MARCH 3, 2024


hour 1: "Lowering Healthcare Costs Through Site-Neutral Policies" with Dr. Josh Umbehr  WE THE PEOPLE RADIO


hour 2: "THE RACE TO ZERO: How ESG Investing Will Crater the Global Financial System - Paul Ticen  WE THE PEOPLE RADIO

"Lowering Healthcare Costs Through Site-Neutral Policies"



About our Guest Dr. Josh Umbehr, M.D.

I was born and raised in Alma, Kansas where I met my high school sweetheart, Lisa, while playing football at Manhattan High School and followed her to Kansas State University. While there, I majored in human nutritional sciences with a minor in biology. I also did extensive research on the effects of vitamin A on lung cancer. I then graduated from The University of Kansas School of Medicine and completed my family medicine residency at Wesley Medical Center in Wichita. After completing training and becoming a board certified Family Physician, I opened Atlas MD, a practice that I had been dreaming about for nearly a decade. Atlas MD represents my ideal medical practice where I’m able to shrug off the burdens and restrictions of government and insurance regulation so I can focus solely on my patients and their needs.

Lisa and I have three gorgeous children who keep us busy — Katelyn, Paige and Cole. Katelyn, our eldest, has Down Syndrome and we’re blessed to have her in our lives. We’ve happily made supporting the Down Syndrome Society of Wichita a focus of ours and the clinic’s.
Personal Statement for Residency
Personal Statement for Medical School


Privious show: Sept 20, 2020 Show "Direct Primary Care Doctors Reduce Emergency Room Visits by more than 40%"

Lowering Healthcare Costs Through Site-Neutral Policies
By Josh Umbehr
November 28, 2023
The United States is facing a healthcare affordability crisis with inflation expected to drive costs up by 6.5 percent next year. While Americans worry about the rising costs of medical care, many of the underlying causes of higher prices are overlooked. Bad government policies, especially Medicare reimbursement policies, foster an environment of consolidation in the healthcare industry, leading to higher prices that hurt everyone. Medicare policies must be changed to bring down costs.

Medicare accounts for almost a quarter of all U.S. health expenditures. In addition, Medicare covers a population with the highest utilization rate of the healthcare system. Individuals over 65 make up only 17 percent of the population but are responsible for roughly 35 percent of all healthcare spending.

The structure of Medicare requires that the government dictate the prices it will pay as well as the out-of-pocket co-pays patients will have to pay. In determining these prices, Medicare should focus on patient care and reimburse doctors and medical practices the same amounts for providing the same care. However, that is not how the system operates today.

Medicare bases their reimbursement amount on the “type” of provider, but that many of these off-campus HOPDs look more like a regular doctor’s office. So, when a patient receives medical services from a facility owned by a hospital, Medicare reimburses at a higher rate than if the service was provided at a private practice.

This dual reimbursement rate creates an unintended incentive: If a hospital can buy a private medical practice, it will be considered part of its outpatient department, and Medicare will pay higher reimbursement rates than its physician-owned competitors. Consolidation within the healthcare industry is a sad consequence of these policies.

A report to Congress on Medicare found that "in recent years, the number of services billed in HOPDs (Hospital Outpatient Departments) has been increasing, while the number of services provided in freestanding offices has been declining.” And researchers from Harvard University report that “consolidation of healthcare entities and services is a key driver of higher prices and tends to reduce rather than increase patient satisfaction." When hospitals buy smaller competitors, there is less competition, and the hospital gains market power. More market power enables hospitals to raise prices without competitors and market forces to check them.

Congress should mandate that Medicare implement site-neutral reimbursements that would require payments of the same amount regardless of where the service is provided and whether a hospital owns a physician practice. Site-neutral payments would remove the incentive for hospitals to buy small practices and help keep healthcare costs from rising. The Medicare Payment Advisory Commission (MedPAC), an independent and non-partisan commission established by Congress to advise legislators on Medicare issues, recommended in its June annual report that Congress adopt site-neutral payments “because of the recent growth in hospital acquisition of physician practices and our own empirical analysis.”

MedPAC expects site-neutral payments over time would decrease Medicare spending “because it would reduce incentives for hospitals to acquire physician practices and bill for services under the usually higher-paying [outpatient provider fees].” It also anticipates Medicare beneficiaries would be better off under site neutrality, noting that “beneficiaries would incur lower cost-sharing liability for site-neutral services, and we expect that they would continue to have access to the services.”

A 2023 study estimates that a site-neutral policy would result in $231 billion in savings for the federal government over a decade and another $152 billion in savings for patients paying out-of-pocket costs.

Fairness in Medicare pricing and lower out-of-pocket costs for seniors and all Americans is a bipartisan issue. Site-neutral payments are a common-sense solution. There is no reason for Congress to hesitate to pass such vital reforms.

Dr. Josh Umbehr, M.D. is a Family Medicine Specialist in Wichita, KS.

Hour 2: "THE RACE TO ZERO: How ESG Investing Will Crater the Global Financial System" with Paul Tice    WE THE PEOPLE RADIO

THE RACE TO ZERO: How ESG Investing Will Crater the Global Financial System

Over the past few years, so-called “sustainable investing”—a new practice based on the theory that environmental, social, and governance (or “ESG”) factors should drive corporate policy and investment decisions—has swept across Wall Street. Spurred on by the United Nations, national governments, and financial regulators, and cheered on by academics, environmental activists, and the media, the ESG orthodoxy has received little public resistance as it has integrated itself into almost every corner of the financial sector. By 2030, the iron curtain of sustainability will have fully cast its shadow across Wall Street.

The Race to Zero provides a detailed rebuttal to the case for sustainable investing from the perspective of a long-time Wall Street analyst, investor, and latter-day finance professor. Sustainable investing does not aim to generate excess returns for investors or to further ethical goals such as improving society or saving the planet; rather, it seeks to seize control of the world’s financial system in order to ensure that the allocation of capital and investments across markets is politically favorable to establishment interests.

By limiting financial market access, ESG is designed to create a compliant corporate sector to serve as both Greek chorus and funding source for the environmental and social causes championed by government and the elite class. Climate change is its driving force and priority goal, and its main targets are fossil fuel companies operating in the industrialized Western world. This book is designed to expose these truths in plain-spoken language—free of financial jargon—to reach the widest possible audience, including the silent majority on Wall Street that is now afraid to speak up about ESG.
About our Guest Paul Tice
Paul H. Tice is an Adjunct Professor of Finance at the Leonard N. Stern School of Business at New York University, where he teaches mainly on the energy, infrastructure and project finance markets. Mr. Tice has been a frequent guest lecturer, panel speaker and case study/research author at NYU Stern since 2013 and served as an Executive-in-Residence at the school from 2015-2017. He also regularly contributes Op-Ed pieces on energy- and finance-related topics to The Wall Street Journal, The Hill and other news media.

Mr. Tice has worked on Wall Street for the past three decades and is a 29-year veteran of the fixed income and credit markets, spanning investment grade, high yield, emerging markets, middle market lending and private/illiquid credit, including stressed/distressed/special situations. For the last 23 years, he has specialized in the energy and infrastructure sector, both as a top-quartile buy-side portfolio/investment manager and as a top-ranked sell-side research analyst.

Mr. Tice currently works at Schroder Investment Management, where he is a Senior Investment Manager and heads up energy sector credit research for the firm’s global fixed income business. Prior to joining Schroders in August 2017, he was a Senior Managing Director and Head of the Energy Capital Group in the asset management division of U.S. Capital Advisors, an energy-focused financial services boutique. Prior to joining U.S. Capital Advisors in 2015, he worked at BlackRock, where he was the Head of private energy investments for the firm’s Credit platform and Americas Fixed Income business, while also serving as the Lead Portfolio Manager for the Energy Strategy book within BlackRock’s R3 Fund.

Prior to joining BlackRock in 2009, Mr. Tice was the Chief Operating Officer, Co-Chief Investment Officer and a Senior Partner of R3 Capital Management, a multi-strategy, credit-focused hedge fund manager that was spun out of Lehman Brothers in May 2008 and subsequently acquired by BlackRock in April 2009.

Prior to R3 Capital Management, Mr. Tice worked for a total of 14 years at Lehman Brothers (2002-2008, 1989-1997) in a variety of roles, most recently as a Managing Director in the firm’s Global Principal Strategies (GPS) division, an internal, credit-focused proprietary fund that was formed in June 2006 and spun out in May 2008. While at GPS, Mr. Tice supervised the fund’s investments in the energy and power sector, while also managing the overall GPS research effort and approving all private equity and longer-term investments by the fund.

Prior to joining the GPS group in 2006, Mr. Tice spent 17 years in sell-side credit research, both at Lehman Brothers and Deutsche Bank/Bankers Trust (1997-2002), where he mainly covered the energy sector, both as a senior analyst and a producing manager.
Mr. Tice has covered the energy sector since 1995 and was one of the top-ranked Investment Grade Energy analysts over 1995-2006. In 2006 and 1998, he was the #1 ranked Investment Grade Energy analyst on Institutional Investor’s All-America Fixed Income Research Team. Prior to originally joining Lehman Brothers in 1989, Mr. Tice was a senior financial analyst at JPMorgan Chase.

Mr. Tice has previously served on the Board of Directors for Lightfoot Capital Partners GP LLC, International Resource Partners GP LLC, Arc Terminals GP LLC, Crown Oil Partners IV, LP and Richland-Stryker Investment LLC, all of which were investment portfolio companies of the R3 Fund.

Mr. Tice earned a BA degree in English, magna cum laude, from Columbia University in 1983, and an MBA degree in Finance from the Leonard N. Stern School of Business at New York University in 1988. He is a member of Phi Beta Kappa.

Courses Taught
  • FINC-GB.3186, Project Finance and Infrastructure Investment

Academic Background
MBA, Finance, 1988
NYU Stern School of Business
BA, English, 1983
Columbia University

Selected Publications
Paul H. Tice (2016)
In Remembrance of Lehman Brothers
Paul H. Tice (2014)
How Climate Change Conquered the American Campus