Sam Rohrer: Well, welcome to Stand in the Gap Today. I’m Sam Rohrer and I’m gonna be accompanied by Dave Kistler today and here again the President has addressed the United Nations. Much anticipated address. A little bit differently than the one done last year, but certainly highlighting American sovereignty and foreign policy, but all on the backdrop of the fact that Iran’s leaders have just yesterday, last evening pledged an attack on Israel and the United Arab Emirates and Saudi Arabia. Right on the backstop of Russia announcing that it was going to be sending its most sophisticated S300 missile system to Syria, which is in a direct violation or disagreement with an earlier agreement that they had with Israel not to do so. And then of course all of what’s happening in D.C. with the Kavanaugh hearing.
So, the news today is full, and we’re gonna talk about more of those things I just went over tomorrow with special guest IQ al Rassooli who will be calling in from overseas where he lives, and we’re going to be talking about some of these events as they have more profound world implications. However, today on Stand in the Gap Today we’re going to focus on the matter of healthcare and specifically the reality that big brother is in fact in the exam room with you when you’re there and frankly when you’re not there. And your information, which you thought was confidential and used to be protected by law no longer protected and in fact might be just as available to elementary hackers as they stroke their keyboard as it to anyone.
So, we’re going to talk about how big brother is in the exam room and what it means to you. Our expert guest and friend of quality, competitive health care, is Twila Brase. She’s the founder and the president of Citizen’s Council for Health Freedom. And her website is cch, which stands for Citizen’s Council for Health Freedom, cchfreedom.org. So, again let me welcome you into the program again today. We have a lot to cover so I’m going to get right into it and welcome our guest right now, Twila, to the program. Thanks for being with us today.
Twila Brase: Oh, I’m so glad to be here. Thank you Sam.
Sam Rohrer: Twila, it’s been a few months I think since we’ve had you on, but I want to get you back because there are a lot of things happening and the healthcare issue is one that used to be front page news. It’s only been shoved to the side by the Kavanaugh hearings, but I am convinced that the importance of it is no less. It’s just gotten bumped to the side momentarily. But with that, you just wrote a book entitled “Big Brother in the Exam Room” where you share vital information about one very troubling change about which all of our listeners need to know, but before we get into why you wrote this book. Could you just share a moment bout the Citizen’s Council for Health Freedom? Twila, you formed this organization. What’s its mission and why did you put together this organization Citizen’s Council for Health Freedom?
Twila Brase: Well, I am a registered nurse by training, worked in the Pediatric ER and have taken in a lot of patients in my life. And really the mission is to protect patients and doctors to protect their freedom, to protect the individual choices that they can make and their individualized patient care so that every patient is treated as an individual. And then part of our mission is also to protect the patients’ medical and genetic privacy and the reason that we want to do that is because we understand that privacy is the foundation of freedom and that whoever holds the data makes the rules and that in any nation where there’s a dictator or a tyrant surveillance is one of the key ways that people are controlled. So, our mission is really to protect patient and doctor freedom and all that stuff goes in there.
All that stuff also means of course that we’re opposed to the government take over of the practice of medicine. The government takeover of the exam room and the government control of what your choices are and whether or not you can even have a medical service that you need when you need it.
Dave Kistler: Twila let me ask you and by the way it is a delight to have you on the program again. But a lot of positive things in our opinion have happened since the election of Donald Trump as President but in the last two years, Congress has refused to fully appeal Obama Care, so my question to use is, is the healthcare system in the U.S. improving? Has it improved in the last two years or has that refusal in a large degree thanks to John McCain, on the part of Congress refusing to fully repeal it. Has that continued just to cause the healthcare system in America to just erode?
Twila Brase: So the healthcare system continues to erode because the Affordable Care Act is still in place because Medicare is basically running the show and moving towards managed care for all, which is a health plan for all. A health plan for all was part of Hillary Care. I don’t think people remember that. She planned to run the entire national healthcare system through integrated networks and through HMOs, and now the Affordable Care Act has put those HMOs, which are now called health plans in charge of everything.
As a matter of fact the law specifically says you cannot have catastrophic coverage or what we used to call indemnity coverage which is true insurance. So that’s not being allowed.
The health plans are not true insurance because true insurance does not interfere. True insurance simply sets prices and then pays the patient, who then pays the doctor and pays the hospital. That’s what we used to have and that was true insurance. Now we have a health plan that has legal authority to deny access to care.
Even the U.S. Supreme Court in the year 2000, in a court case about a woman who died because a health plan said no to the care that she needed. In that case the U.S. Supreme Court ruled against the woman who had died, against that side because they said Congress put the health plans in place to ration care and if Congress wants to change that they can.
So when you’re now talking about the Affordable Care Act and the fact that it has not been repealed, it’s really important to understand that the Affordable Care Act really brings us so much closer to Hillary Care and where Hillary wanted to take healthcare. And the amazing thing that even the Republicans won’t try to undo it, and it’s not just John McCain, really that was only what was called a skinny repeal. It wouldn’t have repealed almost all of it. It was really minimal.
They have never tried to repeal the entire law and people miss that.
Sam Rohrer: That’s a good point.
Twila Brase: And I think it’s because they’ve got really big donors, the health plans, the data industry, the hospital systems are really big donors for them. And all of them are making out like bandits under the Affordable Care Act. It’s the patient and the doctor that are penalized, that are being taken advantage of and that are being harmed.
Sam Rohrer: Well when it comes to healthcare information, patient healthcare specific information, what ailments that you’re visiting the doctor about, what prescription drugs you’re taking, what treatment plans you may be on. All of those things have historically been private. After all, why should anyone accept your doctor and you know your most private health problems?
And why should this private information be routinely shared with all people, above all people the federal government and it’s hordes of bureaucrats with their known ability to access any private data it seems and potentially release it to the public as we been witnessing in the deep state leaks against the Trump administration. But what would you say if you knew that thanks to big brother government that your private data, your own specific prescription drugs and more are all now in essence being placed on billboards for all to see.
Yes, electronic billboards. That kind of reporting that places private health data, your private health data on electronic billboards just waiting for some cyber hacker or more to access and then of course potentially share what they may want.
We’re going to talk about this now in this segment with Twila Brase. She’s the Founder and the President of Citizens Council for Health Freedom. Twila, your organization is heavily focused on health freedom as both your name and your comments in the last segment indicate and because of your commitment to the protection of healthcare freedom, I imagine you wrote in your most recent book Big Brother in The Exam room had to do with that.
Big Brother has been sticking his nose into the healthcare arena, into the doctors offices and the hospitals and drug manufacturers for quite a long time. Your book uses the term exam room to indicate I suppose something new, if you could right now before I get into the super details, give us a brief overview of the legal justification being used by the federal government to now force itself into the doctor’s exam room and to collect this heretofore private data. What are they using to justify this major change?
Twila Brase: So I there were two things. One is old and one is new. One is old and that is HIPPA. So a lot of people think protects your privacy but HIPPA does the exact opposite. It says that you no longer have any consent rights over how your information is shared unless your doctor or your hospital decide to let you refuse to let the share it but they don’t have to let you refuse. And so that’s what HIPPA does, it allows this grand amount of sharing and it was really part of Hilary’s plan. It was in Hillary Care, so that all of our data could be put into an electronic format without our consent and could be shared through that electronic format.
Sam Rohrer: Okay. Twila?
Twila Brase: Yes.
Sam Rohrer: Let me interrupt you just one second here. I just want to clarify something ’cause it think it’s key. You said HIPPA, which most people are aware of used to go in before you had a practice of a procedure done patients would sign the HIPPA agreement and that used to you said protect the data but then you said now under changes, HIPPA exposes your data. Is that what you’re saying?
Twila Brase: No. So before HIPPA became the law of the land, when you went in for a procedure you would sign a consent for that procedure and only if you wanted to share your data or your doctor wanted to share your data would you sign another form that gave specific consent to a specific provider to be able to see your information or to share it with a specific hospital, right?
Sam Rohrer: Okay.
Twila Brase: But then HIPPA happened. And HIPPA was part of Hilary Care but it wasn’t passed in Hilary Care, it was passed three years later. And what HIPPA says is that you have no consent rights over your data. That has been going on now for 22 years. We actually did something on the 22nd anniversary and gave 22 things that are happening because of HIPPA and anybody can find that on our Facebook page, CCH Freedom.
So, that’s the distinction. So we have this old law that’s been going on and moving us forward to digitizing all of our medical records and putting them into a national medical records systems whereby anybody all over the country under HIPPA can have access to that information if those who hold it open up your medical records. They are fully allowed to open up your medical records and give all these folks access without your consent. So that’s one legal justification.
The other legal justification, why the government in particular and the health plans as well are saying they need to access your information is because it’s something called pay for performance, which has been around for a while. But now under the Affordable Care Act, something called value based payments. They want to pay doctors only for the value of the services that they give you, not for their expertise, not for their time in training, not for how many hours they stand at the operating table taking care of you; only for value.
This is really moving towards the socialism in paying doctors not for what they do but for what the government and the collaborators the health plans decide that they’re worth. So your doctor could actually be paid very, very little for what they do for you to save your life because it doesn’t fit a formula of great value.
And so they need all of your data, they need all of the doctor’s treatment decisions, they need all of the medications, they want to know who you are, what you eat, when you sleep. That’s what’s happening now to figure out exactly by the government and health plans, how much they’ll pay your doctor and whether.
Dave Kistler: Twila, let me ask you this. Having traveled around the world I have had on two occasions to take advantage, if I could use that phrase or use the healthcare system in a foreign country. And it was in the country of England, is what you’re describing here the same as what we have witness take place in Europe, as far as the healthcare system? Or is what you’re describing as far as the electronic record keeping, the doctor being paid for value rather than what they actually do, is this far worse than anything we’ve seen on the European continent?
Twila Brase: Well I’ll say this, it’s different and so it’s a little like a combination of Canada and England. And so, I think that the American style version of single payer will be run by the health plans. The health plans will control it won’t actually even be the government controlling it because we’ve got 325 million people in this country whereas Canada has something like 30 or 35 million people in their country.
It’s easier to run a single payer system in Canada. It’s easier to run a single payer system in England, in the British what am I trying to think of … the United Kingdom, right, because it’s far few people. And so I believe the government will put the health plans in charge and will do much as they are doing now under the Affordable Care Act, they’ll just answer the call of the health plans because the government doesn’t want to take it back. They don’t want to run the healthcare system, they don’t have the capacity to run the healthcare system. So they’re going to pay the health plans to run it for them.
As a matter of fact, there was a news article in Accesos where a Wall Street advisor was talking about how the big investors were not afraid of single payer in America because they think that Medicare for all which is the new name for single payer, Medicare for all will be Medicare Advantage for all. And for your listeners who don’t understand that, Medicare Advantage is the health plan version, the HMO version of Medicare. It’s where the federal government pays a set price to the health plan to take care of all of the enrollees needs and so the health plan gets all of this money and then has the authority to deny access to care if they think it’s not necessary, of low value, whatever, right.
So, that’s what the investors are seeing. They’re seeing a single payer system in America run by the health plans who will tell the government how high to jump, how much to pay and Congress will do it to try and keep this all politically in place. So they don’t have to face the voters when the whole things collapses. They’ll always be able to blame the health plans, they won’t have to blame themselves. They’ll be like the health plan is denying you care, we offer you coverage for everything, yes, and so it’s the health plans problem. That I think, is what the American version of single payer will look like if we let it get to that point. We’re so close.
It’s actually what Hillary wanted right. She had the health plans running healthcare and Obama Care said the health plans would get the entire market and now people are talking about Medicare for all but it will be run by the health plans. And that’s where the American Healthcare system is going unless we can stop it.
Sam Rohrer: You know Twila, you are describing … you used the word socialism but what you’re describing is much more in line with the word fascism. It’s socialism … fascism is when government actually controls the processes of private enterprise. Socialism is when they actually own it. Really what you are saying is that you have big government and then you have big business or big healthcare or whatever that does and effect the bidding of government but gives government deniability but at the same time it’s not the patient that runs it and it’s not the doctor who runs it.
You’re describing something that is really, I think everybody who’s been out have been accessing healthcare would say yep I’ve run into pieces of what you’re describing Twila Brase and I don’t like it.
When we come back here, we’re going to breakaway just now, just a few seconds we’re going to break. When we come back I want you to talk a little bit more specifically what information is being collected and where it is going. Who has access to it specifically because that’s what the who book is about where your talking here about big brother in the exam room and the dangers of electronic health record.
We’re dealing with an issue that’s important to every one of us and that is our healthcare. Specifically the concern now as raised by Twila Brase, who is the President and co-Founder of Citizens Council for Health Freedom, and that is the information that is being collected, your private information. The stuff that you really don’t want anybody to know about and you think that only your doc and you knows about it. It’s not that way anymore. Other people know about it. The start reality as Twila has raised, is that big brother in the form of big government as she described, big insurance companies, big pharma and big others I’m going to put in there.
They now have and are collecting evermore of your vital and my vital information heretofore private, always sensitive health records and they are posting them on electronic mediums. I’m going to call them billboards, giant, worldwide billboards because whatever is posted out there electronically, somebody sitting in Russia or China can access it just as well as you. Frankly probably more easily than you. But the logically next question is, what are the implications from all of this? What’s the real concern?
The collection of this data actually going to do anything to improve healthcare? Or is it all a downside. And so Twila I want to get you back now, before you go into the implications here which is where I want to go in this segment. I want to go back to the last question I posed in the last segment and that is what information, kind of describe the extent of the health data that is now being collected and put on this I want to call it again, electronic billboard?
Twila Brase: So I think that the patient’s … people go into the exam room, they go to their doctor’s office, they go to the hospital, they are faced with these long questionnaires before they ever get there. Some of them find that when they arrive they are handed an iPad and they’re supposed to answer all these questions about their family, about themselves, about their medical history, about their alcohol use, whether they feel safe at home, whether they’re guns in the home. There are all these sort of questions that they’re asked to relay before they even get into the exam room.
So patients have some idea in that way but then there’s also all of the things that happen once the doctor enters the room sometimes with a scribe, which is someone who doesn’t have necessarily any particular medical training could just be a good typist. No medical training, no nurses training, no medical assistant training, nothing right. And so these folks come into the exam room in the midst their asking questions and the scribe or the doctor will start writing what you say.
Now, we had a woman call our office once and she was really friendly with her doctor, knew her doctor for a very long time and she told the doctor all the woes of the day and at the end the doctor handed her a prescription for an antidepressant and she looked up, shocked and surprised like I’m not depressed, I just was telling you all these things because it’s just kind of a bad day; and goes oh just take it. And she goes, no I don’t need it; and he goes oh you can take it and just throw it away.
So she gets her medical records to take them to someone else and she sees that she got an antidepressant written in there, depression written in there. She’s got all the details that she told her doctor about her dog and her husband and her house and everything right. And she doesn’t want to share this information with the next doctor. But I told her you know here’s the deal, one of the things that you don’t realize is that depression is one of the things that doctors get paid more for. So there are these quality metrics that the health plans and the government have imposed on the doctor offices and according to those quality metrics, they either get scored as a good doctor, a bad doctor, a medium doctor. They get paid better or worst according to how they comply and essentially how you as a patient comply.
So the fact that this doctor could find depression and treat depression is a positive for his score, it’s a positive for payment and it’s just terrible. It’s just terrible because the doctors are essentially treating to the test. When patients are pushed into vaccination, and they’re pushed and they’re pushed, and they’re pushed and they finally give them the I’ll sign fine.
The reason is because the doctors have to have a certain percentage of all of their adult patients and a certain percentage of all of their pediatric patients vaccinated. That information is reported to the health plan, to the government and they’re scored accordingly and paid accordingly.
Sam Rohrer: Twila, I know Dave has got a question, I want him to get to it but how long has that been going on? I mean really that’s a conditioning of the doc, that’s a conditioning of the treatment style of the doc. Those are adverse, upside down incentives.
Twila Brase: That’s exactly right. Pay for performance was part of the Medicare Monetization Act in 2003 and that really started this move. But quality measurement was also part of Hillary Care and came in as a voluntary reporting law and I think it was 1998 or 1999 but now it’s mandatory. That’s how these things happen, right. They start out as voluntary and then they become mandatory.
It has just gotten worse and worse and worse. Now they’ve got quality measures that they have to pick a certain number of them that they’re going to report on and that will determine how they’re paid and how they’re scored. In 2015, the Republicans were in charge, right, and they passed their law which is called MECRA, the Medicare Access and Chip Reauthorization Act, MECRA and that really embedded this payment system further into law. It really strengthened it and President Obama, his White house economic council advisor, his chief one was giving a speech to a group and said that the President Obama would be happy to sign this law MECRA because it further the payment reforms of the Affordable Care Act.
And so when we see something like that, it’s kind of shocking isn’t it that the Republicans are just helping to push this further and further and further in because they want to use the doctors and they want to use the health plans to control Medicare and Medicaid spending by essentially paying them less, paying them only for their value, paying them to deny access to care, refusing to cover certain things.
This kind of control cannot happen outside of the electronic health record. It is the electronic health record that has been imposed by Congress. The Democrats and Obama in 2009 just four weeks after his inauguration passed the American Recovery and Reinvestment Act and that’s what included the electronic record mandate.
So that’s what I write about in the book. People can find the book by the way at bigbrotherintheexamroom.com I write about the fact that this, I call it the government EHR, electronic health record because it has to do what the government says it has to do. And it has to be used meaningfully which is the government defines what meaningfully is. Otherwise they get docked. They can get docked as much as 20% on every Medicare patient if they don’t use it meaningfully.
So the book just talks about the controls that are being exerted through the government electronic health record and though the reporting requirements and through now the cloud. I have a quote in there that talks about how the centers for disease control and prevention are planning to reach into the cloud, and the cloud … I’ll share what the cloud is in a moment. They going to reach into the cloud to find data buried in EHRs, that’s their word buried in EHRs.
So the cloud because of the mandate everybody’s got this monitor in the exam room and that monitor is connected to a server. Often times the server is offsite like at the epic headquarters or the headquarters of another electronic health records company that has made oodles of kaboodles of money off of this law. Those are called server farms and they’re called the cloud. It means that the data is not sitting in your doctor’s office. It means that it’s not sitting in a server in your doctor’s office. It’s sitting somewhere else, offsite, far away under control in an electronic health record company.
Dave Kistler: Twila let me jump in and ask you this. In fact I have a recommendation, could we try to at some point get the same type of quality assessment applied to the members of Congress? and let their payment be based on that?
Twila Brase: Oh I have thought the same thing. Imagine if they had scorecards for their quality metrics. But those quality metrics in the exam room aren’t really quality, they’re compliance. They’re not quality.
Dave Kistler: Yeah. Let me ask you this. I mean this is stunning information you’re sharing with us. It’s got to be as eye opening to our listening audience as it is to Sam and me, is there anything redemptive that is coming out of the electronic collection of medical records? Are there any positives or are they all negatives?
Twila Brase: So you know there were electronic health records before the government mandate and those electronic health records worked for the doctor and one thing that you’ll learn about in the book is how the government EHR does not work for the doctors, it doesn’t work of the patients. It doesn’t follow the flow of taking care of a patient and that’s why there have been so many errors, that’s why people have died. The FDA agrees that people have died because of this move to electronic health records and health information technology. They died, they’ve been injured because doctors can’t find things. They can’t figure out which screen they’re on. It doesn’t follow the workflow, it doesn’t follow the way doctors and nurses take care of patients. And so the electronic health records could be good if they actually followed that and it didn’t report everybody else what’s happening in the exam room.
Sam Rohrer: But it’s unfortunately as you say Twila, it has more to do with compliance, not with good healthcare.
Well as we swing now into our last segment already. The program has gone so very, very fast. We’re talking about healthcare, the title Big Brother in the Exam Room. That happens to be the name of a book, of a new book written by Twila Brase. She’s the president and co-founder of Citizens Council of Health Freedom.
We’re talking about big brother in the exam room in the form of mandated record keeping which is placed electronically on what I’m calling giant billboards, electronic billboards that are really sitting in servers across this country. Twila just talked about them being in the cloud and for those that were listening knows what that means. But what it means is that it’s not secure. That’s what it means and that is part of the major problem.
Twila and to conclude this segment by making another application to the danger of the collecting of this information and as you have so very clearly made clear the forcing of the compliance on the doctor, forcing the doctor to do things that would not otherwise be done under the true provision of quality healthcare [inaudible 00:30:58] by the doctor in favor of the patient. There’s other mandated government factors that he has to do and you cited finding people who he think could be treated for depression because he thinks he’s going to get paid more for it as an example that kind of a thing.
But the tracking of doctors, you referred to it … the way they qualify and rate a quality doctor by providing value to the patient and all of that being determined by some governmental entity.
But I want to go here very quickly for some comments from you because in China right now, China with their 1.4 billion people are imposing a new system where they’re calling it social credit scores. We talked about it on this program last week where we talked about the actual collection of biometric data and how that is being done and combined but they’re actually tracking everything on those citizens. They’re tracking what they buy and sell. They’re tracking where they travel and how they access public transportation and when and how. They’re listening to phone conversations and tracking their voices, they know who’s speaking and what they’re doing. They know where they’re going on the internet. They have physical surveillance that they’re tracking and whether they’d dropped on the street because they will get a negative score for littering.
These are unbelievable 1984 George Orwellian type of things but it’s being done right now. But Twila one of the things I noticed was that as a part of the information collected is their medical records. All being put together and being examined. Talk to me a little bit about that Twila. Are we on that same path here in the United States or are we far down the road perhaps but talk to me about it because when you put it all together it is a controlled society. I don’t like it.
Twila Brase: Right. Well they would like to put it all together. They found when they put out the mandate in 2009 and they made it required by January of 2014 that every doctor’s office and hospital has this government EHR installed, they didn’t actually make really strong requirement that they’d all be able to talk to each other.
So we have been saved as it were by the lack of interoperability because as I described before, HIPPA would allow all of this information to be shared so they don’t talk to each other very well. So a majority of information is shared between doctors and hospitals by fax, still because they don’t all talk to each other. So Congress has tried in the end of 2016 they did a ‘no information blocking bil’l and they said we had to make it all interoperable and they had to work in that direction. And they have built something called the eHealth Exchange which is a national health information infrastructure. A lot of our medical records are already on there but not all of them.
So we’re moving in that direction and one of the things that I do in Big Brother in the Exam Room which by the way could be find at bigbrotherintheexamroom.com. That’s where you can order your own copy, bigbrotherintheexamroom.com. One of the things that I do is not only explain where we’re at so that people can figure it out but at the very end I give four lists of action steps and there’s a specific one for Congress, for state legislators, for doctors and practitioners and then there’s one for citizens and patients.
Because you need to protect yourself from this and because you need to raise awareness and because you need to stop the doctors from doing what they’re doing and because you need to call them on it. You need to make it more difficult for them to comply with these orders from on high because this entire health information system is all about controlling your doctor, limiting your access to care, profiling you, profiling your doctor. Actually the head of the Epic EHR system told all the users at a conference that they wanted to know how long patients sleep, what do they eat, what are their social conditions, what are their living arrangements.
All of this stuff that they want to have on you because data, data is two things. Data is money, it’s the 21st version of gold mine today and they all want it. They all can use it and they’re making billions off of it. But the other things is data is control. Control not only to control the doctors but to control how much money leaves the health plan. So the more that they can control the doctors the more money they have for themselves.
So, Big Brother in the Exam Room is meant to try and stop this trajectory. To get all of you aware of what’s happening and then engage you in real concrete ways to stop it. One of the best things that everybody who is listening can do is tell their legis … well give their legislate a copy but then tell their legislator that HIPPA is a federal law that a state law can better. So if you have a real privacy law inactive in your state by your state legislators, everybody has to follow it. No information could be shared without your consent if the state legislator does that.
So that’s a real concrete way and it’s mentioned in the steps of what individuals can do because this is all about not only saving our healthcare system, protecting patients, protecting doctors, protecting freedom; it’s about protecting freedom for the entire country. Imagine if they knew everything that happened in the exam room with President Trump or with you or with celebrity of any sort. Anybody with power, right. As soon as they have all of that information on everything that happens that’s control. That’s losing our country, that’s losing our freedom and that’s ending up in a society that we don’t want to end up in.
Sam Rohrer: Absolutely Twila and we’re getting close to the end. I wanted to go where you were going right there. Tell our listeners again what they can do help frustrate the implementation of this system or help as you say contact legislators to put into place a proactive low. Summarize that just briefly as we come to close here.
Twila Brase: Yes. So one thing is just raise awareness. Everybody thinks HIPPA protects privacy. It doesn’t. I have an entire section in the book to say it doesn’t protect privacy, it is a disclosure law that does not protect you. So we have to raise awareness, the book is about raising awareness, talking to your doctors about raising awareness. Talking to your legislators. But I have these steps. One of the steps that I say is when your doctor tells you we’re going to give you this kind of care, you say to your doctor, now is that the kind of care you think is the best for me or is that the kind of care that computer allows.
Sam Rohrer: That’s a good question. Say that again.
Twila Brase: Is that the kind of care that your thinking, your critical thinking, your expertise says is best for me or is that the only kind of care that the computer allows. That’s the only box you can check.
Sam Rohrer: And with that we’re going …