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But seriously, how are you going to pay for it?


Sarah, Dylan, and Matt discuss Pramila Jayapal’s Medicare-for-all bill, its lack of pay-fors, and an interesting white paper on income transparency.

Sarah on private insurance in other countries

Dylan's interview with Matt Bruenig

Sarah's interview with Rep. Jayapal on her bill

White paper

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Yeah this is Marquez Brownlee Acre a m could be eighty, and this is Andrew, Manga, Nellie Movement. Introduce you to our pod cast way form the newest addition to them. Media Pike S network, so I spent over ten Here's reviewing tech products and consumer electronics for millions of people on the incubation Youtube Channel and now on the way forward. cast Andrew, and I use that experience to dig even deeper into latest tech for smartphones too. I max to electric cars. So if you're gadget lover or attack head or if you just want to figure out whether the latest gadget is worth your harder and cash give us a lesson say, can find way form the empty beefy pie cast on your favorite Pakistan every Friday see over their aid printed out there I favour a dead ice idea. You're right paper than other Dylan left. His tax returns in their old guy. They re as I didn't read your tax for you gonna get away, but do you wanna get the YAP
Ella. Welcome to another episode of the weeds on the box media, podcast networks, Matthew Iglesias here with Sarah Clip enjoyed by special guess, STAR, Dylan, Scott and that's cause we are going to do now, demands on Dylan's here of carrying out, but don't worry, we are going to talk about some Nordic Administrative Data later they just spilled out on the internet, for everyone to see, but first
Sarah? What's up with health, there is a new Medicare for all plan in town and so last week, Priscilla Jaya, Paul. She is the co chair of the Congressional Progressive Caucus, a house member from Seattle. She rolled out this kind of much anticipated house bill to expand. Medicare to everybody is so this comes after Sanders is Bell last year. This is a updated version of a bill that Jaya Paul took over from some other folks with since left the house, the most recent owner. This bell would keep Elsa and who is now serving as Ms Minnesota attorney general. He leaves a house these in a dry Paul's hands and which
rose out. Something she's been working on for months is, in my view, probably the most generous version, I've seen of Medicare for All- and I would have said that was true of the Sanders plans when it was rolled out. If you look at the Sanders plan, there's no co payments, there's no deductibles. The benefits covered include, obviously doktor visits, hospital visits, but also vision, dental prescription, reproductive health, the whole wide array of benefits. Basically, anything you could think of his health care seem to be in there, which is much more generous than the canadian system than european systemic, who usually of some kind of limit on benefits or some kind of car sharing. The Jaya Paul bill comes out last week and it goes even further. It includes a benefit to cover long term care which we did not see the same plan, which is a pretty challenging area. An expensive area of healthcare, that's being used by more and more Americans with an aging population. It all
and visions, and I the something big dark relevant, more a much faster transition to Medicare for also, whereas the same this plan at this four year ramp up to moving everyone to a government plan. The Jaya Paul plan is a two year transition which, to me seems very optimistic, given after watching the roll out of healthcare doktor over four years, and that didn't go so well but I have you to represent job how we talked about this, and I can save your innocence conversation before listening this pod cast. You might want to listen to an interview I did with representative Gyre Paul on the other kind show where I was guest hosting for him, where he talks where she talks lied about these issues and we had a pretty robust discussion about this transition period about the benefits covered and then egg is just a zoom out a little bed. I think one thing that is striking to me about this plan rolling out is how aggressively technocrats continue to go at the health
issue that now either in the Senate for a while, there has been as Sanders Bell that if you are you, a democratic, senator you're, getting some pressure to sign on two of your President Plant Canada, especially now you essentially have that equivalent in the house, and you have more chance for things to happen in the house with democratic control. One of the things Gibe hall did pretty early on in this session is secured a commitment from speaker policy to have hearings on Medicare for all, which I think will be some time in the fall or so, but don't you might know a little bit better, so they really want to be talking about this to be debating this. They seem to be bringing a little more of their caucus on board. I thought I was pretty. What about that? I'm Joe Kennedy from Massachusetts, who was the one member of the progressive cock as would not backed Medicare for all. He came on board with this bill with the addition of the long term care. So it is something Democrats really want to talk about, but I think they are going to have to get a bit more realistic about the structure of their plan if they really wanted to
dig into the details of what is actually going to work yeah, I mean it seems like Democrats of Numb if they have back down at all from the idea of kind of setting this north star goal, which of liquor basically healthcare system, covers everybody with no out of pocket cause. I did think it was interesting like this was a pretty good. Attic rewrite of the bill and the fact that they were still able they got a hundred and six co sponsors for which is basically half a little less than half of the New House democratic Cock, Then they got some. They got even got members from some of the some newly enact elected members from competitive house districts like Guy Katy Porter in Orange County Katy Hill, so out in California. I wish I was surprised to see Jared Golden who a new representative from main signed onto the bill and so think there was sort of ay a question of how much this up there with all the big names
they're, like a yo, see Russia to leave were on their as well. But I thought I thought it was notable that they manage to get some of the new members from competitive districts on board as well and so yeah. I think that is a signal of how the Democrats have have decided that this is yet a place where they want to go all in and there. Finally, like I thought, the addition of long term care provision was the most notable thing about this plant. You kill you, you ve done some reporting this basic. Do what have you learned about? I was added what it covers like. What's the story, Let me underline the vocs voice here. What is long, the long term there is like I mean, that's your nursing homes. That's you know, people who get have home health aids, basic care for the elderly and disabled people who need just like help with their day to day activities because of certain impairments that they have. That is what falls under long term services and support. This is something that was a move right, I mean, I think, driven by TED Canada. To ride, to include a long term care element in a bar
care, but it was too expensive and when I saw it was too was included, and then these are. They included this programme, where you could buy long term care insurance at an affordable price. MA am, and then they also included this like little line. That said, if the actuaries at age just determine that this is not feasible, you can kill the programme and it turns out. You know the only people who, by long term care insurance, are the people who really have an acute need for long term care so the programme was quickly determined to be unsustainable under the Obama administration, not the Trump administration, former eight or just secretary cuffing Tiberius, killed off that long term care part of Obama CARE, and I think it was again instructive tale of how so they want to do a cheaper version of long term care where they just that. If you want to buy insurance for it, you can, unfortunately, because it is just like a classic insurance market. It doesn't really work as a benefit where you d
to opt in or not. It was like, having Obama care about the individual mandate. Only the people who needed the benefits that that was the last Democrats attempted long term care, and it just did not go well and it was Big carve out of the old versions of Medicare. For all I thing, because this is such a vulnerable population and, if, like the goal of this entire project, is providing health care to the especially to the people who need it most. I always thought that leaving out long from care was yet a really big gap in what the Medicare for all promoted said they wanted to achieve, and what their plan will actually do. And so now they ve been incorporated that into the giant Paul plan. They did say why I asked them about this on the press call last week and they did say that they don't know how much it's going to cost yet, and I think that was the reason I know from talking Sanders the staff that that was the reason it was left out before us, just too expensive. Why little? One thing I think it's important point out is that when things are always the prizes me about american health care is that long term care actually isn't covered by Medicare, currently a bizarre systematic. We often think of
really having Medicare the elderly are nursing for homes. They probably get medical coverage there, it's actually Medicaid that does most to the long term care coverage, but it leads to a kind of bizarre situation where, in order to qualify for long term care, you often have to spend down all of your assets, so you you know or selling off your house, you like putting things in other people's names. It becomes a very challenging situation for people who need a long term care resource, so this isn't even Part of Medicare right Now- and I think I love that- has to do with the costs being quite quite expensive and getting more expensive, as we have an aging population right now. This lives in Medicaid, with some kind of stringent rules around who'd It doesn't have access to it, but I should think there's a visit political question he right, which is that for a long time there was not a sharp age gradient in american politics,
defending Social Security Medicare was a critical part of Democrats pitch to senior citizens swayed and in starting in the MID Bush years, when Bush kindness stole the Medicare prescription, drugs issue from Democrats and put that into place, and then up a certain style, cultural or politics, and, following through very much into the Trump years right, voting behaviour has become starkly divided along age lie, swayed and a big pitch that Republicans now make against Medicare. For all type plants, but also against the affordable care act. Is that Democrats are three meaning senior citizens privileged access to publicly provided healthcare by offering publicly provided healthcare to other
people who write and there's a two ways that I think you can conceptualize the healthcare fight playing out along those lines. One which I think is the Sanders vision is like got a beat. These people write like Bernice Constituency, is very, very young, and this is in some sense, like a question of fairness and equity. Like now, we are going to have Medicare for all. We are not going to let you say, like I've got mine view is that the position of the United States on Healthcare words Gyre Paul vision is like goes the other.
Way, is like we are going to include a gigantic benefit for the elderly at near elderly in this programme right and if you think that would work right, if you think that that will make fifty something people be like. Oh yeah, there's something valuable in this for me to them like that makes a lot of sense, but if you think it just like further adds to the already vast, nebulous fiscal cost of this single, elderly people hate. Then it's like what like what what have you accomplish? Yeah, I don't know I'm curious cause like I do think. A lot of people have a very direct experience with this print part, two serious point, because so many people are getting older and it's not just them. It's not The elderly are the ones who are figuring out like how to divest their finances so that they can qualify for Medicaid, like their kids, who are now like forty and fifty year. Olds are also like having to our very are, have have had to go through this experience with them and are therefore very cognizant. I think
the shortcomings of the current system. I don't know how that that political question plays out, but it did seem me that, like the only way to really accomplished the goals Medicare for, I think, were to incorporate long term care into, unlike the Gyre Paul folk said that they have an estimate. I think that there are like five hundred thousand people right now, who are we awaiting less to get onto Medicaid said that their long term care work would be covered and where that is like a baseline of of the potential constituency, fray yeah, I'm part of their little is a benefit for the elderly. By also think that I have seen especially the easy repeal fight, a more act, in NAM influential lobbying effort from the disability community, particularly around medicate, repeal in twenty seventeen there's a group I covered a decent amount called the little lobbyists that worked with a lot of young children who rely on long term care. So kid to need around
clock aid who needed aid to go them to school. I thought those communities who had been doing work before this. No doubt they became very activated around the Obama CARE, repeal push and were a constant presence upon Capitol Hill, and I think that what's going on here too, I mean aid agree. Part of this is about swaying another constituency, but is also a health justice thing. A grocer dealing with people who have disabilities, who need some kind of support who are not elderly but just to do their job or to go to school, biased This becomes this becomes a really tricky area. That, usually you know the kids I covering all these benefits recovered through Medicaid Lotta lot of them spent a lot of time on waiting lists to get those benefits, which is obviously a huge drag on their parents, productivity on the entire family so think. That's like a health justice element of at that's going on as well
When you look at the tie up all bell, when I look at a giant Marbella just feels like fuck it. Let's do everything like letter of cover every single benefit. Let's get there as quick as possible. Be too. I was pretty interesting. This idea to transition in two years, which just seemed my view, pretty unrealistic of a vision and representative gibe halls view she felt like it was necessary because once you kind of announced and insurance market is going to be closing, you know either though jacket prices the leave like be, it would be very tumultuous to have a long transition. I am less optimistic that you can move that quickly to that sort of system is given what I've seen from the government, but it really seems like a vision of like let's start negotiating it like the optimal sis
and negotiate down like I even heard from anyone being like. Oh, you forgot to cover that thing with the evolving like it's all. There is a little bit like asking you know if Superman's could beat up the whole right like that. You know, for various reasons, there has been a stylistic shift in how thought leading Democrats think about policy proposals away from trying to craft ideas that are in the neighbourhood of something that, if they think they get a beneficial election result, and convince a couple people like could be enacted or pitching ideas that they believe could be the basis of a bipartisan compromise to kind of do in like acting more like those of us in the hot takes game right and so then, like once you get into that space. It's again like like give what? Why have a four year implementation schedule like why not to lag? Why carve out long term care?
but but everything I because, because you just talking about, I mean it, it tells you something that almost half of the House Democratic Caucus asylum. As, but it also tells you something that, like nowhere near half the- U S house members have signed onto this, and while Democrats could game how seeds those would be like even redder how seats
the ones that they already have, and so whatever it is, that Jean Paul is doing here. It's like not it's, not the road to eighteen votes, right, she's like laying out her view right of how things should be, and I think the thing we don't know is like what the actual like single pair constituency is inside the Democratic Party, especially thinking about like the voters as opposed to lake. I think democratic voters embraced the ideas of of universal health care and expanding health coverage to more people, but I dont get the sense that there is necessarily a huge coalition that is Hell bent on apps NEO on a single pair system in giving too it immediately and so yeah. My question is sort of like especially looking at looking at it through the
democratic primary lens, like how many people are, is committed to this as Bernie Sanders and privilege. I apologize. I guess. Oh, my question is this: how do you pay for it and MILAN here twice a year I mean, let's, let's, let's, let's take a break in answer to dive into that, because this is like, if you look at where single pair advocates where three months ago, it seemed like the hard question was the like work on financing and viable chose to work on a different question which is like: how do you make that hard question even harder. If you like, basically anyone listening to this right now, I'm willing to bet that you are you're dealing with stress, maybe there's it of it like an overwhelming amount, or maybe it's more like a low but steady drumbeat background stress. Remember how you are experiencing stress. It's likely fucking. moods your energy in so many other areas of your life, you feel, like stress, is starting to take over stranger relationships and shorten your temper partly tend to unload and better health,
is perfect for that better help is customized online therapy that offers videophone and even live chat sessions which therapists, she wrote to see anyone on camera. If you don't want you it's much more affordable than in person therapy and you could start communicating with a therapist none. Forty hours on the distress using its unbiased feedback. You be pretty surprise when you can gain for it see if it's for you, the weeds, sponsored by better help and listeners get ten percent off the first month, better help dot com such weeds, that's, b, e t, T, R, HD, L, a p d come slash weeds. This episode is brought to you by Fender Foot ball is back, and the best bet you can make is downloading the fan Dual Sports Bookshop. It doesn't matter if you new to gambling or an old pro fan. Dual has something for everyone and as an official sports betting partner of the NFL. You know, you're, better, safe, there's, also never been a better time to use fan do because, right now,
you'll get up to one thousand dollars back. If your first bet doesn't win, you can even too the small wager into a big payday with the same game, parlay that just sign up with the problem mode Spotify place. Your first bet risk free on fan. Dual sports book download fan dual today. twenty one plus and present in Pennsylvania, first online, real money, wager only refund. Who does not withdrawal side, credit that expires in fourteen days. Restrictions apply, see terms at sports booked out, fan, dual dotcom gambling problem call one eight hundred gambler yet said: no, one thing I would say is missing from the giant all bell and didn't, I think, should probably quibble with may use the word missing, but as a financing plan and when I was I do, and I were on this press call with their office. This is one of the first questions she got from. Importers was. How do you pay for it and she responded by saying you know: most legislation comes out without a pay, for we figured out the future. You know
kind of a bit of a non sequitur of saying, while republicans don't get asked how they're going to pay for their tax cuts, which was in or not really relevant to the conversation that we were having then, early unsatisfying. It was a very answer. We are both on this cause, a very unsatisfying answer that was like half we'll. Do it later, half that's, not an important question. When I think like we and am gesturing Dylan here, the punt guess studio, we would think it's like one of the most port on questions. You know one of the people who really influenced my views on this there's a guy at Harvard Nimble, Ciao, who am apparently is like the guy, the the economist. You call of your country trying to build a single payers SAM. He worked on Taiwan's system which launched a few decades ago. He worked with Vermont when they are trying to do so. Where and when I interviewed him a few years, he told me you know about half of countries that trying to single pair that he's worked with fail on the place. They always fail is at the financing, and so I really see this is a very crucial
step in developing legislation and one that Democrats are just not super enthusiastic about engaging in a way that is pretty frustrating to me. You too, I don't think it's unfair to ask him how you gonna pay for because it is a massive part of figuring out media, whether this is going to be to abolish or not, and you would have that was a law- and I think that most before I turn to that, I think would most maddening about. It is the token things that they will throw out like taxing the wealthier repealing the republican tax bill like don't. generate nearly enough money to pay for us. Like that, Caesar what I was going to say that, like I don't think it is that important to know
that there is a certain style of politics? We are like finding the offsets exactly like aid, a b to be this pays for that and like this, on how the government works and in some respects, as like, not that important to work out in detail. But when I see all the time is progressive, who are miss stating by several orders of magnitude like what is this gale of money that would be involved so, like I saw There- was a Bernie Sanders tweet. I think it was treating a line from his speech and he was like we're. Gonna spend money on investing in health care and education. Not, endless war and like I agree that health care and education are more important things to spend than endless waters, but the high end estimate that I've sea and of the wars in Iraq and Afghanistan, which taken a long time been very expensive, is six trail,
the cost of Medicare for all over that same time, period is over six times and then I see you buggy micro versions of that right, like people looking at the two them bloated costs of a single aircraft carrier or selling I got but like what they are talking about. Doing is much more expensive than that. It is much more expensive than the Trump tax cut. Its is much more expensive than the entire american military budget and its it's true that, like the funds exist, largely because we ve already spending on it, but like you, actually need to devise a strategy to like cat a large share of the private sector, healthcare spending, unlike redirect it into the public sector, and how you actually do that like makes a big if it makes a really big deal.
Friends to the question, which is important alike, are you depending on who you are going to be better off under this scheme? Are you not going to be because, like the the promise is that by giving you this much more generous package of healthcare benefits like you will be better off than you are with your current uncertain, stingier benefits, and that might be true. But look it up. Might not be true depending on Halloran income level. Words is not be sure right, like bill Gates is going to pay more. like. I think it is a sound like a really interesting point that the review in and met brunette talk about. Your interview is actually the poor bright yeah. So I talked yesterday Last week, I should say the interview went up yesterday with Matt Brunette, who runs a lefty, think tank called the people's policy project in one of the questions that I put to him because he thought about it is how do you pay for a Medicare for all system? And, yes, he said his primary preoccupation was. How do you make sure that,
People who are poor people, especially where on Medicaid right now and therefore don't have to pay any money for their health insurance, don't end up paying more under a medicare for also and so his idea, man, I'm curious what you think of us, because I just don't have the I just don't have the wherewithal to know what to make of it. His idea was basically to take the payroll taxes that everybody pays right now and so those are unemployment benefits, Social Security and Medicare, which are actually. I currently have a regressive structure where, for the first seven thousand dollars of earnings, your employer pays unemployment, ensure taxes for the first hundred and twenty five thousand dollars every you pay for social security and then Medicare is actually spent up spread out over all of your earnings, and his idea would be to like take unemployment, take social security, and rather than have them apply to this initial. A band of earth
thank you to ply them across all earnings and that would allow you to flattened the tax rate and bring it down, because you be taxing more earnings and it would be less regressive. It would just be a flat system and his idea is that, by doing that, you would suddenly have a gap where you could increase taxes for Medicare to pay for this Medicare for all system that would basically be equivalent to what employers and employees or plant are paying and private health insurance premiums right now, like that's the just. Yes, I think that that works. If you ignore the fact that these Medicare for all plans envision a large increase in spending on the elderly and to some extent, an increase in spending the the
magnitude of the increase in spending on the non working is smaller because there are as many of those people. But if you pay for this whole thing through apparel tax, went like a fairly large share of the adult population is not currently employed right. There's some because they're all unemployed read some of them are students. Some of them are our elderly and retired. Some of them are homemakers right, but they're not work right. So if we provide a universal benefit with payroll tax as your backbone, if you could go back in time and like not have the aid, Social Security or Medicare thou. I think works fairly. Well, you know, eat creates a question on the margin with the unemployed ride, but your basically like putting a huge tax increase on working people to pay extra benefits to non working people in a way that I think Matt will probably not find him
general, but in a way that, like how the c b o is gonna tell you, that's gonna cause people to retire earlier at the margin or drop out of the labour force. At the margin, I think would give some pause to progresses about it. I it's gonna register. I e there was a related debate with affordable care ACT, where they were saying that giving people more generous health insurance would cause a fairly modest number of people to accelerate retirement, and it became a big republican talking point about killing You don't make a much larger and scale tab shift. Here I mean I don't know exactly how they would model it, but my guess is that that would be a concern there right like they were a vice that since it in really see it happening as much some curious, I mean I'm actually areas about giving us a theory. We hardly fordable care act that, like when you until other insurance and work in Medicare for all, would go even further
because, right now you generally you could get Obamacare insurance, but usually the insurance you get at work is better, so they're still an incentive if you'd see that until the ring or or if you know, there's something else about. Work away to fill your day a way to make an income racked with a keep people. At what I'm saying you were envisioning now a big tax increase for working weight. So it's like if you go The exact same healthcare benefits whether you were working or not, but in effect you had to pay for those benefits only if you are working because you pay very rural tax right. But if you If you drop bow right, not to say that, like I would drop out, but a person whose sixty three my drop out rate, then you get to keep the same healthcare benefits, but now you get them for free right. In fact, and yet I had all peril deck structure, so I
I think that's a little bit daisy right, like there's a reason why european welfare states usually rely have a heavy value added tax element to it. Which is just to make sure that you are taxing everybody, you don't something there all that I think that sometimes gets like exaggerated, but there you wonder what the opposite political problem, which is that you're raising taxes on elderly retirees to provide a benefit that, even though their there like is a big benefit to retirees. Because the benefits packages actually much more generous. I'm not sure that we see evidence that elderly people are clamour. for this, you have like Mary, here, STAR yeah for all right, which is why I mean this is we'll get me thrown out of the progressive caucus but, like I think, ultimately, Democrats are gonna want to try to enact something that is much more similar to medic thy, that you mean, like aim a less,
robust benefit, Backards yeah guy, just ledges more similar to like other countries too, I would say let us I mean there is a reason why I mean again when you, when you listen to not what is in the plans but to what the proponents of these plants say What they say is that every other country has done this, and I think that you envision a feasible skim, it will look more like what the other countries have in fact done unless, like this thing, they're saying prepared I guess I mean I spent some time reporting on this, and I don't think I ever actually exists is a question that came up on the weeds and unnecessary short story on that, and I did what do the things notable about other countries? Healthcare systems ones? Are we consider universal all of them that I could
and they have some role for private health insurance, because you are either we take months in the weeds me weeks ago. There is always some kind of gap in the government coverage that gap might be Co. Payments are deductible cost sharing. When you are that doctor, the gap may be certain benefits in Canada, for example, the public plan doesn't cover prescription drugs, so two thirds Canadians by private plan to cover prescription drugs, dental vision in either the gap might be the ability to see a doctor quickly. I think actually, the australian healthcare system is super interesting in that they actually really encourage people to buy private plans that compete with the public plans as increasing the public plan as the base, and then forty seven percent of Australians are buying a private plan that can get them into sort. Hospitals that can get them seem quicker for elective surgeries that can get them private rooms. At the
but all I am- and I think there are two things that are important about that about those gaps and like the private insurance that comes in two to fill. Those one is easily lobbyists that how health insurance plan costs last when its covering future fewer things. When you ask people to pay for them, the second, is that it also has a downward pressure on how much healthcare people use where we, if not ever. We know this from a classic healthy parents experiment the Rand experiments that when there is some kind of cost sharing for health care, when you have to pay a little and even if it's a little bit, it causes you to pause, and thank you know, do I want to go to the doktor and in some cases you'll say. Yes, I feel sick. I will pay my ten will. However, money dollar copious goes to the doktor. In some cases you say: oh wait. A few days like sepia goes away that can be good for unnecessary care, it can be worrisome and bad for necessary care. You known, I spoke with joy, of how about this her view.
As no one should ever pause and think before going to the doktor like that, we even pausing in thinking too long. Most people who have constructed International healthcare systems disagree with that philosophy. Aims to Sanders shares that philosophy to Sanders very philosophically, like does not want anyone to pay anything, whether it's me or bill gates. Sir, you know somebody is unemployed when they go to the doktor, but most european countries have really come to the opposite conclusion, and I think that is something the important we say everyone else's done. This nobody has the health care system, like the ones that Jaya Pollen Sanders are proposing. Right now, and also in I mean in canada- you nobody pause, is to get primary care because their concerned about the Copa but so instead they have more administrative rationing of access to the procedures, and this is because, like eight
in some ways, the like getting into the pay for stuff like the accounting exercise could be misleading. It's like there's a finite quantity of medical professionals, and like in America, we ration with a really heavy tilt to your income right and likes. If your prosperous, like you, can get like anyting on demand anytime and if you're poor like world of trouble right and then you can have on the other side like the UK. Where is a pure administrative rationing system and your access to care is determined by nice and you know like a bureaucratic rationalists system. Canada is a little bit different from that more flexibility, but still fundamentally determined by the global budgets and that the administrator in nordic systems usually make health care cheap, but not free to try
to ensure that there's like some space till I go, get in to see the doctor by paying your twenty dollars, and this don't magic whereby you can just like eliminate the quantitative limits on the existence of healthcare facilities, and you can do things to blog. You could build more hospitals if not Zat impossible yeah, but is also not lag. Having as it just happened, my doctors onto materialise out of the ether it takes many years to train all that was thought the most interesting point the map made in our interview. That the thing he worried most about was the capacity of the health care system to be able to provide health care for everybody for providing health insurance everybody and he acknowledged that the plans that we have right now. bill up the sanders. Build dont, really do a lot to address the supply issue like he floated out there. We could make it easier for people to become.
Actors are, we can make it easier from doctors from abroad to come to the United States, but I think he was very self aware that this is a part of the plan that Medicare for all supporters haven't really necessarily thought through. Yet the other pieces I guess I'm curious about is on this issue of lake price sensitivity and and whether we want to we do want to have some costs to the consumer as a way of kind of modulating. Their utilization of healthcare is like. I guess I asked me: about this in his he cut dismissed the budgetary side of this, which I thought ass interesting. But he did talk a little bit about some of the behavior. All research that we ve seen, and I guess I wonder, I'm curious what you guys think, because you have a little longer history than this like. I do think there is a lie of evidence at this point that people are not really reasonable. Consumers of healthcare
They don't exercise like reasonable discretion about what kind of health care that they get. There was a really good study, Madame forgetting the source of his you're gonna, have to forgive me that suggested the like women who have breast cancer delayed, getting treatment because as alarming in part because of the outer pocket obligations that they had under their healthcare system? With this new reports and health affairs, the basically showed nobody, like nobody, talks to their doktor about like trying to find the cheapest healthcare options, They don't like shop or our entire define their factors may take this healthcare proceeded. You are the exception, maybe even room and ancillary so around like so I guess I wonder lake in terms of like you know what an eventual plan like mine look like like is the idea that we just need to bring the costs down, because then you have to tax people lesson and like that makes it a little
easier to finance idea, they act. We we do want people to be a little bit sensitive to the costs, because that helps regulate some of these utilization issues. So I think we Debbie. We definitely need to bring the prices down at some level right like I don't. I don't think we can get to Canada level prices without causing like a massive disruptions and like hospital. closures, but you know we're in a situation where you know I've written about, like twenty five thousand dollar am arise and like six hundred IBM Aids and like you need some kind of price regulation to make any of this workable at some level. But I think this idea, the idea of car sharing and, like a house changes your behaviour in health care, that's a really tricky wine. Creating everything. I've seen from the healthcare research suggests that people do respond to price signals that you people go to the doktor last. There is a co pay, but the thing we're really bad at is like determining in determining when to cut out
care, that we are very bad at patients at figuring out. This is unnecessary visit where I should pay my co pay, and this is an unnecessary visit where I shut ends, and so I think there are like all these statistics about how much of american medicine is spent on like wasteful care and if we could just cut out the wasteful care, the Herbert is determining what is wasteful and what is it like? A really barbaric version of this that I have written about it the health insurance plan in them was creating a new policy where emergency room warrants visits warrant cover it. If it turns out, they were not an emergency, but like the point of going to the emergency room is like find out The thing is an emergency, and I think that is one of the trade offs you make in building a healthcare system. I give you are going to create some level of cash hearing. You have to be ok with both unnecessary and unnecessary care. You know both getting caught a little bed. I think actually there some, like health tech things that
this a little better like I'm pretty bullish on telemedicine, unlike nursing, hotlines is like low cost ways to help patients navigate like that necessary verses, unnecessary divide, but it's tough area that has that has trade offs and you the way I don't think there anyway around like to do it perfectly clear. Yes, I I look at this is, like the other, like ended the telescope ray we're. Just like you see, what's what's the problem with Healthcare in America, rain and selling. One problem right now is very inequitable. Another problem is, there is very costly. Rather, the aggregate spending is very high
and then the treatments are distributed very unequally. So to me, any steps you can take to equal eyes are good and any steps you can take to press our good and on paper that these Medicare, for all plans aimed to write like they claim. They're gonna cut national health expenditures by tackling the price issue, and they are also going to equal eyes by treating people equal, which I think is great. Then they also tend to claim that what they're going to do is eliminate all of hassle from the system, and that, I think, is a little bit unreal list. If you, I too compressed national health expenditures. Add equalize acts
You are not going to be able to increase the aggregate amount of access that people have as whole right. You can increase the amount of access that the poor and the chronically ill because they are the ones who are like really screwed by the current american system, but you probably gonna end up making hard forsake me ride, like I'm in good health and reasonably affluent, and have like a good job and, like I pay extra to one medical and to its. I really really easy for me to go see doktor on the rare occasions that I want to its really challenging to make a system that, like will solve the two big problems, while also holding me, unless you ve been making it easier by sort of eliminating like Michael payments. So then-
the question of how do you want to rush access right like gonna, get because people sometimes mishear me right but like assuming we address chronic illness spread so, like your insulin, is gonna, be free, if your diabetic, by because there's no reason to try to dissuade diabetics from taking insolent- and you have you set me free report right because again, if you didn't really don't have money like the government has to fill in red. But there's someone, ok, you're, like a middle class person with no chronic element, but you decide for some reason. You need to see the doctor. It's got to either be that we are drastically increasing national health expenditure, surrender just like doctors from everyone, or else did it's hard for me to get in to see the doctor, because the slots are taken by people with serious medical conditions, and my nonsense, like has to wait for a week or it has to be that, like there is a co pay for
middle class people of random non chronic stuff, to make sure that, like their free appointments, right is like the worst private insurance plan that you then or a private ass. It goes like if the restaurant was free, like they'll, be great nobody, we need to start, but also you can get a table rate Susan have to do some day. Worse, you what you are proposing, as it is a huge increase in the amount of healthcare spending which I dont think is. Maritime like when I look at studies of. Why is U S? Life expectancy lower than Canada's I have not seen any by credibly claim that treatment of diagnosed illness in the United States is like inadequate in the aggregate and contributing to port how
right. So it's like a because it gives confusing, because, like America has a very serious like public health problem. Well, there's a lot of these other countries, and also our health care system is scary, but they seem to be like largely separate issue yeah right I mean most that, like the other opium crisis, arising suicide rates, like that's the stuff, that's to blame, you I'm in Rio, we we have more murderers. Higher obesity rates. Are, I think, but it's not. The people aren't getting healthcare rates. It was like. I would want to put money into like like extra money, as opposed to just like we working hours ending, I would one I put into like. Are the critical social problems in United States like just poverty, as opposed to like cancer treatments for the poor have enriched this? Obviously, both important right, but it's like is like that living conditions in poverty, a very bad in a very bad health impacts like before you develop chronic illnesses and that we need to support
people like throughout their wives. She talk about some some nordic countries now earlier I got some problems, not in health care. This episode, brought to you by own up every bank says they ve got great mortgage rates, so Why are people paying billions of dollars and extra interest every year, because it's too hard to know what a great deal looks like for? You are unique scenario owner makes it easy to get the personalized data to help you make a smarter home financing decision, learn when a great looks like for your mortgage, so you never over pay bills. Your profile today at owner dotcom, equal housing, opportunity, M L S idea number one. Four five await o five people Often ask me of prosecuting the mob is like the movies. Well, There is violence, he cracks disguise over their head and pop. Just like a melon. There are heads, so wasn't just permission to take a map of permission to take out his own
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and in the nordic countries they make this information available to people in some different kinds of ways, and Norway had an experiment early in the twenty first century. We they made access to this information, really easy. It wasn't like you had to go to To a records hall and like fish out some piece of paper, you can just go on the internet and look up any bodies, tax information. Basically- and I don't know if this is fascinating. People like to talk about it. It always seems like a good idea to me. Either was eventually political backlash: Norway to this in twenty thirteen and they they sort of restricted access. But this paper from Africa parents Cerulia in slicking at what what happened as a result of this to people's sense of well being and he sort of
shows a pretty convincingly that it made people a lot less a lot less happy because their misperceptions about how well they were doing in the norwegian income hierarchy were debunked minute in Atlanta, making the mad or sad and made the lower income people Less happy right were over the rich people. I thought the richer people were happy at the rear happier, the lower income- basically, it seem like people were perceiving themselves as more. equal than anyone in the world. Then you know, people who are low income realized there alone common like tat about that people who are higher income realized their higher income got a bit of a boost around that ceiling. Everyone like polarized little, that's so so she seems to see this as a critique of the programme and it
reminds me of like philosophy, class thought, experiments or like brave new world right that, like what was happening here, is that new regions discovered that they were living in a less gal tearing society. Then they thought that they were, and this had psychological impacts and an interesting question is, if they had stuck with it like would it have had political impacts, but instead Norway opted to like put people. Back into the experience box where they could Rebecca per day, they were better off. This like the ignorance is Bless is like. I guess one view of it and the like
the we know that income in the United States and wealth and meticulous are distributed less equally than people think. So, if we had this kind of tax transparency that they had in Norway, it would presumably negatively impact people's well being yeah by telling them the truth. I am very uncomfortable with the idea that public policy that reveals true information to people is bad because it reveals the true information to people write about the I mean I understand like a standard critical of this, as I primacy right, but like his critique, is actually not about privacy. Providing people with accurate information about where they stand in the relative hierarchy is bad because
it reduces the welfare of the poor, and I agree I mean we should care of him fact of policy on the poor, but like to say we should lie to them and tell them that their that the rest of the country is poorer than it really is, so that they can be confused that that, doesn't I don't buy it such an interest at its contradiction exactly, but I was just struck in the room in the paper like as it is setting up its findings like how popular this was like the fact that on the beach, this day of the year it got more. This website got more hits than you too bad, like it became a whole phenomenon that they called tax born. I just I was using and like they too, he talks all of it about how people it seemed like people spent the most time like looking at like what their friends in the families incomes were like. You could see how it could very quickly become a sort of toxic experiment, the if your constantly like holding yourself up against. Like her. You know your best friend from ice
wars like imagine what highschool reunions would be like if you are able to look after their aim of all the people that you used to go to school at so anyway, I just feel like I could anywhere like. I guess, I'm. What I'm saying is. I'm not surprised like about the fact that ended up having on people it's embarrassing to see the outcome because another get another world you could see this nordic society is people get angry about the lack of quality inn. The make more policies are made to train like close that gap in some way like that is the other, and instead of the policy outcome of just taking this information, down, I guess I'm a little. I M a little less both by living in, like my experience bags, without knowing this information like it is really hard to be poor, and it is hard to like to like layer this on top of like something else, you have to feel shitty about like, feels bad. Another give there's another desire to like fix the problem,
We know that it is hard for me, like I am generally for information transparency, as in a lot of time like trying to make health care data public, but it's it's hard for me to get behind like making data public that, like generally just like, is almost like regressive and the way it's making data public like it's, making things worse and harder for low income. People like that, I don't know. I feel I feel bad about that. Well, but I mean So this comes up all the time. I you here in the: U S, conduct people usually don't talk about what we should have a national or database of this, but they say that lag here I hear feminist say all the time that, like in our peoples, who talk more about what their pain so that we can understand, you know gender pay gaps and, and things like that, the people can can know what they're worth and you know, I think, there's there is always a question about what would that kind of transparency, but what would the short term impact of it be right? It's like if you just heard.
Like, you are getting paid way less than a man who you feel is doing equivalent work to you, like, I don't I feel I think that would probably make you feel bad. You through the angry and you'll, be upset if we did a measure of your subjective. Well being so, I guess you could say the real feminist position, as we should hide from women the extent. Discrimination, because the impact of transparency is particularly deleterious to women, but I dont that's. What any that cause? That's that's crazy. What is the upshot of like, in the case of a word to talking about the other, not resign fuck it? This is bad. The goods is hide everything again and like if the transparency is in services like getting to a better place I guess I don't understand what was the motivation of like these nordic lawmakers in the first place? Was it just like, like let's liberalism, data or is it because it when you look at the wage gap? Example the ideas like, let's liberalized data, to achieve a certain
policy goal? But I'm really understand that what they were trying to do with their national tax database in this case was so I mean one thing that I could imagine in the: U S coming from this right now. Obviously, lots of people are just gonna look up, but like their friends and family or doing out of sort of tax point like ass it right, but another thing you silly, you wouldn't have these like questions outstanding about Donald Trump.
right man, internal sums capacity as president, but don't rubs capacity as a tax pay right that, like tax enforcement, is not perfect and, like Republicans as we discuss previously in the show, have I cut iris enforcement budgets and Bob Bob BAR in a transparent system, a famous which celebrity like would have people would look at their tax returns, rightly not like you and me, but like the legal experts, and they re like whoa, this guy is breaking the law or woe. You won't believe what is legal to do here with your taxes. Write em like that could conceivably be just a deterrent to aggressive tax reduction strategy is right because I anything you do it. Sanchez you'd be running the risk of an
Arrest, audit, at which point you blame you're accountant and get off Scot Free, but like actually, you could be caught right and also we could create political pressure for change, and I think what you see in Norway is that, like information is not like a self actual icing solution, like norwegian politics did not have the collective will to produce a greater level of equality that people seem to desire. But, like I'm just very uncomfortable with the idea, Why? What we need to do is this hide from people the inequities in the system, because if they are exposed, they'll be upset. When you can answer, may the question I was going to us, which is like what is the value of having identifiable data as opposed to deep personalized data, be asked at me now why why why do we want people to be able to look up Donald Trump tax returns, instead of like individual ones,
I wonder about this is like what, if to look up somebody's, actually turn you had to pay five dollars or did they had to know you wanna get there tell, but something where it's like. You didn't go pay man down. I knew that sort of mean words like if you had any kind of good freeze right like the five dollars it would cost you to be able to produce like a huge expos, ay and average person. Sacks return is trivial and the scheme of things like could get your editor to improve the time. It would take you to do that story. You can also get the five bucks ran, but as idle curiosity just like going through all of your co workers would become expensive and you also you would give you think to yourself fight is. Is this while he is so my time are my just make myself upset for no reason. Plus, you would raise the money. I guess I got I come back to. It was like what was the point
this and the point does it seem to be clear in the fact like people got upset and they closed it, and I think I would be into something like this is a public policy if the Go if you like, we will make this data public and then we will try to do acts, verses, Ike, here's some data. I like good luck with it. Sorry, if it makes you upset like we're, not really going to do anything about the thing that is making you upset. That just seems like kind of a situation for everyone, and maybe if you wanna, itemised your tax deductions, you, how do you have to go in the public debate? sorry, vaguely government. I guess you could do it. You can do your taxes on postcard. Keep your private or you could go through the long lines and everyone's gonna. Now we ve got some tax reform. Eighty as it sounds like Paul Ryan cause agenda, weeds phrase. Regrouping you propaganda, allow free time now, that's lots of stuff.
Scots, yes out. So thanks Dylan for joining us here, there's going to be a mother weeds episode released on Friday, Dara and Jane, and I also doing a couple of live shows this weekend in Austin Texas. Recordings of that should be released at later. After that and you can catch me this week- I am guest hosting today explained our daily news podcast. All we accept you haven't listen to that before or if you do this and already he'll hear me there, but am there's jungle, a bonanza of weeds content, delighted a lotta, weeds host, Sol Criss crossing the shows in the country, the spanish universe. Ok, so so thanks have ready. Therefore, listening. Thank you to our producer, Jeffrey Gold, and we ve seen again soon accessible, affordable broadband helps coming
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Transcript generated on 2021-09-11.