« The Weeds

Three roads to universal coverage

2020-01-21

Dylan Scott and special guest Sarah Kliff join Matt for a close look at health care in Taiwan, Australia, and the Netherlands.

Recommended reading:

"Everybody Covered" by Dylan Scott, Ezra Klein, and Tara Golshan, Vox

"Taiwan’s single-payer success story — and its lessons for America" by Dylan Scott, Vox

"Two sisters. Two different journeys through Australia’s health care system." by Dylan Scott, Vox

"The Netherlands has universal health insurance — and it’s all private" by Dylan Scott, Vox

Hosts:

Matthew Yglesias (@mattyglesias), Senior correspondent, Vox

Dylan Scott (@dylanlscott), National security reporter, Vox

Sarah Kliff (@sarahkliff), Investigations and health policy, New York Times

More to explore:

Subscribe to Impeachment, Explained on Apple Podcasts, Spotify, Stitcher, Overcast, Pocket Casts, or your favorite podcast app to get stay updated on this story every week.

About Vox

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Our project, Everybody Covered, was made possible by a grant from The Commonwealth Fund.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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to apply now at Womply COM box and see if you qualify for a ppp loan, that's won p. L, why dot com, Slash, Veo Ex Wife is not a lender terms and programme rules, apply oh that's judge rail is like YAP aces alone. Welcome to another episode of the weeds on the box media gas network, I met your glasses joined today by box outcomes. Don't Scott by an old weeds friend, New York Times, Zat, investigate reporter Sarah Club, guy, hey, let's were virtually clap all glad to have Sarah back with us The occasion for this this momentous event is we have a series of articles called everybody covered this coming out.
With some help from the Commonwealth fund. We were able to send as journalists to a variety of countries learn about their health systems abroad. Dylan has been do the Netherlands, Taiwan and Australia learning about three different, very different, models of universal health care systems, and I mean I think it's interesting just so you hear a lot on the internet. Is that, like every other country, has the kind of thing that is known as Medicare for all it in the United States? I think weeds listeners know that that is not true, but it can be hard to grasp like the true. Diversity of things that are that are really out there, and I think that was one of the goals of this project was demonstrating that there are all these different pass to universal health coverage like the one way that all of these countries were covering have exceeded. The United States is that they do effectively cover a hundred percent of their populations with health insurance, but they ve come up
with these different models, do it like Taiwan, does look a lot like Amerika for all program like it's at one national health insurance plan, pretty low cost sharing, but the Netherlands is Villona diametric opposite it's a fully privatized health insurance scheme, it's like compulsory private health insurance, so everybody hasn't in health insurance plan, but there, stirred by private companies. So we really can have run the whole spectrum that the dutch system is sort of like back in that I dont say Obamacare days, Belike filling protein a care days when like backs Bokkis was like drawn stuff and envelopes. I don't know Peter or zag I think was somewhere may be still in the think tank world. This is like the thing that they would say. Well, it's probably the most similar to our system and the affordable care act too. Right like if you look at like the health insurance marketplace, like almost like a supercharged version of where we are all in the market place. I think I'm telling you no more cause. You went there, but I think that would be some.
Yeah similar to a dutch system so like weeds listeners are also, I think, familiar with the three legged stool right like the battery. On community rating. You know everybody s be charged the self same insurance premium more or less, regardless of health status and guarantee covered guaranteed issue can be denied coverage because your health status of an individual mandate, meaning get out there Finally, if you dont sign up and that those are the three legs that the dutch private insurance market are built on. But the difference as Sarah says, is that, rather than this being, you know like the individual insurance market. In the: U S words, just like you know twenty million people who don't happen to knock it insurance to their work. Every dutch citizen, every year, purchases, a private health, their own individual, private health, ensure
this plan that under girded by those right, because this is a really big difference- I mean I feel, like I've- wrote the phrase a million times at some point and that this three legged stool as like modeled on the dutch and swift systems, looking back on, it like, still under forgetting tromp bright, like full implementation, easier, like the plurality of people, would have had job based insurance. A lot of people are over the age of sixty I have it in nontrivial. Number of people are like military veterans. Things like that, then like people who are poor, we're getting. Or so it was actually like a they had taken some concept. From wretch system but like actually the the sailing thing about the digestive. Is that everybody everybody that Russia, its Obama Carol yet will end, question I have about the Dutch is more about the politics of health care
because we all know that the individual mandate has been like so incredibly unpopular in the? U s: thee like few was repealed a few years ago, there's like Supreme Court case after Supreme Court, around the mandate. How does work in the Netherlands. Do people care or think about it like is the penalty giant and that's why it works, because I've always been fascinated with this idea, like other countries like Switzerland which, I think is pretty similar to the Netherlands that they seem to have this requirement to carry health insurance and just kind of like a nothing burger in the exact opposite of the way. It is here right So I think there's two things here: one is looking at it from a political point of view, like the dutch system as it exists today was the creation of a conservative government air so like that before two thousand six, they had like a two tier system. Wealthier people with coverage, poor people in a public programme- and that was a working very well. So in brown, two thousand sick they decide to remake it and sorted. The compromise between the conservative majority,
and the liberal minority was like we're. Gonna have universal coverage, everybody agrees. We need to do that, but we're going to try to do it in a marketplace way to appeal to the conservative government that was in charge at the time so. I think maybe that's for starters. One reason that that is that there is no one with an internet. Nobody just like I am there's no equivalent to like the way the Republicans were running its did the German because I was gonna be Emmy, those like the fraud, political story of the SBA rate is like when Hilary, and what, when Bill Clinton, is trying to do a different reform some conservatives are like. No, no, we could accomplices for the mandate. That doesn't happen, then idea kind of kicks around four million years. Then it comes back As I can idea, Democrats think moderate Republicans might sign to and they will not create jobs right. So now you have like
whereas in the Netherlands, this takes the form that it originally had in the United States right, which is a conservative political parties, alternate vision for achieving universality right, exactly and then I think the other piece of it is that the mandate in the Netherlands is much harsher than the one that we saw in the United States. Thing? Is it what is so little time you get shopping dont get jail, but then you get your hands you again. If you do, carry insurance you, you will get find twice, which basically a fee that is more than the insurance premium. You would have paid if you had just signed up for insurance as you're supposed to and that after two finds the government will actually automatically enroll you in the health insurance plan and, if necessary, the lake. Take the wage earners take the premiums out of your wages, so the very forceful mandate
in a way that the Asians was and then how is it? I mean you, don't the other concerns people want up having with with sort of the marketplace plants when they came out with the unsubsidized premiums were very high right the subsidies are generous if you're really close to a hundred thirty three percent, but once you get up into the middle class that the subsidies are not that big and then the product still carries very high and our very eyes substantial deductibles and co payments. I mean to the Dutch, give you is it like a much more generous insurance so, like insurance premiums are kept for everybody. So it's a. I think the average nominal premium is about sixteen hundred dollars a year, and I like the most anybody would have to pay if people with Lord
comes get like an additional subsidy or additional assistance for the government to bring their monthly premiums down even further. But, yes, they have sort of like they have applied. That level of sort of government assistance to every to make sure that premium stay yeah, I mean that's like a really big. I mean I see this. I wish I could take this knowledge back in time because you know again, that's like okay, yes, like formalistic lly, like that's the same three legged stool, but like the company. Nation of a much more severe mandate. So they like it's, never a good deal to pay the fine right with and one reason why it's never good deal from pay divine. Is it the premiums Wade, flower right, exact and I'm not I'm willing, would the mandate have been so unpopular right if, like, if the her native to being fined. Was you pay sixteen hundred dollars? You get comprehensive health. It is the only way to get there, and I think this is like waiting we're talking about the differences between the systems. Building they have in common is the regulating the healthcare prices, like, I don't think,
You didn't like it all. There are a lot of different says, but if you look at all these countries that they are all stepping in and the reason you can like cap premiums at that amount is because the healthcare just costs less than it is here I mean I guess you could have done much more expensive. If you went to create that cap in the United States, it just be so much more expensive to write those benefits than it would would be in the Netherlands, so it that almost drives home to me away like sure it's about the deductibles evidence about the site the mandate, but I think at the heart of it is that is the prices like I've helped on this. The reason for this is not new YAP, like the praises make it so so so much harder to create a cap like the one they haven't than other rights, and they actually so in two thousand six. They introduce this new scheme for universal private health insurance is very like a catchy name.
Not that I am aware of, and if there is a good one in Dutch I would horribly under which it took me. It took me a while to even get down pronouncing the name of the city that I was what say my wedding was knife mayhem, it sounds like so yeah, so two thousand and six we introduced this new private insurance, private insurance. They were worried after that. The health spending was increasing too quickly, and so in two thousand and twelve they. Deuce, a new costs containment programme, the core of which was global budgets like basically- of the individual health, insurers would operate a global budget under a kind of guidance provided by the government and of health spending started increase to quickly after that than the government had the power to like step in and impose spending cuts to keep costs down. So yes, your points are, I think, one of the critical differences here, as they have a more sort of holistic approach to trying to constrain healthcare costs than we do.
What happens in terms of like that. The old timey right, like like bugaboos, about universal programs like is there a lot of Is there like a lot of rationing? Is there like a government committee telling you you know you can't get some kinds of treatments. Like what's, there is like so there's like the good dutch Health CARE Authority which, like in conjunction with the providers and the insurers, helps to sat like these annual spending. That kind of thing I mean, I think it's important to note that women have you Caballero spending. I guess we're pointless red, like somebody at some point for the country efficacious, somebody has to be like. I would like something and then somebody else you're not going to go over in Taiwan like Guinea. Certain drugs immigrants is true in the UK might come up in the UK story. I know of your colleagues is working on. Is that those exe?
medication. That's often one of the big trade offs. You have these expensive medication or the government. It's just going to say it's not if the government's going to negotiate price control to be able to say as many people on the left think they should, you send AMS, have to walk away right. So I think that has been a little bit less of a problem, and it's just not something. I came up much in my reporting on the Netherlands, I think in part because they do try to impose cost sharing on patients to prevent over utilization. So I thought as away I think, of making sure that, like spending for the programme overall remains manageable, so it's not join in supposing imposing these spending caps and then everybody sort of as free rein to try to get as much healthcare I try to manage it at the patient level and it's interesting. You see that, like in a lot of the countries, you're writing about, and I think that's one of the things that hasn't really come up as much in our single payer debate is the idea that you can have universal systems where you still have to pay
When you go to the doktor right, you know. I've talked to Bernie Sanders about this and he does a very strong philosophical objection to this. He feels like nobody should pay money when money when they go to the doctor, that other canadian system works there and when you have asked me about well, you know why in one. He doesn't want it, discouraging anyone from getting healthcare and to you things like the administrative work around you know, collecting a ten dollar co pay from a billionaire just isn't worth like that. Ten days Why build the administrative system where you have to check people's incomes, see who has to pay Kopek Kobe Hooves, either to low income to pay? But you do see most the countries. I think I is it a case of all the countries you written about of some level, there are some level of cash airing is, I think, Canada's outlier in not doing sharing, but Canada shapes our debates so much that the main proposal we talk about the Sanders proposal that vetoes hunted are worn assigned on
it eliminates any sort of payment at the time of service is different from the countries you've been to tell me about. The Netherlands was sort of how rationally the insurance benefits were designed. So like going to your general practitioners generally pretty much free, you have, if you can it, we will do have like a copy for medication That kind of thing, but if you go to the hospital or the emergency room, you have like a four hundred dollar deductible that you have to pay first before your insurance benefits kick in and that I think, that is just in the in terms of the way they have designed insurance benefits, how they ve tried to encourage. Unlike you, if you, you can't go if you go to a specialist without getting a referral from your JP, your insurance won't cover at or you'll, have like a higher out of pocket cost. That kind of thing- and so I have a question about insurance in the Netherlands, the gear. Person to ask one of the things. I've always wondered about these, like multi payer systems like Germany and the Netherlands and Switzerland. What are ensure that what what are the insurers actually doing are they compete
their benefits different in some way. I'm wondering if I'm like dutch their shopping for health insurance, How am I exit another tightly, regulated right? What what's actually different and like are they bring? any value or they just like another layer. So you go to health care, and what do you find? I will say my impression: is that, like allow dutch patient store I think of themselves as like active shoppers for health insurance Lake, seven, The people I met said like yeah. I ended up in this plan like five years ago and I'm just still in it, because there aren't that many noticeable differences like the insurance benefit, so like those deduct those annual deductibles are set by the government and because the cost like the copies and there's a homepage are set by the government. There is a little bit of choice in that like if you want to pay a smaller monthly premium like if your younger person, it doesn't think you'll use lot health care. You can do that in exchange for having like a higher deductible like they'll? Take it up to like him. I think it's about nine.
Hundred euros if you want in exchange for your lower premium and the ensure as do contract with particular providers like they create networks but there there are extremely it's on how much patients can be chairing charge for out of network care. So it's all, like my sense, was like they basically have these various multi nonprofit insurers to admit stir the programme, but they aren't like necessarily in for like some kind of fierce competition for each other with one another trying to add at the others out like part fully it just breaking down broken down by geography. This ensure covers that area that ensure cover the stellar fear. They thing. You know that that I think is out well of indifference, that in retrospect, the east Our protection of thought about harder is that they want, and we ve seen in the market places is that the multiplayer competition is much more functional and places with high population density made good. When you have a lot of people, you have a lot of providers. You can have multiple overlap.
Being provider. Networks right in the Netherlands is the most densely populated advance country ride. So so now I'm a hen is like not the largest city in the Netherlands. No Niven close it's like a little bit of a small town by dutch standards. It says dances LOS Angeles right in terms of its its population and like not fall, are from Amsterdam yeah right like if you needed a major surgery, and so you had to go all the way to the biggest city in the countries in our and a half later. So that's the kind of terrain in which the issue is working, its bass, yeah right, and so, if you are looking at the hat and trying to apply it to a giant, varies parsley populated country. One thing in retrospect you should have thought about is like how is this going to work in? Why only right, because, like you, can get within, why arming
further from whatever the biggest city in my opening is, then you can from Amsterdam and the biggest anyway homing is way smaller right. That then answer right, and that's a huge problem right out of here, small town and your three hours away from a medium sized city than like how much provider competition could you know, would realists ever exist for it right, and I was something that humbled me at the beginning of reporting out this whole project lake, Realizing that you know translating policies from other places to here is not gonna, be very easy. It's a exe! I should like in my mind it's much more of sort of like you can talk about them. Clients were like look at values, and I think that it is interesting to see how these individual policy works, but it's obviously not as simple as yet just like transposing what the Dutch or the Taiwanese they Australians do. Unto the? U S,
what is things I find so hard about? You know bringing these policies back here. Like you look at it, I, like thinking of your serious, is almost like a menu of options like there's so many different ways. You could build a single payer system, but what are they think about more lately as the fact we let our seas. Some get so entrenched and so big locating the stories of yours. I've read so far. None of these health care systems. Nearly as our but like everyone tackled this a little earlier, I guess I mean you heard about Taiwan and the really the most recent country to build a single pair system, but they did it. Pointless, nearly three million or two years ago. Although I learned today that I thought it looks like Kenya is kind of rolling out a new and also healthcare programme, but I dont have a tender share about the outlay just learned about a future without a quiver you, but it seems like that's one of those things they. U run up against. It is even in the this is where there was
There's organise medicine, there's opposition. It wasn't quite as strong where something like we have to contend with both in terms of the political cloud and just we've built this whole system that, like structured around a certain level of prices in a certain way of doing things. It makes me wonder whether, like you can actually go back to the nineteen sixteen, when most of these systems are being built right and do the things that were done, then it seems like a much better I heard all to get too I'm get to something like any of the system's you're writing about. With such a such an entrenched this that we have now yeah, and I mean I do think each these systems is certainly reflection of of their political history, but sort of A commonality across those histories is that, like it was a real crisis that forced governments to tax like in Taiwan. They had they two things happening. They had both like a forty percent, uninsured rates, so just like a real sort of like practical problems that need to be solved with the same time like this was in the mid nineties, eighties. They were starting,
there do like democratic reforms. They're gonna have their first presidential elections, and so the authoritarian government that had been in charge for long time looked around looked like what their preferred progressive up and was talking about and was like you know. Maybe we should try to like fix that, Can we allow our before people votes and like there is this huge problem to solve or like in the Netherlands, they had had this two tier system for a long time, but according to like the experts I talked to us for, like it had become untenable and its work force, the governments have to try to do something to fix it. I thought so in theirs. Is one nine around the Taiwan story about how when it was introduced? Whoop everybody hated everybody hate like they were, I'm treating like a funeral only. I saw in the like in the room where the legislature meets when they were passing the single pair build these protein there's who mostly came from labour unions because labour you were the ones who had health insurance before they introduce single pair. For the most part, they were the only
They came in and there's like this funeral right or like you burn the special kind of, like a temple or something, and so they brought that money into the parliament and through it on the floor like as as one of the guys I talk to spot. Put it like this, a sort of the most severe form of practical, and I thought that was so interesting- reminded me of a swindler stories. I wrote it vocs about how the canadian doctors and sketch one they went on strike when their system was created, and then I fell down like a bit of a research rabbit hall EC sing like and it seems allow these systems when there actually created there, not that popular like the public. If in a kind of where it is in the? U s now around Medicare for all when these systems capacity in your stories that public opinion polls show that most people, actually oh, is that when it was being out like I said, I felt rabbit, who is looking like UK public opinion and there's not a lot from like this, and you can for parties, but there's some that suggests people weren't jazzed about the birth of that nature
into scotch one people were really fraud. I looked up there in Belgium, there was a big doctor strike, it's interesting to me. You know there is a crisis that force. Is it, but it seems like a lot of these countries that, like now love their healthcare systems and, like you, know Britain, it's like the crown jewel of the country at the time that it's done there he's a ton of public opposition and like it's, never like the countries like unified around like one less and less. Let's see the brake than come back and back up, because if we were now to comment Taiwan's, we should. We should explain Taiwan's shore clearly If you're, a gig worker or self employed, there's some good news about PPP loans. You might want to consider millions of sir, employed workers may qualify for up to fifty thousand dollars in one hundred percent forgivable loans. You might be one of those millions as the leader PPP loans. Wobbly can help you find out. They ve helped over three hundred thou. In small businesses across Amerika get a ppp loan funds are limited,
so apply now wildly dot com, slash, vocs and see if you qualify for a ppp loan that, W O m p l, why dot com, Slash, Veo ex wobbly not a lender terms and programme rules, apply for it. For this episode comes from visa, helping you rethink how you drink We're visa is a web based program that works by helping you notice the negative thought patterns you might experience in your relationship to alcohol and then do the tools you need to break those patterns rooted in Hundreds of behavioral therapy for veto is designed to help you prepare for the future by arming you with techniques to help you during class. It's totally private one percent web based. So you can act they're from anywhere. You can visa risk free with sixty day money back guarantee. Now, at U S daughter, or visa dot com
So we started to get into this, but Taiwan is an interesting case, because Americans don't talk about Taiwan a lot and when they do it's usually about like hypothetical WAR with China? This is closest to like the political revolution scenario. Ride like they were Bob and along for a while, and then a simple the maid eighties. They were like no, we should have a single payer system and they'll just completely read it red and the way everybody got health care the way every in the health care industry had to work. We just like all turned on its head, like add, isn't it's a kind of weird story like that? How did this happen? So yeah back up before single pair taiwanese healthcare was certainly broken, so there was like a forty percent uninsured rate. There were labour and transfer plans for like fish men, farmers, government workers, but they didn't covered dependence. So yet a lot of UNAM shirt, elderly people, a lot of uninsured children, and so that was sort of the underlying people would go bankrupt because of medical expenses,
actually learned that apparently likened the nineteen seventies out. Egregious healthcare costs were like a common trope on taiwanese opera is like it was that kind of embedded in the culture that, like health care, is a mess and honour for citizens like if you imagine like Security ACT of of nineteen, sixty five right. This happen. Free Medicare pre met this answer scenario round Medicare medicate rise at once. It was I give Medicare medicate had been like filibustered today of right and those like the problems. We have both Also, the image around the world are keeping all gave landlord lingering furs for another twenty years into the future right and then you get up push for a bigger yeah and, like I said, I think that was as much sort of the nationalist government seeing democracy coming around the corner and thinking like we sort of, we need to outflank the progressive opposition by introducing a national healthcare system.
So they went about it very deliberately like they just started. Convening a bunch of meetings with like health care it's from around the world, the most notable of whom was Uva Reinhart, who was married to May Chang, who is, she is still with us. Uva has died, but may is taiwanese, and so they brought, though he was amongst the foreign contingent that they had brought in to advise them on what kind of healthcare system they should set up. They kind of put as I am may told, the story. It's like they literally at one of these meetings. This kind of put the question to very like what is the best healthcare system like what should we build and he and may talked about it for a couple days like, while they were in their hotel room and he came back- and he was like single pair- is the way to go. The most efficient system, gonna be the most equitable the sum. Apparently, they didn't really like quite understand what he meant. So he came up with this metaphor of a single pipe
like through a diagram of it, and everything to explain like there's this one pipe where all the payments for health, insurance or health care are going to go through to cover everybody, and after that, you out, as may put it like. They left Taiwan not quite sure why what's gonna happen, but then somebody from the town government called like six months later, and I was like that sounds good to us. That's what we're going to do and so then they had the they had all along legislative fight and then to me the most absurd, so this bill, the single pair bill passes in nineteen. Ninety four and then the government that's been in charge for decades decides that rather than roll it out around two thousand like they were originally planning. They moved it all the way up to ninety ninety five because they're like we need to get this done and get this out of the way ahead of the first popular elections and ninety ninety six, so it just kind of became the sort of like mad. A dash to try to get a single pair healthcare system up and running and literally like a year, but for the most part it seems like they succeeded. I
But this is also like a transition. A a military dictatorship lane laying the groundwork origins as when you look back at Medicare and Medicaid. It was the same timeline negligent year between it being signed and rolling out. I think it shows like, but then you have liked Healthcare Dhaka which had for years like did not roll out. Very well. I think it shows like that these things are feasible when the programme is very simple. You know what I called Kara God. It's like. You have to figure out what subsidies people are eligible for in the machine didn't work, but even unlike the non military dictatorship of the EU, It states like they got millions of people in short, did, you know actually rolled out Medicare, very very smoothly at ninety nine nineteen? Sixty six by my, I did a story ages ago, arise at the postcode of reading back over old news. Clippings around us and there's a lot of fear like oh, my gosh, what's gonna happen or senior is going to overwhelm our hospitals and it was just kind of fine like you have to go up
find the old people without linking them. The insurance mean if you go back and listen to the administrative burden, episode of the weeds. I also talk about the roll out of security in the United States, which, given the analogue technology of the time, seemed quite daunting, but actually did it really fast step, and you know, but part of it that right was like it was just like what would you like to get this money from the government? recently people as they would Medicare eight. Would you like that? How do you do that? Wasn't there wasn't it I mean. Obviously there was administrative work to be done, but there wasn't like a ton of like what are we going to hunt people down and like force them to collect their social security check the error rate, because they what is wanted, yeah yeah, some of the officials I talked to her around at the time like while this programme was being stood up said like go to move was to go to meet with, like the matriarch of a family like grandma somebody and be like hey were reduced
this new health insurance programme, it's gonna, be great, get all of your grandkids and your kids to sign up four, and so I think in the first year they had member they afford uninsured rate, I think, by launch they had covered. They had gotten ninety ninety two percent of people like an insurance card and then over the next couple of years. They got all the way up to ninety nine points. But how are you going to pay for well I mean so. This is one of those things were. It's like, I feel like the Taiwanese had to have benefited from Sweden, away from how bad their system was before so was less about, like How are we gonna like a redirect all this existing healthcare funding and try to capture, and so we can create a medic her father programme here was more about like we just need to build like a new revenue stream that doesn't exist, and so with the Taiwanese have done as they have based
premiums towards which both employers and employees contribute, and it varies depending on like what industry or an what your income level is. That's what industry Yeah varies across very the look. I don't know if that's just a reflection of the different incomes that those in private and generally expect, but the way I saw it brought down was like phobia like farmers. Are. Farmers are pretty bad example, but for like government workers, they pay acts the governmental pet, their employer. The government will pay. What so they are that that's where the bulk of the funding come from. They have had to increase premiums a couple of times over the last twenty five years and then there's sort of a hotchpotch of like progressive income, taxes and levies on tobacco alcohol that kind of that make up, but it's like it's like the work horse is like a payroll tax, yeah, the middle class people that middle class people pay, yeah, technically contributions from them and their employers. So that's
my God, like also how high is because I mean this- is gonna loop back to serious point about the prices right like like how much you know like share of GDP. Is going in to this system so right, so Taiwan spans, like six percent of its GDP on Healthcare, which is like a third of what the? U S is, and I had a critically that is less than what the public sector in the United States Curtain paints right right. So, like taiwanese taxes, their government run hell how I feel they are less rather than american. What am I a camera tat s house for Medicare Medicaid? Is he a subsidy? Is rents generally true? think for most, I knows, is one of hazards. Favorite charts is like the chart showing our public spending. I think we spend more per capita than, I would mention in almost every that age, Switzerland and Norway are the exception, but most of those countries also have privates right. So it's like Taiwan has a wholly government funded systems.
But like not just like it I'll see. You, money in the like aggregate share, very bright red like it so put another way right if, when Elizabeth Warren stands up and his like, I'm going to cover everybody and what she needed was to write down how she was gonna, get six percentage, p. I gotta be occurring now where we would have had all these podcast episodes. I'd tedious debates like six percent of GDP is easy branches. Take the existing taxes for Medicare Medicaid, and you just like the gun into this pact yeah and I will say the most interesting idea, I came or one of the most interesting ideas. I came off a came across in the Taiwan for. I was this idea that basically Taiwan actually under funds its healthcare system, like their biggest problem, is provider capacity. Like because their such low cost sharing people go to them. Doktor, alot people go to the house
but a lot, they are particularly they don't exercise a much discretion in terms of where they end up seeking care, and so the response that potentially would be to increase funding so that you can pay more to providers to increase the capacity on the supply side. But obviously that would mean increasing taxes, increasing caution in just to give a sense of this magnitude. So let s look at this one figure, while you're talking, I think I remember, stories like taiwanese people pay like an average of five percent is payroll tax, so, when Vermont was working on their single payer, the numbers they came up with these are eventually the numbers that killed the whole scheme was that they would need to increase payroll taxes by eleven point: five percent in income taxes by nine percent like when those numbers came out. The thing was: actually dad, but that gives you kind of a ball park of. If you want to build a single payers system with American,
prices and I think, you're right. It sounds like from reading your story that maybe Taiwan could like bump up a little bit and their system would run a little bit better, but that would be nowhere near the ballpark of the tax increases that we're talking about that Elizabeth Warren has to come up with Bernie Sanders has to be asked about. It is just such a different magnitude when you're dealing with the is. Is that we're dealing with Jack is right? Now you there's a two point: nine percent peril tax for Medicare, yet right so if you could get Medicare for ah from five percent payroll tax and then the whole big like well, how are you going to pay for? It? Is I'm gonna increase peril text by one point one percent, I M not to say there wouldn't be political push back Yes, I mean it's safer from like mine, are aware. I think you would say that the that the Medicare for all people would have a strong winning hand right. If the paper was a one point, one percent error tax increase. The difficulty is that they have maybe a fifteen percent Petrie ride like that.
That's it from ballgame. But so do the Taiwanese like. There are their long waiting lines like what what how do these capacity constraints like beneficial. If you will go to the door to allow people go to the doktor a time they, actually do do quite well in terms of weight times for like hip replacement surgery act surgeries they actually outperform like Canada in the UK. I think it is more sort of lake They are worried about their provider, workforce being depleted. So, like oh Eddie Taiwan in terms like doctors per capita, basically has a much lower rate than like the Aussi OECD average. They have fewer nurses than other oecd countries. Unlike especially unlike more rule areas, there is a shortage of lake primary care provider, specialists that kind of things I get there are the sort of going to the doctor if the doctors tonics, if doctors, Is that so a government has tried to address that problem through
Like a rule. Healthcare program that they are set up, that lake basically pays doctors to both be stationed in these health clinics in rule townships across the country and so to do like sort of these roving mobile clinics? That will I go up into the mountains and see like aboriginal villages patients there, that kind of any just paid less and actors in the city Like you, I mean are definitely paid. Thus, yes ends and they ve. Seen like it's hard, it's been hard to put numbers on it, but there is definitely like prevailing concern about a brain drain were like Taiwanese. Doctors are just leaving the country to go back this elsewhere have knowingly. May I won his doctors who laughed ok, don't after they say they went left because they hated the national health insurance. Or did you get into the idea that Deirdre extensive interviews, I gotta get there
but that is like an overarching concerned like I met a doctor who, like you, used to pack due to be a pediatrician and has shifted more and more of his practice like cosmetic surgeries and some that are paid for private. By patients? So I think that is more. That is like how that the concern, the patient's actually haven't experience, especially unlike the highly urbanized areas where most taiwanese live, don't necessarily experience like a lack of access, but the worry is that the system is putting so much pressure on providers that they're gonna. That capacity is gonna continued. Should I think it's a thing single pair advocates think about here, like I think I've had a number of interesting conversations with them, Daphne I M gonna get us acronym wrong. The physicians physicians for now have later when they got great. Thank you. This. I need you here for progress and whether this conversation about you he does
I feel another single parent advocates? Don't feel like you need the insurance companies? You could eliminate them, but you do need the hospitals and you do need the doctors and your kind of trying to figure out this balance of. Yes, we want to cut the prices, but we do want to see hospitals closing and we do want to see pediatricians like going into plastic surgery, because I'm pediatrics isn't paying enough and I think that's one of those tricky balances and thinking through like yes, we want a system that cost less, but how much can we cut costs while keeping grow but all is up and running, and keeping doctors. Thinking like its keeping students thinking they want to train doktor aside they, even without this conversation, it has kind of shaped how I think about you knew well. What is the gall and how much can you caught while maintaining the services are making the services that you think are valuable, Can american healthcare system right- and I do think I want- is still sort of like rising up to me. What I think would be sort of a more rational level of cost, sharing a special
That would encourage more rational use of healthcare. Like the director general of the National Health Insurance Programme said like after this, for actual action that they just had like Armand Pitch the new government on increasing copious, because because not just as like, a revenue razor, but because it's not sustainable to keep pushing putting these pressure on proprietor as a sort of right where, as I as a demand, constrain as a great strain on it, which is the typical in single pair system Fraid, so like it's almost comical how low, like Swedish Capades, are with their mouths, zere right and their cause. Enough to hear you don't like five dollars, because each I e to elect their obviously not raising meaningful revenue. Out of this, I nickel and dime co payment the philosophy. Is that it's like you know, if you ever go to Ben Jerry's and free ice cream? one day, the line is like a billion things long right We just make it cheap. It turns out like ok, only so many people, but one ice cream on any given day
no know like the Canadians of the Brett and Bernie Sanders have a strong philosophical. Objection to that idea, but it is the most common sort of way of implementing this kind of thing I wonder on the provider side because it's like, I think, the whirl issue, which I think we should talk about. Australia because shows very well and the like training issue are almost distinct trade because, like I think you could make the argument that the average quality of american doctors is too high and like, if you look at their m cat scores like it's gone up over the years as more women have entered the profession and the aggregate number of doctors hasn't got up, and it's not obvious that, like the
An offensive that are commensurate to the incredibly high prices that we pay when anyone is needs media, ochre, cheaper it after me, look even you cut the reimbursement. Raids like it's true, like the desirability of going to medical school, might go down this really hard to get into medical school right. Now you don't talk about. Nobody would be trained ass, a doktor they might just be like at the average em tat score of nineteen seventies doctors, but with modern technology, and it will be way cheaper That could be fine right, whereas the war will all the doctors just a band in rural America is a bigger problem because, like the? U S is much larger than Taiwan, like we
Can't like Mobile, held vans based in Chicago cannot serve like the entire. U S heartland like you actually need the hunters and end like hospitals right. They need like giant machines and like expensive operations. All throughout the country- and I mean you know like Sanders Team- is obviously aware of world states because he's from from and today they have provisions about that. But I've been eight working it out in detail. Strikes me as hard yeah cause America's that's where that's looks of like a uniquely american challenge, like I think it's telling that in Taiwan Australia, pretty guy they have set up sort of like specialised rule, healthcare deliver programs like Australia, has a system. The basically kind of like pays doctors basically to go practice in areas that are addressed
right right out, and then Taiwan is set up this this kind of system of clinics and like roving mobile units for especially like their indigenous populations, but I get there just there dealing with a problem on a much smaller scale of what the? U S, have to deal with besides us another breakin and turned to contact with Australia. Let's do it. Everything you don't rush hours in the day to get everything done. It might be because you're missing out on three of them. Where does where's girl? They probably fell into a deep dark. A bits opens up when we switch between workshops and those three hours to all the productive time we miss out thanks to at home, distractions, disorganization fatigue. It's no wonder the days feel too short. Work should work and with clear up debts cook up as a flexible productivity platform. That brings all your work into one place it's all your chats, apps docks and tasks. One central S place like mission control companies like whoop
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learn more at every bottle, back org all right these days. We mostly hear about Australia because it's on fire, but it's also Australia. I feel like never gets talked about in the US. Health see contacts and even though our shared rang it such as the one I think of Australia, I'm so glad you to the story. Eleven waiting for someone to do the story. It's like this ring. It feels like it's the one that speaks the most the american ethos to me of. If we were to do single pay, because everyone gets like some based coverage, but then you can cut the lion or get something nice, sir. If you want to pay more and it really surprised me- I mean- maybe it's just because it's like eons away, but it surprised me that the australian system hasn't come
really at all. In the american debate like I could have seen a moderate because Austria is like the United States readily. Is this giant mostly empty country? It's like founded by these, like genocide, errors who stole the land region's population? You know their fair. Like rustic down there until he named enjoy less stare, cried like they know what nobody should tell you. I know you can't do that fr? I write so they just give you something right and it's like this low tier one. You could see it PETE Buddha, Joe Biden, alternative world thing like yeah. I think every inch of the base thing and if you more like if you want to keep your plan you keeping for at it interesting to me that it is not entered the American debates, although so, how does it work where? What is right does not work it. Does it work? That is the the gray unanswered so Australia has does a universal public health Insurance program called Medicare that every australian citizen is eligible for and so
of the governmental pay for your care. You can go to public hospitals to get your care that sort of the baseline that's available to everyone. On top of that is a private health insurance system in about half of people take out private health insurance, mostly concentrated in the higher income bracket and you get some perks to Sarah's point with that private health insurance lake you can a private hospitals. For starters, more. You can be treated at a public hospital as private patient and you can get like you know get your own room, you get more choice about your provider, you get more choice. You can cut the line for waiting times for elective circular aid, getting your food and it goes all the way to it, because all the way from here those the big things like your care to the little things like yeah, the food that you gave me. This is how public services, in general, all work in the United States. Right, like everybody, can go to public school, but like a rich five to ten percent of the population.
To private school. Everybody can go to the library, but a bigger than the group of people who go to private school, buy books, a book stores. A lot of people do both sometimes depending on what the situation is. You know there's computers to use there for free, which is nice but, like I have my own computer, which is also nice like there's a city network and mass transit DC, but a lot of people in DC own cars and drive them around right. Emily ass, if its is like not how we normally think about healthcare care, actually is how we think about when it's a kind of common that I was surprised that some of little
go. I learned that in the UK they have a similar system, but about like ten to fifteen percent of am Brits by private coverage is much lower fares interested in the country, I think of it like the most national eyes, like the hospitals, are part of the government that they also have this private option. I think would so interesting, but Australia, and if you could tell us more about this, is it seems that the government, at least in some periods, really actively encourages people to get private ensure that there's penalties rate, if you don't have by the private insurance by certain age, which reminded me like a little bit of like mandate, ask sort of our health economic area, and I That's what distinguishes the australian system is like they are vague, heavily incentivize private health industry, not just like something that's available. If you want to like their pushing. People to sign up? So I mean the story. There is back in the nineties, they set up their Medicare program, this universal public health insurance program. It has largely been private health insurance before that
So the interviews introduce a universal public programme in the mid eighties and private insurance coverage, which had been up in like sixty. Seventy percent started to drop off precipitous so by like the MID ninety nineties, only like thirty percent of Austrians, her private health insurance, and so the conservative government that was in charge at the time, saw that there were like this is not in line with our market driven economic principles and they set sort of they said like we're, worried that the public system is going to become overwhelmed. If, like everybody up there. And so they created carrots and sticks to encourage more people to take up private health insurance and therefore to seek medical care in private hospitals and other private settings, and so what look like are like if your income is above a certain level, you have to take out private insurance or you pay a fine. It's basically like em light version of an individual mandate, they try to encourage young people to sign up before they turn. Thirty, because after you
once you turned thirty one. You can be charged like a small surcharge for being older when you first sign up for coverage. And for certain like kind of middle class families? There are also like subsidies. Tax rebates available, encouraging those folks are six sign up. And so like tat, they ve kind of created this compound scheme to sounds like Obamacare perched on top of single pay has, I think, that's a fair way to think about it. Actually, and it has been like. The whole thing has been sorted. This, like tug of war between lichens, again being a reflection of the political history between, like conservatives and liberals, the it was the left, leaning, governments brought in the public programmes are labour. The conservatives are called very concerned in very confusing. Can I ask the question because if I hear from sometimes from single pair advocates here in the states, is that they feel like the private insurance markets in Austria are eroding the pub
market. Are you mentioned in the Netherlands right they felt like this to cheer system was in working like are they working to gather? Is their risks of lake, the private, the? Because I can see that the private insurance market, siphoning off like the good doctor red, unlike you, ve long way times in the public system, but the rich people in private system are getting better Frederick are, that is it felt like the two are working together I mean in the aggregate yes like it should be. It should be made clear. The lake Australian have Austria has like World Class healthcare like if you look at some of the metrics that try to you're for, like you, know how well a country does intervening and preventing deaths that should be affordable with timely medical care like Australia does amazing So, like I think in the aggregate it works there are these weird sort of lake conflicting concerns that I don't quite know how to so
On the one hand, there is actually like a cry vot per hour crisis for private health insurance right now, because more and more people are dropping their private coverage, especially the younger people, because they have this like underlying free, more or less free public alternative in southern like. Why would I pay you spent a couple hundred bucks a month for peace, health insurance plan, when I can just get care for free in the public plan. So that, on the one that's kind of on the one, On the other hand, though, there are concerns raised that a lot of doctors split their time between the public and private systems, but the private system offers a lot of advantages for doctors, both in terms like the the loads both like easier and you get more time with your patients. Like I talked, I talked to a surgeon who did both work at the major try
unit in Melbourne and also at a private hospital, and he was like I used to kind of like love, the buzz of work in the emergency room and not knowing what was gonna come through the front door at the public hospital. But like that start where, on me, now, I'm gettin in middle age of got like three kids and so the work I get to do at the private hospital where I could spend like a year with this patient who's going to need orthopedic surgery, just sounds so much more appealing, and there was this report. That came out last summer. The kind of laid bare all the underlying problems with private health insurance industry right now and one of the can They raised is like we're spending all this money to subsidize the private health insurance mark, private private health edge and at the same time like, we are clay, encouraging doctors to work in the promoter and the private healthcare market because it pays better because it has or your basic on all the time they spend at the private hospitals is less time their spending
public hospitals and there are like disparate wait times between the public and private setting. So it's its weirdly, both like private health insurance is in trouble because of the underlying public universal public program, but the private insurance industry and private health care industry also drains resources away from public system kid. I went what I like about the austrian system. Conceptually, though, is that, like, I feel like the underlying theory of Like Uk Health CARE or canadian healthcare, right. Is this this notion very midcentury vision like almost heroic collision of healthcare care like like Healthcare, is really really difficult right and also in credit, valuable right, so we need to make it like free for everybody and exactly equal for everybody, because it's like it so important right. It's it's so critical and I think what we see there
with by modern technology and modern research. Is that, like the most genuinely valuable healthcare tends to be fairly easy? you're doing screenings you're, giving people vaccines. You get a stress test and then you get in I attics for it and like that, does not require like state of the art like medical. Science, like aid, can be provided in pretty regular as way, but then also that there's like a big market for health care, like as a service that people just care alot about like their doktor, unlike how is it and how to define to go into this place and have reassured do I feel I mean like we're all parents of young kids and it's like so there's you just like wanna talk it through with your pediatrician ride, If you look back in retrospect, it's like well if they had just totally ignored this illness like if you will be fine people just mostly get better but like I was stressed out and like. I was really glad that my like fence, he pro
Pediatrician was like it's gonna, be ok man that just like meant a lot to me right and so like I cared right and I would find it incredibly frustrating if, like a low ceiling was placed on the amount of healthcare that I was able to purchase for my family. Even though looking back on it, I don't think there is any circumstance in which me having spent extra money and health care for my family actually generated better health outcomes ragists like, but I meant a lot. And so the the combination of like everybody gets the basic healthcare which Genuinely very useful and can be provided cheaply billing. Also, if you just like a blunt nicer healthcare like you, can get it down the edit like it, like it reflects the realities of the situation that that, like health, as a human right is like a very powerful idea,
I also like, if I want more health care for my loved ones, I should fail to get it. There is a very powerful idea, but also there can't be infinite healthcare bright at public expense, and so it's like you, give people so much, and then you let people do I want it rather than the can it in mentality, which is like because everybody has to get the exact same thing all the time like, on the one hand, like people can't by healthcare. That with blank, unless it would make sense to collectively by it. For everyone like, while the situation in Canada is, it is illegal to offer help insurance that competes with the with the public plans, those australian plans, they let you are barred from from offering those from doctors participating in those it too. Very different layers, because no worried about this very age and Bobby bubble buys their like saying. Like look. You don't really need the sprang up, and so nobody can get because, like everyone is providing witness,
care all the time and its great, it's so good that everybody gets the necessary care, but like people with good reason like want unnecessary care, one one of the patients we talk to a kind of she manages manage, have sort of like a foot in both camps in a way that, I think is illustrated. So we met with two sisters: Madeline analyses who, at one of whom are always a given birth and a public house, but all Madeline had given birth in a private hospital, unlike the story walks through some of the differences in their experiences but to focus on Lois, so when she was pregnant and needed both like prenatal care and to give birth she's a pretty like nonchalant person. She decide. The public hospital would be fine, even though she had private health, insurance and you'd would be basic
free- and you know, even though she had like share room with other new moms and like the food, was very good like it was fine, more or less right. But then one of her kids has this rare bone disorder called prostheses. Disease, which basically means like his hip, is almost kind of like It has to be in a wheelchair, any need surgery for that care, and so once they got that I notice diagnosis and we're trying to figure out his treatment plant. They looked at the public hospitals in it was like. Oh, my god, we would have to wait like six months for him to get the surgery which is like six months of him. You know we have stay in a wheelchair not being able to play not being on his road to recovery. And so they decided to use their private health insurance to schedule surgery much earlier. They were able to like match it up with this leave the elevators husband had coming up and so like. I think that sort of encapsulate cisely, like you, do have this public option that lake is cheaper and if you do care that much about what the experience, if you're, just going to be at the hospital for a couple of days when you are giving birth to your kid it's going to,
Fine? But when you have this really sick, its medical condition and something where you really. You want to have more control over your care and be able to like Russia, something because it's you know imperative for your child's just quality of life are able to do anything that raises the question that wages for me thou and is like their families in Australia who they don't have the who, who they could be in a similar scenario, but but dont have the means to buy the private insurance. I think that's where you worry about the inequality of like there is the alternative family out there in Australia who set you know kid is the same disease, but they can afford the private insurance who they are Having that like longer wait in the public system, as you mentioned, I think that is mostly high income people who are purchasing the private interests right oil, and I think yes, like that- is sort of one of these trade offs of setting up a system. The way the Australians have, as you are gonna, have various kinds of disparities that exist persist. They, I think, think it's
with it because they are trying to balance these values of like universal access and personal choice, but that does come at a cost. Yeah I I think it is really would interest me about international health systems there, and I can't help its chicken and egg like if these systems influenced how people think about health care, how people think about her garlic when two different systems, and they really do like reflect such different. Use a Yemen's, you picked, they kind of tell you something about what the country values and like how they do there policy. May gain anything Australia's one values seem to align like much more closer to American Valley. The geography aside reject Greece. Also, you don't interesting similarity that how they think about. Just how of us Chileans think about health care and the idea of buying your way to the front of the line feels like something Americans the value, and it is very hard for me to see like a canadian or taiwanese sales is somewhere. All of us wait in the same q, you being,
Sceptre Bob too, to the American Jappy, when we did our focus groups where voters in late twenty seventeen even kinda like democratic voters in suburban Washington DC, you would hear a lot like almost word for word like if I can afford more, I won't be able to get more, and I do think that is yeah like, which is why the present Australia, like I hope I hope your story is the beginning of a boom, lit a venture astray, Austria and somewhat uneasy renaissance, because if you don't seem like two things that, like most, you could get most Americans sign on. Four right is that like there, to be a guaranteed level of health care provision for everybody, just because you're poor, like if you're sick and you need health care. You should be able to and then, conversely, it's like, if you not poor If you like, sitting on a giant stack of money- and this like something you want to get a doctor- you and the damage is willing to do it for you, but you should be able to do that.
Yet not vision based some like abstract principle, does like no you're not allowed to purchase this health care services like it's very. It it strikes me as I kind of genuinely unamerican, and I do feel the Canadians are like a reason for having designed this system. That way, but I feel like their thinking about it, is like shaped around the eggs. Since everywhere else. It I mean it's starting to face pushed back and you start to see some lawsuits coming up through provincial courts where this has been challenged. I think it mostly comes from doctors who, like want to operate outside the public system, so I think it is. The timeframe might be changing to write that you set a new you dislike midcentury kind of realistic vision of the same thing for everyone. Even in Canada, I think people they are generally very supportive of the healthcare system and they named Tommy Douglas. The former premier is the sketch on
name the greatest Canadian and accompanied who created the Zapatista. Juno geography is relevant here too, like. I think american conservatives like tend to wildly overstate the like Canadians coming south of the border to get healthcare, but he does happen. You know and like It is very close to the United States, like in particular, its main population centres are very close to the United States, so true Cases like dont get tested under that system like if you are a genuinely like very wealthy canadian person. And you sincerely have it really powerful desire to cut the line of your hip replacement Sri Lankans actually not hard to do that, even though it's not like cortical. Allow would write like if it's something to come to the. U S and I get some luxury healthcare as a rich canadian person is very feasible. Any means you don't quite have to like fight it out and the level of prince
where's like Austria is the opposite way is like this island in the middle of nowhere. You can't get anywhere from strategy, so you know too, like prohibit something there's like, you're late, aggressive dvd, Yet no, and I do think like for the problems. If the private health insurance industry is enduring right now, like you can see, from their history like there are lovers that you can pull and like they that basing its has been an ongoing. As one expert I talked to put it sort of like every eighteen months, there's a new policy, the about how this sort of like keep the private health insurance side viable, am I but that's like that. I'd like that's how and where I ministers for aid like right right, which I think is part of the reason that, like there's been there's a charge in the story that sort it shows various interventions in the health insurance market, and there are constant dots ran over me. That's I mean I don't know like
you gonna, kill you if you can sometimes say right. It's like people. I too, like Google, out than we like here's, how healthcare works in country x, Belike. Obviously they have politics like at all countries right and they and they do change things in it. Equally like countries that have bore a sort of. Middle ground, it's like when you're in the middle between different polls, then it's like you're, always going to be pulled to kind of one way or the other, depending on one last election or what scandal happen to have, and this is a place where, like all too we the scope of sword. The austrian healthcare debate is pretty narrow, like everybody accepts the existence of Medicare, the liberal, except the existence of the private insurance industry, its basically like a question of sort of like how do we strike this balance between The two: how do we like you now try to provide the penalties and, as in subsidies, to keep the private insurance
I'd sustainable without like draining the public side, but like that's just lakes or the very narrow calculus that they're trying to figure out, which I think is much different than the Euro swear like in a lot of ways. The political parties have like twenty Romania is always somewhere in a place where we accept kind of Medicare Medicaid. You know, as likely do I mean men I mean we are since Davy is submitted in this twenty fifty and then we have accepted The care and baby accept Medicaid, I think, there's general political consensus around keeping Medicare Kate around maybe I'll, be back in the weeds and a few years of improvement, I'm using you're wrong. I'm just like that. The novelty of the right I mean if we did the weeds, maybe we were doing weeds like in twenty four We are now entering its maritime safety in twenty fourteen, like let's eliminate Medicare and replace it with a privatized system.
Was like an area where I have a care over selling the republic and what I do is still a commitment to giving health insurance to seniors that I do now. The it was a structural transformation. It so a commitment that there are certain groups of people that have health, ensuring that reminds me of kind of the Australia's thinks every one should be in that group and we have decided like certain populations should be in that grew, but we have never. We haven't really gotten passed the night in sixty I've consensus that we develop Kido before any of us were were born to have any more consensus about. Like ok, look What about all the other people who are not in those groups right and in the Taiwan story? There's a great quote that I felt very lucky to run across from over Reinhardt in his last book before he died about how like basically, Canada, Europe and all the developed nation. In Asia have sort of settled on this idea that health care is a social good and then the question becomes like how to administer it, but the United States has not reached that kind of consent:
they have for so yeah. I sort you Bob, you wonder. I mean the Gwendolyn historical things. I wonder about is the? U S created Medicare medicate, at a time when a lot of other countries are making their national health insurance system like Canada was building Medicare. For, although we are making these programmes looking back, almost wonder if that like shot us in the fuddles, merely we had ended up like Taiwan and let this fester a little bit longer, unlike the crisis, would have been much worse for a number of decades. But then you end up at this crisis. Point where everyone gets insurance verses, I'm? U do we were able to help the vulnerable populations and they will have access to health care. It made the problem. Less acute never occurred that critique of the affordable, correct,
from people who wanted more that like well, maybe we should have just done nothing and then you I mean, like I'm, I'm normally a half a loafer, but not in this case. I know I mean. I think this is a serious question about about Medicare Medicaid in eighteen, sixty five in part because, like that bill passed so overwhelmingly, you know it's a clear that, like the Kennedy and Johnson ministrations we're not even operating at like the outer edge of what was legislatively possible, they like chose to take like like a big win right for four and a half a loaf, and I think the clear expectation of progressive minded people at that time was like we had the new deal thirty years ago, so security was expanded several times during the Eisenhower administration. Like this is like, like the arc of history, bends toward justice amends like fairly rapidly
That is not proven to be like the the real history, unlike holding out you know, might of might have been a better idea past too easily. I guess you is everybody likes it when the building cosponsor gets like ninety eight votes, maybe assign you left something right, exactly exactly exactly so yeah Taiwan Taiwan, Australia, Australia million over the next presidential debate. Question about Australia, yeah that, while this is this is why I have asked why they need to get frankly a weeds presidential debate, because we have much nerdy year more random and obscure questions. And we can see who out there even knows anything about it. I want to hear the answer to Sarah you tweeted about this. I think like ask every candidate what their favorite system, if anyone lets me moderate, a debate. That's my question. That's the dream! No one's asking! Do it? Sarah cliff debate? Okay, thank you! So much for joining us! Sarah, it's been a pleasure to me. I'm sure the listeners have been. They were adding
hiding last ask weeds anything's like once they're coming back here am I can tell him that thanks, Dylan of, of course, overcome by. I wish thank our fund again for helping make this Williams possible extent. Muggah protests are mere jets here from certain back.
Transcript generated on 2021-05-22.