« The David Pakman Show

9/2/19: Healthcare Is Broken, And We're Not Fixing It

2019-09-02 | 🔗

--On the Show:

--A themed show on the American health care system, consisting of stories and commentary from The David Pakman Show over the years

--The Commonwealth Fund finds that the United States spends far more than eleven other high-income countries on health care, yet ranks last in outcomes

--The Obama administration confirms that under the Affordable Care Act, premiums will be up 22% next year and many consumers will be down to just one insurer

--David's $829 10-minute-long doctor's appointment

--Republican Senator Rand Paul, who previously claimed that single payer healthcare is "slavery," reveals that he will be traveling to Canada, a country with socialized medicine, for an operation

--Gerald Friedman, Professor of Economics at the University of Massachusetts Amherst, joins David to discuss the predicted costs associated with Bernie Sanders' Medicare-for-all proposal

--Audience Question: Won't Medicare for All kill private health insurance jobs?

--Caller wants to know how to rebut the right-wing argument that the United States is too big a country for single-payer to work

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Today, we're going to take a deep dive into the issue of healthcare it's Labor Day and one of the primary issues that is intertwined with labor and working in the United States is health care and that's a problem. I've been an advocate for a long time of actually severing that tie, and this would be not only good economically. Not only would it be good for both workers and companies economically to separate health care and health insurance from job, but it would also be really good psychologically. It would be really good, morally and ethically, quite frankly, for people to be able to pursue interests and jobs on the basis of what they actually care about and find rewarding rat other than having to make decisions about sticking it out in a job that you hate, because if you leave job you will lose health insurance that could be still quite frankly, mediocre but
other than the alternative were cheaper than the alternative. So we're going to actually start today with GR understanding where the United States Health care system is ranked first of all, because unless we understand what we have now accurately, it's going to be hard to figure out the direction that we should go in. We will then look at the impact of Obamacare over the last several years, something that we talked about before. I will also tell a story of my eight version: twenty nine dollar, a ten minute specialists visit, which still has not been resolved by way ahh and then we're going to get into debunking some of the really bad arguments against changing the health care system, for something more like every single other rich western developed country has whether it's Canada or jail
Germany or the UK, or many others that we've talked about, and then we will ultimately circle back to. How do we pay for the stuff, and we will talk to Gerald Freedom, Jerry Friedman from my undergraduate alma mater, the University of Massachusetts about uh? What would this actually cause? What we're doing something like what Bernie Sanders wants to do? Cost what you will notice when we go back to the way that we have covered healthcare over the years, is that the themes and the substance have stayed quite similar over the years. The language used has become language that understands that these ideas, the ideas of Bernie Sanders and other leftist in the United States around Healthcare have become Signific totally mainstreamed where the language used to be sort of apologetic. We used to have to understand that these were at least considered radical, far left ideas
which have been extraordinarily mainstream, particularly over the last three years, dating back really to Bernie Sanders. Presidential candidacy DES Cratic presidential candidacy in the two thousand and sixteen cratic primary. So the substance is much the same. The and AL these have not drastically changed, but there's definitely a different tone in terms of the political will and the interpretation of a lot of this stuff. So let's get right into it. A deep dive today into
american Health care system, David Pakman, show at David Pakman, dot com, the right likes to say national health care systems, air, bad, bad, bad, Canada's terrible. The UK is a disaster. It's all bad, all in defense of this immoral for profit, employer connected health system that we have in the United States. The Dc Think tank, when is the Commonwealth Fund, did a study of the health care Sis terms of eleven wealthy countries, and it found maybe a surprise to some of you, maybe not that the american system is the
worst by multiple measures in this includes countries like the UK, Australia, Canada, Germany, Sweden, the UK's national health services was the best in many categories. The file categories evaluated were access to care, equality of access for people of different incomes, administrative efficiency, how well the care process works and how good the health outcomes are. Now it's not all a panacea for these other countries right so like, for example, the UK system was first overall, but was tenth in terms of health care outcomes, but the big consistency was that the US did terribly in every single area access to care. The US was a disaster. For example, forty four percent of low income people in the United States have trouble accessing care compared to only seven
scent of low income. People in the UK, and notably the report, says that there's been some improvement as a result of Obama CARE, but this is more evidence that Obama care is no incredible. Wonderful up ending of the health care status quo, it's a slight improvement or it has slowed down the worsening of some areas of the system, but it's no massive victory and in total, in overall performance the US was dead last the leaders were, as I mentioned, the UK was first followed by Australia and the Netherlands. Where did the US turn up at the top of the list of countries? Well in terms of how much we spend we are leading the way and this yr it's too many many issues. This relates to the fact that we have a system that seeks profit. We've got a total bureaucratic, Inaf Regency due to the medical billing and insurance system, that we have it's a total trainwreck. We spend more than every other country on the list and we
have the worst overall health care system. How can anyone be proud that you know right wingers go on and on about how America is number one? I don't think we're number one in this category is number eleven here. This should be a point of national pride right I mean to the right wing patriots. Wouldn't it be nice to be able to be really proud of how well our health care system works instead of like how many bombs we have or something like that, or does that point of view make me a beta male? I don't know, maybe it does that I think it would be nice to be proud of. Our health care system seems like you, want more people to survive in this country in there for people to live longer and get over these's perspective. To have and no no country is perfect- some will point out that uh waiting times for some procedures or longer and some of the countries on the list, others might point out that boss might be lower in other countries, because maybe nurses aren't paid well or something like that. There are always problems, but this study pretty nicely sums up sort of like the net impact of all aspects of the system,
and it's just absolutely vile and disgusting- and I want to remind you, have said this before there is some called hr: six. Seventy six out their hr six six. Seventy six is a house proposal called the expanded and improved Medicare for all act, and it basically is single her health care, not in a literal sense. What it actually would do is take the Medicare system we have, which has done a bad. Their job of holding costs not as high I lower, might be a bit of a stretch, but from going as high it's a system that works quite well in many ways. The idea would be to expand care to everybody. This is we proposed a number of times by House Democrats. It basically never has a shot at going anywhere, but it is there is there and a lot of people don't know about it and you can go to whoismyrepresentative dot com figure out who does represent you in both the Senate and the house start making calls send fat taxes do whatever you want. I mean it seems like whenever we talk
overhauling the healthcare system you're going to have legislation, that's hundreds of pages long. You know it's not going to be this simple, but you're effectively just may in the age requirement for Medicare zero, and that's a lot easier to do then to maybe pass Obamacare or the American Healthcare All you're doing is going into Medicare, and this is a slight oversimplification, but changing the minimum age at which you can get Medicare. It is a very into proposal that is totally dead in the water, unfortunately, but still hr six. Seventy six just talk about it, call your representatives about it. Let's talk about Obama, care, affordable care act. The last few days have seen a number of very, very apoplectic and out of control headlines, saying shocking Obama. Care premiums up twenty two percent, twenty five percent in some cases- and yes, it is true that Under the Obama CARE, affordable care act, law premiums for those plans,
will be up an average of twenty two percent next year. There are many consumers you will be down to basically just one plan option through the Obama care exchanges- and this is not just opposition reporting. The administration itself has indeed confirmed this, but the misinformation from so much of the alarmist out of control reporting on this, it's so extensive. I want to dig into it with you here at the top of the show. There are a whole bunch of different pieces of in nation that are missing from these reports. People see a report saying Obamacare premiums up twenty two percent number, one that ignores the subsidies on those land. So while you will have an average- and this is based on the silver level plans out, there's bronze silver gold and platinum level plans that sort of it's
bliss generally. How much of one's health insurance expenditures are covered by insurance silver is the sort of benchmark that is used. Twenty two percent increase Obama care silver level plans. However, most of that increase for many Obama care recipients is going to be covered by subsidies, so you see the headline and for a really great headline, but it's not actually telling us well, how much more are the individuals actually going to be paying and, of course this ignores altogether that this has nothing to do at all, with individuals who have insurance through their parents, insurance through their employer insurance through their school, etc. So
really really interesting. Headline Republicans are going absolutely nuts about this. We've heard the term death spiral be used, many many times that Obama care is just going to basically self destruct and implode. But it is super super important to understand that this refers to a small percentage of all the people in the country, and it also is not accounting for the fact that many of these increases are going to be covered. Additionally, let's not forget that that we've been seeing increases to premiums for a very very long time and even without the affordable care act we would be seeing increases to premiums. Would they be at higher or lower than with the affordable care act? Well, it's hard to say remember that, even without the affordable care act, even without an insurance mandate, uninsured people are still going to go to the emergency room, use it as prime ery care and the who have insurance are going to subsidize that that is a cost, part of which is eliminate
did by mandating insurance. The way we see through the affordable care act so there's a whole bunch of stuff here guys which is not in the headlines and it completely upends. What story here really is yeah. We don't really have a roll here to see how high higher the prima it would have gone out up without Obamacare from one thousand nine hundred and ninety nine to two thousand and nine. According to the Kaiser Institute, premiums prefer has nearly doubled in the republican response to all. This is just blow the whole thing up to repeal it and kick twenty million people off their coverage. No doubt yeah and insurance subsidies, cap premiums at a percentage of families income, so many Americans won't end up paying more in another issue here is that this number also high. That's a lot of local variation. That people are unaware of. This is not a perfect system right. I don't think Pat thinks Obama. Care is perfect. I don't think Rachel thinks Obama. Care is perfect. I've clear that Obamacare is not perfect right. It does some good things. The
banning of outrageous price increases or rejection of coverage for pre existing conditions is a really good thing, allowing people under age, twenty six to stay on their parents insurance until age. Twenty six is a really good thing, reduce Bing or I guess it's really the opposite. Growing. The pool of people who have insurance that are paying something in is, good thing and, of course, covering millions of additional people is a really good thing, but the system at its core is so corrupt. And so immoral and so unethical that Israel, the the basic issue for me and the Republicans who complain about the twenty two percent increase to silver level, Obamacare plans, not accounting for premiums and the fact that most people aren't even on these ends. It all ignores that the entire for profit system we have is the problem and if you turned it over to Republicans they're, not going to fix that going to say we need more competition. We need
to allow insurers to say: oh, you have a pre existing condition, you're out, etc. Their views would only make this problem worse and we know what the most popular and cost effective health Their programs are around the world, get it's single payer, that's what works well in Britain and all over Europe all over the world, and instead we, America have a long tradition of getting health care coverage through our employers, but really it's not the best way to go and Rachel think about all of the ways in which the costs are obviously going to be high. You have middle men, earning profits in in our health care system. All over the place, you have bureaucracy and complexity you have the entire medical billing apparatus. In many cases, preventative medicine is ignored, which we know over the long term increases costs you're paying for the insured anyway. Anyway, we have this current situation of
aging baby Boomer Population, combined with an obesity crisis that we can't possibly separate from the factory food epidemic in sedentary lifestyles. Of course, it's going to be expensive yeah. It's really difficult, also for the families who make too much to qualify. First up is the subsidies. They will find themselves in a pinch and I'm equally worried for people with chronic illnesses that have to switch plans. That may have been right getting out of a good price for a drug that they're receiving for treatment and then when they saw that costs can go up, and it's super easy to hear what Rachel is saying and say: well, it's Obama's fault. The these are systemic issues that are inherent to the type of of arrangement we have in this country with Red health insurance. I've been saying it all week, Hillary in being the next president, will not solve this anyway. I want to be super clear about that, but it will allow us a ninth tenth, eleven
in 12th year of democratic presidents to try to take the affordable care act and expand it and move it further to the left do people also completely just disregard the fact that since Obamacare was enacted, a lot more people have health insurance or not yeah. That's ignored yeah, no, no, that's kind of cool. That is, we might as well yeah hey. You know if you either get it or you're going to ignore it right I mean it, doesn't even make it it. It really is you? Will the David Pakman show at David Pakman, dot com? Today's program that brought to you in part by Blink ist dot com, Slash Hackman link, is, is a great service that I use all the time. What they do is they take thousands of the most
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you like it, you can continue enjoying thousands of condensed audio books for about five bucks. A month, that's b, L, I n K. I S, t dot com forward, Slash P, a k M, A n, the David Pakman show at David Pakman, dot com. Okay, I have an annex, that's really all it is, but it's an interesting one in in, in a sense about the failures of our health. System, although I know that this is both number one relatively minor in the grand scheme of things, and that I'm fortunate enough to be in a position not to be crippled financially by what I'm about to tell you and it's also not a serious health issue. Okay, so here's my medical background on on this particular story. Years and years ago I was having knee pain when I would run and when I would I can when I would play basketball and my doctor said it seems like it's
More than just you know, you're, not nineteen anymore, you should go and see a podiatrist and see what's going on could be related to your feet so, like ten years ago or something I went to a podiatrist and the podiatrist yep your knees and ankles are not correctly aligned. We need to correct your arches with some orthotic insoles made me the insoles. Obviously, in the United States, the insoles themselves were not covered by insurance, so I bought the insoles and paid my co pay for the podiatrist, and I've had those in as for a year and over time for many years over time. Name the insoles start to flatten out just from the weight of the person wearing them, and I was starting to have knee pain again. So I wanted to go to a podiatrist. Get a new evaluation find out if I new insoles so have them look at my feet. I have something called greek feet: hilariously, where the second toe is longer than the big toe, and it can sometimes scrunch that second to and creates
weird stuff on the front of the foot and the nail. So I wanted that looked at as well. Okay, so I made an appointment with my podiatrist. I did uh all of the right things. I have insurance. The insurance is totally normal middle of the road, what's called the silver plan, meaning that my specialist copays are forty dollars. This is with a big insurer here in Massachusetts, called Tufts Health plan. I don't know if people around the country know about health is a pretty big insurer here. So I do all the right things. I call my insurance, I say: does my plan cover Podiatry David? Yes, it does great, which podiatrists does my insurance cover? Here's a list great. Do. I need a referral from my regular doctor to see a podiatrist. No you don't you just call the podiatrist and make an appointment fantastic. Do I need pre authorization from you, my insurance in order to have the visit covered? No, you don't David, you just go.
If it's someone on our list, we will cover all, but the copay perfect. I make the appointment I go. The doctor sees me for ten minutes. Okay, ten minutes says David, Your arches is are flat, so you need new insoles. We don't make insoles here, here's a prescription for how the so should be made. Go to this other place, the ensure it's not going to cover the insoles. The insoles are going to be three hundred and seventy five dollars, but your toes look fine, nothing to worry about there with your greek feet. Perfect. I take my and I pay my forty dollars copay and I'm on my way. Two weeks go by I get a bill for four hundred hundred fourteen dollars from the podiatrist. Now, how could this be? I paid my forty dollars. Copay I didn't need preauthorization. I didn't need a girl. Podiatry is covered. I went to a podiatrist covered by my plan. Well, it turns out that Podiatry is covered
and I didn't need a referral and I didn't need preauthorization, but the diagnosis of flat feet is not covered, and that is how I was diagnosed and there- or I owe four hundred and fifty four dollars for the visit Mina, the forty dollars copay or four hundred and fourteen so I say wait hold on a second. I went in for knee pain. How should I know in advance what the diagnosis is going to be mine? Sure says: that's simply not our problem so Ok, I was able to speak to someone who said what you should do is call the doctor and ask if this is definitely wink, wink the right diagnosis. Now, of course, someone at Tufts Health plan can't say David. Let me help you commit insurance fraud, call the doctor and ask for a different diagnose this, so that we will cover it. Obviously they can't do that, but I'm reading between the lines- and they say this- is the system we have. I would call the doctors office and explain the situation, so I call the doctors office and I
plan and they say: oh we're going to get someone to talk to the doctor. Maybe the dock. We can rebuild this some other way, maybe focusing on the greek feet, part or or some other diagnosis other than flat feet. So at this point again, fortunately, this is more a curiosity for me. Can I ultimately get discovered? I may well end up paying three hundred and seventy five for the insoles four fourteen for the visit plus my forty dollars. Ok right! That's eight hundred and twenty nine dollars in addition to my monthly insurance premium of four hundred and twenty five dollars a month to get insoles. Okay in other countries in souls are one hundred bucks and the podiatrist themselves makes them and it would be a fraction of the cost so understand that part of the efficiency here is look at the number of people that are involved. With this ten minute specialist visit. I spoke to one insurance person before making the visit appointment to figure
what is and what isn't covered. I spoke to another insurance person after I saw the doctor. I was then checked out at the office by someone in the billing department to pay for my co pay. I then called and spoke to someone in the finance off office for the podiatrist who then we'll go back and speak to the doctor, and the care supervisor were up to set seventy six people being spoken to in seven different in actions and they may end up re building this some other way how much of the gap between the hundred dollars this would have cost in other countries up, maybe one fifty to the one hundred to the twenty nine that in total I'm going to pay, how much of that nearly so
one hundred dollars. Difference is related to the fact that I spoke to six different people about billing related issues and again I'm lucky that this isn't serious and that I can afford it if I end up having no choice but to pay eight hundred and twenty nine total for this ridiculous fiasco, I'll be okay, that's not the case for a lot of people who can't afford an unexpected four hundred dollars, expense and then, of course, there's the broader question of. Why would a ten minute visit to a podiatrist even be priced at four hundred and fifty four dollars, which is again related to all of the bs? That is part of the system? Inefficiencies, bureaucracy, billing coding up of non payment from people who don't have insurance and ultimately are just going to skip out on the bill? It is truly a perverse system and I don't want to make my story so any more important than it is. I tell it merely as an anecdote that I have send me your thoughts
if you have a similar story, please post it in the comments for the Youtube video for this segment. I do want to hear from you about it: Kentucky Senator ophthalmologist, Rand, Paul known as one of the more kind of strictly libertarian members of the Us Senate and one of his. I call one of his greatest hits in terms of just saying. Wacky things was when he said that single payer healthcare is effectively slavery, that it makes doctors slaves, that it makes. Nurses, slaves, everybody's slave. When you have single payer healthcare, and we've now learned he's going to be going to healthcare slavery headquarters set up for a hernia operation. You can't write this stuff, so I want to take this piece by piece with you. Let me set it up. First, here's is Rand Paul with his now infamous claim that single payer healthcare is a of slavery. Thank you very much with regard to the idea of whether or not you have a right to a health care you have to realize.
What that implies. It's not an abstraction. I'm a physician That means you have a right to come to my house and conscript. Me means you even slavery. It means that you're going to enslave not only me but the janitor at my hospital. The person cleans my office the assist into work in my office, the nurses, if you have right to their services. Basically, once you imply a belief in a right to someone service, do you have a right to plumbing so there it is every one is a slave in a single payer health care system, according to Rand Paul. If you have single payer health care, everybody involved in the system is condemned to a lifetime of slavery, and I'm assuming that when he says that when he makes that critique, he believe slavery is bad so that he wouldn't want to be participating in such a six system, except that Saturday and Paul is now opting to go to Canada for Hernia surgery. Remember that incident that took place
where Rand Paul was, I guess, raking leaves on his front lawn and a neighbor who, I believe, was an anesthesiologist tackled him and and Paul ended up with six broken ribs and a bruised lung. And apparently this hernia resulted from the incident as well or from the recovery from the incident. So we have this market. System, which I guess he believes is great in the United States, socialized medicine is bad. Canadians are being put on horrible waiting lists for non emergency procedures, but it turns out that Shoul DS these or shoulder I'm, not exactly sure how it's pronounced. Hernia Hospital in Ontario is a really good place to have hernia repair done and that's where Rand Paul is going to go now. I'm I'm anticipate already anticipate already defense. The
Anders of Rand Paul are going to say they will write in and say David hold on. I am opposed to the socialized medicine system like Rand Paul, but this particular hospital that Rand Paul is going to is a private hospital, not a public hospital. That is true by the letter. But most of the money of this clinic comes from the government. They accept the socialized health care plan, they're doing just fine, no slaves, no problems, one of the best places in the world have Hernia repair done, and it's a perfectly reasonable model. You don't need to have the government be the health care provider and the employer of the doctors and the employer of the nurses. You still can have private hospitals, but you have one payer, which is the government which provides a system of non profit health insurance period, just because the
provider is private, as is the case here, understand that it's mostly a publicly funded provider and that's a model, that's very popular in the single payer world and what we have in the end is Rand, Paul choosing because of the quality of care at a mostly publicly funded health clinic in healthcare, slavery, ah Hub Canada. He is today king, his taxpayer, salary out of the United States and to a different country, and I was thinking on the one hand, there's this kind of hypocrisy or double standard. In another sense, this is word of libertarianism as intended by them. He is rich and powerful, so he can go to Canada and get better better care. Other people can't even afford the flight to Canada, never mind paying for the care as a non citizen, so they end up with the key
care that happens to be available to them with their terrible health insurance in the part of the country where they happen to live. It's both an incredible double standard, but of version of libertarianism that a lot of people like Rand Paul, actually support. I really just can't get over how dumb. The argument is that if you are for single payer healthcare, your for slavery, like doctors, are compensated a good deal of money. They make six figure salaries. They don't have to be in that position. If they don't want to the free to go, you can't say the same thing about slaves and if you're going to make the slavery argument when it comes to the universal health care, you have to make it when it comes to any public official like Rand Paul. As a politician he's a slave to, apparently we will see what other follow up. There is from Rand Paul here and it'll, probably just kind of fade away. Like many of these stories. Do it's just our luck,
officials being hypocritical that that, sadly, is not actually the David Pakman show at David Pakman dot com. The number one funding source for the David Pakman show has been and continues to be. Membership and membership is not just a feel good thing. You get access to the world famous bonus, show every single day just for members as well as commercial, free, audio and video feeds of the show day. In and day out, you can sign up for membership very, very quickly at Join Hackman dot com that join P, a K M, a n dot com. If the normal prices strike you as high by all means use the coupon code vote soon. Eighteen, all one word all lower case become a member today.
Welcome back to the David Pakman, show it's great to welcome back to the Graham Gerald Friedman, professor of economics, at my undergraduate alma mater of the University of Massachusetts. Jerry we've spoken before about your detailed analyses of the costs and benefits too Medicare for all or other single payer type healthcare system in the United States. We now have Bernie Sanders is two thousand and seventeen care for all proposal. So what better time than now to actually talk about what such a system would cost? Now you see the detractors of these systems say big tax increase incredibly expensive, it's more promising a free stuff- that's not really free
counter to that would be that it would save much more money than it would cost so top line. How do we start thinking about those numbers? Okay? Well, the first thing to do is to think about. There are actually three different numbers. The first number is what Medicare for all system would do for the entire US economy versus what have now, because, of course, there's there. Big numbers involved, what we have now a big numbers. Eighteen percent of our will domestic product eighteen cents of every dollar that we produce in this country, because the health care now. On Medicare, for all system would lower that we would be able to at the same health care the less money, and this is a point on which I there is almost no disagreement. Critics will admit that yeah it would save money on the current healthcare system. It's almost
possible to argue otherwise, because Medicare is a more efficient bill payer. Then the current insurance systems, private health insurance Medicare, does involves type of marketing or profits that are in in the current system. Medicare say, saves money or providers, because it's easier for provide is to build a single system, then to build the dozens of insurance companies and hundreds of insurance plans in an average american state. Just one quick, easy example to show this in Toronto General Hospital in Ontario, Canada,. With a single payer system, there are two people who do billing in that hospital Massachusetts. General Hospital is about the same size, the same
beds more or less in other patients. There are four hundred and fifty people who do filling them. I mean so. You go save money yeah now what about the there's, an argument that part of the savings would be because if you have a single payer, they could force providers to just have to charge less, and thus it would significantly depressed wages within the medical infrastructure for doctors and nurses right. How do you respond to that not particularly for doctors and nurses? Now they would pay provide this last. Those providers would have low, of course, because of this buildings that saving on the billing process um and all some providers who currently earning what economists call rents, which is a situation where you have a monopoly, and you exploit everybody else- the biggest rents,
are in the pharmaceutical sector? You have this hepatitis c pill that sells a course treatments cost eighty five thousand dollars in the United States. It costs no joke two hundred dollars in India, so they are exploiting the rest of and the research for, that, as for most drugs is paid for in the first placed by the National Institutes of Health in the National Science Foundation. So we already paid for this drug and then we're paying again. So, in my estimates, the Medicare for all you'd be saving large sums on bargaining effectively for drugs, and there were also some elite hospitals that would be facing cuts, but not that much Medicare currently pays hospitals about
twenty two percent less than what hospitals get from private insurance companies. That's overall now that is about my estimate. It's a little more than my, but it's close to my estimate of the administrative savings from single payer so hospital. Some hospitals, like mass general, would probably get a bit less because they have currently explore the rest of us to some extent. There's abundant evidence on this, but overall hospitals would be why doctors would be awash. Doctors would actually benefit those doctors who currently treat Medicaid patients would get a raise, so overall we would achieve savings of maybe hundred billion dollars or so on. Our total healthcare spending and those savings would largely come from being more efficient,
doing the same stuff. Better Sowell laugh lines along those lines was an analysis done of the proposal that Bernie Sanders had during the campaign right. So this is not the most recent proposal, but from the one during during his campaign, and it's estimated that the cost to people who are earning salaries, wage earners would be about a two point. Two percent surcharge, which I estimated on someone earning fifty thousand dollars, would be about twelve or one thousand three hundred dollars. Roughly, can you talk a little bit about in the analysis, you've run sort of what would be the cost to different parties? Ok! Well, there we get to the second and third questions. The first question is the total economy. The second question is the federal government, and yes, there would be a tie. Tax increase that two point two percent was actually what Bernie was proposing last year, plus some payroll tax
would be. The federal government would be spending more and taxing more, but that would be replace think what we're already spending on taxes that go to private bodies when we buy health she it's mandated by the government. We have to buy health insurance and we have to pay for health insurance premiums to me and to the Supreme Court. That means it's attacks. It's just the tax collected by private agencies. Now the third question is for the individual, which who would be paying more, who would be paying less well overall, will be paying less in public taxes to the government than in private taxes to health insurance company, because the whole system will be more efficient but they'll all to be particular savings for some people, because in Bernie's Prope Puzzle and in the proposals that I've written we
an element of an income tax or a tax related to how much money you have and how much you can afford to pay. Where is now your health insurance premium is either a lump sum Everybody pays the same or sick people, people and families with a sick family. Member pay more so we put a tax on sickness, which is a double tax in the because, if you're sick or you have a family member is sick, learn capacity goes down because he's spending time taking care of your family. Member of that family member can't have a job because they have disability whatever, and then, on top of that, you have to pay this extra health insurance, because the health insurance figures out that your second and they put they get you into a plan that covers sick people. I mean yeah,
have to sell you insurance and they can't charge you extra of pre existing conditions, but they work at well. That's good that that relates to this idea of everybody with pre existing conditions under Trump Kerr versions. One two and three point, oh all of which, which which so have so far failed, would have access to a plan regardless of pre existing conditions, but that's a very different than it being affordable, and it sounds like that's sort of what you're getting out. Yes, what we already have have is something in that direction, but then we'll limits on it, whereas what they were proposing access. That's just that's! I would use the word that you can't put on television or radio, but access just means they have to offer you a plan. But thank you true that eighty thousand dollars hundred fifty thousand dollars and the ok you have access. You can buy it if you could afford it and have
so you- and I have been talking about a single payer system and are you experiencing that there are people who are used, understandably, so not as a criticism between a single payer system. Where is where the government would be the one pair vs, nationalizing health care where the government runs and operates the hospitals and employs the doctors and nurses. Do you see as much confusion about that as I'm? Seeing oh yes, absolutely this, and that confusion is promoted by critics who say going to have a government takeover of health insurance. Now now now we're going to have a government provision of health insurance for people on if you want to buy health insurance on your own, this isn't in Bernie's planned. But it's in all a lot of the plans that I envision then yes
pie out the Jones. Why somebody would do that? I don't know because they would already be getting it through the government for Frank in effect, because they'd already be paying the taxes, but there would not be a government takeover of the provisions of health care. Britain has that right and arguably the health care system in the United Kingdom is the best in the world. Government provision of healthcare through the National Health service is extraordinarily efficient and come is very good care, but we're not talking about that. We're talking about something Canada where they have pry. They have private provision of healthcare. Care is work independently frozen run independently, but there is government finance. So all the bills go to a government agency. If you go to a doctor in Canada, billing amount
to the following, you swipe a car through the machine, the or the nurse types in the diagnostic code and the and the treatment code and you're done. That's. The government agency will send a check for your services to the doctor. The doctor deposits that check in hop private bank account uh Carrie. What is the best place for people to be able to check out your detailed proposals of how this would all work financially and economically well? Um, ah one place would be positions for national Health plan Bnhp DOT. Org are my two thousand, and thirteen financing puzzle is up there and there's a wealth of good information. There, top quality research on
canadian health care system bar and health care systems, issues in the United States Health care system there. Some of my work is up there and there's a lot of work by other excellence. Colace also, another very good place for health care in general is the CHI, the family Foundation, Kf, F, DOT, org and finally, the Commonwealth commonwealthfund dot org. My most recent published work on single payer was from two thousand and fifteen from New York and that is if you, Google, New York Health plan um, I don't remember the website. Yeah yeah, you're awesome, you know, is right to Maine, yes and people, I'm sure we'll find how to do that. We've been speaking with you, sir of Economics, Gerald Friedman always great to talk to thank you,
the David Pakman show at David Pakman, dot com. The David Pakman show is audience supported, media and you can contribute any amount. You want on Patrie on as little as one dollar per month, plus you can get the daily bonus show world famous at this point and the daily commercial free tv show by making those pledges at Patrie on dot com, Slash David Pakman show. This is audience supported. Media depend on the support of our viewers and listeners, whether you listen to the podcast watch on Youtube or watches on tv or even listen on the radio patris on dot com. Slash David Pack
Show David Pakman show at David Pakman dot com, hey David, won't Medicare for all kill jobs. This is a really loaded question and I'm glad to have the opportunity to talk about it. There's this imagery of killing jobs. That is a very political imagery. To be quite honest with you, because the reality is that all the time, governments, federal government state governments, departments of the government, whoever all the time decisions are being made that have an economic impact and they have an employment impact times were talking about. Thousands were talking about one thousand new jobs, but we lose two hundred, but there's some economic gain or some social gain from that
change. So number one. We've got to get away from this imagery of quote killing jobs, because all the time as a country of all these decisions are made to create jobs and that eliminate jobs they cause firings, they cause layoffs, they create new industries at cetera. What we have to understand is that a lot of those jobs that exist in the medical field right now, which we be unnecessary and thus would disappear under a medicare for all system, are not jobs that are actually providing for the raider good. What I mean by that is, if you consider medical insurance, health, insurance, fraud, investigators, medical billing and coding experts on the insurance side, medical bill, encoding experts on the hospital
side by the way, not all of them would go away under single payer under many single payer systems. They remain all of this bureaucracy, plus the profit that is implicit in the system that doesn't lead to better health outcomes. It doesn't lead to lower costs. It's simply yes providing work to the people that are in those jobs, and it is work that is being paid for at the expense of people who are buying availing themselves of health care services, so would say of those things be eliminated. If Medicare for all work to be passed, yeah some of them would the economy would have to adjust in history. This has happened many many times. I give this example often, and I think it applies here. Think back to the development of the auto mobile, the automobile was a much more efficient means of transportation, then horse and buggy carriage or whatever you call them. There were people who said this
is going to eliminate the jobs of the drivers. I don't know what they were called of the horse buggy. Would that be a reasonable reason not or not allow cars to be developed or to prevent the development of automobiles? Of course, not, ultimately those individuals, no long we're in demand in that role of horse buggy drivers, they were real integrated into the workplace. In other ways, some of them probably suffered long term unemployment. That's true, but we need to stop falling for this idea that any policy that will result in any job loss is unacceptable. In fact, it's actually a very sort of center right idea. I mean there's this infamous video of Milton Friedman, arguing with some college kid. Where the college kid says shouldn't there have been consequences for some car company that had a a car that was dangerous and Milton Friedman said: okay will hold on. So there was a negative consequence from the car.
Some kind of negligence uh. How much should that car company have paid to fix that problem. If the car cost ten grand and it cost him ten grand to fix their problems, that they have been forced to do? Oh it, what about? Should they have paid one hundred thousand dollars to fix a problem on a ten thousand dollars car? At a certain point? You get to this, ah realization that there are going to be consequences to doing the right thing and whether you're on the Milton Friedman side of that or not it doesn't actually matter. The point is every single day decisions are being made. Policy is being affected where some jobs are lost. There is some economic cost, it has to be accepted in a country three hundred and forty million people anytime, you make any kind of change. There will be people who gain and people who lose right now. The losers are people who can't afford to pay for care people who get substandard care, people who are going back
corrupt because of medical bills and those who gain are the for profit insurance companies, the elected officials that perpetuate the status, so in exchange for donations and whatever else yes, some jobs won't be necessary under under Medicare. For all the net benefit is gigantic, and that or some system like it is still the right thing. Even though there will be jobs, that will know Grammy necessary and we just have to accept that and not fall for the right wing talking point that it will kill jobs and by the way that is, that is an under the defensive talking point when the right goes to Medicare for all will kill jobs. They've often already conceded some of the benefits of such a system in terms of access to care and in reducing cost. That's why they retreat to it, and it is a very, very weak counterpoint to some kind of non profit system, the likes of which many countries have already employed. Let me know what you think: we have a great only show for you today become a member or a patron to get instant access at
ewww, DOT, join Packman dot com or at Patri on dot com. Slash David Pakman show, let's go to the phones at six hundred and seventeen thousand eight hundred and thirty forty seven and fifty starting today with our caller from the nine hundred and seventeen area code who's calling today from nine hundred and seventeen. That is you indeed, who is this. Milo Milo, what's going on to be so, my question is about Medicare for all, so. A really common right wing- and quite frankly, you know talking point also from like a lot of centrist democrats- is that you know Medicare for all really only works in countries with like smaller populations like when I bring up that it works in like sweet in our Norway or Finland or other nordic countries. They say like, oh well, you know those countries have like relatively smaller populations, but in a country,
America, with like three hundred and twenty million plus people who can't work yeah. So I'm just wondering like how do you robot that point? Well, first of all, with now twenty percent of the people who say that you just say why not, why would more people make it not work and use so that'll get rid of ninety percent? Ninety percent won't have an answer. The other ten percent will have the answer, and then typically you know I mean the the best thing is not to rebut it with some concocted talking point, but just to tell the truth, which is the way that insurance works, the larger the risk pool the more predictable the spend is going to be per person and that actually having more people in the risk pool makes the system more financially viable, that you have way more people who are paying into system and that it will actually make healthcare spending signal Bentley, more predictable, and that there is simply no reason to say that it only works in smaller countries, I mean is math and
ethically untrue and it's logically untrue, right, yeah and also just like sort of one other quick question. I had one of um and I think I'll kalinsky also brought up this point recently, which is that one sort of I guess ah solution to that worry or you know another way we can sort of do it. And America is you sort of federally mandate that each individual state implemented like on the state level, so that population is no longer worried and then yeah? I've actually mentioned this before? This is a really good point if you, if you want to make a states rights, sort of positive, version of Medicare for all you actually have each state. You could argue that states for geographical reasons or because some states have these. Like cancer alley, factories have higher rates of certain additions. You can actually say that different states
may actually need slightly different financial characteristics and that each state could implement their own single payer system partially subsidized by the federal government through the sort of taxation that Bernie Sanders, for example, has proposed. That's a fantastic idea. All right. Oh yeah. Thanks for answering my question did alright appreciate the thank you very, very important stuff, great to hear from the David Pakman show at David Pakman, dot com
Transcript generated on 2019-09-13.