Healing to Homeless People: A Doctor’s NYT Best-Selling Story

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Speaker 1: Welcome to Conversations on Health Care. This week, we welcome Dr. Jim
O'Connell, founder of Boston Healthcare for the Homeless, featured in The New
York Times Bestseller by Tracy Kidder, Rough Sleepers. Now, here are your
hosts, Mark Masselli and Margaret Flinter.

Mark Masselli: The mayor of Los Angeles has declared homeless emergency in New York City.
The mayor wants to take more mentally ill people from the streets to the
hospital. In Washington, D. [00:00:30] C., case workers just cleared do zens of
unhoused citizens from a park right near the White House. Data shows that on
any given night in the United States, about a half a million people are
experiencing homelessness.

Margaret Flinte...: Dr. Jim O'Connell is the subject of The New York Tim es bestselling book. It's
titled Rough Sleepers. The new book focuses on his urgent mission to bring
health and healing to homeless people, and it's written by Pulitzer Prize winner,
Tracy Kidder.

Mark Masselli: Dr. [00:01:00] O'Connell, or Dr. Jim, if we may, welcome to Conversations on
Health Care.

Dr. Jim O'Conne...: Oh, I'm actually very thrilled to be here. Thanks for having me.

Mark Masselli: Oh, great. I think about people who are walking down streets all across the
country and asking themselves if o ur homeless problem is getting worse, and if
it is, what caused the increase? Was it the pandemic? Or what do you have to
say [00:01:30] about the question?

Dr. Jim O'Conne...: First of all, I feel a little bit sheepish because I've long admired what you b oth
have been doing and the Community Health Center we all look to for guidance
and inspiration has been yours, so let me start by just saying that and making it
clear.

Mark Masselli: Oh, you're too kind.

Dr. Jim O'Conne...: I'm a newcomer compared to the two of you. I think what's contributing to the
growing numbers of homelessness, and it tends to fluctuate a little bit, but what
continues [00:02:00] to feed it, I think, is the things we all know all too well.
There's a growing disparity in income. Rents are getting very high. Finding new
housing is expensive and difficult to do and the scale at which we need help
with both the rental units and with housing is really a scale that we haven't
achieved yet, so I think as we work very hard, many, many cities a round the
country are being incredibly creative along with [00:02:30] help from HUD and
their state governments to find new housing, but the rate at which they can find
new housing doesn't seem to be able to keep up with the numbers of people
that are comi ng in newly homeless, so I think we have a big challenge ahead of
us.

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Mark Masselli: Yeah, I think I just saw today's paper that the year - over - year cost for housing
had increased 7.9%, probably creating more people who are facing
homelessness as well.

Dr. Jim O'Conne...: That's correct. [00:03:00] I realize that medicine is what I know and I think it's
kind of complicated, but when I look at housing and the issues around housing
with community development and all the rules and regulations, it's probably
eve n more complicated than housing, so I am by no means an expert, but I do
know that my friends that are involved in doing housing projects in big cities like
L.A. and San Francisco and Seattle, and to some degree in Boston, when you go
through the whole pro cess of trying to build new housing [00:03:30] for
formerly homeless people, once you get through all of the rules and regulations,
the legal fees, the community things, it takes a very long time to create it, and
by the time you get there, the average plu s of housing, for example, of a unit in
San Francisco now is about six or $700,000 by the time all is said and done,
marginally less in L.A., and about the same in some other cities, so the expense
of creating new housing is kind of overwhelming, and we ne ed to understand
that.

Margaret Flinte...: [00:04:00] Well, Boston is no stranger to those escalating prices or the shortage
of housing, and certainly, you've been engaged with this work for decades. Of
course, you're joining us from Boston where you're th e president of Boston
Healthcare for the Homeless, certainly a program to advocates around the state
who try and address the needs of people who are homeless. You're also an
assistant professor of medicine at Harvard Medical School and I think it's
probabl y safe to say that [00:04:30] your practice is not exactly like the models
of care that you were trained to when you were a medical student and then a
resident. I thought one of the comments in the book that was really interesting
was that your medical deg ree is often less valuable than your bartending skills,
that bartending made you a good listener. One of our physicians told me the
same thing years ago. But take us through your treatment approach. In all
seriousness, certainly listening and communication is at the heart of what
you've needed to do to build this program, [00:05:00] but tell us about what it
means to treat people in this context of homelessness.

Dr. Jim O'Conne...: Yeah, and I appreciate the way you phrased that, Margaret, but certainly I'm an
accidental tourist in this world. I was planning to do something completely
different. I wanted to stay hospital - based medicine, wanted to become a
specialist in oncology, and I had no inkling of what it meant to go to the
community and try to take car e of populations that we were traditionally
[00:05:30] excluding from the mainstream. When I got sent as a one year,
"Please go do this," by my chief of medicine, I remember getting to this shelter
and realizing it was completely foreign to me, even though it was only six blocks
away from where I had just finished being the senior resident in charge of the
intensive care unit, and I kept thinking, "How hard can a shelter clinic be after
you do that?" It turns out it's immensely more difficult because you ha ve so

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little control over [00:06:00] so many factors. I realized with some joy in the
intensive care unit, you control lots and lots of things, but not in the shelter.

I remember the first thing that the nurses who were already working there told
me was o n no uncertain terms... By the way, I have an older sister who's a
nurse, so I know when nurses are getting very, very precise, and so they
basically told me I had to relearn how to approach people. I had to soak feet, for
example, for about two months bef ore they would let me do any [00:06:30]
doctoring. I think the lessons I learned from the nurses back then are still the
lessons that have lived through all of these years. That's that you have to take
time to get to know people who have been really disenf ranchised and they are
vulnerable, fragile, often very chary of the mainstream system, so for me to go
march in as I wanted to do and get their chief complaint and write a script and
do all that within the first 10 or 15 minutes was just not possible.

I r emember [00:07:00] that experience of how to take time to earn trust, have
coffee with your patients, talk to them, share a little bit, all the things that I
think that kind of time had not been treasured or valued when we were in the
hospital training. We learned that was the only way to begin doing any kind of
long - term continuity of really good care was to take a lot of time upfront, so
that more than anything I remember stands out. The homeless people that put
us together and designed [00:07:30] the mod el of care, which I could claim we
did that, but we did not, they did. But they insisted that they really wanted
continuity of care, that they didn't want fragmented care. They said their lives
were already fragmented enough and people were coming and goin g. They
wanted consistency in their doctors and their nurses, so they wanted to know if
I saw somebody on Monday night, if they were sick on Thursday, they could call,
and I would answer the phone.

Mark Masselli: There's so many challenges that you face, c ertainly managing [00:08:00]
individuals with addiction and mental illness or the combination and wondering,
how did you acquire those skills? Certainly, you also have a pretty good team
with a wide range of skill sets, but take us through your own learnin g process
about addiction and mental illness.

Dr. Jim O'Conne...: No, it's a really poignant point because I was clearly trained in medicine and I
did not have much sense [00:08:30] of social medicine or of addiction care or
care for substance use disorder s and very little experience in caring for people
with severe and persistent mental illness. They were always people we referred
to another system to be cared for. But as all of you probably know all too well,
the people who have been chronically living in our city streets and in our
shelters tend to bear a very, very high burden of co - occurring medical,
[00:09:00] psychiatric, and substance use disorders, and if you really want to
care for them, you have to learn how to integrate the care, not only
theoret ically, but co - locate the care if you're really going to do care well.

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They were skills we had to learn. We now have a psychiatrist on, we have had
for 20 years a psychiatrist on our team whose panel of patients is the same
panel that we all care for. We' ve learned that has been critical, so when
[00:09:30] I'm seeing someone for their medical problems to know, the
psychiatrist that's with me on the team is the person that can see them if they
need help. Then we also have a wonderful recovery coach who hel ps us
integrate our substance use care into the mainstream so we can do all of the, as
many people are doing now, make sure we offer all the medications for opioid
and other dependencies and make sure people have easy access to that. I think
finally it was learning that you [00:10:00] can't silo this care. You really have to
learn how to integrate. I've often thought that homeless people when you reach
out to take care of them will teach you before we realize that ourselves the real
weaknesses in our mainst ream healthcare system. The lack of integration
coordination was certainly one of them.

Margaret Flinte...: Well, I think you're absolutely right about how much we have to learn from
people. I'm going to ask you in a minute to comment on this phrase, the r ough
sleepers that you talk about [00:10:30] in your book and what that means. It's
such a great phrase, but I don't think it necessarily is clear to people what you
mean. I want to preface that by saying when people see homeless people on the
street, when they read about it, they often ask, "Why? There's shelters they
could go to. There's housing vouchers in the city. There's some hotels
sometimes," and it is true in our experience that some people will not go to a
shelter [00:11:00] facility. What have yo u learned about why we have so many
of what's called these "rough sleepers" and what is a rough sleeper?

Dr. Jim O'Conne...: All of my preconceptions turned out to be very wrong, as you can imagine. In
Boston, at any rate, the mayors and the governors for years have made sure
there have been shelter beds for any adult that really wants one. In our clinics,
our Boston Healthcare for the Homeless Program, which is our FQHC, has for
year since [00:11:30] the beginning done clinics and all of the shelters, and so
we thought we were getting out to be exactly where people were.

The first winter I was working, remember, I remember thinking, "Wow, people
are dying, but they're the people who are staying outside, not even coming into
the shelter," so as much as we t hought we were doing a great job of reaching
out to be where people were, we had to get to know this in Boston, a relatively
small population of what they called themselves to be "rough sleepers." They
were sleeping the rough. Looks like it's an old Englis h word. I know [00:12:00] I
worked for a little bit in London trying to understand what was going on there.
They actually had a department of rough sleepers in the government. But they
had the folks who, as I've learned, they will get upset if you say, "Wh y do you
choose to live on the streets?" 'Cause they'll laugh at me and say, "I'm not
choosing to live on the streets. I'm choosing not to go to a 500 - bed shelter
where I have to sleep with a lot of other people or where someone's going to
tell me when I c an go to the bathroom and when I have to turn the lights off."

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[00:12:30] Other reasons are a little bit more complicated. I'd like to say the
biggest lesson I had was one night, it's freezing cold, it was - 10 degrees, there
was a northeaster predicted, a nd I was trying to get this poor man who had
pretty severe schizophrenia living under a bridge trying to get him to come in.
We had gotten to know him slowly, but he put his hand up to me, and when I
said, "Come on, please come in," he said, "No, I can't g o in there." He said, "You
don't understand. When I go into the shelter, I can't tell which voices are mine,
[00:13:00] but when I'm here under the bridge, I know the voice is mine, and I
can contain it and control it," so I started to realize there are im mensely
complicated reasons why people, or their individual reasons, cannot go into a
shelter. By the way, we've learned that all of them, if you offer them a place to
live, a house, they'll say yes, but a shelter, they'll say no.

Mark Masselli: I want to talk a little bit about I started at top of the show referencing Mayor
Adams, who's called for more [00:13:30] homeless to be hospitalized, and so
this whole issue of hospitalization, we're talking to you from Middletown,
Connecticut, which has the last ps ychiatric hospital in the state. When we were
starting back in the '70s, the deinstitutionalization was occurring, and so we had
lots of patients coming out. Now, there's this whole initiative around
hospitalizing patients. I'm wondering, and of course, th e probate judges,
[00:14:00] at least in this area, are not inclined to just simply say, "Somebody
should be hospitalized because they're homeless." It's a complicated issue. I'm
wondering where you come down on the use of hospitalization for homeless in
s evere need.

Dr. Jim O'Conne...: I concur completely that it's a very complicated situation and I can think over
the years of how much we've tortured over the decisions [00:14:30] you make
about whether you can just allow someone to make their own decisions and
stay out in the bitter cold when they're vulnerable or when you take away their
rights. What I can say is that, and I would love to hear your experiences with
deinstitutionalization, I didn't get to medical school till the late '70s when it
already ha ppened, but hadn't quite filtered into the streets yet.

But what is our experience is that even when you bring somebody in, which is a
very difficult thing to do [00:15:00] against their will, the availability of
treatment afterwards is so limited that mo re often than not that person ends
back up on the street after several days or several weeks without the long - term
care I think they really need and deserve, so I'm always hesitant to talk about
committing people unless we know what's on the other side, th at there is a real
plan for treatment afterwards. I think that's the big gap in the system. As you
were saying it, now we've during deinstitutionalization, we've lost [00:15:30]
whatever it was. I think we went from 800,000 beds in the country down to less
than 200,000. Now, when we bring somebody to the emergency room, there's
really no place for them to go. They often will be committed and hang out or
languish in the emergency room for days before they can find any place to go,
and often by that time, the y're ready to be discharged, so I think we have a
challenge as a country.

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I think first of all, I think Mayor Adams is absolutely correct to point to the
problem. This is a terrible problem. When I think of the people we see night
after [00:16:00] night w ho have thought disorders and are outside, very
vulnerable living what I think are really difficult lives because of a thought
disorder, not because of a real choice, and you think you really want to do
whatever you can to help that person, but that means you have treatment
options, and so we only do it on rare occasions now when we know somebody's
in imminent danger of harm to themselves or others. We do it trying hard to
work with the emergency room and everyone in the Department of Mental
Health to make sure that [00:16:30] that person has a treatment plan on the
other side. But it is a really, really difficult problem.

I don't know if it's fair to say, but I learned my lesson when I've been working on
a van that goes out at nighttime. Every night, it go es out from 9:00 at night till
5:00 in the morning run by these amazing people from Pine Street Inn with
money from the State Department of Public Health. They've gotten to know
everybody outside and the van serves soup and sandwich and blankets. The
homel ess people didn't want a medical van, they wanted something... I've been
writing on that for [00:17:00] years and learning how to, with the help of these
folks, to get to know people, slowly give them soup, and get to know them.

I remember one woman who w e tried hard. She was very crusty and really
tough, but we worked hard, and finally, she started taking soup from us and a
blanket. We thought that was really good. She was living on a stoop. One day
something happened and the police had to commit her agai nst her will and I
didn't see her till about two years later. Was at a meeting on the South Shore
[00:17:30] and there she was looking really together, dressed, and really literally
on the board of one of the shelters at that point, and I went up and I wan ted to
hug her and I said, "Wow, you look great. It's been so long." She turned and
looked at me and she said, "Get away from me, you [inaudible 00:17:46]." She
said, "You left me out there for 10 years and never did anything."

Margaret Flinte...: Wow.

Dr. Jim O'Conne...: I always balance, I don't know what is the right thing to do, and I think we
should all drop down the tenor of it all and try to understand this is a tough
[00:18:00] argument we should all be discussing.

Mark Masselli: Right, a little hum ility. Yeah.

Margaret Flinte...: Yeah. Wow. That is a great story. Maybe I can pull a few threads together. Your
patient who was under the bridge who said, "No, I'm not going to a shelter, but
if he gave me a place to live, I'd come out from under this bri dge where I would
be in someplace where I don't have all the voices in my head." I was thinking
that something that the COVID pandemic presented to us was that [00:18:30] all
of these large congregate shelters suddenly, which have always been intolerable
t o me to see them, 20, 30, 40 men sharing a dormitory room, they suddenly

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were untenable from the public health department's perspective, too. Where
was their space? Whether there was space in hotels, Super 8 being one of my
most favorite here in Connecticu t.

These hotels were taken over by the systems of care and the health
department, at least in Connecticut, and became [00:19:00] the most civilized,
comfortable logical place for people to be sheltering one person to a room or
two people to a room, the mo st that we'd seen. I was 100% convinced when the
pandemic ended that that model would persist, but chalk up naivete for me. I'm
really curious what your experience was throughout. How did it change things
for our homeless population? Did it make it better in some ways because we
had [00:19:30] to protect them and protect the population, I suppose from
them as well.

Dr. Jim O'Conne...: COVID, we are still, I think, suffering from the lingering effects of COVID from
just from how we approach life point of vie w. But in Boston where we have
shelters, some of our shelters are not... Many of them, like Pine Street Inn was
four or 500 beds and the city's shelter was about 400 beds, so we were
panicked when COVID came [00:20:00] that once anyone with COVID got into
that, it would be nightmare, so we converted ourselves, as did most healthcare
things, into really becoming a COVID prevention and treatment kind of
operation, we thought temporarily.

What we found is when one person with COVID was in the shelter, we need ed
to get them somewhere and we didn't have the advantage of hotels the way
you did. I looked with great admiration and respect [00:20:30] with Connecticut
and California where they really did really creative hotels. We couldn't do that in
Boston, I don't think. I don't know what the story was, so we had to come up
with other ideas, but isolating somebody during COVID, we learned a lot. One is
we learned that COVID was a great equalizer. Everybody in the city was equally
affected, and so there was a lot of sympathy toward homeless people, or
empathy maybe toward homeless people that had not been done before.
[00:21:00] But then there was a difficulty of if you have no money and you're
living on the edge in homelessness and you need to be isolated or quaranti ned,
it's impossible if you don't have food and money and more than just the shelter,
so we learned a lot about, I think all of us in our particular city, learned a lot
about the needs of homeless people. I think that was really good. People started
to und erstand how complicated and difficult this was.

A good story to come [00:21:30] from COVID, though, is what we found is that
40% of everybody in the shelters got COVID, so it was along with one other city
in Massachusetts, the highest incidents of COVID. But much to our surprise, we
were the ones that had to do, because we have clinics and all the shelters and
people out on the streets, we did the vaccinating ourselves, and much to our
surprise, there were very few people who refused the vaccine from us. I think
they had a very clear idea among themselves [00:22:00] as a community of that
they needed to protect each other. It was striking to us you didn't run into any

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of the issues I thought we were going to run into. Some of that, I think, was
because the nurses they know and the doctors they know were giving them the
shots. It wasn't some stranger coming in. But I do know that it's a real sense of
community that most of us don't appreciate exists within the homeless
population.

Mark Masselli: Thank you. Th inking of things that we don't appreciate, you started off by noting
in San Francisco [00:22:30] that the cost of a unit of housing is 600,000 - plus. I
had the opportunity of chairing a housing authority and would always tell my
friends, "Why not just build housing?" It is very expensive and we simply don't
have the resources to do it, nor do we have the right sizing for Section 8 that we
need to have and at a price point that's going to build housing.

But I'm interested [00:23:00] in two other things. One, the tiny house
movement and what your thought is about that, and then also just sort of the,
you've mentioned four or five cities, but I didn't hear Houston, which seems to
me to have probably one of the best success rates for doing that. I was thinking
a bout tiny housing in Houston. Houston has one of the most liberal planning
and zoning regulations in the United States. You can sort of do anything
anywhere, which is kind of exciting. [00:23:30] But how do you put together,
what are your thoughts about th is structural reform that needs to take place so
that we can start to do in addition to the support services, which you all have
done just a fantastic job in developing and being a role model for, but the
physical building of these housing, any thoughts or people that you're working
with are devoting time to that?

Dr. Jim O'Conne...: Oh, yeah, no, [00:24:00] there are lots of really creative people working on this
problem overall. In Boston, they've done some immensely creative thing, and I
think we're star ting to see progress be made toward bringing the numbers
down. But it is painful in places like L.A. or San Francisco or Boston, there are
very complicated community processes you have to go through before you can
get something approved and there's a lot o f zoning variances [00:24:30] you
have to do and a lot... You have to have enough parking spots per unit. You
realize all of those things, while done with all the best intentions to protect the
citizens, also mitigate against the ability to build very low - income housing in any
kind of density.

I've been fascinated by Houston, they've done extraordinary things. But it is
true, if I owned a piece of land in Houston right now and I wanted to build a
shelter, I could just do it tomorrow. If I tried to do that [00:25:00] in Boston, it
would take, as we've already experienced, about four and a half years to even
get to break in the ground. That gives you the cities that have done a lot to
protect each other with zoning and stuff like that also then suffer a lot w hen it
comes time to low - income housing, so I think we have to figure out how to
bring all of those together.

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I'm more deeply admiring of you now to know that you were part of a housing
authority because [00:25:30] those issues come up and they are so com plicated
and so difficult and I think we all as a society have to come together and figure
out how do we break through this log jam and come up with something
reasonable that protects everybody's concerns.

Margaret Flinte...: Well, Dr. Jim, I know that you are probably connected to everybody around the
country who's engaged with this issue, but I was surprised to learn that the
United States is really for the first time devoting funds and resources specifically
to the issue of homelessness [00:26:00] in rur al areas. The focus has really been
on urban areas. What do we know, or do you have any insights into the unique
challenges of helping those who are homeless in rural America?

Dr. Jim O'Conne...: I don't have any unique insight, but I have been with friend s who work in rural
areas and I realize where I can go down to Pine Street Inn six blocks away and
see two or 300 people, they will take two weeks to be able to see that number
of people because of the spread out [00:26:30] area, so there are very differen t
challenges for urban homelessness from rural homelessness. I think we have a
lot to learn from our colleagues, for example, that have worked on the
reservations, for example, where we've long had community workers when I say
that and public health nursin g that goes out into the hills and sees people. There
are models there that we could probably learn a lot from. Not to say that
everyone is resource - poor right now, but with enough [00:27:00] resources, I
think we know what we would work.

One of the issues that confounds everybody, just to point out, is that when you
step back and look at the numbers, big numbers, if you look at the main urban
centers is in the country, that's about 80 to 85% of all homeless people, and the
other numbers, even though they're significant, are smaller in respect to that,
so it's always been difficult to get funding to go to the smaller places, which
need it equally much, just that they're not as [00:27:30] visible as the big city
places.

Mark Masselli: Now, I wonder if y ou could talk a little bit about your team. You've built a really
incredible network, a medical alliance, employs 400, serves 11,000 homeless a
year. Just a little bit about the struggle to keep operations alive. I don't think
people realize, just doesn't come from heaven, but it takes a lot [00:28:00] of
work of partnerships that you have to cultivate. But you've also attracted
people who believe in your mission and believe in the mission of providing
dignity and respect to people who are facing difficult times. But tell us a little
more about your team.

Dr. Jim O'Conne...: Sure. I would sort of put the mirror up to the two of you and say you more than
anyone know what this struggle is all about and about behind the scenes
[00:28:30] to provide the funding to allow your clinicians to do the kind of work
that you need to do to care for these very vulnerable populations. But I would

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say it was difficult for me because I was a doctor, I didn't know anything about
the financing of these things.

In truth, which you would appreciate, we were a grant from the Rob Wood
Johnson Foundation back in 1985, so we had this four years' worth of grant
money. We didn't even have a finance department. I used to be able to write a
two - page thing to the foundation at the end of the year saying we saw this
number of people in this [00:29:00] many places. Then, come 1988, that grant
funding ended, and I remember being panicked about, "What are we going to
do? We've got this program going but no money." Then we were grandfathered
in under OBRA '87 or something like that to become an FQHC, and you know the
thing then, so we all of a sudden had to think of ourselves as we needed a
finance department. We had to learn how to bill Medicaid. We had to learn how
to look at our visits in way s of, "How do [00:29:30] you produce revenue to keep
us going?"

We always knew that that would never be enough revenue to really allow us the
time we needed to be people, so we also had to figure out how to get the grants
and the foundation money to balan ce it out. But I remember those were a
hundred - plus hour weeks for years trying to figure out the foundation on which
the funding came from. We had a lot of help in that. What I did learn is that
Massachusetts has a remarkably wonderful creative and genero us Medicaid
[00:30:00] program who really feels, and has over the years, who really feel
dedicated to making sure they reach to the real Medicaid population. We were
expanded, as you know, under RomneyCare back in the late 1990s, so that
almost people esse ntially all became insured, and that allowed us to continue to
build.

Then there were two other challenges. One, we had to be part of the shelters
where we are guests. We're guests in these 30 - some shelters where we run the
clinics from every day [00:30:3 0] to once a week depending on the size of the
shelter and then we also were mandated by the homeless people who were
many of whom were on a board now to stay part of the hospital community
because the homeless folks in Boston anyway knew when they got ver y sick
they ended up in one of the big academic hospitals and they wanted their
doctors and nurses to be involved in their care, so we had to stay part of the
hospitals, be part of the shelters, and then get funding from the city, the state,
and the feds, so it was this learning to be a partner with all [00:31:00] of them.

I think the years of just doing our work and then appealing to them is what I
think helped us out in the long run. It's really about a collaborative approach
that's both public health an d medicine and we had to be integrated with the
substance use care. In our state, the Department of Public Health does
substance use disorders, departmental health does the mental health issues,
and then Medicaid does the medical stuff for the most part, s o we had to learn
to bring all of those [00:31:30] together, and they were great. They were great
about doing that. But as I look back now, it seems simple, but it was incredibly

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difficult. I don't talk about that very much, but that's the legacy we have, I
guess.

Mark Masselli: That's great.

Margaret Flinte...: We remember some of those transitions well from our own history. Dr. Jim,
you're an inspiration to all those who provide healthcare to persons who are
homeless and all those who are working to end h omelessness and I'm so glad
that Tracy [00:32:00] Kidder has captured your work so wonderfully and really
brings to people the hope that you bring to Americans who face all these
challenges, so thank you for joining us, and thank you to our audience. There 's
more online about Conversations on Health Care, including a way to sign up for
email updates. Our web address is chchradio.com. Dr. Jim, thank you so much.
Continued good luck with your work.

Dr. Jim O'Conne...: Okay, and thank you both for being such h eroes for so long. I appreciate it.

Mark Masselli: Well, thank you so much, and [00:32:30] we look forward to being in person,
not in Zoom, and connect with you and with your team, so thank you so much
again for all that you do for this country.

Margaret F linte...: Yeah.

Dr. Jim O'Conne...: Thank you so much. I appreciate it.

Margaret Flinte...: Take care.

Mark Masselli: Yeah.

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