« The Weeds

Do we need private insurance?

2019-02-05

Sarah, Ezra, and Matt break down the latest twist in the Medicare-for-all debate — plus rigorous new research on Facebook.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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We got a new new white paper about Facebook, but first we want a better. A media policy debate has finally Gun centre stage in democratic party circles, maybe another slightly confused way, so Sarah
sound like what's what's happening, Hauser we're Talkin Healthcare again, so there has been a time I try to get out of hand. So there has been we ve seen over the past week or so candidates, getting more questions about accepting the real central central question in the single paramedic overall debate, but one that can get a bit confused and its whether or not employers monitored insurance. Well continue, so just a kind of lay the groundwork a little bit about half of Americans. I think the number is like a hundred and fifty six million get their health insurance at work. It is the most common source of health insurance for someone who is not a senior. A lot of this has to do with some tax code provisions that go back to a round world war two
that makes it very advantageous to compensate your employees with health insurance. Some employers are not taxed on those benefits, so centrally your dollars, we're going a lot further than the dollars you spend on actual salary and one of the key debates its playing out in the democratic primary and the Democratic Party is about whether we want this system of employer sponsored insurance to continue, and you know, One side of this I'd say you have senator cinders point people over to the left towards supporting a system. Where there is no more employer, sponsored insurance, that everyone is getting. Some version of government run health care calmly, Harris seated He said in an interview CNN about a week ago. Edam is, she would support eliminating of them and we kind of new, thus because she had endorse the cinders bill, but it was still you pretty notable that she didn't seem to hesitate. You gave this answer very quickly. Where
then you have you any kind of confusing exchange. We can talk about a little bit more with court. Booker asked about. You know whether he'd continue private health care. It wasn't super clear about. You knew was this: insurance was this private hospitals and he gave an answer that is not quite as firm as Harris, but I think this is you know an interesting debate where Democrats, as far as I can tell, are a little bit torrent, I think there's an increasing desire in the party to get rid of employer sponsored insurance. I dont think you actually, to do that to build a universal system, but it seems to be something that there is increasing desire to do. At the same time, there is a lot of trepidation about how you actually get there. You know a hundred fifty six million people have health insurance at work right now. That's a hundred. Fifty six million people who need to be moved something else who might be excited about moving to something else, you might not be the pulling suggests dumb public, less excited, more people who are not excited about it
so it is a key issue that I feel it is dividing the carcass a little about when you look at you know the folks in Congress, when you look at the folks are running for president and its in one place where this is a big decision that if there is going to be a medic overall debate, this is going to be one of the key decisions at legislators are going to have to to make in deciding they laughed so I ve almost want to frame this a little bit of a rare point of framing disagreement with Sarah, and I feel we can agree on everything for us to be episode summoned a relish it here are carried out. I don't really think this about employer. In short, I think it's about private insurance full stop ii of about twenty. I wish million more people who get private insurance on the individual market. Some them a lot most him now through Obamacare, but under the Santos plan, which is, I think, what is framing lawless debate that two and so is by the way the private insurance under Medicare advantage, which is a program inside Medicare. Were you
sign up for private, basically managed care options on their reasons. People do it, but I think the main thing to nose at thirty percent of Medicare, unrolls or action, private Medicare advantage insurance and also Medicare itself, has party, which is the prescription drug benefit which has run privately, and I think the real fight here is one. Do you have private insurance at all, because you could totally imagine a plan that didn't have an employer sponsored insurance market but had been but was based on private insurance? That's how like the widened, Bennett Healthy Americans ACT was proposed to work a couple years ago, but the other thing here, which I think is much more than the kind of like tactical debate in the Democratic party. Even if you think there shouldn't private insurance, even if they could be great, that there was never a profit incentive in health insurance whatsoever. Is it too dangerous? You know so you you, you have this sort of these other plans, like, I think, like that private best version of it as a Medicare for America ACT, which is agenda house.
In Russia, the Loro in the house and his have written in large part by Jacob Hacker, whose very thoughtful health policy want at Yale, and that would be it builds out. This Medicare plan uses Medicare price. And puts you know a bomb care people on it, medicate people onto the uninsured on it and let's individuals and employers by into it, but the idea there is it rather than like forcing people off of stuff. They may currently, like you, let them transition to insurance. It should be cheaper nnn better over time, and the downside of that is it like. Maybe it's harder to get that pricing advantage? Cuz, you have more hospitals or doctors say, I'm just not going to take any of Medicare at all. I'm just stick with the private insurers, although you know, by the same token, if they're going to be that opposed to Medicare or Medicare for all you're going to have other political problems that aren't that are hard to storm out. But I think this is the real thing that they should. You have private insurance at all, and even if you don't
private insurance, or is it really plausible to go to a hundred and eighty million Americans, or even more, if you think, of people like medicated Medicare advantage and say to them? We're gonna take what you have and you have to trust us of what we're gonna put in its place. It will be better. I don't think that this is about any of those things or like any, hang at all like just not nihilist. This is a debate about whether Bernie Sanders should be the twenty twenty Domini. Then I think has virtually no content to it. Like did this Bernie Sanders Bill is like tat. Gonna be law like that, it doesn't matter at all, dislike hair splitting about like what Corey Booker saying nor legs, should we settle. I think there is a debate about like Sanders. Had this bell and then a bunch of evil sign onto them,
cause, I don't want to. I Bernie Sanders. Getters laughed then cause your family. Nation did a Paul and what they found in the pool at the popularity of Medicare for all is very susceptible to framing the facts right, and so they demonstrate this very clearly by showing that like this, and why swings going. Twenty per se in specially unemployed response it? Wouldn't we can make particularly different think saintly. Try so one thing they found the way they tested. The question was How would it change your feeling when you find out that it banned all private health insurance, so that turned out to be one of the most unfavourably my static ages, upwards of numbers, either exactly fifty six percent supported that
generally? And then it follows that thirty seven, when you say that the pirate, and so there is a saying what happened next, was that a journalist saw that this particular framing pulls very poorly and so put that framing to Combat Harris. Who was it a sensible Medicare for all supporter? So then, Harris goes to bite the bullet and say I endorse the bill that I have endorsed. When you give it this negative framing. So then, because that's a negative framing, this was widely perceived as potentially a political problem for Harris, and so then the decision was made. Ok, we're gonna, put every put the screws to everybody with his negative framing and Corey Booker. It seems like didn't wanna bite the bullet on the negative, meaning and started go and ah ha ha. I want to say is weakening twice at his answers unclear in it. Wasn't that heavy he said, look a lot, a european.
Systems. You have public health care, you still private insurance. So no like it. It was not. I in my view, like an unclear answer. He just said no, but he's also cosponsor. This bell rang Then you get floating levels of unclear. Eighty right, which is, is it true really that Bernice Bill bans private and parents, unlike no it- doesn't ban private insurance. That is a possible way to frame it. What would it As easy, it says the exact way: the Canadian system- that's right, like there's a government insurance plan that everybody is in then there is no ability to opt out of the government insurance plan and private companies cannot offer duplicative coverage right. So it also is the case that Bernice Vision in the bill is extraordinarily expansive. So it's very hard to see what need would be left for programmes are in Canada, they don't cover dental prescription, drugs or vision and wherethrough usually get your private, hasn't it, and yet cinders care,
Primarily here right I mean then between the current progress it, if you think about it, if you want to understand the world like how does the world work? The fact is that, like there is no provision of that law that says, private health insurance is now illegal union. Now Republicans will say that it does right bit like this is just a politics thing that has come up bright and one thing that is revealed that is very important a number of ambitious democratic party politicians assigned. Two Bernie Sanders as Healthcare Bell, because they decided fuck this we're not letting Bernie get to our left on health care anymore, without having really fully familiarize themselves with all of its details. Right, like there are lots of ways you could have punched back on that negative, framing question that, like I think he should have done
been like this bill doesn't ban private insurance, and then we could, all you know, go through the fact. Checking lawyers and Glenn Kessler could rule how many Pinocchio did she get but like Ernie, who, I am sure you know, has thought a lot about Bernie smell. Like he's gonna answer this question by counter punching he's gonna say he doesn't think people love Signa, unlike its true signal, has a very low rating and he's going to say this is the richest country and we should guarantee insurance for everybody as a matter of right and when people like really try to nail him down like he does want, let himself get nail down and it showed, I think, like a certain level of unpreparedness and amateurishness on the part of palaces campaign there, but at the same time like nobody's gonna, pass this law so like who can where's right like if your number one concern in life is, will pray.
Health insurance be banned in twenty twenty one by the new democratic president. Ideas there's no like that is not going to happen if you're fanatically committed to it. Can the president who will ban it like you're out of luck, if you're really worried that the president is gonna bandit, like I got great news for a catholic None of that is going to happen so like who cares aside, I mean I, I do not take quite a nail super, to this debate. I think it is shaping where I think it is notable that Democrats, even after the affordable care activate, have decided like this is the thing they want to invest a lot of policy energy and in one of the things I ve talked about the show before is that privatisation matters a lot of what you are seeing re now, I think, is
prioritization of healthcare and like a one thing, that's been really notable to me over the past two years has been that's real proliferation of plans and Congress from liberal think, tanks like CAP and Urban Institute Dylan Scott night at this big peace at the beginning of the year. Looking at these eight different plans to get to that expand public coverage in some way, I think there is a really important debate that is being fought out in this primary right now being fought out in Congress about like what this vision looks like what happened in twenty twenty one like no, probably not what happened and like twenty thirty, I don't know. Maybe, even though this is the discussion
Proceeds he'd have figuring out like which of these eight plans, Dylan I wrote about which is the one that they want you ultimately get by, but this is this is why what is exactly frustrating me about it like? I think the prioritization issue is so important right, and I think that it is like wrong too. I think that what is happening here is a lot of there's a tendency to equate taking the most extreme position on the policy issue, with saying that you want to prioritize
but, like I just know personally reader to access like how much time do you want to spend on health care and twenty twenty one is like one thing, I'm on the: why access and then the x axis is like what do you agree with your vision of healthcare and I'm like often a corner somewhere like a hundred percent on board with birdies plan like that is absolutely how the healthcare systems work. The government should pay for everything like it should be done with taxes. Absolutely I totally Ruth now do I want the next president to make their top priority health Well, I thought no. What please don't write like please like, let's address anything else other than how does your priority like little? I know I'm just so I'm just too I'm just trying to say that. I think that that is, I think, that's a coherent to answer to the question and I think it would be good to see the candidates debate not What is your pie in the sky ultimate vision, but like
Do you want to make a big push for healthcare reform in twenty twenty one or not like a much more telling thing that Harris said in, I think, with separate we would just sign. Was that, like she wanted to make her number one priority, lift act bill that gives you a lot of information about policy making in the Harris Administration right like if you make that your top priority than you're not making a big healthcare push your top priority, which I think is a big deal and is a wise choice, and like she's, really really not gonna ban private health insurance, Wyandotte prioritizing so a couple things here, one did just go to the question of like who cares and should we talk about things that are probably not gonna passing. I had a good time listening to the weeds from Friday, where there
a lot of discussion of HR, one which has automatically a registration and changes to vote, a suppression, efforts into money and politics, everything in eight hour one can be filibustered. Nothing can dependent reconciliation as none of its fundamentally budgetary. So it's like nothing. Pass bright, probably unless we gotta get rid of the filibuster, but this stuff is worth talking about, because maybe it will pass and also its you're you're, beginning to see the dumb efforts to build political strategy beginning to bid see efforts to actually clarify what the agenda even is to first approximation like american politics is built. So nothing happens. But like here we are twice a week bud guessed. The other thing, though, that I do think is important. Is it there are
people in the Democratic Party who prioritized healthcare first in inner there's, a new washing post, ABC News, Paul D, tat it as the plurality of democratic voters. But healthcare is the number one issue and there are different strategies of how to reform the healthcare system that are being laid out here. I do think that's actually important. The Bernie sent a strategy, talked- is people it's basically a maximum of bargaining strategy, the ideas you start with a thing all the way on the left, and then you know, if you have do you're gonna bargain back down to something that that that's more moderate since it, you begin with organ read it we're gonna, abolish private insurance, and then it's like you painfully make the compromise of ok. You can not an austere, Medicare advantage plan or supplementary plan of a different kind, or you say I guess it's gonna, have everything with no co pays in that they give away to the Republican some co pace, and then I think, there's other version, which is that's not
that's not a viable model because it assumes an outcome. It assumes that, like there's going to be an end point to the negotiation that isn't just like the bill dies, but if you don't assume at which I think a lot of people dont in one in american politics should and will then, if you start with a plan, that's gonna begin unpopular like we're gonna, get to any that bargaining are gonna, kill you before it ever happens. So it's like a real lay question like is Bernie Sanders right that running on his highly expansive candidate, like Canada, but more generous style plan is gonna, build out the political. Evolution and give him you know a bigger total and more flexibility and is gonna like mobilise. People who felt disaffected from political system before or brown, I thought, was actually one of the most interesting entrance into all this. I don't think I got as much attention, but in What the other day he said like, unlike all their democrats. I'm not going to talk about Medicare for Onshore Bryce, very liberal. He said like I want to talk about bringing Medicare down to fifty five years old, because weak
actually pass at and, like I don't wanna make promises, I can't I can't fulfil. I want to talk about the things that can actually pass and he's right. He probably can best. I can promise you that their budget reconciliation and you could probably get yet he may be able even get some. You know where they get republican, both actually probably unlikely, but if you could get it for anything good, probably be that until like Brown isn't saying he doesn't support Medicare for all he's just saying he's a different view of of the politics here and though I do think this debate matters. I think, like the book or ideas which it it seems to me, he's going to end up coming out with his own play as priority them. Well, that is gonna. Look more like Medicare for America, where it's more of a transition and like that's the idea like the Sanders idea like go Maxim, molested people, gonna, love it and they're gonna support you and like then you can borrow. Out from it all the way to the brown of like let's go incremental list and use him Medicare branding to do something much more careful non threatening the way the Democratic Party chooses to do. This will be important
on whether it happens, but also in whether or not a democratically elected in twenty twenty, because if they help your plan is popular unpopular like and actually matter in an election year. Absolutely So, like sure Brown I totally great like we should talk about because, like his ideas, bad and realistic so I am legitimately worried that shit brown or somebody else will be elected president and will pursue a like age reduction, Medicare strategy, which I think like the political economy. That I think is cattle. Strong right. That, like one thing that we have seen, is it because elderly people have Medicare they have become like four,
article right wingers on healthcare issues, who seemed really fear that any further expansion of public insurance is going to wreck them and it's gonna come out of their pockets, and this has become a huge problem for Democrats and for the country and, like I think, this brown ideas, like not only feasible but like quite pernicious right whereas like Bernie, is pan as written. I think, is a little Lupi but also like each other. You shouldn't talk about the plan because it's not going to be enacted, but because it's not going to be enacted. There is no particular reason to sit here and, like White knuckle terror about the caprice, the problems inherent in a zero copies for anything system, because as you say as you like, it's a bargain ex strategy, you don't even like- which is fine right but then like so isn't that anything. We should talk with these things
I think we should talk about what is actually different between the different people. Here and what's going on, and in particular this thing around the banning private insurance. Is this like triple back flap of like. Paul revealed a negative framing, so then report you are kind of put in the candidates to the test. People who work fanatical Bernie Sanders supporters. They know right before anything is ever happened all the Bernie, I know that everybody else is going to betray them so they're like hyper a tune for signs that they're going to be betrayed and softness on these questions is evidence of that, and that's like a big dynamic going here at the same time like elect abilities, important, nobody wants to vote for candidates, who's gonna like embrace highly negative, framing and like clobber themselves, with it and there's a difference in bargaining strategies, but there's a really big difference in prioritization which, like I think, is a much more
significant element here that I have not seen in getting the level of explicit kind of debate that it should read like? was a political article where they asked and Democrats like how they feel about filibuster, and it seems, like some Democrats are really quite committed to filibuster right, so I don't think that's a great idea, but it means like we're talking about reconciliation packages realistically, and I guess it would be good to like Squeeze the candidates not so much unlike hostile, framing Family foundation poles, but, unlike what do you think could be achieved with the budgetary conciliation, you can do a lot. You know so what I want to secure this portion of private insurance, I agree. I would Andrei prior Decision debate lake, if Canada have that that's great, but I want to talk a little bit about how we structure healthcare systems. That is what I want to stay in doing coming into this episode of the weeds, and I think one of them
things. That's become a little difficult. To tell this. To be done in this debate is that a universal coverage in a way has gotten acquainted with government sponsored healthcare, and I think that, because our proximity to Canada, because of how similar the Sanders plan looks to a canadian healthcare system that its kind, come ingrained in the conversation that you know over gonna. Do universal coverage of we're gonna get everyone in the health insurance, then we'll do it can does- and you know what have the country or in the case of candidate province, is going to run a health care plan, their own be no private plans that can compete with the healthcare plan and that's the way we are going to get low prices. The government is going to set them, but I think one of the things it gets lost, maybe just because the countries are a little bit further away. As if you look at the european model of health care, then you see something quite different. You see in countries like
but through in Germany that there is actually a lot of private health insurance plans that these are countries that have long have universal health care, but they do so in really really tightly regulated health insurance markets. We still some government rate setting, but you during the government actually running. Of care benefits, it is kind of interesting, a notable to me that you don't did you don't get as much positive, about doing a european style healthcare system in the United States that canada- and I think, because of the role the cinders plan- plays, is kind of an outside influence and like how we think of like what policies are possible in our health care system. When it almost seems like a bit of a false dichotomy. That's been created in this debate about of your for universal health care. You eliminate private insurance and you know you want something more moderate. You keep private insurance. You can do some pretty extreme things with.
With keeping private insurance and you can regulate their profits, you can regulate their prices that you can get a heck of a way towards the type of system. Sanders is envisioning with private insurers remaining around here. What's it look, let's take a break here and then I go. I want to delve into the history of how we got to this point. 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 effect.
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the economy or anything of substance, is it they desperately desperately desperately wanted the congressional Budget Office to agree that they had not raise taxes of increased spending by all that much right, and so, therefore, it was important to use this mandate structure so that you were going to be incentive ized to purchase insurance with a lot of the dollar's being technically private right, and so then it became really important to revisit this debate. From the nineties, when the ceo had decided that if the government regulated the healthcare sector too much that they were gonna score the premiums as taxes, because there was one of the things that happen to Hilary care right was it. She propose something that was, I guess it was. It was model on Germany, more or less are
it was like, I think, of it. Almost acres egg, as if, like everything became Obama, cares exchanges weight, but also it was very tightly regulated ride to the pointed the c b scored the premiums as taxes. So the clinging people regard that as a key reason that that plan fell apart, so the Obama people were determined to of void that mistake by making sure that the regulation was lacks enough, unlike this came up specifically with the medical loss ratio provisions where they from the sea bio than if they made the medical as medical ass ratio is basically like, you have to say, And most of the mighty reclined right, so they made the medical loss ratio to high the sepia was gonna score. It is tax swag. Does he really was a gun takeover in you can not under it debate. How much more! This c b, O scoring business weighed on people's minds than any substantive
duration, and that's important when you go back to considering the potential for a Like Switzerland, Germany, regulated style system, because if the problem with the move to single payer that you're trying to solve is that it's important to preserve some choice and role for private insurance, then the continental you, in model- offers you a real alternative fright. But if the problem with the single payer model that you're trying to solve is Scipios sticker shock then the european model doesn't solve your problem and that, I think, is what you ve wound up with such a polarize debate, because middle ground solution, doesn't actually fix what people in the middle want facts?
right, whereas some other stuff does fix that right. If you take the affordable care act as it is, and you do some of this stuff- that's floating around Congress to like shore up the exchanges, and you add a public option to the exchanges that actually saves money right rather than costing money, and then, if you take some of those savings. You can make taxes lower rather than higher, and then, if you want to make the exchanges even bigger, you can go back to run, widen had some plan to like open the exchanges of right. Should we do public option any open the exchanges, then you can have a system that drastically increases insurance coverage levels, does something to control costs and critically doesn't ring taxes at all right, so like that's an appealing middle ground but going
Switzerland, even though like infuriate like sweats healthcare is fine right, but going to Switzerland would still score. Is a huge tax increase and, like that's, what gives people that's what gives normal Democrats in Congress like dont I have a twenty trillion dollar tax increase, so wanna? Have I want to go back to something, though there was in what sorrow was saying, which is before we get to the question of legal. Will the median Democrats and up finding to be the thing that really scares M kazoo cause you're, totally right, method, oftentimes, it's been taxes and if it is still true that it is tax Like none of these plants ago of the Elise, not the Santos plant, the do not go on any work. As it would require huge unbelievable. I popping tax increases, as basically entire healthcare system is brought onto the federal budget, and you can say, as often as you like that. Oh it's actually not more total Nath National Health expenditure spending, it's just a movement in where it's coming from
but like when it was your employer doing it, and you don't know about it before, but now it's you doing it and your employer hasn't giving you all that back in wages, necessarily you know or its that employers. I say what I reserve the whatever you do it like? How do you do it then of losers, and also like people perceive themselves to be losers, could be unbelievably high, but I actually, I think this is an interesting question here, which is ideal. If you, you know, if you assume that the rate settings the same in both systems, write the amount of it that the pricing people are paying the same bus as soon as what you can be, you don't need it to only be the government providing insurance for it to be the government to setting prices as the system Sarah's talking about show. Do you want to have private insurance like? Is there a role for it
like the ones you might think of a right or are if private insurers are structuring. Some of these benefits may be. There will be useful innovation and how the benefits are structured, like maybe they will give you. I don't know like access to emailing your doktor kind of things that currently people don't have or that the government itself wouldn't think of having or maybe it would be that you know you. You want to be able to do it too, by higher levels of of different kinds of services that guinea, depending on how you to find what duplicative would be YO being able to get some of that country are self, might be important to people or maybe bringing profit incentives
it would be bad because you'd have you know, you have risk selection or a number of other things, but I actually think lay recognising that this probably like I I do not think we can get rid of private health insurance and in twenty twenty one, having a clear idea like what you think the ideal system is and how would be structured, I think, is worthwhile, and certainly my sense of the situation is that most european countries over the past twenty thirty forty years have moved towards a a system to more kinds of insurance: competition, not like private insurers, setting rates and not private insurance, often the way we think about it, but they alot of whom have seemed to move towards a little bit more choice and insurance products. I dont know the stories of the individual systems well enough to dispute with a ton of authority on it, but, but I take it as some level of information,
Similarly, the way that Medicare has evolved towards having Medicare advantage and two in which Medicare advantage has become a higher part of the system, a larger part of the system. You know you can make arguments about why that is. Maybe it's a Medicare advantages, overly subsidized. Her or something else, but there it does appear to be some pressure inside different systems, including initially quite pure, single pair ones, too. Old, insurance products up to more kinds of private competition and innovation, and I do wonder if that one of the reasons for that aren't being, I dont, have a great hand on what they are, because I don't think that private insurance competition works very well, but that their there, I think, is information that should be taken only somewhat seriously. In this conversation you- and I think that often gets lost, because it affects I think we're gets lost as Canada is actually a bit of an outlier in that way that Canada has had this a really you firm commitment to not having private and
although you too, as we noted earlier, Canada does allow private insurance or something as important as prescription drugs, that even in a system that really values, government sponsored healthcare and everyone having the same plan. There is a little work around. I believe Ontario trying to do some work to get prescription drug coverage, but I think that the key point in one the just does not get thought through, but I think it is. It is a crucial point of like what value brought to a system where the prices are regulated, but you have different people running different health care benefits. You know another one. Another thing you would see going on is what benefits are covered, something like a veto in fertility treatment, autism treatment, that those are things were some states of mandates. Some don't like that is one place where you could see those benefits being different between the different providers versus. If you have one government run system, your kind of dealing with the insurance that government gives you and you're not going to have to act
two covered for those sorts of benefits. That can be a bit of an edge case, but I dont really here that debate happening much and in health care that debate between, like Tightly regulated private market verses. You know a government run market. It's just like private covered, we have now or not that cover just say I mean I think, sir. She was making a critical point there right, which is that we oh government, run health insurance systems, do not cover everything in the way that the theoretical cinders king, what right in order to reduce the fiscal cost? They both have services that they dont cover, and they have Co. Payments were not Eu Canada than, I sure sure footed mean they are limited in some ways right and so to measures. Question right like the appeal of a private option, any real world public system is to say
Kay, rather than having the government make a unitary choice of your trade offs between choice of providers, co payments and of coverage with the same amount of money that it would cost to give you the government choice of trade offs me. You should be allowed to choose between multiple different tradeoff vendor sprite and the reason that conversation doesn't get off the ground in a context that structured around the cinders care proposal weight. Is that like, if you had Bernie Kay as your public option, there would be no reason to take a private option because Bernie CARE not making any trade offs so say what I want the right to get. A different set of traders doesn't make sense, Medicare take action. Medicare for elderly people, rather than hypothetical Medicare for all makes trade. Swayed, and the reason why a lot of people in particular
larger metro areas, like the Medicare advantage plans, is that they give you different sets of cradle. Where you can accept a narrower network of providers but get a more generous coverage or you can accept a wider network with less generous coverage and different peoples, tastes and financial situations and medical situations are different right. Where's in rural areas is very little. Medicare advantage take up because there's nothing like there's nothing. You can do right like people in low density areas, have almost no choice of providers anyway, so there's nothing that the private insurers get can do it all, and
think I mean, I think it's true read. If we move to a Medicare for all system, the actual system would end up being not as generous as the Bernie system, and then they would be pressure to offer more choice. I gilligan obvious one. Is abortion right? Like it's unlikely to me that we're gonna have publicly financed free abortions in the United States, where the private insurance group up, but I think normally want to offer abortion coverage because it is a and attract or product of many people and be proud
we a lot cheaper than covering pregnancy, delivery and a new child. You know so they're happy to do it, and this is when Colorado was trying to have a single pair Balin initiative like it eventually fell apart. Injustice like in fighting around the abortion topic, because protrudes groups don't want a single pair system that leaves abortion out but like moderates, unlike they don't you know turning it into a proxy fight about. Abortion is not constructive, so choice private providers is a sort of natural potential solution to that. But all that means that legally comes in Wednesday, like step out of the universe and which will just cover every there's a lot more to say on this, but I think we should take a break: a move to our white paper, ok, though often ask me of prosecuting the mob, is like the movies. Well,
There is violence he cracks disguised over their head and a pop. Just like a melancholy. There are heads, so wasn't just permission to take em apple permission to take out his own nephew. But after taking down over one hundred mobsters, I can tell you this is the real thing is much more interesting. Nl. We wholly former mob prosecutor and host of the new pod cast up against a man up against the mob lists. Bail on the world's most secretive criminal organization, La Cosa, Nostra we'll talk to process Peters, former mobsters, an undercover agents and- and Hollywood. All these stories are true. New episodes drop every Wednesday starting September. Eighth, listen and follow up
Hence the Bob on Apple podcast Spotify or your favorite podcast app. The cut is applied cast from New York magazine, but it's so much more than that. Its thirty minutes a week where we really wrestle with ourselves we're talking Seidel expectations, race, sex career ambitions and our bodies. I just spend our time on Instagram looking at health at any size nutritionist. Talks and unified I've. You know, I'm that girl on the internet. They just come to me baby. The algorithm we're here, conversations. You'd only have with your most trusted friend so Gabby. What were the most painful memories?
I'm jazz. Nike air listened a cat on spot if I apple or your favorite pied cast out. So the White Paper Day is the welfare effects of social media is by Hunt Alcott Loose a brig gurry, I'm sorry for Miss Bonanza, Sarah Ike, Meyer and Matthew against go, and this a pretty interesting and in the world of papers. Assessing social media use extremely rigorous paper. So what they did is actually created a randomized evaluation of how Facebook affects you and makes you feel they took two thousand eight hundred and four, for Facebook users, they randomly assigned a subset of them to actually delete their accounts for a while. You know like that, but the line on totally your Catholic. We actually got people to do this by paying them and then using a suite of like
bays and direct measurements and different ways of measuring outcomes. They followed them to see what would happen and the basic take away. This is that, if you stop using Facebook, literally every measurable affected has on your life is positive but one there is reduced online activity and also reduced other social media use, but increased offline activities like watching tv. And also socializing with family and friends. So, if you stop sort of digitally doing so much social housing, family friends, you actually spend more time with them in person it reduced both factual nous knowledge and political polarisation. You saw less You like new, a little bit less about the news and you were less polarized about it. It increase subjective, well being increase how good people felt, and then this is a most interesting. It caused a large and persisting reduction in Facebook use after the experiment, so you pay people to quit Facebook for a little while people who already use it, people who were not
quitted, if you're, not given the money and at the end of that study, a lot of them keep not using Facebook. They prefer the world in which they dont useless thing, but they were using before which, as the authors note really fits well with an addiction model of how Facebook is working with us as opposed to a normal like we use it, because it is a product that people enjoy give aiming at precious back against this idea of venom use. Facebook being that case have revealed crap frightened said he a head closer media than theirs, but not this time on it because actually those the thing they enjoy and pushes more towards an understanding of social media. Like your thing, Azra as, moreover, you know it, addiction model
I think your braces, I mean for me, I kind of like raises interesting questions like we're. Does it leave us like it? You could almost even with if we're like, actually sing healthgains. Our people are feeling better like it. Just has fallen of weird case of public health intervention where like this is something you would want to promulgate in some way and not just for a randomized trial, but like literally giving people money to quit social media because like that is part of the greater guide. It left me with a bit of a unit where too, we are to take this from here, but deadly making. We think like this is not a case of you. Proper inside the other thing that really jumped out at me. As the am lowered news consumption. I thought that was pretty interesting. I think it surprised me the most. I would have thought if you quit Facebook, you would have found your news l through elsewhere. It acts reminds me a little bit in the summer when, as out on maternity leave, I wasn't and so for to super busy trying to attain
human alive minors, consumption went down. Time like it was the first time like I heard things on the radio, and I was surprised by like the news I was learning like. Oh Scott prove it is doing whatever he is doing at that point, but that was a little bit surprising, an interesting to me that people weren't finding their news elsewhere. You know when they were doing facebook time you mean, I think you know that the numbers on what is sort of crowded in by limiting people's Facebook are interesting and telling. Why? Because I think with thing that happens on the internet. That people say is terrible. It usually is terrible, but the optimistic cases always worlds crowding hotel. Because television is more terrible than terrible things on the internet like whenever it is like fake news. All everything is worse on on television But what you see in this study is that, like Y, all making people not use Facebook did crowd in extra telling
watching like it also crowded in extra socializing an extra exercising, and I think I don't know They get sued unkind Rachel. To claim that, like most people's well being, would be better off in the long term. If they did more in person living and more physical activity and a little television is like a small price to pay for that, I am always like the facebook critic so to give them a break. For once. It does seem like almost adjusted generic internet kind of thing read that it's like this, only twenty four hours in the day and we're not obtaining like technologies that let us go without sleeping at people need to work to live right. So it's like you just like put more stuff on the leg, entertainment options, bus
and this is kind of what you get is gonna, not great right like to have so much of the innovation and progress and like we ve me, billions of dollars stuff happening just specifically in the end, ten minutes zone is like maybe not actually great, for people's lives right leg. I don't know that anybody says, like you know those jokes, I, what do you look back and you death bed is like? Do you ever strike? Wish you'd? We watched more classic television series on Netflix, like I don't know right or like scrawled more through Facebook. Graded, sir, is a striking paradigm that, like we ve, made so much progress in ways to waste time. I think to two things about that. I think are interesting. One is that I completely agree with your your broad point there that were sort of seeing you noticed an effect on semi addictive, entertain, Minister in General, like if you paid people to quit video games, you might see some
numbers among people play lot of video games, but where- or I do think it's interesting one. I think the political polarisation findings interesting, I mean not because its shocking just because, like you know it backs up what people are. But something Facebook is argued against. Similarly, by the way the the paper finds that there is not a difference in subject of well being between people who are using passively, which is to say, like scrolling through the noose, feed, look and stuff and people using it actively so cooking lake and leaving comments face. You said the latter does improve well being and an end. This paper finds it doesn't, but I think of the big picture of this paper as being here, we have this communications platform
There has begun to reshape almost everything in society. Its reshaping journals omits reshaping politics, its reshaping, how we communicate with each other. We drew shaping how we feel reshaping, how practically younger people develop their identities and how they re like how they're doing as a social, human being an actor, and it just doesn't appear to be a good platform right like all. This is happening on top of a structure that, if you take the structure out of people's lives, you seem a little bit happier and it all you can do about this exactly, but it's it's a bad. If we are kind of rushing towards you not having one of the really foundational technologies be a technology that is on net bad for people and it's not believable bad for people read. I want to note that the magnitudes in this paper are not unbelievably shocking or or anything else, but you to what you are saying that, and I recognise people things about tv anymore,
right about tv right, like maybe the credit card, is right about all of this stuff, but I'm not even sure facebook better than tv in the sense of it. I think it's probably a long term cost for the kind of like constant contact. Switching and like a rapid, attentional distraction and, like you know, I find it increasingly hard to like sit down and watch a movie which you know seems ridiculous, but I think it's because I'm like increasing that used to to ever smaller information. So I don't take the results of the study, a saying that Facebook is like unbelief. Bad in any individual case. But what I do take it is suggesting is it we are building an awful lot of our society around I'm just gonna passively, accepting that everything that needs to be constructed on top of a technology that does not appear to be good for us or have hit us happier, yeah and won't digits, How onto that, like a natural thing in the regulatory debate like a regulatory bay, but any industry is like yeah. That sounds,
but you might just like deflate the product as a whole. Right and like, I think, just what we see in these studies is that we should think of, social media companies anymore. As he's like promising, delicate flowers, there were afraid will be killed by our you know over stretching arm there more like those like terrible weeds. You know that, like just Grove relentlessly everywhere and if you can keep them away, if you can like rain the men from the most pro matic areas like even if there are some unintended consequences gets probably find like they do really good job of getting people addicted to like scorn round on their own and that's not good. What is good is good. Your father do you know about to join the weeds Facebook group. It's ok! Well,
as long as you're addicted to Facebook you may as well. I know it's very sore group, I it's probably healthier, but will you know like a c c? If other weeds Facebook group members living your town hang out in person, talk about politics and policy, the matters walk or jog to the destination bicycle was larva that's a good ways, yes and get out of the house and listen to podcast all the Vocs media podcast, I'm going to plug the Ezra Concho. I love the Cape man sugar, going to write a great book but she's. Is it really enlightening interview? I think it shed light on a ton of staff. People should check that out, but all vocs media network Pike S really and I've got Ralph NATO out today. Oh my god, that's that
Forgive me. I listen to the came in one instead and things as always to our producer, Jeffrey Gold and weeds. We return on Friday. The cat is applied cast from New York magazine, but it's so much more than that. Its thirty minutes a week where we really wrestle with our Yes, we're talking societal expectations, race, sex career ambitions and our bodies. I just spend our time Instagram looking at health at any size nutritionist, talks and unified? I you know factor on the internet. They just come to me baby. The algorithm we're here conversations you'd only have with your most trusted friend, so Gabby. What were the most painful memories,
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Transcript generated on 2021-09-11.