Delay, Deny, Depose:Corp' Extraction in Healthcare & How Tokens Heal America | Micah Baylor - Opolis

[Music] hello eth Denver hey everyone I am Micah Baylor I'm the lead benefit Steward at opis and today I'm here to talk to you all about um healthc Care Health insurance as a public good uh yeah we got a lot to unpack you see it was December the 4th 2024 at 6:30 in the morning that CEO Brian Thompson was shot in the streets of New York now if Brian Thompson was anyone other than the CEO of America's largest Health insurer we probably wouldn't know about him but the fact of the matter is that people are so frustrated with America's Health Care system that they shot the SE CEO of United Healthcare in the back on a normal morning in December written on the bullet casing delay deny depose the words that every Health insurer uses to drag out claims to deny claims and to put more money into their coffers you know it's it's never it's never a good thing when there's murder in the streets but the fact of the matter is is that 500 50,000 American families went bankrupt in just 2024 we're we're up to our eyeballs we're we're frustrated with this 550,000 Americans went bankrupt United Healthcare covers 50 million of them that's that's a that's a ratio that's just not okay I mean if the customer satisfaction rate was that good at Wendy's no one would be going to windy the the problem the problem is is a lot at the end of the day it's just a broken system you can't hate the player you have to hate the game and the game in healthcare is make profit return profit to Wall Street Health insurers are allowed to make 15% profit and the incentive is to grow the cost the overall cost of doing things as much as possible because hey they can only make 15% so they got to make 15% on more cost so they add steps and extra processes redundancies Administration deny appeal deny appeal prior authorization you all understand over the course of a last year health insurance profits have skyrocketed and when they dipped a little into 2024 health insurance companies come out and they tell us oh we're not making as much money as we used to things could get bad when in reality they reported less profit but had more stock BuyBacks than they've ever had on recorded history American satisfaction in healthcare continues to dwindle something's broken something's got to give and I believe the thing that must give isn't the players the players are often well-intended people however it's just that they're working in a broken system that only rewards increased Wall Street dividend send more money to Wall Street the only thing you can do is open cooperatives cooperatives are not big government they're not big government takeover of health care they're not big Insurance cooperatives can often operate just like a business they can grow coffers they can pay claims but they can be owned by the people who are using them so what what might it look like it might look something like this the first thing you need to know is what's currently happening hey when you send a 100 bucks to the health insurance company it goes into a few different buckets usually only about 50% is actually going to paying for your your doctor and your Pharmacy stuff that's all and then what they do is they sell you Pharmaceuticals that they've marked up God knows how much they buy in bulk and then sell you the individual price they're incentivized to have as much Administration as possible because again they can only make 15% and then at the very top of this awful stack is just endless profit taking at the top with more and more reinsurers and just little fractions adding cost to your bottom line and honestly taking away your ability to get the care you need if you just made it Community owned I mean hypothetically right if you just put it on chain then you know what when when you're in the dark you see ghosts and when you put it on chain you bring light to the system you start to see of the dollars are going and you're more okay with it the thing is though is that if it's community-owned there's not just a incentive to make profit for Wall Street quarterly reports there's also a an incentive to take care of the people who own it so you can lower Administration you can take out all this overhead all this process that's been added to this system just to grow the cost of it this is honestly conservative if you made health insurance awesome I have 10% savings at the top but I'm just I'm uh I'm being judicious yeah yeah it's very possible I've seen uh plans that maybe would be better than 10% and something that you can definitely do when you bring the total cost of healthc Care on chain is generate a lot of real yields health insurance premiums are paid every single month no one's going to miss that they don't want to get sick and not have the ability to go see of a doctor and there's profit in health insurance you can simply create real yield that pays the stakers way less money than the insurance companies are taking from us you really only need three pieces to have an insurance company you need to have a network you need to have claims Administration and you need to have a ton of money and you know the network idea is honestly from like the 1980s and it's just outdated technology there's better technology it's called Cash you give a doctor cash on the spot and the doctor actually charges you less because they don't have to go fight the insurance company for their money it's pretty amazing cash Works anywhere you can still build things like hey uh po into the back end but try to pay cash first all that you're doing is removing the incentive to deny And Delay you're making it so that it takes care of the Community First network not actually that big of a problem there's a lot of solutions out there in trafy insurance claims Administration it's it's the same thing like it's super easy to get ACA compliant claims Administration done and then you can just gradually bring this onchain once you know all of your privacy is firmly in place certainly you can't mess around with privacy um pertaining to health information but it's also a thing where hey ZK proofs and these things can make it happen fully autonomous onchain claims not that far out not that many steps as you would think and then the money hey there's $14 billion locked up in just igen layer there's billions of dollars in Stak crypto assets and what all of them want is a real yield all of them are just looking for real yields and guess what you can do you can just you can just do math like people have been doing Actuarial underwriting on how much risk is inside of a Health Insurance Pool for a long long time and you can bake in real yield into your health insurance protocol for the part for the purpose of borrowing liquidity from that protocol when things heat up and you know there's more sick people than normal money the three pieces all of those things on chain all Community owned not that far out why now I don't know the current landscape maybe this is more like a landscape slide for you all there's a big Trend in the provider industry we're talking about hospitals we're talking about cardiologists ear nose and throat specialists we're talking about the people who actually take care of you there's a huge movement in this group of people to just take cash in fact 177,000 clinics take only cash in America they say we're done with a networks we'll take only cash I'm seeing 74% red uctions and the cost of claims when you don't run your claims through the network remember those insurance companies how they were going to build networks that negotiated better prices for us turns out if you just pay cash it's like a lot cheaper most of the time why now hey employers are looking for a different option most people get their health insurance from their employer in America and the rising cost of Health care has been the number one pain Point outside of like just being broke for any business in the US when you take it on chain you gain a lot of transparency you give employers the ability to actually take care of their people I mean 50% of employers in the US are cutting benefits this year they're cutting cost or they are cutting the quality of their benefits and they've been doing that every year for last decade they've been doing that as long as I can remember the current system certainly isn't sustainable there's $4.8 trillion in premiums paid every single year and 50% of those people are going to change their health care this year these Health insurers have underwritten profits into our premiums and stored away $8.4 trillion into their coffers imagine if only Healthcare was community-owned for a decade how much money when we have sitting in our coffers and what would we do with that yield how would we take care of our community how would we do the conversations that no one has an answer for right now mental health uh fertility treatment IVF all of these things all these things could just become more and more accessible if we give the power to the people and remove bureaucracy to replace it with technology public good Community owned what you've got is on one side of the aisle you've got the the right you've got the right and you got the left on the right they cry out we don't want a government takeover of health insurance government takeover of health insurance who would possibly want that and big insurance will spend tens of millions of dollars promoting that propaganda anytime that we have a public option come available we will never see a centralized government health system in the US it is entirely too easy to Market government takeover of health care and have people show up at The Ballot Box and vote no even if it would actually take care of them we've seen it time and time again and on the other side you've got Bel they don't want big insurance they think for-profit insurance is evil and yeah for-profit health insurance is inherently evil I'd agree the only thing that I can think to do after spending 13 years doing group Healthcare is just to make it all Community owned cooperatives are you know they they're corporate vehicles that can operate in a capitalistic environment and if they accidentally make money then that money can sustain the community that it came from there's just no other option people shouldn't have to pay insurers profits to access the care that they need I think I said 50% earlier turns out as 53% of employers plan to make a change 80% of consumers think health insurance companies prioritize profits over patients and they are right Health insurers deny claims at an all high rate United Healthcare set up an AI that denied 90% of the claims that came its way 90% of the claims that came its way why is that because hey the longer they hold on to your money the longer they're getting profits off of your money sitting in their vaults and sitting in their coffers they have no incentive but to deny delay and depose your claim and America's sick of it the only people that are happy with Healthcare are people who are not using it that's pretty much what I got guys it's incredibly easy it's well incredibly hard I mean honestly like taking on big insurance is going to be like fighting an ugly gorilla they're going to pump out propaganda as they always have done and they're going to fight at all cost all cost to protect their profits because it's super sustainable money once you get a big enough group of people together you just do math and you know how much money you're going to make in a given year it's pretty much that straightforward no no when I say it's going to be incredibly easy what I'm talking about is mostly this insurance Beast is not as complicated as you might think all of the complexities that you uh maybe don't understand it's propaganda they've created this confusing complex system so that when you think of it you immediately want to stop thinking of it that's how it works and at the end of the day it's really just black and white is a person sick or hurt pay the claim networks why all doctors take money Pharmacy if you buy in bulk you should be getting the bulk discount these people shouldn't be buying a a a million uh well Butrin doses for 10 cents and turning around to sell them to you for $4 and this happens all the time every day no no these things don't have to be ACA compliance black and white Arisa compliance black and white Insurance compliance black and white the only thing that we need is a whole lot of people to just jump in the thing at the same time and then you know we'll just be better together I think that that's that's my point if anyone has questions thoughts concerns I would take a question otherwise I'll wish you all a beautiful day and hope that you don't have to go run into your co-pays and deductibles anytime soon I'm a yeah mic Baylor lead benefit steart atopis and thanks for coming around to chat with us today none of you want to talk about your PO okay byebye friends