What California’s Healthcare Spending Doesn’t Guarantee | Sally Pipes

In California, we spend $220 billion a year on health care for the people that need it the most, covering millions of people. But at the same time, this system unfortunately is facing significant amounts of fraud, with people making up fake patients and charging the system. The Federal Centers for Medicare and Medicaid Services put a hold on federal government payments to California, $867 million because of the investigation. And some of the people that are under the care and the coverage, unfortunately, don't have access to doctors because the pay is not much for the doctors. Today we sit down with Sally Pipes. She will help us understand how the fraud works and how can the system in California survive and improve its delivery to the patients. The issue is that very few hospitals actually are abiding by the law and they're charged fines and they're paying these fines. Some of them aren't even paying the fines, but it should not be that way. Sally, it's great to have you on. Welcome. Well, thank you for having me. There's a lot to talk about going on in California and around the country, so glad to be here. Yeah, we want to talk to you about an important topic, which is health care. And there is a lot of talk about fraud in health care in California. We've had a number of cases. If you can tell us what you're seeing right now with fraud, and then we want to get into the health care system. Right. Well, first of all, we need to know that Medicaid and Medi-Cal, the California version of Medicaid, was signed into law in 1965 under Lyndon Johnson and his War on Poverty, his Great Society. So it's been around a long time, but it was really designed, Medicaid, Medi-Cal in California, to help those people who were disabled, who were vulnerable, low-income people. And now it has expanded to cover about 80 million Americans. And in California, we have 15 million Californians out of a population of 39, 40 million who are on Medi-Cal. That is 37 percent of our population. So it's a very expensive program. And when you have these large government programs without verification of eligibility and things, you find out there are some very creative people out there who can become fraudulent. And so fraud has become a big issue in California. The centers, the federal centers for Medicare and Medicaid services, back on July 1st, put a hold on federal government payments to California, $867 million because of the investigation into the fraud that they found out was going on. Fraud in California, fraud in Minnesota, and I'm sure there's fraud in many other states around the nation because it's a huge program. $220 billion of our budget last year was for Medi-Cal, and our budget for this year is $351 billion. So Medi-Cal is a huge part of our government. And we need to get the fraud out so that the program is there for the vulnerable people, the legacy population who really need Medi-Cal to get access to health care. Tell us about the fraud. How does that happen? And you mentioned that this is a big pool of people, 15 million people are on it. Well, part of it is a lot of fraud comes because there are people who are ineligible that get on Medi-Cal or Medicaid, and there's no oversight of whether they should be on the program. It covers individuals who earn below $22,000 a year. They are eligible under the federal poverty, FPL, federal poverty level. But because of no oversight and no verification, there are a lot of people that are earning a lot more, but they get on the program and they don't get off because nobody says they're ineligible. Or there are probably a lot of dead people who are on the rolls and someone is receiving that money even though that person isn't alive. So, you know, we have a lot of fraud in the managed care organizations, and we need oversight on that. 270 hospice licenses have been revoked in California because the government has discovered fraud. I'm excited that the federal government, the Department of Justice has started up a watchdog, a federal fraud watchdog organization for looking at California and looking into fraud. So let's hope they find out where that fraud is and they get rid of it because it's expensive. And it means that taxpayers in California have to pay more in taxes to cover the cost of fraudulent people who shouldn't be getting Medi-Cal. Does the money come from taxpayers from California or does it come from the federal government? The Medicaid program which was set up was a joint federal and state program. So the traditional Medicaid was between 50 to 75 percent of the funding for the states would come from the feds and the difference would come from the state. But under Obamacare and then under COVID, about 90 percent of the funding has been coming from the feds to the states. So a great opportunity for state legislators to say, let's just put more people on Medi-Cal because we're getting all this money from the feds. And that is, of course, the government doesn't have any money. It's our money. And so we have to keep paying higher and higher taxes to cover these government programs. And when this type of fraud happens, do the doctors make up patients or do the patients will get services they're not supposed to get? I hope that most of the doctors I know are pretty honest people. And I don't think, I mean, you occasionally will see like some ophthalmologist in Florida, you know, was charged with fraud of over a million dollars doing, you know, charging for cataract operations they didn't do. But most doctors that I know are very, very honest. I think the issue is because there are so many people on the program and the fact that doctors are reimbursed at rates below what they get paid for Medicare patients for our seniors and well below what they get paid for patients with private coverage. So the issue is that a lot of docs will not even take Medi-Cal patients because the reimbursement rates are so low. Or if they do take a patient, those patients are on a waiting list for a long time. And so, you know, the legacy population that needs the kind of health care that they should be entitled to aren't getting medical care on a timely basis or they can't even get that care. So we need to return the program to the covering the vulnerable, the people that it was designed to cover. Even Robert F. Kennedy Jr., the secretary of HHS, he has said himself that Medicaid was designed to help the vulnerable and we shouldn't be paying for people that are not really eligible for the program. So let's return it to its roots to help those people who are low income, who are disabled and need medical care. Now, Sally, in terms of the Medi-Cal, can you explain to us how it works? 15 million people are on it. It's like 40%, almost 40% of the state population. You mentioned that people are not getting the care that they need because their reimbursement levels are low. Can you tell us more about it? You know, doctors have to cover their costs. And if they're not, you know, getting the reimbursement rate from the state government for taking people who are on Medi-Cal, you know, they're going to limit the number of patients they take or not take any at all. And we're seeing increasingly under Medicare, the program for our seniors, that a lot of docs, you know, are no longer taking Medicare patients. So it's really hurting those people that should be able to access health care. So it's a problem. And we have, of course, another reason for the tremendous growth in Medi-Cal is because when Jerry Brown was our governor back in 2010, he started saying that undocumented immigrants, illegals, children could get Medi-Cal coverage. By January 1st, 2024, under Governor Gavin Newsom, everyone who is an undocumented immigrant was eligible for the Medi-Cal program. So in 2024, the state spent about $8 billion to cover 1.7 million illegal immigrants. Our budget has gone down. We don't have the revenue. So the legislature under Gavin Newsom put a freeze on increasing the number, allowing new undocumented immigrants to join our Medi-Cal program this year. And starting next year in 2027, they're going to make some of these undocumented people, when they find out, you know, what money they're really making and make them pay a premium to be on the program. So that's a little bit of oversight that is actually going to help those people who are on Medi-Cal for a certain reason, and they qualify for it. So people have the insurance, but it's hard to get the service when they need to go to the doctors. Now, the logic has been that we should put people on these programs so they don't end up in the emergency rooms. Can you tell us about the health care system, how the hospitals do allow you to get care if you come to the emergency room? Right. So anyone, legal or illegal, in this country can turn up at an emergency room and they have to be given care. And so, you know, and it's very costly care. Even Michelle Obama, before President Obama became president, she was at the University of Chicago Medical School and their hospital. And even she said, you know, it's a tremendous cost on the system when you have people who have, like, a sore throat or a toenail or whatever problem, and they come and use the system. The emergency rooms should be there in the great hospitals like Chicago, Harvard, Yale, New York, Presbyterian. The people that come there should be people who are having serious issues, a heart attack, a stroke, but not there for people have, you know, who have these minor ailments who are turning up. It's very costly for the system and it's hurting the people that really need that kind of care that they need. Under Obamacare, of course, illegals are not covered under the Obamacare exchanges, either the federal exchange, the healthcare.gov, or under the state programs. So it's interesting. So people are still people who have an ailment and don't have coverage and haven't signed up for Obamacare or aren't on Medicare or Medicaid. They're turning up at emergency rooms and they have to be treated, but they can't get coverage at the national level unless they are citizens of our country. It's a really big problem and it's growing. Brian Blaze, who runs Paragon Health out of Washington, he has predicted that the Medicaid system, there's about $1 trillion of fraud in the system nationally over the past decade. That's a lot of money. And so now, finally, attention at the national level and the state level is turning to, we need verification of eligibility, we need oversight of managed care companies, and we need to get a grip on this program. And I think the Fraud Task Force is a great idea. I mean, it's now some of the fraudsters are going to be thinking about what are they doing and what am I going to do now if my fraudulent career ends? Where am I going to make all this money? And as I say, 280 hospice centers had their licenses revoked, a lot of fraud there. And for the people who need hospice care, you need the program to work well and to provide good care for those people. And a lot of those hospice care places are not very nice and not very good. Now, in terms of the healthcare system, you mentioned there's a big chunk of fraud in there, but the cost of care every year is going up double-digit. It's outpacing the cost of the inflation. What do you attribute that to? So our healthcare system is about, about, what, $5.7 trillion a year for the full healthcare system. We don't have a total free market system in healthcare in this country. 50% of healthcare in this country is in the hands of government through Medicare, the seniors, Medicaid for low-income people, the CHIP program for children, and of course, the Veterans Administration. So there's a lot of the cost of our healthcare system. As I say, $5.7 trillion, about 18% of our gross domestic product is for healthcare. It's the largest component of the federal budget. And there's so many rules, mandates, regulations on healthcare plans. Under Obamacare, for example, 10 essential health benefits have to be provided under any exchange plan. So therefore, you've got alcohol rehabilitation, in vitro fertilization, knee replacements, whatever. And the healthcare system should be there and people should be able to get the kind of coverage that suits their needs and those of their families. I might want a plan that covers alcohol rehabilitation because I've been fighting against single payer healthcare my whole life. And you may want in vitro fertilization for your friends, female friends or whatever, but you should have to pay for that if you want it. But not everyone should have to pay for all of these expensive programs. And certainly under President Trump in his first term, he brought in short-term limited duration plans where you could sign up for a plan that doesn't have all the essential benefits. Very good for young people, people between jobs. You could get a plan for very inexpensive and you could have it for one year. And it was renewable for up to three years. President Biden came in and he cut that back to three months and renewable for one month. Well, nobody wants that kind of coverage but you do want a catastrophic coverage and short-term limited duration plans are a great example. And I'm hoping that Mr. Trump is going to sign an executive order and expand them back so that people who are between jobs and young people can get coverage for catastrophes. The other thing is association health plans. The Department of Labor has just proposed a rule where so maybe Epoch Times has, I don't know how many employees you have. But there might be Newsmax and other smaller groups. So groups of people and organizations, smaller groups can band together and form an association health plan so they can negotiate a better rate for insurance premiums with the insurance companies because it spreads the risk, you get a lower price. So I would love to see Obamacare eliminated. Unfortunately, when John McCain was a senator and his vote caused it not to be revoked. But anyways, we have it. But these plans are very, very expensive. So we've got that issue. We also have in insurance plans, we have a couple of programs. One is the 340B program, which is costing a lot of money. It was designed originally for rural hospitals to make rural hospitals have the funding from the government to support low-income people and disabled people. We need to reform 340B. It's very expensive. It's grown to, I think over $80 billion now. And the hospitals, it was for rural hospitals. And now a lot of the big hospital chains are all benefiting from 340B. The other is PBMs, Pharmaceutical Benefit Managers, the middlemen between the insurance company. These middlemen, there's rebates and discounts. And those rebates and discounts originally were to be returned to the patient. So when you go to the drugstore, you would get your prescription at a lower price. But unfortunately, the way it is, the PBMs, the Express Scripts, the CVS Caremark, and UnitedHealth, they're the middlemen. They're the PBMs. And they are taking the money, and they're not passing the savings onto the patient. So we need 340B reform. We need PBM reform. We need to open up the market, allow short-term limitation plans, association health plans, bring about competition, empower doctors and patients, and not the federal government and state government. We will then be able to reduce the cost of care and get to affordable, accessible, quality care for all Americans, which is what we all want. So when we go as patients, when we go to the doctor or we go to the hospital, we have no idea what's the cost, what we're getting ourselves into, because our insurance will cover it. Do you think the system has to change where people would know if they go to ABC Hospital, they're going to end up paying $10,000 for this operation. They go to XYZ Hospital. Right. I mean, right now there are no site-neutral payments. So if you go to the hospital with some condition and have a mammogram or an MRI, the hospital is charging more than if you were going to an urgent care kind of thing. The price should be the same, whether you go to an urgent care clinic or to the hospital. But the hospitals are benefiting from getting higher money from their services. So that's an important part of it. The real issue is transparency. When you take out a credit card, you know what the percentage, the interest rate is going to be. When you get your phone service, you negotiate with that. But with your health insurance, you have no idea when you're going to the hospital to have a baby, say, you don't ask, you don't know. But there was a law passed that effective in January 1st, 2024, all hospitals, all large hospital systems had to provide the transparency and let patients know what the cost is. The issue is that very few hospitals actually, you know, are abiding by the law and they're charged fines and they're paying these fines. Some of them aren't even paying the fines, but we need price transparency so people can decide, you know, do you want to get your MRI at Huntington Hospital or Hoag Hospital or do you want to go clinic down the road? And so we need price transparency. We have price transparency in everything, but in our healthcare system. So when people can shop around for the kind of deal that is better for them, that is going to reduce the cost of healthcare too. What's the logic of not having transparency? Because we're hearing that different insurance companies have different deals with the hospitals. Yeah, they negotiate. If you pay cash, is it different? We have transparency in most aspects of our lives. Why it hasn't happened in healthcare? I mean, the hospital people say, well, you know, we have newer machines or they're more expensive or we can do it faster, whatever, but it should not be that way. As I say, you get your car insurance, you get your house insurance. You shouldn't be getting your healthcare insurance through your employer. That was a gift to employers at the end of World War II when wage and price controls were in. So employers couldn't lure you to their company or if they lured you, they couldn't offer you more money. So this was a great benefit to offer tax deductible health insurance as part of your benefit package. Of course, you're earning less money because your employer is paying for that part of the premium or the full premium, whatever, whichever way it is. But we need to open this up. It's a very odd system and it shouldn't be that way. And there's certainly a lot of research and things that I do trying to open up the system and get out of this, you know, the federal government, the state governments and all of the mandates and regulations which make healthcare very expensive and also makes it difficult for some people to get access to care. So the benefit we're getting right now by having employers pay for our insurance, we are saving the tax money, right? The people that are employed. Well, the companies, yes. And the employees. Yes, right. And about 160 million Americans have employer-based coverage. But, you know, but now more and more, the average cost of an employer-based plan for a family of four is about $24,000 a year. And a lot of employees would rather, you know, have a more stripped down plan, depending on the situation within your own family. One of the exciting things under, one thing is health savings accounts where you put your money away tax-free and you use your HSA to pay for things out of pocket. And you're saving money. It's a very great system. The other thing is it was called individual coverage health reimbursement accounts where employers could allow you to choose. They will give you a certain amount of money. You buy your own coverage. And they just changed the name of that to choice arrangements, which is much better because, you know, individual coverage, health reimbursement, nobody knows what that is. But I think we are going to see some tremendous growth in companies putting the money into your account and you decide what kind of plan is better for you. So if I want a plan that includes, say, in vitro fertilization, and you can go out and purchase the kind of plan that is best for you, and it will reduce cost. Some people say, Sally, that the cost is higher here because most of the innovation in this space is the American companies like doing the drug discovery, doing all this work. What are your thoughts on that? That is definitely true. I wrote a book, it was published in 2025 by Encounter Books called The World's Medicine Chest, How America Achieved Pharmaceutical Supremacy and How to Keep It. Many countries, England, France, Germany, you know, back in the early days, they were great innovators in new medicines, new treatments. But as these countries more and more adopted price controls on healthcare and on drugs, they stopped doing the research and development. The big European companies do their research and development in the US. Why is that? Because there are no price controls. You can do research and development. It's very, very expensive. It costs about $2.6 billion a year from an idea to getting a drug through all the trials and onto the market. Only one in 10 makes it to market. And it takes about 12 years to go through the process. So we're the country where this is all done. President Biden signed into law in August 2022. The Inflation Reduction Act, which included price increasing. They started this year price controls on drugs for Medicare beneficiaries. That's going through. They keep adding more and more. It started with 10. Now 20 drugs are going to be. This Inflation Reduction Act and price controls has already had a negative impact on companies doing research and development into many new treatments. This is where America is where all the new treatments, all of the new biologics come. We have intellectual property protection for a small molecule drug for nine years and a biologic for 13 years. These other countries are free riding off our research and development. And that needs to be changed. But we want to keep our market open for research and development because we all want to live longer and healthier lives. And a lot of the new drugs, you don't have to go to the hospital and have surgery where there's all kinds of implications of bad things happening. And then Mr. Trump, of course, is a big proponent of the most favoured nation. Price controls tying our drug prices to those other countries which are lower because they don't do the research and development. I don't know why he is for these price controls because it's going to destroy innovation. Thomas Phillips and University of Chicago economists has done a lot of great work on that and showing that the number of new drugs and the R&D is going to go way down. So we need to keep the market open. Just right now, the new mRNA vaccine drug has received approval from the FDA. We've got some new treatments for pancreatic cancer, one of the worst cancers that one can get and the lowest survival rates. So these have been approved here in America. They're not developed and approved in other countries. So we want to keep that open because I want to live longer. If I have cancer, I want to have the best drugs and the best treatments and the best programs to keep me alive. So we want to keep our pharmaceutical sector alive and well. And they all went, they just basically disappeared in Germany and in England and France because of these price controls. Now, Sally, about the healthcare, some people argue that we should focus more on keeping people healthy and there's not enough emphasis because there's not a lot of money in that. What are your thoughts? Well, I mean, wellness is an important part of our lives but I think people should be responsible for how they eat. I mean, you don't have to be a genius to know that fruits and vegetables and non-fried foods and that are better for you but it's easier for families, you work all day, you come home, it's easier to go to McDonald's and get a burger and fries than it is to say, go to the store and get chicken breasts and some fresh fruits and vegetables for dinner. But people know what is best and easiest for them. So people need to take control of how they eat, what they eat and be responsible. In terms of the single-payer healthcare, this has been a conversation in California and many, many times and also, you're from Canada and you guys have this system and there are certain countries that have this single-payer model healthcare. What are your thoughts on that? I am totally against, I've spent my whole life fighting against single-payer. Canada has a true single-payer healthcare system. There is no private coverage for anything considered medically necessary. So when the government took over the system in 1984, people thought, oh, you don't pay anything at the point of service, oh, this will be great. Well, what has happened now by 1993, the average waiting time in Canada from seeing a primary care doc to treatment by a specialist was 9.3 weeks. That's just over two months. Last year, 2024, the average wait 28.6 weeks from seeing a primary care to getting treatment, that's over half the year. There's a shortage of doctors, about 6 million Canadians out of a population of 39 million can't even find a primary care doctor. And the Canadian Association of Radiologists shows that the equipment in the hospitals are owned by the government too. The equipment is so old that they can't even rely on a lot of the results that they get. The average wait for getting an MRI in Canada across the country is about 18 weeks and the equipment is old. You know, this is what happened when government controls the purse, the feds make transfer payments to the provinces, the provinces also raise taxes for this. But the system is denying people care. In the UK, under the National Health Service, which came into being in 1947, they allowed private healthcare to run parallel to the National Health Service. So an increasing number of Brits, including the royal family, always goes private. Companies now provide private coverage because there are about 7 million Brits are on a waiting list to get into the National Health Service and the service is not that good. Doctors in the UK are paid on average about 280,000. Here in the US, it's about 380,000. So, you know, you want the best and brightest people to go into medicine and if the government is totally in control, the best and brightest aren't going to go into medicine or if they do, they're going to get out of it because they can't do the kinds of treatments and surgeries and procedures that they were trained to do. So it's a very, it's a terrible problem. And the cost, the average, Bernie Sanders gets up on the stump and says, you know, single payer Canadian healthcare is free. Well, no, it's not. The hidden tax burden for a family of four in Canada, last year, $21,114 in hidden taxes for a system where you have long waits, ration care and lack of access to the latest equipment. So when you see Bernie Sanders saying it's free, it's not free. And when you look at single payer in this country, it's estimated by Mercatus and even the Urban Institute that the cost of complete takeover in this country would be about $3 to $4 trillion a year. So we're spending right now about $5.7 trillion on healthcare. You're almost doubling the cost of our healthcare system. And invariably, you will see long waits, ration care, just like in these other countries. Two hundred and some thousand Canadians cross the border every year and come to Canada, pay out of pocket for... Come to U.S. Come to the U.S., yes. In order to get, if you think you have a brain tumor or you're thinking of a heart issue, AFib, any of these things, and you're going to pay because you want to live longer and you can't get that kind of service in Canada when the government is controlling the purse strings, both nationally and at the provincial level. You mentioned it's about $21,000 of hidden tax. How is it hidden? Well, because you pay for it when you buy tobacco, when you buy alcohol, all of these taxes, you don't know them. You don't know they're going to healthcare. And the tax burden is a lot higher there. Their tax freedom day in Canada is over a month higher later in the year than it is here for taxes being paid to the three levels of government. So you mentioned that it takes weeks to just get an appointment to see your doctor. It's like almost six months. Over six months, yes. 28.6 weeks. What about a procedure or an operation? That is from seeing a primary care doctor to getting the treatment by the specialist, which might be an operation. I know so many people that when you have to wait months to get chemotherapy or radiation therapy, your cancer can move along a lot when you have to wait for such a long time. But it's just the way that it is because the government can't afford to put all the money in for the demand for healthcare. So they need to, the province of Alberta, which is the most American of Canada's provinces, their premier is doing some things, setting up some privatization of the healthcare system, whether the feds will come and shut them down, who knows. But it's exciting that where all the oil and gas is in Alberta and a lot of Americans there, that she, Daniel Smith, is actually trying to open up the systems of some private alternatives, which will then reduce the waiting list for everyone when people can choose some private options. Sally, there's another thought about this. Now you're bringing Canada, there is now assisted suicide, right? Yes. The government can help you. There's an impact in the healthcare side of things because as we get older, the cost of our healthcare goes up a lot. Because we use it a lot more, yes. So MADE, Medical Assistance in Dying, which is called, which is MADE, it's assisted suicide. Canada allows, it's legal to have assisted suicide in Canada. And of course, it reduces the cost of healthcare because if instead of treating you for cancer and allowing you to survive and live maybe five, 10, 20, 30 years longer, if when you're diagnosed and they say, well, you might die in two years, well, would you like to have assisted suicide? So a lot of docs are now offering assisted suicide as an alternative to getting treatment and allowing you to recover from something. Because what assisted suicide does is it reduces the cost of healthcare because you don't have to cover the cost of keeping you alive with all of these different treatments and drugs. So it's rampant in Canada. And a lot of patients are really, and families are upset that when you go in and say, I've got a pain in my chest, the first thing the doc will say, well, have you considered assisted suicide? And so it's really, it's a terrible way. Now in Kathy Hochul in New York, I don't know if she's signed the MADE law yet, but if she hasn't, she's going to very soon. California has assisted suicide in dying. It is a way to cut the cost, but we have so much innovation. I mean, if you have a cancer today and you get chemotherapy and you live, you never know when the next real treatment and allow you to live longer is going to come out. So you want to be able to be available and alive to get access to the latest treatments. So rather than just saying, well, okay, well, I guess I'm not going to live, so I'll take assisted suicide as a way to put me out of pain and also to reduce the cost of our healthcare system. And it's interesting in the UK, the Parliament has had a number of bills in the House and in the House of Lords, the House of Commons, the House of Lords, bills on medical assisted suicide. And the latest one just went down to defeat, even with the Labour government in control in the House and in the House of Lords, they're appointed there. So I was very excited that Britain said no to assisted suicide, but unfortunately a number of states are saying, oh, we can reduce our healthcare costs by encouraging people. Especially when the government is in charge of healthcare. Right, whether it's Medicare, Medi-Cal, Medicaid. Yes. So do you see the healthcare system broken here? Do you think there's a way to make changes? Do we have to make drastic changes? I see America as the best healthcare system in the world. We have some problems and we've talked about them, making PBM reform, making 340B reform, allowing people to buy the kind of coverage that suits their needs, taking it away from employer-based coverage is going to be very difficult, but that would reduce the cost and give people more opportunities. So we have the best healthcare system in the world. Our cancer survival rates five years out are the best in the world because we have the best surgeons, the best treatments available. So we need to make some reforms and that's it, but we don't need more government in our healthcare system. If you look at the military system, the VA system is a single payer system. You read in the paper all the time about how the vets cannot get access to the best doctors. They have long waiting lists. They have to go travel a long way to get treatment. So we don't want that for the American people. American people want choice and they want to be able to get the best healthcare so they can live longer and healthier lives. And we're seeing some great new innovations in cancer treatments. They're all happening in this country. Cancer is one of the words that people dread the most when you go to the doctor and find out you have a cancer diagnosis. We want to continue making it possible for these innovators to discover these new treatments that allow us to either eliminate cancer or at least survive a lot longer. Do you have any recommendations on Medi-Cal? Yes, I do. One, we need to make sure that the eligibility is verified every six months that you're eligible for the program, not just you're on it forever. You have to verify your income and whether or not you're eligible, what your situation is. And then you need to, we need the oversight of the managed care organizations. There's a lot of fraud in the managed care organizations, health maintenance organizations, HMOs. And we need to just keep up, keep the healthcare fraud task force going so that they can do their investigations and find out what's going on. So we need to ensure that the program is there for if you get rid of all of this fraud and abuse, the program will be there for the people that it was designed to help as Dr. Oz and Robert F. Kennedy Jr. have been talking about lately. Sally Pipes with Pacific Research Institute. It was great to have you back in California Insider. Well, thank you. Great to be on. There's a lot to understand and it's complicated. I always say understanding healthcare is like unraveling an onion, many layers and many tearful moments. And as my great friend, P.J. O'Rourke, who passed away sadly a few years ago, he used to say, if you think healthcare is expensive now, just wait until it's free. That's financially and medically. So we want to keep our system open. It was great to talk to you. Please come back and give us updates in the future. Will do, yes. Tell us what you think about this conversation with Sally. Do you or any of your loved ones, have you guys seen any fraud in the system? Make sure to tell us in the comments or email us at ciamac.californiansider.com. We read all of your emails and comments. I'm Ciamak Karami. This is California Insider. We'll see you next time.