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<v Speaker 1>Fundamental principles, how do the lead them last last?

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<v Speaker 2>And self interest and the individual wise. It is the

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<v Speaker 2>Ran book show, all right. I think weird is going on.

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<v Speaker 2>There's gonna be nice and echo music anyway, welcome you

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<v Speaker 2>on bookshel I should put it on the music show.

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<v Speaker 2>Medium that's better echo a co eco. It's only there.

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<v Speaker 2>I don't think you're not hearing an echo from me, right,

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<v Speaker 2>I think it's just uh anyway, the music, the music.

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<v Speaker 2>All right, Thanks for joining me, everybody. I really appreciate it.

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<v Speaker 2>We are going to talk about healthcare today. We're gonna

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<v Speaker 2>do to healthcare what we try to do to find

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<v Speaker 2>nancial regulation, to China policy, to what was it immigration

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<v Speaker 2>and now healthcare. I mean, at the end of the day,

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<v Speaker 2>what we will have here I think by the time

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<v Speaker 2>we finished the series is a blueprint, a blueprint for

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<v Speaker 2>how to move the US economy, how to move US politics,

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<v Speaker 2>how do you move the US government towards having a

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<v Speaker 2>rational policy overall? So this is a roadmap for all

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<v Speaker 2>of that. Maybe maybe we can get transcripts of this

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<v Speaker 2>and get it wrong in writing and put it on

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<v Speaker 2>a book called, you know, rational policy for irrational World,

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<v Speaker 2>Rational Policy for the world in which we live, So

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<v Speaker 2>it's going to be a plan, a plan. So I

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<v Speaker 2>will be kind of using the same template us with

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<v Speaker 2>immigration and with with China policy. I think to some

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<v Speaker 2>extent I keep making slight changes to it, but generally,

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<v Speaker 2>generally this is the template. And this one is sponsored

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<v Speaker 2>by a few of you, so a few of you

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<v Speaker 2>sent money in. Let me also say this, this is

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<v Speaker 2>a big one health can in particular, it's like finance.

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<v Speaker 2>As I said, in Finance, it can't be done in

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<v Speaker 2>one show, and I didn't try to do every aspect

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<v Speaker 2>of finance and everything in finance. You can't do health

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<v Speaker 2>can one show. There's so many dimensions to this. We'll

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<v Speaker 2>cover a lot, but we could go in depth into

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<v Speaker 2>any one of these. And I am not familiar with

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<v Speaker 2>all the laws and all the regulations and all the

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<v Speaker 2>complexities associated here. So we're gonna take a kind of

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<v Speaker 2>big picture. We're gonna go into more detail on things

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<v Speaker 2>that I know and understand and I think are important.

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<v Speaker 2>But we need a few shows to do this, and

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<v Speaker 2>we will be doing more shows on this, so stay tuned.

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<v Speaker 2>There will be more healthcare shows. This has shown number one.

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<v Speaker 2>Thank you for those of you who have sponsored this show.

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<v Speaker 2>Let me just put it out there that if anybody

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<v Speaker 2>out there wants to sponsor a show on I can

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<v Speaker 2>think of Education would be really really good. Open somebody

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<v Speaker 2>suggested labor laws, label laws would be good, although I

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<v Speaker 2>probably have to bring in somebody. No, I mean labor laws.

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<v Speaker 2>I could do label laws and think think about anything else,

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<v Speaker 2>any other realms that you might want to that you

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<v Speaker 2>might want to meet a cover in this way on

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<v Speaker 2>the show. I mean, we've done one aspect of phone

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<v Speaker 2>policy China. We could do other aspects of phone policy.

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<v Speaker 2>We could do the Defense Department. We just do a

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<v Speaker 2>show on the Defense Department and what that would look like.

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<v Speaker 2>But yeah, I mean so basically it saw a thousand

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<v Speaker 2>dollars a show. But we can aggregate. I think this

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<v Speaker 2>healthcare show, we had a couple of people do five

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<v Speaker 2>hundred each. And you know, hopefully if you guys want

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<v Speaker 2>to do education or one of these others, we can

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<v Speaker 2>put together, you know, whether it's two hundred and fifty

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<v Speaker 2>each or you know, five hundred, five hundred each, or

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<v Speaker 2>we can put something together to make that happen. So

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<v Speaker 2>just let me know if there is interest and we'll

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<v Speaker 2>organize it. And of course, if you have ideas for

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<v Speaker 2>other topics, you know, let me know. Environmental regulation would

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<v Speaker 2>be a pretty good one. I don't think I have

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<v Speaker 2>anything to add to what you know Alex publicizes on

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<v Speaker 2>a regular basis on energy policy. Environmental law would be

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<v Speaker 2>would be really good. It would be the government's perspective

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<v Speaker 2>environment And then we could do more on finance, and

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<v Speaker 2>we will do more in healthcare. So what to do

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<v Speaker 2>with federal lands, that's easy. That w take ten minutes,

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<v Speaker 2>five three sentences, two words, two words. Here, here you go.

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<v Speaker 2>Here's what to do with federal lands. Sell them, sell them,

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<v Speaker 2>auction them off to the highest bid of That's it.

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<v Speaker 2>That's what I have to say about federal alians. We

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<v Speaker 2>can talk more about it. We can do a show

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<v Speaker 2>about that anyway. Yep, please please let me know what

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<v Speaker 2>you want. Now in terms of today's show, you can

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<v Speaker 2>ask questions again, you can ask questions about anything. I

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<v Speaker 2>will get priority in terms of time to the questions

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<v Speaker 2>about healthcare. So any questions you have about health care,

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<v Speaker 2>health care policy comparison to other countries, NHS, I don't

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<v Speaker 2>know that much about I don't know Switzerland or some

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<v Speaker 2>of these other countries. That have highbrid systems. But I

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<v Speaker 2>know something about the NHS, a little bit about the

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<v Speaker 2>Canadian system, a little bit about the Israeli system. Those

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<v Speaker 2>are the international systems I know of I know about

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<v Speaker 2>I don't know that much about the other systems other

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<v Speaker 2>than a few things that I'll say at the begin

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<v Speaker 2>at the beginning of the show here, all right, I

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<v Speaker 2>think we've kind of summarized it. Yeah, we can do

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<v Speaker 2>one on again laws. Yeah, you know, whoever puts the

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<v Speaker 2>money up, that's what we'll do. This is market driven.

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<v Speaker 2>The one book show is very market driven. Whoever puts

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<v Speaker 2>up the money that not. You don't get a say

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<v Speaker 2>in what positions I will take, on, what opinions I

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<v Speaker 2>hold on, what recommendations I make. But in terms of

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<v Speaker 2>the broad topics, yeah, we can do that. We can

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<v Speaker 2>do that, all right, So let us start with healthcare

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<v Speaker 2>a gain. Super chat is open. We have a regular

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<v Speaker 2>goal and this is probably go long, just because I

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<v Speaker 2>have a lot to say. Of course, there might not

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<v Speaker 2>be any questions, so it might be showed and what

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<v Speaker 2>else that I want to say. Yeah, you get to

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<v Speaker 2>ask the questions and feel free to ask about anything,

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<v Speaker 2>but priority will be given to healthcare. So one thing,

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<v Speaker 2>one thing I think everybody can agree about when it

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<v Speaker 2>comes to healthcare is that it seems that pretty much

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<v Speaker 2>nobody is happy. Nobody is happy with the system. Now,

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<v Speaker 2>it might be true that healthcare right now is not

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<v Speaker 2>a big issue politically. It's not top priority for Trump,

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<v Speaker 2>it's not top priority, wasn't top priority for Biden. Since Obamacare,

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<v Speaker 2>there was some movement to abolish Obama, kay, But other

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<v Speaker 2>than that, there's been very little, very little really uh excitement,

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<v Speaker 2>and very little emphasis, very little focus on healthcare over

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<v Speaker 2>the last few administrations. And the system just keeps chugging along.

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<v Speaker 2>We'll talk about what that means, but it seems it

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<v Speaker 2>just it just keeps going and nobody wants to touch it.

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<v Speaker 2>And a big part of nobody wants to touch it

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<v Speaker 2>is everybody knows the complexity of doing anything with healthcare.

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<v Speaker 2>And more importantly than the complexity for this purpose is

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<v Speaker 2>the number of pressure groups, the number of the number

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<v Speaker 2>of people who are who have an opinion, who have

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<v Speaker 2>a view, who are going to fight tooth and nail

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<v Speaker 2>for whatever it is for their piece of the healthcare pie,

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<v Speaker 2>if you will, So that the amount of pressure group

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<v Speaker 2>politics here is as bad as probably in finance. Uh

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<v Speaker 2>and uh and and really really really horrific, much worse

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<v Speaker 2>than immigration or almost every other topic because of the

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<v Speaker 2>because of the complexity and the scale of this issue. Right,

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<v Speaker 2>the scale. While nobody's unhappy with the system, healthcare in

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<v Speaker 2>the United States is massive, right, it is a four

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<v Speaker 2>trillion dollar expenditure a year. It constitutes seven last constituents

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<v Speaker 2>I think twenty three seventeen point six percent of GDP,

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<v Speaker 2>A massive portion of government spending. Government spending goes to

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<v Speaker 2>you know, goes to healthcare, Medicare and Medicaid, a huge

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<v Speaker 2>chunk a two trillion dollars of government expenditures. So in

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<v Speaker 2>a you know, twenty eight trillion dollar economy, we spend

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<v Speaker 2>about four trillion twenty seven trillion dollar economy, twenty eight

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<v Speaker 2>trillion dollar economy, you spent about four trillion on healthcare.

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<v Speaker 2>Think about for trillion, and healthcare as ninety thousand dollars

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<v Speaker 2>per person. I mean, it's huge, It employs millions of people.

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<v Speaker 2>It is a massive industry which nobody is excited about.

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<v Speaker 2>Nobody is particularly happy with. I mean, you hear lots

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<v Speaker 2>of complaints. It's super expensive and as a percent of

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<v Speaker 2>GDP seventeen point six is the highest I think in

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<v Speaker 2>a developed goal. I don't know in the world, probably

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<v Speaker 2>in the world as a percent of GDP spending on healthcare,

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<v Speaker 2>and you know, other countries are close that are twelve thirteen, fourteen.

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<v Speaker 2>Nobody even comes close to the seventeen point six. And

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<v Speaker 2>yet the argument is I'm not saying this is true,

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<v Speaker 2>but the argument is that outcomes are not that much better.

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<v Speaker 2>That as life expectancy, the broadest outcome that people measure,

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<v Speaker 2>is lower in the United States than most of the

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<v Speaker 2>developed world. Now that number is cheating. There's a lot

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<v Speaker 2>of cheating going on with numbers generally to make different points.

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<v Speaker 2>Life expectancy in the United States is lower than the

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<v Speaker 2>rest of the world at birth, and that's because of

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<v Speaker 2>two things. Basically, one, it is the case that infant

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<v Speaker 2>mortality mortality of childbirth is higher in the United States

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<v Speaker 2>than the rest of the developing world. But the big

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<v Speaker 2>difference in life expectancy at birth is unrelated to healthcare.

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<v Speaker 2>It's related to drugs, suicide, crime, traffic accidents, which all

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<v Speaker 2>as a percent of the population are very high in

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<v Speaker 2>the United States compared to the rest of the world

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<v Speaker 2>and are actually the things that cause did I say

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<v Speaker 2>rug overdoses, If not, I should have drug overdoses have

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<v Speaker 2>led to decline in life expectance. You should also say

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<v Speaker 2>that a big issue here is obesity, which the United States.

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<v Speaker 2>I mean, the UK is pretty bad, but I think

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<v Speaker 2>the United States is still the most obese country in

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<v Speaker 2>the world. Maybe the UK's was, maybe there are a

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<v Speaker 2>few other places, but generally it's really really bad here.

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<v Speaker 2>So if you take into account all those things that

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<v Speaker 2>have nothing to do with the delivery of healthcare, they're

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<v Speaker 2>the ones that have an impact on life expectancy. Interesting fact,

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<v Speaker 2>life expectancy of Americans who reach seventy years old, So

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<v Speaker 2>life expectancy of people who reach seventy years old higher

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<v Speaker 2>in the United States than anywhere else in the developed world.

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<v Speaker 2>So once you can take out all the other factors

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<v Speaker 2>and just folk us in a sense of healthcare delivery,

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<v Speaker 2>we keep people alive, really really well. People us complaining

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<v Speaker 2>that healthcare in the United States is not universal, not

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<v Speaker 2>everybody has access to it, not everybody can afford it.

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<v Speaker 2>It's because it's so expensive. It's not just expensive kind

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<v Speaker 2>of a national account. It's expensive for individuals and if

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<v Speaker 2>they are people who supposedly can't afford it, and as

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<v Speaker 2>a consequence, you know, it is not universal, and they

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<v Speaker 2>are harvest stories of people who don't get healthcare in

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<v Speaker 2>the United States dying, and if you go outside the

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<v Speaker 2>United States, in the UK and in Europe, everybody believes

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<v Speaker 2>that basically people are dying in the streets on a

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<v Speaker 2>regular basis for lack of healthcare in the United States.

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<v Speaker 2>It's really the amount of mythology that exists in the

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<v Speaker 2>UK and in Europe about the healthcare system in the

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<v Speaker 2>US is astounding. Add to that the fact that people

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<v Speaker 2>get denied health insurance and people upset about that, and

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<v Speaker 2>that again there's a huge mythology out there that many, many,

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<v Speaker 2>many many people in US die or do not get

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<v Speaker 2>treated because they're denied coverage. You know, I got so

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<v Speaker 2>many stories from my debate in Cambridge where the audience

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<v Speaker 2>was like, you know, I would have never got treated

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<v Speaker 2>for this and this in the United States. I was

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<v Speaker 2>born with this disease. Now would have never got treated.

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<v Speaker 2>I was born with this, you know, handicap, and I

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<v Speaker 2>would have never got treated because I couldn't afford it.

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<v Speaker 2>You know, in the in the United States, which is

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<v Speaker 2>mostly ninety nine percent of it is perc It's just

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<v Speaker 2>not true. And then finally, the one big problem that

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<v Speaker 2>exists with god costs, which is real. I mean the

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<v Speaker 2>US in many respects it's expensive. But we'll get to

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<v Speaker 2>whether that's real or not. But the one way which

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<v Speaker 2>it's really expensive and is that basically healthcare costs of

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<v Speaker 2>bankrupting the federal budget. In other words, Medicare and Medicaid

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<v Speaker 2>are unsustainable. Spending on Medicaid and Medicaid is just an unbelievable,

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<v Speaker 2>unbelievably expensive and not sustainable if you look into the future,

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<v Speaker 2>something has to give. Given the amount of revenue the

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<v Speaker 2>United States brings in, it cannot sustain medicaan Medicaid spending

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<v Speaker 2>at the rates that they are. So, you know, so

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<v Speaker 2>we do have we do have an obesity problem, which

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<v Speaker 2>is blamed on the healthcare system. We have a service

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<v Speaker 2>denial problem, which is blamed on what we call health insurance.

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<v Speaker 2>There is a quality of service. Primarily people can plaining

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<v Speaker 2>about the very little time they get to spend with doctors.

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<v Speaker 2>Doctors complain about the very little time they have to

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<v Speaker 2>spend with patients. There's very little, if any preventive care

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<v Speaker 2>or very little of it, and there's very little emphasis

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<v Speaker 2>on it. Physician compensation is actually has declined in real

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<v Speaker 2>terms or being stagnant, and the quality of life in

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<v Speaker 2>terms of the quality of the enjoyment of the profession,

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<v Speaker 2>in terms of time with patient time, solving problems of

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<v Speaker 2>physicians and health care healthcare people in the healthcare system

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<v Speaker 2>is down. The system has no real transparency. We have

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<v Speaker 2>we don't know how things are going to cost. We

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<v Speaker 2>don't know exactly what we're consuming, how much, how much

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<v Speaker 2>we're consuming. There is complete mystery about healthcare costs from

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<v Speaker 2>the consumer's perspective. So all of these are many many

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<v Speaker 2>other things are real costs are real problems in the

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<v Speaker 2>United States, and and people are frustrated and and and

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<v Speaker 2>people upset. They're insurance premiums. They are paid by primarily

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<v Speaker 2>the employers. We'll get to that, but you know, they

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<v Speaker 2>pay an ever growing portion of it, and it's expensive.

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<v Speaker 2>And you know, as we'll see, there all kinds of

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<v Speaker 2>distortions and perversions that are caused because of the system

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<v Speaker 2>the way it's comprised. That just creates uncertain the angst

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<v Speaker 2>and frustration. So what is it about the system as

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<v Speaker 2>his gifts today. What is it about the policy, the

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<v Speaker 2>healthcare policy in the United States as it is today

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<v Speaker 2>that that has caused the system to be as frustrating

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<v Speaker 2>and as upsetting the people as it is as it is.

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<v Speaker 2>So let's let's go over kind of the way the

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<v Speaker 2>healthcare system is structured today and the way this leads

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<v Speaker 2>to these frustrations. So let's I think that we should

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<v Speaker 2>start with kind of the way most of us experience

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<v Speaker 2>the healthcare system, and the way most of us experience

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<v Speaker 2>the healthcare system is through the purchase of insurance. And

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<v Speaker 2>while insurance is not the delivery of healthcare, insurance is

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<v Speaker 2>the way we fund healthcare, and the insurance dictates the

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<v Speaker 2>large extent what kind of healthcare we actually get. So

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<v Speaker 2>we need to step back here and talk about what

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<v Speaker 2>insurance is. Insurance is real. Insurance is something that covers

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<v Speaker 2>you for where unexpect acted and you know, significantly costly events.

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<v Speaker 2>So insurance is a mechanism to protect you from things

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<v Speaker 2>that are unexpected, you know, a known that is there's

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<v Speaker 2>a huge amount of uncertainty around when they will happen,

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<v Speaker 2>if they will happen, and where the cost could be

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<v Speaker 2>very high. So think about it what's the probability your

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<v Speaker 2>house will burn down? It's very low. Do you know

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<v Speaker 2>when it will happen. No, you can't predict when it

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<v Speaker 2>will happen. What are the financial consequences of your house

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<v Speaker 2>bringing down? Pretty catastrophic, it's really bad. It's a lot

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<v Speaker 2>of money. Think about auto insurance. We write our insurance

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<v Speaker 2>not for our regular service. Doesn't cover up kind of

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<v Speaker 2>the three thousand mile or whatever. It doesn't cover oil changes.

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<v Speaker 2>You know, for the most part, it doesn't even cover

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00:20:06.759 --> 00:20:09.839
<v Speaker 2>like little dents and bumps and stuff like that. It

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<v Speaker 2>covers you really for when you have a significant accident,

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<v Speaker 2>and the cost it can be thousands of dollars. Now,

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<v Speaker 2>it's not as expensive as a fire burning down your home.

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<v Speaker 2>The probability is higher that you get into a car

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<v Speaker 2>accident than your home burns down, and it's less expensive,

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<v Speaker 2>but it's still relative to the cost of the car,

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00:20:32.680 --> 00:20:35.680
<v Speaker 2>a lot of money. So you buy insurance to cover that.

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<v Speaker 2>You don't cover the little bumps and the little things,

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<v Speaker 2>and you don't cover maintenance. Life insurance, you don't know

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<v Speaker 2>when you're gonna die. Dying, let's say when you buy

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00:20:53.359 --> 00:20:56.319
<v Speaker 2>life insurance. Typically a good age to buy life insurance

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00:20:56.519 --> 00:20:59.640
<v Speaker 2>is when you start a family and you've got dependence,

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00:20:59.759 --> 00:21:01.240
<v Speaker 2>and I want to make sure that if you drop dead,

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<v Speaker 2>they have some money, and so you want to buy

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00:21:04.559 --> 00:21:06.599
<v Speaker 2>life insurance to cover you from age I don't know,

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00:21:06.640 --> 00:21:10.160
<v Speaker 2>thirty to sixty something like that. Those thirty years is

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00:21:10.319 --> 00:21:12.039
<v Speaker 2>while you've got a family and that dependent on you,

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00:21:12.119 --> 00:21:13.799
<v Speaker 2>and you want to be able to if you die,

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00:21:13.960 --> 00:21:15.680
<v Speaker 2>they get a million dollars or whatever. You want to

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00:21:15.680 --> 00:21:18.240
<v Speaker 2>be able to cover it. You don't know when it's

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00:21:18.240 --> 00:21:21.400
<v Speaker 2>going to happen. What's the probability you die between thirty

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00:21:21.400 --> 00:21:29.160
<v Speaker 2>and sixty pretty low, and it's catastrophic. It's catastrophic. And

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00:21:29.799 --> 00:21:32.519
<v Speaker 2>think about business interruption insurance, Think about all the kinds

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00:21:32.519 --> 00:21:36.720
<v Speaker 2>of business insurance. Think about maritime insurance. The ship, you

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00:21:36.759 --> 00:21:46.480
<v Speaker 2>know sinks, pretty low, probability, uncertainty about it, catastrophic. And

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00:21:46.559 --> 00:21:51.720
<v Speaker 2>yet health insurance doesn't work that way. And it doesn't

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00:21:51.759 --> 00:21:56.880
<v Speaker 2>work that way because it's really not insurance. It's really

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00:21:57.039 --> 00:22:04.279
<v Speaker 2>not insurance. It's a form of risk pooling, it's a

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00:22:04.319 --> 00:22:10.240
<v Speaker 2>form of redistribution of wealth. But we really should not

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00:22:10.359 --> 00:22:13.519
<v Speaker 2>call it insurance. It doesn't have the characteristics of insurance.

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<v Speaker 2>If I have a cold and I go to the doctor.

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<v Speaker 2>You know, that's gonna cost me fifty dollars, maybe one

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00:22:22.599 --> 00:22:24.599
<v Speaker 2>hundred dollars, maybe maybe one hundred and fifty dollars if

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00:22:24.599 --> 00:22:30.200
<v Speaker 2>you have a relatively expensive doctor. It's not catastrophic. It's

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00:22:30.240 --> 00:22:33.160
<v Speaker 2>pretty common to get a cold. I get one once

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00:22:33.200 --> 00:22:36.559
<v Speaker 2>a year, pretty common to get a cold or to

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00:22:36.559 --> 00:22:47.240
<v Speaker 2>get the flu. And yet we cover uh. And you know,

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00:22:47.359 --> 00:22:54.839
<v Speaker 2>if you if you have you know, diabetes and you

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00:22:54.960 --> 00:22:57.720
<v Speaker 2>have to get you know, insulin or you have to

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00:22:57.720 --> 00:23:00.759
<v Speaker 2>get diabetes drugs or whatever. And now it's a constant

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00:23:00.799 --> 00:23:10.480
<v Speaker 2>cost forever, insurance covers it. You know, we cover, we

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00:23:10.519 --> 00:23:15.519
<v Speaker 2>cover things. You know, we cover a relatively minor, relatively

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00:23:15.559 --> 00:23:25.680
<v Speaker 2>low cost recurring expected events with this insurance. So it's

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<v Speaker 2>not And of course we don't even buy the insurance.

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00:23:32.279 --> 00:23:36.000
<v Speaker 2>We might choose if our employer has options, we might

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<v Speaker 2>choose between different health insurance plans, but we're not really

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00:23:42.440 --> 00:23:47.759
<v Speaker 2>buying them. Our employer is buying them, and employers buying them,

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<v Speaker 2>you know, they and you know, they're the ones who

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<v Speaker 2>contract have a contract with the life with the health insurance.

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<v Speaker 2>And one of the one of.

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<v Speaker 1>The issues with these insurance policies is they're not else

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<v Speaker 1>So for example, if you leave a job, you don't

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<v Speaker 1>have insurance anymore, you're not covered.

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<v Speaker 2>I mean, you their laws in place that allow you

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00:24:09.240 --> 00:24:13.160
<v Speaker 2>to continue to get COBRA, and the employer, by law,

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00:24:13.240 --> 00:24:17.319
<v Speaker 2>has to contribute towards that COBRA and COBRA is a

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00:24:17.359 --> 00:24:20.119
<v Speaker 2>continuation of your existing insurance policy for a certain amount

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00:24:20.119 --> 00:24:23.680
<v Speaker 2>of time. But it's not really your insurance policy. It's

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00:24:23.720 --> 00:24:28.119
<v Speaker 2>a it's a it's a the employer has bought it.

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00:24:28.119 --> 00:24:37.000
<v Speaker 2>It covers you, but it's their policy they pay. So

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<v Speaker 2>one of the problems we have is that we don't

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<v Speaker 2>really have insurance. We don't. We call it insurance, but

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00:24:45.759 --> 00:24:50.039
<v Speaker 2>it really isn't insurance. We have a third party system

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00:24:50.519 --> 00:24:57.759
<v Speaker 2>where our employers get us insurance and then we get

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00:24:57.759 --> 00:25:02.880
<v Speaker 2>to consume healthcare and basically bility to the insurance company.

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<v Speaker 2>I mean, this creates all kinds of model houses, It

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00:25:07.279 --> 00:25:12.079
<v Speaker 2>creates over consumption, It creates a system by which we

347
00:25:13.160 --> 00:25:16.000
<v Speaker 2>don't care about the cost of insurance. By the way,

348
00:25:16.039 --> 00:25:18.440
<v Speaker 2>the cost of insurance has nothing to do with your health.

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<v Speaker 2>The other thing about insurance is we've talked about this

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<v Speaker 2>in the past. In fire insurance, the insurance company determines

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<v Speaker 2>the premium based on, for example, how likely it is

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<v Speaker 2>that there will be a fire in your area that

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<v Speaker 2>your house will be caught up into. So some areas

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<v Speaker 2>in California that are very very very very high a

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00:25:39.279 --> 00:25:42.079
<v Speaker 2>fire insurance because the likelihood of a fire is relatively high.

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<v Speaker 2>Other places really cheap because the likelihood of a fire

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00:25:45.680 --> 00:25:49.680
<v Speaker 2>reaching you is very low. Same with flood insurance or

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00:25:49.680 --> 00:25:52.839
<v Speaker 2>the flood insurance and earthquake insurance very distorted markets, but

359
00:25:53.519 --> 00:25:58.519
<v Speaker 2>when they functioned where you were, the risk that you

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00:25:58.559 --> 00:26:02.680
<v Speaker 2>would the risk that you are susceptible to this catastrophe

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00:26:03.079 --> 00:26:07.759
<v Speaker 2>is taking into acount in your premium. Health insurance companies

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00:26:07.920 --> 00:26:13.000
<v Speaker 2>don't assess the risk of you receiving a disease. For example,

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00:26:14.160 --> 00:26:17.039
<v Speaker 2>you and your coworker, you might be at the same age,

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00:26:17.519 --> 00:26:19.319
<v Speaker 2>but he might be, I don't know, one hundred pounds

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00:26:19.359 --> 00:26:22.160
<v Speaker 2>heavier than you. Now the fact that he's one hundred

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00:26:22.200 --> 00:26:27.240
<v Speaker 2>pounds heavier than you makes him susceptible to diabetes. Diabetes

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00:26:27.279 --> 00:26:30.880
<v Speaker 2>makes them susceptible to heart disease, which you know, and

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00:26:31.839 --> 00:26:37.359
<v Speaker 2>even cancer. It makes them susceptible to potentially all time

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<v Speaker 2>is at a young age insurance company, they don't care.

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00:26:43.039 --> 00:26:45.559
<v Speaker 2>I mean maybe they care, but the system is not

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<v Speaker 2>structured to take that into acount. None of that is relevant. Indeed,

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<v Speaker 2>it's illegal for them to take any of that into account.

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<v Speaker 2>You might have a gene that makes you most susceptible

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00:27:00.119 --> 00:27:05.599
<v Speaker 2>to certain cancers. They can't take that into account. So

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00:27:05.640 --> 00:27:11.799
<v Speaker 2>they're pricing off of a pool where they're basically estimating

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00:27:12.960 --> 00:27:16.480
<v Speaker 2>the relatively ages of the people in that pool. But

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00:27:16.519 --> 00:27:19.160
<v Speaker 2>that's really the only in sex. Age and sex are

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00:27:19.160 --> 00:27:22.519
<v Speaker 2>the only parameters they can play with, and they figure

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00:27:22.559 --> 00:27:25.759
<v Speaker 2>some out, be some or not, and they come up

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00:27:25.759 --> 00:27:28.480
<v Speaker 2>with an average price, and then everybody pays basically. You know,

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00:27:28.559 --> 00:27:31.400
<v Speaker 2>I think there's an age adjustment, but everybody pays a

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00:27:31.480 --> 00:27:36.880
<v Speaker 2>price based on your age, and that's it. So again,

383
00:27:37.039 --> 00:27:41.359
<v Speaker 2>non insurance. What we have today in the United States

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00:27:41.440 --> 00:27:45.119
<v Speaker 2>is a mechanism by which we redistribute wealth, We distribute

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00:27:45.960 --> 00:27:50.599
<v Speaker 2>health expenditures from healthy to sick, from young to old.

386
00:27:52.240 --> 00:27:54.079
<v Speaker 2>But don't call it insurance. I mean, we call it

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00:27:54.200 --> 00:27:56.880
<v Speaker 2>insurance because that's every that's what everybody calls it, and

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00:27:56.880 --> 00:28:02.400
<v Speaker 2>it's the way it's called. But it is not insurance,

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00:28:02.680 --> 00:28:07.319
<v Speaker 2>not by any financial measure of it. It is a

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00:28:07.359 --> 00:28:13.880
<v Speaker 2>polling of risk. It's a pulling of risk without you know,

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00:28:15.119 --> 00:28:19.200
<v Speaker 2>to some extent, a blind pool of risk. And by

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00:28:19.240 --> 00:28:23.119
<v Speaker 2>the way, so now why do we do that? Well,

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00:28:24.880 --> 00:28:26.720
<v Speaker 2>I don't want to get into the entire history of it,

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00:28:26.839 --> 00:28:33.279
<v Speaker 2>but the basic idea is that employers versus employees. Employers

395
00:28:33.319 --> 00:28:37.000
<v Speaker 2>have an advantage in buying health insurance. If an employer

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00:28:37.200 --> 00:28:41.599
<v Speaker 2>buys health insurance, the health insurance premiums are tax deductible.

397
00:28:43.519 --> 00:28:47.000
<v Speaker 2>If you, as an individual buy health insurance, your health

398
00:28:47.039 --> 00:28:54.039
<v Speaker 2>insurance premiums are not tax deductible. So you have a

399
00:28:54.119 --> 00:28:58.880
<v Speaker 2>huge advantage in letting the employer buy the health insurance

400
00:28:58.920 --> 00:29:01.880
<v Speaker 2>for you because they do it with pre tax dollars

401
00:29:02.279 --> 00:29:04.160
<v Speaker 2>and if you did it, you would be doing it

402
00:29:04.200 --> 00:29:14.839
<v Speaker 2>with after tax dollars. So again that provides a massive

403
00:29:15.319 --> 00:29:20.440
<v Speaker 2>incentive for employers to buy the health insurance. And a

404
00:29:20.440 --> 00:29:22.880
<v Speaker 2>lot of employees don't even buy insurance. They have insurance

405
00:29:22.920 --> 00:29:26.720
<v Speaker 2>companies administer what they call insurance, and they're really in

406
00:29:26.759 --> 00:29:31.039
<v Speaker 2>a sense self insuring. They're creating reserves, financial reserves, and

407
00:29:31.119 --> 00:29:33.440
<v Speaker 2>it's their money that is paying out. It's not the

408
00:29:33.480 --> 00:29:40.160
<v Speaker 2>insurance company that pays the money out for your healthcare,

409
00:29:40.319 --> 00:29:46.640
<v Speaker 2>but the company that the company does. So the fact

410
00:29:46.640 --> 00:29:51.039
<v Speaker 2>that we have an employer based system. The fact that

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00:29:51.079 --> 00:29:56.920
<v Speaker 2>our system, by regulation is not an insurance system but

412
00:29:58.000 --> 00:30:04.720
<v Speaker 2>a pooling of risk jumiative system is at the core,

413
00:30:05.279 --> 00:30:08.599
<v Speaker 2>I'd say, one of the two cores of really all

414
00:30:08.640 --> 00:30:13.640
<v Speaker 2>the problems that we have today in healthcare. The other

415
00:30:14.160 --> 00:30:21.240
<v Speaker 2>the other is the about fifty percent, actually it's over

416
00:30:21.319 --> 00:30:30.079
<v Speaker 2>fifty percent of all healthcare expenditures are spent by the government.

417
00:30:32.240 --> 00:30:36.160
<v Speaker 2>Basically the government covers through its so called insurance policies,

418
00:30:36.240 --> 00:30:39.960
<v Speaker 2>right Medicare and Medicaid. The government covers one hundred and

419
00:30:39.960 --> 00:30:43.160
<v Speaker 2>fifty million Americans. I mean, people say, you don't have

420
00:30:43.200 --> 00:30:45.759
<v Speaker 2>a single payer healthcare system, or one hundred and fifty

421
00:30:45.759 --> 00:30:49.880
<v Speaker 2>million Americans have a government healthcare system. That's about ninety

422
00:30:49.960 --> 00:30:52.680
<v Speaker 2>million people. Ninety I didn't realize the numbers this week.

423
00:30:53.160 --> 00:30:58.559
<v Speaker 2>Ninety million people are on Medicaid. Sorry, yes, Medicaid that

424
00:30:58.799 --> 00:31:03.279
<v Speaker 2>is healthcare for people who cannot afford insurance. This is

425
00:31:03.319 --> 00:31:07.279
<v Speaker 2>supposed to healthcare for the poor. That includes CHIP, which

426
00:31:07.400 --> 00:31:11.640
<v Speaker 2>is the healthcare for children whose parents cannot afford to

427
00:31:11.759 --> 00:31:18.720
<v Speaker 2>buy insurance. And so that's ninety million and sixty something million.

428
00:31:18.759 --> 00:31:21.720
<v Speaker 2>So it's over one hundred and fifty million, sixty something

429
00:31:21.799 --> 00:31:26.799
<v Speaker 2>million people on Medicare, which is basically everybody over the

430
00:31:26.839 --> 00:31:29.519
<v Speaker 2>age of sixty five, no matter whether you can afford

431
00:31:29.559 --> 00:31:33.039
<v Speaker 2>it or not, everybody over sixty five gets Medicare, and

432
00:31:33.519 --> 00:31:37.759
<v Speaker 2>that number will grow to over seventy million by twenty

433
00:31:37.839 --> 00:31:38.279
<v Speaker 2>thirty two.

434
00:31:39.599 --> 00:31:40.920
<v Speaker 1>So we have a.

435
00:31:42.920 --> 00:31:52.880
<v Speaker 2>Government run healthcare system that basically provides healthcare funding for

436
00:31:52.920 --> 00:31:55.359
<v Speaker 2>one hundred and fifty million Americans out of three hundred

437
00:31:55.359 --> 00:31:58.599
<v Speaker 2>and fifty million. So it's a big chunk. It's not

438
00:31:58.759 --> 00:32:02.079
<v Speaker 2>quite half, but it's forty percent thirty five. Forty percent

439
00:32:03.119 --> 00:32:07.920
<v Speaker 2>is all government and fifty percent of expenditures because when

440
00:32:08.000 --> 00:32:12.680
<v Speaker 2>you spend the most on healthcare when you're old, that's

441
00:32:12.720 --> 00:32:16.240
<v Speaker 2>all covered by government, all covered by government, all covered

442
00:32:16.279 --> 00:32:26.440
<v Speaker 2>by government, right because Medicare pays for sixty five and over.

443
00:32:26.680 --> 00:32:29.240
<v Speaker 2>So you have a situation where fifty cents of every

444
00:32:29.279 --> 00:32:32.559
<v Speaker 2>dollar spent on healthcare, actually more than fifty cents is

445
00:32:32.720 --> 00:32:37.559
<v Speaker 2>covered is government spenditure. So we don't have a private system.

446
00:32:38.920 --> 00:32:43.599
<v Speaker 2>We have a pseudo insurance that's non insurance system, and

447
00:32:43.759 --> 00:32:49.279
<v Speaker 2>we have a government system. Those are the two alternatives,

448
00:32:49.359 --> 00:32:58.599
<v Speaker 2>and the government system dictates a lot because it's it's massive.

449
00:33:00.200 --> 00:33:04.960
<v Speaker 2>So let's take Medicare. Medicare represents sixty something sixty let's

450
00:33:04.960 --> 00:33:09.200
<v Speaker 2>say sixty two million people, all eight sixty five huge

451
00:33:09.319 --> 00:33:16.039
<v Speaker 2>consumers of healthcare, and they're all getting hiperplacements and bipus

452
00:33:16.240 --> 00:33:23.799
<v Speaker 2>surgeries and cancer treatment. Right, And so when doctors and

453
00:33:23.920 --> 00:33:29.119
<v Speaker 2>hospitals a billion for all those treatments, they are facing

454
00:33:29.680 --> 00:33:35.960
<v Speaker 2>this kind of monopoly. There's only one entity representing people

455
00:33:36.000 --> 00:33:40.920
<v Speaker 2>over sixty five. And so who has the pricing power

456
00:33:41.039 --> 00:33:44.920
<v Speaker 2>in that relationship, Well, clearly the government does. So the

457
00:33:45.000 --> 00:33:49.359
<v Speaker 2>government can dictate prices. The government can drive prices down

458
00:33:49.599 --> 00:33:54.839
<v Speaker 2>on some things. And by driving prices down, for example,

459
00:33:55.880 --> 00:33:59.000
<v Speaker 2>you know, doctors get very little money from Medicare for

460
00:34:00.200 --> 00:34:03.720
<v Speaker 2>complicated procedures. It's sometimes hard to believe how little money

461
00:34:03.759 --> 00:34:14.280
<v Speaker 2>they get per procedure from Medicare. And hospitals have to

462
00:34:14.360 --> 00:34:22.280
<v Speaker 2>negotiate with Medicare, and Medicare drives prices down. And now

463
00:34:23.119 --> 00:34:25.719
<v Speaker 2>hospitals and doctors and everybody else still have to make

464
00:34:25.719 --> 00:34:29.280
<v Speaker 2>a living. They still have to make a profit. And

465
00:34:29.360 --> 00:34:31.480
<v Speaker 2>there's a sense in which they make the profit off

466
00:34:31.519 --> 00:34:34.920
<v Speaker 2>of driving up the price for private health private insurance.

467
00:34:35.360 --> 00:34:39.480
<v Speaker 2>For the insurance it's outside the Medicare system. So you

468
00:34:39.599 --> 00:34:47.960
<v Speaker 2>get a system in which the private so called insurance

469
00:34:49.079 --> 00:34:55.360
<v Speaker 2>is subsidizing Medicare and Medicaid. And of course one of

470
00:34:55.400 --> 00:34:59.239
<v Speaker 2>the big controversies right now is should Medicare and Medicaid

471
00:34:59.280 --> 00:35:03.440
<v Speaker 2>be able to gootiate drug prices, because if they can

472
00:35:03.480 --> 00:35:08.559
<v Speaker 2>negotiate drug prices, they can lower drug prices dramatically, like

473
00:35:08.880 --> 00:35:14.079
<v Speaker 2>European countries have and like Canadian system has by basically,

474
00:35:14.639 --> 00:35:19.039
<v Speaker 2>you know, being the dominant buyer of a drug in

475
00:35:19.119 --> 00:35:23.400
<v Speaker 2>the economy. And if they can drive down prices dramatically,

476
00:35:24.320 --> 00:35:32.199
<v Speaker 2>either drug companies now you know they they their profitability plummets.

477
00:35:32.920 --> 00:35:37.360
<v Speaker 2>They which reduces their availability of capital for them, which

478
00:35:37.480 --> 00:35:39.519
<v Speaker 2>is useless, R and D and all the other consequences

479
00:35:39.840 --> 00:35:46.000
<v Speaker 2>or drug sales to private individuals through their so called

480
00:35:46.000 --> 00:35:50.800
<v Speaker 2>the insurance policies have to go up. Something has to give, right,

481
00:35:50.880 --> 00:35:53.239
<v Speaker 2>the money has to come from somewhere. And if the

482
00:35:53.280 --> 00:35:56.960
<v Speaker 2>government's going to squeeze drug companies as so many people

483
00:35:57.039 --> 00:35:59.840
<v Speaker 2>want it, Bide administration has already started the process to

484
00:36:00.000 --> 00:36:03.079
<v Speaker 2>woulds that, and Trump is indicated he would like to continue,

485
00:36:04.880 --> 00:36:09.000
<v Speaker 2>then you know drug drug companies are going to be

486
00:36:09.239 --> 00:36:12.000
<v Speaker 2>profitability is going to be squeezed completely and given the

487
00:36:12.079 --> 00:36:16.920
<v Speaker 2>cost of drugs and and and the length of development

488
00:36:17.039 --> 00:36:23.639
<v Speaker 2>and expense of developing them. What happens then, what happens then.

489
00:36:25.880 --> 00:36:30.039
<v Speaker 2>So the fact that the government is such a big

490
00:36:30.199 --> 00:36:36.559
<v Speaker 2>buyer of healthcare services is a major, major, major problem

491
00:36:37.320 --> 00:36:47.840
<v Speaker 2>which UH basically distorts distorts the pricing, UH, the pricing

492
00:36:47.880 --> 00:36:52.840
<v Speaker 2>of healthcare in the United States. As a consequence of that,

493
00:36:53.000 --> 00:36:58.559
<v Speaker 2>what you see is massive cost subsidization, healthy subsidizing the sick.

494
00:36:58.639 --> 00:37:02.280
<v Speaker 2>We talked about that. The subsidizing the old, We've talked

495
00:37:02.280 --> 00:37:07.400
<v Speaker 2>about that again. We're all subsidizing the Medicaid, Medicaid that

496
00:37:07.519 --> 00:37:09.920
<v Speaker 2>the old get after sixty five, those of us who

497
00:37:09.920 --> 00:37:12.880
<v Speaker 2>are not yet sixty five. I'm not quite there. I'm

498
00:37:12.960 --> 00:37:18.480
<v Speaker 2>almost there. And insurance companies or the so called insurance framework,

499
00:37:18.639 --> 00:37:20.599
<v Speaker 2>it's not the companies, it's the people who pay the

500
00:37:20.679 --> 00:37:26.320
<v Speaker 2>insurance of subsidizing government programs, huge amount of cost oftization,

501
00:37:26.880 --> 00:37:29.000
<v Speaker 2>and it's really hard to keep track of it. I mean,

502
00:37:29.039 --> 00:37:31.039
<v Speaker 2>I don't think I don't know that anybody has in

503
00:37:31.199 --> 00:37:34.119
<v Speaker 2>terms of the actual numbers, but keeping track of it

504
00:37:34.239 --> 00:37:36.440
<v Speaker 2>is almost impossible because it's going on all the time,

505
00:37:36.840 --> 00:37:43.079
<v Speaker 2>and it's super complex. Now, top all of that off

506
00:37:44.039 --> 00:37:50.840
<v Speaker 2>with the fact that healthcare is heavily, heavily regulated. So

507
00:37:51.039 --> 00:37:55.440
<v Speaker 2>these pseudo insurance policies, what they offer, how they offer

508
00:37:56.079 --> 00:37:59.599
<v Speaker 2>is unbelievably regulated. What you can and cannot offer, what

509
00:38:00.159 --> 00:38:04.400
<v Speaker 2>the policies, the kind of deductibles, the kind of coverages.

510
00:38:05.119 --> 00:38:08.320
<v Speaker 2>Now most of that regulation, not all of it, but

511
00:38:08.440 --> 00:38:10.360
<v Speaker 2>most of that regulation is not at the state level.

512
00:38:10.840 --> 00:38:14.760
<v Speaker 2>But that means they're fifty different types of regulation. It

513
00:38:14.880 --> 00:38:19.039
<v Speaker 2>also means that because of that, if I live in California,

514
00:38:19.719 --> 00:38:23.559
<v Speaker 2>I cannot buy a health insurance policy from Nevada. I

515
00:38:23.639 --> 00:38:27.440
<v Speaker 2>can only buy it in California because health insurance is

516
00:38:27.639 --> 00:38:32.159
<v Speaker 2>regulated at the state level, and you cannot buy across

517
00:38:32.199 --> 00:38:40.400
<v Speaker 2>state lines health insurance, so there's no real competition. So

518
00:38:40.480 --> 00:38:43.559
<v Speaker 2>it's heavily regulate the insurance level. I mean every aspect

519
00:38:44.159 --> 00:38:45.880
<v Speaker 2>of what you can buy. I mean, if you look

520
00:38:45.880 --> 00:38:51.559
<v Speaker 2>at the Obamacare exchanges, the policies all look very similar,

521
00:38:53.119 --> 00:38:55.880
<v Speaker 2>and they look very similar because there's only a range

522
00:38:56.840 --> 00:38:59.960
<v Speaker 2>in which they can play around. They have to cover

523
00:39:00.719 --> 00:39:05.159
<v Speaker 2>I don't know, psychological care, they have to cover pregnancy,

524
00:39:05.239 --> 00:39:08.519
<v Speaker 2>they have to cover all kinds of things. In California,

525
00:39:08.719 --> 00:39:12.320
<v Speaker 2>alternative healthcare like acupuncture has to be covered. All kinds

526
00:39:12.320 --> 00:39:16.519
<v Speaker 2>of stuff like that, and then the actables cannot be

527
00:39:16.599 --> 00:39:21.000
<v Speaker 2>too high. You cannot get catastrophic health insurance. It's very

528
00:39:21.039 --> 00:39:23.599
<v Speaker 2>difficult to find a state where you can actually just

529
00:39:23.719 --> 00:39:28.760
<v Speaker 2>buy catastrophic health insurance. We'll get to that. That's insurance.

530
00:39:29.239 --> 00:39:34.920
<v Speaker 2>But then everything about the delivery of healthcare is regulated. Hospitals,

531
00:39:36.920 --> 00:39:41.679
<v Speaker 2>massive regulations on hospitals. We saw that during COVID. And

532
00:39:42.400 --> 00:39:45.920
<v Speaker 2>isn't it interesting that given the failure during COVID, the

533
00:39:47.599 --> 00:39:53.400
<v Speaker 2>you know, the lack of capacity, the lack of communication,

534
00:39:53.760 --> 00:39:57.559
<v Speaker 2>the bad policies coming down from government visa v. COVID,

535
00:39:58.159 --> 00:40:02.400
<v Speaker 2>that healthcare there was really no reform. There's really no

536
00:40:03.360 --> 00:40:06.320
<v Speaker 2>lessons learned, not just about how to deal with the pandemic,

537
00:40:06.400 --> 00:40:09.000
<v Speaker 2>but maybe there's something in our healthcare system that is

538
00:40:09.119 --> 00:40:11.920
<v Speaker 2>not working right. For example, you remember there were hospital

539
00:40:11.960 --> 00:40:14.639
<v Speaker 2>bed shortages. Why is that, Well, it turns out the

540
00:40:15.039 --> 00:40:18.320
<v Speaker 2>state governments regulate how many beds you can have in

541
00:40:18.400 --> 00:40:20.760
<v Speaker 2>the hospital, and if you want to expand, you have

542
00:40:20.840 --> 00:40:24.880
<v Speaker 2>to get permissioned because they're looking at something about competition

543
00:40:25.079 --> 00:40:28.519
<v Speaker 2>within a particular band. In the nineteen fifties, there was

544
00:40:28.519 --> 00:40:32.679
<v Speaker 2>passed a law that said that within every certain radius

545
00:40:32.719 --> 00:40:35.039
<v Speaker 2>there has to be a hospital. So lots and lots

546
00:40:35.039 --> 00:40:37.559
<v Speaker 2>of hospital were built. Some of that has gone away,

547
00:40:38.000 --> 00:40:43.559
<v Speaker 2>but again, you know where hospitals are, how many beds

548
00:40:43.599 --> 00:40:46.440
<v Speaker 2>they have, what kind of services, for example, emergency services

549
00:40:46.480 --> 00:40:49.920
<v Speaker 2>are not they can provide, all regulated, all controlled by government,

550
00:40:51.239 --> 00:40:54.199
<v Speaker 2>heavily heavily regulated. And of course what the government, what

551
00:40:54.519 --> 00:40:57.159
<v Speaker 2>a doctor can prescribe you, what kind of drugs are available,

552
00:40:57.320 --> 00:41:02.320
<v Speaker 2>the whole issue of drugs, whole issue drugs massively regulated,

553
00:41:02.400 --> 00:41:09.239
<v Speaker 2>massively controlled by government, the FDA, and the whole process

554
00:41:09.320 --> 00:41:11.760
<v Speaker 2>of getting drugs to you. The whole reason it's so

555
00:41:11.840 --> 00:41:14.639
<v Speaker 2>expensive and it takes so long is because of the

556
00:41:14.760 --> 00:41:21.199
<v Speaker 2>extent of regulations. And then finally, well not finally, because

557
00:41:21.199 --> 00:41:22.760
<v Speaker 2>I think there's a lot more than I'm not even

558
00:41:22.800 --> 00:41:26.679
<v Speaker 2>getting to. But there's the supply of medical staff is regulated,

559
00:41:27.519 --> 00:41:33.440
<v Speaker 2>is controlled, doctors, nurses, people who working in hospitals. Licensing

560
00:41:33.559 --> 00:41:38.039
<v Speaker 2>laws very across states but are pretty stringent. They are

561
00:41:38.440 --> 00:41:42.320
<v Speaker 2>restricted restrictions and funding for medical schools that can increase

562
00:41:42.360 --> 00:41:44.320
<v Speaker 2>the number of doctors or decrease the number of doctors,

563
00:41:44.400 --> 00:41:48.039
<v Speaker 2>depending on decisions that are made in terms of funding

564
00:41:48.119 --> 00:41:53.280
<v Speaker 2>medical schools. And then there's immigration, the fact that doctors

565
00:41:53.320 --> 00:41:55.519
<v Speaker 2>who are highly qualified, who are being trained in the

566
00:41:55.559 --> 00:41:58.880
<v Speaker 2>best universities in the world outside the United States and

567
00:42:00.119 --> 00:42:04.079
<v Speaker 2>licensed in those other countries, and not a lot of

568
00:42:04.119 --> 00:42:06.360
<v Speaker 2>work in the United States and cannot get immigration visas.

569
00:42:06.360 --> 00:42:08.840
<v Speaker 2>So it's very difficult to get immigration visas to come

570
00:42:08.880 --> 00:42:11.079
<v Speaker 2>to the US to work here on a permanent basis.

571
00:42:14.079 --> 00:42:21.239
<v Speaker 2>So we've got a a financing system that is completely

572
00:42:21.400 --> 00:42:26.000
<v Speaker 2>messed up because it's not real insurance, and it creates

573
00:42:26.280 --> 00:42:32.039
<v Speaker 2>mal hazard, which means over consumption. It creates distortions of

574
00:42:32.239 --> 00:42:37.239
<v Speaker 2>pricing where we as consumers don't know and don't care

575
00:42:37.960 --> 00:42:42.519
<v Speaker 2>how much any procedure costs. We just don't care, as

576
00:42:42.599 --> 00:42:46.400
<v Speaker 2>compared for example, to lask which is not covered by insurance,

577
00:42:46.800 --> 00:42:50.760
<v Speaker 2>where we do care how much it costs and you know,

578
00:42:51.960 --> 00:42:55.719
<v Speaker 2>or what is the other one, and prices have come down,

579
00:42:55.800 --> 00:42:59.599
<v Speaker 2>by the way, and plastic surgery, which is not typically

580
00:42:59.639 --> 00:43:03.800
<v Speaker 2>covered with insurance and where prices of us come down.

581
00:43:04.440 --> 00:43:08.480
<v Speaker 2>And there's massive innovation in both LASY or health eye health,

582
00:43:08.639 --> 00:43:14.440
<v Speaker 2>different different aspects of improving I say, massive improvements dropping costs,

583
00:43:15.239 --> 00:43:19.480
<v Speaker 2>and certainly that's true of plastic surgery. Lots of options,

584
00:43:20.199 --> 00:43:26.679
<v Speaker 2>real competition, and we as consumers get to decide what

585
00:43:26.880 --> 00:43:30.199
<v Speaker 2>to do, who to do it with, and so on.

586
00:43:33.119 --> 00:43:37.000
<v Speaker 2>All right, so I've laid out kind of the system

587
00:43:37.039 --> 00:43:39.559
<v Speaker 2>the way it is now. This is not this is

588
00:43:39.719 --> 00:43:41.679
<v Speaker 2>just a fraction of it. Right. We haven't got into,

589
00:43:44.800 --> 00:43:49.920
<v Speaker 2>you know, how drugs are delivered through. Uh these you

590
00:43:50.000 --> 00:43:54.159
<v Speaker 2>know entities that sit between pharma and your pharmaceutical and

591
00:43:54.320 --> 00:44:01.199
<v Speaker 2>your pharmacy. I just forgot the acronym just slipped out

592
00:44:01.239 --> 00:44:06.280
<v Speaker 2>of my mind, right, pb PBS's maybe anyway, and they

593
00:44:06.360 --> 00:44:08.079
<v Speaker 2>sit in between. I think most of them our owned

594
00:44:08.119 --> 00:44:10.920
<v Speaker 2>now by insurance companies. I think one may be owned

595
00:44:10.920 --> 00:44:14.760
<v Speaker 2>by one of the pharmacies. But these entities that are

596
00:44:14.800 --> 00:44:19.079
<v Speaker 2>supposed to make things more efficient but have created massive

597
00:44:19.159 --> 00:44:24.800
<v Speaker 2>complexity within the drug delivery and drug pricing. You know,

598
00:44:24.920 --> 00:44:28.360
<v Speaker 2>we haven't talked about, you know, all the other ways

599
00:44:28.519 --> 00:44:33.440
<v Speaker 2>in which regulations drive and drive all kinds of distortions

600
00:44:33.480 --> 00:44:37.480
<v Speaker 2>and perversions within the healthcare system. Pharmacy benefits managers p

601
00:44:38.199 --> 00:44:45.440
<v Speaker 2>b MS not pb SspB MS, thank you. The complexity

602
00:44:45.519 --> 00:44:48.360
<v Speaker 2>is massive. Now, a free market would be pretty complex.

603
00:44:48.599 --> 00:44:51.880
<v Speaker 2>We'd have actually more options, but it would be simpler

604
00:44:52.239 --> 00:44:57.320
<v Speaker 2>for you as a consumer. All Right, what should be

605
00:44:57.519 --> 00:45:01.480
<v Speaker 2>a goal in reforming a healthcare system. We want a

606
00:45:01.519 --> 00:45:06.559
<v Speaker 2>system that provides consumers with choices regarding treatment and cost,

607
00:45:07.320 --> 00:45:12.239
<v Speaker 2>that maximizes individual health outcomes and avoids both personal and

608
00:45:12.679 --> 00:45:18.960
<v Speaker 2>government bankruptcy. Right, So, healthcare system that provides consumers consumers

609
00:45:19.000 --> 00:45:23.559
<v Speaker 2>of health care with choices regarding treatment and cost, maximizes

610
00:45:23.599 --> 00:45:27.719
<v Speaker 2>individual health outcome and avoids what personal government bankruptcy. And

611
00:45:28.119 --> 00:45:33.920
<v Speaker 2>add to this, maximizes the freedom of doctors to exercise

612
00:45:34.000 --> 00:45:38.840
<v Speaker 2>their profession based on their judgment. And that's something we

613
00:45:38.920 --> 00:45:41.280
<v Speaker 2>also haven't talked that much about the fact that so

614
00:45:41.440 --> 00:45:44.000
<v Speaker 2>much of the system, so much of what doctors are

615
00:45:44.119 --> 00:45:47.320
<v Speaker 2>left doing in what is covered and what is not covered,

616
00:45:47.320 --> 00:45:49.800
<v Speaker 2>and what is permitted and was not permitted and soon

617
00:45:50.000 --> 00:45:53.639
<v Speaker 2>is dictated by Medicare and Medicaid and be insurance companies,

618
00:45:54.119 --> 00:45:57.599
<v Speaker 2>and so much of that is just it's much easier

619
00:45:57.760 --> 00:46:02.400
<v Speaker 2>just to regimen in certain convey mentional medical treatments and

620
00:46:02.760 --> 00:46:07.480
<v Speaker 2>and and be be conservative about, you know, not trying

621
00:46:07.519 --> 00:46:13.800
<v Speaker 2>new stuff, not being radical in in in how one

622
00:46:16.679 --> 00:46:21.360
<v Speaker 2>delivers services, because we've got a particular way in which

623
00:46:21.440 --> 00:46:25.000
<v Speaker 2>this is financed. So for example, the pter T model

624
00:46:26.559 --> 00:46:29.119
<v Speaker 2>where you're not really paying him like you do a

625
00:46:29.159 --> 00:46:33.199
<v Speaker 2>part you pay him a retainer if you will, or

626
00:46:33.239 --> 00:46:37.960
<v Speaker 2>the concierge doctor model is not covered by these insurance policies.

627
00:46:39.599 --> 00:46:42.519
<v Speaker 2>Most of us pay insurance, and then we have these

628
00:46:42.599 --> 00:46:44.519
<v Speaker 2>concierge doctors that we have to pay out of pocket.

629
00:46:45.000 --> 00:46:49.559
<v Speaker 2>It's double the money. You know, you're, you're, It's just

630
00:46:49.760 --> 00:46:55.719
<v Speaker 2>it's just overly cumbersome, overly complex, and way overly expensive.

631
00:46:57.960 --> 00:47:02.519
<v Speaker 2>I have so many would done dincies in the healthcare

632
00:47:03.280 --> 00:47:06.639
<v Speaker 2>coverage that I have. It is ridiculous because I have

633
00:47:06.719 --> 00:47:10.000
<v Speaker 2>concierge doctors. You know, I have a very expensive health

634
00:47:10.039 --> 00:47:15.199
<v Speaker 2>insurance policy because because anyway, I have a very experienceive

635
00:47:15.199 --> 00:47:19.800
<v Speaker 2>of health insurance policy and I pay out of pocket

636
00:47:19.880 --> 00:47:21.880
<v Speaker 2>for a lot of things. And yet I have this

637
00:47:21.960 --> 00:47:24.920
<v Speaker 2>expensive insurance policy that just doesn't cover all the things

638
00:47:24.960 --> 00:47:32.159
<v Speaker 2>that I value and that I pay out of pocket. So,

639
00:47:32.840 --> 00:47:34.320
<v Speaker 2>you know, this is the health care system we have.

640
00:47:34.400 --> 00:47:38.079
<v Speaker 2>Why do we have it? Why is the healthcare system

641
00:47:38.119 --> 00:47:41.599
<v Speaker 2>the way it is? Why is goverment so immersed in healthcare?

642
00:47:42.159 --> 00:47:47.440
<v Speaker 2>And why have we taken decisions away from individuals? Now,

643
00:47:48.000 --> 00:47:50.440
<v Speaker 2>you can take an historical perspective on this and see

644
00:47:50.480 --> 00:47:52.840
<v Speaker 2>all the different points in which this was created by

645
00:47:53.159 --> 00:47:56.719
<v Speaker 2>many can't MEDICAI a relatively new in the nineteen sixties. Somehow,

646
00:47:56.800 --> 00:47:59.159
<v Speaker 2>old people and poor people survived in the health care

647
00:47:59.199 --> 00:48:02.960
<v Speaker 2>system up until the nineteen sixties, yet Medicare and Medicaid

648
00:48:03.320 --> 00:48:09.639
<v Speaker 2>were instituted. You know, the whole idea of employer based

649
00:48:09.679 --> 00:48:14.039
<v Speaker 2>healthcare was a way was introduced during the World War

650
00:48:14.119 --> 00:48:17.400
<v Speaker 2>Two as a way for companies who faced price controls

651
00:48:17.440 --> 00:48:22.920
<v Speaker 2>over wages increase benefits to their employees as a way

652
00:48:22.920 --> 00:48:25.360
<v Speaker 2>of giving them a raise. They weren't allowed to give

653
00:48:25.360 --> 00:48:27.840
<v Speaker 2>them an actual raise, so they gave them an added

654
00:48:27.880 --> 00:48:32.119
<v Speaker 2>benefits and then that was institutionalized in the nineteen fifties

655
00:48:32.599 --> 00:48:36.880
<v Speaker 2>early fifties by giving them attacks deduction on that benefit.

656
00:48:36.960 --> 00:48:41.039
<v Speaker 2>But just imagine if during World War Two we didn't

657
00:48:41.079 --> 00:48:43.320
<v Speaker 2>have a cap on wages, we didn't have price control

658
00:48:43.360 --> 00:48:47.679
<v Speaker 2>on wages, then we wouldn't have maybe the insurer based

659
00:48:47.880 --> 00:48:51.519
<v Speaker 2>the employer based so called insurance system that we have today.

660
00:48:51.559 --> 00:48:57.000
<v Speaker 2>So a lot of this happens incrementally, slowly, it builds,

661
00:48:57.119 --> 00:49:01.480
<v Speaker 2>and then as we know, every government's invention creates problems

662
00:49:01.519 --> 00:49:04.679
<v Speaker 2>that then lead to more govermnent intervention that creates problem

663
00:49:04.719 --> 00:49:06.360
<v Speaker 2>to the least, the more goverment intervention, and we get

664
00:49:06.400 --> 00:49:08.800
<v Speaker 2>this stacking on top one on top of the other.

665
00:49:09.159 --> 00:49:11.079
<v Speaker 2>You see this with Medicare and the Medicare pod D.

666
00:49:11.239 --> 00:49:15.920
<v Speaker 2>You see this with healthcare, and all the regulations are

667
00:49:16.079 --> 00:49:19.320
<v Speaker 2>like this. I have great examples on this from finance.

668
00:49:20.199 --> 00:49:24.639
<v Speaker 2>But it's the same is true in healthcare. But what

669
00:49:24.840 --> 00:49:28.760
<v Speaker 2>is excuse given for why the government plays such a

670
00:49:28.800 --> 00:49:34.159
<v Speaker 2>big role in healthcare? Why it basically covers the expenses

671
00:49:34.159 --> 00:49:38.960
<v Speaker 2>of one hundred and fifty million Americans, Why it's you know,

672
00:49:39.039 --> 00:49:42.800
<v Speaker 2>it's very difficult if you want to buy individual health care.

673
00:49:42.800 --> 00:49:45.480
<v Speaker 2>Why the government makes it so difficult for you? And

674
00:49:45.599 --> 00:49:49.760
<v Speaker 2>why the choices are so constrained, particularly at the insurance level.

675
00:49:49.880 --> 00:49:55.000
<v Speaker 2>Right insurance level, we have very very limited, limited options.

676
00:49:55.360 --> 00:49:59.159
<v Speaker 2>I will say this. You know Americans want choices. And

677
00:49:59.440 --> 00:50:02.039
<v Speaker 2>one way you can and tell that we want choices

678
00:50:02.719 --> 00:50:05.320
<v Speaker 2>is the failure of the kind of the PPO model.

679
00:50:05.360 --> 00:50:08.360
<v Speaker 2>This is the PPP model. The PPO model is a

680
00:50:08.440 --> 00:50:12.400
<v Speaker 2>model which you paid less for the so called insurance,

681
00:50:13.440 --> 00:50:16.039
<v Speaker 2>but you got fewer choices in terms of doctors and

682
00:50:16.639 --> 00:50:22.880
<v Speaker 2>hospitals and facilities to treat you. The sorry, that's the

683
00:50:23.079 --> 00:50:28.039
<v Speaker 2>HMO model, and then that's HMO model. Get fewer choices

684
00:50:28.079 --> 00:50:31.800
<v Speaker 2>in doctors, few choices in hospitals, fewer choices in places

685
00:50:31.840 --> 00:50:36.840
<v Speaker 2>to treat you. The PPO model is wide choices. And

686
00:50:37.639 --> 00:50:41.719
<v Speaker 2>while the h model was popular what twenty twenty something

687
00:50:41.800 --> 00:50:45.840
<v Speaker 2>years ago, maybe thirty years ago, it pretty much shrunk

688
00:50:46.000 --> 00:50:48.519
<v Speaker 2>dramatically because people didn't choose it. People didn't like it,

689
00:50:48.639 --> 00:50:52.480
<v Speaker 2>They didn't like to speak to choices. People want choices.

690
00:50:53.199 --> 00:50:56.280
<v Speaker 2>So the government keeps finding ways to reduce the choices

691
00:50:56.360 --> 00:51:00.599
<v Speaker 2>while while we were giving us the tense that we

692
00:51:00.679 --> 00:51:03.639
<v Speaker 2>still have them, given us the pretense we still have them.

693
00:51:04.239 --> 00:51:07.320
<v Speaker 2>And why, well, I hear these arguments all the time,

694
00:51:07.360 --> 00:51:10.000
<v Speaker 2>why we can't have more free markets in healthcare? There's

695
00:51:10.079 --> 00:51:18.960
<v Speaker 2>asymmetrical information. You know, you don't know what's good for you.

696
00:51:18.960 --> 00:51:20.960
<v Speaker 2>You can't judge a good doctor and a baghdad. You

697
00:51:21.000 --> 00:51:27.559
<v Speaker 2>can't judge what procedure you should take. There's too much,

698
00:51:28.119 --> 00:51:30.639
<v Speaker 2>you know, the difference in knowledge between you and the doctor,

699
00:51:31.039 --> 00:51:34.719
<v Speaker 2>or you and the providers of healthcare is too large.

700
00:51:35.119 --> 00:51:43.400
<v Speaker 2>It's just too large. Healthcare is too expensive, and if

701
00:51:43.480 --> 00:51:46.239
<v Speaker 2>we don't provide it as a government, you'll all go bankrupt.

702
00:51:47.199 --> 00:51:49.840
<v Speaker 2>Healthcare will just collapse if the government doesn't provide it

703
00:51:49.920 --> 00:51:52.679
<v Speaker 2>for you. There's no mechanism. The market does not have

704
00:51:52.760 --> 00:51:56.880
<v Speaker 2>a mechanism by which to allow you. So people just die,

705
00:51:57.280 --> 00:52:00.719
<v Speaker 2>right you. Poor people won't get any health care, they'll

706
00:52:00.840 --> 00:52:04.559
<v Speaker 2>just die. Old people will just not be able to

707
00:52:04.599 --> 00:52:07.320
<v Speaker 2>afford Who can afford a cancer treatment? It costs millions

708
00:52:07.360 --> 00:52:14.840
<v Speaker 2>of dollars some cancer treatments. So it's too expensive and

709
00:52:14.920 --> 00:52:17.880
<v Speaker 2>it's way too complicated. So which goes through with the

710
00:52:17.880 --> 00:52:22.960
<v Speaker 2>asymmetric confirmation. In other words, you're not smart enough most

711
00:52:23.000 --> 00:52:26.000
<v Speaker 2>of you, and you're not responsible enough. A lot of

712
00:52:26.079 --> 00:52:28.199
<v Speaker 2>you won't buy insurance, you'll buy the wrong insurance, you'll

713
00:52:28.199 --> 00:52:34.280
<v Speaker 2>buy too little insurancy. Whatever. And then finally, the profit motive.

714
00:52:35.960 --> 00:52:40.559
<v Speaker 2>The profit motive is a really bad incentive in healthcare.

715
00:52:41.480 --> 00:52:43.480
<v Speaker 2>It's going to lead people to try to you know,

716
00:52:43.719 --> 00:52:47.639
<v Speaker 2>like everywhere. How can you trust the profit motive? The

717
00:52:47.719 --> 00:52:52.199
<v Speaker 2>profit motive is about greed, and greed will lead people

718
00:52:52.719 --> 00:52:56.840
<v Speaker 2>to undertreat you. As if that happens anywhere else in markets,

719
00:52:57.519 --> 00:53:00.199
<v Speaker 2>like in food, to get rotten food because of the

720
00:53:00.400 --> 00:53:05.559
<v Speaker 2>farmer's greed. Food is privatized, it's not provided by the government.

721
00:53:06.039 --> 00:53:09.960
<v Speaker 2>Do we get a lack of variety in food because

722
00:53:10.159 --> 00:53:23.079
<v Speaker 2>of the farmer's greed. It's completely nuts, completely nuts. So

723
00:53:24.159 --> 00:53:28.079
<v Speaker 2>profit is an incentivizer to increase quality, actually reduce costs,

724
00:53:29.960 --> 00:53:36.840
<v Speaker 2>it's to innovate. Profit is to provide great service. That's

725
00:53:36.880 --> 00:53:39.920
<v Speaker 2>what the profit motive actually does. But people don't believe that.

726
00:53:41.000 --> 00:53:43.599
<v Speaker 2>And then finally, and I think this is important. Healthcare

727
00:53:43.679 --> 00:53:48.960
<v Speaker 2>now is perceived as a right. I must have it

728
00:53:49.800 --> 00:53:53.280
<v Speaker 2>because I need it, because we all need it. We

729
00:53:53.360 --> 00:53:55.519
<v Speaker 2>all need it, will require healthcare at some point in

730
00:53:55.559 --> 00:53:58.360
<v Speaker 2>our lives. Therefore we must have it. There's a more

731
00:53:58.400 --> 00:54:03.760
<v Speaker 2>responsibility for it. There's a responsibility to take care of anybody, everybody,

732
00:54:05.119 --> 00:54:08.159
<v Speaker 2>and therefore the government must step in because we wouldn't

733
00:54:08.599 --> 00:54:13.280
<v Speaker 2>fulfill them our responsibility otherwise, altruism demands it. And ultimately

734
00:54:13.960 --> 00:54:17.320
<v Speaker 2>it boils down to a really emotional argument. And the

735
00:54:17.440 --> 00:54:24.320
<v Speaker 2>consequence of this, of course, costs are indeed high. Some

736
00:54:24.440 --> 00:54:28.480
<v Speaker 2>people get so its denial, but generally we're not exposed

737
00:54:28.480 --> 00:54:32.519
<v Speaker 2>to the best alternatives. Necessarily, you need to invest a

738
00:54:32.639 --> 00:54:36.239
<v Speaker 2>lot in figuring out what's going on if you are

739
00:54:36.320 --> 00:54:40.960
<v Speaker 2>sick and you need treatment, complete subversion of customer from prices.

740
00:54:41.039 --> 00:54:44.639
<v Speaker 2>There's from prices, this massive mal hazard. There's just a

741
00:54:44.760 --> 00:54:53.440
<v Speaker 2>lot of unnecessary complexity and opaqueness and confusion, not just

742
00:54:53.559 --> 00:54:59.400
<v Speaker 2>among customers patients, but among doctors as well. I mean,

743
00:54:59.440 --> 00:55:03.000
<v Speaker 2>think about how much time and effort doctors today put

744
00:55:03.039 --> 00:55:07.679
<v Speaker 2>into the paperwork. How many people they have to hire

745
00:55:08.360 --> 00:55:15.559
<v Speaker 2>to fill out paperwork, paperwork, everything's paperwork to get reimbursed,

746
00:55:17.400 --> 00:55:23.159
<v Speaker 2>and the time wasted waiting for reimbursements, and the effort exists.

747
00:55:24.159 --> 00:55:26.599
<v Speaker 2>You know, so many doctors get MBA's not so much

748
00:55:26.599 --> 00:55:28.519
<v Speaker 2>because they want to grow their business, but because they

749
00:55:28.719 --> 00:55:30.800
<v Speaker 2>just need to survive. They need to know some accounting,

750
00:55:30.840 --> 00:55:33.880
<v Speaker 2>they need to know some stuff because it's become so complicated.

751
00:55:38.559 --> 00:55:41.320
<v Speaker 2>So they're real destructive consequences. And a lot of this

752
00:55:41.440 --> 00:55:43.480
<v Speaker 2>has to do with destructive consequences the doctors, and I

753
00:55:43.559 --> 00:55:47.639
<v Speaker 2>think doctors feel like they become bureaucrats. The producers of

754
00:55:47.760 --> 00:55:51.280
<v Speaker 2>healthcare feel like they become bureaucrats. The producers of healthcare

755
00:55:51.360 --> 00:55:56.159
<v Speaker 2>feel like, you know, they're not being compensated appropriately to

756
00:55:57.320 --> 00:56:01.320
<v Speaker 2>what they're doing. And a lot of people leave healthcare,

757
00:56:01.920 --> 00:56:06.960
<v Speaker 2>the people entering healthcare of a lower quality. Generally, healthcare

758
00:56:07.000 --> 00:56:14.400
<v Speaker 2>is less rewarding. It's as it becomes more bureaucratized. And again,

759
00:56:14.440 --> 00:56:18.800
<v Speaker 2>the talent is the talent pool is smaller. Fewer people

760
00:56:18.880 --> 00:56:21.559
<v Speaker 2>go in for the right reasons and all kinds of

761
00:56:21.639 --> 00:56:24.519
<v Speaker 2>distinctions and medical schools and so on, but just from

762
00:56:24.559 --> 00:56:26.599
<v Speaker 2>a pure economic perspective, fewer people are going to go

763
00:56:26.639 --> 00:56:35.400
<v Speaker 2>in because more bureaucratic, less opportunity to innovate, and expensive.

764
00:56:35.719 --> 00:56:42.320
<v Speaker 2>Medical school is expensive, and you know, salaries income stagnant,

765
00:56:45.000 --> 00:56:49.159
<v Speaker 2>and you know, then think about drug companies and think

766
00:56:49.199 --> 00:56:51.840
<v Speaker 2>about medical device companies, and think about all of that

767
00:56:52.519 --> 00:56:55.639
<v Speaker 2>and the degree to which we regulate and control all

768
00:56:55.719 --> 00:57:00.599
<v Speaker 2>of that. To that degree, we don't get massive innovations,

769
00:57:00.760 --> 00:57:06.719
<v Speaker 2>new products. I mean, it's stunning and amazing and heartwarming,

770
00:57:06.800 --> 00:57:10.000
<v Speaker 2>and you know, just amazing that we get as much

771
00:57:10.039 --> 00:57:13.400
<v Speaker 2>innovation as we do. I mean, we get huge amounts

772
00:57:13.400 --> 00:57:17.039
<v Speaker 2>of innovation. And yet imagine what we could get if

773
00:57:17.079 --> 00:57:20.840
<v Speaker 2>we didn't control and regulate and mandate and so on.

774
00:57:21.039 --> 00:57:23.400
<v Speaker 2>And I'm not even getting you know, one of the

775
00:57:23.480 --> 00:57:26.679
<v Speaker 2>issues with healthcare that we should discuss but we won't

776
00:57:26.679 --> 00:57:34.320
<v Speaker 2>discuss today is medical research, which is government dominated and

777
00:57:36.199 --> 00:57:39.639
<v Speaker 2>it is far from optimal. And it's a whole other topic.

778
00:57:39.840 --> 00:57:47.599
<v Speaker 2>Think about the NH, the NHS and NIH National Answer

779
00:57:47.639 --> 00:57:51.000
<v Speaker 2>for Health and all the money that the government gives

780
00:57:51.039 --> 00:57:55.559
<v Speaker 2>out in grants and so on, not an efficient productive

781
00:57:58.880 --> 00:58:05.639
<v Speaker 2>you know, method or outcome. All right, So we've described

782
00:58:05.800 --> 00:58:08.599
<v Speaker 2>the system as it is, at least parts of it. Again,

783
00:58:08.800 --> 00:58:12.119
<v Speaker 2>I'm sure there are big holes here. Let's talk about

784
00:58:12.119 --> 00:58:15.440
<v Speaker 2>what we can do to fix it. And I think

785
00:58:15.519 --> 00:58:22.280
<v Speaker 2>that the two things that have to happen in order

786
00:58:22.719 --> 00:58:28.400
<v Speaker 2>to fix the system, and the main thing is the

787
00:58:28.559 --> 00:58:30.559
<v Speaker 2>main thing is the main thing one has to do

788
00:58:31.599 --> 00:58:34.800
<v Speaker 2>is to reduce the involvement of government in health care.

789
00:58:36.880 --> 00:58:40.039
<v Speaker 2>To reduce the involvement in government healthcare in every dimension.

790
00:58:41.880 --> 00:58:44.800
<v Speaker 2>So we need to reduce the amount of government regulation

791
00:58:45.039 --> 00:58:48.159
<v Speaker 2>of health care. We need to reduce the amount of

792
00:58:48.199 --> 00:58:53.440
<v Speaker 2>government regulation of insurance, health insurance. We need to reduce

793
00:58:53.880 --> 00:58:59.960
<v Speaker 2>the moment of government in actually funding health care, Medicare, Medicare,

794
00:59:02.679 --> 00:59:05.719
<v Speaker 2>each one of those is huge, each one of those

795
00:59:05.960 --> 00:59:08.639
<v Speaker 2>all to some extended related And of course we need

796
00:59:08.719 --> 00:59:14.360
<v Speaker 2>a change tax policy to change the kind of incentives

797
00:59:14.599 --> 00:59:21.280
<v Speaker 2>in terms of who's buying insurance. So and I'd say

798
00:59:21.360 --> 00:59:24.400
<v Speaker 2>that's part of regulation of health insurance. So we need

799
00:59:24.440 --> 00:59:27.760
<v Speaker 2>to reduce the eliminated regulation of healthcare providers. We need

800
00:59:27.800 --> 00:59:31.360
<v Speaker 2>to reduce the eliminate regulation of health insurance. And we

801
00:59:31.440 --> 00:59:39.320
<v Speaker 2>need to reduce and ultimately eliminate government as a provider

802
00:59:39.960 --> 00:59:47.480
<v Speaker 2>of healthcare direct healthcare financing. Now, all of that is

803
00:59:47.599 --> 00:59:51.719
<v Speaker 2>a lot. We're talking about seventeen point six percent of GDP.

804
00:59:52.559 --> 00:59:57.880
<v Speaker 2>We're talking about the largest single industry out there again,

805
00:59:57.960 --> 01:00:04.000
<v Speaker 2>employees millions and millions of people, and spends for trillion dollars.

806
01:00:04.840 --> 01:00:07.199
<v Speaker 2>And we want to do it all in a way

807
01:00:08.280 --> 01:00:12.239
<v Speaker 2>that does not bankrupt people, that does not have people

808
01:00:12.280 --> 01:00:15.840
<v Speaker 2>who are sick dying in the streets, that does not

809
01:00:17.440 --> 01:00:21.480
<v Speaker 2>disrupt medical innovation, that does not disrupt the ability of

810
01:00:21.519 --> 01:00:23.960
<v Speaker 2>doctors to do their job. So we want to make

811
01:00:24.000 --> 01:00:27.280
<v Speaker 2>the transition as smooth as possible. Not that they're no costs.

812
01:00:27.880 --> 01:00:29.760
<v Speaker 2>Whenever you have a system like this and you're trying

813
01:00:29.760 --> 01:00:32.639
<v Speaker 2>to make it more free, there are costs of transitioning

814
01:00:33.320 --> 01:00:38.199
<v Speaker 2>because so much infrastructure is built around this. The disrupting

815
01:00:38.239 --> 01:00:41.800
<v Speaker 2>it is going to some Pospitals might go out of business,

816
01:00:41.840 --> 01:00:45.079
<v Speaker 2>some doctors might go, some insurance companies might go. There's

817
01:00:45.159 --> 01:00:49.400
<v Speaker 2>going to be a restructure, a restructure, a repositioning of

818
01:00:49.440 --> 01:00:56.000
<v Speaker 2>the whole system. All right, So let's let's think about

819
01:00:56.119 --> 01:01:00.239
<v Speaker 2>how to do this. Let's talk about let's take step

820
01:01:00.320 --> 01:01:06.039
<v Speaker 2>by step Step one is we want to phase out

821
01:01:06.079 --> 01:01:09.920
<v Speaker 2>the employer provided healthcare. We want to get employers out

822
01:01:09.960 --> 01:01:13.480
<v Speaker 2>of the business of health care, of out of funding it,

823
01:01:13.679 --> 01:01:18.480
<v Speaker 2>financing it, buying it, whatever, out of it. And we

824
01:01:18.599 --> 01:01:23.519
<v Speaker 2>want to move to a system where individuals own their

825
01:01:23.639 --> 01:01:28.000
<v Speaker 2>own health insurance policies. And we'll see that if we

826
01:01:28.159 --> 01:01:33.039
<v Speaker 2>move towards individually owned insurance policies, that will also be

827
01:01:33.039 --> 01:01:39.039
<v Speaker 2>an opportunity to move towards real insurance. We want to

828
01:01:39.199 --> 01:01:46.079
<v Speaker 2>at the same time completely deregulate the insurance marketplace. Now

829
01:01:46.119 --> 01:01:48.400
<v Speaker 2>I don't know how you do this because the insurance

830
01:01:48.400 --> 01:01:53.559
<v Speaker 2>marketplace is governed state by state. Now you could federalize it.

831
01:01:54.159 --> 01:02:01.000
<v Speaker 2>You could say, states, you cannot regulate insurance anymore. It's

832
01:02:01.039 --> 01:02:02.679
<v Speaker 2>going to happen in the state. It's going to happen.

833
01:02:03.039 --> 01:02:05.800
<v Speaker 2>You know, we're not going to regulate insurance. Oh, here

834
01:02:05.880 --> 01:02:08.199
<v Speaker 2>are a few standards by which you can regulate, but

835
01:02:08.760 --> 01:02:10.960
<v Speaker 2>that means ninety percent of what you're regulating goes away.

836
01:02:11.519 --> 01:02:15.960
<v Speaker 2>So you can't maindate what coverage, you can't mandate what deductibles.

837
01:02:16.000 --> 01:02:21.159
<v Speaker 2>You can mandate all these things, or one alternative if

838
01:02:21.199 --> 01:02:24.079
<v Speaker 2>you don't want to completely trample on so called on

839
01:02:24.199 --> 01:02:28.760
<v Speaker 2>the states is to say, is to have a federal

840
01:02:28.840 --> 01:02:31.519
<v Speaker 2>law that basically says you can buy insurance in any

841
01:02:31.559 --> 01:02:36.079
<v Speaker 2>state and create competition among the states, and who can

842
01:02:36.159 --> 01:02:50.480
<v Speaker 2>deregulate the fastest, who can deregulate the fastest, so you

843
01:02:50.559 --> 01:02:54.320
<v Speaker 2>can have competition between states. So I'm open to either

844
01:02:54.320 --> 01:02:56.960
<v Speaker 2>one of those. I ideally I would love to see

845
01:02:57.079 --> 01:03:03.519
<v Speaker 2>all state regulations go away, the regulations about the kind

846
01:03:03.559 --> 01:03:06.000
<v Speaker 2>of policies, the type of policies, what can be offered,

847
01:03:09.159 --> 01:03:12.119
<v Speaker 2>and maybe a federal law could do that. And if

848
01:03:12.199 --> 01:03:14.639
<v Speaker 2>it can, then it should. I'm not sure the Streame

849
01:03:14.679 --> 01:03:17.079
<v Speaker 2>quote would accept it, but it should. It should try

850
01:03:18.920 --> 01:03:22.360
<v Speaker 2>to get rid of state level regulations. In that sense,

851
01:03:22.360 --> 01:03:25.760
<v Speaker 2>you should federalize it. It was done in banking there

852
01:03:25.800 --> 01:03:30.440
<v Speaker 2>were state level regulations that were basically nationalized and eliminated.

853
01:03:34.519 --> 01:03:37.000
<v Speaker 2>So we need to do that. How do you move

854
01:03:37.559 --> 01:03:40.800
<v Speaker 2>to individual owned healthcare policies, Well, you need to stop

855
01:03:41.679 --> 01:03:46.320
<v Speaker 2>giving companies a tax deduction on healthcare expenditures. They cannot

856
01:03:47.199 --> 01:03:53.599
<v Speaker 2>they cannot spend money, they cannot, sorry, they cannot get

857
01:03:53.639 --> 01:03:57.559
<v Speaker 2>it to tax deduction, and then offer individuals a tax

858
01:03:57.599 --> 01:04:01.039
<v Speaker 2>deduction at least in the short run. Like this could

859
01:04:01.039 --> 01:04:03.400
<v Speaker 2>be a policy that is phased out over time, because

860
01:04:03.599 --> 01:04:07.320
<v Speaker 2>I don't particularly like giving people deductions on taxes, because

861
01:04:07.320 --> 01:04:10.960
<v Speaker 2>I like really really simple taxes with no deductions. But

862
01:04:13.360 --> 01:04:15.679
<v Speaker 2>to solve the problem that we have, and maybe this

863
01:04:15.719 --> 01:04:18.760
<v Speaker 2>would also be done in education for a decade, let's

864
01:04:18.760 --> 01:04:22.719
<v Speaker 2>say you give people the ability to deduct their insurance

865
01:04:23.159 --> 01:04:29.360
<v Speaker 2>premiums from the taxes at the individual level, not at

866
01:04:29.360 --> 01:04:32.719
<v Speaker 2>the corporate level, not at the business level. Businesses have

867
01:04:32.800 --> 01:04:37.760
<v Speaker 2>to pay taxes, cannot deduct insurance costs, and nows you

868
01:04:37.960 --> 01:04:43.360
<v Speaker 2>shift the incentive to individuals, and for example, what about

869
01:04:43.360 --> 01:04:46.920
<v Speaker 2>individuals who don't itemize, give them a deduction in spite

870
01:04:46.960 --> 01:04:50.639
<v Speaker 2>of that. There are ways to do it right. One

871
01:04:50.679 --> 01:04:53.559
<v Speaker 2>way to do that is, you know, to have a

872
01:04:53.639 --> 01:04:57.840
<v Speaker 2>medical saving account. Medical saving accounts allow you to put

873
01:04:57.920 --> 01:05:02.320
<v Speaker 2>money pre tax into an account and use that money

874
01:05:03.360 --> 01:05:07.559
<v Speaker 2>for healthcare, including insurance, and now you're not having to

875
01:05:07.719 --> 01:05:12.000
<v Speaker 2>deduct anything from your taxes other than the money that

876
01:05:12.119 --> 01:05:14.360
<v Speaker 2>you put into that account, which is not going to

877
01:05:14.400 --> 01:05:18.679
<v Speaker 2>be taxed. That's a simple way to do this. So

878
01:05:18.880 --> 01:05:24.960
<v Speaker 2>medical saving accounts should become universal. Everybody should have availability

879
01:05:25.039 --> 01:05:30.840
<v Speaker 2>to them. They should be unlimited. Let individuals make decisions

880
01:05:30.840 --> 01:05:33.079
<v Speaker 2>about how much money they want to put into a

881
01:05:33.119 --> 01:05:35.880
<v Speaker 2>medical saving account. It doesn't make sense to put in

882
01:05:37.400 --> 01:05:40.400
<v Speaker 2>you know, more than what you're going to use for healthcare.

883
01:05:41.320 --> 01:05:43.119
<v Speaker 2>You should be able to roll them over from year

884
01:05:43.119 --> 01:05:46.239
<v Speaker 2>to year. So this can become basically a way for

885
01:05:46.320 --> 01:05:52.880
<v Speaker 2>you to save money for healthcare emergencies or for expected

886
01:05:54.960 --> 01:05:59.440
<v Speaker 2>significant healthcare costs come in the future, and you should

887
01:05:59.480 --> 01:06:01.880
<v Speaker 2>be able to use that money to buy health insurance.

888
01:06:03.519 --> 01:06:06.320
<v Speaker 2>Now with a system like this where I have a

889
01:06:06.480 --> 01:06:10.480
<v Speaker 2>vehicle in which I can save money for healthcare expenditures,

890
01:06:11.280 --> 01:06:12.960
<v Speaker 2>a system where I can do this in a pre

891
01:06:13.239 --> 01:06:18.360
<v Speaker 2>tax manner, a system where I own the insurance policy

892
01:06:18.440 --> 01:06:22.159
<v Speaker 2>that I'm buying, and I own this account where I'm

893
01:06:22.199 --> 01:06:25.400
<v Speaker 2>saving money to cover my expenses in a sense self insuring.

894
01:06:27.519 --> 01:06:30.000
<v Speaker 2>What it makes sense for individuals to do, and what

895
01:06:30.079 --> 01:06:34.480
<v Speaker 2>I think individuals would do is actually buy real insurance,

896
01:06:34.760 --> 01:06:39.079
<v Speaker 2>not a risk pool, but real insurance. And what that

897
01:06:39.199 --> 01:06:45.480
<v Speaker 2>insurance would be would be insurance against catastrophic laws. This

898
01:06:45.559 --> 01:06:48.440
<v Speaker 2>would be insurance that would cover you if you had

899
01:06:48.480 --> 01:06:51.199
<v Speaker 2>to have surgery, or if you had a heart attack,

900
01:06:51.800 --> 01:06:55.880
<v Speaker 2>or if you had cancer, or it would cover certain

901
01:06:55.960 --> 01:06:59.679
<v Speaker 2>expenses if you develop diabetes. Maybe not all the expenses

902
01:07:00.280 --> 01:07:04.320
<v Speaker 2>maybe not the recurring expenses that you can expect, but

903
01:07:04.440 --> 01:07:09.840
<v Speaker 2>some of the dramatic, big ones. So I mean it

904
01:07:09.880 --> 01:07:14.440
<v Speaker 2>would be a competitive market in which different companies would

905
01:07:14.440 --> 01:07:18.199
<v Speaker 2>offer different coverages and the market would figure out what

906
01:07:18.320 --> 01:07:21.400
<v Speaker 2>made sense and what didn't make sense. You could imagine

907
01:07:21.519 --> 01:07:25.159
<v Speaker 2>insurance policies that this is the way you could take

908
01:07:25.239 --> 01:07:27.960
<v Speaker 2>care of what do you call it a PI existing condition?

909
01:07:28.440 --> 01:07:33.039
<v Speaker 2>Insurance policies that covered you for life price to today

910
01:07:33.199 --> 01:07:37.320
<v Speaker 2>based on your health today, had a payment schedule into

911
01:07:37.400 --> 01:07:43.079
<v Speaker 2>it for the rest of your life, and that covered

912
01:07:43.519 --> 01:07:47.039
<v Speaker 2>just these catastrophic losses. You can imagine all kinds of

913
01:07:47.079 --> 01:07:52.559
<v Speaker 2>things developing, right, you know, insurance policies that encouraged you

914
01:07:53.480 --> 01:07:58.360
<v Speaker 2>to take care of yourself, gave you discounts when you exercised,

915
01:07:58.400 --> 01:08:03.760
<v Speaker 2>and actually maybe insurance policies that actually tracked your fitness

916
01:08:04.639 --> 01:08:07.119
<v Speaker 2>monitors that actually encouraged you to wear them. I know,

917
01:08:07.440 --> 01:08:09.639
<v Speaker 2>privacy concerns. I don't care about privacy. If I'm going

918
01:08:09.719 --> 01:08:11.800
<v Speaker 2>to get a discount, I want my insurance company to

919
01:08:11.840 --> 01:08:16.520
<v Speaker 2>know how much I exercise. And maybe, you know, you

920
01:08:16.560 --> 01:08:19.520
<v Speaker 2>could even take photos of what you eat. I don't know,

921
01:08:21.239 --> 01:08:24.439
<v Speaker 2>But the point is you'd get innovation you'd get competition,

922
01:08:24.920 --> 01:08:29.479
<v Speaker 2>and you'd get real insurance, and you get insurance that

923
01:08:29.920 --> 01:08:32.560
<v Speaker 2>does its job. If it was good insurance, it would

924
01:08:32.600 --> 01:08:36.079
<v Speaker 2>do its job to lower your risk of actually incurring

925
01:08:36.119 --> 01:08:41.760
<v Speaker 2>the catastrophic risk. Right, so, fire insurance insurance company might

926
01:08:41.840 --> 01:08:44.119
<v Speaker 2>come to the house they certainly do this with big

927
01:08:44.479 --> 01:08:49.359
<v Speaker 2>expenses like industrial insurance, and say, look, we would actually

928
01:08:49.600 --> 01:08:53.159
<v Speaker 2>lower your cost of insurance if you did these five

929
01:08:53.279 --> 01:08:57.319
<v Speaker 2>things to make your home more fireproof. For example, I

930
01:08:57.439 --> 01:09:01.560
<v Speaker 2>remember we changed the type of tiling on our roof

931
01:09:02.760 --> 01:09:06.359
<v Speaker 2>and the kind of insulation in our attic. That actually

932
01:09:06.600 --> 01:09:10.439
<v Speaker 2>lowered a cost of home insurance. Why because the house

933
01:09:10.640 --> 01:09:14.760
<v Speaker 2>was less likely to burn down. Well, imagine again the

934
01:09:15.600 --> 01:09:20.000
<v Speaker 2>insurance companies, we're willing to lower your health insurance because

935
01:09:20.720 --> 01:09:24.319
<v Speaker 2>you let's even say you are taking a statin that

936
01:09:24.520 --> 01:09:28.199
<v Speaker 2>lowers your a POB to a level that makes it

937
01:09:28.359 --> 01:09:34.119
<v Speaker 2>very unlikely that you will get a heart attack, And

938
01:09:34.319 --> 01:09:37.000
<v Speaker 2>the insurance company might say, you know, we'll even now.

939
01:09:37.479 --> 01:09:40.920
<v Speaker 2>Now it turns out that statins cost almost nothing, but

940
01:09:41.199 --> 01:09:44.279
<v Speaker 2>some of these other mechanisms are lower condition are quite expensive.

941
01:09:44.600 --> 01:09:47.359
<v Speaker 2>I mean, insurance company might even say, you know, yeah,

942
01:09:47.399 --> 01:09:52.600
<v Speaker 2>we'll cover that cost because you know, because we're going

943
01:09:52.640 --> 01:09:54.960
<v Speaker 2>to have you as a client for many years, and

944
01:09:55.319 --> 01:09:58.520
<v Speaker 2>it lowers the chances of you actually needing this catastrophic

945
01:09:59.159 --> 01:10:03.560
<v Speaker 2>I don't know. My point is you'd get innovative products.

946
01:10:05.199 --> 01:10:09.279
<v Speaker 2>Hospitals might provide insurance, Doctors associations might provide different types

947
01:10:09.279 --> 01:10:12.399
<v Speaker 2>of insurance. I mean, we might be able to move

948
01:10:12.479 --> 01:10:15.760
<v Speaker 2>into what p dot T calls healthcare three point zero,

949
01:10:16.399 --> 01:10:19.359
<v Speaker 2>which is a healthcare much more focused on prevention than

950
01:10:19.439 --> 01:10:26.239
<v Speaker 2>on treatment, and to fund and the odience everybody and everything,

951
01:10:26.319 --> 01:10:30.119
<v Speaker 2>and the incentives both of the doctors and the customers

952
01:10:30.159 --> 01:10:38.680
<v Speaker 2>towards prevention rather than towards just treating you when you're sick. So,

953
01:10:40.560 --> 01:10:44.439
<v Speaker 2>once we get the employers out of it, and we

954
01:10:45.880 --> 01:10:49.920
<v Speaker 2>get individuals to buy their own policies, and we provide

955
01:10:49.960 --> 01:10:53.319
<v Speaker 2>them with an incentive to put money aside for their

956
01:10:53.359 --> 01:10:57.760
<v Speaker 2>health care through a tax deduction MSA, uh medical saving incomes,

957
01:10:58.279 --> 01:11:00.680
<v Speaker 2>and an incentive to buy some kind of insurance, but

958
01:11:00.880 --> 01:11:06.760
<v Speaker 2>any kind of insurance, you've solved the huge part of

959
01:11:07.000 --> 01:11:10.399
<v Speaker 2>the American healthcare system, you know, And then I am

960
01:11:10.520 --> 01:11:13.640
<v Speaker 2>buying healthcare. I'm going to my doctor and saying, okay,

961
01:11:14.479 --> 01:11:16.680
<v Speaker 2>you know, how much does it cost to fuse my

962
01:11:16.800 --> 01:11:21.720
<v Speaker 2>back if I need black back fusion, what are the alternatives?

963
01:11:21.720 --> 01:11:25.439
<v Speaker 2>How much did they cost? What are the outcomes? All right,

964
01:11:25.520 --> 01:11:27.520
<v Speaker 2>let's sit down and figure out what I should do.

965
01:11:28.399 --> 01:11:31.920
<v Speaker 2>What is insurance going to cover? Will insurance cover any

966
01:11:31.960 --> 01:11:34.479
<v Speaker 2>of it? And if so, what of it will it cover?

967
01:11:35.239 --> 01:11:38.319
<v Speaker 2>Given its catastrophic nature? Does this coount? All of that

968
01:11:38.399 --> 01:11:42.279
<v Speaker 2>would then go into decision making. Now, this requires people

969
01:11:42.359 --> 01:11:46.199
<v Speaker 2>to actually be engaged, to be involved, or you know,

970
01:11:46.399 --> 01:11:49.880
<v Speaker 2>just like it could be that just like we have

971
01:11:50.079 --> 01:11:53.079
<v Speaker 2>financial advisors where we say, you know, I don't want

972
01:11:53.119 --> 01:11:54.479
<v Speaker 2>to I don't want to think about how to invest

973
01:11:54.520 --> 01:11:56.880
<v Speaker 2>my money. It's too difficult. I'm going to hire somebody.

974
01:11:57.560 --> 01:11:59.479
<v Speaker 2>I'm going to do my research and hire the best

975
01:11:59.520 --> 01:12:02.199
<v Speaker 2>person I can and then basically they can invest my

976
01:12:02.319 --> 01:12:04.760
<v Speaker 2>money and then good someone how it's going to be invested.

977
01:12:04.880 --> 01:12:10.720
<v Speaker 2>Maybe we have healthcare consultants healthcare advisors who when we

978
01:12:10.880 --> 01:12:14.000
<v Speaker 2>have healthcare decisions that are really complex and time consuming,

979
01:12:14.359 --> 01:12:16.800
<v Speaker 2>we hire them to come in and provide us with

980
01:12:16.880 --> 01:12:19.000
<v Speaker 2>all the facts and help us make the right decisions.

981
01:12:20.159 --> 01:12:23.600
<v Speaker 2>I don't know. That's the beauty of markets whenever they

982
01:12:23.640 --> 01:12:27.720
<v Speaker 2>are asymmetries of information, and they're huge in medcare healthcare,

983
01:12:27.800 --> 01:12:33.399
<v Speaker 2>no question, Whole sectors the economy develop, new professions develop

984
01:12:33.880 --> 01:12:39.039
<v Speaker 2>in order to mitigate the asymmetry. So when can only

985
01:12:39.199 --> 01:12:42.840
<v Speaker 2>imagine the kind of products, the kind of innovations that

986
01:12:42.840 --> 01:12:49.119
<v Speaker 2>would happen to deal with the complexities of healthcare. And

987
01:12:49.239 --> 01:12:52.119
<v Speaker 2>maybe that consultant is just how Maybe that consultant is

988
01:12:52.199 --> 01:12:58.039
<v Speaker 2>simply our physician, how our general physician. Maybe you actually

989
01:12:58.119 --> 01:13:02.319
<v Speaker 2>maybe that's generally part of their will is to help

990
01:13:02.399 --> 01:13:08.239
<v Speaker 2>us navigate. It's to organize what specialists are saying, and

991
01:13:08.399 --> 01:13:10.319
<v Speaker 2>it's to sit down with us and say, Okay, here

992
01:13:10.319 --> 01:13:14.359
<v Speaker 2>are the options, and here's what possible. And maybe and

993
01:13:14.840 --> 01:13:20.079
<v Speaker 2>one would expect, given that I am paying, that they

994
01:13:20.119 --> 01:13:23.399
<v Speaker 2>would start treating me a lot better, spending more time

995
01:13:23.479 --> 01:13:28.359
<v Speaker 2>with me, and that the general physician would become much

996
01:13:28.399 --> 01:13:32.760
<v Speaker 2>more of a consultant, coordinating all aspects of my care

997
01:13:34.680 --> 01:13:40.800
<v Speaker 2>with specialists and hospitals and clinics. Then just a guy

998
01:13:40.840 --> 01:13:42.439
<v Speaker 2>I go see for a general check up and go

999
01:13:42.560 --> 01:13:44.640
<v Speaker 2>to get get get a couple of aspens when I'm

1000
01:13:44.680 --> 01:13:50.720
<v Speaker 2>not feeling well. So imagine your primary care physician becoming

1001
01:13:50.760 --> 01:13:54.840
<v Speaker 2>that a real consultant to you, somebody who is really

1002
01:13:54.960 --> 01:13:58.880
<v Speaker 2>there to work with you through a healthcare plan, how

1003
01:13:58.960 --> 01:14:05.159
<v Speaker 2>to avoid disease, how to stay healthy, and then when

1004
01:14:05.199 --> 01:14:09.319
<v Speaker 2>you do something does happen, how to maneuver, how to

1005
01:14:09.479 --> 01:14:15.359
<v Speaker 2>deal with the complexities of the system. All right, so

1006
01:14:16.800 --> 01:14:21.479
<v Speaker 2>if we phase out, you got to phase out, uh

1007
01:14:21.920 --> 01:14:24.119
<v Speaker 2>the end, and you got to do it over time.

1008
01:14:24.199 --> 01:14:27.600
<v Speaker 2>You can't do it all at once. I would start

1009
01:14:27.680 --> 01:14:33.920
<v Speaker 2>by offering mssas to everybody, and then I would basically

1010
01:14:34.199 --> 01:14:38.279
<v Speaker 2>put a sunset a year from now on the tax

1011
01:14:38.359 --> 01:14:43.399
<v Speaker 2>addictability of health costs. So first off of them mssas. First,

1012
01:14:43.520 --> 01:14:48.800
<v Speaker 2>give everybody an opportunity off open a medical saving accounts.

1013
01:14:50.439 --> 01:14:53.840
<v Speaker 2>Then tell employers you're not going to get the text

1014
01:14:53.840 --> 01:14:57.159
<v Speaker 2>deduction anymore. Not going to get the text deduction anymore.

1015
01:14:58.359 --> 01:15:02.479
<v Speaker 2>You've got a year, two years to adjust, to adapt,

1016
01:15:03.439 --> 01:15:08.479
<v Speaker 2>and to educate your employees to the fact that you

1017
01:15:08.560 --> 01:15:11.520
<v Speaker 2>know they will get a better deal if they buy

1018
01:15:11.560 --> 01:15:17.880
<v Speaker 2>insurance through the MSA, through the medical saving income. And

1019
01:15:18.199 --> 01:15:23.239
<v Speaker 2>what what happen is you'll get insurance markets developing, you know,

1020
01:15:23.359 --> 01:15:29.279
<v Speaker 2>a little bit like Obamacare, but better, more efficient. We'll

1021
01:15:29.319 --> 01:15:38.640
<v Speaker 2>get to Obamacare later, but so a vast majority of

1022
01:15:38.800 --> 01:15:41.920
<v Speaker 2>working adults get their healthcare today through the employers that

1023
01:15:41.960 --> 01:15:44.000
<v Speaker 2>would go away, and they'd start getting it personally in

1024
01:15:44.079 --> 01:15:48.399
<v Speaker 2>a big chunk of the healthcare system would suddenly be privatized. Now,

1025
01:15:48.439 --> 01:15:51.760
<v Speaker 2>if you couple that with real deregulation of hospitals, real

1026
01:15:51.840 --> 01:15:58.399
<v Speaker 2>deregulation of doctors, real deregulation starting of drugs, massive benefits.

1027
01:16:01.600 --> 01:16:06.479
<v Speaker 2>But you still need to deal with Medicaid Medicare. And

1028
01:16:06.760 --> 01:16:12.239
<v Speaker 2>this is not easy because that's so big and so

1029
01:16:12.399 --> 01:16:15.560
<v Speaker 2>much depends. So many people depend on it, so many

1030
01:16:15.600 --> 01:16:18.119
<v Speaker 2>people are being conditioned to depend on it. You can

1031
01:16:18.279 --> 01:16:21.720
<v Speaker 2>just take it away tomorrow. Everybody has pre existing conditions.

1032
01:16:22.199 --> 01:16:24.439
<v Speaker 2>It would be very, very difficult for them to fund it.

1033
01:16:24.520 --> 01:16:27.560
<v Speaker 2>People have not saved for their healthcare when they're old,

1034
01:16:28.079 --> 01:16:32.119
<v Speaker 2>So let's just start with Medicare. So I think Medicare

1035
01:16:32.199 --> 01:16:34.640
<v Speaker 2>needs to be phased out. It needs to be phased

1036
01:16:34.680 --> 01:16:37.720
<v Speaker 2>out over time, and it might take a generation to

1037
01:16:37.760 --> 01:16:43.960
<v Speaker 2>phase it out completely. The best idea I've seen around

1038
01:16:44.079 --> 01:16:52.119
<v Speaker 2>phasing out Medicare is to move Medicare away from health care,

1039
01:16:54.399 --> 01:17:00.279
<v Speaker 2>to make it a purely a system that subsidizes healthy shaans.

1040
01:17:03.239 --> 01:17:10.720
<v Speaker 2>So Medica should stop writing checks to hospitals for drugs

1041
01:17:10.880 --> 01:17:15.720
<v Speaker 2>for anything. Medica should move to basically a voucher system,

1042
01:17:17.399 --> 01:17:24.279
<v Speaker 2>a voucere system that allows the elderly, anybody over sixty

1043
01:17:24.319 --> 01:17:34.479
<v Speaker 2>five to buy health care and to buy catastrophic insurance.

1044
01:17:35.960 --> 01:17:38.960
<v Speaker 2>So basically, take what we spend today per person on Medicare,

1045
01:17:40.479 --> 01:17:45.119
<v Speaker 2>have them all open up in medical saving accounts and

1046
01:17:45.239 --> 01:17:47.239
<v Speaker 2>put the money into the medical Saving acount The government

1047
01:17:47.319 --> 01:17:50.680
<v Speaker 2>literally puts the money into their saving accounts, and they

1048
01:17:50.760 --> 01:17:54.680
<v Speaker 2>can use that money to buy insurance and to pay

1049
01:17:54.760 --> 01:18:04.760
<v Speaker 2>for health care spending that they might have. This is

1050
01:18:04.840 --> 01:18:07.720
<v Speaker 2>going to be incredibly expensive because but Medicare is already

1051
01:18:07.840 --> 01:18:11.439
<v Speaker 2>pretty expensive, so it would stay expensive. But what you

1052
01:18:11.479 --> 01:18:16.479
<v Speaker 2>would do is every year, maybe two years, the amount

1053
01:18:16.520 --> 01:18:21.840
<v Speaker 2>of money that went into this medical saving counts would

1054
01:18:21.880 --> 01:18:26.399
<v Speaker 2>be slightly lower for new people entering the system. So

1055
01:18:26.520 --> 01:18:29.079
<v Speaker 2>for old people you would guarantee, I'm just making numbers

1056
01:18:29.159 --> 01:18:31.680
<v Speaker 2>up now, you'd guarantee every year you get ten thousand dollars,

1057
01:18:31.760 --> 01:18:33.159
<v Speaker 2>or you get one thousand dollars or whatever it is,

1058
01:18:33.720 --> 01:18:36.159
<v Speaker 2>you get it every year until you die. Into the

1059
01:18:36.199 --> 01:18:42.239
<v Speaker 2>medical saving incounts. For anybody who sixty five or older today,

1060
01:18:43.199 --> 01:18:47.119
<v Speaker 2>if you're sixty three, when you turn sixty five, you'll

1061
01:18:47.119 --> 01:18:52.319
<v Speaker 2>only get nine thousand dollars. If you're sixty one, when

1062
01:18:52.359 --> 01:18:55.960
<v Speaker 2>you turn sixty five, you'll only get eight thousand dollars

1063
01:18:58.039 --> 01:19:01.239
<v Speaker 2>and so on. So the young people can look at

1064
01:19:01.239 --> 01:19:04.319
<v Speaker 2>it and say, huh, okay, the gunment's gonna give me

1065
01:19:04.359 --> 01:19:08.359
<v Speaker 2>a lot less money. So, but I have more time

1066
01:19:08.520 --> 01:19:11.359
<v Speaker 2>to prepare for that. And part of that preparation is

1067
01:19:11.399 --> 01:19:13.960
<v Speaker 2>going to be I'm gonna save more money in my

1068
01:19:14.119 --> 01:19:17.319
<v Speaker 2>medical saving account for when I probably most need it,

1069
01:19:17.520 --> 01:19:20.720
<v Speaker 2>in my sixties and seventies. So I'm gonna start accumulating

1070
01:19:20.760 --> 01:19:24.520
<v Speaker 2>money in my medical saving accounts. I'm going to start saving,

1071
01:19:25.680 --> 01:19:27.720
<v Speaker 2>and I'm going to keep this private insurance. I'm gonna

1072
01:19:28.279 --> 01:19:31.039
<v Speaker 2>get policies that will cover me when I'm in my

1073
01:19:31.520 --> 01:19:39.319
<v Speaker 2>sixties and seventies. So the subsidy, whatever the amount is

1074
01:19:39.560 --> 01:19:44.359
<v Speaker 2>per senior, we keep, in a sense the promise to

1075
01:19:44.479 --> 01:19:48.840
<v Speaker 2>the people you know today who are retiring or sixty

1076
01:19:48.880 --> 01:19:53.319
<v Speaker 2>five and older. But anybody entering the system is going

1077
01:19:53.439 --> 01:19:56.760
<v Speaker 2>to get less. Now how much less you'd have to

1078
01:19:56.800 --> 01:19:58.560
<v Speaker 2>do the math. You'd have to figure it out. You'd

1079
01:19:58.600 --> 01:20:00.560
<v Speaker 2>have to see how the markets evolved too. I mean,

1080
01:20:00.600 --> 01:20:03.359
<v Speaker 2>it could be the insurance prices go down quite a bit,

1081
01:20:04.399 --> 01:20:08.159
<v Speaker 2>and healthcare costs could go down quite a bit now

1082
01:20:08.239 --> 01:20:11.920
<v Speaker 2>that we're creating a real market for insurance, real consumer

1083
01:20:12.079 --> 01:20:13.880
<v Speaker 2>now sorry, a real market for insurance and a real

1084
01:20:13.920 --> 01:20:16.840
<v Speaker 2>market for health care. And now we're creating consumers for

1085
01:20:16.880 --> 01:20:23.720
<v Speaker 2>health care, real demand, not demand by big entities negotiating,

1086
01:20:24.439 --> 01:20:29.479
<v Speaker 2>but by individuals. You'd expect healthcare costs to come down,

1087
01:20:31.079 --> 01:20:34.800
<v Speaker 2>and you'd expect the whole industry to focus on profitability

1088
01:20:37.119 --> 01:20:44.359
<v Speaker 2>and making themselves profitable by reducing costs, so prices come

1089
01:20:44.399 --> 01:20:52.920
<v Speaker 2>down through competition and through innovation. Now, I think you

1090
01:20:52.920 --> 01:20:55.960
<v Speaker 2>would do the same thing with Medicaid. I think for

1091
01:20:56.079 --> 01:21:00.399
<v Speaker 2>every poor person, however you categorized it, you would open

1092
01:21:00.479 --> 01:21:05.479
<v Speaker 2>up a medical saving account and you would say, you know,

1093
01:21:05.680 --> 01:21:09.520
<v Speaker 2>we will fill it up depending on how poor you are,

1094
01:21:10.279 --> 01:21:14.640
<v Speaker 2>up to a certain amount. And again, we are going

1095
01:21:14.720 --> 01:21:17.159
<v Speaker 2>to phase this program out. This is not permanent. We're

1096
01:21:17.199 --> 01:21:19.279
<v Speaker 2>going to face this program. Although even if it was permanent,

1097
01:21:19.399 --> 01:21:20.920
<v Speaker 2>it would be far better than what we do today.

1098
01:21:22.119 --> 01:21:25.720
<v Speaker 2>And notice what happens now. Now you've got insurance companies

1099
01:21:25.760 --> 01:21:28.159
<v Speaker 2>competing for their dollars. You've got insurance companies competing for

1100
01:21:28.199 --> 01:21:33.520
<v Speaker 2>the Medicaid and Medicaid recipients dollars because they're still offering

1101
01:21:33.600 --> 01:21:40.760
<v Speaker 2>them through the market products catastrophic primarily products. But now

1102
01:21:40.800 --> 01:21:44.199
<v Speaker 2>you've got doctors and hospitals competing for their dollars rather

1103
01:21:44.319 --> 01:21:48.760
<v Speaker 2>than negotiating with the you know this massive Medicare or Medicaid.

1104
01:21:49.640 --> 01:21:52.680
<v Speaker 2>Now they're negotiating with real customers who are price sensitive.

1105
01:22:01.359 --> 01:22:08.479
<v Speaker 2>So you know you you I rather you subsidize generally

1106
01:22:10.199 --> 01:22:19.319
<v Speaker 2>and eliminate all regulations, then regulate and become a direct purchaser,

1107
01:22:20.800 --> 01:22:23.319
<v Speaker 2>So it's better. I think I'm gonna just subsidize its

1108
01:22:23.359 --> 01:22:26.720
<v Speaker 2>in a sense that provides a cash benefit to people.

1109
01:22:27.800 --> 01:22:29.960
<v Speaker 2>And in this sense, you know, I have some sympathy

1110
01:22:30.439 --> 01:22:34.680
<v Speaker 2>for the universal basic income. If you could guarantee to

1111
01:22:34.760 --> 01:22:38.399
<v Speaker 2>me that you would, you will need to get rid

1112
01:22:38.439 --> 01:22:43.800
<v Speaker 2>of every single welfare and healthcare and education dollars spent

1113
01:22:44.039 --> 01:22:50.399
<v Speaker 2>by state, local, and federal government, every dollar spent on welfare,

1114
01:22:50.880 --> 01:22:57.520
<v Speaker 2>but also on healthcare, education, every dollar spent. Then I

1115
01:22:57.560 --> 01:23:02.520
<v Speaker 2>think a universal basic income would make a lot of sense. Basically,

1116
01:23:02.600 --> 01:23:07.279
<v Speaker 2>what this valture system is moving us towards that giving

1117
01:23:07.319 --> 01:23:09.920
<v Speaker 2>them the money so they can buy it and then

1118
01:23:10.960 --> 01:23:14.560
<v Speaker 2>start phasing it out. So have a universe of basic

1119
01:23:14.640 --> 01:23:17.880
<v Speaker 2>camcome let's say, University of basic income, says everybody gets

1120
01:23:17.920 --> 01:23:20.199
<v Speaker 2>fifteen thousand dollars a year. I'm just making that up,

1121
01:23:21.439 --> 01:23:25.920
<v Speaker 2>and then every year would go down by a thousand,

1122
01:23:26.880 --> 01:23:29.039
<v Speaker 2>so that in fifteen years there's nothing and the welfare

1123
01:23:29.039 --> 01:23:32.920
<v Speaker 2>state is zero. Doubt or maybe you think that's too quick,

1124
01:23:33.079 --> 01:23:34.920
<v Speaker 2>and every the year it goes down by five hundred

1125
01:23:35.640 --> 01:23:38.600
<v Speaker 2>and within thirty years it's zeroed out. It's fine with

1126
01:23:38.720 --> 01:23:41.920
<v Speaker 2>me by me as well, and the same here. Ultimately,

1127
01:23:43.560 --> 01:23:46.399
<v Speaker 2>the push should get nothing from government to buy health

1128
01:23:46.479 --> 01:23:51.439
<v Speaker 2>insurance or to cover their health expenses. And to a

1129
01:23:51.520 --> 01:23:56.439
<v Speaker 2>large extent, you know, capitalism would eradicate poverty. That is,

1130
01:23:57.239 --> 01:23:59.279
<v Speaker 2>the whole goal should be to grow the economy so

1131
01:23:59.439 --> 01:24:05.520
<v Speaker 2>fast that in absolute terms, nobody is put and for

1132
01:24:05.600 --> 01:24:09.800
<v Speaker 2>the freak event where somebody really can't afford it, that's

1133
01:24:09.840 --> 01:24:14.359
<v Speaker 2>what charity is for. And the same thing with old people.

1134
01:24:15.640 --> 01:24:21.760
<v Speaker 2>People should be incentifized to be responsible to save save

1135
01:24:21.840 --> 01:24:24.199
<v Speaker 2>money for old age and if they can't or if

1136
01:24:24.199 --> 01:24:29.560
<v Speaker 2>they don't, if they don't because everybody can, then charity

1137
01:24:29.600 --> 01:24:32.000
<v Speaker 2>will have to take care of them. But I get

1138
01:24:32.039 --> 01:24:35.560
<v Speaker 2>it that you can't advocate for that today. That is

1139
01:24:35.960 --> 01:24:39.720
<v Speaker 2>long term, that is in fifteen years, when we phased

1140
01:24:39.760 --> 01:24:42.640
<v Speaker 2>out all these programs are thirty years when we phased

1141
01:24:42.680 --> 01:24:46.119
<v Speaker 2>it all out. And this of course brings you to

1142
01:24:46.199 --> 01:24:50.159
<v Speaker 2>Medicaire Obamacare Obamacare. If we phase our medicaid and phase

1143
01:24:50.199 --> 01:24:53.960
<v Speaker 2>our medicare and we move all insurance to individual insurance,

1144
01:24:54.239 --> 01:24:59.000
<v Speaker 2>Obamacare goes away. There's no reason to subsidize exchanges. You're

1145
01:24:59.079 --> 01:25:02.560
<v Speaker 2>ready in a sense, subsidizing the individual to buy the

1146
01:25:02.600 --> 01:25:06.640
<v Speaker 2>healthcare there. They're either medicared or and insurance costs. Because

1147
01:25:06.720 --> 01:25:10.600
<v Speaker 2>the insurance market is deregulated, the insurance costs are going down,

1148
01:25:11.119 --> 01:25:15.199
<v Speaker 2>and there's just everybody can afford insurance. And those people

1149
01:25:15.239 --> 01:25:18.479
<v Speaker 2>who are really too poor to affod real insurance, real

1150
01:25:18.560 --> 01:25:27.279
<v Speaker 2>insurance being catastrophic insurance. Uh, you know, you're basically giving

1151
01:25:27.359 --> 01:25:34.520
<v Speaker 2>them a subsidy. So today Obamacare subsidizes people who are

1152
01:25:34.560 --> 01:25:37.239
<v Speaker 2>not in medicaid but who don't have enough money to

1153
01:25:37.279 --> 01:25:40.159
<v Speaker 2>buy insurance. But that's because insurance is so expensive today

1154
01:25:40.359 --> 01:25:43.640
<v Speaker 2>because it covers so much, it's so heavily regulated, and

1155
01:25:43.760 --> 01:25:46.359
<v Speaker 2>it's not real insurance. It's a risk pool. But if

1156
01:25:46.399 --> 01:25:50.960
<v Speaker 2>insurance becomes real just catastrophic, and if everybody can have

1157
01:25:51.039 --> 01:25:55.119
<v Speaker 2>an MSA and they can start saving even if it's

1158
01:25:55.159 --> 01:25:57.920
<v Speaker 2>a little bit of money for the annual doctor visit,

1159
01:25:58.079 --> 01:26:00.640
<v Speaker 2>for the getting a flu or getting a something like that.

1160
01:26:03.960 --> 01:26:07.439
<v Speaker 2>You take away the need for the additional subsidies on

1161
01:26:07.520 --> 01:26:11.279
<v Speaker 2>top of Medicaid and Medicaid that Obamacare requires, and now

1162
01:26:11.359 --> 01:26:15.479
<v Speaker 2>you just have a real marketplace and insurance. But then

1163
01:26:15.520 --> 01:26:22.600
<v Speaker 2>it becomes real insurance i e. For catastrophic where unpredictable

1164
01:26:22.640 --> 01:26:34.880
<v Speaker 2>events and the rest you're safer. So again I'm advocated

1165
01:26:34.880 --> 01:26:38.439
<v Speaker 2>of a UBI to be phased out as a step

1166
01:26:38.880 --> 01:26:42.800
<v Speaker 2>towards getting rid of the welfare state. So you're not

1167
01:26:42.840 --> 01:26:44.920
<v Speaker 2>going to get rid of the welfare state without some

1168
01:26:45.079 --> 01:26:47.319
<v Speaker 2>kind of transition. You're not going to get rid of

1169
01:26:47.359 --> 01:26:51.399
<v Speaker 2>the welfare state like that. The best way to phase

1170
01:26:51.479 --> 01:26:54.720
<v Speaker 2>it all out, you can phase out Medicare, Medicaid, you

1171
01:26:54.800 --> 01:26:58.640
<v Speaker 2>can phase out. And by the way, one thing you

1172
01:26:58.680 --> 01:27:01.640
<v Speaker 2>could do with medicaire is the valure system could be

1173
01:27:01.720 --> 01:27:05.199
<v Speaker 2>means tested, right, the values system can be done in

1174
01:27:05.319 --> 01:27:11.680
<v Speaker 2>a way that and this reduces cost dramatically. Not everybody

1175
01:27:11.720 --> 01:27:13.840
<v Speaker 2>gets it, so it's like medicaid, if you need it,

1176
01:27:13.920 --> 01:27:15.399
<v Speaker 2>you get it. If you don't need it, if you

1177
01:27:15.479 --> 01:27:19.359
<v Speaker 2>can afford the manic the the health insurance costs and

1178
01:27:19.479 --> 01:27:22.520
<v Speaker 2>the and your health expenditures, then you don't get it.

1179
01:27:22.600 --> 01:27:25.359
<v Speaker 2>So you can come up with a way in which

1180
01:27:25.800 --> 01:27:31.600
<v Speaker 2>the annual expenditures is already going down dramatically, and yeah,

1181
01:27:31.680 --> 01:27:34.680
<v Speaker 2>that makes it. You know, it's it's now mean tested.

1182
01:27:34.720 --> 01:27:37.920
<v Speaker 2>But I paid all my life taxes for medicaire. You

1183
01:27:38.079 --> 01:27:41.239
<v Speaker 2>just pay taxes. We all just pay taxes. It's not

1184
01:27:41.359 --> 01:27:44.880
<v Speaker 2>going to any particular thing. It's all fungible. So security

1185
01:27:44.920 --> 01:27:49.520
<v Speaker 2>is functible, Medicare is fungible. And indeed most most people

1186
01:27:49.640 --> 01:27:56.640
<v Speaker 2>spend uh spend four times more, four times more than

1187
01:27:57.279 --> 01:28:00.359
<v Speaker 2>they ever paid into. So all of these things need

1188
01:28:00.399 --> 01:28:02.640
<v Speaker 2>to be phased up. The idea that you can get

1189
01:28:02.720 --> 01:28:05.920
<v Speaker 2>rid of them all in a bang, it's never going

1190
01:28:06.000 --> 01:28:11.079
<v Speaker 2>to fly. It's not doable. Maybe in a horrific crisis,

1191
01:28:11.920 --> 01:28:13.159
<v Speaker 2>but then you don't want to you don't want to

1192
01:28:13.159 --> 01:28:20.199
<v Speaker 2>live through that, so you phase it out. So UBI

1193
01:28:20.479 --> 01:28:22.840
<v Speaker 2>only as a means to phasing out the welfare state.

1194
01:28:24.159 --> 01:28:28.560
<v Speaker 2>All right, I'll just add that part of the massive

1195
01:28:28.600 --> 01:28:35.840
<v Speaker 2>deregulation would dramatically involve FDA reform and ultimately the prioritization

1196
01:28:35.920 --> 01:28:38.920
<v Speaker 2>of the FDA. The first step of the reform could

1197
01:28:38.960 --> 01:28:43.640
<v Speaker 2>be uh, the FDA approves drugs only in the basis

1198
01:28:43.800 --> 01:28:50.960
<v Speaker 2>of safety, not efficiacy, and then you know a market

1199
01:28:51.000 --> 01:28:56.520
<v Speaker 2>will evolve for different labs that evaluate efficacy, and then

1200
01:28:56.600 --> 01:28:59.680
<v Speaker 2>you can basically get rid of the safety issues around

1201
01:28:59.680 --> 01:29:03.279
<v Speaker 2>the FD as well and privatize those. It's ultimately you

1202
01:29:03.359 --> 01:29:11.680
<v Speaker 2>want all drug development approval to be to be private.

1203
01:29:13.520 --> 01:29:17.359
<v Speaker 2>And here you know, you've got to reform the way

1204
01:29:17.479 --> 01:29:20.680
<v Speaker 2>drug development is done. We've got to reform the way

1205
01:29:21.439 --> 01:29:24.319
<v Speaker 2>science has done, the way grants are given. That's a

1206
01:29:24.359 --> 01:29:27.880
<v Speaker 2>whole other topic we can do another time. But ultimately

1207
01:29:27.920 --> 01:29:30.680
<v Speaker 2>you want the government out of that as well, out

1208
01:29:30.720 --> 01:29:33.119
<v Speaker 2>of that as well. But every again, all of these

1209
01:29:33.199 --> 01:29:38.520
<v Speaker 2>things involve phasing out over time. You're not going to

1210
01:29:38.600 --> 01:29:41.960
<v Speaker 2>get a government that is going to just drive everything

1211
01:29:42.079 --> 01:29:48.000
<v Speaker 2>down to zero. I mean, you want the fdiut of

1212
01:29:48.119 --> 01:29:50.960
<v Speaker 2>recommending food, you want them out of food inspection, you

1213
01:29:51.039 --> 01:29:54.600
<v Speaker 2>want them out of the whole gamut of what they do.

1214
01:29:55.600 --> 01:29:59.039
<v Speaker 2>But in healthcare, what you want is to reform so

1215
01:29:59.159 --> 01:30:00.880
<v Speaker 2>that you can get more dru on to the market

1216
01:30:01.239 --> 01:30:09.720
<v Speaker 2>and then privatize, re fum and privatized. Now, note that

1217
01:30:09.880 --> 01:30:13.760
<v Speaker 2>if you do all this, wages will go up quite

1218
01:30:13.760 --> 01:30:21.199
<v Speaker 2>a bit because you know employers who now do not

1219
01:30:21.359 --> 01:30:23.840
<v Speaker 2>have to buy you health insurance will be able to

1220
01:30:23.880 --> 01:30:27.279
<v Speaker 2>give you that money as salary. That is money that

1221
01:30:27.319 --> 01:30:32.239
<v Speaker 2>can immediately go into your medical saving account. So wages

1222
01:30:32.319 --> 01:30:37.359
<v Speaker 2>go up as a consequence of all this. As government

1223
01:30:37.800 --> 01:30:42.840
<v Speaker 2>spends less on healthcare because it's phasing out Medicare and

1224
01:30:42.960 --> 01:30:48.319
<v Speaker 2>Medicaid and making Medicare means tested. As all of that

1225
01:30:48.479 --> 01:30:50.960
<v Speaker 2>is being phased out, the government is spending less money

1226
01:30:51.760 --> 01:30:58.119
<v Speaker 2>and hopefully taxes come down at the same time. At

1227
01:30:58.159 --> 01:31:04.039
<v Speaker 2>the same time, outcomes improved dramatically. It's more innovation in

1228
01:31:04.119 --> 01:31:10.039
<v Speaker 2>the system. There's more doctor and generally producer involvement in

1229
01:31:10.119 --> 01:31:15.159
<v Speaker 2>the system. Hospitals start caring about you. Doctors start caring

1230
01:31:15.199 --> 01:31:17.279
<v Speaker 2>about you. Not that they don't care now, but they

1231
01:31:17.319 --> 01:31:20.119
<v Speaker 2>have an incentive to provide great service because you are

1232
01:31:20.119 --> 01:31:28.479
<v Speaker 2>the one paying them. Doctors become more engaged in potentially

1233
01:31:28.560 --> 01:31:35.359
<v Speaker 2>alternative solutions, more interested in finding alternative means to solve problems.

1234
01:31:35.840 --> 01:31:39.279
<v Speaker 2>They become much more engaged in problem solving than just

1235
01:31:39.359 --> 01:31:47.079
<v Speaker 2>being bureaucrats. They become engaged, involved and responsible for your

1236
01:31:47.199 --> 01:31:54.760
<v Speaker 2>health together with you. So the whole system shifts. It

1237
01:31:54.920 --> 01:32:02.760
<v Speaker 2>becomes dynamic, interesting, exciting it and again, particularly if we

1238
01:32:02.880 --> 01:32:06.199
<v Speaker 2>get to shift to where the tear calls three point zero,

1239
01:32:06.399 --> 01:32:09.960
<v Speaker 2>where the doctor now becomes your consultant on staying healthy.

1240
01:32:11.600 --> 01:32:16.479
<v Speaker 2>It can become fun, experimental, It becomes something that even

1241
01:32:16.479 --> 01:32:20.600
<v Speaker 2>as a consumer you embrace and look forward to, versus

1242
01:32:20.680 --> 01:32:22.960
<v Speaker 2>going to the doctor. Now, when you go it's typically

1243
01:32:23.000 --> 01:32:27.319
<v Speaker 2>because you're sick. Imagine going to doctor in order to

1244
01:32:27.359 --> 01:32:36.159
<v Speaker 2>stay healthy, in order to stay fit. You would see,

1245
01:32:37.039 --> 01:32:40.840
<v Speaker 2>you know, new drugs on the market, new medical techniques,

1246
01:32:41.840 --> 01:32:49.239
<v Speaker 2>new medical devices, new procedures, and a general orientation towards health,

1247
01:32:51.279 --> 01:32:56.079
<v Speaker 2>a general orientation towards staying healthy, rather than the orientation

1248
01:32:56.680 --> 01:33:02.319
<v Speaker 2>of just you know, solving problems when the problem already

1249
01:33:02.359 --> 01:33:07.920
<v Speaker 2>exists and when solutions are limited. I think you'd see

1250
01:33:07.960 --> 01:33:10.960
<v Speaker 2>a lot more medical trials. I think, particularly if we

1251
01:33:11.039 --> 01:33:13.159
<v Speaker 2>have formed the way medical trials are done, which I

1252
01:33:13.199 --> 01:33:16.399
<v Speaker 2>think needs to be done in dramatic fashion. A lot

1253
01:33:16.479 --> 01:33:19.680
<v Speaker 2>more medical trials, a lot more experimentation. I mean, we

1254
01:33:19.880 --> 01:33:23.960
<v Speaker 2>are I believe on the costs potentially of just a

1255
01:33:24.079 --> 01:33:29.680
<v Speaker 2>revolution in not just prevention, which I think again people

1256
01:33:29.800 --> 01:33:33.760
<v Speaker 2>like a t leading, but of treatment. You know, whether

1257
01:33:33.840 --> 01:33:42.840
<v Speaker 2>it's vaccines against cancer, immuno therapeutic, all kinds of immuno

1258
01:33:42.960 --> 01:33:47.199
<v Speaker 2>therapies where we teach our body or train our body,

1259
01:33:47.399 --> 01:33:50.560
<v Speaker 2>or induce our body to fight the cancer, which is

1260
01:33:50.600 --> 01:33:56.520
<v Speaker 2>what the vaccines do, or whether it's massive amounts of

1261
01:33:57.479 --> 01:34:01.520
<v Speaker 2>new drugs in the pipeline to treat autoimmune diseases, which

1262
01:34:01.600 --> 01:34:11.840
<v Speaker 2>could be major evolutions, major evolutions. So you know, again

1263
01:34:12.279 --> 01:34:16.960
<v Speaker 2>we could see life expectancy, but more importantly, the quality

1264
01:34:17.000 --> 01:34:21.560
<v Speaker 2>of life dramatically improve now. And I want to say this.

1265
01:34:21.680 --> 01:34:24.079
<v Speaker 2>I think it's important to say this to finish off.

1266
01:34:26.840 --> 01:34:29.319
<v Speaker 2>In spite of all the problems that medical system has today,

1267
01:34:29.560 --> 01:34:32.399
<v Speaker 2>and it has big ones, particularly when you think about

1268
01:34:32.399 --> 01:34:35.159
<v Speaker 2>the potential and what could be and how long we

1269
01:34:35.279 --> 01:34:38.600
<v Speaker 2>could live and how well we could live. What is

1270
01:34:38.720 --> 01:34:41.720
<v Speaker 2>truly amazing. And this is a testament to the heroism

1271
01:34:41.800 --> 01:34:45.520
<v Speaker 2>and the dedication of doctors and researchers and scientists and

1272
01:34:45.520 --> 01:34:50.439
<v Speaker 2>pharmaceutical industry. Why I hate that tax on pharma. What

1273
01:34:50.640 --> 01:34:54.840
<v Speaker 2>is truly amazing is how much gets done, how much

1274
01:34:54.880 --> 01:34:59.479
<v Speaker 2>innovation is indeed happening. As I said, the American healthcare system.

1275
01:34:59.560 --> 01:35:02.479
<v Speaker 2>If you are sick, there's no better system in the

1276
01:35:02.520 --> 01:35:07.840
<v Speaker 2>world to be under. If you take away the light

1277
01:35:07.960 --> 01:35:11.760
<v Speaker 2>the stupid lifestyle choices that Americans make and if you

1278
01:35:11.960 --> 01:35:16.760
<v Speaker 2>just look at outcomes, if you get cancer, which healthcare

1279
01:35:16.800 --> 01:35:19.600
<v Speaker 2>system would you rather be in? It's not even close.

1280
01:35:20.359 --> 01:35:22.600
<v Speaker 2>You'd rather be in the US. If you had heart disease,

1281
01:35:22.640 --> 01:35:29.439
<v Speaker 2>which healthcare system would you rather be in? Now? So

1282
01:35:30.720 --> 01:35:35.960
<v Speaker 2>we have an amazing healthcare system, and if we make it,

1283
01:35:36.359 --> 01:35:41.039
<v Speaker 2>and if we make these changes, we can have a

1284
01:35:41.520 --> 01:35:46.119
<v Speaker 2>just an unbelievably amazing healthcare system. Health care system. I

1285
01:35:46.239 --> 01:35:53.239
<v Speaker 2>think there could be better, you know, uh, in extending

1286
01:35:53.279 --> 01:35:55.760
<v Speaker 2>our lives and more importantly in improving the quality of

1287
01:35:55.800 --> 01:35:59.640
<v Speaker 2>our lives than anything we can imagine today, anything we

1288
01:35:59.680 --> 01:36:13.199
<v Speaker 2>can aagine today. So it's yeah, I think it's super exciting.

1289
01:36:13.239 --> 01:36:16.840
<v Speaker 2>I think the potential is super exciting. The depressing part

1290
01:36:16.960 --> 01:36:21.479
<v Speaker 2>is that these things are very unpopular and almost impossible

1291
01:36:21.520 --> 01:36:24.159
<v Speaker 2>to get through, and there's no energy, there's no passion,

1292
01:36:24.600 --> 01:36:32.359
<v Speaker 2>there's no real drive to get big time healthcare reform done,

1293
01:36:32.439 --> 01:36:38.359
<v Speaker 2>particularly not dramatic, dramatic reform like I've articulated here. There's

1294
01:36:38.520 --> 01:36:41.800
<v Speaker 2>too much of this idea. It's not become inculcated in

1295
01:36:41.840 --> 01:36:44.520
<v Speaker 2>people's minds that healthcare is are right, which is the

1296
01:36:44.640 --> 01:36:47.520
<v Speaker 2>I think the biggest barrier to this, and therefore must

1297
01:36:47.560 --> 01:36:50.000
<v Speaker 2>be supplied by the government. Healthcare is are right in

1298
01:36:50.119 --> 01:36:52.720
<v Speaker 2>the sense that you have a right to go out

1299
01:36:52.760 --> 01:36:57.520
<v Speaker 2>and seek whatever treatment you want, as long as you're

1300
01:36:57.520 --> 01:36:58.760
<v Speaker 2>willing to pay for it and as long as the

1301
01:36:58.840 --> 01:37:09.119
<v Speaker 2>providers willing to provide it. All right, Yeah, hopefully that

1302
01:37:09.439 --> 01:37:16.359
<v Speaker 2>was useful, helpful, informative. And again there's this idea of

1303
01:37:16.439 --> 01:37:19.079
<v Speaker 2>a if we could just get medical saving accounts for everybody,

1304
01:37:21.640 --> 01:37:25.399
<v Speaker 2>that would be a huge leap forward. And there was

1305
01:37:25.479 --> 01:37:28.680
<v Speaker 2>work done on that, and some of it led by

1306
01:37:28.720 --> 01:37:33.199
<v Speaker 2>objectivists ten, fifteen, twenty years ago, but it never took off,

1307
01:37:34.359 --> 01:37:38.119
<v Speaker 2>partially because of massive regulations, and partially because msas were

1308
01:37:38.199 --> 01:37:42.920
<v Speaker 2>always limited, always constrained, and partially because it's hard to

1309
01:37:42.960 --> 01:37:45.680
<v Speaker 2>compete with employers who can just provide this. The employer

1310
01:37:46.479 --> 01:37:49.640
<v Speaker 2>tax deductability has to be eliminated, it has to be

1311
01:37:49.680 --> 01:37:58.079
<v Speaker 2>phased up. All right, Thank you guys, So we can

1312
01:37:58.159 --> 01:38:01.279
<v Speaker 2>go to our super chatter is. We've got a lot

1313
01:38:01.319 --> 01:38:03.880
<v Speaker 2>of questions here and we've done really well in super chat,

1314
01:38:03.960 --> 01:38:07.720
<v Speaker 2>primarily because Wes came in with five hundred dollars. Wes,

1315
01:38:07.960 --> 01:38:11.319
<v Speaker 2>thank you, thank you, thank you. This is fantastic. We're

1316
01:38:11.319 --> 01:38:13.680
<v Speaker 2>about fifty eight dollars short of where we need to

1317
01:38:13.760 --> 01:38:16.600
<v Speaker 2>be to get to our seven to fifty, which is

1318
01:38:16.640 --> 01:38:19.520
<v Speaker 2>the goal for a three hour show, and it's likely,

1319
01:38:19.600 --> 01:38:21.479
<v Speaker 2>given the number of questions, that will at least at

1320
01:38:21.560 --> 01:38:25.000
<v Speaker 2>least enter into the third hour, but we will see.

1321
01:38:25.159 --> 01:38:27.920
<v Speaker 2>Actually not that many questions, so maybe not. But anyway,

1322
01:38:28.159 --> 01:38:32.000
<v Speaker 2>we're doing great, So thank you. Let's see what do

1323
01:38:32.079 --> 01:38:34.159
<v Speaker 2>I wanna what I want to remind you of. I

1324
01:38:34.159 --> 01:38:35.840
<v Speaker 2>want to remind you of that you can become a

1325
01:38:35.880 --> 01:38:39.079
<v Speaker 2>monthly support of the show by going to patreon dot

1326
01:38:39.159 --> 01:38:43.680
<v Speaker 2>com and putting on the irun Book Show and a

1327
01:38:43.880 --> 01:38:47.359
<v Speaker 2>huge value that it is. It is a huge It's

1328
01:38:47.399 --> 01:38:49.079
<v Speaker 2>where most of the money comes for the show is

1329
01:38:49.079 --> 01:38:52.479
<v Speaker 2>from PayPal and Patreon, and it's what keeps the show going.

1330
01:38:53.199 --> 01:38:56.479
<v Speaker 2>And you know you can express your values that way

1331
01:38:56.560 --> 01:38:58.880
<v Speaker 2>and that way if you're listening on a podcast, if

1332
01:38:58.920 --> 01:39:01.800
<v Speaker 2>you sometimes arelive, some times not doing a super chest

1333
01:39:01.880 --> 01:39:05.159
<v Speaker 2>sometimes sometimes not that way, you know that you are

1334
01:39:05.279 --> 01:39:08.119
<v Speaker 2>trading value for value by supporting the show. And at

1335
01:39:08.199 --> 01:39:11.520
<v Speaker 2>ten dollars a month or more, you get to listen

1336
01:39:11.560 --> 01:39:15.199
<v Speaker 2>to the podcast ad free with no advertising, and you

1337
01:39:15.279 --> 01:39:17.359
<v Speaker 2>can listen to the podcast on any podcast app you

1338
01:39:17.439 --> 01:39:21.520
<v Speaker 2>want ad free. If you go do it through Patreon

1339
01:39:21.760 --> 01:39:25.840
<v Speaker 2>and ten dollars for ten dollars or more. I also

1340
01:39:25.920 --> 01:39:28.000
<v Speaker 2>want to remind you that we have two sponsors, Alex

1341
01:39:28.039 --> 01:39:34.319
<v Speaker 2>Epstein alex Epstein substack dot com. Alex provides the best

1342
01:39:34.399 --> 01:39:38.680
<v Speaker 2>talking points, the best information, the best knowledge about what's

1343
01:39:38.720 --> 01:39:43.199
<v Speaker 2>going on in energy, in environmentalism and climate change that

1344
01:39:43.279 --> 01:39:46.680
<v Speaker 2>you will find anyway. So check out Alex Epstein dot

1345
01:39:46.960 --> 01:39:50.840
<v Speaker 2>substack dot com, check out his talking points because check

1346
01:39:50.880 --> 01:39:54.840
<v Speaker 2>out is alex ai for information about this. Make yourself

1347
01:39:55.600 --> 01:39:59.319
<v Speaker 2>better educated and more importantly or not more importantly as

1348
01:39:59.359 --> 01:40:04.359
<v Speaker 2>importantly a better communicator of what you know about these

1349
01:40:04.439 --> 01:40:08.239
<v Speaker 2>topics with the help of Alex, the world's expert on

1350
01:40:08.359 --> 01:40:12.800
<v Speaker 2>these things. And then the Iron Institute is looking for

1351
01:40:12.920 --> 01:40:16.000
<v Speaker 2>people who would like to come to Austin, Texas for

1352
01:40:16.239 --> 01:40:20.760
<v Speaker 2>a in depth weekend in depth study of objectivism with

1353
01:40:20.920 --> 01:40:26.399
<v Speaker 2>people like professors like Greg Selmerian Binbert and others who

1354
01:40:27.039 --> 01:40:30.640
<v Speaker 2>will take you deep into the philosophy of objectivism. You'll

1355
01:40:30.680 --> 01:40:33.039
<v Speaker 2>be there with other students. It'll be a blast, particularly

1356
01:40:33.079 --> 01:40:36.039
<v Speaker 2>people who have an interest in becoming maybe maybe not

1357
01:40:36.159 --> 01:40:40.039
<v Speaker 2>even for sure, but maybe professional intellectuals one day, professionally

1358
01:40:40.039 --> 01:40:44.760
<v Speaker 2>intellexos one day you should consider Austin, Texas, late February,

1359
01:40:45.720 --> 01:40:50.119
<v Speaker 2>a weekend conference, all expenses paid. But to do that

1360
01:40:50.239 --> 01:40:52.199
<v Speaker 2>you have to apply for scholarship. To apply for scholarship,

1361
01:40:52.279 --> 01:40:56.920
<v Speaker 2>go to iron ran dot org slash dot here iron

1362
01:40:57.000 --> 01:41:04.600
<v Speaker 2>ran dot org slash start here. All right, so let's uh,

1363
01:41:04.880 --> 01:41:07.760
<v Speaker 2>let's look it out super chat and cover that and

1364
01:41:08.000 --> 01:41:17.399
<v Speaker 2>see where we go from there. And we will start

1365
01:41:17.439 --> 01:41:22.880
<v Speaker 2>with Wes. Five hundred dollars really really appreciated. Wes a regular,

1366
01:41:23.840 --> 01:41:27.640
<v Speaker 2>ongoing super Chat supporter of the Iron Books show and

1367
01:41:29.159 --> 01:41:33.319
<v Speaker 2>just just steady, regular amazing and then you know, once

1368
01:41:33.359 --> 01:41:35.520
<v Speaker 2>in a while a big chunk like five hundred dollars

1369
01:41:35.600 --> 01:41:38.960
<v Speaker 2>that that is. You know, it really motivates me to

1370
01:41:39.039 --> 01:41:41.279
<v Speaker 2>do shows like this that not only do we have

1371
01:41:41.359 --> 01:41:44.359
<v Speaker 2>sponsors for, but we also didn't have somebody like West

1372
01:41:44.399 --> 01:41:46.520
<v Speaker 2>willing to put a lot of money in for it.

1373
01:41:46.640 --> 01:41:47.960
<v Speaker 2>It's not going to get a show like this is

1374
01:41:48.000 --> 01:41:50.239
<v Speaker 2>not going to get the most views. My Immigration to

1375
01:41:50.359 --> 01:41:52.840
<v Speaker 2>China shows did not get the most views because people

1376
01:41:53.039 --> 01:41:56.479
<v Speaker 2>like the newsy stuff. They like the the controversial stuff,

1377
01:41:57.640 --> 01:42:00.800
<v Speaker 2>and they're not interested in the solutions. Necess certainly they're

1378
01:42:00.880 --> 01:42:04.800
<v Speaker 2>interested in the in the angst, in the in the controversy,

1379
01:42:04.960 --> 01:42:08.560
<v Speaker 2>and the bash the bashed the left kind of stuff

1380
01:42:08.640 --> 01:42:11.760
<v Speaker 2>or bashed Trump kind of stuff. UH. So I appreciate

1381
01:42:11.800 --> 01:42:15.159
<v Speaker 2>it when I do a show focused on solutions, uh,

1382
01:42:15.319 --> 01:42:18.840
<v Speaker 2>focused on on potential solutions, that it gets so much support.

1383
01:42:18.960 --> 01:42:22.840
<v Speaker 2>All right, Wes says, I am a data analyst that

1384
01:42:22.960 --> 01:42:25.920
<v Speaker 2>has worked with some of the largest healthcare systems in

1385
01:42:26.079 --> 01:42:29.720
<v Speaker 2>the country. The whole system is so convoluted. I can

1386
01:42:29.760 --> 01:42:32.920
<v Speaker 2>say that almost no one knows how hospitals actually make money,

1387
01:42:33.159 --> 01:42:37.119
<v Speaker 2>including the people who work in the industry. Yes, I mean,

1388
01:42:37.520 --> 01:42:40.079
<v Speaker 2>I mean basically, hospitals make money by charging more than

1389
01:42:40.279 --> 01:42:44.560
<v Speaker 2>they spend. But here's the thing. A lot of times

1390
01:42:44.640 --> 01:42:51.399
<v Speaker 2>hospital will lose money on the Medicaid patients and then

1391
01:42:51.560 --> 01:42:55.560
<v Speaker 2>make money on their private insurance patients. And in some

1392
01:42:55.720 --> 01:42:58.520
<v Speaker 2>cases they might lose money on some procedures and make

1393
01:42:58.600 --> 01:43:02.800
<v Speaker 2>money on other procedures. And the whole thing is convoluted

1394
01:43:02.840 --> 01:43:06.520
<v Speaker 2>by the fact that there's no pricing transparency because the

1395
01:43:06.680 --> 01:43:11.560
<v Speaker 2>customer don't care about prices, so hospitals come up with

1396
01:43:11.720 --> 01:43:18.319
<v Speaker 2>all these They're acquired by law to have prices for everything,

1397
01:43:19.640 --> 01:43:23.680
<v Speaker 2>so they basically have prices that are ridiculous. I heard

1398
01:43:24.119 --> 01:43:29.760
<v Speaker 2>sixteen dollars gauze a gauze patch right now, nobody actually

1399
01:43:29.800 --> 01:43:32.720
<v Speaker 2>pays sixteen dollars to the gauze, but that's the price

1400
01:43:33.119 --> 01:43:35.880
<v Speaker 2>that the hospital lists. I guess you pay the sixteen

1401
01:43:35.920 --> 01:43:37.640
<v Speaker 2>dollar gaus. If you go in and say i'll pay

1402
01:43:37.720 --> 01:43:40.439
<v Speaker 2>cash and you don't negotiate with them, then maybe you'll

1403
01:43:40.479 --> 01:43:44.439
<v Speaker 2>pay the sixteen dollars. But that's because why not have

1404
01:43:44.680 --> 01:43:48.640
<v Speaker 2>the highest prices possible on your website and then kind

1405
01:43:48.680 --> 01:43:50.439
<v Speaker 2>of not on your website, but because they don't do

1406
01:43:50.560 --> 01:43:52.399
<v Speaker 2>it on their website, but has as they on their

1407
01:43:52.439 --> 01:43:56.039
<v Speaker 2>price sheet, and then they sit down with the insurance

1408
01:43:56.079 --> 01:44:01.640
<v Speaker 2>companies and they negotiate down from that and a lot

1409
01:44:01.680 --> 01:44:05.039
<v Speaker 2>of it. The way it's paid is not paid by item,

1410
01:44:05.760 --> 01:44:08.640
<v Speaker 2>but paid by procedure, and then before it includes all

1411
01:44:08.680 --> 01:44:12.479
<v Speaker 2>the things that go into the procedure. So Bye bys surgery,

1412
01:44:13.399 --> 01:44:15.760
<v Speaker 2>all the all the hard way involved in a bite

1413
01:44:15.760 --> 01:44:18.279
<v Speaker 2>by surgery is going to be is going to be

1414
01:44:18.520 --> 01:44:21.920
<v Speaker 2>paid in bulk. There's a price for that, and then

1415
01:44:22.239 --> 01:44:27.279
<v Speaker 2>the doctor gets paid and the staff gets paid. Do

1416
01:44:27.319 --> 01:44:29.680
<v Speaker 2>you know how much a doctor gets for bye by surgery?

1417
01:44:30.039 --> 01:44:34.760
<v Speaker 2>Something like between a thousand and two thousand dollars. That's

1418
01:44:34.760 --> 01:44:36.960
<v Speaker 2>how much he's reimbossed by an insurance company for bye

1419
01:44:36.960 --> 01:44:40.039
<v Speaker 2>By surgery. And you'd think it would be a lot

1420
01:44:40.119 --> 01:44:44.319
<v Speaker 2>more than that, right, given I want to pay the

1421
01:44:44.399 --> 01:44:47.680
<v Speaker 2>guy who's doing who's opening me up and playing around

1422
01:44:47.720 --> 01:44:49.880
<v Speaker 2>inside of me with my heart, I want to pay

1423
01:44:49.960 --> 01:44:52.720
<v Speaker 2>him a lot of money. I wanted to get a

1424
01:44:52.760 --> 01:44:56.159
<v Speaker 2>lot of money because I wanted to do a good job.

1425
01:44:58.439 --> 01:44:59.800
<v Speaker 2>But they do a lot of them, so they make

1426
01:44:59.800 --> 01:45:03.439
<v Speaker 2>a lot of money at the end. But and a

1427
01:45:03.520 --> 01:45:05.840
<v Speaker 2>thousand dollars might a thousand and two thousand dollars might

1428
01:45:05.920 --> 01:45:08.920
<v Speaker 2>include all the meetings you had before and all their

1429
01:45:09.159 --> 01:45:12.199
<v Speaker 2>post up meetings you have with them. It's pretty amazing

1430
01:45:12.279 --> 01:45:20.159
<v Speaker 2>how cheap it really is. So the pricing. So they

1431
01:45:20.199 --> 01:45:22.800
<v Speaker 2>have a whole thing where they negotiate with insurance companies

1432
01:45:23.720 --> 01:45:25.760
<v Speaker 2>so when you go into the hospital. So when I

1433
01:45:25.840 --> 01:45:28.439
<v Speaker 2>was in hospital, I got a bill from the hospital

1434
01:45:28.520 --> 01:45:32.720
<v Speaker 2>even though I wasn't paying, I didn't care, And it

1435
01:45:33.319 --> 01:45:35.239
<v Speaker 2>was like absurd. It was like half a million dollars.

1436
01:45:35.319 --> 01:45:37.000
<v Speaker 2>I was in the hospital for like five six days,

1437
01:45:38.199 --> 01:45:41.720
<v Speaker 2>I think six days half a million dollars, and I

1438
01:45:41.760 --> 01:45:44.600
<v Speaker 2>think the insurance companies maybe paid one hundred and fifty thousand,

1439
01:45:45.720 --> 01:45:49.000
<v Speaker 2>and given what was done to me. Then, given the

1440
01:45:49.039 --> 01:45:50.760
<v Speaker 2>service I got and given everything else, that's not a

1441
01:45:50.840 --> 01:45:53.279
<v Speaker 2>lot of money. I don't think for the five days

1442
01:45:53.399 --> 01:45:56.840
<v Speaker 2>six days at back surgery. But it was complicated back surgery,

1443
01:45:56.840 --> 01:45:58.840
<v Speaker 2>and it took hours and hours and hours, and I

1444
01:45:58.840 --> 01:46:00.840
<v Speaker 2>don't know how much the doctor got it. I hope

1445
01:46:00.880 --> 01:46:02.199
<v Speaker 2>he got a lot of money, because he spent the

1446
01:46:02.239 --> 01:46:04.760
<v Speaker 2>whole day just on me, like it was a nine

1447
01:46:04.880 --> 01:46:07.840
<v Speaker 2>hour surgery, and then he had to go back in

1448
01:46:07.960 --> 01:46:11.560
<v Speaker 2>two days later for another four hours.

1449
01:46:11.600 --> 01:46:11.840
<v Speaker 1>I think.

1450
01:46:12.720 --> 01:46:15.960
<v Speaker 2>I mean, that's a lot of time. I mean, I

1451
01:46:16.119 --> 01:46:18.000
<v Speaker 2>hope he got paid a lot of money for it.

1452
01:46:18.800 --> 01:46:23.479
<v Speaker 2>Probably not so. Anyway, there's a convoluted way in which

1453
01:46:23.560 --> 01:46:28.239
<v Speaker 2>that's paid. And then Medicare sits down with hospital and says,

1454
01:46:28.600 --> 01:46:31.840
<v Speaker 2>this is how much we're willing to pay, and sometimes

1455
01:46:31.920 --> 01:46:36.560
<v Speaker 2>Medicare probably overpays. Sometimes that underpays, and the hospital has

1456
01:46:36.600 --> 01:46:39.800
<v Speaker 2>to take into account what Medicare is paying them in

1457
01:46:39.960 --> 01:46:41.520
<v Speaker 2>order to figure out how much they can afford of

1458
01:46:41.520 --> 01:46:49.720
<v Speaker 2>a discount to give the the private insurance companies. And

1459
01:46:49.720 --> 01:46:52.520
<v Speaker 2>the same thing with drug prices. Drug prices are listed

1460
01:46:52.600 --> 01:46:58.159
<v Speaker 2>at these incredible rates, but then the insurance companies get

1461
01:46:58.199 --> 01:47:04.760
<v Speaker 2>discounts and the pharmacies get discounts and individuals get discounts.

1462
01:47:05.640 --> 01:47:08.640
<v Speaker 2>And I don't know a lot of drugs I see

1463
01:47:08.640 --> 01:47:10.399
<v Speaker 2>out there in the market, you know, the ones that

1464
01:47:10.479 --> 01:47:14.800
<v Speaker 2>are popular and maybe out of patent, unbelievably cheap, a

1465
01:47:14.880 --> 01:47:18.479
<v Speaker 2>buck of pill, less than a buck of pill. Sometimes

1466
01:47:18.520 --> 01:47:22.640
<v Speaker 2>you just get them free. The insurance is covering all

1467
01:47:22.680 --> 01:47:26.039
<v Speaker 2>of it. I mean, it's bizarre, and so price becomes

1468
01:47:27.479 --> 01:47:34.279
<v Speaker 2>it becomes meaningless instead of private individuals actually seeing a price,

1469
01:47:35.159 --> 01:47:42.399
<v Speaker 2>choosing partially based on price, you know, paying their doctor directly,

1470
01:47:43.840 --> 01:47:47.560
<v Speaker 2>and the insurance stepping in with only oh, you know,

1471
01:47:47.720 --> 01:47:50.840
<v Speaker 2>the real massive amounts you had to go to hospital.

1472
01:47:50.880 --> 01:47:53.880
<v Speaker 2>You didn't expect the one hundred thousand and a million

1473
01:47:53.920 --> 01:47:56.880
<v Speaker 2>dollar cancer treatment. Stuff like that is where the insurance

1474
01:47:56.920 --> 01:48:00.159
<v Speaker 2>companies and they they are fine with it because they

1475
01:48:00.239 --> 01:48:05.520
<v Speaker 2>priced it is catastrophic they know. And then there's less

1476
01:48:06.239 --> 01:48:08.560
<v Speaker 2>than out of coverage because it's understood what the insurance

1477
01:48:08.680 --> 01:48:18.720
<v Speaker 2>is for. So yeah, it's unbelievably convoluted, unbelievably complex because

1478
01:48:18.760 --> 01:48:23.680
<v Speaker 2>it's trying to do what cannot be done, which is,

1479
01:48:24.039 --> 01:48:26.960
<v Speaker 2>you know, have a third party allocator fund all these

1480
01:48:27.079 --> 01:48:31.600
<v Speaker 2>things that it shouldn't be funding. You're trying to fit

1481
01:48:31.720 --> 01:48:37.560
<v Speaker 2>into an insurance model something that's clearly not insurance, and

1482
01:48:38.079 --> 01:48:40.279
<v Speaker 2>that just makes no sense and it provides all the

1483
01:48:40.359 --> 01:48:49.000
<v Speaker 2>wrong incentives to individuals. Thank yous, all right, Andrew fifty dollars.

1484
01:48:50.960 --> 01:48:53.840
<v Speaker 2>Any honest economist knows that free market's lower prices and

1485
01:48:53.920 --> 01:49:00.199
<v Speaker 2>increase quality. Yet mainstream intellectuals, according Rand, practically catatonic when

1486
01:49:00.239 --> 01:49:02.960
<v Speaker 2>it comes to capitalism. Health Care is too important to

1487
01:49:03.039 --> 01:49:08.560
<v Speaker 2>be left of markets, They say, what say you, well,

1488
01:49:08.720 --> 01:49:12.960
<v Speaker 2>I mean health care is too important not to be

1489
01:49:13.800 --> 01:49:15.479
<v Speaker 2>left of markets. The same with the education, the same

1490
01:49:15.520 --> 01:49:22.560
<v Speaker 2>with everything. You know, help government is force, government is coursion,

1491
01:49:22.600 --> 01:49:25.880
<v Speaker 2>and a gun cursion and a gun have no room

1492
01:49:25.960 --> 01:49:28.279
<v Speaker 2>in the doctor's office. They have no place in the

1493
01:49:28.359 --> 01:49:34.000
<v Speaker 2>operating room. They have no place in drug development. So

1494
01:49:35.039 --> 01:49:39.520
<v Speaker 2>what you want a market's? Now, well, markets always lower costs,

1495
01:49:39.880 --> 01:49:43.920
<v Speaker 2>I mean yeah, for equal quality, but quality might go

1496
01:49:44.079 --> 01:49:47.880
<v Speaker 2>up and cost might increase. And the point about health

1497
01:49:47.920 --> 01:49:53.039
<v Speaker 2>care being expensive is for whom like I get it

1498
01:49:53.119 --> 01:49:59.520
<v Speaker 2>that Medicare Medicaid are unsustainable, and they are unsustainable, But

1499
01:50:01.159 --> 01:50:06.279
<v Speaker 2>you know, is healthcare is how much of your budget

1500
01:50:06.319 --> 01:50:09.800
<v Speaker 2>as an individual would you be willing to spend on healthcare?

1501
01:50:14.000 --> 01:50:19.239
<v Speaker 2>You know, a lot. What percentage of your lifetime income

1502
01:50:20.640 --> 01:50:26.920
<v Speaker 2>are you willing to spend to be healthy? I don't know.

1503
01:50:27.119 --> 01:50:30.159
<v Speaker 2>Some people spend, and I don't think this is outrageous

1504
01:50:30.920 --> 01:50:34.159
<v Speaker 2>twenty five percent of their income to stay healthy and

1505
01:50:34.560 --> 01:50:39.239
<v Speaker 2>to treat diseases when they crop up? Is that unreasonable?

1506
01:50:39.840 --> 01:50:43.399
<v Speaker 2>Other people spend a fraction of that. But what's the

1507
01:50:43.520 --> 01:50:47.159
<v Speaker 2>right number? Well, only the individual can decide what the

1508
01:50:47.239 --> 01:50:50.560
<v Speaker 2>right number to spend on healthcare. Healthcare is not expensive.

1509
01:50:51.720 --> 01:50:54.279
<v Speaker 2>Seventeen point six percent of GDP? Is that a lot?

1510
01:50:54.680 --> 01:50:55.079
<v Speaker 2>I don't know.

1511
01:50:55.640 --> 01:50:56.119
<v Speaker 1>Is that a lot?

1512
01:50:56.920 --> 01:50:59.239
<v Speaker 2>I don't know. That's not what troubles me. It's not

1513
01:50:59.359 --> 01:51:02.039
<v Speaker 2>troubles me if if twenty percent of GDP is spent

1514
01:51:02.119 --> 01:51:04.760
<v Speaker 2>on healthcare, that doesn't worry me. Well, why is me

1515
01:51:04.960 --> 01:51:11.079
<v Speaker 2>is that government is spending it, and it has no

1516
01:51:11.279 --> 01:51:15.680
<v Speaker 2>means by which to pay it off other than to

1517
01:51:16.920 --> 01:51:20.039
<v Speaker 2>you know, and and all it's doing when government is

1518
01:51:20.039 --> 01:51:22.319
<v Speaker 2>spending it is redistributing wealth, which I think is evil

1519
01:51:22.359 --> 01:51:25.760
<v Speaker 2>and wrong, and and on top of being evil and

1520
01:51:25.880 --> 01:51:30.840
<v Speaker 2>wrong andymol inefficient. So what I want is a system

1521
01:51:30.880 --> 01:51:35.680
<v Speaker 2>that gets rid of redistribution, gets rid of the cross subsidization.

1522
01:51:36.079 --> 01:51:38.359
<v Speaker 2>Now again, you can't do that all once, so you're

1523
01:51:38.359 --> 01:51:41.359
<v Speaker 2>gonna have to subsidize over time in order to get

1524
01:51:41.439 --> 01:51:45.119
<v Speaker 2>rid of the subsidies ultimately. But the worst kind of subsidies,

1525
01:51:45.680 --> 01:51:48.319
<v Speaker 2>and this is I think an important point, generally, the

1526
01:51:48.439 --> 01:51:53.239
<v Speaker 2>worst kind of subsidies are the hidden subsidies explicit out

1527
01:51:53.319 --> 01:51:59.560
<v Speaker 2>there here. It is, you know, Eavy Electric, call you

1528
01:51:59.680 --> 01:52:02.039
<v Speaker 2>by the gouvernment gives you a two thousand and our check.

1529
01:52:02.239 --> 01:52:04.720
<v Speaker 2>All right, we get that, we might not like it,

1530
01:52:05.000 --> 01:52:09.319
<v Speaker 2>but we get it. But when the subsidies involved, well,

1531
01:52:09.640 --> 01:52:12.319
<v Speaker 2>we're going to actually subsidize the battery and we're going

1532
01:52:12.399 --> 01:52:19.800
<v Speaker 2>to subsidize the development of whatever. If you look at

1533
01:52:19.840 --> 01:52:23.840
<v Speaker 2>EV subsidies, for example, of the subsidies are hidden, you

1534
01:52:23.960 --> 01:52:26.880
<v Speaker 2>never see them. What you see is just the tax

1535
01:52:26.960 --> 01:52:29.039
<v Speaker 2>advantage that the gunment gives you to buy an EV.

1536
01:52:29.560 --> 01:52:32.119
<v Speaker 2>But that's not the main subsidy. The main subsidies all

1537
01:52:32.199 --> 01:52:34.399
<v Speaker 2>kind of little things that are inside those are the

1538
01:52:34.439 --> 01:52:38.279
<v Speaker 2>ones that do the real damage, because those we don't

1539
01:52:38.279 --> 01:52:41.600
<v Speaker 2>even know exist. So get rid of those, and then

1540
01:52:42.159 --> 01:52:49.159
<v Speaker 2>then we can phase out the known subsidies. So many

1541
01:52:49.199 --> 01:52:56.279
<v Speaker 2>can't medicate huge subsidies, huge subsidies, super inefficient subsidies, super

1542
01:52:56.359 --> 01:52:59.039
<v Speaker 2>distortive subsidies because they start the whole market for healthcare

1543
01:53:00.119 --> 01:53:04.239
<v Speaker 2>by voucherrousing them. You still subsidize, but now the subsidy

1544
01:53:04.319 --> 01:53:07.079
<v Speaker 2>is explicit. Everybody knows how much it costs per person,

1545
01:53:07.720 --> 01:53:12.720
<v Speaker 2>and those vultures are used in a private economy in

1546
01:53:12.840 --> 01:53:19.279
<v Speaker 2>a lesser stortive way. Now, the supply side of healthcare

1547
01:53:19.479 --> 01:53:24.479
<v Speaker 2>response to demand directly, not through some government entity or

1548
01:53:24.640 --> 01:53:27.640
<v Speaker 2>through some kind of employer provided a third party payer,

1549
01:53:28.399 --> 01:53:32.399
<v Speaker 2>but directly. And again then you have a means also

1550
01:53:32.479 --> 01:53:34.159
<v Speaker 2>to phase it out. You have a means to get

1551
01:53:34.239 --> 01:53:36.000
<v Speaker 2>rid of it. That is, you just reduce the subsidy

1552
01:53:36.039 --> 01:53:44.760
<v Speaker 2>every year, you make it smaller. All right, thank you, Andrew.

1553
01:53:45.159 --> 01:53:51.000
<v Speaker 2>All right, John, are you familiar with former Rand fan

1554
01:53:51.279 --> 01:53:54.680
<v Speaker 2>John Goodman, whose policy ensued promote healthcare form. Yes, I

1555
01:53:54.720 --> 01:53:59.760
<v Speaker 2>think it's in Dallas. I know John, We've talked periodically

1556
01:53:59.800 --> 01:54:04.239
<v Speaker 2>over years. He's quite good on certain things, you know.

1557
01:54:04.479 --> 01:54:08.359
<v Speaker 2>He Unfortunately he's abandoned Ie Randa a long time ago,

1558
01:54:09.560 --> 01:54:15.720
<v Speaker 2>and is a little too forgiving of government intervention in

1559
01:54:15.760 --> 01:54:19.960
<v Speaker 2>the economy, government intervention in healthcare too moderate when it

1560
01:54:20.000 --> 01:54:22.000
<v Speaker 2>comes to that. Some of you consider me too moderate

1561
01:54:22.479 --> 01:54:25.680
<v Speaker 2>in my reform proposals. But he's even moderate, more moderate

1562
01:54:25.720 --> 01:54:27.560
<v Speaker 2>to me, but on the other hand has a deep

1563
01:54:27.640 --> 01:54:32.119
<v Speaker 2>understanding of the field, often has interesting solutions to particular problems.

1564
01:54:32.760 --> 01:54:36.119
<v Speaker 2>And it is one of the people working towards making

1565
01:54:36.199 --> 01:54:39.079
<v Speaker 2>healthcare free. And I give him credit for that. And

1566
01:54:39.319 --> 01:54:43.000
<v Speaker 2>we need a lot more think tanks institutes that are

1567
01:54:43.079 --> 01:54:44.960
<v Speaker 2>dedicated to things like that. There were a number of

1568
01:54:45.079 --> 01:54:50.159
<v Speaker 2>good free market healthcare institute. The one run by objectivists

1569
01:54:50.239 --> 01:54:56.560
<v Speaker 2>is AFCAM. I mispronounced its name last time. It was

1570
01:54:57.840 --> 01:55:01.960
<v Speaker 2>Americans for Freedom of in Medicine. I think American's Freedom

1571
01:55:01.960 --> 01:55:04.359
<v Speaker 2>of Choice in medicine. Somebody correct me on the chat

1572
01:55:04.399 --> 01:55:08.439
<v Speaker 2>if I'm wrong. They're an objectives to run organization. Amy

1573
01:55:08.439 --> 01:55:12.199
<v Speaker 2>Schidlog is part of it. We've got one of our

1574
01:55:12.680 --> 01:55:16.399
<v Speaker 2>scholars at the Inran Institute is running it these days.

1575
01:55:19.079 --> 01:55:23.560
<v Speaker 2>Ray and Ray sure and yeah, I mean it's going

1576
01:55:23.600 --> 01:55:26.880
<v Speaker 2>to be exciting as Ray ramps up what they do

1577
01:55:27.199 --> 01:55:33.560
<v Speaker 2>to see how they start trying to influence the healthcare system.

1578
01:55:34.680 --> 01:55:38.359
<v Speaker 2>We will have somebody from AFGHAM on the show later

1579
01:55:38.720 --> 01:55:41.960
<v Speaker 2>this month. They will be sponsoring a show to talk

1580
01:55:42.000 --> 01:55:47.720
<v Speaker 2>about their approach to privatizing healthcare, to fixing healthcare in

1581
01:55:47.720 --> 01:55:54.079
<v Speaker 2>the United States. So you'll get a perspective of doctors

1582
01:55:54.119 --> 01:55:58.720
<v Speaker 2>and physicians and people in the field, rather than my perspective,

1583
01:55:58.760 --> 01:56:06.840
<v Speaker 2>which is as a economist inspired by a philosophy Jason.

1584
01:56:07.520 --> 01:56:12.039
<v Speaker 2>Europe would have us believe you have the public mandate

1585
01:56:12.159 --> 01:56:15.800
<v Speaker 2>insurance eight percent of income, but you can go to

1586
01:56:15.880 --> 01:56:18.920
<v Speaker 2>a private doctor and pay out of pocket and it

1587
01:56:19.079 --> 01:56:22.079
<v Speaker 2>is still far more affordable than the United States, granted

1588
01:56:22.720 --> 01:56:30.960
<v Speaker 2>not the male clinic. So I don't think that's true.

1589
01:56:32.000 --> 01:56:36.840
<v Speaker 2>It's probably true of a lot of day to day stuff.

1590
01:56:36.960 --> 01:56:40.960
<v Speaker 2>I don't think it's true when it comes to big

1591
01:56:41.039 --> 01:56:47.640
<v Speaker 2>items heart disease, cancer, autoimmune diseases, Alzheimer's. I just don't

1592
01:56:47.840 --> 01:56:57.079
<v Speaker 2>think that's true. But look what Europe does. What Europe

1593
01:56:57.119 --> 01:57:07.680
<v Speaker 2>does is Europe basically places restrict supply. It places constraints

1594
01:57:07.720 --> 01:57:13.319
<v Speaker 2>and supply, and therefore that is a that is a

1595
01:57:13.399 --> 01:57:16.159
<v Speaker 2>way for them. Then they do that with price controls.

1596
01:57:17.039 --> 01:57:19.800
<v Speaker 2>That is a way for them to they so they

1597
01:57:19.960 --> 01:57:25.079
<v Speaker 2>ration Europe and socialized medicine JET generally is a rationing

1598
01:57:25.199 --> 01:57:29.439
<v Speaker 2>mechanism and that's how they keep prices under control. And

1599
01:57:29.960 --> 01:57:33.199
<v Speaker 2>so it's cheap in the system because it's it's a

1600
01:57:33.279 --> 01:57:36.800
<v Speaker 2>rational system. Because a suppliers will only provide so much

1601
01:57:37.000 --> 01:57:40.039
<v Speaker 2>at those prices, so I guess you can go to

1602
01:57:40.079 --> 01:57:44.720
<v Speaker 2>a doctor and get stuff on top of that. I

1603
01:57:44.800 --> 01:57:46.600
<v Speaker 2>haven't run the numbers. I don't know what it would

1604
01:57:46.640 --> 01:57:50.600
<v Speaker 2>cost uh, and it could be. I mean, our employer

1605
01:57:50.720 --> 01:57:54.159
<v Speaker 2>based insurance system is very, very, very expensive postively for

1606
01:57:54.239 --> 01:57:57.600
<v Speaker 2>the reasons Wes said. It's so convoluted that nobody knows

1607
01:57:57.640 --> 01:58:03.520
<v Speaker 2>what anything costs, and there's a huge amount of waste,

1608
01:58:04.199 --> 01:58:06.760
<v Speaker 2>and there's a massive amount of bureaucracy, and the reality

1609
01:58:06.920 --> 01:58:09.319
<v Speaker 2>is that there is a sense in which like the

1610
01:58:09.439 --> 01:58:12.800
<v Speaker 2>NHS has less bureaucracy than the American elcare system because

1611
01:58:12.800 --> 01:58:21.880
<v Speaker 2>it's so convoluted. Single payer is simpler. You want an MRI, fine,

1612
01:58:22.760 --> 01:58:25.760
<v Speaker 2>you don't stand in the queue. But it's simpler in

1613
01:58:25.840 --> 01:58:31.079
<v Speaker 2>the sense that we don't have negotiate prices. We don't

1614
01:58:31.119 --> 01:58:33.720
<v Speaker 2>have to monitor which MA you got. You know, you

1615
01:58:33.800 --> 01:58:35.159
<v Speaker 2>just stand in que and you get the MRI. Like

1616
01:58:35.199 --> 01:58:37.479
<v Speaker 2>everybody else is m A. You don't have any choices.

1617
01:58:39.319 --> 01:58:43.960
<v Speaker 2>So if you reduce choice, you can reduce cost. Now,

1618
01:58:48.199 --> 01:58:52.560
<v Speaker 2>the private sector in these systems is typically very small,

1619
01:58:52.760 --> 01:58:55.840
<v Speaker 2>particularly in the UK, and you can't get the major

1620
01:58:55.880 --> 01:59:00.479
<v Speaker 2>procedures there. You can't get major surgery and get the

1621
01:59:02.239 --> 01:59:12.800
<v Speaker 2>treatment under the major major stuff. Socialized medicine eliminates choice.

1622
01:59:13.359 --> 01:59:16.439
<v Speaker 2>So the one thing it eliminates, I mean, and it

1623
01:59:16.520 --> 01:59:21.119
<v Speaker 2>constraints supply, so it rations. So the choice you have

1624
01:59:21.279 --> 01:59:27.800
<v Speaker 2>is rationed. Alexis says on the chat seven hour wait

1625
01:59:27.920 --> 01:59:31.880
<v Speaker 2>in er emergency room in Central London Hospital for an

1626
01:59:32.039 --> 01:59:35.439
<v Speaker 2>allergic reaction. Now you can get long waits in the

1627
01:59:35.560 --> 01:59:38.479
<v Speaker 2>US as well, but that's because we have regulations, for example,

1628
01:59:39.199 --> 01:59:43.920
<v Speaker 2>that four stocked hospitals emergency rooms to treat anybody who

1629
01:59:43.960 --> 01:59:48.119
<v Speaker 2>walks into an emergency room, anybody, whether they have insurance,

1630
01:59:48.159 --> 01:59:50.920
<v Speaker 2>they don't, where they can pay, where they can't, whether

1631
01:59:51.039 --> 01:59:54.800
<v Speaker 2>they have a heart attack, or whether they have the flu,

1632
01:59:57.159 --> 01:59:59.840
<v Speaker 2>And that creates bottlenecks, and then that turns it into

1633
02:00:00.520 --> 02:00:04.960
<v Speaker 2>a European like emergency room. But if you basically said, yeah,

1634
02:00:05.000 --> 02:00:09.680
<v Speaker 2>we're not treating flu patients, We'll only treat who we

1635
02:00:09.800 --> 02:00:15.520
<v Speaker 2>want to treat. It's an emergency room, then you would

1636
02:00:15.560 --> 02:00:31.439
<v Speaker 2>have a very different emergency room experience. All right, thank you, Jason, Jennifer.

1637
02:00:31.840 --> 02:00:35.000
<v Speaker 2>My dad and yours were doctors. People have no idea

1638
02:00:35.319 --> 02:00:37.920
<v Speaker 2>how hard they work to get there. It makes me

1639
02:00:38.119 --> 02:00:42.079
<v Speaker 2>so sad, so mad when people think they know medicine

1640
02:00:42.199 --> 02:00:44.159
<v Speaker 2>when they never study to practicity. Yeah, I mean you

1641
02:00:44.199 --> 02:00:47.800
<v Speaker 2>see it all the time. We've got we've got amateur

1642
02:00:47.920 --> 02:00:54.600
<v Speaker 2>doctors everywhere, experts in the field of I mean, you know, vaccines, immunization,

1643
02:00:56.079 --> 02:01:01.760
<v Speaker 2>you know, diet everything, and heart disease and cancer, and

1644
02:01:01.800 --> 02:01:03.920
<v Speaker 2>they know exactly the causes and the cures and everything.

1645
02:01:04.399 --> 02:01:06.359
<v Speaker 2>It's ridiculous. But it's not just how hard they work

1646
02:01:06.439 --> 02:01:08.880
<v Speaker 2>to get this, it's how hard they work as doctors.

1647
02:01:09.279 --> 02:01:12.960
<v Speaker 2>At least now, my father worked mostly under a socialized

1648
02:01:13.000 --> 02:01:16.199
<v Speaker 2>medicine system in Israel, but he had to make a

1649
02:01:16.319 --> 02:01:18.479
<v Speaker 2>living because he got paid by the government, and the

1650
02:01:18.520 --> 02:01:21.239
<v Speaker 2>government paid doctors very little, so he then had to

1651
02:01:21.279 --> 02:01:23.640
<v Speaker 2>have a private practice on the side, so that was

1652
02:01:23.720 --> 02:01:28.840
<v Speaker 2>in the evenings. And you know, see, he worked all day,

1653
02:01:30.199 --> 02:01:34.920
<v Speaker 2>taught at the medical school, ran a department at the hospital,

1654
02:01:35.399 --> 02:01:38.680
<v Speaker 2>and then in the evening he had a private practice.

1655
02:01:38.840 --> 02:01:41.199
<v Speaker 2>So we never saw him skids. He just worked to work.

1656
02:01:41.319 --> 02:01:47.920
<v Speaker 2>A quote Bobara illustration had a new replacement last year

1657
02:01:47.960 --> 02:01:52.560
<v Speaker 2>in Europe using private paid. Total cost including five days

1658
02:01:52.600 --> 02:01:55.199
<v Speaker 2>in hospital, was ten thousand Europe. In the US, the

1659
02:01:55.279 --> 02:01:58.359
<v Speaker 2>cost is one hundred thousand Euromon and patients are sent

1660
02:01:58.479 --> 02:02:03.840
<v Speaker 2>home the day of surgery. Yeah, absolutely, I mean I had.

1661
02:02:07.439 --> 02:02:14.159
<v Speaker 2>I had back surgery in the in the US right outpatient.

1662
02:02:15.119 --> 02:02:20.359
<v Speaker 2>I was sent home within hours, which I like. I

1663
02:02:20.399 --> 02:02:21.960
<v Speaker 2>don't want to spend the time in hospital. I don't

1664
02:02:22.000 --> 02:02:24.000
<v Speaker 2>like to spending time in hospital. You shouldn't have to

1665
02:02:24.079 --> 02:02:29.880
<v Speaker 2>be five days in hospital for a knee replacement. And

1666
02:02:31.640 --> 02:02:35.640
<v Speaker 2>I didn't pay anything. I didn't pay anything. I don't

1667
02:02:35.640 --> 02:02:37.319
<v Speaker 2>know how much it cost the insurance company. I have

1668
02:02:37.399 --> 02:02:42.720
<v Speaker 2>no idea. It wasn't one hundred thousand because it was outpatient.

1669
02:02:43.600 --> 02:02:47.079
<v Speaker 2>It was probably ten thousand. But I got out of there.

1670
02:02:47.720 --> 02:02:50.600
<v Speaker 2>And the only reason it cost me And this is

1671
02:02:51.039 --> 02:02:52.720
<v Speaker 2>the beauty of the American system, and maybe you can

1672
02:02:52.880 --> 02:02:54.680
<v Speaker 2>and I think you can do this in parts of Europe.

1673
02:02:54.880 --> 02:02:59.079
<v Speaker 2>Not every way, though, is I convinced my doctor to

1674
02:02:59.199 --> 02:03:02.920
<v Speaker 2>inject me with STAY, to inject the disc that he

1675
02:03:03.039 --> 02:03:08.840
<v Speaker 2>was cleaning up with stem cells, and for that I

1676
02:03:08.920 --> 02:03:11.319
<v Speaker 2>had to pay in cash. So I think that was

1677
02:03:11.359 --> 02:03:16.119
<v Speaker 2>five thousand dollars that I paid cash. He basically had

1678
02:03:16.159 --> 02:03:21.159
<v Speaker 2>to get a machine and to spind the stem cells.

1679
02:03:21.199 --> 02:03:23.960
<v Speaker 2>He has to go into my hip and extract bone

1680
02:03:24.039 --> 02:03:26.720
<v Speaker 2>marrow and then spin it and then inject mice themselves

1681
02:03:26.760 --> 02:03:30.279
<v Speaker 2>back in and so the whole thing cost me out

1682
02:03:30.319 --> 02:03:32.720
<v Speaker 2>of pocket five thousand because I paid nothing for the

1683
02:03:33.079 --> 02:03:35.720
<v Speaker 2>rest of the surgery that was all covered by the

1684
02:03:35.800 --> 02:03:40.920
<v Speaker 2>so called the insurance that I had. I've spent time

1685
02:03:41.000 --> 02:03:43.000
<v Speaker 2>in hospital when I got my fusion. I had back

1686
02:03:43.079 --> 02:03:45.880
<v Speaker 2>fusion that was before that, more than ten years ago,

1687
02:03:46.079 --> 02:03:51.079
<v Speaker 2>and there I spent six days in hospital, two surgeries,

1688
02:03:51.760 --> 02:03:54.520
<v Speaker 2>one of them dayly full day, A whole day. New

1689
02:03:54.560 --> 02:03:59.039
<v Speaker 2>replacement is not and again it costs me nothing. Now

1690
02:03:59.079 --> 02:04:00.760
<v Speaker 2>I don't know how much it cost my showings company.

1691
02:04:02.119 --> 02:04:06.640
<v Speaker 2>That's part of the problem. So it could be that

1692
02:04:06.880 --> 02:04:14.760
<v Speaker 2>in Europe, if you use the private system, it's ultimately cheaper.

1693
02:04:15.880 --> 02:04:19.560
<v Speaker 2>I don't know. I mean, you know, I have healthy shows.

1694
02:04:19.600 --> 02:04:24.000
<v Speaker 2>In the US, it covers a lot. All my surgeries

1695
02:04:24.159 --> 02:04:29.199
<v Speaker 2>are paid for with private doctors in private setting that

1696
02:04:29.279 --> 02:04:33.279
<v Speaker 2>I choose my back surge US, with doctors I chose

1697
02:04:37.119 --> 02:04:38.800
<v Speaker 2>when I spent in hospital. When I didn't, I just

1698
02:04:38.880 --> 02:04:41.760
<v Speaker 2>had showed the surgery he and Puerto Rico the same

1699
02:04:41.880 --> 02:04:46.439
<v Speaker 2>day in and out of the hospital. I chose the doctor.

1700
02:04:48.560 --> 02:04:50.000
<v Speaker 2>I could have gone to the US. I could have

1701
02:04:50.079 --> 02:04:52.640
<v Speaker 2>chosen any doctor in the US to do the same surgery.

1702
02:04:52.880 --> 02:04:56.079
<v Speaker 2>I didn't want to because I wanted to be you know,

1703
02:04:56.119 --> 02:04:58.079
<v Speaker 2>if there was complications or anything that I wanted to

1704
02:04:58.119 --> 02:04:59.560
<v Speaker 2>be close to the doctor. Didn't want to have to

1705
02:04:59.640 --> 02:05:05.119
<v Speaker 2>fly to see the doctor. But the I could have

1706
02:05:05.199 --> 02:05:07.479
<v Speaker 2>chosen any doctor in the United States to do the procedure.

1707
02:05:08.039 --> 02:05:10.960
<v Speaker 2>It would have cost me the same here as it

1708
02:05:11.000 --> 02:05:13.239
<v Speaker 2>would have if I'd gone to the male clinic to

1709
02:05:13.319 --> 02:05:17.600
<v Speaker 2>have it done. Zero. So I am You know, you

1710
02:05:17.640 --> 02:05:21.159
<v Speaker 2>could argue I'm super happy with kind of the direct

1711
02:05:21.960 --> 02:05:24.079
<v Speaker 2>costs and the healthcare that I get because I get

1712
02:05:24.119 --> 02:05:29.439
<v Speaker 2>to choose my doctors. What I'm not happy about is

1713
02:05:30.760 --> 02:05:36.159
<v Speaker 2>what I know is possible in a proper privatized HEALTHCA system.

1714
02:05:37.319 --> 02:05:43.279
<v Speaker 2>What's missing is the innovation, the dynamism. And I pay

1715
02:05:43.319 --> 02:05:46.600
<v Speaker 2>a lot of a lot of money for insurance. I personally,

1716
02:05:46.640 --> 02:05:48.359
<v Speaker 2>it's not through a business. And I pay a lot

1717
02:05:48.359 --> 02:05:52.239
<v Speaker 2>of money for insurance because again I'm subsidizing Medicare, I'm

1718
02:05:52.319 --> 02:06:00.800
<v Speaker 2>subsidizing the the the I'm probably subsidizing the employer based system.

1719
02:06:02.119 --> 02:06:06.279
<v Speaker 2>I'm not getting a tax deduction on it. So you know,

1720
02:06:06.359 --> 02:06:09.399
<v Speaker 2>there's a there's a huge subsidization cross upsietization going on

1721
02:06:09.479 --> 02:06:13.199
<v Speaker 2>here from me to other people that I'm not happy about,

1722
02:06:13.640 --> 02:06:16.680
<v Speaker 2>and again I'm not happy about the fact that it

1723
02:06:16.760 --> 02:06:20.439
<v Speaker 2>could be so much better. But I get I believe

1724
02:06:20.560 --> 02:06:22.479
<v Speaker 2>that today I get the best healthcare in the world,

1725
02:06:24.520 --> 02:06:27.640
<v Speaker 2>and for me, in terms of my expenses on healthcare,

1726
02:06:28.840 --> 02:06:35.920
<v Speaker 2>probably about as cheap as it gets. I mean, I yeah,

1727
02:06:36.000 --> 02:06:39.560
<v Speaker 2>I mean I wish it was different because I think

1728
02:06:39.680 --> 02:06:42.319
<v Speaker 2>I can imagine what else could be. But I wouldn't

1729
02:06:42.319 --> 02:06:45.359
<v Speaker 2>want to be in Europe. And I appreciate what you're saying, Baba,

1730
02:06:46.199 --> 02:06:54.199
<v Speaker 2>and but yeah, and you know, I think that if

1731
02:06:54.239 --> 02:06:56.600
<v Speaker 2>you can get, if you can, if you can be

1732
02:06:56.760 --> 02:07:00.079
<v Speaker 2>in a private healthcare system in I think, like the

1733
02:07:00.119 --> 02:07:02.520
<v Speaker 2>Swiss system is really good, and there may be other

1734
02:07:02.560 --> 02:07:04.199
<v Speaker 2>systems that are really good. I would never want to

1735
02:07:04.239 --> 02:07:07.079
<v Speaker 2>be in the UK, even with private healthcare. I wouldn't

1736
02:07:07.199 --> 02:07:10.039
<v Speaker 2>even with the potential for private insurance. I wouldn't want

1737
02:07:10.079 --> 02:07:13.840
<v Speaker 2>to be in a lot of these social life medicine countries.

1738
02:07:14.119 --> 02:07:16.640
<v Speaker 2>I think Switzerland is unique because it has a private

1739
02:07:16.720 --> 02:07:21.520
<v Speaker 2>sector adjacent to it. It's also relatively less regulated. You

1740
02:07:21.560 --> 02:07:23.840
<v Speaker 2>can do a lot of procedures in Switzerland you can't

1741
02:07:23.880 --> 02:07:26.840
<v Speaker 2>get here in the US. There's a lot of stuff

1742
02:07:26.840 --> 02:07:29.520
<v Speaker 2>you can do with stem cells in Switzerland but also

1743
02:07:29.680 --> 02:07:31.880
<v Speaker 2>in South America that you can't do in the US.

1744
02:07:32.840 --> 02:07:36.239
<v Speaker 2>So imagine if we got rid of all those regulations

1745
02:07:36.279 --> 02:07:42.439
<v Speaker 2>and all those controls yield twenty five. Can you recommend

1746
02:07:42.439 --> 02:07:46.039
<v Speaker 2>any good articles of books that discuss healthcare in the

1747
02:07:46.239 --> 02:07:51.119
<v Speaker 2>way you just did or smaller? God, I don't know.

1748
02:07:51.960 --> 02:07:54.880
<v Speaker 2>I mean John Goodman. I think look John Goodman for

1749
02:07:54.960 --> 02:07:59.079
<v Speaker 2>books on healthcare. I can't remember now, I've read some

1750
02:07:59.279 --> 02:08:03.439
<v Speaker 2>in the past. There were some good books on medical

1751
02:08:03.479 --> 02:08:08.319
<v Speaker 2>saving accounts, but no, I don't have off the cuff books.

1752
02:08:08.359 --> 02:08:11.079
<v Speaker 2>But look for books on medical saving accounts, privatizing healthcare.

1753
02:08:11.920 --> 02:08:16.119
<v Speaker 2>There are some good books by Cato people, by John

1754
02:08:16.119 --> 02:08:19.800
<v Speaker 2>Goodman's institute. There's an student in San Francisco, I forget

1755
02:08:19.800 --> 02:08:22.279
<v Speaker 2>the woman's name, that's written some good books on this.

1756
02:08:22.640 --> 02:08:28.000
<v Speaker 2>So there is material out there. Alexis what is the

1757
02:08:28.039 --> 02:08:31.039
<v Speaker 2>common thread between finance and healthcare that made them prime

1758
02:08:31.159 --> 02:08:34.960
<v Speaker 2>targets for the intellectual status. Assuming you expect that prem

1759
02:08:35.199 --> 02:08:43.000
<v Speaker 2>accept that premise, fear asymmetric information, you always get that

1760
02:08:45.880 --> 02:08:51.399
<v Speaker 2>you know you'll be taking advantage of by the financier

1761
02:08:51.840 --> 02:08:54.000
<v Speaker 2>if they don't have to register at their SEC and

1762
02:08:54.039 --> 02:08:56.920
<v Speaker 2>they don't have to jump through all these hoops. We

1763
02:08:57.039 --> 02:09:00.359
<v Speaker 2>need to license these people because otherwise they'll you out

1764
02:09:00.399 --> 02:09:02.600
<v Speaker 2>of your money, they'll commit fraud. We need to make

1765
02:09:02.640 --> 02:09:06.760
<v Speaker 2>sure they're good people. So asymmetric information in both, you've

1766
02:09:06.800 --> 02:09:08.560
<v Speaker 2>got experts to know a lot more than you do.

1767
02:09:09.239 --> 02:09:11.199
<v Speaker 2>I mean, that's true of everything in life. That's the

1768
02:09:11.279 --> 02:09:14.439
<v Speaker 2>beauty of a society of division of labor and specialization.

1769
02:09:15.000 --> 02:09:21.000
<v Speaker 2>But finance and medicine, I think are particularly so. And

1770
02:09:21.119 --> 02:09:25.600
<v Speaker 2>everybody appreciates that. Wow, yes, specialized knowledge is really needed there.

1771
02:09:27.960 --> 02:09:34.239
<v Speaker 2>That's one, you know. Regulation of them evolved completely differently.

1772
02:09:34.800 --> 02:09:39.600
<v Speaker 2>Finance was regulated from the beginning of time because it

1773
02:09:39.760 --> 02:09:44.960
<v Speaker 2>was viewed as exploitative for the beginning of time because

1774
02:09:44.960 --> 02:09:49.680
<v Speaker 2>of the attitude was usually the fear of great financial power,

1775
02:09:50.760 --> 02:09:53.600
<v Speaker 2>the fear of wealth associated with finance. That doesn't exist

1776
02:09:53.640 --> 02:10:00.520
<v Speaker 2>in healthcare. So other than the asymmetric information and if

1777
02:10:00.520 --> 02:10:02.439
<v Speaker 2>you that were too stupid to take care of ourselves,

1778
02:10:02.560 --> 02:10:08.319
<v Speaker 2>which involves both the fear that greed i e. Profit

1779
02:10:08.399 --> 02:10:15.439
<v Speaker 2>motive will cause real harm exists in both. Other than

1780
02:10:15.560 --> 02:10:21.279
<v Speaker 2>I think they're quite different. Healthcare evolved in a particular way,

1781
02:10:22.119 --> 02:10:25.119
<v Speaker 2>and nobody thinks you have a right to a saving account.

1782
02:10:25.199 --> 02:10:29.439
<v Speaker 2>But you have a right to healthcare, and that makes

1783
02:10:29.640 --> 02:10:36.359
<v Speaker 2>it even more difficult to separate, to separate healthcare from

1784
02:10:36.439 --> 02:10:39.560
<v Speaker 2>government than it is financing government. You're right, they're both

1785
02:10:39.560 --> 02:10:45.399
<v Speaker 2>emostly charged, but they're mostly charged because on the healthcare

1786
02:10:45.479 --> 02:10:49.760
<v Speaker 2>side it's viewed as a need, and on the finance side,

1787
02:10:50.479 --> 02:10:54.760
<v Speaker 2>it's fear of being exploited. I think it's mostly charged

1788
02:10:54.800 --> 02:11:01.239
<v Speaker 2>for different reasons. Suddenly altruism dominates the healthcare I'm not

1789
02:11:01.319 --> 02:11:04.560
<v Speaker 2>just as dominant in the finance. It's there, but it's

1790
02:11:04.600 --> 02:11:11.479
<v Speaker 2>not as dominant, all right, Andrew, Republicans don't have them

1791
02:11:11.520 --> 02:11:14.399
<v Speaker 2>all based from which to be serious about challenging how

1792
02:11:14.439 --> 02:11:18.079
<v Speaker 2>healthcare works in any fundamental way. Ultimately, they agree with

1793
02:11:18.239 --> 02:11:21.439
<v Speaker 2>mass collectivization of health care. Yes, and you saw that

1794
02:11:21.520 --> 02:11:24.640
<v Speaker 2>by the inability to repeal Obamacare, by the inability to

1795
02:11:24.720 --> 02:11:30.239
<v Speaker 2>repeal Medicare and Medicaid. I mean, go back to nineteen

1796
02:11:30.319 --> 02:11:33.800
<v Speaker 2>sixty four, the election of nineteen sixty four, and the

1797
02:11:33.960 --> 02:11:39.119
<v Speaker 2>speeches that Ronald Reagan gave in nineteen sixty four against

1798
02:11:39.399 --> 02:11:43.840
<v Speaker 2>Medicare Medicare. They're brilliant, they're really good, really really good speeches.

1799
02:11:44.199 --> 02:11:48.960
<v Speaker 2>He makes a lot of good arguments, but once it

1800
02:11:49.079 --> 02:11:53.920
<v Speaker 2>was passed. Nobody stood up against it. No Republican ever

1801
02:11:53.960 --> 02:11:58.800
<v Speaker 2>talked about downsizing it, never mind reforming it, never mind

1802
02:11:59.039 --> 02:12:04.479
<v Speaker 2>eliminating it. All they've done is expanded expansion of medicares.

1803
02:12:04.479 --> 02:12:08.079
<v Speaker 2>Happened out the Republicans by Melianda George Bush two thousand

1804
02:12:08.079 --> 02:12:13.199
<v Speaker 2>and two three something like that. So, yeah, there's nothing.

1805
02:12:13.960 --> 02:12:17.840
<v Speaker 2>They never undo any socialist program that's already put in

1806
02:12:17.920 --> 02:12:24.239
<v Speaker 2>place because they basically they basically accept them all premise

1807
02:12:24.319 --> 02:12:30.600
<v Speaker 2>under which it exists. Andrew, people have no idea how

1808
02:12:30.760 --> 02:12:34.000
<v Speaker 2>good healthcare would be under capitalism. It really is the

1809
02:12:34.079 --> 02:12:37.039
<v Speaker 2>unknown ideal. Thanks for making it a little bit more known. Yeah,

1810
02:12:37.399 --> 02:12:39.079
<v Speaker 2>it really is an unknown idea in the sense that

1811
02:12:39.479 --> 02:12:45.680
<v Speaker 2>you can't imagine the technologies, the drugs, the knowledge, the help,

1812
02:12:45.840 --> 02:12:51.039
<v Speaker 2>the suggestions, the yeah that would be available under free

1813
02:12:51.119 --> 02:12:57.319
<v Speaker 2>market healthcare system working to allow us to live longer

1814
02:12:57.399 --> 02:13:02.359
<v Speaker 2>and healthier. While we're at it, I mean, the experimentation,

1815
02:13:02.560 --> 02:13:07.359
<v Speaker 2>the innovation, just how to believe, how to imagine, not

1816
02:13:07.439 --> 02:13:09.920
<v Speaker 2>how to believe very believable, just how to imagine what

1817
02:13:10.039 --> 02:13:15.000
<v Speaker 2>it cook says, solving us healthcare is easy. You just

1818
02:13:15.199 --> 02:13:18.319
<v Speaker 2>gotta outload the profit motive. Then plenty of medicines and

1819
02:13:18.479 --> 02:13:23.439
<v Speaker 2>healthcare will magically appear for everyone. That's it. It's the

1820
02:13:23.520 --> 02:13:26.760
<v Speaker 2>profit motive. It's exact opposite. I mean what Cook is saying,

1821
02:13:26.880 --> 02:13:30.199
<v Speaker 2>it's exact opposite. What we need to do is reinvigorate

1822
02:13:30.239 --> 02:13:34.840
<v Speaker 2>the profit motive, refocus the now, refocus, we establish the

1823
02:13:34.920 --> 02:13:37.920
<v Speaker 2>focus motive, the profit motive of every aspect of healthcare.

1824
02:13:38.399 --> 02:13:41.479
<v Speaker 2>We need to expand the profit motive to touch every

1825
02:13:41.880 --> 02:13:47.560
<v Speaker 2>every little bit of healthcare. Rix says, should HIPPA be

1826
02:13:47.720 --> 02:13:52.399
<v Speaker 2>scrapped and let patients choose how their information is used?

1827
02:13:52.520 --> 02:13:55.399
<v Speaker 2>So much or a petition of data for every doctor

1828
02:13:55.439 --> 02:13:59.560
<v Speaker 2>and visit. Yes, if HIPPA were scrapped, I think you'd

1829
02:13:59.600 --> 02:14:06.800
<v Speaker 2>get a lot more innovation in digital analysis, digital of storing,

1830
02:14:06.960 --> 02:14:13.279
<v Speaker 2>digital integration of healthcare information. And yeah, HIPPA makes no sense.

1831
02:14:13.399 --> 02:14:16.920
<v Speaker 2>I mean, you want a law that says the patient

1832
02:14:16.960 --> 02:14:19.319
<v Speaker 2>should be able to decide what is done with its

1833
02:14:19.359 --> 02:14:24.640
<v Speaker 2>information unless, yeah, the patient should decide, including not caring

1834
02:14:24.680 --> 02:14:27.079
<v Speaker 2>and giving it all to you. And that's it. That's

1835
02:14:27.159 --> 02:14:30.680
<v Speaker 2>all you want is a law that says the information

1836
02:14:30.920 --> 02:14:36.319
<v Speaker 2>belongs to the patient. Other than that, you need nothing else.

1837
02:14:37.079 --> 02:14:42.199
<v Speaker 2>HIPPA is just another creation, another huge bureaucracy that slows

1838
02:14:42.319 --> 02:14:50.439
<v Speaker 2>down a progress raphel in a country with NHS. How

1839
02:14:50.479 --> 02:14:53.239
<v Speaker 2>would you go from NHS to MSA's in a free

1840
02:14:53.279 --> 02:14:57.840
<v Speaker 2>market healthcare system? I mean it would be a lot

1841
02:14:57.920 --> 02:15:01.560
<v Speaker 2>more difficult. It's a lot more trenched. How would you

1842
02:15:01.640 --> 02:15:13.479
<v Speaker 2>do it? You would basically have to phase it out again.

1843
02:15:13.800 --> 02:15:15.840
<v Speaker 2>You would have to create some kind of means testing,

1844
02:15:17.720 --> 02:15:23.000
<v Speaker 2>So you would start with I think you would start

1845
02:15:23.039 --> 02:15:26.199
<v Speaker 2>with Okay, if you make more than one hundred thousand

1846
02:15:26.199 --> 02:15:31.359
<v Speaker 2>pounds a year, the NHS is not for you, and

1847
02:15:31.479 --> 02:15:33.840
<v Speaker 2>that's gonna start a year for now. You can't start immediately.

1848
02:15:33.880 --> 02:15:35.960
<v Speaker 2>That's gonna start a year for now. That creates in

1849
02:15:36.039 --> 02:15:41.279
<v Speaker 2>the center now for hospitals to be built, clinics to open,

1850
02:15:42.640 --> 02:15:47.159
<v Speaker 2>doctors and insurance companies to come about. You do also

1851
02:15:47.239 --> 02:15:50.159
<v Speaker 2>have to, I mean, immigration policy is really important. You

1852
02:15:50.199 --> 02:15:53.359
<v Speaker 2>have to be able to adjust the supply of doctors

1853
02:15:53.520 --> 02:15:57.159
<v Speaker 2>to the new demand. But yet now anybody making over

1854
02:15:57.199 --> 02:16:02.960
<v Speaker 2>one hundred thousand pounds gets no NHS zero, and maybe

1855
02:16:03.439 --> 02:16:05.000
<v Speaker 2>it has to be more than a year because you

1856
02:16:05.079 --> 02:16:07.199
<v Speaker 2>have to build hospitals. These are kind of factors that

1857
02:16:07.319 --> 02:16:09.319
<v Speaker 2>have to be put in because I don't know how

1858
02:16:09.880 --> 02:16:14.159
<v Speaker 2>many private hospitals they are, how many private clinics. Maybe

1859
02:16:14.199 --> 02:16:16.720
<v Speaker 2>it has to be two years. Maybe you start with

1860
02:16:16.800 --> 02:16:22.079
<v Speaker 2>five hundred thousand pounds stoling and then you slowly decrease

1861
02:16:22.159 --> 02:16:25.239
<v Speaker 2>it to one hundred and then to zero ultimately, so

1862
02:16:26.039 --> 02:16:28.720
<v Speaker 2>you phase it out. You say, who are the people

1863
02:16:28.760 --> 02:16:32.319
<v Speaker 2>who can who really, really really depend today on NHS.

1864
02:16:32.959 --> 02:16:36.680
<v Speaker 2>It's the poor, it's people making who couldn't afford insurance

1865
02:16:36.719 --> 02:16:40.799
<v Speaker 2>even if it was available. And of course by doing that,

1866
02:16:42.360 --> 02:16:44.959
<v Speaker 2>you make it possible to cut taxes and to free

1867
02:16:45.000 --> 02:16:47.079
<v Speaker 2>up people's resources so they can spend it on healthcare,

1868
02:16:47.120 --> 02:16:52.479
<v Speaker 2>which is really really important. Barbara, I'm glad you brought

1869
02:16:52.559 --> 02:16:56.440
<v Speaker 2>up the universal Basic income. I'm okay with that as well,

1870
02:16:56.600 --> 02:16:59.639
<v Speaker 2>at least as a temporary program. I think the money

1871
02:16:59.719 --> 02:17:02.559
<v Speaker 2>saved and administrative costs would more than fund a reasonable

1872
02:17:07.040 --> 02:17:10.319
<v Speaker 2>a MT. I don't know, I'm not sure what that

1873
02:17:10.360 --> 02:17:13.680
<v Speaker 2>says anyway, I yeah, I mean I would only support

1874
02:17:13.719 --> 02:17:18.360
<v Speaker 2>it again if it did the following. Every single other

1875
02:17:18.959 --> 02:17:25.520
<v Speaker 2>welfare and redistributive program has to be eliminated, including Medicare,

1876
02:17:25.680 --> 02:17:33.520
<v Speaker 2>Medicaid and education, right, and then you introduce it, so

1877
02:17:33.680 --> 02:17:35.680
<v Speaker 2>all of that would have to be eliminated. And that's

1878
02:17:35.680 --> 02:17:38.760
<v Speaker 2>a lot. And then I would say it has to

1879
02:17:38.840 --> 02:17:41.760
<v Speaker 2>be phased in, phase out, Sorry, phased out. It can't

1880
02:17:42.079 --> 02:17:44.040
<v Speaker 2>stay at the high level. The whole point is the

1881
02:17:44.159 --> 02:17:47.399
<v Speaker 2>incentivized markets to develop and then slowly get the government

1882
02:17:47.479 --> 02:17:50.079
<v Speaker 2>out of it and at the same time cut taxes.

1883
02:17:55.479 --> 02:18:02.799
<v Speaker 2>So yeah, universal based income. Oh right. Boba says, no

1884
02:18:02.920 --> 02:18:06.559
<v Speaker 2>means testing, higher administrative costs would eat up the savings.

1885
02:18:07.159 --> 02:18:10.399
<v Speaker 2>Means testing does not have to involve high administrative costs

1886
02:18:10.399 --> 02:18:12.799
<v Speaker 2>if you make it very very simple and very very easy.

1887
02:18:12.840 --> 02:18:16.399
<v Speaker 2>But yes, for the UBI, there should be no means testing.

1888
02:18:16.440 --> 02:18:19.200
<v Speaker 2>If it's ten thousand dollars or fifteen thousand dollars, everybody,

1889
02:18:20.040 --> 02:18:27.200
<v Speaker 2>everybody just gets a check. And you could roughly means

1890
02:18:27.239 --> 02:18:29.440
<v Speaker 2>tested by saying, okay, if you make if you have,

1891
02:18:29.799 --> 02:18:32.840
<v Speaker 2>if you make over a turn of fifty thousand dollars,

1892
02:18:32.879 --> 02:18:36.399
<v Speaker 2>you don't get the check. I don't you know. I

1893
02:18:36.440 --> 02:18:39.399
<v Speaker 2>think something like that some some very high number. And

1894
02:18:39.479 --> 02:18:42.239
<v Speaker 2>then and then U bureaucracy creed is not high, and

1895
02:18:42.280 --> 02:18:43.920
<v Speaker 2>you reduce the cost for the government to do it

1896
02:18:47.840 --> 02:18:50.440
<v Speaker 2>as atery economy, Hey you're on. If health insurance is

1897
02:18:50.520 --> 02:18:53.319
<v Speaker 2>they coupled from the employment, would there be a phase

1898
02:18:53.399 --> 02:18:58.440
<v Speaker 2>where employers are required to fund individual hsas or up wages. No,

1899
02:18:58.600 --> 02:19:02.879
<v Speaker 2>but that would happen. Employees would have no choice. Just

1900
02:19:02.959 --> 02:19:05.719
<v Speaker 2>competition would drive that very very quickly, and employees would

1901
02:19:05.719 --> 02:19:08.959
<v Speaker 2>know that, so they would do it immediately. You could theoretically,

1902
02:19:09.719 --> 02:19:12.959
<v Speaker 2>you know, force that. I don't like force. I don't

1903
02:19:13.040 --> 02:19:16.600
<v Speaker 2>like requiring things like that, but you could force the

1904
02:19:16.639 --> 02:19:19.879
<v Speaker 2>employer to provide that as an increase in wages or

1905
02:19:20.040 --> 02:19:24.559
<v Speaker 2>as an initial funding of HSA. But ideally you just

1906
02:19:24.639 --> 02:19:28.559
<v Speaker 2>let the market develop in that direction. But yeah, one

1907
02:19:28.600 --> 02:19:31.639
<v Speaker 2>way to kind of get it spur it is to say, okay,

1908
02:19:32.200 --> 02:19:37.479
<v Speaker 2>for the first year that we've eliminated employer based the

1909
02:19:37.520 --> 02:19:39.760
<v Speaker 2>employee has to take whatever they paid the previous year

1910
02:19:40.000 --> 02:19:44.280
<v Speaker 2>and put it into a medical saving account for the

1911
02:19:45.000 --> 02:19:50.799
<v Speaker 2>or health saving account that basicam using them interchangeably put

1912
02:19:50.840 --> 02:19:54.799
<v Speaker 2>them into one of these accounts for the employee, and

1913
02:19:54.879 --> 02:19:57.280
<v Speaker 2>that way we guarantee that everybody gets an account and

1914
02:19:57.399 --> 02:19:59.840
<v Speaker 2>has some money there to begin with, and then starts

1915
02:20:00.079 --> 02:20:03.959
<v Speaker 2>thinking about buying insurance through that and spending healthcare money

1916
02:20:04.000 --> 02:20:06.200
<v Speaker 2>through that. And that's a way to transition, I guess

1917
02:20:06.239 --> 02:20:07.799
<v Speaker 2>you could. You could do that. You could do that

1918
02:20:07.840 --> 02:20:10.559
<v Speaker 2>as part of the transition, but ultimately you wouldn't want

1919
02:20:10.559 --> 02:20:14.600
<v Speaker 2>to force that, Bob. But when in the US, I

1920
02:20:14.760 --> 02:20:17.760
<v Speaker 2>use private clinics when possible, in pay cash. My other

1921
02:20:17.840 --> 02:20:21.440
<v Speaker 2>pocket cost is almost always less than copey. With insurance,

1922
02:20:22.399 --> 02:20:24.799
<v Speaker 2>my copey is almost zero. So I don't know why

1923
02:20:26.559 --> 02:20:30.520
<v Speaker 2>why you know for you, insurance is so expensive noway,

1924
02:20:30.840 --> 02:20:33.920
<v Speaker 2>I pay very high premius with the insurance, but then

1925
02:20:34.559 --> 02:20:38.360
<v Speaker 2>my cope is a very low twenty bucks. I never

1926
02:20:38.440 --> 02:20:41.680
<v Speaker 2>pay more than twenty bucks. Can't remember when I paid

1927
02:20:41.680 --> 02:20:45.920
<v Speaker 2>more than twenty bucks. Twenty two, sorry, twenty two is

1928
02:20:46.000 --> 02:20:50.520
<v Speaker 2>what I pay for my shoulder guy every time I

1929
02:20:50.559 --> 02:20:54.680
<v Speaker 2>go see him. My cope is twenty two bucks. If

1930
02:20:54.719 --> 02:20:57.200
<v Speaker 2>I paid cash, my guess is he would charge one

1931
02:20:57.280 --> 02:21:02.680
<v Speaker 2>hundred dollars as a Turke dichotomy. I love these informative

1932
02:21:02.680 --> 02:21:05.719
<v Speaker 2>shows the most. Thank you, Thanks. I appreciate that. I'm

1933
02:21:05.760 --> 02:21:09.760
<v Speaker 2>glad you like it. Phil says the way, I'm not

1934
02:21:09.840 --> 02:21:13.520
<v Speaker 2>sure what that refers to. Alejandro says, I moved from

1935
02:21:13.559 --> 02:21:16.440
<v Speaker 2>my third world country to the US. The only area

1936
02:21:16.479 --> 02:21:20.040
<v Speaker 2>where my quality of life is declined is healthcare. That's

1937
02:21:20.079 --> 02:21:22.600
<v Speaker 2>interesting because I don't feel that way. I feel like

1938
02:21:22.680 --> 02:21:27.600
<v Speaker 2>I get phenomenal healthcare in the United States, So I

1939
02:21:27.799 --> 02:21:31.079
<v Speaker 2>just think you have to navigate the system and figure

1940
02:21:31.079 --> 02:21:33.200
<v Speaker 2>it out, and then once you figure it out, you

1941
02:21:33.319 --> 02:21:35.680
<v Speaker 2>can get amazing healthcare here, not as good as it

1942
02:21:35.719 --> 02:21:46.159
<v Speaker 2>could be, a bit amazing. All right, guys, thank you,

1943
02:21:46.680 --> 02:21:49.920
<v Speaker 2>thanks to all the super chatters, particularly Wes and Andrew

1944
02:21:50.159 --> 02:21:52.120
<v Speaker 2>did it a lot as well, So thank you Andrew,

1945
02:21:52.239 --> 02:21:55.840
<v Speaker 2>but thank you Wes. Thanks to Wes, we made I'll

1946
02:21:55.920 --> 02:22:01.319
<v Speaker 2>tugget so I appreciate that. I will be back tomorrow's

1947
02:22:01.959 --> 02:22:05.079
<v Speaker 2>showing Hebrew for those of you who understand Hebrew at

1948
02:22:05.440 --> 02:22:09.159
<v Speaker 2>eleven am East Coast time. So my show in Israel,

1949
02:22:09.479 --> 02:22:14.600
<v Speaker 2>and the next US English show is going to be

1950
02:22:16.600 --> 02:22:19.120
<v Speaker 2>is going to be on Monday.

1951
02:22:19.719 --> 02:22:20.319
<v Speaker 1>I have not.

1952
02:22:22.200 --> 02:22:25.280
<v Speaker 2>I did not call for a universal basic income. I

1953
02:22:25.360 --> 02:22:29.280
<v Speaker 2>called for usage of versus basic income phased out over

1954
02:22:29.319 --> 02:22:32.600
<v Speaker 2>a generation. And if you don't include the phased out

1955
02:22:32.719 --> 02:22:37.239
<v Speaker 2>over generation, and if you don't include the eliminate every

1956
02:22:37.440 --> 02:22:40.799
<v Speaker 2>other redistributed program that the government engages in, then you're

1957
02:22:41.159 --> 02:22:44.639
<v Speaker 2>misrepresenting my views, because that is what is important. So

1958
02:22:44.680 --> 02:22:47.159
<v Speaker 2>as an objectivist, I want to get rid of all

1959
02:22:47.200 --> 02:22:52.799
<v Speaker 2>the redistributed programs, lump them into UBI, and then phase

1960
02:22:52.879 --> 02:22:56.639
<v Speaker 2>that UBI out. That's how you get rid of the

1961
02:22:56.719 --> 02:22:59.440
<v Speaker 2>welfare state. I think that's us how you get rid

1962
02:22:59.600 --> 02:23:04.399
<v Speaker 2>of government involvement in healthcare and government involvement in education. Now,

1963
02:23:05.280 --> 02:23:08.159
<v Speaker 2>if you just want to treat them independently as you

1964
02:23:08.239 --> 02:23:11.840
<v Speaker 2>can deal with them through medical saving accounts and education

1965
02:23:12.000 --> 02:23:15.719
<v Speaker 2>Saving accounts, which are kind of UBI like in the

1966
02:23:15.799 --> 02:23:19.159
<v Speaker 2>sense that the government gives you a cash payment, but

1967
02:23:19.799 --> 02:23:22.079
<v Speaker 2>UBI is an opportunitiosity to get rid of all the

1968
02:23:22.159 --> 02:23:26.760
<v Speaker 2>welfare on top of all of that. All right, everybody,

1969
02:23:27.760 --> 02:23:31.959
<v Speaker 2>I will see you all on Monday. Thank you have

1970
02:23:32.120 --> 02:23:35.399
<v Speaker 2>a great weekend. And yeah, let's hope we get a

1971
02:23:35.479 --> 02:23:38.319
<v Speaker 2>little bit of what I'm suggesting. Any one of these

1972
02:23:38.399 --> 02:23:40.000
<v Speaker 2>reforms would be amazing.