Money Talk

Episode 17

The Stress Free Path to Megabucks-Not For Profit Hospital CEO

Forget dealing drugs. Open up a hospital. Hospital CEO’s coined the phrase “laughing all the way to the bank”. The Me Too Movement. Hospital CEO’s want special treatment when they get a manicure. Dogs receive better medical treatment than people. No one knows how much a new knee costs.

Welcome to our listener-supported podcast, Money Talk, uncompromised absolute financial truths behind financial perceptions with host, Ed Sutkowski and Chuck LeFebvre. Let’s listen in.

Chuck LeFebvre: This is Chuck.

Ed Sutkowski: I’m Ed.

Chuck: Today, we are still talking about the accumulation phase. Specifically, we’re talking about the stress-free path to megabucks, this time, the not-for-profit hospital chief executive officer.

Ed: Yes. Let’s first address the issue of the industry. Specifically, we’re talking about a $3.5 trillion industry. Now, a billion is nine zeros, this is 12 zeros.

Chuck: To put it in perspective, the entire US economy was $3.5 trillion during the Reagan administration, 1983 or so. $3.5 trillion today represents one sixth of the total US economy. It’s a gigantic industry– not industry, but sector, the healthcare sector is just enormous and growing.

Ed: That’s a percentage of the Gross Domestic Product you’re talking about.

Chuck: Yes. The Gross Domestic Product representing essentially the entire output of the economy. Everything we do in every industry would be calculated and added together, and that’s what is generally referred to as the Gross Domestic Product, which in 2018 was around $18 trillion. 3.5, it’s a lot of money. If it sounds like a lot, it’s because it’s actually a lot of money.

Ed: Looking at some of the numbers for 2017, the drug makers are really beat up, but the reality is quite different. Specifically of that $3.5 trillion in 2017 numbers, the drug makers are really toward the bottom of the list just above dental services, versus the hospitals are nearly $1.12 trillion of the $3.5 trillion downwards.

Chuck: More importantly, the growth in the total amount being spent on hospitals has grown over the last decade or so at a more rapid rate than the amount that is being spent on prescription drugs. I think the prescription drug industry, I don’t want to try too hard to defend them because they’ve had a few pretty high profile cases where they’ve been fairly abusive with their pricing scheme, but as an industry, they’re soaking the economy a lot less than other parts of this sector. It seems to me, what is happening is that hospitals are absorbing a greater share of what is happening in the healthcare industry. In other words, you’re having fewer and fewer private physicians, and they’re all being gobbled up by these hospitals, and that’s one of the reasons why the revenue associated with hospitals is growing, but also they’re just charging more.

Ed: We’ll talk about that. I’m not in a position to defend the drug industry. There are some outliers. In my experience, we’re talking about hospitals, doctors and the drug industry. Well, the drug industry is making an investment that may fail. Hospitals are not making investments that may fail, doctors are not making an investment that may fail. Well, I’m not suggesting that all pharmaceutical companies are absolutely perfect, I am suggesting that you must decide where are they coming from, and what kind of an investment must the drug company make to come up with something that now has a limited duration versus the generics that are coming.

Chuck: Right. One of the pharmaceutical industry by design must invest money in R&D, and they don’t know, when they fund a particular project, whether that particular project is going to bear any fruit. Frankly, we could probably have a whole other podcast, if we wanted to, about maybe where that particular financial incentive is not in alignment with the needs of the public. Particularly when you talk about the failure to invest in new antibiotics, which is there’s simply aren’t being investments made even though that’s a very critically important to be developing those. Part of that is because it’s very hard to capture revenue off of those if you are successful in developing a new antibiotic, versus other types of medications like cancer drugs or drugs that are going to address long term chronic illnesses and that kind of thing. I think that the pharmaceutical industry has some fascinating mechanics of its own, but in spite of being much maligned, again, I think largely because of a few high profile examples, it does not appear to be the source of this rapid growth in healthcare spending overall.

Ed: Well, typically, the journalists say it’s a whole different topic. If it bleeds, it leads. We’re looking at activities that are off the radar screen that attract those issues. I’ve had some firsthand experience with these opportunities and the trials that you must go through. The cost of these trials is fantastic. A small organization, a capitalization of more than a hundred million dollars can’t do much in this area, you have to have the mega bucks in the organization to fund all these government approvals.

Chuck: Yes, very true, very true. Even when they have a medication that appears to be successful, they still have to spend an awful lot of money just to get it across the finish line.

Ed: I think about the insurance. Insurance premiums have increased by approximately 54% over the last 10 years. It’s far excessive the wage increases. Speaking about wages, I like to focus on the way to accumulate megabucks with no skin into the game and no stress. Now, historically, we’ve talked about the corporate chief executive officer, and let’s just say that’s an easy one, but the easiest, Chuck, if you were to accumulate all kinds of– how to accumulate all kinds of money, you become a hospital, not-for-profit CEO. Example, this is back in the early years of 2009, the numbers I have, the US children’s hospital, a not-for-profit, Mercy Hospital, Kansas City, its CEO, get this, $5,987,194. Wisconsin, Milwaukee, $5,465,948. Akron, Ohio, $5 million. Kansas City, nearly 6 million. I don’t get it. I don’t understand what justifies that payment. Do you have any idea?

Chuck: Well, remember, and this is of course right when the economy was collapsing too. There were people literally losing their homes in some of those very same communities, people getting kicked out on the street. In the meantime, these are not-for-profit organizations in those communities paying their chief executive millions of dollars each, and of course I’m sure those numbers have gone up since then for each of those organizations. It’s just bizarre to me that that is all funded by, not just insurance premiums that people pay and the fees that are being paid for services, but then they’re going out and they’re asking for fundraising from the public in order to fund, in part, these high salaries. I think you probably could very easily find people who have no problem with those pay levels, but it’s the type of thing that I personally find pretty hard to justify.

Ed: I will be talking about, but I lay this at the doorstep of the directors, as far as I’m concerned, no one’s monitoring this, and we’ll get to that in more detail. The bottom line is, who’s watching the hen house here? The foxes are in the hen house, and no one’s watching it.

Chuck: Well, I think, Ed, part of the reason I react the way I do to these numbers, is because returning to some of the themes that we’ve covered over and over again in our podcasts here, which is that, it always strikes me as a bit of a fool’s errand when I think about this from the perspective of those executives themselves, and all of the people surrounding them. This is just the chief executive. They’ve got their cadre of people who are immediately surrounding them, who are also receiving extremely high compensation.

Ed: Let me interrupt you. To the local information I’ve picked up, this is back several years for 2016, two doctors, one million 150, and the other round numbers, a million dollars, but 18 others more than $500,000. and three in excess of 800,000, four excess of 700,00, and nine in excess of $600,000. With that regard to severance benefits and alike. What you’ve said happens to be the case.

Chuck: Right, yes. There’s always an entire collection of people who are making extremely high salaries. This is the main point here, which is that in my experience, people will cringe when they hear me say this, but that is not the path to wealth. That’s just, it strikes me as an ego project to be chasing compensation at those levels when in any city in the United States, you can live very comfortably and you can accumulate wealth and provide for the financial security of your descendants without being paid nearly that much.

Ed: After-tax, I suppose, if a CEO were here, that CEO would say, “Well, wait a minute. The corporate CEO has all these perks, restricted stock, stock options, blah, blah, blah. I don’t have that. I’m sorry. What is the downside?” You’re not being asked to invest in the organization, and directors of a good listed company will insist that the CEO has skin in the game, has borrowed money to buy shares. I’m not sure that’s to be the case. Nonetheless, that’s the SOP that, “Look, I need all this.” We’ll get to why, but I’m not sure after-tax why you need all this. In my world is that the higher you go up on this ladder, the less you do, and that’s my view called the inverse rule.

Chuck: Yes, I agree. I think that you see that in particular with these health organizations where what you’re overseeing is the activities of a collection of licensed and heavily regulated professionals. This is a little bit different in my mind than a corporate CEO, who is directing a company. We’ve got, in the news recently, all of this fiasco that happened with Boeing and the release of the 737 airliner and the modifications that were made to the software and how that got botched. There was a failure of the management, obviously, at the core of that issue. That’s the type of thing where the people in management in a company like that, have to exercise a great deal of oversight over the workers who are engaged in the day-to-day activities involving the development of the safety programs and protocols and so on, versus, correct me if I’m wrong here, Ed, but when you’re supervising a bunch of doctors, each of those doctors is bound by their own standards of ethics. They have their own professional judgment that they’re exercising. They don’t really need direction from the CEO, do they?

Ed: Well, I want to get back to the Boeing issue. I lay the problem at the doorstep of the director. My thesis is that the CEO makes sure that CEO nominates the directors. Each director is typically a generalist with no particular expertise in that sector. You look at the SCC filings and see the identity of the directors, my view, you’ll find more that are there because of the name versus the substance. At Boeing, yes, the buck stops with the CEO, but who’s watching the CEO? Who’s watching the CEO of the hospital? The point is that directors are being paid off to line their pockets and have this information on their respective obituaries.

Chuck: That’s a good way of putting it.

Ed: They’re important. Let’s just say that’s right. I think about the hospital CEO. What’s that individual’s, and this could be male, female or whatever, what’s the risk? Losing the job.

Chuck: Yes. I think that that’s really what it comes down to because, in many ways, they’re at less-risk than individual physicians who are performing medical services in that organization where they’ve got personal liability and reputational liability for potentially doing something wrong or versus the CEO who’s really– There’s not even that type of skin in the game when you’re talking about– I wouldn’t even limit this just to the CEO but to the management team in general. In many ways, they’re undertaking less risk than a medical tech who’s working face-to-face with a patient and may not be facing the same kind of malpractice risks as a physician, but certainly must be feeling the stress of delivering that care and doing it properly.

Ed: There’s no drawbacks, there’s no transparency. You look at the 990Ps, it’s almost impossible to determine– First, they’re not very current, they always get extensions. It’s very hard to determine who’s getting what typically that’s after the fact. No drawbacks, no return on investment, no measure of ratios of W2 to that of the average individual employed by the organization. None of the typical safeguards that are expressed on the list of organizations are present in the hospital sector.

Chuck: What do you think it would take for a hospital CEO to be fired, Ed?

Ed: Well, I think in today’s world, Me Too movement, that seems to be the most recent way of getting yourself, CEO, HR guy, it goes on and on. I’m not talking about Weinstein, that’s egregious. That’s just terrible. Whatever it is, that’s all it takes. Failure to meet goals is always an excuse. We had a storm, we couldn’t use the ER room. I don’t know what the excuses would be. Have you ever been heard of a CEO of a healthcare organization not-for-profit being fired?

Chuck: I have not. I think that, generally, there can be some accountability, as you pointed out, for what might be best referred to as personal failings. When it comes to really even in the private sector, this is pretty rare to see management really take a hit, because of financial performance of an organization, even there. It takes several years of things going south before really there’s accountability. In the hospital context, I’m not sure I’ve heard of that happening.

Ed: At least in the corporate world, we know that the board members are agents of the CEO. I’m overstating it slightly, but not that much. I mean, individuals being paid, and there’s a back-scratching, I’m in the board of Company A and then you’ll put me out of Company B. I’ve run into some folks that their profession as being on multiple boards, and making $120,000 a year, for example, from each. That’s not a bad deal when you have no responsibility.

Chuck: Right. How is that not largely true when you’re talking about the nonprofit board? I know that the financial remuneration is not there in the same sense. There is still a fairly small circle of people who tend to rotate on these boards. Even if we’re not talking about making a lot of money, there’s maybe side benefits, there are social benefits and so on.

Ed: Well, they think they’re going to get better care. I’ve heard about that. I’m a director of new co hospital. I want to go and get my nails trimmed, I’m going to get some special treatment. I will tell you, when you’re off the board, that doesn’t occur. I think it’s more ego. We’re all ego-driven, otherwise we would be– I don’t know what we’d be doing.

Chuck: Well, my own limited experience on serving on the board of a nonprofit organization is that, if you’re a board member and you’re trying to hold the CEO of the organization accountable, you find that that is a terribly difficult thing to do.

Ed: I think the other members, I can’t speak to your experience, but I sense it’s popularly with the borders, people in the community, and those people in the community are on all kinds of boards. They are typically employed by an organization that funds them and tells them go on these boards.

Chuck: That’s exactly right. The other thing that happens is that, if you’re serving on the board of a not-for-profit, and you do not like the direction that management is taking in that not-for-profit, the fact that you are generally not receiving compensation, and this is a volunteer activity, really augurs in favor of rather than mount the battle that would be involved in terms of making changes with management, the low friction path is simply to resign. Someone else will take that board seat who is less prone to actually look under the hood and really hold management accountable.

Ed: At least in Illinois if you’re not being compensated as a board member, you’re related with the most responsibilities. We know it’s to your best interest not to be paid enough in not-for-profit board. That sounds upside down, but who’s watching the executive? Well, the delusions that the board members are the subject of, the hint there’s a free market that we’ve got to Aaron Rodgers, we’ve got to pay Aaron Rodgers to be the executive of this organization, because the other hospital is going to pay him more. Excuse me, and that the CEO is extra responsible. Talking about hospitals, and it may be also with the executive for profit, responsible for the performance of the organization.

Chuck: How do you measure performance?

Ed: No, we’re not going to– No, no, because that person is a nice person. He is active in the community. We’re delivering how– You can’t measure, it’s qualitative in a not-for-profit.

Chuck: Right. Yes, that’s the– I think it’s very difficult for board members, to maybe defend board members a little bit here, I think it is very difficult for them to really have a good sense of how they’re supposed to be measuring performance. Because it’s not merely the bottom line. If the organization is doing poorly financially, the conversation can vary easily, by the management team, be shifted over to, “Well, yes, but that’s really not what we’re here for, and here’s all the great things we’re doing for the community.” If the organization is not performing all that, well, in terms of serving the community, first of all, I’m not sure exactly how that information makes its way into the hands of the board of directors, but even if it is, even if it does somehow filter through, then the message for management can very easily be, “Well, we would really love to be able to do more for the community, but take a look at our financials here.” I think that in this context, as a board member, you’re maybe always playing a little bit of a game of whack a mole when it comes to exactly which goals are we hitting, and which ones are a priority that can always shift under your feet. I think that’s a little bit different than in the for-profit community where if you lose money year after year after year, after a while–

Ed: You’re out

Chuck: Yes, there just are no excuses for that. Because there’s one overriding goal that nothing else can wait make up for. That just isn’t the case in the not-for-profit community.

Ed: Let’s get to the issue of measurement. I’m speaking now of quantitative value. The not-for-profits, at least in this day, are granted an exemption for real estate taxes, in theory equal to the charitable activities provided by that subject organization.

Chuck: Well, that’s more of a aspiration than a rule, right?

Ed: Yes. The point is, that is a theoretical justification for the absence of the greater part of these real estate taxes. Now, there’s all kinds of litigation and what part, but nonetheless, that is the theory. We’ll get to the issue of low payment of income taxes. That’s the big number, even at 21%.

Chuck: Yes, that dwarfs anything we’re talking about with property taxes.

Ed: Yes, I’m talking about de minimis. I’m talking about nothing. I’m talking about pocket change, but nonetheless, that’s the theory. What do the numbers say? The numbers say something else. There’s some articles, the Illinois Health of Salaries and Service will review the 2018 numbers. Instead of– Let me give you just samples here. The percentage of charity care as a percentage of the net revenue for 2018. Northwestern Memorial Hospital Chicago, 1.2%. The charity cares 23.2 million, the net revenue is 1.9 billion.

Chuck: Yes.

Ed: That’s on one end of the scale. On the other hand, the Stroger Hospital in Chicago, 54% of the revenue is in charitable care, with charity care of 325 million, and the revenue is only 600 million. We have things off the chart and you’re telling me that that is a function of the real estate taxes being saved. I’m sorry, if that is the case, I will have a full head of hair tomorrow morning.

Chuck: No, the other thing to remember is that this is probably not true in Chicago, and of course, we’re focusing on Illinois here. In many communities, once you get out of that Chicago metropolitan area, it’s not too unusual for the most valuable real estate in a community to be the real estate that is owned by the local hospital. I’m not sure if that’s strictly true in Peoria, but if you looked at these other communities that come to mind, Springfield, Decatur, Champaign, Bloomington, you can go down to the metro East area, I think in a lot of those communities, certainly in the top two or three in terms of real estate owners, some of the greatest value of the real estate in each of those communities is going to be owned by the local hospital, and in many cases, what’s happening is those hospitals are owning the real estate, and then they turn around and they rent it to a private physicians group that is then providing for profit services in the tax exempt for real estate.

Ed: Yes. What we suggest with the property taxes is a fraction of the income tax is saved. I get the biggest kick out of that. Because we look at valuing an organization three a function of the cash flow. That’s hopefully pre tax. In this instance, you have to worry about it is cash or whatever it is, and how do you determine cash flow, your bill and your margins. Have you ever looked at a recent statement invoice for a medical bill?

Chuck: You can’t make any sense out of them. At least I can’t. Maybe someone nearby can, but I find they’re completely incomprehensible.

Ed: Its transparency. You should know what it’s about. By the way, do you ever bargain for that? If you’re going to a vet with having your dog or cat x-rayed, guess what happens? They give you a quote up front.

Chuck: Oh, right. Yes. It’s actually quite astonishing, as a pet owner, the difference in experience, both in terms of the quality of the care, frankly, and also the billing practices, when you talk about major medical events for a human being versus an animal. I have this story that I often tell my friends about this one time when I had a dog that was not breathing very well. We just happen to have an emergency veterinary clinic in our community. This was on a weekend, and I took her in. On the spot, we had an X ray, and 10 minutes later, I’m looking at the X ray with a veterinarian and going over, exactly what happened with the dog, and what needs to happen next. Over the course of that weekend, it turns out she needed to have a surgery. The bottom line was that we had an X ray, and then we had a hospital admission, and we had a surgery on her lungs. All in, the whole thing cost about $3,000. Now, of course, you don’t have insurance to pay for any of that. I knew upfront exactly what it would cost. All of this service was delivered, essentially within 48 hours of seeking it, versus what happens with you. It might take you two months to get through a process that took 48 hours with a dog, and you would never know upfront how much it would cost, and even six months later, you’d still have bills dribbling in that are almost incomprehensible. I bet it would cost $20,000 or $30,000.

Ed: Easily. Let alone if you’re in the outpatient’s area, or you’re in the emergency room and watch out, or if you have a helicopter transporting you from one place to the other ,or a car. It’s crazy. I’m thinking ¬†of airplane bills, airline bills. Before you book a flight, you know what it’s going to cost. The variables are built-in, I think.

Chuck: Yes. In this particular industry, you can even ask your doctor. Most people don’t, but you could even say, “Well, wait a minute, doctor. You’re recommending surgery on my knee here, how much would that cost?” Your doctor would have no idea. It’s just amazing. Even the people providing the service don’t know what it costs.

Ed: You have to be able to determine the final cost is going to be. You’re telling me that there are certain procedures, the individual’s no longer with us, but it’s a little different, but you should be able to gauge what it’s going to– How many days in the hospital, how many days in the ICU, with some variances, what’s the hourly– You should be able to unbundle the services. Guess what? Why are these not subject to being unbundled? The CEO, who is responsible for everything, that’s how their margins are so significant– Cost of goods sold is probably– They’re getting a margin of, maybe, 80%. That then permits you to go ahead and pad the CEO compensation.

Chuck: The most expensive aspirin needle you’ll ever take in your life is one that is given to you while you’re in the hospital. It’s just amazing. It’s the lack of transparency, is the key to extremely high-profit margins here. I’m amazed that people are not more outraged about the fact that we’re talking about profit margins being astronomical in the context of a not-for-profit organization.

Ed: The way you’re taken advantage of is in an emergency situation. I had occasion just this last week, be involved with a very young man suffered a massive stroke while on a cruise. The cruise ship had to dock in Florida. They had to be airlifted. I haven’t seen the amount of the bill for the airlifting, but my bid is, if it’s less than $40,000, I’ll eat this microphone. The point is, when you have no opportunity to negotiate, you are being taken advantage of, versus if you could negotiate those activities, you could come out with a better number, but are you equipped to negotiate?

Chuck: Well, no, because you don’t know anyone’s prices are. This is one area where I think there’s currently a proposal. I’m not sure if it’s ever really going to become a regulation or law, but there’s currently a proposal circulating around Washington to require any hospital that receives Medicare, which is essentially all of them, to publish what their fee schedule is. I think that would be a big move forward because people could actually shop if they wanted to. Right now, even if you wanted to, you simply don’t have the option.

Ed: Maybe there’ll be a whole group of representatives that will represent you in negotiating price. That might be an opportunity, Chuck, for-profit organization to act as an adviser to negotiate health bills.

Chuck: Well, that’s what these insurance companies are supposed to be doing for you, but I’m not sure how well it’s working for most people.

Ed: I’m thinking about trends, for just a moment here. We do know that, for example, there’s a clinic outside of Chicago that got rid of all about 15 doctors. Why? They hired them as replacements, these non-physicians, to help with the health care. The operating margins. Whether or not you should be recommending anyone that should go to medical school, that’s an open issue, because you no longer are a private practitioner and that you have the joy of seeing the fruits of your labors worked out where a patient becoming well again. It’s almost like a cookie-cutter situation. The share of US physicians employed by hospitals that rose to 44% from about 26%. The country has over 6,000 hospitals, only 1,300 are for-profits. What’s going on? We’re having all these consolidations. The docs are no longer in private practice. They’re working for the hospital with contracts that I’ve seen, 10, 15 single-spaced pages with a non-compete that’ll choke a horse. Guess what? If that doc doesn’t produce, out. The private practice sector is being emasculated, and the good docs are leaving the practice. Is that fair?

Chuck: That’s what I’m noticing too, is that while there are some doctors that do– We mentioned earlier in this podcast how some doctors are receiving extremely-high compensation,that is no longer a ticket. Medical school is no longer a ticket toward the financial freedom necessarily just by going to go to medical school itself. Then, what I’ve noticed is that the doctors who are doing well, they’re just extraordinarily busy. It’s very, very difficult for them to spend any time with their patients if they want to. I’ve personally heard complaints along these lines about how difficult it is to practice medicine the way that some doctors would like to practice medicine because of the way the industry is treating them. We have this really weird confluence of these increasing costs across the board for patients, and you’ve got not necessarily decreasing salaries for doctors, but certainly some financial pressure on the physicians themselves with respect to the total employment package, certainly less freedom over their time in their lives and in their practice and so on, and you have a service that’s in a great deal of demand. It’s hard to figure out who is winning with this system that we have, other than the administrators. From what I understand, device manufacturers do pretty well.

Ed: Yes. The tragedy here for the physician, is the economic life cycle is so narrow. Post-internship and all the rigors you must go through, the debt, what goes on as an intern, is fantastic. Yet at age 62 or 65, you’re burned out. If you’ve been employed by a non-for-profit or for-profit and you have a 41k plan and that’s about it, I’m not sure how much you can accumulate for, let alone retirement, but as being able to pass that on to other family members, I don’t think this is the way to go, if money is a consideration. If quality care is a consideration, why would you be employed by a hospital?

Chuck: Well, yes, but isn’t the answer to that question because that seems to be what the industry is consolidating towards.

Ed: It’s the only way.

Chuck: Because everybody’s being employed by these hospitals. I think that the point here is that we’ve got this industry that increasingly seems to not be working well for basically anyone who’s experience we should care about. We should care, I think, about the experience of patients. I think we should care about the experience of the actual service delivery people. I would say that’s the doctors, the nurses, the med techs, the people who are really face-to-face with the patients. Those people, I believe, we should care about that. I think we should care about the experience of satelite industries that need to be able to profitably deliver new technologies and so on to the medical field. This is an industry that doesn’t seem to really be working well for many of those key players. At the center of this industry, are a collection of not-for-profit organizations. It’s just bizarre that something that’s working so poorly for the entire country is essentially being controlled by organizations who, at their core, are supposed to be serving a community.

Ed: And are not. Now, I can accept from the observations expressed, the Mayo Clinics, John Hopkins, Cleveland Clinic where– my experience, I’m sucking at the numbers, is there’s no one outrageously compensated in any of those systems.

Chuck: That’s my understanding as well, and as a matter of fact, I’ve personally spoken to people who have left those organizations because they were seeking higher income. In my mind, that gives me greater confidence in those organizations, knowing that that’s not the place to pursue riches.

Ed: The bottom line here, if you’re trying to accumulate mega box, of course that’s pre-tax, and that’s the delusion. What are you taking home post-tax, but who engages to that? Ideally, you’d be a CEO of a listed organization because you’re going to get stock options and restricted stock, you have the opportunity to get capital gain transactions, but in the CEO of the hospital, not-for-profit, it’s all W2, and so they increase it so that you’ve got more money than you can shake a stick at it, but net, it’s not such a good deal. You’re pursuing an activity that makes no sense, but yet, we’re charging the patients with all these opportunity costs that you have no opportunity to negotiate. It’s just delusional. I don’t get it.

Chuck: I agree with you 100%, Ed.

Ed: The bottom line here is, I know I’m not going to any local hospital

Chuck: Especially now.

Ed: Especially now, but then again, I must tell you, Chuck, I sleep real well most of the time. Thanks, and we’ll see you folks again.

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