Board of Health: July 22, 2025

Transcript captured from MHTV’s Vimeo auto-captioning. No speaker labels; proper names and dollar figures occasionally misheard. Click any timecode to jump to that moment in the source video.

0:00 There you go.

0:03 All right. It’s seven 30 on the 22nd of July. Um, and this is the open meeting of the Marblehead Board of Health. Um, everyone has the agenda, I believe. Um, I see tonight’s meeting as really the second installment in an important communication from the board, the health department to the, to the community, sharing what everyone needs to know and should know about the strike that’s going on. And I, I wanna make a little bit of a personal comment. My neighbor in Charlottesville for maybe 15 years was a pretty distinguished, uh,

0:49 professor in the Commerce school. And her specialty was management communication. And I think she would feel if she were to look at what has happened in Marblehead in the past two and a half weeks, I think she would say we have done a pretty good job. Um, the, the level and the variety of the communication in the town has really been terrific. Now, I said I’ve done nothing, but I, I, as an observer, your presenta, Andrew, your presentation last week was full to the, it, it, it gave people what they needed

1:37 to know about Republic, about our contract and about, um, the, the quality of the people we have at the transfer station, all of which maybe everybody knew a little bit. But it was important to be emphasized in this environment. I’m sure that if Tommy were in my neighbor’s class, he would get an A.

2:05 Um, he, he, he, he was on there. Uh, I remember talking to her often. Her bottom, her mantra for teaching management communication was bottom line upfront. By that she meant, know what you want to say, say it clearly, say it early and say it often. Tommy would get an a i Lee was trying to keep the digital ver of the current and Weekly news, tried to do everything it could to keep the paper up to date, but Lee particularly tried to keep the digital

2:53 version of the current as up as possible. Um, we didn’t have many things to give her, uh, on a regular basis, but I think that down at least knew that everyone was trying to share the information. It was the ultimate in transparency. So I, I really think that that’s, that’s a positive, what we have to have on our agenda once this is over, we have to learn from this and make sure that we communicate everything that we do at the same level of sophistication, if not maybe all the detail to the town. Because I think that’s the, that’s the key to building trust

3:42 and the trust that, that, that, um, many groups have lost during the pandemic. So I, I think that we can start this tonight. The organization, the, the agenda is that Andrew will give us an update on the strike and certainly help us with understand how the, our team at the Transfer Nation is doing. Sounds good. Uh, so yeah, so we’re entering the fourth week of the Republic Strike. Um, and not a lot to update that except four. Uh, we will continue to have two trucks in town. We will continue to concentrate on trash removal. Um, we are doing, as the team is getting used to the town and they’re familiar with the streets

4:28 and we’re familiar with the collection area, we are receiving less phone calls and less emails, which means that they’re doing a better job. The other big piece is that people are using the transfer station, which is wonderful. Um, it’s a huge outlet for obviously recycling. It’s also allows ‘em to get rid of any of the additional trash or their weekly traction, stuff like that. Now, Republic last Friday did have mediation again with the Teamsters, unfortunately did not come any further, closer to finishing or ending the strike. Um, at this point, they do not, we’re not aware, but an additional mediation dates we’ve recommended to Republic that essentially they should sit in a room and wait for the Teamsters to be there at any moment, as we all want this strike to come to a conclusion. At this point. Um, again, yes,

5:15 through Tom, through the office. Um, what happens is that obviously, uh, Monday collection happens. Yeah, I should have mentioned your red Oh, your red phone every night. Oh, yeah. Code red. Yeah. So we try to push out Code Reds at the beginning of the week, uh, and towards the end of the week so we can, so people can understand what to expect for the week, and then what to kind of expect for Friday and Saturday a little bit. Those are kind of the two times that we feel that people are looking for information. Um, so that’s kind of the update with the day to day. But yes, it’s great to have Tom online. He’s catching people. He’s forwarding or emailing me directly and saying, Hey, can you take a look at this? Um, so what happens is that we have two kind of classes. We’ve missed streets and then we’ve missed pickups. Um, so a missed pickup can be a one person,

6:02 or it could be a couple people. Um, and then we have a whole missed streets, um, for the missed streets. The missed streets go directly to Republic, uh, and we want the trucks to go back there. Uh, it could be a whole neighborhood. It could be an area where they didn’t have time to finish the day before collection, or they ran outta hours on Friday or Saturday and have to go back to finish the last week’s collection, um, for the single missed pickups. Um, you know, anything can happen with some of this stuff. Again, you know, we always tell people to make sure the trash is out their curbside. You’re allowed to leave the trash curbside at this point. You do not have to bring it back into your home. That’s a big piece. The trucks can come at any time during the day, and they’re working anywhere between 7:00 AM and five o’ 5:00 PM and sometimes a little bit

6:48 after that, depending on what time they start. Now, the truck drivers are only allowed to work a total of 60 hours a week. Once they get that 60 hours, they have to stop. And so that’s the end of the collection and stuff like that. So that dictates if they’re able to get through the whole week and they have to come back on Monday to finish up a little bit of Friday’s route, or if they’re able to finish the whole thing. We also have a small truck route. Uh, we have a couple really small streets, uh, and the regular trash truck can’t get there. Um, we’re fulfilling that job through the DPW, so we’re extremely thankful, uh, to a small group of people at the DPW that is doing that route. Um, that tends to take place on a Tuesday or Wednesday. Um, so again, with the transfer station, we are very, very lucky to have that facility. We’re very lucky for those employees.

7:34 Uh, you know, they come today, we all come to work every day with a smile. We’re all excited to see each other. We all know we have a big day ahead of us. Uh, but everybody’s willing to get to work right away. Um, I show up there, you know, just about seven o’clock and everybody’s getting going with their day again. So you’re either getting ready for the day, cans come in early, early in the morning, uh, to change out recyclables, change out the residential trash, and kind of get ready for the onslaught of people. People start to line up to come into the facility at seven as well. Um, and that’s done so we can alleviate traffic on Green Street. Uh, that’s the agreement we’ve had for a long time. As we go through the day, obviously we have change outs for recycling and stuff like that. We’re working with Waste Management to come and deal with our recycling.

8:20 Currently, the issue that we see across the Commonwealth is that because of the strike, there’s multiple facilities and a lot of trucks that are down, and a lot of trucks, they’re trying to service a lot of additional people. Um, when you’re talking about the 17 communities, you’re talking about 400,000 residents, but you’re also talking about all, a lot of the commercial businesses in those areas can be affected as well. Um, so for us, waste Management is doing a huge job by coming in and picking up recycling from us. Um, and so we’re, they’re there at least once a day. We’re trying to get them there twice a day. Sometimes they’re there as many as four times a day. Um, today when I looked at the, I now can look at the number of cars entering the facility for the residential side. Today, when I looked around just after two o’clock, it was close to a thousand cars.

9:07 Um, so again, extremely busy place. We are able to keep up with the capacity at the end of the day. At times we have a gluttony of recycling that we have kind of spillover or we can’t get into the cans. We have some additional 65 gallon toters that we’re using and we’re waiting for that can to show up in the middle of the night or in the early morning. So we can fill those things first thing and then get ready for the public. So a lot of times we’re, or occasionally we’re hearing, can’t you extend your hours? Can’t you, you know, run additional times and stuff like that. And that’s something that’s extremely hard for us to do. We just don’t have the capacity. Um, all, most employees are operating six days a week. Obviously the employee, the facilities open six days a week. So that add time is extremely hard.

9:53 I can’t just grab people off the street and expect them to do the job. Same job as the employees up there. Obviously for the heavy equipment, it requires licensure. Uh, but just daily operations. If you just threw somebody into the mix, you have this, have ‘em stand next to Buddy and really show them what to do. And it’s not as efficient as we’re working now. Um, so really the hours are what they are. Um, but again, you know, people are able to get in there at seven 30 in the morning and three 30 the afternoon. We do feel that we’re able to capture kind of both sides. They’re really early in kind of some of the later morning people and stuff like that. Uh, questions,

10:32 Uh, if I may, um, in one of our conversations, I think go going back to Republic. Yep. I think you indicated that each of the municipalities has a slightly different wage rate. Yep. And, um, you’ve thought that in general there was about a $5 gap between Republic’s offer and the average of that. Yes. So when you look at Boston, what the Boston drivers, a lot of the Boston drivers are making currently for trash trucks drivers is close to that $51 an hour. Uh, our current driver is making $39 an hour. If you include what has been offered to him through, uh, the teamsters and stuff like that, that pumps him up to 46.

11:20 That’s still a considerable gap to that 51. Now, I’m not saying that that’s what everybody deserves, but I think that’s what they’re asking for, essentially. But you also said in that conversation that one of the things that re I think Republic would like is to have all the drivers on the same rate. That would that mean all the municipalities have to get together? No. Would that slow the ultimate, um, end of the strike? Not necessarily. So obviously the drivers are trying to get, get paid a similar number to Boston and, and this is all what we believe to be. Um, we’re not in on negotiations and stuff like that. But so Republic has to honor the contract or honor the negotiations with the teamsters,

12:07 they would come to an agreement. But we have our contract and we have our contract price. And that wouldn’t change until we have a new contract. So obviously they’ve come up with the number that they feel it costs to complete the collection route and deal with the recycling that they’re collecting. ‘cause they own that under our contract. And they, you know, it’s either a losing contract or it could be a winning contract. Ours is technically a losing contract. Um, so the other questions that have losing Because they hit the recycling and they can no longer make money on recycling. Yeah. They own all the recycling. So we don’t pay for any disposal of the recycling. It’s not a share, it’s not a blended value. They own it.

12:52 Whatever the value is they own. And other municipalities, It’s a shared, or we pay out for the collection of the recycling, uh, for the disposal. Yeah. That’s the huge difference here. And We suspect the next contract will, Oh yeah. There’ll be a large increase for, it’s either gonna be a blended value share or there’s gonna be, there is gonna be a cost for, uh, not just the collection, but the, you know, the recycling of all the recyclables. The other piece that a lot of people are talking about, you’ve seen that five municipalities have filed a lawsuit with Republic, um, that went to court. I think today is Tuesday. I think that was coming out at the end of today. Um, we decided not to join that.

13:38 Um, obviously what we’re doing is that we’re looking at the costs associated with the strike. We’ve put Republic on notice. We’ll evaluate the cost, so the additional cost for waste management for hauling the additional overtime that we’re spending. And we’ll look at that and taking that off. So we haven’t paid Republic for the month of July. We don’t pay until services are rendered at that time on which we receive the bill. We’ll review that bill and see what things are, what items we would like to take off of that, or our side versus theirs Includes the small truck and the DPW workers. So it wouldn’t include the DPW workers ‘cause they’re at work already. It would include the extra costs for waste management over time associated with the strike. All those costs, anything out

14:25 and beyond your normal costs essentially.

14:29 Yeah. And Andrew, correct me if I’m wrong, those, um, suits, the goal of them is just to pick up the trash recycling. They’re not suing for a monetary amount. That’s correct. They’re just looking to have additional trucks come in and, you know, complete the collection routes. Yeah. Yeah. So they, they’re all in a very different situation than we’re in. They, they have no options. So that’s, yeah. Yeah. Yep. Did we start with two trucks originally? The only one In the beg? Like in the beginning, beginning of the strike? Yeah. Yeah. We started with two trucks. But you have to remember that these guys are coming from other parts of the country. They’ve never been to this town. If you drove around this town, you would think half these streets are driveways.

15:15 And so even for efficiency, trying to come up with a collection route and then add in all the construction that’s going on, add in all the additional traffic, trying to figure out which way to go on some of these roads and making sure that you’re not missing barrels. That takes some time. And if you don’t get the same guys back into town every day, you’re starting again. So essentially what happens is that they’re bringing republic’s, bringing scabs in on a two week basis. Um, so they told these guys they’re gonna come in for two weeks. We’ll reevaluate after it’s two weeks. Some of them are going home, some are staring here. Um, so you might see a whole new crew that comes into town. We have a couple new guys. It may slower for a little while. It depends on, it depends on where the guys come from.

16:00 Depends on what they’re used to. Um, are they used to the heat? Are they used to the humidity? Can they handle some of this stuff? Are they okay with the traffic? Are they okay with the small streets? It all kind of plays into their efficiency and how long it takes ‘em to complete the route.

16:18 Um, but yeah, I mean, essentially we will continue with the, the trash removal. Um, once Republic is able to slowly increase numbers or increase trucks, um, and they signal to us that they’re gonna wanna begin removing the recycling, that’s when we would make notice to all the residents in town. It’s time to put your recycling back out and we’ll begin collecting at that time. But please wait until that, please remove all recycling from the curb. It just makes it harder on the driver driving around. He’s loose looking for barrels. Um, and so if, if it’s a barrel that might have a recycling sticker on it, he’s probably gonna stop and take a look at that. So it’s just adding to his time. So we’ve asked all residents to remove all recycling from the curb at this time, the trash, you can put it out on your trash day.

17:05 If it gets missed or not collected, you’re allowed to leave it there until it’s collected. Um, if you feel that there’s an issue with it, please call the office, send us an email. Uh, we’ll look into it. If it’s a whole Miss Street, we will assign that to Republic. They’ll add that to their missed streets list. If it’s a one-off, like a miss pick up, we’ll go out and take care of that.

17:26 Like, so there’s far few, um, Yeah, the numbers are going down drastically at this time, so Yeah. Seem like there’s nearly as many. Correct. So on the first couple days I was seeing about 500 emails a day. Um, the phone was ringing nonstop all day long to four phones and were drastically down on that. Um, so we’re seeing, you know, a fraction of the emails. We are still in scene, a fraction of the phone calls. Yes, we have an additional person in the office to answer the phone, uh, to help us out with some of that stuff. Um, Nadine from the COA has been wonderful. We really appreciate her support and the fact that she came over from the COA to help us. Um, again, we’ve had some co couple great departments, uh, that’s help us out. Uh, but again, we’re very, very lucky to have the crew that we have up at the transfer station.

18:13 Everyone gets along, everybody knows that they’re coming into a hard day’s work. They’re willing to do that. Most of them have a smile on their face. Most of them have great customer service. Um, it’s a long hot day out there. Um, but we’re very thankful for all their support and the hard work.

18:33 Tom, do you have anything to add? Um, no. Not that. Well. I did, maybe I’ll do it again, but I did it once. I was up there checking residency for people coming in. Uh, ‘cause I know that was a concern and I did not have one, not even one person from out of town attempt to come in and that I was there from seven 30 till noon, um, two Saturdays ago. So it was, that was, that was a good sign, I think. Yeah. Yeah. Um, what’s the status on the license plate readers? Uh, so the license plate readers are installed or up and running. So, um, the way they work, and obviously this is different times because we’re getting people, we’re letting people in that don’t use the facility.

19:18 Um, so the way the license plate readers work is that when you drive in that gate off of Green Street, there’s a license plate reader that reads the front of your plate and their rear plate that communicates up to the booth at the top of the hill. Um, and if it’s green, there’s no sound. You’ll see it. Like if you’re sitting in the booth, uh, you’ll see the plate both front and back, and it’s got a green bar across it. If the plate is not registered and does not have a sticker, it will call out the license plate. So I’ll read it out to you, and then you can actually go out and approach the car and say, Hey, I need to talk to you. Your vehicle does not have a sticker. Um, what are you doing at the facility? What are you trying to do? What are you paying for a monitor? You know, that’s the status of that. Um, it also gives us car counts for the day. You can go back and review history from it.

20:06 Um, that piece is a little new, so we don’t know how far back in time we can kind of go. Um, but yeah, it reads out to you so that attending in that booth, um, that’s gonna be their job to both take, do transactions if people are dropping off brush or dropping off a tv, but also be paying attention to those, those stickers.

20:26 Uh, and obviously, you know, we would like to communicate and discuss. In a perfect world, uh, the beaches would also have a license plate meter system in the future.

20:41 Questions from the floor? Uh, just can you, I know the last time that you gave an you, you were emphasizing how much more recycling you’re getting because, um, it’s not getting picked up curbside. Yep. Can you gimme a sense of like, what’s the percentage over? Is it a hundred percent more, 20% more, 10% more? Oh, it’s over a hundred percent more, but it’s, you know, um,

21:07 it’s definitely a hundred percent more because it’s all coming from curbside where most of it gets disposed that way. Yes. I have a huge number of people that come in on a daily basis and do bring some recycling. The people that tend to come in on a daily basis, um, a lot of times just disposing of trash and similar items like that. Okay. Going to the brush pile stuff. Okay. Um, but yeah, it’s a significant volume increase for us. Okay. And so far that your guys are able to keep up with it and they’re, It’s always a challenge. It’s always a, a game of, you know, what bins do we have available? Do we need to make space available somehow? Um, can we swish a little bit more into these? Um, you know, the hard thing is that, so obviously on a regular time, we have up there, we have a cardboard compactor, we have a paper bin,

21:55 we have a small commingle, we have a large cardboard, and we have a metal right now, the majority. So at home you commingle everything. So it’s all your paper, your cardboard, um, your bottles and stuff like that, that doesn’t compact well. So when it comes up to the facility, it’s a much larger volume than like paper or, you know, stuff like that. So again, it’s a volume issue. It’s a capacity issue. Um, so we’ve started to switch over. We use, tend to use a 40 yard can for the co-mingle rather than a 30 yard can, because we can get so much more in that. Um, so we’ve made some adjustments. Um, and so yeah, it definitely helps. Um, we are getting occasionally a can. So when I say a can, it’s a, it’s a roll off container.

22:40 Mm-hmm. So it can be anywhere. You know, they make cans everywhere from 10 yards up to 40. Um, generally we’ll get a can from Republic, um, and it can be a 25 or a 30 yard roll off. Um, but we’re able to fill those, you know, in a couple hours. Okay. So we fill it up, we set it up to the side and we grab another can and put it on the line and continue on. Um, and we’re continuing to do that all through the day. Um, we’ll have waste management that will come in often early in the morning and drop a can off pick a can up. Uh, and then we’re, they generally come back later in the morning, um, around 10 o’clock. And so we’re shuffling stuff all the time. That’s why at the end of the day, we start to run outta space and we start to have to use 65 gallon toters. Sometimes it gets left on the ground

23:25 until first thing in the morning when we have to pick it up and dump it into a can. Um, and so yeah, it’s just a kind of a shuffle game. What do we have for capacity? What, you know, where can we make some money? Okay. Thank you. Yep. And so far you haven’t needed to use any needs or shut down? No, there’s, it’s not, yeah. I mean, people are always allowed to leave it, um, no matter what. Because o once it’s out of their car, it’s not going back into their car. So what happens is that in front of the cans, it starts to fill up a little bit. So it will come out four or five feet. Um, and we’ll take care of that. If it’s not at the end of the day, we’ll do that first thing in the morning.

24:05 And again, it’s recycling. It’s not solid waste. So there really isn’t a, a public health issue with recycling. Recycling is supposed to be dry, technically clean or washed. Um, so it shouldn’t really have any food stains. Food odors, yes. It’s not always perfect. We understand that. But this is why we have these regulations in place. The other piece about the curbside collection that we always wanna remind everybody is we do have curbside collection regulations. All items that’s going into the barrel should be in a trash bag that’s tied up into the barrel with a tight fitting lid that makes it sanitary that, you know, you can leave that outside your house with a tight fitting lid all week until your trash is picked up.

24:50 If it’s loose trash in there, it makes it extremely hard and often will not get collected. The guys have a maximum load lifting of 50 pounds. So those bags start to get heavy. Generally what happens for efficiency is that you reach in and pull out trash bags. If it’s loose trash, it becomes unmanageable. It’s not for the regulation, they’re allowed to leave it. You also begin to see all the mixed items that people are throwing in there. We often see boxes, we often see plant material. Those are all technically against the law to be thrown out in your trash. Um, so all that stuff becomes evident. And a normal time we will be doing reviews of all this stuff if things are bad, we do leave stickers.

25:37 We do leave cars to say this was not collected for these reasons, but these regulations came into place because of situations like this. Um, during 2015 when we were dealing with the blizzards, um, during the winter, trash was being left on the curbs curb bags open. At that time. It wasn’t horrible. But the reason that we created these regulations was to deal with that. Everything needs to be in a trash bag in a barrel with the type fitting lid.

26:08 Yeah, I’ve noticed since you have the bigger open co-mingle, what a difference. Yeah, hugely. I’ve been willing to take my neighbors Yeah. Stuff now, which I’ve been taking six or seven rubbish. I say it won’t take your recycled. Yeah, I did it this week. Easy peasy in and Yeah, in and out. Um, generally receiving the, the 40 yarders for the, all the cardboard, but we’re just inundated with all the commingle, so we have to Ship it. They match it down with the backhoe. Yeah. The guys up there are super, it’s nice. Yeah. Really Some of the clients up there are much better than they had been in the past. That’s right. Notice that. Yep. Yes, sir. We’re very fortunate. Yeah.

26:47 You mentioned that we chose not to participate in some of the trial, uh, court cases and all of that. Yeah. So there’s only been one court case. Okay.

26:59 I I mean this in the most polite and political way. Do we do, do you we have the authority to make that decision? Or is there someone else in the town that we have to decide if we, if if things weren’t going well, would other people be thinking they’re screwing up over here, let’s take over. No, so, so the only, um, board that can enter into litigation is technically the select board. So if we were going down a path where we felt like we needed to do something, we would have a joint executive session with them to say, Hey, we need to enter into litigation. And these are the reasons why. Now, obviously we’re always talking to our attorneys. Town council does advise us about how to do certain things.

27:47 So we did talk to counsel quickly about, Hey, this litigation that the other communities are filing, it doesn’t seem right for us to be part of this. You’re just spending money. It doesn’t seem like we’re gonna get anything out of this. We have a bill that we’re not gonna pay, but let’s put them on notice. Let’s send a letter to say, Hey, we’re putting you on notice. We’re gonna be reviewing this and we’ll see what happens with that. And that was sent by our lawyer. Yep. Realtor Republic. Yep. It, uh, I’ll say I, I’ve talked to some friends in Beverly in Pea who are going through the same thing and they’re like wildly jealous of us. And that’s, I think that’s part of the reason why we aren’t in this suit, is because we have the transfer station. They don’t. So literally if they don’t get picked up, it’s just sitting there and there’s nothing they can do about it. Some of them have no place to bring it, nothing.

28:35 So we are in like a, so their suit is just to have Republic pick it up. But if their workers are on strike, I don’t even know what that suit really achieves. Right. But The big difference with some of these other communities again, is that, yeah. So for Beverly, their contract is for both residential collection and some business collection. So all these restaurants, all these establishments, they’re responsible for their dumpsters. So their dumpsters are overflowing with trash. Ours is just curbside collection. Yes. It includes, um, highway department, Mary Alley building the police department, the schools. But at this time, you know, we can handle those facilities.

29:22 Um, we are not having to deal with our restaurants with overflowing trash. They might have to a little bit, but that’s not our responsibility.

29:34 If the owner of a restaurant is a Marblehead resident and has a sticker for their own household, No, they’re not allowed to. You can’t card their business. Obviously all anybody can go into way and pay. So they would be allowed to do way and pay and get rid of their trash. Okay. But we can’t, you can’t take the recycling and throw it in the trash. They’ve, they also have a, they have way more flexibility. So I think, like, you know, if you, I, I think I’ve read somewhere where, where someone ditched Republic as picking up their restaurant stuff because they can, they can just make a phone call and, and do it. It’s easy like that. Yeah. It’s not so easy when you’re doing a whole town with Roots and all, and you know, you have a contract in place and Yeah.

30:19 Is there anyone on the outside who would like to ask a question?

30:29 Yeah, there’s nobody that’s raising their hand at this time. Okay. I don’t know if anyone else has been in this situation, but it, what my wife and I sort of talk, if you buy a red car, you know, you see a lot of red cars. Mm-hmm. Well, I pay attention. I’m, I’m a geek. I admit this, but I pay attention to the publications of the National Academies of Science, engineering and Medicine, usually the medicine side. But I’m happy to tell you that our red car today has made the red car on the highway, national academies of, uh, science, um, of, of engineering and medicine, actually put out a 256 page

31:18 document this month, actually this week. This on municipal solid waste recycling in the United States. Analysis of current and alternate approaches. Now, I know you’re taking a few days off, but if you would like 250 pages, I, I brought a summary for you. That would be good. You can just have, but if you want, I’ll try to have it finished by the get back. Sounds good. But back, seriously, you, you make a decision that we don’t need council, we no need to get when you’re gone, we’re gonna talk about associate chairs. I think that we certainly wanna make sure that anyone who comes here to ask things, uh,

32:08 talks to the board member who’s really been the most. Yep. Okay. Um, if there’s nothing else, then we can proceed to the rest of the agenda. Um, last year, uh, when I was new, I had suggested that in addition to having a chair, the, the board of health, we had in, we had anticipated going to five this year. And, and I thought this was important when we were at five, that we had begun to divide tasks. So we were, we agreed last year to have an associate chair for community health and an associate chair. We debated, and I admit I was wrong, I admit it publicly.

32:58 I, uh, you, you were suggesting, and I think the chair agreed with you, that we should have an associate chair for waste. Yeah. Now, my suggestion was to make that a bigger title and make an associate chair for environmental health. ‘cause I was thinking, especially when we go to five, I think the board will want to get involved in climate change. It’ll want to get involved in pollution. It will, uh, wa air and water. It will want to get involved in more than we can handle now. Yep. But I have to say that this year, uh, I will, I would admit last year I was overly ambitious. But I would like to propose that we go

33:43 and have an associate chair for community medicine, for community health and an associate chair for, um, for waste. And that they be the go-to person. You could certainly always come to the chair, but if the chair’s not around, or if you’re not around and someone else needs to know who to talk to, then in any of the, the, the waste recycling issues, comment would be the person. And if you’re willing to, to, like I, the, the editorial person the other day that wanted to talk vaccines, um, I think you’ve already agreed that you’ll work with the Marblehead Mental Health Task Force. Those issues. I did, by the way, write a letter

34:32 to the Attorney General asking that we could be, we could waive the open meeting, uh, regulations and talk to each other about clinical things and all of that. And it, I’m sure it will come to, no one’s surprised. I got a very personal, very polite letter from an assistant attorney general saying, you gotta be kidding. Kidding. But there are are ways that we can figure out ways, uh, uh, because if we, if we are willing to say we wanna talk about something, we, and then we have two days notice. We’ll call a meeting and we’ll sit and we, anybody else wants to sit in on our meeting, uh, three of us.

35:18 We don’t even have to have all three at the same time. But if we wanna write a paper about vaccines or if we run a red paper about climate change in a suburb of Boston, we can get around it. So they seem to accommodate that. Mm-hmm. Um, so do we need a motion and a vote to have two vice chairs with the names necessary? You should. Um, may I have a motion? Uh, I’ll make the motion to have two There a second. Vice chairs. Yeah. Any discussion? Um, all in favor, unanimous. Thank you very much.

36:03 Uh, my update on, uh, community health. Uh, I spend most of that effort now on, on the comm issue. And Andrew and I had a good meeting with UMass Boston. Today we have a, a much better sense of where we’re going. We have a small task force that’s going to review the 50 or 45 questions or so on the survey. The task force is gonna meet and review. Right now, UMass Boston apparently has 50 questions in their, um, initial draft. And so we’ll review that, see if they’re appropriate,

36:50 and we’ll talk to, to people about how things are going. Um, that’ll occur in mid, mid or early mid-August. And once that’s done, the plan will be to send the communication to the town that the surveys are ready. You, you’ll be able to get a hard copy. You’ll be able to get a copy on the QR code or any number of different ways. Um, that’ll occur sometime around September 15th, six 16th, I think she said, with the expectation that the surveys will be in

37:36 somewhere, um, third, second week of October around the 10th. Depending on how we can promote getting enough surveys in, maybe it’ll go faster. If we have to encourage people to do more, we will try to do that as well. So the, the UMass Boston people expect that, that, that they’ll have the surveys by, certainly by the end of October. Um, they, the surveys, I, I suspect will be pretty robust. They have a three person team that will be totally anonymously. Totally, uh, confidentially, they will be analyzing the numbers, not, they can’t tell who, who said what,

38:21 but they will be working through the holiday period and expect to have some preliminary results about that time. Then, uh, in, in the first quarter of next year, we’ll, we will, we will anticipate our focus groups taking place. We, when we’ve talked about comm, we’ve suggested there’ll be probably four groups. We’ve this, you know, some things that we think we want to talk about. But what UMass Boston will do for us, they’ll review the data and they will suggest, Ooh, your community is very interested in X.

39:11 And then the group, uh, of us that are there will, will be assigned to find the best 10 to 15 people we can in town who know about X. And they will become the focus group question. Oh, no, I just cleared my throat. Okay. And so then they’ll have the focus groups, and they’ll feed those focus groups, supposedly that will allow them to reinforce what they’ve learned from the, from the surveys. That will just be boxes checked or rankings

39:57 or something like that. So with those surveys, with the, those focus groups, then, then they’ll begin to write the report that we, we will receive from them as part of our contract. We will be able to feed things into, uh, that analysis as well from some of the other things that we might be doing. Um, the, the, the grant that we have, for example, on the landscape for child and maternal health, that’s been going very well. We now know, we learned today that we will be helpful to come if we could have our preliminary report into UMass Boston sometime in January.

40:43 And so we will definitely do that. And whatever else we can find in that, that is w which, which is relevant to the, the overall wellness and health status of the town, they will have the plan for them would be then to provide at least a, a pretty robust draft by the end of the first quarter of that year of 26. And then prepare for a town presentation. Um, again, I, I go through all the things I make mistakes on. I was thinking we were gonna do this, uh, town meeting, but Andrew, as I now sat through three days

41:28 of 10 town meeting, we would make much more, much more debate than we had in town meeting, and hopefully much more unified in the community. We hope that the, the calm process will be a unifier, and we will work very hard to make it a unifier, uh, by including as many people as when we go back to some, we, we wanna get 15 people to talk about X. We were going, we’re gonna try to get as many perspectives on X as we can in that room so that the town really gets a chance to hear, hear people out. Um, and so sometime in the second quarter, I fake, at least hopefully before the town meeting,

42:13 we should be able to have a, uh, um, a open session to the town telling the, the residents what we’ve learned, what’s the value, and how can we maximize the benefit from having done all of that. And I think one of the things we learned today is that, uh, I asked, uh, Dr. Co, you know, she’s done 80 of these and if she has some ones that towns that, uh,

42:50 probably were the most successful, and she said, yes, you didn’t want to n name them, but the ones that planned ahead for being ready to take the recommendations and run with it are the ones that really make it makes a difference. So we, we will be bringing that kind of issue to this group and to as many other people as we can over, over the next three to five months through the survey, through the focus groups to make sure we have a leadership group that is, that is ready to run with the ball, to say, okay, Marblehead, this is what you’ve said about yourself.

43:38 Here’s what the options are to make things even better than they are today. What should we do about it? Okay. So I, I think that, um,

43:53 I’ve never doubted that this was the right thing to do, but every time I meet with the our partners, I’m, I’m reinforced even more. Uh, and I think, yeah.

44:08 And we had a figure, maybe we should call some of those meetings as open meetings so you and Tommy can sit it. Maybe we ought to do one of that. Thanks. Yeah. Uh, we’ll try to figure out how to make that happen. Are there any questions? Do you all understand calm? How do you anticipate, um, passing out the questionnaires? I know you talked about it once or twice in the past. Well, it won’t Be effective unless it’s a good cross section. If you send ‘em on to The school. Well, current plan, and we welcome any thoughts. The current plan is, is to give every adult over 18 get, mail them a postcard,

44:54 and the postcard will have on it, uh oh. Yeah. Instead hard copy or the drawing postcard. It, it, it will have, um, the QR code or the telephone number, or it will have, um, where they people can go to get paper copies. And so we’re going to, there, there’ll be three different ways that people getting surveys. We’re going to, we’re gonna, in addition to that, we’re gonna work to try to get a, a laptop at, say the senior center so that people can get, get QR code, get their survey on their phone there. They can get hard copies if it there.

45:39 Um, you, you’re absolutely right. We, we, we want to be able to try to get 30% or plus a, a survey to really make it meaningful. And, uh, she says they’ve, they’ve been able, with the right promotion, that they’ve been able to convince people, usually they give, they have a window of about three weeks that, you know, those little orange things that are parked by the side of the road that right now are saying, don’t put your recycling by the side of the road. Hopefully during that time, Andrew has friends, he’s gonna be able to get those little orange, uh, signs.

46:25 Notice saying, fill out your survey. Fill out your survey, let us know what you think. That sort of thing. I think we’re gonna, if, if, if we’ve gotta go to football games and, and have a a a, somebody handing out surveys, if football games, we will do it. That’s the goal. Did you Say the survey will be open for three weeks? That’s the plan. Although she said it, sometimes they’ve had to extend it a little bit. If there’s been bad weather or something during that time. And That’s in September? Yeah. Well, no, it’ll be later late September through maybe the 10th or 15th of October. Okay. Early fall. Early fall. Right. In other towns, have they offered a drawing?

47:12 Like fill out the survey and you’ll enter to win a $250 No. The market basket or something? Not that I know of. Get a free dump sticker beach sticker. Ooh. Ooh, that’s good. Yeah, that’s a good idea. That’s, I mean, a lot of times you see, you know, $5 gift cards to Amazon, that per survey filled out per Yeah. Per survey filled out. Yeah. That, that’s like one of the big ones right now. I mean, it depends, you know, we, we will run the numbers and stuff like that and try to, obviously the age groups, one of the hardest age groups is that 18 to 30. So you’re obviously, when you’re trying to complete a really robust survey, you’re gonna have groups

47:57 that you have tons and tons of, and then you have groups that you’re trying to gather more. Um, so we might have to talk and discuss how, how do you accomplish that? But like, we may go to the Y and sit there on a Saturday afternoon and try to get everybody, there’s a lot of 18 to 30 years old at that time. That may not be all marble headers, but we’ll get the ones that are marble headers, get their QR code. I I, I, I’m the, I’m the only two truly retired person on the board, so I have the time to do that sort of thing. And I, I really, I really think if we do this right, it will be meaningful. Yep. And we’re gonna work every very hard to do it. Right. Sorry,

48:42 Last question. You said there were three ways people could take the survey. So it’s it on paper, online, and what’s the third way? Well, you can call that them and they’ll bring or mail or deliver one to you. Okay. You Okay, cool. Thank You. It, it would be a paper one if that’s what you want. Oh, it’s, or they’ll to, Or you can Well, they’ll You would help you. Yeah. Okay. Complete notes on, or if they want, if you wanted, if you wanted to do a digital, they’ll help. Maybe we’ll have somebody at the, at the senior center helping out with the digital. Gotcha. How long will It take to fill out the survey today? She said 15 minutes, right? Yeah. 45 questions. 40, 45 questions Pretty quick.

49:29 Could have passed out a thousand of those that the dump this week, Right? While You’re waiting. Yeah. But, but again, but, you know, but that, put that off, you know, that idea is not crazy. I mean, there’s a huge number of people. So we do have certain rules about people doing that. Now it’s different where it’s the Board of Health facility. Um, so that, that’s something totally different. Well, sooner you publicize this better and better before it actually happens, people be on the lookout for it. Yeah. So obviously, again, with the communication, that will be a huge piece. Um, we’ll do at least three press releases. They’re gonna be doing articles to be promoting it. We’ll be using all the newspapers. Again, the communication to get people to know this is coming, trying to get it back

50:15 to us will be huge. The timeframe that we’ve chosen handing out to surveys in mid to late September is not accidental. We think that the town really to doing anything in the summer would be crazy. So after Labor Day, the kids will be back in school after Labor Day for the two or three weeks before the postcards go out. We’ll put a little ad in both of the newspapers. We’ll do everything we can to say, Hey, town, your, your, your survey’s coming. It’s important. It’s your voice to tell the Board of health how to prioritize its energy and what little money it has. Um, and, and we will do everything we can to,

51:01 to let everybody know it’s coming and that it’s worthwhile. And, and it’s completely apolitical, non-partisan. It, it’s for the good of the town, for the wellbeing of, of the individuals and the community as a whole.

51:19 Good. Mm-hmm.

51:23 Um, at the, my next issue with, I, I would really like feedback. Um, one of the things I would like to do during that post Labor Day timeframe, in addition to the, um, in addition to the, uh, advertising and the little orange, uh, information, uh, things on the side of the road when I lived in, in, uh, Santa Fe. Santa Fe does not have a U University at all. The closest university is 70 miles away in Albuquerque, and they have an Institute for Adult Education. It’s not adult education, learning how to keep your job or anything pleasant.

52:09 It it, it’s an institute that, um, people take classes for enjoyment and intellectual development. And, uh, I taught a course in the American healthcare system there, uh, while I was there. And I’m, I’m willing, I mean, I taught this kind of thing for three decades, uh, in lots of places. And I’m willing to do it anywhere. I, I, I know if we talked about this last time, but does anybody know how much we spend in healthcare

52:50 in, you said United States? You said something like $3 trillion or something like 5 trillion. Even since the last time I taught this, which is, which was in Santa Fe five years ago, when, when I taught it in Santa Fe, it was the, if it had been a country, it would’ve been the fifth largest country in the world.

53:17 This year. It’s the third largest country in the world. We passed Germany. The American healthcare system spends more money than the entire, I think 80 million people in Germany spend on everything.

53:43 Yet we don’t have the best outcomes in the world. I, I think Dr. K you mentioned N Netherlands, we last time, right? My, my mentor in Stanford had helped design the Netherlands, the Netherlands health system. So we, we studied that when I was in, in school. Um, and it, there are things we can learn and I think at the margin can do better. But, but the first thing I think the community needs to understand is, um,

54:24 what, what Pogo said, many of you don’t remember Pogo, but Po pogo, but he, we have meant the enemy and he is us. Um, and, and we asked for this system indirectly, and we need to understand it better to ask for it to move differently. The Massachusetts is way ahead of, of, of the other 49 states. There’s no question about that. Um, but if anyone has any idea how I can best get an audience to listen to, to participate in a seminar.

55:09 Now, one of the things we could do, instead of, we could still meet the Board of Health at seven 30, but we could have our seminar from six 30 to seven 30 on three or four different times. My sense is if we, I did in, in, in, in New New Mexico, I did four classes first, first the day I there about 90. What we know about adult education is that 90 minutes is about, well, anybody can pay attention. 80 80 is the number we we taught in, in, in UVA, um, the first session is who pays and who spends, where does the money go?

55:56 I handed out that Globe article the other day that, um, health insurance going up 14%. You know, how much do we spend on health, health insurance, private health insurance? Of that $5 trillion, 1.5, $1.4 trillion goes into private health insurance.

56:22 And the term that’s used is called the medical loss ratio, which means the difference between premiums collected and expenses, uh, paid for the medical loss ratio by the Affordable Care Act for people in the Affordable Care Act programs has to be below 12%.

56:49 In Massachusetts or in the United States, private health insurance, medical loss ratio is 20%. So we are spending 20% of $1.4 trillion to manage health insurance. I am sure our practicing physician can tell you where, just, just imagine what it’s like. All geezer like me comes into her office needs an MRI. How many health insurance programs do you cover in your office? Oh my gosh. I, there are a thousand health insurance firms in the United States.

57:34 When I was at UVA 10 years ago, we had 85 insurance firms that we had to go. So the old geezer comes in and needs an MRI, the first thing she has to do, or one of her assistants has to do is go and look up what insurance plan I’m in, what does the insurance plan demand that she say in order to allow me to get an MRI. And the plans are not all the same, and then they deny it, and then I have to appeal it. Okay. I, okay. Even forgot about that. Usually in the ICU, they didn’t drive.

58:20 But nonetheless, it’s not only the, the, the 20% medical loss ratio, the administration of the insurance firms themselves, the way we do health insurance, the delivery system pays for the health insurance inefficiency as well. And I would like more people to understand that that’s the reality of the us. And when I first came here, I, uh, uh, I was a little surprised. There was a bill going through the Massachusetts legislature to, uh, increase local funding to the town, the town, to expand public health services.

59:07 And I looked at the list of legislators who were co-sponsoring it, and neither one of them were our legislators. So I, being shy and unassuming, I called them up and asked to meet. So we met and I said, why aren’t you guys co-sponsoring this legislation? And both of them said to me, anytime any resident wants something, they will do that. And that they had neither of them, neither of them in their capacity as state legislators had ever had anyone go to them and say, the state should provide more money

59:53 to make public health stronger in the town of Marblehead. I would like to teach a little class so that I know that 15 or 20 or some fraction of my students would be there every time. Well, uh, it, it is part, if we’re spending $5 trillion, the democratic process means we ought to understand where that money is going. And that’s what I’d like to provide in however, uh, context it, it is. And it, when we, when we did it in, in New Mexico, and, uh, I’ve done it in other, many other places. Hmm. People got into it. And it’s not dry lecturing.

1:00:40 It’s, it’s you if you understand what it means to be part of an enormous system. So if you have any thoughts on how we, the board for the first time and forever, I think there are two people who are capable of trying to explain the system.

1:01:05 Why not take advantage of us? What’s the vehicle? How do we do it? I mean, I, I see the, the, the primary role that, that I have as chair is education.

1:01:24 And how can, how can we, how can we together stay clear of the open meeting law, but still be able to talk to people in the town and, and share what it’s like to, to be, um, in the front lines of the, what would be the third largest country in the world spending healthcare comparatively. Germany’s the second, uh, one of the second most expensive. It spends about half of the percentage of GDP, the little more than half that we do. But I, I go into, in the class, I, I talk about the Canadian system. We have a visiting professor who’s already volunteered for

1:02:12 that part, uh, on that. But I mean, I’ve written papers in Singapore. Singapore, very, very interesting system. Everybody has their, everybody’s their own health insurer, medical save. Everybody has a medical savings account and it works beautifully. Um, so, and, and people find, you know, once you understand, once you can explain these things, the world out there is no longer fuzzy. It makes some logical sense. For me, it was an incredible tragedy when, um, the, the president or CEO of UnitedHealthcare got shot in in Manhattan.

1:02:59 He was a de everybody said he was a human being. He was a decent person, good husband, good father, but the person who shot him was angry about his health insurance issues for the society to, to be so angry about the health system. And they, and we know so little about it, I think that you, you have the opportunity here. What, how can we do that for it many, the town doesn’t want it. Maybe we will learn. Um, but I think that just knowing the two of us, I think we can provide energy, we can provide concept,

1:03:44 we can, we can, um, if, if nothing else, we can almost guarantee we people will walk out of the class, say, wow, I didn’t know that.

1:03:56 Who was that? How dumb was that sort of thing. Um, we talk about drugs being expensive. Well, why are drugs being expensive? ‘cause we’re the only country in the OEC need that doesn’t regulate the price of drugs.

1:04:12 That my mentor who, who uh, designed the, the Dutch healthcare system, um, had previously as an economist, he previously worked in, in the, um, Pentagon. And his principal paper in the Pentagon was, uh, how much is enough? And he calculated how many bomb this is Cold War, how many bombs we needed to destroy Russia or Soviet Union at the time. And then he moved into healthcare because it was the only other place that needed to ask how much is enough. And we still don’t ask about it. But in any event, I I wanna add something here because I think it’s very important as you’re talking all about this, what has happened,

1:05:00 ‘cause I’ve practiced for 40 years, is defensive medicine. And what was behind defensive medicine is malpractice. That is something the United States has never, ever handled. And it’s a huge part of what goes on. Uh, do, do you wanna define, give your definition of defensive medicine? People order tests, do things that they honestly don’t think, or they think of only a very slight chance of being positive, but they’re doing it defensively. Because in court what can happen is it’s a doctor was an MRI available to you, yes or no?

1:05:47 Yes. And so, uh, with an adverse outcome, you, you’re on the spot. And if you’ve ever been sued, you know exactly what this is like. And it engenders lots. And this is something that nobody talks about, but it’s huge and it makes a lot of this extra spending part of it. And yeah. Let, let’s the example, the old D are brought into the, the doc, maybe I got, I got a little bit of a headache. There’s a maybe one in a hundred chance that it’s a brain tumor. Correct. But probably a 90% chance that I was out drinking with my buddies last night and I didn’t sleep well.

1:06:34 Right. But defensive medicine in, in a doctor practicing in lati, litigious world would think maybe I better do the c the MRI or the CT scan. Correct. And so another two or three or $5,000 get gets into the system. Correct. And that’s, yeah. In one of the sessions, we’ll, we will talk, but I’m just saying other countries don’t deal with this. And we keep forgetting this. We talk about drugs, of course. These are, these are the relatively simple things, but it’s that extra sort of layer there that you really have to think about. Mm-hmm. Um, and,

1:07:22 But we are not, I think the three of us would certainly agree. There are times docs make mistake and people are injured, and therefore the legal system requires that there be some some response. But I think what you’re, I know what you’re saying, but people ought to have to understand is there are times that people, the, the ordering person does not order things out of clinical judgment. It’s out of protection from the legal system. Correct. But we have to talk about that. Uh, I, I, that’s, that’s the, that’s the perfect kind. ‘cause usually in a session like this, you’ll get a couple lawyers. We don’t have, we don’t have a lawyer here tonight, but you get a couple lawyers in the room talking about it. And it, it’s a, it’s a very good conversation.

1:08:11 Right. Well, I mean, and there are solutions, there are tribunals where you have actually, rather than going to court, you have a tribunal of three, three people who actually go and in. And so I’m just saying this is part of our system that we own also, you know, He is meant the, so we’re Kaiser Permanente to sign in as an insurance and insured by Kaiser Permanente, which is one of the larger private system. You have to agree to have mediation or a tribunal, a mediation before one goes to system. I, there we can talk all night about the different examples about the kind of things No, but, but help, just

1:08:58 Help me. It’s a Help us, help us understand, help us help the community understand the complexity of the American system.

1:09:13 I mean, I didn’t have a lot of hair before I went into medicine, but I, I can tell you, I, I mean I learned a great deal. Uh, I, I went to engineering school and, and it’s medicine at Norris Public Health have the same rigor as an engineering decision. It’s, it’s very different. And we, we, we would like people to understand that.

1:09:46 So if there are any thoughts, either one of us, um, Yeah, so I, I have some thoughts on it. So You kind, You kind of talked about the four classes. Um, and we’re very fortunate to have two doctors on the board. Um, and obviously, you know, when I look at the people that we serve, you have the aging population. Well, the other big populations, the new families. We happen to have experts in both fields. Maybe you’re able to teach two classes and you’re able to, to teach two classes. And then depending on the outcome or the questions, you have additional classes to kind of answer some of that stuff. Yeah. Frank, that sounds great. One of the things I was thinking we would do is maybe make the

1:10:33 whole fourth class questions that people brought to us. Yep. We planned on three. We, we shared the way I was thinking. We talked last week about, um, say we let, let’s talk about the first time. Who, who pays, who sells, um, where’s the money come from, um, how much the hos, how much of the five, $5 trillion goes to hospitals, how much of the $5 trillion goes to doctors. Um, and then we talk about that. We give the slides and we give, uh, the maybe even a, a written, uh, uh, backup of the slides to, to our partners in, in the newspapers so people can

1:11:18 see what we’re talking about. They might have questions, they can come back. It, it’s the questions, quite frankly, that make, make it fun teaching. ‘cause as often as I’ve done this, there’s always somebody in the room who can ask a better question than I could have thought of in advance. And it, and it, it, it, it, that’s, and, and it’s, well, you know, we, like, I think I mentioned here, we went to Marblehead Pediatrics. I, we asked what was the, what’s the best thing about, uh, uh, working in Marblehead in a minute. The, the whole team said smart parents

1:12:00 to be able to teach a class to the people, the kind of smart people that are in Marblehead, um, that, that would push us to think differently and push, we’re at least articulate, hopefully articulate enough to push back and let, maybe help them see something differently. So you, you’ve got us, you’re paying out, you’re paying your a hundred dollars a piece. I haven’t got my hundred dollars the End of the year after this.

1:12:44 I see why you are paying for us. You’ve elected us. Get the best you can out of us. I mean, it’s just crazy. So I know you were asking for input and just as a resident, we kind of talked about it before too, some ideas that just popped into my head. The library’s always looking for programming. This could be something, uh, you could host at the library. You could host ‘em in the evenings or during, on a weekend. You can vary it so you could get different populations. Right. Um, COA we, I went at, at your suggestion, I went, Lisa, I’m gonna meet with the, uh, program direct. The program directors is away this week. I’m gonna meet with her the week of April 4th, hopefully, to schedule something April 4th.

1:13:29 Uh, August, August 4th, sorry, August 4th. Wish it was to, to, uh, to schedule something. Uh, if, if they think they can get 20 people 30, I, I’ll teach a a, we, we, we can teach any, any group, but it’s really better to have at least 20 people. Because if you have only 10, especially in a topic like this, you can get one person who, or two people who are, do, have dominant, strong feelings or have had some bad experience or something like that. And other people are shy. You really wanna be in a place where you can get ev everybody talking and everybody listening.

1:14:15 And so it’d be nice if we can get 20 people to do it, but we’ll, for the first time around. If we have to, we can do it any other way. And recording it. Yeah. I was just gonna say essential to be, And if you could put it up on YouTube. There you go. You know, um, I don’t know about all of those. The rights we can the board. Well, anyway, we, I, I don’t have, I don’t prob I’m always embarrassed when I go, you, uh, watch YouTube, watch these meetings. ‘cause I feel sometimes I feel unreasonably articulate. I watch myself like, zoom, zoom. I, well, holy Mac, they elected me. I mean, it’s unbelievable. Um, so I don’t know.

1:15:03 So just two other quick ideas and then I’ll be quiet. Um, Salem State, I don’t know, are you familiar with the Salem State Explorers program? So it’s a free, it’s not free, but it’s very low price education program that Salem State runs. And a lot of people from Marvel Head attend. You have to be over a 55. Um, so that, and they may be interested in running a course on public health, but by, you know, by two doctors. That’s just two. One other idea. And then another location I thought was, especially when it, when there’s so many changes in Medicare and Medicaid that may be coming, maybe some of the housing developments in town that are run by the Housing Authority MHA. ‘cause a lot of those folks are rely on Medicaid and, and obviously on Medicare. ‘cause a lot of them are seniors. So that’s just another thing.

1:15:50 The talking about the changes to Medicaid will clearly be important. E even without the housing stuff. Right. Um, and we’ll, we’ll have to do everything we can to try to make that apolitical. Right. Um, first, let, let’s everybody understand Medicaid, right? Let’s make sure everybody understands the difference between Medicaid and Medicare, and then understands the four flavors of Medicare. Um, and so we, that is a fascinating discussion. Um, the the four different Medicare, A, B, C, and D, um, we,

1:16:38 we can do any of these things. Um, it, it is, it, it’s, it’s a wonderful opportunity

1:16:48 for a recovering academic. I got what mad on. But, but it is also, it, it, it is, when your country is spending $5 trillion,

1:17:01 17% GDP

1:17:09 money, most people on the street think that bombers cost more than MRIs. But we spend a lot more, the, the, the defense budget, I think this year will go over a trillion. But it’s the first time.

1:17:30 And the, it, it’s an important discussion of the nature of what it is to be an American. Um, because of the way we have treated healthcare in a way, and particularly public health. Um,

1:17:51 Franklin Ano Roosevelt put a national health insurance program into the Social Security Act that he passed in his first term. But the politics, the American Medical Association, made it so difficult that he, he never pushed forward with it. And so the, even understanding the dynamics of the politics of why the United States went certain ways, at least has been fascinating to me. Um, so I

1:18:29 I’m pretty sure that we can make it, that people won’t be bored.

1:18:39 But anyway, um, we may finish.

1:18:48 I have, uh, are there any other questions from the floor or from, uh, Amanda, Tom, anything? Um, I was gonna say, one thing you could add into that, I don’t want to go too much more on it, is, like I said, I’ve dabbled in all the different types of insurance. And I think the most shocking thing to me is two, two things. One, that even when you go to a doctor’s office, sometimes they don’t know how much their own procedures cost. And so, like, I’ve done that before where I’ve gone in and been like, yeah, how much is this? I have a high deductible plan, I need to pay it. And they’re like, I don’t know that you talked to your insurance company. So they literally want you to get the procedure and then find out how much it pays, because how much it costs, because they don’t know. And I think also people have a fundamental misunderstanding

1:19:35 of how much they pay for insurance. I think if you ask most people whose businesses provide it for them, how much their insurance is, they’d just be like, I don’t how much they pay for insurance. They probably just say, um, I don’t know. My company pays for it. Which, which isn’t true. And most people I know, even when you think about, it’s like paycheck. Yeah. It’s like, if I made a hundred thousand dollars a year, I’m pay, and my insurance was 10 to $12,000 a year. That’s how much I’m paying because my company sees my value at 110 or $112,000. But they have to pay for the insurance. So I think people misunderstand those types of things, really, how much they are paying out of their own pocket. And maybe it would change people’s thoughts a little bit.

1:20:21 I don’t know. Well, we, in the, in the financial, the two slides that we show about where the money comes from, where the one money goes Yeah. Real out of pocket is there. Yes. And we have, we, we have a high out of pocket. And it’s rising. Yeah. And unfortunately, it’s, it, it, it’s, it’s regressive because the poorer you are, the more you’re paying out of pocket because the poorer you are, the less quality, lower quality insurance you’ve been able to afford. Even in the Affordable Care Act, the, the different stages. So, um, it is something that everyone, well, even, even you’re, you’re talking about the,

1:21:07 you asked the doc how much it costs, the doc doesn’t know. Yeah. Because the, the, the hospital could be charging different insurance companies Right. Differently for the same fit for the same study. Right, right. And does that, who, who can that possibly make sense? Exactly. So when I, when I was on a high deductible plan, you know, there were certain things that were covered and certain things that weren’t. So I had to weigh whether I wanted to do something or not. So I’d go in and be like, Hey, I want to, you know, have this checked out. This is a little sore. I’d be like, how much is it? And they’d be like, well, I don’t know, ask your insurance. But they’d look at me right there. So it’s like you’d find out after. It’s very, it was very odd. Glad I don’t do it anymore.

1:21:58 Uh, public comment. Anybody on the, Something I’ve seen with a lot of my rentals that I have, especially over in Lynn, a lot of people don’t have a primary care physician. Yeah. They call an ambulance, they’ll take ‘em to whatever hospital and it cost a fortune and it gs up the emergency center, especially Salem Hospital. I would go to Beverly first. Personally wanna Speak To that. Well, so, so there’s a, there’s an, a law called Tala that it, it mandates that every ER must treat anyone regardless. Accent. Which is, it’s important, but it is, it is way overused because It’s a waste of a lot of money. There’s primary better way to do it. Yes. Yeah. And I, the mol is actually for pre only pregnancies,

1:22:47 I, that’s universal for everyone.

1:22:51 It’s Very Complicated. And it certainly, it positive the emergency rooms makes the waits long. Um, and that shouldn’t be a place where you get routine care. Um, But if you look at this, would, if it came from Amanda, be self-serving. I’m not a primary care doc. We don’t pay primary care docs anything close to what they’re worth. Because the primary care docs pay attention to the patients in front of them. And they save a lot of money in the system upstream. But if the primary ca credit, credit docs aren’t available, and they’re the ones who have to be on call at night, when the, certainly Dr.

1:23:38 Kruger will know all that. When, when the mom has an eight month old with an ear infection, he’s the one who gets called. Not the intensive care doc, not the neonatologist or not the pediatric cardiologist. But yet we, we don’t pay the primary care docs. And, and I can tell you, I I, I, I work in an worked in NICU and pictures, which, which meant that I saw only six kids. The only thing my job was to keep them alive in until morning, until the smart people came. Um, but I never had to worry about, I, is this it, should I do this or not? Everything I knew how to do,

1:24:25 because this kid was clearly sick. I, I was able to do in her job. Certainly in his job when he was seeing, he saw 99 well babies for one sick kid. And he has, he has to have a certain kind of intelligence that allows him to have an in instinctive feel. Yeah, this kid just doesn’t look right. I better do some, you must have that with adults as well. But see, in an ICU or in cardiology or in nephrology, you never cardiology.

1:25:11 Oh yeah, you got a heart. Let’s, let’s spend money on it. I, I mean it, but the primary care docs, and that’s why it’s tough for the primary care docs. They don’t get paid nearly as well as the specialists or the subspecialists. And, um, And it’s, it’s not even, it is just, it’s not even just the money. It’s, it’s the, the amounts of work that is generated from the electronic medical record and all the after hours work, that’s just never ending. And that limits how many patients you can see because of documentation We taught, my friends and I, at, at the law school I used to work with, taught this course somewhat course like this to 50 federal judges.

1:25:58 Hmm. The University of Virginia Law School had a program for masters in law. And the judges who were out there making decisions about healthcare had no idea about the healthcare system. And it was a fascinating, a fascinating opportunity to hear the other song. So, um, yeah, it, the, the simple answer is there aren’t enough primary care docs to go around. Um, I don’t know what the shortage is in Massachusetts, but in New Mexico, it was unbelievable. I think. Are you fully staffed? Oh,

1:26:43 Yes. We, yeah. We’re, we’re full. It’s, it’s hard to find the primary care doctors. Um, and yeah, I know a lot of people in, in our area don’t have primary care. And that’s, that’s something we should, we should talk about and, and give people resources of maybe who is taking pictures that, do we have something like that that we give to? No. Yeah. Well, and, and at, at one interface, maybe some things that primary care docs do, public health might do in a different way. Public Health can certainly come in and fill in that gap.

1:27:20 The difference between primary care and public health is primary care. Every patient is the only patient in the doc’s room. Public health tries to bundle a hundred people together and make some decisions. Not very many, but some decisions that might be relevant for all hundred. And so you can therefore by scale, do it cheaper. Um, you know, and then the prevention issues of stopping smoking and all those things. But primary care is very, very, very tough as a person who would never, ever survive in that. I, I, I could not, I, I would not trust my judgment enough

1:28:09 to know that, yeah, the kid does have an ear infection, but, but maybe he’s a little sicker. Uh, what should I do about getting them through the morning? It it, Well, what, what I’m going to, there’s so much that changed, but part of it was that is how the time is being used. Um, and this is a huge problem. The time is being used charted, whereas before, let’s take your example here. This was not uncommon. I would see a kid and I’d told the mother, come back tomorrow and I’d just, you know, maybe five minutes. It didn’t have to be a slotted thing. And I, we could tell right then and there so that I’m not doing an unnecessary test.

1:28:56 I’m basing my judgment, but also I’m putting guidelines around so that she goes home or he goes home. The father, they go home knowing they’re gonna see me the next day and we’re gonna figure this out. Then they may call the next morning and say, keg, you know what? The fever went away. He’s acting totally normal. I said, wait, that got lost. Because among many other things, this automated medical, whatever, electronic medical system actually is an insurance system. Very little of it is actually a medical record system. And people don’t realize that, because I can go on and on because your actual remuneration is how you

1:29:43 use this in code. And because the higher you code, the insurance will give you more money. But what happens is that people start automatically filling in things that they didn’t do. So the insurance company looks to see that things were done. So it’s actually very destructive. Yeah. It’s a destructive system. That has to be, I don’t know whether other countries use an automated system like this, but it has not helped the United States period. Yes. Uh, you know, when you saw a doctor, the lab test being in there, all of that’s very essential, and that’s what it’s good for. But as far as you can read through a whole document

1:30:30 and even at the assessment, not know that a child had a heart mur you reading through and just where the heck this is? So, you know, because it’s a normal exam. So I’m just saying that there are so many aspects as a primary physician that I saw that need addressing. And part of it is the health insurance and the way doctors are remunerated, for example, procedures, procedures are remunerated at a huge level. You know, who makes the most money? What specialty makes the most money? Do you have a guess? You wanna guess? Take a guess. Seriously, take a guess.

1:31:17 I’m sure it’s the specialized surgeons. No gastroenterologists. Oh, because they do so many procedures. All those colonoscopies. Oh, all of those by a large margin.

1:31:36 I’m just saying this, there’s so many aspects of the healthcare system that need looking at. Well, that gets even more complicated because now all the GI practices around by, uh, private equity firms than the private equity firms make most of the money off the GI guys. So it actually, it. But anyway, we’re, we’re this, we, we help us help us share our, our experience. I don’t wanna say even knowledge. Just help us share our experience, because health is a big deal. 17% of GDP $5 trillion,

1:32:22 and nobody feels it works well. And back to the, the, the, the medical record issue. Uh, one of the things I learned in engineering, you never automate a bad process.

1:32:40 You have to work through the process first. Then you see what technology might be available, then you put the technology in the place. But if you, I i, if you go to a technology store and say, yeah, my pediatric ward doesn’t work very well. Give me a pediatric medical record that ain’t, that ain’t gonna work. So what we would try to do is talk about the process of how we deliver care and what might be done or what might incrementally be done to make it better. I will say AI has been a game changer in our practice. Uh, AI note writing. Um, it essentially listens to your visit

1:33:25 and crafts a note for you. So you can say out loud, I, I hear a murmur. It’ll write that in the note section. So you won’t miss that. And it’s, it’s very Terrible. Yeah. Which may, which may change things. That’s, that may be a game changer. Yeah. It’s, it’s made us more efficient, less note writing and the it’s more accurate. Anything you say, it’s, it’s in there. Um, so we can talk About making me feel old. Couldn’t even spell a i when I was practic six.

1:33:56 Um, but I think the, I think the seminar would be great. I like the idea of an hour before the meeting is planned anyway. And, um, or the library. Any thoughts? Any thoughts? Just let us know. I would really like to do this in the post labor day time for period. ‘cause wherever we are, however we’re doing it, we’re gonna be talking about calm, we’re gonna be talking about the calm survey to please fill out the forms. Please, please pay attention to what’s happening and, and, uh, help make it work. I, I really do think that we have an opportunity to, innovative may be too strong a word, but I think we have an opportunity

1:34:43 to be somewhat creative in the public health field, which has not had an opportunity to be exciting or innovative in the past. I’m not saying we can do it all, but if we can just convince 20,000 people in town that, Hey, maybe, maybe we could do something better. Um, I, I, I, and we’ll have fun.

1:35:16 Okay. Um, uh, nobody talking on the outside. Bill, uh, um, move we adjourn. Second. All in favor. Thank you. When is the next meeting? A, oh, that’s the 10th or 11th? Uh, what? It’s the 11th of August. Tuesday. Second Tuesday of the month. It’s the 12th. The 12th. Great.

1:35:50 Well.