Why Can’t America Have a Grown-Up Healthcare Conversation?

Why Can’t America Have a Grown-Up Healthcare Conversation?

Good morning, Hank. It’s Tuesday. So, you know the Obamacare insurance exchanges that, depending on your political perspective, are either the cause of or the solution to so many of America’s health care problems? Only about six percent of Americans actually get their insurance through those exchanges. Now, that’s obviously very important to those six percent of people, but it’s by far the smallest slice of the American health insurance pie. And I think the relentless focus on them in our political discourse speaks to a larger inability to have, for lack of a better phrase, a grown-up conversation about health care. OK, so health care is very complicated and I’m going to paint this in the broadest possible strokes. If you want far more information about health and health care, please check out Healthcare Triage. But let’s start with what health insurance does. Health insurance takes money from healthy people and uses it to buy care for sick people. you can do this through private insurance, which pools people together and takes money from them in the form of monthly premiums, oror you can do it through a public insurer which pools people together and takes money from them in the form of taxes. In the United States, we have both: Almost everyone over the age of 65 is in this publicly funded insurance pool called Medicare. Many military veterans are in a similar pool run by the Veterans Administration and there’s a third public pool that covers many low-income and disabled Americans called Medicaid but just over half of Americans get their insurance through private insurers This includes the six percent of people covered through the Obamacare exchanges, but mostly people who get their insurance from their employers. Because large companies are required to offer health insurance plans to their employees. Then, you have the nine percent of Americans who don’t have any health insurance at all. That number has dropped a lot in the last five years, but it’s still higher than any other wealthy nation’s. So, the current U.S health care system is widely considered to be, if I can use a technical term, bananas. We spend so, so much on health care. About eighteen percent of our total economic output goes to health care. The average among other wealthy nations is closer to twelve percent. And we also don’t get particularly good health care outcomes. Like, we come up short in many, many metrics, including life expectancy, where we trail countries like Chile and Slovenia, both of which spend less than ten percent of their GDP on health care and, for the record, both of which also have higher rates of tobacco usage. Now, you would think with lots of private participation in health care markets, costs would be driven down, right? Like, private companies can make refrigerators or cars much better than governments can make refrigerators or cars. But health care’s a weird market on a few levels. First, there’s the problem of inelastic demand. Like, if I need a medicine to keep me alive, I can’t effectively negotiate the price of that medication because, in the end, I’m going to pay whatever it costs. And then there’s the problem of competition being something of an illusion. Like, for instance, if you’re having a heart attack, it’s generally not considered a good idea to call around to a bunch of area hospitals to find out who has the best deal on heart surgery this week. There should be competition among private insurers but plans are often extremely confusing. Like, you might pay less up front and think you’re getting a good deal, only to find out later that what you need to be covered isn’t covered. Like, it’s hard to compare cell phone plans effectively, let alone health insurance plans that might or might not cover literally thousands of different procedures. Plus, having your insurance status depend partly on whether you work for a big company is a huge disincentive to innovation and entrepreneurship. It tells people, “Don’t start a new business,” “Don’t strike out on your own because you won’t be able to get affordable health insurance.” So, all in all, we’ve ended up with a health care system where more tax dollars per person go to publicly funded health care than in most other countries and yet we don’t have publicly funded health care for most people. And most Americans agree on this: only about thirty-two percent of us think that our health care system is good or excellent. And yet, around seventy percent of Americans think that their personal health care is good or excellent and therein lies the problem. Most serious reform proposals would involve big changes for many people in that seventy percent. And, as the Republican party has lately learned, it’s easy to talk about health care reform in the abstract but when you put pen to paper, it gets complicated. So all health care reform boils down to three factors: Quality, cost, and access. Obamacare sought to improve access: It didn’t do much to change quality or cost. And to do that, it spent a huge amount of money. Like, a trillion dollars in the first decade. Now, it increased some taxes and cut some spending, so as to be deficit-neutral, but it spent a lot of money to get a lot of people health insurance. So today, fewer people are uninsured, but it cost a lot to get there: That was the trade-off. The Republican bill sought to reduce government spending on health care, but that also comes with trade-offs. In this case, it would have resulted in millions of people losing their insurance, which was a hard sell to moderate Republicans, so the GOP bill offered tax credits to help people buy private insurance, but that meant more spending, which made it a hard sell to conservative Republicans. Like the ACA itself, the GOP bill would not have done a lot to address the overall cost of health care in the United States or the fact that our quality of care isn’t great. Because to have those conversations, we need to accept, that, as Healthcare Triage always says, “Tradeoffs are inevitable.” Side note: I just realized my collar is turned, so I fixed that, but I bet it was annoying to a lot of you; sorry. Right: So the most commonly cited solution to the US health care problem is a single-payer health care system, or Medicare-for-all, as Bernie Sanders calls it. In this proposal, all Americans would be able to get the publicly-funded insurance that seniors now get and studies have shown that this would lower overall U.S. health care costs, although probably not to the rate seen in most European countries. Still, there would be less money spent on administration and advertising and also on care itself, because a bigger insurance pool can negotiate prices more aggressively and this would be, like, a huge insurance pool. But there are trade-offs: Like it’s accurate to say that Medicare-for-all would lower overall U.S. health care costs, it’s also accurate to say it would cost hundreds of thousands of jobs. And many of them would be good-paying jobs: From medical device sales people to insurance adjusted to marketing managers. And with less money being spent per procedure, lots of other people would see their incomes go down, including many doctors and nurses. Also, it would be good to spend twelve percent of our GDP on health care instead of eighteen percent if we could get similar outcomes, but there is a word for what happens when six percent of your total economy goes away overnight: Recession. Now, the economy would recover and reallocate capital fairly quickly, but it wouldn’t be painless. It’s also important to note that we currently have a single-payer health care system in the United States: in Medicare, and it’s not a bargain. Compared to other single-payer systems around the world, it’s very expensive because we resist the kind of government regulations and price controls that are ultimately necessary to rein in spending. So a single-payer system on its own would not solve all of our problems and there would be trade-offs. Alternative, some on the right have argued that to increase competition and let market forces work, it’s necessary to dramatically scale back or even eliminate government funding for health care. And that, too, might lower prices, but at the cost of many millions of people losing insurance. Similarly, decreasing regulation might lower prices, but it increases the risks of being treated by an inadequately trained professional or taking an unsafe medication: Trade-offs. We can talk about over-regulation or tort reform or market places or competition, but none of them will be a magic bullet. Because there is no magical solution with our health care system where everyone wins and no one loses. Now, we can continue to make incremental changes, like the ACA or alternatives to it, but as Dr. Carol put it on Twitter, however you want to reform healthcare, there will be tradeoffs. Those who promise you everything are lying. If we want a better health care system in the United States, we need to talk openly about those trade-offs. Because when we allow ourselves to be pandered to, our elected leaders seem more than happy to oblige us. Hank, I’ll see you on Friday.

100 thoughts on “Why Can’t America Have a Grown-Up Healthcare Conversation?

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  2. Single payer is the way to go why spend 6% and give it to people that do nothing and not being able to negotiate price is a monopoly.

  3. I'm Australian and I gotta say I do like how our healthcare system works, I think it's very well balanced and as Hank was implying in this video, balance is crucial here.
    Here are some of my personal opinions which are only my personal opinions on how I see things from all the way Down Under here.

    Gotta swallow the hard truth of debt, this is what a quick Google search gave regarding Aus and USA debt.

    USA: $19.84 Trillion at $60.89k per capita, and I don't really care how Forbes is crunching their numbers here, all debt is a measure of money you don't have and is as such bad. https://www.forbes.com/sites/michaelfoster/2017/11/08/federal-debt-is-reaching-20-trillion-and-i-dont-care/#532217d932ba

    Aus: $6.5 Trillion at $70k per captia.

    Both are in local dollars, Aus debt per captia is $53.7k in US dollars. Lower per capita debt and much lower total national debt. It's very difficult to manage finances for anything when you're in debt especially with such high figures.

    Second is access, I believe you implied that USA access to healthcare is better than other nations, I can't say I believe it tops Australia. I couldn't tell you exactly how and why our systems differ here, I do know that literally everyone has access to at least public healthcare up to and including the unemployed homeless population here, there is nothing actually stopping anyone from accessing it, those who don't (as few as they are) have other individualistic reasons.

    And now for balance. Here it basically comes down to public and private, no real differing flavours of each, just the two, plain and simple. I don't have health insurance myself, I see in their advertising though that the competition is crazy, they're putting in the hardyards to earn their customers, driving down costs, increasing benefits and perks I mean heck some will give you retail chain reward points by the butt load for signing up, some are even doing things like partnering with Fitbit to give you more such points to encourage you to get moving and stay healthy. This makes the private option much more affordable and the difference in quality makes it perfectly reasonable to actually pay for healthcare here instead of just bludging off the system so to speak. Having more people able to go the private route, frees up the public sector so that those who need it get a much higher base quality of care. For example, I had a health issue last year that almost killed me, hospital admission with stay and treatment didn't cost me anything, some day surgery after the hospital visit didn't cost me anything. All I had to pay for was the initial appointment with a GP and an MRI both of which were still subsidised. I think I was out of pocket less than $500aud by the end for something that almost literally killed me. I've also experienced the private sector when I was covered by my parents insurance when I was under 18, didn't have to share a hospital room, had my own bathroom and much better food. The skill of the professionals involved didn't strike me as much of a difference though I was much younger then.

    And finally, another hard truth to swallow, that is prevention is better than cure. We need to consider the number of people who actually need medical care at any given moment and seek to make it as low as possible.

    I realise this is a lot of info, there's obviously a lot more and again this is all just my opinion on things as far as I can see them.

  4. Yes, there will be trade off's but… We have to do something with USA corrupt medical system.

    Lets take my home state of Idaho… Our problem is the same across the USA.

    Hmmm…. If you go to your local 'nonprofit' hospital, now our largest employer in Idaho, or one of its affiliates you'll get charged for a MRI $2,134 or if you go to a local private practice for profit, very few left here in the Treasure Valley because the hospitals of bought them all up, you only pay $575. Doesn't it seem weird to you that are nonprofit that supposed to help out the people they're supposed to serve charge 73% more???

    I have a coupon book that comes to my house and it's kind of sad that I can get a Papa Murphy's coupon or a coupon to Imaging Center the charges significantly less there are nonprofit hospitals here in the Treasure Valley.

    Oh, by the way, is it surprising our local hospitals are one of the biggest lobbies to our local Idaho government for over a decade. Have you ever heard one of our local politicians mention any of the hospitals being a problem? Of course not. Hospitals are to blame for the majority of the price increases that you're paying right now. Hospitals and their associates are allowed to charge more than private practices???

    Secrete be known… I got in a car wreck a few years back and my neurologist told me 'not' to go to any of the local hospitals or affiliates for MRI's. He told me I would save 'a lot' of money with the same quality with Imaging Center of Idaho, private practice that pays taxes. I paid cash, and it was less expensive by hundreds of dollars even with insurance going to our local hospital or their affiliates. Oh, yes again, Idaho nonprofit, largest employer, hospital doesn't pay corporate taxes, 'nonprofit'. What a crime.

    If any nonprofit caused financial duress or even bankruptcy to the people they were supposed to help / serve there would be outrage, i.e. Boise Rescue Mission, Women’s Children’s Alliance, Idaho Food Bank, American Red Cross, etc. Only nonprofit hospitals like Idaho largest employer can! ;-( P.S. Idaho politicians??? Lobby money has kept them silent for years while Idaho citizens suffer.

    Great investigative story would be on the percentage of ‘for profit’ medical practices in Idaho have be acquired by nonprofit hospitals; the effect on competition, loss of taxes revenue here in Idaho. Also, looking into hospitals opening additional nonprofit practices adding to their dominance and impacting competition. How all of this impacts the rising prices of healthcare.

    P.S. Steven Brill has done some of the best investigative work on USA corrupt medical system.

    Steven Brill brought new clarity to the American health care system with his award-winning TIME cover story, “Bitter Bill: Why Medical Bills Are Killing Us.” Now he’s out with a new book on the same theme: “America’s Bitter Bill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.”

    Sixty percent of the nearly one million personal bankruptcies filed
    in the United States last year resulted from medical bills.
    — Steven Brill, America's Bitter Pill: Money, Politics, Backroom Deals,
    and the Fight to Fix Our Broken Healthcare System (2014)

  5. Here's what I think is the biggest factor in all this: America's weird fatalism. Your society is pervaded by the notion that wherever a person is in life, whether they're poor or rich or privileged or oppressed, that's where they should be. It's the flipside of that American dream thing: if you believe that anyone can be whatever they want and do whatever they want, then everyone deserves to be where they are.

    Unfortunately, the world doesn't work that way, and when you try to apply that ideal to an imperfect world, you open yourselves up to fascism. And this is indeed what is happening. Fortunately, it seems this may be a wake up call, and maybe your society will emerge from it healthier.

  6. Single payer is literally the only option when it would save 17 trillion dollars if implemented now, and would cover everyone. It's only difficult because we've all been cultured and conditioned to believe that it is difficult. When 40k people start dying from lack of basic health care it's already an issue. On top of that medical bankruptcies are a leading cause of bankruptcies while that's not the case in other countries. Norway, Sweden, UK, France, Germany, Finland all have universal healthcare and they don't think about it in the way they do because it's not an issue. It's non debatable when people start dying. Can't afford it you say? Tell that military industrial complex the 8 interventions we are in (Syria, Libya, Pakistan, Yemen, Somalia, Iraq, Afghanistan, and Niger), the new 1 trillion dollar f35 fighter jets,the 900+ military bases around the world which cost BILLIONS to sustain. Jeez maybe if we allocated all that money we'd be able to afford that, and even free college. But no. Whenever it's something to help YOU the people ,media and corporatist politicians say "We can't afford that" when in reality WE CAN, they decide NOT TO. This. Is. Non. debatable.

  7. What we need to do as a society is, one, define what kinds of care people have a right to, and be specific, have the government provide what it needs to provide so that everyone can afford it without overspending / overtaxing, and 3, make sure that those who can already afford healthcare, such as the rich and upper middle class who already have enough money, are excluded from any government systems, and number four, do this without reducing the number of healthcare options people have. Some people simply prefer less care, less optimal care, or different kinds of care than the state is willing to approve of. People need to be allowed that freedom to seek their own treatments and put their own weights on things like preventative care.

  8. Single Payer is Doomed Before It Starts
    By Ted Noel, M.D. 9 February 2018

    Donald Trump tweeted that Britain's National Health Service is "broke and not working." All too true: expenses have forced 40% of walk-in health centers to close, all elective surgery in January to be cancelled, and primary care has been decimated, it's not surprising that problems have surfaced. It is just as predictable that the usual call for "more money" echoes around the UK. All this is the result of economic laws that have been completely ignored since the days of Aneurin Bevan, the father of the UK NHS.

    The first is the Law of Rationing. In short, "Everything is rationed, either by price or by rule." I can't afford a private jet. Price rationing limits those to people of substantial wealth, and their high price acts as a signal in the market to balance the supply of private jets with the market of willing buyers.

    But suppose that the government declared that private jets were free. Everyone would want one. Suddenly there would be a shortage of hangars and runway space. And to pay for the jets, taxes on workers would rise, because the workers who build private jets have to get paid. The unintended consequences are mind-blowing. Ultimately, the government would have to start limiting who could have private jets. First, they would require a pilot's license. Then, more secure hangars would be required. Finally, you'd have to prove that you really, really need a private jet.

    Substitute "Free Health Care" for "Private Jets" and you get the picture. Nothing is free. As the protagonist in The Moon is a Harsh Mistress notes,

    "Gospodin," he said presently, "you used an odd word earlier — odd to me, I mean…"

    "Oh, 'tanstaafl.' Means 'There ain't no such thing as a free lunch.' And isn't," I added, pointing to a FREE LUNCH sign across room, "or these drinks would cost half as much. Was reminding her that anything free costs twice as much in long run or turns out worthless."

    "An interesting philosophy."

    "Not philosophy, fact. One way or other, what you get, you pay for."

    Or, as the mechanic in the Fram oil filter ad says, "You can pay me now, or pay me later." You pay either way. Unfortunately, if you try to be cheap by legislating "free" health care now, you'll pay dearly later. Health care that was rationed by price will become rationed by rules that make it less and less available.

    In England, this process is reaching a tipping point. A couple of years ago people were waiting many hours in the Emergency Department just to be seen by a doctor. So the NHS ruled in 2004 that 95% of all patients would be seen within four hours of arrival. In order to avoid breaking the rule, Emergency Departments refused to allow ambulances to unload their patients until the ED could meet the time standard. So patients were stuck in ambulances outside the ED door, and there weren't enough ambulances left to answer calls. Now the rule has been scrapped. Predictably, the left-wing members of Parliament are calling for more money. And that brings us to the second law.

    The Law of Subsidy says that "When you subsidize something, you get more of it and it gets more expensive." In England, this happened a bit more slowly than in the U.S. It may be that the older generations of Britons were a bit more "proper" than us Yanks, and so tended to rely less on the dole than current generations. This slowed the growth of the NHS but did not change the ultimate outcome.

    The National Health Service was sold as a way to provide health care to an underprivileged population. Aneurin Bevan stated that,

    "The collective principle asserts that… no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."

    "The National Health service and the Welfare State have come to be used as interchangeable terms, and in the mouths of some people as terms of reproach. Why this is so it is not difficult to understand, if you view everything from the angle of a strictly individualistic competitive society. A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society."

    The language of his disdain for economic laws should be familiar in tone. By calling capitalism "uncivilised" and "hedonism," he presaged Saul Alinsky's Rules for Radicals and its call to "Pick the target, freeze it, personalize it, and polarize it." The truth is unimportant. Victory is all that matters.

    Bevan succeeded, but his victory is being erased by the Law of Subsidy. What was sold as a boon to the poor has become a subsidy for bureaucrats. The Law of the Bureaucrat declares that while a bureaucracy may have been created to deal with a perceived problem, the bureaucrat's Prime Directive is to ensure that he has a job forever. And because he was appointed to solve the problem, he's smarter than everyone else and should be paid accordingly.

    Perversely, the bureaucrat can never solve the problem, or his job would disappear. So he continues with the language that created him, trying to sell greater and greater funding for his failed enterprise. And when it fails more dramatically, he blames anyone but himself, and gets rewarded with a bigger budget. Ultimately, as Margaret Thatcher famously quipped, "The problem with liberalism is that eventually you run out of other people's money."

    The Law of Subsidy has killed the NHS. It just doesn't realize that it is dead. But thousands of those it was created to care for are dead, because it simply cannot fulfill its promised goals. And the U.S. is headed down the same path. Fortunately for us, voices are starting to point out real fixes.

    I have repeatedly pointed out that government is bad for your health. Just as with the NHS, the U.S. population has been sold the lie that insurance is necessary for long life. In fact, all insurance does is increase cost, because it's a subsidy for those who provide health care. But there has been a conspiracy of silence over this fact. Further, the treatment of health insurance premiums as a non-taxed "fringe benefit" makes it easier to subsidize further. In short, Congress passes a pretty "benefit" that you actually pay for. And it ultimately ratchets costs higher.

    President Trump has done a bit to reverse the trend, but private citizens are doing more. Medishare is a private cost sharing program that provides care at a fraction of insurance rates. Outpatient surgery centers such as the Surgery Center of Oklahoma operate at lower costs because they don't have to wrestle with insurance companies. And many physicians are now providing concierge Direct Primary Care at drastically reduced costs.

    What do these have in common? They are completely outside the government and insurance company umbrellas. Patients see how much their care actually costs. Providers work to be competitive in order to attract patients. And patient satisfaction is much greater.

    I spent thirty-two years on the medical staff of a major metropolitan medical center. There was no incentive for the administration to ever negotiate with an individual on price. Instead, it was always a deal between the hospital and the insurance company. My medical group did the same thing. We negotiated prices with Blue Cross, Humana, and other insurance companies. They passed on the costs to patients via premiums, all the while lobbying for more and more mandates on coverage.

    Could there be a system more devoted to screwing the public? No one is personally intending to cause harm to anyone else. In fact, my group worked hard to provide high-quality care. But the incentives are there for all to see, if they will look. The Laws of Rationing, Subsidy, and the Bureaucrat are laws of nature. Nothing will ever repeal them. Our only hope is to stop going down the roads to which they lead us.

  9. How stupid do you have to be robe like this guy. What a huge amount of misleading information. You don’t wait to get healt insurance till you are sick so yes,you can bargain and shop around without putting your life in the line. Back in the days,before government started putting its claws and regulating and chocking and destroying the healthcare system the prices were absolutely competitive and the coverage better for the money. Get the government out of healthcare and all those huge administration departament and bureaucracies that insurance companies have had to create will go away,red tape between patients and doctors will go away,making harder for doctors to practice will go away and the free market will win and us consumers will hugely benefit from it. Right now there’s a huge demand for care and not enough physicians thanks to regulations and we all know how that works in free market .

  10. I noticed your hair before I noticed your collar. After I noticed your collar, I was still more annoyed by your hair. Very informative video. One point I would make is that a grownup conversation on healthcare might involve people grooming themselves and being presentable. I don't think there is a tradeoff in that respect.


  12. Sorry folks, no matter how you look at it, there is no excuse for my single coverage deductible going from $250 in 2010 to $1750 in 2018 (and that's because my employer is pitching in $1250, otherwise it would be $3000). If you insist on having private insurance, this is one of the things that could be regulated better. clearly, the US has failed regarding healthcare no matter what anyone says.

  13. here is an overview of some issues in providing affordable universal healthcare


  14. Proposal: Medicare Part A + HSA's for all. You pay for this by getting rid of thousands of outdated and unconstitutional government programs, agencies, and bureaucracy that currently cost taxpayers trillions of dollars. Because the HSA would get $10-15,000 per year from government contributions and your employer, you would also have a small nest egg to fall back on if you become unemployed, suffer long term illness, or need paid medical, family, or sick leave. You never have to go back to some government office to get your money back because–if you don't misuse the HSA–there would always be money in that account to pay for expenses. This is essentially a very, very frugal version of the Nordic Model.


  15. 1:19 untrue.
    1:40 untrue among single payer countries the average is 10%.
    3:19 untrue 2016 gallop pole shows 65% are "satisfied" with their personal care. much smaller slices of which would say good or excellent.
    3:27 true, but the big changes would all be positive!
    5:25 it is untrue that doctors would see incomes go down. u.s doctors are the third highest paid now. the highest paid are in the netherlands and australia. showing we could cut procedure cost almost in half and still give doctors a raise.(if we want to)

    also there is much talk here about trade offs, most of it is untrue. if we adopt other nations methods we will get very similar results. ( ie universal access, greatly reduced cost and improved care ) they have solved every objection raised as a negative tradeoff.

  16. For me it's very selfish (and if you believe in God it's not christian) to say "healthy people shouldn't pay for the sick people". Especially because the sick people are the ones in need for help. Lots of people can't work during the time when they are sick, some will not be able to work anymore, if they don't have a family to support them, how would they live without public help? This is why people should pay taxes, to help their people when they need.

  17. Predatory is right. And privatized health care was so successful the second heavy hit is coming. Its the GREAT AMERICAN ALLOWANCE. The reason the privatized health care was enacted is the vocal minority of desperate parents of children with life threatening incurable conditions. They were used to pave the way for the 'everybody pays in' health care formula Obama enacted. Here's what's next: the LD now admitted to not benefit from ANY non drug intervention and claimed to be fewer than 3% are overwhelming the stressed parents trying to home school exactly because they are disruptive in the school room. The desperate parents—and I do not think that is an accident—will be behind the $500 for all as the child is going to be home forever, in much the same situation as the children with non ending medical conditions.
    I think these two desperate conditions are going to be the clinchers in passing the $500 for everyone and like the privatized health care, we will discover the 'conditions' attached to the $500 are onerous. Have you noticed that the only way legislation gets enacted supposedly to benefit the public is when there are crisis situations? and then it has well planned 'gotcha' clauses.
    i think our government plans to have this as part of the 'new world order' in 2020.

  18. Medicare-for-all, though Bernie's best proposal, would be the most expensive (though only on the wealthiest 5% of families whom can afford it) and likely the hardest thing to pass congress… You look at everything else he's proposed (including the jobs guarantee though he's yet to come up with the plan to pay for it. We know the cost which is actually doable) is all actually incredibly affordable (free tuition, expanding social security, etc) when you look at the numbers. Alas, if he were to become president in 2020, and by the stroke of luck he had a democratic super majority, Medicare-for-all still seems like a far off reality sadly.. Still think it's something to fight for!!

  19. The American health care system terrifies me. I rely on public healthcare in Australia and I paid nothing for surgery with 3 nights in the hospital and the surgery itself save for the pain medication I took home with me (oxycodone) which cost me less than $50. This was a semi-elective surgery (tonsillectomy) and I would have surely spent so much money in the US having my gigantic potentially cancerous (it wasn’t) tonsil removed

  20. Wow…this is the first time I understood why Americans might be reluctant to switch the system. As a pampered European I still recommend making the hard choices because it will ultimatively benefit the majority…Good luck!

  21. you got a couple things wrong. fees for providers will not go down in medicare for all. the cost of the treatment might go down, but that will not affect provider salaries. the costs that will that be eliminated are in the area of non medical administrative overhead, and in the price of medical devices, and the cost of prescription drugs. You mentioned that "medicare for all will result in a loss of insurance industry jobs," this is true, but, have you read the bill HR676 Expanded and Improved Medicare For All? if you had, you would have noticed the line about $20 billion dollars being allocated to pay for two years of full pay, capped at $100,000 per year, for all displaced insurance workers. However, a much larger point is the massive economic stimulus of lowering the cost of healthcare. Currently, one of the major reasons the USA has been losing manufacturing jobs over the past 20 years, more so in the last ten years, is the fact that we spend 2x per capita what other nations spend on healthcare. why would a company set up a base of operations where the healthcare overhead is the highest in the world? they don't. so, by passing HR676, the loss of non necessary, parasitic insurance jobs will be offset by the creation of a wide spectrum of new jobs, due to a lower cost of business. www.fixithealthcare.com www.pnhp.org I"ve only watched half the video. i'll watch the rest tomorrow.

  22. Cultists don't get it, but the US is not a free market and removing government won't make it one. From the start, medicine is not a normal market good. The price isn't determined by supply and demand. If your life or health are at stake, you arent in a position to shop around or negotiate.

  23. Changing your healthcare system will be excruciating. But please, do it anyway. Drag the entire country kicking and screaming if you have to. Because the benefits are endless. No pain, no gain, as they say.

  24. Perhaps when America's politicians are working for the public and seeking healthcare for all American citizens that is based on being easily available, affordable and of a good quality rather than what most are doing today which is serving their corporate donors, the likes of the big insurance companies, the pharmaceutical industry and others in the US healthcare business who are making a fortune out of this dysfunctional, deliberately bureaucratic system. If by giving every American access to affordable healthcare saves lots of money but also causes many people connected to the healthcare industry to be laid off then its worth it, but with the money saved can go on new badly needed public works and the restoration of America's crumbling infrastructure so these people will soon have new jobs to go to and also with some of that investment going towards jobs in the field of alternative energy they can also be good paying jobs.

  25. A fair video, and no question, there would be short-term pain for many whose livelihoods depend on private insurance if the US were to go to single payer or Medicare for all. But there is no question that the benefits will far outweigh the costs. The real greater cost as I see it would be the political backlash to it, as we have seen from Obamacare.

  26. vlogbrothers You do not address perhaps the single most important argument against a single payer system which is that the rate of medical advancement would decrease by 30-50% according to numerous studies. This is especially important because we’ve just hit an exponential curve in the amount of new medical technologies being developed, a phenomenon that is referred to in tech spheres as the Longevity Escape Velocity.

    The most important question we should ask ourselves is this: Are we ready to sacrifice countless lives that depend on new therapies being developed in exchange for a small discount in medical insurance for the middle class?

    Think of all the cancer patients who are being saved by new immunotherapies; think of the new Hepatitis C drug that had been so elusive for decades; think of St. Jude’s!

    Do we want to cure cancer and AIDS within the next decade or do we want to give the middle class a few thousand dollars in savings per year?

  27. Because every opening question from both sides starts with the childish embedded assumption that anyone who disagrees is inherently childish.

  28. People here in the U.S aren't willing to pay for other people's healthcare. Bottom line. Which is basically what you would have, it would be played for by a tax increase.

  29. I'm a twenty year old British girl and, despite a few of your not very good things, I'd quite like to visit America and stay there for a few months. There's one downside: I have epilepsy. Which I take medication for.
    Obviously, I can take some of my epilepsy medication into the country, but there's only a limited amount and if I ever went there, I'd want to stay for two-three months, perhaps try to get a job, or at least try to make some contacts in my current field of work.
    Holiday travel insurance would not cut that and it would be outrageously expensive to afford that amount of medication in the States for so long. Argh.

  30. What America need is better mental health care for a couple of years…. they then may be sane enough to vote for health care for all.

  31. We dint need free healthcare that is only free to leaches that don’t pay taxes but we need a free market in healthcare like any other trade or good that will lower cost

  32. The six oligarch media monopolies are little more than stenographers of the corporate state. And too many Americans have not figured that out yet so they think Medicare for all is communist. They have been somewhat successful in stupefying a large portion of less educated white Americans. It’s a constant fight battling the lies of corporate state media.

  33. When I read about gun violence and all the lives ruined by 'stray' bullets in the United States. I can't help but think that I as an English person have the right to health care, and Americans have the right to bear arms. I know what I'd change the 2 nd amendment to.

  34. We cant have a grown up conversation about health because there is no functional middle ground for what both sides want. Republicans want a free and unregulated market. Dems want singlepayer. As far as I'm concerned thats where the debate lies, but we dont debate policy in this country, the masses may debate policy at times but almost all of the pundits and (excuse me for showing my bias) the left seem to just devolve into character attacks and we never hear about the facts behind a particular policy. God i was for single payer for about 2 whole years until I finally found strong arguments and studies that have since persuaded me against the system.

  35. You can avoid expensive and ineffective options about healthcare with a simple, commonsensical technology. It's non-invasive, non-chemical and can be done right in the comfort and privacy of one's home. Its use only requires two simple things: an open logical mind, and a strong will to drink one glass of water for every ten pounds of body weight. If you can do that, search for and learn more about Virutron today.

  36. US should provide a national health cost less, cover more and more helpful. And we should let mexican pay our bill.😅😃😜

  37. the fact is that there is no silver bullet but there are things that can be done to rein in the cost of healthcare incrementally. tort reform and allowing for insurance across state lines being the main items that the right has talked about

  38. slovenia is an awesome country actually, if you ever been there, you would know… their are ahead of many EU countries in many things, just a view of European…

  39. Concern about lost jobs is always a canard. A lot of former insurance company workers will be able to go directly into new Medicare jobs, for one thing. The rest will find work elsewhere, because the saved money doesn't go away. It gets spent on other things we'd prefer to spend it on instead of health care. We just need a smooth transition where insurance companies don't lose all their customers all at once.

  40. Guess what? Good news! We can have Medicare for All if Congress legislates it. We can afford it …. because the United States government is monetarily sovereign and thus can never run out of the currency it issues. The government “pays for” anything that Congress appropriates by crediting accounts digitally. That’s how trillions go to wars, and why they really are not concerned about billionaire tax cuts. It’s just keyboard strokes and digits.

    It’s not run like a household, state or local budget …. we cannot make currency! The feds can. Since Nixon.

  41. BECAUSE… the healthcare industry is a powerful class who have the ability to make legislators vote in their favor. They are able to elect candidates through media monopolies and campaign finance. They are protected by courts that favor corporate power. They utilize tax havens and obtain favorable tax code advantages. They neuter regulatory agencies. They continuously merge and form powerful virtual monopolies. They are subsidized by the government. They deny care. They patent for monopoly. They benefit from sickness rather than health. Wake up. You can’t rationalize with psychopaths. They have too much power. This train isn’t stopping till it crashes.

  42. I’m curious whether nations that have adopted single payer after having a system more approximate to the US have actually seen recessions. Obviously “cancelling a third of health care spending overnight” would have a recessive impact, but it’s hard to say that a “Medicare for all” proposal would actually have that impact if implemented.

  43. Well, you're young, don't really bother much with research, and make a lot of broad generalizations based on superficial observations. You hinted at the problem of competition but only looked at it from the life threatening treatment perspective. You are right, the problem is one of competition in that it is not a consumer oriented perspective. That is, healthcare is a series of monopolies. We have the AMA, which controls certification of medical schools, appointments to board certification programs, and a host of other "public" policy programs and posts. Thus the number of medical schools and enrollment is limited by the AMA not as a means to keep the quality of medical education high and thus protect the public but as a barrier to entry in the job market. The hospital industry has become its own private trust group using collusion and price fixing. Since most graduates from medical school have excessively high student loan balances and cannot afford to set up shop in their own practice or even a partnership, they must work for a medical corporation such as a hospital or specialty practice corporation. And these medical healthcare suppliers are not required to post their prices, give estimates, and in any way divulge their prices to the individual. Your auto mechanic is regulated in this manner, imagine that. The list of unacceptable behaviors by the healthcare system goes on for a mile while the state and federal regulatory systems and legislative systems ignore or condone such practices. And rather than reform the abuses of the various members of the healthcare systems, Congress wants to enact a single payer system that insures the healthcare members have a regular and ever increasing income. Think of yourself, John Q Public, as the personal ATM machine of the healthcare industry.

  44. You simply cannot have free healthcare for everyone because it’s not free. If you make healthcare free then hospitals have to earn profit somehow so the government taxes people MORE to pay for their healthcare. This brings in more government which sucks and overall ends up costing the working class the same amount just in a different form of taxation.

  45. If American people really want a Clean Government, please support
    Anti-Corruption Bill introduced by Senator Elizabeth Warren … If  you want to be a patriotic lawmaker in the
    future, you could begin your dream today …

  46. Single Payer means each person paying for himself (or herself).
    Insurance Industries should change its career by building more hospitals and
    clinics … Healthcare is human right granted by God – don’t make this human
    right profitable to feed evils and political puppets …

  47. The Government hasnt proven its effective at properly managing any spending program. Keep them out of healthcare. Unless you prefer a bureaucrat deciding how much they are willing to spend for your situation.

  48. Stop saying "Medicare for all" is the answer. US citizens deserve universal, full coverage health care. Medicare is basically bottom of the barrel minimal coverage with 20%+ co-pays and deductibles. It's actually so bad, recipients (if they can afford it) are compelled to purchase additional insurance sold as Medi-Gap coverage to help alleviate just some of the holes (gaps) with Medicare's glaring inadequacies. The insurance corporations of course absolutely love this fact, and do not want it to change.

    Medicare recipients are also required to purchase a private, for-profit insurance policy for prescription drug coverage from one of these capitalistic corporations. Even with these expensive add-on polices, patients still have large deductibles, co-pays, restrictive coverage limits, "doughnut holes" and wide open areas of zero coverage. Also, you're not going to find coverage in Medicare for dental, vision, mental health, chiropractic or alternative medicine.

    If you're rich, don’t worry, you'll still be able to buy luxury medical plans from your favorite profit driven insurance corporation. Wake up Americans! It's time to get into the civilized world with universal, full coverage health care for all. When the rich start paying their fair share of taxes (which is far more than what the average citizen should pay), there will be plenty of revenue to cover it.

  49. Already disqualified as a valid argument. You forgot that public health insurance forces people at the threat of death by the government in the form of taxes.

    Oh and it’s cheaper to not have insurance. I can pay 15,000 a year or I can pay 150 dollars for one or two doctor visits.


  50. Sooner or later, one of our Democratic Presidential Candidates, will promise to-turn-back-on Obama Care and win the election. Obama Care is still the law of the land. Trump is just not releasing the funds. There should be no tax increases because America will push the cost to future generations. The insurance companies should like this because it does not put the insurance companies out of business like Medicare For All.

  51. Why not shock everyone with the idea of offering a free education for graduates in the medial professions willing to work five years in rural or urban areas at Medicare compliant hospitals/clinics for a below typical salary? Politicians are sick to be tempting people to vote themselves the public purse rather than the nation's welfare.

  52. Health insurance and Medicare are inflationary. Both plans have money to pay by reaching into so many pockets and they do reach.

  53. Okay, I keep having people tell me that the reason we can't have universal healthcare in the US is because we're too busy driving all of the world's innovation. They're saying that we're covering almost all of the costs of research and development, which is why the rest of the world can afford it.

    Is this true, or am I being yanked around by more conservative propaganda?

  54. A big thing i disagree with is him saying our quality of healthcare isnt good. First off, in places like Canada, many people are forced to wait in pain for excessively long periods of time to get any sort of help. We do not have that problem. We also have some of the best healthcare professionals in the world. So yes, we're expensive. But it's a trade-off =)

  55. Excellent video. As one of the 9% who don't have healthcare (the successfully self-employed are completely shat upon by the ACA) it's tough to see the 91%, and our government have turned away from this issue to pursue the partisan spats that so consume Washington and our media. When health insurance for two 50ish healthy people would cost over $25K a year we said no. We have banked the money, and pay cash when we need something – hoping this mess gets fixed before our health goes to crap.

  56. No 1 huge factor. Cost. Because from when health insurance was paid by your job, and covered everything, to Medicare, paid by everyone's taxes; people have been brainwashed that it's " free" , and " somebody else pays for it."

  57. My solution to the problem, everybody in America gets the same coverage as Congress. Probably not a great solution, but that's my take — your mileage may vary.

  58. From an Australian perspective, I think the major thing that is missing in these comparisons to Universal Health care in other Western Countries, is that it's not an isolated tax. It' forms part of the tax structure that includes, maternity leave, daycare subsidies, Affordable University education, guaranteed holidays that you can accrue and carry in the following years, guaranteed employer contributions to your superannuation (pension). You can't have Universal health care if the tax structure does not include all the other benefits too. Only then can you discuss wages. You need to get way more bang for your tax buck across the whole of the community. Then professionals won't be hammered with College fees and those who initially lose jobs will have a safety net and the opportunity to get new qualifications. Community social values will have to become more valuable then believing in trickle down economics.

  59. This is so weird for me as a European. I’m an outspoken libertarian. I hate both the left and the right because it’s indoctrination. You need to look at individual issues and really delve down.
    So I’m all for socialized healthcare, thanks to The EUSSR we needed to (semi) privatize it. Something that I am still against as it became more expensive and not better! So it’s a loose loose, which is obvious because companies need to make a profit, countries do not!

    So when I’m in the US and they hear in a libertarian, I’m immediately put in the pro-life and anti socialized healthcare.
    When I argue against these two points you see a mental disconnect happening.
    It’s as though in the Is you can’t be probsmall government, self governing (which imo is pro-choice and the means to terminate your own life).

    I am a lot in the US and I love it and I would love to live and work there. And like my brother said when he lived there was: as long as you have a job and your health, it’s the best western country. If either one goes it’s by far the worst western country.

    I pay 49% income tax here in NL and 21% VAT and that’s a lot! And I am not happy about that because I see that people are increasingly reliant on extra support like a food bank or other foundations. I am happy to pay the 52%, that I used to, when we didn’t need those.

    As a libertarian I see that libertarianism was high jacked by neo-liberalism.
    Initially it was impossible for Americans to shift between left and right issues and pick the best (or the least bad). Now the whole world is divided in this idiotic left vs right.

    Let go people! And look into individual issues and I am so angry at our Democratic Party, that they abolished the referendum. Because I think we thebpeiple need to vote on these undividual important matters.
    It works in Switzerland why not eventually here and in the US too?

    Healthcare, housing and education are a common good and it therefore needs to be affordable for everybody! If that makes me a leftwinger in America than fine. If protecting these resources by having to close our borders makes me a right winger fine…
    Look into the issue and calculate them through!

  60. This video violates its own logic and undersells single payer. It claims health care is a "tradeoff" involving 3 principles of Cost, Quality, and Access. But look at how single payer Medicare for All does on those metrics:

    Cost: LESS than our current system
    Quality: HIGHER than our current system (video cites longer life expectancy)

    Wait, did we violate the "tradeoff" principle? No! You only need a tradeoff when the status quo is some kind of optimized mix of cost/quality/access (i.e. "non-dominated" or "Pareto-optimal" solution is the technical term). Our shitty system is definitely NOT optimal. So we can improve on all 3 of those metrics!

    As for jobs–yes, the private health insurance industry will contract when we switch to single payer and no, we should not leave workers behind! That's why the two Medicare for All bills have a jobs program to help them. Note that other proposals lack a jobs program…to me, that betrays that either they don't care about leaving workers behind, or admit that their proposed half-measures like a public option won't actually make a meaningful dent in health insurance costs.

    The grown-up position is to have single payer!

  61. How about job created through better care because more people will eligible for care. Or techs for increasing efficiency. Funny that most people like these are okay with automation killing manufacturing job but with insurance industry people seem to care a lot more all of a sudden.

  62. I have a solution, outlaw healthcare insurance in any form. People will pay what they can afford, and die with that runs out. But that is as it should be, because we way over consumed Healthcare. Overall health outcomes will probably improve because the number one cause of death in a hospital is medical malpractice. Fewer people in hospitals means west medical malpractice. Also people paying for their own health care, as opposed to going through an insurance policy, is the ultimate form of competition among hospitals. And while the counter argument is and is not price elastic in the eyes of the consumer, this is simply not true in as much as people will be unwilling to waste money I'm trivialities. Consequently, there will be a excess supply driving down the price for non-trivial treatment. Of course no one likes this idea because of that 70% of the people that think that they have a good deal; but facts are facts, and our health outcomes show otherwise. And besides, the delusion that HMOs add value by managing care should by now ring hallow to anyone with a brain. HMOs are motivated by the profit they skim off the top of the Healthcare System, just like every other corporation is motivated by the profit they generate. In My grandfather's day there were no insurance companies profiting from people's desperation and fears. It's time that we return to that sanity.

  63. Weird. I was looking for the blog bros video on 5/21/2019, and I saw this one, and assumed it was it. I recognized some of the topics, and figured he was just reiterating a good point. Then… I didn't hear anything I hadn't heard already… and then I saw the time stamp.

    So… cool? Also weird.

  64. Steven crowder does a video that gives an opposite point of view as to why America has a better healthcare system. Always look at both sides

  65. I live in Australia , I love our govt run healthcare system . Worry about healthcare bills ? ummm nope …worry about the cost of drugs ? ummm nope ..

  66. Why? Because somebody paid "James Adams" to post nonsensical and idiotic comments antagonizing random persons and wasting everybody's time. Ok, maybe "James Adams" has some mental problems. In any case, the conversation becomes more grown-up if you just skip "James Adams" the troll. Read at your own peril: "No, blah nonsense blah made-up blah…"

  67. At 3:05, the graph shows Norway paying 4500/person and the USA paying 3800/person. The difference is that a person in Norway RECEIVES health care for those 4500 , while a person in the USA DOES NOT RECEIVE health care for those 3800, unless that person is destitute and very sick and somehow ends up in an Emergency Room still alive. Absent those conditions, a person in the USA has to pay the 3800 in taxes and then still buy incredibly expensive health insurance and pay very high deductibles and co-payments on top. Norway is cheaper and better by far.

  68. "Medicare for all would cost hundreds of thousands of jobs"… Where is that objection when private companies lay off thousands of workers to reduce costs? When private companies do it, it is good management and top managers get millions in bonuses. But when government needs to do it, it is a red herring. It is Socialism.

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