Speaker 1: Fundamental principles, how do the lead them last last?
Speaker 2: And self interest and the individual wise. It is the
Speaker 2: Ran book show, all right. I think weird is going on.
Speaker 2: There's gonna be nice and echo music anyway, welcome you
Speaker 2: on bookshel I should put it on the music show.
Speaker 2: Medium that's better echo a co eco. It's only there.
Speaker 2: I don't think you're not hearing an echo from me, right,
Speaker 2: I think it's just uh anyway, the music, the music.
Speaker 2: All right, Thanks for joining me, everybody. I really appreciate it.
Speaker 2: We are going to talk about healthcare today. We're gonna
Speaker 2: do to healthcare what we try to do to find
Speaker 2: nancial regulation, to China policy, to what was it immigration
Speaker 2: and now healthcare. I mean, at the end of the day,
Speaker 2: what we will have here I think by the time
Speaker 2: we finished the series is a blueprint, a blueprint for
Speaker 2: how to move the US economy, how to move US politics,
Speaker 2: how do you move the US government towards having a
Speaker 2: rational policy overall? So this is a roadmap for all
Speaker 2: of that. Maybe maybe we can get transcripts of this
Speaker 2: and get it wrong in writing and put it on
Speaker 2: a book called, you know, rational policy for irrational World,
Speaker 2: Rational Policy for the world in which we live, So
Speaker 2: it's going to be a plan, a plan. So I
Speaker 2: will be kind of using the same template us with
Speaker 2: immigration and with with China policy. I think to some
Speaker 2: extent I keep making slight changes to it, but generally,
Speaker 2: generally this is the template. And this one is sponsored
Speaker 2: by a few of you, so a few of you
Speaker 2: sent money in. Let me also say this, this is
Speaker 2: a big one health can in particular, it's like finance.
Speaker 2: As I said, in Finance, it can't be done in
Speaker 2: one show, and I didn't try to do every aspect
Speaker 2: of finance and everything in finance. You can't do health
Speaker 2: can one show. There's so many dimensions to this. We'll
Speaker 2: cover a lot, but we could go in depth into
Speaker 2: any one of these. And I am not familiar with
Speaker 2: all the laws and all the regulations and all the
Speaker 2: complexities associated here. So we're gonna take a kind of
Speaker 2: big picture. We're gonna go into more detail on things
Speaker 2: that I know and understand and I think are important.
Speaker 2: But we need a few shows to do this, and
Speaker 2: we will be doing more shows on this, so stay tuned.
Speaker 2: There will be more healthcare shows. This has shown number one.
Speaker 2: Thank you for those of you who have sponsored this show.
Speaker 2: Let me just put it out there that if anybody
Speaker 2: out there wants to sponsor a show on I can
Speaker 2: think of Education would be really really good. Open somebody
Speaker 2: suggested labor laws, label laws would be good, although I
Speaker 2: probably have to bring in somebody. No, I mean labor laws.
Speaker 2: I could do label laws and think think about anything else,
Speaker 2: any other realms that you might want to that you
Speaker 2: might want to meet a cover in this way on
Speaker 2: the show. I mean, we've done one aspect of phone
Speaker 2: policy China. We could do other aspects of phone policy.
Speaker 2: We could do the Defense Department. We just do a
Speaker 2: show on the Defense Department and what that would look like.
Speaker 2: But yeah, I mean so basically it saw a thousand
Speaker 2: dollars a show. But we can aggregate. I think this
Speaker 2: healthcare show, we had a couple of people do five
Speaker 2: hundred each. And you know, hopefully if you guys want
Speaker 2: to do education or one of these others, we can
Speaker 2: put together, you know, whether it's two hundred and fifty
Speaker 2: each or you know, five hundred, five hundred each, or
Speaker 2: we can put something together to make that happen. So
Speaker 2: just let me know if there is interest and we'll
Speaker 2: organize it. And of course, if you have ideas for
Speaker 2: other topics, you know, let me know. Environmental regulation would
Speaker 2: be a pretty good one. I don't think I have
Speaker 2: anything to add to what you know Alex publicizes on
Speaker 2: a regular basis on energy policy. Environmental law would be
Speaker 2: would be really good. It would be the government's perspective
Speaker 2: environment And then we could do more on finance, and
Speaker 2: we will do more in healthcare. So what to do
Speaker 2: with federal lands, that's easy. That w take ten minutes,
Speaker 2: five three sentences, two words, two words. Here, here you go.
Speaker 2: Here's what to do with federal lands. Sell them, sell them,
Speaker 2: auction them off to the highest bid of That's it.
Speaker 2: That's what I have to say about federal alians. We
Speaker 2: can talk more about it. We can do a show
Speaker 2: about that anyway. Yep, please please let me know what
Speaker 2: you want. Now in terms of today's show, you can
Speaker 2: ask questions again, you can ask questions about anything. I
Speaker 2: will get priority in terms of time to the questions
Speaker 2: about healthcare. So any questions you have about health care,
Speaker 2: health care policy comparison to other countries, NHS, I don't
Speaker 2: know that much about I don't know Switzerland or some
Speaker 2: of these other countries. That have highbrid systems. But I
Speaker 2: know something about the NHS, a little bit about the
Speaker 2: Canadian system, a little bit about the Israeli system. Those
Speaker 2: are the international systems I know of I know about
Speaker 2: I don't know that much about the other systems other
Speaker 2: than a few things that I'll say at the begin
Speaker 2: at the beginning of the show here, all right, I
Speaker 2: think we've kind of summarized it. Yeah, we can do
Speaker 2: one on again laws. Yeah, you know, whoever puts the
Speaker 2: money up, that's what we'll do. This is market driven.
Speaker 2: The one book show is very market driven. Whoever puts
Speaker 2: up the money that not. You don't get a say
Speaker 2: in what positions I will take, on, what opinions I
Speaker 2: hold on, what recommendations I make. But in terms of
Speaker 2: the broad topics, yeah, we can do that. We can
Speaker 2: do that, all right, So let us start with healthcare
Speaker 2: a gain. Super chat is open. We have a regular
Speaker 2: goal and this is probably go long, just because I
Speaker 2: have a lot to say. Of course, there might not
Speaker 2: be any questions, so it might be showed and what
Speaker 2: else that I want to say. Yeah, you get to
Speaker 2: ask the questions and feel free to ask about anything,
Speaker 2: but priority will be given to healthcare. So one thing,
Speaker 2: one thing I think everybody can agree about when it
Speaker 2: comes to healthcare is that it seems that pretty much
Speaker 2: nobody is happy. Nobody is happy with the system. Now,
Speaker 2: it might be true that healthcare right now is not
Speaker 2: a big issue politically. It's not top priority for Trump,
Speaker 2: it's not top priority, wasn't top priority for Biden. Since Obamacare,
Speaker 2: there was some movement to abolish Obama, kay, But other
Speaker 2: than that, there's been very little, very little really uh excitement,
Speaker 2: and very little emphasis, very little focus on healthcare over
Speaker 2: the last few administrations. And the system just keeps chugging along.
Speaker 2: We'll talk about what that means, but it seems it
Speaker 2: just it just keeps going and nobody wants to touch it.
Speaker 2: And a big part of nobody wants to touch it
Speaker 2: is everybody knows the complexity of doing anything with healthcare.
Speaker 2: And more importantly than the complexity for this purpose is
Speaker 2: the number of pressure groups, the number of the number
Speaker 2: of people who are who have an opinion, who have
Speaker 2: a view, who are going to fight tooth and nail
Speaker 2: for whatever it is for their piece of the healthcare pie,
Speaker 2: if you will, So that the amount of pressure group
Speaker 2: politics here is as bad as probably in finance. Uh
Speaker 2: and uh and and really really really horrific, much worse
Speaker 2: than immigration or almost every other topic because of the
Speaker 2: because of the complexity and the scale of this issue. Right,
Speaker 2: the scale. While nobody's unhappy with the system, healthcare in
Speaker 2: the United States is massive, right, it is a four
Speaker 2: trillion dollar expenditure a year. It constitutes seven last constituents
Speaker 2: I think twenty three seventeen point six percent of GDP,
Speaker 2: A massive portion of government spending. Government spending goes to
Speaker 2: you know, goes to healthcare, Medicare and Medicaid, a huge
Speaker 2: chunk a two trillion dollars of government expenditures. So in
Speaker 2: a you know, twenty eight trillion dollar economy, we spend
Speaker 2: about four trillion twenty seven trillion dollar economy, twenty eight
Speaker 2: trillion dollar economy, you spent about four trillion on healthcare.
Speaker 2: Think about for trillion, and healthcare as ninety thousand dollars
Speaker 2: per person. I mean, it's huge, It employs millions of people.
Speaker 2: It is a massive industry which nobody is excited about.
Speaker 2: Nobody is particularly happy with. I mean, you hear lots
Speaker 2: of complaints. It's super expensive and as a percent of
Speaker 2: GDP seventeen point six is the highest I think in
Speaker 2: a developed goal. I don't know in the world, probably
Speaker 2: in the world as a percent of GDP spending on healthcare,
Speaker 2: and you know, other countries are close that are twelve thirteen, fourteen.
Speaker 2: Nobody even comes close to the seventeen point six. And
Speaker 2: yet the argument is I'm not saying this is true,
Speaker 2: but the argument is that outcomes are not that much better.
Speaker 2: That as life expectancy, the broadest outcome that people measure,
Speaker 2: is lower in the United States than most of the
Speaker 2: developed world. Now that number is cheating. There's a lot
Speaker 2: of cheating going on with numbers generally to make different points.
Speaker 2: Life expectancy in the United States is lower than the
Speaker 2: rest of the world at birth, and that's because of
Speaker 2: two things. Basically, one, it is the case that infant
Speaker 2: mortality mortality of childbirth is higher in the United States
Speaker 2: than the rest of the developing world. But the big
Speaker 2: difference in life expectancy at birth is unrelated to healthcare.
Speaker 2: It's related to drugs, suicide, crime, traffic accidents, which all
Speaker 2: as a percent of the population are very high in
Speaker 2: the United States compared to the rest of the world
Speaker 2: and are actually the things that cause did I say
Speaker 2: rug overdoses, If not, I should have drug overdoses have
Speaker 2: led to decline in life expectance. You should also say
Speaker 2: that a big issue here is obesity, which the United States.
Speaker 2: I mean, the UK is pretty bad, but I think
Speaker 2: the United States is still the most obese country in
Speaker 2: the world. Maybe the UK's was, maybe there are a
Speaker 2: few other places, but generally it's really really bad here.
Speaker 2: So if you take into account all those things that
Speaker 2: have nothing to do with the delivery of healthcare, they're
Speaker 2: the ones that have an impact on life expectancy. Interesting fact,
Speaker 2: life expectancy of Americans who reach seventy years old, So
Speaker 2: life expectancy of people who reach seventy years old higher
Speaker 2: in the United States than anywhere else in the developed world.
Speaker 2: So once you can take out all the other factors
Speaker 2: and just folk us in a sense of healthcare delivery,
Speaker 2: we keep people alive, really really well. People us complaining
Speaker 2: that healthcare in the United States is not universal, not
Speaker 2: everybody has access to it, not everybody can afford it.
Speaker 2: It's because it's so expensive. It's not just expensive kind
Speaker 2: of a national account. It's expensive for individuals and if
Speaker 2: they are people who supposedly can't afford it, and as
Speaker 2: a consequence, you know, it is not universal, and they
Speaker 2: are harvest stories of people who don't get healthcare in
Speaker 2: the United States dying, and if you go outside the
Speaker 2: United States, in the UK and in Europe, everybody believes
Speaker 2: that basically people are dying in the streets on a
Speaker 2: regular basis for lack of healthcare in the United States.
Speaker 2: It's really the amount of mythology that exists in the
Speaker 2: UK and in Europe about the healthcare system in the
Speaker 2: US is astounding. Add to that the fact that people
Speaker 2: get denied health insurance and people upset about that, and
Speaker 2: that again there's a huge mythology out there that many, many,
Speaker 2: many many people in US die or do not get
Speaker 2: treated because they're denied coverage. You know, I got so
Speaker 2: many stories from my debate in Cambridge where the audience
Speaker 2: was like, you know, I would have never got treated
Speaker 2: for this and this in the United States. I was
Speaker 2: born with this disease. Now would have never got treated.
Speaker 2: I was born with this, you know, handicap, and I
Speaker 2: would have never got treated because I couldn't afford it.
Speaker 2: You know, in the in the United States, which is
Speaker 2: mostly ninety nine percent of it is perc It's just
Speaker 2: not true. And then finally, the one big problem that
Speaker 2: exists with god costs, which is real. I mean the
Speaker 2: US in many respects it's expensive. But we'll get to
Speaker 2: whether that's real or not. But the one way which
Speaker 2: it's really expensive and is that basically healthcare costs of
Speaker 2: bankrupting the federal budget. In other words, Medicare and Medicaid
Speaker 2: are unsustainable. Spending on Medicaid and Medicaid is just an unbelievable,
Speaker 2: unbelievably expensive and not sustainable if you look into the future,
Speaker 2: something has to give. Given the amount of revenue the
Speaker 2: United States brings in, it cannot sustain medicaan Medicaid spending
Speaker 2: at the rates that they are. So, you know, so
Speaker 2: we do have we do have an obesity problem, which
Speaker 2: is blamed on the healthcare system. We have a service
Speaker 2: denial problem, which is blamed on what we call health insurance.
Speaker 2: There is a quality of service. Primarily people can plaining
Speaker 2: about the very little time they get to spend with doctors.
Speaker 2: Doctors complain about the very little time they have to
Speaker 2: spend with patients. There's very little, if any preventive care
Speaker 2: or very little of it, and there's very little emphasis
Speaker 2: on it. Physician compensation is actually has declined in real
Speaker 2: terms or being stagnant, and the quality of life in
Speaker 2: terms of the quality of the enjoyment of the profession,
Speaker 2: in terms of time with patient time, solving problems of
Speaker 2: physicians and health care healthcare people in the healthcare system
Speaker 2: is down. The system has no real transparency. We have
Speaker 2: we don't know how things are going to cost. We
Speaker 2: don't know exactly what we're consuming, how much, how much
Speaker 2: we're consuming. There is complete mystery about healthcare costs from
Speaker 2: the consumer's perspective. So all of these are many many
Speaker 2: other things are real costs are real problems in the
Speaker 2: United States, and and people are frustrated and and and
Speaker 2: people upset. They're insurance premiums. They are paid by primarily
Speaker 2: the employers. We'll get to that, but you know, they
Speaker 2: pay an ever growing portion of it, and it's expensive.
Speaker 2: And you know, as we'll see, there all kinds of
Speaker 2: distortions and perversions that are caused because of the system
Speaker 2: the way it's comprised. That just creates uncertain the angst
Speaker 2: and frustration. So what is it about the system as
Speaker 2: his gifts today. What is it about the policy, the
Speaker 2: healthcare policy in the United States as it is today
Speaker 2: that that has caused the system to be as frustrating
Speaker 2: and as upsetting the people as it is as it is.
Speaker 2: So let's let's go over kind of the way the
Speaker 2: healthcare system is structured today and the way this leads
Speaker 2: to these frustrations. So let's I think that we should
Speaker 2: start with kind of the way most of us experience
Speaker 2: the healthcare system, and the way most of us experience
Speaker 2: the healthcare system is through the purchase of insurance. And
Speaker 2: while insurance is not the delivery of healthcare, insurance is
Speaker 2: the way we fund healthcare, and the insurance dictates the
Speaker 2: large extent what kind of healthcare we actually get. So
Speaker 2: we need to step back here and talk about what
Speaker 2: insurance is. Insurance is real. Insurance is something that covers
Speaker 2: you for where unexpect acted and you know, significantly costly events.
Speaker 2: So insurance is a mechanism to protect you from things
Speaker 2: that are unexpected, you know, a known that is there's
Speaker 2: a huge amount of uncertainty around when they will happen,
Speaker 2: if they will happen, and where the cost could be
Speaker 2: very high. So think about it what's the probability your
Speaker 2: house will burn down? It's very low. Do you know
Speaker 2: when it will happen. No, you can't predict when it
Speaker 2: will happen. What are the financial consequences of your house
Speaker 2: bringing down? Pretty catastrophic, it's really bad. It's a lot
Speaker 2: of money. Think about auto insurance. We write our insurance
Speaker 2: not for our regular service. Doesn't cover up kind of
Speaker 2: the three thousand mile or whatever. It doesn't cover oil changes.
Speaker 2: You know, for the most part, it doesn't even cover
Speaker 2: like little dents and bumps and stuff like that. It
Speaker 2: covers you really for when you have a significant accident,
Speaker 2: and the cost it can be thousands of dollars. Now,
Speaker 2: it's not as expensive as a fire burning down your home.
Speaker 2: The probability is higher that you get into a car
Speaker 2: accident than your home burns down, and it's less expensive,
Speaker 2: but it's still relative to the cost of the car,
Speaker 2: a lot of money. So you buy insurance to cover that.
Speaker 2: You don't cover the little bumps and the little things,
Speaker 2: and you don't cover maintenance. Life insurance, you don't know
Speaker 2: when you're gonna die. Dying, let's say when you buy
Speaker 2: life insurance. Typically a good age to buy life insurance
Speaker 2: is when you start a family and you've got dependence,
Speaker 2: and I want to make sure that if you drop dead,
Speaker 2: they have some money, and so you want to buy
Speaker 2: life insurance to cover you from age I don't know,
Speaker 2: thirty to sixty something like that. Those thirty years is
Speaker 2: while you've got a family and that dependent on you,
Speaker 2: and you want to be able to if you die,
Speaker 2: they get a million dollars or whatever. You want to
Speaker 2: be able to cover it. You don't know when it's
Speaker 2: going to happen. What's the probability you die between thirty
Speaker 2: and sixty pretty low, and it's catastrophic. It's catastrophic. And
Speaker 2: think about business interruption insurance, Think about all the kinds
Speaker 2: of business insurance. Think about maritime insurance. The ship, you
Speaker 2: know sinks, pretty low, probability, uncertainty about it, catastrophic. And
Speaker 2: yet health insurance doesn't work that way. And it doesn't
Speaker 2: work that way because it's really not insurance. It's really
Speaker 2: not insurance. It's a form of risk pooling, it's a
Speaker 2: form of redistribution of wealth. But we really should not
Speaker 2: call it insurance. It doesn't have the characteristics of insurance.
Speaker 2: If I have a cold and I go to the doctor.
Speaker 2: You know, that's gonna cost me fifty dollars, maybe one
Speaker 2: hundred dollars, maybe maybe one hundred and fifty dollars if
Speaker 2: you have a relatively expensive doctor. It's not catastrophic. It's
Speaker 2: pretty common to get a cold. I get one once
Speaker 2: a year, pretty common to get a cold or to
Speaker 2: get the flu. And yet we cover uh. And you know,
Speaker 2: if you if you have you know, diabetes and you
Speaker 2: have to get you know, insulin or you have to
Speaker 2: get diabetes drugs or whatever. And now it's a constant
Speaker 2: cost forever, insurance covers it. You know, we cover, we
Speaker 2: cover things. You know, we cover a relatively minor, relatively
Speaker 2: low cost recurring expected events with this insurance. So it's
Speaker 2: not And of course we don't even buy the insurance.
Speaker 2: We might choose if our employer has options, we might
Speaker 2: choose between different health insurance plans, but we're not really
Speaker 2: buying them. Our employer is buying them, and employers buying them,
Speaker 2: you know, they and you know, they're the ones who
Speaker 2: contract have a contract with the life with the health insurance.
Speaker 2: And one of the one of.
Speaker 1: The issues with these insurance policies is they're not else
Speaker 1: So for example, if you leave a job, you don't
Speaker 1: have insurance anymore, you're not covered.
Speaker 2: I mean, you their laws in place that allow you
Speaker 2: to continue to get COBRA, and the employer, by law,
Speaker 2: has to contribute towards that COBRA and COBRA is a
Speaker 2: continuation of your existing insurance policy for a certain amount
Speaker 2: of time. But it's not really your insurance policy. It's
Speaker 2: a it's a it's a the employer has bought it.
Speaker 2: It covers you, but it's their policy they pay. So
Speaker 2: one of the problems we have is that we don't
Speaker 2: really have insurance. We don't. We call it insurance, but
Speaker 2: it really isn't insurance. We have a third party system
Speaker 2: where our employers get us insurance and then we get
Speaker 2: to consume healthcare and basically bility to the insurance company.
Speaker 2: I mean, this creates all kinds of model houses, It
Speaker 2: creates over consumption, It creates a system by which we
Speaker 2: don't care about the cost of insurance. By the way,
Speaker 2: the cost of insurance has nothing to do with your health.
Speaker 2: The other thing about insurance is we've talked about this
Speaker 2: in the past. In fire insurance, the insurance company determines
Speaker 2: the premium based on, for example, how likely it is
Speaker 2: that there will be a fire in your area that
Speaker 2: your house will be caught up into. So some areas
Speaker 2: in California that are very very very very high a
Speaker 2: fire insurance because the likelihood of a fire is relatively high.
Speaker 2: Other places really cheap because the likelihood of a fire
Speaker 2: reaching you is very low. Same with flood insurance or
Speaker 2: the flood insurance and earthquake insurance very distorted markets, but
Speaker 2: when they functioned where you were, the risk that you
Speaker 2: would the risk that you are susceptible to this catastrophe
Speaker 2: is taking into acount in your premium. Health insurance companies
Speaker 2: don't assess the risk of you receiving a disease. For example,
Speaker 2: you and your coworker, you might be at the same age,
Speaker 2: but he might be, I don't know, one hundred pounds
Speaker 2: heavier than you. Now the fact that he's one hundred
Speaker 2: pounds heavier than you makes him susceptible to diabetes. Diabetes
Speaker 2: makes them susceptible to heart disease, which you know, and
Speaker 2: even cancer. It makes them susceptible to potentially all time
Speaker 2: is at a young age insurance company, they don't care.
Speaker 2: I mean maybe they care, but the system is not
Speaker 2: structured to take that into acount. None of that is relevant. Indeed,
Speaker 2: it's illegal for them to take any of that into account.
Speaker 2: You might have a gene that makes you most susceptible
Speaker 2: to certain cancers. They can't take that into account. So
Speaker 2: they're pricing off of a pool where they're basically estimating
Speaker 2: the relatively ages of the people in that pool. But
Speaker 2: that's really the only in sex. Age and sex are
Speaker 2: the only parameters they can play with, and they figure
Speaker 2: some out, be some or not, and they come up
Speaker 2: with an average price, and then everybody pays basically. You know,
Speaker 2: I think there's an age adjustment, but everybody pays a
Speaker 2: price based on your age, and that's it. So again,
Speaker 2: non insurance. What we have today in the United States
Speaker 2: is a mechanism by which we redistribute wealth, We distribute
Speaker 2: health expenditures from healthy to sick, from young to old.
Speaker 2: But don't call it insurance. I mean, we call it
Speaker 2: insurance because that's every that's what everybody calls it, and
Speaker 2: it's the way it's called. But it is not insurance,
Speaker 2: not by any financial measure of it. It is a
Speaker 2: polling of risk. It's a pulling of risk without you know,
Speaker 2: to some extent, a blind pool of risk. And by
Speaker 2: the way, so now why do we do that? Well,
Speaker 2: I don't want to get into the entire history of it,
Speaker 2: but the basic idea is that employers versus employees. Employers
Speaker 2: have an advantage in buying health insurance. If an employer
Speaker 2: buys health insurance, the health insurance premiums are tax deductible.
Speaker 2: If you, as an individual buy health insurance, your health
Speaker 2: insurance premiums are not tax deductible. So you have a
Speaker 2: huge advantage in letting the employer buy the health insurance
Speaker 2: for you because they do it with pre tax dollars
Speaker 2: and if you did it, you would be doing it
Speaker 2: with after tax dollars. So again that provides a massive
Speaker 2: incentive for employers to buy the health insurance. And a
Speaker 2: lot of employees don't even buy insurance. They have insurance
Speaker 2: companies administer what they call insurance, and they're really in
Speaker 2: a sense self insuring. They're creating reserves, financial reserves, and
Speaker 2: it's their money that is paying out. It's not the
Speaker 2: insurance company that pays the money out for your healthcare,
Speaker 2: but the company that the company does. So the fact
Speaker 2: that we have an employer based system. The fact that
Speaker 2: our system, by regulation is not an insurance system but
Speaker 2: a pooling of risk jumiative system is at the core,
Speaker 2: I'd say, one of the two cores of really all
Speaker 2: the problems that we have today in healthcare. The other
Speaker 2: the other is the about fifty percent, actually it's over
Speaker 2: fifty percent of all healthcare expenditures are spent by the government.
Speaker 2: Basically the government covers through its so called insurance policies,
Speaker 2: right Medicare and Medicaid. The government covers one hundred and
Speaker 2: fifty million Americans. I mean, people say, you don't have
Speaker 2: a single payer healthcare system, or one hundred and fifty
Speaker 2: million Americans have a government healthcare system. That's about ninety
Speaker 2: million people. Ninety I didn't realize the numbers this week.
Speaker 2: Ninety million people are on Medicaid. Sorry, yes, Medicaid that
Speaker 2: is healthcare for people who cannot afford insurance. This is
Speaker 2: supposed to healthcare for the poor. That includes CHIP, which
Speaker 2: is the healthcare for children whose parents cannot afford to
Speaker 2: buy insurance. And so that's ninety million and sixty something million.
Speaker 2: So it's over one hundred and fifty million, sixty something
Speaker 2: million people on Medicare, which is basically everybody over the
Speaker 2: age of sixty five, no matter whether you can afford
Speaker 2: it or not, everybody over sixty five gets Medicare, and
Speaker 2: that number will grow to over seventy million by twenty
Speaker 2: thirty two.
Speaker 1: So we have a.
Speaker 2: Government run healthcare system that basically provides healthcare funding for
Speaker 2: one hundred and fifty million Americans out of three hundred
Speaker 2: and fifty million. So it's a big chunk. It's not
Speaker 2: quite half, but it's forty percent thirty five. Forty percent
Speaker 2: is all government and fifty percent of expenditures because when
Speaker 2: you spend the most on healthcare when you're old, that's
Speaker 2: all covered by government, all covered by government, all covered
Speaker 2: by government, right because Medicare pays for sixty five and over.
Speaker 2: So you have a situation where fifty cents of every
Speaker 2: dollar spent on healthcare, actually more than fifty cents is
Speaker 2: covered is government spenditure. So we don't have a private system.
Speaker 2: We have a pseudo insurance that's non insurance system, and
Speaker 2: we have a government system. Those are the two alternatives,
Speaker 2: and the government system dictates a lot because it's it's massive.
Speaker 2: So let's take Medicare. Medicare represents sixty something sixty let's
Speaker 2: say sixty two million people, all eight sixty five huge
Speaker 2: consumers of healthcare, and they're all getting hiperplacements and bipus
Speaker 2: surgeries and cancer treatment. Right, And so when doctors and
Speaker 2: hospitals a billion for all those treatments, they are facing
Speaker 2: this kind of monopoly. There's only one entity representing people
Speaker 2: over sixty five. And so who has the pricing power
Speaker 2: in that relationship, Well, clearly the government does. So the
Speaker 2: government can dictate prices. The government can drive prices down
Speaker 2: on some things. And by driving prices down, for example,
Speaker 2: you know, doctors get very little money from Medicare for
Speaker 2: complicated procedures. It's sometimes hard to believe how little money
Speaker 2: they get per procedure from Medicare. And hospitals have to
Speaker 2: negotiate with Medicare, and Medicare drives prices down. And now
Speaker 2: hospitals and doctors and everybody else still have to make
Speaker 2: a living. They still have to make a profit. And
Speaker 2: there's a sense in which they make the profit off
Speaker 2: of driving up the price for private health private insurance.
Speaker 2: For the insurance it's outside the Medicare system. So you
Speaker 2: get a system in which the private so called insurance
Speaker 2: is subsidizing Medicare and Medicaid. And of course one of
Speaker 2: the big controversies right now is should Medicare and Medicaid
Speaker 2: be able to gootiate drug prices, because if they can
Speaker 2: negotiate drug prices, they can lower drug prices dramatically, like
Speaker 2: European countries have and like Canadian system has by basically,
Speaker 2: you know, being the dominant buyer of a drug in
Speaker 2: the economy. And if they can drive down prices dramatically,
Speaker 2: either drug companies now you know they they their profitability plummets.
Speaker 2: They which reduces their availability of capital for them, which
Speaker 2: is useless, R and D and all the other consequences
Speaker 2: or drug sales to private individuals through their so called
Speaker 2: the insurance policies have to go up. Something has to give, right,
Speaker 2: the money has to come from somewhere. And if the
Speaker 2: government's going to squeeze drug companies as so many people
Speaker 2: want it, Bide administration has already started the process to
Speaker 2: woulds that, and Trump is indicated he would like to continue,
Speaker 2: then you know drug drug companies are going to be
Speaker 2: profitability is going to be squeezed completely and given the
Speaker 2: cost of drugs and and and the length of development
Speaker 2: and expense of developing them. What happens then, what happens then.
Speaker 2: So the fact that the government is such a big
Speaker 2: buyer of healthcare services is a major, major, major problem
Speaker 2: which UH basically distorts distorts the pricing, UH, the pricing
Speaker 2: of healthcare in the United States. As a consequence of that,
Speaker 2: what you see is massive cost subsidization, healthy subsidizing the sick.
Speaker 2: We talked about that. The subsidizing the old, We've talked
Speaker 2: about that again. We're all subsidizing the Medicaid, Medicaid that
Speaker 2: the old get after sixty five, those of us who
Speaker 2: are not yet sixty five. I'm not quite there. I'm
Speaker 2: almost there. And insurance companies or the so called insurance framework,
Speaker 2: it's not the companies, it's the people who pay the
Speaker 2: insurance of subsidizing government programs, huge amount of cost oftization,
Speaker 2: and it's really hard to keep track of it. I mean,
Speaker 2: I don't think I don't know that anybody has in
Speaker 2: terms of the actual numbers, but keeping track of it
Speaker 2: is almost impossible because it's going on all the time,
Speaker 2: and it's super complex. Now, top all of that off
Speaker 2: with the fact that healthcare is heavily, heavily regulated. So
Speaker 2: these pseudo insurance policies, what they offer, how they offer
Speaker 2: is unbelievably regulated. What you can and cannot offer, what
Speaker 2: the policies, the kind of deductibles, the kind of coverages.
Speaker 2: Now most of that regulation, not all of it, but
Speaker 2: most of that regulation is not at the state level.
Speaker 2: But that means they're fifty different types of regulation. It
Speaker 2: also means that because of that, if I live in California,
Speaker 2: I cannot buy a health insurance policy from Nevada. I
Speaker 2: can only buy it in California because health insurance is
Speaker 2: regulated at the state level, and you cannot buy across
Speaker 2: state lines health insurance, so there's no real competition. So
Speaker 2: it's heavily regulate the insurance level. I mean every aspect
Speaker 2: of what you can buy. I mean, if you look
Speaker 2: at the Obamacare exchanges, the policies all look very similar,
Speaker 2: and they look very similar because there's only a range
Speaker 2: in which they can play around. They have to cover
Speaker 2: I don't know, psychological care, they have to cover pregnancy,
Speaker 2: they have to cover all kinds of things. In California,
Speaker 2: alternative healthcare like acupuncture has to be covered. All kinds
Speaker 2: of stuff like that, and then the actables cannot be
Speaker 2: too high. You cannot get catastrophic health insurance. It's very
Speaker 2: difficult to find a state where you can actually just
Speaker 2: buy catastrophic health insurance. We'll get to that. That's insurance.
Speaker 2: But then everything about the delivery of healthcare is regulated. Hospitals,
Speaker 2: massive regulations on hospitals. We saw that during COVID. And
Speaker 2: isn't it interesting that given the failure during COVID, the
Speaker 2: you know, the lack of capacity, the lack of communication,
Speaker 2: the bad policies coming down from government visa v. COVID,
Speaker 2: that healthcare there was really no reform. There's really no
Speaker 2: lessons learned, not just about how to deal with the pandemic,
Speaker 2: but maybe there's something in our healthcare system that is
Speaker 2: not working right. For example, you remember there were hospital
Speaker 2: bed shortages. Why is that, Well, it turns out the
Speaker 2: state governments regulate how many beds you can have in
Speaker 2: the hospital, and if you want to expand, you have
Speaker 2: to get permissioned because they're looking at something about competition
Speaker 2: within a particular band. In the nineteen fifties, there was
Speaker 2: passed a law that said that within every certain radius
Speaker 2: there has to be a hospital. So lots and lots
Speaker 2: of hospital were built. Some of that has gone away,
Speaker 2: but again, you know where hospitals are, how many beds
Speaker 2: they have, what kind of services, for example, emergency services
Speaker 2: are not they can provide, all regulated, all controlled by government,
Speaker 2: heavily heavily regulated. And of course what the government, what
Speaker 2: a doctor can prescribe you, what kind of drugs are available,
Speaker 2: the whole issue of drugs, whole issue drugs massively regulated,
Speaker 2: massively controlled by government, the FDA, and the whole process
Speaker 2: of getting drugs to you. The whole reason it's so
Speaker 2: expensive and it takes so long is because of the
Speaker 2: extent of regulations. And then finally, well not finally, because
Speaker 2: I think there's a lot more than I'm not even
Speaker 2: getting to. But there's the supply of medical staff is regulated,
Speaker 2: is controlled, doctors, nurses, people who working in hospitals. Licensing
Speaker 2: laws very across states but are pretty stringent. They are
Speaker 2: restricted restrictions and funding for medical schools that can increase
Speaker 2: the number of doctors or decrease the number of doctors,
Speaker 2: depending on decisions that are made in terms of funding
Speaker 2: medical schools. And then there's immigration, the fact that doctors
Speaker 2: who are highly qualified, who are being trained in the
Speaker 2: best universities in the world outside the United States and
Speaker 2: licensed in those other countries, and not a lot of
Speaker 2: work in the United States and cannot get immigration visas.
Speaker 2: So it's very difficult to get immigration visas to come
Speaker 2: to the US to work here on a permanent basis.
Speaker 2: So we've got a a financing system that is completely
Speaker 2: messed up because it's not real insurance, and it creates
Speaker 2: mal hazard, which means over consumption. It creates distortions of
Speaker 2: pricing where we as consumers don't know and don't care
Speaker 2: how much any procedure costs. We just don't care, as
Speaker 2: compared for example, to lask which is not covered by insurance,
Speaker 2: where we do care how much it costs and you know,
Speaker 2: or what is the other one, and prices have come down,
Speaker 2: by the way, and plastic surgery, which is not typically
Speaker 2: covered with insurance and where prices of us come down.
Speaker 2: And there's massive innovation in both LASY or health eye health,
Speaker 2: different different aspects of improving I say, massive improvements dropping costs,
Speaker 2: and certainly that's true of plastic surgery. Lots of options,
Speaker 2: real competition, and we as consumers get to decide what
Speaker 2: to do, who to do it with, and so on.
Speaker 2: All right, so I've laid out kind of the system
Speaker 2: the way it is now. This is not this is
Speaker 2: just a fraction of it. Right. We haven't got into,
Speaker 2: you know, how drugs are delivered through. Uh these you
Speaker 2: know entities that sit between pharma and your pharmaceutical and
Speaker 2: your pharmacy. I just forgot the acronym just slipped out
Speaker 2: of my mind, right, pb PBS's maybe anyway, and they
Speaker 2: sit in between. I think most of them our owned
Speaker 2: now by insurance companies. I think one may be owned
Speaker 2: by one of the pharmacies. But these entities that are
Speaker 2: supposed to make things more efficient but have created massive
Speaker 2: complexity within the drug delivery and drug pricing. You know,
Speaker 2: we haven't talked about, you know, all the other ways
Speaker 2: in which regulations drive and drive all kinds of distortions
Speaker 2: and perversions within the healthcare system. Pharmacy benefits managers p
Speaker 2: b MS not pb SspB MS, thank you. The complexity
Speaker 2: is massive. Now, a free market would be pretty complex.
Speaker 2: We'd have actually more options, but it would be simpler
Speaker 2: for you as a consumer. All Right, what should be
Speaker 2: a goal in reforming a healthcare system. We want a
Speaker 2: system that provides consumers with choices regarding treatment and cost,
Speaker 2: that maximizes individual health outcomes and avoids both personal and
Speaker 2: government bankruptcy. Right, So, healthcare system that provides consumers consumers
Speaker 2: of health care with choices regarding treatment and cost, maximizes
Speaker 2: individual health outcome and avoids what personal government bankruptcy. And
Speaker 2: add to this, maximizes the freedom of doctors to exercise
Speaker 2: their profession based on their judgment. And that's something we
Speaker 2: also haven't talked that much about the fact that so
Speaker 2: much of the system, so much of what doctors are
Speaker 2: left doing in what is covered and what is not covered,
Speaker 2: and what is permitted and was not permitted and soon
Speaker 2: is dictated by Medicare and Medicaid and be insurance companies,
Speaker 2: and so much of that is just it's much easier
Speaker 2: just to regimen in certain convey mentional medical treatments and
Speaker 2: and and be be conservative about, you know, not trying
Speaker 2: new stuff, not being radical in in in how one
Speaker 2: delivers services, because we've got a particular way in which
Speaker 2: this is financed. So for example, the pter T model
Speaker 2: where you're not really paying him like you do a
Speaker 2: part you pay him a retainer if you will, or
Speaker 2: the concierge doctor model is not covered by these insurance policies.
Speaker 2: Most of us pay insurance, and then we have these
Speaker 2: concierge doctors that we have to pay out of pocket.
Speaker 2: It's double the money. You know, you're, you're, It's just
Speaker 2: it's just overly cumbersome, overly complex, and way overly expensive.
Speaker 2: I have so many would done dincies in the healthcare
Speaker 2: coverage that I have. It is ridiculous because I have
Speaker 2: concierge doctors. You know, I have a very expensive health
Speaker 2: insurance policy because because anyway, I have a very experienceive
Speaker 2: of health insurance policy and I pay out of pocket
Speaker 2: for a lot of things. And yet I have this
Speaker 2: expensive insurance policy that just doesn't cover all the things
Speaker 2: that I value and that I pay out of pocket. So,
Speaker 2: you know, this is the health care system we have.
Speaker 2: Why do we have it? Why is the healthcare system
Speaker 2: the way it is? Why is goverment so immersed in healthcare?
Speaker 2: And why have we taken decisions away from individuals? Now,
Speaker 2: you can take an historical perspective on this and see
Speaker 2: all the different points in which this was created by
Speaker 2: many can't MEDICAI a relatively new in the nineteen sixties. Somehow,
Speaker 2: old people and poor people survived in the health care
Speaker 2: system up until the nineteen sixties, yet Medicare and Medicaid
Speaker 2: were instituted. You know, the whole idea of employer based
Speaker 2: healthcare was a way was introduced during the World War
Speaker 2: Two as a way for companies who faced price controls
Speaker 2: over wages increase benefits to their employees as a way
Speaker 2: of giving them a raise. They weren't allowed to give
Speaker 2: them an actual raise, so they gave them an added
Speaker 2: benefits and then that was institutionalized in the nineteen fifties
Speaker 2: early fifties by giving them attacks deduction on that benefit.
Speaker 2: But just imagine if during World War Two we didn't
Speaker 2: have a cap on wages, we didn't have price control
Speaker 2: on wages, then we wouldn't have maybe the insurer based
Speaker 2: the employer based so called insurance system that we have today.
Speaker 2: So a lot of this happens incrementally, slowly, it builds,
Speaker 2: and then as we know, every government's invention creates problems
Speaker 2: that then lead to more govermnent intervention that creates problem
Speaker 2: to the least, the more goverment intervention, and we get
Speaker 2: this stacking on top one on top of the other.
Speaker 2: You see this with Medicare and the Medicare pod D.
Speaker 2: You see this with healthcare, and all the regulations are
Speaker 2: like this. I have great examples on this from finance.
Speaker 2: But it's the same is true in healthcare. But what
Speaker 2: is excuse given for why the government plays such a
Speaker 2: big role in healthcare? Why it basically covers the expenses
Speaker 2: of one hundred and fifty million Americans, Why it's you know,
Speaker 2: it's very difficult if you want to buy individual health care.
Speaker 2: Why the government makes it so difficult for you? And
Speaker 2: why the choices are so constrained, particularly at the insurance level.
Speaker 2: Right insurance level, we have very very limited, limited options.
Speaker 2: I will say this. You know Americans want choices. And
Speaker 2: one way you can and tell that we want choices
Speaker 2: is the failure of the kind of the PPO model.
Speaker 2: This is the PPP model. The PPO model is a
Speaker 2: model which you paid less for the so called insurance,
Speaker 2: but you got fewer choices in terms of doctors and
Speaker 2: hospitals and facilities to treat you. The sorry, that's the
Speaker 2: HMO model, and then that's HMO model. Get fewer choices
Speaker 2: in doctors, few choices in hospitals, fewer choices in places
Speaker 2: to treat you. The PPO model is wide choices. And
Speaker 2: while the h model was popular what twenty twenty something
Speaker 2: years ago, maybe thirty years ago, it pretty much shrunk
Speaker 2: dramatically because people didn't choose it. People didn't like it,
Speaker 2: They didn't like to speak to choices. People want choices.
Speaker 2: So the government keeps finding ways to reduce the choices
Speaker 2: while while we were giving us the tense that we
Speaker 2: still have them, given us the pretense we still have them.
Speaker 2: And why, well, I hear these arguments all the time,
Speaker 2: why we can't have more free markets in healthcare? There's
Speaker 2: asymmetrical information. You know, you don't know what's good for you.
Speaker 2: You can't judge a good doctor and a baghdad. You
Speaker 2: can't judge what procedure you should take. There's too much,
Speaker 2: you know, the difference in knowledge between you and the doctor,
Speaker 2: or you and the providers of healthcare is too large.
Speaker 2: It's just too large. Healthcare is too expensive, and if
Speaker 2: we don't provide it as a government, you'll all go bankrupt.
Speaker 2: Healthcare will just collapse if the government doesn't provide it
Speaker 2: for you. There's no mechanism. The market does not have
Speaker 2: a mechanism by which to allow you. So people just die,
Speaker 2: right you. Poor people won't get any health care, they'll
Speaker 2: just die. Old people will just not be able to
Speaker 2: afford Who can afford a cancer treatment? It costs millions
Speaker 2: of dollars some cancer treatments. So it's too expensive and
Speaker 2: it's way too complicated. So which goes through with the
Speaker 2: asymmetric confirmation. In other words, you're not smart enough most
Speaker 2: of you, and you're not responsible enough. A lot of
Speaker 2: you won't buy insurance, you'll buy the wrong insurance, you'll
Speaker 2: buy too little insurancy. Whatever. And then finally, the profit motive.
Speaker 2: The profit motive is a really bad incentive in healthcare.
Speaker 2: It's going to lead people to try to you know,
Speaker 2: like everywhere. How can you trust the profit motive? The
Speaker 2: profit motive is about greed, and greed will lead people
Speaker 2: to undertreat you. As if that happens anywhere else in markets,
Speaker 2: like in food, to get rotten food because of the
Speaker 2: farmer's greed. Food is privatized, it's not provided by the government.
Speaker 2: Do we get a lack of variety in food because
Speaker 2: of the farmer's greed. It's completely nuts, completely nuts. So
Speaker 2: profit is an incentivizer to increase quality, actually reduce costs,
Speaker 2: it's to innovate. Profit is to provide great service. That's
Speaker 2: what the profit motive actually does. But people don't believe that.
Speaker 2: And then finally, and I think this is important. Healthcare
Speaker 2: now is perceived as a right. I must have it
Speaker 2: because I need it, because we all need it. We
Speaker 2: all need it, will require healthcare at some point in
Speaker 2: our lives. Therefore we must have it. There's a more
Speaker 2: responsibility for it. There's a responsibility to take care of anybody, everybody,
Speaker 2: and therefore the government must step in because we wouldn't
Speaker 2: fulfill them our responsibility otherwise, altruism demands it. And ultimately
Speaker 2: it boils down to a really emotional argument. And the
Speaker 2: consequence of this, of course, costs are indeed high. Some
Speaker 2: people get so its denial, but generally we're not exposed
Speaker 2: to the best alternatives. Necessarily, you need to invest a
Speaker 2: lot in figuring out what's going on if you are
Speaker 2: sick and you need treatment, complete subversion of customer from prices.
Speaker 2: There's from prices, this massive mal hazard. There's just a
Speaker 2: lot of unnecessary complexity and opaqueness and confusion, not just
Speaker 2: among customers patients, but among doctors as well. I mean,
Speaker 2: think about how much time and effort doctors today put
Speaker 2: into the paperwork. How many people they have to hire
Speaker 2: to fill out paperwork, paperwork, everything's paperwork to get reimbursed,
Speaker 2: and the time wasted waiting for reimbursements, and the effort exists.
Speaker 2: You know, so many doctors get MBA's not so much
Speaker 2: because they want to grow their business, but because they
Speaker 2: just need to survive. They need to know some accounting,
Speaker 2: they need to know some stuff because it's become so complicated.
Speaker 2: So they're real destructive consequences. And a lot of this
Speaker 2: has to do with destructive consequences the doctors, and I
Speaker 2: think doctors feel like they become bureaucrats. The producers of
Speaker 2: healthcare feel like they become bureaucrats. The producers of healthcare
Speaker 2: feel like, you know, they're not being compensated appropriately to
Speaker 2: what they're doing. And a lot of people leave healthcare,
Speaker 2: the people entering healthcare of a lower quality. Generally, healthcare
Speaker 2: is less rewarding. It's as it becomes more bureaucratized. And again,
Speaker 2: the talent is the talent pool is smaller. Fewer people
Speaker 2: go in for the right reasons and all kinds of
Speaker 2: distinctions and medical schools and so on, but just from
Speaker 2: a pure economic perspective, fewer people are going to go
Speaker 2: in because more bureaucratic, less opportunity to innovate, and expensive.
Speaker 2: Medical school is expensive, and you know, salaries income stagnant,
Speaker 2: and you know, then think about drug companies and think
Speaker 2: about medical device companies, and think about all of that
Speaker 2: and the degree to which we regulate and control all
Speaker 2: of that. To that degree, we don't get massive innovations,
Speaker 2: new products. I mean, it's stunning and amazing and heartwarming,
Speaker 2: and you know, just amazing that we get as much
Speaker 2: innovation as we do. I mean, we get huge amounts
Speaker 2: of innovation. And yet imagine what we could get if
Speaker 2: we didn't control and regulate and mandate and so on.
Speaker 2: And I'm not even getting you know, one of the
Speaker 2: issues with healthcare that we should discuss but we won't
Speaker 2: discuss today is medical research, which is government dominated and
Speaker 2: it is far from optimal. And it's a whole other topic.
Speaker 2: Think about the NH, the NHS and NIH National Answer
Speaker 2: for Health and all the money that the government gives
Speaker 2: out in grants and so on, not an efficient productive
Speaker 2: you know, method or outcome. All right, So we've described
Speaker 2: the system as it is, at least parts of it. Again,
Speaker 2: I'm sure there are big holes here. Let's talk about
Speaker 2: what we can do to fix it. And I think
Speaker 2: that the two things that have to happen in order
Speaker 2: to fix the system, and the main thing is the
Speaker 2: main thing is the main thing one has to do
Speaker 2: is to reduce the involvement of government in health care.
Speaker 2: To reduce the involvement in government healthcare in every dimension.
Speaker 2: So we need to reduce the amount of government regulation
Speaker 2: of health care. We need to reduce the amount of
Speaker 2: government regulation of insurance, health insurance. We need to reduce
Speaker 2: the moment of government in actually funding health care, Medicare, Medicare,
Speaker 2: each one of those is huge, each one of those
Speaker 2: all to some extended related And of course we need
Speaker 2: a change tax policy to change the kind of incentives
Speaker 2: in terms of who's buying insurance. So and I'd say
Speaker 2: that's part of regulation of health insurance. So we need
Speaker 2: to reduce the eliminated regulation of healthcare providers. We need
Speaker 2: to reduce the eliminate regulation of health insurance. And we
Speaker 2: need to reduce and ultimately eliminate government as a provider
Speaker 2: of healthcare direct healthcare financing. Now, all of that is
Speaker 2: a lot. We're talking about seventeen point six percent of GDP.
Speaker 2: We're talking about the largest single industry out there again,
Speaker 2: employees millions and millions of people, and spends for trillion dollars.
Speaker 2: And we want to do it all in a way
Speaker 2: that does not bankrupt people, that does not have people
Speaker 2: who are sick dying in the streets, that does not
Speaker 2: disrupt medical innovation, that does not disrupt the ability of
Speaker 2: doctors to do their job. So we want to make
Speaker 2: the transition as smooth as possible. Not that they're no costs.
Speaker 2: Whenever you have a system like this and you're trying
Speaker 2: to make it more free, there are costs of transitioning
Speaker 2: because so much infrastructure is built around this. The disrupting
Speaker 2: it is going to some Pospitals might go out of business,
Speaker 2: some doctors might go, some insurance companies might go. There's
Speaker 2: going to be a restructure, a restructure, a repositioning of
Speaker 2: the whole system. All right, So let's let's think about
Speaker 2: how to do this. Let's talk about let's take step
Speaker 2: by step Step one is we want to phase out
Speaker 2: the employer provided healthcare. We want to get employers out
Speaker 2: of the business of health care, of out of funding it,
Speaker 2: financing it, buying it, whatever, out of it. And we
Speaker 2: want to move to a system where individuals own their
Speaker 2: own health insurance policies. And we'll see that if we
Speaker 2: move towards individually owned insurance policies, that will also be
Speaker 2: an opportunity to move towards real insurance. We want to
Speaker 2: at the same time completely deregulate the insurance marketplace. Now
Speaker 2: I don't know how you do this because the insurance
Speaker 2: marketplace is governed state by state. Now you could federalize it.
Speaker 2: You could say, states, you cannot regulate insurance anymore. It's
Speaker 2: going to happen in the state. It's going to happen.
Speaker 2: You know, we're not going to regulate insurance. Oh, here
Speaker 2: are a few standards by which you can regulate, but
Speaker 2: that means ninety percent of what you're regulating goes away.
Speaker 2: So you can't maindate what coverage, you can't mandate what deductibles.
Speaker 2: You can mandate all these things, or one alternative if
Speaker 2: you don't want to completely trample on so called on
Speaker 2: the states is to say, is to have a federal
Speaker 2: law that basically says you can buy insurance in any
Speaker 2: state and create competition among the states, and who can
Speaker 2: deregulate the fastest, who can deregulate the fastest, so you
Speaker 2: can have competition between states. So I'm open to either
Speaker 2: one of those. I ideally I would love to see
Speaker 2: all state regulations go away, the regulations about the kind
Speaker 2: of policies, the type of policies, what can be offered,
Speaker 2: and maybe a federal law could do that. And if
Speaker 2: it can, then it should. I'm not sure the Streame
Speaker 2: quote would accept it, but it should. It should try
Speaker 2: to get rid of state level regulations. In that sense,
Speaker 2: you should federalize it. It was done in banking there
Speaker 2: were state level regulations that were basically nationalized and eliminated.
Speaker 2: So we need to do that. How do you move
Speaker 2: to individual owned healthcare policies, Well, you need to stop
Speaker 2: giving companies a tax deduction on healthcare expenditures. They cannot
Speaker 2: they cannot spend money, they cannot, sorry, they cannot get
Speaker 2: it to tax deduction, and then offer individuals a tax
Speaker 2: deduction at least in the short run. Like this could
Speaker 2: be a policy that is phased out over time, because
Speaker 2: I don't particularly like giving people deductions on taxes, because
Speaker 2: I like really really simple taxes with no deductions. But
Speaker 2: to solve the problem that we have, and maybe this
Speaker 2: would also be done in education for a decade, let's
Speaker 2: say you give people the ability to deduct their insurance
Speaker 2: premiums from the taxes at the individual level, not at
Speaker 2: the corporate level, not at the business level. Businesses have
Speaker 2: to pay taxes, cannot deduct insurance costs, and nows you
Speaker 2: shift the incentive to individuals, and for example, what about
Speaker 2: individuals who don't itemize, give them a deduction in spite
Speaker 2: of that. There are ways to do it right. One
Speaker 2: way to do that is, you know, to have a
Speaker 2: medical saving account. Medical saving accounts allow you to put
Speaker 2: money pre tax into an account and use that money
Speaker 2: for healthcare, including insurance, and now you're not having to
Speaker 2: deduct anything from your taxes other than the money that
Speaker 2: you put into that account, which is not going to
Speaker 2: be taxed. That's a simple way to do this. So
Speaker 2: medical saving accounts should become universal. Everybody should have availability
Speaker 2: to them. They should be unlimited. Let individuals make decisions
Speaker 2: about how much money they want to put into a
Speaker 2: medical saving account. It doesn't make sense to put in
Speaker 2: you know, more than what you're going to use for healthcare.
Speaker 2: You should be able to roll them over from year
Speaker 2: to year. So this can become basically a way for
Speaker 2: you to save money for healthcare emergencies or for expected
Speaker 2: significant healthcare costs come in the future, and you should
Speaker 2: be able to use that money to buy health insurance.
Speaker 2: Now with a system like this where I have a
Speaker 2: vehicle in which I can save money for healthcare expenditures,
Speaker 2: a system where I can do this in a pre
Speaker 2: tax manner, a system where I own the insurance policy
Speaker 2: that I'm buying, and I own this account where I'm
Speaker 2: saving money to cover my expenses in a sense self insuring.
Speaker 2: What it makes sense for individuals to do, and what
Speaker 2: I think individuals would do is actually buy real insurance,
Speaker 2: not a risk pool, but real insurance. And what that
Speaker 2: insurance would be would be insurance against catastrophic laws. This
Speaker 2: would be insurance that would cover you if you had
Speaker 2: to have surgery, or if you had a heart attack,
Speaker 2: or if you had cancer, or it would cover certain
Speaker 2: expenses if you develop diabetes. Maybe not all the expenses
Speaker 2: maybe not the recurring expenses that you can expect, but
Speaker 2: some of the dramatic, big ones. So I mean it
Speaker 2: would be a competitive market in which different companies would
Speaker 2: offer different coverages and the market would figure out what
Speaker 2: made sense and what didn't make sense. You could imagine
Speaker 2: insurance policies that this is the way you could take
Speaker 2: care of what do you call it a PI existing condition?
Speaker 2: Insurance policies that covered you for life price to today
Speaker 2: based on your health today, had a payment schedule into
Speaker 2: it for the rest of your life, and that covered
Speaker 2: just these catastrophic losses. You can imagine all kinds of
Speaker 2: things developing, right, you know, insurance policies that encouraged you
Speaker 2: to take care of yourself, gave you discounts when you exercised,
Speaker 2: and actually maybe insurance policies that actually tracked your fitness
Speaker 2: monitors that actually encouraged you to wear them. I know,
Speaker 2: privacy concerns. I don't care about privacy. If I'm going
Speaker 2: to get a discount, I want my insurance company to
Speaker 2: know how much I exercise. And maybe, you know, you
Speaker 2: could even take photos of what you eat. I don't know,
Speaker 2: But the point is you'd get innovation you'd get competition,
Speaker 2: and you'd get real insurance, and you get insurance that
Speaker 2: does its job. If it was good insurance, it would
Speaker 2: do its job to lower your risk of actually incurring
Speaker 2: the catastrophic risk. Right, so, fire insurance insurance company might
Speaker 2: come to the house they certainly do this with big
Speaker 2: expenses like industrial insurance, and say, look, we would actually
Speaker 2: lower your cost of insurance if you did these five
Speaker 2: things to make your home more fireproof. For example, I
Speaker 2: remember we changed the type of tiling on our roof
Speaker 2: and the kind of insulation in our attic. That actually
Speaker 2: lowered a cost of home insurance. Why because the house
Speaker 2: was less likely to burn down. Well, imagine again the
Speaker 2: insurance companies, we're willing to lower your health insurance because
Speaker 2: you let's even say you are taking a statin that
Speaker 2: lowers your a POB to a level that makes it
Speaker 2: very unlikely that you will get a heart attack, And
Speaker 2: the insurance company might say, you know, we'll even now.
Speaker 2: Now it turns out that statins cost almost nothing, but
Speaker 2: some of these other mechanisms are lower condition are quite expensive.
Speaker 2: I mean, insurance company might even say, you know, yeah,
Speaker 2: we'll cover that cost because you know, because we're going
Speaker 2: to have you as a client for many years, and
Speaker 2: it lowers the chances of you actually needing this catastrophic
Speaker 2: I don't know. My point is you'd get innovative products.
Speaker 2: Hospitals might provide insurance, Doctors associations might provide different types
Speaker 2: of insurance. I mean, we might be able to move
Speaker 2: into what p dot T calls healthcare three point zero,
Speaker 2: which is a healthcare much more focused on prevention than
Speaker 2: on treatment, and to fund and the odience everybody and everything,
Speaker 2: and the incentives both of the doctors and the customers
Speaker 2: towards prevention rather than towards just treating you when you're sick. So,
Speaker 2: once we get the employers out of it, and we
Speaker 2: get individuals to buy their own policies, and we provide
Speaker 2: them with an incentive to put money aside for their
Speaker 2: health care through a tax deduction MSA, uh medical saving incomes,
Speaker 2: and an incentive to buy some kind of insurance, but
Speaker 2: any kind of insurance, you've solved the huge part of
Speaker 2: the American healthcare system, you know, And then I am
Speaker 2: buying healthcare. I'm going to my doctor and saying, okay,
Speaker 2: you know, how much does it cost to fuse my
Speaker 2: back if I need black back fusion, what are the alternatives?
Speaker 2: How much did they cost? What are the outcomes? All right,
Speaker 2: let's sit down and figure out what I should do.
Speaker 2: What is insurance going to cover? Will insurance cover any
Speaker 2: of it? And if so, what of it will it cover?
Speaker 2: Given its catastrophic nature? Does this coount? All of that
Speaker 2: would then go into decision making. Now, this requires people
Speaker 2: to actually be engaged, to be involved, or you know,
Speaker 2: just like it could be that just like we have
Speaker 2: financial advisors where we say, you know, I don't want
Speaker 2: to I don't want to think about how to invest
Speaker 2: my money. It's too difficult. I'm going to hire somebody.
Speaker 2: I'm going to do my research and hire the best
Speaker 2: person I can and then basically they can invest my
Speaker 2: money and then good someone how it's going to be invested.
Speaker 2: Maybe we have healthcare consultants healthcare advisors who when we
Speaker 2: have healthcare decisions that are really complex and time consuming,
Speaker 2: we hire them to come in and provide us with
Speaker 2: all the facts and help us make the right decisions.
Speaker 2: I don't know. That's the beauty of markets whenever they
Speaker 2: are asymmetries of information, and they're huge in medcare healthcare,
Speaker 2: no question, Whole sectors the economy develop, new professions develop
Speaker 2: in order to mitigate the asymmetry. So when can only
Speaker 2: imagine the kind of products, the kind of innovations that
Speaker 2: would happen to deal with the complexities of healthcare. And
Speaker 2: maybe that consultant is just how Maybe that consultant is
Speaker 2: simply our physician, how our general physician. Maybe you actually
Speaker 2: maybe that's generally part of their will is to help
Speaker 2: us navigate. It's to organize what specialists are saying, and
Speaker 2: it's to sit down with us and say, Okay, here
Speaker 2: are the options, and here's what possible. And maybe and
Speaker 2: one would expect, given that I am paying, that they
Speaker 2: would start treating me a lot better, spending more time
Speaker 2: with me, and that the general physician would become much
Speaker 2: more of a consultant, coordinating all aspects of my care
Speaker 2: with specialists and hospitals and clinics. Then just a guy
Speaker 2: I go see for a general check up and go
Speaker 2: to get get get a couple of aspens when I'm
Speaker 2: not feeling well. So imagine your primary care physician becoming
Speaker 2: that a real consultant to you, somebody who is really
Speaker 2: there to work with you through a healthcare plan, how
Speaker 2: to avoid disease, how to stay healthy, and then when
Speaker 2: you do something does happen, how to maneuver, how to
Speaker 2: deal with the complexities of the system. All right, so
Speaker 2: if we phase out, you got to phase out, uh
Speaker 2: the end, and you got to do it over time.
Speaker 2: You can't do it all at once. I would start
Speaker 2: by offering mssas to everybody, and then I would basically
Speaker 2: put a sunset a year from now on the tax
Speaker 2: addictability of health costs. So first off of them mssas. First,
Speaker 2: give everybody an opportunity off open a medical saving accounts.
Speaker 2: Then tell employers you're not going to get the text
Speaker 2: deduction anymore. Not going to get the text deduction anymore.
Speaker 2: You've got a year, two years to adjust, to adapt,
Speaker 2: and to educate your employees to the fact that you
Speaker 2: know they will get a better deal if they buy
Speaker 2: insurance through the MSA, through the medical saving income. And
Speaker 2: what what happen is you'll get insurance markets developing, you know,
Speaker 2: a little bit like Obamacare, but better, more efficient. We'll
Speaker 2: get to Obamacare later, but so a vast majority of
Speaker 2: working adults get their healthcare today through the employers that
Speaker 2: would go away, and they'd start getting it personally in
Speaker 2: a big chunk of the healthcare system would suddenly be privatized. Now,
Speaker 2: if you couple that with real deregulation of hospitals, real
Speaker 2: deregulation of doctors, real deregulation starting of drugs, massive benefits.
Speaker 2: But you still need to deal with Medicaid Medicare. And
Speaker 2: this is not easy because that's so big and so
Speaker 2: much depends. So many people depend on it, so many
Speaker 2: people are being conditioned to depend on it. You can
Speaker 2: just take it away tomorrow. Everybody has pre existing conditions.
Speaker 2: It would be very, very difficult for them to fund it.
Speaker 2: People have not saved for their healthcare when they're old,
Speaker 2: So let's just start with Medicare. So I think Medicare
Speaker 2: needs to be phased out. It needs to be phased
Speaker 2: out over time, and it might take a generation to
Speaker 2: phase it out completely. The best idea I've seen around
Speaker 2: phasing out Medicare is to move Medicare away from health care,
Speaker 2: to make it a purely a system that subsidizes healthy shaans.
Speaker 2: So Medica should stop writing checks to hospitals for drugs
Speaker 2: for anything. Medica should move to basically a voucher system,
Speaker 2: a voucere system that allows the elderly, anybody over sixty
Speaker 2: five to buy health care and to buy catastrophic insurance.
Speaker 2: So basically, take what we spend today per person on Medicare,
Speaker 2: have them all open up in medical saving accounts and
Speaker 2: put the money into the medical Saving acount The government
Speaker 2: literally puts the money into their saving accounts, and they
Speaker 2: can use that money to buy insurance and to pay
Speaker 2: for health care spending that they might have. This is
Speaker 2: going to be incredibly expensive because but Medicare is already
Speaker 2: pretty expensive, so it would stay expensive. But what you
Speaker 2: would do is every year, maybe two years, the amount
Speaker 2: of money that went into this medical saving counts would
Speaker 2: be slightly lower for new people entering the system. So
Speaker 2: for old people you would guarantee, I'm just making numbers
Speaker 2: up now, you'd guarantee every year you get ten thousand dollars,
Speaker 2: or you get one thousand dollars or whatever it is,
Speaker 2: you get it every year until you die. Into the
Speaker 2: medical saving incounts. For anybody who sixty five or older today,
Speaker 2: if you're sixty three, when you turn sixty five, you'll
Speaker 2: only get nine thousand dollars. If you're sixty one, when
Speaker 2: you turn sixty five, you'll only get eight thousand dollars
Speaker 2: and so on. So the young people can look at
Speaker 2: it and say, huh, okay, the gunment's gonna give me
Speaker 2: a lot less money. So, but I have more time
Speaker 2: to prepare for that. And part of that preparation is
Speaker 2: going to be I'm gonna save more money in my
Speaker 2: medical saving account for when I probably most need it,
Speaker 2: in my sixties and seventies. So I'm gonna start accumulating
Speaker 2: money in my medical saving accounts. I'm going to start saving,
Speaker 2: and I'm going to keep this private insurance. I'm gonna
Speaker 2: get policies that will cover me when I'm in my
Speaker 2: sixties and seventies. So the subsidy, whatever the amount is
Speaker 2: per senior, we keep, in a sense the promise to
Speaker 2: the people you know today who are retiring or sixty
Speaker 2: five and older. But anybody entering the system is going
Speaker 2: to get less. Now how much less you'd have to
Speaker 2: do the math. You'd have to figure it out. You'd
Speaker 2: have to see how the markets evolved too. I mean,
Speaker 2: it could be the insurance prices go down quite a bit,
Speaker 2: and healthcare costs could go down quite a bit now
Speaker 2: that we're creating a real market for insurance, real consumer
Speaker 2: now sorry, a real market for insurance and a real
Speaker 2: market for health care. And now we're creating consumers for
Speaker 2: health care, real demand, not demand by big entities negotiating,
Speaker 2: but by individuals. You'd expect healthcare costs to come down,
Speaker 2: and you'd expect the whole industry to focus on profitability
Speaker 2: and making themselves profitable by reducing costs, so prices come
Speaker 2: down through competition and through innovation. Now, I think you
Speaker 2: would do the same thing with Medicaid. I think for
Speaker 2: every poor person, however you categorized it, you would open
Speaker 2: up a medical saving account and you would say, you know,
Speaker 2: we will fill it up depending on how poor you are,
Speaker 2: up to a certain amount. And again, we are going
Speaker 2: to phase this program out. This is not permanent. We're
Speaker 2: going to face this program. Although even if it was permanent,
Speaker 2: it would be far better than what we do today.
Speaker 2: And notice what happens now. Now you've got insurance companies
Speaker 2: competing for their dollars. You've got insurance companies competing for
Speaker 2: the Medicaid and Medicaid recipients dollars because they're still offering
Speaker 2: them through the market products catastrophic primarily products. But now
Speaker 2: you've got doctors and hospitals competing for their dollars rather
Speaker 2: than negotiating with the you know this massive Medicare or Medicaid.
Speaker 2: Now they're negotiating with real customers who are price sensitive.
Speaker 2: So you know you you I rather you subsidize generally
Speaker 2: and eliminate all regulations, then regulate and become a direct purchaser,
Speaker 2: So it's better. I think I'm gonna just subsidize its
Speaker 2: in a sense that provides a cash benefit to people.
Speaker 2: And in this sense, you know, I have some sympathy
Speaker 2: for the universal basic income. If you could guarantee to
Speaker 2: me that you would, you will need to get rid
Speaker 2: of every single welfare and healthcare and education dollars spent
Speaker 2: by state, local, and federal government, every dollar spent on welfare,
Speaker 2: but also on healthcare, education, every dollar spent. Then I
Speaker 2: think a universal basic income would make a lot of sense. Basically,
Speaker 2: what this valture system is moving us towards that giving
Speaker 2: them the money so they can buy it and then
Speaker 2: start phasing it out. So have a universe of basic
Speaker 2: camcome let's say, University of basic income, says everybody gets
Speaker 2: fifteen thousand dollars a year. I'm just making that up,
Speaker 2: and then every year would go down by a thousand,
Speaker 2: so that in fifteen years there's nothing and the welfare
Speaker 2: state is zero. Doubt or maybe you think that's too quick,
Speaker 2: and every the year it goes down by five hundred
Speaker 2: and within thirty years it's zeroed out. It's fine with
Speaker 2: me by me as well, and the same here. Ultimately,
Speaker 2: the push should get nothing from government to buy health
Speaker 2: insurance or to cover their health expenses. And to a
Speaker 2: large extent, you know, capitalism would eradicate poverty. That is,
Speaker 2: the whole goal should be to grow the economy so
Speaker 2: fast that in absolute terms, nobody is put and for
Speaker 2: the freak event where somebody really can't afford it, that's
Speaker 2: what charity is for. And the same thing with old people.
Speaker 2: People should be incentifized to be responsible to save save
Speaker 2: money for old age and if they can't or if
Speaker 2: they don't, if they don't because everybody can, then charity
Speaker 2: will have to take care of them. But I get
Speaker 2: it that you can't advocate for that today. That is
Speaker 2: long term, that is in fifteen years, when we phased
Speaker 2: out all these programs are thirty years when we phased
Speaker 2: it all out. And this of course brings you to
Speaker 2: Medicaire Obamacare Obamacare. If we phase our medicaid and phase
Speaker 2: our medicare and we move all insurance to individual insurance,
Speaker 2: Obamacare goes away. There's no reason to subsidize exchanges. You're
Speaker 2: ready in a sense, subsidizing the individual to buy the
Speaker 2: healthcare there. They're either medicared or and insurance costs. Because
Speaker 2: the insurance market is deregulated, the insurance costs are going down,
Speaker 2: and there's just everybody can afford insurance. And those people
Speaker 2: who are really too poor to affod real insurance, real
Speaker 2: insurance being catastrophic insurance. Uh, you know, you're basically giving
Speaker 2: them a subsidy. So today Obamacare subsidizes people who are
Speaker 2: not in medicaid but who don't have enough money to
Speaker 2: buy insurance. But that's because insurance is so expensive today
Speaker 2: because it covers so much, it's so heavily regulated, and
Speaker 2: it's not real insurance. It's a risk pool. But if
Speaker 2: insurance becomes real just catastrophic, and if everybody can have
Speaker 2: an MSA and they can start saving even if it's
Speaker 2: a little bit of money for the annual doctor visit,
Speaker 2: for the getting a flu or getting a something like that.
Speaker 2: You take away the need for the additional subsidies on
Speaker 2: top of Medicaid and Medicaid that Obamacare requires, and now
Speaker 2: you just have a real marketplace and insurance. But then
Speaker 2: it becomes real insurance i e. For catastrophic where unpredictable
Speaker 2: events and the rest you're safer. So again I'm advocated
Speaker 2: of a UBI to be phased out as a step
Speaker 2: towards getting rid of the welfare state. So you're not
Speaker 2: going to get rid of the welfare state without some
Speaker 2: kind of transition. You're not going to get rid of
Speaker 2: the welfare state like that. The best way to phase
Speaker 2: it all out, you can phase out Medicare, Medicaid, you
Speaker 2: can phase out. And by the way, one thing you
Speaker 2: could do with medicaire is the valure system could be
Speaker 2: means tested, right, the values system can be done in
Speaker 2: a way that and this reduces cost dramatically. Not everybody
Speaker 2: gets it, so it's like medicaid, if you need it,
Speaker 2: you get it. If you don't need it, if you
Speaker 2: can afford the manic the the health insurance costs and
Speaker 2: the and your health expenditures, then you don't get it.
Speaker 2: So you can come up with a way in which
Speaker 2: the annual expenditures is already going down dramatically, and yeah,
Speaker 2: that makes it. You know, it's it's now mean tested.
Speaker 2: But I paid all my life taxes for medicaire. You
Speaker 2: just pay taxes. We all just pay taxes. It's not
Speaker 2: going to any particular thing. It's all fungible. So security
Speaker 2: is functible, Medicare is fungible. And indeed most most people
Speaker 2: spend uh spend four times more, four times more than
Speaker 2: they ever paid into. So all of these things need
Speaker 2: to be phased up. The idea that you can get
Speaker 2: rid of them all in a bang, it's never going
Speaker 2: to fly. It's not doable. Maybe in a horrific crisis,
Speaker 2: but then you don't want to you don't want to
Speaker 2: live through that, so you phase it out. So UBI
Speaker 2: only as a means to phasing out the welfare state.
Speaker 2: All right, I'll just add that part of the massive
Speaker 2: deregulation would dramatically involve FDA reform and ultimately the prioritization
Speaker 2: of the FDA. The first step of the reform could
Speaker 2: be uh, the FDA approves drugs only in the basis
Speaker 2: of safety, not efficiacy, and then you know a market
Speaker 2: will evolve for different labs that evaluate efficacy, and then
Speaker 2: you can basically get rid of the safety issues around
Speaker 2: the FD as well and privatize those. It's ultimately you
Speaker 2: want all drug development approval to be to be private.
Speaker 2: And here you know, you've got to reform the way
Speaker 2: drug development is done. We've got to reform the way
Speaker 2: science has done, the way grants are given. That's a
Speaker 2: whole other topic we can do another time. But ultimately
Speaker 2: you want the government out of that as well, out
Speaker 2: of that as well. But every again, all of these
Speaker 2: things involve phasing out over time. You're not going to
Speaker 2: get a government that is going to just drive everything
Speaker 2: down to zero. I mean, you want the fdiut of
Speaker 2: recommending food, you want them out of food inspection, you
Speaker 2: want them out of the whole gamut of what they do.
Speaker 2: But in healthcare, what you want is to reform so
Speaker 2: that you can get more dru on to the market
Speaker 2: and then privatize, re fum and privatized. Now, note that
Speaker 2: if you do all this, wages will go up quite
Speaker 2: a bit because you know employers who now do not
Speaker 2: have to buy you health insurance will be able to
Speaker 2: give you that money as salary. That is money that
Speaker 2: can immediately go into your medical saving account. So wages
Speaker 2: go up as a consequence of all this. As government
Speaker 2: spends less on healthcare because it's phasing out Medicare and
Speaker 2: Medicaid and making Medicare means tested. As all of that
Speaker 2: is being phased out, the government is spending less money
Speaker 2: and hopefully taxes come down at the same time. At
Speaker 2: the same time, outcomes improved dramatically. It's more innovation in
Speaker 2: the system. There's more doctor and generally producer involvement in
Speaker 2: the system. Hospitals start caring about you. Doctors start caring
Speaker 2: about you. Not that they don't care now, but they
Speaker 2: have an incentive to provide great service because you are
Speaker 2: the one paying them. Doctors become more engaged in potentially
Speaker 2: alternative solutions, more interested in finding alternative means to solve problems.
Speaker 2: They become much more engaged in problem solving than just
Speaker 2: being bureaucrats. They become engaged, involved and responsible for your
Speaker 2: health together with you. So the whole system shifts. It
Speaker 2: becomes dynamic, interesting, exciting it and again, particularly if we
Speaker 2: get to shift to where the tear calls three point zero,
Speaker 2: where the doctor now becomes your consultant on staying healthy.
Speaker 2: It can become fun, experimental, It becomes something that even
Speaker 2: as a consumer you embrace and look forward to, versus
Speaker 2: going to the doctor. Now, when you go it's typically
Speaker 2: because you're sick. Imagine going to doctor in order to
Speaker 2: stay healthy, in order to stay fit. You would see,
Speaker 2: you know, new drugs on the market, new medical techniques,
Speaker 2: new medical devices, new procedures, and a general orientation towards health,
Speaker 2: a general orientation towards staying healthy, rather than the orientation
Speaker 2: of just you know, solving problems when the problem already
Speaker 2: exists and when solutions are limited. I think you'd see
Speaker 2: a lot more medical trials. I think, particularly if we
Speaker 2: have formed the way medical trials are done, which I
Speaker 2: think needs to be done in dramatic fashion. A lot
Speaker 2: more medical trials, a lot more experimentation. I mean, we
Speaker 2: are I believe on the costs potentially of just a
Speaker 2: revolution in not just prevention, which I think again people
Speaker 2: like a t leading, but of treatment. You know, whether
Speaker 2: it's vaccines against cancer, immuno therapeutic, all kinds of immuno
Speaker 2: therapies where we teach our body or train our body,
Speaker 2: or induce our body to fight the cancer, which is
Speaker 2: what the vaccines do, or whether it's massive amounts of
Speaker 2: new drugs in the pipeline to treat autoimmune diseases, which
Speaker 2: could be major evolutions, major evolutions. So you know, again
Speaker 2: we could see life expectancy, but more importantly, the quality
Speaker 2: of life dramatically improve now. And I want to say this.
Speaker 2: I think it's important to say this to finish off.
Speaker 2: In spite of all the problems that medical system has today,
Speaker 2: and it has big ones, particularly when you think about
Speaker 2: the potential and what could be and how long we
Speaker 2: could live and how well we could live. What is
Speaker 2: truly amazing. And this is a testament to the heroism
Speaker 2: and the dedication of doctors and researchers and scientists and
Speaker 2: pharmaceutical industry. Why I hate that tax on pharma. What
Speaker 2: is truly amazing is how much gets done, how much
Speaker 2: innovation is indeed happening. As I said, the American healthcare system.
Speaker 2: If you are sick, there's no better system in the
Speaker 2: world to be under. If you take away the light
Speaker 2: the stupid lifestyle choices that Americans make and if you
Speaker 2: just look at outcomes, if you get cancer, which healthcare
Speaker 2: system would you rather be in? It's not even close.
Speaker 2: You'd rather be in the US. If you had heart disease,
Speaker 2: which healthcare system would you rather be in? Now? So
Speaker 2: we have an amazing healthcare system, and if we make it,
Speaker 2: and if we make these changes, we can have a
Speaker 2: just an unbelievably amazing healthcare system. Health care system. I
Speaker 2: think there could be better, you know, uh, in extending
Speaker 2: our lives and more importantly in improving the quality of
Speaker 2: our lives than anything we can imagine today, anything we
Speaker 2: can aagine today. So it's yeah, I think it's super exciting.
Speaker 2: I think the potential is super exciting. The depressing part
Speaker 2: is that these things are very unpopular and almost impossible
Speaker 2: to get through, and there's no energy, there's no passion,
Speaker 2: there's no real drive to get big time healthcare reform done,
Speaker 2: particularly not dramatic, dramatic reform like I've articulated here. There's
Speaker 2: too much of this idea. It's not become inculcated in
Speaker 2: people's minds that healthcare is are right, which is the
Speaker 2: I think the biggest barrier to this, and therefore must
Speaker 2: be supplied by the government. Healthcare is are right in
Speaker 2: the sense that you have a right to go out
Speaker 2: and seek whatever treatment you want, as long as you're
Speaker 2: willing to pay for it and as long as the
Speaker 2: providers willing to provide it. All right, Yeah, hopefully that
Speaker 2: was useful, helpful, informative. And again there's this idea of
Speaker 2: a if we could just get medical saving accounts for everybody,
Speaker 2: that would be a huge leap forward. And there was
Speaker 2: work done on that, and some of it led by
Speaker 2: objectivists ten, fifteen, twenty years ago, but it never took off,
Speaker 2: partially because of massive regulations, and partially because msas were
Speaker 2: always limited, always constrained, and partially because it's hard to
Speaker 2: compete with employers who can just provide this. The employer
Speaker 2: tax deductability has to be eliminated, it has to be
Speaker 2: phased up. All right, Thank you guys, So we can
Speaker 2: go to our super chatter is. We've got a lot
Speaker 2: of questions here and we've done really well in super chat,
Speaker 2: primarily because Wes came in with five hundred dollars. Wes,
Speaker 2: thank you, thank you, thank you. This is fantastic. We're
Speaker 2: about fifty eight dollars short of where we need to
Speaker 2: be to get to our seven to fifty, which is
Speaker 2: the goal for a three hour show, and it's likely,
Speaker 2: given the number of questions, that will at least at
Speaker 2: least enter into the third hour, but we will see.
Speaker 2: Actually not that many questions, so maybe not. But anyway,
Speaker 2: we're doing great, So thank you. Let's see what do
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Speaker 2: intellexos one day you should consider Austin, Texas, late February,
Speaker 2: a weekend conference, all expenses paid. But to do that
Speaker 2: you have to apply for scholarship. To apply for scholarship,
Speaker 2: go to iron ran dot org slash dot here iron
Speaker 2: ran dot org slash start here. All right, so let's uh,
Speaker 2: let's look it out super chat and cover that and
Speaker 2: see where we go from there. And we will start
Speaker 2: with Wes. Five hundred dollars really really appreciated. Wes a regular,
Speaker 2: ongoing super Chat supporter of the Iron Books show and
Speaker 2: just just steady, regular amazing and then you know, once
Speaker 2: in a while a big chunk like five hundred dollars
Speaker 2: that that is. You know, it really motivates me to
Speaker 2: do shows like this that not only do we have
Speaker 2: sponsors for, but we also didn't have somebody like West
Speaker 2: willing to put a lot of money in for it.
Speaker 2: It's not going to get a show like this is
Speaker 2: not going to get the most views. My Immigration to
Speaker 2: China shows did not get the most views because people
Speaker 2: like the newsy stuff. They like the the controversial stuff,
Speaker 2: and they're not interested in the solutions. Necess certainly they're
Speaker 2: interested in the in the angst, in the in the controversy,
Speaker 2: and the bash the bashed the left kind of stuff
Speaker 2: or bashed Trump kind of stuff. UH. So I appreciate
Speaker 2: it when I do a show focused on solutions, uh,
Speaker 2: focused on on potential solutions, that it gets so much support.
Speaker 2: All right, Wes says, I am a data analyst that
Speaker 2: has worked with some of the largest healthcare systems in
Speaker 2: the country. The whole system is so convoluted. I can
Speaker 2: say that almost no one knows how hospitals actually make money,
Speaker 2: including the people who work in the industry. Yes, I mean,
Speaker 2: I mean basically, hospitals make money by charging more than
Speaker 2: they spend. But here's the thing. A lot of times
Speaker 2: hospital will lose money on the Medicaid patients and then
Speaker 2: make money on their private insurance patients. And in some
Speaker 2: cases they might lose money on some procedures and make
Speaker 2: money on other procedures. And the whole thing is convoluted
Speaker 2: by the fact that there's no pricing transparency because the
Speaker 2: customer don't care about prices, so hospitals come up with
Speaker 2: all these They're acquired by law to have prices for everything,
Speaker 2: so they basically have prices that are ridiculous. I heard
Speaker 2: sixteen dollars gauze a gauze patch right now, nobody actually
Speaker 2: pays sixteen dollars to the gauze, but that's the price
Speaker 2: that the hospital lists. I guess you pay the sixteen
Speaker 2: dollar gaus. If you go in and say i'll pay
Speaker 2: cash and you don't negotiate with them, then maybe you'll
Speaker 2: pay the sixteen dollars. But that's because why not have
Speaker 2: the highest prices possible on your website and then kind
Speaker 2: of not on your website, but because they don't do
Speaker 2: it on their website, but has as they on their
Speaker 2: price sheet, and then they sit down with the insurance
Speaker 2: companies and they negotiate down from that and a lot
Speaker 2: of it. The way it's paid is not paid by item,
Speaker 2: but paid by procedure, and then before it includes all
Speaker 2: the things that go into the procedure. So Bye bys surgery,
Speaker 2: all the all the hard way involved in a bite
Speaker 2: by surgery is going to be is going to be
Speaker 2: paid in bulk. There's a price for that, and then
Speaker 2: the doctor gets paid and the staff gets paid. Do
Speaker 2: you know how much a doctor gets for bye by surgery?
Speaker 2: Something like between a thousand and two thousand dollars. That's
Speaker 2: how much he's reimbossed by an insurance company for bye
Speaker 2: By surgery. And you'd think it would be a lot
Speaker 2: more than that, right, given I want to pay the
Speaker 2: guy who's doing who's opening me up and playing around
Speaker 2: inside of me with my heart, I want to pay
Speaker 2: him a lot of money. I wanted to get a
Speaker 2: lot of money because I wanted to do a good job.
Speaker 2: But they do a lot of them, so they make
Speaker 2: a lot of money at the end. But and a
Speaker 2: thousand dollars might a thousand and two thousand dollars might
Speaker 2: include all the meetings you had before and all their
Speaker 2: post up meetings you have with them. It's pretty amazing
Speaker 2: how cheap it really is. So the pricing. So they
Speaker 2: have a whole thing where they negotiate with insurance companies
Speaker 2: so when you go into the hospital. So when I
Speaker 2: was in hospital, I got a bill from the hospital
Speaker 2: even though I wasn't paying, I didn't care, And it
Speaker 2: was like absurd. It was like half a million dollars.
Speaker 2: I was in the hospital for like five six days,
Speaker 2: I think six days half a million dollars, and I
Speaker 2: think the insurance companies maybe paid one hundred and fifty thousand,
Speaker 2: and given what was done to me. Then, given the
Speaker 2: service I got and given everything else, that's not a
Speaker 2: lot of money. I don't think for the five days
Speaker 2: six days at back surgery. But it was complicated back surgery,
Speaker 2: and it took hours and hours and hours, and I
Speaker 2: don't know how much the doctor got it. I hope
Speaker 2: he got a lot of money, because he spent the
Speaker 2: whole day just on me, like it was a nine
Speaker 2: hour surgery, and then he had to go back in
Speaker 2: two days later for another four hours.
Speaker 1: I think.
Speaker 2: I mean, that's a lot of time. I mean, I
Speaker 2: hope he got paid a lot of money for it.
Speaker 2: Probably not so. Anyway, there's a convoluted way in which
Speaker 2: that's paid. And then Medicare sits down with hospital and says,
Speaker 2: this is how much we're willing to pay, and sometimes
Speaker 2: Medicare probably overpays. Sometimes that underpays, and the hospital has
Speaker 2: to take into account what Medicare is paying them in
Speaker 2: order to figure out how much they can afford of
Speaker 2: a discount to give the the private insurance companies. And
Speaker 2: the same thing with drug prices. Drug prices are listed
Speaker 2: at these incredible rates, but then the insurance companies get
Speaker 2: discounts and the pharmacies get discounts and individuals get discounts.
Speaker 2: And I don't know a lot of drugs I see
Speaker 2: out there in the market, you know, the ones that
Speaker 2: are popular and maybe out of patent, unbelievably cheap, a
Speaker 2: buck of pill, less than a buck of pill. Sometimes
Speaker 2: you just get them free. The insurance is covering all
Speaker 2: of it. I mean, it's bizarre, and so price becomes
Speaker 2: it becomes meaningless instead of private individuals actually seeing a price,
Speaker 2: choosing partially based on price, you know, paying their doctor directly,
Speaker 2: and the insurance stepping in with only oh, you know,
Speaker 2: the real massive amounts you had to go to hospital.
Speaker 2: You didn't expect the one hundred thousand and a million
Speaker 2: dollar cancer treatment. Stuff like that is where the insurance
Speaker 2: companies and they they are fine with it because they
Speaker 2: priced it is catastrophic they know. And then there's less
Speaker 2: than out of coverage because it's understood what the insurance
Speaker 2: is for. So yeah, it's unbelievably convoluted, unbelievably complex because
Speaker 2: it's trying to do what cannot be done, which is,
Speaker 2: you know, have a third party allocator fund all these
Speaker 2: things that it shouldn't be funding. You're trying to fit
Speaker 2: into an insurance model something that's clearly not insurance, and
Speaker 2: that just makes no sense and it provides all the
Speaker 2: wrong incentives to individuals. Thank yous, all right, Andrew fifty dollars.
Speaker 2: Any honest economist knows that free market's lower prices and
Speaker 2: increase quality. Yet mainstream intellectuals, according Rand, practically catatonic when
Speaker 2: it comes to capitalism. Health Care is too important to
Speaker 2: be left of markets, They say, what say you, well,
Speaker 2: I mean health care is too important not to be
Speaker 2: left of markets. The same with the education, the same
Speaker 2: with everything. You know, help government is force, government is coursion,
Speaker 2: and a gun cursion and a gun have no room
Speaker 2: in the doctor's office. They have no place in the
Speaker 2: operating room. They have no place in drug development. So
Speaker 2: what you want a market's? Now, well, markets always lower costs,
Speaker 2: I mean yeah, for equal quality, but quality might go
Speaker 2: up and cost might increase. And the point about health
Speaker 2: care being expensive is for whom like I get it
Speaker 2: that Medicare Medicaid are unsustainable, and they are unsustainable, But
Speaker 2: you know, is healthcare is how much of your budget
Speaker 2: as an individual would you be willing to spend on healthcare?
Speaker 2: You know, a lot. What percentage of your lifetime income
Speaker 2: are you willing to spend to be healthy? I don't know.
Speaker 2: Some people spend, and I don't think this is outrageous
Speaker 2: twenty five percent of their income to stay healthy and
Speaker 2: to treat diseases when they crop up? Is that unreasonable?
Speaker 2: Other people spend a fraction of that. But what's the
Speaker 2: right number? Well, only the individual can decide what the
Speaker 2: right number to spend on healthcare. Healthcare is not expensive.
Speaker 2: Seventeen point six percent of GDP? Is that a lot?
Speaker 2: I don't know.
Speaker 1: Is that a lot?
Speaker 2: I don't know. That's not what troubles me. It's not
Speaker 2: troubles me if if twenty percent of GDP is spent
Speaker 2: on healthcare, that doesn't worry me. Well, why is me
Speaker 2: is that government is spending it, and it has no
Speaker 2: means by which to pay it off other than to
Speaker 2: you know, and and all it's doing when government is
Speaker 2: spending it is redistributing wealth, which I think is evil
Speaker 2: and wrong, and and on top of being evil and
Speaker 2: wrong andymol inefficient. So what I want is a system
Speaker 2: that gets rid of redistribution, gets rid of the cross subsidization.
Speaker 2: Now again, you can't do that all once, so you're
Speaker 2: gonna have to subsidize over time in order to get
Speaker 2: rid of the subsidies ultimately. But the worst kind of subsidies,
Speaker 2: and this is I think an important point, generally, the
Speaker 2: worst kind of subsidies are the hidden subsidies explicit out
Speaker 2: there here. It is, you know, Eavy Electric, call you
Speaker 2: by the gouvernment gives you a two thousand and our check.
Speaker 2: All right, we get that, we might not like it,
Speaker 2: but we get it. But when the subsidies involved, well,
Speaker 2: we're going to actually subsidize the battery and we're going
Speaker 2: to subsidize the development of whatever. If you look at
Speaker 2: EV subsidies, for example, of the subsidies are hidden, you
Speaker 2: never see them. What you see is just the tax
Speaker 2: advantage that the gunment gives you to buy an EV.
Speaker 2: But that's not the main subsidy. The main subsidies all
Speaker 2: kind of little things that are inside those are the
Speaker 2: ones that do the real damage, because those we don't
Speaker 2: even know exist. So get rid of those, and then
Speaker 2: then we can phase out the known subsidies. So many
Speaker 2: can't medicate huge subsidies, huge subsidies, super inefficient subsidies, super
Speaker 2: distortive subsidies because they start the whole market for healthcare
Speaker 2: by voucherrousing them. You still subsidize, but now the subsidy
Speaker 2: is explicit. Everybody knows how much it costs per person,
Speaker 2: and those vultures are used in a private economy in
Speaker 2: a lesser stortive way. Now, the supply side of healthcare
Speaker 2: response to demand directly, not through some government entity or
Speaker 2: through some kind of employer provided a third party payer,
Speaker 2: but directly. And again then you have a means also
Speaker 2: to phase it out. You have a means to get
Speaker 2: rid of it. That is, you just reduce the subsidy
Speaker 2: every year, you make it smaller. All right, thank you, Andrew.
Speaker 2: All right, John, are you familiar with former Rand fan
Speaker 2: John Goodman, whose policy ensued promote healthcare form. Yes, I
Speaker 2: think it's in Dallas. I know John, We've talked periodically
Speaker 2: over years. He's quite good on certain things, you know.
Speaker 2: He Unfortunately he's abandoned Ie Randa a long time ago,
Speaker 2: and is a little too forgiving of government intervention in
Speaker 2: the economy, government intervention in healthcare too moderate when it
Speaker 2: comes to that. Some of you consider me too moderate
Speaker 2: in my reform proposals. But he's even moderate, more moderate
Speaker 2: to me, but on the other hand has a deep
Speaker 2: understanding of the field, often has interesting solutions to particular problems.
Speaker 2: And it is one of the people working towards making
Speaker 2: healthcare free. And I give him credit for that. And
Speaker 2: we need a lot more think tanks institutes that are
Speaker 2: dedicated to things like that. There were a number of
Speaker 2: good free market healthcare institute. The one run by objectivists
Speaker 2: is AFCAM. I mispronounced its name last time. It was
Speaker 2: Americans for Freedom of in Medicine. I think American's Freedom
Speaker 2: of Choice in medicine. Somebody correct me on the chat
Speaker 2: if I'm wrong. They're an objectives to run organization. Amy
Speaker 2: Schidlog is part of it. We've got one of our
Speaker 2: scholars at the Inran Institute is running it these days.
Speaker 2: Ray and Ray sure and yeah, I mean it's going
Speaker 2: to be exciting as Ray ramps up what they do
Speaker 2: to see how they start trying to influence the healthcare system.
Speaker 2: We will have somebody from AFGHAM on the show later
Speaker 2: this month. They will be sponsoring a show to talk
Speaker 2: about their approach to privatizing healthcare, to fixing healthcare in
Speaker 2: the United States. So you'll get a perspective of doctors
Speaker 2: and physicians and people in the field, rather than my perspective,
Speaker 2: which is as a economist inspired by a philosophy Jason.
Speaker 2: Europe would have us believe you have the public mandate
Speaker 2: insurance eight percent of income, but you can go to
Speaker 2: a private doctor and pay out of pocket and it
Speaker 2: is still far more affordable than the United States, granted
Speaker 2: not the male clinic. So I don't think that's true.
Speaker 2: It's probably true of a lot of day to day stuff.
Speaker 2: I don't think it's true when it comes to big
Speaker 2: items heart disease, cancer, autoimmune diseases, Alzheimer's. I just don't
Speaker 2: think that's true. But look what Europe does. What Europe
Speaker 2: does is Europe basically places restrict supply. It places constraints
Speaker 2: and supply, and therefore that is a that is a
Speaker 2: way for them. Then they do that with price controls.
Speaker 2: That is a way for them to they so they
Speaker 2: ration Europe and socialized medicine JET generally is a rationing
Speaker 2: mechanism and that's how they keep prices under control. And
Speaker 2: so it's cheap in the system because it's it's a
Speaker 2: rational system. Because a suppliers will only provide so much
Speaker 2: at those prices, so I guess you can go to
Speaker 2: a doctor and get stuff on top of that. I
Speaker 2: haven't run the numbers. I don't know what it would
Speaker 2: cost uh, and it could be. I mean, our employer
Speaker 2: based insurance system is very, very, very expensive postively for
Speaker 2: the reasons Wes said. It's so convoluted that nobody knows
Speaker 2: what anything costs, and there's a huge amount of waste,
Speaker 2: and there's a massive amount of bureaucracy, and the reality
Speaker 2: is that there is a sense in which like the
Speaker 2: NHS has less bureaucracy than the American elcare system because
Speaker 2: it's so convoluted. Single payer is simpler. You want an MRI, fine,
Speaker 2: you don't stand in the queue. But it's simpler in
Speaker 2: the sense that we don't have negotiate prices. We don't
Speaker 2: have to monitor which MA you got. You know, you
Speaker 2: just stand in que and you get the MRI. Like
Speaker 2: everybody else is m A. You don't have any choices.
Speaker 2: So if you reduce choice, you can reduce cost. Now,
Speaker 2: the private sector in these systems is typically very small,
Speaker 2: particularly in the UK, and you can't get the major
Speaker 2: procedures there. You can't get major surgery and get the
Speaker 2: treatment under the major major stuff. Socialized medicine eliminates choice.
Speaker 2: So the one thing it eliminates, I mean, and it
Speaker 2: constraints supply, so it rations. So the choice you have
Speaker 2: is rationed. Alexis says on the chat seven hour wait
Speaker 2: in er emergency room in Central London Hospital for an
Speaker 2: allergic reaction. Now you can get long waits in the
Speaker 2: US as well, but that's because we have regulations, for example,
Speaker 2: that four stocked hospitals emergency rooms to treat anybody who
Speaker 2: walks into an emergency room, anybody, whether they have insurance,
Speaker 2: they don't, where they can pay, where they can't, whether
Speaker 2: they have a heart attack, or whether they have the flu,
Speaker 2: And that creates bottlenecks, and then that turns it into
Speaker 2: a European like emergency room. But if you basically said, yeah,
Speaker 2: we're not treating flu patients, We'll only treat who we
Speaker 2: want to treat. It's an emergency room, then you would
Speaker 2: have a very different emergency room experience. All right, thank you, Jason, Jennifer.
Speaker 2: My dad and yours were doctors. People have no idea
Speaker 2: how hard they work to get there. It makes me
Speaker 2: so sad, so mad when people think they know medicine
Speaker 2: when they never study to practicity. Yeah, I mean you
Speaker 2: see it all the time. We've got we've got amateur
Speaker 2: doctors everywhere, experts in the field of I mean, you know, vaccines, immunization,
Speaker 2: you know, diet everything, and heart disease and cancer, and
Speaker 2: they know exactly the causes and the cures and everything.
Speaker 2: It's ridiculous. But it's not just how hard they work
Speaker 2: to get this, it's how hard they work as doctors.
Speaker 2: At least now, my father worked mostly under a socialized
Speaker 2: medicine system in Israel, but he had to make a
Speaker 2: living because he got paid by the government, and the
Speaker 2: government paid doctors very little, so he then had to
Speaker 2: have a private practice on the side, so that was
Speaker 2: in the evenings. And you know, see, he worked all day,
Speaker 2: taught at the medical school, ran a department at the hospital,
Speaker 2: and then in the evening he had a private practice.
Speaker 2: So we never saw him skids. He just worked to work.
Speaker 2: A quote Bobara illustration had a new replacement last year
Speaker 2: in Europe using private paid. Total cost including five days
Speaker 2: in hospital, was ten thousand Europe. In the US, the
Speaker 2: cost is one hundred thousand Euromon and patients are sent
Speaker 2: home the day of surgery. Yeah, absolutely, I mean I had.
Speaker 2: I had back surgery in the in the US right outpatient.
Speaker 2: I was sent home within hours, which I like. I
Speaker 2: don't want to spend the time in hospital. I don't
Speaker 2: like to spending time in hospital. You shouldn't have to
Speaker 2: be five days in hospital for a knee replacement. And
Speaker 2: I didn't pay anything. I didn't pay anything. I don't
Speaker 2: know how much it cost the insurance company. I have
Speaker 2: no idea. It wasn't one hundred thousand because it was outpatient.
Speaker 2: It was probably ten thousand. But I got out of there.
Speaker 2: And the only reason it cost me And this is
Speaker 2: the beauty of the American system, and maybe you can
Speaker 2: and I think you can do this in parts of Europe.
Speaker 2: Not every way, though, is I convinced my doctor to
Speaker 2: inject me with STAY, to inject the disc that he
Speaker 2: was cleaning up with stem cells, and for that I
Speaker 2: had to pay in cash. So I think that was
Speaker 2: five thousand dollars that I paid cash. He basically had
Speaker 2: to get a machine and to spind the stem cells.
Speaker 2: He has to go into my hip and extract bone
Speaker 2: marrow and then spin it and then inject mice themselves
Speaker 2: back in and so the whole thing cost me out
Speaker 2: of pocket five thousand because I paid nothing for the
Speaker 2: rest of the surgery that was all covered by the
Speaker 2: so called the insurance that I had. I've spent time
Speaker 2: in hospital when I got my fusion. I had back
Speaker 2: fusion that was before that, more than ten years ago,
Speaker 2: and there I spent six days in hospital, two surgeries,
Speaker 2: one of them dayly full day, A whole day. New
Speaker 2: replacement is not and again it costs me nothing. Now
Speaker 2: I don't know how much it cost my showings company.
Speaker 2: That's part of the problem. So it could be that
Speaker 2: in Europe, if you use the private system, it's ultimately cheaper.
Speaker 2: I don't know. I mean, you know, I have healthy shows.
Speaker 2: In the US, it covers a lot. All my surgeries
Speaker 2: are paid for with private doctors in private setting that
Speaker 2: I choose my back surge US, with doctors I chose
Speaker 2: when I spent in hospital. When I didn't, I just
Speaker 2: had showed the surgery he and Puerto Rico the same
Speaker 2: day in and out of the hospital. I chose the doctor.
Speaker 2: I could have gone to the US. I could have
Speaker 2: chosen any doctor in the US to do the same surgery.
Speaker 2: I didn't want to because I wanted to be you know,
Speaker 2: if there was complications or anything that I wanted to
Speaker 2: be close to the doctor. Didn't want to have to
Speaker 2: fly to see the doctor. But the I could have
Speaker 2: chosen any doctor in the United States to do the procedure.
Speaker 2: It would have cost me the same here as it
Speaker 2: would have if I'd gone to the male clinic to
Speaker 2: have it done. Zero. So I am You know, you
Speaker 2: could argue I'm super happy with kind of the direct
Speaker 2: costs and the healthcare that I get because I get
Speaker 2: to choose my doctors. What I'm not happy about is
Speaker 2: what I know is possible in a proper privatized HEALTHCA system.
Speaker 2: What's missing is the innovation, the dynamism. And I pay
Speaker 2: a lot of a lot of money for insurance. I personally,
Speaker 2: it's not through a business. And I pay a lot
Speaker 2: of money for insurance because again I'm subsidizing Medicare, I'm
Speaker 2: subsidizing the the the I'm probably subsidizing the employer based system.
Speaker 2: I'm not getting a tax deduction on it. So you know,
Speaker 2: there's a there's a huge subsidization cross upsietization going on
Speaker 2: here from me to other people that I'm not happy about,
Speaker 2: and again I'm not happy about the fact that it
Speaker 2: could be so much better. But I get I believe
Speaker 2: that today I get the best healthcare in the world,
Speaker 2: and for me, in terms of my expenses on healthcare,
Speaker 2: probably about as cheap as it gets. I mean, I yeah,
Speaker 2: I mean I wish it was different because I think
Speaker 2: I can imagine what else could be. But I wouldn't
Speaker 2: want to be in Europe. And I appreciate what you're saying, Baba,
Speaker 2: and but yeah, and you know, I think that if
Speaker 2: you can get, if you can, if you can be
Speaker 2: in a private healthcare system in I think, like the
Speaker 2: Swiss system is really good, and there may be other
Speaker 2: systems that are really good. I would never want to
Speaker 2: be in the UK, even with private healthcare. I wouldn't
Speaker 2: even with the potential for private insurance. I wouldn't want
Speaker 2: to be in a lot of these social life medicine countries.
Speaker 2: I think Switzerland is unique because it has a private
Speaker 2: sector adjacent to it. It's also relatively less regulated. You
Speaker 2: can do a lot of procedures in Switzerland you can't
Speaker 2: get here in the US. There's a lot of stuff
Speaker 2: you can do with stem cells in Switzerland but also
Speaker 2: in South America that you can't do in the US.
Speaker 2: So imagine if we got rid of all those regulations
Speaker 2: and all those controls yield twenty five. Can you recommend
Speaker 2: any good articles of books that discuss healthcare in the
Speaker 2: way you just did or smaller? God, I don't know.
Speaker 2: I mean John Goodman. I think look John Goodman for
Speaker 2: books on healthcare. I can't remember now, I've read some
Speaker 2: in the past. There were some good books on medical
Speaker 2: saving accounts, but no, I don't have off the cuff books.
Speaker 2: But look for books on medical saving accounts, privatizing healthcare.
Speaker 2: There are some good books by Cato people, by John
Speaker 2: Goodman's institute. There's an student in San Francisco, I forget
Speaker 2: the woman's name, that's written some good books on this.
Speaker 2: So there is material out there. Alexis what is the
Speaker 2: common thread between finance and healthcare that made them prime
Speaker 2: targets for the intellectual status. Assuming you expect that prem
Speaker 2: accept that premise, fear asymmetric information, you always get that
Speaker 2: you know you'll be taking advantage of by the financier
Speaker 2: if they don't have to register at their SEC and
Speaker 2: they don't have to jump through all these hoops. We
Speaker 2: need to license these people because otherwise they'll you out
Speaker 2: of your money, they'll commit fraud. We need to make
Speaker 2: sure they're good people. So asymmetric information in both, you've
Speaker 2: got experts to know a lot more than you do.
Speaker 2: I mean, that's true of everything in life. That's the
Speaker 2: beauty of a society of division of labor and specialization.
Speaker 2: But finance and medicine, I think are particularly so. And
Speaker 2: everybody appreciates that. Wow, yes, specialized knowledge is really needed there.
Speaker 2: That's one, you know. Regulation of them evolved completely differently.
Speaker 2: Finance was regulated from the beginning of time because it
Speaker 2: was viewed as exploitative for the beginning of time because
Speaker 2: of the attitude was usually the fear of great financial power,
Speaker 2: the fear of wealth associated with finance. That doesn't exist
Speaker 2: in healthcare. So other than the asymmetric information and if
Speaker 2: you that were too stupid to take care of ourselves,
Speaker 2: which involves both the fear that greed i e. Profit
Speaker 2: motive will cause real harm exists in both. Other than
Speaker 2: I think they're quite different. Healthcare evolved in a particular way,
Speaker 2: and nobody thinks you have a right to a saving account.
Speaker 2: But you have a right to healthcare, and that makes
Speaker 2: it even more difficult to separate, to separate healthcare from
Speaker 2: government than it is financing government. You're right, they're both
Speaker 2: emostly charged, but they're mostly charged because on the healthcare
Speaker 2: side it's viewed as a need, and on the finance side,
Speaker 2: it's fear of being exploited. I think it's mostly charged
Speaker 2: for different reasons. Suddenly altruism dominates the healthcare I'm not
Speaker 2: just as dominant in the finance. It's there, but it's
Speaker 2: not as dominant, all right, Andrew, Republicans don't have them
Speaker 2: all based from which to be serious about challenging how
Speaker 2: healthcare works in any fundamental way. Ultimately, they agree with
Speaker 2: mass collectivization of health care. Yes, and you saw that
Speaker 2: by the inability to repeal Obamacare, by the inability to
Speaker 2: repeal Medicare and Medicaid. I mean, go back to nineteen
Speaker 2: sixty four, the election of nineteen sixty four, and the
Speaker 2: speeches that Ronald Reagan gave in nineteen sixty four against
Speaker 2: Medicare Medicare. They're brilliant, they're really good, really really good speeches.
Speaker 2: He makes a lot of good arguments, but once it
Speaker 2: was passed. Nobody stood up against it. No Republican ever
Speaker 2: talked about downsizing it, never mind reforming it, never mind
Speaker 2: eliminating it. All they've done is expanded expansion of medicares.
Speaker 2: Happened out the Republicans by Melianda George Bush two thousand
Speaker 2: and two three something like that. So, yeah, there's nothing.
Speaker 2: They never undo any socialist program that's already put in
Speaker 2: place because they basically they basically accept them all premise
Speaker 2: under which it exists. Andrew, people have no idea how
Speaker 2: good healthcare would be under capitalism. It really is the
Speaker 2: unknown ideal. Thanks for making it a little bit more known. Yeah,
Speaker 2: it really is an unknown idea in the sense that
Speaker 2: you can't imagine the technologies, the drugs, the knowledge, the help,
Speaker 2: the suggestions, the yeah that would be available under free
Speaker 2: market healthcare system working to allow us to live longer
Speaker 2: and healthier. While we're at it, I mean, the experimentation,
Speaker 2: the innovation, just how to believe, how to imagine, not
Speaker 2: how to believe very believable, just how to imagine what
Speaker 2: it cook says, solving us healthcare is easy. You just
Speaker 2: gotta outload the profit motive. Then plenty of medicines and
Speaker 2: healthcare will magically appear for everyone. That's it. It's the
Speaker 2: profit motive. It's exact opposite. I mean what Cook is saying,
Speaker 2: it's exact opposite. What we need to do is reinvigorate
Speaker 2: the profit motive, refocus the now, refocus, we establish the
Speaker 2: focus motive, the profit motive of every aspect of healthcare.
Speaker 2: We need to expand the profit motive to touch every
Speaker 2: every little bit of healthcare. Rix says, should HIPPA be
Speaker 2: scrapped and let patients choose how their information is used?
Speaker 2: So much or a petition of data for every doctor
Speaker 2: and visit. Yes, if HIPPA were scrapped, I think you'd
Speaker 2: get a lot more innovation in digital analysis, digital of storing,
Speaker 2: digital integration of healthcare information. And yeah, HIPPA makes no sense.
Speaker 2: I mean, you want a law that says the patient
Speaker 2: should be able to decide what is done with its
Speaker 2: information unless, yeah, the patient should decide, including not caring
Speaker 2: and giving it all to you. And that's it. That's
Speaker 2: all you want is a law that says the information
Speaker 2: belongs to the patient. Other than that, you need nothing else.
Speaker 2: HIPPA is just another creation, another huge bureaucracy that slows
Speaker 2: down a progress raphel in a country with NHS. How
Speaker 2: would you go from NHS to MSA's in a free
Speaker 2: market healthcare system? I mean it would be a lot
Speaker 2: more difficult. It's a lot more trenched. How would you
Speaker 2: do it? You would basically have to phase it out again.
Speaker 2: You would have to create some kind of means testing,
Speaker 2: So you would start with I think you would start
Speaker 2: with Okay, if you make more than one hundred thousand
Speaker 2: pounds a year, the NHS is not for you, and
Speaker 2: that's gonna start a year for now. You can't start immediately.
Speaker 2: That's gonna start a year for now. That creates in
Speaker 2: the center now for hospitals to be built, clinics to open,
Speaker 2: doctors and insurance companies to come about. You do also
Speaker 2: have to, I mean, immigration policy is really important. You
Speaker 2: have to be able to adjust the supply of doctors
Speaker 2: to the new demand. But yet now anybody making over
Speaker 2: one hundred thousand pounds gets no NHS zero, and maybe
Speaker 2: it has to be more than a year because you
Speaker 2: have to build hospitals. These are kind of factors that
Speaker 2: have to be put in because I don't know how
Speaker 2: many private hospitals they are, how many private clinics. Maybe
Speaker 2: it has to be two years. Maybe you start with
Speaker 2: five hundred thousand pounds stoling and then you slowly decrease
Speaker 2: it to one hundred and then to zero ultimately, so
Speaker 2: you phase it out. You say, who are the people
Speaker 2: who can who really, really really depend today on NHS.
Speaker 2: It's the poor, it's people making who couldn't afford insurance
Speaker 2: even if it was available. And of course by doing that,
Speaker 2: you make it possible to cut taxes and to free
Speaker 2: up people's resources so they can spend it on healthcare,
Speaker 2: which is really really important. Barbara, I'm glad you brought
Speaker 2: up the universal Basic income. I'm okay with that as well,
Speaker 2: at least as a temporary program. I think the money
Speaker 2: saved and administrative costs would more than fund a reasonable
Speaker 2: a MT. I don't know, I'm not sure what that
Speaker 2: says anyway, I yeah, I mean I would only support
Speaker 2: it again if it did the following. Every single other
Speaker 2: welfare and redistributive program has to be eliminated, including Medicare,
Speaker 2: Medicaid and education, right, and then you introduce it, so
Speaker 2: all of that would have to be eliminated. And that's
Speaker 2: a lot. And then I would say it has to
Speaker 2: be phased in, phase out, Sorry, phased out. It can't
Speaker 2: stay at the high level. The whole point is the
Speaker 2: incentivized markets to develop and then slowly get the government
Speaker 2: out of it and at the same time cut taxes.
Speaker 2: So yeah, universal based income. Oh right. Boba says, no
Speaker 2: means testing, higher administrative costs would eat up the savings.
Speaker 2: Means testing does not have to involve high administrative costs
Speaker 2: if you make it very very simple and very very easy.
Speaker 2: But yes, for the UBI, there should be no means testing.
Speaker 2: If it's ten thousand dollars or fifteen thousand dollars, everybody,
Speaker 2: everybody just gets a check. And you could roughly means
Speaker 2: tested by saying, okay, if you make if you have,
Speaker 2: if you make over a turn of fifty thousand dollars,
Speaker 2: you don't get the check. I don't you know. I
Speaker 2: think something like that some some very high number. And
Speaker 2: then and then U bureaucracy creed is not high, and
Speaker 2: you reduce the cost for the government to do it
Speaker 2: as atery economy, Hey you're on. If health insurance is
Speaker 2: they coupled from the employment, would there be a phase
Speaker 2: where employers are required to fund individual hsas or up wages. No,
Speaker 2: but that would happen. Employees would have no choice. Just
Speaker 2: competition would drive that very very quickly, and employees would
Speaker 2: know that, so they would do it immediately. You could theoretically,
Speaker 2: you know, force that. I don't like force. I don't
Speaker 2: like requiring things like that, but you could force the
Speaker 2: employer to provide that as an increase in wages or
Speaker 2: as an initial funding of HSA. But ideally you just
Speaker 2: let the market develop in that direction. But yeah, one
Speaker 2: way to kind of get it spur it is to say, okay,
Speaker 2: for the first year that we've eliminated employer based the
Speaker 2: employee has to take whatever they paid the previous year
Speaker 2: and put it into a medical saving account for the
Speaker 2: or health saving account that basicam using them interchangeably put
Speaker 2: them into one of these accounts for the employee, and
Speaker 2: that way we guarantee that everybody gets an account and
Speaker 2: has some money there to begin with, and then starts
Speaker 2: thinking about buying insurance through that and spending healthcare money
Speaker 2: through that. And that's a way to transition, I guess
Speaker 2: you could. You could do that. You could do that
Speaker 2: as part of the transition, but ultimately you wouldn't want
Speaker 2: to force that, Bob. But when in the US, I
Speaker 2: use private clinics when possible, in pay cash. My other
Speaker 2: pocket cost is almost always less than copey. With insurance,
Speaker 2: my copey is almost zero. So I don't know why
Speaker 2: why you know for you, insurance is so expensive noway,
Speaker 2: I pay very high premius with the insurance, but then
Speaker 2: my cope is a very low twenty bucks. I never
Speaker 2: pay more than twenty bucks. Can't remember when I paid
Speaker 2: more than twenty bucks. Twenty two, sorry, twenty two is
Speaker 2: what I pay for my shoulder guy every time I
Speaker 2: go see him. My cope is twenty two bucks. If
Speaker 2: I paid cash, my guess is he would charge one
Speaker 2: hundred dollars as a Turke dichotomy. I love these informative
Speaker 2: shows the most. Thank you, Thanks. I appreciate that. I'm
Speaker 2: glad you like it. Phil says the way, I'm not
Speaker 2: sure what that refers to. Alejandro says, I moved from
Speaker 2: my third world country to the US. The only area
Speaker 2: where my quality of life is declined is healthcare. That's
Speaker 2: interesting because I don't feel that way. I feel like
Speaker 2: I get phenomenal healthcare in the United States, So I
Speaker 2: just think you have to navigate the system and figure
Speaker 2: it out, and then once you figure it out, you
Speaker 2: can get amazing healthcare here, not as good as it
Speaker 2: could be, a bit amazing. All right, guys, thank you,
Speaker 2: thanks to all the super chatters, particularly Wes and Andrew
Speaker 2: did it a lot as well, So thank you Andrew,
Speaker 2: but thank you Wes. Thanks to Wes, we made I'll
Speaker 2: tugget so I appreciate that. I will be back tomorrow's
Speaker 2: showing Hebrew for those of you who understand Hebrew at
Speaker 2: eleven am East Coast time. So my show in Israel,
Speaker 2: and the next US English show is going to be
Speaker 2: is going to be on Monday.
Speaker 1: I have not.
Speaker 2: I did not call for a universal basic income. I
Speaker 2: called for usage of versus basic income phased out over
Speaker 2: a generation. And if you don't include the phased out
Speaker 2: over generation, and if you don't include the eliminate every
Speaker 2: other redistributed program that the government engages in, then you're
Speaker 2: misrepresenting my views, because that is what is important. So
Speaker 2: as an objectivist, I want to get rid of all
Speaker 2: the redistributed programs, lump them into UBI, and then phase
Speaker 2: that UBI out. That's how you get rid of the
Speaker 2: welfare state. I think that's us how you get rid
Speaker 2: of government involvement in healthcare and government involvement in education. Now,
Speaker 2: if you just want to treat them independently as you
Speaker 2: can deal with them through medical saving accounts and education
Speaker 2: Saving accounts, which are kind of UBI like in the
Speaker 2: sense that the government gives you a cash payment, but
Speaker 2: UBI is an opportunitiosity to get rid of all the
Speaker 2: welfare on top of all of that. All right, everybody,
Speaker 2: I will see you all on Monday. Thank you have
Speaker 2: a great weekend. And yeah, let's hope we get a
Speaker 2: little bit of what I'm suggesting. Any one of these
Speaker 2: reforms would be amazing.