine because I was about to leave. There you go. 25% of people in Texas don't have insurance. Yeah. Isn't that crazy? It's insane. It's insane. The numbers are startling about how many people don't have insurance. And it's for a lot of reasons. Number one is that Texas is one of the only states, one of the last 10 remaining states that has opted not to expand Medicaid coverage. So the Affordable Care Act, what it did was at first it's tried to cover all these gaps that we have in health coverage in America by expanding Medicaid. But the Supreme Court decision made it so that states could decide. And Texas has just been one of those

states that has decided, no, we are just not expanding Medicaid to cover the poor. And so you have to be exceedingly poor in Texas to qualify for Medicaid if you're a single adult or in many cases. So that's one of the reasons. And also because of the state's lack of investment in the state coverage funds that established by Obamacare, it's also just extremely expensive. And so a lot of people have opted not to. I mean, and that's one of the interesting things in the urban centers, like Dallas, like Houston, in order to care for those people, public systems that are locally based have arisen. And to be honest with you, they, they, they compete in quality and certainly in cost, but in quality with the private system. And that's what this book is in many parts about is just about how healthcare

can be different in America. It could be cheaper. It could be much more accessible for everybody. It could be better quality. We just have to understand why it is the way it is right now and to change that. Wow. So you guys are providing a successful model then. So it is possible, all these high-profit things. So this is really interesting. Is there a lot of people's hospitals in Texas? They're in the big urban centers, Parkland Hospital, which I'll be visiting next week in Dallas. That's the hospital where John F. Kennedy, when he was shot, was taken to in Dallas.

So these hospitals have come from a tradition of serving as trauma centers, as the place where you want your best surgeons to care for those who are traumatized by gun violence. And in Texas, of course, there's a lot of gun violence, but also automobile trauma. So, yeah, these centers have arisen because they're teaching centers for the students, the medical students and residents in medical schools. But they've also had to care for the community in these centers. Because remember, Houston and Texas has a very large uninsured but also undocumented population and they cannot qualify for any coverage. So here's the problem. We also have a law called EMTALA, the Emergency Medical Treatment and Labor Act, which guarantees that every single person in America, regardless of citizenship,

regardless of insurance, can get emergency care, stabilizing care in this country. That's a right every single person has. Oh, really? Yeah. So it doesn't matter if you have bad insurance. You can go and get stabilized at an emergency room if it takes Medicare, and all of them pretty much do. Now, they will still generate bills and bill you, you know, but when you cannot pay those bills, those get thrown into a big, big pot of, you know, we're not getting recompensated for this in the hospitals, you know. And so we as America have had to develop patchwork for this and designate funds. And what we found out,

what we're finding out, what we've known, but we're finding out is, is that it is so much more expensive to care for people in emergency situations than just to give them healthcare and let them and try to prevent those illnesses. And that's the springboard of these systems in Texas. You have Dallas, you have Houston, you have San Antonio, you have El Paso. They have started to grow these systems because they're saying we can't we can't let our hospitals bleed like this. We need a public system because if people are going to the emergency room and they will go to the emergency room if they need care. Yeah, it's just going to be so more much more expensive for everybody so it's a sub it's it's in many ways it's also a

subsidy for the private hospitals in uh the state yeah we've had we've had doctors on uh that have been really open and honest they've written books and talked about how, you know, the healthcare system largely in the U.S. is you're just a dollar sign. You're not a human being anymore. You're just a dollar sign. And so I think I thought that's why your book was interesting because it focuses more on people. And, yeah, preventative care is really the key. I mean, what you said isn't, I don't think, any news to anybody

because, you know, if you go in and, you know, you get your mammograms and colonoscopies and, you know, you, you do the pre-work and, uh, also if you eat right, you know, I, I know people that have put off, I think I had a friend recently who they'd, uh, you know, had something happen to him. They didn't want to go in the hospital. They ended up dying of an infection. Uh, you know, you, you see a lot of people with sepsis now and you're like, how did you get like, how did that? I mean, there are things where it can get out of hand. Like I had a friend who had surgery and got sepsis from the surgery, but you know, there's times where, you know's times where you know people you know do stupid stuff and and uh they don't they're just like oh that'll clear up you know even i'm at the age now where it takes longer to heal stuff and and uh you know i had some spider bites and you take some penicillin for it

uh because i guess it started getting a little nasty yeah and uh so you know as soon as i saw that like hey this isn't going to clear up man i gotta go get this looked at um but yeah people and there's a lot of people it's kind of interesting that use emergency rooms for doctor visits now it's because it's just so expensive i mean let me give you an example. My wife, who, you know, has insurance, she had two children. And during COVID, she hadn't been established with her primary care doctor. So she called and said, you know, I'd like to reestablish myself on primary care doctor, fine. Six month wait, fine. She waited the six months, the day before the appointment after the six months, the day before the appointment, after those six months, the office manager says, oh, by the way, tomorrow, we have you down as just a physical. If you were to say that there's

any complaints, any symptoms, that's going to be an extra 35 bucks. And I mean, so it's, we can feel as Americans that they're ringing us for every single penny. And that's what we feel at the primary care doctor. That's how the system is based. And it's really, Chris, I'm going to be honest with you. I wouldn't practice anywhere else but a place like where I'm practicing, where it's not transaction, where I can focus on medicine. It's enough to be thinking about the medical problems of all those complicated cases that you're talking about sepsis. It's enough of that. But when you throw that extra variable where, you know, the way that it happens is pressure

from the powers that be, Oh, this person's uninsured. Do you, are you sure this person needs to stay in the hospital every five, you know, like getting paged a lot. Oh, the insurance company's not going to, you know, take on that cost of the MRI that you want, you know, all that. It's, you know, I just wouldn't practice outside of the system where it's the focus is not actually taking, keeping people healthy and using what you have to take care of the bed, do the best you can to take care of people. Yeah. And so tease out some of the stories you tell in the book. Yeah. So Stephen, I'll start with Stephen.

Stephen is a 60-something-year-old guy who works as a restaurant manager. He makes $75,000 a year. And just like a lot of Texans, a lot of, a lot of people in general, not, not had to see a doctor and he kind of sees everything as a racket. So he chooses as part of his job, you know, I'm going to have the lowest insurance, uh, because, you know, I, uh, you know, I, why in God's green earth, what I, uh, what I need, what I pay more. Well, COVID starts. And coincidentally, right then he starts to feel a mass on his neck. And he goes to an emergency room. Finally, after days and days of fevers and knowing that this is bad, it's grown to the size of a baseball really quickly.

He says, okay, I have my insurance. I'll go to the nearest private hospital. And they charge him $650 just to sit in the waiting room. And they give him the runaround. And then a doctor does a CAT scan and comes out and says, you have tonsil cancer. However, you have to leave the hospital. We can't give you treatment with your insurance. Holy crap.

So he's stuck there again i i want i want to like frame this for everybody because the hospital where i work the public hospital in houston maybe nationwide people would be like that's where other people go that's where the homeless people go that's where the people who use drugs go that's where like the dregs of society and that's what steven is thinking when a social worker comes and tells him, go to that hospital, they'll take care of you. And, you know, his story is in the book, you know, what he expects. He thinks he has hit rock bottom going to the public healthcare system. What his, you know, what, what are his expectations and how this is different than his expectations is a part of the book.

Hint, he actually really loves his care. And he actually is, even though he has insurance now, he gets very good treatment. He gets what he thinks is like the greatest treatment. He still goes to the hospital because of the way that it's patient focused and because of the cost effectiveness and he got good care. Yeah. One of the interesting things about what goes on in, in our healthcare system is anywhere I go,

I can get pricing and I've, and I've tried to nail down, you know, I've, I've tried to control my healthcare costs because I understand it impacts the whole system. I mean, I have insurance, but I still shop doctors. And when you call a doctor and be like, hey, man, what's the general roundabout cost for this? And you can't get fees.

And I think there was some legislation that was supposed to force this, but my understanding is it's been resisted, which I, it's not, yeah, it's, it's not being enforced as much, you know, it's, and you know, the stranglehold is so deep in America of like how corporations have a stranglehold over, over healthcare, because it's really, you know, what you're talking about is this, that there should be a market, right? I should be able to kind of like say to somebody, Oh, can we, can we, can we work something, you know, transparent pricing, transparent pricing. And that's part of like that market. Right. But we don't, we don't have that. We don't have that. And I think one of the reasons is because the power is so consolidated in corporations that own insurance companies. They own doctor's practices, too.

The same companies will own doctor's practices. They'll own insurance companies. They'll own hospitals. So they're kind of like, you know, running the show. And they lobby very strongly for the laws to be generous to them. So the reason why I think that Houston's system is a model is because I feel we got to compete with that. And the only way to compete with that is a public entity. Think about it like this is the way I think about it. What if you're a 23, 24 year old,

you're coming out of college or you're not, you know, but you're kind of, you're pretty healthy in general. You take on a job and right now you have to pay out of your pocket to, you know, but you're kind of, you're pretty healthy in general. You take on a job and right now you have to pay out of your pocket to, you know, it's, there's going to be a copay, but your, your, your business is going to take, your employer is going to take some of that cost of healthcare, but you're going to still have to take some out of your paycheck so you can get insurance. Right. Well, what if we had a good system, a system enough where you were like, you know what? I don't need to do that. I don't need to do that. Because I can go to the public health care system. If I get sick, I can trust that I will go just to the hospital downtown or the clinic in my neighborhood, they'll treat me and they'll and they'll charge me like, like base price because there's not a middleman they're trying to make profit, right.

So what happens then I think that what happens is, is that the insurance companies and the corporations have to compete for your business now, right? Because that's a real palatable, that's a real palatable competitor right there. That if you, if you're saying, what am I paying? Like all of us are saying, why are we paying for insurance? Right? Because if we, we get charged, we get charged a lot regardless. But if we could say, we're not going to pay for insurance, we could go to the public healthcare system. Those guys have to start competing for our business. Maybe they lower the prices. Maybe they're like, oh, well, all of a sudden we're going to give you better terms. But they don't

have to do that right now because they have such a stranglehold on the industry. It's crazy, man. And people live and die. People live and die. Yeah. The value of life in America is just crazy. I mean, don't we have one of the highest mortality rates for births and stuff? Oh, for maternal? So for infant mortality, we're in like the teens.

So we pay 18 cents of every dollar in America goes to healthcare. That's like round double of what Western European countries spend. Okay. That is, it's an enormous, it's more than any other industry that we pay for. So imagine like, you know,

you pay four bucks towards something and another buck goes into a, like everything that you buy, almost like 20% of it goes toward health care in america and what we and what we get for that is is that those rank or the rankings for infant mortality maternal mortality which are markers of how a system is doing for everybody we're kind of not not that great we're in the teens we're in the 20s you know we're not doing we're kind of not, not that great. We're in the teens, we're in the twenties, you know, we're not doing, we're not, you know, so it's, there's a huge disparity, but yes, there's a huge disparity, but there's this focus on extracting profit that is so intense that those things don't pay, you know, like keeping internal more, keeping infant mortality,

keeping maternal mortality rates good, you know, ultimately they don't pay well. So it's, it's, that's why we have the system that we have. It's because it's focused on corporatism. It's focused on extracting money out of our pockets. We have all felt it. That's the thing. You can have a principle about like, you know what, I believe in the market, all that stuff, but We have all felt it. That's the thing. You can have a principle about like, you know what, I believe in the market, all that stuff, but we've all felt it at some way that these people are trying to extract as much money from our, from our pockets at our most vulnerable times when we're sick. Definitely at our most vulnerable times. That's the craziness. And so you tell these stories, is there, is there a there a way like who's who owns this uh business

and you know is there a way to uh extrapolate this across the nation is so there's a model that can be uh scaled yeah so harris health for instance the the so the the public health care system in houston is called harris, and it's funded by local taxpayers. It's funded through property taxes. I pay into that system. And so that gives more than, you know, the budget is more than a billion dollars of health care spent in Houston. And what that goes to is a centralized local system. The health care system has clinics in different

parts of town. It has two hospitals, provides specialty care, primary care, you know, chemotherapies for cancer, all of the evidence-based things. So it's when you start to look at guidelines, what doctors recommend of like how the treatments should go. You get that standard care at these hospitals and in these clinics. And if you make 150% or less of the federal poverty level, you get it, you, you get that care virtually for a nominal fees. I'm talking like $3 for clinic visits, things like that. If you, if you don't qualify for that financial assistance, you pay, you can, you pay out of pocket, but the cost, because there's no middleman, there's no, um, you know, there's, there's no insurance company company in between you and

the system that's trying to make money there. The hospital is not driven for profit. The doctors are not proven because I make a salary for instance instance, and I don't make enormous bonuses for every person that I bring in. Since that has been cut out, it's affordable care. And the prices are even in New York Times articles have been shown to be among the lowest in the country. So, you know, yeah, I think that we have to think scaling that would have to take a federal local efforts. I think that we would have to really think about how,

uh, how we organize healthcare right now and, and, and, and reapportion money. But I'm giving you the model of how that's happened in Houston. That seed was planted in the 1960s to make this healthcare system. It's similar to the one that's in England in the National Health Service,

but it's on a local level. And it's not as, it's, if you, the National Health Service is for everybody. But I think that what Americans don't really realize is just how valuable that could be in our lives. A system where you don't have to worry about your insurances. You don't have to worry about coverages. All of that is very helpful for patient care. And I think we really have to start thinking about it. Most definitely.

I mean, it's funny how we just kind of take healthcare for granted. And we're just like, yeah, we'll get to that part when it comes up. And, you know, we don't take care of our health. We don't, you know, try and make sure that we're, we don't do the preventive stuff. We've gotten away from all that stuff. And then, you know, when we then you know when we you know end up in trouble then we're just like running the thing in fact you know I know a lot of I know a lot of one-way friends and some other friends that have

young kids their wives you know insurance really gets abused sometimes too where anytime there's an issue they they're running to the ER. Right. And you're just like, you know, if the baby's a little sick. I agree with that. You don't have to run to the ER for, you know, everything. They just use it for everything because, I don't know. I agree. And, I mean, I think that that has been to a certain level encouraged

because there's money to be made there, you know. We are based versus all other countries. We're based on the fundament of fee for service in this country. And what that is, that's, that's from the time of the revolutionary war. That is, that is a principle that the lobby of doctors has reinforced time and again, over, over centuries in America. It's very different than the rest of the world, which is basically that doctors should be able to bill for everything that they do. Okay? So what that means is that, like, I give the example.

If you're coming in for gallbladder surgery and the doctor leaves a rag inside of you during the surgery, he can bill for two surgeries, all of that. That's just instead of looking at the the the end goal we are doing, we're billing for each part of the American healthcare system, which is that we, we, we give doctors the incentive to do more, to treat sickness rather than to, to keep people in good health. And so that's, that's one of the big problems that we have. We have that fundamental, you know, the Affordable Care Act tried to change some of that stuff, but a lot of it is still operative. You know, in fact, it's still the way that medicine is based. It's just like you do something, you bill for it. You do something, you bill for it. I think it's starting to wear on doctors, too.

Now, I know that that's the carrot that's dangled so that doctors can get that's why what brings you know the compensation in medicine is is really one of the things that brings people to the field it's i'm i'm you know listen i i benefit from that but i i also want to say that people are leaving the profession at high numbers people are are not working. They're, you know, they're stopping after like years because they they're sick of this. And so I think it's become one of the things that the system is imploding upon itself like that. We don't, we're going to lose so many doctors that, you know, we're not going to have enough for all of the medical ailments that we need to fix. Yeah. In fact, I've heard that from doctors that we've had on the show,

that doctors are in decline as an industry. And, you know, COVID and what you're talking about, the insurance issues. And, you know, it's gotten to the point where you're just like, I can go make more money doing something else. I mean, I've had girlfriends that have worked as the insurance, you know, they're working in a had girlfriends that have worked as the insurance, you know, they're working doctor's office trying to hustle the insurance companies to pay their bills. And it's extraordinary. Some of the stories they've told me, I'm just like, seriously?

Wow. I mean, they must have felt it like what that's like on a daily basis. That must be, you know, I know that when you're on the line with somebody, because I have been on the line complaining about, and there's another human being on the other side of it. I've thought, wow, that person has to take that home because it's like they're giving the bad news of like what is happening in our system, you know? Yeah, it's pretty crazy, all the stuff that's out there. Well, this has been really insightful. And hopefully people pick up your book and, you know know somehow we need to change the model of this but it seems like uh all the rich and powerful corporations make all the rules in america thanks to citizens united and their scotus rulings so uh well that's why starting democrat you know the way that this

system was founded the way that it happened in the 1960s, we had one charity hospital that took, that was the only place that poor African Americans of Houston could go to, it's called Jefferson Davis Hospital. Okay, so what happened was, is that it just took one person to write op eds about how atrocious the conditions were, the county and the city didn't want to fund it. And it became a civic issue. And what ended up being is that the citizens of Houston voted in favor of a system to fund health care for the people who couldn't afford it. And that seed was planted 60 years ago. So we have to think about planting seeds right now.

We have to think about trying to use our democracy in order to change our health care. I'm a big believer in capitalism but we have an unbridled capitalism and i think i've had enough authors on this show to realize that yeah you know i believe in capitalism i believe that it's hard to even think beyond it but this is not capitalism like you said this is this is a this is um death monopoly this is a death monopoly. This is a death monopoly. This is a cartel, really, of corporations that are setting their prices. And unfortunately, there's no responsibility. So capitalism, the basis of capitalism, there's something about the person purchasing that retains responsibility.

But there's no responsibility here. It's like stockholders that are in completely different states are dealing so in fact you could make the argument and i think i've thought about this a lot that to save capitalism we're going to have to like do something about health care because if people start to if this continues to implode people are going to doubt the whole system you know and so I think that we need to really think of the nuances here. If we really, you know, to think about like, uh, how to use healthcare to, to, to save our other institutions as well. Yeah, we really do. And things seem to

change. I mean, we're, we're beyond the breaking point, I think, of everything. Well, thank you very much for coming on the show. We really appreciate it, Dr. Nwila. Give us your.com so people can find you on the interwebs. Ricardo Nwila, I'll spell it out because it's a weird last name, but it's R-I-C-A-R-D-O, N as in Nancy, U-I-L-A.com. I'm also Rico Nwila on Twitter and at Rico Nwila on Instagram. And I'd love, you know, and, and, and through my website, I, you can, you can message me. I keep in contact with people. And you can find links on how to buy the book.

And that book is really like a conversation storytelling about the people who need healthcare, why they can't get healthcare, but also showing us why we got into this situation and ways that we can get out. It's important that we, you know, we recognize that there are models of success and we just need to apply them and all that good stuff. So, uh, you know, that's what we need to do them exactly and uh all that good stuff so uh you know that's what we need to do so thank you very much for coming on uh thanks for tuning in order of the book wherever fine books are sold uh this is also editor's pick right now for best non-fiction on amazon so there's a nice uh endorsement uh the people's hospital hope and in American Medicine, March 14th, 2023 it came out. Order up wherever fine books are sold. Go to goodreads.com Fortress Chris Voss, youtube.com Fortress Chris Voss, all those crazy places we have

on the internet. Thanks for tuning in. Be good to each other. Stay safe. We'll see you guys next time.