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How Health Care in the United States Works Right Now

2009-09-15 | 🔗

The United States is abuzz with talk of health care reform, but why does the system need repairs in the first place? Josh and Chuck explore how the current American health care system works (and doesn't) in this episode, the first in a four-part series.

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ready are you welcome to study, should now from house external hurry and welcome to the I guess I'm just Clark with these always is Mr Charles Johnny Chuck, Bryant faded well, Sir good well with the word. It is for this reason, this step we should know and are actually the special additional studies for one of a four heart series. Yes, should I break it up here? Yeah care reform. Everyone seems to be really confused about what lies ahead the United States and our health care system. It's so confusing check that. Not even certain. If healthcare spell there's one word or two, I dont even pretty much the level that were at and understand if I d of health care, let alone health care afore. I so we're trying to figure this out and, along with you guys, may be, can learn something here.
So why am I guess was kicked off. Let's get this boy yeah we're gonna we're not going to talk about future plans. We can talk about how it is they will in this protest right in this addition- and this is therefore one of four for want of four It's about the current healthcare system in the United States and Chuck. Have you ever gone without health insurance, our man, I seemed that, after my parents, ceased is a thing. Is that the familiar story for everyone here, some time around after college till I got my first real job, which was at least seventeen years later, yeah. I think it is dead. Yeah same same story and the parents are always on. You know like how you know if you had an accident nose like I'm, invisible, exactly and luckily worked out the same here and I works out quite so over,
nobody ever yet ebbing United led charmed lives. I will, I guess, we'll get to the uninsured soon enough. The Czech go back to the beginning, nineteen twenties and Texas again ingesting Kimball, founded a company name Blue Cross still run two days. I understand we shall we understand, as there have a four right below us. I believe that's right. That's wherever that name, you haven't we so he started in insurance. Some a programme plan, where women can we did. I think teachers specifically contributed fifty hence out of every paycheck toward there. Ensure maternity needs rights, they went to the hospital, have a baby. They were already prepaid, it's not, the insurance prepaid plant right, the creditor was something that came out of it that really gave birth to the insurance industry. The? U S, if you will forgive the metaphor, sure
not all these teachers had kids thing being so You can actually make money yet selling premiums, selling policies, the people, because not everybody's going to get cancer right and that's how the whole system still works, that it's a gamble. You know NED Flanders once said on the Simpsons. Actually wasn't NED Maud, Flanders was its position perfect that they dont have any kind of insurance, because it considers that a form of gambling- and it really is on one side you, the insured, are betting. That's at some point in time. Some injury or illness ran befall. You that's going to cost more to treat than you ve put in right in monthly payments toward your policy. They love it. Total gambling. The insurance company, on the other hand, is bedding that you will be hit by a bus and die immediately
something along those lines where you're not going to need any kind of care or that you to sleep a healthy life in nothing, Cadis, nothing happens to you, which is growing and not yet clearly not yet happened. I think the hip, The bus scenarios is an absolute best. It can happen for Asia Entrance got an insurance company s, but so yeah, it's a form of gambling and you're going head to head with the insurance company, and sometimes it pays off. Sometimes it doesn't right, but for the most part it it it it's a pretty good system. Basically, speaking again, you pay for peace of mind. A lot of time to quite a lot of people say he's only to show someone consoling exactly those from Barton Fink was it: a Jack Goodman said that he sells peace of mind, nice well, Chuck, let's fast forward. A little bit by the nineteen forty star companies,
had already begun, offering employer space insurance plant leaves a great incentive to get the ass in the brightest. Definitely, and actually still is because of this business, which is a sector where society right obviously part the economy, which is what I wanted to say, but businesses a sector dislike. You know populations, sector, governments, a sector that anything business said we're gonna, take the burden of health. On our shoulders, NEA sort. If in nineteen forty three the Iris supported this and encouraged it with the ruling that said, employers can pay for these programmes. These plans for their employees out of pretexts dollars right, makes the whole thing really attractive. In with sudden the. U S has what amounts to a state sanctioned employer health care system right at which still thrives today, which is
I am pretext. Dollar seem deal with IRA. The chances are good that you, if you have insurance in the? U S, you have it through and employer yeah Most people have insurance through other company in their employer. I'm not as many people have the more expensive and harder to get individual insurance. Yeah, I think fifty six percent did it through their employer and thirty percent get it to the government run programme, medicate or Medicare. Many came later there were created in. I think nineteen sixty five by the Johnson administration, J and on the s. Chip is the other big one for children. State run. Like me, many cares for the elderly and the chronically is the end, didn't. I dont really early people with with kidney failure, real failure, yeah Medicaid,
as I said it, state run, is for other people with disabilities. Refer for it and pregnant women right and then s, chip is for kids and that is covers uninsured children under the age of nineteen, whose families earn up to thirty six thousand two hundred per year. With the status of their last at those gonna say, since it is the first of many right and then actually there was one more than enough. He knew about the high risk health insurance pools and the other people there, pre existing conditions that normally not be able again insurance at all, and they what they do is a group. These people together same concept is as employ, employ basting Those are the ones you see on little. Ninety nine cent signs on the side of the road like need insurance kind of thing you just get lumped together so yeah, there's that you
pointed out one type of insurance and his group in sure its most employer plans. Probably all employer plans are group insurance yeah evokes because it is a group because you, and these are good because usually dont have to fill out the big question air about Europe: eating habits in your smoking. But there's no physical exam. Exactly and pretty much. Anybody who wants to take part can contribute and be insured right, any employee. I should say in the usual their family kids. They kind of measure a small portion of the mule S. Population has individual, in one of the reasons: why is because you have to go through a rigorous screening process is not cheap if you are found to have a pre existing condition you can be I'd insurance very easily. I imagine pretty heartbreaking here, and yet it's really expensive. It's it's very! It's expensive proposition
whether you're, an employer or in individuals her or an increasing an employee right. So I get to that in a minute. What are some of the types of insurance plans that are out there in the? U S today, this pretty much too umbrellas right, Yours models go, I would say so that I think you're talking about the affair ass, the fee for sir, model and then the managed care model you will be so were which, under the manage cares when you hear about H, moves in ppm in key lesson that those raw managed care yeah, the big, the the I guess, the young main characteristic of fee for Service- is, and this is the original model for Georgia Indemnity insurance. Again. May I implore you, you are you pay your monthly premium and are you you're ensured you come down with a cold? You go to the doctor, you're the doktor cures. You gives you a coke. Instead, drink. This and you'll be fine or I instruct the cigarette right. This is a nice authorities here
dad you pay the doktor. You file some paperwork. Near insurance company reimburses you and you go along your Mary way, continuing paying you monthly premiums again right, The old school model like what our grandparents probably happened right and then I think of the eighties that ETA most came about manage care became much more popular than the the first model and actually there some plans that kind of combining the two, but with manage care with fee for service the The emphasis is on treatment right with manage care, there's more emphasis on prevention physically and that's where it really that's. One of the big sticking points with this whole mess that we have in this country is a lot of doctors and a lot of managed care still don't practice enough preventative care. Right, so at the centre of the manage care model is a primary physician right who supposed to know. You know you
family. I know your history. You know that you eat more doughnuts, then you should know that you lied on your insurance form. When you said you don't smoke. Right ran his saying that you're getting diabetes, you're gonna, get round canter. Somebody who knows you who you ve seen in who who can you? You can trust right too, and of guide in manage your held by the kind of a dying Bree to sadly definitely and there's a good reason why Chuckie read that CNN article Hills Distressing actually was an editorial by Doktor Vince Harris. I believe yes and I he basically a run down of why the primary care physician is becoming a dinosaur right. Yes, pretty pretty depressing, actually so he was saying that for every several thousand dollars he saves the health care industry right I using his medical training to actually make diagnoses rather than really expensive screening. Like our eyes, treatment as opposed to procedure. He said that, for every so
thousand dollars. He saves the industry. He makes fifty bucks. Yes, seventy five bucks so he's there, its primary care physicians are not making. The money? What's more, there's a lot, there's a lot of issues surrounding malpractice, on one hand you can say well the very fact that there's a malpractice losses out there in the often add up to astronomical amount of money being paid out to people who are found to have been the victim of malpractice right Actors are a little nervous about relying on their medical training to make a diagnosis when there's an MRI machine in the next room right that they can just say this is going to solve it one way or another hour. I know for a fact and then the very least even at by Miss it I could say, while the MRI manufacture, screwed up right. You know there's a lot of passing the buck because of that supposedly, but there is another way of looking at the correct: well, medical malpractice,
Is you hear a lot about doktor saying that striving is out of business? We care for the premiums we have too many patients. We haven't Sweden, patients that that come in for you now, does the worried of cyber contrary of feeds into it. People read on the internet. I've got reflexes get it in the end. Endoscopy men they going demand, one which I mean you really it's. There, it you're right, you're, a patient, and you want to make sure that you have healthy body is tricky business there. It is. Because they're, what did you call us recovery, yeah, excellent it's an argument that often used against the pharmaceutical companies advertising television right, you get the impression that they are educated, the consumer to say: hey, here's the words you usually you talk to your downright yet our pill. Yet you know How much of an effect has that had on over prescription
sure bunch and there's a there's so much information out there. Now that's the first, I do I diagnosed myself on the internet. All the time and I know a lot of people. Do they really oh yeah, I'm in which you would have had a reflex. Do you know her big time? You know much of the complainant shut up. You know really had had no idea you have referred to that reflects the fellow friends I want to tell you about love book, the very easy way to personalize a book to someone you love in three easy steps. Love books, helps customers express the sentiments that may be difficult to say out loud for some of us looking in anyone's particular direction, users can create characters that look just like themselves and the recipient right down to the outfits and accessories customers have the option to personalize each page as much as they like, but the express option creates a complete book with just a few clicks. Lubbock now offers a membership programme as well. You receive a free book when you sign up fifty percent off any additional books. Unlimited free
digital books and discounts on gift, rap and other products. Love books are the perfect gift for all occasions or just because so right now you can check out love books. By going to love book online dotcom, Slash crush, you will receive a special twenty percent discount. That is it love book online. Dotcom, slash, crush, let's take effect were you? Can we talk about malpractice again, regret that you have a study, please We hear a lot about how those costs are driving doctors out of business and not say in one way or the other. I'm just gonna throw the study out the Americans for insurance reform there, a coalition made up of consumer Federation of America consumer start that organ a hundred other public interest groups. They really, study this week. Actually, that found that outbreak premiums are down and at the lowest they ve been in thirty years. Malpractice claims are down forty five percent since two thousand and in states where the states
what'd the consumer's ability to sue for malpractice, yeah premiums or about the same as in other states Ruth. So I'm they're not paint a lot and it's not putting a dead, but they they say that malpractice claims only constitute one fifth of one percent of annual health care costs in the United States, so that and obsolete argument these allow it maybe a little overblown. I mean, of course, tell the doktor there has to pay a lot of money, but from what I read it, it's not the central problem, like some people say like it needs reform unease be controlled by the government. Who knows and issued a point that the facts- and you did an excellent job- that let's go back to arm talking about where you get your internet. Try. Yes, we talked about employer based plants. Are we talking about people who get there the their insurance individually right people who get it from the state and then there's another group known as the uninsured
yeah. This is where it gets really. Hanky, the number of the uninsured is kind of all over the map. Right now, oh yeah, and also it's one of the central folk. I of the insurance health care reform debates law had theirs forty five actually as far as August, two thousand nine cents of pure figures. Forty, point: six million uninsured american right that, if you are personally that health care is a human right, and you think that these people should be covered in some form or fashion right right and there really nit picking this number, because that number, the number of uninsured, is largely what a lot of that the financing, as can be based on yeah we're trying to project elect a decade into the future And if they don't get that number right? You know the money doesn't work out than that's when you're really screwed will sure saying that not everybody's on the same page with not a young uninsured, are how many there are there's a guy named Michael D, tenor of the Cato Institute
when he pointed out that our think tank right. Actually, I'm were Brookings Institute for Man it is pretty girls to be all about cater. I was I've still. I might, but I like Brookings, he says you ve changed so tanners potato points out there, dumb about twelve million of the forty five points, million people who are uninsured in the? U S: r, L, for four Medicaid or s chip they just haven't signed up for well, maybe troops really good point. He also that if they ever go in for treatment that should pop up in whatever pace data that the administrator takes in and he'll be automatically enrolled in whatever programme suits them right right, so that takes care of twelve million I wanted the ones I dont a surly agree with, and I think people who think that health care is a universal human right would disagree with very much as he points out at about ten million of these people,
insured in America aren't Americans as higher depends on when you start looking, these numbers started looking around their people all members are everybody's got a number. It is it's hard to count and account for these people yet either. Generally illegal immigrants are gonna, have stepped forward and say you know count me on your report rightly says one reason, but Ten are also makes one last point that you and I are of anomalies, chalk and having gone several years without insurance when we're younger man right that about fifty percent of the uninsured in the U S go six months or less without any Really this forty five point six million Americans, even if the number remains the same. Who makes this popular? she is changing, constantly, writes a snapshot basically rice, always one person put it Monday articles he sent me so yeah exactly how many uninsured people there are who they are, is kind of a big part of this about whether you know health care needs reform,
Actually, let me only correct myself. I haven't run across anybody who says that healthcare doesn't need reforming of you now now. Everybody agrees that there is something wrong that it's broken in the world. Position would probably agree with what my. However first talk about some of the different arguments. There's some people who say that public health care is more than just a week. Part of the IMF. The welfare state, and why should my taxes pay for some other eyes, right, health insurance when I'm paying through the nose right the you could say that competition, My is this right. This giving people vouchers by their own insurance might make them a little more penny wise right with you spend their money, Ultimately, what seems to be
agreed upon by everybody is that the american healthcare system is too expensive for what it provides big time. So, let's talk about, as you mentioned, the World Health Organization, this is huge, and this this still. The study was from two thousand and it remains a real piece of ammunition. That's used. Many different ways in the debate on health care he has a groundbreaking study- and I, like you, said we are the most expensive. We spend more money on health care than anyone in the world we spend sixteen into. Doesn't eight. We spent sixteen point: six percent of our GDP on health care, not just government spending, but just across the board cheese. Sixteen point: six of the market, sixteen point, six percent of the market value of the United States and that that year was spent just on healthcare, that's more than defence body. So do we were in Iraq and Afghanistan at the time,
gimme. A number like that, I would say in response: Josh, that of the hundred ninety one country say studied in that probably means that, where at the top of the list and for what you get for your dollar, you think we should be since we have the most expensive and technologically sophisticated. Here's certain my world top ten I would say TAT Cross, patrimony, honest, you think what oh, the where we should be coming out and not go I've easy you ever, I'm gonna give you some leeway into top ten ok argue or how? What is it really what have we rarely seven thirty seven in the world four hundred and ninety one country. Yes, do you know who is just above us, Costa Rica, some you know who is just below us, Slovenia, while yeah
That's where the? U S rags needed here. They literally greek. There would be a gently against Slovenia right, but yeah is, since we have the most expensive healthcare system in the entire world on the planet we should by proxy. Have the best healthcare system is rated by the World Health organization. You wanna hear something else chilling I do. Americans life expectancy is lower than Canada. Half of the Caribbean, including pottery in Cuba, Chalais, our western Europe, some of Eastern Europe, Israel, Jordan, Singapore, Hong Kong, Japan, Australia and New Zealand. Our life expectancies, lower than all countries, well an unnecessarily saying that definitely means it, though their healthcare system is so much better, but it is probably lends itself to
that argument? Another study, you refer the article you referring to chuck and dumb it references a study from the New England Journal of Medicine from about ten years ago that showed that the average black man in Harlem was less likely to reach aged sixty five. Then a man in Bangladesh that Mr that's not supposed to be now now that when you're spending the captain and we're not saying because America so much better, it's because we see the kind of money we spend right unless a better result. That's one thing that allowed people of greed of the the other point to this is what you, by the way, we spent two point. Four trillion dollars into. Doesn't even health care right health care spending and costs continue to increase, but, as someone else pointed out it in ninety ninety six hour, mortality rate flattened hasn't gotten better since that right, so In short, the? U S is not getting enough bang for a buck as far as its healthcare system were not getting healthier, but were certainly spending more. My wits
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There's more arm. I think they discover medical errors in article. I read because of understanding. That's one reason we! U what you're talking about could actually be considered symptoms and we should poverty say just four c, o eight that it. If you put Jerry and man in here, you would get a totally different podcast with all the same research right. There are so many ways of looking at this issue that all you- and I can do here chuck- is try to get to the central focus of it right without you know, leading into partisan politics or anything like right right. It seems to me from what I saw come up time and time again from sources on both the left and the right pro business pro labour is that the american healthcare system,
two sophisticated it's too advanced entertained. Patients have too much access to it right. You could say frivolous access to it, so the MRI scanner we're talking about right right, the wise as I outlined all demand right. The patient demands it because that money that goes towards your employer based ensuring the house he comes out of your paycheck yeah right and when you think so right there. This is money you haven't even seen. It comes out before you're you're patron, redirect deposited in your account right. Secondly, its relatively cheap, and when you, The doktor you not actually showing out money. Now, you're Copa right so you have a real incentive to be cheap. What was the Simpson, Sir?
you're talking about so you remember, do you remember the one they their home, Homer in LISA, goats in the ice, elation tanks right right which, by the way I did recently- and it was cool and homers isolation tankers, possessed, while he's in there and one of the labourers whose reprocessing this thing tells the other went to live with his knees and the other Geiger screw it. I've got health insurance right and that's kind of the attitude some people take his I'm paying for this. To get my money were thought of it exactly so I'll get some heartburn, I'm gonna go demanding the camera down the throat instead of trying to treat it
either not eat chocolate and red wine right for their heads. The other thing that it betrays is that we aren't taking responsibility for our own health as the Americans. We know and that's where, as a start, buddy definitely and part of that is putting that focus back on prevention again rather than treatment, because consider this, if you have a in advance disease, how much more rigorous is yours we're going to be how many more doctors, businesses that entail how many more scans does that MRI Miser entail how much more for medication right into can we start on the pharmaceutical companies. Yet it's a different like how much more time and effort and just cost is going to take the train advanced stage disease. Then it's
to be to prevent it retreated early on exactly zuleika when they recommended it. I think forty or so for women to start getting your mammogram in for men to get the old how's your father treatment with from here, doktor yeah, these things beautiful her dead people of the stuff and then all of a sudden you have like he said. Holy cow got a tumor that advanced stage. Yet, as I haven't even care myself and I haven't done the regular check ups like a need,
And the cost a lot more so that this infrastructure that we're talking about the health system, infrastructure right it keeps growing and growing costs a lot to manufacture anymore? I miss machine in Turkey. I keep using their bodies. Is such an easy example yeah and as a result of just not just the MRI machine, but all these different external factors impossibly corporate greed. Ah, deference two thousand for the two thousand nine average cost and healthcare premiums increased four times faster than the average wage. In the U S, and I saw the sudden healthcare is getting more and more and more expensive, and not just for you or me chuck it. We are premium from nineteen ninety nine to two
the nine are they employ contribution white from an average of fifteen hundred forty three dollars to three thousand three hundred and fifty four dollars right. That's just our contribution. This isn't including employers contributions which is affecting their bottom line and as health care costs rise, they're losing a competitive edge in the global market in an increasingly globalized world and our businesses have budgets, they work on budget set also might affect the rays. You might
not get because of that the budget, how much they haven't you spend. I know my Father in law has a small business and did he is a really small business. I keenly has a painful employs, but he has a health insurance programme and one of the Ladys it works with him is one of these people that does not take care of herself. She has like three or four surgeries a year and its drive him out of business. Do this one lady, you and let me tell you something else: what buddy the World Health Organisation estimates it between nineteen and twenty four percent of the total dollars? it on healthcare here spent on administrative costs, while administrative costs and another reason that is so expensive is there's been a big shift. If you ve noticed in for profit, hospitals yeah as opposed to the old nonprofit model, the community model and that's gonna- help private prices too, so they say well sure, not only that, but the uninsured drive up prices thee that medical, Medicare are notoriously terrible,
paying out billing to physicians, hospitals are starting to use something called balanced billing where they start building patients for procedures, they didn't know they weren't covered for an insurance companies, refusing the paying all of a sudden. You ve got a collection age in all. You, because the hospital in say, oh by the way, this doctor right here row you you're about to see, is out of your network, so you're gonna have to pay for about a pocket. There's just there's. We have big problems here, yeah now getting the chuck. How do we solve this? I have no idea other people too thank Heavens, where there were one of those people is a man named. Mr Brok, Obama, known as President Obama sure he's, got a plan for health care form, and I were going to cover that in the next instalment of the podcast crack Obama's healthcare reform plan soup. To not yes, but again, this is kind of a weighty topic and we're gonna need some help
so we're gonna, Recruit, Molly, Admit, Molly, Edmunds, averse stuff man, never told you. The ocular sister pike, ass right, in our era, healthcare, writer, well yeah, she's, been completely submerged in health care for the last three, we health in General she's our health right. She is, but been studiously studying. Healthcare reforms that she's gonna come in for the next few, a package to help us or through things we can rely and her lower end. We also spoke to a doctor, Michael Royston, who is the chief wellness, observe the Cleveland clinic? Yes, and more famously known as co, author of the EU, the owners manual series of works with, him on the throne yeah he was asking, so it can like a whiz Bang Super big health care for Pakistan. Hopefully, by the end, you will know as much as Mali Edmunds witches angel, so stay tuned for the second observed, which will be out in a week in the meanwhile
You can go to how stuff works that come type in health care in our handy search bar you're, going to find a slew of really thoroughly researched and well written articles by Molly Edmunds? And if you want to send an email about health care anything else, you can shoot that to stuff podcast at how stuff works that count Furthermore, on this and thousands of other topics, is it how stuff works out com? what moorhouse tough words check out. Our blogs on the house works that come homepage brought you by the reinvented two thousand twelve Camry. It's ready are you text they will be. Here before you know it everybody but relax, because each in our black is your one. Stop tack shop, their tax pressure, experts, certified and train and eighteen are black, has up front transparent pricing, which means you know the price before
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Transcript generated on 2020-01-28.