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Carolina Journal Radio No. 892: Reopened schools will continue to face COVID-19 challenges

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Truth Network Radio
June 22, 2020 8:00 am

Carolina Journal Radio No. 892: Reopened schools will continue to face COVID-19 challenges

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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June 22, 2020 8:00 am

North Carolina’s public schools are expected to reopen for the fall, but they’ll face some changes linked to continuing concerns about COVID-19. Terry Stoops, John Locke Foundation vice president for research and resident scholar, analyzes state guidelines for public school operations in the 2020-21 academic year. The pandemic already has created a nearly $5 billion hole in North Carolina’s budget. Forecasters are not certain whether that hole will grow larger in the months ahead. You’ll hear recent projections from chief legislative economist Barry Boardman, along with reaction from top N.C. House and Senate budget writers. Count Senate leader Phil Berger, R-Rockingham, among those who would like to see a quicker reopening of the N.C. economy. Berger shared his ideas about reopening during a recent news conference. Before the pandemic struck North Carolina, lawmakers already were taking a look at the impact of the Raise the Age initiative. It shifts most 16- and 17-year-old criminal offenders from the adult court system to the juvenile justice system. William Lassiter, N.C. deputy secretary of juvenile justice, offered lawmakers a recent status report on implementation of Raise the Age. The COVID-19 pandemic has helped focus attention on the importance of primary care. Jordan Roberts, John Locke Foundation health care policy analyst, highlights primary care’s role in a world focused on serious health care challenges.

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From Cherokee to current attack from the largest city to the smallest town and from the statehouse into the schoolhouse Carolina Journal radio your weekly news magazine discussing North Carolina's most of public policy events and issues welcome to Carolina Journal radio why Michiko got during the next hour, Donna Martinez and I will explore some major issues affecting our state. The covert 19 pandemic is blown a multibillion-dollar hole with North Carolina's state budget, and it's not clear if that hole will get deeper will highlight one experts projections. The leader of the North Carolina Senate among those who want to see it quicker reopening of the state's economy to learn why North Carolina continues to move forward with the raise the age initiative. You'll hear recent status report about the program targets 16 and 17-year-old criminal offenders. Plus, during a time of concern about covert, 19 primary health care remains important to learn why with expert insight from the John Locke foundation's healthcare policy analyst. Those topics are just ahead.

But first, Donna Martinez joins us and she has this week's Carolina Journal headline will they or one thing that is the question now swirling around the fall school year in North Carolina, whether or not kids will return to their bricks and mortar campuses and if they do what rules will apply as we deal with the covert, 19 situation Gov. Roy Cooper says that it all depends on the metrics for covert, 19 he's released a three-part plan through his Department of Health and Human Services based on the what gifts that were now facing Dr. Terry stoops is joining us now to talk about the plans and the different questions that arise from all of this. He is vice president for research. Also, the director of education studies for the John Locke foundation Terry welcome back. Thank you.

What's a curious conundrum that we are facing. So we know that the governor and DHHS. They have put forth essentially a three-part plan three different options, but the state Board of Education also has a role role in this, and they have met and talked about it where they come down on this well they in large part agree with the document that was produced by the department of Health and Human Services and their role at this point is simply to advise the governor and Dr. Mandy Cohen, the secretary of the department on education matters and to provide guidance and direction to school districts for implementing each of the three plan so they are not actually handing down any mandates. They are basically leaving it up to the governor and then leaving it up to the local school districts to be able to determine how to implement what the governor is mandated. Looks like there's going to be a decision fairly quickly as to which which of the three options that the governor says that debt will proceed with Telus about that looks like on July 1 the governor's gonna make a decision to pursue one of three courses of action plan a would require minimal social distancing, and there's a list of requirements of of schools to be able to do that and it requires things like temperature checks and ways to organize students ways to organize the school day plan B if things are improving. According to the department would have moderate social distancing with even more requirements imposed on schools and then plan C would be to go back to a full-time remote learning plan. This is would be one of these plans that we've seen at the end of the last school year where kids were at home and they were pursuing their education using online or copies of materials that were provided to them. Do we know what metrics or which metrics that the governor is going to be relying on in order to make this decision between plan a plan B or plan C and would that then require the members of the Council of State, the other statewide elected officials to weigh in on this and in approve the choice. Those are questions we don't have answers to, and big props to Lieut. Gov. for bringing both of those questions to the discussion of the state Board of Education meeting where they unveiled their guidance document because we don't know how this is going to proceed. Presumably, he would have to ask the Council states to get permission to do this, but in the past. We know that he hasn't necessarily followed those statutory guidelines for for that of the metrics is by far the most disturbing of the two issues because not knowing what metrics North Carolina has to meet in order to implement one of these plans means that the decisions can be made behind closed doors and it might just be arbitrary.

You know, we need to have goalposts and we need to have goalposts that are staying in one place. In order to determine where we need to be is the states as far as a what metrics will be looking at in order to go back and and that just isn't clear right now and I'm assuming that it's not going to be clear in the weeks ahead, in anticipation of the July 1 decision. These three plans have been in the public domain for a few days now. You follow a lot of them teacher chat room social media, etc. what's the reaction been from the folks who will actually be back in the classroom set to try to teach these kids. I have yet to find a teacher that really has embraced this plan at all.

And that's just a nice way of saying they really dislike it and and don't think that it's going to be feasible. What's the issue that there are there are multiple issues the masks issue is has been one that's really come to the fore the document doesn't require masks, but it does recommend strongly recommend that students and teachers wear them. A lot of teachers would like there to be a requirement that everyone wears masks in order to protect the students. The teachers and staff so that's that's one issue, but they also understand that things like daily temperature checks are are near impossible.

The example that I like to point out as we we have a high school, and in North Carolina Myers Park high school that has 3500 kids in their imagine doing a daily temperature check of 3500 kids, or if your elementary school teacher, you are required to incorporate handwashing and sanitation in your classroom activities. I don't know how a teacher can manage to do that. Teachers are also asked to try to limit the amount of sharing that happens between students. So my so if if if one student needs a pencil. When asked his friends front for that pencil and and there is an exchange there. The teacher is supposed to step in and stop it. Really, what this comes down to us as a document asking teachers to concentrate on surveillance and sanitation rather than instruction, and so most of the teachers time really will be on those two tasks and I can imagine the have much time left to be able to actually execute their lessons in teach kids what they're there to learn. Where does this leave us then because on the one hand, were unclear of the metrics and what the situation in terms of public health will be and what and how this decision will be based, but on the other hand, it just sounds so impractical based on the scenarios that you provided so what would we do to me what is the best approach here. Well, I predict that the decision will be to go to a full-time remote learning plan. I just don't see how either plan a is a minimal social distance or plan B the moderate social distance can work and this is going to be a real issue for families that have working parents. You know, we have an issue with parents being able to stay home with their kids while there's remote learning happening and really this affects the poor disproportionately because those of us that have jobs that can function if we stayed home. Aren't the problem. I mean we can easily adapt to a schedule where children are home full time, but those who have hourly jobs. Those that don't have flexible schedules will be the ones that really lose out in this and and that's what I really fear is that if we choose to go to a full-time remote learning plan that the parents that can least afford to stay home are the ones who will be forced to. We've already talked to previously here on the show about the inconsistencies in terms of instruction that we know is already occurred from county to county school district to school district based on the early months of covert, 19, and so would you look forward to potentially another year or or a few months of more virtual instruction. What is that mean for what kids are or aren't learning well, it's deftly going to affect learning and it's definitely going to mean that students are going to be further behind, and where they are right now there's some discussion of the state board meeting about using the state test to be able to determine where students are, that was a recommendation that we had in our Carolina rebound document to use state test to determine how much students know how much they don't know and so I think we'll see that the beginning of the upcoming school year.

Whether it's remote or in person.

Administration of those test to see just where students are, how much they've lost, and where we need to go.

Terry stoops think.

Think you can stay with us much more Carolina journal radio to come in just a moment tired of fake names tired of reporters with political axes to grind. What you need to be reading Carolina journal, honest, uncompromising, old-school journalism, you expect and you need even better, the monthly Carolina journal is free to subscribers sign epic Carolina journal.com you'll receive Carolina journal newspaper in your mailbox each month. Investigations into government spending revelations about boondoggles. The powerful leaders are and what they're doing in your name and with your money. We shine the light on it all with the stories and angles. Other outlets barely cover but there's a bonus print newspapers published monthly by our daily news site gives you the latest news each and every day lot onto Carolina journal.com once, twice, even three times a day. You won't be disappointed. It's fresh news if you'd like a heads up on the daily news sign up for our daily email do that Carolina journal.com Carolina journal rigorous unrelenting old-school journalism. We hold government accountable for you.

Welcome back to Carolina journal radio why Michiko got the covert, 19 pandemic is had a major negative impact on North Carolina's state budget and the overall impact is still unclear legislative economist Barry Boardman recently delivered the bad news. Boardman told lawmakers that experts in the state legislative and executive branches expect the loss of $1.6 billion in the general fund budget year that Cindy they also revised forecast for the new budget year revision at $2,000,566.9 revision, or 9.9% decline think the easiest way to think about these numbers. We really need to think about. This is a $4.1 billion reduction in the money available .2% decline at in lost transportation revenue in the total budget hole reaches $5 billion, but Boardman reminded state lawmakers about the uncertainty related to the forecast notice around doing forecasting now overhead deal with trying to determine telehealth prices going to impact the economy for how long. That's what were trying to do. We know that national economies are entered in the recession we know the state is going into recession, you can't lose the type of appointment we have.

Without that occurring forecasters are seeing right now this is a national economy. Seeing gross domestic product GDP dropping 7 to 10% in the second quarter May through June 7-10 percent. We often hear that number reported on a seasonally adjusted annualized rate on an annualized rate that would be equivalent to up to 46% drop in beauty that significant. After the initial decline that were talking about the second quarter, things get a little murky agreement on where we move forward in the economy differ from forecaster to forecaster some say that this will be a quick bounce back in the recovery was third-quarter and things begin to smooth back and we approach where we were before this pandemic by the middle to end of 2021 forecasters have completely different scenarios. For that, we began to put our forecast together were dependent on those types of national forecasts. Think about how state economies will be effective in our revenue structures typically in most situations always p.m. at fiscal researcher grappling over whether wages and salaries of better grasp of 4.9% or 4.7% documents were off the charts. We start looking at information like there's another reason for budget uncertainty.

Adding to that uncertainty was the federal tax lien payments normally in April. We waited revised forecast in May because April tells us a whole lot surprises are either upbeat collect a lot more than we thought are down but things are changing and were were seeing a decline get that information this year because of all the delay payments. Like is that over $1 billion are estimated to have been delayed in April.

In addition to that we also had some processing delays as the rotavirus case was detected in New York headquarters for five days at the end of April. They had a shut down process to build this forecast. We were left with one very noisy day-to-day reporting that was called April.

There wasn't a very good one and all this uncertainty, and with a desire to help facilitate the budget process. The consensus forecasting group came up with a different strategy with which this forecast, we do not produce the usual line item revenue by revenue for plan our forecast. We work hard to forecast auto individual income corporate franchise alcohol beverage tobacco so forth and so on. All 22 items that make up the total tax and nontax revenue. We tried we reach agreement on a consensus basis. We cannot do that this year with all the noise all the difficulty what we brought forward to you is a bottom line only forecast think it's a good forecast given where we are where we stand today. We also think it's a cautious one that is not a worst-case scenario forecast were not putting second waves of pandemic and were not saying that pandemic continues to grow or escalate is pretty much the basic track the overall forecasters were using so it's not a worst-case who still think it's a cautious forecast listening to the North Carolina Gen. assembly's lead economist Barry Boardman. He says he and his colleagues will return to budget forecasting in the summer and he makes no promises about the results. I have no projections as to whether it August things will be better forecast be worse in terms of forecast that is not what I'm suggesting here. I do know that will have three more months of data we will have been able to tabulate her lease as best we can all the way tax payments will have a better understanding of how reopening is going is working Boardman answer questions. A big one. What happens if there's a second wave of covert, 19 cases we see a second wave of pandemic outbreak.

What one might ask, back if the response to that second wave is similar to this response that we had to undertake will see the same type of drop all of potential in revenue that we are experiencing now. It would be if you will, a second wave of revenue which revenue streams are likely to get hit hardest with respect to revenue streams. In general, speak in general particular because I have to, because we didn't dig deep into each of the revenue sources restraint to key drivers are all almost across the board. Notably, your employment situation and income, income growth and employment growth will we know right now that we've had a 30% or more draw employment. Some of that is temporary.

Some of that is acting like layoffs. Some of that we don't expect to be permanent, but we've already earned double digit employment rank over usual drivers are clearly telling us that almost all sources of revenue are going to see a decline, but our biggest one of course is personal and compact so much of your client is going to become come from a drop in income. Boardman's forecast had an impact for lawmakers like Representative Donnie Lamberth top state house budget writer. So grim picture were looking at some might even say it's a pretty scary picture you looking at the sellout work ahead of us. Lamberth offered budget writing colleagues of warning because it is such a tight fiscal year, we had to be very fiscally prudent to make sure that any dollars. We stand we stand on absolutely necessary services. So we are looking to follow those principles we been a very frugal Journal simile in the past 70 years that I've been here, certainly in the we will continue need to do that. State Sen. Harry Brown offered his own assessment of the budget picture you can see about 5 million total uniting from revenue as far as bailouts go, so we were looking so just make it simple. Numbers 25 million. The general fund, 24 to 25 billion cellular canal 21 billion. Roughly her little ass transportation IBM 707 million by name and transportation. So you can imagine his preparation shares once I know a lot of times in the next few months so it's this will be tough to balance and the thing about us state government.

Just like local government, you have to balance your budget so will be working hard to figure out a way to do that, but it's going make saying no to a lot of people so you need to understand that as we move forward.

That's Senate Republican leader Harry Brown responding to the latest information about Carolina's budget forecasting Carolina journal radio in a moment. If you have freedom we got great news to share with you now.

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Sen. Phil Berger addressed issues related to the COBIT 19 pandemic in a recent news conference, Berger explained why reopening the economy now makes sense for seeing it in many other states, particularly those in our region we would we see in North Carolina of the. The fact that the virus impacts urbanized areas more than the rural areas withdraws very first study seems to believe that that that rule so it can and should be modified to to reflect the of the area. We also know that many of the more serious cases are occurring and congregate care facilities. I think we may need to tighten up all not all those facilities, but that doesn't mean that everybody in the state needs to be and not in a situation where they are unable to to get around Berger and colleagues still hope the federal government will offer more flexibility for use of COBIT 19 relief funds will be to snarky books of anybody in this room or anybody in this country knows what federal government is going to do, particularly the differences between the U.S. Congress in the U.S. Senate. At this time. Confident they will reach some agreement but we have not received anything thus far so the approximately $2 billion that was sought not stand from the cares money that came to the site, North Carolina. That would be utilized by the state. We do not have updated guidance on that. It is my expectation that we will need to have of those dollars in order to make sure that we don't see the kinds of layoffs and freezes that that that occurred before. I have been in communication with members of federal them. Goshen, they understand the importance seems to me that the what I would call the line of scrimmage at the federal level is that there are some folks who want to print even more money at the federal level and send it to the states and there are others who feel the amount of money has thus far been adequate to see how that money is going to work. I think what we need in North Carolina is simply not necessarily more dollars coming to the site but what we need is flexibility with the dollars that better here so that we can make sure that our normal budgetary items can be. That's state Senate leader Phil Berger speaking in a recent news conference return with North Carolina journal radio and a moment where dabbling down on freedom at Carolina journal radio were proud to bring you stories that impact your life and your wallet. And now get twice as much freedom when you also listen to our podcast headlock available on iTunes and@johnlocke.org/podcast headlock is a little bit different.

It's a no holds barred discussion that challenges softheaded ideas from the left and the right, like Carolina journal radio headlock is smart and timely but with headlock you'll hear more about the culture wars get some more humor as well. We guarantee great information and a good time double down with S. Listen to Carolina journal radio each week and listen to headlock to remember, you can listen to headlock@johnlocke.org/podcast or subscriber download each week iTunes Carolina journal radio and headlock just what you need to stay informed and stay entertained both brought to you in the name of freedom by the John Locke foundation. Welcome back to Carolina journal radio I Michiko guy since December.

North Carolina has been dealing with the raise the image initiative. It shifts most 16 and 17-year-old criminal offenders from the adult court system to the juvenile justice system. William Lassiter's deputy secretary for juvenile Justice and the state Department of Public Safety. He offered lawmakers a recent update on raise the age implementation.

We are meeting the projections were not going extremely above those projections and so right now things are holding up pretty well is as far will as far as what we expected to see. We are seeing an increase number of violent offenses under what we were projecting overall and that's not just true with the older population rashly seen that with some of the younger kids stayed were not quite sure what that that jump is NAV just a short-term trend there's been a greater demand for detention that's I think that's probably the biggest area that we may need your assistance in the upcoming session is for helping us figure out how we can get a little bit more on funding for detention beds that we can house all the juveniles that are coming into the system on the original projection that we made based off of the population.

We thought would be coming into the system that we would need $13.4 million you all allocated a $6.7 million to do that with and said since the projections are holding our and actually a little bit higher.

Were hoping that we can at least get that additional 6.7 million that we are projecting for detention beds in the upcoming session to help with that additional population. Lassiter says the population of offenders has changed the overall risk score for our older populations come in the system is higher level I prefiled system, a 16 or 17 are coming in, typically as a four which means they are higher than average risk of reoffending on and that's why you're seeing many more than in detention is because they are at risk of reoffending and we need to make sure that so that the public is safe and were holding them in a secure location raise the age has required new facilities we've Artie open see a Dylan. This was an old youth development center that was up in Greenville County, it has been opened.

We have currently 10 juveniles that are already there so that allocation came to us on as a special on one of the many budgets that you all past last year and thank you so much for doing that. We desperately needed those funds to make sure that we can make sure that Ray's gaze could be implemented effectively on silly. I've already been able to open that facility in a four-month process of the time we got the funding to when we actually open the door with his record time for opening a facility for sure with Artie got 10 kids already in this bed Lassiter mentioned other new facilities. But he also talked about projects designed to keep kids out of court rooms and lockups in general were talking about over 9000 additional juveniles that we serve free community-based services for diversion programming to try to keep juveniles out of the system moving toward some of the things that we've Artie funded for this community-based dollars are additional teen courts. Tinkler is a program that is a diversion for kids that school resource officers or law enforcement officers can directly refer a kid to the program indicate goes through a mock trial that they are put in by other juveniles in the community. Often kids at volunteer to be lawyers or judges or to be part of that process a a volunteer adult in the community. Also as part of the process and on. This allows for kids to stay out of the system. Our recidivism rate for kids that go to give to teen court is 14%. Only 14% of the kids that go for the teen court program ever come back into the system again. This saves us a lot of money because the average teen court program cost is about $900 on to operate per child versus a child one day in court for child cost on the $5000 and said this is a big savings for the state but is also much more effective because a lifetime existing courts actually hand out tougher sentences because when you're one of the parts of the sentence is that you have to start on the jury for three trials in the future. And so you're being truly judged by your peers in a lifetime.

Their peers are tougher on him. Then the judge or will be in those cases into on the teen court program is one that really excited about that has been expanded were down to only four counties in the state that will not had teen court and were working on this for counties to see if we can get something in place to make sure that all juveniles across the signal. Carolina will have access to the teen court program you're listening to William Lassiter of the state Department of Public Safety he's discussing implementation of North Carolina's raise the age initiative.

Lassiter discussed funding for other programs. The keep offending kids out of court at 6.6 million is already been sent to our describe to counties and RFPs request for proposals for local nonprofits in your counties are currently applying for those dollars to put in place a CPC funding right now on the funding process is currently underway in almost every county cost the state for this.

Are these the fun additional diversion programs for kids and also on interventions and sanctions that court can order for juveniles were adding six additional crisis beds that are being put in place right now, we've also put in place. I additional transitional living-on the transitional living homes are for kids that really can't go back home. We have lots of kids that come into our youth development centers that are in DSS custody or are involved in gangs in their local community and they just returning to their home community is not the right option for that child onto the transitional living homes are set up so that kids can go and get a skill they are required to go to community college whether they are in the return required to get a job either at that transitional living facility had really great success with a transitional items for expanding the number of beds across the state to do that and were adding additional crisis beds in the eastern part of the state. We had three crisis that facilities currently in the state and the central in the Piedmont and in the West we do not have ones in the eastern part of the state. Their work dollars are allocated in the budget to do that are currently establishing that facility right now that the reentry to resiliency program that were doing, which is a new program where they're given a success coach when they get out of the facility to help them get back into school or community college or our job on were doing this with communities in schools of North Carolina, who Artie have great connections with schools across the state so that we can make this connection to the Ford.

In addition to new facilities and alternatives to court action rings the age is incorporating new uses of technology for putting in place, teleconferencing, teleconferencing right now. A juvenile must go back to court within the first five days and then every 10 days. After that, if there in a secure setting. They must go back to court in a very detention for secure custody hearing.

There is no such thing as bond for a juvenile.

And so in order to make sure that they had their right to have a chance to get out of detention and musket that the court.

The problem is this court hearings last about three minutes often where the judge vaguely said there's no reason to release yet this time is that we want to start doing this for teleconferencing.

We started that process with the purchase the equipment wanted start the teleconferencing process said that we can do that from the detention center to the courtroom where the juveniles can be seen through that teleconferencing is also there to be very important with the new virus that striking out to try to do that without dictation and other ways that we can make sure that we don't invite in on is the virus into our facilities that can be a big help on that too. Lassiter says, technology is helping with more than just court appearances starting tele-psychiatry and psychiatry at our detention centers on detention is again where kids are, by their awaiting trial right now we we don't have a whole lot of mental health services in the detention facilities we do in the long term committed facilities on sewer adding tele-psychiatry to our detention facilities conversing on the 70% of the juveniles coming into our detention centers have a mental health diagnosis on 70% of and so we want to make sure that we are providing the services, especially for those kids may be sitting there for 6 to 9 months and is facilities. That's William Lassiter, Deputy Sec. for juvenile Justice at the North Carolina Department of Public Safety he's discussing implementation of the raise the age initiative will return with more Carolina journal radio in a moment real influence. You either have it or you don't and at the John Mott foundation we have it, you'll find our guiding principles in many of the freedom forward reforms of the past decade here in North Carolina. So while others talk or complain or name call. We provide research solutions and hope our team analyzes the pressing issues of the day jobs, healthcare, education, and more.

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We are the John Locke foundation. Welcome back to Carolina journal radio I'm Donna Martinez for lots of Americans. A primary care doctor is the first person that you call if you have a nonemergency medical issue yet. You might be surprised to learn a lot of folks who do not have a primary care doctor, particularly if they are younger and that's a problem right.

Our next guest, Jordan Roberts is he healthcare policy analyst for the John Locke foundation.

He is been writing about the importance of primary care joins us now to talk about that Jordan. Welcome back. Examine it in the column that you wrote which is that posted that John Locke.org. One of the things that you wrote I thought was pretty fascinating. You said that primary care has a profound impact on a person's life for many many years. So your primary care doctor is your point of contact to the medical field and that their distorted gatekeeper that keeps scattered that you know allows you to access care and helps you get any other care.

You might need outside of the primary care setting. And so it's so important to have this relationship with your doctor for a long period of time because they can understand your conditions and understand your your all different kind of ailments you may have, and they can help. Best serve you and that's why it's so important to have this doctor-patient relationship with your primary care doctor because they they essentially are gatekeeper for everything else and they have the most experience with you in terms of your healthcare so it's just hard to understate the importance of that sound like they're really the foundation, and in my mind I Jordan I kind of picture this almost as a hub and spoke system in the primary care doctor is the hub and in the spokes go out if you need specialists are additional types of care. It's that primary care doctor who knows you intimately and can then assess and recommend so that you can go forward and have specialty care that's exactly right.

And so you know that's right so important to maintain that relationship with your doctor and make sure to be honest about all your conditions and in symptoms and everything and this has a profound effect on healthcare spending later in your life. The prevalence of chronic diseases. Things like this so you know establishing that relationship with your doctor at a young age, keeping up, maintaining that relationship is that it's hard understate the effects it has on one's life.

Despite all of that, though you have found that there are many people who don't have a primary care doctor, particularly younger people what's going to weld the outlets for the data showing that you know there's been slight falloff in the number of people that are accessing and have a primary care doctor in a number of recent years and you know it's particularly with younger folks because you know is a younger person myself, you know, maybe if you're feeling pretty healthy say I don't need to go get a physical.

See my doctor to pay the co-pay you know things like that but you know it's like we talked about before it.

It has profound effects on later in life. If you need to maintain that relationship and keep up with all of your vitals and everything you need to be a healthy healthy person. So Jordan does that mean that were talking about people who don't have health insurance or is it people who may be Seiji and I'm feeling pretty pretty peaked today, and rather than go to a doctor on disk and run down to the CVS that has set someone there. Or maybe they run down to an urgent care is a little bit about the little bit of both. You know some people just may not have insurance.

So a lot of primary care doctors you know you need insurance to access that or you a lot of people my age just you know that may be very healthy and they know they have health insurance and they can use it anytime they want. But it was it worth the time. Is it worth it. Of the exposure in today's world, and is it worth that money to go and see when you may think your all all all set but that insurance point is a fascinating one because Sam let's hearken back to my gosh it's been probably a decade now Obama care is affordable care act damn huge debate big Supreme Court decision that says that yes Sam is constitutional. Wasn't Obama care supposed to take care of this problem. All of the uninsured right and you know will receive is that it did you extend health insurance to a lot of folks but not nearly the type of comprehensive, universal coverage that was promised and will receive is this just driven up healthcare costs arm you included for primary care and you know that's you know when we have a health insurance system that makes it harder for people to access the health healthcare system. You know it we really got ask ourselves is this system really working the best for Americans. We have people than who are choosing or maybe not choosing to circumstances or dictating that they don't have a primary care Dr. Jordan are there enough doctors to go around. Should everyone decide, hey, that's for me.

I need to choose a person or that's another thing the roosting in the data that a lot of projections show that were never serious shortage of primary care doctors currently and even more so in the future and one of those reasons is that you know a lot of testimonials from primary care doctors will say that there just burnt out you with all the insurance paperwork and everything else that they have to deal with to get paid and how little time they can actually spend with their patients on because of the system. The third-party payer system we have and so that diminishes the doctor-patient relationship.

Doctors do it. They don't have control over their patients. If they're part of a larger hospital system. They may have to you know operate under the policies of the hospital dictates that may not be able to practice medicine the way they want and what that leads to his people choosing not to go into primary care once they leave medical school and maybe choosing to go to specialty care. So this is a big problem at work and I have to deal with than the projections are paint a very bleak picture of primary care in the future will that's unfortunate, but I tell you what, as we talk a lot about here at the John Locke foundation innovation naturally occurs when we meet a challenge and, in fact, that whole insurance web has now led to a new type of primary care.

It's called direct primary care tell us about that yes to direct primary care completely box the third-party insurance paper third-party payer insurance model and what it does.

Doctors who participate in a drug primary care practice. They do not accept insurance. They contract directly with the patient and what this does is it significantly decreases the price of primary care and so you know the way it works is a sort of like a gym membership, an individual or family would pay a monthly monthly fee to the doctor for an exchange for around-the-clock care and we see it is as more doctors. Like I say get burnt out from all this. Some ensure the insurance what they have to deal with a lot of them are switching to this direct contracting model where they did a contract directly with patients and they can get paid. That way, but not to worry about insurance payments and they can spend more time manage their patients better save money and then create better health outcomes of his a lot of benefits of this model. If someone chooses direct primary care. Let me propose this scenario to you and and you can tell me if this would work or not. Let's say that I have health insurance, but I don't want to access that insurance just for a cold and cough something like that.

But I essentially cannot save my health insurance for something serious and go ahead and go outside the insurance system and just set up a direct primary care relationship with the doctor just for the basics well if you were to our contract with the direct primary care doctor normally what you would do is you have high deductible health plan and you would pay for the pay for the out-of-pocket expenses of the direct primary care direct primary care and people needing to choose a primary care doctor does that help us control costs while the drug primary care profession grows and more people are starting to realize the benefits of this what it could do is US as the traditional comprehensive third-party payer model starts to decrease prior people start to use it last and certainly will be more competition among providers and especially ones that can offer this very affordable model of direct contracting so it certainly will instill some more competition in the market. Hopefully that's what drive down prices healthcare policy analyst Jordan Roberts think that's all the time we have for Carolina general radio this week on behalf of my cohost Michiko.

I'm Donna Martinez. Hope you join us again next week for more Carolina internally.

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