The Charlie Kirk Show - November 21, 2025


The Minneapolis Mogadishu Looting Operation


Episode Stats


Length

45 minutes

Words per minute

182.81389

Word count

8,251

Sentence count

570

Harmful content

Misogyny

7

sentences flagged

Hate speech

22

sentences flagged


Summary

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

On today's show, we're joined by Ryan Thorpe of the Manhattan Institute and Chris Rufo of City Journal to discuss a new piece from City Journal on the massive amount of fraud going on in the Somali community in Minnesota.

Transcript

Transcripts from "The Charlie Kirk Show" are sourced from the Knowledge Fight Interactive Search Tool. Explore them interactively here.
Misogyny classifications generated with MilaNLProc/bert-base-uncased-ear-misogyny .
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
00:00:03.000 My name is Charlie Kirk.
00:00:05.000 I run the largest pro-American student organization in the country fighting for the future of our republic.
00:00:11.000 My call is to fight evil and to proclaim truth.
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00:00:49.000 Here we go.
00:00:56.000 The Charlie Kirk Show is proudly sponsored by Preserve Gold, the leading gold and silver experts and the only precious metals company I recommend to my family, friends, and viewers.
00:01:09.000 All right, welcome to hour two of the Charlie Kirk Show.
00:01:11.000 I'm Andrew Colvett, executive producer of this show, along with Blake Neff.
00:01:16.000 Really exciting hour two, actually.
00:01:17.000 We're going to get a little deeper, more, I don't want to say philosophical, but this is going to be a smart, elevated hour because we're talking about some of these themes in American life, especially the modern American life, that kind of go under the radar, but they're having a profound impact on your taxes, the way your government spends money, some of the fraud that's happening.
00:01:35.000 We just had a congresswoman out of Florida who was a grand jury returned an indictment charging her for stealing $5 million of COVID funds.
00:01:44.000 So this is kind of a story in that realm.
00:01:47.000 We're going to welcome Ryan Thorpe.
00:01:48.000 He's an investigative journalist with Manhattan Institute.
00:01:51.000 He's got a new piece he co-authored with Chris Rufo at City Journal, and it's entitled, The Largest Funder of Al-Shabaab is the Minnesota Taxpayer.
00:02:00.000 Al-Shabaab, of course, is a radical Islamic terrorist group in Somalia.
00:02:05.000 We have a lot of Somalis in Minnesota, and we've hit this beat a few times that there's a lot of fraud of various kinds that goes on because it's an insular community. 1.00
00:02:16.000 But this piece really lays out how a lot of it works.
00:02:19.000 So, Ryan, are you there?
00:02:20.000 I am.
00:02:21.000 It's a pleasure to be here.
00:02:22.000 Thank you very much.
00:02:24.000 So, Ryan, how about you just dive into it?
00:02:26.000 Al-Shabaab, largest funder, Minnesota taxpayer.
00:02:29.000 What do you mean by that?
00:02:30.000 Well, so what we're seeing in Minnesota is that there's billions of dollars of fraud going on, particularly targeting government welfare programs.
00:02:40.000 The fraud has gotten so bad that the U.S. Attorney's Office has indicated that there are entire government welfare programs where the fraud outstrips the legitimate claims.
00:02:51.000 These large-scale fraud rings to date have largely been concentrated in Minnesota's Somali community.
00:03:00.000 But this is an inconvenient fact that progressive politicians in Minnesota, and I would also say the mainstream media, has been unwilling or unable to acknowledge.
00:03:11.000 And over the course of our investigation for City Journal, we developed several counterterrorism sources, law enforcement sources, who confirmed to us that some of these stolen funds, millions of dollars, are being sent abroad through Hawala networks, which are informal money transfer networks that are popular in Islamic countries.
00:03:32.000 This money has then gone overseas, and some of that money has ended up in the hands of al-Shabaab to the point that one of our sources said the largest funder of al-Shabaab is the Minnesota taxpayer.
00:03:43.000 Well, can I just read?
00:03:45.000 I just want to give you some kudos here, Ryan, because this is your opening.
00:03:50.000 You had me at hello kind of moment.
00:03:52.000 Your opening to this article is just so blunt and to the point.
00:03:56.000 I love it.
00:03:56.000 I have to read it.
00:03:58.000 Minnesota is drowning in fraud.
00:04:00.000 Billions in taxpayer dollars have been stolen during the administration of Governor Tim Waltz alone.
00:04:06.000 Democrat state officials overseeing one of the most generous welfare regimes in the country are asleep at the switch.
00:04:12.000 And the media, duty-bound by progressive pieties, refused to connect the dots.
00:04:16.000 I mean, it's just, I want really direct.
00:04:18.000 I want to flag the numbers on here.
00:04:20.000 So this is one, this is so incredible.
00:04:22.000 We're having Curmu on next to talk about healthcare.
00:04:24.000 And when he came out on the show with Charlie a few months ago, one of the things he said is he's like, he says, I think the number, the growth of autism in America is overstated because they overdiagnose it.
00:04:34.000 And the example he said is he said, in Minnesota, Somalis are just scamming the autism system to get a ton of money. 0.97
00:04:41.000 And this is a quote.
00:04:42.000 I want to read this.
00:04:43.000 So, like with another program, autism claims to Medicaid in Minnesota have skyrocketed from $3 million in 2018, 3 million, to, I'm going to abbreviate it, 399 million in 2023.
00:04:56.000 So they went up more than 100 times over in five years.
00:05:02.000 And it mentions the number of autism providers went from 41 to 328.
00:05:06.000 And then it says the Somali community has established autism treatment centers for culturally appropriate programming.
00:05:14.000 One in 16 Somali four-year-olds has reportedly been diagnosed with autism.
00:05:20.000 Are they just letting anything happen and they're not doing any policing whatsoever, Ryan?
00:05:24.000 Well, it's very clear with these government programs that there weren't many checks and balances that were built into the system and that this was done by design.
00:05:34.000 I mean, this was done purposely to help facilitate money going out the door, ostensibly to people in need.
00:05:41.000 And what's interesting about the autism fraud case, the first indictment that's come down, the U.S. Attorney's Office indicates that more indictments will be coming, is that it is very clear the extent to which this fraud scheme penetrated the wider Somali community.
00:05:56.000 So this wasn't just a bad apple.
00:05:59.000 The woman accused in this case would approach members of the Somali community in Minnesota who had children. 0.99
00:06:06.000 She would sign them up for autism services.
00:06:09.000 If the child wasn't autistic, she would get them a fraudulent diagnosis. 0.64
00:06:15.000 And then kickbacks would be paid to Somali parents in the state who had signed up their children for fraudulent autism services.
00:06:24.000 And the U.S. Attorney's Office noted that if the kickbacks were too low, the parents would threaten to pull their child from one provider and order and take them over to a different fraudulent provider in order to get more money that was being stolen from taxpayers through the scheme.
00:06:41.000 So that's that's the autism was an example.
00:06:44.000 Can you also describe this homelessness one, the Medicaid housing stabilization service?
00:06:51.000 Can you explain how that fraud worked as well and any others that come to mind?
00:06:55.000 Yeah, the housing stabilization services program was quite interesting because if you were to design a government program specifically to facilitate fraud fraudulent claims, it would probably look a lot like this program was designed.
00:07:09.000 There were almost no checks and balances baked into this system.
00:07:14.000 It was launched in 2020 with, I would say, a fairly noble goal.
00:07:19.000 It was seeking to get people who are struggling with drug and alcohol addiction, mental illness, people with disabilities to help them find and secure housing.
00:07:29.000 The U.S. Attorney's Office claims that fraudulent companies were set up.
00:07:34.000 They were operating out of dilapidated storefronts.
00:07:39.000 They would target people that were exiting drug and drug rehabs.
00:07:44.000 They would sign them up for Medicaid services that they had no intention of providing.
00:07:50.000 And then they would simply pocket the money.
00:07:52.000 And yet again, we've seen the claims under this program absolutely skyrocket.
00:07:57.000 When it was launched in 2020, government officials estimated it would cost about $2.6 million a year.
00:08:04.000 By 2024, it cost $104 million.
00:08:07.000 And in the first six months of this year alone, claims were $61 million.
00:08:13.000 At that point, the state stepped in and shuttered the program because they realized that they had a significant problem on their hands in regards to fraud.
00:08:23.000 And the U.S. Attorney's Office has indicated in a press conference that he, the U.S. Attorney at the time, he believed there was more fraudulent activity in this program than there were legitimate claims.
00:08:35.000 There have been eight indictments to date for HSS fraud.
00:08:40.000 Six of the eight men who have been accused were of Somali heritage.
00:08:44.000 Two were Nigerian, of Nigerian heritage.
00:08:48.000 And they're accused of defrauding millions of dollars from this government welfare program.
00:08:53.000 And yet again, it's been indicated that more charges will be coming.
00:08:58.000 Is it as simple as it looks where I guess the stereotype would be it's Minnesota?
00:09:02.000 You've got a lot of Swedes, Norwegians, sort of Nordic, high trust people, very used to doing pro-social behaviors.
00:09:10.000 And it's almost like they're like an animal on an island that has no predators.
00:09:15.000 So the thought that someone would just fleece a program or just lie about it is so alien to like they just have no defenses against this sort of behavior.
00:09:24.000 Is it that simple?
00:09:25.000 Is there any interest in fixing this other than arresting people occasionally?
00:09:30.000 Well, you know, I think that's a really good point.
00:09:32.000 I think that does help explain some of what's going on.
00:09:36.000 As I was reporting this piece out, the picture that was emerging was really of a perfect storm in Minnesota to facilitate fraud on a massive scale.
00:09:46.000 You have a sizable Somali community that comes from a tribal clan-based society, and it has proven itself willing to cynically deploy accusations of racism as a shield in order to help cover up criminal behavior. 0.99
00:10:01.000 You have a very generous, very progressive welfare state.
00:10:07.000 And in many of these programs, checks and balances, they were specifically designed with very few in place.
00:10:14.000 And then you have a progressive political establishment that is terrified of being seen as politically incorrect and also worried about alienating the Somali community, which is a sizable voting bloc in the state and has also established significant political connections.
00:10:34.000 And so when those three things kind of collide, this is what you get.
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00:11:50.000 We're joined by Ryan Thorpe from the Manhattan Institute.
00:11:53.000 He has a great new piece about Mogadishu, Minnesota.
00:11:58.000 And I want to get into this, Ryan, because how much of this is essentially Western culture confronting, I mean, let's just be honest, a very backwards, tribalistic African culture that has been imported into our country and they're just colliding and they don't understand each other. 1.00
00:12:16.000 Or is Somalis seem to understand us? 1.00
00:12:18.000 They're taking us taking advantage of Minnesota.
00:12:21.000 Nice.
00:12:22.000 How much of it is a cultural breakdown, though, where Americans in Minnesota, they simply cannot fathom the cynical nature of these schemes and these cons?
00:12:32.000 Well, I would say that sources I've spoken to in Minnesota have indicated that as a significant contributing factor in regards to these large-scale fraud rings that we're seeing, there is a cultural component here.
00:12:46.000 You know, when you're talking about people of Somali heritage that have landed in Minnesota, these are people that come from a very tribal, clan-based society.
00:12:56.000 They have likely spent time in a refugee camp prior to arriving in America, where I would imagine you have to be pretty resourceful in order to get by.
00:13:07.000 They then come to a traditionally very high trust state with significant welfare programs, perhaps the most generous in the country.
00:13:18.000 And quite clearly, by the criminal indictments that have been coming down, many people in the Somali community have figured out how to fraudulently obtain significant amounts of money. 0.98
00:13:30.000 We're talking about billions of taxpayer dollars here that have been stolen, fraud rings that run to hundreds of millions of dollars alone.
00:13:39.000 So I don't think you can discount that clash of cultures as a major factor in what we're seeing that's going on.
00:13:47.000 Well, listen to this.
00:13:48.000 This is a quote from your piece.
00:13:50.000 What we see are schemes stacked upon schemes, draining resources meant for those in need.
00:13:55.000 It feels never ending.
00:13:57.000 I've spent my career, this is a guy named Thompson, as a fraud prosecutor, and the depth of the fraud in Minnesota takes my breath away.
00:14:05.000 What can be done?
00:14:06.000 Like, if you are going to, I mean, is there a significant move to actually denaturalize, to deport some of these people that are here on protected status or on a temporary status of some nature?
00:14:16.000 Is there a way that you would dismantle this that would actually fix the problem?
00:14:20.000 Or it feels like we're just going to be playing whack-a-mole for years here in Minnesota.
00:14:25.000 Well, the sources that I've spoken to, these are political people, law enforcement, counterterrorism folks.
00:14:31.000 I put this question to them.
00:14:34.000 What needs to happen here?
00:14:36.000 They don't discount the fact that there is a role for law enforcement to play.
00:14:41.000 They have been cracking down on many of these major fraud rings.
00:14:44.000 There's more work to be done.
00:14:47.000 More indictments will be coming.
00:14:49.000 But pretty much across the board, people that I spoke to said there really isn't a law enforcement solution to this problem.
00:14:56.000 As you said, that's simply playing whack-a-mole.
00:15:00.000 People pretty consistently told me that, you know, there needs to be a policy change here.
00:15:05.000 And there clearly needs to be more accountability from the state government in Minnesota, which under Tim Waltz has been overseeing fraud after fraud to the point where the fraud has taken over entire government programs.
00:15:20.000 So there has to be a policy solution here.
00:15:24.000 Simply hoping for law enforcement to clean the mess up is naive.
00:15:29.000 Yeah, it really is a striking case.
00:15:32.000 The most extreme thing of when you bring in people from a different culture, you bring in a different culture. 1.00
00:15:37.000 And it really manifests the way that it's so large and so many people are involved.
00:15:42.000 Like, we didn't even talk about the Feeding Our Future scam, another scam they did during COVID where they were pretending to feed thousands and thousands of kids, got millions of dollars.
00:15:50.000 And it was, I think, one white Lutheran woman at the top of it, and then 50 plus people from the Somali community doing the rest of it.
00:15:58.000 It really is just who you have any moral relationship to as people in your extended family, people in your clan, people in that community, and you have no moral relationship or otherwise with the government, with wider society.
00:16:12.000 You've basically brought a people within a separate group of people who just don't feel any obligation to the rest of the citizenry, and they think it's totally valid to just loot that community for everything they have.
00:16:26.000 And I think the only way, yeah, the only way you can deal with that is you basically need to impose far higher standards for any benefits you're going to dole out.
00:16:34.000 Or you also have to say, frankly, why are we doing this in the first place?
00:16:39.000 Why have we imported an alien culture that thinks it's their duty to just loot us? 1.00
00:16:43.000 Now, isn't now with Trump's travel restrictions, because we had this in Trump 1.0, now 2.0.
00:16:48.000 What's the status of immigration from Somalia right now?
00:16:52.000 To be honest, I haven't looked into that, so I would not be sure Somalia.
00:16:57.000 Yeah, I'm pretty sure Somalia is on the new track. 1.00
00:16:59.000 So I don't know if we're making this problem worse right now, or if we've sort of stopped the bleeding, or if there's backdoor ways for chain migration and family reasons.
00:17:08.000 Before we close it up, I want to throw up, put up 298.
00:17:10.000 It's the social contract in Minnesota.
00:17:12.000 You have Ole, 30 years old, and all of his money is going to Al-Shabaab to Feeding Our Future to cause more chaos in Somalia so that more migrants move in to Minnesota so that they can give more money to them. 0.86
00:17:24.000 I wanted to share that one.
00:17:25.000 Rand, great job.
00:17:26.000 Really good reporting.
00:17:27.000 Thank you so much.
00:17:28.000 Thank you guys.
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00:18:34.000 We now have our next guest, Cray-Mu.
00:18:38.000 He's the author of the Cremu substack, and you can find him on exit Cray-Mu Rique.
00:18:46.000 How do you pronounce that, Cremu?
00:18:48.000 Cré-Mu, welcome to the show.
00:18:49.000 Crému Rique.
00:18:51.000 We wanted to have you on because there's been, you're a big expert on healthcare.
00:18:56.000 Healthcare has totally taken over a lot of the discussion in the U.S. as one of the biggest sources of rising costs in America.
00:19:04.000 You know, people are.
00:19:06.000 Let's just play one of these clips, actually.
00:19:08.000 I think that'll set it up nicely.
00:19:10.000 How about we do let's just do 263.
00:19:13.000 We're going to hear horrible stories.
00:19:15.000 People are not going to be able to afford their insurance.
00:19:18.000 I don't think even with subsidies, they're going to be able to afford the premiums that are hiking up 100, 200, 300%.
00:19:27.000 Was nobody supposed to fix that?
00:19:29.000 No, well, not without the universal.
00:19:30.000 I mean, there's Affordable Care Act.
00:19:33.000 Affordable was the first word.
00:19:34.000 And I want to throw up this as the last primer here, Cray-Mu. 1.00
00:19:38.000 279.
00:19:38.000 This is the average annual expenditures for health insurance per household consumer unit.
00:19:44.000 And you can see that big jump there right when the Affordable Care Act was implemented into law.
00:19:50.000 So healthcare is far outpacing the trend that we saw before the ACA was passed.
00:19:55.000 So we call it the Unaffordable Care Act.
00:19:58.000 And that really is the foundation for our discussion.
00:20:01.000 So, Craymu, what is going wrong with American healthcare?
00:20:05.000 So I would qualify that last bit a little bit.
00:20:08.000 I would say healthcare spending isn't really growing over what you would expect before the ACA.
00:20:16.000 We're looking at different metrics there, but if you use consistent ones, it looks pretty fine.
00:20:21.000 The bigger issue is that we have, it just shouldn't be growing this way in the first place.
00:20:26.000 It is a completely broken system in the sense that we have created incentives to make it worse.
00:20:32.000 So we have a lot of things in healthcare, post-ACA especially, that are terrible in the sense that, for example, take the medical loss ratio requirement.
00:20:43.000 This is the requirement that health insurers have to spend 80 to 90%, depending on the type of plan.
00:20:48.000 So 85% are there.
00:20:49.000 So of their premiums each year.
00:20:52.000 So if they charge their customers X amount, they have to spend 85% of X.
00:20:58.000 And the fact that they have to spend that amount is effectively a profit gap.
00:21:01.000 So they have to make profits in other ways.
00:21:02.000 And to make those profits, they look into other things like buying up the pharmacy benefit managers or buying up hospitals or sneakily changing the prices or even overpaying for drugs in order to meet the threshold of things they have to pay for.
00:21:22.000 So you end up with costs just kind of running everywhere.
00:21:26.000 You end up with incentives for vertical integration such that they're buying up everything else and the number of competitors that comes into the market is very, very small.
00:21:35.000 Because again, who's going to invest in a company, a new company that has to spend 85% of its revenues every year?
00:21:40.000 That's not a very good investment.
00:21:43.000 But there's a lot of other issues.
00:21:44.000 The ACA also, for example, had a lot of stuff that was informed by small kind of crappy studies.
00:21:51.000 So there was this idea that came about as an example of this where hospitals run by doctors would be lower performing.
00:21:59.000 And the reality was they actually tend to be higher performing.
00:22:02.000 But the ACA, when it was written, wasn't like, it wasn't based.
00:22:05.000 This idea was not based on good empirical evidence.
00:22:07.000 It was based on bad evidence.
00:22:09.000 So they ended up banning doctors from establishing new like physician-run hospitals.
00:22:16.000 Wow.
00:22:16.000 They do, there's a lot of things in there that are just kind of very sensitive.
00:22:19.000 But Cray-Mu, that seems like it should be illegal. 0.70
00:22:21.000 How could you ban somebody from starting a business?
00:22:24.000 I don't understand.
00:22:26.000 Is this like a real ban or you just can't get access to insurance funds or something?
00:22:30.000 No, it's a real ban.
00:22:31.000 Unfortunately, you cannot start new ones.
00:22:33.000 There are some existing physician-run hospitals that predate the ACA's ban going into effect, but you can't start new physician-run hospitals.
00:22:39.000 And that's a specific thing.
00:22:40.000 So if you want to give up being a practicing physician, you can still start a hospital, but you can't both be a practicing physician and run the hospital.
00:22:49.000 That's so interesting.
00:22:50.000 So I guess just big picture, there's a lot of debate.
00:22:52.000 The GOP and Trump's first term tried to repeal and replace Obamacare.
00:22:55.000 They failed thanks to our late senator here.
00:22:58.000 But I guess people talk a lot about rising costs, but if there were targeted reforms that the Republican Party could start advocating, what do you think some of the best ones would be?
00:23:10.000 Tons.
00:23:12.000 So a lot of the problem is that we have good ideas that have been actually supposed to be put into effect.
00:23:19.000 For example, price transparency is the law of the land right now.
00:23:22.000 If you go to a hospital, they are required to provide you with a credible list of all the prices before any operation is done on you.
00:23:30.000 You are supposed to be given a price that is reasonable and that you will end up paying because once they put the number out there, they have to charge that for you unless some reasonable complication comes up.
00:23:41.000 But the law is not enforced.
00:23:43.000 The regulation for price transparency was supposed to go into effect on October 1st.
00:23:47.000 And I looked around at a sample of local hospitals and I found, hey, you guys still aren't transparent about your prices.
00:23:53.000 It's.
00:23:55.000 A lot of the issue with this stuff is that we don't actually enforce the rules, which is bizarre.
00:24:02.000 I don't know.
00:24:03.000 What do you say about that at the end of the day?
00:24:06.000 That sounds like a good chance to do populism, you know, have the Trump admin just sue a big hospital or like perf walk some random like official at like a really big hospital. 0.95
00:24:16.000 When was that law?
00:24:18.000 When was that law passed into law that was supposed to go into effect on October 1st?
00:24:23.000 So that was a regulation.
00:24:25.000 The law that provided the regulation with power was like very old, I think.
00:24:29.000 It's like a decade old, if I remember.
00:24:31.000 Did that get caught up in like the government shutdown or something?
00:24:34.000 I mean, or we're just.
00:24:35.000 No, it predated it.
00:24:36.000 There's just not a mechanism to enforce it.
00:24:38.000 Yeah, the Trump administration should absolutely start ensuring this.
00:24:43.000 Yeah, what else though?
00:24:44.000 Yeah, we cut you off there a bit.
00:24:45.000 Well, there are tons of things.
00:24:45.000 So, for example, patients are actually entitled to all of your data.
00:24:48.000 If a doctor generates some data and goes in your EHR, you are supposed to be able to get access to that.
00:24:53.000 You should be able to ask your physician and have your physician give that to you in some format that can be used by you, the patient.
00:25:00.000 The same thing applies to the CMS's CLIA-certified labs.
00:25:03.000 So, like IVF clinics, if a parent has some sequencing done in like one of their embryos, they should be able to get that data, but they don't.
00:25:13.000 In fact, I think it was September 14th, if I'm recalling the date correctly, RFK put out a little video saying that patients are entitled to their data.
00:25:21.000 And at some date in the future, there'd be a little, not a hotline, but like a little form online that you can go fill out to report when data is not provided to you when you ask for it.
00:25:31.000 And they just don't, they don't do it.
00:25:33.000 So it's not even things that are high cost that aren't being enforced.
00:25:37.000 It's also things that are just good, like from a patient rights perspective, that just nobody follows the rules because there are enforcement mechanisms, to be clear.
00:25:47.000 CMS can really start hitting hospitals very hard.
00:25:51.000 They can hit providers in ways that make their pocketbooks scream, but they don't.
00:25:56.000 And that is the big issue at the end of the day is that they have enforcement mechanisms that don't enforce them for all sorts of things.
00:26:01.000 Another thing is, for example, site-neutral payments.
00:26:04.000 So if you are running a hospital chain and you buy up a clinic, you can charge hospital prices at that clinic location, even if they're totally separate.
00:26:13.000 You just bought the location.
00:26:15.000 You didn't change any way it's run, but that allows you to charge the hospital rates.
00:26:19.000 You're associated with the chain.
00:26:20.000 Like that sort of thing should be outlawed.
00:26:22.000 And it was supposed to be outlawed on October 1st.
00:26:24.000 But guess what's still in effect?
00:26:26.000 Non-neutral payments.
00:26:28.000 It's absurd.
00:26:30.000 So, Kremu, it feels like you're sort of painting a picture that the health industry is plagued by death of a thousand cuts.
00:26:37.000 There maybe isn't one silver bullet, but, you know, we were talking about a thousand cuts.
00:26:42.000 It seems like they just feel that it's so big and so impenetrable.
00:26:42.000 It's so big.
00:26:46.000 They can just ignore.
00:26:47.000 They can just ignore.
00:26:47.000 But so we have to.
00:26:49.000 That's right.
00:26:49.000 There has to be an initiative, though, from probably the highest levels of our government to start enforcing some of these regulatory changes that are supposed to benefit the patients.
00:26:59.000 A lot of the problems in the country, you could sort of trace back to illegal migration, illegal immigrants. 0.65
00:27:05.000 How much of the rise in healthcare prices could you trace back to illegal immigrants on the dole or within the system?
00:27:14.000 Or is that not a driver, in your opinion?
00:27:16.000 Not a big driver.
00:27:17.000 The most liberal estimate that I've seen that's credible is about 0.9%.
00:27:20.000 And that's quite, that's stretching it, honestly.
00:27:22.000 I think it's not that much.
00:27:24.000 The main cost drivers have to do with old people.
00:27:28.000 Old people are the biggest parts here. 1.00
00:27:30.000 And the fact that we have bad incentives for cost control and we don't allow certain types of cost control to even be put into place.
00:27:36.000 So the AMA is really your bigger problem here.
00:27:39.000 Most of your growth is provider-side rents.
00:27:41.000 And that means the payments that go to doctors that are way in excess of what the doctors, like the care they're providing is worth.
00:27:50.000 That's most of your issue.
00:27:51.000 And we could lower provider-side rents by allowing more physicians.
00:27:56.000 But we have placed an effective cap on the rate of growth, not on the actual number of slots, but on the rate of growth in Medicare funding for residency slots.
00:28:05.000 So the number of doctors who can actually come in and compete with the doctors and lower the rents and make it so they, you know, they're paid less, but they provide more because there are going to be more of them is limited.
00:28:16.000 It's been limited since 1994.
00:28:18.000 And we just don't know what to do.
00:28:20.000 What happened in 94?
00:28:21.000 What happened in 94?
00:28:22.000 Oh, this is amazing.
00:28:23.000 So the AMA argued there was going to be a surplus of doctors.
00:28:26.000 There were going to be too many doctors and that this would cause a big problem.
00:28:30.000 And you have to think, how can there be a surplus of doctors?
00:28:34.000 Don't we always need more doctors? 0.97
00:28:35.000 The answer is, yeah, of course.
00:28:37.000 But they managed to somehow convince Congress this was an issue that would impact the quality of care when it makes no sense.
00:28:43.000 And then they got these limits set in place.
00:28:45.000 And now they argue to get away from the fact that they did this.
00:28:49.000 They argue, well, we don't limit the actual number of residency slots, but they ignore that, yes, there's still limitations on the growth in the number of slots and the funding mechanisms available to create more slots outside of Medicare funding.
00:29:03.000 So they created a broken system where we can't actually fix the issue with provider-side rents, which is roughly a third of all of the spending problem.
00:29:13.000 Thanksgiving holds so many memories, and I'm sure it's the same for you.
00:29:18.000 Right now, there's a girl finding out she's pregnant. 1.00
00:29:20.000 In the next couple of weeks, she's going to make a decision.
00:29:23.000 And whatever decision she makes will become her memory of this Thanksgiving for the rest of her life.
00:29:29.000 What will she be thankful for a year from now?
00:29:31.000 You.
00:29:31.000 She'll be thankful that you introduced her to her baby by providing a free ultrasound.
00:29:37.000 And she'll be thankful that she chose life as she prepares for her baby's first Thanksgiving.
00:29:42.000 Take a stand for life by providing an ultrasound with pre-born. 0.60
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00:30:05.000 Call 833-850-2229 or click on the pre-born banner at charliekirk.com today.
00:30:15.000 I just, it's so, it's so enraging that specific fact on that we've basically intentionally capped the number of residencies by extension, capped the number of doctors we make in America.
00:30:26.000 And then we'll also say, oh, we need to import.
00:30:29.000 It's like part of the immigration hustle. 0.80
00:30:31.000 Have lots of foreign doctors come in.
00:30:33.000 Just have more residency slots.
00:30:36.000 Have more people go to medical school in the U.S.
00:30:38.000 That will be more opportunities for Gen Z people who want to work hard and get the market work.
00:30:44.000 Let the market work.
00:30:45.000 I mean, okay, now let's go back to ACA because you seem to think that maybe the ACA is not driving costs like the No, Let me rephrase.
00:30:56.000 The ACA is terrible.
00:30:57.000 The biggest problem with the healthcare system is the medical loss ratio requirement.
00:31:01.000 It is by far slowly.
00:31:04.000 Yes, yes.
00:31:05.000 Okay.
00:31:05.000 Let me be slow here.
00:31:06.000 So the ACA's medical loss ratio, the MLR thing that I mentioned a moment ago, where you have to spend 85% of your premiums leads to an enormous level of cost shifting.
00:31:18.000 It leads to vertical integration where insurers will buy up every other part of the medical space.
00:31:23.000 It leads to, it prevents AI and healthcare from actually being useful.
00:31:29.000 And it gives a lot of leverage to doctors and doctors' cartels like the AMA and like the American Society of Anesthesiologists and all these other groups to continue to do things that increase costs.
00:31:42.000 It's the worst thing on the books.
00:31:44.000 And it can be fixed in two ways.
00:31:49.000 So drug spending is like a problem in its own right.
00:31:51.000 That's like 9% of the problem.
00:31:53.000 But the ACA's medical loss ratio thing is a much, much larger portion of it.
00:31:56.000 It's closer to 40% of the actual problem.
00:31:58.000 And if you eliminated the problem, you could immediately start embarking on a massive wave of innovation in healthcare because you would allow AI stuff to be slotted in to the prior off departments where insurers do the rejections or they accept a medical call by a doctor.
00:32:21.000 But we don't allow this.
00:32:22.000 We have effectively banned it.
00:32:23.000 We've made there no incentives to do it.
00:32:25.000 So just so I'm understanding, because I want to make sure I'm understanding exactly what you're saying.
00:32:30.000 If we send a dollar, if we spend $1 on health care, 85% of that has to go to the actual treatments, meaning that the providers are only allowed to take 15% of anything non-administrative.
00:32:47.000 So that 15% is whatever's left over.
00:32:49.000 And what that means is that in order to meet that level, like at the end of a bailing cycle, what they'll do is they'll just pay more for stuff.
00:32:57.000 So if a doctor says, like, I want to build blah, blah, blah, they can't build, blah, blah, blah.
00:33:02.000 They'll pay more for medication. 0.89
00:33:03.000 They'll overpay for all sorts of things.
00:33:05.000 They'll get wrong claims and just pay them because they have to meet this legal requirement.
00:33:09.000 Absolutely.
00:33:11.000 And in order to manage this fact, they transfer large portions of their medical claim revenue to their PBMs, their subsidiaries that aren't regulated directly by this regulation.
00:33:24.000 So Cray Moo, it sounds like you said that these two buckets, they essentially lead to 90% of the problems with the ACA. 0.79
00:33:33.000 So if you were consulting President Trump, JD Vance, would you just say deal with this 85% ratio issue?
00:33:40.000 And it sounds like one of the, I forget what the other one is.
00:33:42.000 No, no, okay.
00:33:44.000 So these issues are unfortunately statutory.
00:33:47.000 There are, so statutory means that Congress is the reason for the issue.
00:33:52.000 Congress has, in the case of the MLR, the medical loss ratio requirement that drives so much of the spending issues and so much of the lack of AI-related innovation in healthcare, the issue was given, Congress gave the HHS the opportunity to write up the rules.
00:34:07.000 And they gave them some limits.
00:34:09.000 And it's like, you have to write the rules a certain way.
00:34:11.000 And these rules are terrible.
00:34:15.000 But in order to reform it, you can't just have the HHS rewrite the rules because of those limits put in place by Congress.
00:34:20.000 If you actually wanted to fix this issue, you would have to very likely, unless you can get some Democrats to agree, and I really doubt you could, you would very likely have to suspend the filibuster, which is what something the Republicans should be doing right now, and then go and get Congress to change it.
00:34:34.000 So were I to offer this advice to Trump, I would say push on the filibuster.
00:34:39.000 Keep pushing, pushing, pushing.
00:34:40.000 You have to get them to change the thing because you can't do it directly.
00:34:44.000 But as president, you will be blamed for any sort of healthcare mishaps or just continuations of bad trends that we've had going on.
00:34:49.000 That is the big, tough question.
00:34:50.000 We've talked about the filibuster a lot on this show because Trump wanted to get rid of it to end the shutdown.
00:34:56.000 And we've generally said end the shutdown, but only or end the filibuster, but only if you have a home run slate of legislation to pass.
00:35:04.000 Otherwise, you're just going to do some lame thing and then fart around.
00:35:09.000 And then Democrats will have no filibuster to do their agenda, which is a lot more clear-cut on what they want.
00:35:14.000 It's scarier, too, by the way.
00:35:15.000 And so there are two, like, there's popular aspects of ACA, right?
00:35:19.000 It's the uninsured, uninsurable people, right?
00:35:22.000 that you couldn't have some very expensive treatment that you need for the rest of your life.
00:35:27.000 The pre-existing conditions like being on their parents' insurance.
00:35:30.000 And then being on your parents' insurance.
00:35:31.000 Would your recommendation, just from a political standpoint, put your political hat on?
00:35:35.000 Would you say, let's keep those things in place and fix these underlying, I guess, statutory issues.
00:35:42.000 I mean, instead of replacing automatic care, you pitch it as like, hey, these reforms would make it better.
00:35:48.000 Yes, I absolutely would.
00:35:49.000 So the big thing is, with respect to the pre-existing condition requirement, it does add a lot of costs.
00:35:54.000 I mean, it obviously does because you have suddenly people who are high cost being covered and you're in the same pool as them and you got to cover them.
00:35:59.000 So that's a big issue.
00:36:01.000 But if you fix the medical loss ratio requirement and you allow health care providers, or sorry, if you allow health insurers to make better use of their prior authorization apartments, you can minimize the downside of those people because you can offer them more tailored care.
00:36:15.000 You can offer them, you can say, hey, your doctor called for this, but we actually think there's a better option here.
00:36:21.000 You can figure out what is more optimal to give them in terms of care and save a lot of that money that you would have wasted anyway.
00:36:28.000 But you're forced to spend it.
00:36:30.000 So it doesn't matter.
00:36:31.000 At the moment, it becomes a bad thing in large part because there are no incentives to fix the issue from a technological perspective.
00:36:38.000 Like you can't go the technological route and minimize the issue the other way, which we totally could do if we fixed this other issue.
00:36:45.000 So I think keep that in place.
00:36:46.000 It's fine because it's so popular.
00:36:48.000 No one wants to touch it.
00:36:50.000 And you really do still want these people to be covered somehow.
00:36:53.000 Like it's a humane issue.
00:36:55.000 At the end of the day, you want them to be covered in some way that isn't just like...
00:36:58.000 So one last question I'm thinking.
00:37:01.000 So you've mentioned it's statutory issues on the biggest things.
00:37:04.000 But what is the best thing you think the Trump administration could do right now just with its regulatory executive branch authority?
00:37:12.000 Doesn't need Congress, which is its own big problem.
00:37:14.000 What could they do tomorrow if they wanted to?
00:37:16.000 Yeah.
00:37:17.000 They could fix tons of the issues with CMS.
00:37:19.000 So like that site neutrality thing I mentioned before is totally able to be fixed.
00:37:22.000 The issue is the enforcement there.
00:37:24.000 They have that power to fix that issue and enforce it. 0.62
00:37:27.000 And they've written up those rules and they have changed those rules and they have not enforced it.
00:37:31.000 That is the big issue is enforcement.
00:37:32.000 And there are tons of things like this.
00:37:34.000 So they could get away with fixing a lot by just enforcing the rules and change.
00:37:40.000 There are some things they could change too.
00:37:41.000 So they could be adventurous.
00:37:43.000 There are some untested legal theories here.
00:37:45.000 Like Section 804 is the thing that allows you states to sign up to start importing drugs for their Medicare Medicaid programs from Canada at Canadian prices.
00:37:57.000 If they were to be a little adventurous with this, they could expand that by changing two parts of the regulation so that states could import Canadian generics that don't yet have a generic equivalent in the U.S., thus lowering prescription drug prices a lot.
00:38:12.000 It's totally on the table to do a lot of little fixes that are in untested legal territory if they want to try that.
00:38:21.000 And they could meaningfully lower the cost of health care considerably beyond what they've done so far with the negotiations because the negotiations have actually been getting kind of duped on.
00:38:31.000 Like a lot of the Trump RX stuff that they've done where they've tried to directly go to Pfizer and tell them, give us most favored nation rates.
00:38:39.000 That stuff doesn't really work to cut prices very much.
00:38:41.000 Unfortunately, like you think there's a lot of room there, but the issue is those companies aren't really giving you a great problem.
00:38:47.000 I was texting Blake that, you know, I assumed that it was the subsidies for people who couldn't otherwise afford, or at least so they say, couldn't afford health care that was driving up the cost of health insurance for average American families.
00:39:00.000 Yeah, we've all heard the story of the illegals who just go in for everything to be, causes overflow, causes all of these extra costs, and they never pay for any of it. 0.96
00:39:11.000 It's all eaten by the taxpayer.
00:39:12.000 But you say it's maybe 1% of total cost inflation.
00:39:17.000 Poor Americans, working class Americans that qualify for the subsidy. 1.00
00:39:21.000 So they get discounted insurance rates.
00:39:24.000 So that's the assumption is that's what's driving most of the cost increase.
00:39:28.000 Ah, that is, yeah, that assumption is very wrong.
00:39:30.000 Healthcare is a $5 trillion industry.
00:39:33.000 It is so much larger than these subsidies.
00:39:36.000 And it's growing.
00:39:37.000 It grows faster than the rate of inflation by a considerable margin, too.
00:39:40.000 So the majority of the cost growth is just way away from these things.
00:39:46.000 And there's been no detectable change in trend related to the subsidies either in terms of like prices of drugs and whatnot.
00:39:53.000 They're just negotiated on too like long-term a scale and too large a scale for this stuff to really matter all that much.
00:39:59.000 And the government has their rates they get through with CMS stuff like Medicare and Medicaid that aren't going to be meaningfully changed if they get the subsidies.
00:40:07.000 Like they're not going to lose negotiating leverage the moment they start financing plans a different way.
00:40:12.000 So ultimately this stuff doesn't make much of a difference.
00:40:15.000 The big stuff is systemic incentive related stuff that has been put in place for too long and needs to be changed at a more fundamental level.
00:40:23.000 Yeah, I have an anecdote for you, and I wonder if there's a root cause that I'm not aware of.
00:40:28.000 So for example, Daisy is pregnant. 0.86
00:40:31.000 She works here in the office.
00:40:32.000 I've had three kids.
00:40:33.000 I understand this process well.
00:40:34.000 You get towards the end of your pregnancy.
00:40:36.000 And the first time with your first kid, you're like really grateful for it.
00:40:39.000 And you go to the OBGYN like every week in that final run-up to having your baby.
00:40:45.000 But then on baby two and three, you're like, I don't need to go every week.
00:40:48.000 I know what we're doing.
00:40:49.000 We do not need to go everywhere.
00:40:50.000 But the OBGYN is going to say, hey, you got to come in every week.
00:40:53.000 It's mandatory.
00:40:54.000 Stuff like that.
00:40:55.000 No, okay, maybe I'm not a doctor.
00:40:57.000 Maybe that's really medically necessary.
00:40:58.000 But for me and my wife, and I've heard this from other parents, like you don't, like, I'm not going in again.
00:41:03.000 Sorry.
00:41:03.000 I'm just going to like skip that one.
00:41:05.000 We're not doing it.
00:41:06.000 You start taking control of your own health care a little bit.
00:41:09.000 But the doctors, it occurs to me, are getting paid every time you're going in.
00:41:13.000 That's money.
00:41:13.000 That's expense to the system.
00:41:15.000 And here's what else they know is that you've already hit your $5,000 or $6,000, $8,000 deductible.
00:41:20.000 And the incentive structure for the client, the patient in this case, is off because you know it's not going to cost you anything more out of pocket.
00:41:28.000 So the whole system just has to absorb this cost.
00:41:31.000 What am I describing there?
00:41:33.000 And how do you fix it?
00:41:34.000 What you're describing is actually related to the MLR issue again, the medical loss ratio thing.
00:41:38.000 So medically necessary care is the majority of care, but it's a slim majority.
00:41:45.000 30 to 40% of the care, and I'm leaning more towards the 40% side, that we give out in this country just isn't necessary.
00:41:52.000 So many things don't need to be done, and we don't have the ability to say no to doctors in a very meaningful way because there's no incentive to.
00:41:59.000 There are incentives to say yes to doctors, to overpay for care.
00:42:04.000 And they only recently added prior authorization, that's the rejection department basically, to Medicare, fee-for-service plans.
00:42:11.000 But they need to make that a more extensively used thing everywhere.
00:42:15.000 They need to be able to say no more often.
00:42:17.000 They need to be able to target care better.
00:42:18.000 They need to make individualized guidelines.
00:42:21.000 And I don't mean in some hockey, personalized medicine sort of way.
00:42:24.000 I mean in a, we need access to massive amounts of data in order to properly tailor everything for individual patients in a way that like still provides them with all the care that they personally need without having them go over by like getting five times more well visits than they actually need or getting a mammogram when they're in the lowest decile of risk or something like that.
00:42:45.000 Like it's that sort of thing is just far too common and it is the big issue.
00:42:50.000 And that is why if you were to fix that MLR requirement, you would basically be able to start cutting back on medically unnecessary care and allocating care better.
00:43:00.000 And you'd be incentivized to figure out people who are currently underserved, who you're not currently incentivized to go out and find, and to bring them into the doctor's office.
00:43:10.000 So for example, there are a lot of young people these days, not a lot in absolute terms relative to the old, but like an increasing number of young people who get colorectal cancer.
00:43:19.000 And we have wonderful algorithms for finding those people young, but nobody implements them in the prior authorization stage because there's no financial reason to.
00:43:28.000 There are financial reasons not to, but no financial reason to.
00:43:32.000 We have totally distorted the incentives away from promoting health for people and towards promoting cost because that's just how it is.
00:43:40.000 I mean, that's just, we've made some very, very bad decisions in designing these systems.
00:43:44.000 And we totally could fix them.
00:43:47.000 I always feel so much more optimistic because you're always like, oh, there's like all these big changes we could make.
00:43:52.000 And then you go back into politics and it's such a mess.
00:43:55.000 But before we lose you, I want to congratulate you when you came out and you talked to Charlie.
00:43:59.000 He loved it, by the way.
00:44:00.000 He just wanted to talk to you as long as he possibly could.
00:44:04.000 One of his favorite segments of the past year, I think.
00:44:06.000 So I wanted to thank you for that.
00:44:07.000 But when we talked about autism, rising autism rates, one of the things you told us is you said, I think this is basically just it's a matter of diagnosis.
00:44:16.000 And one of the things you said was the Somali community in Minnesota is scamming the autism system, way inflating their rates to just scam everyone. 0.99
00:44:24.000 And our segment just before you was we were talking to Ryan Thorpe about the Somali scam. 1.00
00:44:29.000 They're sending all the autism dollars to al-Shabaab in Somalia.
00:44:33.000 So I wanted to congratulate you for calling that shot months in advance.
00:44:38.000 And I wanted to thank you again for coming on and giving us your time.
00:44:41.000 Craymu, we got to get you in touch with some people that can actually implement some of this stuff.
00:44:46.000 So we'll work on that too.
00:44:47.000 But really, I mean, enlightening conversation.
00:44:50.000 I hope people at home appreciate it just as much.
00:44:53.000 So Craymu, thanks for making the time, my friend.
00:44:56.000 And we'll see you again, I'm sure, when the next hot topic comes up.
00:45:00.000 Extremely complicated topic.
00:45:01.000 Yeah, exactly.
00:45:01.000 And you're looking at the macro data trends.
00:45:04.000 So we appreciate it.
00:45:05.000 Tremendous.
00:45:06.000 All right.
00:45:06.000 Have a good one, guys.
00:45:07.000 You too.