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Colfax Avenue here in Denver, Colorado

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was once called the longest,
wickedest street in America.

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My office is there in the same place,
it's a medical desert.

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There are government clinics
and hospitals nearby,

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but they're not enough to handle
the poor who live in the area.

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By poor, I mean those who are on Medicaid.

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Not just for the homeless;
20 percent of this country is on Medicaid.

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If your neighbors have a family of four
and make less than 33,000 a year,

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then they can get Medicaid.

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But they can't find a doctor to see them.

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A study by Merritt Hawkins

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found that only 20 percent
of the family doctors in Denver

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take any Medicaid patients.

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And of those 20 percent, some have caps,
like five Medicaid patients a month.

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Others make Medicaid patients
wait months to be seen,

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but will see you today,
if you have Blue Cross.

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This form of class discrimination is legal
and is not just a problem in Denver.

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Almost half the family
doctors in the country

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refuse to see Medicaid patients.

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Why?

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Well, because Medicaid pays less
than private insurance

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and because Medicaid patients
are seen as more challenging.

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Some show up late for appointments,
some don't speak English

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and some have trouble
following instructions.

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I thought about this
while in medical school.

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If I could design a practice
that caters to low-income folks

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instead of avoiding them,

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then I would have guaranteed customers
and very little competition.

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(Laughter)

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So after residency, I opened up shop
doing underserved medicine.

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Not as a non-profit,
but as a private practice.

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A small business,
seeing only resettled refugees.

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That was six years ago,

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and since then we've served
50,000 refugee medical visits.

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(Applause)

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Ninety percent of our
patients have Medicaid,

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and most of the rest we see for free.

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Most doctors say you can't
make money on Medicaid,

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but we're doing it just fine.

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How?

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Well, if this were real capitalism,
then I wouldn't tell you,

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because you'd become my competition.

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(Laughter)

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But I call this
"bleeding heart" capitalism.

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And we need more people doing this,
not less, so here's how.

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We break down the walls
of our medical maze

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by taking the challenges
of Medicaid patients,

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turning them into opportunities,
and pocketing the difference.

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The nuts and bolts may seem
simple, but they add up.

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For example, we have no appointments.

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We're walk-in only.

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Of course, that's how it works
at the emergency room,

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at urgent cares and at Taco Bell.

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(Laughter)

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But not usually
at family doctor's offices.

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Why do we do it?

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Because Nasra can't call
for an appointment.

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She has a phone, but she
doesn't have phone minutes.

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She can't speak English
and she can't navigate a phone tree.

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And she can't show up on time
for an appointment,

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because she doesn't have a car,
she takes the bus,

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and she takes care of three kids
plus her disabled father.

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So we have no appointments;

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she shows up when she wants.

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But usually waits less
than 15 minutes to be seen.

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She then spends as much
time with us as she needs.

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Sometimes that's 40 minutes,
usually it's less than five.

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She loves this flexibility.

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It's how she saw doctors in Somalia.

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And I love it, because I don't pay
staff to do scheduling,

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and we have a zero no-show rate
and a zero late-show rate.

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(Laughter)

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(Applause)

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It makes business sense.

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Another difference is our office layout.

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Our exam rooms open
right to the waiting room,

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our medical providers
room their own patients,

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and our providers stay in one room
instead of alternating between rooms.

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Cutting steps cuts costs
and increases customer satisfaction.

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We also hand out free medicines,
right from our exam room,

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over-the-counter ones
and some prescription ones, too.

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If Nasra's baby is sick,

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we put a bottle of children's Tylenol
or amoxicillin right in her hand,

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she can take that baby straight back home
instead of stopping at the pharmacy.

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I don't know about you, but I get sick
just looking at all those choices.

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Nasra doesn't stand a chance in there.

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We also text patients.

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We're open evenings and weekends.

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We do home visits.

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We've jumped dead car batteries.

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(Laughter)

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With customer satisfaction so high,
we've never had to advertise.

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Yet are growing at 25 percent a year.

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And we've become real good
at working with Medicaid,

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since it's pretty much the only
insurance company we deal with.

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Other doctor's offices chase
10 insurance companies

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just to make ends meet.

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That's just draining.

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A single payer system is like monogamy:
it just works better.

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(Laughter)

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(Applause)

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Of course, Medicaid is funded
by tax payers like you,

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so you might be wondering
how much does this cost the system.

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Well, we're cheaper than the alternatives.

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Some of our patients
might go to the emergency room,

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which can cost thousands,
just for a simple cold.

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Some may stay home
and let their problems get worse,

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but most would try to make an appointment
at a clinic that's part of the system

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called the Federally
Qualified Health Centers.

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This is a nation-wide network
of safety-net clinics

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that receive twice as much
government funding per visit,

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than private doctors like me.

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Not only they get more money,

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but by law, there can
only be one in each area.

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That means they have a monopoly
on special funding for the poor.

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And like any monopoly,

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there's a tendency for cost to go up,
and quality to go down.

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I'm not a government entity,
I'm not a non-profit.

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I'm a private practice.

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I have a capitalist drive to innovate.

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I have to be fast and friendly.

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I have to be cost-effective
and culturally sensitive.

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I have to be tall, dark and handsome.

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(Laughter)

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And if I'm not, I'm going out of business.

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I can innovate faster than a non-profit,

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because I don't need a meeting
to move a stapler.

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(Applause)

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Really, none of our innovations
are new or unique,

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we just put them together in a unique way

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to help low-income folks
while making money.

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And then instead of taking
that money home,

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I put it back into the refugee community
as a business expense.

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This is Mango House.

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My version of a medical home.

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In it, we have programs
to feed and clothe the poor.

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An after-school program, English classes,

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churches, dentist, legal help,
mental health, and the scout groups.

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These programs are run
by tenant organizations

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and amazing staff,

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but all receive some amount of funding
form profits from my clinic.

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Some call this social entrepreneurship.

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I call it social service arbitrage.

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Exploiting inefficiencies in our
health care system to serve the poor.

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We're serving 15,000 refugees a year

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at less cost than where else
they would be going.

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Of course, there's downsides
to doing this as a private business,

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rather than as a non-profit
or a government entity.

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There's taxes and legal exposures.

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There's changing Medicaid rates
and specialists who don't take Medicaid.

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And there's bomb threats.

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Notice there's no apostrophes, it's like,

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"We were going to blow up
all you refugees!"

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(Laughter)

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"We were going to blow up
all you refugees,

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but then we went
to your English class, instead."

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(Laughter)

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(Applause)

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Now, you might be thinking
"This guy's a bit different."

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(Laughter)

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Uncommon.

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(Laughter)

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A communal narcissist.

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(Laughter)

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A unicorn maybe,

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because if this was so easy,
then other doctors would be doing it.

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Well, based on Medicaid rates,
you can do this in most of the country.

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You can be your own boss,

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help the poor and make
good money doing it.

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Medical folks,

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you wrote on your school
application essays

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that you wanted to help
those less fortunate.

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But then you had your idealism
beaten out of you in training.

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Your creativity bred out of you.

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It doesn't have to be that way.

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You can choose underserved medicine
as a life style specialty.

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Or you can be a specialist

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who cuts cost in order to see
low-income folks.

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And for the rest of you,
who don't work in health care,

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what did you write on your applications?

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Most of us wanted to save the world,
to make a difference.

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Maybe you've been
successful in your career,

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but are now looking for that meaning?

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How can you get there?

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I don't just mean giving
a few dollars or a few hours,

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I mean how can you use your expertise
to innovate new ways of serving others.

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It might be easier than you think.

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The only way we're going to bridge
the underserved medicine gap

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is by seeing it as a business opportunity.

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The only way we're going to bridge
the inequality gap

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is by recognizing our privileges
and using them to help others.

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(Applause)